Diagnostic performance of a computer-aided system for tuberculosis screening in two Philippine cities

Background and Objectives@#The Philippines faces challenges in the screening of tuberculosis (TB), one of them being the shortage in the health workforce who are skilled and allowed to screen TB. Deep learning neural networks (DLNNs) have shown potential in the TB screening process utilizing chest radiographs (CXRs). However, local studies on AIbased TB screening are limited. This study evaluated qXR3.0 technology's diagnostic performance for TB screening in Filipino adults aged 15 and older. Specifically, we evaluated the specificity and sensitivity of qXR3.0 compared to radiologists' impressions and determined whether it meets the World Health Organization (WHO) standards.@*Methods@#A prospective cohort design was used to perform a study on comparing screening and diagnostic accuracies of qXR3.0 and two radiologist gradings in accordance with the Standards for Reporting Diagnostic Accuracy (STARD). Subjects from two clinics in Metro Manila which had qXR 3.0 seeking consultation at the time of study were invited to participate to have CXRs and sputum collected. Radiologists' and qXR3.0 readings and impressions were compared with respect to the reference standard Xpert MTB/RiF assay. Diagnostic accuracy measures were calculated. @*Results@#With 82 participants, qXR3.0 demonstrated 100% sensitivity and 72.7% specificity with respect to the reference standard. There was a strong agreement between qXR3.0 and radiologists' readings as exhibited by the 0.7895 (between qXR 3.0 and CXRs read by at least one radiologist), 0.9362 (qXR 3.0 and CXRs read by both radiologists), and 0.9403 (qXR 3.0 and CXRs read as not suggestive of TB by at least one radiologist) concordance indices. @*Conclusions@#qXR3.0 demonstrated high sensitivity to identify presence of TB among patients, and meets the WHO standard of at least 70% specificity for detecting true TB infection. This shows an immense potential for the tool to supplement the shortage of radiologists for TB screening in the country. Future research directions may consider larger sample sizes to confirm these findings and explore the economic value of mainstream adoption of qXR 3.0 for TB screening.

Integrated primary healthcare delivery of hypertension and diabetes services: A task analysis of nurses and doctors in Rural Philippines

Objectives@#This study aimed to describe the roles and responsibilities of doctors and nurses in managing conditions like hypertension and diabetes in rural areas.@*Methods@#This study employed a cross-sectional study design using the task analysis methodology. A self-administered questionnaire derived from a national health practice guideline was used. A combination of frequency, criticality, and performance was assessed to identify tasks that needed attention by educators and policymakers.@*Results@#Of the 142 health workers who participated in the study, 81% were nurses and 19% were doctors. The tasks most frequently performed by these professionals were taking vital signs (88.7%), recording patient history (87.3%), and advising patients on regular follow-ups (86.6%). In terms of criticality, the top three tasks were performing diagnostic tests for acute chest pain (50.8%), diagnosing neurological disorders (49.2%), and referring patients for specialized tests at other facilities (43.6%). However, the tasks perceived as most challenging or outside their capability were the Fagerstorm test for assessing nicotine dependence (57.5%), the AUDIT tool for identifying binge drinkers (55.5%), and fundoscopy for diagnosing diabetic retinopathy (54%).@*Conclusion@#The primary care practice of the participants typically involved tasks that are centered on health promotion or disease prevention. Many of the tasks are shared by doctors and nurses, with some highly critical tasks performed less frequently due to a lack of training. Pre-service courses may need to be revised to ensure that health professionals have the required skills to carry out shared tasks.

Acceptability of task shifting primary care diabetes self-management education services to volunteer barangay health workers in a Philippine City

Objective@#The primary objective of this study was to explore the acceptability of task shifting to volunteer barangay health workers (BHWs) in the implementation of community-based Diabetes Self-Management Education (DSME) in the Philippines.@*Methods@#This study employed a descriptive qualitative study design. Data were collected through semi-structured interviews with twelve stakeholders. The study was conducted in the urban city of Marikina which has a high prevalence of diabetes, and high death rates for diabetes and cerebrovascular disease relative to the regional and national rates. A purposive sampling technique was used in selecting participants.@*Results@#Task shifting Diabetes Self-Management Education to BHWs is generally acceptable to the participants. Expanding the roles of BHWs should be supported by adequate training, compensation, supervision, and financial and non-financial incentives. Ensuring adequate support and resources to execute BHWs’ duties and responsibilities as volunteer health workers can promote the effective implementation of task shifting DSME in primary care.@*Conclusion@#Findings from this study provide preliminary evidence of the acceptability of task shifting to BHWs in the management of diabetes mellitus. The study highlights the importance of institutionalizing task shifting in the health system to promote acceptance and sustainability.

