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Background and study aims Complete esophageal obstruction (CEO) is a rare complication of radiation therapy for esophageal or head and neck cancers and can be challenging to manage endoscopically. A rendezvous approach by combined anterograde and retrograde endoscopic dilation (CARD) can be used to re-establish luminal integrity in such cases. Our study aimed to review our experience with patients with CEOs managed by CARD. Patients and methods Six patients who had CARD for CEO were reviewed. The primary outcomes were immediate technical and clinical success of CARD. Secondary outcomes were adverse events (AEs) associated with the procedure and continued dependency on the percutaneous endoscopic gastrostomy (PEG)-or jejunostomy tube. Results The mean age was 59 years (range 38-83). Five patients had CEO secondary to neoadjuvant chemoradiotherapy for esophageal cancer, and one patient had complete obstruction secondary to neck trauma. CARD was technically successful in five patients (86%). Two patients had AEs. One had pneumomediastinum requiring no intervention, while the other had bilateral pneumothorax requiring chest tube placement. The median follow-up duration of repeated dilations to maintain liminal patency was 20 months. Four patients had improvement in dysphagia, tolerating oral intake, and mouth secretions after the procedure, with a mean functional oral intake scale (FOIS) score > 3 and an overall success rate of 83%. Conclusions The CARD approach to re-establish esophageal luminal patency in CEO is a safer alternative to high-risk blind antegrade dilation or an invasive surgical approach. It is usually technically feasible with improved swallowing ability in most patients., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Young-onset dementia (YOD) affects individuals under 65 years of age, often leading to loss of employment and independence. Families provide increasing levels of care to family members with YOD, resulting in changes to their daily lives, including their occupational pursuits. This review examines evidence of the occupational implications for family members who provide care to a family with YOD to identify: (i) the influence and impact caregiving tasks and responsibilities have on employment, volunteering, and education, and (ii) caregiver, and caregiving situation factors associated with changes in employment, volunteering, and education. A scoping review was performed using eight electronic databases. Included articles were narratively synthesized using a thematic analysis. Sixteen studies met the inclusion criteria and were included for review. The over-arching (main) theme of 'decision-making' was identified, with family members required to make choices about their own occupational goals and roles to be able to provide care to family living with YOD. The outcomes of these decisions are dynamic and changeable across the caregiving trajectory. Three caregiving factors influence decision-making: (1) Implications of Combining Caregiving and Occupations, (2) Altered Identity (3) Strategies to Support Caregivers of Individuals Living with YOD. A fourth theme was also identified 'Guidance for Researchers To Support Caregivers'. There is a scarce body of literature examining the influence caregiving has on occupational outcomes for the YOD caregiver population. Much of this work is descriptive and lacks focus on the implications, particularly long-term impacts. This review provides a foundational guide for future research and practices to support YOD family caregivers to obtain and sustain occupations., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Older adults living in residential care often experience challenges in sustaining meaningful social relationships, which can result in compromised health and well-being. Online social networking has the potential to mitigate this problem, but few studies have investigated its implementation and its effectiveness in maintaining or enhancing well-being. This pilot study used a cluster-randomized pre-post design to examine the feasibility of implementing a 12-week group-based technology-training intervention for older adults ( n = 48) living in residential care by exploring how cognitive health, mental health, and confidence in technology were impacted. Analysis of variance revealed significant increases in life satisfaction, positive attitudes toward computer use, and self-perceived competence among participants who received the intervention, but increased depressive symptoms for the control group. These findings suggest that, despite challenges in implementing the intervention in residential care, group-based technology training may enhance confidence among older adults while maintaining or enhancing mental health.

With the advent of serial X-ray crystallography on microfocus beamlines at free-electron laser and synchrotron facilities, the demand for protein microcrystals has significantly risen in recent years. However, by in vitro crystallization extensive efforts are usually required to purify proteins and produce sufficiently homogeneous microcrystals. Here, we present InCellCryst, an advanced pipeline for producing homogeneous microcrystals directly within living insect cells. Our baculovirus-based cloning system enables the production of crystals from completely native proteins as well as the screening of different cellular compartments to maximize chances for protein crystallization. By optimizing cloning procedures, recombinant virus production, crystallization and crystal detection, X-ray diffraction data can be collected 24 days after the start of target gene cloning. Furthermore, improved strategies for serial synchrotron diffraction data collection directly from crystals within living cells abolish the need to purify the recombinant protein or the associated microcrystals., (© 2024. The Author(s).)

