Eco-friendly approach for the determination of moxifloxacin in pharmaceutical formulations and biological fluids based on fluorescence quenching of l-tryptophan.

A rapid, novel and cost-effective spectrofluorimetric method developed to determine moxifloxacin (MFX) in pharmaceutical preparations because MFX in a pH 10 medium could reduce the fluorescence intensity of l-tryptophan. The maximum fluorescence excitation and emission wavelengths were found to be 280 and 363 nm respectively. A range of factors affecting fluorescence quenching and the effect of co-existing substances were investigated. Fluorescence quenching values (ΔF = FL-tryptophan - FMoxi-L-tryptophan ) displayed a strong linear relationship with the MFX concentration ranging from 0.2 to 8.0 µg/ml under optimum conditions. The limit of detection was found to be 6.1 × 10-4  µg/ml. The proposed method was shown to be suitable for MFX determination in pharmaceutical tablets and biological fluids by the linearity, recovery and limit of detection. The spectrofluorimetric approach that has been developed is extremely eco-friendly, as evidenced by the fact that all the experimental components and solvents were safe for the environment.

Neonatal mortality among preterm infants admitted to neonatal intensive care units in India and Pakistan: A prospective study.

OBJECTIVE: To explore potential reasons for differences in preterm neonatal mortality in neonatal intensive care units (NICUs) in India and Pakistan. DESIGN: A prospective observational study, the Project to Understand and Research Stillbirth and Preterms in Southeast Asia (PURPOSe) was conducted July 2018 to February 2020. SETTING: Three hospitals in Davangere, India, and a large public hospital in Karachi, Pakistan. POPULATION: Of a total of 3,202 preterm infants enrolled, 1,512 were admitted to a study NICU. METHODS: We collected data for neonates, including length of stay, diagnoses, and diagnostic tests. MAIN OUTCOME MEASURES: Neonatal mortality, tests performed, diagnoses ascertained. RESULTS: For infants of equivalent weights and gestational ages, neonatal mortality in Pakistan was twice that in the Indian NICU. The mean newborn length of stay in Pakistan was 2 days compared with 10 days for India. Fewer diagnostics and other investigations were used to determine neonatal condition or guide treatment in the Pakistani NICU. Because of limited information from testing in Pakistan concerning clinical respiratory distress, respiratory distress syndrome appeared to be over-diagnosed, whereas other conditions including pneumonia, sepsis, necrotising entercolitis and intraventricular haemorrhage were rarely diagnosed. CONCLUSION: In the Pakistani site, the limited resources available to the NICU appeared related to a shorter length of stay and decreased diagnostic testing, likely explaining the higher mortality. With improved care, reduction in mortality among preterm neonates should be achievable.

Dietary tea tree (Melaleuca alternifolia) essential oil as alternative to antibiotics alleviates experimentally induced Eimeria tenella challenge in Japanese quails.

Coccidiosis is one of the most common infectious diseases seen in Japanese quails. The current study was conducted to evaluate the impact of tea tree essential oil (TTEO) on growth performance and intestinal health of quails in response to Eimeria tenella challenge. A total of 250 Japanese quails were divided into five treatments: untreated uninfected (negative control); untreated infected (positive control); infected + Amprolium; infected and 1% TTEO; infected and 2% TTEO. Except negative control, all groups were orally dosed with 5 × 104 sporulated oocysts of E. tenella. The results revealed that supplementation of 1% TTEO and treatment of amprolium improved feed intake, weight gain and feed conversion ratio in infected quails compared to the positive control. Similarly, lesion score and mortality was significantly (p < 0.01) reduced in quails supplemented with 2% TTEO and amprolium treated birds. Moreover, oocysts counts and histological features of caecum in infected birds were reversed in 1% TTEO and amprolium treatment. The histological findings of amprolium and 1% TTEO supplemented quails showed intact intestinal villi with mild sloughed epithelium. In conclusion, 1% TTEO can be safely used to control coccidiosis in Japanese quails as natural effective compound.

Interrelationship of serum S100B and P53 in brain tumour patients.

