Health Care Innovation for Low-Resource Settings: The Value of Local Immersion and Partnership.

Health Care Innovation is the creation, development, and translation of new and better solutions to health care challenges. At its core, this endeavor does not require extending the frontiers of science or the creation of new fundamental technologies. Rather, it is primarily focused on the use of existing science and established technologies in the design of new solutions to problems in health care. Successfully innovating for low- and middle-income countries (LMICs) requires a needs and stakeholder-driven approach to enable development and adoption of available, accessible, and acceptable solutions tailored to the specific need and context of care.

Temporary Immersion System for Biomass Production of Salvia spp.: A Mini-Review.

Salvia is a very valuable medicinal plant for the pharmaceutical industry. Tissue culture techniques can be used to increase the number of plants in a shorter time. Although protocols for in vitro propagation of more than 15 plant species have been developed, they are not yet efficient enough to increase mass propagation of plants. Therefore, the use of temporary immersion systems is necessary to increase the morphological quality of plants as well as their biomass in several Salvia species. In this chapter, progress in in vitro propagation in several Salvia species using liquid medium and automation is described.

Submersion Injuries and the Cost of Injury Associated with Drowning Events in the United States, 2006-2015.

INTRODUCTION: The World Health Organization has reported submersion injuries as the third most common cause of death due to unintentional injury in the world. Greater detail in the rates, risk factors, and healthcare associated costs of submersion injuries could be instrumental in demonstrating the need for further funding and intervention. METHODS: The study was a cross-sectional analysis of a nationally representative dataset of inpatient and emergency department (ED) encounters between 2006 and 2015 in the United States (US). Healthcare utilization costs were provided within the datasets and adjusted to reflect actual charges and provider fees. Lastly, the final cost values were adjusted to the 2020 US dollar (USD) and summarized using a log adjusted mean. RESULTS: On average, there were 11,873 submersion injuries per year that presented to the ED in the US. Resulting in a rate where approximately 9 out of every 100,000 ED visits were associated with a submersion injury. Slightly more than 6% died in the ED, 24.2% were admitted, and 69.3% were discharged from the ED. In total, annual cost of submersion injuries in the US for ED care is approximately $12.5 million, inpatient care is approximately $27.5 million, and total annual healthcare cost exceeds $40 million. DISCUSSION: While these results only represent a fraction of the total cost associated with submersion injuries, it remains substantial and unchanged over the 10-year study period. Certain demographic groups showed higher rates of injury and disease burden, thus bearing a greater amount of the cost.

Comprehensive assessment of physiological responses in women during the ESA dry immersion VIVALDI microgravity simulation.

Astronauts in microgravity experience multi-system deconditioning, impacting their inflight efficiency and inducing dysfunctions upon return to Earth gravity. To fill the sex gap of knowledge in the health impact of spaceflights, we simulate microgravity with a 5-day dry immersion in 18 healthy women (ClinicalTrials.gov Identifier: NCT05043974). Here we show that dry immersion rapidly induces a sedentarily-like metabolism shift mimicking the beginning of a metabolic syndrome with a drop in glucose tolerance, an increase in the atherogenic index of plasma, and an impaired lipid profile. Bone remodeling markers suggest a decreased bone formation coupled with an increased bone resorption. Fluid shifts and muscular unloading participate to a marked cardiovascular and sensorimotor deconditioning with decreased orthostatic tolerance, aerobic capacity, and postural balance. Collected datasets provide a comprehensive multi-systemic assessment of dry immersion effects in women and pave the way for future sex-based evaluations of countermeasures.

Blind Image Quality Assessment for Pathological Microscopic Image Under Screen and Immersion Scenarios.

