"Our people has got to come to terms with that": changing perceptions of the digital rectal examination as a barrier to prostate cancer diagnosis in African-Caribbean men

Objective: African‐Caribbean men in the United Kingdom in comparison with other ethnicities have the highest incidence rate of prostate cancer. Psychosocial aspects related to screening and presentation impact on men's behavior, with previous studies indicating a range of barriers. This study explores one such barrier, the digital rectal examination (DRE), due to its prominence within UK African‐Caribbean men's accounts. Methods: African‐Caribbean men with prostate cancer (n = 10) and without cancer (n = 10) were interviewed about their perceptions of DRE. A synthetic discursive approach was employed to analyze the data. Results: Findings illustrate that an interpretative repertoire of homophobia in relation to the DRE is constructed as having an impact upon African‐Caribbean men's uptake of prostate cancer screening. However, the discursive focus on footing and accountability highlight deviations from this repertoire that are built up as pragmatic and orient to changing perceptions within the community. Conclusions: Health promotion interventions need to address the fear of homophobia and are best designed in collaboration with the community

PROCEE: a PROstate Cancer Evaluation and Education serious game for African Caribbean men

Purpose – Prostate cancer is the most common cancer diagnosed in men in the UK. Black men are in a higher prostate cancer risk group possibly due to inherent genetic factors. The purpose of this paper is to introduce PROstate Cancer Evaluation and Education (PROCEE), an innovative serious game aimed at providing prostate cancer information and risk evaluation to black African-Caribbean men. Design/methodology/approach – PROCEE has been carefully co-designed with prostate cancer experts, prostate cancer patients and members of the black African-Caribbean community in order to ensure that it meets the real needs and expectations of the target audience. Findings – During the co-design process, the users defined an easy to use and entertaining game which can effectively raise awareness, inform users about prostate cancer and their risk, and encourage symptomatic men to seek medical attention in a timely manner. Originality/value – During focus group evaluations, users embraced the game and emphasised that it can potentially have a positive impact on changing user behaviour among high risk men who are experiencing symptoms and who are reluctant to visit their doctor

Exploring the use of game making across the school curriculum

Computer games as part of education is a well-established topic for research, suggesting that creating games is linked to a range of cognitive and behavioural outcomes. Creating games in all subject disciplines is becoming increasingly possible due to the increasingly higher status of computing in schools across Europe and the prevalence of visual programming languages such as Scratch and Pocket Code. The use of games within education is not new; in a systematic review of 129 papers [1] found that playing games impacts across a range of areas including engagement, cognitive ability and, most commonly, knowledge acquisition and content understanding. However, while research has thus far examined game play and game based learning in education there is limited work focussing on the process of game creation as a method of classroom teaching. This is a prospect which is increasingly possible with the introduction of visual programming languages such as Scratch [2] and Pocket Code. It is suggested that playful learning through computer games could stimulate students’ intrinsic motivation ([3] and that knowledge creation can emerge through the construction of artefacts in a playful learning environment via the co-creation of games [4]. The research presented in this paper is from a pilot study examining the impact of game making in traditional primary and secondary school classrooms (5-18 years) in the United Kingdom (UK). The research, funded by Horizon 2020, is part of a wider European project; No-one Left Behind. In the UK the project has introduced game making into disciplines such as Religious Education, Science and History. Data indicates that although not all students found this a positive experience, computational thinking skills have increased, and students, disaffected with their learning, have re-engaged with learning, increasing their persistence and resulting in a deeper understanding of subject knowledge. In addition initial results suggest that game making has the potential to increase engagement with classroom learning and lead to increased learner satisfaction within lessons. Non-computing teachers have gained in confidence in developing game creation in their subject discipline, increasing their awareness of computational thinking. Barriers identified include teacher familiarity with programming as a means to teach non-STEM subject knowledge, a potential to decrease knowledge acquisition during the process of familiarisation with the teaching tool and a need for software developers to consider design for children with SEND. The project is changing the learning environment and emerging pedagogy has been identified which will be shared in this paper. As a result of the study lesson resources have been created for teachers to use across disciplines which are now available via the project URL; these will be shared in this paper

