CardioStart Online: A Virtual High School Tissue Engineering Course.

In this paper, we altered an in-person high school tissue engineering program to create a virtual course. Through this alteration, we aimed to show that online programs can still be engaging and at the same time provide greater accessibility and flexibility to students. This was achieved through utilizing Google classroom as a virtual platform for students to engage with course modules and assessments. After analyzing pre- and post-program survey responses in both the in-person and online offerings of the CardioStart program, it was found that students improved in their understanding of all of the tissue engineering topics that were introduced in the programs. Furthermore, when comparing the results from the in-person versus online offerings of the program, it was found that the level of student understanding and learning of these topics was similar across the in-person and online programs. We were also able to engage five times the number of students online as compared to the in-person program, which was conducted yearly for six summers. However, many students indicated that their experience would have been better if hands-on activities were included to supplement their knowledge of cell culture techniques after completing the course. The online program improved accessibility and scalability of the program compared to in-person workshops. Future work will consist of bridging this virtual course and the hands-on experiments performed during the in-person program to provide interested students access to laboratory experiences.

Becoming a better paramedic through the special needs school placement program.

Paramedics provide care in medical emergencies to patients with varying ages and from a range of settings, cultures, backgrounds and experiences. As such, the paramedic needs a very diverse skill set which is difficult to obtain at university. For this reason, undergraduate paramedic students often engage in clinical placements to apply their knowledge to real world experiences. Most of these placements, however, are in hospitals or ambulance settings, but part of the diverse community that paramedics treat are children with special needs, including children with disabilities. This study measured the attitudes of paramedic students to people with disabilities and explored the effectiveness of paramedic student clinical placements in special needs schools. 109 paramedic students enrolled in their first year of the Bachelor of Paramedicine at Monash University undertook placements in special needs schools across Victoria, Australia. These students completed the Interactions with Disabled Persons Scale. Of these students, 5 participated in two focus groups to gain a deeper understanding of their placement experience. The results showed that paramedic students enjoyed their placements and gained a more positive attitude towards special needs students, but also felt challenged and overwhelmed. Also found were four main characteristics that students believed paramedics needed to be effective; empathy, being genuine, the ability to listen to someone even though they are not speaking to you verbally, and the ability to gain the trust of someone quickly where gaining trust is difficult. This study was the first time an entire cohort of paramedic students have undertaken placements at special needs schools. The findings provide a baseline and incentive for further exploration of the benefits of the placement of paramedic students (and student from a variety of healthcare professions) in special needs schools, as well as other marginalised communities.

Impact of COVID-19 on paramedicine students: A mixed methods study.

BACKGROUND: Viral epidemics have negative and sometimes extreme impacts on psychological well-being, particularly in health care workers. Studies have reported higher levels of depression, anxiety, insomnia, stress, distress, fear, burnout, and post-traumatic symptoms. OBJECTIVE: This research aimed to explore the psychological impacts of COVID 19 on paramedicine students. METHODS: A convergent mixed method design study was undertaken using self-reporting instruments and qualitative interviews. RESULTS: Responses were received from 151 students (38.3% responses rate). Most students experienced some level of anxiety (62%), although severe levels were only reported by 6% of respondents. Students had significantly greater odds (OR = 2.05, p = 0.045, 95% CI: 1.02, 4.12) of higher anxiety levels if they were female. Thematic analysis of the interviews largely supported these results, with themes focused on changing approaches to study, financial situation, social support, University adaptation, acceptance and career pathway choice. CONCLUSIONS: This study identified and explored the anxiety and coping strategies in an undergraduate paramedicine cohort when faced with a viral epidemic. Although most of the responding paramedic students reported above normal levels of anxiety in the initial stages of the COVID-19 outbreak, many students, with the help of learning, financial and social support, and a range of positive coping strategies, have adapted well to the impact of the pandemic and associated lockdown period.

Online Laboratory Experiment Learning Module for Biomedical Engineering Physiological Laboratory Courses.

