Continuous Monitoring Research Articles

Ethical dimensions of generative AI: a cross-domain analysis using machine learning structural topic modeling

Purpose The purpose of this study is to comprehensively examine the ethical implications surrounding generative artificial intelligence (AI). Design/methodology/approach Leveraging a novel methodological approach, the study curates a corpus of 364 documents from Scopus spanning 2022 to 2024. Using the term frequency-inverse document frequency (TF-IDF) and structural topic modeling (STM), it quantitatively dissects the thematic essence of the ethical discourse in generative AI across diverse domains, including education, healthcare, businesses and scientific research. Findings The results reveal a diverse range of ethical concerns across various sectors impacted by generative AI. In academia, the primary focus is on issues of authenticity and intellectual property, highlighting the challenges of AI-generated content in maintaining academic integrity. In the healthcare sector, the emphasis shifts to the ethical implications of AI in medical decision-making and patient privacy, reflecting concerns about the reliability and security of AI-generated medical advice. The study also uncovers significant ethical discussions in educational and financial settings, demonstrating the broad impact of generative AI on societal and professional practices. Research limitations/implications This study provides a foundation for crafting targeted ethical guidelines and regulations for generative AI, informed by a systematic analysis using STM. It highlights the need for dynamic governance and continual monitoring of AI’s evolving ethical landscape, offering a model for future research and policymaking in diverse fields. Originality/value The study introduces a unique methodological combination of TF-IDF and STM to analyze a large academic corpus, offering new insights into the ethical implications of generative AI across multiple domains.

Clinical significance of coefficient of variation in continuous glucose monitoring for glycemic management in children and adolescents with type 1 diabetes.

Coefficient of variation (CV) is an indicator for glucose variability in continuous glucose monitoring (CGM), and the target threshold of %CV in type 1 diabetes is proposed to be ≤36%. This study aimed to evaluate the clinical significance of CV in children and adolescents with type 1 diabetes. Participants included 66 children with type 1 diabetes. A total of 48 participants were treated with multiple daily injections of insulin, and 18 with continues subcutaneous insulin infusion, using intermittently scanned CGM. The frequencies of the CGM metrics and glycosylated hemoglobin values were examined, and the significance of a threshold %CV of 36% was evaluated. The mean frequencies in time in range (TIR), time below range, %CV and the mean glycosylated hemoglobin value were 59.3 ± 16.1, 4.0 ± 3.5, 39.3 ± 6.2 and 7.3 ± 0.8%, respectively. The frequencies of participants who achieved a TIR >70% and a %CV of ≤36% were 24.1 and 27.3%, respectively. A total of 18 participants with a %CV of ≤36% had significantly higher TIR, lower time below range and lower glycosylated hemoglobin than the 48 with a %CV of >36% (72.6 ± 12.6 vs 52.4 ± 13.6, 2.4 ± 1.9 vs 4.6 ± 3.6, 6.9 ± 0.8 vs 7.4 ± 0.7%, respectively). Children and adolescents with type 1 diabetes using intermittently scanned CGM had difficulties in achieving the recommended targets of TIR and CV. However, the target %CV of ≤36% seems to be an appropriate indicator for assessing glycemic control and risk of hypoglycemia in pediatric patients with type 1 diabetes with any treatment.

Management of Chronic Kidney Disease: Importance of early diagnosis and continuous monitoring

Introduction: Chronic Kidney Disease (CKD) is a serious public health problem, affecting approximately 10% of the world population. It is characterized by the progressive and irreversible loss of kidney function, often caused by diabetes mellitus and arterial hypertension. Early diagnosis of CKD is essential to slow its progression, improve patients' quality of life, and reduce treatment costs. Markers such as glomerular filtration rate (GFR) and albuminuria are essential for early detection. Methods: A comprehensive literature review was conducted on advances in early diagnosis and continuous monitoring of CKD. The search included studies published between 2013 and 2023, indexed in the PubMed, Lilacs, and SciELO databases, using terms such as "Chronic Kidney Disease management", "early diagnosis", and "continuous monitoring". Twenty articles were selected after applying strict inclusion and exclusion criteria, with the final analysis of the full texts. Results: The analysis of the selected studies highlighted the importance of robust protocols for early diagnosis and continuous monitoring in the management of CKD. The introduction of new biomarkers, such as Leucine-Rich α-2-Glycoprotein 1 (LRG1), complements traditional methods by offering more accurate detection of CKD. Furthermore, remote monitoring via telemedicine has been shown to be effective in reducing hospitalizations and improving treatment adherence, particularly in patients on home dialysis. The combination of these strategies not only improves clinical outcomes for patients but also reduces the financial burden on health systems. Conclusion: The review highlighted the need for robust protocols for early diagnosis and continuous monitoring in the management of CKD. The integration of new biomarkers and telemedicine technologies represents a significant advance, enabling more effective and cost-effective interventions. Such practices can improve patients’ quality of life and provide a more sustainable approach for health systems, aligning with public health objectives.

The Seasonal Characterization and Temporal Evolution of Nitrogen, Phosphorus and Potassium in the Surface and Groundwater of an Agricultural Hydrographic Basin in the Midwestern Brazilian Savanna

The Brazilian savanna (Cerrado Biome) is one of the most important regions in the world in terms of food production, with the use of fertilizers based on nitrogen, phosphorus and potassium (NPK). When not applied properly, fertilizers can alter and affect water quality. The objective of this study was to evaluate the presence of these compounds in surface and groundwater in the Upper Jardim River Hydrographic Unit, Federal District, thus characterizing seasonal variations during the dry and rainy seasons in two periods. A total of 207 groundwater samples and 23 surface water samples were collected in the years 2014, 2015, 2019 and 2020. The parameters analyzed were pH and nitrate, nitrite, ammonium, phosphate and potassium ions. In groundwater samples, pH values were significantly higher and ion levels lower in samples collected during the early years (except for nitrate), and the ammonium concentrations were lower in the dry season than the rainy (in 2014 and 2019). In surface samples, total phosphorus levels were significantly higher in the rainy/2019 compared to the rainy/2020 season, while this tendency was inverted for potassium during the dry season. The use of NPK-based fertilizers has increased considerably in recent years in the region due to the expansion of the agricultural area, and although the results of the study show that concentrations in water are much lower than the maximum values allowed by Brazilian legislation, continuous monitoring is necessary to guarantee water quality.

Glucose Variability in People with Type 1 Diabetes: Associations with Body Weight, Body Composition, and Insulin Sensitivity

The prevalence of overweight and obesity increases in people with type 1 diabetes (T1D). However, the impact of fat accumulation on glucose dynamics in T1D is poorly understood. We assessed continuous glucose monitoring (CGM) parameters in patients with T1D depending on their body weight, body composition, and insulin sensitivity. In 547 patients, including 238 overweight/obese individuals, CGM-derived time in range (TIR) and glucose variability (GV) were estimated. Body composition was assessed by DXA. Estimated glucose disposal rate (eGDR) was used as an indicator of insulin sensitivity. Overweight/obese patients, when compared to normal-weight ones, have a lower time below range (TBR) (<3 mmol/L), GV, and experienced fewer episodes of low glucose. In men, lower TIR, higher time above range (TAR), and GV reduction were associated with central adiposity assessed by total, trunk, and android fat mass. In women, gynoid fat mass only was associated with a lower TIR and higher TAR. The eGDR was a positive predictor of TIR and a negative predictor of TAR, TBR, and GV in men and women. In conclusion, adiposity in people with T1D is associated with a lower risk of CGM-confirmed hypoglycemia, higher TAR, and reduced GV. These features of daily glucose dynamics may be mediated by insulin resistance.

Condition-based Predictive Maintenance as an Efficient Strategy for Industrializing Additive Manufacturing Technology

Objective: Traditional manufacturing has several issues to determine a general maintenance strategy. Additive Manufacturing (AM) is a special type of fabrication, which possesses different issues, especially uncertainty failure cases. This forms a big obstacle to becoming an industrialized production strategy. The objective of this work is to provide the most suitable maintenance strategy in order to reduce the likelihood of failure that can help in industrializing the AM technology. Methods: Among the different maintenance strategies, Predictive Maintenance (PdM) became widely treated in academia and industry. According to the methods used for detecting the failure signs, it can be classified into two types: Condition-Based Predictive Maintenance (CBPdM) and Statistical-Based Predictive Maintenance (SBPdM). The use of the last type highly depends on available and accessible data. However, CBPdM depends on only periodic or continuous condition monitoring tools for detecting the failure signs. Results: The existence of various types of failure cases yields to a big difficulty to predict failures. In addition, because of insufficient data, SBPdM cannot be selected as a suitable maintenance strategy for additive manufacturing. According to the presented examples, the CBPdM can be considered here as the best maintenance strategy for AM. Conclusion: CBPdM strategy is the best compromise between cost and applicability where there is not enough data. This selected maintenance approach represents an efficient tool in industrializing AM technology.

Harnessing cellular therapeutics for type 1 diabetes mellitus: progress, challenges, and the road ahead.

Type 1 diabetes mellitus (T1DM) is a growing global health concern that affects approximately 8.5 million individuals worldwide. T1DM is characterized by an autoimmune destruction of pancreatic β cells, leading to a disruption in glucose homeostasis. Therapeutic intervention for T1DM requires a complex regimen of glycaemic monitoring and the administration of exogenous insulin to regulate blood glucose levels. Advances in continuous glucose monitoring and algorithm-driven insulin delivery devices have improved the quality of life of patients. Despite this, mimicking islet function and complex physiological feedback remains challenging. Pancreatic islet transplantation represents a potential functional cure for T1DM but is hindered by donor scarcity, variability in harvested cells, aggressive immunosuppressive regimens and suboptimal clinical outcomes. Current research is directed towards generating alternative cell sources, improving transplantation methods, and enhancing cell survival without chronic immunosuppression. This Review maps the progress in cell replacement therapies for T1DM and outlines the remaining challenges and future directions. We explore the state-of-the-art strategies for generating replenishable β cells, cell delivery technologies and local targeted immune modulation. Finally, we highlight relevant animal models and the regulatory aspects for advancing these technologies towards clinical deployment.

Determining calf traceability and cow–calf relationships in extensive farming using geolocation collars and BLE ear tags

Extensive farming is often considered very beneficial to animals for its potential to enhance animal welfare, providing animals with free-range access to their natural environment where they can engage in innate behaviors like grazing and exploration. However, despite these benefits, extensive production still faces welfare and health challenges due to unpredictable weather conditions and limited supervision by stockholders. Moreover, increasing consumer demand for information regarding food quality, safety, and production conditions poses a challenge for extensive farming, where animals are less controlled. Precision livestock farming (PLF) emerges as a possible solution by enabling the continuous real-time monitoring of the health, welfare, and behavior of animals. A novel approach combining geolocation collars for cows and Bluetooth low energy (BLE) ear tags for calves appears promising to enhance traceability and monitoring in extensive farming. Nevertheless, challenges persist, including limitations in the data transmission capacity and associated costs. This study evaluated the effectiveness of combining geolocation collars and BLE ear tags for monitoring calf traceability and cow–calf relationships across three scenarios: 1) Equilibrated: same collar/ear tag ratio; good coverage; 2) intermediate: more collars than ear tags; fair coverage; 3) worst: more ear tags than collars; lousy coverage. Our results indicate that the equilibrated scenario (ES) with an equal number of geolocation collars and BLE ear tags, was the best scenario, demonstrating the highest fix rate (22%) and the longest mean consecutive days of detecting the same ear tag (22.30 days), followed by the intermediate scenario (IS) and the worst scenario. In all scenarios, there was a mean period of 14–15 d without detecting a calf. However, this shortcoming can be overcome as calves usually graze alongside their mothers, ensuring comprehensive traceability in farm breeding. Additionally, by comparing differences in the number of ear tags received from offspring compared to other calves, the BLE ear tags successfully associated every mother with their calf in the ES and IS. Finally, this valuable information, would enable the development of a traceability system that ensures transparency and reliability throughout the supply chain and could allow consumers to access to product information related to animal welfare.

Gradient Scale Monitoring for Federated Learning Systems

As the computational and communicational capabilities of edge and IoT devices grow, so do the opportunities for novel Machine Learning solutions. This leads to an increase in popularity of Federated Learning (FL), especially in cross-device settings. However, while there is a multitude of ongoing research works analyzing various aspects of the FL process, most of them do not focus on issues of operationalization and monitoring. For instance, there is a noticeable lack of research in the topic of effective problem diagnosis in FL systems. This work begins with a case study, in which we have intended to compare the performance of four selected approaches to the topology of FL systems. For this purpose, we have constructed and executed simulations of their training process in a controlled environment. We have analyzed the obtained results and encountered concerning periodic drops in the accuracy for some of the scenarios. We have performed a successful reexamination of the experiments, which led us to diagnose the problem as caused by exploding gradients. In view of those findings, we have formulated a potential new method for the continuous monitoring of the FL training process. The method would hinge on regular local computation of a handpicked metric - the gradient scale coefficient (GSC). We then extend our prior research to include a preliminary analysis of the effectiveness of GSC and average gradients per layer as potentially suitable for FL diagnostics metrics. In order to perform a more thorough examination of their usefulness in different FL scenarios, we simulate the occurrence of the exploding gradient problem, vanishing gradient problem and stable gradient serving as a baseline. We then evaluate the resulting visualizations based on their clarity and computational requirements. We introduce a gradient monitoring suite for the FL training process based on our results.

Identification of Major Interfering Substances for Heavy Metal Determination in Northern Sea Areas of Sri Lanka

This study investigated the physicochemical characteristics of seawater from five locations along the northern Sri Lankan coast, encompassing areas with varying degrees of anthropogenic activity. The analysis revealed significant variations in several parameters, potentially influenced by human influences. The results reveal significant variations in several parameters. For instance, turbidity levels varied from 1.88 NTU in Thalaiyadi to 13.3 NTU in Pannai, with Pannai, Myliddy, and Kakkaithivu exceeding the recommended limit of 5 NTU. Total suspended solids (TSS) ranged from 3 mg/L in Thalaiyadi to 83 mg/L in Pannai, surpassing the recommended limit of 30 mg/L. Electrical conductivity (EC) ranged from 45,700 µS/cm in Nainathivu to 49,500 µS/cm in Pannai, exceeding the typical seawater range. Nitrate levels ranged from 10.4 mg/L in Thalaiyadi to 19.1 mg/L in Myliddy. Major cations such as calcium (361 mg/L to 417 mg/L), magnesium (1,222 mg/L to 1,327 mg/L), and sodium (10,140 mg/L to 10,530 mg/L) also showed significant differences across locations. These findings highlight the need for continuous monitoring and effective management strategies to mitigate the negative impacts of anthropogenic activities on these coastal ecosystems. Furthermore, the complex seawater matrix presents challenges for heavy metal determination using Graphite Furnace Atomic Absorption Spectroscopy (GFAAS) due to spectral interferences from major cations, non-specific matrix effects, and interferences from organic matter, turbidity, and suspended solids. Careful consideration of these factors through background correction techniques, matrix modifiers, sample pre-treatment, and optimization of analysis parameters is crucial for accurate heavy metal determination in these environments. This study contributes to a better understanding of the environmental conditions and emphasizes the need for further research on heavy metal contamination and the development of robust analytical methods tailored to address the challenges posed by the complex seawater matrix in northern Sri Lanka.

A Pilot and Feasibility Study of Continuous Cardiac Output and Blood Pressure Monitoring during Intermittent Hemodialysis.

Hypotension is common during intermittent hemodialysis (IHD) and may be due to a decreased cardiac index (CI). However, no study has simultaneously and continuously measured CI and mean arterial pressure (MAP) to understand the prevalence, severity, and duration of CI decreases or relate them to MAP, blood volume (BV) and net ultrafiltration (NUF) rate. In a prospective, pilot and feasibility investigation, we studied 10 chronic IHD patients. We used the ClearSight System™ to continuously monitor CI and MAP; the CRIT-LINE®IV monitor to detect BV changes and collected data on NUF rate. Device tolerance and compliance was 100%. All patients experienced at least ≥ 1 episode of severe CI decrease (> 25% from baseline), with a median duration of 24 minutes [IQR 6-87] and of 68 minutes [14-106] for moderate decreases (>15% but  25% from baseline). Eight patients experienced a low CI state (<2.2 L/min/m2). The lowest CI was 0.9 L/min/m2 with a concomitant MAP of 94 mmHg. When the fall in CI was severe, MAP increased in 58% of cases and remained stable in 28%. Overall, CI decreased by -0.55 L/min/m2 when BV decrease was moderate vs mild (p<0.001) and by -0.8 L/min/m2 when NUF rate was high vs low (p<0.001). Continuous CI monitoring is feasible in IHD and shows frequent moderate-severe CI decreases, sometimes to low CI state levels. Such decreases are typically associated with markers of decreased intravascular volume status but not with a decrease in MAP, implying marked vasoconstriction.

Hydrological and pedological effects of combining Italian alder and blackberries in an agroforestry windbreak system in South Africa

Abstract. The Western Cape in South Africa is a water-scarce region which will likely receive less rainfall and higher air temperatures under projected climate change scenarios. The integration of trees within agricultural systems provides an effective measure for improving water retention on agricultural land. Studying an established and irrigated agroforestry system (AFS) combining alder (Alnus cordata (Loisel.) Duby) as a linear windbreak with a blackberry (Rubus fructicosus L.) crop, we explore the water use dynamics of the intercrop as influenced by the windbreak element by combining methods from hydrology, soil science and forestry disciplines. Our objective is to explore whether the AFS positively impacts the water balance by combining measurement campaigns to characterise the spatial variability of various key system properties with continuous monitoring. The campaigns encompassed extensive soil sampling to determine soil characteristics (nutrient concentrations, hydraulic conductivity, texture, water retention) in the laboratory as well as terrestrial laser scans of the field site, especially of the windbreaks. The continuous measurements covered meteorological, soil water content and soil water potential observations over a 6-month period (in summer). These were applied to understand soil water dynamics during rainstorms and dry spells, including root water uptake as well as soil water storage. We recorded a total of 13 rainfall events delivering 2.5–117.6 mm of rainfall with maximum intensities of 4.1 to 82.6 mm h−1. Further analyses showed that infiltration is likely dominated by preferential flow, with root water uptake potentially occurring in two depth zones corresponding to different plant communities. While soil water content varied by depth and was influenced by physical and environmental factors, it was generally higher in the intercrop zone than within the windbreak-influenced zone. During dry spells, soil water content did not drop below the water content of the permanent wilting point (<-1500 kPa). Values corresponding to soil water tensions above 1000 kPa were recorded on several occasions; these were mitigated by irrigation and, thus, did not result in water stress. Nutrient distribution and soil physical properties differed near the windbreak in comparison to the blackberry crop, and the carbon sequestration potential is great in comparison to monoculture farming. We could demonstrate positive effects of the windbreak on the water balance and dynamics in the blackberry field site, even though questions remain as to the extent of these benefits and how they compared to disadvantageous aspects brought about by the presence of the trees (e.g. increased water usage). Irrigation did, in fact, shift the AFS from a water-limited regime to an energy-limited one.

Early-Stage Prototype Assessment of Cost-Effective Non-Intrusive Wearable Device for Instant Home Fetal Movement and Distress Detection: A Pilot Study

Clinical fetal monitoring devices can only be operated by medical professionals and are overly costly, prone to detrimental false positives, and emit radiation. Thus, highly accurate, easily accessible, simplified, and cost-effective fetal monitoring devices have gained an enormous interest in obstetrics. In this study, a cost-effective and user-friendly wearable home fetal movement and distress detection device is developed and assessed for early-stage design progression by facilitating continuous, comfortable, and non-invasive monitoring of the fetus during the final trimester. The functionality of the developed prototype is mainly based on a microcontroller, a single accelerometer, and a specialized fetal phonocardiography (fPCG) acquisition board with a low-cost microphone. The developed system is capable of identifying fetal movement and monitors fetal heart rhythm owing to its considerable sensitivity. Further, the device includes a Global System for Mobile Communication (GSM)-based alert system for instant distress notifications to the mother, proxy, and emergency services. By incorporating digital signal processing, the system achieves zero false negatives in detecting fetal movements, which was validated against an open-source database. The acquired results clearly substantiated the efficacy of the fPCG acquisition board and alarm system, ensuring the prompt identification of fetal distress.

Design and Development of Mobile Based Application for Competency Oriented Dental Education

Abstract Background: Teaching, Learning and Asssessment in Competency Based Dental Education need to be digitally captured in an user friendly manner which can be accessed by students and mentor which would be useful for continuous monitoring, periodic assessment and maintenance of a digital record. Methods: A novel customised mobile based application MSCORE© developed for competency oriented dental training among undergraduate interns of an institute. Initial perception on the use of the application was recorded using a questionnaire from the entire batch of interns. Factor Analysis was done to check the validity and reliability of the questionnaire. Results: From the 30-item questionnaire, factor analysis extracted four aforementioned factors and reliability was found for 22 questions. Sixty-three percent of students felt that the application is easy to learn. Overall high scores were recorded for 71% of the students. Eighty-five percent of the students scored high on the suitability of the task. Seventy three scored the high on the satisfaction scale. However, advantages over existing written methods scored high only among 49% of the students. Conclusions: Mobile application-based mentoring, monitoring and assessment can be a better alternative to conventional models as it was found to demonstrate good perception by the digital natives of the present generation.

From flood to turbidity current: combined models to simulate continent to ocean sediment transport in the Var system, France

Turbidity currents are a form of gravity-driven flow that occurs in subaqueous environments. These currents contain a low volumetric percentage of particles but are very important in transporting them from coastal to deep-marine environments. In the Var sediment routing system, southeastern France, there is a sedimentary record of turbidity currents formed by submarine landslides and flooding of the Var River. In 2006, there was continuous monitoring of the marine section that recorded four turbidity currents. To explore the connectivity between the terrestrial source and marine basin we linked two reduced complexity models of sediment transport and landscape change. The aim of the paper is to combine two models, one dedicated to the prediction of river water and sediment run-off, and the second dedicated to the transport, erosion, and sedimentation by a turbidity current. The landscape evolution model CAESAR-Lisflood was used to model discharge and sediment yield. The behaviour of turbidity currents was modelled with the cellular automata model CATS. From calibration of the two models against observations of discharge and suspended sediment in the Var River system, we find that in 2006, two rainfall events would have led to hyperpycnal turbidity currents. These two events match well with two of the four-recorded events. Focusing on the largest event we find that the source pulse of sediment from the terrestrial environment is short-lived, less than half a day, but contains a significant quantity of fine particles. The event transferred on the order of 105 m3 of suspended sediment from source to sink. This study demonstrates that hyperpycnal turbidity currents can be generated with concentrations as low as 2-6 kg/m3 at the Var River mouth far below the theoretical 40 kg/m3 threshold, suggesting active convective sedimentation in the surface plume and sea-water dilution at the flooding river mouth. A substantial amount of sediment (35% of the input volume) is directly transferred towards the deepest part of the system during a short-living hyperpycnal turbidity current. However, a considerable (65%) part remains in the surface as a hypopycnal plume feeding the hemipelagic sedimentation.

Cadena de abastecimiento que integra la planeación estratégica y BSC en una empresa constructora

The general objective of this research was to propose a supply chain model based on strategic planning and the Balance Scorecard for the construction company GARES PERU S.A.C., Trujillo, 2021. Non-experimental type, descriptive cross-sectional design. The results indicate that 38% of the clients of the construction company GARESPERU SAC indicate that the level of supply management is regular; 40% of those surveyed indicated that the level of strategic planning is inefficient; 36% of respondents indicated that the level of the BSC is inefficient. A strategic direction was proposed for the company, these are: product development strategy, market penetration strategy and market development strategy. A Balance Scorecard model was developed, obtaining the control panel that integrates indicators. A supply chain model was designed. As a main conclusion, the general objective was met because a supply chain model was developed for the construction company GARES PERU S.A.C., which is aligned with the company's strategic planning, in addition to having support in the BSC dashboard that will facilitate continuous monitoring of the main management indicators.

Enhancing Personalized Rehabilitation: Integrating AAN System with Real-Time Feedback

Abstract Conventional rehabilitation programs often lack precise real-time feedback, leading to varied training results at different centers. To address this, personalized rehabilitation strategies have been developed using robotic technologies and exoskeletons with Assist-as-Needed (AAN) controllers to improve recovery rates for individuals with stroke and neuromuscular disorders. This research introduces an automated therapy approach with a patient-specific AAN support strategy that provides immediate feedback, enhancing the rehabilitation process. The system uses minimal data to create effective personalized models and integrates sensors and algorithms for continuous monitoring, improving the efficacy of therapy. Initial trials with an exoskeleton that focused on elbow movements showed promising results in adjusting support in real time and providing personalized interventions through torque-controlled motors. This system assesses impairment levels, visualizes motor energy needs, and helps design customized rehabilitation programs, significantly enhancing therapeutic results.

Effect of Screening for UndiagnosedAtrial Fibrillation onStrokePrevention.

Atrial fibrillation (AF) often remains undiagnosed, and it independently raises the risk of ischemic stroke, which is largely reversible by oral anticoagulation. Although randomized trials using longer term screening approaches increase identification of AF, no studies have established that AF screening lowers stroke rates. To address this knowledge gap, the GUARD-AF (Reducing Stroke by Screening for Undiagnosed Atrial Fibrillation in Elderly Individuals) trial screened participants in primary care practices using a 14-day continuous electrocardiographic monitor to determine whether screening for AF coupled with physician/patient decision-making to use oral anticoagulation reduces stroke and provides a net clinical benefit compared with usual care. GUARD-AF was a prospective, parallel-group, randomized controlled trial designed to test whether screening for AF in people aged≥70 years using a 14-day single-lead continuous electrocardiographic patch monitor could identify patients with undiagnosed AF and reduce stroke. Participants were randomized 1:1 to screening or usual care. The primary efficacy and safety outcomes were hospitalization due to all-cause stroke and bleeding, respectively. Analyses used the intention-to-treat population. Enrollment began on December 17, 2019, and involved 149 primary care sites across the United States. TheCOVID-19 pandemic led to premature termination of enrollment, with 11,905 participants in the intention-to-treat population. Median follow-up was 15.3months (Q1-Q3: 13.8-17.6months). Median age was 75 years (Q1-Q3: 72-79 years), and 56.6% were female. The risk of stroke in the screening group was 0.7% vs 0.6% in the usual care group (HR:1.10; 95%CI: 0.69-1.75). The risk of bleeding was 1.0% in the screening group vs 1.1% in the usual care group (HR:0.87; 95%CI: 0.60-1.26). Diagnosis of AF was 5% in the screening group and 3.3% in the usual care group, and initiation of oral anticoagulation after randomization was 4.2% and 2.8%, respectively. In this trial, there was no evidence that screening for AF using a 14-day continuous electrocardiographic monitor in people≥70 years of age seen in primary care practice reduces stroke hospitalizations. Event rates were low, however, and the trial did not enroll the planned sample size.(Reducing Stroke by Screening for Undiagnosed Atrial Fibrillation in Elderly Individuals [GUARD-AF]; NCT04126486).

Continuous Rhythm Monitoring With Implanted Loop Recorders in Children and Adolescents With Brugada Syndrome

BackgroundYoung (<18 years of age) patients with Brugada syndrome (BrS) are often under-represented in BrS studies and their management, especially related to syncopal episodes, remains unclear. ObjectivesThis study sought to describe the arrhythmia prevalence among young patients with BrS undergoing continuous rhythm monitoring by implantable loop recorder (ILR) and to assess the etiology behind syncope of undetermined origin. MethodsA total of 147 patients with BrS with ILR were enrolled in 12 international centers and divided into pediatric (age <12 years; n = 77, 52%) and adolescents (age 13-18 years; n = 70, 48%). ResultsMean age was 11.3 years, 53 patients (36.1%) were female, and 31 (21.1%) had spontaneous type 1 electrocardiograms. Over a median follow-up of 3.6 years (Q1-Q3: 1.6-4.8 years), an arrhythmic event was recorded in 33 patients (22.4%), mainly of nonventricular origin: 15 atrial (10.2%) and 16 bradyarrhythmic events (10.9%). Ventricular arrhythmias occurred in 4 patients, all with spontaneous BrS, and were fever-related in one-half. Among all patients with recurrence of syncope during follow-up, true arrhythmic syncope was documented in 5 (17.8%), and it was due to bradyarrhythmias or atrial arrhythmias in 3 cases (60%). ConclusionsContinuous rhythm monitoring with ILRs in young patients with BrS detects a broad range of arrhythmias. Ventricular arrhythmias occur predominantly in patients with spontaneous type 1 electrocardiograms and during fever. Despite the young age, bradyarrhythmias and atrial arrhythmias are frequent and represent the cause of arrhythmic syncope in 60% of patients. Young patients with BrS with syncope of undetermined origin may benefit from ILR implant.

Advancing elderly diabetes care: exploring the usability and acceptance of continuous glucose monitoring (CGM)

ObjectivesThis study aimed to evaluate the acceptability, usability, compliance, and satisfaction of Continuous Glucose Monitoring (CGM) among elderly diabetic patients. DesignUtilizing a mixed-methods approach, the study involved 30 participants, averaging 74.79 years in age. Participants wore two CGM devices, and their experiences, along with survey data, were comprehensively analyzed to gauge the effectiveness of CGM in managing diabetes. ResultsThe study demonstrated that -CGM- is highly usable and acceptable among elderly diabetic patients. Participants effectively utilized CGM to monitor and predict blood glucose trends, positively influencing their glucose control and lifestyle. The average adherence rate was found to be 81 %, indicating a substantial level of effective self-management and treatment decision-making. ConclusionThe study recommends developing CGM educational programs tailored for the elderly, educating healthcare professionals, expanding insurance coverage for CGM, and promoting real-time CGM technology to improve usability and acceptance among the elderly.