title: Do‐it‐yourself continuous glucose monitoring in people aged 16 to 69 years with type 1 diabetes: A qualitative study

authors: Sehgal, Shekhar

abstract: Aims: In many countries, real-time continuous glucose monitoring (rt- CGM) is not funded, and cost presents a barrier to access. A do-it-yourself conversion of intermittently scanned  CGM  (DIY-  CGM)  is a  cheaper alternative.  This qualitative study aimed to explore user experiences with DIY- CGM in people aged 16 to 69 years with type 1 diabetes (T1D).
Methods: Convenience sampling was used to recruit participants for semi-structured virtual interviews exploring experiences of DIY- CGM use. Participants were recruited after completing the intervention arm of a crossover randomised controlled trial that evaluated  DIY-  CGM  versus intermittently scanned  CGM  (isCGM).  Participants were previously naive to  DIY-  CGM  and rt-  CGM  but not isCGM. The DIY- CGM intervention consisted of a Bluetooth bridge connected to isCGM, adding rt- CGM functionality over 8 weeks. Interviews were transcribed, then thematic analysis was performed.
Results: Interviews were with  12  people aged  16  to  65  years,  with  T1D:  mean age ± SD  43 ±14 years; baseline mean HbA1c ± SD  60 mmol/mol ± 9.9  (7.6 ± 0.9%) and time in range 59.8% ±   14.8%. Participants perceived that using DIY- CGM improved both glycaemic control and aspects of quality of life.  Alarm and trend functionality allowed participants to perceive reduced glycaemic variability overnight and following meals. The addition of a smartwatch increased discrete access to glucose information.  There was a  high degree of trust in  DIY-  CGM.  Challenges while using DIY- CGM included signal loss during vigorous exercise, alarm fatigue and short battery life. 
Conclusions: This study suggests that for users, DIY- CGM appears to be an acceptable alternative method of rt- CGM.

text: Do‐it‐yourself continuous glucose monitoring in people aged 16 to 69 years with type 1 diabetes: A qualitative study Aims: In many countries, real-time continuous glucose monitoring (rt- CGM) is not funded, and cost presents a barrier to access. A do-it-yourself conversion of intermittently scanned  CGM  (DIY-  CGM)  is a  cheaper alternative.  This qualitative study aimed to explore user experiences with DIY- CGM in people aged 16 to 69 years with type 1 diabetes (T1D).
Methods: Convenience sampling was used to recruit participants for semi-structured virtual interviews exploring experiences of DIY- CGM use. Participants were recruited after completing the intervention arm of a crossover randomised controlled trial that evaluated  DIY-  CGM  versus intermittently scanned  CGM  (isCGM).  Participants were previously naive to  DIY-  CGM  and rt-  CGM  but not isCGM. The DIY- CGM intervention consisted of a Bluetooth bridge connected to isCGM, adding rt- CGM functionality over 8 weeks. Interviews were transcribed, then thematic analysis was performed.
Results: Interviews were with  12  people aged  16  to  65  years,  with  T1D:  mean age ± SD  43 ±14 years; baseline mean HbA1c ± SD  60 mmol/mol ± 9.9  (7.6 ± 0.9%) and time in range 59.8% ±   14.8%. Participants perceived that using DIY- CGM improved both glycaemic control and aspects of quality of life.  Alarm and trend functionality allowed participants to perceive reduced glycaemic variability overnight and following meals. The addition of a smartwatch increased discrete access to glucose information.  There was a  high degree of trust in  DIY-  CGM.  Challenges while using DIY- CGM included signal loss during vigorous exercise, alarm fatigue and short battery life. 
Conclusions: This study suggests that for users, DIY- CGM appears to be an acceptable alternative method of rt- CGM.

year: 2023-06-18

title: An evaluation of oVRcome, a low-cost vrtual reality exposure therapy app

authors: Wallace, Rory

subjects: app

abstract: Emetophobia (fear of vomiting) is an understudied disorder that affects 0.2% of people, with extreme (non-phobic) fear affecting up to 8% of people. The most effective treatment for specific phobias is exposure therapy. One exposure therapy approach, virtual reality exposure therapy (VRET), has become a viable treatment alternative to traditional in vivo or imaginal exposure therapy in recent years. However, using VRET to treat emetophobia has not yet been explored. I used a within-subjects, multiple-baseline-across-participants design with six participants to evaluate the emetophobia programme of oVRcome, a low-cost, Aotearoa New Zealand-based VRET app. After using the oVRcome VRET app, all participants’ phobia severity reduced on one or both measures, with two participants scoring below the threshold for a likely phobia diagnosis. The emetophobia programme of the oVRcome VRET app was effective at reducing emetophobia severity, and my results support research showing eHealth apps can be a low-cost and effective treatment for a range of psychological issues.

