Globally, about 2.3 billion people are current alcohol drinkers, and 283 million have an alcohol use disorder. Alcohol use while driving is a major contributor to road traffic injuries (RTI). We need to understand the culture and perception of drink-driving in this setting to understand why people continue to drink drive and allow policymakers to develop more effective ways to address drink-driving behavior. This study aims to qualitatively determine what injury patients, their families, and community advisory board members in Tanzania believe about drink-driving to help inform policies to address this problem.The semi-structured focus group was designed based on the grounded theory and assessed using thematic analysis. Focus groups participants were a convenience sample of injury patients, their families, and community advisory board (CAB) members. Analysis was iterative throughout the study. All transcripts were coded using a thematic narrative approach. Representative quotes for each theme were then selected based on comparative analysis of coding with input from research team members.A total of ten focus groups were conducted  with a total of 104 participants . The normalization of drinking among drivers has allowed this behavior to become ingrained in the culture. Participants expressed notions that passengers are responsible for their own safety, rather than drivers being responsible for their passengers. Most participants believe it is a citizen’s duty to inform the police of suspected drink-driving, however there were differing opinions about how effective informed police officers can be in practice. Focus group discussions between all three population types highlighted major themes of ‘drinking is ingrained in boda boda driver culture’, ‘individuals have a personal responsibility to address drink-driving’, and a ‘police enforcement on drink-driving is necessary’.Normalization of drink-driving in commercial driver culture creates a dangerous environment for passengers which can be mitigated by education and health promotion. As most passengers already take personal responsibility for their own road traffic safety, they may be likely to make use of safe ride options, if available. While legislation is in place against drink-driving, police officers need to be empowered with appropriate training and funding to enforce them. Globally, about 2.3 billion people are current alcohol drinkers, and 283 million have an alcohol use disorder . AlcoholRTIs are particularly a problem in low- and middle-income countries (LMICs) with poor infrastructure and weakly enforced traffic laws ,4. In paA total of 36 traffic crash hotspots have been identified in Moshi, Tanzania alone, with 40% of crash sites on local roads with increased motorcycle density . One croDriver drunkenness is perceived as one of the leading causes of RTI in Tanzania , howeverFor the study, we obtained IRB approval from the Duke Institutional Review Board, Kilimanjaro Christian Medical Center Ethics Committee and National Institute of Medical Research. There was a minimal level of risk for this study. Patients completed a written informed consent prior to participation but to ensure privacy, names or identifying information of participants were not collected.The semi-structured focus group was designed based on the grounded theory and assessed using thematic analysis. Grounded theory is a research method that generates theories grounded in data . ConstanFocus groups were conducted by two trained female research nurses at Kilimanjaro Christian Medical Center (KCMC). The research nurses both have over ten years of experience conducting focus groups among similar patient populations. A relationship was established with the participants at the onset of the focus group sessions. Focus group participants were informed of the aims of the study as well as the qualifications of the research team and focus group facilitators. They were informed that the focus group is a component of a greater research collaboration aimed at reducing alcohol related injury in northern Tanzania. Facilitators reported their interest in the research as based on an investment in the livelihood and betterment of the community.This project took place in Moshi, a city in the Kilimanjaro region of Northern Tanzania with a population of 143,799. Moshi is home to Kilimanjaro Christian Medical Center (KCMC), the third largest hospital in the country and the referral hospital for northwestern Tanzania . KCMC seAlthough Tanzania does have a national blood alcohol limit of 0.08g/dl for the general population and 0g/dl for commercial drivers . The strFocus groups participants were a convenience sample of injury patients, their families, and community advisory board members. Patients and their family members were identified face-to-face in the KCMC ED waiting or treatment areas, after treatment or stabilization, and were offered participation in the focus group. If patients or family members accepted, they were invited to return to the hospital for patient and family focus group days, respectively.Injury patients (both patients and drivers) were included in the focus groups if they were ≥18 years of age, seeking care at KCMC for any acute (<6 hours) injury, clinically sober at the time of enrollment, medically stable, able to communicate in Swahili or English and consent to participate. Patients were excluded from enrollment if they were medically unstable or had a deteriorating condition, were too critically ill to participate, did not speak English or Swahili, were <18 years of age, presented for non-injury related complaints or follow-up care, or did not consent to be enrolled. Family member focus group participants were family members of a patient who was able to be enrolled in the study, who also agreed to participate, and speak English or Swahili.Research nurse facilitators attended Community Advisory Board (CAB) meeting to conduct focus groups in order to utilize this group's perspective on drinking behavior within the community. The KCMC CAB is comprised of 30–40 adult community members who understand research, have advised investigators on pertinent research questions, cultural norms, and cultural acceptability of interventions, treatments and research protocols. All interested CAB participants enrolled were ≥18 years of age and were present at the monthly CAB meeting when we conducted the focus group discussion.Patient and family focus groups were scheduled once 5–10 eligible interested participants were recruited from the emergency department and provided informed consent. CAB focus groups took place prior to the monthly CAB meeting and consisted of 5 to 10 members who provided informed consent. No participants dropped out. Each focus group, led by trained research nurses, lasted between 45 and 60 minutes. They were audiotaped and transcribed for formal qualitative analysis utilizing thematic analyses. Transcriptions occurred within days following the focus group and research nurse notes were included in the transcriptions about the content.Focus groups among each population group, patients, families, and CAB members, were conducted using an iterative process until thematic saturation was reached. This was done for four patient, four family member, and two CAB focus groups. The original focus group questions were designed to understand the general perceptions of drink-driving in Moshi Tanzania. These questions included “What is acceptable drinking behavior?” and “What is thought of a person who drinks and drives?”. These scripted questions were piloted by the research nurses conducting focus groups. After thematic saturation was reached, the focus group script was altered to expose reasons for preliminary data from patient surveys. Focus groups were conducted until thematic saturation was again reached.After the focus groups were recorded and transcribed, each script was translated from Swahili to English. English scripts were then assessed for potential cultural misinterpretations, back translated and annotated for English, American comprehension. Transcripts were assessed by bilingual American and Tanzanian researchers and not returned to participants as they were difficult to contact after completion of the study. All transcripts, audio tapes, and related data will be kept for six years after study completion.Analysis was iterative throughout the study, which allowed emerging themes, derived from the data to be explored in later focus groups. The focus groups among patients, family members, and CAB members were coded separately and then analyzed. Comparing and contrasting across and within these datasets highlighted emerging themes and divergence of perspectives. Thematic saturation occurred when no new themes developed from focus group analysis and marked the end of the qualitative study for individual population subsets.All transcripts were coded by DE and BM, using a thematic narrative approach, reflecting the research questions and themes raised by the participants . The resA total of ten focus groups were conducted  with a total of 104 participants . Demographic information is not presented here in the interest of maintaining respondent confidentiality. While the study was not intended to focus on commercial drivers, most participants spoke about boda boda or dala dala drivers. Focus group discussions between all three population types highlighted major themes of ‘drinking is ingrained in boda boda driver culture’, ‘individuals have a personal responsibility to address drink-driving’, and a ‘police enforcement on drink-driving is necessary’.