Antibacterial Effect of Acoustic Cavitation Promoted by Mesoporous Silicon Nanoparticles.

As-prepared mesoporous silicon nanoparticles, which were synthesized by electrochemical etching of crystalline silicon wafers followed by high-energy milling in water, were explored as a sonosensitizer in aqueous media under irradiation with low-intensity ultrasound at 0.88 MHz. Due to the mixed oxide-hydride coating of the nanoparticles' surfaces, they showed both acceptable colloidal stability and sonosensitization of the acoustic cavitation. The latter was directly measured and quantified as a cavitation energy index, i.e., time integral of the magnitude of ultrasound subharmonics. The index turned out to be several times greater for nanoparticle suspensions as compared to pure water, and it depended nonmonotonically on nanoparticle concentration. In vitro tests with Lactobacillus casei revealed a dramatic drop of the bacterial viability and damage of the cells after ultrasonic irradiation with intensity of about 1 W/cm2 in the presence of nanoparticles, which themselves are almost non-toxic at the studied concentrations of about 1 mg/mL. The experimental results prove that nanoparticle-sensitized cavitation bubbles nearby bacteria can cause bacterial lysis and death. The sonosensitizing properties of freshly prepared mesoporous silicon nanoparticles are beneficial for their application in mild antibacterial therapy and treatment of liquid media.

Water Saturated with Pressurized CO2 as a Tool to Create Various 3D Morphologies of Composites Based on Chitosan and Copper Nanoparticles.

Methods for creating various 3D morphologies of composites based on chitosan and copper nanoparticles stabilized by it in carbonic acid solutions formed under high pressure of saturating CO2 were developed. This work includes a comprehensive analysis of the regularities of copper nanoparticles stabilization and reduction with chitosan, studied by IR and UV-vis spectroscopies, XPS, TEM and rheology. Chitosan can partially reduce Cu2+ ions in aqueous solutions to small-sized, spherical copper nanoparticles with a low degree of polydispersity; the process is accompanied by the formation of an elastic polymer hydrogel. The resulting composites demonstrate antimicrobial activity against both fungi and bacteria. Exposing the hydrogels to the mixture of He or H2 gases and CO2 fluid under high pressure makes it possible to increase the porosity of hydrogels significantly, as well as decrease their pore size. Composite capsules show sufficient resistance to various conditions and reusable catalytic activity in the reduction of nitrobenzene to aniline reaction. The relative simplicity of the proposed method and at the same time its profound advantages (such as environmental friendliness, extra purity) indicate an interesting role of this study for various applications of materials based on chitosan and metals.

COVID-19 Vaccinating Russian Medical Students-Challenges and Solutions: A Cross-Sectional Study.

Background: The role of preventive measures increases significantly in the absence of effective specific COVID-19 treatment. Mass population immunization and the achievement of collective immunity are of particular importance. The future development of public attitudes towards SARS-CoV-2 immunization depends significantly on medical students, as future physicians. Therefore, it seemed relevant to determine the percentage of COVID-19-vaccinated medical students and to identify the factors significantly affecting this indicator. Methods: A total of 2890 medical students from years one to six, studying at nine leading Russian medical universities, participated in an anonymous sociological survey. The study was performed in accordance with the STROBE guidelines. Results: It was found that the percentage of vaccinated Russian medical students at the beginning of the academic year 2021 was 58.8 ± 7.69%, which did not significantly differ from the vaccination coverage of the general population in the corresponding regions (54.19 ± 4.83%). Student vaccination rate was largely determined by the region-specific epidemiological situation. The level of student vaccination coverage did not depend on the gender or student residence (in a family or in a university dormitory). The group of senior students had a higher number of COVID-19 vaccine completers than the group of junior students. The lack of reliable information about COVID-19 vaccines had a pronounced negative impact on the SARS-CoV-2 immunization process. Significant information sources influencing student attitudes toward vaccination included medical professionals, medical universities, academic conferences, and manuscripts, which at that time provided the least information. Conclusion: The obtained results make it possible to develop recommendations to promote SARS-CoV-2 immunoprophylaxis among students and the general population and to increase collective immunity.

Recent trends in telerehabilitation of stroke patients: A narrative review.

