IntroductionThe use of protective masks, especially medical masks, increased dramatically during the COVID-19 crisis. Medical masks are made of synthetic materials, mainly polypropylene, and a majority of them are produced in China and imported to the European market. The urgency of the need has so far prevailed over environmental considerations.ObjectiveAssess the environmental impact of different strategies for the use of facemaskMethod Different strategies for the use of medical and community masks are being investigated for their environmental impact in this study. 8 scenarios, differentiating the typologies of masks and the modes of reuse are compared using several environmental impact indicators, mainly the Global Warming Potential (GWP100), and the plastic leakage (PL). This study attempts to provide clear recommendations that consider both the environmental impact and the protective effectiveness of face masks used in the community.Results The environmental impact of single-use masks is the most unfavorable, with a GWP of 0.4 -1.3 kgCO₂ eq., depending on the transport scenario, and a PL of 1.8 g, for a one month protection against COVID-19. The use of home-made cotton masks and prolonged use of medical masks through wait-and-reuse are the scenarios with the lowest impact.ConclusionThe use of medical masks with a wait and reuse strategy seems to be the most appropriate when considering both environmental impact and effectiveness. Our results also highlight the need to develop procedures and the legal/operational framework to extend the use of protective equipment during a pandemic.

Introduction Color vision deficiency (CVD) constitutes one of the frequently observed eye disorders in all human populations. Color is a prominent sign utilized in the medical profession to study and identify histopathological specimens, lab instruments, and patient examination. Color deficiency affects the medical skills of students resulting in poor clinical examination and color appreciation. There is no effective screening of CVD at any level of the medical profession. Hence, this study was aimed to determine the prevalence of CVD among medical students. Materials and methods This was a cross-sectional study conducted from September 2019 to February 2020 over a period of six months in Karachi, Pakistan. All medical students aged 18-21 years of either gender enrolled in the first and second years of medical college were included in this study. The examination was performed during daylight. Ishihara plates were placed at a distance of 75 cm from the subject and tilted so that the plane of the paper lies perpendicular to the line of vision. Students were given five seconds to read the plate and one examiner was instructed to mark the checklist. A score of less than 12 out of 14 red/green test plates (not including the demonstration plate) was considered as a CVD. All statistical analysis was performed using Statistical Package for Social Sciences version 20.0 (Armonk, NY: IBM Corp). Results The mean age of the medical students was 19.61± 1.22 years. There were (n=123) 53.0% females and (n=111) 47.0% males. Most of the medical students (n=131, 56.0%) belonged to the upper-middle-class socioeconomic group. CVD was observed in (n=13) 6.0%of medical students. Age (p=0.001) and socioeconomic status (p=0.001) were the only demographic factors significantly associated with color deficiency. Conclusions Color deficiency, although an unnoticed concern, is fairly common among medical students. Medical students must be screened for CVD as this will enable them to be aware of their limitations in their future observational skills as a doctor and devise ways of overcoming them in clinical practice.

Students’ anxiety due to the COVID-19 pandemic was expressed by some medical students in the form of anger and mistrust. This study aims to explore the reasons for mistrust between students and faculty among medical schools in Egypt that have flared during the COVID-19 pandemic. This is a three-phase exploratory qualitative study depending on thematic emergence from appreciative interviews (AI) sessions. Students are revealed to be very well-educated regarding contemporary medical education concepts. The most important factors from the student perspective were the presence of a well-designed assessment system aligned with the learning outcomes and teaching methodologies and the presence of extracurricular activities and soft skills, respectively. A balanced student life respecting their mental health was found important to increase trust. A roadmap to breaking the mistrust must be planned on several pivots: curriculum structure, extracurricular life, communication strategies, and identifying student roles in their learning and in decision making.

Coronavirus (COVID19) appears to be an inflection point that is forcing a disruption in medical education. However, it is not clear what the responses of the institutions are to this pandemic and how the adaptation of new methods may impact medical education in the post COVID-19 era. Objective: The study aims to explore how medical schools in Egypt responded to COVID-19 pandemic regarding the teaching and learning/assessment for undergraduate students. Design: A mixed method exploratory two-phase study was conducted. A survey was prepared and disseminated to a convenient non-probability sample of the medical school faculty through various social platforms. Then, a focus group guide was conducted to explore in more depth the findings. Results: The staff level of preparedness for that unexpected shift was evaluated by 55.1% of the survey participants as optimum to high and a good leadership support was reported by 70 % of them. They reported conflicting views about the proper role of medical education units but reinforced the idea of Egyptian Knowledge Bank’s crucial role in this transition. Additionally, there is a communication problem with the students that leads to their detachment. Subsequently, 84.6 % of the participants reported that their schools used alternative teaching methods for small groups, large groups, pre-clinical and clinical clerkships. However, 64.1 % of the participants identified a clinical skills teaching challenge. Although, 68.4% reported that alternative methods were used for formative assessment but absence of alternative methods for summative assessment was declared by 76.3%. Conclusions: Individuals moved faster than bodies and relied on support existing outside the universities when catastrophe happened. However, institutes which have experience in adapting modern engaging learning methods should organize a better response for crisis. Online learning should be integrated in the curriculum with a fair percentage especially in the early years of medical study.

Big Data in medicine includes possibly fast processing of large data sets, both current and historical in purpose supporting the diagnosis and therapy of patients' diseases. Support systems for these activities may include pre-programmed rules based on data obtained from the interview medical and automatic analysis of test results diagnostic results will lead to classification of observations to a specific disease entity. The current revolution using Big Data significantly expands the role of computer science in achieving these goals, which is why we propose a Big Data computer data processing system using artificial intelligence to analyze and process medical images.

COPD is currently the fourth leading cause of death in the world. Globally, due to continued exposure to COPD risk factors and an aging population, the burden of COPD is expected to increase in the coming decades. The BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index is a practical and multidimensional predictor for prognosis of COPD, and better than FEV1.We used the database of Kaohsiung Chang Gung Memorial Hospital medical center, Taiwan to analyze the correlation between BODE index, healthcare resource utilization, and Charlson comorbidity index (CCI). This retrospective study to collect COPD patients with complete BODE index data who had undergone a 6-minute walk examination in our hospital from January 2015 to December 2016. The medical cost and comorbidities database were analyzed from January 1, 2015, to August 31, 2017. Of 396 patients, 382 (96.5%) were male, with an average age of 71.3 ± 8.4 years. There was a significant association between the BODE index and the CCI of COPD patients (p < 0.001). Healthcare resource utilization was positively correlated with the BODE index during the 32 months of retrospective clinical outcomes: positively correlated with the number of hospitalizations (p<0.001), hospitalization days (p<0.001), hospitalization expenses (p=0.005), and total medical expenses (p=0.024), respectively. Our findings provide the crucial information for clinician to predict medical burden and comorbidities in patients with COPD by using BODE index.

Placing the needle inside the epidural space for locoregional anesthesia is a challenging procedure, which even today is left to the expertise of the operator. Recently, we have demonstrated that the use of optically sensorized needles significantly improve the effectiveness of such procedure. Here we propose an optimized configuration, where the optical fiber strain sensor is directly integrated inside the epidural catheter. The new design allows to solve the biocompatibility issues and increases the versatility of the former configuration. Through an in vivo study carried out on a porcine model we confirm the reliability of our approach, which also opens the way to catheter monitoring during its insertion inside biological spaces.

With recent focus on deep neural network architectures for development of algorithms for computer-aided diagnosis (CAD), we provide a review of studies within the last 3 years (2015-2017) reported in selected top journals and conferences. 29 studies that met our inclusion criteria were reviewed to identify trends in this field and to inform future development. Studies have focused mostly on cancer-related diseases within internal medicine while diseases within gender-/age-focused fields like gynaecology/pediatrics have not received much focus. All reviewed studies employed image datasets, mostly sourced from publicly available databases (55.2%) and few based on data from human subjects (31%) and non-medical datasets (13.8%), while CNN architecture was employed in most (70%) of the studies. Confirmation of the effect of data manipulation on quality of output and adoption of multi-class rather than binary classification also require more focus. Future studies should leverage collaborations with medical experts to aid future with actual clinical testing with reporting based on some generally applicable index to enable comparison. Our next steps on plans for CAD development for osteoarthritis (OA), with plans to consider multi-class classification and comparison across deep learning approaches and unsupervised architectures were also highlighted.

At present, medical institutes generally use EMR to record patient's condition, including diagnostic information, procedures performed and treatment results. EMR has been recognized as a valuable resource for large scale analysis. However, EMR has the characteristics of diversity, incompleteness, redundancy and privacy, which make it difficult to carry out data mining and analysis directly. Therefore, it is necessary to preprocess the source data in order to improve data quality and improve the data mining results. Different types of data require different processing technologies. Most structured data commonly needs classic preprocessing technologies, including data cleansing, data integration, data transformation and data reduction. For semi-structured or unstructured data, such as medical text, containing more health information, it requires more complex and challenging processing methods. The task of information extraction for medical texts mainly includes NER (Named Entity Recognition) and RE (Relation Extraction). In this paper, we introduce the process of EMR processing, including data collection, data preprocessing, data mining, evaluation and knowledge application, analyze the current status of the key technologies, such as data preprocessing and data mining, and provide an overview of the application domains and prospects of EMR mining technologies. Finally, we summarize the existing problems in the research of EMR mining, and review the development trends.

Bosom disease remains a main source of death among women around the world. Early identification is significant for further developing endurance rates, accordingly making effective indicative strategies fundamental. This undertaking the malignant growth discovery utilizing mammography images (low dose x-ray), utilizing profound learning methods to robotize conclusions and upgrade exactness. The framework's center includes preprocessing the mammogram images, separating highlights, and arranging them utilizing Convolutional neural networks (CNNs) and other high-level profound learning models.

Biomedical large language models (LLMs) have made significant strides, but their reliance on external retrieval mechanisms presents challenges in accuracy and computational efficiency. To address these issues, we propose MedRAG-Refine, a generative LLM designed specifically for the biomedical domain. Our model integrates a two-stage fine-tuning process, incorporating a self-reflection mechanism to improve reasoning quality. We evaluate our model on MedQA, MedMCQA, and MMLU datasets, demonstrating superior performance over state-of-the-art methods. Additionally, human evaluations confirm the enhanced accuracy and reasoning quality of our model in real-world medical tasks.

Problem-Based Learning (PBL) has emerged as an innovative and effective pedagogical methodology in medical education. This student-centered approach promotes the development of critical thinking, problem-solving, and self-directed learning skills, essential for the training of competent physicians. This article explores the theoretical foundations of PBL, its implementation methodology, and the benefits it offers to medical students as well as to the quality of medical care. Through a comprehensive literature review and analysis of experiences in different contexts, the importance of PBL as a tool to improve medical training is highlighted and recommendations are offered for its effective implementation.

This study evaluates the preparedness of Siloam Hospital Bali for medical tourism using Actor-Network Theory (ANT) to analyze human and non-human interactions within social networks. The objective is to identify factors influencing the hospital's readiness. Data was collected through interviews with hospital administration, specialized physicians, local officials, and tourism organization members, supplemented by document and archival research. Network visualization with GraphCommons.com revealed interaction patterns, key actors, and potential impediments. The results show that effective hospital administration, professional care by doctors, and cooperation with tourism groups and local authorities significantly impact the hospital's readiness. However, dependencies on core nodes, lack of redundancy, and underutilization of peripheral nodes are vulnerabilities. Recommendations include enhancing integration with peripheral nodes, establishing network redundancy, involving educational institutions, and aligning with international insurance and immigration policies. This study contributes to a comprehensive understanding of medical tourism dynamics and offers strategies to enhance Siloam Hospital's readiness.

Recent developments in flexible printed heaters (FPH) for wearable thermal applications, driven by the advancement of printed electronics, show great promise in revolutionizing patient care through the development of wearable flexible heaters for medical applications. Wearable heaters with high thermal stability, heat uniformity, safety, flexibility, comfort, biocompatibility, and power efficiency are desirable for stand-alone medical thermotherapy applications. This paper reviews recent advancements in the design of FPHs for wearable thermal applications. Materials for FPHs, fabrication methods, designs, temperature control mechanisms, medical applications, and performance analysis of specific FPHs are all thoroughly discussed. Materials for FPHs, such as conductive and substrate materials, have received special attention, along with the heater design parameters. Finally, the challenges and future directions for developing FPHs for wearable medical applications are addressed.

Background: Vaccine hesitancy, identified by the World Health Organization as a top ten global health threat, presents a significant barrier to public health efforts, exacerbated by the politicization of vaccines during the COVID-19 pandemic.1 Motivational interviewing (MI) has been shown to be effective in addressing difficult topics, including vaccine hesitancy, emphasizing the need for its integration into medical education.2 Objective: This study explores ways to enhance the medical student curriculum on MI, specifically targeting the management of conversations with vaccine-hesitant patients. These authors seek to evaluate the impact of different teaching approaches on the efficacy of MI training within clinical education. Methods: A blinded study design was implemented, comparing two groups of medical students trained using distinct MI teaching methods: Learning Through Experience (LTE) and Traditional Teaching (TT). The LTE group engaged with a Vaccine Hesitant Standardized Patient (VHSP) before and after an instructional module on the use of MI to combat vaccine hesitancy. In contrast, the TT group interacted with a control Standardized Patient (SP) before the same module and then with the VHSP. Any medical student above the age of 18 was eligible for this study. All students in a vaccine elective at RVUCOM on the Colorado and Utah campuses were enrolled, as well as student volunteers. We excluded any students who opted out of the study. The effectiveness of each method was assessed through confidence and performance scores derived from participant self-evaluations and standardized patient feedback, respectively. Results: Participants in the TT group demonstrated superior mastery of MI skills as taught in the didactic session based on statistically significant findings across more tested variables. The LTE group exhibited enhanced ability in practical applications with standardized patients based on statistically significant findings. Both groups showed increased confidence in MI techniques, with the LTE group reporting greater confidence in vaccine knowledge and MI abilities. That said, the LTE method did not drastically outperform the TT approach in overall efficacy. Conclusions: The study indicates that while traditional TT training effectively imparts MI skills, the LTE approach may offer benefits in applying these skills in clinical scenarios. These findings suggest the potential for integrating multiple teaching methods into the medical curriculum to better prepare students for engaging with vaccine-hesitant patients. Further research is needed to explore the long-term effects of these teaching strategies on student performance and patient outcomes.

