Search

The increasing demand for wastewater treatment has become a notable trend for addressing global water scarcity. However, fouling is a significant challenge for wastewater distribution engineering systems. This study provides an approach using nanobubbles (NBs) to control fouling. The antifouling capacities of three types of NBs, six oxygen concentrations, and two application procedures (prevention and removal) are investigated. The results show that NBs effectively mitigate composite fouling—including biofouling, inorganic scaling, and particulate fouling—in comparison with the non-NBs group. More specifically, hydroxyl radicals generated by the self-collapse of NBs oxidize organics and kill microorganisms in wastewater. The negatively charged surfaces of the NBs transform the crystalline form of CaCO3 from calcite to looser aragonite, which reduces the likelihood of ion precipitation. Furthermore, the NBs gas-liquid interfaces act as gas “bridges” between colloidal particles, enhancing the removal of particles from wastewater. Lastly, although the NBs inhibit the growth of fouling, they do not significantly remove the already adhered fouling in non-NBs treated groups. This study anticipates that the application of NBs will address the significant fouling issue for various wastewater distribution engineering systems in order to meet the global challenge of sustainable water supplies.

Abstract Introduction The COVID-19 pandemic unveiled huge challenges in health workforce governance in the context of public health emergencies in Africa. Several countries applied several measures to ensure access to qualified and skilled health workers to respond to the pandemic and provide essential health services. However, there has been limited documentation of these measures. This study was undertaken to examine the health workforce governance strategies applied by 15 countries in the World Health Organization (WHO) Africa Region in responding to the COVID-19 pandemic. Methods We extracted data from country case studies developed from national policy documents, reports and grey literature obtained from the Ministries of Health and other service delivery agencies. This study was conducted from October 2020 to January 2021 in 15 countries - Angola, Burkina Faso, Chad, Eswatini, Ghana, Guinea, Guinea Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal and Togo. Results All 15 countries had national multi-sectoral bodies to manage the COVID-19 response and a costed national COVID-19 response plan. All the countries also reflected human resources for health (HRH) activities along the different response pillars. These activities included training for health workers, and budget for the recruitment or mobilization of additional health workers to support the response, and for provision of financial and non-financial incentives for health workers. Nine countries recruited additional 35,812 health workers either on a permanent or temporary basis to respond to the COVID-19 with an abridged process of recruitment implemented to ensure needed health workers are in place on time. Six countries redeployed 3671 health workers to respond to the COVID-19. The redeployment of existing health workers was reported to have impacted negatively on essential health service provision. Conclusion Strengthening multi-sector engagement in the development of public health emergency plans is critical as this promotes the development of holistic interventions needed to improve health workforce availability, retention, incentivization, and coordination. It also ensures optimized utilization based on competencies, especially for the existing health workers.

Preparing patients for posthospital care may improve readmission risk. Alternative payment models (APMs) incent hospitals to reduce readmissions by tying payment to outcomes. The impact of APMs on preparation for discharge is not well understood. We assessed whether patient-reported preparation for posthospital care was associated with reduced readmissions, and whether APM participation was associated with improved preparation for posthospital care. We used mixed-effects regression on retrospective (2013–2017) observational data for 2685 U.S. hospitals. We measured patient-reported preparation for posthospital care using the 3-Item Care Transition Measure and readmission using 30-day all-cause risk-adjusted readmissions from Hospital Compare. Participation in accountable care organizations (ACOs), Medical Homes, and Medicare's Bundled Payments for Care Improvement program was obtained from Medicare, the American Hospital Association's Annual Survey, and Leavitt Partner's ACO database. We found that APMs are not associated with improved preparation for posthospital care, even though it was associated with reduced readmissions (Marginal Effect: −0.012 percentage points). This may be because hospitals are not investing in patient engagement. This study has limited insight into causality and reduced generalizability among smaller, rural, and non-teaching hospitals.

Abstract Background Globally, countries are taking actions to ensure that their population have improved access to people-centred and integrated health services. Attaining this requires improved access to health workers at all levels of health service delivery and equitably distributed by geographical location. Due to the persistent health worker shortages, countries have resorted to implementing task shifting and task sharing in various settings to optimally utilize existing health workers to improve access to health services. There are deliberations on the need for an implementation framework to guide the adoption and operationalization of task shifting and task sharing as a key strategy for optimally utilizing the existing health workforce towards the achievement of UHC. The objective of this study was to develop an implementation framework for task shifting and task sharing for policy and practice in Africa. Methods A sequential multimethod research design supported by scoping reviews, and qualitative descriptive study was employed in this study. The evidence generated was synthesized into an implementation framework that was evaluated for applicability in Africa by 36 subject matter experts. Results The implementation framework for task shifting and task sharing has three core components – context, implementation strategies and intended change. The implementation strategies comprise of iterative actions in the development, translation, and sustainment phases that to achieve an intended change. The implementation strategies in the framework include mapping and engagement of stakeholders, generating evidence, development, implementation and review of a road map (or action plan) and national and/or sub-national policies and strategies, education of health workers using manuals, job aids, curriculum and clinical guidelines, and monitoring, evaluation, reviews and learning. Conclusion The implementation framework for task shifting and task sharing in Africa serves as a guide on actions needed to achieve national, regional and global goals based on contextual evidence. The framework illustrates the rationale and the role of a combination of factors (enablers and barriers) in influencing the implementation of task shifting and task sharing in Africa.

Promotion of colorectal cancer (CRC) screening can be expensive and unnecessary for many patients. The use of predictive analytics promises to help health systems target the right services to the right patients at the right time while improving population health. Multilevel data at the interpersonal, organizational, community, and policy levels, is rarely considered in clinical decision making but may be used to improve CRC screening risk prediction. We compared the effectiveness of a CRC screening risk prediction model that uses multilevel data with a more conventional model that uses only individual patient data.We used a retrospective cohort to ascertain the one-year occurrence of CRC screening. The cohort was determined from a Health Maintenance Organization, in Oregon. Eligible patients were 50–75 years old, health plan members for at least one year before their birthday in 2018 and were due for screening. We created a risk model using logistic regression first with data available in the electronic health record (EHR), and then added multilevel data.In a cohort of 59,249 patients, 36.1% completed CRC screening. The individual level model included 14 demographic, clinical and encounter based characteristics, had a bootstrap-corrected C-statistic of 0.722 and sufficient calibration. The multilevel model added 9 variables from clinical setting and community characteristics, and the bootstrap-corrected C-statistic remained the same with continued sufficient calibration.The predictive power of the CRC screening model did not improve after adding multilevel data. Our findings suggest that multilevel data added no improvement to the prediction of the likelihood of CRC screening.

# Background Nigeria developed a National Task Shifting and Sharing Policy due to protracted inequitable distribution of health workers, especially at the primary level of care, and the low stock and production rate of skilled health workforce. Following the development of Nigeria’s task shifting and sharing policy and strategy, implementation was promulgated at various levels, with States adopting and implementing the national policy. However, the policy environment for task shifting and sharing varies widely. Consequently, evidence on barriers to and factors promoting successful implementation are inconclusive. Hence, strategies for improving implementation are needed. The evidence from this study can inform the scale-up and strengthening of implementation approaches as Nigeria strives to achieve the national goals, universal health coverage and sustainable development goals. # Methods An explorative, descriptive research study approach was applied with 20 key informant interviews conducted to explore the perception of policymakers on barriers and promoters of task shifting and sharing in Nigeria. In addition, strategies for improving task shifting and sharing implementation were explored. # Results The barriers to effective implementation of task shifting ad sharing from our study were the persistent shortage of health workers, inter-cadre rivalry, perceived sub-optimal capacity of the beneficiary cadres, and lack of adequate equipment for delivery of needed services. The factors promoting the implementation of task shifting and sharing were the availability of adapted policies, the political will of the health sector leadership, acceptance of task shifting and sharing implementation by health workers, and the implementation of actions to improve knowledge and skills of health workers to implement shifted or shared tasks by various actors. The strategies to improve future task shifting and sharing implementation include improving staffing levels, scaling up training and periodic retraining, mentoring and supportive supervision, and improving the, use and dissemination of evidence generated. # Conclusions Several factors influence the implementation of task shifting and sharing. Hence the identification and implementation of relevant strategies are pertinent in achieving set objectives and national goals. In policy and practice, therefore, a proactive exploration of the contextual understanding, barriers to implementation, enablers and learning from the performance of similar interventions is pertinent in shaping strategies for translating evidence to practice through an implementation framework. This should be done in collaboration with stakeholders to foster acceptance and participation.

# Background Universal access to a qualified, skilled, motivated and equitably distributed health workforce is pertinent for the delivery of quality health services needed to achieve national health sector goals and sustainable development goals. However, there remains a shortage of health workers attributed to health workers' choices of not taking up postings due to the characteristics of workplace locations, amongst other factors. This study sought to understand the factors influencing primary healthcare workers' choice of workplace locations in Nigeria. # Methods This study applied a qualitative research design. We interviewed 41 primary healthcare workers, including nurses, midwives, and community health practitioners, in Bauchi and Cross River States in Nigeria. The interviews elicited responses on the important issues that health workers consider when thinking of taking up or staying in a work location. # Results We found that the working conditions, living environment and human resources for health (HRH) management practices influence the choice of work location amongst health workers. For working conditions, the quality of facilities, workload concerns, the scope of practice and community support were suggested as important factors. The living environment, specifically the availability of quality housing or an allowance to pay for quality accommodation, availability of transport facilities, and quality schools for children's education were suggested as important factors. Lastly, the HRH management practices linked to supportive management, remunerations, career advancement and continuing education were highlighted as central factors. # Conclusions Our study highlights the importance of work location to health workers. In practice, there is a need for policymakers and health planners to gain and apply contextual evidence on factors influencing health workers' choice of workplace locations in health and HRH planning and management. This is pertinent in designing and implementing tailored interventions for ensuring the equitable distribution of health workers.

Summary: Neocortical layer 6 (L6) is less understood than other more superficial layers, largely owing to limitations of performing high-resolution investigations in vivo. Here, we show that labeling with the Challenge Virus Standard (CVS) rabies virus strain enables high-quality imaging of L6 neurons by conventional two-photon microscopes. CVS virus injection into the medial geniculate body can selectively label L6 neurons in the auditory cortex. Only three days after injection, dendrites and cell bodies of L6 neurons could be imaged across all cortical layers. Ca2+ imaging in awake mice showed that sound stimulation evokes neuronal responses from cell bodies with minimal contamination from neuropil signals. In addition, dendritic Ca2+ imaging revealed significant responses from spines and trunks across all layers. These results demonstrate a reliable method capable of rapid, high-quality labeling of L6 neurons that can be readily extended to other brain regions.

Abstract Background For countries to achieve universal health coverage, they need to have well-functioning and resilient health systems. Achieving this requires a sufficient number of qualified health workers and this necessitates the importance of investments in producing and regulating health workers. It is projected that by 2030, Africa would need additional 6.1 million doctors, nurses, and midwives. However, based on the current trajectory, only 3.1 million would be trained and ready for service delivery. To reduce current shortages of the health workforce, Africa needs to educate and train 3.0 million additional health workers by 2030. This study was conducted to describe the distribution and ownership of the health training institutions, production of health workers, and the availability of accreditation mechanisms for training programmes in the WHO African Region. Methods A cross-sectional study was conducted using a standardized questionnaire from January 2018 to April 2019. All the 47 countries in the Region were invited to complete a structured questionnaire based on available secondary information from health sector reports, annual HRH reports, country health workforce profiles, and HRH observatories and registries. Results Data from 43 countries in the World Health Organization African Region in 2018 show that there were 4001 health training institutions with 410, 1469 and 2122 being medical, health sciences, and nursing and midwifery schools, respectively, and 2221, 1359 and 421 institutions owned by the public, private for-profit and private not-for-profit sectors, respectively. A total of 148 357 health workers were produced in Region with 40% (59, 829) being nurses and midwives, 19% (28, 604) other health workers, and 14% (20 470) physicians. Overall, 31 countries (79%) in the Region have an accreditation framework for the health training institutions and seven countries do not have any accreditation mechanism. Conclusion To achieve universal health coverage, matching of competencies with population needs, as well as increasing capacities for health worker production to align with demand (numbers and skill-mix) for improved service delivery should be prioritized, as this would improve the availability of skilled health workforce in the Region.

Abstract Background Nigeria’s health sector aims to ensure that the right number of health workers that are qualified, skilled, and distributed equitably, are available for quality health service provision at all levels. Achieving this requires accurate and timely health workforce information. This informed the development of the Nigeria Health Workforce Registry (NHWR) based on the global, regional, and national strategies for strengthening the HRH towards achieving universal health coverage. This case study describes the process of conceptualizing and establishing the NHWR, and discusses the strategies for developing sustainable and scalable health workforce registries. Case presentation In designing the NHWR, a review of existing national HRH policies and guidelines, as well as reports of previous endeavors was done to learn what had been done previously and obtain the views of stakeholders on how to develop a scalable and sustainable registry. The findings indicated the need to review the architecture of the registry to align with other health information systems, develop a standardized data set and guidance documents for the registry including a standard operating procedure to ensure that a holistic process is adopted in data collection, management and use nationally. Learning from the findings, a conceptual framework was developed, a registry managed centrally by the Federal Ministry of Health was developed and decentralized, a standardized tool based on a national minimum data was developed and adopted nationally, a registry prototype was developed using iHRIS Manage and the registry governance functions were integrated into the health information system governance structures. To sustain the functionality of the NHWR, the handbook of the NHWR that comprised of an implementation guide, the standard operating procedure, and the basic user training manual was developed and the capacity of government staff was built on the operations of the registry. Conclusion In establishing a functional and sustainable registry, learning from experiences is essential in shaping acceptable, sustainable, and scalable approaches. Instituting governance structures that include and involve policymakers, health managers and users is of great importance in the design, planning, implementation, and decentralization stages. In addition, developing standardized tools based on the health system's needs and instituting supportable mechanisms for data flow and use for policy, planning, development, and management is essential.

Cognitive–achievement relations research has been instrumental in understanding the development of academic skills and learning difficulties. Most cognitive–achievement relations research has been conducted with large samples and represent average relations across the ability spectrum. A notable gap in the literature is whether these relations vary by cognitive ability levels (IQ). This study examined cognitive–achievement relations across different general ability levels (Low, Average, and High) to fill this gap. Based on Spearman’s Law of Diminishing Returns, it would be expected that general intelligence would be a stronger predictor of academic skills at lower levels of IQ, and more specific abilities would be stronger predictors of academic skills at higher levels of IQ. To test this, multi-group path analysis and structural equation modeling were used to examine whether integrated models of cognitive–reading relations are differentiated by IQ levels in the Woodcock–Johnson III and Woodcock–Johnson IV standardization samples. Global and broad cognitive abilities were used as predictors of basic reading skills and reading comprehension for elementary and secondary school students. The magnitude of prediction differed across ability groups in some cases, but not all. Importantly, the variance explained in basic reading skills and reading comprehension tended to be larger for the Low group compared to the Average and High groups. When variance accounted for by general intelligence was removed from the broad abilities, the effects of the broad abilities were similar across ability groups, but the indirect effects of g were higher for the Low group. Additionally, g had stronger relative effects on reading in the Low group, and broad abilities had stronger relative effects on reading in the Average and High groups. The implications and limitations of this study are discussed.

