Variation in Normal Ear Temperature

In-ear integrated sensor array for the continuous monitoring of brain activity and of lactate in sweat

Owing to the proximity of the ear canal to the central nervous system, in-ear electrophysiological systems can be used to unobtrusively monitor brain states. Here, by taking advantage of the ear's exocrine sweat glands, we describe an in-ear integrated array of electrochemical and electrophysiological sensors placed on a flexible substrate surrounding a user-generic earphone for the simultaneous monitoring of lactate concentration and brain states via electroencephalography, electrooculography and electrodermal activity. In volunteers performing an acute bout of exercise, the device detected elevated lactate levels in sweat concurrently with the modulation of brain activity across all electroencephalography frequency bands. Simultaneous and continuous unobtrusive in-ear monitoring of metabolic biomarkers and brain electrophysiology may allow for the discovery of dynamic and synergetic interactions between brain and body biomarkers in real-world settings for long-term health monitoring or for the detection or monitoring of neurodegenerative diseases.

The value of fever assessment in addition to the Early Detection Infection Scale (EDIS). A validation study in nursing home residents in Sweden

BACKGROUND

In order to improve detection of suspected infections in frail elderly there is an urgent need for development of decision support tools, that can be used in the daily work of all healthcare professionals for assessing non-specific and specific changes. The aim was to study non-specific signs and symptoms and fever temperature for early detection of ongoing infection in frail elderly, and how these correlates to provide the instrument, the Early Detection Infection Scale (EDIS), which is used to assess changes in health condition in frail elderly.

METHODS

This was an explorative, prospective cohort study, including 45 nursing home residents, 76 to 99 years, in Sweden. Nursing assistants measured morning ear body temperature twice a week and used the EDIS to assess individual health condition daily for six months. The outcome comprised events of suspected infection, compiled from nursing and medical patient records. Factor analysis and multivariate logistic regression analysis were performed to analyse data.

RESULTS

Fifteen residents were diagnosed with at least one infection during the six-month follow-up and 189 observations related to 72 events of suspected infection were recorded. The first factor analysis revealed that the components, change in cognitive and physical function, general signs and symptoms of illness, increased tenderness, change in eye expression and food intake and change in emotions explained 61% of the variance. The second factor analysis, adding temperature assessed as fever to > 1.0 °C from individual normal, resulted in change in physical function and food intake, confusion and signs and symptoms from respiratory and urinary tract, general signs and symptoms of illness and fever and increased tenderness, explaining 59% of the variance. In the first regression analysis, increased tenderness and change in eye expression and food intake, and in the second change in physical function and food intake, general signs and symptoms of illness and fever (> 1.0 °C from individual normal) and increased tenderness were significantly associated with increased risk for ongoing infection.

CONCLUSION

No items in the EDIS should be removed at present, and assessment of fever as > 1.0 °C from individual normal is a valuable addition. The EDIS has the potential to make it easier for first line caregivers to systematically assess changes in health condition in fragile elderly people and helps observations to be communicated in a standardised way throughout the care process. The EDIS thus contributes to ensuring that the decisions not being taken at the wrong level of care.

A Continuously Worn Dual Temperature Sensor System for Accurate Monitoring of Core Body Temperature from the Ear Canal

The objective of this work was to develop a temperature sensor system that accurately measures core body temperature from an ear-worn device. Two digital temperature sensors were embedded in a hearing aid shell along the thermal gradient of the ear canal to form a linear heat balance relationship. This relationship was used to determine best fit parameters for estimating body temperature. The predicted body temperatures resulted in intersubject limits of agreement (LOA) of ±0.49 °C over a range of physiologic and ambient temperatures without calibration. The newly developed hearing aid-based temperature sensor system can estimate core body temperature at an accuracy level equal to or better than many devices currently on the market. An accurate, continuously worn, temperature monitoring and tracking device may help provide early detection of illnesses, which could prove especially beneficial during pandemics and in the elderly demographic of hearing aid wearers.

Measurement of body temperature in the oral cavity with a temperature sensor integrated with a powered toothbrush

This paper presents a method for collecting core body temperature data via a temperature sensor integrated into a powered toothbrush. The purpose is to facilitate the collection of temperature data without any extended effort from the user. Twelve participants use a powered toothbrush with a temperature sensor mounted on the brush head twice daily for two months. The obtained values are compared with those from a conventional fever thermometer approved for intraoral use. The results show that the temperature sensor–integrated powered toothbrush can measure the core body temperature and provide values comparable to those provided by a traditional oral thermometer. The use of the device can facilitate disease monitoring, fertility control, and security solutions for the elderly.

