A MATLAB app to assess, compare and validate new methods against their benchmarks

Emerging technologies for physiological signals and data collection enable the monitoring of patient health and well-being in real-life settings. This requires novel methods and tools to compare the validity of this kind of information with that acquired in controlled environments using more costly and sophisticated technologies. In this paper, we describe a method and a MATLAB tool that relies on a standard sequence of statistical tests to compare features obtained using novel techniques with those acquired by means of benchmark procedures. After introducing the key steps of the proposed statistical analysis method, this paper describes its implementation in a MATLAB app, developed to support researchers in testing the extent to which a set of features, captured with a new methodology, can be considered a valid surrogate of that acquired employing gold standard techniques. An example of the application of the tool is provided in order to validate the method and illustrate the graphical user interface (GUI). The app development in MATLAB aims to improve its accessibility, foster its rapid adoption among the scientific community and its scalability into wider MATLAB tools

Pupillometry via smartphone for low-resource settings

The photopupillary reflex regulates the pupil reaction to changing light conditions. Being controlled by the autonomic nervous system, it is a proxy for brain trauma and for the conditions of patients in critical care. A prompt evaluation of brain traumas can save lives. With a simple penlight, skilled clinicians can do that, whereas less specialized ones have to resort to a digital pupilometer. However, many low-income countries lack both specialized clinicians and digital pupilometers. This paper presents the early results of our study aiming at designing, prototyping and validating an app for testing the photopupillary reflex via Android, following the European Medical Device Regulation and relevant standards. After a manual validation, the prototype underwent a technical validation against a commercial Infrared pupilometer. As a result, the proposed app performed as well as the manual measurements and better than the commercial solution, with lower errors, higher and significant correlations, and significantly better Bland-Altman plots for all the pupillometry-related measures. The design of this medical device was performed based on our expertise in low-resource settings. This kind of environments imposes more stringent design criteria due to contextual challenges, including the lack of specialized clinicians, funds, spare parts and consumables, poor maintenance, and harsh environmental conditions, which may hinder the safe operationalization of medical devices. This paper provides an overview of how these unique contextual characteristics are cascaded into the design of an app in order to contribute to the Sustainable Development Goal 3 of the World Health Organization: Good health and well-being

Rooting Out Genetic Structure of Invasive Wild Pigs in Texas

Invasive wild pigs (Sus scrofa), also called feral swine or wild hogs, are recognized as among the most destructive invasive species in the world. Throughout the United States, invasive wild pigs have expanded rapidly over the past 40 years with populations now established in 38 states. Of the estimated 6.9 million wild pigs distributed throughout the United States, Texas supports approximately 40% of the population and similarly bears disproportionate ecological and economic costs. Genetic analyses are an effective tool for understanding invasion pathways and tracking dispersal of invasive species such as wild pigs and have been used recently in California and Florida, USA, which have similarly long-established populations and high densities of wild pigs. Our goals were to use molecular approaches to elucidate invasion and migration processes shaping wild pig populations throughout Texas, compare our results with patterns of genetic structure observed in California and Florida, and provide insights for effective management of this invasive species. We used a high-density single nucleotide polymorphism (SNP) array to evaluate population genetic structure. Genetic clusters of wild pigs throughout Texas demonstrate 2 distinct patterns: weakly resolved, spatially dispersed clusters and well-resolved, spatially localized clusters. The disparity in patterns of genetic structure suggests disparate processes are differentially shaping wild pig populations in various localities throughout the state. Our results differed from the patterns of genetic structure observed in California and Florida, which were characterized by localized genetic clusters. These differences suggest distinct biological and perhaps anthropogenic processes are shaping genetic structure in Texas. Further, these disparities demonstrate the need for location-specific management strategies for controlling wild pig populations and mitigating associated ecological and economic costs

Ruminal in vitro fermentation kinetics and chemical composition of Sorghum cv. Nutritop at different stage of regrowth.

The objective was to estimate the ruminal degradation kinetics and chemical composition of Sorghum cv. Nutritop at different stages of regrowth, as fed for background lambs

Diabetes promotes invasive pancreatic cancer by increasing systemic and tumour carbonyl stress in Kras G12D/+mice

