Preclinical validation of NeoWarm, a low-cost infant warmer and carrier device, to ameliorate induced hypothermia in newborn piglets as models for human neonates.

Introduction: Approximately 1.5 million neonatal deaths occur among premature and small (low birthweight or small-for gestational age) neonates annually, with a disproportionate amount of this mortality occurring in low- and middle-income countries (LMICs). Hypothermia, the inability of newborns to regulate their body temperature, is common among prematurely born and small babies, and often underlies high rates of mortality in this population. In high-resource settings, incubators and radiant warmers are the gold standard for hypothermia, but this equipment is often scarce in LMICs. Kangaroo Mother Care/Skin-to-skin care (KMC/STS) is an evidence-based intervention that has been targeted for scale-up among premature and small neonates. However, KMC/STS requires hours of daily contact between a neonate and an able adult caregiver, leaving little time for the caregiver to care for themselves. To address this, we created a novel self-warming biomedical device, NeoWarm, to augment KMC/STS. The present study aimed to validate the safety and efficacy of NeoWarm. Methods: Sixteen, 0-to-5-day-old piglets were used as an animal model due to similarities in their thermoregulatory capabilities, circulatory systems, and approximate skin composition to human neonates. The piglets were placed in an engineered cooling box to drop their core temperature below 36.5°C, the World Health Organizations definition of hypothermia for human neonates. The piglets were then warmed in NeoWarm (n = 6) or placed in the ambient 17.8°C ± 0.6°C lab environment (n = 5) as a control to assess the efficacy of NeoWarm in regulating their core body temperature. Results: All 6 piglets placed in NeoWarm recovered from hypothermia, while none of the 5 piglets in the ambient environment recovered. The piglets warmed in NeoWarm reached a significantly higher core body temperature (39.2°C ± 0.4°C, n = 6) than the piglets that were warmed in the ambient environment (37.9°C ± 0.4°C, n = 5) (p < 0.001). No piglet in the NeoWarm group suffered signs of burns or skin abrasions. Discussion: Our results in this pilot study indicate that NeoWarm can safely and effectively warm hypothermic piglets to a normal core body temperature and, with additional validation, shows promise for potential use among human premature and small neonates.

Not only COVID-19: a systematic review of anti-COVID-19 measures and their effect on healthcare-associated infections.

BACKGROUND: Healthcare-associated infections (HAIs) burden healthcare globally. Amid the SARS-CoV-2 pandemic, intensified infection control measures, such as mask usage and hand hygiene, were implemented. AIM: To assess the efficacy of these measures in preventing HAIs among hospitalized patients. METHODS: Using the PICO framework (Population, Intervention, Comparison, Outcome), the study focused on hospitalized patients and the effectiveness of anti-COVID-19 measures in preventing HAIs. A systematic review of literature published in 2020-2022 was conducted, examining interventions such as mask usage, hand hygiene, and environmental cleaning. FINDINGS: This systematic review analysed 42 studies: two in 2020, 21 in 2021, and 19 in 2022. Most studies were from high-income countries (28). Most studies (30 out of 42) reported a reduction in HAIs after implementing anti-COVID-19 measures. Gastrointestinal infections and respiratory tract infections showed significant reduction, unlike bloodstream infections and urinary tract infections. Some wards, like cardiology and neurology, experienced reduced HAIs, unlike intensive care units and coronary care units. There was an increase in studies reporting no effect of hygiene measures on HAIs in 2022, eventually indicating a shift in effectiveness over time. CONCLUSION: Anti-COVID-19 measures have shown selective efficacy in preventing HAIs. The study emphasizes the need for context-specific strategies and increased focus on regions with limited resources. Continued research is essential to refine infection control practices, especially in high-risk settings.

Early Changes in Porcine Larynges Following Injection of Motor-Endplate Expressing Muscle Cells for the Treatment of Unilateral Vocal Fold Paralysis.

