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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.

Transitional care interventions have the potential to optimize continuity of care, improve health outcomes and enhance quality of life for adolescents and young adults living with chronic childhood-onset disabilities, including neurodevelopmental disorders, as they transition to adult health and social care services. The paucity of research in this area poses challenges in identifying and implementing interventions for research, evaluation and implementation. The purpose of this project was to advance this research agenda by identifying the transitional care interventions from the scientific literature and prioritize interventions for study. A modified-Delphi approach involving two rounds of online surveys followed by a face-to-face consensus meeting with knowledge users, researchers and clinician experts in transitional care (n = 19) was used. A subsequent virtual meeting concluded the formulation of next steps. Experts rated 16 categories of interventions, derived from a systematic review, on importance, impact, and feasibility. Seven of the 16 interventions categories received a mean score rating of ≥7 (out of 10) on all three rating categories. Participants then rank ordered the reduced list of seven interventions in order of priority and the top four ranked interventions advanced for further discussion at a consensus meeting. Using the Template for Intervention Description and Replication (TIDieR) checklist as a guide, the participants identified that a study of a peer system navigator was worthy of future evaluation. This study highlighted that transitional care interventions are complex and multifaceted. However, the presence of a peer to support system navigation, advocacy and individual and family education was considered the most ideal intervention addressing the current gap in care. Future research, which aims to engage patients and families in a co-design approach, is recommended to further develop this intervention.

Abstract Background Early readmission amongst older safety-net hospitalized adults is costly. Interventions to prevent early readmission have had mixed success. The role of perceived social support is unclear. We examined the association of perceived social support in 30-day readmission or death in older adults admitted to a safety-net hospital. Methods This is an observational cohort study derived from the Support From Hospital to Home for Elders (SHHE) trial. Participants were community-dwelling English, Spanish and Chinese speaking older adults admitted to medicine wards at an urban safety-net hospital in San Francisco. We assessed perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). We defined high social support as the highest quartile of MSPSS. We ascertained 30-day readmission and mortality based on a combination of participant self-report, hospital and death records. We used multiple/multivariable logistic regression to adjust for patient demographics, health status, and health behaviors. We tested for whether race/ethnicity modified the effect high social support had on 30-day readmission or death by including a race-social support interaction term. Results Participants (n = 674) had mean age of 66.2 (SD 9.0), with 18.8% White, 24.8% Black, 31.9% Asian, and 19.3% Latino. The 30-day readmission or death rate was 15.0%. Those with high social support had half the odds of readmission or death than those with low social support (OR = 0.47, 95% CI 0.26–0.88). Interaction analyses revealed race modified this association; higher social support was protective against readmission or death among minorities (AOR = 0.35, 95% CI 0.16–0.76) but increased likelihood of readmission or death among Whites (AOR = 3.7, 95% CI 1.07–12.9). Conclusion In older safety-net patients nearing discharge, high perceived social support may protect against 30-day readmission or death among minorities. Assessing patients’ social support may aid targeting of transitional care resources and intervention design. How perceived social support functions across racial/ethnic groups in health outcomes warrants further study. Trial registration NIH trials registry number ClinicalTrials.gov: NCT01221532.

Abstract Background Monoclonal antibodies against calcitonin gene-related peptide (CGRP) or its receptor are efficacious for the prevention of migraine headaches. The downstream molecular mechanisms following ligand-receptor blockade by which these antibodies prevent CGRP signaling through CGRP receptors have not been demonstrated. Methods Here we produced tool monoclonal functional antagonist antibodies against CGRP and its canonical receptor and developed a novel cellular model using fluorogen-activated protein technology that allows detection of CGRP receptor internalization by flow cytometry and, for an extended time course, visualization by confocal microscopy. Results Using this cell model we showed that these antagonist antibodies block both CGRP-induced cAMP signaling and CGRP receptor internalization. At least 10-fold higher concentrations of either antibody are necessary to block CGRP receptor internalization compared with cAMP accumulation in our cell model. Conclusion These data reinforce our understanding of how monoclonal functional antagonist antibodies interfere with CGRP signaling.

Abstract Background Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. We present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research. Methods/design Participants are patients at a Federally Qualified Health Center in Portland, Oregon that serves patients experiencing homelessness or who have substance use disorders. Participants meet at least one of the following criteria: > 1 hospitalization over past 6 months; at least one medical co-morbidity including uncontrolled diabetes, heart failure, chronic obstructive pulmonary disease, liver disease, soft-tissue infection; and 1 mental health diagnosis or substance use disorder. We exclude patients if they have

Abstract Background Dysnatremias are associated with increased mortality in critically ill patients. Hypernatremia in burn patients is also associated with poor survival. Based on these findings, we hypothesized that high plasma sodium variability is a marker for increased mortality in severely burn-injured patients. Methods We performed a retrospective review of adult burn patients with a burn injury of 15% total body surface area (TBSA) or greater from 2010 to 2014. All patients included in the study had at least three serum sodium levels checked during admission. We used multivariate logistic regression analysis to determine if hypernatremia, hyponatremia, or sodium variability independently increased the odds ratio (OR) for death. Results Two hundred twelve patients met entry criteria. Mean age and %TBSA for the study was 45 ± 18 years and 32 ± 19%. Twenty-nine patients died for a mortality rate of 14%. Serum sodium was measured 10,310 times overall. The median number of serum sodium measurements per patient was 22. Non-survivors were older (59 ± 19 vs. 42 ± 16 years) and suffered from a more severe burn injury (50 ± 25% vs. 29 ± 16%TBSA). While mean sodium was significantly higher for non-survivors (138 ± 3 milliequivalents/liter (meq/l)) than for survivors (135 ± 2 meq/l), mean sodium levels remained within the laboratory reference range (135 to 145 meq/l) for both groups. Non-survivors had a significantly higher median number of hypernatremic (> 145 meq/l) measurements (2 vs. 0). Coefficient of variation (CV) was significantly higher in non-survivors (2.85 ± 1.1) than survivors (2.0 ± 0.7). Adjusting for TBSA, age, ventilator days, and intensive care unit (ICU) stay, a higher CV of sodium measurements was associated with mortality (OR 5.8 (95% confidence interval (CI) 1.5 to 22)). Additionally, large variation in sodium ranges in the first 10 days of admission may be associated with increased mortality (OR 1.35 (95% CI 1.06 to1.7)). Conclusions Increased variability in plasma sodium may be associated with death in severely burned patients.

Both intrinsic and external signals regulate stem cell fate. Here, the authors perform a genome-wide RNAi screen to identify regulators of testis germline stem cells (GSC) in Drosophila, finding more than half of the genes were external regulators and heterochromatin/cytokinesis proteins mediated GSC fate.

Non-medical prescription opioid use is a growing public health concern. Social media is an emerging tool to understand health attitudes, beliefs, and behaviors.We retrieved a sample of publicly available Twitter messages in early 2014, using common opioid medication names and slang search terms. We used content analysis to code messages by user, context of message (personal vs general experiences), and key content themes.We reviewed 540 messages, of which 375 (69%) messages were related to opioid behaviors. Of these, 316 (84%) originated from individual user accounts; 125 messages expressed personal experience with opioids. The majority of personal messages referenced using opioids to obtain a "high", use for sleep, or other non-intended use (87,70%). General attitudes regarding opioid use included positive sentiment (52, 27%), comments on others peoples opioid use (57, 30%), and messages containing public health information or links (48, 25%).In a sample of social media messages mentioning opioid medications, the most common theme amongst English users related to various forms of opioid misuse. Social media can provide insights into the types of misuse of opioids that might aid public health efforts to reduce non-medical opioid use.

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]

Identification of small and large molecule pain therapeutics that target the genetically validated voltage-gated sodium channel Na V1.7 is a challenging endeavor under vigorous pursuit. The monoclonal antibody SVmab1 was recently published to bind the Na V1.7 DII voltage sensor domain and block human Na V1.7 sodium currents in heterologous cells. We produced purified SVmab1 protein based on publically available sequence information, and evaluated its activity in a battery of binding and functional assays. Herein, we report that our recombinant SVmAb1 does not bind peptide immunogen or purified Na V1.7 DII voltage sensor domain via ELISA, and does not bind Na V1.7 in live HEK293, U-2 OS, and CHO-K1 cells via FACS. Whole cell manual patch clamp electrophysiology protocols interrogating diverse Na V1.7 gating states in HEK293 cells, revealed that recombinant SVmab1 does not block Na V1.7 currents to an extent greater than observed with an isotype matched control antibody. Collectively, our results show that recombinant SVmab1 monoclonal antibody does not bind Na V1.7 target sequences or specifically inhibit Na V1.7 current.

