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In a world where demands for freshwater are ever-growing, wastewater remediation becomes a global concern. Especially, water, which is contaminated by oil, dyes, poses challenges to the management of water resources. The development of innovative processes for wastewater treatment is still a major obstacle. With regard to its fast removal rate and environmental compatibility, cellulose aerogel composites are recently considered as a potential contributor for water remediation. In this study, cellulose aerogel composites are fabricated using the sol-gel method from two-agroindustrial wastes: pineapple leaf fibers and cotton waste fibers in alkali-urea solution followed by freeze-drying. The prepared cellulose aerogel composites are extremely lightweight with a low density (0.053−0.069 g.cm−3) and high porosity of nearly 95%. It is worth noting that the mechanical strength of the cellulose aerogel composites is remarkably improved with their Young’s modulus increasing by 5-9 times compared to that of the previous aerogel composites using polyvinyl alcohol as a binder. The as-synthesized aerogel composites are directly applied to adsorb cationic methylene blue and exhibit a maximum adsorption uptake of 34.01 g.g-1. The methyltrimethoxysilane-coated cellulose aerogel composites also show their ability to deal with oil pollution with a maximum oil adsorption capacity of 15.8 g.g−1 within only 20 sec. Besides the oil removal, our developed cellulose aerogel composites have demonstrated their capability in treating dye-contaminated wastewater for the first time based on their evidenced ability to eliminate methylene blue.

Background: Increased data availability has prompted the creation of clinical decision support systems. These systems utilise clinical information to enhance health care provision, both to predict the likelihood of specific clinical outcomes or evaluate the risk of further complications. However, their adoption remains low due to concerns regarding the quality of recommendations, and a lack of clarity on how results are best obtained and presented. Methods: We used autoencoders capable of reducing the dimensionality of complex datasets in order to produce a 2D representation denoted as latent space to support understanding of complex clinical data. In this output, meaningful representations of individual patient profiles are spatially mapped in an unsupervised manner according to their input clinical parameters. This technique was then applied to a large real-world clinical dataset of over 12,000 patients with an illness compatible with dengue infection in Ho Chi Minh City, Vietnam between 1999 and 2021. Dengue is a systemic viral disease which exerts significant health and economic burden worldwide, and up to 5% of hospitalised patients develop life-threatening complications. Results: The latent space produced by the selected autoencoder aligns with established clinical characteristics exhibited by patients with dengue infection, as well as features of disease progression. Similar clinical phenotypes are represented close to each other in the latent space and clustered according to outcomes broadly described by the World Health Organisation dengue guidelines. Balancing distance metrics and density metrics produced results covering most of the latent space, and improved visualisation whilst preserving utility, with similar patients grouped closer together. In this case, this balance is achieved by using the sigmoid activation function and one hidden layer with three neurons, in addition to the latent dimension layer, which produces the output (Pearson, 0.840; Spearman, 0.830; Procrustes, 0.301; GMM 0.321). Conclusion: This study demonstrates that when adequately configured, autoencoders can produce two-dimensional representations of a complex dataset that conserve the distance relationship between points. The output visualisation groups patients with clinically relevant features closely together and inherently supports user interpretability. Work is underway to incorporate these findings into an electronic clinical decision support system to guide individual patient management.

ImportancePediatric emergency department (ED) visits for mental health crises are increasing. Patients who frequently use the ED are of particular concern, as pediatric mental health ED visits are commonly repeat visits. Better understanding of trends and factors associated with mental health ED revisits is needed for optimal resource allocation and targeting of prevention efforts.ObjectiveTo describe trends in pediatric mental health ED visits and revisits and to determine factors associated with revisits.Design, Setting, and ParticipantsIn this cohort study, data were obtained from 38 US children’s hospital EDs in the Pediatric Health Information System between October 1, 2015, and February 29, 2020. The cohort included patients aged 3 to 17 years with a mental health ED visit.ExposuresCharacteristics of patients, encounters, hospitals, and communities.Main Outcomes and MeasuresThe primary outcome was a mental health ED revisit within 6 months of the index visit. Trends were assessed using cosinor analysis and factors associated with time to revisit using mixed-effects Cox proportional hazards regression.ResultsThere were 308 264 mental health ED visits from 217 865 unique patients, and 13.2% of patients had a mental health revisit within 6 months. Mental health visits increased by 8.0% annually (95% CI, 4.5%-11.4%), whereas all other ED visits increased by 1.5% annually (95% CI, 0.1%-2.9%). Factors associated with mental health ED revisits included psychiatric comorbidities, chemical restraint use, public insurance, higher area measures of child opportunity, and presence of an inpatient psychiatric unit at the presenting hospital. Patients with psychotic disorders (hazard ratio [HR], 1.42; 95% CI, 1.29-1.57), disruptive or impulse control disorders (HR, 1.36; 95% CI, 1.30-1.42), and neurodevelopmental disorders (HR, 1.22; 95% CI, 1.14-1.30) were more likely to revisit. Patients with substance use disorders (HR, 0.60; 95% CI, 0.55-0.66) were less likely to revisit.Conclusions and RelevanceMarkers of disease severity and health care access were associated with mental health revisits. Directing hospital and community interventions toward identified high-risk patients is needed to help mitigate recurrent mental health ED use and improve mental health care delivery.

