An alginate-PHMB-AgNPs based wound dressing polyamide nanocomposite with improved antibacterial and hemostatic properties.

Wound dressing should be impenetrable against microorganisms and it should keep the wound wet. Gauze and polyamide (PA) substrate were treated with various concentrations of AgNPs (25, 50, 75, and 100 ppm), PHMB (0.2, 0.4, 0.6, 0.8, and 1% w/v), and constant concentration of alginate (0.5% W/V) using a simple dipping method. Prepared samples were characterized by various techniques including Fourier transform infrared spectroscopy and scanning electron microscopy. The results indicated that the particles were successfully applied onto both substrates with an average diameter of particle size of 78 nm on gauze and 172 nm on the PA substrate surface (based on 50 nanoparticles). Antibacterial activity of the prepared nanocomposite against Staphylococcus aureus (gram-positive) bacteria on PA substrate and gauze were evaluated using the disc diffusion method. The results indicated that the prepared nanocomposites offer favorable antibacterial properties and bacteria would not grow in culture media. The water uptake capacity test of the treated samples was assessed and the data demonstrated that the water absorption rate significantly increases on both treated substrates (gauze and PA substrate) due to the presence of alginate polymer. Also, observing the results of the coagulation test showed that treated samples caused blood clots on the dressing. This is due to the presence of alginate polymer. The present work demonstrates that the prepared samples offer excellent antibacterial properties and good water uptake capacity that capable of being a potential candidate for wound dressings. Due to the results, the produced PA substrate could be an appropriate replacement for the cotton gauze as a wound dressing.

A cross-sectional study examining convergent validity of a frailty index based on electronic medical records in a Canadian primary care program.

BACKGROUND: An electronic frailty index (eFI) has been developed and validated in the UK; it uses data from primary care electronic medical records (EMR) for effective frailty case-finding in primary care. This project examined the convergent validity of the eFI from Canadian primary care EMR data with a validated frailty index based on comprehensive geriatric assessment (FI-CGA), in order to understand its potential use in the Canadian context. METHODS: A cross-sectional validation study, using data from an integrated primary care research program for seniors living with frailty in Edmonton, AB. Eighty-five patients 65 years of age and older from six primary care physicians' practices were recruited. Patients were excluded if they were under 65 years of age, did not provide consent to participate in the program, or were living in a long term care facility at the time of enrolment. We used scatter plots to assess linearity and Pearson correlation coefficients to examine correlations. RESULTS: Results indicate a strong statistically significant correlation between the eFI and FI-CGA (r = 0.72, 95% CI 0.60-0.81, p < 0.001). A simple linear regression showed good ability of the eFI scores to predict FI-CGA scores (F (1,83) = 89.06, p < .0001, R2 = 0.51). Both indices were also correlated with age, number of chronic conditions and number of medications. CONCLUSIONS: The study findings support the convergent validity of the eFI, which further justifies implementation of a case-finding tool that uses routinely collected primary care data in the Canadian context.

Correction to: A cross-sectional study examining convergent validity of a frailty index based on electronic medical records in a Canadian primary care program.

Following the publication of this article [1], the authors reported a typesetting error in the "Results" section.

Application of an electronic Frailty Index in Australian primary care: data quality and feasibility assessment.

BACKGROUND: The primary care setting is the ideal location for identifying the condition of frailty in older adults. AIMS: The aim of this pragmatic study was twofold: (1) to identify data items to extract the data required for an electronic Frailty Index (eFI) from electronic health records (EHRs); and (2) test the ability of an eFI to accurately and feasibly identify frailty in older adults. METHODS: In a rural South Australian primary care clinic, we derived an eFI from routinely collected EHRs using methodology described by Clegg et al. We assessed feasibility and accuracy of the eFI, including complexities in data extraction. The reference standard for comparison was Fried's frailty phenotype. RESULTS: The mean (SD) age of participants was 80.2 (4.8) years, with 36 (60.0%) female (n = 60). Frailty prevalence was 21.7% by Fried's frailty phenotype, and 35.0% by eFI (scores > 0.21). When deriving the eFI, 85% of EHRs were perceived as easy or neutral difficulty to extract the required data from. Complexities in data extraction were present in EHRs of patients with multiple health problems and/or where the majority of data items were located other than on the patient's summary problem list. DISCUSSION: This study demonstrated that it is entirely feasible to extract an eFI from routinely collected Australian primary care data. We have outlined a process for extracting an eFI from EHRs without needing to modify existing infrastructure. Results from this study can inform the development of automated eFIs, including which data items to best access data from.

Improving Care Experiences, Efficiencies and Quality of Care for Seniors in Alberta.

Improving Care Experiences, Efficiencies and Quality of Care for Seniors in Alberta Forum was held to explore the current challenges and opportunities in seniors' care. A diverse group of 53 attendees, representing a cross section of healthcare organizations, front-line healthcare providers, researchers and patients, participated in facilitative, small group discussions to share and propose solutions to barriers to coordinating and integrating care for the senior population across the continuum within the Edmonton zone, to comment on a standardized assessment that may inform integrated care and support planning and to outline steps towards health information continuity.

Fabrication and evaluation of electrospun polyacrylonitrile/silver nanofiber membranes for air filtration and antibacterial activity.

Particulate matter and airborne microorganisms are two of the most severe indoor air problems due to their significant risks to human health. Comprehensive research on air filtration with good filtration performance for fine particles and antibacterial function is essential. In this study, after some experimentations and optimization of conditions, polyacrylonitrile (PAN) 10-1% silver nanoparticles (AgNPs) membranes with suitable morphology and uniform diameter distribution are fabricated by an electrospinning method. These electrospun mats exhibited antibacterial activity toward Staphylococcus aureus (Gram-positive bacteria) and Escherichia coli (Gram-negative bacteria). With its small pore size, high porosity, the high specific surface area of 42 m2/g, and robust mechanical strength of 7.14 MPa properties, the resultant PAN10%-1%Ag membranes exhibit high filtration efficiency of 99.27%, the low pressure drop of 33 Pa, and higher quality factor compared to the two standard commercial masks including, the three-ply surgical mask and the respirator face mask. After 24 h of the filtration process in a simulated living environment, the obtained air filter still displayed a high filtration efficiency and a less pressure drop variation. In addition, the R 2 value was 0.99, which indicates that the calculation results are in good agreement with the measured results. The fabrication of PAN-Ag membranes will have broad applications, including face masks, indoor air filtration and clean room.

The microtubule plus-end tracking protein Bik1 is required for chromosome congression.

During mitosis, sister chromatids congress on both sides of the spindle equator to facilitate the correct partitioning of the genomic material. Chromosome congression requires a finely tuned control of microtubule dynamics by the kinesin motor proteins. In Saccharomyces cerevisiae, the kinesin proteins Cin8, Kip1, and Kip3 have a pivotal role in chromosome congression. It has been hypothesized that additional proteins that modulate microtubule dynamics are involved. Here, we show that the microtubule plus-end tracking protein Bik1-the budding yeast ortholog of CLIP-170-is essential for chromosome congression. We find that nuclear Bik1 localizes to the kinetochores in a cell cycle-dependent manner. Disrupting the nuclear pool of Bik1 with a nuclear export signal (Bik1-NES) leads to slower cell-cycle progression characterized by a delayed metaphase-anaphase transition. Bik1-NES cells have mispositioned kinetochores along the spindle in metaphase. Furthermore, using proximity-dependent methods, we identify Cin8 as an interaction partner of Bik1. Deleting CIN8 reduces the amount of Bik1 at the spindle. In contrast, Cin8 retains its typical bilobed distribution in the Bik1-NES mutant and does not localize to the unclustered kinetochores. We propose that Bik1 functions with Cin8 to regulate kinetochore-microtubule dynamics for correct kinetochore positioning and chromosome congression.

Phosphosites of the yeast centrosome component Spc110 contribute to cell cycle progression and mitotic exit.

Spc110 is an essential component of the spindle pole body (SPB), the yeast equivalent of the centrosome, that recruits the γ-tubulin complex to the nuclear side of the SPB to produce the microtubules that form the mitotic spindle. Here, we identified phosphosites S11 and S36 in maternally originated Spc110 and explored their functions in vivo. Yeast expressing non-phosphorylatable Spc110S11A had a distinct spindle phenotype characterised by higher levels of α-tubulin, which was frequently asymmetrically distributed between the two SPBs. Furthermore, expression of the double mutant Spc110S11AS36A had a delayed cell cycle progression. Specifically, the final steps of mitosis were delayed in Spc110S11AS36A cells, including expression and degradation of the mitotic cyclin Clb2, disassembling the mitotic spindle and re-localizing Cdc14 to the nucleoli, resulting in late mitotic exit and entry in G1. Thus, we propose that Spc110 phosphorylation at S11 and S36 is required to regulate timely cell cycle progression in budding yeast. This article has an associated First Person interview with the first author of the paper.

The Seniors' Community Hub: An Integrated Model of Care for the Identification and Management of Frailty in Primary Care.

(1) Background: Integrated models of primary care deliver the comprehensive and preventative approach needed to identify and manage frailty in older people. Seniors' Community Hub (SCH) was developed to deliver person-centered, evidence-informed, coordinated, and integrated care services to older community dwelling adults living with frailty. This paper aims to describe the SCH model, and to present patient-oriented results of the pilot. (2) Methods: SCH was piloted in an academic clinic with six family physicians. Eligible patients were community dwelling, 65 years of age and older, and considered to be at risk of frailty (eFI > 0.12). Health professionals within the clinic received training in geriatrics and interprofessional teamwork to form the SCH team working with family physicians, patients and caregivers. The SCH intervention consisted of a team-based multi-domain assessment with person-centered care planning and follow-up. Patient-oriented outcomes (EQ-5D-5L and EQ-VAS) and 4-metre gait speed were measured at initial visit and 12 months later. (3) Results: 88 patients were enrolled in the pilot from April 2016-December 2018. No statistically significant differences in EQ-5D-5L/VAS or the 4-metre gait speed were detected in 38 patients completing the 12-month assessment. (4) Conclusions: Future larger scale studies of longer duration are needed to demonstrate impacts of integrated models of primary care on patient-oriented outcomes for older adults living with frailty.

Family Physician's and Primary Care Team's Perspectives on Supporting Family Caregivers in Primary Care Networks.

BACKGROUND: Research, practice, and policy have focused on educating family caregivers to sustain care but failed to equip healthcare providers to effectively support family caregivers. Family physicians are well-positioned to care for family caregivers. METHODS: We adopted an interpretive description design to explore family physicians and primary care team members' perceptions of their current and recommended practices for supporting family caregivers. We conducted focus groups with family physicians and their primary care team members. RESULTS: Ten physicians and 42 team members participated. We identified three major themes. "Family physicians and primary care teams can be a valuable source of support for family caregivers" highlighted these primary care team members' broad recognition of the need to support family caregiver's health. "What stands in the way" spoke to the barriers in current practices that precluded supporting family caregivers. Primary care teams recommended, "A structured approach may be a way forward." CONCLUSION: A plethora of research and policy documents recommend proactive, consistent support for family caregivers, yet comprehensive caregiver support policy remains elusive. The continuity of care makes primary care an ideal setting to support family caregivers. Now policy-makers must develop consistent protocols to assess, and care for family caregivers in primary care.

Developing a Decision-Making Capacity Assessment Clinical Pathway for Use in Primary Care: a Qualitative Exploratory Case Study.

BACKGROUND: With an ageing population, the incidence of dementia will increase, as will the number of persons requiring decision-making capacity assessments. For over 10 years, we have trained family physicians in conducting decision-making capacity assessments. Physician feedback post-training, however, has highlighted the need to integrate the decision-making capacity assessment process into the primary care context. The purpose of this study was to develop a decision-making capacity assessment clinical pathway for implementation in primary care. METHODS: A qualitative exploratory case-study design was used to obtain participants' perspectives regarding the utility of a visual algorithm detailing a decision-making capacity assessment clinical pathway for use in primary care. Three focus groups were conducted with family physicians (n=4) and allied health professionals (n=6) in two primary care clinics in Alberta. A revised algorithm was developed based on their feedback. RESULTS: In the focus groups, participants identified inconsistencies and a lack of standardization regarding decision-making capacity assessments within primary care, and provided feedback regarding a decision-making capacity assessment clinical pathway to make it more applicable to primary care. Participants described this pathway as appealing and straightforward; they also made suggestions to make it more primary care-centric. Participants indicated that the presented pathway would improve teamwork and standardization of decision-making capacity assessments within primary care. CONCLUSIONS: Use of a decision-making capacity assessment clinical pathway has the potential to standardize decision-making capacity assessment processes in primary care, and support least intrusive and least restrictive patient outcomes for community-dwelling older adults.

Medicinal plants used in wound dressings made of electrospun nanofibers.

Nanofibers are a type of nanostructures, which due to their unique properties can be used in wound dressing, and electrospinning is a good way to produce them. The benefits of wound dressings made of electrospun nanofibers include a large surface area to volume ratio, high absorption of secretions from the wound, and high air permeability, mimicking the morphology of extracellular matrix (ECM) of the damaged tissue and the possibility of the gradual release of the drug agents loaded on nanofibers. Because of the adaptability of plants to the body, low side effects and the prevalence of antibiotic resistance, interest in using plants is increasing. Combining nanofibers with plants is a way to integrate the physical properties of the structure of nanofibers and the chemical and antibacterial properties of the plants. In recent years, many plants in the forms of extracts, essential oils, and pure active ingredients have been used in the electrospininng and production of nanofiber-containing plants; some of the plants may be a good choice for wound dressings made of electrospun nanofibers.

Calendula officinalis extract/PCL/Zein/Gum arabic nanofibrous bio-composite scaffolds via suspension, two-nozzle and multilayer electrospinning for skin tissue engineering.

This work investigates the incorporation of the Calendula officinalis (C. officinalis) extract in electrospun fiber scaffolds composed of poly (ε-caprolactone) (PCL), Zein and gum arabic (GA). Three methods of electrospinning were used: suspension electrospinning, in which C. officinalis extract was directly added in the PCL/Zein/GA solution, two-nozzle electrospinning, in which hybrid PCL/Zein/GA and PCL/C. officinalis nanofibrous layers were prepared by two syringes and multilayer electrospinning, in which layer-by-layer scaffold was fabricated of PCL/Zein/GA and PCL/C.officinalis nanofibrous mats. SEM micrographs of fabricated scaffolds depicted beadless nanofibers with interconnected pores. The PCL/Zein/GA/C.officinalis scaffolds possess good hydrophilicity with high porosity (about 80%) and also exhibited desirable mechanical properties and suitable degradability for skin tissue engineering. Multilayer produced scaffold showed more tensile strength than other C. officinalis-loaded PCL/Zein/GA scaffolds. In vitro C.officinalis release exposed gradual and sustained release behavior for fabricated scaffold by multilayer electrospinning. The results of MTT analysis and SEM images confirmed that PCL/Zein/GA/C.officinalis nanocomposite scaffold had favorable proliferation and adhesion against fibroblast cell as compared to PCL/Zein/GA scaffold for regenerating skin. The C. officinalis-loaded PCL/Zein/GA scaffold indicated better antibacterial properties and biocompatibility than PCL/Zein/GA scaffold. The results confirmed that C. officinalis-loaded PCL/Zein/GA nanocomposite scaffolds would be desirable biomaterial for skin regeneration.

Identification of Frailty in Primary Care: Feasibility and Acceptability of Recommended Case Finding Tools Within a Primary Care Integrated Seniors' Program.

Background: Case finding for frailty is recommended as part of routine clinical practice. We aimed to test feasibility and acceptability of three recommended case finding tools in primary care as part of an integrated seniors' program. Method: Program of Research to Integrate Services for the Maintenance of Autonomy-7 (PRISMA-7), 4-m walk test, and electronic frailty index (eFI) were used as frailty case finding tools for a target population of community-dwelling seniors ≥65 years of age enrolled in a seniors' program within an academic primary care clinic in Alberta, Canada. Feasibility was measured by percent completion rate and requirements for training/equipment/space/time, and acceptability by health care providers was measured using focus groups. Results: Eighty-five patients underwent case finding and 16 health care providers participated in the focus groups. Completion rate for PRISMA-7, 4-m walk test, and eFI was 97.6%, 93%, and 100%, respectively. No special training or equipment was required for PRISMA-7; brief training, equipment, and space were required for 4-m walk test. Both tools took less than 5 min to complete. Despite eFI requiring 10 to 20 min/patient chart, providers found it less intrusive. Conclusion: Despite feasibility of the tests, acceptance was higher for tools with minimal clinic interruption, low requirements for resources, and those with added benefit.

Appropriateness of Medications in Older Adults Living With Frailty: Impact of a Pharmacist-Led Structured Medication Review Process in Primary Care.

Background: Older persons with frailty take multiple medications and are vulnerable to inappropriate prescribing. Objective: This study assesses the impact of a team-based, pharmacist-led structured medication review process in primary care on the appropriateness of medications taken by older adults living with frailty. Methods: This was a quasi-experimental pretest-posttest design in 6 primary care practices within an academic clinic in Edmonton, Alberta, Canada. We enrolled community dwelling older adults 65 years and older with frailty who have polypharmacy and/or 2 or more chronic conditions (ie, high-risk group for drug-related issues). The intervention was a structured pharmacist-led medication review using evidence-based explicit criteria (ie, Beers and STOPP/START criteria) and implicit criteria (ie, pharmacist expertise) for potentially inappropriate prescribing, done in the context of a primary care team-based seniors' program. We measured the changes in the number of medications pre- and postmedication review, number of medications satisfying explicit criteria of START and STOPP/Beers and determined the association with frailty level. Data were analyzed using descriptive and inferential statistics (a priori significance level of P < .05). Results: A total of 54 participants (61.1% females, mean age 81.7 years [SD = 6.74]) enrolled April 2017 to May 2018 and 52 participants completed the medication review process (2 lost to hospitalization). Drug-related problems noted on medication review were untreated conditions (61.1%), inappropriate medications (57.4%), and unnecessary therapy (40.7%). No significant changes in total number of medications taken by patients before and after, but the intervention significantly decreased number of inappropriate medications (1.15 meds pre to 0.9 meds post; P = .006). Conclusion: A pharmacist-led medication review is a strategy that can be implemented in primary care to address inappropriate medications.

Fabrication and characterization of PCL/zein/gum arabic electrospun nanocomposite scaffold for skin tissue engineering.

The main role of tissue engineering is to produce the artificial tissue for replacing the biological functions in tissue regeneration and wounds healing. The purpose of this research was to produce porous nanofiber scaffold by electrospinning to compensate deep skin damages. In order to simulate a scaffold similar to the natural extracellular matrix of the skin, a mixture of corn protein (Zein), polycaprolactone (PCL) and gum arabic (GA) was used with different concentrations and ratios. Zein and GA polymers were used as a protein and polysaccharide component of the scaffold and PCL polymer for elasticity, strength and time setting of scaffold degradability. For investigating morphology and scaffold compounds, scanning electron microscopy (SEM) and Fourier transform infrared techniques were used. Furthermore, mechanical properties, porosity, water absorption and degradability in phosphate buffered saline (PBS) were investigated. Antibacterial properties, cell adhesion and proliferation were also evaluated. SEM results showed that fabricated PCL/Zein/GA scaffolds had a porous structure with bimodal diameters distribution. PCL/Zein/GA scaffolds showed high hydrophilic properties, favorable porosity (about 80%) and tensile strength of 1.36-3 MPa with an elongation of 19.13-44.06% desirable for skin tissue engineering. SEM images of degraded specimens show that the scaffold retains its fibrous structure during its destruction. The results of bacterial culture indicated that the scaffold containing GA had antibacterial properties. Moreover, in vitro assays revealed favorable L929 cells proliferation compared to tissue culture polystyrene (control). Hence, the PCL/Zein/GA scaffold shows a good potential for application in skin tissue engineering.

Infection of placental trophoblasts by Toxoplasma gondii.

How the intracellular parasite Toxoplasma gondii causes placental inflammation and infects the fetus is unknown. By use of a culture model of primary human trophoblasts, we examined the consequences of infection by a virulent strain of T. gondii. Infection fractions (parasitophorous vacuoles per trophoblast nuclei) < or =0.9 were observed 1 day after challenge at an inoculum ratio of T. gondii to nuclei of 10. The culture content of infectious T. gondii increased 45-fold in 48 h. Two days after infection, almost 30% of trophoblast nuclei became apoptotic, and 30%-35% of nuclei were lost. Almost 90% of apoptotic nuclei were not adjacent to a parasitophorous vacuole, suggesting infection protected against apoptosis. However, there was no T. gondii-dependent accumulation of putative cytotoxic factors, such as tumor necrosis factor-alpha, that could mediate paracrine killing. Both mature and immature trophoblasts can be productively infected, and uninfected, but not infected, cells undergo apoptosis.