Supporting Accurate Interpretation of Self-Administered Medical Test Results for Mobile Health: Assessment of Design, Demographics, and Health Condition

Background: Technological advances in personal informatics allow people to track their own health in a variety of ways, representing a dramatic change in individuals’ control of their own wellness. However, research regarding patient interpretation of traditional medical tests highlights the risks in making complex medical data available to a general audience. Objective: This study aimed to explore how people interpret medical test results, examined in the context of a mobile blood testing system developed to enable self-care and health management. Methods: In a preliminary investigation and main study, we presented 27 and 303 adults, respectively, with hypothetical results from several blood tests via one of the several mobile interface designs: a number representing the raw measurement of the tested biomarker, natural language text indicating whether the biomarker’s level was low or high, or a one-dimensional chart illustrating this level along a low-healthy axis. We measured respondents’ correctness in evaluating these results and their confidence in their interpretations. Participants also told us about any follow-up actions they would take based on the result and how they envisioned, generally, using our proposed personal health system. Results: We find that a majority of participants (242/328, 73.8%) were accurate in their interpretations of their diagnostic results. However, 135 of 328 participants (41.1%) expressed uncertainty and confusion about their ability to correctly interpret these results. We also find that demographics and interface design can impact interpretation accuracy, including false confidence, which we define as a respondent having above average confidence despite interpreting a result inaccurately. Specifically, participants who saw a natural language design were the least likely (421.47 times, P=.02) to exhibit false confidence, and women who saw a graph design were less likely (8.67 times, P=.04) to have false confidence. On the other hand, false confidence was more likely among participants who self-identified as Asian (25.30 times, P=.02), white (13.99 times, P=.01), and Hispanic (6.19 times, P=.04). Finally, with the natural language design, participants who were more educated were, for each one-unit increase in education level, more likely (3.06 times, P=.02) to have false confidence. Conclusions: Our findings illustrate both promises and challenges of interpreting medical data outside of a clinical setting and suggest instances where personal informatics may be inappropriate. In surfacing these tensions, we outline concrete interface design strategies that are more sensitive to users’ capabilities and conditions

Differential Use of Diagnostic Ultrasound in U.S. Emergency Departments by Time of Day

Background: Survey data over the last several decades suggests that emergency department (ED) access to diagnostic ultrasound performed by the radiology department is unreliable, particularly outside of regular business hours.Objective: To evaluate the association between the time of day of patient presentation and the use of diagnostic ultrasound services in United States (U.S.) EDs.Methods: This was a cross-sectional study of ED patient visits using the National Hospital Ambulatory Medical Care Survey for the years 2003 to 2005. Our main outcome measure was the use of diagnostic ultrasound during the ED patient visit as abstracted from the medical record. We performed multivariate analyses to identify any association between ultrasound use and time of presentation for all patients, as well as for two subgroups who are more likely to need ultrasound as part of their routine workup: patients at risk of deep venous thrombosis, and patients at risk for ectopic pregnancy.Results: During the three-year period, we analyzed 110,447 patient encounters, representing 39 million national visits. Of all ED visits, 2.6% received diagnostic ultrasound. Presenting to the ED “off hours” (defined as Monday through Friday 7pm to 7am and weekends) was associated with a lower rate of ultrasound use independent of potential confounders (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.65 - 0.82). Patients at increased risk of deep venous thrombosis who presented to the ED during “off hours” were also less likely to undergo diagnostic ultrasound (OR 0.34, 95% CI: 0.15 - 0.79). Similarly, patients at increased risk of ectopic pregnancy received fewer diagnostic ultrasounds during “off hours” (OR 0.56, 95% CI 0.35 - 0.91).Conclusion: In U.S. EDs, ultrasound use was lower during “off hours,” even among patient populations where its use would be strongly indicated. [West J Emerg Med. 2011;12(1):90-95.