By early spring 2020, the COVID-19 pandemic caused mandatory campus closures of academic institutions nationwide, prompting the rapid transition to online instruction. While lectures and exams were more straightforwardly administered online using video-chatting software, many hands-on laboratory-based courses were forced to develop creative solutions. In response to online instructional requirements, instructors at the University of California Irvine developed an online electroencephalography (EEG) laboratory to simulate the laboratory experiment for students unable to perform the experiment on campus. The laboratory experiment was performed and video recorded by the instructional team under three different scenarios to provide students with multiple data sets acquired under various experimental conditions often enacted by students. Students were required to complete a pre-lab quiz, analyze the acquired EEG data offline, complete a post-lab quiz, and submit their laboratory report to communicate their findings prior to final exams. Student performances compared to prior student performances, and qualitative survey responses, were examined to assess the effectiveness of and response to the online laboratory format. Based on student feedback and lab report grades, the majority of students responded positively and demonstrated an understanding of the EEG experiment's learning outcomes. In summary, the online EEG laboratory enabled students to achieve the main learning objectives and become familiar with the laboratory experiment, indicating its success as an alternative laboratory experiment.

Association Between Immunoglobulin E Levels and Kaposi Sarcoma in African Adults With Human Immunodeficiency Virus Infection.

It has been demonstrated that activated mast cells (MCs) are enriched in Kaposi sarcoma (KS) tumors and contribute to the inflammatory microenvironment. Mechanisms driving MC activation, however, are incompletely understood. We sought to understand whether immunoglobulin E (IgE), a potent activator of MCs, was associated with KS incidence and severity. In a cross-sectional study of untreated human immunodeficiency virus (HIV)-infected adults with or without KS in Uganda, we found that patients with KS had higher plasma IgE levels than those without KS. After adjustment for age, sex, CD4+ T-cell count, and HIV RNA levels, there was a dose-response relationship between plasma IgE levels and the presence and severity of KS. Higher eosinophil counts were also associated with IgE levels, and plasma interleukin 33 concentrations were higher in individuals with KS. These findings suggest that IgE-driven atopic inflammation may contribute the pathogenesis of KS. Therapies targeting IgE-mediated MC activation thus might represent a novel approach for treatment or prevention of KS.

Mobilization and Activation of the Innate Immune Response to Dengue Virus.

Dengue virus is an important human pathogen, infecting an estimated 400 million individuals per year and causing symptomatic disease in a subset of approximately 100 million. Much of the effort to date describing the host response to dengue has focused on the adaptive immune response, in part because of the well-established roles of antibody-dependent enhancement and T cell original sin as drivers of severe dengue upon heterotypic secondary infection. However, the innate immune system is a crucial factor in the host response to dengue, as it both governs the fate and vigor of the adaptive immune response, and mediates the acute inflammatory response in tissues. In this review, we discuss the innate inflammatory response to dengue infection, focusing on the role of evolutionarily conserved innate immune cells, their effector functions, and clinical course.

Interprofessional Cooperation: An Interventional Study Among Saudi Healthcare Teaching Staff at King Saud University.

BACKGROUND: Collaborative interprofessional practice improves health outcomes. Interprofessional education (IPE) is essential in improving this collaboration and the quality of care. Although the majority of IPE research focuses on students, the delivery of IPE requires multiple levels of support within educational institutions, particularly teaching staff that are positive about and advocate for IPE. This study explored the attitudes of teaching staff towards interprofessional collaboration across a range of professions in Health at King Saud University, Saudi Arabia. METHODS: A pre-test post-test design was used with 53 teaching staff from the Health Colleges, King Saud University, before and after an interprofessional development workshop. A 12-item, 3-subscale version of the IEPS was used to evaluate changes in the 3-subscales "competency and autonomy", "perceived need for cooperation" and "perception of actual cooperation". RESULTS: This study involved teaching staff from medicine, nursing, pharmacy, dentistry, applied medical science and emergency medical services. Results showed positive attitudes towards IPE, including competency and autonomy, the need for cooperation, and the perception of actual cooperation. The analysis also showed a statistically significant effect of subscale 1 (competency and autonomy) was produced between the pre- and post-workshop training. CONCLUSION: Interprofessional collaboration across the Health Colleges is an essential component of IPE, just as IPE is an integral component of interprofessional collaborative practice. The findings provided a baseline, as well as an incentive, for further development in IPE, from policy through to practice, across the Health Colleges. Findings also showed teaching staff having a positive attitude towards interprofessional collaboration. Further research is needed on tools for measuring IPC across university hierarchies and disciplines, as well as on enablers of IPE (and not just barriers).

BET 1: Esmolol-a novel adjunct to the ACLS algorithm?

A short-cut review of the available medical literature was carried out to establish whether esmolol was an effective treatment for patients in cardiac arrest. After abstract review, two papers were found to answer this clinical question using the detailed search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that there is insufficient research addressing this question to know whether esmolol is a potential treatment for cardiac arrest.

Serum IL-1RA levels increase from follicular to luteal phase of the ovarian cycle: A pilot study on human female immune responses.

The immune responses exhibited by females are distinct from those of males. Females are known to generate, among others, higher levels of antibodies, greater interferon responses, and increased levels of inflammatory mediators in response to pathogens. Mounting evidence suggests that gonadal hormones play a key role in these differences. To better understand the effect of cycling hormones on the immune response, we sought to investigate the relationship between gonadal hormone fluctuations during the ovarian cycle and the levels of interleukin 1ß and IL-1RA, both in circulation and in PBMCs in response to TLR4 stimulation, in healthy premenopausal females. To do this we measured the gonadal hormones 17ß-estradiol, progesterone, and luteinizing hormone, and the cytokines IL-1ß and IL-1RA in nine cycling females at several time points throughout one complete cycle. We evaluated 35 follicular, 17 ovulatory, and 44 luteal time points in our cohort and found a clear increase in serum levels of anti-inflammatory IL-1RA in the luteal phase, as compared to the follicular phase, and a positive correlation between both 17ß-estradiol and progesterone and IL-RA. There was no difference in the serum levels of IL-1ß and no difference in IL-1 ß or IL-1RA produced in response to LPS by PBMCs isolated from different phases. Division of the cycle into sub-phases revealed an increase in the level of IL-1RA by ovulation that persisted through the luteal phase. These data suggest that significant changes in the immune response occur throughout the ovarian cycle in healthy females.

Dengue virus non-structural protein 1 activates the p38 MAPK pathway to decrease barrier integrity in primary human endothelial cells.

Dengue virus (DENV) causes an estimated 390 million infections worldwide annually, with severe forms of disease marked by vascular leakage. Endothelial cells (EC) are directly responsible for vascular homeostasis and are highly responsive to circulating mediators but are not commonly infected. DENV encodes seven non-structural (NS) proteins; with only one of those, NS1, secreted from infected cells and accumulating in the blood of patients. NS1 has been implicated in the pathogenesis of vascular permeability, but the mechanism is not completely understood. Here we used primary endothelial cells and an array of in vitro approaches to study the effect of NS1 in disease-relevant human ECs. Confocal microscopy demonstrated rapid NS1 internalization by ECs into endosomes with accumulation over time. Transcriptomic and pathway analysis showed significant changes in functions associated with EC homeostasis and vascular permeability. Functional significance of this activation was assessed by trans-endothelial electrical resistance and showed that NS1 induced rapid and transient loss in EC barrier function within 3 h post-treatment. To understand the molecular mechanism by which NS1 induced EC activation, we evaluated the stress-sensing p38 MAPK pathway known to be directly involved in EC permeability and inflammation. WB analysis of NS1-stimulated ECs showed clear activation of p38 MAPK and downstream effectors MAPKAPK-2 and HSP27 with chemical inhibition of the p38 MAP kinase pathway restoring barrier function. Our results suggest that DENV NS1 may be involved in the pathogenesis of severe dengue by activating the p38 MAPK in ECs, promoting increased permeability that characterizes severe disease.

The "Ideal" Clinical Supervision Environment in Nursing and Allied Health.

BACKGROUND: The importance of effective clinical supervision for emerging clinicians is well recognised, not only for practice preparation, but also for reducing future attrition rates. Also recognised are the challenges faced by both students and supervisors during the supervision experience. This study aimed to identify the qualities of the "ideal" clinical supervision environment from the perspective of clinical supervisors from both nursing and allied health. DESIGN: A qualitative study using an interview method based on action research. METHODS: The convergent interview method was used with 20 clinical supervisors and educators from nursing and allied health across Victoria. Interviews were recorded and data analysis occurred at the end of each pair of interviews to develop deeper questions in line with the method. RESULTS: 12 major themes emerged as "ideal" qualities with a range of suggestions on how these can be achieved. CONCLUSION: The "ideal" qualities can be used in assessing and improving current contexts, as well as designing new clinical supervision processes, models, programs and guidelines or policies. The convergent interview method allowed for deeper level analysis than previous research.

Avoiding Difficult Conversations in the Australian Health Sector.

