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.

Lindane residues in cultivated cucumber and in the most consumed fish in Caspian Sea (Iran).

In this study, the concentrations of lindane residues (organochlorine pesticides) were analyzed in samples of cultivated cucumbers (Cucumis sativus L.) and four species of most consumed fish (Sefid, Koli, Kilca and Kafal fish). Samples of cucumber were collected from five sites in Sari city (north, south, east, west and central areas) and samples of fish were caught using electric fishing from four major fishing centers (Chalous and Babolsar cities, Khazar Abad and Miankaleh regions) in Mazandaran province of Iran. Quantitative determination of the lindane content was performed by gas chromatography electron-capture detection (GC-ECD). The results showed that the concentration of lindane in cucumber samples and in the dorsal muscle of the selected fish were less than the Food and Agriculture Organization/World Health Organization (FAO/WHO) recommended intake.

Combined ultrasound and fluorescence spectroscopy for physico-chemical imaging of atherosclerosis.

This paper describes a combined ultrasonic and spectroscopic system for remotely obtaining physico-chemical images of normal arterial tissue and atherosclerotic plaque. Despite variations in detector-tissue separation, R, fluorescence powers corresponding to pixels in the image are converted to the same set of calibrated units using distance estimations from A-mode ultrasound reflection times. An empirical model, validated by Monte Carlo simulations of light propagation in tissue, is used to describe changes in fluorescence power as a function of R. Fluorescence spectra of normal and atherosclerotic human aorta obtained with this system are presented as a function of R. To compensate for changes in fluorescence power with R, the empirical model was used in each case to calculate the fluorescence power at a constant reference value of R(Rref = 1.67 mm). Prior to compensation, tissue fluorescence power decreased more than a factor of two as R was increased from 2.5 to 5 mm. Following compensation, the fluorescence power varied less than +/- 10% of the average compensated peak. The chemical composition of each sample was determined by fitting its fluorescence spectrum (in calibrated units) to a model of tissue fluorescence incorporating structural protein and ceroid fluorescence, as well as structural protein and hemoglobin attenuation. Parameters of the fit were used to classify tissue type. Without compensation for distance variation, classification of tissue type was frequently incorrect; however, with compensation, predictive value was high. A 1-D chemical image of a section of human aorta containing both normal and atherosclerotic regions obtained with this system is also presented. After compensation for detector-sample separation, tissue classifications along the cross-section closely resemble those obtained from histology. Regions of elevated ceroid concentration and intimal thickening are clearly observable in the resultant chemical image. The potential value of this type of system in the diagnosis and treatment of coronary artery disease is discussed.

Monte Carlo fluorescence verification of experimental results for the combined ultrasonic and spectroscopic imaging of coronary artery disease.

A system is being tested that combines fluorescence spectroscopy and intravascular ultrasound to image both chemical composition and structure of arterial tissue in vitro. In this system, distances obtained from A-mode ultrasound will be used to compensate for decreases in fluorescence intensity due to the detector-sample separation distance r. For concentrated rhodamine, a fluorescent dye, compensation has been experimentally achieved assuming fluorescence is emitted isotropically and decreases as 1/r2. For dilute rhodamine and human arterial tissue, however, compensation must be achieved with different models, since light penetration into the sample is more significant. Using optical properties consistent with those of the aforementioned samples, experimental results are successfully simulated with a Monte Carlo model for tissue fluorescence. Angular profiles are presented that demonstrate the quantitative difference between the fluorescence of these mediums. The profiles support the hypothesis that, although fluorescence is emitted isotropically within tissue, the angular distribution of light exiting the tissue is not isotropic due to reabsorption events.

A single transducer transaxial compression technique for the estimation of sound speed in biological tissues.

In this paper we report an extension to the TACT method for the estimation of sound speed with a single transducer to any depth. This method is based on the hypothesis that the displacement of the tissue caused by transaxial compression follows a theoretical function which we derive analytically. In this method, as in the original TACT, a transducer imparts an accurate transaxial compression to the tissue, and the corresponding change in the arrival time of an echo at a range of interest is measured. This procedure results in a biased speed estimate whose value is range dependent. The theoretical function is fitted to the experimental estimates, from which the unbiased sound speed is then computed.

Elastography: a quantitative method for imaging the elasticity of biological tissues.

We describe a new method for quantitative imaging of strain and elastic modulus distributions in soft tissues. The method is based on external tissue compression, with subsequent computation of the strain profile along the transducer axis, which is derived from cross-correlation analysis of pre- and post-compression A-line pairs. The strain profile can then be converted to an elastic modulus profile by measuring the stresses applied by the compressing device and applying certain corrections for the nonuniform stress field. We report initial results of several phantom and excised animal tissue experiments which demonstrate the ability of this technique to quantitatively image strain and elastic modulus distributions with good resolution, sensitivity and with diminished speckle. We discuss several potential clinical uses of this technique.

A transaxial compression technique (TACT) for localized pulse-echo estimation of sound speed in biological tissues.

We describe a new method for the estimation of the speed of sound in soft tissues in the pulse-echo mode. A transducer imparts an accurate transaxial compression to the tissue, and the corresponding change in the arrival time of an echo feature is measured. The ratio between the compressed depth and the difference in arrival time is taken as the estimate of the speed of sound. A second, noncompressing transducer is used to correct for distal tissue movement. We show theoretically and experimentally that accurate speed of sound estimations can be made in overlying and underlying tissue mimicking layers.

Correlation artifacts in speed of sound estimation in scattering media.

A recently described method for speed of sound estimation in tissues in pulse-echo mode involves reception of echoes generated by an ultrasonic pulse by means of a linearly tracking transducer. When the peaks of echo amplitudes are used as markers of arrival time, stairstep-like artifacts appear in the echo arrival time vs. transducer position plots. We postulate that these artifacts are a consequence of the speckle phenomenon commonly encountered in ultrasonic imaging. To test this hypothesis, we report computer simulations and water tank experiments which demonstrate similarities between the behavior of the stairsteps and the properties of ultrasonic speckle. Additionally, equations describing the precision of the speed of sound estimation in terms of the second order statistical properties of the stairstep artifact are derived.

Correction of refraction and other angle errors in beam tracking speed of sound estimations using multiple tracking transducers.

The beam tracking approach to the estimation of the speed of sound has shown potential for making unbiased estimates in tissues. The speed of sound in a medium can be found from the arrival times of echoes as a function of the position of a tracking transducer. There is a problem in this approach if the angle between the direction of tracked beam and the direction of tracking translation is not zero due to refraction or other effects. An angle error as small as 1 degree would result in an error that is too large for diagnostic applications. A modified technique using three or more tracking transducers is described. This yields a corrected speed of sound estimate, and calculates the angle error. A simulation program has shown that this modified technique could indeed correct for the angle errors.

Optimization of speed-of-sound estimation from noisy ultrasonic signals.

The effects of prefiltering and the choice of time-delay estimators and statistical data reduction techniques on the precision of speed-of-sound estimation were investigated using the beam-tracking technique. It was found that prefiltering the data with an ideal 50-kHz low-pass filter improved the precision of the estimation in all cases. Echo cross-correlation had an advantage over peak detection for low signal-to-noise ratio (SNR) levels, but its advantage diminished as the signal-to-noise level improved due to filtering. The linear regression method was superior to the paired-point analysis technique under all conditions. Using the optimal set of parameters, precision on the order of 0.1% was achieved in a tissue-mimicking phantom when one beam was tracking along 75 mm in 1-mm increments.