Monitoring outpatients in palliative care through wearable devices

Patients in palliative care suffer from a life-threatening disease. Holistic treatment includes control of symptoms (e. g., pain, nausea, sleeplessness) as well as psychosocial and spiritual help which is also extended to the relatives of a patient. For advanced cancer patients in palliative care, a crucial phase is the transition from palliative care in the hospital to the home setting, where care around the clock is not guaranteed any more, leads to an increased number of unplanned hospital re-admissions and emergency visits. Physicians aim to fill this care gap by monitoring physical and social activities as well as vital signs. Daily monitoring data, provided to caregivers, could enable caregivers to timely intervene when symptoms of a patient deteriorate. Besides patients in palliative care, also cancer survivors suffering from cancer-related fatigue could benefit from activity monitoring. Up to now, the remedies and effective treatments for cancer-related fatigue are limited. Research still has to unveil the underlying mechanisms that lead to a state of chronic exhaustedness. Measures that help healthy people like regenerative sleep show no or little effect in fatigued patients. Besides psycho-stimulants that come with the risk of addiction, cognitive behavioural therapy and moderate physical exercise have been shown to be effective. However, research still has to investigate timing, frequency and intensity of physical activity and researchers need a better understanding how the fatigue evolves during the day and in long-term. This thesis investigates the possibilities and limitations of activity monitoring using wearable devices such as smartphones and an armworn devices that is capable of measuring vital signs such as heart rate. Three studies involving cancer patients are conducted: - An interview study including 12 cancer patients enabled a patient-centric design for an Android activity monitoring app for smartphones. - Only using the smartphone as monitoring device, a study with 7 cancer survivors suffering from cancer-related fatigue was conducted as a pre-study in order to gain first experiences and to explore the possible knowledge gain about cancer-related fatigue through activity monitoring. - During a planned study period of 12 weeks per patient, 30 patients in ambulatory palliative care were wearing a smartphone and the arm-worn sensor as monitoring devices. The age range of the study participants was 39 to 85 years. In weekly interviews, patients were asked about their experiences with the devices and their quality of life. The aim of the study was to evaluate feasibility and acceptance of activity monitoring in this patient group. Furthermore, exploratory data analysis investigated the possibilities and limitations of unsupervised methods on this real-world data set. The two data sets, collected during the fatigue study and during the palliative care study, were pre-processed including cleaning steps, classification and clustering methods to add higher level information such as visited locations (anonymized). From these prepared data sets, features were extracted such as number of places visited per day. On the resulting datasets of features, statistical methods were applied to explore relations between sensor data, self-reports and, in case of the palliative care study, emergency visits to the hospital. For the latter analysis, patients who experienced an emergency room visit and those who did not were compared by means of hypothesis testing. For each feature, the underlying alternative hypothesis was that the change of a feature between the first week of study participation at home and the week before an emergency visit (or the last week of study participation for the patients without an emergency visit), differs in the two patient groups. The rate of change was defined by the ratio of the medians of the two weeks. Changes of three features, namely resting heart rate, resting heart rate variability and step speed were identified to have significant group differences: - The resting heart rate had an increasing trend in the group with emergency visits (median=1.01, interquartile range [0.96, 1.12]) and a decreasing trend in the group without an emergency visit (median=0.9, interquartile range [0.89, 0.99]) with a nominal significance of p=.021 and a medium effect size r=.46. - The resting heart rate variability had a decreasing trend in the group with emergency visits (mean=0.81, standard deviation=0.14) and an increasing trend in the group without an emergency visit (mean=1.17, standard deviation=0.46) with a nominal significance of p=.011 and a large effect size r=.53. - The step speed had an increasing trend in the group with emergency visits (median=1.1, interquartile range [1.08, 1.13]) and a decreasing trend in the group without an emergency visit (median=0.99, interquartile range [0.96, 1.04]) with a nominal significance of p=.003 and a large effect size r=.61. In contrast, hypothesis testing for features based on patients’ subjective self-reports for pain, distres and global quality of life did not reveil any significant differences. Hence, activity monitoring of vital signs and physical activity outperformed patients’ self-reports. However, a power analysis based on the three nominally significant results would recommend an independent study with 84 patients to confirm the results of this study. Furthermore, a set of recommendations for future research was concluded from the experiences gained through conducting these studies

