Proposing an Ecosystem of Digital Health Solutions for Teens With Chronic Conditions Transitioning to Self-Management and Independence: Exploratory Qualitative Study.

BACKGROUND: Chronic disease management is critical to quality of life for both teen patients with chronic conditions and their caregivers. However, current literature is largely limited to a specific digital health tool, method, or approach to manage a specific disease. Guiding principles on how to use digital tools to support the transition to independence are rare. Considering the physiological, psychological, and environmental changes that teens experience, the issues surrounding the transition to independence are worth investigating to develop a deeper understanding to inform future strategies for digital interventions. OBJECTIVE: The purpose of this study was to inform the design of digital health solutions by systematically identifying common challenges among teens and caregivers living with chronic diseases. METHODS: Chronically ill teens (n=13) and their caregivers (n=13) were interviewed individually and together as a team. Verbal and projective techniques were used to examine teens' and caregivers' concerns in-depth. The recorded and transcribed responses were thematically analyzed to identify and organize the identified patterns. RESULTS: Teens and their caregivers identified 10 challenges and suggested technological solutions. Recognized needs for social support, access to medical education, symptom monitoring, access to health care providers, and medical supply management were the predominant issues. The envisioned ideal transition included a 5-component solution ecosystem in the transition to independence for teens. CONCLUSIONS: This novel study systematically summarizes the challenges, barriers, and technological solutions for teens with chronic conditions and their caregivers as teens transition to independence. A new solution ecosystem based on the 10 identified challenges would guide the design of future implementations to test and validate the effectiveness of the proposed 5-component ecosystem.

Inhibitory effect of extracellular purine nucleotide and nucleoside concentrations on T cell proliferation.

The release of nucleic acids and derivatives after tissue-injury may affect cellular immune-response. We studied the impact of extracellular ribo-, desoxyribonucleotides and nucleosides on T-cell immunity. Peripheral-blood-mononuclear-cells (PBMCs) or isolated CD3+T-cells obtained from 6 healthy donors were stimulated via CD3/CD28 Dynabeads or dendritic cells (DCs) in the presence or absence of pyrimidine-, purine-nucleotides and -nucleosides (range 2-200µM). Addition of deoxy-, guanosine-triphosphate (dGTP, GTP) and guanosine resulted concentration dependent in a complete, adenosine-triphosphate (ATP) in a partial inhibition of the induced T-cell-proliferation. Deoxyadenosine-triphosphate (dATP), adenosine and the pyrimidine-ribo- and -deoxyribonucleotides displayed no inhibitory capacity. Inhibitory effects of dGTP and GTP, but not of guanosine and ATP were culture-media-dependent and could be almost abrogated by use of the serum-free lymphocyte-culture-media X-Vivo15 instead of RPMI1640 with standard-supplementation. In contrast to RPMI1640, X-Vivo15 resulted in a significant down-regulation of the cell-surface-located ectonucleotidases CD39 (Ecto-Apyrase) and CD73 (Ecto-5'-Nucleotidase), critical for the extracellular nucleotides-hydrolysis to nucleosides, explaining the loss of inhibition mediated by dGTP and GTP, but not Guanosine. In line with previous findings ATP was found to exert immunosuppressive effects on T-cell-proliferation. Purine-nucleotides, dGTP and GTP displayed a higher inhibitory capacity, but seem to be strictly dependent on the microenvironmental conditions modulating the responsiveness of the respective T-lymphocytes. Further evaluation of experimental and respective clinical settings should anticipate these findings.

Effects of transfer distance on spine kinematics for de-palletizing tasks.

One approach to reducing lateral bending and twisting in manual lifting tasks is to separate the lift's origin and destination, thereby encouraging lifters to step and turn their entire bodies. The objective of the current study was to determine how the degree to which one laterally bends and twists changes with transfer distance and initial lift height. Eighteen males lifted 10.9 kg boxes from a conveyor 0.5 m, 0.9 m, and 1.3 m above the floor and placed the boxes on a conveyor .50, .75, 1.00, 1.25, 1.50, or 1.75 m away at a height of .9 m. During picking, lateral bending and trunk extension velocities increased with increasing transfer distances. When placing the box, the degree of twisting decreased with increased transfer distance. In sum, when attempting to control the twisting and lateral bending during de-palletizing, the lift origin and destination should be separated by between 1 and 1.25 meters.

A structural equation modelling approach to predicting adoption of a patient-handling intervention developed for EMS providers.

