Initial evaluation of a technologyenabled change in delivery of the dementia service during COVID-19 in North Warwickshire.

BACKGROUND: Remote monitoring technologies show potential to help health professionals deliver preventative interventions which can avoid hospital admissions and allow patients to remain in a home setting. AIMS: To assess whether an Internet of Things (IoT) driven remote monitoring technology, used in the care pathway of community dementia patients in North Warwickshire improved access to care for patients and cost effectiveness. METHOD: Patient level changes to anonymised retrospective healthcare utilisation data were analysed alongside costs. RESULTS: Urgent care decreased following use of an IoT driven remote monitoring technology; one preventative intervention avoided an average of three urgent interventions. A Chi-Square test showing this change as significant. Estimates show annualised service activity avoidance of £201,583 for the cohort; £8764 per patient. CONCLUSIONS: IoT driven remote monitoring had a positive impact on health utilisation and cost avoidance. Future expansion of the cohort will allow for validation of the results and consider the impact of the technology on patient health outcomes and staff workflows.

Correction: The biotoxin BMAA promotes dysfunction via distinct mechanisms in neuroblastoma and glioblastoma cells.

[This corrects the article DOI: 10.1371/journal.pone.0278793.].

The biotoxin BMAA promotes dysfunction via distinct mechanisms in neuroblastoma and glioblastoma cells.

Chronic exposure to the Cyanobacteria biotoxin Beta-methylamino-L-alanine (BMAA) has been associated with development of a sporadic form of ALS called Amyotrophic Lateral Sclerosis/Parkinsonism-Dementia Complex (ALS/PDC), as observed within certain Indigenous populations of Guam and Japan. Studies in primate models and cell culture have supported the association of BMAA with ALS/PDC, yet the pathological mechanisms at play remain incompletely characterized, effectively stalling the development of rationally-designed therapeutics or application of preventative measures for this disease. In this study we demonstrate for the first time that sub-excitotoxic doses of BMAA modulate the canonical Wnt signaling pathway to drive cellular defects in human neuroblastoma cells, suggesting a potential mechanism by which BMAA may promote neurological disease. Further, we demonstrate here that the effects of BMAA can be reversed in cell culture by use of pharmacological modulators of the Wnt pathway, revealing the potential value of targeting this pathway therapeutically. Interestingly, our results suggest the existence of a distinct Wnt-independent mechanism activated by BMAA in glioblastoma cells, highlighting the likelihood that neurological disease may result from the cumulative effects of distinct cell-type specific mechanisms of BMAA toxicity.

Self-management programs for Aboriginal and Torres Strait Islander Peoples with chronic conditions: A rapid review.

OBJECTIVES: Review the evidence for the effectiveness of chronic condition self-management programs applied to Aboriginal and Torres Strait Islander Peoples. METHODS: A rapid review methodology was followed to develop an evidence summary from peer-reviewed and grey literature. RESULTS: Only seven peer-reviewed studies were identified. The evidence indicated that group programs, particularly the Stanford Program, and structured individual chronic condition self-management programs were of good quality for Aboriginal and Torres Strait Islander Peoples, although these need to be integrated into practice in order to see the greatest benefits. The Flinders Program showed promise as a standardised program with content designed specifically with and for these populations. Numerous grey literature sources were identified, many using strong participatory approaches developed locally within Aboriginal and Torres Strait Islander Peoples. However, few of these programs have been subject to rigorous evaluation. DISCUSSION: Despite the significant focus on chronic condition self-management programs to help address the burden of disease for Aboriginal and Torres Strait Islander Peoples, few studies exist that have been properly evaluated. The Closing the Gap Principles developed by the Australian Institute of Health and Welfare offer important guidance for how to proceed to maximise engagement, cultural appropriateness and ownership of program initiatives.