Description of an advanced practice nursing consultative model to reduce restrictive siderail use in nursing homes

Researchers have demonstrated that the use of physical restraints in nursing homes can be reduced, particularly where advanced practice nurses (APNs) are utilized. We examined the link between APN practice, siderail reduction, and the costs of siderail alternatives in 273 residents in four Philadelphia nursing homes. The majority of participants were cognitively and physically impaired with multiple co-morbidities. APNs recommended a total of 1,275 siderail-alternative interventions aimed at reducing fall risk. The median cost of siderail alternatives to prevent falls per resident was $135. Residents with a fall history experienced a significantly higher cost of recommendation compared to non-fallers. Findings suggest that an APN consultation model can effectively be implemented through comprehensive, individualized assessment without incurring substantial costs to the nursing home.     

硝苯地平膜控型控释微丸的制备及体外评价

目的研究硝苯地平(NF)膜控型24 h控释微丸的处方与工艺,并考察其体外释放特性。方法采用液相层积、丸芯上药法制备载药速释微丸,以Eudragit RL100、RS100为包衣材料,流化床悬浮包衣法制备膜控型控释微丸,并对影响微丸释放的处方因素进行了考察。通过与市售渗透泵片拜新同的体外释放度的对比研究,探讨硝苯地平膜控型控释微丸的体外释药特征。结果调整Eudragit RL100、RS100的比例、衣层厚度、致孔剂的用量,可以改变药物的释放速率。当Eudragit RL100、RS100的比例为3∶7,包衣增重为6%时,制备的控释微丸体外释药与市售渗透泵片相似(f2=62.8),具有良好的零级释放特性。结论以丸芯上药法,Eudragit RL100、RS100为控释材料制备的NF膜控型控释微丸,具有良好的零级释放特性,结果可为硝苯地平多单元控释制剂的研究开发提供参考。     

Distribution of AMPA receptor subunit glur1 in the bed nucleus of the stria terminalis and effect of stress

The brain circuitry thought to be involved in stress responses includes several nuclei of the extended amygdala. The bed nucleus of the stria terminalis (BNST) is thought to be involved in the generation of sustained, nonspecific anxiety. Previous behavioral and electrophysiological experiments demonstrate that glutamate systems are involved in anxiety‐like behaviors in the BNST. Antagonists for AMPA receptors injected into the BNST decrease anxiety‐like behaviors. However, little is known about the role of AMPA receptors and the mechanism by which they act in the establishment of anxiety‐like behavior in response to a stressor. We hypothesized that the distribution of AMPA receptors is changed following a paradigm of unpredictable footshock as has been seen in the basolateral amygdala (BLA). We examined the subcellular localization of the GluR1 subunits of the AMPA receptor. We found that the neuropil of the BNST had a lower density of dendritic spines compared to dendritic shafts in the BLA. The majority of elements immunolabeled for GluR1 were dendritic shafts and spines with axonal and glial elements rarely labeled. Compared with controls, no significant effect was observed on days 1, 6, or 14 poststress. However, there was a trend for an increase at 6 and 14 days poststress. These data demonstrate that GluR1 subunits are primarily located on postsynaptic elements in the BNST. Moreover, it was shown that the response of the AMPA GluR1 subunit does not undergo a significant migration into spines from dendrites in response to a stressor as has been demonstrated in the BLA. Synapse 68:194–201, 2014 . Published 2014     

Hardening Slurries with Fluidized-Bed Combustion By-Products and Their Potential Significance in Terms of Circular Economy

Hardening slurries (water-bentonite-binder mixtures) constitute a well-established material used broadly, i.a., for cut-off walls in civil and water engineering. Although they usually contain Portland cement, similar to common concrete, their properties differ greatly, mostly due to a much higher water content. This characteristic of hardening slurries creates unique opportunities for the utilization of significant quantities of industrial by-products that are deemed problematic in the concrete industry. This article investigates the effect of the addition of by-products of fluidized-bed combustion of hard, brown coal and municipal sewage sludge, as well as ground granulated blast furnace slag, on the properties of slurries. Unconfined compressive strength tests, as well as mercury porosimetry, scanning electron microscopy, and X-ray diffraction analyses were performed. The results suggest that it is possible to design hardening slurry mixes of desired properties, both in liquid and solid state, containing at least 100–300 kg/m³ of industrial waste. This includes cement-free slurries based entirely on industrial by-products as binders. In addition, the analyzed slurries exhibited good chemical resistance to landfill eluates, at the same time effectively immobilizing heavy metals. It was concluded that hardening slurry technology can ensure the safe deposition of significant amounts of waste that would be otherwise difficult to manage, thus contributing to the circular economy concept.     

Process–Structure–Property Relationships of Copper Parts Manufactured by Laser Powder Bed Fusion

The process–structure–property relationships of copper laser powder bed fusion (L-PBF)-produced parts made of high purity copper powder (99.9 wt %) are examined in this work. A nominal laser beam diameter of 100 μm with a continuous wavelength of 1080 nm was employed. A wide range of process parameters was considered in this study, including five levels of laser power in the range of 200 to 370 W, nine levels of scanning speed from 200 to 700 mm/s, six levels of hatch spacing from 50 to 150 μm, and two layer thickness values of 30 μm and 40 μm. The influence of preheating was also investigated. A maximum relative density of 96% was obtained at a laser power of 370 W, scanning speed of 500 mm/s, and hatch spacing of 100 μm. The results illustrated the significant influence of some parameters such as laser power and hatch spacing on the part quality. In addition, surface integrity was evaluated by surface roughness measurements, where the optimum Ra was measured at 8 μm ± 0.5 μm. X-ray photoelectron spectroscopy (XPS) and energy-dispersive X-ray spectroscopy (EDX) were performed on the as-built samples to assess the impact of impurities on the L-PBF part characteristics. The highest electrical conductivity recorded for the optimum density-low contaminated coils was 81% IACS.     

