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BackgroundTelestroke networks aim to address variability in both quality and access to stroke care in rural areas, by providing remote access to expert stroke neurologists. Implementation of telestroke requires adaptation of workflow processes and education. We previously developed virtual reality (VR) workflow training and documented acceptability, utility and feasibility. The effects on acute stroke treatment metrics have not been previously described.AimsThe overall aim was to improve hyperacute stroke metrics and shorten the time-to-reperfusion therapy administration in rural settings.MethodsThis study applies a natural experiment approach, collecting stroke metric data during transition from a pre-existing pilot to a statewide telestroke service at five rural hospitals. Pre- and post-intervention data included baseline patient demographics and assessment, diagnosis, and treatment delivery metrics. The primary study outcome was door-to-decision time (thrombolysis and endovascular thrombectomy). Secondary outcomes included door-to-computerized tomography time, door-to-thrombolysis time and proportion of patients receiving thrombolysis or thrombectomy treatment. Usage data relating to the VR stroke workflow training of interprofessional healthcare professionals was automatically captured via Wi-Fi. Statistical comparisons of clinical metrics between the pre- and post-intervention time periods, defined as the timeframes before and after VR deployment, were performed.ResultsA total of 2,683 patients were included (April 2013–December 2022); 1910 pre- and 773 post-intervention. All acute stroke time metrics significantly improved post-intervention. The primary outcome, door-to-decision time, decreased from 80 min [56–118] to 54 min [40–76; P < 0.001]. Secondary outcomes also improved, including door-to-thrombolysis time (90 min [68–114] vs. 68.5 min [54–90]; P < 0.001) and proportion of patients thrombolysed (11 vs. 16%; P < 0.001). The proportion of patients transferred for thrombectomy was unchanged (6 vs. 7%; P = 0.69). Seventy VR sessions totaling 15 h 39 min of training time were logged. VR training usage varied across sites (3–31 sessions per site).ConclusionsDelivery of a multi-factorial intervention including infrastructure, funding, education and training (with VR workflow training) as part of a state-wide telestroke rollout was associated with improved acute stroke treatment metrics. Additional work is required to identify the contribution of each intervention component on clinical outcomes and to increase training uptake and sustainment.

We present a case of a hemorrhagic duodenal ulcer complicated by occlusion of the celiac artery (CA) by acute median arcuate ligament (MAL) compression. Angiography revealed retrograde flow through the gastroduodenal artery (GDA) to the hepatic artery, with occlusion at the CA origin. This unique presentation required coordinated release of the MAL to reestablish antegrade CA flow before pyloroplasty and GDA ligation. The presence of preexisting MAL compression of the CA should be considered during the repair of bleeding duodenal ulcers through embolization or ligation of the GDA, because impaired CA perfusion could result in foregut ischemia.

Monitoring honey beehives is mainly done manually by beekeepers to evaluate the health of their hives and determine their growth and yield. With the emergence of Internet of Things (IoT) devices and tools, there have been some efforts in recent years to automate such monitoring. This can significantly benefit beekeepers as they can obtain critical data and insight into their hives' health and performance more regularly. In this paper, we use IoT devices and the Thingsboard dashboard to track the status of 28 honey beehives installed in the Western region of North Carolina as part of the Appalachian Multi-Apiary Informatics System (AppMAIS) project. In order to acquire data from a beehive, humidity and temperature sensors, as well as a microphone, have been placed inside the hives. In addition, a video camera has been placed at the top of the hive's entrance to obtain video recordings of the bees entering and leaving the hives, and a scale is placed under the hive to report the weight. The data collected from the sensors and peripherals installed in each of the AppMAIS hives are sent to the Thingsboard dashboard for management and visualization. In this paper, we report on our success with Thingsboard IoT tool to monitor honey beehives and take advantage of their capabilities to interact with the devices as needed to adjust operational parameters.

BackgroundStroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks. The New South Wales Telestroke Service provides neurologist-led telehealth to 23 rural spoke hospitals aiming to improve treatment delivery and patient outcomes. The training of clinical staff was identified as a critical aspect for the successful implementation of this service. Virtual reality (VR) training has not previously been used in this context. ObjectiveWe sought to develop an evidence-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess the feasibility of workplace deployment and collected feedback from spoke hospital staff involved in stroke management on training acceptability and usability as well as perceived training impact. MethodsThe TACTICS VR Stroke Telehealth application was developed with subject matter experts. During implementation, both quantitative and qualitative data were documented, including VR use and survey feedback. VR hardware was deployed to 23 rural hospitals, and use data were captured via automated Wi-Fi transfer. At 7 hospitals in a single local health district, staff using TACTICS VR were invited to complete surveys before and after training. ResultsTACTICS VR Stroke Telehealth was deployed to rural New South Wales hospitals starting on April 14, 2021. Through August 20, 2023, a total of 177 VR sessions were completed. Survey respondents (n=20) indicated a high level of acceptability, usability, and perceived training impact (eg, accuracy and knowledge transfer; mean scores 3.8-4.4; 5=strongly agree). Furthermore, respondents agreed that TACTICS VR increased confidence (13/18, 72%), improved understanding (16/18, 89%), and improved awareness (17/18, 94%) regarding stroke telehealth. A comparison of matched pre- and posttraining responses revealed that training improved the understanding of telehealth workflow practices (after training: mean 4.2, SD 0.6; before training: mean 3.2, SD 0.9; P

As Industry 4.0 networks continue to evolve at a rapid pace, they are becoming increasingly complex and distributed. These networks incorporate a range of technologies that are integrated into smart manufacturing systems, requiring adaptability, security, and resilience. However, managing the complexity of Industry 4.0 networks presents significant challenges, particularly in terms of security and the integration of diverse technologies into a functioning and efficient infrastructure. To address these challenges, emerging digital twin standards are enabling the connection of various systems by linking individual digital twins, creating a system of systems. The objective is to develop a “universal translator” that can interpret inputs from both the real and digital worlds, merging them into a seamless cyber-physical reality. It will be demonstrated how the myriad of technologies and systems in Industry 4.0 networks can be connected through the use of digital twins to create a seamless “system of systems”. This will improve interoperability, resilience, and security in smart manufacturing systems. The paper will also outline the potential benefits and limitations of digital twins in addressing the challenges of Industry 4.0 networks.

Measurement(s) room temperature ambient air • room relative humidity • outdoor weather • window status • door status • fan status • HVAC measurement • lighting status • occupancy measurement • plug load • shade status Technology Type(s) Temperature Sensor Device • relative humidity sensor • weather station • window status sensor • door status sensor • fan status sensor • HVAC measurement sensors • lighting sensor • occupancy sensor • power sensor • shade status sensor

Teleworking offers various socio-economic benefits to the workforce, especially during major disasters. However, the holistic net energy and greenhouse gas (GHG) emissions impacts of telework remain poorly understood. This paper develops and tests a longitudinal mixed-methods approach to estimate energy and emissions in three domains: home office, transportation, and information and communications technology (ICT). A pilot study of 11 participants from Ottawa, Canada, is used to evaluate the method, while generating a rich dataset and new insights. The results show transportation, home heating and cooling account for > 94% of telework-related energy, while home office equipment, lighting and ICT account for the remaining 6% (and < 2% of GHG emissions). Not including employer offices, teleworking will likely yield a net reduction in energy and GHG emissions compared with conventional working arrangements, but this result is dependent on personal choices, routines, purchasing decisions and household structure. The paper concludes with a discussion and future recommendations for the developed method based on the lessons learned. Practice relevance A new mixed-methods approach was developed and piloted to study the holistic energy impacts of teleworking. This demonstrates measurement tools, data analysis measures and scenario modelling. It provides lessons learned and acknowledges limitations. It is a major step forward in setting the stage for larger scale studies. The specific results showed that compared with conventional working arrangements, nine of the 11 participants are likely to consume less energy and produce fewer GHG emissions when teleworking based on a scenario-based analytical approach. However, if workers use sustainable transportation, teleworking may not yield any energy savings as increases in the home domain are expected. Future studies should include the employer offices.

