Mobile App Interventions for Parkinson's Disease, Multiple Sclerosis and Stroke: A Systematic Literature Review.

Central nervous system diseases (CNSDs) lead to significant disability worldwide. Mobile app interventions have recently shown the potential to facilitate monitoring and medical management of patients with CNSDs. In this direction, the characteristics of the mobile apps used in research studies and their level of clinical effectiveness need to be explored in order to advance the multidisciplinary research required in the field of mobile app interventions for CNSDs. A systematic review of mobile app interventions for three major CNSDs, i.e., Parkinson's disease (PD), multiple sclerosis (MS), and stroke, which impose significant burden on people and health care systems around the globe, is presented. A literature search in the bibliographic databases of PubMed and Scopus was performed. Identified studies were assessed in terms of quality, and synthesized according to target disease, mobile app characteristics, study design and outcomes. Overall, 21 studies were included in the review. A total of 3 studies targeted PD (14%), 4 studies targeted MS (19%), and 14 studies targeted stroke (67%). Most studies presented a weak-to-moderate methodological quality. Study samples were small, with 15 studies (71%) including less than 50 participants, and only 4 studies (19%) reporting a study duration of 6 months or more. The majority of the mobile apps focused on exercise and physical rehabilitation. In total, 16 studies (76%) reported positive outcomes related to physical activity and motor function, cognition, quality of life, and education, whereas 5 studies (24%) clearly reported no difference compared to usual care. Mobile app interventions are promising to improve outcomes concerning patient's physical activity, motor ability, cognition, quality of life and education for patients with PD, MS, and Stroke. However, rigorous studies are required to demonstrate robust evidence of their clinical effectiveness.

RESPOnSE-A Framework for Enforcing Risk-Aware Security Policies in Constrained Dynamic Environments.

The enforcement of fine-grained access control policies in constrained dynamic networks can become a challenging task. The inherit constraints present in those networks, which result from the limitations of the edge devices in terms of power, computational capacity and storage, require an effective and efficient access control mechanism to be in place to provide suitable monitoring and control of actions and regulate the access over the resources. In this article, we present RESPOnSE, a framework for the specification and enforcement of security policies within such environments, where the computational burden is transferred to high-tier nodes, while low-tier nodes apply risk-aware policy enforcement. RESPOnSE builds on a combination of two widely used access control models, Attribute-Based Access Control and Role-Based Access Control, exploiting the benefits each one provides. Moreover, the proposed mechanism is founded on a compensatory multicriteria decision-making algorithm, based on the calculation of the Euclidean distance between the run-time values of the attributes present in the security policy and their ideal values, as those are specified within the established policy rules.

The Anti-tuberculosis Battle in Greece in the 1800s and 1900s.

Tuberculosis is an infectious disease that mainly affects the lungs (known as pulmonary tuberculosis). Mycobacterium tuberculosis is a species of pathogenic bacteria in the family of Mycobacteriaceae and the causative agent of tuberculosis; it was discovered by Robert Koch in 1882. From about 1918 to 1939, tuberculosis in Greece was characterized as a social disease because it seemed to spread among the lower social classes, including displaced people living in refugee camps. The battle against tuberculosis involved private initiatives aimed at educating people on hygiene and establishing anti-tuberculosis institutions, such as sanatoria and preventoria.

Reliability, validity and minimal detectable change of the Mini-BESTest in Greek participants with chronic stroke.

OBJECTIVES: This study aimed to investigate the psychometric characteristics of reliability, validity and ability to detect change of a newly developed balance assessment tool, the Mini-BESTest, in Greek patients with stroke. DESIGN: A prospective, observational design study with test-retest measures was conducted. METHODS: A convenience sample of 21 Greek patients with chronic stroke (14 male, 7 female; age of 63 ± 16 years) was recruited. Two independent examiners administered the scale, for the inter-rater reliability, twice within 10 days for the test-retest reliability. Bland Altman Analysis for repeated measures assessed the absolute reliability and the Standard Error of Measurement (SEM) and the Minimum Detectable Change at 95% confidence interval (MDC95%) were established. The Greek Mini-BESTest (Mini-BESTestGR) was correlated with the Greek Berg Balance Scale (BBSGR) for assessing the concurrent validity and with the Timed Up and Go (TUG), the Functional Reach Test (FRT) and the Greek Falls Efficacy Scale-International (FES-IGR) for the convergent validity. RESULTS: The Mini-BESTestGR demonstrated excellent inter-rater reliability (ICC (95%CI) = 0.997 (0.995-0.999, SEM = 0.46) with the scores of two raters within the limits of agreement (meandif = -0.143 ± 0.727, p > 0.05) and test-retest reliability (ICC (95%CI) = 0.966 (0.926-0.988), SEM = 1.53). Additionally, the Mini-BESTestGR yielded very strong to moderate correlations with BBSGR (r = 0.924, p < 0.001), TUG (r = -0.823, p < 0.001), FES-IGR (r = -0.734, p < 0.001) and FRT (r = 0.689, p < 0.001). MDC95 was 4.25 points. CONCLUSION: The exceptionally high reliability and the equally good validity of the Mini-BESTestGR, strongly support its utility in Greek people with chronic stroke. Its ability to identify clinically meaningful changes and falls risk need further investigation.

