Monitoring Adherence to Asthma Inhalers Using the InspirerMundi App: Analysis of Real-World, Medium-Term Feasibility Studies

Background: Poor medication adherence is a major challenge in asthma and objective assessment of inhaler adherence is needed. InspirerMundi app aims to monitor inhaler adherence while turning it into a positive experience through gamification and social support. Objective: We assessed the medium-term feasibility of the InspirerMundi app to monitor inhaler adherence in real-world patients with persistent asthma (treated with daily inhaled medication). In addition, we attempted to identify the characteristics of the patients related to higher app use. Methods: Two real-world multicenter observational studies, with one initial face-to-face visit and a 4-month telephone interview, were conducted in 29 secondary care centers from Portugal. During an initial face-to-face visit, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients took a photo of the medication (inhaler, blister, or others) using the image-based medication detection tool. Medication adherence was calculated as the number of doses taken as a percentage of the number scheduled. Interacting with the app ≥30 days was used as the cut-off for higher app use. Results: A total of 114 patients {median 20 [percentile 25 to percentile 75 (P25-P75) 16-36] years, 62% adults} were invited, 107 (94%) installed the app and 83 (73%) completed the 4-month interview. Patients interacted with the app for a median of 18 [3-45] days, translated on a median use rate of 15 [3-38]%. Median inhaler adherence assessed through the app was 34 [4-73]% when considering all scheduled inhalations for the study period. Inhaler adherence assessed was not significantly correlated with self-reported estimates. Median adherence for oral and other medication was 41 [6-83]% and 43 [3-73]%, respectively. Patients with higher app use were slightly older (p = 0.012), more frequently taking medication for other health conditions (p = 0.040), and more frequently prescribed long-acting muscarinic antagonists (LAMA, p = 0.024). After 4 months, Control of Allergic Rhinitis and Asthma Test (CARAT) scores improved (p < 0.001), but no differences between patients interacting with the app for 30 days or less were seen. Conclusions: The InspirerMundi app was feasible to monitor inhaler adherence in patients with persistent asthma. The persistent use of this mHealth technology varies widely. A better understanding of characteristics related to higher app use is still needed before effectiveness studies are undertaken.info:eu-repo/semantics/publishedVersio

Bird-spiders (Arachnida, Mygalomorphae) as perceived by the inhabitants of the village of Pedra Branca, Bahia State, Brazil

This paper deals with the conceptions, knowledge and attitudes of the inhabitants of the county of Pedra Branca, Bahia State, on mygalomorph spiders locally known as 'caranguejeiras' (bird-spiders). It is launched here a new filed within ethnozoology: ethnoarachnology, which is defined as the transdisciplinary study of the relationships between human beings and bird-spiders. Data were collected from February to June 2005 by means of open-ended interviews carried out with 30 individuals, which ages ranged from 13 to 86 years old. It was recorded some traditional knowledge regarding the following items: taxonomy, biology, habitat, ecology, seasonality, and behavior. Results show that bird-spiders are classified as "insects". The most commented aspect of the interaction between bird-spiders and inhabitants of Pedra Branca is related to their dangerousness, since they said these spiders are very venomous and can cause health problems. In general, the traditional zoological knowledge of Pedra Branca's inhabitants concerning these spiders is coherent with the academic knowledge

A Customized Pigmentation SNP Array Identifies a Novel SNP Associated with Melanoma Predisposition in the SLC45A2 Gene

As the incidence of Malignant Melanoma (MM) reflects an interaction between skin colour and UV exposure, variations in genes implicated in pigmentation and tanning response to UV may be associated with susceptibility to MM. In this study, 363 SNPs in 65 gene regions belonging to the pigmentation pathway have been successfully genotyped using a SNP array. Five hundred and ninety MM cases and 507 controls were analyzed in a discovery phase I. Ten candidate SNPs based on a p-value threshold of 0.01 were identified. Two of them, rs35414 (SLC45A2) and rs2069398 (SILV/CKD2), were statistically significant after conservative Bonferroni correction. The best six SNPs were further tested in an independent Spanish series (624 MM cases and 789 controls). A novel SNP located on the SLC45A2 gene (rs35414) was found to be significantly associated with melanoma in both phase I and phase II (P<0.0001). None of the other five SNPs were replicated in this second phase of the study. However, three SNPs in TYR, SILV/CDK2 and ADAMTS20 genes (rs17793678, rs2069398 and rs1510521 respectively) had an overall p-value<0.05 when considering the whole DNA collection (1214 MM cases and 1296 controls). Both the SLC45A2 and the SILV/CDK2 variants behave as protective alleles, while the TYR and ADAMTS20 variants seem to function as risk alleles. Cumulative effects were detected when these four variants were considered together. Furthermore, individuals carrying two or more mutations in MC1R, a well-known low penetrance melanoma-predisposing gene, had a decreased MM risk if concurrently bearing the SLC45A2 protective variant. To our knowledge, this is the largest study on Spanish sporadic MM cases to date

Malignant melanoma arising from a perianal fistula and harbouring a BRAF gene mutation: a case report

