Rich context information for just-in-time adaptive intervention promoting physical activity.

Sedentary lifestyle and inadequate levels of physical activity represent two serious health risk factors. Nevertheless, within developed countries, 60% of people aged over 60 are deemed to be sedentary. Consequently, interest in behavior change to promote physical activity is increasing. In particular, the role of emerging mobile apps to facilitate behavior change has shown promising results. Smart technologies can help in providing rich context information including an objective assessment of the level of physical activity and information on the emotional and physiological state of the person. Collectively, this can be used to develop innovative persuasive solutions for adaptive behavior change. Such solutions offer potential in reducing levels of sedentary behavior. This work presents a study exploring new ways of employing smart technologies to facilitate behavior change. It is achieved by means of (i) developing a knowledge base on sedentary behaviors and recommended physical activity guidelines, and (ii) a context model able to combine information on physical activity, location, and a user's diary to develop a context-aware virtual coach with the ability to select the most appropriate behavior change strategy on a case by case basis.

Promoting autonomy in a smart home environment with a smarter interface.

In the not too distant future, the median population age will tend towards 65; an age at which the need for dependency increases. Most older people want to remain autonomous and self-sufficient for as long as possible. As environments become smarter home automation solutions can be provided to support this aspiration. The technology discussed within this paper focuses on providing a home automation system that can be controlled by most users regardless of mobility restrictions, and hence it may be applicable to older people. It comprises a hybrid Brain-Computer Interface, home automation user interface and actuators. In the first instance, our system is controlled with conventional computer input, which is then replaced with eye tracking and finally a BCI and eye tracking collaboration. The systems have been assessed in terms of information throughput; benefits and limitations are evaluated.

A review of the role of assistive technology for people with dementia in the hours of darkness.

Assistive Technology (AT) has been utilized to support people with dementia (PwD) and their carers in the home. Such support can extend the time that PwD can remain safely at home and reduce the burden on the tertiary healthcare sector. Technology can assist people in the hours of darkness as well as during the day. The objective of this literature review is to evaluate reported healthcare technologies appropriate to night time care. This paper summarises and categorises the current evidence base. In all, 131 abstracts were returned from a database search, yielding fifty four relevant papers which were considered in detail. While night-time specific studies identified very few papers (4 papers, 7%), most of the more general AT findings could be adopted to benefit night-time assistance. Studies have used technology for prompting and reminding as loss of time and forgetfulness are major problems; for monitoring daily activities in a sensor enriched environment and utilised location aware technologies to provide information to enhance safety. Technology also supports a range of therapies to alleviate symptoms. Therapies include the delivery of music and familial pictures for reminiscing, the use of light therapy to enhance wellbeing and the provision of mental tasks to stimulate the brain and maintain activity levels.

An unusual case of Epstein-Barr virus driven lymphoproliferative disorder of the conjunctiva which mimicked a high grade lymphoma: a sheep in wolf's clothing.

Lymphoid proliferations represent 25-33% of acquired sub-epithelial conjunctival lesions which are excised or biopsied in patients over 15 years of age. These lesions are reported in association with Epstein-Barr virus (EBV). One such case of EBV associated spontaneously regressed monoclonal B cell infiltrate in conjunctiva that mimicked a large B cell lymphoma is reported.

A comparison of modelling and imagery in the acquisition and retention of motor skills.

Although many researchers have examined the effects of imagery and/or modelling interventions, it is unclear which of the two interventions is more effective. In two experiments, novice learners assessed over multiple trials of a free weight squat lifting or a stabilometer balancing task were given modelling, imagery, a combination of modelling and imagery, or control interventions. Group differences indicated, in general, that groups receiving modelling (modelling, combination) evidenced a more appropriate form than groups that did not receive modelling (imagery, control). When apparent, these differences were already in place after the first of several interventions. Practical implications are that even a single bout of modelling can have immediate beneficial effects on movement form (Experiments 1 and 2) and outcome (Experiment 1).

Differentiation of the follicle-associated epithelium in ileal Peyer's patch and production of 50-nm particles are maintained in B-cell-depleted fetal sheep.