Purpose: This study is an in-depth exploration of the unfolding experiences of five persons who developed dementia while still in paid work/employment, and of their significant others. Namely, we explore how they experienced the actions and decisions taken with respect to work, and what the consequences meant to them., Methods: A qualitative longitudinal case study design with multiple cases was used, including five participants with dementia and significant others of their choice. Interviews were undertaken longitudinally and analysed with the Formal Data-Structure Analysis approach., Results: The joint analysis resulted in two intertwined themes: 1) The significance and consequences of a dementia diagnosis: a double-edged trigger, and 2) Sensemaking and agency. The prevalent images of what dementia is, who can/cannot get it and what it will bring, were revealed as the critical aspects. Having the opportunity to make sense of what has happened and participate in decision-making, contributed decisively to the participants' experiences., Conclusions: Findings illustrate how a dementia diagnosis is alien in work-life, but once diagnosed, it may trigger self-fulfiling expectations based upon stereotypical understanding of dementia. A shift is needed from a deficit-focused perspective, to viewing people with dementia as citizens capable of agency.

Introduction: This pilot study employed a non-randomized control trial design to explore the impact of physical activity within a virtual reality (VR) environment on multisensory processing among community-dwelling older adults., Methods: The investigation compared both chronic (over 6 weeks) and acute effects of VR-based physical activity to a reading control group. The evaluation metrics for multisensory processing included audiovisual response time (RT), simultaneity judgments (SJ), sound-induced flash illusion (SIFI), and temporal order judgments (TOJ). A total of 13 older adults were provided with VR headsets featuring custom-designed games, while another 14 older adults were assigned to a reading-based control group., Results: Results indicated that acute engagement in physical activity led to higher accuracy in the SIFI task (experimental group: 85.6%; control group: 78.2%; p = 0.037). Additionally, both chronic and acute physical activity resulted in quicker response times (chronic: experimental group = 336.92; control group = 381.31; p = 0.012; acute: experimental group = 333.38; control group = 383.09; p = 0.006). Although the reading group showed a non-significant trend for greater improvement in mean RT, covariate analyses revealed that this discrepancy was due to the older age of the reading group., Discussion: The findings suggest that immersive VR has potential utility for enhancing multisensory processing in older adults. However, future studies must rigorously control for participant variables like age and sex to ensure more accurate comparisons between experimental and control conditions., Competing Interests: The authors collaborated with VR Vision to co-design the exergame entitled “Seas the Day”. This exergame however has been freely published and is available at no cost in the Oculus Store., (Copyright © 2023 Basharat, Mehrabi, Muñoz, Middleton, Cao, Boger and Barnett-Cowan.)

Background: People with dementia often do not receive optimal person-centred care (PCC) in care settings. Family members can play a vital role as care partners to support the person with dementia with their psychosocial needs. Participatory research that includes the perspectives of those with lived experience is essential for developing high-quality dementia care and practices., Objective: Throughout 2021-2022, a mobile app, called WhatMatters, was co-developed to provide easy-to-access and personalised support for people with dementia in hospitals and long-term care homes, with input from patients/residents, family partners and healthcare staff. This article discusses and critically reflects on the experiences of patients/residents, family partners, and healthcare staff involved in the co-design process., Methods: For the app development, we applied a participatory co-design approach, guided by a User Experience (UX) model. The process involved co-design workshops and user testing sessions with users (patients/residents, family partners, healthcare staff) to co-develop the WhatMatters prototype. We also conducted focus groups and one on one interviews with staff and caregiver participants to explore their experiences. Our research team, which also included patient partners, took part in regular team meetings during the app's development, where we discussed and reflected on the co-design process. Reflexive thematic analysis was performed to identify themes that represent the challenges and rewarding experiences of the users involved in the co-design process, which guided our overall reflective process., Findings: Our reflective analysis identified five themes (1) clarifying the co-design process, (2) ensuring inclusive collaborations of various users, and (3) supporting expression of emotion in a virtual environment, (4) feeling a sense of achievement and (5) feeling valued., Implications: WhatMatters offers potential for providing personally relevant and engaging resources in dementia care. Including the voices of relevant users is crucial to ensure meaningful benefits for patients/residents. We offer insights and lessons learned about the co-design process, and explore the challenges of involving people with lived experiences of dementia in co-design work, particularly during the pandemic., (© 2023 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)

