Low-resource Environments Research Articles

"Resilience unveiled: empowering Pakistani anesthetists in challenging low-resource environment"

This review paper explores the difficulties that the Pakistani anesthetists experience while working in settings with limited resources and emphasizes the need of offering them support, help, and encouragement. Similar to many other poor nations, Pakistan has substantial shortages of the healthcare resources, which can have a negative influence on anesthetists' working conditions. The paper emphasizes the need for efforts to improve Pakistani anesthetist’s well-being and professional growth, while also inviting attention to the special challenges they have to confront during discharge of their professional duties. This narrative review suggests that encouraging, assisting, and supporting anesthetists who operate under such demanding circumstances can improve their motivation, job satisfaction, and generally, their ability to offer high level of patient care.

How pubertal timing and self-regulation predict adolescent sexual activity in resource-poor environments.

Studies found support for a link between pubertal timing and self-regulation in low-resource environments. This link could potentially explain a link between pubertal timing and early risk behavior. This study builds on this body of research by examining the mediated effect of pubertal timing on sexual activity through self-regulation in 728 adolescents and their families in a group with poor resources and a group with adequate resources. Income-to-Needs (ITN) was measured at age 7.5 to establish two groups (low-ITN and Medium/High-ITN). Pubertal timing was measured at age 10.5, self-regulation was assessed at age 14 and operationalized with effortful control, and sexual activity was assessed at age 16. Structural equation modeling was employed to test the hypothesized model in both groups. The link between pubertal timing and sexual activity mediated by effortful control was only significant in the low-ITN group. Specifically, more advanced pubertal maturity was associated with lower levels of adolescents' effortful control, which in turn was associated with more sexual activity at age 16. Findings were partially replicated with a drug use index replacing sexual activity. This study shows a different operating link from pubertal timing to effortful control and subsequent risk behavior in resource-poor environments. Implications are discussed.

Optimizing a Technology-Based Body and Mind Intervention to Prevent Falls and Reduce Health Disparities in Low-Income Populations: Protocol for a Clustered Randomized Controlled Trial.

The lack of health care coverage, low education, low motivation, and inconvenience remain barriers to participating in fall prevention programs, especially among low-income older adults. Low-income status also contributes to negative aging self-perceptions and is associated with a high perceived barrier to care. Existing fall prevention intervention technologies do not enable participants and practitioners to interact and collaborate, even with technologies that bring viable strategies to maintain independence, prevent disability, and increase access to quality care. Research is also limited on the use of technology to enhance motivation and help individuals align their perception with physiological fall risk. We developed a novel, 8-week Physio-Feedback Exercise Program (PEER), which includes (1) technology-based physio-feedback using a real-time portable innovative technology-the BTrackS Balance Tracking System, which is reliable and affordable, allows for home testing, and provides feedback and tracks balance progression; (2) cognitive reframing using the fall risk appraisal matrix; and (3) peer-led exercises focusing on balance, strength training, and incorporating exercises into daily activities. This study consists of 3 aims. Aim 1 is to examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity (PA). Aim 2 is to examine the effects of the PEER intervention on fall risk appraisal shifting and negative self-perceptions of aging. Aim 3 is to explore participants' experiences with the PEER intervention and potential barriers to accessing and adopting the technology-based PEER intervention to inform future research. This is an intention-to-treat, single-blinded, parallel, 2-arm clustered randomized controlled trial study. We will collect data from 340 low-income older adults at baseline (T1) and measure outcomes after program completion (T2) and follow-up at 3 months (T3) and 6 months (T4). Participants will be enrolled if they meet all the following inclusion criteria: aged ≥60 years, cognitively intact, and able to stand without assistance. Exclusion criteria were as follows: a medical condition precluding exercise or PA, currently receiving treatment from a rehabilitation facility, plan to move within 1 year, hospitalized >3 times in the past 12 months, and does not speak English or Spanish. As of August 2023, the enrollment of participants is ongoing. This study addresses the public health problem by optimizing a customized, technology-driven approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities in low-income older adults. The PEER is a novel intervention that combines concepts of physio-feedback, cognitive reframing, and peer-led exercise by motivating a shift in self-estimation of fall risk to align with physiological fall risk to improve balance, PA, and negative aging self-perception. ClinicalTrials.gov NCT05778604; https://www.clinicaltrials.gov/ct2/show/study/NCT05778604. DERR1-10.2196/51899.

