Inhibitory effect of natural flavone luteolin on Streptococcus mutans biofilm formation.

Streptococcus mutans is one of the key pathogens responsible for dental caries, which is known to be one of the most prevalent biofilm-associated diseases worldwide. S. mutans virulence strongly depends on its biofilm formation and enamel demineralization abilities due to the production of surface adhesins, exopolysaccharides, and acid in the presence of sugar. Luteolin is an abundant natural flavone with a prominent anti-bacterial function. However, it remains unclear how luteolin affects S. mutans pathogenicity including its acidogenicity and biofilm formation. In this study, the effect of luteolin on S. mutans growth, acid production, and its early and late biofilm formation and biofilm disruption was tested. Luteolin shows strong anti-biofilm activity, while it remains non-toxic for bacterial cell viability. In the biofilm, luteolin reduces the expression of S. mutans virulence genes such as gbpC, spaP, gtfBCD, and ftf encoding for surface adhesins and extracellular polysaccharides (EPS)-producing enzymes, which reflects in the strong reduction of bacteria and EPS. Further, it reduces water-insoluble glucan production in the biofilm, potentially, via direct interference with glucosyltransfereases (Gtfs). Moreover, at biofilm inhibitory concentrations, luteolin significantly reduces acid production by S. mutans. Finally, luteolin could target S. mutans amyloid proteins to disrupt the biofilm based on the observation that it inhibits the uptake of the amyloid dye, thioflavin T, by S. mutans extracellular proteins and failed to inhibit biofilm formation by the mutant strain lacking three main amyloid proteins. In conclusion, luteolin appears to be a potent natural compound with pleiotropic anti-biofilm properties against one of the main cariogenic human pathogens, S. mutans. IMPORTANCE Flavonoids are natural compounds with proven anti-bacterial and anti-biofilm properties. Here, we describe the anti-biofilm properties of natural flavone luteolin against the main cariogenic bacteria, S. mutans. Luteolin inhibited gene expression of cell surface adhesins, fructosyltransferases, and glucosyltransferases, which promotes a significant reduction of bacterial and EPS biomass in early and late biofilms. Moreover, luteolin could directly target S. mutans Gtfs and functional amyloids to modulate pathogenic biofilms. These observations provide important insights into the anti-biofilm properties of luteolin while laying out a framework for future therapeutic strategies targeting biofilm-associated virulence factors of oral pathogens.

Hearing health care access for adult cochlear implant candidates and recipients: Travel time and socioeconomic status.

Objectives: Access to cochlear implantation may be negatively influenced by extended travel time to a cochlear implant (CI) center or lower socioeconomic status (SES) for the individual. There is a critical need to understand the influence of these variables on patient appointment attendance for candidacy evaluations, and CI recipients' adherence to post-activation follow-up recommendations that support optimal outcomes. Methods: A retrospective chart review of adult patients referred to a CI center in North Carolina for initial cochlear implantation candidacy evaluation between April 2017 and July 2019 was conducted. Demographic and audiologic data were collected for each patient. Travel time was determined using geocoding. SES was proxied using ZCTA-level Social Deprivation Index (SDI) information. Independent samples t tests compared variables between those who did and did not attend the candidacy evaluation. Pearson correlations assessed the association of these variables and the duration of time between initial CI activation and return for first follow-up visit. Results: Three hundred and ninety patients met the inclusion criteria. There was a statistically significant difference between SDI of those who attended their candidacy evaluation versus those who did not. Age at referral or travel time did not show statistical significance between these two groups. There was no significant correlation with age at referral, travel time, or SDI with the duration of time (days) between initial activation and the 1-month follow-up. Conclusions: Our findings suggest that SES may influence a patient's ability to attend a cochlear implantation candidacy evaluation appointment and may further impact the decision to pursue cochlear implantation.Level of evidence: 4 - Case Series.

Influence of Electric Frequency-to-Place Mismatches on the Early Speech Recognition Outcomes for Electric-Acoustic Stimulation Users.

