Factors associated with transition to a nursing home in older adults living in naturally occurring retirement communities.

BACKGROUND: Naturally occurring retirement communities (NORCs) are geographic areas (generally high-rise buildings or neighborhoods) that have a high concentration of individuals 65 years and older. Supportive service programs in NORCs can address resident needs and delay nursing home (NH) admission but understanding what factors are associated with NORC residents requiring NH admission is needed to tailor such programs. Our aim was to examine individual- and neighborhood-level factors associated with NH wait-list status in NORC residents in Ontario. METHODS: We conducted a population-based, cross-sectional study of Ontario adults 65 years of age or older living in a NORC building as of January 1, 2020, by linking a provincial registry of NORC high-rise buildings with health administrative data. Older adults were classified as being on the NH wait-list if they had an open application for a NH on the index date. We conducted a multilevel logistic regression analysis using generalized estimating equations to determine individual- and neighborhood-level factors associated with NH wait-list status, including sociodemographic, clinical, healthcare use, and building factors. We explored the role of sex and age through stratification by sex (male, female) and age (65-80 and 80+ years). RESULTS: Among 220,864 NORC residents, 4710 individuals (2.1%) were on the NH wait-list. Female sex, older age, immigrant status, dementia diagnosis, receiving homecare, multimorbidity, and polypharmacy (five or more unique drug names) were associated with an increased odds of wait-list status. Several neighborhood-level variables were associated with a significantly increased likelihood of wait-list status, including low income, high dependency, high ethnic diversity, and living in a building with supports. CONCLUSION: NORC supportive service programs can be tailored to account for the factors associated with NH wait-list status, allowing NORC residents who are living in the community to age in their desired place and achieve optimal health outcomes.

Using Blood Wisely: lessons learnt in establishing a national implementation programme to reduce inappropriate red blood cell transfusion.

BACKGROUND: Up to 50% of blood is transfused inappropriately despite best evidence. In 2020, Choosing Wisely Canada launched a major national programme, 'Using Blood Wisely', the aim was to engage hospitals to audit their red blood cell transfusion use against national benchmarks and participate in a programme to decrease inappropriate use. STUDY DESIGN: Using Blood Wisely is a quality improvement programme including national benchmarks, an audit tool, recommended evidence-based effective interventions and a designation to reward success. Hospital engagement was measured using the number of hospitals signing up, performing a baseline audit, submitting the planning survey, entering two or more audits and achieving hospital designation. Barriers to implementation were collected. RESULTS: From 1 September 2020 to 31 December 2022, 229 individual hospitals signed up over time to participate. Their results are reported as 159 hospitals and hospital groups. Collectively, this accounts for 72% of the blood used in Canada. Overall, 147 (92%) performed a baseline audit, 10 (6%) submitted a planning survey and 130 (82%) entered two or more audits. At baseline (time of enrolment), 75 (51%) met both benchmarks. The designation was awarded to 62 (39%) hospital groups (a total of 105 individual hospitals) that met and sustained benchmarks. Barriers to implementation included human resource shortages, lack of local expertise to advise the team, need for more education of transfusion prescribers and competing priorities. CONCLUSION: In its initial phase, Using Blood Wisely engaged a substantial number of hospitals in transfusion quality improvement work and maintained that engagement. This large-scale engagement across a big country was more successful than anticipated. Additional efforts are needed to rigorously evaluate the programme's impact on utilisation.

Cell-Derived Extracellular Matrix Fiber Scaffolds Improve Recovery from Volumetric Muscle Loss.