The high-quality pathological microscopic images are essential for physicians or pathologists to make a correct diagnosis. Image quality assessment (IQA) can quantify the visual distortion degree of images and guide the imaging system to improve image quality, thus raising the quality of pathological microscopic images. Current IQA methods are not ideal for pathological microscopy images due to their specificity. In this paper, we present deep learning-based blind image quality assessment model with saliency block and patch block for pathological microscopic images. The saliency block and patch block can handle the local and global distortions, respectively. To better capture the area of interest of pathologists when viewing pathological images, the saliency block is fine-tuned by eye movement data of pathologists. The patch block can capture lots of global information strongly related to image quality via the interaction between different image patches from different positions. The performance of the developed model is validated by the home-made Pathological Microscopic Image Quality Database under Screen and Immersion Scenarios (PMIQD-SIS) and cross-validated by the five public datasets. The results of ablation experiments demonstrate the contribution of the added blocks. The dataset and the corresponding code are publicly available at: https://github.com/mikugyf/PMIQD-SIS.

Assessment of post-mortem submersion interval using total aquatic decomposition scores of drowned human cadavers.

Investigating drowning-related deaths remains a significant problem for forensic personnel all over the world. The previously published decomposition scoring method like the total aquatic decomposition (TAD) score promises to estimate the correct post-mortem submersion interval (PMSI) in aquatic habitats through the assessment and calculation of the decomposition rate and accumulated degree days (ADD). The current study comprised of 53 drowned death cases belonging to various districts of Haryana from May 2016 to August 2017. The regression and Pearson's correlation indicated a significant correlation between the TAD scores and the actual ADD (calculated through water temperatures) (r2  = 0.917) and between the actual and the estimated ADDs (calculated through TAD scores used by Heaton et al. [21]) (r = 0.9585). The results indicated that the estimated ADD tends to over predict the PMSI compared to the actual ADD. It is further confirmed by paired t-test, which showed the mean of actual ADD (mean = 349) to be significantly lower than the mean of estimated ADD (mean = 663). Moreover, these methods will help forensic investigators and researchers formulate region-specific regression equations for PMSI estimation.

Reflections on an evaluation of the 'Remote Health Experience' - an interprofessional learning, cultural immersion program.

INTRODUCTION: Cultural immersion can be an effective method of health professional student cultural learning, and part of interprofessional learning. This evaluation aimed to report the views of staff and Aboriginal and Torres Strait Islander contributors about a cultural immersion program, as well as the student perspective. METHODS: Semi-structured interviews with staff (11 non-Aboriginal, 3 Aboriginal) and Aboriginal contributors (n=3) were conducted after the 2020 immersion program. Data were collected from 138 student participants following the 2018 (n=45), 2019 (n=33) and 2020 (n=60) remote health experience immersion weekends in Katherine, in the Northern Territory of Australia. Seven staff of the 2020 weekend provided written feedback about their experiences. Qualitative data were analysed thematically, and quantitative results scored from ratings on a five-point scale were presented as means, standard deviations and percentage of respondents agreeing or strongly agreeing with evaluative statements. RESULTS: Results are presented under the four themes that were identified: (1) understanding remote practice, (2) Aboriginal culture, (3) working together and learning from each other, and (4) ongoing opportunities. Feedback from students and staff was overwhelmingly positive, with learning occurring in each of the intended areas. Relationship building and embedding Aboriginal and Torres Strait Islander culture and knowledge throughout the weekend were seen as invaluable components. CONCLUSION: The Katherine Remote Health Experience is a valuable, immersive introduction to remote health practice for students from multiple disciplines. As a standalone event it has developed positive relationships, improved knowledge, and encouraged students to consider practising outside of metropolitan areas. There is scope to further develop pathways into remote practice for interested students.

Community immersion project to enhance medical students understanding of the health needs of the most vulnerable in the community.