OBJECTIVES: No curative injectable therapy exists for unilateral vocal fold paralysis. Herein, we explore the early implications of muscle-derived motor-endplate expressing cells (MEEs) for injectable vocal fold medialization after recurrent laryngeal nerve (RLN) injury. METHODS: Yucatan minipigs underwent right RLN transection (without repair) and muscle biopsies. Autologous muscle progenitor cells were isolated, cultured, differentiated, and induced to form MEEs. Three weeks after the injury, MEEs or saline were injected into the paralyzed right vocal fold. Outcomes including evoked laryngeal electromyography (LEMG), laryngeal adductor pressure, and acoustic vocalization data were analyzed up to 7 weeks post-injury. Harvested porcine larynges were examined for volume, gene expression, and histology. RESULTS: MEE injections were tolerated well, with all pigs demonstrating continued weight gain. Blinded analysis of videolaryngoscopy post-injection revealed infraglottic fullness, and no inflammatory changes. Four weeks after injection, LEMG revealed on average higher right distal RLN activity retention in MEE pigs. MEE-injected pigs on average had vocalization durations, frequencies, and intensities higher than saline pigs. Post-mortem, the MEE-injected larynges revealed statistically greater volume on quantitative 3D ultrasound, and statistically increased expression of neurotrophic factors (BDNF, NGF, NTF3, NTF4, NTN1) on quantitative PCR. CONCLUSIONS: Minimally invasive MEE injection appears to establish an early molecular and microenvironmental framework to encourage innate RLN regeneration. Longer follow-up is needed to determine if early findings will translate into functional contraction. LEVEL OF EVIDENCE: NA Laryngoscope, 134:272-282, 2024.

Selective Collection of Exhaled Breath Condensate for Noninvasive Screening of Breath Glucose.

BACKGROUND: Although exhaled breath condensate (EBC) is a promising noninvasive sample for detecting respiratory analytes such as glucose, current EBC collection methods yield inconsistent results. METHODS: We developed a custom EBC collection device with a temperature-based algorithm to selectively condense alveolar air for reproducible EBC glucose detection. We characterized the condensate volumes and the corresponding glucose concentrations. We performed a pilot study demonstrating its use during oral glucose tolerance tests. RESULTS: The novel device selectively captured alveolar air resulting in slightly higher and less variable glucose concentrations than the overall EBC. Participants with type 2 diabetes demonstrated significantly higher blood plasma-EBC glucose ratios than normoglycemic participants. CONCLUSIONS: Temperature-based selective EBC collection allows EBC glucose measurement and is a promising sampling method to distinguish patients with and without diabetes.

Correlations between cerebrospinal fluid biomarkers, neurocognitive tests, and resting-state electroencephalography (rsEEG) in patients with HIV-associated neurocognitive disorders.

HIV-associated neurocognitive disorders (HAND) are highly prevalent in people living with HIV (PLWH) despite successful treatment with combination antiretroviral therapy (cART). HAND pathogenesis is complex and definitive surrogate biomarkers are not clearly defined. Brain function has been assessed through the evaluation of cortical source rhythms with delta waves associated with neurological impairment. The aim of this study was to assess the correlation between EEG cortical sources, cerebrospinal fluid (CSF) biomarkers, and neurocognitive tests in PLWH with HAND. PLWH with HAND without significant comorbidities were enrolled. Baseline rsEEG-LORETA waves, CSF biomarkers (t-tau, p-tau, ß-amiloid42, neopterin, S100ß), and neurocognitive tests were correlated and compared through non-parametric tests (Spearman's rho and Mann-Whitney); data are presented as medians (interquartile ranges). Fifty-four patients were enrolled. Median time of suppressed HIV-RNA and CD4+ T-lymphocyte were 10 years (5.5-15) and 691/uL (477-929). Thirty-nine participants (72%) underwent CSF collection: abnormal biomarkers were found in a small percentage. Only neopterin showed a statistically significant correlation with delta activity [parietal (rho 0.579; p < 0.001), occipital (rho 0.493; p = 0.007), and global sources (rho 0.464 p = 0.011)]. Seven patients (12.9%) showed an abnormal neopterin level (> 1.5 ng/mL) with significantly higher delta source activity compared to the ones with in-range concentrations. We observed a statistically significant correlation between working memory test Trail Making B with both CSF neopterin levels and delta waves (p values < 0.05). In a small sample of PLWH with HAND, we observed that higher CSF neopterin levels were associated with higher EEG delta waves and worse working memory tests.

