Deep learning classification of ex vivo human colon tissues using spectroscopic optical coherence tomography.

Screening for colorectal cancer (CRC) with colonoscopy has improved patient outcomes; however, it remains the third leading cause of cancer-related mortality, novel strategies to improve screening are needed. Here, we propose an optical biopsy technique based on spectroscopic optical coherence tomography (OCT). Depth resolved OCT images are analyzed as a function of wavelength to measure optical tissue properties and used as input to machine learning algorithms. Previously, we used this approach to analyze mouse colon polyps. Here, we extend the approach to examine human biopsied colonic epithelial tissue samples ex vivo. Optical properties are used as input to a novel deep learning architecture, producing accuracy of up to 97.9% in discriminating tissue type. SOCT parameters are used to create false colored en face OCT images and deep learning classifications are used to enable visual classification by tissue type. This study advances SOCT toward clinical utility for analysis of colonic epithelium.

The power of peer networking for improving STEM faculty job applications: a successful pilot programme.

To attain a faculty position, postdoctoral fellows submit job applications that require considerable time and effort to produce. Although mentors and colleagues review these applications, postdocs rarely receive iterative feedback from reviewers with the breadth of expertise typically found on an academic search committee. To address this gap, we describe an international peer-reviewing programme for postdocs across disciplines to receive reciprocal, iterative feedback on faculty applications. A participant survey revealed that nearly all participants would recommend the programme to others. Furthermore, our programme was more likely to attract postdocs who struggled to find mentoring, possibly because of their identity as a woman or member of an underrepresented population in STEM or because they changed fields. Between 2018 and 2021, our programme provided nearly 150 early career academics with a diverse and supportive community of peer mentors during the difficult search for a faculty position and continues to do so today. As the transition from postdoc to faculty represents the largest 'leak' in the academic pipeline, implementation of similar programmes by universities or professional societies would provide psycho-social support necessary to prevent attrition of individuals from underrepresented populations as well as increase the chances of success for early career academics in their search for independence.

Oral Processing of Three Guenon Species in Taï National Park, Côte d'Ivoire.

Three guenon species in Taï National Park frequently form and maintain stable polyspecific associations despite significant feeding competition. This dietary overlap provides an opportunity to examine how closely related and anatomically similar taxa process the same foods. Our research examines whether the oral-processing behaviors of these guenons differ when they consume the same foods. Methods: Data on oral-processing behavior were collected on one habituated group each of Cercopithecus campbelli, C. diana, and C. petaurista in Taï National Park, Côte d'Ivoire from January 2016 to December 2018. We recorded the frequency with which foods were introduced to the mouth (ingestive action) and the frequency with which foods were processed using incisors, canines, and postcanine teeth. Oral-processing profiles for species-specific plant foods, fungi, and invertebrates were compared using Monte Carlo resampling. We quantified oral-processing behavior during a total of 2316 five-minute focal periods. Diana monkeys use their incisors significantly more per ingestive action than Campbell's monkeys or Lesser spot-nosed guenons. Lesser spot-nosed guenons use their incisors more than Campbell's monkeys. Diana monkeys also use significantly more post-canine chews per ingestive action than Campbell's monkeys and Lesser spot-nosed guenons. Lesser spot-nosed guenons generally use fewer post-canine chews than Diana monkeys but more than Campbell's monkeys. Canine use during feeding was rare in all three taxa. The three study species use different oral-processing profiles when consuming the same foods. These results are intriguing given the overall similarity in dental and cranial anatomy in these taxa. The oral-processing profiles we report do not encompass the full dietary breadth of all species; however, the behavioral diversity demonstrated during consumption of the same foods suggests that insight into feeding behavior is more likely obtained by examining oral processing of individual foods rather than broad food categories. Furthermore, these results underscore that important variation in feeding behavior is not necessarily associated with morphological differences in dental or craniofacial anatomy.

Application of a parallel laser apparatus to measure forearms and flanges of wild Bornean orangutans (Pongo pygmaeus wurmbii).

