Ethical Stakes for Past, Present, and Prospective Tuberculosis Isolate Research Towards a Multicultural Data Sovereignty Model for Isolate Samples in Research

Tuberculosis (TB) is a potentially fatal infectious disease that, in Aotearoa New Zealand (NZ), inequitably affects Asian, Pacific, Middle Eastern, Latin American, and African (MELAA), and Māori people. Medical research involving genome sequencing of TB samples enables more nuanced understanding of disease strains and their transmission. This could inform highly specific health interventions. However, the collection and management of TB isolate samples for research are currently informed by monocultural biomedical models often lacking key ethical considerations. Drawing on a qualitative kaupapa Māori-consistent study, this paper reports on preliminary discussions with groups of Māori, Pacific, and Afghan people in NZ, whose communities have been harmed by TB and TB stigma. Participants' discussions highlight key concerns and meanings that ought to inform the development of guidelines and a more robust consultative process for the governance of how TB isolate samples are collected and used both retrospectively and in future research. We argue for ethical processes to be culturally nuanced and community-generated, flexible and meaningful, and situated in relation to the physical and symbolic effects of TB. We discuss the significance of Indigenous data sovereignty, rights, and kāwanatanga (governorship) in shaping a multicultural data sovereignty model.

Enhancing emission control and analyzing the performance and combustion attributes of vehicular engines with spirulina microalgae diesel Ce2O3 nanoparticles blends

The current research investigates the utilization of spirulina microalgae biodiesel blends in a naturally aspirated constant speed compression ignition engine with Ce2O3 nanoparticles at the concentration of 50 ppm under diverse engine loading conditions. Blends of microalgae dispersed with neat diesel at the volume of 20% and 40%. A series of tests were conducted to evaluate the combined effects of microalgae and nanoparticles on engine performance, combustion efficiency, and emission characteristics. The study revealed that increasing the microalgae concentration in the diesel fuel resulted in reduced brake thermal efficiency due to less effective atomization and lower calorific value. Surprisingly, the 20% biodiesel blend with nanoparticles exhibited the highest brake thermal efficiency across various engine loads, while the 40% blend showed higher brake specific fuel consumption compared to both the 20% blend and neat diesel, primarily because of its lower heating value necessitating increased fuel consumption. Furthermore, the biodiesel blends led to lower in-cylinder pressure than pure diesel, mainly attributable to suboptimal atomization. In terms of emissions, the utilization of microalgae-based fuel led to a significant reduction in NOx, CO, and smoke emissions, attributed to the lower cylinder temperatures associated with these blends. In conclusion, this study underscores the potential of spirulina microalgae, particularly when combined with nanoparticles at an optimal concentration, as a promising and environmentally friendly alternative for compression ignition engines.

Pharmacy-based methadone treatment in the US: views of pharmacists and opioid treatment program staff

BACKGROUND

The US federal regulations allow pharmacy administration and dispensing of methadone for opioid use disorder (PADMOUD) to increase the capability of opioid treatment programs (OTPs) in providing methadone maintenance treatment (MMT) for opioid use disorder (OUD) as part of a medication unit. However, there is a lack of research data from both pharmacy and OTP staff to inform the implementation of PADMOUD.

METHODS

Staff of a pharmacy (n = 8) and an OTP (n = 9) that participated in the first completed US trial on PADMOUD through electronic prescribing for methadone (parent study) were recruited to participate in this qualitative interview study to explore implementation-related factors for PADMOUD. Each interview was recorded and transcribed verbatim. NVivo was used to help identify themes of qualitative interview data. The Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to guide the coding and interpretation of data.

RESULTS

Six pharmacy staff and eight OTP staff (n = 14) completed the interview. Results based on PARIHS domains were summarized, including evidence, context, and facilitation domains. Participants perceived benefits of PADMOUD for patients, pharmacies, OTPs, and payers. PADMOUD was considered to increase access for stable patients, provide additional patient service opportunities and revenues for pharmacies/pharmacists, enhance the capability of OTPs to treat more new patients, and reduce patients' cost when receiving medication at a pharmacy relative to an OTP. Both pharmacy and OTP staff were perceived to be supportive of the implementation of PADMOUD. Pharmacy staff/pharmacists were perceived to need proper training on addiction and methadone as well as a protocol of PADMOUD to conduct PADMOUD. Facilitators include having thought leaders to guide the operation, a certification program to ensure proper training of pharmacy staff/pharmacist, having updated pharmacy service software or technology to streamline the workflow of delivering PADMOUD and inventory management, and reimbursement for pharmacists.

