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Problems of adverse pH and bacterial strategies to combat it.

This chapter aims to survey the problems faced by bacteria found in environments of adverse pH, to review strategies used to combat those problems and to ask how those strategies are implemented. At acid or alkaline pH, bacteria are challenged not just by excess of H+ or OH- but also by excess of metal ions (aluminium, heavy metals at acidic pH, Na+ at alkaline pH), as well as shortages. Bacteria attempt to maintain their intracellular pH by minimizing membrane permeability to H+ and other ions, buffering the cytoplasm, ameliorating the external pH through catabolism or selective substrate utilization, and developing ionic pumping systems. The amelioration of pH depends on the availability of substrate, and is unlikely in most naturally stressful environments. Ion pumping is expensive energetically, although the cost to growth is unknown. The response to adverse pH involves sensing systems and responsive regulatory systems. The adaptive acid tolerance response is now well known in and other bacteria, but is there a widespread adaptive alkali tolerance response? What and where are the sensors? Whether they sense intracellular pH, extracellular pH or delta pH is unclear, although an external sensory input seems essential. Is there one major sensory system responsive to pH or multiple systems with back-up mechanisms? What and where are the regulators? Is there one central regulator controlling all the responses or are there cascades of responses?

Bacteria↗

Recombinase-mediated cassette exchange to rapidly and efficiently generate mice with human cardiac sodium channels.

SCN5A encodes the predominant voltage-gated sodium channel isoform in human heart and nearly 100 variants have now been described and studied in vitro. However, development of animal models to analyze function of such large numbers of human gene variants represents a continuing challenge in translational medicine. Here, we describe the implementation of a two stage procedure, recombinase-mediated cassette exchange (RMCE), to efficiently and rapidly generate mice in which a full-length human cDNA replaces expression of the murine ortholog. In the first step of RMCE, conventional homologous recombination in mouse ES cells was used to replace scn5a exon 2 (that contains the translation start site) with a cassette acceptor that includes the thymidine kinase gene, flanked by loxP/inverted loxP sites. In the second step, the cassette acceptor site was replaced by the full-length wild-type human SCN5A cDNA by Cre/loxP-mediated recombination. The exchange event occurred in 7/29 (24%) colonies, and the time from electroporation to first homozygotes was only 8 months. PCR-restriction fragment length polymorphism (RFLP) showed that the murine isoform was replaced by the human one, and functional studies indicated that mice with human cardiac sodium channels have wild-type sodium current density, action potential durations, heart rates, and QRS durations. These data demonstrate that RMCE can be used to generate mice in which a targeted allele can be rapidly and efficiently replaced by variants of choice, and thereby can serve as an enabling approach for the functional characterization of ion channel and other DNA variants.

Animals↗

Triage and workflow optimization with artificial intelligence in pediatric imaging.

Artificial intelligence (AI) is being increasingly utilized in various aspects by the radiology department. With an ever-increasing burden on the healthcare system, particularly in emergency units, the need to incorporate AI in patient triage and workflow optimization cannot be overstated. Machine learning (ML)-based algorithms form the core of AI-based software, aiding healthcare professionals at nearly every step in delivering appropriate patient care. Regarding the radiology section of the hospital, AI-based algorithms have proven exceptionally useful in assisting radiologists and technicians with image acquisition. From accurate clinical referrals to scheduling computed tomography/magnetic resonance imaging scan appointments, from ensuring the lowest radiation exposure to offering timely follow-up reminders, ML-based software has indeed revolutionized the concept of modern image acquisition, especially in the pediatric radiology section. Although the implementation of these algorithms is swift, several technical challenges and the limited availability of pediatric datasets preclude their widespread use. The utility of multimodal pediatric datasets, which combine imaging, genomics, and clinical data, for comprehensive AI triage models can help AI systems evolve toward greater adaptability and integration, resulting in enhanced efficiency, reduced turnaround times, and improved patient outcomes in pediatric radiology departments in the future. In this article, we highlight and review the utility of AI and machine learning-based algorithms in efficiently aiding triage and streamlining the workflow in the pediatric radiology section, thereby ensuring an overall improvement in the departmental workflow.

Triage↗

Next-Generation Disease Profiling by Integrating Histopathology with Spatial Multi-Omics Data.

