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Background Hypoxemia in neonates with clinical respiratory distress has a high mortality. Downes score is used as an alternative to evaluate clinical respiratory distress if blood gas analysis instrument or pulse oxymetry is not available. Objective To evaluate the validity of Downes score for assessing hypoxemia in neonates with clinical respiratory distress. Methods A cross sectional study was carried out on neonates with clinical respiratory distress hospitalized at level 2 and 3 Neonatal Care Unit and in Emergency Room of Dr. Sardjito General Hospital, Yogyakarta. Downes score and oxygen saturation measured by a pulse oximetry were compared. Hypoxemia was defined as oxygen saturation less than 90% in term and post- term infants, less than 88% in preterm neonates, or Downes score 2:5 according to Basic Emergency Service Training for Obstetry and Neonatology (PONED) in 2007. The accuracy of Downes score in predicting hypoxemia was assessed by sensitivity, specificity, positive-predictive value, negative-predictive value, and likelihood ratio. Results Eighty nine neonates were evaluated. Downes score had sensitivity of 88%, specificity of 81 o/o, positive-predictive value of 72%, negative- predictive value of 92%, positive likelihood ratio 4.53, negative likelihood ratio 0.15, prevalence of 36%, and post test probability of 72%. Conclusion Downes score can be used as a clinical diagnostic means for assessing hypoxemia in clinical respiratory distressed neonates with 88% sensitivity (95% CI 79 to 99), and specificity 81% sensitivity (95% CI 70 to 91).

The use of oil palm shells aims to reduce the amount of waste and make concrete environmentally friendly, but it also has maximum flexural and compressive strength values. The proportion of oil palm shells used is 10%, the optimum value as a substitute for coarse aggregate. The test specimens used concrete blocks of dimension 10×10×50 cm and cylinders of diameter 75 mm and height 150 mm. This study has a variation value of the water–cement ratio (w/c ratio) of 0.37 and 0.48 and contains FM additives with a percentage of 0% and 0.2% and 0.25% superplasticizer. There are five concrete curing methods to find the most effective: soaking concrete with plain water, lime water, and salt water, placing it in a temperature room, and wrapping wet burlap sacks—28-day test samples tested for compressive strength and flexural strength of concrete. Based on the results, the highest flexural strength value is 2.45 MPa in the curing method of soaking with plain water in the concrete with a w/c ratio value of 0.37 and 0% FM. The highest compressive strength value was 31.32 MPa using the burlap sack curing method, w/c ratio value 0.37, and 0.20% fiber mask.

Objective To assess the validity of pulse oximetry for detecting hypoxemia and hyperoxemia in neonates and children. Methods This was a diagnostic test study conducted in Neonatal Intensive Care Unit (NICU). The subjects of the study were neonates of 0-28 days and children aged one month to 14 years in Pediatric Intensive Care Unit (PICU) of Sardjito Hospital. Hypoxemia and hyperoxemia were obtained by using NellcorR pulse oximetry, at the same time as blood gas analysis was obtained as a gold standard. Results There were 240 neonates and 268 children enrolled in this study. Pulse oximetry test with cut-off point 91% (neonates) and 90% (children) for detecting hypoxemia had sensitivity of 81% and 80%, specificity of 79% and 95% positive predictive value of 54% and 82% negative predictive value of93% and 93% positive likelihood ratio of 3. 79 and 14.20 and negative likelihood ratio of0.25 and 0.24. Pulse oximetry test with cut-off point 95% (neonates) and 97% (children) for detecting hyperoxemia had sensitivity of 7 8% and 81% specificity of 66% and 79%, positive predictive value of77% and 76% negative predictive value of 66% and 83% positive likelihood ratio of 2.26 and 3.84 and negative likelihood ratio of 0.34 and 0.24. Conclusion Pulse oximetry has a fairly good validity in detecting hypoxemia in neonates and children and in detecting hyperoxemia in children to however, it is not good enough to be used to detect hyperoxemia in neonates.

Introduction: Artificial intelligence (AI) models trained on audio data may have the potential to rapidly perform clinical tasks, enhancing medical decision-making and potentially improving outcomes through early detection. Existing technologies depend on limited datasets collected with expensive recording equipment in high-income countries, which challenges deployment in resource-constrained, high-volume settings where audio data may have a profound impact on health equity., Methods: This report introduces a novel protocol for audio data collection and a corresponding application that captures health information through guided questions., Results: To demonstrate the potential of Voice EHR as a biomarker of health, initial experiments on data quality and multiple case studies are presented in this report. Large language models (LLMs) were used to compare transcribed Voice EHR data with data (from the same patients) collected through conventional techniques like multiple choice questions. Information contained in the Voice EHR samples was consistently rated as equally or more relevant to a health evaluation., Discussion: The HEAR application facilitates the collection of an audio electronic health record ("Voice EHR") that may contain complex biomarkers of health from conventional voice/respiratory features, speech patterns, and spoken language with semantic meaning and longitudinal context-potentially compensating for the typical limitations of unimodal clinical datasets., Competing Interests: The authors declare no competing non-financial interests but the following competing financial interests. NIH may own intellectual property in the field. NIH and BJW receive royalties for licensed patents from Philips, unrelated to this work. BW is Principal Investigator on the following CRADA's=Cooperative Research & Development Agreements, between NIH and industry: Philips, Philips Research, Celsion Corp, BTG Biocompatibles/Boston Scientific, Siemens, NVIDIA, XACT Robotics. Promaxo (in progress). The following industry partners also support research in CIO lab via equipment, personnel, devices and/or drugs: 3T Technologies (devices), Exact Imaging (data), AngioDynamics (equipment), AstraZeneca (pharmaceuticals, NCI CRADA), ArciTrax (devices and equipment), Imactis (Equipment), Johnson & Johnson (equipment), Medtronic (equipment), Theromics (Supplies), Profound Medical (equipment and supplies), QT Imaging (equipment and supplies). The content of this manuscript does not necessarily reflect the views, policies, or opinions of the Uniformed Services University of the Health Sciences, the National Institutes of Health, the US Department of Health and Human Services, the US Department of Defense, the U.K. National Health Service, the U.K. National Institute for Health Research, the U.K. Department of Health, InnoHK – ITC, or the University of Oxford. The mention of commercial products, their source, or their use in connection with material reported herein is not to be construed as an actual or implied endorsement of such products by the U.S. government. This work was prepared by a military or civilian employee of the US Government as part of the individual's official duties and therefore is in the public domain and does not possess copyright protection (public domain information may be freely distributed and copied; however, as a courtesy it is requested that the Uniformed Services University and the author be given an appropriate acknowledgement). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2025 Anibal, Huth, Li, Hazen, Daoud, Ebedes, Lam, Nguyen, Hong, Kleinman, Ost, Jackson, Sprabery, Elangovan, Krishnaiah, Akst, Lina, Elyazar, Ekawati, Jansen, Nduwayezu, Garcia, Plum, Brenner, Song, Ricotta, Clifton, Thwaites, Bensoussan and Wood.)

