A tailored Internet of Things lighting solution to support circadian rhythms and wellbeing for people living with dementia

Light is a requirement for setting and maintaining the body’s circadian rhythm, however our knowledge of the spectral content, timing and duration of lighting exposure for the indoors is not well defined. For people living with dementia, this knowledge gap is important to address since they experience more heavily disrupted circadian rhythms, which can heighten symptoms of sundowning, agitation, low mood and poor sleep quality. This paper focuses on the required design aspects for a dynamic lighting and sensing device tailored towards supporting the wellbeing of people living with dementia. The authors discuss the current understanding of lighting for health, identify the gaps to be addressed and propose the design and research protocol for an indoor lighting and sensing solution. The device is currently deployed within a care home and analysis of results is forthcoming

Evaluating the 'lessons learned' in transitioning a digital health technology for dementia from lab to care home

The introduction of technologies and devices to support wellbeing in dementia are often evaluated using sensing technologies in a rather tech-heavy approach. The information presented by these devices is efficiently generated and typically low maintenance but this does not come without certain caveats.By nature, sensing of any type is a probing modality. Hence the information is inquisitory and personal in one form or another. The assurance that this information is collected, managed and shared in the correct manner is essential in ensuring its acceptability. Therefore it seems apparent that careful design of the system architecture and research protocols are key to achieving these objectives. However, as with any research study there are unforeseen circumstances that emerge when operating technology within a new site, presenting new challenges while seemingly at the pinnacle of a study protocol. This can be a head-scratcher for researchers and case-specific issues can demand thinking outside the box. This study considers the specific case of a lighting technology to support the synchronisation of the circadian rhythm for people living with dementia. This represents an interesting case since the amount of research conducted in this area is scarce making standard guidelines for implementation essentially non-existent. As such, this research dissects the following themes from technical, ethical, logistical and coordination issues often present when implementing a new technology in a care home. 1) Technical: The issues of networking and gateway communications are discussed alongside the question of data. How do we ensure it is of the required quality? Is it consistently transferred and stored? How does it remain secure?2) Ethical: The ethical process for implementing technology in care homes is addressed, while considering the perspective of people living with dementia. The question of medical device status is outlined alongside the discussion of consent.3) Logistical/planning: A review of site survey checklists, materials and structural composition of the built environment is evaluated, alongside an insight into the adherence to site-specific requirements.4) Coordination: Implementing a research protocol requires aligning the needs of the residents and care staff in an approach that best suits them in their daily routines, therefore the coordination and communication involved in this process is also outlined.To conclude, an informal evaluation of the entire system and study design is conducted between researchers and the care home manager. The study therefore closes with an approach to revising future designs for larger scale deployments and recommendations for a step-by-step process for designing trials from the lab to care home environment.<br/

The effects of non-native signal crayfish (Pacifastacus leniusculus) on fine sediment and sediment-biomonitoring

The North American signal crayfish (Pacifastacus leniusculus) has invaded freshwater ecosystems across Europe. Recent studies suggest that predation of macroinvertebrates by signal crayfish can affect the performance of freshwater biomonitoring tools used to assess causes of ecological degradation. Given the reliance on biomonitoring globally, it is crucial that the potential influence of invasive species is better understood. Crayfish are also biogeomorphic agents, and therefore, the aim of this study was to investigate whether sediment-biomonitoring tool outputs changed following signal crayfish invasions, and whether these changes reflected post-invasion changes to deposited fine sediment, or changes to macroinvertebrate community compositions unrelated to fine sediment. A quasi-experimental study design was employed, utilising interrupted time series analysis of long-term environmental monitoring data and a hierarchical modelling approach. The analysis of all sites (n=71) displayed a small, but statistically significant increase between pre- and post-invasion index scores for the Proportion of Sediment-sensitive Invertebrates (PSI) index biomonitoring tool (4.1, p<0.001, 95%CI: 2.1, 6.2), which can range from 0 to 100, but no statistically significant difference was observed for the empirically-weighted PSI (0.4, p=0.742, 95%CI: -2.1, 2.9), or fine sediment (-2.3, p=0.227, 95%CI: -6.0, 1.4). Subgroup analyses demonstrated changes in biomonitoring tool scores ranging from four to 10 percentage points. Importantly, these subgroup analyses showed relatively small changes to fine sediment, two of which were statistically significant, but these did not coincide with the expected responses from biomonitoring tools. The results suggest that sediment-biomonitoring may be influenced by signal crayfish invasions, but the effects appear to be context dependent, and perhaps not the result of biogeomorphic activities of crayfish. The low magnitude changes to biomonitoring scores are unlikely to result in an incorrect diagnosis of sediment pressure, particularly as these tools should be used alongside a suite of other pressure-specific indices

