Non-invasive home telemonitoring in patients with decompensated heart failure: a systematic review and meta-analysis

cited By 0We planned this systematic review and meta-analysis to study an estimate of the effect of non-invasive home telemonitoring (TM) in the treatment of patients with recently decompensated heart failure (HF). A systematic literature search was conducted in the Medline, Cinahl, and Scopus databases to look for randomized controlled studies comparing TM with standard care in the treatment of patients with recently decompensated HF. The main outcomes of interest were all-cause hospitalizations and mortality. Eleven original articles met our eligibility criteria. The pooled estimate of the relative risk of all-cause hospitalization in the TM group compared with standard care was 0.95 (95% CI 0.84-1.08, P = 0.43) and the relative risk of all-cause death was 0.83 (95% CI 0.63-1.09, P = 0.17). There was significant clinical heterogeneity among primary studies. HF medication could be directly altered in three study interventions, and two of these had a statistically significant effect on all-cause hospitalizations. The pooled effect estimate of TM interventions on all-cause hospitalizations and all-cause death in patients with recently decompensated heart failure was neutral.Peer reviewe

”Taivashan siinä on rajana minkälaisia toiminnallisia menetelmiä sitä voi kehitellä”:undersökning om funktionella undervisningsmetoder som ämnes- och speciallärare använder i sin svenskundervisning

Abstrakt. Syftet med denna avhandling var att forska i funktionella undervisningsmetoder som ämneslärare i svenska språket och speciallärare använder i sin svenskundervisning. Därtill studerades hur ämneslärare och speciallärare beaktar i funktionell svenskundervisning elever som behöver någon form av stöd i sitt lärande och sin skolgång. Undersökningsmaterialet samlades in genom ett elektroniskt frågeformulär i Webropol samt intervjuer. Informanterna var 16 ämneslärare i svenska språket, fem speciallärare och en som har behörighet som ämnes- och speciallärare. Materialet analyserades genom kvantitativ enkätundersökning och kvalitativ innehållsanalys. Undersökningens resultat visade att både ämneslärare och speciallärare använder mångsidigt olika funktionella undervisningsmetoder i sin svenskundervisning. De funktionella undervisningsmetoder som nämndes indelades i sex kategorier: lekar och spel, rörelse, drama, visualisering, berättelser och musik. Lekar och spel omfattade över hälften och rörelse ungefär fjärdedelen av alla funktionella undervisningsmetoder som informanterna utnyttjar. Resultaten visade även att det inte fanns stora skillnader i användningen av funktionella undervisningsmetoder mellan ämneslärare och speciallärare. Enligt ämneslärares svar på frågeformuläret indelades stödet de ger vid funktionell svenskundervisning i differentiering, stödet från läraren eller från skolgångsbiträdet, stödet från klasskamrater samt tydliga instruktioner och en tydlig struktur i undervisningen. Speciallärare lyfte fram alla ovannämnda stödåtgärder utom stödet från klasskamrater i sina svar på frågeformuläret och i intervjuerna. Både ämnes- och speciallärare ansåg att differentiering var den mest använda stödåtgärden vid funktionell svenskundervisning. Å ena sidan lyfte ungefär hälften av informanterna fram att funktionella undervisningsmetoder vanligtvis är nyttiga speciellt för elever som behöver någon form av stöd. En del av dessa informanter nämnde att funktionella undervisningsmetoder exempelvis förbättrade elevernas förmåga till koncentration. Å andra sidan var både ämneslärare och speciallärare eniga om att funktionella undervisningsmetoder inte lämpar sig för alla och att läraren ska känna sina elever för att kunna planera så ändamålsenlig undervisning som möjligt.Tiivistelmä. Tämän tutkimuksen tarkoituksena oli selvittää, mitä toiminnallisia opetusmenetelmiä ruotsin kielen aineenopettajat ja erityisopettajat käyttävät ruotsin opetuksessa. Lisäksi tutkittiin, millaista tukea aineenopettajat ja erityisopettajat antavat oppilaille, jotka tarvitsevat tukea oppimisessaan ja koulunkäynnissään. Tutkimusaineisto kerättiin elektronisen kyselylomakkeen sekä haastattelujen avulla. Tutkimukseen osallistui 16 ruotsin kielen aineenopettajaa, viisi erityisopettajaa sekä yksi opettaja, jolla on sekä aineenopettajan että erityisopettajan pätevyys. Aineiston analyysissä käytettiin kvantitatiivista kyselytutkimusta ja kvalitatiivista sisällönanalyysia. Tutkimuksen tulokset osoittivat sekä aineenopettajien että erityisopettajien käyttävän monipuolisesti erilaisia toiminnallisia opetusmenetelmiä ruotsin opetuksessa. Toiminnalliset opetusmenetelmät jaoteltiin leikkeihin ja peleihin, liikkumiseen, draaman keinoihin, visualisointiin, tarinoihin sekä musiikkiin. Leikkien ja pelien osuus oli yli puolet, kun taas liikkumisen osuus neljäsosa kaikista käytetyistä toiminnallisista menetelmistä. Tutkimuksen tulokset osoittivat myös, ettei toiminnallisten opetusmenetelmien käytössä ollut suuria eroja aineenopettajien ja erityisopettajien välillä. Aineenopettajien antama tuki jaoteltiin puolestaan eriyttämiseen, opettajan tai koulunkäynninavustajan tukeen, koulukavereiden tukeen sekä selkeisiin ohjeisiin ja selkeään opetuksen rakenteeseen. Erityisopettajat mainitsivat kyselyn vastauksissa ja haastatteluissa kaikki edellä mainitut tukimuodot lukuun ottamatta kavereilta saatavaa tukea. Sekä aineenopettajat että erityisopettajat käyttivät eniten eriyttämistä toiminnallisessa ruotsin opetuksessa. Yli puolet tutkimukseen osallistuneista oli sitä mieltä, että toiminnalliset opetusmenetelmät ovat hyödyllisiä erityisesti oppilaille, jotka tarvitsevat tukea oppimisessa ja koulunkäynnissä. Osa mainitsi toiminnallisten opetusmenetelmien parantavan esimerkiksi oppilaiden keskittymiskykyä. Toisaalta sekä aineenopettajat että erityisopettajat olivat yksimielisiä siitä, etteivät toiminnalliset opetusmenetelmät sovellu kaikille. Heidän mielestään opettajan pitää tuntea oppilaansa, jotta pystyy suunnittelemaan kaikille soveltuvaa opetusta