Feasibility and Usability Aspects of Continuous Remote Monitoring of Health Status in Palliative Cancer Patients Using Wearables

Background: Mobile health is a promising strategy aiming to anticipate and prevent the deterioration of health status in palliative cancer patients. A prerequisite for successful implementation of this technology into clinical routine is a high level of usability and acceptance of devices. Objectives: We aimed to evaluate feasibility as well as patients’ acceptance of remote monitoring using wearables in palliative cancer patients. Methods: In this prospective single-center observational feasibility study, 30 cancer patients treated with palliative intent in an inpatient setting with an estimated life expectancy of >8 weeks and <12 months were provided with a smartphone including a pre-installed “Activity Monitoring” app and a sensor-equipped bracelet and monitored over a period of 12 weeks starting at discharge from hospital. We report detailed feasibility and usability aspects and comment on patients’ acceptance of the wearables. Results: Between February 2017 and May 2018 a total of 30 patients were included in the study. From these, 25 participants (83%) completed the whole study period. On average, the bracelet was worn on 53% and smartphone used on 85% of the study days. The completion rate of daily digital questionnaires for subjective ratings (pain and distress scale) was 73%, and 28 patients were able to handle the wearables and to operate the app without major problems. Use of the bracelet was low during the night hours, with a wearing time of 1.7% of all night hours (8 p.m. to 8 a.m.). Conclusions: Remote monitoring of health care status in palliative cancer patients with a limited life expectancy is feasible and patients are able to handle the smartphone and the sensor-equipped bracelet. Feedback towards use of this monitoring system was mostly positive

mHealth technologies for palliative care patients at the interface of in-patient to outpatient care : protocol of feasibility study aiming to early predict peterioration of patient’s health status

Palliative care patients are a particularly vulnerable population and one of the critical phases in patients' trajectories is discharge from specialized in-patient palliative care into outpatient care, where availability of a palliative care infrastructure is highly variable. A relevant number of potentially avoidable readmissions and emergency visits of palliative patients is observed due to rapid exacerbation of symptoms indicating the need for a closer patient monitoring. In the last years, different mHealth technology applications have been evaluated in many different patient groups

Gender differences in paediatric patients of the swiss inflammatory bowel disease cohort study.

PURPOSE: Gender differences in paediatric patients with inflammatory bowel disease (IBD) are frequently reported as a secondary outcome and the results are divergent. To assess gender differences by analysing data collected within the Swiss IBD cohort study database since 2008, related to children with IBD, using the Montreal classification for a systematic approach. METHODS: Data on gender, age, anthropometrics, disease location at diagnosis, disease behaviour, and therapy of 196 patients, 105 with Crohn's disease (CD) and 91 with ulcerative or indeterminate colitis (UC/IC) were retrieved and analysed. RESULTS: THE CRUDE GENDER RATIO (MALE : female) of patients with CD diagnosed at &lt;10 years of age was 2.57, the adjusted ratio was 2.42, and in patients with UC/IC it was 0.68 and 0.64 respectively. The non-adjusted gender ratio of patients diagnosed at ≥10 years was 1.58 for CD and 0.88 for UC/IC. Boys with UC/IC diagnosed &lt;10 years of age had a longer diagnostic delay, and in girls diagnosed with UC/IC &gt;10 years a more important use of azathioprine was observed. No other gender difference was found after analysis of age, disease location and behaviour at diagnosis, duration of disease, familial occurrence of IBD, prevalence of extra-intestinal manifestations, complications, and requirement for surgery. CONCLUSION: CD in children &lt;10 years affects predominantly boys with a sex ratio of 2.57; the impact of sex-hormones on the development of CD in pre-pubertal male patients should be investigated

