Smartphone-Based Sensing of Cortisol by Functionalized Rhodamine Probes.

During a stress condition, the human body synthesizes catecholamine neurotransmitters and specific hormones (called "stress hormones"), the most important of which is cortisol. The monitoring of cortisol levels should be extremely important to control the stress levels, and for this reason, it shows important medical applications. The common analytical methods (HPLC, GC-MS) cannot be used in real life, due to the bulky size of the instruments and the necessity of specialized personnel. Molecular probes solve these problems due to their fast and easy use. The synthesis of new fluorescent rhodamine probes, able to interact by non-covalent interactions with cortisol, the recognition properties in solution as well as in solid state by Strip Test, using a smartphone as detector, are here reported. DFT calculations and FT-IR measurements suggest the formation of supramolecular complexes through hydrogen bonds as main non-covalent interaction. The present study represents one of the first sensor, based on synthetical chemical receptors, able to detect cortisol in a linear range from 1 mM to 1 pM, based on non-covalent molecular recognition and paves the way to the realization of practical point-of-care device for the monitoring of cortisol in real live.

Smart Sensing of Nerve Agents.

The recent international scenario highlights the importance to protect human health and environmental quality from toxic compounds. In this context, organophosphorous (OP) Nerve Agents (NAs) have received particular attention, due to their use in terrorist attacks. Classical instrumental detection techniques are sensitive and selective, but they cannot be used in real field due to the high cost, specialized personnel requested and huge size. For these reasons, the development of practical, easy and fast detection methods (smart methods) is the future of this field. Indeed, starting from initial sensing research, based on optical and/or electrical sensors, today the development and use of smart strategies to detect NAs is the current state of the art. This review summarizes the smart strategies to detect NAs, highlighting some important parameters, such as linearity, limit of detection and selectivity. Furthermore, some critical comments of the future on this field, and in particular, the problems to be solved before a real application of these methods, are provided.

Cortisol sensing by optical sensors.

During a stress condition, the human body synthesizes catecholamine neurotransmitters and specific hormones (called "stress hormones"), the most important of which is cortisol. The monitoring of cortisol levels is extremely important for controlling the stress levels. For this reason, it has important medical applications. Common analytical methods (HPLC, GC-MS) cannot be used in real life due to the bulkiness of the instruments and the necessity of specialized operators. Molecular probes solve this problem. This review aims to provide a description of recent developments in this field, focusing on the analytical aspects and the possibility to obtain real practical devices from these molecular probes.

Association between sleep disorders and health care utilization in children with chronic medical conditions: a Medicaid claims data analysis.

STUDY OBJECTIVES: To examine the risk of increased health care utilization (HU) linked to individual sleep disorders in children with chronic medical conditions. METHODS: Medicaid claims data from a cohort of 16,325 children enrolled in the Coordinated Healthcare for Complex Kids (CHECK) project were used. Sleep disorders and chronic medical conditions were identified using International Classification of Diseases, Ninth, and 10th Revision, codes. Three HU groups were identified based on participants' prior hospitalizations and emergency department (ED) visits in the 12 months prior to enrollment: low (no hospitalization or ED visit), medium (1-2 hospitalizations or 1-3 ED visits), and high (≥ 3 hospitalizations or ≥ 4 ED visits). The odds of being in an increased HU group associated with specific sleep disorders after controlling for confounding factors were examined. RESULTS: Children with chronic medical conditions and any sleep disorder had nearly twice the odds (odds ratio = 1.83; 95% confidence interval: 1.67-2.01) of being in an increased HU group compared with those without a sleep disorder. The odds of being in the increased HU group varied among sleep disorders. Only sleep-disordered breathing (odds ratio = 1.51; 95% confidence interval : 1.17-1.95), insomnia (odds ratio = 1.46; 95% confidence interval : 1.06-2.02), and circadian rhythm sleep disorder (odds ratio = 2.45; 95% confidence interval : 1.07-5.64) increased those odds. Younger age and being White were also linked to increased HU. CONCLUSIONS: Sleep disorders are associated with increased risk of heightened HU (ED visits and/or hospitalizations) in children with chronic medical conditions. This risk varies by specific sleep disorders. These findings indicate the need for careful evaluation and management of sleep disorders in this high-risk cohort. CITATION: Adavadkar PA, Brooks L, Pappalardo AA, Schwartz A, Rasinski K, Martin MA. Association between sleep disorders and health care utilization in children with chronic medical conditions: a Medicaid claims data analysis. J Clin Sleep Med. 2024;20(4):595-601.

