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1.  Trehalose Is a Chemical Attractant in the Establishment of Coral Symbiosis 
PLoS ONE  2015;10(1):e0117087.
Coral reefs have evolved with a crucial symbiosis between photosynthetic dinoflagellates (genus Symbiodinium) and their cnidarian hosts (Scleractinians). Most coral larvae take up Symbiodinium from their environment; however, the earliest steps in this process have been elusive. Here we demonstrate that the disaccharide trehalose may be an important signal from the symbiont to potential larval hosts. Symbiodinium freshly isolated from Fungia scutaria corals constantly released trehalose (but not sucrose, maltose or glucose) into seawater, and released glycerol only in the presence of coral tissue. Spawning Fungia adults increased symbiont number in their immediate area by excreting pellets of Symbiodinium, and when these naturally discharged Symbiodinium were cultured, they also released trehalose. In Y-maze experiments, coral larvae demonstrated chemoattractant and feeding behaviors only towards a chamber with trehalose or glycerol. Concomitantly, coral larvae and adult tissue, but not symbionts, had significant trehalase enzymatic activities, suggesting the capacity to utilize trehalose. Trehalase activity was developmentally regulated in F. scutaria larvae, rising as the time for symbiont uptake occurs. Consistent with the enzymatic assays, gene finding demonstrated the presence of a trehalase enzyme in the genome of a related coral, Acropora digitifera, and a likely trehalase in the transcriptome of F. scutaria. Taken together, these data suggest that adult F. scutaria seed the reef with Symbiodinium during spawning and the exuded Symbiodinium release trehalose into the environment, which acts as a chemoattractant for F. scutaria larvae and as an initiator of feeding behavior- the first stages toward establishing the coral-Symbiodinium relationship. Because trehalose is a fixed carbon compound, this cue would accurately demonstrate to the cnidarian larvae the photosynthetic ability of the potential symbiont in the ambient environment. To our knowledge, this is the first report of a chemical cue attracting the motile coral larvae to the symbiont.
doi:10.1371/journal.pone.0117087
PMCID: PMC4309597  PMID: 25629699
2.  Bringing psychosocial support to headache sufferers using information and communication technology: Lessons learned from asking potential users what they want 
BACKGROUND:
Headaches are a major concern for which psychosocial interventions are recommended. However, headache sufferers do not always have ready access to these interventions. Technology has been used to improve access, especially in young people.
OBJECTIVES:
To examine user preferences to inform the development of an Internet-based psychosocial intervention including smartphone technology, referred to as the Wireless Headache Intervention.
METHODS:
The methodology followed a participatory design cycle, including 25 headache sufferers (14 to 28 years of age) who informed the prototype design. All participants were familiar with smartphones and the Internet. Through two iterative cycles of focus groups stratified according to age, qualitative data were collected by asking user preferences for the different planned components of the intervention (ie, smartphone pain diary, Internet-based self-management treatment, social support) and other relevant aspects (ie, smartphone versus computer delivery, and ways of reaching target audience). NVivo 8 with content analysis was used to analyze data and reflect themes as guided by the thematic survey.
RESULTS:
Participants reported a preference for completing the smart-phone pain diary on a daily basis. Participants believed that the program should facilitate easy access to information regarding headaches and management strategies. They also wanted access to other headache sufferers and experts. Participants believed that the program should be customizable and interactive. They reinforced the need and value of an integrated smartphone and Internet-based application.
CONCLUSIONS:
The results provide insight into a participatory design to guide design decisions for the type of intervention for which success relies largely on self-motivation. The results also provide recommendations for design of similar interventions that may benefit from the integration of mobile applications to Internet-based interventions. The present research contributes to the theoretical frameworks that have been formulated for the development of Internet-based applications.
PMCID: PMC3938344  PMID: 24511572
Distance treatment; Focus group; Headache; Psychosocial intervention; Wireless
3.  iCanCope with Pain™: User-centred design of a web- and mobile-based self-management program for youth with chronic pain based on identified health care needs 
Chronic pain self-management involves providing patients with knowledge, coping strategies and social support that help them to manage their pain. This type of intervention has been shown to be useful in treating chronic pain; however, many eligible chronic pain patients never receive such treatment due to limited accessibility and high cost. The use of Internet-based cognitive behavioural therapy has the potential to change this. In this study, the authors report their progress in the development of an Internet- and smartphone-based application for chronic pain self-management.
BACKGROUND:
While there are emerging web-based self-management programs for children and adolescents with chronic pain, there is currently not an integrated web- and smartphone-based app that specifically addresses the needs of adolescents with chronic pain.
OBJECTIVES:
To conduct a needs assessment to inform the development of an online chronic pain self-management program for adolescents, called iCanCope with Pain™.
METHODS:
A purposive sample of adolescents (n=23; 14 to 18 years of age) was recruited from two pediatric chronic pain clinics in Ontario. Interdisciplinary health care providers were also recruited from these sites. Three focus groups were conducted with adolescents (n=16) and one with pediatric health care providers (n=7). Individual adolescent interviews were also conducted (n=7).
