Effectiveness of a telephone-based nursing intervention to reduce hospital utilization by COVID-19 patients.

OBJECTIVE: Determine the effectiveness of a COVID-19 remote monitoring and management program in reducing preventable hospital utilization. DESIGN: A retrospective cohort study utilizing data from electronic health records. SAMPLE: Two hundred ninety-three patients who tested positive for COVID-19 at a drive-through testing site in Michigan. [Correction added on 11 April 2022, after first online publication: In the preceding sentence, "Two hundred and ninety-third" has been corrected to "Two hundred ninety-three" in this version.] The intervention group, consisting of 139 patients, was compared to a control group of 154 patients. MEASUREMENTS: The primary outcome was the 30-day probability of hospital utilization. The covariates included in the analysis were age, gender, tobacco use, body mass index (BMI), race, and ethnicity. INTERVENTION: A nurse-led, telephone-based active management protocol for COVID-19 patients who were isolating at home. RESULTS: The intervention group had a non-statistically significant 42% reduction in risk of hospital utilization within 30 days of a positive COVID-19 test when compared to the control group (HR = 0.578, p-value .111, HR 95% CI [0.29, 1.13]). CONCLUSIONS: A nurse-led remote monitoring and management program for COVID-19 reduced the probability of 30-day hospital utilization. Although the findings were not statistically significant, the program yielded practical significance by reducing hospital utilization, in-person interaction, and the risk of infection for healthcare workers.

Determination of kjeldahl nitrogen in fertilizers by AOAC official methods 978.02: effect of copper sulfate as a catalyst.

In AOAC Official Method 955.04, Nitrogen (Total) in Fertilizers, Kjeldahl Method, fertilizer materials are analyzed using mercuric oxide or metallic mercury HgO or Hg) as a catalyst. AOAC Official Methods 970.02, Nitrogen (Total) in Fertilizers is a comprehensive total nitrogen (including nitrate nitrogen) method adding chromium metal. AOAC Official Method 978.02, Nitrogen (Total) in Fertilizers is a modified comprehensive nitrogen method used to measure total nitrogen in fertilizers with two types of catalysts. In this method, either copper sulfate or chromium metal is added to analyze for total Kjeldahl nitrogen. In this study, the part of AOAC Official Method 978.02 that is for nitrate-free fertilizer products was modified. The objective was to examine the necessity of copper sulfate as a catalyst for the nitrate-free fertilizer products. Copper salts are not environmentally friendly and are considered pollutants. Products such as ammonium sulfate, diammonium phosphate, monoammonium phosphate, urea-containing fertilizers such as isobutylene diurea (IBDU), and urea-triazone fertilizer solutions were examined. The first part of the study was to measure Kjeldahl nitrogen as recommended by AOAC Official Method 978.02. The second part of the study was to exclude the addition of copper sulfate from AOAC Official Method 978.02 to examine the necessity of copper sulfate as a catalyst in nitrate-free fertilizers, which was the primary objective. Our findings indicate that copper sulfate can be eliminated from the method with no significant difference in the results for the nitrogen content of the fertilizer products.

Early detection of emerging infectious diseases - implications for vaccine development.

Vast quantities of open-source data from news reports, social media and other sources can be harnessed using artificial intelligence and machine learning, and utilised to generate valid early warning signals of emerging epidemics. Early warning signals from open-source data are not a replacement for traditional, validated disease surveillance, but provide a trigger for earlier investigation and diagnostics. This may yield earlier pathogen characterisation and genomic data, which can enable earlier vaccine development or deployment of vaccines. Early warning also provides a more feasible prospect of stamping out epidemics before they spread. There are several of such systems currently, but they are not used widely in public health practice, and only some are publicly available. Routine and widespread use of open-source intelligence, as well as training and capacity building in digital surveillance, will improve pandemic preparedness and early response capability.

Quantitative and Qualitative Analysis of the Impact of Adoption of a Mobile Application for the Assessment of Professionalism in Medical Trainees.

