The influence of attributes on community preferences regarding antibiotic treatment: evidence from a discrete choice model.

Antibiotic resistance (AR) rates in Vietnam are among the highest in Asia, and recent infections due to multi-drug resistance in the country have caused thousands of deaths each year. This study investigated a Vietnamese community's preferences for antibiotic treatment and its knowledge and attitudes regarding antibiotics. A discrete choice experiment-based survey was developed and administered to the population of interest. The respondents were given sociodemographic-, knowledge- and attitude-related items and 17 pairs of choice tasks. Two hypothetical options were included in each choice task. Latent class analysis was conducted to determine the differences among the respondents' preferences. Among 1,014 respondents, 805 (79.4%) gave valid questionnaires. A three-latent-class model with four covariates (age, healthcare-related education or career, occupation, and attitude classifications) was used in the analysis. All five attributes significantly influenced the respondents' decisions. The majority, including young employed respondents with non-healthcare-related work or education, found treatment failure more important. Older respondents who had healthcare-related education/careers and/or appropriate antibiotic use- and antibiotics resistance-related attitudes, regarded contribution to antibiotic resistance as an important attribute in selecting antibiotic treatments. Unemployed individuals with correct knowledge identified the cost of antibiotic treatment as the most essential decision-making factor. Findings suggest minimal antibiotic impact on resistance; only 7.83% view it as amajor concern. The respondents exhibited substantial preference heterogeneity, and the general Vietnamese public had poor knowledge of and attitudes toward antibiotic use and antibiotic resistance. This study emphasizes the need for individual responsibility for antibiotic resistance and appropriate antibiotic use.

Analytical validation and clinical utilization of K-4CARE™: a comprehensive genomic profiling assay with personalized MRD detection.

Background: Biomarker testing has gradually become standard of care in precision oncology to help physicians select optimal treatment for patients. Compared to single-gene or small gene panel testing, comprehensive genomic profiling (CGP) has emerged as a more time- and tissue-efficient method. This study demonstrated in-depth analytical validation of K-4CARE, a CGP assay that integrates circulating tumor DNA (ctDNA) tracking for residual cancer surveillance. Methods: The assay utilized a panel of 473 cancer-relevant genes with a total length of 1.7 Mb. Reference standards were used to evaluate limit of detection (LOD), concordance, sensitivity, specificity and precision of the assay to detect single nucleotide variants (SNVs), small insertion/deletions (Indels), gene amplification and fusion, microsatellite instability (MSI) and tumor mutational burden (TMB). The assay was then benchmarked against orthogonal methods using 155 clinical samples from 10 cancer types. In selected cancers, top tumor-derived somatic mutations, as ranked by our proprietary algorithm, were used to detect ctDNA in the plasma. Results: For detection of somatic SNVs and Indels, gene fusion and amplification, the assay had sensitivity of >99%, 94% and >99% respectively, and specificity of >99%. Detection of germline variants also achieved sensitivity and specificity of >99%. For TMB measurement, the correlation coefficient between whole-exome sequencing and our targeted panel was 97%. MSI analysis when benchmarked against polymerase chain reaction method showed sensitivity of 94% and specificity of >99%. The concordance between our assay and the TruSight Oncology 500 assay for detection of somatic variants, TMB and MSI measurement was 100%, 89%, and 98% respectively. When CGP-informed mutations were used to personalize ctDNA tracking, the detection rate of ctDNA in liquid biopsy was 79%, and clinical utility in cancer surveillance was demonstrated in 2 case studies. Conclusion: K-4CARE™ assay provides comprehensive and reliable genomic information that fulfills all guideline-based biomarker testing for both targeted therapy and immunotherapy. Integration of ctDNA tracking helps clinicians to further monitor treatment response and ultimately provide well-rounded care to cancer patients.

A High Precision, Wide Dynamic Range Closed-Loop Neuromodulation IC With Rapid Stimulation Artifact Recovery.

This article presents a high precision, wide dynamic range (DR) closed-loop neuromodulation (CLNM) system that can completely reject stimulation artifacts (SA) and achieve rapid SA recovery. In the recorder, a novel SA quick-blanking scheme is proposed for rail-to-rail SA rejection while minimizing SA recovery time. Besides, a new analog front-end (AFE) architecture based on a frequency-shaping (FS) technique is developed to extend DR intrinsically. In the stimulator, a stimulation driver implemented with a proposed redundant crossfire (RXF) technique is incorporated to improve the effective resolution of the stimulation current. The designed CLNM system is implemented in a 180 nm Bipolar-CMOS-DMOS (BCD) process. Measurement results show that the system is capable of tolerating rail-to-rail (5 V) SA and reducing the SA recovery time from 12 ms to 0.15 ms. The FS recorder extends the DR at low frequencies (LF) to 17.5 bits to enhance tolerance to LF interferences. The proposed stimulator adopting the 4-way RXF topology improves the effective resolution to 12.75 bits without consuming much extra area and power. Animal experiments demonstrate that the designed system can acquire high-fidelity neural signals immediately after stimulation onsets, thus supporting concurrent recording and stimulation.

An MRI Compatible Data Acquisition Device for Rat Brain Recording Inside 16.4T Magnet.

Concurrent recording of neural activities and functional magnetic resonance imaging (fMRI) data is useful for studying the neurovascular coupling relationship. This article presents a low-noise, frequency-shaping based neural recorder chip that is insensitive to radio frequency (RF) pulses and gradient echo artifacts under strong magnetic environment. To support simultaneous recording of local field potentials (LFPs), extracellular spikes, and fMRI data, a magnetic resonance imaging (MRI) compatible data acquisition (DAQ) device based on the designed recorder chip is developed with multiple circuit optimization techniques. Bench-top measurement shows that the designed DAQ device has 4.5 µV input-referred noise integrated from 300 Hz to 3000 Hz, which is not greatly affected by electromagnetic interference (EMI) at ultrahigh magnetic field (UMF, 16.4 T). In animal experiments, the designed DAQ device has been demonstrated to be capable of acquiring both the LFPs and extracellular spikes from a rat's brain before, during, and after MRI scanning. Besides, no obvious artifacts are seen from the designed DAQ device at multiple typical MRI scanning modes, and the system recovery time after gradient artifacts is reduced from more than 25 ms to less than 5 ms. The proposed DAQ device architecture based on the frequency-shaping neural recorder chip is MRI compatible and can provide highly competitive performance for concurrent recording of neural activities and fMRI data.

Minimal invasive plate osteosynthesis for the dislocated humeral head fracture associated with ipsilateral humeral shaft fracture: A case report.

The condition combining a dislocated humeral head fracture and an ipsilateral humeral shaft fracture is seen to be rare in literature, which is limited to case report or case series. Furthermore, effective management of these coexistent injuries is still a subject of debate. The essential purpose of this article is to report another treatment method for this condition. We present a case of a 79-year-old female patient who suffered a three-part humeral head fracture-dislocation associated with the ipsilateral humeral shaft fracture. The combined injuries were managed by minimal invasive plate osteosynthesis (MIPO) through the deltopectoral approach with the eventual result of bone healing and good function after thirty-three months of follow-up. In conclusion, MIPO should be considered a safe and effective option, however, the risk of traumatic osteonecrosis of the humeral head is taken into account before operation decision-making.

Enhanced Photothermal Effect Assisted by Resonance Energy Transfer in Carbon/Covellite Core-Shell Nanoparticles toward a High-Performance Interfacial Water Evaporation Process.

Carbon and semiconductor nanoparticles are promising photothermal materials for various solar-driven applications. Inevitable recombination of photoinduced charge carriers in a single constituent, however, hinders the realization of a greater photothermal effect. Core-shell heterostructures utilizing the donor-acceptor pair concept with high-quality interfaces can inhibit energy loss from the radiation relaxation of excited species, thereby enhancing the photothermal effect. Here, core-shell structures composed of a covellite (CuS) shell (acceptor) and spherical carbon nanoparticle (CP) core (donor) (abbreviated as CP/CuS) are proposed to augment the photothermal conversion efficiency via the Förster resonance energy transfer (FRET) mechanism. The close proximity and spectral overlap of the donor and acceptor trigger the FRET mechanism, where the electronic excitation relaxation energy of the CP reinforces the plasmonic resonance and near-infrared absorption in CuS, resulting in boosting the overall photothermal conversion efficiency. CP/CuS core-shell coated on polyurethane (PU) foam exhibits a total solar absorption of 97.1%, leading to an elevation in surface temperature of 61.6 °C in dry conditions under simulated solar illumination at a power density of 1 kW m-2 (i.e., 1 sun). Leveraging the enhanced photothermal conversion emanated from the energy transfer effect in the core-shell structure, CP/CuS-coated PU foam achieves an evaporation rate of 1.62 kg m-2 h-1 and an energy efficiency of 93.8%. Thus, amplifying photothermal energy generation in core-shell structures via resonance energy transfer can be promising in solar energy-driven applications and thus merits further exploration.

Intrathoracic herniation of retrosternal gastric conduit after thoracolaparoscopic esophagectomy causing gastric conduit obstruction: A case report.

INTRODUCTION AND IMPORTANCE: Intrathoracic herniation of gastric conduit (IHGC) is a specific complication following esophagectomy with retrosternal gastric pull-up but is not well recognized. Diagnosis and management are challenging due to the lack of literature reviews. CASE PRESENTATION: We report a 50-year-old man where a reconstructed gastric conduit hernia into the mediastinal pleural cavity after esophagectomy. The patient underwent minimally invasive esophagectomy with cervical anastomosis for middle esophageal carcinoma followed by retrosternal reconstruction; during the tunneling phase, the mediastinal pleura was injured. Subsequently, the patient developed progressive dysphagia postoperatively, and chest CT scans revealed that the dilating gastric tube had moved into the mediastinal pleural cavity. CLINICAL DISCUSSION: After ruling out the pyloric stenosis by endoscopy, our diagnosis was severe gastric outlet obstruction due to gastric conduit herniation. We performed laparoscopic surgery to mobilize and straighten the redundant gastric conduit. No recurrence occurred throughout the follow-up for one year. CONCLUSION: IHGC can cause gastric conduit obstruction, which requires reoperation to repair. The laparoscopic approach is an appropriate strategy with the advantages of being less invasive and effective in mobilizing and straightening the gastric conduit. To prevent mediastinal pleural injury - which affects the continuation of the reconstructions, the surgeon should use blunt dissection with direct observation during the route creation.

Oral Lichen Planus in Patients With Good's Syndrome: A Literature Review.

Good's syndrome is defined as the association of a thymoma with an immune deficiency. Many patients with Good's syndrome also have oral lichen planus involvement, and some authors have even considered it to be one of the clinical signs of Good's syndrome. In the literature, to our knowledge, clinical forms of oral lichen planus associated with Good's syndrome have not been described. We therefore aimed to characterize the forms of oral lichen planus occurring in the context of Good's syndrome. To this end, we carried out a scoping review of the literature according to the Joanna Briggs Institute guide and included 17 articles on the theme of "the forms and clinical locations of oral lichen planus associated with Good's syndrome". A total of 17 articles were selected, and 19 patients with Good's syndrome including oral lichen planus were identified. Most of them were women aged 60 years with erosive oral lichen planus of the tongue and inner cheeks. The treatments used were thymectomy, to which immunoglobulin infusions were added in some cases. All these treatments resulted in improvement of the oral lichen planus in 70.6% of cases. The management of Good's syndrome allows the improvement of oral lichen. In patients over 50 years of age with acute erosive oral lichen planus refractory to conventional therapies, Good's syndrome should be investigated.

Deposition of Ultrathin MgB2 Films from a Suspension Using Cosolvent Marangoni Flow.

Magnesium diboride (MgB2) has demonstrated, theoretically and experimentally, promise as a candidate material for hydrogen storage and has thus attracted much contemporary research interest. To study hydrogen gas adsorption on MgB2 thin films using a quartz crystal microbalance (QCM)─a workhorse apparatus for this specific experiment─MgB2 must be deposited uniformly on the active surface of the QCM without damaging the quartz's performance. In work presented here, a wet-chemistry colloid synthesis and deposition process of a MgB2 thin film on a gold (Au) surface was established to avoid the extreme conditions of conventional physical deposition methods. This process also counteracts the unwanted phenomena of drying droplets on a solid surface, particularly the coffee-ring effect. To verify the normal function of the QCM after MgB2 deposition and its ability to obtain meaningful data, simple gas adsorption tests were conducted on the QCM, and the MgB2 film on the QCM was characterized with X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) for elemental analysis and surface roughness, respectively. To obtain information about the thickness and the involvement of the coffee-ring effect, the same synthesis route was applied on a similar gold substrate─an evaporated Au film on glass. XPS characterization of the film and its precursor suspension shows the potential existence of both MgB2 and its oxide forms. The film's thickness on evaporated Au was measured by scanning transmission electron microscopy (STEM) to be 3.9 nm. The resulting samples show mitigation of the coffee-ring effect through roughness measurements with AFM at two scan sizes of 50 × 50 and 1 × 1 µm2.