Background: Type 1 and 2 diabetes confer an increased risk of pancreatic cancer (PaC) of similar magnitude, suggesting a common mechanism. The recent finding that PaC incidence increases linearly with increasing fasting glucose levels supports a central role for hyperglycaemia, which is known to cause carbonyl stress and advanced glycation end-product (AGE) accumulation through increased glycolytic activity and non-enzymatic reactions. This study investigated the impact of hyperglycaemia on invasive tumour development and the underlying mechanisms involved. Methods: Pdx1-Cre;LSL-Kras G12D/+ mice were interbred with mitosis luciferase reporter mice, rendered diabetic with streptozotocin and treated or not with carnosinol (FL-926-16), a selective scavenger of reactive carbonyl species (RCS) and, as such, an inhibitor of AGE formation. Mice were monitored for tumour development by in vivo bioluminescence imaging. At the end of the study, pancreatic tissue was collected for histology/immunohistochemistry and molecular analyses. Mechanistic studies were performed in pancreatic ductal adenocarcinoma cell lines challenged with high glucose, glycolysis- and glycoxidation-derived RCS, their protein adducts AGEs and sera from diabetic patients. Results: Cumulative incidence of invasive PaC at 22 weeks of age was 75% in untreated diabetic vs 25% in FL-926-16-gtreated diabetic and 8.3% in non-diabetic mice. FL-926-16 treatment suppressed systemic and pancreatic carbonyl stress, extracellular signal-regulated kinases (ERK) 1/2 activation, and nuclear translocation of Yes-associated protein (YAP) in pancreas. In vitro, RCS scavenging and AGE elimination completely inhibited cell proliferation stimulated by high glucose, and YAP proved essential in mediating the effects of both glucose-derived RCS and their protein adducts AGEs. However, RCS and AGEs induced YAP activity through distinct pathways, causing reduction of Large Tumour Suppressor Kinase 1 and activation of the Epidermal Growth Factor Receptor/ERK signalling pathway, respectively. Conclusions: An RCS scavenger and AGE inhibitor prevented the accelerating effect of diabetes on PainINs progression to invasive PaC, showing that hyperglycaemia promotes PaC mainly through increased carbonyl stress. In vitro experiments demonstrated that both circulating RCS/AGEs and tumour cell-derived carbonyl stress generated by excess glucose metabolism induce proliferation by YAP activation, hence providing a molecular mechanism underlying the link between diabetes and PaC (and cancer in general)

Comportamiento frente a diferentes condiciones físico químicas presentes de procesamiento de los alimentos de Escherichia coli productor de toxina Shiga (STEC) serotipo O157:H7

Escherichia coli productor de toxina Shiga (STEC) serotipo O157:H7 es un patógeno de transmisión alimentaria endémico en la Argentina, responsable principal del Síndrome Urémico Hemolítico. Algunas de sus cepas se consideran hipervirulentas (clado 8). Su capacidad de supervivencia en el ambiente, muchas veces incrementada por la producción de biofilm y su baja dosis infectiva representan un problema en la producción e industrialización de los alimentos. Los objetivos del presente estudio fueron evaluar la resistencia y el daño metabólico de 52 cepas de STEC O157:H7 del clado 8 y clados 4/5, frente a pH ácidos (RA), presión osmótica alta y baja (PO), ciclos de congelación y descongelación sucesivos (CCD), almacenamiento congelado (RC), inanición celular (IC) y presencia de antibióticos (PA). Se obtuvieron y cuantificaron inóculos en fase estacionaria (109 células/ml) y se expusieron al medio TSB con pH 2,5 y 3.5; al medio TSB con 20% de NaCl; a solución de NaCl 0,85%, a agua destilada, a CCD sucesivos, a almacenamiento a -18°C y a PA. Los tiempos de exposición fueron: 0, 2, 6, 8 y 12h para RA y PO, hasta 12 meses en ambiente congelado y hasta 7 días para el resto de las condiciones. Las cepas expuestas a IC se evaluaron hasta 30 días. Luego se cuantificaron las células viables en dos medios de cultivo y se calcularon los tiempos de reducción decimal (valor D) y la proporción de células injuriadas. El 100% de las cepas resultó RA y sensibles a PA. En las demás condiciones se presentaron diferentes comportamientos según cepa y factor. Se observa que las cepas del clado 8 son significativamente más resistentes al estrés ácido que las del clado 4/5 (p < 0.05). No se observaron diferencias significativas en las resistencias de las cepas de ambos clados al estrés osmótico, por inanición y a los CCD. El daño metabólico varió según el tiempo de contacto y el factor. Se concluye que las cepas de E. coli O157:H7 presentes en el ambiente exhiben distintos grados de resistencia y que es necesario conocer su magnitud para poder delinear métodos de conservación eficaces

Renal outcome in patients with congenital anomalies of the kidney and urinary tract.

15openopenSanna-Cherchi S; Ravani P; Corbani V; Parodi S; Haupt R; Piaggio G; Innocenti ML; Somenzi D; Trivelli A; Caridi G; Izzi C; Scolari F; Mattioli G; Allegri L; Ghiggeri GM.Sanna Cherchi, S; Ravani, P; Corbani, V; Parodi, S; Haupt, R; Piaggio, G; Innocenti, Ml; Somenzi, D; Trivelli, A; Caridi, G; Izzi, C; Scolari, Francesco; Mattioli, G; Allegri, L; Ghiggeri, G. M

Active management of the third stage of labour without controlled cord traction: a randomized non-inferiority controlled trial