The interrelationship of serum S100B and P53 concentrations and their association with tumour type and size in patients was determined. S100B and P53 concentrations were measured in serum of patients and normal healthy volunteers. Serum S100B concentrations were significantly higher in patients (mean 50%) than in healthy controls (p< 0.001). P53 concentrations were elevated only in five patients (mean 28%). No significant correlation was found between S100B and P53. Significant positive correlation was observed between S100B concentration and large tumour size (p< 0.05) but not with small tumours. Similarly,there was no significant correlation between P53 concentrations and tumour size.Heterogeneity of S100B expression exists in brain tumours. However, S100B was also found to be pituitary-specific. High serum concentration of P53 was found in five patients with large tumour. These findings warrant further larger clinical studies for better understanding the interrelationship of these serum makers and the development and/or progression of these malignancies.

Hypocalcemia in jaundiced neonates receiving phototherapy.

OBJECTIVE: To determine the frequency of hypocalcemia in term neonates with jaundice receiving phototherapy. METHODS: This was a cross sectional study conducted at Neonatal intensive care unit, National Institute of Child Health, Karachi from 1st January 2014 to 30th December 2014. A total of 123 term neonates with jaundice of either gender managed by phototherapy were enrolled in the study. Gestational age was assessed through modified Ballard scoring. Duration of phototherapy was recorded. A sample of 3 ml of blood was sent to the laboratory for serum calcium level before initiating phototherapy and after 24 hours of continued phototherapy. All the data were recorded in the preformed proforma. Data was analyzed using SPSS version 19. P value <0.05 was taken as significant. RESULTS: The mean age of the neonates was 8.35±6.74 days. Mean gestational age at the time of birth was 39.08±1.37 weeks. Mean duration of jaundice was 2.4±1.20 days. Mean duration of phototherapy was 1.74±0.98 days. Serum calcium level before and after 24 hours of initiating phototherapy was 8.73±0.68 mg/dl and 7.47±0.82mg/dl respectively Frequency of hypocalcemia in term jaundiced neonates receiving phototherapy were observed in 22.76% (28/123). CONCLUSIONS: The frequency of hypocalcemia is significant in the jaundiced neonates treated with phototherapy. One needs to be vigilant in dealing neonates in this context while serial monitoring for hypocalcemia and its complications should be considered in institutional policy and research priority.

A Tale of Two Diagnoses; Gout Vs Chronic Osteomyelitis. A Case Report.

Gout can potentially be diagnosed clinically and treated, if classical symptoms are present. In some cases, gout and osteomyelitis can have similar presenting signs and symptoms and it may be difficult to differentiate just on clinical presentation, routine laboratory workup and imaging like radiography or ultrasound. Arthrocentesis can be crucial in such scenarios to differentiate the two entities as missed opportunity to treat infectious etiology can have detrimental outcomes. We present a case of patient with ankle pain and swelling treated as recurrent gout, as there were no risk factors for osteomyelitis. Arthrocentesis confirmed the diagnosis of osteomyelitis and patient was treated with intravenous antibiotics, resulting in resolution of symptoms.

Exploration of the effect of multiple acceptor and π-spacer moieties coupled to indolonaphthyridine core for promising organic photovoltaic properties: a first principles framework.

Herein, the indolonaphthyridine-based molecules (INDTD1-INDTD8) with A1-π-A2-π-A1 configuration were designed by the end-capped modification of INDTR reference with various acceptors. The density functional theory (DFT) and time-dependent DFT (TD-DFT) analyses at M06/6-31G(d,p) level were reported in this research to explore their optoelectronic and photovoltaic features. Their geometrical structures were initially optimized at the afore-said level and followed by various calculations such as the frontier molecular orbitals (FMOs), UV-Visible, density of states (DOS), transition density matrix (TDM), binding energy (Eb), open circuit voltage (Voc) and fill factor (FF). Moreover, their global reactivity parameters (GRPs) were depicted by using the HOMO-LUMO band gaps obtained from the FMOs study. The tailored molecules demonstrated lower band gaps (2.183-2.269 eV) than INDTR (2.288 eV). They also showed bathochromic shifts in the visible region in chloroform (735.937-762.318 nm) and gas phase (710.384-729.571 nm) as compared to INDTR (724.710 and 698.498 nm, respectively). Further, intramolecular charge transfer (ICT) was demonstrated via the DOS and TDM graphical maps. Among all the entitled chromophores, INDTD7 showed significantly reduced band gap (2.183 eV), red-shifted absorption value (760.914 nm) in chloroform solvent and minimal Eb value (0.554 eV). The presence of -SO3H groups on the terminal acceptors of INDTD7  may enhance the mobility of charges. The results suggested that the newly designed chromophores can be effective candidates for the future organic solar cell applications. Moreover, this study may encourage the experimentalists to develop photovoltaic materials.

