Deep Learning Classification of Active Tuberculosis Using Chest X-Rays: Efficacy of Transfer Learning and Generalization Performance of Cross-Population Datasets

Chest X-ray based diagnosis of active Tuberculosis (TB) is one of the oldest ubiquitous tests in medical practice. Artificial Intelligence (AI) based automated detection of abnormality in chest radiography is crucial in radiology workflow. Most deep convolutional neural networks (DCNN) for diagnosing TB by transfer learning from natural images and using the same dataset to evaluate the model performance and diagnostic accuracy. However, dataset shift is a known issue in predictive models in AI, which is unexplored. In this work, we fine-tuned, validated, and tested two benchmark architectures and utilized the transfer learning methodology to measure the diagnostic accuracy on cross-population datasets. We achieved remarkable calcification accuracy of 100% and area under the receiver operating characteristic (AUC) 1.000 [1.000 – 1.000] (with a sensitivity 0.985 [0.971 – 1.000] and a specificity of 0.986 [0.971 – 1.000]) on intramural test set, but significant drop in extramural test set. Accuracy on various extramural test sets varies 50% - 70%, AUC ranges 0.527 – 0.865 (sensitivity and specificity fluctuate 0.394 – 0.995 and 0.443 – 0.864 respectively). Diagnostic performance on the intramural test set observed in this study shows that DCNN can accurately classify active TB and normal chest radiographs, however the external test set shows DCNN is less likely to generalize well on models trained on specific population dataset.

Implantable Cardioverter Defibrillator Multisensor Monitoring during Home Confinement Caused by the COVID-19 Pandemic

Aims: The utilization of remote monitoring platforms was recommended amidst the COVID-19 pandemic. The HeartLogic index combines multiple implantable cardioverter defibrillator (ICD) sensors and has proved to be a predictor of impending heart failure (HF) decompensation. We examined how multiple ICD sensors behave in the periods of anticipated restrictions pertaining to physical activity. Methods: The HeartLogic feature was active in 349 ICD and cardiac resynchronization therapy ICD patients at 20 Italian centers. The period from 1 January to 19 July 2020, was divided into three phases: pre-lockdown (weeks 1–11), lockdown (weeks 12–20), post-lockdown (weeks 21–29). Results: Immediately after the implementation of stay-at-home orders (week 12), we observed a significant drop in median activity level whereas there was no difference in the other contributing parameters. The median composite HeartLogic index increased at the end of the Lockdown. The weekly rate of alerts was significantly higher during the lockdown (1.56 alerts/week/100 pts, 95%CI: 1.15–2.06; IRR = 1.71, p = 0.014) and post-lockdown (1.37 alerts/week/100 pts, 95%CI: 0.99–1.84; IRR = 1.50, p = 0.072) than that reported in pre-lockdown (0.91 alerts/week/100 pts, 95%CI: 0.64–1.27). However, the median duration of alert state and the maximum index value did not change among phases, as well as the proportion of alerts followed by clinical actions at the centers and the proportion of alerts fully managed remotely. Conclusions: During the lockdown, the system detected a significant drop in the median activity level and generated a higher rate of alerts suggestive of worsening of the HF status.

PENDAMPINGAN PROMOSI PARIWISATA DESA SUMBER REJO PURWOSARI PASURUAN (JEMPINANG RAFTING)

In an era of pandemics like this, tourism everywhere is subject to the same impact, a significant drop in the number of visitors and also the large losses experienced by tourism managers make it a big pr to continue to improve. In experiencing a pandemic like this, promotions must be carried out so that visitors continue to come to these tours and also the stability of managers and traders in tourist attractions remains prosperous. Therefore, the authors carry out Real Work Practices (PKN) in assisting rural tourism promotion that focuses on social media including Facebook, Instagram, Tik Tok, and news media. So that the jempinang rafting tour will be better known by people throughout Indonesia. From the use of these three media, Instagram is more dominant for promotion on social media because many social media users have created new interests, namely promotion through social media. The second is occupied by the Tik Tok application and the third is the news media.

