Exocytic machineries differentially control mediator release from allergen-triggered RBL-2H3 cells.

BACKGROUND: Mast cells utilize SNAREs (soluble-N-ethyl-maleimide sensitive factor attachment protein receptors) and SM (Sec1/Munc18) proteins to secrete/exocytose a variety of proinflammatory mediators. However, whether a common SNARE-SM machinery is responsible remains unclear. METHODS: Four vesicle/granule-anchored SNAREs (VAMP2, VAMP3, VAMP7, and VAMP8) and two Munc18 homologs (Munc18a and Munc18b) were systematically knocked down or knocked out in RBL-2H3 mast cells and antigen-induced release of ß-hexosaminidase, histamine, serotonin, and TNF was examined. Phenotypes were validated by rescue experiments. Immunofluorescence studies were performed to determine the subcellular distribution of key players. RESULTS: The reduction of VAMP8 expression inhibited the exocytosis of ß-hexosaminidase, histamine, and serotonin but not TNF. Unexpectedly, however, confocal microscopy revealed substantial co-localization between VAMP8 and TNF, and between TNF and serotonin. Meanwhile, the depletion of other VAMPs, including knockout of VAMP3, had no impact on the release of any of the mediators examined. On the other hand, TNF exocytosis was diminished specifically in stable Munc18bknockdown cells, in a fashion that was rescued by exogenous, RNAi-resistant Munc18b. In line with this, TNF was co-localized with Munc18b (47%) to a much greater extent than with Munc18a (13%). CONCLUSION: Distinct exocytic pathways exist in mast cells for the release of different mediators.

Examining the social networks of older adults receiving informal or formal care: a systematic review.

PURPOSE: To address the care needs of older adults, it is important to identify and understand the forms of care support older adults received. This systematic review aims to examine the social networks of older adults receiving informal or formal care and the factors that influenced their networks. METHODS: A systematic review was conducted by searching six databases from inception to January 31, 2023. The review included primary studies focusing on older adults receiving long-term care, encompassing both informal and formal care. To assess the risk of bias in the included studies, validated appraisal tools specifically designed for different study types were utilized. Network analysis was employed to identify the grouping of study concepts, which subsequently formed the foundation for describing themes through narrative synthesis. RESULTS: We identified 121 studies relating to the formal and informal care of older adults' networks. A variety of social ties were examined by included studies. The most commonly examined sources of care support were family members (such as children and spouses) and friends. Several factors were consistently reported to influence the provision of informal care, including the intensity of networks, reciprocity, and geographical proximity. In terms of formal care utilization, older age and poor health status were found to be associated with increased use of healthcare services. Additionally, physical limitations and cognitive impairment were identified as factors contributing to decreased social engagement. CONCLUSION: This review found that older people were embedded within a diverse network. The findings of this review emphasize the importance of recognizing and incorporating the diversity of social networks in care plans and policies to enhance the effectiveness of interventions and improve the overall well-being of older adults.

Digital interventions for subjective and objective social isolation among individuals with mental health conditions: a scoping review.

BACKGROUND: Social isolation encompasses subjective and objective concepts. Both are associated with negative health consequences and are more prevalent among people with mental health problems than among the general population. To alleviate social isolation, digital interventions have potential as accessible alternatives or adjuncts to face-to-face interventions. This scoping review aimed to describe the types of digital interventions evaluated for feasibility, acceptability and effectiveness in alleviating social isolation among individuals with mental health problems, and to present an overview of the quantitative evidence yielded to inform future intervention design. METHODS: We searched five electronic databases for quantitative and mixed methods studies published between January 2000 and July 2020. Studies were included if they evaluated digital interventions for individuals with mental health conditions, had subjective and/or objective social isolation as their primary outcome, or as one of their outcomes if no primary outcome was specified. Feasibility studies were included if feasibility outcomes were the primary outcomes and social isolation was among their secondary outcomes. A narrative synthesis was conducted to present our findings. The protocol was registered on Open Science Framework (doi: https://doi.org/10.17605/OSF.IO/CNX8A ). RESULTS: Thirty-two studies were included for our review: 16 feasibility studies, seven single-group studies and nine effectiveness trials. There was great variation in the interventions, study designs and sample populations. Interventions included web-based programmes, phone-based programmes, blended interventions, socially assistive robots and virtual reality interventions. Many were feasibility studies, or otherwise not fully powered to detect an effect if one were present, thus preventing clear conclusions about clinical effectiveness. Satisfactory feasibility outcomes indicated potential for future trials to assess these interventions. CONCLUSION: Our scoping review identified a range of digital approaches utilized to alleviate social isolation among individuals with mental health disorders. Conclusions regarding clinical effectiveness cannot be reached due to variability of approaches and lack of large-scale randomized controlled trials. To make clear recommendations for digital social isolation interventions, future research needs to be based on rigorous methods and larger samples. Future studies should also focus on utilizing theory-driven approaches and improving existing approaches to advance the field.

