Tissue integration is an important property when inducing transplant tolerance, however, the hemocompatibility of the biomaterial surface also plays an important role in the ultimate success of the ...implant. Therefore, in order to induce transplant tolerance, it is critical to understand the interaction of blood components with the material surfaces. In this study, we have investigated the adsorption of key blood serum proteins, in vitro adhesion and activation of platelets and clotting kinetics of whole blood on flat polycaprolactone (PCL) surfaces, nanowire (NW) surfaces and nanofiber (NF) surfaces. Previous studies have shown that polymeric nanostructured surfaces improve cell adhesion, proliferation and viability; however it is unclear how these polymeric nanostructured surfaces interact with the blood and its components. Protein adsorption results indicate that while there were no significant differences in total albumin (ALB) adsorption on PCL, NW and NF surfaces, NW surfaces had higher total fibrinogen (FIB) and immunoglobulin-G (IgG) adsorption compared to NF and PCL surfaces. In contrast, NF surfaces had higher surface FIB and IgG adsorption compared to PCL and NW surfaces. Platelet adhesion and viability studies show more adhesion and clustering of platelets on the NF surfaces as compared to PCL and NW surfaces. Platelet activation studies reveal that NW surfaces have the highest percentage of unactivated platelets, whereas NF surfaces have the highest percentage of fully activated platelets. Whole blood clotting results indicate that NW surfaces maintain an increased amount of free hemoglobin during the clotting process compared to PCL and NF surface, indicating less clotting and slower rate of clotting on their surfaces.
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Dental utilization patterns and costs of providing comprehensive oral healthcare for older adults in different settings have not been examined.
Retrospective longitudinal cohort data from Apple Tree ...Dental (ATD) were analyzed (N = 1,159 total; 503 outpatients, 656 long-term care residents) to describe oral health status at presentation, service utilization patterns, and care costs. Generalized estimating equation (GEE) repeated measures analysis identified significant contributors to service cost over the three-year study period.
Cohort mean age was 74 years (range = 55-104); the outpatient (OP) group was younger compared to the long-term care (LTC) group. Half (56%) had Medicaid, 22% had other insurance, and 22% self-paid. Most (72%) had functional dentitions (20+ teeth), 15% had impaired dentitions (9-19 teeth), 6% had severe tooth loss (1-8 teeth), and 7% were edentulous (OP = 2%, LTC = 11%). More in the OP group had functional dentition (83% vs. 63% LTC). The number of appointments declined from 5.0 in Year 1 (OP = 5.7, LTC = 4.4) to 3.3 in Year 3 (OP = 3.6, LTC = 3.0). The average cost to provide dental services was $1,375/year for three years (OP = $1,427, LTC = $1,336), and costs declined each year, from an average of $1,959 (OP = $2,068, LTC = $1,876) in Year 1 to $1,016 (OP = $989, LTC = $1,037) by Year 3. Those with functional dentition at presentation were significantly less costly than those with 1-19 teeth, while edentulous patients demonstrated the lowest cost and utilization. Year in treatment, insurance type, dentition type, and problem-focused first exam were significantly associated with year-over-year cost change in both OP and LTC patients.
Costs for providing comprehensive dental care in OP and LTC settings were similar, modest, and declined over time. Dentate patients with functional dentition and edentulous patients were less costly to treat. LTC patients had lower utilization than OP patients. Care patterns shifted over time to increased preventive care and decreased restorative care visits.
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Farm habitat enrichment is crucial for sustainable production of pollinator-dependent crops. Correct choice of crop and non-crop plant species in habitat management support resilient pollinator fauna ...and effective pollination service delivery. We identify key network metrices to recognize suitable crop and non-crop plant species for farm habitat enrichment. We also highlight the importance of seasonal variation of the key plant and pollinator species that will crucially inform farm management. Crop species played a key role in maintaining plant–pollinator network integrity. In contrast to the conventional practice of focussing on non-crop plants for pollination service restoration, we find crop plants across seasons hold a key role in maintaining healthy plant–pollinator networks. Our study highlights the importance of non-bee pollinators especially, flies and butterflies in sustaining healthy plant–pollinator network. Bees were important as connector species and controlled other species in the network. Only 16.67% bees and 33.33% of plant species acted as connector species. Our study also shows that the identity of connector species in a plant–pollinator network can change drastically across seasons.
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34.
Nursing Care Smith, Barbara; Field, Linda
2020, 20190820, 2019, 2019-08-20, Volume:
3
eBook
This new edition of Nursing Care: An Essential Guide for Nurses and Healthcare Workers in Primary and Secondary Care is a comprehensive introductory textbook to nursing care for pre-registration ...nursing students and nursing associate students in the UK, and is relevant to other allied health students. This 'back to basics' edition is a concise, clear text on the essentials of nursing care which:
Comprehensively covers all aspects of essential care
Puts care into context and relates it to current UK government policy and targets
Shows how to apply theory in practice with diagrams and case studies
Provides opportunities to reflect on the theory and think critically on key issues
Explains clinical skills in the context of care
Includes features such as recap questions, points for debate, a glossary, further reading lists and a companion website to allow students to reinforce and expand their knowledge
Fully updated to address the latest Nursing and Midwifery Council and government policy, this new edition of Nursing Care: An Essential Guide for Nurses and Healthcare Workers in Primary and Secondary Care is designed to help the student develop a proactive approach to the assessment, planning, implementation and evaluation of the care that they give. The invaluable advice can be applied to all branches of nursing and to all environments where patients are nursed, whether in hospital, at home or in care homes.
This book is essential reading for nursing students, qualified nurses and all health and social care workers.
Native plant species are routinely planted or sown in ecological restoration projects, but successful establishment and survival depend on where and how seeds are collected. Research suggests that it ...is important to use locally adapted seeds. Local populations often show a home-site advantage and non-local genotypes may be maladapted to local environmental conditions. Furthermore, intraspecific hybridisation of local and non-local genotypes may have a negative impact on the genetic structure of local populations via mechanisms such as outbreeding depression. Many species show a strong small-scale genetic differentiation between different habitats so that matching habitats of the restoration and donor site can be more important than minimizing geographical separation. It is a challenge to identify appropriate seed sources because strong small-scale population differentiation makes it difficult to delineate geographically defined seed zones to which seed exchange should be limited. Moreover, it is important to consider the genetic diversity of introduced material because it may be crucial to avoid genetic bottlenecks, inbreeding depression and poor establishment of plant populations. Repeated propagation in stock, which is often required to obtain a sufficient amount of seeds, can further reduce genetic diversity and may select for particular genotypes. Negative impacts of improper seed choice for nursery planting stock may become detectable only after many years, especially in long-lived and slow growing plants. Although scientific information on many species remains limited, the increasing demand for translocation of seed means that mandatory regulations are necessary. Guidelines should prescribe a specification of seed provenance, a record of genetic diversity of wild collections and rules for subsequent processing such as direct transfer and propagation of stock or seed orchards. We use a literature review to evaluate current legislation and to develop recommendations for herbaceous and woody species.
