Diagnostic Equipment Research Articles

From pilot to a multi-site trial: refining the Early Detection of Deterioration in Elderly Residents (EDDIE +) intervention

BackgroundEarly Detection of Deterioration in Elderly Residents (EDDIE +) is a multi-modal intervention focused on empowering nursing and personal care workers to identify and proactively manage deterioration of residents living in residential aged care (RAC) homes. Building on successful pilot trials conducted between 2014 and 2017, the intervention was refined for implementation in a stepped-wedge cluster randomised trial in 12 RAC homes from March 2021 to May 2022. We report the process used to transition from a small-scale pilot intervention to a multi-site intervention, detailing the intervention to enable future replication.MethodsThe EDDIE + intervention used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide the intervention development and refinement process. We conducted an environmental scan; multi-level context assessments; convened an intervention working group (IWG) to develop the program logic, conducted a sustainability assessment and deconstructed the intervention components into fixed and adaptable elements; and subsequently refined the intervention for trial.ResultsThe original EDDIE pilot intervention included four components: nurse and personal care worker education; decision support tools; diagnostic equipment; and facilitation and clinical support. Deconstructing the intervention into core components and what could be flexibly tailored to context was essential for refining the intervention and informing future implementation across multiple sites. Intervention elements considered unsustainable were updated and refined to enable their scalability. Refinements included: an enhanced educational component with a greater focus on personal care workers and interactive learning; decision support tools that were based on updated evidence; equipment that aligned with recipient needs and available organisational support; and updated facilitation model with local and external facilitation.ConclusionBy using the i-PARIHS framework in the scale-up process, the EDDIE + intervention was tailored to fit the needs of intended recipients and contexts, enabling flexibility for local adaptation. The process of transitioning from a pilot to larger scale implementation in practice is vastly underreported yet vital for better development and implementation of multi-component interventions across multiple sites. We provide an example using an implementation framework and show it can be advantageous to researchers and health practitioners from pilot stage to refinement, through to larger scale implementation.Trial registrationThe trial was prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).

Graphene transistor-based biosensors for rapid detection of SARS-CoV-2

Field-effect transistor (FET) biosensors use FETs to detect changes in the amount of electrical charge caused by biomolecules like antigens and antibodies. COVID-19 can be detected by employing these biosensors by immobilising bio-receptor molecules that bind to the SARS-CoV-2 virus on the FET channel surface and subsequent monitoring of the changes in the current triggered by the virus. Graphene Field-effect Transistor (GFET)-based biosensors utilise graphene, a two-dimensional material with high electrical conductivity, as the sensing element. These biosensors can rapidly detect several biomolecules including the SARS-CoV-2 virus, which is responsible for COVID-19. GFETs are ideal for real-time infectious illness diagnosis due to their great sensitivity and specificity. These graphene transistor-based biosensors could revolutionise clinical diagnostics by generating fast, accurate data that could aid pandemic management. GFETs can also be integrated into point-of-care (POC) diagnostic equipment. Recent advances in GFET-type biosensors for SARS-CoV-2 detection are discussed here, along with their associated challenges and future scope.

Blockchain-based trusted accountability in the maintenance of medical imaging equipment

Preventative maintenance is imperative for ensuring the longevity and reliability of diagnostic medical imaging equipment. However, conventional maintenance systems face challenges related to centralization, fragmented information, and ineffective tracking mechanisms. In response to these challenges, this research presents a blockchain-based solution that introduces a robust framework for managing preventative maintenance tasks. The proposed solution leverages blockchain technology, smart contracts, IPFS, and timer oracles to promote transparency, accountability, and traceability in maintenance operations. To ensure the integrity and availability of maintenance data while preserving the confidentiality of sensitive information, a detailed system architecture is outlined. Sequence diagrams and algorithms are developed to define the flow and logic of the solution, focusing on automatic fault detection and diagnosis. The smart contracts, which are made publicly available on GitHub, were rigorously tested to guarantee their intended functionality, thus addressing software reliability concerns. Additionally, the solution includes a maintenance incentive mechanism, actively motivating stakeholders to engage in preventative maintenance activities, and establishing accountability. Security testing confirms the absence of vulnerabilities in smart contracts, aligning with the scope of automatic fault detection and diagnosis. Furthermore, potential generalizations of the solution are discussed, and future directions emphasize the importance of continuous improvement and innovation in maintenance practices.

