Exploring the barriers to using assistive technology for individuals with chronic conditions: a meta-synthesis review.

PURPOSE: Assistive technology can provide a key tool to enabling independence, greater inclusion and participation in society for individuals with chronic conditions. This potential is currently not always realized due to barriers to accessing and using assistive technology. This review aims to identify the common barriers to acquiring and using assistive technology for users with chronic conditions through a systematic meta-synthesis. This differs from other systematic reviews by applying a transdiagnostic approach to identify if barriers are common across chronic conditions. MATERIALS AND METHODS: A systematic literature search of five scientific databases (PubMed, SCOPUS, PsycINFO, CINAHL and Medline) was conducted to identify relevant qualitative studies. The search was conducted in November 2019. For the identified articles, thematic content analysis was conducted and the methodological quality was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. RESULTS: Forty papers met the inclusion criteria and were included in the analysis. Fifty-one descriptive themes grouped into six overarching analytical themes were identified from the studies. The analytical themes identified were: the design and function of the assistive technology, service provision, information and awareness, psychological barriers, support network and societal barriers. CONCLUSIONS: The barriers are interconnected and common across different health conditions. More involvement in personalized care for developing strategies, adaptation of home technologies and provision of assistive technology could overcome the service provision and design barriers to assistive technology. Accessible information and providing greater awareness will be important to overcoming information, psychological and societal barriers to assistive technology.Implications for rehabilitationIndividuals with chronic conditions face complex barriers to acquiring and using assistive technology as a result of the devices themselves, their individual context, the healthcare context where assistive technology is provided and wider societal barriers.The provision of assistive technology needs to change away from the traditional medical model of the "expert" clinician and instead focus on more user involvement to deliver personalised care that utilises the users lived knowledge and experiences.Assistive technology provision should be considered alongside how to adapt everyday mainstream technology to meet user needs; the provision of devices should encourage creative problem solving rather then relying on pre-defined prescription lists of assistive technology.

Construal beliefs moderate the usability and effectiveness of a novel healthy eating mobile app.

Reduced self-control is a strong predictor of overeating and obesity. Priming a high construal level mind-set has been shown to enhance self-control and reduce snack consumption in the lab but the long-term and real-world effects are not known. The use of digital technology is an efficient way to deliver priming cues in real-world settings. Many mobile apps claim to support healthy eating but few are grounded in psychological theories of self-control. The aim of this study was to test the feasibility and effectiveness of a novel, construal-theory-based mobile app to promote self-control and healthy eating. In an exploratory analysis, the moderating influence of user characteristics was also examined. Using an iterative process involving users at every stage of the process, a prototype mobile app was developed. The final version included a high construal, self-control priming task, sent personalised reminder cues before each eating occasion, provided a just-in time 'crave-buster' for unanticipated eating opportunities and an optional food log. In a longitudinal trial the app was used over an eight-week period (N=71; 51 females; M (SD) Age = 33.34 (11.68) years; M (SD) BMI = 26.22 (4.94)) with pre-post measures of weight, percent body fat and dietary intake. The app received high usability ratings on the System Usability Scale (M=76.55; SD=11.35), however food intake, per cent body fat and weight pre- and post- app use showed no significant change (p>.05). Exploratory analyses showed that baseline construal belief moderated the extent to which engagement with the app predicted dietary changes (p<.05). These findings indicate that this novel app was user-friendly and effective but that this was dependent on the user's characteristics. Future development in this area should consider tailoring apps to the specific characteristics of the user for improved support and effectiveness.

A smart curtailment approach for reducing bat fatalities and curtailment time at wind energy facilities.

The development and expansion of wind energy is considered a key global threat to bat populations. Bat carcasses are being found underneath wind turbines across North and South America, Eurasia, Africa, and the Austro-Pacific. However, relatively little is known about the comparative impacts of techniques designed to modify turbine operations in ways that reduce bat fatalities associated with wind energy facilities. This study tests a novel approach for reducing bat fatalities and curtailment time at a wind energy facility in the United States, then compares these results to operational mitigation techniques used at other study sites in North America and Europe. The study was conducted in Wisconsin during 2015 using a new system of tools for analyzing bat activity and wind speed data to make near real-time curtailment decisions when bats are detected in the area at control turbines (N = 10) vs. treatment turbines (N = 10). The results show that this smart curtailment approach (referred to as Turbine Integrated Mortality Reduction, TIMR) significantly reduced fatality estimates for treatment turbines relative to control turbines for pooled species data, and for each of five species observed at the study site: pooled data (-84.5%); eastern red bat (Lasiurus borealis, -82.5%); hoary bat (Lasiurus cinereus, -81.4%); silver-haired bat (Lasionycteris noctivagans, -90.9%); big brown bat (Eptesicus fuscus, -74.2%); and little brown bat (Myotis lucifugus, -91.4%). The approach reduced power generation and estimated annual revenue at the wind energy facility by ≤ 3.2% for treatment turbines relative to control turbines, and we estimate that the approach would have reduced curtailment time by 48% relative to turbines operated under a standard curtailment rule used in North America. This approach significantly reduced fatalities associated with all species evaluated, each of which has broad distributions in North America and different ecological affinities, several of which represent species most affected by wind development in North America. While we recognize that this approach needs to be validated in other areas experiencing rapid wind energy development, we anticipate that this approach has the potential to significantly reduce bat fatalities in other ecoregions and with other bat species assemblages in North America and beyond.

