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Anterior cruciate ligament (ACL) instability poses a considerable challenge in traumatology and orthopedic medicine, demanding precise diagnostics for optimal treatment. The pivot-shift test, a pivotal assessment tool, relies on subjective interpretation, emphasizing the need for supplementary imaging. This study addresses this limitation by introducing a machine learning classification algorithm integrated into a mobile application, leveraging smartphones' built-in inertial sensors for dynamic rotational stability assessment during knee examinations. Orthopedic specialists conducted knee evaluations on a cohort of 52 subjects, yielding valuable insights. Quantitative analyses, employing the Intraclass Correlation Coefficient (ICC), demonstrated robust agreement in both intraobserver and interobserver assessments. Specifically, ICC values of 0.94 reflected strong concordance in the timing between maneuvers, while signal amplitude exhibited consistency, with the ICC ranging from 0.71 to 0.66. The introduced machine learning algorithms proved effective, accurately classifying 90% of cases exhibiting joint hypermobility. These quantifiable results underscore the algorithm's reliability in assessing knee stability. This study emphasizes the practicality and effectiveness of implementing machine learning algorithms within a mobile application, showcasing its potential as a valuable tool for categorizing signals captured by smartphone inertial sensors during the pivot-shift test.

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Resumen Antecedentes: Las consultas virtuales aumentaron exponencialmente, pero presentan como limitación la imposibilidad de valorar los signos vitales (SV), siendo especialmente útiles en los pacientes con insuficiencia cardiaca (IC) para titular medicación que modifica pronóstico. Este problema podría potencialmente solucionarse mediante una herramienta que pueda medir la presión arterial (PA) y frecuencia cardiaca (FC) de manera precisa, accesible y remota. Los teléfonos móviles equipados con tecnología de imágenes ópticas transdérmicas podrían cumplir con estos requisitos. Objetivo: Evaluar la precisión de una app basada en imagen óptica transdérmica para estimar SV en relación con la valoración clínica en pacientes con IC. Métodos: Estudio de cohorte prospectivo, se incluyeron pacientes evaluados en una unidad ambulatoria de IC de febrero a abril del 2022. Se valoró simultáneamente la PA y FC mediante la app y el examen clínico (PA con un esfigmomanómetro automatizado y FC por palpación braquial). Se realizaron tres mediciones por app y clínica en cada paciente, por dos médicos independientes, encontrándose ciegos a los resultados. Resultados: Se incluyeron 30 pacientes, con 540 mediciones de TA y de FC. Edad media de 66 (± 13) años, el 53.3% de sexo masculino. La fracción de eyección del ventrículo izquierdo media fue de 37 ± 15, con hospitalizaciones previas por IC el 63.3%, en CF II-III el 63.4%. La diferencia media entre la medición de la app y su medición de referencia clínica fue de 3.6 ± 0.5 mmHg para PA sistólica (PAS), 0.9 ± -0.2 mmHg para PA diastólica (PAD) y 0.2 ± 0.4 lpm para FC. Cuando se promedian las diferencias medias emparejadas para cada paciente, la media entre los 30 pacientes es de 2 ± 6 mmHg para PAS, -0.14 ± 4.6 mmHg para PAD y 0.23 ± 4 lpm para FC. Conclusión: La estimación de PA y FC por una app con tecnología de imagen óptica transdérmica fue comparable a la medición no invasiva en pacientes con IC, y cumple los criterios de precisión de la medición de PA en este estudio preliminar. La utilización de esta nueva tecnología de imagen óptica transdérmica brinda datos prometedores, que deberán ser corroborados en cohortes de mayor tamaño.

