- Administered questionnaires
- Performed skin prick tests to common aeroallergens
- Collected blood samples for total IgE & specific IgE
FENO measurement:
- Using NIOX MINO ( Aerocrine AB, Solna, Sweden)
- According to ATS/ERS guidelines
JACI. 2011; 127 ( 5) : 1165-72.e5.
Allergic sensitization:
- Positive SPT ( wheal diameter ≥ 3 mm) to at least one allergen
- Or specific IgE ≥ 0.35 kU/L to at least one allergen
Asthma:
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
This presentation describes the indications, contraindications, methods of performing spirometry. It explains the interpretation of spirometry with examples.
New technology called Electromagnetic Navigation Bronchoscopy® (ENB) that uses virtual bronchoscopy and real time 3-dimensional CT images that enable me to localize these peripheral lung nodules for diagnosis and treatment. This outpatient procedure is minimally invasive and therefore has a small risk of pneumothorax (2-3%) and its published diagnostic yield rates range from 67% - 86%
This presentation describes the indications, contraindications, methods of performing spirometry. It explains the interpretation of spirometry with examples.
What are the pulmonary function tests used?
What are the indications?
What are the contraindications?
How to perform each and prepare patients?
How to interpret and reach a diagnosis?
How to clean and calibrate devices?
Bronchial Thermoplasty (BT) Novel Treatment for Patients with Severe AsthmaBassel Ericsoussi, MD
Do our Asthma Patients Know What They Are Missing?Now, A Revolutionary Procedure Can Help Them Lead A Fuller Life.
Bronchial Thermoplasty (BT) Novel Treatment For Patients With Severe Asthma
Basic information on the Graphics displayed on the Ventilators. Prepared to educate about the graphics to train the professionals who work with Ventilators.
What are the pulmonary function tests used?
What are the indications?
What are the contraindications?
How to perform each and prepare patients?
How to interpret and reach a diagnosis?
How to clean and calibrate devices?
Bronchial Thermoplasty (BT) Novel Treatment for Patients with Severe AsthmaBassel Ericsoussi, MD
Do our Asthma Patients Know What They Are Missing?Now, A Revolutionary Procedure Can Help Them Lead A Fuller Life.
Bronchial Thermoplasty (BT) Novel Treatment For Patients With Severe Asthma
Basic information on the Graphics displayed on the Ventilators. Prepared to educate about the graphics to train the professionals who work with Ventilators.
In this study, we focused on the effect of β-glucan supplementation of children with chronic respiratory problems. We measured the levels of cortisol, salivary IgE and cotinine in 56 children and evaluated the effect of 30 day supplementation with 100 mg/day oral dose of yeast-derived β-glucan. Our results showed strong decrease of cotinine and cortisol levels in saliva of β-glucan-supplemented children. The increase of total salivary IgE levels in both groups was not statistically significant. The positive effects of complex curative treatment using β-glucan were accompanied by increased physical endurance and by significant reduction of negative clinical problems of affected children.
biological exploration of immunoallergic events at the pasteur institute of c...IJAEMSJORNAL
Introduction : The Immunology Laboratory at the Pasteur Institute of Côte d'Ivoire (IPCI) provides the diagnosis of many diseases including immuno-allergic diseases. This study aimed to indicate the various biological tests used in the diagnosis of immuno-allergic diseases. Patients and methods: This was a retrospective study from 2012 to 2014with 113 patients. Multi allergenic specific IgE Test, ALL ONZE and ALL CHECK and automated assay VIDAS systemfor total IgE were used on sera of patients. Results: Private and public hospitals provided all the patients. The clinical manifestations were mostly skin,respiratory and ENT diseases (76,10%) .About 65,48 % of patients were aged 3 to 45 years. Pneumallergens occupied the first place,followed by dust cockroaches ,moulds, and pollens.Conclusion: It is necessary to advocate epidemiological investigation on a large scale following the U.S. and Europe investigation models to screen local allergens.
Efficacy and safety of immunomodulators in pediatric age - Slideset by Profes...WAidid
«The first cause of recurrent infections in children is... childhood itself.» (J. Gary Wheeler)
Is it possibe to treat and prevent recurrent respiratory infections (RTIs) in pediatric age? Some studies have shown that immunostimulants/immunomodulators can reduce and prevent RTIs in children.