Performances of Dried Blood Spots and Point-of-Care Devices to Identify Virological Failure in HIV-Infected Patients: A Systematic Review and Meta-Analysis.

To broaden access to HIV viral load monitoring (VLM), the use of blood samples from dried blood spots (DBS) or point-of-care (POC) devices, could be of great help in settings where plasma is not easily accessible. The variety of assays available makes the choice complex. This systematic review and meta-analysis aims to estimate the sensitivity and specificity of DBS and POC devices to identify patients in virological failure using World Health Organization (WHO) recommendations (viral load ≥1000 copies/mL), compared with plasma, for the assays currently available. Four databases were searched for articles, and two reviewers independently identified articles reporting sensitivity and specificity of DBS and/or POC to identify patients in virological failure. We excluded articles that used other thresholds as well as articles with a total number of participants below 50 to avoid reporting bias. Heterogeneity and factors associated with assays' performances were assessed by I2 statistics and metaregression. The protocol of this review follows the PRISMA guidelines. Out of 941 articles, 47 were included: 32 DBS evaluations and 16 POC evaluations. Overall, when using DBS, the Abbott RT HIV-1, Roche CAP-CTM, NucliSENS BioMerieux and Aptima assays presented sensitivity and specificity exceeding 85%, but reported results were highly heterogeneous. Factors associated with better performances were high volume of blood and the use of the same assay for DBS and plasma VLM. Regarding the POC devices, SAMBA I, SAMBA II, and GeneXpert devices presented high sensitivity and specificity exceeding 90%, with less heterogeneity. DBS is suitable VLM, but performances can vary greatly depending on the protocols, and should be performed in trained centers. POC is suitable for VLM with less risk of heterogeneity but is more intensive in costs and logistics.

A study evaluating the extrinsic and intrinsic determinants of farmers' adoption of climate change adaptation strategies: A novel approach for improving farmers' health.

Small-scale farmers living in mountainous areas are particularly vulnerable to climate change. Although governments have implemented various support programs and policies to support a range of farmers to tackle climatic changes, there are still several difficulties in the implementation of these adaptation strategies. Using the survey data of 758 small-scale farmers this paper employs Multivariate Probit (MVP) and Poisson regression models to measure the effects of intrinsic and extrinsic factors affecting farmers adaptation decision in rural Vietnam. The results reveal that the extrinsic factors such as annual rainfall variations and farm size motivate farmers' adoption of their adaptations. The findings also reveal that the political connection has a significantly positive impact on the respondents' selection, while government interference such as extension training programs has a negative association with the farmers adaptation choice. Public extension programs should be simultaneously redesigned to support farmers in mitigating the impacts of climate change.

Real-Time Monitoring of Biofilm Formation Using a Noninvasive Impedance-Based Method.

Biofilms are complex three-dimensional microbial communities that adhere to a variety of surfaces and interact with their surroundings. Because of the dynamic nature of biofilm formation, establishing a uniform technique for quantifying and monitoring biofilm volume, shape, and features in real-time is challenging. Herein, we describe a noninvasive electrochemical impedance approach for real-time monitoring of dental plaque-derived multispecies biofilm growth on a range of substrates. A working equation relating electrochemical impedance to live biofilm volume has been developed that is applicable to all three surfaces examined, including glass, dental filling resin, and Ca2+-releasing resin composites. Impedance changes of 2.5, 35, 50, and 65% correlated to biofilm volumes of 0.10 ± 0.01, 16.9 ± 2.2, 29.7 ± 2.3, and 38.6 ± 2.8 µm3/µm2, respectively. We discovered that glass, dental filling resin, and Ca2+-releasing dental composites required approximately 3.5, 4.5, and 6 days, respectively, to achieve a 50% change in impedance. The local pH change at the biofilm-substrate interfaces also monitored with potentiometry pH microsensor, and pH change varied according to biofilm volume. This impedance-based technique can be a useful analytical method for monitoring the growth of biofilms on a variety of substrates in real-time. Therefore, this technique may be beneficial for examining antibacterial properties of novel biomaterials.