Abstract Background: Virtual consultations have increased exponentially, but a limitation is the inability to assess vital signs (VS). This is particularly useful in patients with heart failure (HF) for titrating prognosis-modifying medication. This issue could potentially be addressed by a tool capable of measuring blood pressure (BP) and heart rate (HR) accurately, remotely, and conveniently. Mobile phones equipped with transdermal optical imaging technology could meet these requirements. Objective: To evaluate the accuracy of a transdermal optical imaging-based app for estimating VS compared to clinical assessment in patients with HF. Methods: A prospective cohort study included patients evaluated in an HF outpatient unit between February and April 2022. BP and HR were simultaneously assessed using the app and clinical examination (BP with an automated sphygmomanometer and HR by brachial palpation). Three measurements were taken by both the app and clinic for each patient, by two independent blinded physicians. Results: Thirty patients were included, with 540 measurements of BP and HR. The mean age was 66 (± 13) years, 53.3% were male. The mean left ventricular ejection fraction was 37 ± 15, with 63.3% having previous hospitalizations for HF, and 63.4% in NYHA class II-III. The mean difference between the app measurement and its clinical reference measurement was 3.6 ± 0.5 mmHg for systolic BP (SBP), 0.9 ± -0.2 mmHg for diastolic BP (DBP), and 0.2 ± 0.4 bpm for HR. When averaging the paired mean differences for each patient, the mean across the 30 patients was 2 ± 6 mmHg for SBP, -0.14 ± 4.6 mmHg for DBP, and 0.23 ± 4 bpm for HR. Conclusion: The estimation of BP and HR by an app with transdermal optical imaging technology was comparable to non-invasive measurement in patients with HF and met the precision criteria for BP measurement in this preliminary study. The use of this new transdermal optical imaging technology provides promising data, which should be corroborated in larger cohorts.

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BACKGROUND: Virtual consultations have increased exponentially, but a limitation is the inability to assess vital signs (VS). This is particularly useful in patients with heart failure (HF) for titrating prognosis-modifying medication. This issue could potentially be addressed by a tool capable of measuring blood pressure (BP) and heart rate (HR) accurately, remotely, and conveniently. Mobile phones equipped with transdermal optical imaging technology could meet these requirements. OBJECTIVE: To evaluate the accuracy of a transdermal optical imaging-based app for estimating VS compared to clinical assessment in patients with HF. METHODS: A prospective cohort study included patients evaluated in an HF outpatient unit between February and April 2022. BP and HR were simultaneously assessed using the app and clinical examination (BP with an automated sphygmomanometer and HR by brachial palpation). Three measurements were taken by both the app and clinic for each patient, by two independent blinded physicians. RESULTS: Thirty patients were included, with 540 measurements of BP and HR. The mean age was 66 (± 13) years, 53.3% were male. The mean left ventricular ejection fraction was 37 ± 15, with 63.3% having previous hospitalizations for HF, and 63.4% in NYHA class II-III. The mean difference between the app measurement and its clinical reference measurement was 3.6 ± 0.5 mmHg for systolic BP (SBP), 0.9 ± -0.2 mmHg for diastolic BP (DBP), and 0.2 ± 0.4 bpm for HR. When averaging the paired mean differences for each patient, the mean across the 30 patients was 2 ± 6 mmHg for SBP, -0.14 ± 4.6 mmHg for DBP, and 0.23 ± 4 bpm for HR. CONCLUSION: The estimation of BP and HR by an app with transdermal optical imaging technology was comparable to non-invasive measurement in patients with HF and met the precision criteria for BP measurement in this preliminary study. The use of this new transdermal optical imaging technology provides promising data, which should be corroborated in larger cohorts.

ANTECEDENTES: Las consultas virtuales aumentaron exponencialmente, pero presentan como limitación la imposibilidad de valorar los signos vitales (SV), siendo especialmente útiles en los pacientes con insuficiencia cardiaca (IC) para titular medicación que modifica pronóstico. Este problema podría potencialmente solucionarse mediante una herramienta que pueda medir la presión arterial (PA) y frecuencia cardiaca (FC) de manera precisa, accesible y remota. Los teléfonos móviles equipados con tecnología de imágenes ópticas transdérmicas podrían cumplir con estos requisitos. OBJETIVO: Evaluar la precisión de una app basada en imagen óptica transdérmica para estimar SV en relación con la valoración clínica en pacientes con IC. MÉTODOS: Estudio de cohorte prospectivo, se incluyeron pacientes evaluados en una unidad ambulatoria de IC de febrero a abril del 2022. Se valoró simultáneamente la PA y FC mediante la app y el examen clínico (PA con un esfigmomanómetro automatizado y FC por palpación braquial). Se realizaron tres mediciones por app y clínica en cada paciente, por dos médicos independientes, encontrándose ciegos a los resultados. RESULTADOS: Se incluyeron 30 pacientes, con 540 mediciones de TA y de FC. Edad media de 66 (± 13) años, el 53.3% de sexo masculino. La fracción de eyección del ventrículo izquierdo media fue de 37 ± 15, con hospitalizaciones previas por IC el 63.3%, en CF II-III el 63.4%. La diferencia media entre la medición de la app y su medición de referencia clínica fue de 3.6 ± 0.5 mmHg para PA sistólica (PAS), 0.9 ± ­0.2 mmHg para PA diastólica (PAD) y 0.2 ± 0.4 lpm para FC. Cuando se promedian las diferencias medias emparejadas para cada paciente, la media entre los 30 pacientes es de 2 ± 6 mmHg para PAS, ­0.14 ± 4.6 mmHg para PAD y 0.23 ± 4 lpm para FC. CONCLUSIÓN: La estimación de PA y FC por una app con tecnología de imagen óptica transdérmica fue comparable a la medición no invasiva en pacientes con IC, y cumple los criterios de precisión de la medición de PA en este estudio preliminar. La utilización de esta nueva tecnología de imagen óptica transdérmica brinda datos prometedores, que deberán ser corroborados en cohortes de mayor tamaño.