We constructed a parallel laser photogrammetry apparatus constructed from commercially available parts, and measured forearm lengths and flange widths of 16 wild Bornean orangutans. Our objectives were to validate our method and apparatus, discuss issues encountered, and construct preliminary growth curves. For adult males, we also compared flange width to forearm length as a way to investigate the relationship between body size and flange development. We used a camera cage around a DSLR camera, on top of which we attached two parallel green lasers. We estimated error with repeatability, accuracy, and interobserver reliability measures, and measured forearm lengths in three different ways to see which was most consistent. The longest forearm measure was the most repeatable (CV = 1.64%), and was similar to flange repeatability (3.50%). Accuracy measurements of a known object were high (error = 0.25%), and Interobserver discrepancy low (3.74%). Laser spacing increased with distance to the subject, but we corrected for this using calibration photos after each session. We transparently discuss the issues we encountered with the aim that this accessible method can help expand the use of laser photogrammetry. Preliminary measurements show that male flange widths and forearm length do not reliably increase in tandem, and that female growth plateaus at around the age at first birth (15 years old). We conclude with suggested improvements to the apparatus and method to ensure the lasers remain parallel.

Bed downtime: the novel use of a quality metric allows inpatient providers to improve patient flow from the emergency department.

BACKGROUND: Emergency department (ED) boarding time is associated with increased length of stay (LOS) and inpatient mortality. Despite the documented impact of ED boarding on inpatient outcomes, a disparity continues to exist between the attention paid to the issue by inpatient and ED providers. A perceived lack of high yield strategies to address ED boarding from the perspective of the inpatient provider may discourage involvement in improvement initiatives on the subject. As such, further work is needed to identify inpatient metrics and strategies to address patient flow problems, and which may improve ED boarding time. METHODS: After initial system analysis, our multidisciplinary quality improvement (QI) group defined the process time metric 'bed downtime'-the time from which a bed is vacated by a discharged patient to the time an ED patient is assigned to that bed. Using the Lean Sigma QI approach, this metric was targeted for improvement on the internal medicine hospitalist service at a tertiary care academic medical centre. INTERVENTIONS: Interventions included improving inpatient provider awareness of the problem, real-time provider notification of empty beds, a weekly retrospective emailed performance dashboard and the creation of a guideline document for admission procedures. RESULTS: This package of interventions was associated with a 125 min reduction in mean bed downtime for incoming ED patients (254 min to 129 min) admitted to the intervention unit. CONCLUSION: Use of the bed downtime metric as a QI target was associated with marked improvements in process time during our project. The use of this metric may enhance the ability of inpatient providers to participate in QI efforts to improve patient flow from the ED. Further study is needed to determine if use of the metric may be effective at reducing boarding time without requiring alterations to LOS or discharge patterns.

Resource utilisation among patients with syncope presenting to the emergency department.

BACKGROUND: Syncope is a common problem encountered in the emergency department (ED) and a significant source of ED resource utilisation, including advanced imaging modalities. Current guidelines do not recommend routine Computed Tomography (CT) imaging of the head for patients seen in the ED due to syncope. OBJECTIVE: In this study, we investigate resource allocation in the ED for syncope-related visits, including advanced imaging modalities using a large national database. OUTCOMES ANALYSIS: Data from the CDC's National Hospital Ambulatory Medical Care Survey (NHAMCS) for years 2008-2017 were compiled and analysed. Intrinsic survey and constructed variables were utilised to identify and investigate all syncope-related ED visits in the United States during the study period that met study criteria. Appropriate bivariate and multivariate statistical analyses were applied in order to identify and compare the resource utilisation, demographics, and ED visit dynamics of syncope and non-syncope-related ED visits. RESULTS: During the study period, there were over 15 million ED visits for syncope. A high percentage of syncope visits received head CT compared with non-syncope visits (34% vs. 4.5%, P > .001). When investigated by age-grouping utilisation of head CT ranged from 26.5 (95% CI 18.9-27.5) for ages 18-40 to as high as 40.2% (95% CI 33.8-47.1) for ages 80 and higher. Compared with non-syncope ED visits, syncope-related ED visits were older and more likely to have Medicare or private insurance. CONCLUSION: Syncope continues to be a large and growing share of visits to US EDs. Despite well-supported, evidence-based recommendations that do not recommend routine utilisation of head CT in syncope-related ED visits, these data suggest that emergency physicians routinely over-utilise this modality. More specific guidelines may be required to help reduce the use of imaging studies for patients who present to the ED with syncope.

Remote patient monitoring for ED discharges in the COVID-19 pandemic.

