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Designing for patients: Using a cultural probe in the development of a mobile health device and application for swallowing therapy in head and neck cancer patients

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... Initial development has been for, and with the input of, head and neck cancer (HNC) patients. 8,9 The hardware includes three surface electromyography sensors (sEMG), two active and one ground, that measure the activity of muscles under the chin (submental) during swallows and swallow-like exercises. This information is transmitted via Bluetooth to the smartphone app and presented as visual biofeedback to the user. ...
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The objective of this study was to conduct the first patient usability testing of a mobile health (mHealth) system for in-home swallowing therapy. Five participants with a history of head and neck cancer evaluated the mHealth system. After completing an in-application (app) tutorial with the clinician, participants were asked to independently complete five tasks: pair the device to the smartphone, place the device correctly, exercise, interpret progress displays, and close the system. Quantitative and qualitative methods were used to evaluate the effectiveness, efficiency, and satisfaction with the system. Critical changes to the app were found in three of the tasks, resulting in recommendations for the next iteration. These issues were related to ease of Bluetooth pairing, placement of device, and interpretation of statistics. Usability testing with patients identified issues that were essential to address prior to implementing the mHealth system in subsequent clinical trials. Of the usability methods used, video observation (synced screen capture with videoed gestures) revealed the most information.
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Background: Health care providers' perceptions regarding appropriateness in end-of-life treatments have been widely studied. While nurses and physicians believe that rationing and other cost-related practices sometimes occur in the intensive care unit (ICU), they allege that treatment is often excessive. Objective: To prospectively determine the incidence and causes of health care providers' perceptions regarding appropriateness of end-of-life treatments. Methods: The present prospective study collected data from patients admitted to the medical-surgical trauma ICU of a 30-bed, Canadian teaching hospital over a three-month period. Daily surveys were completed independently by bedside nurses, charge nurses and attending physician. Results: In total, 5224 of 6558 expected surveys (representing 294 patients) were analyzed, yielding a response rate of 79.7%. The incidence of perceived inappropriate care in the present study was 6.5% (19 of 294 patients), with ongoing treatment for >2 days after this determination occurring in 1% (three of 294 patients). However, at least one caregiver perceived inappropriate care at some point in 110 of 294 (37.5%) patients. In these cases, in which processes to address care were not already underway, respondents believed that important issues resulting in provision of inappropriate treatments included patient-family issues and communication before or in the ICU. Caregivers did not know their patients' wishes 22% (1129 of 5224) of the time. Conclusions: Although ongoing inappropriate care appeared to be a rare occurrence, the issue was a concern to at least one caregiver in one-third of cases. Public awareness for end-of-life issues, adequate communication, and up-to-date knowledge and practice in determining the wishes of critically ill patients are potential target areas to improve end-of-life care and reduce inappropriate care in the ICU. A daily, prospective survey of multidisciplinary caregivers, such as the survey used in the present study, is a viable and valuable means of determining the scope and causes of inappropriate care in the ICU.
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Assesses how the mainstream availability and acceptability of vegetarian food has impacted on the organised vegetarian movement in the UK. Presents data collected during an ethnographic case study to show the dilemmas facing the leading UK vegetarian organisation during the mid-1990s. In order to understand these dilemmas distinguishes between vegetarian food and the ideology of vegetarianism, using existing evidence about variability in diets, motives and organisational politics. When reflecting on the implications of the case study suggests that mainstream acceptance is a double-edged sword that facilitates the adoption of the diet but threatens the moral foundations of the ideology.
