Electronic patient-reported symptom monitoring in patients recovering from ambulatory minimally invasive gynecologic surgery: A prospective pilot study.

OBJECTIVE: To evaluate the feasibility of an electronic symptom-tracking platform for patients recovering from ambulatory surgery. METHOD: We assessed user response to an electronic system designed to self-report symptoms. Endpoints included compliance, postoperative symptoms, patient satisfaction. An 8-item symptom inventory (pain, nausea, vomiting, shortness of breath, fever, swelling, discharge, redness) was developed and made available on postoperative days (POD) 2-6. Responses exceeding defined thresholds of severity triggered alerts to healthcare providers. Symptoms, alerts, actions taken, urgent care center (UCC) visits, hospital admissions were tracked until POD 30. Patient satisfaction was evaluated on POD 7. A patient was defined as "responder" if at least 5/8 items on at least 3 PODs were completed. The assessment method was deemed successful if 64/100 patients responded. RESULTS: 97/102 patients were evaluable; 65 met "responder" criteria (67% responder rate; 95% CI 57-76%). 321 surveys were completed (median 4/patient), 248 (77%) in ≤2 min. Involving caregivers and allowing additional symptom-reporting improved the responder rate to 72% (95% CI 58-84%). Most commonly-reported moderate, severe, very severe symptoms were pain, nausea, swelling; 71% reported moderate to very severe pain on POD 2. Phone calls and adjustment of medications adequately addressed most symptoms. Two patients (2%) presented at UCC before, 6 (6%) after, POD 6; 1 (1%) was admitted. Most agreed or strongly agreed that electronic symptom-tracking was helpful, easy to use, and would recommend it to others. CONCLUSION: Electronic symptom-tracking is feasible for patients undergoing ambulatory gynecologic cancer surgery. Symptom burden is high in the early postoperative period. Addressing patient-reported symptoms in a timely, automated manner may prevent severe downstream adverse events, reduce UCC visits and admission rates, and improve outcomes.

Classifying Degraded Modern Polymeric Museum Artefacts by Their Smell.

The use of VOC analysis to diagnose degradation in modern polymeric museum artefacts is reported. Volatile organic compound (VOC) analysis is a successful method for diagnosing medical conditions but to date has found little application in museums. Modern polymers are increasingly found in museum collections but pose serious conservation difficulties owing to unstable and widely varying formulations. Solid-phase microextraction gas chromatography/mass spectrometry and linear discriminant analysis were used to classify samples according to the length of time they had been artificially degraded. Accuracies in classification of 50-83 % were obtained after validation with separate test sets. The method was applied to three artefacts from collections at Tate to detect evidence of degradation. This approach could be used for any material in heritage collections and more widely in the field of polymer degradation.

Equilibrium distribution of diethyl phthalate plasticiser in cellulose acetate-based materials: Modelling and parameter estimation of temperature and composition effects.

Understanding the transport and fate of semi-volatile organic compounds (SVOCs) such as phthalates in indoor environments is fundamental for quantifying levels of human exposure and preventing adverse health effects. In this context, the partition coefficient of phthalates between indoor built materials and/or consumer goods and the surrounding atmosphere represents a key parameter for determining concentration distributions. Partition coefficients are also of fundamental importance for describing degradation phenomena associated with plasticiser loss from polymeric materials. However, this key parameter has only been determined for a limited number of systems and environmental conditions. Here, we assess the partitioning behaviour of the diethyl phthalate (DEP) plasticiser in cellulose acetate (CA)-based materials for the first time, determining the effects of temperature and plasticiser composition on equilibrium distributions at temperatures between 20 and 80 °C and using CA samples with DEP contents ranging from 6 to 22 wt%. Additionally, we propose a model to describe and quantify the effect of temperature and plasticiser composition, with model parameters being estimated using non-linear regression and measurements from 130 distinct experiments. Finally, we assess the suitability of our developed model to simulate the migration of DEP from CA-based materials.

Exploring the Materials and Condition of 20th-Century Dolls in Zoe Leonard's Mouth Open, Teeth Showing 2000.

Systematic condition and analytical surveys were carried out on Zoe Leonard's (b. 1961) Mouth Open, Teeth Showing 2000, an installation artwork in Tate's collection consisting of 162 children's dolls. The dolls were manufactured at various points within the 20th century and encompass several potentially problematic synthetic polymers found in modern and contemporary museum collections. To explore the doll materials and conservation condition, a multi-analytical approach was used to identify key synthetic polymer types and additives present, including portable and bench analytical techniques. Challenging degradation phenomena associated with different types of doll have been discussed and related to their material composition, which has helped our understanding of the conservation challenges inherent to this contemporary artwork.

