Assessment of the feasibility of an ultra-low power, wireless digital patch for the continuous ambulatory monitoring of vital signs.

BACKGROUND AND OBJECTIVES: Vital signs are usually recorded at 4–8 h intervals in hospital patients, and deterioration between measurements can have serious consequences. The primary study objective was to assess agreement between a new ultra-low power, wireless and wearable surveillance system for continuous ambulatory monitoring of vital signs and a widely used clinical vital signs monitor. The secondary objective was to examine the system's ability to automatically identify and reject invalid physiological data. SETTING: Single hospital centre. PARTICIPANTS: Heart and respiratory rate were recorded over 2 h in 20 patients undergoing elective surgery and a second group of 41 patients with comorbid conditions, in the general ward. OUTCOME MEASURES: Primary outcome measures were limits of agreement and bias. The secondary outcome measure was proportion of data rejected. RESULTS: The digital patch provided reliable heart rate values in the majority of patients (about 80%) with normal sinus rhythm, and in the presence of abnormal ECG recordings (excluding aperiodic arrhythmias such as atrial fibrillation). The mean difference between systems was less than ±1 bpm in all patient groups studied. Although respiratory data were more frequently rejected as invalid because of the high sensitivity of impedance pneumography to motion artefacts, valid rates were reported for 50% of recordings with a mean difference of less than ±1 brpm compared with the bedside monitor. Correlation between systems was statistically significant (p<0.0001) for heart and respiratory rate, apart from respiratory rate in patients with atrial fibrillation (p=0.02). CONCLUSIONS: Overall agreement between digital patch and clinical monitor was satisfactory, as was the efficacy of the system for automatic rejection of invalid data. Wireless monitoring technologies, such as the one tested, may offer clinical value when implemented as part of wider hospital systems that integrate and support existing clinical protocols and workflows

Shelf-life Evaluation of Packaged Fermented Cassava Flour

Cassava is a carbohydrate source with high productivity per hectare of plantation. Cassava is made into flour to extend its shelf life. However, traditional flour still has low quality due to its yellowish color and distinct odor. Fermented cassava flour (FERCAF) is produced by fermentation of cassava chips in a circulated retting fermenter by using a combination of Lactobacillus plantarum, Bacillus subtilis, and Aspergillus oryzae, followed by drying and milling. This process has been used successfully to produce flour with a white color and a neutral aroma. To enable industrial scale production and market introduction, the quality deterioration and shelf life of packaged FERCAF should be determined. The objective of this research was to investigate the effect of storage time and packaging type on the physicochemical properties and to determine shelf life of packaged FERCAF. FERCAF was stored in a controlled-incubator over 94 days using two packaging types: LDPE plastic and kraft paper. Based on the result, the number of microorganisms over 94 days of storage was within safe limits. The average estimated shelf life of packaged FERCAF was in the range of 3-4 months at ambient temperature. The shelf life of FERCAF packaged in LDPE plastic was approximately 15 days longer than that packaged in kraft paper

Correlated two-pion exchange and large-N(C) behavior of nuclear forces

The effect of correlated scalar-isoscalar two-pion exchange (CrTPE) modes is considered in connection with central and spin-orbit parts of the NN force. The two-pion correlation function is coupled directly to the scalar form factor of the nucleon which we calculate in the large-N(C) limit where the nucleon can be described as a soliton of an effective chiral theory. The results for the central NN force show a strong repulsive core at short internucleon distances supplemented by a moderate attraction beyond 1 fm. The long-range tail of the central NN potential is driven by the the pion-nucleon sigma term and consistent with the effective $\sigma$ meson exchange. The spin-orbit part of the NN potential is repulsive. The large-N(C) scaling behavior of the scalar-isoscalar NN interaction is addressed. We show that the spin-orbit part is O(1/N^2(C)) in strength relative to the central force resulting in the ratio $\simeq 1/9$ suggested by the 1/N(C) expansion for N(C)=3. The latter is in agreement with our numerical analysis and with the Kaplan-Manohar large-N(C) power counting. Unitarization of the $\pi \pi$ scattering amplitude plays here an important role and improves the tree level results. Analytical representations of the CrTPE NN potential in terms of elementary functions are derived and their chiral content is discussed.Comment: 29 pages, 7 figure

