Web-based alcohol screening and brief intervention for Māori and non-Māori: the New Zealand e-SBINZ trials

BACKGROUND: Hazardous alcohol consumption is a leading modifiable cause of mortality and morbidity among young people. Screening and brief intervention (SBI) is a key strategy to reduce alcohol-related harm in the community, and web-based approaches (e-SBI) have advantages over practitioner-delivered approaches, being cheaper, more acceptable, administrable remotely and infinitely scalable. An efficacy trial in a university population showed a 10-minute intervention could reduce drinking by 11% for 6 months or more among 17-24 year-old undergraduate hazardous drinkers. The e-SBINZ study is designed to examine the effectiveness of e-SBI across a range of universities and among Māori and non-Māori students in New Zealand. METHODS/DESIGN: The e-SBINZ study comprises two parallel, double blind, multi-site, individually randomised controlled trials. This paper outlines the background and design of the trial, which is recruiting 17-24 year-old students from seven of New Zealand's eight universities. Māori and non-Māori students are being sampled separately and are invited by e-mail to complete a web questionnaire including the AUDIT-C. Those who score >4 will be randomly allocated to no further contact until follow-up (control) or to assessment and personalised feedback (intervention) via computer. Follow-up assessment will occur 5 months later in second semester. Recruitment, consent, randomisation, intervention and follow-up are all online. Primary outcomes are (i) total alcohol consumption, (ii) frequency of drinking, (iii) amount consumed per typical drinking occasion, (iv) the proportions exceeding medical guidelines for acute and chronic harm, and (v) scores on an academic problems scale. DISCUSSION: The trial will provide information on the effectiveness of e-SBI in reducing hazardous alcohol consumption across diverse university student populations with separate effect estimates for Māori and non-Māori students. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12610000279022.

Statistical comparisons of non-deterministic IR systems using two dimensional variance

Retrieval systems with non-deterministic output are widely used in information retrieval. Common examples include sampling, approximation algorithms, or interactive user input. The effectiveness of such systems differs not just for different topics, but also for different instances of the system. The inherent variance presents a dilemma - What is the best way to measure the effectiveness of a non-deterministic IR system? Existing approaches to IR evaluation do not consider this problem, or the potential impact on statistical significance. In this paper, we explore how such variance can affect system comparisons, and propose an evaluation framework and methodologies capable of doing this comparison. Using the context of distributed information retrieval as a case study for our investigation, we show that the approaches provide a consistent and reliable methodology to compare the effectiveness of a non-deterministic system with a deterministic or another non-deterministic system. In addition, we present a statistical best-practice that can be used to safely show how a non-deterministic IR system has equivalent effectiveness to another IR system, and how to avoid the common pitfall of misusing a lack of significance as a proof that two systems have equivalent effectiveness.

Locating learning: making connections between virtual and physical spaces with mobile touch-screen devices

This paper is concerned with the potential of mobile touch-screen devices and emerging socio-technological practices to support pedagogies of place that provide a means for young people to reflect critically on the social construction of place and to take actions that speak of and to their own locatedness. Drawing on de Certeau’s (1984) concept of space as a practiced place and Massey’s (2005) perspective of spatiality and interrelatedness, we examine two school-based examples of learning activities that bring together the virtual and physical as in experiences and representations of place. The first example is an Australian local history unit, where lower secondary school students participated in a series of field trips, planned and conducted under the guidance of an indigenous elder. They used Smartphones and iPads to capture and create personalised audio-visual records of their knowledge of place that were then used to create geo-location games. In the second example, upper primary school students worked with local authorities and environmental educators to select sites for two environmental monitoring posts, which were then installed and provided a locus for the students’ school-based environmental science learning as well as a vehicle for community engagement. Drawing on interview, video and photographic data, this paper examines the way mobile technologies were deployed for student knowledge production, engagement with place, reconstruction of place and engagement with community.

The influence on population weight gain and obesity of the macronutrient composition and energy density of the food supply

Rates of overweight and obesity have increased dramatically in all regions of the world over the last few decades. Almost all of the world's population now has ubiquitous access to low-cost, but highly-processed, energy-dense, nutrient-poor food products. These changes in the food supply, rather than decreases in physical activity, are most likely the primary driver of population weight gain and obesity. To-date, the majority of prevention efforts focus on personalised approaches targeting individuals. Population-wide food supply interventions addressing sodium and trans fat reduction have proven highly effective and comparable efforts are now required to target obesity. The evidence suggests that strategies focusing upon reducing the energy density and portion size of foods will be more effective than those targeting specific macronutrients. Government leadership, clearly specified targets, accountability and transparency will be the key to achieving the food supply changes required to address the global obesity epidemic.

