Diabetes Mobile App Usability for Adult Patients with Diabetes

University of Minnesota Ph.D. dissertation. May 2018. Major: Nursing. Advisor: Jean Wyman. 1 computer file (PDF); x, 103 pages pages.More than 1,100 diabetes apps are available, but are infrequently used. A systematic review identified unsatisfactory diabetes app usability and its clinical effect to lower hemoglobin A1c level (0.15% to 1.9%), with variations in interactive app features for real-time feedback through automatic data analysis, clinician text messages, reminder alerts, or an app-initiated phone call. This result identified the need for health behavior theory applications to guide diabetes app usability evaluation. This study applied the Self-Determination Theory on human motivation to select app testing functions and to understand adult patient perspectives to use apps. A total of 92 adults with diabetes type 1 or 2 participated in a randomized crossover trial to test the usability of two top-rated Android diabetes apps (mySugr and OnTrack). Multivariable linear regression models assessed the effects of patient characteristics (i.e., age, education, and diabetes) and psychological needs on user satisfaction and user performance. Psychological needs important for motivation and behavioral change were associated with diabetes app usability. Higher user satisfaction was observed for participants who reported competence, autonomy, or connectivity with a healthcare provider. To enhance motivation to use apps for self-management, clinicians should consider addressing the patient’s competence, autonomy, and connectivity. User performance was associated with patient characteristics of age, sex, education, and diabetes duration because they affect the patient’s ability to use apps efficiently, successfully, and accurately. App training and ongoing technical support should be tailored for older adults, men, patients with less education, and those with diabetes duration more than 10 years

Evidence for the Presentation of Major Histocompatibility Complex Class I–restricted Epstein-Barr Virus Nuclear Antigen 1 Peptides to CD8+ T Lymphocytes

The Epstein-Barr virus (EBV)-encoded nuclear antigen 1 (EBNA1) is expressed in all EBV-associated tumors, making it an important target for immunotherapy. However, evidence for major histocompatibility complex (MHC) class I–restricted EBNA1 peptides endogenously presented by EBV-transformed B and tumor cells remains elusive. Here we describe for the first time the identification of an endogenously processed human histocompatibility leukocyte antigen (HLA)-B8–restricted EBNA1 peptide that is recognized by CD8+ T cells. T cell recognition could be inhibited by the treatment of target cells with proteasome inhibitors that block the MHC class I antigen processing pathway, but not by an inhibitor (chloroquine) of MHC class II antigen processing. We also demonstrate that new protein synthesis is required for the generation of the HLA-B8 epitope for T cell recognition, suggesting that defective ribosomal products (DRiPs) are the major source of T cell epitopes. Experiments with protease inhibitors indicate that some serine proteases may participate in the degradation of EBNA1 DRiPs before they are further processed by proteasomes. These findings not only provide the first evidence of the presentation of an MHC class I–restricted EBNA1 epitope to CD8+ T cells, but also offer new insight into the molecular mechanisms involved in the processing and presentation of EBNA1

The Role of Management Practices in Closing the Productivity Gap

There is no doubt that management practices are linked to the productivity and performance of a company. However, research findings are mixed. This paper provides a multi-disciplinary review of the current evidence of such a relationship and offers suggestions for further exploration. We provide an extensive review of the literature in terms of research findings from studies that have been trying to measure and understand the impact that individual management practices and clusters of management practices have on productivity at different levels of analysis. We focus our review on Operations Management (om) and Human Resource Management (hrm) practices as well as joint applications of these practices. In conclusion, we can say that taken as a whole, the research findings are equivocal. Some studies have found a positive relationship between the adoption of management practices and productivity, some negative and some no association whatsoever. We believe that the lack of universal consensus on the effect of the adoption of complementary management practices might be driven either by measurement issues or by the level of analysis. Consequently, there is a need for further research. In particular, for a multi-level approach from the lowest possible level of aggregation up to the firm-level of analysis in order to assess the impact of management practices upon the productivity of firms

