Reasons Not to Turf a Patient Whose "Belonging" in a Hospital Is Unclear.

Through the lens of metaphor and the arts, this article aims to illuminate how persons who are ill tarry through uncertainty to receive care, and, in response, clinicians must resist turfing such patients in a health system that often confers upon patients unclear criteria for belonging. In addition, this article considers relationships among clinicians, patients, and their loved ones through the perspectives of Maris and Ludlow, characters in the book, A Hospital Odyssey, by Gwyneth Lewis. The article suggests that engaged curiosity and empathy are helpful responses to clinical detachment, distraction, and disengagement.

Highly efficient lead removal from water by Nd0.90Ho0.10FeO3 nanoparticles and studying their optical and magnetic properties.

Ho-doped NdFeO3 was synthesized using the citrate method. The X-ray diffraction (XRD) illustrated that Nd0.90Ho0.10FeO3 was crystalline at the nanoscale, with a crystallite size of 39.136 nm. The field emission scanning electron microscope (FESEM) illustrated the porous nature of Nd0.90Ho0.10FeO3, which increases the active sites to absorb the heavy metals on the sample surface. Energy-dispersive X-ray (EDX) data assures the prepared sample has the chemical formula Nd0.90Ho0.10FeO3. The magnetic properties of Nd0.90Ho0.10FeO3 were determined using the magnetization hysteresis loop and Faraday's method. Many magnetic parameters of the sample have been discussed, such as the coercive field, the exchange bias (Hex), and the switching field distribution (SFD). Ho-doped NdFeO3 has an antiferromagnetic (AFM) character with an effective magnetic moment of 3.903 B.M. The UV-visible light absorbance of Nd0.90Ho0.10FeO3 is due to the transfer of electrons from the oxygen 2p state to the iron 3d state. Nd0.90Ho0.10FeO3 nanoparticles have an optical direct transition with an energy gap Eg = 1.106 eV. Ho-doped NdFeO3 can adsorb many heavy metals (Co2+, Ni2+, Pb2+, Cr6+, and Cd2+) from water. The removal efficiency is high for Pb2+ ions, which equals 72.39%. The Langmuir isotherm mode is the best-fit model for adsorbing the Pb2+ ions from water.

A facile novel synthesis of AgCuO2 delafossite nanoparticles and evaluation of their antimicrobial activity.

Bi-functional nano-oxides are of growing interest to address environmental issues. In the present study, the structural and magnetic data are presented together with the antimicrobial activities (AMA). For the first time, silver delafossite oxide (AgCuO2) is successfully fabricated using a simple, low-cost technique to target antibiotic photodegradation and inactivation of model waterborne pathogens. It is prepared with an equimolar initial Ag+:Cu+ concentration ratio. The structure, morphology, and magnetic properties are studied by different characterization techniques. The size and shape of AgCuO2 NPs, in addition to their structural polytypes of 2H (hexagonal) or 3R (rhombohedral), are dependent on the preparation conditions. The existence of Cu, Ag, and O in the synthesized delafossite AgCuO2 NPs with no evidence of any impurity is ratified by the XPS spectrum. AFM measurements are taken to characterize the surface morphologies of AgCuO2. The distributed spiks are evaluated by roughness kurtosis (Rku). The roughness kurtosis has a value of 2.65 (< 3), indicating that the prepared sample is classified as bumpy. The prepared sample has 13.0, 10.0, 14.0, and 14.0 mm Inhibition Zone Diameter (IZD) antimicrobial activity against gram-positive Bacillus subtilis (B. subtilis), Bacillus cereus (B. cereus), Enterococcus faecalis (E. faecalis), and Staphylococcus aureus (S. aureus), respectively. The IZD for gram-negative Escherichia coli (E. coli), Neisseria Gonorrhoeae (N. Gonorrhoeae), Pseudomonas aeruginosa (P. aeruginosa), and Salmonella typhimrium (S. typhimrium) were found to be 12.0, 13.0, 14.0, and 13.0 mm, respectively. Therefore, the AgCuO2 NPs reveal excellent antimicrobial efficiency, and they can be effortlessly separated using a tiny magnet or a simple magnetic separator. The adequate cytotoxicity and magnetic characteristics of the antimicrobial sample suggest a promising future for it in biomedical applications.