Numerous studies have reported task shifting and task sharing due to various reasons and with varied scopes of health services, either task-shifted or -shared. However, very few studies have mapped the evidence on task shifting and task sharing. We conducted a scoping review to synthesize evidence on the rationale and scope of task shifting and task sharing in Africa. We identified peer-reviewed papers from PubMed, Scopus, and CINAHL bibliographic databases. Studies that met the eligibility criteria were charted to document data on the rationale for task shifting and task sharing, and the scope of tasks shifted or shared in Africa. The charted data were thematically analyzed. Sixty-one studies met the eligibility criteria, with fifty-three providing insights on the rationale and scope of task shifting and task sharing, and seven on the scope and one on rationale, respectively. The rationales for task shifting and task sharing were health worker shortages, to optimally utilize existing health workers, and to expand access to health services. The scope of health services shifted or shared in 23 countries were HIV/AIDS, tuberculosis, hypertension, diabetes, mental health, eyecare, maternal and child health, sexual and reproductive health, surgical care, medicines’ management, and emergency care. Task shifting and task sharing are widely implemented in Africa across various health services contexts towards ensuring access to health services.

Abstract Dose-response models (DRMs) are used to predict the probability of microbial infection when a person is exposed to a given number of pathogens. In this study, we propose a new DRM for Staphylococcus aureus (SA), which causes skin and soft-tissue infections. The current approach to SA dose-response is only partially mechanistic and assumes that individual bacteria do not interact with each other. Our proposed two-compartment (2C) model assumes that bacteria that have not adjusted to the host environment decay. After adjusting to the host, they exhibit logistic/cooperative growth, eventually causing disease. The transition between the adjusted and un-adjusted states is a stochastic process, which the 2C DRM explicitly models to predict response probabilities. By fitting the 2C model to SA pathogenesis data, we show that cooperation between individual SA bacteria is sufficient (and, within the scope of the 2C model, necessary) to characterize the dose-response. This is a departure from the classical single-hit theory of dose-response, where complete independence is assumed between individual pathogens. From a quantitative microbial risk assessment standpoint, the mechanistic basis of the 2C DRM enables transparent modeling of dose-response of antibiotic-resistant SA that has not been possible before. It also enables the modeling of scenarios having multiple/non-instantaneous exposures, with minimal assumptions.

Importance The rise of novel, more infectious SARS-CoV-2 variants has made clear the need to rapidly deploy large-scale testing for COVID-19 to protect public health. However, testing remains limited due to shortages of personal protective equipment (PPE), naso- and oropharyngeal swabs, and healthcare workers. Simple test methods are needed to enhance COVID-19 screening. Here, we describe a simple, and inexpensive spit-test for COVID-19 screening called Patient Self-Collection of Sample-CoV2 (PSCS-CoV2). Objective To evaluate an affordable and convenient test for COVID-19. Methods The collection method relies on deep throat sputum (DTS) self-collected by the subject without the use of swabs, and was hence termed the Self-Collection of Sample for SARS-CoV-2 (abbreviated PSCS-CoV2). We used a phenol-chloroform extraction method for the viral RNA. We then tested for SARS-CoV-2 using real-time reverse transcription polymerase chain reaction with primers against at least two coding regions of the viral nucleocapsid protein (N1 and N2 or E) of SARS-CoV-2. We evaluted the sensitivity and specificity of our protocol. In addition we assess the limit of detection, and efficacy of our Viral Inactivating Solution. We also evaluated our protocol, and pooling strategy from volunteers on a local college campus. Results We show that the PSCS-CoV2 method accurately identified 42 confirmed COVID-19 positives, which were confirmed through the nasopharyngeal swabbing method of an FDA approved testing facility. For samples negative for COVID-19, we show that the cycle threshold for N1, N2, and RP are similar between the PSCS-CoV2 and nasopharynx swab collection method (n = 30). We found a sensitivity of 100% (95% Confidence Interval [CI], 92-100) and specifity of 100% (95% CI, 89-100) for our PSCS-CoV2 method. We determined our protocol has a limit of detection of 1/10,000 for DTS from a COVID-19 patient. In addition, we show field data of the PSCS-CoV2 method on a college campus. Ten of the twelve volunteers (N1 < 30) that we tested as positive were subsequently tested positive by an independent laboratory. Finally, we show proof of concept of a pooling strategy to test for COVID-19, and recommend pool sizes of four if the positivity rate is less than 15%. Conclusion and Relevance We developed a DTS-based protocol for COVID-19 testing with high sensitivity and specificity. This protocol can be used by non-debilitated adults without the assistance of another adult, or by non-debilitated children with the assistance of a parent or guardian. We also discuss pooling strategies based on estimated positivity rates to help conserve resources, time, and increase throughput. The PSCS-CoV2 method can be a key component of community-wide efforts to slow the spread of COVID-19.