Administering Cognitive Tests Through Touch Screen Tablet Devices: Potential Issues.

Mobile technologies, such as tablet devices, open up new possibilities for health-related diagnosis, monitoring, and intervention for older adults and healthcare practitioners. Current evaluations of cognitive integrity typically occur within clinical settings, such as memory clinics, using pen and paper or computer-based tests. In the present study, we investigate the challenges associated with transferring such tests to touch-based, mobile technology platforms from an older adult perspective. Problems may include individual variability in technical familiarity and acceptance; various factors influencing usability; acceptability; response characteristics and thus validity per se of a given test. For the results of mobile technology-based tests of reaction time to be valid and related to disease status rather than extraneous variables, it is imperative the whole test process is investigated in order to determine potential effects before the test is fully developed. Researchers have emphasized the importance of including the 'user' in the evaluation of such devices; thus we performed a focus group-based qualitative assessment of the processes involved in the administration and performance of a tablet-based version of a typical test of attention and information processing speed (a multi-item localization task), to younger and older adults. We report that although the test was regarded positively, indicating that using a tablet for the delivery of such tests is feasible, it is important for developers to consider factors surrounding user expectations, performance feedback, and physical response requirements and to use this information to inform further research into such applications.

Temperature gradients drive radial fluid flow in Petri dishes and multiwell plates.

Liquid in a Petri dish spontaneously circulates in a radial pattern, even when the dish is at rest. These fluid flows have been observed and utilized for biological research, but their origins have not been well-studied. Here we used particle-tracking to measure velocities of radial fluid flows, which are shown to be linked to evaporation. Infrared thermal imaging was used to identify thermal gradients at the air-liquid interface and at the bottom of the dish. Two-color ratiometric fluorescence confocal imaging was used to measure thermal gradients in the vertical direction within the fluid. A finite-element model of the fluid, incorporating the measured temperature profiles, shows that buoyancy forces are sufficient to produce flows consistent with the measured particle velocity results. Such flows may arise in other dish or plate formats, and may impact biological research in positive or negative ways.

A quantitative comet infection assay for influenza virus.

The virus comet assay is a cell-based virulence assay used to evaluate an antiviral drug or antibody against a target virus. The comet assay differs from the plaque assay in allowing spontaneous flows in 6-well plates to spread virus. When implemented quantitatively the comet assay has been shown to have an order-of-magnitude greater sensitivity to antivirals than the plaque assay. In this study, a quantitative comet assay for influenza virus is demonstrated, and is shown to have a 13-fold increase in sensitivity to ribavirin. AX4 cells (MDCK cells with increased surface concentration of α2-6 sialic acid, the influenza virus receptor) have reduced the comet size variability relative to MDCK cells, making them a better host cell for use in this assay. Because of enhanced antiviral sensitivity in flow-based assays, less drug is required, which could lead to lower reagent costs, reduced cytotoxicity, and fewer false-negative drug screen results. The comet assay also serves as a readout of flow conditions in the well. Observations from comets formed at varying humidity levels indicate a role for evaporation in the mechanism of spontaneous fluid flow in wells.

Keeping In Touch Everyday (KITE) project: developing assistive technologies with people with dementia and their carers to promote independence.

BACKGROUND: The role of technology to facilitate independent living for people with dementia is not fully realized, with initial attempts (e.g. tracking devices) being considered unacceptable from a practical and ethical perspective. The aim of this study is to create acceptable and effective prototype technologies to facilitate independence for people with dementia through a user-centered design process involving them and their carers. METHOD: The study comprised a three-stage participatory design process: scoping stage (five focus groups, 10 people with dementia and 11 carers); participatory design stage (five workshops, 22 participants) and prototype development stage (four meetings with two people with dementia and one carer). Focus groups and workshops were digitally recorded, fully transcribed and subjected to constant comparative analysis. RESULTS: People with mild to moderate dementia enjoy a variety of activities both on their own and with their families; however, concerns included getting lost, a loss of confidence with curtailment of usual activities, and carer anxiety. Existing technologies (mobile phones) were used intermittently. Participants felt strongly that future devices should be disguised and be integrated easily into their daily routines. Suggested areas for functional improvement included two-way communications, flexibility of function as the illness progresses, and something to "guide" them home when out walking or driving. Attention should also be focused on minimizing the size, weight and visibility of devices to reduce stigmatization. CONCLUSION: Prototypes for two devices (armband and electronic notepad) were developed. The study showed that involving people with dementia in the process of participatory design is feasible and could lead to devices which are more acceptable and relevant to their needs.

