Meloxicam loaded hydroxypropyl methylcellulose (HPMC) microparticulate: Fabrication, characterization and in vivo pharmacokinetic assessment.

Meloxicam (MEL) is an oxicam derivative with low water solubility that is useful in the treatment of colorectal cancer (CRC) as a COX-2 inhibitor. MEL-loaded HPMC micro particles were fabricated using an oil-in-oil (o/o) emulsion solvent evaporation (ESE) method. FTIR, XRD, particle size analysis, DSC, SEM and in vitro dissolution investigation were utilized to evaluate the produced micro particles physiochemically. Finally, rabbits were used as animal models in an in vivo pharmacokinetic study to assess the MEL concentration in the plasma of rabbits. Pure MEL, F1 and F2 were given to rabbits by a single dose for in vivo pharmacokinetic investigations. The XRD and DSC results confirmed the transformation of MEL from its crystalline nature to the amorphous state in micro particles. The formulations F1 and F2 particle sizes were determined 92.43µm and 163.26µm, respectively. The prepared micro particles had a smooth, non-porous and spherical surface. In comparison to the pure drug (22.4%), the F1 and F2 cumulative drug release (%) was 86.19% and 79.57%, respectively. Pure MEL, F1 and F2 have estimated Cmax values of 7.21, 25.41 and 22.38µg/mL, respectively. MEL had a half-life of 19.98 hours, which rose to 22.19 hours and 24.75 hours for F1 and F2, respectively. MEL, F1 and F2 had AUC0-α values of 116.034, 445.95 and 462.72µg/mL*h, respectively. Considering these aspects, MEL-loaded HPMC micro particles may have the potential to better the delivery and control the release of drug that is not easily dissolved in water which could lead to improved therapeutic efficacy and limited side effects.

Evaluation of anti-inflammatory and analgesic effects of Hertia intermedia (Boiss.) Kuntze extract.

Hertia intermedia is a traditional medicinal plant of Balochistan, used for pain management and stomach problems. Current research work was intended to evaluate the anti-inflammatory and analgesic activities of crude ethanolic extract of H. intermedia. Anti-inflammatory activity was determined by the carrageenan-induced and histamine-induce Rat paw edema in rats, analgesic activity was determined by acetic acid-Induced writhing test, formalin-induced hind paw licking in mice and Tail immersion test. H. intermedia crude ethanolic extract showed significant (p<0.05) effect in both carrageenan and histamine-induced rat paw edema at both 250 and 500 mg/kg oral doses. There were significant analgesic activities in comparison with standard drug and control (p<0.05). It is concluded that H. intermedia crude ethanolic extract possesses significant anti-inflammatory and analgesic effects. However further studies may be carried out to isolate the phytochemicals responsible for anti-inflammatory and analgesic activities.

Chemical Gas Sensors: Recent Developments, Challenges, and the Potential of Machine Learning-A Review.

Nowadays, there is increasing interest in fast, accurate, and highly sensitive smart gas sensors with excellent selectivity boosted by the high demand for environmental safety and healthcare applications. Significant research has been conducted to develop sensors based on novel highly sensitive and selective materials. Computational and experimental studies have been explored in order to identify the key factors in providing the maximum active location for gas molecule adsorption including bandgap tuning through nanostructures, metal/metal oxide catalytic reactions, and nano junction formations. However, there are still great challenges, specifically in terms of selectivity, which raises the need for combining interdisciplinary fields to build smarter and high-performance gas/chemical sensing devices. This review discusses current major gas sensing performance-enhancing methods, their advantages, and limitations, especially in terms of selectivity and long-term stability. The discussion then establishes a case for the use of smart machine learning techniques, which offer effective data processing approaches, for the development of highly selective smart gas sensors. We highlight the effectiveness of static, dynamic, and frequency domain feature extraction techniques. Additionally, cross-validation methods are also covered; in particular, the manipulation of the k-fold cross-validation is discussed to accurately train a model according to the available datasets. We summarize different chemresistive and FET gas sensors and highlight their shortcomings, and then propose the potential of machine learning as a possible and feasible option. The review concludes that machine learning can be very promising in terms of building the future generation of smart, sensitive, and selective sensors.

Nurses Knowledge, Attitude, and Practices Toward Pain Assessment and Management of Patients Unable to Communicate Verbally.