Data reuse in the social sciences and humanities : project report of the SWITCH Innovation Lab “Repositories & Data Quality”

The underlying data and additional materials in connection with this publication are available at: https://doi.org/10.5281/zenodo.4609834 The code used for data analysis is available at: https://github.com/ZHAW-Services-Research-Data/SWITCH-Innovation-Lab-Repositories-Data-QualityThis report is the result of the SWITCH Innovation Lab “Repositories & Data Quality”, a project that ran from October 2020 until February 2021 as a collaboration between SWITCH and ZHAW Zurich University of Applied Sciences. Its aim was to complement previous studies on research data management issues (conducted in part as earlier SWITCH Innovation Labs) and to identify relevant data sources for researchers in the social sciences and humanities (SSH) in Switzerland. More particularly, the project focused on the reuse of existing data sets by SSH researchers and the criteria they applied when choosing a suitable data source for their work and research. Some of the steps in this task consisted of finding the locations where valuable data is shared, published and accessed as well as conducting a more specific investigation into data availability, modes of accessibility and aspects related to assessing data quality. For this purpose, the project team designed and carried out an online survey targeted specifically at active SSH researchers in Switzerland. To disseminate the survey questionnaire towards this target audience, mailing lists of several research organizations in these fields were utilized. The survey ran for about 8 weeks until early February 2021 and received responses from 260 participants. Some of the main findings include a generally high number of researchers making use of existing data for their own work. Central data providers such as FORSbase, FSO and the GESIS data archive are the most frequently named sources. Trust in these data sources and sufficient additional materials like documentation and methodologies are key criteria for selecting data for reuse. Some data sources could provide desired data sets but are hardly accessible and reusable for researchers (if at all). This mainly includes administrative data and records of (Swiss) public authorities and offices, as well as historic assets from archives, libraries and museums. Furthermore, qualitative research data like interviews, surveys, questionnaires and observations were often highlighted among valuable yet usually inaccessible data sources. At the same time, the case of qualitative data such as interview recordings and ethnographic fieldnotes illustrate well a certain reusability dilemma. To enable “reusability” of such materials from a legal perspective (i.e. to protect personal identities of research participants), much of sensitive context-related details need to be removed. Yet, it is exactly those details that are necessary to contextualize and reuse these data in a proper way from a qualitative researcher’s point of view. Finally, the list of relevant data sources in the SSH contains a large number of individual studies, data sets and resources. This fact supports the idea to connect and link this data, as repeatedly voiced by survey respondents. This demand presents a particular opportunity for future efforts in this area that directly align with the broad objectives at SWITCH. More specifically, the vision of the SWITCH Research Data Connectome is to interconnect research data from different sources, which contributes to the current development of a knowledge graph. Building on this knowledge base that documents and links metadata to enable a more effective search for and reuse of data, new specialized services could be employed in the future. The results of the SWITCH Innovation Lab “Repositories & Data Quality” project shall help lay the groundwork for such future client-oriented services, by providing more detailed information about the handling and reuse of data in Switzerland

Monitoring patients in ambulatory palliative care : a design for an observational study

We present the setup of an observational study that aims to examine the application of wearables in ambulatory palliative care to monitor the patients’ health status – especially during the transition phase from hospital to home since this phase is critical and often patients are re-hospitalised. Following an user-centred design approach, we performed interviews with patients recruited at the Clinic of Radiation Oncology of the University Hospital Zurich, Switzerland. The patient group was perceived as vulnerable and varied largely in physiological burden and mental aspects. Special needs concern primarily obtrusiveness of the system and sensitivity in the work with this patient group. With the deployment of the system, we gathered first experiences: the first patient was tracked over 12 weeks resulting in 84 tracked days, 181 digital questionnaire answers, 40908 collected GPS points, 861 hours of heart rate measurements and positive feedback of the patient

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI