ABA triblock copolymers are used as thermoplastic elastomers (TPEs) for a wide variety of applications. Herein, we describe incorporation of sugar-based glassy components to create sustainable ...triblock copolymers as alternatives for commodity TPEs. Poly(glucose-6-acrylate-1,2,3,4-tetraacetate) PGATA and poly(acetylated acrylic isosorbide) PAAI end blocks were chain-extended from a poly(n-butyl acrylate) PnBA midblock. PAAI–PnBA–PAAI exhibited excellent adhesion properties: peel = 8.74 N cm–1, loop tack = 2.96 N cm–2, no shear failure up to 100 h, and shear adhesion failure temperature (SAFT) = 60 °C. Although similar peel adhesion and higher loop tack were observed for PGATA–PnBA–PGATA, the shear strength and SAFT were moderate (18 h and 42 °C, respectively). PAAI–PnBA–PAAI are tough elastomers and demonstrated high stress and elongation at break (σ = 6.5 MPa and ε = 620%, respectively) while the GATA-based analogue exhibited weaker tensile properties (σ = 0.8 MPa and ε = 476%). To address this, the anomeric hydroxyl groups of GATA units were selectively deprotected to promote self-complementary hydrogen bonding in the glassy domains, resulting in 80% enhancement in the ultimate tensile stress at break (σ = 1.5 MPa). This study aims to demonstrate effects of noncovalent interactions, such as chain entanglements and self-complementary hydrogen bonding, to enhance the adhesion and mechanical performance of sugar-derived TPEs.
Postoperative pancreatic fistula (POPF) remains the major cause of morbidity after pancreatic resection, affecting up to 41% of cases. With the recent development of a consensus definition of POPF, ...there has been a large number of reports examining various risk factors, prediction models, and mitigation strategies for this costly complication. Despite these strategies, the rates of POPF have not significantly diminished. Here, we review the literature and evidence regarding both traditional and emerging concepts in POPF prediction, prevention, and management. In particular, we review the evidence for the association between postoperative pancreatitis and POPF, and present a novel proposed mechanism for the development of POPF.
Fluorescence detection is employed in high-performance liquid chromatography (HPLC) due to its high specificity and sensitivity. However, it is often limited by expensive components and bulkiness. ...Recently, advances in technology and electronics have led to the development of smartphones that can serve as portable recording, analysis, and monitoring tools. Smartphone-based detection provides advantages of cost effectiveness, rapid signal/data processing, and the display of results on a handhold monitor. The combination of smartphone-based detection with HPLC can offer unique features that are beneficial in overcoming limitations of commercial fluorescence detectors. (90)
A miniaturized and low-cost HPLC fluorescence detector based on a smartphone is introduced for the detection of six fluorescent molecules. The smartphone is able to capture emitted fluorescence in video format while MATLAB code is used for data processing to provide chromatograms based on different detection channels. A custom designed double-channel flow cell was utilized to enable simultaneous detection of fluorescent compounds with different excitation wavelengths. The detector consists of a lab-made flow cell, monochromatic LEDs as the light source, 3D printed housing and connector box, fiber optic cables, and a smartphone. The effects of flow cell geometry, channel width and light slit diameter, as well as a comparison of different flow cell manufacturing techniques, are studied and discussed. The validated system was successfully applied to samples from diverse water sources, yielding spiking recoveries within the range of 91.7% and 109.7%. (141)
This study introduces the first smartphone-based fluorescence detector for HPLC with cost-effective and customizable flow cells, allowing for the simultaneous detection of fluorescent compounds with different excitation wavelengths and offering a potential solution for the analysis of co-eluting compounds. Beyond its user-friendly interface and low-cost, smartphone detection in HPLC provides tremendous opportunities in further miniaturizing chromatographic instrumentation while offering high sensitivity and can be expanded to other mechanisms of detection. (70)
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•Smartphone fluorescence detector coupled to high performance liquid chromatography.•Smartphone captured emitted fluorescence of dye molecules in video format.•Flow cells were designed and constructed using computer numerical control milling.•MATLAB code used for data processing to give chromatograms for detection channels.•Double-channel flow cell enables analysis of co-eluting coumarin and rhodamine B dyes.
