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Background: Lesbian, gay, and bisexual youth face a disproportionate risk of suicidal ideation and attempt compared to heterosexual counterparts. Escalation from ideation to attempt can occur quickly, and youth who survive suicide attempts are likely to pursue subsequent, riskier attempts. This study examines the effects of bullying and sexual orientation on suicidal outcomes. Methods: Data came from the national, school-administered 2017 Youth Risk Behavior Survey (N = 14,765). Bivariate associations, binomial logistic regressions, and ordinal logistic regressions were performed. Results: Lesbian/gay, bisexual, and unsure youth reported greater odds of ideation and attempts compared to heterosexual youth. For ideation, increased effects were inconsistent across bullying types and significant interactions were found for bisexual youth who were bullied in school, and for lesbian/gay youth who were cyberbullied. Conclusion: These results underscore the need to understand bullying victimization for lesbian, gay, and bisexual youth. Awareness of increasing cyberbullying and creating school environments of no-bullying tolerance in the post-pandemic era are among the challenges ahead.

Purpose Approximately 800 children annually suffer unintentional firearm injuries and deaths from unsecured firearms in the United States. These injuries are preventable, and may be avoided by providing parents with firearm safety guidance (FSG). The purpose of this study was to evaluate the experience of pediatric providers in delivering FSG following incorporation of the American Academy of Pediatrics (AAP) infographic. Methods Qualitative study completed July 2019-December 2019. Community pediatricians in Houston, Texas were provided the AAP firearm safety infographic and encouraged to provide FSG routinely during well-child visits with firearm-owning parents. Efficacy, feasibility of use and barriers to FSG were assessed via focus groups. Content analysis was utilized to identify emergent themes from provider experiences. Results Forty-four pediatricians across eight clinics delivered FSG using the AAP infographic. Of these, thirty-four participated in focus groups discussing their experience. Only 34% of those in the focus groups had routinely provided FSG prior to the study. The AAP infographic was a useful tool because of its visibility, valuable information, and assistance with broaching the topic of firearm safety with parents. Three themes were identified from qualitative analysis: methods of successful delivery of FSG (62%), patient responses to FSG (25%), and barriers to delivery of FSG (13%). Parents were generally receptive to the guidance. Conclusions The AAP firearm safety infographic, which is free and publicly available, can be a valuable and satisfactory tool for delivery of firearm safety guidance by pediatric providers, including surgeons. Further study is needed to assess whether the guidance changes parental storage behaviors. Level of evidence Level VI

Purpose Pediatric unintentional firearm injuries are potentially preventable with firearm safety guidance (FSG). In baseline assessment, we learned that providers feel uncomfortable delivering FSG due to lack of training, but are inclined to learn. Here we present the development and concept testing of an FSG training program. Methods Using Kern's 6 rules of curriculum development, a training template was developed: 1. Program development, 2. Review by multidisciplinary expert team, 3. Concept testing, and 4. Modifications. Foundations included: raising awareness, increasing provider knowledge of safe storage methods, introducing a visual aide (American Academy of Pediatrics [AAP] infographic), and providing examples of guidance delivery. In-person training was provided and modifications made until there was uniform provider satisfaction. Program effectiveness and satisfaction were evaluated through surveys and focus groups. Descriptive statistics and univariate analyses were utilized. Results Over one year, in-person training was provided to 44 pediatric providers (residents and practicing pediatricians) at 8 clinics. Modifications included: addition of a Spanish-version visual aide, instruction on safety device use, simulation scenarios, making the handout more child-friendly, and development of a home safety video to include firearm safety with other topics. Following training, routine FSG by pediatricians increased from 34% to 71% (p = 0.001). Focus groups revealed provider satisfaction with the AAP infographic and increased comfort of FSG delivery. Conclusion Following development and quality improvement, our FSG training model received positive feedback and increased provider delivery by pediatric providers. This model could be used for development of FSG training programs in other settings.

Background/purpose Access to firearms is a preventable cause of unintentional injury and suicide in children. Pediatric physicians provide injury prevention guidance, but firearm safety may not routinely be included. The purpose of this pilot study was to evaluate the effectiveness of firearm safety guidance (FSG) provided by a physician. Methods Prospective, randomized-controlled, trial assessing physician-delivered FSG at two pediatric clinics in Houston, Texas. Firearm-owning parents were randomized to physician guidance (PG) versus control (CG) groups. The CG received a handout with firearm safety facts and a free cable lock. The PG additionally received FSG by a physician. Pre- and post-intervention surveys were conducted. Results were analyzed using descriptive statistics and Chi square analysis. Results Thirty-two families participated; most (70%) were satisfied with the guidance. Pre-intervention safe firearm storage was high in both groups, and the intervention did not lead to improved habits in either group [PG: Pre 93% vs. Post 89%, p = 0.7 and CG: Pre 82% vs. 78%, p = 0.7].There was no difference in use of the free cable lock among groups (44% vs. 22%, p = 0.9). The PG demonstrated improved knowledge of the state child access protection law (PG: Pre 60% vs. Post 100% vs. CG: Pre 29% vs. Post 67%; p = 0.02). Conclusions For firearm-owning parents, physician-delivered safe storage guidance may not be more effective than self-directed guidance provided by a handout. A larger trial is underway to confirm the findings of this pilot study.

We present a method for monitoring spatially localized antigen-antibody binding events on physiologically relevant substrates (cell and tissue sections) using fluorescence lifetime imaging. Specifically, we use the difference between the fluorescence decay times of fluorescently tagged antibodies in free solution and in the bound state to track the bound fraction over time and hence deduce the binding kinetics. We make use of a microfluidic probe format to minimize the mass transport effects and localize the analysis to specific regions of interest on the biological substrates. This enables measurement of binding constants (

Colorimetric sandwich-type biosensors that can both provide sensitivity competitive with fluorescence-based approaches, and leverage reagents that are cost-effective, widely available and as safe as possible, are highly sought after. Herein, we demonstrate an alternative highly-sensitive colorimetric method for paper-based sandwich-type biosensing that uses starch–iodide complexation to simplify practical biosensing using ubiquitous reagents. Targeting the mycotoxin ochratoxin A (OTA), a covalently-immobilised OTA antibody on a cellulose surface captures OTA and forms a sandwich with OTA aptamer-conjugated glucose oxidase. Adding the chromogenic reagents at an optimized concentration, a distinct blue color develops within 30 min, offering excellent contrast with the clear/white of the negative sample. With a sampling volume down to just 5 μL, the assay exhibits concentration limits of detection and quantitation of 20 and 320 pg mL−1, respectively, and a linear range from 10−1 to 105 ng mL−1 (R2 = 0.997). The method displays excellent selectivity against related mycotoxins, excellent %recovery (95–117%) and robust operation in complex matrices (beer, urine and human serum), with no significant difference versus gold-standard liquid chromatography. Along with its excellent analytical performance, this assay benefits from non-toxic and extremely cheap reagents that can be safely disposed of in the field, and presents an attractive alternative to toxic dyes and nanoparticles.

