From book to bedside: putting evidence to use in the care of the elderly.

BACKGROUND: Infusion of research findings into clinical practice is a challenging part of the research process. Because the length of time between discovery and use of knowledge averages 20 years, methods are needed to speed translation of research findings into practice. Few efforts have been made to coordinate the generation of new knowledge with the dissemination of findings from research to improve care of the elderly. RESEARCH-BASED PRACTICE PROTOCOLS: The Research Development and Dissemination Core (RDDC) of the Gerontological Nursing Interventions Research Center (GNIRC) at the University of Iowa emphasizes development of research-based (RB) protocols, which requires collecting relevant literature, critiquing studies, and synthesizing research findings for practice. GNIRC-generated research is disseminated to nurses in practice, and the RDDC links nurses who identify clinical problems in care of the elderly with GNIRC scientists. Currently, 19 RB protocols are offered for dissemination through the RDDC, and 5 protocols are under development. Implementation and evaluation of research-based practices on "Split Thickness Skin Graft Donor Site Care" and "Nasogastric/Nasointestinal Tube Placement" are described. CONCLUSIONS: Lessons learned on the basis of experience in disseminating and implementing research-based practices include the necessity of tailoring them to the local needs of various clinical settings in which they are used, reinfusing them periodically to keep staff motivated, and making them consumer friendly. The challenge remains to integrate these practices into the fiber of organizations and to keep staff educated and motivated to carry out research-based practices to improve the care of the elderly.     

Good clinical laboratory practice (GCLP): the need for a hybrid of good laboratory practice and good clinical practice guidelines/standards for medical testing laboratories conducting clinical trials in developing countries.

There has been a significant increase in the number of clinical drug trials (particularly phase III) being conducted in developing countries for infectious diseases such as HIV, malaria, and tuberculosis. Laboratory results provided by medical testing laboratories in the region are critical to ensuring the safety of patients and the generation of good quality data. A number of well accepted Good Clinical Practice (GCP) and Good Laboratory Practice (GLP) guidelines govern the conduct of clinical trials internationally. Good Clinical Practice guidelines remain too vague with respect to sample analysis to ensure practical implementation in these laboratories. In their strictest sense, Good Laboratory Practice guidelines refer to the analysis of samples from non-clinical studies. A specific set of minimum standards or requirements for practical implementation of clinical trial requirements in medical testing laboratories in the developing world is urgently required.     

Anticoagulation,delivered dose and outcomes in CRRT: The program to improve care in acute renal disease (PICARD)

Delivered dialysis dose by continuous renal replacement therapies (CRRT) depends on circuit efficacy, which is influenced in part by the anticoagulation strategy. We evaluated the association of anticoagulation strategy used on solute clearance efficacy, circuit longevity, bleeding complications, and mortality. We analyzed data from 1740 sessions 24 h in length among 244 critically ill patients, with at least 48 h on CRRT. Regional citrate, heparin, or saline flushes was variably used to prevent or attenuate filter clotting. We calculated delivered dose using the standardized Kt/V_urea. We monitored filter efficacy by calculating effluent urea nitrogen/blood urea nitrogen ratios. Filter longevity was significantly higher with citrate (median 48, interquartile range [IQR] 20.3–75.0 hours) than with heparin (5.9, IQR 8.5–27.0 hours) or no anticoagulation (17.5, IQR 9.5–32 hours, P < 0.0001). Delivered dose was highest in treatments where citrate was employed. Bleeding complications were similar across the three groups (P = 0.25). Compared with no anticoagulation, odds of death was higher with the heparin use (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.02–3.32; P = 0.033), but not with citrate (OR 1.02 95% CI 0.54–1.96; P = 0.53). Relative to heparin or no anticoagulation, the use of regional citrate for anticoagulation in CRRT was associated with significantly prolonged filter life and increased filter efficacy with respect to delivered dialysis dose. Rates of bleeding complications, transfusions, and mortality were similar across the three groups. While these and other data suggest that citrate anticoagulation may offer superior technical performance than heparin or no anticoagulation, adequately powered clinical trials comparing alternative anticoagulation strategies should be performed to evaluate overall safety and efficacy.     

