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Abstract Printed Circuit Boards (PCBs) are key devices for the modern-day electronic technologies. During the production of these boards, defects may occur. Several methods have been proposed to detect PCB defects. However, detecting significantly smaller and visually unrecognizable defects has been a long-standing challenge. The existing two-stage and multi-stage object detectors that use only one layer of the backbone, such as Resnet’s third layer ( $$C_4$$ C 4 ) or fourth layer ( $$C_5$$ C 5 ), suffer from low accuracy, and those that use multi-layer feature maps extractors, such as Feature Pyramid Network (FPN), incur higher computational cost. Founded by these challenges, we propose a robust, less computationally intensive, and plug-and-play Attentive Context and Semantic Enhancement Module (ACASEM) for two-stage and multi-stage detectors to enhance PCB defects detection. This module consists of two main parts, namely adaptable feature fusion and attention sub-modules. The proposed model, ACASEM, takes in feature maps from different layers of the backbone and fuses them in a way that enriches the resulting feature maps with more context and semantic information. We test our module with state-of-the-art two-stage object detectors, Faster R-CNN and Double-Head R-CNN, and with multi-stage Cascade R-CNN detector on DeepPCB and Augmented PCB Defect datasets. Empirical results demonstrate improvement in the accuracy of defect detection.

Background Establishment of a systematic way of measurement and utilization of indicators for improvement is one of the most challenging issues in monitoring and evaluation of indicators in healthcare settings. In realizing these fundamental challenges, we designed a monitoring and evaluation system incorporating a hospital-wide quality variance report (QVR) system using linked Microsoft Excel® spreadsheets on Microsoft SharePoint®. Methods Indicators were determined at the departmental/unit level in line with the institutional goals, departmental functions, quality expectations, inputs/outputs, clinical priorities, compliance to policies/procedures/protocols/guidelines/pathways as well as in response to gaps in service delivery picked during root cause analyses. The sample design was determined in accordance with the characteristics of the population. Drawing of sample units was done using a simple random sampling technique without replacement or systematic random sampling. The indicator’s monitoring was enhanced visually by allocating colour codes based on performance across the months and quarters. The action plan tab consisted of a platform that aids in documenting corrective actions arising from the performance reviews. Results and discussion The QVR reporting system ensured a standardized format of monitoring throughout the institution with a reduced turnaround time from data collection to analysis. Further, continuity of the monitoring and evaluation (M&E) system was guaranteed even if an individual left the institution. The analysis of the QVR allowed hospital-wide trending on cross-cutting indicators with consequent ease of communication to multiple stakeholders. The automation has saved time and increased accuracy which has enhanced credible engagements during quality meetings. Conclusions Use of this system greatly enhanced quality performance monitoring in the hospital, identification of major bottlenecks that warranted hospital-wide projects or departmental-level projects. The QVR system enhanced the efficiency and accuracy of quality monitoring from data collection through to performance reviews. The QVR structure allows for customized development of an M&E database application software.

In wireless communication systems, the design and optimization of antenna arrays play a crucial role in achieving desired performance metrics. Many constraints on optimizing antenna arrays to achieve minimum SLL, high Gain, and good impedance matching require a starting point to achieve the intended goal at the minimum cost. This article analyzes the trade-offs associated with utilizing non-identical elements within antenna arrays. By varying the shape, size, and arrangement of array elements, the aim is to analyze the impact on Gain and sidelobe levels. The article explores non-identical antenna arrays’ potential advantages and limitations through computational simulations. The analysis is divided into two sections: Uniform shapes with varying sizes and diverse shapes and sizes. The simulations employed advanced electromagnetic modeling software to predict the performance of different array configurations. Gain, sidelobe levels, and impedance matching were the primary parameters analyzed. Arrays with uniform shapes and varying sizes achieved a superior gain of 20 dB and recorded an SLL of 14 dB. Whereby arrays with non-uniform elements yielded a gain of 15 dB and an SLL of 8 dB. These findings suggest that non-identical antenna arrays offer distinct advantages depending on the specific performance criteria. Arrays with uniform shapes but varying sizes are highly effective in maximizing Gain, while those with diverse shapes and sizes excel in minimizing sidelobe levels. Future work could explore the balance between cost and performance, potentially incorporating more complex element variations and real-world environmental factors.