An X-Ray View of the Jet-Cycle in the Radio Loud AGN 3C120

We present a study of the central engine in the broad-line radio galaxy 3C120 using a multi-epoch analysis of a deep XMM-Newton observation and two deep Suzaku pointings (in 2012). In order to place our spectral data into the context of the disk-disruption/jet-ejection cycles displayed by this object, we monitor the source in the UV/X-ray bands, and in the radio band. We find three statistically acceptable spectral models, a disk-reflection model, a jet-model and a jet+disk model. Despite being good descriptions of the data, the disk-reflection model violates the radio constraints on the inclination, and the jet-model has a fine-tuning problem, requiring a jet contribution exceeding that expected. Thus, we argue for a composite jet+disk model. Within the context of this model, we verify the basic predictions of the jet-cycle paradigm, finding a truncated/refilling disk during the Suzaku observations and a complete disk extending down to the innermost stable circular orbit (ISCO) during the XMM-Newton observation. The idea of a refilling disk is further supported by the detection of the ejection of a new jet knot approximately one month after the Suzaku pointings. We also discover a step-like event in one of the Suzaku pointings in which the soft band lags the hard band. We suggest that we are witnessing the propagation of a disturbance from the disk into the jet on a timescale set by the magnetic field.Comment: 14 pages, 10 figures, accepted for publication in Ap

Enteric helminths promote Salmonella co-infection by altering the intestinal metabolome

Intestinal helminth infections occur pre dominantly in regions where exposure to enteric bacterial pathogens is also common. Helminth infections inhibit host immunity against microbial pathogens, which has largely been attributed to the induction of regulatory or type 2 (Th2) immune responses. Here we demonstrate an additional three-way interaction in which helminth infection alters the metabolic environment of the host intestine to enhance bacterial pathogenicity. We show that an ongoing helminth infection increased colonization by Salmonella independently of T regulatory or Th2 cells. Instead, helminth infection altered the metabolic profile of the intestine, which directly enhanced bacterial expression of Salmonella pathogenicity island 1 (SPI-1) genes and increased intracellular invasion. These data reveal a novel mechanism by which a helminth-modified metabolome promotes susceptibility to bacterial co-infection

高効率線形送信法におけるPWM包絡線発生法の研究

電気通信大学200

Comparative transcriptomic analysis of Porphyromonas gingivalis biofilm and planktonic cells

<p>Abstract</p> <p>Background</p> <p><it>Porphyromonas gingivalis </it>in subgingival dental plaque, as part of a mature biofilm, has been strongly implicated in the onset and progression of chronic periodontitis. In this study using DNA microarray we compared the global gene expression of a <it>P. gingivalis </it>biofilm with that of its planktonic counterpart grown in the same continuous culture.</p> <p>Results</p> <p>Approximately 18% (377 genes, at 1.5 fold or more, <it>P</it>-value < 0.01) of the <it>P. gingivalis </it>genome was differentially expressed when the bacterium was grown as a biofilm. Genes that were down-regulated in biofilm cells, relative to planktonic cells, included those involved in cell envelope biogenesis, DNA replication, energy production and biosynthesis of cofactors, prosthetic groups and carriers. A number of genes encoding transport and binding proteins were up-regulated in <it>P. gingivalis </it>biofilm cells. Several genes predicted to encode proteins involved in signal transduction and transcriptional regulation were differentially regulated and may be important in the regulation of biofilm growth.</p> <p>Conclusion</p> <p>This study analyzing global gene expression provides insight into the adaptive response of <it>P. gingivalis </it>to biofilm growth, in particular showing a down regulation of genes involved in growth and metabolic activity.</p

Implications of climate change for managing urban green infrastructure in Indiana

Urban areas around the world are increasingly investing in networks of urban forests, gardens, and other forms of green infrastructure for its many benefits, including enhanced livability, sustainability, and climate change mitigation and adaptation. Proactive planning for climate change requires anticipating potential climate change impacts to green infrastructure and adjusting management strategies accordingly. We apply climate change projections for Indiana to assess the possible impacts of climate change on common forms of urban green infrastructure, and identify management implications. Projected changes in Indiana’s temperature and precipitation could pose numerous management challenges for managing urban green infrastructure, including water stress; pests, weeds, disease and invasive species; flooding; frost risk; and timing of maintenance. Meeting these challenges will involve managing for key characteristics of resilient systems (e.g. biodiversity, redundancy) as well as more specific strategies addressing particular climate changes (e.g. shifting species compositions, building soil water holding capacity). Climate change also presents opportunities to promote urban green infrastructure. Unlike human built infrastructure, green infrastructure is conducive to grassroots stewardship and governance, relieving climate change-related strains on municipal budgets. Many online resources for adapting urban green infrastructure to climate change are already available, and emerging research will enhance understanding of best management practices

