Artigos de revistas sobre o tema "Non-Intrusive medical devices"

Wearable electronic medical devices can realize non-intrusive and non-invasive monitoring of human body, which has the characters of removable operation, easy to use, long-lasting work, smart display diagnostic results, abnormal physiological condition alarms, wireless data transmission, achieve treatment data remote real-time monitoring and so on. In this paper, we collect information of the development process of wearable medical devices, and make the detailed description of the characteristics and development history about wearable electronic medical systems’ hardware and software design, pointing out the shortcomings and the development direction of existing equipment.

The aging global population has catalyzed a paradigm shift in healthcare, emphasizing disease prevention over treatment and underscoring the need for large-scale, long-term monitoring of physiological parameters. Wearable health monitoring devices have emerged as a pivotal solution, offering real-time physiological data collection across prevention, treatment, and rehabilitation phases, thus revolutionizing traditional health monitoring approaches. This paper explores the integration of advanced materials—conductive polymers, flexible carbon nanomaterial electrodes, and metal foil substrates—into wearable health technologies. These materials enhance device flexibility, biocompatibility, and non-intrusive monitoring capabilities, providing medical-grade data crucial for early diagnosis and treatment guidance. With the wearable device market projected to expand significantly, fueled by the Internet of Things (IoT) and device miniaturization, this study delves into the technological advancements in detection technologies for electrophysiological, physical, biochemical, and photoelectric signals. It also examines the challenges and future directions in wearable health devices, focusing on material innovation, device miniaturization, and the integration of plastic electronics to improve wearability, sustainability, and interactivity. Through systematic analysis, this paper aims to highlight the transformative impact of wearable health technologies on enhancing patient care, facilitating early disease detection, and offering personalized health management solutions.

Diabetes is one of the most common non-communicable diseases globally, and is the fourth or fifth leading cause of death in many countries. Medical technology for the management of diabetes has advanced steadily since the discovery of insulin in the early 20th century. Today, individuals with diabetes benefit from home-use blood glucose meters, continuous insulin pumps and, most recently, continuous glucose monitoring (CGM). Numerous studies have shown that frequent use of real-time CGM can improve glycaemic control with reduced risk of hypoglycaemia. However, current CGM devices have not been wholeheartedly embraced, limiting their potential. A CGM device that is accurate, non-invasive, pain-free and non-intrusive to daily activities could drive increased adoption and use of CGM, potentially improving health and quality of life for many individuals living with diabetes.

Clinical fetal monitoring devices can only be operated by medical professionals and are overly costly, prone to detrimental false positives, and emit radiation. Thus, highly accurate, easily accessible, simplified, and cost-effective fetal monitoring devices have gained an enormous interest in obstetrics. In this study, a cost-effective and user-friendly wearable home fetal movement and distress detection device is developed and assessed for early-stage design progression by facilitating continuous, comfortable, and non-invasive monitoring of the fetus during the final trimester. The functionality of the developed prototype is mainly based on a microcontroller, a single accelerometer, and a specialized fetal phonocardiography (fPCG) acquisition board with a low-cost microphone. The developed system is capable of identifying fetal movement and monitors fetal heart rhythm owing to its considerable sensitivity. Further, the device includes a Global System for Mobile Communication (GSM)-based alert system for instant distress notifications to the mother, proxy, and emergency services. By incorporating digital signal processing, the system achieves zero false negatives in detecting fetal movements, which was validated against an open-source database. The acquired results clearly substantiated the efficacy of the fPCG acquisition board and alarm system, ensuring the prompt identification of fetal distress.

Sleep is essential to physical and mental health. However, the traditional approach to sleep analysis—polysomnography (PSG)—is intrusive and expensive. Therefore, there is great interest in the development of non-contact, non-invasive, and non-intrusive sleep monitoring systems and technologies that can reliably and accurately measure cardiorespiratory parameters with minimal impact on the patient. This has led to the development of other relevant approaches, which are characterised, for example, by the fact that they allow greater freedom of movement and do not require direct contact with the body, i.e., they are non-contact. This systematic review discusses the relevant methods and technologies for non-contact monitoring of cardiorespiratory activity during sleep. Taking into account the current state of the art in non-intrusive technologies, we can identify the methods of non-intrusive monitoring of cardiac and respiratory activity, the technologies and types of sensors used, and the possible physiological parameters available for analysis. To do this, we conducted a literature review and summarised current research on the use of non-contact technologies for non-intrusive monitoring of cardiac and respiratory activity. The inclusion and exclusion criteria for the selection of publications were established prior to the start of the search. Publications were assessed using one main question and several specific questions. We obtained 3774 unique articles from four literature databases (Web of Science, IEEE Xplore, PubMed, and Scopus) and checked them for relevance, resulting in 54 articles that were analysed in a structured way using terminology. The result was 15 different types of sensors and devices (e.g., radar, temperature sensors, motion sensors, cameras) that can be installed in hospital wards and departments or in the environment. The ability to detect heart rate, respiratory rate, and sleep disorders such as apnoea was among the characteristics examined to investigate the overall effectiveness of the systems and technologies considered for cardiorespiratory monitoring. In addition, the advantages and disadvantages of the considered systems and technologies were identified by answering the identified research questions. The results obtained allow us to determine the current trends and the vector of development of medical technologies in sleep medicine for future researchers and research.

Wearable medical technology is becoming increasingly popular. Such devices have the potential to vastly improve the effectiveness, safety and economy of monitoring vital signs including temperature by both patients and clinicians. The purpose of this paper is to present design and implementation of a reliable, low cost and non-intrusive system that is to monitor a child’s body temperature using high precision temperature sensor and alarm his/her parents or guardian on their mobile phones as well as on a webpage which can be accessed via internet connection so as to avoid convulsions brought on by a significant rise in body temperature.

Healthcare professionals, industry, and academics have all recently expressed a strong interest towards WiFi sensing. These techniques could be used to identify critical occurrences that sensitive persons may suffer, such as falls, sleep abnor-malities, wandering behavior, respiratory illnesses, and irregular heart activity. In this paper, we propose a low-cost, non-intrusive method to remotely monitor el-derly people without deploying devices on their bodies in a given space, using channel state information (CSI) from passive WiFi detection. Specifically, we monitored variables such as sitting and standing activity, and experimental valida-tion in practical situations with variable occupants, various environmental set-tings, and interference from other WiFi devices demonstrates robustness and scalability. Our results suggest that the proposed method can be put into practical-real use to detect activity and alert emergency personnel immediately, providing rapid medical assistance, saving lives, minimizing damage, and reducing anxiety for elderly people residing alone.

The rapid proliferation of the Internet of Things (IoT) has paved the way for transformative innovations, and this paper explores its profound impact on the realm of elderly care within smart homes. We present a pioneering IoT-based approach for human activity recognition, addressing the critical need for accurate and non-intrusive monitoring of elderly individuals. Our IoT-based approach begins with data preprocessing, where raw sensor data is refined using median filtering, reducing noise and ensuring high-quality inputs for our model. We apply the series_to_supervised transformation to convert the sensor data into a supervised learning format, which is critical for training the GRU-based activity recognition model. The heart of our approach lies in the federated distillation-based training strategy. Edge devices within the IoT network locally train their GRU models using their datasets while sharing knowledge with a central server and other edge devices. Knowledge distillation further enhances the model's performance by transferring knowledge from the global model to the edge devices. Experimental analysis demonstrated an impressive accuracy of 95% and an F1-score of 0.94, Our system excels in recognizing and classifying a wide range of human activities, from daily routines to emergencies.

