Background: Tele-emergency physicians (TEPs) take an increasingly important role in the need-oriented provision of emergency patient care. To improve emergency medicine in rural areas, we set up the project Land|Rettung (English: Rural|Rescue), which uses TEPs to restructure professional rescue services using information and communication technologies (ICTs) in order to reduce the therapy-free interval. Successful implementation of ICTs relies on user acceptance and knowledge sharing behavior. Methods and findings: We conducted a factorial design with active knowledge transfer and technology acceptance as a function of work satisfaction (high vs. low), workload (high vs. low) and point in time (prior to vs. after digitalization). Data were collected via machine readable questionnaires issued to 755 persons (411 pre, 344 post), of which 304 or 40.3% of these persons responded (194 pre, 115 post).Technology acceptance was higher after the implementation of TEP for nurses but not for other professional groups, and it was higher when the workload was high. Regarding active communication and knowledge sharing, employees with low work satisfaction are more likely to share their digital knowledge as compared to employees with high work satisfaction. Additional and more detailed analyses reveal that this is an effect of previous knowledge concerning digitalization. After implementing the new technology, work satisfaction increased for the more experienced employees, but not for the less experienced ones. Results are discussed considering the Dunning-Kruger effect. The Dunning-Kruger effect describes a cognitive bias. People with high expertise often underestimate their actual skill level. They have a more critical attitude towards their performance and feel the urgent need to fill possible knowledge gaps they notice. Conclusions: Our research illustrates that employees’ workload has an impact on the intention of using digital applications. The higher the workload, the more people are willing to use TEPs. Regarding active knowledge sharing, we see that employees with low work satisfaction are more likely to share their digital knowledge compared to employees with high work satisfaction. This might be attributed to the Dunning-Kruger effect. Highly knowledgeable employees initially feel uncertain about the change, which translates into temporarily lower work satisfaction. They feel the urge to fill even small knowledge gaps, which in return leads to higher work satisfaction. Those responsible need to acknowledge that digital change affects their employees’ workflow and work satisfaction. During such times, employees need time and support to gather information and knowledge in order to cope with digitally changed tasks.

Chronic kidney disease (CKD) is a progressive condition that affects more than 10% of the world's population. Monitoring urine albumin and creatinine ratio (µACR) has become the gold standard for nephropathy diagnosis and control. The objective of the present study was to develop a simple, accurate, sensitive, and rapid point-of-care test (PoCT) device - MYμALBUMIN that community healthcare professionals can use in resource-limited facilities and by patients in their own homes for screening the risk and monitoring the progress of CKD. Albumin and creatinine concentrations in urine samples were determined using spectrophotometric dye (tetrabromophenol blue)-binding and colorimetric Jaffe’assay, respectively. Urine samples were diluted with distilled water (1:80) and mixed separately with albumin and creatinine reaction mixture. The creatinine reaction was incubated at room temperature (25oC) for 30 minutes before analysis. Optical density (OD) was measured at the wavelengths of 625 nm (albumin) and 515 nm (creatinine). All calibration curves (2-60 mg/L and 0.25-2 mg/dL for albumin and creatinine) yielded linear relationships with correlation coefficients (r2) of > 0.999. Good accuracy (%DMV < + 2.88%) and precision (%CV < 3.0%) were observed from both the intra- or interday assays for the determination of albumin and creatinine by MYµALBUMIN. The limit of quantification (LOQ) of albumin and creatinine in urine samples determined by MYµALBUMIN and laboratory spectrophotometer were 2 mg/L and 0.1 mg/dL, respectively, using 37.5 μL urine samples. The device was well applied with clinical samples from 13 CKD patients. The median (range) of %DMV of the central (hospital) laboratory method (immune-based assay) was 3.18 (-10.11 to 14.12)%, with a high correlation coefficient (r2 >0.99). In conclusion, MYμALBUMIN showed satisfactory test performance in terms of accuracy, reproducibility, sensitivity, and specificity. The device would have significant economic benefits besides obviously improving clinical decision-making processes.

Keywords: Energy harvesting, Hybrid, Medical Wearable Sensor Nodes, Health Monitoring, Power Management

Paramedics are increasingly being subjected to violence, creating the potential for significant physical and psychological harm. Where a patient has a history of violent behavior, hazard flags - applied either to the individual, their residential address, or phone number - can alert paramedics to the possibility of violence, potentially reducing the risk of injury. Leveraging a novel violence reporting process embedded in the electronic patient care record, we reviewed violence reports filed over a thirteen-month period since its inception in February 2021to assess the effectiveness of hazard flagging as a potential risk mitigation strategy. Upon reviewing a report, paramedic-supervisors can generate a hazard flag if recurrent violent behavior from the patient is anticipated. In all, 502 violence reports were filed, for which paramedic-supervisors generated hazard flags in 20% of cases (n=99). In general, cases were not flagged either because the incident occurred at a location not amenable to flagging, or because the supervisors felt that a hazard flag was not warranted based on the details in the report. Hazard flagging was associated with an increased risk of violence during subsequent paramedic attendance (Odds Ratio [OR] 6.21, p

This review summarizes available data on invasive procedures applied with questionable indications in Russia in the recent past: mastectomy with the removal of muscles, gastrectomy for peptic ulcers, spleno-renal anastomosis for diabetes mellitus, thoracic surgery for bronchial asthma, overuse of surgery in tuberculosis, excessive and compulsory treatments of alcohol-dependent patients, etc. Among factors contributing to the use of invasive procedures with unproven efficiency have been the partial isolation from international scientific community, insufficient consideration of the principles of professional autonomy, informed consent and scientific polemics, training of medical personnel. It is known that invasive procedures can exert a placebo effect, which might have contributed to reported efficiency of some methods discussed here. However, by definition, placebo must be free of risks.

We review the literature on medical discourse and attempt to build a computational model of it. Medical discourse sheds a light on communication structure of patient-doctor and other communication scenarios in healthcare and should be leveraged to facilitate and automate this communication when it is possible and practical. We propose a unified framework to represent communication discourse at the meta-level, where the subject of the communication is expressed in a language object. So far, the broad range of work on medical discourse is detached from computational discourse analysis, and we explore the possibilities of filling this gap and computationally treat the peculiarities of how information is passed between the agents in a hospital setting. We select the domain of question answering (QA) against a corpus of medical documents of diverse nature to evaluate our computational model of medical discourse. It turns out that applying specific structures obtained in medical discourse studies improves the relevance and efficiency of question answering.

Culture signifies the customs, language, ceremonies, Indigenous Medical Knowledge (IMK) and other material objects of a tribe. These and many other features are a representation of identity for many Zambian communities. IMK practices are skills inherent by certain individuals in a tribal grouping who are chosen by the spirits (gods) or trained by those who practice. This intrinsic skill is in danger of diminishing as a result of modern medication. This article attempts to understand the role of traditional healers (also known as asing’anga in local language) in preservation of IMK in Chibombo District of Zambia. In so doing, the paper examined methods of preservation used by asing’anga and the challenges faced. Using hermeneutic phenomenology and linear snowball sampling, findings revealed that preservation was done through training. The study found unwillingness, expiration, and spirituality as challenges in the process of preserving IMK. The study recommended that the Lenje Cultural Association consider documenting and disseminating information to the local people by showcasing what is available in the Mukuni Culture Village Museum and Library. This was seen as a way through which many youths would be encouraged to appreciate the indigenous values in their culture.

Malaria is one of the life-threatening disease caused by the Anopheles mosquitoes affecting the human red blood cells. It is the global health concern which is quite common in tropical as well as sub-tropical parts of the World. Therefore, it is an important to have an effective computer aided system in place for early detection and treatment. State of the art machine learning techniques are used to detect the infected malaria cells from the pool of images. As the visual heterogeneity of the malaria dataset is highly complex and dynamic, therefore higher number of images are needed to train the machine learning models effectively. However, hospitals as well as medical institutions do not share the medical image data for collaboration due to general data protection regulation (GDPR) and data protection act (DPA). To overcome this collaborative challenge, our research is inspired to use the real-time medical image data while using the framework of federated learning (FL) framework that will ensure the data privacy while mutual collaboration of hospitals and medical institutes. We have used the state of the art machine learning models that include the Resnet50 and densenet in a federated learning framework. We have experimented both models in different settings and our preliminary results showed that the densenet model performed better in accuracy (75%) in contrast to resnet50 (72%) while considering 8 clients, while the trend is observed common in 4 clients with the similar accuracy of 94% and 6 client showed that the densenet model performed quite well with the accuracy of 92% while resnet50 achieving only 72%.

Cell therapy has used mesenchymal stem cells (MSCs) which in cell culture are multipotent progenitors, capable of producing a variety of cells limited to the mesoderm layer. There are two types of MSCs sources: 1) adult MSCs, which are obtained from the bone marrow, adipose tissue, peripheral blood, and dental pulp; and 2) neonatal tissue-derived MSCs, obtained from extra-embryonic tissues such as the placenta, amnion, and umbilical cord. Until April 2023, there are 1,120 registered clinical trials using MSCs therapies worldwide, but there are only 12 MSCs therapies that have been approved by regulatory agencies for commercialization. Nine of the twelve approved MSCs products are from Asia, with South Korea being the country with the most approved therapies. In the future, MSCs will play an important role in the treatment of many diseases. However, there are many issues to deal with before their application and usage in medical practice. Some strategies have been proposed to face these problems with the hope of reaching the objective of applying these MSCs therapies at optimal therapeutic levels.

No-show appointments in healthcare is a problem faced by medical centers around the world, and understand the factors associated with the no-show behavior is essential. In the last decades, artificial intelligence took place in the medical field and machine learning algorithms can work as a efficient tool to understand the patients behavior and to achieve better medical appointment allocation in scheduling systems. In this work, we provide a systematic literature review (SLR) of machine learning techniques applied to no-show appointments aiming at establishing the current state-of-the-art. Based on a SLR following the Kitchenham methodology, 24 articles were found and analyzed, in which the characteristics of the database, algorithms and performance metrics of each studies were synthesized. Results regarding which factors have a higher impact on missed appointment rates were analyzed too. The results indicate that the most appropriate algorithms for building the models are decision tree algorithms. Furthermore, the most significant determinants of no-show were related to the patients age, whether the patient missed a previous appointment, and the distance between the appointment and the patients scheduling.

This study assesses the efficacy of a microwave colonoscopy algorithm to detect colorectal cancer precursors or polyps in an ex-vivo human colon model. The algorithm works with a device composed of a cylindrical ring-shaped switchable antenna array, which can be attached to the tip of a conventional colonoscope as an accessory. The accessory is connected to an external processing unit that generates an acoustic signal when a polyp is detected. Nowadays, 22% of polyps go undetected with conventional colonoscopy and the risk of cancer after a negative colonoscopy can be up to 7.9%. Fifteen ex-vivo freshly excised human colons with cancer (n=12) or polyps (n=3) were examined with the microwave-assisted colonoscopy system simulating a real colonoscopy exploration. Successive measurements of the colon were taken with the microwave-based colonoscopy device and processed with a microwave imaging algorithm. After the experiment, the dielectric properties of the specimens were measured with a coaxial probe and finally the samples underwent a pathology analysis. The results show that all the neoplasms were detected with a sensitivity of 100% and specificity of 87.4%.

Raman Spectroscopy has long been anticipated to augment clinical decision making, such as classifying oncological samples. Unfortunately, the complexity of Raman data has thus far inhibited its routine use in clinical settings. Traditional machine learning models have been used to help exploit this information, but recent advances in deep learning have the potential to improve the field. However, there are a number of potential pitfalls with both traditional and deep learning models. We conduct a literature review to ascertain the recent machine learning methods used to classify cancers using Raman spectral data. We find that while deep learning models are popular, and ostensibly outperform traditional learning models, there are many methodological considerations which may be leading to an over-estimation of performance: primarily, small sample sizes which compound upon sub-optimal choices regarding sampling and validation strategies. Amongst several recommendations is a call to collate large benchmark Raman datasets, similar to those that have helped transform digital pathology, which researchers can use to develop and refine deep learning models.

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.

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.

Currently, Pythagorean fuzzy sets (PFSs) have been widely applied in various fields due to their substantial advantages in expressing and dealing with uncertainty. However, measuring the similarity and difference between PFSs effectively remains an unresolved issue. Inspired by Tanimoto similarity, we propose a novel set of similarity and distance measures for PFSs. We delve into the theoretical properties of the proposed measures and compare it with existing PFSs measures. Numerous numerical examples validate their rationality and effectiveness. Furthermore, our experimental findings suggest that in contrast to existing measures, the introduced measures successfully circumvent various counter-intuitive issues encountered by current measures, and yield more pronounced outcomes in the discrimination of different fuzzy sets. This enhances the uniqueness and superiority of our measures. Finally, we developed two decision models based on the proposed measures and validated their applicability in three applications.

Motorcycles can be considered a new form of smart vehicle when taking into account their small and modern structure and due to the fact that nowadays they are used in the new role of ambu-lance to rapidly reach emergency patients in large cities with traffic congestion. However, there is no study regarding the measuring of access time for motorcycle ambulances in large cities of Thailand. Therefore, this study aims to compare access times to patients between motorcycle ambulances and conventional ambulances, including analysis of the use of AED installed on motorcycle ambulances to contribute to the sustainable development of public health policies. In two hundred and seventy-one operations, it was found that the times from dispatch to vehicle (ambulance and motorlance) being en route and times from the 1669 center (center for com-mand-and-control EMS in Thailand) call receipt to arrival on scene (response time) of motorcycle ambulances was shorter than that of a conventional ambulance and the use of AED on a motor-cycle ambulance can increase the chances of survival for patients with cardiac arrest outside the hospital in public places where AEDs are not available and in all cases where access to an AED was less than eight minutes.

Background: During the COVID-19 pandemic, hygiene behaviors such as keeping distance, avoid-ing masses, wearing face masks and adhering to hand hygiene recommendations became impera-tive. The current study aims to determine factors interrelating with hygiene behaviors. Methods: 4,049 individuals (1,305 male, 2,709 female, aged 18-80 years) were recruited from rehabilitation clinics or freely on the internet and surveyed via online questionnaire between May 2020 and August 2021. Socio-demographics, hygiene behaviors, emotions (fear), life-satisfaction, risk factors and disability as well as communication were assessed. Results: Prevalence for hygiene behaviors was: keeping the distance 84.9%, avoiding mass gatherings 84.6%, wearing face masks 96.5% and hand hygiene 80.7%. Hygiene behaviors were significantly related to fear with linear and quad-ratic associations. Conclusion: Individuals with disabilities, risk factors and psychological symp-toms are more compliant. Especially hand hygiene should be targeted to achieve higher compli-ance rates. A medium level of fear is more functional than too elevated fear. Behavioral interven-tions and targeted communication aiming at improving different behaviors in orchestration can help individuals to remain healthy and maintain a high life-satisfaction. Thereby, communication in the healthcare setting is imperative and all involved individuals should become more aware of this to ensure high hygiene standards and patient safety.

The United States is plagued with the highest rates of preventable metabolic diseases it has ever seen, and while poor nutrition is increasingly recognized as a critical contributing factor, good nutrition has been shown to be a potent factor in prevention and management of these illnesses. Notably, nutrition is inextricably intertwined with farming practices and the stewardship of our environment – particularly its soil. In this proposal, we propose a method to expose medical students to basic agricultural and environmental knowledge regarding the production of food, as well as educate them in practical nutrition education within the interactive, case-based, and longitudinal preclinical curriculum at Case Western Reserve University School of Medicine (CWRU SOM). We propose a two-part approach; first: integrating relevant topics in nutrition, culinary medicine, and farming practices into the preclinical blocks through Official Learning Objectives, and second: an optional 8-week, zero credit elective for students interested in pursuing a deeper understanding of these topics. Through these interventions, we believe courses like this will support a generation of physicians able to understand health from soil to plate with a consideration for the environment in addition to exemplifying healthful lifestyles themselves. We believe these kinds of future physicians will be the most effective in treating (and ideally reversing) the chronic disease epidemic.

This paper presents novel feature descriptors and classification algorithms for automated scoring of HER2 in Whole Slide Images (WSI) of breast cancer histology slides. Since a large amount of processing is involved in analyzing WSI images, the primary design goal has been to keep the computational complexity to the minimum possible level and to use simple, yet robust feature descriptors that can provide accurate classification of the slides. We propose two types of feature descriptors that encode important information about staining patterns and the percentage of staining present in ImmunoHistoChemistry (IHC) stained slides. The first descriptor is called a characteristic curve which is a smooth non-increasing curve that represents the variation of percentage of staining with saturation levels. The second new descriptor introduced in this paper is an LBP feature curve which is also a non-increasing smooth curve that represents the local texture of the staining patterns. Both descriptors show excellent interclass variance and intraclass correlation, and are suitable for the design of automatic HER2 classification algorithms. This paper gives the detailed theoretical aspects of the feature descriptors and also provides experimental results and comparative analysis.

This is the second of a series of two papers comparing the end of life issues in human and veterinary medicine. We outline the main differences between human and animal patients such as patient communication, finance and ‘conflicts of interest’ between animal, owner and veterinarian. We discuss striking similarities between human and veterinary issues such as assessing quality of life and the primary role of the attending veterinarian or doctor being the welfare and care of the patient. This paper takes the form of an ethical argument in favour of allowing euthanasia in human medicine, by providing insights into end of life issues for humans from an independent veterinary perspective. Veterinary surgeons are well trained in the ethics of euthanasia and put it to good use in the best interest of their animal patients. Doctors in the UK are limited and unwilling to put forward a case for the option of euthanasia for those patients who face a slow and agonizing death. With advances in medical science being able to significantly prolong the dying process, autonomy for the patient demands a review of the law regarding patient choice in the UK.

The ankle is a complex joint with a high injury incidence. Rehabilitation Robotics applied to the ankle is a very active research field. We present cable-driven reconfigurable robot kinematics and statics. We studied how the tendons pull mid-foot bones around the talocrural and subtalar axes. Likewise, we propose a hybrid serial-parallel mechanism analogous to the ankle. Then, using screw theory, we synthesized a cable-driven robot with the human ankle in the closed-loop kinematics. We incorporate a draw-wire sensor to measure the axes’ pose and compute the product of exponentials. We reconfigure the cables to balance the tension and pressure forces using the axis projection on the base and platform planes. Likewise, we also computed the workspace to show that the reconfigurable design fits several sizes. The data used is from anthropometry and statistics. Finally, we validated the robot’s statics with MuJoCo for various cable length groups corresponding to the axes’ range of motion. We suggested a platform adjusting system and an alignment method. The design is lightweight, and the cable-driven robot has advantages over rigid parallel robots, such as Stewart platforms. We will use compliant actuators.

Peritoneal fluid is an ovarian exudate from the growing follicle or corpus luteum. Therefore, the free concentrations of estrogens and progesterone are always much higher than in plasma, especially after ovulation. The peritoneum is not vascularised, and peritoneal implants and the superficial portion of deep endometriosis are likely influenced mainly by peritoneal fluid. Follicular phase progesterone concentrations are as high as during the luteal phase in plasma. This explains that most peritoneal implants are rarely proliferative and out of phase with the endometrium. From some 5 mm of depth onwards, endometriosis is rather influenced by plasma hormone concentra-tions, and the deeper parts can be proliferative as the endometrium. Because of these progesterone concentrations, progesterone resistance has to be postulated, permitting endometriosis lesions to initiate and develop. This opens the discussion of whether endometriosis is similar to the basal endometrium. These peritoneal fluid concentrations are important to understand the natural history and medical therapy of endometriosis. Most medical therapies decrease ovarian function and affect peritoneal fluid steroid hormone concentrations. It is suggested that the efficacy of medical therapy for endometriosis-associated pain is a consequence of the decreased estrogen concentrations in the peritoneal cavity and that the local effect of progestins may not be determinant for pain relief. If this is true, a history of endometriosis should not be considered a contraindication for hormone re-placement therapy.

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.

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.

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 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.

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 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 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 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.

This study examines the psychological repercussions of the COVID-19 pandemic on a medical team in an Israeli general hospital. The research explores the professional quality of life, burnout symptoms, secondary traumatic stress, and mindfulness among team members across three distinct phases of the pandemic. Analysis was conducted for different subgroups based on job roles and seniority, allowing for an evaluation of the phase-specific effects on the ProQOL (Professional Quality of Life) and mindfulness. Results align with established crisis trajectories, encompassing honeymoon/heroic phases, inventory, disillusionment, and recovery. The findings demonstrate a negative correlation between compassion satisfaction and burnout, as well as between mindfulness and burnout/secondary traumatic stress. Remarkably, male doctors exhibit a more pronounced negative impact on mindfulness compared to their female counterparts, primarily comprising healthcare workers. Temporal analysis reveals significant differences in compassion satisfaction and mindfulness, with baseline measurements being notably higher. Furthermore, the study sheds light on the vulnerability of male doctors, emphasizing the crucial role of hospital management in conveying the message and implementing effective measures to support professional quality of life. These findings underscore the necessity of prioritizing the well-being of medical professionals, particularly male doctors who face unique challenges in seeking assistance.

Objective: To use the ancient and modern medical record cloud platform (V2.3.5) to organize and explore the medication patterns of the "Three Causes, Extremity, and One Disease Syndrome Formula" by Chen Wuxuan, and to summarize its therapeutic ideas. Method: Collect and organize the "San Yin Si Tian Fang" in the "San Yin Ji Yi Zheng Fang Lun", and use the modern medical record cloud platform (V2.3.5) to conduct medication frequency statistical analysis, cluster analysis, and complex network analysis. As a result, a total of 16 Chinese herbal medicines were collected in the "Three Causes, Extreme and One Disease Syndrome Formula", involving 75 traditional Chinese medicines. Statistical analysis showed that roasted licorice was the most commonly used, followed by Pinellia ternata, papaya, ginger, and Poria cocos; Medications mainly include warm drugs, sweet and pungent flavors, as well as drugs that promote lung and spleen meridians. Cluster analysis can divide the above-mentioned traditional Chinese medicine into two groups, with specific grouping as follows. Group 1: ginger, white peony, aconite, papaya, and achyranthes bidentata; Group 2: roasted licorice, poria cocos, dried ginger, pinellia ternata, and green peel. Conclusion: The characteristics of the 16 prescriptions are biased towards Xin Gan Wen, emphasizing the regulation of the spleen and stomach, which may be related to the common use of prescription by doctors in the Song Dynasty and the tendency towards warm and dry medication.

Access to nasopharyngeal swabs for sampling remain a bottleneck in some regions for COVID-19 testing. This study develops a distributed manufacturing solution using only an open source manufacturing tool chain consisting of two types of open source 3-D printing and batch UV curing, and provides a parametric fully free design of a nasopharyngeal swab. The swab was designed using parametric OpenSCAD in two components (a head with engineered break point and various handles), which has several advantages: i) minimizing print time on relatively slow SLA printers, ii) enabling the use of smaller print volume open source SLA printers, iii) reducing the amount of relatively expensive UV resin, and iv) enabling production of handle on more accessible material extrusion 3-D printers. A modular open source UV LED box was designed, fabricated for $45 and tested for batch curing. Swabs can be fabricated for $0.06-$0.12/swab. The results of the mechanical validation tests showed that the swabs could withstand greater forces than would be expected in normal clinical use. The swabs were also able to absorb a significant amounts of synthetic mucus materials and passed abrasion and handling tests. The results show the open source swab are promising candidates for clinical trials.

Background: Open AI developed ChatGPT, a language model based on the GPT architecture, designed for text-based communication. Trained on diverse internet texts, ChatGPT generates contextually appropriate responses using machine learning. It understands input through analysis and context interpretation, generating coherent and contextually relevant responses. Interaction is possible through messaging platforms. Materials and Methods: In November 2023, we utilized ChatGPT 3.5, the default version at that time, to answer questions from the Italian National Residency Program Admission Tests (SSMs) of 2021, 2022, and 2023. The questions cover clinical, diagnostic, analytical, therapeutic, and epidemiological scenarios, sometimes accompanied by images. The study compared ChatGPT's answers to the official corrections on the Italian Ministry of University and Research (MUR) website. The scoring method used for evaluation was 1 point for correct answers, 0 points for unanswered questions, and -0.25 points for incorrect answers, reflecting the SSM test scoring system. Results: In summary, ChatGPT was tested with a total of 420 questions, 140 for each test. It achieved an overall accuracy of 80.48%, providing correct answers for 338 questions and incorrect answers for 82 questions. When faced with questions containing both text and images, it answered 55% correctly and 45% incorrectly. The model's performance varied over time, with an 82.14% accuracy rate in 2021 and 2022 (115 correct out of 140) and a 77.14% accuracy rate in 2023 (108 correct out of 140). Applying thisscoring method to the SSM test, ChatGPT would have scored 105 points in 2021 and 2022, and 100 points in 2023. Conclusions: ChatGPT has exhibited above-average performance in the last three SSM tests, highlighting its robust capability to interpret clinical scenarios and offer precise diagnostic and therapeutic guidance. Despite this, some limitations persist, notably the software's inability to interpret non-textual information.

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.

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.

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.

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.

Medical Self-service Terminals (MST) offer potential for process optimization and enhanced patient convenience in hospitals, including the elderly. However, the behavioral inclination (BI) of elderly Chinese individuals towards MST adoption remains suboptimal. This study aims to elucidate BI determinants for MST among the aging demographic, focusing on User Interface (UI) attributes within the extended Unified Technology Acceptance and Use Theory (UTAUT) Model. The empirical inquiry examines seven factors, comprising three key UI attributes and four fundamental UTAUT factors. Results reveal significant positive associations of Performance Expectancy (β=0.40, p<0.001), Effort Expectancy (β=0.50, p<0.001), and Social Influence (β=0.25, p<0.05) with BI. Notably, User Interface Design positively correlates with Performance Expectancy (β=0.89, p<0.001) and Effort Expectancy (β=0.81, p<0.001). These findings emphasize the interplay between objective UI attributes and subjective UTAUT determinants. This research enhances understanding of UI's impact on MST BI and acceptance, particularly within the Chinese elderly population, urging MST researchers to prioritize elderly attitudes for effective technological integration in healthcare.

Patient safety is a top priority for all healthcare systems globally. Promoting the adoption of policies for reporting and learning from errors is an important strategy for improving care safety. Therefore, the aim of our study was to detect how much patient safety culture influences the reporting of adverse events and the use of the incident reporting tool. The study protocol was developed according to PRISMA guidelines. Articles were searched electronically in PubMed/MEDLINE, the COCHRANE library, and Google Scholar by two independent reviewers, and those that met the eligibility criteria were included. Synthesis of qualitative data from included studies was performed by graphical descriptive statistical analysis. The results of the systematic review showed that health care organizations' increasing focus on staff development of a safety culture has led to a significant increase in incident reporting rates over the years. Moreover, in situations where safety culture is placed at the top of the nations, there is a higher frequency of incident reporting. An efficient incident reporting system should be an essential foundation for healthcare organizations, as it allows them to collect experiences and data and provide feedback to healthcare providers and staff involved in care.

Fall prediction using machine learning has become one of the most fruitful and socially relevant applications of computer vision in gerontological research. Since its inception in the early 2000s, this subfield has proliferated into a robust body of research underpinned by various machine learning algorithms (including neural networks, support vector machines, and decision trees) as well as statistical modeling approaches (Markov chains, Gaussian mixture models, and hidden Markov models). Furthermore, some advancements have been translated into commercial and clinical practice, with companies in various stages of development capitalizing on the aging population to develop new commercially available products. Yet despite the marvel of modern machine learning-enabled fall prediction, little research has been conducted to shed light on the security and privacy concerns that such systems pose for older adults. The present study employs an interdisciplinary lens in examining privacy issues associated with machine learning fall prediction and exploring the implications of these models in elderly care and the Internet of Medical Things (IoMT). Ultimately, a justice-informed set of best practices rooted in social geroscience is suggested to help fall prediction researchers and companies continue to advance the field while preserving elderly privacy and autonomy.

In this article we present a SCILAB implementation of algebraic iterative reconstruction methods for discretisation of inverse problems in imaging. These so-called row action methods rely on semi-convergence for achieving the necessary regularisation of the problem. We implement this method using SCILAB and provide a few simplified test problems: medical tomography, seismic tomography and walnut tomography.Numerical results show the capability of this method for the original and perturbed right-hand side vector.

This study evaluates the accessibility of primary care physicians (PCPs) in Eastern Quebec using an enhanced two-step floating catchment area (E2SFCA) methodology. The E2SFCA methodology considers both the population supply of PCPs and the travel time between PCPs and dissemination areas, and was found to be effective in identifying possibly underserved areas. The availability of primary care services is contingent upon the presence of adequate road infrastructure, and populations residing in areas with limited access to main road networks may experience compromised access to primary care. The study concludes that the E2SFCA methodology can facilitate the identification of areas experiencing a shortage of PCPs, and this information can be used to inform the development of regional medical workforce programs and support the establishment of rural residency initiatives.

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.

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.

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.

Medical Device Design process carries a high responsibility when defining the characteristics of the object for its correct interaction with users. This study presents a proposal for the improvement of the medical device design processes, in order to increase user acceptance, considering two key factors: the hierarchy of users and the relationship with the patient's health status. The goal of the study seeks to address this research gap and raise design factors with practical suggestions for the design of new medical devices. The results obtained will help medical device designers in the development stage to make more informed decisions about the functions and features required in the final product; As well, in the design process didactics, demonstrating the importance of the correct execution of the process, and how the factors considered can generate an impact on the final product. An experiment was carried out with Forty design engineering students, who designed birthing beds, with two design processes, the traditional product design process, and the new design process based on hierarchies (proposed in this study). The results showed that there is a significant increase in user acceptance with the new birthing bed that was developed with the hierarchical based design process.

Background: ED overcrowding is described as one of the main issues in emergency departments (EDs) of any hospital. In Saudi Arabia, the ministry of health applied new telemedicine technology to serve patients by using the mobile application which include Sehha application and 937 medical call center. The main aim of this study is to determine the role of different telemedicine services in reducing non-urgent visits to EDs in Saudi Arabia. Methods: A cross-section study was conducted during August 2020 - May 2021 among 319 patients were using two telemedicine services in Saudi Arabia, including medical call center, and Sehha smart phone application. The primary endpoint of this study aims to determine the role of different telemedicine services in reducing non-urgent visits to EDs in Saudi Arabia. Results: This study analyzed the data from 319 patients who completed the survey provided by the Saudi Ministry of Health that concerning on information related to their health status, and ED visits. Among patients that had the intention to visit the ED (N=159), 53 of them did not go to EDs after using telemedicine services (p-value < 0.01). Regarding medical call center and Sehha application, 9.6% and 24.4%, respectively of the patients used these telemedicine services had changed their mind concerning visiting ED after taking the medical advice (p-values < 0.01).Conclusion: The implemented telemedicine services in Saudi Arabia, namely Sehha application and medical call center showed to be effective in reducing ED overload by providing medical advices to less- and non-urgent patients and deal with their minor medical issues.

At present, the health systems of many countries face complex challenges even if their priority objectives remain the same - to provide sustainable health systems at the current and the prognostic demographic changes and requirements in a health system. The quality and the efficiency of healthcare delivery and their mutual conformity have been brought to public attention. Similarly, the quality and the efficiency of an entire process depends on the instrumentation and its procurement that represents a significant economic and procedural issue in the healthcare systems for a long time. Many reports of the public procurement processes and research studies declare this fact. The primary aim of this study is to evaluate the public procurement efficiency in the health system by means of the valuation approach, or savings’ estimates that are achieved by the public procurement. The savings were defined as a percentage difference between the estimated and the final contract price. The secondary objective is to examine an influence of selected variables on a creation of savings in the public procurement process by means of a regression analysis. The researched variables are as follows: time, method, procurement, NUTS level of procurement, Common Procurement Vocabulary Code, number of offers. The analysis results showed interesting findings. The number of offers has a significantly positive impact on the savings. It means that if the number of offers increases by one unit, the savings will increase by 15.6%. Also, time variable (year) has a positive impact on the savings. Consequently, it may be assumed that the public procurement process is improving from a time perspective. It may be partially caused by the fact that a new public procurement legislative has been valid since 2015. The NUTS level has also an impact on the savings in relation to the public procurement. The public procurements which took place at the level of a state were more beneficial as the public procurements at the regional level. Also, the procurement method was statistically significant parameter of a regression analysis. The competition actions together with a negotiation process created higher savings in comparison to tenders. In case of the CPV codes, the most significant savings were achieved in the group of ‘various medicinal products’. The study’s results provide a valuable knowledge for the creators of policies and a realization of the national strategic plans within the health system. Also, these results support a creation of national and international benchmarks in this area and a networking of international partnerships in the area of a public procurement that focus on a development of methodologies and comparative platforms creation.

Introduction: Due to the spread of SARS CoV-2 virus responsible for COVID-19 disease, there is an urgent need to analyse COVID-19 epidemic perception in Poland. This study aims to investigate social perception of coronavirus in the Internet media during the epidemic. It is a signal report highlighting the main issues in public perception and medical commutation in real time. Methods: We study the perception of COVID-19 epidemic in Polish society using quantitative analysis of its digital footprints on the Internet on platforms: Google, Twitter, YouTube, Wikipedia and electronic media represented by Event Registry, from January 2020 to 29.04.2020 (before and after official introduction to Poland on 04.03.20). We present trend analysis with a support of natural language processing techniques. Results: We identified seven temporal major clusters of interest on the topic COVID-19: 1) Chinese, 2) Italian, 3) Waiting, 4) Mitigations, 5) Social distancing and Lockdown, 6) Anti-crisis shield, 7) Restrictions releasing. There was an exponential increase of interest when the Polish government “declared war against disease” around 11/12.03.20 with a massive mitigation program. Later on, there was a decay in interest with additional phases related to social distancing and an anti-crisis legislation act with local peaks. We have found that declarations of mitigation strategies by the Polish prime minister or the minister of health gathered the highest attention of Internet users. So enacted or in force events do not affect interest to such extent. Traditional news agencies were ahead of social media (mainly Twitter) in dissemination of information. We have observed very weak or even negative correlations between a colloquial searching term 'antiviral mask' in Google, encyclopaedic definition in Wikipedia “SARS-CoV-2” as well official incidence series, implying different mechanisms governing the search for knowledge, panic related behaviour and actual risk of acquiring infection. Conclusions: Traditional and social media do not only reflect reality, but also create it. Risk perception in Poland is unrelated to actual physical risk of acquiring COVID-19. As traditional media are ahead of social media in time, we advise to choose traditional news media for a quick dissemination of information, however for a greater impact, social media should be used. Otherwise public information campaigns might have less impact on society than expected.

Deep behavioral covariates (DBCs) introduced in this perspective form a new class of covariates that have the potential to enhance the performance of predictive models and improve analytics in clinical decision support applications. DBCs can measure how engaged a patient tends to be and how he or she tends to respond to events, and they may be highly predictive of the patient’s outcomes for a planned treatment. DBCs may potentially serve as a standard to measure patient engagement and activation and may form highly efficient mechanisms for improving patient outcomes.

Interdisciplinary research into the underlying neural processes of music therapy (MT) and subjective experiences of patients and therapists are largely lacking. The aim of the current study was to assess the feasibility of newly developed procedures (including EEG/ECG hyperscanning, synchronous audio-video monitoring, and qualitative interviews) to study the personal experiences and neuronal dynamics of moments of interest during MT with stroke survivors. The feasibility of our mobile set-up and procedures as well as their clinical implementation in a rehabilitation centre and an acute hospital ward were tested with four phase C patients. Protocols and interviews were used for the documentation and analysis of the feasibility. Recruiting patients for MT sessions was feasible, although data collection on three consecutive weeks was not always possible due to organisational constraints, especially in the hospital with acute ward routines. Research procedures were successfully implemented, and according to interviews, none of the patients reported any burden, tiredness or increased stress due to the research procedures, which lasted approx. 3 hours (ranging from 135min to 209min) for each patient. Implementing the research procedures in a rehabilitation unit with stroke patients was feasible and only small adaptations were made for further research.

In this work, an analog front-end (AFE) circuit for Electrocardiogram (ECG) detection system has been designed, implemented, and investigated in an industry-standard Cadence simulation framework using advanced technology node of 45 nm. The AFE consists of an instrumentation amplifier, a Butterworth band-pass filter (with fifth-order low-pass and second-order high-pass sections), and a second-order notch filter- all are based on two-stage, Miller-compensated operational transconductance amplifiers (OTA). The OTAs have been designed employing the $g_m/I_D$ methodology. Both the pre-layout and post-layout simulation were carried out. The layout consumes an area of 0.0058 mm$^2$ without the resistors and capacitors. Analysis of various simulation results were carried out for the proposed AFE. The circuit demonstrates a post-layout bandwidth of 239 Hz with a variable gain between 44 to 58 dB, a notch depth of -56.4 dB at 50.1 Hz, a total harmonic distortion (THD) of -59.65 dB (less than 1\%), an input referred noise spectral density of $

Obstructive Sleep Apnea (OSA) is nowadays one of the respiratory pathologies with a higher in-cidence globally in developed countries. This situation led to an increase in the demand for medical appointments and diagnostic studies related to that condition, especially those based on poly-somnographies and cardiorespiratory polygraphies. These studies are limited in resources, causing long waiting lists with the subsequent impact on the patients’ health. Furthermore, it is necessary to mention that OSA’s symptomatology is not very specific, and it is typically present in the general population (excessive sleepiness, snore, etc.). In this regard, this paper proposes a novel intelligent clinical decision support system for the diagnosis of OSA which could be used to help medical teams, both in primary care settings and in units specialized in respiratory pathologies. The aim of the proposed system is to help discriminate the patients suspected of suffering from the pathology from those who are not. To this end, two types of information sets of heterogeneous nature are consid-ered. The first one encompasses objective data, related to the patient's health profile with infor-mation usually available in electronic health records. The second type comprises subjective data, referred to the symptomatology reported by the patient in a previous interview. To process the first group of information, a Machine Learning classification algorithm is used, Bagged Trees in this case. For processing the second information set, related with the symptomatology of the patient, a col-lection of expert systems based on fuzzy inferential systems arranged in cascade are employed. As a result, the system is able to determine two risk indicators related to the patient's risk of suffering from OSA: the Statistical Risk and the Symbolic Risk respectively. Subsequently, by interpreting both risk indicators mentioned it will be possible to determine the severity of the patients’ health, proposing a preliminary evaluation on their condition. For the initial tests of the system, a software artifact has been built using a dataset with 4,978 selected patients, suspected of suffering from OSA, from the Álvaro Cunqueiro Hospital in Vigo. The results obtained are promising, demonstrating the potential usefulness of this type of tools in medical diagnosis. Once the system has been validated with new data from clinical environments, it is considered as possible to obtain a relevant improvement in the quality of the healthcare services, and a reduction in the associated costs.

Background: Handover is a critical process for ensuring quality and safety in healthcare. Considerable research suggests that poor handover results in significant morbidity, mortality, dissatisfaction, and excess financial costs. Despite this, little formal attention, education, and evaluation has been given to handover. There is also paucity of data on the opinions of practitioners on the safety of handover.Objectives: The aim of this study was to measure the perceived risk, degree of patient harm and the systems used to support handover, and to understand how this varied by care setting, type of clinical practice, location, or level of experience. Methods: An open, anonymous and confidential online questionnaire covering: (a) respondent characteristics; (b) peer-to-peer handover; (c) internal referrals; (d) discharges and transfers between organisations; and (e) leading and improving handover was conducted with healthcare practitioners and managers from various settings. Results: We gathered a total of 432 completed responses from 26 countries. The average reported performance of handover was rated as 3.9 out of 5.For each type of handover, 12 - 14% reported errors occurring more than weekly. Of those that knew the outcome of such errors, between 29% and 34% reported that they had witnessed moderate or severe harm. 12% and 17% of respondents believed that handover was high or very high risk (See table 4). These respondents were more likely to have witnessed moderate or severe harm, or to be more senior.A wide combination of handover systems was utilised by respondents. 28% - 32% relied exclusively on EPRs (with or without face-to-face contact). 21% used Office documents such as Word and Excel for peer-to-peer handover, and over 30% used hand-written or manual systems. Conclusions: This study suggests the need to do more — and go further — to improve communication and reduce risk during all types of handovers. Clinical leaders should find ways to train and support handover with effective systems, with less experienced staff being the primary focus. More research is needed to demonstrate the interventions that improve the safety of handover.

Burnout represents a concern for all healthcare providers, particularly those specializing in emergency medical care for whom burnout outcomes have been well-documented. What remains unknown is the effect of burnout on redeployed medical specialists during the COVID-19 pandemic from an appointment-centered practice to emergency care directed by public health considerations. This research aims to identify and assess the burnout responses of fourteen medical specialties noted in searched returns of the four most cited articles published since 2020 about non-emergency physicians regarding their burnout brought on by the unanticipated need for them to provide emergency care during the recent pandemic. The hypothesis is that medical specialists accustomed to planning for emergency possibilities in their appointment-centered practice would demonstrate the least burnout regarding COVID-19-related emergencies. Considering coping as a process based on Lazarus's research, comparing and ranking the COVID-19 emergency responses across the various normally appointment-centered medical specialties in their employed coping strategies determines the outcome. With the hypothesis supported, suggested interventions for future pandemics—when these specialists are, again, redeployed to emergency care directed by public health considerations—are those coping strategies identified as most effective in reducing burnout while maintaining the viability of the medical specialty and excellent patient care.

The German health authorities' guidelines for medical devices in 2012 highlighted the importance of cleaning ultrasound probes, emphasizing their validation and reliability. In addition to automated and validated options, alternative manual methods such as wipe disinfection have gained traction due to their independence from additional hardware. The study examines the effectiveness of manual disinfection methods, specifically the cleaning process, addressing concerns raised by the Robert Koch Institute regarding the lack of validation for wipe disinfection of semi-critical devices. The EQUINOS colored wipe disinfection kit identified wetting gaps in all cleanings across four probes tested. The results indicate significant challenges in ensuring complete surface wetting, particularly in complex body parts such as clip-on areas and shapes for additional biopsy attachments, suggesting that manual methods alone may not adequately mitigate the risk of infection transmission (p value .001). The study concludes that while manual disinfection methods are a viable alternative to automated reprocessing, there is a critical need for enhanced training and potentially the development of more effective manual disinfection techniques or colored wipes to ensure patient safety and compliance with healthcare hygiene standards.

A systematic and comprehensive review of critical applications of Blockchain Technol-ogy with Differential Privacy integration lies within the privacy and security enhancement. This paper aims to highlight the research issues in the e-health domain (e.g., Electronic Medical Rec-ords) and to review the current research directions in Differential Privacy integration with Blockchain Technology.(1) Background: The current state of the art in the e-health domain is identified as follows: (a) healthcare information poses a high level of security and privacy concerns due to its sensitivity; (b) due to vulnerabilities surrounding the healthcare system, a data breach is common and presents a risk for attacks by an adversary; and (c) the current privacy and security apparatus needs further fortification. (2) Methods: The methodology uses a systematic literature review (SLR) to identify and select relevant research papers and academic journals in DP and BT. (3) Results: The results are categorized into: e-Health Record Privacy, Real-Time Health Data, and Health Survey Data Protection to identify inherent issues with Differential Privacy integra-tion with Blockchain and technical challenges.(4) Conclusion: This review thoroughly surveyed and summarized Differential Privacy mechanisms in EMR privacy, real-time health data, and health survey data protection while highlighting challenges.

Live cell imaging is a powerful technique to study the dynamics and mechanics of various biological molecules like proteins, organelles, DNA, and RNA. With the rapid evolution of optical microscopy, our understanding of how these molecules is implicated in the cells’ most critical physiological roles deepens. Here in this review, we focus on how spatiotemporal nanoscale live cell imaging on a single molecule level allows for profound contributions towards new discoveries in life science. This review will start by summarizing how single molecule tracking has been used to analyze membrane dynamics, receptor ligand interactions, protein-protein interactions, inner- and extracellular transport, gene expression/transcription, and whole organelle tracking. We then move on to how current authors are trying to improve single molecule tracking and overcome current limitations by offering new ways in labeling protein of interests, multi-channel/color detection, improvements in time laps imaging, and new methods and programs to analyze colocalization and movement of targets. We later discuss how single molecule tracking can be a beneficial tool used for medical diagnosis. Finally wrapping up with limitation and future perspective of single molecule tracking and total internal refection microscopy.

Atrial fibrillation (AF), the most prevalent type of sustained cardiac dysrhythmia globally, confers strikingly enhanced risks for cognitive dysfunction, stroke, chronic cardiac failure, and sudden cardiovascular demise. Aggregating studies underscore the crucial roles of inherited determinants in the occurrence and perpetuation of AF. However, due to conspicuous genetic heterogeneity, the inherited defects accounting for AF remain largely indefinite. Here, via the whole-genome genotyping with genetic markers and linkage assay in a family suffering AF, a new AF-causative locus was located at human chromosome 7p14.2-p14.3, a ~4.89-cM (~4.43-Mb) interval between the markers D7S526 and D7S2250. Exome-wide sequencing assay unveiled that at the defined locus, solely the mutation in the TBX20 gene, NM_001077653.2: c.695A&gt;G; p.(His232Arg), co-segregated with AF in the family. Additionally, Sanger sequencing assay of TBX20 in another family suffering AF uncovered a novel mutation, NM_001077653.2: c.862G&gt;C; p.(Asp288His). Neither of the two mutations was observed in 600 unrelated control individuals. Functional investigations demonstrated that the two mutations both significantly reduced the transactivation of the target gene KCNH2 (a well-established AF-causing gene) and the ability to bind the promoter of KCNH2, while without effect on the nuclear distribution of TBX20. Conclusively, these findings reveal a new AF-causative locus at human chromosome 7p14.2-p14.3 and strongly indicate TBX20 as a novel AF-causative gene, shedding light on the mechanism underlying AF and suggesting clinical significance for allele-specific treatment of AF patients.

Recent advancements in surgical and anti-cancer therapies have provided significant hope of long survival in patients with pancreatic cancer (PC). To realize this hope, routine medical checkups of asymptomatic people should be performed to identify operable PCs. In this study, we evaluated the efficacy of medical checkups using abdominal ultrasonography (US). We retrospectively analyzed 374 patients with PC at our institute between 2010 and 2021. We divided these patients into several groups according to the diagnostic approach and compared their background and prognosis. These groups comprised PCs diagnosed through (a) symptoms, 242 cases; (b) US during medical checkup for asymptomatic individuals, 17; and other means. Of the 375 patients, 192 were men (51.3%), and the median age was 74 years (34–105). Tumors were located in the pancreatic tail in 67 patients (17.9%). Excision ratio and 5-year survival rate were significantly better in group (b) than in (a) (58.8% vs. 23.1%, P<0.01 and 42.2% vs. 9.4%, P<0.001, respectively). The prognosis of patients diagnosed using US during medical checkup was better than that of patients identified through symptomatic presentation of PC. US for asymptomatic individuals with PC might be useful for promoting better prognosis of PCs.

The study was conducted on applying machine learning and data mining methods to personalizing the treatment. This allows investigating individual patient characteristics. Personalization is built on the clustering method and associative rules. It was suggested to determine the average distance between instances for optimal performance metrics finding. The formalization of the medical data pre-processing stage for finding personalized solutions based on current standards and pharmaceutical protocols is proposed. The model of patient data is built. The paper presents the novel approach to clustering built on ensemble of cluster algorithm with better than k-means algorithm Hopkins metrics. The personalized treatment usually is based on decision tree. Such approach requires a lot of computation time and cannot be paralyzed. Therefore, it is proposed to classify persons by conditions, to determine deviations of parameters from the normative parameters of the group, as well as the average parameters. This made it possible to create a personalized approach to treatment for each patient based on long-term monitoring. According to the results of the analysis, it becomes possible to predict the optimal conditions for a particular patient and to find the medicaments treatment according to personal characteristics.

We report an easy-to-implement device for SERS-based detection of various analytes dissolved in water droplets at trace concentrations. The device combines an analyte-enrichment system and SERS-active sensor site, both produced via inexpensive and high-performance direct fs-laser printing. Fabricated on a surface of water-repellent polytetrafluoroethylene substrate as an arrangement of micropillars, the analyte-enrichment system supports evaporating water droplet in the Cassie-Baxter superhydrophobic state, thus ensuring delivery of the dissolved analyte molecules towards the hydrophilic SERS-active site. The efficient pre-concentration of the analyte onto the sensor site based on densely-arranged spiky plasmonic nanotextures results in its subsequent label-free identification by means of SERS spectroscopy. Using the proposed device, we demonstrate reliable SERS-based fingerprinting of various analytes, including common organic dyes and medical drugs at ppb concentrations. The proposed device is believed to find applications in various areas, including label-free environmental monitoring, medical diagnostics, and forensics.

This study describes the development of an automated bag valve mask (BVM) compression system, which, during acute shortages and supply chain disruptions can serve as a temporary emergency ventilator. The resuscitation system is based on the Arduino controller with a real-time operating system installed on a largely RepRap 3-D printable parametric component-based structure. The cost of the system is under $170, which makes it affordable for replication by makers around the world. The device provides a controlled breathing mode with tidal volumes from 100 to 800 milliliters, breathing rates from 5 to 40 breaths/minute, and inspiratory-to-expiratory ratio from 1:1 to 1:4. The system is designed for reliability and scalability of measurement circuits through the use of the serial peripheral interface and has the ability to connect additional hardware due to the object-oriented algorithmic approach. Experimental results demonstrate repeatability and accuracy exceeding human capabilities in BVM-based manual ventilation. Future work is necessary to further develop and test the system to make it acceptable for deployment outside of emergencies in clinical environments, however, the nature of the design is such that desired features are relatively easy to add with the test using protocols and parametric design files provided.

Multivariate Time Series Classification (MTSC) is one of most important tasks in time series analysis, aiding in activities such as human motion recognition and medical diagnostics. Existing methods for MTSC do not explicitly model temporal differences and generalize the idea of temporal difference into a efficient temporal module. Additionally, existing methods are not yet able to capture cross-variable relationships well during network training. As a result, they are unable to achieve convincing feature representation, leading to suboptimal classification accuracy. In this paper, we propose a novel MTSC model called Temporal Difference and Cross-variate Fusion Network (TDCFN), which integrates a two-stream differential LSTM network and a cross-variate feature extraction network to enhance feature representation. TDCFN achieves superior classification accuracy by capturing dynamic temporal evolution and inter-variable relationships. The experimental results show that TDCFN can achieve competitive performance with state-of-the-art multivariate time series classification approaches.

Deep Neutral Networks (DNNs) were initially proposed towards the midst of the 20th century, motivated by the neural structure and mechanism of the human brain. Thanks to major ad-vancements in computational resources, during the past decade DNN-based systems have demonstrated unprecedented performance in terms of accuracy and speed. However, recent work has shown that such models may not be sufficiently robust during the inference process. Furthermore, due to the data-driven learning nature of DNNs, designing interpretable and gen-eralizable networks is a major challenge, especially in critical applications, such as medical Computer Aided Diagnostics (CAD) and other medical imaging tasks, including classification, regression and reconstruction. Within this context, a line of physics-driven approaches for deep learning has recently emerged, aimed at improving the stability and generalization capacity of DNNs for medical imaging applications. In this paper, we review recent work focused on phys-ics-driven or prior-information learning for a variety of imaging modalities and medical applica-tions. We discuss how the inclusion of domain-related knowledge into the learning process and networks’ design supports their stability and generalization capability. In addition, we highlight current and future challenges within this scope.

This comprehensive review unfolds a detailed narrative of Artificial Intelligence (AI) making its foray into radiology, a move that is catalysing transformational shifts in the healthcare landscape. It sheds light on the journey of radiology, from the pioneering discovery of X-rays to today’s intricate imaging technologies, infused with machine learning and deep learning in medical image analysis. At the crux of this review lies an in-depth study of AI applications in radiology, elucidating its seminal roles in image segmentation, computer-aided diagnosis, predictive analytics, and workflow optimisation. A spotlight is cast on the profound impact of AI on diagnostic processes, personalised medicine, and clinical workflows, with empirical evidence derived from a series of case studies across multiple medical disciplines. However, the integration of AI in radiology is not devoid of challenges. The review ventures into the labyrinth of obstacles that are inherent to AI-driven radiology — data quality, the ’black box’ enigma, infrastructural and technical complexities, as well as ethical implications. Peering into the future, the review contends that the road ahead for AI in radiology is paved with promising opportunities. It advocates for continuous research, embracing avant-garde imaging technologies, and fostering robust collaborations between radiologists and AI developers. It concludes by firmly cementing the role of AI as a catalyst for change in radiology, a stance that is firmly rooted in sustained innovation, dynamic partnerships, and a steadfast commitment to ethical responsibility.

The Internet of Medical Things (IoMT) is playing a pivotal role in the healthcare sector by allowing faster and more informed hospital care, personalized treatment, and medical solutions. A very effective and trustworthy solution for resource-constrained medical devices is provided by Physical Unclonable Functions (PUF) - based identity and authentication systems, however they are not yet entirely reliable. This paper proposes VXorPUF, a Vedic Principles - Based Hybrid XOR Arbiter PUF. Modeling attacks were performed on the proposed architecture and an accuracy of 49.80 % was achieved. Uniqueness, Reliability and Randomness were the figures of merit used to evaluate PUF.

This paper presents an overview of tomography and different tomographic imaging modalities. The goal of this paper is to provide an understanding of various imaging modalities; in particular, how the imaging is performed, working principles, and applications. It was not intended to provide the in-depth mathematical principles of these imaging modalities, rather this paper focuses on providing the knowledge in an easy-to-grasp manner for the readers' benefit. Imaging modalities are categorized based on the physics behind image generation. First, the paper explains the general tomography principle. Then explains Ultrasound Imaging, Electrical Impedance Tomography, Computed Tomography, Magnetic Resonance Imaging (MRI), Photoacoustic Tomography (PAT), and Positron Emission Tomography (PET). In the end, the paper provides the fundamentals and review of two relatively new imagining modalities, Diffuse Optical Tomography (DOT) and functional Near-infrared Spectroscopy (fNIRS).

Malaysia implemented a movement control order (MCO) to curb the spread of the SARS-CoV-2 virus in March 2020. Despite healthcare services remaining operational, rising COVID-19 infections and MCO restrictions have forced healthcare professionals to seek a compromise between service capacity and standard operating procedure compliance. A cross-sectional survey was conducted among public and private sector doctors, dentists and pharmacists to determine how lockdown measures impacted healthcare services. Responses from 413 doctors, 193 dentists, and 163 pharmacists were analysed. Pharmacy services remained mostly unaffected throughout the MCO. In contrast, operational capacities for surgical and dental services were severely affected during the MCO. All service sectors reported restricting patients or accompanying individuals at the workplace, reductions in staffing capacity, and shortened patient contact time at various degrees. Many pharmacy and medical participants reported supplying extended medication supplies to patients. Adoption of virtual healthcare services was generally poor. All private service sectors suffered financial losses ranging between 59 to 75%. Periodic assessments of the healthcare system throughout the pandemic are required to identify which patients have their treatment compromised so that healthcare managers and policy makers can plan and implement appropriate interventions that help alleviate pressure within the health system.

