Patient interest in and clinician reservations on polygenic embryo screening: a qualitative study of stakeholder perspectives.

PURPOSE: We explored and compared perspectives of reproductive endocrinology and infertility specialists (REIs) and in vitro fertilization (IVF) patients regarding polygenic embryo screening (PES), a new type of preimplantation screening that estimates the genetic chances of developing polygenic conditions and traits in the future. METHODS: Qualitative thematic analysis of semi-structured interviews with US-based REIs and IVF patients. RESULTS: Clinicians and patients often held favorable views of screening embryos for physical or psychiatric conditions, though clinicians tended to temper their positive attitudes with specific caveats. Clinicians also expressed negative views about screening embryos for traits more frequently than patients, who generally held more positive views. Most clinicians were either unwilling to discuss or offer PES to patients or were willing to do so only under certain circumstances, while many patients expressed interest in PES. Both stakeholder groups envisioned multiple potential benefits or uses of PES and raised multiple potential, interrelated concerns about PES. CONCLUSION: A gap exists between clinician and patient attitudes toward PES; clinicians generally maintained reservations about such screening and patients indicated interest in it. Clinicians and patients sometimes imagined using PES to prepare for the birth of a predisposed or "affected" individual-a rationale that is often associated with prenatal testing. Many clinicians and patients held different attitudes depending on what is specifically screened, despite the sometimes blurry distinction between conditions and traits. Considerations raised by clinicians and patients may help guide professional societies in developing guidelines to navigate the uncertain terrain of PES.

Polygenic embryo screening: four clinical considerations warrant further attention.

Recent advances in developing polygenic scores have made it possible to screen embryos for common, complex conditions and traits. Polygenic embryo screening (PES) is currently offered commercially, and though there has been much recent media and academic coverage, reproductive specialists' points of view have not yet been prominent in these discussions. We convened a roundtable of multidisciplinary experts, including reproductive specialists to discuss PES and its implications. In this Opinion, we describe four clinically relevant issues associated with the use of PES that have not yet been discussed in the literature and warrant consideration.

Health Impact of Street Sweeps from the Perspective of Healthcare Providers.

BACKGROUND: Homeless street sweeps are frequent operations in many cities in the USA in which government agencies move unhoused people living in public outdoor areas. Little research exists on the health impact of street sweeps operations. OBJECTIVE: This study was created at the request of community advocacy groups to investigate and document the health impacts of street sweeps from the perspective of healthcare providers. DESIGN: This is a qualitative study using data gathered from open-ended questions. PARTICIPANTS: We recruited 39 healthcare providers who provided health and wellness services in San Francisco for people experiencing homelessness (PEH) between January 2018 and January 2020. INTERVENTIONS: We administered a qualitative, open-ended questionnaire to healthcare providers using Qualtrics surveying their perspectives on the health impact of street sweeps. APPROACH: We conducted qualitative thematic analysis on questionnaire results. KEY RESULTS: Street sweeps may negatively impact health through two outcomes. The first outcome is material loss, including belongings and medical items. The second outcome is instability, including geographic displacement, community fragmentation, and loss to follow-up. These outcomes may contribute to less effective management of chronic health conditions, infectious diseases, and substance use disorders, and may increase physical injuries and worsen mental health. Providers also reported that sweeps may negatively impact the healthcare system by promoting increased usage of emergency departments and inpatient hospital care. CONCLUSIONS: Sweeps may have several negative consequences for the physical and mental health of the PEH community and for the healthcare system.

Exacerbations of Severe Asthma While on Anti-IL-5 Biologics.

Anti-interleukin 5 (IL-5) and anti-IL-5 receptor α monoclonal antibodies markedly decrease airway and peripheral blood eosinophil numbers and are thus highly effective in reducing asthma exacerbations. Nonetheless, these biologics do not completely resolve exacerbations. There is very little information on the cellular nature of exacerbations during treatment with biologics. Using illustrative clinical case scenarios, we highlight the importance of carefully characterizing asthmatics at the time of exacerbation and recognizing neutrophilic causes of exacerbations to ensure optimal management. While an eosinophilic exacerbation may improve with more corticosteroids or by switching to another anti-IL-5 monoclonal antibody, a noneosinophilic exacerbation will likely not. An infective exacerbation needs to be recognized, and the pathogen must be identified and treated with the appropriate antimicrobial agent.

Status of pesticide residues in water, sediment, and fishes of Chilika Lake, India.

