Real-time monitoring and prediction of water quality parameters and algae concentrations using microbial potentiometric sensor signals and machine learning tools.

The overarching hypothesis of this study was that temporal microbial potentiometric sensor (MPS) signal patterns could be used to predict changes in commonly monitored water quality parameters by using artificial intelligence/machine learning tools. To test this hypothesis, the study first examines a proof of concept by correlating between MPS's signals and high algae concentrations in an algal cultivation pond. Then, the study expanded upon these findings and examined if multiple water quality parameters could be predicted in real surface waters, like irrigation canals. Signals generated between the MPS sensors and other water quality sensors maintained by an Arizona utility company, including algae and chlorophyll, were collected in real time at time intervals of 30 min over a period of 9 months. Data from the MPS system and data collected by the utility company were used to train the ML/AI algorithms and compare the predicted with actual water quality parameters and algae concentrations. Based on the composite signal obtained from the MPS, the ML/AI was used to predict the canal surface water's turbidity, conductivity, chlorophyll, and blue-green algae (BGA), dissolved oxygen (DO), and pH, and predicted values were compared to the measured values. Initial testing in the algal cultivation pond revealed a strong linear correlation (R2 = 0.87) between mixed liquor suspended solids (MLSS) and the MPSs' composite signals. The Normalized Root Mean Square Error (NRMSE) between the predicted values and measured values were <6.5%, except for the DO, which was 10.45%. The results demonstrate the usefulness of MPSs to predict key surface water quality parameters through a single composite signal, when the ML/AI tools are used conjunctively to disaggregate these signal components. The maintenance-free MPS offers a novel and cost-effective approach to monitor numerous water quality parameters at once with relatively high accuracy.

Measurement of free chlorine levels in water using potentiometric responses of biofilms and applications for monitoring and managing the quality of potable water.

Residual free chlorine is not monitored continuously at scale in drinking water distribution systems because existing real-time sensor technologies require frequent maintenance, cleaning, and calibration, which makes these products too costly to be used throughout a distribution system. As a result, current measurement approaches require manual sampling, which is not feasible for the consistent monitoring of free chlorine because chlorine concentrations vary significantly throughout pipeline distribution and over time and space. This research presents an alternative and cost-effective method of predicting free chlorine levels in drinking water using graphite electrodes coated with naturally grown microbial biofilms. This Microbial Potentiometric Sensor (MPS) array was installed in a Continuously Mixed Batch Reactor (CMBR), and drinking water containing variable free chlorine concentrations. The chlorine concentrations were introduced in a controlled manner, and the MPS signals were monitored over time. MPS signals were measured from the change in Open Circuit Potential (OCP) across the MPS array in real-time. An empirically derived relationship between the normalized change in OCP and free chlorine was established by fitting individual and average MPS data to a decaying exponential growth function in order to predict free chlorine levels. The results show that free chlorine can be predicted with reasonable accuracy, with model validation showing an average absolute error of ±0.09 ppm below 1.1 ppm and ±0.30 ppm between 1.1 and 2.7 ppm. However, the accuracy of predictions was reduced at higher free chlorine levels. The researchers conclude that MPS systems may benefit drinking water distribution systems by measuring free chlorine. These advantages of the MPS are especially pronounced in the developing world because this system is inexpensive and does not require routine maintenance or cleaning. The system relies on a naturally forming and regenerating biofilm and an inexpensive potentiometric meter to produce stable measurements.

Microbial potentiometric sensor array measurements in unsaturated soils.

The overarching goal of this study is to demonstrate a novel technology for monitoring changes in electrical potential of unsaturated soils using biofilm-populated electrodes. The novelty of the study stems from the fact that it demonstrates a method for measuring open-circuit potentials (OCP) in environments without the presence of an electrolyte solution. This study also reveals that using a biofilm-populated electrode as a reference in stable environments could successfully be employed to assess and monitor the electrochemical potential generated by plants and microorganisms. The findings imply that long-term (months to years) and real-time measurements of the open-circuit potential in unsaturated soils are possible. Because MPS arrays can directly measure open-circuit potential from the biofilm, the challenges related to locally induced electrochemical changes caused by microorganisms in the soil to achieve optimum physiological levels are eliminated. The simplicity of the technology, which allows for multiple indicator electrodes to be referenced against an "internal" reference electrode, enables spatial-temporal monitoring of the changes in the soil and the generation of 2D- or 3D-signal patterns. Once a signal pattern, generated by an array of sensors, develops (usually after 30 to 90 days), it does not significantly change unless the soil is exposed to external stimuli. The observed OCP phenomena, however, suggests that the change in OCP signal is independent of changes in soil conductivity resulting from the addition of water. In brief, findings suggest that the proposed technology can enable multidimensional profiling and long-term monitoring of changes occurring in unsaturated soils without direct implications of presence of water. The changes in the 2D or 3-D signal patterns, however, can be correlated to other important parameters that characterize soil health.