Large differences between test strategies for the detection of anti-Borrelia antibodies are revealed by comparing eight ELISAs and five immunoblots

We investigated the influence of assay choice on the results in a two-tier testing algorithm for the detection of anti-Borrelia antibodies. Eighty-nine serum samples from clinically well-defined patients were tested in eight different enzyme-linked immunosorbent assay (ELISA) systems based on whole-cell antigens, whole-cell antigens supplemented with VlsE and assays using exclusively recombinant proteins. A subset of samples was tested in five immunoblots: one whole-cell blot, one whole-cell blot supplemented with VlsE and three recombinant blots. The number of IgM- and/or IgG-positive ELISA results in the group of patients suspected of Borrelia infection ranged from 34 to 59%. The percentage of positives in cross-reactivity controls ranged from 0 to 38%. Comparison of immunoblots yielded large differences in inter-test agreement and showed, at best, a moderate agreement between tests. Remarkably, some immunoblots gave positive results in samples that had been tested negative by all eight ELISAs. The percentage of positive blots following a positive ELISA result depended heavily on the choice of ELISA–immunoblot combination. We conclude that the assays used to detect anti-Borrelia antibodies have widely divergent sensitivity and specificity. The choice of ELISA–immunoblot combination severely influences the number of positive results, making the exchange of test results between laboratories with different methodologies hazardous

Intentional Foreign Body Ingestion: A Complex Case of Pica

Intentional ingestion of foreign objects, a form of self-injurious behavior, is rarely discussed in the medical literature but often requires extensive evaluation, management, and resources. It can be especially problematic for gastroenterologists, who are often consulted for removal of the foreign body. Pica is the psychiatric diagnosis for intentional ingestion of nonnutritive objects and is most commonly seen in prison inmates and those diagnosed with intellectual disability or psychiatric illness. This case report presents a challenging case of pica, highlighting the complexity involved in diagnosis and the need for early psychiatric intervention. It also aims to provide a general review of the literature and practical recommendations to assist with managing this form of self-injurious behavior in the inpatient setting. Collaborative efforts among specialties in addition to primary prevention are vital to successful management of these patients

Brain oscillatory activity as a biomarker of motor recovery in chronic stroke

In the present work, we investigated the relationship of oscillatory sensorimotor brain activity to motor recovery. The neurophysiological data of 30 chronic stroke patients with severe upper‐limb paralysis are the basis of the observational study presented here. These patients underwent an intervention including movement training based on combined brain–machine interfaces and physiotherapy of several weeks recorded in a double‐blinded randomized clinical trial. We analyzed the alpha oscillations over the motor cortex of 22 of these patients employing multilevel linear predictive modeling. We identified a significant correlation between the evolution of the alpha desynchronization during rehabilitative intervention and clinical improvement. Moreover, we observed that the initial alpha desynchronization conditions its modulation during intervention: Patients showing a strong alpha desynchronization at the beginning of the training improved if they increased their alpha desynchronization. Patients showing a small alpha desynchronization at initial training stages improved if they decreased it further on both hemispheres. In all patients, a progressive shift of desynchronization toward the ipsilesional hemisphere correlates significantly with clinical improvement regardless of lesion location. The results indicate that initial alpha desynchronization might be key for stratification of patients undergoing BMI interventions and that its interhemispheric balance plays an important role in motor recovery.Bundesministerium für Bildung und Forschung, Grant/Award Numbers: 13GW0053, 16SV7754; Deutsche Forschungsgemeinschaft; Deutscher Akademischer Austauschdienst, Grant/Award Number: 9156335

A Whole-Genome RNA Interference Screen Reveals a Role for Spry2 in Insulin Transcription and the Unfolded Protein Response.

Insulin production by the pancreatic β-cell is required for normal glucose homeostasis. While key transcription factors that bind to the insulin promoter are known, relatively little is known about the upstream regulators of insulin transcription. Using a whole-genome RNA interference screen, we uncovered 26 novel regulators of insulin transcription that regulate diverse processes including oxidative phosphorylation, vesicle traffic, and the unfolded protein response (UPR). We focused on Spry2-a gene implicated in human type 2 diabetes by genome-wide association studies but without a clear connection to glucose homeostasis. We showed that Spry2 is a novel UPR target and its upregulation is dependent on PERK. Knockdown of Spry2 resulted in reduced expression of Serca2, reduced endoplasmic reticulum calcium levels, and induction of the UPR. Spry2 deletion in the adult mouse β-cell caused hyperglycemia and hypoinsulinemia. Our study greatly expands the compendium of insulin promoter regulators and demonstrates a novel β-cell link between Spry2 and human diabetes