To Study Acute Changes in Brain Oxygenation on MRI in Healthcare Workers Using N95 Mask and PPE Kits for Six Hours a Day

Background Due to long working hours wearing an N95 mask and PPE kit during the COVID-19 pandemic, the healthcare workers (HCWs) complained of headaches, confusion, and exhaustion. This study was therefore performed to study the changes in brain oxygenation. Aim To compare brain oxygenation in health care workers wearing an N95 mask with a PPE kit versus a three-ply mask during an intensive care setting for 6 hours. Materials and Methods Thirty clinicians and 30 paramedical staff participated in the study. The control (three-ply mask) and subject (N95 mask with PPE) groups included 15 clinicians and 15 paramedical staff. A comparative analysis of brain oxygenation using a 3T magnetic resonance imaging (MRI) machine was performed in these two groups at the beginning and the end of their work shift. Results The mean age of the individuals in the control and subject groups was 30.8 and 30.13 years, respectively. The median value of brain oxygenation in the control and subject groups in the pre-shift was between 33 and 31 and post-shift was 30 and 24. The drop in brain oxygenation in subjects was more than the controls (p = 0.004) in the post-shift assessments. The cerebral blood flow (CBF) in the bilateral middle cerebral artery (MCA) using arterial spin labeling (ASL) showed a rise in CBF in both groups post-shift as compared with the pre-shift values. The median values of the right and left MCA in the control and subject groups pre-shift were 82.75/83.45 and 89.75/106.65. The post-shift median values of both MCAs of the control and subject groups were 115.65/115.55 and 109.60/119.49. Conclusion MRI-BOLD imaging revealed a significant drop in brain oxygenation in the subject group as compared with the control group. Multiphasic-ASL showed a compensatory rise in CBF in both groups.

Adequate Immunogenicity And Low Rate of Severe Adverse Events After SARS-CoV-2 mRNA-Based Vaccination In Patients With Solid Malignancies On Active Treatment Starts To Decline 3 Months After Complete Primary Course of Vaccination

Background: SARS-CoV-2 vaccination in cancer patients is crucial since they are at increased risk of severe COVID-19 disease course, but data on efficacy and safety of vaccination are scarce.Methods: We performed a prospective observational study of patients with solid cancers on active anticancer treatment (chemotherapy, immunotherapy with immune checkpoint inhibitors (ICI) or targeted therapy) that received mRNA-based SARS-CoV-2 vaccination at two institutions in Slovenia. The immunogenicity was assessed by the detection of anti-SARS-CoV-2 S1 IgG antibodies in serum; patients were sampled before, 2-3 weeks after the first dose, 2-3 weeks after the second dose, and 3 months after the complete primary course of vaccination. The results were also compared to controls, sampled at similar time points.Results: Between March and July 2021 112 patients were included in the analysis. The seroconversion rate in patients without prior COVID-19 infection was 96% after the complete primary course of vaccination with 2 doses, compared to 100% for healthy controls. The seroconversion rate after vaccination for patients on chemotherapy, ICI, and targeted therapy was 100%, 91%, and 97%, respectively. All controls and the majority of patients on chemotherapy and targeted therapy, but only 83% for patients on ICI were adequate responders (anti-SARS-CoV-2 S1 IgG ≥ 880 ng/ml). Three months after the vaccination, a significant drop in antibody levels was observed in patients receiving ICI compared to controls (P < 0.001). Adverse events were mostly mild and predictable, none of the patients experienced serious adverse events after vaccination.Conclusions: Immunogenicity after mRNA-based vaccination against SARS-CoV-2 in cancer patients is only slightly impaired, but influenced by the type of anticancer therapy received. Patients on ICI have the slightest and gradual antibody production. Since antibody levels decline after three months, a third vaccination dose is reasonable to provide adequate protection against severe COVID-19 disease course.The study was approved by the National Ethics Committee (No. 0120-39/2021/6)

Effect of Spray Distance and Powder Feed Rate on Particle Velocity in Cold Spray Processes

Cold spray technology using micron-sized particles to produce coatings is increasingly used for reparative tasks in various industries. In a cold spray setup, the gun is usually connected to a robotic arm to deposit coatings on components with complex geometries. For these components, the standoff distance used in the cold spray process has to be large enough for easy maneuverability of the gun around a small radial feature. However, a small standoff distance is commonly found in most studies, which is thought to prevent a velocity drop of the particles over a larger distance. Here, a study was carried out by measuring the Inconel 625 particle velocity at different spray distances, ranging from 3 to 40 cm. The highest average velocity of 781 m/s was found at a spray distance of 8 cm. Furthermore, a study with varying powder feed rates was also conducted. An increase in the powder feed rate was found to have a minimal effect on the particle velocity. Inconel 625 coatings deposited at the optimum standoff distance (8 cm) were found to have low porosity and high hardness. The results in this study demonstrate that a larger standoff distance can be applied without a significant drop in velocity for cold spray applications requiring high maneuverability.

