Beyond Wearables : Experiences and Trends in Design of Portable Medical Devices

The use of Portable Medical Devices (PMDs) has become increasingly widespread over the last few years. A combination of factors; including advances in technology, the pressure to reduce public health costs and the desire to make health solutions accessible to a wider patient base are contributing to the growth in the PMD market. Design has a clear role to play in the current and future context of the PMD landscape. In this paper, we identify emerging trends in the design of PMDs; including changes in the form, purpose and mode of use, and explore how these trends are likely to fundamentally impact the nature of healthcare and the patient experience from an experience design perspective. We conclude by identifying a research opportunity for design within the healthcare and PMD context.

Levels and trends of PBDEs and HBCDs in the global environment : status at the end of 2012

In this paper, we have compiled and reviewed the most recent literature, published from January2010 to December 2012, relating to the human exposure, environmental distribution, behaviour, fate and concentration time trends of polybrominated diphenyl ether (PBDE) and hexabromocyclododecane (HBCD) flame retardants, in order to establish their current trends and priorities for future study. Due to the large volume of literature included, we have provided full detail of the reviewed studies as Electronic Supplementary Information and here summarise the most relevant findings. Decreasing time trends for penta-mix PBDE congeners were seen for soils in northern Europe, sewage sludge in Sweden and the USA, carp from a US river, trout from three of the Great Lakes and in Arctic and UK marine mammals and many birds, but increasing time trends continue in Arctic polar bears and some birds at high trophic levels in northern Europe. This is a result of the time delay inherent in long-range atmospheric transport processes. In general, concentrations of BDE209 (the major component of the deca-mix PBDE product) are continuing to increase. Of major concern is the possible/likely debromination of the large reservoir of BDE209 in soils and sediments worldwide, to yield lower brominated congeners which are both more mobile and more toxic, and we have compiled the most recent evidence for the occurrence of this degradation process. Numerous studies reported here reinforce the importance o f this future concern. Time trends for HBCDs are mixed, with both increases and decreases evident in different matrices and locations and, notably, with increasing occurrence in birds of prey.

Exploration of diarrhoea seasonality and its drivers in China

This study investigated the diarrhoea seasonality and its potential drivers as well as potential opportunities for future diarrhoea control and prevention in China. Data on weekly infectious diarrhoea cases in 31 provinces of China from 2005 to 2012, and data on demographic and geographic characteristics, as well as climatic factors, were complied. A cosinor function combined with a Poisson regression was used to calculate the three seasonal parameters of diarrhoea in different provinces. Regression tree analysis was used to identify the predictors of diarrhoea seasonality. Diarrhoea cases in China showed a bimodal distribution. Diarrhoea in children <5 years was more likely to peak in fall-winter seasons, while diarrhoea in persons > = 5 years peaked in summer. Latitude was significantly associated with spatial pattern of diarrhoea seasonality, with peak and trough times occurring earlier at high latitudes (northern areas), and later at low latitudes (southern areas). The annual amplitudes of diarrhoea in persons > = 5 years increased with latitude (r = 0.62, P<0.001). Latitude 27.8° N and 38.65° N were the latitudinal thresholds for diarrhoea seasonality in China. Regional-specific diarrhoea control and prevention strategies may be optimal for China. More attention should be paid to diarrhoea in children <5 years during fall-winter seasons.

Comparison of oropharyngeal and oral cavity squamous cell cancer incidence and trends in New Zealand and Queensland, Australia

Background Increases in the incidence of squamous cell oropharyngeal cancer (OPC) have been reported from some countries, but have not been assessed in Australia or New Zealand. This study examines trends for squamous cell OPC and squamous cell oral cavity cancer (OCC) in two similarly sized populations, New Zealand and Queensland, Australia. Methods Incidence data for 1982–2010 were obtained from the respective population-based cancer registries for squamous cell OPC and OCC, by subsite, sex, and age. Time trends and annual percentage changes (APCs) were assessed by joinpoint regression. Results The incidence rates of squamous cell OPC in males in New Zealand since 2005 and Queensland since 2006 have increased rapidly, with APCs of 11.9% and 10.6% respectively. The trends were greatest at ages 50–69 and followed more gradual increases previously. In females, rates increased by 2.1% per year in New Zealand from 1982, but by only 0.9% (not significant) in Queensland. In contrast, incidence rates for OCC decreased by 1.2% per year in males in Queensland since 1982, but remained stable for females in Queensland and for both sexes in New Zealand. Overall, incidence rates for both OCC and OPC were substantially higher in Queensland than in New Zealand. In males in both areas, OPC incidence is now higher than that of OCC. Conclusions Incidence rates of squamous cell OPC have increased rapidly in men, while rates of OCC have been stable or reducing, showing distinct etiologies. This has both clinical and public health importance, including implications for the extension of human papilloma virus (HPV) vaccination to males.

