ABSTRACTMajor technical challenges often prevent developers from producing new point-of-care technologies that deliver the required clinical performance in the intended settings of use. However, even ...when devices meet clinical requirements, they can fail to be adopted and successfully implemented. Adoption barriers occur when decision makers do not understand the “value proposition” of new technologies. Current discussions of value in the context of point-of-care testing focus predominantly on the intended use and performance of the device from the manufacturerʼs point of view. However, the perspective of potential adopters in determining whether new devices provide value is also important, as is the opinion of all stakeholders who will be impacted. Incorporating value concepts into decisions made across the full development-to-adoption continuum can increase the likelihood that point-of-care testing will have the desired impact on health care delivery and patient outcomes. This article discusses how various approaches to technology development impact adoption and compares the characteristics of these approaches to emerging value concepts. It also provides an overview of value initiatives and tools that are being developed to support the evaluation of value propositions. These are presented for a range of technology adoption decision contexts, with particular applicability to point-of-care testing. Expanding the focus of research to address gaps in both the creation and evaluation of value propositions is imperative in order for value concepts to positively influence the adoption of point-of-care testing.
Iron(II) octaethyltetraazaporphyrin has been discovered to exist as two polymorphs at room temperature, α- and β-Fe(OETAP). This has been established by X-ray powder diffraction and scanning electron ...microscopy. Both ac and dc SQUID magnetometry show that the α phase is a soft molecular ferromagnet with T Curie = 2.8 K. The β phase possesses the same number of unpaired spins and a similar g value, but it does not order above ∼1 K. Zero-field splitting is likely competing with ferromagnetic coupling in this compound. 57Fe Mössbauer spectroscopy has been used to support the local structural similarity between the two phases and to study the ferromagnetic transition. The isomorphous manganese analogue of α-Fe(OETAP), α-Mn(OETAP), expected to be a ferromagnet with a higher T Curie, exhibits many characteristics of ferromagnetism, notably hysteresis at 1.8 K with H coer = 2.5 kG and M rem = 4 kemu-G/mol. However, in contrast to ferromagnetic α-Fe(OETAP), α-Mn(OETAP) shows strongly frequency-dependent ac susceptibility in the range from 1 to 1000 Hz, indicating that it exists in a spin-glass-like state. This result underscores the need for frequency-dependent ac magnetometry to fully characterize ferromagnetic molecular materials.
With the growing number of fatalities resulting from the 100 or so cancer-related diseases, new enabling tools are required to provide extensive molecular profiles of patients to guide the clinician ...in making viable diagnosis and prognosis. Unfortunately with cancer-related diseases, there is not one molecular marker that can provide sufficient information to assist the clinician in making effective prognoses or even diagnoses. Indeed, large panels of markers must typically be evaluated that cut across several different classes (mutations in certain gene fragments—DNA; over/under-expression of gene activity as monitored by messenger RNAs; the amount of proteins present in serum or circulating tumor cells). The classical biosensor format (dipstick approach for monitoring the presence of a single element) is viewed as a valuable tool in many bioassays, but possesses numerous limitations in cancer due primarily to the single element nature of these sensing platforms. As such, if biosensors are to become valuable tools in the arsenal of the clinician to manage cancer patients, new formats are required. This review seeks to provide an overview of the current thinking on molecular profiling for diagnosis and prognosis of cancers and also, provide insight into the current state-of-the-art in the biosensor field and new strategies that must be considered to bring this important technology into the cancer field.
Rapid advances in telehealth development and adoption are increasing the spectrum of information and communication technologies that can be applied not only to individual patient care but more ...broadly to population health as well. Participants in this breakout session were asked to address, from their diverse perspectives, a series of questions relating to the current and potential uses of telehealth applications and networks for public health and emergency/disaster preparedness and response systems. Participants identified several gaps in current understanding and research emphasis. There is a clear need for more and larger outcome studies to assess the impact and cost benefit of telehealth applications in terms of improving public health at the population and community levels. In addition, more research is needed to demonstrate the ability of telehealth tools and technologies to facilitate and extend the reach of major national clinical and public health research initiatives. Perhaps most importantly, the National Institutes of Health should develop and/or strengthen strategic partnerships with other funding agencies with overlapping or complementary interests to accelerate interdisciplinary research in this rapidly evolving but relatively understudied and complex field.
ABSTRACTThe first part of this article is an introduction to systems engineering and how it may be applied to health care and point-of-care testing (POCT). Systems engineering is an interdisciplinary ...field that seeks to better understand and manage changes in complex systems and projects as a whole. Systems are sets of interconnected elements that interact with each other, are dynamic, change over time, and are subject to complex behaviors.The second part of this article reports on the results of the National Institute of Biomedical Imaging and Bioengineering workshop exploring the future of POCT and technologies and the recognition that these new technologies do not exist in isolation, that they exist within ecosystems of other technologies and systems, and that these systems influence their likelihood of success or failure and their effectiveness.In this workshop, a diverse group of individuals from around the country, from disciplines ranging from clinical care, engineering, regulatory affairs, and many others to members of the 3 major National Institutes of Health–funded efforts in the areas such as the Centers for POCT for sexually transmitted disease, POCT for the future of Cancer Care, and POCT primary care research network, gathered together for a modified deep dive workshop exploring the current state of the art, mapping probable future directions and developing longer term goals.The invitees were broken up into 4 thematic groups as followshome, outpatient, public/shared space, and rural/global. Each group proceeded to explore the problem and solution space for point-of-care tests and technology within their theme. Although each thematic area had specific challenges, many commonalities also emerged. This effort thus helped create a conceptual framework for POCT as well as identifying many of the challenges for POCT going forward.Four main dimensions were identified as defining the functional space for both POCT and treatment, these are the followingtime, location, interpretation, and tempo. A framework is presented in this study.There were several current and future challenges identified through the workshop. These broadly fall into the categories of technology development and implementation. More specifically, these are in the areas of (1) design, (2) patient-driven demand and technology, (3) information characteristics and presentation, (4) health information systems, (5) connectivity, (6) work flow and implementation, (7) maintenance/cost, and (8) quality control. Definitions of these challenge areas and recommendations to address them are provided.
