Quantitative assessment of pneumothorax by using Shannon entropy of lung ultrasound M-mode image and diaphragmatic excursion based on automated measurement.

Background: Lung ultrasound (LUS) and diaphragm ultrasound (DUS) are the appropriate modalities for conservative observation to those patients who are with stable pneumothorax, as well as for the timely detection of life-threatening pneumothorax at any location, due to they are portable, real-time, relatively cost effective, and most important, without radiation exposure. The absence of lung sliding on LUS M-mode images and the abnormality of diaphragmatic excursion (DE) on DUS M-mode images are the most common and novel diagnostic criteria for pneumothorax, respectively. However, visual inspection of M-mode images remains subjective and quantitative analysis of LUS and DUS M-mode images are required. Methods: Shannon entropy of LUS M-mode image (ShanEnLM) and DE based on the automated measurement (DEAM) are adapted to the objective pneumothorax diagnoses and the severity quantifications in this study. Mild, moderate, and severe pneumothoraces were induced in 24 male New Zealand rabbits through insufflation of room air (5, 10 and 15, and 25 and 40 mL/kg, respectively) into their pleural cavities. In vivo intercostal LUS and subcostal DUS M-mode images were acquired using a point-of-care system for estimating ShanEnLM and DEAM. Results: ShanEnLM and DEAM as functions of air insufflation volumes exhibited U-shaped curves and were exponentially decreasing, respectively. Either ShanEnLM or DEAM had areas under the receiver operating characteristic curves [95% confidence interval (CI)] of 1.0000 (95% CI: 1.0000-1.0000), 0.9833 (95% CI: 0.9214-1.0000), and 0.9407 (95% CI: 0.8511-1.0000) for differentiating between normal and mild pneumothorax, mild and moderate pneumothoraces, and moderate and severe pneumothoraces, respectively. Conclusions: Our findings imply that the combination of ShanEnLM and DEAM give the promising potential for pneumothorax quantitative diagnosis.

Health Utilities of Bilateral Severe-to-Profound Hearing Loss with Assistive Devices.

Hearing loss is a common sensory disorder in newborns. Early intervention with assistive devices benefits children's auditory and speech performance. This study aimed to measure the health utilities of children with bilateral severe-to-profound hearing impairment with different assistive devices. The descriptions of four hypothetical health states were developed, and their utility values were obtained from healthcare professionals via the visual analogue scale (VAS) and time trade-off (TTO) methods. Thirty-seven healthcare professionals completed the TTO interview and were included in the analysis. The mean utility scores obtained via VAS were 0.31 for no assistive devices, 0.41 for bilateral hearing aids, 0.63 for bimodal hearing, and 0.82 for bilateral cochlear implants. As for the utility scores obtained via TTO, mean values were 0.60, 0.69, 0.81, and 0.90, respectively. None of the four groups had the same VAS- or TTO-elicited utility (p < 0.001). The post hoc test results showed that the difference was significant between any two groups (all p < 0.05). In conclusion, this study elicited health utility of bilateral hearing impairment with different assistive devices using the VAS and TTO methods. The utility values obtained provide critical data for future cost-utility analysis and health technology assessment.

Cost-Benefit Analysis of Involving Pharmacist for Medication Therapy Management in a Heart Transplant Clinic.

BACKGROUND: Drug-related problems (DRPs) are common in recipients of solid organ transplants. Pharmacist-led medication therapy management (MTM) has cost benefits in kidney and liver transplants; however, whether MTM is also beneficial in heart transplants remains unclear. This study explored the cost benefits of involving pharmacists in the heart transplant clinic. METHODS: This retrospective study evaluated DRPs for 1 year after implementation of pharmacist-led MTM in a heart transplant clinic. The DRPs were compared between patients receiving transplantation for <1 and >1 year. The risk matrix method was used to assess each DRP in terms of the estimated probability and severity of consequent adverse drug events (ADEs). For cost analysis, both estimated cost savings and avoidance were calculated. RESULTS: During the 1-year MTM, 372 DRPs were identified by the pharmacist, among which 169 (45%) and 203 (55%) were from patients at <1-year and ≥1-year post-transplant periods, respectively. The 2 post-transplant periods (<1 year and ≥1 year) exhibited significant differences in the distribution of the dosage or frequency problems (30% vs 18%, P = .005) and the suggestion of more appropriate medication (4% vs 10%, P = .024). In all, 92 (29%) DRPs had an ADE probability of >10%; and 63 (17%) DRPs were estimated to cause ADEs with moderate severity or higher. The estimated cost savings and cost avoidance were US $4902 and US $4519, which equaled a cost-benefit ratio of 2.39. CONCLUSION: Integration of pharmacists into heart transplant clinics could help address DRPs and may have cost benefits.