Digital solutions in the field of restorative neurology offer significant assistance, enabling patients to engage in rehabilitation activities remotely. This research introduces ReMoVES, an Internet of Medical Things (IoMT) system delivering telemedicine services specifically tailored for Multiple Sclerosis rehabilitation, within the overarching framework of the STORMS project. The ReMoVES platform facilitates the provision of a rehabilitative exercise protocol, seamlessly integrated into the Individual Rehabilitation Project, curated by a multidimensional medical team operating remotely. This manuscript delves into the second phase of the study, elucidating the technology employed, the outcomes achieved, and the practical, professional, and academic implications. The STORMS initiative, as the genesis of digital telerehabilitation solutions, aims to enhance the quality of life for Multiple Sclerosis patients.

Diabetic retinopathy (DR) is the primary factor leading to vision impairment and blindness in diabetic people. Uncontrolled diabetes can damage the retinal blood vessels. Initial detection and prompt medical intervention are vital in preventing progressive vision impairment. Today's growing medical field poses more significant workload and diagnostic demands on medical professionals. In the proposed study, a convolutional neural network (CNN) is employed to detect the stages of DR. This research is crucial for studying DR because of its innovative methodology incorporating two different public datasets. This strategy enhances the model's capacity to generalize unseen DR images, as each dataset encompasses unique demographics and clinical circumstances. The network can learn and capture complicated hierarchical image features with asymmetric weights. Each image undergoes preprocessing using contrast-limited adaptive histogram equalization (CLAHE) and the discrete wavelet transform (DWT). The model is trained and validated using the combined datasets of Dataset for Diabetic Retinopathy (DDR) and the Asia Pacific Tele-Ophthalmology Society (APTOS). The CNN model is tuned with different learning rates and optimizers. The CNN model with Adam optimizer achieved 70% accuracy and an area under curve (AUC) score of 0.82. The recommended study results may reduce diabetes-related vision impairment by early DR severity identification.

Background: Citicoline, a medical food, lacks proven efficacy for ischemic stroke and has uncertainties around its harms. The continued prescription should be reevaluated given the more robust, high-quality Evidence against that medical food. This essay is based on a recent Cochrane review and uses only one all-cause mortality as the primary outcome. Therefore, the essay should be considered as something other than an updated Cochrane review but like a reflection based on Evidence-based Medicine and Philosophy of Science analysis. Question Research: Why citicoline (a medical food) should not be prescribed to treat people with acute ischemic stroke: The certainty of the Evidence.? Objective: Demonstrate from evidence-based medicine and philosophy of science perspective that citicoline should not be prescribed for acute ischemic stroke due to lack of efficacy and harm uncertainties. Search publications: We searched in PubMed and Cochrane Library from 2020 until 30 October 2023. We, furthermore, used engineering machines Bing and Google Scholar to detect additional papers. Additionally, we also reviewed reference lists of the retrieved publications and review articles and searched the websites of the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA). Selection criteria: We included systematic reviews, meta-analyses, randomized clinical trials, clinical guidelines focused on acute ischemic stroke and comparing citicoline versus placebo or no intervention. We excluded narrative reviews, observational studies and ongoing trials. Data collection and analysis: We identified only new randomized clinical trials and assessed the risk of bias in seven domains. The other eight trials were already included in the mentioned Cochrane review. The systematic reviews with or without meta-analyses were assessed using McMaster University guidelines. We estimated risk ratios (RRs) for that outcome. We measured statistical heterogeneity using the I² statistic. We conducted our analyses using the fixed effect model. We did not use the GRADE approach due to what is shown in a Cochrane review published in 2020 by Martí-Carvajal et al. We used the RevMan 5.4 software from Cochrane Collaboration to conduct the forest plot. We used a Trial Sequential Analysis with Copenhagen Trial Unit Software. We estimated a Bayes factor from the relative risk and 95% confidence interval. Results: We identified only one new RCT (N = 99) reported mortality data and three clinical guidelines. We conducted a new meta-analysis with nine trials (N = 4461) having a high risk of bias and showing little to no difference in mortality between citicoline and placebo (17.1% vs 18.4%; RR 0.94, 95% CI 0.82 to 1.06; I2 = 0%). The Bayes factor was 0.7, indicating weak Evidence for the null over the alternative hypothesis. Trial sequential analysis suggested sufficiency of Evidence for mortality. No guidelines recommend citicoline. Conclusions: This essay reassessed citicoline for acute ischemic stroke after the 2020 Cochrane review. Adding a new RCT further supported the lack of mortality benefit with citicoline. The overall evidence quality could be better. Analyses using evidence-based medicine and philosophy of science approaches do not support prescribing citicoline due to a lack of efficacy substantiation and potential harms.

There are four categories of medical waste that cannot be mixed as this will cause serious problems such as environmental pollution or infection. In the past, the classification of medical waste often involved a lot of human and material resources to process, with workers at risk of exposure to infectious substances. Therefore, an augmented reality (AR) and artificial intelligence (AI) medical waste classification system and method were developed. This innovative medical waste classification system and method combines AR and AI identification technology to reduce the risk of manual judgment errors by clinical staff when handling medical waste.

Wildfires are a rising environmental threat which health impact remains poorly documented, in particular beyond the fire period. This ecological study investigates changes in health conditions before, during, and after two consecutive wildfires that occurred in France´s Gironde district in the summer 2022. Electronic records from the district´s emergency medical communication centre were used to identify calls with respiratory and cardiovascular diseases, and two specific subgroups of those, asthma (all ages and 0-5 years) and cardiac arrest, respectively. Compared to before the fires, respiratory disease cases were fewer during each fire (OR = 0.85, 95% CI: 0.79, 0.90 and OR = 0.62, 95% CI: 0.58, 0.67, respectively), cardiovascular disease cases, more common during the second fire, and asthma cases, higher following the fires (ORall ages= 1.85, 95% CI: 1.56, 2.21 and ORchildren= 3.52, 95% CI: 2.62, 4.80). Asthma cases also rose during the same calendar time in 2021, but to a lesser extent. In sum, except for asthma, emergency calls data in Gironde reveal few significant potentially smoke-related symptoms around fire periods, apart from post-fire asthma. Whether the effects are smoke- or season-related remains to be determined, preferably using additional data sources.

Unexpected preoperative surgery cancellations are one of the important problems in daily anesthesia practice. It's an even bigger problem if these cancellations happen in the operating room. Our aim was to draw attention to this issue and reveal the reasons. This prospective, cross-sectional study aimed to assess the prevalence and causes of elective surgery cancellations once patients are in the operating room. The study sample consisted of 7482 adult patients scheduled for elective surgeries and taken to the operating room. Sixty-seven patients whose surgeries were canceled were grouped into Group 1, while the remaining 7415 whose surgeries were completed were in Group 2. Patients were divided into two groups based on whether their surgeries were completed or canceled. Factors such as age, American Society of Anesthesiologists physical status, and surgical department were analyzed. Metrics involved comparisons between the two groups regarding age, American Society of Anesthesiologists physical status classification, surgical department, and timing of the surgery. The prevalence of elective surgery cancellations after patients were in the operating room was 0.9%. Group 1 was significantly older than Group 2 (p&lt;0.001). The proportion of patients classified as American Society of Anesthesiologists physical status III was higher in Group 1 (p&lt;0.001). The department with the highest cancellation rate was ophthalmology(2.5%), followed by general surgery(2.1%), urology(1.5%), and ear, nose, and throat(1.4%). Approximately 59.7% of cancellations were deemed potentially avoidable. The study suggests that many of these cancellations are potentially avoidable, underscoring the need for optimized surgical scheduling and patient assessment protocols.

In recent years, semiconductor survey meters have been developed and are in increasing demand worldwide. This study aimed to investigate whether it is possible to calculate the time constant of the semiconductor survey meter using the X-ray equipment installed in each medical facility and whether it is possible to calibrate the semiconductor survey meter. Attach an additional filter to the medical X-ray system to satisfy the standards of N-60 to N-120, add more copper plates from there, and calculate the first and second half-value layers to compare with N-60 to N-120 values. Next, we will measure the leakage dose using a medical X-ray system and calculate the time constant of the survey meter. The survey meter is then calibrated and compared with the calibration factors in industrial X-ray system. Per experimental results, it is possible to reproduce the N-60 to N-120 radiation quality using a medical X-ray system and to calculate the time constant from the measured results assuming actual leakage dosimetry using that radiation quality. We also found that the calibration factor was equivalent to that of an industrial X-ray device. It was revealed that semiconductor survey meters can be calibrated using a medical X-ray system.

Nurses in disaster response require comprehensive understanding, training, and col-laboration among educators, researchers, and practitioners to overcome challenges and improve their capabilities. This study evaluates the impact of simulation-based training on improving nursing students' knowledge and performance in crisis management and triage during mass casualty incidents in Saudi Arabia, aiming to enhance existing pro-tocols in disaster management. This quantitative interventional pre-post study aimed to assess the impact of a training intervention on the disaster nursing skills of nursing students at Taif University in Saudi Arabia. The study involved a random sample of 101 nursing students and utilized a realistic train accident simulation with a response team comprising healthcare professionals and emergency specialists. A detailed questionnaire was used to measure emergency management skills and knowledge, and pre-test and post-test evaluations were conducted. Data analysis was performed using SPSS, and the study was conducted on a voluntary basis with necessary approvals obtained. The findings have the potential to enhance disaster management protocols and improve the preparedness of nursing professionals in Saudi Arabia. The posttest analysis revealed that a significant portion of participants achieved excellent, very good, and good levels of performance, indicating the effectiveness of the training program. In contrast, the pretest grades showed a higher percentage of participants receiving fail level grades, high-lighting the need for improvement prior to the training intervention. This study high-lights the importance of comprehensive training and education in disaster nursing for improving emergency response and patient outcomes

With the popularization of intelligent sensing and the improvement of modern medical technology, intelligent medical sensing technology has emerged as the times require. This technology combines basic disciplines such as physics, mathematics, and materials with modern technologies such as semiconductors, integrated circuits, and artificial intelligence, and has become one of the most promising focuses in the medical field. The core of intelligent medical sensor technology is to make existing medical sensors intelligent, portable, and wearable with full consideration of ergonomics and sensor power consumption issues, for conforming to the current trends in cloud medicine, personalized medicine, and health monitoring. With the development of automation and intelligence in measurement and control systems, it is required that sensors have high accuracy, reliability, stability, as well as certain data processing capabilities, self-checking, self-calibration, and self-compensation，while traditional medical sensors cannot meet such requirements. In addition, in order to manufacture high-performance sensors, it is also difficult to improve the material process alone, and it is necessary to combine computer technology with sensor technology to make up for its performance shortcomings. Intelligent medical sensing technology combines medical sensors with microprocessors to produce powerful intelligent medical sensors. On the basis of the original sensor functions, intelligent medical sensors also have functions such as self-compensation, self-calibration, self-diagnosis, numerical processing, two-way communication, information storage, and digital output. This review focuses on the application of intelligent medical sensing technology in biomedical sensing detection from three aspects: physical sensor, chemical sensor, and biosensor.

Aims: Medical Nutritional Treatment (MNT) can be complex and associated to potential meta-bolic complications, which has been recently described as Nutritrauma. There is no data on the effect of applying this strategy in clinical practice. The aim of our work is to describe if applica-tion of Nutritrauma concept in real live is useful to detect metabolic complications associated to the prescription of MNT in critically ill patients. Methods: In this descriptive prospective study at a single center, we enrolled 30 consecutive crit-ical ill patients of a 14 beds medical – surgical Intensive Care Unit. The Nutritrauma strategy implementation was based in four M steps: Metabolic screening, MNT prescription, Biochemical Monitoring and Nutritional Management. The primary endpoint was to describe the metabolic complications of the MNT detected with Nutritrauma strategy. Secondary endpoint was to de-scribe the most frequent causes of inappropriate prescription. Results: We analysed 28 patients (mean age 69,7 ± 11,3 years; APACHE II 18,1 ± 8,1, SOFA 7,5 ± 3,7; Nutric Score modified 4,3 ± 2,01 and mean BMI 27,2 ± 3,8). The most frequent disease on admission was sepsis (46,4%). Length of ICU stay was 20,6 ± 15,1 days and 39,3% died during the ICU stay. Enteral nutrition (82,1%) was more frequent than parenteral nutrition (17,9%). During nutritional monitoring 54 specific analytical determinations were made. Hyperglycemia was the most frequent metabolic alteration (83,3% of the determinations). Electrolyte disturbance were hypocalcemia (50%), hypophosphatemia (29,6%) and hypokalemia (27,8%). The most frequent lipid profile abnormality were hypocholesterolemia (64,8%) and hypertriglyceridemia (27,8%). Furthermore, nutritional prescription was modified in the 53,6% of patients: increase protein dosage (25%), increase caloric dosage (21,4%) and change to an organ-specific diet (17,8%). Conclusions: The application of Nutritrauma strategy facilitate the detection of metabolic com-plications and the evaluation of the appropiate prescription of the MNT.

