Diagnostic Instrument Research Articles

Autism: Clinical impacts and late diagnosis in women - Literature review

Autism Spectrum Disorder (ASD) is a common neurodevelopmental disorder, marked by deficits in communication and social interaction and restricted and repetitive behavior patterns. With the expansion of information dissemination about autism and improvements in diagnostic methods, the prevalence of the disorder has increased considerably in recent decades. However, because autism has multiple facets and different presentations, diagnosis is still a challenge, especially in females, where there are singularities that further undermine suspicions, leading to underdiagnosis. Given this, there are multiple questions about the causes and implications of these factors in the diagnosis of autistic girls and women. Thus, the objective of this research is to verify the causal factors and clinical implications associated with the difficulty in diagnosing ASD in females. This is a narrative bibliographic review, in which research was carried out in established databases. In general, it is noted that the diagnosis of autism in girls and women can be impacted by genetic, developmental, psychological, social and cultural influences, involving factors such as subtlety of symptoms, capacity for social adaptability, lack of studies, failure to diagnostic methodologies and instruments, as well as stereotypes and prejudices. Understanding these elements is essential to broaden the perspective of girls and women with ASD, highlight their particularities and ensure that they receive early diagnosis and treatment.

A compact microfluidic laser-induced fluorescence immunoassay system using avalanche photodiode for rapid detection of alpha-fetoprotein.

Alpha-fetoprotein (AFP), commonly employed for early diagnosis of liver cancer, serves as a biomarker for cancer screening and diagnosis. Combining the high sensitivity and specificity of fluorescence immunoassay (FIA), developing a low-cost and efficient immunoassay system for AFP detection holds significant importance in disease diagnosis. In this work, we developed a miniaturized oblique laser-induced fluorescence (LIF) immunoassay system, coupled with a microfluidic PMMA/paper hybrid chip, for rapid detection of AFP. The system employed an avalanche photodiode (APD) as the detector, and implemented multi-level filtering in the excitation light channel using the dichroic mirror and optical trap. At first, we employed the Savitzky-Golay filter and baseline off-set elimination methods to denoise and normalize the original data. Then the cutoff frequency of the low-pass filter and the reverse voltage of the APD were optimized to enhance the detection sensitivity of the system. Furthermore, the effect of laser power on the fluorescence excitation efficiency was investigated, and the sampling time during the scanning process was optimized. Finally, a four-parameter logistic (4PL) model was utilized to establish the concentration-response equation for AFP. The system was capable of detecting concentrations of AFP standard solution within the range of 1-500 ng/mL, with a detection limit of 0.8 ng/mL. The entire immunoassay process could be completed within 15 min. It has an excellent potential for applications in low-cost portable diagnostic instruments for the rapid detection of biomarkers.

Clinical correlates of diagnostic certainty in children and youths with Autistic Disorder

BackgroundClinicians diagnosing autism rely on diagnostic criteria and instruments in combination with an implicit knowledge based on clinical expertise of the specific signs and presentations associated with the condition. This implicit knowledge influences how diagnostic criteria are interpreted, but it cannot be directly observed. Instead, insight into clinicians’ understanding of autism can be gained by investigating their diagnostic certainty. Modest correlations between the certainty of an autism diagnosis and symptom load have been previously reported. Here, we investigated the associations of diagnostic certainty with specific items of the ADOS as well as other clinical features including head circumference.MethodsPhenotypic data from the Simons Simplex Collection was used to investigate clinical correlates of diagnostic certainty in individuals diagnosed with Autistic Disorder (n = 1511, age 4 to 18 years). Participants were stratified by the ADOS module used to evaluate them. We investigated how diagnostic certainty was associated with total ADOS scores, age, and ADOS module. We calculated the odds-ratios of being diagnosed with the highest possible certainty given the presence or absence of different signs during the ADOS evaluation. Associations between diagnostic certainty and other cognitive and clinical variables were also assessed.ResultsIn each ADOS module, some items showed a larger association with diagnostic certainty than others. Head circumference was significantly higher for individuals with the highest certainty rating across all three ADOS modules. In turn, head circumference was positively correlated with some of the ADOS items that were associated with diagnostic certainty, and was negatively correlated with verbal/nonverbal IQ ratio among those assessed with ADOS module 2.LimitationsThe investigated cohort was heterogeneous, e.g. in terms of age, IQ, language level, and total ADOS score, which could impede the identification of associations that only exist in a subgroup of the population. The variability of the certainty ratings in the sample was low, limiting the power to identify potential associations with other variables. Additionally, the scoring of diagnostic certainty may vary between clinicians.ConclusionSome ADOS items may better capture the signs that are most associated with clinicians’ implicit knowledge of Autistic Disorder. If replicated in future studies, new diagnostic instruments with differentiated weighting of signs may be needed to better reflect this, possibly resulting in better specificity in standardized assessments.