There are currently no surgical procedures that effectively address the treatment of volumetric muscle loss (VML) injuries that has motivated the development of implantable scaffolding. In this study, the effectiveness of an allogenic scaffold fabricated using fibers built from the extracellular matrix (ECM) collected from muscle fibroblast cells during growth in culture was explored using a hindlimb VML injury (tibialis anterior muscle) in a rat model. Recovery outcomes (8 weeks) were explored in comparison with unrepaired controls as well previously examined allogenic scaffolds prepared from decellularized skeletal muscle (DSM) tissue (n = 9/sample group). At 8-week follow-up, we found that the repair of VML injuries using ECM fiber scaffolds in combination with an autogenic mince muscle (MM) paste significantly improved the recovery of peak contractile torque (79% ± 13% of uninjured contralateral muscle) when compared with unrepaired VML controls (57% ± 13%). Similar significant improvements were measured for muscle mass restoration (93% ± 10%) in response to ECM fiber+MM repair when compared with unrepaired VML controls (73% ± 13%). Of note, mass and contractile strength recovery outcomes for ECM fiber scaffolds were not significantly different from DSM+MM repair controls. These in vivo findings support the further exploration of cell-derived ECM fiber scaffolds as a promising strategy for the repair of VML injury with recovery outcomes that compare favorably with current tissue-sourced ECM scaffolds. Furthermore, although the therapeutic potential of ECM fibers as a treatment strategy for muscle injury was explored in this study, they could be adapted for high-throughput fabrication methods developed and routinely used by the textile industry to create a broad range of woven implants (e.g., hernia meshes) for even greater clinical impact.

Lattice Strain and Composition Effects on the Methanol Oxidation Performance of Platinum-Ruthenium-Nickel Ternary Nanocatalysts.

Ternary Pt-based structures are a positive progress in addressing the disadvantages of monometallic and bimetallic Pt-based alloys for the electrochemical oxidation process of simple alcohols, which is a vital half-reaction in fuel cell technologies. We herein report a facile NaBH4-assisted ethylene glycol reduction process for fabricating a series of nanosized PtRuNi ternary alloys to explore the relationship between physicochemical properties and electrocatalytic behaviors for the acidic methanol oxidation reaction (MOR). Owing to a balance between lattice strain and synergistic effects, the Pt60Ru20Ni20/C electrocatalyst shows the highest MOR efficiency with the mass activity/specific activity of 844.48 mA mgMetal-1/1.93 mA cm-2, being a 1.94 and 2.38 times increase compared to those of the PtRu catalyst, respectively. Also, the Pt60Ru20Ni20/C catalyst possesses superior CO-tolerance and durability in strongly acidic electrolytes. This work suggests that optimizing the surface strain and electronic effects can boost the overall MOR efficiency of multicomponent Pt-based materials, which can help to further develop next-generation catalysts for energy conversion-related technologies.

Integrating Low Pt-Based Ternary NiRuPt Nanoalloy on Hybrid TiO2-Based Oxide-Carbon Composite for Enhanced Ethanol Oxidation.

Ternary NiRuPt nanoscale alloy on hybrid Ti0.9Ir0.1O2-C composite is herein reported to overcome the high cost and tenuous catalytic efficiency of anode catalysts in direct ethanol fuel cells. The small-size NiRuPt alloy is anchored on the Ti0.9Ir0.1O2-C surface via a NaBH4-ethylene glycol-assisted coreduction route. Benefiting from advantages of favorable structure and synergistic effects of compounds, the NiRuPt/Ti0.9Ir0.1O2-C catalyst exhibits high electrocatalytic performance for the ethanol electro-oxidation reaction (EOR) with mass activity of 720.75 mA mgMetal-1 and specific activity of 2.15 mA cm-2, which are 2.25- and 5-fold increases compared to those of the Pt/C (E-TEK) catalyst. The as-synthesized EOR catalyst also shows impressive anti-CO-poisoning ability and great electrocatalytic stability after 5000-cycling ADT. This work can open up an efficient strategy for designing multicomponent catalysts to reduce Pt content and enhance the catalytic performance of electrocatalysts in renewable energy-related technologies.

Transcriptome profiling of a synergistic volumetric muscle loss repair strategy.

