Patient Engagement in Medical Device Design: Refining the Essential Attributes of a Wearable, Pre-Void, Ultrasound Alarm for Nocturnal Enuresis.

BACKGROUND: To date, no pre-void wearable alarm exists to treat nocturnal enuresis (NE)-night-time bedwetting, and children with NE and their families are disappointed in relation to the post-void moisture alarms and medicine currently available. Development of a safe, comfortable and non-invasive wearable pre-void alarm and associated technology, using advanced mechatronics, is underway (the MyPAD device). Each stage of development includes patient and public involvement (PPI), particularly with respect to human factors, in collaboration with physicians, radiologists, psychologists, nurses, engineers and designers. OBJECTIVES: The aim of this study was to help us understand the families' experience of the condition of enuresis, and to provide opinion relating to existing NE alarms, designed to detect moisture, and most importantly, the initial design of the MyPAD wearable technology. METHODS: A PPI workshop in the form of a focus group, made up of children with enuresis and their parents, was conducted during the early stage of the MyPAD product development. The key research questions (RQs) were: (RQ1) What were the families' experiences of using existing post-void enuresis alarms? (RQ2) What do families like about the MyPAD prototype? and (RQ3) What do families not like about the MyPAD prototype? A nurse specialised in terms of NE treatment, including post-void alarms, from the Lancashire Teaching Hospitals NHS Foundation Trust, and two MyPAD design engineers were also present, to explain the MyPAD design concept. Braun and Clarke's six-phase approach to thematic analysis was implemented, which included familiarisation with the data, initial descriptive coding, identifying themes, reviewing themes, defining and labelling themes and producing a report. RESULTS: Four common themes were identified from the focus group discussions: the importance of sleep; children do not want to feel different; parents feel frustrated and concerned; resilience and perseverance. These themes applied across the research questions; for example, sleep disruption was highlighted as an issue with existing post-void alarms and as an important requirement for the design of MyPAD. The evaluation of the early version of the MyPAD device has prompted the consideration of changes to some existing facets of the device, including providing multiple alarm types, more options for the design of the garment that houses the device, and the need for clear, age-appropriate and informative instructions relating to how the device should be used, in order to maximise its performance/efficiency and acceptance. CONCLUSIONS: The qualitative data derived from the focus group discussion was incredibly valuable as it enabled the research and design team to experience the perspectives of the families in terms of the challenges and conflicts of managing the condition and the limited utility of existing post-void alarms. This has improved our understanding of the social and environmental challenges that will need to be considered during the design process.

Rapid isolation and characterization of microsatellites in the critically endangered mountain bongo (Tragelaphus eurycerus isaaci).

High-throughput sequencing tools promise to revolutionize many aspects of genetic research, e.g. by allowing the identification of functional adaptive genetic variation. However, the expense and expertise required to apply these tools to basic conservation questions is a challenge for applications outside academia, resulting in a so-called 'conservation genomics gap' (Shafer et al. 2015). The conservation genetics paradigm is that, basic information about inbreeding and gene flow are often critical to inform conservation management of small populations (Ouborg et al. 2010). This information is often needed quickly and ideally should be accessible to workers without special expertise in genomics (DeSalle and Amato 2004). While the inferential power of highthroughput sequencing to interrogate the genome is profound, the cost for population analysis is higher (though decreasing) than for traditional neutral markers. Thus, the use of neutral markers is still relevant in conservation applications. However, this assumes that neutral markers have been discovered and characterized for a given species of conservation concern, which is often untrue for nonmodel organisms. Here, we use a fast, cost-efficient, high-throughput sequencing method (Illumina MiSeq) to rapidly identify and characterize microsatellites in the mountain bongo (Tragelaphus eurycerus isaaci), which has a clear and timely conservation imperative but lacks any described neutral markers.

Multiple host-plant use may arise from gender-specific fitness effects.

Ovipositing females are predicted to select host-plants that will maximise offspring survival and fitness. Yet hosts often differ in the component of larval fitness affected so host-selection often involves a trade-off between short development times and large size and high fecundity of offspring. If host-species can directly affect development rates and body size, and if there are gender differences in resource allocation during development, there can be different sex-specific selection pressures associated with different hosts. Using a Madeiran population of the speckled wood butterfly Pararge aegeria (L.) as the model species gender differences in larval development and size were examined in response to the hosts Brachypodium sylvaticum, Holcus lanatus and Poa annua. It was observed that male and female P. aegeria larvae differed, with their responses dependent on the host species. These results would suggest that oviposition behavior is a complex process, and use of multiple hosts may have evolved to balance the conflicting needs of male and female larvae. Co-evolution of host selection and oviposition behaviors may help to balance the differing performance needs of offspring.

Intraspecific competition in the speckled wood butterfly Pararge aegeria: effect of rearing density and gender on larval life history.

In insects, the outcome of intraspecific competition for food during development depends primarily upon larval density and larval sex, but effects will also depend on the particular trait under consideration and the species under study. Experimental manipulations of larval densities of a Madeiran population of the speckled wood butterfly Pararge aegeria confirmed that intraspecific competition affected growth. As densities increased P. aegeria adults were smaller and larval development periods were longer. Sexes responded differently to rearing density. Females were more adversely affected by high density than males, resulting in females having smaller masses at pupation. Survivorship was significantly higher for larvae reared at low densities. No density effect on adult sex ratios was observed. Intraspecific competition during the larval stage would appear to carry a higher cost for females than males. This may confer double disadvantage since females are dependent on their larval derived resources for reproduction as they have little opportunity to accumulate additional resources as adults. This suggests that shortages of larval food could affect fecundity directly. Males, however, may be able to compensate for a small size by feeding as adults and/or by altering their mate location tactics.