Diagnostic Program Research Articles

Open HBIM-IoT Monitoring Platform for the Management of Historical Sites and Museums. An Application to the Bourbon Royal Site of Carditello

ABSTRACT This paper describes the implementation of an open-source platform integrating HBIM-IoT monitoring sensors, applied to the Royal Site of Carditello, a Bourbon 18th-century Palace near the city of Capua (Italy). Based on open standards and processes, the platform is accessible on different devices through the Internet and acts as a digital representation of the building and the monitoring system therein, allowing users to navigate a detailed HBIM model and query, visualise and manipulate static and dynamic information attributed to the building and its collections, as well as the data from applied sensors, linked to their virtual objects’ equivalent in the model. Integrating robust data management with a user-friendly 3D interface, this solution aims to enhance the preventive conservation of historical buildings and their collections, which depend on regular monitoring and a systematic diagnostic programme over time.

More Than a Decade of GeneXpert®Mycobacterium tuberculosis/Rifampicin (Ultra) Testing in South Africa: Laboratory Insights from Twenty-Three Million Tests.

This study seeks to describe the rollout and current state of South Africa's GeneXpert molecular diagnostic program for tuberculosis (TB). Xpert MTB/RIF was introduced in 2011 with a subsequent expansion to include extra-pulmonary and paediatric testing, followed by Xpert MTB/RIF Ultra in 2017. Through a centralised laboratory information system and the use of a standardised platform for more than a decade, over 23 million tests were analysed, describing the numbers tested, Mycobacterium tuberculosis complex detection, rifampin resistance, and the unsuccessful test rates. The stratification by province, specimen type, age, and sex identified significant heterogeneity across the program and highlighted testing gaps for men, low detection yield for paediatric pulmonary TB, and the effects of inadequate specimen quality on the detection rate. The insights gained from these data can aid in the monitoring of interventions in support of the national TB program beyond laboratory operational aspects.

Why Medical Students Pursue Radiology: A Current Longitudinal Survey on Motivations and Controversial Issues in Radiology

Radiology is an increasingly competitive specialty. Various current factors influence medical students' decision to pursue a radiology career, including artificial intelligence (AI), remote reading, and COVID-19. This study seeks to determine the decision-making factors of all alumni from our medical school who matched into a radiology residency, and to gather opinions on emerging radiology topics. A survey querying decision-making factors and opinions on current radiology topics was distributed to all alumni from our medical school (first graduating class in 2011) who previously matched into a diagnostic or interventional radiology residency program (n=57). Wilcoxon Rank-Sum and Fisher's Exact tests were used to determine statistical significance. Forty-three of fifty-seven responses were received (75% response rate). The most influential factor that sparked respondents' interest in radiology was a radiology elective (25/43, 58%). Students who will finish radiology training in 2023 or later were more likely to be influenced by a mentor (15/23, 65%) than those who finished radiology training before 2023 (5/20, 25%) (p=0.04). Respondents reported a 1.6/5 concern about AI negatively impacting their future career in radiology. There was 1.7/5 concern about performing radiology procedures on patients during the COVID-19 pandemic. Respondents predicted that remote reading would have a 3.2/5 positive impact on helping them achieve their preferred lifestyle. Job satisfaction among attending radiologists is rated at 4.3/5. Radiology electives had the greatest influence in piquing students' interest in radiology, while mentorship is assuming increasing influence. AI is perceived as a relatively minimal threat to negatively impact radiologists' jobs. Respondents had little concern about performing radiology procedures during the COVID-19 pandemic. Remote reading is viewed as having a moderately positive impact on lifestyle. Responding radiologists enjoy notably high job satisfaction.

