Fire seasons are longer, with more and larger wildfires, placing increased demands and risks on those fighting wildland fires. There are multiple agencies involved with fighting wildland fires and unique worksite conditions make meeting these workers’ needs a challenge.The aim of the study is to develop and establish the effectiveness of a web-based safety and health program for those fighting wildland fires.t tests for pre- and post-Likert agreement scale survey items, adjusted for multiple comparisons. In addition to assessing mean and SD at baseline and postsurvey, observed effect sizes were calculated (Cohen d). Usability and reaction to the program among firefighters who responded to postsurvey were also assessed.This mixed methods project had 3 phases. The initial qualitative phase assessed the needs of 150 diverse firefighters through interviews and focus groups across 11 US sites to establish and prioritize program content. Interview transcripts were read for thematic content with iterative readings used to identify, code, and rank health and safety issues. The second phase used that information to build a comprehensive Total Worker Health program for those fighting wildfires. The program content was based on the qualitative interview data and consisted of 6 core and 8 elective 30-minute, web-based modules primarily done individually on a smartphone or computer. The final, third phase evaluated the program with a quantitative prospective proof-of-concept, usability, and effectiveness trial among wildland firefighter participants. Effectiveness was assessed with paired 2-tailed P<.001) and cardiovascular risk (P=.01), nutrition behaviors (P=.01), hydration or overheating (P=.001), binge drinking (P=.002), and getting medical checkups (P=.001). More than 80% (n=40) of postsurvey respondents agreed or strongly agreed that the program was easy to use and would recommend it to others.The qualitative themes and subthemes were used to inform the program’s content. For the effectiveness trial, 131 firefighters completed the presurvey, and 50 (38.2%) completed the postsurvey. The majority of the participants were White , male , with an average age of 41 (SD 12.9) years. Significant increases in knowledge and desired health and safety behaviors were found for both cancer (An innovative web-based safety and health promotion program for those fighting wildland fires was feasible, scalable, and usable. It improved the health and safety of those fighting wildland fires.ClinicalTrials.gov NCT05753358; https://classic.clinicaltrials.gov/ct2/show/NCT05753358 In recent years, the size and severity of wildfires have increased. In the United States, the annual number of acres burned has doubled in the last 2 decades, breaking records in many states. In addition, more housing development near forests, an area referred to as the wildland-urban interface (WUI), creates an expanding aspect of wildfires -3. TheseProviding services to this dispersed and varied workforce is a challenge. The “typical” wildland firefighter is one of approximately 19,000 federal employees responding to wildfires that begin on federal lands. However, that number includes those working full-time year-round, full-time seasonal employees, and part-time seasonal workers. The Forest Service, within the US Department of Agriculture, employs nearly 70% of federal firefighters, with the remaining divided among 4 Department of the Interior agencies . The demographics, work histories, training, duties, and supervising hierarchy vary across all those agencies and types of workers.The term wildland fire refers not only to federal land forest fires but any nonstructure fire that occurs in vegetation and natural fuels in a forest, grassland, brushland, or land sown to crops. Accordingly, nonfederal firefighters, through city, county, or district fire agencies, are responsible for responding to wildfires that begin on state, local, and private lands. A large percentage of the more than 400,000 career structural firefighters are involved in both fighting WUI fires and deployed to fire camps during the peak of fire seasons. Finally, wildland firefighting also includes the largest group of US firefighters, the 800,000 volunteers who comprise the majority of those protecting smaller rural communities. These individuals often are those first arriving at a wildland fire. Each of these sectors, often further regionally subdivided, has unique training and certification processes.Despite these complexities, the need is great to address the safety and health of those fighting wildland fires. There is a growing literature on the safety and health risks associated with fighting wildland fires. Smoke exposure is an obvious aspect, as unlike structural firefighters, they cannot use self-contained breathing protection and are exposed to smoke’s particulate matter and other toxic or carcinogenic contaminants. That exposure is associated with an elevated risk of respiratory and cardiovascular disease . In 2017Those fighting wildfires have an increased risk for cardiovascular disease. Despite public perceptions to the contrary, firefighters have a concentration of the most prevalent harmful health behaviors, such as unhealthy diets, lack of sleep, and other cardiovascular risk factors ,9. ThoseAtlantic magazine article, “Quiet Rise in Wildland-Firefighter Suicides,” focused attention on the growing stress that accompanies fighting wildland fires [A recent nd fires . These wnd fires . These fnd fires .The literature on wildland firefighting confirms that this work adversely affects mental health, physical well-being, and social connections. A recent 10-person panel of wildland firefighting experts ranked the needs of wildland firefighters, and the highest ranking was for a comprehensive, holistic program called Total Worker Health (TWH) . The namInvolving workers in a structured process defining their safety and health needs is a key tenet of TWH . AccordiThis mixed methods TWH for wildland firefighters project had 3 phases. The initial qualitative phase was assessing the needs of wildland firefighters across segments and geographic locations to identify and prioritize program components. During that first phase, we recruited firefighters plus collected and analyzed focus group and interview data to assess their needs. The second phase was to use the phase 1 findings to build a comprehensive, engaging TWH program for those fighting wildfires. It needed to be accessible on smartphone, tablet, or computer and suitable for individual, group, and classroom settings. The final, third phase was to evaluate that program with a prospective single-arm proof-of-concept, usability, and effectiveness trial among all types of wildland firefighters in different geographic locations.The sites for both the initial qualitative needs assessment and the later effectiveness trial are listed in At each location, we contacted the top individuals in management as well as union representatives and health or safety officers if available. This was followed by a conference call or in-person meeting to explain the study. With agreement to proceed, information concerning the study was disseminated widely to all eligible firefighters. We arranged for a convenient time to meet with firefighters, for example, at an existing training session or during another prescheduled meeting to explain the study and obtain informed consent prior to any data gathering. Participants in this study were a convenience sample of firefighters able to attend informational sessions on the study, although we did make additional efforts to involve women and ethnic minority firefighters.The Oregon Health & Science University Institutional Review Board approved the study and its procedures (21022).We had planned to visit sites to collect the focus group data in person. However, we had just completed meeting with 2 local sites when COVID-19 travel restrictions made in-person visits impossible. Our methods were altered to assess participants using web-based Webex methods. The validity of these methods for data gathering has been reported ,31. We cPrior to the focus groups, each participant signed informed consent, followed by a brief confidential survey. The survey oriented them to the domains included in the interviews, and they were asked to identify the importance of 13 health topics (1=strongly disagree to 5=strongly agree) and list their top 3 most relevant topics.Survey completion was followed by group interviews for firefighters and individual key-informant interviews for those in charge, with each lasting approximately 60 minutes. The individual and group interviews use a trained facilitator and semistructured interview guide  and a scFor the qualitative analyses, 4 members of the research team read 4 different transcripts to inductively identify an initial list of codes, which were added to the list of topics from the survey. All these proposed codes were collapsed into 1 list and loaded into Kardsort , an openThe interview and focus group transcripts were loaded into Taguette , an openData were collected from February 2020 through November 2020. We held 24 focus groups (5 in-person and 19 Webex) that ranged from 2 to 15 firefighters with an average of 6 (SD 3.04) participants per group. In addition, we held 11 key informant interviews of supervisors (2 in-person and 9 Webex). These occurred at 10 locations and are presented in All the survey health and safety topics  were rated highly by those fighting wildland fires with no significant differences among the topics. When asked for their top 3 topics, more than 40% included physical fitness, hydration, personal protective equipment, and mental health.The importance of hydration was often mentioned. Information concerning those subthemes was used in constructing the hydration module. Subthemes for hydration and heat included the relationship to nutrition and the importance of drinking and eating before you thought you needed it, even before deployed, “you know, had a couple of cups of coffee in the morning. Wasn't well hydrated got out there and spent an hour and a half on hillside and a hundred-degree temperatures and I ended up barely making it to the fire station.” Also noted were regional variability in heat and humidity that may place a firefighter deployed to a different region particularly at risk. “You get people from parts of the country that are closer to sea level, more humidity. They're not used to the environment.” Many different types of replacement fluids were mentioned , resulting in clear general recommendations being included in the program. Although many were familiar with the term rhabdomyolysis, few knew the risks particularly related to vigorous preseason training when not in shape. As a result, that information was accompanied by a link for watching the US Department of Agriculture YouTube informational