Diagnostic Equipment Research Articles

Does a Tuberculosis Peritonitis Imitate an Advanced Ovarian Cancer?: A Case Report at Iringa Regional Referral Hospital in Tanzania

Tuberculosis (TB) Peritonitis is unexpected tuberculosis that happens in less than 2% of the patients worldwide. The incident rates are higher in the developing countries as a result of the inadequate diagnostic equipment. The mimicking of the tuberculosis peritonitis with an advanced ovarian cancer affects the decision of the gynecologist even after coming up with the confirmatory investigation of image findings. A 34-year-old female presented with progressive abdominal distension for 2 months, discomfort, abnormal vaginal discharge, which was foul smell and yellowish in color, painful sex intercourse, and denied history of diarrhea or constipation. Furthermore, present the history of passing black stool, but she denied history of vomiting blood or epigastric pain. A pelvic scan revealed the adnexal masses and ascites, with a conclusion of advanced ovarian cancer. A laparotomy was done; total abdominal hysterectomy and bilateral salpingoophorectomy were done. A specimen sent for histopathology, which revealed tuberculosis peritonitis and not ovarian cancer. A patient was administered anti-tuberculosis drugs, and on follow-up, the patient showed an improvement. Therefore, in this case, the gynecologist should think of tuberculosis peritonitis as a differential diagnosis of advanced ovarian cancer, and this can be confirmed by the laparoscope and histopathology of the specimen hence preventing unnecessary total abdominal hysterectomy.  Implication for policy makers: The diagnostic tools in the health care facilities should be readily accessible and available for such rare cases hence more on job training to equip the gynecologists with updated knowledge and skills.  Implication for public: The public health should be emphasized in the community by offering health promotion, encouraging screening, and prevention of diseases so as to prevent the consequences which affects the life of an individual.

Digital indicator for evaluating the hydraulic control system of the tractor gearbox

The effi ciency of using energy-saturated tractors in agriculture largely depends on the level of preparation for fi eld work, which in turn depends on an objective assessment of the general technical condition of components and assemblies to justify the repair and maintenance work carried out. Various diagnostic tools are widely used for a non-selective assessment of the general technical condition of the internal combustion engine: motor testers, crankcase gas fl ow meters, etc. However, there are no such means to assess the technical condition of the transmission (gearbox) of energy-saturated equipment of domestic production. In conditions of logistical remoteness from service centers, there is a need to develop digital indicators to assess the general technical condition of a hydraulically controlled gearbox according to the time of the transition process, allowing the end user to contact the dealer’s service company in a timely manner (The purpose of the study) to study the status of the issue, analyze the NTD and search experiments and develop an experimental digital indicator for monitoring the general technical condition of boxes transmission changes of energy-saturated tractors of domestic production according to the transition process in the hydraulic control system. (Materials and methods) Conducted an analysis, studied the NTD, as well as methodological guidelines for diagnosing and managing the reliability of agricultural machinery, previously produced control and diagnostic equipment, KI-112383 was chosen as an analog for the development of a digital indicator. It has been established that the method of transient characteristics is widely used to diagnose rapidly changing processes. Monitoring the time of the transition process in the hydraulic control system is a necessary diagnostic procedure that allows you to indiscriminately assess the overall technical condition of the KP of operated energysaturated tractors. (Results and discussion) the results of staged experiments using the E-14-140M ADC when running in the gearbox of the K-744R tractor on the stand showed the possibility of a comparative assessment of the general technical condition according to the transient characteristics of pressure recovery in the control system during gear shifting. To develop a prototype of the digital indicator, a virtual simulation was carried out with simulation of the algorithms of operation, and test tests were carried out on the developed laboratory installation. The developed experimental digital indicator can be used as an integrated monitoring tool to automatically determine the general technical condition of the gearbox, as well as inform the operator to minimize the infl uence of the «human» factor when changing gears. (Conclusions) For eff ective management of the general technical condition of tractors, it is necessary to pilot the implementation of the developed digital indicator, which will allow assessing the dynamics of changes in the transient pressure recovery process as a diagnostic parameter during the repair of the gearbox and under operating conditions of tractors without making changes to the design.

