Privacy Concerns Related to Data Sharing for European Diabetes Devices

Background: Individuals with diabetes rely on medical equipment (eg, continuous glucose monitoring (CGM), hybrid closed-loop systems) and mobile applications to manage their condition, providing valuable data to health care providers. Data sharing from this equipment is regulated via Terms of Service (ToS) and Privacy Policy documents. The introduction of the Medical Devices Regulation (MDR) and In Vitro Diagnostic Medical Devices Regulation (IVDR) in the European Union has established updated rules for medical devices, including software. Objective: This study examines how data sharing is regulated by the ToS and Privacy Policy documents of approved diabetes medical equipment and associated software. It focuses on the equipment approved by the Norwegian Regional Health Authorities. Methods: A document analysis was conducted on the ToS and Privacy Policy documents of diabetes medical equipment and software applications approved in Norway. Results: The analysis identified 11 medical equipment and 12 software applications used for diabetes data transfer and analysis in Norway. Only 3 medical equipment (OmniPod Dash, Accu-Chek Insight, and Accu-Chek Solo) were registered in the European Database on Medical Devices (EUDAMED) database, whereas none of their respective software applications were registered. Compliance with General Data Protection Regulation (GDPR) security requirements varied, with some software relying on adequacy decisions (8/12), whereas others did not (4/12). Conclusions: The study highlights the dominance of non-European Economic Area (EEA) companies in medical device technology development. It also identifies the lack of registration for medical equipment and software in the EUDAMED database, which is currently not mandatory. These findings underscore the need for further attention to ensure regulatory compliance and improve data-sharing practices in the context of diabetes management

Phosphatidylinositol 3-kinase signaling in proliferating cells maintains an anti-apoptotic transcriptional program mediated by inhibition of FOXO and non-canonical activation of NFκB transcription factors

<p>Abstract</p> <p>Background</p> <p>Phosphatidylinositol (PI) 3-kinase is activated by a variety of growth factor receptors and the PI 3-kinase/Akt signaling pathway is a key regulator of cell proliferation and survival. The downstream targets of PI 3-kinase/Akt signaling include direct regulators of cell cycle progression and apoptosis as well as a number of transcription factors. Growth factor stimulation of quiescent cells leads to robust activation of PI 3-kinase, induction of immediate-early genes, and re-entry into the cell cycle. A lower level of PI 3-kinase signaling is also required for the proliferation and survival of cells maintained in the presence of growth factors, but the gene expression program controlled by PI 3-kinase signaling in proliferating cells has not been elucidated.</p> <p>Results</p> <p>We used microarray analyses to characterize the changes in gene expression resulting from inhibition of PI 3-kinase in proliferating cells. The genes regulated by inhibition of PI 3-kinase in proliferating cells were distinct from genes induced by growth factor stimulation of quiescent cells and highly enriched in genes that regulate programmed cell death. Computational analyses followed by chromatin immunoprecipitations demonstrated FOXO binding to both previously known and novel sites in promoter regions of approximately one-third of the up-regulated genes, consistent with activation of FOXO1 and FOXO3a in response to inhibition of PI 3-kinase. NFκB binding sites were similarly identified in promoter regions of over one-third of the down-regulated genes. RelB was constitutively bound to promoter regions in cells maintained in serum, however binding decreased following PI 3-kinase inhibition, indicating that PI 3-kinase signaling activates NFκB via the non-canonical pathway in proliferating cells. Approximately 70% of the genes targeted by FOXO and NFκB regulate cell proliferation and apoptosis, including several regulators of apoptosis that were not previously known to be targeted by these transcription factors.</p> <p>Conclusion</p> <p>PI 3-kinase signaling in proliferating cells regulates a novel transcriptional program that is highly enriched in genes that regulate apoptosis. At least one-third of these genes are regulated either by FOXO transcription factors, which are activated following PI 3-kinase inhibition, or by RelB, which is activated by PI 3-kinase via the non-canonical pathway in proliferating cells.</p

Early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma:An economic evaluation based on data from the EAGLE trial