Willingness to Pay to Reduce the Ecological and Health Risks from Water Pollution in Emerging Urban Regions: The Case of the Red River Delta in Vietnam.

The soaring economic development of export activities of handicrafts centralized in emerging urban regions in Vietnam has accelerated the increase in the occurrence of diseases and threats to ecosystems induced by water pollution. We design a discrete choice experiment to elicit the willingness-to-pay of handicraft enterprises to restore the environment and diminish health risks from polluted wastewater through water quality improvement under different scenarios. Estimates from five latent classes reveal that one-half of entrepreneurs strongly value the provision of wastewater treatment services, and their decisions are mostly driven by preferences to reduce the risk of sickness caused by water pollution. This finding lends support to the argument that self-interested preferences predominate pro-environmental behavior in the readiness to pay for water quality services. While entrepreneurs' preferences attributed to ecological remediation seem to vary according to their educational background, the status-quo group shows low environmental awareness. This divergent behavioral pattern suggests that the design of wastewater management policies requires a mixture of measures that aim at different groups of individuals pursuing economic incentives and the creation of awareness.

An intervention pilot to facilitate harm reduction service decentralization in Vietnam.

INTRODUCTION: Harm reduction services, including methadone maintenance therapy (MMT), have been decentralized to Vietnam's community health care settings. This study aims to pilot test an intervention to facilitate decentralized harm reduction service delivery in Vietnam. METHODS: The research team conducted an intervention pilot between August 2020 and May 2021 with six community MMT distribution sites in Thai Nguyen Province of Vietnam. We recruited five commune health workers (CHW) from each center (N = 30). In-person intervention training included content to correct misconceptions about harm reduction and reduce stigmatizing attitudes toward patients who use drugs and teach CHWs to self-examine and improve their service provision process. The study team developed a web-based platform to streamline CHW's patient monitoring and referral efforts. The team assessed intervention outcomes at baseline, 3-, and 6-months. CHWs in the intervention group provided acceptability ratings and feedback on the intervention at 6-months. RESULTS: CHWs in both intervention and control groups had similar background characteristics and outcome measures at baseline. CHWs in the intervention group, compared to those in the control group, showed a significantly higher level of improvement in adherence to service delivery protocol at 3-months. CHW in the intervention group had a significantly lower level of management-related stress compared to the control group at 6-months, although the intervention effect measured by the difference in change from baseline was not statistically significant. CHWs who participated in the final focus group reported high acceptability of the intervention. CONCLUSION: This intervention pilot demonstrated acceptability and promising outcomes on community-based harm reduction service delivery. Similar intervention strategies can be applied to enhance the decentralization of other chronic disease treatment services.

Enhancing the electrical properties of graphite nanoflake through gamma-ray irradiation.

Understanding changes in material properties through external stimuli is critical to validating the expected performance of materials as well as engineering material properties in a controlled manner. Here, we investigate a change in the c-axis electrical properties of graphite nanoflakes (GnFs) induced by gamma-ray irradiation, using conductive probe atomic force microscopy (CP-AFM). The fundamentals behind the change in their electrical properties are elucidated by analyzing the interlayer spacing, graphitization, and morphology. An increase in gamma-ray irradiation dose for GnFs leads to an exponential increase in the electrical conductance and a gradual decrease in the interlayer spacing, while accompanying indistinguishable changes in their morphology. Our experimental results suggest that the c-axis electrical conductance enhancement of GnFs with gamma-ray irradiation might be attributed to a reduction in interlayer spacing, though the created defects may also play a role. This study demonstrates that gamma-ray irradiation can be a promising route to tailor the electrical properties of GnFs.

Cystic pulmonary tuberculosis: A rare form of an ancient disease.

Cystic pulmonary tuberculosis is a unique form of pulmonary tuberculosis (PTB) presenting with multiple reversible cysts of the lung. Unlike the other forms, this cystic lung disease can improve with prompt tuberculosis treatments. Here we report the case of a 15-year-old girl who presented with respiratory failure and severe lung damage at hospital admission. We diagnosed her with PTB based on her positive GeneXpert result test. The patient was treated with a standard tuberculosis regimen for 6 months and recovered completely.

Reproductive development of female wallago catfish (Wallago attu) in captivity.