Access to diagnostic imaging and radiotherapy technologies for patients with cancer in the Baltic countries, eastern Europe, central Asia, and the Caucasus: a comprehensive analysis

Only 10-40% of patients with cancer in low-income and middle-income countries were able to access curative or palliative radiotherapy in 2015. We aimed to assess the current status of diagnostic imaging and radiotherapy services in the Baltic countries, eastern Europe, central Asia, and the Caucasus by collecting and analysing local data. This Access to Radiotherapy (ART) comprehensive analysis used data from 12 countries: the three Baltic countries (Estonia, Latvia, and Lithuania), two countries in eastern Europe (Moldova and Ukraine), four countries in central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan), and three countries in the Caucasus (Armenia, Azerbaijan, and Georgia), referred to here as the ART countries. We were not able to obtain engagement from Turkmenistan. The primary outcome was to update the extent of shortfalls in the availability of diagnostic imaging and radiotherapy technologies and radiotherapy human resources for patients with cancer in former Soviet Union countries. Following the methods of previous similar studies, we developed three questionnaires-targeted towards radiation oncologists, regulatory authorities, and researchers-requesting detailed information on the availability of these resources. Authors from participating countries sent two copies of the appropriate questionnaire to each of 107 identified institutions and coordinated data collection at the national level. Questionnaires were distributed in English and Russian and responses in both languages were accepted. Two virtual meetings held on May 30 and June 1, 2022, were followed by an in-person workshop held in Almaty, Kazakhstan, in September, 2022, attended by representatives from all participating countries, to discuss and further validate the data submitted up to this point. The data were collected on a dedicated web page, developed by the International Cancer Expert Corps, and were then extracted and analysed. Data were collected between May 10 and Nov 30, 2022. 81 (76%) of the 107 institutions contacted, representing all 12 ART countries, submitted 167 completed questionnaires. The Baltic countries, which are defined as high-income countries, had more diagnostic imaging equipment and radiotherapy human resources (eg, Latvia [1·74] and Lithuania [1·47] have a much higher number of radiation oncologists per 100 000 population than the other ART countries, all of which had <1 radiation oncologist per 100 000 population) and greater radiotherapy technological capacities (higher numbers of linear accelerators and, similar to Georgia, high total external beam radiotherapy capacity) than the other ART countries, as well as high cancer detection rates (Latvia 311 cases per 100 000 population, Lithuania 292, and Estonia 288 vs, for example, 178 in Armenia, 144 in Ukraine, and 72 in Kazakhstan) and low cancer mortality-to-cancer incidence ratios (Estonia 0·43, Latvia 0·49, and Lithuania 0·48; lower than all but Kazakhstan [0·41]). The highest cancer mortality-to-cancer incidence ratios were reported by Moldova (0·71) and Georgia (0·74). Our findings show that the number of cancer cases, availability of diagnostic imaging equipment, radiation oncologists and radiotherapy capacity, and cancer mortality-to-cancer incidence ratios all vary substantially across the countries studied, with the three high-income, well resourced Baltic countries performing better in all metrics than the included countries in eastern Europe, central Asia, and the Caucasus. These data highlight the challenges faced by many countries in this study, and might help to justify increased investment of financial, human, and technological resources, with the aim to improve cancer treatment outcomes. US Department of Energy's National Nuclear Security Administration's Office of Radiological Security.

Overview of Key Technologies in Surgical Robots and Optimization Discussions

Surgical robot is the national strategic diagnostic and therapeutic equipment research focus, get a number of scientific research institutes, colleges and universities and enterprises pay extensive attention to the design and development of a variety of surgical robots, and registration declaration. This article explores the critical technologies of surgical robots and key areas for optimizing their performance, including kinematic positioning errors, pose errors, feedback model errors, image recognition positioning errors, path planning, and safety aspects. The findings not only provide a scientific basis for future standardization research on surgical robots but also offer significant theoretical and practical references for the research, manufacturing, and registration processes in the medical robotics industry.

Evaluation of quadriceps muscle cross-sectional area using an ultrasonic diagnostic equipment with a wide field of view.