video on rhabdomyolysis among wildland firefighters.As demonstrated by the number of tagged utterances in Nutrition was a theme that was integrated with physical health and the logistics of what they could and could not control. Nutritional demands mentioned at fire camps were so unique that program content was partitioned as nutrition on the line and off the line. For nutrition on the line, guidance focused on matching intake to caloric demands and eating frequently, like an endurance athlete. The firefighters told us how they wanted the information presented: “Streamline information source for people to kind of like, you know, this will help fuel you in a correct way versus, you know, like I said, this, the sugar bombs that destroy you all day long.” The comments relevant to a topic were reviewed as that module was built. Those “vicarious experiences” provided by the focus groups provided a deeper understanding and “tacit knowledge” more influential than “propositional knowledge” for informing the program’s content ,36. In aThe program was built based on the needs assessment, consultation with content experts, and review of available wildland training. Translating that information into a scope, sequence, and educational process was aided by our long experience constructing evidence-based safety and health curricula for varied occupational groups, including the fire service and other first responders -22.The program is structured as 30-minute modules that can be done individually, with a partner, as a group, or in a classroom setting. The 6 core modules are supplemented with 8 elective modules . The proThe sessions were built using Articulate 360 , which iEach of the modules contains approximately 20 wireframes. The wireframes are the baseline structure to which interactive features  can be attached. Each module follows a similar format. New knowledge is actively processed and placed in context with the learner’s own experiences, such as by completing quizzes, watching a 2-minute video, or reflecting on experiences. Each content area concludes by asking individuals to personalize specific behavioral objectives. In addition, the use of phase 1’s qualitative findings to build a program designed by wildland firefighters for wildland firefighters was emphasized with deidentified firefighter quotes used to underscore content in each module. Modules 2-6 begin with a follow-up on the prior session’s respective objectives to enhance self-efficacy for positive change, reinforce intrinsic motivation, and if done as a group, social support. This structure has been repeatedly shown effective, and we have demonstrated the validity of this framework for effective behavior change .Core modulesCore 1 Heart healthCore 2 Hydration and heat injuryCore 3 Physical fitnessCore 4 Nutrition on the lineCore 5 Sleep and fatigueCore 6 Mental fitnessElective modulesElective advanced mental fitnessElective alcohol scienceElective cancer preventionElective injury prevention and treatmentElective medical checkupElective nutrition off the lineElective effective leadershipElective supplements: help or hypeInformational emails about the final phase or effectiveness trial of the program were sent to management at each of the original sites and distributed to those firefighters. In addition, contact information obtained during phase 1 was used to reconnect with individuals and invite them to participate in phase 3. At a site, those who did not participate in phase 1 but expressed interest in the program were allowed to participate in phase 3. Web-based meetings were set up for interested firefighters at sites 1, 8, and 9. In-person visits were made to sites 2 through 7. During those web-based and in-person meetings, researchers answered questions, explained and obtained consent, administered the baseline preprogram survey, and led participants through the first program module. Not all participants from phase 1 were still at participating sites, and so, those who no longer were at the participating sites did not complete the program.A quasi-experimental single group pre- to postdesign was used to evaluate the program. The research team’s experience with phase 1 and the practical issues of data collection among busy firefighters being contacted digitally led to the use of a brief survey in phase 2 rather than the longer instruments with validated constructs used in our prior research -22. In aThe link to the follow-up survey was sent to a participant’s email approximately 4 months after they received the 14-week program. Those not responding to an initial email were contacted by 2 additional emails and a personal phone call asking them to complete the survey. A technical issue at site 2 precluded using its data.t tests for continuous variables [t tests to assess within-group changes. In addition to assessing mean and SD at baseline and postsurvey, we also looked at observed effect sizes (Cohen d). Calculation of Cohen d was done by dividing the mean difference (subtracting postsurvey mean from baseline) by the average SD of both repeated measures (ignoring the correlation between repeated measures) [d=0.2), medium (d=0.5), and large (d=0.8) [Demographics and other characteristics of all the included participants were summarized using mean (SD) or median (IQR) for continuous variables and frequency (percentage) for categorical variables. To assist in assessing whether there was a selection bias among those completing the postsurvey, we compared all firefighters who completed postsurvey to those not completing postsurvey using chi-squared or Fisher exact test for categorical variables and independent 2-sample 2-tailed ariables . Presurveasures) . Based o (d=0.8) . Usabili (d=0.8) . AnalyseP=.02).A total of 150 firefighters completed the prestudy and had access to the program. We excluded firefighters from site 2 (n=19) due to technical issues. Among the 131 firefighters completing the presurvey, 50 (38.2%) completed the postsurvey. The pre or postparticipants included individuals from all geographic areas. The completion rate was comparable among sites. As shown in d=0.49), cardiovascular risk factors , and cancer risk factors  after the survey. In addition, their intention to get a physical examination  and commitment to seeing a primary care provider increased by a modest effect size . Intention to eat every 2 hours , knowledge about protein-containing foods , and knowledge of binge drinking increased by modest effect size . There was no statistically significant difference in physical activity as the firefighters were already getting 150 minutes of physical activity at baseline. Most did the modules alone , and most used a computer or tablet  with only 14% (n=7) using their smartphone.Usability has several dimensions, including user satisfaction, effectiveness, efficiency, and flexibility in use . Based oA TWH program integrating health promotion with health protection was feasible, scalable, and positively impacted the health and safety outcomes of those fighting wildland fires. TWH involves integrating health and safety with organizational and environmental policy. This program integrated safety and health into the topics presented, for example, leadership module that included supervisory training, and included the organizational training policies of the wildland firefighter departments.Recent studies document the adverse impacts of wildland firefighting on mental and physical health ,44. ThosSignificant dietary changes were observed in several important areas. Participants reported a significant increase in their intentions to eat frequently when doing strenuous work. Participants also better understood that carbohydrates are the preferred fuel for high-intensity work and that protein is in plant-based foods. Those changes are relevant as it is well established that supplemental feedings during exercise lasting more than 2 hours result in increased ability to complete physical work . TrackinWildland firefighters are a challenging group to study. Most of the published literature focuses on the short-term health effects of working a fire season on injuries, respiratory effects, skin exposure, hearing impairment, and mental health issues . KoopmanWe recognize the limitations of a single-arm pre- to poststudy. However, participants were selected to be representative of a spectrum of wildland firefighters and geographic areas to enhance generalizability. Although the pretest may sensitize individuals, we did not find significant changes in all areas, suggesting sensitization and social desirability accounts for all the changes.A second limitation or challenge of this study was this research trial started prior to the COVID-19 pandemic with the Oregon fire department’s qualitative assessment being conducted and completed by in-person research staff. We had planned to visit all sites to collect the focus group data in person. Once the pandemic started in March 2020, the strict COVID-19 travel restrictions made in-person visits impossible. We altered our methods to assess participants using web-based Webex methods. The validity of these methods for data gathering has been reported .A third challenge occurred during the postintervention quantitative assessment. Our plan was to collect data near the end of the wildfire season, at which time the majority of wildland firefighters would have returned to their department from deployment. Unfortunately, our postintervention data collection occurred during the largest and most devastating wildfires in US history. It was tragic to hear that one of our Oregon study fire departments had a wildland firefighter fatality, and some of our study participants either lost personally or knew someone who had lost their homes and buildings. In a study fire department in Montana, one of our study participants suffered a tragic accident with severe burns over most of his body during a wildfire, having to be airlifted to a large urban hospital burn unit. Our postintervention study subject numbers reflected this prolonged and devastating fire season that took its toll on firefighters.TWH includes individual and organizational strategies integrating protection from work-related safety and health hazards to advance worker well-being, including injury and illness prevention. A limitation of this program focused only on the individual level and did not address the organizational structure and policy.The potential benefits of this novel web-based program targeting a high-risk group will advance the health and safety of those fighting wildland fires at minimal expense (the program is free). As designed and developed, the platform and structure can easily be adapted for all fire service agencies as part of a classroom training setting or incorporated into an educational curriculum learning management system to be made accessible and free to all firefighters and agencies.


