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Introduction: This paper outlines the design, implementation, and usability study results of the patient empowerment process for chronic disease management, using Patient Reported Outcome Measurements and Shared Decision-Making Processes. Background: The ADLIFE project aims to develop innovative, digital health solutions to support personalized, integrated care for patients with severe long-term conditions such as Chronic Obstructive Pulmonary Disease, and/or Chronic Heart Failure. Successful long-term management of patients with chronic conditions requires active patient self-management and a proactive involvement of patients in their healthcare and treatment. This calls for a patient-provider partnership within an integrated system of collaborative care, supporting self-management, shared-decision making, collection of patient reported outcome measures, education, and follow-up. Methods: ADLIFE follows an outcome-based and patient-centered approach where PROMs represent an especially valuable tool to evaluate the outcomes of the care delivered. We have selected 11 standardized PROMs for evaluating the most recent patients' clinical context, enabling the decision-making process, and personalized care planning. The ADLIFE project implements the "SHARE approach' for enabling shared decision-making via two digital platforms for healthcare professionals and patients. We have successfully integrated PROMs and shared decision-making processes into our digital toolbox, based on an international interoperability standard, namely HL7 FHIR. A usability study was conducted with 3 clinical sites with 20 users in total to gather feedback and to subsequently prioritize updates to the ADLIFE toolbox. Results: User satisfaction is measured in the QUIS7 questionnaire on a 9-point scale in the following aspects: overall reaction, screen, terminology and tool feedback, learning, multimedia, training material and system capabilities. With all the average scores above 6 in all categories, most respondents have a positive reaction to the ADLIFE PEP platform and find it easy to use. We have identified shortcomings and have prioritized updates to the platform before clinical pilot studies are initiated. Conclusions: Having finalized design, implementation, and pre-deployment usability studies, and updated the tool based on further feedback, our patient empowerment mechanisms enabled via PROMs and shared decision-making processes are ready to be piloted in clinal settings. Clinical studies will be conducted based at six healthcare settings across Spain, UK, Germany, Denmark, and Israel. [ABSTRACT FROM AUTHOR]

This paper studies the form and emergence of the construction and representation of the self-proclamed State of caliphate by Islamic State. Dabiq magazine, the bridge between the organization and its readers (allies and enemies) has been used completely in this paper (15 total issues) with the purpose of knowing and comprehending critically how ISIS uses a propagandist and its communicative line to construct and represent itself and its idea of State as safe and pious. Great quality visual and textual resources of the magazine reproduce the populist, hegemonic and antagonistic self-construction of the caliphate as a form of life and government. It will also show the self-projection of ISIS to the outside and the we-other equation. In short, this work aims to approach the propagandistic discourse of an organization that shapes itself as the savior of society, designed and self-proclaimed through social institutions and forms of government that reinforce its domination and particular cultural hegemony. [ABSTRACT FROM AUTHOR]

Introduction: In the ADLIFE project (H2020, SC1-DTH-11-2019, 875209), an integrated care planning approach is used where patients are assigned various care plan activities by multidisciplinary care teams. To increase patients' adherence to the care plan, a continuous behavioral monitoring architecture is developed for delivering digital personalised, just-in time adaptive interventions. Continuous behavioral monitoring necessitates real-time tracking of a patient's care plan activity achievements, through various sources of data, such as medical devices, electronic health records and the mobile ADLIFE app, used by the patient. Theory/Methods: The integration architecture consists of personal medical devices, a FHIR repository, a mobile application, a health data ingestion stack and a rule-based intervention engine. Medical devices and electronic health records are used as patient health data sources. The mobile application is used as an intermediary device for integrating personal medical device data with standard based interfaces. The mobile application gathers personal health data from devices and forwards them to the health data ingestion stack, using predefined inbound adapters. In addition, the mobile application has appropriate graphical interfaces for end-users to check their care plan activities, their adherence performance and to receive and configure motivational interventions/reminders about their activities. The ingestion stack streaming layer starts with inbound adapters, which can consume incoming data and forward them to the plan intervention engine, using Apache Kafka. The real-time analytics engine uses Apache Spark Streaming modules to gather data from Kafka and transform them to the desired format to process and plan interventions to be delivered to the patient. Furthermore, the ingestion stack queries the FHIR repository periodically to make all the data available for the plan intervention engine. The rule-based plan intervention engine uses all integrated data to calculate a patient's adherence performance and to confirm if an intervention should be sent to a patient; it then delivers such intervention(s) to the patient, through a mobile phone notification. Results and Discussion: We will present the implementation of ingestion stack and rule-based plan intervention engine. In the ADLIFE project, we have decided to deliver behavioural change interventions to increase adherence and motivate patients to realize the following activities: selfmeasurement of selected clinical parameters and vital signs; symptom recording; completing PROM questionnaires; and physical exercise. At the time of writing of this abstract, twenty-two different intervention delivery rules have been defined to provide motivational messages and reminders based on the patient's most recent achievement status. Conclusions: This work is being carried out within the scope of the ADLIFE project and will be validated in part by the ADLIFE pilot studies, including seven clinical pilot sites with a total of 882 patients, 1243 caregivers and 577 healthcare professionals. Implications for applicability/transferability, sustainability, and limitations: The technical architecture and intervention delivery rules are ready to be piloted. The usability and acceptance of the technology, by patients, and the effectiveness of the behavioral interventions on patient's adherence will be assessed during pilot studies. [ABSTRACT FROM AUTHOR]

