Dual purpose fibre - SERS pH sensing and bacterial analysis.

The exploitation of fibre based Raman probes has been challenged by often complicated fabrication procedures and difficulties in reproducibility. Here, we have demonstrated a simple and cost-effective approach for sensing pH through an optical fibre, by employing a wax patterned filter paper-based substrate for surface enhanced Raman spectroscopy (SERS). Through this method, high reproducibility between fibres was achieved. In addition to sensing pH, it was possible to extract fluid samples containing P. aeruginosa for further analysis. This dual purpose fibre is bronchoscope deployable, and is able to gather information about both the host and pathogen, which may lead to an improved treatment plan in future in vivo applications.

Cellulomonas, an emerging pathogen: a case report and review of the literature.

Cellulomonas is a rare but emerging human pathogen, causing infection in only 4 reported cases in the literature. We present the first case of ascending cholangitis with Cellulomonas bacteremia and sepsis, as well as a brief review of the literature. We summarize every case of Cellulomonas reported in the medical literature, including treatments and outcomes.

Exploring context and culture in clinical reasoning medical education: A qualitative exploratory study.

BACKGROUND: Clinical reasoning processes are complex and interwoven with culture and context. While these relationships have been explored to understand the outcomes of clinical reasoning, there has been little exploration of how to integrate these relationships when teaching and learning clinical reasoning. METHODS: Using semi-structured interviews, this research explored the role of context and culture in clinical reasoning medical education. Participants were clinical teachers recruited from across Northern Ontario. The data were analysed independently by two reviewers using both thematic analysis and critical discourse analysis, and peer reviewed by a third researcher. RESULTS: The role of context and culture is inherent to the personal, professional and pedagogical aspects of clinical reasoning, especially when teaching about the complexities of Northern Ontario. The major themes that came through were: 1) teaching and learning clinical reasoning needs reflexivity, 2) developing clinical reasoning skills needs time and 3) clinical reasoning pedagogy should acknowledge and encompass practice variation and patient diversity. CONCLUSION: Teaching clinical reasoning in Northern Ontario involves being aware of the complexities that are inherent in interacting with patients and communities. Through personal, professional and pedagogical models, the students and teachers can address the complexities of cultural and contextual clinical reasoning.

Artificial intelligence and social accountability in the Canadian health care landscape: A rapid literature review.

BACKGROUND: Situated within a larger project entitled "Exploring the Need for a Uniquely Different Approach in Northern Ontario: A Study of Socially Accountable Artificial Intelligence," this rapid review provides a broad look into how social accountability as an equity-oriented health policy strategy is guiding artificial intelligence (AI) across the Canadian health care landscape, particularly for marginalized regions and populations. This review synthesizes existing literature to answer the question: How is AI present and impacted by social accountability across the health care landscape in Canada? METHODOLOGY: A multidisciplinary expert panel with experience in diverse health care roles and computer sciences was assembled from multiple institutions in Northern Ontario to guide the study design and research team. A search strategy was developed that broadly reflected the concepts of social accountability, AI and health care in Canada. EMBASE and Medline databases were searched for articles, which were reviewed for inclusion by 2 independent reviewers. Search results, a description of the studies, and a thematic analysis of the included studies were reported as the primary outcome. PRINCIPAL FINDINGS: The search strategy yielded 679 articles of which 36 relevant studies were included. There were no studies identified that were guided by a comprehensive, equity-oriented social accountability strategy. Three major themes emerged from the thematic analysis: (1) designing equity into AI; (2) policies and regulations for AI; and (3) the inclusion of community voices in the implementation of AI in health care. Across the 3 main themes, equity, marginalized populations, and the need for community and partner engagement were frequently referenced, which are key concepts of a social accountability strategy. CONCLUSION: The findings suggest that unless there is a course correction, AI in the Canadian health care landscape will worsen the digital divide and health inequity. Social accountability as an equity-oriented strategy for AI could catalyze many of the changes required to prevent a worsening of the digital divide caused by the AI revolution in health care in Canada and should raise concerns for other global contexts.

SERS microsensors for pH measurements in the lumen and ECM of stem cell derived human airway organoids.

Patient derived organoids have the potential to improve the physiological relevance of in vitro disease models. However, the 3D architecture of these self-assembled cellular structures makes probing their biochemistry more complex than in traditional 2D culture. We explore the application of surface enhanced Raman scattering microsensors (SERS-MS) to probe local pH gradients within patient derived airway organoid cultures. SERS-MS consist of solid polymer cores decorated with surface immobilised gold nanoparticles which are functionalised with pH sensitive reporter molecule 4-mercaptobenzoic acid (MBA). We demonstrate that by mixing SERS-MS into the extracellular matrix (ECM) of airway organoid cultures the probes can be engulfed by expanding organoids and report on local pH in the organoid lumen and ECM.