Background and Purpose: CT perfusion (CTP) has been implemented widely in regional areas of Australia for telestroke assessment. The aim of this study was to determine if, as part of telestroke assessment, CTP provided added benefit to clinical features in distinguishing between strokes and mimic and between transient ischaemic attack (TIA) and mimic.Methods: We retrospectively analysed 1,513 consecutively recruited patients referred to the Northern New South Wales Telestroke service, where CTP is performed as a part of telestroke assessment. Patients were classified based on the final diagnosis of stroke, TIA, or mimic. Multivariate regression models were used to determine factors that could be used to differentiate between stroke and mimic and between TIA and mimic.Results: There were 693 strokes, 97 TIA, and 259 mimics included in the multivariate regression models. For the stroke vs. mimic model using symptoms only, the area under the curve (AUC) on the receiver operator curve (ROC) was 0.71 (95% CI 0.67–0.75). For the stroke vs. mimic model using the absence of ischaemic lesion on CTP in addition to clinical features, the AUC was 0.90 (95% CI 0.88–0.92). The multivariate regression model for predicting mimic from TIA using symptoms produced an AUC of 0.71 (95% CI 0.65–0.76). The addition of absence of an ischaemic lesion on CTP to clinical features for the TIA vs. mimic model had an AUC of 0.78 (95% CI 0.73–0.83)Conclusions: In the telehealth setting, the absence of an ischaemic lesion on CTP adds to the diagnostic accuracy in distinguishing mimic from stroke, above that from clinical features.

Smart manufacturing is a vision and major driver for change in today’s industry. The goal of smart manufacturing is to optimize manufacturing processes through constantly monitoring, controlling, and adapting processes towards more efficient and personalised manufacturing. This requires and relies on technologies for connected machines incorporating a variety of computation, sensing, actuation, and machine to machine communications modalities. As such, understanding the change towards smart manufacturing requires knowledge of the enabling technologies, their applications in real world scenarios and the communication protocols and their performance to meet application requirements. Particularly, wireless communication is becoming an integral part of modern smart manufacturing and is expected to play an important role in achieving the goals of smart manufacturing. This paper presents an extensive review of wireless communication protocols currently applied in manufacturing environments and provides a comprehensive review of the associated use cases whilst defining their expected impact on the future of smart manufacturing. Based on the review, we point out a number of open challenges and directions for future research in wireless communication technologies for smart manufacturing.

Introduction: A telestroke network in Northern New South Wales, Australia has been developed since 2017. We theorized that the telestroke network development would drive a progressive improvement in stroke care metrics over time.Aim: This study aimed to describe changes in acute stroke workflow metrics over time to determine whether they improved with network experience.Methods: We prospectively collected data of patients assessed by telestroke who received multimodal computed tomography (mCT) and were diagnosed with ischemic stroke or transient ischemic attack from January 2017 to July 2019. The period was divided into two phases (phase 1: January 2017 – October 2018 and phase 2: November 2018 – July 2019). We compared median door-to-call, door-to-image, and door-to-decision time between the two phases.Results: We included 433 patients (243 in phase 1 and 190 in phase 2). Each spoke site treated 1.5–5.2 patients per month. There were Door-to-call time (median 39 in phase 1, 35 min in phase 2, p = 0.18), and door-to-decision time (median 81.5 vs. 83 min, p = 0.31) were not improved significantly. Similarly, in the reperfusion therapy subgroup, door-to-call time (median 29 vs. 24.5 min, p = 0.12) and door-to-decision time (median 70.5 vs. 67.5 min, p = 0.75) remained substantially unchanged. Regression analysis showed no association between time in the network and door-to-decision time (coefficient 1.5, p = 0.32).Conclusion: In our telestroke network, acute stroke timing metrics did not improve over time. There is the need for targeted education and training focusing on both stroke reperfusion competencies and the technical aspects of telestroke in areas with limited workforce and high turnover.

