The diabetic retinopathy screening workflow : potential for smartphone imaging

Complications of diabetes mellitus, namely diabetic retinopathy and diabetic maculopathy, are the leading cause of blindness in working aged people. Sufferers can avoid blindness if identified early via retinal imaging. Systematic screening of the diabetic population has been shown to greatly reduce prevalence and incidence of blindness within the population. Many national screening programmes have digital fundus photography as their basis. In the past five years several techniques and adapters have been developed that allow digital fundus photography to be performed using smartphones. We review recent progress in smartphone - based fundus imaging and discuss its potential for integration into national systematic DR screening programmes. Some systems have produced promising initial results with respect to their agreement with reference standards. However further multi-site trialling of such systems’ use withi n implementable screening workflows is required if an evidence base strong enough to affect policy change is to be established. If this were to occur national diabetic retinopathy screening would, for the first time, become possible in low-and middle-income settings where cost and availability of trained eye-care personnel are currently key barriers to implementation. As diabetes prevalence and incidence is increasing sharply in these settings, the impact on global blindness could be profound

Towards a workflow driven design for mHealth devices within temporary eye clinics in low-income settings

Only a small minority of mobile healthcare technologies that have been successful in pilot studies have subsequently been integrated into healthcare systems. Understanding the reasons behind this discrepancy is crucial if such technologies are to be adopted. We believe that the mismatch is due to a breakdown in the relation between technical soundness of the original mobile health (mHealth) device design, and integration into healthcare provision workflows. Quantitative workflow modelling provides an opportunity to test this hypothesis. In this paper we present our current progress in developing a clinical workflow model for mobile eye assessment in low-income settings. We test the model for determining the appropriateness of design parameters of a mHealth device within this workflow, by assessing their impact on the entire clinical workflow performance

PHOTOSYNTHETIC – FERMENTATIVE FUEL CELL USED IN A BIOFUEL PROCESSING FACILITY

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Intravascular MR-monitored balloon angioplasty: An in vivo feasibility study

PURPOSE: To develop a new method for monitoring balloon angioplasty by using an intravascular magnetic resonance (MR) imaging technique. MATERIALS AND METHODS: Nine New Zealand White rabbits were used: seven for technique refinement, including surgery, device insertion, stenosis creation, and MR protocol development; and two for the final MR imaging of the balloon angioplasty. The in vivo experimental method involved insertion of a catheter antenna and a balloon catheter, via femoral arteriotomies bilaterally, into the target site of the upper abdominal aorta, where a stenosis was artificially created by binding a plastic cable tie. Then, the entire process of the dilation of the stenosis with balloon inflation was monitored under MR fluoroscopy. RESULTS: Catheter insertions were successful, and a 5-mm-long stenosis of the aorta was produced in all nine rabbits. Eight complete balloon angioplasty procedures were satisfactorily monitored and recorded, showing clearly the stenosis of the aorta at the beginning of the procedure, the dilation of the stenosis during the balloon inflation, and the complete opening of the stenosis after balloon dilation. CONCLUSION: Preliminary results of in vivo balloon angioplasty monitored with intravascular MR imaging are presented. MR fluoroscopy, based on the intravascular MR imaging technique, may represent a potential alternative to x-ray fluoroscopy for guiding interventional treatment of cardiovascular diseases

Association of Tramadol Use With Risk of Hip Fracture.

Several professional organizations have recommended tramadol as one of the first-line or second-line therapies for patients with chronic noncancer pain and its prescription has been increasing rapidly worldwide; however, the safety profile of tramadol, such as risk of fracture, remains unclear. This study aimed to examine the association of tramadol with risk of hip fracture. Among individuals age 50 years or older without a history of hip fracture, cancer, or opioid use disorder in The Health Improvement Network (THIN) database in the United Kingdom general practice (2000-2017), five sequential propensity score-matched cohort studies were assembled, ie, participants who initiated tramadol or those who initiated one of the following medications: codeine (n = 146,956) (another commonly used weak opioid), naproxen (n = 115,109) or ibuprofen (n = 107,438) (commonly used nonselective nonsteroidal anti-inflammatory drugs [NSAIDs]), celecoxib (n = 43,130), or etoricoxib (n = 27,689) (cyclooxygenase-2 inhibitors). The outcome was incident hip fracture over 1 year. After propensity-score matching, the included participants had a mean age of 65.7 years and 56.9% were women. During the 1-year follow-up, 518 hip fracture (3.7/1000 person-years) occurred in the tramadol cohort and 401 (2.9/1000 person-years) occurred in the codeine cohort. Compared with codeine, hazard ratio (HR) of hip fracture for tramadol was 1.28 (95% confidence interval [CI] 1.13 to 1.46). Risk of hip fracture was also higher in the tramadol cohort than in the naproxen (2.9/1000 person-years for tramadol, 1.7/1000 person-years for naproxen; HR = 1.69, 95% CI 1.41 to 2.03), ibuprofen (3.4/1000 person-years for tramadol, 2.0/1000 person-years for ibuprofen; HR = 1.65, 95% CI 1.39 to 1.96), celecoxib (3.4/1000 person-years for tramadol, 1.8/1000 person-years for celecoxib; HR = 1.85, 95% CI 1.40 to 2.44), or etoricoxib (2.9/1000 person-years for tramadol, 1.5/1000 person-years for etoricoxib; HR = 1.96, 95% CI 1.34 to 2.87) cohort. In this population-based cohort study, the initiation of tramadol was associated with a higher risk of hip fracture than initiation of codeine and commonly used NSAIDs, suggesting a need to revisit several guidelines on tramadol use in clinical practice. © 2020 American Society for Bone and Mineral Research