Volumetric muscle loss overwhelms skeletal muscle's ordinarily capable regenerative machinery, resulting in severe functional deficits that have defied clinical repair strategies. In this manuscript we pair the early in vivo functional response induced by differing volumetric muscle loss tissue engineering repair strategies that are broadly representative of those explored by the field (scaffold alone, cells alone, or scaffold + cells) to the transcriptomic response induced by each intervention. We demonstrate that an implant strategy comprising allogeneic decellularized skeletal muscle scaffolds seeded with autologous minced muscle cellular paste (scaffold + cells) mediates a pattern of increased expression for several genes known to play roles in axon guidance and peripheral neuroregeneration, as well as several other key genes related to inflammation, phagocytosis, and extracellular matrix regulation. The upregulation of several key genes in the presence of both implant components suggests a unique synergy between scaffolding and cells in the early period following intervention that is not seen when either scaffolds or cells are used in isolation; a finding that invites further exploration of the interactions that could have a positive impact on the treatment of volumetric muscle loss.

Local IL-10 delivery modulates the immune response and enhances repair of volumetric muscle loss muscle injury.

This study was designed to test the hypothesis that in addition to repairing the architectural and cellular cues via regenerative medicine, the delivery of immune cues (immunotherapy) may be needed to enhance regeneration following volumetric muscle loss (VML) injury. We identified IL-10 signaling as a promising immunotherapeutic target. To explore the impact of targeting IL-10 signaling, tibialis anterior (TA) VML injuries were created and then treated in rats using autologous minced muscle (MM). Animals received either recombinant rat IL-10 or phosphate buffered saline (PBS) controls injections at the site of VML repair beginning 7 days post injury (DPI) and continuing every other day (4 injections total) until 14 DPI. At 56 DPI (study endpoint), significant improvements to TA contractile torque (82% of uninjured values & 170% of PBS values), TA mass, and myofiber size in response to IL-10 treatment were detected. Whole transcriptome analysis at 14 DPI revealed activation of IL-10 signaling, muscle hypertrophy, and lymphocytes signaling pathways. Expression of ST2, a regulatory T (Treg) cell receptor, was dramatically increased at the VML repair site in response to IL-10 treatment when compared to PBS controls. The findings suggest that the positive effect of delayed IL-10 delivery might be due to immuno-suppressive Treg cell recruitment.

Mixed-oxide-containing composite-supported MoPt with ultralow Pt content for accelerating hydrogen evolution performance.

The hybridization of MoPt with ultralow Pt content (2.81 wt%) on a rutile Ti0.9Ir0.1O2-C composite (MoPt/Ti0.9Ir0.1O2-C) is fabricated by a self-growth-assisted reduction route, serving as an efficient catalyst for the hydrogen evolution reaction (HER). Due to unique structural features, the MoPt/Ti0.9Ir0.1O2-C catalyst requires an extremely low overpotential of 21.35 mV at 10 mA cm-2 and an impressive HER mass activity of 849.36 mA mgMetal-1 at 300 mV overpotential. In addition, the as-made HER electrocatalyst shows superior catalytic stability and chemical after 10 h of testing.

A method to detect influencers in social networks based on the combination of amplification factors and content creation.

A social network is one of the efficient tools for information propagation. The content is the bridge between the product and its customers. Evaluating the user's content creation is a valuable feature to improve information spreading on the social network. This paper proposes a method for extracting brand value with influencers by combining the user's amplification and content creation in influencer marketing. The amplification factors are studied based on the propagation of the posts on the social network in a duration time. Those factors are more valuable than before when using influencer marketing at a determined time. Moreover, the content creation score is also studied to measure content creation based on the passion point with a brand and its quality. The amplification factors and content creation score are combined to analyze posts' interest in detecting the emerging influent users for a product in the influencer marketing campaign. Using the amplification factors, the passion points, and the content creation score, a system to manage the influencer marketing on Facebook has been constructed and tested in the real-world campaign. The experimental results show that the proposed method's influencers bring the conversion rate's efficiency and revenue in the influencer marketing campaign.

One-pot production of a sea urchin-like alloy electrocatalyst for the oxygen electro-reduction reaction.

