Progressive ischaemic damage in animals is associated with spreading mass depolarizations of neurons and astrocytes, detected as spreading negative slow voltage variations. Speculation on whether spreading depolarizations occur in human ischaemic stroke has continued for the past 60 years. Therefore, we performed a prospective multicentre study assessing incidence and timing of spreading depolarizations and delayed ischaemic neurological deficit (DIND) in patients with major subarachnoid haemorrhage (SAH) requiring aneurysm surgery. Spreading depolarizations were recorded by electrocorticography with a subdural electrode strip placed on cerebral cortex for up to 10 days. A total of 2110 h recording time was analysed. The clinical state was monitored every 6 h. Delayed infarcts after SAH were verified by serial CT scans and/or MRI. Electrocorticography revealed 298 spreading depolarizations in 13 of the 18 patients (72%). A clinical DIND was observed in seven patients 7.8 days (7.3, 8.2) after SAH. DIND was time-locked to a sequence of recurrent spreading depolarizations in every single case (positive and negative predictive values: 86 and 100%, respectively). In four patients delayed infarcts developed in the recording area. As in the ischaemic penumbra of animals, delayed infarction was preceded by progressive prolongation of the electrocorticographic depression periods associated with spreading depolarizations to >60 min in each case. This study demonstrates that spreading depolarizations have a high incidence in major SAH and occur in ischaemic stroke. Repeated spreading depolarizations with prolonged depression periods are an early indicator of delayed ischaemic brain damage after SAH. In view of experimental evidence and the present clinical results, we suggest that spreading depolarizations with prolonged depressions are a promising target for treatment development in SAH and ischaemic stroke.

IMPORTANCE The mechanisms by which engagement with internet-delivered psychological interventions are associated with depression and anxiety symptoms are unclear. OBJECTIVE To identify behavior types based on how people engage with an internet-based cognitive behavioral therapy (iCBT) intervention for symptoms of depression and anxiety.

Design and digital technologies to support a sense of self and human relationships for people living with dementia are both urgently needed. We present an enquiry into design for dementia facilitated by a public art commission for an adult mental health unit in a hospital in the UK. The interactive art piece was informed by the notion of personhood in dementia that foregrounds the person's social being and interpersonal relationships as sites where self is maintained and constructed. How clients, clients' family members and staff used the piece is reported and insights related to the notions of home, intimacy, possessions and self are presented. The art piece served as window on both dementia and the institution leading to a number of insights and implications for design.

In this paper we continue work to investigate how we can engage young adults in behaviors of recycling and the prevention of food waste through social media and persuasive and ubiquitous computing systems. Our previous work with BinCam, a two-part design combining a system for the collection of waste-related behaviors with a Facebook application, suggested that although this ubiquitous system could raise awareness of recycling behavior, engagement with social media remained low. In this paper we reconsider our design in terms of engagement, examining both the theoretical and practical ways in which engagement can be designed for. This paper presents findings from a new user study exploring the redesign of the social media interface following this analysis. By incorporating elements of gamification, social support and improved data visualization, we contribute insights on the relative potential of these techniques to engage individuals across the lifespan of a system's deployment.

There are currently over 1.1 million Syrian refugees in need of healthcare services from an already overstretched Lebanese healthcare system. Access to antenatal care (ANC) services presents a particular challenge. We conducted focus groups with 59 refugees in rural Lebanon to identify contextual and cultural factors that can inform the design of digital technologies to support refugee ANC. Previously identified high utilization of smartphones by the refugee population offers a particular opportunity for using digital technology to support access to ANC as well as health advocacy. Our findings revealed a number of considerations that should be taken into account in the design of refugee ANC technologies, including: refugee health beliefs and experiences, literacy levels, refugee perceptions of negative attitudes of healthcare providers, and hierarchal and familial structures.