Evaluating the influence of feedback on motor skill learning and motor performance for children with developmental coordination disorder: a systematic review.

Introduction: Children with developmental coordination disorder (DCD) have difficulties with learning and performing physical tasks. It is well known that task-specific practice is effective in improving motor skills. Additional feedback during practice may function as a quality improvement mechanism and therefore enhance motor skill outcomes. Aims: To investigate the effect of different forms of feedback on motor learning and motor performance in children with DCD. Methods: A systematic review was conducted (registration CRD42020175118) to investigate the effectiveness of different types of feedback, compared to other forms of feedback, or no additional feedback, on motor learning and motor performance outcomes in children with DCD. The search was run across six electronic databases (last search January 2024). Two reviewers independently screened studies for inclusion, assessed the quality of included studies, and extracted relevant data. A narrative synthesis was performed and included studies that assessed motor learning and/or performance outcomes following an intervention that delivered a specific form of feedback in comparison to another form of feedback or no specific feedback. Results: 14 articles from 13 trials were included in this review. Feedback was delivered by providing various forms of feedback, including: knowledge of results, focus of attention and augmented feedback delivered via technology. No significant differences were found between different forms of feedback for motor learning or performance outcomes for children with DCD. Interventions that used technology (with augmented feedback) to deliver the intervention were found to be as effective as traditional therapy. All groups who participated in therapy, regardless of the presence or type of feedback received, improved in overall scores on a motor performance outcome assessment. Conclusion: Despite the clear rationale for using feedback-oriented interventions for children with DCD, there is surprisingly limited and low-quality research. There is no clear evidence that one form of feedback is more effective than another, although it appears that feedback delivered via technology may be as effective as feedback delivered in traditional therapy interventions for children with DCD. Further exploration is required from appropriately powered and well-designed trials. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=175118, identifier (CRD42020175118).

Development and Co-design of NeuroOrb: A Novel "Serious Gaming" System Targeting Cognitive Impairment in Parkinson's Disease.

Whilst Parkinson's disease (PD) is typically thought of as a motor disease, a significant number of individuals also experience cognitive impairment (CI), ranging from mild-CI to dementia. One technique that may prove effective in delaying the onset of CI in PD is cognitive training (CT); however, evidence to date is variable. This may be due to the implementation of CT in this population, with the motor impairments of PD potentially hampering the ability to use standard equipment, such as pen-and-paper or a computer mouse. This may, in turn, promote negative attitudes toward the CT paradigm, which may correlate with poorer outcomes. Consequently, optimizing a system for the delivery of CT in the PD population may improve the accessibility of and engagement with the CT paradigm, subsequently leading to better outcomes. To achieve this, the NeuroOrb Gaming System was designed, coupling a novel accessible controller, specifically developed for use with people with motor impairments, with a "Serious Games" software suite, custom-designed to target the cognitive domains typically affected in PD. The aim of the current study was to evaluate the usability of the NeuroOrb through a reiterative co-design process, in order to optimize the system for future use in clinical trials of CT in individuals with PD. Individuals with PD (n = 13; mean age = 68.15 years; mean disease duration = 8 years) were recruited from the community and participated in three co-design loops. After implementation of key stakeholder feedback to make significant modifications to the system, system usability was improved and participant attitudes toward the NeuroOrb were very positive. Taken together, this provides rationale for moving forward with a future clinical trial investigating the utility of the NeuroOrb as a tool to deliver CT in PD.

Optimizing Cognitive Training for the Treatment of Cognitive Dysfunction in Parkinson's Disease: Current Limitations and Future Directions.

Cognitive dysfunction, primarily involving impairments in executive function, visuospatial function and memory, is one of the most common non-motor symptoms of Parkinson's disease (PD). Currently, the only pharmacological treatments available for the treatment of cognitive dysfunction in PD provide variable benefit, making the search for potential non-pharmacological therapies to improve cognitive function of significant interest. One such therapeutic strategy may be cognitive training (CT), which involves the repetition of standardized tasks with the aim of improving specific aspects of cognition. Several studies have examined the effects of CT in individuals with PD and have shown benefits in a variety of cognitive domains, but the widespread use of CT in these individuals may be limited by motor impairments and other concerns in study design. Here, we discuss the current state of the literature on the use of CT for PD and propose recommendations for future implementation. We also explore the potential use of more recent integrative, adaptive and assistive technologies, such as virtual reality, which may optimize the delivery of CT in PD.