Ceruminous gland tumours are rare injuries of the external auditory canal (EAC). This tumor, even if considered a slow-growing carcinoma, has high rate of perineural invasion and metastasis. For this reason, it must be promptly diagnosed, then it must be treated with aggressive surgery combined with postoperative radiation. The present case report is about a case of an adenoid cystic carcinoma arising the external auditory canal of 46 years old female patient, who complained hypoacusis and pain. The profile of medical liability is substantiated on the delayed diagnosis when the lately observed tumor progression by the invasion of both surrounding bone and vascular structures.

The health equipment are used to keep track of significant health indicators, automate health interventions, and analyze health indicators. People have begun using mobile applications to track health characteristics and medical demands because all devices are linked to high-speed internet and phones. Such a combination of smart devices, the internet, and mobile applications expands the usage of remote health monitoring through the Internet of Medical Things (IoMT). The accessibility and unpredictable aspects of IoMT create massive security and confidentiality threats in IoMT systems. In this proposed paper - Octopus, Physically Unclonable Functions (PUFs) have been used to provide privacy to the healthcare device by masking the data, and machine learning (ML) technique is used to retrieve the health data back and for reducing security breaches on networks. This technique has exhibited 99.45% accuracy, which proves that this technique could be used to secure health data with masking.

Background: The effect of the COVID-19 pandemic has transformed medical education and is likely to have long-lasting effects on student learning, mental well-being, and eating behaviour. This study aimed to examine the learning behaviors of medical students at the American University of Integrative Sciences (AUIS), Barbados, during the COVID-19 pandemic. Methods: A cross-sectional web-based online survey was administered to medical students at AUIS from July until November 2021. The data collecting instrument recorded students’ demographic and learning behaviour information (Meo et al. 2020), and eating disorders (SCOFF questionnaire). Results: The overall response rate was 55% (n=120). In relation to learning behaviour, students agreed with the following statements: ‘deterioration in work performance and studying’ (48.4%), ‘remember subject’s contents appropriately’ (40.4%), ‘concentration on the studies’ (40.3%), ‘difficulty in performing two tasks simultaneously’ (38.7%), ‘difficulty in performing mental calculations’ (33.9%), ‘difficulty in recalling recent information’ (32.3%), and ‘difficulty in recalling old information’ (38.7%). Among the 8 dimensions of learning behaviors, deterioration in work performance or studying, and difficulties in recalling recent information were found to be significantly associated with the gender of the students. For SCOFF questionnaire, approximately 24.2% screened positive for eating disorders. Screening with the SCOFF test demonstrated that female, older (>25 years), overweight + obese, Clinical Sciences + PreMed, and non-USA-based students were at more risk of eating disorders. Conclusions: The results indicate that during the COVID-19 pandemic AUIS students have developed learning difficulties, and are likely to have eating disorders. University policymakers should take appropriate measures to support a healthy learning environment and improve students' mental well-being and eating behaviours.

Diffuse optical tomography (DOT) is an optical medical imaging method that can assess the structural properties of tissues and their functional characteristics, such as hemoglobin concentration, water content, as well as lipid concentration, via three-dimensional image reconstruction. This paper presents the theoretical basis and working principle of diffuse optical tomography. The paper explains how the optical properties of tissue can be imaged by photon migration techniques based on diffusion theory. The author presents the reasoning for near-infrared (NIR) imaging as the most effective technique in terms of quantitative recovery of spectroscopic optical parameters. This work also listed various advantages, applications, and challenges of DOT. The paper also briefly discusses current progress in near-infrared medical imaging and its future direction.

The Coronavirus disease 2019 (COVID-19) rapidly spread to over 180 countries and abruptly disrupted the production rates and supply chains worldwide. Since then, 3D printing also recognized as additive manufacturing (AM) and known to be a novel technique that uses layer-by-layer deposition of material to produce the intricate 3D geometry, has been engaged in reducing the distress caused by the outbreak. During the early stages of this pandemic, shortages of Personal Protection Equipment (PPE), including facemasks, shields, respirators, and other medical gears, were significantly answered by remotely 3D printing them. Amidst the growing testing requirements, the 3D printing emerged as a potential and fast solution manufacturing process to meet the production needs due to its flexibility, reliability, and rapid response capabilities. In the recent past, some of the other medical applications that have gained prominence in the scientific community include 3D printed ventilator splitters, device components, and patient-specific products. Regarding the non-medical applications, researchers have successfully developed contact-free devices to address the sanitary crisis in public places. This work aims to systematically review the applications of 3D printing or AM techniques that have been involved in producing various critical products essential to limit this deadly pandemic's progression.

Over recent years, the importance of patent literature has become more recognized in the academic setting. In the context of artificial intelligence, deep learning, and data sciences, patents are relevant to not only industry but also academe and other communities. In this article, we focus on deep tomographic imaging and perform a preliminary landscape analysis of the related patent literature. Our search tool is PatSeer . Our patent bibliometric data is summarized in various figures and tables. In particular, we qualitatively analyze key deep tomographic patent literature.

Background: Serious games are conceptualized as a broad topic and overlap segments of more modern forms of education: e-learning, edutainment, game-based learning, and digital game-based learning. Serious Games aligns with digitalization and the modern era and creates novel opportunities for learning and assessment in medical education. Escape rooms, a type of serious games, merge mental and physical aspects to reinforce critical skills useful in daily life. It challenges logic and reasoning and demands careful analysis of situations to correlate and solve different stages of the escape room under pressurized, timed conditions. Furthermore, it serves as an adequate environment to build problem-solving skills, communication skills, and leadership skills through the collaboration of people to achieve a common goal. The aim of this study was to investigate the applications of escape rooms in Medical Education. Method: This study investigated the applications of escape rooms in medical education. Serious games are expanding in education and have attained great relevance due to their intriguing and intrinsically motivating attributes. Within serious games, we focused on escape rooms in which participants are locked in a room, faced with puzzles that must be solved to ‘escape the room’. Compiling the data from the first 100 hits of medical application of escape rooms, we found 72 cases and categorized them by year, specialty, participants structure, simulation experience, and design. Results: We reported on escape rooms in medical education by the year in which they were reported, the medical specialty, the participant structure, grouped or individual, the experience design; real, hybrid, or digital, and the modality of the delivery. 72% of the escape rooms focused on four main areas: nursing education (25.0%), emergency medicine (22.2%), pharmacy (12.5%), and interprofessional education (12.5%). Most of the escape rooms had a group-based physical design and little attention was given to provide a detailed description of the design considerations, such as the pathway type (linear, semi-linear, open). Conclusion: Escape rooms are applied in a wide range of medical education areas. In Medical Education, group-based on-site escape rooms with a focus on nursing, emergency medicine, pharmacy and interprofessional education dominates the implementation landscape. To further advance the field, stronger emphasis on making explicit the design considerations will advance the research and inform implementations.

This study evaluated the impact of didactic videos and service user testimonial videos on mental illness stigma among medical students. Two randomized controlled trials were conducted in Nepal. Study 1 examined stigma reduction for depression. Study 2 examined depression and psychosis. Participants were Nepali medical students (Study 1:n=94, Study 2:¬n=213) randomized to three conditions: a didactic video based on the mental health Gap Action Programme (mhGAP), a service user video about living with mental illness, or a control condition with no videos. In Study 1, videos only addressed depression. In Study 2, videos addressed depression and psychosis. In Study 1, both didactic and service user videos reduced stigma compared to the control (F2,91=6.37, p=0.003). In Study 2 (depression and psychosis), there were no differences among the three arms (F2,210=2.07, p=0.13). When comparing Study 1 and 2, there was greater stigma reduction in the service user video arm with only depression versus service user videos with depression and psychosis (t(31)=-3.04, p=0.005). In summary, didactic and service user videos were associated with decreased stigma when content addressed only depression. However, no stigma reduction was seen when including depression and psychosis. This calls for different strategies based on types of mental illnesses. ClinicalTrials.gov identifier: NCT03231761

The COVID-19 pandemic has wreaked havoc on the whole world, taking over half a million lives and capsizing the world economy in unprecedented magnitudes. With the world scampering for a vaccine, early detection and containment is the only redress. Existing diagnostic technologies with high accuracy like RT-PCRs are expensive and sophisticated, requiring skilled individuals for specimen collection and screening, resulting in lower outreach. So, methods excluding direct human intervention are much sought after, and artificial intelligence-driven automated diagnosis, especially with radiography images, captured the researchers' interest. This survey marks a detailed inspection of the deep-learning-based automated detection of COVID-19 works done to date, a comparison of the available datasets, methodical challenges like imbalanced datasets, and others, along with probable solutions with different pre-processing methods, and scopes of future exploration in this arena. We also benchmarked the performance of 315 deep models in diagnosing COVID-19, Normal, and Pneumonia from x-ray images of a custom dataset created from four others. The dataset is publicly available at https://github.com/rgbnihal2/COVID-19-X-ray-Dataset. Our results show that DenseNet201 model with Quadratic SVM classifier performs the best (accuracy: 98.16%, sensitivity: 98.93%, specificity: 98.77%) and maintains high accuracies in other similar architectures as well. This proves that even though radiography images might not be conclusive for radiologists, but it is so for deep learning algorithms for detecting COVID-19. We hope this extensive review will provide a comprehensive guideline for researchers in this field.

This paper aims to implement histogram pyramids with marching cubes method for 3D medical volumetric rendering. The histogram pyramids are used for feature extraction by segmenting the image into the hierarchical order like the pyramid shape. The histogram pyramids can decrease the number of sparse matrixes that will occur during voxel manipulation. The important feature of the histogram pyramids is the direction of segments in the image. This feature will be then used for connecting pixels (2D) to form up voxel (3D) during marching cubes implementation. The proposed method is fast and easy to implement and it also produces a smooth result (compared to the traditional marching cubes technique). The experimental results show that time consuming for generating 3D model can be reduced by 15.59% in average. The paper also shows the comparison between the surface rendering using the traditional marching cubes and the marching cubes with histogram pyramids. Therefore, for the volumetric rendering such as 3D medical models and terrains where a large number of lookups in 3D grids are performed, this method is a particularly good choice for generating the smooth surface of 3D object.

The advance of the medical field in the 21st century has influenced the development of many innovations, including in medical education. PBL (problem-based learning) is one of the pedagogical approaches that has been studying and implementing worldwide to attract medical students’ attention with their learning style and learning environment. China is the most significant “receiver” country of foreign students in Asia, and clinical medicine is one of the most chosen majors for undergraduate. In China, PBL has been implementing in some schools, but mostly with the local students and only a few implementations to the international students. International medical students in China faced a variety of challenges during their studies. In this review paper, we give the solution to adapt to the challenges by focusing on the implementation the integrated organ/system curriculum/syllabus with the PBL method to the school system with the support of the school stakeholders and students’ role.

This work addresses the problem of the application of artificial intelligence to the creation and maintenance of medical documentation and the use of big data in medicine to support efficient patient diagnosis and treatment. This study covers the latest advances in AI and big data, based on literature reviews and interviews with leading experts in these fields. The following conclusions were obtained: (1) Based on the needs of patients and providers of medical services, and given the latest technological advances, all medical documentation should be digital and the processes of its creation, access, sharing, and consistency checking should by supported by suitably designed AI systems. (2) The knowledge contained in medical documentation constitutes a resource of strategic importance for humanity, with almost unlimited potential. (3) All medical documentation should be anonymised and should be made widely available, just like data and research results in the field of experimental physics. (4) This will accelerate development of new treatments, best practice and help to identify new medical emergencies, such as Covid-19. In practice today, unfortunately, the design of medical record systems is fragmented between institutions and countries, often focusing discussions on narrow technical details, and forcing clinicians to waste time on filling up multiple pages of illness history. This leads to many inefficiencies and lost opportunities and necessitates a fundamentally new approach.

The universal health insurance system in Taiwan was formed with good intentions to help vulnerable groups. However, the possibility of bankrupting the system due to wasted medical resources. In this study, using the medical expenditures of the Taiwanese Government and gross domestic product (GDP) as variables, the wavelet analysis method was used to empirically study the correlations and leading-lagging relationships in quarterly data in the period from 1996 to 2016. In addition, the dependent population of the insured was used as the control variable. This population had no income and had high medical demands. Results: After the dependent population was included as a control variable, there was a period of low-frequency (one to four years short-term) linkage correlation, as well as a period of high-frequency (four to eight years long-term) linkage correlation. In addition, for more than eight years, there was also a high degree of linkage correlation, indicating that the linkage between medical expenditures and GDP occurred over the long term. Moreover, since medical expenditures positively affected GDP, one-way causality was observed. However, after 2008, regardless of whether a long or short term was examined, there was almost no linkage correlation. Before 2008, the medical expenditures of the government were positively correlated with economic growth; i.e., they enhanced economic growth. But, after 2008, this effect had already disappeared. The universal health insurance system has long been denounced as a waste of medical resources, and the waste must be immediately stopped. The government urgently needs to find a new solution.