Graphene Transport at High Carrier Densities using a Polymer Electrolyte Gate

We report the study of graphene devices in Hall-bar geometry, gated with a polymer electrolyte. High densities of 6 $\times 10^{13}/cm^{2}$ are consistently reached, significantly higher than with conventional back-gating. The mobility follows an inverse dependence on density, which can be correlated to a dominant scattering from weak scatterers. Furthermore, our measurements show a Bloch-Gr\"uneisen regime until 100 K (at 6.2 $\times10^{13}/cm^{2}$), consistent with an increase of the density. Ubiquitous in our experiments is a small upturn in resistivity around 3 $\times10^{13}/cm^{2}$, whose origin is discussed. We identify two potential causes for the upturn: the renormalization of Fermi velocity and an electrochemically-enhanced scattering rate.Comment: 13 pages, 4 figures, Published Versio

Association of proinflammatory cytokines and chemotherapy-associated cognitive impairment in breast cancer patients: a multi-centered, prospective, cohort study.

BackgroundExisting evidence suggests that proinflammatory cytokines play an intermediary role in postchemotherapy cognitive impairment. This is one of the largest multicentered, cohort studies conducted in Singapore to evaluate the prevalence and proinflammatory biomarkers associated with cognitive impairment in breast cancer patients.Patients and methodsChemotherapy-receiving breast cancer patients (stages I-III) were recruited. Proinflammatory plasma cytokines concentrations [interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating factor, interferon-γ and tumor necrosis factor-α] were evaluated at 3 time points (before chemotherapy, 6 and 12 weeks after chemotherapy initiation). The FACT-Cog (version 3) was utilized to evaluate patients' self-perceived cognitive disturbances and a computerized neuropsychological assessment (Headminder) was administered to evaluate patients' memory, attention, response speed and processing speed. Changes of cognition throughout chemotherapy treatment were compared against the baseline. Linear mixed-effects models were applied to test the relationships of clinical variables and cytokine concentrations on self-perceived cognitive disturbances and each objective cognitive domain.ResultsNinety-nine patients were included (age 50.5 ± 8.4 years; 81.8% Chinese; mean duration of education = 10.8 ± 3.3 years). Higher plasma IL-1β was associated with poorer response speed performance (estimate: -0.78; 95% confidence interval (CI) -1.34 to -0.03; P = 0.023), and a higher concentration of IL-4 was associated with better response speed performance (P = 0.022). Higher concentrations of IL-1β and IL-6 were associated with more severe self-perceived cognitive disturbances (P = 0.018 and 0.001, respectively). Patients with higher concentrations of IL-4 also reported less severe cognitive disturbances (P = 0.022).ConclusionsWhile elevated concentrations of IL-6 and IL-1β were observed in patients with poorer response speed performance and perceived cognitive disturbances, IL-4 may be protective against chemotherapy-associated cognitive impairment. This study is important because cytokines would potentially be mechanistic mediators of chemotherapy-associated cognitive changes

Comparison of engagement and emotional responses of older and younger adults interacting with 3D cultural heritage artefacts on personal devices

The availability of advanced software and less expensive hardware allows museums to preserve and share artefacts digitally. As a result, museums are frequently making their collections accessible online as interactive, 3D models. This could lead to the unique situation of viewing the digital artefact before the physical artefact. Experiencing artefacts digitally outside of the museum on personal devices may affect the user's ability to emotionally connect to the artefacts. This study examines how two target populations of young adults (18–21 years) and the elderly (65 years and older) responded to seeing cultural heritage artefacts in three different modalities: augmented reality on a tablet, 3D models on a laptop, and then physical artefacts. Specifically, the time spent, enjoyment, and emotional responses were analysed. Results revealed that regardless of age, the digital modalities were enjoyable and encouraged emotional responses. Seeing the physical artefacts after the digital ones did not lessen their enjoyment or emotions felt. These findings aim to provide an insight into the effectiveness of 3D artefacts viewed on personal devices and artefacts shown outside of the museum for encouraging emotional responses from older and younger people