Mobile health (mHealth) connects patients, their families, and health care professionals by creating a network with mobile and specialized devices with wearable sensors, recording health parameters, and gathering health data. Health information can be subsequently converted and transferred to physicians and other health care professionals involved in the care of patients via medical application interfaces. By enabling patients to access and share their health information, mHealth empowers patients to become more engaged and to take initiative in self-management and shared management of their health. Since the first description of the concept of mHealth [ 1 ], its popularity has exponentially increased. This is primarily because of the fast expanding technological advances including the development of smartphones and fourth generation mobile communication system networks. The impressive popularity of mHealth apps in the last decade is reflected by the number of downloads in recent years, exceeding 200 million in 2010 [ 2 ]. On the wider mHealth market, various apps have been developed for different purposes. The latter include apps for disease prevention among healthy users [ 3 ] and apps for people with existing chronic health conditions [ 4 ]. A recent study, for example, demonstrated that apps can contribute to improve disease control in people with diabetes [ 5 ], hypertension [ 6 ], or asthma [ 7 ] and can help for the monitoring and self-management of obesity [ 8 ], mental health diseases [ 9 ], and multimordbidities [ 10 ]. A total of 17.3 million people report having rheumatic and musculoskeletaldiseases (RMDs), the most frequent being low back pain and osteoarthritis (OA) [ 11 ]. As RMDs have multidimensional consequences on health, the increasing availability of apps has an important role to play in enabling people with RMDs to better self-manage their health [ 12 ]. Moreover, in a recent study of people with rheumatoid arthritis (RA), 86% agreed that an app to support self-management would be useful and welcomed [ 13 ]. This being said, the dramatic increase and adoption of mHealth apps and the business it generates raise some fundamental questions, such as (1) How is the scientific content controlled? and (2) How can we make sure that apps are appropriate for patients?
The role of self-management in rheumatic and musculoskeletaldiseases (RMDs) has become increasingly recognized, especially in support of holistic and patient-centered care [ 1 ]. A growing number of patients seek out various sources of information to better understand and manage their disease as part of their quest to take a more active role in their care [ 2 , 3 ]. Self-management refers to “the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences, and lifestyle changes inherent in living with a chronic condition” [ 4 ]. In line with this, the past decade has witnessed an exponential growth of mobile phones and other electronic apps. A cumulative willingness of healthy individuals to improve their lifestyle has led to the demand for new digital lifestyle management solutions. The use of apps could support people taking personal responsibility for their well-being and contribute to their disease management in a more proactive way. Indeed, the number of health-related devices downloaded from various app stores has more than doubled from 1.7 billion in 2013 to 3.7 billion in 2017 [ 5 ].
including, but not limited to, rheumatic and muscu- loskeletal diseases (RMDs), 5 psychiatric, 6 respiratory, 7
cardiovascular diseases 8 and diabetes mellitus. 9
The use of such apps is becoming more and more popular among people living with long-term conditions. Aside from the increasing popularity of apps among people with long-term conditions, mHealth apps can support disease assessment by health professionals and enhance doctor– patient interactions. For example, they have been useful tools to facilitate the calculation of disease activity scores, and monitor patients through the collection of clinical and laboratory parameters. 10 A survey performed among
& Medications that affect bone bones (e.g., glucocorticoids, antiepileptic medications)
& Postbariatric surgery.
High-risk minority groups mentioned above with a confirmed diagnosis of vitamin D deficiency should receive higher than normal doses than the general population. While other non- skeletal metabolic abnormalities linked to vitamin D deficiency in the Saudi population such as obesity [ 26 ], metabolic syndrome [ 27 ], type 2 diabetes mellitus [ 28 ], and auto-immune diseases [ 29 ] may benefit from vitamin D status correction, mandatory screening is not recommended unless the patient has other risk factors and clinical features consistent with the ones mentioned above.
The fact that patients proactively shared research opportunities might indicate a
heightened level of research readiness, which could help recruit people with RMDs into research studies during and after a pandemic. Studies reported the successful use of SM for research participant recruitment efforts across different diseases , a notion supported by our patient research partner who stated: “The importance of this study lies in the fact that it [uses patient-generated] real-time data, [where] patients do not have the stress of answering questions by a researcher, do not worry if they give ‘the right answer’ so their responses are more spontaneous and authentic.”