An assessment of bacterial contamination of indirect ophthalmoscopes and condensing lenses used in clinical practice: A multi-center study.

To investigate bacterial contamination of indirect ophthalmoscopes and condensing lenses used in three UK veterinary referral centers, and the impact of an implemented cleaning protocol. Bacteriology samples from 10 indirect ophthalmoscopes and 10 condensing lenses were taken at each center (n = 30 T0), before initiating one of three cleaning frequencies (every 2 weeks/once weekly/daily) for 28 days. The most contaminated indirect ophthalmoscope and condensing lens from each center were re-sampled 30 min prior to (T1; n = 9) and 30 min after (T2; n = 9) the final clean. Sensitivity testing was completed using MIC. Seventy-three isolates representing 15 different bacterial populations (genus/species) were cultured from 36 of 48 (75%) swabs tested. The most frequently cultured isolates were Staphylococcus spp. 30%, Micrococcus 22%, and Bacillus 14%. Pseudomonas aeruginosa, Pantoea, and Staphylococcus pseudintermedius demonstrated resistance to >50% of antibiotics against which they were tested. Eighty-three percent of T0 samples (54 isolates across 11 species, median 2 isolates/swab), all T1 samples (15 isolates across 8 species, median 2 isolates/swab), and 22% of T2 samples (4 isolates across 4 species, median 0 isolates/swab) were contaminated. Head contact points were most contaminated irrespective of time point. A T1 sample was 57 times more likely (95% CI: 2.4-1376) to have a positive culture than a T2 sample (p = .01). Baseline contamination was high, representing a potential source of nosocomial infection in ophthalmic patients and handlers of diagnostic equipment. No center implemented a cleaning protocol prior to this study. Routine cleaning reduces bacterial contamination.

Detection of inhomogeneous magnetic fields by magnetoelectric composite

Magnetoelectric (ME) composites can be useful due to their wide range of possible applications, especially as sensors of weak magnetic fields at room temperature for magnetocardiography and magnetoencephalography techniques in medical diagnostic equipment. In most works on the topic of ME composites, structures are tested in uniform magnetic fields; however, for practical application, a detailed consideration of the interaction with inhomogeneous magnetic fields (IMF) is necessary. In this work we made measurements of IMF with radial symmetry of individual thin wire with AC voltage with different placements of ME sensor. A ME self-biased structure b-LN/Ni/Metglas with a sensitivity to magnetic field of 120 V/T was created for IMF detection. The necessity of external biasing magnetic field is avoided by a nickel layer and its remanent magnetization. ME composite shows a non-zero ME coefficient of 0.24 V/(cm·Oe) in absence of DC external magnetic field. It is shown that output voltage amplitude from ME composite, which is located in AC IMF, is dependent from relative position of investigated sample and magnetic field lines. Maximum ME signal is obtained when long side of ME sample is perpendicular to the wire, and symmetry plane which divides the long side in two similar pieces contains an axis of the wire. In frequency range from 400 Hz to 1000 Hz in absence of vibrational and other noises a limit of detection has value of (2 ± 0.4) nT/Hz1/2.

Barriers and facilitators of people living with HIV receiving optimal care for hypertension and diabetes in Tanzania: a qualitative study with healthcare professionals and people living with HIV