Designing a cost-effective catalyst with high performance towards the oxygen electro-oxidation reaction (ORR) is of great interest for the development of green energy storage and conversion technologies. We report herein a facile self-assembly strategy in a mild reducing environment to realize an urchin-like NiPt bimetallic alloy with the domination of the (111) facets as an efficient ORR electrocatalyst. In the rotating-disk electrode test, the as-obtained NiPt nanourchins (NUCs)/C catalyst demonstrates an increase in both onset potential (0.96 VRHE) and half-wave potential (0.92 VRHE) and a direct four-electron ORR pathway with enhanced reaction kinetics. Additionally, the as-made NiPt NUCs/C electrocatalyst also shows impressive ORR catalytic stability compared to a commercial Pt NPs/C catalyst after an accelerated durability test with 15.29% degradation in mass activity, which is 3.04-times lower than 46.48% of the Pt NPs/C catalyst. The great ORR performance of the as-made catalyst is due to its unique urchin-like morphology with the dominant (111) facets and the synergistic and electronic effects of alloying Ni and Pt. This study not only provides a robust ORR electrocatalyst, but also opens a facile but effective route for fabricating 3D Pt-based binary and ternary alloy catalysts.

Implementation, spread and impact of the Patient Oriented Discharge Summary (PODS) across Ontario hospitals: a mixed methods evaluation.

BACKGROUND: Traditional discharge processes lack a patient-centred focus. This project studied the implementation and effectiveness of an individualized discharge tool across Ontario hospitals. The Patient Oriented Discharge Summary (PODS) is an individualized discharge tool with guidelines that was co-designed with patients and families to enable a patient-centred process. METHODS: Twenty one acute-care and rehabilitation hospitals in Ontario, Canada engaged in a community of practice and worked over a period of 18 months to implement PODS. An effectiveness-implementation hybrid design using a triangulation approach was used with hospital-collected data, patient and provider surveys, and interviews of project teams. Key outcomes included: penetration and fidelity of the intervention, change in patient-centred processes, patient and provider satisfaction and experience, and healthcare utilization. Statistical methods included linear mixed effects models and generalized estimating equations. RESULTS: Of 65,221 discharges across hospitals, 41,884 patients (64%) received a PODS. There was variation in reach and implementation pattern between sites, though none of the between site covariates was significantly associated with implementation success. Both high participation in the community of practice and high fidelity were associated with higher penetration. PODS improved family involvement during discharge teaching (7% increase, p = 0.026), use of teach-back (11% increase, p < 0.001) and discussion of help needed (6% increase, p = 0.041). Although unscheduled healthcare utilization decreased with PODS implementation, it was not statistically significant. CONCLUSIONS: This project highlighted the system-wide adaptability and ease of implementing PODS across multiple patient groups and hospital settings. PODS demonstrated an improvement in patient-centred discharge processes linked to quality standards and health outcomes. A community of practice and high quality content may be needed for successful implementation.

In vivo testing of an injectable matrix gel for the treatment of shoulder cuff muscle fatty degeneration.

INTRODUCTION: Extracellular matrix (ECM) gels have shown efficacy for the treatment of damaged tissues, most notably cardiac muscle. We hypothesized that the ECM gel prepared from skeletal muscle could be used as a treatment strategy for fatty shoulder cuff muscle degeneration. METHODS: We conducted experiments to (1) evaluate host biocompatibility to ECM gel injection using a rat model and (2) examine the effect of ECM gel injection on muscle recovery after delayed repair of a released supraspinatus (SSP) tendon using a rabbit model. RESULTS: The host biocompatibility to the ECM gel was characterized by a transient rise (first 2 weeks only) in several genes associated with macrophage infiltration, matrix deposition, and inflammatory cytokine production. By 8 weeks all genes had returned to baseline levels and no evidence of fibrosis or chronic inflammation was observed from histology. When gel injection was combined with SSP tendon repair, we observed a significant reduction (7%) in SSP muscle atrophy (24 + 3% reduction from uninjured) when compared with treatment with tendon repair only (31 + 7% reduction). Although fatty degeneration was elevated in both treatment groups, fat content trended lower (2%) in response to combined tendon repair and intramuscular ECM injection (4.1 + 2.1%) when compared with tendon repair only (6.1 + 2.9%). Transcriptome analysis revealed adipogenesis and osteoarthritis pathway activation in the repair only group. These key pathways were abrogated in response to treatment using combined repair plus gel. DISCUSSION: The findings suggest that ECM injection had a modest but positive effect on muscle mass, fatty degeneration, and key cellular signaling pathways.