ABSTRACT TP-271 is a novel, fully synthetic fluorocycline antibiotic in clinical development for the treatment of respiratory infections caused by susceptible and multidrug-resistant pathogens. TP-271 was active in MIC assays against key community respiratory Gram-positive and Gram-negative pathogens, including Streptococcus pneumoniae (MIC90 = 0.03 µg/ml), methicillin-sensitive Staphylococcus aureus (MSSA; MIC90 = 0.25 µg/ml), methicillin-resistant S. aureus (MRSA; MIC90 = 0.12 µg/ml), Streptococcus pyogenes (MIC90 = 0.03 µg/ml), Haemophilus influenzae (MIC90 = 0.12 µg/ml), and Moraxella catarrhalis (MIC90 ≤0.016 µg/ml). TP-271 showed activity (MIC90 = 0.12 µg/ml) against community-acquired MRSA expressing Panton-Valentine leukocidin (PVL). MIC90 values against Mycoplasma pneumoniae, Legionella pneumophila, and Chlamydia pneumoniae were 0.004, 1, and 4 µg/ml, respectively. TP-271 was efficacious in neutropenic and immunocompetent animal pneumonia models, generally showing, compared to the burden at the start of dosing, ~2 to 5 log10 CFU reductions against MRSA, S. pneumoniae, and H. influenzae infections when given intravenously (i.v.) and ~1 to 4 log10 CFU reductions when given orally (p.o.). TP-271 was potent against key community-acquired bacterial pneumonia (CABP) pathogens and was minimally affected, or unaffected, by tetracycline-specific resistance mechanisms and fluoroquinolone or macrolide drug resistance phenotypes. IMPORTANCE Rising resistance rates for macrolides, fluoroquinolones, and β-lactams in the most common pathogens associated with community-acquired bacterial pneumonia (CABP) are of concern, especially for cases of moderate to severe infections in vulnerable populations such as the very young and the elderly. New antibiotics that are active against multidrug-resistant Streptococcus pneumoniae and Staphylococcus aureus are needed for use in the empirical treatment of the most severe forms of this disease. TP-271 is a promising new fluorocycline antibiotic demonstrating in vitro potency and nonclinical efficacy by intravenous and oral administration against the major pathogens associated with moderate to severe CABP.

Abstract  Despite being rich in later prehistoric and historic archaeology that includes megalithic monuments, Bronze age copper mines and medieval castles, the Mizen Peninsula, south-west Ireland, has revealed little about its stone age past. Evidence for a Mesolithic presence in SW Ireland is rare and, to date, all archaeological finds of this age in Co. Cork are further north and east of the Mizen Peninsula. However a recent palaeoecological study of pollen, non-pollen palynomorph, plant macrofossil and microscopic charcoal data from a peat bog located near Mount Gabriel has provided evidence for disturbances, characterised by fire disturbance of woodland and exploitation of wetlands, since ca. 8400 years b.p. Two working hypotheses are considered to explain these disturbances: human activity or natural agencies. If the human activity hypothesis is accepted, they represent the first possible evidence of a Mesolithic presence on the Mizen Peninsula. [ABSTRACT FROM AUTHOR]

Background: The use of physical activity (PA) monitors is commonly associated with an increase in habitual PA level in healthy and clinical populations. The PiezoRx is a medical-grade PA monitor that uses adjustable step rate thresholds to estimate moderate-to-vigorous physical activity (MVPA) and is a valid indicator of free-living PA in adults. Laboratory validation of step count derived MVPA in adults is needed to justify the use of these monitors in clinical practice to track individuals' progress toward meeting PA guidelines that are based on MVPA, not steps. Objective: The objective of our study was to assess the validity and interinstrument reliability of the PiezoRx to derive step count and MVPA in a laboratory setting compared with criterion measures and other frequently used PA monitors in a diverse sample of adults. Methods: The adult participants (n=43; 39.4 years, SD 15.2) wore an Omron HJ-320 pedometer, an ActiGraph GT3X accelerometer, and four PiezoRx monitors during a progressive treadmill protocol conducted for 6 minutes at speeds of 2.4, 3.2, 4.0, 5.6, 6.4, and 7.2 km/hour, respectively. The four PiezoRx monitors were set at different MVPA step rate thresholds (MPA in steps/minute/VPA in steps/minute) 100/120, 110/130, height adjusted, and height+fitness adjusted. Results: The PiezoRx was more correlated (intraclass correlation, ICC=.97; P<.001) to manual step counting than the ActiGraph (ICC=.72; P<.001) and Omron (ICC=.62; P<.001). The PiezoRxs absolute percent error in measuring steps was 2.2% (ActiGraph=15.9%; Omron=15.0%). Compared with indirect calorimetry, the height-adjusted PiezoRx and ActiGraph were accurate measures of the time spent in MVPA (both ICC=.76; P<.001). Conclusions: The PiezoRx PA monitor appears to be a valid and reliable measure of step count and MVPA in this diverse sample of adults. The device's ability to measure MVPA may be improved when anthropometric differences are considered, performing at par or better than a research grade accelerometer. [ABSTRACT FROM AUTHOR]

