Review of a frugal cooling mattress to induce therapeutic hypothermia for treatment of hypoxic-ischaemic encephalopathy in the UK NHS

Hypoxic ischaemic encephalopathy (HIE) is a major cause of neonatal mortality and disability in the United Kingdom (UK) and has significant human and financial costs. Therapeutic hypothermia (TH), which consists of cooling down the newborn’s body temperature, is the current standard of treatment for moderate or severe cases of HIE. Timely initiation of treatment is critical to reduce risk of mortality and disability associated with HIE. Very expensive servo-controlled devices are currently used in high-income settings to induce TH, whereas low-income settings rely on the use of low-tech devices such as water bottles, ice packs or fans. Cooling mattresses made with phase change materials (PCMs) were recently developed as a safe, efficient, and affordable alternative to induce TH in low-income settings. This frugal innovation has the potential to become a reverse innovation for the National Health Service (NHS) by providing a simple, efficient, and cost-saving solution to initiate TH in geographically remote areas of the UK where cooling equipment might not be readily available, ensuring timely initiation of treatment while waiting for neonatal transport to the nearest cooling centre. The adoption of PCM cooling mattresses by the NHS may reduce geographical disparity in the availability of treatment for HIE in the UK, and it could benefit from improvements in coordination across all levels of neonatal care given challenges currently experienced by the NHS in terms of constraints on funding and shortage of staff. Trials evaluating the effectiveness and safety of PCM cooling mattresses in the NHS context are needed in support of the adoption of this frugal innovation. These findings may be relevant to other high-income settings that experience challenges with the provision of TH in geographically remote areas. The use of promising frugal innovations such as PCM cooling mattresses in high-income settings may also contribute to challenge the dominant narrative that often favours innovation from North America and Western Europe, and consequently fight bias against research and development from low-income settings, promoting a more equitable global innovation landscape.

The role of geographic bias in knowledge diffusion: a systematic review and narrative synthesis

BACKGROUND

Descriptive studies examining publication rates and citation counts demonstrate a geographic skew toward high-income countries (HIC), and research from low- or middle-income countries (LMICs) is generally underrepresented. This has been suggested to be due in part to reviewers' and editors' preference toward HIC sources; however, in the absence of controlled studies, it is impossible to assert whether there is bias or whether variations in the quality or relevance of the articles being reviewed explains the geographic divide. This study synthesizes the evidence from randomized and controlled studies that explore geographic bias in the peer review process.

METHODS

A systematic review was conducted to identify research studies that explicitly explore the role of geographic bias in the assessment of the quality of research articles. Only randomized and controlled studies were included in the review. Five databases were searched to locate relevant articles. A narrative synthesis of included articles was performed to identify common findings.

RESULTS

The systematic literature search yielded 3501 titles from which 12 full texts were reviewed, and a further eight were identified through searching reference lists of the full texts. Of these articles, only three were randomized and controlled studies that examined variants of geographic bias. One study found that abstracts attributed to HIC sources elicited a higher review score regarding relevance of the research and likelihood to recommend the research to a colleague, than did abstracts attributed to LIC sources. Another study found that the predicted odds of acceptance for a submission to a computer science conference were statistically significantly higher for submissions from a "Top University." Two of the studies showed the presence of geographic bias between articles from "high" or "low" prestige institutions.

CONCLUSIONS

Two of the three included studies identified that geographic bias in some form was impacting on peer review; however, further robust, experimental evidence is needed to adequately inform practice surrounding this topic. Reviewers and researchers should nonetheless be aware of whether author and institutional characteristics are interfering in their judgement of research.

Discrimination of photon from proton irradiation using glow curve feature extraction and vector analysis

Two types of thermoluminescence dosemeters (TLDs), the Harshaw LiF:Mg,Ti (TLD-100) and CaF(2):Tm (TLD-300) were investigated for their glow curve response to separate photon and proton irradiations. The TLDs were exposed to gamma irradiation from a (137)Cs source and proton irradiation using a positive ion accelerator. The glow curve peak structure for each individual TLD exposure was deconvolved to obtain peak height, width, and position. Simulated mixed-field glow curves were obtained by superposition of the experimentally obtained single field exposures. Feature vectors were composed of two kinds of features: those from deconvolution and those taken in the neighbourhood of several glow curve peaks. The inner product of the feature vectors was used to discriminate among the pure photon, pure proton and simulated mixed-field irradiations. In the pure cases, identification of radiation types is both straightforward and effective. Mixed-field discrimination did not succeed using deconvolution features, but the peak-neighbourhood features proved to discriminate reliably.

Glow curve analysis applied to the discrimination of X ray versus proton irradiation

Three types of thermoluminescence dosemeters (TLDs): LiF:Mg,Ti (TLD-100), CaF2:Tm (TLD-300), and alpha-Al2O3:C (TLD-500), were investigated for their glow curve response to separate X ray and proton irradiations. The glow curve structure for each individual TLD's exposure to the X ray and proton irradiations was analysed and compared. Distinguishable differences between the glow curve structure characteristic of each type of radiation were observed. The proton TLD-100 glow curve has revealed a complex high-temperature peak structure that was used for the proton/X ray discrimination algorithm. Proton irradiation of TLD-300 resulted in an apparent switch in the relative heights of peaks 3 and 5 as compared to X ray. In TLD-500, proton irradiation produced a more subtle difference in the glow curve with an increase in the ratio between high- and low-temperature peaks. Results demonstrate promising differences in glow curve structure present allowing for discrimination between X ray and proton radiation field exposures.

Hearing aid electromagnetic interference from digital wireless telephones

Several in-the-ear (ITE) and behind-the-ear (BTE) hearing aids were tested for audible interference at various distances from five types of digital wireless telephones. The interference which takes the form of a buzzing and a static sound was quantified using a calibrated system including a frequency analyzer and a pressure field microphone. The output of the each hearing aid was coupled to the microphone via Tygon tubing and a standard 2 cc coupler. The highest interference-induced sound pressure level (SPL), 122.5 dB, was measured from a BTE hearing aid placed within 2 cm of a transmitting Global System for Mobile Communications (GSM) phone. In this case, interference was detected up to a separation distance of almost 3 m. While all phones tested produced a similar interference level within 2 cm of this hearing aid, interference SPL from the code division multiple access (CDMA)-based system decreased more rapidly with distance than the time division multiple access (TDMA)-based phones tested.

Ignaz Philipp Semmelweis, the prophet of bacteriology

Although by 1931 I. Ph. Semmelweis' achievements and the tragedy of his life had been given their due place in the history of mankind, Alexander Fränkel, formerly Theodor Billroth's assistant and later his biographer, critically stated that the discoverer of the causes of puerperal fever should have defended his discovery with facts rather than with fanaticism. It was only a few years after Semmelweis' death, for instance, that Billroth made laborious experiments. Billroth's work on Coccobacteria had important implications and even influenced Robert Koch, although his hypotheses did not really predict the pathogenic and specific nature of microbes. In 1847 Semmelweis postulated his theory; ie, that the pathological-anatomical changes which he observed in the bodies of the women who died in childbed, in their newborn infants, and in the autopsy findings on his friend Jakob Kolletschka were an entity, morphologically and clinically. He summed them up under the concept of pyemia. Even though Semmelweis was continually abhorred by the evident statistics and would have been able to prove his discovery through animal experiments, he primarily took to the pen to defend his opinion vehemently. Only the clinical facts proved him right during his lifetime; the triumph of bacteriology which began after his death made him not only the "savior of mothers" but also a genial ancestor of bacteriology.