COVID-19 has had a significant effect on healthcare resources worldwide, with our knowledge of the natural progression of the disease evolving for the individual patient. To allow for early detection of worsening clinical status, protect hospital capacity and provide extended access for vulnerable patients, our emergency department developed a remote patient monitoring programme for discharged patients with COVID-19. The programme uses a daily emailed secure link to a survey in which patients submit biometric and symptoms data for monitoring. Patients' meeting criteria are escalated to a physician for a phone or video visit. Here, we describe the development, implementation and preliminary analysis of utilisation of the programme.

Single-step purification of a small non-mAb biologic by peptide-ELP-based affinity precipitation.

Affinity precipitation using stimulus-responsive biopolymers such as elastin-like polypeptides (ELPs) have been successfully employed for the purification of monoclonal antibodies. In the current work, we extend these studies to the development of an ELP-peptide fusion for the affinity precipitation of the therapeutically relevant small non-mAb biologic, AdP. A 12-mer affinity peptide ligand (P10) was identified by a primary phage biopanning followed by a secondary in-solution fluorescence polarization screen. Peptide P10 and AdP interacted with a KD of 19.5 µM. A fusion of P10 with ELP was then shown to be successful in selectively capturing the biologic from a crude mixture. While pH shifts alone were not sufficient for product elution, the use of pH in concert with fluid-phase modifiers such as NaCl, arginine, or ethylene glycol was effective. In particular, the use of pH 8.5 and an arginine concentration of 500 mM enabled >80% product recovery. The overall process performance evaluated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and reversed-phase ultra-performance liquid chromatography analyses indicated successful single-step purification of the biologic from an Escherichia coli lysate resulting in ∼90% purity and >80% recovery. These results demonstrate that phage display can be readily employed to identify a peptide ligand capable of successfully carrying out the purification of a non-antibody biological product using ELP-based affinity precipitation.

Oral Processing Behavior of Diana Monkeys (Cercopithecus diana) in Taï National Park, Côte d'Ivoire.

Primates are hypothesized to "fall back" on challenging-to-process foods when preferred foods are less available. Such dietary shifts may be accompanied by changes in oral processing behavior argued to be selectively important. Here, we examine the oral processing behavior of Diana monkeys (Cercopithecus diana) in the Taï Forest across their dietary breadth, testing relationships among food intake, fruit availability, preference, and oral processing behaviors including those involved in food ingestion and breakdown. We conducted 1,066 focal follows from April 2016 to September 2017 documenting frequencies of incisor, canine, and cheek tooth mastications (i.e., chews) per ingestive action (n = 11,906 feeding events). We used phenological survey and scan sample data collected between 2004 and 2009 to examine dietary preference and food availability. Our analyses show that Diana monkeys processed foods in significantly different ways (H2 = 360.8, p < 0.001), with invertebrates requiring the least oral processing, fruit requiring intermediate amounts, and leaves requiring the most oral processing. There was no relationship between fruit availability and consumption of preferred or nonpreferred fruits (p > 0.05); however, preferred fruits were processed with significantly fewer mastications (i.e., less chewing) than nonpreferred fruits (U = 6,557, p < 0.001). We thus demonstrate that, when preferred foods are scarce, Diana monkeys do not fall back on difficult-to-process foods. Changes in processing profiles occurred throughout the year and not solely when preferred foods were in short supply. Though preferred fruits required less processing than nonpreferred fruits, we found no relationship between fruit preference and fruit availability. Diana monkeys' lack of readily identifiable fallback foods may be attributable to the relatively high tree diversity and productivity of the Taï Forest. We conclude that Diana monkeys engage in resource switching, consuming a relatively easy-to-process diet year-round.

Redesigning emergency department operations amidst a viral pandemic.

As shown by the current COVID-19 pandemic, emergency departments (ED) are the front line for hospital-and-community-based care during viral respiratory disease outbreaks. As such, EDs must be able to reorganize and reformat operations to meet the changing needs and staggering patient volume. This paper addresses ways to adapt departmental operations to better manage in times of elevated disease burden, specifically identifying areas of intervention to help limit crowding and spread. Using experience from past outbreaks and the current COVID-19 pandemic, we advise strategies to increase surge capacity and limit patient inflow. Triage should identify and geographically cohort symptomatic patients within a designated unit to limit exposure early in an outbreak. Screening and PPE guidelines for both patient and staff should be followed closely, as determined by hospital administration and the CDC. Equipment needs are also greatly affected in an outbreak; we emphasis portable radiographic equipment to limit transport, and an upstocking of certain medications, respiratory supplies, and PPE.

