An e-health driven laboratory information system to support HIV treatment in Peru: E-quity for laboratory personnel, health providers and people living with HIV

<p>Abstract</p> <p>Background</p> <p>Peru has a concentrated HIV epidemic with an estimated 76,000 people living with HIV (PLHIV). Access to highly active antiretroviral therapy (HAART) expanded between 2004-2006 and the Peruvian National Institute of Health was named by the Ministry of Health as the institution responsible for carrying out testing to monitor the effectiveness of HAART. However, a national public health laboratory information system did not exist. We describe the design and implementation of an e-health driven, web-based laboratory information system - NETLAB - to communicate laboratory results for monitoring HAART to laboratory personnel, health providers and PLHIV.</p> <p>Methods</p> <p>We carried out a needs assessment of the existing public health laboratory system, which included the generation and subsequent review of flowcharts of laboratory testing processes to generate better, more efficient streamlined processes, improving them and eliminating duplications. Next, we designed NETLAB as a modular system, integrating key security functions. The system was implemented and evaluated.</p> <p>Results</p> <p>The three main components of the NETLAB system, registration, reporting and education, began operating in early 2007. The number of PLHIV with recorded CD4 counts and viral loads increased by 1.5 times, to reach 18,907. Publication of test results with NETLAB took an average of 1 day, compared to a pre-NETLAB average of 60 days. NETLAB reached 2,037 users, including 944 PLHIV and 1,093 health providers, during its first year and a half. The percentage of overall PLHIV and health providers who were aware of NETLAB and had a NETLAB password has also increased substantially.</p> <p>Conclusion</p> <p>NETLAB is an effective laboratory management tool since it is directly integrated into the national laboratory system and streamlined existing processes at the local, regional and national levels. The system also represents the best possible source of timely laboratory information for health providers and PLHIV, allowing patients to access their own results and other helpful information about their health, extending the scope of HIV treatment beyond the health facility and providing a model for other countries to follow. The NETLAB system now includes 100 diseases of public health importance for which the Peruvian National Institute of Health and the network of public health laboratories provide testing and results.</p

A robust wavelet-based approach for dominant frequency analysis of atrial fibrillation in body surface signals

This is an author-created, un-copyedited versíon of an article published in Physiological Measurement. IOP Publishing Ltd is not responsíble for any errors or omissíons in this versíon of the manuscript or any versíon derived from it. The Versíon of Record is available online at https://doi.org/10.1088/1361-6579/ab97c1.[EN] Objective: Atrial dominant frequency (DF) maps undergoing atrial fibrillation (AF) presented good spatial correlation with those obtained with the non-invasive body surface potential mapping (BSPM). In this study, a robust BSPM-DF calculation method based on wavelet analysis is proposed. Approach: Continuous wavelet transform along 40 scales in the pseudo-frequency range of 3¿30 Hz is performed in each BSPM signal using a Gaussian mother wavelet. DFs are estimated from the intervals between the peaks, representing the activation times, in the maximum energy scale. The results are compared with the traditionally widely applied Welch periodogram and the robustness was tested on different protocols: increasing levels of white Gaussian noise, artificial DF harmonics presence and reduction in the number of leads. A total of 11 AF simulations and 12 AF patients are considered in the analysis. For each patient, intracardiac electrograms were acquired in 15 locations from both atria. The accuracy of both methods was assessed by calculating the absolute errors of the highest DFBSPM (HDFBSPM) with respect to the atrial HDF, either simulated or intracardially measured, and assumed correct if ¿1 Hz. The spatial distribution of the errors between torso DFs and atrial HDFs were compared with atria driving mechanism locations. Torso HDF regions, defined as portions of the maps with |DF ¿ HDFBSPM| ¿ 0.5 Hz were identified and the percentage of the torso occuping these regions was compared between methods. The robustness of both methods to white Gaussian noise, ventricular influence and harmonics, and to lower spatial resolution BSPM lead layouts was analyzed: computer AF models (567 leads vs 256 leads down to 16 leads) and patient data (67 leads vs 32 and 16 leads). Main results: The proposed method allowed an improvement in non-invasive estimation of the atria HDF. For the models the median relative errors were 7.14% for the wavelet-based algorithm vs 60.00% for the Welch method; in patients, the errors were 10.03% vs 12.66%, respectively. The wavelet method outperformed the Welch approach in correct estimations of atrial HDFs in models (81.82% vs 45.45%, respectively) and patients (66.67% vs 41.67%). A low positive BSPM-DF map correlation was seen between the techniques (0.47 for models and 0.63 for patients), highlighting the overall differences in DF distributions. The wavelet-based algorithm was more robust to white Gaussian noise, residual ventricular activity and harmonics, and presented more consistent results in lead layouts with low spatial resolution. Significance: Estimation of atrial HDFs using BSPM is improved by the proposed wavelet-based algorithm, helping to increase the non-invasive diagnostic ability in AF.This study was supported in part by grants from Sao Paulo Research Foundation (2017/19775-3), Instituto de Salud Carlos III FEDER (Fondo Europeo de Desarrollo Regional PI17/01106) and Generalitat Valenciana Grants (AICO/2018/267).Marques, V.; Rodrigo Bort, M.; Guillem Sánchez, MS.; Salinet, J. (2020). A robust wavelet-based approach for dominant frequency analysis of atrial fibrillation in body surface signals. Physiological Measurement. 41(7):1-14. https://doi.org/10.1088/1361-6579/ab97c1S11441