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.

Geoinformatics significantly enables the identification and tracking of global pandemic outbreaks such as coronavirus disease 2019 (COVID-19), from spatial mapping at various sizes to location-based alerts. This article seeks to review online attempts to geographically map COVID-19, using several established techniques such as choropleth rendering, graduated circles, graduated pie charts, buffering, overlay analysis, and animation. The import of these mapping services is primarily to educate the public (especially travelers to potentially affected areas) and empower public health authorities in mapping spatial and temporal trends and patterns in COVID-19, as well as in assessing/reviewing the efficacy of current control protocols and actions.

The global coronavirus pandemic which has already caused unprecedented damage and misery has put an almost complete halt to our way of life. The epidemic will have significant and enduring economic and social implications in every corner of the globe. Only through successful cooperation and coordination between scientists, experts, innovators and policymakers can we solve the COVID-19 pandemic. Sharing observations and perspectives in real time will be crucial to improving the connection between research , policy and community, and leading to the solutions we need. When the Covid-19 pandemic is under control, and the world economy is back on track, it is important to reassess the status and fate of the 2030 Agenda, also known as Sustainable Development Goals ( SDGs). The Decade of Operation was scheduled to kick-off the year 2020. With only 10 years to go, plans have been made to undertake “ambitious global efforts” to deliver the promise of 2030—by mobilizing more governments, civil society, businesses, and calling on all people to make their own the Global Goals.

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.

The massive cluster MACSJ1149.5+2223(z = 0.544) displays five very large lensed images of a well-resolved spiral galaxy at zspect = 1.491. It is within one of these images that the first example of a multiply lensed supernova (SN) has been detected recently as part of the Grism Lens-Amplified Survey from Space. The depth of this data also reveals many H II regions within the lensed spiral galaxy which we identify between the five counter-images. Here, we expand the capability of our free-form method to incorporate these H II regions locally, with other reliable lensed galaxies added for a global solution. This improved accuracy allows us to estimate when the Refsdal SN will appear within the other lensed images of the spiral galaxy to an accuracy of ~7 per cent. We predict this SN will reappear in one of the counter-images (RA = 11:49:36.025, Dec. = +22:23:48.11, J2000) and on 2015 November 1 (with an estimated error of ±25 d) it will be at the same phase as it was when it was originally discovered, offering a unique opportunity to study the early phases of this SN and to examine the consistency of the mass model and the cosmological model that have an impact on the time delay prediction. [ABSTRACT FROM AUTHOR]

INTRODUCTION: von Willebrand Disease (vWD) is the most prevalent bleeding disorder. Women are more likely to manifest abnormal bleeding symptoms due to physiologic events and menorrhagia is the most common presenting symptom. METHODS: this case-control study included 168 women aged between 18 and 45. The cases had menorrhagia whilst the controls did not. Blood grouping, activated partial thromboplastin time and von Willebrand factor activity tests were performed on samples collected from consenting study participants. Blood grouping, activated partial thromboplastin time and von Willebrand factor activity tests were performed on samples collected from consenting study participants. RESULTS: the mean age was 29.96 ± 7.37. Mean vWF activity of cases was 66.6% and of controls 97.8%. The mean activated Partial ThromboplastinTime (aPTT) of cases was 31.09s and of controls was 30.40s. There was no difference in the vWF activity between blood group O (86.3%) and non-blood group O (88.0%) participants. Eight women were diagnosed with von Willebrand disease, 6 cases and 2 controls. Higher odds of von Willebrand disease were seen in the cases (OR = 6.6). Epistaxis, von Willebr and factor activity levels and family history of menorrhagia were associated with an increased risk for menorrhagia. CONCLUSION: von Willebrand factor activity levels were associated with menorrhagia while activated partial thromboplastin time was not. vWF activity levels did not depend on any specific blood group. The prevalence of von Willebrand disease was significantly higher in participants with menorrhagia and repeated epistaxis and family history of menorrhagia pointed to a higher risk of menorrhagia.

