An effective device to enable consistent scratches for in vitro scratch assays.

BACKGROUND: The in-vitro scratch assay is a useful method in wound healing research to assess cell migration. In this assay, a scratch is created in a confluent cell layer by mechanically removing cells through manual scraping with a sharp-edged tool. This step is traditionally done with pipette tips and is unsuitable for high-throughput assays, as the created scratches are highly variable in width and position. Commercially available solutions are often expensive, and require specific cultureware which might not be suitable for all studies. RESULTS: In this study, we have developed a flexible cell scratch device comprising a single wounding tool, a guide and an imaging template for consistent and reproducible scratch assays in 96-well plates. Our results showed that the device produced a more consistent scratch profile compared to the conventional method of using pipette tips. The imaging template also allowed operators to easily locate and image the same region of interest at different time points, which potentially could be used for other assays. CONCLUSIONS: Our flexible yet effective scratch device thus enables robust scratch assays that can be applied to different experimental needs, providing researchers with an easy and reliable tool for their studies.

Early humoral and cellular responses after bivalent SARS-CoV-2 mRNA-1273.214 vaccination in long-term care and retirement home residents in Ontario, Canada: An observational cohort study.

Immunogenicity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) bivalent mRNA-1273.214 vaccine (Original/Omicron B.1.1.529 [BA.1]) is underreported in vulnerable older adults in congregate care settings. In residents of 26 long-term care and retirement homes in Ontario, Canada, humoral (i.e., serum anti-spike and anti-receptor binding domain [anti-RBD]) IgG and IgA antibodies and live SARS-CoV-2 neutralization) and cellular (i.e., CD4+ and CD8+ activation-induced marker spike-specific T cell memory) responses were assessed 7-120 days postvaccination with four monovalent mRNA vaccines (n = 494) or subsequent bivalent mRNA-1273.214 vaccination (fifth vaccine) (n = 557). Within 4 months, anti-spike and anti-RBD antibody levels were similar after monovalent and bivalent vaccination in infection-naïve individuals. Hybrid immunity (i.e., vaccination and natural infection) generally increased humoral responses. After bivalent vaccination, compared to monovalent vaccination, residents with hybrid immunity had elevated anti-spike and anti-RBD IgG and IgA antibodies. Omicron BA.1 antibody-mediated neutralization, and CD8+ T cell memory responses to the Omicron BA.1 spike protein, were also higher after bivalent vaccination. Humoral and cellular responses were, therefore, noninferior within 4 months of bivalent mRNA-1273.214 vaccination compared to monovalent mRNA vaccination. Waning of humoral but not cellular immunity was particularly evident in individuals without hybrid immunity. Continued monitoring of vaccine-associated and hybrid immunity against emerging Omicron variants of concern is necessary to assess longevity of protection.

The framework of Systematic Assessment for Resilience (SAR): development and validation.

BACKGROUND: Burnout and depression among health professions education (HPE) students continue to rise, leading to unwanted effects that ultimately jeopardise optimal medical care and patient health. Promoting the resilience of medical students is one solution to this issue. Several interventions have been implemented to foster resilience, but they focus on aspects other than the primary cause: the assessment system. The purpose of this study is to develop a framework to promote resilience in assessment planning and practice. METHODS: We followed the guidelines suggested by Whetten for constructing a theoretical model for framework development. There were four phases in the model development. In the first phase, different literature review methods were used, and additional students' perspectives were collected through focus group discussions. Then, using the data, we constructed the theoretical model in the second phase. In the third phase, we validated the newly developed model and its related guidelines. Finally, we performed response process validation of the model with a group of medical teachers. RESULTS: The developed systematic assessment resilience framework (SAR) promotes four constructs: self-control, management, engagement, and growth, through five phases of assessment: assessment experience, assessment direction, assessment preparation, examiner focus, and student reflection. Each phase contains a number of practical guidelines to promote resilience. We rigorously triangulated each approach with its theoretical foundations and evaluated it on the basis of its content and process. The model showed high levels of content and face validity. CONCLUSIONS: The SAR model offers a novel guideline for fostering resilience through assessment planning and practice. It includes a number of attainable and practical guidelines for enhancing resilience. In addition, it opens a new horizon for HPE students' future use of this framework in the new normal condition (post COVID 19).

Rates of health services use among residents of retirement homes in Ontario: a population-based cohort study.