PURPOSE: Capturing either lapses or excellence in behaviors related to medical professionalism is difficult. The authors report a mixed-methods analysis of a novel mobile platform for assessing medical professionalism in a training environment. METHOD: A mobile Web-based platform to facilitate professionalism assessment in a situated clinical setting (Professional Mobile Monitoring of Behaviors [PROMOBES]) was developed. A professionalism framework consisting of six domains (reliability, adaptability, peer relationships, upholding principles, team relationships, and scholarship) encompassing 25 subelements underpins the reporting structure. This pilot study involved 26 faculty supervising 93 medical trainees at two sites from January 12 to August 8, 2016. Notable professionalism behaviors were linked to the framework domains and elements; narrative details about incidences were captured on mobile devices. Surveys gauged the technological functionality and impact of PROMOBES on faculty assessment of professionalism. Qualitative focus groups were employed to elucidate user experience. RESULTS: Although users anticipated PROMOBES's utility would be for reporting lapses in professionalism, 94.7% of reports were for commendation. Comfort assessing professionalism (P = .04) and recognition of the reporting procedures for professionalism-related concerns (P = .01) improved. PROMOBES attained high acceptance ratings. Focus group analysis revealed that the explicit connection to the professionalism framework was powerful; similarly, the near real-time reporting capability, multiple observer inputs, and positive feedback facilitation were strengths. CONCLUSIONS: Making the professionalism framework visible and accessible via a mobile platform significantly strengthens faculty knowledge and behaviors regarding assessment. The strong desire to capture positive behaviors was an unexpected finding.

Evaluating the Effectiveness of a Front Windshield Sticker Reminder in Reducing Texting while Driving in Young Adults.

Texting while driving is a dangerous activity that is on the rise in the United States (U.S.). Since 2011 there has been a 17% increase in the number of people injured in a motor vehicle crash involving a distracted driver. Bans on the act of texting and driving have already taken place in 46 states in the U.S., but studies have shown that they are ineffective. An unstudied method of reducing texting while driving is sticker reminders. Sticker reminders have already been proven to be an effective intervention in the realm of driver safety; one study found that a "Buckle-Up" dashboard sticker doubled the use of safety belts by front seat passengers. In this study, 104 medical students aged 21 - 29, from the University of Central Florida (UCF) College of Medicine were randomly divided into two groups, an interventional group receiving a "Drive in the Moment" windshield sticker, and a control group not receiving the sticker. Both groups took a pre- and post-survey that recorded self-reported texting and driving frequency. The results showed that the sticker intervention significantly reduced reported rates of sending texts while driving, reading texts while driving, and using social media while driving (p < 0.05). The results of this study suggest that a novel sticker-intervention could potentially serve as a point of attack when addressing the growing and dangerous texting while driving the epidemic.

Wearables and the Internet of Things for Health: Wearable, Interconnected Devices Promise More Efficient and Comprehensive Health Care.

In our recent book Health-e Everything: Wearables and the Internet of Things for Health, we capture in an interactive e-book format some global thought-leader perspectives as well as early examples of case studies and novel innovations that are driving this emerging technology domain. Here, we provide a brief snapshot of key findings related to these novel technologies and use cases, which are driving both health care practitioners and health consumers (patients). As technologists, having a firm understanding of customer-driven innovation and the actual user benefits of interconnective devices for health will help us engineer better solutions that are more targeted to the triple aim of better, faster, and cheaper health solutions.

Electronic State Structure and Optical Properties of Tb(oda)(3)(3)(-) Complexes in Trigonal Na(3)[Tb(oda)(3)].2NaClO(4).6H(2)O Crystals.

Polarized optical absorption and emission measurements are used to locate and assign 95 crystal-field energy levels split out of the 4f( )(8) electronic configuration of Tb(3+) in single crystals of Na(3)[Tb(oda)(3)].2NaClO(4).6H(2)O (where oda denotes an oxydiacetate ligand). The absorption measurements span the 235-490 nm wavelength range, and the emission measurements span the 485-685 nm wavelength range. The combined absorption and emission spectra measurements provide access to the energy-level structures of 46 different 4f( )(8)[SL]J multiplet manifolds of Tb(3+) (all multiplet manifolds with baricenter energies <42 400 cm(-)(1) above ground). The site symmetry of the Tb(3+) ions in Na(3)[Tb(oda)(3)].2NaClO(4).6H(2)O is D(3), and the point-group symmetry of the tris-terdentate Tb(oda)(3)(3)(-) coordination complexes is also D(3). The Tb(oda)(3)(3)(-) complexes are chiral, and they exist in just one, fully resolved enantiomeric form in single crystals of Na(3)[Tb(oda)(3)].2NaClO(4).6H(2)O. The crystals exhibit strong chiroptical activity in their absorption and emission spectra, and results obtained from both circularly polarized and linearly polarized optical spectra measurements are used in making transition line assignments. The energy-level data acquired from the spectroscopic measurements are analyzed in terms of a model Hamiltonian that includes consideration of both isotropic and nonisotropic 4f electron/crystal-field interactions, and the interaction parameters derived from this analysis are discussed and then compared with those obtained for other Na(3)[Ln(oda)(3)].2NaClO(4).6H(2)O systems and for Tb(3+) in other crystalline hosts.

