Can You Hear Me Now? Audio and Visual Interactions That Change App Choices.

Android and iOS mobile operating systems use permissions to enable phone owners to manage access to their device's resources. Both systems provide resource access dialogues at first use and per-resource controls. Android continues to offer permission manifests in the Android PlayStore for older apps but is transitioning away from this. Neither manifests nor first-use dialogues enable people to easily compare apps based on resource requests, and the corresponding privacy and security risks. Without the ability to compare resource requests when choosing an app, customers cannot select those apps that request fewer resources. Unnecessary and excessive permission requests, overuse of resources, information exfiltration, and risky apps are endemic. To address this issue we built upon past work in warning science and risk communication to design multimedia indicators to communicate the aggregate privacy and security risk associated with an app. Specifically, we provided participants with a privacy rating using the familiar padlock icon and used audio notifications to either warn or reinforce user choices. We empirically tested participants' app decisions with these padlock icons and audio notifications. The results showed that people with both visual cues and audio feedback are more likely to make app choices that are inversely correlated with the resources requested by the app. Those with neither indicators made decisions reflecting only app rating, while decisions made by those with either the audio or the visual indicators are sometimes inversely correlated with resource requests. This illustrates that simple clear communication about apps' aggregate risk, as opposed to atomic resource requests, changes participants' app selections potentially mitigating the state of information overuse and potential abuse. Additionally, neither the visual indicator nor the audio feedback affected the time required for participants to make a decision.

Association of orthogeriatric care models with evaluation and treatment of osteoporosis: a systematic review and meta-analysis.

This systematic review and meta-analysis found low-quality evidence that orthogeriatric care is positively associated with diagnosis of osteoporosis, prescription of calcium and vitamin D supplements and bisphosphonates in older hip fracture patients. Evidence on fall and fracture prevention was scarce and inconclusive. Orthogeriatrics may reduce the treatment gap following hip fractures. INTRODUCTION: Hip fracture patients are at imminent risk of additional fractures and falls. Orthogeriatric care might reduce the osteoporosis treatment gap and improve outcomes in these patients. However, the optimal orthogeriatric care model (geriatric liaison service, co-management, or geriatrician-led care) remains unclear. PURPOSE: To summarize the association of different orthogeriatric care models for older hip fracture patients, compared to usual orthopaedic care, with fall prevention measures, diagnosis and treatment of osteoporosis and future falls and fractures. METHODS: Two independent reviewers retrieved randomized controlled trials (RCTs) or controlled observational studies. Random effects meta-analysis was applied (PROSPERO ID: 165914). RESULTS: One RCT and twelve controlled observational studies were included, encompassing 20,078 participants (68% women, median ages between 75 and 85 years). Orthogeriatric care was associated with higher odds of diagnosing osteoporosis (odds ratio [OR] 11.36; 95% confidence interval [CI] 7.26-17.77), initiation of calcium and vitamin D supplements (OR 41.44; 95% CI 7.07-242.91) and discharge on anti-osteoporosis medication (OR 7.06; 95% CI 2.87-17.34). However, there was substantial heterogeneity in these findings. Evidence on fall prevention and subsequent fractures was scarce and inconclusive. Almost all studies were at high risk of bias. Evidence was insufficient to compare different care models directly against each other. CONCLUSIONS: Low-quality evidence suggests that orthogeriatric care is associated with higher rates of diagnosing osteoporosis, initiation of calcium and vitamin D supplements and anti-osteoporosis medication. Whether orthogeriatric care prevents subsequent falls and fractures in older hip fracture patients remains unclear.

Metacognitive functioning in bipolar disorder versus controls and its correlations with neurocognitive functioning in a cross-sectional design.

INTRODUCTION: Metacognition is an important factor in the development and persistence of bipolar disorder. One of the most striking examples of impairment in metacognitive functioning in bipolar disorder is the lack of insight these patients have in their disorder. Despite its importance, research regarding metacognition in bipolar disorder is scarce. Furthermore, the neurocognitive basis of metacognitive functioning is unknown. METHODS: The current study included 29 patients with bipolar disorder and 29 age, educational level and gender matched healthy controls. All the participants filled in a metacognition questionnaire that examined their metacognitive beliefs. In addition, it was tested how well they estimated their performance on a neurocognitive test-battery beforehand (metacognitive knowledge) and afterwards (metacognitive experience). RESULTS: Bipolar disorder patients showed maladaptive metacognitive beliefs in comparison with the healthy controls. They also showed impaired metacognitive knowledge and experience. That is, they overestimated their own cognitive performance. However, the latter result was also true for the healthy controls. In addition, metacognition had neurocognitive correlates. However, for the bipolar patients, depressive symptomatology had an important effect on this relationship and on metacognition in general. CONCLUSION: Maladaptive metacognitive skills are related to depression in bipolar disorder. A more healthy metacognitive thinking should be promoted. An effective training for this could be a therapy that includes various elements, from basic cognitive- to higher order metacognitive training.