Purpose We previously validated a visual aid for the use in the consent process for an appendectomy showing improved parental satisfaction and understanding. In this study, we evaluated provider satisfaction and perceived value of using the visual aid. Methods An IRB approved survey was developed assessing provider experience with use of the visual aid. This was distributed and analyzed via Research Electronic Data Capture (RedCap) Database. Results We administered 58 surveys (45% response rate). Participants included faculty (n = 2), fellows (n = 1), residents (n = 6), and physician assistants (n = 17). The visual aid was used > 10 times by 50% of providers. The most common reason for not using the visual aid was not remembering it was available. Nearly half (40%) did not feel the visual aid added any time. 9/20 (45%) felt it added a small amount of time. Slightly over half of providers (52%) felt using the visual aid significantly increased family ability to give informed consent and made the consenting process easier for both providers and families. Conclusion Using a visual aid in consenting families for appendectomy does not add significant time and subjectively improves the process for providers and increases provider perception of parental understanding. Level of Evidence Cost effectiveness, Level IV.

PURPOSE: To determine the upgrade rate for biopsy-proven radial scars and radial sclerosing lesions (RS). MATERIALS AND METHODS: In this retrospective study, radiology and pathology databases from two tertiary breast centers were searched to identify patients with biopsy-confirmed RS between March 1, 2012, and December 31, 2017, during which all mammography was performed with digital breast tomosynthesis (DBT). Adjunct modalities such as MRI or US are performed at our centers to better characterize lesions identified at DBT. Patient demographics, imaging, needle and excisional biopsies, and follow-up data were collected at the patient level. Clopper-Pearson interval estimate for upgrade was calculated for 95% confidence using PropCIs package with R version 4.1.0 (R Foundation for Statistical Computing) (1). RESULTS: During the study period, a total of 155 885 DBT examinations were performed. From these examinations, 146 biopsy-proven RS were identified in 142 women (median age, 58 years; age range, 26–87 years). A total of 80.1% (117 of 146) of all RS did not have associated atypia or malignancy, and 19.9% (29 of 146) had associated atypia at initial biopsy. A total of 66.7% (78 of 117) of RS without atypia or malignancy were surgically excised, 25.6% (30 of 117) were followed (median, 3 years; range, 1–7 years) with benign findings on imaging, and 7.7% (nine of 117) were lost to follow-up. The rate of malignancy upgrade was 0.9% (one of 117 [95% CI: 0.02, 4.7]); one RS without concurrent atypia or malignancy demonstrated invasive carcinoma at surgical excision. CONCLUSION: RS without atypia had a low upgrade rate. Keywords: Mammography, Breast © RSNA, 2021

Objectives Firearms-related injuries and deaths are a leading cause of death in children and young adults ages 5 to 24 years. This study evaluated the counseling practices and barriers to providing safe firearms storage education by pediatricians and advance practice providers. Methods An online survey was sent to 296 pediatric outpatient providers in Houston, Texas. Pediatric providers were asked about demographics, knowledge, attitudes, and current practices regarding firearms safety counseling. Descriptive and comparative analyses were performed. Results Survey respondents (N = 76) were 86% women and 87% physicians. Most (86%) agree that they should discuss firearms safety with parents, whereas only 32% report routine counseling. The most frequent barrier to providing education was insufficient time (63%), followed by unfamiliarity with guns (26%). Conclusions Pediatric providers are interested in firearms safety counseling, but few incorporate it into their practice. Addressing barriers of time and comfort level around firearms are potential first steps to curbing a leading cause of injury death among children. Further research is needed to develop counseling methods that are time efficient and culturally competent for the pediatric office.

We compared the cost-effectiveness of the common surgical strategies for the management of infants with feeding difficulty.Infants with feeding difficulty undergoing gastrostomy alone (GT), GT and fundoplication, or gastrojejunostomy (GJ) tube were enrolled between 2/2017 and 2/2018. A validated GERD symptom severity questionnaire (GSQ) and visual analog scale (VAS) to assess quality of life (QOL) were administered at baseline, 1 month, and every 6 months. Data collected included demographics, resource utilization, diagnostic studies, and costs. VAS scores were converted to quality adjusted life months (QALMs), and costs per QALM were compared using a decision tree model.Fifty patients initially had a GT alone (71% laparoscopically), and one had a primary GJ. Median age was 4 months (IQR 3-8 months). Median follow-up was 11 months (IQR 5-13 months). Forty-three did well with GT alone. Six (12%) required conversion from GT to GJ tube, and one required a fundoplication. Of those with GT alone, six (14%) improved significantly so that their GT was removed after a mean of 7 ± 3 months. Overall, the median GSQ score improved from 173 at baseline to 18 after 1 year (p 0.001). VAS scores also improved from 70/100 at baseline to 85/100 at 1 year (p 0.001). ED visits (59%), readmissions (47%), and clinic visits (88%) cost $58,091, $1,442,139, and $216,739, respectively. GJ tube had significantly higher costs for diagnostic testing compared to GT (median $8768 vs. $1007, p 0.001). Conversion to GJ tube resulted in costs of $68,241 per QALM gained compared to GT only.Most patients improved with GT alone without needing GJ tube or fundoplication. GT and GJ tube were associated with improvement in symptoms and QOL. GJ tube patients reported greater gains in QALMS but incurred higher costs. Further analysis of willingness to pay for each additional QALM will help determine the value of care.Cost-effectiveness study, Level II.

Background In patients requiring gastrostomies, ventriculoperitoneal (VP) shunts are a frequently encountered comorbidity. The objective of this study is to evaluate the postoperative management of children with VP shunts that undergo laparoscopic gastrostomy placement and determine their incidence of complications. Materials and methods Children 18 y old or younger who underwent laparoscopic gastrostomy placement at a freestanding academic children's hospital between January 2014 and October 2016 were reviewed. Data collected included demographics, management, and outcomes. Patients were compared based on their presence of a VP shunt before laparoscopic gastrostomy. Statistical analysis was performed using chi square, Fisher's exact, and Wilcoxon rank-sum tests. Results We reviewed the medical records of 270 children that underwent laparoscopic gastrostomy placement by 15 pediatric surgeons. Of these, 9% (25) had a previously placed VP shunt. In comparing patients with a VP shunt with those without a VP shunt, there was no significant difference in median age (4 versus 3 y, P = 0.92), gender (48% versus 51% males, P = 0.80), body mass index (15 versus 16, P = 0.69), preoperative diet (48% versus 47% nasogastric tube dependent, P = 0.60), or procedure time (43 versus 42 min, P = 0.37). The postoperative management of these children was similar: day of initiation of postoperative feeds (84% versus 73% on postoperative day #1, P = 0.70), method of initiation of feeds (60% versus 55% continuous, P = 0.25), and type of initial feeds (83% versus 71% Pedialyte, P = 0.24). Similarly, there was no difference in hospital length of stay, return to the emergency department, or postoperative complications within 90 d (P > 0.05). Conclusions Children with ventriculoperitoneal shunts do not have a higher rate of immediate complications after laparoscopic gastrostomy placement and may be managed similar to other children in the postoperative period.

