Experiences and views of patients, carers and healthcare professionals on using modems in domiciliary non-invasive ventilation (NIV): a qualitative study

BACKGROUND: Advances in technology means that domiciliary non-invasive ventilation (NIV) devices can be remotely monitored via modems in patients' homes. Possible benefits and challenges of modem technology have yet to be established. This study explored the perspectives and experiences of patients, their carers and healthcare professionals (HCPs) on the addition of modem technology in managing home NIV. METHODS: A qualitative study using a combination of focus groups for HCPs and interviews for carers/patients was undertaken. 12 HCPs and 22 patients/carers participated. These focus groups and interviews were audio-recorded, transcribed verbatim and analysed thematically. RESULTS: Five main themes were identified. 'Surveillance: a paradox of findings': HCPs were concerned about unduly scrutinising patients' lives, potentially impacting on HCP patient relationships. Conversely, patients welcomed modem monitoring and did not express concerns regarding invasion of privacy. 'Sanctions': HCPs reported the modem increased access to care and allowed appropriate assessment of ongoing treatment. 'Complacency and ethics': HCPs expressed concerns patients may become complacent in seeking help due to expectations of modem monitoring, as well as being concerned regarding the ethics of modems. There was a suggestion patients and carers' expectations of monitoring were different to that of clinical practice, resulting in complacency in some cases. 'Increased time for patient focused care': HCPs in the focus groups described a number of ways in which using modems was more efficient. 'Confidence: can be improved with technology': patients and carers were positive about the impact of the modems on their health and well-being, particularly their confidence. CONCLUSION: HCPs expressed concerns about surveillance were not corroborated by patients, suggesting acceptability of remote monitoring. Data suggests a need for increased clarity to patients/carers regarding clinical practice relating to responsiveness to modem data. The issue of complacency requires further consideration. Modem technology was acceptable and considered a useful addition by HCPs, patients and carers. TRIAL REGISTRATION NUMBER: NCT03905382

The State-Moro Armed Conflict in the Philippines: Unresolved national question or question of governance?

The continuing struggle of the Moro secessionist movement in the Philippines is one of Southeast Asia’s longest armed conflicts. The tenacity of the conflict lies in two competing concerns: the assertion of self-determination rights of the Moro separatist movement; and the affirmation of the Philippines’ sovereign right to territorial integrity. However, beneath these rights are crucial issues that remain unanswered both by the contending forces—problems where internecine violence and conflict emanate from. This article argues that self-determination rights can be adequately exercised by people who have clearly defined their national identity and concept of a nation. Unfortunately, the Moro multi-ethnic national identity has yet to be crystallised while the idea of a Bangsamoro (Bangsa Nation) remains weak. On the other hand, the state has yet to address the Moros’ legitimate demands of political autonomy, socio-economic development, and social justice and discrimination. Without underestimating the ethnic component of secessionism, the article concludes that poor governance has prolonged, complicated, and further justified the Moros’ quest to secede from the Republic

Monitoring symptoms at home: What methods would cancer patients be comfortable using?

PURPOSE: This study aimed to determine which methods of remote symptom assessment cancer outpatients would be comfortable using, including those involving information technology, and whether this varied with age and gender. METHODS: A questionnaire survey of 477 outpatients attending the Edinburgh Cancer Centre in Edinburgh, UK. RESULTS: Most patients reported that they would not feel comfortable using methods involving technology such as a secure website, email, mobile phone text message, or a computer voice on the telephone but that they would be more comfortable using more traditional methods such as a paper questionnaire, speaking to a nurse on the telephone, or giving information in person. CONCLUSIONS: The uptake of new, potentially cost-effective technology-based methods of monitoring patients' symptoms at home might be limited by patients' initial discomfort with the idea of using them. It will be important to develop methods of addressing this potential barrier (such as detailed explanation and supervised practice) if these methods are to be successfully implemented

An evaluation of ciprofloxacin pharmacokinetics in critically ill patients undergoing continuous veno-venous haemodiafiltration

BACKGROUND: The study aimed to investigate the pharmacokinetics of intravenous ciprofloxacin and the adequacy of 400 mg every 12 hours in critically ill Intensive Care Unit (ICU) patients on continuous veno-venous haemodiafiltration (CVVHDF) with particular reference to the effect of achieved flow rates on drug clearance. METHODS: This was an open prospective study conducted in the intensive care unit and research unit of a university teaching hospital. The study population was seven critically ill patients with sepsis requiring CVVHDF.Blood and ultrafiltrate samples were collected and assayed for ciprofloxacin by High Performance Liquid Chromatography (HPLC) to calculate the model independent pharmacokinetic parameters; total body clearance (TBC), half-life (t1/2) and volume of distribution (Vd). CVVHDF was performed at prescribed dialysate rates of 1 or 2 L/hr and ultrafiltration rate of 2 L/hr. The blood flow rate was 200 ml/min, achieved using a Gambro blood pump and Hospal AN69HF haemofilter. RESULTS: Seventeen profiles were obtained. CVVHDF resulted in a median ciprofloxacin t1/2 of 13.8 (range 5.15-39.4) hr, median TBC of 9.90 (range 3.10-13.2) L/hr, a median Vdss of 125 (range 79.5-554) L, a CVVHDF clearance of 2.47+/-0.29 L/hr and a clearance of creatinine (Clcr) of 2.66+/-0.25 L/hr. Thus CVVHDF, at an average flow rate of ~3.5 L/hr, was responsible for removing 26% of ciprofloxacin cleared. At the dose rate of 400 mg every 12 hr, the median estimated Cpmax/MIC and AUC0-24/MIC ratios were 10.3 and 161 respectively (for a MIC of 0.5 mg/L) and exceed the proposed criteria of >10 for Cpmax/MIC and > 100 for AUC0-24/MIC. There was a suggestion towards increased ciprofloxacin clearance by CVVHDF with increasing effluent flow rate. CONCLUSIONS: Given the growing microbial resistance to ciprofloxacin our results suggest that a dose rate of 400 mg every 12 hr, may be necessary to achieve the desired pharmacokinetic - pharmacodynamic (PK-PD) goals in patients on CVVHDF, however an extended interval may be required if there is concomitant hepatic impairment. A correlation between ciprofloxacin clearance due to CVVHDF and creatinine clearance by the filter was observed (r2 = 0.76), providing a useful clinical surrogate marker for ciprofloxacin clearance within the range studied