Background: The progression of periodontal diseases at national Portuguese level and its public awareness are of great interest, mainly due to the high burden of periodontitis. Objectives: To evaluate the prevalence progression of periodontal diseases in Portugal and correspondent public awareness, between 2004 and 2017, by using data from the Global Burden of Disease (GBD), Directorate-General of Health (DGH) and Google® Trends (GT). Methods: For the period 2004-2017, Portuguese national data of periodontal diseases prevalence were searched in the Institute for Health Metrics and Evaluation of GBD and DGH and for public awareness, GT comparison tool between Portuguese words for “Periodontitis”, “Gingivitis”, “Gums” and “Periodontal disease” trends was used. Results: For the period 2004-2017, the overall prevalence of periodontitis slightly increased from 11.3% to 11.7%. During that period the GT search term “Gums” (“Gengivas”) was the most relevant. It increased steadily over time while the search term “Periodontal disease” (“Doença periodontal”) decreased, being these search trends significantly correlated (

The possibility of using additive manufacturing (AM) in the medicine area has created a new opportunities in health care. This has contributed to a sharp increase in demand for 3D printers, their systems and materials that are adapted to strict medical requirements. We described herein a medical-grade thermoplastic polyurethane (S-TPU), which was developed and then formed into a filament for Fused Deposition Modeling (FDM) 3D printers during a melt-extrusion process. S-TPU consisting of aliphatic hexamethylene 1,6-diisocyanate (HDI), amorphous α,ω-dihydroxy(ethylene-butylene adipate) (PEBA) and 1,4 butandiol (BDO) as a chain extender, was synthesized without the use of a catalyst. The filament properties were characterized by rheological, mechanical, physico-chemical and in vitro biological properties. The tests showed biocompatibility of the obtained filament as well as revealed no significant effect of the filament formation process on its properties. This study may contribute to expanding the range of medical-grade flexible filaments for standard low-budget FDM printers.

The operations of digitization, transmission and storage of medical data, particularly images require increasingly effective encoding methods not only in terms of compression ratio and flow of information but also in terms of visual quality. At first, there was DCT (discrete cosine transform) then DWT (discrete wavelet transform) and their associated standards in terms of coding and image compression. After that, the 2nd generation wavelets seeks to be positioned and confronted to the image and video coding methods currently used. It is in this context that we suggested a method combining bandelets and SPIHT (set partitioning in hierarchical trees) algorithm. There are two main reasons for our approach: the first lies in the nature of the bandelet transform to take advantage by capturing the geometrical complexity of the image structure. The second reason stems in the suitability of encoding the bandelet coefficients by the SPIHT encoder. Quality measurements shows that in some cases (for low bit rates) the performances of the proposed coding compete with the well-established ones and opens up new application prospects in the field of medical imaging.

This paper investigates the effects of Inter-generational co-residence on health care market, and labor market outcomes, to see whether or not living under the same roof with at least one parent matters in health care market, and labor market behaviors in post-Affordable-Care Act (ACA) USA. The adopted analytical strategy involves not only looking at the gender differences in co-residence, and its effects on outcomes in the two markets, but also accounting for co-residence endogeneity following the recent literature. Unlike the recent literature that relies on instrumental variables methods, this study adopts a switching regression approach, defining inter-generational co-residence as an endogenous selection process using a binary probit equation, and modeled jointly with the extensive margins and intensive margins in the two markets. This novel approach results in a recursive trivariate probit model for each market, and estimated using penalized maximum likelihood methods. The results suggest that ACA by reorganizing the US health care market, seems to have reduced significantly disparities in health care access among males and females based on race, region of residence, place of birth, and citizenship. However not only do we observe significant differences in inter-generational co-residence status between males and females, we also find significant inequalities in the effects of co-residence on health care market, and labor market outcomes. In fact, co-residence is found to increase health care expenditure by 56.7% among females, while this figure increases to 74.2% among males. In addition co-residing individuals, while spending 69.7% more on health care annually are 1.22 times more likely to access health care, but 31% less likely to use health care intensively during the year. In the labor market, co-residence is found to reduce significantly hours of weekly labor supplied by 41% for females, and 55.6% for males. Furthermore co-residing individuals, while not significantly different in their likelihood of labor force participation, are 1.52 times less likely to work full time once they decide to participate, and also spend about 55.4% less time working in the labor market in post-ACA USA.

This paper presents a new optical, multi-functional, high-resolution 3-axis sensor which serves to navigate and can, for example, replace standard joysticks in medical devices such as electric wheelchairs, surgical robots or medical diagnosis devices. A light source, e.g. a laser diode is affixed to a movable axis and projects a random geometric shape on an image sensor (CMOS or CCD). The software in the downstream microcontroller identifies the geometric shape’s center, distortion and size, then calculates X, Y, and Z coordinates. These coordinates can then be processed in attached devices. The 3-axis sensor is characterized by its very high resolution, precise reproducibility and plausibility of the coordinates produced. In addition, optical processing of the signal provides a high level of safety against electromagnetic and radio frequency interference. The sensor presented here is adaptive and can be adjusted to fit a user’s range of motion (stroke and force). This recommendation aims to optimize sensor systems such as joysticks in medical devices in terms of safety, ease of use, and adaptability.

Centrifuges are commonly required devices in medical diagnostics facilities as well as scientific laboratories. Although there are commercial and open source centrifuges, costs of the former and required electricity to operate the latter, limit accessibility in resource-constrained settings. There is a need for low-cost, human-powered, verified and reliable lab-scale centrifuge. This study provides the designs for a low-cost 100% 3-D printed centrifuge, which can be fabricated on any low-cost RepRap-class fused filament fabrication (FFF) or fused particle fabrication (FPF)-based 3-D printer. In addition, validation procedures are provided using a web camera and free and open source software. This paper provides the complete open source plans including instructions for fabrication and operation for a hand-powered centrifuge. This study successfully tested and validated the instrument, which can be operated anywhere in the world with no electricity inputs obtaining a radial velocity of over 1750rpm and over 50N of relative centrifugal force. Using commercial filament the instrument costs about US$25, which is less than half of all commercially available systems; however, the costs can be dropped further using recycled plastics on open source systems for over 99% savings. The results are discussed in the contexts of resource-constrained medical and scientific facilities.

Objective: Clostridioides difficile, a Gram-positive, spore-forming bacillus, has emerged as a leading cause of healthcare-associated infections, significantly contributing to infectious diarrhea and increasing healthcare costs. Materials and Methods: This cross-sectional, observational study polled Saudi Arabian nursing staff from July 2023 till December 2023 to evaluate their knowledge, attitudes, and habits regarding C. difficile infection (CDI). They were evaluated using a pre-tested, standardized questionnaire. Results: A total of 358 nurses in Saudi Arabia were surveyed, and 66% reported having knowledge of C. difficile procedures. However, only 30.5% of respondents correctly classified C. difficile as an anaerobic bacillus, while 42% were aware of the organism’s common occurrence in healthy adult volunteers. Additionally. 56% of respondents were aware of risk factors, and 49% could name typical medicines that might cause illness. Merely 24% acknowledged the cytotoxin test as the gold standard for detection. Of those who responded, 27% identified hand washing your hands was the greatest preventive approach and 36% thought that oral metronidazole was the best course of action. Conclusions: These findings highlight the global challenge that nurses are adequately knowledgeable on C. difficile. They stress the necessity of continuing education and training to enhance CDI management and patient outcomes, regardless of geographical variances.

Artificial intelligence (AI) shows great potential in medical diagnosis and drug analysis. Through deep learning technology, AI can automatically extract features from large amounts of complex medical data, significantly improving diagnostic accuracy and drug development efficiency. Especially in drug target discovery and antiviral peptide classification, AI technology can accelerate data processing and prediction, helping researchers identify potential therapeutic molecules more quickly and optimize the drug development process. This study proposes and validates a Deep learn-based model, deep-Avpiden, to improve the classification and discovery efficiency of antiviral peptides (AVPs). By using sequential convolutional networks (TCNs), the model outperforms traditional recurrent neural networks (RNNs) and long short-term memory networks (LSTMs) in capturing long-term dependencies and parallel computing capabilities. In terms of dataset, we used AVPs and non-AVPS samples from multiple databases, totaling 5,414 cleaned and de-weighted peptide sequences for model training after data preprocessing and embedding. The Deep-AVPiden model has been shown to outperform existing advanced classifiers in experiments, and its effectiveness has been verified by accuracy, precision, recall rate, and area under the ROC curve (OC-ROC). In addition, to accommodate computing resource constraints, we propose an optimized version of Deep-AvPIDen (DS), which utilizes Deep separation convolution technology to significantly reduce computing resource consumption. Through the online application platform, researchers can efficiently classify antiviral proteins and discover new AVPs. Future research could further optimize the model's computational efficiency, handle larger data sets, and expand its potential for biomedical problems such as drug combination prediction and new drug discovery.

Introduction: The COVID-19 pandemic has triggered several challenges to mental health worldwide. Undergraduate medical students face considerable stress in their academic routines. Thus, there is a need to explore the implications of the mental health of undergraduate medical students during the COVID-19 pandemic. Objective: To review the global literature about anxiety and depression disorders in undergraduate medical students during the COVID-19 pandemic. Method: we developed an integrative literature review on the occurrence of anxiety and depression symptoms in undergraduate medical students during the COVID-19 pandemic. We assessed the results on the occurrence of anxiety and depression and the severity of symptoms in medical students during the COVID-19 pandemic using quantitative studies applying the GAD-7 questionnaire for anxiety or PHQ-9 for depression. Results: We reviewed 85 selected studies, and the results showed a significant prevalence of moderate and severe symptoms of anxiety and depression, with 28.2% of participants presenting scores ≥ 10 on the GAD-7 and 38.9% on the PHQ-9. Statistical analyses revealed associations between higher rates of anxiety symptoms in developing countries and data collected after the lockdown period in 2020, at the Pandemic lockdown. Conclusion: Our findings highlight the need for specific interventions to support the mental health of undergraduate medical students, critically in female students from developing countries during a Pandemic crisis.

The development of intelligent medical service robots for patient care presents significant chal-lenges, particularly in integrating diverse knowledge sources and enabling robots to autono-mously perform tasks in dynamic and unpredictable healthcare environments. This study in-troduces a novel framework that combines large language models (LLMs) with healthcare-specific knowledge and robotic operations to enhance autonomous task execution for a Robotic Health Attendant (RHA). Utilizing OpenAI’s ChatGPT, the RHA processes structured information about patient care protocols and unstructured human inputs to generate context-aware robot actions. A prototype system was tested in a simulated patient room where the RHA successfully performed both simple individual actions and complex tasks involving the execution of multiple actions, based on real-time dialogues with the LLM and predefined task specifications. The results demonstrate the potential of LLMs to reduce the reliance on hardcoded logic and provide healthcare professionals with the ability to interact with robotic systems through natural lan-guage.

The objective of this study was to develop and evaluate artificial intelligence (AI) models for the detection and instance segmentation of vertebrae and spinal metastases in computer tomography (CT) scans. The models were trained on datasets consisting of patients with polytrauma and relatively undamaged spines, as well as patients diagnosed with spinal metastases. Our results indicate that the models achieved high performance in vertebra segmentation, with F-beta scores ranging from 0.88 to 0.96 across all vertebra classes. For spinal metastases, the model attained F-beta scores of 0.68 for lytic type and 0.57 for sclerotic type metastases. Additionally, the models demonstrated the capability to detect isolated metastatic nodes in other bones, highlighting their robustness and potential for broader clinical application. Despite these promising results, the study faced limitations including a relatively small and homogeneous dataset, variability in segmentation mask quality, and the need for real-world clinical validation. Future clinical trials are necessary to evaluate the practical utility and effectiveness of these AI models in improving patient outcomes. Our study emphasizes the potential of AI-assisted detection and segmentation models in enhancing diagnostic accuracy and efficiency in clinical practice.

Cardiovascular disease is a major global health concern, with early detection being critical. This study assesses the effectiveness of the portable ECG device, based on Internet of Medical Things (IoMT) technology, for remote cardiovascular monitoring during daily activities. We conducted a clinical trial involving 2,000 participants who wore the HiCardi device while engaging in hiking activities. The device monitored their ECG, heart rate, respiration, and body temperature in real-time. If an abnormal signal was detected while a physician was remotely monitoring the ECG at the IoMT monitoring center, he notified the clinical research coordinator (CRC) at the empirical research site, and the CRC advised the participant to visit a hospital. Follow-up calls were made to determine compliance and outcomes. Of the 2,000 participants, 318 showed abnormal signals, and 182 were advised to visit a hospital. Follow-up revealed that 139 (76.37%) responded, and 30 (21.58% of those who responded) sought further medical examination. Most visits (80.00%) occurred within one month. Diagnostic approaches included ECG (56.67%), ECG and ultrasound (20.00%), ultrasound alone (16.67%), ECG and X-ray (3.33%), and general treatment (3.33%). Seven participants (23.33% of those who visited) were diagnosed with cardiovascular disease, including conditions such as arrhythmia, atrial fibrillation, and stent requirements. The portable ECG device using the patch-type electrocardiograph detected abnormal cardiovascular signals, leading to timely diagnoses and interventions, demonstrating its potential for broad application in preventative health care.

