Remote Patient Monitoring and Machine Learning in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Dual Systematic Literature Review and Narrative Synthesis.

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with high mortality, morbidity, and poor quality of life and constitute a substantial burden to patients and health care systems. New approaches to prevent or reduce the severity of AECOPD are urgently needed. Internationally, this has prompted increased interest in the potential of remote patient monitoring (RPM) and digital medicine. RPM refers to the direct transmission of patient-reported outcomes, physiological, and functional data, including heart rate, weight, blood pressure, oxygen saturation, physical activity, and lung function (spirometry), directly to health care professionals through automation, web-based data entry, or phone-based data entry. Machine learning has the potential to enhance RPM in chronic obstructive pulmonary disease by increasing the accuracy and precision of AECOPD prediction systems. OBJECTIVE: This study aimed to conduct a dual systematic review. The first review focuses on randomized controlled trials where RPM was used as an intervention to treat or improve AECOPD. The second review examines studies that combined machine learning with RPM to predict AECOPD. We review the evidence and concepts behind RPM and machine learning and discuss the strengths, limitations, and clinical use of available systems. We have generated a list of recommendations needed to deliver patient and health care system benefits. METHODS: A comprehensive search strategy, encompassing the Scopus and Web of Science databases, was used to identify relevant studies. A total of 2 independent reviewers (HMGG and CM) conducted study selection, data extraction, and quality assessment, with discrepancies resolved through consensus. Data synthesis involved evidence assessment using a Critical Appraisal Skills Programme checklist and a narrative synthesis. Reporting followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS: These narrative syntheses suggest that 57% (16/28) of the randomized controlled trials for RPM interventions fail to achieve the required level of evidence for better outcomes in AECOPD. However, the integration of machine learning into RPM demonstrates promise for increasing the predictive accuracy of AECOPD and, therefore, early intervention. CONCLUSIONS: This review suggests a transition toward the integration of machine learning into RPM for predicting AECOPD. We discuss particular RPM indices that have the potential to improve AECOPD prediction and highlight research gaps concerning patient factors and the maintained adoption of RPM. Furthermore, we emphasize the importance of a more comprehensive examination of patient and health care burdens associated with RPM, along with the development of practical solutions.

Empowered to cook: The crucial role of 'food agency' in making meals.

What makes an individual, on any given occasion, able and willing to prepare a meal for themselves: that is, to cook? As home cooking has increasingly become the focus of public-health, nutrition, and policy interventions and campaigns, the need for a better understanding has become apparent. It is clear that cooking is not merely a matter of mechanical skill or rote training; beyond this, it is difficult to explain why similar individuals have such different capacities for setting and achieving food-related goals. This paper proposes a new paradigm for cooking and food provisioning - termed "food agency" - that attempts to describe how an individual's desires form and are enacted in correspondence with social environments: broadly, agency emerges from the complex interplay of individual technical skills and cognitive capacities with social and cultural supports and barriers. Drawing on a close reading of anthropological and sociological research into cooking, the authors propose that an individual's ability to integrate such complexity in regard to provisioning - to possess 'food agency' - is crucial. This argument is supplemented by empirical case studies from a large body of ethnographic observations and interviews with home cooks from the United States, conducted over the last decade. Overall, more food agency means the cook is more empowered to act. Adopting the paradigm of food agency into the consideration of everyday cooking practices has the potential to support transdisciplinary food scholarship integrating individual actions within a food system and thus inform nutrition and public health interventions related to meal preparation.

Transfusion-free treatment strategies for acute anemia in critical care.

Acute anemia is a frequently encountered diagnosis in critically ill patients, and can be a challenge if blood products are not readily available or if patients refuse these products on the basis of their religious beliefs. This article discusses the goals of anemia management and summarizes several alternatives to blood transfusions that can be used to prevent and treat acute anemia.

'Attorneys of the poor': Training physicians to tackle health inequalities.

The stellar gains in life expectancy and health over the past century have been accompanied by an increase in societal and health inequalities. This health gap between the most and least fortunate in our society is widening, driven by complex social determinants of health, as well as healthcare systems themselves. Physicians are not just well-qualified and well-placed to act as advocates for change, but have a moral duty to do so: to stand by silently is to be complicit. Following a workshop on health inequalities and medical training at the Royal College of Physicians Trainees Committee, we sought to examine how health inequalities could be addressed through changes to the medical education system. We discuss the arguments for reform in recruitment to medicine, and changes to undergraduate, postgraduate and continuing medical education in order to equip the profession to deliver meaningful improvements in health inequalities. We propose a population health credential as a mechanism by which specialists can gain additional skills to take on leadership roles addressing health inequalities, allowing them to support colleagues in public health and bring in specialty-specific knowledge and experience.

When to consider tuberculosis: bronchiectasis in the elderly population.

