Search

Medical implant-associated infections (IAI) is a growing threat to patients undergoing implantation surgery. IAI prevention typically relies on medical implants endowed with bactericidal properties achieved through surface modifications with antibiotics. However, the clinical efficacy of this traditional paradigm remains suboptimal, often necessitating revision surgery and posing potentially lethal consequences for patients. To bolster the existing anti-IAI arsenal, we propose herein a chitosan-based bioactive coating, i.e., ChitoAntibac, which exerts bacteria-inhibitory effects either through immune modulation or phage-directed microbial clearance, without relying on conventional antibiotics. The immuno-stimulating effects and phage-induced bactericidal properties can be tailored by engineering the loading dynamic of macrophage migration inhibitory factor (MIF), which polarizes macrophages towards the proinflammatory subtype (M1) with enhanced bacterial phagocytosis, and Staphylococcal Phage K, resulting in rapid and targeted pathogenic clearance (>99.99%) in less than 8 h. Our innovative antibacterial coating opens a new avenue in the pursuit of effective IAI prevention through immuno-stimulation and phage therapeutics.

Latino children of Migrant and Seasonal Farmworkers (MSFWs) with asthma are at risk for poor health outcomes due to medical access barriers. We compared differences in acute care utilization for asthma exacerbations among migrant and non-migrant Latino and non-Hispanic white (NHW) children at U.S. community health centers.A retrospective observational study utilizing electronic health record data from the ADVANCE Clinical Research Network of United States community health centers included 13,423 children ages 3–17 with a primary care visit between 2005 and 2017 from eight states. Emergency department (ED) and hospitalization data came from Oregon Medicaid claims. Outcomes included acute clinic visits, ED visits, and hospitalizations for asthma exacerbation. Regression analyses adjusted for patient-level covariates.Latino children had higher odds of acute clinic visits for asthma exacerbation compared to NHW children (MSFW odds ratio [OR] = 1.17, 95 % CI = 1.03–1.33; without migrant status OR = 1.13, 95 % CI = 1.03–1.23). MSFW children using Oregon Medicaid had fewer ED visits (rate ratio [RR] = 0.72, 95 % CI = 0.52–0.99) and hospitalizations (RR = 0.47, 95 % CI = 0.26–0.86) compared to NHW children.Increased community health center visits may help mitigate disparities in acute asthma care for MSFW children.

Heteromorphic sex chromosomes are usually thought to have originated from a pair of autosomes that acquired a sex-determining locus and subsequently stopped recombining, leading to degeneration of the sex-limited chromosome. The majority of nematode species lack heteromorphic sex chromosomes and determine sex using an X-chromosome counting mechanism, with males being hemizygous for one or more X chromosomes (XX/X0). Some filarial nematode species, including important parasites of humans, have heteromorphic XX/XY karyotypes. It has been assumed that sex is determined by a Y-linked locus in these species. However, karyotypic analyses suggested that filarial Y chromosomes are derived from the unfused homologue of an autosome involved in an X-autosome fusion event. Here, we generated a chromosome-level reference genome for Litomosoides sigmodontis, a filarial nematode with the ancestral filarial karyotype and sex determination mechanism (XX/X0). By mapping the assembled chromosomes to the rhabditid nematode ancestral linkage (or Nigon) elements, we infer that the ancestral filarial X chromosome was the product of a fusion between NigonX (the ancestrally X-linked element) and NigonD (ancestrally autosomal). In the two filarial lineages with XY systems, there have been two independent X-autosome chromosome fusion events involving different autosomal Nigon elements. In both lineages, the region shared by the neo-X and neo-Y chromosomes is within the ancestrally autosomal portion of the X, confirming that the filarial Y chromosomes are derived from the unfused homologue of the autosome. Sex determination in XY filarial nematodes therefore likely continues to operate via the ancestral X-chromosome counting mechanism, rather than via a Y-linked sex-determining locus.

The search for the chiral magnetic effect (CME) in heavy-ion collisions has been impeded by the significant background arising from the anisotropic particle emission pattern, particularly elliptic flow. To alleviate this background, the event shape selection (ESS) technique categorizes collision events according to their shapes and projects the CME observables to a class of events with minimal flow. In this study, we explore two event shape variables to classify events and two elliptic flow variables to regulate the background. Each type of variable can be calculated from either single particles or particle pairs, resulting in four combinations of event shape and elliptic flow variables. By employing a toy model and the realistic event generator, event-by-event anomalous-viscous fluid dynamics (EBE-AVFD), we discover that the elliptic flow of resonances exhibits correlations with both the background and the potential CME signal, making the resonance flow unsuitable for background control. Through the EBE-AVFD simulations of Au+Au collisions at sNN=200 GeV with various input scenarios, we ascertain that the optimal ESS strategy for background control entails utilizing the single-particle elliptic flow in conjunction with the event shape variable based on particle pairs.