A good working environment or work is very important for global, national and local economic and social development. Legislation and inspection of workplaces is done to help monitor compliance with health and safety agencies and also insure health and safety in workplaces. Occupational health is a multi-disciplinary action that concentrates on protecting and promoting the health of workers by preventing and controlling occupational diseases and accidents. In Africa occupational health also looks at the factors and conditions that are hazardous to the health and safety of workers. Occupational health focuses on enabling workers to conduct socially and economically productive lives and contribute to sustainable development. According to the UN statistics about 300 million people are disabled in Africa. With the increasing number of people living with disability a number of countries have developed laws and regulations that allow disabled people to work. This paper aims at addressing different occupational and health issues which will help understand occupational health, the problems that comes it and how to address those problems. This article will also review the challenges of people living with disability face in employment and how they are treated at their workplaces. This review will be passed on other articles downloaded from google search. 14 articles where downloaded but only 11 where used. The others were excluded because of the limitation on the number of word and pages the review article was supposed to have.

Among the neglected population in NCD awareness is the population of people with hearing impairment or deaf. Little effort is made to ensure that people are deaf are covered in these NCDs awareness programs. Hence this study aimed at assessing the NCDs awareness among people who are deaf in Zambia, particularly assessing the knowledge of NCDs risk factors, diagnosis and treatment. The study utilized a phenomenological study type with were 10 participants who were purposively sampled. 5 males and 5 females were chosen, 2 from Grade ten, 4 from Grade eleven and 4 from Grade twelve. These were chosen because of their ability to adequately read and understand English language. The study highlighted that among the many factors, the major factors were identified as; lack of communication between the health personnel and the deaf person (pupil), attitude (stigma) of the health personnel towards the person who are deaf (pupil), lack of health education in the school curriculum and lack of specific information on NCDs. Other identified factors were lack of regular health campaign within the school premises, lack of health materials on NCDs and poor organization of physical education.some issues such as lack of communication between the health personnel and them, the attitude of the health personnel, lack of health education in the school curriculum and lack of specific information on NCDs were found to be the major cause of low awareness among the target

As a result of physical disability after stroke, most of the patients need physiotherapy. Due to different backgrounds, knowledge, clinical experiences, personal preferences, and continually developing clinical practices, physiotherapists use different methods to treat their stroke patients. This study was designed to determine physiotherapists' perspective on the physiotherapy interventions for stroke patients at the University Teaching Hospital and Levy Mwanawasa University Teaching Hospital in Lusaka. This was a cross-sectional study. Data was collected through a standardized questionnaire with modifications to fit the scope of the study. A total of 36 participants consisting of 23 Physiotherapists and 13 physiotherapy Technologists was considered. The data obtained was analyzed by using descriptive analysis and chi-square test was used to test the association. The results showed that PNF/Brumstrom (92%) was the most taught approach among the respondents in their professional education. The preferred treatment approaches in stroke rehabilitation which are used by Physiotherapists and physiotherapy Technologists are repetitive functional task practice (72%), motor learning (69%) and PNF/Brumstrom (67%). There is need to incorporate the newer physiotherapy treatment approaches into the physiotherapy practice as the scope of practice that reflects the latest evidence base improves the provision of services and contributes to better and cost-effective physiotherapy interventions for stroke patients.