“reporting those drivers is very rare”  making it difficult to change. Along with the perception that drink-driving is normal comes the normalization of its consequences. One focus group member admits that, “Although accidents still happen and people cut their leg or break their head [due to alcohol attributable road traffic injuries], our society sees it as normal” .Among all three focus group types, a prominent theme was that drinking is so common among boda boda drivers that it is seen as normal. The normalization of drinking among boda boda drivers has allowed this behavior to become ingrained in the culture, so “boda boda drivers cannot work well until they drink something” . Additionally, drivers believe that because they are both experienced drinkers and drivers that they can do both successfully. One patient related that “I am experienced with alcohol. I can drink even four containers so that I have energy to work” .A strong drinking culture may stem from occupational stressors. Boda boda driving is seen as a difficult job and therefore deserving of a drink. Society believes that alcohol gives drinkers more energy, so “help one another buy alcohol by contributing money if one person cannot afford a drink” . This implies that boda boda drivers find camaraderie through drinking, making it even more difficult to stop. Reverse stigma, or a negative attitude among heavy drinkers towards someone who stops drinking, may play a role in perpetuating drink-driving culture among boda boda drivers. For example, if one driver quit drinking, “his fellows will see him as a betrayer. They will want to pull him back to his previous ways so he cannot escape their company of drinking alcohol” .Drinking is so ingrained in the boda boda driver culture that fellow drivers have been known to Throughout focus groups, participants expressed notions that passengers are responsible for their own safety, rather than drivers being responsible for their passengers. Generally, there were two responses showing different levels of commitment to personal safety. Some act passively, not taking any action against drunk driving because they feel that drink-driving is inevitable and changing this behavior is hopeless. Others look out for the personal safety of themselves and others by taking actions such as looking for a sober driver and stopping a drink driver.“won’t listen to anyone or ask for any assistance”  these participants reluctantly accept drink-driving. Most passengers maintain the idea that those drivers who drink are set in their ways because past confrontations with drivers have not made a difference and have become passive towards drink-driving as a result. One person from the CAB focus group recalls trying to positively influence a drink driver, but was unsuccessful, saying, “We have tried to advise him but he said he can’t stop drinking alcohol until he dies.” The perception that changing drink-driving behavior is impossible discourages citizens from taking action or pushing for stronger law enforcement.Participants who act passively typically know the dangers of drink-driving, but feel that trying to change this behavior is useless. Because they feel that drink drivers “If I find a dala-dala driver is drunk, I must go find another dala-dala driver”  and “It’s better not to enter the bus if you realize that the driver is drunk” . Participants in this group believed that safety was important enough to intervene, using methods to stop drink drivers. If the passengers have not gotten into the vehicle yet, they will avoid riding with the driver and “tell fellow passengers that the driver is drunk”  while “disagreeing [that the driver is ready] because he is drunk and then report him” . Alternatively, “If there is only one driver on whom we depend and he is drunk, he will have to rest until the drunkenness is over. Then we will ask him to drive” (CAB 2). If the passengers are already in the vehicle, and see that “he is losing concentration, then we use force to stop him and tell him not to drive the vehicle” . These passengers understand the danger of riding with a drink driver and believe taking responsibility for their own safety is necessary.Rather than feeling hopeless and becoming passive, another sub-group of participants took personal safety into their own hands. One way of doing so is refusing to ride with a drink driver and finding another driver. Participants said, The final contributing theme that emerged from the perceptions of drink-driving focus groups was ‘necessary police enforcement on drink-driving’. Most participants believe it is a citizen’s duty to inform the police of suspected drink-driving, however there were differing opinions about how effective informed police officers can be in practice.“passengers should be very careful with a drunk driver and inform the traffic police immediately” . Reflecting the thought that police should be informed, one participant notes, “If you know he is drunk then you have to stop him driving a car or inform a policeman that he is drunk and can’t drive the vehicle” .Those who thought citizens should be actively involved expressed that “it’s just a matter of reporting the driver who is drunk. He will be stopped and you will be given another driver, therefore it’s very easy” .In practice, informing the police should be simple, “If three people from the same bus tell [the police] that the driver is drunk, he may not believe them. It would take the bus getting into an accident for him to believe” . Because the police do not take the people’s word, many feel that the police are not doing enough to enforce drink-driving laws.However, others feel that even if you do go to the law enforcement, not much can be done to resolve the situation. In reply to the previous quote, a CAB member explained that in his or her experience, getting a sober replacement driver can be difficult and very slow, pointing to the need for improved policies and police enforcement. Another issue is the reliability of the passengers’ report in the police’s eyes. If a law enforcement officer cannot confirm that a driver is drunk, he or she may not take any precautions, as this participant describes, This innovative study is the first to examine the perceptions of drink-driving in the Moshi, Tanzania community as experienced by injury patients, their family members and a community advisory board. Focus group discussions demonstrated three specific themes: 1) that drinking is ingrained in boda boda driver culture, 2) if individuals take responsibility to address drink-driving it is at the personal level, and 3) police enforcement needs to be strengthened. These results highlight areas that potential interventions could focus on to be the most productive; For example, the normalization of drink-driving among boda boda drivers needs to be addressed, utilizing personal motivation to avoid drink-driving exposure could be increasing safe ride options, and there is a perception that strengthening enforcement would decrease drink-driving.We found that drink-driving behavior is specifically ingrained in boda boda driver culture. While previous studies have shown that drinking alcohol is a regular part of social interactions throughout Tanzania, ,22 we foWe also found that if individuals take responsibility to address drink-driving, it is at the personal level. We can leverage the personal responsibility most passengers feel for their own safety by providing more alternatives to drink-driving or riding with impaired drivers. Safe ride programs are the provision of free to low cost transportation, which have been implemented differently in various high-income settings with mixed effectiveness . The UniWhen taking into context the overwhelming cultural acceptance and the fact that many take personal responsibility for self-protection, one intervention that can address education and harness personal choice would be a brief intervention (BI). The BI has been used in emergency departments in high income countries to encourage the reduction of alcohol consumption among injury patients ,32. WhilParticipants identified a perceived lack of police enforcement of legislation against drink-driving. Proper police enforcement of traffic laws is important as it is associated with decreased road traffic fatalities and injuries . Using bOne limitation of the study is the potential for social desirability bias, especially on a stigmatized topic such as drink-driving. To limit the effect of this potential bias, we used research personnel who were comfortable talking about stigmatizing topics and included questions to talk about the general society and not the participants individual actions or behaviors. As inclusion criteria required participants to be injury patients who were medically stable to enroll in the study, we lack the perspective of those who were critically ill or in deteriorating condition. The fact that we enrolled injury patients and their family allows us to understand the motivations for continued drink-driving to plan for interventions, but might not fully represent the Tanzanian general society’s perspective about drinking or drink-driving.Normalization of drink-driving in commercial driver culture creates a dangerous environment for passengers. Interventions like education and health promotion can help mitigate drinking and spark change among commercial drivers. As most passengers already take personal responsibility for their own road traffic safety, they may be likely to make use of safe ride options, if available. Implementing the BI in emergency departments can encourage high risk drinkers to take personal responsibility for their drinking behaviors as well. While legislation is in place against drink-driving, police officers need to be empowered to enforce them. With training and funding, police officers can implement checkpoints for random breathalyzer tests, which has been shown to decrease drink-driving and save lives.


Action video gaming can promote neural plasticity. Short-term monocular patching drives neural plasticity in the visual system of human adults. For instance, short-term monocular patching of 0.5–5 h briefly enhances the patched eye’s contribution in binocular vision . In this study, we investigate whether action video gaming can influence this plasticity in adults with normal vision. We measured participants’ eye dominance using a binocular phase combination task before and after 2.5 h of monocular patching. Participants were asked to play action video games, watch action video game movies, or play non-action video games during the period of monocular patching. We found that participants’ change of ocular dominance after monocular patching was not significantly different either for playing action video games versus watching action video game movies (Comparison 1) or for playing action video games versus playing non-action video games (Comparison 2). These results suggest that action video gaming does not either boost or eliminate short-term ocular dominance plasticity, and that the neural site for this type of plasticity might be in the early visual pathway. Recent studies have shown that short-term (0.5–5 h) monocular patching induces a new form of short-term ocular dominance plasticity in human adults, in which the patched eye rather than the unpatched eye gets stronger, and the effect is transient. On the other hand, there is evidence that action video gaming has potential in enhancing perceptual learning induced visual plasticity in adulthood. In this study, we found that action video gaming did not impact short-term ocular dominance plasticity in visually normal adults. Our psychophysical evidence suggests that the neural site of this plasticity should be local and early in the cortical pathway.Action video gaming has been popular in the general public and for research . It is fRecently, a new form of neural plasticity has been reported in adults. Patching one eye  for a short period (0.5–5 h) of time increases the contribution of the patched eye in binocular vision . The chaRecent studies  suggest We recruited twelve normal adults  for this study. According to their reported playing habits and the ranks given by their games, four of the participants were considered “expert” whereas the other eight were considered “less experienced”. We did not recruit “novices” (with no experience of the action video games that we used) in this study. This was because the gaming tasks could be difficult for novices to finish due to the complexity of this game genre . All participants had normal or corrected-to-normal visual acuity (no worse than 0.0 logMAR) in both eyes, with spherical equivalent no more than 1.00D and astigmatism no more than 0.75D. No participants had ophthalmic diseases including but not limited to strabismus, amblyopia and nystagmus, or had history of visual training, occlusion therapy or ophthalmic surgeries including recently-performed refractive surgeries. During the experiments, participants were required to wear their normal refractive correction if needed.A written informed consent was obtained from each participant before the beginning of the experiments. This study was in line with the Declaration of Helsinki and was approved by the Ethics Committee of Wenzhou Medical University.In the ocular dominance measures, all stimuli were generated on a MacBook Pro  running MATLAB R2016b (The MathWorks Inc) with Psychtoolbox 3.0.14 extensions. We used a head-mounted display, GOOVIS , to achieve dichoptic viewing. The refresh rate of the display was 60 Hz, and the resolution was 1920 × 1080. Gamma correction was applied to ensure a linear output in the test. We used a custom-made chinrest to prevent movements of participants’ heads during the measurement sessions.https://pvp.qq.com, https://pubgm.qq.com, and https://pg.qq.com) as action video games in this study. For non-action video games, we included Minesweeper (http://minesweeperonline.com/). Participants used their own devices (either laptops or mobile devices) for all tasks.We included two desktop games, the League of Legends (Riot Games) and the PlayerUnknown’s Battlegrounds (PUBG Corporation), and their similar mobile versions , after which the participant received 2.5-h patching of their dominant eye with a translucent patch. During this stage, one of the three tasks , was assigned to each participant. Participants completed the tasks at a comfortable distance depending on the platform of the games (whether desktop or mobile) under normal indoor illuminance. Participants were allowed to take a restroom break as needed; during most of the time, however, participants were instructed to focus on the assigned tasks, under supervision of the experimenter. Subsequently, ocular dominance was measured at 0, 3, 6 and 9 min  and 30 min (T5) after the patch was removed. These post-patching results were then compared with the initial baseline, and any changes in ocular dominance would indicate the strength of ocular dominance plasticity.Each participant completed three experiment sessions. In a typical session , initialThese three experiment sessions  were conducted on separate days in a random order. To compare the impact of pure visual stimulation versus that of complex integrated stimulation , we turned off the sound while participants were watching action video game movies; in this way, action video game movies should be interpreted as movies that provided the same visual inputs as when participants were playing the games. The former condition would enable us to quantify the pure visual plasticity, while the latter would enable us to quantify the additional benefits of playing action video games.Measurement of ocular dominance was completed by a binocular phase combination paradigm . In eachH tests. The results of different tasks in Comparison 1 and Comparison 2, respectively, were compared by repeated-measures ANOVA. To further investigate the magnitude of the effect over time, we calculated the areal measures [area under curve (AUC)] from 0 min to 9 min .We grouped the task of playing action video games and that of watching action video game playing into Comparison 1, and the task of playing action video games and that of playing non-action video games into Comparison 2. The ocular dominance changes at different time sessions after monocular patching were compared by Kruskal–Wallis H tests also showed that the perceived phase changes were significantly different between different time sessions for both playing action video games (H(5) = 39.498, p < 0.001) and watching action video game movies (H(5) = 42.798, p < 0.001) conditions. A repeated-measures ANOVA further showed that the perceived phase was not significantly different between the two viewing conditions  = 1.122, p =0.312). To better show the difference between the two viewing conditions in different individuals, we also calculated the areal measures (AUC) within the first 10 min  = −0.813, p = 0.433; two-tailed paired samples t test).In Comparison 1, we compare the change in ocular dominance of action video game play during monocular patching with that of action video game movie watching. As shown in Through a power analysis, we found that the effect size of Comparison 1 was 0.288542, and the sample size needed for power = 80% and significance level = 0.05 would be at least 97. Therefore, we conclude that the difference between the two tasks, if any, would be very small.H tests also showed that the perceived phase changes were significantly different between different time sessions for both playing action video games (H(5) = 39.498, p < 0.001) and playing non-action video games (H(5) = 37.250, p < 0.001) conditions. ANOVA further showed that the perceived phase was not significantly different between the two viewing conditions  = 0.004, p = 0.951). To better show the difference between the two viewing conditions in different individuals, we calculated the areal measures (AUC) within the first 10 min  = 0.092, p = 0.928; two-tailed paired samples t test).In Comparison 2, we compare the change in ocular dominance of participants playing action video games during monocular patching with that of playing non-action video games. As shown in Through a power analysis, we found that the effect size of Comparison 2 was 0.022656, and the sample size needed for power = 80% and significance level = 0.05 would be at least 15,294. Therefore, we conclude that there was no difference between these two tasks.t(10) = −0.074, p = 0.942 (t(10) = 0.405, p = 0.694  or watching  action video games. Since the visual stimuli in these two conditions were the same, any difference in short-term monocular patching induced visual plasticity would be due to the outcome of playing action video games. In Comparison 2, we investigated whether there would be a difference in short-term monocular patching induced visual plasticity between when observers were playing either action or non-action video games. A typical action video game is more perceptually demanding and difficult to perform than a non-action video game. Because of this difference, we had hypothesized that action video gaming would exert a larger influence on visual plasticity. However, we found that patching with playing action video games did not enhance or eliminate the magnitude of ocular dominance change in either Comparison 1 or Comparison 2. Eye fatigue was not monitored in this experiment; however, some participants did report eye fatigue after playing action video games while others did not.As a novel form of visual plasticity, short-term ocular dominance plasticity, with its effect on binocular balance and potential for amblyopic treatment , has draThe finding is interesting that there is no significant difference between action video game play and non-action video game play in our participants in terms of short-term ocular dominance plasticity. It is worth noting that in a previous study, Li and colleagues demonstrated a larger improvement in contrast sensitivity with action video game training than with non-action video game training in visually normal adults . It is lWe had expected to see an enhancement of ocular dominance change by action video game play for two reasons. First, during patching, playing action video games via the unpatched eye could recruit additional attentive processes involving top-down feedback from higher visual areas . If suchIn fact, our finding that the complex integrated stimulation may not play a significant role in short-term ocular dominance plasticity is consistent with the ones from other studies which demonstrate that only low-level areas are locally involved in short-term ocular dominance plasticity in human adults . To illuIn short, we found that action video gaming does not impact short-term ocular dominance plasticity in visually normal adults more than watching action video game movies or playing non-action video games. Thus, complex integrated stimulation, in contrast to visual stimulation alone, may not play a significant role in this plasticity in human adults. Our findings suggest the neural mechanism responsible for short-term ocular dominance plasticity might occur early in the cortical pathway.