Background Communication failures secondary to damaged infrastructure have caused difficulties in coordinating disaster responses. Two-way radios commonly serve as backup communication for hospitals. However, text messaging has become widely adopted in daily life and new technologies such as wireless mesh network (WMN) devices allow for text messaging independent of cellular towers, Wi-Fi networks, and electrical grids. Objective To examine the accuracy of communication using text-based messaging transmitted over WMN devices (TEXT-WMN) compared to voice transmitted over two-way radios (VOICE-TWR) in disaster simulations. Secondary outcomes were patient triage accuracy, perceived workload, and device preference. Methods 2 × 2 Latin square crossover design: 2 simulations (each involving 15 min of simulated hospital-wide disaster communication) by 2 modalities (TEXT-WMN and VOICE-TWR). Physicians were randomized to one of two sequences: VOICE-TWR first and TEXT-WMN second; or TEXT-WMN first and VOICE-TWR second. Analyses were conducted using linear mixed effects modeling. Results On average, communication accuracy significantly improved with TEXT-WMN compared to VOICE-TWR. Communication accuracy also significantly improved, on average, during the second simulation compared to the first. There was no significant change in triage accuracy with either TEXT-WMN or VOICE-TWR; however, triage accuracy significantly improved, on average, during the second simulation compared to the first. On average, perceived workload was significantly lower with TEXT-WMN compared to VOICE-TWR, and was also significantly lower during the second simulation compared to the first. Most participants preferred TEXT-WMN to VOICE-TWR. Conclusion TEXT-WMN technology may be more effective and less burdensome than VOICE-TWR in facilitating accurate communication during disasters.

Two previously unreported dimethylpyranoflavanones, pyronomelodorones A and B (

OBJECTIVES Infant cardiopulmonary resuscitation (CPR) has been taught to caregivers of infants in inpatient settings. There are no studies to date that look at teaching infant CPR in the emergency department (ED). Using a framework of cognitive load theory, we compared teaching infant CPR to caregivers in a pediatric ED versus an inpatient setting. METHODS Knowledge tests, 1-minute infant CPR performances on a Resusci Baby QCPR (Laerdal) manikin, and self-reported questionnaires were completed before and after caregivers were self-taught infant CPR using Infant CPR Anytime kits. The proportions of chest compression depth and rate that met quality standards from the American Heart Association's Basic Life Support program were measured. RESULTS Seventy-four caregivers participated. Mean knowledge scores (out of a total score of 15) increased in both settings (ED preintervention: Mean (M) = 4.53 [SD = 1.97]; ED postintervention: M = 10.47 [SD = 2.90], P < 0.001; inpatient preintervention: M = 4.83 (SD = 2.08); inpatient postintervention: M = 10.61 [SD = 2.79], P < 0.001). Improvement in the proportion of chest compression that met high quality standards for depth increased in the inpatient group only. Neither groups had improvements in compression rates. There were no statistically significant differences in the difficulty of learning CPR, frequency of interruptions/distractions, or difficulty staying concentrated in learning CPR between the 2 settings. CONCLUSIONS Caregivers in the ED and inpatient settings after a self-instructional infant CPR kit did not demonstrate adequate infant CPR performance. However, both groups gained infant CPR knowledge. Differences in cognitive loads between the 2 settings were not significant.

To describe the social needs of families screened by the Community Health Advocates Team (CHAT) Desk, situated within a pediatric emergency department (PED); and to evaluate the effectiveness of this help desk in connecting families to community resources.Trained undergraduates, onsite in the PED 30 hours/week during daytime and evening hours, weekdays and weekends, screened a convenience sample of families of patients in the PED for social needs, and provided information on available community resources. Families were offered a follow-up phone call several weeks after their PED visit to assess program satisfaction and success, and identify remaining social needs.Between January 2019 and March 2020, CHAT Desk screened and assisted 682 families. CHAT routinely provided resources about free outdoor recreational activities for families, but after that, the most commonly provided informational resources pertained to: health care (n = 200), housing (n = 143), and food (n = 137). Of families who completed the follow-up phone call (n = 294), almost half (n = 134, 46%) reported being able to contact at least one of the resources; 100 reported that the resource was able to assist them, and 99 families planned to continue using the resource. When asked about satisfaction, 93% (n = 274) reported being very satisfied or somewhat satisfied with CHAT; 94% (n = 276) said they would recommend it to others.The PED of a busy tertiary care children's hospital is an opportune location to screen families for social needs, and provide them with information on requested community resources.

Chitosan hydrogel is a smart and highly applicable drug delivery carrier because of its nature, biocompatibility, biodegradability, and ability to encapsulate, carry and release the drug to the desired target flexibly depending on the conditions of the patient. Not only developing delivery systems but natural compounds are also increasingly being studied in supporting the treatment of diseases. However, the physicochemical and pharmacokinetic issues of the phytochemicals are remaining. This review summarizes the remarkable properties of chitosan hydrogel; approaches to loading natural extracts on the hydrogels to overcome the susceptibility of the phytochemicals to degradation; and their applications in biomedical fields. The drug loading efficiency, release profile, in vitro and in vivo results of the chitosan hydrogels carrying natural compounds are discussed to point out the remaining challenges of combining the extracts with chitosan hydrogels and controlling the release of the carried substances.