A programme to improve quality of care for patients with chronic diseases, Kazakhstan.

OBJECTIVE: To evaluate the effect of a disease management programme in Kazakhstan on quality indicators for patients with hypertension, diabetes and chronic heart failure. METHODS: A supportive, interdisciplinary, quality improvement programme was implemented between November 2014 and November 2015 at seven polyclinics in Pavlodar and Petropavlovsk. Quality improvement teams were established at each clinic and quality improvement tools were introduced, including patient flowsheets, decision support tools, patient registries, a patient recall process, support for patient self-management and patient follow-up with intensity adjusted for level of disease control. Clinic teams met for four 3-day interactive learning sessions within 1 year, with additional coaching visits. Implementation was managed by five local coordinators and consultants trained by international consultants. National and regional steering committees monitored progress. FINDINGS: Between July and October 2015, the proportion of hypertensive patients with the recommended blood pressure increased from 24% (101/424) to 56% (228/409). Among patients with diabetes, the proportion who recently underwent eye examinations increased from 26% (101/391) to 71% (308/433); the proportion who had their low-density lipoprotein cholesterol measured increased from 57% (221/391) to 85% (369/433); and the proportion who had their albumin : creatinine ratio measured increased from 11% (44/391) to 49% (212/433). The proportion of chronic heart failure patients who underwent echocardiography rose from 91% (128/140) to 99% (157/158). All patients set themselves self-management goals. CONCLUSION: This intensive, supportive, multifaceted programme was associated with significant improvements in quality of care for patients with chronic disease. Further investment in coaching capacity is needed to extend the programme nationally.

Analysis of Accredited Gastroenterology Fellowship Internet-Available Content: Twenty-Nine Steps Toward a Better Program Website.

GOAL: To assess publicly available content derived from official websites of accredited gastroenterology fellowship programs, specifically evaluating data pertinent to prospective applicants. BACKGROUND: The Internet provides access to key information for applicants applying to gastroenterology fellowship, particularly as competition drives applicants to apply to a large number of programs. Thus, it is important for fellowship program websites to be up to date and contain accurate and pertinent information. METHODS: Twenty-nine variables, determined as important website content on the basis of prior published website analyses and from surveys of preferences, were extracted from the relevant websites of all accredited gastroenterology fellowships in the USA. Results were binary-i.e., a website either contained or did not contain each item. RESULTS: A total of 178 websites were evaluated. The mean number of online content items was 14.1(± 3.2 SD) out of a possible 29 (47.1%). Program coordinator contact information, application information, and the number of current fellows were accessible on > 80% of websites. In contrast, the typical number and types of procedures performed by fellows and number of hospitals covered by fellows on call were found on < 10% of websites. Analysis revealed that 23.2% of lifestyle, 48.3% of training, and 59.6% of program variables were met. CONCLUSIONS: Gastroenterology fellowship websites lacked important content. Websites had a lower mean percentage of lifestyle content compared to training and program-related items. An organized website containing relevant information may not only attract qualified applicants but also avert unnecessary email inquiries and inappropriate applications. This study may provide guidance to gastroenterology fellowship programs seeking to improve their websites for applicants.

Light- and bias-induced structural variations in metal halide perovskites.

Organic-inorganic metal halide perovskites have gained considerable attention for next-generation photovoltaic cells due to rapid improvement in power conversion efficiencies. However, fundamental understanding of underlying mechanisms related to light- and bias-induced effects at the nanoscale is still required. Here, structural variations of the perovskites induced by light and bias are systematically investigated using scanning probe microscopy techniques. We show that periodically striped ferroelastic domains, spacing between 40 to 350 nm, exist within grains and can be modulated significantly under illumination as well as by electric bias. Williamson-Hall analysis of X-ray diffraction results shows that strain disorder is induced by these applied external stimuli. We show evidence that the structural emergence of domains can provide transfer pathways for holes to a hole transport layer with positive bias. Our findings point to potential origins of I-V hysteresis in halide perovskite solar cells.