Evaluating the Feasibility and Outcomes of a Scoliosis Surgical Camp in a Resource-Limited Setting in Sub-Saharan Africa

In sub-Saharan Africa, the estimated prevalence of scoliosis ranges from 3.3% to 5.5%. The management of these deformities is restricted due to lack of infrastructure and access to deformity spine surgeons. Utilizing surgical camps has been demonstrated to be efficient in transferring skills to low-resource environments; however, this has not been documented concerning deformity surgery. We conducted a cross-sectional study. The scoliosis camp was held at a major referral spine center in East Africa. We documented information about the organization of the course. We also collected clinical and demographic patient data. Finally, we assessed the knowledge and confidence among surgeon participants on the management scoliosis. The camp lasted 5days and consisted of lectures and case discussions, followed by casting and surgical sessions. Five patients were operated during the camp. All the patients in the study were diagnosed with AIS, except one with a congenital deformity. The primary curve in the spine was in the thoracic region for all patients. Sixmonths postoperative Scoliosis Research Society-22R Scoring System (SRS-22R) score ranged from 3.3-4.5/5. 87.5% of the participants found the course content satisfactory. To the best of our knowledge, this is the first time an African scoliosis camp has been established. The study highlights the difficulty of conducting such a course and illustrates the feasibility of executing these complex surgeries in a resource-limited environment.

A-365 Carbohydrate-binding Module Proteins to Functionalize Paper for Lateral Flow Applications

Abstract Background Lateral flow (LF) tests have employed nitrocellulose membrane since their introduction. Refinement of nitrocellulose and LF production techniques have led to substantial improvements in reproducibility, sensitivity, clarity, and speed of results. The recent surge in demand for LF tests during the COVID-19 pandemic has drawn increased attention to the consequences of using non-biodegradable or non-recyclable materials in test production, requiring disposal via landfill. The nitrocellulose substrate is a critical component for substitution with an equivalent or superior material to address environmental concerns. Additionally, nitrocellulose and the specific molecular recognition reagents, typically antibodies, contribute significantly to the test cost, and whilst LF tests are less expensive than most other formats, challenges remain with respect to providing affordable tests with adequate performance globally in low resource environments. Despite attempts to substitute cellulose for nitrocellulose, principally for reducing cost and more latterly, environmental impact, cellulose is not widely used due to inferior performance, especially in relation to the clarity and quality of the signal line and reagent requirements. Here, we present preliminary data supporting the use of cellulose membrane (paper) as an alternative substrate to nitrocellulose for LF assays. We demonstrate that cellulose-binding module (CBM)-streptavidin fusion proteins for the immobilisation of capture antibodies on cellulose addresses the performance limitations, yielding sensitivity, clarity and speed of result matching current clinical and industry requirements for a qualitative SARS-CoV-2 antigen LF test. Methods We expressed and purified CBM-streptavidin fusion proteins from E.coli to a purity of >90%. Binding to biotinylated proteins and cellulose material was confirmed. An inhouse SARS-CoV-2 antigen assay was adapted for use with the CBM-streptavidin fusion protein on cellulose material. Using methods compatible with current LF test production, we conjugated and dried down 40nm gold (BBI) with anti-nucleocapsid antibodies (Hytest). The biotinylated anti-nucleocapsid capture antibody was dried down on a separate pad. CBM-streptavidin fusion protein was plotted on Whatman 43 paper at the test line. We evaluated assay performance using SARS-CoV-2 nucleocapsid protein and UV-inactivated SARS-CoV-2 virus (NIBSC) in artificial mucus. We further evaluated accelerated stability of the CBM-paper system at 45°C. Results Plotting of the CBM-fusion protein on the test line (0.3 mg/mL, 1 uL/cm) resulted in a tightly focused line, while the control line antibody, without CBM-fusion protein (1 mg/mL, 1 uL/cm), diffused from its deposition line. Additionally, we were able to substantially reduce the amount of capture antibody needed using the CBM-fusion protein system. The cellulose-based assay exhibited a runtime of 30 minutes and an analytical sensitivity of 10^3 pfu/mL. No significant changes in performance were observed after 9 weeks of incubation at 45°C, representing an approximate accelerated shelf-life of 12 months. Conclusion Our results indicate that paper-based tests match sensitivity, clarity, and speed of current qualitative antigen tests on nitrocellulose, with a shelf-life of at least one year. This preliminary investigation demonstrates the viability of using paper as a replacement for nitrocellulose when coupled with CBM-fusion proteins for antibody immobilisation, offering significantly reduced material cost and environmental impact.

Design and fabrication of a low-cost microfluidic cartridge with integrated pressure-driven check valve for molecular diagnostics platforms

This paper describes the design, fabrication, and preliminary testing of a low-cost, easy to manufacture microfluidics cartridge capable of fluid storage and manipulation through a custom pressure-driven check valve. Cartridge components are fabricated using a desktop CNC and laser cutter, the check valve is fabricated using PDMS in a custom acrylic mold, and the components are assembled using a thermal diffusion welder. Following assembly, preliminary testing of the cartridge, including fluid manipulation and use for molecular diagnostics, was performed. To pull a sample into the lysing chamber, a vacuum over 1.4PSI was required. No opening of the valve to the reaction chamber was observed. Moving fluid across the custom valve from the lysing chamber to the reaction chamber then required a vacuum over 4.5PSI. Finally, a proof-of-concept demonstration of one potential application was performed using a custom benchtop LAMP system for molecular diagnostic testing. The low-cost nature of the design, ease of manufacturing, fluid storage and manipulation demonstrated make this design ideal for research and high-volume testing in low resource environments.

Loop-mediated isothermal amplification assay for screening congenital cytomegalovirus infection in newborns

Congenital cytomegalovirus (CMV) infection is a common cause of sensorineural hearing loss and neurodevelopmental impairment in newborns. However, congenital CMV infection cannot be diagnosed using samples collected more than 3 weeks after birth because testing after this time cannot distinguish between congenital infection and postnatal infection. Herein, we developed a robust loop-mediated isothermal amplification (LAMP) assay for the large-scale screening of newborns for congenital CMV infection. In contrast to conventional quantitative polymerase chain reaction (qPCR), which detects CMV within a dynamic range of 1.0 × 106 to 1.0 × 102 copies/μL, our quantitative LAMP assay (qLAMP) detects CMV within a dynamic range of 1.1 × 108 to 1.1 × 103 copies/μL. Moreover, the turnaround time for obtaining results following DNA extraction is 90 min in qPCR but only 15 min in qLamp. The colorimetric LAMP assay can also detect CMV down to 1.1 × 103 copies/μL within 30 min, irrespective of the type of heat source. Our LAMP assay can be utilized in central laboratories as an alternative to conventional qPCR for quantitative CMV detection, or for point-of-care testing in low-resource environments, such as developing countries, via colorimetric naked-eye detection.Key points• LAMP assay enables large-scale screening of newborns for congenital CMV infection.• LAMP allows colorimetric or quantitative detection of congenital CMV infection.• LAMP assay can be used as a point-of-care testing tool in low-resource environments.

“Feeling Like an Island”: Perceptions of Professional Isolation Among Emergency Nurses

IntroductionProfessional isolation, feelings of being isolated from one’s professional peers and lacking mentoring and opportunities for professional interaction, collaboration, and development, is a challenge for workers across the labor market. The notion of professional isolation is particularly prevalent in low-resource health care settings and is common among emergency nurses. MethodsThis study explored the perceptions of professional isolation among emergency nurses working in a low-resource environment using individual interviews with 13 participants in 5 settings in Lesotho. ResultsThe data were analyzed using qualitative content analysis and revealed an overarching theme of “feeling like an island” containing 3 categories, namely lack of interprofessional collaboration and consultation, skills mismatch, and enforced loneliness. DiscussionThis study suggests that lack of interprofessional collaboration and consultation, skills mismatch, and enforced loneliness have influenced feelings of professional isolation among emergency nurses working in low-resource environments. The findings of this research lend support to the idea that communities of practice may have a potential impact in addressing professional isolation.