CONCLUSION

This study presents the first findings on perspectives of PADMOUD from both staff of a community pharmacy and an OTP in the US. Finding on barriers and facilitators are useful data to guide the development of strategies to implement PADMOUD to help address the US opioid crisis.

Bioluminescence resonance energy transfer biosensor for measuring activity of a protease secreted by Pseudomonas fluorescens growing in milk

Bacterial proteases are sporadic contributors to milk spoilage, reducing the quality of ultra-heat treated (UHT) milk and other dairy products. Current methods for measuring bacterial protease activity in milk are insensitive and too slow to be used in routine testing in dairy processing plants. We have designed a novel bioluminescence resonance energy transfer (BRET)-based biosensor to measure the activity of proteases secreted by bacteria in milk. The BRET-based biosensor is highly selective for bacterial protease activity compared with other proteases tested, notably including plasmin, which is abundant in milk. It incorporates a novel peptide linker that is selectively cleaved by P. fluorescens AprX proteases. The peptide linker is flanked by green fluorescent protein (GFP²) at the N-terminus and a variant Renilla luciferase (RLuc2) at the C-terminus. Complete cleavage of the linker by bacterial proteases from Pseudomonas fluorescens strain 65, leads to a 95% decrease in the BRET ratio. We applied an azocasein-based calibration method to the AprX biosensor using standard international enzyme activity units. In a 10-min assay, the detection limit for AprX protease activity in buffer was equivalent to 40 pg/mL (≈0.8 pM, 22 μU/mL) and 100 pg/mL (≈2pM, 54 μU/mL) in 50% (v/v) full fat milk. The EC₅₀ values were 1.1 ± 0.3 ng/mL (87 μU/mL) and 6.8 ± 0.2 ng/mL (540 μU/mL), respectively. The biosensor was approximately 800x more sensitive than the established FITC-Casein method in a 2-h assay, the shortest feasible time for the latter method. The protease biosensor is sensitive and fast enough to be used in production settings. It is suitable for measuring bacterial protease activity in raw and processed milk, to inform efforts to mitigate the effects of heat-stable bacterial proteases and maximise the shelf-life of dairy products.

Utilization of the Nannochloropsis microalgae biochar prepared via microwave assisted pyrolysis on the mixed biomass fuel pellets

Nannochloropsis microalgae biochar has become increasingly attractive due to its potential as a component of microalgae-based biodiesel blends. This biochar is a by-product of the pyrolysis process, but its use in the energy sector has been limited. In this study, pellets were formed using microalgae residues and their physiochemical properties were analyzed to assess the feasibility of using microalgae biochar as a fuel source. Three types of biomasses, namely date seed dust, coconut shell waste, and microalgae biochar, were utilized to produce fuel pellets. These pellets were categorized into three types, B1, B2, and B3, based on the composition of the biomass. The inclusion of microalgae biochar in the pellets resulted in enhanced calorific value, as well as improved heating value and bulk density. Moreover, the mechanical strength of microalgae-based pellets was higher due to their high lignin content compared to another biomass. The moisture absorption test results showed that the use of mixed biomass reduced the moisture content over an extended period. Microalgae pellets exhibited higher young's modulus and greater impact resistance, indicating greater mechanical strength. Furthermore, due to their higher calorific value, the combustion time of microalgae pellets was greater than that of other biomass. In conclusion, the results of this study suggest that microalgae biochar can be a promising alternative fuel source for the energy sector.

Patient perspectives on community pharmacy administered and dispensing of methadone treatment for opioid use disorder: a qualitative study in the U.S

BACKGROUND

Pharmacy administration and dispensing of methadone treatment for opioid use disorder (PADMOUD) may address inadequate capability of opioid treatment programs (OTPs) in the US by expanding access to methadone at community pharmacies nationally. PADMOUD is vastly underutilized in the US. There is no published US study on OUD patients' perspectives on PADMOUD. Data are timely and needed to inform the implementation of PADMOUD in the US to address its serious opioid overdose crisis.