Generalization of exponential based hyperelastic to hyper-viscoelastic model for investigation of mechanical behavior of rate dependent materials.

In this research, the exponential stretched based hyperelastic strain energy was generalized to the hyper-viscoelastic model using the heredity integral of deformation history to take into account the strain rate effects on the mechanical behavior of materials. The heredity integral was approximated by the approach of Goh et al. to determine the model parameters and the same estimation was used for constitutive modeling. To present the ability of the proposed hyper-viscoelastic model, the stress-strain response of the thermoplastic elastomer gel tissue at different strain rates from 0.001 to 100/s was studied. In addition to better agreement between the current model and experimental data in comparison to the extended Mooney-Rivlin hyper-viscoelastic model, a stable material behavior was predicted for pure shear and balance biaxial deformation modes. To present the engineering application of current model, the Kolsky bars impact test of gel tissue was simulated and the effects of specimen size and inertia on the uniform deformation were investigated. As the mechanical response of polyurea was provided over wide strain rates of 0.0016-6500/s, the current model was applied to fit the experimental data. The results were shown more accuracy could be expected from the current research than the extended Ogden hyper-viscoelastic model. In the final verification example, the pig skin experimental data was used to determine parameters of the hyper-viscoelastic model. Subsequently, a specimen of pig skin at different strain rates was loaded to a fixed strain and the change of stress with time (stress relaxation) was obtained. The stress relaxation results were revealed the peak stress increases by applied strain rate until the saturated loading rate and the equilibrium stress with magnitude of 0.281MPa could be reached.

Preventing sintering of nanoclusters on graphene by radical adsorption.

Metal nanoclusters, supported on inert substrates, exhibiting well-defined shapes and sizes in a broad range of temperatures are a major object of desire in nanotechnology. Here, a technique is presented that improves the thermal stability of monodisperse and crystalline transition metal nanoclusters grown in a regular array on metal-supported graphene. To stabilize the clusters after growth under ultrahigh vacuum the system composed of the aggregates and the graphene/metal interface is exposed to radicals resulting from the dissociation of diatomic gases. As a model system we have used Pt as the metal element for cluster growth and the template consisting of the moiré pattern resulting from the lattice mismatch between graphene and the Ir(111) surface. The study has been performed for deuterium and oxygen radicals, which interact very differently with graphene. Our results reveal that after radical exposure the thermally activated motion of Pt nanoclusters to adjacent moiré cells and the subsequent sintering of neighbor aggregates are avoided, most pronounced for the case of atomic O. For the case of D the limits of the improvement are given by radical desorption, whereas for the case of O they are defined by an interplay between coalescence and graphene etching followed by Pt intercalation, which can be controlled by the amount of exposure. Finally, we determined the mechanism of how radical adsorption improves the thermal stability of the aggregates.

Illness beliefs among patients with chronic widespread pain - associations with self-reported health status, anxiety and depressive symptoms and impact of pain.