A Clinical Study on Traumatic Pericarditis and Traumatic Reticuloperitonitis in Twelve Holstein Friesian Cattle

Background: Traumatic injury caused by swallowed sharp foreign object is one of the common conditions in dairy animal resulting into development of traumatic pericarditis (TP) and traumatic reticuloperitonitis (TRP). Under field conditions both conditions mimic the same clinical signs making it difficult to differentiate as well as render to choose ideal therapeutic management. The present study was aimed to evaluate clinical, hematobiochemical and ultrasonographic changes in cattle to clinically differentiate between TP and TRP cases. Methods: From the period of January 2020 to December 2020, total twelve Holstein Friesian cattle were investigated for TP and TRP. In the present study, six animals each suffering from TP and TRP were included along with six normal healthy animals as control. Different clinical signs, haemato-biochemical parameters and ultrasonographical findings were recorded in each group and comparative analysis was done. Result: Brisket edema, bilateral jugular vein engorgement and arched back conditions were most reported clinical signs in both the groups. Significant changes were recorded in the values of red blood cells, lymphocyte, blood urea nitrogen, creatinine and SGOT between both the groups. Significant drop in hemoglobin level was observed in TP affected group. No significant changes were observed in white blood cells, packed cell volume, monocyte counts and eosinophil counts. Significant increase in fibrinogen concentration recorded in both the groups. In ultrasonography, accumulation of anechoic fluid around heart in TP and reticular wall thickening in TRP was most consistent findings.

Assessing the International Student Enrolment Strategies in Australian Universities

Travel restrictions in the COVID-19 pandemic cause a significant drop in international student enrolment. To cope with such drastic change, this study aims to assess the international student enrolment strategies in Australian universities during the pandemic. Using the critical theory as a theoretical framework, this case study first probed into the problems of the current international student enrolment strategies by taking power and discourses into consideration. The problems identified include the marginalisation of international students and hindrance in their empowerment. Then, this study proposed some future directions for international student enrolment in relation to international students' concerns and needs, alongside migration policies and workforce demands. The future directions include increasing their chances to be academically competitive and equip them to prepare for their future career. The findings can be useful for university management to devise better strategies to recruit and retain international students in the post-pandemic era.

Busting contraception myths and misconceptions among youth in Kwale County, Kenya: results of a digital health randomised control trial

ObjectivesThe objective of this randomised controlled trial in Kenya was to assess the effect of delivering sexual and reproductive health (SRH) information via text message to young people on their ability to reject contraception-related myths and misconceptions.Design and settingA three-arm, unblinded randomised controlled trial with a ratio of 1:1:1 in Kwale County, Kenya.Participants and interventionsA total of 740 youth aged 18–24 years were randomised. Intervention arm participants could access informational SRH text messages on-demand. Contact arm participants received once weekly texts instructing them to study on an SRH topic on their own. Control arm participants received standard care. The intervention period was 7 weeks.Primary outcomeWe assessed change myths believed at baseline and endline using an index of 10 contraception-related myths. We assessed change across arms using difference of difference analysis.ResultsAcross arms, <5% of participants did not have any formal education, <10% were living alone, about 50% were single and >80% had never given birth. Between baseline and endline, there was a statistically significant drop in the average absolute number of myths and misconceptions believed by intervention arm (11.1%, 95% CI 17.1% to 5.2%), contact arm (14.4%, 95% CI 20.5% to 8.4%) and control arm (11.3%, 95% CI 17.4% to 5.2%) participants. However, we observed no statistically significant difference in the magnitude of change across arms.ConclusionsWe are unable to conclusively state that the text message intervention was better than text message ‘contact’ or no intervention at all. Digital health likely has potential for improving SRH-related outcomes when used as part of multifaceted interventions. Additional studies with physical and geographical separation of different arms is warranted.Trial registration numberISRCTN85156148.

Medical data integration using HL7 standards for patient’s early identification

Integration between information systems is critical, especially in the healthcare domain, since interoperability requirements are related to patients’ data confidentiality, safety, and satisfaction. The goal of this study is to propose a solution based on the integration between queue management solution (QMS) and the electronic medical records (EMR), using Health Level Seven (HL7) protocols and Extensible Markup Language (XML). The proposed solution facilitates the patient’s self-check-in within a healthcare organization in UAE. The solution aims to help in minimizing the waiting times within the outpatient department through early identification of patients who hold the Emirates national ID cards, i.e., whether an Emirati or expatriates. The integration components, solution design, and the custom-designed XML and HL7 messages were clarified in this paper. In addition, the study includes a simulation experiment through control and intervention weeks with 517 valid appointments. The experiment goal was to evaluate the patient’s total journey and each related clinical stage by comparing the “routine-based identification” with the “patient’s self-check-in” processes in case of booked appointments. As a key finding, the proposed solution is efficient and could reduce the “patient’s journey time” by more than 14 minutes and “time to identify” patients by 10 minutes. There was also a significant drop in the waiting time to triage and the time to finish the triage process. In conclusion, the proposed solution is considered innovative and can provide a positive added value for the patient’s whole journey.