Gesture-Based Interactions: Integrating Accelerometer and Gyroscope Sensors in the Use of Mobile Apps

This study investigates the feasibility and functionality of accelerometer and gyroscope sensors for gesture-based interactions in mobile app user experience. The core of this innovative approach lies in introducing a dynamic and intuitive user interaction model with the device sensors. The Android app developed for this purpose has been created for its use in controlled experiments. Methodologically, it was created as a stand-alone tool to both capture quantitative (time, automatically captured) and qualitative (behavior, collected with post-task questionnaires) variables. The app's setting features a set of modules with two levels each (randomized presentation applied, minimizing potential learning effects), allowing users to interact with both sensor-based and traditional touch-based scenarios. Preliminary results with 22 participants reveal that tasks involving sensor-based interactions tend to take longer to complete when compared to the traditional ones. Remarkably, many participants rated sensor-based interactions as a better option than touch-based interactions, as seen in the post-task questionnaires. This apparent discrepancy between objective completion times and subjective user perceptions requires a future in-depth exploration of factors influencing user experiences, including potential learning curves, cognitive load, and task complexity. This study contributes to the evolving landscape of mobile app user experience, emphasizing the benefits of considering the integration of device sensors (and gesture-based interactions) in common mobile usage.

Upper extremities deep vein thrombosis and DOAC treatment: a prospective cohort study

Background

Data on the use of direct oral anticoagulants (DOACs) in patients with upper extremities deep vein thrombosis (UEDVT) are limited.

Purpose

To assess the effectiveness and safety of DOACs in the treatment of UEDVT.

Methods

Data on patients with an objective diagnosis of acute UEDVT treated with DOACs were merged from prospective cohorts of patients with venous thromboembolism (VTE). Study outcomes were recurrent VTE and major bleeding (MB) occurring during DOAC treatment.

Results

Overall, 132 patients were included: mean age was 47.7±18.0 years (range 18 to 97), males were 42.4%. Twenty-seven percent of patients had 2 or more risk factors for VTE, 29.5% had UEDVT complicating a central venous line or after pacemaker implantation (Table). Ninety-two patients (70%) were managed as outpatients. Increased age (OR 1.03, 95% CI 1.0–1.05) and anemia (OR 1.35, 95% CI 1.07–1.70) were associated with in-patient management. Among patients treated with apixaban (40) or rivaroxaban (85) loading dose was used in 72%; in patients treated with dabigatran (5) or edoxaban (2) mean heparin pre-treatment was 8 days. DOACs were started after 1 month from UEDVT diagnosis in 12.9% of patients; active cancer was a main predictor for delayed initiation (OR 22.2, 95% CI 5.8–84.4). Mean treatment duration in patients with a scheduled stop was 4.9 months, while mean followup in those who continued DOACs was 9.3 months. No recurrence of VTE nor MBs occurred during DOAC treatment; one patient had acute limb ischemia (1.38% patient-year), 7 clinically relevant non-MBs (3 genital, 2 epistaxis, 1 gingival, 1 genital bleeding plus epistaxis; 10.51% patient-year), 5 deaths (4 cancer, 1 advanced age; 9.69% patient-year).

Conclusions

Our data support the effectiveness and safety of DOACs for the treatment of acute UEDVT. Further studies are required to confirm these findings.

Funding Acknowledgement

Type of funding source: None

Glucose-6-phosphate dehydrogenase deficiency and Gilbert syndrome: a gene interaction underlies severe jaundice without severe hemolysis

The authors describe the paradoxical clinical phenotype of an undetected severe hemolysis in parallel with the development of severe jaundice in a 13-year-old male suffering from a confirmed interaction of glucose-6-phosphate dehydrogenase deficiency (Mediterranean variant, 563 C/T) and Gilbert syndrome [variant (TA)7/(TA)7]. The child had 2 acute hemolytic episodes at the age of 10 and 13 years following infections of unknown origin. Both episodes were characterized by considerably high bilirubin levels (1st episode: 10.8 mg/dL, 2nd episode: 17.8 mg/dL) associated with unexpectably mild hemolysis indices (1st episode hemoglobin levels, 11.1 g/dL; reticulocyte counts, 2.5%; 2nd episode hemoglobin values, 12.7 g/dL; reticulocyte counts, 2.5%). During the steady-state condition of the child, hemoglobin values were within the normal ranges for his age (14.2 g/dL) and bilirubin levels were slightly elevated (1.70 mg/dL, indirect 1.5 mg/dL). The interaction of the two genetic abnormalities in the causation of this odd clinical phenotype is discussed.