In England patients aged 65 years and over experience a delay of more than 4 months between onset of symptoms and diagnosis of pulmonary TB. This report examines three cases of patients experiencing significant delays in both diagnosis and treatment. Each case had a background of bronchiectasis. Symptoms were initially believed to be secondary to their pre-existing lung disease. Immunosenescence, atypical presentation and pre-existing lung disease mean there is often a significant delay in diagnosis in this population at both a primary care and specialist level.

SARS-CoV-2 Tests: Bridging the Gap between Laboratory Sensors and Clinical Applications.

This review covers emerging biosensors for SARS-CoV-2 detection together with a review of the biochemical and clinical assays that are in use in hospitals and clinical laboratories. We discuss the gap in bridging the current practice of testing laboratories with nucleic acid amplification methods, and the robustness of assays the laboratories seek, and what emerging SARS-CoV-2 sensors have currently addressed in the literature. Together with the established nucleic acid and biochemical tests, we review emerging technology and antibody tests to determine the effectiveness of vaccines on individuals.

Respiratory samples to diagnose tuberculosis in the absence of chest x-ray abnormalities.

BACKGROUND: The World Health Organisation states that the chest x-ray (CXR) has a 'high sensitivity for pulmonary tuberculosis (TB)' [1] and as such, is relied on worldwide as the cornerstone of screening for active pulmonary TB (pTB). METHOD: This is a retrospective analysis of plain chest radiographs and microbiological yield in all patients who were diagnosed with pTB or intra-thoracic nodal tuberculosis (ITLN) in two London NHS Trusts. RESULTS: Between 2011 and 2017 8% of those diagnosed with pTB and 32% with ITLN TB had normal CXR appearances in the 6 weeks preceding diagnosis. DISCUSSION: Pulmomary TB was diagnosed in an additional 51 people based on CT scan and 43 people based on respiratory samples. ITLN TB was also diagnosed in a further 20 people using CT but only an extra 3 people from standard respiratory sampling. Our data suggests that CT imaging and respiratory samples should be sent on all suspected cases of pTB and ITLN TB even if the CXR is normal.

Sampling tomorrow's lunch today: Examining the effect of sampling a vegetable-focused entrée on school lunch participation, a pilot study.

School lunch programs are important pillars in the food system, as they impact children's health, local agriculture, and community food security. When offering a new lunch entrée that contains vegetables, schools must consider whether students will choose the new entrée to avoid low participation rates and decreased revenue. Previous research in marketing suggests that sampling (i.e. taste testing) can positively impact consumer choice. In terms of encouraging students to eat school lunch and particularly items that include vegetables, it is often assumed that sampling will help direct food choice to healthier items, but little research has investigated the impact of sampling on food choice in a school lunch environment. The objective of this research was to investigate in a pilot study whether providing samples of a vegetable-focused lunch entrée the day before it appeared on the school lunch menu increased National School Lunch Program (NSLP) participation. The study took place at a Vermont middle school in 2015. Four new vegetable-focused entrées were supplied over three consecutive months. During month two, the entrées were sampled at a middle school the day before they were offered for sale, and NSLP participation, as well as revenue was tracked over three months. Our results suggest that sampling may have a positive impact on NSLP participation rates and food service revenue, but that more research is needed to better assess how sampling can be utilized in the most efficacious way to promote NSLP participation and healthy eating patterns.

The explanatory structure of unexplainable events: Causal constraints on magical reasoning.

A common intuition, often captured in fiction, is that some impossible events (e.g., levitating a stone) are "more impossible" than others (e.g., levitating a feather). We investigated the source of this intuition, hypothesizing that graded notions of impossibility arise from explanatory considerations logically precluded by the violation at hand but still taken into account. Studies 1-4 involved college undergraduates (n = 357), and Study 5 involved preschool-aged children (n = 32). In Studies 1 and 2, participants saw pairs of magical spells that violated one of 18 causal principles-six physical, six biological, and six psychological-and were asked to indicate which spell would be more difficult to learn. Both spells violated the same causal principle but differed in their relation to a subsidiary principle. Participants' judgments of spell difficulty honored the subsidiary principle, even when participants were given the option of judging the two spells equally difficult. Study 3 replicated those effects with Likert-type ratings; Study 4 replicated them in an open-ended version of the task in which participants generated their own causal violations; and Study 5 replicated them with children. Taken together, these findings suggest that events that defy causal explanation are interpreted in terms of explanatory considerations that hold in the absence of such violations.

Tuning of vertically-aligned carbon nanotube diameter and areal density through catalyst pre-treatment.

By controlling the timing and duration of hydrogen exposure in a fixed thermal process, we tuned the diameters of carbon nanotubes (CNTs) within a vertically aligned film by a factor of 2, and tuned the areal densities by an order of magnitude. The CNT structure is correlated with the catalyst morphology, suggesting that while chemical reduction of the catalyst layer is required for growth, prolonged H2 exposure not only reduces the iron oxide and enables agglomeration of the Fe film, but also leads to catalyst coarsening. Control of this coarsening process allows tuning of CNT characteristics.