This article examines major themes in 24 contemporary Canadian picture books to identify their potential to support children who are newcomers to Canada. Transition to a new country can be challenging for children and picture books are an effective tool for supporting their cultural and often linguistic transition. Through multimodal content analysis, the authors identify major themes that emerge from the visual and textual data in the books. Analysis identified prevailing themes related to family, food, multiculturalism, and geographic information. Each theme offers valuable insights into the diverse perspectives represented in the texts, providing a foundation for meaningful pedagogical applications for immigrant and newcomer children.

Gas, appears as radiolucent on X-ray, is normally absent in the orbit. However, intraocular surgeries occasionally utilize retained intraocular gas for tamponade effect. Intravitreal gas persists after retinal surgery, being confounded by the scleral shell of the operated eye, outlines the shape of the eyeball, and gives the characteristic bubble appearance on skull X-ray. This is different from orbital emphysema caused by orbital fracture when gas is located outside the globe but confined by the orbit, giving a crescent or concave shape over the superior orbit usually. Falls is common after intraocular retinal surgeries due to change of usual stereopsis, prolonged prone posturing, and other systemic comorbidities. By identifying the “Bubble Eye sign” described, attending physician should alert the presence of intravitreal gas, most commonly iatrogenic. Further ophthalmological history taking and examinations are thus indicated, instead of exposing patients to unnecessary radiation under computed tomography scan for orbital fracture investigation.

# Background Weak health governance mechanisms and inequitable distribution of health investments exist in Nigeria, and this is negatively affecting the health system, and health workforce availability and performance. This is evident at the primary level of care and necessitates the need to ensure that staffing levels are informed by workloads. # Methods This study applied the workload indicators of staffing need (WISN) method to determine the staffing requirements for nurses, midwives, community health officers (CHO), community health extension workers (CHEWS), and junior community health extension workers (JCHEWS). It was conducted in 11 purposefully selected primary-level health facilities in two local government areas in Cross River State, Nigeria. # Results Eighteen health service activities were identified for the primary level of care across the life course. Whilst nurses, midwives, CHO and CHEWS perform all the activities, the JCHEWS performed 10 of these functions. The staffing requirement findings for the facilities in Calabar Municipal indicated that there were staffing shortages for nurses and midwives in 4 of the 5 sampled facilities, three facilities had sufficient or excess numbers of CHO/CHEWS, and 4 facilities had sufficient or excess numbers of JCHEWS. In Calabar South local government area, the calculated requirement showed a cumulative shortage of 5 nurses/midwives and 26 CHO/CHEW, and appropriate staffing of JCHEWS in 4 facilities. # Conclusions The results of this study illustrate the staffing needs of nurses, midwives, CHO, CHEWS and JCHEWS in the sampled facilities and indicate the need for using evidence for staffing decisions. This is pertinent considering it ultimately contribute to improvements in service delivery and health indices. The evidence from the application of the WISN tool and the scale-up of its application has the potential of contributing to the achievement of national goals as well as universal health coverage and sustainable development goals.

These data represent the abundance, diversity and predicted function gene profiles of the microbial communities present on human skin before and after swimming in the ocean. The skin microbiome has been shown to provide protection against infection from pathogenic bacteria. It is well-known that exposure to ocean water can cause skin infection, but little is known about how exposure can alter the bacterial communities on the skin. Skin microbiome samples were collected from human participants before and after swimming in the ocean. These data were used to analyze the changes in abundance and diversity of microbial communities on the skin and the changes in the functional profiles of the bacteria, specifically focusing on genes involved in antibiotic resistance and bacterial virulence.

Primary cilia are microtubule-based organelles present on most cells that regulate many physiological processes, ranging from maintaining energy homeostasis to renal function. However, the role of these structures in the regulation of behavior remains unknown. To study the role of cilia in behavior, we employ mouse models of the human ciliopathy, Bardet-Biedl Syndrome (BBS). Here, we demonstrate that BBS mice have significant impairments in context fear conditioning, a form of associative learning. Moreover, we show that postnatal deletion of BBS gene function, as well as congenital deletion, specifically in the forebrain, impairs context fear conditioning. Analyses indicated that these behavioral impairments are not the result of impaired hippocampal long-term potentiation. However, our results indicate that these behavioral impairments are the result of impaired hippocampal neurogenesis. Two-week treatment with lithium chloride partially restores the proliferation of hippocampal neurons which leads to a rescue of context fear conditioning. Overall, our results identify a novel role of cilia genes in hippocampal neurogenesis and long-term context fear conditioning.