RESULTS:
Qualitative analysis uncovered four major themes: pain impact; barriers to care; pain management strategies; and transition to adult care. Pain impacted social, emotional, physical and role functioning, as well as future goals. Barriers to care were revealed at the health care system, patient and societal levels. Pain management strategies included support systems, and pharmacological, physical and psychological approaches. Transition subthemes were: disconnect between pediatric and adult systems; skills development; parental role; and fear/anxiety. Based on these identified needs, the iCanCope with Pain™ architecture will include the core theory-based functionalities of: symptom self-monitoring; personalized goal setting; pain coping skills training; peer-based social support; and chronic pain education.
CONCLUSIONS:
The proposed iCanCope with Pain™ program aims to address the self-management needs of adolescents with chronic pain by improving access to disease information, strategies to manage symptoms and social support.
PMCID: PMC4197753  PMID: 25000507
Adolescent; Chronic pain; E-health; Mobile-health; Needs assessment; Self-management
4.  A qualitative review of the psychometric properties and feasibility of electronic headache diaries for children and adults: Where we are and where we need to go 
BACKGROUND:
While paper headache pain diaries have been used to determine the effectiveness of headache treatments in clinical trials, recent advances in information and communication technologies have resulted in the burgeoning use of electronic diaries (e-diaries) for headache pain.
OBJECTIVE:
To qualitatively review headache e-diaries, assess their measurement properties, examine measurement components and compare these components with recommended reporting guidelines.
METHODS:
The databases Medline, the Cumulative Index to Nursing and Allied Health Literature, Embase, PsychInfo, the Education Resources Information Centre and ISI Web of Science were searched for self-report headache e-diaries for children and adults. A total of 21 publications that involved e-diaries were found; five articles reported on the development of an e-diary and 16 used an e-diary as an outcome measure in randomized controlled trials or observational studies. The diary measures’ components, features and psychometric properties, as well as the quality of evidence of their psychometric properties, were evaluated.
RESULTS:
Five headache e-diaries met the a priori criteria and were included in the final analysis. None of these e-diaries had well-developed evidence of reliability and validity. Three e-diaries showed evidence of feasibility. E-diaries with ad hoc measures developed by the study investigators were most common, with little to no supportive evidence of reliability and/or validity. Compliance with the reporting guidelines was variable, with only one-half of the e-diaries measuring the recommended primary outcome of headache frequency.
CONCLUSIONS:
Specific recommendations regarding the development (including essential components) and testing of headache e-diaries are discussed. Further research is needed to strengthen the measurement of headache pain in clinical trials using headache e-diaries.
PMCID: PMC3673932  PMID: 23748255
Adults; Children; Electronic pain diaries; Headache diary; Psychometric properties
5.  The value of usability testing for Internet-based adolescent self-management interventions: “Managing Hemophilia Online” 
Background
As adolescents with hemophilia approach adulthood, they are expected to assume responsibility for their disease management. A bilingual (English and French) Internet-based self-management program, “Teens Taking Charge: Managing Hemophilia Online,” was developed to support adolescents with hemophilia in this transition. This study explored the usability of the website and resulted in refinement of the prototype.
Methods
A purposive sample (n=18; age 13–18; mean age 15.5 years) was recruited from two tertiary care centers to assess the usability of the program in English and French. Qualitative observations using a “think aloud” usability testing method and semi-structured interviews were conducted in four iterative cycles, with changes to the prototype made as necessary following each cycle. This study was approved by research ethics boards at each site.
Results
Teens responded positively to the content and appearance of the website and felt that it was easy to navigate and understand. The multimedia components (videos, animations, quizzes) were felt to enrich the experience. Changes to the presentation of content and the website user-interface were made after the first, second and third cycles of testing in English. Cycle four did not result in any further changes.
Conclusions
Overall, teens found the website to be easy to use. Usability testing identified end-user concerns that informed improvements to the program. Usability testing is a crucial step in the development of Internet-based self-management programs to ensure information is delivered in a manner that is accessible and understood by users.
doi:10.1186/1472-6947-13-113
PMCID: PMC3856537  PMID: 24094082
Usability testing; Internet; Patient education; Self-management; Adolescent; Hemophilia
6.  Measurement Properties of Questionnaires Assessing Complementary and Alternative Medicine Use in Pediatrics: A Systematic Review 
PLoS ONE  2012;7(6):e39611.
Objective
Complementary and alternative medicine (CAM) is commonly used by children, but estimates of that use vary widely partly due to the range of questionnaires used to assess CAM use. However, no studies have attempted to appraise measurement properties of these questionnaires. The aim of this systematic review was to critically appraise and summarize measurement properties of questionnaires of CAM use in pediatrics.
Study design
A search strategy was implemented in major electronic databases in March 2011 and conference websites, scientific journals and experts were consulted. Studies were included if they mentioned a questionnaire assessing the prevalence of CAM use in pediatrics. Members of the team independently rated the methodological quality of the studies (using the COSMIN checklist) and measurement properties of the questionnaires (using the Terwee and Cohen criteria).