Identification of etiological agents by LPA and PCR in childhood meningitis.

OBJECTIVES: To determine the etiological agents by Latex Particle Agglutination (LPA) and Polymerase Chain Reaction (PCR) in patients admitted with Cerebrospinal Fluid (CSF) culture negative bacterial meningitis Methods: This descriptive case series was conducted at National Institute of Child Health, Karachi from January 2010 to December 2012. Patients meeting the WHO case definition of suspected meningitis from one month to 59 months of age were included in the study. CSF examination and culture was carried out on every patient and CSF culture negative patients were enrolled. Demographic data, clinical signs & symptoms and laboratory findings were entered into the proforma. Data was analyzed using statistical package for social sciences (SPSS) version 17. P-value <0.05 was taken as significant. RESULTS: A total of 166 patients were included. Male were 96 and female were 76 with the male to female ratio of 1.26. The mean age of patient was ± SD 14.6 ± 14.5 months. The etiological agents identified by LPA were in 26/166 (15.66%) cases and the organisms were H. influenzae type b 10 cases, streptococcus pneumoniae 15 cases and meningococcus only one case respectively. The organisms identified by PCR were in 65/166 (39.15%) cases and the isolates were H. influenzae type b 16 cases, streptococcus pneumoniae 48 cases and meningococcus 01 case respectively. CONCLUSION: LPA and PCR are superior and useful diagnostic tools in microbiology. They can be used for rapid etiological diagnosis of bacterial meningitis for the early administration of proper antibiotic. Abbreviation: LPA = Latex Particle Agglutination, PCR = Polymerase Chain Reaction, CSF = Cerebrospinal Fluid, CNS = Central Nervous System.

There's More Than Meets the Eye: Wolfram Syndrome in a Type I Diabetic Patient.

Wolfram syndrome (WS) is a rare neurodegenerative and genetic disorder, also known by the synonym DIDMOAD, which stands for diabetes insipidus (DI), childhood-onset diabetes mellitus (DM), optic atrophy (OA), and deafness (D). We present a case of a 25-year-old diabetic patient, using insulin for 15 years, who had increasing polyuria and polydipsia, along with progressive hearing and vision loss. Laboratory tests revealed elevated hemoglobin A1c (HbA1c) and blood sugar levels. Optic nerve, optic chiasm, pons, and brain stem atrophy was seen on magnetic resonance imaging (MRI) of brain. After workup, a diagnosis of DI was made. Once the diagnosis was reached, treatment with subcutaneous insulin and nasal desmopressin improved patient's symptoms. In juvenile diabetic patients presenting with new onset or worsening polyuria and polydipsia, the possibility of WS should be considered. Early diagnosis and initiation of appropriate management leads to improved outcomes and the quality of life.

Exploration of linear and third-order nonlinear optical properties for donor-π-linker-acceptor chromophores derived from ATT-2 based non-fullerene molecule.

In the current study, seven non-fullerene compounds abbreviated as ATTD2-ATTD8 were designed through structural tailoring and their nonlinear optical (NLO) properties were reported. The objective of this study was to explore the potential for newly configured D-π-A type non-fullerene-based compounds. Quantum chemical methods were adopted and revealed the molecules as highly efficient materials with favorable NLO characteristics for use in optoelectronic devices. The M06 functional along with the 6-311G(d,p) basis set in chloroform solvent were utilized for the natural bonding orbital (NBO) analysis, absorption spectra and computational assessments of frontier molecular orbitals (FMOs), global reactivity descriptors (GRPs), transition density matrix (TDM) and nonlinear optical properties (NLO) for ATTR1 and ATTD2-ATTD8. The HOMO-LUMO energy gap was significantly reduced in all the designed moieties compared to the reference compound in the following decreasing order: ATTR1 > ATTD8 > ATTD4 > ATTD5 > ATTD2 > ATTD7 > ATTD6 > ATTD3. All of the designed molecules (ATTD2-ATTD8) showed good NLO response. Global reactivity parameters were found to be closely associated with the band gap between the HOMO and LUMO orbitals, and the compound with the smallest energy gap, ATTD3, exhibited a lower hardness value of 1.754 eV and higher softness value of 0.570 eV with outstanding NLO response. For the reference compound and ATTD2-ATTD8 derivatives, attributes like dipole moment (µtot), average polarizability 〈α〉, first hyperpolarizability (ßtot), and second hyperpolarizability γtot were calculated. Out of all the derivatives, ATTD3 revealed the highest amplitude with a ßtot of 8.23 × 10-27 esu, which was consistent with the reduced band gap (1.754 eV) and suggested it was the best possibility for NLO materials in the future.