Chilika Lake is the largest coastal lagoon in Asia and the second largest in the world covering an area of 1100 km2 and spread over three districts of Odisha state of India. It is the first Indian wetland designated as a wetland of international importance under the Ramsar Convention in 1981. The lake ecosystem sustains large and diversified resources of plants and animals including fisheries. Pollution of the ecosystem caused by residues of pesticides originating from different sources was assessed through multiple sampling from 2012 to 2016 from three potential sites of contamination, viz., Palur Bridge, Daya River Estuary, and Makara River. Incidence of organochlorinated (OC) pesticide residues was noticed in about 25% water samples. HCH (α, γ&δ), DDD (op|), DDE (op|&pp.|) and heptachlor were the OCs detected in concentration varying from 0.025 to 23.4 µg/l. None of the eight targeted synthetic pyrethroid (SP) pesticides was found in water, but among the organophosphates (OP), chlorpyrifos (0.019-2.73 µg/l), and dichlorvos (0.647 µg/l) were recorded. In sediment samples, residues of OC or OP pesticides were not present, but one SP pesticide was recorded. Fish samples were contaminated to the extent of 55%, mostly with residues of OCs and OPs and less with SPs. However, their concentrations were below the permissible limit, so there was no direct threat of health hazards to humans.

Electronic structure of twisted and planar rubrene molecules: a density functional study.

X-ray absorption spectra (XAS), the density of states (DOS) and the electron density distribution of the HOMO and LUMO for flat and twisted rubrene molecules have been calculated using density functional theory (DFT). The simulated XAS spectra are validated by experimental C K-edge near-edge X-ray absorption fine structure (NEXAFS) data. We demonstrate that the NEXAFS spectra of rubrene thin films of different thicknesses can be explained in terms of different combinations of spectral intensity from the twisted and the flat randomly oriented molecules. All the fine structure of the NEXAFS spectra is well reproduced and the energetic positions of the resonances agree within a window of ±0.3 eV with the calculated XAS. Our calculation reveals that the peak at lowest photon energy (α') of the NEXAFS spectra at the lower coverage of rubrene molecules appears only from the twisted molecules. Other peaks in the case of the flat molecules appear either from the backbone or the wings, whereas, for the twisted molecules, the backbone and the wings contribute somewhat equally. Lowering of the HOMO-LUMO gap, as well as redistribution of the electron density of both the frontier orbitals, is found to take place in the case of the twisted molecule. The redistribution explains the reduction in conductivity for the twisted molecule compared to the flat one despite the lower band gap for the former. This finding will further strengthen the progress of rubrene thin film based devices.

Effect of non-ß-lactams on stable variants of inhibitor-resistant TEM ß-lactamase in uropathogenic Escherichia coli: implication for alternative therapy.

AIMS: ß-lactamase inhibitor resistance (BLIR) among the uropathogenic Escherichia coli (UPEC) minimizes treatment options. This study aimed to identify inhibitor-resistant TEM (IRT) ß-lactamase that impart BLIR phenotype and explore non-ß-lactams as alternative therapeutics. METHODS AND RESULTS: Thirty BLIR UPEC isolates were detected by Kirby-Bauer disc diffusion technique using ß-lactam-ß-lactamase inhibitor combination. Conjugal transfer of BLIR was successful from 17 isolates. PCR and sequencing of the TEM ß-lactamases from the transconjugants indicated 14 TEM-84 (IRT) and three novel IRT variants (pUE184TEM, pUE203TEM, pUE210TEM). Three-dimensional models of the latter were predicted and validated. Molecular docking of selected non-ß-lactams (morin, catechin, naringenin triacetate) with the variants using AutoDock 4.2 showed comparable docking scores with significant hydrogen bond and hydrophobic interactions. Molecular dynamics simulation study confirmed stability of the non-ß-lactams inside the catalytic pocket of the enzymes. Moreover, all three non-ß-lactams were found to inhibit the purified TEM ß-lactamase variants in vitro. Microbroth dilution method indicated naringenin triacetate 64 µg ml-1 in combination with ceftazidime (CAZ) 30 µg ml-1 to be most effective against the BLIR transconjugants. CONCLUSIONS: BLIR phenotypes were primarily attributed to the production of IRT ß-lactamases. Administration of the non-ß-lactams with CAZ demonstrated an alternative therapeutic strategy against the IRT ß-lactamase producers. SIGNIFICANCE AND IMPACT OF THE STUDY: This study indicates high risk of transmission of IRT ß-lactamases and suggests ß-lactam-non-ß-lactam combination therapy to combat BLIR.