Wastewater reclamation and reuse have the potential to supplement water supplies, offering resiliency in times of drought and helping to meet increased water demands associated with population growth. Non-potable water reuse represents the largest potential reuse market. Yet, economic constraints for new water reuse infrastructure and safety concerns due to microbial water quality, especially viral pathogen exposure, limit the widespread implementation of water reuse. Cost-effective, real-time methods to measure or indicate the viral quality of recycled water would do much to instill greater confidence in the practice. This manuscript discusses advancements in monitoring and modeling viral health risks in the context of water reuse. First, we describe current wastewater reclamation processes and treatment technologies with an emphasis on virus removal. Second, we review technologies for the measurement of viruses, both culture- and molecular-based, along with their advantages and disadvantages. We outline promising viral surrogates and specific pathogenic viruses that can serve as indicators of viral risk for water reuse. We suggest metagenomic analyses for viral screening and flow cytometry for quantification of virus-like particles as new approaches to complement more traditional methods. Third, we describe modeling to assess health risks through quantitative microbial risk assessments (QMRAs), the most common strategy to couple data on virus concentrations with human exposure scenarios. We then explore the potential of artificial neural networks (ANNs) to incorporate suites of data from wastewater treatment processes, water quality parameters, and viral surrogates. We recommend ANNs as a means to utilize existing water quality data, alongside new complementary measures of viral quality, to achieve cost-effective strategies to assess risks associated with infectious human viruses in recycled water. Given the review, we conclude that technologies will be ready to identify and implement viral surrogates for health risk reduction in the next decade. Incorporating modeling with monitoring data would likely result in a more robust assessment of water reuse risk.

Biofouling poses considerable technical challenges to agricultural irrigation systems. Controlling biofouling with strong chemical biocides is not only expensive and sometimes ineffective, but also contributes to environmental pollution. This study investigated the application of nanobubbles (NBs) on minimizing biofouling in agricultural irrigation water pipelines. Treatment performances were assessed using low concentration bubbles (LCB) and high concentration bubbles (HCB) together with a negative control (CK: no-NBs). 16 s rRNA gene sequencing and X-ray diffraction were used to characterize the microbial community and mineral compositions of biofilms in water emitters. Results demonstrated that NBs effectively mitigated biofouling through reducing fixed-biomass by 31.3−52.1%. A significantly different microbial composition was found in the biofilm community with reduced biodiversity. Molecular ecological network analysis revealed that NBs were detrimental to the mutualistic interactions among microbial species – destabilizing the network complexity and size, which was expressed as decreasing in extracellular polymers and biofilm biomass. Furthermore, NBs significantly decreased the deposition of carbonate, silicate, phosphate, and quartz on the pipe surfaces, leading to reductions of total content of minerals in biofilms. Therefore, this study demonstrated that NBs treatment could be an effective, and eco-friendly solution for biofouling control in agricultural water distribution systems.

Abstract Background Health Information Organizations (HIOs) are third party organizations that facilitate electronic health information exchange (HIE) between providers in a geographic area. Despite benefits from HIE, HIOs have struggled to form and subsequently gain broad provider participation. We sought to assess whether market-level hospital and EHR vendor dynamics are associated with presence and level of hospital participation in HIOs. Methods 2014 data on 4523 hospitals and their EHR vendors were aggregated to the market level. We used multivariate OLS regression to analyze the relationship between hospital and vendor dynamics and (1) probability of HIO presence and (2) percent of hospitals participating in an HIO. Results 298 of 469 markets (64%) had HIO presence, and in those markets, 47% of hospitals participated in an HIO on average. In multivariate analysis, four characteristics were associated with HIO presence. Markets with more hospitals, markets with more EHR vendors, and markets with an EHR vendor-led HIE approach were more likely to have an HIO. Compared to markets with low hospital competition, markets with high hospital competition had a 25 percentage point lower probability of HIO presence. Two characteristics were associated with level of hospital HIO participation. Markets with more hospitals as well as markets with high vendor competition (compared to low competition) had lower participation. Conclusion Both hospital and EHR vendor dynamics are associated with whether a market has an HIO as well as the level of hospital participation in HIOs.

Many aptamer-fluorophore complexes suffer from low quantum yield and low extinction coefficients limiting their usability. Here the authors isolate new Mango aptamers with improved fluorescent properties for both fixed and live-cell imaging by using competitive ligand binding microfluidic selection.

In September 2017, two category-5 hurricanes Irma and Maria swept through the Caribbean Sea in what is now known as the region’s most active hurricane season on record, leaving disastrous effects on infrastructure and people’s lives. In the U.S. Virgin Islands, rain cisterns are commonly used for harvesting roof-top rainwater for household water needs. High prevalence of Legionella spp. was found in the cistern water after the hurricanes. This study carried out a quantitative microbial risk assessment to estimate the health risks associated with Legionella through inhalation of aerosols from showering using water from cisterns after the hurricanes. Legionella concentrations were modeled based on the Legionella detected in post-hurricane water samples and reported total viable heterotrophic bacterial counts in cistern water. The inhalation dose was modeled using a Monte Carlo simulation of shower water aerosol concentrations according to shower water temperature, shower duration, inhalation rates, and shower flow rates. The risk of infection was calculated based on a previously established dose–response model from Legionella infection of guinea pigs. The results indicated median daily risk of 2.5 × 10−6 to 2.5 × 10−4 depending on shower temperature, and median annual risk of 9.1 × 10−4 to 1.4 × 10−2. Results were discussed and compared with household survey results for a better understanding of local perceived risk versus objective risk surrounding local water supplies.