Without affecting the integrity or stability of the heritage monuments, vibration-based techniques provide useful solutions for acquiring global information about them. By studying the dynamic response to suitable excitation sources, it is feasible to define the mechanical characteristics of structures and identify and locate defects in their global behaviour. Laser Doppler vibrometry (LDV), which enables non-contact measurements of the vibration velocity of moving surfaces using a focused laser beam, is a highly desirable technique for qualitative dynamic characterisation and damage assessment. LDV is a simple and non-intrusive approach. It permits remote measurements and has a high degree of sensitivity and frequency adaptation. In addition, the system is entirely computer controlled, providing simple data storage, processing, and analysis. LDV has been originally researched and developed for structural and modal shape analysis of physical prototypes, in-service devices (e.g., machinery components), medical imaging applications, and damage detection and analysis relevant to small-scale non-destructive testing (NDT), and evaluation of micro to meso-targets (e.g., fracture detection and mapping in composites, modal shape and vibration analysis of objects, etc.). In spite of several successful applications in the case of bridges and thin structures, ambient vibration testing in an integrated form that includes dynamic identification, sensitivity analysis, and numerical modelling update employing modern sensor non-contact technologies is still uncommon. In this paper, the authors intend to explore further the possibility of combining ambient vibrations and OMA in combination with the non-contact LDV sensing technique in order to remotely acquire mechanical waves travelling in historical structures, track the actual behaviour of such structures, and calibrate their finite element numerical models.

Hypertension is the most frequent chronic and non-communicable disease all over the world, with about 1.5 billion affected individuals worldwide. Its impact is currently growing, particularly in low-income countries. Even in high-income countries, hypertension remains largely underdiagnosed and undertreated, with consequent low rates of blood pressure (BP) control. Notwithstanding the large number of clinical observational studies and randomized trials over the past four decades, it is sad to note that in the last few years there has been an impressive paucity of innovative studies. Research focused on BP mechanisms and novel antihypertensive drugs is slowing dramatically. The present review discusses some advances in the management of hypertensive patients, and could play a clinical role in the years to come. First, digital/health technology is expected to be increasingly used, although some crucial points remain (development of non-intrusive and clinically validated devices for ambulatory BP measurement, robust storing systems enabling rapid analysis of accrued data, physician-patient interactions, etc.). Second, several areas should be better outlined with regard to BP diagnosis and treatment targets. Third, from a therapeutic standpoint, existing antihypertensive drugs, which are generally effective and well tolerated, should be better used by exploiting available and novel free and fixed combinations. In particular, spironolactone and other mineral-corticoid receptor antagonists should be used more frequently to improve BP control. In particular, some drugs initially developed for conditions different from hypertension including heart failure and diabetes have demonstrated to lower BP significantly and should therefore be considered. Finally, renal artery denervation is another procedure that has proven effective in the management of hypertension.

Quantitative analysis of human gait is critical for the early discovery, progressive tracking, and rehabilitation of neurological and musculoskeletal disorders, such as Parkinson’s disease, stroke, and cerebral palsy. Gait analysis typically involves estimating gait characteristics, such as spatiotemporal gait parameters and gait health indicators (e.g., step time, length, symmetry, and balance). Traditional methods of gait analysis involve the use of cameras, wearables, and force plates but are limited in operational requirements when applied in daily life, such as direct line-of-sight, carrying devices, and dense deployment. This paper introduces a novel approach for gait analysis by passively sensing floor vibrations generated by human footsteps using vibration sensors mounted on the floor surface. Our approach is low-cost, non-intrusive, and perceived as privacy-friendly, making it suitable for continuous gait health monitoring in daily life. Our algorithm estimates various gait parameters that are used as standard metrics in medical practices, including temporal parameters (step time, stride time, stance time, swing time, double-support time, and single-support time), spatial parameters (step length, width, angle, and stride length), and extracts gait health indicators (cadence/walking speed, left–right symmetry, gait balance, and initial contact types). The main challenge we addressed in this paper is the effect of different floor types on the resultant vibrations. We develop floor-adaptive algorithms to extract features that are generalizable to various practical settings, including homes, hospitals, and eldercare facilities. We evaluate our approach through real-world walking experiments with 20 adults with 12,231 labeled gait cycles across concrete and wooden floors. Our results show 90.5% (RMSE 0.08s), 71.3% (RMSE 0.38m), and 92.3% (RMSPE 7.7%) accuracy in estimating temporal, spatial parameters, and gait health indicators, respectively.

Drowsy driving imposes a high safety risk. Current systems often use driving behavior parameters for driver drowsiness detection. The continuous driving automation reduces the availability of these parameters, therefore reducing the scope of such methods. Especially, techniques that include physiological measurements seem to be a promising alternative. However, in a dynamic environment such as driving, only non- or minimal intrusive methods are accepted, and vibrations from the roadbed could lead to degraded sensor technology. This work contributes to driver drowsiness detection with a machine learning approach applied solely to physiological data collected from a non-intrusive retrofittable system in the form of a wrist-worn wearable sensor. To check accuracy and feasibility, results are compared with reference data from a medical-grade ECG device. A user study with 30 participants in a high-fidelity driving simulator was conducted. Several machine learning algorithms for binary classification were applied in user-dependent and independent tests. Results provide evidence that the non-intrusive setting achieves a similar accuracy as compared to the medical-grade device, and high accuracies (>92%) could be achieved, especially in a user-dependent scenario. The proposed approach offers new possibilities for human–machine interaction in a car and especially for driver state monitoring in the field of automated driving.

Abstract Introduction Sleep Apnea Syndrome (SAS) is largely underdiagnosed due to the cost and availability of Polysomnography (PSG). We aimed at evaluating the diagnosis of SAS with the WITHINGS Sleep Apnea Detector (SAD), a non-intrusive pressure and sound sensor placed under the mattress. Methods 118 patients (67 F, 49 years, BMI 33kg/m²) suspected of SAS had an in-laboratory PSG together with Sleep Apnea Detector. From the pressure signal, Sleep Apnea Detector derives respiratory and cardiac signals and movements. From the microphone, snoring and snorting are detected. These features are used to detect sleep periods with a Random Forest classifier and apnea and hypopnea events with a Convolutional Neural Network. The Total Sleep Time (TST) and Apnea Hypopnea Index (AHI) deduced (TSTsad, AHIsad) are compared with the PSG results scored according to AASM rules (TSTpsg, AHIpsg). AHI and TST were compared using bias and Mean Absolute Error (MAE). Sensitivity, specificity, likelihood ratios (LR) and AUROC were calculated for AHI thresholds of 15 and 30/hr. Results The average (SD) TSTpsg was 367 (61) minutes. Sleep Apnea Detector overestimated TST by 25 minutes, 7.0% of the average duration in the sample. The precision is acceptable, with a MAE=53 minutes. Average AHIpsg was 32.5 (30.1) and AHIsad 32.8 (29.9). The bias was 0.3 (95% CI [-2.7, 3.3]), MAE=10.3. The sensitivity (Se15) and specificity (Sp15) and their 95% confidence intervals were Se15=88.0% [79.0, 94.1] and Sp15=88.6% [73.3, 96.8]. Positive and negative LR were respectively LR+15=7.70 and LR-15=0.136. AUROC15=0.926. At the 30 threshold, Se30=86.0% [73.3, 94.2] and Sp30=91.2% [81.8, 96.7]. Positive and negative LR were LR+30=9.75 and LR-30=0.153. AUROC30=0.954. Conclusion Sleep Apnea Detector has excellent sensitivity and specificity, low bias and good precision. Thus it can be used as an unattended SAS screening device in patients likely to suffer from SAS. Support WITHINGS

Due to recent technological improvements, namely in the field of piezoelectric sensors, ballistocardiography – an almost forgotten physiological measurement – is now being object of a renewed scientific interest.Transcending the initial purposes of its development, ballistocardiography has revealed itself to be a useful informative signal about the cardiovascular system status, since it is a non-intrusive technique which is able to assess the body’s vibrations due to its cardiac, and respiratory physiological signatures.Apart from representing the outcome of the electrical stimulus to the myocardium – which may be obtained by electrocardiography – the ballistocardiograph has additional advantages, as it can be embedded in objects of common use, such as a bed or a chair. Moreover, it enables measurements without the presence of medical staff, factor which avoids the stress caused by medical examinations and reduces the patient’s involuntary psychophysiological responses.Given these attributes, and the crescent number of systems developed in recent years, it is therefore pertinent to revise all the information available on the ballistocardiogram’s physiological interpretation, its typical waveform information, its features and distortions, as well as the state of the art in device implementations.

