Challenges and future solutions for detection of Clostridioides difficile in adults.

There are no established standards for the diagnosis of Clostridioides difficile infection (CDI), even though the importance of this infection in humans is well known. The effectiveness of the commercially available techniques, which are all standardized for use with human feces, is also limited in terms of the accuracy of the tests. Furthermore, the current approach lacks a point-of-care diagnosis with an acceptable range of sensitivity and specificity. This article reviews the challenges and possible future solutions for the detection of CDI in adults. Existing diagnostic methods, such as enzyme-linked immunoassays and microbial culturing for the detection of toxins A and B, appear to work poorly in samples but exhibit great sensitivity for glutamate dehydrogenase. Real-time polymerase chain reaction and nucleic acid amplification tests have been investigated in a few studies on human samples, but so far have shown poor turnaround times. Thus, developing a multiplex point-of-care test assay with high sensitivity and specificity is required as a bedside approach for diagnosing this emerging infection.

Artificial intelligence enabled non-invasive T-ray imaging technique for early detection of coronavirus infected patients.

A new artificial intelligence (AI) supported T-Ray imaging system designed and implemented for non-invasive and non-ionizing screening for coronavirus-affected patients. The new system has the potential to replace the standard conventional X-Ray based imaging modality of virus detection. This research article reports the development of solid state room temperature terahertz source for thermograph study. Exposure time and radiation energy are optimized through several real-time experiments. During its incubation period, Coronavirus stays within the cell of the upper respiratory tract and its presence often causes an increased level of blood supply to the virus-affected cells/inter-cellular region that results in a localized increase of water content in those cells & tissues in comparison to its neighbouring normal cells. Under THz-radiation exposure, the incident energy gets absorbed more in virus-affected cells/inter-cellular region and gets heated; thus, the sharp temperature gradient is observed in the corresponding thermograph study. Additionally, structural changes in virus-affected zones make a significant contribution in getting better contrast in thermographs. Considering the effectiveness of the Artificial Intelligence (AI) analysis tool in various medical diagnoses, the authors have employed an explainable AI-assisted methodology to correctly identify and mark the affected pulmonary region for the developed imaging technique and thus validate the model. This AI-enabled non-ionizing THz-thermography method is expected to address the voids in early COVID diagnosis, at the onset of infection.

Concept design of the physical structure for ICU ventilators for COVID-19 pandemic.

A new disease known as COVID-19 caused by the SARS CoV2 virus has engulfed the entire world and led to a global pandemic situation. Till December 9, 2020, the disease has infected 68 million people worldwide and more than 1.56 million people have been killed. The origin of the COVID-19 disease has been traced back to the bats, but the intermediary contact is unknown. The disease spreads by respiratory droplets and contaminated surfaces. In most cases, the virus shows mild symptoms such as fever, fatigue, dyspnea, cough, etc. which may become severe if appropriate precautions are not adhered to. For people with comorbidities (usually elderly) the disease may turn deadly and cause pneumonia, Acute Respiratory Distress Syndrome (ARDS), and multi-organ failure, thereby affecting a person's ability to perform normal breathing which may put them on ventilator support. The virus causes Acute Respiratory Distress Syndrome (ARDS) that can lead to multi-organ failure in the most severe form. A patient suffering from ARDS must be put on a mechanical ventilator. These assistive devices help patients with respiratory disorders perform normal breathing. Presently nearly sixty thousand COVID-19 patients are in critical condition worldwide, fighting for survival requiring ventilator support. In India, the number stands close to eight thousand such individuals especially when the second wave of COVID-19 is expected to spread globally with initial signs arising from European and Middle East countries. With a large number of patients requiring ventilators, it puts a huge strain on the already weak health infrastructure of the developing countries. This is where some manufacturing and automobile companies have stepped in to help hospitals by developing ventilators at a faster rate and lower costs without comprising on the quality with the support of different government initiatives. This paper aims to study the basic requirements to be considered while designing the physical structure of an elementary level ICU ventilator for the hospital environment. The challenges related to research in electronic wiring of a mechanical ventilator, the overall structural design, and surrounding base could be appropriately done for different loads by simulating the conditions on tools like ANSYS software with accurate dimensions which could improve their future designs.