Maritime Safety Education with VR Technology (MarSEVR)

This paper presents the development of a virtual training technology that can be used in maritime safety training. This system is under testing phase and has being developed with a multidisciplinary team consisting of maritime specialists, computer scientists, business developers and VR experts. The technology is a cost effective, portable maritime training system that can be used on board, in training centers or even at home environments. Boosting situation awareness in navigation with VR-training applications is an easy and efficient method to practice whenever an officer has time for training. This can be done in an effective and fun way, giving measurable training progress indexes. The paper emphasizes on the need of VR Training in the shipping industry, the industry challenges and the description of the proof-of the-concept through the MarSEVR (Maritime Safety Education with VR) technology. The main objective in this paper is to present a prototype of the technology which can be utilized to train trainees and professionals in immersive training scenarios

Prerequisites of inspection conditions for uniform post-mortem inspection in broiler chicken slaughterhouses in Finland

Meat inspection of broiler chickens (broiler) in the European Union is regulated by common legislation to secure meat safety. However, the legislation is general in nature and proper post-mortem inspection (PMI) of every carcass and visceral organs of broilers is challenging in slaughterhouses (SHs) with a high slaughter line speed. The aim of this study was to investigate the on-site organization and possible differences of the PMI in four Finnish SHs, which slaughter over 99% of broilers in Finland. Our results show that the meat inspector's available inspection time per broiler in the PMI varied between 0.28 and 0.90 s, with the shortest available inspection time in the SH with the highest slaughter line speed and the longest available inspection time in the SH with the slowest line speed. We observed that only part of the total inspection time per broiler could be used for true PMI in most (3/4) SHs, as the meat inspectors also performed other tasks during the PMI. We observed deficiencies in the visual inspection of broiler carcasses; in particular, the proper inspection of all or most of the body cavities was impossible in all SHs during the PMI. Some deficiencies in facilities (e.g. in recording system) were observed. Moreover, lighting properties varied between the SHs and a significant difference between illumination conditions at the first inspection stations in the SHs was observed. This study considered the prerequisites for proper PMI and revealed that the PMI of broilers was not completely uniform in Finland. The results emphasize the need for more precise guidelines and recommendations, especially for inspection time and lighting at inspection stations.Peer reviewe

A comparative analysis of meat inspection data as an information source of the health and welfare of broiler chickens based on Finnish data

