1,210 research outputs found
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/
A cluster randomized controlled trial of the effectiveness and cost-effectiveness of Intermediate Care Clinics for Diabetes (ICCD) : study protocol for a randomized controlled trial
Background
World-wide healthcare systems are faced with an epidemic of type 2 diabetes. In the United Kingdom, clinical care is primarily provided by general practitioners (GPs) rather than hospital specialists. Intermediate care clinics for diabetes (ICCD) potentially provide a model for supporting GPs in their care of people with poorly controlled type 2 diabetes and in their management of cardiovascular risk factors. This study aims to (1) compare patients with type 2 diabetes registered with practices that have access to an ICCD service with those that have access only to usual hospital care; (2) assess the cost-effectiveness of the intervention; and (3) explore the views and experiences of patients, health professionals and other stakeholders.
Methods/Design
This two-arm cluster randomized controlled trial (with integral economic evaluation and qualitative study) is set in general practices in three UK Primary Care Trusts. Practices are randomized to one of two groups with patients referred to either an ICCD (intervention) or to hospital care (control).
Intervention group: GP practices in the intervention arm have the opportunity to refer patients to an ICCD - a multidisciplinary team led by a specialist nurse and a diabetologist. Patients are reviewed and managed in the ICCD for a short period with a goal of improving diabetes and cardiovascular risk factor control and are then referred back to practice.
or
Control group: Standard GP care, with referral to secondary care as required, but no access to ICCD.
Participants are adults aged 18 years or older who have type 2 diabetes that is difficult for their GPs to control. The primary outcome is the proportion of participants reaching three risk factor targets: HbA1c (≤7.0%); blood pressure (<140/80); and cholesterol (<4 mmol/l), at the end of the 18-month intervention period. The main secondary outcomes are the proportion of participants reaching individual risk factor targets and the overall 10-year risks for coronary heart disease(CHD) and stroke assessed by the United Kingdom Prospective Diabetes Study (UKPDS) risk engine. Other secondary outcomes include body mass index and waist circumference, use of medication, reported smoking, emotional adjustment, patient satisfaction and views on continuity, costs and health related quality of life. We aimed to randomize 50 practices and recruit 2,555 patients
Sebomic identification of sex- and ethnicity-specific variations in residual skin surface components (RSSC) for bio-monitoring or forensic applications
Background: “Residual skin surface components” (RSSC) is the collective term used for the superficial layer of sebum, residue of sweat, small quantities of intercellular lipids and components of natural moisturising factor present on the skin surface. Potential applications of RSSC include use as a sampling matrix for identifying biomarkers of disease, environmental exposure monitoring, and forensics (retrospective identification of exposure to toxic chemicals). However, it is essential to first define the composition of “normal” RSSC. Therefore, the aim of the current study was to characterise RSSC to determine commonalities and differences in RSSC composition in relation to sex and ethnicity. Methods: Samples of RSSC were acquired from volunteers using a previously validated method and analysed by high-pressure liquid chromatography–atmospheric pressure chemical ionisation–mass spectrometry (HPLC-APCI-MS). The resulting data underwent sebomic analysis. Results: The composition and abundance of RSSC components varied according to sex and ethnicity. The normalised abundance of free fatty acids, wax esters, diglycerides and triglycerides was significantly higher in males than females. Ethnicity-specific differences were observed in free fatty acids and a diglyceride. Conclusions: The HPLC-APCI-MS method developed in this study was successfully used to analyse the normal composition of RSSC. Compositional differences in the RSSC can be attributed to sex and ethnicity and may reflect underlying factors such as diet, hormonal levels and enzyme expression.Peer reviewedFinal Published versio
Impact of generic alendronate cost on the cost-effectiveness of osteoporosis screening and treatment
Introduction: Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women. Methods: Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorptiometry (DXA), and alendronate treatment for individuals with osteoporosis; with a comparator of "no screening" and treatment only after fracture occurrence. We evaluated annual alendronate costs of 800; outcome measures included fractures; nursing home admission; medication adverse events; death; costs; quality-adjusted life-years (QALYs); and incremental cost-effectiveness ratios (ICERs) in 2010 U.S. dollars per QALY gained. A lifetime time horizon was used, and direct costs were included. Base-case and sensitivity analyses were performed. Results: Base-case analysis results showed that at annual alendronate costs of 400 through 714 per QALY gained through 50,000/QALY at all alendronate costs evaluated. Conclusions: Osteoporosis screening followed by alendronate treatment is effective and highly cost-effective for postmenopausal women across a range of alendronate costs, and may be cost-saving at annual alendronate costs of $200 or less. © 2012 Nayak et al
First report of generalized face processing difficulties in möbius sequence.
