Physiological-based cord clamping stabilised cardiorespiratory parameters in very low birth weight infants

AIM

We investigated the influence of physiological-based cord clamping (PBCC) on cardiorespiratory stability in very low birth weight (VLBW) infants during the first 72 h of life.

METHODS

This retrospective study comprised VLBW infants born at <32 + 0 weeks of gestation and admitted to the neonatal intensive care unit of the Medical University of Graz, Austria, from December 2014 to April 2021. VLBW infants delivered with PBCC were matched by gestational age and birth weight to delayed cord clamping controls. The PBCC group was stabilised after birth with an intact cord. Routine monitoring parameters were compared between the groups.

RESULTS

We included 54 VLBW infants. The mean gestational ages of the PBCC group and controls were 27.4 ± 1.9 versus 27.4 ± 1.8 weeks (p = 0.87), and the mean birth weights were 912 ± 288 versus 915 ± 285 g (p = 0.96), respectively. The mean cord clamping time was 191 ± 78 s in the PBCC group. Heart rate was lower in the PBCC group during the first 3 days after birth, reaching significance by 10 h. Other monitoring parameters did not reveal any differences between the two groups.

CONCLUSION

PBCC stabilised cardiorespiratory parameters in VLBW infants. The lower heart rate in the PBCC group suggested higher blood volume following intact cord resuscitation.

In Vitro Assessment of Wound-Healing Efficacy of Stabilized Basic Fibroblast Growth Factor (FGF-2) Solutions

Chronic tympanic membrane perforations (TMP) pose a significant clinical challenge, but basic fibroblast growth factor (FGF-2) shows promise for their treatment, despite its instability in aqueous solutions which hampers the sustained delivery crucial for the healing process. Addressing this, our research focused on the development of stabilized FGF-2 formulations, F5 and F6, incorporating dual, generally regarded as safe (GRAS) excipients to enhance stability and therapeutic efficacy. F5 combined FGF-2 (1600 ng/mL) with 0.05% w/v methylcellulose (MC) and 20 mM alanine, while F6 used FGF-2 with 0.05% w/v MC and 1 mg/mL human serum albumin (HSA). Our findings demonstrate that these novel formulations not only significantly improve the cytoproliferation of human dermal fibroblasts but also exhibit the most potent chemoattractant effects, leading to the highest fibroblast monolayer closure rates (92.5% for F5 and 94.1% for F6 within 24 h) compared to other FGF-2 solutions tested. The comparable performance of F5 and F6 underscores their potential as innovative, less invasive, and cost-effective options for developing otic medicinal products aimed at the effective treatment of chronic TMP.

Rehabilitation following shoulder arthroscopic stabilisation surgery: A survey of UK practice

Background

Optimal rehabilitation following arthroscopic shoulder stabilisation for traumatic anterior instability is unknown. The purpose of this study was to establish current UK practice for this patient group.

Methods

A self-administered online questionnaire was developed and distributed to UK surgeons and physiotherapists.

Results

138 responses were received. Routine immobilisation was reported in 79.7% of responses with a cross-body sling being the preferred position (63.4%). Duration of immobilisation and timescales to initiate movement were highly variable. Return to light work was advised when patients felt able (25.4%) or after 6 weeks (26.1%). 58.7% recommended waiting for 12 weeks to return to manual work. 56% recommended non-contact sport could be resumed after 12 weeks. For contact sport, recommendations varied from 6 weeks (3.8%) to 6 months (5.8%). Psychological readiness was the most frequently cited criteria for return to play (58.6%). Factors such as hyperlaxity (40.6%), age (32.6%) and kinesiophobia (28.3%) were not considered as relevant as reported quality of surgical fixation (50%).

Conclusion

There is no clear consensus regarding optimal post-operative rehabilitation following arthroscopic shoulder stabilisation. Further work is required to establish high value, personalised pathways for this patient group.

Conversion of Retinyl Palmitate to Retinol by Wheat Bran Endogenous Lipase Reduces Vitamin A Stability

Wheat bran can be used as a cost-effective food ingredient to stabilise vitamin A. However, wheat bran endogenous enzymes have been shown to reduce vitamin A stability. In this study, we elucidated the mechanism for this negative effect in an accelerated storage experiment with model systems consisting of native or toasted wheat bran, soy oil and retinyl palmitate (RP). Both native and toasted wheat bran substantially stabilised RP. While RP was entirely degraded after ten days of storage in the absence of wheat bran, the RP retention after ten days was 22 ± 2% and 75 ± 5% in the presence of native and toasted bran, respectively. The significantly stronger stabilising effect of toasted bran was attributed to the absence of bran endogenous enzymes. In contrast to toasted bran systems, noticeable free fatty acid production was observed for native bran systems. However, this did not result in a pronounced lipid oxidation. Next to lipid hydrolysis, wheat bran lipase was shown to hydrolyse retinyl esters to the less stable retinol and fatty acids. This reaction could explain the major part, about 66 ± 5%, of the difference in RP stabilisation between native and toasted wheat bran.

XIII International Conference on Kangaroo Mother Care - Different opinions, experiences and related KMC issues: Good practices, stabilisation concept, nutrition and basic respiratory support

AIM

This study aimed to summarise the views and experiences of the participants in the workshop of the XIII International Conference on Kangaroo Mother Care (KMC).

METHODS

The results of the discussions held during the workshop of the XIII International Conference on KMC were summarised. There were 152 participants from 47 countries. Four main KMC topics were discussed: good practices, immediate implementation, nutrition and basic ventilation.

RESULTS

Several agreements were reached, namely that professional societies and governments should develop official recommendations to promote KMC as standard care for preterm and low birth weight infants and that parents should be involved as active caregivers in neonatal care units. Moreover, the criteria for referring community-born infants to KMC require standardisation. Important inequalities in resource availability among high-, middle- and low-income countries were recognised for all topics. Specific needs were identified for parenteral nutrition and fortifiers, nasal continuous positive airway pressure (nCPAP) and oxygen blenders, which are rarely available in low- and middle-income countries. Immediate implementation of KMC was discussed as a new concept. Its benefits were recognised, but its application has some variability.

CONCLUSION

Adequate preterm care requires a basic neonatal package, including KMC, nCPAP, immediate management protocols and adequate nutrition and feeding strategies. The differences in resources among high-, middle- and low-income countries highlight the wide disparities in neonatal care according to the place of birth.

Trauma-Informed Care on mental health wards: the impact of Power Threat Meaning Framework Team Formulation and Psychological Stabilisation on self-harm and restrictive interventions

Aim

The aim of this evaluation was to assess the impact of introducing a model of Trauma-Informed Care (TIC), comprising weekly Power Threat Meaning Framework (PTMF) Team Formulation and weekly Psychological Stabilisation staff training, to a National Health Service (NHS) adult acute inpatient mental health unit over a four-year period.

Method

A retrospective service evaluation design was employed to assess for differences in the number of incidents of self-harm, seclusion and restraint in the four-year period following the introduction of TIC, when compared to the year prior.

Results

Significant reductions were demonstrated in the monthly number of incidents of self-harm (p < 0.01; r = 0.42), seclusion (p < 0.05; r = 0.30) and restraint (p < 0.05; d = 0.55) following the introduction of TIC.

Conclusion

Findings suggest that PTMF Team Formulation and Psychological Stabilisation training can contribute to significant reductions in self-harm and restrictive interventions (seclusion and restraint) on adult mental health wards. Qualitative interviews with staff and service users from the unit will support a better understanding of the mechanisms of this change. Further research, employing a randomised control trial design, could increase the validity and generalisability of findings. However, the ethical implications of withholding potentially beneficial practices from a control group would need to be considered.

Respiratory outcomes after delivery room stabilisation with a new respiratory support system using nasal prongs

AIM

To study if stabilisation using a new respiratory support system with nasal prongs compared to T-piece with a face mask is associated with less need for mechanical ventilation and bronchopulmonary dysplasia.

METHODS

A single-centre follow-up study of neonates born <28 weeks gestation at Karolinska University Hospital, Stockholm included in the multicentre Comparison of Respiratory Support after Delivery (CORSAD) trial and randomised to initial respiratory support with the new system versus T-piece. Data on respiratory support, neonatal morbidities and mortality were collected up to 36 weeks post-menstrual age.

RESULTS

Ninety-four infants, 51 female, with a median (range) gestational age of 25 + 2 (23 + 0, 27 + 6) weeks and days, were included. Significantly fewer infants in the new system group received mechanical ventilation during the first 72 h, 24 (52.2%) compared with 35 (72.9%) (p = 0.034) and during the first 7 days, 29 (63.0%) compared with 39 (81.3%) (p = 0.045) in the T-piece group. At 36 weeks post-menstrual age, 13 (28.3%) in the new system and 13 (27.1%) in the T-piece group were diagnosed with bronchopulmonary dysplasia.

CONCLUSION

Stabilisation with the new system was associated with less need for mechanical ventilation during the first week of life. No significant difference was seen in the outcome of bronchopulmonary dysplasia.

Two cases of sternoclavicular joint replacement arthroplasty: A case report. A novel prosthesis and surgical technique for recalcitrant instability, arthropathy of the sternoclavicular joint with medial clavicular bone loss

Instability arthropathy of the sternoclavicular joint is most commonly managed by rehabilitation, injection, and either arthroscopic or open debridement with or without interposition arthroplasty. When these options fail to achieve symptom relief, excision arthroplasty is an option. This is associated with a risk of persistent instability and incomplete pain relief. We describe two cases in which custom sternoclavicular joint replacement was performed for painful insufficiency of scapular suspension. Although the prostheses remained secure in both cases, the first case was complicated by persistent instability due to insufficient reconstruction of the intrinsic sternoclavicular capsular ligaments. This was recognised and corrected for in the second case, in which stability of the sternoclavicular joint replacement has been noted on more than a 5-year review. We conclude that sternoclavicular joint replacement is an option for patients in whom instability arthropathy remains an intrusive problem in daily life after other conventional treatments have not controlled symptoms. Stability of the joint remains a concern. We offer one method of achieving stability through an iterative design process including the ability to reconstruct the intrinsic capsular ligaments around the articulation.

Behaviour and Microstructural Characteristics of Lime-GGBS-Treated Kaolin Clay Contaminated with Gypsum

In this experimental study, the physico-mechanical and microstructural properties of sulphate-bearing clays have been investigated. Sulphate bearing soils constituted by mixing kaolin and gypsum at 0%, 15%, 25%, and 35% gypsum contents were treated with 12% ordinary Portland cement (OPC) and 4%Lime (L) and 8% ground granulated blast furnace slag (GGBS) and subjected to compaction, swell, unconfined compressive strength (UCS), California bearing ratio (CBR), and scanning electron microscopy (SEM) and energy dispersive spectrometry (EDX) analyses. The results of the study showed that the use of L-GGBS improved the soaked CBRs of the treated samples by over 43% when compared to OPC-treated samples after 7-days curing. A reduction in water absorption by 82% was also observed with L-GGBS treatment after 28-days curing. The UCS results also showed better performance with L-GGBS treatment exceeding 856% at 28 days. The effect of increased cementitious product with increasing gypsum content was negated by simultaneous and rapid growth of ettringite minerals which reduced the strength and increased swelling of OPC treated samples up to 18.92%, exceeding allowable limits of 2.5% as specified in Highway Agency Advice Note HA 74/07. The L-GGBS treated gypseous soil samples meet the strength requirement for stabilised sub-base (CS) and stabilised road-bases (CB1 and CB2) as described in TRL ORN31. Hence, the use of L-GGBS combination was found to be effective in ameliorating sulphate-induced expansion and therefore encouraged in the stabilisation of subgrade and road-base materials with high sulphate contents.

Geosynthetics for Filtration and Stabilisation: A Review

Geosynthetics have been commonly used for the construction of civil engineering structures such as retaining wall, road and railways, coastal protection, soft ground improvement work, and landfill systems since the 1960s. In the past 40 years, the development of polymer materials has helped to prolong the life of geosynthetics. In terms of the practical use of geosynthetics, engineers must understand their appropriate application. The first part of this paper provides a basic description of geosynthetics, including their types, components, and functions. The second part deals with the geosynthetics used as filters. This part briefly presents the mechanism of filtration, the factors affecting the durability of geotextile filters, design concepts, laboratory tests, and case studies. The third part of the study covers the use of geosynthetics for stabilisation. Its mechanism was explained separately for geogrids and for geocells. Several examples of applications with geosynthetics intended for the stabilisation function are described in the last part of this paper.

Dynamics of Strength Gain in Sandy Soil Stabilised with Mixed Binders Evaluated by Elastic P-Waves during Compressive Loading

This paper addresses the problem of stabilisation of poor subgrade soil for improving its engineering properties and stiffness. The study aim is to evaluate the effects from single and mixed binders on the gain of strength in sandy soil over the period of curing. We propose an effective non-destructive approach of using P-waves for identifying soil strength upon stabilisation. The growth of strength and stiffness is strongly dependent on time of curing and type of the stabilising agents which can include both single binders and their blended mixtures. The diverse effects from mixed binders on the properties of soil were evaluated, compared and analysed. We performed the experimental trials of five different binders for stabilisation of sandy soil using cement, lime, Ground Granulated Blast Furnace Slag (GGBFS), energy fly ash and bio fly ash. The methodology included soil stabilisation by binders during a total period of 90 days, strength test for the Unconfined Compressive Strength (UCS) and seismic tests on the stabilised samples. The dynamics of soil behaviour stabilised by different binders for days 7, 14, 28 and 90 was statistically analysed and compared. The optimisation of binder blending has been performed using mixture simplex lattice design with three binders in each case as independent variables. Using P-waves naturally exploited strength characteristics of soil samples and allowed us to compare the effects from the individual and blended binders over the complete period of curing with dominating mixes. The results indicate that strength growth in stabilised soil samples is nonlinear in both time and content of binders with dominating effects from slag which contributed the most to the compressive strength development, followed by cement.

Impact of Physical Contact on Preterm Infants' Vital Sign Response to Live Music Therapy

Evidence that music therapy stabilises vital parameters in preterm infants is growing, but the optimal setting for therapy is still under investigation. Our study aimed to quantify the effect of physical contact during live music therapy in preterm infants born < 32 weeks’ gestational age (GA) on post-therapy vital sign values. Live music therapy was delivered twice-weekly until discharge from hospital to 40 stable infants < 32 weeks’ GA. Baseline and post-therapy heart rate, respiratory rate, oxygen saturation and physical contact during each session were recorded. 159 sessions were performed with, and 444 sessions without, physical contact. Descriptive and multivariable regression analyses based on directed acyclic graphs were performed. The mean GA was 28.6 ± 2.6 weeks, and 26 (65%) infants were male. Mean absolute values for heart and respiratory rates lowered during music therapy regardless of physical contact. The mean post-therapy SaO2 was higher compared to baseline values regardless of physical contact (mean differences −8.6 beats/min; −13.3 breaths/min and +2.0%). There were no clinically relevant changes in vital sign responses between therapy sessions, with or without physical contact, or adjusted post-therapy values for any of the studied vital signs. Physical contact caused better baseline and post-therapy vital sign values but did not enhance the vital sign response to music therapy. Thus, the effect of music therapy on preterm infants’ vital signs is independent of physical contact and parents’ presence during music therapy in the neonatal intensive care unit.

La stabilisation néonatale au Canada : des mises à jour aux pratiques du Programme de soins aigus aux nouveau-nés à risque (ACoRN)

On constate des écarts dans les taux de prématurité et de mortalité néonatale au Canada, en partie à cause d'une formation insuffisante en réanimation et en stabilisation néonatales et de même que d'une adhésion inégale aux pratiques exemplaires. Depuis les années 1990, le Programme de réanimation néonatale est la norme dans tous les établissements qui prodiguent des soins périnatals, mais les fournisseurs et les formateurs de soins périnatals ont continué d'observer des lacunes sur le plan des connaissances et des habiletés en matière de stabilisation des nouveau-nés après la réanimation, particulièrement dans les milieux où ces soins sont rarement requis. Le Programme de soins aigus aux nouveau-nés à risque (ACoRN) a été mis sur pied pour corriger ces lacunes. Dans l'ACoRN, une évaluation primaire et des trajectoires pour soigner les divers systèmes organiques (les séquences) priorisent et orientent l'évaluation, les soins essentiels et la prise en charge des nouveau-nés à risque ou malades pendant les premières heures et les premiers jours de vie. Le présent point de pratique fait ressortir les changements aux pratiques et aux recommandations depuis 2012, année de la dernière révision du texte et du fonctionnement de l'ACoRN, qui n'était alors offert qu'en anglais. À l'instar du Programme de réanimation néonatale, l'ACoRN est géré par la Société canadienne de pédiatrie au Canada. Un manuel et un programme d'enseignement révisés, mis à jour, traduits en français et lancés en 2021 standardiseront les soins, accroîtront les compétences et la confiance chez les dispensateurs de soins périnatals et amélioreront les pronostics néonatals au Canada et ailleurs au cours des prochaines années.

Design and development of a smart blind walking stick using machine learning

Visually impaired people are often subjugated under extreme circumstances even in their day-to-day life. The daily requirements of a common man appear to be an impediment in their routine life. Simplest of tasks like walking, eating, bathing, conversing and even eating is of utmost difficulty to them. Moreover, with such difficulties their only way-out seems to be dependency on the privileged lot, which further diminishes their confidence in themselves and gradually makes them even more dependent. The conventional devices that are used by visually impaired people include basic walking sticks which fail at the job in hand by not providing adequate stabilisation on rough surfaces and misguiding the users into unfavourable conditions. There is no way for the person to know what the object in front of them is without hitting it with the stick, which could also lead to accidents. To solve these problems, a smart walking stick is developed which not only recognises the object in front of it using Machine Learning (ML) models, but also gives a voice output to alert its user about the particular object thereby limiting the chance of any and all accidents. The concept is realised in hardware and integrated to the walking stick. This helps in stabilisation of phone and to produce better results in object identification. Further an application is developed to alert the user by converting the obtained image into a voice messages.

