Control, Extract, Legitimate: COVID-19 and Digital Techno-opportunism across Africa.

Across Africa, the deployment of digital solutions such as track and trace apps and vaccine passports to tackle COVID-19 largely failed in their public health objectives. Yet, in the process, these material interventions revealed and unleashed new potentialities of governance throughout the continent. This article examines these developments and their significance through historical and theoretical lenses. Since colonialism, African states have been built partially through responses to public health emergencies. Such emergencies have enabled authorities to experiment with and enact logics of control, extraction and legitimation. By interrogating the relationship between epidemics, power and technological artefacts, this article argues that COVID-19 constituted an exceptional event that both unmasked pre-existing logics of governance but also enabled experiments with novel techniques through digital technology. Digital techno-opportunist interventions did little to curb the spread of COVID-19, but such interventions nevertheless have ramifications and implications that extend beyond this moment. While the political outcomes of the rupture caused by COVID-19 are not yet fully known, and are subject to resistance and reimagination from below, the political opportunity of 'crisis' reveals distinctly new ways in which states and corporations are combining to pursue logics of control, extraction and legitimation across Africa in a digital age.

Injured patients who would benefit from expedited major trauma centre care: a consensus-based definition for the United Kingdom.

INTRODUCTION: Despite the importance of treating the 'right patient in the right place at the right time', there is no gold standard for defining which patients should receive expedited major trauma centre (MTC) care. This study aimed to define a reference standard applicable to the United Kingdom (UK) National Health Service major trauma networks. METHODS: A one-day facilitated roundtable expert consensus meeting was conducted at the University of Sheffield, UK, in September 2019. An expert panel of 17 clinicians was purposively sampled, representing all specialities relevant to major trauma management. A consultation process was subsequently held using focus groups with Public and Patient Involvement (PPI) representatives to review and confirm the proposed reference standard. RESULTS: Four reference standard domains were identified, comprising: need for critical interventions; presence of significant individual anatomical injuries; burden of multiple minor injuries; and important patient attributes. Specific criteria were defined for each domain. PPI consultation confirmed all aspects of the reference standard. A coding algorithm to allow operationalisation in Trauma Audit and Research Network data was also formulated, allowing classification of any case submitted to their database for future research. CONCLUSIONS: This reference standard defines which patients would benefit from expedited MTC care. It could be used as the target for future pre-hospital injury triage tools, for setting best practice tariffs for trauma care reimbursement and to evaluate trauma network performance. Future research is recommended to compare patient characteristics, management and outcomes of the proposed definition with previously established reference standards.

Signaligner Pro: A Tool to Explore and Annotate Multi-day Raw Accelerometer Data.

Human activity recognition using wearable accelerometers can enable in-situ detection of physical activities to support novel human-computer interfaces. Many of the machine-learning-based activity recognition algorithms require multi-person, multi-day, carefully annotated training data with precisely marked start and end times of the activities of interest. To date, there is a dearth of usable tools that enable researchers to conveniently visualize and annotate multiple days of high-sampling-rate raw accelerometer data. Thus, we developed Signaligner Pro, an interactive tool to enable researchers to conveniently explore and annotate multi-day high-sampling rate raw accelerometer data. The tool visualizes high-sampling-rate raw data and time-stamped annotations generated by existing activity recognition algorithms and human annotators; the annotations can then be directly modified by the researchers to create their own, improved, annotated datasets. In this paper, we describe the tool's features and implementation that facilitate convenient exploration and annotation of multi-day data and demonstrate its use in generating activity annotations.

A Framework for Integrating Arts, Science, and Social Justice Into Culturally Responsive Public Health Communication and Innovation Designs.

Objectives. To increase the scale and efficacy of health promotion practice, culturally responsive approaches to well-being are needed in both communication and practice innovation. This mixed-methods evaluation sought to identify specific mechanisms used in a promising practice model and offers a potential theoretical framework to support public health programs in integrating culture and social justice into communication and intervention programs. Study Design. Rooted at the intersection of ethnographic and phenomenological worldviews, this mixed-methods, retrospective process evaluation used publicly available empirical and experiential data centered on the arts, science, and social justice to identify critical mechanisms used and incorporate them into an emergent theoretical framework. Method. The retrospective process evaluation used an ethnography-informed approach combined with scientific literature reviews. To integrate adjacent ideas into the emergent theoretical framework, a phenomenologically informed theme development approach was used. Results. The evaluation resulted in a five-step framework, called MOTIF, with the potential to be utilized in diverse situational and geographic contexts. Data that surfaced from related literature reviews revealed adjacent mechanisms from positive psychology, critical consciousness theory, and innovation design that were incorporated into the emergent framework. Conclusion. MOTIF may offer a culturally responsive public health communication and innovation process capable of promoting health equity through the cultivation of relationships between artists, community participants, and public health agencies and researchers who collectively endeavor to craft innovative solutions for population health and well-being.

