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Sample records for scaffolding improves outcome

  1. Problem-Based Learning, Scaffolding, and Coaching: Improving Student Outcomes through Structured Group Time

    Science.gov (United States)

    Murray, Lynn M.

    2012-01-01

    Live-client projects are increasingly used in marketing coursework. However, students, instructors, and clients are often disappointed by the results. This paper reports an approach drawn from the problem-based learning, scaffolding, and team formation and coaching literatures that uses favor of a series of workshops designed to guide students in…

  2. Making the Failure More Productive: Scaffolding the Invention Process to Improve Inquiry Behaviors and Outcomes in Invention Activities

    Science.gov (United States)

    Holmes, N. G.; Day, James; Park, Anthony H. K.; Bonn, D. A.; Roll, Ido

    2014-01-01

    Invention activities are Productive Failure activities in which students attempt (and often fail) to invent methods that capture deep properties of a construct before being taught expert solutions. The current study evaluates the effect of scaffolding on the invention processes and outcomes, given that students are not expected to succeed in their…

  3. Improvement of PHBV scaffolds with bioglass for cartilage tissue engineering.

    Directory of Open Access Journals (Sweden)

    Jun Wu

    Full Text Available Polymer scaffold systems consisting of poly(hydroxybutyrate-co-hydroxyvalerate (PHBV have proven to be possible matrices for the three-dimensional growth of chondrocyte cultures. However, the engineered cartilage grown on these PHBV scaffolds is currently unsatisfactory for clinical applications due to PHBV's poor hydrophilicity, resulting in inadequate thickness and poor biomechanical properties of the engineered cartilage. It has been reported that the incorporation of Bioglass (BG into PHBV can improve the hydrophilicity of the composites. In this study, we compared the effects of PHBV scaffolds and PHBV/BG composite scaffolds on the properties of engineered cartilage in vivo. Rabbit articular chondrocytes were seeded into PHBV scaffolds and PHBV/BG scaffolds. Short-term in vitro culture followed by long-term in vivo transplantation was performed to evaluate the difference in cartilage regeneration between the cartilage layers grown on PHBV and PHBV/BG scaffolds. The results show that the incorporation of BG into PHBV efficiently improved both the hydrophilicity of the composites and the percentage of adhered cells and promoted cell migration into the inner part the constructs. With prolonged incubation time in vivo, the chondrocyte-scaffold constructs in the PHBV/BG group formed thicker cartilage-like tissue with better biomechanical properties and a higher cartilage matrix content than the constructs in the PHBV/BG group. These results indicate that PHBV/BG scaffolds can be used to prepare better engineered cartilage than pure PHBV.

  4. Improvement of PHBV Scaffolds with Bioglass for Cartilage Tissue Engineering

    Science.gov (United States)

    Li, Haiyan; Sun, Junying; Liu, Kai

    2013-01-01

    Polymer scaffold systems consisting of poly(hydroxybutyrate-co-hydroxyvalerate) (PHBV) have proven to be possible matrices for the three-dimensional growth of chondrocyte cultures. However, the engineered cartilage grown on these PHBV scaffolds is currently unsatisfactory for clinical applications due to PHBV’s poor hydrophilicity, resulting in inadequate thickness and poor biomechanical properties of the engineered cartilage. It has been reported that the incorporation of Bioglass (BG) into PHBV can improve the hydrophilicity of the composites. In this study, we compared the effects of PHBV scaffolds and PHBV/BG composite scaffolds on the properties of engineered cartilage in vivo. Rabbit articular chondrocytes were seeded into PHBV scaffolds and PHBV/BG scaffolds. Short-term in vitro culture followed by long-term in vivo transplantation was performed to evaluate the difference in cartilage regeneration between the cartilage layers grown on PHBV and PHBV/BG scaffolds. The results show that the incorporation of BG into PHBV efficiently improved both the hydrophilicity of the composites and the percentage of adhered cells and promoted cell migration into the inner part the constructs. With prolonged incubation time in vivo, the chondrocyte-scaffold constructs in the PHBV/BG group formed thicker cartilage-like tissue with better biomechanical properties and a higher cartilage matrix content than the constructs in the PHBV/BG group. These results indicate that PHBV/BG scaffolds can be used to prepare better engineered cartilage than pure PHBV. PMID:23951190

  5. Hemocompatibility improvement of perfusion-decellularized clinical-scale liver scaffold through heparin immobilization

    National Research Council Canada - National Science Library

    Bao, Ji; Wu, Qiong; Sun, Jiu; Zhou, Yongjie; Wang, Yujia; Jiang, Xin; Li, Li; Shi, Yujun; Bu, Hong

    2015-01-01

    .... However, the scaffold's poor hemocompatibility poses a major obstacle. This study was intended to improve the hemocompatibility of perfusion-decellularized porcine liver scaffold via immobilization of heparin...