BACKGROUND: Stroke is the main reason for disabilities worldwide leading to motor dysfunction, spatial neglect and cognitive problems, aphasia, and other speech-language pathologies, reducing the life quality. To overcome disabilities, telerehabilitation (TR) has been recently introduced. OBJECTIVE: The aim of this review was to analyze current TR approaches for stroke patients' recovery. METHODS: We searched 6 online databases from January 2018 to October 2021, and included 70 research and review papers in the review. We analyzed TR of 995 individuals, which was delivered synchronously and asynchronously. RESULTS: Findings show TR is feasible improving motor function, cognition, speech, and language communication among stroke patients. However, the dose of TR sessions varied significantly. We identified the following limitations: lack of equipment, software, and space for home-based exercises, insufficient internet capacity and speed, unavailability to provide hands on guidance, low digital proficiency and education, high cognitive demand, small samples, data heterogeneity, and no economic evaluation. CONCLUSIONS: The review shows TR is superior or similar to conventional rehabilitation in clinical outcomes and is used as complementary therapy or as alternative treatments. More importantly, TR provides access to rehabilitation services of a large number of patients with immobility, living in remote areas, and during COVID-19 pandemic or similar events.

Fano-type Effect in Hydrogen-Terminated Pure Nanodiamond.

Two novel properties, unique for semiconductors, a negative electron affinity and a high p-type surface electrical conductivity, were discovered in diamond at the end of the last century. Both properties appear when the diamond surface is hydrogenated. A natural question arises: is the influence of the surface hydrogen on diamond limited only to the electrical properties? Here, for the first time to our knowledge, we observe a transparency peak at 1328 cm-1 in the infrared absorption of hydrogen-terminated pure (undoped) nanodiamonds. This new optical property is ascribed to Fano-type destructive interference between zone-center optical phonons and free carriers (holes) appearing in the near-surface layer of hydrogenated nanodiamond. This work opens the way to explore the physics of electron-phonon coupling in undoped semiconductors and promises the application of H-terminated nanodiamonds as a new optical material with induced transparency in the infrared optical range.

Inter-Observer Agreement between Low-Dose and Standard-Dose CT with Soft and Sharp Convolution Kernels in COVID-19 Pneumonia.

Computed tomography (CT) has been an essential diagnostic tool during the COVID-19 pandemic. The study aimed to develop an optimal CT protocol in terms of safety and reliability. For this, we assessed the inter-observer agreement between CT and low-dose CT (LDCT) with soft and sharp kernels using a semi-quantitative severity scale in a prospective study (Moscow, Russia). Two consecutive scans with CT and LDCT were performed in a single visit. Reading was performed by ten radiologists with 3-25 years' experience. The study included 230 patients, and statistical analysis showed LDCT with a sharp kernel as the most reliable protocol (percentage agreement 74.35 ± 43.77%), but its advantage was marginal. There was no significant correlation between radiologists' experience and average percentage agreement for all four evaluated protocols. Regarding the radiation exposure, CTDIvol was 3.6 ± 0.64 times lower for LDCT. In conclusion, CT and LDCT with soft and sharp reconstructions are equally reliable for COVID-19 reporting using the "CT 0-4" scale. The LDCT protocol allows for a significant decrease in radiation exposure but may be restricted by body mass index.

Network effects in influenza spread: The impact of mobility and socio-economic factors.

This paper introduces new methods of modeling and analyzing social networks that emerge in the context of disease spread. Four methods of constructing informative networks are presented, two of which use. static data and two use temporal data, namely individual citizen mobility observations taken over an extensive period of time. We show how the built networks can be analyzed, and how the numerical results can be interpreted, using network permutation-based surprise analysis. In doing so, we explain the relationship of surprise analysis with conventional network hypothesis testing and Quadratic Assignment Procedure regression. Surprise analysis is more comprehensive, and can be without limitation performed with any form(s) of network subgraphs, including those with multiple nodal attributes, weighted links, and temporal features. To illustrate our methodological work in application, we put them to use for interpreting networks constructed from the data collected over one year in an observational study in Buffalo and Erie counties in New York state during the 2016-2017 influenza season. Even with the limitations in the data size, our methods are able to reveal the global (city- and season-wide) patterns in the spread of influenza, taking into account population mobility and socio-economic factors.

The Effect of Conformation Order on Gas Separation Properties of Polyetherimide Ultem Films.