Role of donors in triggering second order non-linear optical properties of non-fullerene FCO-2FR1 based derivatives: A theoretical perspective.

The organic compounds are known as an emerging class in the field of nonlinear optical (NLO) materials. In this paper, D-π-A configured oxygen containing organic chromophores (FD2-FD6) were designed by incorporating various donors in the chemical structure of FCO-2FR1. This work is also inspired by the feasibility of FCO-2FR1 as an efficient solar cell. Theoretical approach involving DFT functional i.e., B3LYP/6-311G(d,p) was utilized to achieve useful information regarding their electronic, structural, chemical and photonic properties. The structural modifications revealed significant electronic contribution in designing HOMOs and LUMOs for the derivatives with lowered energy gaps. The lowest HOMO-LUMO band gap obtained was 1.223 eV for FD2 compound in comparison to the reference molecule (FCO-2FR1) i.e., 2.053 eV. Moreover, the DFT findings revealed that the end-capped substituents play a key role in enhancing the NLO response of these push-pull chromophores. The UV-Vis spectra of tailored molecules revealed larger λ max values than the reference compound. Furthermore, strong intramolecular interactions showed the highest stabilization energy (28.40 kcal mol-1) for FD2 in the natural bond orbitals (NBOs) transitions, combined with the least binding energy (-0.432 eV). Successfully, the NLO results were favorable for the same chromophore (FD2) which showed the highest value for dipole moment (µ tot = 20.049 D) and first hyper-polarizability (ß tot = 11.22 × 10-27 esu). Similarly, the largest value for linear polarizability ⟨α⟩ was obtained as 2.936 × 10-22 esu for FD3 compound. Overall, the designed compounds were calculated with greater NLO values as compared to FCO-2FR1. The current study may provoke the researchers towards designing of highly efficient NLO materials via using the suitable organic linking species.

Laparoscopy in Low- and Middle-Income Countries: A Survey Study.

INTRODUCTION: An increasing shift towards non-communicable diseases and an existing high surgical burden of disease in low-middle-income countries (LMICs) has impelled the need for implementing laparoscopic surgery, a safe and cost-effective surgical service. However, despite countless benefits, laparoscopic surgery programs remain limited throughout LMICs, and limited understanding is known of healthcare professionals' views regarding the implementation of laparoscopic surgery in their local healthcare environments. Therefore, the purpose of this study is to better understand the perceived challenges and barriers to implementing long-term laparoscopic surgery programs from the perspective of healthcare professionals. METHODS: Upon receiving ethical approval from the McGill University Health Center (MUHC), a nine-question survey (concerning attributes required to establish a successful laparoscopic program in LMICs and to gain insight into what surgeons from LMICs believed were the necessary next steps) was pilot tested amongst faculty members, and subsequently disseminated to healthcare professionals practicing in LMICs. Explicit consent was obtained from the participants before answering the survey.  Results: Thirty-four participants representing a total of 35 countries participated in the survey with the majority having received laparoscopic surgery training. Overall, participant responses were characterized by two major themes. Highlighted in the first theme, Laparoscopic Experience and Training Curriculum, were responses concerning current laparoscopic training and education, improved career opportunities provided by laparoscopic training, and a particular existing potential to incorporate laparoscopic surgery into the current surgical curriculum at various levels of training. Emphasized in the second theme, Challenges and Next Steps, were responses concerning barriers to the implementation of laparoscopic surgery, current institutional capabilities, and the need for improving mentorship through existing surgical societies such as the College of Surgeons of East, Central, and Southern Africa (COSECSA), West African College of Surgeons (WACS), and The Pan-African Academy of Christian Surgeons (PAACS). CONCLUSIONS: A buy-in from the government, hospitals, staff, and industry is crucial for the long-term implementation of laparoscopic surgery in LMICs, which can only be accomplished through increased advocacy and the dissemination of the benefits of minimally invasive surgery both economically and socially.