Skeletal muscle index measurement via dual-energy X-ray absorptiometry or bioelectrical impedance analysis is used to evaluate muscle mass when diagnosing sarcopenia. However, inherent challenges exist with these methods. We previously focused on muscle mass evaluation in the quadriceps femoris by using computed tomography (CT). In this observational study, we utilized a new ultrasound device with a wide field of view that can obtain CT-like images and investigated its usefulness. Reproducibility was investigated by calculating the intra- and inter-examiner intraclass correlation coefficient (ICC) by using three examiners and performing five measurements in 12 participants. In 123 participants (48 men, 75 women, mean age 78.2 ± 8.1 years), we investigated the correlation between the quadriceps cross-sectional area measured with supine ultrasound and CT images as well as between supine and sitting ultrasound images. Unadjusted, age-adjusted, and age-sex-adjusted correlations were calculated. Reproducibility was excellent (intra-examiner ICC[1,1]: 0.978, 0.987, and 0.994; inter-examiner ICC[2,1]: 0.993). The unadjusted, age-adjusted, and age-sex-adjusted correlations between the quadriceps cross-sectional area measured using supine ultrasound and CT were 0.949, 0.940, and 0.894, respectively. For sitting ultrasound, the corresponding values were 0.958, 0.953, and 0.912, respectively. Correlations between the supine and sitting ultrasound measurements were also good, with corresponding values of 0.952, 0.945, and 0.904, respectively. The tested ultrasound device showed excellent measurement reproducibility and had good correlations with CT images. Further studies with an increased numbers of clinical cases and additional evaluations should allow the device to become a screening tool for diagnosing sarcopenia.

Raman Spectroscopy for Instant Bladder Tumor Diagnosis: System Development and In Vivo Proof-Of-Principle Study in Accordance with the European Medical Device Regulation (MDR2017/745).

This work reports on an in vivo Raman-based endoscopy system, invaScope, enabling Raman measurements of healthy and tumor bladder tissue during an endoscopic procedure in the operating theatre. The presented study outlines the progression from the initial concept (validated through previously performed ex vivo studies) to the approval and implementation of a clinical investigational device according to the requirement within the framework of the European Medical Device Regulation (MDR2017/745). The study's primary objective was to employ the invaScope Raman system within the bladder, capturing in vivo spectroscopic Raman data followed by standard histo- and cytopathological examinations of urological tissue (considered the gold standard). The collected data were analyzed and correlated with histopathological findings post-procedure. Additionally, the study aimed to assess the feasibility of using diagnostic equipment, probes, and software for application in a clinical setting, evaluating usability aspects that are important during surgical procedures. This research represents a pivotal step toward advancing Raman spectroscopy for routine clinical use in characterizing bladder lesions.

Evaluating lead-free alternatives for radiation shielding in diagnostic radiology: a case study from a tertiary general hospital in Korea.

With the continued increase in the number of pieces of diagnostic medical radiography equipment being used, radiation shielding in radiology departments is becoming increasingly important. Lead is the most commonly used material for radiation protection; however, there are numerous disadvantages associated with the use of lead, including environmental hazards and harm to the human body. Alternative shielding materials that can be used as replacements include barium sulfate, tungsten, or bismuth. Among alternative materials, barium sulfate appears to be the most cost-effective and easiest to process. In the present study, before constructing shielding barriers, a barrier thickness program for lead-free barrier materials based on National Council on Radiation Protection and Measurements (NCRP) Report No. 147 was used to determine the appropriate barrier thickness. The required thickness for lead-free boards for each type of diagnostic radiography room was calculated based on a tertiary general hospital in the Republic of Korea.

Application of machine learning algorithms in predicting carotid artery plaques using routine health assessments.

Cardiovascular diseases (CVD) constitute a grave global health challenge, engendering significant socio-economic repercussions. Carotid artery plaques (CAP) are critical determinants of CVD risk, and proactive screening can substantially mitigate the frequency of cardiovascular incidents. However, the unequal distribution of medical resources precludes many patients from accessing carotid ultrasound diagnostics. Machine learning (ML) offers an effective screening alternative, delivering accurate predictions without the need for advanced diagnostic equipment. This study aimed to construct ML models that utilize routine health assessments and blood biomarkers to forecast the onset of CAP. In this study, seven ML models, including LightGBM, LR, multi-layer perceptron (MLP), NBM, RF, SVM, and XGBoost, were used to construct the prediction model, and their performance in predicting the risk of CAP was compared. Data on health checkups and biochemical indicators were collected from 19,751 participants at the Beijing MJ Health Screening Center for model training and validation. Of these, 6,381 were diagnosed with CAP using carotid ultrasonography. In this study, 21 indicators were selected. The performance of the models was evaluated using the accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, and area under the curve (AUC) value. Among the seven ML models, the light gradient boosting machine (LightGBM) had the highest AUC value (85.4%). Moreover, age, systolic blood pressure (SBP), gender, low-density lipoprotein cholesterol (LDL-C), and total cholesterol (CHOL) were the top five predictors of carotid plaque formation. This study demonstrated the feasibility of predicting carotid plaque risk using ML algorithms. ML offers effective tools for improving public health monitoring and risk assessment, with the potential to improve primary care and community health by identifying high-risk individuals and enabling proactive healthcare measures and resource optimization.

