The impact of stoichiometry on the initial steps of crystal formation: Stability and lifetime of charged triple-ion complexes.

Minerals form in natural systems from solutions with varying ratios of their lattice ions, yet non-stoichiometric conditions have generally been overlooked in investigations of new formation (nucleation) of ionic crystals. Here, we investigated the influence of cation:anion ratio in the solution on the initial steps of nucleation by studying positively and negatively charged triple ion complexes and subsequent particle size evolution. Our model systems are carbonates and sulfates of calcium and barium, as it was recently shown that solution stoichiometry affects the timing and rate of their nucleation. Molecular dynamics (MD) simulations and dynamic light scattering (DLS) flow experiments show that nucleation correlates with the stability and lifetime of the initial complexes, which were significantly impacted by the cation:anion stoichiometry and ion type. Specifically, B a S O 4 2 2 - ${{\rm B}{\rm a}{\left({{\rm S}{\rm O}}_{4}\right)}_{2}^{2-}}$ was found to have higher association constants and its lifetime was twofold longer than B a 2 S O 4 2 + ${{{\rm B}{\rm a}}_{2}{{\rm S}{\rm O}}_{4}^{2+}}$ . Similar trends were observed for B a C O 3 ${{{\rm B}{\rm a}{\rm C}{\rm O}}_{3}}$ and C a S O 4 ${{{\rm C}{\rm a}{\rm S}{\rm O}}_{4}}$ . Contrastingly, for C a C O 3 ${{{\rm C}{\rm a}{\rm C}{\rm O}}_{3}}$ , C a C O 3 2 2 - ${{\rm C}{\rm a}{\left({{\rm C}{\rm O}}_{3}\right)}_{2}^{2-}}$ was found to have lower association constants and its lifetime was shorter than C a 2 C O 3 2 + ${{{\rm C}{\rm a}}_{2}{{\rm C}{\rm O}}_{3}^{2+}}$ . These trends in stability and lifetime follow the same asymmetrical behaviour as observed experimentally for particle formation using techniques like DLS. This suggests a causal relationship between the stability and lifetime of the initial charged complexes and the nucleation under non-stoichiometric conditions.

The never-ending patient journey of chronically ill patients: A qualitative case study on touchpoints in relation to patient-centered care.

BACKGROUND: Healthcare professionals caring for chronically ill patients increasingly want to provide patient-centered care (PCC). By understanding each individual patient journey, they can significantly improve the quality of PCC. A patient journey consists of patient interactions, so-called touchpoints, with healthcare professionals distributed over three periods: pre-service, service, and post-service period. The aim of this study was to ascertain chronically ill patients' needs for digital alternatives for touchpoints. Specifically, we aimed to explore which digital alternatives patients would like to see implemented into their patient journey to help healthcare professionals providing PCC. METHODS: Eight semi-structured interviews were conducted either face-to-face or via Zoom. Participants were included if they had visited the department of internal medicine and had received treatment for either arteriosclerosis, diabetes, HIV, or kidney failure. The interviews were analyzed utilizing a thematic analysis approach. RESULTS: The results suggest that the patient journey of chronically ill patients is a continuous cycle. Furthermore, the results showed that chronically ill patients would like to see digital alternatives for touchpoints implemented into their patient journey. These digital alternatives consisted of video calls, digitally checking in before a physical appointment, digitally self-monitoring one's medical condition and personally uploading monitoring results into the patient portal, and viewing their own medical status in a digital format. Particularly, patients who were familiar with their healthcare professional(s) and were in a stable condition mostly opted for digital alternatives. CONCLUSION: In the cyclical patient journey, digitalization can help put the wishes and needs of the chronically ill patients at the center of care. It is recommended that healthcare professionals implement digital alternatives for touchpoints. Most chronically ill patients consider digital alternatives to lead to more efficient interactions with their healthcare professionals. Furthermore, digital alternatives support patients to be better informed about the progress of their chronical illness.

Medical and surgical treatment of postbariatric hypoglycaemia: Retrospective data from daily practice.

AIM: To evaluate medical and surgical treatment of postbariatric hypoglycaemia (PBH) in daily practice. MATERIALS AND METHODS: Retrospective data were extracted from medical records from four hospitals. PBH was defined by neuroglycopenic symptoms together with a documented glucose <3.0 mmol/L in the postprandial setting after previous bariatric surgery. Data were scored semiquantitatively on efficacy and side effects by two reviewers independently. Duration of efficacy and of use were calculated. RESULTS: In total, 120 patients were included with a median follow-up of 27 months with a mean baseline age of 41 years, total weight loss of 33% and glucose nadir 2.3 mmol/L. Pharmacotherapy consisted of acarbose, diazoxide, short- and long-acting octreotide and glucagon-like peptide-1 receptor agonist analogues (liraglutide and semaglutide) with an overall efficacy in 45%-75% of patients. Combination therapy with two drugs was used by 30 (25%) patients. The addition of a second drug was successful in over half of the patients. Long-acting octreotide and the glucagon-like peptide-1 receptor agonist analogues scored best in terms of efficacy and side effects with a median duration of use of 35 months for octreotide. Finally, 23 (19%) patients were referred for surgical intervention. Efficacy of the surgical procedures, pouch banding, G-tube placement in remnant stomach and Roux-en-Y gastric bypass reversal, pooled together, was 79% with a median duration of initial effect of 13 months. CONCLUSIONS: In daily practice, pharmacotherapy for PBH was successful in half to three quarters of patients. Combination therapy was often of value. One in five patients finally needed a surgical procedure, with overall good results.

