Panniculectomy for a Rare End-Stage Complication of Severe Obesity and Increasing Surgical Phenomenon.

Panniculus morbidus (PM) is a presentation of severe chronic abdominal lymphoedema associated with obesity resulting in oedema and chronic fibrosis. It is a multifaceted condition with significant clinical and psychosocial implications. A 29-year-old female weighing 260 kg with a body mass index of 95 kg/m2 had recurrent infections and sepsis associated with an abdominal pannus extending to her knees and an area of ulceration. The pannus was indurated with extensive fibrosis that significantly affected her quality of life (QOL) requiring assistance for all activities of daily living (ADLs). A panniculectomy was performed with a negative pressure skin dressing over the skin wound. She was discharged after two days. Two months postoperatively, she reported significant improvement in QOL and can now mobilise and perform ADLs independently with no recurrent admissions. The global prevalence of obesity is reaching pandemic proportions and so will its complications. It can be functionally debilitating and worsen obesity. Surgical resection is indicated to restore mobility and function, prevent recurrent infections, improve QOL, and reduce economic burden. Patients report high satisfaction rates following surgery. Panniculectomy is an effective treatment to alleviate morbidity in severe obesity and should be considered in patients with recurrent infections and a significant impact on QOL.

Stabilised Hyaluronic Acid (sHA) gel as a novel marker for breast cancer tumour bed cavity: Surgical feasibility.

Introduction: Consistent delineation of the breast conserving surgery (BCS) tumour bed (TB) for breast cancer remains a challenge for radiation oncologists. Accurate delineation allows for better local control and reduces toxicity when planning partial breast or TB boost radiation therapy (RT). Methods: In the operating theatre (OT) breast surgeons inserted stabilised hyaluronic acid (sHA) gel as small drops approximately one cm into the walls surrounding the resection cavity. Surgical feasibility was determined by the rate of successful sHA gel insertion procedure, the ease of insertion as rated by surgeons, the time required for insertion procedure, the quantity used, and any adverse events (AE) relating to sHA gel insertion. Results: Thirty-five patients were enrolled. All patients underwent sHA gel insertion successfully. The procedure added a median of 2.8 min to the OT time and was rated as 'easy' in 89 % of patients. There were no immediate AE in OT. Five (14 %) patients experienced a grade 2 or higher AE. Three of the five patients were prescribed oral antibiotics for breast infection. Two of the five patients experienced a grade 3 AE - haematoma which required evacuation in OT day 1 post-BCS, and infected seroma which required drainage and washout in OT 2 months post-BCS. All five patients recovered and underwent the planned adjuvant therapies for their BC. The AE data reflects common risks with standard BCS and are not clearly attributed to sHA gel insertion alone. Conclusion: We show that sHA gel is surgically feasible as a marker to help define the TB cavity for post-BCS adjuvant MRI-based RT planning.

Malaysian joint societies' consensus recommendations on diagnosis and management of disorders of esophagogastric junction outflow.

Disorders of esophagogastric junction (EGJ) outflow, including achalasia and EGJ outflow obstruction, are motility disorders characterized by inadequate relaxation of lower esophageal sphincter with or without impaired esophageal peristalsis. Current guidelines are technical and less practical in the Asia-Pacific region, and there are still massive challenges in timely diagnosis and managing these disorders effectively. Therefore, a Malaysian joint societies' task force has developed a consensus on disorders of EGJ outflow based on the latest evidence, while taking into consideration the practical relevance of local and regional context and resources. Twenty-one statements were established after a series of meetings and extensive review of literatures. The Delphi method was used in the consensus voting process. This consensus focuses on the definition, diagnostic investigations, the aims of treatment outcome, non-surgical or surgical treatment options, management of treatment failure or relapse, and the management of complications. This consensus advocates the use of high-resolution esophageal manometry for diagnosis of disorders of EGJ outflow. Myotomy, via either endoscopy or laparoscopy, is the preferred treatment option, while pneumatic dilatation can serve as a secondary option. Evaluation and management of complications including post-procedural reflux and cancer surveillance are recommended.