In the case of diabetes, measuring blood sugar levels is made challenging by the need to pick one's finger. Laboratory testing and one-touch glucometers are intrusive procedures that increase the risk of blood-related illnesses. In the current work, we propose a novel edge device with IoMT (Internet-of-Medical-Things) capabilities for precise, non-invasive blood glucose monitoring to solve this crucial issue. In this study, a NIR (Near-Infrared) spectroscopy method is used to identify the glucose molecule in human blood at two wavelengths (940 nm, and 1300 nm). The cutting-edge gadget known as iGLU is based on high-accuracy ML (Machine Learning) models and NIR spectroscopy. For accurate measurement, a DNN (Deep Neural Network) model and an ideal multiple polynomial regression model have been provided. An open IoT platform is used to evaluate the proposed gadget, and blood glucose levels are then saved there for endocrinologist remote monitoring. For device validation, the blood glucose measurements obtained from the invasive device and the projected blood glucose levels have been compared. The AvgE (Average Error) & MARD (Mean Absolute Relative Difference) of the predicted blood glucose concentration levels were determined to be 4.66 percent and 4.61 percent, respectively. There is a 0.81 regression coefficient. An accurate and economical solution for smart healthcare is offered by the suggested spectroscopic non-invasive gadget.

Objectives: This study aimed at evaluating the reliability of respiratory rate obtained by a non-contact technology with respect to a medically validated monitor among preterm babies. Design: This observational study compared the respiratory rates from raybaby’s non-contact technology and FDA approved Earlysense unit for the same instants of time through 760 hours of monitoring. 18 preterm babies in the NICU of a paediatric specialty hospital in India were considered for the study. The raybaby device was installed in front of the incubator and the contact-free FDA approved device was placed below the mattress of the incubator. The Respiratory Rate monitored was displayed on the device’s monitoring screen. Respiratory rates from both devices were compared to calculate the agreement between the values. Correlation, Accuracy, Hit Percentage and Fit Curves for the non-contact technology of raybaby with respect to the clinically certified device. Results: With 760 hours of monitoring, 37404 breathing instances were analysed. This yielded an accuracy of 98%. 95% of the data points fell within the +/- 5 units error range which is usually followed by medical devices. Conclusions: Raybaby uses a non-contact technology for monitoring Respiratory Rate. The average breathing rate observed was 33 to 43 breaths per minute, which falls within the breathing range of 30-60 breaths per minute. From the 37404 data points analysed, raybaby® establishes further proof for the breathing range and trend found in babies. The accuracy of non-contact technology for respiratory monitoring establishes great potential for making health monitoring less intrusive and efficient for use. This renders the technology as a hopeful tool for respiratory monitoring to deploy at observation units during the pandemic.

AbstractContinuous vital signal monitoring is becoming more relevant in preventing diseases that afflict a large part of the world’s population; for this reason, healthcare equipment should be easy to wear and simple to use. Non-intrusive and non-invasive detection methods are a basic requirement for wearable medical devices, especially when these are used in sports applications or by the elderly for self-monitoring. Arterial blood pressure (ABP) is an essential physiological parameter for health monitoring. Most blood pressure measurement devices determine the systolic and diastolic arterial blood pressure through the inflation and the deflation of a cuff. This technique is uncomfortable for the user and may result in anxiety, and consequently affect the blood pressure and its measurement. The purpose of this paper is the continuous measurement of the ABP through a cuffless, non-intrusive approach. The approach of this paper is based on deep learning techniques where several neural networks are used to infer ABP, starting from photoplethysmogram (PPG) and electrocardiogram (ECG) signals. The ABP was predicted first by utilizing only PPG and then by using both PPG and ECG. Convolutional neural networks (ResNet and WaveNet) and recurrent neural networks (LSTM) were compared and analyzed for the regression task. Results show that the use of the ECG has resulted in improved performance for every proposed configuration. The best performing configuration was obtained with a ResNet followed by three LSTM layers: this led to a mean absolute error (MAE) of 4.118 mmHg on and 2.228 mmHg on systolic and diastolic blood pressures, respectively. The results comply with the American National Standards of the Association for the Advancement of Medical Instrumentation. ECG, PPG, and ABP measurements were extracted from the MIMIC database, which contains clinical signal data reflecting real measurements. The results were validated on a custom dataset created at Neuronica Lab, Politecnico di Torino.

The development of medical decision-support technologies that provide accurate biomarkers to physicians is an important research area. For example, in the case of Parkinson's Disease (PD), the current supervisions of patients become intrusive, occasional, and subjective. However, new technologies such as wearable devices, signal processing, computer vision, and deep learning could offer a non-intrusive, continuous, and objective solution to help physicians with patient monitoring. The Parkinson's Disease Spiral Drawings public dataset was selected to face PD detection in this work by comparing four representation methods of the X, Y, and the pressure time series: signal, visual, hand-crafted, and fusion. The signal approach uses the Fast Fourier Transform of recording windows and a Convolutional Neural Network for modeling; the visual strategy employs visual transformer features from gray-scale images; the hand-crafted technique utilizes statistics calculated from temporal signals, and the fusion combines the information from the previous approaches. In these procedures, a Random Forest classifier was used for PD detection using the attributes extracted from each type of representation. The best results showed an F1 score of 93.33% and 93.06% at the user level using a signal approach with the three signals for the Static Spiral Task and an image-based proposal with X and Y coordinates for the Dynamic Spiral Task, respectively.

Abstract Advances in technology have transformed healthcare and laboratory medicine. Biosensors have emerged as a promising technology in healthcare, providing a way to monitor human physiological parameters in a continuous, real-time, and non-intrusive manner and offering value and benefits in a wide range of applications. This position statement aims to present the current situation around biosensors, their perspectives and importantly the need to set the framework for their validation and safe use. The development of a qualification framework for biosensors should be conceptually adopted and extended to cover digitally measured biomarkers from biosensors for advancing healthcare and achieving more individualized patient management and better patient outcome.

Abstract Objective: Wearable devices that measure vital signals using photoplethysmography are becoming more commonplace. To reduce battery consumption, computational complexity, memory footprint or transmission bandwidth, companies of commercial wearable technologies are often looking to minimize the sampling frequency of the measured vital signals. One such vital signal of interest is the pulse arrival time (PAT), which is an indicator of blood pressure. To leverage this non-invasive and non-intrusive measurement data for use in clinical decision making, the accuracy of obtained PAT-parameters needs to increase in lower sampling frequency recordings. The aim of this paper is to develop a new strategy to estimate PAT at sampling frequencies up to 25 Hertz.
Approach: The method applies template matching to leverage the random nature of sampling time and expected change in the PAT.
Main results: The algorithm was tested on a publicly available dataset from 22 healthy volunteers, under sitting, walking and running conditions. The method significantly reduces both the mean and the standard deviation of the error when going to lower sampling frequencies by an average of 16.6% and 20.2%, respectively. Looking only at the sitting position, this reduction is even larger, increasing to an average of 22.2% and 48.8%, respectively.
Significance: This new method shows promise in allowing more accurate estimation of PAT even in lower frequency recordings.