BACKGROUND: Chronic widespread pain (CWP) is a disabling condition associated with a decrease in health. Illness beliefs are individual and are acquired during life. Constraining beliefs may prevent patients from regaining health. Understanding these patients' illness beliefs may be a way to improve the health care they are offered. The aim of this study was to describe illness beliefs among patients with CWP and associations with self-reported health, anxiety and depressive symptoms, and impact of pain. METHOD: In this cross-sectional study, questionnaires were sent by mail to 330 patients including socio-demographic information, the Illness Perception Questionnaire (IPQ-R), the Short-Form General Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Data were analysed using descriptive statistics, non-parametric tests and linear regression analyses. RESULTS: Patients experienced and related a high number of symptoms to CWP (mean (SD) 9 (3)). The patients believed their illness to be long lasting, to affect their emotional well being, and to have negative consequences for their lives. Some 72% reported having severe or very severe pain, and impact of pain according to SF-36 was negatively correlated to several illness beliefs dimensions, anxiety- and depressive symptoms. In regression analyses, the Identity, Consequences and Personal control dimensions of IPQ-R and Anxiety- and Depressive symptoms explained 32.6-56.1% of the variance in the two component scores of SF-36. CONCLUSION: Constraining illness beliefs in patients with CWP are related to worse health status, especially in cases of high number of physical or mental symptoms, beliefs of negative consequences or the illness affecting them emotionally. Identification and understanding of these beliefs may reduce patients' suffering if they are taken into consideration in rehabilitation programs and in development of new evidence-based interventions aimed at increasing health in patients with CWP.

Antibacterial activity and composition of the essential oil of Nepeta hormozganica Jamzad from Iran.

The composition and antibacterial activity of the essential oil of the aerial flowering parts of Nepeta hormozganica Jamzad have been studied. Analysis of the oil was conducted by GC-FID and GC-MS. Thirty-two components were characterized accounting for 99.4% of the total oil. Oxygenated monoterpenes (87.5%) were found to be the predominant group of compounds, of which 18-cineole (65.0%) and 4aα-7α-7aß-nepetalactone (13.0%) were the main constituents. The antibacterial activity of the essential oil and its main constituents showed that all of the tested microorganisms were highly inhibited by the essential oil with inhibition zones ranged from 12 to 24 mm. The most sensitive bacteria were Staphylococcus aureus and Staphylococcus epidermidis with the lowest MIC values of 0.3 and 0.6 mg/mL, respectively. Considering sensitivity screening it is conceivable that the activity of the oil from N. hormozganica could be attributed mainly to the synergistic property of 18-cineole and nepetalactone.

The SPECIES beamline at the MAX IV Laboratory: a facility for soft X-ray RIXS and APXPS.

SPECIES is an undulator-based soft X-ray beamline that replaced the old I511 beamline at the MAX II storage ring. SPECIES is aimed at high-resolution ambient-pressure X-ray photoelectron spectroscopy (APXPS), near-edge X-ray absorption fine-structure (NEXAFS), X-ray emission spectroscopy (XES) and resonant inelastic X-ray scattering (RIXS) experiments. The beamline has two branches that use a common elliptically polarizing undulator and monochromator. The beam is switched between the two branches by changing the focusing optics after the monochromator. Both branches have separate exit slits, refocusing optics and dedicated permanent endstations. This allows very fast switching between two types of experiments and offers a unique combination of the surface-sensitive XPS and bulk-sensitive RIXS techniques both in UHV and at elevated ambient-pressure conditions on a single beamline. Another unique property of the beamline is that it reaches energies down to approximately 27 eV, which is not obtainable on other current APXPS beamlines. This allows, for instance, valence band studies under ambient-pressure conditions. In this article the main properties and performance of the beamline are presented, together with selected showcase experiments performed on the new setup.

Effects of Photobiomodulation and Mesenchymal Stem Cells on Articular Cartilage Defects in a Rabbit Model.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of the application of cultured autologous bone marrow mesenchymal stem cells (BMSCs) with scaffold and low-level laser therapy (LLLT) on the repair of articular cartilage defects in rabbits. BACKGROUND DATA: For healing of the articular cartilage defects, although positive effects of BMSCs and LLLT have been demonstrated, their combination effect is still unknown; therefore, we investigated combining these two techniques has a synergistic effect. MATERIALS AND METHODS: After bone marrow aspiration from 10 rabbits, BMSCs were isolated, cultured in monolayer, suspended on a type I collagen scaffold and then implanted onto a full-thickness osteochondral defect (4 mm in diameter), artificially made on the patellar groove of both knees in the same rabbits. Then a knee was selected randomly in each rabbit as the experimental group, and subjected to Ga-Al-As (810 nm) laser irradiation with energy density of 4 J/cm2 every other day for 3 weeks. As the control group, the other knee did not receive LLLT. After this period, animals were euthanized and osteochondral defects were evaluated by histomorphometric methods. RESULTS: No significant difference in new cartilage formation and inflammation was found between the groups (p > 0.05). However, there was significantly more new bone formation in the experimental group (p < 0.05). CONCLUSIONS: In terms of our research, although better healing in osteochondral defects was seen when combining BMSCs and LLLT compared with the use of BMSCs alone, this improvement was predominantly caused by new bone formation rather than new cartilage formation.