Problematic smartphone usage, objective smartphone engagement, and executive functions: A latent variable analysis.

The negative consequences of smartphone usage have seen frequent discourse in popular media. While existing studies seek to resolve these debates in relation to executive functions, findings are still limited and mixed. This is partly due to the lack of conceptual clarity about smartphone usage, the use of self-reported measures, and problems related to task impurity. Addressing these limitations, the current study utilizes a latent variable approach to examine various types of smartphone usage, including objectively measured data-logged screen time and screen-checking, and nine executive function tasks in 260 young adults through a multi-session study. Our structural equation models showed no evidence that self-reported normative smartphone usage, objective screen time, and objective screen-checking are associated with deficits in latent factors of inhibitory control, task-switching, and working memory capacity. Only self-reported problematic smartphone usage was associated with deficits in latent factor task-switching. These findings shed light on the boundary conditions of the link between smartphone usage and executive functions and suggest that smartphone usage in moderation may not have inherent harms on cognitive functions.

Iodine-125 seed versus hook-wire guided breast conserving surgery: do post operative complication rates differ?

BACKGROUND: Radio-guided occult lesion localisation using iodine 125 seeds (ROLLIS) is used to localize impalpable breast cancers for breast conserving surgery (BCS). Previous studies have suggested improved efficiency and patient outcomes with ROLLIS compared with hook-wire localisation (HWL). The aim of this report is to compare the post-operative complication rates and safety profiles of ROLLIS versus hook-wire guided surgery. METHODS: Between September 2013 and March 2018, 690 women with non-palpable breast cancer eligible for breast-conserving surgery were randomly assigned to either pre-operative localisation with 125 I seed or hook-wire as part of the ROLLIS clinical trial. Medical record review of 170 women (30% of the total participants) from three tertiary hospitals in Western Australia was performed. Post-operative complications were classified using the Common Terminology Criteria for Adverse Events(CTCAE) grade I to V. RESULTS: Total of 170 surgeries were performed: 82 by ROLLIS and 88 by hook-wire. The overall complication rate in the ROLLIS group was 19.5%, with 15.9% being grade II and 3.66% grade III. In the HWL group, the complication rate was 22.7% with 20.5% being grade II and 2.27% grade III. There was no statistically significant difference in complication grades between the 2 groups. No grade IV or grade V complications were reported. Complications observed included drainable seroma, drainable haematoma and surgical site infection. CONCLUSION: ROLLIS is a safe method of localisation for surgical resection with similar complication rates as hookwires. We encourage its use as an alternative localisation technique as it has demonstrable superiority and efficacy.

Pathologic Complete Response and Oncologic Outcomes in Locally Advanced Breast Cancers Treated With Neoadjuvant Radiation Therapy: An Australian Perspective.

PURPOSE: To assess the degree of pathologic complete response (pCR), postoperative surgical complication rates, and oncological outcomes in women with locally advanced breast cancer or high-risk breast cancers treated with neoadjuvant radiation therapy (NART). METHODS AND MATERIALS: This retrospective, multi-institutional review involved 138 clinically staged patients with 140 breast cancers treated with NART between January 2014 and February 2021. Treatments involved sequential neoadjuvant chemotherapy and NART, followed by mastectomy with or without axillary surgery and immediate autologous breast reconstruction. Descriptive statistics were used to assess patient and disease features, treatment regimens, pathologic response, and factors affecting postoperative complications. Kaplan-Meier curves were performed to assess locoregional recurrence-free, distant metastasis-free, and overall survival outcomes. RESULTS: Median age was 47 years (interquartile range, 42-52). The median follow-up was 35.2 months (interquartile range, 17.1-46.5). pCR was achieved in 36.4% (as defined by Chevallier classification) or 42.1% (as defined by Miller-Payne scores) of patients. Greater pCR rates were achieved for HER2+ (73.8%-85.7%) and triple-negative phenotypes (47.6%-57.1%). There were 21 grade 3 surgical complications including 10 grade 3B breast events and 8 grade 3B donor-site events, where surgical reintervention was required. At 3-years' follow-up, the locoregional recurrence-free survival was 98.1%, distant metastasis-free survival was 83.6%, and overall survival was 95.3%%. CONCLUSIONS: NART is feasible to facilitate a single-stage mastectomy and immediate autologous breast reconstruction. This study demonstrated comparable rates of postoperative complication to standard of care, and high rates of pCR, which translates to high rates of locoregional control, distant metastasis-free survival, and overall survival.

