Context-Aware Medical Systems within Healthcare Environments: A Systematic Scoping Review to Identify Subdomains and Significant Medical Contexts.

Context awareness is a field in pervasive computing, which has begun to impact medical systems via an increasing number of healthcare applications that are starting to use context awareness. The present work seeks to determine which contexts are important for medical applications and which domains of context-aware applications exist in healthcare. A systematic scoping review of context-aware medical systems currently used by patients or healthcare providers (inclusion criteria) was conducted between April 2021 and June 2023. A search strategy was designed and applied to Pub Med, EBSCO, IEEE Explore, Wiley, Science Direct, Springer Link, and ACM, articles from the databases were then filtered based on their abstract, and relevant articles were screened using a questionnaire applied to their full texts prior to data extraction. Applications were grouped into context-aware healthcare application domains based on past reviews and screening results. A total of 25 articles passed all screening levels and underwent data extraction. The most common contexts used were user location (8 out of 25 studies), demographic information (6 out of 25 studies), movement status/activity level (7 out of 25 studies), time of day (5 out of 25 studies), phone usage patterns (5 out of 25 studies), lab/vitals (7 out of 25 studies), and patient history data (8 out of 23 studies). Through a systematic review process, the current study determined the key contexts within context-aware healthcare applications that have reached healthcare providers and patients. The present work has illuminated many of the early successful context-aware healthcare applications. Additionally, the primary contexts leveraged by these systems have been identified, allowing future systems to focus on prioritizing the integration of these key contexts.

Morbidity and Mortality of Melanoma on the Trunk and Extremities Treated With Mohs Surgery Versus Wide Excision: A Systematic Review.

BACKGROUND: Recommendations for the approved use of Mohs surgery for cutaneous melanoma on the trunk and extremities remain uncertain. OBJECTIVE: To compare survival and recurrence between patients treated with Mohs surgery versus wide excision for melanoma on the trunk and extremities. METHODS: The databases Medline, Embase, Web of Science, CENTRAL, and EMCare were searched from inception on January 11, 2021. Contemporary comparisons were included exclusively. Meta-analysis was conducted using generic inverse variance and a fixed effects model. RESULTS: Four studies were eligible for inclusion. The study population (n = 279,556) was 52.1% men and 97.2% White. There were no observed differences in 5-year overall survival (hazard ratio 0.98, 95% confidence interval 0.90-1.07, I2 = 0%), disease-free survival (HR 0.89, 95% CI 0.12-6.47, I2 = 0), or local recurrence among patients treated with Mohs surgery relative to wide excision. Quality of the evidence was very low. CONCLUSION: This systematic review found survival and local recurrence were comparable among patients treated with Mohs surgery or wide excision for melanoma on the trunk and extremities. Future prospective contemporary studies with more diverse representation that report surgical complications and costs may facilitate more definitive recommendations.

IL6 Induces an IL22+ CD8+ T-cell Subset with Potent Antitumor Function.

CD8+ T cells can be polarized into several different subsets as defined by the cytokines they produce and the transcription factors that govern their differentiation. Here, we identified the polarizing conditions to induce an IL22-producing CD8+ Tc22 subset, which is dependent on IL6 and the aryl hydrocarbon receptor transcription factor. Further characterization showed that this subset was highly cytolytic and expressed a distinct cytokine profile and transcriptome relative to other subsets. In addition, polarized Tc22 were able to control tumor growth as well as, if not better than, the traditional IFNγ-producing Tc1 subset. Tc22s were also found to infiltrate the tumors of human patients with ovarian cancer, comprising up to approximately 30% of expanded CD8+ tumor-infiltrating lymphocytes (TIL). Importantly, IL22 production in these CD8+ TILs correlated with improved recurrence-free survival. Given the antitumor properties of Tc22 cells, it may be prudent to polarize T cells to the Tc22 lineage when using chimeric antigen receptor (CAR)-T or T-cell receptor (TCR) transduction-based immunotherapies.

MetaGxData: Clinically Annotated Breast, Ovarian and Pancreatic Cancer Datasets and their Use in Generating a Multi-Cancer Gene Signature.

A wealth of transcriptomic and clinical data on solid tumours are under-utilized due to unharmonized data storage and format. We have developed the MetaGxData package compendium, which includes manually-curated and standardized clinical, pathological, survival, and treatment metadata across breast, ovarian, and pancreatic cancer data. MetaGxData is the largest compendium of curated transcriptomic data for these cancer types to date, spanning 86 datasets and encompassing 15,249 samples. Open access to standardized metadata across cancer types promotes use of their transcriptomic and clinical data in a variety of cross-tumour analyses, including identification of common biomarkers, and assessing the validity of prognostic signatures. Here, we demonstrate that MetaGxData is a flexible framework that facilitates meta-analyses by using it to identify common prognostic genes in ovarian and breast cancer. Furthermore, we use the data compendium to create the first gene signature that is prognostic in a meta-analysis across 3 cancer types. These findings demonstrate the potential of MetaGxData to serve as an important resource in oncology research, and provide a foundation for future development of cancer-specific compendia.