Optimal Team for Diagnostic Imaging Equipment Installation

Optimal Team for Diagnostic Imaging Equipment Installation

Domestic researchers who have made important contributions to the study of digestive system diseases: images in art. Nina Fedorivna Deyneko

Nina Fedorivna Deyneko is a Doctor of Medical Sciences, Professor, an honored worker of science and technology of Ukraine, an outstanding health care worker, a labor veteran, and an academician of the International Academy of Sciences in apiphytotherapy and beekeeping. Under Prof. N. F. Deyneko’s supervision, 86 clinical residents, including 34 foreign ones, and postgraduate students were taught during her tenure at the Kharkiv departments of therapy and gastroenterology. Additionally, 25 candidate dissertations and one doctorate thesis were defended. She served as the head of the Kharkiv Medical Institute’s state examination commission for 15 years, founded and presided over the Kharkiv Medical Society of Gastroenterologists for 20 years, was a member of the All‑Union Society of Gastroenterologists’ Presidium of the Board for more than 20 years, and worked as the deputy chairman of the board of the Ukrainian Republican Society of Gastroenterologists. More than 200 research publications, four monographs, textbooks, and copyright certificates have been produced by Nina Fedorivna. Kharkiv Railway Clinical Hospital №1 became the clinical base of the Department of Gastroenterology of the Ukrainian Institute for Advanced Medical Studies, which was headed by Professor Nina Fedorivna Deyneko. Contemporary diagnostic equipment made it possible to perform diagnosis and treatment of patients with pathologies of the gastrointestinal, liver, biliary and pancreatic pathologies. The goal of methodological and pedagogical work was to optimize the educational process by using modern techniques for tracking students’ practical skills and initial, intermediate, and final levels of learning. Four‑ and three‑ month specialty cycles, as well as pre‑certification and theme improvement in the field of gastroenterology, were implemented during the first five years of the department’s existence. In addition to receiving 20 copyright certificates and publishing over 300 research papers, department staff members have also developed 62 rationalization recommendations that have been put into practice in the healthcare industry. The staff of the department participated in many scientific forums, including those conducted abroad.

Low-cost and convenient screening of disease using analysis of physical measurements and recordings

In recent years, there has been substantial work in low-cost medical diagnostics based on the physical manifestations of disease. This is due to advancements in data analysis techniques and classification algorithms and the increased availability of computing power through smart devices. Smartphones and their ability to interface with simple sensors such as inertial measurement units (IMUs), microphones, piezoelectric sensors, etc., or with convenient attachments such as lenses have revolutionized the ability collect medically relevant data easily. Even if the data has relatively low resolution or signal to noise ratio, newer algorithms have made it possible to identify disease with this data. Many low-cost diagnostic tools have been created in medical fields spanning from neurology to dermatology to obstetrics. These tools are particularly useful in low-resource areas where access to expensive diagnostic equipment may not be possible. The ultimate goal would be the creation of a “diagnostic toolkit” consisting of a smartphone and a set of sensors and attachments that can be used to screen for a wide set of diseases in a community healthcare setting. However, there are a few concerns that still need to be overcome in low-cost diagnostics: lack of incentives to bring these devices to market, algorithmic bias, “black box” nature of the algorithms, and data storage/transfer concerns.

Takayasu Arteritis Presented with Unilateral Vision Loss : A Case Report

Background: Takayasu Arteritis (TA) is a rare chronic granulomatous inflammation of the aorta or its branches and is prevalent all around the world. It causes stenosis of large arteries and ischaemic damage to target organs. There is usually a delay in recognising TA because of the rarity and unfamiliarity with the disease, unspecific early symptoms and lack of diagnostic equipment for early diagnosis. The purpose of the study to reminding readers of this issue and emphasize the necessity for further research on how to deal with in the best way. Case Report: We report a case of 30 years old male presented on 22nd August 2023 at Institute of Applied Health Sciences (IAHS) Chattogram with gradual loss of vision of left eye over a month accompanied by headache and later on diagnosed as a case of Takayasu’s Arteritis. Conclusion: Visual loss is the most common ocular symptom in Takayasu arteritis. Since a variety of causes may result in reduced vision in Takayasu arteritis. A careful history is very important to ascertain the cause of visual loss in Takayasu arteritis patients to reduce unnessary investigations and referrals. IAHS Medical Journal Volume 6(2) December 2023; 90-92