Changes of the spectral characteristics of absorption bands depending on the films' treatment method were registered for polyetherimide Ultem films. The possibility of selection of structural criteria (the ratio of the functional groups absorption bands intensities) showing all conformational changes in elementary unit with metrological processing of the results is shown. It is demonstrated that film formation from chloroform solution leads to elementary unit fragments, Ph-O-Ph', which have an effect on macromolecule conformation and result in increasing of space between fragments of macromolecules (local polymer matrix packing loosening). Desorption of residual chloroform from films by ethanol or supercritical CO2 leads to a change of conformers set in Im-Ph-Im' units. Quantum chemical modeling showed the possibility of convergence of these fragments in neighboring macromolecules, and consequently of interchain π-π interaction (local densification of chain packing of the polymer matrix). After annealing at a temperature higher than glass transition temperature, the polyetherimide film exhibits the most disordered (amorphous) state at all of the fragments. It is demonstrated that the results, obtained by the combination of theoretical and experimental vibrational spectroscopy methods, are in good agreement with data of chain packing ordering found by analysis of gas separation parameters.

Macrophages Derived From Human Induced Pluripotent Stem Cells Are Low-Activated "Naïve-Like" Cells Capable of Restricting Mycobacteria Growth.

In peripheral tissues, immune protection critically depends on the activity of tissue resident macrophages, which makes our understanding of the biology of these cells of great significance. Until recently, human macrophage studies were largely based on the analysis of monocyte-derived macrophages that differ from tissue resident macrophages by many characteristics. To model tissue resident macrophages, methods of generating macrophages from pluripotent stem cells have been developed. However, the immunological properties of macrophages derived from pluripotent stem cells remain under-investigated. In this study, we aimed to perform the multifarious immunological characteristics of macrophages generated from human induced pluripotent stem cells (iMϕs), including an analysis of their phenotype, secretory and antibacterial activities, as well as their comparison with macrophages derived from blood monocytes and infected lung tissue. We report that iMϕs displayed the morphology and the CD11b+CD45+CD14+ phenotype typical for mononuclear phagocytes. The cells co-expressed markers known to be associated with classically (CD80, CD86, CCR5) and alternatively (CD163 and CD206) activated macrophages, with a bias toward a higher expression of the latter. iMϕs secreted pro-inflammatory (IL-6, CXCL8, CCL2, CCL4, CXCL1, CXCL10) and anti-inflammatory (IL-10, IL-1RA, CCL22) cytokines with a high IL-10/IL-12p70 index (>20). iMϕs were phagocytic and restricted Mycobacterium tuberculosis growth in vitro by >75%. iMϕs differed from blood monocytes/macrophages by a lower expression level of HLA-DR and the CD14+CD16int phenotype and shared several phenotypic characteristics with lung macrophages. In response to LPS, iMϕs up-regulated HLA-DR and produced TNF-α. IFN-γ increased iMϕ reactivity to LPS, but did not increase iMϕ mycobactericidal capacity. The results characterize iMϕs as differentiated but low-activated/low-polarized "naïve-like" macrophages that are capable of mounting inflammatory and antibacterial responses when exposed to inflammatory stimuli or pathogens. iMϕs represent a valuable model for studying antibacterial responses of tissue resident macrophages and for developing approaches to modulating macrophage activity.

Causal analysis of the impact of homecare services on patient discharge disposition.

This study uses observational causal inference to evaluate the impact of different combinations of home care services (nursing, therapies, social work, home aides) on end-of-episode disposition for individuals with chronic diseases associated with the circulatory, endocrine, and musculoskeletal systems. The potential to generate actionable recommendations for personalizing home care services, or treatment plans, from limited clinical and care needs data is demonstrated. For patients with chronic disease in the circulatory or musculoskeletal systems, a 2.91% and 3.38% decrease, respectively, in acute care hospitalization rates could be obtained by providing patients with therapy and nursing services, rather than therapy services alone.

Non-invasive approach to diagnosis of pulmonary tuberculosis using microdroplets collected from exhaled air.

In this report we present a proof-of-principle study aimed at developing non-invasive diagnostics for pulmonary TB that are based on analyzing TB biomarkers in exhaled microdroplets of lung fluid (MLFs). Samples were collected on electrospun filters recently developed by the authors, and then tested for the presence of Mycobacterium tuberculosis (Mtb) cells, Mtb DNA, and protein biomarkers (secreted Mtb antigens and antigen-specific antibodies). The latter were detected using rapid ultra-sensitive immunochemistry methods developed in our laboratory. Neither Mtb cells (limit of detection, LOD = 1 cell) nor Mtb DNA (LOD âˆ¼ 10 CFU) were found in the MLF samples exhaled by TB patients. However, immunoglobulin A (IgA) was found in over 90% of samples from TB patients and healthy volunteers. Antigen-specific IgA were detected at higher rates in the patient samples as compared to those from nominally healthy volunteers resulting in a modest discrimination level of 72% sensitivity and 58% specificity. As such, this novel, non-invasive and fast breath diagnostic method shows promise for further development.