Molecular biology methods and technologies have advanced substantially over the past decade. These new molecular methods should be incorporated among the standard tools of planetary protection (PP) and could be validated for incorporation by 2026. To address the feasibility of applying modern molecular techniques to such an application, NASA conducted a technology workshop with private industry partners, academics, and government agency stakeholders, along with NASA staff and contractors. The technical discussions and presentations of the Multi-Mission Metagenomics Technology Development Workshop focused on modernizing and supplementing the current PP assays. The goals of the workshop were to assess the state of metagenomics and other advanced molecular techniques in the context of providing a validated framework to supplement the bacterial endospore-based NASA Standard Assay and to identify knowledge and technology gaps. In particular, workshop participants were tasked with discussing metagenomics as a stand-alone technology to provide rapid and comprehensive analysis of total nucleic acids and viable microorganisms on spacecraft surfaces, thereby allowing for the development of tailored and cost-effective microbial reduction plans for each hardware item on a spacecraft. Workshop participants recommended metagenomics approaches as the only data source that can adequately feed into quantitative microbial risk assessment models for evaluating the risk of forward (exploring extraterrestrial planet) and back (Earth harmful biological) contamination. Participants were unanimous that a metagenomics workflow, in tandem with rapid targeted quantitative (digital) PCR, represents a revolutionary advance over existing methods for the assessment of microbial bioburden on spacecraft surfaces. The workshop highlighted low biomass sampling, reagent contamination, and inconsistent bioinformatics data analysis as key areas for technology development. Finally, it was concluded that implementing metagenomics as an additional workflow for addressing concerns of NASA's robotic mission will represent a dramatic improvement in technology advancement for PP and will benefit future missions where mission success is affected by backward and forward contamination.

Background: We are using genetics to identify genes specifically involved in hearing regeneration. In a large-scale genetic screening, we identified mgat5a, a gene in the N-glycosylation biosynthesis pathway whose activity negatively impacts hair cell regeneration. Methods: We used a combination of mutant analysis in zebrafish and a hair cell regeneration assay to phenotype the loss of Mgat5a activity in zebrafish. We used pharmacological inhibition of N-glycosylation by swansonine. We also used over-expression analysis by mRNA injections to demonstrate how changes in N-glycosylation can alter cell signaling. Results: We found that mgat5a was expressed in multiple tissues during zebrafish embryo development, particularly enriched in neural tissues including the brain, retina, and lateral line neuromasts. An mgat5a insertional mutation and a CRISPR/Cas9-generated truncation mutation both caused an enhancement of hair cell regeneration which could be phenocopied by pharmacological inhibition with swansonine. In addition to hair cell regeneration, inhibition of the N-glycosylation pathway also enhanced the regeneration of lateral line axon and caudal fins. Further analysis showed that N-glycosylation altered the responsiveness of TGF-beta signaling. Conclusions: The findings from this study provide experimental evidence for the involvement of N-glycosylation in tissue regeneration and cell signaling.

As more countries engage in water reuse, either intended or de facto, there is an urgent need to more comprehensively evaluate resulting environmental and public health concerns. While antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) are increasingly coming under the spotlight, as emerging contaminants, existing water reuse regulations and guidelines do not adequately address these concerns. This perspectives paper seeks to frame the various challenges that need to be resolved to identify meaningful and realistic target types and levels of antibiotic resistance benchmarks for water reuse. First, there is the need for standardized and agreed-upon methodologies to identify and quantify ARB and ARGs. Second, even if methodologies are available, identifying which ARB and ARGs to monitor that would best relate to the occurrence of disease burden remains unknown. Third, a framework tailored to assessing the risks associated with ARB and ARGs during reuse is urgently needed. Fourth, similar to protecting drinking water sources, strategies to prevent dissemination of ARB and ARGs via wastewater treatment and reuse are required to ensure that appropriate barriers are emplaced. Finally, current wastewater treatment technologies could benefit from modification or retrofit to more effectively remove ARB and ARGs while also producing a high quality product for water and resource recovery. This perspectives paper highlights the need to consider ARB and ARGs when evaluating the overall safety aspects of water reuse and ways by which this may be accomplished.

Heavy metal contamination due to industrial and agricultural waste represents a growing threat to water supplies. Frequent and widespread monitoring for toxic metals in drinking and agricultural water sources is necessary to prevent their accumulation in humans, plants, and animals, which results in disease and environmental damage. Here, the metabolic stress response of bacteria is used to report the presence of heavy metal ions in water by transducing ions into chemical signals that can be fingerprinted using machine learning analysis of vibrational spectra. Surface-enhanced Raman scattering surfaces amplify chemical signals from bacterial lysate and rapidly generate large, reproducible datasets needed for machine learning algorithms to decode the complex spectral data. Classification and regression algorithms achieve limits of detection of 0.5 pM for As3+ and 6.8 pM for Cr6+, 100,000 times lower than the World Health Organization recommended limits, and accurately quantify concentrations of analytes across six orders of magnitude, enabling early warning of rising contaminant levels. Trained algorithms are generalizable across water samples with different impurities; water quality of tap water and wastewater was evaluated with 92% accuracy.

