Quintessential Solutions to Existential Problems: How Human Factors and Ergonomics Can and Should Address the Imminent Challenges of Our Times

OBJECTIVE

To examine and evaluate ways in which an understanding of the quintessential element of Human Factors/Ergonomics can address the spectrum of existential threats that confront contemporary civilization.

BACKGROUND

HF/E is dedicated to improving quality of life. Paradoxically, many processes which sustain contemporary civilization act to reduce that overall quality. Some technological developments themselves now even present existential threats to the fragile skein of civilization itself. Many disciplines address these diverse threats, and each may be advised and facilitated by HF/E knowledge and methods. It is a moral imperative of our science to contribute what we can to proposed resolutions.

METHOD

A primary conduit, by the established strengths of HF/E can contribute to potential solutions is identified. The present work advocates for specific, practical interventions using a direct-perception mediated, panopticon principle, that derives from the corpus of our science.

RESULT

Limitations upon a general, social understanding of imminent global concerns, which are largely ignorable when not actually present, are brought to immediate consciousness via an HF/E principle emphasizing the direct-perception of threat. It is argued that this, and allied HF/E insights can generate practical steps toward problem resolution at both macroscopic and localized levels of implementation.

APPLICATIONS

The primary, practical application of the proposed panopticon principle is to use our science to save global civilization. It is postulated that this represents useful employment of the knowledge we have adduced and accumulated across our discipline's existence.

Proton Pump Inhibitors Do Not Affect the Bioavailability of a Novel Liquid Formulation of Levothyroxine

OBJECTIVE

This study evaluates the impact of a representative proton pump inhibitor (PPI) (omeprazole), administered simultaneously or staggered, on the pharmacokinetics of levothyroxine (LT4) solution (Tirosint-SOL).

METHODS

This was a randomized, 3-way crossover, comparative bioavailability study in 36 healthy adults under fasting conditions. Omeprazole 40 mg delayed-release capsule was administered once daily from Day 1 to 6 (mornings, Treatment-A; evenings, Treatment-B; none, Treatment-C) to increase and stabilize gastric pH. In the morning of Day 5, a single dose of LT4 solution 600 mcg was administered. Blood samples were collected 0 to 48 hours post-LT4 administration. Noncompartmental pharmacokinetic parameters were calculated for total serum thyroxine using baseline-corrected data. Maximum concentration (Cmax) and area under the concentration-time curve (AUC0-48) were included in an analysis of variance to obtain geometric mean ratios and 90% confidence intervals.

RESULTS

For both comparisons (A/C and B/C), geometric mean ratios and 90% confidence intervals for all parameters were within the equivalence boundaries (80%-125%), indicating bioequivalence: for A/C, AUC0-48 98.98% [94%-104%], and Cmax 91.68% [87%-97%]; for B/C, AUC0-48 98.94% [95%-103%], and Cmax 94.90% [90%-100%]. Median Tmax (time associated with Cmax) was similar across treatments.

CONCLUSION

This study demonstrated that Tirosint-SOL bioavailability is unaffected by coadministration of a representative PPI, given simultaneously or staggered by about 12 hours, compared to administration of LT4 solution alone. For hypothyroid patients on PPI therapy, administration of LT4 solution may reduce variations in thyroid stimulating hormone levels related to intermittent use of acid-reducing drugs and consequently the need for dose adjustments.

Use of Topical Corticosteroids in the Treatment of Noninfectious Inflammatory Dermatoses of the Scalp: A Survey of Practicing Dermatologists and Dermatology Residents Using Delphi Methodology

Background

Noninfectious inflammatory dermatoses of the scalp are common, and their symptomsin particular, those affecting appearance, can have a psychological effect that may be disproportionate to their clinical severity. Effective, cosmetically acceptable treatments are important to manage these conditions. Topical corticosteroids form the cornerstone of acute treatment for many of these conditions. We surveyed practicing dermatologists and dermatology residents to determine the current clinical practice in prescribing topical corticosteroids for these disorders in their various preparation formats.

Methods

A Delphi method was used, consisting of 2 questionnaire rounds. The first round contained 34 questions and was completed by 612 dermatologists and dermatology residents via email. The first round of responses was analyzed, and points that had > 70% agreement were used to form a second questionnaire of 21 statements. This second round was completed by 346 participants, and their responses were used to generate a final report. Participants were practicing in both public and private practices.

Results

Clobetasol propionate 0.05% topical solution was considered to be the most appropriate treatment for noninfectious inflammatory scalp dermatoses in general, with 75.1% agreement in the second round of questionnaire. The main advantages of clobetasol propionate over other topical corticosteroids were reported as potency, effectiveness, and broad action spectrum (94.8% agreement). The preferred pharmaceutical format was the solution of clobetasol propionate.

Conclusion

Clobetasol propionate was the preferred topical treatment for the management of scalp dermatoses, usually as first-line treatment; solution was the preferred preparation.

Explaining ethical challenges and practical solutions from a nursing managements' perspective: A phenomenological study

Introduction and Objective

Ethical practice is a vital aspect of nursing interventions. Complying with the ethical aspects of the intervention procedure in a stressful nursing environment is not easy and nurse managers always face ethical challenges which are in conflict with their personal values and norms. Identifying and solving these challenges improves the efficiency and effectiveness of nursing care activities. Therefore, this research was done to explain the ethical challenges of nurse managers and practical solutions from their perspective.

Material and Method

It is a qualitative study that was carried out based on the phenomenological method in 2022. The participants of this study were 20 nurse managers of Arak hospitals who were selected by purposive sampling until data saturation. The data were collected through semi-structured interviews for 30 to 90 minutes. Data collection was carried out with the participant's consent, using a digital recording device and verbatim transcription, and then it was analyzed using Van Manen's six-step hermeneutic phenomenological approach.

Findings

The results of this study could provide a clear picture of ethical challenges and their practical solutions from the nurse managers' perspective in the form of four themes of managerial ethical challenges which include challenges facing physicians, organizations, employees, managers, and three themes for practical solutions, including organizational solutions, interpersonal solutions, and educational solutions which were manifested.

Conclusion

Nurse managers are always faced with ethical challenges in their daily activities. To deal with these challenges, they must be familiar with the rules and principles of professional ethics, practical standards, and laws related to patients' rights. Ethical principles and awareness of the ethical decision-making process are useful and effective in having capable and ethical nurses who provide competent care. To deal with ethical challenges, it is suggested to consider self-care strategies and structural and specialized support in each center, which will ultimately lead to the improvement of service quality and the promotion of ethics in care-treatment environments.

Capacity and kinetics of zearalenone adsorption by Geotrichum candidum LG-8 and its dried fragments in solution

The application of LG-8 and its dry fragments as zearalenone (ZEN) adsorbents was investigated. The study showed that Geotrichum candidum LG-8 and its fragments dried at 55°C or through lyophilization are able to adsorb around 80% of ZEN. However, besides in water and 55°C-drying conditions, SEM indicated that higher 90% of ZEN binding tended to occur when cell walls of fragments were intact with less adhesion among themselves. Notably, ZEN/LG-8 fragments complexes were quite stable, as only 1.262% and 1.969% of ZEN were released after successive pH treatments for 4 h and 5 min. The kinetic data signified that adsorption of ZEN onto LG-8 fragments followed well the pseudo-first-order kinetic model. Isotherm calculations showed Langmuir model was favourable and monolayer adsorption of ZEN occurred at functional binding sites on fragments surface. Therefore, we conclude that it can be an alternative biosorbent to treat water contained with ZEN, since LG-8 is low-cost biomass and its fragments have a considerable high biosorption capacity avoiding impacting final product quality and immunodeficient patients.

