A hybrid evaluation approach and guidance for mHealth education applications

© Springer International Publishing AG 2018. Mobile health education applications (MHEAs) are used to support different users. However, although these applications are increasing in number, there is no effective evaluation framework to measure their usability and thus save effort and time for their many user groups. This paper outlines a useful framework for evaluating MHEAs, together with particular evaluation metrics: an efficient hybrid of selected heuristic evaluation (HE) and usability evaluation (UE) factors to enable the determination of the usefulness and usability of MHEAs. We also propose a guidance tool to help stakeholders choose the most suitable MHEA. The outcome of this framework is envisioned as meeting the requirements of different users, in addition to enhancing the development of MHEAs using software engineering approaches by creating new and more effective evaluation techniques. Finally, we present qualitative and quantitative results for the framework when used with MHEAs

Vitamin D in women with class II/III obesity: Findings from the DieTBra trial

Objective: To assess the prevalence of vitamin D deficiency and factors associated with serum vitamin D levels in adult women with class II/III obesity. Methods: We analysed baseline data from 128 adult women with class II/III obesity i.e. BMI ≥35 kg/m2 who participated in the DieTBra clinical trial. Sociodemographic, lifestyle, sun exposure, sunscreen, dietary intake of calcium and vitamin D, menopause, diseases, medication, and body composition data were analysed using multiple linear regression. Results: 128 women had mean BMI 45.53 ± 6.36, mean age 39.7 ± 8.75 kg/m2 and serum vitamin D 30.02 ng/ml ± 9.80. Vitamin D deficiency was 14.01%. There was no association between serum vitamin D levels and BMI, body fat percentage, total body fat and waist circumference. Age group (p = 0.004), sun exposure/day (p = 0.072), use of sunscreen (p = 0.168), inadequate calcium intake (p = 0.030), BMI (p = 0.192), menopause (p = 0.029) and lipid-lowering drugs (p = 0.150) were included in the multiple linear regression. The following remained associated with low serum vitamin D: being 40–49 years (p = 0.003); ≥50 years of age (p = 0.020) and inadequate calcium intake (p = 0.027). Conclusion: The prevalence of vitamin D deficiency was lower than expected. Lifestyle, sun exposure and body composition were not associated. Age over 40 years and inadequate calcium intake were significantly associated with low serum vitamin D levels

Phosphorylated c-Src in the nucleus is associated with improved patient outcome in ER-positive breast cancer

Elevated c-Src protein expression has been shown in breast cancer and <i>in vitro</i> evidence suggests a role in endocrine resistance. To investigate whether c-Src is involved in endocrine resistance, we examined the expression of both total and activated c-Src in human breast cancer specimens from a cohort of oestrogen receptor (ER)-positive tamoxifen-treated breast cancer patients. Tissue microarray technology was employed to analyse 262 tumour specimens taken before tamoxifen treatment. Immunohistochemistry using total c-Src and activated c-Src antibodies was performed. Kaplan–Meier survival curves were constructed and log-rank test were performed. High level of nuclear activated Src was significantly associated with improved overall survival (<i>P</i>=0.047) and lower recurrence rates on tamoxifen (<i>P</i>=0.02). Improved patient outcome was only seen with activated Src in the nucleus. Nuclear activated Src expression was significantly associated with node-negative disease and a lower NPI (<i>P</i><0.05). On subgroup analysis, only ER-positive/progesterone receptor (PgR)-positive tumours were associated with improved survival (<i>P</i>=0.004). This shows that c-Src activity is increased in breast cancer and that activated Src within the nucleus of ER-positive tumours predicts an improved outcome. In ER/PgR-positive disease, activated Src kinase does not appear to be involved in <i>de novo</i> endocrine resistance. Further study is required in ER-negative breast cancer as this may represent a cohort in which it is associated with poor outcome

Diffusion-weighted magnetic resonance imaging to detect synchronous uterine endometrial and endocervical adenocarcinoma