Management of appendicitis in a De Garengeot hernia: Lockwood approach.

A De Garengeot hernia is a femoral hernia containing the vermiform appendix. This extremely rare hernia is associated with appendicitis and the risk of perforation and abscess formation. Given limited data, it poses both diagnostic and management difficulties. While management is generally surgical, questions remain about the best operative approach, indications for appendicectomy and optimum hernia repair technique. We describe a case of acute appendicitis within a De Garengeot hernia that was managed with an open appendicectomy via a Lockwood incision. This case helps to illustrate the management considerations present for this rare clinical pathology and describes a method to effectively identify the hernia and resect the appendix.

Successful En Bloc Resection of Complicated Giant Stomach Gastrointestinal Stromal Tumor in an Elderly Patient.

BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and mostly affect the stomach. The size of the tumors vary, ranging from 0.6 cm to 25.5 cm, with a median size of 6.8 cm. CASE REPORT We report a case of a giant GIST (25×18×8.5 cm) in an 83-year-old woman, which we believe is the largest reported GIST, in Borneo, Malaysia. She presented with gradually increasing abdominal distension with occasional discomfort on movement for 1 month. Computed tomography revealed a large multilobulated enhancing mass measuring 10×20×22 cm with no clear plane with the posterior gastric wall, duodenum, and pancreas. We performed a distal gastrectomy and transverse colon segmentectomy, as the tumor was plastered to the mesentery of the transverse colon. Despite extensive surgery, she recovered well after surgery. Due to her advanced age and the tumor size, a tyrosine kinase inhibitor was not given owing to the possibility of adverse effects. CONCLUSIONS The management of GIST is complicated, especially for a huge GIST with local invasion. Despite the benefits of a tyrosine kinase inhibitor, the role of surgery in managing GIST is crucial, especially for patients with huge tumor size, advanced age, and local complications from the tumor.

Evaluation of the Antioxidant and Antimicrobial Activities of Ethyl Acetate Extract of Saccharomyces cerevisiae.

RESEARCH BACKGROUND: Antioxidants are important compounds present at low concentrations that inhibit oxidation processes. Due to the side effects of synthetic antioxidants, research interest has increased considerably towards finding natural sources of antioxidants that can replace the synthetic ones. The emergence and spread of antibiotic resistance require the development of new drugs or some potential sources of novel medicine. This work aims to extract the secondary metabolites of Saccharomyces cerevisiae using ethyl acetate as a solvent and to determine the antioxidant and antimicrobial activities of these extracted metabolites. EXPERIMENTAL APPROACH: The antioxidant activity of the secondary metabolites of S. cerevisiae were determined using DPPH, ABTS and FRAP assays. Furthermore, the antimicrobial potential of the ethyl acetate extract of S. cerevisiae against Cutibacterium acnes, Staphylococcus aureus and Staphylococcus epidermidis was assessed. RESULTS AND CONCLUSION: Five out of 13 of the extracted secondary metabolites were identified as antioxidants. The antioxidant activity of the S. cerevisiae extract exhibited relatively high IC50 of 455.26 and 294.51 µg/mL for DPPH and ABTS respectively, while the obtained FRAP value, expressed as ascorbic acid equivalents, was 44.40 µg/mL. Moreover, the extract had a significant antibacterial activity (p<0.05) against Staphylococcus aureus and Staphylococcus epidermidis at the concentrations of 100 and 200 mg/mL, respectively. However, no inhibitory effect was observed against Cutibacterium acnes as the extract was only effective against the bacterium at the concentrations of 300 and 400 mg/mL (inhibition zones ranging from 9.0±0.0 to 9.3±0.6) respectively (p<0.05). Staphylococcus aureus was highly sensitive to the extract, with a MIC value of 18.75 mg/mL. NOVELTY AND SCIENTIFIC CONTRIBUTION: This report confirmed the efficacy of the secondary metabolites of S. cerevisiae as a natural source of antioxidants and antimicrobials and suggested the possibility of employing them in drugs for the treatment of infectious diseases caused by the tested microorganisms.