Identification of Students' Misconceptions using Four-Tier Diagnostic Assessment in Physics Learning Phase F

This research aims to identify students' misconceptions about momentum and impulse material using a four-tier diagnostic assessment instrument to implement learning evaluation in the Merdeka curriculum. This type of research is descriptive with a qualitative approach, with data collection techniques carried out through assessments and interviews. Interview data is used to reinforce assessment data. The instrument used in the study is a four-tier diagnostic test on momentum and impulse developed by the researchers. The results showed that 50% of students experienced misconceptions about momentum matter due to the assumption that if two objects move with the same kinetic energy should have the same speed so that the momentum of both objects can be determined by ignoring their velocity. Then, as many as 13. 9% of students experience misconceptions about the law of conservation of matter momentum because of students' assumptions that ignore direction on velocity vector quantities. In other physics concepts, some students are less careful in calculations. The results of this study are expected to be a reference for teachers in designing more meaningful Merdeka curriculum-based learning plans to help students better understand the concepts of momentum and impulse.

Exploring altered bovine sperm trajectories by sperm tracking in unconfined conditions.

Mammalian sperm motility is getting more relevant due to rising infertility rates worldwide, generating the need to improve conventional analysis and diagnostic approaches. Nowadays, computer assisted sperm analysis (CASA) technologies represent a popular alternative to manual examination which is generally performed by observing sperm motility in very confined geometries. However, under physiological conditions, sperm describe three-dimensional motility patterns which are not well reconstructed by the limited depth of standard acquisition chambers. Therefore, affordable and more versatile alternatives are needed. Here, a motility analysis in unconfined conditions is proposed. In details, the analysis is characterized by a significant longer duration -with respect to conventional systems- with the aim to observe eventually altered motility patterns. Brightfield acquisition in rectangular glass capillaries captured frozen-thawed bovine spermatozoa which were analyzed by means of a self-written tracking routine and classified in sub-populations, based on their curvilinear velocity. To test the versatility of our approach, cypermethrin -a commonly used pesticides- known to be responsible for changes in sperm motility was employed, assessing its effect at three different time-steps. Experimental results showed that such drug induces an increase in sperm velocity and progressiveness as well as circular pattern formation, likely independent of wall interactions. Moreover, this resulted in a redistribution of sperm with the rapid class declining in number with time, but still showing an overall velocity increase. The flexibility of the approach permits parameter modifications with the experimental needs, allowing us to conduct a comprehensive examination of sperm motility. This adaptability facilitated data acquisition which can be computed at different frame rates, extended time periods, and within deeper observation chambers. The suggested approach for sperm analysis exhibits potential as a valuable augmentation to current diagnostic instruments.

Electrocardiography changes and different stages of heart failure in central Iran: A cross-sectional study from Yazd Health Study.

Electrocardiography (ECG) is a widely accessible, noninvasive, and cost-effective diagnostic instrument used to evaluate patients with suspected heart failure (HF). The aim of this study is to investigate electrocardiographic changes in patients with different stages of HF in a random population of Yazd city. This prospective cross-sectional study included 319 individuals, randomly selected, aged 40 years and more, registered in the Yazd Health Study was conducted from March 2022 to May 2023 at Afshar Hospitals. In accordance with the AHA/ACC guidelines, HF was classified into four stages (A, B, C, and D). The 159 individuals were classified in the stage 0 group, 77 were in Stage A, 65 were in Stage B, and 18 were in Stage C of HF. In the Stage 0, the PR interval (PRi) was 130.5 ± 18.1 ms, while in Stage C, it was 143.3 ± 21.9 ms, with a significant difference (p = 0.047). Similarly, the QRS interval (QRSi) increased with HF staging (p = 0.001). The frequency of diabetes mellitus (DM), hypertension (HTN), hyperlipidemia (HLP), chronic heart disease, alcoholism, and PRi, QRSi, QT interval levels were independent predictors of HF stage in multivariate regression analysis. The prevalence of HF stages, as classified by the AHA/ACC guidelines, was observed, with significant correlations between ECG parameters and HF progression. abnormal rhythms, left bundle branch block, ischemia, hypertrophy, and left atrial enlargement increased with higher HF stages. Major risk factors like DM and HTN exhibited a heightened prevalence in advanced HF stages, accentuating their pivotal role in the progression of HF.

