"Switching Hats": Insights From Experienced Clinical Interviewers Turned Novice Research Interviewers.

Health professionals/clinicians interview people regularly as part of their role. However, a qualitative research interview differs considerably to a clinical interview. If clinicians approach qualitative research interviewing based on their expertise in clinical interviewing, it could cause insufficiencies in qualitative data generation. In this reflection article, we, a team of four experienced clinical occupational therapists with no previous experience in qualitative research interviewing, share our experiences while learning to become qualitative research interviewers before undertaking our first qualitative research project. We engaged in self-directed reading, formal training on qualitative interviewing, and practice interviews and used peer feedback and reflection to prepare ourselves to conduct qualitative interviews. We drew upon the work-role transitions theory to work through our adjustment to the new role. Although we set out to "switch hats" as the research topic itself was not clinical, interviewing people on health-related topics will mean bringing our clinical instincts into our research role, while still recognizing the difference between a clinical and research interview. This article can inform experienced clinicians/novice qualitative researchers as they develop this new skillset.

A High-Throughput Microfluidic Cell Sorter Using a Three-Dimensional Coupled Hydrodynamic-Dielectrophoretic Pre-Focusing Module.

Dielectrophoresis (DEP) is a powerful tool for label-free sorting of cells, even those with subtle differences in morphological and dielectric properties. Nevertheless, a major limitation is that most existing DEP techniques can efficiently sort cells only at low throughputs (<1 mL h-1). Here, we demonstrate that the integration of a three-dimensional (3D) coupled hydrodynamic-DEP cell pre-focusing module upstream of the main DEP sorting region enables cell sorting with a 10-fold increase in throughput compared to conventional DEP approaches. To better understand the key principles and requirements for high-throughput cell separation, we present a comprehensive theoretical model to study the scaling of hydrodynamic and electrostatic forces on cells at high flow rate regimes. Based on the model, we show that the critical cell-to-electrode distance needs to be ≤10 µm for efficient cell sorting in our proposed microfluidic platform, especially at flow rates ≥ 1 mL h-1. Based on those findings, a computational fluid dynamics model and particle tracking analysis were developed to find optimum operation parameters (e.g., flow rate ratios and electric fields) of the coupled hydrodynamic-DEP 3D focusing module. Using these optimum parameters, we experimentally demonstrate live/dead K562 cell sorting at rates as high as 10 mL h-1 (>150,000 cells min-1) with 90% separation purity, 85% cell recovery, and no negative impact on cell viability.

Healthcare workers' knowledge and practice of the South African national tuberculosis management guidelines.

BACKGROUND: Tuberculosis (TB) remains a global public health concern. The 2014 South African (SA) national TB management guidelines were developed to decrease the burden of TB, but implementation remains a challenge. OBJECTIVES: To estimate healthcare workers' level of knowledge about the national TB management guidelines and to assess the implementation of these guidelines. METHODS: A cross-sectional descriptive study was conducted in four randomly selected health facilities in Dr Kenneth Kaunda district, North West Province, SA. We administered a TB knowledge questionnaire and reviewed TB registers and 204 patient files. RESULTS: A total of 38 participants completed the TB knowledge questionnaire. The majority were professional nurses (89%). The participants' mean (standard deviation) age was 46 (8) years, and the median (interquartile range) career length was 10 (8 - 17) years. Inadequate knowledge of the national TB management guidelines was revealed in 12 participants (32%). The review of the TB register showed that 163 153 patients were screened for TB. Of these, 9 308 (6%) had presumptive TB, 8 116 (87%) had an Xpert test and 1 292 (16%) had positive Xpert results. Overall, 1 150 (12%) of the patients with presumptive TB were diagnosed with drug-sensitive TB and started treatment based on laboratory results and a clinical diagnosis. Of this sample, 999 patients (87%) were treated successfully. The patient file review showed that a total of 197 patients (97%) received the correct treatment dose according to body weight and treatment phase. Smear microscopy was consistently done throughout the intensive and continuation phases of TB treatment. Body weight was monitored in 199 patients (98%). Contact investigation was conducted for 133 patients (65%), and there was evidence that child contacts aged <5 years were started on isoniazid preventive therapy. Only 110 patients (54%) had documented HIV status. Of these, 66 (60%) were HIV positive, and 39 (59%) of them received antiretroviral therapy. Body mass index was monitored in 55 patients (27%). Eighty (39%) of the patients with TB were women of childbearing potential, and only 8 (10%) of them had their pregnancy test results recorded. Treatment side-effects were reported in 17 patient files (8%); 13 (76%) were managed and 8 (62%) had resolved side-effects. CONCLUSION: Most participants had adequate knowledge of the national TB management guidelines. A high TB treatment success rate was noted, along with some good practices. The study also highlights several knowledge and practice gaps that can be overcome by measures such as quality audits to improve record keeping. Adequate training of healthcare workers, sustaining and updating knowledge through continuous training, and strengthened supervision mechanisms to ensure compliance with the guidelines are recommended.

Microfluidic viscometer by acoustic streaming transducers.

Measurement of fluid viscosity represents a huge need for many biomedical and materials processing applications. Sample fluids containing DNA, antibodies, protein-based drugs, and even cells have become important therapeutic options. The physical properties, including viscosity, of these biologics are critical factors in the optimization of the biomanufacturing processes and delivery of therapeutics to patients. Here we demonstrate an acoustic microstreaming platform termed as microfluidic viscometer by acoustic streaming transducers (µVAST) that induces fluid transport from second-order microstreaming to measure viscosity. Validation of our platform is achieved with different glycerol content mixtures to reflect different viscosities and shows that viscosity can be estimated based on the maximum speed of the second-order acoustic microstreaming. The µVAST platform requires only a small volume of fluid sample (∼1.2 µL), which is 16-30 times smaller than that of commercial viscometers. In addition, µVAST can be scaled up for ultra-high throughput measurements of viscosity. Here we demonstrate 16 samples within 3 seconds, which is an attractive feature for automating the process flows in drug development and materials manufacturing and production.

Titering of Chimeric Antigen Receptors on CAR T Cells enabled by a Microfluidic-based Dosage-Controlled Intracellular mRNA Delivery Platform.

Chimeric antigen receptor (CAR) T-cell therapy shows unprecedented efficacy for cancer treatment, particularly in treating patients with various blood cancers, most notably B-cell acute lymphoblastic leukemia (B-ALL). In recent years, CAR T-cell therapies are being investigated for treating other hematologic malignancies and solid tumors. Despite the remarkable success of CAR T-cell therapy, it has unexpected side effects that are potentially life threatening. Here, we demonstrate the delivery of approximately the same amount of CAR gene coding mRNA into each T cell propose an acoustic-electric microfluidic platform to manipulate cell membranes and achieve dosage control via uniform mixing, which delivers approximately the same amount of CAR genes into each T cell. We also show that CAR expression density can be titered on the surface of primary T cells under various input power conditions using the microfluidic platform.

Endemic mycoses in children in North America: a review of radiologic findings.

Clinically significant endemic mycoses (fungal infections) in the United States (U.S.) include Blastomyces dermatitidis, Histoplasma capsulatum, and Coccidioides immitis/posadasii. While the majority of infections go clinically unnoticed, symptomatic disease can occur in immunocompromised or hospitalized patients, and occasionally in immune-competent individuals. Clinical manifestations vary widely and their diagnosis may require fungal culture, making the rapid diagnosis a challenge. Imaging can be helpful in making a clinical diagnosis prior to laboratory confirmation, as well as assist in characterizing disease extent and severity. In this review, we discuss the three major endemic fungal infections that occur in the U.S., including mycology, epidemiology, clinical presentations, and typical imaging features with an emphasis on the pediatric population.

Cell-Sized Lipid Vesicles as Artificial Antigen-Presenting Cells for Antigen-Specific T Cell Activation.

In this study, efficient T cell activation is demonstrated using cell-sized artificial antigen-presenting cells (aAPCs) with protein-conjugated bilayer lipid membranes that mimic biological cell membranes. The highly uniform aAPCs are generated by a facile method based on standard droplet microfluidic devices. These aAPCs are able to activate the T cells in peripheral blood mononuclear cells, showing a 28-fold increase in interferon gamma (IFNγ) secretion, a 233-fold increase in antigen-specific CD8 T cells expansion, and a 16-fold increase of CD4 T cell expansion. The aAPCs do not require repetitive boosting or additional stimulants and can function at a relatively low aAPC-to-T cell ratio (1:17). The research presents strong evidence that the surface fluidity and size of the aAPCs are critical to the effective formation of immune synapses essential for T cell activation. The findings demonstrate that the microfluidic-generated aAPCs can be instrumental in investigating the physiological conditions and mechanisms for T cell activation. Finally, this method demonstrates the feasibility of customizable aAPCs for a cost-effective off-the-shelf approach to immunotherapy.

A blue enzyme from marine bacterium for green technological applications.

Laccases are the green tools that can find potential applications in various industries. There are many reports available on laccases from plants and fungal sources but very few reports are available on bacterial laccases. Bacterial laccases show broad range of substrate specificity and it is easy to isolate and purify the bacterial extracellular laccases as compared to fungal laccases. Therefore, there are many advantages of bacterial laccases over fungal laccases.

Hypoplastic Left Heart Syndrome: A Review.

Hypoplastic left heart syndrome is a rare and poorly understood congenital disorder featuring a univentricular myocardium, invariably resulting in early childhood death if left untreated. The process to palliate this congenital cardiomyopathy is of high complexity and may include invasive interventions in the first week of life. The preferred treatment strategy involves a staged correction with 3 surgical procedures at different points in time. The Norwood procedure is usually performed within the first weeks of life and aims to increase systemic circulation and relieve pulmonary vascular pressure. This procedure is followed by the bidirectional Glenn and the Fontan procedures in later life, which offer to decrease stress in the ventricular chamber. The prognosis of children with this disease has greatly improved in the past decades; however, it is still largely driven by multiple modifiable and nonmodifiable variables. Novel and clever alternatives have been proposed to improve the survival and neurodevelopment of these patients, although they are not used as standard of care in all centers. The neurodevelopmental outcomes among these patients have received particular attention in the last decade in light to improve this very limiting associated comorbidity that compromises quality of life.

Implementing the English health inequalities agenda: addressing challenges to person-level, cross-sectoral data linkage, access and routine use for local authority public health.

Local authorities are central to the implementation of English Integrated Care Systems' health inequalities agendas, embedding public health into population health management planning. They work with partners to deliver a range of 'health determinant' services and facilities for people in a defined geographic area. This work is substantially premised on the use of cross-sectoral data that is linked at the individual level, readily available, longitudinal and contemporaneous. However, multiple challenges exist to such data availability. This paper elaborates upon these challenges to local authority public health systems and their potential solutions.

Experiences of homeless men in an affluent town in South Africa.

The aim of this study was to explore experiences of homelessness in an affluent university town. Seven homeless men were recruited at a welfare program for homeless people to participate in in-depth, semistructured interviews that explored their experiences of homelessness in the town. The ages of the participants ranged from 36 to 52 years. There were three White participants, two of mixed race, and two Black participants. Thematic analysis was used to analyze the data, from a bottom-up systems perspective. The results revealed some of the participants' drug-related experiences, their structural experiences (e.g., shelter policy, low wages, and the poverty trap), their social experiences (e.g., the loss of their families and the lack of social standards in the homeless community), and their psychological experiences (i.e., fatalism, complacency, and responsibility). Subsidized housing and social grants are unlikely to effectively address the homelessness of men if other components of their experience, such as their drug-related experiences, their structural experiences, their social experiences, and their psychological experiences, are not attended to.

Exploring Factors That Helped Adolescents Adjust and Continue With Life After the Death of a Parent.

The aim of this study was to explore factors that helped adolescents to adjust and continue with life after the death of a parent. A qualitative research design was utilized, in which 12 participants participated in semistructured interviews. Data were analyzed according to thematic analysis. The following categories and themes emerged from the data: family support-supportive remaining parent, parent has a supportive partner and supportive extended family; social support-child has supportive friends and supportive community; religion--religion as a coping mechanism and religion as means of communicating with the deceased parent; and a strong personal sense of coherence (the ability to relate to and make sense of the world) as an intrapersonal coping mechanism. In addition, the following themes also emerged: exercising, allowing time to prepare for the death of a terminally ill parent, tangible reminders of the deceased, and journal writing. The findings can be used to design interventions for adolescents whose parent has passed away.

Venous thromboembolic disease in adults admitted to hospital in a setting with a high burden of HIV and TB.

BACKGROUND: HIV and tuberculosis (TB) independently cause an increased risk for venous thromboembolic disease (VTE): deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Data from high HIV and TB burden settings describing VTE are scarce. The Wells' DVT and PE scores are widely used but their utility in these settings has not been reported on extensively. OBJECTIVES: To evaluate new onset VTE, compare clinical characteristics by HIV status, and the presence or absence of TB disease in our setting. We also calculate the Wells' score for all patients. METHODS: A prospective cohort of adult in-patients with radiologically confirmed VTE were recruited into the study between September 2015 and May 2016. Demographics, presence of TB, HIV status, duration of treatment, CD4 count, viral load, VTE risk factors, and parameters to calculate the Wells' score were collected. RESULTS: We recruited 100 patients. Most of the patients were HIV-infected (n=59), 39 had TB disease and 32 were HIV/TB co-infected. Most of the patients had DVT only (n=83); 11 had PE, and 6 had both DVT and PE. More than a third of patients on antiretroviral treatment (ART) (43%; n=18/42) were on treatment for <6 months. Half of the patients (51%; n=20/39) were on TB treatment for <1 month. The median (interquartile range (IQR)) DVT and PE Wells' score in all sub-groups was 3.0 (1.0 - 4.0) and 3.0 (2.5 - 4.5), respectively. CONCLUSION: HIV/TB co-infection appears to confer a risk for VTE, especially early after initiation of ART and/or TB treatment, and therefore requires careful monitoring for VTE and early initiation of thrombo-prophylaxis.

Correction: The vascular niche in next generation microphysiological systems.

Correction for 'The vascular niche in next generation microphysiological systems' by Makena L. Ewald et al., Lab Chip, 2021, DOI: 10.1039/d1lc00530h.

The vascular niche in next generation microphysiological systems.

In recent years, microphysiological system (MPS, also known as, organ-on-a-chip or tissue chip) platforms have emerged with great promise to improve the predictive capacity of preclinical modeling thereby reducing the high attrition rates when drugs move into trials. While their designs can vary quite significantly, in general MPS are bioengineered in vitro microenvironments that recapitulate key functional units of human organs, and that have broad applications in human physiology, pathophysiology, and clinical pharmacology. A critical next step in the evolution of MPS devices is the widespread incorporation of functional vasculature within tissues. The vasculature itself is a major organ that carries nutrients, immune cells, signaling molecules and therapeutics to all other organs. It also plays critical roles in inducing and maintaining tissue identity through expression of angiocrine factors, and in providing tissue-specific milieus (i.e., the vascular niche) that can support the survival and function of stem cells. Thus, organs are patterned, maintained and supported by the vasculature, which in turn receives signals that drive tissue specific gene expression. In this review, we will discuss published vascularized MPS platforms and present considerations for next-generation devices looking to incorporate this critical constituent. Finally, we will highlight the organ-patterning processes governed by the vasculature, and how the incorporation of a vascular niche within MPS platforms will establish a unique opportunity to study stem cell development.

Ethnic Culture as Related to Sexual and Reproductive Behavior in the Republic of Suriname: The Pervasiveness of Culture.

We examined the effects of culture and ethnicity on life history strategies in terms of sexual and reproductive behaviors. The sample included 500 adults, aged 25-50 years, from the five major ethnic groups in Suriname, i.e., the Maroons, Creoles, Hindustani, Javanese, and Mixed. First, there were strong gender differences: men reported to have had more sex partners and to have had their first sexual experience earlier than women, whereas women had their first child earlier and had more children than men. Second, in general, ethnicity affected life history substantially. The Maroons stood out by a relatively fast life history: they reported to have had more sexual partners, to have had their first sex and first child at an earlier age, and to have more children than all other groups. The Creoles were in general similar to the Maroons, whereas the Hindustani and the Javanese were characterized by a relatively slow life history: they reported to have had the lowest number of sexual partners, to have had their first sex and first child at the latest age, and to have had the lowest number of children. The differences between the ethnic groups were upheld when controlling for income, educational level, and father absence during childhood. A lower education was associated with reporting to have had one's first sex as well as one's first child at a younger age and children who grew up without a father reported to have had their first sex at a younger age.

Investigating PLGA microparticle swelling behavior reveals an interplay of expansive intermolecular forces.

This study analyzes the swelling behavior of native, unmodified, spherically uniform, monodisperse poly(lactic-co-glycolic acid) (PLGA) microparticles in a robust high-throughput manner. This work contributes to the complex narrative of PLGA microparticle behavior and release mechanisms by complementing and extending previously reported studies on intraparticle microenvironment, degradation, and drug release. Microfluidically produced microparticles are incubated under physiological conditions and observed for 50 days to generate a profile of swelling behavior. Microparticles substantially increase in size after 15 days, continue increasing for 30 days achieving size dependent swelling indices between 49 and 83%. Swelling capacity is found to correlate with pH. Our study addresses questions such as onset, duration, swelling index, size dependency, reproducibility, and causal mechanistic forces surrounding swelling. Importantly, this study can serve as the basis for predictive modeling of microparticle behavior and swelling capacity, in addition to providing clues as to the microenvironmental conditions that encapsulated material may experience.