With growing mental health concerns among college students, they need to effectively develop skills to alleviate stress amidst the demands of university life. Teaching mindfulness skills to engineering students early in their programs, such as during introductory courses, may provide students with the tools they need to effectively cope with academic stressors, support well-being, and mitigate mental health concerns. This study aimed to understand the variation in experiences of engineering students who participated in weekly mindfulness meditation during a first-year cornerstone engineering course. This study used a thematic analysis approach to analyze students’ in-class, weekly reflections from eight meditation exercises across two course sections. The frequency of codes and themes were then analyzed across meditation types to identify trends in student experiences. Our results show that the most common student experience from engaging in mindfulness meditation was feeling less stressed, calmer, and more relaxed. Other positive experiences include feeling more energized and focused. Some students, however, did report some negative experiences, such as distress and tiredness. The Dynamic Breathing exercise, in particular, showed higher rates of negative experiences than other meditation types. The results also demonstrate that different types of meditations produce different student experiences. Meditation exercises with open monitoring components showed higher rates of insight/awareness and difficulty focusing attention than focused attention meditations. These findings indicate that utilizing weekly mindfulness exercises in introductory engineering courses can benefit students’ overall mental health and well-being when adequately implemented.

Microbial resistance to current antibiotics therapies is a major cause of implant failure and adverse clinical outcomes in orthopaedic surgery. Recent developments in advanced antimicrobial nanotechnologies provide numerous opportunities to effective remove resistant bacteria and prevent resistance from occurring through unique mechanisms. With tunable physicochemical properties, nanomaterials can be designed to be bactericidal, antifouling, immunomodulating, and capable of delivering antibacterial compounds to the infection region with spatiotemporal accuracy. Despite its substantial advancement, an important, but under-explored area, is potential microbial resistance to nanomaterials and how this can impact the clinical use of antimicrobial nanotechnologies. This review aims to provide a better understanding of nanomaterial-associated microbial resistance to accelerate bench-to-bedside translations of emerging nanotechnologies for effective control of implant associated infections.

Abstract Background Residential treatment is a common approach for treating opioid use disorder (OUD), however, few studies have directly compared it to outpatient treatment. The objective of this study was to compare OUD outcomes among individuals receiving residential and outpatient treatment. Methods A retrospective cohort study used linked data from a state Medicaid program, vital statistics, and the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episodes Dataset (TEDS) to compare OUD-related health outcomes among individuals treated in a residential or outpatient setting between 2014 and 2017. Multivariable Cox proportional hazards and logistic regression models examined the association between treatment setting and outcomes (i.e., opioid overdose, non-overdose opioid-related and all-cause emergency department (ED) visits, hospital admissions, and treatment retention) controlling for patient characteristics, co-morbidities, and use of medications for opioid use disorders (MOUD). Interaction models evaluated how MOUD use modified associations between treatment setting and outcomes. Results Of 3293 individuals treated for OUD, 957 (29%) received treatment in a residential facility. MOUD use was higher among those treated as an outpatient (43%) compared to residential (19%). The risk of opioid overdose (aHR 1.39; 95% CI 0.73–2.64) or an opioid-related emergency department encounter or admission (aHR 1.02; 95% CI 0.80–1.29) did not differ between treatment settings. Independent of setting, MOUD use was associated with a significant reduction in overdose risk (aHR 0.45; 95% CI 0.23–0.89). Residential care was associated with greater odds of retention at 6-months (aOR 1.71; 95% CI 1.32–2.21) but not 1-year. Residential treatment was only associated with improved retention for individuals not receiving MOUD (6-month aOR 2.05; 95% CI 1.56–2.71) with no benefit observed in those who received MOUD (aOR 0.75; 95% CI 0.46–1.29; interaction p = 0.001). Conclusions Relative to outpatient treatment, residential treatment was not associated with reductions in opioid overdose or opioid-related ED encounters/hospitalizations. Regardless of setting, MOUD use was associated with a significant reduction in opioid overdose risk.

