MOBILE INTERVENTION FOR FAMILY DEMENTIA CAREGIVERS: FROM FOCUS GROUPS TO SMARTPHONE PLATFORM

There is growing recognition that in-person delivery of caregiver interventions limits scalability due to distance from locations where interventions are available, and costs associated with locating substitute care for the person living with dementia. Internet-based interventions are often not optimized for smartphones, which are more accessible than desktops to minoritized populations and those of lower socioeconomic status. In this study, focus groups were conducted with 17 English language and 12 Spanish language family dementia caregivers regarding needs for smartphone-based technological intervention. We employed an inductive and deductive driven mixed method analytic approach. Identified needs included psychoeducation regarding dementia, provision of caregiver skills information, activities for the person living with dementia, and relaxation techniques. Similarities and differences among preferences between the two populations were identified. Family dementia caregivers endorsed several needs for mobile intervention. The development of a new mobile application platform to meet these needs will be described.

Using a Facebook Virtual Examination Room to Enhance ROP Training in Armenia

Purpose

Retinopathy of prematurity (ROP) is a leading cause of worldwide childhood blindness with increasing incidence in low and middle income countries (LMICs) due to advances in neonatal care. There are insufficient numbers of healthcare professionals specialized in ROP management and few local training opportunities in LMICs. Social media platforms provide a promising solution to enable interactive medical education across geographic and logistic barriers. As an adjunct to an ROP training program for ophthalmologists in Armenia, we implemented a Facebook Virtual Examination Room (VER) for case discussion with a global community of collaborators and preceptors. To evaluate training through VER, we operationalized engagement as a multilayer meta-construct that includes cognitive, behavioral, and social-emotional domains.

Methods

A concurrent mixed methods approach was taken to collect and analyze data from comments and activities within VER. Quantitative data was analyzed for descriptive statistics on group utilization, participant activity, and clinical metrics. Qualitative data was analyzed by conducting thematic analysis involving initial and pattern coding.

Results

Ten participants (7 trainees and 3 preceptors) interacted in the Facebook group across 153 unique cases, with 218 threads, 414 comments, and 216 likes. Of the 120 unique cases eligible for consensus evaluation, treatment was mentioned most frequently (87), followed by location (68), staging (65), and plus disease (31), with agreement ranging from 67% to 97%. Based on the qualitative analysis, the most common themes of discussion were clinical management, dilemma resolution, knowledge growth, and gratitude.

Conclusion

A closed Facebook group for case-based discussions can be a useful adjunct to an existing ROP training program by engaging learners across social-emotional, behavioral, and cognitive domains. For international training partnerships, the financial and logistical advantages can be significant, though focus should remain on the primary curriculum and training modality.

Mentalizing imagery therapy to augment skills training for dementia caregivers: Protocol for a randomized, controlled trial of a mobile application and digital phenotyping

More than 50 million people worldwide live with a dementia, and most are cared for by family members. Family caregivers often experience chronic stress and insomnia, resulting in decreased mental and physical health. Accessibility of in-person stress reduction therapy is limited due to caregiver time constraints and distance from therapy sites. Mentalizing imagery therapy (MIT) provides mindfulness and guided imagery tools to reduce stress, promote self and other understanding, and increase feelings of interconnectedness. Combining MIT with caregiver skills training might enable caregivers to both reduce stress and better utilize newly learned caregiving skills, but this has never been studied. Delivering MIT through a smartphone application (App) has the potential to overcome difficulties with scalability and dissemination and offers caregivers an easy-to-use format. Harnessing passive smartphone data provides an important opportunity to study behavioral changes continuously and with higher granularity than routine clinical assessments. This protocol describes a randomized, controlled, superiority trial in which 120 family dementia caregivers, aged 60 years or older, will be assigned to smartphone App delivery of caregiver skills with MIT (experimental condition) or without MIT (control condition). The primary objectives of the trial are to assess whether the experimental condition is superior to control on reducing family caregiver stress, insomnia and related outcomes and to demonstrate the feasibility of developing behavioral markers from passive smartphone data that predict health outcomes in older adults. Trial outcomes may inform the suitability of our intervention for caregivers and provide new methods for assessment of older adults.

Pattern and prevalence of eye disorders and diseases in school-aged children: findings from the Nationwide School Sight Sampling Survey in Armenia

Objective

This study aims to identify the prevalence of eye disorders and their causes among secondary schoolchildren aged 6–15 years old in Armenia, based on analysis of the Nationwide School Sight Sampling Survey.