BACKGROUND: Because there are no standardized reporting systems specific to residents of retirement homes in North America, little is known about the health of this distinct population of older adults. We evaluated rates of health services use by residents of retirement homes relative to those of residents of long-term care homes and other populations of older adults. METHODS: We conducted a retrospective cohort study using population health administrative data from 2018 on adults 65 years or older in Ontario. We matched the postal codes of individuals to those of licensed retirement homes to identify residents of retirement homes. Outcomes included rates of hospital-based care and physician visits. RESULTS: We identified 54 733 residents of 757 retirement homes (mean age 86.7 years, 69.0% female) and 2 354 385 residents of other settings. Compared to residents of long-term care homes, residents of retirement homes had significantly higher rates per 1000 person months of emergency department visits (10.62 v. 4.48, adjusted relative rate [RR] 2.61, 95% confidence interval [CI] 2.55 to 2.67), hospital admissions (5.42 v. 2.08, adjusted RR 2.77, 95% CI 2.71 to 2.82), alternate level of care (ALC) days (6.01 v. 2.96, adjusted RR 1.51, 95% CI 1.48 to 1.54), and specialist physician visits (6.27 v. 3.21, adjusted RR 1.64, 95% CI 1.61 to 1.68), but a significantly lower rate of primary care visits (16.71 v. 108.47, adjusted RR 0.13, 95% CI 0.13 to 0.14). INTERPRETATION: Residents of retirement homes are a distinct population with higher rates of hospital-based care. Our findings can help to inform policy debates about the need for more coordinated primary and supportive health care in privately operated congregate care homes.

Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada.

BACKGROUND: Many residents of assisted living facilities live with dementia, but little is known about the characteristics of assisted living facilities that provide specialized care for older adults who live with dementia. In this study, we identify the characteristics of assisted living facilities that offer a dementia care program, compared to those that do not offer such a program. METHODS: We conducted a population-level cross-sectional study on all licensed assisted living facilities in Ontario, Canada in 2018 (n = 738). Facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of the other 12 provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program. RESULTS: There were 123 assisted living facilities that offered a dementia care program (16.7% versus 83.3% no dementia care). Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7% versus 21.6% no dementia care) and more than 115 suites (46.3% versus 20.8% no dementia care). All assisted living facilities that offered a dementia care program also offered nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjustment for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding (Prevalence Ratio [PR] 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that offered medical services (PR 1.78, 95% CI 1.00 to 3.17), compared to those that did not. CONCLUSIONS: A dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and offered at least five of the other 12 regulated care services. Our findings deepen the understanding of specialized care for dementia in assisted living facilities.

Efficacy and Safety of Pleurodesis Using Platelet-Rich Plasma and Fibrin Glue in Management of Postoperative Chylothorax After Esophagectomy.

INTRODUCTION: Chylothorax is by definition a collection of lymphatic fluids in the pleural cavity because of leakage from main thoracic duct or its tributaries. It is an uncommon but serious postoperative complication in esophageal cancer patients. There is no standard therapeutic algorithm for chylothorax because no prospective or randomized trials have yet been performed to evaluate the available treatment options. The aim of this study was to evaluate the efficacy of pleurodesis with a combination of platelet-rich plasma (PRP) and fibrin glue to the treatment of chylothorax after trans-hiatal esophagectomy. MATERIALS AND METHODS: We randomly allocated 52 consecutive esophageal cancer patients with postoperative chylothorax who did not respond to conservative management to either PRP fibrin glue pleurodesis or surgical thoracic duct ligation. 26 patients in each group were treated with PRP fibrin glue pleurodesis or surgical thoracic duct ligation in order to control chylothorax. Perioperative data, including success rate and complications of both interventions, were analyzed. RESULTS: Two groups were similar in terms of patients' demographics and tumor characteristics. All 26 patients in pleurodesis group (100%) and 20 patients in surgery group (76.9%) were successfully treated (p = 0.009). Seven patients (26.92%) in pleurodesis group required a second application of PRP fibrin glue after a week. The mean length of hospital stay was 53.50 ± 16.662 days in surgery group and 36.04 ± 8.224 days in pleurodesis group (p < 0.001). Although mortality rate in surgery group was higher than pleurodesis group, it was not statistically significant (p = 0.1621). There was no significant difference in complications between two groups either. No serious side effect occurred with PRP fibrin glue application. CONCLUSION: In conclusion, pleurodesis using PRP and fibrin glue for chylothorax after trans-hiatal esophagectomy was associated with significantly increased success rate, decreased ICU stay, decreased overall hospital stay, and decreased mortality compared with surgical thoracic duct ligation. No patient after PRFG required additional intervention including surgery. Thus, given the improved outcomes with PRFG pleurodesis, this technique may be considered in all patients with postoperative chylothorax after or during conservative management and before proceeding to more invasive interventions.

Biodegradation of polyethylene (PE), polypropylene (PP), and polystyrene (PS) microplastics by floc-forming bacteria, Bacillus cereus strain SHBF2, isolated from a commercial aquafarm.

