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Safary E, Lepeska M, Beran D, Ewen M, Zhaparova A, Rukare J, Boulle P, Aebischer Perone S, Makohliso S, Pleus S, Vetter B. Development of a target product profile for new glucose self-monitoring technologies for use in low- and middle-income countries. PLoS One 2024; 19:e0309062. [PMID: 39186719 PMCID: PMC11346918 DOI: 10.1371/journal.pone.0309062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024] Open
Abstract
AIMS Most glucose self-monitoring devices have been developed with high-income countries in mind. We developed a target product profile (TPP) for new glucose self-monitoring technologies for users in low- and middle-income countries (LMICs). METHODS A draft TPP including 39 characteristics was developed by an expert group including diabetes specialists, device specialists, and people with diabetes, incorporating findings from qualitative research in LMICs. Each characteristic had minimal and optimal requirements for two use cases, frequent and sporadic use. Characteristics requiring refinement were identified via online survey. Characteristics with agreement level <90% for any requirement were reviewed by the expert group and amended as appropriate. RESULTS One characteristic (shelf life) had agreement <75% (both requirements for both use cases). Characteristics with agreement ≥75% and <90% for the frequent use case included infrastructure level, measurement cycle, duration of use before replacement, interchangeability, and calibration (both requirements), and activity log and price per month to end payer (minimal requirement). Intended use (both requirements), accuracy, and price per month to end payer (optimal requirement) had agreement ≥75% and <90% for the sporadic use case. CONCLUSIONS This TPP will inform developers on requirements for glucose self-monitoring technologies for LMICs, and support decision-makers in evaluating existing devices.
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Affiliation(s)
| | | | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | | | | | | | | | - Sigiriya Aebischer Perone
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
- International Committee of the Red Cross, Geneva, Switzerland
| | - Solomzi Makohliso
- Essential Tech Centre, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Stefan Pleus
- Institut für Diabetes Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
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2
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Somerville L, Nagy L. The refurbishment and redistribution of disability equipment from the UK to low- and middle-income countries: a case study focusing on 2016-2021 redistributions to Romania. Disabil Rehabil Assist Technol 2024:1-7. [PMID: 39066516 DOI: 10.1080/17483107.2024.2367717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 07/28/2024]
Abstract
The surplus of used disability equipment contributing to waste in the UK and the lack of access to disability equipment in low- and middle-income countries (LMICs) are two issues in need of solution. To address such problems, UK charities refurbish and redistribute used disability equipment to LMICs. To date, there is a scarcity of data on how LMICs could access surplus disability equipment from UK organisations. This study aimed to collate and map out the process by which equipment is refurbished and redistributed from the UK to LMIC's and identify factors which influence the development and sustainability of the partnership. An explorative qualitative case study design was used. Nine semi-structured interviews were conducted with participants from sender (UK) and a receiver (Romania) organisation between January-February 2022, with real-time translation where necessary. Intelligent verbatim transcription was used, and data was analysed using latent thematic analysis. The process of collection, refurbishment and redistribution of disability equipment from the UK to a LMIC organisation was mapped. Three key themes were identified from the interviews: (1) Development out of need; (2) Service development requires an adequate working relationship; (3) Process consolidation and future. Strong, honest and transparent relationships between organisations was identified as underpinning the success of the initiative. Raising service provision standards to meet specific needs of LMIC organisations supports development of suitable equipment prescription. Development of similar partnerships has potential of reducing the inequity gap and waste. Global collaboration and planning are required to address challenges of access to disability equipment in LMICs.