Recently, microfluidic-based flow cytometry platforms have been shown to be powerful tools for the manipulation and analysis of single cells and micron-sized particles in flow. That said, current microfluidic flow cytometers are limited in both their analytical throughput and spatial resolution, due to their reliance on single point interrogation schemes. Conversely, high-speed imaging techniques can be applied to a wide variety of problems in which analyte molecules are manipulated at high linear velocities. Such an approach allows a detailed visualization of dynamic events through acquisition of a series of image frames captured with high temporal and spatial resolution. Herein, we describe some of the most significant recent advances in the development of multi-parametric, optofluidic imaging flow cytometry for the enumeration of complex cellular populations.

Significant non-genetic stochastic factors affect aging, causing lifespan differences among individuals, even those sharing the same genetic and environmental background. In Caenorhabditis elegans, differences in heat-shock response (HSR) are predictive of lifespan. However, factors contributing to the heterogeneity of HSR are still not fully elucidated. Here, the authors characterized HSR dynamics in isogenic C. elegans expressing GFP reporter for hsp-16.2 for identifying the key contributors of HSR heterogeneity. Specifically, microfluidic devices that enable cross-sectional and longitudinal measurements of HSR dynamics in C. elegans at different scales are developed: in populations, within individuals, and in embryos. The authors adapted a mathematical model of HSR to single C. elegans and identified model parameters associated with proteostasis—maintenance of protein homeostasis—more specifically, protein turnover, as the major drivers of heterogeneity in HSR dynamics. It is verified that individuals with enhanced proteostasis fidelity in early adulthood live longer. The model-based comparative analysis of protein turnover in day-1 and day-2 adult C. elegans revealed a stochastic-onset of age-related proteostasis decline that increases the heterogeneity of HSR capacity. Finally, the analysis of C. elegans embryos showed higher HSR and proteostasis capacity than young adults and established transgenerational contribution to HSR heterogeneity that depends on maternal age., Small, 17 (30), ISSN:1613-6810, ISSN:1613-6829

We present a sheathless, microfluidic imaging flow cytometer that incorporates stroboscopic illumination for blur-free fluorescence detection at ultra-high analytical throughput. The imaging platform is capable of multiparametric fluorescence quantification and sub-cellular localization of these structures down to 500 nm with microscopy image quality. We demonstrate the efficacy of the approach through the analysis and localization of P-bodies and stress granules in yeast and human cells using fluorescence and bright-field detection at analytical throughputs in excess of 60,000 and 400,000 cells/s, respectively. Results highlight the utility of our imaging flow cytometer in directly investigating phase-separated compartments within cellular environments and screening rare events at the sub-cellular level for a range of diagnostic applications., Cell Reports, 34 (10), ISSN:2666-3864, ISSN:2211-1247

Loop-mediated isothermal amplification (LAMP) has been widely used to detect many infectious diseases. However, minor inconveniences during the steps of adding reaction ingredients and lack of simple color results hinder point-of-care detection. We therefore invented a fluorometric paper-based LAMP by incorporating LAMP reagents, including a biotinylated primer, onto a cellulose membrane paper, with a simple DNA fluorescent dye incubation that demonstrated rapid and accurate results parallel to quantitative polymerase chain reaction (qPCR) methods. This technology allows for instant paper strip detection of methicillin-resistant

Aim To discuss the virtual learning strategies used in population health nursing course during the coronavirus disease 2019 (COVID-19) pandemic. Background The School of Nursing faculty in a South Central University in the United States quickly combined innovation with digital resources and transitioned a course in population health during the COVID-19 pandemic. Nursing faculty were challenged to develop student nursing objectives in assessment, planning, intervention and evaluation of vulnerable populations in the community through a virtual environment. Reflections of population health nursing clinical education The experiences of five clinical groups are described, covering adults with disabilities, older people, patients with COVID-19 and youth populations. Discussion The course objectives were met through use of a digital environment. Collaborative interventions were designed and implemented with community stakeholders while maintaining social distancing policies. Successes included increased frequency of communication and learning opportunities for students and the community, and student satisfaction. Barriers to student learning were not related to the digital learning environment, although the older adults required modifications to use electronic devices. Conclusion Virtual classrooms are a viable platform to teach population health nursing and to benefit vulnerable populations. Implications for nursing practice Virtual learning offers benefits within academia and the community. Technology offers the possibility to improve mental health among older people and enhance knowledge among the general population. Students are better able to connect with clinical faculty and stakeholders through digital platforms. Implications for nursing policy Nurses play a vital role in improving population health and can collaborate with community stakeholders to implement innovative and sustainable solutions to nursing education, practices and policy. Digital platforms can enhance the involvement of students through these collaborations during and after the pandemic.

Driven by complex and interconnected factors, including population growth, climate change, and geopolitics, infectious diseases represent one of the greatest healthcare challenges of the 21st century. Diagnostic technologies are the first line of defense in the fight against infectious disease, providing critical information to inform epidemiological models, track diseases, decide treatment choices, and ultimately prevent epidemics. The diagnosis of infectious disease at the genomic level using nucleic acid disease biomarkers has proven to be the most effective approach to date. Such methods rely heavily on enzymes to specifically amplify or detect nucleic acids in complex samples, and significant effort has been exerted to harness the power of enzymes for in vitro nucleic acid diagnostics. Unfortunately, significant challenges limit the potential of enzyme-assisted nucleic acid diagnostics, particularly when translating diagnostic technologies from the lab toward the point-of-use or point-of-care. Herein, we discuss the current state of the field and highlight cross-disciplinary efforts to solve the challenges associated with the successful deployment of this important class of diagnostics at or near the point-of-care.