BACKGROUND: The third stage of labour refers to the period between birth of the baby and complete expulsion of the placenta. Some degree of blood loss occurs after the birth of the baby due to separation of the placenta. This period is a risky period because uterus may not contract well after birth and heavy blood loss can endanger the life of the mother. Active management of the third stage of labour (AMTSL) reduces the occurrence of severe postpartum haemorrhage by approximately 60-70%. Active management consists of several interventions packaged together and the relative contribution of each of the components is unknown. Controlled cord traction is one of those components that require training in manual skill for it to be performed appropriately. If it is possible to dispense with controlled cord traction without losing efficacy it would have major implications for effective management of the third stage of labour at peripheral levels of health care. OBJECTIVE: The primary objective is to determine whether the simplified package of oxytocin 10 IU IM/IV is not less effective than the full AMTSL package. METHODS: A hospital-based, multicentre, individually randomized controlled trial is proposed. The hypothesis tested will be a non-inferiority hypothesis. The aim will be to determine whether the simplified package without CCT, with the advantage of not requiring training to acquire the manual skill to perform this task, is not less effective than the full AMTSL package with regard to reducing blood loss in the third stage of labour.The simplified package will include uterotonic (oxytocin 10 IU IM) injection after delivery of the baby and cord clamping and cutting at approximately 3 minutes after birth. The full package will include the uterotonic injection (oxytocin 10 IU IM), controlled cord traction following observation of uterine contraction and cord clamping and cutting at approximately 3 minutes after birth. The primary outcome measure is blood loss of 1000 ml or more at one hour and up to two hours for women who continue to bleed after one hour. The secondary outcomes are blood transfusion, the use of additional uterotonics and measure of severe morbidity and maternal death.We aim to recruit 25,000 women delivering vaginally in health facilities in eight countries within a 12 month recruitment period. MANAGEMENT: Overall trial management will be from HRP/RHR in Geneva. There will be eight centres located in Argentina, Egypt, India, Kenya, Philippines, South Africa, Thailand and Uganda. There will be an online data entry system managed from HRP/RHR. The trial protocol was developed following a technical consultation with international organizations and leading researchers in the field. EXPECTED OUTCOMES: The main objective of this trial is to investigate whether a simplified package of third stage management can be recommended without increasing the risk of PPH. By avoiding the need for a manual procedure that requires training, the third stage management can be implemented in a more widespread and cost-effective way around the world even at the most peripheral levels of the health care system. This trial forms part of the programme of work to reduce maternal deaths due to postpartum haemorrhage within the RHR department in collaboration with other research groups and organizations active in the field. TRIAL REGISTRATION: ACTRN12608000434392

Ethics and biomedical engineering for well-being : a cocreation study of remote services for monitoring and support

The well-being of students and staff directly affects their output and efficiency. This study presents the results of two focus groups conducted in 2022 within a two-phase project led by the Applied Biomedical and Signal Processing Intelligent e-Health Lab, School of Engineering at the University of Warwick, and British Telecom within “The Connected Campus: University of Warwick case study” program. The first phase, by involving staff and students at the University of Warwick, aimed at collecting preliminary information for the subsequent second phase, about the feasibility of the use of Artificial Intelligence and Internet of Things for well-being support on Campus. The main findings of this first phase are interesting technological suggestions from real users. The users helped in the design of the scenarios and in the selection of the key enabling technologies which they considered as the most relevant, useful and acceptable to support and improve well-being on Campus. These results will inform future services to design and implement technologies for monitoring and supporting well-being, such as hybrid, minimal and even intrusive (implantable) solutions. The user-driven co-design of such services, leveraging the use of wearable devices and Artificial Intelligence deployment will increase their acceptability by the users

Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review.

Background: Further investigation of confirmed UTI in children aims to prevent renal scarring and future complications. Methods: We conducted a systematic review to determine the most effective approach to the further investigation of confirmed urinary tract infection (UTI) in children under five years of age. Results: 73 studies were included. Many studies had methodological limitations or were poorly reported. Effectiveness of further investigations: One study found that routine imaging did not lead to a reduction in recurrent UTIs or renal scarring. Diagnostic accuracy: The studies do not support the use of less invasive tests such as ultrasound as an alternative to renal scintigraphy, either to rule out infection of the upper urinary tract (LR- = 0.57, 95%CI: 0.47, 0.68) and thus to exclude patients from further investigation or to detect renal scarring (LR+ = 3.5, 95% CI: 2.5, 4.8). None of the tests investigated can accurately predict the development of renal scarring. The available evidence supports the consideration of contrast-enhanced ultrasound techniques for detecting vesico-ureteric reflux (VUR), as an alternative to micturating cystourethrography (MCUG) (LR+ = 14.1, 95% CI: 9.5, 20.8; LR- = 0.20, 95%CI: 0.13, 0.29); these techniques have the advantage of not requiring exposure to ionising radiation. Conclusion: There is no evidence to support the clinical effectiveness of routine investigation of children with confirmed UTI. Primary research on the effectiveness, in terms of improved patient outcome, of testing at all stages in the investigation of confirmed urinary tract infection is urgently required