Utilization of Bioinorganic Nanodrugs and Nanomaterials for the Control of Infectious Diseases Using Deep Learning.

As one of the main causes of morbidity and mortality, viral infections have a major impact on the well-being and economics of every nation in the globe. The ability to predictably diagnose viral infections improves the provision of good healthcare as well as the control and prevention of these conditions. Nanomaterials have gained widespread usage in the medical industry recently due to the rapid advancement of nanotechnology and their exceptional chemical and physical qualities, such as their small size and synthesized surface properties. The utilization of nanoparticles for illness detection, surveillance, control, preventive, and therapy, such as the treatment of bacterial infections, is referred to as nanomedicine. Nanomedicine is a comprehensive discipline that is founded on the usage of nanotechnology for clinical objectives. Nanoparticles, which have a nanoscale dimension and exhibit highly controllable optical and physical characteristics as well as the ability to bind to a large variety of chemicals, are among the most popular nanomaterials in nanomedicine. A deep learning framework of autoencoder for categorization study on viral infections is built based on actual hospital patient history of viral infections from August 2015 to August 2020. The information comprises of 10,950 cases, comprising outpatients and inpatients, encompassing the infectious diseases. Of such 10,950 instances, training set made up 70% or 7665 instances, and testing data made up 30% or 3285 instances. The data processing was done using the presented recurrent neural network-artificial bee colony (RNN-ABC) method. Sparse data densifying processes are done through the autoencoder to enhance the system learning outcome. The suggested autoencoder system was also evaluated to other widely used models, including support vector machine, logistic regression, random forest, and Naïve Bayes. In comparison to other approaches, the study's findings demonstrate how well the suggested autoencoder model can predict viral diseases. The methods used for this research can aid in removing reported lags in current monitoring systems, hence reducing society's expenses.

Unfamiliar personal protective equipment: The role of routine practice and other factors affecting healthcare personnel doffing strategies.

BACKGROUND: Healthcare personnel (HCP) may encounter unfamiliar personal protective equipment (PPE) during clinical duties, yet we know little about their doffing strategies in such situations. OBJECTIVE: To better understand how HCP navigate encounters with unfamiliar PPE and the factors that influence their doffing strategies. SETTING: The study was conducted at 2 Midwestern academic hospitals. PARTICIPANTS: The study included 70 HCP: 24 physicians and resident physicians, 31 nurses, 5 medical or nursing students, and 10 other staff. Among them, 20 had special isolation unit training. METHODS: Participants completed 1 of 4 doffing simulation scenarios involving 3 mask designs, 2 gown designs, 2 glove designs, and a full PPE ensemble. Doffing simulations were video-recorded and reviewed with participants during think-aloud interviews. Interviews were audio-recorded and analyzed using thematic analysis. RESULTS: Participants identified familiarity with PPE items and designs as an important factor in doffing. When encountering unfamiliar PPE, participants cited aspects of their routine practices such as designs typically used, donning and doffing frequency, and design cues, and their training as impacting their doffing strategies. Furthermore, they identified nonintuitive design and lack of training as barriers to doffing unfamiliar PPE appropriately. CONCLUSION: PPE designs may not be interchangeable, and their use may not be intuitive. HCP drew on routine practices, experiences with familiar PPE, and training to adapt doffing strategies for unfamiliar PPE. In doing so, HCP sometimes deviated from best practices meant to prevent self-contamination. Hospital policies and procedures should include ongoing and/or just-in-time training to ensure HCP are equipped to doff different PPE designs encountered during clinical care.

Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System.

BACKGROUND: Many critically ill children are initially evaluated in front-line settings by clinicians with variable pediatric training before they are transferred to a pediatric intensive care unit (PICU). Because clinicians learn from past performance, communicating outcomes of patients back to front-line clinicians who provide pediatric emergency care could be valuable; however, referring clinicians do not consistently receive this important feedback. OBJECTIVES: Our aim was to determine the feasibility, usability, and clinical relevance of a semiautomated electronic health record (EHR)-supported system developed at a single institution to deliver timely and relevant PICU patient outcome feedback to referring emergency department (ED) physicians. METHODS: Guided by the Health Information Technology Safety Framework, we iteratively designed, implemented, and evaluated a semiautomated electronic feedback system leveraging the EHR in one institution. After conducting interviews and focus groups with stakeholders to understand the PICU-ED health care work system, we designed the EHR-supported feedback system by translating stakeholder, organizational, and usability objectives into feedback process and report requirements. Over 6 months, we completed three cycles of implementation and evaluation, wherein we analyzed EHR access logs, reviewed feedback reports sent, performed usability testing, and conducted physician interviews to determine the system's feasibility, usability, and clinical relevance. RESULTS: The EHR-supported feedback process is feasible with timely delivery and receipt of feedback reports. Usability testing revealed excellent Systems Usability Scale scores. According to physicians, the process was well-integrated into their clinical workflows and conferred minimal additional workload. Physicians also indicated that delivering and receiving consistent feedback was relevant to their clinical practice. CONCLUSION: An EHR-supported system to deliver timely and relevant PICU patient outcome feedback to referring ED physicians was feasible, usable, and important to physicians. Future work is needed to evaluate impact on clinical practice and patient outcomes and to investigate applicability to other clinical settings involved in similar care transitions.

