This article explores the deep impact of the COVID-19 pandemic on pediatric care volunteerism and specifically highlights the innovative responses and adaptations made by Project Sunshine, an ...international nonprofit organization headquartered in New York, NY. Prior to the pandemic, Project Sunshine's in-person volunteers played a critical role in providing comfort and support to hospitalized children and their families, bridging the gap between clinical treatment and patient satisfaction. However, COVID-19 brought unprecedented challenges to hospitals around the world, including widespread interruption of volunteer activities due to safety concerns and visitation restrictions. In response, Project Sunshine swiftly pivoted to virtual volunteering by launching TelePlay, an online playroom offering live interactive sessions between trained volunteers and pediatric patients. This approach addressed the immediate volunteering needs of patients during the pandemic and also extended support beyond traditional hospital settings, allowing Project Sunshine to reach children at home facing isolation and socialization challenges. Early pilot data is very encouraging: TelePlay participants were noted by their caregivers to be less anxious after a TelePlay session compared to before (p < 0.001). Additionally, the flexibility and accessibility of TelePlay have opened new avenues for volunteers to engage with their communities, transcending geographical barriers and accommodating varied schedules. As the healthcare landscape transitions back to in-person volunteerism, Project Sunshine embraces a hybrid model, offering both in-person and virtual volunteering opportunities. This flexible approach reflects the organization's commitment to helping shape the future of volunteerism to meet the evolving needs of pediatric patients and volunteers alike.
Itch is an unpleasant sensation that elicits robust scratching and aversive experience. However, the identity of the cells and neural circuits that organize this information remains elusive. Here, we ...show the necessity and sufficiency of chloroquine-activated neurons in the central amygdala (CeA) for both itch sensation and associated aversion. Further, we show that chloroquine-activated CeA neurons play important roles in itch-related comorbidities, including anxiety-like behaviors, but not in some aversive and appetitive behaviors previously ascribed to CeA neurons. RNA-sequencing of chloroquine-activated CeA neurons identified several differentially expressed genes as well as potential key signaling pathways in regulating pruritis. Finally, viral tracing experiments demonstrate that these neurons send projections to the ventral periaqueductal gray that are critical in modulation of itch. These findings reveal a cellular and circuit signature of CeA neurons orchestrating behavioral and affective responses to pruritus in mice.
Chemical analysis has shown that Plasmodium falciparum trophozoites contain 61+/-2% of the iron within parasitized erythrocytes, of which 92+/-6% is located within the food vacuole. Of this, 88+/-9% ...is in the form of haemozoin. (57)Fe-Mössbauer spectroscopy shows that haemozoin is the only detectable iron species in trophozoites. Electron spectroscopic imaging confirms this conclusion.
Nitrilases are oligomeric, helix-forming enzymes from plants, fungi and bacteria that are involved in the metabolism of various natural and artificial nitriles. These biotechnologically important ...enzymes are often specific for certain substrates, but directed attempts at modifying their substrate specificities by exchanging binding pocket residues have been largely unsuccessful. Thus, the basis for their selectivity is still unknown. Here we show, based on work with two highly similar nitrilases from the plant
, that modifying nitrilase helical twist, either by exchanging an interface residue or by imposing a different twist, without altering any binding pocket residues, changes substrate preference. We reveal that helical twist and substrate size correlate and when binding pocket residues are exchanged between two nitrilases that show the same twist but different specificities, their specificities change. Based on these findings we propose that helical twist influences the overall size of the binding pocket.
The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year.
Retrospective comparison of ...linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the rest of the population. Health records were extracted with event dates between 23 March 2020 and 22 March 2021 for the comparator cohort and from the date of inclusion until 1 year later for the shielded cohort.
The shielded cohort included 117,415 people, with 3,086,385 in the comparator cohort. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). People in the shielded cohort were more likely to be female, aged ≥50 years, living in relatively deprived areas, care home residents and frail. The proportion of people tested for COVID-19 was higher in the shielded cohort (odds ratio OR 1.616; 95% confidence interval CI 1.597–1.637), with lower positivity rate incident rate ratios 0.716 (95% CI 0.697–0.736). The known infection rate was higher in the shielded cohort (5.9% vs 5.7%). People in the shielded cohort were more likely to die (OR 3.683; 95% CI: 3.583–3.786), have a critical care admission (OR 3.339; 95% CI: 3.111–3.583), hospital emergency admission (OR 2.883; 95% CI: 2.837–2.930), emergency department attendance (OR 1.893; 95% CI: 1.867–1.919) and common mental disorder (OR 1.762; 95% CI: 1.735–1.789).
Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders; however, lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.
Antibiotic-associated diarrhoea (AAD) occurs most commonly in older people admitted to hospital and within 12 weeks of exposure to broad-spectrum antibiotics. Although usually a mild and ...self-limiting illness, the 15-39% of cases caused by Clostridium difficile infection C. difficile diarrhoea (CDD) may result in severe diarrhoea and death. Previous research has shown that probiotics, live microbial organisms that, when administered in adequate numbers, are beneficial to health, may be effective in preventing AAD and CDD.
To determine the clinical effectiveness and cost-effectiveness of a high-dose, multistrain probiotic in the prevention of AAD and CDD in older people admitted to hospital.
A multicentre, randomised, double-blind, placebo-controlled, parallel-arm trial.
Medical, surgical and elderly care inpatient wards in five NHS hospitals in the UK.
Eligible patients were aged ≥ 65 years, were exposed to one or more oral or parenteral antibiotics and were without pre-existing diarrhoeal disorders, recent CDD or at risk of probiotic adverse effects. Out of 17,420 patients screened, 2981 (17.1%) were recruited. Participants were allocated sequentially according to a computer-generated random allocation sequence; 1493 (50.1%) were allocated to the probiotic and 1488 (49.9%) to the placebo arm.