Critically ill patients usually experience a significant level of pain during rest or during routine care such as turning, wound care, and endotracheal suctioning. Pain assessment is the cornerstone of pain management. Adequate pain assessment and management are major responsibilities of critical care nurses. The purpose of this study was to evaluate the nurses' knowledge, attitudes, and practices toward pain assessment and management of the intensive care unit (ICU) patients who are unable to communicate verbally. A descriptive cross-sectional design was used in this study. The study was conducted at ICUs in 5 hospitals from the north, middle, and south areas of Jordan. A self-administered questionnaire developed by Rose was used in this study. The most important finding in this study was that a large number of ICU nurses do not use assessment tools to evaluate the level of pain in patients who are unable to communicate verbally. Moreover, the nurses have inadequate knowledge about pain assessment and management. As perceived by the nurses, "restlessness" was the highest rated routine indicator of pain (25.1%), followed by "not following commands" (24%). Half of the participants (50%) answered that nurses were the persons who provide the most accurate rating of pain intensity. However, the participants showed positive attitude toward pain assessment and management.

Effect of noise and light levels on sleep of intensive care unit patients.

BACKGROUND: Previous studies emphasized that the noise and light levels in intensive care units (ICUs) exceeded the recommended levels by the World Health Organization and the Environmental Protection Agency. This might disturb patients' sleep in these units. AIMS AND OBJECTIVES: The aim of this study is to explore the effect of noise and light levels on the perceived quality of sleep (QOS) of patients in ICUs. DESIGN: A cross-sectional exploratory correlational design was used. METHODS: The noise and light levels were measured on an hourly basis from 10 pm to 6 am, and their impact on ICU patients' QOS was evaluated. RESULTS: The overall light level correlation with the overall QOS was statistically significant at an α level of .05, r (101) = - 0.35, P < .001. The Pearson correlation between the overall ICU nocturnal sound level and patients' overall perceived QOS was statistically significant at an α level of .05, r (101) = - 0.42, P < .001. CONCLUSION: The noise and light levels in the ICUs in the selected hospitals are higher than the recommended levels. High noise and light levels have a negative correlation with the patients' QOS. RELEVANCE TO CLINICAL PRACTICE: High levels of light and sound are associated with poor QOS among ICU patients.

Factors influencing sleep quality among Jordanian intensive care patients.

Sleep disturbance is common in patients in the intensive care unit (ICU). Numerous factors can contribute to this. High noise and light levels, nursing interventions and medication administration are major factors. This study investigated the demographic and environmental factors that might adversely affect ICU patients' quality of sleep. Data were collected from 103 patients using a demographic data sheet, the Freedman Quality of Sleep Scale and the Richards-Campbell Sleep Scale. Patients' demographic characteristics were found to have no significant effects on their perceived quality of sleep. Environmental factors, including noise, light, nursing interventions, diagnostic testing, the administration of medication, talking and phones ringing, were significantly related to the patients' perceived quality of sleep.

The effect of palliative care intervention program on the quality of life among Jordanian caregivers of cancer patients.

The purpose of this study was to evaluate the effect of palliative care intervention on the quality of life among Jordanian caregivers of cancer patients. Repeated measures design was used in this study. Data were collected from 137 Jordanian caregivers of cancer patients utilizing a self-administered questionnaire. An intervention program called SHARE was implemented to the experimental groups and its effectiveness in improving the overall quality of life for caregivers of cancer patients was evaluated using repeated measure ANOVA test. The results showed a statistically significant effect on the quality of life domains. For workshop experimental group (F = 26.822, p < .001) and for home visit experimental group (F = 10.236, p = .003).

Measurement and Nonpharmacologic Management of Sleep Disturbance in the Intensive Care Units: A Literature Review.

The general goal of this review is to summarize, clarify, and evaluate what is known about patients' sleep in the intensive care units (ICUs) in terms of sleep measurement and management. In addition, this review focuses on the gap in knowledge in this field. A review of online databases for relevant articles in the period between 2000 and 2017 was conducted. The results of this study indicate that there are several methods to measure patients' quality of sleep. Polysomnography and actigraphy are the most common standard objective and valid methods used to measure sleep disorders in the ICU. On the contrary, several subjective instruments are used such as the Richards-Campbell Sleep Scale, Verran Snyder Harper Sleep Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Sleep Efficiency Index. To improve patients' sleep in the ICU, various strategies are used internationally. These strategies include reducing the noise and light levels; using relaxation technique, meditation, hypnosis, earplugs, eye masks, relaxation music; and modifying the time of delivering nursing care.

Effectiveness of using eye mask and earplugs on sleep length and quality among intensive care patients: A quasi-experimental study.