Moment-to-Moment Continuous Attention Fluctuation Monitoring through Consumer-Grade EEG Device.

While numerous studies have explored using various sensing techniques to measure attention states, moment-to-moment attention fluctuation measurement is unavailable. To bridge this gap, we applied a novel paradigm in psychology, the gradual-onset continuous performance task (gradCPT), to collect the ground truth of attention states. GradCPT allows for the precise labeling of attention fluctuation on an 800 ms time scale. We then developed a new technique for measuring continuous attention fluctuation, based on a machine learning approach that uses the spectral properties of EEG signals as the main features. We demonstrated that, even using a consumer grade EEG device, the detection accuracy of moment-to-moment attention fluctuations was 73.49%. Next, we empirically validated our technique in a video learning scenario and found that our technique match with the classification obtained through thought probes, with an average F1 score of 0.77. Our results suggest the effectiveness of using gradCPT as a ground truth labeling method and the feasibility of using consumer-grade EEG devices for continuous attention fluctuation detection.

Determinants of Newly-Diagnosed Raised Blood Pressure: The Malaysian Context.

BACKGROUND: Raised blood pressure, also known as hypertension (HPT), has been a distressing health concern among Malaysians. An upward trend is found on the prevalence of newly-diagnosed HPT, contributing to the high number of overall hypertensive patients in Malaysia. To understand the cause and reduce the economic burden caused by HPT, current research aims to examine the dependency among sociodemographic and behavioural determinants of newly-diagnosed HPT among Malaysians. METHODS: The current study uses secondary data from the Fifth National Health and Morbidity Survey (NHMS V) 2015, a population based cross-sectional study. This study uses the Bayesian Network (BN) modelling to design and build a 'causal' model and identify potential determinants and their respective conditional probability on the prevalence of newly-diagnosed HPT among Malaysians. RESULTS: This study shows that Malaysians with newly-diagnosed HPT are directly affected by the age and body mass index (BMI). Additionally, household income, sex, marital status, ethnicity, strata, education levels, occupation, fruit intake, vegetable intake, smoking status, physical activity and plain water intake indirectly affect the incidence of the newly-diagnosed HPT. CONCLUSION: These results may be helpful in implementing appropriate policies to prevent and monitor the increasing prevalence of newly-diagnosed HPT among adults in Malaysia.

Perceptions and Acceptability of Digital Interventions Among Tuberculosis Patients in Cambodia: Qualitative Study of Video-Based Directly Observed Therapy.

BACKGROUND: Despite the development of effective drugs for treatment, tuberculosis remains one of the leading causes of death from an infectious disease worldwide. One of the greatest challenges to tuberculosis control is patient adherence to treatment. Recent research has shown that video-based directly observed therapy is a feasible and effective approach to supporting treatment adherence in high-income settings. However, few studies have explored the potential for such a solution in a low- or middle-income country setting. Globally, these countries' rapidly rising rate of mobile penetration suggests that the potential for translation of these results may be high. OBJECTIVE: We sought to examine patient perceptions related to the use of mobile health, and specifically video-based directly observed therapy, in a previously unstudied patient demographic: patients with tuberculosis in a low-income country setting (Cambodia). METHODS: We conducted a cross-sectional qualitative study in urban and periurban areas in Cambodia, consisting of 6 focus groups with tuberculosis patients who were receiving treatment (standard directly observed therapy) through a nongovernmental organization. RESULTS: Familiarity with mobile technology and apps was widespread in this population, and overall willingness to consider a mobile app for video-based directly observed therapy was high. However, we identified potential challenges. First, patients very much valued their frequent in-person interactions with their health care provider, which may be reduced with the video-based directly observed therapy intervention. Second, there may be technical issues to address, including how to make the app suitable for illiterate participants. CONCLUSIONS: While video-based directly observed therapy is a promising technology, even in country settings where mobile penetration is reportedly almost universal, it should be introduced with caution. However, the results were generally promising and yielded important insights that not only will be translated into the further adaptation of key features of video-based directly observed therapy for tuberculosis patients in Cambodia, but also can inform the future design and successful implementation of video-based directly observed therapy interventions in low- and middle-income settings more generally.