Microrobots and metal–organic frameworks (MOFs) have been identified as promising carriers for drug delivery applications. While clinical applications of microrobots are limited by their low drug loading efficiencies and the poor degradability of the materials used for their fabrication, MOFs lack motility and targeted drug delivery capabilities. The combination of these two fields marks the beginning of a new era; MOF‐based small‐scale robots (MOFBOTs) for biomedical applications. Yet, biodegradability is a major hurdle in the field of micro‐ and nanoswimmers including small‐scale robots. Here, a highly integrated MOFBOT that is able to realize magnetic locomotion, drug delivery, and selective degradation in cell cultures is reported for the first time. The MOF used in the investigations does not only allow a superior loading of chemotherapeutic drugs and their controlled release via a pH‐responsive degradation but it also enables the controlled locomotion of enzymatically biodegradable gelatin‐based helical microrobots under magnetic fields. The degradation of the integrated MOFBOT is observed after two weeks, when all its components fully degrade. Additionally, drug delivery studies performed in cancer cell cultures show reduced viability upon delivery of Doxorubicin within short time frames. This MOFBOT system opens new avenues for highly integrated fully biodegradable small‐scale robots., Advanced Healthcare Materials, 9 (20), ISSN:2192-2640, ISSN:2192-2659

This study examined individual and community demographic characteristics surrounding suicides in one of the most populous counties in the United States. We paired medical examiner records with U.S. Census data and analyzed them using geospatial software. The majority of decedents were non-Hispanic, white males who died primarily of gunshot wounds. Salient age characteristics included interpersonal violence and depression among ages younger than 40. Despite lower incomes and education levels, areas with higher population density and racial/ethnic minorities had fewer suicides. Additional research should address depression among males and the elderly, interpersonal violence, firearm access, and culture.

Objectives The aims of this study were to assess parent acceptance of firearms education delivered by clinical providers, determine whether parents engage in firearms safety dialog with their children, and evaluate reasons for ownership and storage behaviors. Methods The parents of children ages 0 to 18 years completed surveys while in a pediatric inpatient setting in Texas. Demographics, acceptability, current behaviors, and storage practices were queried. Responses between firearms owners and nonowners were analyzed using the Fisher exact and χ2 tests. Results Of the 115 parents who completed surveys, 41% reported owning firearms. Most parents were likely or highly likely to follow their pediatrician's gun safety advice (67%), were accepting of safety videos in waiting rooms (59%), and accepted firearms locks distributed by clinical providers (69%). Nonowners were less likely than owners to have spoken to their children about gun safety (P = 0.004). Parents owned firearms for self-protection and recreation (50%), self-protection only (38%), or recreation only (12%). Owners stored them unloaded (75%), used safety devices (95%), and stored them in the closet of the master bedroom (54%). Conclusions Talking about firearms safety in a healthcare setting was not a contentious issue in the majority of our sample. Parents were accepting of provider-led firearms guidance regardless of ownership status. This provides an opportunity for providers to focus on effective messaging and time-efficient delivery of firearms safety education.

To date, 55% of inhabitants of the developing world still live in rural regions and they have a very urgent need to improve the level of disease diagnosis, especially in resource-limited settings. Herein, we present a microfluidic system that centrifuges whole blood and quantifies contained biomarkers in a rapid, feasible and integrated way. Such a device provides a blood-in/answer-out capability and is small enough to be carried by any individual in any environment. The successful integration a hand-powered centrifuge and immunoassay unit within a rotational paper-based device allows for diagnostic application by untrained users and in environments where access to electricity cannot be assumed. In addition, the low cost (~$ 0.5), light weight and small instrumental footprint make the device ideally suited for rapid on-site detection. To validate the applicability of the system in a clinical diagnostic testing, we successfully perform enzyme-linked immunosorbent assay (ELISA) analysis of carcinoembryonic antigen and alpha fetoprotein from human blood samples. We expect that this powerful platform technology will provide the opportunities for point-of-care diagnosis in resource-limited settings.

Outcomes and resource utilization were evaluated after implementing a novel complex appendicitis (CA) pathway limiting postoperative antibiotics based on clinical parameters.Children with intraoperative CA (gangrenous, perforated, or abscess) were treated with intravenous antibiotics postoperatively until clinical criteria were met, without utilizing CBC or oral antibiotics at discharge. An interrupted time series (pre-intervention, transition, post-intervention) was used to assess outcomes. Hospital length of stay (LOS) was analyzed using segmented regression. Intra-abdominal abscess and readmission rates were analyzed using non-inferiority and multivariate logistic regression.Five hundred ten children were included with a median age of 10 [IQR7-12] years. There were no differences in postoperative LOS (slope - 0.008; p = 0.855), intra-abdominal abscess rate (5% vs. 8%; p = 0.135), or readmission rate (12% vs. 8%; p = 0.113) across time periods which remained true when adjusting for age, gender, and intraabdominal disease severity. Post-intervention outcomes were not inferior to pre-intervention, abscess rate (p = 0.002), or readmission rate (p 0.001). Intraoperative findings of perforation (OR9.0; 95% CI1-71; p = 0.044) and perforation with abscess (OR18.2; 95% CI2-36; p = 0.005) were associated with a greater likelihood of postoperative abscess compared to gangrenous appendicitis.A CA protocol based on clinical parameters is safe and effective, resulting in similar intra-abdominal abscess and readmission rates compared to more resource-intense regimens.III TYPE OF RESEARCH: Interrupted Time Series.

A variety of automated sample-in-answer-out systems for in vitro molecular diagnostics have been presented and even commercialized. Although efficient in operation, they are incapable of quantifying targets, since quantitation based on analog analytical methods (via standard curve analysis) is complex, expensive, and challenging. To address this issue, herein, we describe an integrated sample-in-digital-answer-out (SIDAO) diagnostic system incorporating DNA extraction and digital recombinase polymerase amplification, which enables rapid and quantitative nucleic acid analysis from bodily fluids within a disposable cartridge. Inside the cartridge, reagents are pre-stored in sterilized tubes, with an automated pipetting module allowing facile liquid transfer. For digital analysis, we fabricate a simple, single-layer polydimethylsiloxane microfluidic device and develop a novel and simple sample compartmentalization strategy. Sample solution is partitioned into an array of 40,044 fL-volume microwells by sealing the microfluidic device through the application of mechanical pressure. The entire analysis is performed in a portable, fully automated instrument. We evaluate the quantitative capabilities of the system by analyzing Mycobacterium tuberculosis genomic DNA from both spiked saliva and serum samples, and demonstrate excellent analytical accuracy and specificity. This SIDAO system provides a promising diagnostic platform for quantitative nucleic acid testing at the point-of-care. Graphical abstract ᅟ.

This study examines non-accidental trauma (NAT) fatalities as a percentage of all injury fatalities and identifies injury patterns in NAT admissions to two level 1 pediatric trauma centers.We reviewed all children (5years old) treated for NAT from 2011 to 2015. Patient demographics, injury sites, and survival were obtained from both institutional trauma registries.Of 4623 trauma admissions, 557 (12%) were due to NAT. However, 43 (46%) of 93 overall trauma fatalities were due to NAT. Head injuries were the most common injuries sustained (60%) and led to the greatest increased risk of death (RR 5.1, 95% CI 2.0-12.7). Less common injuries that increased the risk of death were facial injuries (14%, RR 2.9, 95% CI 1.6-5.3), abdominal injuries (8%, RR 2.8, 95% CI 1.4-5.6), and spinal injuries (3%, RR 3.9, 95% CI 1.8-8.8). Although 76% of head injuries occurred in infants1year, children ages 1-4years old with head injuries had a significantly higher case fatality rate (27% vs. 6%, p0.001).Child abuse accounts for a large proportion of trauma fatalities in children under 5years of age. Intracranial injuries are common in child abuse and increase the risk of death substantially. Preventing NAT in infants and young children should be a public health priority.Retrospective Review.II.

