RATIONALE: Remote monitoring of COPD patients has the potential to improve clinical outcomes. The ability to successfully deploy home monitoring technologies to COPD patients remotely without in-person encounters is of particular interest during the SARS-CoV-2 pandemic. We present interim results from a prospective implementation study of a home monitoring system in COPD patients at-risk for frequent acute exacerbations of COPD (AECOPD). METHODS: We recruited non-hospitalized individuals aged 40-80 years with spirometryconfirmed COPD and increased AECOPD risk (one hospitalization or two outpatient AECOPD in the prior year). The home system includes: a GoHome™ Data Collection Platform and GoSpiro® spirometer (Monitored Therapeutics, Dublin, OH), and a 3230 pulse oximeter (Nonin Medical, Plymouth, MN). The tablet-based GoHome™ has an auto-start system requiring no computer skills for operation. Eligible participants were contacted via phone, and if interested, were sent a participation kit containing informed consent and the home system. After remotely collecting ICF, participants completed device setup and baseline spirometry using Avatar coaching. At set times, the device collects responses for an automated COPD Action Plan and displays reminders for the patient to use the integrated Bluetooth® spirometer and pulse oximeter. The GoSpiro® measures slow vital capacity (SVC) and forced vital capacity (FVC) using an Avatar-assisted technology coach on the GoHome™ (Figure). The Avatar coaches the patient through each measurement following ATS recommendations for instructions and coaching, followed by error identification and maneuver error correction without human intervention. Patients are engaged daily with the COPD Action Plan. Automated scores return immediate patient guidance along with appropriate clinician alerts. Results are cellular or Wi-Fi uploaded to a cloud server for realtime investigator review. Following demonstrated proficiency, daily measurements of spirometry (FVC Tuesday/Thursday, SVC all other days), daily pulse oximetry and COPD Action Plan were performed. Participant study duration was three months. RESULTS: To date, seven of 12 planned participants have been enrolled. All enrolled participants have successfully activated all device components and performed FVC maneuvers meeting ATS acceptability standards. All participants were able to complete collection and transmission of daily pulse oximetry and COPD Action Plan data. One participant requested study withdrawal after three weeks and six participants remain on study. CONCLUSIONS: Deployment of a COPD home telemonitoring system platform including daily spirometry, pulse oximetry and electronic questionnaire without in-person contact is feasible. This technology may be useful in settings where in-person visits are not feasible due to patient safety, remote location or access-related issues. .

The adoption of blockchain shows a variety of benefits owing to an incorruptible digital ledger and a decentralized database. This has eliminated the need for a gatekeeper to oversee all associated transactions. Blockchain, the underlying technology behind Bitcoin and other crypto-currencies, has found use in many industries besides finance, such as healthcare, where it is used for verifying medical licensing and credentialing, for tracking medical equipment (or consumables) from production to usage, and in cases associated with high levels of privacy and security. Patient data is collected using a plethora of patient-generated data devices, such as Internet of Things (IoT)-enabled wearables, health trackers, and home use medical devices. As a result, the data is siloed amongst several applications and/or vendors’ proprietary solutions. Of all this data, only some of it is transmitted to Electronic Medical Records. This produces the risk that not all data collected will be reviewed at the point of care due to the abundance of data collected. This article explains the areas within healthcare where blockchain could address data usability challenges and analyzes new ways in which patient health data can be collected to address the increasing number of challenges associated with the amount of data being generated over time. It also describes the drivers behind this data collection trend, the associated challenges and the subsequent ramifications. It concludes with a review of previous studies on data usability challenges and the means by which blockchain can be used to overcome these challenges.

This article offers a systematic and practical framework for identifying sustainable manufacturing practices from a resource efficiency perspective to assist small and medium-sized enterprises (SMEs) achieve industry-specific resource efficiency goals. It describes a tool called the Resource Efficiency Guidebook (REG) that combines a resource efficiency principle matrix and spreadsheet calculators to offer SMEs a systematic model for identifying and selecting industrial resource efficiency projects. REG contains assessment recommendations selected from industrial resource assessments performed in real manufacturing facilities. REG consists with six distinct resource categories where each category is accompanied by a list of common assessment recommendations (ARs). These ARs address specific improvements in resource efficiency and cost savings opportunities from across all genres of manufacturing industry. Each AR is accompanied by information containing all of the necessary calculations to re-produce the AR in another plant. Additionally, each resource category is accompanied by a set of best practices that explains the fundamentals of resource efficiency principles. This paper presents brief case studies to demonstrate the effectiveness of the REG for improving resource efficiency both economically and environmentally and discusses for the continued development of holistic and practical methods for assessing, developing and implementing resource efficiencies.

Rebecca Watson, MSc RVN, clinical specialist EMEA for Midmark Animal Health continues her overview of disorders of the equine respiratory tract

Rebecca Watson, MSc RVN, Clinical specialist EMEA for Midmark Animal Health, outlines the use of boots as an alternative to bandages during exercise

Rebecca Watson, MSc RVN, clinical specialist EMEA for Midmark Animal Health, examines how, when and why we bandage our horses' legs

Rebecca Watson, MSc RVN, Clinical specialist EMEA for Midmark Animal Health, discusses the prevention and treatment of some of the more common respiratory diseases