Melanoma prevention using an augmented reality-based serious game.

OBJECTIVES: The purpose of this study was to field-test a recently developed AR-based serious game designed to promote SSE self-efficacy, called Spot. METHODS: Thirty participants played the game and answered 3 questionnaires: a baseline questionnaire, a second questionnaire immediately after playing the game, and a third questionnaire 1 week later (follow-up). RESULTS: The majority of participants considered that the objective quality of the game was high, and considered that the game could have a real impact in SSE promotion. Participants showed statistically significant increases in SSE self-efficacy and intention at follow-up. Of the 24 participants that had never performed a SSE or had done one more than 3 months ago, 12 (50.0%) reported doing a SSE at follow-up. CONCLUSIONS: This study provides supporting evidence to the use of serious games in combination with AR to educate and motivate users to perform SSE. Spot seems to be an inconspicuous but effective strategy to promote SSE, a cancer prevention behavior, among healthy individuals. PRACTICE IMPLICATIONS: Patient education is essential to tackle skin cancer, particularly melanoma. Serious games, such as Spot, have the ability to effectively educate and motivate patients to perform a cancer prevention behavior.

Disruption of the skin, gill, and gut mucosae microbiome of gilthead seabream fingerlings after bacterial infection and antibiotic treatment.

The activity of the microbiome of fish mucosae provides functions related to immune response, digestion, or metabolism. Several biotic and abiotic factors help maintaining microbial homeostasis, with disruptions leading to dysbiosis. Diseases and antibiotic administration are known to cause dysbiosis in farmed fish. Pathogen infections greatly affect the production of gilthead seabream, and antibiotic treatment is still frequently required. Here, we employed a 16S rRNA high-throughput metataxonomics approach to characterize changes in the gut, skin, and gill microbiomes occurring due to infection with Photobacterium damselae subsp. piscicida and subsequent antibiotic treatment with oxytetracycline (OTC), as well as during recovery. Although microbiota response differed between studied tissues, overall changes in composition, diversity, structure, and predicted function were observed in all mucosae. The skin and gill microbiomes of diseased fish became largely dominated by taxa that have been frequently linked to secondary infections, whereas in the gut the genus Vibrio, known to include pathogenic bacteria, increased with OTC treatment. The study highlights the negative impacts of disease and antibiotic treatment on the microbiome of farmed fish. Our results also suggest that fish transportation operations may have profound effects on the fish microbiome, but further studies are needed to accurately evaluate their impact.

Development and process evaluation of a new entertainment-education TV series for cancer prevention in Portugal.

Cancer is a primary societal challenge worldwide, with over 23 million new cases/year, and 10 million deaths/year. Estimates of preventable cancer deaths rise as high as 70%, but such estimates rely heavily on individual behaviors, which in turn are correlated with knowledge and attitudes towards health and cancer. This paper describes the iterative evidence-based development of the first entertainment-education series on cancer prevention to be televised, and reports its effectiveness evaluation. A nominal group defined the guiding principles that were translated into key characteristics for a series named '2' Life-changing minutes'. Pilot episodes were produced and evaluated in two complementary studies-a focus group study with medical doctors and a survey study with prospective viewers. Results from these studies guided the optimization and production of the full series, which was broadcast on national public TV, in prime time. An evaluation study was performed afterwards with naturally-occurring viewers and results show audience reach on par with purely entertainment series, that health messages can be clearly conveyed through fictional narratives, and that the series has high levels of appreciation and health promotion potential. '2' Life-changing minutes' constitutes a novel and effective proposal for health promotion, that challenges the primacy of information and statistics still common in health communication, with a new format based on stories, characters and social contexts to successfully promote health.

Provoking Artificial Slips and Trips towards Perturbation-Based Balance Training: A Narrative Review.

Humans' balance recovery responses to gait perturbations are negatively impacted with ageing. Slip and trip events, the main causes preceding falls during walking, are likely to produce severe injuries in older adults. While traditional exercise-based interventions produce inconsistent results in reducing patients' fall rates, perturbation-based balance training (PBT) emerges as a promising task-specific solution towards fall prevention. PBT improves patients' reactive stability and fall-resisting skills through the delivery of unexpected balance perturbations. The adopted perturbation conditions play an important role towards PBT's effectiveness and the acquisition of meaningful sensor data for studying human biomechanical reactions to loss of balance (LOB) events. Hence, this narrative review aims to survey the different methods employed in the scientific literature to provoke artificial slips and trips in healthy adults during treadmill and overground walking. For each type of perturbation, a comprehensive analysis was conducted to identify trends regarding the most adopted perturbation methods, gait phase perturbed, gait speed, perturbed leg, and sensor systems used for data collection. The reliable application of artificial perturbations to mimic real-life LOB events may reduce the gap between laboratory and real-life falls and potentially lead to fall-rate reduction among the elderly community.

