Macromolecular crowding effects on protein dynamics.

Macromolecular crowding experiments bridge the gap between in-vivo and in-vitro studies by mimicking some of the cellular complexities like high viscosity and limited space, while still manageable for experiments and analysis. Macromolecular crowding impacts all biological processes and is a focus of contemporary research. Recent reviews have highlighted the effect of crowding on various protein properties. One of the essential characteristics of protein is its dynamic nature; however, how protein dynamics get modulated in the crowded milieu has been largely ignored. This article discusses how protein translational, rotational, conformational, and solvation dynamics change under crowded conditions, summarizing key observations in the literature. We emphasize our research on microsecond conformational and water dynamics in crowded milieus and their impact on enzymatic activity and stability. Lastly, we provided our outlook on how this field might move forward in the future.

The Effect of a Separate Flow of Patients With Small Traumatic Injuries on Consult Time and Patient Satisfaction: A Retrospective Cohort Study During COVID-19 in the Emergency Department.

Background: With emergency department (ED) crowding and high workloads burdening healthcare, efficient patient flow management becomes increasingly crucial. A significant portion of this crowding is attributed to patients with minor traumatic injuries. The objective of this study is to investigate to what extent a separate patient flow for patients with small traumatic injuries influences consult times and patient satisfaction. Methods: During COVID-19, patients with small traumatic injuries in the ED were redirected to an outpatient clinic (the Fracture Clinic). The Fracture Clinic was maintained for seven weeks during which the consult time and patient satisfaction were recorded for every individual. Retrospectively, the same procedure was followed for the seven weeks prior to the outbreak of COVID, with the regular procedure in place. Results: In total, 922 patients were included in the research: 415 patients in the intervention group (Fracture Clinic) and 507 patients in the control group (ED group). The consult time in the Fracture Clinic (median = 30 min) is significantly lower compared to the ED group (median = 86 min) (U = 25,147.500, z = 19.9, p < 0.001). The overall consult in terms of patient satisfaction scored higher for the Fracture Clinic Group than the ED group (T[df] = -4.449 [479], p < 0.001). Conclusions: The Fracture Clinic resulted in shorter consult times and an increased patient satisfaction compared to the usual patient flow for patients with small traumatic injuries in the ED. These patients could be redirected to an outpatient clinical setting to improve efficiency in patient flow, while avoiding a negative impact from the triage system in which they usually are the lowest priority.

Conformational fluidity of intrinsically disordered proteins in crowded environment: a molecular dynamics simulation study.

The class of intrinsically disordered proteins lacks stable three-dimensional structures. Their flexibility allows them to engage in a wide variety of interactions with other biomolecules thus making them biologically relevant and efficient. The intrinsic disorders of these proteins, which undergo binding-induced folding, allow alterations in their topologies while conserving their binding sites. Due to the lack of well-defined three-dimensional structures in the absence of their physiological partners, the folding and the conformational dynamics of these proteins remained poorly understood. Particularly, it is unclear how these proteins exist in the crowded intracellular milieu. In the present study, molecular dynamic simulations of two intrinsically unstructured proteins and two controls (folded proteins) were conducted in the presence and absence of molecular crowders to obtain an in-depth insight into their conformational flexibility. The present study revealed that polymer crowders stabilize the disordered proteins through enthalpic as well as entropic effects that are significantly more than their monomeric counterpart. Taken together, the study delves deep into crowding effects on intrinsically disordered proteins and provides insights into how molecular crowders induce a significantly diverse ensemble of dynamic scaffolds needed to carry out diverse functions.Communicated by Ramaswamy H. Sarma.

Quantitative phenotyping of verbal and non-verbal cognitive impairment using diffusion-weighted MRI connectome: Preliminary study of the crowding effect in children with left hemispheric epilepsy.

The "crowding" effect (CE), wherein verbal functions are preserved presumably at the expense of nonverbal functions, which diminish following inter-hemispheric transfer of language functions, is recognized as a specific aspect of functional reorganization, offering an insight about neural plasticity in children with neural insult to the dominant hemisphere. CE is hypothesized as a marker for language preservation or improvement after left-hemispheric injury, yet it remains challenging to fully discern it in preoperative evaluation. We present a novel DWI connectome (DWIC) approach to predict the presence of CE in 24 drug-resistant epilepsy (DRE) patients with a left-hemispheric focus and 29 young healthy controls. Psychometry-driven DWIC analysis was applied to create verbal and non-verbal modular networks. Local efficiency (LE) was assessed at individual regions of the two networks and its Z-score was compared to predict the presence of CE. Compared with a traditional organization (TO) group, wherein verbal functions are adversely affected, while non-verbal functions are preserved, the CE group showed significantly higher Z-scores in verbal network and significantly lower Z-scores in non-verbal network, corresponding to network reorganization in CE. A larger number of antiseizure drugs was significantly associated with more decreased Z-score in the right non-verbal network of the CE group and left verbal network of the TO group. These findings hold great potential to identify DRE patients whose verbal/language skills may over time be preserved due to effective inter-hemispheric reorganization and identify those whose verbal/language impairments may persist due to lack of inter-hemispheric reorganization.

An improved N-N dimethylacetamide-based non-flammable molecular crowding electrolyte using NaOTf for cobalt-based prussian blue//hard carbon aqueous solution battery.

Aqueous sodium-ion batteries (ASIBs) are promising for large-scale electrical energy storage (LSEES) applications due to their cost and safety advantages. However, the low voltage stabilization window of water (∼1.23 V) and the lack of cathode with high specific capacity and long cycle life have limited their development. Cobalt-based Prussian blue analogues (NaCoPBAs) have the advantage of high theoretical specific capacity but short cycle life. Recently, the molecular crowding electrolyte (MCE) strategy has been proposed to improve the electrolyte voltage stability window (ESW) of electrolytes, in this work, we report an improved xMC (x: ratio, MC: molecular crowding agent) electrolyte that uses N-N dimethylacetamide (DMAC) as the molecular crowding agent and NaOTf as the advanced salt with an ESW of 2.65 V and excellent nonflammability. The side reactions of the NaCoPBA//Hard Carbon (HC) full-cell active material are improved with the aid of the electrolyte. Capacity retention of 75 % after 600 cycles with excellent cycling stability. These results demonstrate that this advanced MCE strategy can be utilized for practical applications designed for safety, high specific capacity and long cycle (ASIB).

Prescription for crisis: the compounding effect of community drug shortages on Lebanon's healthcare system.

The multifaceted crises that Lebanon is facing have led to a shortage of medications in the country's community pharmacies. This shortage has triggered a cascade of adverse effects, rippling throughout the nation's healthcare system. In this report, we examine the causes, which range from economic turmoil to inadequate resource distribution, along with the profound impacts on public health, such as increased length of hospital stays and compromised patient care. The paper also proposes a suite of solutions aimed at mitigating the immediate challenges and paving the way for a more resilient healthcare framework.

Unfolding Mechanism and Fibril Formation Propensity of Human Prion Protein in the Presence of Molecular Crowding Agents.

The pathological process of prion diseases implicates that the normal physiological cellular prion protein (PrPC) converts into misfolded abnormal scrapie prion (PrPSc) through post-translational modifications that increase ß-sheet conformation. We recently demonstrated that HuPrP(90-231) thermal unfolding is partially irreversible and characterized by an intermediate state (ß-PrPI), which has been revealed to be involved in the initial stages of PrPC fibrillation, with a seeding activity comparable to that of human infectious prions. In this study, we report the thermal unfolding characterization, in cell-mimicking conditions, of the truncated (HuPrP(90-231)) and full-length (HuPrP(23-231)) human prion protein by means of CD and NMR spectroscopy, revealing that HuPrP(90-231) thermal unfolding is characterized by two successive transitions, as in buffer solution. The amyloidogenic propensity of HuPrP(90-231) under crowded conditions has also been investigated. Our findings show that although the prion intermediate, structurally very similar to ß-PrPI, forms at a lower temperature compared to when it is dissolved in buffer solution, in cell-mimicking conditions, the formation of prion fibrils requires a longer incubation time, outlining how molecular crowding influences both the equilibrium states of PrP and its kinetic pathways of folding and aggregation.

