Effects of Augmented Reality-Based Remote Mentoring on Task Performance and Communication: A Simulation Study in the Context of Emergency Medical Services.

Background: Augmented reality head-worn displays (HWDs) may enable efficient remote support in the prehospital environment due to their hand-free operability, their "see-what-I-see" features, and their ability to superimpose digital content over the environment. Methods: In this simulation-based randomized controlled study, a remote mentor used either a phone or HWD to instruct 23 physicians on how to insert a Multi-Lumen Access Catheter into a mannequin. In the phone condition, information could be exchanged only verbally. In the HWD condition, the mentor could additionally see the participant's first-person view and show reference images. We hypothesized that participants who received instructions via the HWD would achieve better procedural performance (lower task completion times, fewer errors advancing the catheter) and exhibit different communication patterns than participants who received instructions via phone. Results: The HWD did not significantly reduce task completion times or errors during catheter advancement. However, by analyzing the frequency of communication events with a Poisson regression, we could demonstrate that with the HWD, the mentor had to request situation reports less often (p < 0.001) but provided more instructions (p = 0.004) and more feedback (p = 0.008). As a possible consequence, participants in the HWD condition rated their workload as lower than participants who used a phone to communicate (p = 0.45). Conclusion: The study demonstrates that HWD-based telemedicine systems can be rated positively by physicians, can benefit communication, and can provide more opportunities for the detection of clinical errors.

Terminalia ferdinandiana Fruit and Leaf Extracts Inhibit Methicillin-Resistant Staphylococcus aureus Growth.

The development of multiple antibiotic-resistant bacteria has vastly depleted our repertoire of effective antibiotic chemotherapies. The development of multi-ß-lactam-resistant strains are particularly concerning due to our previous reliance on this class of antibiotics because of their initial efficacy and broad-spectrum activity. With increases in extended-spectrum ß-lactam-resistance and an expanded resistance to other classes of antibiotics, there is an urgent need for the development of effective new antibiotic therapies. Terminalia ferdinandiana is an endemic Australian plant known for its high antioxidant and tannin contents. T. ferdinandiana fruit and leaf extracts have strong antibacterial activity against a wide variety of bacterial pathogens. However, T. ferdinandiana extracts have not been tested against ESBL and MRSA antibiotic-resistant pathogens. An objective of this study was to screen T. ferdinandiana fruit and leaf extracts for bacterial growth inhibitory activity by disc diffusion assay against ß-lactam-sensitive and -resistant E. coli strains and against methicillin-sensitive and -resistant S. aureus. The minimum inhibitory concentration (MIC) was quantified by liquid dilution techniques. The fruit methanolic extract, as well as the methanolic, aqueous, and ethyl acetate leaf extracts strongly inhibited the growth of the MRSA, with MICs as low as 223 µg/mL. In contrast, the extracts were ineffective inhibitors of ESBL growth. Metabolomic fingerprint analysis identified a diversity and relative abundance of tannins, flavonoids, and terpenoids, several of which have been reported to inhibit MRSA growth in isolation. All extracts were nontoxic in the Artemia nauplii and HDF toxicity assays, further indicating their potential for medicinal use.

Unprecedented Microbial Conversion of Biliverdin into Bilirubin-10-sulfonate.

Biliverdin (BV) possesses antioxidant and anti-inflammatory properties, with previous reports identifying protection against oxidant and inflammatory injury in animal models. Recent reports indicate that intra-duodenal administration of BV results in the formation of an uncharacterised metabolite, which is potently absorbed into the blood and excreted into the bile. This compound may be responsible for protection against inflammatory responses. This study aimed to identify novel, enterally-derived BV metabolites and determine the source of their metabolic transformation. Rat duodena and bacterial cultures of Citrobacter youngae were treated with BV and subsequently analysed via high performance liquid chromatography/high resolution tandem mass spectrometry to identify and characterise metabolites of BV. A highly abundant metabolite was detected in duodenal wash and bacterial culture supernatants with a 663.215 m/z (3 ppm mass accuracy) and a composition of C33N4O9H36S, which conformed to the predicted structure of bilirubin-10-sulfonate (BRS) and possessed a λmax of 440 nm. Bilirubin-10-sulfonate was then synthesized for comparative LCMS/MS analysis and matched with that of the biologically formed BV metabolite. This report confirms the formation of a previously undocumented metabolite of BV in mammals, indicating that a new metabolic pathway likely exists for BV metabolism requiring enteric bacteria, Citrobacter youngae. These data may have important implications with regard to understanding and harnessing the therapeutic efficacy of oral BV administration.

Terminalia ferdinandiana Exell: Extracts inhibit Shewanella spp. growth and prevent fish spoilage.

Shewanella spp. are major causes of fish spoilage. Terminalia ferdinandiana (Kakadu plum) extracts were investigated for their ability to inhibit Shewanella spp. growth. Leaf and fruit extracts displayed potent growth inhibitory properties against all Shewanella spp. The methanolic leaf extract was a particularly potent inhibitor of S. putrefaciens (DD MIC 93; LD MIC 73 µg/mL), S. baltica (DD MIC 104 µg/mL; LD MIC 85 µg/mL), S. frigidimarina (DD MIC 466 µg/mL; LD MIC 391 µg/mL) and S. loihica (DD MIC 95 µg/mL; LD MIC 55 µg/mL) growth. The aqueous and ethyl acetate leaf extracts were also potent growth inhibitors, with MIC values generally substantially <1000 µg/mL. Treatment of Acanthopagrus butcheri Munro fillets with methanolic Kakadu plum extracts significantly inhibited bacterial growth for 15 days at 4 °C. All Kakadu plum extracts were nontoxic in the Artemia franciscana bioassay. LC-MS analysis identified several compounds which may contribute to the inhibition of Shewanella spp. growth.

Rethinking one of criminology's 'brute facts': The age-crime curve and the crime drop in Scotland.

Examining annual variation in the age-crime curve as a way to better understand the recent crime drop, this paper explores how the age distribution of convicted offending changed for men and women in Scotland between 1989 and 2011. This analysis employs shaded contour plots as a method of visualizing annual change in the age-crime curve. Similar to recent findings from the USA, we observed falling rates of convicted offending for young people, primarily owing to lower rates of convicted offending for young men. In contrast to the US literature we also find increases in the rate of convicted offending for those in their mid-twenties to mid-forties, which are relatively greater for women than men. Analysis of annual change shows different phases in the progression of these trends, with falls in prevalence during the 1990s reflecting lower rates of convictions for acquisitive crime, but falls between 2007 and 2011 being spread across multiple crime types. Explanations of the crime drop in Scotland and elsewhere must be able to account for different patterns of change across age, sex, crime type and time.

People, processes, and systems: An observational study of the role of technology in rural youth mental health services.

The merits of technology-based mental health service reform have been widely debated among academics, practitioners, and policy makers. The design of new technologies must first be predicated on a detailed appreciation of how the mental health system works before it can be improved or changed through the introduction of new products and services. Further work is required to better understand the nature of face-to-face mental health work and to translate this knowledge to computer scientists and system designers responsible for creating technology-based solutions. Intensive observation of day-to-day work within two rural youth mental health services in South Australia, Australia, was undertaken to understand how technology could be designed and implemented to enhance young people's engagement with services and improve their experience of help seeking. Data were analysed through a lens of complexity theory. Results highlight the variety of professional roles and services that can comprise the mental health system. The level of interconnectedness evident in the system contrasted with high levels of service self-organization and disjointed information flow. A mental health professional's work was guided by two main constructs: risk and engagement. Most clients presented with a profile of disability, disadvantage, and isolation, so complex client presentations and decision-making were core practices. Clients (and frequently, their families) engaged with services in a crisis-dependent manner, characterized by multiple disengagements and re-engagements over time. While significant opportunities exist to integrate technology into existing youth mental health services, technologies for this space must be usable for a broad range of medical, psychological and cognitive disability, social disadvantage, and accommodate repeat cycles of engagement/disengagement over time.

The promise and the reality: a mental health workforce perspective on technology-enhanced youth mental health service delivery.

BACKGROUND: Digital technologies show promise for reversing poor engagement of youth (16-24 years) with mental health services. In particular, mobile and internet based applications with communication capabilities can augment face-to-face mental health service provision. The literature in this field, however, fails to adequately capture the perspectives of the youth mental health workforce regarding utility and acceptability of technology for this purpose. METHODS: This paper describes results of in-depth qualitative data drawn from various stakeholders involved in provision of youth mental health services in one Australian rural region. Data were obtained using focus groups and semi-structured interviews with regional youth mental health clinicians, youth workers and support/management staff (n = 4 focus groups; n = 8 interviews) and analysed via inductive thematic analysis. RESULTS: Results question the acceptability of technology to engage clients within youth mental health services. Six main themes were identified: young people in a digital age, personal connection, power and vulnerability, professional identity, individual factors and organisational legitimacy. CONCLUSIONS: These findings deepen the understanding of risks and challenges faced when adopting new technologies in mental healthcare. Recommendations for technology design and implementation in mental health services are made.

