{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T04:36:35Z","timestamp":1788237395516,"version":"build-2803163510"},"reference-count":40,"publisher":"BMJ","issue":"4","funder":[{"DOI":"10.13039\/100014229","name":"MIT Media Lab","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014229","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,2,22]]},"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Technology-enabled non-invasive diagnostic screening (TES) using smartphones and other point-of-care medical devices was evaluated in conjunction with conventional routine health screenings for the primary care screening of patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Dental conditions, cardiac ECG arrhythmias, tympanic membrane disorders, blood oxygenation levels, optic nerve disorders and neurological fitness were evaluated using FDA-approved advanced smartphone powered technologies. Routine health screenings were also conducted. A novel remote web platform was developed to allow expert physicians to examine TES data and compare efficacy with routine health screenings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted at a primary care centre during the 2015 Kumbh Mela in Maharashtra, India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>494 consenting 18\u201390 years old adults attending the 2015 Kumbh Mela were tested.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>TES and routine health screenings identified unique clinical conditions in distinct patients. Intraoral fluorescent imaging classified 63.3% of the population with dental caries and periodontal diseases. An association between poor oral health and cardiovascular illnesses was also identified. Tympanic membrane imaging detected eardrum abnormalities in 13.0% of the population, several with a medical history of hearing difficulties. Gait and coordination issues were discovered in eight subjects and one subject had arrhythmia. Cross-correlations were observed between low oxygen saturation and low body mass index (BMI) with smokers (p=0.0087\u2009and p=0.0122, respectively), and high BMI was associated with elevated blood pressure in middle-aged subjects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TES synergistically identified clinically significant abnormalities in several subjects who otherwise presented as normal in routine health screenings. Physicians validated TES findings and used routine health screening data and medical history responses for comprehensive diagnoses for at-risk patients. TES identified high prevalence of oral diseases, hypertension, obesity and ophthalmic conditions among the middle-aged and elderly Indian population, calling for public health interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-018774","type":"journal-article","created":{"date-parts":[[2018,4,20]],"date-time":"2018-04-20T12:15:40Z","timestamp":1524226540000},"page":"e018774","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Technology-enabled examinations of cardiac rhythm, optic nerve, oral health, tympanic membrane, gait and coordination evaluated jointly with routine health screenings: an observational study at the 2015 Kumbh Mela in India"],"prefix":"10.1136","volume":"8","author":[{"given":"Pratik","family":"Shah","sequence":"first","affiliation":[{"name":"Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Yauney","sequence":"additional","affiliation":[{"name":"Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otkrist","family":"Gupta","sequence":"additional","affiliation":[{"name":"Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Patalano II","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Cambridge Health Alliance, Cambridge, Massachusetts, USA"},{"name":"Department of Opthalmology, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mrinal","family":"Mohit","sequence":"additional","affiliation":[{"name":"Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rikin","family":"Merchant","sequence":"additional","affiliation":[{"name":"Department of Prosthodontics, Karmaveer Bhausaheb Hiray Dental College and Hospital, Nashik, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S V","family":"Subramanian","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,4,20]]},"reference":[{"key":"2025120520013324000_8.4.e018774.1","first-page":"1051","article-title":"2008 World Health Report emphasizes importance of primary health care","volume":"79","author":"Rivo","year":"2009","journal-title":"Am Fam Physician"},{"key":"2025120520013324000_8.4.e018774.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61853-3"},{"key":"2025120520013324000_8.4.e018774.