Biofilm exopolysaccharides alter sensory-neuron-mediated sickness during lung infection.

Infections of the lung cause observable sickness thought to be secondary to inflammation. Signs of sickness are crucial to alert others via behavioral-immune responses to limit contact with contagious individuals. Gram-negative bacteria produce exopolysaccharide (EPS) that provides microbial protection; however, the impact of EPS on sickness remains uncertain. Using genome-engineered Pseudomonas aeruginosa (P. aeruginosa) strains, we compared EPS-producers versus non-producers and a virulent Escherichia coli (E. coli) lung infection model in male and female mice. EPS-negative P. aeruginosa and virulent E. coli infection caused severe sickness, behavioral alterations, inflammation, and hypothermia mediated by TLR4 detection of the exposed lipopolysaccharide (LPS) in lung TRPV1+ sensory neurons. However, inflammation did not account for sickness. Stimulation of lung nociceptors induced acute stress responses in the paraventricular hypothalamic nuclei by activating corticotropin-releasing hormone neurons responsible for sickness behavior and hypothermia. Thus, EPS-producing biofilm pathogens evade initiating a lung-brain sensory neuronal response that results in sickness.

Bacterial cyclic diguanylate signaling networks sense temperature.

Many bacteria use the second messenger cyclic diguanylate (c-di-GMP) to control motility, biofilm production and virulence. Here, we identify a thermosensory diguanylate cyclase (TdcA) that modulates temperature-dependent motility, biofilm development and virulence in the opportunistic pathogen Pseudomonas aeruginosa. TdcA synthesizes c-di-GMP with catalytic rates that increase more than a hundred-fold over a ten-degree Celsius change. Analyses using protein chimeras indicate that heat-sensing is mediated by a thermosensitive Per-Arnt-SIM (PAS) domain. TdcA homologs are widespread in sequence databases, and a distantly related, heterologously expressed homolog from the Betaproteobacteria order Gallionellales also displayed thermosensitive diguanylate cyclase activity. We propose, therefore, that thermotransduction is a conserved function of c-di-GMP signaling networks, and that thermosensitive catalysis of a second messenger constitutes a mechanism for thermal sensing in bacteria.

A Mobile App (BEDSide Mobility) to Support Nurses' Tasks at the Patient's Bedside: Usability Study.

BACKGROUND: The introduction of clinical information systems has increased the amount of clinical documentation. Although this documentation generally improves patient safety, it has become a time-consuming task for nurses, which limits their time with the patient. On the basis of a user-centered methodology, we have developed a mobile app named BEDSide Mobility to support nurses in their daily workflow and to facilitate documentation at the bedside. OBJECTIVE: The aim of the study was to assess the usability of the BEDSide Mobility app in terms of the navigation and interaction design through usability testing. METHODS: Nurses were asked to complete a scenario reflecting their daily work with patients. Their interactions with the app were captured with eye-tracking glasses and by using the think aloud protocol. After completing the tasks, participants filled out the system usability scale questionnaire. Descriptive statistics were used to summarize task completion rates and the users' performance. RESULTS: A total of 10 nurses (aged 21-50) participated in the study. Overall, they were satisfied with the navigation, layout, and interaction design of the app, with the exception of one user who was unfamiliar with smartphones. The problems identified were related to the ambiguity of some icons, the navigation logic, and design inconsistency. CONCLUSIONS: Besides the usability issues identified in the app, the participants' results do indicate good usability, high acceptance, and high satisfaction with the developed app. However, the results must be taken with caution because of the poor ecological validity of the experimental setting.

IT-based wellness tools for older adults: Design concepts and feedback.

OBJECTIVE: To explore older adults' preferences regarding e-health applications through use of generated concepts that inform wellness tool design. METHODS: The 6-8-5 method and affinity mapping were used to create e-health design ideas that were translated into storyboards and scenarios. Focus groups were conducted to obtain feedback on the prototypes and included participant sketching. A qualitative analysis of the focus groups for emerging themes was conducted, and sketches were analyzed. RESULTS: Forty-three older adults participated in six focus group sessions. The majority of participants found the wellness tools useful. Preferences included features that supported participants in areas of unmet needs, such as ability to find reliable health information, cognitive training, or maintaining social ties. Participants favored features such as use of voice navigation, but were concerned over cost and the need for technology skills and access. Sketches reinforced these wants, including portability, convenience, and simplicity. CONCLUSIONS: Several factors were found to increase the desirability of such devices including convenient access to their health and health information, a simple, accessible interface, and support for memory issues. Researchers and designers should incorporate the feedback of older adults regarding wellness tools, so that future designs meet the needs of older adults.

