Telehealth Rapid Access Chest Pain Clinic: Initial Experience During COVID-19 Pandemic.

Objectives: Rapid Access Chest Pain Clinics (RACPCs) provide safe and efficient follow-up for outpatients presenting with new-onset chest pain. RACPC delivery by telehealth has not been reported. We sought to evaluate a telehealth RACPC established during the coronavirus disease 2019 (COVID-19) pandemic. There was a need to reduce the frequency of additional testing arranged by the RACPC during this time, and the safety of this approach was also explored. Methods: This was a prospective evaluation of a cohort of RACPC patients reviewed by telehealth during the COVID-19 pandemic compared with a historical control group of face-to-face consultations. The main outcomes included emergency department re-presentation at 30 days and 12 months, major adverse cardiovascular events at 12 months, and patient satisfaction scores. Results: One hundred forty patients seen in the telehealth clinic were compared with 1,479 in-person RACPC controls. Baseline demographics were similar; however, telehealth patients were less likely to have a normal prereferral electrocardiogram than RACPC controls (81.4% vs. 88.1%, p = 0.03). Additional testing was ordered less often for telehealth patients (35.0% vs. 80.7%, p < 0.001). Rates of adverse cardiovascular events were low in both groups. One hundred twenty (85.7%) patients reported being satisfied or highly satisfied with the telehealth clinic service. Conclusions: In the setting of COVID-19, a telehealth RACPC model with reduced use of additional testing facilitated social distancing and achieved clinical outcomes equivalent to a face-to-face RACPC control. Telehealth may have an ongoing role beyond the pandemic, supporting specialist chest pain assessment for rural and remote communities. Pending further study, it may be safe to reduce the frequency of additional testing following RACPC review.

The effects of surface stripping ZnO nanorods with argon bombardment.

ZnO nanorods are used in devices including field effects transistors, piezoelectric transducers, optoelectronics and gas sensors. However, for efficient and reproducible device operation and contact behaviour, surface contaminants must be removed or controlled. Here we use low doses of argon bombardment to remove surface contamination and make reproducible lower resistance contacts. Higher doses strip the surface of the nanorods allowing intrinsic surface measurements through a cross section of the material. Photoluminescence finds that the defect distribution is higher at the near-surface, falling away in to the bulk. Contacts to the n-type defect-rich surface are near-Ohmic, whereas stripping away the surface layers allows more rectifying Schottky contacts to be formed. The ability to select the contact type to ZnO nanorods offers a new way to customize device behaviour.

Snapshot Sampling May Not Be Enough to Obtain Robust Estimates for Riverine Microplastic Loads.

Wastewater treatment plants (WWTPs) have been described as key contributors of microplastics (MPs) to aquatic systems, yet temporal fluctuations in MP concentrations and loads downstream are underexplored. This study investigated how different sampling frequencies (hourly, weekly, and monthly) affect MP estimates in a stream linked to a single WWTP. Utilizing fluorescence microscopy and Raman spectroscopy, considerable hourly variations in MP concentrations were discovered, while the polymer composition remained consistent. This temporal variability in MP loads was influenced by MP concentration, discharge rates, or a mix of both. These results show a high uncertainty, as relying on sparse snapshot samples combined with annual discharge data led to significant uncertainties in MP load estimates (over- and/or underestimation of emissions by 3.8 billion MPs annually at this site). Our findings stress the necessity of higher-frequency sampling for better comprehending the hydrodynamic factors influencing MP transport. This improved understanding enables a more accurate quantification of MP dynamics, crucial for downstream impact assessments. Therefore, preliminary reconnaissance campaigns are essential for designing extended, representative site-monitoring programs and ensuring more precise trend predictions on a larger scale.

Easy and accessible way to calibrate a fluorescence microscope and to create a microplastic identification key.

We present here a technique for setting up detection limits on any fluorescent microscope in conjunction with the fluorophore Nile Red for microplastic identification. Our method also describes a rigorous morphology-specific identification key for microplastics to reduce subjectivity between researchers. The detection limits were established for nine common polymer types and five natural substrates which could result in false-positive signals when using Nile Red for microplastic identification. This method was then applied to real freshwater samples and identified particles were validated with micro-FTIR or Raman spectroscopy. This approach may reduce subjectivity in microplastic identification and counting and enhances transparency, repeatability and harmonization within microplastic research community.•Instructions for calibration of detection limits for microplastics on fluorescence microscope systems described•Microplastic identification key developed and tested to reduce false positive detection•Lower subjectivity for microplastic identification obtained using the detection limits & identification key.