Neuroinflammatory and neurodegenerative disorders including Alzheimer’s disease (AD), Parkinson’s disease (PD), traumatic brain injury (TBI) and Amyotrophic lateral sclerosis (ALS) are chronic major health disorders. The exact mechanism of the neuroimmune dysfunctions of these disease pathogeneses is currently not clearly understood. These disorders show dysregulated neuroimmune and inflammatory responses, including activation of neurons, glial cells, and neurovascular unit damage associated with excessive release of proinflammatory cytokines, chemokines, neurotoxic mediators, and infiltration of peripheral immune cells into the brain, as well as entry of inflammatory mediators through damaged neurovascular endothelial cells, blood–brain barrier and tight junction proteins. Activation of glial cells and immune cells leads to the release of many inflammatory and neurotoxic molecules that cause neuroinflammation and neurodegeneration. Gulf War Illness (GWI) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are chronic disorders that are also associated with neuroimmune dysfunctions. Currently, there are no effective disease-modifying therapeutic options available for these diseases. Human induced pluripotent stem cell (iPSC)-derived neurons, astrocytes, microglia, endothelial cells and pericytes are currently used for many disease models for drug discovery. This review highlights certain recent trends in neuroinflammatory responses and iPSC-derived brain cell applications in neuroinflammatory disorders.

Substantial heterogeneity in practice patterns around the world has resulted in wide variations in the quality and type of dialysis care delivered. This is particularly so in countries without universal standards of care and governmental (or other organizational) oversight. Most high-income countries have developed such oversight based on documentation of adherence to standardized, evidence-based guidelines. Many low- and lower-middle-income countries have no or only limited organized oversight systems to ensure that care is safe and effective. The implementation and oversight of basic standards of care requires sufficient infrastructure and appropriate workforce and financial resources to support the basic levels of care and safety practices. It is important to understand how these standards then can be reasonably adapted and applied in low- and lower-middle-income countries.

Kidney transplant provides superior outcomes to dialysis as a treatment for end-stage kidney disease. Therefore, it is essential that kidney transplantation be part of an integrated treatment and management plan for chronic kidney disease (CKD). Developing an effective national program of transplantation is challenging because of the requirement for kidney donors and the need for a multidisciplinary team to provide expert care for both donors and recipients. This article outlines the steps necessary to establish a national kidney transplant program, starting with the requirement for effective legislation that provides the legal framework for transplantation whilst protecting organ donors, their families, recipients, and staff and is an essential requirement to combat organ trafficking. The next steps involve capacity building with the development of a multiskilled workforce, the credentialing of transplant centers, and the reporting of outcomes through national or regional registries. Although it is accepted that most transplant programs will begin with living related kidney donation, it is essential to aspire to and develop a deceased donor program. This requires engagement with multiple stakeholders, especially the patients, the general community, intensivists, and health departments. Development of transplant centers should be undertaken in concert with the development of a dialysis program. Both are essential components of integrated care for CKD and both should be viewed as part of the World Health Organizations initiative for universal health coverage. Provisions to cover the costs of treatment for patients need to be developed taking into account the state of development of the overall health framework in each country.

Kidney transplant provides superior outcomes to dialysis as a treatment for end-stage kidney disease. Therefore, it is essential that kidney transplantation be part of an integrated treatment and management plan for chronic kidney disease (CKD). Developing an effective national program of transplantation is challenging because of the requirement for kidney donors and the need for a multidisciplinary team to provide expert care for both donors and recipients. This article outlines the steps necessary to establish a national kidney transplant program, starting with the requirement for effective legislation that provides the legal framework for transplantation whilst protecting organ donors, their families, recipients, and staff and is an essential requirement to combat organ trafficking. The next steps involve capacity building with the development of a multiskilled workforce, the credentialing of transplant centers, and the reporting of outcomes through national or regional registries. Although it is accepted that most transplant programs will begin with living related kidney donation, it is essential to aspire to and develop a deceased donor program. This requires engagement with multiple stakeholders, especially the patients, the general community, intensivists, and health departments. Development of transplant centers should be undertaken in concert with the development of a dialysis program. Both are essential components of integrated care for CKD and both should be viewed as part of the World Health Organization's initiative for universal health coverage. Provisions to cover the costs of treatment for patients need to be developed taking into account the state of development of the overall health framework in each country.

The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle-income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide.

This paper presents a compact sensor system for estimating the dielectric properties of materials based on commercial, off-the-shelf (COTS) modules. The dielectric constant and conductivity of a material under test can be determined from the measurement of the microwave reflected from the material. By using dual microwave sensor modules with a slightly different radio frequency, an identical intermediate frequency at the mixers of the modules was obtained. The intermediate frequency was chosen such that the associated microwave and data processing components could be easily obtainable, leading to a practical realization of the sensor system. Synchronization of the two microwave sensor modules was achieved using electronically controlled relays that simultaneously switch on the power supplies of both modules. Two microcontrollers were used to capture the corresponding signals. The sensor was designed at a 10 GHz band for measuring reflected waves from various kinds of materials, especially soils with different moisture and fertilizer contents. The evaluation results indicate a good agreement between the measured results from the proposed sensor and the ones from a network analyzer, verifying that the proposed sensor is fully functional for monitoring variation in the dielectric properties of materials, including soil. The average sensitivity for the dielectric constant of moist soil is 0.26/% moisture content and the error rate for dielectric constant measurement is 4.83%.