New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine  is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter.This study aimed to determine if patient satisfaction differs between video and in-person visits.In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters  at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre–COVID-19 and COVID-19 . Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively.P<.001). In adjusted analyses, video visits  and the COVID-19 period  were associated with higher patient satisfaction. Younger age , female gender , and new visit type  were associated with lower patient satisfaction.We experienced an 8729% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9% vs 92.5%; Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine. New York City was the world’s COVID-19 epicenter in early 2020 .Historically, telemedicine focused on rural medicine  and/or mWe examined patient acceptance of video visits by comparing Press Ganey patient satisfaction scores for video vs in-person visits at an urban, quaternary referral, academic medical center from April 1, 2019, to March 31, 2020. We hypothesized that there would be no difference in Press Ganey patient satisfaction scores between video and in-person visits. We captured one month of clinic visits during the COVID-19 pandemic and sought to determine the factors associated with patient satisfaction during this time frame.NewYork-Presbyterian/Weill Cornell Medical Center (NYP/WCM) is a large nonprofit academic medical center located in New York City. As of May 8, 2020, NYP/WCM has admitted a total of 1443 COVID-19 patients. At our institution, inpatient services are provided at NYP, while outpatient services are provided predominately at WCM facilities; both institutions share the same providers.We used a customized version of the Press Ganey Outpatient Medical Practice Survey to evaluate patient satisfaction following clinic encounters at WCM from April 1, 2019, to March 31, 2020. The Press Ganey survey is used by more than 26,000 health care organizations, including over 60% of all US hospitals. It is the most commonly used, validated tool for assessing patient satisfaction in the outpatient setting . The datThe WCM Press Ganey Medical Practice Survey contains 31 items assessed on a 5-point Likert scale  to evaluate seven domains of patient care: Background Questions (3 items), Access (8 items), Moving Through Your Visit (4 items), Nurse/Assistant (3 items), Care Provider (6 items), Personal Issues (4 items), and Overall Assessment (3 items). WCM surveyed patients with 19 items from the standardized Press Ganey Outpatient Medical Practice Survey; the remaining 12 were by WCM from the Press Ganey item bank. The same survey instrument was used across all specialties and providers without variation for video vs in-person visits. Press Ganey sent the survey instrument 2-3 days after completion of the outpatient visit or video visit. Press Ganey then reported deidentified satisfaction scores to WCM without linkage to the patient’s electronic health record to maintain confidentiality.COVID-19 period. This timing corresponds with a WCM mandate to shift the majority of outpatient care from in-person to video visits.We performed a retrospective study of patients aged 18 years and older. In order to adjust for the COVID-19 pandemic, we categorized visits after March 3, 2020, as the Our total data included 45,667 outpatient visits across 210 visit categories with 2670 (5.8%) outpatients visits during the COVID-19 period. We defined the study group as consisting of video visits, which were identified if the visit type contained the words “Video Visit.” A total of 7058 outpatient visits were excluded: 4030 outpatient visits involving procedures  or imaging, 2993 visits comprising pediatric patients <18 years of age, 33 visits that did not have Press Ganey scores, and 2 visits that did not include patient gender. The comparison group consisted of in-person outpatient visits. After applying our exclusion criteria, our final WCM Press Ganey data included 38,609 visits across 88 visit categories; of these, 620 (1.6%) video visits constituted the study population .t test and the chi-squared test. Hypothesis testing was conducted using the nonparametric Wilcoxon-Mann-Whitney test, comparing Press Ganey satisfaction scores between in-person and video visits across the study period. Additionally, we compared in-person and video visits in the pre–COVID-19 period to in-person and video visits during the COVID-19 period, respectively.Independent variables were compared by pre–COVID-19 vs COVID-19 period using the paired The dependent variable in our study was the Press Ganey patient satisfaction score. We fit a multivariable linear regression model with the following covariables: video visit (vs in-person), gender, age , COVID-19 period (yes vs no), and new vs established visit.P<.05. Statistical analysis was performed in R  and STATA 14.0 (StataCorp LLC). The study was approved by the WCM Institutional Review Board and patient consent was not required for this study.Significance was established at NYP/WCM experienced an 8729% increase in video visit use during the COVID-19 period compared to the pre–COVID-19 period.P=.03) . Patients were slightly older in the pre–COVID-19 period than COVID-19 period  . There wIn the pre–COVID-19 period, very few outpatient visits types were video visits (0.3%). During the COVID-19 period, video visits comprised 21.9% of outpatient visits. The proportion of all in-person visit types decreased except for postoperative visits. The visit type “follow-up” showed the greatest decline in share of outpatient visits, decreasing from 50.0% to 36.5% over the past year. Internal medicine outpatient visits constituted the greatest proportion of visits in both time periods.P<.001). Notably, across the study period, patient satisfaction with video was significantly higher than in-person visits  (P<.001) and COVID-19 periods . While Press Ganey scores with video visits did not change across time periods , the scores for in-person visits increased in the COVID-19 period .Press Ganey patient satisfaction scores were significantly higher in the COVID-19 period when compared to the pre–COVID-19 period  ; this asOverall, all of our covariables were statistically significant . In adjuTraditionally, health care encounters between a provider and a patient have occurred face to face in a physical location. Over the past 20 years, the internet and technology have made it possible for health care to be delivered digitally, providing new avenues for medicine to improve the value of care. Bridging gaps in time and distance, video visits have enabled providers to remotely care for patients with acute stroke , requiriTelemedicine is a new, and potentially disruptive, innovation and must be shown to be safe, effective, patient-centered, timely, efficient, and equitable . ClinicaUsing the most current Press Ganey satisfaction scores, we found that video visits were associated with greater patient satisfaction when compared to in-person visits, which was not what we initially hypothesized. However, our results do not justify the use of telemedicine in lieu of in-person visits if both were equally accessible given the limitations outlined below. Furthermore, we observed that overall patient satisfaction is higher in the COVID-19 period, and that younger age, female gender, and new visit type were associated with lower patient satisfaction. To our knowledge, this is the largest study of patient satisfaction comparing video to in-person visits. The results of our study have particular relevance due to the unprecedented public health crisis that has necessitated the widespread adoption of video visits for patient safety and practicality.Our study must be interpreted in the context of the study design. First, this is a retrospective study that prevents us from establishing causality between video visits and increased patient satisfaction. However, our data captures a rapid transition of outpatient care to video visits associated with the COVID-19 pandemic, and our analysis was adjusted for time. Second, our deidentified data did not capture patient-level variables that may influence Press Ganey scores, such as race, income, education, comorbidities, and other characteristics as they were not reported to WCM by Press Ganey to maintain patient confidentiality. Third, the same Press Ganey survey items were used for both video and in-person visits even though Press Ganey developed a new telemedicine version of the Medical Practice Survey in 2018 that may better characterize unique aspects pertinent to video visits . Fourth,In conclusion, we demonstrate that patient satisfaction with video visits compared favorably with in-person visits over the past year and during the COVID-19 pandemic. Our findings support the use of video visits as a viable alternative to traditional in-person visits. The New York City experience may offer insights into the future use of video visits as a new paradigm for health care delivery generally and in times of public health crisis.


