Malaria is an infectious disease caused by Plasmodium parasites, transmitted through mosquito bites. Symptoms include fever, headache, and vomiting, and in severe cases, seizures and coma. The World Health Organization reports that there were 228 million cases and 405,000 deaths in 2018, with Africa representing 93% of total cases and 94% of total deaths. Rapid diagnosis and subsequent treatment are the most effective means to mitigate the progression into serious symptoms. However, many fatal cases have been attributed to poor access to healthcare resources for malaria screenings. In these low-resource settings, the use of light microscopy on a thin blood smear with Giemsa stain is used to examine the severity of infection, requiring tedious and manual counting by a trained technician. To address the malaria endemic in Africa and its coexisting socioeconomic constraints, we propose an automated, mobile phone-based screening process that takes advantage of already existing resources. Through the use of convolutional neural networks (CNNs), we utilize a SSD multibox object detection architecture that rapidly processes thin blood smears acquired via light microscopy to isolate images of individual red blood cells with 90.4% average precision. Then we implement a FSRCNN model that upscales 32 × 32 low-resolution images to 128 × 128 high-resolution images with a PSNR of 30.2, compared to a baseline PSNR of 24.2 through traditional bicubic interpolation. Lastly, we utilize a modified VGG16 CNN that classifies red blood cells as either infected or uninfected with an accuracy of 96.5% in a balanced class dataset. These sequential models create a streamlined screening platform, giving the healthcare provider the number of malaria-infected red blood cells in a given sample. Our deep learning platform is efficient enough to operate exclusively on low-tier smartphone hardware, eliminating the need for high-speed internet connection.

Primary hemostasis results in a platelet-rich thrombus that has long been assumed to form a solid plug. Unexpectedly, our 3-dimensional (3D) electron microscopy of mouse jugular vein puncture wounds revealed that the resulting thrombi were structured about localized, nucleated platelet aggregates, pedestals and columns, that produced a vaulted thrombus capped by extravascular platelet adherence. Pedestal and column surfaces were lined by procoagulant platelets. Furthermore, early steps in thrombus assembly were sensitive to P2Y₁₂ inhibition and late steps to thrombin inhibition. Based on these results, we propose a Cap and Build, puncture wound paradigm that should have translational implications for bleeding control and hemostasis.

Gastrojejunostomy tube (GJT) placement is commonly performed for enteral access and post-pyloric feeding in children with gastric feeding intolerance. Prior studies have suggested the risk of surgical complications is elevated in infants compared to older children. We aim to characterize GJT usage in children and investigate the risk factors for postoperative complications through two national databases. We performed a multi-institutional retrospective cohort study on children who underwent GJT placement utilizing two national databases, the Pediatric American College of Surgeons National Surgical Quality Improvement Program (Ped-NSQIP) and the Pediatric Health Information System (PHIS). Analyses were performed within each cohort separately to determine differences in outcomes between infants (<1 year of age) and non-infants (≥1 year of age). Multivariable logistic regression was performed to determine associations with postoperative complications. Infants did not have an increased rate of surgical complications compared to non-infants in the Ped-NSQIP cohort (26.9 % vs. 29.0 %, p = 0.84) or PHIS cohort (35.3 % vs. 30.7 %, p = 0.07). There was an increased risk of complications in African American infants (OR 1.93, 95 % CI 1.01-3.67) and non-infants (OR 1.64, 95 % CI 1.27-2.10) and for urgent procedures or emergent procedures in both infants and non-infants (OR 5.42-6.46 and OR 2.12-2.61, respectively). GJT placement and complication rates significantly varied across institutions. We demonstrate substantial but similar overall complication rates of GJT placement between infants and non-infants. These findings suggest age alone should not negate placement of GJTs when indicated for enteral access in children. Multi-institutional, retrospective, cohort study.

Invented in 2010, NanoCluster Beacons (NCBs) (1) are an emerging class of turn-on probes that show unprecedented capabilities in single-nucleotide polymorphism (2) and DNA methylation (3) detection. As the activation colors of NCBs can be tuned by a near-by, guanine-rich activator strand, NCBs are versatile, multicolor probes suitable for multiplexed detection at low cost. Whereas a variety of NCB designs have been explored and reported, further diversification and optimization of NCBs require a full scan of the ligand composition space. However, the current methods rely on microarray and multi-well plate selection, which only screen tens to hundreds of activator sequences (4, 5). Here we take advantage of the next-generation-sequencing (NGS) platform for high-throughput, large-scale selection of activator strands. We first generated a ~10⁴ activator sequence library on the Illumina MiSeq chip. Hybridizing this activator sequence library with a common nucleation sequence (which carried a nonfluorescent silver cluster) resulted in hundreds of MiSeq chip images with millions of bright spots (i.e. light-up polonies) of various intensities and colors. With a method termed Chip- Hybridized Associated Mapping Platform (CHAMP) (6), we were able to map these bright spots to the original DNA sequencing map, thus recovering the activator sequence behind each bright spot. After assigning an “activation score” to each “light-up polony”, we used a computational algorithm to select the best activator strands and validate these strands using the traditional in-solution preparation and fluorometer measurement method. By exploring a vast ligand composition space and observing the corresponding activation behaviors of silver clusters, we aim to elucidate the design rules of NCBs.

Objective: To evaluate the utility of ordering chest x‐rays after pediatric tracheostomy tube placement in identifying acute, post‐operative complications and how it impacts clinical decision‐making.Methods: In this retrospective cohort study, we identified tracheostomies performed in 139 pediatric patients through CPT codes over a 5‐year period from 2013 to 2018. Manual chart review was performed for demographic and clinical characteristics, pre‐procedure and post‐procedure chest x‐ray interpretations, and the presence of complications. Each complication was reviewed to see if action was taken due to post‐procedure chest x‐ray findings. Multivariable logistic regression was performed to determine associations with changes in pre‐procedure versus post‐procedure chest x‐rays.Results: In a cohort of 139 pediatric patients with pre‐procedure and post‐procedure chest x‐rays, 40 (28.8%) of patients had new significant post‐procedure chest x‐ray findings compared to pre‐procedure chest x‐ray findings. Of these 40 instances of changes in pre‐procedure versus post‐procedure chest x‐ray findings, only eight resulted in action being taken due to the observed findings. Among these eight instances of action being taken, only one instance involved in invasive action being taken with a bronchoscopy. With multivariable regression analysis, patient age, race, gender, and the presences of genetic syndromes, were not found to be significant risk factors in predicting changes in pre‐procedure versus post‐procedure chest x‐ray.Conclusion: In our study, post‐procedure chest x‐ray after tracheostomy tube placement did not significantly impact clinical decision making. It may be worth reconsidering the value in routine chest x‐rays after tracheostomy tube placement in pediatric patients.

We report an industrially relevant approach to both scalable and fast open-air perovskite photovoltaic (PV) module production. This work resolves some of the most formidable barriers to module-level scaling that the perovskite community has been facing. Key advances include scalable large-area spray deposition, new monolithic integration scribing techniques, advanced photoluminescence characterization, and reproducible high-throughput manufacturability. Our rapid spray processing techniques enabled the highest perovskite PV efficiency produced in open-air. Innovations in scribing techniques enabled the first single-source laser process to achieve perovskite module monolithic integration and technoeconomic analysis led to a comprehensive cost model for perovskite module manufacturing. We report significant progress in reducing perovskite manufacturing costs necessary to potentially compete with incumbent Si-based PV for utility-scale power generation.