Portable Oxygen Monitor for Older Adults With Respiratory Illness

Portable Oxygen Monitor for Older Adults With Respiratory Illness

There are many age-related changes in the pulmonary, immune, and respiratory systems. These changes include reduced lung volume, weakened cough strength, and more susceptibility to infections.

A Clinical Interventions in Aging study showed that chronic lower respiratory tract disease is the third primary cause of death in individuals aged 65 years and older.

The decline in respiratory health can increase the risks of rare lung-related conditions like mesothelioma.

Mesothelioma is rare cancer that usually affects the lungs and is typically caused by asbestos exposure. The incidence rate of this condition is higher in older adults.

Mesothelioma symptoms vary depending on the condition’s progress. For example, this mesothelioma stages guide lists difficulty in breathing as an early symptom.

Suppose your senior loved one has a respiratory-related condition like mesothelioma. In that case, a portable oxygen monitor may help them manage their symptoms.

Other age-related changes in the lungs include:

  • Peak airflow (how fast one can exhale) and oxygen-carbon dioxide exchange rates decline
  • Weakening respiratory muscles
  • Decreases in lung function measures like vital capacity or the maximum amount of air that people can breathe out after a full inhalation
  • The lungs’ natural immunity is less effective

A portable oxygen monitor is a small device you can attach to your finger. This tool can monitor your heart rate and the amount of oxygen in your blood.

How can a portable oxygen monitor help older adults with respiratory illnesses? What is a portable oxygen monitor?

This article discusses the use and value of portable oxygen monitors for older adults with respiratory conditions.

The Benefits of a Portable Oxygen Monitor for Older Individuals With Respiratory Conditions

If you know an older adult or an individual at high risk for respiratory illnesses like coronavirus, a portable oxygen monitor or oximeter can help them monitor their oxygen levels.

Depending on a person’s health, oxygen saturation levels can vary greatly, but older individuals often have lower oxygen saturation levels.

The blood should have an oxygen level between 95% and 100%. However, hospitalized individuals due to coronavirus have oxygen saturation levels of 70% to 80%.

With an oxygen monitor, patients more susceptible to respiratory conditions like the coronavirus can be admitted to the hospital sooner and before their oxygen levels fall dangerously low.

A portable oxygen monitor is often helpful for individuals with illnesses that reduce oxygen saturation. For example, a sleep specialist can advise people with severe snoring or sleep apnea to use a pulse oximeter for monitoring oxygen saturation throughout the night.

At the same time, some medical professionals can suggest wearing an oximeter while exercising or using one to determine whether physical activity is safe for patients with respiratory conditions.

Moreover, some hospitals use pulse oximeters for vulnerable patients. For example, they might attach a pulse oximeter to an infant in a neonatal critical care unit to notify the medical staff of low oxygen saturation.

Furthermore, your doctor can use an oxygen monitor as a stress test.

Typically, you use a portable oxygen monitor by inserting your finger into the gadget. After a few seconds, the device will give you a complete measurement of your oxygen levels.

These smart gadgets assess blood oxygen levels using light.

A sensor analyzes the amounts of light wavelengths absorbed by hemoglobin with and without oxygen.

Then, a LED (light-emitting diode) sends the light waves from one side of the finger to the photodetector sensor on the other side of the finger.

The amount of oxygen in the blood affects how much light is absorbed.

Blood Oxygen Levels

“Blood oxygen level” means the amount of oxygen in your blood.

Low blood oxygen levels could indicate a lung or circulatory problem.

Portable oxygen monitors cannot diagnose conditions like coronavirus disease. Still, this device can help older individuals track their overall well-being and identify potential symptoms.

Here’s a list of things you can consider that may help you identify if your senior loved one is showing symptoms of a respiratory condition:

  • Your loved one is shaking or shivering.
  • If you use an oxygen monitor, your loved one’s blood oxygen level is 94% or 93% or continues to decline than their typical reading where their normal oxygen saturation is below 95%.
  • Your loved one is feeling breathless or having difficulty breathing, especially when moving or standing up.
  • Your loved one experiences severe muscle aches or tiredness.

You might have read or heard about oxygen monitors and how medical professionals use them to keep an eye on the well-being of people with coronavirus disease.

But hospitals typically use oxygen monitors to spot early signs of respiratory conditions.

