Co-design of a digital dietary intervention for adults at risk of type 2 diabetes.

BACKGROUND: Co-design has the potential to create interventions that lead to sustainable health behaviour change. Evidence suggests application of co-design in various health domains has been growing; however, few public-facing digital interventions have been co-designed to specifically address the needs of adults at risk of Type 2 diabetes (T2D). This study aims to: (1) co-design, with key stakeholders, a digital dietary intervention to promote health behaviour change among adults at risk of T2D, and (2) evaluate the co-design process involved in developing the intervention prototype. METHODS: The co-design study was based on a partnership between nutrition researchers and designers experienced in co-design for health. Potential end-users (patients and health professionals) were recruited from an earlier stage of the study. Three online workshops were conducted to develop and review prototypes of an app for people at risk of T2D. Themes were inductively defined and aligned with persuasive design (PD) principles used to inform ideal app features and characteristics. RESULTS: Participants were predominantly female (range 58-100%), aged 38 to 63 years (median age = 59 years), consisting of a total of 20 end-users and four experts. Participants expressed the need for information from credible sources and to provide effective strategies to overcome social and environmental influences on eating behaviours. Preferred app features included tailoring to the individual's unique characteristics, ability to track and monitor dietary behaviour, and tools to facilitate controlled social connectivity. Relevant persuasive design principles included social support, reduction (reducing effort needed to reach target behaviour), tunnelling (guiding users through a process that leads to target behaviour), praise, rewards, and self-monitoring. The most preferred prototype was the Choices concept, which focusses on the users' journey of health behaviour change and recognises progress, successes, and failures in a supportive and encouraging manner. The workshops were rated successful, and feedback was positive. CONCLUSIONS: The study's co-design methods were successful in developing a functionally appealing and relevant digital health promotion intervention. Continuous engagement with stakeholders such as designers and end-users is needed to further develop a working prototype for testing.

Exploring the Socio-Demographic and Psychosocial Factors That Enhance Resilience in the COVID-19 Crisis.

The Coronavirus disease 2019 (COVID-19) has greatly affected mental health worldwide. This study aimed to identify sociodemographic and psychosocial factors that influence the level of resilience among Singaporeans amidst the pandemic. An online questionnaire was administered to Singaporeans and permanent residents aged 21 and above. The online questionnaire collected information on sociodemographics, infection, and contact with COVID-19. Psychosocial variables-specifically optimism, self-efficacy, hope, and resilience-were also assessed through validated questionnaires. A total of 404 responses were collected in this study. Men were reported to have higher resilience compared to women (28.13 vs. 25.54, p-value < 0.001). Married individuals were observed to have higher resilience compared to their single counterparts (27.92 vs. 25.77, p-value < 0.001). Interestingly, participants who knew of family members/friends who had contracted COVID-19 were reported to be more resilient than those who did not (28.09 vs. 26.19, p-value = 0.013). Optimism, self-efficacy, and hope were also found to be associated with higher resilience (p-value < 0.001). In conclusion, one's sex, marital status, contact with COVID-19, level of optimism, self-efficacy, and hope were shown to significantly affect resilience. Given the long-drawn nature of the COVID-19 pandemic, interventions should aim to improve optimism, self-efficacy, and hopefulness in the community.

Heat selection enables highly scalable methylome profiling in cell-free DNA for noninvasive monitoring of cancer patients.

Genome-wide analysis of cell-free DNA methylation profile is a promising approach for sensitive and specific detection of many cancers. However, scaling such assays for clinical translation is impractical because of the high cost of whole-genome bisulfite sequencing. We show that the small fraction of GC-rich genome is highly enriched in CpG sites and disproportionately harbors most of the cancer-specific methylation signature. Here, we report on the simple and effective heat enrichment of CpG-rich regions for bisulfite sequencing (Heatrich-BS) platform that allows for focused methylation profiling in these highly informative regions. Our novel method and bioinformatics algorithm enable accurate tumor burden estimation and quantitative tracking of colorectal cancer patient's response to treatment at much reduced sequencing cost suitable for frequent monitoring. We also show tumor epigenetic subtyping using Heatrich-BS, which could enable patient stratification. Heatrich-BS holds great potential for highly scalable screening and monitoring of cancer using liquid biopsy.

Single-cell and bulk transcriptome sequencing identifies two epithelial tumor cell states and refines the consensus molecular classification of colorectal cancer.

The consensus molecular subtype (CMS) classification of colorectal cancer is based on bulk transcriptomics. The underlying epithelial cell diversity remains unclear. We analyzed 373,058 single-cell transcriptomes from 63 patients, focusing on 49,155 epithelial cells. We identified a pervasive genetic and transcriptomic dichotomy of malignant cells, based on distinct gene expression, DNA copy number and gene regulatory network. We recapitulated these subtypes in bulk transcriptomes from 3,614 patients. The two intrinsic subtypes, iCMS2 and iCMS3, refine CMS. iCMS3 comprises microsatellite unstable (MSI-H) cancers and one-third of microsatellite-stable (MSS) tumors. iCMS3 MSS cancers are transcriptomically more similar to MSI-H cancers than to other MSS cancers. CMS4 cancers had either iCMS2 or iCMS3 epithelium; the latter had the worst prognosis. We defined the intrinsic epithelial axis of colorectal cancer and propose a refined 'IMF' classification with five subtypes, combining intrinsic epithelial subtype (I), microsatellite instability status (M) and fibrosis (F).

Co-Design Practices in Diet and Nutrition Research: An Integrative Review.

Co-design, the method of involving users, stakeholders, and practitioners in the process of design, may assist to improve the translation of health evidence into tangible and acceptable intervention prototypes. The primary objective of this review was to identify and describe co-design techniques used in nutrition research. The secondary objective was to identify associations between co-design techniques and intervention effectiveness. An integrative review was performed using the databases Emcare, MEDLINE, PsycINFO and Google Scholar. Eligible studies included those that: (1) utilised participatory research or co-design techniques, (2) described development and/or evaluation of interventions aimed at improving dietary behaviours or nutrition, and (3) targeted community-dwelling adults aged ≥18 years. We identified 2587 studies in the initial search and included 22 eligible studies. There were 15 studies that utilised co-design techniques, with a strong focus on engagement of multiple stakeholder types and use of participatory research techniques. No study implemented a complete co-design process. Most studies (14/15) reporting outcomes reported positive health (maximum p < 0.001) or health behaviour outcomes attributed to the intervention; hence, associations between co-design techniques and effectiveness could not be determined. Currently published intervention studies have used participatory research approaches rather than co-design methods. Future research is required to explore the effectiveness of co-design nutrition interventions.

Tissue-specific cell-free DNA degradation quantifies circulating tumor DNA burden.

Profiling of circulating tumor DNA (ctDNA) may offer a non-invasive approach to monitor disease progression. Here, we develop a quantitative method, exploiting local tissue-specific cell-free DNA (cfDNA) degradation patterns, that accurately estimates ctDNA burden independent of genomic aberrations. Nucleosome-dependent cfDNA degradation at promoters and first exon-intron junctions is strongly associated with differential transcriptional activity in tumors and blood. A quantitative model, based on just 6 regulatory regions, could accurately predict ctDNA levels in colorectal cancer patients. Strikingly, a model restricted to blood-specific regulatory regions could predict ctDNA levels across both colorectal and breast cancer patients. Using compact targeted sequencing (<25 kb) of predictive regions, we demonstrate how the approach could enable quantitative low-cost tracking of ctDNA dynamics and disease progression.