A Comparative Preclinical Evaluation of a Novel Difluprednate 0.04% BID Ophthalmic Solution and Marketed 0.05% QID Ophthalmic Emulsion

Purpose: The purpose of this study was to compare the efficacy, and ocular pharmacokinetics of a new 0.04% w/v bis in die means twice a day (BID) ophthalmic solution and marketed 0.05% w/v quater in die means four times a day (QID) ophthalmic emulsion of difluprednate in New Zealand white (NZW) rabbits. Methods: The preclinical proof of concept was established in paracentesis-induced acute inflammation, endotoxin-induced acute uveitis, and bovine serum albumin-induced chronic uveitis in NZW rabbit animal models. A comparison of clinical score, total cell count, and total protein was performed to determine efficacy. An ocular pharmacokinetic study was conducted to study the influence of the vehicle on the ocular absorption of the drug. Results: In both uveitis models, the new solution formulation and marketed emulsion formulation inhibited total clinical score, total cell count, PGE2, and total protein significantly more than the placebo and lipopolysaccharide (disease control) groups and were comparable. In an ocular pharmacokinetic study, the Cmax and AUC0-t of difluoroprednisolone 17-butyrate in humor were ∼2-fold higher after 14 days' instillation of new solution formulation (0.04% w/v, BID) compared with 14 days' instillation of marketed emulsion (0.05% w/v, QID). Conclusions: The study demonstrated that the efficacy of the solution formulation at a lower dose and reduced dosing regimen were comparable to that of the emulsion formulation. The reduction in strength and regimen may result in improved patient adherence and outcomes.

Building on Existing Classifications of Behavior Change Techniques to Classify Planned Coping Strategies: Physical Activity Diary Study

BACKGROUND

When trying to be more physically active, preparing for possible barriers by considering potential coping strategies increases the likelihood of plan enactment. Digital interventions can support this process by providing personalized recommendations for coping strategies, but this requires that possible coping strategies are identified and classified. Existing classification systems of behavior change, such as the compendium of self-enactable techniques, may be reused to classify coping strategies in the context of physical activity (PA) coping planning.

OBJECTIVE

This study investigated whether coping strategies created by a student population to overcome barriers to be physically active can be mapped onto the compendium of self-enactable techniques and which adaptations or additions to the frameworks are needed.

METHODS

In total, 359 Flemish university students created action and coping plans for PA for 8 consecutive days in 2020, resulting in 5252 coping plans. A codebook was developed iteratively using the compendium of self-enactable techniques as a starting point to code coping strategies. Additional codes were added to the codebook iteratively. Interrater reliability was calculated, and descriptive statistics were provided for the coping strategies.

RESULTS

Interrater reliability was moderate (Cohen κ=0.72) for the coded coping strategies. Existing self-enactable techniques covered 64.6% (3393/5252) of the coded coping strategies, and added coping strategies covered 28.52% (n=1498). The remaining coping strategies could not be coded as entries were too vague or contained no coping strategy. The added classes covered multiple ways of adapting the original action plan, managing one's time, ensuring the availability of required material, and doing the activity with someone else. When exploring the data further, we found that almost half (n=2371, 45.1%) of the coping strategies coded focused on contextual factors.

CONCLUSIONS

The study's objective was to categorize PA coping strategies. The compendium of self-enactable techniques addressed almost two-thirds (3393/5252, 64.6%) of these strategies, serving as valuable starting points for classification. In total, 9 additional strategies were integrated into the self-enactable techniques, which are largely absent in other existing classification systems. These new techniques can be seen as further refinements of "problem-solving" or "coping planning." Due to data constraints stemming from the COVID-19 pandemic and the study's focus on a healthy Flemish student population, it is anticipated that more coping strategies would apply under normal conditions, in the general population, and among clinical groups. Future research should expand to diverse populations and establish connections between coping strategies and PA barriers, with ontologies recommended for this purpose. This study is a first step in classifying the content of coping strategies for PA. We believe this is an important and necessary step toward digital health interventions that incorporate personalized suggestions for PA coping plans.

Dispensing Oral Temozolomide in Children: Precision and Stability of a Novel and Ready to Use Liquid Formulation in Comparison with Capsule Derived Mixtures

Temozolomide (TMZ) is part of the therapeutic armamentarium used in managing pediatric cancers; however, available oral forms (capsules) are not adapted for use in children. Our aim was to assess the dose accuracy and stability of TMZ using capsule contents mixed with food compared with a novel, ready-to-use liquid formulation specifically developed for children (Ped-TMZ, brand name KIZFIZO). Dose accuracy and TMZ stability testing were performed with TMZ capsule contents (90 mg) mixed with food vehicles (apple juice, apple sauce, cream, milk, and mashed potatoes) and compared to an equivalent dose of Ped-TMZ. Acceptance criteria were predefined for TMZ (95.0-105.0%) and its degradation product amino-imidazole-carboxamide (AIC; <1%) content. The delivered dose was significantly higher using Ped-TMZ (96.6 ± 1.2%) and within the predefined criteria for TMZ content, whereas it was systematically under the lower specifications of 95% using capsule-derived preparations with apple juice (91.0 ± 1.5%) and apple sauce (91.6 ± 1.4%), respectively (p < 0.0001). In chemical stability tests, the four food vehicles (apple sauce, cream, milk, mashed potatoes) had a significant effect on TMZ stability (p = 0.0042), and the AIC significantly increased with time in three of the four vehicles (p < 0.0001). Only 1/72 of preparations from capsules met the predefined acceptance criteria, whereas Ped-TMZ showed no TMZ loss, and the AIC remained within specifications. In conclusion, mixing TMZ capsule content with food may result in significant underexposure, possibly even greater in routine practice, as complete food intake by the child is unlikely.

Crystallization Selectivity of Ribavirin Solution and Amorphous Phase

Crystallization selectivity is an important principle in polymorph control. Ribavirin Form I, Form II, DMSO solvate, and amorphous ribavirin are prepared, and the short-range order similarities between these solid forms and ribavirin aqueous solution and DMSO solution are compared via mid-frequency Raman difference spectra (MFRDS). The crystallization process from amorphous ribavirin to Form I and from solution to amorphous phase is explained. Reasons for the difficulty in preparing the DMSO solvate are proposed. The rationale provided for the crystallization selectivity provides a foundation for the synthesis of metastable phases with a robust and convenient method.

Review: Kirkwood-Riseman Model in Non-Dilute Polymeric Fluids

In two prior articles, I demonstrated from extensive simulational studies by myself and others that the Rouse model of polymer dynamics is invalid in polymer melts and in dilute solution. However, the Rouse model is the foundational basis for most modern theories of polymeric fluid dynamics, such as reptation/scaling models. One therefore rationally asks whether there is a replacement. There is, namely by extending the Kirkwood-Riseman model. Here, I present a comprehensive review of one such set of extensions, namely the hydrodynamic scaling model. This model assumes that polymer dynamics in dilute and concentrated solution is dominated by solvent-mediated hydrodynamic interactions; chain crossing constraints are taken to create only secondary corrections. Many other models assume, contrariwise, that in concentrated solutions, the chain crossing constraints dominate the dynamics. An extended Kirkwood-Riseman model incorporating interchain hydrodynamic interactions is developed. It yields pseudovirial series for the concentration and molecular weight dependencies of the self-diffusion coefficient Ds and the low-shear viscosity η. To extrapolate to large concentrations, rationales based on self-similarity and on the Altenberger-Dahler positive-function renormalization group are presented. The rationales correctly predict how Ds and η depend on polymer concentration and molecular weight. The renormalization group approach leads to a two-parameter ansatz that correctly predicts the functional forms of the frequency dependencies of the storage and loss moduli. A short description is given of each of the papers that led to the hydrodynamic scaling model. Experiments supporting the aspects of the model are noted.

Medications and Food Interfering with the Bioavailability of Levothyroxine: A Systematic Review

Purpose

Levothyroxine is a common prescribed drug. Many medications and food, however, can interfere with its bioavailability. The aim of this review was to summarize the medications, food and beverages that interact with levothyroxine and to assess their effects, mechanisms and treatments.

Methods

A systematic review on interfering substances that interact with levothyroxine was performed. Web of Science, Embase, PubMed, the Cochrane library, grey literature from other sources and the lists of references were searched for human studies comparing the levothyroxine efficacy with and without interfering substances. The patient characteristics, drug classes, effects and mechanism were extracted. The NHLBI study quality assessment tools and the JBI critical appraisal checklist were used to assess the quality of included studies.

Results

A total of 107 articles with 128 studies were included. Drugs interactions were revealed in calcium and iron supplements, proton pump inhibitors, bile acid sequestrants, phosphate binders, sex hormones, anticonvulsants and other drugs. Some food and beverage could also induce malabsorption. Proposed mechanisms included direct complexing, alkalization, alteration of serum thyroxine-binding globulin levels and acceleration of levothyroxine catabolism via deiodination. Dose adjustment, administration separation and discontinuation of interfering substances can eliminate the interactions. Liquid solutions and soft-gel capsules could eliminate the malabsorption due to chelation and alkalization. The qualities of most included studies were moderate.

Conclusion

Lots of medications and food can impair the bioavailability of levothyroxine. Clinicians, patients and pharmaceutical companies should be aware of the possible interactions. Further well-designed studies are needed to provide more solid evidence on treatment and mechanisms.

On the Aging Kinetics of a Flame-Resistant AZ91D-1.5%Ca Magnesium Alloy Processed with Ultrasonic Vibration

The Mg-Al-Zn-Ca system has demonstrated excellent flame resistance and mechanical properties in the as-cast condition. However, the potential of these alloys to be heat-treated, e.g., by aging, as well as the influence of the initial microstructure on the precipitation kinetics, is yet to be comprehensively explored. Ultrasound treatment was applied during the solidification of an AZ91D-1.5%Ca alloy to promote microstructure refinement. Samples from treated and non-treated ingots were subjected to solution treatment at 415 °C for 480 min, followed by aging at 175 °C for up to 4920 min. The results showed that the ultrasound-treated material could reach the peak-age condition in a shorter period than the non-treated one, suggesting accelerated precipitation kinetics and, thus, enhanced aging response. However, the tensile properties showed a decrease in the peak age compared to the as-cast condition, probably due to the formation of precipitates at the grain boundaries that promote the formation of microcracks and intergranular early fracture. This research shows that tailoring the material's as-cast microstructure may positively affect its aging response, shortening the heat treatment duration, thereby making the process less expensive and more sustainable.

Solution-Processable NiOx:PMMA Hole Transport Layer for Efficient and Stable Inverted Organic Solar Cells

For organic solar cells (OSCs), nickel oxide (NiO_x) is a potential candidate as the hole transport layer (HTL) material. However, due to the interfacial wettability mismatch, developing solution-based fabrication methods of the NiO_x HTL is challenging for OSCs with inverted device structures. In this work, by using N, N-dimethylformamide (DMF) to dissolve poly(methyl methacrylate) (PMMA), the polymer is successfully incorporated into the NiO_x nanoparticle (NP) dispersions to modify the solution-processable HTL of the inverted OSCs. Benefiting from the improvements of electrical and surface properties, the inverted PM6:Y6 OSCs based on the PMMA-doped NiO_x NP HTL achieves an enhanced power conversion efficiency of 15.11% as well as improved performance stability in ambient conditions. The results demonstrated a viable approach to realize efficient and stable inverted OSCs by tuning the solution-processable HTL.

Boron nitride nanotube-salt-water hybrid:crystalline precipitation

Molecular dynamics simulation is used to study the transport characteristics of NaCl solution in boron nitride nanotubes (BNNTs). It presents an interesting and well-supported MD study of the crystallization of NaCl from its water solution under the confinement of a 3 nm thick boron nitride nanotube with varied surface charging conditions. The results of the molecular dynamics simulation indicate that NaCl crystallization occurs in charged BNNTs at room temperature when the concentration of NaCl solution reaches about 1.2 M. The reason for this phenomenon is as follows: when the number of ions in the nanotubes is high, the double electric layer that forms at the nanoscale near the charged wall surface, the hydrophobicity of BNNTs, and the interaction among ions cause ions to aggregate in the nanotubes. As the concentration of NaCl solution increases, the concentration of ions when they aggregate in the nanotubes reaches the saturation concentration of the NaCl solution, resulting in the crystalline precipitation phenomenon.

Comparative Bioavailability of a Novel Solution and a Tablet Formulation of Levothyroxine

Levothyroxine (LT4) is the standard of care for treating hypothyroidism. Despite the established efficacy of LT4, 50% of treated patients fail to achieve normal thyrotropin levels. Oral formulations of LT4 that bypass the gastric phase of dissolution may offset some of the therapeutic shortcomings observed with tablets. An oral solution of LT4 can be administered to patients who are unable to swallow tablets; allows flexibility to individualize dosing; and may mitigate interference with LT4 absorption caused by food, coffee, increased gastric pH from atrophic gastritis, and malabsorption from bariatric surgery. The bioavailability of a novel LT4 oral solution and a reference LT4 tablet were compared in a randomized, laboratory-blinded, single-dose, 2-period, 2-sequence, crossover study in healthy euthyroid subjects. A single 600-μg oral dose of LT4 solution (30 mL × 100 μg/5 mL) or tablet (2 × 300-μg tablet) was administered under fasting conditions in each study period, and total thyroxine concentrations were measured for 72 hours after administration. The ratio of geometric least-squares means and 90% confidence intervals for area under the concentration-time curve from time 0 to 72 hours and maximum plasma concentration were calculated. Among 42 subjects in the pharmacokinetic population, the geometric least-squares mean ratio of area under the concentration-time curve from time 0 to 72 hours and maximum plasma concentration for baseline-adjusted thyroxine was 109.1% and 107.9%, respectively, meeting Food and Drug Administration bioequivalence criteria. Adverse events (AEs) were similar between treatment groups with no serious AEs or discontinuations for AEs. Comparable bioavailability was observed between the LT4 oral solution and reference tablet after a single oral 600-μg dose under fasting conditions.

Neglected Tropical Diseases (NTDs) and COVID-19 Pandemic in Africa: Special Focus on Control Strategies

Neglected Tropical Diseases (NTDs) are a group of twenty (20) chronic, communicable, infectious diseases endemic to the tropics and sub-tropics climate countries, which are intimately associated with poverty, poor sanitation, limited clean water, and healthcare delivery; and dwellers live in proximity to pathogens and diseases vectors. The pathogens are protozoans, bacteria, helminths, fungi, and viruses. NTDs currently affect about one billion people globally, out of which 500 million are Africans living in rural settlements with low political voice and support. In recent years, NTDs have received little research recognition, development, and funding because more research efforts by global health stakeholders are focused on recognized diseases like cancers, hepatitis, tuberculosis, Acquired Immune-Deficiency Syndrome (AIDS), and malaria that affects most developed countries. The emergence of the viral novel COVID-19 will exacerbate the burden of NTDs on disadvantaged communities as global health efforts are again focused on COVID-19 clearance in terms of research and development to find a drug/vaccine amidst other investigations on recognized infections. This development can result in high death tolls due to NTDs if control measures are not prioritized now. This perspective addresses the need for NTDs control amidst COVID-19 clearance efforts to mitigate another viral health crisis in Africa.

A Novel Levothyroxine Solution Results in Similar Bioavailability Whether Taken 30 or Just 15 Minutes Before a High-Fat High-Calorie Meal

Background: Levothyroxine (LT4) sodium is a standard treatment for hypothyroidism. Its absorption and bioavailability when taken as a tablet have been shown to be significantly decreased with concomitant food ingestion. Therefore, LT4 formulations are recommended to be taken on an empty stomach, at least 30, ideally 60, minutes before breakfast, potentially affecting adherence to therapy. A novel LT4 solution (Tirosint^®-SOL) has been shown to result in a faster absorption process than tablets or soft-gel capsule formulations. The objective of this trial was to evaluate the bioavailability of this preparation taken 15 minutes before a high-fat high-calorie meal in comparison with the minimally recommended 30-minute interval. Methods: Thirty-six (33 completers, 24 males and 9 females) healthy volunteers participating in the randomized study took 600 mcg of LT4 oral solution, single doses after a 10-hour fast, 15 or 30 minutes before a high-fat, high-calorie, FDA-approved standardized meal in a controlled research setting. We measured serum total thyroxine using Liquid Chromatography with Tandem Mass Spectrometry at baseline and multiple time points up to 72 hours after LT4 administration. The predefined equivalence boundaries for the extent of exposure reflected by the area under the curve (AUC) were 80-125%. The washout period was at least 35 days. Results: The geometric mean ratios and confidence intervals (CIs) for the baseline-adjusted extent of exposure represented by AUCs truncated at both 48 and 72 hours after dosing (AUC_0-48: 90% [90% CI 86-94]; and AUC_0-72: 92% [90% CI 87-97]) were within the prespecified equivalence boundaries. The baseline-adjusted peak concentration was also clinically similar (C_max: 85% [90% CI 80-90]). The median t_max was 1.5 hours in each group. The rate of adverse events was similar between groups. Conclusions: We observed no significant difference in the pharmacokinetic properties of a novel LT4 solution administered 15 and 30 minutes before a high-fat high-calorie meal in normal subjects. Further research is needed to evaluate (a) the differences in overall bioavailability at other time points (including immediately premeal) and (b) the real-world effectiveness of this preparation in newly proposed administration conditions to optimize treatment outcomes in hypothyroid patients.

Femoral prosthesis fracture after hip arthroplasty revision: A Case Report and Review of Literature

RATIONALE

A solution revision prosthesis has a multilayer microporous Porocoat coating, and the availability of multiple stem body sizes ensures that the prosthesis is adapted to each patient's anatomical structure so that there a firm attachment with the bone cortex in the middle of the femur. Therefore, the Solution prosthesis is one of the most commonly used and most effective prostheses in total hip arthroplasty worldwide.

PATIENT CONCERNS

We reported a case of a 54-year-old female patient with periprosthetic femoral fractures after hip arthroplasty.

DIAGNOSIS

The case was identified as type B2 prosthesis loosening according to the Vancouver classification.

INTERVENTIONS

We performed revision surgery on her using the Solution prosthesis. Seven months after the surgery, the patient developed a mid-femoral prosthesis fracture for no apparent reason. We performed a second revision surgery of the hip joint and allogeneic bone plate fixation.

OUTCOMES

The patient was satisfied with the treatment.

LESSONS

For patients with type B2 prosthesis loosening and prosthesis fracture, hip arthroplasty revision and an allogeneic bone plate could be used to ensure more stable support.

The relationship between responsibility attribution and session outcomes: Two-dimension attribution and two-person perspective

OBJECTIVE

Blame attribution (who is to blame for problem causes) and solution attribution (who is to control problem solving) are two critical dimensions of responsibility attribution in psychotherapy. The present study aimed to (1) investigate the impacts of blame attribution and solution attribution on session outcomes from both client and therapist perspectives and (2) clarify the relationship between the therapist-client congruence of responsibility attribution and session outcomes.

METHOD

A total of 69 clients were recruited at a university counselling centre. Client-rated responsibility attribution (to what extent they were responsible for the causes and solution of their current concerns), therapist-rated responsibility attribution (to what extent they thought their clients should be responsible for the causes and solution of clients' current concerns), client-rated session quality and symptom level for each session were collected across 387 sessions. Multilevel regression was used to explore the relationship between responsibility attribution and session outcomes. Truth and bias model and response surface analysis were utilized to analyse the within-client and between-client client-therapist congruence effects.

RESULTS

The main results included that (1) the clients with higher solution responsibility had more symptom improvement and higher evaluation of session quality (between-client level). A client's perceived solution responsibility predicted better session quality and fewer next session symptom levels (within-client level). (2) If a therapist attributed more solution responsibility to his/her client, the session quality was higher (within-client level). (3) Neither clients' nor therapists' perspectives on blame attribution directly affected session outcomes. But the higher the client's blame for his/her problem causes, the stronger the association between solution responsibility and symptom reduction (within-client level). (4) Higher within-client client-therapist congruence on blame responsibility led to better session outcomes.

CONCLUSION

The clients' solution responsibility and client-therapist congruence on blame for problem causes contribute to session outcomes in psychotherapy.

Hospital preparations of ethanol-free furosemide oral solutions: Formulation and stability study

Furosemide is a diuretic frequently used in the therapeutic management of edema associated with cardiac, renal, and hepatic failure and hypertension. However, there are a very low number of pharmaceutical dosage forms containing furosemide that are suitable for children under 6- years old. Therefore, there is a real need to develop hospital preparations, especially in the hospital. Four oral pediatric solutions of furosemide (2 mg/Ml) were formulated. Two of those solutions did not contain ethanol. For each formulation, 12 batches of 1600.0 Ml were prepared and packaged in 250.0 Ml brown glass bottles with polypropylene screw caps. The physicochemical properties (visual appearance, pH, osmolarity, drug content) and microbiological quality of the finished product were determined on the freshly prepared solutions and after 90 days of storage at 30°C/65% RH. The physicochemical and microbiological characteristics of the freshly prepared solutions were within the prescribed specifications. After 90 days of storage at 30°C/65% RH, the solutions containing sucrose and those without ethanol showed a slight decrease in pH and furosemide content of about 2.5%–4.5% (w/w). Despite this slight decrease, the characteristics remained within the prescribed specifications. Based on the stability profile of the ethanol-free solution containing sorbitol, it could be implemented in hospitals for the care of pediatric patients.

The Role of Structure in Polymer Rheology: Review

The review is devoted to the analysis of the current state of understanding relationships among the deformation-induced structure transformations, observed rheological properties, and the occurrence of non-linear effects for polymer liquids (melts, solutions, and composites). Three levels of non-linearity are the base for consideration. The first one concerns changes in the relaxation spectra of viscoelastic liquids, which are responsible for weak non-linear phenomena. The second one refers to the strong non-linearity corresponding to such changes in the structure of a medium that leads to the emergence of a new relaxation state of a matter. Finally, the third one describes the deformation-induced changes in the phase state and/or the occurring of bifurcations and instability in flow and reflects the thermodynamic non-linear behavior. From a structure point of view, a common cause of the non-linear effects is the orientation of macromolecules and changes in intermolecular interaction, while a dominant factor in describing fluid dynamics of polymer liquids is their elasticity. The modern understanding of thixotropic effects, yielding viscoplastic materials, deformation-induced phase transition, and the experimental observations, demonstrating direct correlations between the structure and rheology of polymer liquids, are the main objects for discussion. All these topics are reviewed and discussed mainly on the basis of the latest five-year publications.

Understanding dexamethasone kinetics in the rabbit tear fluid: drug release and clearance from solution, suspension and hydrogel formulations

Rapid precorneal loss of topically applied eye drops limits ocular drug absorption. Controlling release and precorneal residence properties of topical formulations may improve ocular drug bioavailability and duration of action. In this study, we evaluated in vivo ocular pharmacokinetics of dexamethasone in rabbits after application of a drug solution (0.01%), suspension (Maxidex® 0.1%), and hydrogels of 2-hydroxyethyl methacrylate (HEMA) and acrylic acid (AAc) copolymers. The rabbits received a single eyedrop (solution or suspension) or dexamethasone-loaded hydrogel topically. Dexamethasone in tear fluid was sampled with glass capillaries and quantitated by LC-MS/MS. Higher dexamethasone exposure (AUC) in the tear fluid was observed with the suspension (≈ 3.6-fold) and hydrogel (12.8-fold) as compared to the solution. During initial 15 min post-application, the highest AUC of dissolved dexamethasone was seen after hydrogel application (368 min*µg/mL) followed by suspension (109.9 min*µg/mL) and solution (28.7 min*µg/mL. Based on kinetic simulations, dexamethasone release from hydrogels in vivo and in vitro is comparable. Our data indicate that prolonged exposure of absorbable dexamethasone in tear fluid is reached with hydrogels and suspensions. Pharmacokinetic understanding of formulation behavior in the lacrimal fluid helps in the design of dexamethasone delivery systems with improved ocular absorption and prolonged duration of action.