Usage of allergy codes in primary care electronic health records: a national evaluation in Scotland.

BACKGROUND: The UK's NHS intends to move from the current Read code system to the international, detailed Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to facilitate more clinically appropriate coding of conditions and associated risk factors and outcomes. Given concerns about coding behaviour of general practitioners, we sought to study the current coding patterns in allergies and identify lessons for the future migration to SNOMED-CT. METHODS: Data from 2 014 551 primary care consultations in over 100 000 patients with one or more of 11 potentially allergic diseases (anaphylaxis, angioedema, asthma, conjunctivitis, drug allergies, eczema, food allergy, rhinitis, urticaria, venom allergy and other probable allergic disorders) from the Scottish Primary Care Clinical Informatics Unit Research (PCCIU-R) database were descriptively analysed and visualized to understand Read code usage patterns. RESULTS: We identified 352 Read codes for these allergic diseases, but only 36 codes (10%) were used in 95% of consultations; 73 codes (21%) were never used. Half of all usage was for Quality and Outcomes Framework codes for asthma. Despite 149 detailed codes (42%) being available for allergic triggers, these were infrequently used. CONCLUSIONS: This analysis of Read codes use suggests that introduction of the more detailed SNOMED-CT, in isolation, will not improve the quality of allergy coding in Scottish primary care. The introduction of SNOMED-CT should be accompanied by initiatives aimed at improving coding quality, such as the definition of terms/codes, the availability of terminology browsers, a recommended list of codes and mechanisms to incentivize detailed coding of the condition and the underlying allergic trigger.

Emergence of co-production of plasmid-mediated AmpC beta-lactamase and ESBL in cefoxitin-resistant uropathogenic Escherichia coli.

Plasmid-mediated AmpC (pAmpC) and ESBL co-production was detected in Escherichia coli a major etiologic agent of urinary tract infection. Isolates resistant to cefoxitin by CLSI methodology were tested for pAmpC beta-lactamase using phenylboronic acid and ESBLs by combined disk diffusion method. pAmpC/ESBL genes were characterized by PCR and sequencing. Transconjugation experiments were done to study the transfer of pAmpC and ESBL production from clinical isolates as donor to E. coli J53 AziR as recipient. Incompatibility groups of transmissible plasmids were classified by PCR-based replicon typing (PBRT). Among 148 urine culture positive isolates, E. coli was reported in 39.86 % (59/148), with 93.22 % (55/59) of cefoxitin resistance. pAmpC production was detected in 25, with varied distribution of blaCMY-2 and blaDHA-1type genes alone (n = 13 and 7 respectively) or in combination (n = 5). ESBL co-production was observed in 88 % (22/25) of pAmpC producing isolates with predominance of blaTEM (n = 20). Twenty-three transconjugants showed transmission of pAmpC-and ESBL-resistant genes with co-carriage of blaCMY-2 and blaTEM (n = 15) in plasmids of IncF type (n = 9) being predominant, followed by IncI1 (n = 4) and IncH1 (n = 2) in combination. All clinical isolates were clonally diverse. Resistance against different beta-lactams in uropathogenic E. coli has been an emerging concern in resource- poor countries such as India. Knowledge on the occurrence of AmpC beta-lactamases and ESBL amongst this pathogen and its transmission dynamics may aid in hospital infection control.

Oxidation of rubrene thin films: an electronic structure study.

The performances of organic semiconductor devices are crucially linked with their stability at the ambient atmosphere. The evolution of electronic structures of 20 nm thick rubrene films exposed to ambient environment with time has been studied by UV and X-ray photoemission spectroscopy (UPS and XPS), near edge X-ray absorption fine structure (NEXAFS) spectroscopy, and density functional theory (DFT). XPS, NEXAFS data, and DFT calculated values suggest the formation of rubrene-epoxide and rubrene-endoperoxide through reaction of tetracene backbone with oxygen of ambient environment. Angle dependent XPS measurement indicates that the entire probed depth of the films reacts with oxygen by spending only about 120 min in ambient environment. The HOMO peak of pristine rubrene films almost disappears by exposure of 120 min to ambient environment. The evolution of the valence band (occupied states) and NEXAFS (unoccupied states) spectra indicates that the films become more insulating with exposure as the HOMO-LUMO gap increases on oxidation. Oxygen induced chemical reaction completely destroys the delocalized nature of the electron distribution in the tetracene backbone of rubrene. The results are relevant to the performance and reliability of rubrene based devices in the environment.