Enhancing biofeedback-driven self-guided virtual reality exposure therapy through arousal detection from multimodal data using machine learning

Virtual reality exposure therapy (VRET) is a novel intervention technique that allows individuals to experience anxiety-evoking stimuli in a safe environment, recognise specific triggers and gradually increase their exposure to perceived threats. Public-speaking anxiety (PSA) is a prevalent form of social anxiety, characterised by stressful arousal and anxiety generated when presenting to an audience. In self-guided VRET, participants can gradually increase their tolerance to exposure and reduce anxiety-induced arousal and PSA over time. However, creating such a VR environment and determining physiological indices of anxiety-induced arousal or distress is an open challenge. Environment modelling, character creation and animation, psychological state determination and the use of machine learning (ML) models for anxiety or stress detection are equally important, and multi-disciplinary expertise is required. In this work, we have explored a series of ML models with publicly available data sets (using electroencephalogram and heart rate variability) to predict arousal states. If we can detect anxiety-induced arousal, we can trigger calming activities to allow individuals to cope with and overcome distress. Here, we discuss the means of effective selection of ML models and parameters in arousal detection. We propose a pipeline to overcome the model selection problem with different parameter settings in the context of virtual reality exposure therapy. This pipeline can be extended to other domains of interest where arousal detection is crucial. Finally, we have implemented a biofeedback framework for VRET where we successfully provided feedback as a form of heart rate and brain laterality index from our acquired multimodal data for psychological intervention to overcome anxiety

An evaluation of an adaptive learning system based on multimodal affect recognition for learners with intellectual disabilities

Artificial intelligence tools for education (AIEd) have been used to automate the provision of learning support to mainstream learners. One of the most innovative approaches in this field is the use of data and machine learning for the detection of a student's affective state, to move them out of negative states that inhibit learning, into positive states such as engagement. In spite of their obvious potential to provide the personalisation that would give extra support for learners with intellectual disabilities, little work on AIEd systems that utilise affect recognition currently addresses this group. Our system used multimodal sensor data and machine learning to first identify three affective states linked to learning (engagement, frustration, boredom) and second determine the presentation of learning content so that the learner is maintained in an optimal affective state and rate of learning is maximised. To evaluate this adaptive learning system, 67 participants aged between 6 and 18 years acting as their own control took part in a series of sessions using the system. Sessions alternated between using the system with both affect detection and learning achievement to drive the selection of learning content (intervention) and using learning achievement alone (control) to drive the selection of learning content. Lack of boredom was the state with the strongest link to achievement, with both frustration and engagement positively related to achievement. There was significantly more engagement and less boredom in intervention than control sessions, but no significant difference in achievement. These results suggest that engagement does increase when activities are tailored to the personal needs and emotional state of the learner and that the system was promoting affective states that in turn promote learning. However, longer exposure is necessary to determine the effect on learning

Smoking cigarettes of low nicotine yield does not reduce nicotine intake as expected: a study of nicotine dependency in Japanese males