Results and conclusion: Recommendations were restricted to clinical practice and concern
adult patients with or at risk for fractures, falls, cardiovascular or autoimmune diseases, and cancer. The panel reached substantial agreement about the need for vitamin D
supplementation in specific groups of patients in these clinical areas and the need for assessing their 25-hydroxyvitamin D (25(OH)D) serum levels for optimal clinical care. A target range of at least 30 to 40 ng/mL was recommended. As response to treatment varies by environmental factors and starting levels of 25(OH)D, testing may be warranted after at least 3 months of supplementation. An assay measuring both 25(OH)D 2 and 25(OH)D 3 is recommended. Dark-skinned or veiled individuals not exposed much to the sun, elderly and institutionalized individuals may be supplemented (800 IU/day) without baseline testing.
Arts et Metiers Paristech, CNRS, LSIS, Aix-en-Provence, France
Keywords: musculoskeletal models; multiphysical systems; bond graphs
Under certain flight conditions, a rotorcraft fuselage motions and vibrations might interact with its pilot voluntary and involuntary actions leading to potentially dangerous dynamic instabilities known as rotorcraft-pilot couplings (RPCs). A better understanding of this phenomenon could be achieved by being able to reproduce the phenomenon during simulations. Design guidelines could be then obtained at an early stage of development of rotorcrafts improving flight safety for pilots and passengers. In this work, an upper limb musculoskeletal model using bond graphs is presented. It is then integrated in a larger aeroelastic rotorcraft bond graph model that allows simulating pilot-rotor-fuselage couplings under several flight conditions. Simulations are performed and compared to literature’s models and experimental data.
Hagberg, M., Silverstein, B. A., Wells, R., Smith M.J., Herbert, R., Hendrick H.W., Carayon P., and Pérusse M. (1995). Work related musculoskeletal disorders (WMSDs). A reference book for prevention. Taylor and Francis, Bristol.
Heinrich, J., Blatter, B. M., and Bongers, P. M. (2004) - A comparison of methods for the assessment of postural load and duration of computer use. Occup. Environ. Med.; 61 1027-1031. Kaergaard, A. and Andersen, J. H. (2000) - Musculoskeletal disorders of the neck and shoulders in female sewing machine operators: prevalence, incidence, and prognosis. Occup. Environ. Med.; 57 528-534.
Methods. We used data from the 2002-2003 French experimental network of Upper-limb
work-related musculoskeletal disorders (UWMSD), performed on 2685 subjects in which 37 variables assessing biomechanical exposures were available (divided into four ordinal categories, according to the task frequency or duration). Principal Component Analysis (PCA) with orthogonal rotation was performed on these variables. Variables closely associated with factors issued from PCA were retained, except those highly correlated to another variable (rho>0.70). In order to study the relevance of the final list of variables, correlations between a score based on retained variables (PCA score) and the exposure score suggested by the SALTSA group were calculated. The associations between the PCA score and the prevalence of UWMSD were also studied. In a final step, we added back to the list a few variables not retained by PCA, because of their established recognition as risk factors.
2.1.3 Boundary and loading condition
In FE models representing in vitro specimens, boundary and loading conditions are normally based on corresponding controlled in vitro studies. Such studies mostly focused on repro- ducing in vitro experiments. For instance, passive flexion load as displacement was applied on the tibia in a study to understand the behavior of stressed and stress-free ligament (Lim- bert, Taylor, and Middleton, 2004 ). Other studies also attempted to implement in vivo alike dynamic loads. To observe detailed biomechanics (e.g., joint kinematics, ligament and ex- tensor muscle forces) of the knee joint in various closed kinematics chain exercises, (Mesfar and Shirazi-Adl, 2005 ) introduced flexion load at the tibia under various quadriceps force by keeping the femur fixed. Based on the results, this study advocated the use of squat exercises in post-ligament reconstruction period. In a similar fashion, (Baldwin et al., 2012 ) and their subsequent works used a whole joint knee simulator (Kansas Knee Simulator) to apply dy- namic loads on the joint of a cadaveric specimen. Then the experimental loading profile was implemented to evaluate the FE model of the knee joint. Although such models based on cadaveric specimens are admirable in increasing knowledge on interaction between passive stabilizers of the joint, yet debatable for muscular activity in the absence of physiological loading conditions. Moreover, such implemented loads are largely generic as same loading pattern were applied for different specimens, whereas the knee joint is subjected to variable loading conditions during daily life activities such as walking. In vivo based computational models such as musculoskeletal models seem to be an efficient alternative since such models can embody physiological loading conditions based on motion analysis data.
G. De Magistris, A. Micaelli, C. Andriot, J. Savin, and J. Marsot. Dynamic virtual manikin control design for the assessment of the workstation er- gonomy, 2011.
LI Guangyan and P. Buckle. Current techniques for assessing physical ex- posure to work-related musculoskeletal risks, with emphasis on posture- based methods. Ergonomics, 42(5):674–695, 1999.
V) A new paradigm: reducing meat consumption
In this final part, we emphasize another regulatory direction. As illustrated in the previous Section, essentially all the literature on animal infectious disease prevention, including various reports produced by international institutions such as FAO, WHO, OIE or the World Bank, concentrates on the supply side. It typically overlooks the issues related to the demand for meat, or essentially takes this demand as exogenously given. But meat production increases because there is a demand for it. In 50 years, between 1960 and 2010, the global stocks of chickens and pigs increased by factors of 5 and 2.5, respectively (Gilbert et al. 2014). In Asia, during this period, meat consumption has been multiplied by 15 while population has been multiplied by 2.6. While designing the regulation of the supply side is highly complex as argued above, in contrast, reducing meat consumption appears to be a silver bullet. Since not one single pandemic in human history can be traced back to plants (Schuck Paim and Alonso, 2020), substituting animal-based food with plant-based food should largely reduce overall zoonotic risks. In other words, a shift to more sustainable plant-based proteins should offer resilience where various forms of animal protein production have failed. This advantage should then be added to the long list of benefits of reducing meat consumption, including the decrease in greenhouse gases emissions, air pollution, land use, water use, water pollution, and likely the incidence of major noncommunicable diseases in developed countries (i.e., cancers, diabetes, cardiovascular diseases) (Godfray et al., 2018; Poore and Nemecek, 2018; Tschofen et al., 2019; Willett et al., 2019).
Promising therapeutic options include macrolides. Indeed, these antibiotics have been shown to display a number of anti-inflammatory and immunomodulatory actions. Although the mechanisms and cellular targets specific to macrolide activity remain to be elucidated, beneficial effects in several chronic lung diseases includ- ing chronic obstructive pulmonary diseases (COPD) and cystic fibrosis have been reported [207,208]. Of interest is the ability of macrolides to accumulate in host cells including epithelial cells and phagocytes. In a recent report, a favorable response to treatment with clarithro- mycine has been described in an adult patient with DIP . Other new therapeutic strategies currently pro- posed in adult patients target fibrogenic cytokines. The Th1 cytokine interferon-g has an antifibrotic potential through suppression of Th2 fibrogenic functions. Antagonists to TGF-b include pirfenidone and decorin. The use of molecules directed against TNF-a such as the soluble TNF-a receptor agent etanercept is also under investigation. To date, there are no reports on the use of these novel therapies in pediatric ILD. Finally, in the coming years, it is likely that an expanding number of molecules aimed at favoring alveolar surface regen- eration and repair through activation and proliferation of tissue-resident (progenitor) cells will come out.
Under homeostatic conditions, as well as in various diseases, leukocyte migration is a crucial issue for the immune system that is mainly organized through the acti- vation of bone marrow-derived cells in various tissues. Immune cell trafficking is orchestrated by a family of small proteins called chemokines. Leukocytes express cell-surface receptors that bind to chemokines and trigger transendothelial migra- tion. Most allergic diseases, such as asthma, rhinitis, food allergies, and atopic dermatitis, are generally classified by the tissue rather than the type of inflamma- tion, making the chemokine/chemokine receptor system a key point of the immune response. Moreover, because small antagonists can easily block such receptors, various molecules have been developed to suppress the recruitment of immune cells during allergic reactions, representing potential new drugs for aller- gies. We review the chemokines and chemokine receptors that are important in asthma, food allergies, and atopic dermatitis and their respectively developed antagonists.