Suppose you don’t have a portable oxygen monitor. In that case, you should order from providers that can deliver the device in a few weeks or months.

You may also ask a friend to lend you the device or request your doctor to check your senior loved one’s oxygen levels.

Reference

1. The aging lung

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825547/

Wellue O2Ring Pulse Oxygen Monitor Review From Wacky Racky

Wellue O2Ring Pulse Oxygen Monitor Review From Wacky Racky

I really don’t even know where to start with this little gadget. Hands down this is the best pulse oxygen monitor on the market that I have found.

Pros:

  • Alarms- Low Oxygen, High and Low Pulse
  • Reports
  • Bluetooth connected Phone App
  • Spot Check Rates While Active

Cons:

  • Not Waterproof (probably not something easily done either)
  • Price (a little on the high side but well worth it)
  • Battery Life (approx 12 hours per charge)

Many consumer-grade pulse oximeters have a hard time getting a reading while you are active. Forget smartwatches, they require you to remain still while they check your oxygen saturation too. This is of no benefit to people with heart or lung disease that need to spot check while active and resting.

While the price tag may seem a little high at $165 let me tell you why it’s worth every penny. Especially with Christmas around the corner, this might be the perfect gift for someone you love who is chronically ill. Personally, if you have it in your budget to buy 2, I would highly recommend doing so especially if the person is on oxygen 24/7. Let me explain why.

Whenever I don’t wear my O2ring, I almost always regret it. The reason is, frankly, I am a dumbass that rarely listens to my body’s warning whistles until it’s to the point of no return. This little device has kept me from going past the point of no return many times since getting it.

Usually, I don’t realize there is something wrong with my oxygen until I have that horrible low oxygen headache. Which feels like someone took a blender to my brain. No alarm bells go off when I am getting more short of breath because I am always short of breath. Even as the headache is building, my internal alarm bells fail to sound the warning. This O2 ring can literally save you from all the headaches low oxygen saturation causes your body.

I live in a house with critters of all kinds. If it isn’t my husband or kids accidentally disconnecting my oxygen, it’s one of the four-legged kids. Or it’s a crack in the line that is making it so my oxygen flow is reduced. One time, this ring alerted me to my oxygen concentrator failing as the compressor was dying and my oxygen flow dropped.

Yes, this ring alerts you not only when your oxygen is dropping but heart rate increase and drop as well. It has several levels of vibration intensity that you can control. You can also custom set your thresholds for your oxygen and heart rate in the phone app.

Several weeks ago my oxygen kept falling and my heart rate kept rising. I couldn’t figure out why for the life of me. To top it off I wasn’t feeling well so I knew something was wrong. However, my line was connected and the tubing was new. So I just kept hitting the ignore.

Over the next few hours, I started feeling even worse and my alarms kept going off. This time I listened to the monitor and decided to check my flow rate was on my concentrator.  This is usually set to 4 LPM. My concentrator was barely registering 1 LPM. At first, I assumed a dog bumped into it and dropped my flow rate down. But when I tried turning it up nothing happened. The next thing I knew, the ear-piercing alarm from my concentrator was going off too. For several hours this little device was trying to tell me something was wrong, I just wasn’t listening.

Had I listened to my O2 Ring when it first started alerting me of the problems I would’ve gotten my concentrator to my supplier during normal business hours instead of relying on their emergency service?

Another time when moving from house to vehicle, from concentrator to tank, I forgot to connect the tubing to the tank or didn’t secure it tight enough. I turned the tank on but somehow the O2 line wasn’t connected. Within a mile down the road, my O2 ring was vibrating. My son immediately checked my tank and noted the detached tubing. I was able to thwart a severe headache because I was wearing this ring.

I decided to take this ring to our local hospital’s Cardio-Pulmonary Rehab to let them try it out for a few weeks. I wanted to get the opinion of respiratory therapists who could run this unit through testing along with their units. This also allowed other patients to try it out to get even more thoughts and opinions. Just like me, everyone loved it. The RTS gave it a 9/10!

If you need a pulse ox this is the best one I have found on the market. If cost is a concern they do make another similar unit. It just doesn’t have all the bells and whistles of this unit but you should check it out below.