BackgroundPeople living with HIV (PLWH) are at a higher risk for developing diabetes and hypertension. Often services are separate for HIV and non-communicable diseases (NCDs), but how this impacts NCD care among PLWH is unknown. We aimed to understand the barriers and facilitators for prevention, early diagnosis and safe effective care for diabetes and hypertension among PLWH.MethodsSemi-structured interviews (SSIs) were conducted with 10 healthcare professionals (HCPs) that care for PLWH, 10 HCPs that care for people with diabetes and hypertension and 16 PLWH with a comorbidity of diabetes and/or hypertension. Participants were recruited from two healthcare facilities in Dodoma, Tanzania and purposively sampled based on age and sex. Interviews were conducted in Swahili using pre-developed topic guides, audio recorded then translated verbatim into English. An inductive thematic analysis was conducted using The Framework Method.ResultsThree themes were found: organisational/healthcare system factors, individual factors and syndemic factors. Organisational/healthcare system factors comprised the only facilitators for prevention (education on lifestyle behaviours and counselling on adherence), but included the most barriers overall: fragmented services, no protocol for NCD screening and lack of access to diagnostic equipment were barriers for early diagnosis whereas the former plus lack of continuity of NCD care were barriers for safe effective care. Individual factors comprised four sub-themes, three of which were considered facilitators: HCPs’ knowledge of NCDs for early diagnosis, self-monitoring of NCDs for safe effective care and HCPs’ personal practice for both early diagnosis and safe effective care. HCPs’ knowledge was simultaneously a barrier for prevention and PLWH knowledge was a barrier for prevention and safe effective care. Syndemic factors comprised three sub-themes; all were barriers for prevention, early diagnosis and/or safe effective care: poverty and mental health of PLWH and HIV stigma.ConclusionsOrganisational/healthcare system, individual and syndemic factors were found to be interlinked with barriers and facilitators that contribute to the prevention, early diagnosis and safe effective care of diabetes and hypertension among PLWH in Tanzania; these findings can inform future initiatives for making small and large health system changes to improve the health of aging PLWH.

Untethered Microgrippers for Precision Medicine.

Microgrippers, a branch of micro/nanorobots, refer to motile miniaturized machines that are of a size in the range of several to hundreds of micrometers. Compared with tethered grippers or other microscopic diagnostic and surgical equipment, untethered microgrippers play an indispensable role in biomedical applications because of their characteristics such as miniaturized size, dexterousshape tranformation, and controllable motion, which enables the microgrippers to enter hard-to-reach regions to execute specific medical tasks for disease diagnosis and treatment. To date, numerous medical microgrippers are developed, and their potential in cell manipulation, targeted drug delivery, biopsy, and minimally invasive surgery are explored. To achieve controlled locomotion and efficient target-oriented actions, the materials, size, microarchitecture, and morphology of microgrippers shall be deliberately designed. In this review, the authors summarizes the latest progress in untethered micrometer-scale grippers. The working mechanisms of shape-morphing and actuation methods for effective movement are first introduced. Then, the design principle and state-of-the-art fabrication techniques of microgrippers are discussed. Finally, their applications in the precise medicine are highlighted, followed by offering future perspectives for the development of untethered medical microgrippers.

A smartphone-based centrifugal mHealth platform implementing hollow daisy-shaped quick response chip for hematocrit measurement

Due to the ever-increasing challenge of emerging and reemerging infections on global health, the development of POCT tools has been propelled. However, conventional point-of-care testing methods suffer from several limitations, including cumbersome operation, long detection times, and low accuracy, which hamper their widespread application. Compared to traditional disease diagnostic equipment, mobile health platforms offer several advantages, including portability, ease of operation, and automated analysis of detection results through recognition algorithms. Consequently, they hold great promise for the future. Here, we developed a smartphone-based centrifugal mHealth platform implementing daisy-shaped quick response chip for hematocrit measurement. The centrifugal microfluidic chip is combined with a smartphone through a back-clip-on mobile phone adapter whose control circuit is designed with low power consumption to enable the platform to operate without requiring a high-power source that is inconvenient to carry, thereby achieving the goal of portability. Concurrently, we designed a quick response chip featuring a unique hollow daisy structure that is in line with the properties of hematocrit detection. The distinctive configuration of the chip enables adequate centrifugal force to be supplied for hematocrit detection. Additionally, our customized quick response code recognition algorithm is able to recognize this chip, facilitating non-experts in performing hematocrit intelligent recognition with their smartphones.

Progress in the Application of Portable Ultrasound Combined with Artificial Intelligence in Pre-Hospital Emergency and Disaster Sites

With the miniaturization of ultrasound and the development of artificial intelligence, its application in disaster scenes and pre-hospital emergency care has become more and more common. This study summarizes the literature on portable ultrasound in pre-hospital emergency and disaster scene treatment in the past decade and reviews the development and application of portable ultrasound. Portable ultrasound diagnostic equipment can be used to diagnose abdominal bleeding, limb fracture, hemopneumothorax, pericardial effusion, etc., based on which trauma can be diagnosed pre-hospital and provide guiding suggestions for the next triage and rescue; in early rescue, portable ultrasound can guide emergency operations, such as tracheal intubation, pericardial cavity puncture, and thoracic and abdominal puncture as well as improve the accuracy and timeliness of operation techniques. In addition, with the development of artificial intelligence (AI), AI-assisted diagnosis can improve the diagnosis level of ultrasound at disaster sites. The portable ultrasound diagnosis system equipped with an AI robotic arm can maximize the pre-screening classification and fast and concise diagnosis and treatment of batch casualties, thus providing a reliable basis for batch casualty classification and evacuation at disaster accident sites.