BACKGROUND: Health professionals avoiding difficult conversations with each other can lead to serious negative consequences for patients. Clinical supervisors are in the unique position of interacting both with students as well as colleagues and peers. This study explores the avoidance of difficult conversations from the perspective of clinical supervisors in order to better understand why health professionals avoid difficult conversations. OBJECTIVE: This study aimed to identify the reasons why difficult conversations are avoided between health-care professionals and to gain deeper insight into the phenomenon of avoiding difficult conversations in general. METHODS: Convergent interviewing was used with 20 clinical supervisors to explore the following question: Why do you think that people in your workplace avoid difficult conversations? RESULTS: Major reasons for avoiding difficult conversations included the fear of negative consequences, a general distaste for confrontation, and a lack of confidence in their skills to have such conversations. Additional factors included individual qualities such as personality type and communication style, available time, size of the workplace, and a range of perceived cultural barriers standing in the way of having difficult conversations. CONCLUSION: There is a need to encourage clinical supervisors and other health professionals to embrace difficult conversations to reduce adverse events and enhance patient outcomes. This requires additional training and educational opportunities to enhance knowledge, skills, and confidence to plan and engage in difficult conversations. Some types of difficult conversations require more skills than others.

Continuous Renal Replacement Therapy Dosing in Critically Ill Patients: A Quality Improvement Initiative.

RATIONALE & OBJECTIVE: Clinical practice guidelines recommend delivering a continuous renal replacement therapy (CRRT) dose of 20 to 25mL/kg/h. However, practice patterns nationwide are highly variable; this inconsistent prescribing may lead to errors in medication dosing and increase rates of electrolyte and acid-base abnormalities. We describe an initiative to standardize CRRT practice patterns and reduce dosing variability. STUDY DESIGN: Quality improvement study. SETTING & PARTICIPANTS: Adult patients treated with CRRT at the University of Colorado Hospital between January 2016 and October 2017. QUALITY IMPROVEMENT ACTIVITIES: An assessment of the magnitude of the variability in CRRT dosing and the following specific interventions were implemented during the course of 1 year: (1) modification of the electronic medical record (EMR) to include calculated average 24-hour dose in real time, (2) modification of the CRRT procedure note to include comments on dosing, (3) modification of the CRRT order set to display calculations, and (4) yearly educational sessions for renal fellows outlining CRRT-specific dosing targets. OUTCOMES: The primary outcome was weekly percentage of CRRT treatments with an average delivered daily dose of 20 to 25mL/kg/h. Process and balancing outcomes included CRRT flowsheet accuracy, documentation of rates of delivered dose, and nursing satisfaction. ANALYTICAL APPROACH: Rates of weekly CRRT dosing in compliance with national guidelines were determined and used to create run charts showing compliance rates before and after the quality improvement interventions. RESULTS: Among 837 treatments before the intervention, 279 (33%) daily CRRT sessions achieved an average dose of 20 to 25mL/kg/h. Following implementation of interventions, 631 of 952 (66%) treatments achieved this goal. Week-to-week variation in dosing was significantly reduced. LIMITATIONS: A single-center study generating data that may not be generalizable to institutions with different CRRT nursing models or different EMR systems. CONCLUSIONS: Changes to the EMR and documentation templates and education of CRRT providers about dosing were associated with doubling of the rate of appropriate CRRT dosing and reduction in dosing variability.

Applying Multivariate Segmentation Methods to Human Activity Recognition From Wearable Sensors' Data.