Pheromone-trapping of Carpophilus spp. (Coleoptera: Nitidulidae) in stone fruit orchards near Gosford, New South Wales: Fauna, seasonality and effect of insecticides

Traps baited with synthetic aggregation pheromones of Carpophilus hemipterus (L.), Carpophilus mutilatus Erichson and Carpophilus davidsoni Dobson and fermenting bread dough were used to identify the fauna and monitor the seasonal abundance of Carpophilus spp. in insecticide treated peach and nectarine orchards in the Gosford area of coastal New South Wales. In four orchards 67 178 beetles were trapped during 1994–1995, with C. davidsoni (82%) and Carpophilus gaveni (Dobson) (12.2%) dominating catches. Five species (C. hemipterus, C. mutilatus, Carpophilus marginellus Motschulsky, Carpophilus humeralis (F.) and an unidentified species) each accounted for 0.2–3.2% of trapped beetles. Carpophilus davidsoni was most abundant during late September–early October but numbers declined rapidly during October, usually before insecticides were applied. Spring populations of Carpophilus spp. were very large in 1994–1995 (1843–2588 per trap per week). However, despite a preharvest population decline of approximately 95% and 2–11 applications of insecticide, 14–545 beetles per trap per week (above the arbitrary fruit damage threshold of 10 beetles per trap per week) were recorded during the harvest period and fruit damage occurred at three of the four orchards. Lower preharvest populations in 1995–1996 (< 600 per trap per week) and up to six applications of insecticide resulted in < 10 beetles per trap per week during most of the harvest period and minimal or no fruit damage. The implications of these results for the integrated management of Carpophilus spp. in coastal and inland areas of southeastern Australia are discussed.

Organic Contaminant Analytical Methods of the National Status and Trends Program: 2000-2006

This document describes the analytical methods used to quantify core organic chemicals in tissue and sediment collected as part of NOAA’s National Status and Trends Program (NS&T) for the years 2000-2006. Organic contaminat analytical methods used during the early years of the program are described in NOAA Technical Memoranda NOS ORCA 71 and 130 (Lauenstein and Cantillo, 1993; Lauenstein and Cantillo, 1998) for the years 1984-1992 and 1993-1996, respectively. These reports are available from our website (http://www.ccma.nos.gov) The methods detailed in this document were utilized by the Mussel Watch Project and Bioeffects Project, which are both part of the NS&T program. The Mussel Watch Project has been monitoring contaminants in bivalves and sediments since 1986 and is the longest active national contaminant monitoring program operating in U.S. costal waters. Approximately 280 Mussel Watch sites are sampled on a biennial and decadal timescale for bivalve tissue and sediment respectively. Similarly, the Bioeffects Assessment Project began in 1986 to characterize estuaries and near coastal environs. Using the sediment quality triad approach that measures; (1) levels of contaminants in sediments, (2) incidence and severity of toxicity, and (3) benthic macrofaunal conmmunities, the Bioeffects Project describes the spatial extent of sediment toxicity. Contaminant assessment is a core function of both projects. These methods, while discussed here in the context of sediment and bivalve tissue, were also used with other matricies including: fish fillet, fish liver, nepheloid layer, and suspended particulate matter. The methods described herein are for the core organic contaminants monitored in the NS&T Program and include polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), butyltins, and organochlorines that have been analyzed consistently over the past 15-20 years. Organic contaminants such as dioxins, perfluoro compounds and polybrominated biphenyl ethers (PBDEs) were analyzed periodically in special studies of the NS&T Program and will be described in another document. All of the analytical techniques described in this document were used by B&B Laboratories, Inc, an affiliate of TDI-Brook International, Inc. in College Station, Texas under contract to NOAA. The NS&T Program uses a performance-based system approach to obtain the best possible data quality and comparability, and requires laboratories to demonstrate precision, accuracy, and sensitivity to ensure results-based performance goals and measures. (PDF contains 75 pages)

Sampling and analytical methods of the National Status and Trends Program Mussel Watch Project: 1993-1996 Update

Polycyclic aromatic hydrocarbons, butyltins, polychlorinated biphenyls, DDT and metabolites, other chlorinated pesticides, trace and major elements, and a number of measures of contaminant effects are quantified in bivalves and sediments collected as part of the NOAA National Status and Trends (NS&T) Program. This document contains descriptions of some of the sampling and analytical protocols used by NS&T contract laboratories from 1993 through 1996. (PDF contains 257 pages)