AIM: This study aims to assess the effect of using a combination of eye mask and earplugs on the perceived quality of sleep among patients admitted to intensive care units. DESIGN: Control group, pretest and posttest, quasi-experimental design was used. METHODS: Data were collected from 103 intensive care patients in two governmental hospitals in Jordan. The participants were assigned either an experimental or a control group. The experimental group participants received routine care in the first night and used the eye mask and earplug during their sleep in the second night. Control group participants, on the other hand, received routine care only in both nights. The number of hours slept was reported by nurses, and the perceived quality of sleep was self-reported by participants using the Richards-Campbell Sleep Scale. RESULTS: Experimental group participants slept more hours and reported significantly better perceived quality of sleep after the use of eye mask and earplugs, as compared both with themselves in the first night and with control group participants. CONCLUSION: Combining eye masks and earplugs is effective in prolonging the sleep of intensive care patients and improving its quality.

Quality of Sleep Among Intensive Care Unit Patients: A Literature Review.

Investigating sleep disturbances among intensive care unit (ICU) patients and its serious consequences is considered a crucial issue for nurses. The need of sleep increases during hospitalization time to preserve energy for the healing process. Previous studies have demonstrated that sleep disturbance is one of the most common complaints of patients in the ICUs, with a prevalence of more than 50%. Although the total sleep time might be normal, the patients' sleep is fragmented and light in the intensive care settings. The main purpose of this review is to generate a clear view of what is known about sleep disturbances among ICU patients as well as to identify the gap in knowledge regarding this issue. This was done by describing, summarizing, clarifying, and evaluating well-selected previous studies about this topic. In addition, this concise review has focused on the prevalence of sleep disturbances in the ICU, factors contributing to poor quality of sleep among ICU patients, and the physiological effects of poor sleep on the patients' prognosis.

Fusobacterium nucleatum, inflammation, and immunity: the fire within human gut.

Fusobacterium nucleatum is an identified proinflammatory autochthonous bacterium implicated in human colorectal cancer. It is also abundantly found in patients suffering from chronic gut inflammation (inflammatory bowel disease), consequently contributing to the pathogenesis of colorectal cancer. Majority of the studies have reported that colorectal tumors/colorectal adenocarcinomas are highly enriched with F. nucleatum compared to noninvolved adjacent colonic tissue. During the course of multistep development of colorectal cancer, tumors have evolved many mechanisms to resist the antitumor immune response. One of such favorite ploy is providing access to pathogenic bacteria, especially F. nucleatum in the colorectal tumor microenvironment, wherein both (colorectal tumors and F. nucleatum) exert profound effect on each other, consequently attracting tumor-permissive myeloid-derived suppressor cells, suppressing cytotoxic CD8+ T cells and inhibiting NK cell-mediated cancer cell killing. In this review, we have primarily focused on how this bug modulates the immune response, consequently rendering the antitumor immune cells inactive.

Emerging tale of UPR and cancer: an essentiality for malignancy.

A set of cellular response to counter any alteration in homeostasis of a cell originating at endoplasmic reticulum is collectively termed as unfolded protein response (UPR). It initially is adaptive in nature as to restore cellular normalcy failing in course often activates pro-apoptotic signaling pathway resulting in cell death. UPR has emerged as an essential adaptation mechanism that cross talk with various cellular processes for cancer pathogenesis. Interestingly, it plays diverse role in plethora of signaling pathways instrumental in transformation, cell invasion, cell migration, metastasis, neovascularization, proliferation, and maintenance of energy metabolism of cancerous cells. In cancerous cells, it is triggered by change in microenvironment of a cell usually driven by hypoxia, acidosis, and nutrient deprivation, which often leads to positive selection pressure involving the reprogramming of energy metabolism which promotes channelization of limited metabolites into the hexosamine biosynthetic pathway (HBP). Substantial evidences suggest the role of UPR in oncogene (Myc, mTOR, RAS, HER2) driven cancer transformation and progression. In this review, we have comprehensively underlined the role played by UPR in adaptation, transformation, proliferation, invasion, and metastasis of cancerous cells.

Nonlinear-Based MEMS Sensors and Active Switches for Gas Detection.

