Younger adolescents’ perceptions of physical activity, exergaming, and virtual reality:qualitative intervention development study

Background. Novel strategies to promote physical activity (PA) in adolescence are required. The vEngage study aims to test whether a virtual reality (VR) exergaming intervention can engage younger adolescents (13-15 year old) with physical activity. Objective: This study aimed to gather adolescents’ views of using VR to encourage PA and identify the key features they would like to see in a VR exergaming intervention via interviews. Methods: Participants were recruited through two schools in London, UK. Semi-structured interviews were conducted with adolescents about their views on PA and what might work to increase PA, technology, knowledge and experience of VR, and desired features in a VR exergaming intervention. Data were analysed using Framework Analysis. Results: 31 13-15 year olds (58% female, 62% from non-white ethnicities) participated in this interview study. The vast majority had no awareness of government PA recommendations, but felt they should be more thoroughly informed. All participants were positive about the use of VR in PA promotion. Rewards, increasing challenges and a social/multiplayer aspect were identified by participants as crucial aspects to include in a VR exercise game. Barriers were related to cost of high-end systems. Being able to exercise at home was very appealing. VR exergaming was viewed as a way to overcome multiple perceived social and cultural barriers to PA, particularly for girls. Conclusions: Key elements that should be incorporated into a VR for health intervention were identified and described. These also included the use of rewards, novelty and enjoyment in immersive game play, multi-player options, real-world elements, as well as continual updates and new challenge levels. The use of VR to promote PA in adolescents is promising, but some barriers were raised

Prune belly syndrome – Case report and review of the literature

We describe a 2-year-old boy seen in Kenya who presented with fever, dysuria, foul smelling urine, anddiarrhea. His previous ultrasonography showed an overdistended bladder and hydronephrosis. Physicalexamination revealed a distended abdomen, loose abdominal wall muscles with thin, flabby, and wrinkledskin on the abdominal wall, hypoplastic scrotum, and bilateral cryptorchidism. A diagnosis of prune bellysyndrome was promptly made. The urinary tract infection was duly treated with intravenous ceftriaxoneand the child followed by pediatric urology

Discovery of the most luminous quasar of the last 9 Gyr

We report the discovery of a bright (g = 14.5 mag (AB), K = 11.9 mag (Vega)) quasar at redshift z = 0.83 -- the optically brightest (unbeamed) quasar at z > 0.4. SMSS J114447.77-430859.3, at a Galactic latitude of b = +18.1deg, was identified by its optical colours from the SkyMapper Southern Survey (SMSS) during a search for symbiotic binary stars. Optical and near-infrared spectroscopy reveals broad MgII, H-beta, H-alpha, and Pa-beta emission lines, from which we measure a black hole mass of log10(M_BH/M_Sun) = 9.4 +/- 0.5. With its high luminosity, L_bol = (4.7 +/- 1.0) * 10^47 erg/s or M_i(z=2) = -29.74 mag (AB), we estimate an Eddington ratio of ~1.4. As the most luminous quasar known over the last ~9 Gyr of cosmic history, having a luminosity 8 times greater than 3C 273, the source offers a range of potential follow-up opportunities.Comment: 13 pages. Accepted for publication in PAS

What do players of virtual reality exercise games want? A thematic analysis of online reviews of virtual reality exergames