Catch-per-unit-effort and biological parameters from the Massachusetts coastal lobster (Homarus americanus) resource: Description and trends

Acomprehensive description of the Massachusetts coastal lobster (Homarus americanus) resou,rce was obtained by sampling commercial catches coastwide at sea and at dealerships between 1981 and 1986. Acommercial lobster sea-sampling program, wherein six coastal regions were sampled monthly, with an areal and temporal data weighting design, was the primary source of data. An improved index of catch per trap haul/set-over-day was generated by modeling the relationship between catch and immersion time and standardizing effort. This 6-year time-series of mean annual catch rates tracked closely the landings trend for territorial waters. During the study period there was a gradual increase in indices of exploitation and total annual mortality which corresponded to a gradual decline in mean carapace length of marketable lobster. The frequency of culls escalated from 10.0% in 1981 to 20.9% in 1986, while the percentage of lobster found dead in traps was consistently less than 1%. The sex ratio (%F:%M) was significantly different from 50:50 and approximated a 60:40 relationship during the study period. Male and female weight-length relationships were significantly different. Females weighed more than males at smaller sizes and less than males at larger sizes. A north-south clinal trend was evident wherein lobster north of Cape Cod weighed less at length than those from regions south of Cape Cod. Functional size-maturity relationships were developed for female lobster by staging cement gland development. Proportions mature at size represent more realistic values than those obtained by analyses of percent of females ovigerous. Regional variation occurred in most of the parameters studied. Three lobster groups, differing in major population descriptors, are defined by our data.(PDF file contains 28 pages.)

Estimates of body sizes at maturation and at sex change, and the spawning seasonality and sex ratio of the endemic Hawaiian grouper (Hyporthodus quernus, F. Epinephelidae)

A case study of the reproductive biology of the endemic Hawaiian grouper or hapu’upu’u (Hyporthodus quernus) is presented as a model for comprehensive future studies of economically important epinephelid groupers. Specimens were collected throughout multiple years (1978–81, 1992–93, and 2005–08) from most reefs and banks of the Northwestern Hawaiian Islands. The absence of small males, presence of atretic oocytes and brown bodies in testes of mature males, and both developed ovarian and testicular tissues in the gonads of five transitional fish provided evidence of protogynous hermaphroditism. No small mature males were collected, indicating that Hawaiian grouper are monandrous (all males are sex-changed females). Complementary microscopic criteria also were used to assign reproductive stage and estimate median body sizes (L50) at female sexual maturity and at adult sex change from female to male. The L50 at maturation and at sex change was 580 ±8 (95% confidence interval [CI]) mm total length (TL) and 895 ±20 mm TL, respectively. The adult sex ratio was strongly female biased (6:1). Spawning seasonality was described by using gonadosomatic indices. Females began ripening in the fall and remained ripe through April. A February–June main spawning period that followed peak ripening was deduced from the proportion of females whose ovaries contained hydrated oocytes, postovulatory follicles, or both. Testes weights were not affected by season; average testes weight was only about 0.2% of body weight—an order of magnitude smaller than that for ovaries that peaked at 1–3% of body weight. The species’ reproductive life history is discussed in relation to its management.

National Status and Trends Bioeffects Program: field methods

Environmental quality indicators provide resource managers with information useful to assess coastal condition and scientifically defensible decisions. Since 1984, the National Oceanic and Atmospheric Administration (NOAA), through its National Status and Trends (NS&T) Program, has provided environmental monitoring data on chemical, physical, and biological indicators of coastal environments. The program has two major monitoring components to meet its goals. The Bioeffects Assessments Program evaluates the health of bays, estuaries, and the coastal zone around the nation using the Sediment Quality Triad technique that includes measuring sediment contaminant concentrations, sediment toxicity and benthic community structure. The Mussel Watch Program is responsible for temporal coastal monitoring of contaminant concentrations by quantifying chemicals in bivalve mollusks. The NS&T Program is committed to providing the highest quality data to meet its statutory and scientific responsibilities. Data, metadata and information products are managed within the guidance protocols and standards set forth by NOAA’s Integrated Ocean Observing System (IOOS) and the National Monitoring Network, as recommended by the 2004 Ocean Action Plan. Thus, to meet these data requirements, quality assurance protocols have been an integral part of the NS&T Program since its inception. Documentation of sampling and analytical methods is an essential part of quality assurance practices. A step-by–step summary of the Bioeffects Program’s field standard operation procedures (SOP) are presented in this manual.

