Impact of dermoscopy-aided pediatric teledermatology program on the accessibility and efficiency of dermatology care at community health centers

Background There are few studies focusing on pediatric teledermatology, and the impact of a large-scale pediatric teledermatology program on the accessibility and efficiency of dermatology care remains unclear. This study evaluated the impact of a state-wide implementation of a store-and-forward teledermatology program augmented by the incorporation of dermoscopy in pediatric patients visiting community health centers. Methods It was a descriptive, retrospective cohort study of 876 pediatric dermatology referrals. Results In the traditional referral system, only 60 patients (17.6%) were seen by dermatologists with average waiting times of 75 days due to limited access. In comparison, with an implementation of dermoscopy-aided teledermatology, all 536 teledermatology referrals received dermatological care within 24 h, of which only 64 (12%) patients requires face-to-face (F2F) consultation. Patients referred for F2F consultation via eConsults had a much lower no-show rate as compared to the traditional referral system (39% vs. 71%). Side by side comparison between general population and pediatric population has demonstrated shared features in efficiency and access improvement but revealed specific characteristics of pediatric teledermatology in terms of diagnosis and treatment. Conclusion Coordinated store-and-forward teledermatology platform with incorporation of dermoscopy between large community care network and dermatology provider can greatly improve access to pediatric dermatology care especially in underserved population. The efficiency of teledermatology in access improvement for pediatric population is comparable with adult population in eConsults. There are also unique features and challenges in pediatric teledermatology that require further research.

Accuracy of Store-and-Forward Teledermatology for the Diagnosis of Skin Cancer: The Nouvelle-Aquitaine Experience

Background In Nouvelle-Aquitaine (a French region with a population of almost 6 million), the density of dermatologists is less than 3.8/100,000 inhabitants. This lack of dermatological care is delaying diagnosis and management, especially for skin cancer. The SmartDerm Project is a store-and-forward (SAF) teledermatology platform for primary care in Nouvelle-Aquitaine providing dermatological counselling to general practitioners (GPs). Objective The main objective was to determine the concordance between the diagnosis of skin cancer made by dermatologists and the pathologists’ diagnosis. Methods GPs in 3 pilot departments of Nouvelle-Aquitaine (Lot-Et-Garonne, Deux-Sèvres, Creuse) sent their dermatology requests using their smartphone, via an app called PAACO/Globule; dermatologists at the University Hospital of Bordeaux answered within 48-72 hours. Consecutive cases of skin cancer suspected by the referent dermatologists during the intervention were included, if the result of biopsy interpreted by a certified pathologist was available at the time of the study. Results Among the 1727 requests, 163 (9%) concerned a possible diagnosis of skin cancer and were eligible. For 61 cases, the histopathological findings were not available. Eventually, 93 patients with a total of 102 skin lesions were included. Median age was 75 years (range 26-97 years), with 53% women. The skin lesions had progressed for 8 months on average (range 0.5-36 months). The median response time was 1 day (range 0-61 days); 65 days (range 1-667 days) elapsed on average between the SAF opinion and the histological sample. Histopathology diagnosed 83 malignant lesions (57 basal cell carcinomas, 69%; 18 squamous cell carcinomas, 22%; 6 melanomas, 7%; 1 cutaneous lymphoma, 1%; 1 secondary location of a primary cancer, 1%), 1 precancerous lesion, and 18 benign lesions. The concordance between the opinion of the referent dermatologist and the final pathological finding was 83% for nonmelanocytic lesions and 67% for melanocytic lesions. Conclusions This study showed the reliability of SAF teledermatology in the diagnosis of skin cancer, comparable to literature data in the absence of dermatoscopy. The median delay of about two months between request and histology was an improvement compared to the delay of usual appointments in the intervention area. The lack of data for 61 patients showed that SAF telemedicine requires better coordination and follow-up, especially for the management of skin cancer. With this reservation in mind, teledermatology offers an alternative answer for the triage of patients with skin cancer residing in areas with low medical density. Conflicts of Interest None declared.