Double glass transition in polyethylene naphthalate structural relaxation by MDSC, BDS and TSDC

We present the experimental study of the primary, $\alpha$, and secondary, $\beta^*$, relaxations of the glassy polymer polyethylene naphthalate (PEN), by Modulated Differential Scanning Calorimetry (MDSC), Thermally Stimulated Discharge Currents (TSDC) and Broadband Dielectric Spectroscopy (BDS). Results show how the $\alpha$ and $\beta^*$ relaxations can be considered part of a very broad and distributed relaxation. The $\beta^*$ relaxation is composed of a main contribution ($\beta_3^*$) and two additional ones ($\beta_1^*$ and $\beta_2^*$) and each elementary mode of the relaxation has its own glass transition temperature. This scenario gives rise to an extended glass transition mainly centered in $T_{g\beta^*} \sim 305$ K and $T_{g\alpha} \sim 387$ K

Non-invasive Mechanism Classification and Localization in Supraventricular Cardiac Arrhythmias

[EN] In this study, we investigated the most relevant biomarkers for noninvasive classification and mechanism location in atrial tachycardia (AT), flutter (AFL) and fibrillation (AF). Biomarkers were calculated using noninvasive body surface (BSPM) dominant frequency and phase maps. We used 19 simulations of 567 to 64-lead BSPMs, from which were extracted 32 biomarkers. Biomarker ranking was performed with ANOVA, Kendall and Lasso techniques. The best four biomarkers were identified and used to classify the arrhythmias in all combinations, and the best two used for noninvasive driver localization. Arrhythmia classification accuracy was 94.74%. The feature combination which best distinguish AF from non-AF were mean filament displacement and mean OI, while those that best distinguish AFL from AT were mean and SD of SP distribution. There was good agreement across ranking techniques. Mechanism location accuracy was 78.95%, with the most important biomarkers being percentage SPs within each torso division, and SD of filament histogram cluster area. This study highlights that organization related features well identifies AF and spatial SP distribution discriminate AT from AFL and also it¿s localization.VGM is funded by the European Union's Horizon 2020 research and innovation programme under the Marie Skodowska-Curie grant agreement No. 860974. IS, JAS and JS are supported by grant #2018/25606-2, Sao Paulo Research Foundation (FAPESP).Sandoval, I.; Marques, VG.; Sims, JA.; Rodrigo, M.; Guillem Sánchez, MS.; Salinet, J. (2021). Non-invasive Mechanism Classification and Localization in Supraventricular Cardiac Arrhythmias. 1-4. https://doi.org/10.22489/CinC.2021.2261