Effects of excessive use of mobile phone technology in India on human health during COVID-19 lockdown.

OBJECTIVE: The global health crisis in the form of COVID-19 has forced people to shift their routine activities into a remote environment with the help of technology. The outbreak of the COVID-19 has caused several organizations to be shut down and forced them to initiate work from home employing technology. Now more than ever, it's important for people and institutions to understand the impact of excessive use of mobile phone technology and electronic gadgets on human health, cognition, and behavior. It is important to understand their perspective and how individuals are coping with this challenge in the wake of the COVID-19 pandemic. The investigation is an effort to answer the research question: whether dependency on technology during lockdown has more effects on human health in comparison to normal times. METHODS: The study included participants from India (n = 122). A questionnaire was framed and the mode of conducting the survey chosen was online to maintain social distancing during the time of the Pandemic. The gathered data was statistically analysed employing RStudio and multiple regression techniques. RESULTS: The statistical analysis confirms that lockdown scenarios have led to an increase in the usage of mobile phone technology which has been confirmed by around 90% of participants. Moreover, 95% of the participants perceive an increased risk of developing certain health problems due to excessive usage of mobile phones and technology. It has been evaluated that participants under the age group 15-30 years are highly affected (45.9%) during lockdown due to excessive dependence on technology. And, amongst different professions, participants involved in online teaching-learning are the most affected (42.6%). CONCLUSION: The findings indicate that dependency on technology during lockdown has more health effects as compared to normal times. So, it is suggested that as more waves of pandemics are being predicted, strategies should be planned to decrease the psychological and physiological effects of the overuse of technology during lockdown due to pandemics. As the lockdown situation unfolds, people and organization functioning styles should be rolled back to the limited dependency on technology.

Study and overview of the novel corona virus disease (COVID-19).

In December 2019, a new disease with pneumonia-like symptoms was spreading throughout Wuhan in China which was entitled as novel coronavirus disease or COVID -19 caused by the virus SARS CoV-2. Within a span of a few days, this disease became a global threat and was termed as a pandemic by the World Health Organization (WHO) on March 11, 2020, since then the disease has affected more than 1.5 crore people worldwide and around 6.9 lakh people in India as of July 5, 2020. The origin of the COVID-19 disease has been traced back to the bats, but the intermediary contact is unknown. The disease spreads by respiratory droplets and contaminated surfaces. In most cases, the virus shows mild symptoms like fever, fatigue, dyspnea, cough, etc. which may become severe if appropriate precautions are not adhered to. For people with comorbidities (usually elderly) the disease may turn deadly and cause pneumonia, Acute Respiratory Disease Syndrome (ARDS), and multi-organ failure, thereby affecting a person's ability to breathe leading to being put on the ventilator support. The reproduction number (Rℴ) of COVID-19 is much higher than its predecessors and genetically similar diseases like SARS-CoV and MERS-CoV. This paper discusses the epidemiological characteristics of the SARS-CoV-2 virus, its phylogenetic relationship with the previous pandemic causing viruses such as SARS-CoV-1 and MERS-CoV and analyzes the various responses to this global pandemic worldwide, focusing on the actions taken by India and their outcomes.

Development of Viroreaper sanitization chamber for COVID 19.

