Patient perspective on remote monitoring of cardiovascular implantable electronic devices: rationale and design of the REMOTE-CIED study

Background

Remote patient monitoring is a safe and effective alternative for the in-clinic follow-up of patients with cardiovascular implantable electronic devices (CIEDs). However, evidence on the patient perspective on remote monitoring is scarce and inconsistent.

Objectives

The primary objective of the REMOTE-CIED study is to evaluate the influence of remote patient monitoring versus in-clinic follow-up on patient-reported outcomes. Secondary objectives are to: 1) identify subgroups of patients who may not be satisfied with remote monitoring; and 2) investigate the cost-effectiveness of remote monitoring.

Methods

The REMOTE-CIED study is an international randomised controlled study that will include 900 consecutive heart failure patients implanted with an implantable cardioverter defibrillator (ICD) compatible with the Boston Scientific LATITUDE® Remote Patient Management system at participating centres in five European countries. Patients will be randomised to remote monitoring or in-clinic follow-up. The In-Clinic group will visit the outpatient clinic every 3–6 months, according to standard practice. The Remote Monitoring group only visits the outpatient clinic at 12 and 24 months post-implantation, other check-ups are performed remotely. Patients are asked to complete questionnaires at five time points during the 2-year follow-up.

Conclusion

The REMOTE-CIED study will provide insight into the patient perspective on remote monitoring in ICD patients, which could help to support patient-centred care in the future.     

Remote sensing of biodiversity: what to measure and monitor from space to species?

Global biodiversity monitoring systems through remote sensing can support consistent assessment, monitoring, modelling and reporting on biodiversity which are key activities intended for sustainable management. This work presents an overview of biodiversity monitoring components, i.e. biodiversity levels, essential biodiversity variables, biodiversity indicators, scale, biodiversity inventory, biodiversity models, habitat, ecosystem services, vegetation health and biogeochemical heterogeneity and discusses what remote sensing through Earth Observations has contributed to the study of biodiversity. The technological advancements in remote sensing have enabled information-rich data on biodiversity. Remote sensing data are making a strong contribution in providing unique information relevant to various biodiversity research and conservation applications. The extensive use of Earth observation data are not yet realized in biodiversity assessment, monitoring and conservation. The development of direct remote sensing approaches and the techniques for quantifying biodiversity at the community to species level is likely to be a great challenge for comprehensive earth observation-based monitoring strategy.

     

Cultivation of Mammalian Cells Using a Single-use Pneumatic Bioreactor System

Recent advances in mammalian, insect, and stem cell cultivation and scale-up have created tremendous opportunities for new therapeutics and personalized medicine innovations. However, translating these advances into therapeutic applications will require in vitro systems that allow for robust, flexible, and cost effective bioreactor systems. There are several bioreactor systems currently utilized in research and commercial settings; however, many of these systems are not optimal for establishing, expanding, and monitoring the growth of different cell types. The culture parameters most challenging to control in these systems include, minimizing hydrodynamic shear, preventing nutrient gradient formation, establishing uniform culture medium aeration, preventing microbial contamination, and monitoring and adjusting culture conditions in real-time. Using a pneumatic single-use bioreactor system, we demonstrate the assembly and operation of this novel bioreactor for mammalian cells grown on micro-carriers. This bioreactor system eliminates many of the challenges associated with currently available systems by minimizing hydrodynamic shear and nutrient gradient formation, and allowing for uniform culture medium aeration. Moreover, the bioreactor’s software allows for remote real-time monitoring and adjusting of the bioreactor run parameters. This bioreactor system also has tremendous potential for scale-up of adherent and suspension mammalian cells for production of a variety therapeutic proteins, monoclonal antibodies, stem cells, biosimilars, and vaccines.     