The longitudinal course of cognitive insight and mood in bipolar disorder.

Cognitive insight or the ability to be self-reflective and to retain from being over-confident in own beliefs is an upcoming topic in research regarding psychiatric disorders. In bipolar disorder investigations are scarce and an important lacuna is the unexamined longitudinal relationship between cognitive insight and mood. Therefore, in this study the level of cognitive insight, mania and depression were assessed in a total of 56 patients with bipolar disorder at baseline, four months and eight months follow-up. In addition, the cognitive insight of 35 healthy controls was assessed at baseline and at four months follow-up. The current research shows that self-reflectiveness and self-certainty remained stable over time in bipolar disorder. The improvement of mood did not affect the course of cognitive insight. However, at baseline higher levels of depression were correlated with more self-reflectiveness. In addition, self-reflectiveness was higher for bipolar disorder patients in comparison with the healthy controls. Our results could imply that higher levels of self-reflectiveness are a specific characteristic in bipolar disorder that is independent from an improvement in mood.

Cognitive insight: A systematic review.

Cognitive insight is the ability to re-evaluate thoughts and beliefs in order to make thoughtful conclusions. It differs from clinical insight, as it focuses on more general metacognitive processes. Therefore, it could be relevant to diverse disorders and non-clinical subjects. There is a growing body of research on cognitive insight in individuals with and without psychosis. This review has summarised the current state of the art regarding this topic. We conclude that while cognitive insight in its current form seems valid for use in individuals with psychosis, it is less so for individuals without psychosis. Additionally, higher cognitive insight not always leads to better psychological functioning. For instance, higher levels of self-reflection are often associated with depressive mood. We therefore recommend the sub-components of cognitive insight to be studied separately. Also, it is unclear what position cognitive insight takes within the spectrum of metacognitive processes and how it relates to other self-related concepts that have been defined previously in literature. Combining future and past research on cognitive insight and its analogue concepts will help in the formation of a uniform definition that fits all subjects discussed here.

Challenges in the Management of Breast Cancer in a Low Resource Setting in South East Asia.

BACKGROUND: Breast cancer is the second most common cancer in women in Cambodia, a low income country in SouthEast Asia. The Sihanouk Hospital Centre of Hope (SHCH) is a charity hospital set up by an international nongovernmental organisation, HOPE Worldwide. In 2008, SHCH partnered with AmeriCares, a global health organisation to set up and deliver a breast cancer programme to provide education, diagnosis and treatment for women with breast cancer. The objective of this study is to characterise the presentation, diagnosis, treatment and outcomes of women treated under this program. MATERIALS AND METHODS: A total of 215 women newly diagnosed with breast cancer from 1 March 2008 until 31 March 2011 were studied. Age at diagnosis, tumour size, histological type, tumour grade, ER, lymph node involvement, treatment modalities (surgery, radiotherapy, chemotherapy, hormone therapy) were recorded. Data on mortality at 3 years were obtained whenever possible. RESULTS: The median age was 47 years old. Some 77.8% were diagnosed with stage 3 and 4 lesions, and 78.5% underwent mastectomy, of which 28.4% the intent was palliative. Of those whose ER status were known, only 48.3% were ER positive. Only 6 patients could afford chemotherapy while only 1 patient had radiotherapy. Hormone therapy was provided free for those who were ER positive. The overall survival rate at 3 years was 39.1%. CONCLUSIONS: Breast cancer presents at a late stage, and because treatment is suboptimal, survival is poor in Cambodia. A more aggressive approach to early detection and treatment needs to be developed to improve outcome from this potentially curable disease.

How self-reflection and self-certainty are related to neurocognitive functioning: an examination of cognitive insight in bipolar disorder.

INTRODUCTION: The pattern of associations between clinical insight, cognitive insight, and neurocognitive functioning was assessed in bipolar disorder patients. METHODS: Data from 42 bipolar disorder patients were examined. Cognitive insight was measured using the Beck Cognitive Insight Scale (BCIS). The BCIS is a 15-item self-report instrument consisting of two subscales, self-reflectiveness and self-certainty. Clinical insight was measured by the use of the item G12 of the Positive and Negative Syndrome Scale. Neurocognitive functioning was assessed using the International Society for Bipolar Disorders-Battery for Assessment of Neurocognition. RESULTS: Correlation analyses revealed significant positive associations between self-reflectiveness and speed of processing, attention, working memory, visual learning, and reasoning and problem solving. The subscale self-certainty was negatively correlated to working memory, however, this correlation disappeared when we controlled for confounding variables. No correlations between clinical insight and neurocognition were found. In addition, there was no association between cognitive insight and clinical insight. CONCLUSION: Better neurocognitive functioning was more related to higher levels of self-reflectiveness than to diminished self-certainty.