Methods and Analysis

A two-stage proportionate stratified cluster sample was designed for the survey. 22 600 students were screened for visual acuity in schools; 5944 of them were selected for analysis as a nationally representative sample. Those with 20/40 or worse vision were referred to photoscreening and rapid ophthalmic assessment in schools and then were provided with vouchers for free comprehensive eye examination in eye clinics. Data were collected through data collection forms and analysed using SPSS V.23.

Results

While majority of the children (85%) had normal vision, 15% had a visual acuity ≤20/40. The prevalence of vision impairment (VI) in at least one eye was 9.7% and blindness in at least one eye was 0.05%. The prevalence of abnormal vision and VI was higher among girls and older children. VI was more prevalent in urban areas. The most common diagnoses were myopia (60%), astigmatism (33.7%), hyperopia (29.5%) and strabismus (3.8%).

Conclusion

Majority of the vision abnormalities and VI among schoolchildren are a result of refractive error and are treatable. Our results highlight the importance of regular eye examinations for schoolchildren to detect and prevent VI. Raising awareness among parents, school staff and children about eye health is vital.

Uniform persistence for sigmoidal diet selection with keystone prey species

In this paper we discuss uniform persistence (UP) criteria of two prey- one predator systems, where we consider that the predator's diet selection is a sigmoidal function of the most profitable prey type in place of a step function of conventional diet choice theory. We also derive UP results of the system with direct interspecific competition between the prey. The role of the most profitable prey item as a keystone species, the magnitude of its carrying capacity, the ability to withstand predation of both prey species, and the ratios of their profitability values (to predators) are important to whether or not adaptive foraging may promote UP. In general, foraging decision rules play no role in UP if the alternative prey item is the keystone species. The result is also not affected by the effect of direct competitive coexistence or dominance relationship of the prey. In some cases, dominance of one of the prey species provides the most advantageous situation for ensuring UP.

Optimal foraging and predator-prey dynamics, II

In this paper we consider one-predator-two-prey population dynamics described by a control system. We study and compare conditions for permanence of the system for three types of predator feeding behaviors: (i) specialized feeding on the more profitable prey type, (ii) generalized feeding on both prey types, and (iii) optimal foraging behavior. We show that the region of parameter space leading to permanence for optimal foraging behavior is smaller than that for specialized behavior, but larger than that for generalized behavior. This suggests that optimal foraging behavior of predators may promote coexistence in predator-prey systems. We also study the effects of the above three feeding behaviors on apparent competition between the two prey types.

Attracting theorems for cyclic sets and impermanence

We derive attraction theorems for a cycle connecting nonempty compact (isolated) invariant sets using an average Lyapunov function. An application is given to a concrete system having such a cycle with the object to obtain the impermanence of the system.

Persistence of a generalized gause-type two prey-two predator pair linked by competition

We consider a generalized Gause-type model of a two predator-two prey system in which the predators are prey-specific and the prey are in competition with each other. Uniform persistence, weak persistence, and the existence of different types of heteroclinic cycles with multiple boundary equilibria are discussed.

Multiple cyclic sets connecting saddle points and limit cycles of a four-species system and its uniform persistence

Considering a model of a generalized Gause-type four-species system of two predator-prey pairs linked by competition, the authors derive sufficient conditions for the existence of three different invariant cyclic sets connecting saddle points and limit cycle(s) on the boundary of its state space. Also discussed is the uniform persistence of the model in the presence of such cycle sets.

A co-evolutionary model of mutualism from a commensal association on Lotka-Volterra dynamics

This paper considers a Lotka-Volterra type of model of competition between a commensal pair of species and a mutualistic pair, presumed to have descended from a single ancestral pair of species. The species are behaviourally isolated but compete for resources. We have studied in detail the effects of the benefits of mutualism over commensalism. Specifically, it is shown that co-evolution of the mutalistic pair from the commensal association is not possible if (i) some of the interacting parameters coincide for the two pairs, or (ii) mutualists suffer more from competition, or (iii) mutualists produce a smaller competitive effect. If the costs of mutualism are density-independent, co-evolution of the mutualism is possible provided (i) the specific growth rate(s) of one or both of the mutualistic species is positive at the steady state of the commensal pair and (ii) the specific growth rate(s) of one or both of the commensal species is positive at the steady state of the mutualistic pair. Lastly, whenever the mutualists co-exist with the commensalists and the feasible interior equilibrium of the model is unstable, we have shown that the co-evolutionary model of mutualism collapses to the stable two-species mutualistic relationship, causing the ultimate extinction of both the species of the original commensal association.

Persistence of a four species food chain with full omnivory

We consider here a food chain composed of four species with full omnivory with Lotka-Volterra dynamics. Conditions for uniform persistence and weak persistence of the food chain are derived. It is also shown that the system exhibits a heteroclinic cycle.