Use of temperature changes and pro-inflammatory biomarkers to diagnose bacterial infections in patients with severe cerebral trauma

Background: In patients undergoing neurosurgeries, inflammation and infection are strongly related; however, inflammation can be present without infection. Midregional proadrenomedullin (MR-proADM) is a relatively new sepsis biomarker that is rarely used clinically. Recently, the concept of DiffTemp was introduced, that is, a >1°C rise from individual normal temperature accompanied by malaise, as a more accurate definition of temperature assessed as fever. The aim of the present study was to examine the importance of C-reactive protein (CRP), white blood cells, procalcitonin, and MR-proADM levels and DiffTemp.Methods: This prospective, comparative study had a quantitative approach. Forty-two patients, aged >18 years and presenting with severe cerebral trauma were included from a neurosurgery intensive care unit. The outcome variable was infection; group 0, no infection (n=11); group 1, suspected infection (n=15); and, group 2, confirmed infection (n=16). Group assignments were performed using biomarkers, medical records, bacterial cultures, and International Classification of Diseases-10, and by the clinical assessment of criteria for nosocomial infections by a neurosurgeon.Results: On comparing groups 1 and 2, MR-proADM and DiffTemp were associated with a higher risk of confirmed infection (odds ratio, 5.41 and 17.14, respectively). Additionally, DiffTemp had a 90.9% specificity in patients with no infection and a 93.8% sensitivity in patients with confirmed infections. CRP and procalcitonin levels were not associated with an increased risk of confirmed infection.Conclusion: Increased levels of MR-proADM were associated with a higher risk of confirmed infection. DiffTemp was associated with a higher risk of having a confirmed infection.

SARS-CoV-2 (Covid-19) workplace temperature screening: Seasonal concerns for thermal detection in northern regions

Workplace temperature screening has become standard practice during the SARS-CoV-2 pandemic. The objective was to determine the consistency of four temperature devices during exposure to simulated and actual environmental conditions reflective of a workplace. An infrared (IR) digital thermometer (accuracy(A)±0.2), IR laser thermometer (A±1), and thermal imaging camera (A±0.3) were used to measure forehead and tympanic (digital only) temperatures. The first experiment was conducted in a controlled simulated environment (-20 to 20 °C) with three participants (32-YOF, 27-YOM, 20-YOF). The second experiment used actual outdoor conditions (-0.48 to 45.6 °C) with two participants (32-YOF, 27-YOM). The tympanic measurement was the least impacted by environmental temperature (mean(±SD)): simulated (36.8(±0.18) °C) and actual (36.9(±0.16) °C). The thermal imaging camera had the lowest RMSE values (0.81-0.97 °C), with outdoor temperatures ranging from 0 to 45 °C. Environmental temperature influenced forehead temperature readings and required a resting period in a thermoneutral environment (5-9 min (-20 to -10 °C) to immediate (15-20 °C)).

Evaluation of a Wearable Non-Invasive Thermometer for Monitoring Ear Canal Temperature during Physically Demanding (Outdoor) Work

Aimed at preventing heat strain, health problems, and absenteeism among workers with physically demanding occupations, a continuous, accurate, non-invasive measuring system may help such workers monitor their body (core) temperature. The aim of this study is to evaluate the accuracy and explore the usability of the wearable non-invasive Cosinuss° °Temp thermometer. Ear canal temperature was monitored in 49 workers in real-life working conditions. After individual correction, the results of the laboratory and field study revealed high correlations compared to ear canal infrared thermometry for hospital use. After performance of the real-life working tasks, this correlation was found to be moderate. It was also observed that the ambient environmental outdoor conditions and personal protective clothing influenced the accuracy and resulted in unrealistic ear canal temperature outliers. It was found that the Cosinuss° °Temp thermometer did not result in significant interference during work. Therefore, it was concluded that, without a correction factor, the Cosinuss° °Temp thermometer is inaccurate. Nevertheless, with a correction factor, the reliability of this wearable ear canal thermometer was confirmed at rest, but not in outdoor working conditions or while wearing a helmet or hearing protection equipment.