Usability of smart infusion pumps: A heuristic evaluation.

Although smart infusion pumps were built to eliminate medication errors, new types of usability errors have arisen. The purposes of this study were to determine potential risks when using smart pumps during secondary medication administration and to identify opportunities for design improvements. We observed and analyzed nurses when they interacted with smart pumps and heuristically evaluated the smart pump to identify usability problems. Forty-three usability problems were identified with the smart pump. The usability problems have the potential to create high cognitive burden on nurses and to increase the likelihood of mistakes. We discuss design and process improvement recommendations for each major finding from this study.

A Theoretical Framework for Understanding Creator-Consumer Information Interaction Behaviors in Healthcare Documentation Systems.

The advent of electronic documentation systems has made it easy to generate and store vast amounts of information, and has enabled easy access to patient care information, so much so that they are now considered a critical infrastructure for supporting the cognitive tasks in healthcare work. But, electronic documentation systems are not without their share of problems. Accountability and liability requirements have made electronic information creation and documentation particularly challenging. Mandatory documentation requirements and templated electronic formats have increased the amount of information, but have not always resulted in reliable, useful, or meaningful information. Documentation systems have become rigid, offering little opportunity for healthcare providers to engage in meaningful conversations about the information, and to sense problem status without additional coordination. A particularly significant information interaction problem that we have identified from our field work in healthcare information modeling, which this paper focuses on, deals with what we term creator-consumer interaction behaviors. The purpose of this paper is to examine in-depth the problem of creator-consumer information interaction behaviors in electronic healthcare documentation systems. A creator-consumer interaction behavioral framework highlights satisficing behavior during creation and consumption of medical documentation, and the characteristics of the work system that may lead to satisficing on documentation tasks.

Impact of untreated and Sargassum wightii-treated brilliant green dye exposure on Indian major carp, Labeo rohita Ham.: hematology, biochemistry, enzymology and histopathology.

Water pollution due to agricultural and industrial processes may cause adverse biological effects in aquatic organisms such as fishes. The removal of brilliant green (BG) dye from aqueous solution using seaweed Sargassum wightii was carried out. Further, it aimed to evaluate the exposure of BG dye activity on hematological, plasma biochemical, enzymological activities and histopathology of Indian major carp, Labeo rohita as a biomarker. High mortality rate (T2 65%) in the fishes exposed to untreated BG dye shows the toxic nature of the dye. Whereas fishes grown in treated BG dye showed less mortality rate (T3 25%) and (T1 30%) which depicts the less toxicity. The observed behavioral, biochemical, hematological and enzymological parameters were showed a significant increase in the treated BG dye. Extensive histopathological lesions in gill, liver and kidney tissues were observed in untreated BG dye compared to fishes grown in S. wightii-treated BG dye might be due to the stress caused by the toxic presence in the dye. The results concluded that S. wightii-treated BG dye does not have any inhibitory effect which reveals the nontoxic nature.

Healthcare Workers' Strategies for Doffing Personal Protective Equipment.