Exploring digital support for the student transition to university through questionable concepts.

New students face challenges when they make the transition from school to university. Existing digital technologies used during this transition can sometimes increase the stressors associated with change. In order to explore ways forward for technology design in this space, we developed a brochure of questionable concepts. The concepts were grounded in findings of our prior research, yet were also intended to act as provocations to promote discussion in workshops involving 32 first year university students. Our analysis of workshop discussions documents the diverse issues students face around social bonding, their home environment, and their academic performance. Our findings challenge assumptions made in prior work about the ease of transition to university. We demonstrate how questionable concepts can play an important role in prompting 'safe' conversations around stressful life events for adolescents.

Digital mental health and peer support: Building a Theory of Change informed by stakeholders' perspectives.

Digital Mental Health and Peer support has the potential to bridge gaps in support through its scalability and accessibility. Despite the increasing use of these platforms, there remains a lack of understanding of how they operate in real life, from initial engagement to longer-term impact. We aimed to explore the key inputs, processes, user interactions, assumptions, barriers, facilitators, outcomes, and impacts associated with the use of DMH and peer support platforms by developing a Theory of Change with stakeholders. Stakeholders (n = 77) contributed to the formulation of the Theory of Change through a series of online workshops, focus groups, interviews, and open-ended survey feedback. Workshops were structured to capture information related to aspects of the Theory of Change and to allow stakeholders to provide feedback to improve the diagram. A thematic framework approach was used to analyze transcripts to enable comparisons of factors reported by members, commissioners, and platform staff. Stakeholders identified a variety of factors contributing to initial inputs, processes, outcomes, and impact. Engagement emerged as the most significant barrier to the use of platforms. Motivations for use included filling in gaps in available support, connecting with others and upskilling. Different member types determined how users would interact with the platform which could influence the social response of others. Outcomes were largely positive including provision of a safe online space, improvement in wellbeing, and feeling connected to others. Stakeholders noted impact was harder to identify due to the preventative nature of these platforms but suggested this related to the knowledge of available support, reduction in waiting for support and in referrals, and increasing engagement and uptake of the platforms. Stakeholders identified assumptions regarding internet access as a significant barrier. The Theory of Change illustrated three distinct pathways in digital mental health and peer support. Further research is needed to improve engagement and factors influencing engagement, the member experience and how impact is measured.

A Smartphone App to Support Self-Management for People Living With Sjögren's Syndrome: Qualitative Co-Design Workshops.

BACKGROUND: Sjögren's syndrome (SS) is the second most common autoimmune rheumatic disease, and the range of symptoms includes fatigue, dryness, sleep disturbances, and pain. Smartphone apps may help deliver a variety of cognitive and behavioral techniques to support self-management in SS. However, app-based interventions must be carefully designed to promote engagement and motivate behavior change. OBJECTIVE: We aimed to explore self-management approaches and challenges experienced by people living with SS and produce a corresponding set of design recommendations that inform the design of an engaging, motivating, and evidence-based self-management app for those living with SS. METHODS: We conducted a series of 8 co-design workshops and an additional 3 interviews with participants who were unable to attend a workshop. These were audio recorded, transcribed, and initially thematically analyzed using an inductive approach. Then, the themes were mapped to the Self-Determination Theory domains of competency, autonomy, and relatedness. RESULTS: Participants experienced a considerable demand in the daily work required in self-managing their SS. The condition demanded unrelenting, fluctuating, and unpredictable mental, physical, and social efforts. Participants used a wide variety of techniques to self-manage their symptoms; however, their sense of competency was undermined by the complexity and interconnected nature of their symptoms and affected by interactions with others. The daily contexts in which this labor was occurring revealed ample opportunities to use digital health aids. The lived experience of participants showed that the constructs of competency, autonomy, and relatedness existed in a complex equilibrium with each other. Sometimes, they were disrupted by tensions, whereas on other occasions, they worked together harmoniously. CONCLUSIONS: An SS self-management app needs to recognize the complexity and overlap of symptoms and the complexities of managing the condition in daily life. Identifying techniques that target several symptoms simultaneously may prevent users from becoming overwhelmed. Including techniques that support assertiveness and communication with others about the condition, its symptoms, and users' limitations may support users in their interactions with others and improve engagement in symptom management strategies. For digital health aids (such as self-management apps) to provide meaningful support, they should be designed according to human needs such as competence, autonomy, and relatedness. However, the complexities among the 3 Self-Determination Theory constructs should be carefully considered, as they present both design difficulties and opportunities.