Abstract Background Cerebral palsy is a major cause of disability and most survivors are left with residual disability and are dependent on parents/caregivers for essential care. This study aimed to determine the experiences of parents/caregivers of cerebral palsy children receiving out-patient physiotherapy. A concurrent mixed methods was used to collect data in the present study. The modified caregiver strain index (MCSI-13) was used to detect Disturbed sleep, Inconvenient/Tiresome, Physical strain, Confining, Family changes, Changes in personal plan, Other demands, Emotional adjustments, Upsetting behavior, Patient has changed, Work adjustments, Financial Strain and Feeling Overwhelmed (strain morbidity) in 25 parents/caregivers of CP children. A purposive sample of 25 parents/caregivers was selected for both the quantitative part and qualitative part of the study. The study was conducted at Community Based Intervention Association Out-patients at the University Teaching Hospital in Lusaka, Zambia. The MCSI was used to collect quantitative data and in-depth interviews provided the qualitative data. Results The median age of the participants was 33.6 years and a range of 27 to 50 years. The study sample consisted of more females (92%) than males (8%). being overwhelmed and inconvenient/tiresome followed by family adjustments and work adjustment 72 and 68% respectively for each were the experiences mostly highlighted by the parents/caregivers in this study. When it came to the needs of the parents/caregivers more than half of them needed help with caring. To this effect participants expressed their perception; one mother had this to say, “…I need someone to help in caring. Sometimes I need to do some other things but can’t, because if I do then no one will remain with the child…”. Conclusion This study point out to some evidence that the burden inflicted on those caring for children with cerebral palsy should be addressed if the quality of care for those with cerebral palsy is to be improved.

We have constructed two mechanical snails, Robosnail 1 and Robosnail 2, inspired by the propulsion mechanisms of live gastropods. Each uses a different mechanical strategy to move on a thin layer of viscous fluid. Robosnail 1 uses a flexible flapping sheet to generate lubrication pressures in a viscous Newtonian fluid which in turn propels the snail. Robosnail 2 uses a compressible sliding sheet on a layer of Laponite, a non-Newtonian, finite-yield stress fluid. [ABSTRACT FROM AUTHOR]

Many stroke survivors usually have permanent disability such as aphasia, which results in the need for support from caregivers. Care required for stroke survivors differs depending on the type of stroke but there is little research done in this regard. However, current literature provides evidence that support services and interventions for caregivers, especially in relation to managing affective symptoms, are unsatisfactory. The aim of this study was to explore the experiences of caregivers handling aphasic stroke patients at the University Teaching Hospital. An explorative study utilizing qualitative phenomenological approach was utilized with sample of 15 participants who by purposeful sampling were drawn and using thematic method of analysis. This study found that caregivers go through a lot of things in caring for their loved ones and their experience involve a complicated and sometimes unpredictable interplay of multiple processes. Lack of preparedness in assuming the role of caregiving caused the caregivers to go through what seemed to be insurmountable challenges. There is therefore need of caregiver education so that they can deliver appropriate care to the stroke survivors.

Stroke is one of the leading causes of severe handicap, disabling and impairing the ability to walk in 80% of all stroke survivors. Physiotherapists, all over the globe, use Observational gait analysis as a preferred method of gait assessment in their clinical practice to assess, monitor change, evaluate treatment and identify areas needing intervention in the rehabilitation of patients with gait disability. The objective of the study was to determine factors affecting the use of observational gait analysis in assessment of stroke survivors among physiotherapy practitioners at the University Teaching Hospital. The study was a cross sectional descriptive study aimed at determining the knowledge and factors affecting use of observational gait analysis and the adaption thereof as a Standard Observational Gait Assessment Tool at the University Teaching Hospital. The essential factors to the use of assessment tools were lack of guidelines and lack of knowledge on use of OGA. Also a lack of organizational support, lack of formal knowledge and no availability of assessment tools. To overcome these barriers, it is necessary to provide training of standardized assessment, and to recommend appropriate guidelines.

Over the years, they have been suggestions that people with disabilities face barriers when accessing health care services unlike their abled counter-parts. However, information regarding the nature of these barriers, especially for those in low income and middle income countries is not abundant and very sparse. signing of the United Nations Convention on the Rights of Persons with Disabilities on May 3, 2008 is one of the most important disability actions taken to date which marked national recognition of the rights for persons with disabilities, of which included access. The studies explored in this article review issues related to access to health care and those mostly used in areas within the Sub-Saharan as their sample site. The following document contains published studies that determine if disability limits access to health care and to attempt to identify what contextual factors (environmental and personal factors), interact with to limit this access. The findings were that people with disability who came from rural areas did find it harder to access healthcare than their urban counterparts. The major reason behind this is transportation from home to the health facility. A number of other reasons were also considered, such as no services were available.

