Physiological monitoring in the complex multimorbid heart failure patient - Conclusions.

Comorbidities are increasingly recognized as crucial components of the heart failure syndrome. Main specific challenges are polypharmacy, poor adherence to treatments, psychological aspects, and the need of monitoring after discharge. The chronic multimorbid patient therefore represents a specific heart failure phenotype that needs an appropriate and continuous management over time. This supplement issue covers the key points of a series of meeting coordinated by the Heart Failure Association of the European Society of Cardiology (ESC), that have discussed the issues surrounding the effective monitoring of our ever more complex and multimorbid heart failure patients. Here, we present an overview of the complex issues from a healthcare delivery perspective

Who approves/pays for additional monitoring?

Major considerations in the provision of healthcare are availability, affordability, accessibility, and appropriateness, especially in the setting of heart failure where disease burden is growing, developments have been rapid and newer biomarkers, diagnostic and imaging techniques, monitoring systems, devices, procedures, and drugs have all been developed in a relatively short period of time. Many monitoring and diagnostic systems have been developed but the disproportionate cost of conducting trials of their effectiveness has limited their uptake. There are added complexities, in that the utilization of doctors for the supervision of the monitoring results may be optimal in one setting and not in another because of differences in the characteristics of organization of healthcare provision, making even interpretation of the trials we have had, still difficult to interpret. New technologies are continuously changing the approach to healthcare and will reshape the structure of the healthcare systems in the future. Mobile technologies can empower patients and carers by giving them more control over their health and social care needs and reducing their dependence on healthcare professionals for monitoring their health, but a significant problem is the integration of the multitude of monitored parameters with clinical data and the recognition of intervention thresholds. Digital technology can help, but we need to prove its cost/efficacy and how it will be paid for. Governments in many European countries and worldwide are trying to establish frameworks that promote the convergence of standards and regulations for telemedicine solutions and yet simultaneously health authorities are closely scrutinizing healthcare spending, with the objective of reducing and optimizing expenditure in the provision of health services. There are multiple factors to be considered for the reimbursement models associated with the implementation of physiological monitoring yet it remains a challenge in cash-strapped health systems

Assessing the Water Energy Nexus and Sustainability Benefits of a Closed Loop Water Treatment System in Qatar

Qatar has very limited freshwater resources. This paper assesses the sustainability implications of using bore water and treated sewage effluent (TSE) for residential water supply (for non-drinking purposes) in a residential compound in Doha, Qatar. The treated bore water was considered for non-drinking domestic applications in kitchens and bathrooms, while the TSE was considered for use in air conditioning cooling systems. Excess TSE was also considered for irrigation use. Water quality from the aquifer in the Al Waab area of Doha was used to design a pre-treatment and desalination process to produce potable water for a local residential compound consisting of 113 villas. The wastewater from these villas consisted of both grey and black water and was proposed to be treated in a sewage treatment plant to produce TSE to operate the cooling systems in the compound. The reject brine from the desalination process was designed to be discharged to sea through the storm water network and the blowdown water from the cooling systems was considered for use in irrigation in surrounding areas. A lifecycle assessment of this closed loop water recycling system was conducted to assess the potential sustainability benefits of reduced greenhouse gas emissions, embodied energy consumption, and water consumption, together with cost savings and employment generation from these water recycling options

Pembuatan Alat Garasi Mobil Automatic Berbasis Mikrokontroler Atmega 16

Saat ini dunia semakin berkembang dan maju di bebagai bidang. Pekembangan bidang teknologi dan Komputerisasi ataupun Semikomputerisasi pada dunia USAha sangat beragam adanya, dengan menggunakan system komputerisasi yang mempermudah manusia mengakomodir semua aktifitas dalam kehidupan sehari-hari. Perkembangan system tersebut, mencakup juga teknologi penyediaan system yang bekerja secara otomatis untuk menghemat waktu dan tenaga, salah satunya perkembangan teknologi adalah “Grasi Otomatis Sensor Foto Dioda Berbasis Mikrokontroler”. Masalah yang sering dihadapi oleh pemilik kendaraan yang akan memasukkan kendaraan kedalam Garasi adalah perlunya bantuan dari orang lain untuk membukan dan menutup Garasi, jika tidak ada yang membantu maka pemilik kendaraan butuh waktu untuk turun terlebih dahulu dan membuka Garasi sendiri, hal tersebut jelas membutuhkan waktu dan tenaga untuk membuka dan menutup garasi mobil. Dengan adanya permasalahan diatas pada penelitian ini penulis mempunyai tujuan untuk menciptakan inovasi dengan menciptakan alat untuk membuka dan menutup Garasi mobil otomatis. Dalam aplikasinya alat ini berfungsi sebagai garasi (Tempat Kendaraan) otomatis yang bisa membuka secara otomatis saat ketika kendaraan berada di depan garasi dan menutup secara otomatis juga saat beberapa meter kendaraan sudah keluar dari garasi dan pada gari juga ada lampu indicator yang menandakan ada tidak kendaaran didalam garasi. Kelebihan alat ini adalah driver tidak perlu lagi turun untuk membuka garasi saat inggin memasukan kendaraan dan mengeluarkan kendaraanya secara otomatis garasi ini akan terbuka dan menutup sendiri

