Guidance to 2018 good practice : ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma

AimsMobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases.MethodsMASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients.StakeholdersInclude patients, health care professionals (pharmacists and physicians), authorities, patient's associations, private and public sectors.ResultsMASK is deployed in 23 countries and 17 languages. 26,000 users have registered.EU grants (2018)MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour).Lessons learnt(i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.Peer reviewe

Plant–Rhizobium symbiosis, seed nutraceuticals, and waste quality for energy production of Vicia faba L. as affected by crop management

Background: Broad bean fits sustainable agriculture model due to symbiosis with Rhizobium, the seeds being a good source of energy, proteins, polyphenols, and fiber. The large amount of broad bean biomass residues can be employed for biofuel production, thus valorizing the overall production process. This research was aimed to investigate on the effects of farming management, such as greenhouse cultivation and appropriate planting time on the qualities of broad bean seeds and residual biomass for conversion into biofuel. The related balances of energy gain associated to both ethanol yield and nitrogen fertilizer saving due to Rhizobium nitrogen fixation were assessed. Methods: Research was carried out on broad bean in Portici, province of Naples, southern Italy, based on the factorial combination of two farming systems (open field, greenhouse) and five planting times: 27 September and 11 October, to obtain early production; 25 October, which fell in the usual period for broad bean planting in the province area; and 8 November and 22 November, for late production. For each of these cultivation conditions, the quality of seeds, in terms of protein, fiber and antioxidant concentrations, and of crop residual biomass were determined. In addition, the energy yield as ethanol production from residual biomass and nitrogen fertilizer saving due to Rhizobium atmospheric fixation were assessed. Results and discussion: The highest plant nitrogen uptake was recorded under the fourth planting time in open field and the third in greenhouse, the average accumulation attaining 87% in residual biomass, 7.4% in pods, and 5.6% in seeds. Seed protein content was 12.6% higher in greenhouse than in open field and 16.2% higher under the latest planting time compared to the earliest one. Seed polyphenol concentration was higher in open field than in greenhouse and with the two earliest planting times. Greenhouse grown biomass showed higher values of lignin, hemicellulose and pectin, compared to open field, whereas the opposite trend was for cellulose. Lignin showed a decrease from the first to the last crop cycle, opposite to cellulose, and glucose was the most represented monosaccharide. Both the highest theoretical ethanol and overall energy production were highest with the fourth planting time. Conclusions: Greenhouse management enabled broad bean plants to accumulate higher proteins in seeds, but open field conditions resulted in better residual biomass quality for ethanol and Rhizobium-depending energy production

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air (R) App

Background In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently. Methods All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated. Results A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures. Conclusions VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.Peer reviewe

Allergic Rhinitis and its Impact on Asthma (ARIA) Phase 4 (2018): Change management in allergic rhinitis and asthma multimorbidity using mobile technology

Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional