Mixology: a tool for calculating required masses and volumes for laboratory solutions

Laboratory work often requires making up solutions with defined concentrations of various components. Mixology is a tool we have created to simplify calculation of the masses and volumes required to obtain particular concentrations. It operates with many kinds of volumetric, mass and concentration units, including conversion between molarity- and mass-based concentrations using molecular masses retrieved from the Chemical Entities of Biological Interest (ChEBI) database. Mixology can be accessed at https://mixology.science.

Understanding the Methodological Issues and Solutions in the Research Design of Stroke Caregiving Technology

The rise in the number of cases of stroke has resulted in a significant burden on the healthcare system. As a result, the majority of care for the person living with stroke occurs within the community, resulting in caregivers being a central and challenged agent in care. To better support caregivers during the recovery trajectory poststroke, we investigated the role of health technologies to promote education and offer various kinds of support. However, the introduction of any new technology comes with challenges due to the growing need for more user-centric systems. The integration of user-centric systems in stroke caregiving has the potential to ensure long-term acceptance, success, and engagement with the technology, thereby ensuring better care for the person living with stroke. We first briefly characterize the affordances of available technologies for stroke caregiving. We then discuss key methodological issues related to the acceptance to such technologies. Finally, we suggest user-centered design strategies for mitigating such challenges.

Electronic health record-based disease surveillance systems: A systematic literature review on challenges and solutions

OBJECTIVE

Disease surveillance systems are expanding using electronic health records (EHRs). However, there are many challenges in this regard. In the present study, the solutions and challenges of implementing EHR-based disease surveillance systems (EHR-DS) have been reviewed.

MATERIALS AND METHODS

We searched the related keywords in ProQuest, PubMed, Web of Science, Cochrane Library, Embase, and Scopus. Then, we assessed and selected articles using the inclusion and exclusion criteria and, finally, classified the identified solutions and challenges.

RESULTS

Finally, 50 studies were included, and 52 unique solutions and 47 challenges were organized into 6 main themes (policy and regulatory, technical, management, standardization, financial, and data quality). The results indicate that due to the multifaceted nature of the challenges, the implementation of EHR-DS is not low cost and easy to implement and requires a variety of interventions. On the one hand, the most common challenges include the need to invest significant time and resources; the poor data quality in EHRs; difficulty in analyzing, cleaning, and accessing unstructured data; data privacy and security; and the lack of interoperability standards. On the other hand, the most common solutions are the use of natural language processing and machine learning algorithms for unstructured data; the use of appropriate technical solutions for data retrieval, extraction, identification, and visualization; the collaboration of health and clinical departments to access data; standardizing EHR content for public health; and using a unique health identifier for individuals.

CONCLUSIONS

EHR systems have an important role in modernizing disease surveillance systems. However, there are many problems and challenges facing the development and implementation of EHR-DS that need to be appropriately addressed.

Meta-Intelligence: Understanding, Control, and Interactivity between Creative, Analytical, Practical, and Wisdom-Based Approaches in Problem Solving

A deeper understanding of the processes leading to problem framing and behind finding solutions to problems should help explain variability in the quality of the solutions to those problems. Using Sternberg's WICS model as the conceptual basis of problem solving, this article discusses the relations between creative, analytical, practical, and wisdom-based approaches as bases for solutions to problems. We use a construct of meta-intelligence to encompass understanding, control, and coordination between these constructs. We propose that constraints can act at each of three levels-individual, contextual, and interactive. Individual constraints include the metacomponents (executive processes) that underpin each of the four kinds of solutions. Contextual constraints direct which of the four approaches are preferred under what circumstances. Finally, interactive constraints involve individual and contextual constraints directly impacting each other's actions. The model of meta-intelligence and its functioning helps to explain the variability in the ways that individuals frame problems and, as a consequence, in the solutions that are found. The model of meta-intelligence also helps explain why some solutions to problems are so much more comprehensive, and often better, than others.

Stability of 10-mg/mL and 50-mg/mL ketamine oral solutions

PURPOSE

Ketamine is an anesthetic agent commonly used for the induction of anesthesia. Ketamine is also given to control pain, for treatment of posttraumatic stress disorder, and to induce bronchodilation in refractory asthma. Moreover, ketamine therapy is gaining ground as an intervention for patients with treatment-resistant depression and individuals who have depression with serious suicidal ideation. Recently, the drug has been used to disrupt maladaptive reward memories in individuals with harmful alcohol consumption behaviors. The stability of 10-mg/mL and 50-mg/mL ketamine solutions stored at ambient and refrigeration temperatures was assessed over 90 days.

METHODS

Three batches of 10-mg/mL and 50-mg/mL ketamine solutions were stored for 90 days under two temperature conditions (2°C-8°C and 22°C-25°C) in amber plastic bottles. Chemical stability was assessed using a stability-indicating high-performance liquid chromatography assay. At each study time, visual inspection and pH assessments of ketamine concentration and pH were conducted.

RESULTS

For all solutions tested at each condition, the ketamine concentration remaining was at least 98% of the initial concentration over 90 days of storage. Throughout the study period, solution pH remained stable and the color and odor of the suspensions remained unchanged.

CONCLUSION

Extemporaneously compounded 10-mg/mL and 50-mg/mL oral solutions of ketamine prepared in a flavored suspending excipient and stored in amber polypropylene plastic bottles were stable for at least 90 days at both ambient and refrigeration temperatures.

An Intelligent Future for Medical Imaging: A Market Outlook on Artificial Intelligence for Medical Imaging

Radiologists today are under increasing work pressure. We surveyed radiologists in the United States across practice settings, and the overwhelming majority reported an increased workload. Artificial intelligence (AI), which includes machine learning, can help address these issues. It also has the potential to improve clinical outcomes and raise further the value of medical imaging in ways yet to be defined. In this article, we report on recent McKinsey & Company work to understand the growth of AI in medical imaging. We highlight progress in its clinical application, the investments that are backing it, and the barriers to broader adoption. We also offer a view on how the market will develop. AI is set to have a big impact on the medical imaging market and hence on how radiologists work, helping them to speed up scan time, make more accurate diagnoses, and ease their workload. As AI in medical imaging increasingly proves its worth, it is hard to imagine that AI will not ultimately transform radiology.

Climate action for health and wellbeing in cities: a protocol for the systematic development of a database of peer-reviewed studies using machine learning methods

Cities produce more than 70% of global greenhouse gas emissions. Action by cities is therefore crucial for climate change mitigation as well as for safeguarding the health and wellbeing of their populations under climate change. Many city governments have made ambitious commitments to climate change mitigation and adaptation and implemented a range of actions to address them. However, a systematic record and synthesis of the findings of evaluations of the effect of such actions on human health and wellbeing is currently lacking. This, in turn, impedes the development of robust knowledge on what constitutes high-impact climate actions of benefit to human health and wellbeing, which can inform future action plans, their implementation and scale-up. The development of a systematic record of studies reporting climate and health actions in cities is made challenging by the broad landscape of relevant literature scattered across many disciplines and sectors, which is challenging to effectively consolidate using traditional literature review methods. This protocol reports an innovative approach for the systematic development of a database of studies of climate change mitigation and adaptation actions implemented in cities, and their benefits (or disbenefits) for human health and wellbeing, derived from peer-reviewed academic literature. Our approach draws on extensive tailored search strategies and machine learning methods for article classification and tagging to generate a database for subsequent systematic reviews addressing questions of importance to urban decision-makers on climate actions in cities for human health and wellbeing.

Allocation of the "Already" Limited Medical Resources Amid the COVID-19 Pandemic, an Iterative Ethical Encounter Including Suggested Solutions From a Real Life Encounter

The shortage of healthcare providers is well-documented in low-income countries (LIC) prior to COVID-19, due to various causes including the migration to developed countries, scarcity of supplies, poor healthcare infrastructure, limited ICU facilities, and lack of access to guidelines and protocols. One of the important hitches in LIC is the insufficient testing capacity that precluded accurate assessment of disease burden and subsequently resource allocations. Trying to adhere to the principles of bioethics including respect to others, beneficence, and justice should be applied on the ground in the particular setting of the LIC. Solutions should be tailored to the tangible needs and possibility of implementation in real life in the face of the “already” limited resources by making use of simple, yet plausible, measures. Implementing guidelines and frameworks that were set to work in the better-resourced nations is a call for futility. The adoption of novel solutions to overcome the unique challenges in the LIC is exigent. These include the use of automated screening algorithms and virtual video clinics. Moreover, integrating electronic intensive care unit (e-ICU) software may allow for remote monitoring of multiple patients simultaneously. Telemedicine could help in getting consultations worldwide. It can also enhance healthcare workers' knowledge and introduce new skills through teleconferences, e-workshops, and free webinars. Healthcare workers can be remotely trained to enhance their skills. Agencies, such as the WHO, should develop comprehensive programs to tackle different health issues in LIC in collaboration with major institutions and experts around the world.

Small Ruminant Production in Tanzania, Uganda, and Ethiopia: A Systematic Review of Constraints and Potential Solutions

Sheep and goats are an important commodity for smallholder farmers across East Africa, but severe limitations remain in small ruminant production. This review aimed to identify specific constraints to small ruminant production and identify practical and sustainable solutions. From 54 eligible articles, most were focused in Ethiopia (n = 44) with only 6 studies performed in Tanzania and 4 in Uganda. The most frequently identified constraint in Ethiopia and Tanzania was disease (n = 28 and n = 3, respectively), and in Uganda, it was the lack of access to veterinary services (n = 4). Additionally, access to good breeding stock, lack of animal records, and an established marketing chain were also mentioned in all the three countries. Ectoparasites, gastrointestinal parasites, orf, and sheep/goat pox were the most frequently mentioned disease challenges causing productivity losses. Many articles provided potential solutions as suggested by farmers, including improved access to veterinary services and medicines, improved record keeping, and access to good breeding stock. Farmers highlighted the value of community-based participatory development plans to increase education on disease control, land management, and husbandry. This review also highlighted knowledge gaps, the need for further research, particularly in Tanzania and Uganda, and the importance of addressing multiple challenges holistically due to the links between constraints.

Anaesthesiologist-intensivist phycisians at the core of the management of critically ill COVID-19 patients in Africa: persistent challenges, some resolved dilemma and future perspective

Unlike developed countries which have purely intensivists also called critical care physicians or intensive care physicians to manage critically ill patients like those with severe forms of COVID-19, the practice of critical care medicine in Africa is coined to anaesthesiology. Hence, anaesthesiologist-intensivist physicians are the medical specialists taking care of critically ill COVID-19 patients in Africa. Likewise, unlike intensive care units (ICUs) in high income countries, those in most African countries face the challenge of a lack of emergency drugs and resuscitation equipment, limited health infrastructure and understaffed and underfunded health care systems. The COVID-19 pandemic is an unprecedented one faced by intensivists in high-income countries and anaesthesiologist-intensivist phycisians in Africa. Infected patients with severe forms of the disease like those having grave COVID-19 complications like massive pulmonary embolism, severe cardiac arrhythmias, cardiogenic shock, septic shock, acute kidney injury or acute respiratory distress syndrome require ICU admission for better management. Both intensivists or anaesthesiologist-intensivist physicians have the peculiarity of securing the airways of critically COVID-19 patients and providing respiratory support with mechanical ventilation after laryngoscopy and endotracheal intubation when needed. In so doing, they can easily be infected from respiratory droplets or aerosols expired by the COVID-19 patients. Hence, in Africa, anaesthesiologist-intensivist phycisians have a higher risk of contracting COVID-19 compared to other health professionals. It's worth to mention that the COVID-19 pandemic struck African anaesthesiologist-intensivist phycisians and ICUs when there were neither prepared skillfully or lacked the required ICU capacity to meet the demands of thousands of severe COVID-19 African patients. These further weakened the already strained health systems in Africa. It required a lot of creativity, engineering skills and courage for these ill prepared African anaesthesiologist-intensivist physicians to provide care to these critically ill patients and improve their outcomes as the pandemic progressed. However, despites the numerous efforts made in African anaesthesiologist-Intensivist phycisians to care for critically ill COVID-19 patients, the pandemic is spreading at a rapid rate across Africa. There is an urgent need for African health authorities to anticipate on how to scale up the future high ICU capacity needs and limited ICU workforce, infrastructure and equipment to manage severe forms of COVID-19 in future. It cannot be overemphasized that these severe forms of COVID-19 are potentially fatal and are a major contributor to the death toll of the COVID-19 pandemic.

Barriers to Making House Calls by Primary Care Physicians and Solutions: A Literature Review

BACKGROUND

The number of house calls made by physicians has been declining over the years, while the number of people requiring house calls, especially the elderly, is growing.

AIM

To consolidate the literature regarding the barriers faced by primary care physicians in making house calls.

DESIGN OF THE STUDY

Literature review.

METHOD

Studies were sourced from PubMed and Embase.

RESULTS

7 studies were selected to be in the literature review. Barriers to making house calls by primary care physicians include inadequate remuneration, lack of time and training, unconducive home environment, concerns with professional liability and safety, and perceived low value-added in the patient's quality of care.

CONCLUSION

While primary care physicians do recognize the value of house calls in patient care, the perceived limited standard of care that can be achieved in the home setting, busy clinic practice (large patient loads), coupled with inadequate remuneration make house calls unrealistic for many doctors. These barriers must be addressed to ensure accessibility to primary health care services for the immobile, frail, and sick is not being compromised. One of the solutions may be to expose medical students and residents to house calls early through mentorship.

