Validation of a novel device to objectively measure adherence to long-term oxygen therapy

Sun-Kai V Lin1, Daniel K Bogen1, Samuel T Kuna2,31Department of Bioengineering; 2Department of Medicine, Pulmonary, Allergy and Critical Care Division, and Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Pennsylvania, USA; 3Department of Medicine, Philadelphia Veterans Affairs Medical Center Philadelphia, Pennsylvania, USARationale: We have developed a novel oxygen adherence monitor that objectively measures patient use of long-term oxygen therapy. The monitor attaches to the oxygen source and detects whether or not the patient is wearing the nasal cannula.Objective: The study’s purpose was to validate the monitor’s performance in patients with chronic obstructive pulmonary disease during wakefulness and sleep.Methods: Ten adult males with stable chronic obstructive pulmonary disease (mean ± SD FEV1 37.7 ± 14.9% of predicted) on long-term continuous oxygen therapy were tested in a sleep laboratory over a 12–13 hour period that included an overnight polysomnogram.Measurements: The monitor’s measurements were obtained at 4-minute intervals and compared to actual oxygen use determined by review of time-synchronized video recordings.Main results: The monitor made 1504/1888 (79.7%) correct detections (unprocessed data) across all participants: 957/1,118 (85.6%) correct detections during wakefulness and 546/770 (70.9%) during sleep. All errors were false negatives, ie, the monitor failed to detect that the participant was actually wearing the cannula. Application of a majority-vote filter to the raw data improved overall detection accuracy to 84.9%.Conclusions: The results demonstrate the monitor’s ability to objectively measure whether or not men with chronic obstructive pulmonary disease are receiving their oxygen treatment. The ability to objectively measure oxygen delivery, rather than oxygen expended, may help improve the management of patients on long-term oxygen therapy.Keywords: chronic obstructive pulmonary diseas

Late presentation of a mucinous ovarian adenocarcinoma which was initially diagnosed as a primary pancreatic carcinoma: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Adenocarcinoma of the ovary is an aggressive neoplasm which often metastasizes to the lung or liver. Metastases rarely occur to the pancreas, but a tissue diagnosis is required to confirm this event. Although most tumors of the pancreas are primary pancreatic neoplasms, metastatic lesions have been reported most commonly as arising from renal cell carcinoma.</p> <p>Case presentation</p> <p>We report the case of a 51-year-old Caucasian woman with ovarian mucinous adenocarcinoma with metastasis to the head of the pancreas that was originally misdiagnosed as a pancreatic primary tumor.</p> <p>Conclusion</p> <p>Mucinous ovarian adenocarcinomas rarely metastasize to the pancreas. New pancreatic lesions should be investigated through tissue biopsy and tumor markers, while keeping an open-minded differential diagnosis to avoid a misdiagnosis or a delay in treatment.</p

On the Societal Impact of Open Foundation Models

Foundation models are powerful technologies: how they are released publicly directly shapes their societal impact. In this position paper, we focus on open foundation models, defined here as those with broadly available model weights (e.g. Llama 2, Stable Diffusion XL). We identify five distinctive properties (e.g. greater customizability, poor monitoring) of open foundation models that lead to both their benefits and risks. Open foundation models present significant benefits, with some caveats, that span innovation, competition, the distribution of decision-making power, and transparency. To understand their risks of misuse, we design a risk assessment framework for analyzing their marginal risk. Across several misuse vectors (e.g. cyberattacks, bioweapons), we find that current research is insufficient to effectively characterize the marginal risk of open foundation models relative to pre-existing technologies. The framework helps explain why the marginal risk is low in some cases, clarifies disagreements about misuse risks by revealing that past work has focused on different subsets of the framework with different assumptions, and articulates a way forward for more constructive debate. Overall, our work helps support a more grounded assessment of the societal impact of open foundation models by outlining what research is needed to empirically validate their theoretical benefits and risks

Care Workers and Managers’ Experiences of Implementing Infection Control Guidance in an Epidemic Context: A Qualitative Study in the South East of England, during the COVID-19 Prevaccination Era

The national response to COVID-19 has had a severe impact on adult social care settings, with high mortality amongst people receiving and providing care in England. Care workers had to rapidly adapt to new infection control measures to protect themselves, their colleagues, and the people receiving care. Infection control in residential and domiciliary care is always complex, but COVID-19 infection control measures impacted exceptionally on care workers’ working and everyday lives. We undertook qualitative interviews with care workers and managers (n = 10) in residential and domiciliary care for older people in the Southeast England during the first wave of the pandemic to understand their experiences, solutions, and concerns to implement guidance in practice. Data were analysed using framework analysis, and the following eight themes were identified: (1) Increasing visibility and support for the sector; (2) the impact of negative messaging about the sector; (3) feelings of isolation; (4) accessibility and usability of guidance; (5) social care staff as agents in producing and sharing good practice; (6) managing expectations and the impact of conflicting messages in the media; (7) improving communication with hospitals; and (8) problems in the early pandemic. The findings reveal widespread concerns for the marginalisation of the sector in the policy response and the inadequacy of infection control guidance. Guidance would benefit from a better understanding of domiciliary and residential care settings. This might involve the following steps: (a) coproduction of guidance with adult social care stakeholders, including those in direct-care roles and (b) a shift away from a clinical model of infection control towards a more flexible approach that attends to the inherent variability of care settings