The whole world at present is dealing with the COVID 19 pandemic. As per studies worldwide SARS-CoV-2 by sequencing analysis is 95% homogenous similar to the bat coronavirus and almost 70% similar to the SARS-CoV-1. SARS CoV 2 is a respiratory problem which in its worst form of disease causes ARDS and hampers the patient's ability to breathe on his own and has to be put on Ventilator. As per WHO (World Health Organization) guidelines, sanitization is an effective way of prevention from the infection. The proper sanitization being not feasible and time consuming in certain cases, faster and effective alternatives of sanitization processes are necessary. As per recently published study by researchers in Beijing, China, it was observed that with each degree rise in temperature and percent humidity, the contagiousness of the disease caused by the Coronavirus, named COVID 19 goes down significantly. R-naught or RO can be referred as the average number of people that gets infected from one sick person among a population which is not immune to the virus. The closer to zero an RO value the better the results indicating less spread of the disease. A lower RO means the outbreak is slowing or declining while a higher one means its swelling or growing at faster rate. The RO of the coronavirus hovers between 2 and 2.5 as per World Health Organization or WHO meaning that each new person spreads the disease to about 2.2 people on an average. The chamber being developed is aimed at lowering the Ro value so that the infection rate slows down. RO is not a fixed value, it changes depending on various factors such as proximity among people, the environmental surroundings and climatic conditions. The higher temperatures (38 °C) at 80-90% relative humidity decreases the virus activity within 24 h. Moreover, in a condition where the virus that was dried was stored at higher temperature (>38 °C) and high relative humidity (>95%), there was observed an additional degradation in virus activity at each point in time. Taking into consideration the above research, we developed a COVID De-Incubator chamber to disinfect the clothes and commonly used daily wear items. Our results were exciting as the disinfection proved to be effective at temperatures of 75 °C-80 °C and humidity levels at 80%-90%. Moreover, the chamber was developed at significantly lower costs. In this study, an attempt has been made to fabricate a chamber with temperature and humidity-controlled environment to disinfect daily used material. Using fins and momentum source, a homogenous environment is created inside the chamber for better results, with the help of numerical simulation to decide the optimum angle for the inclination of fins and location of the momentum source.

Applications of paper as a support material in biomedical sciences: A decadal review.

In human history, the paper has long been used as a platform to record and preserve information. However, over the decades, paper has found its application in Biomedical Sciences, too. Both paper-based microfluidic devices (µPADs) and paper-based cultures and scaffolds have shown immense potential to be used as a sensor as well as a supporting material for in vitro tissue engineering. µPADs can be used to perform low-cost and fast biomolecular assays at Point-Of-Care (POC). They are being used to detect various biomarkers like viral proteins, metabolites, oncogenes, and antigens; and conditions like Venous Thromboembolism (VTE). On the other hand, the paper has also been used to develop paper-based 3D cultures and scaffolds to test drugs, and monitor cytotoxic effects in vitro cell microenvironments and also as implantable tissues. In this review, we intend to enumerate the development in the field of µPADs, paper-based cell cultures, and paper-based scaffolds and their plethora of applications over the last decade.

Increasing Number of Therapy Sessions of Repetitive Transcranial Magnetic Stimulation Improves Motor Development by Reducing Muscle Spasticity in Cerebral Palsy Children.

BACKGROUND: Repetitive TMS (rTMS), a non-invasive neuro-stimulation tool based on the principle of electromagnetic induction is recently being employed both for investigational and interventional purposes. The stimulating effect of rTMS on motor cortex areas of the brain leads to increased motor activity and decreased muscle tone in spastic cerebral palsy (CP) patients. OBJECTIVE: This modulatory effect of rTMS is used in this study to evaluate its effect on motor function and spasticity by increasing the number of therapy session and keeping frequency of 10Hz and pulse train of 2500 constant. METHODS: Total thirty spastic CP patients participated in this study after written informed consent from their parents/guardians. The participants were equally divided into three groups, namely, S-20, S-30 and S-40 depending on the number of therapy sessions. The mean age±SD of participants in different groups were 8.9±3.6, 9.5±2.9 and 8.4±3.5 in S-20, S-30 and S-40 respectively. Participants in S-20, S-30 and S-40 were provided 20, 30 and 40 sessions of rTMS therapy respectively followed by physical therapy of 30 minutes daily. Each rTMS session was of 25 minutes duration and was administered once daily for 5 days a week. Prior to start and after completion of the therapy, pre and post assessment of gross motor function measure (GMFM) for motor function and modified Ashworth scale (MAS) for muscle spasticity was performed on all the participants. OUTCOMES: The result of pre-versus-post GMFM score showed that 4.27%, 3.12% and 2.36% motor gain was obtained after 40, 30 and 20 sessions of therapy respectively. In addition, significant reduction in spasticity in both upper and limb muscles was also observed in all the three groups.