AIM: A group of eight fourth year medical students formed the 'UBMS public health crew' to conduct a community immersion project within elderly ethnic minority communities. The aim of the study was to understand their health perceptions regarding influenza vaccinations and learn about the enablers and barriers in accessing the vaccination. METHODOLOGY: Interviews were held by the students at community lunch clubs with the help of questionnaires. RESULTS: 76 people participated in the focus groups of which 56.5% were Asians and 43% were Irish. Feedback was sought from the students in the form of an online survey. CONCLUSION: This project helped the medical students improve their public health knowledge, gave them an opportunity to interact with members of the community and learn about the health and social problems faced by underserved/vulnerable communities. The students were also able to appreciate the cultural, sociodemographic and psychological determinants of health in an underserved community. Providing such community immersion projects can enable future doctors to be better prepared for care closer to the community and have better insight into patient-centred care. RESULTS: 76 people participated in the focus groups of which 56.5% were Asians and 43% were Irish. Feedback was sought from the students in the form of an online survey. this project helped the medical students improve their public health knowledge, gave them an opportunity to interact with members of the community and learn about the health and social problems faced by underserved/vulnerable communities. The students were also able to appreciate the cultural, sociodemographic and psychological determinants of health in an underserved community. Providing such community immersion projects can enable future doctors to be better prepared for care closer to the community and have better insight into patient-centred care. METHODS: Interviews were held by the students at community lunch clubs with the help of questionnaires. 76 people participated in the focus groups of which 56.5% were Asians and 43% were Irish. Feedback was sought from the students in the form of an online survey which found that this project helped the medical students improve their public health knowledge, gave them an opportunity to interact with members of the community and learn about the health and social problems faced by underserved/vulnerable communities. The students were also able to appreciate the cultural, sociodemographic and psychological determinants of health in an underserved community. Providing such community immersion projects can enable future doctors to be better prepared for care closer to the community and have better insight into patient-centred care. AIM: A group of eight fourth year medical students formed the 'UBMS public health crew' to conduct a community immersion project within elderly ethnic minority communities. The aim of the study was to understand their health perceptions regarding influenza vaccinations and learn about the enablers and barriers in accessing the vaccination. Interviews were held by the students at community lunch clubs with the help of questionnaires. 76 people participated in the focus groups of which 56.5% were Asians and 43% were Irish. Feedback was sought from the students in the form of an online survey which found that this project helped the medical students improve their public health knowledge, gave them an opportunity to interact with members of the community and learn about the health and social problems faced by underserved/vulnerable communities. The students were also able to appreciate the cultural, sociodemographic and psychological determinants of health in an underserved community. Providing such community immersion projects can enable future doctors to be better prepared for care closer to the community and have better insight into patient-centred care.

Effects of Massage and Cold Water Immersion After an Exhaustive Run on Running Economy and Biomechanics: A Randomized Controlled Trial.

ABSTRACT: Duñabeitia, I, Arrieta, H, Rodriguez-Larrad, A, Gil, J, Esain, I, Gil, SM, Irazusta, J, and Bidaurrazaga-Letona, I. Effects of massage and cold water immersion after an exhaustive run on running economy and biomechanics: A randomized controlled trial. J Strength Cond Res 36(1): 149-155, 2022-This study compares the effects of 2 common recovery interventions performed shortly after an exhausting interval running session on running economy (RE) and biomechanics. Forty-eight well-trained male runners performed an exhaustive interval running protocol and an incremental treadmill test 24 hours later at 3 speeds: 12, 14, and 16 km·h-1. Subjects randomly received either massage, cold water immersion (CWI), or passive rest (control). Runners repeated the treadmill test 48 hours after the first test. A two-way mixed analysis of variance was performed comparing groups and testing times. The massage group had significantly better recovery than the control group at 14 km·h-1 in RE (p < 0.05; η2 = 0.176) and greater stride height and angle changes at 16 km·h-1 (p < 0.05; η2 = 0.166 and p < 0.05; η2 = 0.208, respectively). No differences were observed between the CWI and control groups. The massage group had greater stride height and angle changes at 16 km·h-1 than the CWI group (p < 0.05; η2 = 0.139 and p < 0.05; η2 = 0.168, respectively). Moreover, differences in magnitude suggested moderate effects on RE (η2 = 0.076) and swing time (η2 = 0.110). These results suggest that massage intervention promotes faster recovery of RE and running biomechanics than CWI or passive rest.

The metabolic cost of subcutaneous and abdominal rewarming in king penguins after long-term immersion in cold water.