A double-blind, placebo-controlled, phase II, randomized study of lovastatin therapy in the treatment of mildly active rheumatoid arthritis

© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. 3-hydroxy-3-methylglutaryl coenzyme-A (HMG Co-A) reductase inhibitors (statins) are standard treatment for hyperlipidaemia. In addition to lipid-lowering abilities, statins exhibit multiple anti-inflammatory effects. The objectives of this study were to determine whether treatment of patients with RA with lovastatin decreased CRP or reduced disease activity. Methods: We conducted a randomized double-blind placebo-controlled 12 week trial of lovastatin vs placebo in 64 RA patients with mild clinical disease activity but an elevated CRP. The primary efficacy end point was the reduction in mean log CRP. Secondary end points included disease activity, RF and anti-CCP antibody titres. Mechanistic end points included levels of serum cytokines. Safety was assessed; hepatic and muscle toxicities were of particular interest. Results: Baseline features were similar between groups. No significant difference in mean log CRP reduction between the two groups was observed, and disease activity did not change from baseline in either treatment group. Mechanistic analyses did not reveal significant changes in any biomarkers. A post hoc analysis of subjects not using biologic therapy demonstrated a significantly greater proportion achieving ≥20% reduction in CRP from baseline in the lovastatin group compared with placebo (P-value = 0.007). No difference was observed in subjects receiving biologics. Lovastatin was well tolerated with no serious safety concerns. Conclusion: This study showed no anti-inflammatory or clinical effects on RA disease activity after 12 weeks of treatment with lovastatin. Lovastatin had a modest effect on CRP in subjects not using biologics, suggesting statins may be anti-inflammatory in selected patients. Trial registration: ClinicalTrials.gov, http://clinicaltrials.gov, NCT00302952

A review of feature-based retinal image analysis

Retinal imaging is a fundamental tool in ophthalmic diagnostics. The potential use of retinal imaging within screening programs, with consequent need to analyze large numbers of images with high throughput, is pushing the digital image analysis field to find new solutions for the extraction of specific information from the retinal image. The aim of this review is to explore the latest progress in image processing techniques able to recognize specific retinal image features. and potential features of disease. In particular, this review aims to describe publically available retinal image databases, highlight different performance evaluators commonly used within the field, outline current approaches in feature-based retinal image analysis, and to map related trends. This review found two key areas to be addressed for the future development of automatic retinal image analysis: fundus image quality and the affect image processing may impose on relevant clinical information within the images. Performance evaluators of the algorithms reviewed are very promising, however absolute values are difficult to interpret when validating system suitability for use within clinical practice

Coupled influences of particle shape, surface property and flow hydrodynamics on rod-shaped colloid transport in porous media

Hypothesis: Natural or engineered colloidal particles are often non-spherical in shape. In contrast to the widely-used “homogeneous sphere” assumption, the non-spherical particle shape is expected to alter particle–fluid-surface interactions, which in turn affect particle transport and retention. Experiments and Simulations: Polystyrene microspheres were stretched to rod-shaped particles of two aspect ratios (2:1, 6:1). The transport and retention behaviors of rods versus spheres were investigated in packed quartz sand columns and impinging jet systems. In parallel, a 3D trajectory model was employed to simulate particle translation and rotation, and to elucidate the role and underlying mechanisms of particle shape impact on transport. Findings: Rods were observed to undergo rotating and tumbling motions in response to fluid shear from experiments and simulations. However, no distinct retention trends between rods and spheres were observed from column studies, despite BSA-coating on particles, Fe-coating on sand or velocity change. This was primarily due to the super-hydrophobic nature of colloid surfaces acquired from stretching process, which in hydrophilic sand columns, dominated particle–surface charge interactions. Simulations using colloids with randomly distributed charge patches qualitatively produced the observed insensitivity in retention respecting aspect ratio under low charge coverage (<30%). Hence, particle shape influences were strongly coupled with colloid surface properties and flow hydrodynamics

Development and Validation of a Smartphone-based Contrast Sensitivity Test.

PURPOSE: Contrast sensitivity (CS) testing is an important measure of visual function reflecting variations in everyday visual experience in different conditions and helps to identify more subtle vision loss. However, it is only infrequently used. To make this more accessible, we have developed and validated a smartphone-based CS test. METHODS: A new tumbling-E smartphone-based CS test was developed, Peek Contrast Sensitivity (PeekCS). This was field tested and refined through several iterations. Reference standard was a tumbling-E Pelli-Robson CS test (PRCS). The validation study was conducted in community clinics in Ethiopia. Test-retest variability was measured for both PRCS and PeekCS. PRCS and PeekCS were then compared. Correlation coefficients and 95% confidence intervals (CIs) were calculated; 95% limits of agreement were calculated and displayed on Bland-Altman plots. RESULTS: PeekCS showed strong repeatability (correlation coefficient: 0.93; 95% CI: 0.91-0.95), which was comparable with PRCS (correlation coefficient: 0.96; 95% CI: 0.95-0.97). The 95% limit of agreement for test-retest variability of PRCS and PeekCS were -0.20 to 0.21 and -0.31 to 0.29, respectively. PRCS and PeekCS were highly correlated: 0.94 (95% CI: 0.93-0.95); 95% limits of agreement -0.27 to 0.29; and mean difference 0.010 (95% CI: -0.001 to 0.022). PeekCS had a faster testing time (44.6 seconds) than PRCS (48.6 seconds): mean difference -3.98 (95% CI: -5.38 to -2.58); P < 0.001. CONCLUSIONS: The smartphone-based PeekCS is a repeatable and rapid test, providing results that are highly comparable with the commonly used PRCS test. TRANSLATIONAL RELEVANCE: PeekCS provides an accessible and easy to perform alternative for CS testing, particularly in the community setting