Abstract Background Chronic kidney disease is highly prevalent across the globe with more than 2 million people worldwide requiring renal replacement therapy. Interdialytic weight gain is the change in body weight between two sessions of haemodialysis. Higher interdialytic weight gain has been associated with an increase in mortality and adverse cardiovascular outcomes. It has long been questioned whether using a lower dialysate sodium concentration during dialysis would reduce the interdialytic weight gain and hence prevent these adverse outcomes. Methods This study was a single blinded cross-over study of patients undergoing twice weekly haemodialysis at the Aga Khan University Hospital, Nairobi and Parklands Kidney Centre. It was conducted over a twelve-week period and patients were divided into two groups: dialysate sodium concentration of 137 meq/l and 140 meq/l. These groups switched over after a six-week period without a washout period. Univariate analysis was conducted using Fisher’s exact test for categorical data and Mann Whitney test for continuous data. Results Forty-one patients were included in the analysis. The mean age was 61.37 years, and 73% were males. The mean duration for dialysis was 2.53 years. The interdialytic weight gain was not significantly different between the two groups (2.14 for the 137 meq/l group and 2.35 for the 140 meq/l group, p = 0.970). Mean blood pressures were as follows: pre-dialysis: DNa 137 meq/l: systolic 152.14 ± 19.99, diastolic 78.99 ± 12.20, DNa 140 meq/l: systolic 156.95 ± 26.45, diastolic 79.75 ± 11.25 (p = 0.379, 0.629 respectively). Post-dialysis: DNa 137 meq/l: systolic 147.29 ± 22.22, diastolic 77.85 ± 12.82 DNa 140 meq/l: systolic 151.48 ± 25.65, diastolic 79.66 ± 15.78 (p = 0.569, 0.621 respectively). Conclusion There was no significant difference in the interdialytic weight gain as well as pre dialysis and post dialysis systolic and diastolic blood pressures between the two groups. Therefore, using a lower dialysate sodium concentration does not appear useful in altering the interdialytic weight gain or blood pressure although further studies are warranted with a larger sample size, taking into account residual renal function and longer duration for impact on blood pressures.

Background Establishment of a systematic way of measurement and utilization of indicators for improvement is one of the most challenging issues in monitoring and evaluation of indicators in healthcare settings. In realizing these fundamental challenges, we designed a monitoring and evaluation system incorporating a hospital-wide quality variance report (QVR) system using linked Microsoft Excel® spreadsheets on Microsoft SharePoint®. Methods Indicators were determined at the departmental/unit level in line with the institutional goals, departmental functions, quality expectations, inputs/outputs, clinical priorities, compliance to policies/procedures/protocols/guidelines/pathways as well as in response to gaps in service delivery picked during root cause analyses. The sample design was determined in accordance with the characteristics of the population. Drawing of sample units was done using a simple random sampling technique without replacement or systematic random sampling. The indicator’s monitoring was enhanced visually by allocating colour codes based on performance across the months and quarters. The action plan tab consisted of a platform that aids in documenting corrective actions arising from the performance reviews. Results and discussion The QVR reporting system ensured a standardized format of monitoring throughout the institution with a reduced turnaround time from data collection to analysis. Further, continuity of the monitoring and evaluation (M&E) system was guaranteed even if an individual left the institution. The analysis of the QVR allowed hospital-wide trending on cross-cutting indicators with consequent ease of communication to multiple stakeholders. The automation has saved time and increased accuracy which has enhanced credible engagements during quality meetings. Conclusions Use of this system greatly enhanced quality performance monitoring in the hospital, identification of major bottlenecks that warranted hospital-wide projects or departmental-level projects. The QVR system enhanced the efficiency and accuracy of quality monitoring from data collection through to performance reviews. The QVR structure allows for customized development of an M&E database application software.