Foveal crowding in children with developmental dyslexia.

Excessive crowding in the visual periphery has been demonstrated in children with developmental dyslexia (DD). However, less is known about crowding in the fovea, even though foveal crowding is at least equally important, as reading is mostly accomplished through foveal vision. Here we used a special set of digit stimuli (Pelli fonts) to measure foveal crowding in DD and DD + ADHD children, and compared it to that in TD (typically developing) and ADHD children. We also used the Chinese reading acuity charts (C-READ) to assess the maximum reading speed and reading acuity, along with tests to evaluate cognitive attributes including phonological awareness, rapid automatized naming, morphological awareness, and orthographic knowledge. The results indicate significantly stronger foveal crowding in the DD and DD + ADHD groups, as well as in the ADHD group, than in the TD group. Furthermore, the DD and DD + ADHD groups exhibited poorer maximum reading speed and reading acuity compared to the ADHD and TD groups. Within the two DD groups, the slower maximum reading speed and higher reading acuity can be predicted by stronger foveal crowding. In addition, the DD and DD + ADHD groups performed the worst in four cognitive skills, with the DD group showing negative correlations between foveal crowding and performances across all these skills. Our findings thus move beyond previously well-documented peripheral crowding in dyslexia, and the easy administration of the Pelli-font-based crowding test may be useful for early diagnosis of developmental dyslexia in young children.

Mimicking a Cellular Crowding Environment for Enzyme-Free Paper-Based Nucleic Acid Tests at the Point of Care.

Point of care (PoC) nucleic acid amplification tests (NAATs) are a cornerstone of public health, providing the earliest and most accurate diagnostic method for many communicable diseases in the same location where the patient receives treatment. Communicable diseases, such as human immunodeficiency virus (HIV), disproportionately impact low-resource communities where NAATs are often unobtainable due to the resource-intensive enzymes that drive the tests. Enzyme-free nucleic acid detection methods, such as hybridization chain reaction (HCR), use DNA secondary structures for self-driven amplification schemes, producing large DNA nanostructures, capable of single-molecule detection in cellulo. These thermodynamically driven DNA-based tests have struggled to penetrate the PoC diagnostic field due to their inadequate limits of detection or complex workflows. Here, we present a proof-of-concept NAAT that combines HCR-based amplification of a target nucleic acid sequence with paper-based nucleic acid filtration and enrichment capable of detecting sub-pM levels of synthetic DNA. We reconstruct the favorable hybridization conditions of an in cellulo reaction in vitro by incubating HCR in an evaporating, microvolume environment containing poly(ethylene glycol) as a crowding agent. We demonstrate that the kinetics and thermodynamics of DNA-DNA and DNA-RNA hybridization is enhanced by the dynamic evaporating environment and inclusion of crowding agents, bringing HCR closer to meeting PoC NAAT needs.

The financial burden of noncommunicable diseases from out-of-pocket expenditure in sub-Saharan Africa: a scoping review.