Background: Physical activity (PA) is associated with a variety of physical and psychosocial health benefits, but levels of moderate-to-vigorous intensity PA remain low worldwide. Virtual reality (VR) gaming systems involving movement (VR exergames) could be used to engage people in more PA. Objective: This study aimed to synthesize public reviews of popular VR exergames to identify common features that players liked or disliked to inform future VR exergame design. Methods: We conducted a thematic analysis of 498 reviews of the 29 most popular exergames sold in the top 3 VR marketplaces: Steam (Valve Corporation), Viveport (Valve Corporation), and Oculus (Oculus VR). We categorized reviews as positive and negative as they appeared in the marketplaces and identified the most common themes using an inductive thematic analysis. Results: The reviews were often mixed, reporting a wide variety of expectations, preferences, and gaming experiences. Players preferred highly realistic games (eg, closely simulated real-world sport), games that were intuitive (in terms of body movement and controls), and games that provided gradual increases in skill acquisition. Players reported feeling that they reached a high level of exertion when playing and that the immersion distracted them from the intensity of the exercise. Some preferred features included music and social aspects of the games, with multiplayer options to include friends or receive help from experienced players. There were 3 main themes in negative reviews. The first concerned bugs that rendered games frustrating. Second, the quality of graphics had a particularly strong impact on perceived enjoyment. Finally, reviewers disliked when games had overly complex controls and display functions that evoked motion sickness. Conclusions: Exergames prove to be a stimulating avenue for players to engage in PA and distract themselves from the negative perceptions of performing exercise. The common negative aspects of VR exergames should be addressed for increased uptake and continued engagement

Developing a virtual reality exergame to engage adolescents in physical activity: description of the formative intervention development process

Background: Early adolescence (13-17 years) is a critical developmental stage for physical activity promotion. Virtual reality (VR) exergaming is a promising intervention strategy to engage adolescents in physical activity. Objective: The vEngage project aims to develop a physical activity intervention for adolescents using VR exergaming. Here, we describe the formative intervention development work and process of academic-industry collaboration. Methods: The formative development was guided by the Medical Research Council framework and included recruiting an adolescent user group to provide iterative feedback, a literature review, a quantitative survey of adolescents, qualitative interviews with adolescents and parents, inductive thematic analysis of public reviews of VR exergames, a quantitative survey and qualitative interviews with users of the augmented reality running app Zombies, Run!, and building and testing a prototype with our adolescent user group. Results: VR exergaming was appealing to adolescents and acceptable to parents. We identified behavior change techniques that users would engage with and features that should be incorporated into a VR exergame, including realistic body movements, accurate graphics, stepped levels of gameplay difficulty, new challenges, in-game rewards, multiplayer options, and the potential to link with real-world aspects such as physical activity trackers. We also identified some potential barriers to use, such as cost, perceived discomfort of VR headsets, and motion sickness concerns. A prototype game was developed and user-tested with generally positive feedback. Conclusions: This is the first attempt to develop a VR exergame designed to engage adolescents in physical activity that has been developed within a public health intervention development framework. Our formative work suggests that this is a very promising avenue. The benefit of the design process was the collaborative parallel work between academics and game designers and the involvement of the target population in the game (intervention) design from the outset. Developing the game within an intervention framework allowed us to consider factors, such as parental support, that would be important for future implementation. This study also serves as a call to action for potential collaborators who may wish to join this endeavor for future phases and an example of how academic-industry collaboration can be successful and beneficial

Principal component analysis-aided statistical process optimisation (PASPO) for process improvement in industrial refineries

Integrated refineries and industrial processing plant in the real-world always face management and design difficulties to keep the processing operation lean and green. These challenges highlight the essentiality to improving product quality and yield without compromising environmental aspects. For various process system engineering application, traditional optimisation methodologies (i.e., pure mix-integer non-linear programming) can yield very precise global optimum solutions. However, for plant-wide optimisation, the generated solutions by such methods highly rely on the accuracy of the constructed model and often require an enumerate amount of process changes to be implemented in the real world. This paper solves this issue by using a special formulation of correlation-based principal component analysis (PCA) and Design of Experiment (DoE) methodologies to serve as statistical process optimisation for industrial refineries. The contribution of this work is that it provides an efficient framework for plant-wide optimisation based on plant operational data while not compromising on environmental impacts. Fundamentally, PCA is used to prioritise statistically significant process variables based on their respective contribution scores. The variables with high contribution score are then optimised by the experiment-based optimisation methodology. By doing so, the number of experiments run for process optimisation and process changes can be reduced by efficient prioritisation. Process cycle assessment ensures that no negative environmental impact is caused by the optimisation result. As a proof of concept, this framework is implemented in a real oil re-refining plant. The overall product yield was improved by 55.25% while overall product quality improved by 20.6%. Global Warming Potential (GWP) and Acidification Potential (AP) improved by 90.89% and 3.42% respectively

Principal component analysis-aided statistical process optimisation (PASPO) for process improvement in industrial refineries

Integrated refineries and industrial processing plant in the real-world always face management and design difficulties to keep the processing operation lean and green. These challenges highlight the essentiality to improving product quality and yield without compromising environmental aspects. For various process system engineering application, traditional optimisation methodologies (i.e., pure mix-integer non-linear programming) can yield very precise global optimum solutions. However, for plant-wide optimisation, the generated solutions by such methods highly rely on the accuracy of the constructed model and often require an enumerate amount of process changes to be implemented in the real world. This paper solves this issue by using a special formulation of correlation-based principal component analysis (PCA) and Design of Experiment (DoE) methodologies to serve as statistical process optimisation for industrial refineries. The contribution of this work is that it provides an efficient framework for plant-wide optimisation based on plant operational data while not compromising on environmental impacts. Fundamentally, PCA is used to prioritise statistically significant process variables based on their respective contribution scores. The variables with high contribution score are then optimised by the experiment-based optimisation methodology. By doing so, the number of experiments run for process optimisation and process changes can be reduced by efficient prioritisation. Process cycle assessment ensures that no negative environmental impact is caused by the optimisation result. As a proof of concept, this framework is implemented in a real oil re-refining plant. The overall product yield was improved by 55.25% while overall product quality improved by 20.6%. Global Warming Potential (GWP) and Acidification Potential (AP) improved by 90.89% and 3.42% respectively

BRCA2 inhibition enhances cisplatin-mediated alterations in tumor cell proliferation, metabolism, and metastasis

Tumor cells have unstable genomes relative to non-tumor cells. Decreased DNA integrity resulting from tumor cell instability is important in generating favorable therapeutic indices, and intact DNA repair mediates resistance to therapy. Targeting DNA repair to promote the action of anti-cancer agents is therefore an attractive therapeutic strategy. BRCA2 is involved in homologous recombination repair. BRCA2 defects increase cancer risk but, paradoxically, cancer patients with BRCA2 mutations have better survival rates. We queried TCGA data and found that BRCA2 alterations led to increased survival in patients with ovarian and endometrial cancer. We developed a BRCA2-targeting second-generation antisense oligonucleotide (ASO), which sensitized human lung, ovarian, and breast cancer cells to cisplatin by as much as 60%. BRCA2 ASO treatment overcame acquired cisplatin resistance in head and neck cancer cells, but induced minimal cisplatin sensitivity in non-tumor cells. BRCA2 ASO plus cisplatin reduced respiration as an early event preceding cell death, concurrent with increased glucose uptake without a difference in glycolysis. BRCA2 ASO and cisplatin decreased metastatic frequency invivo by 77%. These results implicate BRCA2 as a regulator of metastatic frequency and cellular metabolic response following cisplatin treatment. BRCA2 ASO, in combination with cisplatin, is a potential therapeutic anti-cancer agent

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Guidelines from an expert panel for the management of diabetic macular edema in the Malaysian population

AIM: To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group's efforts for diagnosis, treatment, and best practices of diabetic macular edema (DME). The experts' panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula. The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load. METHODS: On two different occasions, a panel of 14 retinal specialists from Malaysia, together with an external expert, responded to a questionnaire on management of DME. A consensus was sought by voting after compiling, analyzing and discussion on first-phase replies on the round table discussion. A recommendation was deemed to have attained consensus when 12 out of the 14 panellists (85%) agreed with it. RESULTS: The terms target response, adequate response, nonresponse, and inadequate response were developed when the DME patients' treatment responses were first characterized. The panelists reached agreement on a number of DME treatment-related issues, including the need to classify patients prior to treatment, first-line treatment options, the right time to switch between treatment modalities, and side effects associated with steroids. From this agreement, recommendations were derived and a treatment algorithm was created. CONCLUSION: A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME