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.

A recently proposed single image parasite quantification (SIMPAQ) platform based on a Lab-On-a-Disc (LOD) device has been earlier successfully tested in field conditions demonstrating the efficiency in soil-transmitted helminths (STH) egg detection and analysis. A related study (Micromachines 2021, 12, 1032) revealed the effects that can limit the performance of a SIMPAQ method due to the action of the Euler and Coriolis forces, and the interaction of the moving eggs with the walls of the LOD chamber. Here we propose a new improved design that allows to overcome those limitations and enhance the yield of the SIMPAQ LOD device which is demonstrated in the experiments with synthetic particle model system and real parasite eggs.

Thermoelectrics, in particular solid-state conversion of heat to electricity and vice versa, is expected to be a key energy harvesting and temperature management solution in coming years. There has been a resurgence in the search for new materials for advanced thermoelectric energy conversion applications and to enhance the properties of existing materials. In this paper, we review recent efforts on improving figure-of-merit (ZT) through alloying and nano structuring. As heatsink characteristics dictate the performance of thermoelectric modules, various types of heatsink designs has been investigated. Several reported strategies for improving ZT are critically assessed. A notable increase in figure-of-merit of thermoelectric materials (TE) has opened up new areas of applications especially in the medical field. Peltier cooling devices are widely employed for patient core temperature control, skin cooling, medical device and laboratory equipment cooling. Application of these devices in the medical field both in temperature control and power generation has been studied in detail. It is envisioned that this study will provide profound knowledge on the thermoelectric based materials and its role in medical applications.

Abstract—Low-frequency Fahræus–Lindqvist-driven (not blood pressure-driven) oscillations in the small vessels are crucial because oscillations in small vessels support nutrient supply. Understanding of this is critical in type 2 diabetes mellitus (T2DM) to develop therapeutic measures to prevent Alzheimer's Disease Related Dementias: vascular factors contribute to cerebrovascular disease as well as mild cognitive impairment and dementia, which are predicted to affect 152 million people by 2050 (Alzheimer's Disease International London, UK, 2019). In this clinical study, we performed functional near-infrared spectroscopy (fNIRS) of the forehead to investigate the effect of the Mini-Cog with three-item recall test on the prefrontal cortex (PFC) activation and the relative oscillatory power in the 0.01–0.02-Hz (Fahræus–Lindqvist effect) and 0.021–0.052 Hz (smooth muscle autonomic innervation) frequency bands in elderly (60 years and older) T2DM and age-matched controls. We found a significant (p<0.01) difference in the PFC activation between elderly subjects with T2DM and age-matched elderly controls. Moreover, power spectral density (PSD) analysis revealed a significantly lower relative power in 0.021–0.052 Hz (smooth muscle autonomic innervation) frequency band in elderly subjects with T2DM during the Mini-Cog three-item recall test. Furthermore, a drop in the oscillatory power in the 0.01–0.02-Hz frequency band during Mini-Cog three-item recall test was found more pronounced in the elderly subjects with T2DM. Therefore, our study highlighted portable brain imaging to capture cerebrovascular reactivity to cognitive load that may provide a biomarker of cerebrovascular dysfunction in T2DM.Clinical Relevance— Our study establishes forehead portable brain imaging for monitoring cerebrovascular function in T2DM under cognitive load.

Objectives: This study was performed to estimate diagnostic accuracy of the two commercially available point-of-care tests to identify poor glycemic control defined by HbA1c levels, with HPLC as a reference. Settings: The study was carried at two locations, general medical out-patient department of a teaching medical college in Bhopal (urban), and a primary health care centre in rural area in the state of Madhya Pradesh, India.Participants: All individuals with diabetes mellitus who presented to the health care facility for assessment of glycemic control. We excluded participants who denied a written informed consent. No other exclusions were used. We compared HbA1c estimated from two index tests (Hemocue Hb501, Sweden; SD Biosensor, South Korea) from capillary blood samples with HPLC performed from venous blood, as a reference standard. Primary and secondary outcome measures: Diagnostic properties of index tests such as sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for identifying poor glycemic control were primary outcome measures. Lin’s concordance correlation coefficient (CCC) was secondary outcome measure.Results: Out of 114 patients, all received reference standard, 103-Hemocue A1C test, and 110- SD Biosensor test. Overall both the index-tests had similar diagnostic accuracy estimates. The area under the Receiver Operating Curve for SDA1c device was 0.935 (95%CI 0.886-0.983), and for Hemocue device was 0.938 (95%CI 0.893-0.984). The Hemocue device HbA1c value of above 7.0 (positive) correctly predicted poor glycemic control 92% times (81.58% for SD device). There were 4 vs. 11 device failures and 14 vs. 12 failures with SD and Hemocue respectively. Ambient air temperatures were no different for the device test failures.Conclusions: Commercially available point-of-care tests evaluated in this study are comparable and an acceptable alternative to HPLC based measurements for assessment of glycemic control. Tests and device failure rates of both the index tests are similar.

Introduction: Austere environments include the wilderness and many lower-and-middle-income countries, many of these facing unrest and war. The access to advanced diagnostic equipment is often unaffordable even if available and is often liable to breakdown. This short review paper examines the options available to medical professionals to undertake clinical and point of care diagnostic testing in resource constrained environments and also illustrates the development of mobile advanced diagnostic equipment. The aim is to provide an overview of the spectrum and functionality of these devices beyond clinical acumen.

Despite the many advantages of lung ultrasound (LUS) in the diagnosis and management of patients with dyspnea, adoption among hospitalists has been slow. We performed semi-structured interviews of hospitalists from 4 diverse health systems in the US to understand determinants of adoption within a range of clinical settings. We used the Diffusion of Innovation Theory to guide a framework analysis of the data. Of 27 hospitalists invited, we performed in-terviews of 22 from 4 hospitals of diverse types. Median years post-residency of interviewees was 10.5 [IQR:5-15]. Four main themes emerged: 1) There are important clinical advantages to LUS despite operator dependence, 2) LUS enhances patient and clinician experience, 3) Investment of clinician time to learn and perform LUS is a barrier to adoption but yields improved efficiency for the health system and 4) Mandated training and use may be necessary to achieve broad adoption as monetary incentives are less effective. Despite perceived benefits of LUS for patients, clinicians and health systems, an important barrier to broad LUS adoption is the experience of time scarcity by hospitalists. Future implementation strategies should focus on changes to the clinical environment that address clinician barriers to learning and adoption of new skills.

Managing blood cholesterol levels is important for the treatment and prevention of diabetes, cardiovascular disease, and obesity. An easy-to-use, portable cholesterol blood test will accelerate more frequent testing by patients and at-risk populations. We aim to evaluate the performance of smartphone-based point-of-care cholesterol blood tests as compared to that of hospital-grade laboratory tests. We used smartphone systems that are already familiar to many people. Because smartphone systems can be carried around everywhere, blood can be measured easily and frequently. We compared the results of cholesterol tests with those of existing clinical diagnostic laboratory methods. We found that smartphone-based point-of-care lipid blood tests are as accurate as hospital-grade laboratory tests (N=116, R>0.97, P<0.001 for all 3 cholesterol blood tests: total cholesterol, high density lipoprotein, and triglyceride). Our system will be useful for those who need to manage blood cholesterol levels to motivate them to track and control their behavior.

Keywords: renal replacement therapy. Point-of-Care Ultrasound; intensive care; acute kidney injury; nephrologist.Point of care ultrasonography (POCUS) is gaining heightened significance in critical care settings as it allows for quick decision making at the bedside. While computerized to-mography is still considered the standard imaging modality for many diseases, the risks and delays associated with transferring a critically ill patient out of the Intensive Care Unit (ICU) have prompted physicians to explore alternative tools. Ultrasound guidance has increased safety of invasive procedures in the ICU, such as the placement of vascular catheters and drainage of collections. Ultrasonography is now seen as an extension of the clinical examination, providing quick answers for rapidly deteriorating patients in the ICU. The field of nephrology is increasingly acknowledging the value of diagnostic Point-of-Care Ultrasound (POCUS). By employing multi-organ POCUS, nephrologists can address specific queries arising during the diagnosis and treatment of patients with acute kidney injury. This approach aids in ruling out hydronephrosis and offering immediate information on hemodynamics, thereby consolidating patient data and facilitating the development of personalized treatment strategies.

COVID-19, the disease caused by the new coronavirus, SARS-CoV-2, has caused significant human and economic burden. Of the three major methods to mitigate the effect of the virus, diagnostics have become the focal point because vaccines and therapeutics, despite the intense effort of scientists worldwide, will take months to develop, test for safety and efficacy, scaleup and distribute to millions. This perspective aims to clarify some of the issues related to COVID-19 diagnostics and highlights some of the challenges key stakeholders including policymakers, businesses, managers, scientists and individuals face during this evolving pandemic.

Simultaneous measurement of different substances from a single sample is an emerging issue to achieve efficient and high-throughput detection in several fields of application. Although immunoanalytical techniques have well-established and prevailing advantages over alternative screening analytical platforms, one of the incoming challenges for immunoassay is exactly multiplexing. The Lateral Flow Immunoassay (LFIA) is a leading immunoanalytical technique for onsite analysis thanks to its simplicity, rapidity and cost-effectiveness. Moreover, LFIA architecture is adaptable to multiplexing and therefore candidates as a possible answer to the pressing demand of multiplexing point-of-need analysis. The review present an overview of diverse approaches for multiplex LFIA, with a special focus on strategies based on new types of magnetic, fluorescent and colored labels

The process of blood coagulation, wherein circulating blood transforms into a clot in response to internal or external injury, is a critical physiological mechanism. Monitoring this coagulation process is vital to ensure that blood clotting occurs neither too rapidly nor too slowly. Anticoagulants, a category of medications designed to prevent and treat blood clots, require meticulous monitoring to optimise dosage, enhance clinical outcomes, and minimise adverse effects. This review article delves into the various stages of blood coagulation, explores commonly used anticoagulants and their targets within the coagulation enzyme system, and emphasises the electrochemical methods employed in anticoagulant testing. Electrochemical sensors for anticoagulant monitoring are categorised into two types. The first type focuses on assays measuring thrombin activity via electrochemical techniques. The second type involves modified electrode surfaces that either directly measure the redox behaviour of anticoagulants or monitor the response of standard redox probes in the presence of these drugs. The review provides a comprehensive list of different electrode compositions and their detection and quantification limits. Additionally, it discusses the potential of employing a universal calibration plot to replace individual drug-specific calibrations. The insights presented are anticipated to significantly contribute to the sensor community's efforts in this field.

More than one million curable sexually transmitted infections occur every day. Trichomonas vaginalis is one of the main responsible for these epidemiological data, however, the diagnosis of this protozoan is still mainly based on microscopic and culture identification. The commerciali-zation of immunological tests and the development of molecular techniques have improved the sensitivity of classical methods. Nevertheless, the fact that trichomoniasis is a neglected parasitic infection, hinders the development of novel techniques and their implementation in routine di-agnosis. This review article shows the different methods developed to identify T. vaginalis in population and the difficulties to diagnose male and asymptomatic patients. The importance of including this parasite in routine gynecological screening, especially in pregnant women, and the importance of considering T. vaginalis as an indicator of high-risk sexual behavior is also discussed.

Versatility, sensitivity and accuracy have made the real-time polymerase chain reaction (qPCR) a crucial tool for research as well as diagnostic applications. However, for point-of-care (PoC) use traditional qPCR faces two main challenges: long run times mean results are not available for half an hour or more and the requisite high-temperature denaturation requires more robust and pow-er-demanding instrumentation. This study addresses both issues and revised primer and probe designs, modified buffers and low ∆T protocols which, together, speed up qPCR on conventional qPCR instruments and will allow the development of robust, point-of-care devices. Our approach, called "FlashPCR", also allows efficient reverse transcription as part of a one-step RT-qPCR pro-tocol, making it universally applicable for both rapid research and diagnostic applications.

Background Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is helpful in the assessment of intracranial pressure. The aim of this study was to determine whether the Trendelenburg position during laparoscopic urological surgery changed the ONSD and whether changes correlated with postoperative complications. Methods In this prospective study, we measured ONSD before patients were placed in the Trendelenburg position. Then the Trendelenburg position was established by tilting the operating table to 20-25 degrees. After surgery, the patients were placed in a horizontal position, and the second measurement of ONSD was obtained. Results The study included 69 patients. The average preoperative ONSD in the right eye was 5.8 ± 0.7 mm and 5.8 ± 0.8 mm in the left eye. The average postoperative ONSD in the right eye was 6.6 ± 0.8 mm and 6.6 ± 0.7 mm in the left eye. The differences between postoperative and preoperative values in the right and left eyes were statistically significant (p <0.000001). ONSD increases above the norm did not correlate with the incidence of postoperative nausea (p = 0.94), delirium (p = 0.81), or the time to patient awakening (p = 0.29). Conclusion ONSD increased in patients who underwent surgical procedures performed in the Trendelenburg position, but the increase did not correlate with postoperative complications.

Inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC), defines as an idiopathic, chronic, relapsing, inflammatory disease affecting the gastrointestinal tract and leading to chronic damage. Endoscopy with biopsies is considered the gold standard for IBD diagnosis, whereas magnetic resonance (MRI) for CD extension and complication assess-ment. However, the latter are invasive procedures; thus, the need for a reliable, accessible and noninvasive way to perform IBD diagnosis and monitoring in the tight control era, like intestinal ultrasound (IUS) is. Compared to endoscopy and MRI, IUS has shown reliable diagnostic accuracy in assessing CD and UC severity and extension. Performing IUS in a point-of-care setting (POCIUS) can guide the clinician in driving the diagnostic and therapeutic pathway, thus accel-erating clinical decisions. POCIUS performed with pocket devices can represent the future of physical examination in outpatient or inpatient examination. Accordingly, we performed a liter-ature review about the application of IUS in CD and UC diagnosis. Furthermore, we explored the technical aspects of this imaging technique and its application in a point-of-care setting.

Since the systematic evolution of ligands by exponential enrichment (SELEX) method was developed, aptamers have made significant contributions as bio-recognition sensors. Microdevice systems allow for low reagent consumption, high-throughput of samples, and disposability. Due to these advantages, there has been an increasing demand to develop microfluidic-based aptasensors for analytical technique applications. This review introduces the principal concepts of aptasensors and then presents some advanced applications of microdevice-based aptasensors on several platforms. Highly sensitive detection techniques such as electrochemical and optical detection have been integrated into lab-on-a-chip devices and researchers have moved towards the goal of establishing point-of-care diagnoses for target analyses.

Accurate clinical diagnosis of patients presenting to primary care settings with acute sore throat remains challenging, often resulting in the over-prescribing of antibiotics. Using point-of-care tests (POCTs) to differentiate between respiratory infections is well-accepted, yet evidence on the application within primary care is sparse. We assessed the application of testing patients (n=160) from three family practices with suspected Streptococcal infections using rapid molecular tests (ID NOW Strep A2, Abbott). In addition to comparing clinical evaluation and prescription rates with either usual care or with testing, patients and staff completed a questionnaire about their experience of molecular POCT in primary care. The immediate availability of the result was important to patients (100%) and staff (≈90%) stated that molecular testing improved quality of care. Interestingly, only 22.73% of patients with a Centor score >2 tested positive for Strep A and overall, less than 50% of Centor scores 3 and 4 tested positive for Strep A with the ID NOW testing platform. The addition of rapid molecular POCTs to clinical assessment resulted in a 55- 65% reduction in immediate and deferred antibiotic prescriptions. The intervention was popular with patients and medical staff but was associated with increased cost and a longer appointment length.

We investigated the development of a simple and sensitive assay for the identification of minute amounts of animal and human biological material. The suggested system uses isothermal amplification of DNA in a rapid assay format, which returns the results in as little as 40 minutes from sampling. The assay used for the proof of concept employs the novel handheld SaLux19 device (Max-Planck Innovation prototype, Germany). This well-established infield detection system could also be utilized for forensic scenarios. The results presented here demonstrated that the assay is sufficiently specific and sensitive and can detect the presence of Sus scrofa nucleic acids.

Although relatively rare, affecting 8% of the general population, autoimmune disorders are causative linked with chronic diseases and morbidity. Control of the course of the disease is closely dependent on the ability to monitor its onset as well as response to treatment. In the present report, we review the progress in the development of biosensor-based approaches and related tools for the Point-of-Care diagnosis and monitoring of biomarkers related to several autoimmune diseases, such as Myasthenia Gravis, Rheumatoid Arthritis, Multiple Sclerosis, Systemic Erythematosus Lupus, Crohn’s Disease, Diabetes Mellitus, Behcet’s disease, Psoriasis and Celiac Disease. Various biosensing technologies are discussed, including electrochemical, optical and mechanical ones, along with the use of advanced nanomaterials and immobilization techniques for the biorecognition elements. The need for innovative devices with unique features of rapid, low-cost, real-time detection is considered in the context of preventing permanent organ and tissue damage from chronic autoimmune diseases.

Accumulated data show the utility of diagnostic multi-organ point-of-care ultrasound (PoCUS) in the assessment of patients admitted to an internal medicine ward. Assess whether multi-organ PoCUS (lung, cardiac, and abdomen) provides relevant diagnostic and/or therapeutic information in patients admitted for any reason to an internal medicine ward. Prospective, observational, and single-center study, at a secondary hospital. Multi-organ PoCUS was performed during the first 24 hours of admission. The sonographer had access to the patients’ medical history, physical examination, and basic complementary tests performed in the ED (laboratory, X-ray, electrocardiogram). We considered a relevant ultrasound finding if it implied a significant diagnostic and/or therapeutic change. In the second semester of 2019, 310 patients were enrolled (48.7% men, mean age 70.5 years). Relevant ultrasound findings were detected in 86 patients (27.7%) and in 60 (19.3%) triggered a therapeutic change. These findings were associated with older age (Mantel-Haenszel 2 = 25.6; p&lt; .001) and higher degree of dependency (Mantel Haenszel 2 = 5.7; p = .017). Multi-organ PoCUS provides relevant diagnostic information, complementing traditional physical exam, and facilitates therapy adjustment, regardless of the cause of admission. Multi-organ PoCUS to be useful need to be systematically integrated into the decision-making process in internal medicine.

The ongoing pandemic of COVID-19 has not only commenced a global health emergency but agitated various aspects of humanity. During this period of crisis researchers over the world have ramped their efforts to constrain the disease in all possible ways whether it is vaccination, therapy, or diagnosis. Since the spread of the disease has not yet elapsed sharing the ongoing research findings could be the key to disease control and management. An early and efficient diagnosis could leverage the outcome until a successful vaccine is developed. Molecular tests both in-house and commercial kits are preferably being used worldwide in the COVID-19 diagnosis. However, the limitation of high prices and lengthy procedures impede their use for mass testing. Keeping the constant rise of infection in mind search for an alternative test that should be cost-effective, simple, and suitable for large scale testing and surveillance is a need of an hour. One such alternative could be the immunological tests. Therefore, in the last few months deluge of immunological rapid tests has been developed and validated across the globe. The objective of the present review is to share the diagnostic performance of various immunological assays reported so far in SARS-CoV-2 case detection. The article consolidated the studies (published and preprints) related to the serological tests such as chemiluminescence, enzyme-linked and lateral flow-based point-of-care tests in COVID-19 diagnosis and updated the current scenario. This review will hopefully be an add-on in COVID-19 research and will contribute to congregate the evidence for decision-making.

The current coronavirus disease 2019 (COVID-19) pandemic is largely driven by community transmission, after 2019 novel Coronavirus (2019-nCoV or SARS-CoV-2) crosses the borders. To stop the spread, rapid testing is required at community clinics and hospitals. These rapid tests should be comparable with the standard PCR technology. Isothermal amplification technology provides an excellent alternative that is highly amenable to resource limited settings, where expertise and infrastructure to support PCR are not available. In this review, we provide a brief description of isothermal amplification technology, its potential and the gaps that need to be considered for SARS-CoV-2 detection. Among this emerging technology, loop mediated amplification (LAMP) and recombinase polymerase amplification (RPA) technologies have been identified as potential platforms that could be implemented at community level, without samples referral to a centralised laboratory and prolonged turn-around-time associated with the standard COVID-19 RT-PCR test. LAMP, for example, has recently been shown to be comparable with PCR and could be performed in less than 30 min by non-laboratory staff, without RNA extractions commonly associated with PCR. More so, it is cost effective and could easily be scaled up to resource limited settings. Diagnostics developers, scientific community and commercial companies could consider this alternative method to help stop the spread of COVID-19.

Theoretical analysis into the energetics of a novel putative electromagnetic field propulsion device by the author, found that it was able to impart momenergy to the ground state of the electromagnetic field; some rest-energy of the craft was converted to kinetic energy of the craft. Electrical analysis showed that the propulsor was always a net electrical load – if the device accelerated from one frame, then deaccelerated to the original frame, both processes would consume electrical work. The aim of this paper is to look further into this sinking of high-grade electrical energy into the field ground state and to show that an even more pernicious form of 2^nd Law of Thermodynamics exists.

The accelerated pace with which new diagnostic possibilities are produced and the budget re-strictions of the healthcare sector require that the decision-making process of acquiring new technologies becomes systematic in nature. There are some methodologies such as the Health Technology Assessment (HTA) that encompasses technological domains, clinical effectiveness, patient safety, organizational and financial aspects, among others. However, these methods do not contemplate the learning curve (LC) which is a differential factor in operator-dependent technologies. An assessment model was conceived based on the assessment domains of the AdHopHTA project with the addition of LC. The model was validated and calibrated through System Dynamics (SD) and using as case study the assessment of Point-of-care Ultrasound (POCUS) equipment in dengue screening. The model helped identify the influence of the LC and patient demand on the income and costs for the healthcare system regarding dengue screening as well as the cost-benefit indicator. The control charts LC-CUSUM and CUSUM are graphic tools to intuitively assess the learning curve which can be used for real-time monitoring once students reach a certain skill level.

COVID-19 pandemic will continue to pose a major public health threat until vaccination-mediated herd immunity is achieved. Most projections predict vaccine will reach a large subset of the population late in 2021 or early 2022. In the meantime, countries are exploring options to remove strict lockdown measures and allow for society and the economy to return to normal function. One possibility is to expand on existing COVID-19 testing strategies by including large-scale rapid point of care diagnostic tests (POCTs). Currently, there is significant variability in performance and features of available POCTs, making selection and procurement of appropriate test for specific use case difficult. In this review, we have used the World Health Organization’s (WHO) recently published Target Product Profiles (TPPs) for specific use cases of COVID-19 diagnostic tests to screen for top-performing POCTs on the market. Several top-performing POCTs, based on clinical sensitivity/specificity, the limit of detection, and time to results, that meet WHO TPP criteria for direct detection of SARS-CoV-2 (acute infection), or indirect diagnosis of past infection (host antibodies) are highlighted here.

Abstract: Our goal is to create point-of-care (POC) strategies that accelerate decision making, increase efficiency, improve outcomes, and enhance standards of care in island communities faced with global warming, rising oceans, population migration, and intensifying weather disasters. We assessed needs in the Bantayan Archipelago and mainland Cebu Province, Visayas Islands, Philippines, to map POC diagnostics, rescue times, and spatial care paths. Significant deficiencies were lack of cardiac troponin testing for rapid diagnosis of acute myocardial infarction, absence of blood gas and pH testing for support of critically ill patients, and geographic gaps prolonging patient transfers and delaying treatment. Strengths comprised primary care that can be facilitated by POC testing, logical inter-island transfers for which decision making and triage could be accelerated with onboard diagnostic testing, and healthcare small-world networks amenable to POC advances, such as pre-hospital testing, that avoid overloading emergency rooms. Healthcare resources must be distributed to archipelago islands, not concentrated in large metropolitan areas inaccessible for emergency interventions. We conclude that a point-of-need focus will help improve public health, decrease disparities in mortality among rural islanders versus urban dwellers, and pave the way for heightened resilience in anticipation of the adverse impact of global warming on vulnerable coastal areas.

Mechanical bowel obstruction is a common symptom for admission to emergency services, diagnosed annually in more than 300,000 patients in the States, from whom 51% will undergo emergency laparotomy. This condition is associated with serious morbidity and mortality, but it also causes a high financial burden due to long hospital stay. The EUPEMEN project aims to incorporate the expertise and clinical experience of national clinical specialists into development of perioperative rehabilitation protocols. Providing special recommendations for all aspects of patient perioperative care and the participation of diverse specialists, the EUPEMEN protocol for bowel obstruction, as presented in the current paper, aims to provide faster postoperative recovery and reduce length of hospital stay, postoperative morbidity and mortality rate.

Artificial intelligence (AI) is increasingly being used to improve the quality control of point-of-care diagnostics. This is caused by a number of factors, including the following: 1. AI can accelerate and improve testing accuracy. In comparison to humans, AI technology can review data more quickly and precisely, reducing errors and improving overall quality assurance. 2. When it comes to improving POC test findings on healthcare issues such as infectious diseases or medical crises such as heart attacks, AI can be used for sophisticated predictive analytics and modeling that aid in better decision-making. 3. Artificial intelligence facilitates process automation, increasing productivity and lowering labor costs in labor-intensive tasks such as testing and analyzing samples collected at point-of-care facilities. 4. The use of AI enables organizations implementing these solutions to gain insights from large volumes of raw diagnostic data generated faster and more accurately, allowing them to build solid frameworks around preventive care initiatives and significantly influence public health outcomes.5. Artificial intelligence (AI) has been demonstrated to be a useful tool for real-time monitoring systems that identify any problems with test results early so that they can be corrected before affected patients receive inaccurate diagnoses or treatment plans based on false information provided by diagnostic tests performed at points of care such as clinics or hospitals.Using these technologies would allow healthcare organizations to spend less on labor while still receiving exact diagnoses and rapid treatment delivery at a fraction of the cost that manual approaches required earlier.

The measurement of sP4 often varies due to different laboratory methodologies and individual canine characteristics. In this investigation, sP4 outcomes obtained from a commercial POC analyzer, designed for efficient sP4 assessment in bitches, were compared with results derived from CMIA, the reference laboratories in Thailand. Thorough documentation encompassed various parameters: mean, standard deviation (SD), 95% confidence interval (CI), minimum and maximum sP4 concentration values. Additionally, we meticulously recorded the Pearson’s correlation coefficient, Lin’s concordance correlation coefficient, and the bias correction factor. Interestingly, there was no significant difference (p &gt; 0.05) in the means obtained by the POC and CMIA. The Pearson’s correlation coefficient between POC and CMIA stood at 0.957, with Lin’s concordance correlation coefficient for POC recorded as 0.949. Furthermore, the bias correction factor was established at 0.991. This investigation followed established CMIA guidelines, modified to incorporate the mean and 95% CI as criteria for optimal breeding time using the POC analyzer. In conclusion, the commercial POC immunologic analyzer emerges as a valuable tool, aiding in precisely determining the optimal timing for natural mating or artificial insemination in bitches.

Yaws is a skin debilitating disease caused by Treponema pallidum subspecies pertenue with most cases reported in children. World Health Organization (WHO) aims at total eradication of this disease through mass treatment of suspected cases followed by an intensive follow-up program. However, effective diagnosis is pivotal in the successful implementation of this control program. Recombinase polymerase amplification (RPA), an isothermal nucleic acid amplification technique offers a wider range of differentiation of pathogens including those isolated from chronic skin ulcers with similar characteristics such as Haemophilus ducreyi (H. ducreyi). We have developed a duplex RPA assay for the simultaneous detection of Treponema pallidum (T. pallidum) and H. ducreyi (TPHD-RPA). TPHD-RPA assay demonstrated no cross-reaction with other pathogens and enable detection of T. pallidum and H. ducreyi within 15 minutes at 42 oC. The duplex RPA assay was validated with 49 clinical samples from individuals confirmed to have yaws by serological tests. Compared with commercial multiplex real-time PCR, the TPHD-RPA assay demonstrated 94-95% sensitivity for T. pallidum and H. ducreyi confirmed samples, respectively and 100% specificity. This simple novel TPHD-RPA assay enables the rapid detection of both T. pallidum and H. ducreyi in yaws-like lesions. This test could support the yaws eradication programs by ensuring effective diagnosis as well as enable monitoring of eradication efforts success or failure and planning of follow-up interventions at the community level.

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.

This study was undertaken to investigate and analyze noise pollution in a large Chinese governmental hospital’s medical intensive care unit and compare to the WHO guidelines.This cross-sectional study was conducted in a MICU at a public governmental teaching hospital in Fujian province between July and August of 2017. A WENSN® WS1361 Integrated Sound Level Meter (China) was used for continuous every five seconds one week noise levels recording. After this measurement, the decibel meter was used for recording different location of isolation rooms and open bays, including occupied and unoccupied patient, and recording sound events occurs in the ICU to identify sources of noise. Peak and average noise levels were obtained from the meter, and data were downloaded from the WS1361 into a laptop computer. The measured mean equivalent sound pressure levels (L) and standard Aeq deviation over one week period were 66.64±7.57 dB(A), with acute spikes reaching 119.7 dB(A), the average sound level for a 24 hour period in a work day was 68.03±5.07 dB(A). These are higher than the current daytime environmental noise limit of 40-45 decibels in China and WHO. Mean work day noise was significantly louder than weekend time, there was a significant difference in work days and weekend (t=16.85;P=0.000).There was a statistical difference between the day time and night time shifts (t=34.67;P=0.000). The isolation rooms were significantly quieter than the open-bay rooms(t=46.15; p=0.00), sound levels in the occupied and unoccupied rooms also had significant difference(t=17.26; P=0.000).Two types of noise resources, including twenty kinds sources were identified and measured, mean noise levels ranged from of 61.33 to 79.21 dB(A). This study shows noise levels in intensive care units were exceeded the recommended. The study of the influence of noise on patient and staff is needed, and noise reduction strategies must be conduct in ICU.

Purpose The gradual increase in geriatric issues and global imbalance of the ratio between patients and healthcare professionals has created a demand for intelligent systems with the least error-prone diagnosis results to be used by less medically trained persons and save clinical time. This paper aims at investigating the development of an image-based colourimetric analysis. The purpose of recognising such tests is to support wider users to begin a colourimetric test to be used at homecare settings, telepathology, etc. Design/methodology/approach The concept of an automatic colourimetric assay detection is delivered by utilising two cases. Training Deep Learning (DL) models on thousands of images of these tests using transfer learning, this paper i) classifies the type of the assay, and ii) classifies the colourimetric results. Findings This paper demonstrated that the assay type can be recognised using DL techniques with 100% accuracy within a fraction of a second. Some of the advantages of the pre-trained model over the calibration-based approach are robustness, readiness and suitability to deploy for similar applications within a shorter period of time. Originality/value To the best of our knowledge, this is the first attempt to provide Colourimetric Assay Type Classification (CATC) using DL. Humans are capable to learn thousands of visual classifications in their life. Object recognition may be a trivial task for humans, due to photometric and geometric variabilities along with the high degree of intra-class variabilities it can be a challenging task for machines. However, transforming visual knowledge into machines, as proposed, can support non-experts to better manage their health and reduce some of the burdens on experts.

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.

Quantification of erythrocytes and leukocytes is an essential aspect of hemogram diagno- 23 sis in Veterinary Medicine. Flow cytometry analysis, laser scattering, and impedance detection are 24 standard laboratory techniques, verified by manual microscopy counting. Although single-cell scat- 25 tering is already used as a standard technology for differentiating cell counts in flow cytometry, it 26 requires capillary cell separation. The current study investigates the scattering characteristics of 27 whole blood to identify correlations with erythrocytes and leukocytes counts. The scattering infor- 28 mation present in blood samples can be classified into three types: i) geometrical scattering, which 29 occurs when non-absorbed light is reflected and scattered, ii) Mie scattering, which happens when 30 light is scattered by particles of a similar size to the wavelength, and iii) Rayleigh scattering, which occurs when light is scattered by particles that are smaller than the incident light wavelength. In 32 this study, we investigate the scattering correction coefficients of dog blood absorption spectra in 33 the visible-near infrared range, to establish direct correlations with erythrocytes and leukocytes 34 counts, using multivariate linear regression. Our findings demonstrate the possibility of using the 35 scattering properties of dog blood, which is a step towards the existence of a portable and miniatur- 36 ized hemogram diagnosis in Veterinary Clinics worldwide.

The purpose of this work was to evaluate a novel methodology developed by Digital Blood Corporation (DBC) to calculate critical blood values using four non-invasive measured values as input. The values obtained using a point-of-care testing (POCT) device were utilized for comparison and reference. Radial arterial blood was collected for the POCT comparator analysis using the Abbott i-STAT^® device. The non-invasive methodology from DBC requires four parameters to be directly measured: temperature, hemoglobin, pO2, and pCO2. Subsequently, sodium, potassium, chloride, ionized calcium, total carbon dioxide, pH, bicarbonate, and oxygen saturation are calculated using an algorithm. The agreement between the POCT and DBC’s methodology was analyzed using Bland-Altman difference plots. For a second data set, pO2 and pCO2 values collected with the POCT were used as input for DBC’s algorithm to test its robustness. Data from 37 healthy ambulatory individuals, mean age: 42.4 + 13 years; range: 18-64 years, were included in the primary analysis. In the case of the non-invasive gained four input values the greatest variation between POCT and DBC’s approach was observed for pO2 and consequently for algorithm values that depend upon pO2 precision. Replacing transcutaneous pO2 and pCO2 with POCT values demonstrates the principal ability of DBC’s algorithm to predict the additional 8 blood values in sufficient agreement with a standard POCT device in healthy patients. The algorithm developed by DBC appears to be robust in the case of healthy patients but does need the four measured input values with preciseness comparable to a POCT device to give reliable and clinically relevant results. The present study thus serves as a proof of concept to facilitate future study and further development of this methodology into a non-invasive device.

Smartphone-based point-of-care testing (POCT) is rapidly emerging as an alternative to traditional screening and laboratory testing, particularly in resource-limited settings. In this proof-of-concept study, we present a smartphone- and cloud-based artificial intelligence quantitative analysis system (SCAISY) for relative quantification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific IgG antibody lateral flow assays that enables rapid and accurate evaluation of test strips. By capturing an image with a smartphone camera, SCAISY quantitatively analyzes antibody levels and provides results to the user. We analyzed changes in antibody levels over time in over 248 individuals, including vaccine type, number of doses, and infection status, with a standard deviation of less than 10%. We also tracked antibody levels in six participants before and after SARS-CoV-2 infection. Finally, we examined the effects of lighting conditions, camera angle, and smartphone type to ensure consistency and reproducibility. This study suggests that SCAISY is a simple and powerful tool for real-time public health surveillance, enabling the acceleration of quantifying SARS-CoV-2-specific antibodies generated by either vaccination or infection and tracking of personal immunity levels.

The coronavirus disease of 2019, COVID-19, is caused by an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was recognized in late 2019 and has since spread worldwide leading to a pandemic with unprecedented health and financial consequences. There remains an enormous demand for new diagnostic methods that can deliver fast, low-cost, and easy-to-use confirmation of a SARS-CoV-2 infection. We have developed an affordable electrochemical biosensor for the rapid detection of serological immunoglobulin (Ig) G antibody in sera against the Spike protein. Materials and Methods: A previously identified linear B-cell epitope (EP) specific to SARS-CoV-2 spike glycoprotein and recognized by IgG in patient sera was selected for the target molecule. After synthesis, the EP was immobilized onto the surface of the working electrode of a commercially available screen-printed electrode (SPE). The capture of SARS-CoV-2 specific IgGs allowed the formation of an immunocomples that was measured by square wave voltammetry from its generation of hydroquinone (HQ). Results: An evaluation of the performance of the EP-based biosensor presented a selectivity and specificity for COVID-19 of 93% and 100%, respectively. No cross-reaction was observed to antibodies against other diseases that included Chagas disease, Chikungunya, Leishmaniosis, and Dengue. Differentiation of infected and non-infected individuals was possible even at high dilution factor that decreased the required sample volumes to a few microliters. Conclusion: The final device proved suitable for diagnosing COVID-19 assaying actual serum samples and the results displayed good agreement with the molecular biology diagnoses. The flexibility to conjugate other EPs to SPEs suggests that this technology could be rapidly adapted to diagnose new variants of SARS-CoV-2 or other pathogens.

Biosensors have shown great potential in realizing rapid, low cost and portable on-site detection for diseases. This work reports the development of a new bioelectronic sensor called AC electrokinetics-based capacitive (ABC) biosensor, for the detection of genomic DNA (gDNA) of methicillin-resistant Staphylococcus aureus (MRSA). The ABC sensor is based on interdigitated microelectrodes biofunctionalized with oligonucleotide probes. It uses a special AC signal for direct capacitive monitoring of topological change on nanostructured sensor surface, which simultaneously induce dieletrophoretic enrichment of target gDNAs. As a result, rapid and specific detection of gDNA/probe hybridization can be realized with high sensitivity. It requires no signal amplification such as labelling, hybridization chain reaction, or nucleic acid sequence-based amplification. This method involves only simple sample preparation. After optimization of nano-structured sensor surface and signal processing, the ABC sensor demonstrated fast turnaround of results (~10 s detection), excellent sensitivity (a detection limit of 4.7 DNA copies /µL MRSA gDNA) and high specificity, suitable for point of care diagnosis. As a bioelectronic sensor, the developed ABC sensors can be easily adapted for detection of other infectious agents.

The COVID-19 pandemic has created huge damage to society and brought panics around the world. Such panics can be ascribed to the seemingly deceptive features of the COVID-19: compared to other deadly viral outspreads, it has medium transmission and mortality rates. As a result, the severity of the causative coronavirus, SARS-CoV-2, was deeply underestimated by the society at the beginning of the COVID-19 outbreak. Based on this, in this review, we define the viruses with features similar to those of SARS-CoV-2 as the Panic Zone viruses. To contain those viruses, accurate and fast diagnosis followed by effective isolation and treatment of patients are pivotal at the early stage of virus breakouts. This is especially true when there is no cure or vaccine available for a transmissible disease, which is the case for current COVID-19 pandemic. As of January 2021, more than two hundred kits for the COVID-19 diagnosis on the market are surveyed in this review, while emerging sensing techniques for SARS-CoV-2 are also discussed. It is of critical importance to rationally use these kits for the efficient management and control of the Panic Zone viruses. Therefore, we discuss guidelines to select diagnostic kits at different outbreak stages of the Panic Zone viruses, SARS-CoV-2 in particular. While it is of utmost importance to use nucleic acid-based detection kits with low false negativity (high sensitivity) at the early stage of an outbreak, the low false positivity (high specificity) gains its importance at later stages of the outbreak. When a society is set to reopen from the lock-down stage of the COVID-19 pandemic, it becomes critical to have antibody based immunoassay kits with high specificity to identify people who can safely return to the society after their recovery of SARS-CoV-2 infections. Given that the emergence of mutant viruses at the beginning of 2021 has complicated current battle against the COVID-19, we also discussed approaches and guidelines to detect viral mutants in the middle of the second wave of the pandemic that started at the end of 2020. Finally, since a massive attack from a viral pandemic requires a massive defense from the whole society, we urge both government and private sectors to research and develop more affordable and reliable point-of-care testing (POCT) kits, which can be used massively by the general public (and therefore called as massive POCT) to contain Panic Zone viruses in future.

Analytical chemistry applied to medical and diagnostic analysis, recently focused on the development of cost-effective biosensors able to monitor the health status or to assess the level of specific biomarkers that can be indicative for several diseases. The improvement of technologies relating to the possibility of non-invasive sampling of biological fluids, as well as sensors for the detection of analytical signals and the computational capabilities of the systems routinely employed in everyday life (e.g. smartphones, computers, etc.), make the complete integration of self-standing analytical devices more accessible. This review aims to discuss the biosensors that have been proposed in the last 5 years focusing on two principal detecting approaches, optical and electrochemical, which have been employed for quantifying different kind of target analytes reaching detection limits below the clinical sample levels required. These detection principles applied to Point-of-care (POC) devices, have been extensively reported in literature and even the limited examples found on the market are based on these strategies. This work will show the latest innovations considering the integration of optical and electrochemical detection with the most commonly reported analytical platforms for POC applications such as paper-based or wearable and implantable devices.

Background and Objectives: Acute Heart Failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying the pulmonary hypertension (PH) in patients admitted due to AHF, predict the evolution of the disease during hospitalization and identify areas of improvement in the care of patients with AHF. Materials and Methods: Patients were evaluated with a standard exam of lung ultrasound, echocardiography, inferior vena cava (IVC) and femoral, renal, hepatic, portal venous Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation – SD 13,4). Seven patients (23.3%) had a renal function worsening. Regarding ultrasound findings, venous excess ultrasonography score (VExUS) score was calculated at admission and at discharge, surprisingly remaining unchanged or even worsened in most of them (21 patients, 70.0%). The area under the curve for the Lung Score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (p &lt;0.001), hepatic vein Doppler (p &lt;0.001), portal vein Doppler (p = 0.030), intra-renal vein Doppler (p = 0.025) and VExUS score (p = 0.023), remaining similar the femoral vein Doppler (p = 0.177) and IVC (p = 0.132). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VExUS score, should be further studied in different populations before expanding its use in AHF patients.

Glioblastoma (GBM) is one of the most aggressive solid tumors, particularly due to the presence of cancer stem cells (CSCs). Today the characterization of this type of cells with an efficient, fast and low-cost method remains an issue. Hence, we have developed a microfluidic lab-on-a-chip based on dielectrophoresis (DEP) single cell electro-manipulation to measure the two crossover frequencies: f_x01 in low frequency range (below 500 kHz) and f_x02 in Ultra High Frequency range (UHF, above 50 MHz). First, in vitro conditions were investigated. U87-MG cell lines were cultured in different conditions in order to induce an undifferentiated phenotype. Then, ex vivo GBM cells from patients’ primary cell culture, were passed through the developed microfluidic system and characterized in order to reflect clinical conditions. This article demonstrates that the usual exploitation of low frequency range DEP does not allow the discrimination of the undifferentiated from the differentiated phenotypes of GBM cells. However, the presented study highlights the use of UHF-DEP as a relevant discriminant parameter. The proposed microfluidic lab-on-a-chip is able to follow the kinetic of U87-MG phenotype transformation in a CSC enrichment medium and their cancer stem cells phenotype acquirement.

This paper investigates the role of English language proficiency (ELP) as a measure of cultural integration on U.S. immigrant families’ economic integration, as measured by annual earnings, and health care market integration, as captured by annual medical care spending. Bayesian Markov Chain Monte Carlo (MCMC) estimation of a mixed bivariate ordered probit (MBOP) model of annual earnings and medical care spending is conducted using a nationally representative pooled cross-sectional sample data from the U.S. National Health Interview Surveys (NHIS). The results reveal that limited English proficiency is associated with lower marginal earnings propensities (-$44.83, -$50.66, and -$56.97), and higher marginal medical care spending propensities ($8.09, $6.09, and $4.32) for each of the three decreasing levels of ELP. Furthermore, we find a small yet statistically significant positive 7.2% correlation between immigrant families’ annual earnings and medical care spending propensities. Therefore investing to raise immigrants’ families ELP in the U.S. would not only contribute to more effective socio-economic integration, but also strengthen the U.S. workforce and economy for decades to come.

The cannabis plant has been known for millennia for its properties such as textile fiber, food, recreational and medicinal use. Since the origin of its domestication in Asia, cannabis has been transported to the rest of the continents by merchants, nomads, settlers, and slaves, who have also carried with them valuable knowledge about its uses. Its medical use was one of the major contributions of this plant in the various civilizations through which it passed. This article aims to understand its origins, dissemination, and medical use over the years to the present day.

An increasingly frail population in nursing homes accentuates the need for high quality care at the end of life and better access to palliative care in this context. Implementation of palliative care and its outcomes can be monitored by using quality indicators. Therefore, we developed a quality indicator set for palliative care in nursing homes and a tailored measurement procedure using a mixed-methods design. We developed the instrument in three phases: 1) literature search, 2) interviews with experts and 3) indicator and measurement selection by expert consensus (RAND/UCLA). Second, we pilot tested and evaluated the instrument in nine nursing homes in Flanders, Belgium. After identifying 26 indicators in the literature and expert interviews, 19 of them were selected through expert consensus. Setting-specific themes were advance care planning, autonomy and communication with family. The quantitative and qualitative analyses showed the indicators were measurable, had good preliminary face validity and discriminative power and were considered useful in terms of quality monitoring according to the caregivers. The quality indicators can be used in a large implementation study and process evaluation in order to achieve continuous monitoring of the access to palliative care for all residents in nursing homes.

Low-complexity ultrasound systems are increasingly desired for wearable point-of-care ultra-sound and massive-channel ultrasound for 3-D matrix imaging. However, the system complexity is closely associated with the imaging capabilities, remaining as a challenge. To resolve this limitation, this study revisits the general structures of analog and digital beamformers and in-troduces a hybrid approach to implement efficient ultrasound systems. The suggested hybrid beamforming takes two stages, where the first analog stage partially beamforms M-channel RF signals to N sum-out data (M-to-N beamforming), and the second digital stage beamforms N partial sums to single final beamformed data (N-to-1 beamforming). Our approach was systematically designed and implemented, which was demonstrated with a customized 64-channel 1-D phased array using a tissue mimicking phantom. The demonstrated results indicate that the analog-digital hybrid beamforming can be applied to any kind of arrays for sophisticated 3-D imaging and tiny wearable ultrasound applications.

: Early and accurate detection of infectious diseases is a key step for surveillance, epidemiology, and control, notably timely disease diagnosis, patient management and follow-up. In this study, we aimed to develop hand-held ultra-fast duplex PCR assays coupled to amplicon detection by lateral flow (LF) immunoassay to deliver a rapid, and simple molecular diagnostic test for con-comitant detection and identification of the main Leishmania parasites encountered in Tunisia and the Old World. We selected two DNA targets to amplify L. major/L. tropica and L. infantum/L. tropica group of species DNAs, respectively. We optimized the experimental conditions of a du-plex ultra-fast PCR. The amplification is performed by a portable Palm convection PCR machine within 18 min and the products are detected by a LF cassette within 10 minutes. The test allows the identification of the infecting species according to the position and number of test lines re-vealed. Tested on a selection of DNAs of representative Leishmania strains of the three studied species (N=37), the ultra-fast duplex PCR-LF showed consistent, stable, and reproducible results. The analytical limit of detection of the test was 0.4pg for L. major, 4pg for L. infantum and 40pg for L. tropica.

Blood gas analysis plays a central role in modern medicine. Advances in technology have expanded the range of available parameters and increased the complexity of their interpretation. By applying user-centered design principles, it is possible to reduce the cognitive load associated with interpreting blood gas analysis. In this international, multicenter study, we explored anesthesiologists' perspectives on Visual Blood, a novel visualization technique for presenting blood gas analysis results. We conducted interviews with participants following two computer-based simulation studies: the first utilizing Virtual Reality (VR) (50 participants) and the second without VR (70 participants). Employing the template approach, we identified key themes in the interview responses and formulated six statements, which were rated using Likert scales: from 1 (strongly disagree) to 5 (strongly agree) in an online questionnaire. The most frequently mentioned theme was the positive usability features of Visual Blood. The online survey revealed that participants found Visual Blood to be an intuitive method for interpreting blood gas analysis (median 4, IQR 4-4, p<0.001). Participants noted that minimal training was required to effectively learn how to interpret Visual Blood (median 4, IQR 4-4, p<0.001). However, adjustments are necessary to reduce visual overload (median 4, IQR 2-4, p<0.001). Overall, Visual Blood received a favorable response. The strengths and weaknesses derived from these data will help optimize future versions of Visual Blood to improve the presentation of blood gas analysis results.

Background: A malfunction of the innate immune response in COVID-19 is associated with eosinopenia particularly in more severe cases. This study tested the hypothesis that this eosinopenia is COVID-19 specific and is associated with systemic activation of eosinophils.. Methods: Blood of 15 healthy controls and 75 adult patients with suspected COVID-19 at the ER were included before PCR testing and analyzed by point-of-care automated flow cytometry (CD10, CD11b, CD16 and CD62L) in the absence or presence of a formyl peptide (fNLF). 45 SARS-CoV-2 PCR positive patients were grouped based on disease severity. PCR negative patients with proven bacterial (n=20) or other viral (n=10) infections were used as disease controls. Eosinophils were identified with the use of the FlowSom algorithm. Results: Low blood eosinophil numbers (<100 cells/microL; p<0.005) were found both in patients with COVID-19 and with other infectious diseases albeit less pronounced. Two discrete eosinophil populations were identified in healthy controls both before and after activation with fNLF based on the expression of CD11b. Before activation, the CD11bbright population consisted of 5.4% (CI95% = 3.8, 13.4) of total eosinophils. After activation, this population of CD11bbright cells comprised nearly half the population (42.21%, CI95% = 35.9, 54.1). Eosinophils in COVID-19 had a similar percentage of CD11bbright cells before activation (7.6%, CI95% = 4.5, 13.6), but were clearly refractory to activation with fNLF as a much lower percentage of cells end up in the CD11bbright fraction after activation (23.7%, CI95% = 18.5, 27.6; p<0.001). Conclusion: Low eosinophil numbers in COVID-19 are associated with refractoriness in responsiveness to fNLF, which is likely caused by migration of fully functional cells to the tissue. Such homing might be beneficial as eosinophils have been implicated in viral killing.

Introduction: Identifying the complexity of palliative care needs is a key aspect of referral to specialised multidisciplinary early palliative care (EPC) teams. The PALCOM scale is an instrument consisting of five multidimensional assessment domains, developed in 2018 and validated in 2023, to identify the level of complexity in patients with advanced cancer. Objectives: The main objective of this study was to determine the degree of instability (likelihood of level change or death), health resource consumption and survival of patients according to the level of palliative complexity assigned at the baseline visit during a 6-month follow-up. Method: An observational, prospective, multicentre study was conducted using pooled data from the development and validation cohort of the PALCOM scale. The main outcome variables were: a) instability ratio (IR), defined as the probability of level change or death; b) emergency department visits; c) days of hospitalisation; d) hospital death; e) survival. All variables were analysed monthly according to the level of complexity assigned at the baseline visit. Results: A total of 607 patients with advanced cancer were enrolled. According to the PALCOM scale, 20% of patients were classified as low complexity, 50% as medium and 30% as high complexity. The overall IR was 45% in the low complexity group, 68% in the medium complexity group and 78% in the high complexity group (p

Neonatal palliative care (NPC) is an integrated and holistic approach that is an integral part of the contemporary neonatal treatment delivery paradigm. It is the highest fulfillment of the notion of beneficence (doing or creating 'good') that has otherwise been neglected/underestimated by the focus of modern medicine on technology and instrumental treatments by its commitment to alleviating patient pain and quality of life. For decades, the Double-Effect Doctrine (DDE) has been used to consider and address a range of ethically questionable circumstances, often at the end of life, including euthanasia, termination of pregnancy to save maternal life, and morally justified warfare. The theory has continued to be mired in controversy as ethicists, legal scholars, theologians, and philosophers discuss the abstract concepts of moral reasoning, purpose, foresight, and other underlying moral theories. In this paper, the moral theory of DDE is discussed in its clinical application to the ethical decision-making process in neonatal palliative and end-of-life treatment, specifically 1) the administration of opioids as required for symptom control and 2) the use of palliative sedation for intractable symptom care.

Determination of the presence in the blood of antibodies specific to the causative agent of a particular disease (serodiagnosis) is an effective approach in medical analytical chemistry. Serodiagnostics performed in the lateral flow immunoassay format (immunochromatography) meet the modern requirements for point-of-care testing and are supported by existing technologies of large-scale diagnostic tests production—thus raising increased attention in a tense epidemiological situation. For traditional lateral flow serodiagnostics formats, a large number of nonspecific immunoglobulins in the sample significantly reduces the degree of detectable binding. To overcome these limitations, an assay based on the formation of immobilized antigen— specific antibody—labeled antigen complexes detection was proposed. However, the requirements for its implementation, providing maximum sensitivity, have not been established. This article describes the mathematical model for the above assay. The influence of the ratio of reagent concentrations on the analysis results is considered. It is noted that the formation of specific antibody complexes with several labeled antigens is the main limiting factor in reducing the detection limit, and methods are proposed to minimize this factor. Recommendations for the choice of the assay conditions, following from the analysis of the model, are confirmed experimentally.

Objective: To examine variations in end-of-life care for breast cancer, heart failure, and dementia patients. Data and methods: Data from four Norwegian health registries were linked using a personal identification number. Longitudinal trends over 365 days and the type of care on the final day of life were analyzed using descriptive techniques and logistic regression analysis. Results: Patients with dementia were most commonly placed in nursing homes, while patients with heart failure and breast cancer were more frequently hospitalized. Breast cancer and heart failure patients had a higher likelihood of dying at home. The presence of general practitioners increased the probability of home-based end-of-life care for cancer patients, while non-physician healthcare workers increased the likelihood of home-based care for the other patient groups. Conclusion: Diagnoses, individual characteristics, and service availability are all associated with the place of death in end-of-life care.

Caudal regression syndrome (CRS) is a congenital abnormality characterized by an incomplete development of the spinal cord (SC) and other abnormalities. We studied a 9-months old CRS child presenting: interruption of SC at L2-L3 level, sacral agenesis, lack of innervation of the inferior limbs (flaccid paraplegia) and neurogenic bladder and bowel. Given the effects of growth hormone (GH) on the proliferation, differentiation and migration of neural stem cells (NSCs), we treated him with GH and rehabilitation, trying to induce the recovery of main sequelae. GMFM-88 test score was 12.31%. After a blood analysis, GH treatment (0.3 mg/day, 5 days/week, 3 months and then 15 days without GH) and rehabilitation commenced. This protocol was followed during 5 years, being the last GH dose 1 mg/day. Blood analysis and physical exams were performed every 3 months initially and every 6 months later. Six months after commencing the treatment GMFM-88 score increased to 39.48%. Responses to sensitive stimuli appeared in most of the territories explored; 18 months later sensitive innervation was complete and the patient moved any muscle over the knees and controlled his sphincters. Three years later he walked with the help of canes, there was plantar flexion and GMFM-88 score was 78.48%. In summary, GH plus rehabilitation may be useful for innervating distal territories, below the level of the incomplete spinal cord in CRS. Most likely, GH acts on ependymal SC NSCs, as the hormone does in the neurogenic niches in the brain.

Background: Two types of medicinal systems are available in Korea: Western and oriental. These exist as separate services that independently provide medical care to patients. We determined the utility and benefits of compressive and integrated medical services (CIMS) comprising 12 sessions of acupuncture and healing programs over 6 weeks. Methods: In this two-group parallel single-center randomized controlled assessor-blinded trial, 24 participants were assigned to either the experimental (conventional medical treatment plus CIMS, n = 12) or control (conventional medical treatment, n = 13) group. Spinal nerve root block was performed on the compressed spinal nerve root (identified using magnetic resonance imaging) when no improvement was observed after the initial treatment. The experimental group received 12 cycles of acupuncture and manual therapy for 6 weeks; the control group received conventional medical treatment alone. Results: The average age of participants in the experimental and control groups was 70.73 ± 5.95 and 67.33 ± 8.89 years, respectively. There were no significant differences between the groups in terms of age, body mass index, Leeds Assessment of Neuropathic Symptoms and Signs, sex, and current medical history. We found high compliance for both programs (acupuncture and healing). On exclusion of between-group effects, the visual analog scale (VAS) score improved significantly over time (p = 0.045). Further, comparison of the groups after excluding the effects of visits revealed significantly lower VAS scores in the experimental group than in the control group (p = 0.000). Conclusions: Patients with degenerative lumbar spinal stenosis who mainly complain of radiating pain in the lower leg may benefit from CIMS after spinal nerve root block for ≤3 months after treatment. Our study findings suggest that this treatment improves spinal function and Oswestry Disability Index score. However, CIMS did not improve QoL.

8-Hydroxydeoxyguanosine (8-OHdG) was the most widely used oxidative stress biomarker of the free radical-induced oxidative damage product of DNA, which may allow a premature assessment of various diseases. This paper designed a label-free, portable biosensor device to direct detect 8-OHdG by plasma coupled electrochemistry on transparent and conductive indium tin oxide (ITO) electrode. We reported a flexible printed ITO electrode made from particle-free silver and carbon inks. After inkjet printing, the working electrode was sequentially assembled by gold nanotriangles (AuNTAs) and platinum nanoparticles (PtNPs). This nanomaterial-modified portable biosensor showed excellent electrochemical performance for 8-OHdG detection from 10 μg/mL to 100 μg/mL by our self-developed constant voltage source integrated circuit system. This work demonstrated a portable biosensor for simultaneously integrating nanostructure, electroconductivity, and biocompatibility to construct advanced biosensors for oxidative damage biomarkers. The proposed nanomaterial modified ITO-based electrochemical portable device was a potential biosensor to approach 8-OHdG point-of-care testing (POCT) in various biological fluid samples, such as saliva and urine samples.

Lung ultrasound (LUS) allows the detection of a series of manifestations of COVID-19 such as B lines and consolidations. The objective of this work was to study the inter-rater reliability (IRR) when detecting signs associated with COVID-19 in the LUS, as well as the impact of performing the test in the longitudinal or transverse orientation. 33 physicians with advanced experience in LUS, independently evaluated ultrasound videos previously acquired with the ULTRACOV system of 20 patients with confirmed COVID-19. In each patient, 24 videos of 3 seconds were acquired (using 12 positions with the probe in longitudinal and transverse orientations). Physicians had no information about the patients or other previous evaluations. The score assigned to each acquisition followed the convention applied in previous studies. A substantial IRR was found in the cases of normal LUS (κ = 0.74), only a fair IRR for the presence of individual B lines (κ = 0.36) and for confluent B lines occupying &lt;50% (κ = 0.26), and a moderate IRR in consolidations and B-lines &gt;50% (κ = 0.50). No statistically significant differences between the longitudinal and transverse scans were found. The IRR in LUS of COVID-19 patients may benefit from more standardization of the clinical protocols.

Biosensors are measurement devices that can sense several biomolecules, and are widely used for the detection of relevant clinical pathogens such as bacteria and viruses, showing outstanding results. Because of the latent existing risk of facing another pandemic like the one we are living due to COVID-19, researchers are constantly looking forward to developing new technologies for diagnosis and treatment of infections caused by different bacteria and viruses. Regarding that, nanotechnology has improved biosensors design and performance through the development of materials and nanoparticles that enhance their affinity, selectivity, and efficacy in detecting these pathogens, such as employing nanoparticles, graphene quantum dots, and electrospun nanofibers. Therefore, this work aims to present a comprehensive review that exposes how biosensors work in terms of bacterial and viral detection, and the nanotechnological features that are contributing to achieving a faster yet still efficient COVID-19 diagnosis at the point-of-care.

It has become practically impossible to survey the literature on cells derived from adipose tissue with the aim to apply them in regenerative medicine. The aim of this review is to provide a jump start to understanding the potential of UA-ADRCs (uncultured, unmodified, fresh, autologous adipose derived regenerative cells isolated at the point of care) in regenerative medicine. We show that serious and adequate clinical research demonstrates that tissue regeneration with UA-ADRCs is safe and effective. ADRCs are neither 'fat stem cells' nor could they exclusively be isolated from adipose tissue, as ADRCs contain the same adult (depending on the definition) pluripotent or multipotent stem cells that are ubiquitously present in the walls of small blood vessels. Of note, the specific isolation procedure used has significant impact on the number and viability of the cells and hence on safety and efficacy of UA-ADRCs. Furthermore, there is no need to further separate adipose-derived stem cells (ASCs) from ADRCs if the latter were adequately isolated from adipose tissue. Most importantly, UA-ADRCs have the physiological capacity to adequately regenerate tissue without need for manipulating, stimulating and/or (genetically) reprogramming the cells for this purpose. Tissue regeneration with UA-ADRCs fulfills the criteria of homologous use.

This study examines demographic factors which may influence opinions concerning medical students’ self-care and substance use behaviors as a means of providing insights into how future doctors view these issues compared to Australian doctors and members of the public. We conducted national, multicenter, prospective, on-line cross-sectional surveys using hypothetical scenarios to three cohorts- Australian medical students, medical doctors, and the public. Participants’ responses were compared for the different contextual variables within the scenarios and the participants’ demographic characteristics. In total 2,602 medical students, 809 doctors and 503 members of the public participated. Compared with doctors and the public, medical students were least tolerant of alcohol intoxication, and most tolerant of using stimulants to assist with study, and cannabis for anxiety. Doctor respondents more often aligned with the public’s opinions on the acceptability of the medical students’ behaviors. Although opinions are not equivalent to behaviour, Australian students’ views on the acceptability for cannabis to help manage anxiety, and inappropriate use of prescription-only drugs are concerning; these future doctors will be responsible for prescribing drugs and managing patients with substance abuse problems. However, if current Australian medical student’s opinions on alcohol misuse persist, one of the commonest substance addictions amongst doctors may decrease in future.

We aimed to delineate cardiopulmonary interactions in acute bronchiolitis and to evaluate the capacity of a combined cardiopulmonary ultrasonography to predict the need for respiratory support. This was a prospective observational single-center study that includes infants < 12 month of age admitted to a hospital due to acute bronchiolitis. All the included patients under-went clinical, laboratory and cardiopulmonary ultrasonographic evaluation at the same time point within 24 hours of hospital admission. The existence of significant correlation between car-diac and respiratory parameters was the primary outcome. The association of different cardio-pulmonary variables with the need of respiratory support higher than O2, the length of stay hos-pitalization, the PICU stay, and the duration of respiratory support were a secondary outcome. We enrolled 112 infants (median age 1 (0.5-3) months; 62% males) hospitalized with acute bron-chiolitis. Increased values of the pulmonary variables (BROSJOD score, pCO2 and LUS) showed moderate correlations with NT-proBNP and all echocardiographic parameters indicative of pulmonary hypertension and myocardial dysfunction. Up to 36 (32%) infants required respira-tory support during the hospitalization. This group presented with higher lung ultrasound score (p<0.001), and increased values of Tei index (p<0.001) and pulmonary artery pressures (p<0.001). All the analyzed respiratory and cardiac variables showed moderate to strong correlations with the LOS hospitalization and the time of respiratory support. Lung ultrasound and echocardiog-raphy showed a moderate to strong predictive accuracy for the need of respiratory support in the ROC analysis, with AUC varying from 0.74 to 0.87. Conclusion: Those cases of bronchiolitis with a worse pulmonary status presented with a more impaired cardiac status. Cardiopulmonary ul-trasonography could be a good strategy to easily identify high-risk population for a complicated acute bronchiolitis hospitalization.

The Epithelial-Mesenchymal-Transition (EMT) phenotype, identified as a significant clinical indicator in cancer, manifests as a biological process where cells transition from epithelial to mesenchymal characteristics. Physiologically, EMT plays a crucial role in tissue remodeling, promoting healing, repair, and responding to various tissue damages. This study investigates the impact of BNE-RRC on oral cancer cells (KB) and reveals its significant effects on cancer cell growth, migration, invasion, and EMT. BNE-RRC induces the epithelial-like morphology in KB cells, effectively reversing EMT to Mesenchymal-Epithelial Transition (MET). Extraordinarily, sustained culture of cancer cells with BNE-RRC for 14 days maintains an epithelial status even after treatment withdrawal, suggesting BNE-RRC as a potential therapeutic agent for cancer. These findings highligh the promise of BNE-RRC as a comprehensive therapeutic agent in cancer treatment by inhibiting cancer cell growth, migration, and invasion, while also orchestrating a reversal of the EMT process. The study proposes that BNE-RRC could be effective agent for cancer treatment.

Tandem mass spectrometry (MS/MS) for diagnosing inborn errors of metabolism (IEM) is recognized as an ethical, safe, simple, and reliable screening test. Presented bibliometric analysis aims to describe the network structure of the scientific community in the study area at the level of countries, institutions, authors, papers, keywords, and sources; scientific productivity, directions, and collaboration efforts in a considered period (1991–2023.) Using the PRISMA method, we conducted a systematic search for articles reporting using MS/MS to screen for inherited metabolic disorders and inborn errors of metabolism collected from the Web of Science Core Collection (WOSCC.) A total of 451 articles out of 546, by 2,682 authors, published in 190 journals, with 15,440 citations in 8,181 citing articles, with an average citation of 34.24 per article, and an H-index of 64 were retrieved from the WOSCC. The research status of MS/MS in IEM screening was identified. The most relevant current research directions and future areas of interest were revealed: "selective screening for IEM," "new treatments for IEM," "new disorders considered for MS/MS testing," "ethical issues associated with newborn screening," "new technologies that may be used for newborn screening," "use of a combination of MS/MS and gene sequencing," etc.

Duct-dependent lesions are classically divided into duct dependent pulmonary circulation which involves severe right sided obstructive lesions such as pulmonary atresia or critical stenosis, and duct dependent systemic circulation which is characterized by malformation of the left side of the heart, and whose severest spectrum is hypoplastic left heart syndrome. Dextro-transposition of the great arteries remains in gray zone between being included in some old classifications as a duct dependent pulmonary circulation lesion or a new category of duct-dependent or independent mixing lesion. We hypothesize that re-classifying duct dependent congenital defects into duct dependent perfusion and oxygenation offers a model to fit D-TGA into the same category of right sided obstructive lesions and reflects the clinical spectrum in a more comprehensive way.

The SARS-CoV-2 virus that causes the COVID-19 disease has wreaked havoc on the world community in terms of every imaginable parameter. The research output on COVID-19 has been nothing short of phenomenal, especially in the medical and biomedical sciences, where the search for a potential vaccine is being conducted in earnest. Much of the advanced research has been distributed in the leading medical journals, including the Journal of the American Medical Association (JAMA), where the latest research is distributed on a daily basis. The purpose of this paper is to provide some perspectives on 44 interesting and highly topical research papers that have been published in JAMA, at the time of writing, within the past two weeks. The diverse topics include public health, general medicine, internal medicine, oncology, paediatrics, geriatrics, and biostatistics.

The current article examined stoma self-care and health-related quality of life in patients with drainage enterostomy, describe clinical and sociodemographic variables and analyze the relations between all of them. Trained interviewers collected data using a standardized form that queried sociodemographic and clinical variables, collected from the electronic medical record, in addition to the Specific Self-Care for Ostomized Patients Questionnaire (CAESPO) and Stoma Quality of life (S-QoL) from January 2016 to January 2017. This was a multicenter, cross sectional study conducted in four hospitals of the province of Castellon (Spain) where 120 participants were studied. Significant differences were found in Self Care according to sex (p = .043); married participants show higher score (p < .01); also, significant differences according to work activity were observed (p < .01). Regarding the clinical variables, differences were observed according to the autonomy of care, the presence of complications in the stoma, the use of irrigation and the type of effluent (p < .01). We can highlight the importance of the skills related to self-care by ostomized patients has for a good level of quality of life related to health. In this learning process, the figure of the stoma therapist plays a very important role.

This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons’ Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants’ views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.

SARS-CoV-2, influenza A/B virus (IAV/IBV) and respiratory syncytial virus (RSV) are among the common viruses causing acute respiratory infections. Clinical diagnosis to differentiate these viruses is challenging due to similar clinical presentations, thus laboratory-based real-time RT PCR is the gold standard for diagnosis. The study aimed to evaluate the diagnostic performance of STANDARD M10 Flu/RSV/SARS-CoV-2 (SD Biosensor Inc, Seoul, Korea). This retrospective study was conducted with archived respiratory samples positive and negative for SARS-CoV-2, IAV, IBV or RSV. The evaluation study involved a total of 322 respiratory samples comprising 215 positive samples (49 SARS-CoV-2, 48 IAV, 53 IBV, 65 RSV) and 107 negative samples. All samples were tested with both STANDARD M10 and either Xpert Xpress SARS-CoV-2 or Xpert Xpress Flu/RSV (Cepheid, USA). The sensitivity, specificity, positive predictive value and negative predictive value rates of STANDARD M10 were very similar to Xpert Xpress SARS-CoV-2 or Xpert Xpress Flu/RSV ranges for each virus (98-100%). The overall agreement was 99.4% with 99.1% agreement for positive samples and 100% agreement for negative samples. In conclusion, the STANDARD M10 point-of-care test is suitable for rapid simultaneous detection of SARS-CoV-2, IAV, IBV and RSV.

Background: Low-level physical activity (PA) among Chronic Low Back Pain (cLBP) is associated with various biopsychosocial factors. This research aimed to study the predictors of PA behavior among cLBP patients. Methods: In the present study 300 eligible patients with cLBP who referred to comprehensive health service centers in the Shahid Beheshti University of Medical Sciences (SBUMS) in Tehran, Iran were random selected.To diagnose the predictors of PA behavior, all the Theory of Reasoned Action (TRA) constructs were examined as risk factors to see if they influence on the probability of PA behavior occurrence and were interpreted through odds ratio (OR). SPSS version 19 was used to analyze the data. Results: Totally 280 cLBP patients with mean age of 57.07 ±13.09 years old participated in the study. This study showed that motivation to comply significant predictor the cLBP patients for subjective norm OR (%95CI): 2.095(0.116-2.792), p-value<0.001), intention was significant predictor for perform the PA behavior OR (%95CI): 1.431(0.138-1.538), p-value <0.001), behavior beliefs could predictor for attitude OR (%95CI): 1.276(0.106-1.355), p-value= 0.002). attitude, normative beliefs, subjective norm ,and evaluation outcome behavior could predictors the cLBP patients for intention to perform the PA behavior OR (%95CI): 1.188(0.032-1.312), p-value<0.001)., OR (%95CI): 1.158(0.076-2.208), p-value=0.003) ., OR (%95CI): 1.104(0.076-1.128), p-value<0.001) ., OR (%95CI): 0.814(0.301-1.440), p-value=0.007). Conclusions: This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm). This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm). This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm).

Conclusions: Our findings suggest that the NMS-E represents a valuable preoperative diagnostic tool for endometriosis, effectively correlating with the disease's severity and surgical outcomes. Incorporating the NMS-E into clinical practice could significantly enhance the management of endometriosis by addressing current diagnostic limitations and guiding surgical planning.

The study aims to identify the difference in communication needs of women giving birth and women during puerperium. An additional goal includes the analysis of the experience and communication needs through the context of a woman's approach to childbirth. The study is a prospective, cross-sectional, self-report survey. 521 women between 5 and 10 days after birth participated in the study. Women perceived information provided by the medical staff as the most helpful aspect of verbal communication both during labour and puerperium. Maintaining eye contact with the medical staff was perceived as the most helpful aspect of non-verbal communication. Women were more satisfied with communication during labour and birth than in the maternity ward and those after non-instrumental childbirth were more satisfied with communication compared to the instrumental birth group. Women perceiving childbirth as the natural, physiological process considered verbal and non-verbal communication during and after childbirth as less helpful than women perceiving birth as more risky and requiring interventions. The results of the study emphasize the importance of verbal and non-verbal communication during birth and puerperium and different communication needs during labour and early postpartum. It also showed that women who perceive labour as a physiological process seem to be less dependent on the communication with the medical staff than women who accept medical interventions during labour and birth as necessary.

Mental Health Care Users (MHCUs) are admitted in general wards with medical and surgical conditions where non-psychiatric nurses are allocated to render services for medical and surgical conditions. Non-psychiatric nurses are expected to care for MHCUs in general wards regardless of their knowledge and skills which is against the Mental Health Care Act. The purpose of the study was to explore and describe the experiences of non-psychiatric nurses in car-ing for MHCUs admitted in general wards in Limpopo Province. Qualitative approach using explorative, descriptive, and contextual design was adopted for the study. Methodology included the setting, population, sampling, ethical con-siderations, and the measures to ensure trustworthiness. The study was conducted in four general hospitals of Limpopo Province, South Africa with mental health care wards, medical ward and surgical ward which were selected through simple random sampling. Semi structured Individual interviews were used to collect data from twenty professional nurses until data saturation. Data was analysed using Tesch’ s method. Ethical considerations were adhered to throughout the study. Themes that emerged after data analysis were: Managing MHCUs, Types of patient’s behaviour. The study concluded that professional nurses without psychiatry caring for MHCUs in general wards need training to provide holistic care.