Hexavalent chromium-reducing bacteria on biosolids from the San Fernando Wastewater Treatment Plant in Medellín (Colombia) / Bacterias aisladas de biosólidos de la PTAR San Fernando en Medellín-Colombia con capacidad para reducir cromo hexavalente

ABSTRACT During the most recent decades, advances have been made to reduce the environmental impact by anthropogenic activities that constantly release toxic components into the environment, generating instability and damage to the health of biological communities. Among the different pollutants, heavy metals are important by virtue of their properties, which hinder their degradation or transformation into other less toxic compounds. Chromium is one of the metals of greatest global interest due to its use in multiple industries. Conventional methods using chromed materials in their processes, not only throw considerable amounts of waste into the environment, but also give little account of the fraction of hexavalent chromium (Cr6+) present in certain ecosystems. Bioremediation has been proposed as an economically viable and environmentally sustainable alternative. This work aimed to evaluate the chromium reduction capacity by bacteria isolated from a biosolids matrix obtained at the San Fernando Wastewater Treatment Plant (WWTP), located in Medellín (Colombia). Biosolids samples were grown in a nutrient agar enriched with different concentrations of Cr6+. The strains presenting the greater tolerance to chromium were isolated to perform reduction tests by triplicate, monitoring the concentration of the metal over time. Seven different bacterial species were obtained, among which Staphylococcus saprophyticus, Ochrobactrum anthropic, and Bacillus cereus showed the greatest ability to reduce Cr6+ (29.0%, 61.1 and 100%, at 96 h) respectively.

RESUMEN En las últimas décadas se ha trabajado activamente para reducir el impacto ambiental generado por las actividades antrópicas que constantemente liberan componentes tóxicos al ambiente generando inestabilidad y daños en la salud de las comunidades biológicas. Entre los diferentes contaminantes, los metales pesados revisten importancia en virtud de sus propiedades, que dificultan su degradación o transformación en otros compuestos menos tóxicos. El cromo es uno de los metales de mayor interés a nivel global por su uso en múltiples industrias. Los métodos convencionales que utilizan materiales cromados en sus procesos, no sólo arrojan cantidades considerables de residuos al ambiente, sino que dan poca cuenta de la fracción de Cr6+ presente en determinados ecosistemas. La biorremediación se ha propuesto como una alternativa económicamente viable y ambientalmente sostenible. El propósito del presente trabajo fue evaluar la capacidad de reducción de cromo por bacterias, aisladas de una matriz de biosólidos de la Planta de tratamiento de aguas residuales (PTAR) San Fernando en la ciudad de Medellín-Colombia. Muestras de biosólidos se cultivaron en Agar Nutritivo enriquecido con diferentes concentraciones de Cr6+. Las cepas que presentaron mayor tolerancia al cromo fueron aisladas para realizar ensayos de reducción por triplicado, monitoreando la concentración del metal en el tiempo. Se obtuvieron siete especies bacterianas diferentes dentro de las cuales se destacaron Staphylococcus saprophyticus, Ochrobactrum anthropi y Bacillus cereus por la capacidad de reducir Cr6+ a 96 h con eficiencias de 29.0%, 61.1% y 100%, respectivamente.

Laboratory disruption of scaled astrophysical outflows by a misaligned magnetic field.

The shaping of astrophysical outflows into bright, dense, and collimated jets due to magnetic pressure is here investigated using laboratory experiments. Here we look at the impact on jet collimation of a misalignment between the outflow, as it stems from the source, and the magnetic field. For small misalignments, a magnetic nozzle forms and redirects the outflow in a collimated jet. For growing misalignments, this nozzle becomes increasingly asymmetric, disrupting jet formation. Our results thus suggest outflow/magnetic field misalignment to be a plausible key process regulating jet collimation in a variety of objects from our Sun's outflows to extragalatic jets. Furthermore, they provide a possible interpretation for the observed structuring of astrophysical jets. Jet modulation could be interpreted as the signature of changes over time in the outflow/ambient field angle, and the change in the direction of the jet could be the signature of changes in the direction of the ambient field.

Novel concepts and nanostructured materials for thermionic-based solar and thermal energy converters.

Thermal and concentrated solar solid-state converters are devices with no moving parts, corresponding to long lifetimes, limited necessity of maintenance, and scalability. Among the solid-state converters, the thermionic-based devices are attracting an increasing interest in the specific growing sector of energy conversion performed at high-temperature. During the last 10 years, hybrid thermionic-based concepts, conceived to cover operating temperatures up to 2000 °C, have been intensively developed. In this review, the thermionic-thermoelectric, photon-enhanced thermionic emission, thermionic-photovoltaic energy converters are extensively discussed. The design and development processes as well as the tailoring of the properties of nanostructured materials performed by the authors are comprehensively described and compared with the advances achieved by the international scientific community.