Vegetarian capsules containing two strains of lactobacilli and two strains of bifidobacteria (a total of 6 × 10(10) organisms per day) were taken daily for 21 days. The placebo was inert maltodextrin powder in identical capsules.
The occurrence of AAD within 8 weeks and CDD within 12 weeks of recruitment was determined by participant follow-up and checking hospital laboratory records by research nurses who were blind to arm allocation.
Analysis based on the treatment allocated included 2941 (98.7%) participants. Potential risk factors for AAD at baseline were similar in the two study arms. Frequency of AAD (including CDD) was similar in the probiotic (159/1470, 10.8%) and placebo arms 153/1471, 10.4%; relative risk (RR) 1.04; 95% confidence interval (CI) 0.84 to 1.28; p = 0.71. CDD was an uncommon cause of AAD and occurred in 12/1470 (0.8%) participants in the probiotic and 17/1471 (1.2%) in the placebo arm (RR 0.71; 95% CI 0.34 to 1.47; p = 0.35). Duration and severity of diarrhoea, common gastrointestinal symptoms, serious adverse events and quality of life measures were also similar in the two arms. Total health-care costs per patient did not differ significantly between the probiotic (£8020; 95% CI £7620 to £8420) and placebo (£8010; 95% CI £7600 to £8420) arms.
We found no evidence that probiotic administration was effective in preventing AAD. Although there was a trend towards reduced CDD in the probiotic arm, on balance, the administration of this probiotic seems unlikely to benefit older patients exposed to antibiotics. A better understanding of the pathogenesis of AAD and CDD and the strain-specific effects of probiotics is needed before further clinical trials of specific microbial preparations are undertaken. Evaluation of the effectiveness of other probiotics will be difficult where other measures, such as antibiotic stewardship, have reduced CDD rates.
This trial is registered as ISRCTN70017204.
This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 17, No. 57. See the NIHR Journals Library website for further project information.
► High capacity immobilisation of glucose dehydrogenase and NADH oxidase. ► Immobilisation of multimeric glucose dehydrogenase with 40% activity maintenance. ► Improved pH and thermal stability of ...immobilised enzymes.
The use of enzymes in industrial applications is limited by their instability, cost and difficulty in their recovery and re-use. Immobilisation is a technique which has been shown to alleviate these limitations in biocatalysis. Here we describe the immobilisation of two biocatalytically relevant co-factor recycling enzymes, glucose dehydrogenase (GDH) and NADH oxidase (NOD) on aldehyde functional ReSyn™ polymer microspheres with varying functional group densities. The successful immobilisation of the enzymes on this new high capacity microsphere technology resulted in the maintenance of activity of ∼40% for GDH and a maximum of 15.4% for NOD. The microsphere variant with highest functional group density of ∼3500μmolg−1 displayed the highest specific activity for the immobilisation of both enzymes at 33.22Umg−1 and 6.75Umg−1 for GDH and NOD with respective loading capacities of 51% (0.51mgmg−1) and 129% (1.29mgmg−1). The immobilised GDH further displayed improved activity in the acidic pH range. Both enzymes displayed improved pH and thermal stability with the most pronounced thermal stability for GDH displayed on ReSyn™ A during temperature incubation at 65°C with a 13.59 fold increase, and NOD with a 2.25-fold improvement at 45°C on the same microsphere variant. An important finding is the suitability of the microspheres for stabilisation of the multimeric protein GDH.
This study examines whether patients' telehealth experiences differed during a health system mandate for telehealth encounters due to the COVID-19 pandemic versus after the mandate was relaxed. ...Patient experience surveys from telehealth visits across 17 adult (age 18+) primary care sites at a large, urban public health system were analyzed during two periods: when a mandate was active (March 1, 2020-June 30, 2020) and when the mandate was relaxed and any appointment modality was available (July 1, 2020-November 30, 2021). Primary outcomes were odds ratios (ORs) comparing top-box percentages of survey responses at multiple levels: individual questions, four domains, and all questions together as a composite. Key findings: Patients had higher odds of selecting top-box answers in the elective telehealth period for the Care Provider (1.09 95% confidence interval 1.03, 1.16) and General Assessment (1.13 1.02, 1.24) domains and the survey composite (1.08 1.04, 1.13), but there was no difference for individual questions.Women reported more positive experiences during the elective telehealth period in the Access (1.22 1.01, 1.47), Care Provider (1.32 1.17, 1.50), and Telemedicine Technology (1.24 1.04, 1.50) domains.Our findings suggest that patients had better telehealth experiences when mandates were relaxed.
Understanding differences in how demographic groups experience telehealth may be relevant in addressing potential disparities in telehealth usage. We seek to identify and examine themes most ...pertinent to patients' negative telehealth experiences by age and race in order to inform interventions to improve patients' future telehealth experiences. We performed a content analysis of Press Ganey patient experience surveys from adult patients at 17 primary care sites of a large, public healthcare system with visits from April 30, 2020 to August 27, 2021. We used sentiment analysis to identify negative comments. We coded for content themes and analyzed their frequency, stratifying by age and race. We analyzed 745 negative comments. Most frequent themes differed by demographic categories, but overall, the most commonly applied codes were "Contacting the Clinic" (n = 97), "Connectivity" (n = 84), and "Webside Manner" (n = 79). The top three codes accounted for >40% of the negative codes in each race category and >35% of the negative codes in each age category. While there were common negative experiences among groups, patients of different demographics highlighted different aspects of their telehealth experiences for potential improvement.
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