Antibiotic contamination poses potential risks to ecosystems and human health. Laccase (LAC) has emerged as a promising biocatalyst for the oxidation of environmentally toxic contaminants with high catalytic efficiency; however, its large‐scale application is hindered by enzyme costs and dependency on redox mediators. Herein, a novel self‐amplifying catalytic system (SACS) for antibiotic remediation that does not require external mediators is developed. In SACS, a natural mediator‐regenerating koji with high‐activity LAC, derived from lignocellulosic waste, initiates the chlortetracycline (CTC) degradation. Subsequently, an intermediate product, CTC327, identified as an active mediator for LAC via molecular docking, is formed and then starts a renewable reaction cycle, including CTC327‐LAC interaction, stimulated CTC bioconversion, and self‐amplifying CTC327 release, thus enabling highly efficient antibiotic bioremediation. In addition, SACS exhibits excellent performance in producing lignocellulose‐degrading enzymes, highlighting its potential for lignocellulosic biomass deconstruction. To demonstrate its effectiveness and accessibility in the natural environment, SACS is used to catalyze in situ soil bioremediation and straw degradation. The resulting CTC degradation rate is 93.43%, with a straw mass loss of up to 58.35% in a coupled process. This mediator regeneration and waste‐to‐resource conversion in SACS provides a promising route for environmental remediation and sustainable agricultural practices. Efficient removal of antibiotics in soils is enabled by the self‐amplifying catalytic system (SACS). SACS is established via three steps: natural mediator regeneration during straw degradation by a laccase (LAC)‐producing consortium, an active intermediate release, and LAC–intermediate interaction. This low‐cost and environmentally friendly catalytic system allows for organic pollutant remediation and lignocellulosic biomass degradation without the need for additional mediators. In general, TCs are hard to be completely metabolized in vivo, and thus large proportions are excreted into the ecosystem via feces or urine. TC residues not only increase bacterial resistance but also aggravate the proliferation of antibiotic‐resistance genes. Considering the potential ecological and environmental risks, actions should be taken to detoxify antibiotics in various environmental systems including soil.Antibiotic accumulation in agricultural soils poses a potential risk to the soil ecosystem and crop growth, and ultimately threatens human health.1 Tetr but the remediation of TC‐contaminated soil, particularly agricultural soil, has received less attention. Overall, the natural biodegradation of TCs mediated by native microorganisms in the soil is comparatively slow. In recent years, efforts focusing on bioremediation have been made to accelerate the TC degradation process in soil, such as biochar, indigenous bacterial strains, and a microalgae–bacteria consortium.Many research efforts have focused on the removal of TCs from wastewater,4 but  Moreover, their application to soil remediation is hindered by the complexity of the soil environment. Therefore, it is imperative to develop effective and economical bioremediation strategies to enhance the removal of TCs in agricultural soils.Nevertheless, the large‐scale application of these strategies is limited by several shortcomings such as low efficiency, high cost, and long treatment cycles.9 More LAC belongs to the multicopper oxidase family and catalyzes phenolic compound oxidation. The catalytic core of LAC is organized into two copper centers. The T1 copper site (T1 Cu) is the primary electron acceptor. After accepting a single electron, T1 Cu transfers the electron to the T2/T3 trinuclear copper center (T2/T3 Cu), accompanied by the reduction of O2 to H2O. The difference in the redox potential between T1 Cu and the substrate is known as the electrochemical driving force of electron transfer and plays a crucial role in the oxidation efficiency of LAC. Owing to their broad substrate specificity, LACs have been applied for the bioremediation of TCs, dyes, pesticides, polycyclic aromatic hydrocarbons, and endocrine disrupters. However, the application of LAC is hindered because its redox potential is comparatively low (0.4–0.8 V) and thus LAC is incapable of oxidizing substrates with high redox potentials. Several low‐molecular–weight phenolic compounds, termed mediators, have been reported to assist LAC in oxidation by producing active free radicals and are considered key players in enhancing the oxidation efficiency of LAC. Although the LAC‐mediator system has great potential in the area of bioremediation, its feasibility is restricted due to the high cost of LAC as well as mediators.Bioremediation based on laccases  is an environmentally friendly approach for detoxifying persistent organic pollutants.11 LACTrichoderma reesei (T. reesei) ZJ09, Aspergillus niger (A. niger), and Trametes versicolor (T. versicolor). SACS could be established via three steps  using inexpensive lignocellulosic sources to address the aforementioned challenges. The design of this SACS eliminated the need for redox mediators. Instead, SACS is based on a natural mediator‐regenerating koji with high LAC activity (Nm‐Re‐LAC), which was prepared by solid‐state fermentation of rice straw via a fungal consortium (named CTrAT) comprising ps Figure1. Firs22.1T. reesei ZJ09. As shown in Table The antibiotic degradation performance of different LAC‐mediator systems was investigated. The target TCs (OTC and CTC) selected here are the two major residual antibiotics in the soil that are relatively recalcitrant to degradation. The LAC used here was produced by the sei ZJ09.19 As  In contrast, natural mediators, such as syringaldehyde (Syr) and vanillin (Van), are more environmentally friendly. The removal rates of CTC using LAC‐Syr and LAC‐Van systems were 71.43% and 75.80%, respectively  spectroscopy was used to monitor the natural mediator formation during LAC‐catalyzed lignin degradation. The oxidation of mediators is presumed to produce radical intermediates. Thus, the higher radical concentration achieved in the reaction system could be ascribed to a higher concentration of small, soluble radical compounds with function as mediators. As shown in Figure m after 1 h of LAC treatment. Therefore, taking full advantage of this lignin‐derived phenolic compounds mixture could be a promising strategy to boost the catalytic capacity of LAC toward recalcitrant aromatic compounds of environmental interest, including antibiotics.During the lignin biodegradation process, various phenolic compounds related to lignin polymer could be released, forming a mixture of natural mediators for LAC.21 Ele2.2T. reesei ZJ09 can produce a series of lignocellulose‐degrading enzymes  and possesses notable catalytic activity toward lignocellulosic biomass, the current strain has two drawbacks. First, despite the partial degradation of lignin in straw, the efficiency is still insufficient to achieve efficient lignin oxidization. Second, the β‐glucosidase activity (BGA) in the cellulase complex produced by T. reesei ZJ09 is extremely low, which results in the end‐product inhibition of cellulases.Lignin is resistant to degradation owing to its complex and rigid structure, which affects the effective release of redox mediators. Although the mely low,23 whiHere, to construct an a mediator LAC‐natural mediator system for tetracycline antibiotics degradation, we first developed a fungal consortium that could effectively degrade straw (named CTrAT). Subsequently, koji formed via CTrAT‐mediated straw degradation, which contained high‐activity LAC and various phenolic derivatives, was used for antibiotic removal.T. reesei ZJ09, Aspergillus niger (A. niger), and Trametes versicolor (T. versicolor). A. niger is a well‐exploited producer for high‐activity β‐glucosidase with desirable enzymatic properties. As shown in FigureA. niger boosted BGA as well as the endoglucanase activity (CMCase activity) by the consortium of T. reesei ZJ09 and A. niger (Tr–An), and the BGA and CMCase activity reached 25.49 and 1778.72 IU g−1, respectively, which was 18.6‐ and 1.47–fold higher, respectively, than that of T. reesei ZJ09 alone. Accompanied by the BGA enhancement, feedback inhibition caused by cellobiose accumulation could be relieved, leading to an improvement in total cellulase activity (FPA). FPA produced by the Tr–An increased to 194.32 FPU g−1, which was 1.84‐fold higher than that of T. reesei ZJ09 alone. However, the rate of lignin degradation by this fungi combination remains low because of deficient LAC production.First, to fully alleviate the recalcitrance of straw, especially the lignin, and release of lignin‐derived natural mediators, a straw‐degrading fungal consortium was constructed by using operties.25 As T. versicolor has a good capability for LAC production and thus can enable the efficient processing of lignin which T. reesei and A. niger fall short of. Furthermore, besides LAC, T. versicolor can secrete several other lignin‐degrading enzymes targeting a variety of phenolic organic pollutants, and is therefore of particular interest for environmental applications. Although BGA and CMCase activities exhibited mild decreases, the combination of T. reesei ZJ09 and T. versicolor (Tr–Tv) significantly enhanced LAC production. The LAC activity was 1.68‐fold higher to 39.21 IU g−1 compared to that of T. reesei ZJ09 alone  does not result in higher straw degradation ability. On day 10 of SSF, the overall biomass loss achieved with An–Tv was lower than that achieved with T. reesei ZJ09.e Figure , and thee Figure . Howevere Figure . As showT. reesei ZJ09, A. niger, and T. versicolor), designated as CTrAT, indicated that this consortium had good compatibility and could overcome the deficiencies of the two co‐cultured strains. The FPA and LAC activities produced by CTrAT exhibited rapid growth within the initial 2 days. The LAC activity, FPA, xylanase activity, CMCase activity, and BGA were 1.88‐, 2.25‐, 1.45‐, 1.54‐, and 20.10‐fold, respectively, on day 10 than those of T. reesei ZJ09 alone . The overall biomass loss achieved by CTrAT was 63.29% on day 12, 1.24‐fold higher than that of T. reesei ZJ09.The results of enzyme production and straw degradation by a consortium of three fungi  was formed, in which the phenolic compounds released by lignin decomposition could serve as natural mediators for LAC. After 4 h‐treatment, without the addition of any mediator, the Nm‐Re‐LAC‐mediated degradation rates of TCs reached 89.12% for OTC and 95.69% for CTC, comparable to those of suitable LAC‐mediator systems  430.11, 406.09, 327.11, and 284.07  reaction at C7 and oxidized to the corresponding quinone (CTC 284). A similar metabolic pathway was suggested by Pulicharla et al.29 and2.3 thereby promoting the remediation efficiency of contaminants. Quinone‐based compounds have been reported to improve the decolorization rates of multiple azo dyes.In this study, two quinoid compounds (CTC327 and CTC284) were generated via Nm‐Re‐LAC‐catalyzed CTC degradation  LAC and the major CTC degradation products , as well as the typical artificial mediator (HBT) and natural mediators , were investigated using molecular docking. As shown in Table −1, while that of HBT and LAC was −4.8 kcal mol−1, showing the interaction between CTC327 and LAC could occur spontaneously and CTC327 had relatively higher affinity compared to HBT. In addition, CTC327 reduced the T1 Cu‐ligation distance compared to the other mediators  and the benzene ring of CTC327 . After that, T1 Cu transferred the electrons via the Cys‐His pathway to the trinuclear clusters consisting of T2 Cu and two T3 Cu atoms, where the electrons were collected until four electrons were gathered. T3 Cu atoms then transferred the electrons to