Please note, there are no affiliate links. I do not write these reviews to make money on your clicks. I write to educate and help people make informed purchases.

and

https://getwellue.com/pages/wearo2-wearable-pulse-oximeter (I have not tested this unit). This just measures O2 according to the comparison chart. Although images and descriptions show it does both pulse and O2, this unit is also waterproof! It is also documented as lighter, has a longer battery life, and is $65.00 cheaper.

What is Pneumonia?What is the relationship between pneumonia and blood oxygen?

What is Pneumonia?What is the relationship between pneumonia and blood oxygen?

Article overview

1. What is Pneumonia?
2. How Serious is Pneumonia?
3. Causes of Pneumonia
4. Symptoms of Pneumonia
5. Symptoms of Pneumonia in Children
6. What is the relationship between pneumonia and blood oxygen?
7. Wellue O2ring Blood Oxygen Monitor
8. How is Pneumonia Treated?

Respiratory illnesses, including pneumonia, remain a major concern to hospitals around the world, especially during the winter months when an influx of patients can put some hospitals into crisis mode.

Pneumonia ranges in severity from a mild illness to life-threatening. Anyone can contract pneumonia, but babies, young children and older people are particularly susceptible to the dangers of this illness (Healthdirect 2020).

Pneumonia is the leading infectious cause of death in children, with about 15% of deaths attributed to children under five (WHO 2019a).

What is Pneumonia?

 

 

 

 

 

 

Pneumonia is an acute infection of the lungs that causes the alveoli in one or both lungs to fill with pus and fluids.

Pneumonia is an acute infection of the lungs that causes the alveoli in one or both lungs to fill with pus and fluids. This results in lung consolidation (wherein the alveolar spaces are filled with fluid instead of air) and interferes with gas exchange (Better Health Channel 2018; Moyer 2018).

When a person has pneumonia, breathing is painful and oxygen intake is limited (WHO 2019b).

Pneumonia doesn’t discriminate across the lifespan and can affect any age group, though it is more common in young children and older adults (Better Health Channel 2018). Depending on the severity, some people may not necessarily need to be hospitalized, whilst others will.

Generally, those with more comorbidities or any problem that may exacerbate pneumonia will require hospital admission. Pneumonia can also be treated in the community as long as the individual has access to good medical and nursing care.

How Serious is Pneumonia?

In the United States alone, approximately $10 billion is spent each year to manage about 4 million episodes of, and almost 1 million hospitalizations for, pneumonia.

In 2017, over two million people died from pneumonia worldwide (Dadonaite & Roser 2019).

Causes of Pneumonia

 Pneumonia is caused by a viral, bacterial – or rarely – fungal infection (Healthdirect 2020). In some cases, it is triggered by an existing cold or flu that enables pathogens to access the alveoli (Better Health Channel 2018).

 Transmission commonly occurs by inhaling infected droplets in the air from a cough or sneeze of an infected person. It can also spread via blood (WHO 2019b).

Symptoms of Pneumonia

Symptoms may vary depending on age, the cause and severity of the infection, and any existing health problems (Better Health Channel 2018). Assessing the patient and gaining a comprehensive patient history is vital in diagnosis. Symptoms may include:

  • Coughing (dry or productive);
  • Fever, chills, or sweating;
  • Breathing difficulties;
  • Increased respiratory rate;
  • Fatigue or general malaise;
  • Little to no appetite;
  • Chest pain;
  • Abdominal pain or aches;
  • Blue coloring around the mouth (cyanosis); and
  • Nausea, diarrhea, or vomiting.

(Health Direct 2018; Better Health Channel 2018; Healthy WA 2015)

With correct treatment, a health improvement is usually observed within 7 to 10 days (Better Health Channel 2018).

Symptoms of Pneumonia in Children

  • Lethargy;
  • Irritability;
  • Chest pain;
  • Abdominal aches or pain;
  • Fever;
  • Coughing and difficulty breathing;
  • Little to no appetite; and Pallor.

(RCH 2018; Healthy WA 2015)

What is the relationship between pneumonia and blood oxygen?

Low oxygen saturation reflects an integrated noninvasive measure of the extent of lung parenchyma involvement by infection, consequent anatomic and physiologic derangements, and available cardiopulmonary functional reserve, and thus it seems to accurately capture the clinical severity of pneumonia.

Our results suggest that as a single independent criterion for hospital admission, oxygen saturation <92% might be both safer and clinically better-justified for patients with pneumonia.