The growing financial burden of noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA) hinders the attainment of the sustainable development goals. However, there has been no updated synthesis of evidence in this regard. Therefore, our study summarizes the current evidence in the literature and identifies the gaps. We systematically search relevant databases (PubMed, Scopus, ProQuest) between 2015 and 2023, focusing on empirical studies on NCDs and their financial burden indicators, namely, catastrophic health expenditure (CHE), impoverishment, coping strategies, crowding-out effects and unmet needs for financial reasons (UNFRs) in SSA. We examined the distribution of the indicators, their magnitudes, methodological approaches and the depth of analysis. The 71 included studies mostly came from single-country (n = 64), facility-based (n = 52) research in low-income (n = 22), lower-middle-income (n = 47) and upper-middle-income (n = 10) countries in SSA. Approximately 50% of the countries lacked studies (n = 25), with 46% coming from West Africa. Cancer, cardiovascular disease (CVD) and diabetes were the most commonly studied NCDs, with cancer and CVD causing the most financial burden. The review revealed methodological deficiencies related to lack of depth, equity analysis and robustness. CHE was high (up to 95.2%) in lower-middle-income countries but low in low-income and upper-middle-income countries. UNFR was almost 100% in both low-income and lower-middle-income countries. The use of extreme coping strategies was most common in low-income countries. There are no studies on crowding-out effect and pandemic-related UNFR. This study underscores the importance of expanded research that refines the methodological estimation of the financial burden of NCDs in SSA for equity implications and policy recommendations.

The effect of inter-letter spacing on the N170 during visual word recognition: An event-related potentials experiment.

Previous behavioral studies have shown that inter-letter spacing affects visual word recognition and reading. While condensed spacing may hinder the early stages of letter encoding because of increased crowding effects, the impact of expanded inter-letter spacing is still unclear. To examine the electrophysiological signature of inter-letter spacing on visual word recognition, we presented words in three different inter-letter spacing conditions (default, condensed [-1.5 points] or expanded [+1.5 points]) in an event-related potentials go/no-go semantic categorization task. Our focus was on the N170, an event-related potentials component associated with the early encoding of orthographic information, which also is sensitive to crowding effects. Results revealed that the N170 amplitude reached the largest values for the condensed condition than for the default and expanded spacing conditions, which did not differ. While increased crowding impacted the early encoding of orthographic information, extra letter spacing (compared with default spacing) did not. This outcome is consistent with the Modified Receptive Field hypothesis, in which letter receptors adapt their size to cope with letter crowding. These findings reveal that reducing the space between letters more than the default spacing impairs the ability to process written words, whereas slightly expanding the space between letters does not provide any additional benefit.

Scientific rationale for Clinical Practice Guidelines (part 1): what are the factors that determine the choice of retention? / Argumentaire scientifique en vue de l'élaboration de recommandations professionnelles (partie 1) : facteurs de choix préalables à la réalisation d'une contention.

Introduction: Retention is the set of means, processes or devices that contribute to maintaining the teeth in the position and the arches in the shape given by the orthodontic treatment. The main objective is to propose Clinical Practice Guidelines (CPG) on orthodontic retention by answering 4 main questions. This article provides the answer to the first question: What are the factors that determine whether or not to use a retainer? Material and Methods: A literature review was carried out after a bibliographic search using keywords in bibliographic databases and in international organizations websites. Results: 652 articles were selected after the bibliographic search, and only 53 met the inclusion criteria. These were used to develop the CPG full-text and guidelines. Discussion: 12 CPGs were issued from this review, divided into 15 items, 8 of which were grade C and 7 were expert agreements. Conclusion: 40 CPGs about orthodontic retention were proposed from this literature review, 12 of which are presented in this first part. The stability of orthodontic treatment depends on the initial orthodontic anomalies, residual growth, orthodontic treatment modalities, and the final occlusion. Orthodontists must consider the effectiveness of the appliances, the patients' compliance and oral hygiene. The amount of alveolar bone, the neuromuscular and functional balance are relapse factors.