The effect of community nurse on mortality and hospi- talization in a group of over-75 older adults: a nested case-control study.

Background: Bio-psycho-social frailty can negatively affect the health status of an ageing population. The integration between community nurses and social services can emphasize community care and prevent the onset of both health and social negative outcomes in the older population. The aim of the paper is to explore the causal association through the analysis of the hospitalization and mortality rate after a pro-active social service integrated by the community nurse. Study Design: A nested case-control study comparing groups of older adults has been carried out. Methods. The paper compares data stem from a cohort followed up by the University of Rome "Tor Vergata" with data from the "Long Live the Elderly!" program (LLE) cohort. Results: One-year standardized mortality rate was 6.5%, 4.7% and 7.5% in the control group, the LLE group and the LLE group integrated by the community nurse (LLE-CN), respectively. One-year hospitalization rate was 15.4%, 15.5% and 10.8% in the control group, the LLE group and the LLE-CN group, respectively. Conclusions: According to our results a social service with a pro-active approach, integrated by the community nurse, appears to be able to reduce mortality and hospitalization in a group of older adults aged>75. The multidimensional assessment of frailty stands for the first step of a new organization of community services.

Demonstrating the presence of Ehrlichia canis DNA from different tissues of dogs with suspected subclinical ehrlichiosis.

BACKGROUND: Nowadays, Ehrlichia canis receives increasing attention because of its great morbidity and mortality in animals. Dogs in the subclinical and chronic phases can be asymptomatic, and serological tests show cross-reactivity and fail to differentiate between current and past infections. Moreover, there could be low parasitaemia, and E. canis might be found only in target organs, hence causing results to be negative by polymerase chain reaction (PCR) on blood samples. METHODS: We evaluated by PCR the prevalence of E. canis in blood, liver, spleen, lymph node and bone marrow samples of 59 recently euthanised dogs that had ticks but were clinically healthy. RESULTS: In total, 52.55% of the blood PCRs for E. canis were negative, yet 61.30% yielded positive results from tissue biopsies and were as follows: 63.15% from bone marrow; 52.63% from liver; 47.36% from spleen; and 15.78% from lymph node. In addition, 33% had infection in three tissues (spleen, liver and bone marrow). CONCLUSIONS: Our results show the prevalence of E. canis from tissues of dogs that were negative by blood PCR. Ehrlichia canis DNA in tissue was 30% lower in dogs that tested negative in PCR of blood samples compared to those that were positive. However, it must be taken into account that some dogs with negative results were positive for E. canis in other tissues.

Kick Ring LL: A Multi-Sensor Ring Capturing Respiration, Electrocardiogram, Oxygen Saturation, and Skin Temperature1.

With the growing trend towards personalized health, wearable fitness trackers have become a staple of the consumer electronics industry. As the prevalence of such devices booms, the medical community has been compelled to investigate the potential of such devices and explore how they can be used to create positive clinical outcomes. In this report we detail a smart-ring capable of determining heart rate (HR), respiratory rate (RR), blood oxygen saturation (SpO2), and temperature. The ring implements a photoplethysmogram (PPG), electrocardiogram (ECG), and thermistor to attain these metrics. After evaluation, significant correlation was found between the experimentally reported HR and RR recordings with their respective standards (p<0.05). Experimentally derived SpO2 had trial-dependent similarities with its reference standards, and temperature measurements were within expected values of normal skin temperature.

NeoWarm: Kangaroo Mother Care with Continuous Temperature Tracking and Heating.

Premature births are highly prevalent; world-wide, one in every ten births is premature. A common complication of premature birth is the inability of the newborns to regulate their own body temperature (hypothermia). Kangaroo Mother Care (KMC) is an effective strategy to mitigate this problem but has challenges. Namely, KMC requires constant engagement from the caregiver in order to keep the baby warm and to monitor the baby's temperature every 4 hours. In this report we describe NeoWarm, a device designed to address these challenges via continuous integrated warming and automated temperature monitoring of the infant, both during KMC and when the caregiver takes a break. Pilot studies demonstrate the ability of the device to warm a simulated newborn from moderate hypothermia to ideal core temperatures within two hours.