 

-Clinical Infectious Diseases

Testing for fever, high pulse rate, crackly breath sounds, and low oxygen levels could be key to helping GPs distinguish pneumonia from less serious infections, according to a large study published in the European Respiratory Journal.

-ScienceDaily

Wellue O2ring Blood Oxygen Monitor

 

Wear the ring, it will automatically start to track your overnight blood oxygen saturation, heart rate and body movements continuously.

The report shows how long your oxygen is below 90%; how many times during a night your oxygen drops over 4%. You can share personal overnight oximetry reports with your doctor and it hepls you stay informed with your blood oxygen level at any time.

How is Pneumonia Treated?

Antibiotics

Treatment depends on the severity of pneumonia. In mild cases, the individual may be able to take oral antibiotics in a community setting. For more severe cases, they may require admission to hospital and treatment with intravenous antibiotics, oxygen therapy and chest physiotherapy (Dunn 2005).

As pneumonia is an infection, antibiotic therapy should be started as soon as possible. Sometimes this can be before the causative organism has been determined, however, the type of antibiotic can be changed if necessary. Depending on the severity of pneumonia, this can be in either an intravenous or oral form (Watson 2008).

Oxygen Therapy

Another important aspect of pneumonia treatment is oxygen therapy and maintaining adequate oxygen saturation levels. Depending on the patient, oxygen saturation levels should be above 93%, with the oxygen concentrations also varying depending on the patient, their comorbidities and severity of pneumonia. Humidified oxygen therapy can also be used in order to assist the patient with expectoration (Watson 2008).

Sometimes pulse oximetry can be inaccurate on these patients, and this is where arterial blood gas levels may play a role in ensuring adequate oxygenation is being achieved. Some patients, even when receiving high flow oxygen, can still remain hypoxic, and therefore, continuous positive airway pressure may be indicated (Farrell & Dempsey 2013; Watson 2008).

 

Pain Management

It is important to remember that a patient with pneumonia may be in pain. This means that their lung expansion may be compromised, which can further exacerbate their condition. This pain can often be described as pleuritic-type chest pain (Farrell & Dempsey 2013; Watson 2008).

Those with severe pneumonia may require treatment from physiotherapists. As part of an interprofessional team, physiotherapists can assist in not only any concurrent physical decline and chest physiotherapy, but can also help teach the patient effective breathing patterns and posture to promote lung expansion and expectoration (Watson 2008).

Hydration

 Other treatments for pneumonia should focus on ensuring the patient is adequately hydrated and if not, ensure that intravenous fluids are commenced. Adequate hydration is important for the expectoration of secretions and will also help with any associated hypotension. The individual may have increased fluid loss if they are febrile and continue to have an increased respiratory rate, therefore, urinary output should also be monitored, as this can flag deterioration in the patient’s condition (Dunn 2005; Watson 2008).

Oxygen Monitor for Baby – Frequent Q&A for New Parents

Oxygen Monitor for Baby – Frequent Q&A for New Parents

Oxygen monitors for babies especially for newborns are thought to give peace of mind to parents. Do you know why?

Compared to adults, the respiratory status of newborns requires close attention. If a newborn is found to have hypoxia during delivery, it is even more important to monitor the blood oxygen status closely after the baby is discharged from the hospital. That is to avoid severe hypoxia from occurring and affecting the normal development of the baby. So new parents are worried to check for their baby’s breath all night. Then the oxygen monitor for baby is bought by new parents at home to monitor the infant’s blood oxygen levels and heart rate and to sound alarms when detecting abnormalities.

Wellue has launched their innovative product BabyO2 S2 baby oxygen monitor to ease parents’ worries. In addition, Wellue health editors searched some frequent questions and answers for new parents encountered as follows, and we hope this can be helpful.

1. Manifestations of neonatal hypoxemia

The main manifestations of neonatal hypoxia are:

① Increased or decreased respiratory rate;

The criteria for increased respiratory rate are: in the condition of calm without oxygen, (less than 2 months of age) ≥ 60 breaths/min, (2 months of age – 12 months of age) ≥ 50 breaths/min.

② Over deep or shallow breathing: infants or newborns may show open-mouth breathing, moaning, grunting sound, nasal flaring, head bobbing;

③ Purple or gray lips and face;

④ Concave chest, etc.