The comprehensive, reliable, and comparable meat inspection (MI) data of broiler chickens (i.e. broilers) are essential for the monitoring and surveillance of broiler health and welfare at the national and European Union (EU) levels. We compared the condemnation causes issued to broiler carcasses during MI in four large Finnish broiler slaughterhouses (SHs) by investigating the similarities and differences between local MI instructions used in the SHs. The way in which MI condemnations were recorded in the Finnish Food Authority's (FFA's) MI statistics were also explored. We additionally analysed the FFA's official MI data from the 2015-2019 period. The study showed that the MI criteria used in the SHs differed from one another regarding how severe or extensive a broiler defect or disease must be to cause condemnation during MI. In Finland, the annual total condemnation prevalence of whole broilers varied between 2.6% and 4.8% in 2015-2019, and a significant difference was observed between the SHs' monthly total condemnation prevalences, except in two SH pairs. Mistakes in recording the FFA's MI statistics and differences in the SH operators' reasons to reject broilers from the food chain affect the comparability of the condemnation prevalences between the SHs. Only half of the SHs partially condemned broiler carcasses and collected data concerning these condemnations. Cellulitis (0.3-1.0%), ascites (0.3-0.4%), and body cavity disorders (0.2-0.3%) were the most common causes for condemning whole broiler carcasses in 2015-2019. The MI data can be used for monitoring and surveillance purposes only once the differences between the SH data and data reliability are known. Although the harmonization of all condemnation causes is impossible, harmonizing the condemnations of carcasses with diseases that most threaten broiler health and welfare and cause the largest economic losses would be important.Peer reviewe

SOD3 Reduces Inflammatory Cell Migration by Regulating Adhesion Molecule and Cytokine Expression

Inflammatory cell migration characteristic of ischemic damages has a dual role providing the tissue with factors needed for tissue injury recovery simultaneously causing deleterious development depending on the quality and the quantity of infiltrated cells. Extracellular superoxide dismutase (SOD3) has been shown to have an anti-inflammatory role in ischemic injuries where it increases the recovery process by activating mitogen signal transduction and increasing cell proliferation. However, SOD3 derived effects on inflammatory cytokine and adhesion molecule expression, which would explain reduced inflammation in vascular lesions, has not been properly characterized. In the present work the effect of SOD3 on the inflammatory cell extravasation was studied in vivo in rat hind limb ischemia and mouse peritonitis models by identifying the migrated cells and analyzing SOD3-derived response on inflammatory cytokine and adhesion molecule expression. SOD3 overexpression significantly reduced TNFα, IL1α, IL6, MIP2, and MCP-1 cytokine and VCAM, ICAM, P-selectin, and E-selectin adhesion molecule expressions in injured tissues. Consequently the mononuclear cell, especially CD68+ monocyte and CD3+ T cell infiltration were significantly decreased whereas granulocyte migration was less affected. According to our data SOD3 has a selective anti-inflammatory role in ischemic damages preventing the migration of reactive oxygen producing monocyte/macrophages, which in excessive amounts could potentially further intensify the tissue injuries therefore suggesting potential for SOD3 in treatment of inflammatory disorders

Segregation, precipitation, and \alpha-\alpha' phase separation in Fe-Cr alloys: a multi-scale modelling approach

Segregation, precipitation, and phase separation in Fe-Cr systems is investigated. Monte Carlo simulations using semiempirical interatomic potential, first-principles total energy calculations, and experimental spectroscopy are used. In order to obtain a general picture of the relation of the atomic interactions and properties of Fe-Cr alloys in bulk, surface, and interface regions several complementary methods has to be used. Using Exact Muffin-Tin Orbitals method the effective chemical potential as a function of Cr content (0-15 at.% Cr) is calculated for a surface, second atomic layer and bulk. At ~10 at.% Cr in the alloy the reversal of the driving force of a Cr atom to occupy either bulk or surface sites is obtained. The Cr containing surfaces are expected when the Cr content exceeds ~10 at.%. The second atomic layer forms about 0.3 eV barrier for the migration of Cr atoms between bulk and surface atomic layer. To get information on Fe-Cr in larger scales we use semiempirical methods. Using combined Monte Carlo molecular dynamics simulations, based on semiempirical potential, the precipitation of Cr into isolated pockets in bulk Fe-Cr and the upper limit of the solubility of Cr into Fe layers in Fe/Cr layer system is studied. The theoretical predictions are tested using spectroscopic measurements. Hard X-ray photoelectron spectroscopy and Auger electron spectroscopy investigations were carried out to explore Cr segregation and precipitation in Fe/Cr double layer and Fe_0.95Cr_0.05 and Fe_0.85Cr_0.15 alloys. Initial oxidation of Fe-Cr was investigated experimentally at 10^-8 Torr pressure of the spectrometers showing intense Cr_2O_3 signal. Cr segregation and the formation of Cr rich precipitates were traced by analysing the experimental spectral intensities with respect to annealing time, Cr content, and kinetic energy of the exited electron.Comment: 16 pages, 14 figures, 52 reference

SOD3 Decreases Ischemic Injury Derived Apoptosis through Phosphorylation of Erk1/2, Akt, and FoxO3a