  6. Biologically improved nanofibrous scaffolds for cardiac tissue engineering

    Energy Technology Data Exchange (ETDEWEB)

    Bhaarathy, V. [Centre for Nanofibers and Nanotechnology, NUSNNI, Faculty of Engineering, National University of Singapore, 117576 (Singapore); Department of Nanoscience and Technology, School of Physical Sciences, Bharathiar University, Coimbatore 641046 (India); Lee Kong Chian School of Medicine, Nanyang Technological University, 138673 (Singapore); Venugopal, J., E-mail: nnijrv@nus.edu.sg [Centre for Nanofibers and Nanotechnology, NUSNNI, Faculty of Engineering, National University of Singapore, 117576 (Singapore); Gandhimathi, C. [Centre for Nanofibers and Nanotechnology, NUSNNI, Faculty of Engineering, National University of Singapore, 117576 (Singapore); Ponpandian, N.; Mangalaraj, D. [Department of Nanoscience and Technology, School of Physical Sciences, Bharathiar University, Coimbatore 641046 (India); Ramakrishna, S. [Centre for Nanofibers and Nanotechnology, NUSNNI, Faculty of Engineering, National University of Singapore, 117576 (Singapore)

    2014-11-01

    Nanofibrous structure developed by electrospinning technology provides attractive extracellular matrix conditions for the anchorage, migration and differentiation of stem cells, including those responsible for regenerative medicine. Recently, biocomposite nanofibers consisting of two or more polymeric blends are electrospun more tidily in order to obtain scaffolds with desired functional and mechanical properties depending on their applications. The study focuses on one such an attempt of using copolymer Poly(L-lactic acid)-co-poly (ε-caprolactone) (PLACL), silk fibroin (SF) and Aloe Vera (AV) for fabricating biocomposite nanofibrous scaffolds for cardiac tissue engineering. SEM micrographs of fabricated electrospun PLACL, PLACL/SF and PLACL/SF/AV nanofibrous scaffolds are porous, beadless, uniform nanofibers with interconnected pores and obtained fibre diameter in the range of 459 ± 22 nm, 202 ± 12 nm and 188 ± 16 nm respectively. PLACL, PLACL/SF and PLACL/SF/AV electrospun mats obtained at room temperature with an elastic modulus of 14.1 ± 0.7, 9.96 ± 2.5 and 7.0 ± 0.9 MPa respectively. PLACL/SF/AV nanofibers have more desirable properties to act as flexible cell supporting scaffolds compared to PLACL for the repair of myocardial infarction (MI). The PLACL/SF and PLACL/SF/AV nanofibers had a contact angle of 51 ± 12° compared to that of 133 ± 15° of PLACL alone. Cardiac cell proliferation was increased by 21% in PLACL/SF/AV nanofibers compared to PLACL by day 6 and further increased to 42% by day 9. Confocal analysis for cardiac expression proteins myosin and connexin 43 was observed better by day 9 compared to all other nanofibrous scaffolds. The results proved that the fabricated PLACL/SF/AV nanofibrous scaffolds have good potentiality for the regeneration of infarcted myocardium in cardiac tissue engineering. - Highlights: • Fabricated nanofibrous scaffolds are porous, beadless and uniform structures. • PLACL/SF/AV nanofibers improve the

  7. Scaffolding Improvement in Writing Instruction an Action Research Project

    OpenAIRE

    Miller, Kristine W.

    2012-01-01

    Research has demonstrated students may improve their writing ability when cognitive strategies are demonstrated for them in clear and explicit ways as they observe and participate in writing events directed by knowledgeable writers, particularly when these events are followed by opportunities for independent writing. Carefully crafted scaffolding with abundant amounts of oral interaction such as that in Read’s IMSCI model that includes inquiry, modeling, shared writing, collaboration and inde...

  8. Improved biocomposite development of poly(vinyl alcohol) and hydroxyapatite for tissue engineering scaffold fabrication using selective laser sintering.

    Science.gov (United States)

    Wiria, Florencia Edith; Chua, Chee Kai; Leong, Kah Fai; Quah, Zai Yan; Chandrasekaran, Margam; Lee, Mun Wai

    2008-03-01

    In scaffold guided tissue engineering (TE), temporary three-dimensional scaffolds are essential to guide and support cell proliferation. Selective Laser Sintering (SLS) is studied for the development of such scaffolds by eliminating pore spatial control problems faced in conventional scaffolds fabrication methods. SLS offers good user control over the scaffold's microstructures by adjusting its main processing parameters, namely the laser power, scan speed and part bed temperature. This research focuses on the improvements in the fabrication of TE scaffolds using SLS with powder biomaterials, namely hydroxyapatite (HA) and poly(vinyl alcohol) (PVA). Grinding of as-received PVA powder to varying particle sizes and two methods of mixing are investigated as the preparation process to determine a better mixing method that would enhance the mixture homogeneity. Suitable sintering conditions for the improved biocomposite are then achieved by varying the important process parameters such as laser power, scan speed and part bed temperature.SLS fabricated samples are characterized using Fourier Transform Infrared Spectrometer (FTIR) and Scanning Electron Microscope (SEM). FTIR results show that the grinding and sintering processes neither compromise the chemical composition of the PVA nor cause undue degradation. Visual analysis of the grinding, powder mixing and sintering effect are carried out with SEM. The SEM observations show improvements in the sintering effects. The favorable outcome ascertains PVA/HA biocomposite as a suitable material to be processed by SLS for TE scaffolds.