The effects of non-native signal crayfish (Pacifastacus leniusculus) on fine sediment and sediment-biomonitoring

© 2017 The Authors The North American signal crayfish (Pacifastacus leniusculus) has invaded freshwater ecosystems across Europe. Recent studies suggest that predation of macroinvertebrates by signal crayfish can affect the performance of freshwater biomonitoring tools used to assess causes of ecological degradation. Given the reliance on biomonitoring globally, it is crucial that the potential influence of invasive species is better understood. Crayfish are also biogeomorphic agents, and therefore, the aim of this study was to investigate whether sediment-biomonitoring tool outputs changed following signal crayfish invasions, and whether these changes reflected post-invasion changes to deposited fine sediment, or changes to macroinvertebrate community compositions unrelated to fine sediment. A quasi-experimental study design was employed, utilising interrupted time series analysis of long-term environmental monitoring data and a hierarchical modelling approach. The analysis of all sites (n = 71) displayed a small, but statistically significant increase between pre- and post-invasion index scores for the Proportion of Sediment-sensitive Invertebrates (PSI) index biomonitoring tool (4.1, p <  0.001, 95%CI: 2.1, 6.2), which can range from 0 to 100, but no statistically significant difference was observed for the empirically-weighted PSI (0.4, p = 0.742, 95%CI: − 2.1, 2.9), or fine sediment (− 2.3, p = 0.227, 95%CI: − 6.0, 1.4). Subgroup analyses demonstrated changes in biomonitoring tool scores ranging from four to 10 percentage points. Importantly, these subgroup analyses showed relatively small changes to fine sediment, two of which were statistically significant, but these did not coincide with the expected responses from biomonitoring tools. The results suggest that sediment-biomonitoring may be influenced by signal crayfish invasions, but the effects appear to be context dependent, and perhaps not the result of biogeomorphic activities of crayfish. The low magnitude changes to biomonitoring scores are unlikely to result in an incorrect diagnosis of sediment pressure, particularly as these tools should be used alongside a suite of other pressure-specific indices

Establishment of wMel Wolbachia in Aedes aegypti mosquitoes and reduction of local dengue transmission in Cairns and surrounding locations in northern Queensland, Australia.

Background: The wMel strain of Wolbachia has been successfully introduced into Aedes aegypti mosquitoes and subsequently shown in laboratory studies to reduce transmission of a range of viruses including dengue, Zika, chikungunya, yellow fever, and Mayaro viruses that cause human disease. Here we report the entomological and epidemiological outcomes of staged deployment of Wolbachia across nearly all significant dengue transmission risk areas in Australia. Methods: The  wMel strain of  Wolbachia was backcrossed into the local  Aedes aegypti genotype (Cairns and Townsville backgrounds) and mosquitoes were released in the field by staff or via community assisted methods. Mosquito monitoring was undertaken and mosquitoes were screened for the presence of  Wolbachia. Dengue case notifications were used to track dengue incidence in each location before and after releases. Results: Empirical analyses of the Wolbachia mosquito releases, including data on the density, frequency and duration of Wolbachia mosquito releases, indicate that Wolbachia can be readily established in local mosquito populations, using a variety of deployment options and over short release durations (mean release period 11 weeks, range 2-22 weeks). Importantly, Wolbachia frequencies have remained stable in mosquito populations since releases for up to 8 years. Analysis of dengue case notifications data demonstrates near-elimination of local dengue transmission for the past five years in locations where Wolbachia has been established. The regression model estimate of Wolbachia intervention effect from interrupted time series analyses of case notifications data prior to and after releases, indicated a 96% reduction in dengue incidence in Wolbachia treated populations (95% confidence interval: 84 - 99%). Conclusion: Deployment of the wMel strain of Wolbachia into local Ae. aegypti populations across the Australian regional cities of Cairns and most smaller regional communities with a past history of dengue has resulted in the reduction of local dengue transmission across all deployment areas

Developing a reporting guideline to improve meta-ethnography in health research: the eMERGe mixed-methods study