To learn more please visit www.waidid.org
Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchial Asthmatic P...MatiaAhmed
Asthma affects more than 100 million people worldwide. lncreased morbidrty
include increased exposure to indoor allergens and environmental pollutants
agonist, under-use of anti-inflammatory mediators and limited education about healu' care
סקירה המתמקדת בממצאי תשעה מחקרים אפידמיולוגיים עדכניים שנעשו בעולם ועוסקים בקשר שבין חשיפה קצרת טווח לזיהום אוויר מתחבורה ותחלואה בקרב ילדי בי"ס (ברמה עולמית, אירופה, קנדה ובארה"ב).
מצגת זו הוצגה במסגרת הרצאה אשר ניתנה בפני הפורום לבריאות וסביבה, המשרד להגנת הסביבה, על ידי ד"ר חוה פרץ מהמחלקה לאפידמיולוגיה, אוניברסיטת תל אביב.
Immunotherapy in children SCIT or SLIT. Dra. Desirée Larenas WISC Dec2014 ...Juan Carlos Ivancevich
Symposium: Immunotherapy in Latin America - WISC 2014- Rio de Janeiro
Symposium 5: Latin American Society of Allergy and Immunology (SLAAI) Symposium: Immunotherapy in Latin America Sala 1 & 2 (Sul America)
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. Establishing standard definitions and data collection
methodologies for validated outcomes measures in
asthma clinical research
Identifying promising outcomes measures for asthma
clinical research that require further development
Szefler SJ et al. Asthma outcomes: Biomarkers. JACI. 2012; 129( 3Suppl):S9-23.
3. Core outcome
- A set of asthma outcomes considered by
NIH and other agencies as requirement for
funding support
: Multi-allergen screening to define atopy
Szefler SJ et al. Asthma outcomes: Biomarkers. JACI. 2012; 129( 3Suppl): S9-23.
4. Standard definitions have been developed,
method for measurement can be specified,
validity has been proved but whose inclusion in funded
clinical asthma research will be optional
- CBC to measure total eosinophils
- Fractional exhaled nitric oxide ( Feno)
- Sputum eosinophils
- Urinary leukotrienes
- Total and allergen-specific IgE
Szefler SJ et al. Asthma outcomes: Biomarkers. JACI. 2012; 129( 3Suppl): S9-23.
5. Have potential to : expand/ improve current
aspects of disease monitoring and improve translation
of basic and animal model-based asthma research into
clinical research. They are not yet standardized and
need more development and validation
- Sputum PMN leukocytes
- Cortisol measures
- Airway imaging
- Breath markers
- System-wide studies ( genomics, proteomics)
Szefler SJ et al. Asthma outcomes: Biomarkers. JACI. 2012; 129(3Suppl):
S9-23.
6. Nitric Oxide ( NO) is an pollutant emitting from
vehicle and cigarette smoke
A biological mediator in animal and human
Produced by human lungs
Roles of NO:
- Vasodilator
- Bronchodilator
- Neurotransmitter
- Inflammatory mediator
Palmer RM, Ashton DS, Moncada S. Vascular endothelial cells synthesize nitric
oxide from L-arginine. Nature 1988; 333: 664-666.
Nathan C, Xie QW. Nitric oxide synthases: roles, tolls, and controls. Cell 1994; 78:
915-918.
7. Highly reactive molecule/ free radical and has oxidant
property
Bactericidal and cytotoxicity for tumor cell
Pathophysiology of NO in airway and lung:
- A pro-inflammatory mediator lead to airway
hyper-responsiveness
Reid DW, Johns DP, Feltis B, Ward C, Walters EH. Exhaled nitric oxide
continues to reflect airway hyperresponsiveness and disease activity in inhaled
corticosteroid- treated adult asthmatic patients. Respirology. 2003; 8: 479-486.
8. FENO used as quantitative method of airway nitric oxide
( NO), produced by NO synthases
Noninvasive, simple, and safe method
An indirect marker for eosinophilic airway inflammation
Support diagnosis of eosinophilic asthma
Determining corticosteroid responsiveness ( more
consistently than other methods)
Evaluation of adherence to anti-inflammatory drugs
Dweik RA et al. An official ATS clinical practice guideline: Interpretation of exhaled nitric
oxide levels ( (FENO) for clinical applications. Am J Respir Crit Care Med.