Synchronous endometrial and cervical cancer is a very rare condition. This report describes a case of a 46-year-old woman who presented with a cervical mass that measured 5.6 cm along its longest diameter, whose biopsy analysis revealed an endocervical mucinous adenocarcinoma. She was classified as having an IB2 cervical carcinoma and treated with concurrent chemoradiation plus hysterectomy. Pathological and immunohistochemical analysis of the surgical specimens revealed a synchronous endometrioid grade 2 adenocarcinoma in the endometrium, and a well-differentiated mucinous adenocarcinoma in the cervix. Magnetic resonance imaging (MRI) studies performed prior to treatment were reviewed and apparent diffusion coefficient (ADC) maps were generated. The ADC values demonstrated distinct signal intensity differences between the endometrial and endocervical tumors. In conclusion, diffusion-weighted MRI and ADC maps can help to distinguish the site of origin of synchronous tumors

Monocytes regulate the mechanism of T-cell death by inducing Fas-mediated apoptosis during bacterial infection.

Monocytes and T-cells are critical to the host response to acute bacterial infection but monocytes are primarily viewed as amplifying the inflammatory signal. The mechanisms of cell death regulating T-cell numbers at sites of infection are incompletely characterized. T-cell death in cultures of peripheral blood mononuclear cells (PBMC) showed 'classic' features of apoptosis following exposure to pneumococci. Conversely, purified CD3(+) T-cells cultured with pneumococci demonstrated necrosis with membrane permeabilization. The death of purified CD3(+) T-cells was not inhibited by necrostatin, but required the bacterial toxin pneumolysin. Apoptosis of CD3(+) T-cells in PBMC cultures required 'classical' CD14(+) monocytes, which enhanced T-cell activation. CD3(+) T-cell death was enhanced in HIV-seropositive individuals. Monocyte-mediated CD3(+) T-cell apoptotic death was Fas-dependent both in vitro and in vivo. In the early stages of the T-cell dependent host response to pneumococci reduced Fas ligand mediated T-cell apoptosis was associated with decreased bacterial clearance in the lung and increased bacteremia. In summary monocytes converted pathogen-associated necrosis into Fas-dependent apoptosis and regulated levels of activated T-cells at sites of acute bacterial infection. These changes were associated with enhanced bacterial clearance in the lung and reduced levels of invasive pneumococcal disease

Immune-Complex Mimics as a Molecular Platform for Adjuvant-Free Vaccine Delivery

Protein-based vaccine development faces the difficult challenge of finding robust yet non-toxic adjuvants suitable for humans. Here, using a molecular engineering approach, we have developed a molecular platform for generating self-adjuvanting immunogens that do not depend on exogenous adjuvants for induction of immune responses. These are based on the concept of Immune Complex Mimics (ICM), structures that are formed between an oligomeric antigen and a monoclonal antibody (mAb) to that antigen. In this way, the roles of antigens and antibodies within the structure of immune complexes are reversed, so that a single monoclonal antibody, rather than polyclonal sera or expensive mAb cocktails can be used. We tested this approach in the context of Mycobacterium tuberculosis (MTB) infection by linking the highly immunogenic and potentially protective Ag85B with the oligomeric Acr (alpha crystallin, HspX) antigen. When combined with an anti-Acr monoclonal antibody, the fusion protein formed ICM which bound to C1q component of the complement system and were readily taken up by antigen-presenting cells in vitro. ICM induced a strong Th1/Th2 mixed type antibody response, which was comparable to cholera toxin adjuvanted antigen, but only moderate levels of T cell proliferation and IFN-γ secretion. Unfortunately, the systemic administration of ICM did not confer statistically significant protection against intranasal MTB challenge, although a small BCG-boosting effect was observed. We conclude that ICM are capable of inducing strong humoral responses to incorporated antigens and may be a suitable vaccination approach for pathogens other than MTB, where antibody-based immunity may play a more protective role