The ubiquitous proximity of the commonly used microplastic (MP) particles particularly polyethylene (PE), polypropylene (PP), and polystyrene (PS) poses a serious threat to the environment and human health globally. Biological treatment as an environment-friendly approach to counter MP pollution has recent interest when the bio-agent has beneficial functions in their ecosystem. This study aimed to utilize beneficial floc-forming bacteria Bacillus cereus SHBF2 isolated from an aquaculture farm in reducing the MP particles (PE, PP, and PS) from their environment. The bacteria were inoculated for 60 days in a medium containing MP particle as a sole carbon source. On different days of incubation (DOI), the bacterial growth analysis was monitored and the MP particles were harvested to examine their weight loss, surface changes, and alterations in chemical properties. After 60 DOI, the highest weight loss was recorded for PE, 6.87 ± 0.92%, which was further evaluated to daily reduction rate (k), 0.00118 day-1, and half-life (t1/2), 605.08 ± 138.52 days. The OD value (1.74 ± 0.008 Abs.) indicated the higher efficiency of bacteria for PP utilization, and so for the colony formation per define volume (1.04 × 1011 CFU/mL). Biofilm formation, erosions, cracks, and fragments were evident during the observation of the tested MPs using the scanning electron microscope (SEM). The formation of carbonyl and alcohol group due to the oxidation and hydrolysis by SHBF2 strain were confirmed using the Fourier transform infrared spectroscopic (FTIR) analysis. Additionally, the alterations of pH and CO2 evolution from each of the MP type ensures the bacterial activity and mineralization of the MP particles. The findings of this study have confirmed and indicated a higher degree of biodegradation for all of the selected MP particles. B. cereus SHBF2, the floc-forming bacteria used in aquaculture, has demonstrated a great potential for use as an efficient MP-degrading bacterium in the biofloc farming system in the near future to guarantee a sustainable green aquaculture production.

Predictors of musculoskeletal disorders among special education teachers in Sabah, Malaysia.

Special education teachers encounter considerable occupational challenges, yet there is limited information concerning musculoskeletal disorders (MSD) within this group. Therefore, this study aimed to address this gap by determining the prevalence of MSD, investigating associated factors of MSD, and identifying predictors of MSD among special education teachers. A cross-sectional study was conducted among special education teachers in Kota Kinabalu and Penampang, Sabah. Data were collected through self-administered questionnaires and musculoskeletal fitness assessments. Chi-square tests and independent t-tests were utilized to determine factors associated with MSD, while multiple logistic regression was performed to develop a comprehensive predictive model for MSD, which was then validated and tested for model fitness. A total of 122 individuals participated in the study, yielding a response rate of 95 %. The findings revealed a high prevalence of MSD (77.9 %) among special education teachers, with the lower back, shoulder, neck, knee, upper back, and foot being the most affected regions. The multivariable regression model identified several predictors of MSD, including marital status (adjusted odds ratio [aOR] = 4.78, 95 % confidence interval [CI] = 1.49-15.40), body fat percentage (aOR = 1.06, 95 % CI = 1.00-1.12), teaching in prolonged standing for few days a week (aOR = 3.20, 95 % CI = 0.99-10.29) or every day (aOR = 6.20, 95 % CI = 1.44-26.70), mindfulness (aOR = 0.47, 95 % CI = 0.22-0.98), and back extensor strength (aOR = 5.86, 95 % CI = 1.92-17.92). This study highlights the necessity of implementing interventions focusing on the ergonomic, psychological, and musculoskeletal fitness components to mitigate the prevalence of MSD and improve the overall well-being of special education teachers.

The impact of medical education on psychological health of students: a cohort study.

Many studies have shown that the prevalence of psychological distress among medical students during medical training is higher than that in general population. A few studies have shown that the prevalence of psychological distress among medical students before the onset of medical training was similar to general population. This study aimed to investigate psychological health of medical students before and during medical training. A one-year prospective study was done on successful applicants who undergo the first year of medical training for 2010/2011 academic session. The stress, anxiety and depression were measured by the DASS-21 at five intervals; during interview (Time 0), two months (Time 1), four months (Time 2), six months (Time 3) and final examination (Time 4) of the first year medical training. The prevalence of unfavourable stress, anxiety and depression before the onset of medical training was 4.1%, 55.6% and 1.8%, respectively. The prevalence of unfavourable stress during medical training ranged between 11.8% and 19.9%. The prevalence of anxiety during medical training ranged between 41.1% and 56.7%. The prevalence of depression during medical training ranged between 12% and 30%. Mean scores of stress and depression before (Time 0) and during medical training (Time 1-4) were significantly different (p < 0.001). The prevalence and level of unfavourable stress and depression during medical training were significantly higher than before the onset medical training. This study supports views that medical training is not an optimal environment to psychological health of medical students.