Analysis of liquid metal foams through X-ray radioscopy and microgravity experiments.

Complex liquid structures such as metallic foams were produced in a furnace that allowed in situ X-ray monitoring of the evolution of the structure and distribution of the liquid in the foam. The experiments were carried out during parabolic flights which provided varying levels of gravity. The evolution of the characteristic liquid fraction profiles due to gravity induced drainage was measured and analysed in terms of the foam drainage equation, obtaining viscosity and surface tension by fitting solutions of the equation to the experimental data. The surface tension of the melt in the foam was decreased up to 40%. Effective viscosities of up to 139 times the viscosity of a pure bulk melt were observed. These effects could be attributed to the smaller influence of solid particles dispersed in the melt and the larger influence of the complex foam structure.

Ramp dynamics of phonons in an ion trap: entanglement generation and cooling.

We show that the ramp dynamics of phonons in a one-dimensional ion trap can be used for both generating multiparticle entangled states and motional state cooling of a string of trapped ions. We study such ramp dynamics using an effective Bose-Hubbard model which describes these phonons at low energies and show that specific protocols, involving site-specific dynamical tuning of the on-site potential of the model, can be used to generate entangled states and to achieve motional state cooling without involving electronic states of the ions. We compare and contrast our schemes for these to the earlier suggested ones and discuss specific experiments to realize the suggested protocols.

Enzymatic debridement of large burn wounds with papain-urea: Is it safe?

INTRODUCTION: Enzymatic debridement is a method by which burn wounds can be prepared for coverage by skin grafts in patients presenting late. Many agents have been used in the past but none of them have been thoroughly evaluated. The present study was undertaken to assess the efficacy of Debridace, a commonly available debriding agent with papain and urea as its constituents. MATERIAL AND METHODS: A prospective descriptive study design was used to evaluate our experience. Almost symmetrical areas of the burnt surface were assessed and used for comparison. On one half of the wound, Debridace was applied while on the other silver sulphadiazine was used. The primary end point of this study was the extent of the achieved debridement at the end of the study period. Secondary outcomes were the presence of adverse effects such as pain and fever. All patients with sepsis were excluded from the study. RESULTS: The age of the subjects ranged from 9 to 80 years with an SD of 16. Large areas ranging from 5% to 20% body surface area with an SD of 4.27 were debrided by Debridace. Only two patients (3.33%) could complete the study. The rest of the recruited patients either had high fever (63.33%), excruciating pain (13.33%) or both (16.66%), which brought an end to enzymatic debridement. CONCLUSION: Debridace, a papain-urea product, cannot be considered safe as an enzymatic debriding agent in its present form for use in major burn patients who present late with deep burn wounds that are large in size.

Hydroxyapatite-supported Cu(I)-catalysed cyanation of styrenyl bromides with K4[Fe(CN)6]: an easy access to cinnamonitriles.

An efficient cyanation of styrenyl bromides by K(4)[Fe(CN)(6)] has been achieved under the catalysis of hydroxyapatite-supported copper(I) producing a variety of functionalized cinnamonitriles in high yields. The stereochemistry of the styrenyl double bond is preserved during the process providing the same stereoisomer of product.

Perforator flap: A novel method for providing skin cover to lower limb defects.

BACKGROUND: Soft tissue defects in the lower limb pose a formidable challenge due to lack of reliable local flap options. Due to thin non-expendable soft tissues and predisposition to massive edema formation, even small defects become problematic. Perforator flaps represent the latest trends in soft tissue coverage. The aim of this study was to evaluate the effectiveness of perforator flaps as coverage of soft tissue defects in lower limbs. MATERIAL AND METHODS: A series of patients with soft tissue defects of various etiologies in the lower limb were treated using perforator flap at a tertiary care service hospital. Six were free flaps and fourteen pedicled flaps. Doppler ultrasound was used to identify recipient and donor vessels pre-operatively. RESULTS: Only one flap was lost due to venous congestion. In another case of carcinoma penis there was delayed healing due to persistent lymphorrhoea as a result of post-operative status following lymph node dissection and radiotherapy. Fifteen donor sites required split skin grafting, as they could not be closed directly. CONCLUSION: Perforator flaps are a reliable option for closure of soft tissue defects of lower limb irrespective of size, location and depth. There is minimal donor site morbidity. It has the advantage of rapid dissection, flap elevation and reliable skin territory. As no special equipment is required it can be replicated in smaller centers also.