Factors leading to the late diagnosis and poor outcomes of breast cancer in Matabeleland South and the Bulawayo Metropolitan Provinces in Zimbabwe.

Breast cancer (BC) is the leading cause of female cancer deaths in Africa, and in Zimbabwe, >80% present with advanced disease. A Needs Project (NP) was carried out to determine the key factors responsible for delayed diagnosis and poor BC outcomes and to investigate possible solutions in 6 rural and urban districts of Matabeleland South and Bulawayo Metropolitan Provinces. A mixed method approach was used to collect data in 2 phases. Phase 1: an exploration of key factors leading to poor BC outcomes with >50 professional stakeholders and patient representatives. Phase 2: (i) Quantitative arm; validated questionnaires recording breast cancer knowledge, demographic information and perceived barriers to care administered to women and their relatives (Group 1) and health professionals (HPs) (Group 2). (ii) Qualitative arm; 10 focus group discussions with medical specialists and interested lay representatives (Group 3). The Cochran sample size formulae technique was used to determine the quantitative sample size and data was aggregated and analysed using SPSS Version 23™. Purposive sampling for the qualitative study selected participants with an understanding of BC and the NP. Focus group discussions were recorded and a thematic analysis of the transcriptions was conducted using NVivo9™. Quantitative analysis of Group 1 data (n = 1107) confirmed that younger women (<30years) had the least knowledge of breast cancer (p<0.001). Just under half of all those surveyed regarded breast cancer as incurable. In Group 2 (n = 298) the largest group of health workers represented were general nurses and midwives (74.2%) in keeping with the structure of health provision in Zimbabwe. Analysis confirmed a strong association between age and awareness of BC incidence (p = 0.002) with respondents aged 30-39 years being both the largest group represented and the least knowledgeable, independent of speciality. Nearly all respondents (90%) supported decentralisation of appropriate breast surgical services to provincial and district hospitals backed up by specialist training. Thematic analysis of focus group discussions (Group 3) identified the following as important contributors to late BC diagnosis and poor outcomes: (i) presentation is delayed by poorly educated women and their families who fear BC and high treatment costs (ii) referral is delayed by health professionals with no access to training, skills or diagnostic equipment (iii), treatment is delayed by a disorganised, over-centralized patient pathway, and a lack of specialist care and inter-disciplinary communication. This study confirms that the reasons for poor BC outcomes in Zimbabwe are complex and multi-factorial. All stakeholders support better user and provider education, diagnostic service reconfiguration, targeted funding, and specialist training.

Assessing examination equipment accessibility for the disabled using non-fidelity of checkup items

Abstract Background Even after arriving at the hospital for a health checkup, access to equipment of the disabled is often limited. However, there is a lack of investigation on accessibility of health examination equipment due to difficulty in appropriate evaluation. Methods The Korean national health information database was analyzed to assess the non-fidelity of health checkup screening items for the disabled and non-disabled. Health checkup items included height, weight, BMI, visual acuity, audiometry, blood pressure, urinary protein, hemoglobin and chest X-ray. To analyze the non-fidelity of health checkup items according to the characteristics of the disabled, a chi-square analysis was conducted. Logistic regression analysis was performed to non-fidelity the influencing factors for non-fidelity of each health checkup item for the disabled and non-disabled. Results Among all health checkup participants, women's non-fidelity rate of checkup items was twice higher than men's (OR 2.20, 95% CI 2.18-2.21). The disabled were more twice times higher non-fidelity rate than the non-disabled(OR 2.49, 95% CI 2.47-2.52). It was evident in the case of women disabled, severely disabled or elderly disabled(&amp;lt;.001). Conclusions The non-fidelity rate of the disabled was high, especially for women disabled, severly disabled or elderly disabled. Even if the disabled visit a hospital for health checkup, access to the equipment may be limited. To increase accessibility to diagnostic equipment and improve access to essential health services, it is important to monitor and support the non-fidelity of each checkup item. Key messages • The disabled are more than twice as likely to have higher non-fidelity rates of health checkup items than the non-disabled. • Especially it was high among women disabled, severely disabled or elderly disabled.