An Unprecedented Role Reversal: Ground Beetle Larvae (Coleoptera: Carabidae) Lure Amphibians and Prey upon Them

Amphibians often feed on beetle larvae, including those of ground beetles (Carabidae). Preliminary reports have detailed an unusual trophic interaction in which, in contrast, larvae of the ground beetle Epomis prey upon juvenile and adult amphibians. While it is known that these larvae feed exclusively on amphibians, how the predator-prey encounter occurs to the advantage of the beetle larvae had been unknown to date. Using laboratory observations and controlled experiments, we recorded the feeding behavior of Epomis larvae, as well as the behavior of their amphibian prey. Here we reveal that larvae of two species of Epomis (E. circumscriptus and E. dejeani) lure their potential predator, taking advantage of the amphibian's predation behavior. The Epomis larva combines a sit-and-wait strategy with unique movements of its antennae and mandibles to draw the attention of the amphibian to the presence of a potential prey. The intensity of this enticement increases with decreasing distance between the larva and the amphibian. When the amphibian attacks, the larva almost always manages to avoid the predator's protracted tongue, exploiting the opportunity to attach itself to the amphibian's body and initiate feeding. Our findings suggest that the trophic interaction between Epomis larvae and amphibians is one of the only natural cases of obligatory predator-prey role reversal. Moreover, this interaction involves a small insect larva that successfully lures and preys on a larger vertebrate. Such role reversal is exceptional in the animal world, extending our perspective of co-evolution in the arms race between predator and prey, and suggesting that counterattack defense behavior has evolved into predator-prey role reversal

Studies of micronuclei and other nuclear abnormalities in red blood cells of Colossoma macropomum exposed to methylmercury

The frequencies of micronuclei (MN) and morphological nuclear abnormalities (NA) in erythrocytes in the peripheral blood of tambaqui (Colossoma macropomum), treated with 2 mg.L−1 methylmercury (MeHg), were analyzed. Two groups (nine specimens in each) were exposed to MeHg for different periods (group A - 24 h; group B - 120 h). A third group served as negative control (group C, untreated; n = 9). Although, when compared to the control group there were no significant differences in MN frequency in the treated groups, for NA, the differences between the frequencies of group B (treated for 120 h) and the control group were extremely significant (p < 0.02), thus demonstrating the potentially adverse effects of MeHg on C. macropomum erythrocytes after prolonged exposure

Survival from breast cancer among South Asian and non-South Asian women resident in South East England

Ethnic differences in breast cancer survival have been observed in the USA but have not been examined in Britain. We aimed to investigate such differences between South Asian (i.e. those with family roots in the Indian subcontinent) and non-South Asian (essentially British-native) women in England. Primary breast cancer cases incident in 1986 -1993 and resident in South East England were ascertained through the Thames Cancer and Registry and followed up to the end of 1997. Cases of South Asian ethnicity were identified on the basis of their names by using a previously validated computer algorithm. A total of 1037 South Asian and 50 201 non-South Asian breast cancer cases were included in the analysis; 30% of the South Asian (n=312) and 44% (n=22 201) of the non-South Asian cases died during follow-up. South Asian cases had a higher relative survival than non-South Asians throughout the follow-up period. The 10-year relative survival rates were 72.6% (95% confidence interval: 69.0, 75.9%) and 65.2% (64.5, 65.8%) for South Asians and non-South Asians, respectively. The excess mortality rates experienced by South Asians were 82% (72, 94%) of those experienced by non-South Asians (P=0.004). The magnitude of this effect was slightly reduced with adjustment for differences in age at diagnosis, but was strengthened with further adjustment for differences in stage at presentation and socioeconomic deprivation (excess mortality rates in South Asians relative to non-South Asians=72% (63, 82%), P&<0.001). These findings indicate that the higher survival from breast cancer in the first 10 years after diagnosis among South Asian was not due to differences in age at diagnosis, socioeconomic deprivation or disease stage at presentation