<p>Abstract</p> <p>Background</p> <p>Melanoma of the anal region is a very uncommon disease, accounting for only 0.2-0.3% of all melanoma cases. Mutations of the <it>BRAF </it>gene are usually absent in melanomas occurring in this region as well as in other sun-protected regions. The development of a tumour in a longstanding perianal fistula is also extremely rare. More frequent is the case of a tumour presenting as a fistula, that is, the fistula being a consequence of the cancerous process, although we have found only two cases of fistula-generating melanomas reported in the literature.</p> <p>Case Presentation</p> <p>Here we report the case of a 38-year-old male who presented with a perianal fistula of four years of evolution. Histopathological examination of the fistulous tract confirmed the presence of malignant melanoma. Due to the small size and the central location of the melanoma inside the fistulous tract, we believe the melanoma reported here developed in the epithelium of the fistula once the latter was already formed. Resected sentinel lymph nodes were negative and the patient, after going through a wide local excision, remains disease-free nine years after diagnosis. DNA obtained from melanoma tissue was analysed by automated direct sequencing and the <it>V600E </it>(<it>T1799A</it>) mutation was detected in exon 15 of the <it>BRAF </it>gene.</p> <p>Conclusion</p> <p>Since fistulae experience persistent inflammation, the fact that this melanoma harbours a <it>BRAF </it>mutation strengthens the view that oxidative stress caused by inflammatory processes plays an important role in the genesis of <it>BRAF </it>gene mutations.</p

Modelling large-scale effects of estuarine and morphodynamic gradients on distribution and abundance of the sandy beach isopod Excirolana armata

7 páginas, 5 figuras, 1 tabla.Understanding the relationships between beach morphodynamics and macrofauna assemblages has been critical in theoretical evolution of sandybeach ecology. However, macroscale studies that consider the concurrent effects of large-scaleestuarine and morphodynamicgradients have been exceptional. The present study evaluates the combined effects of large-scale (>400 km) salinity and morphodynamics on the distribution of Excirolanaarmata. Along a salinity gradient (from 0.10 to 34.30) generated by the Río de la Plata estuary (SW Atlantic Ocean), sixteen Uruguayan sandybeaches were analyzed over a two-year period. A conditional two-step procedure using a General Additive Model (2-step GAM) was performed in order to model occurrence (1st-step) and abundance (2nd-step) of E. armata, in relation to salinity, grain size, sand moisture, compaction and organic matter of the sand, slope, beach and swash width, and water and sediment temperature. The 1st-step GAM retained 6 physical descriptors in the model (decreasing order): mean grain size, organic matter, salinity, beach width, sand moisture and water temperature. The 2nd-step GAM showed that mean grain size, salinity, sand moisture, beach width, sand compaction and organic matter were the most important explanatory variables (in decreasing order) of abundance. Mean grain size was the main predictor in both models, suggesting an important substrate specificity of E. armata towards smallest grain sizes. A meta-analysis concerning large-scale variation in abundance of E. armata in sandybeaches of the Rio Grande ecoregion (28°S–35°S) of the Warm-Temperate Southwestern Atlantic Province gave compelling evidence of this high-substrate specificity of the E. armata. Salinity was also a key factor shaping patterns in occurrence and abundance, which increased from low to intermediate/high salinities (>20), reinforcing the notion of E. armata as a marine species with relatively high tolerance to estuarine conditions. The potential role that internal brooding gives for protection of offspring to osmotic stress is discussed.JPL thanks AECID for the financial support (Mutis PhD Grant) and especially Cate for continuous encouragement. Financial support from CONICYT (project n° 1018 and 4034), PDT (project S/C/OP/07/49) and DINARA (UTF/URU/025/URU) is acknowledged.Peer reviewe

A methodological framework for multi-hazard risk assessment in beaches

Beach management has traditionally concentrated on recreational uses and geomorphologic processes, overlooking environmental values. Traditional risk analysis also overlooks environmental services focusing on socio-economic damages and only accounting for a part of the total risk. To overcome this situation, a systemic approach dealing with ecological and social dimensions is required. This paper proposes a risk analysis framework in which coastal hazards and beach ecosystem services are jointly considered. The first phase consists of the definition of the risk profile. This is done by building the beach Pathway of Effect, where links between coastal hazards and ecosystem services are identified following the DPSIR approach. The second phase, risk assessment, includes risk valuation and hazard prioritization, which will help managers to decide where to allocate resources to cope with hazards affecting beach functionality. The methodology was validated at S'Abanell beach (Spanish Mediterranean coast), which provides several ecosystem services and is subjected to a variety of hazards.12 páginasPeer reviewe

Effective Real-Time Wireless Control of an Autonomous Guided Vehicle

Abstract — Wireless communication systems used in industrial environments must guarantee that the information is sent and received within precise time-bounds. However the nature of the radio channels and the medium access control (MAC) generates random communication delays. For networked control systems, these delays can cause severe performance problems. This paper presents an autonomous guided vehicle (AGV) path tracking control system whose closed-loop consists on a vehicle connected over a wireless network to the controller. To mitigate the negative effects of delays, we propose a Kalman-based network delay estimator in the controller, that provides effective control performance. Our approach is compared to previously proposed statistical estimation algorithms by evaluating the vehicle’s travelling time and path deviation. I