These challenging factors make it difficult to perform accurate T1-weighting using a conventional rectangular saturation pulse. Previous studies have shown improved saturation of magnetization at 3 T using adiabatic B1-insensitive rotation (BIR-4) [0), within the whole heart, while remaining within clinically acceptable SAR limits. The purpose of this study was to develop an adiabatic-rectangular pulse train at 3 T that can achieve both of the aforementioned objectives.Cardiac MRI at 3 T is a promising modality to increase the contrast-to-noise ratio (CNR) in first-pass cardiac perfusion imaging. This CNR boost can improve the accuracy of perfusion estimation from dynamic contrast-enhanced images. However, radio-frequency (RF) field B variatio (BIR-4) . UnfortuFigure 0. Relevant imaging parameters include: field of view = 320–400 × 255–324 mm, acquisition matrix = 64 × 52, slice thickness = 8 mm, TE/TR = 1.1/2.3 ms, TD = 3 ms, image acquisition time = 78 ms, flip angle = 10°, parallel imaging acceleration factor = 1.5, and bandwidth = 1002 Hz/pixel. PDW image was acquired using 3° flip angle and without the saturation pulse. The RF and receiver scales were kept constant between the different acquisitions per subject.The residual longitudinal magnetization left behind by the saturation pulse can be measured by performing a saturation-no-recovery experiment using a TurboFLASH pulse sequence with centric k-space reordering, as previously described . NormaliNine volunteers  were imaged in 3 short-axis  views of the left ventricle (LV), 4-chamber view, and 2-chamber view of each ventricle.The LV and right ventricle (RV) were segmented manually. For each subject, the mean normalized signal within the whole heart was computed by averaging the normalized intensities from all five regions of interests (i.e. 3 short-axis and 2 long-axis views). Reported data represent the mean and standard deviation over subjects (n = 9). Student t-test was performed to compare the residual magnetization values between the two RF pulses.The energy of the adiabatic-rectangular pulse was 14.2 times larger than that of the rectangular pulse. Figure This study demonstrates that the new adiabatic-rectangular pulse train can effectively saturate the magnetization within the whole heart at 3 T, while remaining within clinically acceptable SAR limits. This saturation pulse can be used to acquire multiple slices (>5) with our typical clinical first-pass perfusion protocols. Effective saturation of magnetization is likely to produce more accurate estimation of cardiac perfusion.


During the coronavirus disease (COVID-19) pandemic, cardiologists have attempted to minimize risks to their patients by using telehealth to provide continuing care. Rapid implementation of video consultations in outpatient clinics for patients with heart disease can be challenging. We employed a design thinking tool called a customer journey to explore challenges and opportunities when using video communication software in the cardiology department of a regional hospital. Interviews were conducted with 5 patients with implanted devices, a nurse, an information technology manager and two cardiologists. Three lessons were identified based on these challenges and opportunities. Attention should be given to the ease of use of the technology, the meeting features, and the establishment of the connection between the cardiologist and the patient. Further, facilitating the role of an assistant  with the video consultation software who can manage the telehealth process may improve the success of video consultations. Employing design thinking to implement video consultations in cardiology and to further implement telehealth is crucial to build a resilient health care system that can address urgent needs beyond the COVID-19 pandemic. The coronavirus disease COVID-19) crisis has challenged health care professionals to rapidly reduce face-to-face consultations. To ensure care continuity, the use of telehealth is recommended 9 crisis . Many heIn Belgium, cardiologists remotely triaged patients who were originally scheduled for face-to-face consultations; however, many consultations were postponed during the lockdown period. Some patients are afraid to come to the hospital due to the risk of contracting COVID-19. This increases the likelihood that patients will stay at home or postpone consultations despite deteriorating symptoms. In fact, a declining incidence of acute myocardial infarction has been witnessed in the United States during the COVID-19 pandemic . HoweverTelehealth can help mitigate these risks by enabling continued monitoring of patients. Various telehealth solutions can be leveraged for remote cardiology monitoring , such asGiven that rapid acceptance of telehealth during COVID-19 is critical, telehealth technologies must be easy to implement and to scale up. To achieve this, we employed design thinking ,13 to leDesign thinking aims to identify and solve problems in a systematic and collaborative way ,13. CollThe treating cardiologist (YV) identified 13 patients with an ICD who were scheduled for face-to-face consultations in the outpatient clinic. The ICD patient population was prioritized because these patients could especially benefit from telehealth due to the opportunity to access their heart monitoring data remotely. These patients did not have any urgent needs, did not require a physical examination with hospital equipment, and had a telephone number on record. Of these 13 patients, 5  were eligible for a video consultation. Of the 8 patients who were not eligible, 2 (25%) lacked a smartphone or computer, 2 (25%) were not reachable by telephone, 3 (38%) lacked the functionality for remote monitoring, and 1 (13%) had progressed to needing more urgent care.The customer journey  shows thAvailable video consultation solutions were explored with the IT and legal teams based on ease of use and suitability for the patient group, short-term implementation for all stakeholders, adaptability, financial constraints, and compliance with the European Union General Data Protection Regulation (GDPR). Skype for Business (Microsoft Corporation) was accessible by all physicians, as it was installed across the hospital on desktop computers. Given its strong security, lack of additional cost, and availability in the hospital, this appeared to be a good option. However, Skype for Business is a rigid software package that will soon be replaced by Microsoft Teams. Eventually, video communication software will be integrated into the electronic patient record software, as is already the case in larger academic hospitals in Belgium. Therefore, Skype for Business demonstrated little adaptability and no long-term prospects. Given that it would still be necessary to provide training to health care professionals and patients, other software was considered. No solution could be identified that integrated video communication software with ICD monitoring, which would suit the patients best . However, other video communication software was tested, including Zoom . The cardiologist was given