Retroperitoneal Fibrosis

Retroperitoneal fibrosis (RPF) is a rare condition with an incidence of 1.3 per 100 000 population with a peak age of onset at 40 – 65 years old. The idiopathic form of RPF, also known as Ormond’s disease, is more common and makes up about 75% of the case. Here, we are presenting a case of a woman who was referred to our center due to worsening serum creatinine and was diagnosed with retroperitoneal fibrosis. This case has been taken up due to the rarity of the case and to discuss the radiological appearance specifically the CT appearance of retroperitoneal fibrosis. We have also discussed methods to differentiate between primary and secondary retroperitoneal fibrosis specifically based on CT findings. This is to provide guidance for the diagnosis and prompt management of cases, especially in district hospitals with no advanced diagnostic equipment such as MRI or the ability to biopsy.

Lab-on-a-chip – The advent of instantaneous diagnosis for a plethora of diseases

A lab-on-a-chip (LOC) is a device that facilitates the incorporation of a concatenation of various laboratory functions on a unique integrated circuit. The size of this instrument is merely a few millimeters to centimeters designed to attain automation and high-throughput screening. Microfluidic systems used in LOC devices allow the manufacture of millions of microchannels, each measuring mere micrometers. These microchannels enable control of fluids in infinitesimal quantities for a variety of diagnoses. Several labs on a chip have been commercialized in recent times for fundamental procedures, including glucose monitoring, human immunodeficiency virus, early tumor detection, and cardiac diagnostics. The LOC integrates microfluidics, nanosensors, micro-electrics, and biochemistry on one device. The advantages of the chip include its sustainability and cutback wastage. It expedites a decline in reagent costs and requires minimal sample volumes. The analysis and response are faster and the response is better controlled by equipping micro-channels. Countries with exiguous healthcare are in the face of adversity due to increased fatality rates from infectious diseases that are often curable in developed nations. In certain circumstances, impoverished healthcare clinics have the medications requisite to treat a specific condition but are in dearth of the diagnostic equipment needed to determine, in which individuals are in need of the medications. This is where the role of LOC as a potent novel diagnostic instrument would benefit humankind in the nearest future, according to eminent researchers. This article highlights the applications of LOC in a miscellany of fields, its advantages, feasible means to overcome the drawbacks, and the propitious prospects of this technology.

Detection of inhomogeneous magnetic fields using magnetoelectric composites

Magnetoelectric (ME) composites have a wide range of possible applications, especially as room-temperature sensors of weak magnetic fields in magnetocardiography and magnetoencephalography medical diagnostic equipment. In most works on ME composites, structures are tested in uniform magnetic fields; however, for practical application, detailed knowledge of their behaviour in inhomogeneous magnetic fields (IMFs) is necessary. In this work, we measured IMFs with radial symmetry produced by alternate currents (AC) passing through an individual thin wire upon different placements of an ME sensor. An ME self-biased b-LN/Ni/Metglas structure with a sensitivity to the magnetic field of 120 V/T was created for IMF detection. The necessity of an external biasing magnetic field was avoided by the inclusion of a nickel layer having remanent magnetization. The ME composite shows a non-zero ME coefficient of 0.24 V/(cm · Oe) in the absence of an external DC magnetic field. It is shown that the output voltage amplitude from the ME composite, which is located in an AC IMF, is dependent on the relative position of the investigated sample and magnetic field lines. Maximum ME signal is obtained when the long side of the ME sample is perpendicular to the wire, and the symmetry plane which divides the long side into two similar pieces contains the wire axis. In the frequency range from 400 Hz to 1000 Hz in the absence of vibrational and other noises, the detection limit amounts to (2 ± 0.4) nT/Hz1/2.