Th1, Th17, and Th1Th17 Lymphocytes during Tuberculosis: Th1 Lymphocytes Predominate and Appear as Low-Differentiated CXCR3+CCR6+ Cells in the Blood and Highly Differentiated CXCR3+/-CCR6- Cells in the Lungs.

Th1 lymphocytes are considered the main mediators of protection against tuberculosis (TB); however, their phenotypic characteristics and relationship with Th17 and Th1Th17 populations during TB are poorly understood. We have analyzed Th1, Th17, and Th1Th17 lymphocytes in the blood and pulmonary lesions of TB patients. The populations were identified based on the production of IFN-γ and/or IL-17 and the coexpression of CXCR3 (X3) and CCR6 (R6). In the blood, IL-17+ and IFN-γ+IL-17+ lymphocytes were barely detectable (median, <0.01% of CD4+ lymphocytes), whereas IFN-γ+ lymphocytes predominated (median, 0.45%). Most IFN-γ+ lymphocytes (52%) were X3+R6+, suggesting their "nonclassical" (ex-Th17) nature. In the lungs, IL-17+ and IFN-γ+IL-17+ lymphocytes were more frequent (0.3%, p < 0.005), yet IFN-γ+ cells predominated (11%). Phenotypically, lung CD4+ cells were X3+/loR6- The degree of differentiation of blood effector CD4+ lymphocytes (evaluated based on CD62L/CD27/CD28 coexpression) increased as follows: X3+R6+ < X3+R6- < X3-R6-, with X3-R6- cells being largely terminally differentiated CD62L-CD27-CD28- cells. Lung CD4+ lymphocytes were highly differentiated, recalling blood X3+/-R6- populations. Following in vitro stimulation with anti-CD3/anti-CD28 Abs, X3+R6+CD4+ lymphocytes converted into X3+R6- and X3-R6- cells. The results demonstrate that, during active TB, Th1 lymphocytes predominate in blood and lungs, document differences in X3/R6 expression by blood and lung CD4+ cells, and link the pattern of X3/R6 expression with the degree of cell differentiation. These findings add to the understanding of immune mechanisms operating during TB and are relevant for the development of better strategies to control it.

Estimating the causal effects of chronic disease combinations on 30-day hospital readmissions based on observational Medicaid data.

Objective: Demonstrate how observational causal inference methods can generate insights into the impact of chronic disease combinations on patients' 30-day hospital readmissions. Materials and Methods: Causal effect estimation was used to quantify the impact of each risk factor scenario (ie, chronic disease combination) associated with chronic kidney disease and heart failure (HF) for adult Medicaid beneficiaries with initial hospitalizations in 2 New York State counties. The experimental protocol: (1) created matched risk factor and comparator groups, (2) assessed covariate balance in the matched groups, and (3) estimated causal effects and their statistical significance. Causality lattices summarized the impact of chronic disease comorbidities on readmissions. Results: Chronic disease combinations were ordered with respect to their causal impact on readmissions. Of disease combinations associated with HF, the combination of HF, coronary artery disease, and tobacco abuse (in that order) had the highest causal effect on readmission rate (+22.3%); of disease combinations associated with chronic kidney disease, the combination of chronic kidney disease, coronary artery disease, and diabetes had the highest effect (+9.5%). Discussion: Multi-hypothesis causal analysis reveals the effects of chronic disease comorbidities on health outcomes. Understanding these effects will guide the development of health care programs that address unique care needs of different patient subpopulations. Additionally, these insights bring new attention to individuals at high risk for readmission based on chronic disease comorbidities, allowing for more personalized attention and prioritization of care. Conclusion: Multi-hypothesis causal analysis, a new methodological tool, generates meaningful insights from health care claims data, guiding the design of care and intervention programs.

Engagement as a Driver of Growth of Online Health Forums: Observational Study.

