Digital Health in Response to COVID-19 in Low- and Middle-income Countries: Opportunities and Challenges.

COVID-19 has pulled back the curtain on health system fragility to expose persistent and deepening inequities worldwide. The limited capacity of low- and lower-middle income countries (LMICs) to respond to the pandemic and its impact on the health of populations - particularly the most vulnerable - presents a marked challenge. In this context, countries face the enormous task of rethinking the way essential services will be delivered.

Reimagining Health Data Exchange: An Application Programming Interface-Enabled Roadmap for India.

In February 2018, the Government of India announced a massive public health insurance scheme extending coverage to 500 million citizens, in effect making it the world's largest insurance program. To meet this target, the government will rely on technology to effectively scale services, monitor quality, and ensure accountability. While India has seen great strides in informational technology development and outsourcing, cellular phone penetration, cloud computing, and financial technology, the digital health ecosystem is in its nascent stages and has been waiting for a catalyst to seed the system.

Symposium review: Interaction of starter cultures and nonstarter lactic acid bacteria in the cheese environment.

The microbiota of ripening cheese is dominated by lactic acid bacteria, which are either added as starters and adjunct cultures or originate from the production and processing environments (nonstarter or NSLAB). After curd formation and pressing, starters reach high numbers, but their viability then decreases due to lactose depletion, salt addition, and low pH and temperature. Starter autolysis releases cellular contents, including nutrients and enzymes, into the cheese matrix.

Microbiota Characterization of Compost Using Omics Approaches Opens New Perspectives for Phytophthora Root Rot Control.

Phytophthora root rot caused by Phytophthora nicotianae is an economically important disease in pepper crops. The use of suppressive composts is a low environmental impact method for its control. Although attempts have been made to reveal the relationship between microbiota and compost suppressiveness, little is known about the microorganisms associated with disease suppression.

The predictive value of microbiological findings on teeth, internal and external implant portions in clinical decision making.

Aim: The primary aim of this study was to evaluate 23 pathogens associated with peri-implantitis at inner part of implant connections, in peri-implant and periodontal pockets between patients suffering peri-implantitis and participants with healthy peri-implant tissues; the secondary aim was to estimate the predictive value of microbiological profile in patients wearing dental implants using data mining methods.

Material And Methods: Fifty participants included in the present case─control study were scheduled for collection of plaque samples from the peri-implant pockets, internal connection, and periodontal pocket. Real-time polymerase chain reaction was performed to quantify 23 pathogens.

Molecular methods (digital PCR and real-time PCR) for the quantification of low copy DNA of Phytophthora nicotianae in environmental samples.

Background: Currently, real-time polymerase chain reaction (qPCR) is the technique most often used to quantify pathogen presence. Digital PCR (dPCR) is a new technique with the potential to have a substantial impact on plant pathology research owing to its reproducibility, sensitivity and low susceptibility to inhibitors. In this study, we evaluated the feasibility of using dPCR and qPCR to quantify Phytophthora nicotianae in several background matrices, including host tissues (stems and roots) and soil samples.

Changes induced by Trichoderma harzianum in suppressive compost controlling Fusarium wilt.

The addition of species of Trichoderma to compost is a widespread technique used to control different plant diseases. The biological control activity of these species is mainly attributable to a combination of several mechanisms of action, which may affect the microbiota involved in the suppressiveness of compost. This study was therefore performed to determine the effect of inoculation of Trichoderma harzianum (T.

Identification of predictor parameters to determine agro-industrial compost suppressiveness against Fusarium oxysporum and Phytophthora capsici diseases in muskmelon and pepper seedlings.

Background: The lack of reliable prediction tools for evaluation of the level and specificity of compost suppressiveness limits its application. In our study, different chemical, biological and microbiological parameters were used to evaluate their potential use as a predictor parameter for the suppressive effect of composts against Fusarium oxysporum f. sp.

Characterization of Phytophthora nicotianae isolates in southeast Spain and their detection and quantification through a real-time TaqMan PCR.

Background: The soil-borne pathogens Phytophthora nicotianae and P. capsici are the causal agents of root and stem rot of many plant species. Although P.

Reducing communication delays and improving quality of care with a tuberculosis laboratory information system in resource poor environments: a cluster randomized controlled trial.

Background: Lost, delayed or incorrect laboratory results are associated with delays in initiating treatment. Delays in treatment for Multi-Drug Resistant Tuberculosis (MDR-TB) can worsen patient outcomes and increase transmission. The objective of this study was to evaluate the impact of a laboratory information system in reducing delays and the time for MDR-TB patients to culture convert (stop transmitting).

E-health systems for management of MDR-TB in resource-poor environments: a decade of experience and recommendations for future work.

Introduction: Multi-drug resistant TB (MDR-TB) is a complex infectious disease that is a growing threat to global health. It requires lengthy treatment with multiple drugs and specialized laboratory testing. To effectively scale up treatment to thousands of patients requires good information systems to support clinical care, reporting, drug forecasting, supply chain management and monitoring.

Impact of rapid drug susceptibility testing for tuberculosis: program experience in Lima, Peru.

Setting: Programmatic implementation of decentralized rapid drug susceptibility testing (DST) in Lima, Peru.

Objective: Pre-post analysis compared time to diagnosis, treatment outcome and survival among patients tested with direct nitrate reductase assay (NRA) vs. indirect conventional methods.

Quality of life of ALS and LIS patients with and without invasive mechanical ventilation.