The field of pathology has experienced several transformative changes in recent years with the advent of digital pathology and spatial multi-omics. These technologies have enhanced every aspect of pathology practice, from streamlining daily workflows to generating high-fidelity multi-omics data that provide pathologists with novel tools to refine disease profiling and clinical diagnosis. Each layer of multimodal data (genomic, metabolomic, proteomic, or transcriptomic) has uncovered a distinct facet of disease pathologies, and combined with machine learning/artificial intelligence-based data analysis and pattern recognition models, has provided holistic understanding of regulatory mechanisms underpinning them. However, high-dimensional data have far exceeded the volume, scale, and complexity of immunostaining methods implemented by pathologists and, thus, have generated significant challenges related to deconvolution, interpretation, and clinical translation. Furthermore, these multimodal studies have predominantly relied on computational methods to process data and extract disease-relevant insights, thus raising questions around relevance or role of a pathologist in this new era of multi-omics. This review will provide a perspective on the evolving fields of molecular histopathology and spatial -omics, leveraging them to approach disease profiling, and redefining the role of a pathologist during this process.

Humans↗

Advances in optical detection strategies for reporter signal measurements.

Many recent advances in bioreporter technology focus on challenges related to bioengineering, yet in many applications implementation of optical signal measurement is equally susceptible to improvement. For bioluminescent bioreporters, one area of effort lies in the development of semiconductor chip-based detector modules; this holds great promise for ultra-compact and field-deployable instrumentation, but has not yet had a palpable impact on improved detection limits. Regarding lower detection limits, single-molecule detection techniques have seen their first application to bioreporters, and preliminary results serve as an indication of future promise. Another technique applicable to fluorescent bioreporters is fluorescence flow cytometry, which is rapid, suitable for high-throughput screening, and lends itself to increased analytical specificity through simple algorithmic approaches to data treatment.

Biosensing Techniques↗

AIDES to improving medication adherence in older adults.

Medication regimens for older adults are often complex and costly. Designing, implementing, and maintaining an appropriate treatment regimen is challenging. The AIDES method is built on the principles of completing a comprehensive medication Assessment; partnering with patients to ensure Individualization of the regimen; choosing appropriate Documentation; providing accurate and ongoing Education tailored to the age group and needs of the individual; and continuing Supervision after initiation.

Aged↗

Self-perceived health and self-care among diabetic subjects with defective vision: a comparison between subjects with threat of blindness and blind subjects.

The aim of this study was to compare self-perceived health among diabetic patients who experienced threat of blindness with those who had already gone blind. Another aim was to explore different aspects of self-care in relation to self-perceived health among the subjects. Twenty-one diabetic patients under threat of becoming blind and 23 with diabetes-related blindness agreed to participate in the study. The participants were compared with an age- and gender-matched nondiabetic reference group. Self-perceived health was measured using the 63-item Swedish Health-Related Quality of Life Survey (SWED-QUAL) questionnaire. Data on diabetes-related variables were collected from the patient's hospital records. An interview guide was created for measuring dimensions of self-care. Patients with threat of becoming blind showed better self-perceived health than blind patients, but no differences were found in comparison with the Swedish reference group. Blind patients scored lower in 6 of the 13 health domains and they reported more problems with diabetes self-care than patients with threat of becoming blind. One of the 13 health domains, role limitations due to physical health, seemed to be associated with impaired self-care although only a partial understanding could be demonstrated. The results show that blind patients need specific support to cope well with different self-care situations. A great challenge in future research in diabetes is to implement education programs suitable especially for patients who have gone blind because of diabetes.

Adult↗

From population to individual: advocating personalised digital tools for heat-health early warning in a changing climate.

Escalating heat extremes under climate change are imposing substantial health burdens, with 2023 and 2024 consecutively breaking global temperature records. Mounting evidence suggests that heatwaves elevate the risks of hospitalisation and mortality across multiple disease categories, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and acute kidney injury. Nonetheless, most existing heat-health warning systems remain primarily reliant on population-level predictions, and considering individual differences and disease-specific considerations when defining warning levels would benefit the effectiveness of early prevention for high-risk groups. In this Viewpoint, which is based on the framework of precision public health-delivering the right intervention to the right population at the right time-we propose a framework for personalised digital heat-health early warning tools comprising three dimensions: individualised, risk-stratified prediction models that generate tiered early warnings; personalised health prompts coupled with theory-informed behavioural interventions; and adaptive, equity-oriented alert delivery mechanisms tailored to diverse populations. Such tools have the potential to bridge precision disease prevention and climate adaptation, thereby helping to mitigate heat exposure risks and disease burdens, particularly among high-risk populations. Future implementation research will be essential to address substantial challenges related to feasibility, validation, and equity.