Es ist heute gängige Praxis, heimische Pflanzenarten zu Renaturierungszwecken auszubringen. Die erfolgreiche Etablierung hängt jedoch davon ab, wie und wo das Saat- oder Pflanzgut gewonnen wurde. Forschungsergebnisse legen nahe, dass nur lokal angepasste Herkünfte eingesetzt werden sollten. Es ist vielfach festgestellt worden, dass sie eine höhere Fitness als fremde Herkünfte besitzen, und letztere sind daher schlecht an lokale Umweltbedingungen angepasst. Eine intraspezifische Hybridisierung mit gebietsfremden Populationen kann weiterhin einen negativen Einfluss auf die genetische Struktur von lokalen Populationen haben wie z.B. outbreeding depression. Einige Arten zeigen eine starke kleinräumige genetische Differenzierung zwischen verschiedenen Habitaten, so dass die Übereinstimmung von Spender- und Renaturierungsflächen wichtiger sein kann als eine minimale Entfernung. Diese kleinräumige Differenzierung macht es schwierig, geographische Regionen festzulegen, innerhalb derer ein Austausch von Pflanzenmaterial unbedenklich ist. Darüber hinaus muss die genetische Diversität des gesammelten und eingeführten Materials berücksichtigt werden, um genetische Flaschenhälse, Inzuchtdepression und eine geringe Etablierungsrate zu vermeiden. Eine wiederholte Kultivierung und Vermehrung von Pflanzenarten, die oft notwendig ist, um eine ausreichende Samenmenge zu produzieren, kann zu einer weiteren Reduktion der genetischen Diversität beitragen oder zu einer Selektion bestimmter Genotypen führen. Negative Auswirkungen einer ungeeigneten Auswahl von Herkünften werden insbesondere bei langlebigen und langsam wachsenden Arten häufig erst nach vielen Jahren feststellbar. Angesichts des wachsenden Bedarfs an Wildpflanzensaatgut sind verbindliche Regelungen notwendig, auch wenn die Datenlage für viele Arten immer noch unzureichend ist. Diese Richtlinien sollten Vorgaben zur Herkunft und Diversität des Saatgutes bei der Sammlung am natürlichen Standort machen und die nachfolgende Prozesskette von der Saatgutreinigung und Lagerung über die Vermehrung bis hin zur Ausbringung regeln. Unter Verwendung von Literaturdaten bewerten wir die gegenwärtige Gesetzgebung und entwickeln Empfehlungen sowohl für krautige Pflanzen als auch für Gehölze.
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Diagnostic tests in resource-limited settings require technologies that are affordable and easy to use with minimal infrastructure. Colorimetric detection methods that produce results that are ...readable by eye, without reliance on specialized and expensive equipment, have great utility in these settings. We report a colorimetric method that integrates a paper-based immunoassay with a rapid, visible-light-induced polymerization to provide high visual contrast between a positive and a negative result. Using Plasmodium falciparum histidine-rich protein 2 as an example, we demonstrate that this method allows visual detection of proteins in complex matrices such as human serum and provides quantitative information regarding analyte levels when combined with cellphone-based imaging. It also allows the user to decouple the capture of analyte from signal amplification and visualization steps.
To determine whether breast cancer subtype is associated with outcome after breast-conserving therapy (BCT) consisting of lumpectomy and radiation therapy.
We studied 793 consecutive patients with ...invasive breast cancer who received BCT from July 1998 to December 2001. Among them, 97% had pathologically negative margins of resection, and 90% received adjuvant systemic therapy. No patient received adjuvant trastuzumab. Receptor status was used to approximate subtype: estrogen receptor (ER) or progesterone receptor (PR) positive and human epidermal growth factor receptor 2 negative = luminal A; ER+ or PR+ and HER-2+ = luminal B; ER-and PR -and HER-2+ = HER-2; and ER-and PR -and HER-2-= basal. Competing risks methodology was used to analyze time to local recurrence and distant metastases.
Median follow-up was 70 months. The overall 5-year cumulative incidence of local recurrence was 1.8% (95% CI, 1.0 to 3.1); 0.8% (0.3, 2.2) for luminal A, 1.5% (0.2, 10) for luminal B, 8.4% (2.2, 30) for HER-2, and 7.1% (3.0, 16) for basal. On multivariable analysis (MVA) with luminal A as baseline, HER-2 (adjusted hazard ratio AHR = 9.2; 95% CI, 1.6 to 51; P = .012) and basal (AHR = 7.1; 95% CI, 1.6 to 31; P = .009) subtypes were associated with increased local recurrence. On MVA, luminal B (AHR = 2.9; 95% CI, 1.3 to 6.5; P = .007) and basal (AHR = 2.3; 95% CI, 1.1 to 5.2; P = .035) were associated with increased distant metastases.
