Emerging Methods to Objectively Assess Pruritus in Atopic Dermatitis.

INTRODUCTION:Atopic dermatitis (AD) is an inflammatory skin disease with a chronic, relapsing course. Clinical features of AD vary by age, duration, and severity but can include papules, vesicles, erythema, exudate, xerosis, scaling, and lichenification. However, the most defining and universal symptom of AD is pruritus. Pruritus or itch, defined as an unpleasant urge to scratch, is problematic for many reasons, particularly its negative impact on quality of life. Despite the profoundly negative impact of pruritus on patients with AD, clinicians and researchers lack standardized and validated methods to objectively measure pruritus. The purpose of this review is to discuss emerging methods to assess pruritus in AD by describing objective patient-centered tools developed or enhanced over the last decade that can be utilized by clinicians and researchers alike. METHODS:This review is based on a literature search in Medline, Embase, and Web of Science databases. The search was performed in February 2019. The keywords were used "pruritus," "itch," "atopic dermatitis," "eczema," "measurements," "tools," "instruments," "accelerometer," "wrist actigraphy," "smartwatch," "transducer," "vibration," "brain mapping," "magnetic resonance imaging," and "positron emission tomography." Only articles written in English were included, and no restrictions were set on study type. To focus on emerging methods, prioritization was given to results from the last decade (2009-2019). RESULTS:The search yielded 49 results in PubMed, 134 results in Embase, and 85 results in Web of Science. Each result was independently reviewed in a standardized manner by two of the authors (M.S., K.L.), and disagreements between reviewers were resolved by consensus. Relevant findings were categorized into the following sections: video surveillance, acoustic surveillance, wrist actigraphy, smart devices, vibration transducers, and neurological imaging. Examples are provided along with descriptions of how each technology works, instances of use in research or clinical practice, and as applicable, reports of validation studies and correlation with other methods. CONCLUSION:The variety of new and improved methods to evaluate pruritus in AD is welcomed by clinicians, researchers, and patients alike. Future directions include next-generation smart devices as well as exploring new territories, such as identifying biomarkers that correlate to itch and machine-learning programs to identify itch processing in the brain. As these efforts continue, it will be essential to remain patient-centered by developing techniques that minimize discomfort, respect privacy, and provide accurate data that can be used to better manage itch in AD

Mobile Web services authentication using SAML and 3GPP generic bootstrapping architecture

In this paper we present a platform for the direct consumption of web services by a Mobile Station. We give an architectural solution where Mobile Operators play the role of Trusted Third Parties supplying service credentials that allow a co-located 3GPP Network Application Function and Liberty-enabled Identity Provider entity to implement a controlled Shopping Mall service to Mobile Stations from multiple trust domains. We consider both the protocol and the structure and syntax of the various tokens required to minimise service latency over the bandwidth and performance constrained mobile system, whilst providing adequate security services to protect against the perceived threat model. To validate our proposal we have developed code to create a Web Service test scenario using SAML authentication tokens utilising readily available J2ME, Java Card, J2SE and J2EE platforms, Web Services tools from Apache, the KToolBar emulator from Sun, and the JCOPS suite of tools for Java Card applet development

Use of Mobile Phones for Infant and Young Child Feeding Counseling in Sri Lankan Tea Estates: A Formative Study

Despite the availability of free health services, children residing in Sri Lanka’s less developed plantation sector are more likely to be undernourished than children in urban and rural sectors. Hence, we need new approaches to improve their nutritional status. One promising approach involves mobile health initiatives, which is used effectively in other countries in primary health care settings. We studied the nature of mobile phone use in this community, and their perceptions on using m-health counseling for infant and young child feeding. Focus group discussions and in-depth interviews were the study methods. We found that mobile phone usage is common in this community hence; m-health platform could be a promising initiative to strengthen the existing face to face nutritional advice provided by the field health workers to improve the nutritional status of children

Factors Influencing Sleep Difficulty and Sleep Quantity in the Citizen Pscientist Psoriatic Cohort.

IntroductionSleep is essential for overall health and well-being, yet more than one-third of adults report inadequate sleep. The prevalence is higher among people with psoriasis, with up to 85.4% of the psoriatic population reporting sleep disruption. Poor sleep among psoriasis patients is particularly concerning because psoriasis is independently associated with many of the same comorbidities as sleep dysfunction, including cardiovascular disease, obesity, and depression. Given the high prevalence and serious consequences of disordered sleep in psoriasis, it is vital to understand the nature of sleep disturbance in this population. This study was designed to help meet this need by using survey data from Citizen Pscientist, an online patient portal developed by the National Psoriasis Foundation.MethodsOur analysis included 3118 participants who identified as having a diagnosis by a physician of psoriasis alone or psoriasis with psoriatic arthritis. Demographic information, psoriasis severity and duration, sleep apnea status, smoking and alcohol consumption, itch timing, and sleep characteristics were included. Two separate multivariate logistic regression models in STATA were used to determine whether the presence of psoriatic arthritis, age, gender, body mass index, comorbid sleep apnea, psoriasis severity, timing of worst itch, smoking status, or high-risk alcohol consumption were associated with sleep difficulty or low sleep quantity, defined by the American Academy of Sleep Medicine as less than 7 h of sleep per night on average.ResultsResults from the multivariate logistic regressions found that sleep difficulty was associated with psoriatic arthritis (OR 2.15, 95% CI [1.79-2.58]), female gender (2.03 [1.67-2.46]), obese body mass index (BMI ≥ 30) (1.25 [1.00-1.56]), sleep apnea (1.41 [1.07-1.86]), psoriasis severity of moderate (1.59 [1.30-1.94]) or severe (2.40 [1.87-3.08]), and smoking (1.60 [1.26-2.02]). Low sleep quantity was associated with obese BMI (1.62 [1.29-2.03]), sleep apnea (1.30 [1.01-1.68]), psoriasis severity of moderate (1.41 [1.16-1.72]) or severe (1.40 [1.11-1.76]), and smoking (1.62 [1.31-2.00]). Sleep difficulty and low sleep quantity were not associated with age, alcohol consumption, or timing of worst itch.ConclusionThese results are potentially meaningful in several aspects. We identify an important distinction between sleep difficulty and sleep quantity in psoriatic disease, whereby having psoriatic arthritis and being female are each associated with sleep difficulty despite no association with low sleep quantity. Furthermore, there is conflicting evidence from prior studies as to whether psoriasis severity is associated with sleep difficulty, but this well-powered, large study revealed a strong, graded relationship between psoriasis severity and both sleep difficulty and low sleep quantity. Overall, our results show that both sleep difficulty and low sleep quantity were associated with multiple factors in this analysis of a large psoriatic cohort. These findings suggest that dermatologists may gather clinically useful information by screening psoriatic patients for trouble sleeping and low sleep quantity to identify potential comorbidities and to more effectively guide disease management

Functional trait variation related to gap dynamics in tropical moist forests: a vegetation modelling perspective

The conventional representation of Plant Functional Types (PFTs) in Dynamic Global Vegetation Models (DGVMs) is increasingly recognized as simplistic and lacking in predictive power. Key ecophysiological traits, including photosynthetic parameters, are typically assigned single values for each PFT while the substantial trait variation within PFTs is neglected. This includes continuous variation in response to environmental factors, and differences linked to spatial and temporal niche differentiation within communities. A much stronger empirical basis is required for the treatment of continuous plant functional trait variation in DGVMs. We analyse 431 sets of measurements of leaf and plant traits, including photosynthetic measurements, on evergreen angiosperm trees in tropical moist forests of Australia and China. Confining attention to tropical moist forests, our analysis identifies trait differences that are linked to vegetation dynamic roles. Coordination theory predicts that Rubisco- and electron-transport limited rates of photosynthesis are co-limiting under field conditions. The least-cost hypothesis predicts that air-to-leaf CO2 drawdown minimizes the combined costs per unit carbon assimilation of maintaining carboxylation and transpiration capacities. Aspects of these predictions are supported for within-community trait variation linked to canopy position, just as they are for variation along spatial environmental gradients. Trait differences among plant species occupying different structural and temporal niches may provide a basis for the ecophysiological representation of vegetation dynamics in next-generation DGVMs

Use of high density SNP genotypes to determine the breed composition of cross bred dairy cattle in smallholder farms: Assessment of reproductive and health performance

Reproductive performance and disease data were recorded for 2 years on 1,824 dairy cows in smallholder farms using participatory approaches and onfarm recording. Most animals experienced one service to conception. Calving intervals were long, ranging between 261 and 761 days, with an average of 451±101days. Herd level of production (HeL) had significant effect on calving interval. However, there was no difference between crossbreds with different levels of exotic breed percentage or in different HeL classes in disease incidence. Most animals had less than 2 treatment events, despite the high disease burden in the study areas. Mortality rates were low, ranging from 2.13% to 2.65%. Even though the crossbred animals had higher performance compared to indigenous animals, the gains obtained were below what would be possible with better management. These results suggest that crosses with low exotic proportions would be the most optimal for the production systems studied

A novel use of high density SNP assays to optimize choice of different crossbred dairy cattle genotypes in smallholder systems in East Africa

We present use of SNP technologies to obtain for the first time, rapid, large-scale, in situ estimates of performance of crossbred cows in smallholder herds. Compared to historical approaches, our approach allowed optimum crossbreed choices to be determined more rapidly and without question about the relevance of the environment. High-density SNP assays were used to estimate breed composition for a monitored population comprising 1292 cows from 610 smallholder farms in Kenya. The achieved milk yields are much lower than generally assumed and lactation curves are very flat out to 400 days. In poor production environments, lower grade crosses (containing <60% exotic dairy alleles) had the same yield as high grade crosses. Allowing for the larger size and maintenance requirements of high grade exotics, lower grade exotics will be the most economically productive animals in these environments

Leaf-level photosynthetic capacity in lowland Amazonian and high elevation, Andean tropical moist forests of Peru

We examined whether variations in photosynthetic capacity are linked to variations in theenvironment and/or associated leaf traits for tropical moist forests (TMFs) in the Andes/west-ern Amazon regions of Peru. We compared photosynthetic capacity (maximal rate of carboxylation of Rubisco (Vcmax),and the maximum rate of electron transport (Jmax)), leaf mass, nitrogen (N) and phosphorus(P) per unit leaf area (Ma,Naand Pa, respectively), and chlorophyll from 210 species at 18field sites along a 3300-m elevation gradient. Western blots were used to quantify the abun-dance of the CO₂-fixing enzyme Rubisco. Area- and N-based rates of photosynthetic capacity at 25°C were higher in upland than low-land TMFs, underpinned by greater investment of N in photosynthesis in high-elevation trees. Soil [P] and leaf Pa were key explanatory factors for models of area-based Vcmax and Jmax but did not account for variations in photosynthetic N-use efficiency. At any given Na and Pa, the fraction of N allocated to photosynthesis was higher in upland than lowland species. For a smallsubset of lowland TMF trees examined, a substantial fraction of Rubisco was inactive. These results highlight the importance of soil- and leaf-P in defining the photosyntheticcapacity of TMFs, with variations in N allocation and Rubisco activation state further influenc-ing photosynthetic rates and N-use efficiency of these critically important forests