METHODS

Patient participants of the first completed US trial on PADMOUD through electronic prescribing for methadone (parent study) were interviewed to explore implementation-related factors for PADMOUD. All 20 participants of the parent study were invited to participate in this interview study. Each interview was recorded and transcribed verbatim. Thematic analysis was conducted to identify emergent themes.

RESULTS

Seventeen participants completed the interview. Patients' perspectives on PADMOUD were grouped into five areas. Participants reported feasibility of taking the tablet formulation of methadone at the pharmacy and identified benefits from PADMOUD (e.g., better access, efficiency, convenience) compared with usual care at the OTP. Participants perceived support for PADMOUD from their family/friends, OTP staff, and pharmacy staff. PADMOUD was perceived to be a great option for stable patients with take-home doses and those with transportation barriers. The distance (convenience), office hours, and the cost were considered factors most influencing their decision to receive methadone from a pharmacy. Nonjudgmental communication, pharmacists' training on methadone treatment, selection of patients (stable status), workflow of PADMOUD, and protection of privacy were considered key factors for improving operations of PADMOUD.

CONCLUSION

This study presents the first findings on patient perspectives on PADMOUD. Participants considered pharmacies more accessible than OTPs, which could encourage more people to receive methadone treatment earlier and help transition stable patients from an OTP into a local pharmacy. The findings have timely implications for informing implementation strategies of PADMOUD that consider patients' views and needs.

Daytime Sleepiness Is Associated with Lower Cognitive Scores: The Look AHEAD Study

Background

Daytime sleepiness is common in older adults and may result from poor nighttime sleep due to sleep disordered breathing, fragmented sleep, or other sleep disorders. Daytime sleepiness may be associated with cognition in older adults.

Objectives

We investigated the association between self-reported daytime sleepiness and cognitive function in the Look AHEAD clinical trial.

Design

Observational follow-up of a randomized clinical trial of an intensive lifestyle intervention.

Setting

Clinic.

Participants

Participants (n=1,778) aged 45-76 years at baseline with type 2 diabetes and overweight or obesity.

Interventions

Participants were randomized to an intensive lifestyle intervention for weight loss or a control condition of diabetes support and education.

Measurements

Participants provided self-reported levels of daytime sleepiness at baseline and years 12-13. Cognitive function was assessed with a neurocognitive battery at years 12-13 and 18-20.

Results

Participants who reported having frequent daytime sleepiness (often or always) performed significantly worse than others on the cognitive composite (-0.35; p-value=0.014) after controlling for covariates. When stratified by intervention arm, participants assigned to the intensive lifestyle intervention who reported often/always having daytime sleepiness performed worse on Digit Symbol Coding (-0.63; p-value=0.05) and Trail Making Part-B (-0.56; p-value=0.02) after controlling for covariates. Statistical interactions revealed associations between daytime sleepiness and the following covariates: race and ethnicity, APOE ε4 carrier status, baseline history of cardiovascular disease, and depression.

Conclusions

Daytime sleepiness over ~13 years predicted poorer cognitive performance in older individuals who, by virtue of having diabetes and overweight/obesity, are at high risk for sleep disorders and cognitive impairment.

Phytochemical profiling, anti-hyperglycemic, antifungal, and radicals scavenging potential of crude extracts of Athyrium asplenioides- an in-vitro approach

This research was aimed to evaluate the phytochemical profile, antifungal, anti-hyperglycemic, as well as antioxidant activity competence of different extracts of Athyrium asplenioides through in-vitro approach. The A. asplenioides crude methanol extract contained considerable quantity of pharmaceutically precious phytochemicals (saponins, tannins, quinones, flavonoid, phenols, steroid, and terpenoids) than others (acetone, ethyl acetate, and chloroform). Interestingly, the crude methanol extract showed remarkable antifungal activity against Candida species (C. krusei: 19.3 ± 2 mm > C. tropicalis: 18.4 ± 1 mm > C. albicans: 16.5 ± 1 mm > C. parapsilosis: 15.5 ± 2 mm  >  C. glabrate: 13.5 ± 2 mm > C. auris: 7.6 ± 1 mm) at a concentration of 20 mg mL-1. The crude methanol extract also showed remarkable anti-hyperglycemic activity on concentration basis. Surprisingly, remarkable free radicals scavenging potential against DPPH (76.38%) and ABTS (76.28%) free radicals at a concentration of 20 mg mL-1. According to the findings, the A. asplenioides crude methanol extract contains pharmaceutically valuable phytochemicals and may be useful for drug discovery.