  9. Bone Marrow Stem Cells Added to a Hydroxyapatite Scaffold Result in Better Outcomes after Surgical Treatment of Intertrochanteric Hip Fractures

    Science.gov (United States)

    Gutierres, Manuel; Lopes, M. Ascenção; Santos, J. Domingos; Cabral, A. T.; Pinto, R.

    2014-01-01

    Introduction. Intertrochanteric hip fractures occur in the proximal femur. They are very common in the elderly and are responsible for high rates of morbidity and mortality. The authors hypothesized that adding an autologous bone marrow stem cells concentrate (ABMC) to a hydroxyapatite scaffold and placing it in the fracture site would improve the outcome after surgical fixation of intertrochanteric hip fractures. Material and Methods. 30 patients were randomly selected and divided into 2 groups of 15 patients, to receive either the scaffold enriched with the ABMC (Group A) during the surgical procedure, or fracture fixation alone (Group B). Results. There was a statistically significant difference in favor of group A at days 30, 60, and 90 for Harris Hip Scores (HHS), at days 30 and 60 for VAS pain scales, for bedridden period and time taken to start partial and total weight bearing (P hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures. PMID:24955356

  10. Instructional scaffolding to improve students' skills in evaluating clinical literature.

    Science.gov (United States)

    Dawn, Stefani; Dominguez, Karen D; Troutman, William G; Bond, Rucha; Cone, Catherine

    2011-05-10

    To implement and assess the effectiveness of an activity to teach pharmacy students to critically evaluate clinical literature using instructional scaffolding and a Clinical Trial Evaluation Rubric. The literature evaluation activity centered on a single clinical research article and involved individual, small group, and large group instruction, with carefully structured, evidence-based scaffolds and support materials centered around 3 educational themes: (1) the reader's awareness of text organization, (2) contextual/background information and vocabulary, and (3) questioning, prompting, and self-monitoring (metacognition). Students initially read the article, scored it using the rubric, and wrote an evaluation. Students then worked individually using a worksheet to identify and define 4 to 5 vocabulary/concept knowledge gaps. They then worked in small groups and as a class to further improve their skills. Finally, they assessed the same article using the rubric and writing a second evaluation. Students' rubric scores for the article decreased significantly from a mean pre-activity score of 76.7% to a post-activity score of 61.7%, indicating that their skills in identifying weaknesses in the article's study design had improved. Use of instructional scaffolding in the form of vocabulary supports and the Clinical Trial Evaluation Rubric improved students' ability to critically evaluate a clinical study compared to lecture-based coursework alone.

  11. Improving surgical outcomes

    Directory of Open Access Journals (Sweden)

    Tony Walia

    2008-12-01

    Full Text Available Outcomes of cataract surgery are worse than we would like them to be. Community-based studies show that up to 40% of eyes have a postoperative presenting vision of < 6/60. Eyes with intraocular lenses (IOLs do better; however, it has been shown that even in prosperous middle-income countries, such as Venezuela, in 20% of pseudophakic eyes presenting vision was < 6/60 and in 15% best corrected vision was worse than 6/60.Poor outcomes matter. Patients deserve improved vision whenever possible and poor outcomes deter prospective patients from coming for surgery and probably reduce their willingness to pay for their treatment – particularly if they have to pay in advance!In this article, we offer some suggestions for improving the quality of cataract surgery. We admit that there is little evidence base for most of these suggestions and that some of them are controversial. However, we hope to stimulate debate.

  12. Teleophthalmology: improving patient outcomes?

    Directory of Open Access Journals (Sweden)

    Sreelatha OK

    2016-02-01

    Full Text Available Omana Kesary Sreelatha,1 Sathyamangalam VenkataSubbu Ramesh2 1Ophthalmology Department, Sultan Qaboos University Hospital, Muscat, Oman; 2Department of Optometry, School of Allied Health Sciences, Manipal University, Manipal, India Abstract: Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP. Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR, glaucoma, age-related macular degeneration (ARMD, and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time

  13. Magnesium Oxide Nanoparticles Reinforced Electrospun Alginate-Based Nanofibrous Scaffolds with Improved Physical Properties

    Directory of Open Access Journals (Sweden)

    R. T. De Silva

    2017-01-01

    Full Text Available Mechanically robust alginate-based nanofibrous scaffolds were successfully fabricated by electrospinning method to mimic the natural extracellular matrix structure which benefits development and regeneration of tissues. Alginate-based nanofibres were electrospun from an alginate/poly(vinyl alcohol (PVA polyelectrolyte complex. SEM images revealed the spinnability of the complex composite nanofibrous scaffolds, showing randomly oriented, ultrafine, and virtually defects-free alginate-based/MgO nanofibrous scaffolds. Here, it is shown that an alginate/PVA complex scaffold, blended with near-spherical MgO nanoparticles (⌀ 45 nm at a predetermined concentration (10% (w/w, is electrospinnable to produce a complex composite nanofibrous scaffold with enhanced mechanical stability. For the comparison purpose, chemically cross-linked electrospun alginate-based scaffolds were also fabricated. Tensile test to rupture revealed the significant differences in the tensile strength and elastic modulus among the alginate scaffolds, alginate/MgO scaffolds, and cross-linked alginate scaffolds (P<0.05. In contrast to cross-linked alginate scaffolds, alginate/MgO scaffolds yielded the highest tensile strength and elastic modulus while preserving the interfibre porosity of the scaffolds. According to the thermogravimetric analysis, MgO reinforced alginate nanofibrous scaffolds exhibited improved thermal stability. These novel alginate-based/MgO scaffolds are economical and versatile and may be further optimised for use as extracellular matrix substitutes for repair and regeneration of tissues.

  14. Improved cell activity on biodegradable photopolymer scaffolds using titanate nanotube coatings

    Energy Technology Data Exchange (ETDEWEB)

    Beke, S., E-mail: szabolcs.beke@iit.it [Nanophysics, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova (Italy); Barenghi, R. [IEIIT, National Research Council (CNR), Via De Marini 6, 16149 Genova (Italy); Farkas, B.; Romano, I. [Nanophysics, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova (Italy); Kőrösi, L. [Department of Biotechnology, Nanophage Therapy Center, Enviroinvest Corporation, Kertváros u. 2, H-7632 Pécs (Hungary); Scaglione, S. [IEIIT, National Research Council (CNR), Via De Marini 6, 16149 Genova (Italy); Brandi, F. [Nanophysics, Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova (Italy); Istituto Nazionale di Ottica, CNR, Via G. Moruzzi 1, 56124-Pisa (Italy)

    2014-11-01

    The development of bioactive materials is in the premise of tissue engineering. For several years, surface functionalization of scaffolds has been one of the most promising approaches to stimulate cellular activity and finally improve implant success. Herein, we describe the development of a bioactive composite scaffold composed of a biodegradable photopolymer scaffold and titanate nanotubes (TNTs). The biodegradable photopolymer scaffolds were fabricated by applying mask-projection excimer laser photocuring at 308 nm. TNTs were synthesized and then spin-coated on the porous scaffolds. Upon culturing fibroblast cells on scaffolds, we found that nanotubes coating affects cell viability and proliferation demonstrating that TNT coatings enhance cell growth on the scaffolds by further improving their surface topography. - Highlights: • Biodegradable scaffolds were produced by mask-assisted UV laser photocuring. • Titanate nanotube deposition was carried out without binding compounds or additives. • Titanate nanotube coatings enhanced cell viability and proliferation.

  15. Bone Marrow Stem Cells Added to a Hydroxyapatite Scaffold Result in Better Outcomes after Surgical Treatment of Intertrochanteric Hip Fractures

    Directory of Open Access Journals (Sweden)

    Joao Torres

    2014-01-01

    Full Text Available Introduction. Intertrochanteric hip fractures occur in the proximal femur. They are very common in the elderly and are responsible for high rates of morbidity and mortality. The authors hypothesized that adding an autologous bone marrow stem cells concentrate (ABMC to a hydroxyapatite scaffold and placing it in the fracture site would improve the outcome after surgical fixation of intertrochanteric hip fractures. Material and Methods. 30 patients were randomly selected and divided into 2 groups of 15 patients, to receive either the scaffold enriched with the ABMC (Group A during the surgical procedure, or fracture fixation alone (Group B. Results. There was a statistically significant difference in favor of group A at days 30, 60, and 90 for Harris Hip Scores (HHS, at days 30 and 60 for VAS pain scales, for bedridden period and time taken to start partial and total weight bearing (P<0.05. Discussion. These results show a significant benefit of adding a bone marrow enriched scaffold to surgical fixation in intertrochanteric hip fractures, which can significantly reduce the associated morbidity and mortality rates. Conclusion. Bone marrow stem cells added to a hydroxyapatite scaffold result in better outcomes after surgical treatment of intertrochanteric hip fractures.