BACKGROUND: Personal protective equipment (PPE) helps protect healthcare workers (HCWs) from pathogens and prevents cross-contamination. PPE effectiveness is often undermined by inappropriate doffing methods. Our knowledge of how HCWs approach doffing PPE in practice is limited. In this qualitative study, we examine HCWs' perspectives about doffing PPE. METHODS: Thirty participants at a Midwestern academic hospital were recruited and assigned to 1 of 3 doffing simulation scenarios: 3 mask designs (n = 10), 2 gown designs (n = 10), or 2 glove designs (n = 10). Participants were instructed to doff PPE as they would in routine practice. Their performances were video-recorded and reviewed with participants. Semistructured interviews about their doffing approaches were conducted and audio-recorded, then transcribed and thematically analyzed. RESULTS: Three overarching themes were identified in interviews: doffing strategies, cognitive processes, and barriers and facilitators. Doffing strategies included doffing safely (minimizing self-contamination) and doffing expediently (eg, ripping PPE off). Cognitive processes during doffing largely pertained to tracking contaminated PPE surfaces, examining PPE design cues (eg, straps), or improvising based on prior experience from training or similar PPE designs. Doffing barriers and facilitators typically related to PPE design, such as PPE fit (or lack of it) and fastener type. Some participants also described personal barriers (eg, glasses, long hair); however, some PPE designs helped mitigate these barriers. CONCLUSIONS: Efforts to improve HCWs' doffing performance need to address HCWs' preferences for both safety and expediency when using PPE, which has implications for PPE design, training approaches, and hospital policies and procedures.

BALANCING DOCUMENTATION AND DIRECT PATIENT CARE ACTIVITIES: A STUDY OF A MATURE ELECTRONIC HEALTH RECORD SYSTEM.

US hospitals now fully embrace electronic documentation systems as a way to reduce medical errors and improve patient safety outcomes. Whether spending time on electronic documentation detracts from the time available for direct patient care, however, is still unresolved. There is no knowledge on the permanent effects of documenting electronically and whether it takes away significant time from patient care when the healthcare information system is mature. To understand the time spent on documentation, direct patient care tasks, and other clinical tasks in a mature information system, we conducted an observational and interview study in a midwestern academic hospital. The hospital implemented an electronic medical record system 11 years ago. We observed 22 health care workers across intensive care units, inpatient floors, and an outpatient clinic in the hospital. Results show that healthcare workers spend more time on documentation activities compared to patient care activities. Clinical roles have no influence on the time spent on documentation. This paper describes results on the time spent between documentation and patient care tasks, and discusses implications for future practice. RELEVANCE TO INDUSTRY: The study applies to healthcare industry that faces immense challenges in balancing documentation activities and patient care activities.

A Clinical Study on Comparative Evaluation of the Effectiveness of Carbamazepine and Combination of Carbamazepine with Baclofen or Capsaicin in the Management of Trigeminal Neuralgia.

BACKGROUND: Trigeminal neuralgia (TN) is characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution. Various medicinal and surgical procedures have been utilized for the treatment of TN. Over the time, several drugs other than carbamazepine have been used but none of them have shown satisfying results. OBJECTIVE: The objective of the study is to evaluate the effectiveness of carbamazepine and combination of carbamazepine with baclofen or capsaicin in the management of TN. MATERIALS AND METHODS: A total of 45 patients diagnosed with TN were randomly divided into three groups. The patients were prescribed carbamazepine in Group 1, carbamazepine and baclofen in Group 2, and carbamazepine and capsaicin in Group 3. All the patients were followed on the 7th day, 15th day, and 1-month period to evaluate the response to the drugs. Data were subjected to statistics. RESULTS: The results are composed of a total of 45 patients (15 in each group). The mean visual analogue scale scores were calculated for each group at day 0, 7th day, 15th day, and 30 days, and it was found that there was statistically significant reduction of pain (P < 0.001) in all the three groups at different intervals. At day 7, comparative percentage reduction of pain in both groups was not statistically significant. At 15-days and 30 days, percentage change in pain reduction in Group 1 was 42.3% and 48.0% respectively and in Group 2 it was found to be 60.3% and 83.4%, respectively. The reduction in pain percentage was found to be statistically significant. Similarly, Group 1 was compared to Group 3, significant reduction of pain was found for carbamazepine-capsaicin combination at 30-day interval but the comparative reduction of pain at 7th day and 15th day was not statistically significant. CONCLUSION: Carbamazepine in combination with baclofen is more efficient and effective in reducing pain in TN patients, followed by carbamazepine-capsaicin combination compared to carbamazepine alone.

Structural changes in cellular membranes induced by ionic liquids: From model to bacterial membranes.