From speculation to reality: Enhancing anticipatory ethics for emerging technologies (ATE) in practice

Various approaches have emerged over the last several decades to meet the challenges and complexities of anticipating and responding to the potential impacts of emerging technologies. Although many of the existing approaches share similarities, they each have shortfalls. This paper takes as the object of its study Anticipatory Ethics for Emerging Technologies (ATE) to technology assessment, given that it was formatted to address many of the privations characterising parallel approaches. The ATE approach, also in practice, presents certain areas for retooling, such as how it characterises levels and objects of analysis. This paper results from the work done with the TechEthos Horizon 2020 project in evaluating the ethical, legal, and social impacts of climate engineering, digital extended reality, and neurotechnologies. To meet the challenges these technology families present, this paper aims to enhance the ATE framework to encompass the variety of human processes and material forms, functions, and applications that comprise the socio-technical systems in which these technologies are embedded.     

Parameter extraction applied to the de-doping of PEDOT:PSS (poly(3,4-ethylenedioxythiophene):poly(styenesulphonate)) thermoelectrics

A recent report suggested that de-doping (reducing the volume of the dopants) could improve the figure-of-merit of PEDOT:PSS (poly(3,4-ethylenedioxythiophene):poly(styenesulphonate)) thermoelectrics through a simultaneous decrease in the thermal conductivity and an increase in the electrical conductivity. While this had been shown to increase the values of ZT, better understanding on the physics would be desirable. This work analyzed the transport data reported by Kim et al. (Nat Mater 12:719–723, 2013) on PEDOT:PSS and evaluated the changes in the materials parameters during de-doping. Our results showed that moderate de-doping had the effect of increasing the carrier mobility while at the same time it decreased somewhat the carrier density. Matching the mobilities computed from the thermal and electrical conductivity data and from theory allowed us to evaluate the width of the density of states σ, the values of the site spacing a′ and the localization length L for a known value of the escape frequency ν_ph. As observed, both L and a′ increased moderately with de-doping while their ratio L/a′ also increased from 0.44 to 0.55 over the ethylene glycol treatment range (up to 200 min). This suggested that de-doping not only reduced the PSS volume and the film thickness but also brought about improvement in the charge transport. The computed value of σ was amazingly small (only ~3.8 meV) contributing to the better thermoelectric performance.     

Federal efforts to improve quality of care: the Quality Interagency Coordination Task Force (QuIC)

FORMATION OF THE QUIC: The Quality Interagency Coordination Task Force (QuIC) was established in 1998 to enable the participating federal agencies to coordinate their activities to study, measure, and improve the quality of care delivered by federal health programs; provide people with information to help them in making more informed choices about their care; and develop the research base and infrastructure needed to improve the health care system, including knowledgeable and empowered workers, well-designed systems of care, and useful information systems. STUDY, MEASURE, AND IMPROVE CARE: The QuIC's initial efforts to improve the care delivered in federal health care programs have focused on diabetes, depression, and the effect of working conditions on quality of care. More recently, patient safety efforts are under way to establish a coordinating center that will enable those who are testing methods of reducing errors to share information across their projects and with experts in error reduction. DEVELOP A RESEARCH BASE AND INFRASTRUCTURE: The QuIC has coordinated efforts in credentialing, information on measures of quality, a taxonomy of quality improvement methods, and errors data collection. PROVIDE INFORMATION TO AMERICANS ABOUT HEALTH CARE QUALITY: The QuIC agencies are developing products that will enhance their ability to communicate with the American people about their health care choices: improved gateways for consumer information available from federal agencies, a glossary of commonly used terms, and guidance for producing report cards on quality of care. MOVING THE QUALITY IMPROVEMENT AGENDA FORWARD: Federal efforts to improve quality of care are moving forward in a more integrated fashion on a wide number of fronts.     

Health technology diffusion: Case of remote patient monitoring (RPM) for the care of senior population

Increase in population is causing further increase in senior population which is the major cost factor in health care. Health information technology has been cited as one of the tools to help reduce this cost for this group of patients. Therefore, our study explores strategies and policies helping reduce the barriers for the adoption of a health information technology – teleconsultation – for senior population. The objective of this research is to develop a model to evaluate alternative solutions to increase the adoption of Remote Patient Monitoring (RPM) for the senior population. The research leverages hierarchical decision modeling (HDM) to build a hierarchical multi criteria assessment model. The model elements are derived through literature and validated by an expert panel.     

Ferrocene adsorbed into the porous octakis(hydridodimethylsiloxy)silsesquioxane after thermolysis in tetrahydrofuran media: An applied surface for ascorbic acid determination

Octakis(hydridodimethylsiloxi)silsesquioxane (Q₈M₈^H) was synthesized and Ferrocene was adsorbed in a polymeric net through electrostatic interactions, with anion forming after the cleavage of any siloxy groups (ESFc). The nanostructured materials (Q₈M₈^H and EsFc) were characterized by Fourier transform infrared spectra (FT-IR), nuclear magnetic resonance (NMR), X-ray diffraction (XRD), Thermogravimetric analyses and Voltammetric technique The cyclic voltammograms of the graphite paste electrode modified with ESFc showed one redox couple with E⁰′ = 0.320 V (1.0 mol L^?1 NaCl, v = 50 mV s^?1), with a diffusion-controlled process and the redox process shows electrocatalytic activity for the oxidation of ascorbic acid.     