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61353-0"},{"key":"2025120520013324000_8.4.e018774.4","doi-asserted-by":"crossref","first-page":"S84","DOI":"10.4103\/0970-0218.94716","article-title":"Key recommendations of high-level expert group report on universal health coverage for India","volume":"36","author":"Thakur","year":"2011","journal-title":"Indian J Community Med"},{"key":"2025120520013324000_8.4.e018774.5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.6064\/2012\/432892","article-title":"The impact of primary care: a focused review","volume":"2012","author":"Shi","year":"2012","journal-title":"Scientifica"},{"key":"2025120520013324000_8.4.e018774.6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1109\/JTEHM.2015.2400919","article-title":"Current and future challenges in point-of-care technologies: a paradigm-shift in affordable global healthcare with personalized and preventive medicine","volume":"3","author":"Dhawan","year":"2015","journal-title":"IEEE J Transl Eng Health Med"},{"key":"2025120520013324000_8.4.e018774.7","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3000484"},{"key":"2025120520013324000_8.4.e018774.8","first-page":"1870","article-title":"Design and preliminary evaluation of a wearable device for mass-screening of sleep apnea","volume":"2016","author":"Puri","year":"2016","journal-title":"Conf Proc IEEE Eng Med Biol Soc"},{"key":"2025120520013324000_8.4.e018774.9","doi-asserted-by":"crossref","unstructured":"Pamplona VF , Mohan A , Oliveira MM , et al . NETRA: interactive display for estimating refractive errors and focal range. ACM T Graphics 2010;29.doi:http:\/\/dx.doi.org\/10.1145\/1778765.1778814","DOI":"10.1145\/1833351.1778814"},{"key":"2025120520013324000_8.4.e018774.10","doi-asserted-by":"crossref","unstructured":"Swedish T , Roesch K , Lee IH , et al . EyeSelfie: self directed eye alignment using reciprocal eye box imaging. ACM T Graphics 2015;34.doi:http:\/\/dx.doi.org\/10.1145\/2766970","DOI":"10.1145\/2766970"},{"key":"2025120520013324000_8.4.e018774.11","doi-asserted-by":"crossref","unstructured":"Das A , Swedish T , Wahi A , et al . Mobile phone based mini-spectrometer for rapid screening of skin cancer. Proc Spie 2015:9482 doi:http:\/\/dx.doi.org\/10.1117\/12.2182191","DOI":"10.1117\/12.2182191"},{"key":"2025120520013324000_8.4.e018774.12","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/scientificamerican0514-28a","article-title":"Using a smartphone to detect cancer","volume":"310","author":"Giller","year":"2014","journal-title":"Sci Am"},{"key":"2025120520013324000_8.4.e018774.13","doi-asserted-by":"publisher","DOI":"10.1159\/000363326"},{"key":"2025120520013324000_8.4.e018774.14","doi-asserted-by":"crossref","first-page":"13368","DOI":"10.1038\/srep13368","article-title":"Malaria diagnosis using a mobile phone polarized microscope","volume":"5","author":"Pirnstill","year":"2015","journal-title":"Sci Rep"},{"key":"2025120520013324000_8.4.e018774.15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0002075","article-title":"A new concept for medical imaging centered on cellular phone technology","volume":"3","author":"Granot","year":"2008","journal-title":"PLoS One"},{"key":"2025120520013324000_8.4.e018774.16","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1097\/QAD.0000000000000907","article-title":"Use of mobile phone technology to improve the quality of point-of-care testing in a low-resource setting","volume":"30","author":"Jani","year":"2016","journal-title":"AIDS"},{"key":"2025120520013324000_8.4.e018774.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jelectrocard.2014.11.005"},{"key":"2025120520013324000_8.4.e018774.18","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s00784-015-1481-9","article-title":"Performance of a light fluorescence device for the detection of microbial plaque and gingival inflammation","volume":"20","author":"Rechmann","year":"2016","journal-title":"Clin Oral Investig"},{"key":"2025120520013324000_8.4.e018774.19","first-page":"1960","article-title":"Full body gait analysis with Kinect","volume":"2012","author":"Gabel","year":"2012","journal-title":"Conf Proc IEEE Eng Med Biol Soc"},{"key":"2025120520013324000_8.4.e018774.20","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1016\/j.ajem.2015.04.063","article-title":"Comparison of traditional otoscope to iPhone otoscope in the pediatric ED","volume":"33","author":"Richards","year":"2015","journal-title":"Am J Emerg Med"},{"key":"2025120520013324000_8.4.e018774.