2011; 184: 602-615.
9.
10.
11.
12. Low FENO ( < 25 ppb in adult, < 20 ppb in kids)
- Less likely eosinophilic inflammation &
responsiveness to corticosteroid
High FENO ( > 50 ppb in adult, > 35 ppb in kids)
- More likely for eosinophilic inflammation &
in symptomatic patient, more response to
corticosteroid
13. Significant increase in FENO
- Greater than 20% ( if value > 50 ppb)
- More than 10 ppb ( if value < 50 ppb)
Significant decrease in FENO
- Greater than 20% (if value > 50 ppb)
- More than 10 ppb ( if value < 50 ppb)
14.
15. Not associated with neutrophilic airway
Inflammation
Children younger than 4 years
False negative in patient already treated with ICS
16. Age , FENO increase 5% per year ( important in children)
Height
Atopic symptoms
Smoking
Anti-inflammatory drugs
Measurement technique
Exhalation flow rate
Nasal NO contamination
NO analyzer used
Borrill Z, Clough D, Truman N, Morris J, Langley S, Singh D, A comparison of exhaled nitric oxide
measurements
performed using three different analyzers. Respir Med 2006; 100: 1392-1396.
Buchvald F et al. Measurements of exhaled nitric oxide in healthy subjects age 4 to 17 years. JACI 2005;115:
1130-1136.
19. To study association between exhaled nitric
oxide, asthma and atopy in a variety clinically relevant
phenotypes in a cohort of 6-year-old children
20. The New Zealand Asthma and Allergy Cohort Study
At Wellington and Christchurch
From 1997-2001
Participants:
- Mothers were recruited randomly by midwives
( previous study)
- Questionnaires were administered by nurses at
start, 3, 15, 24, 36, 48 & 60 mo of age
- Home visit at 3 & 15 months & others by telephone
- Outcomes were measured at 15, 36, 48 & 60 months
Epton M, Town G, Ingham T, et al. The New Zealand infant cohort study : assembly,
demographics and investigations. BMC Public Health 2007; 7: 26.
Pediatr Allergy Immunol 2012; 23: 59-64.
21. Participants:
- Between the ages of 6-7 years
- Questionnaires & clinical assessments :
- FENO measurement
- SPT to food & environmental allergens
- Blood for total & specific IgE
Measurement of exhaled nitric oxide :
- Using Aerocrine NIOX chemiluminescence analyser at flow rate 50
ml/s
- Range of detection from 2- 200 p.p.b.
- FENO was measured according to American Thoracic Society /
European Respiratory Society guidelines
- Before NO measurement, mothers were asked whether the child had a
cold, respiratory infection or had exercised a last hour before
Pediatr Allergy Immunol 2012; 23: 59-64.
22. SPT:
- Allergens: Der p, cat, dog, horse, cockroach mix,
rye grass, olive tree, Aspergillus fumigatus, peanus,
Alternaria tenuis, egg white, & cow’s milk ( Dome/
Hollister-Stier, Spokane, WA, USA)
- Mean wheal diameter was measured
- A positive reaction defined as a mean wheal diameter
of 3 mm or greater
- Atopy defined as positive one or more reaction to SPT
Pediatr Allergy Immunol 2012; 23: 59-64.
23. Wheezing, asthma & family history definitions
- Mother/caregiver was asked for child’s wheezing at each visit
- Wheezing classified as:
- Early transient ( occur from birth to 3 y )
- Late onset ( from 3-6 y)
- Persistent wheeze ( from birth-6 y)
- Current asthma ( previous doctor’s diagnosis
of asthma at any time & current wheeze, inhaler use
- A family history of allergic disease ( a parental report of either parent
having a history of asthma, allergic rhinitis or eczema )
Pediatr Allergy Immunol 2012; 23: 59-64.
24. IgE measurement
- Total IgE
- Specific IgE
- These were measured by IMMULITE 2000
Siemens Medical, Deerfield, IL, USA
- Atopy defined as any sIgE 0.35 kU/l or more
Pediatr Allergy Immunol 2012; 23: 59-64.