Intermolecular chiral recognition processes probed by chiroptical luminescence.

Enantiopreferential energy transfer processes between dissymmetric lanthanide and transition metal complexes dissolved in acetonitrile are studied using chiroptical luminescence techniques. The energy donors (luminophores) in this study are a racemic mixture of Ln(dpa)3 (3-) complexes (where Ln = Eu3+ or Tb3+ and dpa = 2,6-pyridinedicarboxylate), and the energy acceptors (quenchers) are an enantiomerically-resolved population of Co(R,R-chxn)3 3+ (where R,R-chxn = trans-1R,2R-diaminocyclohexane) complexes. The luminophores are dissolved in acetonitrile as (NEt4)3[Ln(dpa)3] (where NEt(4) = tetraethlylammonium) and (NBu4)[Ln(dpa)3] (where NBu4 = tetrabutylammonium) salts. The unquenched luminescence lifetimes are reported for both Eu(dpa)3 (3-) and Tb(dpa)3 (3-) in acetonitrile over the range 263-333 K, and these results are compared to luminescence lifetimes in aqueous solution. Time-resolved chiroptical luminescence measurements of enantiopreferential quenching kinetics are reported for samples with Eu(dpa)3 (3-) and Co(R,R-chxn)3 3+ in acetonitrile over 263-333 K range. These results are analyzed using a phenomenological quenching kinetics model, and the results are compared to results in aqueous solution. These comparisons show that the overall Eu-Co luminescence quenching efficiency is reduced in acetonitrile vs. aqueous samples, because the salts of (NX4)3[Eu(dpa)3] are not completely dissociated in acetonitrile. However, the enantiopreference exhibited is identical in acetonitrile vs. aqueous solution.

Site-isolated luminescent europium complexes with polyester macroligands: metal-centered heteroarm stars and nanoscale assemblies with labile block junctions.

The synthesis of a series of polymeric Eu(III) complexes with polyester ligands, along with supporting emission spectra, luminescence lifetimes, and, for a Eu block copolymer film, atomic force microscopy (AFM) data, is presented. Dibenzoylmethane was derivatized with a hydroxyl initiator site (dbmOH, 1) for tin octoate catalyzed ring opening polymerization of dl-lactide. The resulting poly(lactic acid) macroligand, dbmPLA (2), was combined with EuCl3 to generate Eu(dbmPLA)3 (3). Chelation of both dbmPLA and a polycaprolactone-functionalized bipyridine ligand (bpyPCL2) led to the Eu(III)-centered heteroarm star Eu(dbmPLA)3(bpyPCL2) (4). Unpolarized emission spectra and luminescence lifetimes were recorded for the Eu polymers in CH2Cl2 and for Eu(dbmPLA)3, as a film. Solution data for Eu(dbm)3 and Eu(dbm)3(bpy) were collected for comparison. For Eu tris(dbm) complexes, data were fit to a double exponential decay, indicating the presence of multiple species. Relative amounts of the longer lifetime component increase in the series Eu(dbm)3 solutions to Eu(dbmPLA)3 solutions to Eu(dbmPLA)3 films, perhaps suggesting benefits of the "polymer shell effect" and the diminishment of aquo adducts known to shorten lifetimes. As with the nonpolymeric analogue, data for Eu(dbmPLA)3(bpyPCL2) fit to a single-exponential decay. The sharpness of the feature at 579.7 nm, attributable to the 5D0 --> 7F0 transition in the emission spectrum of 4, lends further support for a homogeneous sample. AFM studies of "as cast" thin films of 4 reveal a lamellar structure with a 17.5 nm repeat. These microstructures, inferred to contain Eu luminophores at the glassy PLA-crystalline PCL domain interfaces, are modified by thermal treatment.