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Affiliation(s)
- Lauren Somerville
- Occupational Therapy, Oxford Brookes University, Oxford, United Kingdom
| | - Liana Nagy
- Occupational Therapy, Oxford Brookes University, Oxford, United Kingdom
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3
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Lai JM, Chen J, Navia JC, Durkee H, Gonzalez A, Rowaan C, Arcari T, Aguilar MC, Llanes K, Ziebarth N, Martinez JD, Miller D, Flynn HW, Amescua G, Parel JM. Enhancing Rose Bengal penetration in ex vivo human corneas using iontophoresis. Ther Deliv 2024; 15:567-575. [PMID: 39023301 PMCID: PMC11412146 DOI: 10.1080/20415990.2024.2371778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Aim: Rose Bengal photodynamic antimicrobial therapy (RB-PDAT) has poor corneal penetration, limiting its efficacy against acanthamoeba keratitis (AK). Iontophoresis enhances corneal permeation of charged molecules, piquing interest in its effects on RB in ex vivo human corneas.Methods: Five donor whole globes each underwent iontophoresis with RB, soaking in RB, or were soaked in normal saline (controls). RB penetration and corneal thickness was assessed using confocal microscopy.Results: Iontophoresis increased RB penetration compared with soaking (177 ± 9.5 μm vs. 100 ± 5.7 μm, p < 0.001), with no significant differences in corneal thickness between groups (460 ± 87 μm vs. 407 ± 69 μm, p = 0.432).Conclusion: Iontophoresis significantly improves RB penetration and its use in PDAT could offer a novel therapy for acanthamoeba keratitis. Further studies are needed to validate clinical efficacy.
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Affiliation(s)
- James M Lai
- Ophthalmic Biophysics Center, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Justin Chen
- Ophthalmic Biophysics Center, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Juan Carlos Navia
- Ophthalmic Biophysics Center, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Heather Durkee
- Ophthalmic Biophysics Center, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Alex Gonzalez
- Ophthalmic Biophysics Center, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Cornelis Rowaan
- Ophthalmic Biophysics Center, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Timothy Arcari
- Ophthalmic Biophysics Center, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146, USA
| | - Mariela C Aguilar
- Ophthalmic Biophysics Center, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | | - Noel Ziebarth
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146, USA
| | - Jaime D Martinez
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Darlene Miller
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Ocular Microbiology Laboratory, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Harry W Flynn
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Ocular Microbiology Laboratory, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Guillermo Amescua
- Ophthalmic Biophysics Center, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Ocular Microbiology Laboratory, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Jean-Marie Parel
- Ophthalmic Biophysics Center, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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4
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Marbán-Castro E, Muhwava L, Kamau Y, Safary E, Rheeder P, Karsas M, Kemp T, Freitas J, Carrihill M, Dave J, Katambo D, Kimetto J, Allie R, Ndungu J, Sigwebela N, Akach D, Girdwood S, Erkosar B, Nichols BE, Haldane C, Vetter B, Shilton S. Implementation research: a protocol for two three-arm pragmatic randomised controlled trials on continuous glucose monitoring devices in people with type 1 diabetes in South Africa and Kenya. Trials 2024; 25:331. [PMID: 38773658 PMCID: PMC11107040 DOI: 10.1186/s13063-024-08132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Self-monitoring of glucose is an essential component of type 1 diabetes (T1D) management. In recent years, continuous glucose monitoring (CGM) has provided an alternative to daily fingerstick testing for the optimisation of insulin dosing and general glucose management in people with T1D. While studies have been conducted to evaluate the impact of CGM on clinical outcomes in the US, Europe and Australia, there are limited data available for low- and middle-income countries (LMICs) and further empirical evidence is needed to inform policy decision around their use in these countries. METHODS This trial was designed as a pragmatic, parallel-group, open-label, multicentre, three-arm, randomised (1:1:1) controlled trial of continuous or periodic CGM device use versus standard of care in people with T1D in South Africa and Kenya. The primary objective of this trial will be to assess the impact of continuous or periodic CGM device use on glycaemic control as measured by change from baseline glycosylated haemoglobin (HbA1c). Additional assessments will include clinical outcomes (glucose variation, time in/below/above range), safety (adverse events, hospitalisations), quality of life (EQ-5D, T1D distress score, Glucose Monitoring Satisfaction Survey for T1D), and health economic measures (incremental cost-effectiveness ratios, quality adjusted life years). DISCUSSION This trial aims to address the substantial evidence gap on the impact of CGM device use on clinical outcomes in LMICs, specifically South Africa and Kenya. The trial results will provide evidence to inform policy and treatment decisions in these countries. TRIAL REGISTRATION NCT05944731 (Kenya), July 6, 2023; NCT05944718 (South Africa), July 13, 2023.
