Surveillance, Self-Governance, and Mortality: The Impact of Prescription Drug Monitoring Programs on U.S. Overdose Mortality, 2000–2016

Policy mechanisms shaping population health take numerous forms, from behavioral prohibitions to mandates for action to surveillance. Rising drug overdoses undermined the state’s ability to promote population-level health. Using the case of prescription drug monitoring programs (PDMPs), we contend that PDMP implementation highlights state biopower operating via mechanisms of surveillance, whereby prescribers, pharmacists, and patients perceive agency despite choices being constrained. We consider whether such surveillance mechanisms are sufficient or if prescriber/dispenser access or requirements for use are necessary for population health impact. We test whether PDMPs reduced overdose mortality while considering that surveillance may require time to reach effectiveness. PDMPs reduced opioid overdose mortality 2 years postimplementation and sustained effects, with similar effects for prescription opioids, benzodiazepines, and psychostimulants. Access or mandates for action do not reduce mortality beyond surveillance. Overall, PDMP effects on overdose mortality are likely due to self-regulation under surveillance rather than mandated action.

Age Estimation from Left-Hand Radiographs with Deep Learning Methods

Bone age is estimated in pediatric medicine for medical and legal purposes. In pediatric medicine, it aids in the growth and development assessment of various diseases affecting children. In forensic medicine, it is required to determine criminal liability by age, refugee age estimation, and child-adult discrimination. In such cases, radiologists or forensic medicine specialists conduct bone age estimation from left hand-wrist radiographs using atlas methods that require time and effort. This study aims to develop a computer-based decision support system using a new modified deep learning approach to accelerate radiologists' workflow for pediatric bone age estimation from wrist radiographs. The KCRD dataset created by us was used to test the proposed method. The performance of the proposed modified IncepitonV3 model compared to IncepitonV3, MobileNetV2, EfficientNetB7 models. Acceptably high results (MAE=4.3, RMSE=5.76, and R2=0.99) were observed with the modified IncepitonV3 transfer deep learning method.

Care practices of specialized outpatient pediatric palliative care teams in collaboration with parents: Results of participatory observations

Background: Collaboration between parents and professional care providers is an essential part of pediatric palliative care. As children are embedded in family systems and many of the patients are not able to communicate verbally, their parents are the primary interaction partners for palliative care providers. International standards for pediatric palliative care in Europe state that parents should be supported, acknowledged as the primary carers and involved as partners in all care and decisions. Aim: To find out through which care practices pediatric palliative care teams shape collaboration with parents in everyday care. Design: Ethnographic method of participatory observations. Field notes were analyzed using thematic analysis. Setting/participants: Researchers accompanied three pediatric palliative care teams on home visits to eight different families caring for a child with life-limiting conditions. Results: Care practices of palliative care teams were characterized by familiarity, a resource-oriented attitude, empowerment of parents, shared decision-making and support for parents. Palliative care teams not only provided palliative medical treatment for the children, but also developed a trusting care partnership with parents. The teams employed a sensitive and multifaceted communication style in their collaboration with parents. Conclusions: Care practices in pediatric palliative care require time, communication skills, and a high level of psychosocial competence, to develop a trusting, collaborative relationship with parents. This should be taken into consideration when establishing pediatric palliative care structures, preparing guidelines, training staff, and deciding upon appropriate remuneration.