text: An evaluation of oVRcome, a low-cost vrtual reality exposure therapy app Emetophobia (fear of vomiting) is an understudied disorder that affects 0.2% of people, with extreme (non-phobic) fear affecting up to 8% of people. The most effective treatment for specific phobias is exposure therapy. One exposure therapy approach, virtual reality exposure therapy (VRET), has become a viable treatment alternative to traditional in vivo or imaginal exposure therapy in recent years. However, using VRET to treat emetophobia has not yet been explored. I used a within-subjects, multiple-baseline-across-participants design with six participants to evaluate the emetophobia programme of oVRcome, a low-cost, Aotearoa New Zealand-based VRET app. After using the oVRcome VRET app, all participants’ phobia severity reduced on one or both measures, with two participants scoring below the threshold for a likely phobia diagnosis. The emetophobia programme of the oVRcome VRET app was effective at reducing emetophobia severity, and my results support research showing eHealth apps can be a low-cost and effective treatment for a range of psychological issues.

year: 2024

title: Time to Diagnosis and Persistence: The Two Major Determinants of Effective Tuberculosis Control

authors: Ruthe, Alaine Tess

subjects: tuberculosis

abstract: The greatest challenge confronting effective tuberculosis (TB) eradication is the time to diagnosis, and duration of treatment of chronically infected individuals which represent a pool of infection. In an attempt to help limit the spread of TB in New Zealand, a fast SNP based diagnostic test was developed, to quickly identify the highly transmissible and virulent endemic Rangipo strain. The role of VapBC toxin-antitoxin systems in M. tuberculosis has been the subject of great interest recently, due to their expanded number in the genome and links with virulence and the regulation of cell growth in response to environmental stress. Their ability to regulate growth under adverse conditions for presumed survival advantages possibly leading to dormancy or persistence, make them ideal candidates for the development of new M. tuberculosis treatments. To establish differential expression of vapC, and therefore identify possible pathways and functions of the VapBC proteins, RT-qPCR was used to assess the expression levels of vapB and vapC in M. smegmatis under conditions of stress. No consistant changes in vapC mRNA levels were observed, resulting in the hypothesis that it is not the transcriptional differences which are important in the regulation of VapC, but post-transcriptional factors. In order to investigate the function(s) of M. tuberculosis VapBCs, these VapBC proteins were expressed and purified in M. smegmatis, and the VapC toxin tested for RNase activity. The purification, expression, RNase testing and bioinformatic analysis of M. tuberculosis VapCs suggested that VapCRv2530c, VapCRv0065 and VapCRv0617 may all target the same recognition sequence, UA*GG. Bioinformatic analysis revealed an abundance of this target sequence in horizontal gene transfer and TA genes, raising the possibility that VapC toxins could be functioning as selfish elements, or initiating transcriptional regulation cascades when a rapid change in the proteomic response and metabolic state of the cell is required. It is intriguing that the three M. tuberculosis VapC proteins tested thus far appear to target the same recognition sequence, possibly suggesting that all 47 VapCs are RNases and are targeting the same sequence. Alternatively; VapCs may belong to sub-groups targeting different sequences, allowing M. tuberculosis to exude both gross and fine metabolic control; or, they may share the same target, but are regulated by different activators triggered in response to different environmental stimuli.

text: Time to Diagnosis and Persistence: The Two Major Determinants of Effective Tuberculosis Control The greatest challenge confronting effective tuberculosis (TB) eradication is the time to diagnosis, and duration of treatment of chronically infected individuals which represent a pool of infection. In an attempt to help limit the spread of TB in New Zealand, a fast SNP based diagnostic test was developed, to quickly identify the highly transmissible and virulent endemic Rangipo strain. The role of VapBC toxin-antitoxin systems in M. tuberculosis has been the subject of great interest recently, due to their expanded number in the genome and links with virulence and the regulation of cell growth in response to environmental stress. Their ability to regulate growth under adverse conditions for presumed survival advantages possibly leading to dormancy or persistence, make them ideal candidates for the development of new M. tuberculosis treatments. To establish differential expression of vapC, and therefore identify possible pathways and functions of the VapBC proteins, RT-qPCR was used to assess the expression levels of vapB and vapC in M. smegmatis under conditions of stress. No consistant changes in vapC mRNA levels were observed, resulting in the hypothesis that it is not the transcriptional differences which are important in the regulation of VapC, but post-transcriptional factors. In order to investigate the function(s) of M. tuberculosis VapBCs, these VapBC proteins were expressed and purified in M. smegmatis, and the VapC toxin tested for RNase activity. The purification, expression, RNase testing and bioinformatic analysis of M. tuberculosis VapCs suggested that VapCRv2530c, VapCRv0065 and VapCRv0617 may all target the same recognition sequence, UA*GG. Bioinformatic analysis revealed an abundance of this target sequence in horizontal gene transfer and TA genes, raising the possibility that VapC toxins could be functioning as selfish elements, or initiating transcriptional regulation cascades when a rapid change in the proteomic response and metabolic state of the cell is required. It is intriguing that the three M. tuberculosis VapC proteins tested thus far appear to target the same recognition sequence, possibly suggesting that all 47 VapCs are RNases and are targeting the same sequence. Alternatively; VapCs may belong to sub-groups targeting different sequences, allowing M. tuberculosis to exude both gross and fine metabolic control; or, they may share the same target, but are regulated by different activators triggered in response to different environmental stimuli.

year: 2015