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Affiliation(s)
| | - Lorrein Muhwava
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Yvonne Kamau
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Elvis Safary
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Paul Rheeder
- University of Pretoria Diabetes Research Centre, Gezina, Pretoria, South Africa
| | - Maria Karsas
- University of Pretoria Diabetes Research Centre, Gezina, Pretoria, South Africa
| | - Tanja Kemp
- University of Pretoria Diabetes Research Centre, Gezina, Pretoria, South Africa
| | - Johanè Freitas
- University of Pretoria Diabetes Research Centre, Gezina, Pretoria, South Africa
| | - Michelle Carrihill
- Red Cross Childrens Hospital, Paediatric Clinic, Cape Town, South Africa
| | - Joel Dave
- Division of Endocrinology, Groote Schuur Hospital and the University of Cape Town, Cape Town, South Africa
| | - Daniel Katambo
- Kenya Diabetes Management and Information Centre, Nairobi, Kenya
| | - Joan Kimetto
- Kenya Diabetes Management and Information Centre, Nairobi, Kenya
| | - Razana Allie
- University of Pretoria Diabetes Research Centre, Gezina, Pretoria, South Africa
| | - Joseph Ndungu
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Ntombi Sigwebela
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Dorcas Akach
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Sarah Girdwood
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Berra Erkosar
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Brooke E Nichols
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Cathy Haldane
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Beatrice Vetter
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
| | - Sonjelle Shilton
- FIND, Campus Biotech, Chemin Des Mines 9, 1202, Geneva, Switzerland
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5
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Soldado-Magraner J, Antonietti A, French J, Higgins N, Young MJ, Larrivee D, Monteleone R. Applying the IEEE BRAIN neuroethics framework to intra-cortical brain-computer interfaces. J Neural Eng 2024; 21:022001. [PMID: 38537269 DOI: 10.1088/1741-2552/ad3852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Abstract
Objective. Brain-computer interfaces (BCIs) are neuroprosthetic devices that allow for direct interaction between brains and machines. These types of neurotechnologies have recently experienced a strong drive in research and development, given, in part, that they promise to restore motor and communication abilities in individuals experiencing severe paralysis. While a rich literature analyzes the ethical, legal, and sociocultural implications (ELSCI) of these novel neurotechnologies, engineers, clinicians and BCI practitioners often do not have enough exposure to these topics.Approach. Here, we present the IEEE Neuroethics Framework, an international, multiyear, iterative initiative aimed at developing a robust, accessible set of considerations for diverse stakeholders.Main results. Using the framework, we provide practical examples of ELSCI considerations for BCI neurotechnologies. We focus on invasive technologies, and in particular, devices that are implanted intra-cortically for medical research applications.Significance. We demonstrate the utility of our framework in exposing a wide range of implications across different intra-cortical BCI technology modalities and conclude with recommendations on how to utilize this knowledge in the development and application of ethical guidelines for BCI neurotechnologies.