Introduction: In the ADLIFE project, Shared Decision-Making is a core concept that has the purpose of giving patients, especially patients with chronic diseases, the opportunity and power to participate constructively and actively in the decision-making processes involved in managing their health and chronic condition. On the surface, it may appear as a simple and straightforward technique, however, to get the optimal outcomes and intended results shared decision-making must be utilised in a new kind of equal partnership between the patient and the clinician, which traditionally has taken a more paternalistic approach where the clinician tells the patient what has been decided. Theory/Methods: The purpose of the review was to investigate the evidence for the impact SDM has on patients with chronic diseases with focus on COPD/CHF with the purpose of implementing SDM in the ADLIFE project. The search in PubMed and CINAHL (May to July 2021) and abstract reading were performed by two researchers. Final selection was performed by the most senior researcher. Inclusion criteria: peer-rewieved scientific articles in English and studies focusing on the effects on applying SDM to adults/elderly patients with chronic conditions (particularly COPD/CHF). Exclusion criteria: validation studies, study protocols, abstracts from congresses or meetings, and decision aids tools. Results and Discussion: Results show SDM interventions are complex but mainly have a positive effect improving: adherence, knowledge, decision quality and chronic illness care, decisional conflict and decision self-efficacy, perceived health status, perceived symptom severity and have an economic benefit. For patients with chronic diseases 15 articles were found describing the effects and significance of SDM. Most studies showed a positive effect of the SDM approach, but a clear outcome of SDM interventions for these patients is difficult to define. However, multi-factor programmes involving different healthcare professionals and several approaches, such as various information material, consultations and follow-up, has the best effect. Conclusions: The Shared Decision-Making process enhance clinicians' and patients' cooperation to reach the best decision for the individual patient, considering both the professional and scientific angle, and the patient's values. Only limited amount of literature clearly describes the effect and significance of SDM for patients with chronic disease. Implications for applicability/transferability, sustainability, and limitations: SDM is not a new concept, but the implementation has only taken place to a limited extent.SDM require for health professionals' training, support and methods to perform. Health professionals and patients require instructions and knowledge of different alternatives. This knowledge will be utilised when implementing SDM in the ADLIFE project. [ABSTRACT FROM AUTHOR]

Abstract  Cytosine DNA methylation is a stable epigenetic mark for maintenance of gene silencing across cellular divisions, but it is a reversible modification. Genetic and biochemical studies have revealed that the Arabidopsis DNA glycosylase domain-containing proteins ROS1 (REPRESSOR OF SILENCING 1) and DME (DEMETER) initiate erasure of 5-methylcytosine through a base excision repair process. The Arabidopsis genome encodes two paralogs of ROS1 and DME, referred to as DEMETER-LIKE proteins DML2 and DML3. We have found that DML2 and DML3 are 5-methylcytosine DNA glycosylases that are expressed in a wide range of plant organs. We analyzed the distribution of methylation marks at two methylated loci in wild-type and dml mutant plants. Mutations in DML2 and/or DML3 lead to hypermethylation of cytosine residues that are unmethylated or weakly methylated in wild-type plants. In contrast, sites that are heavily methylated in wild-type plants are hypomethylated in mutants. These results suggest that DML2 and DML3 are required not only for removing DNA methylation marks from improperly-methylated cytosines, but also for maintenance of high methylation levels in properly targeted sites. [ABSTRACT FROM AUTHOR]

