A use case of low power wide area networks in future 5G healthcare applications

Abstract. The trend in all cellular evolution to the Long-Term Evolution (LTE) has always been to offer users continuously increasing data rates. However, the next leap forwards towards the 5th Generation Mobile Networks (5G) will be mainly addressing the needs of devices. Machines communicating with each other, sensors reporting to a server, or even machines communicating with humans, these are all different aspects of the same technology; the Internet of Things (IoT). The key differentiator between Machine-to-Machine (M2M) communications and IoT will be the added -feature of connecting devices and sensors not only to themselves, but also to the internet. The appropriate communications network is the key to allow this connectivity. Local Area Networks (LANs) and Wide Area Networks (WANs) have been thought of as enablers for IoT, but since they both suffered from limitations in IoT aspects, the need for a new enabling technology was evident. LPWANs are networks dedicated to catering for the needs of IoT such as providing low energy consumption for wireless devices. LPWANs can be categorized into proprietary LPWANs and cellular LPWANs. Proprietary LPWANs are created by an alliance of companies working together on creating a communications standard operating in unlicensed frequency bands. An example of proprietary LPWANs is LoRa. Whereas cellular LPWANs are standardized by the 3rd Partnership Project (3GPP) and they are basically versions of the LTE standard especially designed for machine communications. An example of cellular LPWANs is Narrowband IoT (NB IoT). This diploma thesis documents the usage of LoRa and NB IoT in a healthcare use case of IoT. It describes the steps and challenges of deploying an LTE network at a target site, which will be used by the LoRa and NB IoT sensors to transmit data through the 5G test network (5GTN) to a desired server location for storing and later analysis.Matalan tehonkulutuksen ja pitkänkantaman teknologian käyttötapaus tulevaisuuden 5G:tä hyödyntävissä terveydenhoidon sovelluksissa. Tiivistelmä. Pitemmän aikavälin tarkastelussa matkaviestintäteknologian kehittyminen nykyisin käytössä olevaan Long-Term Evolution (LTE) teknologiaan on tarkoittanut käyttäjille yhä suurempia datanopeuksia. Seuraavassa askeleessa kohti 5. sukupolven matkaviestintäverkkoja (5G) lähestytään kehitystä myös laitteiden tarpeiden lähtökohdista. Toistensa kanssa kommunikoivat koneet, palvelimille dataa lähettävät anturit tai jopa ihmisten kanssa kommunikoivat koneet ovat kaikki eri puolia samasta teknologisesta käsitteestä; esineiden internetistä (IoT). Oleellisin ero koneiden välisessä kommunikoinnissa (M2M) ja IoT:ssä on, että erinäiset laitteet tulevat olemaan yhdistettyinä paitsi toisiinsa myös internettiin. Tätä kytkentäisyyttä varten tarvitaan tarkoitukseen kehitetty matkaviestinverkko. Sekä lähiverkkoja (LAN) että suuralueverkkoja (WAN) on pidetty mahdollisina IoT mahdollistajina, mutta näiden molempien käsitteiden alle kuuluvissa teknologioissa on rajoitteita IoT:n vaatimusten lähtökohdista, joten uuden teknologian kehittäminen oli tarpeellista. Matalan tehonkulutuksen suuralueverkko (LP-WAN) on käsite, johon luokitellaan eri teknologioita, joita on kehitetty erityisesti IoT:n tarpeista lähtien. LP-WAN voidaan jaotella ainakin itse kehitettyihin ja matkaviestinverkkoihin perustuviin teknologisiin ratkaisuihin. Itse kehitetyt ratkaisut on luotu lukuisten yritysten yhteenliittymissä eli alliansseissa ja nämä ratkaisut keskittyvät lisensoimattomilla taajuuksilla toimiviin langattomiin ratkaisuihin, joista esimerkkinä laajasti käytössä oleva LoRa. Matkaviestinverkkoihin perustuvat lisensoiduilla taajuuksilla toimivat ratkaisut on puolestaan erikseen standardoitu 3GPP-nimisessä yhteenliittymässä, joka nykyisellään vastaa 2G, 3G ja LTE:n standardoiduista päätöksistä. Esimerkki 3GPP:n alaisesta LPWAN-luokkaan kuuluvasta teknologiasta on kapea kaistainen IoT-teknologia, NB-IoT. Tässä diplomityössä keskitytään terveydenhoidon käyttötapaukseen, missä antureiden mittaamaa tietoa siirretään langattomasti käyttäen sekä LoRa että NB-IoT teknologioita. Työssä kuvataan eri vaiheet ja haasteet, joita liittyi kun rakennetaan erikseen tiettyyn kohteeseen LTE-verkon radiopeitto, jotta LoRa:a ja NB-IoT:a käyttävät anturit saadaan välittämään mitattua dataa halutulle palvelimelle säilytykseen ja myöhempää analysointia varten. LTE-radiopeiton rakensi Oulun yliopiston omistama 5G testiverkko, jonka tarkoitus on tukea sekä tutkimusta että ympäröivää ekosysteemiä tulevaisuuden 5G:n kehityksessä