Epidemiology of ENT emergencies.

OBJECTIVE: To give an overview of ear, nose, and throat (ENT) pathologies encountered in the emergency room (ER). METHODS: Retrospective analysis of 1296 files of patients visiting the ER between January 2008 and December 2012. Diagnosis, treatment, hospitalisation, referral, and demographic parameters were evaluated. RESULTS: Epistaxis is the most frequent ENT condition seen in the ER. One third of epistaxis patients are on anticoagulant therapy. The second most frequent conditions observed were infections of the pharynx and tonsils. Nasal fractures and vertigo were also frequently observed. CONCLUSION: Epistaxis and its treatment were the most frequent ENT diagnosis and therapy seen in the ER. Infections are the main cause of hospitalisation. Referral to other disciplines and revisits seldom occurred.

DigiSwitch: a device to allow older adults to monitor and direct the collection and transmission of health information collected at home.

Home monitoring represents an appealing alternative for older adults considering out-of-home long term care and an avenue for informal caregivers and health care providers to gain decision-critical information about an older adults' health and well-being. However, privacy concerns about having 24/7 monitoring, especially video monitoring, in the home environment have been cited as a major barrier in the design of home monitoring systems. In this paper we describe the design and evaluation of "DigiSwitch", a medical system designed to allow older adults to view information as it is collected about them and temporarily cease transmission of data for privacy reasons. Results from a series of iterative user studies suggest that control over the transmission of monitoring data from the home is helpful for maintaining user privacy. The studies demonstrate that older adults are able to use the DigiSwitch system to monitor and direct the collection and transmission of health information in their homes, providing these participants with a way to simultaneously maintain privacy and benefit from home monitoring technology.

Characterization and targeting of phosphatidylinositol-3 kinase (PI3K) and mammalian target of rapamycin (mTOR) in renal cell cancer.

BACKGROUND: PI3K and mTOR are key components of signal transduction pathways critical for cell survival. Numerous PI3K inhibitors have entered clinical trials, while mTOR is the target of approved drugs for metastatic renal cell carcinoma (RCC). We characterized expression of p85 and p110α PI3K subunits and mTOR in RCC specimens and assessed pharmacologic co-targeting of these molecules in vitro. METHODS: We employed tissue microarrays containing 330 nephrectomy cases using a novel immunofluorescence-based method of Automated Quantitative Analysis (AQUA) of in situ protein expression. In RCC cell lines we assessed synergism between PI3K and mTOR inhibitors and activity of NVP-BEZ235, which co-targets PI3K and mTOR. RESULTS: p85 expression was associated with high stage and grade (P < 0.0001 for both). High p85 and high mTOR expression were strongly associated with decreased survival, and high p85 was independently prognostic on multi-variable analysis. Strong co-expression of both PI3K subunits and mTOR was found in the human specimens. The PI3K inhibitor LY294002 and rapamycin were highly synergistic in all six RCC cell lines studied. Similar synergism was seen with all rapamycin concentrations used. NVP-BEZ235 inhibited RCC cell growth in vitro with IC(50)s in the low ηM range and resultant PARP cleavage. CONCLUSIONS: High PI3K and mTOR expression in RCC defines populations with decreased survival, suggesting that they are good drug targets in RCC. These targets tend to be co-expressed, and co-targeting these molecules is synergistic. NVP-BEZ235 is active in RCC cells in vitro; suggesting that concurrent PI3K and mTOR targeting in RCC warrants further investigation.

Effect of carbohydrate source on growth performance, carcass traits, and meat quality of growing-finishing pigs.