A longitudinal study of relationships between previous academic achievement, emotional intelligence and personality traits with psychological health of medical students during stressful periods.

CONTEXT: There is considerable evidence that emotional intelligence, previous academic achievement (i.e. cumulative grade point average (GPA)) and personality are associated with success in various occupational settings. This study evaluated the relationships of these variables with psychological health of first year medical students during stressful periods. METHODS: A 1-year prospective study was done with students accepted into the School of Medical Sciences, Universiti Sains Malaysia. Information on emotional intelligence, GPA and personality traits were obtained prior to admission. The validated Universiti Sains Malaysia Emotional Quotient Inventory and Universiti Sains Malaysia Personality Inventory were used to measure emotional intelligence and personality traits, respectively. Stress, anxiety and depression were measured by the 21-item Depression Anxiety Stress Scale during the end-of-course (time 1) and final (time 2) examinations. RESULTS: At the less stressful period (time 1), stress level was associated with agreeableness and the final GPA, anxiety level was associated with emotional control and emotional conscientiousness and depression level was associated with the final GPA and extraversion. At the more stressful period (time 2), neuroticism associated with stress level, anxiety level was associated with neuroticism and emotional expression, and depression level was associated with neuroticism. CONCLUSIONS: This study found that neuroticism was the strongest associated factor of psychological health of medical students during their most stressful testing period. Various personality traits, emotional intelligence and previous academic performance were associated factors of psychological health during a less stressful period. These data suggest that early identification of medical students who are vulnerable to the stressful environment of medical schools might help them maintain psychological well-being during medical training.

Assessment on Water Quality Parameter and Nutrients Level of Nyatuh River in Relations with Macrobrachium Rosenbergii Prawn Populations.

In order to determine the safety level of water parameters and nutrients in the natural environment of fish and freshwater prawn in Nyatuh River, Terengganu, Malaysia, it is necessary to conduct an assessment of water quality parameters. Due to its important, a study was conducted to assess the water quality parameter and nutrients contents from Nyatuh River of Setiu Terengganu in relations to the population of freshwater prawn, Macrobrachium rosenbergii caught along the Nyatuh River basin. Total of four expeditions and five stations at different tidal condition for the water quality parameter were assessed during the study. From the results achieved, the overall temperature varied between (26.56°C-29.30°C), dissolved oxygen, DO (3.59 mg/L-6.50 mg/L), pH (4.99-7.01), salinity (0.01ppt-4.22ppt), depth (2.71 m-5.54 m) while for ammonia (0.01 mg/L-0.24 mg/L), nitrite (0.01 mg/L-0.05 mg/L) and phosphate (0.01 mg/L-0.12 mg/L). While the number of prawns caught are 176, 160, 102 and 68 for Expeditions 1, 2, 4 and 3, respectively. Possibly, the heterogeneous number of prawns caught is a result of significant differences in water level depth during high tides and low tides, as well as a fluctuation in the ammonia concentration levels in each of the stations and expeditions. For statistical analysis, the temperature showed no significant difference between the expedition, stations and tidal. That is p = 0.280, p > 0.05 and F = 1.206, respectively. While dissolved oxygen, DO, showed no significant difference as well, that is p = 0.714, p > 0.05 and F = 0.737. However, the level of water depth was significantly different between expedition, station and tidal, that is p = 0.000, p < 0.05 and F = 3.120. Ammonia, on the other hand shows no significant difference between expedition, station and tidal, that is p = 0.476, p > 0.05 and F = 0.973. The same goes for nitrite and phosphate concentration. There was no significant difference between expedition, stations and tidal, that is p = 0.569, p > 0.05 and F = 0.879 and p = 0.247, p > 0.05, F = 1.255, respectively. In Expedition 1, the good water quality parameter and very low ammonia concentration resulted in a larger prawn population as compared to other expeditions. The distribution or mixture of prawns caught is heterogeneous at different stations due to the significant differences in water depth and also to the fluctuation in water quality due to varying ammonia levels. In conclusion, the water quality in Nyatuh River fluctuated across expeditions, stations, and tides, as well as significant differences in water level depths between high and low tides. Due to the rapid growth and importance of industrial and aquaculture operations along the river, extra attention should be devoted to avoid the impact of excessive pollutant in order to protect the ecosystem.

