Highlights • This research provides a rich description of caring. • Patients experienced caring when competent professionals communicated effectively. • They did so also, when professionals formed ...relationships, engaged emotionally, and displayed positive attitudes. • These findings could underpin education for collaborative, interprofessional practice.
This paper describes a magnetic power split device integrated with a brushless permanent-magnet machine, which acts as a magnetic continuously variable transmission. It employs an atypical ...configuration of magnetic gear which facilitates integration. Nevertheless, 2-D and 3-D finite-element analyses and tests on a prototype have shown that such a device can exhibit a high torque density and a high efficiency. Furthermore, potential applications in hybrid vehicles and wind turbines are also discussed.
Today's Food Industry is a world met with customers with a right-now mentality and increased expectations for special orders. Every day has become a battle of continuous improvement in order to meet ...customer satisfaction. In the past year alone, including pre-COVID-19, eleven of eighteen limited-service category restaurants have seen a decline in customer satisfaction. The greatest challenge is a lack of inventory. Nearly seventy percent of freight in America is distributed though the trucking industry, and there are not enough drivers to meet scheduling demand and deliver inventories. This paper examines the impact of the continuing truck driver shortage, and offers suggestions for ways that it may be alleviated. We also focus on how one very large, national fast-food chain has taken its own steps to address this situation as well as the impact of the coronavirus on all aspects of the supply chain. Benefits and limitations of these approaches are offered, along with exploring the notion that Ecommerce and last-mile Distribution Centers may be the answer for the future.
Pfizer Ireland Ringaskiddy is the new product launch site for the global Pfizer network, but as well as new products, the site manufactures an array of both on- and off-patent active pharmaceutical ...ingredients (APIs). Chemistry is at the forefront of the site, and the Chemistry Centre of Excellence (COE) within Ringaskiddy hosts a wealth of experience and knowledge, with a strong female representation in both process and technical chemist roles. There is a continual focus on process robustness across the site. Green Belt (GB) projects focus on resolving and eliminating process deviations using Six Sigma tools by a cross-functional team. This article will focus on three GB projects on two different APIs manufactured at Ringaskiddy which were led by female process chemists.
Objectives/Hypothesis
To produce a sustained reduction in opioid prescriptions in patients <5 years of age undergoing T&A through utilization of standardized algorithms and electronic health record ...(EHR) automation tools.
Study Design
Prospective quality improvement initiative.
Methods
Plan‐do‐study‐act (PDSA) methodology was used to design an age‐based postoperative pain regimen in which children <5 years of age received a non‐opioid pain regimen, and option to prescribe oxycodone for additional pain relief was given for children >5 years of age. Standardized discharge instructions and automated, age‐specific order sets were created to facilitate adherence. Rate of discharge opioid prescription was monitored and balanced against post‐discharge opioid prescriptions and returns to the emergency department (ED).
Results
In children <5 years of age undergoing T&A, reduction in opioid prescription rates from 65.9% to 30.9% after initial implementation of the order set was noted. Ultimately, reduction of opioid prescribing rates to 3.7% of patients was noted after pain‐regimen consensus and EHR order set implementation. Opioid prescriptions in patients >5 years of age decreased from 90.6% to 58.1% initially, and then down 35.9% by the last time point analyzed. Requests for outpatient opioid prescriptions did not increase. There was no significant change in returns to the emergency ED for pain management, or in the number opioids prescribed when patients returned to the ED.
Conclusions
Iterative cycles of improvement utilizing standardized pain management algorithms and EHR tools were effective means of producing a sustained reduction in opioid prescriptions in postoperative T&A patients. Such findings suggest a framework for similar interventions in other pediatric otolaryngology settings.
Level of Evidence
4 Laryngoscope, 131:E2337–E2343, 2021
Burning mouth syndrome (BMS) is a neuropathic pain disorder associated with a burning sensation on oral mucosal surfaces with frequently reported xerostomia, dysgeusia and tingling or paraesthetic ...sensations. However, patients present no clinically evident causative lesions. The poor classification of the disorder has resulted in a diagnostic challenge, particularly for the clinician/dentist evaluating these individuals. Major research developments have been made in the BMS field in recent years to address this concern, principally in terms of the pathophysiological mechanisms underlying the disorder, in addition to therapeutic advancements. For the purpose of this review, an update on the pathophysiological mechanisms will be discussed from a neuropathic, immunological, hormonal and psychological perspective. This review will also focus on the many therapeutic strategies that have been explored for BMS, including antidepressants/antipsychotics, non‐steroidal anti‐inflammatories, hormone replacement therapies, phytotherapeutic compounds and non‐pharmacological interventions, overall highlighting the lack of controlled clinical studies to support the effectiveness of such therapeutic avenues. Particular focus is given to the cannabinoid system and the potential of cannabis‐based therapeutics in managing BMS patients.
Burning mouth syndrome (BMS) is a neuropathic pain disorder associated with a burning sensation on oral mucosal surfaces. Although still poorly understood, it is believed to be a multifactorial disease with four underlying pathophysiological mechanisms: neuropathic, immunological, hormonal and psychological. Due to its complexity, there is no cure and current treatments lack efficacy. In this context, cannabis‐based therapeutics may present a potential therapeutic alternative for BMS.
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The thiolation of polyallylamine (PAAm) for use in mucoadhesive drug delivery has been achieved. PAAm was reacted with different ratios of Traut’s reagent, yielding products with ...thiol contents ranging from 134–487μmol/g. Full mucoadhesive characterisation of the thiolated PAAm samples was conducted using swelling studies, mucoadhesive testing on porcine intestinal tissue and rheology. Both swelling and cohesive properties of the thiolated PAAm products were vastly improved in comparison to an unmodified PAAm control. The swelling abilities of the thiolated samples were high and the degree of thiolation of the products affected the initial rate of swelling. High levels of mucoadhesion were demonstrated by the thiolated PAAm samples, with adhesion times of greater than 24h measured for all three samples and, thus, thiol content did not appear to influence mucoadhesion. Rheological studies of the thiolated PAAm samples showed an increase in G′ and G″ values upon the addition of a mucin solution which was not observed in the unmodified control, again highlighting the mucoadhesive interactions between these thiolated polymers and mucin. The synthesis of thiolated PAAm by reaction with Traut’s reagent and resulting mucoadhesive properties demonstrates its potential for use a mucoadhesive drug delivery device.
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Synthetic polymers, polyacrylic acid (PAA) and polyallylamine (PAAm), were thiolated using different methods of thiolation. Both polymers resulted in comparable thiol contents, thus ...allowing for the direct comparison of mucoadhesive and cohesive properties between the well-established thiolated PAA and the more novel thiolated PAAm. Thiolation of both polymers improved the swelling ability and the cohesive and mucoadhesive properties in comparison to unmodified control samples. In this study, it was shown that the swelling abilities of the thiolated PAAm sample were far greater than that of the thiolated PAA sample which, in turn, affected the drug release profile of the thiolated PAAm sample. Importantly, however, the mucoadhesive properties of thiolated PAAm were equivalent to that of the thiolated PAA sample as demonstrated by both the adhesion times on porcine intestinal tissue as measured by the rotating cylinder method and by rheological studies with a mucin solution. This study demonstrates the potential thiolated polyallylamine has as a mucoadhesive drug delivery device.
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