Microplastic accumulation in endorheic river basins - The example of the Okavango Panhandle (Botswana).

The Okavango Panhandle is the main influent watercourse of the Okavango Delta, an inland sink of the entire sediment load of the Cubango-Okavango River Basin (CORB). The sources of pollution in the CORB, and other endorheic basins, are largely understudied when compared to exorheic systems and the world's oceans. We present the first study of the distribution of microplastic (MP) pollution in surface sediments of the Okavango Panhandle in Northern Botswana. MP concentrations (64 µm-5 mm size range) in sediment samples from the Panhandle range between 56.7 and 399.5 particles kg-1 (dry weight) when analysed with fluorescence microscopy. The concentrations of MP in the 20 µm to 5 mm grain size range (analysed with Raman spectroscopy) range between 1075.7 and 1756.3 particles kg-1. One shallow core (15 cm long) from an oxbow lake suggests that MP size decreases with depth while MP concentration increases downcore. Raman Spectroscopy revealed that the compositions of the MP are dominated by polyethene terephthalate (PET), polypropylene (PP), polyethene (PE), polystyrene (PS), and polyvinyl chloride (PVC). From this novel data set it was possible to estimate that 10.9-336.2 billion particles could be transported into the Okavango Delta annually, indicating that the region represents a significant sink for MP, raising concerns for the unique wetland ecosystem.

Microplastic distribution and characteristics across a large river basin: Insights from the Neuse River in North Carolina, USA.

While microplastics (MP) have been found in aquatic ecosystems around the world, the understanding of drivers and controls of their occurrence and distribution have yet to be determined. In particular, their fate and transport in river catchments and networks are still poorly understood. We identified MP concentrations in water and streambed sediment at fifteen locations across the Neuse River Basin in North Carolina, USA. Water samples were collected with two different mesh sizes, a trawl net (>335 µm) and a 64 µm sieve used to filter bailing water samples. MPs >335 µm were found in all the water samples with concentrations ranging from 0.02 to 221 particles per m3 (p m-3) with a median of 0.44 p m-3. The highest concentrations were observed in urban streams and there was a significant correlation between streamflow and MP concentration in the most urbanized locations. Fourier Transform Infrared (FTIR) analysis indicated that for MPs >335 µm the three most common polymer types were polyethylene, polypropylene, and polystyrene. There were substantially more MP particles observed when samples were analyzed using a smaller mesh size (>64 µm), with concentrations ranging from 20 to 130 p m-3 and the most common polymer type being polyethylene terephthalate as identified by Raman spectroscopy. The ratio of MP concentrations (64 µm to 335 µm) ranged from 35 to 375, indicating the 335 µm mesh substantially underestimates MPs relative to the 64 µm mesh. MPs were detected in 14/15 sediment samples. Sediment and water column concentrations were not correlated. We estimate MP (>64 µm) loading from the Neuse River watershed to be 230 billion particles per year. The findings of this study help to better understand how MPs are spatially distributed and transported through a river basin and how MP concentrations are impacted by land cover, hydrology, and sampling method.

Prevailing impacts of river management on microplastic transport in contrasting US streams: Rethinking global microplastic flux estimations.

While microplastic inputs into rivers are assumed to be correlated with anthropogenic activities and to accumulate towards the sea, the impacts of water management on downstream microplastic transport are largely unexplored. A comparative study of microplastic abundance in Boulder Creek (BC), and its less urbanized tributary South Boulder Creek (SBC), (Colorado USA), characterized the downstream evolution of microplastics in surface water and sediments, evaluating the effects of urbanization and flow diversions on the up-to-downstream profiles of microplastic concentrations and loads. Water and sediment samples were collected from 21 locations along both rivers and microplastic properties determined by fluorescence microscopy and Raman spectroscopy. The degree of catchment urbanization affected microplastic patterns, as evidenced by greater water and sediment concentrations and loads in BC than the less densely populated SBC, which is consistent with the differences in the degree of urbanization between both catchments. Microplastic removal through flow diversions was quantified, showing that water diversions removed over 500 microplastic particles per second from the river, and caused stepwise reductions of downstream loads at diversion points. This redistribution of microplastics back into the catchment should be considered in large scale models quantifying plastic fate and transport to the oceans.