Hypofibrinolysis in the insulin resistance syndrome: implication in cardiovascular diseases

Insulin resistance syndrome (IRS) is associated with increased cardiovascular morbidity and mortality. IRS is becoming one of the major health problems as its prevalence grows rapidly. Accelerated atherothrombotic process in the IRS is attributed to metabolic abnormalities, inflammation and to impaired fibrinolysis due to increased plasma plasminogen activator inhibitor type 1 (PAI-1) levels. Proinflammatory cytokines may have an important role in PAI-1 overexpression, particularly in the adipose tissue. Studies in genetically modified mice indicate that PAI-1 might be involved in the aetiopathogenesis of obesity. Modifying PAI-1 expression by PAI-1 inhibitors may open a new field of research and may reveal the true role of PAI-1 in atherosclerotic and insulin resistance processes.

Plasminogen activator inhibitor-1, inflammation, obesity, insulin resistance and vascular risk

Elevated plasma plasminogen activator inhibitor-1 (PAI-1) level is a core feature of insulin-resistance syndrome (IRS). Atherothrombotic complications in IRS are partly attributed to impaired fibrinolysis caused by increased plasma PAI-1 levels. Although the etiology of IRS is far from being explained, the clustering of inflammation, adipose tissue accumulation and insulin resistance suggests an etiopathological link. Proinflammatory cytokines might regulate PAI-1 expression in IRS; however, more studies are needed to confirm this complex mechanism in humans. Furthermore, modifying PAI-1 expression by PAI-1 inhibitors provides a new challenge and may reveal the true role of PAI-1 in atherosclerotic and insulin resistance processes.

Subcutaneous abdominal, but not femoral fat expression of plasminogen activator inhibitor-1 (PAI-1) is related to plasma PAI-1 levels and insulin resistance and decreases after weight loss

AIMS/HYPOTHESIS

Abdominal fat produces plasminogen activator inhibitor-1 (PAI-1) and could contribute to increased plasma PAI-1 values in human obesity associated with insulin resistance. Femoral fat, which is not associated with insulin resistance, is thought to be metabolically different from the abdominal fat. This study aimed to assess PAI-1 expression in these two fat territories in obese and lean subjects and to determine if concomitant changes of plasma and adipose tissue PAI-1 values occur after weight reduction.

METHODS

In 24 obese and 16 lean subjects, PAI-1 expression in abdominal and femoral subcutaneous fat, plasma PAI-1, insulin, triglyceride concentrations and insulin resistance were determined at the start of the study and in obese subjects after a 3-month weight reduction programme as well.

RESULTS

PAI-1 mRNA content in the abdominal subcutaneous fat was higher in obese than in lean subjects and positively correlated with plasma PAI-1 values (p < 0.01) and markers of insulin resistance (p < 0.05). In 18 obese subjects, re-examined after successful dieting, PAI-1 mRNA content decreased in the abdominal subcutaneous fat along with plasma PAI-1. However, the absolute changes of these two variables were not associated. In contrast, PAI-1 mRNA content in the femoral subcutaneous fat did not differ between lean and obese subjects, was not associated with plasma PAI-1 values or with markers of insulin resistance, and did not change after weight loss.

CONCLUSION/INTERPRETATION

Only the abdominal, but not the femoral subcutaneous fat PAI-1 expression is a potential contributor to increases in plasma PAI-1 in obesity. Both plasma and abdominal subcutaneous fat PAI-1 values decreased significantly after weight reduction, although their absolute changes were not associated.

Impact of weight reduction on early carotid atherosclerosis in obese premenopausal women

OBJECTIVE

To investigate the extent of carotid atherosclerosis and the effect of weight loss on carotid intima-media thickness (IMT) in obese premenopausal women.

RESEARCH METHODS AND PROCEDURES

In 43 obese premenopausal women who participated in a 3-month weight reduction program with a hypocaloric diet, IMT was measured by B-mode high-resolution ultrasound at entry and after 5 months of follow-up. Blood samples were analyzed at entry, after intervention, and after 5 months of follow-up. Nineteen lean women served as control subjects.