Suitability of Different Thermometers for Measuring Body Core and Skin Temperatures in Suckling Piglets

Simple Summary

After birth, piglets’ temperatures usually drop some degrees because of low ambient temperatures in the stable. Piglets have no ability to increase their body temperatures during their first days of life, which can cause health issues if piglets are not appropriately cared for. Monitoring temperatures can, therefore, contribute to reducing impaired wellbeing and unnecessary losses. The most common method for assessing core temperatures is measuring rectally with a digital thermometer. This, however, takes time and requires securing of the animal, which is stressful. Therefore, the aim of this study was to determine whether other thermometers or thermometric devices, such as an infrared camera, can deliver results similar to the digital thermometer. For the measurements in newborn piglets, infrared ear thermometers, infrared forehead thermometers, and infrared laser thermometers were used, as it was assumed that these would deliver results fast and cause little distress in piglets. The results were compared to rectally measured temperatures and it was found that the temperatures measured in-ear correspond to a great extent to rectal temperatures and show little variation between measurements, while the other used devices can only give a rough estimate of the actual core temperatures.

Abstract

Monitoring the temperature of piglets after birth is critical to ensure their well-being. Rectal temperature measurement is time-consuming, requires fixation of the animal and is stressful for piglets. This study aims to evaluate the effectiveness of infrared thermometry and thermography as compared to rectal temperatures. We investigated digital thermometers for rectal measurements, infrared ear thermometers, infrared forehead thermometers, infrared laser thermometers and an infrared camera during field trials with piglets aged 1–13 days. Temperatures differed between the left and right ear and ear base (p < 0.01), but not between temples. Three forehead and laser devices yielded different temperatures (p < 0.01). Temperatures assessed with a laser thermometer decreased with distance from the target (p < 0.01). The highest correlation observed was between the rectal and tympanic temperatures (r = 0.89; p < 0.01). For temperatures assessed with the camera, inner thigh and abdomen correlated most closely to core temperature (0.60 ≤ r ≤ 0.62; p < 0.01). Results indicate that infrared ear thermometry commonly used in humans is also suited for assessing temperature in piglets. The inner thigh and abdomen seem promising locations for estimating core temperature with an infrared camera, but this approach needs to be adapted to reduce time exposure and stress for the piglets to be used under practical conditions.

Improving early detection of infection in nursing home residents in South Africa

This paper sets out key challenges related to detection and management of infection in nursing home residents, and then explores the situation in South Africa, and use of decision support tools as a mechanism to improve this area of practice. In line with global trends, concerns have been raised about the rapidly increasing aging population in South Africa and the ability of the current healthcare system to keep pace with patient demand, particularly nursing home residents. Nursing home residents, who often exhibit atypical signs and symptoms, are at increased risk of infection and unplanned admissions, which account for 65% of all bed days, and cost the US healthcare economy more than a trillion dollars a year. Evidence suggests that the current workforce in South Africa receive limited training in this area and are largely unprepared to meet the demands of the aging population. Building the capacity and skills of the workforce in South Africa is one approach that could help to improve the early detection of infection and assist the nursing home workforce to provide more effective and timely care, particularly during the current COVID-19 pandemic. Decision support tools, such as the Early Detection of Infection Scale, can help ensure consistency and ensure more timely treatment, minimising unplanned admissions and healthcare expenditure. However, the potential benefits or indeed how easily this could be integrated in to nursing homes in South Africa is unknown. An important first step, as in other parts of the world, is therefore to explore views and opinions of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes.

Characterization of MSlys, the endolysin of Streptococcus pneumoniae phage MS1

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MSlys is a choline binding protein from pneumococcal MS1 phage.

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Planktonic and biofilm S. pneumoniae cells are affected by MSlys treatment.

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MSlys is active against isolates from otitis media infections and works in the conditions commonly found in this environment.

Despite the use of pneumococcal conjugate vaccines, the number of infections related to Streptococcus pneumoniae continues to be alarming.

Herein, we identified, characterized the MSlys endolysin encoded in the phage MS1. We further tested its antimicrobial efficacy against planktonic and biofilm cells, assessing the culturability of cells and biofilm structure by scanning electron microscopy, and confocal laser scanning microscopy.

The modular MSlys endolysin consists of an amidase catalytic domain and a choline-binding domain. MSlys is active against isolates of children with otitis media, and conditions close to those found in the middle ear. Treatment with MSlys (2 h, 4 μM) reduced planktonic cultures by 3.5 log10 CFU/mL, and 24- and 48-h-old biofilms by 1.5 and 1.8 log10 CFU/mL, respectively. Imaging of the biofilms showed thinner and damaged structures compared to control samples.

The recombinantly expressed MSlys may be a suitable candidate for treating pneumococcal infections, including otitis media.

Exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and manager's in nursing homes in England and Sweden: a survey protocol

INTRODUCTION

In order to avoid unnecessary hospital admission and associated complications, there is an urgent need to improve the early detection of infection in nursing home residents. Monitoring signs and symptoms with checklists or aids called decision support tools may help nursing home staff to detect infection in residents, particularly during the current COVID-19 pandemic.We plan to conduct a survey exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes in England and Sweden.

METHODS AND ANALYSIS

An international cross-sectional descriptive survey, using a pretested questionnaire, will be used to explore nurses, care workers and managers views and experiences of how infections are detected and managed in practice in nursing homes. Data will be analysed descriptively and univariate associations between personal and organisational factors explored. This will help identify important factors related to awareness, knowledge, attitudes, belief and skills likely to affect future implementation of a decision support tool for the early detection of infection in nursing home residents.

ETHICS AND DISSEMINATION

This study was approved using the self-certification process at the University of Surrey and Linköping University ethics committee (Approval 2018/514-32) in 2018. Study findings will be disseminated through community/stakeholder/service user engagement events in each country, publication in academic peer-reviewed journals and conference presentations. A LAY summary will be provided to participants who indicate they would like to receive this information.This is the first stage of a plan of work to revise and evaluate the Early Detection of Infection Scale (EDIS) tool and its effect on managing infections and reducing unplanned hospital admissions in nursing home residents. Implementation of the EDIS tool may have important implications for the healthcare economy; this will be explored in cost-benefit analyses as the work progresses.

Monitoring core temperature of firefighters to validate a wearable non-invasive core thermometer in different types of protective clothing: Concurrent in-vivo validation

This study aims (1) to test the validity of a new non-invasive core thermometer, Cosinuss°, in rest and (2) during firefighting simulation tasks, against invasive temperature pill and inner-ear temperature and (3) to compare the change in core temperature of firefighters when working in two types of protective clothing (traditional turnout gear versus new concept). 11 active firefighters performed twice a selection of tasks during their periodic preventive medical examination and a fire-extinguishing task. Without correction no correlation between the Cosinuss° and thermometer pill (ICC≤0.09, p ≥ 0.154, LoA≥1.37) and a moderate correlation between Cosinuss° and inner-ear infrared (ICC = 0.40, p = 0.044, LoA±1.20) was observed. With individual correction both correlations were excellent (ICC≥0.84, p = 0.000, LoA≤0.30). However, during and after working all correlations were poor and non-significant (ICC≤0.38, p ≥ 0.091, LoA≥1.71). During firefighting tasks, the Cosinuss° is invalid for measuring the core temperature. No differences in heat development in the two types of protective clothing was proven.

Sensitivity Analysis of a Numerical Model for Percutaneous Auricular Vagus Nerve Stimulation

Background: Less-invasive percutaneous stimulation of the auricular branch of the vagus nerve (pVNS) gained importance as a possible nonpharmacological treatment for various diseases. The objective is to perform a sensitivity analysis of a realistic numerical model of pVNS and to investigate the effects of the model parameters on the excitation threshold for single and bundled axons. Methods: Sim4Life electrostatic solver and neural tissue models were combined for electromagnetic and neural simulation. The numerical model consisted of a high-resolution model of a human ear, blood vessels, nerves, and three needle electrodes. Investigated parameters include the axon diameter and number, model temperature, ear conductivity, and electrodes’ penetration depth and position. Results: The electric field distribution was evaluated. Model temperature and ear conductivity are the non-influential parameters. Axons fiber diameter and the electrodes’ penetration depth are the most influential parameters with a maximum threshold voltage sensitivity of 32 mV for each 1 μm change in the axon diameter and 38 mV for each 0.1 mm change in the electrodes’ penetration depth. Conclusions: The established sensitivity analysis allows the identification of the influential and the non-influential parameters with a sensitivity quantification. Results suggest that the electrodes’ penetration depth is the most influential parameter.