Marine endotherms in the polar regions face a formidable thermal challenge when swimming in cold water. Hence, they use morphological (fat, blubber) adjustment and peripheral vasoconstriction to reduce demands for heat production in water. The animals then regain normothermia when resting ashore. In the king penguin (Aptenodytes patagonicus) metabolic rate is lower in fed than in fasted individuals during subsequent rewarming on land. This has been suggested to be a consequence of diversion of blood flow to the splanchnic region in fed birds, which reduces peripheral temperatures. However, peripheral temperatures during recovery have never been investigated in birds with different nutritional status. The aim of this study was, therefore, to measure subcutaneous and abdominal temperatures during the rewarming phase on land in fasted and fed king penguins, and investigate to which extent any different rewarming were reflected in recovery metabolic rate (MRR) after long term immersion in cold water. We hypothesized that fed individuals would have a slower increase of subcutaneous temperatures compared to fasted penguins, and a correspondingly lower MRR. Subcutaneous tissues reached normothermia after 24.15 (back) and 21.36 min (flank), which was twice as fast as in the abdomen (46.82 min). However, recovery time was not affected by nutritional condition. MRR during global rewarming (4.56 ± 0.42 W kg-1) was twice as high as resting metabolic rate (RMR; 2.16 ± 0.59 W kg-1). However, MRR was not dependent on feeding status and was significantly elevated above RMR only until subcutaneous temperature had recovered. Contrary to our prediction, fed individuals did not reduce the subcutaneous circulation compared to fasted penguins and did not show any changes in MRR during subsequent recovery. It seems likely that lower metabolic rate in fed king penguins on land reported in other studies might not have been caused primarily by increased circulation to the visceral organs.

Narrow-band imaging with magnification and the water immersion technique: a case-finding, cost-effective approach to diagnose villous atrophy.

INTRODUCTION: Narrow-band imaging with magnification endoscopy (NBI-ME) allows real-time visual assessment of the mucosal surface and vasculature of the gastrointestinal tract. This study aimed to determine the performance of NBI-ME combined with the water immersion technique (NBI-ME-WIT) in detecting villous atrophy. METHODS: All patients who underwent gastroscopy were included. The duodenum was further examined with NBI-ME-WIT only after examination with white light endoscopy did not reveal a cause of anaemia or dyspepsia. Targeted biopsies were taken of visualised areas. NBI-ME-WIT findings were compared with the final histopathological analysis. We calculated the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME-WIT in detecting villous atrophy and the hypothetical cost saved by using a biopsy-avoiding approach. RESULTS: 124 patients (83 female) with a mean age of 46 (range 18-82) years were included. The most common indication for gastroscopy was abdominal pain (39%), followed by anaemia (35%), chronic diarrhoea/altered bowel habits (19%) and dyspepsia (6%). NBI-ME-WIT was able to detect all nine patients with villous atrophy - eight patchy and one total villous atrophy. The Sn, Sp, PPV and NPV of NBI-ME-WIT in detecting villous atrophy were 100.0%, 99.1%, 90.0% and 100.0%, respectively. Taking into account the cost of biopsy forceps (AUD 17) and pathology (AUD 140), this biopsy-avoidance strategy could have saved AUD 18,055 in these patients. CONCLUSION: NBI-ME-WIT is a specific and sensitive tool to recognise and accurately diagnose villous atrophy. Biopsies can be avoided in patients with normal-sized villi, which may decrease the overall cost of the procedure.

An efficient routing protocol based on polar tracing function for underwater wireless sensor networks for mobility health monitoring system application.

In recent times, Underwater Wireless Sensor Networks (UWSNs) have involved various applications in oceanographic data collection, pollution revealing, environmental monitoring, offshore exploration, disaster prevention, military surveillance, etc. nevertheless the unique characterization of UWSNs are designed for the grid division on geographical system with polar tracing function to attain the shortest- path and minimizing the energy consumption for end - to - end transmission. In this paper, we proposed a Grid Division Polar Tracing (GDPT) routing protocol function using greedy algorithm for reducing the energy consumption by incorporating into cubic grids and polar tracing functions. The NS2 simulation results proved that the optimal distance of the found path, packet delivery ratio, network lifetime, energy consumption and propagation delay are the performance metrics in the routing protocols. In proposed case used for application of underwater sensor based health monitoring system for wireless in under water environment.