Rationing of nursing care and its relationship to nurse practice environment in a tertiary public hospital

@#<p style="text-align: justify;"><strong>Objectives:</strong> The purpose of the study is to determine the level of rationing of nursing care and its relationship to nurses' perception of their practice environment.</p><p style="text-align: justify;"><strong>Methods:</strong> The study employed a descriptive, cross-sectional study design. The Basel Extent of Rationing of Nursing Care (BERNCA) was administered to assess the level of care rationing while the Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to describe nurses' practice environment. A total of 147 nurses participated in the study. Multiple regression analysis was conducted to determine the effect of various respondent characteristics and nurse practice environment on care rationing.</p><p style="text-align: justify;"><strong>Results:</strong> Only practice environment total score was significantly associated with rationing of care total scores (B = -0.20, p < 0.05). Results of the regression show that for every unit increase in nurse practice environment total score, indicating a better work environment, there is a 0.20 unit decrease in rationing of nursing care total score, which indicated less rationing of care. Respondent characteristics are not significantly related.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Nurses most frequently rationed tasks in the areas of caring/support and monitoring. The less frequently rationed tasks involved medical, technical, and therapeutic aspects of care. The identification of rationing predictors can aid in determining starting points for hospital policy reforms. Prevalence levels can indicate when care rationing exceeds identified thresholds, if any. Nursing administrators can use implicit rationing of nursing care as a crucial indicator of the impact of strategies and changes in the nurse practice environment (e.g., changes in staffing levels, skill mix, and other resources).</p><p style="text-align: justify;"><strong>Key Words:</strong> Health Care Rationing, Health Facility Environment, Nursing Care</p>

Nurse staffing during the SARS, MERS, and Ebola epidemics: A narrative review

Background@#The COVID-19 pandemic has put an immense strain on health systems worldwide. Nurses at the front line are prone to experience several staffing issues facing ever-increasing stresses to the health care system by a pandemic situation. The staffing experiences of nurses in this context can have a significant impact on current nursing practice and existing policies.@*Objective@#To carry out a synthesis of the scientific evidence available on the staffing experiences of nurses during the SARS, MERS, and Ebola epidemics.@*Method@# A narrative review was conducted. A literature search was carried out in PubMed, Scopus, and CINAHL databases. All studies describing nurses' experiences were included regardless of methodology. Atotal of 16 articles was included in the review.@*Results@#Narrative synthesis revealed ten themes from the results of the articles: training, staffing ratios and models, shifting models, volunteer staffing, skill mix, planning staffing needs, hospital preparedness, communication, effects of workload, and structured workflow processes.@*Conclusions@#Nurses are pivotal to the healthcare response to infectious disease pandemics and epidemics. The results of this review should provide a basis for nurse managers and administrators on how they can actively engage in supporting the staffing concerns and issues of nurses during the COVID-19 pandemic.

Acceptability of task shifting primary care diabetes self-management education services to volunteer barangay health workers in a Philippine City

Objective@#The primary objective of this study was to explore the acceptability of task shifting to volunteer barangay health workers (BHWs) in the implementation of community-based Diabetes Self-Management Education (DSME) in the Philippines. @*Methods@#This study employed a descriptive qualitative study design. Data were collected through semi-structured interviews with twelve stakeholders. The study was conducted in the urban city of Marikina which has a high prevalence of diabetes, and high death rates for diabetes and cerebrovascular disease relative to the regional and national rates. A purposive sampling technique was used in selecting participants. @*Results@#Task shifting Diabetes Self-Management Education to BHWs is generally acceptable to the participants. Expanding the roles of BHWs should be supported by adequate training, compensation, supervision, and financial and non-financial incentives. Ensuring adequate support and resources to execute BHWs’ duties and responsibilities as volunteer health workers can promote the effective implementation of task shifting DSME in primary care. @*Conclusion@#Findings from this study provide preliminary evidence of the acceptability of task shifting to BHWs in the management of diabetes mellitus. The study highlights the importance of institutionalizing task shifting in the health system to promote acceptance and sustainability

Effect of process variables in the production of fried green plantain in vacuum / Efecto de las variables de proceso en la obtención de plátano verde frito en condiciones de vacío