An overview of possible solutions putting an end to the COVID-19 pandemic

In early 2020, a novel coronavirus, SARS-CoV2, started to spread throughout the world. The World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) as a pandemic on March 5, 2020. This 2020's pandemic has to date caused about 200,000 deaths and is still affecting the lives of people worldwide. No solitary solution can overcome the multidimensional challenges associated with the problem of COVID-19. Here, we provide a rapid overview of possible solutions offered by the epidemiological, pharmacological, immunological, and artificial intelligence fields of science on the COVID-19 pandemic. The simultaneous application of all these solutions might bring the world close to an end to the COVID-19 pandemic.

EpiHacks, a Process for Technologists and Health Experts to Cocreate Optimal Solutions for Disease Prevention and Control: User-Centered Design Approach

Background

Technology-based innovations that are created collaboratively by local technology specialists and health experts can optimize the addressing of priority needs for disease prevention and control. An EpiHack is a distinct, collaborative approach to developing solutions that combines the science of epidemiology with the format of a hackathon. Since 2013, a total of 12 EpiHacks have collectively brought together over 500 technology and health professionals from 29 countries.

Objective

We aimed to define the EpiHack process and summarize the impacts of the technology-based innovations that have been created through this approach.

Methods

The key components and timeline of an EpiHack were described in detail. The focus areas, outputs, and impacts of the twelve EpiHacks that were conducted between 2013 and 2021 were summarized.

Results

EpiHack solutions have served to improve surveillance for influenza, dengue, and mass gatherings, as well as laboratory sample tracking and One Health surveillance, in rural and urban communities. Several EpiHack tools were scaled during the COVID-19 pandemic to support local governments in conducting active surveillance. All tools were designed to be open source to allow for easy replication and adaptation by other governments or parties.

Conclusions

EpiHacks provide an efficient, flexible, and replicable new approach to generating relevant and timely innovations that are locally developed and owned, are scalable, and are sustainable.

Treatment of Acne Vulgaris by Topical Spironolactone Solution Compared With Clindamycin Solution

Background: Acne vulgaris is a common skin problem that is encountered in daily clinical work, affecting mostly the adolescent and young adult age group. Many topical therapies have been used in the treatment of mild to moderate types of acne vulgaris. However, none of these modalities is uniformly effective; furthermore, acne vulgaris is also associated with relapse and many topical side effects.

Objective: To compare the effectiveness and side effects of topical 2% spironolactone solution and 1.5% clindamycin solution in the treatment of mild to moderate acne vulgaris.

Material and methods: This was a single-blinded therapeutic clinical comparative study conducted at the Dermatology Center at Medical City in Baghdad, Iraq, from April 2019 to March 2020. Sixty-eight patients with mild to moderate acne vulgaris on the face were included. All sociodemographic data related to the disease were recorded for each patient. Patients were divided into two groups according to the type of therapy: group A (35 patients) used 2% spironolactone solution and group B(33 patients) used 1.5% clindamycin solution. All cases in both groups were instructed to use the solutions twice a day for 12 weeks in the same manner. Patients were seen every two weeks to evaluate the response to therapy and to report any topical side effects; then, follow-up was carried out for one month after cessation of therapy to evaluate relapse.

Results: Spironolactone solution significantly decreased comedone count (p < 0.0001), while the clindamycin solution had no effect on comedones. Although spironolactone was slower than clindamycin solution in reaching the maximum therapeutic effect, the reduction in papules was comparable to that of clindamycin, but it exhibited a greater reduction of pustules (p > 0.05) and the Acne Severity Index (ASI; p > 0.05). Patients in the spironolactone group were more satisfied than those in the clindamycin group. Only minimal local side effects were reported in both groups that did not require cessation of therapy. 

Conclusion: Spironolactone solution is an effective and well-tolerated topical treatment for mild to moderate acne vulgaris and is superior to clindamycin solution.

COVID-19 and the ageing workforce: global perspectives on needs and solutions across 15 countries

BACKGROUND

COVID-19 has a direct impact on the employment of older people. This adds to the challenge of ageism. The World Health Organization has started a worldwide campaign to combat ageism and has called for more research and evidence-based strategies that have the potential to be scaled up. This study specifically aims to identify solutions to combat the adverse effects of COVID-19 on the global ageing workforce.

METHODS

We present 15 case studies from different countries and report on what those countries are doing or not doing to address the impact of COVID-19 on ageing workers.

RESULTS

We provide examples of how COVID-19 influences older people's ability to work and stay healthy, and offer case studies of what governments, organizations or individuals can do to help ensure older people can obtain, maintain and, potentially, expand their current work. Case studies come from Australia, Austria, Canada, China, Germany, Israel, Japan, Nigeria, Romania, Singapore, Sweden, South Korea, Thailand, United Kingdom (UK), and the United States (US). Across the countries, the impact of COVID-19 on older workers is shown as widening inequalities. A particular challenge has arisen because of a large proportion of older people, often with limited education and working in the informal sector within rural areas, e.g. in Nigeria, Thailand and China. Remedies to the particular disadvantage experienced by older workers in the context of COVID are presented. These range from funding support to encouraging business continuity, innovative product and service developments, community action, new business models and localized, national and international actions. The case studies can be seen as frequently fitting within strategies that have been proven to work in reducing ageism within the workplace. They include policy and laws that have increased benefits to workers during lockdowns (most countries); educational activities such as coaching seniorpreneurship (e,g, Australia); intergenerational contact interventions such as younger Thai people who moved back to rural areas and sharing their digital knowledge with older people and where older people reciprocate by teaching the younger people farming knowledge.

CONCLUSION

Global sharing of this knowledge among international, national and local governments and organizations, businesses, policy makers and health and human resources experts will further understanding of the issues that are faced by older workers. This will facilitate the replication or scalability of solutions as called for in the WHO call to combat ageism in 2021. We suggest that policy makers, business owners, researchers and international organisations build on the case studies by investing in evidence-based strategies to create inclusive workplaces. Such action will thus help to challenge ageism, reduce inequity, improve business continuity and add to the quality of life of older workers.

Kinetic and Thermodynamic Characteristics of Fluoride Ions Adsorption from Solution onto the Aluminum Oxide Nanolayer of a Bacterial Cellulose-Based Composite Material

The described research examined the adsorption of fluoride ions from solution immobilized onto an aluminum oxide-coated bacterial cellulose-based composite material in which aluminum oxide had been deposited using ALD technology. The kinetic regularities of the adsorption of fluoride ions from the solution as well as the mechanism of the processes were analyzed. The established equations show that the dynamics of adsorption correspond to first-order kinetics. Based on the Langmuir adsorption isotherms, we defined the adsorption equilibrium constants, parameter maximum adsorption, and change in Gibbs free energy. It is shown that, with increasing temperature, an increase in the reaction rate is constant, both forward and reverse. This testifies to the activated character of adsorption of the first fluoride on the surface of the sorbent based on bacterial cellulose modified with an alumina nanolayer. The activation energy of the desorption process is higher than the activation energy of the adsorption process, which characterizes the adsorption as ionic. The negative value of entropy indicates that in the course of sorption, an adsorption complex "aluminum-fluorine" is formed, where the system is more ordered than the initial system in which fluorine ions are in solution. The limiting stages of the process are revealed. The high sorption capacity of the resulting bacterial cellulose-based composite material obtained by means of biosynthesis through cultivation of the bacterium Komagataeibacter sucrofermentans B-11267 was demonstrated.

Quality of life improvement in patients with hard-to-heal leg wounds treated with Prontosan wound irrigation solution and wound gel

OBJECTIVE

This study evaluated the impact of four weeks of treatment with Prontosan Wound Irrigation Solution and Prontosan Wound Gel (B. Braun Medical Inc., US) on adults with hard-to-heal leg wounds. Overall change (weeks 1-5) in the Global Quality of Life scale (GQOL), changes in body, psyche and everyday life (EDL) quality of life (QoL) subscores, and changes in wound appearance and size after treatment were assessed.

