Gquest: Modeling patient questionnaires and administering them through a mobile platform application

Background

The use of surveys is becoming popular in the health care industry for acquiring information useful to the accomplishment of several studies. Besides their exploitation on a large scale for conducting epidemiological studies, surveys are being increasingly carried out on a narrower perspective through the administration of questionnaires aimed at assessing the quality of life perceived by patients or their clinical status during mid- or long-term treatments. This is useful for managing resources or optimizing and individualizing treatments.

Objectives

This paper describes Gquest, a platform for modeling, generating and administering questionnaires through mobile devices such as smartphones or tablets. Gquest was motivated by the need of administering questionnaires during home treatments, albeit its applicability is rather general. The main requirement was to have a very simple, clean and easy to use platform able to support (a) physicians in the design and delivery of questionnaires and (b) outpatients in sending self-recorded outcomes to the clinical staff.

Methods

Gquest has two basic components. The first one is a model devised for representing questionnaires which is extremely flexible. It allows the generation of questions and answers of different types, supports adaptivity in the dialog with the user and enforces simple consistency rules for checking his input. The second component is an application able to run instances of those questionnaires. It downloads questionnaires over the air in terms of XML files from a server and stores them locally into the mobile repository. Questionnaires become then available to the user, who in our case is a patient or one of his relatives. The user can select which one to fill-in, according to his needs and/or the specific treatment protocol. The selected questionnaire may be filled-in all at once or be completed in subsequent steps over time since any input provided is persisted on a local database. Finally, when a questionnaire is closed all the answers are transparently synchronized to a server for further evaluation or statistical purposes.

Results

The platform has been exploited and tested in two medical domains where questionnaires have very different purposes; a quality of life pilot survey involving patients with atrial fibrillation within the EU-funded project MobiGuide, and an investigation of the users’ needs during the requirements elicitation phase of a telemedicine project for the safe discharge of fragile patients.

Conclusions

Gquest proved to be a suitable tool for dealing with a wide variety of question types and has been positively accepted by the patients enrolled in the pilot study.     

Enzymatic hydrolysis of cotton wastes. Effect of γ-ray pretreatments

Textile cotton wastes were irradiated with γ-rays at different doses and solubilized with 10% NaOH solutions. The regenerated products underwent enzymatic hydrolysis and their degradation pattern was compared with that of the cotton celluloses untreated or treated only with γ-rays. The different samples were characterized by measurements of X-ray diffraction, degree of polymerization, moisture regain and water retention. The structural and morphological modifications induced by the pretreatments were correlated with the variations of kinetic parameters, particularly the V_max/K_m ratio, defined as specificity constant. Only the combination of irradiation with dissolution pretreatments gave a considerable increase of hydrolysis reaction effectiveness.     

Influence of counterface roughness on friction properties of engineering plastics for bearing applications

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Towards cooperative patient management through organizational and medical ontologies

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The permeabilizing ATP receptor, P2X7. Cloning and expression of a human cDNA

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Effects of divalent cations, protons and calmidazolium at the rat P2X7 receptor

The P2X7 receptor is a uniquely bifunctional molecule through which ATP can open a small cationic channel typical of ionotropic receptors and also induce a large pore permeable to high molecular weight molecules (> 600 Da). Activation of this large pore can lead to cell lysis within 1-2 min. We asked whether pharmacological differences existed between the cationic channel and the cell permeabilizing pore by measuring whole-cell currents and uptake of a propidium dye (YO-PRO; Mw 629) in HEK293 cells stably expressing the rat P2X7 receptor, and comparing the actions of divalent cations and protons in these two assays. Currents in response to 2'-3'-(O)-(4-benzoyl benzoyl) ATP (BzATP, 30 microM) were inhibited by extracellular calcium, magnesium, zinc, copper and protons with half-maximal inhibitory concentrations (IC50) of 2.9 mM, 0.5 mM, 11 microM, 0.5 microM and 0.4 microM, respectively. The inhibition was voltage independent in each case. YO-PRO uptake induced by BzATP was also inhibited with similar IC50 values. The rank order of potency of a range of divalents was Cu2+ > Cd2+ = Zn2+ > Ni2+ > Mg2+ = Co2+ > Mn2+ > Ca2+ = Ba2+ > Sr2+. These results suggest that these divalent cations and protons all act primarily as allosteric modulators to alter the affinity of ATP binding to the P2X7 receptor. In contrast, extracellular (but not intracellular) calmidazolium inhibited the BzATP-evoked current by up to 90% (IC50 = 15 nM) but had no effect on YO-PRO uptake. Thus, calmidazolium can block activation of the ionic channel but this does not prevent the formation of the large permeabilizing pore.     

Membrane topology of an ATP-gated ion channel (P2X receptor)

Western blots of Xenopus oocyte membrane preparations showed that the apparent molecular mass of the wild type P2X2 receptor (about 65 kDa) was reduced by pretreatment with endoglycosidase H. Mutagenesis of one or more of three potential asparagines (N182S, N239S, and N298S) followed by Western blots showed that each of the sites was glycosylated in the wild type receptor. Functional channels were formed by receptors lacking any single asparagine, but not by channels mutated in two or three positions. Artificial consensus sequences (N-X-S/T) introduced into the N-terminal region (asparagine at position 9, 16, or 26) were not glycosylated. Asparagines were glycosylated when introduced at the C-terminal end of the first hydrophobic domain (positions 62 and 66) and at the N-terminal end of the second hydrophobic domain (position 324). A protein in which the C terminus of one P2X2 subunit was joined to the N terminus of a second P2X2 subunit (from a concatenated cDNA) had twice the molecular mass of the P2X2 receptor subunit, and formed fully functional channels. The experiments provide direct evidence for the topology originally proposed for the P2X receptor, with intracellular N and C termini, two membrane-spanning domains, and a large extracellular loop.     

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