The Mid-Infrared Emission of M87

We discuss Subaru and Spitzer Space Telescope imaging and spectroscopy of M87 in the mid-infrared from 5-35 um. These observations allow us to investigate mid-IR emission mechanisms in the core of M87 and to establish that the flaring, variable jet component HST-1 is not a major contributor to the mid-IR flux. The Spitzer data include a high signal-to-noise 15-35 $\mu$m spectrum of the knot A/B complex in the jet, which is consistent with synchrotron emission. However, a synchrotron model cannot account for the observed {\it nuclear} spectrum, even when contributions from the jet, necessary due to the degrading of resolution with wavelength, are included. The Spitzer data show a clear excess in the spectrum of the nucleus at wavelengths longer than 25 um, which we model as thermal emission from cool dust at a characteristic temperature of 55 \pm 10 K, with an IR luminosity \sim 10^{39} {\rm ~erg ~s^{-1}}. Given Spitzer's few-arcsecond angular resolution, the dust seen in the nuclear spectrum could be located anywhere within ~5'' (390 pc) of the nucleus. In any case, the ratio of AGN thermal to bolometric luminosity indicates that M87 does not contain the IR-bright torus that classical unified AGN schemes invoke. However, this result is consistent with theoretical predictions for low-luminosity AGNsComment: 9 pages, 7 figures, ApJ, in pres

Characterization of hemin-binding protein 35 (HBP35) in Porphyromonas gingivalis: its cellular distribution, thioredoxin activity and role in heme utilization

<p>Abstract</p> <p>Background</p> <p>The periodontal pathogen <it>Porphyromonas gingivalis </it>is an obligate anaerobe that requires heme for growth. To understand its heme acquisition mechanism, we focused on a hemin-binding protein (HBP35 protein), possessing one thioredoxin-like motif and a conserved C-terminal domain, which are proposed to be involved in redox regulation and cell surface attachment, respectively.</p> <p>Results</p> <p>We observed that the <it>hbp35 </it>gene was transcribed as a 1.1-kb mRNA with subsequent translation resulting in three proteins with molecular masses of 40, 29 and 27 kDa in the cytoplasm, and one modified form of the 40-kDa protein on the cell surface. A recombinant 40-kDa HBP35 exhibited thioredoxin activity <it>in vitro </it>and mutation of the two putative active site cysteine residues abolished this activity. Both recombinant 40- and 27-kDa proteins had the ability to bind hemin, and growth of an <it>hbp35 </it>deletion mutant was substantially retarded under hemin-depleted conditions compared with growth of the wild type under the same conditions.</p> <p>Conclusion</p> <p><it>P. gingivalis </it>HBP35 exhibits thioredoxin and hemin-binding activities and is essential for growth in hemin-depleted conditions suggesting that the protein plays a significant role in hemin acquisition.</p

High resolution Chandra HETG and RXTE observations of GRS 1915+105 : A hot disk atmosphere & cold gas enriched in Iron and Silicon

The time-averaged 30 ks Chandra HETGS observation of the micro-quasar GRS 1915+105 in the low hard state reveals for the first time in this source neutral K absorption edges from Fe, Si, Mg, & S. Ionized resonance absorption from H-, and He-like Fe (XXV, XXVI), Ca XX and possibly emission from neutral Fe Kalpha and ionized Fe XXV (forbidden, or the resonance emission component of a P-Cygni profile) are also seen. We report the tentative detection of the first astrophysical signature of XAFS in the photoelectric edge of Si (and possibly Fe and Mg), attributed to material in grains. The large column densities measured from the neutral edges reveal anomalous Si and Fe abundances. Scenarios for which the anomalous abundances can be attributed to surrounding cold material associated with GRS 1915+105 and/or that the enrichment may signify either a highly unusual supernova/hypernova, or external supernova activity local to the binary are discussed. We attribute the ionized features to a hot disk, disk-wind, or corona environment. These features allow for constraints on the ionization parameter (log xi > 4.15), temperature (T > 2.4 x 10^6 K), and hydrogen equivalent number density (n > 10^{12} cm^{-3}) for this region. Variability studies with simultaneous RXTE data show that the light curve count rate tracks changes in the disk blackbody and the power-law flux. Spectral changes in the Chandra data also track the behavior of the light curve, and may point to changes in both the ionizing flux and density of the absorber. A 3.69 Hz QPO and weak first harmonic is seen in the RXTE data.Comment: Accepted for publication in ApJ., 9 pages, 5 figure