Inflammation-driven malnutrition: a new screening tool predicts outcome in Crohn's disease.

Malnutrition is a frequent feature in Crohn's disease (CD), affects patient outcome and must be recognised. For chronic inflammatory diseases, recent guidelines recommend the development of combined malnutrition and inflammation risk scores. We aimed to design and evaluate a new screening tool that combines both malnutrition and inflammation parameters that might help predict clinical outcome. In a prospective cohort study, we examined fifty-five patients with CD in remission (Crohn's disease activity index (CDAI) <200) at 0 and 6 months. We assessed disease activity (CDAI, Harvey-Bradshaw index), inflammation (C-reactive protein (CRP), faecal calprotectin (FC)), malnutrition (BMI, subjective global assessment (SGA), serum albumin, handgrip strength), body composition (bioelectrical impedance analysis) and administered the newly developed 'Malnutrition Inflammation Risk Tool' (MIRT; containing BMI, unintentional weight loss over 3 months and CRP). All parameters were evaluated regarding their ability to predict disease outcome prospectively at 6 months. At baseline, more than one-third of patients showed elevated inflammatory markers despite clinical remission (36·4 % CRP ≥5 mg/l, 41·5 % FC ≥100 µg/g). Prevalence of malnutrition at baseline according to BMI, SGA and serum albumin was 2-16 %. At 6 months, MIRT significantly predicted outcome in numerous nutritional and clinical parameters (SGA, CD-related flares, hospitalisations and surgeries). In contrast, SGA, handgrip strength, BMI, albumin and body composition had no influence on the clinical course. The newly developed MIRT was found to reliably predict clinical outcome in CD patients. This screening tool might be used to facilitate clinical decision making, including treatment of both inflammation and malnutrition in order to prevent complications.

Residential long-term care: public solutions to access and quality problems.

Residential long-term care in Canada is characterized by unequal access and quality problems largely due to inadequate public funding and regulation, commercial involvement and its exclusion from medicare. Programs are patchwork, with variations across provinces in the availability of services, level of public funding, eligibility criteria and out-of-pocket costs borne by residents. Most provinces have cut long-term care bed capacity relative to the senior population in the past decade, without sufficiently expanding home and community care or adequately increasing staffing to reflect the higher acuity of the remaining residents. As a result, care is often rushed and underfunded, with poor working conditions leading to poor quality of care and quality of life for residents. This relationship between workers' and residents' well-being is well documented but poorly addressed. Also well researched but rarely reported are the negative impacts of privatization, at all levels: financing, ownership, management and delivery. This article describes the state of residential long-term care in Canada and proposes three policy directions: creating a pan-Canadian long-term care program, improving quality and reversing privatization.

Environmental cleaning and healthcare-associated infections.

The authors of "Healthcare-Associated Infections as Patient Safety Indicators" correctly identify healthcare-associated infections (HAIs) as a growing problem with severe consequences. In contrast to most literature, their article acknowledges the importance of environmental cleaning. The paper presents credible reasons why HAIs are treated as lesser threats than other adverse events. It also appropriately emphasizes prevention and calls for multiple interventions, including reducing occupancy rates. This commentary provides additional evidence of the critical role of environmental cleaning and posits that the devaluation of cleaning and other support services lies at the heart of governments' and administrators' inadequate response to HAIs. Staff cuts and contracting out are both a motivating factor and a consequence of this devaluation. The commentary concludes with recommendations.

Full Polymer Dielectric Elastomeric Actuators (DEA) Functionalised with Carbon Nanotubes and High-K Ceramics.

Dielectric elastomer actuators (DEA) are special devices which have a simple working and construction principle and outstanding actuation properties. The DEAs consist of a combination of different materials for the dielectric and electrode layers. The combination of these layers causes incompatibilities in their interconnections. Dramatic differences in the mechanical properties and bad adhesion of the layers are the principal causes for the reduction of the actuation displacement and strong reduction of lifetime. Common DEAs achieve actuation displacements of 2% and a durability of some million cycles. The following investigations represent a new approach to solving the problems of common systems. The investigated DEA consists of only one basic raw polymer, which was modified according to the required demands of each layer. The basic raw polymer was modified with single-walled carbon nanotubes or high-k ceramics, for example, lead magnesium niobate-lead titanate. The development of the full polymer DEA comprised the development of materials and technologies to realise a reproducible layer composition. It was proven that the full polymer actuator worked according to the theoretical rules. The investigated system achieved actuation displacements above 20% regarding thickness, outstanding interconnections at each layer without any failures, and durability above 3 million cycles without any indication of an impending malfunction.