BACKGROUND: Time-resolved quantification of physical activity can contribute to both personalized medicine and epidemiological research studies, for example, managing and identifying triggers of asthma exacerbations. A growing number of reportedly accurate machine learning algorithms for human activity recognition (HAR) have been developed using data from wearable devices (eg, smartwatch and smartphone). However, many HAR algorithms depend on fixed-size sampling windows that may poorly adapt to real-world conditions in which activity bouts are of unequal duration. A small sliding window can produce noisy predictions under stable conditions, whereas a large sliding window may miss brief bursts of intense activity. OBJECTIVE: We aimed to create an HAR framework adapted to variable duration activity bouts by (1) detecting the change points of activity bouts in a multivariate time series and (2) predicting activity for each homogeneous window defined by these change points. METHODS: We applied standard fixed-width sliding windows (4-6 different sizes) or greedy Gaussian segmentation (GGS) to identify break points in filtered triaxial accelerometer and gyroscope data. After standard feature engineering, we applied an Xgboost model to predict physical activity within each window and then converted windowed predictions to instantaneous predictions to facilitate comparison across segmentation methods. We applied these methods in 2 datasets: the human activity recognition using smartphones (HARuS) dataset where a total of 30 adults performed activities of approximately equal duration (approximately 20 seconds each) while wearing a waist-worn smartphone, and the Biomedical REAl-Time Health Evaluation for Pediatric Asthma (BREATHE) dataset where a total of 14 children performed 6 activities for approximately 10 min each while wearing a smartwatch. To mimic a real-world scenario, we generated artificial unequal activity bout durations in the BREATHE data by randomly subdividing each activity bout into 10 segments and randomly concatenating the 60 activity bouts. Each dataset was divided into ~90% training and ~10% holdout testing. RESULTS: In the HARuS data, GGS produced the least noisy predictions of 6 physical activities and had the second highest accuracy rate of 91.06% (the highest accuracy rate was 91.79% for the sliding window of size 0.8 second). In the BREATHE data, GGS again produced the least noisy predictions and had the highest accuracy rate of 79.4% of predictions for 6 physical activities. CONCLUSIONS: In a scenario with variable duration activity bouts, GGS multivariate segmentation produced smart-sized windows with more stable predictions and a higher accuracy rate than traditional fixed-size sliding window approaches. Overall, accuracy was good in both datasets but, as expected, it was slightly lower in the more real-world study using wrist-worn smartwatches in children (BREATHE) than in the more tightly controlled study using waist-worn smartphones in adults (HARuS). We implemented GGS in an offline setting, but it could be adapted for real-time prediction with streaming data.

Chagas Disease in Southern Coastal Ecuador: Coinfections with Arboviruses and a Comparison of Serological Assays for Chagas Disease Diagnosis.

Occurrence of Chagas disease and arbovirus coinfections is unknown, despite the vast co-endemic areas throughout the Americas. This study examined the proportion of individuals positive for Trypanosoma cruzi and coinfections with dengue, chikungunya, and Zika viruses in Machala, Ecuador (January 2014-December 2015). Chagas seropositivity was evaluated with five commercially available assays. Dengue infections were identified by nonstructural protein 1 rapid test and enzyme linked immunosorbent assay (ELISA), immunoglobulin M ELISA, and reverse transcription PCR (RT-PCR); chikungunya and Zika infections were identified by RT-PCR. Of 658 individuals, six were positive for T. cruzi (0.91%), including one T. cruzi/dengue coinfection and one T. cruzi/chikungunya/dengue coinfection. The clinical manifestations of coinfected individuals corresponded to severe dengue and dengue with warning signs, respectively. We observed discrepant results by using the Hemagen Chagas kit and the rapid test Chagas Detect Plus (false positives: 3.9% and 15.4%), highlighting the need to assess diagnostic assays in geographic regions with distinct taxonomic units of T. cruzi.

Mast Cell Activation and KSHV Infection in Kaposi Sarcoma.

Purpose: Kaposi sarcoma (KS) is a vascular tumor initiated by infection of endothelial cells (ECs) with KS-associated herpesvirus (KSHV). KS is dependent on sustained proinflammatory signals provided by intralesional leukocytes and continued infection of new ECs. However, the sources of these cytokines and infectious virus within lesions are not fully understood. Here, mast cells (MCs) are identified as proinflammatory cells within KS lesions that are permissive for, and activated by, infection with KSHV.Experimental Design: Three validated MC lines were used to assess permissivity of MCs to infection with KSHV and to evaluate MCs activation following infection. Biopsies from 31 AIDS-KS cases and 11 AIDS controls were evaluated by IHC for the presence of MCs in KS lesions and assessment of MC activation state and infection with KSHV. Plasma samples from 26 AIDS-KS, 13 classic KS, and 13 healthy adults were evaluated for levels of MC granule contents tryptase and histamine.Results: In culture, MCs supported latent and lytic KSHV infection, and infection-induced MC degranulation. Within KS lesions, MCs were closely associated with spindle cells. Furthermore, MC activation was extensive within patients with KS, reflected by elevated circulating levels of tryptase and a histamine metabolite. One patient with clinical signs of extensive MC activation was treated with antagonists of MC proinflammatory mediators, which resulted in a rapid and durable regression of AIDS-KS lesions.Conclusions: Using complimentary in vitro and in vivo studies we identify MCs as a potential long-lived reservoir for KSHV and a source of proinflammatory mediators within the KS lesional microenvironment. In addition, we identify MC antagonists as a promising novel therapeutic approach for KS. Clin Cancer Res; 24(20); 5085-97. ©2018 AACR.