Hydrodynamic phenomena are ubiquitous in living organisms and can be used to manipulate cells or emulate physiological microenvironments experienced in vivo. Hydrodynamic effects influence multiple cellular properties and processes, including cell morphology, intracellular processes, cell–cell signaling cascades and reaction kinetics, and play an important role at the single-cell, multicellular, and organ level. Selected hydrodynamic effects can also be leveraged to control mechanical stresses, analyte transport, as well as local temperature within cellular microenvironments. With a better understanding of fluid mechanics at the micrometer-length scale and the advent of microfluidic technologies, a new generation of experimental tools that provide control over cellular microenvironments and emulate physiological conditions with exquisite accuracy is now emerging. Accordingly, we believe that it is timely to assess the concepts underlying hydrodynamic control of cellular microenvironments and their applications and provide some perspective on the future of such tools in in vitro cell-culture models. Generally, we describe the interplay between living cells, hydrodynamic stressors, and fluid flow-induced effects imposed on the cells. This interplay results in a broad range of chemical, biological, and physical phenomena in and around cells. More specifically, we describe and formulate the underlying physics of hydrodynamic phenomena affecting both adhered and suspended cells. Moreover, we provide an overview of representative studies that leverage hydrodynamic effects in the context of single-cell studies within microfluidic systems., Chemical Reviews, 118 (4), ISSN:0009-2665, ISSN:1520-6890

In recent years, high-speed imaging has become increasingly effective for the rapid analysis of single cells in flowing environments. Single cell imaging methods typically incorporate a minimum magnification of 10× when extracting sizing and morphological information. Although information content may be significantly enhanced by increasing magnification, this is accompanied by a corresponding reduction in field of view, and thus a decrease in the number of cells assayed per unit time. Accordingly, the acquisition of high resolution data from wide field views remains an unsolved challenge. To address this issue, we present an optofluidic flow cytometer integrating a refractive, microlens array (MLA) for imaging cells at high linear velocities, whilst maximizing the number of cells per field of view. To achieve this, we adopt an elasto-inertial approach for cell focusing within an array of parallel microfluidic channels, each equipped with a microlens. We characterize the optical performance of the microlenses in terms of image formation, magnification and resolution using both ray-tracing simulations and experimental measurements. Results demonstrate that the optofluidic platform can efficiently count and magnify micron-sized objects up to 4 times. Finally, we demonstrate the capabilities of the platform as an imaging flow cyclometer, demonstrating the efficient discrimination of hB and Jurkat cells at throughputs up to 50 000 cells per second.

The mechanical properties of cells are of enormous interest in a diverse range of physio and pathological situations of clinical relevance. Unsurprisingly, a variety of microfluidic platforms have been developed in recent years to study the deformability of cells, most commonly employing pure shear or extensional flows, with and without direct contact of the cells with channel walls. Herein, we investigate the effects of shear and extensional flow components on fluid-induced cell deformation by means of three microchannel geometries. In the case of hyperbolic microchannels, cell deformation takes place in a flow with constant extensional rate, under non-zero shear conditions. A sudden expansion at the microchannel terminus allows one to evaluate shape recovery subsequent to deformation. Comparison with other microchannel shapes, that induce either pure shear (straight channel) or pure extensional (cross channel) flows, reveals different deformation modes. Such an analysis is used to confirm the softening and stiffening effects of common treatments, such as cytochalasin D and formalin on cell deformability. In addition to an experimental analysis of leukaemia cell deformability, computational fluid dynamic simulations are used to deconvolve the role of the aforementioned flow components in the cell deformation dynamics. In general terms, the current study can be used as a guide for extracting deformation/recovery dynamics of leukaemia cell lines when exposed to various fluid dynamic conditions.

Purpose Firearm injuries continue to be a common cause of injury for American children. This pilot study was developed to evaluate the feasibility of providing guidance about firearm safety to the parents of pediatric patients using a tablet-based module in the outpatient setting. Methods A tablet-based questionnaire that included a firearm safety message based on current best practice was administered to parents of pediatric patients at nine centers in 2018. Parents were shown a firearm safety video and then asked a series of questions related to firearm safety. Results The study was completed by 543 parents from 15 states. More than one-third (37%) of families kept guns in their home. The majority of parents (81%, n = 438) thought it was appropriate for physicians to provide firearm safety counseling. Two-thirds (63%) of gun owning parents who do not keep their guns locked said that the information provided in the module would change the way they stored firearms at home. Conclusion Use of a tablet based firearm safety module in the outpatient setting is feasible, and the majority of parents are receptive to receiving anticipatory guidance on firearm safety. Further data is needed to evaluate whether the intervention will improve firearm safety practices in the home. Level of Evidence Level III.

Despite the growing importance of droplet-based microfluidics in high-throughput experimentation, few current methods allow the sensitive measurement of absorbance within rapidly moving droplets. To address this significant limitation, we herein present the application of differential detection photothermal interferometry (DDPI) for single-point absorbance quantification in pL- and fL-volume droplets. To assess the efficacy of our approach, we initially measure absorbance in 100 pL droplets at frequencies in excess of 1 kHz and determine a detection limit of 1.4 μmol L-1 for Erythrosin B (A = 3.8 × 10-4). Subsequently, we apply the method to the analysis of fL-volume droplets and droplets generated at frequencies in excess of 10 kHz. Finally, we demonstrate the utility of DDPI as a detection scheme for colorimetric assays. Specifically, we extract the Michaelis-Menten constant for the reaction of β-galactosidase and chlorophenol-red-β-d-galactopyranoside and monitor the metabolomic activity of a population of HL-60 cells at the single cell level. Results establish single-point absorbance detection as a powerful, sensitive and rapid alternative to fluorescence for a wide range of assays within segmented flows.