T2 Cu, and an O2 molecule reached this metal ion via an oxygen channel and was reduced into H2O, accompanied by the formation of hydroxy radicals. The delocalization of the unpaired electron of the radical intermediate would enhance its chance of interacting with the O—H bond of CTC via the H‐abstraction route, which consequently stimulates the catalytic cycle and boosts the remediation efficiency. The proposed electron transfer route was confirmed using EPR spectra  on CTC degradation rate were studied. As presented in β‐glucosidase, xylanase, and LAC, enabling direct degradation of lignocellulosic biomass such as straw. Therefore, SACS has great potential for the coupled degradation of CTC in soil and straw.In addition to soil bio‐remediation, the SACS based on Nm‐Re‐LAC could achieve simultaneous secretion of multiple lignocellulose‐degrading enzymes, namely endoglucanase, To simulate agricultural practices, two models (synchronous and parted) were employed to investigate the capability of SACS to couple the degradation of CTC in soil and straw. The parted model, meaning that the CTrAT‐inoculated straw was placed on a plastic sheeting shell to obtain the Nm‐Re‐LAC. The synchronous model (Sync) refers to placing the straw inoculated with CTrAT directly onto the CTC‐contaminated soil. After 10 days of cultivation, the Nm‐Re‐LACs obtained from both models were blended into the soil. As shown in Figure To analyze the soil remediation efficiencies of the two models using SACS, the CTC degradation rates at different soil depths were measured on days 10 and 16. As shown in Figure 2.5The key parameters of SACS for the coupled degradation of CTC in soil and straw were studied. Water supplementation was critical for straw degradation and soil remediation because the coupling process was performed in the open air. It is important to mention that the amount of water added may vary depending on the specific ambient temperature because a higher temperature could enhance water volatilization from both straw and soil, and affect the water‐holding capacity of the straw matrix. Therefore, three levels of daily water addition  were applied under temperatures ranging from 25–35 °C. At a fixed temperature, an increase in water supplementation enhanced the water content of the straw matrix Figure . It is nAccording to our previous research, the optimum water content of the straw matrix for LAC and cellulase production by CTrAT was 75%, and the consortium maintained high enzyme production capability when the straw water content was within the range of 60–80% Table . For insAs for CTC degradation on the soil surface at a fixed temperature, the degradation rate increased with daily water addition, which could be associated with the higher leaching and diffusive transport of LAC. Additionally, when the straw water content was within a suitable range (60–80%), at a fixed daily water addition, the maximum CTC degradation rate was achieved at 30 °C which was consistent with the optimal temperature for CTC removal catalyzed by the SACS Figure . In this and thus maintain a suitable environment for the coupled degradation of straw and CTC mediated by SACS. In this study, two strategies were applied to evaluate the effect of soil cover on the coupling process at 30 °C. The first one was designated as “Cover,” meaning that the straw matrix was covered using a plastic film incorporating small pinholes, and meanwhile, daily water supplementation was eliminated in this group. The other was referred to as “Open,” meaning the straw matrix was supplemented with 80% daily water addition without a soil cover. Straw water content, LAC production, and CTC degradation rates at different soil depths were analyzed. According to the changes in the straw water content, both strategies could maintain a comparatively stable humidity range favorable for the coupled degradation  remediation. Ideally, a soil cover over the straw matrix should restrict water in the soil33 and−1 on day 10. Nm‐Re‐LAC initiated CTC degradation and released the active mediator, CTC327, which in turn boosted the catalytic capability of Nm‐Re‐LAC, promoting the conversion of CTC into CTC327, thus forming a self‐amplifying catalytic system. As a result, during Phase II, when Nm‐Re‐Lac was blended into the soil, rapid degradation of CTC was observed, and the average CTC degradation rate reached 93.43% with a straw mass loss of 58.35% on day 14  can transfer electrons to the active mediator CTC327 to initiate oxidation, which facilitates electron transfer between LAC and the substrates, and consequently boosts remediation efficiency. This corroborates the high efficiency of TC degradation in the soil mediated by SACS. Biodegradation has emerged as an effective method for the removal of TCs from aqueous environments. However, information regarding TC biodegradation in soil remains limited. A bacterial consortium comprising Pandoraea sp. and Raoultella sp. showed an increased TTC degradation efficiency compared to a single strain, with the TTC concentration decreased by 43.72% within 65 days. Shi et al. explored the OTC removal in soil using Arthrobacter nicotianae, and observed an increase in OTC degradation by 8.22–45.45%. It was reported that arbuscular mycorrhizal fungi can enhance OTC decomposition and reduce residual OTC concentrations. Besides, the addition of manure slurry to soil was revealed to increase the microbial population or activity and promote the degradation efficiency of sulfadimethoxine. SACS‐mediated transformation of TCs is of great interest because it is a low‐cost as well as environmentally friendly remediation approach. Furthermore, compared to other LAC‐mediator systems, SACS achieves efficient removal of CTC without the addition of any mediators. As shown in Figure Redox mediators have been recognized as key factors for LAC‐catalyzed bioremediation, especially when correlated with pollutants of higher redox potential (>0.8 V), because the mediators can act as electron shuttles between the substrate and the enzyme, thus improving the oxidative capability of LAC. The SACS reported here exhibits a key feature desired for large‐scale LAC‐based bioremediation processes, such as redox mediator regeneration Figure . In sear34 In  White‐rot fungi are of particular interest owing to their ability to produce highly active LACs using lignocellulosic residues as substrates during SSF, which allows for simultaneous LAC production and lignin degradation. Previous studies have investigated various methods to enhance LAC production by white‐rot fungi. For example, Lonappan et al. used various inducers, such as veratryl alcohol and phenol red, to enhance LAC production by T. versicolor, a maximum LAC activity of 49.16 and 14.26 U g−1 was obtained from apple pomace and alfa plant fibers, respectively. LAC production by T. versicolor of 25.7 U g−1 dry substrate was achieved using tea residues. The combination of syringic acid and sweet sorghum bagasse led to an enhanced LAC activity of 67.4 U g−1 on day 16 by Coriolus versicolor. The utilization of Eichhornia crassipes by P. sanguineus was shown to produce LAC with an activity of 7.26 U g−1 dry substrate.Our results also provide insights into the treatment of agricultural waste mediated by the fungal consortium. Cellulosic biomass is resistant to degradation because of its complex and rigid structure. Lignin plays a negative role in deconstruction, and efficient lignin removal can significantly improve the enzymatic digestibility of biomass.43 Whi Recent studies have suggested that the co‐culture of LAC‐producing strains with other microorganisms can offer unique advantages, such as higher LAC yields and more desirable properties for disrupting recalcitrant lignocellulosic structures. In this study, recombinant T. reesei, which can secrete P. sanguineus LAC, together with T. versicolor and A. niger, comprised a biodiversity of LAC‐producing species. The resulting diverse sets of LACs exhibited encouraging results in terms of efficient lignin degradation. Compared with previous studies, efficient LAC production with a higher lignin degradation rate (81.64% on day 10) was achieved using CTrAT.Although research efforts to increase LAC production by white‐rot fungi have been made, the degradation rates of cellulose, hemicellulose, and lignin in lignocellulosic substrates remain low after fungal pretreatment.53 Rec Besides LAC, the marked increases in lignocellulose‐degrading enzyme production by CTrAT were also observed, such as β‐glucosidase, endoglucanase, and xylanase, which led to improved synergistic hydrolysis of the substrate (straw). For instance, the β‐glucosidase contributes to the removal of accumulated cellulose solubilization products  and the feedback inhibition of the enzyme activities of other components in the cellulase complex. Thus, CTrAT—capable of secreting a variety of cellulolytic enzymes—can fully alleviate the recalcitrance of straw, especially the lignin, for the effective deconstruction of lignocellulose  formed during the straw degradation process was abundant in lignin‐derived natural mediators coupled with high‐activity LAC and, as described previously, was employed in launching the CTC degradation. Compared with conventional artificial mediators for LAC (such as ABTS and HBT), natural mediators, which are phenolic compounds generally associated with lignin decomposition, are environmentally friendly substitutions with lower costs.21 Fur4T. reesei ZJ09, harboring the P. sanguineus LAC gene, was constructed in the previous study.A. niger was stored at the Laboratory of Biochemical Engineering of Zhejiang University. T. versicolor was obtained from the New Zealand Timber Anticorrosion Research Center. The strains were preserved on potato dextrose agar (PDA) at 4 °C. The inoculum was prepared according to the previously described. Antibiotics standards (99% purity) and mediators were purchased from Sigma‐Aldrich.Rice straw was collected from a suburban district in Hangzhou, Zhejiang Province, China. For pretreatment, straw samples were cut into 2–3 cm and saturated with ammonium hydroxide for 24 h as previously described.56T. reesei and A. niger, sterile saline (7–9 mL) was pipetted into fully sporulated slants to prepare spore suspensions (1 × 108 spores per mL) that were used as inoculum. For T. versicolor, disks of mycelia (5 mm‐diameter) were cut from the fully grown slants, followed by the addition of 50 mL of the inoculum medium, which consisted of: yeast extract 1.0 g L−1, glucose 10.0 g L−1, CaCl2 0.3 g L−1, KH2PO4 2.0 g L−1, (NH4)2SO4 1.4 g L−1, urea 0.3 g L−1, and MgSO4·7H2O 0.1 g L−1. The pH was adjusted to 4.8. T. versicolor was cultured at 30 °C for 7 days as inoculum.The three strains were cultured on PDA medium for 5–7 days at 30 °C. For  and the degradation process was carried out with a substrate water content of 75% at pH 4.0, at 30 °C for 10 days according to Tables Rice straw degradation by the fungal consortium was performed in 500 g capacity plastic trays . Hundred grams of a total dry straw was mixed with 250 mL SSF nutrient solution,55 andT. reesei spore suspension was inoculated into the trays from the beginning (designated as D0). A. niger was inoculated on D2, 2 days after the inoculation of T. reesei with an A. niger to T. reesei ratio of 1:5 v/v. For straw degradation by Tr–Tv, T. versicolor was inoculated on D1, 1 day after inoculation with T. reesei at a T. versicolor to T. reesei ratio of 1:1 v/v. For straw degradation by An–Tv, T. versicolor and A. niger were inoculated on D0 and D1, respectively, at a 1:5 v/v ratio. For straw degradation by CTrAT, T. reesei, T. versicolor, and A. niger were inoculated on D0, D1, and D2, respectively, at a ratio of 1:1:5 v/v/v.For straw degradation by Tr–An, The total inoculum size was 10% v/w among all groups, and the straw substrate was sampled every 2 days