A SURVEY OF SMARTWATCHES IN REMOTE HEALTH MONITORING.

This systematic review classifies smartwatch-based healthcare applications in the literature according to their application and summarizes what has led to feasible systems. To this end, we conducted a systematic review of peer-reviewed smartwatch studies related to healthcare by searching PubMed, EBSCOHost, Springer, Elsevier, Pro-Quest, IEEE Xplore, and ACM Digital Library databases to find articles between 1998 and 2016. Inclusion criteria were: (1) a smartwatch was used, (2) the study was related to a healthcare application, (3) the study was a randomized controlled trial or pilot study, and (4) the study included human participant testing. Each article was evaluated in terms of its application, population type, setting, study size, study type, and features relevant to the smartwatch technology. After screening 1,119 articles, 27 articles were chosen that were directly related to healthcare. Classified applications included activity monitoring, chronic disease self-management, nursing or home-based care, and healthcare education. All studies were considered feasibility or usability studies, and had limited sample sizes. No randomized clinical trials were found. Also, most studies utilized Android-based smartwatches over Tizen, custom-built, or iOS- based smartwatches, and many relied on the use of the accelerometer and inertial sensors to elucidate physical activities. The results show that most research on smartwatches has been conducted only as feasibility studies for chronic disease self-management. Specifically, these applications targeted various disease conditions whose symptoms can easily be measured by inertial sensors, such as seizures or gait disturbances. In conclusion, although smartwatches show promise in healthcare, significant research on much larger populations is necessary to determine their acceptability and effectiveness in these applications.

The Burden of Dengue Fever and Chikungunya in Southern Coastal Ecuador: Epidemiology, Clinical Presentation, and Phylogenetics from the First Two Years of a Prospective Study.

Here, we report the findings from the first 2 years (2014-2015) of an arbovirus surveillance study conducted in Machala, Ecuador, a dengue-endemic region. Patients with suspected dengue virus (DENV) infections (index cases, N = 324) were referred from five Ministry of Health clinical sites. A subset of DENV-positive index cases (N = 44) were selected, and individuals from the index household and four neighboring homes within 200 m were recruited (N = 400). Individuals who entered the study, other than the index cases, are referred to as associates. In 2014, 70.9% of index cases and 35.6% of associates had acute or recent DENV infections. In 2015, 28.3% of index cases and 12.8% of associates had acute or recent DENV infections. For every DENV infection captured by passive surveillance, we detected an additional three acute or recent DENV infections in associates. Of associates with acute DENV infections, 68% reported dengue-like symptoms, with the highest prevalence of symptomatic acute infections in children aged less than 10 years. The first chikungunya virus (CHIKV) infections were detected on epidemiological week 12 in 2015; 43.1% of index cases and 3.5% of associates had acute CHIKV infections. No Zika virus infections were detected. Phylogenetic analyses of isolates of DENV from 2014 revealed genetic relatedness and shared ancestry of DENV1, DENV2, and DENV4 genomes from Ecuador with those from Venezuela and Colombia, indicating the presence of viral flow between Ecuador and surrounding countries. Enhanced surveillance studies, such as this, provide high-resolution data on symptomatic and inapparent infections across the population.

Spatiotemporal Variation in Environmental Vibrio cholerae in an Estuary in Southern Coastal Ecuador.

Cholera emergence is strongly linked to local environmental and ecological context. The 1991-2004 pandemic emerged in Perú and spread north into Ecuador's El Oro province, making this a key site for potential re-emergence. Machala, El Oro, is a port city of 250,000 inhabitants, near the Peruvian border. Many livelihoods depend on the estuarine system, from fishing for subsistence and trade, to domestic water use. In 2014, we conducted biweekly sampling for 10 months in five estuarine locations, across a gradient of human use, and ranging from inland to ocean. We measured water-specific environmental variables implicated in cholera growth and persistence: pH, temperature, salinity, and algal concentration, and evaluated samples in five months for pathogenic and non-pathogenic Vibrio cholerae, by polymerase chain reaction (PCR). We found environmental persistence of pandemic strains O1 and O139, but no evidence for toxigenic strains. Vibrio cholerae presence was coupled to algal and salinity concentration, and sites exhibited considerable seasonal and spatial heterogeneity. This study indicates that environmental conditions in Machala are optimal for cholera re-emergence, with risk peaking during September, and higher risk near urban periphery low-income communities. This highlights a need for surveillance of this coupled cholera-estuarine system to anticipate potential future cholera outbreaks.