There is an empirical argument that Physiotherapists have a moral and professional obligation to move away from assessment and treatment methods based on anecdotal testimonies or opinion and upgrade their method of practice to Evidence-Based Practice in order to remain alive in the era of scientific research. It is essential to evaluate the quality of service being delivered by referral hospitals. This study aimed to establish linkages of knowledge and awareness of evidence-based practice in selected hospitals of Lusaka and the service quality at the physiotherapy outpatient departments. This study employed a descriptive cross-sectional study. The study was based on primary data collected through a standardized SERVQUAL tool measuring the mean expectations and perception of performance for the quality of physiotherapy care. A total of 75 respondents including both physiotherapists and patients contributed to the study. Limited utilization of EBP practice was seen with only 3(5.1%) participants always and 26(4.1%) mostly reading research to guide the clinical decision. 18(31%) and 14(24.1%) respectively strongly agreed or agreed that the insufficiency of basic EBP skills was the primary barrier to the application of EBP in clinical practice. A negative mean gap score was observed across all five dimensions of the SERVQUAL tool for patients. Despite Physiotherapists in Lusaka being knowledgeable of evidence-based practice, negative gaps in quality of care being offered still persist, an indication that there is a needs to improve on patients' satisfaction with the services being provided.

Health care is important to everyone and everyone should have equal access to health care. The literature available focuses mainly on high-income countries. It is therefore important to bear in mind that many Deaf people, especially in low and middle-income countries, are suffering from much greater health disparities. Deaf people rely on a visual language that does not have a written form. These individuals may lack proficiency in written English. Health literacy, as defined by the National Institutes of Health refers to how well a person can get the health information and services that they need, and how well they understand them. To assess the Health Literacy of Deaf people in Kapiri Mposhi District. This research was a qualitative study; it used a cross-sectional descriptive study design. Snowball sampling was done. The sample size was 15 participants. 10 Deaf individuals and 5 health care providers altogether. Interviews were conducted and manual transcription was used to analyse the data and translate it into themes. Deaf people in Kapiri Mposhi are not aware of issues pertaining to health and wellbeing. It appears that Deaf people, because of communication barriers faced, do not receive full disclosure of their medical situation and the alternatives are not discussed with them. Even when disclosure does occur, many Deaf people may not fully comprehend the options available to them because of communication difficulties with health care providers. This entails that the Deaf people in Kapiri Mposhi District have their health literacy extremely low.

To ensure that there is inclusiveness in the provision of services for PWDs the Zambian government ratified to the UNCRPD by enacting the Zambia PWDs ACT No. 6 of 2012 to precisely look at promoting and protecting the rights of PWDs. Despite this, there has been a lack of implementation of the ACT and specifically about accessibility and mobility of PWDs to public buildings. The aim of this study was to explain barriers to implementation of part five division five of The Zambia PWDs on Accessibility and Mobility to public buildings in Lusaka for PWDs. A qualitative case study approach was utilized with sample of 8 participants who by a method of purposeful and convenient sampling were drawn and using thematic method of analysis. This study found that there is a knowledge gap and reduced general knowledge about the ACT among policy implementers. There is need for awareness among people that own building in Lusaka of the Disability ACT. For the policy makers there is a need for prioritization through national planning, budgeting and various national programs.

We investigate mucosalivary dispersal and deposition on horizontal surfaces corresponding to human exhalations with physical experiments under still-air conditions. Synthetic fluorescence tagged sprays with size and speed distributions comparable to human sneezes are observed with high-speed imaging. We show that while some larger droplets follow parabolic trajectories, smaller droplets stay aloft for several seconds and settle slowly with speeds consistent with a buoyant cloud dynamics model. The net deposition distribution is observed to become correspondingly broader as the source height H is increased, ranging from sitting at a table to standing upright. We find that the deposited mucosaliva decays exponentially in front of the source, after peaking at distance x=0.71m when H=0.5m, and x=0.56m when H=1.5m, with standard deviations ≈0.5m. Greater than 99% of the mucosaliva is deposited within x=2m, with faster landing times further from the source. We then demonstrate that a standard nose and mouth mask reduces the mucosaliva dispersed by a factor of at least a hundred compared to the peaks recorded when unmasked.