Penilaian parameter kualiti air perlu dijalankan untuk menentukan tahap keselamatan parameter air dan nutrien dalam persekitaran semula jadi ikan dan udang air tawar di Sungai Nyatuh, Terengganu, Malaysia. Maka, satu kajian telah dijalankan untuk menilai parameter kualiti air dan kandungan nutrien di Sungai Nyatuh, Setiu, Terengganu dalam hubungan dengan populasi udang air tawar, Macrobrachium rosenbergii yang ditangkap di sepanjang lembangan Sungai Nyatuh. Sebanyak empat ekspedisi dan lima stesen pada keadaan pasang surut berbeza untuk parameter kualiti air telah dinilai semasa kajian dijalankan. Berdasarkan keputusan yang dicapai, suhu keseluruhan berbeza-beza antara (26.56°C­29.30°C), oksigen terlarut (3.59 mg/L­6.50 mg/L), pH (4.99­7.01), kadar kemasinan (0.01ppt­4.22ppt), kedalaman (2.71 m­5.54 m) sementara bagi ammonia (0.01 mg/L­0.24 mg/L), nitrit (0.01 mg/L­0.05 mg/L) dan fosfat (0.01 mg/L­0.12 mg/L). Manakala bilangan udang yang ditangkap adalah 176, 160, 102 and 68 ekor, masing-masing untuk Ekspedisi 1, 2, 4 dan 3. Bilangan heterogen udang yang ditangkap berkemungkinan adalah hasil daripada perbezaan ketara dalam kedalaman paras air semasa air pasang dan air surut, serta turun naik paras kepekatan ammonia di setiap stesen dan ekspedisi. Bagi analisis statistik, suhu tidak menunjukkan perbezaan yang signifikan antara ekspedisi, stesen dan pasang surut, iaitu p = 0.280, p > 0.05 dan F = 1.206, masing-masing. Oksigen terlarut juga tidak menunjukkan perbezaan yang signifikan, iaitu p = 0.714, p > 0.05 dan F = 0.737. Walau bagaimanapun, paras kedalaman air adalah berbeza secara signifikan antara ekspedisi, stesen dan pasang surut, iaitu p = 0.000, p < 0.05 dan F = 3.120. Ammonia pula tidak menunjukkan perbezaan yang signifikan antara ekspedisi, stesen dan pasang surut, iaitu p = 0.476, p > 0.05 dan F = 0.973. Begitu juga dengan kepekatan nitrit dan fosfat. Tidak terdapat perbezaan yang signifikan di antara ekspedisi, stesen dan pasang surut, iaitu masing-masing pada p = 0.569, p > 0.05 dan F = 0.879 dan p = 0.247, p > 0.05, F = 1.255. Dalam Ekspedisi 1, parameter kualiti air yang baik dan kepekatan ammonia yang sangat rendah menghasilkan populasi udang yang lebih besar berbanding ekspedisi lain. Taburan atau campuran udang yang ditangkap adalah heterogen di stesen yang berbeza disebabkan oleh perbezaan ketara dalam kedalaman air dan juga turun naik kualiti air akibat paras ammonia yang berbeza-beza. Kesimpulannya, kualiti air di Sungai Nyatuh berubah-ubah merentasi ekspedisi, stesen dan pasang surut, serta perbezaan ketara dalam kedalaman paras air antara air pasang tinggi dan rendah. Disebabkan pertumbuhan pesat dan kepentingan operasi perindustrian dan akuakultur di sepanjang sungai, perhatian tambahan harus ditumpukan untuk mengelakkan kesan pencemar yang berlebihan untuk melindungi ekosistem.

Arum palaestinum delays hepatocellular carcinoma proliferation through the PI3K-AKT-mTOR signaling pathway and exhibits anticoagulant effects with antimicrobial properties.

