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In the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial, use of a pulmonary artery catheter did not significantly affect advanced heart failure outcomes. However, the success of achieving the targeted hemodynamic goals of pulmonary capillary wedge pressure (PCWP) of 15 mm Hg and right atrial pressure (RAP) of 8 mm Hg and the association of these goals with clinical outcomes were not addressed. Furthermore, goals with 2 independent variables, PCWP and RAP, left room for uncertainties. We assessed the ability of a single hemodynamic target to achieve a threshold sum of PCWP and RAP as a predictor of all-cause mortality, death-or-transplantation (DT), or death-or-rehospitalization (DR) at 6 months in the pulmonary artery catheter–guided treatment arm of ESCAPE (n = 206). Patients with a posttreatment PCWP + RAP of <30 mm Hg had characteristics similar to those of the population who achieved the ESCAPE hemodynamic goals. This group had 8.7% mortality, 13.0% DT, and 58.7% DR at 6 months. The contrasting cohort with PCWP + RAP of ≥30 mm Hg had 45.3% mortality, 54.7% DT, and 84.9% DR at 6 months, with greater relative risk (RR) of death (RR 5.76), DT (RR 4.92), and DR (RR 1.80) and higher prevalence of jugular venous pulsation, edema, hepatomegaly, and ascites at admission and discharge. In conclusion, PCWP + RAP of 30 mm Hg posttreatment, obtained early in the index hospitalization, may represent as a simple congestion index that has prognostic value for heart failure survival and readmission rates at 6 months and as a warning signal for more aggressive intervention, thus warranting further validation.

Autofluorescence imaging with virtual histological staining has shown promising potential to improve the efficiency of postoperative histopathology workflow. Here, a widefield deep‐ultraviolet light‐emitting diode‐based imaging system to generate autofluorescence images of human prostate tissue sections from 12 patients with a lateral resolution of ≈1 μm is used. Subsequently, the autofluorescence images are transformed into virtual hematoxylin and eosin‐stained images via a weakly supervised deep learning framework. The virtual staining results are assessed by four professional pathologists through statistical analysis, which shows high diagnostic accuracy (91%), and high tissue detail quality. Autofluorescence imaging  with virtual histological staining streamlines postoperative histopathology. Using a deep ultraviolet light‐emitting diode (LED)‐based imaging system and a weakly supervised deep learning model, virtual hematoxylin and eosin (H&E)‐stained images are generated from the autofluorescence of prostate tissue. Pathologist evaluations reveal high diagnostic accuracy and detailed tissue visualization, highlighting the potential of this technique to revolutionize pathology workflows.

Gestational diabetes mellitus (GDM) is an increasingly common high-risk pregnancy condition requiring intensive daily self-management, placing the burden of care directly on the patient. Understanding personal and cultural differences among patients is critical for delivering optimal support for GDM self-management, particularly in high-risk populations. Although mobile apps for GDM self-management are being used, limited research has been done on the personalized and culturally tailored features of these apps and their impact on patient self-management. This scoping review aims to explore the extent to which published studies report the integration and effectiveness of personalized and culturally tailored features in GDM mobile apps for patient self-management support. We examined English-language peer-reviewed articles published between October 2016 and May 2023 from PubMed, CINAHL, PsycINFO, ClinicalTrials.gov, Proquest Research Library, and Google Scholar using search terms related to digital tools, diabetes, pregnancy, and cultural tailoring. We reviewed eligible articles and extracted data using the Arskey and O'Malley methodological framework. Our search yielded a total of 1772 articles after the removal of duplicates and 158 articles for full-text review. A total of 21 articles that researched 15 GDM mobile apps were selected for data extraction. Our results demonstrated the stark contrast between the number of GDM mobile apps with personalized features for the individual user (all 15 mobile apps) and those culturally tailored for a specific population (only 3 of the 15 mobile apps). Our findings showed that GDM mobile apps with personalized and culturally tailored features were perceived to be useful to patients and had the potential to improve patients' adherence to glycemic control and nutrition plans. There is a strong need for increased research and development to foster the implementation of personalized and culturally tailored features in GDM mobile apps for self-management that cater to patients from diverse backgrounds and ethnicities. Personalized and culturally tailored features have the potential to serve the unique needs of patients more efficiently and effectively than generic features alone; however, the impacts of such features still need to be adequately studied. Recommendations for future research include examining the cultural needs of different ethnicities within the increasingly diverse US population in the context of GDM self-management, conducting participatory-based research with these groups, and designing human-centered mobile health solutions for both patients and providers.