Reverse simulation models of facial expression recognition suggest that we recognize the emotions of others by running implicit motor programmes responsible for the production of that expression. Previous work has tested this theory by examining facial expression recognition in participants with Möbius sequence, a condition characterized by congenital bilateral facial paralysis. However, a mixed pattern of findings has emerged, and it has not yet been tested whether these individuals can imagine facial expressions, a process also hypothesized to be underpinned by proprioceptive feedback from the face. We investigated this issue by examining expression recognition and imagery in six participants with Möbius sequence, and also carried out tests assessing facial identity and object recognition, as well as basic visual processing. While five of the six participants presented with expression recognition impairments, only one was impaired at the imagery of facial expressions. Further, five participants presented with other difficulties in the recognition of facial identity or objects, or in lower-level visual processing. We discuss the implications of our findings for the reverse simulation model, and suggest that facial identity recognition impairments may be more severe in the condition than has previously been noted
Rotation of planet-harbouring stars
The rotation rate of a star has important implications for the detectability,
characterisation and stability of any planets that may be orbiting it. This
chapter gives a brief overview of stellar rotation before describing the
methods used to measure the rotation periods of planet host stars, the factors
affecting the evolution of a star's rotation rate, stellar age estimates based
on rotation, and an overview of the observed trends in the rotation properties
of stars with planets.Comment: 16 pages, 4 figures: Invited review to appear in 'Handbook of
Exoplanets', Springer Reference Works, edited by Hans J. Deeg and Juan
Antonio Belmont
Intermediate filaments of zebrafish retinal and optic nerve astrocytes and Müller glia: differential distribution of cytokeratin and GFAP
<p>Abstract</p> <p>Background</p> <p>Optic nerve regeneration (ONR) following injury is a model for central nervous system regeneration. In zebrafish, ONR is rapid - neurites cross the lesion and enter the optic tectum within 7 days; in mammals regeneration does not take place unless astrocytic reactivity is suppressed. Glial fibrillary acidic protein (GFAP) is used as a marker for retinal and optic nerve astrocytes in both fish and mammals, even though it has long been known that astrocytes of optic nerves in many fish, including zebrafish, express cytokeratins and not GFAP. We used immunofluorescence to localize GFAP and cytokeratin in wild-type zebrafish and transgenic zebrafish expressing green fluorescent protein (GFP) under control of a GFAP promoter to determine the pattern of expression of intermediate filaments in retina and optic nerve.</p> <p>Findings</p> <p>GFAP labeling and GFAP gene expression as indicated by GFP fluorescence was found only in the Müller glial cells of the retina. Within Müller cells, GFP fluorescence filled the entire cell while GFAP labelling was more restricted in distribution. No GFAP expression was observed in optic nerves. Cytokeratin labeling of astrocytes was observed throughout the optic nerve and less intensely in cells in the retinal inner plexiform layer. The retinal inner limiting membrane was strongly labeled by anti-cytokeratin.</p> <p>Conclusions</p> <p>Studies of astrocyte function during ONR in zebrafish cannot solely rely on GFAP as an astrocyte marker or indicator of reactivity. Future studies of ONR in zebrafish should include evaluation of changes in cytokeratin expression and localization in the optic nerve.</p
Selection of Reserves for Woodland Caribou Using an Optimization Approach
Habitat protection has been identified as an important strategy for the conservation of woodland caribou (Rangifer tarandus). However, because of the economic opportunity costs associated with protection it is unlikely that all caribou ranges can be protected in their entirety. We used an optimization approach to identify reserve designs for caribou in Alberta, Canada, across a range of potential protection targets. Our designs minimized costs as well as three demographic risk factors: current industrial footprint, presence of white-tailed deer (Odocoileus virginianus), and climate change. We found that, using optimization, 60% of current caribou range can be protected (including 17% in existing parks) while maintaining access to over 98% of the value of resources on public lands. The trade-off between minimizing cost and minimizing demographic risk factors was minimal because the spatial distributions of cost and risk were similar. The prospects for protection are much reduced if protection is directed towards the herds that are most at risk of near-term extirpation
Inference of population splits and mixtures from genome-wide allele frequency data
Many aspects of the historical relationships between populations in a species
are reflected in genetic data. Inferring these relationships from genetic data,
however, remains a challenging task. In this paper, we present a statistical
model for inferring the patterns of population splits and mixtures in multiple
populations. In this model, the sampled populations in a species are related to
their common ancestor through a graph of ancestral populations. Using
genome-wide allele frequency data and a Gaussian approximation to genetic
drift, we infer the structure of this graph. We applied this method to a set of
55 human populations and a set of 82 dog breeds and wild canids. In both
species, we show that a simple bifurcating tree does not fully describe the
data; in contrast, we infer many migration events. While some of the migration
events that we find have been detected previously, many have not. For example,
in the human data we infer that Cambodians trace approximately 16% of their
ancestry to a population ancestral to other extant East Asian populations. In
the dog data, we infer that both the boxer and basenji trace a considerable
fraction of their ancestry (9% and 25%, respectively) to wolves subsequent to
domestication, and that East Asian toy breeds (the Shih Tzu and the Pekingese)
result from admixture between modern toy breeds and "ancient" Asian breeds.
Software implementing the model described here, called TreeMix, is available at
http://treemix.googlecode.comComment: 28 pages, 6 figures in main text. Attached supplement is 22 pages, 15
figures. This is an updated version of the preprint available at
http://precedings.nature.com/documents/6956/version/
Will systems biology offer new holistic paradigms to life sciences?
A biological system, like any complex system, blends stochastic and deterministic features, displaying properties of both. In a certain sense, this blend is exactly what we perceive as the “essence of complexity” given we tend to consider as non-complex both an ideal gas (fully stochastic and understandable at the statistical level in the thermodynamic limit of a huge number of particles) and a frictionless pendulum (fully deterministic relative to its motion). In this commentary we make the statement that systems biology will have a relevant impact on nowadays biology if (and only if) will be able to capture the essential character of this blend that in our opinion is the generation of globally ordered collective modes supported by locally stochastic atomisms
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