Antibiotic use at a tertiary hospital in Tanzania: findings from a point prevalence survey

BackgroundIn Tanzania, data on antibiotic use at the patient level is scarce, and intervention measures to optimize antibiotic use and reduce antimicrobial resistance are rarely performed.ObjectivesTo describe antibiotic use at Muhimbili National Hospital.MethodsThis was a point prevalence survey on antibiotic use conducted at Muhimbili National Hospital in August-September 2022. The World Health Organization point prevalence survey data collection tool was used to collect patients’ information from the files. All patients admitted to the wards on the day of the survey were included.ResultsOverall, 47% (185/397) of admitted patients were on at least one antibiotic during the survey. All antibiotics prescribed were for empirical treatment and guideline compliance was low, at 45%. Of 185 patients who received antibiotics, the most common indication was community acquired infection (55%) and 36% had no documentation of the reasons for prescribing antibiotics. Almost 75% of the antibiotics were administered parenterally, with only 2% switching to oral route. Microbiological tests were performed in only 9 (5%) patients out of 185 and results were available for only one patient. Of all participants, 52% received two or more antibiotic in combination, with the combination ceftriaxone-metronidazole being most frequently prescribed, followed by the combination of ampicillin, cloxacillin, and gentamicin. For individual antibiotics, ceftriaxone was the most frequently prescribed antibiotic accounting for 28% (79/283), followed by metronidazole (24%) and amoxicillin-clavulanic acid (11%).ConclusionThe findings of a high prevalence of antibiotic use, inadequate use of bacterial culture, and frequent empiric antibiotic treatment suggests the need for strengthening diagnostic and antimicrobial stewardship programs. Furthermore, this study has identified areas for quality improvement, including education programs focusing on prescription practice.

A Retinal Oct-Angiography and Cardiovascular STAtus (RASTA) Dataset of Swept-Source Microvascular Imaging for Cardiovascular Risk Assessment

In the context of exponential demographic growth, the imbalance between human resources and public health problems impels us to envision other solutions to the difficulties faced in the diagnosis, prevention, and large-scale management of the most common diseases. Cardiovascular diseases represent the leading cause of morbidity and mortality worldwide. A large-scale screening program would make it possible to promptly identify patients with high cardiovascular risk in order to manage them adequately. Optical coherence tomography angiography (OCT-A), as a window into the state of the cardiovascular system, is a rapid, reliable, and reproducible imaging examination that enables the prompt identification of at-risk patients through the use of automated classification models. One challenge that limits the development of computer-aided diagnostic programs is the small number of open-source OCT-A acquisitions available. To facilitate the development of such models, we have assembled a set of images of the retinal microvascular system from 499 patients. It consists of 814 angiocubes as well as 2005 en face images. Angiocubes were captured with a swept-source OCT-A device of patients with varying overall cardiovascular risk. To the best of our knowledge, our dataset, Retinal oct-Angiography and cardiovascular STAtus (RASTA), is the only publicly available dataset comprising such a variety of images from healthy and at-risk patients. This dataset will enable the development of generalizable models for screening cardiovascular diseases from OCT-A retinal images.

A-363 Evaluating the Performance of Emerging STI Point of Care Assays Using Novel, Room Temperature Stable CT/NG/TV/MG Positive Swab Quality Control Materials

Abstract Background The emergence of Point of Care tests that detect Sexually Transmitted Infections (STIs) is critical for screening and diagnostic programs in low-resource settings. Point of Care tests that are designed to simultaneously detect Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), and Mycoplasma genitalium (MG) promote rapid diagnosis and early treatment of the most common etiological agents causing STIs. Along with the roll-out and use of these tests, there is a growing need for complex multi-analyte quality control materials that are stable at room temperature and challenge test performance by identifying result deviations, lot-to-lot variability, and routine laboratory workflow errors. Microbix developed a whole-workflow multiplex quality control desiccated on a Copan FLOQSwab® that is stable at 2–30°C and contains inactivated whole-genome target pathogens. The objective of this study is to evaluate sample performance with multiple Point of Care diagnostic platforms that are currently in development and commercial IVD tests that are routinely used in the laboratory. Methods Microbix designed an inactivated STI whole-workflow control that contains whole-genome CT, NG, TV, MG, and human cells to satisfy sample adequacy control requirements. The formulation is desiccated on a Copan FLOQSwab® to mimic patient specimen formats and ensure sample compatibility with all assay workflows and elution buffers. Sample performance was evaluated with Cepheid Xpert® CT/NG assay, Cepheid Xpert® TV assay, Abbott Alinity m STI assay, BD MAX™ CT/GC/TV assay, Seegene Novaplex™ CT/NG/TV/MG assay, EliTechGroup STI PLUS ELITe MGB®Kit, and commercial Point of Care assays currently in development. Results The STI positive swab formulation demonstrated acceptable performance when tested with various nucleic acid amplification tests that detect CT, NG, TV, and MG targets. The formulations also behaved as useful quality management tools by highlighting design limitations for commercial Point of Care assays that are currently in development. Conclusion CT/NG/TV/MG whole-genome multiplex formulation desiccated on a Copan FLOQSwab® is an advantageous prospective quality control material that is stable at room temperature and supports the clinical use and accuracy of emerging STI assays, including the most challenging Point of Care test formats. The formulations showed acceptable performance on multiple platforms, demonstrating excellent commutability. Additionally, the dry swab format offers great practicality for monitoring assay performance in low-resource settings.