Reducing the Electrogram Review Burden Imposed by Insertable Cardiac Monitors

Background: Insertable cardiac monitors (ICMs) are essential for ambulatory arrhythmia diagnosis. However, definitive diagnoses still require time-consuming, manual adjudication of electrograms (EGMs). Objective: To evaluate the clinical impact of selecting only key EGMs for review. Methods: Retrospective analyses of randomly selected Abbott Confirm Rx devices with ≥90 days of remote transmission history was performed, with each EGM adjudicated as true or false positive (TP, FP). For each device, up to 3 “key EGMs” per arrhythmia type per day were prioritized for review based on ventricular rate and episode duration. The reduction in EGMs and TP days (patient-days with at least 1 TP EGM), and any diagnostic delay (from the first TP), were calculated vs. reviewing all EGMs. Results: In 1,000 ICMs over a median duration of 8.1 months, at least one atrial fibrillation (AF), tachycardia, bradycardia, or pause EGM was transmitted by 424, 343, 190, and 325 devices, respectively, with a total of 95716 EGMs. Approximately 90% of episodes were contributed by 25% of patients. Key EGM selection reduced EGM review burden by 43%, 66%, 77%, and 50% (55% overall), while reducing TP days by 0.8%, 2.1%, 0.2%, and 0.0%, respectively. Despite reviewing fewer EGMs, 99% of devices with a TP EGM were ultimately diagnosed on the same day vs. reviewing all EGMs. Conclusions: Key EGM selection reduced the EGM review substantially with no delay-to-diagnosis in 99% of patients exhibiting true arrhythmias. Implementing these rules in the Abbott patient care network may accelerate clinical workflow without compromising diagnostic timelines.

Detection of invasive Trichosporon asahii in patient blood by a fungal PCR array

Rare invasive fungal infections are increasingly emerging in hosts with predisposing factors such as immunodeficiency. Their timely diagnosis remains difficult, as their clinical picture may initially mimic infections with more common fungal species and species identification may be difficult with routine methods or may require time-consuming subcultures. This often results in ineffective drug administration and fatal outcomes. We report on a patient in their early twenties with mixed cellularity classical Hodgkin lymphoma with a disseminated Trichosporon asahii (T. asahii) infection. Even though pathogen detection and identification was possible via the standard procedure consisting of culture followed by matrix-assisted laser desorption ionisation–time of flight (MALDI-TOF) mass spectrometry, the patient passed away in the course of multi organ failure. Herein, we report on a retrospectively applied experimental diagnostic fungal PCR-analysis used on an EDTA blood sample and consisting of two pan-fungal reactions and seven branch-specific reactions. Regarding invasive T. asahii infection, this PCR array could considerably shorten time to diagnosis and switch to a targeted therapy with triazoles.

Integrated enhanced Raman scattering: a review

The demand for effective, real-time environmental monitoring and for customized point-of-care (PoC) health, requires the ability to detect low molecular concentrations, using portable, reliable and cost-effective devices. However, traditional techniques often require time consuming, highly technical and laborious sample preparations, as well as expensive, slow and bulky instrumentation that needs to be supervised by laboratory technicians. Consequently, fast, compact, self-sufficient, reusable and cost-effective lab-on-a-chip (LOC) devices, which can perform all the required tasks and can then upload the data to portable devices, would revolutionize any mobile sensing application by bringing the testing device to the field or to the patient. Integrated enhanced Raman scattering devices are the most promising platform to accomplish this vision and to become the basic architecture for future universal molecular sensors and hence an artificial optical nose. Here we are reviewing the latest theoretical and experimental work along this direction.

3D full-time anisotropic TEM modelling using a mixed BDF2/SAI method

Transient electromagnetic (TEM) data are affected by resistivity anisotropy, which should be considered in 3D modelling. The influence of anisotropy on full-time response is the main focus of this research. For spatial discretisation of an anisotropic model, the mimetic finite volume approach was applied. The accuracy of the shift-and-invert (SAI) Krylov subspace approach and the two-step backward differentiation formula (BDF2) for modelling 3D full-time electromagnetic data has been demonstrated. However, both algorithms require time-consuming calculations. The SAI technique requires a number of projection subspace constructions, whereas the BDF2 algorithm necessitates numerous coefficient matrix decompositions. We proposed a novel mixed BDF2/SAI algorithm in this paper, which combines the advantages of the two algorithms. The on-time response is computed using BDF2, while the off-time response is computed using the SAI-Krylov subspace method. The forward results of a 1D model with a half-sine waveform demonstrated that the new algorithm is accurate and faster than both the BDF2 algorithm and the SAI algorithm. During the full-time period, the forward results of a 3D anisotropic model with half-sine waveform show that abnormal responses can be induced. It was shown that the relative abnormal of ${{{\bf b}}_{\boldsymbol{z}}}$ is higher during the on-time period, while the relative abnormal of $\partial {{{\bf b}}_{\boldsymbol{z}}}/\partial t$ is higher during the off-time period. Furthermore, the change in relative anomaly is more obvious as the anisotropic block rotates around the x-axis. And the larger the rotation angle, the larger the relative anomaly.