Topical Administration of Cannabidiol: Influence of Vehicle-Related Aspects on Skin Permeation Process

Cannabidiol (CBD) is a non-psychoactive cannabinoid isolated from Cannabis sativa which, given its claimed beneficial properties and therapeutic potential, has lately aroused considerable attention from the scientific community. Starting from the little literature evidence, the main purpose of this study was to investigate the topical administration of CBD, with particular focus on the influence of vehicle-related aspects on the skin permeation process. This could provide useful information for the design of suitable drug delivery systems which could be used in developing topical medicines and cosmetics. In vitro human skin permeation studies were conducted using modified Franz diffusion cells to compare the performance of four solutions and two semisolid formulations. The Hildebrand solubility parameter was used to better understand the thermodynamic aspects implied in the partitioning process of the cannabinoid compound into the skin. It was interestingly found that a hydrophilic gel, mostly consisting of propylene glycol (79%, w/w), can be an optimal choice for the topical administration of CBD. Moreover, the feasibility of the preparation of CBD-loaded (trans)dermal patches, made with new printing technology, was also demonstrated.

Awareness, Policy, Privacy, and More: Post-Secondary Students Voice Their Solutions to Cyberbullying

This paper discusses solutions to cyberbullying posed by post-secondary students from four Canadian universities. The qualitative data used in this analysis were drawn from one open-ended question on an online student survey completed by 1458 undergraduate students, as well as 10 focus group transcripts involving a total of 36 students. Seven key themes emerged: awareness and education; policy; protecting one's privacy; technology-based solutions; empowering better choices and responses; university culture; and disciplinary measures. The findings show that post-secondary institutions need to make preventing and curtailing cyberbullying more of a priority within their campus communities, including engaging in responsive consultation with key stakeholder groups, such as students, to develop meaningful solutions.

The Effect of the Synthetic Procedure of Acrylonitrile-Acrylic Acid Copolymers on Rheological Properties of Solutions and Features of Fiber Spinning

The influence of introducing acrylic acid (AA) into the reaction mixture with acrylonitrile at the synthesis of copolymers by free-radical polymerization (FRP) and radical polymerization with reversible addition-fragmentation chain transfer (RAFT) on the rheological properties of their solutions in dimethyl sulfoxide, as well as on the capability to spin fibers by the mechanotropic method, is analyzed. The influence of AA dosing conditions on the rheological properties of the solutions in the concentration range above the crossover point was not revealed. In the case of RAFT synthesis, the rheological properties differ distinctively in the high concentration region that is expressed by unusual viscoelastic characteristics. Dilute solution viscometry revealed the influence of the comonomer loading order on the interaction intensity of the copolymer macromolecules with a solvent, which is more pronounced for samples synthesized by FRP and can be associated with the copolymers' molecular structure. Fiber spinning from solutions of polyacrylonitrile and its copolymers (PAN) synthesized by the RAFT method was not able to achieve a high degree of orientation drawing, while for polymers with a wider molecular weight distribution synthesized by FRP, it was possible to realize large stretches, which led to high-quality fibers with strength values up to 640 MPa and elongation at a break of 20%.

Solutions for whole grain food development

Owing to the health benefits associated with whole grains, there has been a sustained global effort to increase their consumption, with many countries developing guidelines for recommended amounts of whole grain intake. In China, the consumption of whole grains is low. This is due, in part, to technical obstacles in the development of whole grain foods. This review focuses on possible solutions in the whole value chain and the application of new food technologies to develop whole grain foods that taste better, have more appealing texture, are safe to consume, and better retain bioactive compounds.

Treatment of psoriasis - unburdened by fear during SARS-CoV2 menace

In a matter of mere months, humanity was unexpectedly struck by the appearance of SARS-CoV-2, shifting our perception as medical practitioners regarding our day-to-day activity. One especially disconcerting change was patient addressability to medical facilities, as well as access to proper healthcare in various fields. As these changes occurred rapidly, dermatologists too had to adapt by means of teledermatology, giving us back the ability to reach, treat, and comfort our patients. Among the individuals requiring special dermatological attention are those suffering from psoriasis, especially considering that the biological therapies employed in treating this debilitating disease become questionable in the circumstance of the current pandemic. As more evidence surfaces concerning the pathophysiology of SARS-CoV-2, we become closer to understanding which therapies may interfere with its clearance, and which are actually safe to use. This review aims to answer the question, are biological therapies warranted in the treatment of psoriasis during the COVID-19 outbreak, or should they be discontinued?

Navigating disruptive crises through service-led growth: The impact of COVID-19 on Italian manufacturing firms

This study draws on an extensive survey and interview data collected during the COVID-19 pandemic. The respondents were executives of industrials firms whose factories, warehouses, and headquarters are located in Northern Italy. This is undoubtedly the European region first and most extensively affected by the pandemic, and the government implemented radical lockdown measures, banning nonessential travel and mandating the shutdown of all nonessential businesses. Several major effects on both product and service businesses are highlighted, including the disruption of field-service operations and supply networks. This study also highlights the increased importance of servitization business models and the acceleration of digital transformation and advanced services. To help firms navigate through the crisis and be better positioned after the pandemic, the authors present a four-stage crisis management model (calamity, quick & dirty, restart, and adapt), which provides insights and critical actions that should be taken to cope with the expected short and long-term implications of the crisis. Finally, this study discusses how servitization can enhance resilience for future crises—providing a set of indicators on the presumed role of, and impact on, service operations in relation to what executives expect to be the “next normal.”

•

The COVID-19 lockdown impacted both product and service businesses, but service businesses are showing higher resilience.

•

The impact on business largely depends on market segments and industries.

•

The impact on service business varies depending on the extent of servitization.

•

Firms need to master four elements of resilience: preparedness, agility, elasticity, and redundancy.

•

Digitalization and digital servitization are expected to further accelerate.

Recruitment and methodological issues in conducting dementia research in British ethnic minorities: A qualitative systematic review

OBJECTIVE

Identifying existing recruitment and methodological issues within dementia research conducted in UK studies that included ethnic minorities.

METHODS

We searched for and included any publication detailing dementia research in the UK that included any ethnic minority. The search results and all titles and abstracts were screened according to the inclusion criteria followed by screening of the full texts. We extracted data regarding the recruitment and methodological issues faced by the researchers. This data was combined and listed, and related issues were grouped into overarching themes and subthemes.

RESULTS

Of 52 publications suitable for analysis, 33 provided data collated into six themes: attitudes and beliefs about dementia in ethnic minority communities, recruitment process, data collection issues, practical issues, researcher characteristics, and lack of published research and normative data. These themes allowed us to identify three areas responsible for addressing these recruitment and methodological issues: community and patient education, health services, and researchers' training.