Food Insecurity and Psychosocial Burden in a National Community-Based Sample of Households Managing Food Allergy.

BACKGROUND: Experiencing food allergies and food insecurity has been linked to socioeconomic, physical, and mental health-related challenges, but less is known about the intersection of these experiences. This study aims to better understand the impact of food insecurity on food allergy patients and their caregivers, with the intention of informing ongoing efforts to improve screening for food insecurity and mental health concerns and reducing their burden among households managing food allergy. METHOD: As part of a community needs assessment, a cross-sectional survey was administered to a large, national sample (N=5,940) of US households with at least one food-allergic individual, The Hunger Vital Sign was utilized to assess food insecurity, the Patient Health Questionnaire (PHQ-4) and Food Allergy Independent Measure (FAIM) were leveraged to measure psychosocial outcomes. RESULTS: Among respondents, 69.9% screened at-risk of food insecurity on the Hunger Vital Sign, while 5.6% reported very low food security. Both adults and children with food allergy (FA) from households at risk for food insecurity were more likely to report FA-related anxiety, anger, loneliness, fear of eating, and bullying victimization than their counterparts from households not at risk of food insecurity (p < .0001 for all). Among these specific experiences, FA-related anxiety was the most common (25.4%/30.1% of children/adults). Perceived risk of food allergy-related fatality was positively associated with food insecurity status. CONCLUSION: Individuals with food allergies who are concomitantly experiencing food insecurity are at greater risk of a variety of mental health concerns, including those specific to food allergy as well as more general anxiety and depressive symptoms.

Supramolecular Detection of a Sub-ppm Nerve Agent Simulant by a Smartphone Tool.

The widespread use of smartphones and related tools is extending their applications in several fields. Herein, we report a reusable smartphone coupled portable detection system for the sensing of sub-ppm level of a nerve agent mimic (dimethylmethylphosphonate) in the gas phase. The detection system is based on multiple hydrogen-bond interactions of the vapor analyte with an ad-hoc functionalized Bodipy chromophore scaffold. The multitopic approach used for the molecular recognition of DMMP leads to the highest binding constant values, high selectivity, and low limits of detection.

Women in Allergy and Immunology: The Future Is Female, Let Us Soar!

Despite increases in the number of female physicians in the past 50 years, women remain underrepresented in key areas of medicine, such as practice owners and partners, professional society leaders, principal investigators, full professors, chairs, and deans. Women are paid less, oftentimes for more work. Allergy and Immunology (AI), as a specialty, lacks substantial workforce research, but trends across specialties are consistent. We review what is currently known about women in AI and consider barriers to practice, advancement, and contribution. Through a new inquiry, we find that the challenges women in AI encounter can be summarized through 6 themes: work-life balance, professional advancement, salary equity, mentorship and sponsorship, bias, and sexual harassment and misconduct. Together, we must address these challenges head-on and provide an equitable environment for women in AI to thrive, especially those affected by intersectionality. To do so, we suggest targeted, tangible actions to promote opportunities, offer institutional support, and advance reporting and culture change outlets across AI settings.

Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee.

The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.

Smartphone-Based Dopamine Detection by Fluorescent Supramolecular Sensor.

Supramolecular recognition of dopamine by two quinoxaline cavitands was studied in solution by fluorescence titrations, ESI-MS and ROESY measurements. In addition, the tetraquinoxaline cavitand was dropped onto a siloxane-based polymeric solid support, obtaining a sensor able to detect dopamine in a linear range of concentrations 10 Mm-100 pM, with a detection limit of 1 pM, much lower than the normal concentration values in the common human fluids (plasma, urine and saliva), by using a simple smartphone as detector. This sensor shows also good selectivity for dopamine respect to the other common analytes contained in a saliva sample and can be reused after acid-base cycles, paving the way for the realization of real practical sensor for human dopamine detection.

Smartphone-Assisted Sensing of Trinitrotoluene by Optical Array.