  16. Improving effects of chitosan nanofiber scaffolds on osteoblast proliferation and maturation.

    Science.gov (United States)

    Ho, Ming-Hua; Liao, Mei-Hsiu; Lin, Yi-Ling; Lai, Chien-Hao; Lin, Pei-I; Chen, Ruei-Ming

    2014-01-01

    Osteoblast maturation plays a key role in regulating osteogenesis. Electrospun nanofibrous products were reported to possess a high surface area and porosity. In this study, we developed chitosan nanofibers and examined the effects of nanofibrous scaffolds on osteoblast maturation and the possible mechanisms. Macro- and micro observations of the chitosan nanofibers revealed that these nanoproducts had a flat surface and well-distributed fibers with nanoscale diameters. Mouse osteoblasts were able to attach onto the chitosan nanofiber scaffolds, and the scaffolds degraded in a time-dependent manner. Analysis by scanning electron microscopy further showed mouse osteoblasts adhered onto the scaffolds along the nanofibers, and cell-cell communication was also detected. Mouse osteoblasts grew much better on chitosan nanofiber scaffolds than on chitosan films. In addition, human osteoblasts were able to adhere and grow on the chitosan nanofiber scaffolds. Interestingly, culturing human osteoblasts on chitosan nanofiber scaffolds time-dependently increased DNA replication and cell proliferation. In parallel, administration of human osteoblasts onto chitosan nanofibers significantly induced osteopontin, osteocalcin, and alkaline phosphatase (ALP) messenger (m)RNA expression. As to the mechanism, chitosan nanofibers triggered runt-related transcription factor 2 mRNA and protein syntheses. Consequently, results of ALP-, alizarin red-, and von Kossa-staining analyses showed that chitosan nanofibers improved osteoblast mineralization. Taken together, results of this study demonstrate that chitosan nanofibers can stimulate osteoblast proliferation and maturation via runt-related transcription factor 2-mediated regulation of osteoblast-associated osteopontin, osteocalcin, and ALP gene expression.

  17. Mesoporous Bioactive Glass Functionalized 3D Ti-6Al-4V Scaffolds with Improved Surface Bioactivity

    Directory of Open Access Journals (Sweden)

    Xiaotong Ye

    2017-10-01

    Full Text Available Porous Ti-6Al-4V scaffolds fabricated by means of selective laser melting (SLM, having controllable geometrical features and preferable mechanical properties, have been developed as a class of biomaterials that hold promising potential for bone repair. However, the inherent bio-inertness of the Ti-6Al-4V alloy as the matrix of the scaffolds results in a lack in the ability to stimulate bone ingrowth and regeneration. The aim of the present study was to develop a bioactive coating on the struts of SLM Ti-6Al-4V scaffolds in order to add the desired surface osteogenesis ability. Mesoporous bioactive glasses (MBGs coating was applied on the strut surfaces of the SLM Ti-6Al-4V scaffolds through spin coating, followed by a heat treatment. It was found that the coating could maintain the characteristic mesoporous structure and chemical composition of MBG, and establish good interfacial adhesion to the Ti-6Al-4V substrate. The compressive strength and pore interconnectivity of the scaffolds were not affected by the coating. Moreover, the results obtained from in vitro cell culture experiments demonstrated that the attachment, proliferation, and differentiation of human bone marrow stromal cells (hBMSCs on the MBG-coated Ti-6Al-4V scaffolds were improved as compared with those on the conventional bioactive glass (BG-coated Ti-6Al-4V scaffolds and bare-metal Ti-6Al-4V scaffolds. Our results demonstrated that the MBG coating by using the spinning coating method could be an effective approach to achieving enhanced surface biofunctionalization for SLM Ti-6Al-4V scaffolds.

  18. Hemocompatibility improvement of perfusion-decellularized clinical-scale liver scaffold through heparin immobilization

    Science.gov (United States)

    Bao, Ji; Wu, Qiong; Sun, Jiu; Zhou, Yongjie; Wang, Yujia; Jiang, Xin; Li, Li; Shi, Yujun; Bu, Hong

    2015-01-01

    Whole-liver perfusion-decellularization is an attractive scaffold–preparation technique for producing clinical transplantable liver tissue. However, the scaffold’s poor hemocompatibility poses a major obstacle. This study was intended to improve the hemocompatibility of perfusion-decellularized porcine liver scaffold via immobilization of heparin. Heparin was immobilized on decellularized liver scaffolds (DLSs) by electrostatic binding using a layer-by-layer self-assembly technique (/h-LBL scaffold), covalent binding via multi-point attachment (/h-MPA scaffold), or end-point attachment (/h-EPA scaffold). The effect of heparinization on anticoagulant ability and cytocompatibility were investigated. The result of heparin content and release tests revealed EPA technique performed higher efficiency of heparin immobilization than other two methods. Then, systematic in vitro investigation of prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), platelet adhesion and human platelet factor 4 (PF4, indicates platelet activation) confirmed the heparinized scaffolds, especially the /h-EPA counterparts, exhibited ultralow blood component activations and excellent hemocompatibility. Furthermore, heparin treatments prevented thrombosis successfully in DLSs with blood perfusion after implanted in vivo. Meanwhile, after heparin processes, both primary hepatocyte and endothelial cell viability were also well-maintained, which indicated that heparin treatments with improved biocompatibility might extend to various hemoperfusable whole-organ scaffolds’ preparation. PMID:26030843