Preliminary Effects of a Mobile Interactive Supervised Therapy Intervention on People Living With HIV: Pilot Randomized Controlled Trial.

BACKGROUND: As people living with HIV infection require lifelong treatment, nonadherence to medication will reduce their chance of maintaining viral suppression and increase the risk of developing drug resistance and HIV transmission. OBJECTIVE: This study aimed to evaluate the efficacy of a mobile app, Mobile Interactive Supervised Therapy (MIST), for improving adherence to oral HIV medications among HIV-infected adults in Singapore. METHODS: We conducted a two-group pilot randomized controlled trial (RCT) with a process evaluation, in which 40 HIV-infected participants with once-daily medication regimes were recruited from a public tertiary hospital in Singapore and randomly assigned equally to either the intervention (receiving MIST and routine care) or control (receiving routine care only) groups. The intervention lasted for 2 months. The outcome of antiretroviral therapy (ART) adherence was measured by a 7-day recall self-report (SR), pill count (PC), an electronic medical device-Medication Event Monitoring System (MEMS)-and a mobile app-MIST (for the intervention group only). In total, 20 participants from the intervention group were interviewed at the end of the intervention to assess the acceptability of MIST. Data were collected at baseline and at 1-month and 2-month postintervention. RESULTS: All participants had excellent medication adherence at baseline (median 100, IQR 100-100). The use of MIST did not result in a significant improvement in ART adherence when measured by the SR, PC, and MEMS, as compared with the control group at 1-month (P values >.99, .86, and .74, respectively) and 2-month (P values=.80, .84, and .82, respectively) postintervention. ART adherence also did not improve in each group over the same period. MIST was perceived to be a beneficial tool based on the process evaluation results. CONCLUSIONS: Although MIST did not enhance medication adherence to HIV treatments, mainly owing to the ceiling effect, it was perceived to be beneficial among the participants of this study. Our process evaluation provided useful data to further develop MIST for bigger and long-term mobile phone app-assisted intervention RCTs in the future. TRIAL REGISTRATION: ClinicalTrials.gov NCT03794648; https://clinicaltrials.gov/ct2/show/NCT03794648.

The Risk Factors for Undiagnosed and Known Hypertension among Malaysians.

BACKGROUND: The prevalence of known hypertension has resulted from the progression of undiagnosed hypertension. This study is targeted to examine and compare the risk factors based on the estimated odds ratios of modifiable and non-modifiable risk factors on different outcome levels of hypertension. METHODS: A nationwide representative secondary data from the Fourth National Health of Morbidity Survey (NHMS IV) which consists of 24,632 non-institutionalised Malaysian population conducted by the Ministry of Health in 2011 has been used. Odds ratio (OR) with 95% confidence interval has been estimated using multinomial logistic regression. RESULTS: Obese and overweight respondents exhibit increased likelihood of having undiagnosed and known hypertension. Physically inactive, ex-smokers and unclassified drinkers are found having higher likelihood to have known hypertension. However, current drinkers are found to have higher likelihood of having undiagnosed hypertension. Elderly, retirees, home makers and lower educated respondents are shown higher odds to have undiagnosed hypertension. Likewise, the likelihood of having known hypertension has been found to increase among the elderly and other Bumiputra. CONCLUSION: Through this research, significant predictors which consist of obese and overweight respondents, current drinkers, older respondents (above 65 years old) and primary educated respondents are having higher likelihood to have undiagnosed hypertension.