Various Risk Factors of Overweight and Obesity among Children Aged 5-16 Years.

OBJECTIVE: To determine the determinants of overweight and obesity among children aged 5-16 years. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Emergency and Outpatient Department of National Institute of Child Health, from October 2020 till July 2021. METHODOLOGY: All children of either gender ranged between 5 and 16 years were enrolled. Children with ≥85 and <95 percentile were labeled as overweight and ≥95 percentile as obese. Other determinants like physical factors, high screen time, and environmental factors were noted. Frequency and percentages were computed for gender, residence, overweight, obesity, and physical and environmental factors. Mann-Whitney U-test was applied to determine the median difference of quantitative variables between overweight/obese and healthy children. The comparison was done to see the association of the presence of overweight/obesity with respect to the baseline characteristics. Binary logistic regression analysis was also applied. RESULTS: Of 184 children, 99 (53.8%) were males and 85 (46.2%) females. The median age was 9 (7-12) years. There were 25 (13.6%) overweight and 80 (43.5%) obese children. In combination, the frequency of overweight/obesity was found to be 105 (57.1%). After adjusting for other covariates, the odds of overweight and obesity were significantly higher for children with age ≤9 years (adjusted OR: 3.40, 95% CI: 1.51-7.66) and male gender (adjusted OR: 3.95, 95% CI: 1.80-8.68). However, lower odds of overweight/obesity were observed among children with low physical activity at school (adjusted OR: 0.31, 95% CI: 0.14-0.66) and low screen time (≤4 hours) (adjusted OR: 0.24, 95% CI: 0.11-0.55). CONCLUSION: Children aged 5 to 16 years had a much greater frequency of overweight and obesity. Factors such as younger age, male gender, lower physical activity, and high time screen have been demonstrated to contribute significantly. KEY WORDS: Children, Obese, Overweight, Risk factors, Pakistan.

Hypothyroidism and Depression: A Narrative Review.

There has been an established relationship between hypothyroidism and depression. Studies have demonstrated that somatostatin and serotonin influence the hypothalamus-pituitary-thyroid axis, which links hypothyroidism to depression. Multiple studies concluded that undiagnosed, untreated, undertreated patients with hypothyroidism are at increased risk of developing depression. Autoimmune thyroiditis is also associated with an increased risk of depression. Elevated thyroid-stimulating hormone (TSH), antithyroglobulin (TgAb), and thyroid peroxidase antibodies (TPOAb) levels have all been linked to depression and an increased risk of suicide. Moreover, hypothyroidism is known to be one of the leading causes of treatment-resistant depression. Treating underlying hypothyroidism with thyroid replacement therapy could significantly improve mood disorders such as depression. Levothyroxine therapy is also used as adjunctive therapy to antidepressants in the management of depression, and it is known to improve the symptoms of depression rapidly when compared to antidepressants alone. This review strengthens the link between hypothyroidism and depression, and it also demonstrates how treating the underlying hypothyroidism in people who have been diagnosed with depression will be very beneficial.

Theoretical designing of non-fullerene derived organic heterocyclic compounds with enhanced nonlinear optical amplitude: a DFT based prediction.

In current era, non-fullerene (NF) chromophores have been reported as significant NLO materials due to promising optoelectronic properties. Therefore, a series of NF based chromophores abbreviated as TPBD2-TPBD6 with D-π-A architecture was designed from the reference compound (TPBR1) by its structural tailoring with an efficient donor and various acceptor groups for the first time. First, the structures of said compounds were optimized at M06-2X/6-311G (d,p) level. Further, the optimized structures were utilized to execute frontier molecular orbitals (FMOs), UV-Visible (UV-Vis) absorption, density of states (DOS) and transition density matrix (TDM) analyses at the same level to understand the non-linear (NLO) response of TPBR1 and TPBD2-TPBD6. Promising NLO results were achieved for all derivatives i.e., the highest amplitude of linear polarizability ⟨α⟩, first (ßtotal) and second ([Formula: see text]total) hyperpolarizabilities than their parent molecule. The compound TPBD3 was noted with the most significant NLO properties as compared to the standard molecule. The structural modeling approach by utilizing the acceptor molecules has played a prominent role in attaining favorable NLO responses in the molecules. Thus, our study has tempted the experimentalists to synthesize the proposed NLO materials for the modern optoelectronic high-tech applications.