Evaluating the Effect of Repetitive Transcranial Magnetic Stimulation in Cerebral Palsy Children by Employing Electroencephalogram Signals.

INTRODUCTION: Transcranial magnetic stimulation is a new tool that has been employed to modulate the neuronal activity of brain by its excitatory and inhibitory property. In cerebral palsy (CP) learning of any new task is an extremely slow process due to damage in sensory and motor areas of brain affecting the cognitive ability of the child and putting constraints in achieving timely developmental milestones. For such patients the electroencephalogram (EEG) is one of the most cost effective diagnostic tools used that minimizes hospital stay. Its analysis helps to identify various neurological disorders determining the role of brain waves outlining the present status of mind. MATERIALS AND METHODS: This study evaluated the EEG power spectrum density (PSD) of CP children both pre and post rTMS intervention to identify significance changes in signal patterns arising from different brain regions. thirty CP children participated in this study. Fifteen individuals underwent repetitive TMS (rTMS) therapy for 20 session comprising of 10 Hz frequency for 5 days a week for 4 weeks and another fifteen individual participated in activities of daily living for 20 sessions where they were administered mandatory standard therapy only. pre- EEG versus post EEG data recorded and analyzed employing the standard montage configuration. PSD was extracted employing fast fourier transform post acquisition of artifact free signal to undermine changes in signal pattern. DISCUSSION AND CONCLUSION: The results revealed that rTMS improves learning ability in CP children and it shows higher power peak at frequency of 50 Hz and lower power peak frequency at 100 Hz. The power intensity in gamma wave region shows significant reduction post-rTMS therapy between 38-24 power peak frequency and 7-4 range in 100 Hz power peak frequency. In future, it will be used as effective tool as memory enhancers, especially for children with neurological disorders.

Neuromodulatory effect of repetitive transcranial magnetic stimulation pulses on functional motor performances of spastic cerebral palsy children.

BACKGROUND: Neuromodulation is emerging as a new therapeutic field towards treatment of neurological disorders through advances in medical devices. Repetitive Transcranial Magnetic Stimulation (rTMS) is one such neuromodulatory device that has received increasing interest as a tool for modulating cortical excitability that influence motor activity in both normal and diseased population. However, the therapeutic effect of rTMS varies depending on stimulation frequency, intensity, pulse trains, duration, etc. Our previous studies had already demonstrated that higher frequency of 10 Hz was effective in improving the motor activity of spastic CP patients. OBJECTIVE: This study was aimed to evaluate the effect of different rTMS pulses on gross motor performance of spastic CP patients. METHOD: Thirty spastic CP patients were divided equally into three groups P1500, P2000 and P2500 with mean age (in years) 7.7 ± SD4.4, 6.8 ± SD5.3 and 7.2 ± SD5.1 respectively. Gross Motor Function Measure (GMFM) was employed as an outcome measure to assess the motor performance. Constant rTMS frequency of 10 Hz was delivered to each participant but the number of stimulation pulse varied according to the groups; which were 1500, 2000 and 2500 pulses for P1500, P2000 and P2500 group respectively. rTMS therapy of 15 minutes duration was followed by physical therapy of 30 minutes daily for 20 days. RESULT: Statistical analysis of pre versus post GMFM scores of different groups revealed significant result (p < .001) and the improvement in functional motor activity was 2.33% in P1500, 3.58% in P2000 and 5.17% in P2500 group. INTERPRETATION: The result demonstrated modulatory effect of rTMS pulse by improving motor function of spastic CP patients.

Recent advancements in prosthetic hand technology.