Airborne RF Measurement System and Analysis of Representative Flight RF Environment

Environmental radio frequency (RF) data over a broad band of frequencies were needed to evaluate the airspace around several airports. An RF signal measurement system was designed using a spectrum analyzer connected to an aircraft VHF/UHF navigation antenna installed on a small aircraft. This paper presents an overview of the RF measurement system and provides analysis of a sample of RF signal measurement data over a frequency range of 30 MHz to 1000 MHz

Theoretical and perceived balance of power inside Spanish public hospitals

BACKGROUND: The hierarchical pyramid inside Spanish public hospitals was radically changed by the Health Reform Law promulgated in 1986. According to it, the manpower of the hospitals was divided into three divisions (Medical, Nursing, General Services/Administration), which from then on occupied the same level, only subject to the general manager. Ten years after the implementation of the law, the present study was designed in order to investigate if the legal changes had indeed produced a real change in the balance of power inside the hospitals, as perceived by the different workers within them. MATERIALS AND METHODS: A questionnaire was administered to 1,027 workers from four different public hospitals (two university-based and two district hospitals). The participants belonged to all divisions, and to all three operative levels (staff, supervisory and managerial) within them. The questionnaire inquired about the perceived power inside each division and hierarchical level, as well as about that of the other divisions and hierarchical levels. RESULTS: Every division attributed the least power to itself. The Nursing and the Administrative division attributed the highest power to the physicians, and these attributed the highest power to the General Services/Administrative division. All hierarchical levels (including the formal top of the pyramid) attributed significantly more power to the other than to them. CONCLUSIONS: More than ten years after the implementation of the new law, the majority of workers still perceive that the real power within the hospitals is held by the physicians (whereas these feel that it has shifted to the administrators). No division or hierarchical level believes it holds any significant degree of power, and this carries with it the danger of also not accepting any responsibility

Effets de la protection sur la structure démographique et l’abondance d’Epinephelus marginatus (Lowe, 1834). L’exemple du Parc national de l’archipel des îles Cabrera (Méditerranée centre-ouest)

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Small Aircraft RF Interference Path Loss

Interference to aircraft radio receivers is an increasing concern as more portable electronic devices are allowed onboard. Interference signals are attenuated as they propagate from inside the cabin to aircraft radio antennas mounted on the outside of the aircraft. The attenuation level is referred to as the interference path loss (IPL) value. Significant published IPL data exists for transport and regional category airplanes. This report fills a void by providing data for small business/corporate and general aviation aircraft. In this effort, IPL measurements are performed on ten small aircraft of different designs and manufacturers. Multiple radio systems are addressed. Along with the typical worst-case coupling values, statistical distributions are also reported that could lead to better interference risk assessment

Elimination of Rhodnius prolixus in Central America

Rhodnius prolixus is one of the main vectors of Trypanosoma cruzi, causative agent of Chagas disease. In Central America, it was first discovered in 1915 in El Salvador, from where it spread northwest to Guatemala and Mexico, and southeast to Nicaragua and Costa Rica, arriving also in Honduras in the late 1950s. Indoor residual spraying (IRS) by the antimalaria services of Costa Rica prevented its spread southwards, and similar IRS programmes appear to have eliminated it from El Salvador by the late 1970s. In 1997, by resolution of the Ministers of Health of the seven Central American countries, a multinational initiative against Chagas disease (IPCA) was launched with one of the specific objectives being the elimination of R. prolixus from the region. As a result, more and more infested areas were encountered, and progressively sprayed using an IRS strategy already deployed against Triatoma infestans in the southern cone countries of South America. In 2008, Guatemala became the first of these countries to be formally certified as free of Chagas disease transmission due to R. prolixus. The other infested countries have since been similarly certified, and none of these has reported the presence of R. prolixus since June 2010. Further surveillance is required, but current evidence suggests that R. prolixus may now been eliminated from throughout the mesoamerican region, with a corresponding decline in the incidence of T. cruzi infections