BACKGROUND: Many Japanese believe that low-yield cigarettes are less hazardous than regular cigarettes, and many smokers consume low-yield cigarettes to reduce their risks from smoking. We evaluate the association between actual nicotine intake and brand nicotine yield, and the influence of nicotine dependence on this association. METHODS: The study subjects included 458 Japanese male smokers, aged 51.2 ± 9.9 years, who participated in health check-ups in a hospital in 1998 and 2000. Each subject filled out a self-administered smoking questionnaire and the score of each on the Fagerström Test for Nicotine Dependence was calculated. Urinary cotinine concentration was measured at the time of participation. RESULTS: The geometric mean of urinary cotinine concentration was 535 ng/mgCr for those who smoked brands with the lowest nicotine (0.1 mg on the package), compared with 1010 ng/mgCr for those who smoked brands with the highest (0.9–2.4 mg, weighted mean of 1.1 mg). Thus, despite the 11-fold ratio of nicotine yield on the packages, the ratio of urinary cotinine level was less than twofold. Both nicotine yield on the package and nicotine dependence significantly increased urinary cotinine concentration, and the negative interaction between them almost attained statistical significance. Cotinine concentration in heavily dependent smokers was consistently high regardless of the nicotine yield of brands. CONCLUSIONS: The nicotine yield of cigarettes measured by machine-smoking does not reliably predict the exposure of smokers. Smokers consuming low-yield nicotine cigarettes did not reduce actual intake of nicotine to the level that might be expected, especially for those heavily dependent on nicotine. Current labeling practices are misleading for the two-third of smokers who are moderately or highly dependent on nicotine

Epigenetic control of nuclear architecture

The cell nucleus is a highly structured compartment where nuclear components are thought to localize in non-random positions. Correct positioning of large chromatin domains may have a direct impact on the localization of other nuclear components, and can therefore influence the global functionality of the nuclear compartment. DNA methylation of cytosine residues in CpG dinucleotides is a prominent epigenetic modification of the chromatin fiber. DNA methylation, in conjunction with the biochemical modification pattern of histone tails, is known to lock chromatin in a close and transcriptionally inactive conformation. The relationship between DNA methylation and large-scale organization of nuclear architecture, however, is poorly understood. Here we briefly summarize present concepts of nuclear architecture and current data supporting a link between DNA methylation and the maintenance of large-scale nuclear organization

Alcohol, tobacco and illicit drug use amongst same-sex attracted women: results from the Western Australian Lesbian and Bisexual Women's Health and Well-Being Survey

Background: The prevalence of alcohol, tobacco and illicit drug use has been reported to be higheramongst lesbian and bisexual women (LBW) than their heterosexual counterparts. However, few studieshave been conducted with this population in Australia and rates that have been reported vary considerably.Methods: A self-completed questionnaire exploring a range of health issues was administered to 917women aged 15-65 years (median 34 years) living in Western Australia, who identified as lesbian orbisexual, or reported having sex with another woman. Participants were recruited from a range of settings,including Perth Pride Festival events (67.0%, n = 615), online (13.2%, n = 121), at gay bars and nightclubs(12.9%, n = 118), and through community groups (6.9%, n = 63). Results were compared against availablestate and national surveillance data.Results: LBW reported consuming alcohol more frequently and in greater quantities than women in thegeneral population. A quarter of LBW (25.7%, n = 236) exceeded national alcohol guidelines by consumingmore than four standard drinks on a single occasion, once a week or more. However, only 6.8% (n = 62)described themselves as a heavy drinker, suggesting that exceeding national alcohol guidelines may be anormalised behaviour amongst LBW. Of the 876 women who provided data on tobacco use, 28.1% (n =246) were smokers, nearly double the rate in the female population as a whole. One third of the sample(33.6%, n = 308) reported use of an illicit drug in the previous six months. The illicit drugs most commonlyreported were cannabis (26.4%, n = 242), meth/amphetamine (18.6%, n = 171), and ecstasy (17.9%, n =164). Injecting drug use was reported by 3.5% (n = 32) of participants.Conclusion: LBW appear to use alcohol, tobacco and illicit drugs at higher rates than women generally,indicating that mainstream health promotion messages are not reaching this group or are not perceivedas relevant. There is an urgent need for public health practitioners working in the area of substance useto recognise that drug consumption and use patterns of LBW are likely to be different to the widerpopulation and that special considerations and strategies are required to address the unique and complexneeds of this population

Lung Cancer Occurrence in Never-Smokers: An Analysis of 13 Cohorts and 22 Cancer Registry Studies

Michael Thun and colleagues pooled and analyzed comprehensive data on lung cancer incidence and death rates among never-smokers to examine what factors other than active smoking affect lung cancer risk