Our objective was to test for associations between rhinitis symptoms and respiratory phenotypes through age 10 years in urban children. Chronic nasal symptoms (starting at age 1) and seasonal rhinitis symptoms (starting at age 4 years) were assessed yearly in The Urban Environment and Childhood Asthma study, a high-risk urban birth cohort (n=442). Longitudinal patterns of wheeze, allergic sensitization and lung function through age ten were used to identify six respiratory phenotypes: 1) low wheeze, low atopy ("LW-LA"); 2) transient wheeze, low atopy ("TW-LA"); 3) moderate wheeze, low atopy ("MW-LA"); 4) low wheeze, high atopy ("LW-HA"); 5) moderate wheeze, high atopy ("MW-HA"); 6) high wheeze, high atopy, low lung function ("HW-HA-LF"). Differences in chronic and seasonal rhinitis symptoms among phenotypes were examined using longitudinal data analyses. Rhinitis in the first year was common in all groups, but nasal symptoms differentially associated with wheeze and atopy thereafter. Chronic rhinitis symptoms were more prevalent in the three wheezing phenotypes (HW-HA-LF, MW-LA, and MW-HA) compared to the transient wheeze and low wheeze groups (∼75% increase in symptoms over the first 10 years, p<0.001). Seasonal rhinitis symptoms were most prevalent (>2-fold increase) in the two high-atopy groups with wheeze (MW-HA and HW-HA-LF, p<0.001). Among high risk, urban children, chronic rhinitis is most prevalent in children among the three persistent wheezing respiratory phenotypes, while seasonal rhinitis is most prevalent in children among the high atopy respiratory phenotypes with wheezing. These close relationships between trajectories of wheeze and rhinitis in early life suggest shared pathogenic mechanisms.

Seasonal variation in respiratory illness and exacerbation in pediatric populations with asthma is well described but poorly understood. We hypothesized that nasal microbiota covaries with seasonal clinical trends and that season-specific microbial-host interactions during respiratory illness influence risk of exacerbation. Bacterial (16S rRNA) and fungal (ITS2) profiling was performed on longitudinally collected nasal secretion samples from children with asthma during periods of pulmonary health (Baseline, n=94 samples) and their first subsequent respiratory illness (n=97). Data were analyzed in conjunction with extant clinical and nasal transcriptional modules using R. Generalized linear (mixed) models were utilized to identify seasonal differences in incidence or microbiota composition (P<0.05). Exacerbation and respiratory illness events co-varied similarly with season [Generalized Additive Mixed Models (GAMM) P=0.039, P=<0.001, respectively]. So too did upper airway bacterial [Generalized Additive Model (GAM) P=0.001 baseline, P=0.016 respiratory illness] and fungal (GAM P=0.006 respiratory illness) composition and detection of Human Rhinovirus (GAM P=0.012 Baseline, P=0.003 respiratory illness). In baseline samples adjusted for season, time to respiratory Illness or exacerbation related to the presence of Staphylococcus or Corynebacterium which delayed respiratory events, and Haemophilus, which associated with more imminent illness and exacerbation. In season and age adjusted analysis, interactions during respiratory illness events between the exacerbation-associated SMAD3 transcriptional module and a bacterial network primarily comprised of Streptococcus and Haemophilus increased risk of exacerbation (OR=14.71, P=0.02). Upper airway microbiota co-vary with seasonal trends in respiratory illness and asthma exacerbation. Specific microbial-host interactions at baseline or during respiratory illness events influence risk of exacerbation.

Background Late-life depression (LLD) is associated with poor social functioning. However, previous research uses bias-prone self-report scales to measure social functioning and a more objective measure is lacking. We tested a novel wearable device to measure speech that participants encounter as an indicator of social interaction. Methods Twenty nine participants with LLD and 29 age-matched controls wore a wrist-worn device continuously for seven days, which recorded their acoustic environment. Acoustic data were automatically analysed using deep learning models that had been developed and validated on an independent speech dataset. Total speech activity and the proportion of speech produced by the device wearer were both detected whilst maintaining participants' privacy. Participants underwent a neuropsychological test battery and clinical and self-report scales to measure severity of depression, general and social functioning. Results Compared to controls, participants with LLD showed poorer self-reported social and general functioning. Total speech activity was much lower for participants with LLD than controls, with no overlap between groups. The proportion of speech produced by the participants was smaller for LLD than controls. In LLD, both speech measures correlated with attention and psychomotor speed performance but not with depression severity or self-reported social functioning. Conclusions Using this device, LLD was associated with lower levels of speech than controls and speech activity was related to psychomotor retardation. We have demonstrated that speech activity measured by wearable technology differentiated LLD from controls with high precision and, in this study, provided an objective measure of an aspect of real-world social functioning in LLD.