The objective of this paper is to demonstrate the integration of a MOF thin film on electrostatically actuated microstructures to realize a switch triggered by gas and a sensing algorithm based on amplitude tracking. The devices are based on the nonlinear response of micromachined clamped-clamped beams. The microbeams are coated with a metal-organic framework (MOF), namely HKUST-1, to achieve high sensitivity. The softening and hardening nonlinear behaviors of the microbeams are exploited to demonstrate the ideas. For gas sensing, an amplitude-based tracking algorithm is developed to quantify the captured quantity of gas. Then, a MEMS switch triggered by gas using the nonlinear response of the microbeam is demonstrated. Noise analysis is conducted, which shows that the switch has high stability against thermal noise. The proposed switch is promising for delivering binary sensing information, and also can be used directly to activate useful functionalities, such as alarming.

Simple fall criteria for MEMS sensors: data analysis and sensor concept.

This paper presents a new and simple fall detection concept based on detailed experimental data of human falling and the activities of daily living (ADLs). Establishing appropriate fall algorithms compatible with MEMS sensors requires detailed data on falls and ADLs that indicate clearly the variations of the kinematics at the possible sensor node location on the human body, such as hip, head, and chest. Currently, there is a lack of data on the exact direction and magnitude of each acceleration component associated with these node locations. This is crucial for MEMS structures, which have inertia elements very close to the substrate and are capacitively biased, and hence, are very sensitive to the direction of motion whether it is toward or away from the substrate. This work presents detailed data of the acceleration components on various locations on the human body during various kinds of falls and ADLs. A two-degree-of-freedom model is used to help interpret the experimental data. An algorithm for fall detection based on MEMS switches is then established. A new sensing concept based on the algorithm is proposed. The concept is based on employing several inertia sensors, which are triggered simultaneously, as electrical switches connected in series, upon receiving a true fall signal. In the case of everyday life activities, some or no switches will be triggered resulting in an open circuit configuration, thereby preventing false positive. Lumped-parameter model is presented for the device and preliminary simulation results are presented illustrating the new device concept.

Theoretical prediction of experimental jump and pull-in dynamics in a MEMS sensor.

The present research study deals with an electrically actuated MEMS device. An experimental investigation is performed, via frequency sweeps in a neighbourhood of the first natural frequency. Resonant behavior is explored, with special attention devoted to jump and pull-in dynamics. A theoretical single degree-of-freedom spring-mass model is derived. Classical numerical simulations are observed to properly predict the main nonlinear features. Nevertheless, some discrepancies arise, which are particularly visible in the resonant branch. They mainly concern the practical range of existence of each attractor and the final outcome after its disappearance. These differences are likely due to disturbances, which are unavoidable in practice, but have not been included in the model. To take disturbances into account, in addition to the classical local investigations, we consider the global dynamics and explore the robustness of the obtained results by performing a dynamical integrity analysis. Our aim is that of developing an applicable confident estimate of the system response. Integrity profiles and integrity charts are built to detect the parameter range where reliability is practically strong and where it becomes weak. Integrity curves exactly follow the experimental data. They inform about the practical range of actuality. We discuss the combined use of integrity charts in the engineering design. Although we refer to a particular case-study, the approach is very general.

Design, simulation, and testing of a tunable MEMS multi-threshold inertial switch.

This paper presents a tunable multi-threshold micro-electromechanical inertial switch with adjustable threshold capability. The demonstrated device combines the advantages of accelerometers in providing quantitative acceleration measurements and g-threshold switches in saving power when in the inactive state upon experiencing acceleration below the thresholds. The designed proof-of-concept device with two thresholds consists of a cantilever microbeam and two stationary electrodes placed at different positions in the sensing direction. The adjustable threshold capability and the effect of the shock duration on the threshold acceleration are analytically investigated using a nonlinear beam model. Results are shown for the relationships among the applied bias voltage, the duration of shock impact, and the tunable threshold. The fabricated prototypes are tested using a shock-table system. The analytical results agree with the experimental results. The designed device concept is very promising for the classification of the shock and impact loads in transportation and healthcare applications.

Volar Locking Plating of Extra-articular Distal Radius Fracture: A Retrospective Clinical Study Comparing Locking Screws versus Smooth Locking Pegs.

