Hepatic steatosis is a disorder with high prevalence among obese people. Traditional imaging modalities are more common in hepatic steatosis diagnosis, but they are not suitable for monitoring or treatment evaluation. This study aims at developing a new technique suitable for electromagnetic (EM) tool in the microwave band to differentiate steatotic from nonsteatotic liver. A differential permittivity estimation method for hepatic steatosis detection is proposed. First, the effective permittivity of the right side of the torso is estimated based on the phase difference of EM waves traveling along symmetric paths within the torso. Then, permittivity modeling and statistical frequency selection are performed to model the estimated values and to extract reliable frequency samples. Finally, the percentage of the difference between the permittivity of the left and right sides of the torso is calculated over the selected samples. The effectiveness of the proposed method is validated using simulated signals and phantom measurements. The analyzed results reveal higher contrast between the average permittivity of the left and right sides of the torso for cases with hepatic steatosis (average contrast of 29.2%) compared to those with healthy liver (average contrast of 7.9%). The proposed method can differentiate between steatotic and nonsteatotic liver. It is suitable for clinical applications due to its robustness to unwanted noise and interferences, as well as errors in placement of sensors. The results verify the potential of EM devices, which could overcome shortcomings of traditional imaging techniques by being safe, cost-effective, and portable.

Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.