Increasing access to care: telehealth during COVID-19.

The coronavirus disease 2019 (COVID-19) public health emergency has amplified both the potential value and the challenges with healthcare providers deploying telehealth solutions. As people across the country find ways to stay at home, telehealth preserves an opportunity to obtain necessary healthcare services. Further, telehealth can help individuals avoid COVID-19 infection, free up hospital beds and other resources for those patients most in need, and prevent infected individuals from spreading that infection. Federal and state regulators have recognized this potential of telehealth and have quickly changed a variety of laws and regulations to enable healthcare providers to deploy solutions quickly. These changes can provide lasting benefits for the use of telehealth well after the current crisis. However, to best realize telehealth's benefits, further legal and regulatory actions are necessary. Specifically, lawmakers and regulators should focus on six areas: reimbursement, privacy/cybersecurity, liability, licensure, technology access, and artificial intelligence.

Microbial potentiometric sensor: A new approach to longstanding challenges.

The underlying hypothesis of this study is that simple potentiometric measurements between sensing electrodes and a shared reference electrode - Microbial Potentiometric Sesnor (MPS) system - can be employed in a long-term, continuous mode of operation to resolve the spatial and temporal changes in environmental systems. To address the hypothesis, (1) a conceptual description of the MPS system and its postulated principle of operation are provided; (2) the MPS system performance is documented under controlled laboratory conditions; and (3) the capabilities of the MPS system are documented under quiescent and dynamic field condition. In a laboratory setting, the variability among different MPS signals was insignificant confirming the postulated high accuracy and reproducibility of the sensor performance. It also demonstrated statistically significant correlations with dissolved oxygen (DO) and oxidation-reduction potential (ORP) sensors, while showing capabilities of operating under anoxic and anaerobic conditions. Regardless of their locations in the model wetland system, three MPS sensors functioned without interruption and cleaning for a period >2 years, and thus demonstrating long-term durability of the MPS technology. In real batch-wastewater treatment facility, the deployed MPS system signals were able to describe the organic carbon trends and correlate with each treatment phase in a cycle. Data reproducibility and reliability exceeded the expectations better describing the carbon treatment levels than the DO and ORP sensors (p < 4.4 × 10-162 vs phase adjusted p < 3.0 × 10-58). While MPS signals correlate with specific parameters that describe the local process or environments, it is more prudent to employ both the magnitude and pattern of a composite signal like the MPS signal describe the change to reflect any shift in the local environment. When compared to a baseline pattern, this change in signal magnitude and pattern reveals important information that can be employed to tailor and optimize any condition or process which involves microorganisms.

Efficacy of Intravenous Acetaminophen for Postoperative Analgesia in Primary Total Knee Arthroplasty.

BACKGROUND: The use of intravenous acetaminophen has seen recent enthusiasm as one component of a multimodal approach to pain management. However, there is a lack of literature examining the efficacy of intravenous acetaminophen for pain control in total joint arthroplasty. The purpose of this study was to evaluate the efficacy of intravenous acetaminophen following primary total knee arthroplasty. METHODS: This is a retrospective review of 38 patients undergoing primary total knee arthroplasty by a single surgeon at one institution. Twenty-five patients received 1 gram of intravenous acetaminophen every 6 hours for 24 hours postoperatively. Thirteen patients received no additional intervention. Exclusion criteria were bilateral or concomitant procedures, allergy to medications included in the standard postoperative protocol, neuropathy or sensory disturbances, history of opioid dependence or abuse, deviations from protocol, revision procedures, and incomplete data. Primary outcomes were change in patient-reported visual analog scale (VAS) pain score, overall opioid consumption measured in morphine milligram equivalents, and hospital length of stay. RESULTS: We found no difference in length of stay, at 3.3 days in the control group and 2.9 days in the intervention group. There was a significant difference in VAS score between 16 and 24 hours. There was a statistically significant decrease in overall opioid consumption in the intravenous acetaminophen group 37.6 vs 18.6 morphine milligram equivalents. CONCLUSION: Intravenous acetaminophen is effective in significantly reducing opioid requirements in the first 24 hours following primary total knee arthroplasty. Additionally, there is a clinically significant decrease in VAS pain scores in patients receiving this intervention.

Post-Ictal Transient Atrial Fibrillation As A Rare Manifestation Of Grand Mal Seizure.

Atrial fibrillation (AF) most frequently occurs as a consequence of multiple etiologies including valvular disease, coronary artery disease, hyperthyroidism, alcohol ingestion, and pulmonary embolism. However, on rare occasion transient AF may be a result of generalized tonic-clonic seizures (GTCS). A 33-year-old-man presented to the emergency department following GTCS in AF with rapid ventricular response. He had no previous documented history. Diagnostic evaluation including electrolytes, thyroid function, cardiac enzymes, serum and urine drug screen, and two-dimensional echocardiogram were unremarkable. Diltiazem was initiated for rate control with spontaneous conversion to sinus rhythm with no recurrence. AF post-seizure is a rare phenomenon but should be considered in epileptic patients. Anticoagulation must be considered in AF due to the risk of cardioembolic stroke but should be weighed against the potential risk of head injury and subsequent intracranial bleed in patients with grand mal seizures.