Introduction: La contention est l'ensemble de moyens, procédés ou dispositifs contribuant à maintenir les dents dans la position et les arcades dans la forme, données par le traitement d'orthodontie. L'objectif principal était de proposer des recommandations de bonne pratique (RBP) sur la contention en orthodontie, en répondant à quatre questions principales. Cet article fournit l'argumentaire correspondant à la première question : quels sont les facteurs de choix préalables à la réalisation d'une contention ? Matériel et méthodes: Une revue de la littérature a été réalisée après recherche bibliographique par mots-clés dans les banques de données bibliographiques, ainsi que sur les sites internet d'organismes internationaux. Résultats: Sur 652 articles sélectionnés à l'issue de la recherche bibliographique, seulement 53 répondaient aux critères d'inclusion. Ils ont permis de rédiger l'argumentaire scientifique et d'en tirer des RBP. Discussion: Douze recommandations ont pu être émises à partir de cet argumentaire, divisées en 15 items dont 8 de grade C et 7 accords d'experts. Conclusion: Quarante RBP à propos de la contention en orthodontie ont été proposées à partir de cette revue de la littérature dont 12 qui ont été exposées dans cette première partie. La stabilité du traitement orthodontique dépend des anomalies orthodontiques initiales, de la croissance résiduelle, des modalités thérapeutiques orthodontiques, de l'équilibre occlusal obtenu. L'orthodontiste doit prendre en compte l'efficacité des dispositifs, l'observance et l'hygiène bucco-dentaire du patient. La quantité d'os alvéolaire, l'équilibre neuromusculaire et fonctionnel sont des facteurs de récidive.

Scientific rationale for Clinical Practice Guidelines (part 2): what is the effectiveness of retention devices? / Argumentaire scientifique en vue de l'élaboration de recommandations professionnelles (partie 2) : efficacité des dispositifs de contention en termes de stabilité.

Introduction: Retention is the set of means, processes or devices that contribute to maintaining the teeth in the position and the arches in the shape given by the orthodontic treatment. The main objective is to propose Clinical Practice Guidelines (CPG) on orthodontic retention by answering four main questions. This article provides the first part of the answer to the second question: How effective are the retention devices? Materials and Methods: A literature review was carried out after a bibliographic search using keywords in bibliographic databases and in international organizations websites. Results: 652 articles were selected after the bibliographic search, and only 53 met the inclusion criteria. These were used to develop the CPG full-text and guidelines. Discussion: Ten CPGs were issued from this review, divided into 12 items, 10 of which are grade C and 2 are expert agreements. Conclusion: Forty CPGs about orthodontic retention were proposed from this literature review, 10 of which are presented in this second part. In the mandible, fixed retention provides better stability than removable retention and 6-tooth retention is more effective in maintaining incisal alignment. Fixed and removable retention are equivalent in maintaining extraction spaces and arch length. Removable retention allows for minimal tooth movement and establishment of occlusal contacts.

Introduction: La contention est l'ensemble de moyens, procédés ou dispositifs, contribuant à maintenir les dents dans la position et les arcades dans la forme, données par le traitement d'orthodontie. L'objectif principal était de proposer des recommandations de bonne pratique (RBP) sur la contention en orthodontie, en répondant à quatre questions principales. Cet article fournit la deuxième partie de l'argumentaire correspondant à la deuxième question : quelle est l'efficacité des dispositifs de contention ? Matériel et méthodes: Une revue de la littérature a été réalisée après recherche bibliographique par mots-clés dans les banques de données bibliographiques et sur les sites internet d'organismes internationaux. Résultats: 652 articles ont été sélectionnés à l'issue de la recherche bibliographique, mais seulement 53 répondaient aux critères d'inclusion. Ils ont permis de rédiger l'argumentaire scientifique et d'en tirer des RBP. Discussion: Dix recommandations ont pu être émises à partir de cet argumentaire, divisées en 12 items, dont 10 de grade C et 2 accords d'experts. Conclusion: Quarante RBP concernant la contention en orthodontie ont été proposées à partir de cette revue de la littérature dont dix qui sont exposées dans cette deuxième partie. À la mandibule, la contention fixe permet une meilleure stabilité que la contention amovible et la contention 6 dents est plus efficace pour le maintien de l'alignement incisif. Les contentions fixes et amovibles sont équivalentes pour maintenir les espaces d'avulsion et la longueur d'arcade. Les contentions amovibles permettent d'effectuer des mouvements dentaires minimes et l'établissement de contacts occlusaux.