remote training on Zoom by the researchers while they simultaneously tested its functionalities compared to Skype for Business. They considered that Zoom was easier to use, as the patient would not need to install a software package on their computer and would need to complete fewer steps to use the desktop version or smartphone app (opportunity). The IT and legal teams had heavy workloads and were only able to provide limited technical support, such as a user manual.The nurse first called each patient to make an appointment for a consultation by telephone or video. If the patient preferred a video call, they were asked if they would like to receive the call through an app on their smartphone or on a desktop computer. Video consultation appointments were made using Zoom. To reduce the workload for the cardiologist, the nurse was responsible for making appointments and was then made the host of each meeting (opportunity). Here, opportunities were identified to improve safety by changing meeting settings with a password. Other settings were changed to reduce the number of steps the patient was required to take; immediate activation of the camera was enabled when joining a meeting, bypassing the waiting room function. After these steps were completed, a link with the invitation to the video consultation was sent to the patient. Here, another opportunity was identified to circumvent email use if the patient planned to use the app by sending them the link via SMS text message. However, this required the nurse to use an anonymous mobile phone number. Patients using the desktop version of Zoom were sent an invitation link via email.Before the start of a video consultation, the nurse prepared two screens (opportunity). On one screen, the cardiologist could log in to the patient’s device, while the other screen was prepared to show the video communication software. For all the video consultations, a backup plan was established to switch to telephone and continue the consultation on an audio-only basis. The nurse was present throughout the entire VC process to help manage problems with communication connections and record the experiences of the patient and the cardiologist.In 2 of the 5 video consultations, the patient and the cardiologist were connected with both audio and video via Zoom. In the four cases in which a video connection was established, even without audio (replaced by audio from a telephone), the patients were positive about the experience; however, for the one case in which the video connection could not be established, the patient was disappointed. Key challenges were identified due to failures of the video or audio on either the patient’s or the cardiologist’s side (3 times): in one case, the cardiologist’s computer ran too slowly, in another case, the patient had not signed into the Zoom meeting, and in another case, the patient could not join the Zoom meeting. In addition, the patients were not always immediately in front of their devices at the start of the meeting. The nurse had to attempt to manage these problems in the moment on both the cardiologist and patient sides. However, connections could not always be established or re-established. This reveals the need for more advanced training on the use of video communication software before adopting video consultations, for both patients and health care professionals.Opportunities were identified to improve the audio and video connections between the patient and the cardiologist. First, the nurse could test the Zoom video and audio links with the cardiologist’s and patient’s devices before the start of the consultation. This would require the nurse to be the host for all scheduled video consultations before the consultations start. For example, before the first consultation started, the nurse as the host could conduct a test conversation using the cardiologist’s device to determine if the audio and video were functional and if the connection with the heart device was functioning. Following this, the cardiologist could take over the account from the nurse to start the consultation. The nurse could then prepare the next scheduled patient for their video consultation by starting the next meeting as the host and checking the audio and video connections between the patient’s device and the local device by holding a test conversation.Currently, there are technical challenges in implementing this workflow, as the meeting host cannot simultaneously start and manage multiple meetings . No otheWe employed a design thinking tool called a customer journey, which revealed several challenges and opportunities for stakeholders in a cardiology practice when testing video consultation software. Three lessons were identified to improve the experience for stakeholders:Attempt to reduce the number of clicks or screens that must be navigated to get to a meeting and preferably avoid downloading or registration of software and activation of a microphone or video camera (these appear to be easier to manage on a smartphone). Ideally, provide the ability to access data on implanted devices and video communication software in one integrated software solution.Ensure the video consultations are secure  and facilitate the establishment of video and audio connections by automatically starting microphone and video devices for both the health care professional and the patient. Use a convenient method to send information about the meeting to the patient, such as an SMS text message or email, depending on the wishes of the patient.Reduce the time spent preparing and managing connectivity. One option would be for a nurse to concurrently host multiple meetings to streamline the process of switching between consultations. If this option is not available or proves to be inadequate, it will be crucial to provide additional training for patients and health care professionals. It is therefore important to select a system that will not require time-consuming training, preferably one with an automated testing system (if available).Looking toward the future, the population of heart patients in need of remote care is likely to grow given the prolongation of the COVID-19 pandemic. Using design thinking to improve telehealth for patients who are at risk of acute health problems, such as heart attack and atrial fibrillation, is therefore increasingly urgent. Remote diagnostic tools, such as remote electrocardiogram (ECG) technology, could be integrated into telehealth video communication software, as in smartphones . AlthougThis short design thinking study was limited due to the physical constraints of COVID-19. The data collection would have benefited from more field observations. In addition, to prevent delays in the implementation process of the video consultation software, the traditional problem exploration process started immediately through testing existing software solutions. Therefore, some problems and solutions for the stakeholders may remain unexplored.These initial insights highlight that even though financial regulations currently favor the use of video consultations ,10,11, w