 3. How do you perform a pulse oximetry measurement?

The pulse oximetry probe is wrapped in a wrap around the baby’s right hand or one foot. The probe is connected to a monitor that displays the oxygen levels, just like the Wellue BabyO2 S2 baby oxygen monitor. The Owlet smart sock doesn’t have a single monitor to screen because they use the phone APP. See more details about BabyO2 S2 VS Owlet Sock.

Just bundle the oxygen probe on the baby’s dorsal foot, this location is relatively rich in arterial blood flow. Because the newborn body movement will affect the oxygen measurement, you can use a strap to tie the probe data cable at the ankle to fix it, reducing the role of sensor shaking, and then to monitor the baby’s blood oxygen status for a long time. See multiple ways to wear baby oxygen monitor.

When the baby is calm and warm, it takes only a few minutes to obtain a reading. The number will take longer to obtain if the infant is crying, hypothermic and wet.

4. Why is the pulse oximetry method used to screen CHD (congenital heart disease)

Pulse oximetry can be used to determine the oxygen level in the blood and has been used to monitor the oxygen level in the blood of infants in special monitoring.

It can also indicate the infant’s cardiopulmonary function. Pulse oximetry can also help identify infants with severe congenital heart disease, infections and pneumonia. Infants with severe congenital heart disease, infections and pneumonia often have very low oxygen levels in their blood. If the newborn fails the screening test, the medical workers should use an echocardiogram to complete further diagnosis.

If the newborn fails the screening test, the provider should use an echocardiogram to complete further diagnosis.

 5. What is CHD

Congenital heart disease is a problem with the structure of the heart or the flow of blood through the heart. Congenital heart disease is the most common birth defect and is often asymptomatic in the newborn period.

6. How is congenital heart disease (CHD) monitored?

Before a newborn is discharged from the hospital, the hospital should check:

  • The infant’s heart murmur
  • Abnormal heart rate, breathing or blood pressure

Pulse oximetry can detect low oxygen levels in the blood. Children with critical precocious heart disease are often asymptomatic after birth. However, if the infant has any of these symptoms, further testing should be performed.

7. Will pulse oximetry or baby oxygen monitor hurt my baby

No. It is a painless and non-invasive method.

8. What is the normal reading

For oxygen saturation in the baby’s foot:≥ 95%;

Infants with abnormal function or infection have low oxygen saturation readings. Sometimes low pulse oximetry caused by birth crush is normal. Your child’s physician may also do additional oxygen saturation measurements for the baby.

For resting heart rate (pulse rate):

  • Newborns 0 to 1 month old: 70 to 190 beats per minute
  • Infants 1 to 11 months old: 80 to 160 beats per minute
  • Children 1 to 2 years old: 80 to 130 beats per minute
  • Children 3 to 4 years old: 80 to 120 beats per minute
  • Children 5 to 6 years old: 75 to 115 beats per minute
  • Children 7 to 9 years old: 70 to 110 beats per minute
  • Children 10 years and older, and adults (including seniors): 60 to 100 beats per minute
  • Well-trained athletes: 40 to 60 beats per minute

9. Is it possible for an infant with severe congenital heart disease to have a normal pulse oximetry reading

It is possible. Watch for the following symptoms in your child.

  • Difficulty in breastfeeding
  • Sweating around the head (especially while breastfeeding)
  • Shortness of breath
  • Pale or bluish skin
  • Lethargy and immobility
  • Swollen face, arms and legs
  • Irritable or difficult to calm

10. Premature baby and newborns in the NICU (neonatal intensive care unit)

    Although pulse oximetry monitoring is usually part of daily management for preterm infants and the baby is observed for a longer period of time than other infants without signs of congenital heart disease, some forms of congenital heart disease may go undetected in the NICU.

    Routine care in the NICU does not usually involve blood gas tests for oxygen saturation measurements, raising the possibility of missed screenings.

    For those infants who do not have an echocardiogram, quantitative pulse oximetry screening should be performed as soon as assisted oxygenation is terminated. If the infant has already had an echocardiographic screening, no additional pulse oximetry screening is required.

    Apple Watch VS O2ring, Should You Trust Apple Watch on Blood Oxygen Readings?

    Apple Watch VS O2ring, Should You Trust Apple Watch on Blood Oxygen Readings?