To evaluate the dependence of the differentiation of the follicle-associated epithelium (FAE) on the presence of follicular B-cells, the FAE of ileal Peyer's patch follicles was examined in B-cell-depleted fetal lambs. The FAE of these rudimentary follicles, which are devoid of lymphocytes, showed normal differentiation, including carbonic anhydrase reactivity and ultrastructural characteristics of transcytosis, extensive interdigitation of the lateral plasma membrane and the shedding of membrane-bounded particles, approximately 50 nm in size, resembling exosomes. These 50-nm membrane-bounded particles were abundant in the extracellular space of the epithelium and the dome but no particles were found in the rudimentary follicles. This study confirms that the rudimentary follicles consist of clusters of follicular dendritic cells. Our findings suggest that the differentiation of FAE of ileal Peyer's patch and the production of the 50-nm particles constitute features that appear to be independent of B-cells.

Structure data entry using graphical input: recording symptoms for multiple sclerosis.

Structured Data Entry provides flexible and efficient input to the computer-based patient record. We have utilized the SDE approach to build a prototype interface for recording common symptoms associated with Multiple Sclerosis (MS). The software provides both graphical input and output, to facilitate efficient data entry and monitoring of data. Graphical input is transformed to textual information, which is stored in a database in a hierarchical tree structure. Pain management in MS may be achieved by careful monitoring of the symptom in response to treatment. Pain location is selected on a body image and severity and other attributes represented using a graphical visual analog scale, leading to more convenient input and a less ambiguous coding than is achievable with narrative text alone. This approach could provide an objective means of monitoring the progress of the disease and management of the symptoms. The intuitive interface may also facilitate self-monitoring.

The effect of dosage, gestational age and splenectomy on anti-IgM interception of prenatal B-cell development in sheep.

The administration of a single bolus of anti-IgM antibody to foetal lambs early in pregnancy produces prolonged B-cell depletion. The present study investigated this depletion by examining the effect, on B-cell development in the ileal Peyer's patches, of varying the timing and dosage of antibody administration and by supplementing anti-IgM with surgical splenectomy. The capacity of a 1 mg bolus of anti-IgM to deplete Peyer's patches of B cells was lost if its administration was deferred until two thirds of the way through pregnancy, but persisted beyond this time if weight-adjusted doses were used. Splenectomy of the foetus performed at an earlier age failed to extend the age at which a 1 mg dose of antibody remained effective. As the concentration of murine immunoglobulin in foetal serum was greatly reduced after 21 days, it is inferred that ongoing suppression of B-cell development is not dependent on the continued presence of murine immunoglobulin. The enduring nature of suppression could be attributable to a limited period during which differentiation of B cells from stem cells normally occurs, although further studies will be needed to investigate this and other possible explanations for the effect of anti-IgM treatment on prenatal B-cell development in sheep.

An application of linear output error modelling for studying lymphocyte migration in peripheral lymphoid tissues.

Lymphocyte recirculation between lymphatic and blood vessels and migration through tissues are essential mechanisms underlying immunological surveillance. However, the kinetics of lymphocyte migration through lymphoid tissues remains poorly understood. The present study of lymphocyte migration, based on a sheep model and entailing the long term cannulation of blood vessels and lymphatic vessels efferent from lymph nodes, represents the first attempt to apply control engineering based models to overcome some of the experimental impediments to understanding the complex phenomena involved in lymphocyte migration. An output error model order (1,2,nk) was systematically selected under given criteria from four classes of Linear Time-Invariant Single-Input Single-Output, (LTI-SISO) systems to represent the peripheral lymph node system. The unit impulse responses were simulated under noise free conditions and their features were extracted to describe the dynamics of the system. The findings from this study revealed novel information about several aspects of the dynamics of lymphocyte migration.

Student-centered distance learning in health and medical informatics.

Learning and teaching of health and medical Informatics is currently supported by web based material, which in the main has been derived from traditional texts. Aided by contributions from the expert community, the web site of the handbook of Medical Informatics has been developed to incorporate increased interactivity (with question and answers related to each section). This approach has proved beneficial to both student and teacher. To further increase the interactivity of the WWW we investigate the suitability of authoring tools for developing complex simulations and interactive tutorials, using an example from the area of quantitative decision support (Bayes Theorem). We propose that these tools provide a suitable platform for the preparation and delivery of collaboratively produced HMI courses, which address open and distance learning and pedagogic issues.

Segregation of B lymphocytes into stationary apoptotic and migratory proliferating subpopulations in agglomerate cultures with ileal epithelium.