Accuracy of Store-and-Forward Teledermatology for the Diagnosis of Skin Cancer: The Nouvelle-Aquitaine Experience (Preprint)

BACKGROUND In Nouvelle-Aquitaine (a French region with a population of almost 6 million), the density of dermatologists is less than 3.8/100,000 inhabitants. This lack of dermatological care is delaying diagnosis and management, especially for skin cancer. The SmartDerm Project is a store-and-forward (SAF) teledermatology platform for primary care in Nouvelle-Aquitaine providing dermatological counselling to general practitioners (GPs). OBJECTIVE The main objective was to determine the concordance between the diagnosis of skin cancer made by dermatologists and the pathologists’ diagnosis. METHODS GPs in 3 pilot departments of Nouvelle-Aquitaine (Lot-Et-Garonne, Deux-Sèvres, Creuse) sent their dermatology requests using their smartphone, via an app called PAACO/Globule; dermatologists at the University Hospital of Bordeaux answered within 48-72 hours. Consecutive cases of skin cancer suspected by the referent dermatologists during the intervention were included, if the result of biopsy interpreted by a certified pathologist was available at the time of the study. RESULTS Among the 1727 requests, 163 (9%) concerned a possible diagnosis of skin cancer and were eligible. For 61 cases, the histopathological findings were not available. Eventually, 93 patients with a total of 102 skin lesions were included. Median age was 75 years (range 26-97 years), with 53% women. The skin lesions had progressed for 8 months on average (range 0.5-36 months). The median response time was 1 day (range 0-61 days); 65 days (range 1-667 days) elapsed on average between the SAF opinion and the histological sample. Histopathology diagnosed 83 malignant lesions (57 basal cell carcinomas, 69%; 18 squamous cell carcinomas, 22%; 6 melanomas, 7%; 1 cutaneous lymphoma, 1%; 1 secondary location of a primary cancer, 1%), 1 precancerous lesion, and 18 benign lesions. The concordance between the opinion of the referent dermatologist and the final pathological finding was 83% for nonmelanocytic lesions and 67% for melanocytic lesions. CONCLUSIONS This study showed the reliability of SAF teledermatology in the diagnosis of skin cancer, comparable to literature data in the absence of dermatoscopy. The median delay of about two months between request and histology was an improvement compared to the delay of usual appointments in the intervention area. The lack of data for 61 patients showed that SAF telemedicine requires better coordination and follow-up, especially for the management of skin cancer. With this reservation in mind, teledermatology offers an alternative answer for the triage of patients with skin cancer residing in areas with low medical density.

TELEDENTISTRY DURING THE COVID-19 PANDEMIC: A REVIEW OF LITERATURE

Dentistry is one of the fields that are hugely affected by the COVID-19 pandemic due to high concentrations of contaminated aerosols which can be transmitted while undergoing dental procedures and can potentially lead to the nosocomial spread of the COVID-19 virus. Teledentistry, a subunit of telehealth, is an alternative that is widely chosen to diminish in-clinic appointments and to support social distancing. The four main methods of teledentistry are live or synchronous video, store-and-forward (asynchronous), remote patient monitoring (RPM), and mobile health (mHealth). Teledentistry can be applied to all specialities including oral medicine, oral and maxillofacial surgery, endodontics, orthodontics, prosthodontics, periodontics, pediatric and preventive dentistry with high accuracy and reliability. The process of teledentistry consists of subunits including teleconsultation, telediagnosis, teletriage, and telemonitoring. Focusing on its advantages, regarding the affordability and convenience of teledentistry, it originated a paradigm shift for the prevention and promotion of oral health. COVID-19 patients can still receive dental care with the use of teledentistry. Moreover, it aids patients from rural areas where access to dental specialities is limited. However, solutions to address concerns about the image quality, digital literacy of both healthcare providers and patients, insufficient financial reimbursement of dentists, security and technical issues are required to enhance the effectiveness of teledentistry. Hopefully, this review paper can be helpful for giving information regarding teledentistry.