The Department of Veterans Affairs' (VA) electronic health records (EHR) offer a rich source of big data to study medical and health care questions, but patient eligibility and preferences may limit ...generalizability of findings. We therefore examined the representativeness of VA veterans by comparing veterans using VA healthcare services to those who do not.
We analyzed data on 3051 veteran participants age ≥ 18 years in the 2019 National Health Interview Survey. Weighted logistic regression was used to model participant characteristics, health conditions, pain, and self-reported health by past year VA healthcare use and generate predicted marginal prevalences, which were used to calculate Cohen's d of group differences in absolute risk by past-year VA healthcare use.
Among veterans, 30.4% had past-year VA healthcare use. Veterans with lower income and members of racial/ethnic minority groups were more likely to report past-year VA healthcare use. Health conditions overrepresented in past-year VA healthcare users included chronic medical conditions (80.6% vs. 69.4%, d = 0.36), pain (78.9% vs. 65.9%; d = 0.35), mental distress (11.6% vs. 5.9%; d = 0.47), anxiety (10.8% vs. 4.1%; d = 0.67), and fair/poor self-reported health (27.9% vs. 18.0%; d = 0.40).
Heterogeneity in veteran sociodemographic and health characteristics was observed by past-year VA healthcare use. Researchers working with VA EHR data should consider how the patient selection process may relate to the exposures and outcomes under study. Statistical reweighting may be needed to generalize risk estimates from the VA EHR data to the overall veteran population.
The objective of this secondary analysis was to explore differences in baseline clinical characteristics and opioid replacement therapy treatment outcomes by type (heroin, opioid analgesic OA, or ...combined heroin and OA) and route (injector or non-injector) of opioid use.
A total of 1,269 participants (32.2% female) were randomized to receive one of two study medications (methadone or buprenorphine/naloxone BUP). Of these, 731 participants completed the 24-week active medication phase. Treatment outcomes were opioid use during the final 30 days of treatment (among treatment completers) and treatment attrition.
Non-opioid substance dependence diagnoses and injecting differentiated heroin and combined users from OA users. Non-opioid substance dependence diagnoses and greater heroin use differentiated injectors from non-injectors. Further, injectors were more likely to be using at end of treatment compared with non-injectors. OA users were more likely to complete treatment compared with heroin users and combined users. Non-injectors were more likely than injectors to complete treatment. There were no interactions between type of opioid used or injection status and treatment assignment (methadone or BUP) on either opioid use or treatment attrition.
Findings indicate that substance use severity differentiates heroin users from OA users and injectors from non-injectors. Irrespective of medication, heroin use and injecting are associated with treatment attrition and opioid misuse during treatment. These results have particular clinical interest, as there is no evidence of superiority of BUP over methadone for treating OA users versus heroin users.
Cap-assisted colonoscopy uses a transparent plastic hood attached to the tip of the colonoscope to flatten the semilunar folds and improve mucosal exposure. Several studies have examined the effect ...of cap-assisted colonoscopy on polyp detection, but the data are inconsistent.
This study aimed to evaluate whether cap-assisted colonoscopy improves the yield of colorectal neoplasia detected compared with standard colonoscopy.
A systematic search of the PubMed, MEDLINE, Embase, and Cochrane databases identified 12 studies that met the inclusion criteria for data extraction.
Publications that compared cap-assisted colonoscopy vs standard colonoscopy in adults in a prospective randomized controlled study were selected for review.
The primary outcomes used for meta-analysis were cecal intubation rate, cecal intubation time, and polyp detection rate. The analysis was performed using a fixed-effect model. Outcomes were calculated as odds ratios or standardized mean differences with 95% confidence intervals. The average polyp miss rate determined by tandem colonoscopy was also calculated.