Destination unknown: Parents and healthcare professionals' perspectives on transition from paediatric to adult care in Down syndrome.

BACKGROUND: Transitioning from paediatric medical care to adult care is a challenging process for children, parents and healthcare professionals. The aim of this study was to explore the experiences, concerns and needs of parents of children with Down syndrome and of professionals regarding this transition. METHOD: A qualitative study was performed using semi-structured interviews with 20 parents of children with Down syndrome and six healthcare professionals. RESULTS: We showed that parents and professionals have concerns during each of the three distinct phases of transition (preparation, transfer and integration). Data disclose specific concerns regarding communication, continuity of care and rebuilding trust. We propose a framework for the transition to adult care. CONCLUSIONS: The transition in medical care for children with Down syndrome should be flexible, patient-centred and coordinated together with patients and parents. Only in ensuring continuity of care will individuals with Down syndrome not get lost in transition.

Effects of polymer nonideality on depletion-induced phase behaviour of colloidal disks and rods.

Colloidal dispersions composed of either platelets or rods exhibit liquid crystalline phase behaviour that is strongly influenced by the addition of nonadsorbing polymers. In this work we examined how polymer segment-segment interactions affect this phase behaviour as compared to using either penetrable hard spheres (PHS) or ideal ('ghost') chains as depletants. We find that the simplified polymer description predicts the same phase diagram topologies as the more involved polymer descriptions. Therefore the PHS description is still adequate for qualitative predictions. For sufficiently large polymer sizes we find however that the precise polymer description significantly alters the locations of the phase coexistence regions. Especially the stability region of isotropic-isotropic coexistence is affected by the polymer interactions. To illustrate the quantitative effects some examples are presented.

Phase stability of colloidal spheres mixed with semiflexible supramolecular polymers.

HYPOTHESIS: Mixtures of colloids and supramolecular polymers may exhibit stimuli-responsive phase behaviour. However, in theoretical descriptions of such systems, the polymers are commonly described either as flexible chains or as rigid rods, while in experimental systems supramolecular polymers usually fall in between these two limits. We expect the flexibility of the polymers to have a profound effect on the stimuli-responsive phase behaviour. THEORY: We propose a general approach to predict the phase behaviour of colloidal hard spheres mixed with covalent or supramolecular polymers of arbitrary persistence length using free volume theory and an interpolation between flexible and rigid chains. FINDINGS: The binodals are predicted to shift to lower monomer concentrations as the persistence length is increased, making the polymers more efficient depletants. The persistence length is therefore an additional degree of freedom for manipulating the phase behaviour of colloid-polymer mixtures. We show that by manipulating the persistence length of temperature responsive supramolecular polymers, a wide range of phase diagrams with various topologies can be obtained. For example, we find phase diagrams with a critical point but no triple point or displaying two triple points for temperature-sensitive supramolecular polymers mixed with hard spheres.

Multiphase Coexistences in Rod-Polymer Mixtures.

Using recently derived analytical equations of state for hard rod dispersions, we predict the phase behavior of athermal rod-polymer mixtures with free volume theory. The rods are modeled as hard spherocylinders, while the nonadsorbing polymer chains are described as penetrable hard spheres. It is demonstrated that all of the different types of phase states that are stable for pure colloidal rod dispersions can coexist with any combination of these phases if polymers are added, depending on the concentrations, rod aspect ratio, and polymer-rod size ratio. This includes novel two-, three-, and four-phase coexistences and isostructural coexistences between dilute and concentrated phases of the same kind, even for the more ordered (liquid) crystal phases. This work provides insight into the conditions at which particular multiphase coexistences are expected for well-defined model colloidal rod-polymer mixtures. We provide a quantitative map detailing the various types of isostructural coexistences, which confirms an early qualitative hypothesis by Bolhuis et al. ( J. Chem. Phys. 107, 1997 1551).

Providing person-centered care for patients with complex healthcare needs: A qualitative study.