CONCLUSIONS

This is the first review identifying recruitment and methodological issues within UK dementia research that included ethnic minorities. We now have a compilation of reported existing issues and a framework of areas responsible for addressing them and devising solutions.

Radiotherapy in India: History, current scenario and proposed solutions

The history and current status of a biomedical discipline in a country or region provide important health system indicators. During the last one hundred years, radiotherapy has established its position as a vital specialty in cancer management. It has proved to be one of the most cost effective ways of treating cancer providing both radical and palliative treatments depending on patient stage and performance status. However, access to radiotherapy for cancer patients in India is limited by several factors including physical proximity of centre, cost and availability of required technology. This article gives an outline of the history, existing radiotherapy facilities and future trends related to radiotherapy practice in India.

Patient safety in primary and outpatient health care

Primary care services provide an entry point into the health system which directly impact's people well-being and their use of other health care resources. Patient safety has been recognised as an issue of global importance for the past 10 years. Unsafe primary and ambulatory care results in greater morbidity, higher healthcare usage and economic costs. According to data from World Health Organization (WHO), the risk of a patient dying from preventable medical accident while receiving health care is 1 in 300, which is much higher than risk of dying while travelling in an airplane. Unsafe medication practices and inaccurate and delayed diagnosis are the most common causes of patient harm which affects millions of patients globally. However, majority of the work has been focussed on hospital care and there is very less understanding of what can be done to improve patient safety in primary care. Provision of safe primary care is priority as every day millions of people use primary care services across the world. The present paper focuses on various aspects of patient safety, especially in the primary care settings and also provides some potential solutions in order to reduce patient harm as much as possible. Some important challenges regarding patient safety in India are also highlighted.

The psychology of experimental psychologists: Overcoming cognitive constraints to improve research: The 47th Sir Frederic Bartlett Lecture

Like many other areas of science, experimental psychology is affected by a "replication crisis" that is causing concern in many fields of research. Approaches to tackling this crisis include better training in statistical methods, greater transparency and openness, and changes to the incentives created by funding agencies, journals, and institutions. Here, I argue that if proposed solutions are to be effective, we also need to take into account human cognitive constraints that can distort all stages of the research process, including design and execution of experiments, analysis of data, and writing up findings for publication. I focus specifically on cognitive schemata in perception and memory, confirmation bias, systematic misunderstanding of statistics, and asymmetry in moral judgements of errors of commission and omission. Finally, I consider methods that may help mitigate the effect of cognitive constraints: better training, including use of simulations to overcome statistical misunderstanding; specific programmes directed at inoculating against cognitive biases; adoption of Registered Reports to encourage more critical reflection in planning studies; and using methods such as triangulation and "pre mortem" evaluation of study design to foster a culture of dialogue and criticism.

Transport Properties for Pharmaceutical Controlled-Release Systems: A Brief Review of the Importance of Their Study in Biological Systems

The goal of this work was to comprehensive study the transport properties of controlled-release systems for the safe and reliable delivery of drugs. Special emphasis has been placed on the measurement of the diffusion of drugs, alone or in combination with carrier molecules for enhanced solubility and facilitated transport. These studies have provided detailed comprehensive information—both kinetic and thermodynamic—for the design and operation of systems for the controlled release and delivery of drugs. Cyclodextrins are among the most important carriers used in these systems. The basis for their popularity is the ability of these materials to solubilize poorly soluble drugs, generally resulting in striking increases in their water solubilities. The techniques used in these investigations include pulse voltammetry, nuclear magnetic resonance (NMR) and Raman spectroscopy, ultrasonic relaxation, and dissolution kinetics. Transport in these systems is a mutual diffusion process involving coupled fluxes of drugs and carrier molecules driven by concentration gradients. Owing to a strong association in these multicomponent systems, it is not uncommon for a diffusing solute to drive substantial coupled fluxes of other solutes, mixed electrolytes, or polymers. Thus, diffusion data, including cross-diffusion coefficients for coupled transport, are essential in order to understand the rates of many processes involving mass transport driven by chemical concentration gradients, as crystal growth and dissolution, solubilization, membrane transport, and diffusion-limited chemical reactions are all relevant to the design of controlled-release systems. While numerous studies have been carried out on these systems, few have considered the transport behavior for controlled-release systems. To remedy this situation, we decided to measure mutual diffusion coefficients for coupled diffusion in a variety of drug–carrier solutions. In summary, the main objective of the present work was to understand the physical chemistry of carrier-mediated transport phenomena in systems of controlled drug release.

Algorithmic solutions to common problems encountered during chronic total occlusion angioplasty: The algorithms within the algorithm

Improved technical equipment, dissemination of best practices, and the importance of complete coronary revascularization have led to a renewed interest in coronary chronic total occlusion (CTO) PCI. In particular, the hybrid algorithm has been associated with increasing procedural success rates in the US. However, the hybrid algorithm only covers overarching strategies in the overall approach to these lesions. Several technical challenges can occur during execution of these approaches, each of which has several potential solutions. A systematic or algorithmic approach to dealing with these challenges could contribute to improved procedural efficiency and higher procedural success. While there have been isolated attempts in the past to codify approaches to each of these situations, there has not been a contemporary, comprehensive review of the potential solutions to these problems. We present 10 common problems encountered during CTO PCI and a consensus hierarchical approach to them.

Characterizing the Effects of a "Switchable Water" Additive on the Aqueous Solubility of Small Molecules

"Switchable water" is an aqueous solution containing a water-soluble amine additive that exhibits CO₂ -switchable properties, such as large changes in ionic strength, by forming an ammonium bicarbonate salt. Switchable water has been used to reversibly "salt-out" organic compounds from water. This study explores the salting out of several compounds in switchable water when CO₂ is present and also explores the solubility of small molecules in switchable water, compared to pure water, when CO₂ is absent. The results show that organic compounds are generally more soluble in switchable water than pure water in the absence of CO₂ , but less soluble in the presence of 1 atm CO₂ . Exceptions include carboxylic acids and phenols which, presumably due to their acidity, are more soluble in switchable water than in pure water, even when CO₂ is applied. Kirkwood-Buff solvation theory was applied to gain insights into the effects of the amine additive on the aqueous solubility of caffeine. Furthermore, the switchable properties of the additives allow for the preparation of switchable aqueous two-phase systems.

An Informational Theoretical Approach to the Entropy of Liquids and Solutions

It is well known that the statistical mechanical theory of liquids has been lagging far behind the theory of either gases or solids, See for examples: Ben-Naim (2006), Fisher (1964), Guggenheim (1952) Hansen and McDonald (1976), Hill (1956), Temperley, Rowlinson and Rushbrooke (1968), O’Connell (1971). Information theory was recently used to derive and interpret the entropy of an ideal gas of simple particles (i.e., non-interacting and structure-less particles). Starting with Shannon’s measure of information (SMI), one can derive the entropy function of an ideal gas, the same function as derived by Sackur (1911) and Tetrode (1912). The new deviation of the same entropy function, based on SMI, has several advantages, as listed in Ben-Naim (2008, 2017). Here we mention two: First, it provides a simple interpretation of the various terms in this entropy function. Second, and more important for our purpose, this derivation may be extended to any system of interacting particles including liquids and solutions. The main idea is that once one adds intermolecular interactions between the particles, one also adds correlations between the particles. These correlations may be cast in terms of mutual information (MI). Hence, we can start with the informational theoretical interpretation of the entropy of an ideal gas. Then, we add correction due to correlations in the form of MI between the locations of the particles. This process preserves the interpretation of the entropy of liquids and solutions in terms of a measure of information (or as an average uncertainty about the locations of the particles). It is well known that the entropy of liquids, any liquids for that matter, is lower than the entropy of a gas. Traditionally, this fact is interpreted in terms of order-disorder. The lower entropy of the liquid is interpreted in terms of higher degree of order compared with that of the gas. However, unlike the transition from a solid to either a liquid, or to a gaseous phase where the order-disorder interpretation works well, the same interpretation would not work for the liquid-gas transition. It is hard, if not impossible, to argue that the liquid phase is more “ordered” than the gaseous phase. In this article, we interpret the lower entropy of liquids in terms of SMI. One outstanding liquid known to be a structured liquid, is water, according to Ben-Naim (2009, 2011). In addition, heavy water, as well as aqueous solutions of simple solutes such as argon or methane, will be discussed in this article.

Solid Waste Management Solutions for a Rapidly Urbanizing Area in Thailand: Recommendations Based on Stakeholder Input

Municipal solid waste is a significant problem, particularly in developing countries that lack sufficient infrastructure and useable land mass to process it in an appropriate manner. Some developing nations are experiencing a combination of issues that prevent proper management of solid waste. This paper reviews the management of municipal solid waste in northeast Thailand, using the Tha Khon Yang Sub-district Municipality (TKYSM) in Maha Sarakham Province as a case study. The combination of rapid population and economic growth and its associated affluence has led to an increase in the use of consumer items and a concomitant increase in the production of municipal solid waste. In the TKYSM there is pressure on local government to establish a suitable waste management program to resolve the escalating waste crisis. The aim of this study is to provide viable solutions to waste management challenges in the TKYSM, and potentially to offer guidance to other similar localities also facing the same challenges. It is well established that successful changes to waste management require an understanding of local context and consideration of specific issues within a region. Therefore, extensive community consultation and engagement with local experts was undertaken to develop an understanding of the particular waste management challenges of the TKYSM. Research methods included observations, one-on-one interviews and focus groups with a range of different stakeholders. The outcomes of this research highlight a number of opportunities to improve local infrastructure and operational capacity around solid waste management. Waste management in rural and urban areas needs to be approached differently. Solutions include: development of appropriate policy and implementation plans (based around the recommendations of this paper); reduction of the volume of waste going to landfill by establishing a waste separation system; initiation of a collection service that supports waste separation at source; educating the citizens of the municipality; and the local government staff, and for the local government to seek external support from the local temples and expertise from the nearby university.

Solutions for the problems of silicon-carbon anode materials for lithium-ion batteries

Lithium-ion batteries are widely used in various industries, such as portable electronic devices, mobile phones, new energy car batteries, etc., and show great potential for more demanding applications like electric vehicles. Among advanced anode materials applied to lithium-ion batteries, silicon-carbon anodes have been explored extensively due to their high capacity, good operation potential, environmental friendliness and high abundance. Silicon-carbon anodes have demonstrated great potential as an anode material for lithium-ion batteries because they have perfectly improved the problems that existed in silicon anodes, such as the particle pulverization, shedding and failures of electrochemical performance during lithiation and delithiation. However, there are still some problems, such as low first discharge efficiency, poor conductivity and poor cycling performance, which need to be improved. This paper mainly presents some methods for solving the existing problems of silicon-carbon anode materials through different perspectives.

Role of Early Palliative Care Interventions in Hematological Malignancies and Bone Marrow Transplant Patients: Barriers and Potential Solutions

INTRODUCTION

Despite advances in palliative care management of physical, psychological, and emotional symptoms along the spectrum of chronic conditions, early palliative care interventions are not used frequently and comprehensively in bone marrow transplant units.

METHODS

The literature review of PubMed articles in English published until December 2017.

RESULTS

Patients with hematologic malignancies and bone marrow transplant interventions are a heterogeneous group. The majority experience symptoms associated with induction or condition regimens. Curative intent of treatment is the norm. Pain, mucositis, nausea and vomiting, diarrhea, psychological, spiritual, and emotional concerns may not be properly and comprehensively tackled by primary oncology and bone marrow transplant teams. Quality of life may be decreased due to the presence of these symptoms. Obstacles to early palliative care interventions include overestimation of survival, focus on curative intent with underestimation of palliative care needs, lack of a comprehensive understanding of hematologic malignancies and bone marrow transplant process on the side of palliative care providers, and logistical restrictions. Potential interventions include education of oncologists, palliative care providers, patients, integration of models of care pre- and posttreatment and bone marrow transplantation, development of guidelines, institutional commitment and leadership in creating new initiatives, clinical research activities to measure outcomes, and community-based participatory research.

CONCLUSIONS

Early palliative care interventions are beneficial for patients with hematologic malignancies and bone marrow transplant processes. Better understanding of barriers to its implementation and development of creative initiatives is of paramount importance. New research endeavors should focus on providers' attitudes toward patients and communities.

Safety of Patient-Controlled Analgesia After Surgery in Children And Adolescents: Concerns And Potential Solutions

Patient-controlled analgesia (PCA) is common practice for acute postoperative pain management. Postoperative PCA use decreases pain intensity and improves patient satisfaction when compared to non-PCA routes of medication administration. Although PCA has several advantages regarding efficacy and safety, adverse events remain a concern. Programming errors and protocols, patient monitoring, and PCA by proxy or with continuous infusion are recurring silent dangers of PCA use in children and adolescents. Innovative considerations need to be emphasized for future improvement of PCA devices for elective surgical patients. With technology within the healthcare setting advancing at a fast pace, smart pump technology is something to look forward to.

Evaluation of performance of the Medical Research Department in 'Research naive' non-academic hospital: An audit

Introduction:

Conducting medical research is not limited to academia and pharmaceutical industry but even multispeciality hospitals need to venture in this area along with patient care. To develop research culture among well-established non-acedemic hospital is always difficult and challenging task. This article attempts to evaluate the performance of the department in ‘Research naïve’ hospital in the last two years and review the strengths and challenges it faced at each step.

Methods:

This was a retrospective document analysis study evaluating the steps towards setting and sustaining of Medical Research Department of Bhaktivedanta Hospital during the period of January 2013 to June 2015 (30 Months). The authors developed a checklist (along with performance indicators) to assess the Preparatory phase and Activity phase of the research department which were evaluated by Institute Quality Management Team. Each step of both phases was also reviewed in terms of strengths and challenges as perceived by the authors.

Results:

During 2 year journey of research naïve Hospital, Institute had witnessed Hospital initiated (n=24, 59%) and sponsored projects (n=17, 41%) in all specialties. HRC reviewed (n=2.13) projects per meeting for administrative consideration while IEC reviewed (n=2.15) projects for scientific and ethical review. Challenges during preparatory phases were circumvent by immense cooperation of hospital management for initial investment, sensitization through research workshops for consultants, established procedures and trained support manpower and constant encouragement by research coordinator.

Conclusion:

Considering evaluation of 41 studies in very first 2 years in ‘Research naive non academic institute demonstrated successful implementation of trio model of Hospital Research Committee for administrative review, IEC for scientific-ethical review, centralized MRD for coordinating all research projects under one roof which may act as role model for Research naive institutes

Barriers to adult immunization and solutions: Personalized approaches

Immunization is an important component of preventive healthcare services aiming to prevent and eventually eradicate infectious diseases by immunizing people before they become infected. Although immunization is an integral part of children's healthcare, this fact is underrated, even ignored in adults. In Turkey, adult immunization is available only for certain high risk groups such as health care professionals and populations aged > 65 y and under certain conditions including pregnancy, military service, travel-pilgrimage, and employment procedures. The fact that diseases such as pneumococcal pneumonia, influenza, rubeola, varicella, hepatitis A, and tetanus, which could be associated with severe complications in adults, are vaccine-preventable indicates the importance of adult immunization. In addition to the healthcare providers' knowledge about immunization, effective policies of related professional associations and the management of this issue by regulatory authorities, people's awareness in protecting their own health is of utmost importance in achieving the targeted level of adult immunization. This article focuses on the characteristics of the individuals as one of the 3 main cornerstones (individual, healthcare providers, regulatory authorities and supporting organizations) of immunization practices and discusses barriers to adult immunization and recommends solutions.

Safety of polyethylene glycol 3350 solution in chronic constipation: randomized, placebo-controlled trial

Purpose

To evaluate the safety and tolerability of aqueous solution concentrate (ASC) of polyethylene glycol (PEG) 3350 in patients with functional constipation.

Patients and methods

The patients who met Rome III diagnostic criteria for functional constipation were randomized in this multicenter, randomized, placebo-controlled, single-blind study to receive once daily dose of PEG 3350 (17 g) ASC or placebo solution for 14 days. The study comprised a screening period (visit 1), endoscopy procedure (visits 2 and 3), and followup telephone calls 30 days post-treatment. Safety end points included adverse events (AEs), clinical laboratory evaluations, vital signs, and others. The primary end points were the proportion of patients with abnormalities of the oral and esophageal mucosa, detected by visual and endoscopic examination of the oral cavity and esophagus, respectively, compared with placebo. A secondary objective was to compare the safety and tolerability of ASC by evaluating AEs or adverse drug reactions.

Results

A total of 65 patients were enrolled in this study, 31 were randomized to PEG 3350 ASC and 34 were randomized to placebo, of which 62 patients completed the study. No patients in either group showed abnormalities in inflammation of the oral mucosa during visit 2 (before treatment) or visit 3 (after treatment). Fewer abnormalities of the esophageal mucosa were observed in the PEG 3350 ASC group than in the placebo group on visit 3, with no significant difference in the proportion of abnormalities between the treatment groups. Overall, 40 treatment-emergent AEs were observed in 48.4% of patients treated with PEG 3350 ASC, and 41 treatment-emergent AEs were observed in 55.9% of patients treated with placebo – nonsignificant difference of −7.5% (95% CI: −21.3, 6.3) between treatment groups. No serious AEs or deaths were reported, and no patient discontinued because of an AE.

Conclusion

PEG 3350 ASC is safe and well tolerated in patients with functional constipation (NCT01885104).

Identifying the Challenges of "Small" Pathology Residency Programs and Creating Collaborative Solutions

The majority of pathology residency training programs in the United States are considered to be small training programs. Small training programs, regardless of specialty, encounter unique challenges that have been documented in the literature. With the implementation of the Next Accreditation System (NAS), and other Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements, adequate personnel and other resources are necessary. An online survey was conducted on the pathology program directors’ section listserv to help identify characteristics and challenges of small pathology residency training programs. A discussion group on small pathology residency programs was held at the 2015 Association of Pathology Chairs/Program Directors annual meeting, where the results of the survey were discussed and small breakout groups followed the discussion of the survey. The results of the online survey and discussion groups are discussed in this paper.

Tumor resistance to vascular disrupting agents: mechanisms, imaging, and solutions

The emergence of vascular disrupting agents (VDAs) is a significant advance in the treatment of solid tumors. VDAs induce rapid and selective shutdown of tumor blood flow resulting in massive necrosis. However, a viable marginal tumor rim always remains after VDA treatment and is a major cause of recurrence. In this review, we discuss the mechanisms involved in the resistance of solid tumors to VDAs. Hypoxia, tumor-associated macrophages, and bone marrow-derived circulating endothelial progenitor cells all may contribute to resistance. Resistance can be monitored using magnetic resonance imaging markers. The various solutions proposed to manage tumor resistance to VDAs emphasize combining these agents with other approaches including antiangiogenic agents, chemotherapy, radiotherapy, radioimmunotherapy, and sequential dual-targeting internal radiotherapy.

The global nephrology workforce: emerging threats and potential solutions!

Amidst the rising tide of chronic kidney disease (CKD) burden, the global nephrology workforce has failed to expand in order to meet the growing healthcare needs of this vulnerable patient population. In truth, this shortage of nephrologists is seen in many parts of the world, including North America, Europe, Australia, New Zealand, Asia and the African continent. Moreover, expert groups on workforce planning as well as national and international professional organizations predict further reductions in the nephrology workforce over the next decade, with potentially serious implications. Although the full impact of this has not been clearly articulated, what is clear is that the delivery of care to patients with CKD may be threatened in many parts of the world unless effective country-specific workforce strategies are put in place and implemented. Multiple factors are responsible for this apparent shortage in the nephrology workforce and the underpinning reasons may vary across health systems and countries. Potential contributors include the increasing burden of CKD, aging workforce, declining interest in nephrology among trainees, lack of exposure to nephrology among students and residents, rising cost of medical education and specialist training, increasing cultural and ethnic disparities between patients and care providers, increasing reliance on foreign medical graduates, inflexible work schedules, erosion of nephrology practice scope by other specialists, inadequate training, reduced focus on scholarship and research funds, increased demand to meet quality of care standards and the development of new care delivery models. It is apparent from this list that the solution is not simple and that a comprehensive evaluation is required. Consequently, there is an urgent need for all countries to develop a policy framework for the provision of kidney disease services within their health systems, a framework that is based on accurate projections of disease burden, a full understanding of the internal care delivery systems and a framework that is underpinned by robust health intelligence on current and expected workforce numbers required to support the delivery of kidney disease care. Given the expected increases in global disease burden and the equally important increase in many established kidney disease risk factors such as diabetes and hypertension, the organization of delivery and sustainability of kidney disease care should be enshrined in governmental policy and legislation. Effective nephrology workforce planning should be comprehensive and detailed, taking into consideration the structure and organization of the health system, existing care delivery models, nephrology workforce practices and the size, quality and success of internal nephrology training programmes. Effective training programmes at the undergraduate and postgraduate levels, adoption of novel recruitment strategies, flexible workforce practices, greater ownership of the traditional nephrology landscape and enhanced opportunities for research should be part of the implementation process. Given that many of the factors that impact on workforce capacity are generic across countries, cooperation at an international level would be desirable to strengthen efforts in workforce planning and ensure sustainable models of healthcare delivery.