Combined sequence and copy number analysis improves diagnosis of limb girdle and other myopathies.

Clinical and genetic heterogeneities make diagnosis of limb-girdle muscular dystrophy (LGMD) and other overlapping disorders of muscle weakness complicated and expensive. We aimed to develop a comprehensive next generation sequence-based multi-gene panel ("The Lantern Focused Neuromuscular Panel") to detect both sequence variants and copy number variants in one assay. Patients with clinical diagnosis of LGMD or other overlapping muscular dystrophies in the United States were tested by PerkinElmer Genomics in 2018-2021 via "The Lantern Project," a sponsored diagnostic testing program. Sixty-six genes related to LGMD subtypes- and other myopathies were investigated. Main outcomes were diagnostic yield, gene-variant spectrum, and LGMD subtypes' prevalence. Molecular diagnosis was established in 19.6% (1266) of 6473 cases. Major genes contributing to LGMD were identified including CAPN3 (5.4%, 68), DYSF (4.0%, 51), GAA (3.7%, 47), ANO5 (3.6%, 45), and FKRP (2.7%, 34). Genes of other overlapping MD subtypes identified included PABPN1 (10.5%, 133), VCP (2.2%, 28), MYOT (1.2% 15), LDB3 (1.0%, 13), COL6A1 (1.5%, 19), FLNC (1.1%, 14), and DNAJB6 (0.8%, 10). Different sizes of copy number variants including single exon, multi-exon, and whole genes were identified in 7.5% (95) cases in genes including DMD, EMD, CAPN3, ANO5, SGCG, COL6A2, DOK7, and LAMA2. "The Lantern Focused Neuromuscular Panel" enables identification of LGMD subtypes and other myopathies with overlapping clinical features. Prevalence of some MD subtypes was higher than previously reported. Widespread deployment of this comprehensive NGS panel has the potential to ensure early, accurate diagnosis as well as re-define MD epidemiology.

July 2021 civil unrest: South African diagnostic radiography students' experiences.

South Africa (SA), in 2021, experienced a wave of civil unrest following political events that led to mass looting and the destruction of property. Civil unrests, among other disruptions, have been seen to cause ripple effects on healthcare education, particularly for radiography students who undergo work integrated learning within hospitals and universities, even during these times of unrest. This study aimed to explore and describe the undergraduate diagnostic radiography students' experience of the civil unrest that occurred in SA in 2021. The study was conducted across five universities in South Africa, offering the diagnostic radiography programme. A qualitative, interpretive phenomenological design was employed as it enabled the researchers to facilitate focus group interviews to gain insight into the lived experiences of the students during this time. Four themes emerged from the study data, namely: (1) Negative effects on students' emotional and psychological well-being, (2) Academic and clinical support mechanisms during disruptions, (3) The influence of disruptions on clinical training, (4) Recommendations to support students for future disruptions. The participants from this study described the negative effects that the civil unrest had on their emotional and mental well-being. There is a need for increased support mechanisms during times of disruptions from universities across South Africa. The findings highlight the ripple effects that disruptions, such as civil unrests, have on radiography students. This can assist universities to relook at their institutional support structures, in order to enhance the current support given to students across universities in times of disruptions.