Learning entry profiles of children with autism from multivariate treatment information using restricted boltzmann machines

Entry profiles can be generated before children with Autism Spectrum Disorders (ASD) begin to traverse an intervention program. They can help evaluate the progress of each child on the dedicated syllabus in addition to enabling narrowing down the best intervention course over time. However, the traits of ASD are expressed in different ways in every individual affected. The resulting spectrum nature of the disorder makes it challenging to discover profiles of children with ASD. Using data from 491 children, traversing the syllabus of a comprehensive intervention program on iPad called TOBY Playpad, we learn the entry profiles of the children based on their age, sex and performance on their first skills of the syllabus. Mixed-variate restricted Boltzmann machines allow us to integrate the heterogeneous data into one model making it a suitable technique. The data based discovery of entry profiles may assist in developing systems that can automatically suggest best suitable paths through the syllabus by clustering the children based on the characteristics they present at the beginning of the program. This may open the pathway for personalised intervention.

Examining the effect of time constraint on the online mastery learning approach towards improving postgraduate students' achievement

Time control plays a critical role within the online mastery learning (OML) approach. This paper examines the two commonly implemented mastery learning strategies – personalised system of instructions and learning for mastery (LFM) – by focusing on what occurs when there is an instructional time constraint. Using a large data set from a postgraduate finance course offered at an Australian university, we explore students' online quiz-completion patterns, then empirically investigate whether the imposition of an instructional time constraint in the OML approach has an impact on their final-examination performance. Our results suggest that the LFM strategy with an instructional time constraint has a positive impact on students' learning behaviour and contributes to better overall academic performance. Further, our findings suggest that facilitators should be encouraged to implement an instructional time constraint when adopting an OML approach.

Phospho-mTOR in non-tumour and tumour bladder urothelium: Pattern of expression and impact on urothelial bladder cancer patients

Urothelial bladder carcinoma (UBC) is heterogeneous in its pathology and clinical behaviour. Evaluation of prognostic and predictive biomarkers is necessary, in order to produce personalised treatment options. The present study used immunohistochemistry to evaluate UBC sections containing tumour and non-tumour areas from 76 patients, for the detection of p-mTOR, CD31 and D2-40 (blood and lymphatic vessels identification, respectively). Of the non-tumour and tumour sections, 36 and 20% were scored positive for p-mTOR expression, respectively. Immunoexpression was observed in umbrella cells from non-tumour urothelium, in all cell layers from non-muscle-invasive (NMI) tumours (including expression in superficial cells), and in spots of cells from muscle-invasive (MI) tumours. Positive expression decreased from non-tumour to tumour urothelium, and from pTl/pTis to pT3/pT4 tumours; however, the few pT3/pT4 positive cases had worse survival rates, with 5-year disease-free survival being significantly lower. Angiogenesis occurrence was impaired in pT3/pT4 tumours that did not express p-mTOR. In conclusion, p-mTOR expression in non-tumour umbrella cells is likely a reflection of their metabolic plasticity, and extension to the inner layers of the urothelium in NMI tumours is consistent with an enhanced malignant potential. The expression in cell spots in a few MI tumours and absence of expression in the remaining tumours is intriguing and requires further research. Additional studies regarding the up- and downstream effectors of the mTOR pathway should be conducted.

Prototipo del aplicación de recomendaciones sobre la dieta mediterránea

[ES] Este prototipo pretende servir como base de una aplicación que busca mejorar el estilo de vida mediante la adaptación a la dieta mediterránea,  una de las dietas con mayor aceptación por parte de los expertos del campo de la salud. Este software consiste en una aplicación servidor en entorno Ruby on Rails que realiza la función de gestor de contenidos para la aplicación del dispositivo móvil bajo plataforma iOS usando Objective-C, comunicadas entre sí por una API REST. Entre sus funciones, se permite evaluar el nivel de adaptación a la dieta mediterránea del usuario, ofreciéndole posteriormente un menú variado siguiendo las recomendaciones de dietistas expertos. Dicho menú es individualizado, tomando en cuenta las diferentes alergias que padece el usuario para realizar un filtrado de las recetas, consultables en todo momento desde la aplicación. Se presentan además una serie de pantallas interactivas con información sobre la dieta mediterránea y la vida sana.

Mobile phone technologies and advanced data analysis towards the enhancement of diabetes self-management

Advances in the area of mobile and wireless communication for healthcare (m-Health) along with the improvements in information science allow the design and development of new patient-centric models for the provision of personalised healthcare services, increase of patient independence and improvement of patient's self-control and self-management capabilities. This paper comprises a brief overview of the m-Health applications towards the self-management of individuals with diabetes mellitus and the enhancement of their quality of life. Furthermore, the design and development of a mobile phone application for Type 1 Diabetes Mellitus (T1DM) self-management is presented. The technical evaluation of the application, which permits the management of blood glucose measurements, blood pressure measurements, insulin dosage, food/drink intake and physical activity, has shown that the use of the mobile phone technologies along with data analysis methods might improve the self-management of T1DM.