Big data originating from user interactions on social media play an essential role in infodemiology and infoveillance outcomes, supporting the planning and implementation of public health actions. Notably, the extrapolation of these data requires an awareness of different ethical elements. Previous studies have investigated and discussed the adoption of conventional ethical approaches in the contemporary public health digital surveillance space. However, there is a lack of specific ethical guidelines to orient infodemiology and infoveillance studies concerning infodemic on social media, making it challenging to design digital strategies to combat this phenomenon. Hence, it is necessary to explore if traditional ethical pillars can support digital purposes or whether new ones must be proposed since we are confronted with a complex online misinformation scenario. Therefore, this perspective provides an overview of the current scenario of ethics-related issues of infodemiology and infoveillance on social media for infodemic studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Lotto, Hanjahanja-Phiri, Padalko, Oetomo, Butt, Boger, Millar, Cruvinel and Morita.)

This paper presents a novel hallway gait extraction system that enables an individual's spatiotemporal gait parameter extraction at each gait cycle using a single FMCW (Frequency Modulated Continuous Wave) radar. The purpose of the proposed system is to detect changes in gait that may be the signs of changes in mobility, cognition, and frailty, particularly for older adults in retirement homes. We believe that one of the straightforward applications for gait monitoring using radars is in corridors and hallways, which are commonly available in most retirement and long-term care homes. To achieve in-corridor coverage, we designed an in-package hyperbola-based lens antenna integrated with a radar module package empowered by our fast and easy-to-implement gait extraction method. We validated system functionality by capturing spatiotemporal gait values (e.g., speed, step points, step time, step length, and step count) of people walking in a hallway. The results achieved in this work pave the way to explore the use of stand-alone radar-based sensors in long hallways in retirement apartment buildings or individual's homes for use in day-to-day long-term monitoring of gait parameters of older adults.

Background: Half of long-term care (LTC) residents are malnourished, leading to increased hospitalization, mortality, and morbidity, with low quality of life. Current tracking methods are subjective and time-consuming., Objective: This paper presented the automated food imaging and nutrient intake tracking technology designed for LTC., Methods: A needs assessment was conducted with 21 participating staff across 12 LTC and retirement homes. We created 2 simulated LTC intake data sets comprising modified (664/1039, 63.91% plates) and regular (375/1039, 36.09% plates) texture foods. Overhead red-green-blue-depth images of plated foods were acquired, and foods were segmented using a pretrained food segmentation network. We trained a novel convolutional autoencoder food feature extractor network using an augmented UNIMIB2016 food data set. A meal-specific food classifier was appended to the feature extractor and tested on our simulated LTC food intake data sets. Food intake (percentage) was estimated as the differential volume between classified full portion and leftover plates., Results: The needs assessment yielded 13 nutrients of interest, requirement for objectivity and repeatability, and account for real-world environmental constraints. For 12 meal scenarios with up to 15 classes each, the top-1 classification accuracy was 88.9%, with mean intake error of -0.4 (SD 36.7) mL. Nutrient intake estimation by volume was strongly linearly correlated with nutrient estimates from mass (r 2 =0.92-0.99), with good agreement between methods (σ=-2.7 to -0.01; 0 within each of the limits of agreement)., Conclusions: The automated food imaging and nutrient intake tracking approach is a deep learning-powered computational nutrient sensing system that appears to be feasible (validated accuracy against gold-standard weighed food method, positive end user engagement) and may provide a novel means for more accurate and objective tracking of LTC residents' food intake to support and prevent malnutrition tracking strategies., (©Kaylen Pfisterer, Robert Amelard, Jennifer Boger, Heather Keller, Audrey Chung, Alexander Wong. Originally published in JMIR Aging (https://aging.jmir.org), 17.11.2022.)