1AcademicClinical Fellow and Specialist Registrar, Department of Anaesthesia, University Hospitals PlymouthNHS Trust, Plymouth, UK 2Doctoral Trainee, 3 Lecturer, 4 Senior ResearchAssociate, Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, UK 5 SouthWest Anaesthesia ResearchMatrix (SWARM), https://www.ukswarm.com/ 6 Emeritus Professor, PeninsulaMedical School, University of Plymouth, UK

Children living in low-income urban environments experience high asthma morbidity. Prior phenotyping of these children has identified a subgroup with low levels of allergy (T2-low) but highly symptomatic asthma. Assessment of the airway epithelium in these children can provide important mechanistic insights into disease pathogenesis. We performed RNA-sequencing of nasal brush samples from 123 children in the Asthma Phenotypes in the Inner City (APIC) cohort. These children were previously clustered into 5 phenotypes according to metrics of T2 biomarkers, lung function, rhinitis and asthma symptoms, and asthma severity. Differential gene expression was assessed by modular analysis. The cluster of children characterized by T2-low highly-symptomatic asthma and rhinitis had significantly increased expression of a module of 875 genes. This module was highly enriched for Neuroactive ligand-receptor interaction genes (KEGG; FDR=2.3E-5), Olfactory transduction genes (KEGG; FDR=2.6E-4) and Extracellular matrix genes (UniProtKB; FDR=8.6E-12), the latter of which included multiple collagen and ADAM (a disintegrin and metalloproteinase) genes. This expression module also included a small number of cytokine/receptor pathway genes notable for IL23R, IL26, and IL2 and an absence of canonical T2 genes. This pathway was upregulated 1.5-fold over the cluster of children with T2-low mild asthma, and 2.4-fold over the cluster of children with highly symptomatic T2-high asthma (FDRs <0.05). Our results demonstrate a unique nasal gene expression profile characteristic of urban children with highly symptomatic asthma and rhinitis but with minimal allergy, most notable for numerous genes related to neuronal signaling and components of Th17 signaling, suggesting unique molecular mechanisms of disease.

SummaryThis pilot and feasibility study evaluated wrist‐worn accelerometers to measure recovery from day‐case surgery in comparison with daily quality of recovery‐15 scores. The protocol was designed with extensive patient and public involvement and engagement, and delivered by a research network of anaesthesia trainees. Forty‐eight patients recruited through pre‐operative assessment clinics wore wrist accelerometers for 7 days before (pre‐operative) and immediately after elective surgery (early postoperative), and again at 3 months (late postoperative). Validated activity and quality of recovery questionnaires were administered. Raw accelerometry data were archived and analysed using open source software. The mean (SD) number of valid days of accelerometer wear per participant in the pre‐operative, early and late postoperative periods were 5.4 (1.7), 6.6 (1.1) and 6.6 (1.0) days, respectively. On the day after surgery, Euclidian norm minus one (a summary measure of raw accelerations), step count, light physical activity and moderate/vigorous physical activity decreased to 57%, 47%, 59% and 35% of baseline values, respectively. Activity increased progressively on a daily basis but had not returned to baseline values by 7 days. Patient questionnaires suggested subjective recovery by postoperative day 3 to 4; however, accelerometry data showed that activity levels had not returned to baseline at this point. All activity measures had returned to baseline by 3 months. Wrist‐worn accelerometery is acceptable to patients and feasible as a surrogate measure for monitoring postoperative recovery from day‐case surgery. Our results suggest that patients may overestimate their rate of recovery from day‐case surgery, which has important implications for future research.

Background Hemiplegic Cerebral Palsy causes unilateral weakness and stiffness. Upper limb therapy at effective intensity is not accessible to most. Aim Determine stakeholder views on design of an approach using wrist-worn devices and software (phone application) incorporating positive feedback and peer support, to encourage use of the affected arm and hand. Method Five participatory design workshops, incorporating the views of 5 young people (YP) with hemiplegia and 13 typically developing (TD) (8–18 years) plus three parents, six researchers, three occupational therapists, one teacher and two paediatricians. Results Four themes were noted: Ease/practical issues, Appearance/comfort, Incentives, and Access to participants. Ease/practical issues: Distinguishing between left and right devices proved challenging, so images of differing orientation were added. Concern about teachers’ disapproval was resolved by producing an explanatory ‘business card’ for YP to hand out. Mobile phones are not required in school as the device and app can synchronise later, via Bluetooth. Concerns were addressed, regarding whether devices could gather secure information from arm movement, e.g. PIN numbers. Reassuringly, data is averaged over a minute, rendering this impossible. A parent asked whether GPs could use the data for other purposes (e.g. investigation of tremor) - but this would present challenges. Incentives: Games were a popular incentive, especially those with a competitive element. Inclusion of the game and summarised data showing progress was favoured. Parents were incentivised by this opportunity for their child to receive help and take responsibility for therapy. Appearance/comfort: The devices were programmed to display the time, in response to requests from YP. Wearing two devices was mildly perturbing for older participants as this would be considered unusual, though all were prepared to do it for the project duration. Access to participants: Recruitment to the workshops through advertising and patient groups was challenging; however, in the planned study, we will recruit through the NHS. Conclusion The participatory design process informed plans for the proof of concept stage of the study, hopefully leading to a product and approach that will be fun, easy to integrate into everyday life, and have the capacity to increase use of the affected arm and hand.