Journal Article↗

Prospects for genetic therapy of cardiovascular disease.

Significant progress has been made in cardiovascular gene therapy. Further investigations are required to understand the basic science of vectors, mechanisms of gene delivery, vector-associated immunogenicity, and pathophysiology of vascular and myocardial diseases. In addition, catheter and stent devices will be required to deliver vectors to the vasculature and myocardium (Fig. 3). Despite these scientific challenges, molecular therapies for cardiovascular diseases are being implemented into clinical practice.

Animals↗

Overview of atherosclerosis.

Cardiovascular disease is a serious threat to both life and health, accounting for 44% of the nation's mortality and much of its morbidity. Moreover, atherosclerotic cardiovascular disease is a growing problem because of the aging population. Coronary heart disease is the most common cause of lethal atherosclerotic disease, accounting for two thirds of all deaths resulting from heart disease and 70% of all deaths in those older than 75. A 1997 estimate put the economic cost of atherosclerotic cardiovascular disease at a staggering $259 billion. Indications are that atherosclerotic cardiovascular disease is a generalized process that involves the heart, brain, and peripheral arteries. Clinical manifestations tend to coexist, and the presence of one manifestation increases the likelihood of developing others, because major risk factors tend to affect all arterial territories. Also, clinical atherosclerosis in one area may directly predispose the patient to occurrence of atherosclerosis in another vascular territory. Therefore, measures taken to prevent one clinical manifestation of atherosclerosis should prevent the others as well. Multivariate risk profiles can identify persons at risk for atherosclerotic cardiovascular disease and target them for preventive treatment. Primary preventive measures also appear to be applicable to secondary prevention. Meta-analyses of randomized trials of the efficacy of low-dose aspirin and other antiplatelet agents in persons with overt cardiovascular disease have shown reductions of approximately 25% in the incidences of subsequent myocardial infarctions, strokes, and cardiovascular mortality. Comparison of the risk profiles for atherosclerotic cardiovascular disease indicates that correction of any particular set of risk factors or prevention of any cardiovascular disease outcome prevents other atherosclerotic disease outcomes as well. The challenge for all health care professionals is to implement comprehensive preventive measures for those at high risk for initial atherosclerotic events and even more vigorous measures for those who already have the disease.

Adult↗

An experimental test of an alcohol expectancy challenge in mixed gender groups of young heavy drinkers.

Several studies have shown that a multisession experiential expectancy challenge successfully reduces positive alcohol expectancies and alcohol use in heavy drinking young men, but this has not been shown for heavy drinking young women. Main aim of this study was to test the effect of a multisession expectancy challenge in mixed gender groups of young heavy drinkers. Twenty-five (11 males) heavy drinking students were randomly assigned to the expectancy challenge or control condition (the challenge was adapted to be more suitable for women). Positive expectancies decreased significantly in the experimental but not in the control group. In the experimental group, positive expectancies decreased significantly more in women than in men, and alcohol use showed a statistical trend in the same direction. These findings are the first to indicate that a multisession expectancy challenge may result in reduced positive expectancies and alcohol consumption in young heavy drinking women. An important next question is whether a single experiential session could be effective because recruitment for a multisession challenge proved difficult, which is problematic for further implementation.

Adolescent↗

Contemporary approach to the emergency department management of pediatric asthma.

Asthma continues to be an enormous health problem and economic burden in US society. EDs probably will continue to provide a substantial amount of care for those affected by the disease. Pediatric asthma patients frequently are encountered in EDs. Emergency physicians must remain current in their approach to providing expert care while the management of acute asthma exacerbations continues to evolve, older therapies are challenged and new therapies are developed, tested, and implemented.

Adrenal Cortex Hormones↗

Best laid plans: effective implementation of re-engineering recommendations.

Continuing pressures on health care funding have led most hospitals to undertake re-engineering and restructuring projects to reduce operating expenses. Unfortunately, savings often turn out to be less than anticipated, as the projects falter in the implementation stage. As part of a two-year process improvement and expense reduction project, Toronto's St. Michael's Hospital developed an aggressive and comprehensive implementation process to ensure that it met its savings targets and maintained its financial viability. This article outlines the Hospital's implementation strategy and reviews the project's major challenges and key success factors.