Effects of psychosis-associated genetic markers on brain volumetry: a systematic review of replicated findings and an independent validation.

BACKGROUND: Given psychotic illnesses' high heritability and associations with brain structure, numerous neuroimaging-genetics findings have been reported in the last two decades. However, few findings have been replicated. In the present independent sample we aimed to replicate any psychosis-implicated SNPs (single nucleotide polymorphisms), which had previously shown at least two main effects on brain volume. METHODS: A systematic review for SNPs showing a replicated effect on brain volume yielded 25 studies implicating seven SNPs in five genes. Their effect was then tested in 113 subjects with either schizophrenia, bipolar disorder, 'at risk mental state' or healthy state, for whole-brain and region-of-interest (ROI) associations with grey and white matter volume changes, using voxel-based morphometry. RESULTS: We found FWER-corrected (Family-wise error rate) (i.e. statistically significant) associations of: (1) CACNA1C-rs769087-A with larger bilateral hippocampus and thalamus white matter, across the whole brain; and (2) CACNA1C-rs769087-A with larger superior frontal gyrus, as ROI. Higher replication concordance with existing literature was found, in decreasing order, for: (1) CACNA1C-rs769087-A, with larger dorsolateral-prefrontal/superior frontal gyrus and hippocampi (both with anatomical and directional concordance); (2) ZNF804A-rs11681373-A, with smaller angular gyrus grey matter and rectus gyri white matter (both with anatomical and directional concordance); and (3) BDNF-rs6265-T with superior frontal and middle cingulate gyri volume change (with anatomical and allelic concordance). CONCLUSIONS: Most literature findings were not herein replicated. Nevertheless, high degree/likelihood of replication was found for two genome-wide association studies- and one candidate-implicated SNPs, supporting their involvement in psychosis and brain structure.

The Influence of Non-Optimal Rearing Conditions and Substrates on the Performance of the Black Soldier Fly (Hermetia illucens).

Among the insect species reared as alternative protein sources, Hermetia illucens (black soldier Fly, BSF) has shown a huge potential mostly due to its high protein content, its bioconversion rates, and versatility in using different feeding substrates. Insect rearing may use continuous or batch feeding regimes and, among the used substrates, supermarket feedstock waste has gained recent interest under a circular economy perspective, but several uncertainties remain regarding the heterogeneity and the potential effects of the quantity and quality of these substrates on BSF larvae (BSFL) development. In this experimental work, five replicates of a hundred BSFL were fed in a continuous feeding regime, using seven different isolated vegetables as substrates (wheat bran, pumpkin, apple, grape pomace, red onion, red cabbage, and spinach), at three different temperatures (20, 25, and 30 °C) and two substrate moisture conditions (natural and 70% substrate moisture), until 50% of the larvae achieved the prepupal stage. BSFL performance and bioconversion parameters were evaluated. Our results show that some substrates should be avoided when rearing Hermetia illucens on feedstocks. Among these, apple feed led to poorer and slower development performances with more than 100 days of larval stage, while grape pomace and spinach showed higher mortality rates, which may be due to some anti-nutritional compounds. Larvae fed on pumpkin, red cabbage, and red onion presented good bioconversion results with higher values of efficiency of conversion of digested feed between 14.4 and 25. This work delivers relevant results for black soldier fly reared on a continuous feeding system using vegetable feedstock substrates and their potential trade-offs.

Inertial Data-Based AI Approaches for ADL and Fall Recognition.

The recognition of Activities of Daily Living (ADL) has been a widely debated topic, with applications in a vast range of fields. ADL recognition can be accomplished by processing data from wearable sensors, specially located at the lower trunk, which appears to be a suitable option in uncontrolled environments. Several authors have addressed ADL recognition using Artificial Intelligence (AI)-based algorithms, obtaining encouraging results. However, the number of ADL recognized by these algorithms is still limited, rarely focusing on transitional activities, and without addressing falls. Furthermore, the small amount of data used and the lack of information regarding validation processes are other drawbacks found in the literature. To overcome these drawbacks, a total of nine public and private datasets were merged in order to gather a large amount of data to improve the robustness of several ADL recognition algorithms. Furthermore, an AI-based framework was developed in this manuscript to perform a comparative analysis of several ADL Machine Learning (ML)-based classifiers. Feature selection algorithms were used to extract only the relevant features from the dataset's lower trunk inertial data. For the recognition of 20 different ADL and falls, results have shown that the best performance was obtained with the K-NN classifier with the first 85 features ranked by Relief-F (98.22% accuracy). However, Ensemble Learning classifier with the first 65 features ranked by Principal Component Analysis (PCA) presented 96.53% overall accuracy while maintaining a lower classification time per window (0.039 ms), showing a higher potential for its usage in real-time scenarios in the future. Deep Learning algorithms were also tested. Despite its outcomes not being as good as in the prior procedure, their potential was also demonstrated (overall accuracy of 92.55% for Bidirectional Long Short-Term Memory (LSTM) Neural Network), indicating that they could be a valid option in the future.