Comparison of the impact of ships to size-segregated particle concentrations in two harbour cities of northern Adriatic Sea.

Detailed information on in-harbour shipping contribution to size segregated particles in coastal cities are scarce, especially in the busy Mediterranean basin. This poses issues for human exposure and air quality in urban harbour agglomerates, where only criteria pollutants (i.e. PM10 and/or PM2.5) are usually monitored. In this work, particle number and mass size distributions, in a large size range (0.01-31 µm), were obtained in two coastal cities of northern Adriatic Sea: Venice (Italy) and Rijeka (Croatia). Three size ranges were investigated: nanoparticles (diameter D < 0.25 µm); fine particles (0.25 1 µm). Absolute concentrations were larger in Venice for all size ranges showing, using analysis of daily trends, a large influence of local meteorology and boundary-layer dynamics. Contribution of road transport was larger (in relative terms) in Rijeka compared to Venice. The highest contributions of shipping were in Venice, mainly because of the larger ship traffic. Maximum impact was on nanoparticles 7.4% (Venice) and 1.8% (Rijeka), the minimum was on fine range 1.9% (Venice) and <0.2% (Rijeka) and intermediate values were found in the coarse fraction 1.8% (Venice) and 0.5% (Rijeka). Contribution of shipping to mass concentration was not distinguishable from uncertainty in Rijeka (<0.2% for PM1, PM2.5, and PM10) and was about 2% in Venice. Relative contributions as function of particles size show remarkable similitudes: a maximum for nanoparticles, a quick decrease and a successive secondary maximum (2-3 times lower than the first) in the fine range. For larger diameters, the relative contributions reach a minimum at 1-1.5 µm and there is a successive increase in the coarse range. Size distributions showed a not negligible contribution of harbour emissions to nanoparticle and fine particle number concentrations, compared to PM2.5 or PM10, indicating them as a better metric to monitor shipping impacts compared to mass concentrations (PM2.5 or PM10).

Analysis of patients attitude to undergo urgent endoscopic procedures during COVID-19 outbreak in Italy.

We conducted a survey to investigate to what extent the fear of COVID-19 has influenced the patients decision to undergo or to cancel endoscopic procedures. We collected data from 847 patients from 13 centres. The main indication for endoscopy was anemia, followed by pain and unexplained weight loss. The percentage of not presenters progressively increased throughout the three weeks of study, from 15.1% at the beginning to 48.2% at the end. 37 (34.2%) upper GI endoscopies and 112 (56.3 %) colonoscopies showed an organic cause explaining the symptoms presented by the patients, respectively; 5 cases of gastric cancer (4.6%) and 16 cases of colorectal cancer (CRC) (6.0%), respectively, were detected; during the second week the percentage of organic diseases found at upper endoscopy was 19 (33.3%) with 5 cancer (8.7%), and 61 (49.1% ) at colonoscopy, with 2 CRC (1.6%); finally, during the third week the corresponding figures were 19 (48.7%) for upper GI examinations, with 3 gastric cancers (7.7%), and 43 (60.5%) with 4 (6.5%) CRC cases found.We conclude that patients weighted the fear of having a clinically relevant disease with the fear of becoming infected by coronavirus, and a relevant percentage of them (29.4%) decided not to attend the endoscopy suites at the scheduled date.

KickStat: A Coin-Sized Potentiostat for High-Resolution Electrochemical Analysis.

The demand for wearable and point-of-care devices has led to an increase in electrochemical sensor development to measure an ever-increasing array of biological molecules. In order to move from the benchtop to truly portable devices, the development of new biosensors requires miniaturized instrumentation capable of making highly sensitive amperometric measurements. To meet this demand, we have developed KickStat, a miniaturized potentiostat that combines the small size of the integrated Texas Instruments LMP91000 potentiostat chip (Texas Instruments, Dallas, TX, USA) with the processing power of the ARM Cortex-M0+ SAMD21 microcontroller (Microchip Technology, Chandler, AZ, USA) on a custom-designed 21.6 mm by 20.3 mm circuit board. By incorporating onboard signal processing via the SAMD21, we achieve 1 mV voltage increment resolution and an instrumental limit of detection of 4.5 nA in a coin-sized form factor. This elegant engineering solution allows for high-resolution electrochemical analysis without requiring extensive circuitry. We measured the faradaic current of an anti-cocaine aptamer using cyclic voltammetry and square wave voltammetry and demonstrated that KickStat's response was within 0.6% of a high-end benchtop potentiostat. To further support others in electrochemical biosensors development, we have made KickStat's design and firmware available in an online GitHub repository.