Gut microbes are crucial for human health, which are usually accumulated in urban wastewater systems. Seven wastewater treatment plants in Australia with distinct population obesity rates between 18% and 33% were selected for wastewater sampling and analysis. Human gut microbiome were detected using metagenomic sequencing to investigate their associations with the community obesity rate. To unravel this complex relationship, a range of algorithm models, including linear discriminant analysis effect size (LEfSe), similarity percentage analysis (SIMPER), statistical analysis of metagenomic profiles (STAMP), linear models for microarray and RNA-Seq data analysis (LIMMA), Relief, ratio approach for identifying differential abundance (RAIDA), least absolute shrinkage and selection operator (LASSO), support vector machine (SVM), Boruta, DESeq2 and analysis of compositions of microbiomes with bias correction (ANCOM-BC), were used to identify potential bacterial biomarkers for obesity in the wastewater microbiome. Among these algorithm models, LEfSe, LIMMA, SIMPER and SVM are effective in identifying multiple microbial biomarkers. Specific human gut microbes, including Ruminococcus_E, Agathobacter, Fusicatenibacter, Anaerobutyricum, Blautia_A and Neisseria, were identified as potential consensus microbial biomarkers for obesity in the population. A high obesity rate is mainly characterized by a high abundance of pathogenic bacteria and microorganisms associated with xenobiotic biodegradation and metabolism, endocrine and metabolic diseases, and transcription pathways. This study underscores the innovative potential of leveraging human gut microbes in wastewater as biomarkers for monitoring obesity levels across communities, offering a novel, cost-effective, and indirect approach to public health surveillance.

This study aims to unveil correlations between wastewater microbiota and the catchment-specific population health risk, specifically alcohol abuse, with smoking and obesity as confounding factors. Our study highlights the importance of extracting human-associated microbial communities from wastewater metagenomes by excluding environmental microorganisms, due to their irrelevance to human health. After excluding environmental microbes, we observed strong associations of all three health risk factors, including alcohol abuse, smoking and obesity, with the human gut microbiome in wastewater. The linear discriminant analysis effect size (LEfSe) analysis showed Lactococcus_A, Leuconostoc, Aeromicrobium, Akkermansia, Weissella, Limosilactobacillus, Klebsiella_A, Desulfovibrio and Cloacibacillus as potential microbial biomarkers for alcoholism, after accounting for the confounding effects of smoking and obesity. Functional annotations of microorganisms linked with lower alcoholism rates are primarily related to energy metabolism and intercellular communication. Microorganisms associated with higher alcoholism rates are predominantly involved in immune regulation and cellular DNA architecture. This study highlights the need for a comprehensive exploration of different health risk factors together to identify potential associations between the wastewater microbiome and population lifestyle.

Background: Educational workshops help physicians (MDs) include physical activity and exercise (PAE) content in more patient appointments. It is unclear if MDs with varying degrees of self-confidence discussing PAE with their patients equally benefit from such training. We evaluated whether MDs’ initial self-confidence affects the impact of an educational PAE workshop. Methods: MDs (n = 63) across Canada completed self-reflection questionnaires initially and 3-months following a PAE workshop. MDs were divided into low-confidence [self-efficacy score (out of 100%): 60%; n = 23). Results: PAE counselling self-efficacy increased in all groups (relative increase: Low=~40%, Medium=~20%, High=~10%). Training increased the low-confidence group’s knowledge, awareness of guidance/resources and perception of their patients’ interest in lifestyle management (~30% change; all p < 0.001). Compared to baseline, a greater proportion (all p < 0.001) of MDs reported prescribing exercise at 3-month follow-up in each of the low-confidence (10% to 62%) medium-confidence (16% to 89%) and high-confidence (57% to 87%) groups. Conclusion: PAE training favorably improved MDs’ self-confidence, perceived impact of many barriers and the proportion of MDs prescribing exercise, at each level of confidence. An educational workshop particularly assisted MDs with low-confidence (i.e., those who needed it the most) integrate PAE into their practice.