Nutritional Intake and Training Load of Professional Female Football Players during a Mid-Season Microcycle.

Football (soccer) is a high-intensity intermittent sport with large energy demands. In a repeated-measures design, we analysed the nutritional intake and training load of fourteen female football players (22.50 ± 4.38 y; 57.23 ± 8.61 kg; 164 ± 6.00 cm; 18.33 ± 2.48% of fat mass and 23.71 ± 2.51 kg of muscle mass) competing in the highest female Football Portuguese League across a typical mid-season microcycle. The microcycle had one match day (MD), one recovery session (two days after the MD, MD+2), three training sessions (MD-3, MD-2, MD-1) and two rest days (MD+1). Energy intake and CHO (g.kg.BW−1) intake were lower on the days before the competition (MD+2, MD-3, MD-2 and MD-1 vs. MD; p < 0.05; ES: 0.60−1.30). Total distance, distance covered at high-speed running (HSRD) and the high metabolic distance load (HMLD) were lower on MD+2, MD-3 and MD-1 compared with MD (p < 0.05; ES: <0.2−5.70). The internal training load was lower in all training sessions before the competition (MD+2, MD-3, MD-2 and MD-1 vs. MD; p ≤ 0.01; ES: 1.28−5.47). Despite the small sample size and a single assessment in time, the results suggest that caloric and CHO intake were below the recommendations and were not structured based on the physical requirements for training sessions or match days.

Fall Risk Assessment Using Wearable Sensors: A Narrative Review.

Recently, fall risk assessment has been a main focus in fall-related research. Wearable sensors have been used to increase the objectivity of this assessment, building on the traditional use of oversimplified questionnaires. However, it is necessary to define standard procedures that will us enable to acknowledge the multifactorial causes behind fall events while tackling the heterogeneity of the currently developed systems. Thus, it is necessary to identify the different specifications and demands of each fall risk assessment method. Hence, this manuscript provides a narrative review on the fall risk assessment methods performed in the scientific literature using wearable sensors. For each identified method, a comprehensive analysis has been carried out in order to find trends regarding the most used sensors and its characteristics, activities performed in the experimental protocol, and algorithms used to classify the fall risk. We also verified how studies performed the validation process of the developed fall risk assessment systems. The identification of trends for each fall risk assessment method would help researchers in the design of standard innovative solutions and enhance the reliability of this assessment towards a homogeneous benchmark solution.

A sudden and severe depressive episode after a left cingulate gyrus stroke: a case report of post-stroke depression and review of literature.

Post-stroke depression is a frequent complication of cerebrovascular lesions and mainly occurs within the first 6 months after stroke. Stroke patients who develop depression have slower recovery, greater disability, and higher mortality rates. The pathophysiology of post-stroke depression is not yet clearly defined, but studies suggest contributions from both psychosocial factors and stroke-related factors, such as lesions affecting the frontal-subcortical circuits. Early treatment has a positive impact on post-stroke rehabilitation outcome and survival. We present the case of an 82-year-old man with no psychiatric history who was brought to the psychiatric emergency department after two suicide attempts in the span of 7 days. He was severely depressed, with feelings of hopelessness, insomnia, and suicidal ideation. He had suffered a stroke the week before, affecting the anterior portion of the left cingulate gyrus, causing right hemiparesis and paresthesia. The psychiatric symptoms developed immediately after the stroke and were not present before the event. He was admitted to the psychiatry ward, treated with sertraline 100 mg/day and quetiapine 50 mg/day and discharged within 28 days, after full remission of symptoms. Our case strengthens the association between lesions located to the frontal-subcortical circuits and post-stroke depression. Physicians should be vigilant regarding the occurrence of depression in stroke patients, especially those who suffer lesions affecting the frontal-subcortical circuits and related regions.

Fluoroquinolones Are Associated With Increased Risk of Aortic Aneurysm or Dissection: Systematic Review and Meta-analysis.