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Affiliation(s)
- Joana Soldado-Magraner
- Department of Electrical and Computer Engineering and the Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, United States of America
| | - Alberto Antonietti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano 20131, Italy
| | - Jennifer French
- Neurotech Network, St. Petersburg, FL 33733, United States of America
| | - Nathan Higgins
- School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Michael J Young
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States of America
| | - Denis Larrivee
- Mind and Brain Institute, University of Navarra Medical School, Pamplona, Navarra 31008, Spain
- Loyola University, Chicago, IL 60611, United States of America
| | - Rebecca Monteleone
- Disability Studies Program, University of Toledo, Toledo, OH 43606, United States of America
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6
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Neri L, Gallelli I, Dall'Olio M, Lago J, Borghi C, Diemberger I, Corazza I. Validation of a New and Straightforward Algorithm to Evaluate Signal Quality during ECG Monitoring with Wearable Devices Used in a Clinical Setting. Bioengineering (Basel) 2024; 11:222. [PMID: 38534496 DOI: 10.3390/bioengineering11030222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/03/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Wearable devices represent a new approach for monitoring key clinical parameters, such as ECG signals, for research and health purposes. These devices could outcompete medical devices in terms of affordability and use in out-clinic settings, allowing remote monitoring. The major limitation, especially when compared to implantable devices, is the presence of artifacts. Several authors reported a relevant percentage of recording time with poor/unusable traces for ECG, potentially hampering the use of these devices for this purpose. For this reason, it is of the utmost importance to develop a simple and inexpensive system enabling the user of the wearable devices to have immediate feedback on the quality of the acquired signal, allowing for real-time correction. METHODS A simple algorithm that can work in real time to verify the quality of the ECG signal (acceptable and unacceptable) was validated. Based on simple statistical parameters, the algorithm was blindly tested by comparison with ECG tracings previously classified by two expert cardiologists. RESULTS The classifications of 7200 10s-signal samples acquired on 20 patients with a commercial wearable ECG monitor were compared. The algorithm has an overall efficiency of approximately 95%, with a sensitivity of 94.7% and a specificity of 95.3%. CONCLUSIONS The results demonstrate that even a simple algorithm can be used to classify signal coarseness, and this could allow real-time intervention by the subject or the technician.
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Affiliation(s)
- Luca Neri
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | | | | | - Jessica Lago
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
- IRCCS AOU, Policlinico di S. Orsola, 40138 Bologna, Italy
| | - Igor Diemberger
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
- IRCCS AOU, Policlinico di S. Orsola, 40138 Bologna, Italy
| | - Ivan Corazza
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
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7
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Safary E, Beran D, Vetter B, Lepeska M, Abdraimova A, Dunganova A, Besançon S, Lazo-Porras M, Portocarrero Mazanett J, Pérez-León S, Maixenchs M, Nchimbi H, Ramaiya K, Munishi C, Martínez-Pérez GZ. User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania. BMJ Open 2024; 14:e076685. [PMID: 38367964 PMCID: PMC10875487 DOI: 10.1136/bmjopen-2023-076685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/30/2024] [Indexed: 02/19/2024] Open
Abstract
AIMS Development of non-invasive and minimally invasive glucose monitoring devices (NI-MI-GMDs) generally takes place in high-income countries (HICs), with HIC's attributes guiding product characteristics. However, people living with diabetes (PLWD) in low-income and middle-income countries (LMICs) encounter different challenges to those in HICs. This study aimed to define requirements for NI-MI-GMDs in LMICs to inform a target product profile to guide development and selection of suitable devices. METHODS This was a multiple-methods, exploratory, qualitative study conducted in Kyrgyzstan, Mali, Peru and Tanzania. Interviews and group discussions/activities were conducted with healthcare workers (HCWs), adults living with type 1 (PLWD1) or type 2 diabetes (PLWD2), adolescents living with diabetes and caregivers. RESULTS Among 383 informants (90 HCW, 100 PLWD1, 92 PLWD2, 24 adolescents, 77 caregivers), a range of differing user requirements were reported, including preferences for area of glucose measurement, device attachment, data display, alert type and temperature sensitivity. Willingness to pay varied across countries; common requirements included ease of use, a range of guiding functions, the possibility to attach to a body part of choice and a cost lower than or equal to current glucose self-monitoring. CONCLUSIONS Ease-of-use and affordability were consistently prioritised, with broad functionality required for alarms, measurements and attachment possibilities. Perspectives of PLWD are crucial in developing a target product profile to inform characteristics of NI-MI-GMDs in LMICs. Stakeholders must consider these requirements to guide development and selection of NI-MI-GMDs at country level, so that devices are fit for purpose and encourage frequent glucose monitoring among PLWD in these settings.
