Medical Engineering Innovations (United States)

IntroductionThe prevalence of asthma and the scale of sub-optimal inhaled corticosteroid (ICS) use therein, demands efficient detection of medicines non-adherence. Several tools estimate adherence to medicines in asthma, each with varying complexity of application and limitations. The Test of Adherence to Inhalers1 (TAI) questionnaire asks patients to rate their agreement with 10-items, and the subsequent score classifies adherence as good, intermediate or poor. A more objective, though currently less accessible tool is the electronic monitor (eMonitor), where a Bluetooth enabled sensor is attached to the inhaler device to record the date/time of each actuation. If actual use is >75% of expected use, adherence is good. The resultant impact of guaranteed ICS use on Fractionate expired Nitric Oxide (FeNO) can then allow a judgement of pre-monitor adherence – this is the FeNO suppression test2 (FST).MethodsPatients attending a hospital asthma clinic completed the TAI, received an eMonitor and were followed up 6 weeks later. The FST was positive if the 6-week FeNO decreased by >42% from baseline.ResultsData for 88 patients were included, of whom 76 (86%) had good ICS adherence according to the eMonitor. 35 people had a positive FST; 12 (34%) had a TAI adherence that was designated good, 19/35 (54%) intermediate and 4 (11%) poor. In the negative FST group, 15/41 (37%) had a TAI adherence classification of good, 21 (51%) intermediate and 5 (12%) poor.ConclusionIn this cohort, a third of patients with eMonitoring/biomarker evidence to suggest suboptimal ICS adherence (that is, a positive FST) completed a TAI that over-estimated ICS use. Conversely, in the FST negative patients (likely to have been adherent prior to eMonitor initiation), almost two thirds of patients identified themselves on TAI as having suboptimal adherence. This suggests that the TAI may not accurately predict adherence or potentially, that using the eMonitor in itself encourages better adherence in the short-term.ReferencesPlaza V et al. Test of Adherence to Inhalers Arch Bronchoneumol 2017;53:360–1.Heaney LG et al. Remotely Monitored Therapy and Nitric Oxide Suppression Identifies Non-Adherence in Severe Asthma. American Journal of Respiratory and Critical Care Medicine 2019;199(4):454–464.

We propose Spherical Hierarchical modeling of 3D point cloud. Inspired by Shape Context, we design a receptive field on each 3D point by placing a spherical coordinate on it. We sample points using the furthest point method and creating overlapping balls of points. We divide the space into radial, polar angular, and azimuthal angular bins on which we form a Spherical Hierarchy for each ball. We apply 1x1 CNN convolution on points to start the initial feature extraction. Repeated 3D CNN and max-pooling over the Spherical bins propagate contextual information until all the information is condensed in the center bin. Extensive experiments on five datasets strongly evidence that our method outperforms current models on various Point Cloud Learning tasks, including 2D/3D shape classification, 3D part segmentation, and 3D semantic segmentation.

Introduction: Nighttime SABA use may be a surrogate for sleep disruption and exacerbation risk in patients with asthma or COPD. Aim: To estimate the prevalence of nighttime symptoms via SABA data with electronic medication monitors (EMMs). Methods: EMM-collected SABA use over 180 nights (10pm-6am) were analyzed in patients with asthma (≥4 years) and COPD (≥40 years) from 2016-18. The study included patients with ≥1 nighttime use. SABA use was quantified hourly, and nighttime events (≥1 use/night) were compared by disease and age using Kruskal-Wallis Rank Sum tests. Age-adjusted generalized linear mixed models estimated associations between EMM-recorded daily controller medication adherence and nighttime events. Results: Analyses included 1,930 asthma and 591 COPD patients with EMM-recorded SABA, of whom 723 and 214 had EMM-recorded adherence. 55% (asthma) and 48% (COPD) of nighttime SABA use occurred from 10pm-1am. The median (25th, 75th percentile) number of nighttime events over 180 days was 5 for asthma (2, 15) and 16 for COPD (5, 45). 8% of asthma and 22% of COPD patients had ≥2 nighttime events/week on average. Asthma patients Conclusion: The prevalence of nighttime symptoms via EMM-recorded SABA was high in COPD and asthma. Higher controller adherence may reflect greater disease severity overnight. These data may be used to target interventions to high risk asthma and COPD patients to reduce sleep disturbance and exacerbation risk.

Aminolevulinate-based photodynamic therapy (ALA-PDT) selectively eliminates diseased tissues primarily through the induction of intrinsic apoptotic pathway. ALA-PDT is a first-line therapy for actinic keratosis, however, it is less effective for cutaneous T-cell lymphoma (CTCL). We have previously demonstrated that the resistance of CTCL to apoptosis correlates with decreased expression of death receptors such as FAS, and that methotrexate functions as an epigenetic regulator that reestablishes the susceptibility of CTCL to extrinsic pathway apoptosis. We showed previously that MTX augments the effectiveness of PDT by sensitizing cells to apoptosis by induction of apoptotic factors, a process we call "epigenetically enhanced" PDT (ePDT). Here, in CTCL cell lines, leukemic CTCL cells, and normal blood T cells, we analyzed multiple components of the FAS, TRAIL, and TNF families using multispectral imaging of immunostained cytopreparations, a quantitative technique with five-fold greater sensitivity than standard immunocytology. ePDT induced significantly greater FAS, FASL, TRAIL-R1 & -R2, and TNFα levels than standard PDT. This correlated with significantly greater induction of extrinsic pathway apoptosis and/or overall apoptosis in all CTCL samples. There was no appreciable effect on normal T cells. These data set the stage for clinical trials of ePDT as a novel localized treatment of CTCL.

The objective of this study was to examine cerebrovascular health in MCI, a stage on the AD continuum with varied outcomes.

The effect of levels (0.1%, 0.2%, 0.3%, 0.4%, 0.5%) of added encapsulated (e) phosphate (sodium tripolyphosphate, STP; sodium hexametaphosphate, HMP; sodium pyrophosphate, SPP) on lipid oxidation inhibition during storage (0, 1, and 7 d) of ground meat (chicken, beef) was evaluated. The use of eSTP and eSPP resulted in lower and higher cooking loss (CL) compared to eHMP, respectively (P < 0.05). Increasing encapsulated phosphate level (PL) enhanced the impact of phosphates on CL in both chicken and beef samples (P < 0.05). Encapsulated STP increased pH, whereas eSPP decreased pH (P < 0.05). pH was not affected by PL. The highest orthophosphate (OP) was obtained with eSTP, followed by eSPP and eHMP (P < 0.05). The level of OP determined in both chicken and beef samples increased (P < 0.05) during storage. Increasing PL caused an increase in OP (P < 0.05). The highest reduction rate in the formation of thiobarbituric acid reactive substances (TBARS) and LPO for both meat species were obtained with eSPP, followed by eSTP and eHMP (P < 0.05). Increasing PL resulted in lower TBARS and LPO (P < 0.05). Findings suggest that encapsulated phosphates can be a strategy to inhibit lipid oxidation for the meat industry and the efficiency of encapsulated phosphates on lipid oxidation inhibition can be enhanced by increasing PL.