Evaluation of computed tomography anode voltage in clinical application: the influence of profiled filters

Monitoring of operational parameters of X-ray diagnostic equipment, including computer tomographs, is mandatory during acceptance and periodic tests in medical organizations. The importance of control of anode voltage of X-ray radiator is described (as one of the main technical parameters in diagnostic tests of patients, which can influence the quality of visualization and safe operation of the equipment). Anode voltage is evaluated by non-invasive methods using universal dosimeters in the user mode of equipment operation. The influence of profiled filters of Somatom Definition AS, SOMATOM go.All (Siemens, Germany) scanners on the accuracy of anode voltage measurement was investigated. The tests were conducted in clinic conditions without partial removal of the gantry (a structural element of the tomograph, inside which the system “X-ray emitter – detector” is located) and connection to the high-voltage circuit of the device. The distance between the sensitive elements of the measuring device and the displacement of the center of the sensing area relative to the position of the central axis of the X-ray beam of computed tomography scanner were taken into account. Normalized curves of kerma values, anode voltage values and their approximating analytical functions were obtained using a Piranha R&amp;F/M 657 universal dosimeter (RTI Electronics AB, Sweden) at its displacement relative to the laser centralizer of computed tomography scanner. Based on the scheme for noninvasive estimation of anode voltage value, a formula of the relative deviation of the measured value of the anode voltage associated with the presence of a profiled filter at the output of the X-ray emitter of the tomograph and the displacement of the center point of the sensitive area of the measuring device relative to the central axis of the X-ray beam of the tomograph is obtained. The validity of the data based on the formula is confirmed experimentally. The results of the study will be helpful to technical specialists who maintain or control the X-ray computed tomography operating parameters.

Application study of apnea-hypopnea duration for assessing adult obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a common sleep disordered breathing disorder, which can cause serious damage to multiple human systems. Although polysomnography (PSG) is the current gold standard for diagnosis, it is complex and expensive. Therefore, it is of great significance to find a simple, economical and rapid primary screening and diagnosis method to replace PSG for the diagnosis of OSA. The purpose of this study is to propose a new method for the diagnosis and classification of OSA, which is used to automatically detect the duration of sleep apnea hypopnea events (AHE), so as to estimate the ratio(S) of the total duration of all-night AHE to the total sleep time only based on the sound signal of sleep respiration, and to identify OSA. We performed PSG tests on participants and extracted relevant sleep breathing sound signal data. This study is carried out in two stages. In the first stage, the relevant PSG report data of eligible subjects were recorded, the total duration of AHE in each subject's data was extracted, and the S value was calculated to evaluate the severity of OSA. In the second stage, only the sleep breath sound signal data of the same batch of subjects were used for automatic detection, and the S value in the sleep breath sound signal was extracted, and the S value was compared with the PSG diagnosis results to calculate the accuracy of the experimental method. Among 225 subjects. Using PSG as the reference standard, the S value extracted from the PSG diagnostic data report can accurately diagnose OSA(accuracy rate 99.56%) and distinguish its severity (accuracy rate 95.11%). The accuracy of the S value detected in the sleep breathing sound signal in the diagnosis of severe OSA reached 100%. The results show that the experimental parameter S value is feasible in OSA diagnosis and classification. OSA can be identified and evaluated only by sleep breathing sounds. This method helps to simplify the diagnostic grading of traditional OSA and lays a foundation for the subsequent development of simple diagnostic grading equipment.

Development of fetal magnetic resonance imaging (MRI) phantom.