When periphery rules: Enhanced sampling weights of the visual periphery in crowding across dimensions.

Crowding, our inability to identify a feature or object - the target - due to its proximity to adjacent features or objects - flankers - exhibits a notable inner-outer asymmetry. This asymmetry is characterized by the outer flanker - more peripheral - creating stronger interference than the inner one - closer to the fovea. But crowding is not uniform across different feature dimensions. For example, in the case of orientation, this asymmetry reflects misreport errors: observers are more likely to misidentify the outer flanker as the target than the inner one. However, for spatial frequency (SF), observers tend to average the features of the target and flankers (Yashar et al., 2019). Here, we investigated whether and how the inner-outer asymmetry manifests across various feature dimensions: Gabor orientation and SF, as well as T-shape tilt and color. We reanalyzed continuous estimation reports data published by Yashar et al. (2019), focusing on a previously unanalyzed factor: the relative position of each flanker (inner vs. outer). We fit probabilistic models that assign variable weights to each flanker. Our analysis revealed that observers predominantly misreport the outer flanker as the target with Gabor orientation and T-shape tilt stimuli, and slightly so with color stimuli, whereas with Gabor SF, observers perform a weighted average of all features but also with a bias towards the outer flanker over the inner one. These findings suggest that an increased weighting on the more peripheral items is a general characteristic of crowding in peripheral vision.

Comparison of dental movements in digital setups created by orthodontists and "3shape design service®" engineers: A cross-sectional study.

INTRODUCTION: The demand for faster and invisible orthodontic treatments has led to the increased use of clear aligners, facilitated by advancements in digital treatment planning. This study aims to evaluate the reliability of digital orthodontic setups performed by orthodontists compared to those by 3Shape Design Service®engineers. MATERIAL AND METHODS: A monocentric, cross-sectional observational study was conducted at Bretonneau Hospital from October 2022 to May 2023. All patients meeting the inclusion criteria and willing to participate were included in the study. Intraoral scans were used to create treatment setups using the Ortho System® software, performed by both orthodontists and 3Shape® engineers. The primary objective was to compare the dental movements (rotation, intrusion, extrusion, buccolingual inclination, tipping, mesiodistal translation and buccolingual translation) between the two groups. Secondary objectives included the number of teeth displaced, aligners needed, interproximal enamel reduction and number of attachments placed. RESULTS: Nineteen patients with mild to moderate malocclusion were included. Statistically significant differences were found in tooth displacements between the two groups with engineers executing greater dental movements for derotation (4.9±2.6 vs. 3.7±2.3), tipping (0.79±0.69 vs. 0.26±0.44), bucco-lingual (0.40±0.26 vs. 0.08±0.11) and mesio-distal translations (0.31±0.20 vs. 0.20±0.17). Secondary measures showed no significant differences except for the number of teeth displaced (15.32±5.21 vs. 9.68±4.82), which was higher in the 3Shape group. DISCUSSION: While digital setups by engineers showed more significant tooth movements, the practical impact on mild malocclusion treatment was minimal. This study highlights the need for precise treatment objectives and consideration of overcorrection practices. CONCLUSION: For mild malocclusions, outsourcing setups to 3Shape engineers can be an alternative to in-office setups by orthodontists. However, further studies are needed to evaluate setup reliability for more complex malocclusions.

Class II Correction and Crowding Treatment Using In-House Direct Printed Clear Aligners: A Literature Review and Case Report.