for enzyme assays and determinations of straw components. The koji obtained from SSF using CTrAT for 10 days was designated as Nm‐Re‐LAC and was taken for antibiotic degradation and CTC‐contaminated soil remediation. To simulate CTC‐contaminated soil, 5.0 kg of soil was added into a plastic tray , and CTC in methanol (500 mg L−1) was evenly poured into the soil and mixed several times. The CTC extracted from the soil was used as the initial CTC concentration (≈80 mg kg−1) in the soil remediation experiments.Soil samples were collected from Yuhang District, Hangzhou City, Zhejiang Province, China. The collection of soil was performed as previously described.57 To T. reesei ZJ09 under submerged fermentation, following previously described procedures. A mixture of 80 mg L−1 of CTC or OTC was treated with either Nm‐Re‐LAC containing 0.2 IU mL−1 LAC or LAC‐ZJ09 with or without mediators. The concentration of a single mediator was 0.3 mm. For the syringaldehyde/vanillin complex, 0.3 mm of each mediator was mixed at a Syr to Van proportion of 4 to 6. The reaction was carried out for 4 h at 50 °C and at a pH of 4.0. Residual antibiotic concentrations were determined by high‐performance liquid chromatography (HPLC) .Degradation of TCs (CTC and OTC) was performed using Nm‐Re‐LAC or crude laccase (LAC‐ZJ09). LAC‐ZJ09 was prepared using recombinant ocedures.19 A mP. sanguineus LAC (PDB accession code: 5NQ7) was obtained from the Protein Data Bank. Binding free energies and potential binding sites were explored by AutoDock suite 4.2.6. The docked conformations were visualized by PyMOL, and the non‐covalent interactions between LAC and mediators were identified using the PLIP web server. The docked complex with the lowest score was selected for further dynamics simulations.The crystal structure of te 4.2.6.58 Thehttp://jerkwin.github.io g−1mxtool) was used to calculate molecular mechanics Poisson–Boltzmann surface area.The dynamics simulation was performed using the GROMACS software (version 2020.3). All simulations were performed for 25 ns at a temperature of 300 K and a pressure of 1 atm. The van der Waals force was calculated via Lennard–Jones function, with the non‐bond truncation distance of 1.4 nm. Visual molecular dynamics was used to analyze the trajectory, and gmx_MMPBSA .The key parameters including the koji implementation approach (Cover or Mix), koji dosage (0–0.25 g/g soil), temperature (15 to 35 °C), pH (2.0–7.0), and soil water contents (10–50%) were optimized. Five variables were analyzed individually. The condition that achieved the highest CTC degradation rate was subsequently applied in the optimization experiment for the next factor, while the other factors remained unchanged. For the optimization of the first parameter, temperature, CTC‐contaminated soil (250 g) was added to a 500 g capacity plastic tray. The Nm‐Re‐LAC was mixed with the soil at a dosage of 0.15 g/g soil. The degradation experiment was carried out from 15–40 °C, at a pH of 4.0, and with the soil water content of 40%, in an incubator for 3 days. Soil was sampled using a five‐point sampling method.60 The to determine LAC activity, straw mass loss, and CTC degradation rate.Coupling degradation was performed via two phases (Phase I and Phase II) in a 500 g capacity plastic tray with 250 g of CTC‐contaminated soil. Straw (25 g) was spread on the soil to a height of 2–3 cm. CTrAT at 10% v/w was inoculated into the trays. The pH of the soil was adjusted to 4.0 using citrate buffer. Unless otherwise stated, 80% daily water was added to the straw matrix using citrate buffer (pH 4.0). During Phase I (0–10 days), two models (parted and synchronous) were applied. For the parted model, the inoculated straw matrix was placed on a shell of plastic sheeting for 10 days to obtain Nm‐Re‐LAC. For the synchronous model, the inoculated straw was placed directly on the CTC‐contaminated soil for 10 days to obtain Nm‐Re‐LAC. On day 10, the Nm‐Re‐LACs formed from both strategies were blended into the soil, and the coupling process was conducted for another 6 days under the same conditions (Phase II). The straw matrix and soil were sampled every 2 days using a five‐point sampling method60 to Compositional analyses of the straw samples were performed using the National Renewable Energy Laboratory protocol.61m, pH 4.8) was used for the enzyme extraction of Nm‐Re‐LAC at a solid‐to‐liquid ratio of 1:5. The extraction process was performed by shaking at 30 °C, 200 rpm for 60 min, and then centrifuged at 4 °C, 10 000 × g for 5 min. The obtained supernatant was used for enzyme assays. Assays for LAC activity, FPA, BGA, CMCase activity, and xylanase activity were performed as previously described. The “enzyme activity” represents the mean value of three independent replicates, and “relative enzyme activity” in each set refers to the proportion of the enzyme activity to the highest activity in this set.Citrate buffer .Antibiotic concentrations were determined using HPLC  according to Xia et al.,55 exc within a mass‐to‐charge (m/z) range of 150–700 m/z. Growth inhibition tests of E. coli, B. subtilis, and P. subcapitata by CTC and OTC after Nm‐Re‐LAC treatment were performed according to the methods previously described.The CTC degradation products were identified using HPLC/ESI‐MS acquired by Agilent 6545 Q‐TOF mass spectrometer . MS analysis of the intermediates was performed as previously described40 witThe authors declare no conflict of interest.Y.X. performed the experiments, analyzed the data, and wrote the manuscript; L.X. conceived the study and designed experiments; X.L. revised the manuscript and supervised the project. All authors discussed the results and commented on the manuscript.Supporting InformationClick here for additional data file.


Weak fault detection with stochastic resonance (SR) is distinct from conventional approaches in that it is a nonlinear optimal signal processing to transfer noise into the signal, resulting in a higher output SNR. Owing to this special characteristic of SR, this study develops a controlled symmetry with Woods-Saxon stochastic resonance (CSwWSSR) model based on the Woods-Saxon stochastic resonance (WSSR), where each parameter of the model may be modified to vary the potential structure. Then, the potential structure of the model is investigated in this paper, along with the mathematical analysis and experimental comparison to clarify the effect of each parameter on it. The CSwWSSR is a tri-stable stochastic resonance, but differs from others in that each of its three potential wells is controlled by different parameters. Moreover, the particle swarm optimization (PSO), which can quickly find the ideal parameter matching, is introduced to attain the optimal parameters of the CSwWSSR model. Fault diagnosis of simulation signals and bearings was carried out to confirm the viability of the proposed CSwWSSR model, and the results revealed that the CSwWSSR model is superior to its constituent models. As the industrialization has found its way into society, the safety and reliability of engineering systems and mechanical equipment play a critical role in the production process, which is an essential subject involving technology and people’s livelihoods. It is common knowledge that mechanical failures occur from time to time with the increase in the age of the equipment or the imperfection of the technology in the use of mechanical equipment. Therefore, it is advantageous to find equipment problems as soon as possible because doing so can minimize financial damage and potentially save lives. Yet, in real-world applications, mechanical equipment operates in the presence of very strong background noise, which is manifested as a high frequency of noise overwhelming the presence of the effective signal in the time and frequency domain diagrams. Therefore, the development of novel methods that can identify and extract useful signals under the interference of substantial background noise has become an increasingly important topic in the field of weak fault detection ,2.In general, it is believed that the presence of noise will obstruct the detection of effective signals. The previous approaches to weak fault detection, such as filter technique, empirical mode decomposition, singular value decomposition, and wavelet transform, all use a noise suppression viewpoint ,4,5. TheOver the past two decades, SR has been used in many different fields, including meteorology , pharmacFor the sake of practical engineering needs, time-delayed SR systems have attracted the attention of many scholars. In , Shi et The CBSR model has received the most attention among the several theoretical representations of SR. However, CBSR is only effective for small-amplitude signal identification due to the limitations of its own potential function. The frequent output saturation that CBSR encounters, which limits its ability to enhance performance in weak signal detection, is clearly described in ,32,33,34With the innovative development of SR, the model is not only limited to the CBSR, but also the multistable and monostable SR is gradually researched by scholars. Lu et al. investigated a tri-stable stochastic resonance (TSR) system and adaptively adjusted the parameters using particle swarm optimization (PSO) to obtain the best SNR and spectral output in . ThroughIn this paper, we propose a novel SR model called controlled symmetry with Woods-Saxon stochastic resonance (CSwWSSR). Since the parameters of the WSSR model control the potential wells singly and explicitly, we construct a controlled TSR based on the WSSR with three potential wells controlled by different parameters. In order to establish the optimal control strategy with the highest SNR, we then confirm the ideal parameters for the CSwWSSR model in various noise environments by utilizing PSO in the scenarios of controlled potential well depth and controlled potential well width. The feasibility and superiority of CSwWSSR for practical engineering applications are further verified by comparing the results with the original signal and its constituent model through the detection experiments of simulation signal and bearing.The rest of this essay is structured as follows. The CSwWSSR model and its components are introduced in H, W, and a. The potential well of WSSR is depicted in H is to control the depth of the potential well, W is to control the width of the potential well, and a is to determine the steepness of the potential well.Most of the studies on SR primarily investigated the classical bistable SR model based on the four-time reflection-symmetric potentials. In these models, a change in a single parameter may induce a large change in the shape of the potential function. However, the shape of Woods-Saxon potential illustrated in Equation  can be aH, W, a, A, B, H, W, a) are the parameters of the WSSR and  in any case.Since the potential function of CSwWSSR is generated in the combination of WSSR and CSSR where CSSR has two cases, i.e., the controlled potential well depth and the controlled potential well width, CSwWSSR should also be discussed in two cases. On the basis of the aforementioned analysis of CSSR, we find that H, W, a) of the WSSR control the intermediate potential well of the CSwWSSR, which have the same impact on the potential function as for the WSSR, as shown in H, the width of the well gradually increases with increasing W, and the steepness of the potential well wall gradually becomes slower with increasing a in k of the CSSR, which can be simply realized that the well depth increases with the increase of k in The parameters . In order to optimize the output, the particle swarm optimization (PSO) [N stands for the length of the signal. A larger output SNR indicates superior performance in weak signal detection.In light of the analysis of the CSwWSSR in on (PSO) ,47,48 ison (PSO) , which iStep 