Abstract Background Postsurgical patients’ oral feeding begins with clear fluids 1–3 days after surgery. This might not be sufficiently nutritious to boost the host immune system and provide sufficient energy in gastric neoplastic patients to achieve the goal of enhanced recovery after surgery (ERAS). Our objective was to analyze the significance of early postoperative feeding tubes in boosting patients’ immunity and decreasing incidence of overall complications and hospital stay in gastric cancer patients’ post-gastrectomy. Methods From January 2005 to May 24, 2019, PubMed and Cochrane databases were searched for studies involving enteral nutrition (EN) feeding tubes in comparison to parenteral nutrition (PN) in gastric cancer patients undergoing gastrectomy for gastric malignancies. Relative risk (RR), mean difference (MD), or standard mean difference (SMD) with 95% confidence interval (CI) were used to estimate the effect sizes, and heterogeneity was assessed by using Q and χ 2 statistic with their corresponding P values. All the analyses were performed with Review Manager 5.3 and SPSS version 22. Results Nine randomized trials (n = 1437) and 5 retrospective studies (n = 421) comparing EN feeding tubes and PN were deemed eligible for the pooled analyses, with a categorized time frame of PODs ≥ 7 and PODs

Objective To evaluate medical resource utilisation and timeliness of access to specific aspects of a standard care pathway for breast cancer at tertiary centres in sub-Saharan Africa.Design Data were retrospectively abstracted from records of patients with breast cancer treated within a prespecified 2-year period between 2014 and 2017. The study protocol was approved by local institutional review boards.Setting Six tertiary care institutions in Ghana, Kenya and Nigeria were included.Participants Health records of 862 patients with breast cancer were analysed: 299 in Ghana; 314 in Kenya; and 249 in Nigeria.Interventions As directed by the treating physician.Outcome measures Parameters selected for evaluation included healthcare resource and use, medical procedure turnaround times and out-of-pocket (OOP) payment patterns.Results Use of mammography or breast ultrasonography was

Background: This study was focussed on survival rates of patients admitted to acute care units who utilized medical devices known as central venous catheters (CVC). CVCs are useful devices in clinical care; however some infections such as central line associated bloodstream infections (CLABSI) may occur, which are associated with increased lengths of stay and costs as well as higher morbidity and mortality rates. The overall objective of the present study was to determine survival probabilities and hazard rates for patients who used CVC devices and compare the subgroups by infection status. Methods: The study was focused on all patients who were admitted to Critical Care Units between 8 th December 2012 and 31 st March 2016 and utilized CVC devices. It was a retrospective study. Survival analysis techniques, test of equality of proportions, Man-Whitney test and Chi–square test of independence were used. Results: A total of 363 out of 1089 patients included in the study died during hospitalization. 47 patients developed nosocomial CLABSI. The average duration was 18.19 days and median of 12 days for hospitalized patients who did not develop a nosocomial CLABSI compared to an average of 56.79 days and a median of 51 days for those who did. There was a significantly higher proportion of mortality of those who developed nosocomial CLABSI compared to those that didn’t (p-value=0.01379). The results indicate that there was a significant association between infection status and discharge status, and significant difference to the survival rates of the patients based on infection status. Conclusions: There is a significant impact on mortality and morbidity of patients who develop nosocomial CLABSI. The duration of hospitalization by patients who developed CLABSI was significantly higher compared to patients who did not. Increased length of stay leads to higher cost of hospitalization.

Array antennas offer a wide range of opportunities in the variation of their directivity patterns through amplitude and phase control. Directivity is one of very important parameters when optimizing Antenna. This paper intends to investigate the effects of different geometries of array antenna on directivity and side lobe levels. A six by four antenna array was chosen for investigation with uniform element spacing between the elements and the results were presented for each selected geometry, Array elements of dipole and patch antenna were chosen for the investigation and analysis. An analysis of the effect of the chosen antenna array was done by investigating its response when an incident emw (electromagnetic waves) from a mobile phone impinge on the array antenna where the tapering and beam-forming techniques were used for analysis and results presented.

Background: Children with complicated severe acute malnutrition (SAM) have a greatly increased risk of mortality from infections while in hospital and after discharge. In HIV-infected children, mortality and admission to hospital are prevented by daily co-trimoxazole prophylaxis, despite locally reported bacterial resistance to co-trimoxazole. We aimed to assess the efficacy of daily co-trimoxazole prophylaxis on survival in children without HIV being treated for complicated SAM. Methods: We did a multicentre, double-blind, randomised, placebo-controlled study in four hospitals in Kenya (two rural hospitals in Kilifi and Malindi, and two urban hospitals in Mombasa and Nairobi) with children aged 60 days to 59 months without HIV admitted to hospital and diagnosed with SAM. We randomly assigned eligible participants (1:1) to 6 months of either daily oral co-trimoxazole prophylaxis (given as water-dispersible tablets; 120 mg per day for age