Background Open reduction and internal fixation of distal radius fractures is one of the most common procedures performed in wrist surgery. The use of volar locking plate has gained increasing interest in the past decade. Epiphyseal fixation can be done either with locking screws or smooth locking pegs, with no evidence supporting the use of one rather than the other. Purpose The aim of this study is to compare the stability of distal radius fixation by volar locking plate using locking screws or smooth locking pegs. Methods Adult patients with A2-A3 AO fractures treated with a volar plate with locking screws only or smooth locking pegs only were retrospectively included. Radiographic assessment was performed to evaluate extra-articular parameters in the intraoperative postreduction and fixation period and after bony healing. Forty-seven distal radius fractures were included. Results Twenty-four fractures had fixation with locking screws and 23 had fixation with smooth locking pegs. For both groups, all radiographic parameters measured showed a statistically significant difference between the intraoperative postreduction and fixation period and the remote postoperative period after union of the fracture ( p < 0.05) attesting a slight loss of reduction. Nevertheless, there were no significant differences between the groups in radiographic extra-articular parameters. Conclusion This clinical study shows that there is no difference in stability fixation between locking screws or smooth locking pegs in A2-A3 distal radius fractures. Clinical Relevance The use of smooth locking pegs only for epiphyseal fixation appears to be safe in volar plating of A2-A3 distal radius fractures in adult patients and could be an alternative to locking screws. More clinical data are needed to confirm these results. Level of Evidence Level III; retrospective comparative study.

Nonlinear mode saturation in a U-shaped micro-resonator.

Saturation is an intriguing phenomenon that has captured the attention of scientists since the time of Froude when he reported it for ship motion in the mid of the nineteenth century. This work presents the demonstration and a comprehensive study of the nonlinear saturation phenomenon on a compound micromachined structure of U-shape (micro portal frame). The frame is designed and fabricated as a multi-input and multi-output device for actuating the 1st (sway) and 2nd (symmetric) in-plane vibration modes. Geometric nonlinearities along with the softening effect of the electrostatic force present the necessary conditions for the activation of a 2:1 internal (auto-parametric) resonance between the 1st and 2nd modes. Experimental data complemented with analytical simulations are obtained showing the internal resonance and the saturation phenomenon. These results are promising for further exploration of such compound structures and for further in-depth studies of the saturation phenomenon on a variety of other systems and applications.

Investigations into the impact of nursing unit layout on critical care nurses.

BACKGROUND: Nurses' work environment has apparent implications for maximizing their productivity, satisfaction, and improving patient care. OBJECTIVES: This study aimed to explore the influence of three nursing unit spatial layouts on critical care nurses' satisfaction and walking behavior at a university hospital. METHODS: The research used a comparative design by administering a standardized questionnaire, recording walking steps and distances using pedometers, and tracking nurses' walking behavior. Thirty-six critical care nurses working on the morning shift consented to participate in the research. RESULTS: The study results showed a relationship between the spatial layout of intensive care units (ICUs) and nurses' satisfaction and walking behavior. Questionnaire results indicated statistically significant variations in nurses' satisfaction with the location of the nursing station, the arrangement of patients' rooms, the availability of family space, and the unit's auditory privacy. Nurses in ICU1 were more satisfied with the nursing station's placement and the availability of family space inside patient rooms, while nurses in ICU2 were more satisfied with the patient bed arrangement and the unit's aural privacy than nurses in other units. The pedometer readings and movement maps revealed significant differences in nurses' walking patterns across the three ICUs. The steps, distances, and movement diagrams demonstrated that ICU1 with private rooms outperformed the other units owing to the nurse station's placement and accessibility to patients and support rooms. CONCLUSION: This study concludes that the ICU design impacts nurses' satisfaction and behavior. The optimum placement of nursing stations, patients' beds, and supporting room reduces walking distance and thus increases nurses' satisfaction and performance.

Selective multiple analyte detection using multi-mode excitation of a MEMS resonator.

This work reports highly selective multiple analyte detection by exploiting two different mechanisms; absorption and thermal conductivity using a single MEMS device. To illustrate the concept, we utilize a resonator composed of a clamped-guided arch beam connected to a flexural beam and a T-shaped moveable mass. A finite element model is used to study the mode shapes and mechanical behavior of the device with good agreement reported with the experimental data. The resonator displays two distinct out-of-plane modes of vibration. For humidity detection, we utilize physisorption by functionalizing the surface with graphene oxide (GO), which has strong affinity toward water vapors. The GO solution is prepared and drop-casted over the mass surface using an inkjet printer. On the other hand, cooling the heated flexural beams is used for helium (He) detection (thermal-conductivity-based sensor). The sensor characteristics are extensively studied when the modes are individually and simultaneously actuated. Results affirm the successful utilization of each mode for selective detection of relative humidity and He. This novel mode-dependent selective detection of multiple analytes can be a promising building block for the development of miniature, low-powered, and selective smart sensors for modern portable electronic devices.