Development of a novel scheme for long-term body temperature monitoring: a review of benefits and applications

Body temperature is a health or disease marker that has been in clinical use for centuries. The threshold currently applied to define fever, with small variations, is 38 °C. However, current approaches do not provide a full picture of the thermoregulation process and its correlation with disease. This paper describes a new non-invasive body temperature device that improves the understanding of the pathophysiology of diseases by integrating a variety of temperature data from different body locations. This device enables to gain a deeper insight into fever, endogenous rhythms, subject activity and ambient temperature to provide anticipatory and more efficient treatments. Its clinical use would be a big step in the overcoming of the anachronistic febrile/afebrile dichotomy and walking towards a system medicine approach to certain diseases. This device has already been used in some clinical applications successfully. Other possible applications based on the device features and clinical requirements are also described in this paper.Cuesta Frau, D.; Varela Entrecanales, M.; Valor Pérez, R.; Vargas, B. (2015). Development of a novel scheme for long-term body temperature monitoring: a review of benefits and applications. Journal of Medical Systems. 39(4):1-7. doi:10.1007/s10916-015-0209-3S17394Gai, M., Merlo, I., Dellepiane, S., Cantaluppi, V., Leonardi, G., Fop, F., Guarena, C., Grassi, G., and Biancore, L., Glycemic pattern in diabetic patients on hemodialysis: Continuous Glucose Monitoring (CGM) analysis. Blood Purif. 38(1):68–73 , 2014.Kondziella, D., Friberg, C.K., Wellwood, I., Reiffurth, C., Fabricius, M., and Dreier, J.P.: Continuous EEG monitoring in aneurysmal subarachnoid hemorrhage: A systematic review. Neurocrit. Care (2014)Ciccone, A., Celani, M.G., Chiaramonte, R., Rossi, C., and Righetti, E., Continuous versus intermittent physiological monitoring for acute stroke. Cochrane Database Syst. Rev. 31, 2013.Kushimoto, S., Yamanouchi, S., Endo, T., Sato, T., Nomura, R., Fujita, M., Kudo, D., Omura, T., Miyagawa, N., and Sato, T., Body temperature abnormalities in non-neurological critically ill patients: A review of the literature. J. Intensive Care 2, 2014.Mc Callum, L., and Higgings, D., Measuring body temperature. Nursing Times 108:20–22, 2012.Varela, M., Ruiz-Esteban, R., Martinez-Nicolas, A., Cuervo-Arango, A., Barros, C., and Delgado, E.G., Catching the spike and tracking the flow: Holter-temperature monitoring in patients admitted in a general internal medicine ward. Int. J. Clin. Pract. 65(12):1283–1288, 2011.Lopes, F., Peres, D., Bross, A., Melot, C., and Vincent, J.L., Serial evaluation of the SOFA score to predict outcome in critically ill patients. J. Am. Med. Assoc. 286:1754–1758, 2001.Vincent, J.L., and Moreno, R., Clinical review: Scoring systems in the critically ill. Crit. Care, 14, 2010.Sund-Levander, M., and Grodzinsky, E., Time for a change to assess and evaluate body temperature in clinical practice. Int. J. Nurs. Pract. 15:241–249, 2009.Cuesta-Frau, D., Varela, M., Aboy, M., and Miro, P., Description of a portable wireless device for body temperature acquisition and analysis. Sensors 9(10):7648–7663, 2009.Varela, M., Cuesta-Frau, D., Madrid, J.A., Churruca, J., Miro-Matinez, P., Ruiz, R., and Marinez, C., Holter monitoring of central peripheral temperature: Possible uses and feasibility study in outpatient settings. J. Clin. Monit. Comput. 4(23):209–216, 2009.Jordan, J., Miro, P., Cuesta-Frau, D., Varela, M., and Vargas B.: Aplicacion de analisis multivariante para la deteccion de estados prefebriles en pacientes ingresados (in Spanish), XXXIV Congreso Nacional de Estadistica e Investigacion Operativa, Castellon (Spain) (2013)Richman, J., and Moorman, J.R., Physiological time-series analysis using approximate entropy and sample entropy. Am. J. Physiol. Heart Circ. Physiol. 278(6):H2039–2049, 2000.Young, P., Saxena, M., Eastwood, G.M., Bellomo, R., and Beasley, R., Fever and fever management among intensive care patients with known or suspected infection: A multicentre prospective cohort study. Crit. Care Resusc. 13:97–102 , 2011.Drewry, A.M., Fuller, B.M., Bailey, T.C., and Hotchkiss, R.S., Body temperature patterns as a predictor of hospital-acquired sepsis in afebrile adult intensive care unit patients: A case-control study. Crit. Care,17, 2013.Musher, D., Fainstein, V., Young, E., and Pruett, T., Fever patterns. Their lack of significance. Arch. Intern. Med. 139(11):1225–8, 1979.Varela, M., Calvo, M., Chana, M., Gomez-Mestre, I., Asensio, R., and Galdos, P., Clinical implications of temperature curve complexity in critically ill patients. Crit. Care Med. 33(12):2764–2771, 2005.Varela, M., Churruca, J., Gonzalez, A., Martin, A., Ode, J., and Galdos, P., Temperature curve complexity predicts survival in critically ill patients. Am. J. Respir. Crit. Care Med. 174(3):290–298, 2006.Cuesta-Frau, D., Varela, M., Miro, P., Galdos, P., Abasolo, D., Hornero, R., and Aboy, M., Predicting survival in critical patients by use of body temperature regularity measurement based on Approximate Entropy. Med. Biol. Eng. Computing 45:671–678, 2007.Mackiowak, P. Temperature regulation and the pathogenesis of fever, Principles and Practice of Infectious Diseases, pp. 765–778. New York: Churchill Livingston Elsevier, 2010.Cherbuin N., and Brinkman C., Cognition is cool: Can hemispheric activation be assessed by tympanic membrane thermometry? Brain Cogn. 54:228–231, 2004