There are very few studies where quality of life (QOL) is assessed in patients with complete physical and functional disability and dependence to invasive mechanical ventilation (IV). We compared QOL of amyotrophic lateral sclerosis (ALS) and locked-in-syndrome (LIS) patients with invasive mechanical ventilation to ALS and LIS patients without mechanical invasive ventilation. Thirty-four patients, 27 with ALS and seven with LIS (vascular or tumoral aetiology) were included in the study.

Implementing medical information systems in developing countries, what works and what doesn't.

Global Health Informatics is an emerging field, as demonstrated by several substantial and widely used electronic medical record (EMR) systems along with the emergence of mobile based or"mhealth" systems. We describe here many of the practical lessons we have learned from implementing systems in a wide range of challenging environments over the last decade. Some requirements, like data backups, skilled staff and local leadership are universally important.

Assessing spatiotemporal patterns of multidrug-resistant and drug-sensitive tuberculosis in a South American setting.

We examined the spatiotemporal distribution of laboratory-confirmed multidrug-resistant tuberculosis (MDR TB) cases and that of other TB cases in Lima, Peru with the aim of identifying mechanisms responsible for the rise of MDR TB in an urban setting. All incident cases of TB in two districts of Lima, Peru during 2005-2007 were included. The spatiotemporal distributions of MDR cases and other TB cases were compared with Ripley's K statistic.

Full impact of laboratory information system requires direct use by clinical staff: cluster randomized controlled trial.

Objective: To evaluate the time to communicate laboratory results to health centers (HCs) between the e-Chasqui web-based information system and the pre-existing paper-based system.

Methods: Cluster randomized controlled trial in 78 HCs in Peru. In the intervention group, 12 HCs had web access to results via e-Chasqui (point-of-care HCs) and forwarded results to 17 peripheral HCs.

Human factors for capacity building: lessons learned from the OpenMRS implementers network.

Objectives: The overall objective of this project was to investigate ways to strengthen the OpenMRS community by (i) developing capacity and implementing a network focusing specifically on the needs of OpenMRS implementers, (ii) strengthening community-driven aspects of OpenMRS and providing a dedicated forum for implementation-specific issues, and; (iii) providing regional support for OpenMRS implementations as well as mentorship and training.

Methods: The methods used included (i) face-to-face networking using meetings and workshops; (ii) online collaboration tools, peer support and mentorship programmes; (iii) capacity and community development programmes, and; (iv) community outreach programmes.

Results: The community-driven approach, combined with a few simple interventions, has been a key factor in the growth and success of the OpenMRS Implementers Network.

Electronic laboratory system reduces errors in National Tuberculosis Program: a cluster randomized controlled trial.

Objective: To evaluate the impact of the e-Chasqui laboratory information system in reducing reporting errors compared to the current paper system.

Design: Cluster randomized controlled trial in 76 health centers (HCs) between 2004 and 2008.

Methods: Baseline data were collected every 4 months for 12 months.

E-health technologies show promise in developing countries.

Is there any evidence that e-health-using information technology to manage patient care-can have a positive impact in developing countries? Our systematic review of evaluations of e-health implementations in developing countries found that systems that improve communication between institutions, assist in ordering and managing medications, and help monitor and detect patients who might abandon care show promise. Evaluations of personal digital assistants and mobile devices convincingly demonstrate that such devices can be very effective in improving data collection time and quality. Donors and funders should require and sponsor outside evaluations to ensure that future e-health investments are well-targeted.

Valproic acid-induced encephalopathy in very long course treated patients.

Primary Objective: In patients receiving valproate (VPA) treatment, valproate induced-encephalopathy (VIE) is among the most serious adverse side-effects and hyperammonaemia is a frequent and well-recognized event. This report evaluates adult patients receiving VPA for several years.

Research Design: This study was conducted in adult patients receiving VPA for several years.

Personal digital assistants to collect tuberculosis bacteriology data in Peru reduce delays, errors, and workload, and are acceptable to users: cluster randomized controlled trial.

Objectives: To evaluate the effectiveness of a personal digital assistant (PDA)-based system for collecting tuberculosis test results and to compare this new system to the previous paper-based system. The PDA- and paper-based systems were evaluated based on processing times, frequency of errors, and number of work-hours expended by data collectors.

Methods: We conducted a cluster randomized controlled trial in 93 health establishments in Peru.

Using the e-Chasqui, web-based information system, to determine laboratory guidelines and data available to clinical staff.

13% of all drug susceptibility tests (DSTs) performed at a public laboratory in Peru were duplicate. To determine reasons for duplicate requests an online survey was implemented in the e-Chasqui laboratory information system. Results showed that 59.

Assessing effects of the e-Chasqui laboratory information system on accuracy and timeliness of bacteriology results in the Peruvian tuberculosis program.

We created a web-based laboratory information system, e-Chasqui to connect public laboratories to health centers to improve communication and analysis. After one year, we performed a pre and post assessment of communication delays and found that e-Chasqui maintained the average delay but eliminated delays of over 60 days. Adding digital verification maintained the average delay, but should increase accuracy.

Cost and implementation analysis of a personal digital assistant system for laboratory data collection.

Setting: One hundred and twenty-six public health centers and laboratories in Lima, Peru, without internet.

Background: We have previously shown that a personal digital assistant (PDA) based system reduces data collection delays and errors for tuberculosis (TB) laboratory results when compared to a paper system.

Objective: To assess the data collection efficiency of each system and the resources required to develop, implement and transfer the PDA-based system to a resource-poor setting.