The operation of seawater reverse osmosis (SWRO) desalination facilities has become challenged by the increasing frequency and severity of harmful algal blooms (HABs). The efficiency of algal toxins removal during SWRO and pretreatment processes has critical human health implications. Therefore, a probabilistic materials flow analysis (pMFA) was developed to predict the removal of algal toxins in source water by various pretreatment configurations and operations during SWRO desalination. The results demonstrated that an appreciable quantity of toxins exists in the SWRO permeate (ng/L–µg/L levels), the backwash of pretreatment, and final brine rejects (µg/L–mg/L levels). Varying the pretreatment train configuration resulted in statistically significant differences in toxin removals, where higher removal efficiencies were evidenced in systems employing microfiltration/ultrafiltration (MF/UF) over granular media filtration (GMF). However, this performance depended on operational practices including coagulant addition and transmembrane pressures of MF/UF systems. Acute human health risks during lifetime exposure to algal toxins from ingestion of desalinated water were benign, with margins of safety ranging from 100 to 4000. This study highlights the importance of pretreatment steps during SWRO operation in the removal of algal toxins for managing marine HABs.

Wastewater reuse has become an important part of the urban water supply portfolio in water stressed regions. Effective wastewater treatment processes are critical to protect public health during water reuse practices. However, the microbial removal efficiencies in wastewater reclamation plants are not routinely monitored due to the lack of a simple quantification method. This study applied a near real-time flow cytometry (FCM) technique to quantify the removal of total bacteria and viruses at three wastewater reclamation plants in Southern California. The results showed that the activated sludge process removed 1–2 log10 of bacteria but was not efficient at removing viruses. The membrane bioreactor process was capable of removing both bacteria and viruses with high efficiency. At the plant using chloramines as the main disinfectant, even though culturable total coliform bacteria were effectively reduced to the level meeting the California Title 22 Water Recycling Criteria (7-day median of 2.2 most probable number (MPN)/100 mL, and no more than one sample exceeds 23 MPN/100 mL), the disinfected final effluent still contained greater than 106 bacterial and 108 viral particles per mL in. In contrast, more than 4 log10 removal of both bacteria and viruses were observed at the plant using free chlorine as the main disinfectant. The results indicate that additional microbial indicators are needed and suggest the potential use of FCM as a rapid monitoring tool for evaluation of microbial removal.

Schools are currently facing significant success gaps for students with disabilities, particularly those students with intersectional, marginalized identities. Establishing systematic, collaborative tiered supports is essential to reduce student success gaps and simultaneously prevent staff burnout. Yet, the required system change varies across settings. The authors use case studies to show that the Success Gaps Toolkit is one method school psychologists can use to inform systems change and interdisciplinary collaboration efforts to better support students. Rather than another intervention to implement, the toolkit provides a path to continually evaluate, monitor, and modify efforts until they work (Rohanna, 2017).

Chemokines are best known for their classic leukocyte chemotactic activity, which is critical for directing the immune response to sites of infection and injury. However, recent studies have suggested that at least some chemokines may also interfere with infectious agents directly. Antimicrobial chemokines tend to contain amphipathic alpha helical secondary structure, and broad-spectrum activity against both Gram positive and Gram negative bacteria, as well as fungi. Conversely, several bacteria have been identified that possess mechanisms for specifically blocking the antimicrobial activities of chemokines. Although the precise mechanisms by which chemokines and microbes disarm one another in vitro remain unknown, there is now emerging evidence in vivo that such interactions may be biologically significant. More research will be needed to determine whether chemokines with direct antimicrobial activity may be translated into a novel class of antibiotics.

Wastewater reclamation and reuse have the potential to supplement water supplies, offering resiliency in times of drought and helping meet increased water demands associated with population growth. Non-potable water reuse represents the largest potential reuse market. Yet economic constraints for new water reuse infrastructure and safety concerns due to microbial water quality, and especially viral pathogen exposure, limit widespread implementation of water reuse. Cost-effective, real-time methods to measure or indicate viral quality of recycled water would do much to instill greater confidence in the practice. This manuscript discusses advancements in monitoring and modeling of viral health risks in the context of water reuse. First, we describe the current wastewater reclamation processes and treatment technologies with an emphasis on virus removal. Second, we review technologies for the measurement of viruses, both culture- and molecular-based, along with their advantages and disadvantages. We introduce promising viral surrogates and specific pathogenic viruses that can serve as indicators of viral risk for water reuse. We suggest metagenomic analyses for viral screening and flow cytometry for quantification of virus-like particles as new approaches to complement more traditional methods. Third, we describe modeling to assess health risks through quantitative microbial risk assessments (QMRAs), the most common strategy to couple data on virus concentrations with human exposure scenarios. We then explore the potential of artificial neural networks (ANNs) to incorporate suites of data from wastewater treatment processes, water quality parameters, and viral surrogates. We recommend ANNs as a means to utilize existing water quality data, alongside new complementary measures of viral quality, to achieve cost-effective strategies to assess risks associated with infectious human viruses in recycled water. Given the review, we conclude that technologies are ready for identifying and implementing viral surrogates for health risk reduction in the next decade. Incorporating modeling with monitoring data would likely result in more robust assessment of water reuse risk.