Here we report the design and fabrication of an array-based sensor, containing functionalized Carbon Dots, Bodipy's and Naphthalimide probes, that shows high fluorescence emissions and sensitivity in the presence of low amounts of TNT explosive. In particular, we have fabricated the first sensor device based on an optical array for the detection of TNT in real samples by using a smartphone as detector. The possibility to use a common smartphone as detector leads to a prototype that can be also used in a real-life field application. The key benefit lies in the possibility of even a nonspecialist operator in the field to simply collect and send data (photos) to the trained artificial intelligence server for rapid diagnosis but also directly to the bomb disposal unit for expert evaluation. This new array sensor contains seven different fluorescent probes that are able to interact via noncovalent interactions with TNT. The interaction of each probe with TNT has been tested in solution by fluorescence titrations. The solid device has been tested in terms of selectivity and linearity toward TNT concentration. Tests performed with other explosives and other nitrogen-based analytes demonstrate the high selectivity for TNT molecules, thus supporting the reliability of this sensor. In addition, TNT can be detected in the range of 98 ng∼985 µg, with a clear different response of each probe to the different amounts of TNT.

Fluorescence sensing by carbon nanoparticles.

Sensing is one of the most important fields in which chemists, engineers and other scientists are involved to realize sensoristic devices that can detect different analytes, both chemicals and biologicals. In this context, fluorescence sensing paves the way for the realization of smart sensoristic devices due to the possibility to detect the target analyte via a change in colour or emission. Recently (since 2006), carbon nanoparticles, which are a "new class" of nanostructures based on carbon atoms, have been widely used in sensing applications due to their intriguing optical properties. The scientific literature on this topic started from 2006 and a progressive increase in the corresponding number of publications has been observed. This review summarises the application of carbon nanoparticles in the sensing field, focusing on chemical and ion sensing.

Improving Adherence in Urban Youth With Asthma: Role of Community Health Workers.

BACKGROUND: The Asthma Action at Erie Trial is a comparative effectiveness trial comparing a community health worker (CHW) versus certified asthma educator (AE-C) intervention in low-income minority children. OBJECTIVES: Determine whether asthma medication possession, adherence, technique, and triggers differ in children receiving an asthma CHW compared with an AE-C intervention. METHODS: Children with uncontrolled asthma were randomized to receive 10 CHW home visits or 2 AE-C sessions in a clinic over 1 year. Asthma medication possession and inhaler technique were observed; adherence was measured using self-report, dose counters, and electronic monitors. Environmental triggers were captured by self-report, observation, and objective measurement. Mixed effects linear and logistic regression models were estimated for continuous and binary outcomes. RESULTS: Children (n = 223) were mainly Hispanic (85%) and ages 5 to 16 years. Quick-relievers (82%), spacers (72%), and inhaled corticosteroid (ICS)-containing medications (44%) were tracked. Of those with uncontrolled asthma, 35% lacked an ICS prescription (n = 201). Children in the CHW arm were more likely to have an ICS prescription at 12 months (odds ratio 2.39; 95% CI 0.99-5.79). Inhaler technique improved 9.8% in the CHW arm at 6 months (95% CI 4.20-15.32). The ICS adherence improved in the CHW arm at 12 months, with a 16.0% (95% CI 2.3-29.7; P = .02) difference between arms. Differences in trigger exposure over time were not observed between arms. CONCLUSIONS: The CHW services were associated with improved ICS adherence and inhaler technique, compared with AE-C services. More information is needed to determine the necessary dosage of intervention to sustain adherence.

Rates of diagnoses of sleep disorders in children with chronic medical conditions.

STUDY OBJECTIVES: This investigation examines sleep disorder (SD) diagnoses in a large population of children and adolescents with chronic medical conditions (CMCs). Little is known about SD diagnoses in this population. The large population used in this study allowed examination of SD rates by CMC type and demographics. METHODS: Data were from the Coordinated Health Care for Complex Kids (CHECK) project designed for Medicaid-funded children and adolescents with at least 1 CMC from a large metropolitan area. The study population (n = 16,609) was limited to children and adolescents, 0 to 18 years of age. SD and CMC diagnoses were obtained from Medicaid claims data. RESULTS: Fourteen percent of the population (mean age of 9.1 years [standard deviation = 5.2]; 35.8% African American; 56.4% male; 77 with more than 1 CMC) received a sleep disorder diagnosis. The most frequent diagnosis was sleep-disordered breathing (11.2%), followed by nocturnal enuresis (1.2%) and insomnia (1%). SDs were diagnosed more frequently in those with multiple CMCs than in those with 1 CMC (19.7% vs 5.8%; P < .001). Insomnia rates in Hispanic/Latinx (1.2%) and African American (0.8%) children and adolescents were significantly lower (both P < .001) than in Caucasians (3.5%). Odds of receiving a sleep diagnosis varied among CMCs. CONCLUSIONS: Our analysis of Medicaid claims data of a large urban cohort offers detailed information about the rates of sleep diagnoses and suggests underdiagnosis of SDs in this vulnerable, high-risk, primarily ethnic minority population. Underrecognition of sleep disorders has short- and long-term health and economic consequences. Study results may help clinicians implement appropriate SD screening and management for children and adolescents with CMCs. CITATION: Adavadkar PA, Pappalardo AA, Glassgow AE, et al. Rates of diagnoses of sleep disorders in children with chronic medical conditions. J Clin Sleep Med. 2022;18(8):2001-2007.