Australian healthcare professionals' perspectives on genetic counseling and genetic diagnosis in vascular anomalies.

Genomic technologies are now utilized for the genetic diagnosis of vascular anomalies. This provides the opportunity for genetic counselors to make a significant contribution to patient care for this complex disease. The aim of this study was to explore Australian healthcare professionals' perspectives on the relatively recent integration of molecular diagnostic testing for vascular anomalies, with or without genetic counseling support. Nine semi-structured interviews were conducted with Australian healthcare professionals involved in the provision of care for individuals with vascular anomalies. Thematic analysis identified six themes: (1) Molecular diagnosis is beneficial; (2) psychosocial needs can motivate families to pursue a molecular diagnosis; (3) molecular genetic testing for vascular anomalies is complex; (4) genetic service provision is not a one size fits all; (5) a client-centered approach for genetic service provision can go a long way; and (6) the value of genetic counselors. Based on our findings, implementation of a vascular anomalies genetic diagnostic program inclusive of genetic counseling may be challenging, yet such programs are likely to benefit both patients and their families, as well as healthcare professionals. As this paradigm shift unfolds, genetic counselors have an opportunity to contribute to the vascular anomaly field by educating healthcare professionals and patients, by participating in multidisciplinary clinics to support complex cases and by raising awareness regarding their practice and potential contributions.

A Computer Program for Assessing Histoanatomical Morphometrics in Ultra-High-Frequency Ultrasound Images of the Bowel Wall in Children: Development and Inter-Observer Variability.

Ultra-high-frequency ultrasound (UHFUS) has a reported potential to differentiate between aganglionic and ganglionic bowel wall, referred to as histoanatomical differences. A good correlation between histoanatomy and UHFUS of the bowel wall has been proven. In order to perform more precise and objective histoanatomical morphometrics, the main research objective of this study was to develop a computer program for the assessment and automatic calculation of the histoanatomical morphometrics of the bowel wall in UHFUS images. A computer program for UHFUS diagnostics was developed and presented. A user interface was developed in close collaboration between pediatric surgeons and biomedical engineers, to enable interaction with UHFUS images. Images from ex vivo bowel wall samples of 23 children with recto-sigmoid Hirschsprung's disease were inserted. The program calculated both thickness and amplitudes (image whiteness) within different histoanatomical bowel wall layers. Two observers assessed the images using the program and the inter-observer variability was evaluated. There was an excellent agreement between observers, with an intraclass correlation coefficient range of 0.970-0.998. Bland-Altman plots showed flat and narrow distributions. The mean differences ranged from 0.005 to 0.016 mm in thickness and 0 to 0.7 in amplitude units, corresponding to 1.1-3.6% and 0.0-0.8% from the overall mean. The computer program enables and ensures objective, accurate and time-efficient measurements of histoanatomical thicknesses and amplitudes in UHFUS images of the bowel wall. The program can potentially be used for several bowel wall conditions, accelerating research within UHFUS diagnostics.

WTP7.7 A novel sexually transmitted infection (STI) testing and screening programme in an Ambulatory Surgical Clinic (ASC) for female patients presenting with abdominal pain

Abstract Aims Methods Women aged 18-44 years presenting to ASC were offered a voluntary self-collected high vulvovaginal swab for chlamydia and gonorrhoea at triage. Data was collected over one year (Dec 2021-Dec 2022). Testing was offered to 299 patients, 20 declined to participate and 18 samples were rejected. Positive results were referred to the Sexual Health service for treatment and contact tracing as agreed on a pre-planned referral pathway. Results 5.4% of swabs were positive (2 Gonorrhoea and 12 Chlamydia). The mean age of those testing positive was 24.5. All positive patients presented initially with lower abdominal pain. Of those testing positive 7 had further imaging (USS pelvis) and only 25% had a documented sexual history taken. 4 women had diagnostic imaging indicative of PID and 4 patients were treated for PID empirically. The remaining patients were treated for non-specific abdominal pain or unrelated pathology. Conclusions Undiagnosed sexually transmitted disease is prevalent and young females presenting with lower abdominal pain provide an excellent testing cohort. Given the high incidence of positive tests, further training of surgeons to consider and ask pertinent questions regarding an STI diagnosis is vital. The introduction of self-swab testing has been successful in assisting as a diagnostic tool and screening programme.