Medical devices (MDs) have been designed for monitoring the parameters of patients in many sectors. Nonetheless, despite being high-performing and reliable, they often turn out to be expensive and intrusive. In addition, MDs are almost exclusively used in controlled, hospital-based environments. Paving a path of technological innovation in the clinical field, a very active line of research is currently dealing with the possibility to rely on non-medical-graded low-cost devices, to develop unattended telemedicine (TM) solutions aimed at non-invasively gathering data, signals, and images. In this article, a TM solution is proposed for monitoring the heart rate (HR) of patients during sleep. A remote patient monitoring system (RPMS) featuring a smart belt equipped with pressure sensors for ballistocardiogram (BCG) signals sampling was deployed. A field trial was then conducted over a 2-month period on 24 volunteers, who also agreed to wear a finger pulse oximeter capable of producing a photoplethysmography (PPG) signal as the gold standard, to examine the feasibility of the solution via the estimation of HR values from the collected BCG signals. For this purpose, two of the highest-performing approaches for HR estimation from BCG signals, one algorithmic and the other based on a convolutional neural network (CNN), were retrieved from the literature and updated for a TM-related use case. Finally, HR estimation performances were assessed in terms of patient-wise mean absolute error (MAE). Results retrieved from the literature (controlled environment) outperformed those achieved in the experimentation (TM environment) by 29% (MAE = 4.24 vs. 5.46, algorithmic approach) and 52% (MAE = 2.32 vs. 3.54, CNN-based approach), respectively. Nonetheless, a low packet loss ratio, restrained elaboration time of the collected biomedical big data, low-cost deployment, and positive feedback from the users, demonstrate the robustness, reliability, and applicability of the proposed TM solution. In light of this, further steps will be planned to fulfill new targets, such as evaluation of respiratory rate (RR), and pattern assessment of the movement of the participants overnight.

Abstract Background Ambulatory electrocardiogram (ECG) monitoring is essential for detecting paroxysmal cardiac events and tracking long-term physiological parameters. However, traditional Holter devices are cumbersome, restrict movement, and can cause skin irritation, resulting in sub-optimal patient compliance during extended monitoring periods. Wearable devices utilizing non-conventional form factors are emerging as promising non-intrusive alternatives for ECG monitoring. Purpose To determine the optimal location for single-lead ECG acquisition on the upper arm and assess the feasibility of using dry electrode armbands for cardiac monitoring when coupled with robust ECG processing software. Methods Stationary ECGs from 20 healthy adult participants were recorded across a two-phase data collection protocol and processed with clinically validated ECG software. In the first phase, the average signal amplitudes of wet-electrode ECGs obtained from 30 different configurations across the mid-brachial and proximal-brachial regions of the upper arm were assessed. In the second, the performance of two proprietary dry-electrode armbands, featuring either a single-point or three-point electrode strap, were evaluated on the optimal upper arm configuration using QRS detection and heart rate (HR) metrics. Comparative analysis was performed throughout using data simultaneously acquired on a gold standard Holter device in modified lead III (MLIII) configuration. Performance metrics were calculated relative to manually generated signal annotations. Results Wet-electrode-acquired ECGs from the proximal-brachial region exhibited significantly higher average signal amplitudes (0.12 ± 0.06 mV) compared to those from the mid-brachial region (0.05 ± 0.04 mV) of the upper arm (p < 0.05). The optimal configuration (A-F), positioned at the lateral and medial extents of the proximal-brachial region, demonstrated comparable average signal amplitudes (0.16 ± 0.07 mV, 0.16 ± 0.06 mV, 0.19 ± 0.08 mV) for single-point dry, three-point dry, and wet-electrode setups, respectively. Upon processing with ECG software, data from optimal dry-electrode configurations showed excellent average QRS sensitivity and specificity of 98.2% and 98.9% for the one-point strap, and 98.9% and 99.8% for the three-point strap, respectively. HR metrics from the optimized dry-electrode setups were comparable in accuracy to those derived from the reference Holter device, with the average HR error being similar across the three-point dry electrode strap (0.57% ± 0.28%), one-point dry electrode strap (1.16% ± 1.46%), and Holter device (0.74% ± 1.50%). Conclusion(s) Optimized upper arm single-lead ECG with dry electrodes can yield signals with sufficient amplitude and quality for automated ECG analysis. Coupled with robust ECG signal processing software, the cardiac metrics obtained from the optimized upper arm setups exhibited comparable performance to those derived from medical Holter data.

Abstract Background The primary components driving the current commercial fascination with cannabis products are phytocannabinoids, a diverse group of over 100 lipophilic secondary metabolites derived from the cannabis plant. Although numerous phytocannabinoids exhibit pharmacological effects, the foremost attention has been directed towards Δ9-tetrahydrocannabinol (THC) and cannabidiol, the two most abundant phytocannabinoids, for their potential human applications. Despite their structural similarity, THC and cannabidiol diverge in terms of their psychotropic effects, with THC inducing notable psychological alterations. There is a clear need for accurate and rapid THC measurement methods that offer dependable, readily accessible, and cost-effective analytical information. This review presents a comprehensive view of the present state of alternative technologies that could potentially facilitate the creation of portable devices suitable for on-site usage or as personal monitors, enabling non-intrusive THC measurements. Method A literature survey from 2017 to 2023 on the development of portable technologies and commercial products to detect THC in biofluids was performed using electronic databases such as PubMed, Scopus, and Google Scholar. A systematic review of available literature was conducted using Preferred Reporting Items for Systematic. Reviews and Meta-analysis (PRISMA) guidelines. Results Eighty-nine studies met the selection criteria. Fifty-seven peer-reviewed studies were related to the detection of THC by conventional separation techniques used in analytical laboratories that are still considered the gold standard. Studies using optical (n = 12) and electrochemical (n = 13) portable sensors and biosensors were also identified as well as commercially available devices (n = 7). Discussion The landscape of THC detection technology is predominantly shaped by immunoassay tests, owing to their established reliability. However, these methods have distinct drawbacks, particularly for quantitative analysis. Electrochemical sensing technology holds great potential to overcome the challenges of quantification and present a multitude of advantages, encompassing the possibility of miniaturization and diverse modifications to amplify sensitivity and selectivity. Nevertheless, these sensors have considerable limitations, including non-specific interactions and the potential interference of compounds and substances existing in biofluids. Conclusion The foremost challenge in THC detection involves creating electrochemical sensors that are both stable and long-lasting while exhibiting exceptional selectivity, minimal non-specific interactions, and decreased susceptibility to matrix interferences. These aspects need to be resolved before these sensors can be successfully introduced to the market.

Many common respiratory illnesses like bronchitis, asthma, and chronic obstructive pulmonary disease (COPD) lead to bronchial inflammation and, subsequently, a blockage. However, there are many difficulties in measuring the severity of the blockage. To detect the blockages associated with these illnesses, most medical staff have relied on patients’ descriptions of their symptoms or the doctor’s experience or monitoring through a medical device like the stethoscope. However, these diagnostic measures are error-prone and time-consuming, leading to frequent misdiagnosis and limitations in continuous perioperative monitoring. Therefore, a numeric metric to determine the degree of the blockage severity is necessary. To tackle this demand, we aimed to develop a novel human respiratory model and design a deep-learning program that can constantly monitor and report bronchial blockage by recording breath sounds in a non-intrusive way. A bronchial lung model would provide doctors or medical staff with a better understanding of patients’ conditions and allow faster more targeted treatment. Performing these experiments demands a new design of the artificial respiratory system. Alternative to using human testing, there is more accuracy in characterizing human airways and obtaining various sizes of blockage samples. As a result, we developed a Google TensorFlow deep learning program that recognizes bronchial blockages through sound recordings at a >75% success rate. Through the experiments, the deep learning program had a 99.28% recognition rate when tested on eight representative blockages, demonstrating the potential of sound-based deep learning programs as a method of bronchial blockage analysis to diagnose respiratory illnesses.