Teacher and school staff perspectives on their role in school-based vision programs.

OBJECTIVE: School-based vision programs (SBVPs) are one approach to increase access to vision care by providing vision screenings, eye examinations, and eyeglasses directly in schools. Few studies report on the perspectives of teachers and staff, who are important stakeholders, on SBVPs. We examined teacher and staff perspectives on their involvement in SBVPs. DESIGN: Qualitative study using focus groups. PARTICIPANTS: Teachers and staff at Baltimore and Chicago public schools served by SBVPs between 2016 and 2018. METHODS: We conducted 21 semistructured focus groups with 117 teachers and staff in 10 Baltimore and 11 Chicago public preK-12 schools that participated in SBVPs. Sessions were recorded, transcribed, and coded using inductive thematic analysis. RESULTS: Participants identified 2 main themes regarding teacher and staff involvement in SBVPs: (i) program outreach, including using multiple communication modalities to engage parents, explaining program details to families, and helping with program consent form return and (ii) promoting vision health, including identifying vision problems in the classroom, encouraging eyeglasses wear, and supporting eyeglasses maintenance. Participants also discussed limitations in capacity to partake in these activities. CONCLUSION: Teachers interact with parents and students throughout the SBVP process, undertaking important roles in outreach and health promotion to ensure uptake of SBVP services. SBVPs and other school-based health programs should explore strategies to support teachers in the roles they fill to optimize program impact.

Stakeholders' Perceptions of a School-Based Eye Care Programme in Baltimore, MD.

PURPOSE: To explore stakeholders' perceptions of a school-based vision programme (SBVP). METHODS: We conducted 20 focus groups with 105 parents and teachers at schools in Baltimore, MD, that participated in a SBVP. Facilitators used a semi-structured interview guide to discuss participants' perceptions of the SBVP. Focus groups were audio-recorded, transcribed, and coded using inductive thematic analysis. RESULTS: Participant perceptions fell into three categories: benefits of school-based eye care, limitations of school-based eye care, and observation of impact. The majority of participants had positive comments about the programme; benefits included convenience (location, time, and cost), the comprehensive nature of the programme, the quality of the eyeglasses and ability to receive replacements, and a positive screening/exam experience. Limitations of programme impact were related to communication and organisation, the time to receive the glasses, missed instructional time, and uncertainty about screenings. Observations of impact included academic and classroom improvements, as well as visual and other health improvements. CONCLUSION: Parents and teachers reported mostly positive perceptions regarding the SBVP. Their appreciation for the convenience underscores that location, cost, time, and comprehensive services are crucial aspects for implementing a successful programme. To maximize impact, programs must also implement robust communication campaigns that integrate into the schools' workflow to help parents and teachers stay engaged in the process from start to finish.

Refractive Error Findings in Students Who Failed School-based Vision Screening.

PURPOSE: To report refractive error findings in Baltimore City schoolchildren who failed school-based vision screenings. METHODS: In this cross-sectional analysis, students pre-kindergarten through 8th grade who failed screenings during school years 2016-2019 received an eye examination, including non-cycloplegic autorefraction and visual acuity (VA) measurements. Refractive error was identified when there was at least: -0.50 diopter (D) spherical equivalent (SE) myopia, +0.50D SE hyperopia, 1.00D astigmatism, or 1.00D anisometropia in either eye. Generalized estimating equation models were used to identify factors associated with clinically significant refractive error, defined as decreased VA and more severe refractive error. RESULTS: Of 7520 students who failed screening, 6627 (88%) were analyzed. Clinically significant refractive error and any refractive error were found in 2352 (35.5%) and 5952 (89.8%) students, respectively. Mild myopia (45%, -0.50 D to <-3.00 D SE) and low astigmatism (47%, 1.00 D to <3.00 D cylinder) were the most prevalent types of refractive error. Proportions of students with myopia increased with higher grade levels (Ptrend<0.001). Myopia and astigmatism were more common in black and Latinx. Risk factors for clinically significant refractive error included higher grades (odds ratios [OR] ranged from 1.30 to 2.19 compared with 1st grade, P < .05) and Latinx ethnicity (OR = 1.31, 95%CI: 1.08-1.59). CONCLUSION: A Baltimore school-based vision program identified a substantial number of students with refractive error in a high-poverty urban community. Over 1/3 students who failed vision screening had clinically significant refractive error, with black and Latinx students at higher risk of having myopia and astigmatism.