1. Preprocess input signal. The adiabatic approximation theory, which stipulates that the driving frequency, signal amplitude, and noise intensity should all be considerably less than 1, was the basis for the initial proposal of SR. However, the majority of real signals are high frequency signals in the presence of severe noise, which does not agree with the theory of adiabatic approximation. A rescaling method was used in  to circuStep 2. Optimize parameters. The PSO process is shown in the dotted box in i-th sample value of the input signal after summing the vibration signal and the noise signal, and i-th sample value of the output signal. H, W, a, A, B, A and B can be represented by k in different cases, so the H, W, a, k).Step 3. Calculate the CSwWSSR. The optimal combination of parameters output in the previous step is substituted into CSwWSSR to calculate the output signal. Due to the fact that the SR is based on a phenomenon generated by a nonlinear system, the analytical and approximate analytical methods are no longer applicable. As a consequence, a numerical method is usually used to solve the problem, i.e., fourth-order Runge-Kutta . The solStep 4. Diagnose faults. A power spectrum is created from the output signal via the Fourier transform to detect the weak fault and diagnose mechanical faults. In this work, the output SNR and the amplitude of the power spectrum at the fault characteristic frequency are observed and compared to assess the model’s outstanding performance.D = 5 and A denotes the amplitude of the simulation signal with A = 0.25. To be specific, the fault characteristic frequency N = 4000. To satisfy the requirement of adiabatic approximation theory to achieve small parameters of SR, the scale compression ratio ∂ = 2000, then the step size To illustrate the effectiveness of the proposed CSwWSSR model, the simulation signal is imported into the CSwWSSR model’s weak signal detection for fault diagnosis. The simulation signal can be represented asAiming to demonstrate the fault characteristic detection capability of CSwWSSR, three different models are used to process the above simulation signal, that is WSSR, CSSR, and CSwWSSR. In addition, since CSSR and CSwWSSR are divided into controlled well depth and controlled well width, the input signal is subjected to five experiments. For the sake of fairness, the PSO is used for all five experiments to optimize parameters, where the population size and the number of iterations are both set to 50. After the PSO, From D, in which the fault characteristic frequency D is from 1 to 6. In N = 4000, the signal amplitude A = 0.25, the sampling frequency N = 4000, the signal amplitude A = 0.2, the noise intensity D = 2, and the sampling frequency D and To evaluate the capability of the proposed CSwWSSR model in detecting different fault signals, it is demonstrated by a series of simulation signals with different fault characteristic frequencies and noise intensities. Consistent with the above, Equation  is used We can apparently conclude CSwWSSR is preferable to the other two models in terms of its ability to detect fault signals, whether anti-noise or enhancement of high frequency signals in In the previous section, we demonstrated the effectiveness of the CSwWSSR model for simulation signals. Furthermore, it is applied to practical engineering applications in this section to demonstrate effectiveness of the CSwWSSR model. Here, we adopt the data of rolling bearing provided by Case Western Reserve University, whose sampling frequency is 12 kHz, and speed is 1796 r/min. Taking the outer loop fault as an example, the theoretical value of the outer loop fault frequency is calculated by Equation  which isN = 3000 and the noise intensity D = 4. Since the fault characteristic frequency does not fulfill the adiabatic approximation theory, using a rescaling method is necessary, with two sampling frequency In Equation , n1 reprH, W, a), which have the same impact on the potential structure as the WSSR, and the potential wells on both sides depend on the parameter k. The CSwWSSR parameters are transparent to the control of the potential structure, which means that each parameter controls a different aspect of the potential structure.We analyze the potential functions of WSSR, CSSR, and CSwWSSR to investigate the effects of parameters on the potential structure and dynamical properties. The intermediate potential well of the CSwWSSR is discovered to be controlled by the parameters (The output SNR curves of WSSR, CSSR, and CSwWSSR were examined for various noise intensities and various fault characteristic frequencies, demonstrating how well CSwWSSR combines the benefits of WSSR and CSSR both in terms of anti-noise and enhancement of high frequency signals. It has both the features of stable particle motion in WSSR and the controlled adjustment of potential wells on both sides in CSSR.We compare the output signal time domain and frequency domain diagrams of the WSSR, CSSR, and CSwWSSR after PSO optimized parameters in the simulation signal and bearing experiment. In terms of output SNR and amplitude of fault characteristic frequency, it is apparent that CSwWSSR outperforms CSSR and WSSR, which indicates that CSwWSSR has robust engineering applicability in the future.Linear optimal signal processing is typically less effective with a higher SNR in weak signal detection. However, because weak fault detection is regularly hindered by strong noise, the CSwWSSR model we proposed in this paper exploits noise to enhance weak signal detection. In addition to excellent noise utilization, it also exhibits notable features at the fault characteristic frequency, which is one of the benefits of combining WSSR and CSSR. What’s more, by modifying the parameters, it may visibly alter the potential function’s shape directly. The model parameters with the best SNR may be found for different input signals and noise thanks to an optimization algorithm. Then, comparative experiments are conducted for the controlled potential well depth and controlled potential well width to demonstrate the viability and superiority of the CSwWSSR model in fault characteristic detection. The following conclusions are drawn:In future work, we will consider the optimization problem of two-dimensional signals based on multistable stochastic resonance. In the low SNR environment, it will be a new challenge to make full use of SR techniques to overcome the spatial correlation of two-dimensional signals and recover two-dimensional signals disturbed by environmental noise. It is obvious that the results obtained in this study make a good foundation for the discussed future work.


In the interest of preventing the Coronavirus Disease 2019 (COVID-19) pandemic from spreading, it is crucial to promptly identify and confine afflicted patients. Serological antibody testing is a significant diagnostic technique that is increasingly employed in clinics, however its clinical use is still being investigated. The present study was carried out to scrutinize how well Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) antibody testing using in-house developed rapid antibody assay worked against the chemiluminescence (CLIA) assay. Either IgG positive (IgG + IgM-) or IgM positive (IgM + IgG-); both IgG and IgM positive (IgM + IgG+); and negatives (IgM- IgG-) have been evaluated. A total of 300 samples with diverse age and sexual identity data were included. The combined sensitivities for IgG + IgM+, IgM + IgG-, IgG + IgM- and IgG-IgM- were evaluated. More accurate diagnostic results may be obtained using molecular diagnostic tools. The Antibody Rapid Diagnostic kit’s (in-house developed) performance was satisfactory for determining the presence of Covid-19 infection with IgG and IgM positivity. The IgG and IgM positivity helped evaluate the immune response in the individual for the COVID-19 infection. These results lend support to the additional utilisation of serological antibody tests in the COVID-19 diagnosis. • We performed an archival research analysis to check Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) antibody testing.• We determined the presence of Covid-19 infection with IgG/IgM positivity. SARS-CoV-2 was the unique Sarbecovirus that caused the pandemic Coronavirus disease 2019 (COVID-19), which had a significant influence on people’s health and wealth around the world WHO, . AlthougImmunoglobulin (Ig)A, IgG, IgM, or total antibodies that are directed against the SARS-CoV-2 specific spike protein (S) and/or nucleocapsid protein (N) are typically found in patient serum or plasma through serological testing  was carried out using the fully automated iFlash 1800  chemiluminescence immunoassay analyser. Briefly, 20 L of serum or plasma were directly injected onto an autonomous platform using iFlash-SARS-CoV-2 IgG and/or oriFlash-SARS-CoV-2 IgM kits, as appropriate. In arbitrary units (AU) per millilitre, the reaction signal is indicated. IgM and/or IgG were deemed positive for the given sample if the threshold value exceeded 10.0 AU/mL  device for rapid diagnostic test was developed internally (data not shown). On test lines 1 and 2, respectively, anti-human IgM and anti-human IgG monoclonal antibodies were coated, while biotinylated BSA was used as the control (C). The coated cards were made by adhering sample pads, conjugate cards with COVID-19 antigen coupled to gold nanoparticles (data not shown), nitrocellulose membranes with control and test lines, and absorbent pads to laminating sheets. The entire card is sliced to the required dimensions, which are then put into the plastic cassettes that have already been pre-moulded (by a third-party vendor), and finally pressed on a pressing machine. The final cassette is then sealed and placed into pouches filled with silica gel while being dried out  of the assay buffer were added. Within 15 min, the result was read. In as little as one minute, a strong positive specimen can generate a positive result.If pink bands develop at the control line (C) and/or one or more of the test lines, the sample is deemed to be positive for COVID-19 infection. If discernible bands are evident at test lines 1 and 2, then the sample is positive for both IgM and IgG. If the visible band only shows at test line 1, the sample is only IgG positive, and if it only appears at test line 2, the sample is only IgM positive. If the pink band appears in the control area (C), the sample is thought to be free of COVID-19 infection. The test is deemed unsuccessful if there is not any discernible band at the control region (C) Fig. . With a Data extracted from each study included the first author’s last name acronymed/anonymised, the age and sex of COVID-19 patients, the number of days since the onset of symptoms, the manufacturer of the test kit, the design of the study, the reference standard, the type of blood sample used in the RT-PCR, the methods, the antigen, and the types of antibodies used to detect antibodies. To build the 2–2 contingency table and evaluate sensitivity and specificity, true-positive, false-positive, false-negative, and true-negative findings were retrieved. This study aimed to explore the diagnostic efficacy of various antibody combinations, including IgG + IgM +, IgM + IgG-, IgG + IgM- and IgG- IgM- from CLIA and RDT, respectively. IgM + IgG-; IgG + IgM-; IgM + IgG +; IgM + IgG+/-; IgG + IgM+/-; and IgM + or IgG + combinations have been evaluated in age groups of 20–40, 40–60 and over 60 plus.Using age and gender criteria, we investigated 300 samples. A total of 141 (47%) samples were from individuals above 60 years of age, 68 (22.67%) were between 40 and 60 years of age while 91 (30.33%) were between 20 and 40 years of age. From the 300 samples collected, 158 (52.66%) were from males and 142 (47.33%) were from females.The findings indicated that 54 38.29%) out of 141 samples (from > 60 years