Patient-handling tasks are integral to Emergency Medical Service (EMS) work as are the musculoskeletal injuries associated with these tasks. The aim of this study was to develop and test a structural equation model that describes the interactions between previously identified factors that contribute to the adoption of a specific ergonomics intervention designed for EMS work. EMS responders (n = 187), from six different organisations, participated in a 2-month longitudinal study following the introduction of a foldable patient transfer-board (slide-board) designed to assist with lateral patient transfers. Surveys administered at baseline, after 1 month and after 2 months sampled factors potentially influencing EMS responders' adoption decisions. Perceived ergonomics advantage, which was influenced by access and storage concerns and prior tool experience, contributed most strongly to intention to use at the end of the first month and to the emergence of champions, which contributed to the intention to use at the end of the second month.

Protocol for microbiota analysis of a murine stroke model.

Investigations on the microbiota in neurological diseases such as stroke are increasingly common; however, stroke researchers may have limited experience with designing such studies. Here, we describe a protocol to conduct a stroke microbiota study in mice, from experimental stroke surgery and sample collection to data analysis. We provide details on sample processing and sequencing and provide a reproducible data analysis pipeline. In doing so, we hope to enable researchers to conduct robust studies and facilitate identification of stroke-associated microbial signatures. For complete details on the use and execution of this protocol, please refer to Sorbie et al. (2022).1.

Identification of factors that affect the adoption of an ergonomic intervention among Emergency Medical Service workers.

This study explored factors contributing to intervention adoption decisions among Emergency Medical Service (EMS) workers. Emergency Medical Service workers (n = 190), from six different organisations, participated in a two-month longitudinal study following the introduction of a patient transfer-board (also known as slide-board) designed to ease lateral transfers of patients to and from ambulance cots. Surveys administered at baseline, after one month and after two months sampled factors potentially influencing the EMS providers' decision process. 'Ergonomics Advantage' and 'Patient Advantage' entered into a stepwise regression model predicting 'intention to use' at the end of month one (R (2 )= 0.78). After the second month, the stepwise regression indicated only two factors were predictive of intention to use: 'Ergonomics Advantage,' and 'Endorsed by Champions' (R (2 )= 0.58). Actual use was predicted by: 'Ergonomics Advantage' and 'Previous Tool Experience.' These results relate to key concepts identified in the diffusion of innovation literature and have the potential to further ergonomics intervention adoption efforts. Practitioner Summary. This study explored factors that potentially facilitate the adoption of voluntarily used ergonomics interventions. EMS workers were provided with foldable transfer-boards (slideboards) designed to reduce the physical demands when laterally transferring patients. Factors predictive of adoption measures included perceived ergonomics advantage, the endorsement by champions, and prior tool experience.

It Is a Life Journey: A Roadmap of Teens With Chronic Diseases in Transitioning to Independence.

INTRODUCTION: Adolescents with chronic diseases have to cope with a number of challenges in their transition to independence and need to learn self-management. The purpose of this study was to understand the life journey of adolescents and their caregivers. METHOD: Face-to-face interviews were conducted with 13 adolescents with chronic diseases (e.g., type 1 diabetes, cystic fibrosis, attention deficit hyperactivity disorder, epilepsy) and 13 caregivers (N = 26). Verbal methods were complemented with visual materials. Behavioral models and grounded theory principles guided the analysis of the data. RESULTS: Participants were grouped according to an "archetype" based on the strategy they adopted to manage their chronic diseases. A life journey map was developed having the stages of transition. DISCUSSION: This study proposed a new perspective to the life journey, transition stages, and personal archetypes from a patient-centered approach. We argued the need of a multidimensional approach and outlined the differences of archetypes and transition stages.

The effects of transfer distance on spine kinematics when placing boxes at different heights.

Twisting and lateral bending motions in repetitive lifting tasks are associated with occupational low back injuries and can be challenging to reduce with engineering controls. This study tested the hypothesis that twisting and lateral bending can be reduced by changing the transfer distance. Eighteen males, with no material handling experience lifted 10.9 kg boxes from 0.9 m above the floor and placed the boxes at a destination located 0.50, 0.75, 1.00, 1.25, 1.50, or 1.75 m away and at heights of 0.5 m, 0.9 m, and 1.3 m above the floor. Overall, twisting and forward bending decreased with increased transfer distance when placing the box. Conversely, the lateral bending when lifting and placing the box increased with increasing transfer distance. In short, having a transfer distance between 1 and 1.25 m when performing palletizing tasks to different heights may optimally balance spine kinematics, back injury risk, and productivity measures.