BACKGROUND: People with chronic conditions have complex healthcare needs that lead to challenges for adequate healthcare provision. Current healthcare services do not always respond adequately to their needs. A modular perspective, in particular providing visualization of the modular service architecture, is promising for improving the responsiveness of healthcare services to the complex healthcare needs of people with chronic conditions. The modular service architecture provides a comprehensive representation of the components and modules of healthcare provision. In this study, we explore this further in a qualitative multiple case study on healthcare provision for children with Down syndrome in the Netherlands. METHODS: Data collection for four cases involved 53 semi-structured interviews with healthcare professionals and 21 semi-structured interviews with patients (the parents of children with Down syndrome as proxy). In addition, we gathered data by means of practice observations and analysis of relevant documents. The interviews were audio-recorded, transcribed verbatim and analyzed utilizing the Miles and Huberman approach. RESULTS: Our study shows that the perspectives on healthcare provision of professionals and patients differ substantially. The visualization of the modular service architecture that was based on the healthcare professionals' perspective provided a complete representation of (para)medical outcomes relevant to the professionals' own discipline. In contrast, the modular service architecture based on the patients' perspective, which we define as a person-centered modular service architecture, provided a representation of the healthcare service that was primarily based on functional outcomes and the overall wellbeing of the patients. CONCLUSION: Our study shows that visualization of the modular service architecture can be a useful tool to better address the complex needs and requirements of people with a chronic condition. We suggest that a person-centered modular service architecture that focuses on functional outcomes and overall wellbeing, enables increased responsiveness of healthcare services to people with complex healthcare needs and provision of truly person-centered care.

[Exertional heat stroke in athletes and soldiers]. / Inspanningsgebonden hitteberoerte bij sporters en militairen.

Exertional heat stroke (EHS) is a medical emergency characterized by life-threatening hyperthermia and central nerve system dysfunction during or directly after exercise. Early recognition and aggressive cooling reduces morbidity and mortality of patients with EHS. Therefore, all health care professionals involved in acute care should immediately recognise EHS and start cooling with cold water immersion as soon as possible. Most EHS occur in young and healthy individuals without a medical history, such as athletes or soldiers. We report the case of EHS in a 26-year-old man without a medical history. He suffered from EHS during a military admission test. A few years later he had a second EHS during military training. This time, the EHS was complicated by compartment syndrome, rhabdomyolysis, acute kidney injury and epilepsy. He fully recovered from both EHS episodes. Muscle histology, whole exome sequencing and heat tolerance tests did not show any abnormalities.

Decreased Interfacial Tension of Demixed Aqueous Polymer Solutions due to Charge.

Electric charge at the water-water interface of demixed solutions of neutral polymer and polyelectrolyte decreases the already ultralow interfacial tension. This is demonstrated in experiments on aqueous mixtures of dextran (neutral) and nongelling fish gelatin (charged). Upon phase separation, electric charge and a potential difference develop spontaneously at the interface, decreasing the interfacial tension purely electrostatically in a way that can be accounted for quantitatively by Poisson-Boltzmann theory. Interfacial tension is a key property when it comes to manipulating the water-water interface, for instance to create novel water-in-water emulsions.

Donnan potentials in aqueous phase-separated polymer mixtures.

A promising approach to texturize water is by the addition of mutually incompatible polymers, leading to phase separation. Here, we demonstrate that the phase stability of aqueous polymer solutions is affected not only by chemical differences between the polymers but also by their electric charge. Direct electrochemical measurements are performed of the electric potential difference between two coexisting phases in aqueous solutions of the charged protein fish gelatin (nongelling) and the uncharged polysaccharide dextran. Charge counteracts demixing because of the entropic cost of confining the counterions to one phase, resulting in a strong shift of the critical point upon an increase of the charge on one of the polymers. Upon phase separation, the charged polymer is spatially confined, and due to the Donnan effect, an interfacial electric potential is developed. A direct proportionality is found between this Donnan potential and the difference in gelatin concentration in the two phases, for which we propose a theoretical explanation. The electrostatics may provide a new handle in the development of stable water-in-water emulsions.

Factors affecting timely recognition and diagnosis of dementia across Europe: from awareness to stigma.

BACKGROUND: Timely recognition and diagnosis of dementia is the pre-condition for improving dementia care, but diagnosis often occurs late in the disease process. OBJECTIVE: To compare facilitators and obstacles to the timely recognition of dementia across eight European Union states, in order to implement established policies for earlier diagnosis. METHODS: A modified focus group technique, including a pre and posterior procedure. RESULTS: Twenty-three participants from different disciplines, purposively sampled for professional expertise in dementia research and innovative practice, attended two focus groups. Stigma in ageing and dementia, accompanied by a sense that there is little to offer until later on in the disease, underpinned the widespread reluctance of GPs to recognise dementia at an early stage and were major obstacles to the timely diagnosis of dementia across all eight countries. Dementia care services varied widely across Europe. Countries with the greatest development of dementia health care services were characterised by national guidelines, GPs fulfilling a gatekeeper function, multi-disciplinary memory clinics and innovative programmes that stimulated practice and new services. Dementia-related stigma was perceived as being less prominent in these countries. CONCLUSIONS: Overcome of delays in the timely diagnosis of dementia needs more than specialist services. They should address the processes associated with stigma, age and dementia, especially where these relate to physician practice and diagnostic disclosure. Stigma is perceived as variable across European States, with a promising finding that its impact is relatively small in countries with the widest range of dementia care services.

Posttraumatic stress disorder after dog bites in children.

Of 22 children who were victims of dog bite, 12 had symptoms of posttraumatic stress disorder 2 to 9 months after the bite. Violent dog attacks inflicting multiple and/or deep wounds were associated with risk of posttraumatic stress disorder.