There are days when having a child with Down syndrome can mean losing all hope of being an ordinary mother: a mother with run of the mill concerns, a mother with run of the mill routines. I know. I’ve had such days. I’ve also found that sharing these feelings with other mothers, even those who have a child with a disability, isn’t always easy. Or straightforward. In part I believe my difficulty sharing my experience with other mothers is because the motherhood issues surrounding the birth of a child with Down syndrome are qualitatively different to those experienced by mothers who give birth to children with other disabilities. Disabilities such as autism or cerebral palsy. The mother who has a child with autism or cerebral palsy is usually viewed as a victim - as having had no choice – of life having dealt her a cruel blow. There are after all no prenatal tests that can currently pick up these defects. That she may not see herself as a victim or her child as a victim often goes unreported, instead in the eyes of the popular media to give birth to a child with a disability is seen as a personal tragedy – a story of suffering and endurance. In other words disability is to be avoided if at all possible and women are expected to take advantage of the advances in reproductive medicine – to choose a genetically correct pregnancy – thus improving their lives and the lives of their offspring. Within this context it is not surprising then that the mother of a child with Down syndrome is likely to be seen as having brought the suffering on herself – of having had choices – tests such as amniocentesis and CVS – but of having failed to take control, failed to prevent the suffering of her child. But how informative are tests such as pre-implantation diagnosis, CVS or amniocentesis? How meaningful? More importantly, how safe is it to assume lives are being improved? Could it be, for example, that some lives are now harder rather than easier? As one mother who has grappled with the issues surrounding prenatal testing and disability I would like to share with you our family’s experience and hopefully illuminate some of the more complex and troubling issues these technological advances have the capacity to create. Fraser’s Pregnancy I fell pregnant with Fraser in 1995 at the age of thirty-seven. I was already the mother of a fifteen-month old and just as I had during his pregnancy – I took the routine maternal serum alpha-fetoprotein blood screen for chromosomal abnormalities at sixteen weeks. It showed I was at high risk of having a child with Down syndrome. However as I’d had a similarly high-risk reading in my first pregnancy I wasn’t particularly worried. The risk with Fraser appeared slightly higher, but other than knowing we would have to find time to see the genetic counsellor again, I didn’t dwell on it. As it happened Christopher and I sat in the same office with the same counsellor and once again listened to the risks. A normal foetus, as you both know, has 46 chromosomes in each cell. But given your high AFP reading Fiona, there is a significant risk that instead of 46 there could be 47 chromosomes in each cell. Each cell could be carrying an extra copy of chromosome 21. And as you both know, she continued her voice deepening; Trisomy 21 is associated with mild to severe intellectual disability. It also increases the risk of childhood leukaemia; certain cardiac disorders and is associated with other genetic disorders such as Hirschsprung’s disease. We listened and just as we’d done the first time – decided to have a coffee in the hospital café. This time for some reason the tone was different, this time we could feel the high-octane spiel, feel the pressure pound through our bodies, pulsate through our veins – we should take the test, we should take the test, we should take the test. We were, were we not, intelligent, well-educated and responsible human beings? Surely we could understand the need to invade, the need to extract a sample of amniotic fluid? Surely there were no ifs and buts this time? Surely we realised we had been very lucky with our first pregnancy; surely we understood the need for certainty; for reliable and accurate information this time? We did and we didn’t. We knew for example, that even if we ruled out the possibility of Down syndrome there was no guarantee our baby would be normal. We’d done our research. We knew that of all the children born with an intellectual disability only twenty five percent have a parentally detectable chromosomal disorder such as Down syndrome. In other words, the majority of mothers who give birth to a child with an intellectual disability will have received perfectly normal, utterly reassuring amniocentesis results. They will have put themselves at risk and will have been rewarded with good results. They will have been expecting a baby they could cherish, a baby they could feel proud of – a baby they could love. Our Decision Should we relent this time? Should we accept the professional advice? We talked and we talked. We knew if we agreed to the amniocentesis it would only rule out Down syndrome – or a less common chromosomal disorder such as Trisomy 18 or Trisomy 13. But little else. Four thousand other known birth defects would still remain. Defects such as attention deficit disorder, cleft lip, cleft palate, clubfoot, congenital cardiac disorder, cystic fibrosis, epilepsy, ... would not magically disappear by agreeing to the test. Neither would the possibility of giving birth to a child with autism or cerebral palsy. Or a child with vision, hearing or speech impairment. Neurological problems, skin problems or behavioural difficulties... We were however strongly aware the drive to have a normal child was expected of us. That we were making our decision at a time when social and economic imperatives dictated that we should want the best. The best partner, the best career, the best house ... the best baby. I had already agreed to a blood test and an ultrasound, so why not an amniocentesis? Why stop now? Why not proceed with a test most women over the age of thirty-five consider essential? What was wrong with me? Put simply, the test didn’t engage me. It seemed too specific. Too focused. Plus there was also a far larger obstacle. I knew if I agreed to the test and the words chromosomal disorder were to appear – a certain set of assumptions, an as yet unspoken trajectory would swiftly emerge. And I wasn’t sure I would be able to follow its course. Beyond the Test I knew if the test results came back positive I would be expected to terminate immediately. To abort my affected foetus. The fact I could find it difficult to fall pregnant again after the termination or that any future foetus may also be affected by a birth defect would make little difference. Out the four thousand known birth defects it would be considered imperative not to proceed with this particular one. And following on from that logic it would be assumed that the how – the business of termination – would be of little importance to me given the perceived gravity of the situation. I would want to solve the problem by removing it. No matter what. Before the procedure (as it would be referred to) the staff would want to reassure me, would want to comfort me – and in soothing voices tell me that yes; yes of course this procedure is in your best interests. You and your baby shouldn’t be made to suffer, not now or ever. You’re doing the right thing, they would reassure me, you are. But what would be left as unsaid would be the unavoidable realities of termination. On the elected day, during what would be the twenty-second week of my pregnancy, I would have to consent to the induction of labour. Simultaneously, I would also be expected to consent to a foetal intra-cardiac injection of potassium chloride to ensure the delivery of a dead baby. I would be advised to give birth to a dead baby because it would be considered better if I didn’t hear the baby cry. Better if I didn’t see the tiny creature breathe. Or try to breathe. The staff would also prefer I consent, would prefer I minimised everyone else’s distress. Then after the event I would be left alone. Left alone to my own devices. Left alone with no baby. I would be promised a tiny set of foot and handprints as a memento of my once vibrant pregnancy. And expected to be grateful, to be thankful, for the successful elimination of a pending disaster. But while I knew the staff would mean well, would believe they were doing the right thing for me, I knew it wasn’t the road for me. That I just couldn’t do it. We spent considerably longer in the hospital café the second time. And even though we tried to keep things light, we were both subdued. Both tense. My risk of having a baby with Down syndrome had come back as 1:120. Yes it was slightly higher than my first pregnancy (1:150), but did it mean anything? Our conversation was full of bumps and long winding trails. My Sister’s Experience of Disability Perhaps the prospect of having a child with Down syndrome didn’t terrify me because my sister had a disability. Not that we ever really referred to it as such, it was only ever Alison’s epilepsy. And although it was uncontrollable for most of her childhood, my mother tried to make her life as normal as possible. She was allowed to ride a bike, climb trees and swim. But it wasn’t easy for my mother because even though she wanted my sister to live a normal life there were no support services. Only a somewhat pessimistic neurologist. No one made the link between my sister’s declining school performance and her epilepsy. That she would lose the thread of a conversation because of a brief petit mal, a brief moment when she wouldn’t know what was going on. Or that repeated grand mal seizures took away her capacity for abstract thought and made her more and more concrete in her thinking. But despite the lack of support my mother worked long and hard to bring up a daughter who could hold down a full time job and live independently. She refused to let her use her epilepsy as an excuse. So much so that even today I still find it difficult to say my sister had a disability. I didn’t grow up with the word and my sister herself rarely used it to describe herself. Not surprisingly she went into the field herself working at first as a residential worker in a special school for disabled children and later as a rehabilitation counsellor for the Royal Blind Society. Premature Babies I couldn’t understand why a baby with Down syndrome was something to be avoided at all costs while a baby who was born prematurely and likely to emerge from the labour-intensive incubator process with severe life-long disabilities was cherished, welcomed and saved no matter what the expense. Other than being normal to begin with – where was the difference? Perhaps it was the possibility the premature baby might emerge unscathed. That hope remained. That there was a real possibility the intense and expensive process of saving the baby might not cause any damage. Whereas with Down syndrome the damage was done. The damage was known. I don’t know. Perhaps even with Down syndrome I felt there could be hope. Hope that the child might only be mildly intellectually disabled. Might not experience any of the serious medical complications. And that new and innovative treatments would be discovered in their lifetime. I just couldn’t accept the conventional wisdom. Couldn’t accept the need to test. And after approaching the decision from this angle, that angle and every other angle we could think of we both felt there was little more to say. And returned to our genetic counsellor. The Pressure to Conform Welcome back, she smiled. I’d like to introduce you to Dr M. I nodded politely in the doctor’s direction while immediately trying to discern if Christopher felt as caught off guard as I did. You’ll be pleased to know Dr M can perform the test today, she informed us. Dr M nodded and reached out to shake my hand. It’s a bit of a squeeze, she told me, but I can fit you in at around four. And don’t worry; she reassured me, that’s what we’re here for. I was shocked the heavy artillery had been called in. The pressure to conform, the pressure to say yes had been dramatically heightened by the presence of a doctor in the room. I could also sense the two