Modelling and parameter estimation of diethyl phthalate partitioning behaviour on glass and aluminum surfaces.

The knowledge of the partitioning behaviour of semi-volatile organic compounds (SVOCs), such as phthalates, between different materials and their surrounding air is of extreme importance for quantifying levels of human exposure to these compounds, which have been associated with adverse health effects. Phthalates' partitioning behaviour also represents a key property for modelling and assessing polymer degradation mechanisms associated with plasticiser loss. However, the characterisation of phthalates partitioning behaviour has been reported only for a limited number of compounds, mainly involving di-2-ethylhexyl phthalate (DEHP), di-isononyl phthalate (DINP) and di-isodecyl phtahalate (DIDP), while the characterisation of diethyl phthalate (DEP) partitioning has been overlooked. As one of the first plasticisers employed in the production of semi-synthetic plastics produced industrially in the late 19th and early 20th century, DEP plays an important role for understanding stability issues associated with historically significant artefacts in museum collections and archives. Here we show that the partitioning behaviour of DEP between borosilicate glass and aluminum surfaces and their surrounding air can be described by an exponential function of temperature, presenting a model to describe this relationship for the first time. Model parameters are estimated using nonlinear regression from experimental measurements acquired using 109 samples which have been equilibrated at different temperatures between 20 and 80 °C in sealed environments. Measured partition coefficients have been predicted accurately by our proposed model. The knowledge of DEP equilibrium distribution between adsorptive surfaces and neighbouring environments will be relevant for developing improved mathematical descriptions of degradation mechanisms related to plasticiser loss.

Water sorption and diffusion in cellulose acetate: The effect of plasticisers.

The conservation of cellulose acetate plastics in museum collections presents a significant challenge, due to the material's instability. Several studies have led to an understanding of the role of relative humidity (RH) and temperature in the decay process. It is well established that a major decay mechanism in cellulose acetate museum objects is the loss of plasticiser, and that the main decay mechanism of the polymer chain involves hydrolysis reactions. This leads to the loss of sidechain groups and the breakdown of the main polymer backbone. However, interactions between these decay mechanisms, specifically the way in which the loss of plasticiser can modify the interaction between cellulose acetate and water, has not yet been investigated. This research addresses the role of RH, studying the sorption and diffusion of water in cellulose acetate and how this interaction can be affected by plasticiser concentration using Dynamic Vapour Sorption (DVS).

Prophylactic Negative Pressure Wound Therapy After Laparotomy for Gynecologic Surgery: A Randomized Controlled Trial.

OBJECTIVE: To estimate the effectiveness of prophylactic negative pressure wound therapy in patients undergoing laparotomy for gynecologic surgery. METHODS: We conducted a randomized controlled trial. Eligible, consenting patients, regardless of body mass index (BMI), who were undergoing laparotomy for presumed gynecologic malignancy were randomly allocated to standard gauze or negative pressure wound therapy. Patients with BMIs of 40 or greater and benign disease also were eligible. Randomization, stratified by BMI, occurred after skin closure. The primary outcome was wound complication within 30 (±5) days of surgery. A sample size of 343 per group (N=686) was planned. RESULTS: From March 1, 2016, to August 20, 2019, we identified 663 potential patients; 289 were randomized to negative pressure wound therapy (254 evaluable participants) and 294 to standard gauze (251 evaluable participants), for a total of 505 evaluable patients. The median age of the entire cohort was 61 years (range 20-87). Four hundred ninety-five patients (98%) underwent laparotomy for malignancy. The trial was eventually stopped for futility after an interim analysis of 444 patients. The rate of wound complications was 17.3% in the negative pressure wound therapy (NPWT) group and 16.3% in the gauze group, absolute risk difference 1% (90% CI -4.5 to 6.5%; P=.77). Adjusted odds ratio controlling for estimated blood loss and diabetes was 0.99 (90% CI 0.62-1.60). Skin blistering occurred in 33 patients (13%) in the NPWT group and in three patients (1.2%) in the gauze group (P<.001). CONCLUSION: Negative pressure wound therapy after laparotomy for gynecologic surgery did not lower the wound complication rate but did increase skin blistering. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02682316. FUNDING SOURCE: The protocol was supported in part by KCI/Acelity.