Development of an Assistive Technology for Cognition to Support Meal Preparation in Severe Traumatic Brain Injury: User-Centered Design Study.

BACKGROUND: Although assistive technology for cognition (ATC) has enormous potential to help individuals who have sustained a severe traumatic brain injury (TBI) prepare meals safely, no ATC has yet been developed to assist in this activity for this specific population. OBJECTIVE: This study aims to conduct a needs analysis as a first step in the design of an ATC to support safe and independent meal preparation for persons with severe TBI. This included identifying cooking-related risks to depict future users' profiles and establishing the clinical requirements of the ATC. METHODS: In a user-centered design study, the needs of 3 future users were evaluated in their real-world environments (supported-living residence) using an ecological assessment of everyday activities, a review of their medical files, a complete neuropsychological test battery, individual interviews, observational field notes, and log journals with the residents, their families, and other stakeholders from the residence (eg, staff and health professionals). The needs analysis was guided by the Disability Creation Process framework. RESULTS: The results showed that many issues had to be considered for the development of the ATC for the 3 residents and other eventual users, including cognitive issues such as distractibility and difficulty remembering information over a short period of time and important safety issues, such as potential food poisoning and risk of fire. This led to the identification of 2 main clinical requirements for the ATC: providing cognitive support based on evidence-based cognitive rehabilitation to facilitate meal preparation and ensuring safety at each step of the meal preparation task. CONCLUSIONS: This needs analysis identified the main requirements for an ATC designed to support meal preparation for persons with severe TBI. Future research will focus on implementing the ATC in the residence and evaluating its usability.

Smart Assistive Technology for Cooking for People With Cognitive Impairments Following a Traumatic Brain Injury: User Experience Study.

BACKGROUND: User experience (UX), including usability, should be formally assessed multiple times throughout the development process to optimize the acceptability and integration of a new technology before implementing it within the home environment of people living with cognitive impairments. OBJECTIVE: The aim of this study is to identify UX issues, notably usability issues, and factors to consider for the future implementation of the COOK (Cognitive Orthosis for Cooking) within the home of individuals with traumatic brain injury (TBI) to identify modifications to improve the technology. METHODS: This study comprised two rounds of UX evaluations, including extensive usability testing, which were completed in a laboratory context: 3 sessions with 5 experts and, after improvement of COOK, 2 sessions with 10 participants with TBI. Each session included the use of scenarios and questionnaires on UX and usability. RESULTS: Both rounds demonstrated good usability outcomes and hedonic qualities. Various usability issues were identified by participants, such as navigation inconsistencies, technical bugs, and the need for more feedback. Factors to consider in the future implementation of COOK were also mentioned by participants with TBI, including environmental (eg, space available and presence of pets) and personal factors (eg, level of comfort with technology, presence of visual deficits, and preferences). CONCLUSIONS: By evaluating UX, including usability, various times throughout the development process and including experts and end users, our research team was able to develop a technology that was perceived as usable, pleasant, and well-designed. This research is an example of how and when people with cognitive impairments (ie, people with TBI) can be involved in evaluating the UX of new technology.

Design and usability evaluation of COOK, an assistive technology for meal preparation for persons with severe TBI.

AIM: In Canada, 100,000 people suffer a traumatic brain injury (TBI) every year. The prevalence of moderate to severe TBI is highest for young men, who will live an average of 50 years with this chronic condition associated with physical, emotional and cognitive deficits. Meal preparation, a complex activity with high safety risks, is one of the most significant activities impacted by TBI. Technology shows great promise to support their overall functioning, but no context-aware technology is available to support meal preparation for this population. The main goal of this study was to design and test a technology to support meal preparation with and for persons with severe TBI living in a supported-living residence. METHODOLOGY: As part of a transdisciplinary technology project linking rehabilitation and informatics, COOK (Cognitive Orthosis for coOKing) was designed with and for future users and stakeholders with a user-centred design methodology. COOK was implemented in three participants' apartments, and its usability was evaluated at 1, 3 and 6 months post-implementation. RESULTS: COOK is a context-aware assistive technology consisting of two main systems: security and cognitive support system. After implementation of COOK, participants were able to resume safe preparation of meals independently. Usability testing showed good effectiveness and an acceptable level of satisfaction. CONCLUSION: COOK appears promising for rehabilitating clients with cognitive disabilities, improving safety in a home environment, and diminishing the need for human supervision. Future studies will need to explore how COOK can be adapted to a broader TBI population, other environments, and other clienteles.Implications for rehabilitationThis paper presents a promising context-aware assistive technology for cognition designed with and for clients with severe brain injury to support their independence in meal preparation;COOK, (Cognitive Orthesis for coOKing) is the first cooking assistant in which evidence-based cognitive rehabilitation interventions have been translated into smart technological assistance, to support cognition and ensure safety in a real-life context;Its context-aware characteristic ensures that users receive the assistance they need at the right time and at the right moment.The long-term perspective regarding the use of COOK in clinical practice is promising as this technology has the potential of becoming an additional means of supporting the rehabilitation of people with cognitive impairments and becoming part of a comprehensive solution to help them live at home more independently.

Characterization of Oral Squamous Cell Carcinoma Associated Inflammation: A Pilot Study.