This paper describes Showboater, a simple system architecture for rural community display networks. We outline the context of our 2-year longitudinal study and outline five design goals: a functional, sustainable, scalable, resilient networked display solution which affords roles for the distribution of governance. We describe the design and implementation of Showboater and how it aligns to the design goals, as well as describing two separate deployments. We reflect on evaluation feedback and provide insight into the implications of deploying Showboater as rural community display system, respective of the initial design goals, and present our recommendations for future improvements.

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.

When the Deepwater Horizon oil rig blew out in 2010, the immediate threats to productive deep water and estuarial fisheries and the region's fishing and energy economies were obvious. Less immediately obvious, but equally unsettling, were risks to human health posed by potential damage to the regional food web. This paper describes grassroots and regional efforts by the Gulf Coast Health Alliance: health risks related to the Macondo Spill Fishermen's Citizen Science Network project. Using a community-based participatory research approach and a citizen science structure, the multiyear project measured exposure to petrogenic polycyclic aromatic hydrocarbons, researched the toxicity of these polycyclic aromatic hydrocarbon compounds, and communicated project findings and seafood consumption guidelines throughout the region (coastal Louisiana, Mississippi, and Alabama). Description/analysis focuses primarily on the process of building a network of working fishermen and developing group environmental health literacy competencies.

Encouraging impaired limb use during routine and rehabilitation activities after stroke is challenging. We evaluated changes in stroke arm activity related to vibration prompts delivered by a wrist-worn accelerometer (“CueS wristband”). A pilot randomised controlled trial was conducted with adults < 3 months after stroke causing any arm impairment. All received instruction for a self-directed four-week programme encouraging bimanual tasks, and wore a wristband on the impaired side 8am–8pm. Intervention wristbands were programmed to deliver vibration prompts if hourly activity targets were unmet. To allow for incremental recovery, patient preference and diurnal variability, the target was selected as 5%, 10% or 20% above median levels recorded hourly over the previous 3 days. Data were downloaded at twice weekly reviews. Activity counts per minute (CPM) were calculated from CueS mean signal vector magnitude (1 s epoch) at the first (baseline) and the last (endpoint) review. Standard accelerometers recorded natural arm activity over 72 h starting at 4 and 8 weeks post-baseline. Mann Whitney U test compared CPM between groups, and for 1 hour before/after prompts amongst intervention participants. Thirty-three participants (14 intervention; 19 control) enrolled over 16 months: mean age 71 years (SD11); 13 male; mean days post-stroke 30 (SD19); median baseline Action Research Arm Test 20/57 [IQR 3.5,41]. Median number of prompts delivered were 7 per participant/day [IQR: 6,8]. Median CPM during 1 hour before/after prompts was 651 versus 759 (+16.6%; P = 0.002). CPM increased immediately after prompting, suggesting a direct behavioural impact. Compared to control, the intervention group continued to increase CPM beyond wristband removal. Whilst these results are encouraging, this was a small study and data may not reflect only arm activity. Personalised prompts delivered by a wrist-worn accelerometer may enhance self-directed arm activity after stroke.

Mass adoption and innovation in the field of the Internet of Things has transformed the environments we live in, from stale siloes of technologies into rich interactive playgrounds. Nevertheless, the vast majority of surface area in these spaces are being overlooked and under-utilized in today's research. Surface imaging provides the means to extend and include typically out-of-reach, disconnected objects into these playgrounds. However, existing surface imaging technologies are impractical to embed in everyday environments, restricting researchers from exploring the design and interaction opportunities they can afforded these spaces. In this paper, we propose IRIS, a modular surface imaging prototype capable of providing scalable, low-cost, high-resolution surface imaging. We describe a real-world case study where IRIS is used to identify and track fresh fruit produce being prepared -- a task that is typical infeasible with existing technologies. Through IRIS, we hope to enable the community to exploit these under-explored surface areas and enhance the rich, interactive, connected environments we inhabit.