  19. Improving hip surgery patients’ outcomes:

    DEFF Research Database (Denmark)

    Bagger, Bettan; Poulsen, Dorthe Varning; Taylor Kelly, Hélène

    This presentation focuses upon the improvement of hip surgery patients’ outcomes with respect to health promotion and rehabilitation. The overall aims of the EU financed orthopedic nursing project will be introduced. Speakers highlight the project’s contribution to: -the development of nurse...

  20. Calcium Silicate Improved Bioactivity and Mechanical Properties of Poly(3-hydroxybutyrate-co-3-hydroxyvalerate Scaffolds

    Directory of Open Access Journals (Sweden)

    Cijun Shuai

    2017-05-01

    Full Text Available The poor bioactivity and mechanical properties have restricted its biomedical application, although poly(3-hydroxybutyrate-co-3-hydroxyvalerate (PHBV had good biocompatibility and biodegradability. In this study, calcium silicate (CS was incorporated into PHBV for improving its bioactivity and mechanical properties, and the porous PHBV/CS composite scaffolds were fabricated via selective laser sintering (SLS. Simulated body fluid (SBF immersion tests indicated the composite scaffolds had good apatite-forming ability, which could be mainly attributed to the electrostatic attraction of negatively charged silanol groups derived from CS degradation to positively charged calcium ions in SBF. Moreover, the compressive properties of the composite scaffolds increased at first, and then decreased with increasing the CS content, which was ascribed to the fact that CS of a proper content could homogeneously disperse in PHBV matrix, while excessive CS would form continuous phase. The compressive strength and modulus of composite scaffolds with optimal CS content of 10 wt % were 3.55 MPa and 36.54 MPa, respectively, which were increased by 41.43% and 28.61%, respectively, as compared with PHBV scaffolds. Additionally, 3-(4,5-dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide (MTT assay indicated MG63 cells had a higher proliferation rate on PHBV/CS composite scaffolds than that on PHBV. Alkaline phosphatase (ALP staining assay demonstrated the incorporation of CS significantly promoted osteogenic differentiation of MG63 cells on the scaffolds. These results suggest that the PHBV/CS composite scaffolds have the potential in serving as a substitute in bone tissue engineering.

  1. Corrugated round fibers to improve cell adhesion and proliferation in tissue engineering scaffolds

    NARCIS (Netherlands)

    Bettahalli Narasimha, M.S.; Arkesteijn, I.T.M.; Wessling, Matthias; Poot, Andreas A.; Stamatialis, Dimitrios

    2013-01-01

    Optimal cell interaction with biomaterial scaffolds is one of the important requirements for the development of successful in vitro tissue-engineered tissues. Fast, efficient and spatially uniform cell adhesion can improve the clinical potential of engineered tissue. Three-dimensional (3-D) solid

  2. Clinical outcomes following bioresorbable scaffold implantation for bifurcation lesions: Overall outcomes and comparison between provisional and planned double stenting strategy.

    Science.gov (United States)

    Kawamoto, Hiroyoshi; Latib, Azeem; Ruparelia, Neil; Miyazaki, Tadashi; Sticchi, Alessandro; Naganuma, Toru; Sato, Katsumasa; Figini, Filippo; Chieffo, Alaide; Carlino, Mauro; Montorfano, Matteo; Colombo, Antonio

    2015-10-01

    The aim of this study was to investigate clinical outcomes of patients treated with a provisional stenting (PS) versus a double stenting (DS) strategy for coronary bifurcation lesions with bioresorbable scaffolds (BRS). There are limited data available with regards to outcomes following BRS implantation for bifurcation lesions. A total of 132 bifurcation lesions treated with BRS between 2012 and 2014 were analyzed. Of the total of 132 bifurcation lesions, 10 lesions were treated without crossover stenting. 99 lesions (81%) were treated with a PS strategy and 23 lesions (19%) with a DS strategy. The DS group consisted of patients with a greater number of true bifurcation lesions (PS 52.0% vs. DS 91.3%: P strategy was employed. Larger studies are eagerly awaited to determine longer-term follow-up of this treatment strategy. © 2015 Wiley Periodicals, Inc.