This study was funded by the UK Medical Research Council (ref G0701604), and managed by the National Institute for Health Research (NIHR-EME 09-800-26) on behalf of the MRC-NIHR partnership, Efficiency and Mechanism Evaluation Programme. The Health Services Research Unit and the Health Economics Research Unit are both funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The funders had no role in the study design; collection, analysis, and interpretation of data; the writing of the report; or in the decision to submit the article for publication. The views expressed in this article are those of the authors and do not necessarily reflect the views of the MRC, National Institute for Health Research, the Department of Health, or the Scottish Government.Peer reviewedPublisher PD

Fire risk reduction on the margins of an urbanizing world

Globally, over 95% of fire related deaths and injuries occur in low- and middle-income countries. Within informal settlements, the risk of fire resulting in injury or death is particularly high. This paper examines fire risks in informal settlements in New Delhi and Cape Town, and tented informal settlements in Lebanon. Our analysis draws on primary sources, secondary literature, statistical data and qualitative interviews. The distribution of fire risk across urban societies is a fundamentally political issue. Residential fire risk can be tackled by accessible, affordable, safety-compliant housing. That said, important interim measures can be taken to mitigate fire risk. Some of the risks requiring attention are similar across our case studies, driven by high population densities; flammable housing materials; unreliable or inaccessible access to safe power sources; and - in the case of Cape Town and New Delhi particularly - the inability of fire services to reach sites of fire. However, these common risks are embedded in distinct social, economic and political contexts that must be placed at the centre of any intervention. Interventions must also be aware that the risk of fire is not spread evenly within informal settlements, intersecting as it does with factors like gender, age, health and disability. Informal settlement fires have been under-studied to date. The studies that do exist tend to operate within disciplinary silos. This paper represents an important interdisciplinary approach to fire within informal settlements, which grounds technical data, modelling and experiments in political, social and economic realities

Prenatal development is linked to bronchial reactivity: epidemiological and animal model evidence

Chronic cardiorespiratory disease is associated with low birthweight suggesting the importance of the developmental environment. Prenatal factors affecting fetal growth are believed important, but the underlying mechanisms are unknown. The influence of developmental programming on bronchial hyperreactivity is investigated in an animal model and evidence for comparable associations is sought in humans. Pregnant Wistar rats were fed either control or protein-restricted diets throughout pregnancy. Bronchoconstrictor responses were recorded from offspring bronchial segments. Morphometric analysis of paraffin-embedded lung sections was conducted. In a human mother-child cohort ultrasound measurements of fetal growth were related to bronchial hyperreactivity, measured at age six years using methacholine. Protein-restricted rats' offspring demonstrated greater bronchoconstriction than controls. Airway structure was not altered. Children with lesser abdominal circumference growth during 11-19 weeks' gestation had greater bronchial hyperreactivity than those with more rapid abdominal growth. Imbalanced maternal nutrition during pregnancy results in offspring bronchial hyperreactivity. Prenatal environmental influences might play a comparable role in humans

Intensified follow-up of patients with type 1 diabetes and poor glycaemic control: A multicentre quality improvement collaborative based on data from the Norwegian Diabetes Register for Adults

Background Patients with type 1 diabetes mellitus (T1DM) and poor glycaemic control are at high risk of developing microvascular and macrovascular complications. The aim of this study was to determine if a quality improvement collaborative (QIC) initiated by the Norwegian Diabetes Register for adults (NDR-A) could reduce the proportion of patients with T1DM with poor glycaemic control (defined as glycated haemoglobin (HbA1c)≥75 mmol/mol) and reduce mean HbA1c at participating clinics compared with 14 control clinics. Method Multicentre study with controlled before and after design. Representatives of 13 diabetes outpatient clinics (n=5145 patients with T1DM) in the intervention group attended four project meetings during an 18-month QIC. They were required to identify areas requiring improvement at their clinic and make action plans. Continuous feedback on HbA1c outcomes was provided by NDR-A during the project. In total 4084 patients with type 1 diabetes attended the control clinics. Results Between 2016 and 2019, the overall proportion of patients with T1DM and HbA1c≥75 mmol/mol in the intervention group were reduced from 19.3% to 14.1% (p<0.001). Corresponding proportions in the control group were reduced from 17.3% (2016) to 14.4% (2019) (p<0.001). Between 2016 and 2019, overall mean HbA1c decreased by 2.8 mmol/mol (p<0.001) at intervention clinics compared with 2.3 mmol/mol (p<0.001) at control clinics. After adjusting for the baseline differences in glycaemic control, there were no significant differences in the overall improvement in glycaemic control between intervention and control clinics. Conclusions The registry linked QIC did not result in a significantly greater improvement in glycaemic control at intervention clinics compared with control clinics. However, there has been a sustained improvement in glycaemic control and importantly a significant reduction in the proportion of patients with poor glycaemic control at both intervention and control clinics during and after the QIC time frame. It is possible that some of this improvement may be due to a spillover effect from the QIC.publishedVersio