Translation into Greek and initial validity and reliability testing of a modified version of the SCIM III, in both English and Greek, for self-use.

PURPOSE: To translate and culturally adapt the Spinal Cord Injury Measure version III (SCIM III) into Greek (GR-SCIM III). To conduct initial testing of psychometric properties of both measures by self-report. METHOD: Forward-backward translation was conducted to produce the GR-SCIM III. Participants completed the English or Greek versions in 2008-2009. Both versions were examined for multidimensionality, internal consistency and concurrent/criterion validity with the EQ-5D. RESULTS: Forty-five Greek adults with spinal cord injury (SCI) (23 males), mean age 61 (SD17) years; mean time since injury 11 (SD9) years, completed the GR-SCIM III. One hundred and seventy four English-speaking adults with SCI (111 males), mean age 47 (SD12) years; mean time since injury 12 (SD11) years, completed the SCIM III. Unidimensionality was confirmed for both versions. Internal consistency was acceptable (α = 0.78 for both). Validity was strong for the "self-care" subscale (GR-SCIM III ρ = -0.78, SCIM III ρ = -0.75) and moderate for the "mobility" subscale (GR-SCIM III ρ = -0.58, SCIM III ρ = -0.45). CONCLUSIONS: This has been the first function scale translated and validated in Greek for people with SCI. Both the GR-SCIM III and SCIM III are reliable for use by self-report. More studies are needed to further examine their psychometric properties and compare with observation or interview. IMPLICATIONS FOR REHABILITATION: The Greek version of the Spinal Cord Independence Measure version III (SCIM) is valid and reliable for self-report. Further testing is needed to assess psychometric qualities not assessed in the present study. Researchers and therapists in Greece can use a specific measure to assess functional independence in people with Spinal Cord Injury (SCI). Consideration needs to be given to the participants' type of injury, which may affect the results of SCIM III.

A systematic review of the prevalence of musculoskeletal pain, back and low back pain in people with spinal cord injury.

PURPOSE: To review and summarise the prevalence of chronic back pain (CBP), chronic low back pain (CLBP) and chronic musculoskeletal pain (CMSKP) in people with spinal cord injury (SCI) and evaluate how pain is assessed. METHOD: A systematic literature review between 1990 and 2012 in English language journals. Twelve databases were searched including CINAHL, Cochrane, Embase, PubMed and Science direct. Data were analysed using descriptive statistics and 95% confidence interval (CI). RESULTS: Eight studies fulfilled the inclusion criteria. Four reported on CMSKP, four on CBP and only two on CLBP. Among people with SCI and pain, the prevalence of CMSKP was 49% (95% CI: 44-55%), CBP was 47% (95% CI: 43-50%) and CLBP was 49% (95% CI: 44-55%). There were variations in both the pain classification systems used and the data collected. The type of pain reported in the back and low back areas could not be established due to insufficient evidence. CONCLUSION: The main finding is that the prevalence of CMSKP, and more particularly CBP and CLBP are not sufficiently reported in SCI literature. Implications for Rehabilitation There is sufficient evidence, though modest in quality and quantity, to indicate that chronic musculoskeletal pain (CMSKP), back pain (CBP) and low back pain (CLBP) are common in people with spinal cord injury (SCI). This deserves consideration by health professionals treating such patients. Pain assessment, including BP and LBP, for people with SCI should become part of the overall clinical assessment and it is preferable that standardised pain assessment tools are used. Where people with SCI suffer from CMSKP, and particularly CBP and CLBP, further consideration should be made, likely to include posture, strengthening and seating as is referral for pain medication.

Dissecting the roles of Raf- and PI3K-signalling pathways in melanoma formation and progression in a zebrafish model.

Deregulated Ras signalling is implicated in most human neoplasia, exemplified by melanoma. Whereas Raf activation occurs almost ubiquitously in benign and malignant melanocytic neoplasms, implying an involvement in tumour initiation, phosphoinositide 3-kinase (PI3K) activation occurs predominantly in malignant neoplasms, implying an involvement in malignant progression. Here, we dissect the contributions of these two pathways to tumourigenesis in vivo, by modulating their activities in zebrafish melanocytes. Misexpression of oncogenic Ras (V12RAS) in founder fish induced frequent melanoma, beginning at larval stages, with concomitant activation of Raf-Mek-Erk and PI3K-Akt signalling. Misexpression of effector-domain mutants of V12RAS, or of various downstream effectors, confirmed a selective role for the Raf-Mek-Erk pathway in initiating neoplasia, but highlighted the requirement for additional Ras effector pathways for malignancy. The phenotype of animals with germ-line transmission of V12RAS resembled familial atypical mole and melanoma (FAMM) syndrome: melanocytes displayed hyperplasia, dysplasia, altered terminal differentiation and spontaneously progressed to invasive melanoma. Co-expressing a dominant-interfering form of PI3K abolished V12RAS-induced malignancy, demonstrating a direct role for PI3K signalling in the malignant progression of melanoma in vivo, and highlighting PI3K as a promising target for melanoma therapy.