Clustering of functioning and disability profile based on the WHO disability assessment schedule 2.0 - a nationwide databank study.

OBJECTIVE: To compare and cluster the health status and disability restrictions associated with eight major physiological functions of body systems, using functioning domains of WHO Disability Assessment Schedule 2.0. DESIGN: Retrospective analyses of a nation-wide disability database. SETTING: Population-based study. PARTICIPANTS: Records from patients >18 years of age with disability were obtained from the Taiwan Data Bank of Persons with Disability (July 2012-November 2017). Disability functioning profile of the following diagnosis were analyzed: stroke, schizophrenia, hearing loss, liver cirrhosis, chronic kidney disease, congestive heart failure, burn, head and neck cancer. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic data, severity of impairment, and Disability Assessment Scale scores were obtained and analyzed. Radar charts were constructed using the WHO Disability Assessment Schedule 2.0. functioning domain score. Degree of similarity between any two given diagnosis was assessed by cluster analysis, comparing the Euclidean distances between radar chart data points among the six domains. RESULTS: Based on cluster analysis of similarities between functioning domain profiles, the eight diagnoses were grouped into different disability clusters. Four clusters of disability were named according to the type restriction patterns: global-impact cluster (stroke); interaction-restriction cluster (schizophrenia, hearing loss); physical-limitation cluster, (liver cirrhosis, CKD, and congestive heart failure); and specific-impact cluster (burn, head and neck cancer). The rates of institutionalization and unemployment differed between the four clusters. CONCLUSION: We converted WHO Disability Assessment Schedule 2.0. functioning domain scores into six-dimensioned radar chart, and demonstrate disability restrictions can be further categorized into clusters according to similarity of functioning impairment. Understanding of disease-related disabilities provides an important basis for designing rehabilitation programs and policies on social welfare and health that reflect the daily-living needs of people according to diagnosis.Implication for RehabilitationThe use of radar charts provided a direct visualization of the scope and severity of disabilities associated with specific diagnoses.Diagnosis-related disabilities can be organized into clusters based on similarities in WHODAS 2.0 disability domain profiles.Knowledge of the characteristics of disability clusters is important to understand disease-related disabilities and provide a basis for designing rehabilitation.

Quantitative Assessment of Lung Ultrasound Grayscale Images Based on Shannon Entropy for the Detection of Pulmonary Aeration: An Animal Study.

OBJECTIVE: Lung ultrasound (LUS) is a radiation-free, affordable, and bedside monitoring method that can detect changes in pulmonary aeration before hypoxic damage. However, visual scoring methods of LUS only enable subjective diagnosis. Therefore, quantitative analysis of LUS is necessary for obtaining objective information on pulmonary aeration. Because raw data are not always available in conventional ultrasound systems, Shannon entropy (ShanEn) of information theory without the requirement of raw data is valuable. In this study, we explored the feasibility of ShanEn estimated through grayscale histogram (GSH) analysis of LUS images for the quantification of pulmonary aeration. METHODS: Different degrees of pulmonary aeration caused by edema was induced in 32 male New Zealand rabbits intravenously injected with 0.1 mL/kg saline (the control group) and 0.025, 0.05, and 0.1 mL/kg oleic acid (mild, moderate, and severe groups, respectively). In vivo grayscale LUS images were acquired using a commercial point-of-care ultrasound system for estimation of GSH and corresponding ShanEn. Both lungs of each rabbit were dissected, weighed, and dried to determine the wet weight-to-dry weight ratio (W/D) through gravimetry. RESULTS: The determination coefficients of linear correlations between ShanEn and W/D increased from 0.0487 to 0.7477 with gain and dynamic range (DR). In contrast to visual scoring methods of pulmonary aeration that use median gain and low DR, ShanEn for quantifying pulmonary aeration requires high gain and DR. CONCLUSION: The current findings indicate that ShanEn estimated through GSH analysis of LUS images acquired using conventional ultrasonic imaging systems has great potential to provide objective information on pulmonary aeration.

Noise Induced Hearing Loss and Tinnitus-New Research Developments and Remaining Gaps in Disease Assessment, Treatment, and Prevention.