BackgroundMeta-ethnography is a commonly used methodology for qualitative evidence synthesis. Research has identified that the quality of reporting of published meta-ethnographies is often poor and this has limited the utility of meta-ethnography findings to influence policy and practice.ObjectiveTo develop guidance to improve the completeness and clarity of meta-ethnography reporting.Methods/designThe meta-ethnography reporting guidance (eMERGe) study followed the recommended approach for developing health research reporting guidelines and used a systematic mixed-methods approach. It comprised (1) a methodological systematic review of guidance in the conduct and reporting of meta-ethnography; (2) a review and audit of published meta-ethnographies, along with interviews with meta-ethnography end-users, to identify good practice principles; (3) a consensus workshop and two eDelphi (Version 1, Duncan E, Swinger K, University of Stirling, Stirling, UK) studies to agree guidance content; and (4) the development of the guidance table and explanatory notes.ResultsResults from the methodological systematic review and the audit of published meta-ethnographies revealed that more guidance was required around the reporting of all phases of meta-ethnography conduct and, in particular, the synthesis phases 4–6 (relating studies, translating studies into one another and synthesising translations). Following the guidance development process, the eMERGe reporting guidance was produced, comprising 19 items grouped into the seven phases of meta-ethnography.LimitationsThe finalised guidance has not yet been evaluated in practice; therefore, it is not possible at this stage to comment on its utility. However, we look forward to evaluating its uptake and usability in the future.ConclusionsThe eMERGe reporting guidance has been developed following a rigorous process in line with guideline development recommendations. The guidance is intended to improve the clarity and completeness of reporting of meta-ethnographies, and to facilitate use of the findings within the guidance to inform the design and delivery of services and interventions in health, social care and other fields. The eMERGe project developed a range of training materials to support use of the guidance, which is freely available at www.emergeproject.org (accessed 26 March 2018). Meta-ethnography is an evolving qualitative evidence synthesis methodology and future research should refine the guidance to accommodate future methodological developments. We will also investigate the impact of the eMERGe reporting guidance with a view to updating the guidance.Study registrationThis study is registered as PROSPERO CRD42015024709 for the stage 1 systematic review.FundingThe National Institute for Health Research Health Services and Delivery Research programme

Scaled deployment of Wolbachia to protect the community from dengue and other Aedes transmitted arboviruses.

Background: A number of new technologies are under development for the control of mosquito transmitted viruses, such as dengue, chikungunya and Zika that all require the release of modified mosquitoes into the environment. None of these technologies has been able to demonstrate evidence that they can be implemented at a scale beyond small pilots. Here we report the first successful citywide scaled deployment of Wolbachia in the northern Australian city of Townsville. Methods: The wMel strain of Wolbachia was backcrossed into a local Aedes aegypti genotype and mass reared mosquitoes were deployed as eggs using mosquito release containers (MRCs). In initial stages these releases were undertaken by program staff but in later stages this was replaced by direct community release including the development of a school program that saw children undertake releases. Mosquito monitoring was undertaken with Biogents Sentinel (BGS) traps and individual mosquitoes were screened for the presence of Wolbachia with a Taqman qPCR or LAMP diagnostic assay. Dengue case notifications from Queensland Health Communicable Disease Branch were used to track dengue cases in the city before and after release. Results: Wolbachia was successfully established into local Ae. aegypti mosquitoes across 66 km 2 in four stages over 28 months with full community support.  A feature of the program was the development of a scaled approach to community engagement. Wolbachia frequencies have remained stable since deployment and to date no local dengue transmission has been confirmed in any area of Townsville after Wolbachia has established, despite local transmission events every year for the prior 13 years and an epidemiological context of increasing imported cases. Conclusion: Deployment of Wolbachia into Ae. aegypti populations can be readily scaled to areas of ~60km 2 quickly and cost effectively and appears in this context to be effective at stopping local dengue transmission

Cochrane Qualitative and Implementation Methods Group Guidance paper 2: Methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings

The Cochrane Qualitative and Implementation Methods Group develop and publish guidance on the synthesis of qualitative and mixed-method implementation evidence. Choice of appropriate methodologies, methods and tools is essential when developing a rigorous protocol and conducting the synthesis. Cochrane authors who conduct qualitative evidence syntheses have thus far used a small number of relatively simple methods to address similarly written questions. Cochrane has invested in methodological work to develop new tools and to encourage the production of exemplar reviews to show the value of more innovative methods that address a wider range of questions. In this paper in the series we report updated guidance on the selection of tools to assess methodological limitations in qualitative studies, and methods to extract and synthesise qualitative evidence. We recommend application of GRADE-CERQual to assess confidence in qualitative synthesised findings. This guidance aims to support review authors to undertake a qualitative evidence synthesis that is intended to be integrated subsequently with the findings of one or more Cochrane reviews of the effects of similar interventions. The review of intervention effects may be undertaken concurrently with or separate to the qualitative evidence synthesis. We encourage further development through reflection and formal testing

Analysis of shared heritability in common disorders of the brain

ience, this issue p. eaap8757 Structured Abstract INTRODUCTION Brain disorders may exhibit shared symptoms and substantial epidemiological comorbidity, inciting debate about their etiologic overlap. However, detailed study of phenotypes with different ages of onset, severity, and presentation poses a considerable challenge. Recently developed heritability methods allow us to accurately measure correlation of genome-wide common variant risk between two phenotypes from pools of different individuals and assess how connected they, or at least their genetic risks, are on the genomic level. We used genome-wide association data for 265,218 patients and 784,643 control participants, as well as 17 phenotypes from a total of 1,191,588 individuals, to quantify the degree of overlap for genetic risk factors of 25 common brain disorders. RATIONALE Over the past century, the classification of brain disorders has evolved to reflect the medical and scientific communities' assessments of the presumed root causes of clinical phenomena such as behavioral change, loss of motor function, or alterations of consciousness. Directly observable phenomena (such as the presence of emboli, protein tangles, or unusual electrical activity patterns) generally define and separate neurological disorders from psychiatric disorders. Understanding the genetic underpinnings and categorical distinctions for brain disorders and related phenotypes may inform the search for their biological mechanisms. RESULTS Common variant risk for psychiatric disorders was shown to correlate significantly, especially among attention deficit hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder (MDD), and schizophrenia. By contrast, neurological disorders appear more distinct from one another and from the psychiatric disorders, except for migraine, which was significantly correlated to ADHD, MDD, and Tourette syndrome. We demonstrate that, in the general population, the personality trait neuroticism is significantly correlated with almost every psychiatric disorder and migraine. We also identify significant genetic sharing between disorders and early life cognitive measures (e.g., years of education and college attainment) in the general population, demonstrating positive correlation with several psychiatric disorders (e.g., anorexia nervosa and bipolar disorder) and negative correlation with several neurological phenotypes (e.g., Alzheimer's disease and ischemic stroke), even though the latter are considered to result from specific processes that occur later in life. Extensive simulations were also performed to inform how statistical power, diagnostic misclassification, and phenotypic heterogeneity influence genetic correlations. CONCLUSION The high degree of genetic correlation among many of the psychiatric disorders adds further evidence that their current clinical boundaries do not reflect distinct underlying pathogenic processes, at least on the genetic level. This suggests a deeply interconnected nature for psychiatric disorders, in contrast to neurological disorders, and underscores the need to refine psychiatric diagnostics. Genetically informed analyses may provide important "scaffolding" to support such restructuring of psychiatric nosology, which likely requires incorporating many levels of information. By contrast, we find limited evidence for widespread common genetic risk sharing among neurological disorders or across neurological and psychiatric disorders. We show that both psychiatric and neurological disorders have robust correlations with cognitive and personality measures. Further study is needed to evaluate whether overlapping genetic contributions to psychiatric pathology may influence treatment choices. Ultimately, such developments may pave the way toward reduced heterogeneity and improved diagnosis and treatment of psychiatric disorders

Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed analyses of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hyper-activity disorder, autism spectrum disorder, bipolar disorder, major depression, obsessive-compulsive disorder, schizophrenia, and Tourette syndrome. Genetic correlation analyses revealed a meaningful structure within the eight disorders, identifying three groups of inter-related disorders. Meta-analysis across these eight disorders detected 109 loci associated with at least two psychiatric disorders, including 23 loci with pleiotropic effects on four or more disorders and 11 loci with antagonistic effects on multiple disorders. The pleiotropic loci are located within genes that show heightened expression in the brain throughout the lifespan, beginning prenatally in the second trimester, and play prominent roles in neurodevelopmental processes. These findings have important implications for psychiatric nosology, drug development, and risk prediction.Peer reviewe