Multi-constituent identification in Australian cane toad skin extracts using high-performance liquid chromatography high-resolution tandem mass spectrometry.

Toad skins and venom glandular secretions have been widely used for centuries in traditional Chinese and Japanese medicine for the treatment of various ailments such as cancer, sores, toothache, local inflammation and pain. The active chemical constituents from traditional oriental medicines have demonstrated potential in the development of effective therapeutic pharmaceuticals. Our primary focus in this research was to identify and characterise 'active' compounds or groups of compounds for their potential as neuropsychiatric disorder therapeutics. For this aim, we utilised a variety of solvents, i.e., the aqueous, 60% ethanol (aqueous) and acetic acid (aq) (at two different pHs) for extractions of Australian cane toad skins to identify chemical constituents. The identification of compounds was carried out using HPLC-ESI-Q-TOF-MS/MS based on the accurate mass measurement for molecular ions and MS/MS analysis, whereby accurate mass pseudo-molecular ions and characteristic fragment ions were compared to published reference data, including mass bank and NIST. As a result, we have to date identified 42 major constituents including alkaloids, amino acids, bufadienolides, fatty acids, nucleobases, nucleosides and vitamins mostly from the aqueous and 60% ethanol extracts. Of the 42 constituents identified, 29 were found in the aqueous extract, 35 were found in the ethanol (aq) extract and only 10 in the pH 1.78 acetic acid extract and 11 in the pH 2.17 acetic acid extract of the cane toad skins. Therefore, the aqueous and 60% ethanolic extracts present the greatest potential for ongoing development in our assays. There have been no previous reports on the identification of many of the constituents we have here identified in Australian cane toad skins. These findings, while somewhat consistent with findings in toad skins in other countries, identifies the presence of potential bioactive constituents. Our results showed that HPLC-ESI-Q-TOF-MS/MS is an effective method to characterise and identify components in Australian cane toad skin extracts. Chemical profiling is an essential initial step in the identification and therapeutic exploitation of bioactive agents present in Australian cane toad skin extracts.

High Performance Liquid Chromatography-mass Spectrometry Analysis of High Antioxidant Australian Fruits with Antiproliferative Activity Against Cancer Cells.

BACKGROUND: High antioxidant capacities have been linked to the treatment and prevention of several cancers. Recent reports have identified several native Australian fruits with high antioxidant capacities. Despite this, several of these species are yet to be tested for anticancer activity. MATERIALS AND METHODS: Solvent extracts prepared from high antioxidant native Australian fruits were analyzed for antioxidant capacity by the di (phenyl)-(2,4,6-trinitrophenyl) iminoazanium free radical scavenging assay. Antiproliferative activities against CaCo2 and HeLa cancer cells were determined by a multicellular tumor spheroid-based cell proliferation assay. Toxicity was determined by Artemia franciscana bioassay. RESULTS: Methanolic extracts of all plant species displayed high antioxidant contents (equivalent to approximately 7-16 mg of vitamin C per gram of fruit extracted). Most aqueous extracts also contained relatively high antioxidant capacities. In contrast, the ethyl acetate, chloroform, and hexane extracts of most species (except lemon aspen and bush tomato) had lower antioxidant contents (below 1.5 mg of vitamin C equivalents per gram of plant material extracted). The antioxidant contents correlated with the ability of the extracts to inhibit proliferation of CaCo2 and HeLa cancer cell lines. The high antioxidant methanolic extracts of all species were potent inhibitors of cell proliferation. The methanolic lemon aspen extract was particularly effective, with IC50 values of 480 and 769 µg/mL against HeLa and CaCo2 cells, respectively. In contrast, the lower antioxidant ethyl acetate and hexane extracts (except the lemon aspen ethyl acetate extract) generally did not inhibit cancer cell proliferation or inhibited to only a minor degree. Indeed, most of the ethyl acetate and hexane extracts induced potent cell proliferation. The native tamarind ethyl acetate extract displayed low-moderate toxicity in the A. franciscana bioassay (LC50 values below 1000 µg/mL). All other extracts were nontoxic. A total of 145 unique mass signals were detected in the lemon aspen methanolic and aqueous extracts by nonbiased high-performance liquid chromatography-mass spectrometry analysis. Of these, 20 compounds were identified as being of particular interest due to their reported antioxidant and/or anticancer activities. CONCLUSIONS: The lack of toxicity and antiproliferative activity of the high antioxidant plant extracts against HeLa and CaCo2 cancer cell lines indicates their potential in the treatment and prevention of some cancers. SUMMARY: Australian fruit extracts with high antioxidant contents were potent inhibitors of CaCo2 and HeLa carcinoma cell proliferationMethanolic lemon aspen extract was particularly potent, with IC50 values of 480 µg/mL (HeLa) and 769 µg/mL (CaCo2)High-performance liquid chromatography-mass spectrometry-quadrupole time-of-flight analysis highlighted and putatively identified 20 compounds in the antiproliferative lemon aspen extractsIn contrast, lower antioxidant content extracts stimulated carcinoma cell proliferationAll extracts with antiproliferative activity were nontoxic in the Artemia nauplii assay. Abbreviations used: DPPH: di (phenyl)- (2,4,6-trinitrophenyl) iminoazanium, HPLC: High-performance liquid chromatography, IC50: The concentration required to inhibit by 50%, LC50: The concentration required to achieve 50% mortality, MS: Mass spectrometry.