Nonhost Status of Commercial Sweet Granadilla (Passiflora ligularis) in Peru to Ceratitis capitata (Diptera: Tephritidae) and Anastrepha fraterculus.

The host status of sweet granadilla (Passifflora ligularis Juss.) to Ceratitis capitata (Wiedemann) and Anastrepha fraterculus (Wiedemann) in Peru was determined. Experiments were conducted in Pasco (Peru) in four different orchards, over 2 yr (2016 and 2017), two orchards per year. Choice (granadilla plus natural host) and no-choice foraging behavior trials were conducted using sleeves under field conditions, and forced infestation was examined in laboratory cages, with five females per fruit. The development time of C. capitata was determined, and the oviposition behavior of C. capitata and A. fraterculus was examined. Three fruit maturity stages of intact (n = 1,320) and punctured (n = 1,320) granadilla fruits were examined. Adult C. capitata (n = 4,418) and A. fraterculus (n = 2,484) were trapped in the orchards, and commercial granadilla fruits (n = 1,940) sampled and dissected. Fruit fly infestation was not found in any intact granadilla fruits. Larvae and pupae were found inside punctured granadilla only in fruits broken after 20 d, and adults only emerged when those pupae were removed from the fruit. Ceratitis capitata development time was longer in punctured granadilla than that in host fruit. In the oviposition test, A. fraterculus and C. capitata did not lay eggs in intact granadilla, and C. capitata laid eggs in punctured fruits but larvae were not found. Because of the resistance mechanisms of the pericarp, commercial fruits of Passiflora ligularis are not a natural host of C. capitata and A. fraterculus in Peru.

Assessing the Impact of A Community-Based Pro-Active Monitoring Program Addressing the need for Care of Community-Dwelling Citizens aged more than 80: Protocol for a Prospective Pragmatic Trial and Results of the Baseline Assessment.

The aim of this paper is to describe the protocol of a study assessing the impact of a Community-based pro-Active Monitoring Program, by measuring the effect in counteracting the adverse outcomes related to frailty. METHODS: a prospective pragmatic trial will be carried out to describe the impact of an intervention on people aged>80, adjusted for relevant parameters: demographic variables, comorbidities, disability and bio-psycho-social frailty. They have been assessed with the Functional Geriatric Evaluation questionnaire that is a validated tool. Mortality, Acute Hospital Admission rates, Emergency Room Visit rates and Institutionalization rates are the main outcomes to be evaluated annually, over three years. Two groups of patients, made up by 578 cases (undergoing the intervention under study) and 607 controls have been enrolled and interviewed. RESULTS: at baseline the two groups are quite similar for age, living arrangement, comorbidity, disability and cognitive status. They differ in education, economic resources and physical status (that are better in the control group) and in social resources (that is better in the case group). The latter was expected since the intervention is focused on increasing social capital at individual and community level and aimed at improving survival among the cases as well as reducing the recourse to hospital and residential Long Term Care. CONCLUSION: The proposed study addresses a crucial issue: assessing the impact of a bottom up care service consisting of social and health interventions aimed at reducing social isolation and improving access to health care services.

Microfluidic rapid and autonomous analytical device (microRAAD) to detect HIV from whole blood samples.

While identifying acute HIV infection is critical to providing prompt treatment to HIV-positive individuals and preventing transmission, existing laboratory-based testing methods are too complex to perform at the point of care. Specifically, molecular techniques can detect HIV RNA within 8-10 days of transmission but require laboratory infrastructure for cold-chain reagent storage and extensive sample preparation performed by trained personnel. Here, we demonstrate our point-of-care microfluidic rapid and autonomous analysis device (microRAAD) that automatically detects HIV RNA from whole blood. Inside microRAAD, we incorporate vitrified amplification reagents, thermally-actuated valves for fluidic control, and a temperature control circuit for low-power heating. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) products are visualized using a lateral flow immunoassay (LFIA), resulting in an assay limit of detection of 100 HIV-1 RNA copies when performed as a standard tube reaction. Even after three weeks of room-temperature reagent storage, microRAAD automatically isolates the virus from whole blood, amplifies HIV-1 RNA, and transports amplification products to the internal LFIA, detecting as few as 3 × 105 HIV-1 viral particles, or 2.3 × 107 virus copies per mL of whole blood, within 90 minutes. This integrated microRAAD is a low-cost and portable platform to enable automated detection of HIV and other pathogens at the point of care.