Background: In response to the COVID-19 pandemic, older adults worldwide have increasingly received health care virtually, and health care organizations and professional bodies have indicated that virtual care is "here to stay." As older adults are the highest users of the health care system, virtual care implementation can have a significant impact on them and may pose a need for additional support., Objective: This research aims to understand older adults' perspectives and experiences of virtual care during the pandemic., Methods: As part of a larger study on older adults' technology use during the pandemic, we conducted semistructured interviews with 20 diverse older Canadians (mean age 76.9 years, SD 6.5) at 2 points: summer of 2020 and winter/early spring of 2021. Participants were asked about their technology skills, experiences with virtual appointments, and perspectives on this type of care delivery. Interviews were digitally recorded and transcribed. A combination of team-based and framework analyses was used to interpret the data., Results: Participants described their experiences with both in-person and virtual care during the pandemic, including issues with accessing care and long gaps between appointments. Overall, participants were generally satisfied with the virtual care they received during the pandemic. Participants described the benefits of virtual care (eg, increased convenience, efficiency, and safety), the limitations of virtual care (eg, need for physical examination and touch, lack of nonverbal communication, difficulties using technology, and systemic barriers in access), and their perspectives on the future of virtual care. Half of our participants preferred a return to in-person care after the COVID-19 pandemic, while the other half preferred a combination of in-person and virtual services. Many participants who preferred to access in-person services were not opposed to virtual care options, as needed; however, they wanted virtual care as an option alongside in-person care. Participants emphasized a need for training and support to be meaningfully implemented to support both older adults and providers in using virtual care., Conclusions: Overall, our research identified both perceived benefits and perceived limitations of virtual care, and older adult participants emphasized their wish for a hybrid model of virtual care, in which virtual care is viewed as an addendum, not a replacement for in-person care. We recognize the limitations of our sample (small, not representative of all older Canadians, and more likely to use technology); this body of literature would greatly benefit from more research with older adults who do not/cannot use technology to receive care. Findings from this study can be mobilized as part of broader efforts to support older patients and providers engaged in virtual and in-person care, particularly post-COVID-19., (©Lama Abdallah, Paul Stolee, Kimberly J Lopez, Alexandra Whate, Jennifer Boger, Catherine Tong. Originally published in JMIR Aging (https://aging.jmir.org), 20.10.2022.)

Background: Despite the proven benefits of exercise in older adults, challenges such as access and motivation can deter their engagement. Interactive virtual reality (VR) games combined with exercise (exergames) are a plausible strategy to encourage physical activity among this population. However, there has been little research on the feasibility, acceptability, and potential benefits of deploying at-home VR exergames among community-dwelling older adults., Objective: The objectives of this study are to estimate the feasibility, usability, and acceptability of a co-designed VR exergame in community-dwelling older adults; examine intervention feasibility and assessment protocols for a future large-scale trial; and provide pilot data on outcomes of interest (physical activity, exercise self-efficacy, mood, cognition, perception, and gameplay metrics)., Methods: The study will be a remote, 6-week intervention comprising an experimental and a control group. A sample of at least 12 community-dwelling older adults (with no or mild cognitive impairment) will be recruited for each group. Both groups will follow the same study procedures and assessment methods. However, the experimental group will engage with a co-designed VR exergame (Seas The Day) thrice weekly for approximately 20 minutes using the Oculus Quest 2 (Facebook Reality Labs) VR headset. The control group will read (instead of playing Seas The Day) thrice weekly for approximately 20 minutes over the 6-week period. A mixed methods evaluation will be used. Changes in physical activity, exercise self-efficacy, mood, cognition, and perception will be compared before and after acute data as well as before and after the 6 weeks between the experimental (exergaming) and control (reading) groups. Qualitative data from postintervention focus groups or interviews and informal notes and reports from all participants will be analyzed to assess the feasibility of the study protocol. Qualitative data from the experimental group will also be analyzed to assess the feasibility, usability, and acceptability of at-home VR exergames and explore perceived facilitators of and barriers to uptaking VR systems among community-dwelling older adults., Results: The screening and recruitment process for the experimental group started in May 2021, and the data collection process will be completed by September 2021. The timeline of the recruitment process for the control group is September 2021 to December 2021. We anticipate an estimated adherence rate of ≥80%. Challenges associated with VR technology and the complexity of remote assessments are expected., Conclusions: This pilot study will provide important information on the feasibility, acceptability, and usability of a custom-made VR exergaming intervention to promote older adults' well-being. Findings from this study will be useful to inform the methodology, design, study procedures, and assessment protocol for future large-scale trials of VR exergames with older adults as well as deepen the understanding of remote deployment and at-home use of VR for exercise in older adults., International Registered Report Identifier (irrid): DERR1-10.2196/32955., (©Samira Mehrabi, John E Muñoz, Aysha Basharat, Jennifer Boger, Shi Cao, Michael Barnett-Cowan, Laura E Middleton. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 13.06.2022.)

