Are cuffless devices challenged enough? Design of a validation protocol for ambulatory blood pressure monitors at the wrist: the case of the Aktiia Bracelet.

The US and European guidelines for the diagnosis and management of hypertension recommend the introduction of systematic home and night Blood Pressure (BP) monitoring. Fully-automated wearable devices can address the needs of patients and clinicians by improving comfort while achieving measurement accuracy. Often located at the wrist and based on indirect BP measurements, these devices must address the challenges of ambulatory scenarios. New validation strategies are needed, but little guidance has been published so far.In this work, we propose an experimental protocol for the validation of cuffless wrist BP monitors that addresses ambulatory environment challenges in a controlled experimental setting. The protocol assesses the robustness of the measurement for different body postures, the ability of the device to track BP changes, and its ability to deal with hydrostatic pressure changes induced by different arm heights.Performance testing using Aktiia Bracelet is provided as an illustration. The results of this pilot study indicate that the Aktiia Bracelet can generate accurate BP estimates for sitting and lying positions and is not affected by hydrostatic pressure perturbations.Clinical Relevance- Automated cuffless BP monitoring is opening a new chapter in the way patients are being diagnosed and managed. This paper provides a guidance on how to assess the clinical utility of such devices when used in different body positions.

Healthcare-associated infections and antimicrobial use in long-term care facilities (HALT3): an overview of the Italian situation.

BACKGROUND: Awareness of healthcare-associated infections (HAIs) and antimicrobial use in long-term care facilities (LTCFs) is increasing. In 2017, the third national point prevalence survey (PPS) was conducted in Italy as part of the third 'Healthcare-Associated Infections in European Long-Term Care Facilities' (HALT3) study. AIM: To report the results of HALT3 and analyse the resident population of LTCFs, implementation of good practices, prevalence of infections and antimicrobial use. METHODS: The survey was designed as a PPS, carried out from April to June 2017. All residents who lived full-time in the institution were included. All facilities were asked to complete an institutional questionnaire, a ward list for all residents, and a resident questionnaire for those residents presenting with signs/symptoms of active infection and/or receiving an antimicrobial agent. FINDINGS: In total, 418 facilities took part in the study; 24,132 residents were eligible, and most were aged >85 years, disoriented and incontinent. The prevalence of HAIs was 3.9%, and 50% of the institutions reported that they had a professional trained in infection control on their staff. Only 26.4% of infections were confirmed by a microbiological sample, and 26.9% of the isolated micro-organisms were resistant to at least one antimicrobial class. In total, 1022 residents received at least one antimicrobial agent, and cephalosporins were prescribed most commonly. CONCLUSION: The number of infection control and antimicrobial stewardship measures implemented was found to be considerably higher in this study compared with previous studies. This could lead to a reduction in the prevalence of HAIs, antimicrobial use and antimicrobial resistance. Further studies are needed to monitor these aspects.

E-tools for hospital management: An overview of smartphone applications for health professionals.

BACKGROUND: Commonly, management of the main hospital activities is organized by different software packages that run on desktop computers, which may not always allow fast and practical use by health operators. This problem could be alleviated by combining these software packages with mobile health. The aim of this study is to provide an overview of smartphone and tablet applications used for hospital management and administration in order to evaluate their features and analyze them according to their content, number of downloads and field of application. METHODS: Researchers performed the survey on the two main application stores available on the Internet: iTunes for Apple devices and Google Play for Android devices. Using specific keywords, 47 apps that met the inclusion criteria were identified. RESULTS: Most of the applications were designed for health operators and patient management (76.6%); 12.8% of the apps were focused on the organization and setting of hospital resources, and 10.6% of the apps could help hospital administrators perform self-evaluations of their structures, processes and outcomes. The large majority of apps (80.7%) counted less than 1000 downloads. Most of them (87.5%) were in English and free to download (93.6%). DISCUSSION: The results of the first attempt to provide an overview of this emerging topic showed that, despite the existence of several applications for hospital management purposes, these tools appear to be not very widespread. In our opinion, there is a strong need to further assess the quality of these applications; thus, it may be worth continuing to monitor this field in order to analyze eventual improvements in the design and distribution of these apps.

