Online KidClot education for patients and families initiating warfarin therapy: The eKITE study

Anticoagulation with Vitamin K antagonists (VKA) has always posed challenges in terms of monitoring requirements. These challenges were further exacerbated in the setting of the COVID-19 pandemic, with limited access to and/or avoidance of laboratory testing. The importance of utilizing point of care (POC) health technology for individualized patient management is salient. The foundation of effective home INR monitoring is establishing patient knowledge about their therapy and INR testing proficiency. The eKITE series was developed to support patients in establishing foundational knowledge required for VKA (warfarin) management and INR monitoring. The primary objectives were to evaluate eKITE, a patient-oriented innovative online education program for warfarin therapy, participant learning stress, and patient preference for online learning. This multi-center prospective study provided patients access to warfarin online education. Participants were required to complete written quizzes assessing warfarin knowledge of key concepts proficiency and identifying knowledge deficits. Patient preference, evaluating calm (lack of anxiety) while learning, and an INR on a home meter was completed. Participants performed INR tests at home and reported INRs by telephone. The analysis included 144 children and caregivers enrolled at five US and CDN sites. Most indications for anticoagulation were cardiac (congenital or acquired heart disease) with varied INR target ranges. Mean knowledge scores for warfarin and INR self-testing modules were 97%, with low anxiety with TTR of 84%. Patient preferred online learning. eKITE is an effective teaching modality for warfarin/home INR monitoring with safe INR testing and warfarin management that is appropriate for pediatrics and adults alike. PROLOGUE: The whir in the hallways is deafening. Lights bright, alarms are ringing in a chorus of unsynchronized beeps and screeches. It has been more than a week since I have slept. Snuggled beside me is my precious child, whining and equally irritated with the asynchronous symphony, further compounded by anxiety, procedures, and pain. The sun has broken. The staff smiles are welcoming and incessant, as one after one, they approach hurried, urgent, assiduous, their need to coach me for our upcoming departure to the warmth of home. Each provides essential information that I will require to keep my child, my treasure, safe and healthy. Yet, my eyes are heavy, blurred, and my brain foggy, trapped in a dark heavy cloud. How am I to follow? Comprehend? and retain anything? As they instruct, my precious child yearns for loving arms, compassion and love, whining, crying in disquiet. Overwhelmed does not adequately describe my ineffable exhaustion. Amidst this, how am I to learn about warfarin? Such a challenging medication, with so much to know. Concentrate, I tell myself, focus; now is my only opportunity to learn. I must be alert. It seems to be nonsensical.

Picosecond photoresponse in van der Waals heterostructures

Two-dimensional crystals such as graphene and transition-metal dichalcogenides demonstrate a range of unique and complementary optoelectronic properties. Assembling different two-dimensional materials in vertical heterostructures enables the combination of these properties in one device, thus creating multifunctional optoelectronic systems with superior performance. Here, we demonstrate that graphene/WSe2/graphene heterostructures ally the high photodetection efficiency of transition-metal dichalcogenides with a picosecond photoresponse comparable to that of graphene, thereby optimizing both speed and efficiency in a single photodetector. We follow the extraction of photoexcited carriers in these devices using time-resolved photocurrent measurements and demonstrate a photoresponse time as short as 5.5 ps, which we tune by applying a bias and by varying the transition-metal dichalcogenide layer thickness. Our study provides direct insight into the physical processes governing the detection speed and quantum efficiency of these van der Waals heterostuctures, such as out-of-plane carrier drift and recombination. The observation and understanding of ultrafast and efficient photodetection demonstrate the potential of hybrid transition-metal dichalcogenide-based heterostructures as a platform for future optoelectronic devices.

Generation of photovoltage in graphene on a femtosecond timescale through efficient carrier heating

Graphene is a promising material for ultrafast and broadband photodetection. Earlier studies have addressed the general operation of graphene-based photothermoelectric devices and the switching speed, which is limited by the charge carrier cooling time, on the order of picoseconds. However, the generation of the photovoltage could occur at a much faster timescale, as it is associated with the carrier heating time. Here, we measure the photovoltage generation time and find it to be faster than 50 fs. As a proof-of-principle application of this ultrafast photodetector, we use graphene to directly measure, electrically, the pulse duration of a sub-50 fs laser pulse. The observation that carrier heating is ultrafast suggests that energy from absorbed photons can be efficiently transferred to carrier heat. To study this, we examine the spectral response and find a constant spectral responsivity of between 500 and 1,500 nm. This is consistent with efficient electron heating. These results are promising for ultrafast femtosecond and broadband photodetector applications.

Hot-carrier photocurrent effects at graphene-metal interfaces

Photoexcitation of graphene leads to an interesting sequence of phenomena, some of which can be exploited in optoelectronic devices based on graphene. In particular, the efficient and ultrafast generation of an electron distribution with an elevated electron temperature and the concomitant generation of a photo-thermoelectric voltage at symmetry-breaking interfaces is of interest for photosensing and light harvesting. Here, we experimentally study the generated photocurrent at the graphene-metal interface, focusing on the time-resolved photocurrent, the effects of photon energy, Fermi energy and light polarization. We show that a single framework based on photo-thermoelectric photocurrent generation explains all experimental results.

Effects of temperature on tissue thermal injury and wound strength after photothermal wound closure

BACKGROUND AND OBJECTIVES

Our goal was to determine the effect of temperature on the induction of tissue damage after laser-welded wound closure with and without albumin solder.

STUDY DESIGN/MATERIALS AND METHODS

Multiple full-thickness skin incisions were made in a porcine model. Incisions were repaired by using a 1.32-microm laser at temperatures of 65 degrees C, 75 degrees C, 85 degrees C, or 95 degrees C with and without a 50% human albumin solder. The rate of apoptosis (programmed cell death) was quantified by counting the proportion of cells that stained positively for nuclear DNA fragmentation (nick end labeling). The distance that necrosis extended from the wound edge was also measured. The strength of the weld was measured with a tensiometer.

RESULTS

For laser-welded repairs with solder, the amount of apoptosis at 65 degrees C and 75 degrees C was comparable to that of controls but became significantly elevated at 85 degrees C and 95 degrees C. The extent of necrosis was similar to that of controls at low temperature but also increased at 95 degrees C. Incisions repaired without solder showed increased necrosis compared with those repaired with solder at temperatures of 65 degrees C, 75 degrees C, and 95 degrees C at 0-0.5 mm from the incision. Wounds repaired at 85 degrees C and 95 degrees C showed more apoptosis in the absence of solder. The increased cell death at higher temperatures correlated with significantly decreased wound strengths at 3 days after repair in the solder group. A lower rate of cell death was observed in the solder group, which correlated with superior wound strength when compared with repairs without solder at days 0 (65-95 degrees C) and 3 (95 degrees C).

CONCLUSION

Both apoptotic and necrotic cell death were used as quantitative measures of tissue injury and were accurate predictors of short-term wound strength. The addition of albumin solder decreased overall tissue injury. These results suggest that temperatures of 65-75 degrees C with solder provide the optimal conditions for maximizing acute wound strength and minimizing tissue injury.