The 17-electron complex (C5Ph5)Cr(CO)3 reacts with halogens (C6H5I·Cl2, Br2, and I2) in C6H6 to yield the dimeric oxidation products (C5Ph5)Cr(μ-X)X2 as thermally stable solids. Reactions with other ...chlorinating agents similarly yield (C5Ph5)CrCl22. An X-ray crystal structure of (C5Ph5)Cr(μ-Cl)Cl2 was obtained. The magnetic properties of the Cl2-bridged dimer have been determined and modeled using the usual isotropic Hamiltonian H = −2J Ŝ 1·Ŝ 2, which yields J/k = −30 K. Low-temperature (77 K) Raman spectra of solid (C5Ph5)CrX22 (X = Cl, I) allow assignments to be made for the metal-ring and metal halogen stretching modes in the low-frequency region (<600 cm-1). Tetrahydrofuran (THF) cleaves these dimers to yield complexes of the form (C5Ph5)CrX2(THF).
This article describes the new National Institute of Biomedical Imaging and Bioengineering Point-of-Care (POC) Technologies Research Network and its 4 Centers. The goal is to build expertise in ...development of integrated systems that address unmet POC testing clinical needs. Centers will work individually and also collectively as part of the national network to coordinate development, clinical evaluation, and reduction to practice of new POC devices.
The magnetic properties of first-row transition metal complexes of octaethyltetraazaporphyrin (M$\sp{2+}$OETAP, where M = Mn, Fe, Co, Cu, and Ni) were investigated utilizing SQUID magnetometry. ...Measurements of the temperature and field dependence of susceptibility and magnetization were used to study the nature of exchange interactions in each compound. Suitable models were employed to estimate the magnitude of the coupling constant, J. Magnetic measurements indicate that FeOETAP possesses an intermediate S = 1 ground state as is found in related four-coordinate Fe(II) porphyrin compounds. Low temperature and low field studies indicate the presence of ferromagnetic interactions in FeOETAP that ultimately lead to three-dimensional ordering below T$\sb{\rm c}$ = 2.8 K. The value of the saturation magnetization indicates that the spins are canted in the ordered state. Application of a one-dimensional Ising model incorporating zero-field splitting results in an estimate of the coupling constant (J/k = 5 K) and zero-field splitting constant (D/k = 7 K). The zero-field splitting in FeOETAP is nearly an order of magnitude smaller than in related four-coordinate Fe(II) porphyrin systems in which no exchange interactions are observed. A different phase of FeOETAP has been prepared which demonstrates only zero-field splitting, from which a value of D = 11 K is obtained (assuming S = 1). Powder diffraction measurements indicate that the ordering and non-ordering FeOETAP compounds are different phases. MnOETAP also possesses an intermediate (S = 3/2) ground state as observed in the related Mn(II) phthalocyanine compound. But unlike both MnPc and FeOETAP which undergo cooperative ordering, MnOETAP exhibits spin-glass behavior as observed by a frequency dependence of the ac susceptibility. This is explained by a smaller effective exchange coupling which results in frustration in the canted spin lattice. Powder diffraction results indicate that the spin-glass-like MnOETAP compound crystallizes in the same structure as the ordering FeOETAP. A separate MnOETAP phase has been found in which exchange interactions are absent. The structure of this phase was found to be isomorphous to the FeOETAP phase demonstrating only zero-field-splitting. CoOETAP and CuOETAP exhibit weak antiferromagnetic interactions whereas NiOETAP is diamagnetic as expected. Intermolecular exchange between spins on the metal centers in these systems can be explained via superexchange through the $\pi$-orbital system of the planar porphyrin ring or alternatively by overlap of regions of positive and negative spin density.
We report on the magnetic properties of the molecular solids derived from square-planar, neutral iron(II) octaethyltetraazaporphyrin, FeOETAP. This compound exists as two polymorphs, α and β. dc ...SQUID and ac susceptometry measurements (1-1000 Hz) show that the α polymorph orders as a soft molecular ferromagnet below T
Curie
= 2.8 K, whereas the β form, with the same number of unpaired spins and a similar g value, exhibits zero-field splitting to a non-magnetic ground state.
57
Fe-Mössbauer spectroscopy indicates that α-FeOETAP exhibits a remarkably large internal hyperfine field, H
int
, of 62.4 T. This, to our knowledge, is the highest value of H
int
ever reported for Fe, regardless of its spin state.
PDF
