In this paper, we propose a game adaptation technique that seeks to improve the training outcomes of stroke patients during a therapeutic session. This technique involves the generation of customized ...game levels, which difficulty is dynamically adjusted to the patients’ abilities and performance. Our goal was to evaluate the effect of this adaptation strategy on the training outcomes of post-stroke patients during a therapeutic session. We hypothesized that a dynamic difficulty adaptation strategy would have a more positive effect on the training outcomes of patients than two control strategies, incremental difficulty adaptation and random difficulty adaptation. To test these strategies, we developed three versions of PRehab, a serious game for upper-limb rehabilitation. Seven stroke patients and three therapists participated in the experiment, and played all three versions of the game on a graphics tablet. The results of the experiment show that our dynamic adaptation technique increases movement amplitude during a therapeutic session. This finding may serve as a basis to improve patient recovery.
Few biological prognosticators are useful for prediction of Richter syndrome (RS), representing the transformation of chronic lymphocytic leukemia (CLL) to aggressive lymphoma. Stereotyped B-cell ...receptors (BCR) may have prognostic effect in CLL progression. We tested the prognostic effect of stereotyped BCR for predicting RS transformation.
The prevalence of stereotyped BCR was compared in RS (n = 69) versus nontransformed CLL (n = 714) by a case-control analysis. Subsequently, the effect of stereotyped BCR at CLL diagnosis on risk of RS transformation was actuarially assessed in a consecutive CLL series (n = 753).
RS (n = 69) displayed a higher prevalence of stereotyped BCR (P < 0.001) compared with nontransformed CLL. The actuarial risk of RS transformation was significantly higher in CLL carrying stereotyped BCR (P < 0.001). Among BCR subsets most represented in CLL, subset 8 using IGHV4-39/IGHD6-13/IGHJ5 carried the highest risk of RS transformation hazard ratio (HR), 24.50; P < 0.001. Multivariate analysis selected stereotyped BCR (HR, 3.33; P = 0.001) and IGHV4-39 usage (HR, 4.03; P = 0.004) as independent predictors of RS transformation. The combination of IGHV4-39 usage and stereotyped BCR in the same patient identified CLL with a very high risk of RS transformation (5-year risk, 68.7%). The risk carried by stereotyped BCR and IGHV4-39 usage was specific for RS transformation and had no effect on CLL progression without transformation.
Analysis of BCR features may help identify CLL patients at risk of RS. A close monitoring and a careful biopsy policy may help early recognition of RS in CLL patients using stereotyped BCR, particularly if combined with IGHV4-39.
Splenic marginal zone lymphoma (SMZL) is one of the few B-cell lymphoma types that remain orphan of molecular lesions in cancer-related genes. Detection of active NF-κB signaling in 14 (58%) of 24 ...SMZLs prompted the investigation of NF-κB molecular alterations in 101 SMZLs. Mutations and copy number abnormalities of NF-κB genes occurred in 36 (36%) of 101 SMZLs and targeted both canonical (TNFAIP3 and IKBKB) and noncanonical (BIRC3, TRAF3, MAP3K14) NF-κB pathways. Most alterations were mutually exclusive, documenting the existence of multiple independent mechanisms affecting NF-κB in SMZL. BIRC3 inactivation in SMZL recurred because of somatic mutations that disrupted the same RING domain that in extranodal marginal zone lymphoma is removed by the t(11;18) translocation, which points to BIRC3 disruption as a common mechanism across marginal zone B-cell lymphomagenesis. Genetic lesions of NF-κB provide a molecular basis for the pathogenesis of more than 30% of SMZLs and offer a suitable target for NF-κB therapeutic approaches in this lymphoma.
Collective learning has been advocated to be at the source for innovation, particularly as serendipity seems historically to have been the driving force not only behind innovation, but also behind ...scientific discovery and artistic creation. Informal learning is well known to represent the most significant learning effects in humans, far better than its complement: formal learning with predefined objectives. We have designed an approach—ViewpointS—based on a digital medium—the ViewpointS Web Application—that enables and enhances the processes for sharing knowledge within a group and is equipped with metrics aimed at assessing collective and informal learning. In this article, we introduce by giving a brief state of the art about collective and informal learning, then outline our approach and medium, and finally, present and exploit a real-life experiment aimed at evaluating the ViewpointS approach and metrics.
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