Spectral dependence of direct and trap-mediated recombination processes in lead halide perovskites using time resolved microwave conductivity.

Elucidating the decay mechanisms of photoexcited charge carriers is key to improving the efficiency of solar cells based on organo-lead halide perovskites. Here we investigate the spectral dependence (via above-, inter- and sub-bandgap optical excitations) of direct and trap-mediated decay processes in CH3NH3PbI3 using time resolved microwave conductivity (TRMC). We find that the total end-of-pulse mobility is excitation wavelength dependent - the mobility is maximized (172 cm(2) V(-1) s(-1)) when charge carriers are excited by near bandgap light (780 nm) in the low charge carrier density regime (10(9) photons per cm(2)), and is lower for above- and sub-bandgap excitations. Direct recombination is found to occur on the 100-400 ns timescale across excitation wavelengths near and above the bandgap, whereas indirect recombination processes displayed distinct behaviour following above- and sub-bandgap excitations, suggesting the influence of different trap distributions on recombination dynamics.

Human platelet IgG Fc receptor FcγRIIA in immunity and thrombosis.

Beyond their prominent role in hemostasis and thrombosis, platelets are increasingly recognized as having immunologic functions. Supporting this, human platelets express FcγRIIA (CD32a), a low-affinity Fc receptor (FcR) for the constant region of IgG that recognizes immune complexes (ICs) and IgG-opsonized cells with high avidity. In leukocytes, FcγRIIA engagement initiates strong effector functions that are key for immune and inflammatory responses, including cytokine release, antibody-dependent cell-mediated killing of pathogens, and internalization of ICs. However, the physiologic relevance of platelet-expressed FcγRIIA has received little attention in previous reviews on FcRs. This article summarizes and discusses the available information on human platelet FcγRIIA. The importance of this receptor in heparin-induced thrombocytopenia, a prothrombotic adverse drug effect, is well documented. However, studies demonstrating platelet activation by IgG-opsonized bacteria point to the physiologic relevance of platelet FcγRIIA in immunity. In this context, platelet activation and secretion may facilitate both a direct antimicrobial function of platelets and crosstalk with other immune cells. Additionally, a role for platelet FcγRIIA in IgG-independent hemostasis and physiologic thrombosis, by means of amplifying integrin αII b ß3 outside-in signaling, has also been proposed. Nonetheless, the thrombotic complications found in some infective and autoimmune diseases may result from unbalanced FcγRIIA-mediated platelet aggregation. Moreover, FcγRIIA is not expressed in mice, and thrombocytopenia and/or thrombotic events found after drug administration can only be recapitulated by the use of human FcγRIIA-transgenic mice. Altogether, the available data support a functional role for platelet FcγRIIA in health and disease, and emphasize the need for further investigation of this receptor.

Molecular characterization of the gag gene of caprine arthritis encephalitis virus from goats in the Philippines.