Results
A total of 96 CAM questionnaires were found in 104 publications. The COSMIN checklist showed that no studies reported adequate methodological quality. The Terwee criteria showed that all included CAM questionnaires had indeterminate measurement properties. According to the Cohen score, none were considered to be a well-established assessment, two approached the level of a well-established assessment, seven were promising assessments and the remainder (n = 87) did not reach the score’s minimum standards.
Conclusion
None of the identified CAM questionnaires have been thoroughly validated. This systematic review highlights the need for proper validation of CAM questionnaires in pediatrics, which may in turn lead to improved research and knowledge translation about CAM in clinical practice.
doi:10.1371/journal.pone.0039611
PMCID: PMC3387262  PMID: 22768098
7.  Orexin Receptor Subtype Activation and Locomotor Behavior in the Rat 
Acta physiologica (Oxford, England)  2009;198(3):313-324.
Aim
Orexin producing neurons, located primarily in the perifornical region of the lateral hypothalamus, project to a wide spectrum of brain sites where they influence numerous behaviors as well as modulating the neuroendocrine and autonomic responses to stress. While some of the actions of orexin appear to be mediated via the type 1 receptor, some are not, including its action on the release of one stress hormone, prolactin. We describe here the ability of orexin to increase locomotor behaviors and identify the importance of both receptor subtypes in these actions.
Methods
Rats were tested for their behavioral responses to the central activation of both the type 1 (OX1R) and type 2 (OX2R) receptor (ICV orexin A), as compared to OX2R activation using a relatively selective OX2R agonist in the absence or presence of an orexin receptor antagonist that possesses highest affinity for the OX1R.
Results
Increases in locomotor activity were observed, effects which were expressed by not only orexin A, which binds to both the OX1R and the OX2R receptors, but also by the relatively selective OX2R agonist, [(Ala11, Leu15)-orexin B]. Furthermore the OX1R selective antagonist only partially blocked the action of orexin A on most locomotor behaviors and did not block the actions of [(Ala11, Leu15)-orexin B].
Conclusion
We conclude that orexin A exerts its effects on locomotor behavior via both the OX1R and OX2R and that agonism or antagonism of only one of these receptors for therapeutic purposes (i.e. sleep disorders) would not provide selectivity in terms of associated behavioral side effects.
doi:10.1111/j.1748-1716.2009.02056.x
PMCID: PMC2860644  PMID: 19889100
Orexin; Orexin Receptors; Locomotor Behavior; Stereotypy
8.  Usability Testing of an Online Self-management Program for Adolescents With Juvenile Idiopathic Arthritis 
Background
A new bilingual (English and French) Internet-based self-management program, Teens Taking Charge: Managing Arthritis Online, for adolescents with arthritis and their parents was developed following a needs assessment.
Objectives
This study explored the usability (user performance and satisfaction) of the self-management program for youth with juvenile idiopathic arthritis (JIA) and their parents to refine the health portal prototype.
Methods
A qualitative study design with semi-structured, audio taped interviews and observation by a trained observer was undertaken with two iterative cycles to determine the usability (ease of use, efficiency, errors, and user satisfaction) of the user interface and content areas of the intervention. A purposive sample of English-speaking (n = 11; mean age = 15.4, standard deviation [SD] 1.7) and French-speaking (n = 8; mean age = 16.0, SD 1.2) adolescents with JIA and one of their respective parents/caregivers were recruited from 2 Canadian tertiary care centers. Descriptive statistics and simple content analyses were used to organize data into categories that reflected the emerging usability themes.
Results
All of the participants had access to a computer/Internet at home; however, adolescents were more comfortable using the computer/Internet than their parents. Adolescents and parents provided similar as well as differing suggestions on how the website user interface could be improved in terms of its usability (navigation; presentation and control usage errors; format and layout; as well as areas for further content development). There were no major differences in usability issues between English- and French-speaking participants. Minor changes to the website user interface were made and tested in a second cycle of participants. No further usability problems were identified in the second iterative cycle of testing. Teens and parents responded positively to the appearance and theme of the website (ie, promoting self-management) and felt that it was easy to navigate, use, and understand. Participants felt that the content was appropriate and geared to meet the unique needs of adolescents with JIA and their parents as well as English- and French-speaking families. Many participants responded that the interactive features (discussion board, stories of hope, and video clips of youth with JIA) made them feel supported and “not alone” in their illness.
Conclusions
We describe the usability testing of a self-management health portal designed for English- and French-speaking youth with arthritis and their parents, which uncovered several usability issues. Usability testing is a crucial step in the development of self-management health portals to ensure that the various end users (youth and parents) have the ability to access, understand, and use health-related information and services that are delivered via the Internet and that they are delivered in an efficient, effective, satisfying, and culturally competent manner.
doi:10.2196/jmir.1349
PMCID: PMC2956330  PMID: 20675293
Juvenile idiopathic arthritis; Internet; usability testing; self-management; adolescent

Results 1-8 (8)