Investigation of the use of a sensor bracelet for the presymptomatic detection of changes in physiological parameters related to COVID-19: an interim analysis of a prospective cohort study (COVI-GAPP).

OBJECTIVES We investigated machinelearningbased identification of presymptomatic COVID-19 and detection of infection-related changes in physiology using a wearable device. DESIGN Interim analysis of a prospective cohort study. SETTING, PARTICIPANTS AND INTERVENTIONS Participants from a national cohort study in Liechtenstein were included. Nightly they wore the Ava-bracelet that measured respiratory rate (RR), heart rate (HR), HR variability (HRV), wrist-skin temperature (WST) and skin perfusion. SARS-CoV-2 infection was diagnosed by molecular and/or serological assays. RESULTS A total of 1.5 million hours of physiological data were recorded from 1163 participants (mean age 44±5.5 years). COVID-19 was confirmed in 127 participants of which, 66 (52%) had worn their device from baseline to symptom onset (SO) and were included in this analysis. Multi-level modelling revealed significant changes in five (RR, HR, HRV, HRV ratio and WST) device-measured physiological parameters during the incubation, presymptomatic, symptomatic and recovery periods of COVID-19 compared with baseline. The training set represented an 8-day long instance extracted from day 10 to day 2 before SO. The training set consisted of 40 days measurements from 66 participants. Based on a random split, the test set included 30% of participants and 70% were selected for the training set. The developed long short-term memory (LSTM) based recurrent neural network (RNN) algorithm had a recall (sensitivity) of 0.73 in the training set and 0.68 in the testing set when detecting COVID-19 up to 2 days prior to SO. CONCLUSION Wearable sensor technology can enable COVID-19 detection during the presymptomatic period. Our proposed RNN algorithm identified 68% of COVID-19 positive participants 2 days prior to SO and will be further trained and validated in a randomised, single-blinded, two-period, two-sequence crossover trial. Trial registration number ISRCTN51255782; Pre-results

Prevalence of diabetes mellitus at the end of life: An investigation using individually linked cause-of-death and medical register data

Aims: Although diabetes mellitus at the end of life is associated with complex care, its end-of-life prevalence is uncertain. Our aim is to estimate diabetes prevalence in the end-of-life population, to evaluate which medical register has the largest added value to cause-of-death data in detecting diabetes cases, and to assess the extent to which reporting of diabetes as a cause of death is associated with disease severity. Methods: Our study population consisted of deaths in the Netherlands (2015–2016) included in Nivel Primary Care Database (Nivel-PCD; N = 18,162). The proportion of deaths with diabetes (Type 1 or 2) within the last two years of life was calculated using individually linked cause-of-death, general practice, medication, and hospital discharge data. Severity status of diabetes was defined with dispensed medicines. Results: According to all data sources combined, 28.7% of the study population had diabetes at the end of life. The estimated end-of-life prevalence of diabetes was 7.7% using multiple cause-of-death data only. Addition of general practice data increased this estimate the most (19.7%-points). Of the cases added by primary care data, 76.3% had a severe or intermediate status. Conclusions: More than one fourth of the Dutch end-of-life population has diabetes. Cause-of-death data are insufficient to monitor this prevalence, even of severe cases of diabetes, but could be enriched particularly with general practice data