Indicator of flower status derived from in situ hyperspectral measurement in an alpine meadow on the Tibetan Plateau

Flowering status including flowering date and flower amount could reflect ecological process in assessing plant phenological response to global warming. However, little information is available so far for monitoring flowering status through remote sensing. To provide an ecological indicator for monitoring plant phenology from remotely sensed data, we conducted a field survey in an alpine meadow on the Tibetan Plateau where flower color in July is dominantly yellow due to flowering of Halerpestes tricuspis (Ranunculaceae). We used flower coverage to indicate the flowering status of this species and proposed a flower index derived from in situ hyperspectral data (HFI) to estimate the flower coverage. Results demonstrate that the flower coverage of H. tricuspis can be estimated with high accuracy from the hyperspectral measurements. The indicating ability was further improved when the flower coverage was higher than 0.10 or the fractional coverage of soil was low or known in advance. A simulation also shows that a quadrat or pixel with flower coverage higher than 0.066 can be detected with existence of flower by HFI if soil fraction is less than 50%. These results indicate that HFI is applicable for estimating flower coverage of this species from hyperspectral measurement. The study suggests that the hyperspectral remote sensing technique can be applied for monitoring flowering status, and therefore the technique can provide an important ecological indicator for monitoring plant phenology.     

Mapping Sub-Antarctic Cushion Plants Using Random Forests to Combine Very High Resolution Satellite Imagery and Terrain Modelling

Monitoring changes in the distribution and density of plant species often requires accurate and high-resolution baseline maps of those species. Detecting such change at the landscape scale is often problematic, particularly in remote areas. We examine a new technique to improve accuracy and objectivity in mapping vegetation, combining species distribution modelling and satellite image classification on a remote sub-Antarctic island. In this study, we combine spectral data from very high resolution WorldView-2 satellite imagery and terrain variables from a high resolution digital elevation model to improve mapping accuracy, in both pixel- and object-based classifications. Random forest classification was used to explore the effectiveness of these approaches on mapping the distribution of the critically endangered cushion plant Azorella macquariensis Orchard (Apiaceae) on sub-Antarctic Macquarie Island. Both pixel- and object-based classifications of the distribution of Azorella achieved very high overall validation accuracies (91.6–96.3%, κ = 0.849–0.924). Both two-class and three-class classifications were able to accurately and consistently identify the areas where Azorella was absent, indicating that these maps provide a suitable baseline for monitoring expected change in the distribution of the cushion plants. Detecting such change is critical given the threats this species is currently facing under altering environmental conditions. The method presented here has applications to monitoring a range of species, particularly in remote and isolated environments.     

Ecological Monitoring and Health Research in Luambe National Park,Zambia: Generation of Baseline Data Layers

Classifying, describing and understanding the natural environment is an important element of studies of human, animal and ecosystem health, and baseline ecological data are commonly lacking in remote environments of the world. Human African trypanosomiasis is an important constraint on human well-being in sub-Saharan Africa, and spillover transmission occurs from the reservoir community of wild mammals. Here we use robust and repeatable methodology to generate baseline datasets on vegetation and mammal density to investigate the ecology of warthogs (Phacochoerus africanus) in the remote Luambe National Park in Zambia, in order to further our understanding of their interactions with tsetse (Glossina spp.) vectors of trypanosomiasis. Fuzzy set theory is used to produce an accurate landcover classification, and distance sampling techniques are applied to obtain species and habitat level density estimates for the most abundant wild mammals. The density of warthog burrows is also estimated and their spatial distribution mapped. The datasets generated provide an accurate baseline to further ecological and epidemiological understanding of disease systems such as trypanosomiasis. This study provides a reliable framework for ecological monitoring of wild mammal densities and vegetation composition in remote, relatively inaccessible environments.     

浒苔遥感监测研究进展

浒苔大规模集聚形成的绿潮灾害是海洋生态系统主要生态环境问题之一,基于卫星遥感影像监测浒苔及其扩展动态已成为一种及时有效的手段。对国内外浒苔遥感监测方面文献进行归纳整理,认为光学遥感数据、多波段比值法是最常用的遥感数据和监测方法。对遥感监测浒苔机理进行了阐述,并对分类方法进行评价认为监督分类法解译精度不高。目前单波段阈值法和多波段比值法应用广泛,但在监测漂浮浒苔和混合象元解译存在不足。辐射传输模型法能有效提高信息解译的精度,但还处于起步阶段。遥感监测浒苔灾害的未来发展需要提高影像空间分辨率,深入研究监测方法,进行多种平台和多源遥感数据相结合,并由定性走向定量,从而建立健全遥感监测预警系统。     

Measuring Rao's Q diversity index from remote sensing: An open source solution

Measuring biodiversity is a key issue in ecology to guarantee effective indicators of ecosystem health at different spatial and time scales. However, estimating biodiversity from field observations might present difficulties related to costs and time needed. Moreover, a continuous data update for biodiversity monitoring purposes might be prohibitive. From this point of view, remote sensing represents a powerful tool since it allows to cover wide areas in a relatively low amount of time. One of the most common indicators of biodiversity is Shannon's entropy H′, which is strictly related to environmental heterogeneity, and thus to species diversity. However, Shannon's entropy might show drawbacks once applied to remote sensing data, since it considers relative abundances but it does not explicitly account for distances among pixels’ numerical values. In this paper we propose the use of Rao's Q applied to remotely sensed data, providing a straightforward R-package function to calculate it in 2D systems. We will introduce the theoretical rationale behind Rao's index and then provide applied examples based on the proposed R function.     

A stochastic model of the remote recognition of preferred conformation in a drug-receptor interaction

The energies associated with the interaction and perturbation of model systems simulating drug and receptor have been predicted. The hypothesis of remote recognition of preferred conformation has been tested and found to be valid in these model systems.     

Harmonization of the Land Cover Classification System (LCCS) with the General Habitat Categories (GHC) classification system

Monitoring land cover and habitat change is a key issue for conservation managers because of its potential negative impact on biodiversity. The Land Cover Classification System (LCCS) and the General Habitat Categories (GHC) System have been proposed by the remote sensing and ecological research community, respectively, for the classification of land covers and habitats across various scales. Linking the two systems can be a major step forward towards biodiversity monitoring using remote sensing. The translation between the two systems has proved to be challenging, largely because of differences in definitions and related difficulties in creating one-to-one relationships between the two systems. This paper proposes a system of rules for linking the two systems and additionally identifies requirements for site-specific contextual and environmental information to enable the translation. As an illustration, the LCCS classification of the Le Cesine protected area in Italy is used to show rules for translating the LCCS classes to GHCs. This study demonstrates the benefits of a translation system for biodiversity monitoring using remote sensing data but also shows that a successful translation is often depending on the degree of ecological knowledge of the habitats and its relationship with land cover and contextual information.     

Real-time monitoring of oriental fruit moth,Grapholita molesta,populations using a remote sensing pheromone trap in apple orchards

A fusion of information technology (IT) and sex pheromone monitoring provides a remote sensing IT-pheromone trap to monitor Oriental fruit moth, Grapholita molesta, populations in apple orchards. Once a male of G. molesta is attracted to its sex pheromone lure in the trap, an infrared sensor installed at the funnel-shaped orifice generates an electric signal. The signal is processed in a central processor and then transferred to an internet site via a code division multiple access protocol. The signal also contains information about when each male is caught. Daily trapping information from different localities is archived in a website. The accuracy of IT-pheromone traps in detecting male catches was shown by a high correlation (r = 0.956) between the generated IT signals and actual numbers of males caught in the trap in apple orchards. Using this IT-pheromone trap, G. molesta in apple orchards was monitored for one year. These data were compared with monitoring data obtained from a conventional wing type-based sticky trap containing the identical sex pheromone lure. Both showed four characteristic adult peaks from April to September and were significantly correlated (r = 0.695). IT-pheromone traps also gave real-time signals of male catches in the field. These real-time signals of male catches showed a characteristic diel attraction rhythm from 4 pm to midnight. The diel rhythm of the male response to the sex pheromone started earlier in the evening in the spring season compared to mid and late seasons. This study provides a novel sex pheromone trap for G. molesta to monitor its population in field conditions in real-time without visiting or counting. The field monitoring data can be accessed any time through a designated internet website.     