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Affiliation(s)
- Elvis Safary
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Beatrice Vetter
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Molly Lepeska
- Health Action International, Amsterdam, The Netherlands
| | | | | | | | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, University of Geneva, Geneva, Switzerland
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Silvana Pérez-León
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Happy Nchimbi
- Tanzania NCD Alliance, Dar es Salaam, Tanzania, United Republic of
| | - Kaushik Ramaiya
- Tanzania NCD Alliance, Dar es Salaam, Tanzania, United Republic of
| | - Castory Munishi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
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8
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Rauschendorf P, Bou Saba G, Meara GK, Roodaki N, Conde-Agudelo A, Garcia DEC, Burke TF. Effectiveness of a novel bubble CPAP system for neonatal respiratory support at a referral hospital in the Philippines. Front Pediatr 2023; 11:1323178. [PMID: 38161434 PMCID: PMC10757669 DOI: 10.3389/fped.2023.1323178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Aim To examine the impact of introducing and implementing the Vayu bubble continuous positive airway pressure (bCPAP) system on neonatal survival and neonatal respiratory outcomes in a neonatal intensive care unit (NICU) in the Philippines. Methods We compared clinical outcomes of 1,024 neonates before to 979 neonates after introduction of Vayu bCPAP systems into a NICU. The primary outcome was survival to discharge. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated. Analyses were undertaken separately for the entire NICU population and for neonates who received any form of respiratory support. Results The introduction of the Vayu bCPAP system was associated with (1) significant reductions in intubation (aOR: 0.75; 95% CI: 0.58-0.96) and in the use of nasal intermittent positive-pressure ventilation (NIPPV) (aOR: 0.69; 95% CI: 0.50-0.96) among the entire NICU population and (2) a significant increase in survival to discharge (aOR: 1.53; 95% CI: 1.09-2.17) and significant reductions in intubation (aOR: 0.52; 95% CI: 0.38-0.71), surfactant administration (aOR: 0.60; 95% CI: 0.40-0.89), NIPPV use (aOR: 0.52; 95% CI: 0.36-0.76), and a composite neonatal adverse outcome (aOR: 0.60; 95% CI: 0.42-0.84) among neonates who received any form of respiratory support. Conclusion The use of the Vayu bCPAP system in a NICU in the Philippines resulted in significant improvement in neonatal respiratory outcomes.
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Affiliation(s)
- Paula Rauschendorf
- Vayu Global Health Foundation, Boston, MA, United States
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
| | | | - Grace K. Meara
- Vayu Global Health Foundation, Boston, MA, United States
| | - Navid Roodaki
- Section of Neonatology, Department of Pediatrics, Ilocos Training and Regional Medical Center, San Fernando City, Philippines
- College of Medicine, Mariano Marcos State University, City of Batac, Philippines
- College of Medicine, University of Northern Philippines, Vigan City, Philippines
| | - Agustin Conde-Agudelo
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Daisy Evangeline C. Garcia
- Section of Neonatology, Department of Pediatrics, Ilocos Training and Regional Medical Center, San Fernando City, Philippines
| | - Thomas F. Burke
- Vayu Global Health Foundation, Boston, MA, United States
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
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9
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Fitzgerald TN, Zambeli-Ljepović A, Olatunji BT, Saleh A, Ameh EA. Gaps and priorities in innovation for children's surgery. Semin Pediatr Surg 2023; 32:151352. [PMID: 37976896 DOI: 10.1016/j.sempedsurg.2023.151352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Lack of access to pediatric medical devices and innovative technology contributes to global disparities in children's surgical care. There are currently many barriers that prevent access to these technologies in low- and middle-income countries (LMICs). Technologies that were designed for the needs of high-income countries (HICs) may not fit the resources available in LMICs. Likewise, obtaining these devices are costly and require supply chain infrastructure. Once these technologies have reached the LMIC, there are many issues with sustainability and maintenance of the devices. Ideally, devices would be created for the needs and resources of LMICs, but there are many obstacles to innovation that are imposed by institutions in both HICs and LMICs. Fortunately, there is a growing interest for development of this space, and there are many examples of current technologies that are paving the way for future innovations. Innovations in simulation-based training with incorporated learner self-assessment are needed to fast-track skills acquisition for both specialist trainees and non-specialist children's surgery providers, to scale up access for the larger population of children. Pediatric laparoscopy and imaging are some of the innovations that could make a major impact in children's surgery worldwide.