Age-based disparities in telehealth use in an urban, underserved population in cancer and pulmonary clinics: A need for policy change.

BACKGROUND: During the COVID-19 pandemic, telehealth rapidly emerged as an essential health care service and became particularly important for patients with cancer and chronic conditions. However, the benefits of telehealth have not been fully realized for some of the most vulnerable populations due to inequitable access to telehealth capable technology. PURPOSE: This study aimed to assess accessibility and satisfaction with telehealth technology by vulnerable patients with cancer and pulmonary disease. METHODOLOGY: A paper survey and internet-based survey were developed and administered to adult (≥18 years) cancer and pulmonary clinic patients (July 1, 2020 to October 30, 2020). RESULTS: Descriptive statistics and Fisher exact test were performed. Two hundred eleven patients completed the survey. Adults ≥50 years old (older) had reduced access to smartphone video capability and internet connection compared with adults less than 50 years old (59% vs. 90%, p < .01). Older adults reported more challenges with telehealth visits compared with younger adults (50.3%, 28.6%; p < .01). No difference in access to technology and preferences for telehealth versus in-person care was found by race, gender, or education level. CONCLUSIONS: Nearly all patients (95%) who had a previous experience with a telehealth visit felt confident in the quality of care they received via telehealth. Younger adults preferred video visits compared with older adults (75% vs. 50.6%, p < .01). Older adults were less likely to have access to smartphones with internet access, have more challenges with telehealth visits, and were less likely to prefer audio-video telehealth visits compared with younger adults. IMPLICATIONS: Ensuring equitable access to all health care delivery modalities by telehealth, including audio-only visits for patients across the age continuum, is paramount.

Self-Efficacy Among Caregivers of Children With Food Allergy: A Cohort Study.

OBJECTIVE: The prevalence of pediatric food allergy (FA) is increasing and, due to early disease onset, requires significant caregiver management that is associated with psychosocial burden. Caregiver perception of how they cope and handle FA-related events (self-efficacy) has been linked to psychosocial outcomes in racially/geographically homogenous samples. This study explores FA-related caregiver self-efficacy and associations with FA-related caregiver quality of life (QoL) in a diverse cohort. METHODS: Caregivers of children, diagnosed with IgE-mediated FA who identified as non-Hispanic Black or White, were recruited from U.S. academic allergy clinics. Caregivers completed demographic and medical questionnaires, the Food Allergy Self-Efficacy Scale for Parents (FASE-P), Food Allergy Independent Measure-Parent Form (FAIM), and the Food Allergy Quality of Life-Parental Burden (FAQL-PB). Bivariate and multivariate associations estimated relationships between study variables. RESULTS: Caregivers of 365 children (Mage = 5.8 years, 62.2% male, 31.1% Black) were enrolled. Caregivers reported high FA self-efficacy (M = 82.06/100), moderate perceptions of risk/FA severity (FAIM: M = 3.9/7), and some limitations on the FAQL-PB (M = 3.9/7). Self-efficacy was related to lower perceptions of risk/FA severity across all demographic groups (r = -.42, p < .001). Caregivers who reported higher self-efficacy reported better QoL, particularly Black caregivers (r = .67). CONCLUSIONS: In this sample of caregivers of children with FA, greater self-efficacy was related to improved QoL regardless of sociodemographic factors. Caregivers' perception of risk was lower for those with greater self-efficacy. Future research into the impact of FA management on QoL among diverse caregivers is needed.