Background: The COVID-19 pandemic presents challenges in participant recruitment strategies for clinical research involving people with opioid use disorders recently engaged in treatment. We describe challenges to participant recruitment in a trial comparing virtual buprenorphine treatment platform to office-based buprenorphine treatment. Methods: The parent study was a cohort trial of telehealth delivered buprenorphine treatment compared to office-based buprenorphine treatment, however, due to the pandemic potential participant recruitment for both arms became virtual. Between 9/27/2021 and 7/11/2022, telephone, email, flyers, and word-of-mouth were used to recruit study participants from each treatment setting. Recruitment tracking documents recorded the primary outcomes: number of outreach attempts and most effective contact methods. Results: Treatment settings provided contact information for 1485 potential study participants. Information was incorrect or disconnected for 282 (19%) individuals, 695 (47%) did not respond to outreach, and 508 (34%) responded to outreach. Of these responders, 369 were interested in study participation, 259 completed the online informed consent and screening assessment, and 148 met eligibility criteria and enrolled in the study. A total of 3804 virtual outreach attempts across 1485 potential participants were made, resulting in an average of 2.7 attempts per contact and a mean of 25.7 attempts per enrolled participant (n = 148). Conclusion: Conducting research during the COVID-19 pandemic required shifting from in-person to virtual recruitment strategies to contact and engage potential study participants. Virtual recruitment for this population during a pandemic appears to be less efficient and hindered efforts to meet recruitment goals.

BackgroundDespite the fact that direct oral anticoagulants (DOACs) are favoured over warfarin for stroke prevention in patients with non-valvular atrial fibrillation (NVAF), physicians need to maintain competence in using and monitoring warfarin since many patients have contraindications or other barriers to using DOACs. Unlike DOACs, warfarin therapy requires regular blood testing to ensure that it is within a target range to ensure efficacy and safety. There is limited real-world data on the adequacy of warfarin control and the cost and burden of monitoring warfarin therapy in Canadian NVAF patients.ObjectivesIn a large cohort of Canadian patients with NVAF on warfarin we assessed time in therapeutic range (TTR), determinants of TTR, process of care, direct costs, health related quality of life and loss of work time and productivity related to warfarin therapy.MethodsFive hundred and fifty one patients with NVAF, either newly initiated or stable on warfarin were prospectively enrolled across 9 Canadian provinces from primary care practices and anticoagulant clinics. Participating physicians provided baseline demographic and medical information. Patients completed diaries for 48 weeks, capturing information about International Normalized Ratio (INR) test results, test locations, process of INR monitoring, direct costs of travel, health-related quality of life and work productivity measures. TTR was estimated using linear interpolation of INR results and linear regression used to investigate associations between TTR and factors (defined a priori).ResultsFour hundred and eighty (87.1%) patients had complete follow-up with an overall TTR of 74.4% based on 7,175 physician-reported INR values from 501 patients. 88% of this cohort were monitored through routine medical care (RMC). The average number of INRs per patient during the 48-week period was 14.1 (standard deviation (SD) = 8.3) tests with a mean duration of 23.8 (SD = 11.1) days between tests. We did not find a relationship between TTR and age, sex, presence of major comorbidities, patient's province of residence or rural vs. urban residence. 12% of patients monitored through anticoagulant clinics had significantly better TTR than patients monitored through RMC (82% vs. 74%; 95% confidence interval: -13.8, -1.2; p = 0.02). Health related quality of life utility values were high and remained consistent throughout the study. The majority of patients reported no impact on either work productivity or impairment of regular activities due to being on long-term warfarin treatment.ConclusionsWe showed excellent overall TTR in an observed Canadian cohort, with monitoring through a dedicated anticoagulant clinic being associated with a statistically and clinically significant improvement in TTR. The burden of warfarin therapy on patients' health related quality of life or daily work and activities was low.

Introduction Glaucoma is a progressive, chronic condition that can have a significant impact on a patient’s health-related quality of life (HRQoL). Validated, disease-specific HRQoL tools such as the Health Utility for Glaucoma (HUG-5) tool and the Glaucoma Quality of Life Questionnaire (GlauQoL-17) can be used to monitor a patient’s quality of life. However, the utility of these tools in outpatient clinic practice is not well established. The primary objective of this study is to characterise the feasibility of administering periodic HRQoL questionnaires in glaucoma using a semi-automated workflow.Methods and analysis This study will be a single-centre, unblinded, randomised, parallel-group study with an exploratory data analysis framework. We aim to determine the feasibility of administering the HUG-5 in an outpatient clinic using a semi-automated workflow and determine patient engagement through email and telephone contact methods. We will also be investigating the association of the HUG-5 and GlauQoL-17 with patient visual field testing and visual acuity. Mean differences between groups will be tested with analysis of variance to determine if the frequency of calls affects burden, satisfaction and perceived value of information.Ethics and dissemination This study has been approved by the Hamilton Integrated Research Ethics board (ID: 13046) and will be conducted within Canadian Tri-Council Statement policy. Personal information of the study’s participants will be anonymised with identification codes and data will be kept on an encrypted server. Results of this study will be disseminated through peer-reviewed journals, conferences and internal meetings.