Background: Arum palaestinum Boiss (AP) is a wild plant in Palestine whose leaves have a long history as food and medicine in Middle Eastern countries. The current study aimed to evaluate the biological characteristics of AP flower extract, including its antimicrobial and coagulation cascade activities and its effects on anticancer molecular pathways. Methods: The antimicrobial activity of the aqueous extract of AP flowers was assessed using a microdilution assay against eight pathogens. The coagulation properties were assessed by prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT) tests using standard hematological methods. The biological effects of AP on hepatocellular carcinoma were measured by assessing the impact of AP on cell cycle, proliferation (CFSE), apoptosis (annexin-v+/PI), and tumorigenicity (αFP and HBsAg), as well as its effects on the PI3K-AKT-mTOR molecular signaling pathway. Results: The antimicrobial screening results revealed that the aqueous extract of AP had potent antibacterial effects against P. vulgaris and E. faecium compared to ampicillin, with MIC values of 6.25, 6.25, and 18 µg/mL, respectively. Moreover, the AP aqueous extract exerted anticoagulant activity, with significant prolonged results in the aPTT and TT tests (25 µg/mL and 50 µg/mL, respectively) and slightly prolonged results in the PT test (50 µg/mL). The anticancer results indicated a delay in the cell cycle through decreased cell proliferation rates following incubation with AP fractions. The effect of the aqueous fraction was most evident in a delay in the S phase. The aqueous and DMSO fractions maintained the cells in the G2-M phase, similar to the DOX, while the flower extract in methanol accelerated the cells in the G2-M phase, suggesting that AF flower extracts may have anti-cancer properties. The aqueous extract of AP 1) reduced secretions of HCC αFP by 1.55-fold and 3.3-fold at the 50 and 100 µg/mL concentrations, respectively (p = 0.0008); 2) decreased phosphorylation in the PI3K-AKT-mTOR signaling pathway (p < 0.05); and 3) shifted cells from necrosis to apoptosis by 50% and 70% at the 50 and 100 µg/mL concentrations, respectively (p < 0.05). Conclusion: The results of this study showed the activities of the bioactive components for the treatment of infectious diseases and blood coagulation disorders, which could also be a potential therapeutic approach for delaying HCC tumorigenicity.

The association between patients' timely access to their usual primary care physician and use of walk-in clinics in Ontario, Canada: a cross-sectional study.

BACKGROUND: Challenges in timely access to one's usual primary care physician and the ongoing use of walk-in clinics have been major health policy issues in Ontario for over a decade. We sought to determine the association between patient-reported timely access to their usual primary care physician or clinic and their use of walk-in clinics. METHODS: We conducted a cross-sectional study of Ontario residents who had a primary care physician by linking population-based administrative data to Ontario's Health Care Experience Survey, collected between 2013 and 2020. We described sociodemographic characteristics and health care use for users of walk-in clinics and nonusers. We measured the adjusted association between self-reported same-day or next-day access and after-hours access to usual primary care physicians or clinics and the use of walk-in clinics in the previous 12 months. RESULTS: Of the 60 935 total responses from people who had a primary care physician, 16 166 (weighted 28.6%, unweighted 26.5%) reported visiting a walk-in clinic in the previous 12 months. Compared with nonusers, those who used walk-in clinics were predominantly younger, lived in large and medium-sized urban areas and reported a tight, very tight or poor financial situation. Respondents who reported poor same-day or next-day access to their primary care physician or clinic were more likely to report having attended a walk-in clinic in the previous 12 months than those with better access (adjusted odds ratio [OR] 1.23, 95% confidence interval [Cl] 1.13-1.34). Those who reported being unaware that their primary care physician offered after-hours care had a higher likelihood of going to a walk-in clinic (adjusted OR 1.14, 95% Cl 1.07-1.21). INTERPRETATION: In this population-based health survey, patient-reported use of walk-in clinics was associated with a reported lack of access to same-day or next-day care and unawareness of after-hours care by respondents' usual primary care physicians. These findings could inform policies to improve access to primary care, while preserving care continuity.

Microplastics biodegradation by biofloc-producing bacteria: An inventive biofloc technology approach.

Microplastics pollution has become a threat to aquaculture practices, as nearly all farming systems are saturated with microplastics (MPs) particles. Current research on MPs is limited considering their effects on aquatic organisms and human health. However, limited research has been conducted on potential cures and treatments. In today's world, bioremediation of needful parameters in different culture systems is being successfully practiced by introducing floc-forming bacteria. Researchers had found that some bacteria are efficacious in degrading microplastics particles including polyethylene (PE), polystyrene (PS), and polypropylene (PP). In addition, some bacteria that can form floc, are being used in fish and shellfish culture systems to treat toxic pollutants as the heterotrophic bacteria use organic compounds to grow and are effective in degrading microplastics and minimizing toxic nitrogen loads in aquaculture systems. In this review, the ability of biofloc bacteria to degrade microplastics has been summarized by collating the results of previous studies. The concept of this review may represent the efficacy of biofloc technology as an implicit tool in the fish culture system restricting the MPs contamination in water resources to safeguard ecological as well as human health.

Protection from Omicron Infection in Residents of Nursing and Retirement Homes in Ontario, Canada.