Scientometric analysis of the forensic science literature for fibre as an evidence type: Access and data availability.

The large volume of information available within citation databases has become a challenge to manage and distil in all areas of research. In this study, a scientometric approach has been applied to fibres as an evidence type using information contained in Scopus and Web of Science. A comparison was also made with the references listed in the INTERPOL International Forensic Science Managers Symposium Science (IFSMS) reports (2004-2019) where only a limited number of documents were common with the citation databases, illustrating the value of the IFSMS reports. Finally, this study also highlights that data availability and location are generally omitted in publications. The forensic science community has an opportunity to change this culture and lead the way in making their data available, aligning with the ideals of fairness, openness and transparency of the underpinning data upon which scientific developments are based.

Through-bottle whisky sensing and classification using Raman spectroscopy in an axicon-based backscattering configuration.

Non-intrusive detection systems have the potential to characterise materials through various transparent glass and plastic containers. Food and drink adulteration is increasingly problematic, representing a serious health risk as well as an economic issue. This is of particular concern for alcoholic spirits such as Scotch whisky which are often targeted for fraudulent activity. We have developed a Raman system with a novel geometry of excitation and collection, exploiting the beam propagation from an axicon lens, which results in an annular beam at the bottle surface before focusing within the sample. This facilitates the efficient acquisition of Raman signals from the alcoholic spirit contained inside the bottle, while avoiding the collection of auto-fluorescence signals generated by the bottle wall. Therefore, this technique provides a way of non-destructive and non-contact detection to precisely analyse the contents without the requirement to open the bottle.

Assessment of Long-Term Effects of Sports-Related Concussions: Biological Mechanisms and Exosomal Biomarkers.

Concussion or mild traumatic brain injury (mTBI) in athletes can cause persistent symptoms, known as post-concussion syndrome (PCS), and repeated injuries may increase the long-term risk for an athlete to develop neurodegenerative diseases such as chronic traumatic encephalopathy (CTE), and Alzheimer's disease (AD). The Center for Disease Control estimates that up to 3.8 million sport-related mTBI are reported each year in the United States. Despite the magnitude of the phenomenon, there is a current lack of comprehensive prognostic indicators and research has shown that available monitoring tools are moderately sensitive to short-term concussion effects but less sensitive to long-term consequences. The overall aim of this review is to discuss novel, quantitative, and objective measurements that can predict long-term outcomes following repeated sports-related mTBIs. The specific objectives were (1) to provide an overview of the current clinical and biomechanical tools available to health practitioners to ensure recovery after mTBIs, (2) to synthesize potential biological mechanisms in animal models underlying the long-term adverse consequences of mTBIs, (3) to discuss the possible link between repeated mTBI and neurodegenerative diseases, and (4) to discuss the current knowledge about fluid biomarkers for mTBIs with a focus on novel exosomal biomarkers. The conclusions from this review are that current post-concussion clinical tests are not sufficiently sensitive to injury and do not accurately quantify post-concussion alterations associated with repeated mTBIs. In the current review, it is proposed that current practices should be amended to include a repeated symptom inventory, a cognitive assessment of executive function and impulse control, an instrumented assessment of balance, vestibulo-ocular assessments, and an improved panel of blood or exosome biomarkers.

Alcohol Withdrawal Syndrome: Improving Recognition and Treatment in the Emergency Department.

Alcoholism continues to be a persistent health problem in the United States, accounting for up to 62% of emergency department (ED) visits. This quality improvement (QI) project examined whether identifying the benefit for early use of Alcohol Use Disorders Identification Test (AUDIT C) and Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIW-ar) in the ED would avoid escalation of care and offset poor outcomes of alcohol withdrawal syndrome (AWS). A preimplementation chart review (N = 99) showed an average of 12%-15% of patients requiring escalation of care at the project site. The QI project utilized a single-group, pre-/posttest design. The setting was a Southwest Veterans Affair tertiary care referral center. Thirty-five ED staff members were surveyed for baseline knowledge and attended education sessions, led by an advanced practice nurse, on the use of AUDIT-C and CIWA-ar. Posteducation, patients admitted to the hospital were screened with AUDIT-C and treated with CIWA-ar. Postimplementation, charts were reviewed for admitted patients (N = 42) on the use of AUDIT-C, CIWA-ar, length of stay (LOS), and area patient treated. Although the test scores after didactic education were statistically significant (p ≤ 0.050), there was no significant difference in the use of AUDIT-C or CIWA-ar in the ED, nor a significant decrease in LOS for those patients with CIWA-ar ordered. However, the potential for clinical benefit could not be disavowed. Barriers to implementation included survey fatigue, inability to embed AUDIT-C in the electronic medical record, inconsistency in completing AUDIT-C, interrater reliability, and patient fear of stigmatization. Advanced practice nurses provide an integral role to augment early identification and treatment of AWS in the ED.