The wallago catfish (Wallago attu) is a new potential fish for aquaculture in Vietnam. Data related to the reproductive cycle of W. attu in captivity are, however, not available. To provide reliable indicators for oocyte maturation (OM) and the spawning season of the captive W. attu, this study investigated the temporal variation in hepatosomatic and gonadosomatic indices, oocyte diameter and color (greenish vs yellowish), germinal vesicle migration, and plasma concentrations of estradiol-17ß (E2) and vitellogenin (Vtg) in female broodstock in association with changes in light density, temperature and amount of rainfall during the reproductive cycle. The results of this study displayed a clear seasonality in all the investigated parameters. The highest concentration of E2 (2.6 ± 3.5 ng/mL) was found in April, followed by a peak of Vtg (543 ± 43 ng/mL) in June. Meanwhile, the largest mean oocyte diameter (1.70 ± 0.02 mm) was observed in June. The shortest distance between the germinal vesicle and the edge of the oocyte (0.20 ± 0.01 mm) was recorded in July. Correspondingly, the amount of rainfall increased remarkably in July from 43.9 mm to over 200 mm in August. Taken together, we conclude that OM and the onset of the spawning season of captive W. attu occur in July and August, respectively. The percentage of greenish oocytes increased significantly over sampling time points. The changes in the color of oocytes combined with oocyte diameter could, therefore, be considered as promising indicators to predict the OM and spawning season of captive W. attu.

Effects of gonadotropins, 11-ketotestosterone, and insulin-like growth factor-1 on target gene expression and growth of previtellogenic oocytes from shortfinned eels, Anguilla australis, in vitro.

Pituitary gonadotropins, metabolic hormones, and sex steroids are known factors affecting the advanced stages of ovarian development in teleost fish. However, the effects of these hormones and of the interactions between them on the growth of previtellogenic ovarian follicles are not known. In order to address this void in understanding, previtellogenic ovarian fragments from eel, Anguilla australis, were incubated in vitro with recombinant Japanese eel follicle-stimulating hormone (rec-Fsh), human chorionic gonadotropin (hCG), or 11-ketotestosterone (11-KT) in the presence or absence of recombinant human insulin-like growth factor-1 (IGF1). The results of long-term in vitro culture (21 days) demonstrated that rec-Fsh and 11-KT, rather than hCG, caused significant increases in the diameter of previtellogenic oocytes. Meanwhile, only 11-KT induced a significant increase in lipid accumulation. Moreover, a greater effect on oocyte growth was observed when IGF1 supplementation was combined with 11-KT rather than with rec-Fsh or hCG. For short-term culture (24 h), treatment with 11-KT in the presence or absence of IGF1 had no significant effects on mRNA levels of target genes (lhr, cyp19, cyp11b, lpl, and ldr) except for upregulation of fshr. There were no significant effects of rec-Fsh on expression of any target gene, whereas hCG downregulated the expression of these genes. There was no evidence for any interaction between the gonadotropins and IGF1 that resulted in growth of previtellogenic oocytes. Taken together, these results suggest that hormones from both the reproductive and the metabolic axes regulate the growth of previtellogenic oocytes in Anguilla australis.

Real-time monitoring of the pH microenvironment at the interface of multispecies biofilm and dental composites.

Bacterial-mediated local pH change plays an important role in altering the integrity of resin dental composite materials in a dynamic environment such as the oral cavity. To address this, we developed a 300-µm-diameter, flexible, solid-state potentiometric pH microsensor capable of detecting and quantifying the local pH microenvironment at the interface of multispecies biofilm and dental resin in real time over 10 days. We used fluorinated poly(3,4-ethylenedioxythiophene) as the back contact in our newly developed pH sensor, along with a PVC-based ion-selective membrane and PTFE-AF coating. The high temporal resolution pH data demonstrated pH changes from 7 to 6 and 7 to 5.8 for the first 2 days and then fluctuated between 6.5 to 6 and 6 to 5.5 for the remaining 8 days with the resin composite or glass slide substrate respectively. We could observe the fluctuations in pH mediated by lactic acid production within the biofilm and the re-establishment of pH back to 7. However, acid production started to overwhelm buffering capacity with the continuous feed of sucrose cycles and reduced the local pH nearer to 5.5. No such changes or fluctuations were observed above the biofilm, as the pH remained at 7.0 ± 0.2 for 10 days. The localized real-time monitoring of the pH within the biofilm showed that the pH shift underneath the biofilm could lead to damage to the underlying material and their interface but cannot be sensed external to the biofilm.