Knowledge, attitudes and beliefs towards compulsory vaccination: a systematic review.

Currently, many countries are dealing with groups refusing available recommended vaccinations. Despite several studies having demonstrated the efficacy of mandatory vaccinations in ensuring herd immunity, opposition is widespread. The aim of our study was to systematically review published studies evaluating attitudes towards mandatory vaccination programs. PubMed and Scopus scientific databases were searched and 4,198 results were returned, of these 29 met the inclusion criteria. Twenty-two studies assessed attitudes towards mandatory vaccination programs in general, while 9 papers focused specifically on the Human Papilloma Virus (HPV) vaccine. Most of the studies were performed in Europe and North America. According to the assessed studies, the majority of the population seems to be in favour of compulsory vaccinations, although attitudes differed among studies. The results presented in this review could be an important starting point to further understand the issue of vaccine hesitancy and support the implementation of effective vaccination strategies.

Strategies for optical control and simultaneous electrical readout of extended cortical circuits.

BACKGROUND: To dissect the intricate workings of neural circuits, it is essential to gain precise control over subsets of neurons while retaining the ability to monitor larger-scale circuit dynamics. This requires the ability to both evoke and record neural activity simultaneously with high spatial and temporal resolution. NEW METHOD: In this paper we present approaches that address this need by combining micro-electrocorticography (µECoG) with optogenetics in ways that avoid photovoltaic artifacts. RESULTS: We demonstrate that variations of this approach are broadly applicable across three commonly studied mammalian species - mouse, rat, and macaque monkey - and that the recorded µECoG signal shows complex spectral and spatio-temporal patterns in response to optical stimulation. COMPARISON WITH EXISTING METHODS: While optogenetics provides the ability to excite or inhibit neural subpopulations in a targeted fashion, large-scale recording of resulting neural activity remains challenging. Recent advances in optical physiology, such as genetically encoded Ca(2+) indicators, are promising but currently do not allow simultaneous recordings from extended cortical areas due to limitations in optical imaging hardware. CONCLUSIONS: We demonstrate techniques for the large-scale simultaneous interrogation of cortical circuits in three commonly used mammalian species.

Review article: bismuth-based therapy for Helicobacter pylori eradication in children.

BACKGROUND: Because of the decrease in the Helicobacter pylori eradication rate after standard triple therapy with a proton pump inhibitor and two antibiotics, bismuth-based therapy has recently been recommended as alternate first-line regimen in children. AIM: To comprehensively review the clinical, pharmacologic and microbiologic properties of bismuth salts, and to summarise the evidence for the therapeutic efficacy of bismuth-based therapy for H. pylori eradication in children. METHODS: Bibliographical searches were performed in MEDLINE. Results on the efficacy of bismuth-containing regimens on H. pylori eradication were combined using the inverse variance method. RESULTS: Bismuth monotherapy showed a very low efficacy. Overall, the mean eradication rate with bismuth-based dual therapy was 68% (95% CI, 60-76%) (intention-to-treat analysis-ITT) and 73% (95% CI, 64-81%) (per protocol-PP). In case series, the overall percentages of children with successful eradication for triple therapy containing bismuth were 82% (95% CI, 76-88%) and 86% (95% CI, 80-92%) according to ITT and PP respectively. In comparative studies, H. pylori eradication rates ranged between 69% and 85% according to ITT and between 74% and 96% PP. Side effects included dark stools, urine discoloration, black tongue, burning tongue, and marked darkness of the gums. CONCLUSIONS: The evidence in favour of bismuth compounds for treating infected children is still not clear. Well-designed, randomised, multi-centre studies of H. pylori eradication trials in children comparing bismuth-based triple therapy with the best available recommended first-line therapies are needed. The evidence obtained from audited case series that produce an eradication rate of >95% on PP analysis should also be considered.

Low 25(OH)D3 levels are associated with total adiposity, metabolic syndrome, and hypertension in Caucasian children and adolescents.