  3. Kidney disease: improving global outcomes.

    Science.gov (United States)

    Eckardt, Kai-Uwe; Kasiske, Bertram L

    2009-11-01

    Kidney Disease: Improving Global Outcomes (KDIGO) is an independent organization with the mission to improve care and outcomes of patients with kidney disease worldwide through the development and coordination of clinical practice guidelines. KDIGO has established firm links with other organizations that have previously produced clinical practice guidelines in the field of kidney disease. The first three KDIGO guidelines--treatment of hepatitis C, management of bone and mineral disease, and care of kidney transplant recipients--have been finalized and the next three--acute kidney injury, management of glomerulonephritis, and management of blood pressure in chronic kidney disease--are under development. The ultimate goal is to cover most major aspects of care for patients with kidney disease. Corner stones of KDIGO's guideline development process are independent, multidisciplinary, international work groups, close collaboration with professional methodology experts who perform systematic evidence reviews, and open public review of each guideline. Grades of Recommendation Assessment, Development, and Evaluation (GRADE) methodology is applied for grading the quality of evidence and strength of recommendations. International conferences organized by KDIGO support the coordination of guideline development, assess the suitability of guideline topics and help to establish global consensus on definitions and policies.

  4. Design of a Novel 3D Printed Bioactive Nanocomposite Scaffold for Improved Osteochondral Regeneration.

    Science.gov (United States)

    Castro, Nathan J; Patel, Romil; Zhang, Lijie Grace

    2015-09-01

    Chronic and acute osteochondral defects as a result of osteoarthritis and trauma present a common and serious clinical problem due to the tissue's inherent complexity and poor regenerative capacity. In addition, cells within the osteochondral tissue are in intimate contact with a 3D nanostructured extracellular matrix composed of numerous bioactive organic and inorganic components. As an emerging manufacturing technique, 3D printing offers great precision and control over the microarchitecture, shape and composition of tissue scaffolds. Therefore, the objective of this study is to develop a biomimetic 3D printed nanocomposite scaffold with integrated differentiation cues for improved osteochondral tissue regeneration. Through the combination of novel nano-inks composed of organic and inorganic bioactive factors and advanced 3D printing, we have successfully fabricated a series of novel constructs which closely mimic the native 3D extracellular environment with hierarchical nanoroughness, microstructure and spatiotemporal bioactive cues. Our results illustrate several key characteristics of the 3D printed nanocomposite scaffold to include improved mechanical properties as well as excellent cytocompatibility for enhanced human bone marrow-derived mesenchymal stem cell adhesion, proliferation, and osteochondral differentiation in vitro. The present work further illustrates the effectiveness of the scaffolds developed here as a promising and highly tunable platform for osteochondral tissue regeneration.

  5. Development of soft scaffolding strategy to improve student’s creative thinking ability in physics

    Science.gov (United States)

    Nurulsari, Novinta; Abdurrahman; Suyatna, Agus

    2017-11-01

    Student’s creative thinking ability in physics learning can be developed through a learning experience. However, many students fail to gain a learning experience because of the lack of teacher roles in providing assistance to students when they face learning difficulties. In this study, a soft scaffolding strategy developed to improve student’s creative thinking ability in physics, especially in optical instruments. The methods used were qualitative and quantitative. The soft scaffolding strategy developed was called the 6E Soft Scaffolding Strategy where 6E stands for Explore real-life problems, Engage students with web technology, Enable experiment using analogies, Elaborate data through multiple representations, Encourage questioning, and Ensure the feedback. The strategy was applied to 60 students in secondary school through cooperative learning. As a comparison, conventional strategies were also applied to 60 students in the same school and grade. The result of the study showed that the soft scaffolding strategy was effective in improving student’s creative thinking ability.

  6. Antibiotic Modification of Native Grafts: Improving upon nature's scaffolds

    Science.gov (United States)

    Ketonis, Constantinos

    The use of allograft bone in orthopaedics, spine surgery and dentistry is invaluable for helping restore bone defects and promote osteointegration. However, one, and perhaps the most important, problem associated with the use of allograft is infection. It is a devastating complication for patients and physicians alike, and necessitates repeated surgeries, extended treatment and often times results in increased morbidity and poor outcomes. Previous attempts to incorporate antibiotics into allograft by soaking the graft in antibiotic solution have enjoyed limited success in providing adequate protection against bacterial colonization. To overcome problems associated with controlled release systems, I have described a novel chemical modification that allows for the attachment of vancomycin, or other antibiotics, to free amines of allograft bone thus rendering the graft bactericidal over a long time period. This modification, as evaluated by immunohistochemistry, allowed for the uniform and stable attachment of antibiotics to allograft without adversely affecting its potential for incorporation with bone. Modified allograft, placed in the presence of S. aureus, did not allow colonization by bacteria as evaluated by fluorescent imaging, scanning microscopy, and direct bacterial counts. More importantly, inhibition of bacterial colonization resulted in prevention of biofilm formation. Furthermore, I show that the spectrum of activity of the parent antibiotic was maintained, as the construct was not active against E. coli challenges. Comparison of this technology with simple antibiotic incorporation demonstrated that the covalently-coupled antibiotic did not elute from the bone, but rather remained attached and active on the surface for times out to one year, times that are far longer than currently can be achieved with the elution technologies. Despite its potent activity against bacteria, modified bone remained biocompatible allowing attachment of osteoblastic