Preliminary Analysis of a Wireless and Wearable Electronic-Textile EASI-Based Electrocardiogram.

Background: With cardiovascular disease continuing to be the leading cause of death and the primary reason for hospitalization worldwide, there is an increased burden on healthcare facilities. Electronic-textile (e-textile)-based cardiac monitoring offers a viable option to allow cardiac rehabilitation programs to be conducted outside of the hospital. Objectives: This study aimed to determine whether signals produced by an e-textile ECG monitor with textile electrodes in an EASI configuration are of sufficient quality to be used for cardiac monitoring. Specific objectives were to investigate the effect of the textile electrode characteristics, placement, and condition on signal quality, and finally to compare results to a reference ECG obtained from a current clinical standard the Holter monitor. Methods: ECGs during different body movements (yawning, deep-breathing, coughing, sideways, and up movement) and activities of daily living (sitting, sitting/standing from a chair, and climbing stairs) were collected from a baseline standard of normal healthy adult male using a novel e-textile ECG and a reference Holter monitor. Each movement or activity was recorded for 5 min with 2-min intervals between each recording. Three different textile area electrodes (40, 60, and 70 mm2) and electrode thicknesses (3, 5, and 10 mm) were considered in the experiment. The effect of electrode placement within the EASI configuration was also studied. Different signal quality parameters, including signal to noise ratio, approximate entropy, baseline power signal quality index, and QRS duration and QT intervals, were used to evaluate the accuracy and reliability of the textile-based ECG monitor. Results: The overall signal quality from the 70 mm2 textile electrodes was higher compared to the smaller area electrodes. Results showed that the ECGs from 3 and 5 mm textile electrodes showed good quality. Regarding location, placing the "A" and "I" electrodes on the left and right anterior axillary points, respectively, showed higher signal quality compared to the standard EASI electrode placement. Wet textile electrodes showed better signal quality compared to their dry counterparts. When compared to the traditional Holter monitor, there was no significant difference in signal quality, which indicated textile monitoring was as good as current clinical standards (non-inferior). Conclusion: The e-textile EASI ECG monitor could be a viable option for real-time monitoring of cardiac activities. A clinical trial in a larger sample is recommended to validate the results in a clinical population.

The Effect of Chronic Preoperative Opioid Use on Surgical Site Infections, Length of Stay, and Readmissions.

BACKGROUND: Chronic opioid use in the United States is a well-recognized public health concern with many negative downstream consequences. Few data exist regarding the use of preoperative opioids in relation to outcomes after elective colorectal surgery. OBJECTIVE: The purpose of this study was to determine if chronic opioid use before colorectal surgery is associated with a detriment in postoperative outcomes. DESIGN: This is a retrospective review of administrative data supplemented by individual chart review. SETTING: This study was conducted in a single-institution, multisurgeon, community colorectal training practice. PATIENTS: All patients undergoing elective colorectal surgery over a 3-year time frame (2011-2014) were selected. MAIN OUTCOME MEASURES: Opioid use was stratified based on total dose of morphine milligram equivalents (naive, sporadic use (>0-15 mg/day), regular use (>15-45 mg/day), and frequent use (>45 mg/day)). Primary outcomes were surgical site infections, length of hospital stay, and readmissions. RESULTS: Of the 923 patients, 23% (n = 213) were using opioids preoperatively. The preoperative opioid group contained more women (p = 0.047), underwent more open surgery (p = 0.003), had more nonmalignant indications (p = 0.013), and had a higher ASA classification (p = 0.003). Although median hospital stay was longer (4.7 days vs 4.0, p < 0.001), there was no difference in any surgical site infections (10.3% vs 7.1%, p = 0.123) or readmissions (14.2% vs 14.1%, p=0.954). Multivariable analysis identified preoperative opioid use (17.0% longer length of stay; 95% CI, 6.8%-28.2%) and ASA 3 or 4 (27.2% longer length of stay; 95% CI, 17.1-38.3) to be associated with an increase in length of stay. LIMITATIONS: Retrospectively abstracted opioid use and small numbers limit the conclusions regarding any dose-related responses on outcomes. CONCLUSIONS: Although preoperative opioid use was not associated with an increased rate of surgical site infections or readmissions, it was independently associated with an increased hospital length of stay. Innovative perioperative strategies will be necessary to eliminate these differences for patients on chronic opioids. See Video Abstract at http://links.lww.com/DCR/B280. EFECTOS DEL CONSUMO CRÓNICO DE OPIOIDES EN EL PREOPERATORIO CON RELACIÓN A LAS INFECCIONES DE LA HERIDA QUIRÚRGICA, LA DURACIÓN DE LA ESTADÍA Y LA READMISIÓN: El consumo crónico de opioides en los Estados Unidos es un problema de salud pública bien reconocido a causa de sus multiples consecuencias negativas ulteriores. Existen pocos datos sobre el consumo de opioides en el preoperatorio relacionado con los resultados consecuentes a una cirugía colorrectal electiva.El propósito es determinar si el consumo crónico de opioides antes de la cirugía colorrectal se asocia con un detrimento en los resultados postoperatorios.Revisión retrospectiva de datos administrativos complementada por la revisión de un gráfico individual.Ejercicio durante la formación de multiples residentes en cirugía colorrectal enTodos los pacientes de cirugía colorrectal electiva durante un período de 3 años (2011-2014).El uso de opioides se estratificó en función de la dosis total de equivalentes de miligramos de morfínicos (uso previo, uso esporádico [> 0-15 mg / día], uso regular (> 15-45 mg / día) y uso frecuente (> 45 mg / día)). Los resultados primarios fueron las infecciones de la herida quirúrgica, la duración de la estadía hospitalaria y la readmisión.De los 923 pacientes, el 23% (n = 213) consumían opioides antes de la operación. El grupo con opioides preoperatorios tenía más mujeres (p = 0.047), se sometió a una cirugía abierta (p = 0.003), tenía mas indicaciones no malignas (p = 0.013) y tenía una clasificación ASA más alta (p = 0.003). Aunque la mediana de la estadía hospitalaria fue más larga (4,7 días frente a 4,0; p <0,001), no hubo diferencia en ninguna infección de la herida quirúrgica (10,3% frente a 7,1%, p = 0,123) o las readmisiones (14,2% frente a 14,1%, p = 0,954). El análisis multivariable identificó que el uso de opioides preoperatorios (17.0% más larga LOS; IC 95%: 6.8%, 28.2%) y ASA 3 o 4 (27.2% más larga LOS; IC 95%: 17.1, 38.3) se asocia con un aumento en LOS.La evaluación retrospectiva poco precisa del consumo de opioides y el pequeño número de casos limitan las conclusiones sobre cualquier respuesta relacionada con la dosis - resultado.Si bien el consumo de opioides preoperatorios no se asoció con un aumento en la tasa de infecciones de la herida quirúrgica o las readmisiones, ella se asoció de forma independiente con un aumento de la LOS hospitalaria. Serán necesarias estrategias perioperatorias innovadoras para eliminar estas diferencias en los pacientes consumidores cronicos de opioides. Consulte Video Resumen en http://links.lww.com/DCR/B280.

Electronic textile-based electrocardiogram monitoring in cardiac patients: a scoping review.

OBJECTIVE: The objectives of this scoping review were to explore, organize and present the existing research literature on the use of electronic textile (e-textile)-based resting, signal-averaged, ambulatory or exercise electrocardiogram (ECG) monitoring to evaluate the application of e-textile technologies for ECG cardiac monitoring. INTRODUCTION: E-textile-based ECG monitoring of cardiac patients offers a possible new alternative for in-hospital monitoring and post-discharge monitoring during cardiac rehabilitation. INCLUSION CRITERIA: Studies that included patients (inpatients or outpatients) who qualified for cardiac rehabilitation programs or continuous ambulatory ECG monitoring were considered. The key concepts that were addressed included resting, signal-averaged, ambulatory or exercise ECG monitoring based on e-textile technologies or e-textile-based cardiac rehabilitation. Studies were excluded if they focused only on specific aspects of the e-textile ECG system rather than a complete ECG system. METHODS: Research reports, dissertations or books that evaluated e-textile-based ECG monitoring of cardiac patients in a hospital or at home, written in English, and published between January 2000 and March 2018 were considered for inclusion. Published and unpublished literature was located through databases including Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed Central (PMC), Institute of Electrical and Electronics Engineers (IEEE Xplore), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews, Web of Science, Scopus, Expanded Academic ASAP, ProQuest Dissertations and Theses Global, SPORTDiscus, and ENGINE-Australian Engineering Database (Informit). Two independent reviewers screened citations for inclusion while the third reviewer resolved any discrepancies. Meta-data from each study were extracted, and a narrative summary was used to present the results. Furthermore, 38 study authors were contacted to request missing or additional data as required, with 16 responding within eight weeks. RESULTS: Of the 207 studies that were eligible for full-text review, only 8% (n = 17) were included in the final study. Eighty-eight percent (n = 15) of included studies were conducted with an adult population, and 11 studies reported an in-hospital application. Only three groups of researchers reported e-textile integration beyond the textile electrodes, mostly in the form of wiring and custom-made printed circuit boards. Eight studies utilized two ECG sensors, while single-lead ECG was the most common configuration, used in 10 studies. ECG result was the primary parameter reported across the included studies. Resting ECG was the most common form of ECG acquired (n = 10), followed by exercise ECG (n = 6) and ambulatory ECG (n = 5). Eight studies addressed the issue of power requirements, and seven studies used Bluetooth for wireless communication. The primary problem reported across all studies was noise from motion artifact. CONCLUSIONS: The recent advances in signal quality and noise reduction for e-textile-based ECG applications are promising. However, the use of a 12-lead, personalized, home-based cardiac rehabilitation monitor system containing fully textile-integrated electronics with diagnostic capability is yet to be reported. Therefore, there is potential for future research in this area. Additionally, motion artifact continues to be a challenge.

A Modular Hybrid Exoskeletal-Soft Glove for High Degree of Freedom Monitoring Capability.

In this paper, we present a hybrid exoskeletal-soft glove for the application of on-axis angle sensors that can be placed close to the center of rotation of the digit joints. 3D printed exoskeletal digit segments that run medially on most digits connect to low friction bearings. Exoskeletal segments and bearings provide rigid fixation points for a variety of traditional angle sensors, while a combination of textile and rigid structure fixate exoskeletal digits to the digits and hand. Exoskeletal digits are designed modularly so that only required digits are used and to reduce difficulty in donning and doffing. On-axis measurement may prove useful in control or assessment tasks in rehabilitation. The articulation of the digits while wearing the glove is demonstrated, albeit without sensors, showing little restriction at an early stage of the design process. Exoskeletal metacarpophalangeal joints of the 3rd and 4th digits require more work as the flexion/extension joint axis is inaccessible and moves when he digits are articulated. The proposed device must be customized for an individual and will facilitate an alternative approach to existing hand posture monitoring techniques.

Electronic textile electrocardiogram monitoring in cardiac patients: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: This scoping review aims to explore and scope the literature and research on the use of e-textile electrocardiogram (ECG) monitoring in cardiac patients and provide a unique contribution to the available evidence. The objectives of this scoping review are:The questions of this review are.

Assistive technology products: a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit.

This paper is based on work from the Global Research, Innovation, and Education on Assistive Technology (GREAT) Summit that was coordinated by WHO's Global Cooperation on Assistive Technology (GATE). The purpose of this paper is to describe the needs and opportunities embedded in the assistive product lifecycle as well as issues relating to the various stages of assistive product mobilization worldwide. The paper discusses assistive technology product terminology and the dangers of focusing on products outside the context and rolling out products without a plan. Additionally, the paper reviews concepts and issues around technology transfer, particularly in relation to meeting global needs and among countries with limited resources. Several opportunities are highlighted including technology advancement and the world nearing a state of readiness through a developing capacity of nations across the world to successfully adopt and support the assistive technology products and applications. The paper is optimistic about the future of assistive technology products reaching the people that can use it the most and the excitement across large and small nations in increasing their own capacities for implementing assistive technology. This is expressed as hope in future students as they innovate and in modern engineering that will enable assistive technology to pervade all corners of current and potential marketplaces. Importantly, the paper poses numerous topics where discussions are just superficially opened. The hope is that a set of sequels will follow to continue this critical dialog. Implications for Rehabilitation Successful assistive technology product interventions are complex and include much more than the simple selection of the right product. Assistive technology product use is highly context sensitive in terms of an individual user's environment. The development of assistive technology products is tricky as it must be contextually sensitive to the development environment and market as well. As a field we have much to study and develop around assistive technology product interventions from a global perspective.

Biological effects of Ni(II) on monocytes and macrophages in normal and hyperglycemic environments.