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Affiliation(s)
- Tamara N Fitzgerald
- Department of Surgery, Duke University, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA
| | - Alan Zambeli-Ljepović
- Philip R. Lee Institute for Health Policy Studies, University of California San Fransisco, USA
| | | | | | - Emmanuel A Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria.
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Jiang S, Kumah E. Strategizing global health governance: unpacking opportunities and challenges for least developed nations within the WHO pandemic treaty framework. Front Public Health 2023; 11:1321125. [PMID: 38026386 PMCID: PMC10657804 DOI: 10.3389/fpubh.2023.1321125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Exploring the intricacies of the proposed WHO pandemic treaty, this paper underscores its potential benefits and challenges for Least Developed Nations (LDNs) in the global health landscape. While the treaty could elevate LDNs' access to vital resources, fortify health systems, and amplify their voice in global health governance, tangible challenges in safeguarding equitable access, protecting sovereignty, and ensuring compliance are illuminated. Concluding with targeted recommendations, the paper advocates for treaty revisions that assure resource access, safeguard LDNs' autonomy, and foster capacity-building. In essence, the paper emphasizes the imperative of genuinely empowering LDNs, crafting a pandemic treaty that establishes a more equitable, resilient, and inclusive global health future.
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Affiliation(s)
- Shisong Jiang
- School of Law, Chongqing University, Chongqing, China
| | - Emmanuel Kumah
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana
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Pose F, Ciarrocchi N, Videla C, Redelico FO. Permutation Entropy Analysis to Intracranial Hypertension from a Porcine Model. ENTROPY (BASEL, SWITZERLAND) 2023; 25:267. [PMID: 36832634 PMCID: PMC9955102 DOI: 10.3390/e25020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/20/2022] [Accepted: 12/28/2022] [Indexed: 06/18/2023]
Abstract
Intracranial pressure (ICP) monitoring is commonly used in the follow-up of patients in intensive care units, but only a small part of the information available in the ICP time series is exploited. One of the most important features to guide patient follow-up and treatment is intracranial compliance. We propose using permutation entropy (PE) as a method to extract non-obvious information from the ICP curve. We analyzed the results of a pig experiment with sliding windows of 3600 samples and 1000 displacement samples, and estimated their respective PEs, their associated probability distributions, and the number of missing patterns (NMP). We observed that the behavior of PE is inverse to that of ICP, in addition to the fact that NMP appears as a surrogate for intracranial compliance. In lesion-free periods, PE is usually greater than 0.3, and normalized NMP is less than 90% and p(s1)>p(s720). Any deviation from these values could be a possible warning of altered neurophysiology. In the terminal phases of the lesion, the normalized NMP is higher than 95%, and PE is not sensitive to changes in ICP and p(s720)>p(s1). The results show that it could be used for real-time patient monitoring or as input for a machine learning tool.
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Affiliation(s)
- Fernando Pose
- Instituto de Medicina Traslacional e Ingeniería Biomédica, CONICET, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires C1199ABB, Argentina
| | - Nicolas Ciarrocchi
- Servicio de Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires C1199ABB, Argentina
| | - Carlos Videla
- Servicio de Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires C1199ABB, Argentina
| | - Francisco O. Redelico
- Instituto de Medicina Traslacional e Ingeniería Biomédica, CONICET, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires C1199ABB, Argentina
- Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Bernal B1876BXD, Argentina
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Hu F, Qiu L, Zhou H. Medical Device Product Innovation Choices in Asia: An Empirical Analysis Based on Product Space. Front Public Health 2022; 10:871575. [PMID: 35493362 PMCID: PMC9043244 DOI: 10.3389/fpubh.2022.871575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 12/23/2022] Open
Abstract
Due to the increasing demand for health care, identifying and evaluating the feasibility of local medical device innovation and production is an important guarantee for the long-term sustainable development of a national health system, especially for Asian countries/regions that are plagued by aging populations. This article analyzes the international trade data of 46 HS 6-digit medical device products exported from 49 countries from 1999 to 2019, and constructs a global medical device product space. Furthermore, the innovation potential and opportunities of potential medical device products in major Asian countries are evaluated by examining the dynamic relationship between the product distance and the acquisition of comparative advantages for medical device products based on an empirical model. The regression results suggest that a close product distance improves the feasibility of developing a new medical device product. The smaller the product distance is, the more likely it is to increase the diversity of the medical device products of a country by maintaining the existing comparative advantages and gaining potential comparative advantages. Furthermore, we follow the conclusions of the empirical model and analyze the product space evolution, and potential product distance and gains of major Asian medical device exporters. These conclusions may help entrepreneurs identify potential development directions and help government policy-makers formulate policies that are in line with national realities.