Heat Treatment Improves Hepatic Mitochondrial Respiratory Efficiency via Mitochondrial Remodeling.

Nonacholic fatty liver disease, or hepatic steatosis, is the most common liver disorder affecting the western world and currently has no pharmacologic cure. Thus, many investigations have focused on alternative strategies to treat or prevent hepatic steatosis. Our laboratory has shown that chronic heat treatment (HT) mitigates glucose intolerance, insulin resistance, and hepatic steatosis in rodent models of obesity. Here, we investigate the direct bioenergetic mechanism(s) surrounding the metabolic effects of HT on hepatic mitochondria. Utilizing mitochondrial proteomics and respiratory function assays, we show that one bout of acute HT (42°C for 20 min) in male C57Bl/6J mice (n = 6/group) triggers a hepatic mitochondrial heat shock response resulting in acute reductions in respiratory capacity, degradation of key mitochondrial enzymes, and induction of mitophagy via mitochondrial ubiquitination. We also show that chronic bouts of HT and recurrent activation of the heat shock response enhances mitochondrial quality and respiratory function via compensatory adaptations in mitochondrial organization, gene expression, and transport even during 4 weeks of high-fat feeding (n = 6/group). Finally, utilizing a liver-specific heat shock protein 72 (HSP72) knockout model, we are the first to show that HSP72, a protein putatively driving the HT metabolic response, does not play a significant role in the hepatic mitochondrial adaptation to acute or chronic HT. However, HSP72 is required for the reductions in blood glucose observed with chronic HT. Our data are the first to suggest that chronic HT (1) improves hepatic mitochondrial respiratory efficiency via mitochondrial remodeling and (2) reduces blood glucose in a hepatic HSP72-dependent manner.

Is a definitive trial of prehospital continuous positive airway pressure versus standard oxygen therapy for acute respiratory failure indicated? The ACUTE pilot randomised controlled trial.

OBJECTIVES: To determine the feasibility of a large-scale definitive multicentre trial of prehospital continuous positive airway pressure (CPAP) in acute respiratory failure. DESIGN: A single-centre, open-label, individual patient randomised, controlled, external pilot trial. SETTING: A single UK Ambulance Service, between August 2017 and July 2018. PARTICIPANTS: Adults with respiratory distress and peripheral oxygen saturations below British Thoracic Society target levels despite controlled oxygen treatment. INTERVENTIONS: Patients were randomised to prehospital CPAP (O-Two system) versus standard oxygen therapy in a 1:1 ratio using simple randomisation. PRIMARY AND SECONDARY OUTCOME MEASURES: Feasibility outcomes comprised recruitment rate, adherence to allocated treatment, retention and data completeness. The primary clinical outcome was 30-day mortality. RESULTS: 77 patients were enrolled (target 120), including 7 cases with a diagnosis where CPAP could be ineffective or harmful. CPAP was fully delivered in 74% (target 75%). There were no major protocol violations. Full data were available for all key outcomes (targets ≥90%). Overall 30-day mortality was 27.3%. Of these deceased patients, 14/21 (68%) either did not have a respiratory condition or had ceiling of treatment decisions implemented excluding hospital non-invasive ventilation and critical care. CONCLUSIONS: Recruitment rate was below target and feasibility was not demonstrated. Limited compliance with CPAP, and difficulty in identifying patients who could benefit from CPAP, indicate that prehospital CPAP is unlikely to materially reduce mortality. A definitive effectiveness trial of CPAP is therefore not recommended. TRIAL REGISTRATION NUMBER: ISRCTN12048261; Post-results.

Expertise and Engagement: Re-Designing Citizen Science Games With Players' Minds in Mind.