Objective Formative research was conducted to identify barriers to universal screening for alcohol/substance use, depression, and anxiety in women of childbearing age (WOCA,18–44 years of age) drawn from the general population and from women in a residential treatment program for alcohol and/or drug use. Methods E-surveys (n = 467), focus groups with women aged 18–44 (n = 30), and in-depth interviews (IDIs) with healthcare providers (HCPs, n = 8) were conducted to create a user-centered design for a mHealth application. Results E-surveys revealed that 80% of the women were asked about alcohol use at a visit with their HCP, while 70% were asked about drug use. Only 35% of the respondents indicated an HCP discussed their answers with them. Two focus groups with WOCA revealed minimal to no prior knowledge of risk factors related to alcohol and substance use. Barriers to treatment identified included a lack of readiness to change, cost, minimal social support systems, and a perceived sense of public stigma. In-depth interviews with HCPs revealed not all HCPs use screenings for substance use due to lack of time to conduct a screening, unfamiliarity with standardized screening tools, insufficient training to provide proper follow-up care, no mandates requiring such screenings, and a concern that asking follow-up questions may negatively impact their relationship with the client. Conclusion Results from the formative research studies were used to inform the design and development of the WE-CARE app prototype. The prototype, which includes educational content on alcohol and substance use disorders (SUDs), a moderated discussion forum, FAQs, and a Chatbot to encourage participants to make an appointment with an SUD treatment center if indicated, is undergoing pilot testing.

Background: The majority of women who are pregnant with opioid use disorder (OUD) also smoke tobacco but are rarely offered tobacco cessation counseling. While the effects of exposure to opioids and nicotine in utero are well-understood separately, understanding the impact of the combined exposure to these substances on neonatal outcomes is lacking. Methods: A scoping review was conducted using PubMed and Scopus databases for studies addressing the combined exposure to opioids and nicotine during pregnancy published between 1 January 1980 and 9 July 2019. A total of 29 papers met the eligibility criteria for inclusion, with nine being identified as clinical trials (three from the MOTHER study) and two as secondary data analysis of clinical trial data. Results: Neonatal outcomes for infants who had a combined exposure to opioids and nicotine in utero indicated a reduction in birth weight and birth length. Findings in infants exposed to both nicotine and opioids were mixed with regard to the duration of neonatal abstinence syndrome (NAS), the likelihood of treatment for NAS, doses of medicine used to treat NAS, and NAS scores when compared with infants who had opioid exposure without nicotine. Conclusions: The combined exposure to nicotine and opioids during pregnancy may lead to a reduction in neonatal birth weight and birth length and more severe NAS signs, compared with opioid use alone, but more research is necessary to identify the minimum dosage and length of nicotine exposure to accurately predict these outcomes.

Breastfeeding rates among US mothers, particularly Black or African American mothers, fall short of recommended guidelines. Despite the benefits of human milk, only 24.9% of all infants receive human milk exclusively at 6 months. Our team previously explored the key content areas a mobile health intervention should address and the usability of an initial prototype of the Knowledge and Usage of Lactation using Education and Advice from Support Network (KULEA-NET), an evidence-based mobile breastfeeding app guided by preferences of Black or African American parents. This study aimed to identify the preferences and acceptability of additional features, content, and delivery methods for an expanded KULEA-NET app. Key social branding elements were defined to guide app development as a trusted adviser. The study also aimed to validate previous findings regarding approaches to supporting breastfeeding goals and cultural tailoring. We conducted a qualitative study using in-depth interviews and focus groups with potential KULEA-NET users. A health branding approach provided a theoretical framework. We recruited 24 participants across 12 interviews and 2 focus groups, each with 6 participants. The Data methods aligned with qualitative research principles and concluded once saturation was reached. Given the focus on cultural tailoring, team members who shared social identities with study participants completed data collection and coding. Two additional team members, 1 with expertise in social branding and 1 certified in lactation, participated in the thematic analysis. All participants identified as Black or African American mothers, and most interview participants (7/12, 58%) engaged in exclusive breastfeeding. In total, 4 themes were recognized. First, participants identified desired content, specifying peer support, facilitated access to experts, geolocation to identify resources, and tracking functions. Second, delivery of content differentiated platforms and messaging modality. Third, functionality and features were identified as key factors, highlighting content diversity, ease of use, credibility, and interactivity. Finally, appealing aspects of messaging to shape a social brand highlighted support and affirmation, inclusivity and body positivity, maternal inspiration, maternal identity, social norms, and barriers to alignment with aspirational maternal behaviors as essential qualities. Crosscutting elements of themes included a desire to communicate with other mothers in web-based forums and internet-based or in-person support groups to help balance the ideal medical recommendations for infant feeding with the contextual realities and motivations of mothers. Participants assigned high value to personalization and emphasized a need to achieve both social and factual credibility. This formative research suggested additional elements for an expanded KULEA-NET app that would be beneficial and desired. The health branding approach to establish KULEA-NET as a trusted adviser is appealing and acceptable to users. Next steps include developing full app functionality that reflects these findings and then testing the updated KULEA-NET edition in a randomized controlled trial.