The feasibility and acceptability of using a novel wrist worn cueing device to self-manage drooling problems in people with Parkinson's disease: A pilot study.

INTRODUCTION: Daytime drooling is experienced by around 50% of Parkinson's patients, who fail to swallow saliva in sufficient volume or regularity, despite normal production. This research explored the feasibility and acceptability of using a cueing device, to improve drooling. METHODS: During a four-week intervention, 28 participants were asked to use a cueing device for 1 h per day. During this time, the device vibrated once-per-minute, reminding the participant to swallow their saliva. A daily diary was used to collect self-report around swallowing severity, frequency, and duration. This was filled out by participants for one week before, four weeks during and for one week immediately after intervention. Diaries were also collected for one week during a follow up, carried out four weeks after intervention finished. RESULTS: Participants self-reported benefits in drooling severity (p = 0.031), frequency (p ≤ 0.001), and duration (p = 0.001) after using the device. Improvements were maintained at follow up. Twenty-two participants explicitly reported a positive benefit to their drooling during exit interview. All felt the intervention and device were acceptable and usable. CONCLUSIONS: Using a cueing device for one month had perceived benefit to drooling severity, frequency and duration in patients with Parkinson's. Participants accepted the device and treatment protocol.

Experiences of Loneliness Associated with Being an Informal Caregiver: A Qualitative Investigation.

Although providing care to a family member or friend may provide psychological benefits, informal (i.e., unpaid) caregivers also encounter difficulties which may negatively affect their quality of life as well as their mental and physical health. Loneliness is one important challenge that caregivers face, with this psychological state being associated with morbidity and premature mortality. Although previous research has identified loneliness as an issue associated with being an informal caregiver, there is a paucity of evidence that attempts to understand this phenomenon in depth. This study aimed to examine informal caregivers' reflections on, and accounts of, experiences of loneliness linked to their caregiving situation. As part of a cross-sectional, qualitative study, sixteen semi-structured interviews were conducted with 8 spousal caregivers, 4 daughters caring for a parent, 3 mothers caring for a child (or children), and 1 woman looking after her partner. The cared-for persons were suffering from a range of mental and physical health conditions (e.g., dementia, frailty due to old age, multiple sclerosis, depression, autism). Data were analyzed using an inductive thematic analysis. Experiences of loneliness were described by reference to a context of shrunken personal space and diminished social interaction caused by the restrictions imposed by the caregiving role. Loneliness was also articulated against a background of relational deprivations and losses as well as sentiments of powerlessness, helplessness, and a sense of sole responsibility. Social encounters were also seen to generate loneliness when they were characterized by some form of distancing. Though not all sources or circumstances of loneliness in caregivers are amenable to change, more opportunities for respite care services, as well as a heightened sensibility and social appreciation of caregivers' valued contributions could help caregivers manage some forms of loneliness.

Counter-Discourse Activism on Social Media: The Case of Challenging "Poverty Porn" Television.

In this paper we investigate how online counter-discourse is designed, deployed and orchestrated by activists to challenge dominant narratives around socio-political issues. We focus on activism related to the UK broadcast media's negative portrayal of welfare benefit claimants; portrayals characterised as "poverty porn" by critics. Using critical discourse analysis, we explore two activist campaigns countering the TV programme Benefits Street. Through content analysis of social media, associated traditional media texts, and interviews with activists, our analysis highlights the way activists leverage the specific technological affordances of different social media and other online platforms in order to manage and configure counter-discourse activities. We reveal how activists use different platforms to carefully control and contest discursive spaces, and the ways in which they utilise both online and offline activities in combination with new and broadcast media to build an audience for their work. We discuss the challenges associated with measuring the success of counter-discourse, and how activists rely on combinations of social media analytics and anecdotal feedback in order to ascertain that their campaigns are successful. We also discuss the often hidden power-relationships in such campaigns, especially where there is ambiguity regarding the grassroots legitimacy of activism, and where effort is placed into controlling and owning the propagation of counter-discourse. We conclude by highlighting a number of areas for further work around the blurred distinctions between corporate advocacy, digilantism and grassroots activism.