    The Apple Watch Series 7,continuesto include an ECG for monitoring heart health as well as a blood oxygen monitor. While the existing ECG did receive FDA clearance, the blood oxygen monitor did not. It has raised some questions after its launch:

    ·How accurate or useful (or revolutionary) is that blood oxygen feature?

    ·Should those who can afford the $399 rush out and buy one?

    ·Can the future of health really be on our wrist?

    Health experts say while the data collected from wearable devices is helpful for both patients and doctors, they are not a replacement for medical-grade devices.

    Low blood oxygen levels, or hypoxemia, have been linked to COVID-19 because the disease affects your ability to get enough oxygen. Doctors have used SpO2 levels to determine the severity of COVID-19 cases and treat those patients accordingly. But hypoxemia can be caused by many other heart and lung issues, such as asthma, pneumonia, and congenital heart disease.

    What Is the Accuracy?

    Apple’s marketing release tells us that their blood oxygen sensor “employs four clusters of green, red, and infrared LEDs, along with the four photodiodes on the back crystal of Apple Watch, to measure light reflected back from blood. Apple Watch then uses an advanced custom algorithm built into the Blood Oxygen app, which is designed to measure blood oxygen between 70 percent and 100 percent.”Apple is marketing this as a wellness feature rather than for medical monitoring.

    Although we don’t know for sure about AW7’s accuracy, we do have studies showing us that reflectance oximetry (used in AW7) is not as accurate or stable as transmittance oximetry (used in fingertip pulse oximeters.) It’s important to understand this significant technological difference.

    Since Apple was marketing the ECG as a tool for monitoring health conditions, the company had to prove it worked for its intended purpose.


    “While these devices can help provide patients with a general trend regarding their health, the data should not be used to provide medical care or trigger medical interventions,” said Dwivedi, assistant professor at Donald and Barbara Zucker School of Medicine at Hofstra and cardiologist at Northwell Health.

    How Blood Oxygen Monitor Works

    Oximeters determine oxygen saturation (SpO2) in tissues by quantifying the concentration of hemoglobin bound to oxygen (oxyhemoglobin or HbO2) and hemoglobin (Hb) without oxygen. Pulse oximeters, which are widely utilized in medical settings, utilize photoplethysmography (PPG) performed on pulsatile arterial blood at two different wavelengths to obtain a ratio of HbO2 and Hb. Optoelectronic sensors composed of light-emitting diodes and photodiodes that operate at red and near-infrared wavelengths capitalize on the differing absorptivity of Hb and HbO2.

    Transmission-mode oximetry has been the gold standard but requires sensing at tissue locations that can be transilluminated with the light shining through the tissue such as the earlobes and fingers.

    With reflective mode oximetry, the light sources and photodiodes are on the same side of the tissue and a thin measurement site is not required. Thus, it can be used at measurement sites such as the forehead, chest, and (most relevant for this discussion) the wrist, where a band or watch can be utilized.

    Reflectance mode oximetry, the model utilized by Apple Watch, has been shown to be inferior to the transmission mode used by fingertip pulse oximeters, likely due to increased variability introduced by ambient light, the pressure applied, and positional variation inherent to the method.

    Some smartphone apps have claimed an ability to measure SpO2 using reflectance, but when two were studied they were found to be seriously inaccurate. Walter Schrader, MD, who co-authored the smartphone oximetry study, has told that he does not recommend any smartphone app as a reliable pulse oximeter.

    Should You Buy Apple Watch for Medical Use?

    We can assert that the wrist technique is generally less accurate than the typical technique of measuring blood oxygen using a finger sensor.

    If you are primarily excited by the blood oxygen sensing capabilities of AW, I would recommend instead purchasing an oximeter. At least we have some data on these devices, which use the more reliable transmission mode for measuring oxygen saturation. Anthony C. Pearson, MD, a noninvasive cardiologist, and professor of medicine at St. Louis University School of Medicine.

    Get Your Medical-Grade Devices for Oxygen Monitor

    O2Ring Oximeter Continuous Ring Oxygen Monitor

    Reference:

    1. HealthLine: Here Is What Heart Health Experts Think About the Apple Watch Series 7

    2. Medpagetoday: Should You Trust the New Apple Watch on Blood Oxygen Readings?