Clear aligner therapy has significantly improved orthodontic treatment by offering patients a more aesthetically pleasing option compared to traditional braces. This literature review and case report specifically focus on the effectiveness of directly printed clear aligners in treating Class II malocclusions and crowding. Class II malocclusions are characterized by excessive overjet, which often results from skeletal or dental discrepancies between the upper and lower jaws. Crowding refers to the lack of space for teeth within the dental arch, leading to misalignment and potential functional issues. The review and case report highlight the increasing importance of directly printed clear aligners in modern orthodontics and provide clinicians with a valuable tool to effectively address complex malocclusions and crowding while also meeting patient needs for discretion and comfort. Further research is necessary to validate the long-term stability and outcomes of directly printed clear aligner therapy in various orthodontic cases. A detailed case report demonstrates the successful treatment of a patient with Class II malocclusion and mild crowding using directly printed clear aligners. Treatment outcomes include improvements in dental alignment, occlusion, and facial aesthetics, showcasing the effectiveness of this innovative approach.

Proton Intercalation into an Open-Tunnel Bronze Phase with Near-Zero Volume Change.

Managing safety and supply-chain risks associated with lithium-ion batteries (LIBs) is an urgent task for sustainable development. Aqueous proton batteries are attractive alternatives to LIBs because using water and protons addresses these two risks. However, most host materials undergo large volume changes upon H+ intercalation, which induces intraparticle cracking to accelerates parasitic reactions. Herein, we report that Mo3Nb2O14 bronze exhibits reversible H+ intercalation (200 mAh g-1) with a Coulombic efficiency of 99.7% owing to near-zero volume change and solid-solution-type phase transition. Combination of experimental and theoretical analyses clarifies that rotation and shrinkage of open tunnels, which consist of flexible corner-sharing Mo/NbOn polyhedra, relieve local structural distortions upon H+ intercalation to suppress intraparticle cracking. The prototype full cell of an aqueous proton battery with a Mo3Nb2O14 anode operates stably over 1000 charge/discharge cycles. This study reveals the importance of implementing distortion-relieving voids in host materials to reduce volume change upon charge/discharge.

Myotube formation on micropatterns guiding by centripetal cellular motility and crowding.

The physical microenvironment, including substrate rigidity and topology, impacts myoblast differentiation and myotube maturation. However, the interplay effect and physical mechanism of mechanical stimuli on myotube formation is poorly understood. In this study, we utilized elastic substrates, microcontact patterning technique, and particle image velocimetry to investigate the effect of substrate rigidity and topological constraints on myoblast behaviors. Our findings suggested the interplay of substrate stiffness and cellular confinement improved the myotube formation by inducing centripetal cellular motility. These results shed light on the impact of the topological substrate on myoblast differentiation and emphasize the critical role of asymmetrical cell motility during this process, which is highly correlated with cell movement and crowding. Our research provides insights into the intricate interplay between substrate properties, cell motility, and myotube formation during myogenesis. Understanding these mechanisms could trigger tissue engineering strategies and therapies to enhance muscle regeneration and function.

Improving emergency department flow by introducing four interventions simultaneously. A quality improvement project.

BACKGROUND: Emergency department (ED) crowding is a widespread issue with adverse effects on patient care and outcomes. LOCAL PROBLEM: ED crowding exacerbates wait times and compromises patient care, prompting opportunities for internal process improvement. METHOD: Over one week, the ED flow project team implemented four interventions, including an additional triage station, to optimize patient flow. We compared triage times, length of stay, crowding levels, and patient experiences with two control periods. RESULTS: During peak hours, waiting times to triage decreased significantly with a median of 20 min (IQR 15-30) in the project week and 26 min (IQR 18-37) in the control weeks. Self-referrals decreased, while general practitioner referrals remained unchanged. Individual patient length of stay was unaffected, but crowding reduced notably during the project week. We found no difference in patient experiences between the periods. CONCLUSION: The interventions contributed to reduced crowding and improved patient flow. The dedication of the ED flow project team and the ED nurses was crucial to these outcomes. An additional triage station during peak hours in the ED was established as a structural change.