Long-term noise exposure often results in noise induced hearing loss (NIHL). Tinnitus, the generation of phantom sounds, can also result from noise exposure, although understanding of its underlying mechanisms are limited. Recent studies, however, are shedding light on the neural processes involved in NIHL and tinnitus, leading to potential new and innovative treatments. This review focuses on the assessment of NIHL, available treatments, and development of new pharmacologic and non-pharmacologic treatments based on recent studies of central auditory plasticity and adaptive changes in hearing. We discuss the mechanisms and maladaptive plasticity of NIHL, neuronal aspects of tinnitus triggers, and mechanisms such as tinnitus-associated neural changes at the cochlear nucleus underlying the generation of tinnitus after noise-induced deafferentation. We include observations from recent studies, including our own studies on associated risks and emerging treatments for tinnitus. Increasing knowledge of neural plasticity and adaptive changes in the central auditory system suggest that NIHL is preventable and transient abnormalities may be reversable, although ongoing research in assessment and early detection of hearing difficulties is still urgently needed. Since no treatment can yet reverse noise-related damage completely, preventative strategies and increased awareness of hearing health are essential.

Bioprinting: an assessment based on manufacturing readiness levels.

Over the last decade, bioprinting has emerged as a promising technology in the fields of tissue engineering and regenerative medicine. With recent advances in additive manufacturing, bioprinting is poised to provide patient-specific therapies and new approaches for tissue and organ studies, drug discoveries and even food manufacturing. Manufacturing Readiness Level (MRL) is a method that has been applied to assess manufacturing maturity and to identify risks and gaps in technology-manufacturing transitions. Technology Readiness Level (TRL) is used to evaluate the maturity of a technology. This paper reviews recent advances in bioprinting following the MRL scheme and addresses corresponding MRL levels of engineering challenges and gaps associated with the translation of bioprinting from lab-bench experiments to ultimate full-scale manufacturing of tissues and organs. According to our step-by-step TRL and MRL assessment, after years of rigorous investigation by the biotechnology community, bioprinting is on the cusp of entering the translational phase where laboratory research practices can be scaled up into manufacturing products specifically designed for individual patients.

A systematic approach to forming micro-contact imprints of creatine kinase.

A systematic approach has been used to form molecular imprints of creatine kinase (CK) using micro-contact imprinting. Using thermocalorimetry data, we selected poly(ethylene glycol) 400 dimethacrylate (PEG400DMA) as our crosslinker, on the basis that it would be expected to have minimal specific recognition when incorporated into the imprinted polymer. The functional monomer used, methacrylic acid (MAA), was chosen from a panel of six candidates on the basis of it giving the highest differential affinity with respect to a non-imprinted polymer. A polymer formed with 5% MAA and 95% PEG400DMA showed excellent imprint recognition, with CK binding to the imprinted material being 2.05 +/- 0.07 x 10(-10) mol cm(-2) compared to 9.1 +/- 4.5 x 10(-12) mol cm(-2) control binding. The imprinted polymers (approximate thickness 22.6 mum as measured by Alpha-step) showed clear two-phase binding with maximum absorption achieved after approximately 2 hours. Data extracted from Scatchard plots showed the K(d) for the high affinity binding site population to be 2.56 x 10(-10) M and the binding site population to be 1.97 x 10(-10) mol cm(-2), corresponding data for low affinity binding sites shows the K(d) = 3.27 x 10(-9) M and the binding site population to be 2.32 x 10(-10) mol cm(-2). Re-binding the molecularly imprinted polymers (MIPs) with non-template proteins, namely myoglobin, human serum albumin (HSA) and immunoglobulin G (Ig G), showed these proteins to have comparatively little affinity for the CK imprinted films. The percentage re-binding figures, relative to CK binding, were: 18.7, 3.5, and 3.5 for myoglobin, HSA, and Ig G respectively. This pattern of binding was maintained in competitive binding protocols with two proteins in solution at equal concentrations, where the percentage re-binding figures, relative to CK binding (4.5 +/- 0.06 x 10(-10) mol cm(-2)), were 17.2, 4.5, and 2.9 for myoglobin, HSA, and Ig G respectively. The presence of multiple competing analytes in undiluted human serum did not significantly decrease template protein recognition. Finally, we used circular dichroism to monitor protein denaturation, and showed that the denatured template protein loses a significant proportion (76.8%) of its MIP affinity after being heated at 80 degrees C for 10 minutes.