Prediction and characterisation of a highly conserved, remote and cAMP responsive enhancer that regulates Msx1 gene expression in cardiac neural crest and outflow tract

Double knockouts of the Msx1 and Msx2 genes in the mouse result in severe cardiac outflow tract malformations similar to those frequently found in newborn infants. Despite the known role of the Msx genes in cardiac formation little is known of the regulatory systems (ligand receptor, signal transduction and protein-DNA interactions) that regulate the tissue-specific expression of the Msx genes in mammals during the formation of the outflow tract. In the present study we have used a combination of multi-species comparative genomics, mouse transgenic analysis and in-situ hybridisation to predict and validate the existence of a remote ultra-conserved enhancer that supports the expression of the Msx1 gene in migrating mouse cardiac neural crest and the outflow tract primordia. Furthermore, culturing of embryonic explants derived from transgenic lines with agonists of the PKC and PKA signal transduction systems demonstrates that this remote enhancer is influenced by PKA but not PKC dependent gene regulatory systems. These studies demonstrate the efficacy of combining comparative genomics and transgenic analyses and provide a platform for the study of the possible roles of Msx gene mis-regulation in the aetiology of congenital heart malformation.     

Integration of data from remote monitoring systems and programmers into the hospital electronic health record system based on international standards

Remote follow-up of implanted ICDs may offer a solution to the problem of overcrowded outpatient clinics. All major device companies have developed a remote follow-up solution. Data obtained from the remote follow-up systems are stored in a central database system, operated and owned by the device company and accessible for the physician or technician. However, the problem now arises that part of the patient's clinical information is stored in the local electronic health record (EHR) system in the hospital, while another part is only available in the remote monitoring database. This may potentially result in patient safety issues. Ideally all information should become available in the EHR system. IHE (Integrating the Healthcare Enterprise) is an initiative to improve the way computer systems in healthcare share information. To address the requirement of integrating remote monitoring data in the local EHR, the IHE Implantable Device Cardiac Observation (IDCO) profile has been developed. In our hospital, we have implemented the IHE IDCO profile to import data from the remote databases from two device vendors into the departmental Cardiology Information System. Data are exchanged via an HL7/XML communication protocol, as defined in the IHE IDCO profile.     

Remote monitoring and follow-up of cardiovascular implantable electronic devices in the Netherlands : An expert consensus report of the Netherlands Society of Cardiology

Remote monitoring of cardiac implanted electronic devices (CIED: pacemaker, cardiac resynchronisation therapy device and implantable cardioverter defibrillator) has been developed for technical control and follow-up using transtelephonic data transmission. In addition, automatic or patient-triggered alerts are sent to the cardiologist or allied professional who can respond if necessary with various interventions. The advantage of remote monitoring appears obvious in impending CIED failures and suspected symptoms but is less likely in routine follow-up of CIED. For this follow-up the indications, quality of care, cost-effectiveneness and patient satisfaction have to be determined before remote CIED monitoring can be applied in daily practice. Nevertheless remote CIED monitoring is expanding rapidly in the Netherlands without professional agreements about methodology, responsibilities of all the parties involved and that of the device patient, and reimbursement. The purpose of this consensus document on remote CIED monitoring and follow-up is to lay the base for a nationwide, uniform implementation in the Netherlands. This report describes the technical communication, current indications, benefits and limitations of remote CIED monitoring and follow-up, the role of the patient and device manufacturer, and costs and reimbursement. The view of cardiology experts and of other disciplines in conjunction with literature was incorporated in a preliminary series of recommendations. In addition, an overview of the questions related to remote CIED monitoring that need to be answered is given. This consensus document can be used for future guidelines for the Dutch profession.     