Background: Striving to cope with day-to-day challenges is a basic human behaviour. Self-initiated management approaches provide a resource that has yet to be discovered and systematically used in occupational therapy practice. This resource might be especially important for people with dementia who are less likely to adopt management approaches initiated by others., Aims/objectives: Based on the findings of former studies on management and problem-solving actions among people with cognitive impairment, this article aims to identify and categorize the study participants' self-initiated management approaches and how these may be manifested in strategies in everyday occupations., Material and Methods: The study utilized a form of meta-synthesis; an aggregated analysis, where findings from 11 studies published 2004-2020 were compared and categorized, incorporating the views of participants with dementia/mild cognitive impairment, or acquired brain injury., Results: Thirty strategies were identified and grouped into seven categories of management approaches, used in a variety of everyday occupations and situations. A majority of the strategies were found in both populations, suggesting that management approaches are more similar than different across populations with cognitive impairment., Conclusions and Significance: Attending to the rich variation of self-initiated management approaches/strategies among persons with cognitive impairment offers possibilities for developing occupational therapy interventions.

Earlier diagnosis and longer working careers is resulting in more individuals being identified as having Mild Cognitive Impairment or Early Onset Dementia (MCI/EOD) when they are still in the workforce. While there is growing interest in the dementia research community and beyond to develop technologies to support people with dementia, the use of technology for and by people with MCI/EOD in the workplace has had very little attention. This paper presents a two-part study involving interviews and participatory sessions to begin to understand the workplace experiences and the role of technology among people living with MCI/EOD. We present our findings from working with seven people with MCI/EOD and two care partners to explore technology design. Our results indicate several similarities as well as a few differences between MCI/EOD and later-onset dementia with respect to challenges using technology and design considerations for supporting engagement and use of technology. Lessons learned through the process of working with people with MCI/EOD through participatory methods is presented along with recommendations to foster an inclusive, respectful, and empowering experience for participants with MCI/EOD.

Background: Advancements in supporting personalized health care and well-being using virtual reality (VR) have created opportunities to use immersive games to support a healthy lifestyle for persons living with dementia and mild cognitive impairment (MCI). Collaboratively designing exercise video games (exergames) as a multistakeholder team is fundamental to creating games that are attractive, effective, and accessible., Objective: This research extensively explores the use of human-centered design methods that involve persons living with dementia in long-term care facilitates, exercise professionals, content developers, game designers, and researchers in the creation of VR exergames targeting physical activity promotion for persons living with dementia/MCI., Methods: Conceptualization, collaborative design, and playtesting activities were carried out to design VR exergames to engage persons living with dementia in exercises to promote upper limb flexibility, strength, and aerobic endurance. We involved a total of 7 persons living with dementia/MCI, 5 exercise professionals, 5 community-dwelling older adults, a VR company for content creation, and a multidisciplinary research team with game designers, engineers, and kinesiology experts., Results: An immersive VR exergame called Seas the Day was jointly designed and developed and it is freely available to be played in state-of-the-art VR headsets (Oculus Quest 1, 2). A model for the triadic interaction (health care institution, industry partner, academia) is also presented to illustrate how different stakeholders contribute to the design of VR exergames that consider/complement complex needs, preferences, and motivators of an underrepresented group of end users., Conclusions: This study provides evidence that a collaborative multistakeholder design results in more tailored and context-aware VR games for persons living with dementia. The insights and lessons learned from this research can be used by others to co-design games, including remote engagement techniques that were used during the COVID-19 pandemic., (©John Muñoz, Samira Mehrabi, Yirou Li, Aysha Basharat, Laura E Middleton, Shi Cao, Michael Barnett-Cowan, Jennifer Boger. Originally published in JMIR Serious Games (https://games.jmir.org), 19.01.2022.)