The unified interaction model applied to LiF:Mg,Ti (TLD-100): properties of the luminescent and competitive centres during sensitisation

An attempt is made to predict/interpret theoretically the experimentally measured values of f(D) and S(Ds)/So for composite peak 5 in TLD-100. using the Unified Interaction Model (UNIM) with identical values of the UNIM parameters for both sets of experimental data. Although an excellent fit can be obtained to the experimental f(D) data over the entire dose region where f(D) is greater than unity. i.e. from 5 Gy to several thousand Gy, a satisfactory fit to both sets of data is found to require different values for at least one of the parameters. The lack of success in fining f(D) and S(Ds)/So with the same values of all the parameters, suggests that the sensitisation anneal (particularly the duration of the anneal) may somehow change the structure (S(LC)) and/or the total number of available LCs in an unknown manner.     

Determination of the performance and damage to asphalt of bio-sourced asphalt release agents (ARAs) part I: developing test methods

The objective of this study is to develop testing methods of asphalt release agent (ARA) performance and the degree to which they may damage the asphalt. The testing of ARA performance demonstrated their ability to reduce the adhesion between the asphalt and the surface of steel (asphalt tools, truck beds…) by the asphalt slide test, which provided two indicators for quantifying performance. The testing of the their damage to asphalt consisted of the measurement of the degree to which the compacted asphalt is damaged by the ARA including CBR resistance, indirect-tensile strength and bitumen degradation testing, the latter also serving as a test to find the most effective bitumen remover (BR). For asphalt degradation, the indirect tensile strength test provided more consistent results than CBR resistance.     

Electron spectroscopy (UPS(HeI and II) and metastable impact electron spectroscopy (MIES)) applied to molecular surfaces: the interaction of atoms and molecules with solid water

We report studies of the interaction of atoms and molecules with solid molecular surfaces, water in particular, by combining photoelectron spectroscopy, UPS with HeI and II, and metastable impact electron spectroscopy (MIES). In MIES charge exchange processes of the Auger-type taking place between metastable He atoms and the surface under study are utilized to gain information on their electronic structure. The MIES spectra give a rather direct image of the surface DOS. We concentrate on the following processes taking place on water films produced at 80 K:(1) Interaction of Na Atoms with Amorphous Solid H₂O Films: emphasis was on the role of the 3sNa electrons in the water dissociation process. In order to make a detailed comparison with density functional theory (DFT), DOS (density of states) information is compared with the MIES spectra. Our results are consistent with the theoretical prediction that the 3s-electron is delocalized from the Na-core and trapped (solvated) between the Na-core and water molecules of the surrounding water shell.(2) Ionization and Solvation of NaCl Interacting with Amorphous Solid Water: at 90 K there is no interpenetration of H₂O and NaCl. However, ionic dissociation of NaCl takes place when H₂O and NaCl are in direct contact. At 105 K the solvation of the ionic species Cl⁻ and Na⁺ becomes significant. The desorption of H₂O from the mixed film takes place between 145 and 170 K; those species bound ionically to Na⁺ and Cl⁻ are removed last.(3) The Interaction of PBTs (persistent, bio-accumulative, and toxic substances), chlorobenzene and chlorophenyl, with amorphous solid water: the organic layers produced at 80 K were annealed up to 200 K under in situ control of MIES and UPS. The different behaviour of the interfaces for the three studied cases is traced back to the different mobilities of the molecules with respect to that of water. The interaction between H₂O and the benzene derivatives is discussed on the basis of qualitative free energy profiles.     

Misfit accomodation in epitaxial monolayers on (111) f.c.c. and (110) b.c.c. substrates II: Analytical approach to monolayers in the Nishiyama-Wassermann orientation

In this paper we analyse the stability of (111) f.c.c. ultrathin — of the order of one monolayer-overlayers in the Nishiyama-Wassermann orientation on (110) b.c.c. substrates as a function of lattice parameters and bonding, using a model which has been improved in two respects compared with Part I: the generalization of isotropy in the monolayer to anisotropy and an increase in the number of Fourier terms representing the periodic adsorbate-substrate interaction potential. Analytical tractability required the introduction of constraints which prohibit the determination of the exact conditions for stability. The essential outcome of the theory is the phase boundaries separating the regions of different misfit accomodation modes between overlayer and substrate. Although the model is not an exact representation of the physical system and the analysis is not quantitatively exact either, the predictions should act as excellent guidelines in the search for the properties of such systems.     

