Microbiota are now widely recognized as being central players in the health of all organisms and ecosystems, and subsequently have been the subject of intense study. However, analyzing and converting ...microbiome data into meaningful biological insights remain very challenging. In this review, we highlight recent advances in network theory and their applicability to microbiome research. We discuss emerging graph theoretical concepts and approaches used in other research disciplines and demonstrate how they are well suited for enhancing our understanding of the higher-order interactions that occur within microbiomes. Network-based analytical approaches have the potential to help disentangle complex polymicrobial and microbe–host interactions, and thereby further the applicability of microbiome research to personalized medicine, public health, environmental and industrial applications, and agriculture.
In this issue of Neurocritical Care, the authors continue their analysis and examine degrees of agreement regarding early impressions of prognosis, not just between family members and physicians, but ...for both groups compared with bedside nurses’ impressions, as well 2. For 187 patients, they asked a treating physician, a nurse, and a family member all on the same day to each give his or her opinion on the patient’s likelihood of being “independent” at 6 months, scored from 0 to 100 on a continuous visual scale. ...the mean difference in estimates between these two groups was 23.5%, with an optimistic bias for families.
Electronic skin (e-skin) presents a network of mechanically flexible sensors that can conformally wrap irregular surfaces and spatially map and quantify various stimuli. Previous works on e-skin have ...focused on the optimization of pressure sensors interfaced with an electronic readout, whereas user interfaces based on a human-readable output were not explored. Here, we report the first user-interactive e-skin that not only spatially maps the applied pressure but also provides an instantaneous visual response through a built-in active-matrix organic light-emitting diode display with red, green and blue pixels. In this system, organic light-emitting diodes (OLEDs) are turned on locally where the surface is touched, and the intensity of the emitted light quantifies the magnitude of the applied pressure. This work represents a system-on-plastic demonstration where three distinct electronic components--thin-film transistor, pressure sensor and OLED arrays--are monolithically integrated over large areas on a single plastic substrate. The reported e-skin may find a wide range of applications in interactive input/control devices, smart wallpapers, robotics and medical/health monitoring devices.
Nanoparticles can provide significant improvements in the diagnosis and treatment of cancer. How nanoparticle size, shape, and surface chemistry can affect their accumulation, retention, and ...penetration in tumors remains heavily investigated, because such findings provide guiding principles for engineering optimal nanosystems for tumor targeting. Currently, the experimental focus has been on particle design and not the biological system. Here, we varied tumor volume to determine whether cancer pathophysiology can influence tumor accumulation and penetration of different sized nanoparticles. Monte Carlo simulations were also used to model the process of nanoparticle accumulation. We discovered that changes in pathophysiology associated with tumor volume can selectively change tumor uptake of nanoparticles of varying size. We further determine that nanoparticle retention within tumors depends on the frequency of interaction of particles with the perivascular extracellular matrix for smaller nanoparticles, whereas transport of larger nanomaterials is dominated by Brownian motion. These results reveal that nanoparticles can potentially be personalized according to a patient’s disease state to achieve optimal diagnostic and therapeutic outcomes.
Breakdowns in clinician-family communication in neurologic intensive care units (neuroICUs) are common, particularly for goals-of-care decisions to continue or withdraw life-sustaining treatments ...while considering long-term prognoses. Shared decision-making interventions (decision aids DAs) may prevent this problem and increase patient-centered care, yet none are currently available. We assessed the feasibility, acceptability, and perceived usefulness of a DA for goals-of-care communication with surrogate decision makers for critically ill patients with severe acute brain injury (SABI) after hemispheric acute ischemic stroke, intracerebral hemorrhage, or traumatic brain injury.
We conducted a parallel-arm, unblinded, patient-level randomized, controlled pilot trial at 2 tertiary care US neuroICUs and randomized surrogate participants 1:1 to a tailored paper-based DA provided to surrogates before clinician-family goals-of-care meetings or usual care (no intervention before clinician-family meetings). The primary outcomes were feasibility of deploying the DA (recruitment, participation, and retention), acceptability, and perceived usefulness of the DA among surrogates. Exploratory outcomes included outcome of surrogate goals-of-care decision, code status changes during admission, patients' 3-month functional outcome, and surrogates' 3-month validated psychological outcomes.
We approached 83 surrogates of 58 patients and enrolled 66 surrogates of 41 patients (80% consent rate). Of 66 surrogates, 45 remained in the study at 3 months (68% retention). Of the 33 surrogates randomized to intervention, 27 were able to receive the DA, and 25 subsequently read the DA (93% participation). Eighty-two percent rated the DA's acceptability as good or excellent (median acceptability score 2 IQR 2-3); 96% found it useful for goals-of-care decision making. In the DA group, there was a trend toward fewer comfort care decisions (27% vs 56%,
= 0.1) and fewer code status changes (no change, 73% vs 44%,
= 0.02). At 3 months, fewer patients in the DA group had died (33% vs 69%,
= 0.05; median Glasgow Outcome Scale 3 vs1,
= 0.05). Regardless of intervention, 3-month psychological outcomes were significantly worse among surrogates who had chosen continuation of care.
A goals-of-care DA to support ICU shared decision making for patients with SABI is feasible to deploy and well perceived by surrogates. A larger trial is feasible to conduct, although surrogates who select continuation of care deserve additional psychosocial support.
Clinicaltrials.gov NCT03833375.
This study provides Class IV evidence that the use of a DA explaining the goals-of-care decision and the treatment options is acceptable and useful to surrogates of incapacitated critically ill patients with ischemic stroke, intracerebral hemorrhage, or traumatic brain injury.
Optoelectronic effects of sidewall passivation on micro-sized light-emitting diodes (µLEDs) using atomic-layer deposition (ALD) were investigated. Moreover, significant enhancements of the optical ...and electrical effects by using ALD were compared with conventional sidewall passivation method, namely plasma-enhanced chemical vapor deposition (PECVD). ALD yielded uniform light emission and the lowest amount of leakage current for all µLED sizes. The importance of sidewall passivation was also demonstrated by comparing leakage current and external quantum efficiency (EQE). The peak EQEs of 20 × 20 µm
µLEDs with ALD sidewall passivation and without sidewall passivation were 33% and 24%, respectively. The results from ALD sidewall passivation revealed that the size-dependent influences on peak EQE can be minimized by proper sidewall treatment.
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