ERS/EAACI statement on adherence to international adult asthma guidelines

Clinical practice guidelines based on the best available evidence, aim to standardize and optimize asthma diagnosis and management. Nevertheless, there are concerns that particularly between different groups of healthcare professionals (HCPs), adherence to guidelines is suboptimal. Further to these concerns, the aims of this ERS/EAACI Statement were (1) via an international online survey, to evaluate and compare the understanding of and adherence to international asthma guidelines by HCPs of different specialties, (2) via systematic reviews of the literature, to assess effectiveness of strategies focused at improving implementation of guideline-recommended interventions, and compare process and clinical outcomes in patients managed by Specialists (respiratory physicians or allergists) or Generalists (internists or general practitioners). The online survey identified discrepancies between HCPs of different specialties which may be due to poor dissemination or lack of knowledge of the guidelines but also a reflection of the adaptations HCPs working in different clinical settings make, based on their resources. The systematic reviews demonstrated that multifaceted quality improvement initiatives addressing multiple challenges to guidelines adherence, or the input from additional specialized HCPs are most effective in improving guidelines adherence. More data are needed to evaluate differences in process and clinical outcomes among patients managed by Generalists or Specialists. Our results reveal a need for guidelines to consider the heterogeneity of real-life settings for asthma management and tailor their recommendations accordingly. Continuous, multifaceted quality improvement processes are required to optimize and maintain guidelines adherence. Validated referral pathways for uncontrolled asthma or for uncertain diagnosis are needed

Primary Health Care

This book presents examples from various countries about the provision of health services at the primary care level. Chapters examine the role of professionals in primary healthcare services and how they can work to improve the health of individuals and communities. Written by authors from Africa, Asia, America, Europe, and Australia, this book provides up-to-date information on primary health care, including telehealth services in the era of COVID-19

Hardware-software design of embedded systems for intelligent sensing applications

This Thesis wants to highlight the importance of ad-hoc designed and developed embedded systems in the implementation of intelligent sensor networks. As evidence four areas of application are presented: Precision Agriculture, Bioengineering, Automotive and Structural Health Monitoring. For each field is reported one, or more, smart device design and developing, in addition to on-board elaborations, experimental validation and in field tests. In particular, it is presented the design and development of a fruit meter. In the bioengineering field, three different projects are reported, detailing the architectures implemented and the validation tests conducted. Two prototype realizations of an inner temperature measurement system in electric motors for an automotive application are then discussed. Lastly, the HW/SW design of a Smart Sensor Network is analyzed: the network features on-board data management and processing, integration in an IoT toolchain, Wireless Sensor Network developments and an AI framework for vibration-based structural assessment

Long-term monitoring of respiratory metrics using wearable devices

Recently, there has been an increased interest in monitoring health using wearable sensors technologies however, few have focused on breathing. The utility of constant monitoring of breathing is currently not well understood, both for general health as well as respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD) that have significant prevalence in society. Having a wearable device that could measure respiratory metrics continuously and non-invasively with high adherence would allow us to investigate the significance of ambulatory breathing monitoring in health and disease management. The purpose of this thesis was to determine if it was feasible to continuously monitor respiratory metrics. To do this, we identified pulse oximetry to provide the best balance between use of mature signal processing methods, commercial availability, power efficiency, monitoring site and perceived wearability. Through a survey, it was found users would monitor their breathing, irrespective of their health status using a smart watch. Then it was found that reducing the duty cycle and power consumption adversely affected the reliability to capture accurate respiratory rate measurements through pulse oximetry. To account for the decreased accuracy of PPG derived respiratory rate at higher rates, a long short-term memory (LSTM) network and a U-Net were proposed, characterised and implemented. In addition to respiratory rate, inspiration time, expiration time, inter-breath intervals and the Inspiration:Expiration ratio were also predicted. Finally, the accuracy of these predictions was validated using pilot data from 11 healthy participants and 11 asthma participants. While percentage bias was low, the 95\% limits of agreement was high. While there is likely going to be enthusiastic uptake in wearable device use, it remains unseen whether clinical utility can be achieved, in particular the ability to forecast respiratory status. Further, the issues of sensor noise and algorithm performance during activity was not calculated. However, this body of work has investigated and developed the use of pulse oximetry, classical signal processing and machine learning methodologies to extract respiratory metrics to lay a foundation for both the hardware and software requirements in future clinical research

Proceedings of the 8th Workshop on Detection and Classification of Acoustic Scenes and Events (DCASE 2023)

This volume gathers the papers presented at the Detection and Classification of Acoustic Scenes and Events 2023 Workshop (DCASE2023), Tampere, Finland, during 21–22 September 2023

Space Biology and Medicine

Volume IV is devoted to examining the medical and associated organizational measures used to maintain the health of space crews and to support their performance before, during, and after space flight. These measures, collectively known as the medical flight support system, are important contributors to the safety and success of space flight. The contributions of space hardware and the spacecraft environment to flight safety and mission success are covered in previous volumes of the Space Biology and Medicine series. In Volume IV, we address means of improving the reliability of people who are required to function in the unfamiliar environment of space flight as well as the importance of those who support the crew. Please note that the extensive collaboration between Russian and American teams for this volume of work resulted in a timeframe of publication longer than originally anticipated. Therefore, new research or insights may have emerged since the authors composed their chapters and references. This volume includes a list of authors' names and addresses should readers seek specifics on new information. At least three groups of factors act to perturb human physiological homeostasis during space flight. All have significant influence on health, psychological, and emotional status, tolerance, and work capacity. The first and most important of these factors is weightlessness, the most specific and radical change in the ambient environment; it causes a variety of functional and structural changes in human physiology. The second group of factors precludes the constraints associated with living in the sealed, confined environment of spacecraft. Although these factors are not unique to space flight, the limitations they entail in terms of an uncomfortable environment can diminish the well-being and performance of crewmembers in space. The third group of factors includes the occupational and social factors associated with the difficult, critical nature of the crewmembers' work: the risks involved in space flight, changes in circadian rhythms, and intragroup interactions. The physical and emotional stress and fatigue that develop under these conditions also can disturb human health and performance. In addition to these factors, the risk also exists that crewmembers will develop various illnesses during flight. The risk of illness is no less during space flight than on Earth, and may actually be greater for some classes of diseases