Autocalibration based on dilution of a single concentrated standard is used for the determination of silicate in sea water by the modified molybdenum blue method

The silicate (Si) molybdenum blue method was modified by combining oxalate and ascorbic acid into a single reagent and was used for determining Si in sea water samples. The first step of this automated assay protocol was designed to perform either a calibration by a single Si standard prepared in deionized (DI) water, or to dilute samples in the range of 0-160 μM Si to fit into 0-20 μM Si calibration range using a 20 cm flow cell. By designing the assay protocol to function in batch mode, the influence of salinity on calibration was eliminated, thus making the method suitable for analysis of samples collected in the open ocean, coastal areas, or rivers. Reproducibility and accuracy of this method were evaluated by analysis of certified sea water reference materials. Phosphate (P) does not interfere significantly if the Si:P ratio is 4:1 or larger. The limit of detection was 514 nM Si, r.s.d. 2.1 %, sampling frequency 40 s/h, reagent consumption 700 μL/sample, and using deionized water as the carrier solution.

Sleep-wake behavior and responses to sleep deprivation and immune challenge of protein kinase RNA-activated knockout mice

Protein Kinase RNA-activated (PKR) is an enzyme that plays a role in many systemic processes, including modulation of inflammation, and is implicated in neurodegenerative diseases, such as Alzheimer's disease (AD). PKR phosphorylation results in the production of several cytokines involved in the regulation / modulation of sleep, including interleukin-1β, tumor necrosis factor-α and interferon-γ. We hypothesized targeting PKR would alter spontaneous sleep of mice, attenuate responses to sleep deprivation, and inhibit responses to immune challenge. To test these hypotheses, we determined the sleep-wake phenotype of mice lacking PKR (knockout; PKR-/-) during undisturbed baseline conditions; in responses to six hours of sleep deprivation; and after immune challenge with lipopolysaccharide (LPS). Adult male mice (C57BL/6J, n = 7; PKR-/-, n = 7) were surgically instrumented with EEG recording electrodes and an intraperitoneal microchip to record core body temperature. During undisturbed baseline conditions, PKR -/- mice spent more time in non-rapid eye movement sleep (NREMS) and rapid-eye movement sleep (REMS), and less time awake at the beginning of the dark period of the light:dark cycle. Delta power during NREMS, a measure of sleep depth, was less in PKR-/- mice during the dark period, and core body temperatures were lower during the light period. Both mouse strains responded to sleep deprivation with increased NREMS and REMS, although these changes did not differ substantively between strains. The initial increase in delta power during NREMS after sleep deprivation was greater in PKR-/- mice, suggesting a faster buildup of sleep pressure with prolonged waking. Immune challenge with LPS increased NREMS and inhibited REMS to the same extent in both mouse strains, whereas the initial LPS-induced suppression of delta power during NREMS was greater in PKR-/- mice. Because sleep regulatory and immune responsive systems in brain are redundant and overlapping, other mediators and signaling pathways in addition to PKR are involved in the responses to acute sleep deprivation and LPS immune challenge.

Diagnostic and surgical treatment for traumatic bile peritonitis in dogs and cats

OBJECTIVE

To describe short-term outcomes of dogs and cats undergoing surgery for traumatic bile peritonitis.

ANIMALS

13 dogs and 4 cats.

METHODS

Multi-institutional, retrospective study. Medical records from 6 institutions were reviewed for cases of traumatic bile peritonitis between 2006 and 2022. Clinical presentation, additional injuries, surgical treatment, and outcome were recorded.

RESULTS

Trauma occurred a median of 2 (range, 1 to 22) and 4 (range, 1 to 22) days prior to presentation in dogs and cats, respectively. Total bilirubin was increased in 11 of 13 dogs and 2 of 4 cats. Rupture occurred at the common bile duct (CBD) in 10 dogs and 1 cat, gallbladder in 3 dogs, cystic duct in 2 cats, and hepatic duct in 1 dog and 1 cat. The most common surgeries were cholecystoduodenostomy and CBD repair in dogs and cholecystectomy in cats. Eleven of 13 dogs and all cats survived to hospital discharge (88.2% overall survival). Median follow-up in surviving dogs and cats was 35 days (range, 14 to 401) and 30 days (range, 14 to 90), respectively. One dog that underwent cholecystectomy experienced recurrent bile peritonitis 20 days postoperatively. Short-term survival following surgical treatment of traumatic bile peritonitis was excellent and recurrence appears uncommon. The most frequent site of rupture was the CBD in dogs and the cystic duct in cats.