OBJECTIVES: Evidence of the association between vitamin D and cardiovascular risk factors in the young is limited. We therefore assessed the relationships between circulating 25-hydroxyvitamin D(3) (25(OH)D(3)) and metabolic syndrome (MetS), its components, and early atherosclerotic changes in 452 (304 overweight/obese and 148 healthy, normal weight) Caucasian children. METHODS: We determined serum 25(OH)D(3) concentrations in relation to MetS, its components (central obesity, hypertension, low high-density lipoprotein (HDL)-cholesterol, hypertriglyceridemia, glucose impairment, and/or insulin resistance (IR)), and impairment of flow-mediated vasodilatation (FMD) and increased carotid intima-media thickness (cIMT) - two markers of subclinical atherosclerosis. RESULTS: Higher 25(OH)D(3) was significantly associated with a reduced presence of MetS. Obesity, central obesity, hypertension, hypertriglyceridemia, low HDL-cholesterol, IR, and MetS were all associated with increased odds of having low 25(OH)D(3) levels, after adjustment for age, sex, and Tanner stage. After additional adjustment for SDS-body mass index, elevated blood pressure (BP) and MetS remained significantly associated with low vitamin D status. The adjusted odds ratio (95% confidence interval) for those in the lowest (<17 ng/ml) compared with the highest tertile (>27 ng/ml) of 25(OH)D(3) for hypertension was 1.72 (1.02-2.92), and for MetS, it was 2.30 (1.20-4.40). A similar pattern of association between 25(OH)D(3), high BP, and MetS was observed when models were adjusted for waist circumference. No correlation was found between 25(OH)D(3) concentrations and either FMD or cIMT. CONCLUSIONS: Low 25(OH)D(3) levels in Caucasian children are inversely related to total adiposity, MetS, and hypertension.

Effect of carbohydrate composition of semi-elemental diets on the nutritional recovery of children with chronic diarrhea.

46 of 74 children with chronic diarrhea of unknown etiology between the ages of 44-627 days were studies. They were assigned, by single randomization, to 3 dietary treatments: a) cow's milk, b) a sucrose- free (SED-S), and c) a sucrose containiNG semi-element diet (SED+S), for 15 days. The authors registered the daily increase of body weight, daily amount of ingested kcal, and the increase of body weight/1000 kcal. The number of days with diarrhea before hospitalization, the age and weight of each child before treatment were recorded and analyzed as covariates. Maltase, sucrase, and lactase activity values were compared before treatment, but were not different among the 3 groups. A significant increase of body weight/1000 kcal ingested was observed in children fed the SED-S diet compared to that observed in children on cow's milk (P=.013 in ANCOVA; P+.053 in RANCOVA), and those fed SED+S (P=.009 in Ancova; p.001 in RANCOVA). The covariates did not have any apparent effect on these results. Only 7 of 24 children receiving cow's milk completed the assigned diet. The carbohydrate composition of the semi-elemental diets proved to be fundamental in the nutritional recovery of these patients.

Effect of three dietary treatments upon the histopathology of jejunal biopsies of children with chronic diarrhea.

Thirty two children with chronic diarrhea of unknown etiology were prospectively investigated in a special hospitalization unit. They were all under 5 percentile for weight/height (NCHS). They had no edema and their age range was between three and eighteen months. The patients were given cow's milk and following the first jejunal biopsy they were fed one of three different diets as their only intake for a period of 15 days. The diets consisted of cow's milk and of two semi-elemental diets with different carbohydrate compositions. A second biopsy was taken at the conclusion of the specific diet. The jejunal biopsies were taken with a Crosby capsule just after the duodenal-jejunal junction and were analyzed by light microscopy. The morphological changes before and after 15 days of dietary treatment were evaluated. The children on semi-elemental diets showed a marked reduction of the number of interepithelial lymphocytes, and of lymphocytes in lamina propria. The infants on cow's milk showed no improvement. Our results suggest that cow's milk could be the cause of the persistent mucosal alterations observed in these infants.

Simultaneous determination of serum cholesterol and triglycerides after preliminary column chromatography.

An isopropanolic extract of serum can be made suitable for the simultaneous estimation of cholesterol and triglycerides by passing it through a commercially-available chromatographic column containing activated metallic oxides in which alumina predominates. No centrifugation step nor phase separation is required. Use of the purified extract allows existing methods to be simplified and shortened without loss of reproducibility or stability. Results compare well with those obtained by traditional methods.