Sleep duration and patterns in Chinese older adults: A comprehensive meta-analysis

This meta-analysis examined the mean sleep duration and patterns in Chinese older adult population. A literature search was systematically conducted covering major English (PubMed, Embase and PsycINFO) and Chinese (Chinese National Knowledge Infrastructure (CNKI), WanFang and SinoMed) databases. Data in studies with the mean and standard deviation of sleep duration and/or the proportion of short and long sleep durations in Chinese older adults were extracted and pooled using random-effects models. Subgroup analyses were conducted according to gender, region, area, survey time and sample size. A total of 36 studies with 150,616 subjects were included for analyses. The pooled mean sleep duration of 21 studies with available data was 6.82 hours/day (95% CI: 6.59–7.05 hours/day). The estimated proportions of sleep duration \u3c5 hours/day, \u3c6 hours/day, \u3c7 hours/day were 18.8% (95% CI: 1.7%–35.9%), 26.7% (95% CI: 19.7%–33.7%) and 42.3% (95% CI: 34.8%–49.8%), respectively. The pooled proportions for long sleepers were 22.6% (95% CI: 13.9%–31.4%) (\u3e8 hours/day) and 17.6% (95% CI: 12.4%–22.9%) (\u3e9 hours/day). Given the adverse effects of unhealthy sleep patterns, health professionals should pay more attention to sleep patterns in this population in China

Tumor-Infiltrating γδ T Cells Suppress T and Dendritic Cell Function via Mechanisms Controlled by a Unique Toll-like Receptor Signaling Pathway

Summaryγδ T cells are important contributors to innate immunity against cancer, but their regulatory role in controlling immune responses remains largely unknown. Here we report that a dominant γδ1 T cell population among lymphocytes infiltrating breast tumors possessed a potent ability to suppress naive and effector T cell responses and to block the maturation and function of dendritic cells. Adoptive cotransfer experiments demonstrated their in vivo suppressive activity. However, their immunosuppressive activity could be reversed by human Toll-like receptor (TLR) 8 ligands both in vitro and in vivo. siRNA-mediated knockdown experiments revealed that MyD88, TRAF6, IKKα IKKβ, and p38α molecules in γδ1 cells were required for these cells to respond to TLR8 ligands, whereas TAK1, JNK, and ERK molecules did not appear to be involved in functional regulation. These results provide new insights into the regulatory mechanisms of tumor-specific γδ T cells and identify a unique TLR8 signaling pathway linking to their functional regulation

Identification of a Mutated Fibronectin As a Tumor Antigen Recognized by CD4+T Cells: Its Role in Extracellular Matrix Formation and Tumor Metastasis

CD4+ T cells play an important role in orchestrating host immune responses against cancer, particularly by providing critical help for priming and extending the survival of CD8+ T cells. However, relatively little is known about major histocompatibility complex class II–restricted human tumor antigens capable of activating CD4+ T cells. Here, we describe the identification of a mutated fibronectin (FN) as a tumor antigen recognized by human histocompatibility leukocyte antigen-DR2–restricted CD4+ T cells. Deoxyribonucleic acid (DNA) sequencing analysis indicated that this gene contains a mutation that results in the substitution of lysine for glutamic acid and gives rise to a new T cell epitope recognized by CD4+ T cells. Tumor cells harboring the mutant FN resulted in the loss of FN matrix formation and the gain of metastatic potential based on the migration pattern compared with that of tumor cells that express wild-type FN. Additional experiments using cell lines stably expressing the mutated FN cDNA demonstrated that the point mutation in FN was responsible for the loss of FN staining in extracellular matrices and the enhancement of tumor cell migration. These findings represent the first demonstration that a mutated gene product recognized by CD4+ T cells is directly involved in tumor metastasis, which indicates the importance of CD4+ T cells in controlling the spread of tumor cells to distant anatomic sites