Regulation (EU) 2017/745, addresses medical devices and clarifies the scope regarding products containing viable biological materials or organisms. This regulation excludes products containing viable cells or tissues of human or animal origin, as well as those containing viable biological materials or organisms of other origins intended to achieve or support the intended purpose of the products. The term "inviable" is defined as incapable of metabolism or multiplication. The regulation mandates that products manufactured using non-viable biological substances must ensure the highest safety standards, including validated methods of elimination or inactivation of transmissible agents during manufacturing. Several Directives and Regulations provide context for the term "viable" in medical devices, emphasizing the device's ability to perform effectively and safely. Notified Bodies in the EU have interpreted that thermally inactivated microorganisms in a product do not classify it as a medical device under Regulation 2017/745. To address this, it is crucial to differentiate between the inactivation of microorganisms and the viability of their metabolites. Demonstrating the inviability of microorganisms through rigorous testing and evidence is essential for regulatory compliance and safe use in medical products. Clarifying these points and providing necessary evidence can establish that inactivated microorganisms are inviable and meet the requirements for use in medical products.

With the widespread application of artificial intelligence technology in various industries, users' attention to privacy and data security has increased significantly. Federated learning, as a new technology paradigm combining privacy-enhanced computing and artificial intelligence, resolves the contradiction between data security and open sharing. This paper presents the benefits of federated learning in terms of privacy, real-time processing, model robustness, compliance and cross-industry applications. At the same time, when combined with Edge AI technology, federated learning promotes the decentralisation of intelligent systems, improving data privacy protection and model accuracy. This paper also discusses the application cases of federated learning in the medical field, through local data processing and model training, effectively protecting user privacy, realizing medical data sharing and model optimization, and promoting the development of artificial intelligence.

Background: Upper respiratory tract infections (URTIs) are a major public health concern due to their high incidence and potential for complications. Pharmacists often serve as the first point of contact for patients with URTIs. This study aims to develop and evaluate the RESP-8 tool to assist pharmacists in determining the need for medical evaluation. Methods: This prospective interventional cohort study was conducted over six months (October 2023 to March 2024) in community pharmacies. Participants included adults aged 18 years and older presenting with URTI symptoms. Pharmacists used the RESP-8 tool, which comprises eight criteria to assess the need for medical referral. Data on medical history, symptom duration, and progression were recorded. The primary outcome was the feasibility of implementing the RESP-8 tool. Secondary outcomes included the accuracy of the tool, the percentage of patients recommended for medical evaluation, and compliance with these recommendations. Results: A total of 64 participants were included, with an average age of 55.7 years. Pharmacists recommended medical evaluation for 75% (48/64) of patients using the RESP-8 tool. Among these, 70.83% (34/48) complied with the recommendation. The tool demonstrated high accuracy in identifying patients needing further medical evaluation, with only two noted errors. All compliant patients received appropriate treatment without complications. The tool was easy to implement, taking less than 5 minutes per patient. Discussion: The RESP-8 tool effectively guided pharmacists in recommending medical evaluations for URTI patients. The high compliance rate indicates patient trust in pharmacists' guidance. While the study's small sample size limits generalizability, the results are promising. Future studies with larger populations are necessary to validate these findings and further refine the tool. Conclusion: The RESP-8 tool shows potential in enhancing pharmacists' ability to make informed decisions about medical referrals for URTIs, ultimately improving patient outcomes and optimizing healthcare resource management.

The term “medical error” is quite often used to refer to any mistake committed in the provision of healthcare services which has caused harm to a patient. Objective: To analyze civil lawsuits involving medical errors in pediatrics by evaluating: 1) causal link; 2) type of medical error; 3) conviction of the court and its legal basis; 4) correlation between medical expert understanding and legal understanding. Materials and Method: Retrospective analysis of 60 pediatric forensic medical examinations carried out by a pediatric expert between April 2009 and February 2014 at the Institute of Medicine and Criminology of the State of São Paulo (IMESC). The expert’s reports were analyzed according to age, gender, type of forensic medical report (direct or indirect), conclusion of the expert’s report (causal link between the medical conduct and complaint or not), type of medical error (negligence, recklessness, malpractice), judgment in the first instance (if in accordance with the expert’s report or not), and basis of judgment as objective or subjective (type of law). Results: Most expert’s examinations (65%) were indirect (death). In 27 reports (45%), the expert’s conclusion determined that there was a causal link between medical care and the damage inflicted to a patient. Of the 27 reports with causal link, the judge was not in accordance with the expert’s report in one case, thus not considering medical error. The vast majority of sentences (55) were in accordance with the expert’s conclusion (91.6%). Subjective law was mostly used to support the judge’s ruling (61.70%), followed by objective law (23.30%). All lawsuits claimed moral damages (100%). In the statistical analysis of distribution of nominal variables (frequency), an excellent agreement (kappa= 0.86), with statistical significance, was verified between the expert’s report and the court ruling. Conclusion: Expert evidence supported 91.6% of the sentences and was considered to be highly valuable evidence. Expert evidence had a major impact on the legal proceedings and has proven statistically significant (p<0.005). Subjective law was used to assess medical error in all cases in which healthcare professionals were involved. Claims for moral damages was requested in all lawsuits, and was fully or partially granted in 100% of the cases.

(1) Background: Mixed Reality is a technology that has gained attention due to its unique capabilities for accessing and visualizing information, becoming a valuable tool for medicine, particularly for the operating room and surgical learning; (2) Methods: A systematic review was conducted following the PRISMA guidelines to answer the research questions established using the PICO framework; (3) Results: Although implementation of Mixed Reality applications in the operations room presents some challenges, when used appropriately, it can yield remarkable results. It can make learning easier, flatten the learning curve for several procedures, and facilitate various aspects of the surgical processes; (4) Conclusion: Technical complexity, equipment costs, and steep learning curves present significant obstacles to the widespread adoption of Mixed Reality and computer-assisted evaluation. The possibility of integration of distinct medical imaging modalities and innovative functionalities holds promise for clinical applications. However, it is important to consider issues related to usability, bias, and statistical analyses need consideration. Mixed Reality offers significant benefits, but there are still open challenges such as ergonomic issues, limited field of view, and battery autonomy that must be addressed to ensure widespread acceptance.

Smart electronic devices and telemedicine are widely used in humans' daily lives. This provides remote treatment of patients using information and communications technology. New telemedicine technologies, such as the Internet of Medical Things (IoMT), make it easier for medical and computing devices to communicate regularly and effectively. Critical motivations for adapting the IoMT are reduced cost, increased quality of life, and timely medical intervention. IoMT is significant because it enables continuous, real-time patient monitoring during routine everyday activities using a variety of wearables and sensors. With big data, the IoMT technology makes excellent use of Artificial Intelligence (AI) to support disease detection and health condition prediction, alerting patients and healthcare providers. Many research studies have been conducted to explore various aspects of IoMT and its applications in the real world. However, it is challenging to comprehend all the techniques and solutions proposed by the research community. Therefore, this survey sheds light on some crucial aspects of IoMT technologies and explores the potential research gaps and directions the research community could tackle. The survey examines and discusses the characteristics of IoMT standards, protocols, and types. It then delves into the layers of IoMT and distinguishes them into Fog and edge. The studies published under each type were explored, and the limitations of these works were highlighted. The research gaps and directions on IoMT approaches and technologies were also highlighted. With such findings and research directions, further research endeavors could be carried out to address the issues and existing limitations in the IoMT.

The institutionalization of people with intellectual disabilities has been a common international response across cultures and generations that persists to this day. This chapter recounts its inheritance and manifestation in modern service provision. An institutional mind-set persists among clinicians and managers despite policies that emphasise the rights of persons with intellectual disability and anti-discriminatory practice. Alternative provision is rooted in person-centred practice; with a growing body of evidence for the improved quality of life that results from it. A reflective activity encourages readers to examine a recent case when they were associated with an institutional placement and what alternatives might have been sought. Yet alliances with other professionals, self-advocates and family carers will be needed to effect real and lasting changes in our service cultures and even then, the long shadows of institutional care may still persist.

Background: Obesity is a global health crisis with a rapidly increasing prevalence among university students. Medical students are a unique population that may be at a higher risk of obesity due to the demanding nature of their studies and the associated stress. Objective: This study aimed to determine the prevalence of overweight, obesity, and the associated risk factors among medical students at Jazan University in Saudi Arabia. Methods: A cross-sectional study was conducted among 228 medical students from their 2nd to 6th academic years at the Faculty of Medicine, Jazan University. A self-administered questionnaire was used to collect data regarding sociodemographic characteristics, physical activity, dietary habits, comorbidities, medication use, family history, and lifestyle factors. Anthropometric measurements including height, weight, and waist circumference were recorded. Chi-square test and binary logistic regression were used to identify the risk factors associated with obesity. Results: The prevalence of overweight and obesity among the participants was 13.3% and 15% respectively. Hence, the combined prevalence of overweight and obesity is 28.3%. The mean weight was 63.39 ± 18.93 kilograms, and the mean height was 163.48 ± 9.78 centimeters. On the other hand, 17.3% of participants had underweight whereas 54.4% had normal BMI. Most of the participants (61%) did not engage in regular exercise. A high proportion consumed fruits (82.9%) and vegetables (58.8%) 3 or fewer days per week, and 84.2% consumed 3 or fewer meals per day. Fast food consumption more than 3 days per week was reported by 42.1% of participants. Obesity was not significantly associated with sociodemographic factors, physical activity, dietary habits, comorbidities, medication use, or family histories. However, those with a monthly family income of 15,000-24,999 riyals had significantly lower odds of obesity than those in the lowest income group (OR 0.230, p = 0.045). Conclusion: The prevalence of overweight and obesity among medical students at Jazan University is high. Although no significant associations were found between obesity and most risk factors, this study highlights the need for interventions that promote healthy lifestyles among medical students. Further research is needed to identify effective strategies for preventing and managing obesity in this population.

Dermal injections of hyaluronic acid gel for aesthetic skin rejuvenation are increasingly popular nowadays. Although these products are classified as medical devices, the regulations on their administration by licensed practitioners are still weak, whereas their manufacturers increasingly highlight and advertise the cellular effects that underpin the efficacy of these injections. In this re-view, we discuss all current knowledge on the mode of action of dermally injected hyaluronic acid and the potential toxicological implications especially from crosslinked gels in conjunction with the current global regulations. We conclude that dermal injections of hyaluronic acid have several therapeutic implications that warrant further research, and that strict regulations must be applied on their manufacture/quality control and the required qualifications of licensed aesthetic injectors.

The development of new medical monitoring applications requires precise modeling of the human body effects as well as simulating and emulating realistic scenarios and conditions. The first aim of this paper is to develop realistic and adjustable human body 3D emulation platforms which could be used for evaluating emerging microwave-based medical monitoring/sensing applications such as the detection of brain tumors, strokes, breast cancers as well as for capsule endoscopy studies. The new phantom recipes are developed for microwave ranges for the realistic shaped phantom molds. The second aim is to validate the feasibility and reliability of the phantoms for practical scenarios with electromagnetic simulations using tissue layer models and biomedical antennas. The third aim is to investigate the impact of the water temperature in the phantom cooking phase on the dielectric properties of the stabilized phantom. The evaluations show that the dielectric properties of the developed phantoms correspond closely to those of real human tissue. The error in dielectric properties varies between 0.5-8%. In the practical scenario simulations, the differences obtained with phantoms-based simulations in S21 parameters are 0.1-13dB. However, the differences are smaller in the frequency ranges targeted for medical applications.

Cross-institutional secondary use of medical data benefits from structured semantic annotation, which, ideally, enables matching and merging semantically related data items from different sources and sites. While numerous medical terminologies and ontologies, as well as some tooling, exist to support such annotation, cross-institutional data usage based on independently annotated datasets is challenging for multiple reasons: the annotation process is resource intensive and requires a combination of medical and technical expertise since it often requires judgment calls to resolve ambiguities resulting from non-uniqueness of potential mappings to various levels of ontological hierarchies and relational and representational systems. Divergent resolution of such ambiguities can inhibit joint cross-institutional data usage based on semantic annotation since data items with related content from different sites will not be identifiable based on their respective annotations if different choices were made without further steps such as ontological inference, which is still an active area of research. We hypothesize that a collaborative approach to semantic annotation of medical data can contribute to more resource efficient and high-quality annotation by utilizing prior annotational choices of others to inform the annotation process, thus both speeding up the annotation itself and fostering a consensus approach to resolving annotational ambiguities by enabling annotators to discover and follow pre-existing annotational choices. Therefore, we have implemented a prototypical Collaborative Annotation Tool (CoAT), evaluated its usability, and present first inter-institutional experiences with this novel approach to promoting practically relevant interoperability driven by use of standardized ontologies.