Corrosion and release of nickel ions from biomedical alloys are well documented, but little is still known about the effects of released nickel ions on cellular function with recurrent inflammatory challenges. Evidence suggests Ni(II) ions amplify LPS-induced secretion of several pro-inflammatory cytokines from monocytes. Exacerbating the inflammatory response, hyperglycemic conditions also affect monocytic function. This study investigated how Ni(II) and hyperglycemic conditions, both singly and in combination, alter monocyte proliferation, mitochondrial activity, inflammatory responses, and differentiation. Results showed that Ni(II) did not affect proliferation, but decreased mitochondrial activity in monocytic-cells and macrophages under normal conditions. However, hyperglycemic conditions negated the toxicity seen with Ni(II) exposure. Cytokine secretion in response to LPS was variable, with little effect on IL6 secretion, but significantly increased secretion of IL1ß at intermediate Ni(II) concentrations. Hyperglycemic conditions did not alter these results significantly. Finally, exposure to eluants from nickel-based commercial alloys caused enhanced IL1ß secretion from PMA-treated cells. These data suggest that corrosion products from nickel-containing dental alloys increased Ni(II)-induced changes in cytokine secretion by monocytes and macrophages. By better defining the effects of Ni(II) at these lower, biomedically relevant concentrations, we improve understanding of the biomedical alloy risk in the context of dental inflammation. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A:2433-2439, 2018.

Release of calcium ions from particulate monosodium titanates for dental mineralization applications.

PURPOSE: The calcium ion [Ca(II)] release from monosodium titanates (MST) complexed to calcium ions [Ca(II)], referred to as MST-Ca(II), was examined under varying incubation times, pH conditions, and ion equilibrium disruptions. METHODS: Sample supernatants were analyzed for Ca(II) using the QuantiChrom Calcium Assay Kit. RESULTS: No Ca(II) was detected in native MST (control) supernatants but was detected in MST-Ca(II) supernatants. At pH 7, Ca(II) release increased from 0 to 2.5 mg/dL over 3 days (P< 0.05 compared to MST control), remaining constant over the completed incubation times. At pH 5, 15 mg/dL of Ca(II) was immediately released with no further release. When the pH was modulated pH 4 to pH 9, Ca(II) concentration dropped from 25 mg/dL to ~0 mg/dL. Finally, when equilibrium was disrupted by partial replacement of the supernatant with sterile water, Ca(II) release was ongoing, reaching a cumulative total of 20 mg/dL over 35 days. CLINICAL SIGNIFICANCE: The current results suggest that particulate MST-Ca(II) complexes exhibit sustained release of calcium, and that release might be customized by conditions of pH and ionic strength. Thus, these complexes appear promising for biological applications where calcium-mediated mineralization or re-mineralization are desired.

Resident impact on operative duration for elective general surgical procedures.

BACKGROUND: Resident involvement in operations increases operative duration. This study investigated resident impact on operative time for a single general surgeon in an outpatient surgical setting. METHODS: A retrospective review was performed of index general surgical operations meeting inclusion criteria. Operative duration, patient demographics, 30-day complication/readmission rates, and degree of resident involvement were collected. RESULTS: 625 cases were analyzed. Patient demographics were similar for all procedural comparison groups. Operative time increased with resident involvement for each operation-umbilical hernia repairs were associated with a 19% increase (22.3 ± 6.7 versus 26.5 ± 7.5 min, p = 0.002), laparoscopic cholecystectomies demonstrated a 15% increase (25.8 ± 8.7 versus 29.7 ± 10.2 min, p = 0.001), and laparoscopic inguinal hernia repairs demonstrated a 25% increase (32.1 ± 11.3 versus 40.2 ± 8.9 min, p < 0.001). CONCLUSIONS: Each surgeon must decide if the increase in operative duration caused by resident involvement is justified by the intangible benefits residents provide.

Synthesis and Reaction Chemistry of Nanosize Monosodium Titanate.

This paper describes the synthesis and peroxide-modification of nanosize monosodium titanate (nMST), along with an ion-exchange reaction to load the material with Au(III) ions. The synthesis method was derived from a sol-gel process used to produce micron-sized monosodium titanate (MST), with several key modifications, including altering reagent concentrations, omitting a particle seed step, and introducing a non-ionic surfactant to facilitate control of particle formation and growth. The resultant nMST material exhibits spherical-shaped particle morphology with a monodisperse distribution of particle diameters in the range from 100 to 150 nm. The nMST material was found to have a Brunauer-Emmett-Teller (BET) surface area of 285 m(2)g(-1), which is more than an order of magnitude higher than the micron-sized MST. The isoelectric point of the nMST measured 3.34 pH units, which is a pH unit lower than that measured for the micron-size MST. The nMST material was found to serve as an effective ion exchanger under weakly acidic conditions for the preparation of an Au(III)-exchange nanotitanate. In addition, the formation of the corresponding peroxotitanate was demonstrated by reaction of the nMST with hydrogen peroxide.