RESULTS

At entry, common carotid IMT (0.72 vs. 0.59 mm), carotid bulb IMT (0.90 vs. 0.71 mm), and overall mean IMT (0.81 vs. 0.65 mm) were greater in obese women than in lean women (all p < 0.01). After dietary intervention decreases in blood pressure, low density lipoprotein to high density lipoprotein cholesterol ratio, triglycerides, fibrinogen, plasminogen activator inhibitor-1, and an increase in tissue-type plasminogen activator activity levels were observed. These effects persisted after follow-up in 14 women who maintained reduced weight. Reduction in carotid bulb IMT (to 0.81 mm, p < 0.01) and overall mean IMT (to 0.79 mm, p < 0.05) was observed in this subgroup. No significant change of carotid IMT was detected in eight women who regained weight. Changes in IMT were associated independently and significantly with changes in body mass index, low density lipoprotein to high density lipoprotein cholesterol ratio, and plasminogen activator inhibitor-1 antigen.

DISCUSSION

Obese premenopausal women had greater IMT than did age-matched lean controls. It seems that this early atherosclerotic changes may be reversed by normalization of body weight.

Do baseline serum leptin levels predict weight regain after dieting in obese women?

AIM

Weight loss achieved during weight reduction programme is difficult to maintain. We investigated the possible role of circulating leptin in failure or success in maintaining weight loss.

METHODS

Serum leptin levels were measured in 30 healthy premenopausal obese women before and after 12 weeks of dietary intervention and after 5 months of follow-up.

RESULTS

After intervention body mass index (BMI) decreased from 30.6 to 25.4 kg/m2 (p < 0.01) and leptin levels decreased from 16.7 to 7.7 ng/ml (p < 0.01). After 5 months follow-up 12 women regained reduced weight and 18 women maintained weight loss. In the regainers leptin levels increased again, but remained low in the maintainers. Baseline leptin concentrations were lower in the regainers than in the maintainers (12.1 vs. 21.2 ng/ml, p = 0.04). During intervention leptin levels decreased three times more in the maintainers than in the regainers, although weight loss was similar in both groups.

CONCLUSIONS

This study shows that obese women who regain weight after dieting have significantly lower baseline leptin levels than women who maintain weight loss. Our results suggest that differences in leptin resistance might exist in similarly obese women which could influence the success of dieting.

Seasonal variation of some metabolic and haemostatic risk factors in subjects with and without coronary artery disease

Acute myocardial infarction (AMI) is more frequent in winter months than in summer months. The aetiologic mechanisms underlying this seasonal pattern are poorly understood. We investigate whether seasonal variation of metabolic and haemostatic coronary risk factors exists, and whether this variation is more pronounced in subjects with coronary artery disease (CAD). In 82 subjects (47 free of clinical signs of CAD and in 35 survivors of AMI), measurements of body mass index (BMI), lipoproteins, glucose, insulin, plasminogen activator inhibitor-1, tissue-type plasminogen activator (t-PA), euglobulin clot lysis time, fibrinogen, and platelet count were performed twice in the cold months (December and March) and twice in the warm months (June and September). Significantly higher BMI (26.8 versus 26.2 kg/m2, P < 0.01), glucose (5.5 versus 5.1 mmol/l, P < 0.01), total cholesterol (5.61 versus 5.32 mmol/l, P < 0.05), low-density lipoprotein cholesterol (3.63 versus 3.34 mmol/l, P < 0.05), triglycerides (1.79 versus 1.61 mmol/l, P < 0.01), Lp(a) (270.7 versus 237.5 mg/l, P < 0.01), fibrinogen level (3.50 versus 2.95 g/l, P < 0.00001), platelet count (212 x 10(9) versus 173 x 10(9)/l, P < 0.01) and significantly lower high-density lipoprotein cholesterol level (1.22 versus 1.28 mmol/l, P < 0.05) were observed in the cold months compared with the warm months. Significant seasonal variation of t-PA activity (1.19 versus 0.87 IU/ml, P = 0.015) and t-PA antigen (8.5 versus 7.3 ng/ml, P = 0.05) was demonstrated only in subjects with CAD. Clustering of peak values of several metabolic and haemostatic coronary risk factors was observed in winter months. This variation might be of aetiopathogenetic importance for the seasonal pattern of acute myocardial infarction.

