Persistent infection with hepatitis B virus (HBV) remains a major global health threat, currently aff ecting over 350 million individuals worldwide and causing more than 1 million deaths annually. Immune clearance is thought to be mediated primarily through a strong virus-specifi c CD8 T cell response ( 1 ); marked quantitative and qualitative defects in this response have been described in patients with chronic HBV infection (CHB) ( 2 -4 ). Patients with uncontrolled infection are distinguished from healthy HBV carriers by the presence of a large lymphocytic infi ltrate in their livers, containing a high proportion of non -antigen-specifi c CD8 T cells ( 3,5 ). Little is known about the characteristics of this generalized CD8 T cell population and its potential contribution to the failure of viral control and liver immunopathogenesis.In this study, we defi ne the functional profi le of non -HBV-specifi c CD8 T cells in patients with CHB, and investigate aberrant expression of the proximal TCR-associated signaling molecules CD3 and CD28 as putative mechanisms contributing to the defects seen.In other diseases of chronic infl ammation and high-load antigenic persistence analogous to the situation in CHB, selective defects in global CD8 function have been associated with downregulation of CD3 ± CD28. These include autoimmune disorders ( 6, 7 ), malignancy ( 8 ), and chronic viral ( 9, 10 ) and bacterial ( 11 ) The infl amed liver in chronic hepatitis B virus (HBV) infection (CHB) is characterized by a large infl ux of non -virus-specifi c CD8 T cells. Little is known about the functional capacity of these lymphocytes, which could provide insights into mechanisms of failure of viral control and liver damage in this setting. We compared the effector function of total circulating and intrahepatic CD8 T cells in CHB patients and healthy donors. We demonstrated that CD8 T cells from CHB patients, regardless of their antigen specifi city, were impaired in their ability to produce interleukin-2 and proliferate upon TCR-dependent stimulation. In contrast, these CD8 T cells had preserved production of the proinfl ammatory cytokines interferon-␥ and tumor necrosis factor-␣ . This aberrant functional profi le was partially attributable to down-regulation of the proximal T cell receptor signaling molecule CD3 , and could be corrected in vitro by transfection of CD3 or replenishment of the amino acid arginine required for its expression. We provide evidence for depletion of arginine in the infl amed hepatic microenvironment as a potential mechanism for these defects in global CD8 T cell signaling and function. These data imply that polarized CD8 T cells within the HBV-infected liver may impede proliferative antiviral effector function, while contributing to the proinfl ammatory cytokine environment.
The use of digital technologies in providing health care services is collectively known as eHealth. Considerable progress has been made in the development of eHealth services, but concerns over service integration, large scale deployment, and security, integrity and confidentiality of sensitive medical data still need to be addressed. This paper presents a solution proposed by the Data Capture and Auto Identification Reference (DACAR) project to overcoming these challenges. The DACAR platform uses a Single Point of Contact, a rule based information sharing policy syntax and data buckets hosted by a scalable and cost-effective Cloud infrastructure, to allow the secure capture, storage and consumption of sensitive health care data. Currently, a prototype of the DACAR platform has been implemented. To assess the viability and performance of the platform, a demonstration application, namely the Early Warning Score, has been developed and deployed within a private Cloud infrastructure at Edinburgh Napier University. Simulated experimental results show that the end-to-end communication latency of 97.8% of application messages were below 100ms. Hence, the DACAR platform is efficient enough to support the development and integration of time critical eHealth services. A more comprehensive evaluation of the DACAR platform in a real life medical environment is under development at Chelsea & Westminster Hospital in London.
Results are reported from a study that investigated patterns of information behaviour and use as related to personal reputation building and management in online environments. An everyday life information seeking (ELIS) perspective was adopted. Data were collected by diary and interview from forty-five social media users who hold professional and managerial work roles, and who are users of Twitter, Facebook, and/or LinkedIn. These data were first transcribed, then coded with NVivo10 according to themes identified from a preliminary literature review, with further codes added as they emerged from the content of the participant diaries and interviews. The main findings reveal that the portrayal of different personas online contribute to the presentation (but not the creation) of identity, that information sharing practices for reputation building and management vary according to social media platform, and that the management of online connections and censorship are important to the protection of reputation. The maintenance of professional reputation is more important than private reputation to these users. They are aware of the 'blur' between professional and private lives in online contexts, and the influence that it bears on efforts to manage an environment where LinkedIn is most the useful of the three sites considered, and Facebook the most risky. With its novel focus on the 'whole self', this work extends understandings of the impact of information on the building and management of reputation from an Information Science perspective. Keywords everyday life information seeking, information behaviour and use, identity, information sharing, personas, reputation building, reputation management, social media
The care home sector has great potential to benefit from technological innovations and to be at the forefront of developing novel digital solutions to improve the experiences of care home residents, their families, and the staff caring for them. The COVID-19 pandemic exposed variability in digital capabilities and longstanding data challenges within the care home sector. Paradoxically, however, it also increased the use of digital tools and services to support residents and staff. There are, however, a number of barriers to sustained and widespread adoption of digital solutions by care homes. Here, the focus is on foundation-level barriers and the groundwork required to overcome them. Using data from three Scottish-based studies, foundation-level barriers to the adoption of digital tools and services faced by care homes are discussed. These main barriers are the need for robust basic internet connectivity; capabilities for digital data collection; access to data to inform and drive digital solutions; the need for trust in the use of resident data by commercial companies; and the danger that poorly coordinated strategies undermine efforts to build a care home data platform and the digital solutions it can support. Sustained and widespread adoption of digital solutions by care homes will require these foundation-level barriers to be addressed. Strong and stable data and digital foundations supported by sector-specific scaffolding are major prerequisites to the widespread adoption of digital solutions by care homes.
Active and passive RFID (Radio Frequency Identification) technology are available and licensed for the use in hospitals, and can be used to establish highly reliable pervasive environments within healthcare facilities. They should not be understood as competing technologies and complement each other when intelligently integrated in compact frameworks. This paper describes the state-of-the-art of RFID technology and the current use in the healthcare industry, and points out recent developments and future options.Biographical notes: Christoph Thuemmler is a Consultant Physician with the Scottish NHS who has worked in healthcare systems in Germany, the USA and the UK. He is also a Visiting Reader at the Centre for Distributed Computing within Edinburgh Napier University. Apart from clinical work in general internal medicine, acute and geriatric medicine he has a research interest in patient flow dynamics, real time computing, radio frequency identification and smart system integration.William J Buchanan leads the Centre for Distributed Computing within Edinburgh Napier University. He has extensive research experience in distributed systems, mobile networks, pervasive healthcare, simulation tools, digital forensics and security, and has published over 25 academic books. He has also won several awards for his work with knowledge transfer, and works within several application domains, including healthcare and policing.Amir Hesam Fekri is a research associate with the Centre for Distributed Computing and Security, Napier University. He is currently undertaking an MSc in Advanced Networking. His research interests include RFID systems, wireless networks, security and forensic computing.Alistair Lawson is a Lecturer at Edinburgh Napier University's School of Computing, and a Member of the Centre for Distributed Computing and Security. His research and knowledge transfer interests revolve around applying software engineering, computer intelligence, and distributed computing and security methodologies and technologies to the fields of healthcare, applied data analysis and visualisation, spoken language systems, and e-learning and e-publishing systems.
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