CLINICAL RELEVANCE

Measurement of peritoneal bilirubin should be considered in dogs and cats with peritoneal effusion following trauma. Surgeons should be prepared to identify and address ruptures in locations other than the gallbladder.

Can Artificial Intelligence Chatbots Improve Mental Health?: A Scoping Review

BACKGROUND AND OBJECTIVES

Mental health disorders, including anxiety and depression, are the leading causes of global health-related burden and have increased dramatically since the 1990s. Delivering mental healthcare using artificial intelligence chatbots may be one option for closing the gaps in mental healthcare access. The overall aim of this scoping review was to describe the use, efficacy, and advantages/disadvantages of using an artificial intelligence chatbot for mental healthcare (stress, anxiety, depression).

METHODS

PubMed, PsycINFO, CINAHL, and Web of Science databases were searched. When possible, Medical Subject Headings terms were searched in combination with keywords. Two independent reviewers reviewed a total of 5768 abstracts.

RESULTS

Fifty-four articles were chosen for further review, with 10 articles included in the final analysis. Regarding quality assessment, the overall quality of the evidence was lower than expected. Overall, most studies showed positive trends in improving anxiety, stress, and depression.

DISCUSSION

Overall, using an artificial intelligence chatbot for mental health has some promising effects. However, many studies were done using rudimentary versions of artificial intelligence chatbots. In addition, lack of guardrails and privacy issues were identified. More research is needed to determine the effectiveness of artificial intelligence chatbots and to describe undesirable effects.

Human movement and environmental barriers shape the emergence of dengue

Understanding how emerging infectious diseases spread within and between countries is essential to contain future pandemics. Spread to new areas requires connectivity between one or more sources and a suitable local environment, but how these two factors interact at different stages of disease emergence remains largely unknown. Further, no analytical framework exists to examine their roles. Here we develop a dynamic modelling approach for infectious diseases that explicitly models both connectivity via human movement and environmental suitability interactions. We apply it to better understand recently observed (1995-2019) patterns as well as predict past unobserved (1983-2000) and future (2020-2039) spread of dengue in Mexico and Brazil. We find that these models can accurately reconstruct long-term spread pathways, determine historical origins, and identify specific routes of invasion. We find early dengue invasion is more heavily influenced by environmental factors, resulting in patchy non-contiguous spread, while short and long-distance connectivity becomes more important in later stages. Our results have immediate practical applications for forecasting and containing the spread of dengue and emergence of new serotypes. Given current and future trends in human mobility, climate, and zoonotic spillover, understanding the interplay between connectivity and environmental suitability will be increasingly necessary to contain emerging and re-emerging pathogens.

COVID-19 risk communication gaps, needs, and strategies related to pandemic preparedness plans among vulnerable, Black American subgroups: A qualitative study

OBJECTIVE

Improving current and future risk communication plans is critical to mitigate the COVID-19 pandemic and begin to prepare for future pandemics. Minority groups, particularly African Americans, have been limited in engagement to prepare these plans which has been demonstrated to be disadvantageous. We report findings from a qualitative study that describes gaps, needs, and strategies to improve communication among vulnerable, Black American subgroups during the COVID-19 pandemic.

METHODS

Sixty-two Black Americans in uniquely, vulnerable subgroups participated in qualitative, semi-structured interviews from May to September 2020. Thematic analyses were used to identify themes.