Two experiments were conducted to determine the effect of substituting a more available dietary carbohydrate (CHO) for portions of corn or fat in the diet on growth performance, carcass traits, meat quality, and serum or plasma metabolites in growing-finishing pigs. A three-phase feeding program was used with corn-soybean meal diets formulated to provide 105% of the Lys requirement for barrows or gilts gaining 325 g of lean daily in Exp. 1 or gilts gaining 350 g of lean daily in Exp. 2. Diets were isoenergetic within experiments. All other nutrients met or exceeded suggested requirements. In Exp. 1, pigs were allotted to three dietary treatments (0, 7.5, or 15.0% sucrose), with three replications of barrows and three replications of gilts, and with three or four pigs per replicate pen; average initial and final BW were 25.2 and 106.7 kg. In Exp. 2, gilts were allotted to two dietary treatments (waxy [high amylopectin] or nonwaxy [75% amylopectin and 25% amylose] corn as the grain source), with five replications of four gilts per replicate pen; average initial and final BW were 37.7 and 100.0 kg. In Exp. 1, ADG and gain:feed ratio increased linearly (P < 0.02) as dietary sucrose increased. Minolta color scores, a* and b*, and drip loss (P < 0.06) also increased linearly with added sucrose. In Exp. 2, ADG, carcass weight and length, and the Minolta a* value were greater for pigs fed waxy corn (P < 0.08) than for those fed nonwaxy corn. Feed intake, longissimus muscle area, 10th-rib and average backfat thickness, dressing percentage, fat-free lean, percentage of lean and muscling, lean gain per day, total fat, percentage fat, lean:fat ratio, serum or plasma metabolites (Exp. 1: serum urea N; Exp. 2: serum urea N, and plasma nonesterified fatty acids, triacylglycerols, total and high-density lipoprotein cholesterol, insulin, and total protein), pH of the longissimus muscle, and subjective muscle scores (color, firmness-wetness, and marbling) were not affected by diet in either experiment. In summary, increasing availability of dietary CHO in growing-finishing pig diets improved growth performance, but it did not affect carcass traits.

Extracellular lipid droplets in Idiosepius notoides, the southern pygmy squid.

Cephalopod metabolism typically involves carbohydrates and proteins, so that the lipid content of the mantle and all internal organs except the digestive gland is very low. Despite clear evidence of nonlipoid metabolic trends in cephalopods, we observed extracellular spheres, or droplets, in the cecum and digestive gland of newly collected juvenile, male, and female individuals of Idiosepius notoides, the southern pygmy squid. Prior to staining, the droplets were various shades of yellow and were often large enough to detect at 7 x magnification. The droplets were less dense than water, hydrophobic, and sudanophilic, staining positively with Sudan III, Sudan IV, and Sudan Black B. We conclude that these spheres are lipid and that they derive from the squid's normal field diet. When newly collected squid were starved in the laboratory, the droplets disappeared in 7-8 d and then reappeared in the cecum about 3 h after feeding.

A population-based study of geriatric trauma in a rural state.

BACKGROUND: Urban geriatric trauma patients are known to die more often than their younger counterparts. Little is known of the fate of geriatric trauma patients in a rural environment where delays to definitive treatment are frequent. We hypothesized that rural trauma patients would do worse than their urban counterparts because of prolonged delays to definitive care. METHODS: Five-year retrospective analysis of all trauma deaths occurring within a rural state and retrospective outcome analysis of trauma patients admitted to a tertiary care facility who were less than 55 years old (defined as young) and 55 or more years old (defined as old). Outcome analysis was performed comparing old and young rural hospitalized patients to the Major Trauma Outcome Study data set collected in major urban trauma centers. RESULTS: Of the total trauma deaths in the state, 32.5% were old. Old patients were less likely to die at the scene of the injury than were their younger counterparts (R2 = 0.84, p < 0.001). Hospitalized old patients had a significantly higher mean Revised Trauma Score and a significantly lower Injury Severity Score, a higher complication rate, and a higher mortality rate than did hospitalized young patients. The young group had a significantly better survival (W = 0.59, Z = -3.49, p = 0.0001) than the MTOS data set, but the old group had a significantly worse survival (W = -1.8, Z = -3.49, p = 0.001). CONCLUSION: In a rural environment, old trauma patients die more commonly in the hospital than their younger counterparts, who die more commonly at the scene. Old trauma patients who die in the hospital were less severely injured than their younger counterparts who died in the hospital. Old patients admitted to this rural trauma center have a significantly worse survival than their urban counterparts despite the fact that young rural trauma patients do significantly better than their urban counterparts. Understanding the demographics of rural geriatric trauma may be useful in allocating resources in rural trauma system design. It must be understood that despite relatively low injury severity and physiologic stability, there is a significant potential for rural geriatric trauma patients to do poorly.

Use of cyanoacrylate (super glue) for the fixation and prefabrication of nasal cartilage grafts.