Many studies have already shown that games can be a useful tool to make boring or difficult tasks more engaging. However, with serious game design being a relatively nascent field, such experiences can still be hard to learn and not very motivating. In this paper, we explore the use of learning and motivation frameworks to improve player experience in the well-known citizen science game Foldit. Using Cognitive Load Theory (CLT) and Self Determination Theory (SDT), we developed six interface and mechanical changes to the tutorial levels in Foldit designed to increase engagement and retention. We tested these features with new players of Foldit and collected both behavioral data, using game metrics, and prior experience data, using self-report measures. This study offers three major contributions: (1) we document the process of operationalizing CLT and SDT as new game features, a unique methodology not used in game design previously; (2) the user interface, specifically the level selection screen, significantly impacts how players progress through the game; and (3) a player's expertise, whether from prior domain knowledge or prior gaming experience, increases their engagement. We discuss both implications of these findings as well as how these implementations can generalize to other designs.

Designing Videogames to Crowdsource Accelerometer Data Annotation for Activity Recognition Research.

Human activity recognition using wearable accelerometers can enable in-situ detection of physical activities to support novel human-computer interfaces and interventions. However, developing valid algorithms that use accelerometer data to detect everyday activities often requires large amounts of training datasets, precisely labeled with the start and end times of the activities of interest. Acquiring annotated data is challenging and time-consuming. Applied games, such as human computation games (HCGs) have been used to annotate images, sounds, and videos to support advances in machine learning using the collective effort of "non-expert game players." However, their potential to annotate accelerometer data has not been formally explored. In this paper, we present two proof-of-concept, web-based HCGs aimed at enabling game players to annotate accelerometer data. Using results from pilot studies with Amazon Mechanical Turk players, we discuss key challenges, opportunities, and, more generally, the potential of using applied videogames for annotating raw accelerometer data to support activity recognition research.

A review on protein markers of exosome from different bio-resources and the antibodies used for characterization.

Exosomes are small membrane vesicles (ranging from 30 nm to 150 nm), secreted by different cell types upon fusion of multivesicular bodies (MVB) to the cell plasma membrane under a variety of normal and pathological conditions. Through transferring their cargos such as proteins, lipids and nucleic acids from donor cells to recipient cells, exosomes play a crucial role in cell-to-cell communication. Due to their presence in most body fluids (such as blood, breast milk, saliva, urine, bile, pancreatic juice, cerebrospinal and peritoneal fluids), and their role in carrying bioactive molecules from the cells of origin, exosomes have attracted great interest in their diagnostic and prognostic value for various diseases and therapeutic approaches. Although a large body of literature has documented the importance of exosomes over the past decade, there is no article systematically summarizing protein markers of exosome from different resources and the antibodies that are suited to characterize exosomes. In this review, we briefly summarize the exosome marker proteins, exosomal biomarkers for different diseases, and the antibodies suitable for different bio-resources exosomes characterization.

Pre-hospital CPAP for acute respiratory failure: the ACUTE feasibility and pilot randomised controlled trial.

INTRODUCTION: Acute respiratory failure (ARF) is a common and life-threatening medical emergency. Continuous positive airway pressure (CPAP) is a potentially beneficial alternative treatment; however, it is uncertain whether this could improve important outcomes in NHS ambulance services. The ACUTE study aimed to assess the feasibility of a large-scale pragmatic trial of pre-hospital CPAP. METHODS: The study was a pilot randomised controlled trial of the O-Two system CPAP mask versus standard oxygen therapy, with concealed allocation in identical sealed boxes. Feasibility objectives estimated the incidence of eligible patients; the proportion recruited and allocated to treatment appropriately; adherence to allocated treatment; and retention and data completeness. The primary clinical endpoint was 30-day mortality. Ancillary studies included an ARF incidence study, ARF diagnostic agreement study, clinician perceptions of CPAP mixed methods study and investigation of allocation concealment. RESULTS: Over 12 months, 77 patients were enrolled (target 120). CPAP was fully delivered in 74% (target 75%). There were no major protocol violations/non-compliances. Full data were available for all key outcomes (targets ≥ 90%). Thirty-day mortality was 27.3%. Of deceased patients, 14/21 (68%) either did not have a respiratory condition or had ceiling of treatment decisions implemented excluding hospital NIV and critical care. CONCLUSION: The ACUTE trial recruitment rate was below the target rate and feasibility was not demonstrated. Identification of patients who might benefit from pre-hospital CPAP was challenging. It appeared difficult to exclude conditions where CPAP would not work, or might be harmful, and to select appropriate patients where there was a meaningful chance of success, or where the potential advantages of pre-hospital CPAP would outweigh the burdens of more advanced and aggressive treatment. The limited compliance with CPAP, and the difficulty in identifying patients who could benefit from CPAP, indicate that pre-hospital CPAP is unlikely to materially reduce mortality. A definitive effectiveness trial of CPAP in the NHS is therefore not recommended.