Spatial estimation of actual evapotranspiration over irrigated turfgrass using sUAS thermal and multispectral imagery and TSEB model

Green urban areas are increasingly affected by water scarcity and climate change. The combination of warmer temperatures and increasing drought poses substantial challenges for water management of urban landscapes in the western U.S. A key component for water management, actual evapotranspiration (ETa) for landscape trees and turfgrass in arid regions is poorly documented as most rigorous evapotranspiration (ET) studies have focused on natural or agricultural areas. ET is a complex and non-linear process, and especially difficult to measure and estimate in urban landscapes due to the large spatial variability in land cover/land use and relatively small areas occupied by turfgrass in urban areas. Therefore, to understand water consumption processes in these landscapes, efforts using standard measurement techniques, such as the eddy covariance (EC) method as well as ET remote sensing-based modeling are necessary. While previous studies have evaluated the performance of the remote sensing-based two-source energy balance (TSEB) in natural and agricultural landscapes, the validation of this model in urban turfgrass remains unknown. In this study, EC flux measurements and hourly flux footprint models were used to validate the energy fluxes from the TSEB model in green urban areas at golf course near Roy, Utah, USA. High-spatial resolution multispectral and thermal imagery data at 5.4 cm were acquired from small Unmanned Aircraft Systems (sUAS) to model hourly ETa. A protocol to measure and estimate leaf area index (LAI) in turfgrass was developed using an empirical relationship between spectral vegetation indices (SVI) and observed LAI, which was used as an input variable within the TSEB model. In addition, factors such as sUAS flight time, shadows, and thermal band calibration were assessed for the creation of TSEB model inputs. The TSEB model was executed for five datasets collected in 2021 and 2022, and its performance was compared against EC measurements. For ETa to be useful for irrigation scheduling, an extrapolation technique based on incident solar radiation was used to compute daily ETa from the hourly remotely-sensed UAS ET. A daily flux footprint and measured ETa were used to validate the daily extrapolation technique. Results showed that the average of corrected daily ETa values in summer ranged from about 4.6 mm to 5.9 mm in 2021 and 2022. The Near Infrared (NIR) and Red Edge-based SVI derived from sUAS imagery were strongly related to LAI in turfgrass, with the highest coefficient of determination (R2) (0.76–0.84) and the lowest root mean square error (RMSE) (0.5–0.6). The TSEB’s latent and sensible heat flux retrievals were accurate with an RMSE 50 W m−2 and 35 W m−2 respectively compared to EC closed energy balance. The expected RMSE of the upscaled TSEB daily ETa estimates across the turfgrass is below 0.6 mm  day−1, thus yielding an error of 10% of the daily total. This study highlights the ability of the TSEB model using sUAS imagery to estimate the spatial variation of daily ETa for an urban turfgrass surface, which is useful for landscape irrigation management under drought conditions.Peer reviewe

Analysis of a viral metagenomic library from 200 m depth in Monterey Bay, California constructed by direct shotgun cloning

<p>Abstract</p> <p>Background</p> <p>Viruses have a profound influence on both the ecology and evolution of marine plankton, but the genetic diversity of viral assemblages, particularly those in deeper ocean waters, remains poorly described. Here we report on the construction and analysis of a viral metagenome prepared from below the euphotic zone in a temperate, eutrophic bay of coastal California.</p> <p>Methods</p> <p>We purified viruses from approximately one cubic meter of seawater collected from 200m depth in Monterey Bay, CA. DNA was extracted from the virus fraction, sheared, and cloned with no prior amplification into a plasmid vector and propagated in <it>E. coli </it>to produce the MBv200m library. Random clones were sequenced by the Sanger method. Sequences were assembled then compared to sequences in GenBank and to other viral metagenomic libraries using BLAST analyses.</p> <p>Results</p> <p>Only 26% of the 881 sequences remaining after assembly had significant (E ≤ 0.001) BLAST hits to sequences in the GenBank nr database, with most being matches to bacteria (15%) and viruses (8%). When BLAST analysis included environmental sequences, 74% of sequences in the MBv200m library had a significant match. Most of these hits (70%) were to microbial metagenome sequences and only 0.7% were to sequences from viral metagenomes. Of the 121 sequences with a significant hit to a known virus, 94% matched bacteriophages (Families <it>Podo</it>-, <it>Sipho</it>-, and <it>Myoviridae</it>) and 6% matched viruses of eukaryotes in the Family <it>Phycodnaviridae </it>(5 sequences) or the Mimivirus (2 sequences). The largest percentages of hits to viral genes of known function were to those involved in DNA modification (25%) or structural genes (17%). Based on reciprocal BLAST analyses, the MBv200m library appeared to be most similar to viral metagenomes from two other bays and least similar to a viral metagenome from the Arctic Ocean.</p> <p>Conclusions</p> <p>Direct cloning of DNA from diverse marine viruses was feasible and resulted in a distribution of virus types and functional genes at depth that differed in detail, but were broadly similar to those found in surface marine waters. Targeted viral analyses are useful for identifying those components of the greater marine metagenome that circulate in the subcellular size fraction.</p