BACKGROUND: Cartilage grafts are frequently too small to serve as dorsal grafts so that several segments must be secured together to achieve adequate dimensions. The suturing of graft segments is time-consuming and difficult. OBJECTIVE: This study examines the use of 2-octyl cyanoacrylate for the prefabrication and fixation of nasal cartilage grafts. METHODS: 2-octyl cyanoacrylate was used to prefabricate cartilage grafts and secure nasal tip grafts in 9 patients who underwent open rhinoplasty. RESULTS: Cartilage grafts appeared to maintain their volume and position. There was no evidence that 2-octyl cyanoacrylate led to inflammation, erythema, or fibrosis. CONCLUSIONS: 2-octyl cyanoacrylate is an effective method for prefabricating and securing nasal cartilage grafts. There were no negative sequelae associated with its use in this series of patients. (Aesthetic Surg J 2001;21:328-333.).

"Recommendations for uniform reporting of data following major trauma--the Utstein style" (as of July 17, 1999). An International Trauma Anaesthesia and Critical Care Society (ITACCS).

Basic and advanced care of trauma patients has always been an important aspect of prehospital and immediate in-hospital emergency medicine, involving a broad spectrum of disciplines, specialties and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources and operation. This complex background has, at least in part, hindered the development of a uniform pattern or set of criteria and definitions. This in turn has hitherto rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be readily evaluated or compared with acceptable validity. Guided by previous consensus processes evolved by the ERC, the AHA and other International Organizations--represented in ILCOR--on 'Uniform reporting of data following out-of-hospital and in-hospital cardiac arrest--the Utstein style' an international working group of ITACCS has drafted a document, 'Recommendations for uniform reporting of data following major trauma--the Utstein style'. The reporting system is based on the following considerations: A structured reporting system based on an "Utstein style template" which would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance and quality of care (and enable groups to challenge performance statistics which did not take account of all relevant information). The recommendations and template should encompass both out-of-hospital and in-hospital trauma care. The recommendations and template should further permit intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives. The template should facilitate studies setting out to improve epidemiological understanding of trauma; for example such studies might focus on the factors that determine survival. The document is structured along the lines of the original Utstein Style Guidelines publication on 'prehospital cardiac arrest'. It includes a glossary of terms used in the prehospital and early hospital phase and definitions, time points and intervals. The document uses an almost identical scheme for illustrating the different process time clocks--one for the patient, one for the dispatch centre, one for the ambulance and, finally, one for the hospital. For clarity, data should be reported as core data (i.e. always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein template for pre- or in-hospital cardiac arrest, respectively, the present template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form. The document includes the following sections: The Section Introduction and background The Section on Trauma Data Structure Development: presents a general outline of the development of structured data using object-orientated modelling (which will be discussed in due course) and includes a set of explanatory illustrations. The Section on Terms and Definitions: outlines terms and definitions in trauma care, describing different types of trauma (blunt, penetrating, long bone, major/combined, multiple/polytrauma and predominant trauma). The Section on Factors relating to the circumstances of the injury describes the following items: cause of injury (e.g. type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc. Severity of Injury e.g. prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from 1. Head to 9. External; the physiological disability scale ranging ordinally from 0--unsurvivable. Mechanism of injury recording for transportation incidents etc. e.g. the type of impact, po

Glial cell line-derived neurotrophic factor protects midbrain dopamine neurons from the lethal action of the weaver gene: a quantitative immunocytochemical study.

Glial cell line-derived neurotrophic factor (GDNF) has been shown to protect and repair midbrain dopamine neurons in vivo using animal models created with neurotoxins. The weaver mouse (wv/wv) has natural and spontaneous midbrain dopaminergic cell death which gives a unique opportunity to examine the effects of GDNF. The present study was designed to investigate a possible neuroprotective role by GDNF for midbrain dopamine neurons in the wv/wv. Weaver pups were given 1 microl injections on postnatal day 1. The wv/wv placebo group received a single unilateral injection into the right lateral ventricle of phosphate buffered saline (PBS) while the GDNF treated wv/wv mice received either 1.0 microg/microl or 10.0 microg/microl GDNF in PBS. All mice were sacrificed on postnatal day 20 and their brains were processed for tyrosine hydoxylase (TH) immunocytochemistry. When compared to the placebo group, the 1 microg GDNF group showed significantly less cell death on the injection side, but the contralateral side showed no significant sparing of TH neurons. The combined counts from both sides show significantly more TH staining neurons in the 1 microg GDNF group compared to placebo. When compared to placebo-injected controls, the 10 microg GDNF treated group showed significantly more TH staining neurons on the injected side, contralateral side, and combined. The results demonstrate that GDNF does protect weaver dopaminergic midbrain neurons from the lethal action of the weaver gene and the effect is positively correlated to dosage.