Stabilisation of Recombinant Human Basic Fibroblast Growth Factor (FGF-2) against Stressors Encountered in Medicinal Product Processing and Evaluation

Basic fibroblast growth factor (FGF-2) is a highly labile protein with strong potential for tissue engineering. The aim of this study was to develop FGF-2 formulations that are stable against physical stressors encountered in pharmaceutical processing and evaluation. Pharmaceutical excipients, alone or in combination, were added to aqueous FGF-2 (770 ng/mL) solution and the stability of the resulting solutions on storage at 4–37 °C was evaluated. Stability of the solutions to repeated freeze-thaw cycles and lyophilisation was also evaluated, as well as the stability of the lyophilised stabilised protein to storage at −4, 4 and 18 °C for up to 12 months. In all of these experiments FGF-2 was quantified by ELISA assay. The as-received FGF-2, when dissolved in water, was highly unstable, retaining only 50% of baseline protein content after 30 min at 37 °C or 1 h at 25 °C. By contrast, FGF-2 solutions prepared with 0.5% w/v methylcellulose (MC) and 20 mM alanine (formulation F5) or with 0.5% w/v MC and 1 mg/mL human serum albumin (HSA) (formulation F6) were highly stable, having residual FGF-2 content comparable to baseline levels even after 2 h at 37 °C and 5 h at 25 °C. F5 and F6 were also highly stable to repeated freeze-thaw cycles, with >99% of FGF-2 load remaining after the third cycle. In addition, F5 and F6 were stable to lyophilisation, and the lyophilised products could be stored at −4, 4 or 18 °C for at least 12 months, with less than 1% loss in mean FGF-2 content. Thus, FGF-2 solution is effectively stabilised against both thermal and processing stressors in the presence of MC and alanine (F5), or MC and HSA (F6). The resultant FGF-2 solutions may be applied as medicinal products or further processed into more advanced medicinal products, e.g., scaffolds, for wound healing and tissue regeneration.

Stabilisation of the preterm infant in the delivery room using nasal high flow: A 5-year retrospective analysis

AIM

This study reviews clinical outcomes after initiating a routine policy of preterm respiratory stabilisation using nasal high flow (HF) in the delivery room (DR).

METHOD

This was a retrospective observational cohort study in a single-centre neonatal intensive care unit and included all neonates born before 32 weeks of gestation between 1 April 2015 and 31 March 2020. Stabilisation measures and outcomes were recorded including oxygen requirements, admission temperature, surfactant administration, invasive ventilation within 72 h of birth, bronchopulmonary dysplasia (BPD) and death.

RESULTS

There were 491 eligible babies during the 5-year epoch. 292 were stabilised using HF in the DR. The median admission temperature in babies transferred on HF was 36.8°C, and the median FiO₂ at admission was 25%. 45% of these infants received surfactant. At 72 postnatal hours, 78% were either sustained on HF or were either self-ventilating in air (SVIA) or receiving low-flow nasal cannula (LFNC) respiratory support. 27% were intubated within 7 days. At 36 weeks postmenstrual age, 36% of survivors had BPD.

CONCLUSION

We have demonstrated that preterm babies <32 weeks can be effectively stabilised on HF in the DR.

Surface chemistry-dependent antiviral activity of silver nanoparticles

The toxicity towards viruses of silver nanoparticles (AgNPs) has been reported to be dependent on several factors such as particle concentration, size, and shape. Although these factors may indeed contribute to the toxicity of AgNPs, the results presented in this work demonstrate that surface chemistry and especially surface charge is a crucial factor governing their antiviral activity. Here, this work investigated the influence of capping agents representing various surface charges ranging from negative to positive. These AgNPs were capped with citrate, polyethylene glycol (PEG), polyvinylpyrrolidone (PVP) mercaptoacetic acid (MAA) and (branched polyethyleneimine (BPEI). We show that AgNPs exhibited surface charge-dependent toxicity towards MS2 bacteriophages. Among the capping agents under investigation, BPEI capped AgNPs (Ag/BPEI) exhibited the highest reduction of MS2 resulting in ≥6 log₁₀-units reductions, followed by 4-5 log₁₀-units reductions with PVP and PEG capping's and 3-4 log₁₀-units with MAA and citrate cappings. Bare nanoparticles reported a mere 1-2 log₁₀-units reduction. Electrostatic interaction between the positively charged BPEI-coating and the negatively charged virus surface played a significant role in bringing the MS2 closer to toxic silver ions (Ag⁺). Further results obtained from TEM showed that Ag/BPEI nanoparticles could directly damage the structure of the MS2 bacteriophages. AgNPs and cationic capping agents' observed synergy can lead to much lower and much more efficient dosing of AgNPs for antiviral applications.