Introduction: In an era of increasing public awareness regarding the pivotal role of nutrition in the onset and progression of chronic degenerative diseases, there is a growing demand for information and assistance pertaining to the intricate relationship between diet and disease. Nutritional practices, therefore, emerge as a fundamental element in the prevention and management of these maladies, necessitating a proactive response from healthcare professionals (HCP). This study sought to evaluate the impact of participation in a Culinary Medicine (CM) program on Mediterranean diet adherence, food management skills, culinary proficiency, and counseling confidence among HCP. Methods: A mixed-methods pilot implementation program (PIP) was meticulously designed and executed, engaging a cohort of 20 HCP recruited from Hospital Clinic Barcelona. The program unfolded at the Alícia Foundation kitchen-lab and encompassed a series of interactive, hands-on sessions that delved into the realms of gastronomy, food management, culinary skills, and culinary diet therapy, with a specific focus on prevalent diseases and their prevention, treatment, and care. Tailored questionnaires were administered to all participants both before and after the PIP. Results: Of the 20 participants, 14 successfully completed the study, comprising 86% women, 86% aged above 40, 71% nurses, and 7% medical doctors. Interestingly, 86% of the participants had previously received nutrition training, whereas only 14% had received culinary training. Following the completion of the program, there was a remarkable improvement in adherence to the Mediterranean diet (p < 0.01). However, no statistically significant improvements were observed in food management and culinary skills or counseling confidence (p > 0.5). Despite the absence of statistical significance, there was a noteworthy trend towards greater advocacy for dietary changes before resorting to medication, along with enhanced confidence in providing nutritional and culinary guidance to patients. Conclusion: The findings from this study underscore the potential of hands-on CM training as a vital component of nutrition education for HCP. While statistically significant improvements in certain domains were not observed, the program did demonstrate its ability to influence attitudes, knowledge, and behaviors related to healthy cooking and eating for both HCP themselves and their patients. Given these promising trends, future studies with a larger sample size must be performed to further elucidate the impact of CM training on HCP and its potential benefits for public health.

In recent years, antibacterial coatings have become a significant approach in the global fight against bacterial pathogens. Developments in materials science, chemistry and biochemistry have led to a plethora of materials and chemical compounds that have potential for creating antibacterial coatings. Nonetheless, there has been insufficient consideration given to the analysis of the techniques and technologies used to apply these coatings. Among the various inorganic coating techniques, Atomic Layer Deposition (ALD) is noteworthy. It enables the successful synthesis of high-purity inorganic nanocoatings on surfaces of complex shape and topography, while also providing precise control over their thickness and composition. ALD has various industrial applications, but its practical application in medicine is still limited. In recent years, a substantial number of papers have been published on the suggested implementation of thin films and coatings produced through ALD in medicine, notably those with antibacterial properties. The aim of this paper is to carefully evaluate and analyse the relevant literature on this subject. Simple oxide coatings, including TiO2, ZnO, Fe2O3, MgO, and ZrO2, were examined, as well as coatings containing metal nanoparticles such as Ag, Cu, Pt, and Au, and mixed systems such as TiO2-ZnO, TiO2-ZrO2, ZnO-Al2O3, TiO2-Ag, and ZnO-Ag. Through comparative analysis, we have been able to draw conclusions on the effectiveness of various antibacterial coatings of different compositions, including key characteristics such as thickness, morphology, and crystal structure. ALD has been analysed in its use for developing antibacterial coatings for various applications. Furthermore, assumptions regarding the most promising development areas have been presented.

The automatic diagnosis of cardiovascular diseases has received much attention in the deep learning field. In this context, the segmentation of the left ventricle endocardium constitutes a major task in diagnosing heart conditions such as health failure and hypertrophic cardiomyopathy. The objective of this paper is to propose a "deep convolution network" for segmenting the internal cavity of the left ventricle (endocardium) using MRI images. In particular, we design an improved UNET model which handles additional inception modules for efficiently segmenting the internal cavity of the left ventricle. Our approach has been validated on the Sunnybrook Cardiac Data (SCD) dataset and has showed promising results in terms of precision. More specifically, the improved UNET largely outperforms the baseline UNET model and many existing state-of-the-art methods.

Since the emergence of convolutional neural networks (CNNs), and later vision transformers (ViTs), the standard paradigm for model development has been using a set of identical block types with varying parameters/hyper-parameters. To leverage the benefits of different architectural designs (e.g., CNNs and ViTs), we propose alternating structurally different types of blocks to generate a new architecture, mimicking how Lego blocks can be assembled. Using two CNN-based and one SwinViT-based blocks, we investigate three variations to the so-called LegoNet that apply the new block alternation concept for the segmentation task in medical imaging. We also study a new clinical problem that has not been investigated before – the right internal mammary artery (RIMA) and perivascular space segmentation from computed tomography angiography (CTA). It was proven to demonstrate a prognostic value to primary cardiovascular outcomes. We compare the model performance against popular CNN and ViT architectures using two large datasets (achieving 0.749 dice similarity coefficient (DSC) on the larger dataset). We also evaluate the model’s performance on three external testing cohorts, where an expert clinician corrected model-segmented results (DSC>0.90 for the three cohorts). To assess our proposed model for suitability in clinical use, we perform intra- and inter-observer variability analysis. Finally, we investigate a joint self-supervised learning approach to determine its impact on model performance.

Multimodal medical image fusion is a fundamental but challenging problem in the fields of brain science research and brain disease diagnosis, and it is challenging for sparse representation (SR)-based fusion to characterize activity level with single measurement and no loss of effective information. In this paper, the Kronecker-criterion-based SR framework is applied for medical image fusion with a patch-based activity level integrating salient features of multiple domains. Inspired by the formation process of vision system, the spatial saliency is characterized by textural contrast (TC), which is composed of luminance and orientation contrasts to promote more highlighted texture information to participate in the fusion process. As substitution of the conventional l1-norm-based sparse saliency, a metric of sum of sparse salient features (SSSF) is used for promoting more significant coefficients to participate in the composition of activity level measure. The designed activity level measure is verified to be more conducive to maintain the integrity and sharpness of detailed information. Various experiments on multiple groups of clinical medical images verify the effectiveness of the proposed fusion method on both visual quality and objective assessment. Furthermore, the research work of this paper is helpful for further detection and segmentation of medical images.

Freeze-drying is a well-established process in biomedical engineering for the fabrication of three-dimensional open-porous medical devices, especially those based on biopolymers. One of the most used biopolymers in this field is collagen, the most abundant protein in the human body and the main component of the extracellular-matrix, as well as its derivatives. Freeze-dried collagen-based sponges with a wide variety of attributes can be produced by design and have led to a wide range of successful commercial medical devices, foremost for dental, orthopedic, hemostatic and neuronal applications. However, this is still considered a high-cost and time-consuming process that is often used in a non-optimized manner. By combining advances in other technological fields, the opportunity arises to further evolve this process in a sustainable manner, and optimize the resulting products as well as create new opportunities in this field.

This study aimed to investigate Romanian physicians' awareness, recommendation practices, and opinions regarding using Foods for Special Medical Purposes (FSMPs) products. A total of ten physicians were interviewed using a structured questionnaire, and their responses were analysed using thematic content analysis. The study found that physicians were aware of FSMPs and recommended them to their patients based on nutritional deficits, weight loss, or deglutition impairments. In addition, disease stage, treatment scheme, taste, affordability, and availability were identified as factors influencing the recommendation and use of FSMPs. While physicians generally did not consult clinical trials, clinical experience was deemed essential for recommending FSMPs to patients. Patients' feedback regarding the usage and sourcing of FSMPs was generally positive, with some expressing concerns about the availability of different flavours and the costs of purchasing the products. The study concludes that physicians play a vital role in recommending FSMPs to patients and ensuring they have the necessary nutritional support during treatment. However, more patient education materials and collaboration with nutritionists may be required to improve patient outcomes and reduce patient financial burden.

Chronic non-communicable diseases (NCDs) are major public health problems and a significant financial burden on public health systems. By 2030, mortality due to NCDs, such as cardiovascular diseases, cancer, respiratory diseases, and diabetes, is predicted to increase in Brazil. A peculiar aspect of NCDs involves their long-term and integrated care management. This paper proposes a chronic disease management platform based on artificial intelligence to deliver digital health services everywhere. The proposed platform is anchored and built with healthcare 4.0 technologies, such as wearable devices, the internet of medical things, and artificial intelligence cloud-based solutions that allow the deployment of a smart healthcare system. In addition, the paper presents the feasibility of the platform in a diabetes prediction study case. For the study case, an initial dataset was established with bio-impedance, oxygen concentration, pulse rate, skin impedance, and skin temperature attributes. A baseline was implemented with ten regression models to assess the prediction performance of the mean squared error, root mean squared error, and r-squared score to compare predictive findings with capillary blood glucose measurements. Results evidence that the decision tree regressor and three ensemble methods (bagging decision tree regressor, random forest regressor, and AdaBoost regressor) yielded improvement over the other models. Moreover, a comparison among those models revealed that the decision tree regressor outperforms them and presents promissory outcomes.

Care coordination (CC) for children with special healthcare needs and medical complexity (CSHCN-CMC) is challenging, and medication management is especially difficult for providers, parents/caregivers, and patients alike. While numerous strategies for CC have been suggested and implemented, barriers to medication optimization remain. The report describes the creation of a pediatric clinical pharmacotherapy practice, related standard operating procedures to assure consistent application of screening tools and care provision through comprehensive medication management (CMM), and establishment of a collaborative practice agreement (CPA) to guide drug therapy delegation, monitoring, and modification. The methodology of a prospective case series is also presented to highlight drug therapy problems and their resolution in CSHCN-CMC. Future opportunities to expand the practice for engagement in population health management as well as prior authorization activities on behalf of physicians will be discussed.

Background: Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LD is confirmed in only 10-20% of patients, with a significant number remaining in a diagnostic dead-end. Objectives: To reach a deeper understanding of how patients themselves contribute to the diagnostic process. To describe the genesis of the LD hypothesis in care pathways. Methods: In 2019, 30 patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseille for presumed LD were recruited for semi-structured interviews. The inclusion criteria were : suffering from subjective symptoms for 6 months, no clinical or paraclinical argument suggesting current LD. The patients’ medical trajectories were collected using a biographical approach. Results: The diagnosis of Lyme disease was primarily triggered by identification with personal testimonies found on the internet. Most of patients were leading their own diagnostic investigation. The majority of participants were convinced they had LD despite the lack of medical evidence and the scepticism of their referring GP. Conclusion: GPs should first systematically explore patients’ etiologic representations in order to improve adherence to the diagnosis especially in the management of medically unexplained symptoms. Long COVID-19 syndrome challenge offers an opportunity to promote active patient involvement in diagnosis.

Data sets for medical images are generally imbalanced and limited in sample size because of high data collection costs, time-consuming annotations, and patient privacy concerns. The training of deep neural network classification models on these data sets to improve the generalization ability does not produce the desired results for classifying the medical condition accurately and often overfit the data on the majority of class samples. To address the issue, we propose a framework for improving the classification performance metrics of deep neural network classification models using transfer learning: pre-trained models, such as Xception, InceptionResNet, DenseNet along with the Generative Adversarial Network (GAN) – based data augmentation. Then, we trained the network by combining traditional data augmentation techniques, such as randomly flipping the image left to right and GAN-based data augmentation, and then fine-tuned the hyper-parameters of the transfer learning models, such as the learning rate, batch size, and the number of epochs. With these configurations, the Xception model outperformed all other pre-trained models achieving a test accuracy of 98.7%, the precision of 99%, recall of 99.3%, f1-score of 99.1%, receiver operating characteristic (ROC) - area under the curve (AUC) of 98.2%.

The presented research faces the problem of early detection of sepsis for patients in the Intensive Care Unit. The PhysioNet/Computing in Cardiology Challenge 2019 facilitated the development of automated, open-source algorithms for the early detection of sepsis from clinical data. A labeled clinical records dataset for training and verification of the algorithms was provided by the challenge organizers. However, a relatively small number of records with sepsis, supported by Sepsis-3 clinical criteria, led to highly unbalanced dataset (only 2% records with sepsis label). A high number of unbalanced data records is a great challenge for machine learning model training and is not suitable for training classical classifiers. To address these issues, a number of various models were investigated. A solution including feature selection and data balancing techniques was proposed in this paper. In addition, several performance metrics were investigated. Results show, that for successful prediction, a particular model having few or more predictors based on the length of stay in the Intensive Care Unit should be applied.

The 2019 Coronavirus pandemic which was initially referred to as 2019-nCoV, was first identified in Wuhan, China. Early response from the Chinese government included quarantine of infected persons, isolation and total lockdown of Wuhan province to prevent further spread. With the spread of the disease across national borders and declaration of the disease as a global pandemic, there has been a robust response by the international community to contain this deadly virus and prevent its further spread worldwide. Africa is not left out of this rampaging pandemic with documented cases in over 40 countries and still rising. Although extensive studies have been carried out on the novel SARS-CoV-2 on its pathogenesis, mode of infection and virulence but much is still unknown. However, potentially infectious samples are received routinely in the medical laboratory for analysis. This technical note reviews good laboratory practice (GLP) and processes across the different specialities of Medical Laboratory practice that should minimize the risk of infection to laboratory staff especially in resource-limited settings.

Objective: This study investigated the effect of the hierarchical medical system under the national health insurance program on resident’s healthcare-seeking behavior in Taiwan. Background: Healthcare authorities in Taiwan initiated the allowance reduction of outpatient visits at regional hospitals and higher hierarchical hospitals from 2018. The ultimate goal is to implement a hierarchical medical system and provide the residents accessible as well as consistent medical services. Methods: This research was conducted through the questionnaire survey method and data were collected between August and December 2018 from the records of subjects who had recently sought medical attention. A total of 1,340 valid questionnaires were returned. Results: Regarding the effect on healthcare-seeking behavior, the following factors were significant: being aged between 40 to 49 (p＜.1), subjects with an educational background of junior high school (p＜.05), those who were not aware of the policy (p＜.001), and an awareness about both the hierarchical medical system and the policy to reduce outpatient visits to large hospitals (p＜.001). Conclusion: The public should be made aware about the hierarchical medical system to improve healthcare.