Extracellular superoxide dismutase (SOD3), which dismutates superoxide anion to hydrogen peroxide, has been shown to reduce the free radical stress derived apoptosis in tissue injuries. Since both superoxide anion and hydrogen peroxide have a marked impact on signal transduction pathways and could potentially explain a number of apoptosis and survival -related phenomena in different pathological conditions, we clarified the impact of SOD3 on Akt and Erk1/2 cell survival pathways in rat hind limb injury model. Based on our data, the hind limb ischemic rats treated with virally delivered sod3 have milder injury and less apoptosis than control animals that could be due to parallel activation of pro-proliferative and anti-apoptotic Erk1/2 and Akt pathways. The common downstream factor of both signaling pathways, the apoptosis related forkhead box protein O3a (FoxO3a), was phosphorylated and translocated to the cytoplasm in sod3 treated tissues and cell line. Additionally, we obtained increased mRNA production of elk-1, ets-1, and microRNA 21 (miR-21), whereas synthesis of bim mRNA was decreased in sod3 overexpressing tissues. We further showed that overexpression of sod3 modulated redox related gene expression by downregulating nox2 and inos when compared to injured control animals. The study shows the complexity of SOD3-derived effects on tissue injury recovery that are not limited to the reduction of superoxide anion caused cellular stress but highlights the impact of SOD3 related signal transduction on tissue functions and suggests an important role for SOD3 in attenuating cell stress effects in different pathological conditions

Cardiorespiratory Fitness Estimation Based on Heart Rate and Body Acceleration in Adults With Cardiovascular Risk Factors : Validation Study

Publisher Copyright: © Antti-Pekka E Rissanen, Mirva Rottensteiner, Urho M Kujala, Jari L O Kurkela, Jan Wikgren, Jari A Laukkanen. Originally published in JMIR Cardio (https://cardio.jmir.org), 25.10.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Cardio, is properly cited. The complete bibliographic information, a link to the original publication on https://cardio.jmir.org, as well as this copyright and license information must be included.Background: Cardiorespiratory fitness (CRF) is an independent risk factor for cardiovascular morbidity and mortality. Adding CRF to conventional risk factors (eg, smoking, hypertension, impaired glucose metabolism, and dyslipidemia) improves the prediction of an individual's risk for adverse health outcomes such as those related to cardiovascular disease. Consequently, it is recommended to determine CRF as part of individualized risk prediction. However, CRF is not determined routinely in everyday clinical practice. Wearable technologies provide a potential strategy to estimate CRF on a daily basis, and such technologies, which provide CRF estimates based on heart rate and body acceleration, have been developed. However, the validity of such technologies in estimating individual CRF in clinically relevant populations is poorly known. Objective: The objective of this study is to evaluate the validity of a wearable technology, which provides estimated CRF based on heart rate and body acceleration, in working-aged adults with cardiovascular risk factors. Methods: In total, 74 adults (age range 35-64 years; n=56, 76% were women; mean BMI 28.7, SD 4.6 kg/m2) with frequent cardiovascular risk factors (eg, n=64, 86% hypertension; n=18, 24% prediabetes; n=14, 19% type 2 diabetes; and n=51, 69% metabolic syndrome) performed a 30-minute self-paced walk on an indoor track and a cardiopulmonary exercise test on a treadmill. CRF, quantified as peak O2 uptake, was both estimated (self-paced walk: a wearable single-lead electrocardiogram device worn to record continuous beat-to-beat R-R intervals and triaxial body acceleration) and measured (cardiopulmonary exercise test: ventilatory gas analysis). The accuracy of the estimated CRF was evaluated against that of the measured CRF. Results: Measured CRF averaged 30.6 (SD 6.3; range 20.1-49.6) mL/kg/min. In all participants (74/74, 100%), mean difference between estimated and measured CRF was −0.1 mL/kg/min (P = .90), mean absolute error was 3.1 mL/kg/min (95% CI 2.6-3.7), mean absolute percentage error was 10.4% (95% CI 8.5-12.5), and intraclass correlation coefficient was 0.88 (95% CI 0.80-0.92). Similar accuracy was observed in various subgroups (sexes, age, BMI categories, hypertension, prediabetes, and metabolic syndrome). However, mean absolute error was 4.2 mL/kg/min (95% CI 2.6-6.1) and mean absolute percentage error was 16.5% (95% CI 8.6-24.4) in the subgroup of patients with type 2 diabetes (14/74, 19%). Conclusions: The error of the CRF estimate, provided by the wearable technology, was likely below or at least very close to the clinically significant level of 3.5 mL/kg/min in working-aged adults with cardiovascular risk factors, but not in the relatively small subgroup of patients with type 2 diabetes. From a large-scale clinical perspective, the findings suggest that wearable technologies have the potential to estimate individual CRF with acceptable accuracy in clinically relevant populations.Peer reviewe