Investigating the use of digital health tools in physiotherapy: facilitators and barriers

Background: Digital tools are becoming more and more common in healthcare. Their potential to improve treatment, monitoring, and coaching in physiotherapy has been recognized. Yet studies report that the adoption of digital health tools in ambulatory physiotherapy is rather low and that their potential is underexploited. Objective: This paper aims to investigate how digital health tools in general, and the mobile health tool physitrackTM (hereafter the app) more particularly, are used in outpatient physiotherapy clinics and also to identify what facilitates or hinders the app’s use. Methods: The paper is part of a larger study and adopts an ethnographic approach. It is based on observational and interview data collected at two outpatient clinics. Results: We reveal how physiotherapists and patients use the app in physiotherapy and identify 16 interdependent factors, on the macro-, meso-, and micro-level, that either facilitate or hinder its use. Conclusions: We argue that a single factor’s facilitating or hindering impact cannot be grasped in isolation but needs to be investigated as one piece of a dynamic interplay. Further qualitative research is required, especially to shed more light on the app’s compatibility with physiotherapy practice and use in therapist-patient interactions

Computed tomographic study analysing functional biomechanics in the thoracolumbar spine of horses with and without spinal pathology

To better understand physiological and pathological movement patterns in the equine thoracolumbar spine, investigation of the biomechanics on a segmental level requires a constant moment. A constant moment along the spinal column means that the same torque acts on each vertebral segment, allowing the range of motion of different segments to be compared. The aims of this study were to investigate the range of motion of the equine thoracolumbar spine in horses with and without spinal pathology and to examine whether the pressure between the spinous processes depends on the direction of the applied moment. Thoracolumbar spine specimens (T8-L4) of 23 horses were mounted in a custom-made mechanical test rig to investigate spinal biomechanics during lateral bending, axial rotation, flexion and extension using computed tomographic imaging. Results were compared between horses with spondylosis, overriding spinous processes and specimens free of gross pathology. The interspinous space pressure was additionally determined using a foil sensor. The median lateral bending between T9 and L3 was 3.7°–4.1° (IQR 5.4°–8.0°). Maximum rotational movement with inconsistent coupled motion was observed at T9–T16 (p < 0.05). The dorsoventral range of motion was greatest in segments T9–T11 (p < 0.05). Spondylosis and overriding spinous processes restricted spinal mobility, depending on the severity of the condition. There was no significant difference in interspinous pressure during motion (p = 0.54). The biomechanical study confirmed that the range of motion of intervertebral joints depends on the anatomical position of the joint and the direction of the moment applied. Restricted mobility was evident in the presence of different grades of overriding spinous processes or spondylosis. A better understanding of equine spinal biomechanics in horses with spinal pathology facilitates individual rehabilitation

Digitalisierungsfortschritt föderaler Einheiten : ein Vergleich der Ausgestaltungen kantonaler ePlattformen in der Schweiz