BACKGROUND: The emerging research on nurturing the growth of online communities posits that it is in part attributed to network effects, wherein every increase in the volume of user-generated content increases the value of the community in the eyes of its potential new members. The recently introduced metric engagement capacity offers a means of quantitatively assessing the ability of online platform users to engage each other into generating content; meanwhile, the quantity engagement value is useful for quantifying communication-based platform use. If the claim that higher engagement leads to accelerated growth holds true for online health forums (OHFs), then engagement tracking should become an important tool in the arsenal of OHF managers. Indeed, it might allow for quantifying the ability of an OHF to exploit network effects, thus predicting the OHF's future success. OBJECTIVE: This study aimed to empirically analyze the relationship between internal OHF use (quantified using engagement measurement), and external growth. METHODS: We collected data from 7 OHFs posted between the years 1999 and 2016. Longitudinal analyses were conducted by evaluating engagement in the OHFs over time. We analyzed 2-way causality effects between the engagement value and metrics evaluating OHF growth using Granger causality tests. User activity metrics per week were correlated with engagement metrics, followed by linear regression analyses. RESULTS: Observational data showed a 1-way causal relationship between the OHF engagement value and reach (P=.02). We detected a 2-way causal relationship between the engagement value and delurking, with further analysis indicating that the engagement value was more likely to cause delurking (P<.001 with lag 2; for the reverse hypothesis, P=.01 with lag 2). Users who engaged each other more were more likely (up to 14 times, depending on how much one user engaged another) to develop personal connections. Finally, we found that the more engaging an OHF user was in a given week, the more likely (up to 2 times, depending on their ability to engage others) they were to remain active in the OHF in the following week. CONCLUSIONS: This study supports the claim that network effects play an important role in accelerating OHF growth, opening the door to exploiting these effects in calculated ways. In such efforts, engagement metrics can be used to monitor the "health" of an OHF and to identify the users most important to its success.

Non-invasive lung disease diagnostics from exhaled microdroplets of lung fluid: perspectives and technical challenges.

The combination of ultra-sensitive assay techniques and recent improvements in the instrumentation used to collect microdroplets of lung fluid (MLF) from exhaled breath has enabled the development of non-invasive lung disease diagnostics that are based on MLF analysis. In one example of this approach, electrospun nylon filters were used to collect MLFs from patients with pulmonary tuberculosis. The filters were washed to obtain liquid probes, which were then tested for human immunoglobulin A (h-IgA) and fractions of h-IgA specific to ESAT-6 and Psts-1, two antigens secreted by Mycobacterium tuberculosis. Probes collected for 10 min contained 100-1500 fg of h-IgA and, in patients with pulmonary tuberculosis, a portion of these h-IgA molecules showed specificity to the secreted antigens. Separate MLFs and their dry residues were successfully collected using an electrostatic collector and impactor developed especially for this purpose. Visualization of MLF dry residues by atomic force microscopy made it possible to estimate the lipid content in each MLF and revealed mucin molecules in some MLFs. This exciting new approach will likely make it possible to detect biomarkers in individual MLFs. MLFs emerging from an infection site ('hot' microdroplets) are expected to be enriched with infection biomarkers. This paper discusses possible experimental approaches to detecting biomarkers in single MLFs, as well as certain technological problems that need to be resolved in order to develop new non-invasive diagnostics based on analysing biomarkers in separate MLFs.

The introduction of mesenchymal stromal cells induces different immunological responses in the lungs of healthy and M. tuberculosis infected mice.

Mesenchymal stromal cells (MSC) have strong immunomodulatory properties and therefore can be used to control inflammation and tissue damage. It was suggested recently that MSC injections can be used to treat multi-drug resistant tuberculosis (TB). However, MSC trafficking and immunomodulatory effects of MSC injections during Mycobacterium tuberculosis (Mtb) infection have not been studied. To address this issue we have analyzed MSC distribution in tissues and local immunological effects of MSC injections in Mtb infected and uninfected mice. After intravenous injection, MSC accumulated preferentially in the lungs where they were located as cell aggregates in the alveolar walls. Immunological analysis of MSC effects included detection of activated, IFN-γ and IL-4 producing CD4+ lymphocytes, the frequency analysis of dendritic cells (CD11c+F4/80) and macrophages (CD11c-F4/80+) located in the lungs, the expression of IA/IE and CD11b molecules by these cells, and evaluation of 23 cytokines/chemokines in lung lysates. In the lungs of uninfected mice, MSC transfer markedly increased the percentage of IFN-γ+ CD4+ lymphocytes and dendritic cells, elevated levels of IA/IE expression by dendritic cells and macrophages, augmented local production of type 2 cytokines (IL-4, IL-5, IL-10) and chemokines (CCL2, CCL3, CCL4, CCL5, CXCL1), and downregulated type 1 and hematopoietic cytokines (IL-12p70, IFN-γ, IL-3, IL-6, GM-CSF). Compared to uninfected mice, Mtb infected mice had statistically higher "background" frequency of activated CD69+ and IFN-γ+ CD4+ lymphocytes and dendritic cells, and higher levels of cytokines in the lungs. The injections of MSC to Mtb infected mice did not show statistically significant effects on CD4+ lymphocytes, dendritic cells and macrophages, only slightly shifted cytokine profile, and did not change pathogen load or slow down TB progression. Lung section analysis showed that in Mtb infected mice, MSC could not be found in the proximity of the inflammatory foci. Thus, in healthy recipients, MSC administration dramatically changed T-cell function and cytokine/chemokine milieu in the lungs, most likely, due to capillary blockade. But, during Mtb infection, i.e., in the highly-inflammatory conditions, MSC did not affect T-cell function and the level of inflammation. The findings emphasize the importance of the evaluation of MSC effects locally at the site of their predominant post-injection localization and question MSC usefulness as anti-TB treatment.