Edoxaban use in the context of dental procedures: analysis from the EMIT-AF/VTE database

IntroductionLiterature reviews support continuing anticoagulation during dental procedures. However, studies often present grouped anticoagulation data, and information on individual anticoagulant management would be helpful to dentists. The Edoxaban Management in Diagnostic and Therapeutic Procedures (EMIT-AF/VTE) programme (NCT02950168; NCT02951039) demonstrated low periprocedural bleeding and thrombotic event rates in patients with atrial fibrillation receiving edoxaban.AimsTo report periprocedural edoxaban interruption and clinical events in patients from EMIT-AF/VTE who underwent dental procedures.MethodsDental procedures were categorised by type (cleaning/noncleaning). Edoxaban interruption, bleeding events, and thrombotic events were observed 5 days preprocedure through 29 days postprocedure.ResultsOverall, 196 patients underwent 350 cleaning and/or noncleaning procedures; most patients (171/196 [87.2%]) underwent noncleaning procedures (282/350 [80.6%]), whereas 48/196 (24.5%) underwent 68/350 (19.4%) cleaning procedures. Edoxaban was uninterrupted for most cleanings (53/68 [77.9%]). Preprocedural interruption was common for single and multiple tooth extractions (single, 67/100 [67.0%]; multiple, 16/30 [53.3%]). The only major bleeding occurred after an unrelated cleaning. Minor bleeding occurred in 1/68 (1.5%) cleaning and 4/282 (1.4%) noncleaning procedures. There were no thrombotic events.ConclusionsFor most cleanings, edoxaban was not interrupted, whereas preprocedural interruption was more common for tooth extractions. Overall, bleeding rates were low, and no thrombotic events occurred.

Radiology Resident Diagnostic In-Training Exam Scores: Impact of Subspecialty Imaging Volume and Rotation Scheduling

PurposeTo determine the relationship between resident imaging volumes and number of subspecialty rotations with Diagnostic Radiology In-Training (DXIT) subspecialty scores. MethodsDXIT-scaled subspecialty scores from a single large diagnostic radiology training program from 2014 to 2020 were obtained. The cumulative number of imaging studies dictated by each resident and specific rotations were mapped to each subspecialty for each year of training. DXIT subspecialty scores were compared against the total subspecialty imaging volume and the total number of rotations in a subspecialty for each resident year. A total of 52 radiology residents were trained during the study period and included in the dataset. ResultsThere was a positive linear relationship between the number of neuro studies and scaled neuro DXIT scores for R1s (Pearson coefficient: 0.29; p-value: 0.034) and between the number of breast studies and the number of neuro studies with DXIT scores for R2s (Pearson coefficients: 0.50 and 0.45, respectively; p-values: 0.001 and 0.003, respectively). Furthermore, a positive significant linear relationship between the total number of rotations in cardiac, breast, neuro, and thoracic subspecialties and their scaled DXIT scores for R2 residents (Pearson coefficients: 0.34, 0.49, 0.33, and 0.32, respectively; p-value: 0.025, 0.001, 0.03, and 0.036, respectively) and between the total number of nuclear medicine rotations with DXIT scores for R3s (Pearson coefficient: 0.41; p-value: 0.016). ConclusionResident subspecialty imaging volumes and rotations have a variable impact on DXIT scores. Understanding the impact of study volume and the number of subspecialty rotations on resident medical knowledge will help residents and program directors determine how much emphasis to place on these factors during residency.