age group) tested by the CLIA were IgM + positive and 11 (7.8%) IgG + positive while 27 (19.14%) were found positive for both IgM + and IgG+ , 22 (32.35%), 6 (8.82%) of positives, and 21 (30.88%) negatives respectively with reference to 40 to 60 year-old patients samples tested with 68 out of 300 samples from CLIA investigations. Similarly, from RDT investigations, 18 (26.47%), 22 (35.35%), 7 (10.29%) were positive for IgG + IgM+, IgM +, IgG + respectively and 21 (30.88%) were found negative , low percentages of positives i.e., 3 (3.29%), 7 (7.91%) and 1 (1.09%) positives were IgG + IgM +, IgM + and IgG + respectively. Same pattern was found from RDT results also. A total of 80 (87.91%) samples were negative while 2 (2.19%), 7 (7.69%) and 2 (2.19%) were positive for IgG + IgM+, IgM +, IgG + respectively  males and 23 (16.19%) females were positive for IgG + IgM + while RDT studies reported that 23 (14.55%) and 21 (13.29%) males and females respectively, were positive for IgG + IgM+. A total of 61 (38.60%), 10 (6.32%) males were positive for IgM + and IgG + respectively while 22 (15.49%) and 8 (5.63%) females were positive for IgM + and IgG + respectively from CLIA. From RDT studies, a total of 60 (37.97%) and 13 (8.22%) males were positive for IgM + and IgG + respectively while 22 (15.49%) and 7 (4.92%) females were positive for IgM + and IgG + respectively  and 89 (62.67%) males and females respectively to be negative while RDT reported 62 (39.24%) and 92 (64.78%) males and females respectively negative Fig. .An internal COVID-19 IgG/IgM antibody fast diagnostic kit’s performance can be assessed by comparing it with a recognised reference method, such as CLIA. However, the evaluation should include the following parameters.The test’s sensitivity is its capacity to accurately identify positive cases Yangchun . It is dThe capacity of a test to flawlessly identify negative cases is known as specificity. It is determined by taking the test’s proportion of truly negative cases out of all other negative cases . However, our results from RDT could be vividly used to screen the latest XBB.1.116 variants as well. Although there are variances in sensitivity for various assay types, the antigen of choice did not seem to have an impact on the results of sensitivity. Our findings demonstrate that during the age and gender-based analysis, serological tests based on CLIA IgM-IgG and RDT IgM-IgG were equally sensitive. Because it takes time for an endogenous detectable antibody response to form, antibody detection has limits in error-free diagnosis, as was previously discussed. Nonetheless, serology could be useful in environments with limited resources if the results are interpreted while taking cognizance of the sensitivity’s limitations.


Child and adult obesity continue to be major health concerns in the United States and can contribute to the development of chronic diseases. Culinary medicine, which incorporates teaching kitchens and gardens, may be a useful strategy for preventing and/or treating obesity-related disease by providing the knowledge and skills that encourage consumption of whole plant-based foods prepared at home. Though emerging research describes the benefits of culinary medicine-based programming, examples of teaching kitchens and culinary gardens being integrated into current clinical practice is minimal. Here, we describe the development of innovative, community-centered culinary medicine programming borne from interdisciplinary collaboration at a leading healthcare system. Preliminary outcomes suggest improvements in anthropometrics, cardiometabolic risk factors, and participation in healthy lifestyle behaviors in pediatric weight management patients, as well as improved confidence, knowledge, and likelihood to prepare whole food, plant-based meals in healthcare employees following participation in culinary medicine workshops. Hospitals and culinary medicine partners can support each other through shared knowledge, vision, and resources to provide value-based care to patients in the community. Collaboration among gardeners, chefs, architects, educators, and healthcare professionals can transfer traditional physician-driven care to patients, empowering them with the tools, resources, and confidence to improve health and wellbeing. Childhood and adult obesity continue to be major health concerns in the United States. According to the 2017–2020 National Health and Nutrition Examination Survey (NHANES), one in six (16.1%) children and adolescents aged 2–19 years were overweight and one in five (19.7%) were in the obesity category. Higher prevalence rates were observed among Hispanic and non-Hispanic black children compared to non-Hispanic white and Asian children .Culinary medicine, which includes the use of teaching kitchens, is an evidence-based approach to nutrition education, which blends the art of cooking with the science of medicine . TeachinThe purpose of this commentary is three-fold: (1) to describe the development of an innovative, community-centered nutrition and culinary medicine education program at a pediatric weight management medical clinic and show preliminary evidence of its impact; (2) to describe other organizational efforts formed by interdisciplinary collaboration of community visionaries and healthcare leaders through a local non-profit teaching kitchen and culinary garden; and (3) to describe the expansion of a culinary medicine program for healthcare employees and demonstrate preliminary evidence of its impact on willingness to participate, confidence, and skills. The intent is to demonstrate how passionate thinkers from different, yet complementary sectors in the health and nutrition space collaborate to ensure the success and longevity of impactful programs, show initial health outcomes for past and current patients, and provide inspiration to other systems and organizations by sharing experiences and lessons learned.https://www.adventhealth.com/hospital/adventhealth-children/pediatric-weight-loss-and-wellness-programs). The aim of the PWW program is to address childhood obesity using a multidisciplinary approach to treatment and prevention of weight-related comorbidities that combines whole person care, including medical, psychological, nutritional, and physical activity. The PWW program accepts children and adolescents aged 5–18 years old with a body mass index (BMI) greater than or equal to 85% .In 2010, AdventHealth for Children (AHFC)/AdventHealth Medical Group (AHMG) along with a board-certified physician specialist in pediatric and obesity medicine who has additional certification in culinary medicine initiated the Pediatric Weight and Wellness (PWW) medical practice and program .It provides the following services:Since its inception, AHFC has remained committed to the health and wellness of obese/overweight children in the Central Florida community, supporting the full clinical multidisciplinary team and basic program components. Philanthropy remains crucial to the long-term financial sustainability of the extended PWW programming components. Program funding has been provided by over 90 local and national organizations and partnerships, ranging from gifts in-kind, providing incentives/rewards for program participants, to multi-year grant funding from local and national organizations.As the PWW medical practice and program evolved, it became clear to the medical providers and allied health practitioners that most of the children, teenagers, and families involved in the PWW program did not have the basic skills and understanding to prepare healthy, home-cooked meals. Instilling the confidence and knowledge to identify healthy food, prepare meals at home with fewer processed ingredients, and make healthy choices in restaurants, schools, and social settings became a vital part of the PWW program.Initially, in partnership with the AdventHealth Diabetes Institute’s teaching kitchen space, the PWW program began facilitating cooking classes with a chef educator and PWW dietitian. Gardening workshops, facilitated by a volunteer from a local garden store who provided instruction time and supplies such as soil, tools and seedlings, took place in the evenings or weekends several times per month in the PWW program office lobby or green space in front of the office building. Concurrently, the volunteer garden educator at Orlando Junior Academy (OJA) was teaching OJA students and teachers to combine hands-on garden education with the elementary curriculum. Over time, the PWW program participants also started attending gardening workshops after hours at the school teaching garden within OJA. A description of the workshops is provided in As AHFC PWW and culinary medicine programs continued to grow, simultaneously, the Edible Education Experience (EEE) in Orlando was in development. A group of community wellness innovators came together from the following backgrounds: medical, gardening, culinary, architecture, and academics. Edible Education Experience is a non-profit organization that became incorporated in 2014 and opened in 2017. It operates the award-winning (American Institute of Architects Orlando Chapter Award of Honor) Emeril Lagasse Foundation Kitchen House and Culinary Garden, a teaching kitchen and on-site culinary garden. It is based on the belief that seed-to-table experiences “forge meaningful relationships, develop autonomy and empowerment, build competency with relevance to the natural world and one’s own lives, encourage a shared sense of responsibility, and enable food to become an artistic tool for shifting perspectives” . CombineThe successful partnership between the teaching kitchen and culinary garden and the pediatric practice is made possible by the vital role of key health and wellness advocates at AHFC, AH, and EEE. The Culinary Educators coordinate special programming for adults and children/teens, engage community chefs, design employee wellness programming, oversee kitchen volunteers and assistants, and execute corporate team builders. The Garden Educator manages the 3000 square foot culinary garden, including planning, planting, and harvesting the crops; coordinates “edible lessons” with teachers and culinary educators; provides hands-on experiences to visitors; and oversees the garden volunteers and assistants. The Executive Director steers the organization by managing operations, leading business development with help from the Business Coordinator, fundraises, oversees facility rentals, and works with the EEE team, Board of Directors, and community partners. Capital funders for the Emeril Lagasse Foundation Kitchen House and Culinary Garden were: AdventHealth for Children, the Emeril Lagasse Foundation, Orlando Junior Academy, and other forms of philanthropy, like private donations and gifts-in-kind.After its grand opening, the EEE Kitchen House and Culinary Garden became the primary site of the gardening and culinary medicine workshops for children and teens of the AdventHealth for Children PWW program. The partnership has evolved from providing the backdrop and location for workshops teaching hands-on nutrition, gardening, and culinary education, to developing a shared curriculum for seed-to-table experiences within the framework of culinary and lifestyle medicine. The partnership between the EEE and the AHFC PWW program is featured in the Teaching Kitchen Collaborative Food is Medicine Map .2 (range: −0.10 to −3.70 kg/m2).The PWW team retrospectively analyzed patient outcome data following 6 months of participation in the PWW program from 2022–2023. Participation in the PWW program included behavioral modification interventions/counseling in motivation, nutrition, and exercise; participation in culinary medicine workshops; and clinical interventions, such as screening for and treatment of medical/mental health co-morbidities and, when appropriate, the use of medications (such as metformin for severe insulin resistance or type 2 diabetes mellitus). Patients lost on average 3.67 ± 3.24 kg (range: −0.4 to −13.88 kg) and reduced BMI by 1.29 ± 0.93 kg/mChanges in anthropometric measurements, cardiometabolic risk factors, and surveyed lifestyle behaviors over the 6-month timeframe are shown in These findings suggest promise for the PWW program and, specifically, the culinary medicine workshops, in improving multiple facets of behavioral and physical health, including biomarkers in pediatric patients, when combining clinical expertise with culinary medicine education at teaching kitchens and gardens. Formal research studies are warranted to determine the program’s efficacy and effectiveness more robustly, in addition to the effect of the culinary medicine components, per se, independent of a clinical pediatric obesity program.In 2019, the AdventHealth Health and Wellness Advisory Board and the AdventHealth Culinary Medicine Governance Board were established. These boards have representation from multiple disciplines and departments including high level administration, medical providers, population health, media relations, consumer marketing, and employee health and wellbeing.The shared aims of these boards are to help align nutrition education programming across the AdventHealth Central Florida system and beyond; clearly project the organization’s stance on health and wellness to the community; streamline resources and maximize program reach; and attract local and national partners for long-term financial support and program sustainability. Whole person health with a focus on healthy lifestyles over a lifetime is a major goal at AdventHealth. These boards will continue to provide a vehicle for successful collaboration between AdventHealth departments and facilitate the development of appropriate, evidence-based messaging in health and wellness to the community.The AdventHealth Culinary Medicine Governance Board curriculum subcommittee developed a major advance in culinary medicine programming, the “AdventHealth Culinary Medicine Curriculum Guide”. This guide provides clarity on the vision, goals, and philosophical approach for nutrition and cooking education classes for the intended audiences of the AdventHealth Central Florida community. Both general “back-to-basics” cooking and gardening classes as well as disease-specific classes with emphasis on chronic disease prevention and treatment are included. The guide also includes extensive reviews of evidence-based support for curricula, overarching and guiding principles, the culinary medicine curricula consensus, and asset mapping that includes partner gardens, farms, teaching kitchens, and a recipe database.Continued multi-departmental collaboration between the participants on the AdventHealth Health and Wellness Advisory Board and the Culinary Medicine Governance Board, in conjunction with AdventHealth Press, developed several community resources.During the COVID-19 pandemic, a digital cookbook entitled “Plant-Powered Recipes to Help You Feel Whole”, was created and provided to the hospital community and patients free of charge . The plaA series of books was also developed under the title “Eat Plants Feel Whole”. This includes an educational trade book with 50 plant-based recipes and an accompanying journal to personalize the patient health and wellness journey . The thiwww.PlantWiseFilm.com; accessed on 25 September 2023) was developed to inform viewers about the transformative, life-changing power of a plant-based diet while following six patients with chronic diseases on their journeys towards renewed vitality. Included is commentary from 18 lifestyle medicine experts from 14 medical specialties. It is being utilized by hospitals and healthcare systems, companies for employee wellness, medical schools for physician and allied health training, and physician private practices.The documentary film entitled PlantWise . The difference between processed and unprocessed whole foods is examined and nutritional connections are drawn between eating different parts of a plant . Participants step virtually into the culinary garden, learning about the journey food takes from seed to table and several whole food, plant-based recipes are made together.Session 2 discusses food groups and flavor techniques. The lead garden educator discusses which foods are growing in the current season and introduces composting, drawing parallels between the microorganisms of a garden to that of the human body. For the culinary portion of this session, the focus is on knife skills for seasonal root vegetables and cooking techniques . Educators encourage participants to taste and adjust flavors as needed when cooking to build autonomy in the kitchen.Session 3 discusses sugar science and desserts. Participants are introduced to forms of sugar found naturally in foods and discuss what sugar-added foods are. The impact of different cooking or preparation techniques and how they interact with sugar is demonstrated, such as caramelizing vegetables and freezing bananas. Participants also openly discuss food choices and preferences. In this session, the beauty of food is celebrated, taking time to plate dishes and practice awareness through an observation-based mindful eating activity.The in-person session provides a space for participants to connect with one another while preparing a Mediterranean-style meal together. Participants practice knife skills that were previously described in virtual sessions, recognize flavor additives and techniques to enhance flavor, follow recipes that use general cooking and preparation techniques, and identify how values influence daily choices around food and health.Plans to expand opportunities for physicians, residents and medical students are currently underway.Employees who participated in EEE programming between 2021 and 2022 were surveyed before and after completing the sessions described above. One hundred and sixty-two employees completed the survey prior to entering the program and 28–52 employees completed the survey after the program ended, varying by survey. Changes in confidence, likelihood, and influences of preparing whole food, plant-based meals are shown in The percentage of participants who felt somewhat and/or very confident in his or her ability to design and prepare a balanced plant-based meal, choose nutritious foods, identify the difference between unprocessed and processed food, identify foods growing in the garden, incorporate seasonal foods into meals, and identify a whole grain and refined grain increased following participation in the employee series. Additionally, the number of participants who felt confident using a kitchen knife and other tools while preparing a meal also increased.The percentage of participants who were likely to prepare a new recipe, eat plant-based meals cooked at home, engage in conversations about food choices, and share cooking skills or knowledge increased following program participation. Furthermore, the percentage of participants who placed high importance on cost, nutritional value, taste, environmental impact, social impact, locally grown produce, calorie density, and seasonality for influencing food choices also increased.Employee participation in culinary medicine programming improved confidence and likelihood for healthy meal preparation. These findings should be systematically assessed with validated surveys and scientifically tested in future research to confirm the role of teaching kitchens and culinary gardens in improving employee health and wellness.Value-based care is increasingly becoming a central tenet of healthcare systems in the United States. The partnership between the AH and EEE teams at the Kitchen House and Culinary Garden to form programming integrated into the pediatric and employee wellness practice at AdventHealth may provide promising lessons for extension to the hospital system at large. The successful collaboration between hospital systems and teaching kitchens and culinary gardens can add value for patients within their community. There are several ways that hospitals and teaching kitchen programs can mutually support each other to provide sustainable programming that meets each organization’s community needs.Providing access to experts in various health-related fields, including medicine , psychologists, dietitians, and educators. Experiential seed-to-table experiences in combination with a didactical component in culinary medicine are effective in actively engaging participants .Providing expertise in data acquisition, outcome development, and research methods for demonstrating the efficacy and effectiveness of their program to the scientific community.Providing teaching models for healthy lifestyles.Providing medical leadership for the collaborative development of an evidence-based culinary medicine curriculum.Providing financial resources, such as working with hospital foundations or assisting with obtaining community grants.Providing support through the organization’s governance or advisory boards.Hospital systems can support teaching kitchens and culinary gardens by:Providing research and learning “laboratories” as locations for the early determination of effective interventions in culinary medicine .Providing access to culinary experts including garden and culinary educators, chefs, gardeners, and farmers.Providing effective seed-to-table teaching models for culinary and garden education while empowering the community to make healthy food choices.Providing culinary and garden leadership and expertise in the collaborative development of an evidence-based culinary medicine curriculum.Providing a platform for increased community engagement.Providing program flexibility, including a safe outdoor meeting space, well-ventilated indoor kitchen, and virtual programming in times of public health crises such as the recent COVID-19 pandemic.Teaching kitchens and culinary gardens can support hospital systems by:The recent White House National Strategy on Hunger, Nutrition, and Health, released in 2022, demonstrates federal support for ending hunger, promoting health, and reducing diet-related diseases in Americans . This naCulinary medicine, including teaching kitchens and culinary gardens, is an emerging field with the potential for changing how healthcare systems interact with their communities. Organizations should be encouraged to integrate culinary medicine into clinical practice, particularly in areas such as pediatric obesity management, wherein learning culinary skills at a young age may promote access to and knowledge of healthy eating behaviors that will continue into adulthood. Future priorities include expanding culinary medicine programming within the context of whole person care beyond pediatric obesity medicine; engaging physicians/medical providers, and trainees through education opportunities; investigating the feasibility of incorporating the teaching kitchen and culinary garden into shared medical appointments ; and formally evaluating the efficacy and effectiveness of the programs for pediatric obesity prevention and treatment as well as employee wellness.Teaching kitchens and culinary gardens extend the culture of health and wellness beyond the hospital and clinical walls in which food is used to heal and restore wellbeing. Collaboration among gardeners, chefs, architects, educators, and healthcare professionals can transfer traditional physician-driven care to patients, empowering and equipping them with the tools, knowledge, resources, and confidence to actively promote health and wellbeing for themselves. Hospital systems should consider integrating culinary medicine programming into their practice by forging community partnerships that include teaching kitchens and culinary gardens integrated as “shared assets” into their own campuses . Impleme