Impact of Measurement Conditions and Design Features of IBA Detectors on the Small Radiation Fields Output Factors

The use of modern diagnostic equipment in oncology has made it possible to detect small tumor foci, as&#x0D; well as to detect distant metastases of the disease at an early stage of their formation. In these cases, it&#x0D; becomes possible to refuse surgical interventions, replacing them with stereotactic radiosurgery using&#x0D; radiation therapy devices. In this case, small irradiation fields can be used (from fields less than 1 cm to&#x0D; 4 cm). In such cases, there is a problem of delivering large doses to small foci. It consists in the accuracy of determining the absorbed doses delivered to small targets. The complexity of monitoring the quality of dosimetric support of irradiation with the use of various radiotherapy devices is increasing. Increased requirements are also imposed on the detectors used for measurements.&#x0D; This work has several goals:&#x0D; 1) to study the results of measurements of the output factors using five different detectors of small&#x0D; sizes;&#x0D; 2) to determine the changes in the output factors when using two types of beam collimation (collimator&#x0D; shutters - JAWS and multileaf collimator - MLC) of linear electron accelerators;&#x0D; 3) to study the dependence of the output factors on the source-to-surface distance (SSD), on the depth&#x0D; of measurements and on the type of detectors.&#x0D; The measurements were carried out in 6 MV photon beams with a flattening filter on a TrueBeam linear&#x0D; accelerator. Five IBA detectors were used: two diode detectors (PFD and SFD) and three ionization&#x0D; chambers (CC01, CC04 and CC13). The field sizes varied from 1010 cm to 11 cm. The studies were&#x0D; carried out for the following combinations of parameters: SSD is 100 cm and the measurement depth is&#x0D; 10 cm; SSD is 95 cm and the measurement depth is 5 cm. The fields were formed by JAWS and MLC.&#x0D; The analysis of the obtained results made it possible to compare the data obtained from each detector&#x0D; in similar combinations of measurements. Based on the analysis of the output factors measured by all&#x0D; five detectors, conclusions were drawn about the parameters that affect the change in the output factors.

Hypertrophic Cardiomyopathy Diagnosis and Treatment in High- and Low-Income Countries: A Narrative Review.

Hypertrophic cardiomyopathy (HCM) is a hereditary cardiac condition characterized by unexplained left ventricular hypertrophy without a hemodynamic cause. This condition is prevalent in the United States, resulting in various clinical manifestations, including diastolic dysfunction, left ventricular outflow obstruction, cardiac ischemia, and atrial fibrillation. HCM is associated with several genetic mutations, with sarcomeric mutations being the most common and contributing to a more complex disease course. Early diagnosis of HCM is essential for effective management, as late diagnosis often requires invasive treatments and creates a substantial financial burden.Disparities in HCM diagnosis and treatment exist between high-income and low-income countries. High-income countries have more resources to investigate and implement advanced diagnostic and treatment modalities. In contrast, low-income countries face challenges in accessing diagnostic equipment, trained personnel, and affordable medications, leading to a lower quality of life and life expectancy for affected individuals. Diagnostic tools for HCM include imaging studies such as 2D echocardiography, cardiovascular magnetic resonance (CMR), and electrocardiograms (ECGs). CMR is considered the gold standard but remains inaccessible to a significant portion of the world's population, especially in low-income countries. Genetics plays a crucial role in HCM, with numerous mutations identified in various genes. Genetic counseling is essential but often limited in low-income countries due to resource constraints. Disparities in healthcare access and adherence to treatment recommendations exist between high-income and low-income countries, leading to differences in patient outcomes. Addressing these disparities is essential to improve the overall management of HCM on a global scale. In conclusion, this review highlights the complex nature of HCM, emphasizing the importance of early diagnosis, genetic counseling, and access to appropriate diagnostic and therapeutic interventions. Addressing healthcare disparities is crucial to ensure that all individuals with HCM receive timely and effective care, regardless of their geographic location or socioeconomic status.

Deep learning-based pigment analysis model trained with optical approach and ground truth assistance.

This study introduces an integrated training method combining the optical approach with ground truth for skin pigment analysis. Deep learning is increasingly applied to skin pigment analysis, primarily melanin and hemoglobin. While regression analysis is a widely used training method to predict ground truth-like outputs, the input image resolution is restricted by computational resources. The optical approach-based regression method can alleviate this problem, but compromises performance. We propose a strategy to overcome the limitation of image resolution while preserving performance by incorporating ground truth within the optical approach-based learning structure. The proposed model decomposes skin images into melanin, hemoglobin, and shading maps, reconstructing them by solving the forward problem with reference to the ground truth for pigments. Evaluation against the VISIA system, a professional diagnostic equipment, yields correlation coefficients of 0.978 for melanin and 0.975 for hemoglobin. Furthermore, our model can produce pigment-modified images for applications like simulating treatment effects.