Background Late-life depression (LLD) is associated with a decline in physical activity. Typically this is assessed by self-report questionnaires and, more recently, with actigraphy. We sought to explore the utility of a bespoke activity monitor to characterize activity profiles in LLD more precisely. Method The activity monitor was worn for 7 days by 29 adults with LLD and 30 healthy controls. Subjects underwent neuropsychological assessment and quality of life (QoL) (36-item Short-Form Health Survey) and activities of daily living (ADL) scales (Instrumental Activities of Daily Living Scale) were administered. Results Physical activity was significantly reduced in LLD compared with controls (t = 3.63, p < 0.001), primarily in the morning. LLD subjects showed slower fine motor movements (t = 3.49, p < 0.001). In LLD patients, activity reductions were related to reduced ADL (r = 0.61, p < 0.001), lower QoL (r = 0.65, p < 0.001), associative learning (r = 0.40, p = 0.036), and higher Montgomery–Åsberg Depression Rating Scale score (r = −0.37, p < 0.05). Conclusions Patients with LLD had a significant reduction in general physical activity compared with healthy controls. Assessment of specific activity parameters further revealed the correlates of impairments associated with LLD. Our study suggests that novel wearable technology has the potential to provide an objective way of monitoring real-world function.

This paper describes the challenges and lessons learned in the experience-centered design (ECD) of the Spheres of Wellbeing, a technology to promote the mental health and wellbeing of a group of women, suffering from significant mental health problems and living in a medium secure hospital unit. First, we describe how our relationship with mental health professionals at the hospital and the aspirations for person-centric care that we shared with them enabled us, in the design of the Spheres, to innovate outside traditional healthcare procedures. We then provide insights into the challenges presented by the particular care culture and existing services and practices in the secure hospital unit that were revealed through our technology deployment. In discussing these challenges, our design enquiry opens up a space to make sense of experience living with complex mental health conditions in highly constrained contexts within which the deployment of the Spheres becomes an opportunity to think about wellbeing in similar contexts.

Parkinson's is a complex and multifaceted condition with a myriad of symptoms, thus, designing for and with this user group requires careful consideration. We reflect upon two studies, employing different design methodologies, relating to the design of rehabilitative exergames in Parkinson's. The first explored the concept of designing 'for' People with Parkinson's (PwP) and focused on specifications outlined by clinical stakeholders. The second used a designing 'with' approach and modified a pre-established participatory design method for use with PwP. We call attention to the importance of carrying out design work with PwP and contribute; an empathic understanding of living with Parkinson's, a set of recommendations for how to design with PwP and a set of wider considerations for developing rehabilitative exergames for PwP.

Smart learning environments offer rich opportunities for language learners. In particular, context-aware systems which allow learners’ progress to be sensed within and across an activity, enable instructed language learning to move beyond the traditional confines of the classroom walls. In this paper we present the European Kitchen, a real-world task-based environment for cooking and language learning. In doing so, we demonstrate how specific design decisions, in the development of this longer-term iterative design project, conjoin Human Computer Interaction practice and learning theory for situated language learning. We also show how this approach is combined with Conversation Analysis, which is used as a tool to measure the impact of these decisions on the interactions taking place in and with the kitchen. Our work reveals that in order to design for and evaluate effective and meaningful language learning, there should be more balance between technologically-driven theory and theory driven research which has a strong pedagogical foundation. Our work has implications for a transferable, interdisciplinary model of task-based, situated learning which can be applied and adapted to different skill and knowledge sets.

Collecting large-scale population data on dietary intake is challenging, particularly when resources and funding are constrained. Technology offers the potential to develop novel ways of collecting large amounts of dietary information while making it easier, more convenient, intuitive, and engaging for users. INTAKE24 is an online multiple pass 24 h dietary recall tool developed for use in national food and nutrition surveys. The development of INTAKE24 was a four-stage iterative process of user interaction and evaluation with the intended end users, 11-24 years old. A total of 80 11-24 years old took part in the evaluation, 20 at each stage. Several methods were used to elicit feedback from the users including, 'think aloud', 'eye tracking', semi-structured interviews, and a system usability scale. Each participant completed an interviewer led recall post system completion. Key system developments generated from the user feedback included a 'flat' interface, which uses only a single interface screen shared between all of the various activities (e.g., free text entry, looking up foods in the database, portion size estimation). Improvements to the text entry, search functionality, and navigation around the system were also influenced through feedback from users at each stage. The time to complete a recall using INTAKE24 almost halved from the initial prototype to the end system, while the agreement with an interviewer led recall improved. Further developments include testing the use of INTAKE24 with older adults and translation into other languages for international use. Our future aim is to validate the system with recovery biomarkers.