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Introduction: Age-associated cognitive decline-or normal (non-pathological, normative, usual) cognitive ageing-is an important human experience which differs in extent between individuals. The determinants of the differences in age-related cognitive decline are not fully understood. Progress in the field is taking place across many areas of biomedical and psychosocial sciences. Areas of agreement and controversy: The phenotype of normal cognitive ageing is well described. Some mental capabilities are well maintained into old age. From early adulthood, there are declines in mental domains such as processing speed, reasoning, memory and executive functions, some of which is underpinned by a decline in a general cognitive factor. There are contributions to understanding individual differences in normal cognitive ageing from genetics, general health and medical disorders such as atherosclerotic disease, biological processes such as inflammation, neurobiological changes, diet and lifestyle. Many of these effect sizes are small; some are poorly replicated; and in some cases, there is the possibility of reverse causation, with prior cognitive ability causing the supposed 'cause' of cognitive ability in old age. Emerging areas for developing research: Genome-wide scans are a likely source to establish genetic contributions. The role of vascular factors in cognitive ageing is increasingly studied and understood. The same applies to diet, biomarkers such as inflammation and lifestyle factors such as exercise. There are marked advances in brain imaging, affording better in vivo studies of brain correlates of cognitive changes. There is growing appreciation that factors affecting general bodily ageing also influence cognitive functions in old age.
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Creative expression (CE) programs are emerging interventions to improve the quality of care and life of persons with dementia (PWDs) in long-term care settings. However, limited empirical evidence exists to support the effectiveness of these programs. Here, we report the findings from an assessment of the impact of TimeSlips (TS), a group storytelling program that encourages CE among PWDs and those who care for them. Instruction in TS was provided through a 10-week on-site training. An observational study using an experimental design was conducted in 20 nursing home facilities in 2 states, 10 of which were randomly selected to implement TS. Two weeks after the implementation of TS at the intervention sites, we conducted 4 days of direct observation, using a time-sampling approach, of residents and staff in each facility. Using surveys, we also assessed staff job satisfaction, attitudes toward residents, and burnout. Compared with residents in the control facilities, those in the TS facilities were more engaged and more alert. In TS facilities, there were more frequent staff-resident interactions, social interactions, and social engagement. Also, staff who participated in the TS program had more positive views of residents with dementia and devalued residents less than did the control group staff. There were no differences in staff job satisfaction and burnout among staff in the TS and non-TS facilities. Implementing the TS program in nursing facilities improves the care environment for PWDs. However, additional studies are needed to offer further insights into the mechanisms by which TS improves both staff and resident outcomes.
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General lifestyle activities were examined as a predictor of current cognition and cognitive change over a 6-year interval in older adults. Participants were drawn from a population-based longitudinal study, and they completed the Adelaide Activities Profile and a battery of tests measuring cognition and sensory functioning. Hierarchical regression analyses revealed that, after sensory functioning was controlled for, activity was a significant predictor of current levels of speed, picture naming, incidental recall, and verbal fluency, and of cognitive change in speed, picture naming, and incidental recall. Commonality analyses demonstrated that activity accounted for a notable amount of the total variance in cognition, and that there was prominent overlap in shared variance between activity and age, and between sensory functioning and age. These findings suggest that engaging in general lifestyle activities may help to promote successful cognitive aging.
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To explore the relationship between cognitive functioning and time spent at different intensities of physical activity (PA) in free-living older adults. Cross sectional analyses. Continuing care retirement communities. Older adults residing in seven continuing care retirement communities in San Diego County with an average age of 83; 70% were female, and 35% had a graduate-level education (N = 217). PA was measured objectively using hip worn accelerometers with data aggregated to the minute level. Three cut points were used to assess low light-intensity PA (LLPA), high light-intensity PA (HLPA), and moderate- to vigorous-intensity PA (MVPA). The Trail Making Test (TMT) Parts A and B were completed, and time for each test (seconds) and time for Part B minus time for Part A (seconds) were used as measures of cognitive function. Variables were log-transformed and entered into linear regression models adjusting for demographic factors (age, education, sex) and other PA intensity variables. LLPA was not related to any TMT test score. HLPA was significantly related to TMT A, B, and B minus A but only in unadjusted models. MVPA was related to TMT B and B minus A after adjusting for demographic variables. There may be a dose response between PA intensity and cognitive functioning in older adults. The stronger findings supporting a relationship between MVPA and cognitive functioning are consistent with previous observational and intervention studies.