Recently, significant advances over the past decade have been made in robotics, artificial intelligence and other cognitive related fields, allowing development of highly sophisticated bio-mimetic robotics systems. In addition, enormous number of robots have been designed and assembled by explicitly realising their biological oriented behaviours. To enhance skill behaviours and adequate grasping abilities in these devices, a new phase of dexterous hands has been developed recently with bio-mimetically oriented and bio-inspired functionalities. The aim in writing this review paper is to present a detailed insight towards the development of the bio-mimetic based dexterous robotic multi-fingered artificial hand. An "ideal" upper limb prosthesis should be perceived as a part of their natural body by the amputee and should replicate sensory-motor capabilities of the amputated limb. Upper-limb amputations are most often the result of sudden trauma to the body, although they also can be caused by malignancy, congenital deficiencies and vascular diseases. This paper discusses the different bio-mimetic approaches using a framework that permits for a common description of biological and technical based hand manipulation behaviour. In particular, the review focuses on a number of developments in the inspired robotic systems. In conclusion, the study found that a huge amount of research efforts in terms of kinematics, dynamics, modelling and control methodologies are being put in to improve the present hand technology, thereby providing more functionality to the prosthetic limb of the amputee. This would improve their quality-of-life and help in performing activities of daily living (ADL) tasks with comparative ease in the near future.

Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients.

Spastic cerebral palsy (CP) is the one of most common neurological disorders occurring due to damage to the immature brain or any other brain lesion at the time of birth. To aid in making the life of the CP patient meaningful, several interventions such as medical, surgical and rehabilitation have been employed to date. Besides these, recently repetitive Transcranial magnetic stimulation (r-TMS) is a new found approach which is being employed for treating various neurological and psychological conditions. The aim of this study was to observe the effects of r-TMS on muscle spasticity in CP patients by stimulating the motor cortex area of the brain, which is responsible for muscle movements. In this study, 20 subjects diagnosed with CP were recruited and 10 each were placed in two groups, namely the research group (RG) (mean age, height and weight were 7.99 (SD = 4.66) years, 116.7 (SD = 23.57) cm and 21.40 (SD = 10.95) kg, respectively) and the control group (CG) (mean age, height and weight were 8.41 (SD = 4.32) years, 107.9 (SD = 26.33) cm, 21.40 (SD = 12.63) kg, respectively). r-TMS frequencies of 5 Hz and 10 Hz were administered for 15 min daily to patients in RG followed by standard therapy (ST) of 1 h duration daily for 20 days. Moreover, the patients in the control group (CG) were given only standard therapy (ST) of 1 h duration for 20 days. Modified Ashworth Scale (MAS) was used as an outcome measure to determine the level of muscle spasticity. A pre- assessment of MAS score was performed on both RG and CG to determine the level of spasticity prior to starting therapy; and similarly post-assessment after 20 days was done to observe the changes post-therapy. Statistical analysis of pre vs post MAS scores showed that few muscles showed reduction in muscle tightness after administering only ST in the CG. On the contrary, the RG that underwent r-TMS therapy combined with ST showed a significant decrease (p < 0.05) in muscle tightness for all the muscles selected for the therapy.

siGnum: graphical user interface for EMG signal analysis.

Electromyography (EMG) signals that represent the electrical activity of muscles can be used for various clinical and biomedical applications. These are complicated and highly varying signals that are dependent on anatomical location and physiological properties of the muscles. EMG signals acquired from the muscles require advanced methods for detection, decomposition and processing. This paper proposes a novel Graphical User Interface (GUI) siGnum developed in MATLAB that will apply efficient and effective techniques on processing of the raw EMG signals and decompose it in a simpler manner. It could be used independent of MATLAB software by employing a deploy tool. This would enable researcher's to gain good understanding of EMG signal and its analysis procedures that can be utilized for more powerful, flexible and efficient applications in near future.

Automated ingestion detection for a health monitoring system.

