Deep Learning-Enabled Multiplexed Point-of-Care Sensor using a Paper-Based Fluorescence Vertical Flow Assay.

Multiplexed computational sensing with a point-of-care serodiagnosis assay to simultaneously quantify three biomarkers of acute cardiac injury is demonstrated. This point-of-care sensor includes a paper-based fluorescence vertical flow assay (fxVFA) processed by a low-cost mobile reader, which quantifies the target biomarkers through trained neural networks, all within <15 min of test time using 50 µL of serum sample per patient. This fxVFA platform is validated using human serum samples to quantify three cardiac biomarkers, i.e., myoglobin, creatine kinase-MB, and heart-type fatty acid binding protein, achieving less than 0.52 ng mL-1 limit-of-detection for all three biomarkers with minimal cross-reactivity. Biomarker concentration quantification using the fxVFA that is coupled to neural network-based inference is blindly tested using 46 individually activated cartridges, which shows a high correlation with the ground truth concentrations for all three biomarkers achieving >0.9 linearity and <15% coefficient of variation. The competitive performance of this multiplexed computational fxVFA along with its inexpensive paper-based design and handheld footprint makes it a promising point-of-care sensor platform that can expand access to diagnostics in resource-limited settings.

Poly(dehydroalanine): Synthesis, Properties, and Functional Diversification of a Fluorescent Polypeptide.

Via the design of a new, soluble poly(S-alkyl-l-cysteine) precursor, a route was developed for the successful preparation of long-chain poly(dehydroalanine), ADH, as well as the incorporation of dehydroalanine residues and ADH segments into copolypeptides. Based on experimental and computational data, ADH was found to adopt a previously unobserved "hybrid coil" structure, which combines the elements of 25-helical and 310-helical conformations. Analysis of the spectroscopic properties of ADH revealed that it possesses a strong inherent blue fluorescence, which may be amenable for use in imaging applications. ADH also contains reactive electrophilic groups that allowed its efficient modification to functionalized polypeptides after reactions under mild conditions with thiol and amine nucleophiles. The combined structural, spectroscopic, and reactivity properties of ADH make it a unique reactive and fluorescent polypeptide component for utilization in self-assembled biomaterials.

Rigid versus flexible endoscopy for managing ingested foreign bodies-can we improve pathways?

PURPOSE: This study aims to evaluate management pathways, outcomes and safety of rigid endoscopy (RE) and flexible endoscopy (FE) for the treatment of impacted foreign bodies of the upper gastrointestinal tract (UGIT) in adults. METHODS: Retrospective study, included all patients undergoing RE or FE for impacted UGIT foreign body over an 11-year-period. RESULTS: A total of 144 patients were included (95 FE and 49 RE). FE were performed under local anaesthetic or sedation, and RE under GA. Success rate of FE and RE were 95.8% and 95.9% respectively. During FE an intra-procedural biopsy was performed in 45/95 (47.3%); with 26/95(27.4%) identifying mucosal pathology. Complications was significantly higher in patients having RE (40.8% versus 6.3%, p = .001). CONCLUSION: FE and RE are effective for the therapeutic management of impacted UGIT foreign bodies. However, FE can be performed under LA and was associated with fewer complications, favouring FE where possible as a first line option.

"The Ripple Effect": The influence of social support on participation in a small workplace health promotion program.

ISSUE ADDRESSED: Workplaces are key settings for health promotion. There is limited evidence pertaining to workplace health promotion [WHP] in Australian small and medium enterprises [SMEs], particularly in regional areas. This qualitative study explored employee perceptions of a pilot workplace health promotion program, LifeMAP, conducted in a small health service enterprise in regional Victoria 2014-2017, including facilitators of participation and perceived benefits of participation. METHOD: Ten LifeMAP participants were recruited using convenience sampling. Individual semi-structured interviews (n = 7) and one focus group (n = 3) were conducted between August and September 2017. Data were analysed inductively and thematically to elicit emergent themes. RESULTS: Social support emerged as the overarching theme influencing participation in LifeMAP, and a perceived benefit of participation. Using FitBits® and setting exercise challenges enabled social support to be fostered through role modelling, staff collegiality and community. There may be gendered differences in the experiences of role modelling in WHP. CONCLUSIONS: This SME, and others like it, often feature high levels of employee social connectedness, with a strong workplace and community networks. Social support is a critical influence in social connectedness which needs to be considered and incorporated into the design, implementation and evaluation of WHP programs as a means of overcoming WHP recruitment and participation challenges in regional SMEs. SO WHAT?: The identification of social support as a key factor for WHP participation and employee satisfaction is a valuable finding providing insight into how similar programs may be better designed and implemented to enhance WHP program recruitment and retention.