A significant attention has been made to the accurate detection of diabetes which is a big challenge for the research community to develop a diagnosis system to detect diabetes in a successful way in the IoT e-healthcare environment. Internet of Things (IOT) has emerging role in healthcare services which delivers a system to analyze the medical data for diagnosis of diseases applied data mining methods. The existing diagnosis systems have some drawbacks, such as high computation time, and low prediction accuracy. To handle these issues, we have proposed a IOT based diagnosis system using machine learning methods, such as preprocessing of data, feature selection, and classification for the detection of diabetes disease in e- healthcare environment. Model validation and performance evaluation metrics have been used to check the validity of the proposed system. We have proposed a filter method based on the Decision Tree (Iterative Dichotomiser 3) algorithm for highly important feature selection. Two ensemble learning Decision Tree algorithms, such as Ada Boost and Random Forest are also used for feature selection and compared the classifier performance with wrapper based feature selection algorithms also. Machine learning classifier Decision Tree has been used for the classification of healthy and diabetic subjects. The experimental results show that the Decision Tree algorithm based on selected features improves the classification performance of the predictive model and achieved optimal accuracy. Additionally, the proposed system performance is high as compared to the previous state-of-the-art methods. High performance of the proposed method is due to the different combinations of selected features set and GL, DPF, and BMI are more significantly important features in the dataset for prediction of diabetes disease. Furthermore, the experimental results statistical analysis demonstrated that the proposed method would be effectively detected diabetes disease and can easily be deployed in IOT wireless sensor technologies based e-healthcare environment.

Inequality of health service for different specialty categories not only occurs in different areas inequality of health service for different specialty categories in the world, but also happens in the online service platform. In the online health community (OHC), health service was often of inequality for different specialty categories, including both online views and medical consultation for offline registered service. Moreover, how the factor city-level impacts the inequality of health service in OHC is still unknown. We designed a causal inference study with data on distributions of serviced patients and online views in over 100 distinct specialty categories on one largest OHC in China. To derive the causal effect of the city-levels (two levels inducing 1 and 0) on the Gini coefficient, we matched the focus cases in cities of rich healthcare resources with the potential control cities. For the Gini coefficient of serviced patients in over 100 specialty categories, the average treatment effect of level-1 cities is 0.470, which is 0.029 higher than that of the matched group. Similarly, for the Gini coefficient of online views, the average treatment effect of Level-1 cities is 0.573, which is 0.016 higher than that of the matched group. For each of the specialty categories, we also estimated the average treatment effect the specialty category’s Gini coefficient ( ) with the balanced covariates. The results support the argument that the total Gini coefficient of all the doctors in OHC shows that the inequality of health service is still very serious. This study contributes to the development of the theoretically grounded understanding of the causal effect of city-level on the inequality of health service in an online to offline healthcare service setting.

The present study aimed to evaluate the psychometric properties of the Greek version of the Jefferson Scale of Empathy—Student version (JSE-S) and its association with potential predictors among Greek-speaking undergraduate medical students. This study adopted a cross-sectional, comparative–descriptive research design. The study was conducted during October and November 2023. Cronbach’s α for the JSE-S was 0.846. Cronbach’s α values for the factors “perspective taking”, “compassionate care”, and “standing in the patient’s shoes” were 0.800, 0.715, and 0.748, respectively. The intraclass correlation coefficient for the JSE-S score in the test–retest study was 0.827 (95% CI = 0.647 to 0.915, p-value &lt; 0.001), indicating a high level of reliability. The participants showed moderate empathy levels. Females scored higher than males on the Greek version of the JSE-S (108.8 vs. 102.8, p-value &lt; 0.001). Moreover, students enrolled in the fourth academic year showed higher empathy mean scores than those enrolled in the first year (108.6 vs. 103.6, p-value = 0.012). Statistically significant empathy differences by specialty preferences or faith in God/supreme power were not found. The present study provided satisfactory evidence that the Greek JSE-S is a psychometrically sound measurement instrument. Empathy differences by gender were found in line with prior literature.

Despite the efforts to deliver the best evidence-based care, in-hospital death is an inevitable event among some patients hospitalized in cardiology departments. We retrospectively evaluated mortality events from inpatient admissions to Cardiology Department between 2010-2019. Data were collected from morbidity &amp; mortality meeting presentations which evaluated comorbidities, medical history, treatments, and causes of death for the overall cohort and according to age group and sex. There were 1,182 registered deaths. The most common causes of death among patients were acute myocardial infarction (AMI) (53.0%), heart failure (HF, 11.7%), cardiac arrest (CA, 6.6%), HF with complication/defined cardiomyopathy (6.3%) and sepsis (4.4%). We observed a decline in deaths from AMI from 61.9% in 2010 to 46.7% in 2019 while there was an apparent increase in deaths from HF (11.1% in 2010 to 25.9% in 2019). Compared to patients ≥65 years, younger patients were more likely to have died from CA (15.7% vs. 4.3%, p&lt;0.001) and other cardiac reasons (3.0% vs. 0.4%, p&lt;0.001). The majority of deaths were due to AMI, HF, and CA. We observed a significant decline in the proportion of deaths due to AMI in recent years with an increase in deaths due to HF.

Background: Monitoring of antibiotic prescription practices in hospitals is essential to assess and facilitate appropriate use. This is relevant to halt the progression of antimicrobial resistance. Methods: Assessment of antibiotic prescribing patterns and completeness of antibiotic prescriptions among out-patients in 2021 was conducted at the University Hospital of Kwame Nkrumah University of Science and Technology in the Ashanti region of Ghana. We reviewed electronic medical records (EMR) of 49,660 patients who had 110,280 encounters in the year. Results: The patient encounters yielded 350,149 prescriptions. Every month, 33-36% of patient encounters resulted in antibiotic prescription, higher than the World Health Organization’s (WHO) recommended optimum of 27%. Almost half of the antibiotics prescribed belonged to WHO’s Watch group. Amoxicillin-clavulanic acid (50%), azithromycin (29%), ciprofloxacin (28%), metronidazole (21%), and cefuroxime (20%) were the most prescribed antibiotics. Antibiotic prescribing parameters (indication, name of drug, duration, dose, route and frequency) were documented in almost all prescriptions. Conclusions: Extending antimicrobial stewardship to the out-patient settings by developing standard treatment guidelines, an out-patient specific drug formulary and antibiograms can promote rational antibiotic use at the hospital. The EMR system of the hospital is a valuable tool for monitoring prescriptions that can be leveraged for future audits.

Distributed digital manufacturing offers a solution to medical supply and technology shortages during pandemics. To prepare for the next pandemic, this study reviews the state-of-the-art for open hardware designs needed in a COVID-19-like pandemic. It evaluates the readiness of the top twenty technologies requested by the Government of India. The results show that the majority of the actual medical products have had some open source development, however, only 15% of the supporting technologies that make the open source device possible are freely available. The results show there is still considerable work needed to provide open source paths for the development of all the medical hardware needed during pandemics. Five core areas of future work are discussed that include: i) technical development of a wide-range of open source solutions for all medical supplies and devices, ii) policies that protect the productivity of laboratories, makerspaces and fabrication facilities during a pandemic, as well as iii) streamlining the regulatory process, iv) developing Good-Samaritan laws to protect makers and designers of open medical hardware, as well as to compel those with knowledge that will save lives to share it, and v) requiring all citizen-funded research to be released with free and open source licenses.

This paper introduces the AltumView Sentinare smart activity sensor for senior care and patient monitoring. The sensor uses an AI chip and deep learning algorithms to monitor the activity of people, collect activity statistics, and notify caregivers when emergencies such as falls are detected. To protect privacy, only skeleton (stick figure) animations are transmitted instead of videos. The sensor is highly affordable, accessible, and versatile. It was a CES 2021 Innovation Award Honoree, and has been selected by Amazon as one of only three fall detection devices integrated into its Alexa Together urgent response service, and has received very positive reviews from Amazon customers. It has also been used in different senior care settings in about ten different countries. The paper presents the main features of the system, the evidences and lessons learned from its practical applications, and future directions.