Compare the Performance of Distinct Neural Networks Techniques to diagnose the kidney stone disease

Artificial Neural Networks are excellent at identifying patterns or trends in data, which makes them perfect for forecasting or prediction. Thus, neural networks have extensive application in biological systems. The application of neural networks to kidney stone diagnosis is emphasized in this article. Kidney stone issues can be diagnosed with neural networks by applying technological concepts such as MLP, SVM, RBF, and BPA. The purpose of this research is to use three different neural network algorithms—each with its own specific design and set of properties to identify kidney stone disease. The performance of the three neural networks is compared in this research with respect to training data set size, model creation time, and accuracy. Kidney stone sickness will be diagnosed using radial basis function (RBF) networks, two layers feed forward perceptrons trained with the back propagation training algorithm, and learning vector quantization (LVQ). However, determining the best approach for any particular diagnostic had never been an easy task. Like many other illnesses, kidney stones have already been diagnosed using neural network algorithms. The main objective of this work is to recommend the best medical diagnostic instrument, such as kidney stone detection, to reduce diagnosis times and improve accuracy and efficiency.

Thermal radiation of tongue surface as a human computer interaction diagnostics technique based on image classification with software interface

Backgroundand Purpose: Thermal radiation plays a pivotal role in addressing recognition limitations encountered by traditional Chinese medicine's tongue diagnosis. Modern thermal radiation diagnostic instruments offer enhanced objectivity, and in this study, we strive to further improve the diagnostic process through the integration of Human-Computer Interaction (HCI) principles. Our objective is to introduce the thermal radiation DenseNet ensemble model, synergizing the strengths of Convolutional Neural Networks (CNNs) and HCI principles to advance tongue image recognition in healthcare. This approach aims to enhance classification accuracy, even when faced with limited training data. MethodologyTransfer learning, utilizing fine-tuned CNNs and DenseNet, is employed for precise classification, with a specific focus on distinguishing tooth-marked tongues. A portable hand-held thermal radiation diagnostic instrument, seamlessly integrated with HCI, is developed for both clinical use and research. Experimental resultsMeticulously curated datasets, formed through the annotation of thermal radiation images, confirm the superior performance of the DenseNet architecture in tooth mark and tongue feature recognition. The proposed tooth mark tongue recognition model exhibits a significant accuracy improvement of approximately 25% compared to similar tasks in existing studies. Additionally, an AI health detector tailored for Traditional Chinese Medicine (TCM) thermal radiation image recognition is introduced, showcasing the seamless integration of HCI principles into healthcare applications. This innovative tool not only assesses users' health but also provides personalized health recommendations, illustrating the transformative potential of combining technology and healthcare. Discussion and conclusionIn addressing the limitations of traditional tongue diagnosis, thermal radiation emerges as a key factor enhancing objectivity and accuracy. The thermal radiation DenseNet ensemble model, along with HCI integration through the portable hand-held device, proves effective for improved TCM thermal radiation image identification in healthcare. The fusion of technology and HCI principles underscores the potential to elevate health assessments and offer valuable guidance to users.

Prognostic Value of Cardiac Color Doppler Ultrasound in Patients with Chronic Heart Failure

Objective: To investigate the value of cardiac color Doppler ultrasound (CDUS) in determining the clinical characteristics and assessing the prognosis of patients with chronic heart failure (CHF). Methods: 200 patients with CHF admitted to our hospital from January 2021 to June 2023 were selected as the study subjects, and these 200 patients were followed up for 6 months, with 159 cases in the surviving group and 41 cases in the deceased group, and examined with a diagnostic CDUS instrument (model GEVividE95ACUSONSC2000). The detection rate of chronic heart failure and cardiac function indexes of the two groups were observed. Results: The deceased group showed a chronic heart failure detection rate of 92.68%, which was significantly higher than the surviving group (76.73%; P < 0.05). Moreover, the cardiac function indexes of both groups were significantly different (P < 0.05). Conclusion: By performing cardiac ultrasonography on patients with CHF, their cardiac function can be clearly understood and the changes can be timely detected during treatment, hence physicians can formulate a more reasonable treatment plan for patients and improve their quality of life.