PURPOSE: Cochlear implant (CI) recipients with hearing preservation experience significant improvements in speech recognition with electric-acoustic stimulation (EAS) as compared to with a CI alone, although outcomes across EAS users vary. The individual differences in performance may be due in part to default mapping procedures, which result in electric frequency-to-place mismatches for the majority of EAS users. This study assessed the influence of electric mismatches on the early speech recognition for EAS users. METHOD: Twenty-one participants were randomized at EAS activation to listen exclusively with a default or place-based map. For both groups, the unaided thresholds determined the acoustic cutoff frequency (i.e., > 65 dB HL). For default maps, the electric filter frequencies were assigned to avoid spectral gaps in frequency information but created varying magnitudes of mismatches. For place-based maps, the electric filter frequencies were assigned to avoid frequency-to-place mismatches. Recognition of consonant-nucleus-consonant words and vowels was assessed at activation and 1, 3, and 6 months postactivation. RESULTS: For participants with default maps, electric mismatch at 1500 Hz ranged from 2 to -12.0 semitones (Mdn = -5 semitones). Poorer performance was observed for those with larger magnitudes of electric mismatch. This effect was observed through 6 months of EAS listening experience. CONCLUSIONS: The present sample of EAS users experienced better initial performance when electric mismatches were small or eliminated. These data suggest the utility of methods that reduce electric mismatches, such as place-based mapping procedures. Investigation is ongoing to determine whether these differences persist with long-term EAS use. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22096523.

Barriers to medication adherence in a rural-urban dual economy: a multi-stakeholder qualitative study.

BACKGROUND: One of the most cost-effective treatments for secondary prevention of stroke and other non-communicable diseases is a long-term medication regimen. However, the complexities of medication adherence extend far beyond individual behavior change, particularly in low- and middle-income countries. The purpose of this study was to examine stakeholder perspectives on barriers to medication adherence for stroke patients in Beijing, China, identifying opportunities to improve care and policy in resource-constrained settings. METHODS: We conducted a qualitative, phenomenological analysis of data obtained from 36 individuals. Participants were patients; caregivers; healthcare providers; and representatives from industry and government, purposively selected to synthesize multiple perspectives on medication management and adherence for stroke secondary prevention in Beijing, China. Data was analyzed by thematic analysis across iterative coding cycles. RESULTS: Four major themes characterized barriers on medication adherence, across stakeholders and geographies: limitations driven by individual patient knowledge / attitudes; lack of patient-provider interaction time; lack of coordination across the stratified health system; and lack of affordability driven by high overall costs and limited insurance policies. CONCLUSIONS: These barriers to medication management and adherence suggest opportunities for policy reform and local practice changes, particularly for multi-tiered health systems. Findings from this study in Beijing, China could be explored for applicability in other low- and middle-income countries with urban centers serving large geographic regions.

Influence of Protective Face Coverings on the Speech Recognition of Cochlear Implant Patients.

OBJECTIVES: The objectives were to characterize the effects of wearing face coverings on: 1) acoustic speech cues, and 2) speech recognition of patients with hearing loss who listen with a cochlear implant. METHODS: A prospective cohort study was performed in a tertiary referral center between July and September 2020. A female talker recorded sentences in three conditions: no face covering, N95 mask, and N95 mask plus a face shield. Spectral differences were analyzed between speech produced in each condition. The speech recognition in each condition for twenty-three adult patients with at least 6 months of cochlear implant use was assessed. RESULTS: Spectral analysis demonstrated preferential attenuation of high-frequency speech information with the N95 mask plus face shield condition compared to the other conditions. Speech recognition did not differ significantly between the uncovered (median 90% [IQR 89%-94%]) and N95 mask conditions (91% [IQR 86%-94%]; P = .253); however, speech recognition was significantly worse in the N95 mask plus face shield condition (64% [IQR 48%-75%]) compared to the uncovered (P < .001) or N95 mask (P < .001) conditions. CONCLUSIONS: The type and combination of protective face coverings used have differential effects on attenuation of speech information, influencing speech recognition of patients with hearing loss. In the face of the COVID-19 pandemic, there is a need to protect patients and clinicians from spread of disease while maximizing patient speech recognition. The disruptive effect of wearing a face shield in conjunction with a mask may prompt clinicians to consider alternative eye protection, such as goggles, in appropriate clinical situations. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2038-E2043, 2021.

Uncovering cyberincivility among nurses and nursing students on Twitter: A data mining study.