This article presents a new input device for spastic patients and others with similar symptoms. The sensor consists of a disc used to determine positions and can replace standard joysticks in medical devices such as electric-powered wheelchairs. Using a standard joystick while operating a powered wheelchair can result in dangerous situations when spastic movements occur and extremities cramp making them uncontrollable. To avoid this, a disc was developed that can be controlled with any body part. By shifting weight (x- and y-axis) the disc can tilt in any direction creating a proportional output signal and can also be pushed down in the center (z-axis) to open a menu on a screen for example. When spasms occur it is impossible for users to get stuck on the input device because the disc is flat and can be mounted within a control panel. Body parts coming into contact with the disc would merely slide across the disc without triggering unintentional actions. The sensor presented here is also adaptive and can be adjusted to fit a user’s strength and range of motion. This proposal aims to develop an input device that enables spastic patients to operate sensitive systems safely.

Due to the extreme complexity of Alzheimer's disease (AD), the aetiology of which is not yet known, nor are there any known effective treatments, mathematical modelling can be very useful. Indeed, mathematical models, if deemed reliable, can be used to test medical hypotheses that could be difficult to verify directly. In this context, it is important to understand how $A\beta$ and $\tau$ proteins, which in abnormal aggregate conformations are hallmarks of the disease, interact and spread. We are particularly interested in this paper in studying the spreading of misfolded $\tau$. To this end, we present four different mathematical models, all on networks on which the protein evolves. The models differ in both the choice of network and diffusion operator. Through comparison with clinical data on $\tau$ concentration, that we carefully obtained with multimodal analysis techniques, we show that some models are more adequate than others to simulate the dynamics of the protein. This type of study may suggest that, when it comes to modelling certain pathologies, the choice of the mathematical setting must be made with great care if comparison with clinical data is considered decisive.

Objective: Scaphoid fractures, particularly occult and non-displaced fractures, are difficult to detect using traditional X-ray methods due to their subtle appearance and variability in bone density. The study proposes a two-stage CNN approach to detect and classify scaphoid fractures using anterior-posterior (AP) and lateral (LA) X-ray views for more accurate diagnosis. Methods: The study emphasizes the use of multi-view X-ray images (AP and LA views) to improve fracture detection and classification. The multi-view fusion module helps integrate information from both views to enhance detection accuracy, particularly for occult fractures that may not be visible in a single view. The proposed method includes two stages that are stage 1: Detect the scaphoid bone using Faster R-CNN and Feature Pyramid Network (FPN) for region proposal and small object detection. The detection accuracy for scaphoid localization is 100% with Intersection over Union (IoU) scores of 0.8662 for AP views and 0.8478 for LA views. And stage 2: Perform fracture classification using a ResNet backbone and FPN combined with a multi-view fusion module to combine features from both AP and LA views. This stage achieves a classification accuracy of 89.94%, recall of 87.33%, and precision of 90.36%. Results: The proposed model performs well in both scaphoid bone detection and fracture classification. The multi-view fusion approach significantly improves recall and accuracy in detecting fractures compared to single-view approaches. In scaphoid detection, both AP and LA views achieved 100% detection accuracy. In fracture detection, using multi-view fusion, the accuracy for AP views reached 87.16%, and for LA views, it reached 83.83%. Conclusion: The multi-view fusion model effectively improves the detection of scaphoid fractures, particularly in cases of occult and non-displaced fractures. The model provides a reliable, automated approach to assist clinicians in detecting and diagnosing scaphoid fractures more efficiently.

Deep convolutional neural networks (CNNs) have revolutionised computer vision technology by automatically learning hierarchical representations of image data, leading to state-of-the-art performance in visual recognition tasks. This article presents a comprehensive review of deep CNNs, from their evolution and architectures to the current state-of-the-art research. The review also provides the core concepts and building blocks of CNNs and their concise mathematical representations. Furthermore, it explores applications of deep CNNs in three popular domains, including medical diagnosis, remote sensing, and facial recognition. This review will benefit researchers and practitioners in computer vision and artificial intelligence, as well as industry professionals seeking to leverage the latest advancements in deep learning technologies.

Emergency Medical Response Systems (EMRS) play a vital role in delivering medical aid during disasters. In Serbia, these systems encounter several obstacles due to economic limitations, scarce resources, and ongoing healthcare reforms, all of which affect their performance. This study focuses on examining the risk factors and effectiveness of Serbia's EMRS, identifying systemic issues, and proposing enhancements to improve emergency preparedness for disasters. A survey was conducted across healthcare institutions in Serbia to gather comprehensive insights. The survey explored various aspects, including organizational structures, resource distribution, communication systems, and the speed of emergency responses. Statistical methods such as Pearson's correlation, multivariate regression analysis and chi-square tests were utilized to interpret data collected from 172 healthcare institutions. The multivariate regression analysis of EMS organization identified that factors such as the structuring of working hours and shift patterns are significant predictors, contributing to small but meaningful variations in various EMS outcomes. In contrast, other factors, such as financial resources and the availability of ambulance vehicles, showed more targeted significance depending on the specific EMS aspect being analyzed. Institutions with written mass casualty plans and procedures demonstrate superior effectiveness in EMS activities, excelling in resource allocation, operational continuity, and emergency preparedness, particularly through enhanced coordination and specialized systems for managing large-scale emergencies. The findings highlighted notable disparities in how EMRS are organized, with only 46% of institutions having specific emergency departments. Resource limitations were evident, as many facilities operated with minimal staff and outdated equipment. The communication systems revealed weaknesses, with just 54% having established protocols for handling emergency calls. Response times frequently surpassed international standards, which negatively affected patient outcomes. Additionally, the study found training deficiencies, with 68% of participants expressing a need for further education. Serbia’s EMRS are significantly impacted by systemic issues such as insufficient funding, disjointed service delivery, and inadequate training. Overcoming these challenges necessitates a comprehensive approach that includes boosting financial support, implementing standardized protocols, and fostering enhanced collaboration across different sectors.

Background: Amidst escalating climate change concerns, sustainable practices in healthcare logistics are critical. This study evaluates the ecological impact and efficiency of medical sample transportation using drones, combustion cars, and electric cars across diverse terrains and weather in Liechtenstein and Switzerland. Methods: We conducted a comparative analysis of CO2 emissions, transport distances, and delivery times for each transportation modality. Data collection involved multiple runs under various conditions, with CO2 emissions measured using onboard systems, and transport efficiency assessed via GPS tracking and time monitoring. Results: Combustion cars exhibited the highest average CO2 emissions at 159.5 grams per kilometer (g/km). Electric cars emitted significantly less, averaging 3.43 g/km, which is 2.15% of combustion car emissions. Drones were the most environmentally friendly, with an average emission of 0.09 g/km, representing 0.07% of combustion car emissions and 2.6% of electric car emissions. Drones also showed substantial transport efficiency, covering 17% shorter distances on flat terrain and 24% shorter in mountainous areas, with time savings ranging from 13% to 80%. Conclusion: This study highlights the potential of drone technology to revolutionize healthcare logistics by reducing environmental impact and optimizing operational efficiency. Integrating drones can significantly lower the carbon footprint, improve sample integrity, and enhance patient care, promoting a greener, more resilient healthcare system.

The advent of large models, also known as foundation models, has significantly transformed the AI research landscape, with models like Segment Anything (SAM) achieving notable success in diverse image segmentation scenarios. Despite its advancements, SAM encountered limitations in handling some complex low-level segmentation tasks like camouflaged object and medical imaging. In response, in 2023, we introduced SAM-Adapter, which demonstrated improved performance on these challenging tasks. Now, with the release of Segment Anything 2 (SAM2)—a successor with enhanced architecture and a larger training corpus—we reassess these challenges. This paper introduces SAM2-Adapter, the first adapter designed to overcome the persistent limitations observed in SAM2 and achieve new state-of-the-art (SOTA) results in specific downstream tasks including medical image segmentation, camouflaged (concealed) object detection, and shadow detection. SAM2-Adapter builds on the SAM-Adapter's strengths, offering enhanced generalizability and composability for diverse applications. We present extensive experimental results demonstrating SAM2-Adapter's effectiveness. We show the potential and encourage the research community to leverage the SAM2 model with our SAM2-Adapter for achieving superior segmentation outcomes. Code, pre-trained models, and data processing protocols are available at http://tianrun-chen.github.io/SAM-Adaptor/.

3D Printing /Additive manufacturing holds a promising future in healthcare as it aids in visualizing things and making 3D objects which is very important in different areas of medicine. The concept of one size fits all has failed the quality of care delivered by us in healthcare which demands customised needs for patient care to create 3D printed tissues, make personalized prosthetics, implants and physical models of the human body. The materials used for printing models and other healthcare devices for medical education, patient needs, and prototyping are increasing. The application of different materials for use in healthcare is not studied. New materials are also available for the various applications in healthcare industry. This experimental study was conducted to review the nine distinct 3D printing filament materials like PETG, PA, ABS, PLA, HIPS, PMMA, Ceramic, Carbon Fiber, and (PLA + Metal Composite) with the help of a 3D printed physical model of T-12 thoracic vertebrae using all the abovementioned materials. The evaluation of materials was based on diverse mechanical properties, applications across medical fields, performance metrics, costs, accuracy, and quality. The assessment This study also focuses on comparison of mechanical properties such as tensile strength, compressive strength of the abovementioned materials with human bone. The study also reviews the 3D printing process and explores its utilization in biomedical applications. The Insights about the application of various materials holds a promising future for development of newer materials for healthcare industry.

Medical image segmentation is a critical step in various healthcare applications, aiding in diagnosis, treatment planning, and disease monitoring. In this study, we investigate the efficacy of a segmentation approach based on the 2D wavelet transform. Leveraging a dataset comprising 10 diverse medical images, we evaluate the performance of our segmentation method using three key metrics: accuracy, precision, and recall. Our findings demonstrate that the proposed approach enhances segmentation accuracy, offering promising results compared to existing methods. By harnessing the multi-resolution feature extraction capabilities of the 2D wavelet transform, our method achieves improved delineation of medical image structures, paving the way for more accurate and efficient healthcare interventions.

The knowledge of the precise anatomy and dimensions of the pulp chamber in the different teeth allows the odontologist to perform correct diagnosis, as well as treatment planning and moni-toring. The clinical practice has introduced cone-beam computed tomography (CB-CT) as a method to evaluate the morphology and dimensions of the pulp chamber. Nevertheless, micro-computed tomography (micro-CT) is regarded as the gold standard in approaching those topics. Here we have designed an algorithm that takes as input DICOM images from in vivo CB-CT of permanent molars to determine the accuracy CB-CT for evaluation of pulp chamber volume. The values were compared with those from in vivo CB-CT (rough and expert manipulated) and ex vivo micro-CT. The relative errors obtained with the volume calculated by the algorithm vs. the volume measured by micro-CT do not exceed 5.7%; also, no significant differences were found between algorithm volumes vs. manipulated CB-CT volumes while all volumes were different from those obtained with automatic CB-CT software. These data demonstrate that volume algorithm CB-CT based may be a reliable technique for evaluation of the pulp chamber volume in permanent molars and can be useful in the diagnosis of pulp diseases, as well as in the planning and monitoring of their treatments.

Wearable antennas are increasingly vital in modern healthcare, facilitating continuous monitoring and communication for medical purposes. These antennas are integrated into wearable devices, allowing for the transmission and reception of vital health data, such as heart rate, body temperature, and blood pressure, to medical professionals or monitoring systems in real time. This instantaneous data transmission enables timely interventions, thus improving the quality of healthcare services. This review aims to comprehensively synthesize recent research from reputable databases, focusing on the functionality and effectiveness of wearable antennas in medical applications. The primary objectives of each study were categorized, including antenna design and integration, the performance of medical wearable antenna technology, safety considerations in wearable antenna biomedicine, and the use of antennas in clinical applications and their impact. This synthesis provides valuable insights for researchers and practitioners aiming to develop and deploy wearable antennas in medical settings, ultimately enhancing healthcare delivery and patient outcomes.

Exoskeletons designed to assist patients with activities of daily living are becoming increasingly popular, but still are subject to research. In order to gather requirements for the design of such systems, long-term gait observation of the patients over the course of multiple days in an environment of daily living are required. In this paper a wearable all-in-one data acquisition system for collecting and storing biomechanical data in everyday life is proposed. The system is designed to be cost efficient and easy to use, using off-the-shelf components and a cloud server system for centralized data storage. The measurement accuracy of the system was verified, by measuring the angle of the human knee joint at walking speeds between 3 and 12 km/h in reference to an optical motion analysis system. The acquired data was uploaded to a cloud database via a smartphone application. Verification results showed that the proposed toolchain works as desired. The system reached an RMSE from 2.9° to 8°, which is below most of the comparable system. The system provides a powerful, scalable platform for collecting and processing biomechanical data, which can help to automize the generation of an extensive database for human kinematics.

Fractional flow reserve (FFR) is well recognized as a gold standard measure for the estimation of functional coronary stenosis. Technological progressions in image processing have empowered the reconstruction of three-dimensional models of the coronary arteries via both non-invasive imaging modalities, such as Coronary Computed Tomography Angiography (CCTA), and invasive coronary angiography or intravascular imaging. The application of computational fluid dynamics (CFD) techniques to coronary 3D anatomical models allows the virtual evaluation of the hemodynamic significance of a coronary lesion with high diagnostic accuracy in comparison to the invasive FFR using pressure wires. These opportunities providing hemodynamic information based on anatomy have given rise to a new era of functional angiography and coronary imaging. However, further validations are needed to overcome several scientific and computational challenges before these methods are applied in everyday clinical practice. This review aims to present all the data on the studies and methodologies that have been presented for the virtual estimation of FFR, and the diagnostic execution of the virtual tools for the hemodynamic assessment of coronary lesions compared to the invasive FFR.