Stabilisation of betalains and phenolic compounds extracted from red cactus pear (Opuntia ficus-indica) by spray and freeze-drying using oca (Oxalis tuberosa) starch as drying aid

The objective of this work was to evaluate the stabilisation of betalains and phenolic compounds extracted from red cactus pear by spray and freeze-drying. After hydroethanolic extraction and partial solvent removal under reduced pressure, the highly coloured extracts were enriched with oca starch and maltodextrin as drying aids in different ratios (100:0, 70:30, and 50:50, oca starch: maltodextrin) prior to spray and freeze-drying. The obtained microencapsulated extract powders were characterised by moisture content, hygroscopicity, solubility and morphology. In addition, the stability of the encapsulated betalains and phenolics was evaluated during storage at room temperature for 105 days. All microcapsules showed high retentions of betacyanins (69.9-86.5% after 105 days), betaxanthins (72.2-81.9%), phenolic compounds (46.5-63.5%) and antioxidant capacity (60.1-64.9%, FRAP method; 49.7-57.5%, ABTS method). The system with 70:30 starch:maltodextrin ratio as drying aids showed the highest values of retention regarding the polyphenol content (63.5%), antioxidant capacity (64.9% to FRAP method) and betacyanin content (86.5%), as well as a low degradation rate constant of betacyanins (1.23 × 10^-3 days^-1) and a long half-life (563 days). Oca starch used alone or in combination with maltodextrin has been shown to work adequately as a microencapsulating agent and stabilizer of pigments and antioxidants derived from red cactus pear.

Fibroblast Growth Factor 2-A Review of Stabilisation Approaches for Clinical Applications

Basic fibroblast growth factor (FGF)-2 has been shown to regulate many cellular functions including cell proliferation, migration, and differentiation, as well as angiogenesis in a variety of tissues, including skin, blood vessel, muscle, adipose, tendon/ligament, cartilage, bone, tooth, and nerve. These multiple functions make FGF-2 an attractive component for wound healing and tissue engineering constructs; however, the stability of FGF-2 is widely accepted to be a major concern for the development of useful medicinal products. Many approaches have been reported in the literature for preserving the biological activity of FGF-2 in aqueous solutions. Most of these efforts were directed at sustaining FGF-2 activity for cell culture research, with a smaller number of studies seeking to develop sustained release formulations of FGF-2 for tissue engineering applications. The stabilisation approaches may be classified into the broad classes of ionic interaction modification with excipients, chemical modification, and physical adsorption and encapsulation with carrier materials. This review discusses the underlying causes of FGF-2 instability and provides an overview of the approaches reported in the literature for stabilising FGF-2 that may be relevant for clinical applications. Although efforts have been made to stabilise FGF-2 for both in vitro and in vivo applications with varying degrees of success, the lack of comprehensive published stability data for the final FGF-2 products represents a substantial gap in the current knowledge, which has to be addressed before viable products for wider tissue engineering applications can be developed to meet regulatory authorisation.

Nanomaterials for Combined Stabilisation and Deacidification of Cellulosic Materials-The Case of Iron-Tannate Dyed Cotton

The conservation of textiles is a challenge due to the often fast degradation that results from the acidity combined with a complex structure that requires remediation actions to be conducted at several length scales. Nanomaterials have lately been used for various purposes in the conservation of cultural heritage. The advantage with these materials is their high efficiency combined with a great control. Here, we provide an overview of the latest developments in terms of nanomaterials-based alternatives, namely inorganic nanoparticles and nanocellulose, to conventional methods for the strengthening and deacidification of cellulose-based materials. Then, using the case of iron-tannate dyed cotton, we show that conservation can only be addressed if the mechanical strengthening is preceded by a deacidification step. We used CaCO₃ nanoparticles to neutralize the acidity, while the stabilisation was addressed by a combination of nanocellulose, and silica nanoparticles, to truly tackle the complexity of the hierarchical nature of cotton textiles. Silica nanoparticles enabled strengthening at the fibre scale by covering the fibre surface, while the nanocellulose acted at bigger length scales. The evaluation of the applied treatments, before and after an accelerated ageing, was assessed by tensile testing, the fibre structure by SEM and the apparent colour changes by colourimetric measurements.

Surgical management and long-term outcome of dogs with cervical spondylomyelopathy with an anchored intervertebral titanium device

OBJECTIVE

To assess the short- and long-term outcome of an anchored intervertebral titanium device (C-LOX) for the treatment of 10 dogs with disc-associated cervical spondylomyelopathy (DACSM) and 1 dog with osseous-associated cervical spondylomyelopathy.

DESIGN

Retrospective case series.

METHODS

Dogs were included if they were diagnosed with either DACSM or osseous-associated cervical spondylomyelopathy via myelography with or without advanced imaging and underwent surgical distraction and stabilisation of the affected intervertebral disc with a C-LOX implant. Assessment included short-term neurological outcome, radiography immediately and 6 weeks' postsurgery, owner questionnaire and veterinary clinical assessment.

RESULTS

The mean follow-up time was 12 months. Improvement in neurological status was noted in 10 of 11 dogs. Screw loosening or subsidence occurred in five dogs. Revision surgery was performed in two dogs due to implant fracture (n = 1) and recurrence of spinal cord compression due to endplate subsidence around the implant (n = 1). Adjacent segment disease occurred in three dogs (30%) with DACSM at a mean of 11 months postsurgery.

CONCLUSION

The use of the C-LOX implant for dogs with cervical spondylomyelopathy resulted in a high rate of initial neurological improvement; however, there is a moderate incidence of minor and major complications that is comparable to previously described distraction-stabilisation techniques.

Signs of stabilisation and stable coexistence

Many empirical studies motivated by an interest in stable coexistence have quantified negative density dependence, negative frequency dependence, or negative plant-soil feedback, but the links between these empirical results and ecological theory are not straightforward. Here, we relate these analyses to theoretical conditions for stabilisation and stable coexistence in classical competition models. By stabilisation, we mean an excess of intraspecific competition relative to interspecific competition that inherently slows or even prevents competitive exclusion. We show that most, though not all, tests demonstrating negative density dependence, negative frequency dependence, and negative plant-soil feedback constitute sufficient conditions for stabilisation of two-species interactions if applied to data for per capita population growth rates of pairs of species, but none are necessary or sufficient conditions for stable coexistence of two species. Potential inferences are even more limited when communities involve more than two species, and when performance is measured at a single life stage or vital rate. We then discuss two approaches that enable stronger tests for stable coexistence-invasibility experiments and model parameterisation. The model parameterisation approach can be applied to typical density-dependence, frequency-dependence, and plant-soil feedback data sets, and generally enables better links with mechanisms and greater insights, as demonstrated by recent studies.

[A tale of two encounters]

The moving testimony of a patient shows the impact which a successful encounter can have. Beyond the positive clinical consequences, her rediscovered motivation and pleasure are the essential drivers which have guided her along the pathway of reconstruction. A tale of two encounters which have marked her life course.

Geotechnical and mineralogical characterisations of marine-dredged sediments before and after stabilisation to optimise their use as a road material

Dredging activities to extend, deepen and maintain access to harbours generate significant volumes of waste dredged material. Some ways are investigated to add value to these sediments. One solution described here is their use in road construction following treatment with hydraulic binders. This paper presents the characterisation of four sediments, in their raw state and after 90 days of curing following stabilisation treatment with lime and cement, using a combination of novel and established analytical techniques to investigate subsequent changes in mineralogy. These sediments are classified as fine, moderately to highly organic and highly plastic and their behaviour is linked to the presence of smectite clays. The main minerals found in the sediments using X-ray diffraction (XRD) and automated mineralogy are quartz, calcite, feldspars, aluminium silicates, pyrite and halite. Stabilisation was found to improve the mechanical performances of all the sediments. The formation of cementitious hydrates was not specifically detected using automated mineralogy or XRD. However, a decrease in the percentage volume of aluminium silicates and aluminium-iron silicates and an increase of the percentage volume of feldspars and carbonates was observed.

The time taken for the regional distribution of ventilation to stabilise: an investigation using electrical impedance tomography

Electrical impedance tomography is a novel technology capable of quantifying ventilation distribution in the lung in real time during various therapeutic manoeuvres. The technique requires changes to the patient's position to place the electrical impedance tomography electrodes circumferentially around the thorax. The impact of these position changes on the time taken to stabilise the regional distribution of ventilation determined by electrical impedance tomography is unknown. This study aimed to determine the time taken for the regional distribution of ventilation determined by electrical impedance tomography to stabilise after changing position. Eight healthy, male volunteers were connected to electrical impedance tomography and a pneumotachometer. After 30 minutes stabilisation supine, participants were moved into 60 degrees Fowler's position and then returned to supine. Thirty minutes was spent in each position. Concurrent readings of ventilation distribution and tidal volumes were taken every five minutes. A mixed regression model with a random intercept was used to compare the positions and changes over time. The anterior-posterior distribution stabilised after ten minutes in Fowler's position and ten minutes after returning to supine. Left-right stabilisation was achieved after 15 minutes in Fowler's position and supine. A minimum of 15 minutes of stabilisation should be allowed for spontaneously breathing individuals when assessing ventilation distribution. This time allows stabilisation to occur in the anterior-posterior direction as well as the left-right direction.

Changing tracks as situations change: humanitarian and health response along the Liberia-Côte d'Ivoire border

In recent years, protracted crises and fragile post-conflict settings have challenged the co-existence, and even the linear continuum, of relief and development aid. Forced migration has tested humanitarian and development paradigms where sudden-onset emergencies, violence and displacement arise alongside ongoing development work. Drawing on Médecins Sans Frontières interventions in the region from December 2010 to May 2011, this paper examines aid and healthcare responses to displacement in Côte d'Ivoire and Liberia; it focuses on challenges to the maintenance of preparedness for such foreseeable emergencies and to adaptation in response to changing situations of displacement and insecurity. This 'backsliding' from development to emergency remains a substantial challenge to aid; yet, in exactly such cases, it also presents the opportunity to ensure access to medical care that is much more urgently needed in times of crisis, including the suspension of user fees for medical care.

A group-based approach to stabilisation and symptom management in a phased treatment model for refugees and asylum seekers

BACKGROUND

Traumatised asylum seekers and refugees may present with significant and complex mental health problems as a result of prolonged, extreme, and multiple traumatic events. This is further complicated by ongoing complex social circumstances.

CONCEPTS

In our work at the Traumatic Stress Clinic (TSC), the understanding afforded by the concept of complex posttraumatic stress disorder (PTSD) together with the related notion of a phased treatment model, provides a useful framework for organising our work with this population.

CLINICAL APPLICATIONS

An explication of complex PTSD as it applies to our client group is presented, followed by a description of our phased treatment model and an outline of the core principles, which guide our clinical approach. Our symptom management and stabilisation groups have been developed and refined over time and draw on techniques from a variety of cognitive behavioural therapies. These are described in some detail with illustrative clinical case vignettes.

CONCLUSION

This paper concludes with some reflections on the challenges inherent to working with this complex client group.

A decontamination process to remove metals and stabilise Montreal sewage sludge

The Montreal Urban Community (MUC) treatment plant produces approximately 270 tons of dry sludge daily (tds/day) during physicochemical wastewater treatment. The sludges are burned and contribute to the greenhouse effect by producing atmospheric CO2. Moreover, the sludge emanates a nauseating odour during its thermal stabilisation and retains unpleasant odours for the part (25%) that is dried and granulated. To solve this particular problem, the treatment plant authorities are currently evaluating an acidic chemical leaching (sulfuric or hydrochloric acid) process at a pH between 2 and 3, using an oxidizing agent such as ferric chloride or hydrogen peroxide (METIX-AC technology, patent pending; [20]). They could integrate it to a 70 tds/day granulated sludge production process. Verification of the application of METIX-AC technology was carried out in a pilot plant set up near the sludge production plant of the MUC. The tests showed that METIX-AC technology can be advantageously integrated to the process used at the MUC. The residual copper (274 +/- 58 mg/kg) and cadmium (5.6 +/- 2.9 mg/kg) concentrations in the treated sludge meet legislation standards. The results have also shown that odours have been significantly eliminated for the dewatered, decontaminated, and stabilized biosolids (> 97%) compared to the non-decontaminated biosolids. A high rate of odour elimination also was obtained for the liquid leached biosolids (> 93%), compared to the untreated liquid biosolids. The fertilising value (N and P) is well preserved by the METIX-AC process. Dissolved organic carbon measurements have showed that little organic matter is brought in solution during the treatment. In fact, the average concentration of dissolved organic carbon measured in the treated liquid phase is 966 +/- 352 mg/l, whereas it is 1190 +/- 325 mg/l in untreated sludge. The treated sludge was first conditioned with an organic polymer and a coagulant aid. It was successfully dewatered with various dehydration equipments (filter press, rotary press, centrifuge).

Hartshill rectangle: failure of spinal stabilisation in acute spinal cord injury

A high rate of failure of the internal fixation of unstable spinal fractures in complete cord injured patients was noted in patients referred to the Salisbury Spinal Centre who had been stabilised with a Hartshill rectangle. This prompted a review of the operative notes, radiographs and clinical outcomes of all patients referred to the centre with a Hartshill rectangle in situ. All patients identified with a complete spinal cord injury and Hartshill rectangle were identified. Forty-three such patients referred from 13 different centres were found. Pre- and postoperative radiographs were assessed for fracture pattern and for spinal correction. Operative outcome in terms of pain and complications relating to surgery were identified. The most recent radiographs were assessed for signs of loss of reduction or stabilisation. Follow-up averaged 84 months (range 36-132 months). Of the 43 identified patients, 19 were found to have unsatisfactory stabilisation. Persistent pain, broken implants and worsening kyphosis were the main complications. The failure to use bone graft at the time of stabilisation was significantly (P < 0.001) related to risk of failure. The application and use of the Hartshill is not a technically challenging procedure; however, if the system is to be used, it must be used correctly. Failure to correctly apply the rectangle and to use bone graft will lead to an unacceptably high rate of failure.