Active Controlled and Tunable Coacervation Using Side-Chain Functional α-Helical Homopolypeptides.

We report the development of new side-chain amino acid-functionalized α-helical homopolypeptides that reversibly form coacervate phases in aqueous media. The designed multifunctional nature of the side-chains was found to provide a means to actively control coacervation via mild, biomimetic redox chemistry as well as allow response to physiologically relevant environmental changes in pH, temperature, and counterions. These homopolypeptides were found to possess properties that mimic many of those observed in natural coacervate forming intrinsically disordered proteins. Despite ordered α-helical conformations that are thought to disfavor coacervation, molecular dynamics simulations of a polypeptide model revealed a high degree of side-chain conformational disorder and hydration around the ordered backbone, which may explain the ability of these polypeptides to form coacervates. Overall, the modular design, uniform nature, and ordered chain conformations of these polypeptides were found to provide a well-defined platform for deconvolution of molecular elements that influence biopolymer coacervation and tuning of coacervate properties for downstream applications.

Computerized Electronic Order Set: Use and Outcomes for Heart Failure Following Hospitalization.

BACKGROUND: Quality improvement initiatives improve health care delivery but may be resource intensive and disrupt clinical care. An embedded heart failure order set (HFOS) within a computerized physician order-entry system may mitigate these concerns. METHODS: An HFOS, based on proven interventions, was implemented within an existing computerized physician order-entry system in all adult acute-care hospitals in a single Canadian metropolitan city and interrogated between January 1, 2013 and December 31, 2015. The composite of repeat hospitalization or death within 30 days of hospital discharge and hospital length of stay were reported. RESULTS: In total, 8969 patients were included with mean age 75.6 ± 13.5 years; 4673 (52.1%) were male. The HFOS was used in 731 (8.2%) patients. After analysis of 724 pairs of propensity-score matched cohorts, patients with HFOS use experienced a lower median length of stay (8.6 vs 9.4 days, P = 0.016) and a trend toward lower composite repeat hospitalization or death (14.5% vs 17.7%, P = 0.115, hazard ratio 0.79 (0.60-1.05). Patients with HFOS use were more likely to undergo a test for left ventricular ejection fraction (88.6% vs 76.7%, P < 0.001, and to be referred to a heart failure clinic (48.5% vs 6.3%), with similar rates of discharge prescription of beta-blockers (88.7% vs 86.3) and angiotensin-converting enzyme inhibitors (87.4% vs 89.0%). CONCLUSIONS: Use of a designated HFOS within a computerized physician order-entry system is associated with shorter hospital length of stay without increase in deaths or readmissions. These findings should be confirmed in a prospective controlled trial.

CONTEXTE: Les initiatives visant à l'amélioration de la qualité favorisent la prestation des soins de santé, mais elles peuvent nécessiter beaucoup de ressources et perturber les soins cliniques. Un ensemble d'ordonnances relatives à l'insuffisance cardiaque (HFOS pour heart failure order set) intégré dans un système informatisé de saisie des ordonnances des médecins pourrait atténuer ces préoccupations. MÉTHODES: Un HFOS, basé sur des interventions éprouvées, a été mis en place au sein d'un système informatisé de saisie d'ordonnances médicales existant dans tous les hôpitaux de soins actifs pour adultes d'une même métropole canadienne et a été interrogé entre le 1er janvier 2013 et le 31 décembre 2015. Les données combinées de réadmission ou de décès pour les 30 jours suivant la sortie de l'hôpital et la durée du séjour à l'hôpital ont été répertoriées. RÉSULTATS: Au total, 8 969 patients ont été inclus avec un âge moyen de 75,6 ± 13,5 ans ; 4 673 (52,1 %) étaient des hommes. Le HFOS a été utilisé pour 731 (8,2 %) patients. Après analyse de 724 paires de cohortes appariées par score de propension, les patients associés à l'usage du HFOS ont connu une durée médiane de séjour hospitalier plus faible (8,6 contre 9,4 jours, p = 0.016) et une tendance combinée de réadmission ou de décès plus faible (14,5 % contre 17,7 %, p = 0,115, rapport de risque 0,79 (0,60-1,05). Les patients associés à l'usage du HFOS étaient plus susceptibles de subir un examen pour mesurer leur fraction d'éjection ventriculaire gauche (88,6 % contre 76,7 %, p < 0,001, et d'être orientés vers une clinique d'insuffisance cardiaque (48,5 % contre 6,3 %), avec des taux similaires de prescription à la sortie de bêta-bloquants (88,7 % contre 86,3 %) et d'inhibiteurs de l'enzyme de conversion de l'angiotensine (87,4 % contre 89,0 %). CONCLUSIONS: L'utilisation d'un HFOS particulier dans un système informatisé de saisie d'ordonnances médicales est associée à une réduction de la durée du séjour hospitalier sans augmentation des décès ou des réadmissions. Ces résultats devraient être confirmés dans le cadre d'un essai comparatif prospectif.