Eating disorders among international migrants: a systematic review and meta-analysis.

Migrants may have elevated exposure to stressors, which can affect their physical and mental well-being. However, migrants often experience a healthy immigrant effect, the applicability of this phenomena to eating disorders is unknown. We aimed to synthesize the available literature and estimate a summary measure of prevalence odds ratio for eating disorders in migrant populations compared to local populations. A literature search was conducted using MEDLINE, Embase, PsycINFO, and Web of Science with keywords on migration and eating disorders. Inclusion criteria involved using a validated eating disorder scale and having a comparator group. Two independent reviewers performed study screening and data extraction. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. Random-effects models of meta-analysis were applied to compare eating disorder prevalence between migrants and local populations. There were 10 studies included in our review (meta-analysis = 6, narrative synthesis = 4). Studies provided prevalence estimates for: any eating disorder, binge eating disorder, anorexia nervosa, and bulimia nervosa. Among studies with a diagnostic instrument, the pooled prevalence odds ratio (POR) between migrants and local populations for any eating disorder was 0.45 (95%CI: 0.35-0.59). However, a subgroup analysis of eating disorder instruments among studies using risk assessment tools demonstrated inconsistent findings, with both increases and decreases in prevalence. Migrants were found to have a lower prevalence of eating disorders compared to local populations, supporting the healthy immigrant hypothesis. However, this effect differs between diagnostic and risk assessment tools.

Development of Five-Tier Instruments to Identify Students' Misconceptions about Centripetal and Centrifugal Force

The purpose of the study was to determine the development process and the feasibility of a five-tier diagnostic test instrument to identify students' misconceptions about centripetal and centrifugal forces. This research is a type of Research and Development (R&D) with the development model used, namely the 4D (Four-D) development model. This study uses the R&D method because the results of this study are in the form of a diagnostic test instrument to identify misconceptions in the learning process, and to find out the main source of the causes of misconceptions. The results of the diagnostic test of students who have misconceptions about centripetal and centrifugal forces are 20.31%.The percentage of false positive is 9.62%, the false negative is 8.49 and the Lack of Knowledge is 16.97%. From the percentage results obtained that the false positive (FP) and false negative (FN) values ​​are valid because <10%.The results of the validity test on the instrument are said to be valid because >0.3 and the results of the reliability test are Cronbach's Alpha value obtained at 0.715 from 7 item questions. So this instrument can be said to be reliable because the Cronbach's Alpha value is classified as high based on the reliability criteria.

Evaluating screening for autism spectrum disorder using cluster randomization

We evaluated the rate of autism spectrum disorder (ASD) in a group invited to a screening program compared to the rates in two groups who received usual care. The population eligible for screening was all children in Iceland registered for their 30-month well-child visits at primary healthcare centers (PHCs) from March 1, 2016, to October 31, 2017 (N = 7173). The PHCs in the capital area of Reykjavik were the units of cluster randomization. Nine PHCs were selected for intervention (invited group), while eight PHCs received usual care (control group 1). PHCs outside the capital area were without randomization (control group 2). An interdisciplinary team, including a pediatrician contributing with physical and neurological examination, a psychologist evaluating autism symptoms using a diagnostic instrument, and a social worker interviewing the parents, reached a consensus on the clinical diagnosis of ASD according to the ICD-10 diagnostic system. Children in the population were followed up for at least two years and 119 cases were identified. The overall cumulative incidence of ASD was 1.66 (95% confidence interval (CI): 1.37, 1.99). In the invited group the incidence rate was 2.13 (95% CI: 1.60, 2.78); in control group 1, the rate was 1.83 (95% CI: 1.31, 2.50); and in control group 2, the rate was 1.02 (95% CI: 0.66, 1.50). Although the rate of ASD was higher in the invited group than in the control groups, the wide confidence intervals prevented us from concluding definitively that the screening detected ASD more readily than usual care.