women wanted to talk to me alone. That they wanted to talk woman to woman, that they thought if they could get me on my own I would agree, I would understand. That it must be the male who was the stumbling block. The problem. But I could also tell they were unsure; Christopher was after all a doctor, a member of the medical profession, one of them. Surely, they reasoned, surely he must understand why I must take the test. I didn’t want to talk to them alone. In part, because I felt the decision was as much Christopher’s as it was mine. Perhaps a little more mine, but one I wanted to make together. And much to their dismay I declined both the talk and the amniocentesis. Well, if you change your mind we’re here the counsellor reassured me. I nodded and as I left I made a point of looking each woman in the eye while shaking her hand firmly. Thank you, but no thank you, I reassured them. I wanted the baby I’d felt kick. I wanted him or her no matter what. After that day the whole issue pretty much faded, in part because soon after I developed a heart problem, a tachycardia and was fairly restricted in what I could do. I worried about the baby but more because of the medication I had to take rather than any genetic issue to do with its well being. The Birth Despite my heart condition the birth went well. And I was able to labour naturally with little intervention. I knew however, that all was not right. My first glimmer of recognition happened as I was giving birth to Fraser. He didn't push against me, he didn't thrust apart the walls of my birth canal, didn’t cause me to feel as though I was about to splinter. He was soft and floppy. Yet while I can tell you I knew something was wrong, knew instinctively – at another level I didn't have a clue. So I waited. Waited for his Apgar score. Waited to hear what the standard assessment of newborn viability would reveal. How the individual scores for activity (muscle tone), pulse (heart rate), grimace (reflex response), appearance (colour) and respiration (breathing) would add up. I knew the purpose of the Apgar test was to determine quickly whether or not Fraser needed immediate medical care – with scores below 3 generally regarded as critically low, 4 to 6 fairly low, and over 7 generally normal. Fraser scored 8 immediately after birth and 9 five minutes later. His markers of viability were fine. However all was not fine and within minutes he received a tentative diagnosis – whispers and murmurs placing a virtual sticker on his forehead. Whispers and murmurs immediately setting him apart from the normal neonate. Whispers and murmurs of concern. He was not a baby they wanted anything to do with – an experience they wanted anything to do with. In a very matter of fact voice the midwife asked me if I had had an amniocentesis. I said no, and thankfully because I was still feeling the effects of the gas, the bluntness and insensitivity of her question didn't hit me. To tell the truth it didn't hit me until years later. At the time it registered as a negative and intrusive question – certainly not the sort you want to be answering moments after giving birth – in the midst of a time that should be about the celebration of a new life. And while I can remember how much I disliked the tenor of her voice, disliked the objectifying of my son, I too had already begun a process of defining, of recognising. I had already noted he was floppy and too red. But I guess the real moment of recognition came when he was handed to me and as a way of making conversation I suggested to Christopher our baby had downsy little eyes. At the time Christopher didn’t respond. And I remember feeling slightly miffed. But it wasn’t until years later that I realised his silence had been not because he hadn’t wanted to chat but because at that moment he’d let his dread, fear and sadness of what I was suggesting go straight over my head. Unconsciously though – even then – I knew my son had Down syndrome, but I couldn't take it in, couldn't feel my way there, I needed time. But time is rarely an option in hospital and the paediatrician (who we knew from the birth of our first son) was paged immediately. Disability and the Medical Paradigm From the perspective of the medical staff I was holding a neonate who was displaying some of the 50 signs and symptoms suggestive of Trisomy 21. Of Down syndrome. I too could see them as I remembered bits and pieces from my 1970s nursing text Whaley and Wong. Remembered a list that now seems so de-personalised, so harsh and objectifying. Flat faceSmall headFlat bridge of the noseSmaller than normal, low-set noseSmall mouth, causing the tongue to stick out and look unusually largeUpward slanting eyesExtra folds of skin at the inside corner of each eyeRounded cheeksSmall, misshapened earsSmall, wide handsA deep crease across the center of each palmA malformed fifth fingerA wide space between the big and second toesUnusual creases on the soles of the feetOverly-flexible joints (as in people who are double-jointed)Shorter than normal height Christopher and I awaited the arrival of the paediatrician without the benefits of privacy, only able to guess at what the other was thinking. We only had the briefest of moments alone when they transferred me to my room and Christopher was able to tell me that the staff thought our son had what I had blurted out. I remember being totally devastated and searching his face, trying to gauge how he felt. But there was no time for us to talk because as soon as he had uttered the words Down syndrome the paediatrician entered the room and it was immediately apparent he perceived our birth outcome a disaster. You’re both professionals he said, you both know what we are thinking. But he couldn’t bring himself to say the words, say Down syndrome, and instead went on about the need for chromosomal testing and the likelihood of a positive result. The gist, the message about our son was that while he would walk, might even talk, he would never cook, never understand danger and never live independently, never, never, never... Fraser was only an hour or so old and he’d already been judged, already been found wanting. Creating Fraser’s Cultural Identity The staff wanted me to accept his diagnosis and prognosis. I on the other hand wanted to de-medicalise the way in which his existence was being shaped. I didn’t want to know right then and there about the disability services to which I would be entitled, the possible medical complications I might face. And in a small attempt to create a different kind of space, a social space that could afford my son an identity that wasn’t focused on his genetic make-up, I requested it not be assumed by the staff that he had Down syndrome until the results of the blood tests were known – knowing full well they wouldn’t be available until after I’d left hospital. Over the next few days Fraser had to spend some time in the neonatal intensive care unit because of an unrelated medical problem. His initial redness turning out to be a symptom of polycythemia (too many red blood cells). And in many ways this helped me to become his mother – to concentrate on looking after him in the same way you would any sick baby. Yet while I was deeply confident I was also deeply ashamed. Deeply ashamed I had given birth to a baby with a flaw, a defect. And processing the emotions was made doubly difficult because I felt many people thought I should have had prenatal testing – that it was my choice to have Fraser and therefore my fault, my problem. Fortunately however these feelings of dejection were equally matched by a passionate belief he belonged in our family, and that if he could belong and be included in our lives then there was no reason why he couldn’t be included in the lives of others. How Prenatal Testing Shapes Our Lives It is now twelve years since I gave birth to Fraser yet even today talking about our lives can still mean having to talk about the test – having to explain why I didn’t agree to an amniocentesis. Usually this is fairly straightforward, and fairly painless, but not always. Women have and still do openly challenge my decision. Why didn’t I take control? Aren’t I a feminist? What sort of a message do I think I am sending to younger women? Initially, I wasn’t able to fathom how anyone could perceive the issue as being so simple – take test, no Down syndrome. And it wasn’t until I saw the film Gattaca in 1997 that I began to understand how it could seem such a straightforward issue. Gattaca explores a world in which genetic discrimination has been taken to its logical conclusion – a world in which babies are screened at birth and labeled as either valids or in-valids according to their DNA status. Valids have every opportunity open to them while in-valids can only do menial work. It is a culture in which pre-implantation screening and prenatal testing are considered givens. Essential. And to challenge such discrimination foolish – however in the film the main character Vincent does just that and despite his in-valid status and its inherent obstacles he achieves his dream of becoming an astronaut. The film is essentially a thriller – Vincent at all times at risk of his true DNA status being revealed. The fear and loathing of imperfection is palpable. For me the tone of the film was a revelation and for the first time I could see my decision through the eyes of others. Feel the shock and horror of what must appear an irrational and irresponsible decision. Understand how if I am not either religious or anti-abortion – my objection must seem all the more strange. The film made it clear to me that if you don’t question the genes as destiny paradigm, the disability as suffering paradigm then you probably won’t think to question the prenatal tests are routine and essential paradigm. That you will simply accept the conventional medical wisdom – that certain genetic configurations are not only avoidable, but best avoided. Paradoxically, this understanding has made mothering Fraser, including Fraser easier and more enjoyable. Because I understand the grounds on which he was to have been excluded and how out of tune I am with the conventional thinking surrounding pregnancy and disability – I am so much freer to mother and to feel proud of my son. I Would Like to Share with You What Fraser Can Do He canget dressed (as long as the clothes are already turned the right side out and have no buttons!) understand most of what mum and dad sayplay with his brothers on the computermake a cup of coffee for mumfasten his own seatbeltwait in the car line with his brothersswim in the surf and catch waves on his boogie boardcompete in the school swimming carnivaldraw for hours at a time (you can see his art if you click here) Heis the first child with Down syndrome to attend his schoolloves the Simpsons, Futurama and Star Wars begs mum or dad to take him to the DVD store on the weekendsloves sausages, Coke and salmon rissottoenjoys life is always in the now Having fun with Photo Booth His brothers Aidan and Harrison Brotherly Love – a photo taken by Persia (right) and exhibited in Local Eyes. It also appeared in The Fitz Files (Sun-Herald 30 Mar. 2008) What Excites Me Today as a Mother I love that there is now hope. That there is not just hope of a new test, a reliable non-invasive prenatal test, but hope regarding novel treatments – of medications that may assist children with Down syndrome with speech and memory. And an increasingly vocal minority who want to talk about how including children in mainstream schools enhances their development, how children with Down syndrome can, can, can … like Persia and Tyler for example. That perhaps in the not too distant future there will be a change in the way Down syndrome is perceived – that if Fraser can, if our family can – then perhaps mothering a child with Down syndrome will be considered culturally acceptable. That the nexus between genetics and destiny will be weakened in the sense of needing to choose one foetus over another, but strengthened by using genetic understandings to enhance and assist the lives of all individuals no matter what their genetic make-up. And perhaps one day Down syndrome will be considered a condition with which you can conceive. Can imagine. Can live. And not an experience to be avoided at all costs.