In Vitro Assessment of Cytotoxicity and Estrogenicity of Vivera® Retainers.

AIM: To investigate the cytotoxicity and estrogenicity of Vivera® retainers by assessing their biological behavioral effects as-received from the manufacturer and after retrieved from patients. MATERIALS AND METHODS: In this, in vitro investigation six sets (maxillary and mandibular) of Vivera® retainers, three as received and three retrieved after four weeks of use by patients of an orthodontic postgraduate clinic, were immersed in the normal saline solution for 14 days following different modes of sterilization. The estrogenicity assays involved two cell lines, namely the estrogen-sensitive MCF-7 and the estrogen-insensitive MDA-MB-231. Following a 6 day incubation with the solutions to be tested, at concentrations varying from 5% to 20% v/v in medium supplemented with 2% fetal calf serum devoid of endogenous estrogens, estrogenicity was assessed by cell counting; p-Estradiol was used as positive control. The statistical analysis of data was performed with two-way analysis of variance (ANOVA) with appliance and concentration as predictors. Differences were further investigated with the Tukey multiple comparison tests at the 0.05 level of significance. RESULTS: No significant MCF-7 proliferation was induced by the three samples compared either to the eluents from as-received retainers or to the negative control. As expected, p-estradiol induced a potent stimulation of MCF-7 cell proliferation, while no effect was observed on MDA-MB-231 cells. CONCLUSION: Under the conditions of this experiment eluents of as-received and retrieved Vivera® retainers did not seem to exhibit xenoestrogenic activity. CLINICAL SIGNIFICANCE: Vivera® retainers can be used as part-time removable oral appliances following the manufacturer's instructions.

Large-scale assessment of benthic communities across multiple marine protected areas using an autonomous underwater vehicle.

Marine protected areas (MPAs) are designed to reduce threats to biodiversity and ecosystem functioning from anthropogenic activities. Assessment of MPAs effectiveness requires synchronous sampling of protected and non-protected areas at multiple spatial and temporal scales. We used an autonomous underwater vehicle to map benthic communities in replicate 'no-take' and 'general-use' (fishing allowed) zones within three MPAs along 7o of latitude. We recorded 92 taxa and 38 morpho-groups across three large MPAs. We found that important habitat-forming biota (e.g. massive sponges) were more prevalent and abundant in no-take zones, while short ephemeral algae were more abundant in general-use zones, suggesting potential short-term effects of zoning (5-10 years). Yet, short-term effects of zoning were not detected at the community level (community structure or composition), while community structure varied significantly among MPAs. We conclude that by allowing rapid, simultaneous assessments at multiple spatial scales, autonomous underwater vehicles are useful to document changes in marine communities and identify adequate scales to manage them. This study advanced knowledge of marine benthic communities and their conservation in three ways. First, we quantified benthic biodiversity and abundance, generating the first baseline of these benthic communities against which the effectiveness of three large MPAs can be assessed. Second, we identified the taxonomic resolution necessary to assess both short and long-term effects of MPAs, concluding that coarse taxonomic resolution is sufficient given that analyses of community structure at different taxonomic levels were generally consistent. Yet, observed differences were taxa-specific and may have not been evident using our broader taxonomic classifications, a classification of mid to high taxonomic resolution may be necessary to determine zoning effects on key taxa. Third, we provide an example of statistical analyses and sampling design that once temporal sampling is incorporated will be useful to detect changes of marine benthic communities across multiple spatial and temporal scales.

Assessment of the Effects Exerted by Acid and Alkaline Solutions on Bone: Is Chemistry the Answer?

The treatment of corpses with extremely acid or basic liquids is sometimes performed in criminal contexts. A thorough characterization by chemical analysis may provide further help to macroscopic and microscopic analysis; 63 porcine bone samples were treated with solutions at different pH (1-14) for immersion periods up to 70 days, as well as in extremely acidic sulfuric acid solutions (9 M/18 M) and extremely basic sodium hydroxide. Inductively coupled optical emission spectrometry (ICP-OES)/plasma mass spectrometry (ICP-MS), Fourier transform infrared spectroscopy (FT-IR), energy dispersive X-ray analysis (EDX), X-ray powder diffraction (XRPD), and scanning electron microscopy (SEM) showed that only the sulfuric acid solution 18 M was able to completely dissolve the sample. In addition, chemical analysis allowed to recognize the contact between bone and substances. Hydrated calcium sulfate arose from extreme pH. The possibility of detecting the presence of human material within the residual solution was demonstrated, especially with FT-IR, ICP-OES, and EDX.