Doença de Kikuchi

A doença de Kikuchi-Fugimoto é uma doença rara, autolimitada e de origem desconhecida. O quadro clínico manifesta-se mais frequentemente por adenomegálias cervicais, febre e astenia mas a apresentação pode ser variável. Descrevem-se dois casos desta entidade em adolescentes de 14 e 12 anos, do sexo feminino, cujas apresentações clínicas foram distintas. Ambas apresentavam anemia normocítica, leucopenia e elevação da velocidade de sedimentação. O estudo da autoimunidade revelou anticorpos positivos e os achados histológicos da biópsia ganglionar conduziram ao diagnóstico de doença de Kikuchi-Fugimoto. A doença de Kikuchi-Fugimoto deve ser considerada no diagnóstico diferencial de febre e adenomegálias de etiologia desconhecida. A possível associação com lupus eritematoso sistémico torna necessário o seguimento acompanhamento e vigilância destas doentes a longo prazo

Valoración del grado de dependencia de los pacientes mayores de 75 años que ingresan en la unidad de traumatología

Ageing of the population has been one of the most important social transformations in the last third of the twentieth century. A reality associated with ageing is that the number of dependent people increases with age. As a result, there is increased demand for care in chronic and degenerative processes.We conducted a cross sectional study which aimed to measure the degree of dependency of patients that were admitted to the orthopaedic surgery/ Trauma Unit , General Yagüe Hospital in Burgos when the patient was older than 75 years. We observed dependence when leaving the hospital with medical discharge. Data collection was from January to June 2009To value the functional dependence we used Barthel's Index. In addition, we gathered epidemiological variables, the medical precedents and the information about the admission. We used the clinical history and the information obtained from our health care assistance.We performed an analysis of the data, and used an SPSS statistical package. The findings show that age and degree of dependence when the patient is discharged is significant, with same behaviour being appreciated with other variables. In the case of fractures, the evolution is positive in the Barthel Index, osteoarthritis is negative and there were no changes in other pathologies (dislocations, infections...)Healthcare professionals should provide quality care through our clinical and teaching work, and thus improve the patient's living habits and encourage their independence. Our study is useful if we apply care from the patient being admitted through to discharge in coordination with other levels of care.El envejecimiento de la población, constituye una de las transformaciones sociales más importantes del último tercio del pasado siglo. Una realidad asociada al envejecimiento es que el número de personas con dependencia aumenta con la edad, derivándose de ello el aumento de la demanda de cuidados por procesos crónicos y degenerativos que lleva asociados.Se realizó un estudio descriptivo transversal, con el objetivo de medir el grado de dependencia que presenta al ingreso el paciente mayor de 75 años, en la Unidad de Traumatología del Hospital General Yagüe de Burgos y el grado de dependencia con el que abandona el hospital al alta; el período de recogida de datos se efectuó entre enero y junio de 2009.Para valorar la dependencia funcional utilizamos el Índice de Barthel, además recogimos las variables epidemiológicas, los antecedentes médicos y los datos del ingreso, utilizamos la historia clínica y los datos obtenidos de nuestra labor asistencial. Se realizó análisis de los datos, empleando el paquete estadístico SPSS, encontrando que la edad y el grado de dependencia al alta son estadísticamente significativos, apreciando el mismo comportamiento con otras variables. En el caso de las fracturas constatamos una evolución positiva del Índice de Barthel, negativa en artrosis y sin modificaciones en otras patologías (luxaciones, infecciones…).Los profesionales de enfermería debemos proporcionar cuidados de calidad, mediante nuestra labor asistencial y docente para mejorar los hábitos de vida del paciente y ayudar a su autonomía. Creemos que el estudio es útil para aplicar cuidados al ingreso y la continuidad de los mismos al alta en coordinación con otros niveles asistenciale