The emergence of Internet of Things (IoT) devices is revolutionizing healthcare. This dynamic healthcare environment relies on Internet of Healthcare Things (IoHT) and Internet of Medical Things (IoMT) technologies. Economic, social, and technological opportunities from the IoHT are transforming healthcare systems. This article covers the history, present condition, and future prospects of IoHT, as well as its topologies, platforms, services, applications, market trends, and solution types. It examines security issues, requirements, and a threat taxonomy, studying smart healthcare privacy and security. It explores future research and the challenges IoHT-based solutions face. International health rules and regulations based on the IoT and their social and economic effects on long-term development are also examined. Integrating IoMT into healthcare infrastructures enhances scalability, efficiency, reliability, and accuracy. Through communication networks and data-processing algorithms, IoMT creates smart hardware and software platforms that enhance decision-making. IoMT devices' low resources raise privacy and security concerns. Security and privacy issues are organised by healthcare IoMT adoption in this study. We give an extensive attack taxonomy against the IoMT infrastructure, encompassing devices, security mechanisms, and their pros and cons. Furthermore, it describes the privacy and security requirements for any unique security solutions against IoMT's multiple attack vectors. This article explains the complicated difficulties, security concerns, and future research pathways needed to safeguard and ensure the long-term expansion of these game-changing technologies in the healthcare ecosystem.

Many bio-applicable materials, medical devices, and prosthetics combine both polymer and metal components to benefit from their complementary properties. This goal is normally achieved by their mechanical bonding or casting only. Here, we report an alternative easy method for the chemical grafting of a polymer on the surfaces of a metal or metal alloys using alkoxy amine salt as a coupling agent. The surface morphology of the created composites was studied by various microscopy methods, and their surface area and porosity were determined by adsorption/desorption nitrogen isotherms. The surface chemical composition was also examined by various spectroscopy techniques and electrokinetic analysis. Elements distribution on the surface was determined and successful bonding of the metal/alloys on one side with the polymer on the other one was confirmed by alkoxy amine. The composites show significantly increased wettability, reliable chemical stability of the bonding, excellent bacterial anti-adhesive properties and functionality, i.e. the characteristics promising for their application in biomedical field.

Cancer is the second major cause of disease-related dead worldwide, and its accurate early diagnosis and therapeutic intervention are fundamental for saving the patient’s life. Cancer, as a complex and heterogeneous disorder, results from disruption and alteration of a wide variety of biological entities, including genes, proteins, mRNAs, miRNAs, and metabolites that eventually emerge as clinical symptoms. Traditionally, diagnosis is based on clinical examination, blood tests for biomarkers, histopathology of biopsy, and imaging (MRI, CT, PET, US). Additionally, omics biotechnologies help to further characterize the genome, metabolome, microbiome traits of the patient that could have an impact on the prognosis and patient’s response to the therapy. The integration of all these data relies on gathering of several experts and may require considerable time, and, unfortunately, it is not without the risk of error in the interpretation and therefore in the decision. Systems biology algorithms exploit Artificial Intelligence (AI) combined with omics technologies to perform a rapid and accurate analysis and integration of patient’s big data and support the physician in making diagnosis and tailoring the most appropriate therapeutic intervention. However, AI is not free from possible diagnostic and prognostic errors in the interpretation of images or biochemical-clinical data. Here, we first describe the methods used by systems biology for combining AI with omics and then discuss the potential, challenges, limitations, and critical issues in using AI in cancer research.

Background The workload of nurses in the intensive care unit (ICU) can affect the quality of nursing services. Aim This study aimed to determine the relationship between the nursing activity score and missed care in patients hospitalized in the ICU in Zanjan, Iran. Methods This observational and prospective study was conducted from April 3 to September 18 in 2021. In this study, the tools used included a patient and nurses' profile questionnaire, Nursing Activity Score (NAS). Missed care was observed in the 301 patients for whom the NAS was calculated. Analysis of variance (ANOVA) was used to investigate the differences in mean levels of missed care. Logistic regression models were used to assess the association between factors and missed nursing care. Results Results show that the Medical ICU's mean NAS was 76.31 (95% CI: -13.06 -14.89). In 9 dimensions of care, the extent of missed care was 40.7%. In the care dimensions of assessment, hand hygiene, and infection control, the mean NAS had a statistically significant increase at higher levels of missed care (P<.5). Furthermore, work experience was identified as a protective factor for missed care (OR =.59, 95% CI: .37–.94, χ2= =4.97, p =.026). Conclusion The study revealed a high incidence of missed care. The study revealed that the mean workload was high in certain dimensions of care such as assessment, hand hygiene, and infection control. The increase in workload for nurses results in lost care. Nonetheless, the utilization of experienced nurses can help mitigate this problem. However, utilizing experienced nurses can help reduce this problem.

Understanding the genetic architecture of a disease is crucial for development of valid diagnostic and therapeutic interventions. The analysis of genomic variations associated with pathological conditions is the starting point for uncovering disease-causing pathways (candidate processes). However, the complexity of intergenic and genetic-environmental interactions hinders the identification of pathogenic values of genomic changes. Furthermore, heredity, epigenetics and somatic mosaicism make the interpretation of genomic data even more sophisticated. To succeed, a variety of bioinformatic techniques are applied. Here, reviewing own and literature data, knowledge-based prioritization of genomic variations is described. Theoretical basis of the knowledge-based prioritization is given with a special regard to gene ontology, heuristics, hermeneutics (genomic hermeneutics) and analytics. Practical and methodological issues of prioritization using ontology- or pathway-based systems analysis are considered in the light of optimistic and realistic scenarios of cumulative phenotypic effects of the variome (the whole set of genomic variations in an individual or specific set of genomic variations for a phenotypic outcome). In the present communication, copy number variants (CNVs) in children with neurodevelopmental diseases are used as a practical foundation for the prioritization, inasmuch as these genome variations are systematically overlooked in the so-called NGS era. Nonetheless, it is highly likely that the prioritization is applicable to almost all types of genomic variations (e.g. chromosome abnormalities, gene mutations, functional synonymous variants etc.). The present methodology seems to be a valuable addition to current biomedical science widening the opportunities for medical genomics and genetics.

The rapid progress in artificial intelligence, machine learning, and natural language processing has led to the emergence of increasingly sophisticated large language models (LLMs) enabling their use in healthcare. The study assesses the performance of two LLMs: the GPT-3.5 and GPT-4 models in passing the medical examination for access to medical specialist training in Spain MIR. Our objectives included gauging the model's overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. We studied the 2022 Spanish MIR examination after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM ChatGPT4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length and question sequence d performance. GPT-4 outperformed GPT -3.5, scoring 86.81% in Spanish (p<0.001). English translations had a slightly enhanced performance. Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, with specialties like Pharmacology, ICU, and Infectious Diseases showing lower performance. The error analysis revealed that while a 13.2% error rate existed, gravest categories like "error requiring intervention to sustain life" and "error resulting in death" had a 0% rate. Conclusions: GPT-4 performs robustly on the Spanish MIR examination, varying its capability to discriminate knoweldge across specialties. While the model's high success rate is commendable, understanding the error severity is critical, especially when considering AI's potential role in real-world medical practice and its implication on patient safety.

The fast and reliable processing of medical images is of paramount importance to adequately generate data to feed machine learning algorithms that can prevent and diagnose health issues. Here we benchmark different compressed sensing techniques applied to magnetic resonance imaging as a means to reduce the acquisition time spent in the collection of data and signals that form the image. We show that by using these techniques, it is possible to reduce the number of signals needed and, therefore, substantially decrease the time to acquire the measurements. To this end, we have considered and compared different algorithms: the Iterative Re-Weighted Least Squares, the Iterative Soft Thresholding Algorithm, the Iterative Hard Thresholding Algorithm, the Primal Dual Algorithm and the Log-Barrier Algorithm. We have implemented such algorithms in different analysis programs that have been used to perform the reconstruction of the images and found that the Iterative Soft Thresholding Algorithm gives the optimal results. We found that the images obtained with this algorithm have less quality than the original ones, but the quality is good enough to distinguish each body structure and detect any health problems.

: Medical gloves, along with masks and gowns, serve as the initial line of defense against poten-tially infectious microorganisms and hazardous substances in the health sector. During the COVID-19 pandemic, medical gloves played a significant role, as they were widely utilized by society in daily activities as a preventive measure. These products demonstrated their value as important personal protection equipment (PPE) and reaffirmed their relevance as infec-tion-prevention tools. This review describes the evolution of medical gloves since the discovery of vulcanization by Charles Goodyear in 1839, which fostered the development of this industry. Regarding the current market, a comparison of the main properties, benefits, and drawbacks of the most widespread types of sanitary gloves is presented. The most usual gloves are produced from natural rubber (NR), polyisoprene (IR), acrylonitrile butadiene rubber (NBR), polychloroprene (CR), polyethylene (PE), and poly(vinyl chloride) (PVC). Furthermore, the environmental impacts of the conventional natural rubber gloves manufacturing process and mitigation strate-gies, such as bioremediation and rubber recycling, are addressed. In order to create new smart medical gloves with improved properties, several biopolymers (e.g. poly(vinyl alcohol) and starch) and additives such as biodegradable fillers (e.g., cellulose and chitin), reinforcing fillers (e.g. silica and cellulose nanocrystals), and antimicrobial agents (e.g., biguanides and quaternary ammonium salts) have been evaluated. This paper covers these smart materials and describes different innovative prototypes of gloves and coatings designed with them.

Background: Sensor usage in the classical scientific process has allowed new experimentation in medicine. We report on the design process of a MEMS sensor being used for muscle trauma evaluation in diagnosing acute compartment syndrome (ACS), a medical ailment costing society billions of dollars per year. Objectives: Modeling the disease with scientific process allows a more complete under-standing of the disease. The goal was to formulate a hypothesis that could be tested to aid in making the diagnosis of ACS accurately. Methods: Scientific process was observed throughout the disease modelling process. Background information was improved and clarified, new pre-clinical models were de-signed and verified, a hypothesis built on pressure measurement with MEMS sensors was carried out, and the testing of the model as verified against previous clinical data was accomplished. Results: Scientific process resulted in hypothesis generation around the relationship of intracompartmental pressure measurement and the disease process and therapy. This resulted in new understanding of ACS, accurate modelling, and sensor design resulting in a MEMS device that has an extremely high sensitivity and specificity (over 99%) in treating and diagnosing the disease. Conclusion: MEMS sensor technology defines the new gold standard of implanting a sensor in a muscle compartment that allows accurate diagnosis of ACS with continuous trends in pressure.

The COVID-19 pandemic measures have negatively impacted education worldwide via travel restrictions, student visas, and physical attendanc,e among many other fac-tors. As one of the first places to impose strict pandemic measures and one of the last places to lift the measures, Mainland China provided a unique venue to investigate the effect of public health pandemic control policies on tertiary education. Considering the large portion of international students in medical schools and the higher susceptibility to the pandemic measures due to the natural synergy with teaching hospitals, medical schools can be an early forefront indicator of the impact of the pandemic on tertiary education. We surveyed 513 participants international medical students from Wen-zhou Medical University’s school of international studies in 2019 and 2022 about their satisfaction and demographic and cultural adaptation parameters. We found that the pandemic restrictions did not generally impact student satisfaction. Further analyzing the associated parameters, we found teaching satisfaction to be independent of age (P=.159), years in China (P=.896) and Chinese Level (P=.577) in the medical university. Teaching satisfaction is associated with the region of origin (P <0.001), acceptance of local social norms (P <0.001), satisfaction with the core values of Chinese culture (P <0.001), acclimatization to life in China (P <0.001), can easily make Chinese friends (P <0.001) among other factors. The findings of this study provide an understanding of the effects of pandemic measures on tertiary education satisfaction and other factors that can aid in international student satisfaction.

Despite the fact that COVID-19 is no longer a global pandemic due to development and integration of different technologies for the diagnosis and treatment of the disease. Technological advancement in the field of molecular biology, electronics, computer science, artificial intelligence, Internet of Things, nanotechnology etc. has led to the development of molecular approaches and computer aided diagnosis for the detection of COVID-19. This study provides a holistic approach on COVID-19 detection based on (1) molecular diagnosis which include RT-PCR, antigen-antibody and CRISPR-based biosensors and (2) computer aided detection based on AI-driven models which include Deep Learning and Transfer learning approach. The review also provide comparison between these 2 emerging technologies and open research issues for the development of smart-IoMT-enable platform for the detection of COVID-19.

Patients living with cancer often experience serious adverse events due to their condition or its treatments. Those events may lead to a critical care unit admission or even result in death. One of the most important but challenging part of care is to build a caring plan according to the patient’s wishes, meeting his goals and values. Advance directives (ADs) allow everyone to give their preferences in advance regarding life sustaining treatments, continuation, and withdrawal or withholding of treatments in case one is not able to speak his mind anymore. While the absence of ADs is associated with a greater probability of receiving unwanted intensive care around the end of his life, their existence correlates with the respect of the patient’s desires and his greater satisfaction. Although progress has been made to promote ADs’ completion, they are still scarcely used among cancer patients in many countries. Several limitations to their acceptation and use can be detected. Efforts should be made to provide tailored solutions for the identified hindrances. This narrative review aims to depict the situation of ADs in the oncology context, and to highlight the future areas of improvement.