Resistance of Hydraulic Calcium Silicate Cements to Dislodgment in Short- and Long-term Assessment.

PURPOSE: To investigate the resistance to dislodgment produced by Biodentine (Septodont) and White-MTA (Angelus) after immersion in phosphate-buffered saline (PBS) for different durations. MATERIALS AND METHODS: Dentin disks 1 ± 0.1 mm thick were obtained from the middle third of the roots of 6 human maxillary canines. On the coronal surface of each dentin disk, four 0.8-mm-diameter holes were drilled. Then the slices were halved using a low-speed saw diamond disk, and the two holes in each half were filled with one of the two tested materials. Each filled half was immersed in PBS solution (pH 7.2) either for 7 days (short term) or 60 days (long term) at 37°C. The push-out test was performed after both time periods. A general linear model (GLM) for repeated measures ANOVA was used to verify the effect of the material and duration of contact with PBS on the push-out strength. The material was considered as the within-subject contrast and the contact duration as the between-subjects effect (p < 0.05). RESULTS: Repeated measures GLM indicated a significant impact of material and time on the push-out strength of the samples (p = 0.000 and p = 0.033, respectively). Biodentine significantly improved the push-out strength compared to MTA at both times (p = 0.000). The lack of significance in the interaction between material and time indicates that PBS immersion positively influenced the push-out values of both tested materials. CONCLUSION: Long-term PBS immersion positively influenced the resistance to dislodgement from dentin of all cements tested. The Biodentine cement provided greater resistance to push-out force than did the MTA.

Impact of Arm Immersion Cooling During Ranger Training on Exertional Heat Illness and Treatment Costs.

UNLABELLED: Ranger training includes strenuous physical activities and despite heat mitigations strategies, numerous cases of serious exertional heat illness (EHI) occur. We developed an Arm Immersion Cooling (AIC) system that is not logistically burdensome and may be easily employed in training environments. PURPOSE: To examine the effect of AIC on EHI incidence, severity, and treatment costs during Ranger School. METHODS: The training program was standardized for physical exertion and heat stress factors throughout the study period. AIC was employed summer months of 2010-2012 (n = 3,930 Soldiers) and Control (CON; n = 6,650 Soldiers) data were obtained for summer months of 2007-2009. Descriptive characteristics of all EHI casualties were obtained, including hospitalization status (treated and released [Treat], evacuated [Evac] or admitted [Admit] to the hospital), which served as proxy indicator of illness/injury severity. Medical cost savings were calculated from hospital records. RESULTS: Incidence rates were not different (CON 4.06 vs. AIC 4.00/1,000 person-days). Treat increased during AIC (18.43 vs. 4.84/1,000 person-days) accompanied by marked but non-significant decreases in Evac and Admit rates. AIC use was associated with a medical cost savings of $1,719 per casualty. CONCLUSIONS: AIC implementation during strenuous physical training in summer months can reduce EHI severity and associated medical treatment costs.

Metabolic costs and rating of perceived exertion during backward walking in water and on dry land.

The purpose of this study was to compare metabolic costs, rating of perceived exertion (RPE), and stride frequency during backward walking in water and on land. The walking speeds in water were set to be half of those on land. There was no significant difference in metabolic costs and RPE between backward walking in water with a current and on land, at slow and moderate speeds (P > 0.05). However, at the fast speed (i.e., 3.0 and 6.0 km · h(-1) for water and land, respectively), the metabolic costs and RPE during backward walking on land were significantly higher than when walking backward in water with a current (P < 0.05). With regard to backward walking at faster speeds, if the walking speed in water with a current is set at half the speed on land, then the speed will be inadequate for inducing metabolic costs and RPE that are similar to those produced on land.