Overall, the 5-year local recurrence rate after BCT was low, but varied by subtype as approximated using ER, PR, and HER-2 status. Local recurrence was particularly low for the luminal A subtype, but was less than 10% at 5 years for all subtypes. Although further follow-up is needed, these results may be useful in counseling patients about their anticipated outcome after BCT.
Advancing High-Quality Preschool Inclusion Barton, Erin E.; Smith, Barbara J.
Topics in early childhood special education,
08/2015, Volume:
35, Issue:
2
Journal Article
Peer reviewed
Although considerable progress has been achieved regarding the research and laws supporting preschool inclusion, access to inclusive preschool environments remains intangible for many children with ...disabilities in the United States. The purpose of this article is to discuss current challenges and solutions to high-quality preschool inclusion. We use the conceptual framework identified in the Division for Early Childhood (DEC)/National Association for the Education of Young Children (NAEYC) inclusion position statement to promote solutions to support high-quality inclusion and the success of all children. We provide conceptual and empirical support for preschool inclusion and outline recommendations to the field.
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BACKGROUND:Nipple-sparing mastectomy is increasingly used for treatment and prevention of breast cancer. Few data exist on risk factors for complications and reconstruction outcomes.
METHODS:A ...single-institution retrospective review was performed between 2007 and 2012.
RESULTS:Two hundred eighty-five patients underwent 500 nipple-sparing mastectomy procedures for breast cancer (46 percent) or risk reduction (54 percent). The average body mass index was 24, and 6 percent were smokers. The mean follow-up was 2.17 years. Immediate breast reconstruction (reconstruction rate, 98.8 percent) was performed with direct-to-implant (59 percent), tissue expander/implant (38 percent), or autologous (2 percent) reconstruction. Acellular dermal matrix was used in 71 percent and mesh was used in 11 percent. Seventy-seven reconstructions had radiotherapy. Complications included infection (3.3 percent), skin necrosis (5.2 percent), nipple necrosis (4.4 percent), seroma (1.7 percent), hematoma (1.7 percent), and implant loss (1.9 percent). Positive predictors for total complications included smoking (OR, 3.3; 95 percent CI, 1.289 to 8.486) and periareolar incisions (OR, 3.63; 95 percent CI, 1.850 to 7.107). Increasing body mass index predicted skin necrosis (OR, 1.154; 95 percent CI, 1.036 to 1.286) and preoperative irradiation predicted nipple necrosis (OR, 4.86; 95 percent CI, 1.0197 to 23.169). An inframammary fold incision decreased complications (OR, 0.018; 95 percent CI, 0.0026 to 0.12089). Five-year trends showed increasing numbers of nipple-sparing mastectomy with immediate reconstruction and more single-stage versus two-stage reconstructions (p < 0.05).
CONCLUSIONS:Nipple-sparing mastectomy reconstructions have a low number of complications. Smoking, body mass index, preoperative irradiation, and incision type were predictors of complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, III.
Alternating current (AC) electrolysis is receiving increased interest as a versatile tool for mild and selective electrochemical transformations. This work demonstrates that AC can enable the concept ...of a stirring‐free electrochemical reactor where the periodic switch of electrode polarity, inherent to AC, provides uniform electrolysis across the whole volume of the reactor. Such design implies a straightforward approach for scaling up electrosynthesis. This was demonstrated on the range of electrochemical transformations performed in three different RVC‐packed reactors on up to a 50‐mmol scale. Redox‐neutral, oxidative, and reductive processes were successfully implemented using the suggested design and the applicable frequency ranges were further investigated for different types of reactions. The advantages of the AC‐enabled design – such as the absence of stirring and a maximized surface area of the electrodes – provide the possibility for its universal application both for small‐scale screening experimentation and large‐scale preparative electrosynthesis without significant optimization needed in between.
The use of alternating current enables the concept of a stirring‐free batch reactor, where the periodic switch of electrode polarity provides uniform electrolysis throughout the reactor volume. The AC‐derived design implies a straightforward approach for scaling up electrosynthesis from parallel screening experiments to large‐scale preparative electrolysis.
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