Ionic liquids (ILs) have generated considerable attention recently because of their cytotoxicity and application as antibiotics. However, the mechanism of how they damage cell membranes is not currently well understood. In this paper, the antibacterial activities of two imidazolium-based ILs, namely 1-butyl- 3-methylimidazolium tetrafluroborate ([BMIM][BF4]) and 1-ethyl- 3-methylimidazolium tetrafluroborate ([EMIM][BF4]) have been investigated. The activity of [BMIM][BF4] on gram negative bacteria E. coli is observed to be stronger compared with the short chained [EMIM][BF4]. To explain this observation, the effects of these ILs on the self-assembled structures of model cellular membranes have been investigated. The in-plane elasticity of a monolayer formed at air-water interface by 1,2-dipalmitoyl- sn-glycero- 3-phosphocholine (DPPC) lipids was reduced in the presence of the ILs. The x-ray reflectivity studies on polymer supported lipid bilayer have shown the bilayer to shrink and correspondingly exhibit an increase in electron density. The presence of a certain mol% of negatively charged lipid, 1,2-dipalmitoyl-rac-glycero-3-phospho-L-serine (DPPS), in DPPC mono- and bi-layers enhances the effect considerably.

A qualitative investigation of healthcare workers' strategies in response to readmissions.

BACKGROUND: Readmission of a patient to a hospital is typically associated with significant clinical changes in the patient's condition, but it is unknown how healthcare workers modify their provision of care when considering these changes. The purpose of the present study was to determine how healthcare workers shift their care strategies when treating readmitted patients. METHODS: A typical case sampling study of healthcare workers was conducted using the grounded theory approach. The study setting comprised several patient care units at an academic center and tertiary-care hospital. We purposively sampled 34 healthcare workers (19 women, 15 men) to participate in individual interviews, either face-to-face or by telephone. We asked the participants semi structured questions regarding their thoughts on readmissions and how they altered their process and behavior for readmitted patients. Interviews were audio-recorded and transcribed. We used a qualitative data analyses based on an inductive approach to generate themes about how healthcare workers shift their strategies for readmitted patients. RESULTS: Healthcare workers' shifts in strategy for readmissions were reflected in three major themes: clinical assessment, use and management of information, and communication patterns. Participants reported that they became more conservative in their assessment of the clinical condition of a readmitted patient. The participants also indicated that readmitted patients would be treated in a similar way to normal admission based on care requirements; however, somewhat paradoxically, they also expressed that having access to prior patient information changed the way they treated a readmitted patient. CONCLUSIONS: Although healthcare workers may exhibit a tendency to become more conservative with readmissions, readily available patient information from the previous admission played a large part in guiding their thinking. A more conservative approach with a readmitted patient, on its own, does not necessarily lead to improved documentation or better patient care.

Role of Human Factors Engineering in Infection Prevention: Gaps and Opportunities.

Human factors engineering (HFE), with its focus on studying how humans interact with systems, including their physical and organizational environment, the tools and technologies they use, and the tasks they perform, provides principles, tools, and techniques for systematically identifying important factors, for analyzing and evaluating how these factors interact to increase or decrease the risk of Healthcare-associated infections (HAI), and for identifying and implementing effective preventive measures. We reviewed the literature on HFE and infection prevention and control and identified major themes to document how researchers and infection prevention staff have used HFE methods to prevent HAIs and to identify gaps in our knowledge about the role of HFE in HAI prevention and control. Our literature review found that most studies in the healthcare domain explicitly applying (HFE) principles and methods addressed patient safety issues not infection prevention and control issues. In addition, most investigators who applied human factors principles and methods to infection prevention issues assessed only one human factors element such as training, technology evaluations, or physical environment design. The most significant gap pertains to the limited use and application of formal HFE tools and methods. Every infection prevention study need not assess all components in a system, but investigators must assess the interaction of critical system components if they want to address latent and deep-rooted human factors problems.

Bacterial contamination of nurses' white coats made from polyester and polyester cotton blend fabrics.

In India, nurses wear white coats over their uniform. In this small study, patches of polyester and polyester cotton blend fabrics were attached to the white coats of nurses and sampled for contamination after one shift. Results showed that microbial adhesion is influenced by fabric type, with the microbial load on the polyester cotton blend fabric being 60% higher than that on the polyester fabric. Further studies need to be conducted to establish the correlation between fabric properties and microbial contamination.

Mitotic phosphorylation of Bloom helicase at Thr182 is required for its proteasomal degradation and maintenance of chromosomal stability.