We examined the association of body composition and body mass index (BMI) with submaximal systolic blood pressure (SSBP) among young adult men. The analysis included 211 men with BMI between 20 and 35 kg/m(2). Total lean mass and fat mass were measured using dual x-ray absorptiometry and lean mass percentage was calculated from the total lean mass. Fat mass index (FMI) and BMI were calculated using height and weight (total fat mass and total weight, respectively) measurements. SSBP was measured at each stage of a graded exercise test. Quintiles of lean mass percentage, FMI, and BMI were created with quintile 1 the lowest and quintile 5 the highest lean mass percentage, FMI, and BMI. Compared with men in lean mass percentage quintile 1, those in quintiles 2, 3, and 4 had significantly lower SSBP, whereas there was no significant difference in SSBP between quintile 1 and 5 at 6, 8, and 10 minutes. Compared with men in FMI quintile 5, those in quintiles 2, 3, and 4 had significantly lower SSBP, whereas there was no significant difference in SSBP between quintile 1 and 5. SSBP among men in lean mass percentage quintile 5 and FMI quintile 1 were still less than lean mass percentage quintile 1 and FMI quintile 5, respectively. There were no significant differences in SSBP across BMI quintiles 1 to 4 but a significantly higher SSBP in quintile 5 compared with quintiles 1 to 4. In conclusion, there was a J-curve pattern between SSBP and components of body composition, whereas, a linear relation between SSBP and BMI.

Fluorescence polarization (FP) is a sensitive, robust, and homogeneous assay format, able to probe a diversity of biological molecules and their interactions. Herein, we describe a new FP strategy based on the use of streptavidin as a signal amplifier. Such signal amplified fluorescence polarization (SAFP) was used to monitor the binding affinity of human angiogenin and a single-stranded DNA aptamer. Streptavidin was bound to a biotinylated single-stranded DNA aptamer and the interaction between this complex and Alexa Fluor 488 labelled human angiogenin was measured. A dissociation constant of 135.3 ± 32.9 nM and a limit of detection of 6.3 nM were successfully extracted only when the FP signal was increased (without binding hindrance) via streptavidin. Moreover, the demonstrated approach was specific to target molecules without any non-specific binding. The streptavidin-triggered SAFP method unlike amplification strategies that utilize nanomaterials (such as graphene oxides, carbon nanotubes, and metal nanoparticles) is not compromised by fluorescence quenching, and it is able to operate within nanomolar concentration regimes. Furthermore, unlike the other FP signal amplification strategies that use dual binding DNA probes, the presented method is simple to implement with signal amplification only requiring the binding of streptavidin with biotinylated DNA. This method could be expanded to analyze molecular interactions and it may be a useful tool for FP measurement by reducing the concentration of rare and expensive protein samples.

We report the application of a fully automated surface-enhanced Raman scattering (SERS)-based solenoid-embedded microfluidic device to the quantitative and sensitive detection of anthrax biomarker poly-γ-D-glutamic acid (PGA) in solution. Analysis is based on the competitive reaction between PGA and PGA-conjugated gold nanoparticles with anti-PGA-immobilized magnetic beads within a microfluidic environment. Magnetic immunocomplexes are trapped by yoke-type solenoids embedded within the device, and their SERS signals were directly measured and analyzed. To improve the accuracy of measurement process, external standard values for PGA-free serum were also measured through use of a control channel. This additional measurement greatly improves the reliability of the assay by minimizing the influence of extraneous experimental variables. The limit of detection (LOD) of PGA in serum, determined by our SERS-based microfluidic sensor, is estimated to be 100 pg/mL. We believe that the defined method represents a valuable analytical tool for the detection of anthrax-related aqueous samples.

Purpose This study assesses the impact of extracorporeal membrane oxygenation (ECMO) associated morbidities on long-term quality of life (QOL) outcomes. Methods A single center, retrospective review of neonatal and pediatric non-cardiac ECMO survivors from 1/2005–7/2016 was performed. The 2012 Pediatric Quality of Life Inventory™ (PedsQL™) survey was administered. Clinical outcomes and QOL scores between groups were compared. Results Of 74 patients eligible, 64% (35 NICU, 12 PICU) completed the survey. Mean time since ECMO was 5.5±3years. ECMO duration for venoarterial (VA) and venovenous (VV) were similar (median 9 vs. 7.5days, p=0.09). VA ECMO had higher overall complication rate (64% vs. 36%, p=0.06) and higher neurologic complication rate (52% vs. 9%, p=0.002). ECMO mode and ICU type did not impact QOL. However, patients with neurologic complications (n=15) showed a trend towards lower overall QOL (63/100±20 vs. 74/100±18, p=0.06) compared to patients without neurologic complications. A subset analysis of patients with ischemic or hemorrhagic intracranial injuries (n=13) had significantly lower overall QOL (59/100±19 vs. 75/100±18, p=0.01) compared to patients without intracranial injuries. Conclusion Neurologic complication following ECMO is common, associated with VA mode, and negatively impacts long-term QOL. Given these associations, when clinically feasible, VV ECMO may be considered as first line ECMO therapy. Type of study Retrospective review. Level of evidence II

The ability to manipulate biological cells is critical in a diversity of biomedical and industrial applications. Microfluidic-based cell manipulations provide unique opportunities for sophisticated and high-throughput biological assays such as cell sorting, rare cell detection, and imaging flow cytometry. In this respect, cell focusing is an extremely useful functional operation preceding downstream biological analysis, since it allows the accurate lateral and axial positioning of cells moving through microfluidic channels, and thus enables sophisticated cell manipulations in a passive manner. Herein, we explore the utility of viscoelastic carrier fluids for enhanced elasto-inertial focusing of biological species within straight, rectangular cross section microfluidic channels. Since the investigated polymer solutions possess viscosities close to that of water and exhibit negligible shear thinning, focusing occurs over a wide range of elasticity numbers and a large range of Reynolds numbers. With a view to applications in the robust focusing of cells and bacteria, we assess and characterize the influence of accessible focusing parameters, including blockage ratio, volumetric flow rate, cell concentration, and polymer chain length.

The objective of this study was to evaluate postoperative feeding regimens after laparoscopic gastrostomy placement and their effect on outcomes.Children 18 years of age or younger, who underwent laparoscopic gastrostomy placement at a tertiary-care academic children's hospital between January 2014 and October 2016, were reviewed. Data collected included patient characteristics, postoperative feeding regimen, and clinical outcomes. Statistical analysis was performed using Chi-square, Fisher's exact, and Wilcoxon Rank-Sum tests.We reviewed the medical records of 270 children that underwent laparoscopic gastrostomy placement by 15 pediatric surgeons. The median age was 2.7 (interquartile range [IQR], 0.7-9.6) years, and 50% (n = 136) were male. The median body mass index was 15.5 (IQR, 14.0-17.5). Complications within 90 days included: granulation tissue (34%), leakage (17%), dislodgement (14%), and skin and soft-tissue infection (9%). Two patients returned to the operating room, 1 for a dislodged tube, and another for a volvulus within 10 days of gastrostomy tube placement. A subset analysis of outpatients that underwent elective laparoscopic gastrostomy placement showed variation in the day of initial feeds (0-2 postoperative days [POD]), method of initial feeds (continuous versus bolus) and choice of initial feeds (Pedialyte versus formula/breast milk). There was a significant difference in median hospital length of stay for early versus late initiation of feeds (POD 0: 2.1 days versus POD ≥1: 3.1 days, P .01) without a difference in postoperative complications.There is substantial variation in the postoperative feeding regimen after laparoscopic gastrostomy. Initiation of early postoperative feeds may result in decreased length of stay without increasing complications.