How can risk of COVID-19 transmission be minimised in domiciliary care for older people: development, parameterisation and initial results of a simple mathematical model

This paper proposes and analyses a stochastic model for the spread of an infectious disease transmitted between clients and care workers in the UK domiciliary (home) care setting. Interactions between clients and care workers are modelled using specially generated networks, with network parameters reflecting realistic patterns of care needs and visit allocation. These networks are then used to simulate and SEIR-type epidemic dynamics with different numbers of infectious and recovery stages. The results indicate that with the same overall capacity provided by care workers, the minimum peak proportion of infection, and the smallest overall size of infection are achieved for the highest proportion of overlap between visit allocation, i.e. when care workers have the highest chances of being allocated a visit to the same client they have visited before. An intuitive explanation of this is that while providing the required care coverage, maximising overlap in visit allocation reduces the possibility of an infectious care worker inadvertently spreading the infection to other clients. The model is generic and can be adapted to any directly transmitted infectious disease, such as, more recently, COVID-19, provided accurate estimates of disease parameters can be obtained from real data

Progress towards a public chemogenomic set for protein kinases and a call for contributions

Protein kinases are highly tractable targets for drug discovery. However, the biological function and therapeutic potential of the majority of the 500+ human protein kinases remains unknown. We have developed physical and virtual collections of small molecule inhibitors, which we call chemogenomic sets, that are designed to inhibit the catalytic function of almost half the human protein kinases. In this manuscript we share our progress towards generation of a comprehensive kinase chemogenomic set (KCGS), release kinome profiling data of a large inhibitor set (Published Kinase Inhibitor Set 2 (PKIS2)), and outline a process through which the community can openly collaborate to create a KCGS that probes the full complement of human protein kinases

Ikke-alkoholisk fettleversykdom (NAFLD) i en generell populasjon og assosiasjon til kardiovaskulær sykdom

Bakgrunn: Ikke-alkoholisk fettleversykdom (NAFLD) er i ferd med å bli den vanligste årsaken til kronisk leversykdom i verden, og er også en av de vanligste årsakene til forhøyede leverenzymer. Tilstanden påvirker ikke kun leveren, men er del av en multisystem-sykdom som påvirker en rekke andre organsystemer i kroppen, inkludert det kardiovaskulære system. En økende mengde forskning tyder på at NAFLD er assosiert med en økt forekomst av kardiovaskulær sykdom, og at NAFLD kanskje utgjør en uavhengig risikofaktor for kardiovaskulær sykdom utover etablerte kardiovaskulære risikofaktorer. I denne oppgaven har vi undersøkt assosiasjonen mellom forhøyede leverenzymer og forekomsten av kardiovaskulær sykdom. Hensikten med dette var å vurdere om forhøyede leverenzymer potensielt kan være en parameter man kan benytte seg av for å vurdere hvilke individer i en generell populasjon som kan ha nytte av å bli videre utredet for NAFLD, med tanke på å forebygge kardiovaskulær sykdom. Materiale og metode: I oppgaven benyttet vi data fra den 6. og den 7. Tromsøundersøkelsen (Tromsø 6 og 7), og studiepopulasjonen i oppgaven bestod av individer som hadde deltatt i begge disse undersøkelsene. Vi definerte en utkommevariabel som bestod av de som hadde fått koronarsykdom i tiden mellom disse to undersøkelsene. Deretter undersøkte vi assosiasjonen mellom utkommevariabelen og en rekke målte variabler i Tromsø 6, deriblant etablerte kardiovaskulære risikofaktorer og leverenzymene ALAT, ASAT og gamma-GT, ved hjelp av univariat og multivariat binær logistisk regresjonsanalyse. Resultater: I den univariate logistiske regresjonsanalysen var det kun forhøyet ALAT av leverenzymene som viste signifikant økt oddsratio for utkommevariabelen koronarsykdom. I den multivariate analysen, hvor man justerte for en rekke andre variabler, viste fortsatt forhøyet ALAT signifikant økt oddsratio for utkommevariabelen. Konklusjon: Forhøyet ALAT fremstår å være en uavhengig risikofaktor for fremtidig koronarsykdom i studiepopulasjonen i oppgaven, noe som ikke fremstår å stemme for gamma-GT og ASAT