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Continued advances in surgical techniques and immunosuppressive therapy have allowed liver transplantation to become an extremely successful treatment option for patients with end-stage liver disease. Beginning with the revolutionary discovery of cyclosporine in the 1970s, immunosuppressive regimens have evolved greatly and current statistics confirm one-year graft survival rates in excess of 80%. Immunosuppressive regimens include calcineurin inhibitors, anti-metabolites, mTOR inhibitors, steroids and antibody-based therapies. These agents target different sites in the T cell activation cascade, usually by inhibiting T cell activation or via T cell depletion. They are used as induction therapy in the immediate peri- and post-operative period, as long-term maintenance medications to preserve graft function and as salvage therapy for acute rejection in liver transplant recipients. This review will focus on existing immunosuppressive agents for liver transplantation and consider newer medications on the horizon.
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Article
"Donna Maurer's Vegetarianism: Movement or Moment? is the best resource on vegetarianism I have ever read. This book is not only filled with information; it is as readable as a best-selling novel. I was drawn into the book from start to finish and I loved reading every page." —Howard F. Lyman, author of Mad Cowboy Vegetarianism seems to be increasing in popularity and acceptance in the United States and Canada, yet, quite surprisingly, the percentage of the population practicing vegetarian diets has not changed dramatically over the past 30 years. People typically view vegetarianism as a personal habit or food choice, even though organizations in North America have been promoting vegetarianism as a movement since the 1850s. This book examines the organizational aspects of vegetarianism and tries to explain why the predominant movement strategies have not successfully attracted more people to adopt a vegetarian identity. Vegetarianism: Movement or Moment? is the first book to consider the movement on a broad scale from a social science perspective. While this book takes into account the unique history of North American vegetarianism and the various reasons why people adopt vegetarian diets, it focuses on how movement leaders' beliefs regarding the dynamics of social change contributes to the selection of particular strategies for attracting people to vegetarianism. In the context of this focus, this book highlights several controversies about vegetarianism that have emerged in nutrition and popular media over the past 30 years. "Donna Maurer offers a great service by taking us inside the modern vegetarian movement. She does a very fine job of explaining why people do and do not stop eating meat. [It] will serve as the basic guide to American vegetarianism for many years to come." —Warren Belasco, author of Appetite for Change: How the Counterculture Took on the Food Industry "All new vegetarian advocates should read Dr. Maurer's book. It will give them an understanding of the issues. It shows both where the movement has come from and the outreach methods it has attempted. If someone were to read Vegetarianism early in their advocacy, it would quickly advance their thought on the subject, saving them years of discovering things on their own." —Jack Norris, R.D., President, Vegan Outreach "As both a careful sociologist and a committed vegan, Donna Maurer brings fresh insight into the multi-dimensional character of vegetarianism in the United States: its values, assumptions, and practices." —Amy Bently, Department of Nutrition and Food Studies, New York University
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Cutaneous signs and symptoms in subareolar abscesses of the breast or lactiferous fistula (Zuska's disease, ZD) are common and frequent, but generally dermatologist ignore this clinical entity. An epithelial squamous metaplasia causes plugging and obstruction of the ducts is a pathogenetic event. Subsequent inflammatory reaction and infection produce local and general symptoms. Nipple retraction, recurrent episodes of erysipela and presence of painful nodules under the areola in a non-lactating woman are suspect. The presence of a milky draining sinus in the areola is characteristic. The diagnostic challenge is to differentiate these benign condition from a breast cancer. Treatment with antibiotics in the acute and chronic phase is mandatory, surgical removal of abscess and duct is sometimes resolutive. The authors describe a case of ZD in a pathologically obese woman treated with a long term penicillin schedule with no favorable effects.