RESULTS

Participants were 16 essential workers, 16 parents, 15 young adults, and 15 individuals with underlying medical conditions. Emerging themes were: (1) Poor communication and miscommunication fueled fear and confusion; (2) Information sources and channels: How do I choose one?; (3) Communication needs were simple yet complex; (4) All information sources are not trusted information sources; (5) Preferred yet trusted channels and types of information; and (6) Dissemination of COVID Research: Why and How. Subgroups varied in information sources and processes for choosing the source, communication needs, and channels and types of information needed. They shared why they did and did not trust certain sources along with the importance of COVID research dissemination to promote informed decision-making throughout the pandemic.

DISCUSSION

This study found that Black American subgroups had diverse, yet trusted and non-trusted messages, messengers, and strategies for communication and wanted research results disseminated. We describe multi-level stakeholders and strategies to help improve risk communication for pandemics, and potentially preparedness and health outcomes.

Genomic assessment of invasion dynamics of SARS-CoV-2 Omicron BA.1

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) now arise in the context of heterogeneous human connectivity and population immunity. Through a large-scale phylodynamic analysis of 115,622 Omicron BA.1 genomes, we identified >6,000 introductions of the antigenically distinct VOC into England and analyzed their local transmission and dispersal history. We find that six of the eight largest English Omicron lineages were already transmitting when Omicron was first reported in southern Africa (22 November 2021). Multiple datasets show that importation of Omicron continued despite subsequent restrictions on travel from southern Africa as a result of export from well-connected secondary locations. Initiation and dispersal of Omicron transmission lineages in England was a two-stage process that can be explained by models of the country's human geography and hierarchical travel network. Our results enable a comparison of the processes that drive the invasion of Omicron and other VOCs across multiple spatial scales.

Tissue-resident memory CAR T cells with stem-like characteristics display enhanced efficacy against solid and liquid tumors

Chimeric antigen receptor (CAR) T cells demonstrate remarkable success in treating hematological malignancies, but their effectiveness in non-hematopoietic cancers remains limited. This study proposes enhancing CAR T cell function and localization in solid tumors by modifying the epigenome governing tissue-residency adaptation and early memory differentiation. We identify that a key factor in human tissue-resident memory CAR T cell (CAR-TRM) formation is activation in the presence of the pleotropic cytokine, transforming growth factor β (TGF-β), which enforces a core program of both "stemness" and sustained tissue residency by mediating chromatin remodeling and concurrent transcriptional changes. This approach leads to a practical and clinically actionable in vitro production method for engineering peripheral blood T cells into a large number of "stem-like" CAR-TRM cells resistant to tumor-associated dysfunction, possessing an enhanced ability to accumulate in situ and rapidly eliminate cancer cells for more effective immunotherapy.

Analysis of sunscreens and antibiotics in groundwater during the Covid-19 pandemic in the Riviera Maya, Mexico

Tourism contributes to groundwater pollution, but quantifying its exact impact is challenging due to the presence of multiple pollution sources. However, the COVID-19 pandemic presented a unique opportunity to conduct a natural experiment and assess the influence of tourism on groundwater pollution. One such tourist destination is the Riviera Maya in Quintana Roo, Mexico (specifically Cancun). Here, water contamination occurs due to the addition of sunscreen and antibiotics during aquatic activities like swimming, as well as from sewage. In this study, water samples were collected during the pandemic and when tourists returned to the region. Samples were taken from sinkholes (cenotes), beaches, and wells then tested using liquid chromatography for antibiotics and active ingredients found in sunscreens. The data revealed that contamination levels from specific sunscreens and antibiotics persisted even when tourists were absent, indicating that local residents significantly contribute to groundwater pollution. However, upon the return of tourists, the diversity of sunscreen and antibiotics found increased, suggesting that tourists bring along various compounds from their home regions. During the initial stages of the pandemic, antibiotic concentrations were highest, primarily due to local residents incorrectly using antibiotics to combat COVID-19. Additionally, the research found that tourist sites had the greatest contribution to groundwater pollution, with sunscreen concentration increasing. Furthermore, installation of a wastewater treatment plant decreased overall groundwater pollution. These findings enhance our understanding of the pollution contributed by tourists in relation to other pollution sources.

Correction: Development of a Tailored Mobile Phone-Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study

[This corrects the article DOI: 10.2196/43041.].