Hyperspectral modeling of ecological indicators – A new approach for monitoring former military training areas

Military areas are valuable habitats and refuges for rare and endangered plants and animals. We developed a new approach applying innovative methods of hyperspectral remote sensing to bridge the existing gap between remote sensing technology and the demands of the nature conservation community. Remote sensing has already proven to be a valuable monitoring instrument. However, the approaches lack the consideration of the demands of applied nature conservation which includes the legal demands of the EU Habitat Directive. Following the idea of the Vital Signs Monitoring in the USA, we identified a subset of the highest priority monitoring indicators for our study area. We analyzed continuous spectral response curves and tested the measurability of N = 19 indicators on the basis of complexity levels aggregated from extensive vegetation assemblages. The spectral differentiability for the floristic as well as faunistic indicators revealed values up to 100% accuracy. We point out difficulties when it comes to distinguishing faunistic habitat requirements of several species adapted to dry open landscapes, which in this case results in Overall accuracy of 67, 87–95, and 35% in the error matrix. In summary, we provide an applicable and feasible method to facilitating monitoring military areas by hyperspectral remote sensing in the following.     

Implementation of an Electronic Dashboard with A Remote Management System to Improve Glycemic Management Among Hospitalized Adults

Objective: Better glycemic control for hospitalized diabetic patients significantly reduces health expenditures and improves disease outcomes. We developed a dynamic dashboard with a remote management system and evaluated its impact on inpatient glycemic control.Methods: This was an observational institution-wide study; study participants were enrolled from a 1,500-bed public medical center from 2016 to 2018. We evaluated the impact of a dynamic dashboard system, which analyzed and monitored all glucose data with virtual glycemic management recommendation by a team of endocrinologists, over 3 × 1-year periods: 2016 (pre-implementation), 2017 (development), and 2018 (implementation).Results: A total of 51,641 discharges with 878,159 blood glucose measurements were obtained during the 3-year period. After implementation of the dashboard system, the proportion of patients with poor glycemic control (hyperglycemia or hypoglycemia) was reduced by 31% (from 10.2 to 7.0 per day per 100 patients with glucose monitoring; P<.001); hyperglycemia decreased by 25% (from 6.1 to 4.6 per day per 100 patients with glucose monitoring; P<.001), and hypoglycemia decreased by 45% (from 4.2 to 2.3 per day per 100 patients with glucose monitoring; P<.001). Furthermore, the trend in the proportion of patients within the treat-to-target range showed significant improvement (P<.001) during the development period, with effectiveness maintained throughout the implementation period.Conclusion: We successfully installed a dynamic, electronic medical records-based dashboard monitoring system to improve inpatient glycemic control. The system, supported by a team of endocrinologists via remote recommendations, could efficiently fill an important need for improved glycemic management among hospitalized adults.Abbreviations: CDE = certified diabetes educator; DM = diabetes mellitus; EMR = electronic medical record; POC = point-of-care; TCVGH = Taichung Veterans General Hospital; UCSF = University of California, San Francisco; U.S. = United States; vGMS = virtual glucose management service     

干旱区土壤盐渍化特征空间建模

当前,土壤盐渍化以及因灌溉引起的土壤次生盐渍化问题是我国干旱、半干旱区所面临的主要生态环境问题。在特征空间理论的支持下,以波谱分解技术为基础,以Landsat-TM、Landsat-ETM+多光谱遥感影像和野外调查数据为基础数据源,通过分析干旱区土壤盐渍化对地表生物物理特征的影响,探讨了表征盐渍化过程与地表生物物理特征之间的规律及定量关系,进而利用土壤盐渍化遥感监测中关键的3个指标——经过波谱分解技术获得的直接表征盐渍化的土壤盐渍化光谱、间接表征盐渍化的植被覆盖度和土壤水分含量协同构建了二维特征空间支持下的土壤盐渍化遥感监测模型VSSI(Vegetation fraction and Soil fraction Soil Index)、SVSI(Soil water contents and Vegetation fraction Soil Index)、SSSI(Soil water contents and Soil salinization fraction Soil Index)和三维特征空间支持下的土壤盐渍化遥感监测模型SVWSI和SDI。研究结果表明:基于三维特征空间建立的SVWSI(Soil salinization fraction-Vegetation fraction-Water contents Soil Index)和SDI(Soil Distance Index)模型对不同盐渍化程度土壤的敏感程度要高于基于传统二维特征空间建立的VSSI、SVSI和SSSI模型。其中,SVWSI和SDI模型与实测0—10 cm土壤盐分含量决定系数分别为R2=0.8325和R2=0.8646,这充分说明基于高维数特征空间所构建的土壤盐渍化遥感监测模型能更准确地反映盐渍化土壤地表盐量组合及其变化信息,且指标简单、易于获取,对于今后干旱区区域大尺度盐渍地信息提取以及动态监测研究具有重要意义。     