The Creation of A Three-Tier Multiple-Choice Diagnostic Test Instrument to Identifying High School Students' Misconceptions Regarding Biological Virus Material

This study aims to develop a diagnostic test instrument with three tiers focusing on viral material. Research and Development (R&D) constitutes a form of applied research. The participants for the Field Test were Class X students at SMAN 22 Bone, while those for the subsequent test were Class X students at SMAN 19 Bone. Interviews and documentation serve as the primary research methods employed in this study. A three-tier multiple-choice format is characterized by three levels of questioning within the multiple-choice framework. The resultant diagnostic test instrument comprises three tiers: the first tier includes questions, the second tier offers alternative explanations, and the third tier assesses respondents' confidence levels in selecting answers and providing justifications. The outcomes of this research include answer keys, test questions, and question grids as integral components of the instrument. This study demonstrates the validity of the developed instrument through validation conducted by expert validators. The reliability test yielded a robust average value of 0.91. Only 24 out of the 40 questions were deemed valid during the field test phase. Findings revealed that students exhibited an average misconception rate of 47.2%, spanning two indicators derived from the 40 questions. Notably, misconceptions were prominent in the discussion sub-topic concerning the earliest discovery of viruses and methods for distinguishing viruses and bacteria, with an average misconception rate of 56.8% in viral material. Developing a three-tier diagnostic test effectively identified students' misconceptions regarding viral material, indicating suitability and efficacy for educational application.

Once in Contact, Forever Contaminated! Introducing a Clinically Validated Imagery- and Video-Based Chain of Contagion Task for the Measurement of Disgust and Contamination Change in Experimental Research and Clinical Practice

Tolin et al. (2004) developed the Chain of Contagion Task (CCT) to experimentally test the law of contagion and looming vulnerability (LV). In the CCT, contaminated pencils are brought into contact with clean pencils. The degree of contamination transferred to further new pencils refers to the level of biased contagious beliefs. Although this could be an important transdiagnostic tool, the usability of the original paradigm has been very laborious. Therefore, an imagery- and video-based CCT is introduced and validated in Study 1 in a nonclinical sample with 85 participants. In Study 2, the imagery-based CCT was validated in a clinical study with 15 participants diagnosed with contamination-related obsessive-compulsive disorder (C-OCD), 15 participants suffering from an anxiety disorder, and 15 nonclinical controls. The number of participants is consistent with those in Tolin’s original sample and the statistical evaluation of Study 2 was preregistered. Both CCT could be validated and the results could be replicated. In the imagery-based CCT, the C-OCD group displayed significantly higher contamination ratings, avoidance tendencies and LV than the two control groups. We argue that this open access diagnostic instrument can be applied in research as well as in therapeutic practice (Download CCT videos and imagery: https://doi.org/10.5281/zenodo.7730459).

Posttraumatische Belastungsstörung bei Kindern und Jugendlichen: Ergebnisse einer Querschnittsstudie zu Auswirkungen der neu formulierten Diagnosen PTBS und kPTBS in der ICD-11

ZusammenfassungHintergrundDie in der ICD-11 enger gefassten Kriterien der posttraumatischen Belastungsstörung (PTBS) und die Einführung der komplexen PTBS (kPTBS) mit zusätzlichen Schwierigkeiten in der Selbstorganisation und -regulation (SSO) können deutliche Auswirkungen auf die Diagnosehäufigkeit haben. In der vorliegenden Studie wurde untersucht, aufgrund welcher ICD-11-Cluster Kinder und Jugendliche die Diagnose verfehlen und ob Bezugspersonen Veränderungen im SSO-Bereich eher auf den Entwicklungsstand oder das traumatische Ereignis attribuieren und wie diese Attributionen wiederum mit der Symptomschwere zusammenhängen.MethodenN = 88 deutschsprachige Kinder und Jugendliche (Alter: 7–17) mit traumatischen Ereignissen sowie N = 79 Bezugspersonen wurden zwischen September 2019 und November 2020 zur (k)PTBS-Symptomschwere (CATS-2) und der Attribution der SSO-Symptome (Fragebogen für Bezugspersonen) befragt.ErgebnisseDie ICD-11-Kriterien (CATS‑2 und eine entwicklungsangepasste Version) ergaben geringere Häufigkeitsraten der PTBS als DSM‑5 und ICD-10. Am seltensten wurden die ICD-11-Cluster „Wiedererleben“ und „Übererregung“ erfüllt. Veränderungen der SSO-Symptome wurden vorwiegend als ereignisbedingt eingeschätzt. Diese Attribution hing mit höherer PTBS- und SSO-Symptomschwere im Fremdbericht zusammen. Die entwicklungsbedingte Attribution hing mit einer höheren SSO-, jedoch nicht PTBS-Symptomschwere im Fremdbericht zusammen.DiskussionIm Rahmen der Diagnostik und bei der Überarbeitung von Diagnoseinstrumenten für ICD-11-(k)PTBS sollten auch entwicklungsspezifische Symptomausprägungen berücksichtigt werden. Eine Herausforderung stellt die Abgrenzung von Veränderungen im SSO-Bereich als „traumabezogen“ gegenüber „entwicklungsbedingt“ dar und erfordert mehrere Informationsquellen.