Obesity is a global epidemic that imposes a financial burden and increased risk for a myriad of chronic diseases. Presented here is an overview of a prototype automated ingestion detection (AID) process implemented in a health monitoring system (HMS). The automated detection of ingestion supports personal record keeping which is essential during obesity management. Personal record keeping allows the care provider to monitor the therapeutic progress of a patient. The AID-HMS determines the levels of ingestion activity from sounds captured by an external throat microphone. Features are extracted from the sound recording and presented to machine learning classifiers, where a simple voting procedure is employed to determine instances of ingestion. Using a dataset acquired from seven individuals consisting of consumption of liquid and solid, speech, and miscellaneous sounds, > 94% of ingestion sounds are correctly identified with false positive rates around 9% based on 10-fold cross validation. The detected levels of ingestion activity are transmitted and stored on a remote web server, where information is displayed through a web application operating in a web browser. This information allows remote users (health provider) determine meal lengths and levels of ingestion activity during the meal. The AID-HMS also provides a basis for automated reinforcement for the patient.

Cross-correlation evaluated muscle co-ordination for speech production.

Abstract In this investigation the jaw-mouth-lip (JML) co-ordination is quantified using cross-correlation (CC) between facial electromyography (EMG) while speaking words 'zero to nine'. The facial EMG data of four prominent facial muscles, namely Zygomaticus Major (ZM) from the mouth region, Levator Labii Superioris (LLS), Orbicularis Oris Inferioris (OOI) from the lip region and Anterior Belly of Diagastric (ABD) from the jaw region are collected and analysed. A total of six muscle pairs, (1) ABD-ZM, (2) ZM-LLS, (3) OOI-ZM, (4) ABD-LLS, (5) ABD-OOI and (6) LLS-OOI, are formed based on their position. Based on correlation study, all these muscle pairs show a significantly different co-ordination level (p<0.05). The CC of the ABD-LLS muscle pair is observed with maximum co-ordination level among all spoken words (Tukey's post-hoc, α=0.05). These investigations based on CC in JML co-ordination could be used in designing various biomedical engineering tools such as speech prosthesis, facial lie detectors, etc.

Current interventions in the management of knee osteoarthritis.

Osteoarthritis (OA) is progressive joint disease characterized by joint inflammation and a reparative bone response and is one of the top five most disabling conditions that affects more than one-third of persons > 65 years of age, with an average estimation of about 30 million Americans currently affected by this disease. Global estimates reveal more than 100 million people are affected by OA. The financial expenditures for the care of persons with OA are estimated at a total annual national cost estimate of $15.5-$28.6 billion per year. As the number of people >65 years increases, so does the prevalence of OA and the need for cost-effective treatment and care. Developing a treatment strategy which encompasses the underlying physiology of degenerative joint disease is crucial, but it should be considerate to the different age ranges and different population needs. This paper focuses on different exercise and treatment protocols (pharmacological and non-pharmacological), the outcomes of a rehabilitation center, clinician-directed program versus an at home directed individual program to view what parameters are best at reducing pain, increasing functional independence, and reducing cost for persons diagnosed with knee OA.

Feasibility of facial EMG in gender classification during speech production.

Gender identification has its unique importance in sports and forensic sciences. However, the social issues are major constraints to identify the gender of a human being. A novel approach for gender classification using facial EMG is presented. The time domain features of facial EMGs are explored towards their robustness in gender identification. A Davies-Bouldin index is calculated to evaluate the features. Anterior belly of digastrics along with Orbicularis Oris Inferior showed the promising classification accuracy of 80% with the reported features. A possible enhancement in accuracy could be possible by a larger dataset.

Study of performance and propagation characteristics of wire and planar structures around human body.

Continued miniaturization of electronic devices and technological advancements in wireless communications has made wearable body-centric telemedicine systems viable. Antennas play a crucial role in characterizing the efficiency and reliability of these systems. The performance characteristics such as the radiation pattern, gain, efficiency of the antennas get adversely affected due to the presence of lossy human body tissues. In this paper we investigate the above mentioned performance parameters and radio frequency transmission properties of wire and planar structures operating at ISM frequency band of 2.40-2.50 GHz in the proximity of human body.