Pediatric anxiety during cast room procedures is common and various methods to manage distress may be used. Certified Child Life Specialists (CCLS) are formally trained professionals with proficiency in helping children during taxing events. The utilization of a CCLS has not been well documented in a pediatric orthopedic cast room. The aim of this study was to assess the impact of a CCLS in this setting through a prospective randomized trial. 86 children, age range 2-10 years, who underwent cast room procedures were randomized: group I (42 children) had a CCLS present during their procedure. Group II (44 children) did not have a CCLS present during their procedure. Procedures included cast removal/placement, fracture manipulation, and pin removal. We calculated change in heart rate as beats per min (bpm) during various stages of the visit and a subjective behavior score evaluating behaviors, score range -3 to 3. There was no significant difference in the demographics and age between groups. The mean behavior score for group I was 1.78 versus 1.04 in group II (P0.001). The change in heart rate recorded showed an increase by 7.5 and 9.3 bpm in groups I and II, respectively (P=0.829). CCLS Therapy significantly affects the observed behavior score of children undergoing a procedure in a pediatric orthopedic cast room. A greater increase in heart rate was observed as a trend in those children treated in the absence of a CCLS. The presence of a CCLS appears to positively affect the cast-room experience for children and their caregivers.Level II - Therapeutic Randomized-Controlled Trial.

Objective:To determine whether providing remote neurologic care into the homes of people with Parkinson disease (PD) is feasible, beneficial, and valuable.Methods:In a 1-year randomized controlled trial, we compared usual care to usual care supplemented by 4 virtual visits via video conferencing from a remote specialist into patients' homes. Primary outcome measures were feasibility, as measured by the proportion who completed at least one virtual visit and the proportion of virtual visits completed on time; and efficacy, as measured by the change in the Parkinson's Disease Questionnaire–39, a quality of life scale. Secondary outcomes included quality of care, caregiver burden, and time and travel savings.Results:A total of 927 individuals indicated interest, 210 were enrolled, and 195 were randomized. Participants had recently seen a specialist (73%) and were largely college-educated (73%) and white (96%). Ninety-five (98% of the intervention group) completed at least one virtual visit, and 91% of 388 virtual visits were completed. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% confidence interval [CI] −2.0 to 2.7 points; p = 0.78) nor did quality of care or caregiver burden. Each virtual house call saved patients a median of 88 minutes (95% CI 70–120; p < 0.0001) and 38 miles per visit (95% CI 36–56; p < 0.0001).Conclusions:Providing remote neurologic care directly into the homes of people with PD was feasible and was neither more nor less efficacious than usual in-person care. Virtual house calls generated great interest and provided substantial convenience.ClinicalTrials.gov identifier:NCT02038959.Classification of evidence:This study provides Class III evidence that for patients with PD, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits. The study is rated Class III because it was not possible to mask patients to visit type.

Introduction: Near-eye display devices (such as Google Glass) may improve the efficiency and effectiveness of clinical care by giving clinicians information (such as the patient's vital signs) continuously within their field of vision during various procedures. We describe the use of Glass during a radiological intervention in three patients. Other possible applications (including tele-mentoring and the supervision of trainees) are discussed and a classification proposed. Methods: An app was developed to facilitate the use of Glass, so vital physical signs (pulse and blood pressure) could be projected on the near-eye display, via an intranet to protect sensitive data. The device was then used during radiological interventions (percutaneous transluminal angioplasty) in three patients, and assessed by the interventionalists who were interviewed before and after each procedure. Results: The interventionalists reported that Google Glass improved concentration on the task in hand by reducing head and neck movements (which would be needed to view several remote monitors). However, heat generation by the device and low battery capacity are shortcomings for which solutions must be developed, and data protection is mandatory. Conclusion: Google Glass may have a number of clinical applications and can quicken interventions where vital signs or other visual data need to be monitored by the operator.

The purpose of this study was to compare the accuracy of the spatial registration of conventional PET/CT with that of hybrid PET/MRI of patients with FDG-avid metastatic lesions.Thirteen patients with known metastatic lesions underwent FDG PET/CT followed by PET/MRI with a hybrid whole-body system. The inclusion criterion for tumor analysis was spherical or oval FDG-avid tumor clearly identified with both CT and MRI. The spatial coordinates (x, y, z) of the visually estimated centers of the lesions were determined for PET/CT (PET and CT independently) and PET/MRI (PET, T1-weighted gradient-echo sequence with radial stack-of-stars trajectory, T2-weighted sequence), and the b0 images of an echo-planar imaging (EPI) diffusion-weighted imaging (DWI) acquisition. All MRI sequences were performed in the axial plane with free breathing. The spatial coordinates of the estimated centers of the lesions were determined for PET and CT and PET and MRI sequences. Distance between the isocenter of the lesion on PET images and on the images obtained with the anatomic modalities was measured, and misregistration (in millimeters) was calculated. The degree of misregistration was compared between PET/CT and PET/MRI with a paired Student t test.Nineteen lesions were evaluated. On PET/CT images, the average of the total misregistration in all planes of CT compared with PET was 4.13 ± 4.24 mm. On PET/MR images, lesion misregistration between PET and T1-weighted gradient-echo images had a shift of 2.41 ± 1.38 mm and between PET and b0 DW images was 5.97 ± 2.83 mm. Similar results were calculated for 11 lesions on T2-weighted images. The shift on T2-weighted images compared with PET images was 2.24 ± 1.12 mm. Paired Student t test calculations for PET/CT compared with PET/MRI T1-weighted gradient-echo images with a radial stack-of-stars trajectory, b0 DW images, and T2-weighted images showed significant differences (p0.05). Similar results were seen in the analysis of six lung lesions.PET/MRI T1-weighted gradient-echo images with a radial stack-of-stars trajectory and T2-weighted images had more accurate spatial registration than PET/CT images. This may be because that the whole-body PET/MRI system used can perform simultaneous acquisition, whereas the PET/CT system acquires data sequentially. However, the EPI-based b0 DWI datasets were significantly misregistered compared with the PET/CT datasets, especially in the thorax. Radiologists reading PET/MR images should be aware of the potential for misregistration on images obtained with EPI-based DWI sequences because of inherent spatial distortion associated with this type of MRI acquisition.