Evaluation of "Caserotek" a low cost and effective artificial blood-feeding device for mosquitoes.

Entomological research studies on mosquito vector biology, vector competence, insecticide resistance, dispersal, and survival (using mark-release-recapture techniques) often rely on laboratory-reared mosquito colonies to produce large numbers of consistently reared, aged, and sized mosquitoes. We developed a low-cost blood feeding apparatus that supports temperatures consistent with warm blooded animals, using commonly available materials found in low resource environments. We compare our system ("Caserotek") to Hemotek and glass/membrane feeding methods. Two experiments were conducted with Aedes aegypti (Linnaeus 1762) and one with Anopheles darlingi (Root 1926) (Diptera: Culicidae); 3 replicates were conducted for each experiment. Aedes aegypti female mosquitoes were provided chicken blood once per week for 30 min (Experiment #1) for 14 days or 1 hour (Experiment #2) for 21 days. Anopheles darlingi were fed once for 1 hour (Experiment #3). Blood-feeding rates, survival rates, and egg production were calculated across replicates. Caserotek had a significantly higher 30-min engorgement rate (91.1%) than Hemotek (47.7%), and the glass feeder (29.3%) whereas for 1-hour feeding, Hemotek had a significantly lower engorgement rate than either of the other two devices (78% versus 91%). Thirty-day survival was similar among the feeding devices, ranging from 86% to 99%. Mean egg production was highest for the Caserotek feeder (32 eggs per female) compared to the glass feeder and Hemotek device (21-22 eggs per female). Our new artificial feeding system had significantly higher blood feeding rates than for more expensive artificial systems and was equivalent to other fitness parameters. Caserotek only requires the ability to boil water to maintain blood temperatures using a Styrofoam liner. It can be easily scaled up to large production facilities and used under austere conditions.

Matrix Encryption Walks for Lightweight Cryptography

In this paper, we propose a new symmetric stream cipher encryption algorithm based on Graph Walks and 2-dimensional matrices, called Matrix Encryption Walks (MEW). We offer example Key Matrices and show the efficiency of the proposed method, which operates in linear complexity with an extremely large key space and low-resource requirements. We also provide the Proof of Concept code for the encryption algorithm and a detailed analysis of the security of our proposed MEW. The MEW algorithm is designed for low-resource environments such as IoT or smart devices and is therefore intended to be simple in operation. The encryption, decryption, and key generation time, along with the bytes required to store the key, are all discussed, and similar proposed algorithms are examined and compared. We further discuss the avalanche effect, key space, frequency analysis, Shannon entropy, and chosen/known plaintext-ciphertext attacks, and how MEW remains robust against these attacks. We have also discussed the potential for future research into algorithms such as MEW, which make use of alternative structures and graphic methods for improving encryption models.

Temporal Lobe Surgery for Epilepsy in a Resource-Limited Vietnamese Cohort

Epilepsy surgery is traditionally difficult to pursue in resource-limited countries but is nevertheless essential in the treatment of medication-refractory, surgically amenable epilepsy. With the help of international collaboration, a successful epilepsy program was started in Vietnam. This article comprises a retrospective chart review, combined with prospective longitudinal follow-up of 35 cases of unilateral drug-resistant epilepsy in the temporal lobe who underwent temporal lobectomy, in Viet Duc University Hospital from May 2018 to September2022. The female/male ratio was 0.6:1, and focal seizures with impaired awareness accounted for 97.14% of patients. Of patients with focal awareness seizures, 51.41% were localized and detected by electroencephalography. Postoperatively, 80% of patients were seizure free (Engel I) at 1 year, and the remaining 20% had worthwhile seizure improvement (Engel II). Postoperative temporal lobe pathology was categorized as follows: mesial temporal sclerosis (48.57%), focal cortical dysplasia (25.71%), and low-grade neoplasms (25.71%). Of patients, 17.14% had postoperative complications (5 infections and 1 transient extremity paresis), and there were no deaths. Even in low-resource environments, effective and safe surgical care can be provided for drug-resistant epilepsy caused by temporal lobe disease. This study serves as a model of international collaboration and support for future hospitals in low-resource environments to replicate.