Background: Oral squamous cell carcinoma (OSCC) is a devastating disease that is usually associated with a dense associated inflammatory infiltrate. Characterizing tumor-associated inflammation is critical to understand the pathogenies of tumor development and progression. Methods: We have tested a protocol to analyze tissue and salivary immune cells and mediators of 37 patients with OSCC at different stages and compared to eight chronic periodontitis patients and 24 healthy controls. Tissue analysis was based on fluorescent immunohistochemistry (FIHC) and inflammatory mediators were analyzed using a Luminex-based 30-Plex panel. Immune cells were analyzed using multichannel flow cytometry including CD45, CD66b, CD3, CD4, CD8, CD25, CD56, CD68, CD138, PD-1, and PD-L1. Results: We show an increase in OSCC-associated inflammation characterized by increased pro-inflammatory cytokines including IL-6, IL-8, TNFα, and GMCSF and increased salivary immune cells. Conclusion: We described a new method to analyze salivary inflammatory markers that can be used in future studies to monitor disease progression and prognosis.

Using Ambient Assisted Living to Monitor Older Adults With Alzheimer Disease: Single-Case Study to Validate the Monitoring Report.

BACKGROUND: Many older adults choose to live independently in their homes for as long as possible, despite psychosocial and medical conditions that compromise their independence in daily living and safety. Faced with unprecedented challenges in allocating resources, home care administrators are increasingly open to using monitoring technologies known as ambient assisted living (AAL) to better support care recipients. To be effective, these technologies should be able to report clinically relevant changes to support decision making at an individual level. OBJECTIVE: The aim of this study is to examine the concurrent validity of AAL monitoring reports and information gathered by care professionals using triangulation. METHODS: This longitudinal single-case study spans over 490 days of monitoring a 90-year-old woman with Alzheimer disease receiving support from local health care services. A clinical nurse in charge of her health and social care was interviewed 3 times during the project. Linear mixed models for repeated measures were used to analyze each daily activity (ie, sleep, outing activities, periods of low mobility, cooking-related activities, hygiene-related activities). Significant changes observed in data from monitoring reports were compared with information gathered by the care professional to explore concurrent validity. RESULTS: Over time, the monitoring reports showed evolving trends in the care recipient's daily activities. Significant activity changes occurred over time regarding sleep, outings, cooking, mobility, and hygiene-related activities. Although the nurse observed some trends, the monitoring reports highlighted information that the nurse had not yet identified. Most trends detected in the monitoring reports were consistent with the clinical information gathered by the nurse. In addition, the AAL system detected changes in daily trends following an intervention specific to meal preparation. CONCLUSIONS: Overall, trends identified by AAL monitoring are consistent with clinical reports. They help answer the nurse's questions and help the nurse develop interventions to maintain the care recipient at home. These findings suggest the vast potential of AAL technologies to support health care services and aging in place by providing valid and clinically relevant information over time regarding activities of daily living. Such data are essential when other sources yield incomplete information for decision making.

Oral inflammation promotes oral squamous cell carcinoma invasion.

Oral squamous cell carcinoma (OSCC) represents 95% of oral malignancies and invasion, and metastasis underlies disease morbidity and mortality. We recently established a direct link between oral inflammation and cancer invasion by showing that neutrophils increase OSCC invasion through a tumor necrosis factor (TNFα)-dependent mechanism. The objective of this study was to characterize OSCC-associated inflammation and to determine the molecular mechanisms underlying inflammation-mediated OSCC invasion. Our results showed a significant increase in neutrophil infiltration, the neutrophil-to-lymphocyte ratio in the OSCC microenvironment and increased inflammatory markers, particularly TNFα in saliva. We performed next-generation sequencing of the TNFα-treated OSCC cells and showed marked overexpression of over 180 genes distributed among clusters related to neutrophil recruitment, invasion, and invadopodia. At the molecular level, TNFα treatment increased phosphoinositide 3-kinase (PI3K)-mediated invadopodia formation and matrix metalloproteinase (MMP)-dependent invasion. We show here that TNFα promotes a pro-inflammatory and pro-invasion phenotype leading to the recruitment and activation of inflammatory cells in a paracrine mechanism. Increased TNFα in the tumor microenvironment tips the balance towards invasion leading to decreased overall survival and disease-free survival. This represents a significant advancement of oral cancer research and will support new treatment approaches to control OSCC invasion and metastasis.

Sclerosing Epithelioid Fibrosarcoma of the Jaw: Late Recurrence from a Low Grade Fibromyxoid Sarcoma.

Sclerosing epithelioid fibrosarcoma (SEF) is an uncommon variant of fibrosarcoma that is characterized by a distinct morphology. It most frequently presents in the deep soft tissues of the lower extremities, often in intimate association with fascia and periosteum, although reports of the head and neck involvement have been reported. A minority of cases show morphological, immunohistochemical and molecular overlap with low grade fibromyxoid sarcoma (LG-FMS). Herein, we describe a case of a bland spindle cell neoplasm presenting in the jaw that was initially incompletely excised. Over the course of 20 years the tumor subsequently recurred with a SEF morphology. Molecular testing performed on both specimens subsequently confirmed the presence of an EWSR1-CREB3L1 gene fusion. This report highlights the diagnostic difficulty with LG-FMS, particularly in unusual anatomic locations; reiterates the potential for the uncommon EWSR1-CREB3L1 fusion product in LG-FMS; and, reaffirms the potential for progression and/or overlap between LG-FMS to SEF over time.