Subclavian artery puncture repair with Angio-Seal deployment.

BACKGROUND: Inadvertent placement of a port-a-catheter in an artery during central venous cannulation is rare and can result in devastating complications. Although traditional closure devices have been employed as prompt and adequate treatment, more innovative devices such as collagen plugs are being studied for their efficacy. CASE: We report a case involving a 63-year-old woman who was treated with chemotherapy for recurrent metastatic uterine leiomyosarcoma. During port-a-catheter placement, puncture of the subclavian artery occurred. Vascular surgery and interventional radiology consultation was obtained, wherein an Angio-Seal device was used to seal the exit from the subclavian artery. Angio-Seal placement was successful and the patient has since become clinically stable and was then discharged. CONCLUSION: Subclavian artery puncture is rare but can occur due to the close proximity between the subclavian artery and vein. Prompt vascular surgery and radiology consultation is necessary. Although traditional manual compression and closure devices have been effective at restoring hemostasis, collagen seals or plugs may be more viable to treat this precarious situation.

Is a cystogram necessary after radical prostatectomy?

BACKGROUND: Improvements in the surgical technique of radical prostatectomy have allowed the length of postoperative catheterization to be reduced dramatically over the past 20 years. Today, many surgeons perform a cystogram to ensure the anastomosis is watertight before an 'early' (day 7 or less) trial of void (TOV). We aim to show that achieving an intraoperative watertight anastomosis may preclude the need for routine cystogram prior to TOV. METHODS: Between 31 May 1999 and 29 February 2004, we performed a prospective study of 68 consecutive patients who underwent radical prostatectomy by a single surgeon. We tested the vesicourethral anastomosis for watertightness intraoperatively by instilling 250 mL of normal saline in to the bladder and compared this with evidence of extravasation on the cystogram on day 7. RESULTS: Fifty-four (79.4%) of the 68 patients had a watertight anastomosis intraoperatively. All men had a cystogram on day 7 (6-9 days). Sixty (88.2%) of these cystograms showed no evidence of extravasation. Three men (4.4%) who had evidence of a leak on their cystogram had achieved a watertight anastomosis intraoperatively. However, one of these men had suffered a postoperative septicaemia which may have jeopardized the anastomosis. Only two (2.9%) of the 68 patients had unsuspected extravasation at their day 7 cystogram. Therefore, 97.1% of patients (95% Confidence Interval: 95.1%-99.2%) could be suitably managed by our proposed protocol. CONCLUSION: Achieving an intraoperative watertight anastomosis is a very good predictor of a watertight cystogram on day 7. It seems feasible to avoid routine cystograms prior to TOV in the absence of other postoperative complications.

Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure.

OBJECTIVES: The aim of this study was to explore the value of noninvasive predictors of death/mode of death in ambulant outpatients with chronic heart failure (HF). BACKGROUND: Mortality in chronic HF remains high, with a significant number of patients dying of progressive disease. Identification of these patients is important. METHODS: We recruited 553 ambulant outpatients age 63 +/- 10 years with symptoms of chronic HF (New York Heart Association functional class, 2.3 +/- 0.5) and objective evidence of left ventricular dysfunction (ejection fraction <45%, cardiothoracic ratio >0.55, or pulmonary edema on chest radiograph). After 2,365 patient-years of follow-up, 201 patients had died, with 76 events due to progressive HF. RESULTS: Independent predictors of all-cause mortality assessed with the Cox proportional hazards model were as follows: a low standard deviation of all normal-to-normal RR intervals (SDNN); lower serum sodium and higher creatinine levels; higher cardiothoracic ratio; nonsustained ventricular tachycardia; higher left ventricular end-systolic diameter; left ventricular hypertrophy; and increasing age. Independent predictors of death specific to progressive HF were SDNN, serum sodium and creatinine levels. The hazard ratio of progressive HF death for a 10% decrease in SDNN was 1.06 (95% confidence interval [CI], 1.01 to 1.12); for a 2 mmol/l decrease in serum sodium, 1.22 (95% CI, 1.08 to 1.38); and for a 10 micromol/l increase in serum creatinine, 1.14 (95% CI, 1.09 to 1.19) (all p < 0.01). CONCLUSIONS: In ambulant outpatients with chronic HF, low serum sodium and SDNN and high serum creatinine identify patients at increased risk of death due to progressive HF.