Background: Physical activity (PA) is associated with physical and cognitive benefits among people living with dementia or mild cognitive impairment (PLWD/MCI) and is a meaningful activity that can improve their confidence in everyday life. Exercising in virtual reality environments (VR Exergame) is becoming an increasingly feasible and enjoyable way to promote PA and well-being in PLWD/MCI. Although co-design can significantly improve the design of technology, it is rarely done with PLWD/MCI. This study uses participatory design methods and collaborative approaches to involve key stakeholders to develop and test a VR Exergame "Seas the Day", a novel solution targeting PLWD/MCI well-being., Methods: A multi-stage, user-centered co-design approach was used to custom-build VR Exergames tailored to the unique needs and abilities of PLWD/MCI based on a first generation of the prototype that was previously developed and tested with PLWD/MCI. This paper describes the next iteration of the prototype. Processes included concept ideation and brainstorming activities, iterative prototyping, and playtesting/input/feedback sessions with key stakeholders (PLWD/MCI, exercise professionals, engineers, VR game designers, content developers)., Results: The multidisciplinary and collaborative design process occurred over 15 months (overlapping with COVID-19 pandemic) with 7 PLWD/MCI (6 females; M=81.3 years) and 9 exercise professionals (7 females; M=38.1 years) to date. The game was designed to target movements identified by exercise professionals and researchers (aerobic exercises, range of motion, seated-balance, quick response to stimuli) and is structured in three exercise stages (warm-up, conditioning, cool-down). To ensure safety of participants while using VR headsets, only seated upper-limb exercises were targeted. Stakeholder feedback regarding game mechanics, aesthetics, and visual/auditory cues were gathered during brainstorming and playtesting sessions and implemented into specific game-related scenarios (tai-chi, rowing, fishing)., Conclusion: We presented the process, outcomes, and challenges of adopting a participatory/collaborative approach with multiple stakeholder groups to co-design VR Exergames tailored to PLWD/MCI. Next steps will include a mixed-method evaluation of the VR Exergames among community-dwelling older adults and PLWD/MCI in retirement communities and long-term care to evaluate: i) feasibility and acceptability of use, ii) game user experience, iii) barriers/facilitators to uptake of VR Exergames; and iv) inform/validate VR Exergames gameplay metrics reflective of cognitive and motor performance., (© 2021 the Alzheimer's Association.)

COVID-19 has had a devasting impact on older adults in Canada, including persons living with dementia. This intrinsic case study sought to understand the perceptions of persons living with dementia regarding how COVID-19 has impacted their well-being. Ten persons living with dementia participated in in-depth qualitative interviews about their experience with COVID-19. Using thematic analysis, four themes were identified: (1) expressing current and future concerns; (2) social connections and isolation; (3) adapting to change and resilience through engagement and hope; and (4) we're not all the same: reflecting individual experiences of the pandemic. Results highlight that while COVID-19 contributed to isolation, concerns, and frustrations, persons with dementia also demonstrated adaptation and resilience. This study reinforced that persons with dementia and their responses to challenges are unique. Therefore, interventions to support persons with dementia must also be individualized to each person's abilities and circumstances.

Ballistocardiogram (BCG) is an emerging tool with the potential to monitor heart failure (HF) patients. A close association of the weight to the BCG as an intermediate signal source requires a careful design, where events such as saturation of the weight signal can result in the loss of the BCG. This work closely examined the factors around the weight while load cells placed under each support of a bed collected the BCG (e.g., body weight, distribution over the four supports of the bed). Following the calibration of weights based on the location of the polls, the study examined the ratios of loads in head-foot and lateral directions. The head-foot ratio was also correlated to the height. Twelve non-obese HF patients were recruited, and the weight and BCG were appropriately measured, where the average error of the weight measurements was 0.45 ± 0.30%. The mean ratio of the loads between head to foot sensors was 3.2 ± 0.7 with a maximum ratio of 4.5, showing that the head-ward sensors supported greater body weight. The ratio of the loads between the right to left sensors was 1.2 ± 0.1. The height and the head-to-foot ratio had an inverse correlation (r = 0.52). Based on the analysis, the head-ward sensors should have a higher capacity of up to three times that of the foot-ward sensors to prevent any signal saturation. Mobility issues were observed in some subjects, attributing to the lateral imbalance. These novel findings based on the end-users (i.e., HF population) may allow better allocation of conditioning resources to obtain the BCG (e.g., optimally adjusted sensitivity).