METHOD

In this prospective, open-label, single-arm, five-centre study, non-hospitalised patients with no more than two wounds below the knee were recruited into the study; wounds were ≥5cm² and ≤50cm² and present for ≥4 weeks. The investigator or a designee applied the wound solution and gel to the wounds at clinic visits, and patients/caregivers applied the wound solution and gel at home. Wound-QoL questionnaires were completed at the initial screening and at each week of treatment. Wound size and photographs were obtained at pre- and post-treatment during clinic visits.

RESULTS

A total of 43 patients were enrolled in the study. Mean GQOL scores decreased by 1.11 (46.1%). Body, psyche and EDL decreased by 1.17 (60.0%), 1.26 (41.8%) and 1.00 (42.2%), respectively. Wounds also showed improvement in odour, appearance and size. Adverse events were mild in intensity and transient in nature.

CONCLUSION

This study demonstrated marked improvement in the QoL of patients with hard-to-heal leg wounds below the knee during four weeks of treatment with the wound solution and gel. Wounds also showed improvement in odour, appearance and size, and the treatment solution and gel were well tolerated.

DECLARATION OF INTEREST

B. Braun Medical Inc. funded the research and preparation of this article. AK, DV, CRC and WC are employees of B. Braun Medical Inc. AO and RS declare no conflict of interest.

Alternate dosage formulations of oral targeted anticancer agents

OBJECTIVE

Oral anticancer therapies have demonstrated superior outcomes compared to traditional cytotoxic chemotherapy in many disease states. However, certain patients may not be candidates for these agents due to odynphagia or dysphagia. The purpose of this review is to summarize the data for extemporaneous compounding of oral anticancer agents.

DATA SOURCES

Food and drug administration approvals of oncology agents were reviewed to identify oral anticancer therapies. In order to find alternative administration options: the package inserts of each of these agents were reviewed, each medication was searched in a tertiary drug information resource, the medical information teams of each drug manufacturer were contacted to inquire about proprietary data, sites with pediatric trials were contacted, a primary literature search was performed, and listservs for national pharmacy and oncology organizations were reviewed.

DATA SUMMARY

Eighty-five food and drug administration-approved oral anticancer therapies were identified to be included. Of those agents, nine (11%), had information in the package insert related to alternative administration. After further research, 46 (54%) of the agents had some information related to alternate formulations for administration. The recipes and stability of each of these compounds is included.

CONCLUSIONS

The majority of agents do not have Phase I or II trials that assess safety or pharmacokinetics of alternative formulations. Clinicians should exercise caution when recommending or administering these agents outside of food and drug administration-approved indicated use and utilize clinical judgment in assessing the risks and benefits of altering anticancer compounds. However, the alternative administration considerations presented can increase access to oncology patients who have difficulty swallowing.

Renal and Hepatic Toxicity Analysis of Remdesivir Formulations: Does What Is on the Inside Really Count?

It has been postulated that the injectable solution formulation of remdesivir could be more nephrotoxic than the lyophilized powder since it contains twice as much sulfobutylether-β-cyclodextrin (SBECD). Therefore, we evaluated 1,000 hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who received remdesivir lyophilized powder or solution. A logistic regression model accounting for baseline confounders identified that neither the use of the injectable solution (odds ratio [OR], 1.05; 95% confidence interval [CI], 0.49 to 2.29; P = 0.901) nor a creatinine clearance of <30 ml/min at the time of remdesivir initiation (OR, 1.39; 95% CI, 0.51 to 3.5; P = 0.499) was significantly associated with acute kidney injury. Regarding hepatoxicity, there was no significant difference in early discontinuation of remdesivir due to abnormal liver function tests between patients who received the lyophilized powder versus those who received solution (0.9% versus 2.3%, P = 0.09).

How to Improve the Biocompatibility of Peritoneal Dialysis Solutions (without Jeopardizing the Patient's Health)

Peritoneal dialysis (PD) is an important, if underprescribed, modality for the treatment of patients with end-stage kidney disease. Among the barriers to its wider use are the deleterious effects of currently commercially available glucose-based PD solutions on the morphological integrity and function of the peritoneal membrane due to fibrosis. This is primarily driven by hyperglycaemia due to its effects, through multiple cytokine and transcription factor signalling-and their metabolic sequelae-on the synthesis of collagen and other extracellular membrane components. In this review, we outline these interactions and explore how novel PD solution formulations are aimed at utilizing this knowledge to minimise the complications associated with fibrosis, while maintaining adequate rates of ultrafiltration across the peritoneal membrane and preservation of patient urinary volumes. We discuss the development of a new generation of reduced-glucose PD solutions that employ a variety of osmotically active constituents and highlight the biochemical rationale underlying optimization of oxidative metabolism within the peritoneal membrane. They are aimed at achieving optimal clinical outcomes and improving the whole-body metabolic profile of patients, particularly those who are glucose-intolerant, insulin-resistant, or diabetic, and for whom daily exposure to high doses of glucose is contraindicated.

Overcoming the Challenges Faced by Immigrant Populations While Accessing Primary Care: Potential Solution-oriented Actions Advocated by the Bangladeshi-Canadian Community

Introduction:

Immigrants continue to face significant challenges in accessing primary healthcare (PHC) that often negatively impact their health. The present research aims to capture the perspectives of immigrants to identify potential approaches to enhance PHC access for this group.

Methods:

Focus group discussions (FGDs) were conducted among a sample of first-generation Bangladeshi immigrants who had experience with PHC in Canada. A total of 13 FGDs (7 among women, 6 among men) were conducted with 80 participants (women = 42, men = 38) in their preferred language, Bangla. We collected demographic information prior to each focus group and used descriptive statistics to identify the socio-demographic characteristics of participants. We applied thematic analysis to examine qualitative data to generate a list of themes of possible approaches to improve PHC access.

Results:

The focus group findings identified different levels of approaches to improve PHC access: individual-, community-, service provider-, and policy-level. Individual-level approaches included increased self-awareness of health and wellness and personal knowledge of cultural differences in healthcare services and improved communication skills. At the community level, supports for community members to access care included health education workshops, information sessions, and different support programs (eg, carpool services for senior members). Suggested service-level approaches included providers taking necessary steps to ensure an effective doctor-patient relationship with immigrants (eg, strategies to promote cultural competencies, hiring multicultural staff). FGD participants also raised the importance of government- or policy-level solutions to ensure high quality of care (eg, increased after-hour clinics and lab/diagnostic services).

Conclusions:

Although barriers to immigrants accessing healthcare are well documented in the literature, solutions to address them are under-researched. To improve healthcare access, physicians, community health centers, local health agencies, and public health units should collaborate with members of immigrant communities to identify appropriate interventions.

A New Peritoneal Dialysis Solution Containing L-Carnitine and Xylitol for Patients on Continuous Ambulatory Peritoneal Dialysis: First Clinical Experience

Peritoneal dialysis (PD) is a feasible and effective renal replacement therapy (RRT) thanks to the dialytic properties of the peritoneal membrane (PM). Preservation of PM integrity and transport function is the key to the success of PD therapy, particularly in the long term, since the prolonged exposure to unphysiological hypertonic glucose-based PD solutions in current use is detrimental to the PM, with progressive loss of peritoneal ultrafiltration capacity causing technique failure. Moreover, absorbing too much glucose intraperitoneally from the dialysate may give rise to a number of systemic metabolic effects. Here we report the preliminary results of the first clinical experience based on the use in continuous ambulatory PD (CAPD) patients of novel PD solutions obtained through partly replacing the glucose load with other osmotically active metabolites, such as L-carnitine and xylitol. Ten CAPD patients were treated for four weeks with the new solutions. There was good tolerance to the experimental PD solutions, and no adverse safety signals were observed. Parameters of dialysis efficiency including creatinine clearance and urea Kt/V proved to be stable as well as fluid status, diuresis, and total peritoneal ultrafiltration. The promising tolerance and local/systemic advantages of using L-carnitine and xylitol in the PD solution merit further research.