Large-Scale Analysis of Visualization Options in a Citizen Science Game.

Visualization is a valuable tool in problem solving, especially for citizen science games. In this study, we analyze data from 36,351 unique players of the citizen science game Foldit over a period of 5 years to understand how their choice of visualization options are affected by expertise and problem type. We identified clusters of visualization options, and found differences in how experts and novices view puzzles and that experts differentially change their views based on puzzle type. These results can inform new design approaches to help both novice and expert players visualize novel problems, develop expertise, and problem solve.

A Monte Carlo Approach to Skill-Based Automated Playtesting.

In order to create well-crafted learning progressions, designers guide players as they present game skills and give ample time for the player to master those skills. However, analyzing the quality of learning progressions is challenging, especially during the design phase, as content is ever-changing. This research presents the application of Stratabots-automated player simulations based on models of players with varying sets of skills-to the human computation game Foldit. Stratabot performance analysis coupled with player data reveals a relatively smooth learning progression within tutorial levels, yet still shows evidence for improvement. Leveraging existing general gameplaying algorithms such as Monte Carlo Evaluation can reduce the development time of this approach to automated playtesting without losing predicitive power of the player model.

Developing Cancer Informatics Applications and Tools Using the NCI Genomic Data Commons API.

The NCI Genomic Data Commons (GDC) was launched in 2016 and makes available over 4 petabytes (PB) of cancer genomic and associated clinical data to the research community. This dataset continues to grow and currently includes over 14,500 patients. The GDC is an example of a biomedical data commons, which collocates biomedical data with storage and computing infrastructure and commonly used web services, software applications, and tools to create a secure, interoperable, and extensible resource for researchers. The GDC is (i) a data repository for downloading data that have been submitted to it, and also a system that (ii) applies a common set of bioinformatics pipelines to submitted data; (iii) reanalyzes existing data when new pipelines are developed; and (iv) allows users to build their own applications and systems that interoperate with the GDC using the GDC Application Programming Interface (API). We describe the GDC API and how it has been used both by the GDC itself and by third parties. Cancer Res; 77(21); e15-18. ©2017 AACR.

Bicycle Trains, Cycling, and Physical Activity: A Pilot Cluster RCT.

INTRODUCTION: Increasing children's cycling to school and physical activity are national health goals. The objective was to conduct an RCT of a bicycle train program to assess impact on students' school travel mode and moderate-to-vigorous physical activity (MVPA). STUDY DESIGN: Pilot cluster RCT with randomization at the school level and N=54 participants. SETTING/PARTICIPANTS: Fourth-fifth graders from four public schools serving low-income families in Seattle, WA in 2014 with analyses in 2015-2016. All participants were provided and fitted with bicycles, safety equipment (helmets, locks, and lights), and a 2- to 3-hour bicycle safety course. INTERVENTION: The intervention was a bicycle train offered daily (i.e., students volunteered to cycle with study staff to and from school). MAIN OUTCOME MEASURES: Time 1 assessments occurred prior to randomization. Time 2 assessments occurred after 3-5 weeks of the intervention (i.e., during Weeks 4-6 of the intervention period). The primary outcome was the percentage of daily commutes to school by cycling measured by validated survey. MVPA, measured by accelerometry and GPS units and processed by machine learning algorithms, was a secondary outcome. RESULTS: For two separate adjusted repeated measures linear mixed effects models in which students (N=54) were nested within schools (N=4), intervention participants had: (1) an absolute increase in mean percentage of daily commutes by cycling of 44.9%, (95% CI=26.8, 63.0) and (2) an increase in mean MVPA of 21.6 minutes/day, (95% CI=8.7, 34.6) from Time 1 to Time 2 compared with controls. CONCLUSIONS: A pilot bicycle train intervention increased cycling to school and daily MVPA in the short term among diverse, inner-city elementary school students. The bicycle train intervention appears promising and warrants further experimental trials among large, diverse samples with longer follow-up. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02006186.

A multiancestral genome-wide exome array study of Alzheimer disease, frontotemporal dementia, and progressive supranuclear palsy.