Photo by Mika Baumeister on Unsplash INTRODUCTION When the COVID-19 pandemic swept the globe, governments and healthcare systems scrambled to control it. While most of the global public health community agreed that actions against the COVID-19 pandemic needed to be prompt and efficient, there were disagreements on what those actions should be. Some governments opted to adopt a containment strategy while others implemented mitigation measures; each had reasons to support their course of action, whether rooted in governmental structures, scientific findings, beliefs, or ethical and moral values. However, the dramatically different response strategies may have led to disparate results. This divide is furthered when ethical and moral values and cultural norms are added to this equation. In this paper, I will examine China and Korea, two countries that implemented a preventative containment strategy, and the United States of America and the United Kingdom, which adopted mitigation strategies. I will examine the differences in their outcomes and whether there is a “correct” response to pandemics like COVID-19. l. Response in China and Korea After its initial discovery in December 2019, COVID-19 rapidly spread beyond China to surrounding countries, including South Korea, Japan, and Singapore. China implemented swift measures drawing on its experience with the SARS outbreak. Measures included lockdowns, contact tracing, testing all individuals exposed to the virus, and consequently enforcing isolation and quarantine provisions.[1] During the early stages, the public health systems and the national government moved to a “health care to all” system to avoid nationwide spread. The government and all sectors of society were mobilized to track, contain, and adapt to the overall state of the epidemic.[2] COVID-19 continued and spread in China during Lunar New Year celebrations when population movement within the country was at its peak. Thus, Wuhan entered lockdown to control the number of infected people leaving the city to contain the virus;[3] even in areas where there were few to no cases, the general population of China voluntarily abided by measures like those implemented in Wuhan. The measures included wearing masks, social distancing, and following stay-at-home orders. Furthermore, healthcare workers from all over the country volunteered to travel to Hubei, where Wuhan is, and assembled several Fangcang shelter hospitals.[4] Fangcang hospitals were designed based on emergency medical care cabins that were used after two devastating earthquakes in China and served as temporary quarantine housing and hospital facilities.[5] They are mobile, have fast deployment, and can adapt quickly to different environments. At the start of the pandemic, Wuhan converted gymnasiums, convention centers, sports arenas and training centers, factories, and other venues into Fangcang hospitals. Although temporary, these quarantine hospital facilities were equipped with full medical equipment and personnel, allowing for complete medical functions for “treatment, disease monitoring, diagnosis and other clinical tasks.”[6] Teams of psychologists were also assigned to each hospital to provide counseling for patients.[7] Beyond separating those who were infected from the rest of the population and thus having more control over the community spread of the virus, Fangcang hospitals played a vital role in reducing patient density in traditional hospitals and medical centers by expanding treatment capacities.[8] South Korea reported its first COVID-19 case in January 2020, and, within days, the government activated the Central Disaster and Safety Countermeasures Headquarters.[9] Similar to China, South Korea used existing epidemic protocols and implemented the 3Ts strategy, prioritizing testing, tracing, and treatment.[10] High-capacity screening facilities and working with the private sector to ensure an adequate supply of tests made South Korea’s efforts successful.[11] The South Korean government strictly regulated self-isolation and quarantine. Contact tracing efforts used various data sources, “including credit card transactions and closed-circuit television footage.”[12] The government also placed stringent restrictions on travel, beginning with designated entry lines and questionnaires, but expanding to include temperature checks, testing for all travelers at the border, and a mandatory fourteen-day monitored quarantine for anyone entering the country.[13] The majority of the population responded immediately with compliance, with national weekly movement decreasing by 38 percent between February 24, 2020, and March 1, 2020, compared to the corresponding week the previous month. Schools swiftly closed across the nation, and the entire country transitioned to remote learning until the gradual reopening in May and June 2020.[14] There was some discontentment within the population, especially with the South Korean government’s practice of publicly announcing the names of individuals who tested positive.[15] Critics of this practice say it is an infringement of patient privacy and can even be viewed as an invitation to public bullying.[16] However, even with some dissatisfaction with government regulations, a survey of 1,200 South Koreans in September 2020 asking people to agree if they were satisfied with the government’s response showed that the overwhelming majority either agreed or strongly agreed (44.08 percent and 19.75 percent, respectively), and less than 20 percent of the respondents either disagreed or strongly disagreed (11.50 percent and 5.08 percent, respectively).[17] Regulations surrounding isolation and quarantine were strict and applied to those with confirmed cases of COVID-19, anyone who traveled internationally, or individuals suspected to be infected. Individuals were required to use the Self-Quarantine Safety Protection app that tracked location for fourteen days to ensure that quarantine protocols were followed.[18] Case officers monitored the app, and violators not only faced a substantial fine but were also required to wear electronic wristbands that would alert the officers if the individual left the location of their mobile device.[19] ll. The Western Response: The UK and US COVID-19 was reported in many Western nations around January 2020. However, unlike South Korea, many countries did not immediately respond to the outbreak with surveillance and containment strategies but had a wait-and-see approach. As the pandemic worsened, they gradually adopted mitigation strategies to combat the disease as it progressed. While the US adopted a combination of containment and mitigation strategies, a concrete response from state and federal governments did not occur until March 2020.[20] Even then, many states did little to address the pandemic. Although equipped with a robust healthcare system, a shortage of ventilators and hospital beds became evident in some localities early on. The US healthcare system failed to acknowledge the pandemic and prepare a coordinated response in time to stop the momentum of the disease.[21] The goal became “flattening the curve” (keeping the number of cases that needed hospital care low enough to avoid overwhelming the hospital system) as it was clear containment would be impossible. Once tests were developed, poor coordination of testing efforts and insufficient resources to test at the necessary scale to provide comprehensive national surveillance of the disease further hindered efforts to contain infected individuals and decelerate its spread.[22] Eventually, regulations and mitigation measures were implemented, including mask mandates, school closures, caps or bans on in-person gatherings, and the closure of non-essential businesses.[23] However, enforcement of these measures proved difficult, and people instigated protests against many of the recommended policies and requirements. The UK and the US both encountered a shortage of personal protective equipment for healthcare workers.[24] However, a more prominent problem arose from the UK’s initial response to the pandemic. The UK first said COVID-19 was like influenza and therefore did not call for emergency measures to deter its spread.[25] Furthermore, in the first few weeks of the pandemic, the UK government believed herd immunity was the best course of action, stating that most people would have mild symptoms,[26] and the population would become mostly immune to the virus once enough people were infected.