Many ailments can be diagnosed while they are asymptomatic, meaning that the patient has no signs or symptoms of a progressing disease. If caught in their initial stage of formation, these maladies can be effectively treated, leading to successful outcomes; curative therapies can halt illnesses from advancing, thus improving the quality of life, and long-term survival of the patient. Still cutting-edge upgrades in precision technologies are necessary for early, reliable, affordable, and rapid disease detection, but also are vital for the well-being of people and the future of global public health. The emerging role and utility of non-invasive and repeatable diagnostic test approaches for detection of health conditions has been liquid biopsies based on genomic biomarkers. As such, biological fluids permit any measurable molecular indicator or signature (e.g., proteins), to provide valuable information on individual’s wellness and/or disease. Among the bodily secretions used for non-invasive diagnostics is sputum, a complex viscous gel-like biopolymeric network, that has gained growing recognition as a rich source of biomarkers of airway infections, pulmonary diseases, and serves as a determinant to reveal other illnesses. As per the World Health Organization, the burden of respiratory conditions is exacerbated by factors, ranging from considerable subjection to air pollution and occupational contaminants, to tobacco smoking and second-hand smoke, in addition to poor socio-economic status. Due to the likely increase of these determinants, respiratory tract ailments are on the rise, affecting the health of many individuals, in addition to putting stress on healthcare facilities and services worldwide. We therefore highlight the need to use expectorated or induced sputum specimens as a routine sample source for testing valuable protein biomarkers to diagnose these chronic maladies, to predict inflammation and disease progression, as well as monitor the effectiveness of treatments. Further, we discuss the urgency for fast and reliable point-of-care methods to detect and quantify crucial protein biomarkers in sputum specimens, and limitations faced when dealing with their complex matrices.

Mortality and readmission rates for decompensated acute heart failure (AHF) is overall increasing and risk stratification might be challenging. We sought to evaluate the prognostic role of systemic venous ultraso-nography in patients hospitalized for AHF. We prospectively recruited 74 AHF patients with a NT-proBNP level above 500 pg/mL. Then, a multiorgan ultrasound assessment (lung, inferior vena cava, Doppler of hepatic, portal, intrarenal and femoral veins) were performed at admission, discharge, and follow-up (for 90 days). An intrarenal monophasic pattern (AUC 0.923, Sn 90%, Sp 81%, PPV 43%, NPV 98%), a portal pulsatility >50% (AUC 0.749, Sn 80%, Sp 69%, PPV 30%, NPV 96%) and a VExUS score of 3 (AUC 0.885, sensitivity 80%, specificity 75%, PPV 33%, NPV 96%) predicted death during hospitalization. An IVC above 2 cm (AUC 0.758, Sn 93.l% and Sp 58.3) and the presence of an intrarenal monophasic pattern (AUC 0. 834, sensitivity 0.917, specificity 67.4%) in the follow-up visit predicted AHF related readmission. Addi-tional scans during hospitalization or calculate a VExUS score probably adds unnecessary complexity to the assessment of AHF patients. In conclusion, VExUS score does not contribute to guide therapy or the predic-tion of complications, compared to the presence of an inferior vena cava greater than 2 cm, a venous mo-nophasic intrarenal pattern or a pulsatility > 50% of the portal vein in AHF patients. Early and multidisci-plinary follow-up visit remains necessary to improve prognosis of this highly prevalent disease.

Current clinical treatment options for symptomatic, partial-thickness rotator cuff tear (sPTRCT) offer only limited potential for true tissue healing and improvement of clinical results. In animal models, injections of adult stem cells isolated from adipose tissue into tendon injuries evidenced histological regeneration of tendon tissue. However, it is unclear whether such beneficial effects could also be observed in a human tendon treated with fresh, uncultured, autologous, adipose derived regenerative cells (UA-ADRCs). A specific challenge in this regard is that UA-ADRCs cannot be labeled and, thus, not unequivocally identified in the host tissue. Therefore, histological regeneration of injured human tendons after injection of UA-ADRCs must be assessed using comprehensive, immunohistochemical and microscopic analysis of biopsies taken from the treated tendon a few weeks after injection of UA-ADRCs.

To explore the relevant factors that affect the efficacy of consciousness-regaining therapy (CRT)for prolonged disorder of consciousness(pDOC),a retrospective analysis was conducted on the case data of 114 patients with pDOC admitted to department of functional neurosurgery of Tianjin Huanhu Hospital from January 2019 to January 2022. Basic information on the cases,data on pDOC disease assessment, consciousness-regaining therapy methods, and efficacy evaluation were collected. A total of 114 patients were grouped and compared based on the efficacy at the end of treatment. Among them, there were 61 cases in the ineffective group and 53 cases in the effective group. There was no statistically significant difference (P&gt;0.05) between the two groups in terms of gender, age, etiology, acute cerebral herniation, emergency craniotomy surgery, emergency decompressive craniectomy, time from onset to start of consciousness-regaining therapy , and duration of consciousness-regaining therapy(P&gt;0.05). However, there were statistically significant differences (P&lt;0.05) in terms of secondary hydrocephalus, , consciousness-regaining therapy methods, CRS-R grading before treatment, and GOSE score at 6 months after treatment. Binary logistic regression analysis showed that the type of therapy (OR=0.169, 95% CI: 0.057-0.508) was a related factor affecting the efficacy of consciousness-regaining therapy (P&lt;0.05).Compared with non-invasive therapy, personalized awakening therapy using various invasive consciousness-regaining therapy methods can help improve the efficacy of therapy for pDOC.

Obtaining a genetic diagnosis of a primary mitochondrial disease (PMD) is often framed as a diagnostic odyssey. Yet, even after receiving a diagnosis, parents of affected children experience ongoing therapeutic and prognostic uncertainty, and considerable psychosocial challenges. Semi-structured interviews (N= 24) were conducted with parents of 13 children (aged 2-19 years) with a genetically confirmed PMD. Paternal (N=11) and maternal (N=13) perspectives were obtained, and thematic analysis performed on all interviews. A genetic diagnosis was valuable and empowering for parents, despite eliciting varied emotional responses. While the diagnosis helped focus management decisions, families often felt overwhelmed and unsupported in navigating the healthcare system. Most parents reported a serious impact on their romantic relationship. The sources of social support varied with a preference for established friendship and family support networks over disease-specific community support groups. Most parents favored prenatal genetic testing in the event of a future pregnancy. This study provides insight into the lived experiences of parents after a genetic diagnosis of PMD in their children. The findings draw awareness to supportive care needs and highlight important gaps that should be addressed to ensure that parents feel supported within a holistic framework of management for PMDs.

Schizoaffective disorder and its classification have always been a topic of discrepancy among researchers. The overlapping presentations of schizoaffective disorder, schizophrenia and psychotic bipolar disorder makes it difficult to classify and diagnose. This study is a narrative review of literatures and genetic and epidemiological research evidences, done to determine the similarities and differences between schizoaffective and psychotic bipolar disorder. Beginning from the introduction of schizoaffective disorder as "schizoaffective psychosis" by Kasanin in 1933, various researchers have proposed different views regarding the diagnosis and classifications for schizoaffective disorder. DSM-III considered schizoaffective disorder as a diagnosis of exclusion as it fails to fit the definite diagnostic criteria of schizophrenia, major affective disorders, or schizophreniform disorder. DSM-V updated the criteria of schizoaffective disorder and stated it as a life time illness rather than being an episodic disorder as in DSM-IV and hence is more reliable. However, some studies show that schizoaffective disorder patients are more like schizophrenia than mood disorder. It still remains unclear whether schizoaffective disorder is a heterogenous disease, a form of schizophrenia, a form of mood disorder or a midpoint in the continuation spectrum of schizophrenia and psychotic bipolar disease.

Abstract The aim of this research is to conduct a systematic review analysing the role of the physiotherapy interventions in palliative care. PRISMA as a critical appraisal tool was utilised for the selection of the research articles. The inclusion criteria were based on the year of publication, ease of availability, language, geographical location, and study type. To ensure the credibility, databases such as Elsevier, Proquest, and EBSCO Host were used to filter the grey content. Data published in the past ten years (2009-onwards) was only included to ensure the selection of the most recent interventions used by the physiotherapists. A total of 11 articles were selected which determined that physiotherapy interventions involving breathing exercises, aerobic exercises, manual therapies, and educational awareness were critical to promoting the functional capability and empower the patients.

The contemporary landscape of eHealth is characterized by major concerns related to electronic medical records (EMRs). In an EMR, critical patient health information gets its own repository, which is the core of the eHealth system. Notably, the EMR not only retrieves health information generated in ambulatory clinical settings but also includes court-generated records. These overlapping records assume the role of a foundational data source for a comprehensive electronic health record (EHR). This scholarly review sheds light on recent trends in medical records and associated challenges, while at the same time providing insights into Saudi Arabia’s targeted approaches to healthcare delivery. Additionally, the talk expands to include a description of blockchain technology and its underlying conceptual framework. This demonstration positions blockchain technology as a promising approach that requires consideration for future use in the healthcare system.

The Republic of Venice was one of the longest-lived states in modern history, and its stability and survival has been studied through many different angles, and one of them is to try and find pivotal moments in its history that explain it, or its eventual demise. In this paper, through the rigorous statistical analysis of the dataset of marriages by nobles in the Republic, we will try to define a methodology for the detection of these events through mono and multivariate change point analysis, and validate that methodology through cross-validation of different procedures, as well as matching the results to historical events. Our analysis shows that these change points occur with statistical significance and that they match political and historical events. These results can be built upon for a better understanding of the historical causes of the success and failure of the Republic of Venice and, by extension, other states.

Auto-labeling is one of the main challenges in 3D vehicle detection. Auto-labeled datasets can be used to identify objects in LiDAR data, which is a challenging task due to the large size of the dataset. In this work, we propose a novel methodology to generate new 3D based auto-labeling datasets with a different point of view setup than the one used in the most recognized datasets (KITTI, WAYMO, etc.). The performance of the methodology has been further demonstrated with the development of our own dataset with the auto-generated labels and tested under boundary conditions on a bridge in a fixed position. The proposed methodology is based on the YOLO model trained with the KITTI dataset. From a camera-LiDAR sensory fusion, it is intended to auto-label new datasets while maintaining the consistency of the Ground Truth. The main contribution of this work is a novel methodology to auto-label autonomous driving datasets using YOLO as the main labelling system. The performance of this approach is measured retraining the contrast models of the KITTI benchmark.

The Internet of Things (IoT) has a growing presence in society's daily lives. These lightweight devices can be easily deployed and maintained, enabling extensive adoption in different environments. Furthermore, one of the most promising areas for using IoT devices is healthcare, comprising devices referred to as the Internet of Medical Things (IoMT). Several examples of healthcare services are supported by IoMT devices, e.g., continuous health monitoring. Conversely, there is an increasing concern with the cybersecurity aspects of these devices, and several attacks against IoT infrastructures have been launched in the past few years. These cybersecurity concerns also apply to healthcare applications, where the tradeoff between the benefits and security of IoMT devices must be observed. Given the complexity and amount of data IoMT network traffic generates, advanced methods become especially useful in these environments. Although Machine Learning (ML) brings various techniques and solutions to improve cyberattack detection, prevention, and mitigation, essential features are not addressed in the current state-of-the-art benchmark dataset contributions. Thereupon, the main goal of this research is to propose a realistic benchmark dataset to enable the development and evaluation of IoMT security solutions. In order to accomplish this, 18 attacks were executed against an IoMT testbed composed of 40 IoMT devices (25 real devices and 15 simulated devices), considering the plurality of protocols used in healthcare (e.g., Wi-Fi, MQTT, and Bluetooth). These attacks are categorized into five classes: DDoS, DoS, Recon, MQTT, and spoofing. This effort aims to establish a baseline complementary to the state-of-the-art contributions. The outcome supports researchers in investigating and developing new solutions to make healthcare systems more secure using different mechanisms (e.g., machine learning - ML). This research goes beyond merely conducting attacks on IoMT devices. We also attempt to capture the lifecycle of these devices in different vital phases, from the moment they join the network until they leave, which is called profiling. Profiling allows the different classifiers to identify anomalies of each device individually in the healthcare network. The CICIoMT2024 dataset has been published on CIC's dataset page, making it available for other researchers to use.

Addressing non-unions involves stabilizing the affected area through osteosynthesis and improving bone biology using bone grafts. However, there is no consensus on the optimal treatment method. This study aims to compare outcomes of non-union revision using conventional treatment methods (metal hardware ± graft) versus osteosynthesis with the human, allogeneic cortical bone screw (Shark Screw®). Thirty-four patients underwent conventional treatment, while 28 cases received Shark Screws®. Patient demographics, bone healing, time to bone healing, and complications were assessed. Results revealed a healing rate of 96.4% for the Shark Screw® group, compared to 82.3% for the conventionally treated group. The Shark Screw® group exhibited a tendency for faster bone healing (9.4±3.2 vs. 12.9±8.5 weeks, p=0.05061). Hardware irritations led to six metal removals in the conventional group versus two in the Shark Screw® group. The Shark Screw® emerges as a promising option for personalized non-union treatment in the foot, ankle, and select lower leg cases, facilitating effective osteosynthesis and grafting within a single construct, promoting high union rates, low complications, and a rapid healing process.