Mental models of adherence: parallels in perceptions, values, and expectations in adherence to prescribed home exercise programs and other personal regimens.

Purpose: A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which strongly influences behaviors. This study explored orthopedic outpatients mental models of adherence to prescribed home exercise programs and how they related to mental models of adherence to other types of personal regimens. Methods: The study followed an interpretive description qualitative design. Data were collected via two semi-structured interviews. Interview One focused on participants prior experiences adhering to personal regimens. Interview Two focused on experiences adhering to their current prescribed home exercise program. Data analysis followed a constant comparative method. Results: Findings revealed similarity in perceptions, values, and expectations that informed individuals mental models of adherence to personal regimens and prescribed home exercise programs. Perceived realized results, expected results, perceived social supports, and value of convenience characterized mental models of adherence. Conclusion: Parallels between mental models of adherence for prescribed home exercise and other personal regimens suggest that patients adherence behavior to prescribed routines may be influenced by adherence experiences in other aspects of their lives. By gaining insight into patients adherence experiences, values, and expectations across life domains, clinicians may tailor supports that enhance home exercise adherence. Implications for Rehabilitation A mental model is the collection of an individual's perceptions, values, and expectations about a particular aspect of their life, which is based on prior experiences and strongly influences behaviors. This study demonstrated similarity in orthopedic outpatients mental models of adherence to prescribed home exercise programs and adherence to personal regimens in other aspects of their lives. Physical therapists should inquire about patients non-medical adherence experiences, as strategies patients customarily use to adhere to other activities may inform strategies to promote prescribed home exercise adherence.

Ten-year assessment of the 100 priority questions for global biodiversity conservation.

In 2008, a group of conservation scientists compiled a list of 100 priority questions for the conservation of the world's biodiversity. However, now almost a decade later, no one has yet published a study gauging how much progress has been made in addressing these 100 high-priority questions in the peer-reviewed literature. We took a first step toward reexamining the 100 questions to identify key knowledge gaps that remain. Through a combination of a questionnaire and a literature review, we evaluated each question on the basis of 2 criteria: relevance and effort. We defined highly relevant questions as those that - if answered - would have the greatest impact on global biodiversity conservation and quantified effort based on the number of review publications addressing a particular question, which we used as a proxy for research effort. Using this approach, we identified a set of questions that, despite being perceived as highly relevant, have been the focus of relatively few review publications over the past 10 years. These questions covered a broad range of topics but predominantly tackled 3 major themes: conservation and management of freshwater ecosystems, role of societal structures in shaping interactions between people and the environment, and impacts of conservation interventions. We believe these questions represent important knowledge gaps that have received insufficient attention and may need to be prioritized in future research.

Impact of a Pediatric Cardiology Clinical Program on Congenital Heart Disease Outcomes in Guyana.

Background: Children with congenital heart disease (CHD) in Guyana have not historically been managed with timely intervention, increasing the likelihood of serious, irreversible complications. In 2014, a pediatric cardiology clinical program (Guyana Paediatric Cardiology Steering Committee [GPCSC]) and partnership with International Children's Heart Foundation (BabyHeart) was developed to improve CHD care. Objectives: To describe the characteristics of CHD in Guyanese children and to determine the impact of GPCSC on CHD outcomes. Methods: Qualitative comparison between CHD patients sent for surgery prior to GPCSC (pre-GPCSC cohort) and those managed through GPCSC (post-GPCSC cohort). Findings: Eighty-eight pre-GPHC patients were identified from 2005 to 2014. A total of 319 CHD patients were referred post-GPCSC. In all, 114 patients required surgical or catheterization procedures, with 74 patients prioritized for interventions within 29 months post-GPCSC. Mean age at surgery was 77 months in both cohorts, with younger children represented in the post-GPCSC cohort. Postoperative follow-up was more frequent post-GPCSC (100% vs 35%). Vital status of 48% of pre-GPCSC patients is unknown, with more pre-GPCSC patients known to be deceased compared with post-GPCSC (9% vs 5%). Pre-GPCSC patients had more incorrect diagnosis and inoperable disease when sent for surgery. Interpretation: Patients undergoing surgery post-GPCSC had more appropriate and timely interventions, better follow-up, and increased survival. The feasibility and positive impact of this collaborative pediatric cardiology clinical program in Guyana is demonstrated, with potential applicability for other low- and middle-income countries. Obstacles to referral of children with CHD in Guyana can begin to be addressed, with the goal of more complete access to timely intervention, and improved outcomes for these children.