Candida albicans is considered an exclusive etiologic agent of candidiasis, a very common fungal infection in human. The expression of virulence factors contributes highly to the pathogenicity of C. albicans. These factors include biofilm formation, yeast-to-hyphal transition, adhesins, aspartyl proteases, and phospholipases secretion. Moreover, resistance development is a critical issue for the therapeutic failure of antifungal agents against systemic candidiasis. To circumvent resistance development, the present study investigated the virulence targeted therapeutic activity of the phyto-bioactive compound morin against C. albicans. Morin is a natural compound commonly found in medicinal plants and widely used in the pharmaceutical and cosmetic products/industries. The present study explicated the significant inhibitory potential of morin against biofilm formation and other virulence factors’ production, such as yeast-hyphal formation, phospholipase, and exopolymeric substances, in C. albicans. Further, qPCR analysis confirmed the downregulation of biofilm and virlence-related genes in C. albicans upon morin treatment, which is in correspondence with the in vitro bioassays. Further, the docking analysis revealed that morin shows strong affinity with Hwp-1 protein, which regulates the expression of biofilm and hyphal formation in C. albicans and, thereby, abolishes fungal pathogenicity. Moreover, the anti-infective potential of morin against C. albicans-associated systemic candidiasis is confirmed through an in vivo approach using biomedical model organism zebrafish (Danio rerio). The outcomes of the in vivo study demonstrate that the morin treatment effectively rescues animals from C. albicans infections and extends their survival rate by inhibiting the internal colonization of C. albicans. Histopathology analysis revealed extensive candidiasis-related pathognomonic changes in the gills, intestine, and kidney of animals infected with C. albicans, while no extensive abnormalities were observed in morin-treated animals. The results evidenced that morin has the ability to protect against the pathognomonic effect and histopathological lesions caused by C. albicans infection in zebrafish. Thus, the present study suggests that the utilization of morin could act as a potent therapeutic medication for C. albicans instigated candidiasis. Candida albicans is an opportunistic fungal pathogen responsible for about 50–90% of all cases of candidiasis in humans. It is generally referred to as a dimorphic fungus since it grows both as yeast and filamentous cells , which are comprised of polysaccharides, proteins, and nucleic acids  model system.Due to the imperative virulence factors production by athogens . Hence, operties . Severaloperties . In lighC. albicans ATCC 90028 was used in the present study. The test culture was maintained in Sabouraud dextrose agar  and cultured routinely in YEPD (Yeast extract peptone dextrose) broth. For experimental analysis, a loopful of culture was used to inoculate YEPD medium and incubated at 37°C overnight. Prior to each bioassay, the overnight culture was adjusted to 0.8 OD at 600 nm (108 CFU/ml). Spider broth  was used in the biofilm assay for augmenting hyphal formation . For experimental purpose, a stock solution of 50 mg/ml concentration of morin was prepared using DMSO.C. albicans was assessed using the microbroth dilution method in a 24-well microtitre plate (MTP) as per the guidelines of the C. albicans culture was allowed to grow in 1 ml of YEPD broth in the presence and absence of morin (37.5–600 μg/ml). Wells holding 1 ml of plain YEPD broth served as a blank. The plate was incubated at 37°C for 16 h. After incubation, the growth absorbance was measured at ODnm600  using a multi-mode plate reader   .C. albicans in a 24-well MTP  in order to evaluate the biofilm inhibition upon morin treatment. The least concentration of morin which showed more than 80% of biofilm inhibition was considered as the minimum biofilm inhibitory concentration (MBIC). The percentage of biofilm biomass inhibition was calculated by the following formula:The antibiofilm activity of morin was evaluated against well MTP . About 1C. albicans was quantified as described by 2SO4 was added to this reaction mixture and incubated in the dark at room temperature for 1 h. After incubation, the supernatant was collected and the absorbance was measured at ODnm490 .The effect of morin on exopolysaccharides production in C. albicans cell surface hydrophobicity was assessed by microbial adhesion to hydrocarbons assay  in the presence and absence of morin at MBIC. Then, both control and treated biofilm slides were stained with 0.2% crystal violet for light microscopy  analysis and 0.1% acridine orange for confocal laser scanning microscopy (CLSM)  analysis. For scanning electron microscopic (SEM) analysis, biofilm cells were fixed in glass slides using 2.5% glutaraldehyde for 1 h at 4°C. Then, the fixed slides were gradually dehydrated with 20, 40, 60, 80, and 100% ethanol. Afterward, the slides were sputter coated with gold to observe under SEM .The antibiofilm activity of morin was visually evaluated using microscopic analyses as described by C. albicans was assessed by growth curve analysis. 1 ml of C. albicans culture (108 CFU/ml) was used as the inoculum for 100 ml of YEPD broth, supplemented with and without morin (at MBIC), and incubated at 37°C. Then, the growth absorbance was measured at ODnm600  for every 1 h of incubation period up to 16 h  was stored at 4°C. Subsequently, the cell pellets were suspended in freshly prepared isotonic buffer  and incubated at 4°C overnight. After incubation, the cell-bound EPS containing supernatants were collected by centrifugation at 12,000 rpm for 15 min and pooled with the previously stored CFCS of respective control and morin treated C. albicans cultures. Then, 3 volume of ice-cold ethanol was added with each mixture and incubated at −20°C overnight. Finally, the precipitates of both cell-bound and cell-free EPS were collected by centrifugation at 12,000 rpm for 15 min.The cell-free and cell-bound EPS were collected from morin treated and untreated C. albicans EPS components upon morin treatment. For this, the extracted EPS samples were pelletized with potassium bromide at 1:100 ratio under hydraulic pressure. Then, the pelletized samples were scanned in the spectral range of 1800–500 cm–1. Then, the absorbance of both control and treated spectra was compared to observe the peak variations (Fourier transform infrared (FT-IR) spectrophotometric  analysis was performed to observe changes in riations .C. albicans was evaluated as described by The effect of morin on the filamentous morphology of C. albicans was added to 1 ml of spider broth along with 1% FBS in the presence and absence of morin (at MBIC) at 37°C for 48 h. After incubation, 10 μl of the cells were placed on the glass slides and mounted using a cover slip. Then, three different spots in both the control and treated slides were randomly selected to be observed under light microscope.Further, the hyphal formation was enumerated using light microscopic analysis. About 1% of C. albicans, YEPD agar plates were prepared in the presence and absence of morin (at MBIC). The overnight culture was streaked on agar plates and incubated for 16 h at 37°C. After incubation, the plates were documented using a CCD camera , and the plates were then incubated at 37°C for 72 h (Pz) were calculated as follows: colony diameter/ (colony diameter + precipitation zone). Pz coefficients were classified as negative (Pz = 1.00), positive (0.64 ≥ Pz < 1.00), and strongly positive (Pz < 0.64).For qualitative analysis of phospholipase production, 1 μl of inoculum was placed at the center of the SDA plate containing 1% peptone, 3% glucose, 5.73% NaCl, 0.055% CaClfor 72 h . The diaC. albicans catalase production, a H2O2 sensitivity assay was performed . Then, sterile filter paper disks  were placed at the center of the plates. About 20 μl of 30% H2O2 was loaded in the disks and the plates were incubated for 16 h at 37°C. After incubation, the diameter of the zones of clearance was measured. Subsequently, 100 μl of 30% H2O2 was added to morin treated and untreated C. albicans cell suspension and incubated at room temperature for 10 min. After incubation, the absorbance of each sample was measured at ODnm240  in order to quantify the catalase activity  and incubated at 37°C for 16 h. After incubation, the non-adherent cells were washed with sterile PBS and allowed to dry. Then the biofilm biomass was quantified by the crystal violet staining method and visualized by light microscopic analysis . Isolated RNA was reverse transcribed into cDNA using a high capacity cDNA reverse transcription kit (Applied Biosystems). The primers were designed using primer3 software. The q-PCR was carried out using the SYBR Green PCR master mix in a 7500 Sequence Detection System . The expression levels of the candidate genes (listed in ACT-1 (β-actin) of C. albicans. The relative gene expression level was determined by 2Ct–ΔΔ calculation were obtained from an aquaculture farm . The collected zebrafish were acclimatized at 28 ± 2°C for seven days in a glass aquarium containing filtered fresh water and fed with commercial food pellets twice a day. All the in vivo experiments were performed in accordance with the guidelines of the Committee for the Purpose of Control and Supervision of Experiments on Animals(CPCSEA) (cpcsea.nic. in/WriteReadData/userfiles/file/SOP_CPCSEA_inner_page.pdf), Government of India, and the general guidelines of the Institutional Animal Ethics Committee, Alagappa University (Reg No: 183 2007/GO/ReBi/S/18/CPCSEA dt 14.03.2018). The healthy and equal-sized fishes were selected for the in vivo experiments. All in vivo experiments were performed in triplicate.The wild type adult zebrafish (0). All further experiments were made only at non-lethal concentrations.The toxicity test was carried out to determine the non-lethal concentrations of morin. For this, the healthy acclimatized fish were divided into five groups – one for normal control and four for morin at different concentrations  – in a fresh water (1 L) aquarium. Each group consisted of six animals and the survival percentage was monitored for every 12 h up to 96 h of the post-compound treatments. The concentration at which an 100% survival rate of fish occurred after 96 h was considered as the non-lethal concentration  under aeration in a plastic pocket for 12 h. Then, the post-infected animals were transferred into an aquarium containing either normal or morin (37.5 and 75 μg/ml) treated water (1 L). The survival rate of infection control (post-infected fish) and treated (post-infected fish + morin) groups was assessed every 12 h up to 96 h.For revealing the anti-infective potential of morin against C. albicans-infected control and treated animals were sacrificed and homogenized in 1 ml of PBS. Then, the slurry was serially diluted and spread plate on the SDA medium and incubated at 37°C for 24 h. After incubation, the CFU of each sample was counted.After the infection study, 2PO4, 0.65% Na2HPO4, and 40% formalin. Then, the animals were preserved in 70% ethanol until processing. Subsequently, the samples were dehydrated and embedded in paraffin wax. The tissues were sectioned transversely and stained with hematoxylin and eosin. The samples were examined using a light microscope and documented in Nikon Eclipse, Ti 100.To analyze the systemic infections caused by candidiasis in zebrafish, the infected control and treated zebrafishes were fixed with 10% (v/v) phosphate-buffered formalin containing 0.4% NaHT-test using SPSS statistics v17.0 software package to study the statistical difference between control and treated samples. The significant value was fixed at p ≤ 0.05.All the experiments were performed at least thrice independently. The statistical significance of data was analyzed by Student’s C. albicans. At 150 μg/ml, morin displayed a maximum of 93% biofilm inhibition. Hence, 150 μg/ml of morin was considered as MBIC and used for all in vitro assays. Also, the effect of morin on C. albicans growth was observed by microbroth dilution method, which showed the non-antifungal nature of morin up to 600 μg/ml concentration  C. albicans was similar to that of the untreated control  in  control .–1 and 1300–900 cm–1. representing the proteins and mixed regions of polysaccharides and nucleic acids, respectively, was highly reduced when compared with the intensity of the control spectra  treated agar plate shows loosely attached C. albicans colonies, whereas the robust colonies of C. albicans were observed in the untreated agar plate  of the control and treated samples was found to be 0.31 and 0.42, respectively. These Pz values (Pz < 0.64) represent the strongly positive phospholipase activity of C. albicans, as mentioned above. Also, the low Pz values mean high phospholipase production and, conversely, high Pz values indicate low enzymatic production  treatment.The phospholipase production in oduction . Hence, C. albicans was evaluated by the H2O2 disk diffusion assay. The obtained results illustrate that the H2O2 sensitivity of morin-treated C. albicans was higher than that of the untreated control. The diameter of the H2O2 sensitivity zone of inhibition in the morin-treated plate was found to be 45 mm whereas the diameter of zone of inhibition in the untreated C. albicans plate was 40 mm  treatment  analysis. The obtained result exhibited that the genes sapT1, sapT2, als1, als2, plb1, and hwp1 are significantly downregulated upon morin-(at MBIC) treatment  was measured. The results of molecular docking analysis revealed that the ligand molecule (morin)  builds seven hydrophobic interactions , five polar interactions , and two negative-charge interactions (Glu82 and Asp62) within the region of the receptor  treated post-infected group of zebrafish up to 96 h  did not show any significant lethal effect on the growth pattern of C. albicans. In addition, the mature (48 h) biofilm of C. albicans was efficiently degraded by morin treatment at its MBIC and the light microscopic analysis further validated this observation. The outcome of the present study supports the previous study of C. albicans by reducing EPS production. Since EPS plays a key role in construction of the biofilm matrix  against C. albicans was confirmed. These observations conclude that morin treatment efficiently inhibits C. albicans biofilm production by interfering with EPS production. The hydrophobicity of microbial pathogens contributes to their adherence, which is responsible for biofilm formation and adhesion to epithelial cells. The adherence of C. albicans to the epithelial surface is considered to be an important factor in the development of infection  protein. Hyphal wall protein (Hwp1) is highly expressive in C. albicans yeast – hyphal transition , known as reactive oxygen species. Morin was effective in impeding catalase production of C. albicans, which was confirmed through a H2O2 sensitive test and tube assay.Apart from morphological transition, the secreted virulence factors of t tissue . Morin win vitro bioassay results. In C. albicans, agglutinin-like sequence (ALS) genes, including ALS1 and ALS2, play a crucial role in adhesion-mediated biofilm formation by C. albicans to cause candidiasis. Also, ALS and HWP1 are simultaneously expressed in C. albicans hyphal cells. In the present study, the qPCR analysis reveals that morin treatment significantly downregulated the expression level of als1, als2, and hwp1 genes, which correlated well with the observation of the in vitro filamentation assay. And the genes sap and plb are also responsible for adhesion and biofilm formation by C. albicans, which is also involved in the secretion of extracellular hydrolytic enzymes such as protease, esterase, and lipase  exposed animal group was similar to that of the untreated control group, which portrays the non-lethal effect of morin. Also, the survivability of C. albicans-infected animals were completely rescued upon morin (75 μg/ml) treatment, which is accomplished by hampering the internal colonization of C. albicans. Since internal accumulation of C. albicans results in biofilm formation in the mouth, throat, vagina, and other internal organs, including the kidney, intestinal, spleen, heart, and brain, it is highly related to the pathogenesis of candidiasis . Hence, this is not mandatory regarding the ethical issues, as it is not mentioned in the CPCSEA guideline yet.Ethical review and approval was not required for the animal study because all the experiments in zebrafish were performed followed by the guidelines agreed by the Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA), Government of India (in vivo experiments, data analysis, and reviewing original draft. RD and AV: data analysis and reviewing original draft. AV: conceptualization, supervision, data validation, and writing – original draft. All authors contributed to the article and approved the submitted version.GA: conceptualization, performed the experiments, data analysis, and writing – original draft. RA: performed the The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.