The outcomes of 6185 patients were studied. Cap-assisted colonoscopy detected significantly more patients with polyps (OR 1.13; p = 0.030) and had a lower average polyp miss rate (12.2% vs 28.6%) than standard colonoscopy. Cap-assisted colonoscopy had a significantly higher cecal intubation rate than standard colonoscopy (OR 1.36; p = 0.020), whereas the time to cecal intubation (standard mean difference, 0.04 min; p = 0.280) was similar for the 2 colonoscope types.
Cap-assisted colonoscopy is associated with improved detection of colorectal neoplasia and higher cecal intubation rates than standard adult colonoscopy.
Buprenorphine effectively reduces opioid craving and illicit opioid use. However, some patients may not take their medication as prescribed and thus experience suboptimal outcomes. The study aim was ...to qualitatively explore buprenorphine adherence and the acceptability of utilizing video directly observed therapy (VDOT) among patients and their providers in an office-based program.
Clinical providers (physicians and staff; n = 9) as well as patients (n = 11) were recruited from an office-based opioid treatment program at an urban academic medical center in the northwestern United States. Using a semi-structured guide, interviewers conducted individual interviews and focus group discussions. Interviews were digitally recorded and transcribed verbatim. Transcripts were independently coded to identify key themes related to non-adherence and then jointly reviewed in an iterative fashion to develop a set of content codes.
Among providers and patients, perceived reasons for buprenorphine non-adherence generally fell into several thematic categories: social and structural factors that prevented patients from consistently accessing medications or taking them reliably (e.g., homelessness, transportation difficulties, chaotic lifestyles, and mental illness); refraining from taking medication in order to use illicit drugs or divert; and forgetting to take medication, especially in the setting of taking split-doses. Some participants perceived non-adherence to be less of a problem for buprenorphine than for other medications. VDOT was viewed as potentially enhancing patient accountability, leading to more trust from providers who are concerned about diversion. On the other hand, some participants expressed concern that VDOT would place undue burden on patients, which could have the opposite effect of eroding patient-provider trust. Others questioned the clinical indication.
Findings suggest potential arenas for enhancing buprenorphine adherence, although structural barriers will likely be most challenging to ameliorate. Providers as well as patients indicated mixed attitudes toward VDOT, suggesting it would need to be thoughtfully implemented.
The special series devoted to research on opioid use disorder (OUD) conducted in the National Institute on Drug Abuse Treatment Clinical Trials Network (CTN) and published in Addiction Science and ...Clinical Practice highlights the tremendous progress that the CTN has made over the past two decades in understanding and improving treatment for OUD. 1 summarizes the history and operations of the CTN, points out the shift in focus from studying OUD treatment solely in specialty substance use disorder treatment programs during the CTN’s early years to its nimble pivot to studying OUD treatment in a variety of health care settings including primary care and specialty care, the Emergency Department, and inpatient hospital wards. Because OUD often first manifests in adolescence or early adulthood, Bagley et al. ...as noted in passing above, we cannot ignore the fact that this series, while planned prior to any inkling of the appearance of a worldwide pandemic, was published at the height of the COVID-19 pandemic which colors every aspect of research on and treatment of OUD.
Abstract Objectives Prevalences of bile duct injury (BDI) following laparoscopic cholecystectomy (LC) remain unacceptably high. There is no standardized method for performing an LC. This study aims ...to describe a standardized technique for LC that will allow for the development of a concept LC checklist, the use of which, it is hoped, will decrease the prevalence of BDI. Methods A standardized method for LC was developed based on previously published expert analysis supplemented by video error analysis of operations in which BDI occurred. Established checklist methodology was then used to construct an LC-specific concept checklist. Results A five-step technique for the safe establishment of the critical view was created to guide the development of the checklist. The five steps are: (i) confirm the gallbladder lies in the hepatic principal plane and is retracted to the 10 o'clock position; (ii) confirm Hartmann's pouch is lifted up and toward the segment IV pedicle; (iii) identify Rouvière's sulcus; (iv) confirm the release of the posterior leaf of the peritoneum covering the hepatobiliary triangle, and (v) confirm the critical view with or without intraoperative cholangiography. Conclusions A standardized approach to LC would allow for the creation of an LC-specific checklist that has the potential to lower the prevalence of BDI.
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