Mutations in Bloom helicase (BLM) lead to Bloom Syndrome (BS). BS is characterized by multiple clinical manifestations including predisposition to a wide spectrum of cancers. Studies have revealed the mechanism of BLM recruitment after stalled replication and its role during the repair of DNA damage. We now provide evidence that BLM undergoes K48-linked ubiquitylation and subsequent degradation during mitosis due to the E3 ligase, Fbw7α. Fbw7α carries out its function after GSK3ß- and CDK2/cyclin A2-dependent phosphorylation events on Thr171 and Ser175 of BLM which lies within a well-defined phosphodegron, a sequence which is conserved in all primates. Phosphorylation on BLM Thr171 and Ser175 depends on prior phosphorylation at Thr182 by Chk1/Chk2. Thr182 phosphorylation not only controls BLM ubiquitylation and degradation during mitosis but is also a determinant for its localization on the ultrafine bridges. Consequently lack of Thr182 phosphorylation leads to multiple manifestations of chromosomal instability including increased levels of DNA damage, lagging chromatin, micronuclei formation, breaks and quadriradials. Hence Thr182 phosphorylation on BLM has two functions-it regulates BLM turnover during mitosis and also helps to maintain the chromosomal stability.

Technologies in the wild (TiW): human factors implications for patient safety in the cardiovascular operating room.

We describe different sources of hazards from cardiovascular operating room (CVOR) technologies, how hazards propagate in the CVOR and their impact on cognitive processes. Previous studies have examined hazards from poor design of a specific CVOR technology. However, the impact of different CVOR technologies functioning in context is not clearly understood. In addition, the impact of non-design hazards in technology devices is unclear. Our study identified hazards from organisational, physical/environmental elements, in addition to design of technology in a CVOR. We used observations, follow-up interviews and photographs. With qualitative analyses, we categorised the different hazard sources and their potential impact on cognitive processes. Patient safety can be built into technologies by incorporating user needs in design, decision-making and implementation of medical technologies. PRACTITIONER SUMMARY: Effective design and implementation of technology in a safety-critical system requires prospective understanding of technology-related hazards. Our research fills this gap by studying different technologies in context of a CVOR using observations. Qualitative analyses identified different sources for technology-related hazards besides design, and their impact on cognitive processes.

Using human factors engineering to improve patient safety in the cardiovascular operating room.

Despite significant medical advances, cardiac surgery remains a high risk procedure. Sub-optimal work system design characteristics can contribute to the risks associated with cardiac surgery. However, hazards due to work system characteristics have not been identified in the cardiovascular operating room (CVOR) in sufficient detail to guide improvement efforts. The purpose of this study was to identify and categorize hazards (anything that has the potential to cause a preventable adverse patient safety event) in the CVOR. An interdisciplinary research team used prospective hazard identification methods including direct observations, contextual inquiry, and photographing to collect data in 5 hospitals for a total 22 cardiac surgeries. We performed thematic analysis of the qualitative data guided by a work system model. 60 categories of hazards such as practice variations, high workload, non-compliance with evidence-based guidelines, not including clinicians' in medical device purchasing decisions were found. Results indicated that hazards are common in cardiac surgery and should be eliminated or mitigated to improve patient safety. To improve patient safety in the CVOR, efforts should focus on creating a culture of safety, increasing compliance with evidence based infection control practices, improving communication and teamwork, and designing better tools and technologies through partnership among all stakeholders.

Development of a simulation environment to study emergency department information technology.

INTRODUCTION: This article presents a simulation architecture for a patient tracking system simulator to study caregiver performance in emergency departments (EDs). The architecture integrates discrete event simulation modeling with clinical patient information. Evaluation components for electronic patient tracking system displays are also described. METHODS: A simulation of an ED electronic whiteboard was developed to study situation awareness metrics. Dynamic process data from an actual ED was used to generate simulation parameters including patient arrivals at various hours, distribution of severities, times required to treat the ED patients, and ancillary turnaround times (laboratory and radiology). A team of industrial engineers and ED physicians contributed demographic and clinical information for simulator patients. ED simulation parameters were combined with clinical information resulting in an event timeline database. Event timelines were used to populate a front-end patient-tracking system display simulation. RESULTS: The resulting patient-tracking system display simulation consists of underlying software, desktop and large-screen displays, a phone call/pager system, and typical tasks that enhance the realism of the simulation experience. The system can evaluate the impact of display parameters and ED operations on user performance. CONCLUSIONS: Modular design of the patient-tracking system display simulation helps adaptation for different studies to support various interface features and interaction types. The methodology described in this work exploits the benefits of discrete event simulation to iteratively design and test technologies such as electronic patient tracking systems and allows assessment of human performance measures.