Wire-like Pt on mesoporous Ti0.7W0.3O2 Nanomaterial with Compelling Electro-Activity for Effective Alcohol Electro-Oxidation.

Finding out robust active and sustainable catalyst towards alcohol electro-oxidation reaction is major challenges for large-scale commercialization of direct alcohol fuel cells. Herein, a robust Pt nanowires (NWs)/Ti0.7W0.3O2 electrocatalyst, as the coherency of using non-carbon catalyst support and controlling the morphology and structure of the Pt nanocatalyst, was fabricated via an effortless chemical reduction reaction approach at room temperature without using surfactant/stabilizers or template to assemble an anodic electrocatalyst towards methanol electro-oxidation reaction (MOR) and ethanol electro-oxidation reaction (EOR). These observational results demonstrated that the Pt NWs/Ti0.7W0.3O2 electrocatalyst is an intriguing anodic electrocatalyst, which can alter the state-of-the-art Pt NPs/C catalyst. Compared with the conventional Pt NPs/C electrocatalyst, the Pt NWs/Ti0.7W0.3O2 electrocatalyst exhibited the lower onset potential (~0.1 V for MOR and ~0.2 for EOR), higher mass activity (~355.29 mA/mgPt for MOR and ~325.01 mA/mgPt for EOR) and much greater durability. The outperformance of the Pt NWs/Ti0.7W0.3O2 electrocatalyst is ascribable to the merits of the anisotropic one-dimensional Pt nanostructure and the mesoporous Ti0.7W0.3O2 support along with the synergistic effects between the Ti0.7W0.3O2 support and the Pt nanocatalyst. Furthermore, this approach may provide a promising catalytic platform for fuel cell technology and a variety of applications.

High Conductivity and Surface Area of Mesoporous Ti0.7W0.3O2 Materials as Promising Catalyst Support for Pt in Proton-Exchange Membrane Fuel Cells.

In this work, mesoporous Ti0.7W0.3O2 materials with high conductivity and surface area as promising catalyst support for Pt in Proton-Exchange Membrane Fuel Cells (PEMFCs) were synthesized via a single-step solvothermal process at low-temperature without using any surfactants or stabilizers. The characterizations of material are measured via XRD, TEM, SEM-EDS, and BET as well as electronic conductivity measurement. As a result, Ti0.7W0.3O2 formed a homogenous solid solution with mesoporous anatase-TiO2 structure and uniformly spherical nanoparticles morphology of about ~10 nm diameter, together with a high electrical conductivity of 0.022 S/cm compared to that of undoped-TiO2 (1.37×10-7 S/cm), which implied that tungsten (VI) ions was successfully doped into anatase-TiO2 lattices. The N2 adsorption/desorption isotherms indicated that Ti0.7W0.3O2 is being mesoporous structure with high surface area up to ~202 m²/g, which is nearly similar to that of the commercial Vulcan XC72 (~232 m²/g). The Pt nanoparticles was easily anchored onto Ti0.7W0.3O2 surface by the chemical reduction process using NaBH4 as a reducing agent. The spherical Pt nanoparticles of ~9 nm in diameter were deposited uniformly on the mesoporous support. These results suggested that mesoporous Ti0.7W0.3O2 materials synthesized are promising catalyst supports to replace carbon-based supports for Proton-exchange membrane fuel cells.

One-Step Hydrothermal Synthesis of a New Nanostructure Ti07Ir03O2 for Enhanced Electrical Conductivity: The Effect of pH on the Formation of Nanostructure.