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OBJECTIVE: To develop a mobile application with a standardized routine, to be used by general otolaryngologists for evaluating patients with chronic rhinosinusitis. METHODS: A systematic review was made to identify outcomes, recommendations and what tests that would be used in the routine evaluation of patients with chronic rhinosinusitis; establish an expert consensus on items to be included in this routine evaluation of patients with chronic rhinosinusitis using the Delphi method; development of an application for use on a mobile device, with the routine evaluation of patients with chronic rhinosinusitis. RESULTS: Based on the systematic review, the outcomes used in studies about chronic rhinosinusitis were identified, as well as guidelines recommendations, which showed discrepancies between them. These recommendations and outcomes were presented to specialists in chronic rhinosinusitis, until a consensus was reached. As a result of the Delphi method, the flowchart of the routine evaluation of patients with chronic rhinosinusitis was defined, and then was used for the development of the mobile application. CONCLUSION: The creation of the mobile application for evaluating patients with chronic rhinosinusitis followed an adequate methodology of elaboration made by specialists in the field of chronic rhinosinusitis, standardizing the investigation of these patients. LEVEL OF EVIDENCE: Level 5.

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Abstract Objective To develop a mobile application with a standardized routine, to be used by general otolaryngologists for evaluating patients with chronic rhinosinusitis. Methods A systematic review was made to identify outcomes, recommendations and what tests that would be used in the routine evaluation of patients with chronic rhinosinusitis; establish an expert consensus on items to be included in this routine evaluation of patients with chronic rhinosinusitis using the Delphi method; development of an application for use on a mobile device, with the routine evaluation of patients with chronic rhinosinusitis. Results Based on the systematic review, the outcomes used in studies about chronic rhinosinusitis were identified, as well as guidelines recommendations, which showed discrepancies between them. These recommendations and outcomes were presented to specialists in chronic rhinosinusitis, until a consensus was reached. As a result of the Delphi method, the flowchart of the routine evaluation of patients with chronic rhinosinusitis was defined, and then was used for the development of the mobile application. Conclusion The creation of the mobile application for evaluating patients with chronic rhinosinusitis followed an adequate methodology of elaboration made by specialists in the field of chronic rhinosinusitis, standardizing the investigation of these patients. Level of evidence: Level 5.

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Aim: This study aimed to assess the interest of dental students, clinicians and professors in a mobile app for calculating dosages of medicines for use in Pediatric Dentistry. Methods: The cross-sectional survey involved a random sample of undergraduate and postgraduate pediatric dental students, clinical pediatric dentists and professors. Initially, participants watched a video about an early version of the app. They then answered a questionnaire about their clinical experience, calculation routine, and interest in the app. Descriptive analyses were carried out. Results: Of the 41 participants (20 students, 10 clinicians and 11 professors), 87.8% recognized the need to adjust doses of medicines used in pediatric dentistry, but only 56.1% felt confident in doing so. Almost a fifth of participants (19.5%) admitted errors in prescribing medicines for pediatric dental patients. After seeing the app's functionalities, 92.7% considered it relevant, and 87.8% were interested in the full version. Conclusion: The app is deemed relevant, necessary, and of significant interest to the target audience, indicating potential for investment and full development.