Psicometric properties of an instrument for measuring patient’s satisfaction with physical therapy (medrisk) in spanish population: cultural diversity

The Spanish-language versión of the MedRisk Insttrument for Mesauring Partient Satisfaction with Physical therapy Care was validated in a simple of 203 Spanish-speakers patients in New York City. The purpose of this investigation is to adapt this instrument to Spanish population (patients who assist to physical therapy services in Spain); to corroborate if exist a psychometric equivalence and to identify if Spanish patients consider relevant the same dimensions as the preliminary validation. Relevance: At time to used a measurement instrument that has been validated in another country, it is necessary to assure that it is not only reliable and valid to the country where was developed, but also it needs to be appropriated to the patients subjects of the current investigation. Participants: A total of 300 patients of the Hospital of San Juan de Dios del Aljarafe (in Sevilla, Spain) participated in this study (44% men and 56% women between 13 and 93 years old). Methods: It has been done a cross-sectional descriptive study. Data were collected between April 2008 and November 2009.To the patients involved in the research, it was applied the original 20-item version of the MRPS (18 items and two global measures) and not the validated 12-item MRPS (10 items and two global measures). The main investigator randomly selected days during which the data were collected. The sample was taken finally on by convenience: all patients, in these selected days, who assist to medical care once they were done with their prescribed physiotherapy treatment. Analysis: Like Spanish version in New York, factor structure was investigated using item-correlation and exploratory factor analysis. Group-level reliability for single test administration was assessed using the Cronbach alpha. Results: Factor structure: the inter-item correlation matrix revealed that 3 items were not significantly correlated to both of the global measures . These 3 items were not included in the subsequent analysis. Principal components analysis revealed 4 eigenvalues greater than 2.0 explaining 67.93% of the cumulative variance. This suggested a 4-factor solutions. Following varimax rotation, a total of 14 items loaded on four factors were retained. Reliability: The Cronbach alpha was .87 Conclusions: Spanish version of MRPS that was validated with Spanish-speakers patients in New York is similar but not identical to the validation obtained with Spanish Population. In both of them, 9 of the 12 and 14 items finally selected in each other, have a coincidence. In the first one, there is a conclusion of two factors, internal and external. And in our investigation there were obtained 4 dimensions, 2 of them refer to internal factors (respect of the healthcare team and professional behavior of the therapist) and 2 that does it to external factors (adaptation of the center and accessibility)Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

hp-adaptive Galerkin Time Stepping Methods for Nonlinear Initial Value Problems

This work is concerned with the derivation of an a posteriori error estimator for Galerkin approximations to nonlinear initial value problems with an emphasis on finite-time existence in the context of blow-up. The structure of the derived estimator leads naturally to the development of both h and hp versions of an adaptive algorithm designed to approximate the blow-up time. The adaptive algorithms are then applied in a series of numerical experiments, and the rate of convergence to the blow-up time is investigated

Limited role of spatial selfstructuring in emergent trade-offs during pathogen evolution

Pathogen transmission and virulence are main evolutionary variables broadly assumed to be linked through trade-offs. In well-mixed populations, these trade-offs are often ascribed to physiological restrictions, while populations with spatial self-structuring might evolve emergent trade-offs. Here, we reexamine a spatially-explicit, SIR model of the latter kind proposed by Ballegooijen and Boerlijst with the aim of characterising the mechanisms causing the emergence of the trade-off and its structural robustness. Using invadability criteria, we establish the conditions under which an evolutionary feedback between transmission and virulence mediated by pattern formation can poise the system to a critical boundary separating a disordered state (without emergent trade-off) from a self-structured phase (where the trade-off emerges), and analytically calculate the functional shape of the boundary in a certain approximation. Beyond evolutionary parameters, the success of an invasion depends on the size and spatial structure of the invading and invaded populations. Spatial self-structuring is often destroyed when hosts are mobile, changing the evolutionary dynamics to those of a well-mixed population. In a metapopulation scenario, the systematic extinction of the pathogen in the disordered phase may counteract the disruptive effect of host mobility, favour pattern formation and therefore recover the emergent trade-off.This work has been supported by the Spanish Ministerio de Economía, Industria y Competitividad and FEDER funds of the EU through grants ViralESS (FIS2014-57686-P and FIS2017-84256-P). The internship of VB was financed by the Severo Ochoa Centers of Excellence Program (SEV-2013-0347)