Fluoroquinolone use has been associated with collagen disease events, raising safety concerns. We hypothesized that the use of fluoroquinolones is associated with aortic aneurysm (AA) and aortic dissection or aortic rupture (AD/AR). We performed a systematic review with meta-analysis on studies published until March 2019. Seven observational studies were included, comprising 2,851,646 participants. The studies were evaluated regarding their risk of bias. Results on fluoroquinolone use risk comparing with nontreatment and with beta-lactam antibiotic use were extracted. The estimates were pooled through a random-effects model meta-analysis and heterogeneity assessed through the I2 statistic. Sensitivity analysis were performed, grouping studies per design and with exclusion of studies with critical risk of bias. Fluoroquinolone use was associated with a higher risk of AA/AD/AR, comparing with a nontreatment intervention (odds ratio = 2.26; 95%CI 1.93-2.65; I2 = 30%) and comparing with a beta-lactam intervention (odds ratio = 1.56; 95%CI 1.37-1.79; I2 = 0%). This harm effect remained significant when pooling the results for the AD/AR outcome only and across various study designs. Studies comparing with beta-lactam intervention were considered to have a moderate risk of bias, while the remaining ones were classified as having at least a serious risk of bias. All evaluated outcomes had very low Grading of Recommendation, Assessment, Development and Evaluation evidence. Fluoroquinolone use was associated with a significant risk of AA/AD/AR.

The Impact of Climate Change on Forest Development: A Sustainable Approach to Management Models Applied to Mediterranean-Type Climate Regions.

Forest ecosystems are divided into three major groups: boreal, temperate, and tropical. These can be subdivided according to the particularities of each type due to its relative location (littoral, mountain, etc.), climatic conditions, or even geological substrate. Climate change affects each type of forest ecosystem differently. However, it seems to affect temperate forests in Mediterranean-type climate regions more intensely. These regions are located over several continents, with major impacts of increased temperature during summer and decreased precipitation during winter. This situation affects Mediterranean forest ecosystems by increasing the risk of fires, which arise more frequently and are more severe. In addition, the emergence of pests and the spread of invasive species are well-known problems affecting these ecosystems. All of these conditions contribute to losses of productivity and biodiversity. To avoid the destruction of forest resources, and since Mediterranean-type climate regions are considered climate change hot spots with increased vulnerability to disturbances, the implementation of adaptive forest management models could contribute to increasing the resilience of such forests, which could also contribute to mitigating climate change.

Tribomechanical Comparison between PVA Hydrogels Obtained Using Different Processing Conditions and Human Cartilage.

Designing materials for cartilage replacement raises several challenges due to the complexity of the natural tissue and its unique tribomechanical properties. Poly(vinyl alcohol) (PVA) hydrogels have been explored for such purpose since they are biocompatible, present high chemical stability, and their properties may be tailored through different strategies. In this work, the influence of preparation conditions of PVA hydrogels on its morphology, water absorption capacity, thermotropic behavior, mechanical properties, and tribological performance was evaluated and compared with those of human cartilage (HC). The hydrogels were obtained by cast-drying (CD) and freeze-thawing (FT), in various conditions. It was found that the method of preparation of the PVA hydrogels critically affects their microstructure and performance. CD gels presented a denser structure, absorbed less water, were stiffer, dissipated less energy, and withstood higher loads than FT gels. Moreover, they led to friction coefficients against stainless steel comparable with those of HC. Overall, CD hydrogels had a closer performance to natural HC, when compared to FT ones.

Development of a Strategy to Predict and Detect Falls Using Wearable Sensors.

Falls are a prevalent problem in actual society. Some falls result in injuries and the cost associated with their treatment is high. This is a complex problem that requires several steps in order to be tackled. Firstly, it is crucial to develop strategies that recognize the locomotion mode, indicating the state of the subject in various situations. This article aims to develop a strategy capable of identifying normal gait, the pre-fall condition, and the fall situation, based on a wearable system (IMUs-based). This system was used to collect data from healthy subjects that mimicked falls. The strategy consists, essentially, in the construction and use of classifiers as tools for recognizing the locomotion modes. Two approaches were explored. Associative Skill Memories (ASMs) based classifier and a Convolutional Neural Network (CNN) classifier based on deep learning. Finally, these classifiers were compared, providing for a tool with a good accuracy in recognizing the locomotion modes. Results have shown that the accuracy of the classifiers was quite acceptable. The CNN presented the best results with 92.71% of accuracy considering the pre-fall step different from normal steps, and 100% when not considering.

Development of a Measurement Tool to Assess Students' Knowledge and Perceptions About Cancer (SKPaC).