A microfluidic platform for chemoresistive testing of multicellular pleural cancer spheroids

This study reports on a microfluidic platform on which single multicellular spheroids from malignant pleural mesothelioma (MPM), an aggressive tumor with poor prognosis, can be loaded, trapped and tested for chemotherapeutic drug response. A new method to detect the spheroid viability cultured on the microfluidic chip as a function of the drug concentration is presented. This approach is based on the evaluation of the caspase activity in the supernatant sampled from the chip and tested using a microplate reader. This simple and time-saving method does only require a minimum amount of manipulations and was established for very low numbers of cells. This feature is particularly important in view of personalised medicine applications for which the number of cells obtained from the patients is low. MPM spheroids were continuously perfused for 48 hours with cisplatin, one of the standard chemotherapeutic drugs used to treat MPM. The 50% growth inhibitory concentration of cisplatin in perfused MPM spheroids was found to be twice as high as in spheroids cultured under static conditions. This chemoresistance increase might be due to the continuous support of nutrients and oxygen to the perfused spheroids.

Image-based biomechanical assessment of vertebral body and intervertebral disc in the human lumbar spine

Life expectancy continuously increases but our society faces age-related conditions. Among musculoskeletal diseases, osteoporosis associated with risk of vertebral fracture and degenerative intervertebral disc (IVD) are painful pathologies responsible for tremendous healthcare costs. Hence, reliable diagnostic tools are necessary to plan a treatment or follow up its efficacy. Yet, radiographic and MRI techniques, respectively clinical standards for evaluation of bone strength and IVD degeneration, are unspecific and not objective. Increasingly used in biomedical engineering, CT-based finite element (FE) models constitute the state-of-art for vertebral strength prediction. However, as non-invasive biomechanical evaluation and personalised FE models of the IVD are not available, rigid boundary conditions (BCs) are applied on the FE models to avoid uncertainties of disc degeneration that might bias the predictions. Moreover, considering the impact of low back pain, the biomechanical status of the IVD is needed as a criterion for early disc degeneration. Thus, the first FE study focuses on two rigid BCs applied on the vertebral bodies during compression test of cadaver vertebral bodies, vertebral sections and PMMA embedding. The second FE study highlights the large influence of the intervertebral disc’s compliance on the vertebral strength, damage distribution and its initiation. The third study introduces a new protocol for normalisation of the IVD stiffness in compression, torsion and bending using MRI-based data to account for its morphology. In the last study, a new criterion (Otsu threshold) for disc degeneration based on quantitative MRI data (axial T2 map) is proposed. The results show that vertebral strength and damage distribution computed with rigid BCs are identical. Yet, large discrepancies in strength and damage localisation were observed when the vertebral bodies were loaded via IVDs. The normalisation protocol attenuated the effect of geometry on the IVD stiffnesses without complete suppression. Finally, the Otsu threshold computed in the posterior part of annulus fibrosus was related to the disc biomechanics and meet objectivity and simplicity required for a clinical application. In conclusion, the stiffness normalisation protocol necessary for consistent IVD comparisons and the relation found between degeneration, mechanical response of the IVD and Otsu threshold lead the way for non-invasive evaluation biomechanical status of the IVD. As the FE prediction of vertebral strength is largely influenced by the IVD conditions, this data could also improve the future FE models of osteoporotic vertebra.

Data-driven healthcare: from patterns to actions

The era of big data opens up new opportunities in personalised medicine, preventive care, chronic disease management and in telemonitoring and managing of patients with implanted devices. The rich data accumulating within online services and internet companies provide a microscope to study human behaviour at scale, and to ask completely new questions about the interplay between behavioural patterns and health. In this paper, we shed light on a particular aspect of data-driven healthcare: autonomous decision-making. We first look at three examples where we can expect data-driven decisions to be taken autonomously by technology, with no or limited human intervention. We then discuss some of the technical and practical challenges that can be expected, and sketch the research agenda to address them.

Exploring the logic of mobile search

After more than a decade of development work and hopes, the usage of mobile Internet has finally taken off. Now, we are witnessing the first signs of evidence of what might become the explosion of mobile content and applications that will be shaping the (mobile) Internet of the future. Similar to the wired Internet, search will become very relevant for the usage of mobile Internet. Current research on mobile search has applied a limited set of methodologies and has also generated a narrow outcome of meaningful results. This article covers new ground, exploring the use and visions of mobile search with a users' interview-based qualitative study. Its main conclusion builds upon the hypothesis that mobile search is sensitive to a mobile logic different than today's one. First, (advanced) users ask for accessing with their mobile devices the entire Internet, rather than subsections of it. Second, success is based on new added-value applications that exploit unique mobile functionalities. The authors interpret that such mobile logic involves fundamentally the use of personalised and context-based services.

p-medicine: a medical informatics platform for integrated large scale heterogeneous patient data

Secure access to patient data is becoming of increasing importance, as medical informatics grows in significance, to both assist with population health studies, and patient specific medicine in support of treatment. However, assembling the many different types of data emanating from the clinic is in itself a difficulty, and doing so across national borders compounds the problem. In this paper we present our solution: an easy to use distributed informatics platform embedding a state of the art data warehouse incorporating a secure pseudonymisation system protecting access to personal healthcare data. Using this system, a whole range of patient derived data, from genomics to imaging to clinical records, can be assembled and linked, and then connected with analytics tools that help us to understand the data. Research performed in this environment will have immediate clinical impact for personalised patient healthcare.