The active loop extrusion hypothesis proposes that chromatin threads through the cohesin protein complex into progressively larger loops until reaching specific boundary elements. We build upon this hypothesis and develop an analytical theory for active loop extrusion which predicts that loop formation probability is a nonmonotonic function of loop length and describes chromatin contact probabilities. We validate our model with Monte Carlo and hybrid Molecular Dynamics-Monte Carlo simulations and demonstrate that our theory recapitulates experimental chromatin conformation capture data. Our results support active loop extrusion as a mechanism for chromatin organization and provide an analytical description of chromatin organization that may be used to specifically modify chromatin contact probabilities. [ABSTRACT FROM AUTHOR]

The adoption of Sustainable Land Management (SLM) practices among smallholder farmers remains low, particularly among women farmers. Understanding the relationship between assets, gender, and SLM adoption and how their interaction impinges on household food self-sufficiency and livelihoods is essential for developing gender-responsive SLM programmes that effectively promote sustainable livelihoods and address household food insecurity. This study examines the effects of asset type on SLM practices adoption, women farmers, and their implications on household incomes and food self-sufficiency. Data was collected through a cross-sectional survey of 761 households selected from 11 chiefdoms across six districts in Eastern Zambia. Analysis involved Structural Equation System framework and Propensity Score Matching techniques to examine relationships between SLM adoption, food self-sufficiency, and household incomes, considering various socio-economic factors. Results showed marital status and household size as significant demographics, with education positively correlating with household income and SLM participation (p

BackgroundWhilst malaria is a prominent aetiology associated with acute kidney injury (AKI) in many parts of Africa, a shift in the traditional AKI aetiologies has been witnessed in sections of the continent. Additionally, limited access to dialysis worsens patient outcomes in these low-resource settings. This retrospective cross-sectional study aimed to determine the associated aetiologies, predictors of need for dialysis and malaria-associated AKI (MAKI), and outcomes of AKI and dialysis among children evaluated by the renal service in Lusaka, Zambia.MethodsThe study sampled all children aged 16 years or below, diagnosed with AKI between 2017 and 2021, by the renal unit at the University Teaching Hospitals- Children's Hospital (UTH-CH), and retrospectively abstracted their records for exposures and outcomes. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Frequency and percentage distributions were used to describe the occurrence of AKI aetiologies and treatment outcomes. Predictors of the need for dialysis, MAKI, and poor treatment outcome were identified by using multivariable logistic regression models.ResultsA total of 126 children diagnosed with AKI were included in this study. Malaria was the most frequent aetiology of AKI(61.1% (77/126, 95% Confidence Interval (CI): 52.0%-69.7%)). Of the 126 children with AKI, 74.6% (94) underwent dialysis. Predictors of the need for dialysis were oliguria (p = 0.0024; Odds ratio (OR) = 7.5, 95% CI: 2.1-27.7) and anuria (p = 0.0211; OR = 6.4, 95% CI = 1.3, 30.7). A fifth (18.3%, 23/126) of the children developed chronic kidney disease (CKD), 5.6% (7/126) died and, a year later, 77% (97/126) were lost to follow-up.ConclusionAt UTH-CH, malaria is the most frequent aetiology among children with AKI undergoing dialysis and children from low-medium malaria incidence areas are at risk; a considerable proportion of children with AKI need dialysis and Tenchoff catheter use in AKI is advocated.

Histoplasmosis is the most common endemic fungal infection in the USA. The majority of cases are asymptomatic and have clear exposure to endemic regions. In contrast, we present an adolescent immunocompromised patient with systemic and relatively non-specific symptoms including abdominal pain, weight loss, lower extremity edema, and scabbing skin lesions, without known exposure to endemic areas for histoplasmosis. Histologic analysis of gastrointestinal and skin biopsies eventually revealed a diagnosis of disseminated histoplasmosis; the patient was successfully treated with amphotericin B followed by itraconazole maintenance therapy. Ultimately, a high bar of suspicion for fungal disease must be maintained in immunosuppressed individuals even without apparent exposure history to endemic areas. This case report serves as a valuable reference for practitioners evaluating differential diagnosis of infections in immunocompromised patients.