Influence of Different Alloying Strategies on the Mechanical Behavior of Tool Steel Produced by Laser-Powder Bed Fusion

Additive manufacturing is a high-potential technique that allows the production of components with almost no limitation in complexity. However, one of the main factors that still limits the laser-based additive manufacturing is a lack of processable alloys such as carbon martensitic hardenable tool steels, which are rarely investigated due to their susceptibility to cold cracking. Therefore, this study aimed to expand the variety of steels for laser powder bed fusion (L-PBF) by investigating an alternative alloying strategy for hot work tool steel powder. In this study, a comprehensive investigation was performed on the powder and L-PBF processed specimen properties and their correlation with the existing defects. Cubical specimens were created using the following two alloying strategies by means of L-PBF: conventional pre-alloyed gas-atomized powder and a mixture of gas-atomized powder with mechanically crushed pure elements and ferroalloys. The influence of the particle parameters such as morphology were correlated to the defect density and resulting quasi-static mechanical properties. Micromechanical behavior and damage evolution of the processed specimens were investigated using in situ computed tomography. It was shown that the properties of the L-PBF processed specimens obtained from the powder mixture performs equal or better compared to the specimens produced from conventional powder.     

军队大型综合性医院床位规模效益实证分析

目的分析我国军队大型综合性医院床位规模效益,指导医院改革。方法描述性分析我国20多年来大型综合性医院床位规模现状,运用对我国军队6所大型综合性医院床位规模效益进行分析。结果军队大型综合性医院总体效率较高,但存在投入过多或产出不足,导致部分医院低效率。结论随着社会经济的不断发展,医院床位规模的增长成为必然趋势。医院应根据区域卫生规划、病床的使用情况等因素调整规模。     

Protruded and nonprotruded subungual exostosis: Differences in surgical approach

Background:

In subungual exostosis surgery, repair of the damaged nail bed and surgical excision of the mass without damaging the nail bed is important. The ideal method of surgery is still unclear. This study is done to qualify the effects of different surgical methods on outcome measures in different types of subungual exostosis.

Materials and Methods:

Fifteen patients, operated with a diagnosis of subungual exostosis between January 2008 and June 2012, were evaluated. Protruded masses were excised with a dorsal surgical approach after the removal of the nail bed and nonprotruded masses were excised through a“fish-mouth” type of incision.

Results:

The mean age of the patients in protruded subungual exostosis group was 17.3 years (range 13-22 years) and this group consisting of seven female and two male patients. The patients were followed up for a mean of 14.1 ± 4.8 months. The mean age of the patients in the nonprotruded subungual exostosis group was 14.6 years (range 13-16 years) and consisting of six female patients. The patients were followed up for a mean of 11.6 ± 2.9 months. The results were positively affected by changing the surgical approach depending on whether or not the exostosis is protruded from the nail bed. All patients had healthy toe nails in the postoperative period without any signs of recurrence.

Conclusions:

In patients with a protruded subungual exostosis, the mass should be removed by a dorsal approach with the removal of the nail and injury to the nail bed should be repaired. In patients with a nonprotruded subungual exostosis, the mass should be excised through a “fish-mouth” type incision at the toe tip without an iatrogenic damage.     

Human skeletal muscle fiber type percentage and area after reduced muscle use: A systematic review and meta-analysis

The main objective of this systematic review was to examine the effect of reduced muscle activity on the relative number of type 1 muscle fibers (%) in the human vastus lateralis muscle. Other objectives were changes in type 2A and 2X percentages and muscle fiber cross-sectional area. We conducted systematic literature searches in eight databases and included studies assessing type 1 fiber percentage visualized by ATPase or immunohistochemical staining before and after a period (≥14 days) of reduced muscle activity. The reduced muscle activity models were detraining, leg unloading, and bed rest. Forty-two studies comprising 451 participants were included. Effect sizes were calculated as the mean difference between baseline and follow-up and Generic Inverse Variance tests with random-effects models were used for the weighted summary effect size. Overall, the mean type 1 muscle fiber percentage was significantly reduced after interventions (−1.94%-points, 95% CI [−3.37, −0.51], P = .008), with no significant differences between intervention models (P = .86). Meta-regression showed no effect of study duration on type 1 fiber percentage (P = .98). Conversely, the overall type 2X fiber percentage increased after reduced muscle activity (P < .001). The CSA of the muscle fiber types decreased after the study period (all P-values < 0.001) with greater reductions in type 2 than type 1 fibers (P < .001). The result of this meta-analysis display that the type 1 muscle fiber percentage decrease as a result of reduced muscle activity, although the effect size is relatively small.     

Adaptive radiation therapy of breast cancer by repeated imaging during irradiation

Breast cancer is the most frequent cancer among females and also a leading cause of cancer related mortality worldwide. A multimodality treatment approach may be utilized for optimal management of patients with combinations of surgery, radiation therapy (RT) and systemic treatment. RT composes an integral part of breast conserving treatment, and is typically used after breast conserving surgery to improve local control. Recent years have witnessed significant improvements in the discipline of radiation oncology which allow for more focused and precise treatment delivery. Adaptive radiation therapy (ART) is among the most important RT techniques which may be utilized for redesigning of treatment plans to account for dynamic changes in tumor size and anatomy during the course of irradiation. In the context of breast cancer, ART may serve as an excellent tool for patients receiving breast irradiation followed by a sequential boost to the tumor bed. Primary benefits of ART include more precise boost localization and potential for improved normal tissue sparing with adapted boost target volumes particularly in the setting of seroma reduction during the course of irradiation. Herein, we provide a concise review of ART for breast cancer in light of the literature.