Personal Competencies for Work–Family Integration and Its Relationship with Productivity and Comprehensive Health in Salaried Professionals

Work–Family Integration (WFI) is the decision-making process that enables an individual to effectively balance work, family, and personal responsibilities, generating a level of personal satisfaction aligned with the management of these demands. This research aims to explore the potential links between personal competencies facilitating work and family integration (WFI Competencies), employer-provided support (WFI Support), perceived satisfaction in role integration (WFI Satisfaction), and their association with organizational performance indicators and the overall health of professionals in dependent employment. Data were obtained via an online questionnaire administered to 270 professionals possessing a university education or higher, employed in public or private organizations spanning various sectors in Venezuela. The data were subsequently analyzed utilizing Structural Equation Modeling (SEM). The study was divided into two main parts: the factorial analysis (both exploratory and confirmatory) of measurement models and the analysis of the relationships and modeling inherent to the structural model. Initially, two diagnostic instruments were developed, one for WFI Competencies and another for WFI Indicators; though applied simultaneously, their structuring and validation were conducted separately. In the subsequent phase, conceptual models for structural analysis were defined. A positive relationship was observed between WFI Support and WFI Satisfaction, corroborating findings from previous research. The relationships between WFI Competencies and Satisfaction led to insights into the necessity of training to strengthen the personal decision-making process under the dual pressures of work and family roles. Future longitudinal studies could elucidate the effects of relationships within such programs on WFI Satisfaction. Concerning organizational indicators, this study found that WFI Satisfaction positively correlates with organizational commitment, enhancing work productivity and mitigating negative health effects. This research presents a model that could be replicated in other countries and with various sample types, facilitating comparative analyses that enrich the body of knowledge on this subject.

Unveiling the Potential of VELScope in Potentially Malignant Oral Lesion Early Detection for Future Dental Diagnosis Technology

Introduction: Oral lesions range from innocuous to possibly dangerous, including oral cancer, which is the world's 16th most common malignancy. Early detection of oral cancer can enhance a patient's life expectancy by a decade, emphasizing the need of diagnostic instruments like VELScope. VELScope is a portable device that employs blue light to examine oral tissue, exposing natural fluorescence and emphasizing aberrant regions that would otherwise be invisible without the use of specialized equipment. Objectives: This review looks at the possibility of the VELScope for identifying oral lesions, since it has the potential to be a future dental diagnostic tool. Method: We began with 88 findings and reduced them down to 33 research regarding VELScope technology published in the previous five years. Following screening, we chose ten articles using the same criteria for all research. Results: VELScope uses fluorescence to identify both obvious and concealed oral lesions, which is especially useful when collagen loss occurs in normal tissues. While using autofluorescence requires knowledge, it assists in analyzing margins in probable pre- malignant oral conditions. VELScope, despite its limitations, has promise for early cancer diagnosis as technology develops. Conclusion: When utilized for early diagnosis, VELScope helps to reduce oral cancer mortality, reaching an 83% 5-year survival rate. While it has limits, continuous technical improvements have the potential to improve its accuracy, making it a vital tool for accurate early diagnosis and lowering oral cancer mortality.

A Generalizable Decision-Making Framework for Selecting Onsite versus Send-out Clinical Laboratory Testing.

