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Howard M. A market for diagnostic devices for extreme point-of-care testing: Are we ASSURED of an ethical outcome? Dev World Bioeth 2024; 24:84-96. [PMID: 36680792 DOI: 10.1111/dewb.12389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023]
Abstract
The World Health Organisation (WHO) is leading a global effort to deliver improved diagnostic testing to people living in low-resource settings. A reliance on the healthcare technologies marketplace and industry, shapes many aspects of the WHO project, and in this situation normative guidance comes by way of the ASSURED criteria - Affordable, Sensitive, Specific, User-friendly, Rapid and robust, Equipment-free, and Delivered. While generally improving access to diagnostics, I argue that the ASSURED approach to distributive justice - efficiency - and assessment of worth - productivity - may constrain efforts to deliver timely and accurate diagnosis in the developing world equitably by holding back new and innovative diagnostics and indirectly encouraging program and device design that may unfairly discriminate against certain groups. Even as we try to overcome the problem of global healthcare injustice, we may be entrenching disadvantage. I present my critique of ASSURED by 1) referencing Boltanski and Thévenot's theory of orders of worth to highlight the industrial and market foundations of the ASSURED guidelines; 2) comparing ASSURED with other normative guides that elevate the importance of civic responsibility in evaluations of distributive justice; 3) presenting a case study of the failed promise of microfluidic diagnostic devices. I conclude that a new approach to normative guidance is required to assess the value of developing world diagnostics, preferably, one that does not force global public goods into the marketplace.
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Mancilla RB, Tấn BP, Daul C, Martínez JG, Salas LL, Wolf D, Hernández AV. Anatomical 3D Modeling Using IR Sensors and Radiometric Processing Based on Structure from Motion: Towards a Tool for the Diabetic Foot Diagnosis. Sensors (Basel) 2021; 21:3918. [PMID: 34204151 PMCID: PMC8201207 DOI: 10.3390/s21113918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/31/2022]
Abstract
Medical infrared thermography has proven to be a complementary procedure to physiological disorders, such as the diabetic foot. However, the technique remains essentially based on 2D images that display partial anatomy. In this context, a 3D thermal model provides improved visualization and faster inspection. This paper presents a 3D reconstruction method associated with temperature information. The proposed solution is based on a Structure from Motion and Multi-view Stereo approach, exploiting a set of multimodal merged images. The infrared images were obtained by automatically processing the radiometric data to remove thermal interferences, segment the RoI, enhance false-color contrast, and for multimodal co-registration under a controlled environment and a ∆T < 2.6% between the RoI and thermal interferences. The geometric verification accuracy was 77% ± 2%. Moreover, a normalized error was adjusted per sample based on a linear model to compensate for the curvature emissivity (error ≈ 10% near to 90°). The 3D models were displayed with temperature information and interaction controls to observe any point of view. The temperature sidebar values were assigned with information retrieved only from the RoI. The results have proven the feasibility of the 3D multimodal construction to be used as a promising tool in the diagnosis of diabetic foot.
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Affiliation(s)
- Rafael Bayareh Mancilla
- Departamento de Ingeniería Eléctrica/Sección de Bioelectrónica, Centro de Investigación y de Estudios Avanzados del IPN, Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, Gustavo A. Madero, Ciudad de México 07360, Mexico; (L.L.S.); (A.V.H.)
- Centre de Recherche en Automatique de Nancy (CRAN)/CNRS, Université de Lorraine, 2 Avenue de la Forêt de Haye, 54516 Vandœuvre-Lès-Nancy, Lorraine, France; (B.P.T.); (C.D.); (D.W.)
| | - Bình Phan Tấn
- Centre de Recherche en Automatique de Nancy (CRAN)/CNRS, Université de Lorraine, 2 Avenue de la Forêt de Haye, 54516 Vandœuvre-Lès-Nancy, Lorraine, France; (B.P.T.); (C.D.); (D.W.)
| | - Christian Daul
- Centre de Recherche en Automatique de Nancy (CRAN)/CNRS, Université de Lorraine, 2 Avenue de la Forêt de Haye, 54516 Vandœuvre-Lès-Nancy, Lorraine, France; (B.P.T.); (C.D.); (D.W.)
| | - Josefina Gutiérrez Martínez
- División de Ingeniería Biomédica, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarrra” (INR-LGII), Calzada México-Xochimilco 289, Coapa, Ciudad de México 14389, Mexico;
| | - Lorenzo Leija Salas
- Departamento de Ingeniería Eléctrica/Sección de Bioelectrónica, Centro de Investigación y de Estudios Avanzados del IPN, Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, Gustavo A. Madero, Ciudad de México 07360, Mexico; (L.L.S.); (A.V.H.)
| | - Didier Wolf
- Centre de Recherche en Automatique de Nancy (CRAN)/CNRS, Université de Lorraine, 2 Avenue de la Forêt de Haye, 54516 Vandœuvre-Lès-Nancy, Lorraine, France; (B.P.T.); (C.D.); (D.W.)
| | - Arturo Vera Hernández
- Departamento de Ingeniería Eléctrica/Sección de Bioelectrónica, Centro de Investigación y de Estudios Avanzados del IPN, Av. Instituto Politécnico Nacional 2508, Col. San Pedro Zacatenco, Gustavo A. Madero, Ciudad de México 07360, Mexico; (L.L.S.); (A.V.H.)
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