We assessed multiple readers’ positive predictive values (PPVs) for ACR BI-RADS 3, 4a, 4b, 4c and 5 masses on ultrasound (US) pre- and post-proposed guidelines. This retrospective, IRB-approved study included four American and four non-American readers who assigned BI-RADS categories for US images of 374 biopsy-proved masses. Readers were offered guidelines and re-classified the masses. We assessed readers’ abilities to achieve ACR benchmarks BI-RADS categories pre- and post-guidelines. PPVs increased with BI-RADS category. The PPVs pre- and post-guidelines were 6.0% and 4.4% for category 3, 27.3% and 30.5% for category 4a, 49.9% and 51.5% for category 4b, 69.0% and 67.4% for category 4c, and 79.3% and 80.1% for category 5. Readers achieved the PPV benchmark for category 4c, but not for categories 3, 4a, 4b and 5, with no significant improvement after guidelines. Regular BI-RADS 4 subcategory users missed benchmarks by less than non-regular users. Pre- and post-guidelines, readers’ PPVs increased with BI-RADS categories, ACR PPV benchmarks were achieved in category 4c, missed in other categories, especially in the critical 4a subcategory, where the PPV was too high. BI-RADS 4 subcategory users performed better than non-users. • Readers failed to achieve benchmarks for BI-RADS 4 subcategories, especially 4a. • USA and Brazilian readers performed similarly in ACR BI-RADS 4 subcategorization. • Proposed guidelines did not improve overall, USA or Brazilian reader performance. • Regularly BI-RADS 4 subcategory users performed better than did non-users. • US features distinguished between benign and malignant, not BI-RADS 4 subcategories.

Background: Delivering specialty care remotely directly into people's homes can enhance access for and improve the healthcare of individuals with chronic conditions. However, evidence supporting this approach is limited. Materials and Methods: Connect.Parkinson is a randomized comparative effectiveness study that compares usual care of individuals with Parkinson's disease in the community with usual care augmented by virtual house calls with a Parkinson's disease specialist from 1 of 18 centers nationally. Individuals in the intervention arm receive four virtual visits from a Parkinson's disease specialist over 1 year via secure, Web-based videoconferencing directly into their homes. All study activities, including recruitment, enrollment, and assessments, are conducted remotely. Here we report on interest, feasibility, and barriers to enrollment in this ongoing study. Results: During recruitment, 11,734 individuals visited the study's Web site, and 927 unique individuals submitted electronic interest forms. Two hundred ten individuals from 18 states enrolled in the study from March 2014 to June 2015, and 195 were randomized. Most participants were white (96%) and college educated (73%). Of the randomized participants, 73% had seen a Parkinson's disease specialist within the previous year. Conclusions: Among individuals with Parkinson's disease, national interest in receiving remote specialty care directly into the home is high. Remote enrollment in this care model is feasible but is likely affected by differential access to the Internet.

We report a novel wash-free magnetic immunoassay technique for prostate-specific antigen (PSA) that uses a surface-enhanced Raman scattering (SERS)-based microdroplet sensor. The magnetic bar embedded in a droplet-based microfluidic system segregates the free and bound SERS tags by splitting the droplets into two smaller parts. The presence of PSA targets leads more SERS tags to immunocomplex in one droplet so that fewer SERS tags remain in another supernatant solution droplet. Thus, SERS signal measurement enables the quantitative evaluation of PSA markers. This approach can provide a rapid and sensitive assay that is applicable for PSA cancer markers in serum without any washing. Specifically, SERS signals were measured at 174 droplets per minute and averaged for quantitative evaluation of PSA. The limit of detection (LOD) determined by our SERS-based microdroplet sensor was estimated to be below 0.1 ng mL(-1), which is significantly below the clinical cut-off value for the diagnosis of prostate cancer. In addition, because the entire assay can be carried out automatically, only a minimal amount of sample is needed. Accordingly, the approach is expected to be useful as a potential clinical tool for the early diagnosis of prostate cancer.

Droplet-based microfluidic systems have emerged as a powerful platform for performing high-throughput biological experimentation. In addition, fluorescence polarization has been shown to be effective in reporting a diversity of bimolecular events such as protein-protein, DNA-protein, DNA-DNA, receptor-ligand, enzyme-substrate, and protein-drug interactions. Herein, we report the use of fluorescence polarization for high-throughput protein-protein interaction analysis in a droplet-based microfluidic system. To demonstrate the efficacy of the approach, we investigate the interaction between angiogenin (ANG) and antiangiogenin antibody (anti-ANG Ab) and demonstrate the efficient extraction of dissociation constants (K(D) = 10.4 ± 3.3 nM) within short time periods.

According to recent estimates, there is a shortage of around 45,000 psychiatrists in the United States. It will be very difficult to address this problem without attracting more medical students to psychiatry and motivating the current crop of psychiatrists to see more patients and delay retirement. In this study the authors sought to identify factors that have a significant impact on the career satisfaction of psychiatrists.Data were gathered from 314 psychiatrists who participated in the 2008 Health Tracking Physician Survey conducted by the Center for Studying Health System Change. Independent variables were grouped as practice-related factors, compensation-related factors, patient-related factors, and demographic characteristics of psychiatrists. Career satisfaction of psychiatrists was the outcome measure of this study.Threat of malpractice and the need to consider in treatment decisions out-of-pocket cost to patients had a significant negative impact on career satisfaction. Adequate time with a patient had a significant positive impact on career satisfaction. None of the compensation-related factors was significant. Psychiatrists who worked in practices that accepted new Medicare patients reported significantly higher levels of career dissatisfaction, whereas those who worked in practices that accepted new Medicaid patients reported significantly higher levels of career satisfaction. Older psychiatrists were more satisfied than younger psychiatrists, and white, non-Hispanic psychiatrists were more satisfied than African-American or Hispanic psychiatrists.The results of this study highlight the need for policy makers and health care administrators to develop specific strategies to increase career satisfaction, which in return may help alleviate the shortage of psychiatrists.

Interventions offering peer mentoring programmes promoting moderate-to-vigorous physical activity (MVPA) have shown improvements in MVPA and well-being from baseline; however, research is limited. The purpose of this study was to compare the physical activity (PA) levels and psychosocial well-being of coaches and participants at baseline and following a 12-week intervention. Breast cancer survivors (

Every little drop: The K(D) values of angiogenin (ANG) interactions as shown by FRET analysis of thousands of pL-sized droplets agree with data from bulk-fluorescence polarization measurements. Importantly, the use of fluorophores does not affect the activity of ANG or the binding of anti-ANG antibodies to ANG. Such an experimental platform could be applied to the high-throughput analysis of protein-protein interactions.

Remote patient management (RPM) is a transformative technology that improves chronic care management while reducing net spending for chronic disease. Broadly deployed within the Veterans Health Administration and in many small trials elsewhere, RPM has been shown to support patient self-management, shift responsibilities to non-clinical providers, and reduce the use of emergency department and hospital services. Because transformative technologies offer major opportunities to advance national goals of improved quality and efficiency in health care, it is important to understand their evolution, the experiences of early adopters, and the business models that may support their deployment.