The Risk Factors for Undiagnosed and Known Hypertension among Malaysians

@#Background: The prevalence of known hypertension has resulted from the progression of undiagnosed hypertension. This study is targeted to examine and compare the risk factors based on the estimated odds ratios of modifiable and non-modifiable risk factors on different outcome levels of hypertension. Methods: A nationwide representative secondary data from the Fourth National Health of Morbidity Survey (NHMS IV) which consists of 24,632 non-institutionalised Malaysian population conducted by the Ministry of Health in 2011 has been used. Odds ratio (OR) with 95% confidence interval has been estimated using multinomial logistic regression. Results: Obese and overweight respondents exhibit increased likelihood of having undiagnosed and known hypertension. Physically inactive, ex-smokers and unclassified drinkers are found having higher likelihood to have known hypertension. However, current drinkers are found to have higher likelihood of having undiagnosed hypertension. Elderly, retirees, home makers and lower educated respondents are shown higher odds to have undiagnosed hypertension. Likewise, the likelihood of having known hypertension has been found to increase among the elderly and other Bumiputra. Conclusion: Through this research, significant predictors which consist of obese and overweight respondents, current drinkers, older respondents (above 65 years old) and primary educated respondents are having higher likelihood to have undiagnosed hypertension.

A Thermus phage protein inhibits host RNA polymerase by preventing template DNA strand loading during open promoter complex formation.

RNA polymerase (RNAP) is a major target of gene regulation. Thermus thermophilus bacteriophage P23-45 encodes two RNAP binding proteins, gp39 and gp76, which shut off host gene transcription while allowing orderly transcription of phage genes. We previously reported the structure of the T. thermophilus RNAP•σA holoenzyme complexed with gp39. Here, we solved the structure of the RNAP•σA holoenzyme bound with both gp39 and gp76, which revealed an unprecedented inhibition mechanism by gp76. The acidic protein gp76 binds within the RNAP cleft and occupies the path of the template DNA strand at positions -11 to -4, relative to the transcription start site at +1. Thus, gp76 obstructs the formation of an open promoter complex and prevents transcription by T. thermophilus RNAP from most host promoters. gp76 is less inhibitory for phage transcription, as tighter RNAP interaction with the phage promoters allows the template DNA to compete with gp76 for the common binding site. gp76 also inhibits Escherichia coli RNAP highlighting the template-DNA binding site as a new target site for developing antibacterial agents.

Risk Factors Of Newly Diagnosed Hypertension Among Individuals In Malaysia

@#The aim of this study is to examine the influence of risk factors which include modifiable and non-modifiable risk factors on the likelihood of newly diagnosed hypertension among Malaysians. A cross-sectional population-based survey: The Fourth National Health and Morbidity Survey (2011) was conducted by the Ministry of Health, Malaysia in 2011. The sample included 20,095 participants. This study uses binomial logistic regression techniques to predict the likelihood of modifiable and non-modifiable risk factors of newly diagnosed hypertension among the individuals. The analysis has been carried out by estimating odds ratio with 95% confidence interval. This study reveals that obese and overweight respondents as well as current drinkers have increased chances of having newly diagnosed hypertension. In contrast to that, only physically inactive respondents exhibit lower odds of newly diagnosed hypertension. Besides that, the significant predictors, which include older respondents, retirees and home makers, as well as lower educated respondents are respectively found to be more likely to have newly diagnosed hypertension. On the other hand, female respondents, urban dwellers, including the Chinese and Indian respondents, the highest income earners and underweight respondents have been found to have statistically significant lower odds of newly diagnosed hypertension. Through the insightful findings and evidence, this research provides a platform for the early detection and prevention of newly diagnosed hypertension. Hence, this study offers a means to monitor and control the increasing prevalence of newly diagnosed hypertension in Malaysia.

Effect of the acute general surgical unit: a regional perspective.

