An e-learning application on electrochemotherapy.

BACKGROUND: Electrochemotherapy is an effective approach in local tumour treatment employing locally applied high-voltage electric pulses in combination with chemotherapeutic drugs. In planning and performing electrochemotherapy a multidisciplinary expertise is required and collaboration, knowledge and experience exchange among the experts from different scientific fields such as medicine, biology and biomedical engineering is needed. The objective of this study was to develop an e-learning application in order to provide the educational content on electrochemotherapy and its underlying principles and to support collaboration, knowledge and experience exchange among the experts involved in the research and clinics. METHODS: The educational content on electrochemotherapy and cell and tissue electroporation was based on previously published studies from molecular dynamics, lipid bilayers, single cell level and simplified tissue models to complex biological tissues and research and clinical results of electrochemotherapy treatment. We used computer graphics such as model-based visualization (i.e. 3D numerical modelling using finite element method) and 3D computer animations and graphical illustrations to facilitate the representation of complex biological and physical aspects in electrochemotherapy. The e-learning application is integrated into an interactive e-learning environment developed at our institution, enabling collaboration and knowledge exchange among the users. We evaluated the designed e-learning application at the International Scientific workshop and postgraduate course (Electroporation Based Technologies and Treatments). The evaluation was carried out by testing the pedagogical efficiency of the presented educational content and by performing the usability study of the application. RESULTS: The e-learning content presents three different levels of knowledge on cell and tissue electroporation. In the first part of the e-learning application we explain basic principles of electroporation process. The second part provides educational content about importance of modelling and visualization of local electric field in electroporation-based treatments. In the third part we developed an interactive module for visualization of local electric field distribution in 3D tissue models of cutaneous tumors for different parameters such as voltage applied, distance between electrodes, electrode dimension and shape, tissue geometry and electric conductivity. The pedagogical efficiency assessment showed that the participants improved their level of knowledge. The results of usability evaluation revealed that participants found the application simple to learn, use and navigate. The participants also found the information provided by the application easy to understand. CONCLUSION: The e-learning application we present in this article provides educational material on electrochemotherapy and its underlying principles such as cell and tissue electroporation. The e-learning application is developed to provide an interactive educational content in order to simulate the "hands-on" learning approach about the parameters being important for successful therapy. The e-learning application together with the interactive e-learning environment is available to the users to provide collaborative and flexible learning in order to facilitate knowledge exchange among the experts from different scientific fields that are involved in electrochemotherapy. The modular structure of the application allows for upgrade with new educational content collected from the clinics and research, and can be easily adapted to serve as a collaborative e-learning tool also in other electroporation-based treatments such as gene electrotransfer, gene vaccination, irreversible tissue ablation and transdermal gene and drug delivery. The presented e-learning application provides an easy and rapid approach for information, knowledge and experience exchange among the experts from different scientific fields, which can facilitate development and optimisation of electroporation-based treatments.

Number of microvesicles in peripheral blood and ability of plasma to induce adhesion between phospholipid membranes in 19 patients with gastrointestinal diseases.

It was recently shown that the plasma protein-mediated attractive interaction between phospholipid membranes could in the budding process cause adhesion of the bud to the mother membrane [J. Urbanija, N. Tomsic, M. Lokar, A. Ambrozic, S. Cucnik, M. Kanduser, B. Rozman, A. Iglic, V. Kralj-Iglic, Coalescence of phospholipid membranes as a possible origin of anticoagulant effect of serum proteins, Chem. Phys. Lipids 150 (2007) 49-57]. Since in the in vivo conditions the budding of cell membranes leads to the release of microvesicles into the circulation, a hypothesis was put forward that the ability of plasma to cause adhesion between membranes supresses the microvesiculation process. In the present work, this hypothesis was tested in a population of 19 patients with gastrointestinal diseases. The number of microvesicles in peripheral blood of patients was determined by flow cytometry while the ability of plasma to cause adhesion between membranes was determined by adding patient's plasma to the suspension of giant phospholipid vesicles created by electroformation method, and measuring the average effective angle of contact between the adhered vesicles. Statistically significant negative correlations between the number of microvesicles and the average effective angle of contact (Pearson coefficient -0.50, p=0.031) and between the number of microvesicles per number of platelets and the average effective angle of contact (Pearson coefficient -0.64, p=0.003) were found, which is in favor of the above hypothesis. Patients with gastrointestinal cancer had larger number of microvesicles (difference 140%, statistical significance 0.033) and smaller average effective angle of contact (difference 20%, statistical significance 0.013) compared to patients with other gastrointestinal diseases.

Usability Pitfalls of Diabetes mHealth Apps for the Elderly.

Diabetes mellitus has high prevalence in the ageing population and is often accompanied by other comorbidities, such as Alzheimer's disease, and general disabilities, such as poor eyesight. These comorbidities have redefined ways in which patients use mHealth apps, including diabetes apps. The latter have proven benefits for monitoring blood glucose levels and insulin tracking in the general population. In this paper, we analyse a diabetes monitoring app DeStress Assistant (DeSA), which was developed as a part of an EU project and tested in a hospital setting. Due to the increasing number of older adults, we wanted to ensure the app was suitable for that demographic. Based on a number of supervised tests, we show that the app, which was developed with the help of workshops and feedback from tech-savvy patients and clinicians, is difficult to use by elderly users. We demonstrate that with a small number of changes it is possible to raise the usability of the app in a number of categories. We summarise the lessons learned in the discussion. Our findings demonstrate that special care needs to be taken when developing mHealth apps for the elderly population.

A method for selection of appropriate assistive technology for computer access.

Assistive technologies (ATs) for computer access enable people with disabilities to be included in the information society. Current methods for assessment and selection of the most appropriate AT for each individual are non standardized, lengthy, subjective, and require substantial clinical experience of a multidisciplinary team.This manuscript presents and evaluates an objective approach to test and select an appropriate AT for computer access for people with disabilities. Six user interfaces(standard keyboard, mini and large joystick, mini and large trackball, and head-operated mouse and keyboard) were tested on the control group of 29 people without disabilities and on 63 people with neuromuscular and muscular diseases, using purpose-built software for testing the speed of sentence typing. Different criteria for selecting the optimal AT were tested and compared with the skilled clinician's choice. The learning curves of the people with disabilities proved to follow those of the healthy controls, but with lower performance. Daily computer use was not associated with AT selection, but corresponded nearly perfectly to the level of functional ability of upper limbs. Agreement between clinician's choice and learning-based AT selection was noteworthy,but far from perfect. If partial agreement was taken into account, that is, AT was considered as an ordinal variable based on the corresponding functional ability level, and the second best learning-based choice was taken into account,the agreement was high for highest median typing speed as AT selection criterion. In conclusion, the developed method for AT assessment and selection seems to be an efficient guide for an unskilled clinician to choose an appropriate AT.