Plasma and intracellular (platelet) zinc levels in chronic renal failure (CRF) patients under different treatment modalities

The causes and degree of zinc (Zn) deficiency in uraemia are still controversial. The effect of different treatment modalities are still unsettled. Plasma Zn represents only a small part of the total body Zn (about 0.5%). Thus determination of intracellular Zn in the peripheral blood cells might be more reliable. The present study was designed to assess the actual Zn status in uraemia and to find whether the treatment modalities of CRF (conservative and dialytic) could influence Zn status. Also to determine the elfeet of single dialysis session, type of dialysis and dialysate buffer on the Zn status.This study included ten healthy controls and fourty CRF patients divided in three subgroups on different treatment modalities (10 conservative treatment, 15 on intermittent perioneal dialysis ((IPD) and 15 on haemedialysis (HD). Zinc was measured by atomic absorption spectrophotometry in plasma and platelets. Statistically significant decrease of plasma Zn and significant increase of platelet Zn were found in CRF patients on different treatment modalities as compared to controls (P<0.01), but there was no significant difference in this respect hetween the three uraemic subgroups. There was no difference as regard serum protein and albunun levels in uraemic subgroups compared to controls. Moreover plasma Zn was significantly increased (still less than control) and platelet Zn was significantly decreased (P<0.01) after a single dialysis session in both IPD and HD subgroups, but the changes of both parameters (before and after dialysis) were insignificant in IPD patients compared to HD patients.Significant negative correlation was found between platelet Zn and creatinine clearance in the three uraemic subgroups (r = -0.81 P<0.01 in conservative patients, r= -0.72 P<0.01 in IPD and r= -0.76 P<0.01 in HD) while no correlation could be detected between the duration of dialysis and each of platelet & plasma Zn and between plasma Zn and each of platelet Zn, serum creatinine and clearance. Plasma Zn showed transient significant rise in HD patients using bicarbonate (11.6 ± 1.1 umol/L) as compared to those using acetate buffer (9.1 ± 1.3 umol/L), P<0.01. We can conclude that intracellular measurements of Zn (platelet) is of value in diagnosis and monitoring of Zn status in uraemics. Different treatment modalities does not influence Zn haernostasis. with no superiority of particular type of dialysis in this respect. The effect of a single dialysis session and the use of bicarbonate versus acetate buffer was just a transient rise of plasma Zn due to haemoconcentration and better correction of acidosis during dialysis

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

A systematic review and meta-analysis of evidence for correlation between molecular markers of parasite resistance and treatment outcome in falciparum malaria

<p>Abstract</p> <p>Background</p> <p>An assessment of the correlation between anti-malarial treatment outcome and molecular markers would improve the early detection and monitoring of drug resistance by <it>Plasmodium falciparum</it>. The purpose of this systematic review was to determine the risk of treatment failure associated with specific polymorphisms in the parasite genome or gene copy number.</p> <p>Methods</p> <p>Clinical studies of non-severe malaria reporting on target genetic markers (SNPs for <it>pfmdr1</it>, <it>pfcrt</it>, <it>dhfr</it>, <it>dhps</it>, gene copy number for <it>pfmdr1</it>) providing complete information on inclusion criteria, outcome, follow up and genotyping, were included. Three investigators independently extracted data from articles. Results were stratified by gene, codon, drug and duration of follow-up. For each study and aggregate data the random effect odds ratio (OR) with 95%CIs was estimated and presented as Forest plots. An OR with a lower 95^thconfidence interval > 1 was considered consistent with a failure being associated to a given gene mutation.</p> <p>Results</p> <p>92 studies were eligible among the selection from computerized search, with information on <it>pfcrt </it>(25/159 studies), <it>pfmdr1 </it>(29/236 studies), <it>dhfr </it>(18/373 studies), <it>dhps </it>(20/195 studies). The risk of therapeutic failure after chloroquine was increased by the presence of <it>pfcrt </it>K76T (Day 28, OR = 7.2 [95%CI: 4.5–11.5]), <it>pfmdr1 </it>N86Y was associated with both chloroquine (Day 28, OR = 1.8 [95%CI: 1.3–2.4]) and amodiaquine failures (OR = 5.4 [95%CI: 2.6–11.3, p < 0.001]). For sulphadoxine-pyrimethamine the <it>dhfr </it>single (S108N) (Day 28, OR = 3.5 [95%CI: 1.9–6.3]) and triple mutants (S108N, N51I, C59R) (Day 28, OR = 3.1 [95%CI: 2.0–4.9]) and <it>dhfr</it>-<it>dhps </it>quintuple mutants (Day 28, OR = 5.2 [95%CI: 3.2–8.8]) also increased the risk of treatment failure. Increased <it>pfmdr1 </it>copy number was correlated with treatment failure following mefloquine (OR = 8.6 [95%CI: 3.3–22.9]).</p> <p>Conclusion</p> <p>When applying the selection procedure for comparative analysis, few studies fulfilled all inclusion criteria compared to the large number of papers identified, but heterogeneity was limited. Genetic molecular markers were related to an increased risk of therapeutic failure. Guidelines are discussed and a checklist for further studies is proposed.</p

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability