Antimicrobial Properties of Bacterial Cellulose Films Enriched with Bioactive Herbal Extracts Obtained by Microwave-Assisted Extraction.

The use of bacterial cellulose (BC) as scaffold for active biofilms is one of the most interesting applications, especially for the biomedical and food industries. However, there are currently few studies evaluating the potential of incorporating herbal extracts into various biomaterials, including BC. Thus, the aim of this study is to report a screening of the total phenolic content and antioxidant and antimicrobial activity of ethanolic extracts of oregano, rosemary, parsley, and lovage. At the same time, the bioactive potential of BC enriched with the four ethanolic extracts is described. Microwave-assisted extraction was used to extract bioactive compounds from the four selected herbs. The physical, mechanical, structural, and chemical properties of BC were also assessed. Next, BC was enriched with the extracts, and their effect against Escherichia coli, Staphylococcus aureus, and Candida albicans was evaluated. The results showed that the bioactivity of the herbs varied significantly, with rosemary extract being the most bioactive. The BC films possessed good mechanical properties, and a three-dimensional network fibrillar structure appropriate for ethanolic-extract incorporation. The BC samples enriched with rosemary extracts had the highest antibacterial activity against S. aureus, while E. coli. and C. albicans seemed to be resistant to all extracts, regardless of herbs.

SERS Liquid Biopsy Profiling of Serum for the Diagnosis of Kidney Cancer.

Renal cancer (RC) represents 3% of all cancers, with a 2% annual increase in incidence worldwide, opening the discussion about the need for screening. However, no established screening tool currently exists for RC. To tackle this issue, we assessed surface-enhanced Raman scattering (SERS) profiling of serum as a liquid biopsy strategy to detect renal cell carcinoma (RCC), the most prevalent histologic subtype of RC. Thus, serum samples were collected from 23 patients with RCC and 27 controls (CTRL) presenting with a benign urological pathology such as lithiasis or benign prostatic hypertrophy. SERS profiling of deproteinized serum yielded SERS band spectra attributed mainly to purine metabolites, which exhibited higher intensities in the RCC group, and Raman bands of carotenoids, which exhibited lower intensities in the RCC group. Principal component analysis (PCA) of the SERS spectra showed a tendency for the unsupervised clustering of the two groups. Next, three machine learning algorithms (random forest, kNN, naïve Bayes) were implemented as supervised classification algorithms for achieving discrimination between the RCC and CTRL groups, yielding an AUC of 0.78 for random forest, 0.78 for kNN, and 0.76 for naïve Bayes (average AUC 0.77 ± 0.01). The present study highlights the potential of SERS liquid biopsy as a diagnostic and screening strategy for RCC. Further studies involving large cohorts and other urologic malignancies as controls are needed to validate the proposed SERS approach.

Correction: Bodea et al. Optimization of Moist and Oven-Dried Bacterial Cellulose Production for Functional Properties. Polymers 2021, 13, 2088.

The authors wish to make a change to the published paper [...].

Optimization of Moist and Oven-Dried Bacterial Cellulose Production for Functional Properties.

Bacterial cellulose (BC) is a natural polymer with properties suitable for tissue engineering and possible applications in scaffold production. However, current procedures have limitations in obtaining BC pellicles with the desired structural, physical, and mechanical properties. Thus, this study analyzed the optimal culture conditions of BC membranes and two types of processing: draining and oven-drying. The aim was to obtain BC membranes with properties suitable for a wound dressing material. Two studies were carried out. In the preliminary study, the medium (100 mL) was inoculated with varying volumes (1, 2, 3, 4, and 5 mL) and incubated statically for different periods (3, 6, 9, 12, and 18 days), using a full factorial experimental design. Thickness, uniformity, weight, and yield were evaluated. In the optimization study, a Box-Behnken design was used. Two independent variables were used: inoculum volume (X1: 1, 3, and 5 mL) and fermentation period (X2: 6, 12, and 18 d) to determine the target response variables: thickness, swelling ratio, drug release, fiber diameter, tensile strength, and Young's modulus for both dry and moist BC membranes. The mathematical modelling of the effect of the two independent variables was performed by response surface methodology (RSM). The obtained models were validated with new experimental values and confirmed for all tested properties, except Young's modulus of oven-dried BC. Thus, the optimal properties in terms of a scaffold material of the moist BC were obtained with an inoculum volume of 5% (v/v) and 16 d of fermentation. While, for the oven-dried membranes, optimal properties were obtained with a 4% (v/v) and 14 d of fermentation.

Applying the Ottawa Charter to guide resilience-building programs for health care organizations.

Resilience is situated at the core of the World Health Organization European policy framework for health and well-being and the United Nations Sustainable Development Goals. Resilience refers to how effectively a person, group, or system deals with and recovers from challenging situations. In this paper resilience refers to the capacity of a health care professional to manage complex issues and adapt to situations successfully. This brief paper provides explicit knowledge for strengthening personal resilience in health care using the Ottawa Charter framework as a guide. Developing a resilient health care workforce should address all five Ottawa Charter areas of action, should involve multiple stakeholders, and should incorporate resilience strategies into everyday health care activities. The paper presents recommendations for future programs designed to build a resilient workforce that can provide high quality care in a sustainable manner.

A stepped-wedge randomised controlled trial assessing the implementation, effectiveness and cost-consequences of the EDDIE+ hospital avoidance program in 12 residential aged care homes: study protocol.

BACKGROUND: Older people living in residential aged care homes experience frequent emergency transfers to hospital. These events are associated with risks of hospital acquired complications and invasive treatments or interventions. Evidence suggests that some hospital transfers may be unnecessary or avoidable. The Early Detection of Deterioration in Elderly residents (EDDIE) program is a multi-component intervention aimed at reducing unnecessary hospital admissions from residential aged care homes by empowering nursing and care staff to detect and manage early signs of resident deterioration. This study aims to implement and evaluate the program in a multi-site randomised study in Queensland, Australia. METHODS: A stepped-wedge randomised controlled trial will be conducted at 12 residential aged care homes over 58 weeks. The program has four components: education and training, decision support tools, diagnostic equipment, and implementation facilitation with clinical systems support. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to guide the program implementation and process evaluation. The primary outcome measure will be the number of hospital bed days used by residents, with secondary outcomes assessing emergency department transfer rates, admission rates, length of stay, family awareness and experience, staff self-efficacy and costs of both implementation and health service use. A process evaluation will assess the extent and fidelity of program implementation, mechanisms of impact and the contextual barriers and enablers. DISCUSSION: The intervention is expected to improve outcomes by reducing unnecessary hospital transfers. Fewer hospital transfers and admissions will release resources for other patients with potentially greater needs. Residential aged care home staff might benefit from feelings of empowerment in their ability to proactively manage early signs of resident deterioration. The process evaluation will be useful for supporting wider implementation of this intervention and other similar initiatives. TRIAL REGISTRATION: The trial is prospectively registered with the Australia New Zealand Clinical Trial Registry ( ACTRN12620000507987 , registered 23/04/2020).

Clinical Benefits of Using a Smartphone Application to Assess the Wound Healing Process in a Feline Patient - A Case Report.

The aim of this paper was to determine whether digital imagery can be employed in veterinary medicine to measure and analyze wound healing dynamics. A smartphone application (ImitoMeasure) was used to capture, measure, and analyze the metatarsal wound images in a cat patient. The smartphone app was used to evaluate the wound area, width, length, and circumference at the time of topical treatments. Further analysis of the measurements taken by the ImitoMeasure app revealed significant correlations among all analyzed parameters. The day of treatment was inversely correlated with all the parameters of the wound, showing the healing progress over time. Also, the width was the most influential parameter (P ≤ .05) when assessing wound area. Thus, the app provided a noncontact, easy to use, and accurate smart wound measurement solution. Additionally, this case report describes the treatment of a cat with a severe chronic metatarsal wound and extensive soft tissue loss using a commercially available silver calcium alginate dressing (Askina Calgitrol Ag, B. Braun). The dressing was changed every 2 days, in the first week of treatment, and then every 3 days until the cat was discharged, 21 days later. Granulation tissue formed rapidly, from the fourth day of treatment and continued to expand in the entire wound bed; epithelization process started since the 16th day of treatment and mature scar tissue could be observed 21 days postinjury.

Reducing geriatric outpatient waiting times: Impact of an advanced health practitioner.

OBJECTIVE: To investigate the impact on patient waiting times of a role substitution model introducing an advanced allied health practitioner as the first point of contact within a geriatric outpatient context. METHODS: A pre- to postintervention design was used to determine impact over a five-year period (2008-2012). All patients referred to the geriatric specialist outpatient department were included (n = 1514). Data relating to waiting times were analysed using one-way ANOVA and post hoc Tukey tests to determine effects on patient waiting times. RESULTS: Waiting times were reduced from an average of 82 to as low as 35 days, in a context of increasing referral rates. Medical specialist capacity was increased through improvements to available outpatient times and reduced appointment lengths. Patients seen within their designated triage category timeframe increased from 47 to 86%. CONCLUSION: Health professional substitution in geriatrics can be an effective intervention for reducing patient waiting times and improving access to care.

The evolution of the Community Health Worker program in Papua New Guinea.

New Guinea (PNG) has a special history in regard to the training of Community Health Workers (CHWs) and is currently preparing its frontline health workforce to serve the 85% of the total PNG population of 7.3 million people who live in rural and remote settings. This article identifies and explains the five major developmental stages in the current CHW training program, as well as the changes that have occurred over the past century. The developmental stages are: (1) traditional; (2) early contact; (3) innovation; (4) the 1980s; and (5) new millennium. These developmental stages are discussed in the context of the early literature and investigation by the primary author and examination of the lived experiences of early missionary health workers and local people. This paper documents the development of a CHW program in PNG from the colonisation period, which began in 1883, to the present day. As a developing nation, PNG has gone through many challenges and changes to its healthcare system and has gradually developed an effective program to train its frontline primary health care (PHC) workforce. This article contributes new information with regard to the past and current development of CHW programs in PNG as well as in other developing countries. The training of competent CHWs with the essential skills and knowledge may help deliver quality and cost-effective PHC services to the rural majority and the urban disadvantaged, thereby fulfilling the PNG government's National Health Plan for 2011-2020. Systematic evaluation of the effectiveness of the CHW program will provide guidance for continued development of this frontline health workforce. Improving and introducing a competency-based curriculum is an essential step towards building a healthier nation.

Small-cell carcinoma of the urinary bladder: where do we stand?

Small-cell carcinoma of the urinary bladder is a very rare pathology, but with a very aggressive behavior and disappointing prognosis. The literature concerning this type of cancer is scarce and physicians may encounter difficulty trying to manage it. Most articles involve the study of case series, without definite results due to the small number of patients. The present article aims at gathering the most significant articles and results in order to offer a broad perspective on the existing literature concerning this pathology.

Methodological considerations related to nurse researchers using their own experience of a phenomenon within phenomenology.

AIMS: This paper summarizes phenomenology and discusses how nurses can use their own experiences as data and maintain rigour within the method. It explores how data from researchers experiencing the phenomenon of interest could be used to explicate assumptions and pre-understandings and may also be used as data. BACKGROUND: While the ethnographic concept of insider research has gained popularity, the notion of researcher as participant in phenomenology is relatively new. The lived experience of a phenomenon is unique to each person and utilization of the nurse researcher's experiences of the phenomenon should be considered for inclusion as data. DESIGN: Discussion paper. DATA SOURCES: Articles from 2001 - 2015 in the CINAHL and PubMed databases were identified using keywords such as 'insider research', 'phenomenology', 'bracketing' and 'qualitative research'. In addition, reference lists from articles used were examined to identify additional literature. IMPLICATIONS FOR NURSING: Phenomenology is a valuable research method. Usability, credibility, trustworthiness and auditability of data collected must be considered to ensure rigour and maintain orientation to the phenomenon under investigation. Nurse researchers may be interviewed as participants if these four principles are considered and methods used are made explicit. Utilizing appropriate research methods are as important as getting clinical practice correct to advance knowledge and benefit those under our care. CONCLUSION: We recommend using the researchers' experience as a data source to gain a complete picture of the phenomenon under investigation. Using the approach proposed here, nurses can ensure they are incorporating all data sources available while maintaining research rigour.

Use of videos to support teaching and learning of clinical skills in nursing education: A review.

Information and communications technology is influencing the delivery of education in tertiary institutions. In particular, the increased use of videos for teaching and learning clinical skills in nursing may be a promising direction to pursue, yet we need to better document the current research in this area of inquiry. The aim of this paper was to explore and document the current areas of research into the use of videos to support teaching and learning of clinical skills in nursing education. The four main areas of current and future research are effectiveness, efficiency, usage, and quality of videos as teaching and learning materials. While there is a clear need for additional research in the area, the use of videos seems to be a promising, relevant, and increasingly used instructional strategy that could enhance the quality of clinical skills education.

Role of non-Indigenous researchers in Indigenous health research in Australia: a review of the literature.

Objective This paper explores the body of knowledge around Indigenous health research and aims to outline what roles are appropriate for non-Indigenous researchers within Indigenous health research in Australia. Methods A literature review was conducted using CINAHL, PubMed and Scopus in May 2015. The search terms were 'non-Indigenous researchers' AND 'Indigenous health research' and other combinations of these terms. Additional documents were sourced by hand using the reference lists of key articles. Results Seven thematic categories were identified: (1) Closing the Gap: implications for research; (2) history of Indigenous research; (3) developing Indigenous research using a capacity-building approach; (4) the cultural interface between Western paradigms and Indigenous knowledge; (5) ethical Indigenous research; (6) culturally safe Indigenous research; and (7) positive roles for non-Indigenous researchers in Indigenous research. Conclusion It is important that non-Indigenous researchers become more aware of culturally appropriate ways in which to undertake Indigenous research and to ensure that the research undertaken is safe, ethical and useful for participants. Fostering partnerships between non-Indigenous academic organisations and researchers and Indigenous health researchers is an important development that can promote and enhance the emerging field of Indigenous inquiry. Actively contributing to capacity building with Indigenous researchers and research initiatives is a key role that non-Indigenous researchers and academic institutions can have in improving Indigenous health. Self-determination through health research capacity building and evidence-based advocacy may provide the most useful outcomes for Indigenous people. What is known about the topic? The health status of Indigenous Australians is well below that of other Australians. Historically, research about Indigenous health has been undertaken by non-Indigenous researchers using Western research paradigms. There is a need to identify appropriate roles for non-Indigenous researchers supportive of culturally safe and ethical research. What does this paper add? This paper synthesises available knowledge about the role of non-Indigenous researchers with Indigenous health research and provides suggestions for their contribution to Indigenous research practice. What are the implications for practitioners? Non-Indigenous researchers need to: (1) focus on culturally safe research practices; (2) be willing to address power imbalances within the research process; and (3) advocate for change within academic institutions to support culturally safe research practices.

Building the evidence for CRPS research from a lived experience perspective.

Background and aims Pain is known to be a subjective experience yet the majority of pain related research does not address the lived experience of the condition. Difficult to diagnose, Complex Regional Pain Syndrome (CRPS) is often poorly managed. The aim of this paper was to identify and synthesise the currently available literature on experiences of living with chronic pain in order to understand where and how CRPS research may be best situated in the future. Methods A narrative review was performed and ProQuest, EBSCO, Informit, Scopus/Science Direct and Web of Science, Medline, CINHAL and Google Scholar were searched in order to identify the literature from 1998 until 2015. 301 papers were identified of which 197 described the lived experience of chronic pain conditions. 12 papers were examined closely to determine the experience of living with CRPS or a similar chronic pain condition that does not have a definite pain origin such as cancer or endometriosis. Results Known understandings of pain were identified and a model was developed depicting the lived experience of chronic pain starting with loss of the former healthy, pain free self and culminating in acceptance of the condition. Major themes identified were disbelief/invisibility of pain, loss, coping with a non-compliant/constant painful body, self-management and alleviating pain/treatment. The review also found that there is no peer-reviewed published literature on the lived experience of CRPS. Conclusions Little is known about the lived experience of CRPS. There appears to be a clear indication that research needs to be conducted into CRPS from a lived experience perspective in order to provide information to patients, the general public, health practitioners and policy makers of previously unknown characteristics of this condition which may improve health outcomes for this patient cohort. It has been identified that patients and their families should be active participants in education of health practitioners and in providing information to inform the development of National Pain Strategies currently being devised throughout the world. Implications Research into the lived experience of chronic pain conditions, and CRPS in particular, can help to provide information to enhance understanding enabling national pain strategies and future treatment guidelines strategies to be devised appropriately.

Extended roles for allied health professionals: an updated systematic review of the evidence.

BACKGROUND: Internationally, health care services are under increasing pressure to provide high quality, accessible, timely interventions to an ever increasing aging population, with finite resources. Extended scope roles for allied health professionals is one strategy that could be undertaken by health care services to meet this demand. This review builds upon an earlier paper published in 2006 on the evidence relating to the impact extended scope roles have on health care services. METHODS: A systematic review of the literature focused on extended scope roles in three allied health professional groups, ie, physiotherapy, occupational therapy, and speech pathology, was conducted. The search strategy mirrored an earlier systematic review methodology and was designed to include articles from 2005 onwards. All peer-reviewed published papers with evidence relating to effects on patients, other professionals, or the health service were included. All papers were critically appraised prior to data extraction. RESULTS: A total of 1,000 articles were identified by the search strategy; 254 articles were screened for relevance and 21 progressed to data extraction for inclusion in the systematic review. CONCLUSION: Literature supporting extended scope roles exists; however, despite the earlier review calling for more robust evaluations regarding the impact on patient outcomes, cost-effectiveness, training requirements, niche identification, or sustainability, there appears to be limited research reported on the topic in the last 7 years. The evidence available suggests that extended scope practice allied health practitioners could be a cost-effective and consumer-accepted investment that health services can make to improve patient outcomes.

Immunology of scabies and translational outcomes: identifying the missing links.

PURPOSE OF REVIEW: We propose that a major gap in the control, prevention, diagnosis and treatment of scabies exists because of lack of key translational understandings related to the immunopathology of scabies and the associated severe form of the disease, crusted scabies. Understanding the complex network of innate and adaptive immune responses, including the long lag period from infection to clinical symptoms, is fundamental to developing early interventions and decreasing transmission. Such interventions must be driven by clinical need and include user-friendly translational outcomes for improved control in endemic and resource-poor settings. RECENT FINDINGS: In the last few years, we have seen an increase in the molecular characterization of scabies mite proteins. However, owing to limited capacity in scabies immunology-related research, little is still known regarding the immunological effects of the mite or mite products on disease progression or protection. SUMMARY: Detailing the skin immunopathogenesis in relation to scabies, including the role of macrophages, mast cells and eosinophils, as well as the immunomodulatory effects of parasite evasion mechanisms are essential for the rational design of future therapeutic, diagnostic and preventative tools. Resolving this knowledge gap could ultimately lead to significant improvements in clinical and public health interventions. This article proposes a conceptual model for capacity building to inform future research activities in the field.

From cutting to casting: impact and initial barriers to the Ponseti method of clubfoot treatment in China.

In 2005, a nationwide clubfoot treatment program focused on the Ponseti method -an effective, affordable and minimally-invasive method- was initiated in China. The purpose of this study was to evaluate and identify barriers to the program. A qualitative study (rapid ethnographic study) was conducted using semi-structured interviews of 44 physicians who attended four of the 10 Ponseti training workshops, focus groups with parents of children with clubfoot, and observation. Several barriers to the Ponseti method are quite unique due to China's size, socio-economics, culture, politics, and healthcare systems. The barriers were classified into seven themes: (i) physician education, (ii) caregiver compliance, (iii) culture, (iv) public awareness, (v) poverty, (vi) financial constraints for physicians/hospitals, and (vii) challenges of the treatment process. A number of suggestions that could be helpful in reducing or eliminating the effects of these barriers were also identified: (i) pamphlets explaining clubfoot and treatment for caregivers, (ii) directories of Ponseti providers, (iii) funding/financial support, and (iv) improving public awareness. The information from this study provides healthcare planners with knowledge to assist in meeting the needs of the population and continued implementation of effective and culturally appropriate awareness and treatment programs for clubfoot throughout China.

Dose escalation of second-line sunitinib results in rapid partial remission of multiple hepatic metastases.

A 58-year-old man with metastatic clear cell renal cell carcinoma on sunitinib therapy, who previously failed on sorafenib, was found to have progression of multiple hepatic metastases; he was on a standard sunitinib dose of 50 mg/day (4 weeks on, 2 weeks off). Due to the unavailability of alternative therapies, a sunitinib dose escalation of 50 mg/day was attempted. After one 6-week cycle of continuously dosed sunitinib 50 mg, the hepatic lesions regressed. After the second cycle, virtual disappearance of the lesions was recorded. There was no added toxicity. These findings suggest that sunitinib dose escalation to 50 mg/day using continuous daily administration dosing might represent a valid, effective and well-tolerated therapeutic option in patients who progress on standard sunitinib therapy.

Temptation, restriction, and alcohol consumption among American and German college students.

To assess relationships between alcohol consumption and two dimensions of drinking restraint (temptation and restriction), American and German college students were given the Khavari Alcohol Test (KAT) and the Temptation and Restraint Inventory (TRI). As hypothesized, drinking temptation was a positive predictor of students' alcohol consumption in both countries, but there was no main effect for drinking restriction. Also as hypothesized, American students who were high on drinking temptation drank greater (not smaller) quantities of alcohol if they were also high on drinking restriction. Conversely, German students who were high on drinking temptation drank more alcohol if they were also low on drinking restriction. The results point to cross-cultural similarities and differences in relationships between drinking temptation and restriction and actual alcohol consumption.

Food exposure in patients with bulimia nervosa.

BACKGROUND: The aim of the study was to investigate psychological and physiological responses of bulimic patients to the repeated presentation of food cues. METHOD: On 2 subsequent days, 48 bulimic women (DSM-IV) were confronted with high- or low-caloric food for 20 min. A control group (n = 24) was exposed to high-caloric food once. Blood sugar levels were manipulated with a glucose load. RESULTS: High-caloric food only elicited increases in urge to binge, subjective and physiological stress in the first session. During the second session, reported urge to binge and subjective stress was significantly lower. Bulimic patients confronted with high-caloric food showed higher subjective and physiological stress in the first session compared to bulimic patients confronted with low-caloric food. In the second session, they reported more subjective stress and urge to binge, compared to the low-caloric group. Blood sugar levels did not affect psychological and physiological responses. DISCUSSION: The results are discussed in terms of the conditioning model of binge eating model, habituation models and implications for exposure therapy.