Women of childbearing age (aged 18-44 years) face multiple barriers to receiving screening and treatment for unhealthy alcohol and substance use, depression, and anxiety, including lack of screening in the primary care setting and lack of support in accessing care. The Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE) mobile app was developed to test universal screening with women of childbearing age and linkage to care after an anonymous assessment. In this study, we aimed to investigate the feasibility and acceptability of providing anonymous screening instruments through mobile phones for alcohol and substance use, as well as depression and anxiety, for women of childbearing age. We used agile development principles based on previous formative research to test WE-CARE mobile health app with women of childbearing age (N=30) who resided in 1 of 6 counties in central Florida. WE-CARE included screening instruments (for alcohol, substance use, depression, and anxiety), a moderated discussion forum, educational microlearning videos, a frequently asked questions section, and resources for linkage to treatment. Individuals were recruited using flyers, academic listserves, and a commercial human subject recruiting company (Prolific). Upon completion of the screening instruments, women explored the educational and linkage to care features of the app and filled out a System Usability Scale to evaluate the mobile health app's usability and acceptability. Postpilot semistructured interviews (n=4) were conducted to further explore the women's reactions to the app. A total of 77 women downloaded the application and 30 completed testing. Women of childbearing age gave the WE-CARE app an excellent System Usability Scale score of 86.7 (SD 12.43). Our results indicate elevated risk for substance use in 18 of the 30 (60%) participants, 9/18 (50%) also had an elevated risk for anxiety or depression, and 11/18 (61%) had an elevated risk for substance use, anxiety, or depression. Participants reported that WE-CARE was easy to navigate and use but they would have liked to see more screening questions and more educational content. Linkage to care was an issue; however, as none of the women identified as \"at-risk\" for substance use disorders contacted the free treatment clinic for further evaluation. The mobile health app was highly rated for acceptability and usability, but participants were not receptive to seeking help at a treatment center after only a few brief encounters with the app. The linkage to care design features was likely insufficient to encourage them to seek treatment. The next version of WE-CARE will include normative scores for participants to self-evaluate their screening status compared with their age- and gender-matched peers and enhanced linkages to care features. Future development will focus on enhancing engagement to improve change behaviors and assess readiness for change.

The current ever-changing environment of the construction industry demands Quantity Surveyors to update their knowledge and skills to cope with the changes. In order to provide insights for Quantity Surveyors to be able to manage a construction project productively and increase their ability in accordance with the current demand of the construction industry, this research conduct a questionnaire survey and interviews. As a result, the most critical challenges for Quantity Surveyors are a) Adopting new technologies such as BIM for their current practice, and b) Increasing their knowledge regarding sustainable attributes for a construction project. This research also disclosed that the expected emerging roles for Quantity Surveyors are a) Sustainable Advisory ability, and b) BIM ability for cost management. The research findings are expected to advise the current Quantity Surveyor and Quantity Surveying companies to prepare future competencies in accordance with the global trend.

Background Despite strong evidence about the benefits of exclusive breastfeeding, that is the baby receiving only breast milk, no other foods or liquids, rates have remained relatively unchanged over the past two decades in low- and middle-income countries. One strategy for increasing exclusive breastfeeding is through community-based programs that use peer counselors for education and support. The use of mobile health applications is also gaining increasing applicability in these countries. Minimal information is available about training peer counselors in the use of mobile technologies to support exclusive breastfeeding. The present article describes our curriculum in the state of Karnataka, India for supporting new mothers to exclusively breastfeed using a mobile health application in rural India. Methods Twenty-five women from the community surrounding the city of Belgavi, Karnataka, India were trained to be peer counselors and to use a mobile health application to conduct a structured curriculum to support new mothers in exclusive breastfeeding. The three-day interactive training, conducted in March 2018, was based on the WHO breastfeeding course, translated, and adapted to the local culture The curriculum, which included information collected during a formative research process, consisted of eight visits, two during the antenatal period and continuing for six months postpartum. Twelve nursing and obstetric experts validated curriculum content. Pre-post-evaluation of the training focused on breastfeeding knowledge, self-efficacy, skills, and app usability. Results We observed a significant increase in the mean scores for knowledge ( P < 0.0001) and skills ( P = 0.0006) from pre- to post-training. Age of the peer counselors and their own breastfeeding experience correlated significantly with the acquisition of knowledge and skills. The mobile health app showed high usability scores. Conclusions The culturally adapted curriculum presented here, combined with an mHealth app, can be an important educational strategy for training rural women in the acquisition of exclusive breastfeeding knowledge and skills.

Significant attempts have been recently made regarding nanomaterials due to their several environmental applications especially in wastewater treatment technologies. Among the available nanoparticles, ferrite based substances are gaining a special interest since their superior characteristics such as their magnetic nature, high adsorption capacity and large specific surface area. In this regard, Cd0.5Ag0.5Fe2O4 was prepared using the green simple co-precipitation route. Then, the sample is characterized via Scanning Electron Microscopy (SEM) that proved the produced material’s surface morphology. The substance is then employed as a catalyst source for Fenton reaction to oxidize textile effluent solution containing Rhodamine B (Rh-B 6G) dye. The oxidation experiment conducted under ultraviolet (UV) light with the ferrite-based Fenton catalyst supplemented with hydrogen peroxide showed an exceptional removal rate of up to 94% removals. Notably, the oxidation system is significantly impacted by the operational variables. The oxidation efficiency of the dye was maximized at pH 3.0 and 50 mg/L and 1600 mg/L for ferrite-based Fenton catalyst and H2O2, respectively. The impacts of the operational factors, i.e. initial pH value, initial dye concentration, catalyst, and H2O2 concentrations were also investigated. This perspective introduces the role of a superparamagnetic material to be a recyclable sustained catalyst.