Mental Health Technologies: Designing With Consumers.

Despite growing interest in the promise of e-mental and well-being interventions, little supporting literature exists to guide their design and the evaluation of their effectiveness. Both participatory design (PD) and design thinking (DT) have emerged as approaches that hold significant potential for supporting design in this space. Each approach is difficult to definitively circumscribe, and as such has been enacted as a process, a mind-set, specific practices/techniques, or a combination thereof. At its core, however, PD is a design research tradition that emphasizes egalitarian partnerships with end users. In contrast, DT is in the process of becoming a management concept tied to innovation with strong roots in business and education. From a health researcher viewpoint, while PD can be reduced to a number of replicable stages that involve particular methods, techniques, and outputs, projects often take vastly different forms and effective PD projects and practice have traditionally required technology-specific (eg, computer science) and domain-specific (eg, an application domain, such as patient support services) knowledge. In contrast, DT offers a practical off-the-shelf toolkit of approaches that at face value have more potential to have a quick impact and be successfully applied by novice practitioners (and those looking to include a more human-centered focus in their work). Via 2 case studies we explore the continuum of similarities and differences between PD and DT in order to provide an initial recommendation for what health researchers might reasonably expect from each in terms of process and outcome in the design of e-mental health interventions. We suggest that the sensibilities that DT shares with PD (ie, deep engagement and collaboration with end users and an inclusive and multidisciplinary practice) are precisely the aspects of DT that must be emphasized in any application to mental health provision and that any technology development process must prioritize empathy and understanding over innovation for the successful uptake of technology in this space.

Quorum sensing negatively regulates multinucleate cell formation during intracellular growth of Burkholderia pseudomallei in macrophage-like cells.

Burkholderia pseudomallei is a Gram-negative environmental bacterium and the causative agent of melioidosis, a potentially fatal, acute or chronic disease endemic in the tropics. Acyl homoserine lactone (AHL)-mediated quorum sensing and signalling have been associated with virulence and biofilm formation in numerous bacterial pathogens. In the canonical acyl-homoserine lactone signalling paradigm, AHLs are detected by a response regulator. B. pseudomallei encodes three AHL synthases, encoded by bpsI1, bpsI2 and bpsI3, and five regulator genes. In this study, we mutated the B. pseudomallei AHL synthases individually and in double and triple combination. Five AHLs were detected and quantified by tandem liquid chromatography-mass spectroscopy. The major AHLs produced were N-octanoylhomoserine lactone and N-(3-hydroxy-decanoyl)homoserine lactone, the expression of which depended on bpsI1 and bpsI2, respectively. B. pseudomallei infection of macrophage cells causes cell fusion, leading to multinucleated cells (3 or more nuclei per cell). A triple mutant defective in production of all three AHL synthases was associated with a striking phenotype of massively enhanced host cellular fusion in macrophages. However, neither abrogation of host cell fusion, achieved by mutation of bimA or hcp1, nor enhancement of fusion altered intracellular replication of B. pseudomallei. Furthermore, when tested in murine models of acute melioidosis the AHL synthase mutants were not attenuated for virulence. Collectively, this study identifies important new aspects of the genetic basis of AHL synthesis in B. pseudomallei and the roles of these AHLs in systemic infection and in cell fusion in macrophages for this important human pathogen.