Article
Inflammatory bowel disease (IBD) is a T cell driven inflammatory condition of the gut. Following solid organ transplantation (SOT), de novo IBD has been reported despite anti-T cell therapy for the prevention of organ rejection. This paradox is illustrated with a case report, highlighting the difficult diagnostic criteria, the potential role of Damage or Pathogen Associated Molecular Pattern Molecules [DAMPs and PAMPs] that drives aspects of ongoing inflammation within the transplanted organ as well as the intestine, and the therapeutic strategies applied. Recurrent IBD is more common than de novo IBD following transplantation, with cumulative risks ten years after orthotopic liver transplantation of 70% and 30%, respectively. Furthermore, the annual incidence of de novo IBD following solid organ transplantation has been estimated to be 206 cases/100,000 or ten times the expected incidence of IBD in the general population (approximately 20 cases/100,000). The association of IBD with other autoimmune conditions such as primary sclerosing cholangitis and autoimmune hepatitis, both common indications for liver transplantation, may play a contributory role, particularly in view of the observation that IBD is more common following liver transplant than other solid organ transplants. Recurrent IBD following transplant appears to run a more aggressive course than de novo IBD, with a higher proportion requiring colectomy for medically refractory disease. Risk factors that have been associated with development of post-transplant IBD include acute CMV infection and the use of tacrolimus.
Article
1. Evidence that vegetarian dietary patterns lower blood pressure (BP) comes from both population studies and randomized controlled trials in normotensive and hypertensive subjects. 2. The effect has been shown most clearly in those who keep to a strict lacto-ovo vegetarian diet characterized by a relatively low intake of saturated fat, a high polyunsaturated/saturated fat ratio, and a high intake of fruit, vegetables and other fibre containing products. Randomized controlled dietary trials suggest the effects are independent of dietary sodium, additive to that of calorie restriction, and not due to the absence of meat protein per se. Indeed, recent population studies suggest an inverse relationship between dietary protein and BP. 4. Dietary fats, fibre, potassium, magnesium and calcium do not independently seem to account for the effects. A possible role for complex carbohydrate in conjunction with the other dietary factors has yet to be fully explored.
Article
Lactiferous fistula, or Zuska's disease, is a rare recurrent condition characterized by draining abscesses about the nipple on one or both breasts. Because little is known about the disease, it is often misdiagnosed and inappropriately treated. We reviewed the medical records of 51 women diagnosed as having lactiferous fistula at The Cleveland Clinic Foundation between 1961 and 1991. The clinical features were tabulated. An experienced breast pathologist reviewed the specimens of all the patients, and surgical techniques were compared. Patients ranged in age from 14 to 66 years, with a mean age of 40 years. Thirty-six patients had a swelling or mass at the areola, 51 had a draining fistula from the subareolar tissue, 40 had a chronic thick, pasty discharge from the nipple and 35 reported pain with the discharge. Fourteen patients had unsuccessful operations elsewhere, including four women who had subcutaneous mastectomies before coming to us. The average duration of symptoms was 3.2 years and the average follow-up period postoperatively was 51 months. On histologic examination, we found that, in all instances, keratinizing squamous epithelium had replaced the lining of one or more lactiferous ducts for a variable distance into the subareolar tissue. Core excision of the fistula and all of the retroareolar fibroglandular tissue and the ductal tissue within the nipple proved to be the definitive therapy in 47 of the 48 patients who had follow-up evaluation.
Article
New evidence indicates that neural activity regulates the expression of trophic factors in the brain but regulation of these molecules by select aspects of behaviour remains solely a fascinating possibility. We report that following training in the Morris water maze, a spatial memory task, the hippocampus and cerebellum of learning rats exhibited an increase in basic fibroblast growth factor messenger RNA. Basic fibroblast growth factor messenger RNA levels were higher during the learning of the task and decreased once asymptotic performance was reached, suggesting an involvement of basic fibroblast growth factor in learning/memory. An active control group, which exercised for the same time as the learning group but the spatial learning component of the task was minimized, exhibited a minor increase in basic fibroblast growth factor messenger RNA. The intensification of the physical activity component of the task by massed or intensive training resulted in greater increases in basic fibroblast growth factor messenger RNA for both learning and yoked groups, but levels of basic fibroblast growth factor messenger RNA in the learning group remained higher than yoked only in the cerebellum. Changes in basic fibroblast growth factor were accompanied by an increase in astrocyte density in the hippocampus in agreement with described roles of basic fibroblast growth factor in astrocyte proliferation/reactivity. Results suggest that learning potentiates the effects of physical activity on trophic factor induction in select brain regions. Trophic factor involvement in behaviour may provide a molecular basis for the enhanced cognitive function associated with active lifestyles, and guide development of strategies to improve rehabilitation and successful ageing.