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2004.12.008"},{"key":"2025120520013324000_8.4.e018774.22","first-page":"329","article-title":"Prevalence of dental caries in Early Head Start children as diagnosed using teledentistry","volume":"30","author":"Kopycka-Kedzierawski","year":"2008","journal-title":"Pediatr Dent"},{"key":"2025120520013324000_8.4.e018774.23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2015\/823139","article-title":"A novel device to exploit the smartphone camera for fundus photography","volume":"2015","author":"Russo","year":"2015","journal-title":"J Ophthalmol"},{"key":"2025120520013324000_8.4.e018774.24","first-page":"ecurrents.dis.e8b3053f40e774e7e3","article-title":"Managing the Earth\u2019s Biggest Mass Gathering Event and WASH Conditions: Maha Kumbh Mela (India)","volume":"7","author":"Baranwal","year":"2015","journal-title":"PLoS Curr"},{"key":"2025120520013324000_8.4.e018774.25","doi-asserted-by":"crossref","first-page":"231","DOI":"10.2147\/MDER.S47319","article-title":"Pulse oximetry: fundamentals and technology update","volume":"7","author":"Nitzan","year":"2014","journal-title":"Med Devices"},{"key":"2025120520013324000_8.4.e018774.26","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1017\/S031716710000367X","article-title":"Standardized finger-nose test validity for coordination assessment in an ataxic disorder","volume":"31","author":"Gagnon","year":"2004","journal-title":"Can J Neurol Sci"},{"key":"2025120520013324000_8.4.e018774.27","doi-asserted-by":"crossref","first-page":"50","DOI":"10.3389\/fneur.2013.00050","article-title":"Measures of fine motor skills in people with tremor disorders: appraisal and interpretation","volume":"4","author":"Norman","year":"2013","journal-title":"Front Neurol"},{"key":"2025120520013324000_8.4.e018774.28","first-page":"61","article-title":"Gait and balance disorders in older adults","volume":"82","author":"Salzman","year":"2010","journal-title":"Am Fam Physician"},{"key":"2025120520013324000_8.4.e018774.29","first-page":"181","article-title":"The disc damage likelihood scale: reproducibility of a new method of estimating the amount of optic nerve damage caused by glaucoma","volume":"100","author":"Spaeth","year":"2002","journal-title":"Trans Am Ophthalmol Soc"},{"key":"2025120520013324000_8.4.e018774.30","first-page":"51S","article-title":"Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health","volume":"6(Suppl 2)","year":"1998","journal-title":"Obes Res"},{"key":"2025120520013324000_8.4.e018774.31","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000154900.76284.F6"},{"key":"2025120520013324000_8.4.e018774.32","doi-asserted-by":"crossref","first-page":"429","DOI":"10.4103\/2230-8210.183453","article-title":"Metabolic state of the nation: Results of the national family health survey-4","volume":"20","author":"Kumar","year":"2016","journal-title":"Indian J Endocrinol Metab"},{"key":"2025120520013324000_8.4.e018774.33","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.2147\/COPD.S69438","article-title":"Low FEV1, smoking history, and obesity are factors associated with oxygen saturation decrease in an adult population cohort","volume":"9","author":"Vold","year":"2014","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2025120520013324000_8.4.e018774.34","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.306.6879.688"},{"key":"2025120520013324000_8.4.e018774.35","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(98)00158-5"},{"key":"2025120520013324000_8.4.e018774.36","doi-asserted-by":"crossref","first-page":"37","DOI":"10.4103\/2231-0762.97695","article-title":"Applications of teledentistry: A literature review and update","volume":"1","author":"Jampani","year":"2011","journal-title":"J Int Soc Prev Community Dent"},{"key":"2025120520013324000_8.4.e018774.37","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1111\/idj.12216","article-title":"Epidemiology of dental caries among adolescents in Tamil Nadu, India","volume":"66","author":"Veerasamy","year":"2016","journal-title":"Int Dent J"},{"key":"2025120520013324000_8.4.e018774.38","doi-asserted-by":"publisher","DOI":"10.1097\/IJG.0b013e3181c4ac5b"},{"key":"2025120520013324000_8.4.e018774.39","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1089\/153056203772744644","article-title":"Evaluation of video-otoscopes suitable for tele-otology","volume":"9","author":"Mbao","year":"2003","journal-title":"Telemed J E Health"},{"key":"2025120520013324000_8.4.e018774.40","doi-asserted-by":"crossref","first-page":"588","DOI":"10.4103\/0028-3886.149365","article-title":"Epidemiology of neurological disorders in India: review of background, prevalence and incidence of epilepsy, stroke, Parkinson\u2019s disease and tremors","volume":"62","author":"Gourie-Devi","year":"2014","journal-title":"Neurol India"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-018774","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T04:01:43Z","timestamp":1764993703000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-018774"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,4,20]]},"published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1136\/bmjopen-2017-018774"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-018774","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4]]}}}