OBJECTIVES: To identify factors that contribute to protection from infection with the Omicron variant of SARS-CoV-2 in older adults in nursing and retirement homes. DESIGN: Longitudinal cohort study with retrospective analysis of infection risk. SETTING AND PARTICIPANTS: 997 residents of nursing and retirement homes from Ontario, Canada, in the COVID in LTC study. METHODS: Residents with 3 messenger RNA (mRNA) dose vaccinations were included in the study. SARS-CoV-2 infection was determined by positive nasopharyngeal polymerase chain reaction test and/or circulating antinucleocapsid IgG antibodies. Cumulative probability of Omicron infection after recent COVID-19 was assessed by log-rank test of Kaplan-Meier curves. Cox regression was used to assess risk of Omicron infection by age, sex, mRNA vaccine combination, whether individuals received a fourth dose, as well as recent COVID-19. RESULTS: In total, 171 residents (17.2%) had a presumed Omicron variant SARS-CoV-2 infection between December 15, 2021 (local start of the first Omicron wave) and May 3, 2022. Risk of Omicron infection was not different by age [hazard ratio (95% confidence interval) 1.01 (0.99‒1.02)], or in women compared with men [0.97 (0.70‒1.34)], but infection risk decreased 47% with 3 vaccine doses of mRNA-1273 (Moderna) compared with BNT162b2 (Pfizer) [0.53 (0.31-0.90)], 81% with any fourth mRNA vaccine dose [0.19 (0.12‒0.30)], and 48% with SARS-CoV-2 infection in the 3 months prior to beginning of the Omicron wave [0.52, (0.27‒0.99)]. CONCLUSIONS AND IMPLICATIONS: Vaccine type (ie, mRNA-1273/Spikevax vs BNT162b2/Cominarty), any fourth vaccine dose, and hybrid immunity from recent COVID-19, were protective against infection with the Omicron variant. These data emphasize the importance of vaccine type, and number of vaccine doses, in maintenance of protective immunity and reduction of risk of Omicron variant breakthrough infection. These findings promote continued public health efforts to support vaccination programs and monitor vaccine immunogenicity in older adults.

Microplastics pollution in mud crab (Scylla sp.) aquaculture system: First investigation and evidence.

Microplastics (MPs) occurrence in farmed aquatic organisms has already been the prime priority of researchers due to the food security concerns for human consumption. A number of commercially important aquaculture systems have already been investigated for MPs pollution but the mud crab (Scylla sp.) aquaculture system has not been investigated yet even though it is a highly demanded commercial species globally. This study reported the MPs pollution in the mud crab (Scylla sp.) aquaculture system for the first time. Three different stations of the selected aquafarm were sampled for water and sediment samples and MPs particles in the samples were isolated by the gravimetric analysis (0.9% w/v NaCl solution). MP abundance was visualized under a microscope along with their size, shape, and color. A subset of the isolated MPs was analyzed by scanning electron microscope (SEM), and Fourier transform infrared spectroscopy (FTIR) for the surface and chemical characterization respectively. The average MPs concentration was 47.5 ± 11.875 particles/g in sediment and 127.92 ± 14.99 particles/100 L in the water sample. Fibrous-shaped (72.17%) and transparent-colored (59.37%) MPs were dominant in all the collected samples. However, smaller MPs (>0.05-0.5 mm) were more common in the water samples (47.69%) and the larger (>1-5 mm) MPs were in the sediment samples (47.83%). SEM analysis found cracks and roughness on the surface of the MPs and nylon, polyethylene, polypropylene, and polystyrene MPs were identified by FTIR analysis. PLI value showed hazard level I in water and level II in sediment. The existence of deleterious MPs particles in the mud crab aquaculture system was well evident. The other commercial mud crab aquafarms must therefore be thoroughly investigated in order to include farmed mud crabs as an environmentally vulnerable food security concern.

Improving Tuberculosis Medication Adherence: The Potential of Integrating Digital Technology and Health Belief Model.

Tuberculosis (TB) is a significant public health concern. Globally, TB is among the top 10 and the leading cause of death due to a single infectious agent. Providing standard anti-TB therapy for at least 6 months is recommended as one of the crucial strategies to control the TB epidemic. However, the long duration of TB treatment raised the issue of non-adherence. Non-adherence to TB therapy could negatively affect clinical and public health outcomes. Thus, directly observed therapy (DOT) has been introduced as a standard strategy to improve anti-TB medication adherence. Nonetheless, the DOT approach has been criticized due to inconvenience, stigma, reduced economic productivity, and reduced quality of life, which ultimately could complicate adherence issues. Apart from that, its effectiveness in improving anti-TB adherence is debatable. Therefore, digital technology could be an essential tool to enhance the implementation of DOT. Incorporating the health belief model (HBM) into digital technology can further increase its effectiveness in changing behavior and improving medication adherence. This article aimed to review the latest evidence regarding TB medication non-adherence, its associated factors, DOT's efficacy and its alternatives, and the use of digital technology and HBM in improving medication adherence. This paper used the narrative review methodology to analyze related articles to address the study objectives. Conventional DOT has several disadvantages in TB management. Integrating HBM in digital technology development is potentially effective in improving medication adherence. Digital technology provides an opportunity to improve medication adherence to overcome various issues related to DOT implementation.