Innovative processes in the German pharmaceutical industry

Subject. The article addresses Germany's competitive position in the global pharmaceutical market and R&D development in the pharmaceutical industry. Objectives. The purpose is to provide a unique comprehensive study of innovative processes development in the pharmaceutical industry, using the case of German companies, explore innovative approaches to solving production problems, identify leading German companies in the field of biotechnology, and reveal the most promising areas for the development of German pharmaceuticals. Methods. We employ statistical and cartographic methods, and methods of comparative and economic analysis. Results. In their activities, German pharmaceutical companies combine the production of medicines, medical equipment, innovative developments, and implementation of various treatment, therapy and diagnostic programs. In a highly competitive global generic market, in Germany, there is a trend towards intra-industry structural transformation of pharmaceutical companies. The paper analyzed R&D spending, the geography of research centers of German pharmaceutical companies in the world, and their activities. Conclusions. The specifics of German pharmaceutical industry is the manufacture of high-tech products, using medical biotechnologies, which provides the country's advantage in the world market. Despite the presence of competitors in the generic market, i.e. India and China, German biotechnology-based pharmaceuticals continue to be in high demand among consumers as a high-quality product.

REFLECTION OF CREATIVITY: THE EXPERIENCE OF STUDYING AND DEVELOPMENT

The article substantiates the relevance of studying and developing the creativity reflection, which determines the perspective of the development of creative potential in the process of ontogenesis and which is the “triggering mechanism” of all self-processes of personality and a condition for successful self-realisation of personality in the future. The authors give a working definition of the “reflection of creativity” concept as a meta-ability to realise creative self-processes of personality: self-exploration, self-reconstruction, self-design and self-creation, awareness of creative achievements and individual characteristics of the “Creative Self”. The authors developed a diagnostic programme and a model of creativity reflection. The ascertaining, transforming and control stages of the study were implemented in a group of younger schoolchildren. Based on the results of the ascertaining experiment, the authors developed a transformative experiment, which is a developmental programme. Based on the empirical research, the authors determine the age specificity and dynamics of development, the correlation structure of significant indicators of creativity reflection, the features of the dynamic and contradictory process of formation of creativity reflection that contribute to the development of younger schoolchildren as subjects of creative activity.

РАСПРОСТРАНЕННОСТЬ ГАСТРИТА И ДУОДЕНИТА СРЕДИ ДЕТЕЙ 0-17 ЛЕТ, ПРОЖИВАЮЩИХ В ГОРОДЕ ЯРОСЛАВЛЕ И КРУПНЫХ РАЙОНАХ ЯРОСЛАВСКОЙ ОБЛАСТИ (МЕТААНАЛИЗ)

Chronic gastroduodenitis (CGD) is one of the most common diseases in children. Current data on the prevalence and incidence of CGD in children are contradictory. Currently, no work has been carried out to assess the prevalence and incidence of CGD in a multicenter study in Russia. The aim of the study was to assess the prevalence of CGD in terms of prevalence using meta-analysis among children aged 0-17 years living in the city of Yaroslavl and large districts of the Yaroslavl region. The research material was the indicators of statistical reporting of medical institutions of the region for 2017-2021. At the same time, the figures are higher than the data of local works on the territory of the Russian Federation. According to our study, the cumulative incidence at the end of 2021 ranged from 7.3% to 11.4% in some districts of the Yaroslavl Region of the Central Federal District, while in some age subgroups this figure exceeds 16%. CGD is a common disease of the upper digestive tract (UDT) in children living in the studied territories (from 15% to 26%). At the same time, in the age groups of 6-7 years and 13-14 years, this indicator exceeds the average value in all the studied territories, and in some it exceeds 53%, which reflects the insufficient level of effectiveness of clinical diagnostic programs for the early detection of CGD in children and will further increase the prevalence of CGD in the general population, especially among children from 3 to 14 years old.

Advancing Access to Diagnostic Tools Essential for Universal Health Coverage and Antimicrobial Resistance Prevention: An Overview of Trials in Sub-Saharan Africa.