Antimicrobial Effect of Biocompatible Silicon Nanoparticles Activated Using Therapeutic Ultrasound.

In this study, we report a method for the suppression of Escherichia coli (E. coli) vitality by means of therapeutic ultrasound irradiation (USI) using biocompatible silicon nanoparticles as cavitation sensitizers. Silicon nanoparticles without (SiNPs) and with polysaccharide (dextran) coating (DSiNPs) were used. Both types of nanoparticles were nontoxic to Hep 2 cells up to a concentration of 2 mg/mL. The treatment of bacteria with nanoparticles and application of 1 W/cm2 USI resulted in the reduction of their viabilities up to 35 and 72% for SiNPs and DSiNPs, respectively. The higher bacterial viability reduction for DSiNPs as compared with SiNPs can be explained by the fact that the biopolymer shell of the polysaccharide provides a stronger adhesion of nanoparticles to the bacterial surface. Transmission electron microscopy (TEM) studies showed that the bacterial lipid shell was partially perforated after the combined treatment of DSiNPs and USI, which can be explained by the lysis of bacterial membrane due to the cavitation sensitized by the SiNPs. Furthermore, we have shown that 100% inhibition of E. coli bacterial colony growth is possible by coupling the treatments of DSiNPs and USI with an increased intensity of up to 3 W/cm2. The observed results reveal the application of SiNPs as promising antimicrobial agents.

Mesenchymal Stem Cells and Myeloid Derived Suppressor Cells: Common Traits in Immune Regulation.

To protect host against immune-mediated damage, immune responses are tightly regulated. The regulation of immune responses is mediated by various populations of mature immune cells, such as T regulatory cells and B regulatory cells, but also by immature cells of different origins. In this review, we discuss regulatory properties and mechanisms whereby two distinct populations of immature cells, mesenchymal stem cells, and myeloid derived suppressor cells mediate immune regulation, focusing on their similarities, discrepancies, and potential clinical applications.

Low-Cost Sensor System Design for In-Home Physical Activity Tracking.

An aging and more sedentary population requires interventions aimed at monitoring physical activity, particularly within the home. This research uses simulation, optimization, and regression analyses to assess the feasibility of using a small number of sensors to track movement and infer physical activity levels of older adults. Based on activity data from the American Time Use Survey and assisted living apartment layouts, we determined that using three to four doorway sensors can be used to effectively capture a sufficient amount of movements in order to estimate activity. The research also identified preferred approaches for assigning sensor locations, evaluated the error magnitude inherent in the approach, and developed a methodology to identify which apartment layouts would be best suited for these technologies.

Health care provider social network analysis: A systematic review.

OBJECTIVES: Although considerable progress has been made in understanding networks, their structure, and their development, little has been known about their effectiveness in the health care setting and their contributions to quality of care and patient safety.The purpose of this study was to examine studies using social network analysis (SNA) in the health care workforce and assess factors contributing to social network and their relationships with care processes and patient outcomes. METHODS: We identified all published peer-reviewed SNA articles in CINAHL, PubMed, PsycINFO, JSTOR, Medline (OVID), and Web of Science databases up to April 2013. RESULTS: Twenty-nine published articles met the inclusion criteria. Current evidence of the health care workforce's social networks reveals the nature of social ties are related to personal characteristics, practice setting, and types of patients. A few studies also revealed the social network effects adoption and the use of a health information system, patient outcomes, and coordination. CONCLUSIONS: Current studies on the social ties of health care workforce professionals include several assessments of inefficiencies. The level of technical sophistication in these studies tended to be low. Future study using enhanced sophistication in study design, analysis, and patient outcome testing are warranted to fully leverage the potential of SNA in health care studies.