[27] In theory, herd immunity was a potentially effective strategy. The public health authorities thought that if the threshold for herd immunity was reached, enough people would have developed protective antibodies against any future infection.[28] However, the risks of COVID-19 were high and the cases “would lead to high rates of hospitalization and need for critical care, straining health service capacity past the breaking point.”[29] Furthermore, while getting COVID-19 would offer some natural immunity against reinfection, reinfection remained a possibility, especially during the early stages of the pandemic when vaccines were unavailable.[30] Later, when vaccines were available, a study showed that an unvaccinated person who contracted the virus was more than twice as likely to become reinfected than a fully vaccinated person.[31] The UK government also expressed concern for “behavioral fatigue.”[32] It claimed that if restrictions were enforced pre-emptively and prematurely, people might become progressively “uncooperative and less vigilant.”[33] Regarding the concern for “behavioral fatigue,” numerous behavioral scientists stated that they were unconvinced that this reason was enough to hold off implementing restrictions. There was a lack of evidence of this phenomenon, and a group of 681 UK behavioral scientists said in an open letter that “[s]uch evidence is necessary if we are to base a high-risk public health strategy on it.”[34] Fortunately, this strategy only remained under consideration for a short period. After rapid increases in confirmed cases and deaths due to COVID-19, the UK government implemented more strict measures, like city lockdown, school closures, and the closure of non-essential businesses.[35] These restrictions took legal effect on March 26th, 2020 – around two weeks after the first proposal of the “herd immunity” strategy.[36] lll. Comparing the Two Approaches The Eastern and Western countries experienced significant outbreaks of COVID-19. However, looking at the mortality rate and new confirmed cases, the differences between the two categories of response to COVID-19 are significant. As of December 31, 2020, the mortality rate per 100,000 population for China and South Korea were 0.3 and 1.8, respectively, and new confirmed cases per day per 100,000 population were 87 and 1,029, respectively. However, the mortality rates per 100,000 in the US and the UK were 107 and 108, respectively, and they had up to 234,133 and 56,029 new confirmed cases every day, respectively.[37] As of July 2022, total deaths in China were 22, 994[38] (population 1.45 billion)[39] and in South Korea 24,794[40] (population 51.36 million)[41] compared to 1,015,093[42] in the US (population 335.03 million)[43] and 182,727[44] in the UK (population 68.62 million).[45] Further differences can be seen in the varying sectors of society, such as healthcare systems and authority models, political structures, and cultural customs among these countries, which in turn affect the response and control strategies.[46] In the US and the UK, rights-based political structures affected the response, making tracking and surveillance more problematic early on. But Western countries did have strict lockdowns and quarantines. China and South Korea maintained a proactive approach by “identifying and managing cases, tracking and isolating close contacts, and strictly restricting or controlling population movement when feasible and appropriate.”[47] In contrast, the UK implemented nationwide lockdowns early on, and the US restrictions varied among states. Both the UK and the US focused on treating the severe cases and those with underlying conditions rather than proactively preventing new cases from developing in the early pandemic.[48] They did shift gears to mass testing schemes and attempts to slow transmission. By the time they implemented cohesive strategies, COVID-19 was widespread. Due to their slow initial responses, they needed to manage an onslaught of cases while trying to prevent transmission. lV. Ethical Implications The “West vs. Rest” culture divide emerges when comparing the COVID-19 response strategies of East Asian countries to those of Western countries. The differences in their strategies further highlight the differences in the prevailing moral values influencing public policy. The preventative stance adopted by many East Asian countries shows a stronger collective identity among citizens. But it also may show more substantial governmental power and less appetite for protest. In contrast, the mostly non-interfering nature of Western governments’ actions shows a reliance on the “autonomous and unanimous responsibility of individuals.”[49] The moral values in the US also may reflect the prioritized position of personal rights and the suspicion of intrusive government policies. Culturally, the populations of South Korea and China are generally more tolerant of personal data-sharing and monitoring, suggesting there is less concern for autonomy or privacy. However, many people in the US and UK would consider the use of location tracking apps and electronic bracelets to be violations of individual autonomy and privacy.[50] Sectors of the Western world also argue that mandating masking or social distancing imposes on individual autonomy and free will. Mask-wearing was an existing practice in East Asian countries, even without mandates or pandemics. Individuals wear masks for common colds and influenza and do not consider a mask requirement an infringement of their autonomy. Furthermore, whether it is due to the authoritarian nature of the government or not, there is a general tendency toward public compliance and accepting government policies in many East Asian countries,[51] and the lack of public dissent played an important part in making combating COVID-19 easier for countries like China and South Korea. The lack of initiative from Western nations arguably violates the bioethical principles of beneficence and nonmaleficence.[52] For example, the promotion of the “herd immunity” strategy from the UK government and consequently the government’s inaction, risked the well-being of its citizens. The government failed to avoid the harm that COVID-19 brought. Similarly, by delaying its response until nearly two months after the initial case was reported, the US also violated the principle of non-maleficence. The success seen in South Korea and China during the early pandemic better exemplifies beneficence and nonmaleficence. The strategy of contact tracing and strict containment saved lives. The consequences of the restrictions varied across the countries as well. Not everyone can afford to self-isolate or quarantine and being required to do so can significantly impact many individuals’ well-being. Furthermore, not everyone’s occupation allows them to work from home and business closures disadvantaged portions of the population disparately. For those who are essential workers, school closures may also burden parents who do not have access to affordable childcare. The stringent restrictions regarding quarantine and self-isolation in East Asian countries also harmed people disparately, raising problems surrounding the principle of justice. However, the speed at which China had COVID-19 contained allowed people there to return to their normal lives quickly. Compared to some Western countries’ waves of lockdown and reinforcement of restrictions, the “zero-COVID” strategy in countries like China showed success, at least during the early stages of the pandemic. The contact tracing and containment was likely financially beneficial. While the pandemic resulted in substantial economic growth downgrades and global recessions, regions like East Asia were estimated to grow by around 0.5 percent. In comparison, the economy in regions like Europe contracted by around 4.7 percent.[53] CONCLUSION China arguably had an advantage in combating COVID-19 since the outbreak was relatively concentrated in one region. This allowed early detection of symptoms and quick containment of the virus. Other countries, like the US, had new cases on both coasts early in the pandemic; thus, containment was more challenging than it was in China. However, the delayed and reluctant response from countries like the US and the UK did not benefit the well-being of their populations and proved to put more stress on their healthcare systems. 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