Application of lean principles in a medicare insurance counseling service learning course

BACKGROUND

Lean principles are increasingly applied in healthcare to improve quality and cost. A service-learning course providing Medicare insurance counseling requiring rapid transformation due to the COVID-19 pandemic provided an opportunity for pharmacy students to apply lean skills.

EDUCATIONAL ACTIVITY

Students, already introduced to lean skills earlier in their curriculum, enrolled in the insurance education certificate during their third year in Fall 2020. Students were oriented to the mandated service delivery restrictions. After a review of lean principles, students analyzed existing process for in-person counseling using a value-stream map. Students worked in teams to complete a cause analysis and develop solutions. Collaboratively, students clarified the value of the Medicare insurance counseling services to the community, adapted these components to accommodate environmental risk, and developed standard work for client acquisition, communication procedures, and service delivery to optimize client satisfaction and safety. Outcomes compared before and after application of lean skills included number of pharmacy students completing insurance counselor training, number of clients counseled, and the mean out-of-pocket savings identified for Medicare beneficiaries.

FINDINGS

Students applied lean skills to transform an insurance counseling service by developing and implementing a future state value-stream map and new standard work. Overall Medicare insurance counseling service metrics decreased compared to previous years, but the service was sustained despite pandemic restrictions. Application of lean skills and service redesign provided a method for students to provide services via telepharmacy. Application of lean principles increased student engagement with the course and provided an opportunity to practice quality improvement skills. Lean provides a flexible set of skills that can be introduced and applied in different pharmacy instructional settings.

Development of a Tailored Mobile Phone-Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study

BACKGROUND

Human papillomavirus (HPV) vaccine hesitancy is on the rise, and provider communication is a first-line strategy to address parental concerns. The use of the presumptive approach and motivational interviewing by providers may not be enough to influence parental decision-making owing to the providers' limited time, self-efficacy, and skills to implement these strategies. Interventions to enhance provider communication and build parental HPV vaccine confidence have been undertested. Delivering tailored patient education to parents via mobile phones before they visit the health care provider may address time constraints during clinic visits and positively affect vaccine uptake.

OBJECTIVE

This study aimed to describe the development and evaluate the acceptability of a mobile phone-based, family-focused intervention guided by theory to address concerns of HPV vaccine-hesitant parents before the clinic visit, as well as explore intervention use to facilitate parent-child communication.

METHODS

The health belief model and theory of reasoned action guided intervention content development. A multilevel stakeholder engagement process was used to iteratively develop the HPVVaxFacts intervention, including a community advisory board review, a review by an advisory panel comprising HPV vaccine-hesitant parents, a health communications expert review, semistructured qualitative interviews with HPV vaccine-hesitant parents (n=31) and providers (n=15), and a content expert review. Inductive thematic analysis was used to identify themes in the interview data.

RESULTS

The qualitative interviews yielded 4 themes: overall views toward mobile device use for health information, acceptability of HPVVaxFacts, facilitators of HPVVaxFacts use, and barriers to HPVVaxFacts use. In parent interviews after reviewing HPVVaxFacts prototypes, almost all parents (29/31, 94%) stated they intended to have their child vaccinated. Most of the parents stated that they liked the added adolescents' corner to engage in optional parent-child communication (ie, choice to share and discuss information with their child; 27/31, 87%) and shared decision-making in some cases (8/31, 26%). After incorporating all input, the final intervention consisted of a 10-item survey to identify the top 3 concerns of parents, followed by tailored education that was mapped to each of the following concerns: evidential messages, images or graphics to enhance comprehension and address low literacy, links to credible websites, a provider video, suggested questions to ask their child's physician, and an optional adolescents' corner to educate the patient and support parent-child communication.

CONCLUSIONS

The multilevel stakeholder-engaged process used to iteratively develop this novel intervention for HPV vaccine-hesitant families can be used as a model to develop future mobile health interventions. This intervention is currently being pilot-tested in preparation for a randomized controlled trial aiming to increase HPV vaccination among adolescent children of vaccine-hesitant parents in a clinic setting. Future research can adapt HPVVaxFacts for other vaccines and use in other settings (eg, health departments and pharmacies).