Laparoscopic supracervical hysterectomy versus endometrial ablation for women with heavy menstrual bleeding (HEALTH) : a parallel-group, open-label, randomised controlled trial

UK National Institute for Health Research Health Technology Assessment Programme. Acknowledgments We thank the women who participated in the HEALTH study. We also thank Angela Hyde (Vice Chair of the Royal College of Obstetricians and Gynaecologists Women's Network until September, 2015, and co-applicant on the original grant application until October, 2016) for her contribution to the design of the participant facing documents and participation in trial meetings from the perspective of a patient, Jonathan Cook (statistician and co-applicant on the original grant application until April, 2014) for his contributions to the study design, Rebecca Bruce for her secretarial support and data management, members of the project management group for their ongoing advice and support of the trial, plus the independent members of the trial steering committee (Henry Kitchener [Chair], Patrick Chien, Barbara Farrell, and Isobel Montgomery) and data monitoring committee (Jane Norman [Chair], Peter O'Donovan, and Andy Vail), and the staff at the recruitment sites who facilitated recruitment, treatment, and follow-up of trial participants. The project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (project number 12/35/23). The Health Services Research Unit and the Health Economics Research Unit are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The views expressed herein are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care.Peer reviewedPublisher PD

Astrometry with the Keck-Interferometer: the ASTRA project and its science

The sensitivity and astrometry upgrade ASTRA of the Keck Interferometer is introduced. After a brief overview of the underlying interferometric principles, the technology and concepts of the upgrade are presented. The interferometric dual-field technology of ASTRA will provide the KI with the means to observe two objects simultaneously, and measure the distance between them with a precision eventually better than 100 uas. This astrometric functionality of ASTRA will add a unique observing tool to fields of astrophysical research as diverse as exo-planetary kinematics, binary astrometry, and the investigation of stars accelerated by the massive black hole in the center of the Milky Way as discussed in this contribution.Comment: 22 pages, 10 figures (low resolution), contribution to the summerschool "Astrometry and Imaging with the Very Large Telescope Interferometer", 2 - 13 June, 2008, Keszthely, Hungary, corrected authorlis

CCR7+ dendritic cells sorted by binding of CCL19 show enhanced Ag-presenting capacity and antitumor potency

Dendritic cell therapy has been a promising addition to the current armory of therapeutic options in cancer for more than 20 years but has not yet achieved breakthrough success. To successfully initiate immunity, dendritic cells have to enter the lymph nodes. However, experience to date of therapeutic dendritic cell administration indicates that this is frequently an extremely inefficient process. The major regulator of dendritic cell migration to the lymph nodes is the chemokine receptor CCR7 and in vitro generated dendritic cells typically display heterogeneous expression of this receptor. Here we demonstrate that positive selection for the dendritic cell subpopulation expressing CCR7, using a chemically-synthesized ligand:CCL19, enriches for cells with enhanced lymph node migration and Ag presentation competence as well as a chemokine expression profile indicative of improved interactions with T cells. This enhanced lymph node homing capacity of enriched CCR7+ cells is seen in comparison to a population of unsorted dendritic cells containing an equivalent number of CCR7+ dendritic cells. Importantly, this indicates that separating the CCR7+ dendritic cells from the CCR7− cells, rather than simple CCL19 exposure, is required to affect the enhanced lymph node migration of the CCR7+ cells. In models of both subcutaneous and metastatic melanoma, we demonstrate that the dendritic cells sorted for CCR7 expression trigger enhanced CD8 T-cell driven antitumor immune responses which correlate with reduced tumor burden and increased survival. Finally, we demonstrate that this approach is directly translatable to human dendritic cell therapy using the same reagents coupled with clinical-grade flow-cytometric sorting