Cytotoxicity of Titanate-Calcium Complexes to MC3T3 Osteoblast-Like Cells.

Monosodium titanates (MST) are a relatively novel form of particulate titanium dioxide that have been proposed for biological use as metal sorbents or delivery agents, most recently calcium (II). In these roles, the toxicity of the titanate or its metal complex is crucial to its biological utility. The aim of this study was to determine the cytotoxicity of MST and MST-calcium complexes with MC3T3 osteoblast-like cells; MST-Ca(II) complexes could be useful to promote bone formation in various hard tissue applications. MC3T3 cells were exposed to native MST or MST-Ca(II) complexes for 24-72 h. A CellTiter-Blue® assay was employed to assess the metabolic activity of the cells. The results showed that MST and MST-Ca(II) suppressed MC3T3 metabolic activity significantly in a dose-, time-, and cell-density-dependent fashion. MST-Ca(II) suppressed MC3T3 metabolism in a statistically identical manner as native MST at all concentrations. We concluded that MST and MST-Ca(II) are significantly cytotoxic to MC3T3 cells through a mechanism yet unknown; this is a potential problem to the biological utility of these complexes.

Titanates and Titanate-Metal Compounds in Biological Contexts.

Metal ions are notorious environmental contaminants, some causing toxicity at exquisitely low (ppm-level) concentrations. Yet, the redox properties of metal ions make them attractive candidates for bio-therapeutics. Titanates are insoluble particulate compounds of titanium and oxygen with crystalline surfaces that bind metal ions; these compounds offer a means to scavenge metal ions in environmental contexts or deliver them in therapeutic contexts while limiting systemic exposure and toxicity. In either application, the toxicological properties of titanates are crucial. To date, the accurate measurement of the in vitro toxicity of titanates has been complicated by their particulate nature, which interferes with many assays that are optical density (OD)-dependent, and at present, little to no in vivo titanate toxicity data exist. Compatibility data garnered thus far for native titanates in vitro are inconsistent and lacking in mechanistic understanding. These data suggest that native titanates have little toxicity toward several oral and skin bacteria species, but do suppress mammalian cell metabolism in a cells-pecific manner. Titanate compounds bind several types of metal ions, including some common environmental toxins, and enhance delivery to bacteria or cells. Substantial work remains to address the practical applicability of titanates. Nevertheless, titanates have promise to serve as novel vehicles for metal-based therapeutics or as a new class of metal scavengers for environmental applications.

Plasma filtering techniques for nuclear waste remediation.

Nuclear waste cleanup is challenged by the handling of feed stocks that are both unknown and complex. Plasma filtering, operating on dissociated elements, offers advantages over chemical methods in processing such wastes. The costs incurred by plasma mass filtering for nuclear waste pretreatment, before ultimate disposal, are similar to those for chemical pretreatment. However, significant savings might be achieved in minimizing the waste mass. This advantage may be realized over a large range of chemical waste compositions, thereby addressing the heterogeneity of legacy nuclear waste.

In vitro biological response of micro- and nano-sized monosodium titanates and titanate-metal compounds.

Previous studies report that microsized monosodium titanates (MSTs) deliver metal ions and species to mammalian cells and bacteria with cell-specific and metal-specific effects. In this study, we explored the use of MST and a new synthesized nanosized monosodium titanate (nMST) to deliver gold(III), cisplatin, or platinum(IV) to two human cell lines with different population doubling times, in vitro. The effect was measured using a fluorescent mitochondrial activity assay (CellTiter-Blue(®) Assay). This fluorescence assay was implemented to mitigate optical density measurement errors owing to particulate titanate interference and allowed for the studies to be extended to higher titanate concentrations than previously possible. Overall, native MST significantly (p < 0.05) decreased mitochondrial activity of both cell types by 50% at concentrations of >50 mg/L. Native nMST significantly suppressed the rapidly dividing cell line (by 50%) over untreated cultures, but had no effect on the more slowly dividing cells. For both cell types, increased titanate concentrations resulted in increased effects from delivered metals. However, there was no difference in the effect of metal delivered from micro- versus nano-sized MST.