Objetivo:Este estudo buscou avaliar o interesse de estudantes de odontologia, clínicos e professores em um aplicativo móvel para calcular dosagens de medicamentos para uso em Odontopediatria. Métodos: A pesquisa transversal envolveu uma amostra aleatória de estudantes de odontologia pediátrica de graduação e pós-graduação, odontopediatras clínicos e professores. Inicialmente, os participantes assistiram a um vídeo sobre uma versão inicial do aplicativo. Em seguida, eles responderam a um questionário sobre sua experiência clínica, rotina de cálculos e interesse no aplicativo. Análises descritivas foram realizadas. Resultados:Dos 41 participantes (20 estudantes, 10 clínicos e 11 professores), 87,8% reconheceram a necessidade de ajustar as doses de medicamentos usados em Odontopediatria, mas apenas 56,1% se sentiam confiantes para fazê-lo. Quase um quinto dos participantes (19,5%) admitiu erros na prescrição de medicamentos para pacientes odontopediátricos. Após verem as funcionalidades do aplicativo, 92,7% o consideraram relevante, e 87,8% demonstraram interesse na versão completa. Conclusão: A conclusão é que o aplicativo é relevante, necessário e de interesse para o público-alvo, indicando potencial para investimento e desenvolvimento completo.

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OBJECTIVE: To assess whether using a Dietary Approaches to Stop Hypertension (DASH) diet recommendation application increases primary care physicians' knowledge and dietary counseling skills. DESIGN: A randomized controlled trial. SETTING: Brazilian public primary care service. PARTICIPANTS: Two hundred and twenty-two physicians (intervention group: n = 111; control group: n = 111). INTERVENTION: Thirty days of using the Dieta Dash application. The application provides information about nutritional recommendations for hypertension management. MAIN OUTCOME MEASURES: Nutrition knowledge score. SECONDARY OUTCOMES: self-assessment of knowledge, self-confidence, assessment of eating habits, and barriers to dietary counseling. ANALYSIS: Linear mixed-effects models for repeated measures and generalized estimating equations for comparing changes between groups. RESULTS: A total of 66.2% of participants completed the follow-up. There was no significant difference between the groups regarding the mean knowledge score (P = 0.15). The prevalence of high knowledge increased by 12% (prevalence ratio [PR] = 1.12; 95% confidence interval [CI], 1.00-1.25) in the intervention group and showed an improvement in the self-confidence assessment (PR = 1.21; 95% CI, 1.02-1.44), and increased assessment of eating habits (PR = 1.26; 95% CI, 1.10-1.55). CONCLUSIONS AND IMPLICATIONS: The Dieta Dash application helped address dietary counseling, improving knowledge and self-confidence. However, innovative strategies are needed to minimize the primary care barriers.

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Introducción: El predominio y asequibilidad actual de los teléfonos móviles inteligentes han permitido una amplia difusión de variedad de aplicaciones a nivel mundial para el monitoreo del crecimiento y del estado nutricional de los lactantes. No obstante, la mayoría de estos recursos no son lo suficientemente completos para proveer una interfaz amigable de seguimiento del crecimiento, combinada con una adecuada educación parental en materia de nutrición y alimentación complementaria. Objetivos: Este trabajo pretende presentar el desarrollo y evaluación de la aplicación propuesta "Baby Home", con el fin de estudiar su potencial como herramienta digital de apoyo a padres y cuidadores en el cuidado nutricional de sus niños desde el hogar. Materiales y métodos: Baby Home integra una interfaz de seguimiento interactivo del crecimiento del bebé con una serie de contenidos educativos alimentarios, posibilitando al usuario consultar las prácticas recomendadas según el estado nutricional estimado de su bebé. Un conjunto de 7 jueces expertos fue reunido para evaluar la validez de estos contenidos consignados en la aplicación. Posteriormente, se llevó a cabo un estudio de prueba piloto con 8 madres participantes, las cuales aportaron en las fortalezas y debilidades de las funcionalidades propuestas. Resultados: la aplicación desarrollada muestra una aprobación positiva por los especialistas consultados y una aceptación satisfactoria entre las madres participantes gracias a su diseño amigable y funcionalidades de fácil uso. Los recursos visuales implementados prueban ser adecuados para la apropiación de los contenidos alimentarios y el empoderamiento del usuario en torno a los cuidados nutricionales que requieren sus niños. Conclusiones: Baby Home se ubica como un soporte práctico y accesible para el cuidado nutricional del lactante, otorgando seguridad y confianza al usuario en la alimentación de su niño y disponiendo la posibilidad de detectar oportunamente problemas de crecimiento.