Background: This article technology deep frying green plantain was evaluated. Objectives: To optimize the process of deep frying in the production of green banana slices and set the association in terms of the quality parameter: texture; from the point of sensory and instrumental view. Methods: Was used as a raw material banana green maturity, variety (Dominico Harton) and a mixture of refined vegetable oils from soybeans and palm olein with antioxidant (TBHQ). For the evaluation of the process we worked with various pressure ranges, driving force (∆T) and time; selecting maximum and minimum for these process variables (10-79kPa) values (13-113°C) and (57-663s) respectively. For the analysis of the response variables (moisture content, fat content and texture "hardness") officially sanctioned AOAC methods and protocols in the case of the texture were used. Looking for the best frying conditions, an analysis of response surface optimization process was performed. Results: saddle points were obtained on optimization analysis of the three response variables. A higher time of 550s and between 40 and 80°C, and times 200 to 500s and ∆T 80 to 100°C, zones of influence of moisture content with a value of 0.25% occurred. For the fat content was observed that values below about 20°C and 200s of time and pressures greater than 55kPa, begin to generate relatively low values. Regarding the hardness, treatments 7 and 11 were the most accepted sensorially. Conclusions: The moisture content did not depend on the pressure variable in the process, only the driving force and time altered the outcome of this variable. Considering the sensory evaluation, it was concluded that the desired value for the moisture content was 0.25%, to the fat content values were between 31 and 36%, and hardness between 6.4 and 9.2N.

Antecedentes: En este artículo se evalúo la tecnología de fritura por inmersión en plátano verde. Objetivos: Optimizar el proceso de la fritura por inmersión en la producción de rodajas de plátano verde y establecer la asociación existente en cuanto al parámetro de calidad: textura; desde el punto de vista sensorial e instrumental. Métodos: Se empleó como materia prima plátano en estado de madurez verde, variedad (Dominico Hartón) y una mezcla de aceites vegetales refinados de soya y oleína de palma con antioxidante (TBHQ). Para la evaluación del proceso se trabajó con varios rangos de presión, fuerza im pulsora (∆T) y tiempo; seleccionando unos valores máximos y mínimos para estas variables de proceso (10-79kPa), (13-113ºC) y (57-663s) respectivamente. Para el análisis de las variables de respuesta (contenido de humedad, contenido de grasa y textura "dureza") se utilizaron métodos oficiales de la AOAC y protocolos en el caso de la textura. En busca de las mejores condiciones de fritura, se realizó un análisis de superficie de respuesta para la optimización del proceso. Resultados: Se obtuvieron puntos de silla en el análisis de optimización de las tres variables de respuesta. A tiempos superiores de 550s y ∆T entre 40 y 80°C, y a tiempos entre 200 y 500s y ∆T entre 80 y 100°C, se presentaron zonas de incidencia del contenido de humedad con un valor del 0.25%. Para el contenido de grasa se observó que a valores por debajo de aproximadamente 20°C de ∆T y 200s de tiempo y presiones mayores a 55kPa, se empiezan a generar valores relativamente bajos. En cuanto a la dureza, los tratamientos 7 y 11 fueron los más aceptados sensorialmente. Conclusiones: El contenido de humedad no dependió de la variable presión en el proceso, sólo la fuerza impulsora y el tiempo alteraron el resultado de esta variable. Teniendo en cuenta la evaluación sensorial, se concluyó que el valor deseable para el contenido de humedad fue de 0.25%, para el contenido de grasa los valores estuvieron entre 31 y 36%, y para la dureza entre 6.4 y 9.2 N.

Comparison of gastropod mollusc (Apogastropoda: Hydrobiidae) habitats in two crater lakes in Nicaragua

The aquatic gastropod mollusc, Pyrgophorus coronatus, may perform an important role in the transmission of an emergent ocular pathology among fishes in Lake Apoyo, Nicaragua. This disease emerged after an introduction of tilapia (Oreochromis niloticus) and the subsequent loss of Chara sp. beds in the lake. We compared the mollusc population densities in three habitats (sandy/muddy substrates, rocks, and Chara vegetation) at varying depths (1.5, 10, 20, and 30 m) in two volcanic crater lakes in Nicaragua: Lake Apoyo and Lake Xiloa. where lower numbers of affected fishes were found and tilapia has not been introduced. Duplicate samples at 1.5 m depth were taken in each habitat monthly for a year, and triplicate samples for bathymetric analysis of snail populations were performed during August, 2005. Samples of fixed surface area were filtered in a 0.4 cm size screen and live snails were counted from each sample. The preferred snail habitat in both lakes, Chara beds, was vastly reduced in Lake Apoyo via consumption by introduced Nile tilapia (Oreochromis niloticus). Structureless sandy substrates (mean +/- standard error 3.1+/-1.3 ind/m2) had lower population densities than other habitats in Lake Xiloa (rocks 590.9+/-185.3 ind/m2; vegetation 3 686.5+/-698.2 ind/m2; ANOVA 1, p<0.01 in both cases) but this difference was attenuated in Lake Apoyo (sand 384.4+/-111.1 ind/m2; rocks 1 480.4+/-384.8 ind/m2: 0.0 1