The B lymphocyte-epithelial cell interactions that define the microenvironment of the ileal Peyer's patch, the primary B lymphocyte organ of the fetal lamb, have been replicated in tissue culture. Mixed suspensions of ileal epithelial cells, lymphocytes and fibroblasts from fetuses of 63-103 days of gestation organized into macroscopically visible agglomerates within 72 h. These agglomerates contained translucent spherical cavities and were enclosed within a marginal cell layer and surrounded by an expanding corona of emigrating cells. The lining of the cavities and the marginal layer consisted of well-differentiated, polarized columnar ileal epithelial cells. One population of B lymphocytes in the initial mixed suspension differentiated into two discrete populations reproducing the characteristics of intact fetal ileal Peyer's patches. B cells apposed to follicle-associated epithelium (FAE) within agglomerates underwent apoptosis. The other population of emigrant B cells proliferated and expressed the BAQ44A differentiation marker. Differentiation of ileal epithelial cells into FAE, typical of Peyer's patches, was markedly accelerated. The mutually inductive influences of intestinal epithelial cells and B lymphocytes in these agglomerates replicate normal mid-gestational fetal development of the mucosal immune system and afford new opportunities for its further investigation.

Paradigms for recording cognitive brain electrical activity.

Human event-related potentials reflect cognitive processing, and are normally elicited by external events, such as acoustic sounds or visual stimuli. As such they provide an opportunity to study normal and abnormal brain function noninvasively, at sub-second resolution. Advances in multimedia technology permit specialists in informatics and neuropsychology to co-operate in the design and implementation of paradigms, which influence ERP components. The paper illustrates the progression from standard paradigms such as the auditory oddball, which can be used to study memory update through to contingent negative variation and three condition, visual paradigms which can be used to study cognitive and emotional responses. Data from a study investigating the comparative processing of target pictures and words illustrate how external stimuli influence the later cognitive potentials.

Effect of early fetal splenectomy on prenatal B-cell development in sheep.

The contribution of early splenic B-cell populations to the colonization of the ileal Peyer's patch was investigated following the surgical removal of the spleen in a series of 56-day-old fetal sheep. The fetuses were killed at 140 days of gestation and the ileal Peyer's patch, the distal jejunal lymph node which drains the Peyer's patch, and a peripheral lymph node, the superficial cervical lymph node, were examined. Enzyme and immunohistochemical evaluation concluded that the distribution of B cells, T cells and stromal cells in the ileal Peyer's patch was similar in splenectomized and normal fetal sheep. Thus, the presence of the fetal spleen was not essential for the colonization of the ileal Peyer's patch and other early sites of B-cell accumulation would appear capable of generating the necessary precursor populations. Investigation of B-cell populations in lymph nodes used a combination of terminal deoxynucleotidyl-transferase-mediated deoxyuridine-triphosphate nick-end-labelling (TUNEL) histochemistry and immunofluorescence to determine the average number of apoptotic B cells in the primary follicles of the outer cortex of splenectomized and normal lambs. A significantly increased number of apoptotic B cells was present in the distal jejunal lymph node but not in the superficial cervical lymph node of splenectomized lambs. This finding suggests that splenectomy affected prenatal B-cell development in fetal sheep and raises questions as to the regulation of B-cell lymphopoiesis in a species using a post-rearrangement organ of diversification.

Splenectomy of the fetal lamb early in development as a model for congenital asplenia.

BACKGROUND: The liability to overwhelming infection of children lacking a spleen either as a result of its congenital absence or because of splenectomy, has been frequently documented. Although there have been numerous studies of the consequences of experimental splenectomy in postnatal animals, this is the first study of the effects of this operation in early fetal life. METHODS: A technique is described for microsurgical removal of the spleen from fetal lambs approximately one-third of the way through gestation, when the fetus is approximately the size of a mouse. Lambs that had been splenectomized in utero were submitted to haematological examination in postnatal life and were challenged with pneumococcal polysaccharide to test their immunological competence. RESULTS: Lambs in which splenectomy had been performed close to the gestational age of initiation of the splenic contribution to differentiation of immune and haemopoietic systems, exhibited insignificant deviations from normality in postnatal life. CONCLUSION: Provided the spleen is removed from the fetal lamb sufficiently early in gestation, it is possible for other lymphoid tissues to compensate for most of the deficiencies that would be anticipated in animals lacking a spleen. In this experiment, splenectomy was performed at approximately the developmental stage equivalent to that at which the spontaneous interruption of development that leads to human congenital asplenia occurs. The absence of major postnatal abnormalities observed in these lambs reinforces the significance of the associated abnormalities in the development of the clinical deficits observed in children with spontaneous asplenia.