Abstract  A collection of 143 plants arising from crosses from Monastrell × Cabernet Sauvignon is available in our orchards. A 3-year study enabled us to identify the differences between the different plants. In 2005, we had studied the anthocyanin profile and color characteristics of the most promising hybrids as a part of a project to select those plants showing the most interesting enological characteristics. Differences in the anthocyanin profile were observed between Monastrell and Cabernet Sauvignon grapes, the hybrids showing, in general, an anthocyanin profile intermediate between these two varieties, although closer to that of Cabernet Sauvignon grapes. To the best of our knowledge, this is the first work to study how the anthocyanin profile of two premium Vitis vinifera varieties is inherited by the resulting hybrid plants. [ABSTRACT FROM AUTHOR]

Abstract  The morphology and composition of skin and pulp cell walls of four premium red wine grape (Vitis vinifera L.) varieties were studied to determine whether the technological differences observed in previous studies between the four different varieties during the winemaking process (especially, the anthocyanin extractability) could be partly explained by their respective cell wall compositions. Monastrell grapes showed the highest amount of cell wall material in their skins (55–57 mg cell wall/g skin), while Syrah showed the largest amount of cell wall material in the pulp (5.1 mg cell wall/g pulp). The highest percentage of galactose and cellulosic glucose in skin and pulp cell walls was also found in Monastrell grapes. The cell wall composition of Monastrell grapes, together with their morphology, suggests that the firmer pulp and skin are responsible for the difficulties this variety shows for anthocyanin extraction (extractability index varying from 37 to 60). As cell wall composition may be modulated by the action of enzymes, the activity of pectinmethylesterase, polygalacturonase, cellulase and α- and β-galactosidase was studied. No polygalacturonase and cellulase activity was found. The two galactosidases showed higher activity than pectinmethylesterase (25–290 units/g tissue versus 0.3–0.4 units/g tissue), especially in Cabernet Sauvignon grapes, although in Monastrell grapes α- and β-galactosidase activity was low, which may explain the large amount of galactose in Monastrell grapes cell wall. [ABSTRACT FROM AUTHOR]

Background We sought to examine the relationship between health-related quality of life (HRQL) and a first emergency rehospitalization and mortality in patients with heart failure (HF) having a wide variation in ventricular ejection fraction and functional status. Methods Prospective study conducted with 394 patients admitted for HF-related emergencies at 4 Spanish hospitals. Baseline HRQL was measured with a generic questionnaire, the Medical Outcomes Study 36-item Short Form Survey (SF-36), and with an HF-specific instrument, the Minnesota Living With Heart Failure (MLWHF) questionnaire. Cox proportional hazards models were used to calculate hazard ratios (HRs) for hospitalization and death on the basis of HRQL scores. Results During a median follow-up of approximately 6 months, 138 patients (35.0%) underwent a first emergency rehospitalization and 70 (17.8%) died. After adjustment for biomedical, psychosocial, and health care variables, the frequency of hospital readmission was higher in patients with worse scores on the SF-36 physical functioning (HR, 1.65; 95% confidence interval [CI], 1.11-2.44; P = .01), general health (HR, 1.73; 95% CI, 1.19-2.52; P = .003), and mental health (HR, 1.65; 95% CI, 1.10-2.47; P = .02) subscales. Results were similar for the mortality end point. For the MLWHF questionnaire, worse overall and worse physical and emotional summary scores were associated with higher mortality. Conclusions Worse HRQL is associated with hospital readmission and death in patients with HF. The magnitude of this association, for both physical and mental HRQL components, is comparable to that for other well-known predictors of hospital readmission and death, such as personal history of diabetes, previous hospitalizations, and treatment with angiotensin-converting enzyme inhibitors. [ABSTRACT FROM AUTHOR]