Traumatic intracranial hemorrhage correlates with preinjury brain atrophy, but not with antithrombotic agent use: a retrospective study.

BACKGROUND: The impact of antithrombotic agents (warfarin, clopidogrel, ASA) on traumatic brain injury outcomes is highly controversial. Although cerebral atrophy is speculated as a risk for acute intracranial hemorrhage, there is no objective literature evidence. MATERIALS AND METHODS: This is a retrospective, consecutive investigation of patients with signs of external head trauma and age ≥60 years. Outcomes were correlated with antithrombotic-agent status, coagulation test results, admission neurologic function, and CT-based cerebral atrophy dimensions. RESULTS: Of 198 consecutive patients, 36% were antithrombotic-negative and 64% antithrombotic-positive. ASA patients had higher arachidonic acid inhibition (p = 0.04) and warfarin patients had higher INR (p<0.001), compared to antithrombotic-negative patients. Antithrombotic-positive intracranial hemorrhage rate (38.9%) was similar to the antithrombotic-negative rate (31.9%; p = 0.3285). Coagulopathy was not present on the ten standard coagulation, thromboelastography, and platelet mapping tests with intracranial hemorrhage and results were similar to those without hemorrhage (p≥0.1354). Hemorrhagic-neurologic complication (intracranial hemorrhage progression, need for craniotomy, neurologic deterioration, or death) rates were similar for antithrombotic-negative (6.9%) and antithrombotic-positive (8.7%; p = 0.6574) patients. The hemorrhagic-neurologic complication rate was increased when admission major neurologic dysfunction was present (63.2% versus 2.2%; RR = 28.3; p<0.001). Age correlated inversely with brain parenchymal width (p<0.001) and positively with lateral ventricular width (p = 0.047) and cortical atrophy (p<0.001). Intracranial hemorrhage correlated with cortical atrophy (p<0.001) and ventricular width (p<0.001). CONCLUSIONS: Intracranial hemorrhage is not associated with antithrombotic agent use. Intracranial hemorrhage patients have no demonstrable coagulopathy. The association of preinjury brain atrophy with acute intracranial hemorrhage is a novel finding. Contrary to antithrombotic agent status, admission neurologic abnormality is a predictor of adverse post-admission outcomes. Study findings indicate that effective hemostasis is maintained with antithrombotic therapy.

TEG® and RapidTEG® are unreliable for detecting warfarin-coagulopathy: a prospective cohort study.

BACKGROUND: Thromboelastography® (TEG) utilizes kaolin, an intrinsic pathway activator, to assess clotting function. Recent published studies suggest that TEG results are commonly normal in patients receiving warfarin, despite an increased International Normalized Ratio (INR). Because RapidTEG™ includes tissue factor, an extrinsic pathway activator, as well as kaolin, we hypothesized that RapidTEG would be more sensitive in detecting a warfarin-effect. METHODS: Included in this prospective study were 22 consecutive patients undergoing elective cardioversion and receiving warfarin. Prior to cardioversion, blood was collected to assess INR, Prothrombin Time, TEG, and RapidTEG. RESULTS: INR Results: 2.8 ± 0.5 (1.6 to 4.2). Prothrombin Time Results: 19.1 ± 2.2 (13.9. to 24.3).TEG Results (Reference Range): R-Time: 8.3 ± 2.7 (2-8); K-Time: 2.1 ± 1.4 (1-3); Angle: 62.5 ± 10.3 (55-78); MA: 63.2 ± 10.3 (51-69); G: 9.4 ± 3.5 (4.6-10.9); R-Time within normal range: 10 (45.5%) with INR 2.9 ± 0.3; Correlation coefficients for INR and each of the 5 TEG variables were insignificant (P > 0.05).RapidTEG Results (Reference Range): ACT: 132 ± 58 (86-118); K-Time: 1.2 ± 0.5 (1-2); Angle: 75.4 ± 5.2 (64-80); MA: 63.4 ± 5.1 (52-71); G: 8.9 ± 2.0 (5.0-11.6); ACT within normal range: 9 (40.9%) with INR 2.7 ± 0.5; Correlation coefficients for INR and each of the 5 RapidTEG variables were insignificant (P > 0.05). CONCLUSIONS: TEG, using kaolin activation, and RapidTEG, with kaolin and tissue factor activation, were normal in a substantial percent of warfarin patients, despite an increased INR. The false-negative rate for detecting warfarin coagulopathy with either test is unacceptable. The lack of correlation between INR and all TEG and RapidTEG components further indicates that these methodologies are insensitive to warfarin effects. Findings suggest that intrinsic pathway activation may mitigate detection of an extrinsic pathway coagulopathy.