Barriers to and solutions for improving physical activity in adults during hospital stay: a mixed-methods study among healthcare professionals

PURPOSE

To identify healthcare professionals' perspectives on key barriers to improving physical activity in hospitalized adult patients, and to identify solutions to overcome these barriers. Methods: We used an explanatory sequential mixed-methods study design in a Dutch university hospital. A survey exploring 39 potential barriers was completed by 15 physicians/physician assistants, 106 nurses, four nursing assistants, and four physical therapists working on surgery, internal medicine, and cardiology wards. Next, three in-depth semi-structured focus groups - comprising 30 healthcare professionals - discussed the survey findings to identify key barriers and solutions. Focus group discussions were analyzed using thematic analysis. Results: Five themes were identified that described both the key barriers and the solutions to overcome these barriers. Healthcare professionals proposed several solutions, including clarifying the definition of physical activity, empowering patients to take responsibility for physical activity, giving physical therapists or physicians a prominent role in encouraging physical activity, and changing the hospital ward to entice patients to become physically active. Conclusions: Healthcare professionals need clear guidelines, roles, and responsibilities when it comes to physical activity. They also need personalized interventions that empower patients in physical activity. Finally, hospital wards should be designed and furnished so that patients are encouraged to be active.IMPLICATIONS FOR REHABILITATIONMany healthcare professionals want to sustainably improve physical activity in hospitalized adults.For this they need clear guidelines that not only define physical activity, but also describe the roles and responsibilities of all members of the medical team.Healthcare professionals need interventions that help to empower patients to take an active role in physical activity during hospital stay.Hospital wards should be designed and furnished so that patients are encouraged to be physically active.

Aiming for zero fluid accumulation: First, do no harm

Critically ill patients are often presumed to be in a state of "constant dehydration" or in need of fluid, thereby justifying a continuous infusion with some form of intravenous (IV) fluid, despite their clinical data suggesting otherwise. Overzealous fluid administration and subsequent fluid accumulation and overload are associated with poorer outcomes. Fluids are drugs, and their use should be tailored to meet the patient's individualized needs; fluids should never be given as routine maintenance unless indicated. Before prescribing any fluids, the physician should consider the patient's characteristics and the nature of the illness, and assess the risks and benefits of fluid therapy. Decisions regarding fluid therapy present a daily challenge in many hospital departments: emergency rooms, regular wards, operating rooms, and intensive care units. Traditional fluid prescription is full of paradigms and unnecessary routines as well as malpractice in the form of choosing the wrong solutions for maintenance or not meeting daily requirements. Prescribing maintenance fluids for patients on oral intake will lead to fluid creep and fluid overload. Fluid overload, defined as a 10% increase in cumulative fluid balance from baseline weight, is an independent predictor for morbidity and mortality, and thus hospital cost. In the last decade, increasing evidence has emerged supporting a restrictive fluid approach. In this manuscript, we aim to provide a pragmatic description of novel concepts related to the use of IV fluids in critically ill patients, with emphasis on the different indications and common clinical scenarios. We also discuss active deresuscitation, or the timely cessation of fluid administration, with the intention of achieving a zero cumulative fluid balance.

Highly Resolved Mn Kβ Emission: A Potential Probe in Laboratory for Analysis of Ligand Coordination around Mn Atoms in Gels and Solutions

Mn Kβ spectra of Mn, MnO, MnSO4·H2O, KMnO4, 0.50 M MnSO4 aqueous solution, and the precipitation bands of Mn-Fe-based Prussian blue analogs formed in 2.4 wt.% agarose gel ("Gel") were measured using a laboratory-use X-ray setup with ∼2.6 eV instrumental resolution, which comprises a cylindrically bent Si (400) crystal monochromator and a spherically bent Ge (440) crystal analyzer. The oxidation-state dependent shift of the Mn Kβ1,3 peak (∼1 eV) was clearly observed for Mn, MnO, and KMnO4, confirming that the employed setup can acquire the key features of Mn Kβ spectra. The Mn Kβ spectra of MnSO4·H2O, the 0.50 M solution, and Gel exhibited small but distinguishable differences, whereas the spectra acquired at two positions in Gel were almost the same. These results suggest that highly resolved Mn Kβ spectra can be helpful for assessing ligand coordination around Mn atoms in gels and solutions.

Ingestion of Carbohydrate Prior to and during Maximal, Sprint Interval Cycling Has No Ergogenic Effect: A Randomized, Double-Blind, Placebo Controlled, Crossover Study

Carbohydrate (CHO) ingestion may improve intermittent sprint performance in repeated sprint efforts ≤15 s. Yet, evidence for its efficacy on sprint interval durations ~30 s is lacking. The purpose of this study was to investigate the effects of CHO ingestion on maximal sprint interval exercise. Fifteen (n = 15) recreational athletes (13/2 males/females, age 22 ± 2 years; height 176 ± 11 cm; mass 76.8 ± 11.3 kg) volunteered for this randomised, double-blind, placebo-controlled, crossover design. Participants completed two experimental trials (performed 10-days apart) involving the ingestion of an 8% CHO solution or a flavour and appearance-matched placebo (PLA) solution (5 mL/kg/bw), immediately before exercise, and preceding the second interval of four × 30 s bouts of repeated maximal sprint efforts (separated by 3.5 min of passive recovery). Peak and mean power (W) output progressively decreased during the repeated sprints (main effect of time, p < 0.0001), but there were no differences between CHO and PLA during any of the sprints (p > 0.05 for condition main effect and condition × time interaction). Physiological responses (blood lactate, heart rate, oxygen consumption, respiratory exchange ratio and RPE) were also unaltered by CHO ingestion. In conclusion, CHO ingestion does not enhance performance or modulate physiological responses during intermittent maximal, sprint cycling.

Compositions Based on PAN Solutions Containing Polydimethylsiloxane Additives: Morphology, Rheology, and Fiber Spinning

The effect of additives of polydimethylsiloxanes (PDMS) with various molecular weights on the morphology and rheological behavior of polyacrylonitrile (PAN) solutions in dimethyl sulfoxide has been analyzed. It was shown that only partial compatibility of the PDMS with the lowest molecular weight member of the homologous series studied—hexamethyldisiloxane—with PAN solution takes place. All other PDMS samples form emulsions with PAN solutions. The coalescence rate of PDMS drops depends on the viscosity ratio of the disperse phase and the continuous medium, which determines both the duration of dispersion preparation and the conditions for processing emulsions into fibers and films. An anomalous change in viscosity for a series of emulsions with different concentrations of additives, associated with the slippage, was detected. The relaxation properties of emulsions “feel” macro-phase separation. Modeling of the wet spinning process has shown that the morphology of the deposited solution drop reflects the movement of the diffusion front, leading to the gathering droplets in the center of the deposited formulation drop or to their localization in a certain arrangement. It was shown that the emulsion jets upon stretching undergo phase separation.

A357 Alloy by LPBF for Industry Applications

The aim of this study is to define the process parameters to build components for industrial applications in A357 alloy by Laser Powder Bed Fusion (LPBF) and to evaluate the effects of post-processing heat treatments on the microstructure and mechanical properties in order to obtain the highest hardness and strength. First, process parameters values were defined to obtain full dense components with highest productivity. Then samples were built for microstructural, hardness, and tensile strength investigation in different conditions: as-built, after a stress-relieving treatment, and after a T6 precipitation hardening treatment. For this latest treatment, different time and temperatures for solution and ageing were investigated to find the best in terms of final hardness achievable. It is demonstrated that samples in A357 alloy can be successfully fabricated by LPBF with a density of 99.9% and a mean hardness value achievable of 116 HV0.1, in as-built condition. However, for production purposes, it is fundamental to reduce the residual stresses typical of LPBF. It was shown that a similar hardness value could be obtained after a stress-relieving treatment followed by a proper T6 treatment, together with a coarser but more isotropic microstructure.

Contemporary Australian priming constituents for adult perfusion centres: a survey

AIM

Evidence for the ideal/best practice priming solution remains meagre and largely historical. The aim of this survey was to determine the constituents of contemporary priming solutions in adult open-heart centres across Australia. This would provide insight on the level of variation within current Australian priming practices and inform perfusionists of how their current priming methods compare to the spectrum of Australian practice.