How confident are UK radiographers at performing paediatric computed tomography trauma scans?

INTRODUCTION

Approximately 45% of paediatric deaths in the United Kingdom (UK) were as a result of trauma. Computed tomography (CT) provides time efficient and accurate diagnosis, increasing chances of survival. Whilst use of CT in evaluating paediatric trauma has been invaluable it carries significant radiation risks, largely because children have greater radiation sensitivity than adults. Although national paediatric trauma workload in the UK is proportionately low, the majority of paediatric patients are conveyed to hospitals which predominantly undertake CT scans on adult patients. This research aimed to determine the confidence levels of radiographers when performing paediatric CT trauma scans in three public hospitals in the UK, and whether a teaching intervention improved their perceived self-confidence.

METHODS

Individual questionnaires containing eight qualitative and quantitative questions were used to ascertain radiographers' perceived confidence levels. A teaching intervention was developed based on responses. A post-intervention questionnaire was used to determine whether radiographers' confidence levels had improved.

RESULTS

Radiographers (n = 45) reported a mean confidence score of 5.6 (standard deviation 2.2) and 8.0 (standard deviation 1.7) scanning paediatric trauma patients pre- and post-intervention respectively. A paired two group t-test found this difference to be statistically significant at p < .00001. Radiographers reported several factors which negatively influenced confidence levels, including limited experience and postgraduate education.

CONCLUSION

Radiographers reported to be less confident scanning paediatric CT trauma patients compared to adults, pre- and post-intervention, however this research does not clarify whether this is as a result of an increase in competence. Further research regarding this concept warrants investigation.

IMPLICATIONS FOR PRACTICE

Results suggest further training based on negative factors reported by radiographers can increase confidence when performing this type of scan, assisting radiographers in optimising paediatric patient doses.

WO3 Nanowire-Attached Reduced Graphene Oxide-Based 1D-2D Heterostructures for Near-Infrared Light-Driven Synergistic Photocatalytic and Photothermal Inactivation of Multidrug-Resistant Superbugs

The rapid emergence of superbugs which are resistant to existing antibiotics is becoming a huge global threat to public health, which demands the discovery of next-generation antibacterial agents for combating superbugs. Herein, we report the design of a two-dimensional (2D) reduced graphene oxide (r-GO) and one-dimensional (1D) WO₃ nanowire-based photothermal-photocatalytic heterostructure for combating multiantibiotic-resistant Salmonella DT104, carbapenem-resistant Enterobacteriaceae Escherichia coli, and methicillin-resistant Staphylococcus aureus superbugs. In the presence of near-infrared (NIR) light, due to the generation of electrons and holes, the WO₃-based heterostructure generates reactive oxygen species by photocatalytic reaction from water and oxygen, which kills superbugs. To enhance the photocatalytic superbug killing efficiency, r-GO has been used for suppressing the recombination of the photoinduced electron-hole pairs. Reported data show that NIR light-driven synergistic photocatalytic-photothermal processes can be used for 100% degradation of methylene blue using a heterostructure-based catalyst, and the photodegradation rate for the heterostructure is much better than the literature data for different types of WO₃/GO-based nanocomposites. Experimentally, time-dependent antibacterial efficiency data reveals that the heterostructure can destroy 100% superbugs within 30 min of light exposure via a synergistic photothermal and photocatalytic mechanism, whereas the WO₃ nanowire can kill around 35% superbugs only via photocatalytic action only and r-GO can kill 25% superbugs via photothermal action even after 30 min of exposure to light. Systematic time-dependent microscopy and spectroscopy studies reveal that the excellent antisuperbug activities for heterostructures are due to membrane damage, ATP, and DNA/RNA breakage. For possible real-life applications, sun light-based superbug inactivation shows 100% inactivation possible within 250 min of light exposure using 12 mg/mL heterostructures. The reported sun light-driven killing of superbugs provides a simple and versatile platform to combat drug-resistant superbugs.

Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial

BACKGROUND

Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT.

METHODS

TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890).

FINDINGS

From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64).

INTERPRETATION

In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT.

FUNDING

Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.