El gasterópodo acuático, Pyrgophorus coronatus, podría jugar un papel importante en la transmisión de una patología ocular emergente entre los peces de la laguna de Apoyo, Nicaragua. Esta enfermedad surgió después de una introducción de tilapia (Oreochromis niloticus) y la subsecuente pérdida de lechos de Chara sp. en la laguna. Comparamos las densidades poblacionales del caracol en tres hábitats (substratos arenosos/lodosos, rocas y vegetación de Chara) en dos lagunas cratéricas volcánicas en Nicaragua: La laguna de Apoyo y la laguna de Xiloá, donde no se encuentraron grandes cantidades de peces afectados y donde no se han introducido tilapias. Mensualmente, por un año tomamos muestras duplicadas a 1.5 m profundidad mensualmente por un año, y durante agosto de 2005, muestreos triplicados de las poblaciones del molusco, para análisis batimétrico (1.5, 10, 20 y 30 m). Para determinar el número de individuos por unidad de área superficial, las muestras fueron filtradas en un colador de 0.4 cm de apertura de malla y contamos los moluscos vivos en cada muestra. El hábitat preferido de los caracoles en ambas lagunas fue la vegetación de Chara, que en la laguna de Apoyo fue vastamente reducida al ser consumida por las tilapias nilóticas introducidas (Oreochromis niloticus). Los substratos arenosos, menos estructurados que los otros sustratos estudiados, tuvieron densidades poblacionales más bajas (media ± error estándar 3.1±1.3 ind/m2) que en los otros hábitats en la laguna de Xiloá (vegetation 590.9±185.3 ind/m2; rocas 3 686.5±698.2 ind/m2; ANOVA I, p<0.01 en ambos casos) pero esta diferencia fue atenuada en la laguna de Apoyo (arena 384.4±111.1 ind/m2; rocas 1 480.4±384.8 ind/ m2; 0.01

Trastornos psicosomáticos pacientes que acuden a consulta externa de un hospital de niños / Psicosomatic upsets dune in the pediatric consult of the Robert Reid Cabral Hospital, Santo Domingo, Dominican Republic

Estudio prospectivo y analítico de los trastornos psicosomáticos en la consulta pediátrica del Hospital Robert Read Cabral, Santo Domingo, República Dominicana, de noviembre a diciembre, 1990. De 102 casos en total tratados en este lapso de tiempo se encontró que el sexo masculino fue el más afectado (55.0//), la mayoría estaba entre los 4-9 años de edad (60.0//). Fueron los trastornos psicosomáticos más frecuentes: enuresis (29.41//), cefalea (17.65//) y los dolores abdominales (9.8//). Los niveles socioeconómicos (de medio bajo a bajo en la casi totalidad de los casos) se han considerado de importancia causal entre los trastornos estudiados

Relacion alfafetoproteina delta D.O.a 450 microm en el liquido amniotico de embarazos normales. / Alpha fetoprotein relationship in amniotic fluid in normal pregnancies

A partir de un grupo de 46 gestantes, se dosifica radioinmunologicamente la concentracion de AFP en el liquido amniotico.Paralelamente se valora espectrofotometricamente el Delta D.O. a 450 micrometro; ademas de otros (L/E, test de Clements, etc.) Se obtiene un grupo de gravidas, derivadas del grupo primitivo, que cursaron embarazos normales y que obtuvieron recien nacidos normales; comprobandose a traves del coeficiente de correlacion lineal la certeza de que las concentraciones de AFP en el liquido amniotico estan en relacion directa a los valores espectrofotometricas del Incremento coeficientes de correlacion lineal (AFP/delta D.O.) en embarazos patologicos y con incompatibilidad Rh; por ultimo tambien se correlaciono linealmente la AFP y delta D.O. a 450 micrometro con los valores de bilirrubinemia 24 horas postparto en recien nacidos con ictericia neonatal

Actividad de la beta glucoronidasa hepatica en la litiasis pigmentaria. / Activity of hepatic B-glucoronidasa in pigmented lithiasis

Se determino la actividad de la obra glucoronidasa hepatica en 15 pacientes con litiasis pigmentaria y en 8 personas normales. No se encontro ninguna diferencia estadisticamente significantiva entre ambos grupos

Carcinoma de tiroides luego de radioterapia de cuello. / Thyroid carcinoma after radiotherapy of the neck

Se presenta una observacion de cancer de tiroides originado en una glandula previamente irradiada durante el tratamiento de un neuroblastoma dorsal. Se hacen consideraciones historicas, clinicas y terapeuticas. Se concluye que la cirugia de eleccion, debe ser seguida de terapeutica supresiva y de control clinico seriado; frente a la recidiva se hara tiroidectomia total