Timing of resin-tapping operations in maritime pine forests in Northern Spain

Aim of study: To optimize the timing of resin-tapping activities for maximizing the economic efficiency of resin tapping in Atlantic maritime pine forests. Area of study: Northern Spain. Material and methods: We conducted three small experiments in a mature maritime pine forest aimed to test: i) the impact of groove frequency on resin production, ii) the effect of previous grooves as a driver of temporal patterns of resin production along the seasons and iii) the impact of previous tapping on resin production in the following campaign. Main results: The resin produced decreased as groove frequency decreased, but the reduction was low. Considering that the number of trees that a worker can tap increases with more spaced grooves, higher tapping efficiency can be achieved with monthly grooves. Previous tapping increased resin yield during the following campaign but resin production was not affected by the previous grooves during the current tapping campaign. Research highlights: Responses to wounding seem to require time to be effective and temporal patterns of resin production appear to be driven by weather conditions alone.

Design of Low-Power SPIHT Decoder Based ECG Compression and Reconstruction System

This article proposes a 1D biomedical signal encoding scheme to allow embedding of metadata and to protect privacy. The compression of ECG signal and its reconstruction is implemented. The design concentrates on an overview of the criteria for safe and effective m-health storage, transmission, and access to medical tests. However, existing architectures for encoding SPIHT are designed to process images/videos. Significant memory and complex sorting algorithms are required for both architectures, and they all require time-consuming tasks that do not apply to mobile ECG applications. On the basis of our previously updated SPIHT coding research, we used flags and bit controls to reduce memory needs and code complexity through a combination of three search processes in one phase. The goal of real-time architecture for mobile ECG applications is therefore to be accomplished. In order first, to solve the disadvantages of the low-encryption speed of coded and complex hardware architectures that characterize previous SPIHT algorithms, we propose a SPIHT coding algorithm that uses several types of state registry files because of its need for dynastic c to attain real-time and performance design objectives. Secondly, a highly piped and efficient VLSI architecture is used to implement a high-efficiency and low-power SPIHT design based on the proposed algorithm.

Nanotechnology as a Novel Approach in Combating Microbes Providing an Alternative to Antibiotics

The emergence of infectious diseases promises to be one of the leading mortality factors in the healthcare sector. Although several drugs are available on the market, newly found microorganisms carrying multidrug resistance (MDR) against which existing drugs cannot function effectively, giving rise to escalated antibiotic dosage therapies and the need to develop novel drugs, which require time, money, and manpower. Thus, the exploitation of antimicrobials has led to the production of MDR bacteria, and their prevalence and growth are a major concern. Novel approaches to prevent antimicrobial drug resistance are in practice. Nanotechnology-based innovation provides physicians and patients the opportunity to overcome the crisis of drug resistance. Nanoparticles have promising potential in the healthcare sector. Recently, nanoparticles have been designed to address pathogenic microorganisms. A multitude of processes that can vary with various traits, including size, morphology, electrical charge, and surface coatings, allow researchers to develop novel composite antimicrobial substances for use in different applications performing antimicrobial activities. The antimicrobial activity of inorganic and carbon-based nanoparticles can be applied to various research, medical, and industrial uses in the future and offer a solution to the crisis of antimicrobial resistance to traditional approaches. Metal-based nanoparticles have also been extensively studied for many biomedical applications. In addition to reduced size and selectivity for bacteria, metal-based nanoparticles have proven effective against pathogens listed as a priority, according to the World Health Organization (WHO). Moreover, antimicrobial studies of nanoparticles were carried out not only in vitro but in vivo as well in order to investigate their efficacy. In addition, nanomaterials provide numerous opportunities for infection prevention, diagnosis, treatment, and biofilm control. This study emphasizes the antimicrobial effects of nanoparticles and contrasts nanoparticles’ with antibiotics’ role in the fight against pathogenic microorganisms. Future prospects revolve around developing new strategies and products to prevent, control, and treat microbial infections in humans and other animals, including viral infections seen in the current pandemic scenarios.