Emergency Department Ergonomic Redesign Improves Team Satisfaction in Cardiopulmonary Resuscitation Delivery: A Simulation-Based Quality Improvement Approach.

BACKGROUND: Delivering high-quality cardiopulmonary resuscitation (CPR) requires teams to administer highly choreographed care. The American Heart Association recommends audiovisual feedback for real-time optimization of CPR performance. In our Emergency Department (ED) resuscitation bays, ZOLL cardiac resuscitation device visibility was limited. OBJECTIVE: To optimize the physical layout of our resuscitation rooms to improve cardiac resuscitation device visibility for real-time CPR feedback. METHODS: A simulated case of cardiac arrest with iterative ergonomic modifications was performed four times. Variables included the locations of the cardiac resuscitation device and of team members. Participants completed individual surveys and provided qualitative comments in a group debriefing. The primary outcome of interest was participants' perception of cardiac resuscitation device visibility. RESULTS: The highest scoring layout placed the cardiac resuscitation device directly across from the compressor and mirrored the device screen to a television mounted at the head of the bed. Comparing this configuration to our standard configuration on a five-point Likert scale, cardiac resuscitation device visibility increased 46.7% for all team members, 150% for the team leader, and 179% for team members performing chest compressions. CONCLUSION: An iterative, multidisciplinary, simulation-based approach can improve team satisfaction with important clinical care factors when caring for patients suffering cardiac arrest in the ED.

Hard plant tissues do not contribute meaningfully to dental microwear: evolutionary implications.

Reconstructing diet is critical to understanding hominin adaptations. Isotopic and functional morphological analyses of early hominins are compatible with consumption of hard foods, such as mechanically-protected seeds, but dental microwear analyses are not. The protective shells surrounding seeds are thought to induce complex enamel surface textures characterized by heavy pitting, but these are absent on the teeth of most early hominins. Here we report nanowear experiments showing that the hardest woody shells - the hardest tissues made by dicotyledonous plants - cause very minor damage to enamel but are themselves heavily abraded (worn) in the process. Thus, hard plant tissues do not regularly create pits on enamel surfaces despite high forces clearly being associated with their oral processing. We conclude that hard plant tissues barely influence microwear textures and the exploitation of seeds from graminoid plants such as grasses and sedges could have formed a critical element in the dietary ecology of hominins.

Purification of proteins using peptide-ELP based affinity precipitation.

In this work, we employed fusions of affinity peptides and elastin-like polypeptide (ELP) to carry out a proof-of-concept study for the single-step purification of model, tag-free proteins. Three known peptide-protein binding pairs of varied binding strengths were evaluated. The peptide-protein binding was first characterized through in-solution binding techniques such as fluorescence spectroscopy. Peptide-ELP constructs were then produced in E. coli and purified by phase transition. The binding of the peptide-ELP constructs to the products were then evaluated using competitive fluorescence spectroscopy. Affinity capture, precipitation and recovery experiments were then conducted using the three constructs to evaluate the efficacy of these peptide-ELP based affinity precipitation processes. Two out of the three systems tested were successful in capturing the product and yielding pure protein in a single affinity precipitation step. These results indicated that peptide-protein affinity played an important role in both the effective capture of the protein, and also in the required binding molar ratio for the affinity precipitation process. In addition, for intermediate affinity systems, constructs containing two copies of the peptide at the N-terminus of the ELP were beneficial towards achieving both high purity and yield, likely due to increased affinity from avidity effects. This proof-of-concept study lays the foundations for the development of new peptide-ELP-based affinity purification processes for industrially relevant proteins and other classes of biologics.

Use of Systems Engineering to Design a Hospital Command Center.

BACKGROUND: In hospitals and health systems across the country, patient flow bottlenecks delay care delivery-emergency department boarding and operating room exit holds are familiar examples. In other industries, such as oil, gas, and air traffic control, command centers proactively manage flow through complex systems. METHODS: A systems engineering approach was used to analyze and maximize existing capacity in one health system, which led to the creation of the Judy Reitz Capacity Command Center. This article describes the key elements of this novel health system command center, which include strategic colocation of teams, automated visual displays of real-time data providing a global view, predictive analytics, standard work and rules-based protocols, and a clear chain of command and guiding tenets. Preliminary data are also shared. RESULTS: With proactive capacity management, subcycle times decreased and allowed the health system's flagship hospital to increase occupancy from 85% to 92% while decreasing patient delays. CONCLUSION: The command center was built with three primary goals-reducing emergency department boarding, eliminating operating room holds, and facilitating transfers in from outside facilities-but the command center infrastructure has the potential to improve hospital operations in many other areas.