Introduction: The current prevalence and affordability of smartphones have enabled a broad diffusion of a variety of mobile applications worldwide for monitoring infant's growth and nutritional status. However, most of these resources are not comprehensive enough to provide a user-friendly interface for growth tracking combined with proper parental education on nutrition and complementary feeding. Objectives: This work aims to present the development and evaluation of the proposed application "Baby Home", in order to study its potential as a digital tool for supporting parents and caregivers in the nutritional care of their children from home. Materials and methods: Baby Home integrates an interactive baby growth monitoring interface with a collection of educational content on infant feeding, allowing the user to check the recommended practices based on the estimated nutritional status of their baby. A panel of seven expert judges was assembled to evaluate the validity of these contents included in the application. Subsequently, a pilot study was carried out with eight participating mothers who contributed to the strengths and weaknesses of the proposed functionalities. Results: The developed application received positive feedback by the consulted specialists and a satisfactory acceptance within the participating mothers thanks to its friendly design and easy-to-use functionalities. The implemented visual resources proved to be well suited for the user's appropriation of feeding contents and their empowerment regarding the nutritional care required by their children. Conclusions: Baby Home is positioned as a practical and accessible support for the nutritional care of infants, providing safeness and confidence to the user in their child's feeding and the possibility of timely detection of growth problems.

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Strategies to stir and mix reagents in microfluid devices have evolved concomitantly with advancements in manufacturing techniques and sensing. While there is a large array of reported designs to combine and homogenize liquids, most of the characterization has been focused on setups with two inlets and one outlet. While this configuration is helpful to directly evaluate the effects of features and parameters on the mixing degree, it does not portray the conditions for experiments that involve more than two substances required to be subsequently combined. In this work, we present a mixing characterization methodology based on particle tracking as an alternative to the most common approach to measure homogeneity using the standard deviation of pixel intensities from a grayscale image. The proposed algorithm is implemented on a free and open-source mobile application (MIQUOD) for Android devices, numerically tested on COMSOL Multiphysics, and experimentally tested on a bidimensional split and recombine micromixer and a three-dimensional micromixer with sinusoidal grooves for different Reynolds numbers and geometrical features for samples with fluids seeded with red, blue, and green microparticles. The application uses concentration field data and particle track data to evaluate up to eleven performance metrics. Furthermore, with the insights from the experimental and numerical data, a mixing index for particles (mp) is proposed to characterize mixing performance for scenarios with multiple input reagents.

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INTRODUCTION: Medical students are a population at increased risk for anxiety due to their demanding schedule and concerns about potential stigmatization, which often leads to discouragement when seeking help. COVID-19 pandemic has been reported to worsen this issue by restricting social interaction and mobility. To address this problem, an innovative method known as Asynchronous Digital Cognitive Education GAMA-AIMS (DCE GAMA-AIMS) has been introduced. Compared to traditional therapy, this modality can be accessed independently without the guidance of a therapist. OBJECTIVES: To compare the effectiveness of DCE GAMA-AIMS in reducing anxiety scores compared to guided brief Cognitive Behavioral Therapy (guided bCBT). METHODS: A non-blinding RCT was conducted on 66 medical students. The participants were equally divided into two groups, namely intervention and control. The intervention group was given DCE GAMA-AIMS, while the control was administered with guided bCBT. The data obtained were analyzed using independent t-test and ANOVAs. RESULTS: The application had a significant effect on reducing anxiety scores from the 2nd week (M TMAS = 18) to the 8th week (M TMAS = 13). A faster and more significant improvement was observed in the intervention group from the 1st to the 2nd week compared to the control, which began to improve in the 4th week. Furthermore, the intervention group had larger effect sizes (1.32) compared to the control (0.79) from the 1st to 8th week. CONCLUSION: Asynchronous DCE GAMA-AIMS and guided bCBT could reduce TMAS scores in medical students with anxiety, but DCE GAMA-AIMS yielded a greater effect size.