Microsurgery for drug resistance epilepsy due to temporal lobe lesions in a resource limited condition: a cross-sectional study.

The study was a retrospective and prospective cross-sectional study of 35 cases of drug-resistant temporal lobe epilepsy. All patients were operated on by the primary author between May 2018 and September 2022. The study evaluated various factors including clinical characteristics, electroencephalogram, magnetic resonance imaging, surgical outcomes, and histopathology. The success rate of the surgeries (74.3%) is similar to those reported in high-income countries. 51.4% underwent selective amygdalohippocampectomy for cases that localized to the mesial temporal lobe. Lateral/neocortical lesions underwent lesionectomy (48.6%). Our study found a complication rate of 17.1%: meningitis (8.5%), trainset focal paralysis (2.9%), and soft tissue infection (5.7%). There were no mortalities. The article showcases an international collaborative effort that demonstrates the possibility of providing highly effective and safe surgical care for temporal lobe epilepsy even in low-resource environments. The authors hope that this model can be replicated in other areas with similar resource limitations.

Space exploration as a catalyst for medical innovations.

Aerospace research has a long history of developing technologies with industry-changing applications and recent history is no exception. The expansion of commercial spaceflight and the upcoming exploration-class missions to the Moon and Mars are expected to accelerate this process even more. The resulting portable, wearable, contactless, and regenerable medical technologies are not only the future of healthcare in deep space but also the future of healthcare here on Earth. These multi-dimensional and integrative technologies are non-invasive, easily-deployable, low-footprint devices that have the ability to facilitate rapid detection, diagnosis, monitoring, and treatment of a variety of conditions, and to provide decision-making and performance support. Therefore, they are primed for applications in low-resource and remote environments, facilitating the extension of quality care delivery to all patients in all communities and empowering non-specialists to intervene early and safely in order to optimize patient-centered outcomes. Additionally, these technologies have the potential to advance care delivery in tertiary care centers by improving transitions of care, providing holistic patient data, and supporting clinician wellness and performance. The requirements of space exploration have created a number of paradigm-altering medical technologies that are primed to revitalize and elevate our standard of care here on Earth.

A Comprehensive Assessment of Interventions in Women Cervical Cancer Screening in South Sudan

Introduction: The substantial impact of cervical cancer, particularly in low-resource environments like South Sudan, underscores the urgent need for preventive solutions, as access remains sparse. Contemporary treatment options while accessible, bring about severe side effects without greatly extending disease-free survival, emphasizing the importance of preventive screening, especially for adult women. The glaring absence of screening leads to women potentially suffering from progressed cervical cancer, a grim reality in South Sudan that contributes to around 12% of the female disease burden. Consequently, it is vital to examine the reach, associated elements, and health system initiatives aimed at cervical cancer screening in this region. This study intended to conduct an in-depth analysis of South Sudan's health system with a focus on understanding and evaluating the current interventions in place for cervical cancer screening among women.
 Methods: The research was based on a community-oriented cross-sectional survey aimed at evaluating cervical cancer screening habits among women of childbearing age in five South Sudanese counties. The participants were women aged 26-65 years, with 575 samples in total. A four-stage random sampling procedure was followed in each stratum, focusing on half the Payams per county. Structured interviews were utilized for primary data collection, supplemented by key informant discussions for qualitative data. Descriptive statistics and log-binomial regression models were used for data analysis. The study was conducted in Torit, Magwi, Terekeka, Raja, and Aweil North, targeting women of reproductive age due to their HPV infection risk.
 Results: The study found that only 11.5% of women in South Sudan had been screened for cervical cancer. Factors associated with cervical cancer screening rates included women who reported shorter waiting times for medical services (aPR=3.47 [CI=1.69-7.14]), received HPV vaccination (aPR=4.71 [CI=3.04-7.31]), kind and caring health workers (aPR=3.35 [CI=1.47-7.63]), and integrated cervical screening facilities (aPR=2.28 [CI=1.45-3.60]) had higher screening rates. However, the study found little evidence of community or institutional interventions aimed at increasing cervical cancer screening rates.
 Conclusion: Based on the findings, cervical cancer screening coverage for women in South Sudan is very low, at only 11.5%. However, certain factors were found to be associated with higher screening prevalence, including shorter wait times, caring and kind health workers, and integrated screening facilities were also associated with higher screening prevalence. It is concerning that there were virtually no interventions at the institutional level to increase screening rates. These findings suggest the need for targeted interventions to improve access to screening services and strengthen health systems to increase cervical cancer screening coverage in South Sudan.

Hepatitis C Virus in people with experience of injection drug use following their displacement to Southern Ukraine before 2020

BackgroundDue to practical challenges associated with genetic sequencing in low-resource environments, the burden of hepatitis C virus (HCV) in forcibly displaced people is understudied. We examined the use of field applicable HCV sequencing methods and phylogenetic analysis to determine HCV transmission dynamics in internally displaced people who inject drugs (IDPWID) in Ukraine.MethodsIn this cross-sectional study, we used modified respondent-driven sampling to recruit IDPWID who were displaced to Odesa, Ukraine, before 2020. We generated partial and near full length genome (NFLG) HCV sequences using Oxford Nanopore Technology (ONT) MinION in a simulated field environment. Maximum likelihood and Bayesian methods were used to establish phylodynamic relationships.ResultsBetween June and September 2020, we collected epidemiological data and whole blood samples from 164 IDPWID (PNAS Nexus.2023;2(3):pgad008). Rapid testing (Wondfo® One Step HCV; Wondfo® One Step HIV1/2) identified an anti-HCV seroprevalence of 67.7%, and 31.1% of participants tested positive for both anti-HCV and HIV. We generated 57 partial or NFLG HCV sequences and identified eight transmission clusters, of which at least two originated within a year and a half post-displacement.ConclusionsLocally generated genomic data and phylogenetic analysis in rapidly changing low-resource environments, such as those faced by forcibly displaced people, can help inform effective public health strategies. For example, evidence of HCV transmission clusters originating soon after displacement highlights the importance of implementing urgent preventive interventions in ongoing situations of forced displacement.

Home-Made, Self-Powered, Skin-Attachable Sensing Platform for Diverse Vital Sign Monitoring.

Wearable electronic sensors that can perform real-time, continuous, and high-fidelity monitoring of diverse biophysical signals from the human body are burgeoning and exhibit great potential to transform traditional clinical healthcare. However, such emerging devices often suffer from strict requirements of special precursor materials and sophisticated fabrication procedures. Here, we present a new paradigm of a self-powered, skin-attachable, and multifunctional sensing platform that can be fully created just at home with daily necessities. Its operating mechanism is based on mechanical/thermal regulation of the potential difference output of a primary electrochemical cell. This proposed sensing platform is totally self-powered and can be conformally attached to the skin for continuous monitoring of both mechanical and thermal stimulations. A wide spectrum of vital physiological signs of the human body, including body temperature, heart/pulse rate, respiratory rate, coughing, and body motions, can be continuously monitored and analyzed with this home-made sensing platform. This study demonstrates that the lab-conducted professional and expensive scientific research can also be accomplished at home, opening up new opportunities for home-centered healthcare in low-resource environments. Moreover, this work can serve as a handy and cost-efficient prototype for classroom education and clinical training purposes.

Understanding COVID-19 vaccine hesitancy in health care professionals in Central and West Asia: lessons for future emergency mass vaccination campaigns.