OBJECTIVES/SPECIFIC AIMS: This study’s aims are to optimize the isolation and growth of chondrocytes from pig auricular cartilage; to identify the ideal seeding conditions onto 3D printed auricular bioscaffolds to maximize chondrocyte growth; and to investigate what quantity and types of host tissue can grow on the bioscaffold. Primary outcomes will include comparisons between different seeding conditions in various objective measures of bioscaffold growth and survival as listed in the methods section. Secondary outcomes will include continued optimization of bioscaffolds to minimize extrusion rates and maximize morphologic and histologic similarity to human auricular cartilage. METHODS/STUDY POPULATION: For chondrocyte-seeded scaffolds, cartilage will be collected from freshly harvested porcine auricular tissue and digested in type II collagenase. Chondrocytes derived from the harvest will be seeded into auricular PCL scaffolds using a type I collagen/hyaluronic acid composite gel, which has been previously shown to support chondrogenesis. For scaffolds containing cartilage, punch biopsies will be collected and embedded in specific areas of the scaffold previously shown to experience excessive stress/strain compared to the rest of the construct. From there, five of each chondrocyte-seeded bioscaffolds, chondrocyte-unseeded bioscaffolds, and cartilage-containing bioscaffolds will be implanted into athymic rats. Total follow up will be for six months, with outcomes as measured by clinical assessments, morphologic measurements, radiological imaging, histological analysis, biomechanical evaluation, and photodocumentation. Once these measures are obtained, we will work closely with Dr. Myra Kim, an adjunct professor with the Biostatistics Department, to appropriately analyze differences between the models. RESULTS/ANTICIPATED RESULTS: We believe that while all scaffolds (chondrocyte-seeded, chondrocyte-unseeded, and cartilage-containing) will be structurally sound, the chondrocyte-seeded scaffolds and cartilage-containing scaffolds will exhibit improved soft tissue coverage and have lower exposure and fracture rates. Additionally, between the two, we posit that there will not be appreciable differences histologically, radiologically, or morphologically. DISCUSSION/SIGNIFICANCE OF IMPACT: Auricular reconstruction is a geometrically complex and technically challenging problem. Reconstruction hinges on the physical characteristics of the deformity, patient preferences, and reconstructive materials available. The current gold standard for auricular reconstruction uses autologous rib cartilage as foundational support for overlying soft tissue and these techniques involve freehand carving of the cartilage, requiring high levels of technical skill. Harvesting the materials for this procedure is invasive, and the outcomes of the surgery are largely variable and sometimes undesirable. As alternatives, implantable scaffolds including those made from high density porous polyethylene (commercially referred to as MedPor) have been investigated. However, many of these have proven inadequate due to factors including infection, extrusion, and morphologic and biomechanical dissimilarity from native tissue. 3D printing represents an exciting new avenue through which to address many of these difficulties. Our group has previously demonstrated the successful design, production, and implantation of 3D-printed models: in auricular reconstruction, we have demonstrated the successful creation and implementation of a 3D printed ear scaffold into an athymic rodent model. We now turn our attention to optimization of seeding of our ear scaffold with chondrocytes derived from porcine auricular cartilage or with cartilage punch biopsies, all while maintaining emphasis on regulatory feasibility. With success in this arena, we will be able to provide a much less invasive and technically challenging alternative to the current gold standard, create patient-specific bioscaffolds which are more form fitting and individualized, and provide children with ear malformations better alternatives and treatments for their conditions.

Water clocks measure time by controlling the flow of water into a container. Ancient Persians used the sinking time of Fenjaans, bowls with holes in the center, as a metric for time. The relationship between hole diameter and sinking time of cylindrical containers was investigated. A theoretical model was derived using Torricelli’s Law and Archimedes’ Principle. The experimental relationship was found by drilling holes with diameters ranging from 2 to 13 mm in the center of nearly cylindrical stainless-steel containers and measuring their sinking time. It was found that there was a proportional relationship between the sinking time and the inverse square of the hole diameter with a proportionality constant which matched, within uncertainties, the proportionality constant predicted by the theoretical model.

In the crystal structure of the title compound, C14H11BrClNO4S, the molecules form inversion dimers with R22(8) motifs through pairs of N—H...O hydrogen bonds. The benzene rings are not coplanar and subtend a dihedral angle of 66.27 (8)°. The carbomethoxy group makes a dihedral angle of 75.1 (1)° with the ring to which it is attached.