An Electronic Dashboard to Monitor Patient Flow at the Johns Hopkins Hospital: Communication of Key Performance Indicators Using the Donabedian Model.

Efforts to monitoring and managing hospital capacity depend on the ability to extract relevant time-stamped data from electronic medical records and other information technologies. However, the various characterizations of patient flow, cohort decisions, sub-processes, and the diverse stakeholders requiring data visibility create further overlying complexity. We use the Donabedian model to prioritize patient flow metrics and build an electronic dashboard for enabling communication. Ten metrics were identified as key indicators including outcome (length of stay, 30-day readmission, operating room exit delays, capacity-related diversions), process (timely inpatient unit discharge, emergency department disposition), and structural metrics (occupancy, discharge volume, boarding, bed assignation duration). Dashboard users provided real-life examples of how the tool is assisting capacity improvement efforts, and user traffic data revealed an uptrend in dashboard utilization from May to October 2017 (26 to 148 views per month, respectively). Our main contributions are twofold. The former being the results and methods for selecting key performance indicators for a unit, department, and across the entire hospital (i.e., separating signal from noise). The latter being an electronic dashboard deployed and used at The Johns Hopkins Hospital to visualize these ten metrics and communicate systematically to hospital stakeholders. Integration of diverse information technology may create further opportunities for improved hospital capacity.

Rates and Patterns of Comorbidity Among First-Year College Students With ADHD.

The purpose of this study was to examine rates and patterns of non-attention-deficit/hyperactivity disorder (non-ADHD) psychiatric diagnoses among a large group of 1st-year college students with and without ADHD. A total of 443 participants, including 214 men and 229 women ranging in age from 18 to 22 years of age (M = 18.2), were recruited from 9 colleges involved in a large-scale, multisite longitudinal investigation. Non-Hispanic Caucasian students represented 67.5% of the total sample. A comprehensive multimethod assessment approach was used in conjunction with expert panel review to determine both ADHD and comorbidity status. Significantly higher rates of overall comorbidity were found among college students with well-defined ADHD, with 55.0% exhibiting at least one comorbid diagnosis and 31.8% displaying two or more, relative to the corresponding rates of non-ADHD diagnoses among Comparison students, which were 11.2% and 4.0%, respectively. These differences in overall comorbidity rates were, in large part, attributable to the increased presence of depressive and anxiety disorders, especially major depressive disorder (active or in partial remission) and generalized anxiety disorder, among the students with ADHD. Within the ADHD group, differential comorbidity rates were observed as a function of ADHD presentation type and gender but not ethnic/racial diversity status. The current findings fill a gap in the literature and shed new light on the rates and patterns of comorbidity among emerging adults with ADHD in their 1st year of college. Implications for providing clinical and support services to college students with ADHD are discussed.

Dietary Variation in Diana Monkeys (Cercopithecus diana): The Effects of Polyspecific Associations.

Establishing dietary central tendencies and extremes remains an important goal of primate research. While habitat differences and spatial discontinuity are well-documented contributors to dietary variation, other factors including polyspecific associations may significantly impact diet through changes in strata use and/or increased feeding competition. Here, we examine polyspecific association with closely related species as a source of dietary variation in a rain forest primate. Diana monkeys (Cercopithecus diana) in Côte d'Ivoire's Taï Forest frequently participate in mixed-species groups. We use data collected over a 5-year period on 4 Diana monkey groups to examine how association affects group diets. Groups exhibited significant differences in association rates with other guenon species, but this minimally influenced diet when food categories (fruit, invertebrates, leaves) were compared: diet overlap of 4 groups across the study period ranges from 90.8 to 98.1%. Examination of species composition within food categories is more revealing: intergroup dietary overlap decreases to 69.8-79.4% across the study period when comparing species contributing to total frugivory and folivory. These data support earlier findings that Diana monkeys maintain fruit-rich diets by competitively excluding sympatric congeners while highlighting that even selective frugivores such as Diana monkeys may exhibit remarkable dietary flexibility. Our study underscores the fact that broad categorical labels can obscure significant dietary differences.