Review: Emerging Eye-Based Diagnostic Technologies for Traumatic Brain Injury.

The study of ocular manifestations of neurodegenerative disorders, Oculomics, is a growing field of investigation for early diagnostics, enabling structural and chemical biomarkers to be monitored overtime to predict prognosis. Traumatic brain injury (TBI) triggers a cascade of events harmful to the brain, which can lead to neurodegeneration. TBI, termed the "silent epidemic" is becoming a leading cause of death and disability worldwide. There is currently no effective diagnostic tool for TBI, and yet, early-intervention is known to considerably shorten hospital stays, improve outcomes, fasten neurological recovery and lower mortality rates, highlighting the unmet need for techniques capable of rapid and accurate point-of-care diagnostics, implemented in the earliest stages. This review focuses on the latest advances in the main neuropathophysiological responses and the achievements and shortfalls of TBI diagnostic methods. Validated and emerging TBI-indicative biomarkers are outlined and linked to ocular neuro-disorders. Methods detecting structural and chemical ocular responses to TBI are categorised along with prospective chemical and physical sensing techniques. Particular attention is drawn to the potential of Raman spectroscopy as a non-invasive sensing of neurological molecular signatures in the ocular projections of the brain, laying the platform for the first tangible path towards alternative point-of-care diagnostic technologies for TBI.

Spectroscopic molecular-fingerprint profiling of saliva.

Saliva analysis has been gaining interest as a potential non-invasive source of disease indicative biomarkers due to being a complex biofluid correlating with blood-based constituents on a molecular level. For saliva to cement its usage for analytical applications, it is paramount to gain underpinning molecular knowledge and establish a 'baseline' of the salivary composition in healthy individuals as well as characterize how these factors are impacting its performance as potential analytical biofluid. Here, we have systematically studied the molecular spectral fingerprint of saliva, including the changes associated with gender, age, and time. Via hybrid artificial neural network algorithms and Raman spectroscopy, we have developed a non-destructive molecular profiling approach enabling the assessment of salivary spectral changes yielding the determination of gender and age of the biofluid source. Our classification algorithm successfully identified the gender and age from saliva with high classification accuracy. Discernible spectral molecular 'barcodes' were subsequently constructed for each class and found to primarily stem from amino acid, protein, and lipid changes in saliva. This unique combination of Raman spectroscopy and advanced machine learning techniques lays the platform for a variety of applications in forensics and biosensing.

Detection limits are central to improve reporting standards when using Nile red for microplastic quantification.

Beyond simple identification of either the presence or absence of microplastic particles in the environment, quantitative accuracy has been criticised as being neither comparable nor reproducible. This is, in part, due to difficulties in the identification of synthetic particles amidst naturally occurring organic and inorganic components. The fluorescent stain Nile red has been proposed as a tool to overcome this issue, but to date, has been used without consideration of polymer specific fluorescent variability. The aim of this study was to evaluate the efficacy of Nile red for microplastic detection by systematically investigating what drives variations in particle pixel brightness (PPB). The results showed that PPB varied between polymer type, shape, size, colour and by staining procedure. Sand, an inorganic component of the sample matrix does not fluoresce when stained with Nile red. In contrast the organic components, wood and chitin, fluoresce between 1.40 and 12 arbitrary units (a.u.) and 32 and 74 a.u. after Nile red staining, respectively. These data informed the use of a PPB threshold limit of 100 a.u., which improved the detection of EPS, HDPE, PP and PA-6 from the 6 polymers tested and reduced analysis time by 30-58% compared to unstained samples. Conversely, as with traditional illumination, PET and PVC were not accurately estimated using this approach. This study shows that picking a threshold limit is not arbitrary but rather must be informed by polymer specific fluorescent variability and matrix considerations. This is an essential step needed to facilitate comparability and reproducibility between individual studies.