Assessing the impacts of the Deepwater Horizon oil spill: the National Status and Trends Program response; a summary report of coastal contamination

NOAA’s National Status and Trends Program (NS&T) collected oyster tissue and sediments for quantification of polycyclic aromatic hydrocarbons (PAHs) and petroleum associated metals before and after the landfall of oil from the Deepwater Horizon incident of 2010. These new pre- and post- landfall measurements were put into a historical context by comparing them to data collected in the region over three decades during Mussel Watch monitoring. Overall, the levels of PAHs in both sediment and oysters both pre- and post-landfall were within the range of historically observed values for the Gulf of Mexico. Some specific sites did have elevated PAH levels. While those locations generally correspond to areas in which oil reached coastal areas, it cannot be conclusively stated that the contamination is due to oiling from the Deepwater Horizon incident at these sites due to the survey nature of these sampling efforts. Instead, our data indicate locations along the coast where intensive investigation of hydrocarbon contamination should be undertaken. Post-spill concentrations of oil-related trace metals (V, Hg, Ni) were generally within historically observed ranges for a given site, however, nickel and vanadium were elevated at some sites including areas in Mississippi Sound and Galveston, Terrebonne, Mobile, Pensacola, and Apalachicola Bays. No oyster tissue metal body burden exceeded any of the United States Food and Drug Administration’s (FDA) shellfish permissible action levels for human consumption.

A GIS analysis of coastal development and trends in bottlenose dolphin strandings in Charleston, SC: implications for coastal marine spatial planning

Bottlenose dolphins (Tursiops truncatus) inhabit estuarine waters near Charleston, South Carolina (SC) feeding, nursing and socializing. While in these waters, dolphins are exposed to multiple direct and indirect threats such as anthropogenic impacts (egs. harassment with boat traffic and entanglements in fishing gear) and environmental degradation. Bottlenose dolphins are protected under the Marine Mammal Protection Act of 1972. Over the years, the percentage of strandings in the estuaries has increased in South Carolina and, specifically, recent stranding data shows an increase in strandings occurring in Charleston, SC near areas of residential development. During the same timeframe, Charleston experienced a shift in human population towards the coastline. These two trends, rise in estuarine dolphin strandings and shift in human population, have raised questions on whether the increase in strandings is a result of more detectable strandings being reported, or a true increase in stranding events. Using GIS, the trends in strandings were compared to residential growth, boat permits, fishing permits, and dock permits in Charleston County from 1994-2009. A simple linear regression analysis was performed to determine if there were any significant relationships between strandings, boat permits, commercial fishing permits, and crabpot permits. The results of this analysis show the stranding trend moves toward Charleston Harbor and adjacent rivers over time which suggests the increase in strandings is related to the strandings becoming more detectable. The statistical analysis shows that the factors that cause human interaction strandings such as boats, commercial fishing, and crabpot line entanglements are not significantly related to strandings further supporting the hypothesis that the increase in strandings are due to increased observations on the water as human coastal population increases and are not a natural phenomenon. This study has local and potentially regional marine spatial planning implications to protect coastal natural resources, such as the bottlenose dolphin, while balancing coastal development.

Major and trace element analytical methods of the National Status and Trends Program: 2000-2006

This document contains analytical methods that detail the procedures for determining major and trace element concentrations in bivalve tissue and sediment samples collected as part of the National Status and Trends Program (NS&T) for the years 2000-2006. Previously published NOAA Technical Memoranda NOS ORCA 71 and 130 (Lauenstein and Cantillo, 1993; Lauenstein and Cantillo, 1998) detail trace element analyses for the years 1984-1992 and 1993-1996, respectively, and include ancillary, histopathology, and contaminant (organic and trace element) analytical methods. The methods presented in this document for trace element analysis were utilized by the NS&T Mussel Watch and Bioeffects Projects. The Mussel Watch Project has been monitoring contaminants in bivalves and sediment for over 20 years, and is the longest active contaminant monitoring program operating in U.S. costal waters. Approximately 280 Mussel Watch sites are monitored on biennial and decadal timescales using bivalve tissue and sediment, respectively. The Bioeffects Project applies the sediment quality approach, which uses sediment contamination measurements, toxicity tests and benthic macroinfauna quantification to characterize pollution in selected estuaries and coastal embayments. Contaminant assessment is a core function of both projects. Although only one contract laboratory was used by the NS&T Program during the specified time period, several analytical methods and instruments were employed. The specific analytical method, including instrumentation and detection limit, is noted for each measurement taken and can be found at http://NSandT.noaa.gov. The major and trace elements measured by the NS&T Program include: Al, Si, Cr, Mn, Fe, Ni, Cu, Zn, As, Se, Sn, Sb, Ag, Cd, Hg, Tl and Pb.