A Comprehensive Survey of Energy-Efficiency Approaches in Wired Networks

Energy consumption by the network infrastructure is growing expeditiously with the rise of the Internet. Critical research efforts have been pursued by academia, industry and governments to make networks, such as the Internet, operate more energy efficiently and reduce their power consumption. This work presents an in-depth survey of the approaches to reduce energy consumption in wired networks by first categorizing existing research into broad categories and then presenting the specific techniques, research challenges, and important conclusions. At abroad level, we present five categories of approaches for energy efficiency in wired networks – (i) sleeping of network elements, (ii) link rate adaptation, (iii) proxying, (iv) store and forward, and (v) network traffic aggregation. Additionally, this survey reviews work in energy modeling and measurement, energy-related standards and metrics, and enumerates discussion points for future work and motivations.

Performance Analysis of CAT Swarm Optimization Algorithm in Disruption Tolerant Networks

Disruption tolerant networks (DTN) are networks that provide unguided technologies. Solar technologies and Radio frequencies are used to operate the network. In DTN networks the connectivity does not last for a long time and they do not provide end to end connectivity. Therefore it uses store and forward technique to forward the packets to the destination nodes. When N number of nodes is participating in the network, each node receives packets from the previous node and sends acknowledgment to the sender node. Time delay occurs on receiving and sending acknowledgment continuously. Collision occurs due to the congestion in the network. Due to the irregular connectivity in the network, the compromised nodes try to drop the whole packet or part of the packet. The Blackhole and Greyhole attacks occur due to the packet loss. Optimized algorithm can be used to solve the above attacks. By using CAT Swarm optimization algorithm, the attacks can be prevented and it minimizes the Time delay in delivering the packets.

Development of Bioimpedance Sensors and Measurement System for Biomedical In-Vitro Applications

Bioimpedance analysis is a label-free and easy approach to obtain information on cellular barrier integrity and cell viability more broadly. In this work, we introduce a small, low-cost, portable in vitro impedance measurement system for studies where a shadow-free exposure of the cells is a requirement. It can be controlled by a user-friendly web interface and can perform measurements automated and autonomously at short intervals. The system can be integrated into an existing IoT network for remote monitoring and indepth analyses. A single-board computer (SBC) serves as the central unit, to control, analyze, store and forward the measurement data from the single-chip impedance analyzer. Various materials and manufacturing methods were used to produce a purpose-built lid on top of a modified 24-well microtiter plate in a “do it yourself” fashion. Furthermore, three different sensor designs were developed utilizing anodic aluminum oxide (AAO) membranes and gold-plated electrodes. Preliminary tests with potassium chloride (KCl) showed first promising results.

Investigating Multilayer Omega-Type Networks Operating with the Cut-Through Technique under Uniform or Hotspot Traffic Conditions

The continuous increase in the complexity of data networks has motivated the development of more effective Multistage Interconnection Networks (MINs) as important factors in providing higher data transfer rates in various switching divisions. In this paper, semi-layer omega-class networks operating with a cut-through forwarding technique are chosen as test-bed subjects for detailed evaluation, and this network architecture is modelled, inspected, and simulated. The results are examined for relevant singlelayer omega networks operating with cut-through or ‘store and forward’ forwarding techniques. Two series of experiments are carried out: one concerns the case of uniform traffic, while the other is related to hotspot traffic. The results quantify the way in which this network outperforms the corresponding singlelayer network architectures for the same network size and buffer size. Furthermore, the effects of the dimensions of the switch elements and their corresponding reliability on the overall interconnection system are investigated, and the complexity and the relevant cost are examined. The data yielded by this investigation can be valuable to MIN engineers and can allow them to achieve more productive networks with lower overall implementation costs.