Genotyping Plasmodium vivax relapses can provide insights into hypnozoite biology. We performed targeted amplicon sequencing of 127 relapses occurring in Indonesian soldiers returning to malaria-free Java after yearlong deployment in malarious Eastern Indonesia. Hepatic carriage of multiple hypnozoite clones was evident in three-quarters of soldiers with two successive relapses, yet the majority of relapse episodes only displayed one clonal population. The number of clones detected in relapse episodes decreased over time and through successive relapses, especially in individuals who received hypnozoiticidal therapy. Interrogating the multiplicity of infection in this P. vivax relapse cohort reveals evidence of independent activation and slow depletion of hypnozoites over many months by multiple possible mechanisms, including parasite senescence and host immunity., Competing Interests: The authors have declared that no competing interests exist.

Microscopy performed on stained films of peripheral blood for detection, identification and quantification of malaria parasites is an essential reference standard for clinical trials of drugs, vaccines and diagnostic tests for malaria. The value of data from such research is greatly enhanced if this reference standard is consistent across time and geography. Adherence to common standards and practices is a prerequisite to achieve this. The rationale for proposed research standards and procedures for the preparation, staining and microscopic examination of blood films for malaria parasites is presented here with the aim of improving the consistency and reliability of malaria microscopy performed in such studies. These standards constitute the core of a quality management system for clinical research studies employing microscopy as a reference standard. They can be used as the basis for the design of training and proficiency testing programmes as well as for procedures and quality assurance of malaria microscopy in clinical research.

Importance: Latent hepatic Plasmodium vivax hypnozoites provoke repeated clinical attacks called relapses. Only primaquine phosphate kills hypnozoites, and its therapeutic activity may depend on naturally polymorphic cytochrome P450 2D6 isotype (CYP2D6) activity., Objective: To examine the association of impaired CYP2D6 genotypes and CYP2D6 metabolic phenotypes with therapeutic failure of directly observed high-dose primaquine treatment for P vivax malaria relapse., Design, Setting, and Participants: Nested case-control study of patients who, in July 2014, completed a randomized clinical trial of directly observed primaquine treatment for radical cure of acute P vivax malaria in an area of Indonesia where reinfection during 1 year of posttreatment follow-up was improbable. A total of 177 of 180 patients with P vivax malaria completed the clinical trial of primaquine treatment to prevent relapse; 151 were eligible for recruitment as controls. After screening, 59 potential control individuals (no relapse) and 26 potential case patients (relapse) were considered, and 36 controls and 21 cases were enrolled., Exposures: Cases and controls were exposed to P vivax malaria and primaquine therapy but had variable exposure to the enzymatic activity of CYP2D6, classified as impaired by a genotype-determined qualitative phenotype (poor or intermediate), genotype-determined activity score less than 1.5, or a log of the 24-hour pooled urine dextromethorphan-dextrorphan metabolic ratio greater than -1.0., Main Outcomes and Measures: Unadjusted odds ratios (ORs) of relapse with impaired CYP2D6 metabolism determined by genotype or measured by urinary dextromethorphan-dextrorphan metabolic ratio., Results: Among the 21 cases (mean [SD] age, 30.5 [6.3] years; all male) and 36 controls (mean [SD] age, 29.0 [3.6] years; all male), 6 CYP2D6 alleles (*1, *2, *4, *5, *10, and *41) occurred as 12 distinct genotypes, with model activity scores ranging from 0.0 to 2.0. Among 32 patients with genotypic activity scores of 1.0 or less, 18 had experienced relapse, whereas among the 25 with scores higher than 1.0, 3 had experienced relapse (OR, 9.4; 95% CI, 2.1-57.0; P = .001). When the log of the metabolic ratio of dextromethorphan-dextrorphan was -1.0 or less, only 1 of 18 patients experienced relapse, whereas above that threshold (consistent with low metabolic activity), 20 of 39 patients experienced relapse (OR, 18; 95% CI, 2.2-148.0; P = .007)., Conclusions and Relevance: Genotype-determined and directly measured impaired levels of CYP2D6 activity were associated with elevated risk of therapeutic failure. These findings suggest a natural variability in CYP2D6-dependent metabolism of primaquine as a key determinant of therapeutic efficacy against latent P vivax malaria.