Examining Korean and Korean American older adults' perceived acceptability of home-based monitoring technologies in the context of culture.

OBJECTIVE: Despite the increasing use of home-based monitoring technologies by older adults, few studies have examined older adults' acceptance of these technologies, especially among people from diverse cultural groups. The purpose of this study was to explore Korean and Korean American older adults' attitudes toward and perceptions of home-based monitoring technologies in a cultural context. METHODS: A qualitative analysis of focus groups and individual interviews using inductive coding methods and a constant comparative approach for emerging themes was conducted. RESULTS: Several cultural factors that determine the acceptability of home-based monitoring technologies were identified. Most notably, the necessity of living alone due to loosened filial tradition and immigration was a main motivator for adopting these technologies for both Korean and Korean Americans. The level of satisfaction with the health care system or therapeutic interaction affected participants' perceived need for technologies. Compared with the Korean American group, Korean older adults regarded the government's role as more important in increasing adoption and use of new technologies. CONCLUSIONS: Contextual factors need to be considered when explaining perceptions of home-based monitoring technologies among older adults from various ethnic groups and developing diffusion strategies according to end users' attitudes, experiences, and cultural backgrounds.

Older adults' attitudes and preferences regarding a multifunctional wellness tool: A pilot study.

OBJECTIVE: To examine older adults' attitudes toward multifunctional technology tools and specific preferences and expectations that would maximize their utility and usability. METHODS: We held three focus group sessions for this pilot study to determine perceptions of older adults toward multifunctional wellness tools, including usefulness and barriers to use. Areas discussed included features that would be wanted or unwanted, form factor and context of use. Recordings were transcribed and qualitative content analysis was performed. RESULTS: Fourteen older adults participated in the focus group sessions. Participants viewed potential uses for wellness tools with regard to their health and health information positively, as they felt currently available tools were lacking. In addition, participants felt that a single-user, smaller, portable device would be more useful than a non-portable multi-user device. Concerns were expressed toward technologies that were difficult to use with aging-related changes, privacy and perceptions of technology. CONCLUSIONS: Participants felt generally positively toward a multifunctional wellness tool and would be willing to use one if it were portable, intuitive and had reliable health-related information on the device.

Use of Patient Portals: Personal Health Information Management in Older Adults.

The personal health information management (PHIM) of older adults is poorly understood. We describe initial results from the SOARING (Studying Older Adults & Researching Information Needs and Goals) study at the University of Washington, a participatory design investigation of PHIM in older adults. We conducted in-depth interviews with older adults (n=71) living in a variety of residential settings. A surprising 21% of participants reported using patient portals. Another 17% of participants reported prior use or anticipated use of portals in the future. We identified preferences and needs as well as barriers and facilitators to portal use. Our findings indicate that patient portals designed to target the specific needs for older adults can suport PHIM. We offer recommendations for expanded research.

The use of think-aloud and instant data analysis in evaluation research: Exemplar and lessons learned.

While health information technologies have become increasingly popular, many have not been formally tested to ascertain their usability. Traditional rigorous methods take significant amounts of time and manpower to evaluate the usability of a system. In this paper, we evaluate the use of instant data analysis (IDA) as developed by Kjeldskov et al. to perform usability testing on a tool designed for older adults and caregivers. The IDA method is attractive because it takes significantly less time and manpower than the traditional usability testing methods. In this paper we demonstrate how IDA was used to evaluate usability of a multifunctional wellness tool, discuss study results and lessons learned while using this method. We also present findings from an extension of the method which allows the grouping of similar usability problems in an efficient manner. We found that the IDA method is a quick, relatively easy approach to identifying and ranking usability issues among health information technologies.

Use of Patient Portals for Personal Health Information Management: The Older Adult Perspective.

The personal health information management (PHIM) practices and needs of older adults are poorly understood. We describe initial results from the UW SOARING project (Studying Older Adults & Researching Information Needs and Goals), a participatory design investigation of PHIM in older adults (60 years and older). We conducted in-depth interviews with older adults (n=74) living in a variety of residential settings about their management of personal health information. A surprising 20% of participants report using patient portals and another 16% reported prior use or anticipated use of portals in the future. Participants cite ease of access to health information and direct communication with providers as valuable portal features. Barriers to the use of patient portals include a general lack of computer proficiency, high internet costs and security concerns. Design features based on consideration of needs and practices of older adults will facilitate appeal and maximize usability; both are elements critical to adoption of tools such as patient portals that can support older adults and PHIM.