IMPORTANCE: Previous studies have indicated a heritable component of the etiology of neurodegenerative diseases such as Alzheimer disease (AD), frontotemporal dementia (FTD), and progressive supranuclear palsy (PSP). However, few have examined the contribution of low-frequency coding variants on a genome-wide level. OBJECTIVE: To identify low-frequency coding variants that affect susceptibility to AD, FTD, and PSP. DESIGN, SETTING, AND PARTICIPANTS: We used the Illumina HumanExome BeadChip array to genotype a large number of variants (most of which are low-frequency coding variants) in a cohort of patients with neurodegenerative disease (224 with AD, 168 with FTD, and 48 with PSP) and in 224 control individuals without dementia enrolled between 2005-2012 from multiple centers participating in the Genetic Investigation in Frontotemporal Dementia and Alzheimer's Disease (GIFT) Study. An additional multiancestral replication cohort of 240 patients with AD and 240 controls without dementia was used to validate suggestive findings. Variant-level association testing and gene-based testing were performed. MAIN OUTCOMES AND MEASURES: Statistical association of genetic variants with clinical diagnosis of AD, FTD, and PSP. RESULTS: Genetic variants typed by the exome array explained 44%, 53%, and 57% of the total phenotypic variance of AD, FTD, and PSP, respectively. An association with the known AD gene ABCA7 was replicated in several ancestries (discovery P=.0049, European P=.041, African American P=.043, and Asian P=.027), suggesting that exonic variants within this gene modify AD susceptibility. In addition, 2 suggestive candidate genes, DYSF (P=5.53×10(-5)) and PAXIP1 (P=2.26×10(-4)), were highlighted in patients with AD and differentially expressed in AD brain. Corroborating evidence from other exome array studies and gene expression data points toward potential involvement of these genes in the pathogenesis of AD. CONCLUSIONS AND RELEVANCE: Low-frequency coding variants with intermediate effect size may account for a significant fraction of the genetic susceptibility to AD and FTD. Furthermore, we found evidence that coding variants in the known susceptibility gene ABCA7, as well as candidate genes DYSF and PAXIP1, confer risk for AD.

Absence of the fourth tendon of the flexor digitorum brevis muscle: a cadaveric study.

UNLABELLED: This study was undertaken to help confirm the percentages concerning the presence or absence of the flexor digitorum brevis muscle tendon to the fifth toe. We also hope to be able to determine the presence based on gender and nationality. It is known to be absent occasionally; however, there is no definitive study dedicated to its prevalence. Using a pool of 60 cadavers, 97 total feet were included in our analysis. Of these feet, 47 (48%) lacked a flexor digitorum brevis tendon to the fifth toe at all. Furthermore, 25 (26%) had notably small tendons to the fifth toe. The final 25 (26%) had what the researchers deemed present tendons. This information could be helpful in surgical planning, including tendon transfer techniques, and biomechanical evaluations. Further research would need to be conducted as this was a cadaveric study. LEVELS OF EVIDENCE: Cadaver/anatomy research, Level V.

Altered hypothalamic-pituitary-adrenocortical function in rhesus monkeys (Macaca mulatta) with self-injurious behavior.

Individually housed rhesus monkeys sometimes spontaneously develop self-injurious behavior (SIB) in the form of self-directed biting that, on occasion, results in severe tissue damage and mutilation. We previously demonstrated lower levels of plasma cortisol in rhesus monkeys with a history of self-wounding (SW) when compared to non-wounders (NW). Furthermore, cortisol levels were negatively correlated with rates of self-directed biting. The present study was designed to further characterize the relationships between hypothalamic-pituitary-adrenocortical (HPA) activity, self-wounding, and self-directed biting. Basal 24-h urinary free cortisol excretion, the urinary free cortisol response to a low dose of dexamethasone, and the plasma cortisol response to ACTH were examined in 24 individually housed rhesus monkeys, based on wounding history, i.e. the presence/absence of a veterinary record of self-wounding, and current rates of self-directed biting, i.e. the median split of self-directed biting frequency (independent of wounding status). There were no reliable group differences on any of the physiological measures when analyzed by wounding history. However, the plasma cortisol response 30 min post-ACTH stimulation was significantly correlated with wounding recency, such that lower responsivity was associated with more recent wounding episodes. When the results were analyzed on the basis of biting frequency, high frequency biters (HFB) compared to low frequency biters (LFB) showed decreased HPA negative feedback sensitivity to dexamethasone and a trend towards an attenuated plasma cortisol response to ACTH stimulation. These findings suggest that SIB in socially reared monkeys is associated with complex changes in HPA axis function that are related to the expression of the pathology, i.e. self-directed biting, and to the recency of a wounding episode. It remains to be determined whether humans who exhibit SIB show similar alterations in HPA function.