BACKGROUND: Although misuse of social networking sites, particularly Twitter, has occurred, little is known about the prevalence, content, and characteristics of uncivil tweets posted by nurses and nursing students. OBJECTIVE: The aim of this study was to describe the characteristics of tweets posted by nurses and nursing students on Twitter with a focus on cyberincivility. METHOD: A cross-sectional, data-mining study was held from February through April 2017. Using a data-mining tool, we extracted quantitative and qualitative data from a sample of 163 self-identified nurses and nursing students on Twitter. The analysis of 8934 tweets was performed by a combination of SAS 9.4 for descriptive and inferential statistics including logistic regression and NVivo 11 to derive descriptive patterns of unstructured textual data. FINDINGS: We categorized 413 tweets (4.62%, n = 8934) as uncivil. Of these, 240 (58%) were related to nursing and the other 173 (42%) to personal life. Of the 163 unique users, 60 (36.8%) generated those 413 uncivil posts, tweeting inappropriately at least once over a period of six weeks. Most uncivil tweets contained profanity (n = 135, 32.7%), sexually explicit or suggestive material (n = 37, 9.0%), name-calling (n = 14, 3.4%), and discriminatory remarks against minorities (n = 9, 2.2%). Other uncivil content included product promotion, demeaning comments toward patients, aggression toward health professionals, and HIPAA violations. CONCLUSION: Nurses and nursing students share uncivil tweets that could tarnish the image of the profession and violate codes of ethics. Individual, interpersonal, and institutional efforts should be made to foster a culture of cybercivility.

Mobile Complex Care Plans to Enhance Parental Engagement for Children With Medical Complexity.

Care plans can reduce care fragmentation for children with medical complexity (CMC); however, implementation is challenging. Mobile health innovations could improve implementation. This mixed methods study's objectives were to (1) evaluate feasibility of mobile complex care plans (MCCPs) for CMC enrolled in a complex care program and (2) study MCCPs' impact on parent engagement, parent experience, and care coordination. MCCPs were individualized, updated quarterly, integrated within the electronic health record, and visible on parents' mobile devices via an online portal. In 1 year (September 1, 2016, to August 31, 2017), 94% of eligible patients (n = 47) received 162 MCCPs. Seventy-four percent of parents (n = 35) reviewed MCCPs online. Forty-six percent of these parents (n = 16) sent a follow-up message, and the care team responded within 8 hours (median time = 7.2 hours). In interviews, parents identified MCCPs as an important reference and communication tool. MCCPs for CMC in a complex care program were feasible, facilitated parental engagement, and delivered timely communication.

Cyberincivility in the Massive Open Online Course Learning Environment: Data-Mining Study.

BACKGROUND: Cyberincivility is a pervasive issue that demands upfront thinking and can negatively impact one's personal, professional, social, and educational well-being. Although massive open online courses (MOOCs) environments could be vulnerable to undesirable acts of incivility among students, no study has explored the phenomena of cyberincivility in this learning environment, particularly in a health-related course in which mostly current or eventual health professions students enroll. OBJECTIVE: This study aimed to analyze the characteristics of text entries posted by students enrolled in a medicine and health care MOOC. The objectives were to (1) examine the prevalence of posts deemed disrespectful, insensitive or disruptive, and inconducive to learning; (2) describe the patterns and types of uncivil posts; and (3) highlight aspects that could be useful for MOOC designers and educators to build a culture of cybercivility in the MOOC environment. METHODS: We obtained data from postings in the discussion forums from the MOOC Medical Neuroscience created by a large private university in the southeast region of the United States. After cleaning the dataset, 8705 posts were analyzed, which contained (1) 667 questions that received no responses; (2) 756 questions that received at least one answer; (3) 6921 responses that applied to 756 posts; and (4) 361 responses where the initiating post was unknown. An iterative process of coding, discussion, and revision was conducted to develop a series of a priori codes. Data management and analysis were performed with NVivo 12. RESULTS: Overall, 19 a priori codes were retained from 25 initially developed, and 3 themes emerged from the data-Annoyance, Disruption, and Aggression. Of 8705 posts included in the analysis, 7333 (84.24%) were considered as the absence of uncivil posts and 1043 (11.98%) as the presence of uncivil posts, while 329 (3.78%) were uncodable. Of 1043 uncivil posts analyzed, 466 were coded to >1 a priori codes, which resulted in 1509 instances. Of those 1509 instances, 826 (54.74%) fell into "annoyance", 648 (42.94%) into "disruption", and 35 (2.32%) into "aggression". Of 466 posts that related to >1 a priori codes, 380 were attributed to 2 or 3 themes. Of those 380 posts, 352 (92.6%) overlapped both "annoyance" and "disruption," 13 (3.4%) overlapped both "disruption" and "aggression," and 9 (2.4%) overlapped "annoyance" and "aggression," while 6 (1.6%) intersected all 3 themes. CONCLUSIONS: This study reports on the phenomena of cyberincivility in health-related MOOCs toward the education of future health care professionals. Despite the general view that discussion forums are a staple of the MOOC delivery system, students cite discussion forums as a source of frustration for their potential to contain uncivil posts. Therefore, MOOC developers and instructors should consider ways to maintain a civil discourse within discussion forums.