Introduction: This analysis is conducted as a part of a quality improvement project aiming at identifying racial disparity in inpatient stroke quality of care. Methods: Get With The Guidelines (GWTG) database was used to identify all patients discharged with any stroke diagnosis between January and December 2021. Additional chart review was conducted to ensure the accuracy of racial/ethnic categorization. The sample was dichotomized to White vs non-White groups and compared with univariate analysis. Results: The study sample comprised 1,408 encounters (1,347 patients). Mean age 71±15 years, 51% women, 82% White patients, 15% non-White patients, 72% acute ischemic stroke (AIS); 15% transient ischemic attack (TIA), 9% intracerebral hemorrhage (ICH), 3% subarachnoid hemorrhage (SAH), and 1% stroke not otherwise specified. Non-White patients were younger, had fewer concomitant diagnoses, lower proportion of TIA and higher proportion of ICH (p=0.004). In AIS cohort, compared to White patients, non-White patients had less frequent ambulance (p=0.009), arrived to the hospital later than White patients (7.7 hours longer ; p<0.001), had more severe stroke, and had less frequent IV thrombolysis utilization (7% vs 13%; p=0.042). Similarly in the TIA cohort, non-White patients’ utilization of EMS was lower than White patients and their hospital arrival was delayed. In the ICH cohort, non-White patients were younger, had lower frequency of atrial fibrillation, and a non-significant trend towards higher disease severity. The SAH cohort had only 8 non-White patients, 6 of which were transferred to higher level of care hospital within a few hours of arrival, therefore. Importantly, the hospital-based quality metrics such as door-to-CT time, door-to-needle time, and the Joint Commission stroke quality metrics were similar between the two groups. Conclusion: There is a racial disparity in the pre-hospital phase of the stroke chain of survival of non-White patients impacting the IV thrombolysis utilization. The younger age and worse lipid profile and hemoglobin A1C of non-White patients suggest the need for better preventative care starting at young age.

(1)Background: This report was an effective evaluation of using multimedia educational program for self-care and quality of life in patients with a stoma at postoperative and established a simple threshold for enterostomy self-care skills.(2)Methods:108 patients with enterostomy were randomly assigned to receive either the intervention multimedia education program (including information about preparation for enterostomy care, cleaning method, manual bag replacement steps and precautions). The primary outcome was self-care ability and quality of life (defined as overall enterostomy self-care ability and overall quality of life), which was assessed at 2 weeks after intervention via an interview.(3)Results: Compared with those who in the conventional stoma education program, patients received the multimedia education program significantly improved their overall self-care ability and quality of life in statistically. The threshold of the enterostomy self-care skill scale was 20 points, and its corresponding sensitivity was 77.8%, and the specificity was 75.7%.(4)Conclusions: According to our study, the multimedia education program could enhance self-care ability of home care and quality of life in patients with enterostomy.

Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care. We conducted a systematic review of administrative data-derived health care equity indicators and their association with socio-economic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PUBMED and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine. Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care sensitive condition-related ED visits were the two most frequently used equity indicators. Despite some conflicting results, all identified SEDH (social deprivation, income, education level, social class, insurance coverage and health literacy) are associated with inequalities in access to and use of emergency care. In conclusion, the use of administrative data-derived indicators combined with identified SEDH could improve healthcare equity measurement in emergency care settings across health care systems worldwide.

Cystic Fibrosis is a chronic disease affecting multiple systems including the GI tract. Clinical manifestation in patients can start as early as infancy and vary across different age groups. With the advent of new highly effective modulators, the life expectancy of PwCF has improved significantly. Various GI aspects of CF care such as nutrition are linked to the overall improvement in morbidity, lung function, and quality of life of PwCF. The variable clinical presentations and management of GI diseases in pediatrics and adults CF should be recognized. Therefore, it is necessary to ensure efficient transfer of information between pediatric and adult providers for proper continuity of management and coordination of care at the time of transition. The transition of care is a challenging process for both patients and providers and currently, there are no specific tools for GI providers to help ensure smooth transition. In this review, we aim to highlight the crucial features of GI care at the time of transition and provide a checklist that can assist in ensuring an effective transition and ease the challenges associated with it.

The Internet of Medical Things (IoMT) represents a specialized domain within the Internet of Things, focusing on medical devices that require regulatory approval to ensure patient safety. Trusted composition of IoMT systems aims to ensure high assurance of the entire composed system, despite potential variability in the assurance levels of individual components. Achieving this trustworthiness in IoMT systems, especially when using less-assured, commercial, off-the-shelf networks like Ethernet and WiFi, presents a significant challenge. To address this challenge, this paper advocates a systematic approach that leverages the Architecture Analysis & Design Language (AADL) along with Behavior Language for Embedded Systems with Software (BLESS) specification and behavior. This approach aims to provide high assurance on critical components through formal verification, while using less-assured components in a manner that maintains overall system determinism and reliability. A clinical case study involving an automated opioid infusion monitoring IoMT system is presented to illustrate the application of the proposed approach. Through this case study, the effectiveness of the systemic approach in achieving trusted composition of heterogeneous medical devices over less-assured networks is demonstrated.

After conducting a detailed survey among the villagers of Pallissery and Karukutty, it was observed that in most of the villages the native people have to travel long distances for their basic health needs. Also most of the villagers lack knowledge regarding live health updates. At times, these problems have even resulted in death of many people including pregnant women and children. The objective of our research is to propose an integrated and easy to use Medical Kiosk that can be installed at various locations in rural areas. The Kiosk will provide an integrated environment for all medical related activities and would perform numerous functions like sending notifications regarding medical camps, mobile medical help, important dates for vaccinations, child care, insurance policies and provide other live medical updates to the villagers. It would also support the basic facilities for measurement of body parameters like height, weight, BMI, blood pressure, and heartbeat and also facilitate live consultation facilities with specialized doctors through video and voice chats.

Objective: To recommend how physicians can best respond to families whose hopes for a miracle via divine intervention influence their medical decisions, like, for example, making them not want to withdraw ventilatory support in cases of poor neurologic prognosis because they are still hoping for God to intervene. Methods: Auto-ethnographic analysis of chaplaincy experience in this clinical context yields a nuanced 90-second, point-of-care spiritual intervention physicians can use to address the religious aspect of families who base medical decisions on their hopes for a miracle via divine intervention. Explanation of how spiritual intervention dovetails with existing physician communication protocol for responding to families hoping for a miracle. Results: Spiritual intervention for religious aspect of miracle-hoping families is integrated into existing physician communication protocol for responding to families hoping for a miracle with recommendations for utilization of existing communication technology when necessary. Conclusion: Properly addressing the religious dimension of families hoping for a miracle may be helpful for physicians interested in decreasing their own stress levels, improving outcomes for this clinical context, and ensuring that unintentional discrimination does not perpetuate racial disparities in end-of-life care.

The study reports about a case of a lung cancer patient with increasing difficulties in falling asleep and frequent periods of wakefulness. Severe dyspnea related to pneumonitis caused as a side effect of immunotherapy worsened the situation. Eventually, fear of falling asleep developed, including panic attacks and anxiety of choking, which was shown to lead to nights of complete wakefulness. The patient did not only sleep poorly; he did not sleep at all at night for several days, as evidenced by the notes he made during the night. Polygraphy showed no evidence of sleep-disordered breathing, but frequent periods of wakefulness and reduced basal saturation around 90% during sleep due to lung changes such as extensive functional failure of the left upper lobe with position-dependent shunts. The authors hypothesized that the symptoms described were causally related to a drop in oxygen saturation in the patient's blood. Therefore, they pursued the goal of finding a measurement technique that is as inexpensive as possible and that the patient can operate without outside assistance and great effort. So the patient started using a low-cost wearable device that allows simultaneous measurements of blood oxygen content, pulse rate and movement intensity. It consists of a finger ring with pulse oximetry sensor and a wristband with the control unit containing a vibration motor. The described device reliably warned of disturbances in oxygen concentration in the blood during the night with its vibration alarm. By use of that device during the whole night at home, the events of reduced oxygen saturation and the anxiety symptoms were reduced. Sleep disturbances with sudden awakenings did not occur when using the device. The patient benefited from the security gained in this way and slept much more peacefully, and he could spend nights without waking up again. In conclusion, wearable oximeters with vibration alarm can be recommended for patients’ home care in lung cancer patients.

Deep brain stimulation (DBS) is an effective and safe medical treatment that improves the lives of patients with a wide range of neurological and psychiatric diseases, and has been consolidated as a first-line tool in the last two decades. Closed loop deep brain stimulation (CLDBS) pushes this tool further by automatically adjusting the stimulation parameters to the brain response in real-time. This paper presents a CLDBS with 2 stimulation channels and 2 acquisition channels. Each channel has a low-noise amplifier (LNA) buffer in differential configuration to eliminate the DC signal component of the input. Energy management is efficiently done by the control and communication unit. The battery supports almost 9 hours with both the acquisition and stimulation circuits active. If only the stimulation circuit is used as an Open Loop DBS (OLDBS), the battery can hold sufficient voltage for 24 hours of operation. The whole system is low-cost and portable and therefore it could be used as a wearable.

Background: Prismatic cover test (PCT) is a gold standard assessment of strabismus angle, however it has a significant number of disadvantages which are eliminated in Strabiscan device. Methods: Patients with strabismus (n = 30) and a group of healthy subjects (n = 30) were given a detailed history and underwent ophthalmologic examinations (best corrected visual acuity assessment, cycloplegic autorefractometry, biomicroscopic examination of anterior and posterior part of the eye). Each patient and healthy subjects were then subjected to the PCT, and then the presence of strabismus was detected, and its angle assessed using a Strabiscan demonstrator. Statistical analysis was done with Statistica software. Results: No statistically significant differences were noted in the measurements of strabismus angles made by the differing methods. Among the control group, using the Strabiscan demonstration device, low-angle latent strabismus ≤3PD was diagnosed in 83% of patients, and >3PD in 13% of patients. Those using the PCT, on the other hand, diagnosed latent strabismus ≤3PD in only 13% of patients, and latent strabismus with an angle >3PD in 13% of patients. Conclusion: The Strabiscan demonstration device provides quick and accurate assessment of the strabismus angle.

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.

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

Artery of Percheron Infarct (AOP) is a rare congenital anatomical vascular variant supplying the paramedian thalamus and the rostral midbrain. It arises from either proximal segment of the posterior cerebral artery (P1). The symptoms of an AOP infarction might vary, although they typically manifest as memory loss, altered mental status, and supranuclear vertical gaze palsy. Most of the time, the initial CT scan fails to diagnose the AOP infarct. Most of these diagnoses are made when ischemic stroke patients are not eligible for thrombolytic therapy. We report a case of a 40-year-old female with a history of well-managed hypertension, who presented in the ER with chief complaints of altered behavior, altered gaze palsy, and drowsiness. Initially, the CT scan did not show pathological changes. The diagnosis was made the next hospital day by MRI. Our case presents an unusual presentation and the lack of evidence of AOP infarction on a CT scan does not exclude its diagnosis. An infarcted Percheron artery requires a thorough clinical and radiological examination.

Abstract Objective Variations of sex characteristics (VSC) are atypical genetic, hormonal, gonadal and anatomical sex traits that require holistic medical management. The Chicago Consensus statement 2006 introduced the requirement that multidisciplinary teams organise the transition of care from pediatric to adult services. Yet, the evidence that the transitional care is in place is scarce. The aim of this paper is to examine the implementation of transition of care for people with VSC. Method Seven focus groups were conducted with health care professionals and peer support groups in care teams in Central, Northern and Western Europe. The data from the focus groups were examined using reflexive thematic analysis. Results The participants in the study stated that the transition of care has been implemented in the last two decades. The quality of care depends on available resources and variation of sex characteristics. However, there are significant hurdles to adequate transition of care as there is lack of time and resources. Lack of adult care providers and psychosocial support leaves young adults and adults with VSC navigating the health care system often alone. Conclusion The outcome of the study shows that the transition of care is organized through the department of pediatric endocrinology. The quality of care varies due to resources and variation. Lack of adult specialists and psychosocial support represent the biggest obstacle for young adults and adults to navigate the healthcare system and for the improvement in provision of healthcare to adults, especially psychosocial support.