A Quick Assessment of Vaccine Hesitancy approach was developed to collect population insights on vaccination hesitancy for low resource environments. Insights into COVID-19 vaccine hesitancy were collected through online webinars with heads of healthcare departments and anonymized online surveys of healthcare managers (HCM) and primary healthcare workers (HCW) in four countries in Central and West Asia (Armenia, Georgia, Tajikistan, and Kyrgyzstan) between 28 February 2022 and 29 March 2022. From the responses to the survey some key themes identified that underpinned in vaccine hesitancy across the region were perceived understanding of vaccine efficacy, conflict with individual religious beliefs, concerns for side effects, and the relatively rapid development of the vaccine and that improving communications strategies to address these concerns would be critical in combatting vaccine hesitancy through any future public health emergencies.

SmartOCT: smartphone-integrated optical coherence tomography.

Smartphone devices have seen unprecedented technical innovation in computational power and optical imaging capabilities, making them potentially invaluable tools in scientific imaging applications. The smartphone's compact form-factor and broad accessibility has motivated researchers to develop smartphone-integrated imaging systems for a wide array of applications. Optical coherence tomography (OCT) is one such technique that could benefit from smartphone-integration. Here, we demonstrate smartOCT, a smartphone-integrated OCT system that leverages built-in components of a smartphone for detection, processing and display of OCT data. SmartOCT uses a broadband visible-light source and line-field OCT design that enables snapshot 2D cross-sectional imaging. Furthermore, we describe methods for processing smartphone data acquired in a RAW data format for scientific applications that improves the quality of OCT images. The results presented here demonstrate the potential of smartphone-integrated OCT systems for low-resource environments.

Rectal suction biopsies to diagnose Hirschsprung's disease in a low-resource environment - optimising cost-effectiveness.

The diagnosis of Hirschsprung's disease (HD) by rectal suction biopsy (RSB) has cost implications that could be reduced by ascertaining the optimal number of specimens required. The aim was to audit our experience to optimise cost-effectiveness. Medical records of all patients who underwent an RSB between January 2018 and December 2021 were reviewed. In 2020, we transitioned from using the Solo-RBT to the rbi2 system (requiring single-use cartridges). Descriptive statistics were reported and a comparative analysis of the diagnostic efficacy of the Solo-RBT versus the rbi2 system was performed. The cost of consumables was calculated according to the number of specimens submitted. Of 218 RSBs, 181 were first and 37 were repeat. The mean age at biopsy was 62 days (IQR 22-65). An average of two tissue specimens were obtained per biopsy. Of the 181 first biopsies, 151 were optimal and 30 suboptimal. HD was confirmed in 19 (10.5%) of the patients. Amongst biopsies where a single specimen was obtained, 16% were inconclusive, compared to 14% with two specimens and 5% with three specimens. The cartridges for the rbi2 system cost R530. If two cartridges are used at initial biopsy the total cost is double of a single tissue specimen sent for initial biopsy, and two specimens sent for repeat biopsies. In a low-resource setting, selecting the appropriate RSB system and obtaining a single specimen is sufficient to diagnose HD. Patients with inconclusive results should undergo a repeat biopsy where two specimens are obtained.

REDbox: a comprehensive semantic framework for data collection and management in tuberculosis research

Clinical research outcomes depend on the correct definition of the research protocol, the data collection strategy, and the data management plan. Furthermore, researchers often need to work within challenging contexts, as is the case in tuberculosis services, where human and technological resources for research may be scarce. Electronic Data Capture Systems mitigate such risks and enable a reliable environment to conduct health research and promote result dissemination and data reusability. The proposed solution is based on needs pinpointed by researchers, considering the need for an accommodating solution to conduct research in low-resource environments. The REDbox framework was developed to facilitate data collection, management, sharing, and availability in tuberculosis research and improve the user experience through user-friendly, web-based tools. REDbox combines elements of the REDCap and KoBoToolbox electronic data capture systems and semantics to deliver new valuable tools that meet the needs of tuberculosis researchers in Brazil. The framework was implemented in five cross-institutional, nationwide projects to evaluate the users' perceptions of the system's usefulness and the information and user experience. Seventeen responses (representing 40% of active users) to an anonymous survey distributed to active users indicated that REDbox was perceived to be helpful for the particular audience of researchers and health professionals. The relevance of this article lies in the innovative approach to supporting tuberculosis research by combining existing technologies and tailoring supporting features.