Budgets↗

Clinical use of hepatitis C virus tests for diagnosis and monitoring during therapy.

This article reviewed various methods used for the diagnosis and monitoring of HCV infection and discusses potential clinical applications. Substantial improvements have recently been made in assay technology. Moreover, the role of molecular testing in the clinical setting of hepatitis C is becoming better defined. The major challenge facing clinical laboratories is the further refinement, implementation, and standardization of optimized molecular tests, so that reliable data may be made available to clinicians. In turn, clinicians must understand the limitations of each methodology, including the variability of testing that may occur among different laboratories. As more experience is gathered, molecular testing will probably provide important data regarding the most effective use of current and future therapies for individual patients to achieve maximum benefit in the management of hepatitis C.

Hepatitis C↗

Gene therapy strategies for leukemia.

A number of diverse gene therapy strategies are being evaluated in the search for novel therapeutic approaches to leukemia. Antisense oligonucleotides, ribozymes and retroviral vectors are approaches directed at the molecular mechanisms of cancer. Transfer of genes encoding cytokines and human leukocyte antigens (HLAs) could also be used to elicit immunity against tumor cells. Gene marking strategies have been useful in elucidating the biology of disease relapse after autologous bone marrow transplantation. Suicide genes, such as the herpes simplex thymidine kinase gene, have been used to modulate graft-versus-host disease after allogeneic bone marrow transplantation. Although gene delivery remains a major challenge to gene therapy, some modifications have been implemented to overcome this issue. This review will summarize these gene therapy strategies aimed at increasing the survival of patients with leukemia.

Animals↗

Accomplishments in HIV prevention science: implications for stemming the epidemic.

The past two decades have witnessed substantial advances in the science of preventing HIV infection. Although important issues remain and there is a need for continuing research, arguably the biggest challenge in preventing HIV transmission is the full implementation of existing preventive interventions worldwide.

Anti-HIV Agents↗

Recommendations for return of secondary genomic findings in observational cohort studies.

The return of secondary genomic findings (ROSF) to participants in observational cohort studies has evolved from a topic of debate to an accepted standard. This Perspective synthesizes the proceedings of a 2024 National Heart, Lung and Blood Institute-sponsored workshop and the broader literature to provide updated guidance for ROSF. Building on the 2010 National Heart, Lung and Blood Institute Working Group recommendations and the 2014 Clinical Sequencing Exploratory Research/Electronic Medical Records and Genomics 'floor and ceiling' framework, we address four areas: an integrated ethical framework for observational cohort settings; the emerging challenge of returning novel result types beyond monogenic variants, including polygenic risk scores, somatic mosaicism and pharmacogenomic findings; health equity and community engagement as structural prerequisites for ethical ROSF; and scalability challenges, including technology-assisted disclosure. Drawing on implementation experience from large-scale sequencing programs, we offer recommendations that balance researcher obligations with participant autonomy and equitable access to the benefits of genomic research.

Journal Article↗

Communicating exposure and health effects results to study subjects, the community and the public: strategies and challenges.

The Mickey Leland National Urban Air Toxics Research Center sponsored a Symposium in August 2002 that focused on the communication of health effects results from community studies involving exposure to hazardous substances in the environment. Some of the audiences identified for presentation of study results were the study subjects, the community, and the general public. Principles and approaches to communicating findings were discussed, as were the challenges that may confront researchers in developing and implementing a communication plan. The Symposium included four sessions. The first was an overview session where Timothy McDaniels (University of British Columbia) described risk communication as a decision-aiding process. In the second session, case studies were presented by Timothy Buckley (Johns Hopkins University), Jane Hoppin (National Institute of Environmental Health Sciences), and Anne-Marie Nicol (University of British Columbia). Approaches and strategies used by different stakeholders to communicate study results was the topic for a panel discussion at the third session. Panelists included: James Collins (The Dow Chemical Company), Mary White (Agency for Toxic Substances and Disease Registry), Richard Clapp (Boston University), Valerie Zartarian (Environmental Protection Agency), Pamela Williams (Chemrisk), and Tina Bahadori (American Chemistry Council). The final session was a summary presentation on lessons learned given by Rebecca Parkin of George Washington University, in which she synthesized the preceding presentations and formulated guidelines for effective risk communication in community research studies.

Communication↗