Laboratory networks provide services through onsite testing or through specimen transport to higher-tier laboratories. This decision is based on the interplay of testing characteristics, treatment characteristics, and epidemiological characteristics. Our objective was to develop a generalizable model using the threshold approach to medical decision making to inform test placement decisions. We developed a decision model to compare the incremental utility of onsite versus send-out testing for clinical purposes. We then performed Monte Carlo simulations to identify the settings under which each strategy would be preferred. Tuberculosis was modeled as an exemplar. The most important determinants of the decision to test onsite versus send-out were the clinical utility lost due to send-out testing delays and the accuracy decrement with onsite testing. When the sensitivity decrements of onsite testing were minimal, onsite testing tended to be preferred when send-out delays reduced clinical utility by >20%. By contrast, when onsite testing incurred large reductions in sensitivity, onsite testing tended to be preferred when utility lost due to delays was >50%. The relative cost of onsite versus send-out testing affected these thresholds, particularly when testing costs were >10% of treatment costs. Decision makers can select onsite versus send-out testing in an evidence-based fashion using estimates of the percentage of clinical utility lost due to send-out delays and the relative accuracy of onsite versus send-out testing. This model is designed to be generalizable to a wide variety of use cases. The design of laboratory networks, including the decision to place diagnostic instruments at the point-of-care or at higher tiers as accessed through specimen transport, can be informed using the threshold approach to medical decision making.The most important determinants of the decision to test onsite versus send-out were the clinical utility lost due to send-out testing delays and the accuracy decrement with onsite testing.The threshold approach to medical decision making can be used to compare point-of-care testing accuracy decrements with the lost utility of treatment due to send-out testing delays.The relative cost of onsite versus send-out testing affected these thresholds, particularly when testing costs were >10% of treatment costs.

Detection of α-Thrombin with Platelet Glycoprotein Ibα (GP1bα) for the Development of a Coagulation Marker.

The detection of prothrombotic markers is crucial for understanding thromboembolism and assessing the effectiveness of anticoagulant drugs. α-Thrombin is a marker that plays a critical role in the coagulation cascade process. However, the detection of this enzymatic molecule was hindered by the absence of an efficient modality in the clinical environment. Previously, we reported that one α-thrombin interacts with two α-chains of glycoprotein Ib (GPIbα), i.e., multivalent protein binding (MPB), using bioresponsive hydrogel nanoparticles (nanogels) and optical microscopy. In this study, we demonstrated that GPIbα-mediated platforms led to the highly sensitive and quantitative detection of α-thrombin in various diagnostic systems. Initially, a bioresponsive nanogel-based surface plasmon resonance (nSPR) assay was developed that responds to the MPB of α-thrombin to GPIbα. The use of GPIbα for the detection of α-thrombin was further validated using the enzyme-linked immunosorbent assay, which is a gold-standard protein detection technique. Additionally, GPIbα-functionalized latex beads were developed to perform latex agglutination (LA) assays, which are widely used with hospital diagnostic instruments. Notably, the nSPR and LA assays exhibited a nearly 1000-fold improvement in sensitivity for α-thrombin detection compared to our previous optical microscopy method. The superiority of our GPIbα-mediated platforms lies in their stability for α-thrombin detection through protein-protein interactions. By contrast, assays relying on α-thrombin enzymatic activity using substrates face the challenge of a rapid decrease in postsample collection. These results suggested that the MPB of α-thrombin to GPIbα is an ideal mode for clinical α-thrombin detection, particularly in outpatient settings.

Python Red Pitaya Lockbox (PyRPL): An open source software package for digital feedback control in quantum optics experiments.

We present the Python Red Pitaya Lockbox (PyRPL), an open source software package that allows the implementation of automatic digital feedback controllers for quantum optics experiments on commercially available, affordable Field-Programmable Gate Array (FPGA) boards. Our software implements the digital generation of various types of error signals, from an analog input through the application of loop filters of high complexity and real-time gain adjustment for multiple analog output signals, including different algorithms for resonance search, lock acquisition sequences, and in-loop gain optimization. Furthermore, all necessary diagnostic instruments, such as an oscilloscope, a network analyzer, and a spectrum analyzer, are integrated into our software. Apart from providing a quickly scalable, automatic feedback controller, the lock performance that can be achieved by using PyRPL with imperfect equipment, such as piezoelectric transducers and noisy amplifiers, is better than the one achievable with standard analog controllers due to the higher complexity of implementable filters and possibilities of nonlinear operations in the FPGA. This drastically reduces the cost of added complexity when introducing additional feedback loops to an experiment. The open-source character also distinguishes PyRPL from commercial solutions, as it allows users to customize functionalities at various levels, ranging from the easy integration of PyRPL-based feedback controllers into existing setups to the modification of the FPGA functionality. A community of developers provides fast and efficient implementation and testing of software modifications.