Background: Gender-affirming surgery (GAS) has taken great strides, allowing patients to live in bodies affirming their gender identities. This study reviews the unique nonbinary surgical and aesthetic techniques and preferences for top surgery to aid surgeons and patients in discussions surrounding this procedure. Methods: A literature review was conducted to include “nonbinary,” “gender identity,” “top surgery” and related terms. Peer-reviewed manuscripts addressing any gender-affirming top surgery technique in patients identifying as nonbinary and other synonymous terms were included. Results: Of 818 non-duplicate studies identified, 10 met inclusion criteria. Most reported chest masculinization techniques in nonbinary patients. They most commonly underwent the double incision technique (88.8%), similar to transgender patients. However, nonbinary patients preferred a nonflat, androgynous-appearing chest, versus a flatter, masculine-appearing chest in transgender patients. Breast reduction provided increased flexibility for nonbinary patients to present as feminine or chest bind to present as masculine. Nonbinary patients differed in preferences for the nipple areolar complex (NAC), either preferring larger, rounder NAC located closer to the chest meridian with preserved sensitivity, or forgoing NAC reconstruction altogether. No studies reporting chest feminization techniques in nonbinary patients assigned male at birth (AMAB) were found. Conclusions: Nonbinary patients seeking chest masculinization prefer fuller chests with larger, sensitive NAC located closer to the chest meridian compared to transgender patients. No published studies discuss chest feminization, despite an estimated one-third of nonbinary patients being AMAB. Further studies are needed to provide patient-reported preferences and determine external factors possibly influencing decisions to undergo top surgery.

Adherence to treatment appointments by mothers of children with Cerebral Palsy is one of the factors affected in rehabilitation of a child with Cerebral Palsy, and this is cardinal to ensure effective rehabilitation outcomes for the child. Hence this study aimed to explore the factors influencing poor adherence to physiotherapy appointments by mothers of children with Cerebral Palsy at Chilenje Hospital, in Lusaka. A qualitative case study design utilising a phenomenological approach was conducted with a sample of 12 mothers of children with Cerebral palsy from Chilenje Hospital, Lusaka. Convenient sampling was utilized where mothers who were non-adhering were also purposefully selected into the study to better understand the factors affecting adherence to physiotherapy. The factors that contributed to caregivers defaulting scheduled therapy included economic constraints like unemployment and low education level, caregiver related factors such as marital challenges, and service centered factors such as challenges with the diagnosis of Cerebral Palsy and negative clinician attitudes. Majority of the caregivers admitted that they were motivated to attend therapy by observable improvements in their children. A combination of psychosocial, economic, child centered and service centered factors contributed to caregivers defaulting scheduled therapy. Interventions that may potentially improve caregiver attendance to scheduled therapy include community outreach services, efficient rehabilitation service provision at the hospitals, and facilitation of income generating programmes for mothers and caregivers.

Introduction: Cerebral palsy is the leading cause of disability worldwide and Zambia has its fair share of cases. Most parents/caregivers of children with Cerebral palsy at University Teaching Hospital started attending physiotherapy late when their children were over one year Therefore, the aim of this study was to explore the perceptions of mothers towards factors contributing to late physiotherapy intervention of children with Cerebral palsy at University Teaching Hospital. Furthermore, assess the knowledge of mothers with children between 0-5 years on the role of physiotherapy in Cerebral palsy. Methodology: An exploratory study design using qualitative methods was used. Data collection techniques were FGDs that consisted of purposively sampling of 10 mothers of children with CP attending physiotherapy at University Teaching Hospital. Audio-recording from the FGDs was transcribed verbatim for each session by an independent person. The study employed thematic analysis for data analysis. The data was classified systematically by means of coding to identify key factors or issues such as concepts, categories, themes and the relationship between them. Results: This study identified four themes on factors that influence late physiotherapy intervention of children with Cerebral Palsy at University Teaching Hospital. These included: Socio-economic support; late referral for Physiotherapy; Caregiver's knowledge about Cerebral Palsy; and People's attitude towards Cerebral Palsy. Limited caregiver knowledge about the role of physiotherapy in Cerebral Palsy was reported to be due to; limited community awareness about physiotherapy; and lack of caregiver education. Conclusion: The present study sought to explore the perceptions of mothers towards factors contributing to late physiotherapy intervention in children with Cerebral Palsy. A diversity of factors that led to delayed intervention was highlighted. Rehabilitation professionals should be aware of the factors that impact mothers both positively and negatively in order to implement effective rehabilitation programs.