Practise what you preach: health behaviours and stress among non-consultant hospital doctors

High rates of psychological distress, depression and suicide have been reported among doctors. Furthermore, many doctors do not access healthcare by conventional means. This study aimed to increase understanding regarding non-consultant hospital doctors' (NCHDs') response to stress and barriers to accessing supports, and identify possible solutions. Medical manpower departments in 58 hospitals distributed a 25-item questionnaire to 4,074 NCHDs; we received 707 responses (response rate, 17.4%). 60% of NCHDs were unable to take time off work when unwell; 'letting teammates down' (90.8%) and 'difficulty covering call' (85.9%) were the leading reasons. 'Being too busy' (85%), 'self-prescription' (66.6%) and 'self-management' (53.1%) were ranked highest in deterring NCHDs from visiting a general practitioner (GP). 22.9% of NCHDs would not attend a GP with anxiety or depression until they began to feel hopeless, helpless or suicidal. 12.2% would not seek help at all. 55% of respondents (n = 330) had to move away from partners or dependants due to work, negatively affecting the social supports of 82.9%. Possible practical solutions were explored. NCHDS are a vulnerable population and have a particularly challenging lifestyle. Key recommendations include improved GP and counselling access for NCHDs, and addressing the culture of self-treatment and poor health behaviours through undergraduate and postgraduate education.

Curing neurophobia in medical schools: evidence-based strategies

Medical students often perceive neurology as the most difficult medical specialty. This perception is described as 'neurophobia' in the medical literature. Several studies have cited poor teaching, complex examination, and separation of basic and clinical sciences as major factors in the development of neurophobia. These negative perceptions can have serious implications, such as decreasing the students' desire to consider neurology as a future career and increasing referrals from other specialists to avoid dealing with neurological conditions. Faced with increasing demands of healthcare systems and the global burden of neurological conditions, there is a rising need for further research and innovative strategies to improve students' perceptions of clinical neurology. This review discusses evidence-based recommendations and educational interventions to cure neurophobia in medical education.

[The influence of framework conditions for integrated care programs on their potential of evaluation]

AIM AND METHODS

A common justification of the failure to perform scientific evaluations of integrated care programs (in accordance with Sect. 140 SGB V) is the high level of expenditure which is strongly influenced by the conditions of the particular program. Two practical examples will be used to outline frameworks of integrated care programs that may create obstacles to evaluation. If possible, appropriate solutions that may help to avoid or at least reduce these obstacles will be presented.

RESULTS

In many programs target groups and program objectives are inaccurately defined. Especially disease-specific programs bear the risk of having too small a sample size to exclude random effects. Only a few integrated care programs include evaluations that have been proactively planned from the outdet.

CONCLUSION

In particular, early planning of evaluations plays an important role in avoiding distortions of results and additional expenses. It may also have a positive influence on all other frameworks.

Transformation of organ donation in China

The organ donation system in China has far lagged behind international levels. Transformation of this situation began in July 2005. A complete organ donation system that ensures fairness, impartiality, transparency, and respect for life has now been developed. This system is composed of regulations and policies, an organizational structure, operational guidelines, organ procurement organizations, registration of donors and recipients, and an organ allocation system. Since March 2010, pilot trials on donation after circulatory death (DCD) have been carried out. In 4 years, organ donation has started in 25 of 32 provinces in the country. From 2010 to 2013, the ratio of DCD liver transplantation to total case numbers in China rose from 1.38% to 26.1%, whereas for kidney, the ratio were 0.59% and 24.6%, respectively. The total number of DCD in China has accumulated to 1564 cases, and 4243 organs were transplanted. To alleviate the further difficulties of donation, establishment of professional organ procurement organizations in transplant hospitals, legislation of brain death, and promulgation of legal guidelines on DCD will be the main targets of organ donation development in China.

Voluntary community service in medical school: a qualitative study on obstacles faced by student leaders and potential solutions

Purpose

In medical school, students may participate in various community involvement projects (CIP), which serve disadvantaged communities. However, several obstacles may arise during these projects. The authors conducted a qualitative study with the primary aim of understanding the obstacles and corresponding potential solutions when medical students in Singapore participate in local CIP (LCIP) and overseas CIP (OCIP).

Design

The authors recruited medical students from Yong Loo Lin School of Medicine, National University of Singapore, who were also leaders of a specific community service project done in medical school. Twelve one-to-one interviews were held for the participants from 6 to 8 January 2013. Participants were led in a discussion based on an interview guide. The interviews were audio-recorded and transcribed into free-flow text. Subsequently, content and thematic analyses of the transcripts were performed independently by three researchers.

Results

The medical students faced many common obstacles during their community service projects. These obstacles include difficulties in recruiting and managing volunteers, attaining recognition or credibility for the project to acquire funding and resources, adjusting to a different culture or language, setting goals, and facing project-specific obstacles. Potential solutions were offered for some obstacles, such as building a strong executive committee for the project, grooming successive batches of leaders, and improving the project's public image, mentorship, reflections, and sustainability plans.

Conclusions

Mentorship, reflections, and sustainability are potential solutions that have been proposed to tackle the obstacles faced during community service participation in medical school. However, there may still be difficulty in solving some of the problems even after these measures are put into practice. Future research may focus on evaluating the effectiveness of these suggested solutions.

The Public Health Community Platform: Shared Resources For Enterprise Solutions

This presentation aims to update the public health practice community on the continuing development of the Public Health Community Platform (PHCP). Public health is at a precipice of increasing demand for the consumption and analysis of large amounts of disparate data, the centralization of local and state IT offices, and the compartmentalization of programmatic technology solutions. The PHCP is being developed as a platform to host technological solutions and accompanying community involvement for common public health problems.

An examination of the causes and solutions to eyewitness error

Eyewitness error is one of the leading causes of wrongful convictions. In fact, the American Psychological Association estimates that one in three eyewitnesses make an erroneous identification. In this review, we look briefly at some of the causes of eyewitness error. We examine what jurors, judges, attorneys, law officers, and experts from various countries know about eyewitness testimony and memory, and if they have the requisite knowledge and skills to accurately assess eyewitness testimony. We evaluate whether legal safeguards such as voir dire, motion-to-suppress an identification, cross-examination, jury instructions, and eyewitness expert testimony are effective in identifying eyewitness errors. Lastly, we discuss solutions to eyewitness error.

Meta-analysis of the ocular biocompatibility of a new multipurpose lens care system

Background

The purpose of this paper is to evaluate the biocompatibility of a novel multipurpose solution (MPS) with a dual disinfectant system containing polyaminopropyl biguanide and polyquaternium-1 (Biotrue®) by analysis of biomicroscopy signs and adverse events in six large clinical trials.

Methods

Data from six consecutive, prospective clinical trials conducted from February 2008 to March 2010 were combined for meta-analysis. Subjects used the new MPS daily for periods of 2 weeks to 6 months. Slit-lamp signs were graded at each follow-up visit using an ordinal scale (0, one; 1, trace; 2, mild; 3, moderate; 4, severe). Analysis for biocompatibility included tracking of greater than grade 2 slit-lamp findings and number of adverse events.

Results

A total of 1,567 subjects (3,134 eyes) and 81 clinical investigators participated in the six studies, with 1,499 subjects completing the studies. Based on subject days in the studies, there were 72,904 exposures to the MPS and 7,212 biomicroscopy examinations. The completion rate for the studies was 96.3%. Per observation incidence of any finding greater than grade 2 at the follow-up visits were: corneal staining 0.08%, limbal injection 0.04%, bulbar injection 0.04%, tarsal conjunctiva abnormality 0.09%, and neovascularization 0.01%. There were no other slit-lamp signs greater than grade 2 and no statistically significant difference between hydrogels and silicone hydrogels for any finding. There were no reports of adverse events during the trials.

Conclusion

Analysis of over 72,000 daily exposures and 7,212 eye examinations showed that the novel MPS exhibited excellent biocompatibility in subjects using daily wear hydrogel or silicone hydrogel lenses.

Unequal burden of disease, unequal participation in clinical trials: solutions from African American and Latino community members

African Americans and Latinos are underrepresented in clinical trials. The purpose of this study was to elicit solutions to participation barriers from African Americans and Latinos. Fifty-seven adults (32 African Americans, 25 Latinos) ages 50 years and older participated. The Institute of Medicine's Unequal Treatment conceptual framework was used. Six racially/ ethnically homogenous focus groups were conducted at five sites in three counties. Themes within groups and cross-cutting themes were identified. The NVIVO program was used for data classification. The data were reviewed for final coding and consensus. Shared solutions included addressing costs, recruiting in community contexts, conducting community and individualized patient education, and sharing patient safety information. Participants were unanimously in favor of clinical trials navigation recruitment interventions. Solutions specific to African Americans included diversifying research teams, recognizing past research abuses, and increasing community trust. Solutions specific to Latinos included providing low-literacy materials, providing Spanish-speaking clinicians and advocates, and clarifying that immigration status would neither be documented nor prevent participation. Solutions from African Americans and Latinos reflect their cultural backgrounds and historical experiences. The results suggest the importance of developing a tailored, barriers-focused navigation intervention to improve participation among diverse racial and ethnic populations.

Influence of trace elements on stabilization of aqueous solutions of ascorbic acid

Together with vitamin C, zinc, selenium, manganese, and magnesium play a vital role in the preservation of organs scheduled for transplantation. In the present study, it is shown that addition of 1 mg/l of these elements influences the stability of 0.3 mM ascorbic acid solutions. The solution's stability was estimated using an accelerated stability test. The concentration of vitamin C was measured using a validated spectrophotometric method, which uses the reduction of 2,6-dichlorophenoloindophenol by ascorbic acid. Elevated temperatures, the factor accelerating substances' decomposition reaction rate, were used in the tests. The research was conducted at two temperatures at intervals of 10 °C: 80 ± 0.1 and 90 ± 0.1 °C. It was stated that the studied substances' decomposition occurred in accordance with the equation for first-order reactions. The function of the logarithmic concentration (log%C) over time was revealed to be rectilinear. This dependence was used to determine the kinetics of decomposition reaction rate parameters. The stabilization of vitamin C solutions was measured as the time in which 10 % of the substance decomposed at 20 and 0 °C. Addition of Se(IV) or Mg(II) ions significantly increase the stability of ascorbic acid solution (∼34 and ∼16 %, respectively), but Zn(II) causes a significant decrease in stability by ∼23 %. Addition of Mn(II) has no significant influence on vitamin C stability.

Endocrinology in Thailand: Unique challenges, unique solutions

Thailand is a developing country in Southeast Asia with a nationally acknowledged requirement for improvement of the medical system. At present, endocrinology is a specific branch of medicine that is taught in few medical schools. There are very few endocrinologists in Thailand, who are unable to cope with the large number of patients with endocrinology problems. Primary care for common endocrine disorders, such as diabetes mellitus and thyroid disease, is still the domain of general practitioners. In this article, the author will present unique challenges and unique solutions of endocrinology practice in Thailand.

Ex vivo resuscitation of adult pig hearts

One possible way to expand the human heart donor pool is to include non-heart-beating human donors. To begin validating this approach, we developed an ex vivo cardiac perfusion circuit to support large mammalian hearts in Langendorff mode and beating-ejecting mode and to assess and improve their ischemic tolerance. In vivo hemodynamic data and heparinized blood (4.0 +/- 0.5 L) were collected from 6 anesthetized pigs. Hearts were isolated and connected to a recirculating perfusion circuit primed with autologous buffered blood (pH, 7.40). After retrograde aortic perfusion in Langendorff mode, the left atrium was gravity-filled at 10-20 mmHg, and the left ventricle began to eject against a compliance chamber in series with a systemic reservoir set to a hydraulic afterload of 100-120 mmHg. Left ventricular function was restored and maintained in all 6 hearts for 30 min. Cardiac output, myocardial oxygen consumption, stroke work, aortic pressure, left atrial pressure, and heart rate were measured. The mean myocardial oxygen consumption was 4.8 +/- 2.7 mL/min/100 g (95.8% of in vivo value); and mean stroke work, 5.3 +/- 1.1 g x m/100 g (58.95% of in vivo value). One resuscitated heart was exposed to 30 min of normothermic ischemic arrest, then flushed with Celsior and re-resuscitated. The ex vivo perfusion method described herein restored left ventricular ejection function and allowed assessment of ischemic tolerance in large mammalian hearts, potentially a 1st step toward including non-heart-beating human donors in the human donor pool.