Caprine arthritis encephalitis virus (CAEV) causes caprine arthritis encephalitis syndrome, which is an emerging disease of goats in the Philippines. DNA sequence analysis showed homology of 86-93 % between Philippine CAEV and available CAEV sequences in GenBank. CAEV was detected using nested polymerase chain reaction (PCR), and new sets of primers were designed in order to amplify the gag gene, which is a highly conserved region of the viral genome. In addition, the Philippine CAEV isolate clustered in group B with the prototype caprine lentivirus. Based on amino acid sequence alignments, it is possible that the Philippine CAEV isolate is a new strain of CAEV, but it is also possible that it was already present in the country even before the start of goat importation. Molecular characterization of the CAEV gag gene is important for the development of a detection kit specific for the local strain of CAEV and the establishment of small ruminant lentivirus eradication programs in the Philippines. This study is the first report to describe the molecular characteristics of CAEV circulating in the Philippines.

Glycoprotein Ibα and FcγRIIa play key roles in platelet activation by the colonizing bacterium, Streptococcus oralis.

BACKGROUND: Infective endocarditis (IE) is characterized by thrombus formation on a cardiac valve. The oral bacterium, Streptococcus oralis, is recognized for its ability to colonize damaged heart valves and is frequently isolated from patients with IE. Platelet interaction with S. oralis leads to the development of a thrombotic vegetation on heart valves, which results in valvular incompetence and congestive heart failure. OBJECTIVE: To investigate the mechanism through which platelets become activated upon binding S. oralis. PATIENTS AND METHODS: Platelet interactions with immobilized bacteria under shear conditions were assessed using a parallel flow chamber. S. oralis-inducible platelet reactivity was determined using light transmission aggregometry. Dense granule secretion was measured by luminometry using a luciferin/luciferase assay. RESULTS: Using shear rates that mimic physiological conditions, we demonstrated that S. oralis was able to support platelet adhesion under venous (50-200 s(-1) ) and arterial shear conditions (800 s(-1) ). Platelets rolled along immobilized S. oralis through an interaction with GPIbα. Following rolling, platelet microaggregate formation was observed on immobilized S. oralis. Aggregate formation was dependent on S. oralis binding IgG, which cross-links to platelet FcγRIIa. This interaction led to phosphorylation of the ITAM domain on FcγRIIa, resulting in dense granule secretion, amplification through the ADP receptor and activation of RAP1, culminating in platelet microaggregate formation. CONCLUSIONS: These results suggest a model of interaction between S. oralis and platelets that leads to the formation of a stable septic vegetation on damaged heart valves.

Self-reported health and physical activity among community mental healthcare users.

The aim of the study was to survey the self-reported health and physical activity in a sample of community mental healthcare users in a city of Sweden. The study was conducted through a cross-sectional design with participants requested to fill out a self-report questionnaire. Participants (n = 103) were persons with psychiatric disabilities living in residential psychiatric settings and/or participating in daily activities provided by community mental healthcare services. The results showed that the group is affected with serious risk factors, such as high body mass index, low rated extent and frequency of physical activity and low self-estimated general state of health. Even though some difficulties associated with the answering process of this questionnaire emerged, these self-reported results clearly confirm the fact that persons with psychiatric disabilities constitute a vulnerable group in need for health-promoting caring activities and interventions.

DEG/ENaC but not TRP channels are the major mechanoelectrical transduction channels in a C. elegans nociceptor.

Many nociceptors detect mechanical cues, but the ion channels responsible for mechanotransduction in these sensory neurons remain obscure. Using in vivo recordings and genetic dissection, we identified the DEG/ENaC protein, DEG-1, as the major mechanotransduction channel in ASH, a polymodal nociceptor in Caenorhabditis elegans. But DEG-1 is not the only mechanotransduction channel in ASH: loss of deg-1 revealed a minor current whose properties differ from those expected of DEG/ENaC channels. This current was independent of two TRPV channels expressed in ASH. Although loss of these TRPV channels inhibits behavioral responses to noxious stimuli, we found that both mechanoreceptor currents and potentials were essentially wild-type in TRPV mutants. We propose that ASH nociceptors rely on two genetically distinct mechanotransduction channels and that TRPV channels contribute to encoding and transmitting information. Because mammalian and insect nociceptors also coexpress DEG/ENaCs and TRPVs, the cellular functions elaborated here for these ion channels may be conserved.