Student Housing in the Medieval City of Rhodes

Η Ρόδος φιλοξενεί σχολές του Πανεπιστημίου Αιγαίου με 3000 φοιτητές, ενώ το πανεπιστήμιο μισθώνει ξενοδοχεία για τη στέγαση τους, καθώς δε διαθέτει εστίες. Λόγω της ανάγκης στέγασης φοιτητών, της αξιοποίησης του ανενεργού κτιριακού αποθέματος του Δημοσίου, της ενίσχυσης της κατοικίας στην κατεύθυνση αναζωογόνησης προτείνουμε τη δημιουργία ενός δικτύου φοιτητικών κατοικιών που θα αξιοποιεί ακίνητα του δημοσίου. Στόχος είναι η βελτίωση της ποιότητας ζωής και η προσέλκυση νέων κατοίκων και η αλλαγή της κοινωνικής και χωρικής εσωστρέφειας που έχει παρατηρηθεί, προλαμβάνοντας την περαιτέρω απόσπαση της Εβραϊκής συνοικίας από την υπόλοιπη πόλη. Το συγκρότημα κατοικιών που μελετάμε βρίσκεται στην άνω Εβραϊκή συνοικία σε επαφή με το πάρκο Αλχαδέφ και είναι εποχής Ιπποτοκρατίας με φανερές οθωμανικές επεμβάσεις. Βασικές αρχές αποτέλεσαν η ανάδειξη της αρχικής φάσης των κτιρίων, με διατήρηση των σημαντικότερων αρχιτεκτονικών στοιχείων των επόμενων, καθώς μαρτυρούν την ιστορική τους εξέλιξη, η βιωσιμότητα και η αναστρεψιμότητα των επεμβάσεων. Παρόλο που βρισκόμαστε σε ένα ιστορικό περιβάλλον είναι απαραίτητη η προσαρμογή των κτιρίων στις νέες συνθήκες. Καθώς η αλλαγή είναι αναπόφευκτη, επεμβαίνουμε με μια νέα αρχιτεκτονική που σέβεται το περιβάλλον και τη μνήμη και αντιπροσωπεύει τη σύγχρονη εποχή. Επιδιώκουμε ένα διάλογο μεταξύ των υλικών και σχεδιάζουμε κάτι σύγχρονο παρά μια απομίμηση του παλιού, λαμβάνοντας υπόψη την κλίμακα της περιοχής. Τα δύο συγκροτήματα στεγάζουν 25 φοιτητές και μπορούν να αξιοποιηθούν κατά τους καλοκαιρινούς μήνες ως ενοικιαζόμενα δωμάτια. Τα δωμάτια είναι συνήθως μονόκλινα ενώ συναντώνται και δίκλινα ή τετράκλινα με πατάρι. Κάθε κτίριο διαθέτει κοινόχρηστη κουζίνα και καθιστικό. Στο ένα οικόπεδο προτείνουμε μία κινηματογραφική λέσχη που μπορεί να χρησιμοποιηθεί και για τις συναθροίσεις των φοιτητών. Στον κενό χώρο μπροστά από το πάρκο σχεδιάζουμε ένα αναψυκτήριο, ένα εξωστρεφές κτίριο που επικοινωνεί με το πάρκο και δεν απευθύνεται αποκλειστικά στους φοιτητές, καθώς επίσης ένα πιο εσωστρεφές εστιατόριο, που οργανώνεται γύρω από μία εσωτερική αυλή.The island of Rhodes hosts schools of Aegean University with 3000 students, and the university leases hotels to accommodate them due to the absence of dormitories. Given the need for student housing, the use of inactive public building stock and strengthening of residences towards revitalization, we recommend a network of student housing by utilizing public properties. The aim is to improve the quality of life and attracting new residents to revitalize the city, especially during winter months and to change the social and spatial introversion observed, preventing further detachment of the Jewish Quarter from the rest of the city. The residential complex under study is located in the upper Jewish Quarter, in contact with the Alchadef park and was built during the Knights’ period with apparent ottoman interventions. Fundamentals were the highlight of the initial phase of building, maintaining the major architectural elements of the subsequent periods, sustainability and reversibility of interventions. Although we are in a historic environment it is necessary to adapt the buildings to the contemporary conditions. As change is inevitable, we introduce a new, contemporary architecture that respects the environment and memory and represents the modern era. We aim to a dialogue between materials and design something contemporary rather than an imitation of the old, taking into consideration the scale of the area. The two complexes house 25 students and can be used during the summer as rentals. The rooms are usually single with a few double or quadruple rooms with a loft. Each building has a communal kitchen and living room. In the yard of the first complex we propose a film club that can be used as a gathering space for the students. In the space in front of the park we design a cafeteria, a building that communicates with the park and is not addressed exclusively to the students, as well as a restaurant, organized around a central courtyard.Χριστίνα Δ. ΜητρατζάΜαρία-Μαργαρίτα M. Μίχαλο

Sex-specific differences in physiological parameters related to SARS-CoV-2 infections among a national cohort (COVI-GAPP study).

Considering sex as a biological variable in modern digital health solutions, we investigated sex-specific differences in the trajectory of four physiological parameters across a COVID-19 infection. A wearable medical device measured breathing rate, heart rate, heart rate variability, and wrist skin temperature in 1163 participants (mean age = 44.1 years, standard deviation [SD] = 5.6; 667 [57%] females). Participants reported daily symptoms and confounders in a complementary app. A machine learning algorithm retrospectively ingested daily biophysical parameters to detect COVID-19 infections. COVID-19 serology samples were collected from all participants at baseline and follow-up. We analysed potential sex-specific differences in physiology and antibody titres using multilevel modelling and t-tests. Over 1.5 million hours of physiological data were recorded. During the symptomatic period of infection, men demonstrated larger increases in skin temperature, breathing rate, and heart rate as well as larger decreases in heart rate variability than women. The COVID-19 infection detection algorithm performed similarly well for men and women. Our study belongs to the first research to provide evidence for differential physiological responses to COVID-19 between females and males, highlighting the potential of wearable technology to inform future precision medicine approaches