Article
Brain-derived neurotrophic factor (BDNF) promotes neuron survival, enhances sprouting, protects neurons against insult, and may be involved in several aspects of learning and memory. In this study, rats trained to locate a submerged platform in a water maze had elevated levels of BDNF messenger ribonucleic acid (mRNA) in the hippocampus (p < .05), a structure associated with spatial memory. BDNF mRNA expression increased after 3 and 6 days but not after 1 day of training in the water maze. A yoked control group that swam without the platform present, to control for physical activity, showed a trend for elevated BDNF mRNA at an intermediate level between the learning and sedentary groups. Other cortical and subcortical areas did not show a significant increase in BDNF mRNA after learning or activity (p > .05). These findings suggest that learning can impact BDNF mRNA expression localized to the brain areas involved in the processing of spatial information. Furthermore, behaviors such as physical activity and learning may help maintain and protect neurons at risk in aging and neurodegenerative disease via increased BDNF expression.
Article
The search for truth and its unbiased reporting are ultimate goals of conducting scientific research. Ideally, the reporting of research data ought to be an objective task. In practice, however, it is fraught with numerous statistical and ethical pitfalls, seldom addressed in formal emergency medicine training. The lure of academic celebrity and related influences may persuade researchers to report results in ways that make data appear more interesting, or worthy of publication. Several examples of potentially misleading data reporting are illustrated, including using inappropriate statistical tests, neglecting negative results, omitting missing data points, failing to report actual numbers of eligible subjects, using inappropriate graph labels or terminology, data dredging, and others. Although potentially inaccurate or inflated methods of data reporting may not constitute overt scientific misconduct, the intentional misrepresentation of data is a form of fraud or deception. Publicly funded academic inquiry is a privilege and honor enjoyed by a trusted few. Regardless of outcome, every effort should be made to report data in the most scientifically accurate method. To this end, the Society for Academic Emergency Medicine Code of Conduct and American College of Emergency Physicians Code of Ethics provide important guidance toward the accurate, compassionate, competent, impartial, and honest conduct of scientific research. Accuracy and authenticity in data reporting are first and foremost a matter of individual integrity, and are crucial to the preservation of academic credibility, the protection of future patients, and the public's trust in the medical research enterprise.
Article
Physical activity has shown to be inversely associated with cognitive decline in older people. Whether this association is already present in early life has not been investigated previously. The association between early life physical activity and cognition was studied in 1,241 subjects aged 62-85 years, in a prospective population-based study. Physical activity between ages 15 and 25 years was asked retrospectively. The findings suggest a positive association between regular physical activity early in life and level of information processing speed at older age in men, not in women. The association could not be explained by current physical activity or other lifestyle factors. This finding supports the cognitive reserve hypothesis, and might suggest that early life physical activity may delay late-life cognitive deficits.
Article
The aim was to investigate socio-demographic characteristics, and attitudes to food and health of vegetarians, non-vegetarian consumers of meat substitutes, and meat consumers in The Netherlands. The sample used for this study (participants > or =18 years) was taken from the Dutch National Food Consumption Survey, 1997/1998. Vegetarians (n = 63) and consumers of meat substitutes (n = 39) had similar socio-demographic profiles: higher education levels, higher social economic status, smaller households, and more urbanised residential areas, compared to meat consumers (n = 4313). Attitudes to food were assessed by the food-related lifestyle instrument. We found that vegetarians (n = 32) had more positive attitudes towards importance of product information, speciality shops, health, novelty, ecological products, social event, and social relationships than meat consumers (n = 1638). The health consciousness scale, which was used to assess attitudes to health, supported earlier findings that vegetarians are more occupied by health. Food-related lifestyle and health attitudes of meat substitute consumers (n = 17) were predominantly in-between those from vegetarians and meat consumers. The outcome of this study suggests that in strategies to promote meat substitutes for non-vegetarian consumers, the focus should not only be on health and ecological aspects of foods.