We introduce the Antimicrobial Resistance Diagnostic Use Accelerator program, and the articles in this Supplement, which cover the program in 3 sub-Saharan Africa countries.

Modern Approaches to Providing Telematics Oral Health Services in Pediatric Dentistry: A Narrative Review

A structural and organizational redesign of the dental care system is necessary today due to current trends in the demographic process and the accompanying changes in the population’s healthcare needs. The purpose of this article is to review the literature, analyzing those trends that today represent useful tools for the oral health of pediatric patients, with particular reference to teledentistry and all the supports it uses to reach remote territories or patients who, for various reasons, cannot have access to dental care. An independent literature search was conducted in three electronic databases: PubMed/MEDLINE, Google Scholar, and the COCHRANE library. Thirty-one articles were considered. Reported findings highlight that teledentistry has been used in pediatrics to educate and promote oral health and to provide remote diagnosis and monitoring through mobile health applications, smartphone cameras and apps, intraoral cameras, websites and search engines, and telephonic communications. Specifically, teledentistry has been beneficial in providing dental care in remote locations with difficult access to pediatric dentists, conducting remote diagnostic and screening programs, monitoring patients between appointments, promoting children’s oral health through dental education, and providing behavioral counseling prior to office visits. Future research should further investigate the long-term use, additional applications, and cost-effectiveness of teledentistry in children.

Development of a multiple convolutional neural network-facilitated diagnostic screening program for immunofluorescence images of IgA nephropathy and idiopathic membranous nephropathy.

Immunoglobulin A nephropathy (IgAN) and idiopathic membranous nephropathy (IMN) are the most common glomerular diseases. Immunofluorescence (IF) tests of renal tissues are crucial for the diagnosis. We developed a multiple convolutional neural network (CNN)-facilitated diagnostic program to assist the IF diagnosis of IgAN and IMN. The diagnostic program consisted of four parts: a CNN trained as a glomeruli detection module, an IF intensity comparator, dual-CNN (D-CNN) trained as a deposition appearance and location classifier and a post-processing module. A total of 1573 glomerular IF images from 1009 patients with glomerular diseases were used for the training and validation of the diagnostic program. A total of 1610 images of 426 patients from different hospitals were used as test datasets. The performance of the diagnostic program was compared with nephropathologists. In >90% of the tested images, the glomerulus location module achieved an intersection over union >0.8. The accuracy of the D-CNN in recognizing irregular granular mesangial deposition and fine granular deposition along the glomerular basement membrane was 96.1% and 93.3%, respectively. As for the diagnostic program, the accuracy, sensitivity and specificity of diagnosing suspected IgAN were 97.6%, 94.4% and 96.0%, respectively. The accuracy, sensitivity and specificity of diagnosing suspected IMN were 91.7%, 88.9% and 95.8%, respectively. The corresponding areas under the curve (AUCs) were 0.983 and 0.935. When tested with images from the outside hospital, the diagnostic program showed stable performance. The AUCs for diagnosing suspected IgAN and IMN were 0.972 and 0.948, respectively. Compared with inexperienced nephropathologists, the program showed better performance. The proposed diagnostic program could assist the IF diagnosis of IgAN and IMN.

Development and implementation of an onfarm animal health and diagnostic educational training program for farm workers in antimicrobial stewardship in adult dairy cattle

Antimicrobial stewardship (AMS) is a holistic approach, which promotes judicious use of antimicrobial drugs to preserve their effectiveness and availability. Dairy farm workers are com­monly responsible for disease diagnosis and routine treatment decisions. This highlights the importance of farm workers’ knowledge and skills to successfully implement judicious use of antimicrobials in livestock production systems. Knowledge gaps in animal health and behavior have been recognized be­fore as an important reason to provide training to farm work­ers. A better understanding of cattle sickness behavior will improve early identification of clinical signs of disease and im­prove treatment success. The main objective of this project was to develop and implement an on-farm educational training pro­gram for farm workers in antimicrobial stewardship in adult dairy cattle.