Sickle Cell Disease and Its Respiratory Complications.

Sickle cell disease (SCD) is a hematological disorder that is inherited in an autosomal recessive (AR) fashion. It is caused by mutations in the genes encoding for the globin apoprotein of hemoglobin (Hb), leading to diminished oxygen-carrying ability. Its pathophysiologic mechanism affects multiple organ systems, making it crucial to understand the complications of SCD and find the best ways to prevent and treat them. Some important ways that SCD manifests in the respiratory system are acute chest syndrome (ACS), pulmonary hypertension (PH), asthma, and venous thromboembolism (VTE). This article summarizes their salient features, including pathogenesis related to the adverse outcomes, screening practices, and management guidelines, with the intent to provide greater insight into forming better practices that increase the quality of life in SCD patients.

Chronic Pain-Induced Depression: A Review of Prevalence and Management.

Chronic pain is ongoing pain that has persisted beyond standard tissue healing time along with comorbidities such as depression. This article discusses studies that have shown the prevalence of chronic pain and chronic pain-induced depression and explained methods of prevention for these conditions. The molecular mechanisms such as monoamine neurotransmitters, brain-derived neurotrophic factor, inflammatory factors, and glutamate that are similar in chronic pain and depression have also been discussed. This article reviews the methods of management that utilize the identification of these molecular mechanisms to treat this condition further. It also emphasizes the importance of the awareness of chronic pain-induced depression for the upcoming advances in the subject of mental health.

Factors Contributing to Anastomotic Leakage Following Colorectal Surgery: Why, When, and Who Leaks?

Anastomotic leakage is a common yet one of the most feared complications following colorectal surgery. Dehiscence of the anastomosis can result in fatal complications such as peritonitis, abscess formation, and sepsis, thereby increasing morbidity and mortality, cost and length of hospital stay. Multiple factors contribute to the development of anastomotic dehiscence. Several studies have been published identifying various risk factors that may play a role in causing AL. Our study reviewed prospective and retrospective studies and summarized the risk factors into three categories: preoperative, intraoperative, and postoperative. Among these are various risk factors such as age, gender, comorbidities, American Society of Anesthesiologists (ASA) scores, operative time, smoking, alcohol use, obesity, nutritional status, mechanical bowel preparation, and steroid use. It is crucial for surgeons to have a thorough understanding of the risk factors associated with anastomotic leakage to identify patients at high risk preoperatively. It may also be relevant to intraoperative decision-making when establishing an anastomosis, such as considering proximal diversion or placing a drain if such high-risk features are present. Knowing high-risk features also helps to detect leaks as early as possible postoperatively.

Implementation of a Centralized Telepsychiatry Consult Service in a Multi-Hospital Metropolitan Health Care System: Challenges and Opportunities.

BACKGROUND: Providing adequate psychiatry consultation capacity on a 24/7 basis is an intrinsic challenge throughout many multihospital health care systems. At present, implementation research has not adequately defined the effectiveness and feasibility of a centralized telepsychiatry consultation service within a multihospital health care system. OBJECTIVE: To demonstrate feasibility of a hub and spoke model for provision of inpatient consult telepsychiatry service from an academic medical center to 2 affiliated regional hospital sites, to reduce patient wait time, and to develop best practice guidelines for telepsychiatry consultations to the acutely medically ill. METHODS: The implementation, interprofessional workflow, process of triage, and provider satisfaction were described from the first 13 months of the service. RESULTS: This pilot study resulted in 557 completed telepsychiatry consults over the course of 13 months from 2018 to 2019. A range of psychiatric conditions commonly encountered by consultation-liaison services were diagnosed and treated through the teleconferencing modality. The most common barriers to successful use of telepsychiatry were defined for the 20% of consult requests that were retriaged to face-to-face evaluation. The average patient wait time from consult request to initial consultation was reduced from >24 hours to 92 minutes. CONCLUSIONS: This study demonstrated the feasibility of a centralized telepsychiatry hub to improve delivery of psychiatry consultation within a multihospital system with an overall reduction in patient wait time. This work may serve as a model for further design innovation across many health care settings and new patient subpopulations.