Biliary atresia (BA) is the leading cause of pediatric end-stage liver disease in the United States. Education of parents in the perinatal period with stool cards depicting acholic and normal stools has been associated with improved time-to-diagnosis and survival in BA. PoopMD is a mobile application that utilizes a smartphone’s camera and color recognition software to analyze an infant’s stool and determine if additional follow-up is indicated. PoopMD was developed using custom HTML5/CSS3 and wrapped to work on iOS and Android platforms. In order to define the gold standard regarding stool color, seven pediatricians were asked to review 45 photographs of infant stool and rate them as acholic, normal, or indeterminate. Samples for which 6+ pediatricians demonstrated agreement defined the gold standard, and only these samples were included in the analysis. Accuracy of PoopMD was assessed using an iPhone 5s with incandescent lighting. Variability in analysis of stool photographs as acholic versus normal with intermediate rating weighted as 50% agreement (kappa) was compared between three laypeople and one expert user. Variability in output was also assessed between an iPhone 5s and a Samsung Galaxy S4, as well as between incandescent lighting and compact fluorescent lighting. Six-plus pediatricians agreed on 27 normal and 7 acholic photographs; no photographs were defined as indeterminate. The sensitivity was 7/7 (100%). The specificity was 24/27 (89%) with 3/27 labeled as indeterminate; no photos of normal stool were labeled as acholic. The Laplace-smoothed positive likelihood ratio was 6.44 (95% CI 2.52 to 16.48) and the negative likelihood ratio was 0.13 (95% CI 0.02 to 0.83). kappauser was 0.68, kappaphone was 0.88, and kappalight was 0.81. Therefore, in this pilot study, PoopMD accurately differentiates acholic from normal color with substantial agreement across users, and almost perfect agreement across two popular smartphones and ambient light settings. PoopMD may be a valuable tool to help parents identify acholic stools in the perinatal period, and provide guidance as to whether additional evaluation with their pediatrician is indicated. PoopMD may improve outcomes for children with BA.
Leslie Hancock asks whether Britain's overstretched, under-funded and highly-regulated long-term care provision measures up to the standard set in Canada.
Total MMT program statistics, as well as the summaries of the active projects are also included. The report is compiled, edited, and published for HQ, DARCOM by the Manufacturing Technology Division of the Army Industrial Base Engineering Activity (IBEA) in accordance with AR 700-90, C1, paragraph 3-8e(l). Distribution of this report is extended to Army materiel developers and users and to counterparts in the Navy and the Air Force. Inquiries on the detailed technical aspects of any individual project may be answered by the MMT Program representative of the action command under which the project was completed or is being executed. Inquiries or suggestions concerning this report or other facets of the MMT Program may also be directed to the Manufacturing Technology Division of IBEA. The report is composed of three major sections: a. Projects Added 2nd Half, CY80-A list divided by organization of all projects funded during the second half of CY80. Included is a natrative of the problem for each project. b. Projects Completed 2nd Half, CY8O-A list divided by organization of all projects completed during the second half of CY80. Included is a narrative of the final status for each project. c. Summary Project Status Report-These reports are divided by organization and include a summary of funding by fiscal year and a narrative status for each project. 7 ffiEEMI4 PAM3 BLUwN? ILMJD Also, there was a total of 118 projects completed overall during the current reporting period. This is the largest number of projects completed during a six-month period within the last two years. Figure 3 PROGRAM FUNDING EXPENDITURiS (MILLIONS)
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