Early Omicron infection is associated with increased reinfection risk in older adults in long-term care and retirement facilities.

Background: Older adults are at increased risk of SARS-CoV-2 Omicron infection and severe disease, especially those in congregate living settings, despite high SARS-CoV-2 vaccine coverage. It is unclear whether hybrid immunity (combined vaccination and infection) after one Omicron infection provides increased protection against subsequent Omicron reinfection in older adults. Methods: Incidence of SARS-CoV-2 Omicron infection was examined in 750 vaccinated residents of long-term care and retirement homes in the observational cohort COVID in Long-Term Care Study in Ontario, Canada, within a 75-day period (July to September 2022). Risk of infection was assessed by Cox proportional hazards regression. Serum anti-spike and anti-RBD SARS-CoV-2 IgG and IgA antibodies, microneutralization titres, and spike-specific T cell memory responses, were examined in a subset of 318 residents within the preceding three months. Findings: 133 of 750 participants (17.7%) had a PCR-confirmed Omicron infection during the observation period. Increased infection risk was associated with prior Omicron infection (at 9-29 days: 47.67 [23.73-95.76]), and this was not attributed to days since fourth vaccination (1.00 [1.00-1.01]) or residence outbreaks (>6 compared to ≤6: 0.95 [0.37-2.41]). Instead, reinfected participants had lower serum neutralizing antibodies to ancestral and Omicron BA.1 SARS-CoV-2, and lower anti-RBD IgG and IgA antibodies, after their initial Omicron infection. Interpretation: Counterintuitively, SARS-CoV-2 Omicron infection was associated with increased risk of Omicron reinfection in residents of long-term care and retirement homes. Less robust humoral hybrid immune responses in older adults may contribute to risk of Omicron reinfection. Funding: COVID-19 Immunity Task Force of the Public Health Agency of Canada.

A Study of Psychological Distress in Two Cohorts of First-Year Medical Students that Underwent Different Admission Selection Processes.

BACKGROUND: Medical training is often regarded as a stressful period. Studies have previously found that 21.6%-50% of medical students experience significant psychological distress. The present study compared the prevalence and levels of psychological distress between 2 cohorts of first-year medical students that underwent different admission selection processes. METHODS: A comparative cross-sectional study was conducted by comparing 2 cohorts of first-year medical students; 1 group (cohort 1) was selected based purely on academic merit (2008/2009 cohort) and the other group (cohort 2) was selected based on academic merit, psychometric assessment, and interview performance (2009/2010 cohort). Their distress levels were measured by the General Health Questionnaire, and scores higher than 3 were considered indicative of significant psychological distress. RESULTS: The prevalence (P = 0.003) and levels (P = 0.001) of psychological distress were significantly different between the 2 cohorts. Cohort 1 had 1.2-3.3 times higher risk of developing psychological distress compared to cohort 2 (P = 0.007). CONCLUSION: Cohort 2 had better psychological health than cohort 1 and was less likely to develop psychological distress. This study provided evidence of a potential benefit of multimodal student selection based on academic merit, psychometric assessment, and interview performance. This selection process might identify medical students who will maintain better psychological health.

Factors affecting test anxiety: a qualitative analysis of medical students' views.

BACKGROUND: Medical students are vulnerable to test anxiety (TA), which impacts their professional lives and jeopardizes the optimal health care of their patients. The qualitative exploration of TA among medical students is crucial to understanding the problem. Hence, this study examined medical students' insights into TA and their suggestions on how to reduce it. METHODS: We conducted a phenomenological study on medical students at a public university. We utilized focus group discussions (FGDs) to investigate their experiences of TA. The FGDs were transcribed verbatim, and these transcripts were analyzed using Atlas.ti software. The thematic analysis followed the recommended guidelines. RESULTS: Seven FGD sessions were conducted with 45 students. Three major themes emerged: the students, their academic resources, and the examiner. Each theme comprised mutually exclusive subthemes. The "students" theme was divided into negative vs. positive thoughts and self-negligence vs. self-care, "academic recources" into heavy curriculum vs. facilitative curricular aids, and "examiner" into criticism vs. feedback and strict vs. kind approaches. CONCLUSION: This study provides a solid foundation for policymakers and decision makers in medical education to improve current assessment practices and student well-being. Medical students will be able to significantly alter and reduce TA if they are provided with additional psychological support and their examiners are trained on how to deal with examinees.