Scientometric research assessment in the developing world: A tribute to Michael J. Moravcsik from the perspective of the twenty-first century

Scientometrics - Proceeding from Moravcsik’s paradigmatic ideas of how to build indigenous capability and sustainable science systems in developing countries, we attempted to further focus on...     

Progress in developing spray-drying methods for the production of controlled morphology particles: From the nanometer to submicrometer size ranges

Control of particle size and morphology has increasingly captured the attention of researchers for decades. The exploration of unique sizes and shapes as they relate to various properties has become a great quest for large field applications. To meet these demands, this review covers recent developments in particle processing. An aerosol-assisted self-assembly technique, with a spray-drying method as a representative of it, to create particles is thoroughly reviewed. Its popularity and its broad use in industry for producing particles are the main reason of this review; thus, elucidation of this method is important for the improvement of particle technology. A practical spray-drying method is described from the step-by-step process to the selection of apparatus types (merits and demerits). Elaboration of particle processing of several morphologies (sphere, doughnut, encapsulated, porous, hollow, and hairy) is discussed in terms of the selection of material types, the addition of supporting materials, and the change of process conditions. Controllable size is also discussed in terms of the adjustment of the droplet size, initial precursor concentration, and the addition of specific techniques. A comparison between a theoretical mechanism and current experimental results (over a 15-year period) are shown to clarify how particles with various sizes and morphologies are designed. This method must be considered an art rather than a science because of its advantages in creating wonderful and unique particle shapes. The performance of various particle morphologies is also demonstrated, which is essential for an understanding of the importance that shape can exert on practical use. Because the method outlined here can be broadly applied to the production of various types of functional materials, we believe that this report contributes new information to the field of chemical, material, environmental, and medical engineering.     

Fictitious notch rounding concept applied to sharp V-notches: Evaluation of the microstructural support factor for different failure hypotheses. Part I: Basic stress equations

With the aim to perform a comprehensive and accurate evaluation of the microstructural support factor of sharp V-notches (Neuber’s notch rounding concept), in Part I of this contribution, the indispensable theoretical tools, especially the basic stress equations, are reconsidered and amended in respect of accuracy of results. First, the analytical solution derived by Neuber [Neuber H. Kerbspannungslehre. 2nd ed. Berlin: Springer-Verlag; 1958] for sharp rounded V-notches with an arbitrary flank angle under tension loading is considered. The equation of the normal stress has been obtained with the restriction to the notch bisector. Using the Airy stress function suggested by Neuber, this solution is extended to the region outside the notch bisector, and the complete stress field is derived in this manner. A comparison between Neuber’s solution, a more recent solution due to Filippi et al. [Filippi S, Lazzarin P, Tovo R. Developments of some explicit formulas useful to describe elastic stress fields ahead of notches in plates. Int J Solids Struct 2002;39:4543-65] and highly accurate FE results is performed. Filippi’s equations which include Williams’ solution [Williams ML. Stress singularities resulting from various boundary conditions in angular corners on plates in tension. J Appl Mech 1952;19:526-8] for pointed V-notches, are shown to be superior.     

Comparison of the characteristics of a plasma generated by a d.c. arc plasmatron and a high-voltage a.c. plasmatron with rail-shaped electrodes (gliding arc) as applied to the synthesis of carbon nanomaterials

Comparative results of investigating the parameters of plasmas generated by atmospheric-pressure electric-arc plasmatrons of two types operating in the regime of simultaneous partial oxidation of hydrocarbons and their pyrolysis, have been given. It has been established by spectral and thermophysical measurements that the component composition of the plasma and its thermal characteristics at exit from a d.c. plasmatron significantly differ from the parameters of a plasmatron of the second type — an a.c. plasmatron with rail-shaped electrodes of the gliding-arc type. The temperature nonequilibrium and the presence of the carbon dimers C₂ in the plasma (in the absence of the monomer C) generated by the rail-shaped-electrode plasmatron point to the fact that realization of the synthesis of fullerene-containing particles and, probably, particles containing nanotubes is, in principle, possible in reactors based on it, just as in more energy-intensive reactors with low-voltage d.c. arc plasmatrons. __________ Translated from Inzhenerno-Fizicheskii Zhurnal, Vol. 79, No. 4, pp. 3–11, July–August, 2006.