Kick LL: A Smartwatch for Monitoring Respiration and Heart Rate using Photoplethysmography.

With the growing popularity of wearable devices in the consumer space, interest in leveraging this technological platform in the medical field is rising. In this report, we describe a smartwatch capable of measuring respiration and heart rate using photoplethysmography (PPG). The device couples a photosensor, specifically tuned bandpass filters, and frequency content analysis to extract respiration and heart rate from the PPG signal. The results from the experimental device were compared to a commercial chest strap heart rate monitor. Respiratory rate measurements agreed within 1 breath per minute and heart rate measurements agreed within 3-4 beats per minute of the reference device. Furthermore, the device was packaged in an untethered wristwatch allowing for realtime measurements and analysis.

Delayed diagnosis and treatment of tuberculosis in HIV+ patients in Mozambique: A cost-effectiveness analysis of screening protocols based on four symptom screening, smear microscopy, urine LAM test and Xpert MTB/RIF.

BACKGROUND: Tuberculosis (TB) represents the ninth leading cause of death worldwide. In 2016 are estimated 1.3 million TB deaths among HIV negative people and an additional 374,000 deaths among HIV positive people. In 2016 are estimated 1.4 million new cases of TB in people living with HIV (PLHIV), 74% of whom were living in Africa. In light of these data, the reduction of mortality caused by TB in PLHIV is strongly required specially in low-income countries as Mozambique. According to international guidelines, the initial TB screening in HIV+ patients should be done with the four symptoms screening (4SS: fever, current cough, night sweats and weight loss). The diagnostic test more used in resource-limited countries is smear microscopy (SMEAR). World Health Organization (WHO) recommended Lateral Flow urine LipoArabinoMannan assay (LF-LAM) in immunocompromised patients; in 2010 WHO endorsed the use of Xpert Mycobacterium Tuberculosis/Rifampicin (MTB/RIF) test for rapid TB diagnosis but the assay is not used as screening test in all HIV+ patients irrespectively of symptoms due to cost and logistical barriers. The paper aims to evaluate the cost-effectiveness of three screening protocols: standard (4SS and SMEAR in positive patients to 4SS); MTB/RIF; LF-LAM / MTB/RIF. METHODS: We developed a model to assess the cost-effectiveness of the MTB/RIF protocol versus the common standard and LF-LAM / MTB/RIF protocol. The model considered a sample of 1,000 HIV+ antiretroviral treatment naïve patients in Mozambique. We evaluated disability-adjusted life year (DALY) averted for each protocol, cost per DALY, and incremental cost-effectiveness ratio (ICER), over 1-year, assuming a national healthcare system perspective. The model considered the delayed diagnosis as the time elapsed between a false negative test and the diagnosis and treatment of TB. Additional health system organization delay is defined as the time interval between positive test and treatment initiation caused by a delay in the delivery of results due organization of services. We conducted a sensitivity analysis on more relevant variables. RESULTS: The MTB/RIF protocol was cost-effective as compared to the standard protocol with an ICER of $56.54 per DALY saved. In a cohort of 1,000 patients MTB/RIF and LF-LAM / MTB/RIF protocol generated 1,281 and 1,254 DALY's saved respectively, with a difference of 174 and 147 DALY respect to the standard protocol. The total cost of MTB/RIF protocol was lower ($92,263) than the standard ($147,226) and the LF-LAM / MTB/RIF ($113,196). Therefore, the cost per DALY saved including new infections due to delayed diagnosis with the standard protocol was $79.06, about 5 fold higher than MTB/RIF and LF-LAM / MTB/RIF protocols. The cost of additional TB infections due to delays in diagnosis plus health system delay seemed the more relevant costs. The low sensibility and sensitivity of the standard protocol led to a high number of false negatives, thus delayed TB diagnoses and treatment lead to the development of newly transmitted TB infections. CONCLUSIONS: Our study shows that the MTB/RIF adoption could lead to an increasing of TB case-finding and a reduction in costs compared with standard and LF-LAM / MTB/RIF protocols.