Noncontact detection characteristic of Doppler radar provides an unobtrusive means of respiration detection and monitoring. This avoids additional preparations, such as physical sensor attachment or special clothing, which can be useful for certain healthcare applications. Furthermore, robustness of Doppler radar against environmental factors, such as light, ambient temperature, interference from other signals occupying the same bandwidth, fading effects, reduce environmental constraints and strengthens the possibility of employing Doppler radar in long-term respiration detection, and monitoring applications such as sleep studies. This paper presents an evaluation in the of use of microwave Doppler radar for capturing different dynamics of breathing patterns in addition to the respiration rate. Although finding the respiration rate is essential, identifying abnormal breathing patterns in real-time could be used to gain further insights into respiratory disorders and refine diagnostic procedures. Several known breathing disorders were professionally role played and captured in a real-time laboratory environment using a noncontact Doppler radar to evaluate the feasibility of this noncontact form of measurement in capturing breathing patterns under different conditions associated with certain breathing disorders. In addition to that, inhalation and exhalation flow patterns under different breathing scenarios were investigated to further support the feasibility of Doppler radar to accurately estimate the tidal volume. The results obtained for both experiments were compared with the gold standard measurement schemes, such as respiration belt and spirometry readings, yielding significant correlations with the Doppler radar-based information. In summary, Doppler radar is highlighted as an alternative approach not only for determining respiration rates, but also for identifying breathing patterns and tidal volumes as a preferred nonwearable alternative to the conventional contact sensing methods.
Introduction The aim of this study was to assess the impact of home-based telehealth monitoring on health outcomes, quality of life and costs over 12 months for patients with diabetes and/or chronic obstructive pulmonary disease (COPD) who were identified as being at high risk of readmission to hospital. Methods This pilot study was a randomised controlled trial combined with an economic analysis to examine the outcomes of standard care versus home-based telehealth for people with diabetes and/or COPD who were at risk of hospital readmission within one year. The primary outcomes were (i) hospital admission and length of stay (LOS); and (ii) health-related quality of life (HRQOL); and the secondary outcomes were (i) health-related clinical outcomes; (ii) anxiety and depression scores; and (iii) health literacy. The costs of the intervention and hospitalisations were included. Results A total of 86 and 85 participants were randomised to the intervention and control groups respectively. The difference between groups in hospital LOS was -3.89 (95% confidence interval (CI): -9.40, 1.62) days, and for HRQOL, 0.09 (95% CI: 0.05, 0.14) in favour of the telehealth monitoring group. There was a saving of AUD$6553 (95% CI: -12145, -961) in the cost of hospitalisation over 12 months, which offset the increased cost of tele-monitoring. The intervention group showed an improvement in anxiety, depression and health literacy at 12 months, and in the diabetes group, a reduction in microalbuminuria. Discussion The telehealth monitoring intervention improved patient's health outcomes and quality of life at no additional cost.
A total of 11 of 15 Streptococcus pneumoniae culture filtrates and all five bacterial autolysates produced by cell death in the stationary phase caused slowed ciliary beating and disruption of the surface integrity of human respiratory epithelium in organ culture. This effect was inhibited by cholesterol and was heat labile and reduced by standing at room temperature but was stable at -40°C. The activity was detected at the late stationary phase of culture and was associated with the presence of hemolytic activity. Gel filtration of a concentrated culture filtrate and autolysate both yielded a single fraction of approximately 50 kilodaltons which slowed ciliary beating and were the only fractions with hemolytic activity. Rabbit antiserum to pneumolysin, a sulfhydryl-activated hemolytic cytotoxin released by S. pneumoniae during autolysis, neutralized the effect of the culture filtrate on respiratory epithelium. Both native and recombinant pneumolysin caused ciliary slowing and epithelial disruption. Electron microscopy showed a toxic effect of pneumolysin on epithelial cells: cytoplasmic blebs, mitochondrial swelling, cellular extrusion, and cell death, but no change in ciliary ultrastructure. Recombinant pneumolysin (10 ,ug/ml) caused ciliary slowing in the absence of changes in cell ultrastructure. Release of pneumolysin in the respiratory tract during infection may perturb host defenses, allowing bacterial proliferation and spread.Streptococcus pneirnoniae is an important human pathogen. It is a constituent of the normal nasopharyngeal flora but under permissive conditions is responsible for lower respiratory tract infections, septicemia, and meningitis. The conditions required for its proliferation in and spread from the nasopharynx are unclear, but the determinant, are probably several, including both host and bacterial factors. Changes in status of the specific and nonspecific defenses of the host may be important (3,4). For example, on the one hand, pneumococcal infections are often preceded by damage to host respiratory tract epithelium by either viral infection (4, 25) or other agents, and acquisition of a pneumococcal serotype not previously encountered may permit infection owing to absence of specific antibody (4). On the other hand, the bacterium itself elaborates a number of proteins which have been implicated in its virulence (22). Meningitis and otitis media usually occur as sequelae to respiratory tract infections which are presumably accompanied by a transient bacteremia. Bacterial factors which permit invasion of the epithelium and thus entry into the bloodstream are poorly understood.In this study, we examined the effect of bacterial culture filtrates on human respiratory epithelium in vitro and characterized one moiety responsible for the changes observed. Pneumolysin, a thiol-activated membrane-damaging toxin. caused ciliary slowing, changes in epithelial cell ultrastructure, and disruption of epithelial integrity in a dose-dependent manner. MATERIALS AND METHODSPreparation of bacterial cultu...
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