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Affiliation(s)
- Feng Hu
- Global Value Chain Research Center, Zhejiang Gongshang University, Hangzhou, China
| | - Liping Qiu
- School of Business Administration, Zhejiang Gongshang University, Hangzhou, China
| | - Haiyan Zhou
- Institute of Artificial Intelligence and Change Management, Shanghai University of International Business and Economics, Shanghai, China
- *Correspondence: Haiyan Zhou
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Faulkenberry JG, Luberti A, Craig S. Electronic health records, mobile health, and the challenge of improving global health. Curr Probl Pediatr Adolesc Health Care 2022; 52:101111. [PMID: 34969611 DOI: 10.1016/j.cppeds.2021.101111] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Technology continues to impact healthcare around the world. This provides great opportunities, but also risks. These risks are compounded in low-resource settings where errors in planning and implementation may be more difficult to overcome. Global Health Informatics provides lessons in both opportunities and risks by building off of general Global Health. Global Health Informatics also requires a thorough understanding of the local environment and the needs of low-resource settings. Forming effective partnerships and following the lead of local experts are necessary for sustainability; it also ensures that the priorities of the local community come first. There is an opportunity for partnerships between low-resource settings and high income areas that can provide learning opportunities to avoid the pitfalls that plague many digital health systems and learn how to properly implement technology that truly improves healthcare.
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Affiliation(s)
- J Grey Faulkenberry
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia.
| | - Anthony Luberti
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
| | - Sansanee Craig
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
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Critical elements in the design, development and use of medical devices. A systemic perspective of orthopedic devices landscape in low- and middle-income countries. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lee D, Chua B. Soft Candy as an Electronic Material Suitable for Salivary Conductivity-Based Medical Diagnostics in Resource-Scarce Clinical Settings. ACS APPLIED MATERIALS & INTERFACES 2021; 13:43984-43992. [PMID: 34506102 DOI: 10.1021/acsami.1c11306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Soft candy was discovered to be an excellent electronic material and was used to fabricate electrodes for salivary conductivity-based diagnostics. Using a simple molding process, a soft candy (Tootsie Roll) was made into 20 × 20 × 5 mm electrodes with a stable frequency response (0.1-100 kHz). The soft candy electrode-liquid interface circuit model was also developed for the first time. Using 0.01, 0.05, and 0.1 M phosphate-buffered saline and artificial saliva of varying conductivities, the performance of the soft candy (Tootsie Roll) electrode was evaluated. The electrode has a low temperature coefficient of ∼0.02 V/C, and the evaporation-induced mass change during measurement (<3 min) was negligible. Using a trenched surface, a limit of detection (LOD) of ∼1630 μS/cm was obtained and was lower than the saliva conductivity of a healthy adult at ∼3500 μS/cm. Thus, it is suitable for monitoring the ovulation cycle for natural family planning as well as chronic kidney disease diagnosis. Given the ubiquity of soft candy, the simplicity of the molding process, and the negligible medical waste stream, it is a more appropriate approach to diagnostics design for resource-scarce clinical settings, such as those in developing countries. The broader impact of this work will be the paradigm shift of soft candy from food to a new class of edible, moldable, high-resistivity, and stable electronic materials.
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Affiliation(s)
- Donghyun Lee
- School of Electrical Engineering, Korea University, Seoul 02841, Republic of Korea
- School of Dentistry, Pusan National University, Yangsan 50612, Republic of Korea
| | - Beelee Chua
- School of Electrical Engineering, Korea University, Seoul 02841, Republic of Korea
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