Die Digitalisierung hält nicht nur in Wirtschaft und Gesellschaft Einzug, sondern auch im öffentlichen Sektor finden Digitalisierungsprozesse statt. Electronic Government (eGovernment) bezeichnet die Gesamtheit der elektronischen Dienstleistungen öffentlicher Verwaltungen. Mittels eGovernment sollen Prozesse sowohl optimiert als auch durchgeführt werden. In föderalen Staaten wie der Schweiz unterliegt die Implementierung technischer Systeme dem Subsidiaritätsprinzip. Es stellt sich deshalb die Frage, ob und worin sich der Digitalisierungsfortschritt von Kantonen unterscheidet. Ziel der Studie ist es, eine systematische Übersicht über Charakteristika verschiedener kantonaler ePlattform-Lösungen in der Schweiz zu erstellen. Gleichzeitig wird die Ausgestaltung von eGovernment-Lösungen mit Hilfe verschiedener Faktoren der technischen Umsetzung beurteilt. Mittels Dokumentenanalysen sowie einer Online-Befragung unter eGovernment-Verantwortlichen wurden Umfang und Ausgestaltung sämtlicher 26 kantonalen ePlattformen untersucht. Aus dem Modell zu Übernahmekategorien wurden Faktoren zur Ausgestaltung der technischen Umsetzung von eGovernment-Lösungen abgeleitet und auf den öffentlichen Sektor angewendet, um die eGovernment-Reife anhand der Ausprägungen der Kantone abzubilden. Das Modell der Übernahmekategorien unterteilt Systemmitglieder auf Basis ihrer Innovationsbereitschaft in fünf unterschiedliche Kategorien: Innovatoren, Frühe Übernehmer, Frühe Mehrheit, Späte Mehrheit und Nachzügler. Die Ergebnisse offenbaren einen heterogenen Innovationsgrad der Ausgestaltungen kantonaler ePlattformen. So entsprechen nur 4% der Kantone der Übernahmekategorie Innovatoren, wohingegen sich 23% der Kantone der Kategorie Nachzügler zuordnen lassen. Die Ergebnisse zur Beschaffenheit der Übernahmekategorien erlauben Schlussfolgerungen betreffend des Innovationsgrads verschiedener ePlattformen im schweizerischen Vergleich. Dadurch können die Ergebnisse dazu beitragen, dass sich die als Nachzügler identifizierten Kantone an den ePlattform Lösungen der Innovatoren als Vorbilder orientieren

A New Electronic Monitoring Device to Measure Medication Adherence: Usability of the Helping Hand™

The aim of this study was to test the user performance, satisfaction and acceptability of the Helping Hand™ (B&O Medicom) electronic medication adherence monitor. Using a mixed-method design, we studied 11 kidney transplant patients and 10 healthy volunteers during three weeks. Although testing showed positive usability aspects, several areas requiring technical improvement were identified: the most important obstacles to usability and acceptability were the weak sound signal, problems loading the medication, and the fact that only one medication could be used at a time

Optical Microscopy in the Nano-World

Scanning near-field optical microscopy (SNOM) is an optical microscopy whose resolution is not bound to the diffraction limit. It provides chemical information based upon spectral, polarization and/or fluorescence contrast images. Details as small as 20 nm can be recognized. Photophysical and photochemical effects can be studied with SNOM on a similar scale. This article reviews a good deal of the experimental and theoretical work on SNOM in Switzerland

Ligand Binding Study of Human PEBP1/RKIP: Interaction with Nucleotides and Raf-1 Peptides Evidenced by NMR and Mass Spectrometry

Background Human Phosphatidylethanolamine binding protein 1 (hPEBP1) also known as Raf kinase inhibitory protein (RKIP), affects various cellular processes, and is implicated in metastasis formation and Alzheimer's disease. Human PEBP1 has also been shown to inhibit the Raf/MEK/ERK pathway. Numerous reports concern various mammalian PEBP1 binding ligands. However, since PEBP1 proteins from many different species were investigated, drawing general conclusions regarding human PEBP1 binding properties is rather difficult. Moreover, the binding site of Raf-1 on hPEBP1 is still unknown. Methods/Findings In the present study, we investigated human PEBP1 by NMR to determine the binding site of four different ligands: GTP, FMN, and one Raf-1 peptide in tri-phosphorylated and non-phosphorylated forms. The study was carried out by NMR in near physiological conditions, allowing for the identification of the binding site and the determination of the affinity constants KD for different ligands. Native mass spectrometry was used as an alternative method for measuring KD values. Conclusions/Significance Our study demonstrates and/or confirms the binding of hPEBP1 to the four studied ligands. All of them bind to the same region centered on the conserved ligand-binding pocket of hPEBP1. Although the affinities for GTP and FMN decrease as pH, salt concentration and temperature increase from pH 6.5/NaCl 0 mM/20°C to pH 7.5/NaCl 100 mM/30°C, both ligands clearly do bind under conditions similar to what is found in cells regarding pH, salt concentration and temperature. In addition, our work confirms that residues in the vicinity of the pocket rather than those within the pocket seem to be required for interaction with Raf-1.METASU

RETRACTED ARTICLE: Age-dependent Increase in Desmosterol Restores DRM Formation and Membrane-related Functions in Cholesterol-free DHCR24−/− Mice

Cholesterol is a prominent modulator of the integrity and functional activity of physiological membranes and the most abundant sterol in the mammalian brain. DHCR24-knock-out mice lack cholesterol and accumulate desmosterol with age. Here we demonstrate that brain cholesterol deficiency in 3-week-old DHCR24−/− mice was associated with altered membrane composition including disrupted detergent-resistant membrane domain (DRM) structure. Furthermore, membrane-related functions differed extensively in the brains of these mice, resulting in lower plasmin activity, decreased β-secretase activity and diminished Aβ generation. Age-dependent accumulation and integration of desmosterol in brain membranes of 16-week-old DHCR24−/− mice led to the formation of desmosterol-containing DRMs and rescued the observed membrane-related functional deficits. Our data provide evidence that an alternate sterol, desmosterol, can facilitate processes that are normally cholesterol-dependent including formation of DRMs from mouse brain extracts, membrane receptor ligand binding and activation, and regulation of membrane protein proteolytic activity. These data indicate that desmosterol can replace cholesterol in membrane-related functions in the DHCR24−/− mouse

Minimal information for studies of extracellular vesicles 2018 (MISEV2018):a position statement of the International Society for Extracellular Vesicles and update of the MISEV2014 guidelines

The last decade has seen a sharp increase in the number of scientific publications describing physiological and pathological functions of extracellular vesicles (EVs), a collective term covering various subtypes of cell-released, membranous structures, called exosomes, microvesicles, microparticles, ectosomes, oncosomes, apoptotic bodies, and many other names. However, specific issues arise when working with these entities, whose size and amount often make them difficult to obtain as relatively pure preparations, and to characterize properly. The International Society for Extracellular Vesicles (ISEV) proposed Minimal Information for Studies of Extracellular Vesicles (“MISEV”) guidelines for the field in 2014. We now update these “MISEV2014” guidelines based on evolution of the collective knowledge in the last four years. An important point to consider is that ascribing a specific function to EVs in general, or to subtypes of EVs, requires reporting of specific information beyond mere description of function in a crude, potentially contaminated, and heterogeneous preparation. For example, claims that exosomes are endowed with exquisite and specific activities remain difficult to support experimentally, given our still limited knowledge of their specific molecular machineries of biogenesis and release, as compared with other biophysically similar EVs. The MISEV2018 guidelines include tables and outlines of suggested protocols and steps to follow to document specific EV-associated functional activities. Finally, a checklist is provided with summaries of key points

Rare coding variants in PLCG2, ABI3, and TREM2 implicate microglial-mediated innate immunity in Alzheimer's disease

We identified rare coding variants associated with Alzheimer’s disease (AD) in a 3-stage case-control study of 85,133 subjects. In stage 1, 34,174 samples were genotyped using a whole-exome microarray. In stage 2, we tested associated variants (P<1×10-4) in 35,962 independent samples using de novo genotyping and imputed genotypes. In stage 3, an additional 14,997 samples were used to test the most significant stage 2 associations (P<5×10-8) using imputed genotypes. We observed 3 novel genome-wide significant (GWS) AD associated non-synonymous variants; a protective variant in PLCG2 (rs72824905/p.P522R, P=5.38×10-10, OR=0.68, MAFcases=0.0059, MAFcontrols=0.0093), a risk variant in ABI3 (rs616338/p.S209F, P=4.56×10-10, OR=1.43, MAFcases=0.011, MAFcontrols=0.008), and a novel GWS variant in TREM2 (rs143332484/p.R62H, P=1.55×10-14, OR=1.67, MAFcases=0.0143, MAFcontrols=0.0089), a known AD susceptibility gene. These protein-coding changes are in genes highly expressed in microglia and highlight an immune-related protein-protein interaction network enriched for previously identified AD risk genes. These genetic findings provide additional evidence that the microglia-mediated innate immune response contributes directly to AD development