The effects of ecology and evolutionary history on robust capuchin morphological diversity.

Recent molecular work has confirmed the long-standing morphological hypothesis that capuchins are comprised of two distinct clades, the gracile (untufted) capuchins (genus Cebus, Erxleben, 1777) and the robust (tufted) capuchins (genus Sapajus Kerr, 1792). In the past, the robust group was treated as a single, undifferentiated and cosmopolitan species, with data from all populations lumped together in morphological and ecological studies, obscuring morphological differences that might exist across this radiation. Genetic evidence suggests that the modern radiation of robust capuchins began diversifying ∼2.5 Ma, with significant subsequent geographic expansion into new habitat types. In this study we use a morphological sample of gracile and robust capuchin craniofacial and postcranial characters to examine how ecology and evolutionary history have contributed to morphological diversity within the robust capuchins. We predicted that if ecology is driving robust capuchin variation, three distinct robust morphotypes would be identified: (1) the Atlantic Forest species (Sapajus xanthosternos, S. robustus, and S. nigritus), (2) the Amazonian rainforest species (S. apella, S. cay and S. macrocephalus), and (3) the Cerrado-Caatinga species (S. libidinosus). Alternatively, if diversification time between species pairs predicts degree of morphological difference, we predicted that the recently diverged S. apella, S. macrocephalus, S. libidinosus, and S. cay would be morphologically comparable, with greater variation among the more ancient lineages of S. nigritus, S. xanthosternos, and S. robustus. Our analyses suggest that S. libidinosus has the most derived craniofacial and postcranial features, indicative of inhabiting a more terrestrial niche that includes a dependence on tool use for the extraction of imbedded foods. We also suggest that the cranial robusticity of S. macrocephalus and S. apella are indicative of recent competition with sympatric gracile capuchin species, resulting in character displacement.

Old dogs and new tricks: length of stay for appendicitis improves with an acute care surgery program and transition from private surgical practice to multispecialty group practice.

Acute care surgery (ACS) programs have emerged mainly at academic medical centers to provide timely care for emergency general surgery and trauma patients. We hypothesized that the development of an ACS program in a multispecialty group practice would improve outcomes for patients with acute appendicitis. A retrospective analysis of patients with acute appendicitis was performed in two time periods: 18 months of private practice and the following 12 months with ACS coverage. Length of stay was the primary outcome measure. A total of 871 patients were studied (526 private practice, 345 ACS). The ACS group had a greater proportion of laparoscopic appendectomies (P < 0.001) and more transitions in care between surgeons (P < 0.001). Length of stay was shorter in the ACS group (1.6 ± 1.5 [mean ± standard deviation] vs 1.9 ± 2.4 days, P = 0.01) and a greater proportion of surgeries were performed during the daytime (44.9 vs 36.6%, P = 0.02). Multivariate analysis demonstrated length of stay was related to appendicitis grade (P < 0.001), American Society of Anesthesiologists class (P < 0.001), symptom duration (P = 0.001), and laparoscopic approach (P < 0.001). The initial transition from private practice to ACS resulted in decreased length of stay with no increase in morbidity related to transitions of surgical care in patients with appendicitis.

Evaluation of tertiary pyridine resin for the separation of lanthanides by simulated moving-bed chromatography.

Lanthanide separation by simulated moving-bed chromatography was studied as a model system for separating lanthanide fission products and minor actinides from used nuclear fuels. The simulated moving-bed system was modeled for a tertiary pyridine anion-exchange resin supported on silica particles as the stationary phase and a mixture of methanol and 1 M nitric acid as the mobile phase. Pulse injection tests using a single packed column were used to obtain chromatographic parameters for mathematical modeling of the simulated moving-bed system. Higher concentrations of methanol improved the separation, but the chromatograms showed evidence of nonlinearity of the isotherms. The mathematical model of the simulated moving-bed process predicted a production rate of purified samarium and neodymium at 118 g solute/L resin/day and a purity of 99.5%. The optimal methanol ratio for the production rate for various product purities was determined from the model. The excellent separation of Nd and Sm suggests that the simulated moving-bed system could be applied to the separation of minor actinides such as americium and curium.