Current approaches for generating high-quality research evidence for technology-based interventions in the field of disability and rehabilitation are inappropriate. Prevailing approaches often focus on randomized controlled trials as standard and apply clinical trial practices designed for pharmaceuticals; such approaches are unsuitable for technology-based interventions and are counterproductive to the goals of supporting people with disabilities and creating benefits for society. This communication is designed to: (1) advocate for the use of alternative approaches to generating evidence in the development and evaluation of technology-based interventions; (2) propose an alternative framework and guiding principles; and (3) stimulate action by multiple disciplines and sectors to discuss, adopt, and promote alternative approaches. Our Framework for Accelerated and Systematic Technology-based intervention development and Evaluation Research (FASTER) is informed by established innovation design processes, complex intervention development, evaluation, and implementation concepts as well as our collective experiences in technology-based interventions research and clinical rehabilitation practice. FASTER is intended to be meaningful, timely, and practical for researchers, technology developers, clinicians, and others who develop these interventions and seek evidence. We incorporate research methods and designs that better align with creating technology-based interventions and evidence for integration into practice. We propose future activities to improve the generation of research evidence, enable the selection of research methods and designs, and create standards for evidence evaluation to support rigor and applicability for technology-based interventions. With this communication we aim to improve and advance technology-based intervention integration from conception to use, thus responsibly accelerating innovation to have greater positive benefit for people and society., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Sleep is essential for one's health and quality of life. Wearable technologies that use motion and temperature sensors have made it possible to self-monitor sleep. Although there is a growing body of research on sleep monitoring using wearable devices for healthy young-to-middle-aged adults, few studies have focused on older adults, including those living with dementia., Objective: This study aims to investigate the impact of age and dementia on sleep detection through movement and wrist temperature., Methods: A total of 10 younger adults, 10 healthy older adults, and 8 older adults living with dementia (OAWD) were recruited. Each participant wore a Mi Band 2 (accemetry-based sleep detection) and our custom-built wristband (actigraphy and wrist temperature) 24 hours a day for 2 weeks and was asked to keep a daily sleep journal. Sleep parameters detected by the Mi Band 2 were compared with sleep journals, and visual analysis of actigraphy and temperature data was performed., Results: The absolute differences in sleep onset and offset between the sleep journals and Mi Band 2 were 39 (SD 51) minutes and 31 (SD 52) minutes for younger adults, 49 (SD 58) minutes and 33 (SD 58) minutes for older adults, and 253 (SD 104) minutes and 161 (SD 94) minutes for OAWD. The Mi Band 2 was unable to accurately detect sleep in 3 healthy older adults and all OAWDs. The average sleep and wake temperature difference of OAWD (1.26 °C, SD 0.82 °C) was significantly lower than that of healthy older adults (2.04 °C, SD 0.70 °C) and healthy younger adults (2.48 °C, SD 0.88 °C). Actigraphy data showed that older adults had more movement during sleep compared with younger adults and that this trend appears to increase for those with dementia., Conclusions: The Mi Band 2 did not accurately detect sleep in older adults who had greater levels of nighttime movement. As more nighttime movement appears to be a phenomenon that increases in prevalence with age and even more so with dementia, further research needs to be conducted with a larger sample size and greater diversity of commercially available wearable devices to explore these trends more conclusively. All participants, including older adults and OAWD, had a distinct sleep and wake wrist temperature contrast, which suggests that wrist temperature could be leveraged to create more robust and broadly applicable sleep detection algorithms., (©Jing Wei, Jennifer Boger. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 01.06.2021.)