Patient and provider perspectives on barriers to myocardial infarction care among persons with human immunodeficiency virus in Tanzania: A qualitative study.

People with HIV (PLWH) have an increased risk myocardial infarction (MI), and evidence suggests that MI is under-diagnosed in Tanzania. However, little is known about barriers to MI care among PLWH in the region. In this qualitative study grounded in phenomenology, semi-structured interviews were conducted in northern Tanzania. Purposive sampling was used to recruit a diverse group of providers who care for PLWH and patients with HIV and electrocardiographic evidence of prior MI. Emergent themes were identified via inductive thematic analysis. 24 physician and patient participants were interviewed. Most participants explained MI as caused by emotional shock and were unaware of the association between HIV and increased MI risk. Providers described poor provider training regarding MI, high out-of-pocket costs, and lack of diagnostic equipment and medications. Patients reported little engagement with and limited knowledge of cardiovascular care, despite high engagement with HIV care. Most provider and patient participants indicated that they would prefer to integrate cardiovascular care with routine HIV care. PLWH face many barriers to MI care in Tanzania. There is a need for multifaceted interventions to educate providers and patients, improve access to MI diagnosis, and increase engagement with cardiovascular care among this population.

A Fast Calibration Method for Pneumotachograph with a 3L Syringe.

The pneumotachograph (PNT), a commonly used flowmeter in pulmonary function diagnostic equipment, is the required frequency calibration to maintain high accuracy. Aiming to simplify calibration steps, we developed a fast calibration system with a commercially available 3L syringe to provide a real output flow waveform. The acquisition of the real output flow waveform is based on the reliable measurement of in-cylinder pressure and the real-time detection of plunger speed. To improve the calibration accuracy, the tapping position for measuring in-cylinder pressure was optimized by CFD dynamic-mesh updating technique. The plunger speed was obtained by tracking the handle of the plunger with a smart terminal. Then, the real output flow was corrected using a compensation model equation. The calibration system was verified by the pulmonary waveform generator that the accuracy satisfied the requirements for respiratory flow measurement according to ATS standardization. The experimental results suggest that the developed method promises the fast calibration of PNT.

Adherence to malaria treatment guidelines among health care workers in private health facilities in Kampala's informal settlements, Uganda.

Poor adherence to malaria treatment guidelines among healthcare workers (HCWs) is a major contribution to diagnostic challenges, treatment failure, and non-rational use of antimalarial medicines. However, there is limited information about adherence to malaria treatment guidelines among HCWs in private health facilities in informal settlements in Uganda. This study therefore assessed the level of adherence to malaria treatment guidelines and associated factors among HCWs in private health facilities in Kampala's informal settlements. A cross-sectional study was conducted among 339 HCWs from private health facilities in slums of 4 selected divisions in Kampala, Uganda. Quantitative data was collected using a semi-structured questionnaire, cleaned in MS Excel 2016 and analyzed using STATA 15.0 statistical software. Bivariate and multivariate analysis were conducted using a generalized linear model of modified Poisson regression to obtain factors associated with adherence to malaria treatment guidelines. The study revealed that majority of respondents 71.1%(241/339) were aged 30 years and below, and 50.1%(170/339) of the were female. Almost all of the respondents 98.8%(335/339) reported that they had malaria diagnostic equipment (microscopy or rapid diagnostic tests) at their facilities, 47.5%(161/339) had non-recommended anti-malarial drugs present in stock and 36.0% reported that they did not refer severely ill patients to higher health facilities in the previous 3 months. Although 92.6%(314/339) of the respondents had heard about the national malaria treatment guidelines, 63.1%(214/339) of them adhered to these guidelines. Having a bachelors degree (APR 1.54, (CI: 1.13-2.10)P 0.006), and having high levels of knowledge (APR 1.44, (CI: 1.13-1.60)P 0.001) were positively associated with high adherence to malaria treatment guidelines. In conclusion, adherence to malaria treatment guidelines was suboptimal and less than the national target of 90%. Enforcement, supervision, trainings, and continuous medical education should be enhanced in private healthcare facilities to improve adherence to malaria treatment guidelines in informal settlements.