Non-carbon materials are considered as the promising candidates for carbon-based catalyst support to increase the durability of proton exchange membrane fuel cells (PEMFCs). Due to the high stability and good electrical conductivity of TiO2, M-doped TiO2 (M is transition metals: Mo, Ru, V, W) is an emerging candidate for Pt nanoparticles support on the cathode side of PEMFCs. In this research, the synthesis mechanism of Ti0.7Ir0.3O2 nanostructure by the one-step hydrothermal method at low temperature was studied. We found that by only controlling the pH of the precursor solution, Ti0.7Ir0.3O2 can be synthesized with different morphology and phase selection without any formation of mixed oxides. In particular, Ti0.7Ir0.3O2 nanostructure synthesized at pH = 0 exhibited concomitant anatase, brookite, and rutile phases. The spherical particles of diameter 20-40 nm, cubic particles of 30-50 nm in side-length and rod-like particles with 70 nm in length and 20 nm in diameter represented the anatase, brookite, and rutile phases respectively. At a pH value of 1 or 2, the majority of spherical nanoparticles were homogeneous at 15-20 nm in diameter. It was observed that the electronic conductivity of novel Ti0.7Ir0.3O2 nanostructure was significantly higher than that of the undoped TiO2. Thus the promising properties of this new nanostructure open a new path to the much-needed fuel cell applications.

Advanced Ti0.7W0.3O2 Nanoparticles Prepared via Solvothermal Process Using Titanium Tetrachloride and Tungsten Hexachloride as Precursors.

The degradation of Pt-based catalysts is considered as the main barrier to the commercialization of fuel cells. M-doped TiO2 (M is a transition metal) has been investigated to improve the stability of electrocatalysts. Recently, W-doped TiO2 materials have been found as a good catalyst support for the photocatalyst applications but their application in Proton-exchange membrane fuel cell application has rarely been reported. In addition, the agglomeration of nanoparticles, which are synthesized from the organic precursor, has been reported. Here, we report Ti0.7W0.3O2 nanoparticles prepared via a one-step solvothermal method with inorganic precursors without using surfactants or stabilizers for restricting nanoparticle agglomeration. The properties of the material were measured by XRD, TEM, BET, and electronic conductivity. The mean particle size of ∼5 nm, the high specific surface area of 126.471 m2/g and a moderate electronic conductivity of 0.014 S/cm were obtained for the sample prepared at 220 °C for 4 h. It was observed that using inorganic precursors to prevent particle agglomeration is more advantageous compared to organic precursors as mentioned in previous reports.

Impact of patient-centered discharge tools: A systematic review.

BACKGROUND: Patient-centered discharge tools provide an opportunity to engage patients, enhance patient understanding, and improve capacity for self-care and postdischarge outcomes. PURPOSE: To review studies that engaged patients in the design or delivery of discharge instruction tools and that tested their effect among hospitalized patients. DATA SOURCES: We conducted a search of 12 databases and journals from January 1994 through May 2014, and references of retrieved studies. STUDY SELECTION: English-language studies that tested discharge tools meant to engage patients were selected. Studies that measured outcomes after 3 months or without a control group or period were excluded. DATA EXTRACTION: Two independent reviewers assessed the full-text papers and extracted data on features of patient engagement. DATA SYNTHESIS: Thirty articles met inclusion criteria, 28 of which examined educational tools. Of these, 13 articles involved patients in content creation or tool delivery, with only 6 studies involving patients in both. While many of these studies (10 studies) demonstrated an improvement in patient comprehension, few studies found improvement in patient adherence despite their engagement. A few studies demonstrated an improvement in self-efficacy (2 studies) and a reduction in unplanned visits (3 studies). CONCLUSIONS: Improving patient engagement through the use of media, visual aids, or by involving patients when creating or delivering a discharge tool improves comprehension. However, further studies are needed to clarify the effect on patient experience, adherence, and healthcare utilization postdischarge. Better characterization of the level of patient engagement when designing discharge tools is needed given the heterogeneity found in current studies. Journal of Hospital Medicine 2017;12:110-117.

Implementing Patient-Oriented Discharge Summaries (PODS): A Multisite Pilot Across Early Adopter Hospitals.

Communication gaps when patients transition from hospital to either home or community can be problematic. Partnership between Toronto Central Local Health Integration Network (TC LHIN) and OpenLab addressed this through the Patient-Oriented Discharge Summaries (PODS) project. From January through March 2015, eight hospital departments across Toronto came together to implement the PODS, a tool previously developed through a co-design process involving patients, caregivers and providers. This paper presents data on how the hospitals came together and the impact of PODS on the patient and provider experience across these hospitals and discusses it implications.