Optimizing engine performance and reducing emissions of greenhouse gases through spirulina microalgae and nano-additive blends

The shift in focus towards biofuels has led to the attention towards fourth-generation fuels, particularly microalgae, due to its high oil productivity and simple cultivation processes. The current study aimed to examine the effects of spirulina microalgae blends in a naturally aspirated diesel engine by testing two blend percentages (15% and 30%) and incorporating Fe₂O₃ nanoparticles (75 ppm). A series of test conducted in a single-cylinder engine with an optimum compression ratio of 17.5. The fuels tested include 100% diesel (D0), diesel with Fe₂O₃ nanoparticles (DF), diesel with 15% microalgae blends (B15), diesel with 15% microalgae blends and Fe₂O₃ nanoparticles (B15F), diesel with 30% microalgae blends (B30), and diesel with 30% microalgae blends and Fe₂O₃ nanoparticles (B30F). The results showed that the addition of microalgae blends led to a marginal increase in engine performance, while the addition of Fe₂O₃ nanoparticles led to a significant increase in brake thermal efficiency and decreased fuel consumption. The emissions rate was also lower compared to diesel, but the addition of Fe₂O₃ nanoparticles increased the oxygen content in the fuel, thereby improving the combustion rates. By ensuring the complete combustion the formation of CO₂, HC and smoke intensity was also found to be significantly lower compared to diesel fuel. On the contrary, NOx increased due to the cylinder temperatures. This research highlights the potential of using microalgae as a sustainable source of biofuel, and the positive effects of adding Fe₂O₃ nanoparticles to enhance the fuel's efficiency.

Primary Care Residency Perspectives on Medical Student Performance Evaluations

Introduction

With the transition of the United States Medical Licensing Examination (USMLE) Step 1 exam to pass-fail, residency directors are exploring alternative objective approaches when selecting candidates for interviews. The Medical Student Performance Evaluations (MSPE) portion of the application may be an area where objectivity could be provided. This study explored program directors' (PDs) perspectives on the utility of the MSPE as a discriminating factor for residency candidate selection.

Methods

We invited PDs of primary care residencies listed in the American Medical Association FRIEDA database to participate in a mixed-methods study assessing opinions on the MSPE, and the importance of student skills and application components when considering a candidate for interview. We obtained summary statistics for Likert-scale responses. We used inductive thematic analysis to generate themes from open-ended comments.

Results

Two hundred forty-nine PDs completed the survey (response rate=15.9%). Patient communication (83.6%) and teamwork (81.9%) were rated as very/extremely important skills, and being a graduate of a US medical school in the past 3 years (73.1%), no failures on board exams (58.2%), and MSPEs (54.8%) were rated as very/extremely important application components. Six hundred seventy-eight open-ended comments yielded themes related to desire for more transparency and standardization, importance of student attributes and activities, and other important components of applications.

Conclusion

PDs place a high value on the MSPE but find it limited by concerns over validity, objectivity, and lack of standardization. The quality of MSPEs may be improved by using a common language of skill attainment such as the Association of American Medical Colleges' Entrustable Professional Activities and using the document to discuss students' other attributes and contributions.

Treatment of heavy metals containing wastewater using biodegradable adsorbents: A review of mechanism and future trends

The direct disposal of industrial effluents into the aquatic system is considered as a significant environmental hazard in many countries. Because of poisonous chemicals, substantial volumes of effluent release, as well as the lack of adequate of conventional treatment methodologies, industrial effluent treatment is extremely difficult. Numerous researchers have been interested in adsorption technology for its high efficiency of pollutant removal, low cost, and abundantly available adsorbent. Various adsorbent materials, both natural and modified form, have been widely used for the removal of toxic contaminants from industrial effluent. This paper highlights recent advancements in multiple modification types to functionalize the adsorbent material, resulting in higher adsorption capacity on various toxic pollutants. This review provides an overview of the adsorption mechanism and parameters (pH, adsorbent dosage, initial concentration, temperature and interaction time), which influencing the removal efficiency of adsorbents. Furthermore, this review compiles the desorption study to recover the adsorbent and improve the cycle's financial viability. This review provides a concise overview of the future directions and outlook in the framework of adsorbent application for industrial wastewater treatment.