Cancer literacy is currently one of the most important dimensions of cancer continuum. Objective assessment of cancer knowledge in populations remains a challenging field to public health entities. Different evaluation tools are currently available; still, some groups remain disregarded due to the absence of validated instruments. Cancer literacy in adolescents and young adults has been clearly overlooked being a subject that requires new tools to be properly studied. To address this topic, we developed a new instrument and field tested it in a classroom environment for internal reliability, construct, and face validity. "Students Knowledge and Perceptions about Cancer questionnaire" was designed in Portuguese language and adapted to the Portuguese context by a multidisciplinary team. The final version of the questionnaire includes 35 items organized in three sections, encompassing knowledge and perceptions about cancer and socio-biographic data. Cancer experts ensured content validity, while tailoring of contents was refined with high school teachers. Test and retest of the instrument showed a good reliability of the scale and construct validity. Also, the clarity of the questionnaire and suitability to proper evaluate cancer knowledge was consistent between test and retest. The Students' Knowledge and Perceptions About Cancer Questionnaire (SKPaC) showed to be a valid tool to assess adolescents' knowledge and perceptions about cancer that can be used in the educational context.

Can Smartphones Promote Cancer Prevention Behaviours in Healthy Young Adults? A Prospective Study.

Cancer prevention should start as early as possible. Young adults would benefit largely from the use of a smartphone app aiming at promoting cancer prevention behaviours. The aims of the study described in this paper are to (1) examine the user participation and engagement with a cancer prevention app in real-life settings and (2) assess changes in the users' cancer prevention behaviours. A cancer prevention smartphone app called Happy was developed and released to the general population. Data from registered app users' (N = 3326) demographics and baseline cancer prevention behaviours was analysed. App engagement was measured and all behaviour data logged through the app was analysed to assess the effectiveness of the app in the promotion of cancer prevention behaviours. User demographics and baseline behaviour assessment show that the app reached its intended target population: young adults that generally do not comply with cancer prevention guidelines. Logged behavioural data showed an increased frequency in several cancer prevention behaviours and a significant increase in the overall putative cancer prevention level (p < 0.001). However, user engagement with the app was limited and might condition the long-term impact of such changes. Happy reached its intended population and seems to be an effective tool to promote cancer prevention. Further research is needed to fully assess its long-term persuasive potential.

Pilot study of a smartphone-based intervention to promote cancer prevention behaviours.

BACKGROUND: Estimates predict that more than half of all cancers are due to inadequate lifestyle choices. Smartphones can be successfully used to support the behaviour change needed to prevent cancer. OBJECTIVE: The purpose of this study was to field-test Happy, a smartphone app designed to promote cancer prevention behaviours, based on tailored-messages. METHODS: Thirty-two participants downloaded and used the app for 28 consecutive days (4 weeks). At the end of this period, they all answered an online questionnaire and ten of them were interviewed. Usability, feasibility, message receptivity, and perceived impact of the app were assessed. RESULTS: Compliance with cancer prevention guidelines was lower than expected. Happy was considered simple, intuitive and easy to use. Messages sent by the app were considered easy to understand, providing good advice and meaningful information that catch reader's attention. Participants also considered that Happy might be an effective way to promote cancer prevention. Collected data showed an increased frequency in several cancer prevention related behaviours and an increase in the overall putative cancer prevention level. CONCLUSIONS: This study showed the viability of designing and implementing smartphone-based interventions to promote cancer prevention behaviours. The results suggest that Happy is usable and might help users change their behaviour towards healthier choices and thus reduce their personal cancer risk.

A rare presentation of spontaneous internal carotid artery dissection with Horner's syndrome, VIIth, Xth and XIIth nerve palsies.

Spontaneous internal carotid artery dissection (sICAD) is an uncommon cause of isolated cranial nerve palsies. Commonly patients present with stroke, headache, facial pain and Horner's syndrome, with upto 16% having cranial nerve palsies. We present the case of a 55-year-old man who presented with hoarseness, dysphagia and tongue swelling, mimicking a tongue base tumor. He was found to have unilateral VIIth, Xth and XIIth nerve palsies with Horner's syndrome. Magnetic resonance imaging showed high signal changes and loss of signal void in right internal carotid artery, later confirmed by Angiography as a dissection with pseudo-aneurysm. He was started on anticoagulation and made a good recovery on discharge. This case presents a unique combination of cranial nerve palsies due to internal carotid artery dissection (ICAD) and to our knowledge is the first reported case in the literature. Early recognition and institution of appropriate therapy is critical to prevention of ischemic stroke.