Exploring an informed decision-making framework using in-home sensors: older adults' perceptions.

BACKGROUND: Sensor technologies are designed to assist independent living of older adults. However, it is often difficult for older adults to make an informed decision about adopting sensor technologies. OBJECTIVE: To explore Bruce's framework of informed decision making (IDM) for in-home use of sensor technologies in community-dwelling elders. METHOD: The IDM framework guided development of a semi-structured interview. A theory-driven coding approach was used for analysis. RESULTS: Participants supported most of the elements of the framework, but not all aspects of each element were addressed. Perceived usefulness of technologies was identified as an area for framework extension. CONCLUSION: This paper provides useful information for health care professionals to consider how to enhance IDM of older adults regarding the use of sensor technologies. The results also illuminate elements of the IDM framework that may be critical to facilitating independent living for older adults.

The use of social networking sites for public health practice and research: a systematic review.

BACKGROUND: Social networking sites (SNSs) have the potential to increase the reach and efficiency of essential public health services, such as surveillance, research, and communication. OBJECTIVE: The objective of this study was to conduct a systematic literature review to identify the use of SNSs for public health research and practice and to identify existing knowledge gaps. METHODS: We performed a systematic literature review of articles related to public health and SNSs using PubMed, EMBASE, and CINAHL to search for peer-reviewed publications describing the use of SNSs for public health research and practice. We also conducted manual searches of relevant publications. Each publication was independently reviewed by 2 researchers for inclusion and extracted relevant study data. RESULTS: A total of 73 articles met our inclusion criteria. Most articles (n=50) were published in the final 2 years covered by our search. In all, 58 articles were in the domain of public health research and 15 were in public health practice. Only 1 study was conducted in a low-income country. Most articles (63/73, 86%) described observational studies involving users or usages of SNSs; only 5 studies involved randomized controlled trials. A large proportion (43/73, 59%) of the identified studies included populations considered hard to reach, such as young individuals, adolescents, and individuals at risk of sexually transmitted diseases or alcohol and substance abuse. Few articles (2/73, 3%) described using the multidirectional communication potential of SNSs to engage study populations. CONCLUSIONS: The number of publications about public health uses for SNSs has been steadily increasing in the past 5 years. With few exceptions, the literature largely consists of observational studies describing users and usages of SNSs regarding topics of public health interest. More studies that fully exploit the communication tools embedded in SNSs and study their potential to produce significant effects in the overall population's health are needed.

Testing a theory-based mobility monitoring protocol using in-home sensors: a feasibility study.

Mobility is a key factor in the performance of many everyday tasks required for independent living as a person ages. The purpose of this mixed-methods study was to test a theory-based mobility monitoring protocol by comparing sensor-based measures to self-report measures of mobility and assess the acceptability of in-home sensors with older adults. Standardized instruments to measure physical, psychosocial, and cognitive parameters were administered to 8 community-dwelling older adults at baseline, 3-month, and 6-month visits. Semi-structured interviews to characterize acceptability of the technology were conducted at the 3-month and 6-month visits. Technical issues prevented comparison of sensor-based measures with self-report measures. In-home sensor technology for monitoring mobility is acceptable to older adults. Implementing our theory-based mobility monitoring protocol in a field study in the homes of older adults is a feasible undertaking but requires more robust technology for sensor-based measure validation.

Older adults and mobile phones for health: a review.

OBJECTIVE: To report on the results of a review concerning the use of mobile phones for health with older adults. METHODS: PubMed and CINAHL were searched for articles using "older adults" and "mobile phones" along with related terms and synonyms between 1965 and June 2012. Identified articles were filtered by the following inclusion criteria: original research project utilizing a mobile phone as an intervention, involve/target adults 60 years of age or older, and have an aim emphasizing the mobile phone's use in health. RESULTS: Twenty-one different articles were found and categorized into ten different clinical domains, including diabetes, activities of daily life, and dementia care, among others. The largest group of articles focused on diabetes care (4 articles), followed by COPD (3 articles), Alzheimer's/dementia Care (3 articles) and osteoarthritis (3 articles). Areas of interest studied included feasibility, acceptability, and effectiveness. While there were many different clinical domains, the majority of studies were pilot studies that needed more work to establish a stronger base of evidence. CONCLUSIONS: Current work in using mobile phones for older adult use are spread across a variety of clinical domains. While this work is promising, current studies are generally smaller feasibility studies, and thus future work is needed to establish more generalizable, stronger base of evidence for effectiveness of these interventions.