Anthropomorphic phantoms play an important role in routine clinical practice. They can be used to calibrate magnetic resonance imaging (MRI) scanners, control the diagnostic equipment quality, and reduce the acquisition time. The latter is especially critical for diagnosing fetal anomalies, which requires optimal image quality within the shortest possible time. This paper aims to develop an MRI fetal phantom and determine the materials that best mimic the magnetic resonance (MR) characteristics of its internal organs. Future phantom features will include simulations of fetal limb movements. A single MRI study of a pregnant woman at 20 weeks 3 days of gestation was used as a reference and for image segmentation. Anonymized Digital Imaging and Communication in Medicine (DICOM) files were imported into 3D Slicer v. 5.2.1 for segmentation of the uterus, fetus, and internal organs. Based on the performed segmentation, a three-dimensional model was obtained for printing on a 3D printer. The mold was 3D printed on an Anycubic Photon M3 Max printer. The paper showcases the selection and manufacturing of compositions to simulate the relaxation times of the fetal organs. Formulations for emulsions and carrageenan- and agar-based hydrogels are presented. The selected compositions were used to fill the 3D printed model. Statistical analysis showed no significant differences in absolute and relative signal values obtained from scans of a pregnant woman at 20 weeks and 3 days and a fetal phantom. During the study, an anthropomorphic fetal phantom was constructed, filled with compositions with relaxation times T1 and T2 similar to the control values of the corresponding tissues. The phantom can be used to set up and optimize fetal MRI protocols, train and educate medical students, residents, graduate students, and X-ray technicians, as well as to timely control image quality and equipment serviceability.

Practices Used to Diagnose Hearing Impaired Students with Learning Difficulties in Mathematics

This study aimed to examine how teachers perceive the diagnostic practices used to identify mathematical learning difficulties among hearing-impaired students. This study adopted a quantitative research design, sampling 300 teachers using simple random sampling. We collected data using a self-developed questionnaire and analyzed the data using descriptive and inferential statistics in SPSS. The study highlights the importance of visual aids, non-verbal assessment, and teamwork between the audiologist and educator to identify hearing-impaired students. Teachers believe that we need to design more versatile tools in addition to norm-referenced tests. This underscores the shortcomings in the diagnostic tools. There was a lack of specialized diagnostic equipment for both hearing and learning disabilities, as reported during the observation. It also highlights the need for continuous practice improvement and excellent collaboration among all stakeholders. These findings contribute to the broader literature on inclusive education and underscore the necessity for innovation in diagnostic tools to support students with hearing impairments better. In this area, emerging technologies should be the focus of further research to improve diagnosis.

Virus-like Particles for Disease Diagnosis and Drug Delivery Applications

Abstract: Virus-like particles (VLPs) are nanoscale, self-assembling cage structures made out of proteins with practical uses in biomedicine. They might be used to create better vaccinations, imaging equipment, gene and drug therapy delivery systems, and in vitro diagnostic equipment. VLPs are nanostructures that might be used in medicine, immunization, and diagnostics, among other areas. Many VLPs-based vaccines are now in use for the treatment of infectious diseases, and many more are on their way to clinical testing thanks to recent advancements in biomedical engineering. Although VLPs exhibit promising qualities in terms of efficacy, safety, and diversity, they may become more widely used in the future. Vaccines based on virus-like particles (VLPs) might serve as an effective addition to current immunization strategies for the prevention and treatment of emerging infectious diseases. The growing field of healthcare prevention has become increasingly interested in VLPs, leading to the discovery of various VLP-based candidate vaccines for vaccination towards a wide range of infectious pathogens, one of the most recent that has been developed is the vaccine against SARS-CoV-2, the effectiveness of that is now being tested. VLPs can elicit both antibody and cell-mediated immune responses, unlike standard inactivated viral vaccines. However, several problems persist with this surface display method and will need fixing in the future. VLPs-based medicinal delivery, nanoreactors for treatment, and imaging systems are being developed with promising results. The latest developments in the generation and fabrication of VLPs involve explorations of several expression systems for their creation and their application as vaccines for the avoidance of infectious diseases and malignancies. This manuscript offers the most advanced perspective on biomedical applications based on VLPs, as well as details innovative methods for manufacturing, functionalization, and delivery of VLPs.

Risk Management and Failure Analysis in Diagnostic X-ray Equipment: A Comprehensive Analysis and Novel Approaches for Failure Prevention and System Reliability

Risk Management and Failure Analysis in Diagnostic X-ray Equipment: A Comprehensive Analysis and Novel Approaches for Failure Prevention and System Reliability

Nontechnical Skills Assessment in Acute Care Trauma Simulations: A Mixed Methods Approach Using Eye Tracking and Behavioral Marker Systems.