Article
Growing evidence suggests that physical exercise may be protective against cognitive impairment and decline. A prospective study of a representative rural community sample (N = 1,146) aged 65+ years examined self-reported exercise habits and measured global cognitive function using the Mini-Mental State Examination (MMSE). A composite variable "exercise level" combining type, frequency, and duration of exercise was created with three levels: "high exercise" (aerobic exercise of > or = 30 minute duration > or = 3 times a week), "low exercise" (all other exercise groups), and "no exercise." Cognitive decline was defined as being in the 90 percentile of decline in this cohort, ie, declining by 3 or more MMSE points during the 2-year interval between two assessments. In a multiple regression model, high exercise level at the baseline assessment was negatively associated with, ie, was protective against, being in the group with the greatest amount of decline at the follow-up assessment, after adjusting for likely confounders (odds ratio = 0.39; 95% confidence interval, 0.19, 0.78). When high exercise was redefined using frequency as > or = 5 days per week as the threshold, as per the Surgeon General's guidelines, both low exercise and high exercise were negatively associated with cognitive decline. Exercise may have implications for prevention of cognitive decline.
Article
A pre-post test follow-up design was used to test the effects of a systematically developed photo-novella (Laduma) on knowledge, attitudes, communication and behavioural intentions with respect to sexually transmitted infections, after a single reading by 1168 secondary school learners in South Africa. The reading resulted in an increase in knowledge on the spread of sexually transmitted infections (STIs), change in attitude to condom use and towards people with STIs and/or HIV/AIDS, as well as increased intention to practice safe sex. Laduma did not influence communication about sexually transmitted infections and reported sexual behaviour and condom use. While print media proved to be an effective strategy to reach large numbers of youth and prepare them for adequate preventive behaviours, the study also identified the need to combine print media with other planned theory-based interventions that build confidence and skills to initiate the preventive behaviour.
Article
Health promotion efforts directed at Latinos may be more effective when culturally adapted methods are used. Our study was designed to test a novel communication modality for promoting colorectal cancer (CRC) prevention and screening messages among Latinos. We compared a culturally aligned, brief storytelling educational intervention (ST) to a numeric risk tool intervention (NR) based on the Harvard Cancer Risk Index. Both interventions included risk factor information and recommendations for primary prevention and screening for CRC. Sixty-four Latinos (mean age 46.8, 86% female) were randomized and completed pre- and post-tests. Participants in ST indicated intent to add significantly more servings of vegetables (p=.030) and more minutes of exercise (p=.018) to daily routines than those in NR. Most respondents (ST and NR) reported intentions to recommend CRC screening to friends and relatives. These data provide support for storytelling's potential to promote health behavior change with cultural relevance for Latinos. Storytelling shows promise as an effective method for reaching one of the historically underserved ethnic groups with cancer prevention and screening information.
Article
In science, the data are supposed to speak for themselves. However, investigators have great latitude in how they report their results in the medical literature, even in an era of research protocols, pre-specified endpoints, reporting guidelines, and rigorous peer review. Authors' personal agendas, such as financial, personal, and intellectual conflicts of interest, can and sometimes do color how research results are described. Articles in peer-reviewed medical journals are the evidence base not only for the care of patients but also for legal decisions and the scientific record may be tailored for legal reasons as well. Journal editors preside over where and how the results of scientific research are published. We therefore suggest some actions that editors can take to foster a more trustworthy evidence base both for the care of patients and for legal decisions.
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