METHOD

A total of 15 survey questions covering various aspects of priming constituents were sent via email to perfusionists in all 63 adult open-heart centres across Australia.

RESULTS

This prime survey received a 100% response rate across Australia. All units prime with a balanced physiological solution, 73% of units prime with Plasma-Lyte 148 and 19% with Hartmann's solution. No synthetic colloids are used for priming in Australia. Up to 6,520 (30%) cases per annum receive heparin as the only additive to their prime base solution. All other cases had various combinations of sodium bicarbonate, mannitol and albumin added for a variety of recorded reasons.

CONCLUSION

Contemporary Australian priming practices show a marked level of conformity between units. Variation exists in the rationale for adding sodium bicarbonate, mannitol and albumin. Further investigations into the clinical effects of these additives are required to determine if the rationale for their addition is historical or judicious in this contemporary era of low prime volumes, physiological base solutions and coated bypass circuits.

Ex Vivo Permeation of Carprofen Vehiculated by PLGA Nanoparticles through Porcine Mucous Membranes and Ophthalmic Tissues

(1) Background: Carprofen (CP), 2-(6-chlorocarbazole) propionic acid, is used as an anti-inflammatory, analgesic and anti-pyretic agent and it belongs to the family of non-steroidal anti-inflammatory drugs (NSAIDs). CP has some adverse reactions in systemic administration; for this reason, topical administration with CP nanoparticles (CP-NPs) can be an optimal alternative. The main objective of this work is the investigation of ex vivo permeation of CP through different types of porcine mucous membranes (buccal, sublingual and vaginal) and ophthalmic tissues (cornea, sclera and conjunctiva) to compare the influence of CP-NPs formulation over a CP solution (CP-Solution). (2) Methods: The ex vivo permeation profiles were evaluated using Franz diffusion cells. Furthermore, in vivo studies were performed to verify that the formulations did not affect the cell structure and to establish the amount retained (Qr) in the tissues. (3) Results: Permeation of CP-NPs is more effective in terms of drug retention in almost all tissues (with the exception of sclera and sublingual). In vivo studies show that neither of the two formulations affects tissue structure, so both formulations are safe. (4) Conclusions: It was concluded that CP-NPs may be a useful tool for the topical treatment of local inflammation in veterinary and human medicine.

Preorganization: A Powerful Tool in Intermolecular Halogen Bonding in Solution

Preorganization is a powerful tool in supramolecular chemistry which has been utilized successfully in intra- and intermolecular halogen bonding. In previous work, we had developed a bidentate bis(iodobenzimidazolium)-based halogen bond donor which featured a central trifluoromethyl substituent. This compound showed a markedly increased catalytic activity compared to unsubstituted bis(iodoimidazolium)-based Lewis acids, which could be explained either by electronic effects (the electron withdrawal by the fluorinated substituent) or by preorganization (the hindered rotation of the halogen bonding moieties). Herein, we systematically investigate the origin of this increased Lewis acidity via a comparison of the two types of compounds and their respective derivatives with or without the central trifluoromethyl group. Calorimetric measurements of halide complexations indicated that preorganization is the main reason for the higher halogen bonding strength. The performance of the catalysts in a series of benchmark reactions corroborates this finding.

Benchmarking of Halogen Bond Strength in Solution with Nickel Fluorides: Bromine versus Iodine and Perfluoroaryl versus Perfluoroalkyl Donors

The energetics of halogen bond formation in solution have been investigated for a series of nickel fluoride halogen bond acceptors; trans-[NiF(2-C5 NF4 )(PEt3 )2 ] (A1), trans-[NiF{2-C5 NF3 (4-H)}(PEt3 )2 ] (A2), trans-[NiF{2-C5 NF3 (4-NMe2 )}(PEt3 )2 ] (A3) and trans-[NiF{2-C5 NF2 H(4-CF3 )}(PCy3 )2 ] (A4) with neutral organic halogen bond donors, iodopentafluorobenzene (D1), 1-iodononafluorobutane (D2) and bromopentafluorobenzene (D3), in order to establish the significance of changes from perfluoroaryl to perfluoroalkyl donors and from iodine to bromine donors. 19 F NMR titration experiments have been employed to obtain the association constants, enthalpy, and entropy for the halogen bond formed between these donor-acceptor partners in protiotoluene. For A2-A4, association constants of the halogen bonds formed with iodoperfluoroalkane (D2) are consistently larger than those obtained for analogous complexes with the iodoperfluoroarene (D1). For complexes formed with A2-A4, the strength of the halogen bond is significantly lowered upon modification of the halogen donor atom from I (in D1) to Br (in D3) (for D1: 5≤K285 ≤12 m-1 , for D3: 1.0≤K193 ≤1.6 m-1 ). The presence of the electron donating NMe2 substituent on the pyridyl ring of acceptor A3 led to an increase in -ΔH, and the association constants of the halogen bond complexes formed with D1-D3, compared to those formed by A1, A2 and A4 with the same donors.

Large-Scale, Solution-Synthesized Nanostructured Composites for Thermoelectric Applications

As more than one-half of worldwide consumed energy is wasted as heat every year, high-efficiency thermoelectric materials are highly demanded for the conversion of rejected heat to electricity in a reliable fashion. In the recent few decades, nanoscience has revolutionized thermoelectrics via the quantum confinement effect in electronic structures and grain-boundary scattering of heat carriers. As the gas-phase syntheses of nanomaterials are not easily scalable and solid-state syntheses are not controllable in terms of microstructures at various length scales, significant research efforts have focused on solution syntheses that can build nanostructures with well-defined size, composition, and morphology. Beyond the performance, several novel effects that benefit the portability and cost efficiency have been discovered in the solution-synthesized nanomaterials. Herein, the relevant progress is reviewed and some prospects proposed.

Enhanced brain penetration of pretomanid by intranasal administration of an oil-in-water nanoemulsion

AIM

To enhance the drug delivery to the brain with an oil-in-water nanoemulsion of pretomanid via intranasal (IN) administration.

MATERIALS & METHODS

The study involved 70 male Sprague-Dawley rats (160-180 g) that received either 20 mg/kg body weight (b.w.) a nanoemulsion or a 20 mg/kg b.w. of pretomanid in solution via the IN route. The drug was quantified by liquid chromatography-tandem mass spectrometry to investigate whole tissue-drug concentrations, and mass spectrometric imaging to visualize drug localization in the brain.

RESULTS

Nanoemulsion delivery concentrations of pretomanid in the brain reached peak concentrations (C_max) of 12,062.3 ng/g that is significantly higher than the required therapeutic level. The mass spectrometric imaging analysis clearly showed a time dependent and uniform distribution in the brain.

CONCLUSION

The results of this study show that IN delivery of oil-in-water nanoemulsion may be very promising for targeting anatomical tuberculosis reservoirs, such as the brain.

Use of buccal morphine in the management of pain in children with life-limiting conditions: Results of a laboratory study

BACKGROUND

Children and infants with impaired swallow or compromised enteral absorption require alternative routes for administration of analgesia. Recent clinical guidance and practice for paediatric palliative care teams, who often treat such children, supports buccal morphine sulphate as a fast acting, effective and easily administered agent for pain relief. However, a consideration of the physicochemical properties and potency of morphine would suggest that it is not a suitable candidate for delivery via the transmucosal route, raising questions about its use in children and infants.

AIM

To explore the permeability of buccal morphine sulphate in an established ex vivo porcine buccal mucosa as a necessary step in examining efficacy for use in children with life-limiting conditions and life-threatening illnesses.

DESIGN

A permeation study conducted with morphine sulphate in an ex vivo porcine buccal tissue model. Flux values and pharmacokinetic data were used to calculate the plasma values of morphine that would result following buccal administration in a 20kg child.

RESULTS

Results show that the estimated steady state plasma values of morphine sulphate following buccal administration in this model do not achieve minimum therapeutic concentration.

CONCLUSION

These data strongly suggest that morphine sulphate is not suitable for buccal administration and that further research is needed to establish its efficacy in relief of pain in children with life-limiting conditions and life-threatening illnesses.