BACKGROUND: Acute surgical units have gained favour in Australia and New Zealand. However, there is a lack of evidence regarding their effectiveness in regional centres. We aim to investigate the effect of the introduction of the Acute General Surgical Unit (AGSU) on the outcomes for patients undergoing emergency appendicectomies or cholecystectomies in a regional hospital. METHODS: AGSU was introduced in March 2012. We conducted a retrospective comparison analysis of patients admitted 2 years prior to and 2 years after the introduction of AGSU. Primary outcomes included length of stay, time to theatre, after hours and overnight operating. Secondary outcomes included negative appendicectomy rate, conversion to open cholecystectomy and bile duct injuries. RESULTS: No difference was seen between pre and post-AGSU introduction in median time to theatre in the appendicectomy group (8.00 h versus 9.24 h) or cholecystectomy group (17.63 h versus 17.75 h). Additionally, there was no difference between median length of stay in the appendicectomy group (47.52 h versus 48.00 h) or the cholecystectomy group (71.50 h versus 70.67 h). Night operating was significantly reduced in the positive appendicectomy group (4.4% versus 9.1%, P = 0.027) and the overall cholecystectomy group (0.43% versus 3.4%, P = 0.035), however overall after hours operating remained equivalent. CONCLUSIONS: The introduction of the AGSU unit led to a significant reduction in overnight operating, which may improve patient outcomes and surgeon satisfaction. Length of stay and time to theatre did not change. Future directions include further research into the impact of theatre access on emergency surgery outcomes.

Prospective single-arm interventional pilot study to assess a smartphone-based system for measuring and supporting adherence to medication.

OBJECTIVES: Suboptimal medication adherence for infectious diseases such as tuberculosis (TB) results in poor clinical outcomes and ongoing infectivity. Directly observed therapy (DOT) is now standard of care for TB treatment monitoring but has a number of limitations. We aimed to develop and evaluate a smartphone-based system to facilitate remotely observed therapy via transmission of videos rather than in-person observation. DESIGN: We developed an integrated smartphone and web-based system (Mobile Interactive Supervised Therapy, MIST) to provide regular medication reminders and facilitate video recording of pill ingestion at predetermined timings each day, for upload and later review by a healthcare worker. We evaluated the system in a single arm, prospective study of adherence to a dietary supplement. Healthy volunteers were recruited through an online portal. Entry criteria included age ≥21 and owning an iOS or Android-based device. Participants took a dietary supplement pill once, twice or three-times a day for 2 months. We instructed them to video each pill taking episode using the system. OUTCOME: Adherence as measured by the smartphone system and by pill count. RESULTS: 42 eligible participants were recruited (median age 24; 86% students). Videos were classified as received-confirmed pill intake (3475, 82.7% of the 4200 videos expected), received-uncertain pill intake (16, <1%), received-fake pill intake (31, <1%), not received-technical issues (223, 5.3%) or not received-assumed non-adherence (455, 10.8%). Overall median estimated participant adherence by MIST was 90.0%, similar to that obtained by pill count (93.8%). There was a good relationship between participant adherence as measured by MIST and by pill count (Spearmans rs 0.66, p<0.001). CONCLUSIONS: We have demonstrated the feasibility, acceptability and accuracy of a smartphone-based adherence support and monitoring system. The system has the potential to supplement and support the provision of DOT for TB and also to improve adherence in other conditions such as HIV and hepatitis C.

Neurite Tracing With Object Process.

In this paper we present a pipeline for automatic analysis of neuronal morphology: from detection, modeling to digital reconstruction. First, we present an automatic, unsupervised object detection framework using stochastic marked point process. It extracts connected neuronal networks by fitting special configuration of marked objects to the centreline of the neurite branches in the image volume giving us position, local width and orientation information. Semantic modeling of neuronal morphology in terms of critical nodes like bifurcations and terminals, generates various geometric and morphology descriptors such as branching index, branching angles, total neurite length, internodal lengths for statistical inference on characteristic neuronal features. From the detected branches we reconstruct neuronal tree morphology using robust and efficient numerical fast marching methods. We capture a mathematical model abstracting out the relevant position, shape and connectivity information about neuronal branches from the microscopy data into connected minimum spanning trees. Such digital reconstruction is represented in standard SWC format, prevalent for archiving, sharing, and further analysis in the neuroimaging community. Our proposed pipeline outperforms state of the art methods in tracing accuracy and minimizes the subjective variability in reconstruction, inherent to semi-automatic methods.