Bioassay guided purification of the antimicrobial fraction of a Brazilian propolis from Bahia state

<p>Abstract</p> <p>Background</p> <p>Brazilian propolis type 6 (Atlantic forest, Bahia) is distinct from the other types of propolis especially due to absence of flavonoids and presence of other non-polar, long chain compounds, but presenting good <it>in vitro </it>and <it>in vivo </it>antimicrobial activity. Several authors have suggested that fatty acids found in this propolis might be responsible for its antimicrobial activity; however, so far no evidence concerning this finding has been reported in the literature. The goals of this study were to evaluate the antibacterial activity of the main pure fatty acids in the ethanolic extract and fractions and elucidate the chemical nature of the bioactive compounds isolated from Brazilian propolis type 6.</p> <p>Methods</p> <p>Brazilian propolis type 6 ethanolic extract (EEP), hexane fraction (H-Fr), major fatty acids, and isolated sub-fractions were analyzed using high performance liquid chromatography (HPLC), high resolution gas chromatography with flame ionization detection (HRGC-FID), and gas chromatography-mass spectrometry (GC-MS). Three sub-fractions of H-Fr were obtained through preparative HPLC. Antimicrobial activity of EEP, H-Fr, sub-fractions, and fatty acids were tested against <it>Staphyloccus aureus </it>ATCC 25923 and <it>Streptococcus mutans </it>Ingbritt 1600 using minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC).</p> <p>Results</p> <p>EEP and H-Fr inhibited the growth of the microorganisms tested; nevertheless, no antimicrobial activity was found for the major fatty acids. The three sub-fractions (1, 2, and 3) were isolated from H-Fr by preparative HPLC and only sub-fraction 1 showed antimicrobial activity.</p> <p>Conclusion</p> <p>a) The major fatty acids tested were not responsible for the antimicrobial activity of propolis type 6; b) Sub-fraction 1, belonging to the benzophenone class, was responsible for the antimicrobial activity observed in the present study. The identification of the bioactive compound will improve the development of more efficient uses of this natural product.</p

Comparing genomic variant identification protocols for Candida auris.

Genomic analyses are widely applied to epidemiological, population genetic and experimental studies of pathogenic fungi. A wide range of methods are employed to carry out these analyses, typically without including controls that gauge the accuracy of variant prediction. The importance of tracking outbreaks at a global scale has raised the urgency of establishing high-accuracy pipelines that generate consistent results between research groups. To evaluate currently employed methods for whole-genome variant detection and elaborate best practices for fungal pathogens, we compared how 14 independent variant calling pipelines performed across 35 Candida auris isolates from 4 distinct clades and evaluated the performance of variant calling, single-nucleotide polymorphism (SNP) counts and phylogenetic inference results. Although these pipelines used different variant callers and filtering criteria, we found high overall agreement of SNPs from each pipeline. This concordance correlated with site quality, as SNPs discovered by a few pipelines tended to show lower mapping quality scores and depth of coverage than those recovered by all pipelines. We observed that the major differences between pipelines were due to variation in read trimming strategies, SNP calling methods and parameters, and downstream filtration criteria. We calculated specificity and sensitivity for each pipeline by aligning three isolates with chromosomal level assemblies and found that the GATK-based pipelines were well balanced between these metrics. Selection of trimming methods had a greater impact on SAMtools-based pipelines than those using GATK. Phylogenetic trees inferred by each pipeline showed high consistency at the clade level, but there was more variability between isolates from a single outbreak, with pipelines that used more stringent cutoffs having lower resolution. This project generated two truth datasets useful for routine benchmarking of C. auris variant calling, a consensus VCF of genotypes discovered by 10 or more pipelines across these 35 diverse isolates and variants for 2 samples identified from whole-genome alignments. This study provides a foundation for evaluating SNP calling pipelines and developing best practices for future fungal genomic studies