Pengembangan Sistem Penyediaan Air Minum Di Kecamatan Karang Bintang Kabupaten Tanah Bumbu

Berdasarkan kondisi eksisting PDAM Kabupaten Tanah Bumbu, Unit Instalasi Pengolahan Air di Kecamatan Karang Bintang sudah memenuhi kebutuhan air minum di 1 Desa dengan jumlah terlayani sebesar 2.800 jiwa. Sedangkan 5 Desa lainnya masih belum terlayani kebutuhan air minumnya. Oleh sebab itu, dilakukan pengembangan sistem penyediaan air minum untuk proyeksi 10 tahun yang akan datang di Kecamatan Karang Bintang. Pengembangan dilakukan di Desa Sumber Wangi, Desa Pematang Ulin, Desa Pandan Sari, Desa Karang Rejo dan Desa Rejowinangun. Dalam perencanaan ini dilakukan analisa kebutuhan serta ketersediaan air, Analisa reservoir dan jaringan distribusi untuk mengetahui kapasitas dan kemampuan jaringan distribusi saat ini. Pada Analisa jaringan distribusi menggunakan program bantu WaterCAD V8i dengan control terhadap tekanan dan headloss. Berdasarkan hasil Analisa, total kebutuhan air minum tahun 2032 sebesar 10,750 liter/detik dengan kapasitas produksi IPA 60 liter/detik yang berarti masih mampu memenuhi kebutuhan penduduk sampai tahun 2032. Sistem pendistribusian dilakukan secara gravitasi. Dari hasil simulasi disimpulkan bahwa alternatif 1 menggunakan pipa PVC dengan kombinasi diameter 250 mm – 150 mm – 110 mm dapat diterapkan serta memenuhi kriteria

Elevated pulse pressure is associated with hemolysis, proteinuria and chronic kidney disease in sickle cell disease

A seeming paradox of sickle cell disease is that patients do not suffer from a high prevalence of systemic hypertension in spite of endothelial dysfunction, chronic inflammation and vasculopathy. However, some patients do develop systolic hypertension and increased pulse pressure, an increasingly recognized major cardiovascular risk factor in other populations. Hence, we hypothesized that pulse pressure, unlike other blood pressure parameters, is independently associated with markers of hemolytic anemia and cardiovascular risk in sickle cell disease. We analyzed the correlates of pulse pressure in patients (n 5 661) enrolled in a multicenter international sickle cell trial. Markers of hemolysis were analyzed as independent variables and as a previously validated hemolytic index that includes multiple variables. We found that pulse pressure, not systolic, diastolic or mean arterial pressure, independently correlated with high reticulocyte count (beta 5 2.37, p 5 0.02) and high hemolytic index (beta 5 1.53, p50.002) in patients with homozygous sickle cell disease in two multiple linear regression models which include the markers of hemolysis as independent variables or the hemolytic index, respectively. Pulse pressure was also independently associated with elevated serum creatinine (beta 5 3.21, p 5 0.02), and with proteinuria (beta 5 2.52, p 5 0.04). These results from the largest sickle cell disease cohort to date since the Cooperative Study of Sickle Cell Disease show that pulse pressure is independently associated with hemolysis, proteinuria and chronic kidney disease. We propose that high pulse pressure may be a risk factor for clinical complications of vascular dysfunction in sickle cell disease. Longitudinal and mechanistic studies should be conducted to confirm these hypotheses

Access to preventive health services of migrants in five EU countries

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