Saccharomyces cerevisiae BLYAS, a New Bioluminescent Bioreporter for Detection of Androgenic Compounds

A Saccharomyces cerevisiae strain, capable of autonomous bioluminescence, was engineered to respond to androgenic chemicals. The strain, S. cerevisiae BLYAS, contains the human androgen receptor in the chromosome and was constructed by inserting a series of androgen response elements between divergent yeast promoters GPD and ADH1 on pUTK401 that constitutively expressed luxA and luxB to create pUTK420. Cotransformation of this plasmid with a second plasmid (pUTK404), containing the genes required for aldehyde synthesis (luxCDE) and FMN reduction (frp), yielded a bioluminescent bioreporter responsive to androgenic chemicals. Using dihydrotestosterone (DHT) as a standard, the response time and the 50% effective concentration values were 3 to 4 h and (9.7 ± 4.6) × 10⁻⁹ M, respectively. The lower limit of detection in response to DHT was 2.5 × 10⁻⁹ M, and in response to testosterone it was 2.5 × 10⁻¹⁰ M. This strain is suitable for high-throughput screening of chemicals with potential for remote environmental monitoring systems because of the assay speed, sensitivity, and self-containment.     

The Maintenance of Established Remote Contextual Fear Memory Requires ERK5 MAP Kinase and Ongoing Adult Neurogenesis in the Hippocampus

Adult neurogenesis in the dentate gyrus of the hippocampal formation has been implicated in several forms of hippocampus-dependent memory. However, its role in the persistence of remote memory is unknown. Furthermore, whether the hippocampus plays a role in maintaining remote contextual memories is controversial. Here we used an inducible gene-specific approach for conditional deletion of erk5 in the adult neurogenic regions of the mouse brain to specifically impair adult neurogenesis. The erk5 gene was conditionally deleted under three different experimental conditions: prior to training for contextual fear, 6 days after training, or 5 weeks after training, We present evidence that remote memory was impaired under all three conditions. These data demonstrate that ongoing adult neurogenesis is required both for the initial establishment and the continued maintenance of remote contextual fear memory, even after the remote memory has transferred into extra-hippocampal regions of the brain 5 weeks after training.     

A Taxonomic Review of the Use of IoT and Blockchain in Healthcare Applications

ObjectivesWith the rapid evolution and technology advancement, the healthcare sector is evolving day by day. It is taking advantage of different technologies such as Internet of things and Blockchain. Several applications related to daily healthcare activities are adopting the use of these technologies. In this paper, we present a review in which we group different healthcare applications that integrate the Internet of things and Blockchain in their systems.Material and methodsA review study about the integration of IoT and Blockchain in healthcare systems was conducted. We searched the databases ScienceDirect, IEEE Xplore, Google Scholar and ACM Digital Library.ResultsThis review focuses on categorizing the use cases of IoT and Blockchain in the healthcare sector. The study listed 6 applications in medical services, namely, remote patient monitoring, electronic medical records management, disease prediction, patient tracking, drug traceability and fighting infectious disease especially COVID-19. The paper also investigates the challenges associated with the adoption of the Blockchain technology in healthcare IoT-based systems and some of the existing solutions. It also introduces some future research directions.ConclusionThe survey of the use cases of IoT and Blockchain in the healthcare sector will serve as a state of the art for future researches. In addition, the paper gives some directions to new possible researches that could help to revolutionize the healthcare sector by using other technologies such as artificial intelligence, big data, fog and cloud computing.