Ultra-low background Raman sensing using a negative-curvature fibre and no distal optics.

Measuring Raman spectra through an optical fibre is usually complicated by the high intrinsic Raman scatter of the fibre material. Common solutions such as the use of multiple fibres and distal optics are complex and bulky. We demonstrate the use of single novel hollow-core negative-curvature fibres (NCFs) for Raman and surface-enhanced Raman spectroscopy (SERS) sensing using no distal optics. The background Raman emission from the silica in the NCF was at least 1000× smaller than in a conventional solid fibre, while maintaining the same collection efficiency. We transmitted pump light from a 785-nm laser through the NCF, and we collected back the weak Raman spectra of different distal samples, demonstrating the fibre probe can be used for measurements of weak Raman and SERS signals that would otherwise overlap spectrally with the silica background. The lack of distal optics and consequent small probe diameter (<0.25 mm) enable applications that were not previously possible.

The cysteine-rich whey protein supplement, Immunocal®, preserves brain glutathione and improves cognitive, motor, and histopathological indices of traumatic brain injury in a mouse model of controlled cortical impact.

Traumatic brain injury (TBI) is a major public health problem estimated to affect nearly 1.7 million people in the United States annually. Due to the often debilitating effects of TBI, novel preventative agents are highly desirable for at risk populations. Here, we tested a whey protein supplement, Immunocal®, for its potential to enhance resilience to TBI. Immunocal® is a non-denatured whey protein preparation which has been shown to act as a cysteine delivery system to increase levels of the essential antioxidant glutathione (GSH). Twice daily oral supplementation of CD1 mice with Immunocal® for 28 days prior to receiving a moderate TBI prevented an ~ 25% reduction in brain GSH/GSSG observed in untreated TBI mice. Immunocal® had no significant effect on the primary mechanical injury induced by TBI, as assessed by MRI, changes in Tau phosphorylation, and righting reflex time or apnea. However, pre-injury supplementation with Immunocal® resulted in statistically significant improvements in motor function (beam walk and rotarod) and cognitive function (Barnes maze). We also observed a significant preservation of corpus callosum width (axonal myelination), a significant decrease in degenerating neurons, a reduction in Iba1 (microglial marker), decreased lipid peroxidation, and preservation of brain-derived neurotrophic factor (BDNF) in the brains of Immunocal®-pretreated mice compared to untreated TBI mice. Taken together, these data indicate that pre-injury supplementation with Immunocal® significantly enhances the resilience to TBI induced by a moderate closed head injury in mice. We conclude that Immunocal® may hold significant promise as a preventative agent for TBI, particularly in certain high risk populations such as athletes and military personnel.

Coronary Artery Aneurysmal Disease and Acute Coronary Syndrome.

The patient is a 70-year-old male with no other atherogenic risk factors who presented with an acute coronary syndrome (ACS) of unstable angina subsequently complicated by a non-ST elevation myocardial infarction (NSTEMI). The patient's presentation posed 3 unique features: (1) cardiac catheterization demonstrated nonobstructive 3-vessel multi-aneurysmal coronary artery disease with sluggish antegrade coronary flow; (2) a nonobstructive aneurysmal dissection flap based on contrast staining of the mid left anterior descending artery, which may have led to in situ nonocclusive thrombosis and distal microvascular embolization; and (3) successful conservative medical therapy of coronary artery aneurysmal disease (CAAD) complicated with ACS. CAAD has an incidence of 1.5% to 4.9% in adults. The most common etiology of CAAD is atherosclerotic coronary artery disease. There are no guidelines for the management of CAAD complicated by ACS, and controversies exist as to whether conservative, catheter-based, or surgical management should be pursued.

Pancreaticopericardial Fistula Treated Successfully With Pericardial and Pancreatic Drains.

Pancreaticopericardial fistula (PPF) is a rare subset of thoracopancreatic fistulas with few reported cases in the literature. Historically, treatment of PPF has included pancreatic ductal stenting or surgery, or both, but we present a case of PPF that was successfully treated using only pericardial and pancreatic drains.

Lactococcus garvieae multi-valve infective endocarditis in a traveler returning from South Korea.

Lactococcus garvieae is a rare but emerging human pathogen causing a variety of infections with only ten cases of infective endocarditis reported in the literature. We present the only case of Lactococcus garvieae infective endocarditis affecting both a native and a bioprosthetic valve in a traveler returning from rural South Korea.