Modelling of peripheral lymphocyte migration: system identification approach.

This is the first application of the prediction error method (PEM) of system identification to modelling lymphocyte migration through peripheral lymphoid tissue. The PEM was applied to the emergence of labelled lymphocytes from the efferent lymphatic of a lymph node following their intravenous administration. Advantages of PEM included the capacity to calculate the response to a unit impulse stimulus, unavailable to direct observation, and to allow for the return to the node of labelled cells that had already recirculated once. Calculation of the system delay (time between introduction of cells into the blood and their first appearance in lymph) indicated 4.67 +/- 1.05 h for the total lymphocyte population. The peak in efferent lymph occurred at 11.91 +/- 4.68 h, much earlier than previous reports, which were affected by cells that had already recirculated. While 75% of labelled cells had emerged in efferent lymph by 20.77 +/- 5.62 h, 86.38 +/- 29.44 h was required for 100% emergence. The considerable heterogeneity in migratory behaviour is likely to reflect frequency and duration of binding of lymphocytes by dendritic cells in paracortical cord corridors. It is proposed that differences in the speed with which lymphocytes pass along corridors depend on their functional status, in particular whether they are naïve or memory cells.

The cloning, mapping and expression of a novel gene, BRL, related to the AF10 leukaemia gene.

The MLL gene is reciprocally translocated with one of a number of different partner genes in a proportion of human acute leukaemias. The precise mechanism of oncogenic transformation is unclear since most of the partner genes encode unrelated proteins. However, two partner genes, AF10 and AF17 are related through the presence of a cysteine rich region and a leucine zipper. The identification of other proteins with these structures will aid our understanding of their role in normal and leukaemic cells. We report the cloning of a novel human gene (BRL) which encodes a protein containing a cysteine rich region related to that of AF10 and AF17 and is overall most closely related to the previously known protein BR140. BRL maps to chromosome 22q13 and shows high levels of expression in testis and several cell lines. The deduced protein sequence also contains a bromodomain, four potential LXXLL motifs and four predicted nuclear localization signals. A monoclonal antibody raised to a BRL peptide sequence confirmed its widespread expression as a 120 Kd protein and demonstrated localization to the nucleus within spermatocytes.

Tumour responding accessory cells in testicular seminoma: an immunohistochemical study.

AIM: To investigate the role of accessory cells (and other chronic inflammatory cells) in the host immune response to testicular seminoma by defining their immunophenotypic characteristics and topographical arrangement. METHODS AND RESULTS: A panel of antibodies applicable to paraffin-embedded tissues was employed to characterize the host chronic inflammatory response in eight cases of classical testicular seminoma. The antibodies were directed against CD45RO, CD20, CD68, acid cysteine proteinase inhibitor (ACPI), MAC387, muramidase (MUR), S100 protein, Factor XIIIa, CD21 and HLA Class II. In all cases the majority of the inflammatory cells were T-lymphocytes situated mainly in areas of apparent tumour destruction. Large numbers of macrophages/dendritic cells which had not been evident by conventional light microscopy were also demonstrated. In particular, an immunophenotypically distinct population of accessory cells showing a specific pattern of distribution was revealed. It clearly rimmed islands of tumour and showed strong positive staining for CD68, MAC387 and HLA Class II. CONCLUSION: The study has identified an immunophenotypically distinct population of accessory cells showing a characteristic topographical arrangement. It is proposed that it represents a subpopulation of macrophages which are responding directly to the tumour and are likely to play a part in influencing tumour dynamics.

WWW as a teaching resource for introductory medical informatics in primary care.

This pro and contra report assesses the current state of the WWW as a teaching aid for Medical Informatics, using the experience gained from the delivery of a module to a heterogeneous group of health workers enrolled in an MSc/PgDip in Primary Care. The students were expected to act as both information consumers in a directed bibliographic retrieval task and information providers for Primary Care. The students' perceptions as to the usefulness and local relevance of current resources on the world wide web (WWW) are discussed.