The condition of trauma patients and the urgent need for timely resuscitation present unique challenges to trauma teams. These difficulties are exacerbated for military trauma teams in combat environments. Consequently, there is a need for continued improvement of nontechnical skills (NTS) training for trauma teams. However, current approaches to NTS assessment rely on subjective ratings, which can introduce bias. Accordingly, objective methods of NTS evaluation are needed. Eye-tracking (ET) methods have been applied to studying communication, situation awareness, and leadership in many health care settings, and could be applied to studying physicians' NTS during trauma situations. In this study, we aimed to assess the relationship between trauma team leaders' objective gaze patterns and subjective expert NTS ratings during patient care simulations. After Institutional Review Board approval, 9 trauma teams from first-year post-graduate general surgery and emergency medicine residents were recruited to participate in 1 of 2 trauma simulations (a difficult airway case and a multi-patient trauma). Each scenario lasted approximately 15 minutes. All team leaders wore a mobile ET system to evaluate gaze metrics-time to first fixation (TTFF), average fixation duration (AFD), and total percentage of the scenario (TPS) focused on Areas of Interest (AOI), which included patient, care team, diagnostic equipment, and patient care equipment. Trained faculty raters completed the Non-Technical Skills for Surgeons (NOTSS) assessment tool and the Trauma Non-Technical Skills (T-NOTECHS) scale. One-way analysis of variance, Kruskal-Wallis, and appropriate post-hoc pairwise comparison tests were run to assess differences between ET metrics across AOI groups. Spearman's Rho tests were used to assess correlations between ET and subjective NTS ratings. Compared to other NTS domains, trauma teams scored relatively poorly on communication across both T-NOTECHS (3.29$ \pm $0.61, maximum = 5) and NOTSS (2.87$ \pm $0.66, maximum = 4). We found significant differences in trauma team leaders' TTFF between teammates and the patient (Team: 1.56 vs Patient: 29.82 seconds, P < .001). TTFF on the diagnostic equipment was negatively correlated (P < .05) to multiple measures of subjective NTS assessments. There were no significant differences in AFD between AOIs, and AFD on teammates was positively correlated (P < .05) to communication and teamwork. There were significant differences in TPS across most AOI pairs (P < .05), and the average TPS fixated was highest on the patient (32%). Finally, there were several significant correlations between additional ET and NTS metrics. This study utilized a mixed methods approach to assess trauma team leaders' NTS in simulated acute care trauma simulations. Our results provide several objective insights into trauma team leaders' NTS behaviors during patient care simulations. Such objective insights provide a more comprehensive understanding of NTS behaviors and can be leveraged to guide NTS training of trauma physicians in the future. More studies are needed to apply these methods to capture NTS from a larger sample of teams in both simulated and real trauma environments.

A hospital-based survey assessing the health facility-level factors that contribute to delayed diagnosis of cervical cancer; patients views

Background In Kenya, Cervical Cancer is the 2nd commonly diagnosed type of cancer and the leading cause of cancer-related death among women. Globally, more than 50% of Cervical Cancer diagnoses are made late, with this proportion rising to 80% in developing countries. Poor Health systems can cause delays in diagnosis; thus, this study focused on determining the health facility level factors that contribute to delayed diagnosis among Cervical Cancer patients at Kenyatta National Hospital (KNH). Methods An analytical cross-sectional mixed method study was adopted to collect data on hospital and referral experiences from 139 Cervical Cancer patients systematically sampled at the KNH, using a semi-structured questionnaire. Associations between stage at diagnosis and hospital and referral experience were tested using a logistic regression model at a 95% Confidence Interval. Results 86 (61.9%) patients were diagnosed with advanced stages III and IV. The potential predictors for delayed diagnosis were a higher number of hospital referrals (p =0.000), facing referral challenges (p =0.041), longer time taken for diagnosis appointment (p =0.059), and longer time taken for diagnostic results (p =0.007) in the bivariate analysis. A higher number of hospital referrals (p =0.001) and longer time taken for diagnostic results (p =0.025) were significantly associated with delayed diagnosis of cervical cancer in the multivariate logistic regression test model. Referral challenges include misdiagnosis, cost of diagnosis, and prolonged diagnosis appointments. The study concluded that the advanced stage at presentation for most patients was due to poor health and referral systems, inadequate medical personnel, and diagnostic equipment. Conclusion This study recommends improving referral systems and encouraging partnerships to decentralize diagnostic centers and equipment and to train more experts on Cervical Cancer.