31. FENO is closely related to specific IgE to aeroallergens
among allergic children
The main factor of airway inflammation is sIgE
to aeroallergen & to Der p that children have
continually exposed at a high level
FENO is not elevated in non-allergic asthma
Children
33. Whether FENO was increased in children with allergic
sensitization or asthma
Whether specific allergen exposure increased FENO
level in sensitized , but not in un-sensitized children
Whether sedentary behavior increased
FENO, independent of allergen exposures
JACI. 2011; 127 ( 5) : 1165-72.e5
34. Children whose mothers reside in Boston Metropolitan area
Between Sep 1994-Aug 1996 ( cohort study)*
Children whose mothers:
- Age at least 18 y
- History of hay fever, asthma, or allergy in
at least one of the child’s parents
- Families were not screened if NB was admitted
in NICU, maternal gestational age < 36 wk or
he/she had a congenital anomaly
*Gold DR, Burge HA, Carey V, Milton DK, Platts-Mills T, Weiss ST. Predictors of repeated
wheeze in the first year of life : The relative roles of cockroach, birth weight, acute lower
respiratory illness , and matrnal smoking. Am J Respir Crit Care Med. 1999; 160(1): 227-36.
JACI. 2011; 127 ( 5) : 1165-72.e5.
35. A series of home visit:
- At age 2-3 months, 7 y, 12 y
Questionnaires : by trained research assistants ( home visit)
- Demographics
- Home characteristics
- Environmental exposures
- Tobacco use
- Health outcomes
Questionnaires : by telephone every 6 months
JACI. 2011; 127 ( 5) : 1165-72.e5.
36. Participants :
Enrolled F/U until age 12 y FENO
measurement
430 277
505 ( 64%)
(85%)
JACI. 2011; 127 ( 5) : 1165-72.e5.
37. Home visit & dust sample collection
- Measurement of bed dust mite ( by Eureka Mighty-Mite
vacuum cleaner : Model 3621; Eureka Co. , Bloomington IN)
modified to hold 19*90 mm cellulose extraction thimbles
- All layers of the bedding were vacuumed for 10 min
- Allergen concentrations (ug/g dust) for Der p1,Der f1,
Fel d1, Bla g2 quantified by ELISA
- Cut off point :
for Der p 1, Der f1 greater than 10 ug/g
for Cat allergen greater than 8 ug/g
for Cockroach above detectable levels
JACI. 2011; 127 ( 5) : 1165-72.e5
38. Assessment of allergic sensitization
- Specific IgE to common ( outdoor & indoor) allergens
were done using the UniCap 250
system in 189 children
- Positive test was greater than 0.35 IU/ml
- Specific IgE + SPT + FENO in 208 children
JACI. 2011; 127 ( 5) : 1165-72.e5
39. Assessment of TV watching /video game playing
- Collecting data every 6 months by telephone
- Using the closest time to FENO measurement
- Assess hour of weekday & weekend separately
- Categories: ( none, 1-5 hr, 6-10 hr, 11-15 hr,
or 16-20 hr)
- Also ask for “ physical activity” day/week
Definition of respiratory symptom outcomes
- Collecting every 6 months by telephone
- Outcomes: current asthma; any wheeze;
dry cough at night; current rhinitis
JACI. 2011; 127 ( 5) : 1165-72.e5
40. Spirometry:
- Albuterol was administered ( 180 ug; 2 puffs
with spacer) & wait 10 min
- Apply spirometry before & after medication
- Positive bronchodilator response : 12% increase
in FEV1
JACI. 2011; 127 ( 5) : 1165-72.e5
41. Measurement of FENO :
- FENO level by using a portable electrochemical
device ( NIOX MINO); Aerocrine AB
- Validated by chemiluminescene technology; +-5 ppb
- Subject breathed in through an NO scrubbing filter & exhaled
out into the room air twice
- Then inhaled a third time through the filter & exhaled
into the FENO analyzer
- Flow rate of 50 ml/s without a nose clip
- The last 3 seconds of exhalation was assessed
- This procedure was done 3 times, the median value was used
JACI. 2011; 127 ( 5) : 1165-72.e5
49. The first study to investigate the independent impact of
home allergens and sedentary home behavior on FENO in
high risk children for allergies & asthma
- Sensitization : predictor of airway inflammation
- Allergic sensitization : key factor in NO production
- Sedentary behavior has positive association with FENO
50. FENO : used as a biomarker in assessment and
management of airway inflammatory disease
FENO is a noninvasive, ease of repeat measurement, &
easy use in patients