Impact of adipose tissue on plasma plasminogen activator inhibitor-1 in dieting obese women

The increased incidence of cardiovascular diseases in obese subjects could be partially attributed to impaired fibrinolysis due to elevated plasma levels of tissue plasminogen activator inhibitor 1 (PAI-1). The associations between changes in plasma PAI-1, metabolic variables, and adipose tissue during weight loss and regain were studied in 52 healthy, premenopausal, obese women participating in a weight reduction program with a hypocaloric diet. PAI-1, insulin, triglyceride, leptin, and adipsin levels were determined at entry, after the first week, after completion of the program, and after 5 months of follow-up. In the 33 obese women who completed the program, decreases in PAI-1 antigen (-54%), PAI activity (-74%), and leptin (-51%), but not of adipsin, were observed. Changes in PAI-1 were associated with changes in body mass index (BMI), body fat, leptin, and insulin. The decreased level of PAI-1 remained low after follow-up in the 14 women who maintained their reduced weight but increased in the 16 women who regained weight. This increase in PAI-1 was correlated with an increase in body fat and leptin. On multivariate analysis, BMI was the major determinant of PAI-1 level. In conclusion, during weight reduction with a hypocaloric diet, the decrease in PAI-1 is more closely related to changes in adipose tissue than to changes in metabolic variables, suggesting a significant role for adipose tissue in regulating plasma levels of PAI-1.

The 4G/5G sequence polymorphism in the promoter of plasminogen activator inhibitor-1 (PAI-1) gene: relationship to plasma PAI-1 level in venous thromboembolism

Impaired fibrinolysis due to increased plasminogen activator inhibitor-1 (PAI-1) is observed in up to 40% of patients with venous thromboembolism and might be causally related to the disease. There is evidence that genetic variations in the promoter of the PAI-1 gene and metabolic factors contribute to increased plasma PAI-1 levels. A single nucleotide insertion/deletion (4G/5G) polymorphism in the promoter region of the PAI-1 gene and metabolic factors were studied in 158 unrelated patients below the age of 61 years (43 +/- 11 years, mean +/- standard deviation) with history of objectively confirmed venous thromboembolism and in 145 apparently healthy controls. Patients had on average two times higher PAI activity (11.9 vs. 6.1 IU/ml) and by 40% higher PAI-1 antigen (14.8 vs. 10.7 ng/ml) than healthy controls, and also higher body mass index, lipid levels, fasting glucose and insulin. Patients differed significantly from healthy controls neither in the frequency of the 4G and 5G alleles (0.57/0.43 in patients and 0.52/0.48 in controls) nor in the distribution of the 4G/5G genotypes. Possession of the 4G/4G or the 4G/5G genotype did not increase relative risk for venous thromboembolic disease and the distribution of the 4G/5G genotypes was neither associated with recurrent nor with spontaneous disease. In patients association between the 4G/5G genotypes and PAI activity (adjusted for body mass index, triglyceride and glucose level) was observed, with the highest PAI activity values in the 4G/4G genotype (14.6 IU/ml), intermediate in the 4G/5G genotype (13.3 IU/ml) and the lowest in the 5G/5G genotype (5.2 IU/ml, all values means). Association between PAI activity and triglyceride level was the strongest in the 4G/4G genotype (correlation coefficient r = 0.47, p < 0.01) and the weakest in the 5G/5G genotype (r = -0.04, not significant). In conclusion, the present case-control study shows an association between the 4G/5G polymorphism in the promoter of the PAI-1 gene and plasma PAI-1 levels in patients with venous thromboembolism. Similar distribution of the 4G/5G genotypes in patients and healthy controls suggests that this genetic variation by itself is not a major risk factor for venous thromboembolism.

Reproducibility of fibrinolytic response to venous occlusion in healthy subjects

Fibrinolytic response to venous occlusion is used to assess the efficiency of the fibrinolytic system. Reproducibility of fibrinolytic variables after 20 min upper arm venous occlusion was investigated in 40 apparently healthy subjects tested twice in a period of 11-23 (mean 15) days. Resting and post-venous occlusion euglobulin clot lysis time, tissue-type plasminogen activator (t-PA) activity, t-PA antigen, plasminogen activator inhibitor (PAI) activity and plasminogen activator inhibitor type 1 (PAI-1) antigen determined on the two occasions did not differ significantly. Positive correlation coefficients for variables before (r = 0.43-0.74, all p < 0.01) and after venous occlusion (r = 0.07-0.66) indicated low to moderate associations between repeated measurements. Differences between repeated measurements relative to the initial measurement were greater after venous occlusion than before venous occlusion and were for euglobulin activity 41 (0-826)%, t-PA activity 27 (2-398)%, and for t-PA antigen 27 (0-179)% (medians and ranges). Poor responses were defined by the lowest (euglobulin activity, t-PA activity and t-PA antigen) or the highest (PAI activity) fifth percentile of the distribution. Almost no agreement between poor responses was observed: poor responses at the first occasion were not determined in the same subjects when re-examined after two weeks. It was concluded that due to relatively low reproducibility of the variables measured after venous occlusion the test needs improvement in order to be potentially clinically useful.