  7. Virus immobilization on biomaterial scaffolds through biotin-avidin interaction for improving bone regeneration.

    Science.gov (United States)

    Hu, Wei-Wen; Wang, Zhuo; Krebsbach, Paul H

    2016-02-01

    To spatially control therapeutic gene delivery for potential tissue engineering applications, a biotin-avidin interaction strategy was applied to immobilize viral vectors on biomaterial scaffolds. Both adenoviral vectors and gelatin sponges were biotinylated and avidin was applied to link them in a virus-biotin-avidin-biotin-material (VBABM) arrangement. The tethered viral particles were stably maintained within scaffolds and SEM images illustrated that viral particles were evenly distributed in three-dimensional (3D) gelatin sponges. An in vivo study demonstrated that transgene expression was restricted to the implant sites only and transduction efficiency was improved using this conjugation method. For an orthotopic bone regeneration model, adenovirus encoding BMP-2 (AdBMP2) was immobilized to gelatin sponges before implanting into critical-sized bone defects in rat calvaria. Compared to gelatin sponges with AdBMP2 loaded in a freely suspended form, the VBABM method enhanced gene transfer and bone regeneration was significantly improved. These results suggest that biotin-avidin immobilization of viral vectors to biomaterial scaffolds may be an effective strategy to facilitate tissue regeneration. Copyright © 2013 John Wiley & Sons, Ltd.

  8. A Bayesian Network Meta-Analysis to Synthesize the Influence of Contexts of Scaffolding Use on Cognitive Outcomes in STEM Education

    Science.gov (United States)

    Belland, Brian R.; Walker, Andrew E.; Kim, Nam Ju

    2017-01-01

    Computer-based scaffolding provides temporary support that enables students to participate in and become more proficient at complex skills like problem solving, argumentation, and evaluation. While meta-analyses have addressed between-subject differences on cognitive outcomes resulting from scaffolding, none has addressed within-subject gains.…

  9. Human decellularized bone scaffolds from aged donors show improved osteoinductive capacity compared to young donor bone.

    Directory of Open Access Journals (Sweden)

    Christopher A Smith

    Full Text Available To improve the safe use of allograft bone, decellularization techniques may be utilized to produce acellular scaffolds. Such scaffolds should retain their innate biological and biomechanical capacity and support mesenchymal stem cell (MSC osteogenic differentiation. However, as allograft bone is derived from a wide age-range, this study aimed to determine whether donor age impacts on the ability an osteoinductive, acellular scaffold produced from human bone to promote the osteogenic differentiation of bone marrow MSCs (BM-MSC. BM-MSCs from young and old donors were seeded on acellular bone cubes from young and old donors undergoing osteoarthritis related hip surgery. All combinations resulted in increased osteogenic gene expression, and alkaline phosphatase (ALP enzyme activity, however BM-MSCs cultured on old donor bone displayed the largest increases. BM-MSCs cultured in old donor bone conditioned media also displayed higher osteogenic gene expression and ALP activity than those exposed to young donor bone conditioned media. ELISA and Luminex analysis of conditioned media demonstrated similar levels of bioactive factors between age groups; however, IGF binding protein 1 (IGFBP1 concentration was significantly higher in young donor samples. Additionally, structural analysis of old donor bone indicated an increased porosity compared to young donor bone. These results demonstrate the ability of a decellularized scaffold produced from young and old donors to support osteogenic differentiation of cells from young and old donors. Significantly, the older donor bone produced greater osteogenic differentiation which may be related to reduced IGFBP1 bioavailability and increased porosity, potentially explaining the excellent clinical results seen with the use of allograft from aged donors.

  10. Human platelet-rich plasma improves the nesting and differentiation of human chondrocytes cultured in stabilized porous chitosan scaffolds.

    Science.gov (United States)

    Sancho-Tello, Maria; Martorell, Sara; Mata Roig, Manuel; Milián, Lara; Gámiz-González, M A; Gómez Ribelles, Jose Luis; Carda, Carmen

    2017-01-01

    The clinical management of large-size cartilage lesions is difficult due to the limited regenerative ability of the cartilage. Different biomaterials have been used to develop tissue engineering substitutes for cartilage repair, including chitosan alone or in combination with growth factors to improve its chondrogenic properties. The main objective of this investigation was to evaluate the benefits of combining activated platelet-rich plasma with a stabilized porous chitosan scaffold for cartilage regeneration. To achieve this purpose, stabilized porous chitosan scaffolds were prepared using freeze gelation and combined with activated platelet-rich plasma. Human primary articular chondrocytes were isolated and cultured in stabilized porous chitosan scaffolds with and without combination to activated platelet-rich plasma. Scanning electron microscopy was used for the morphological characterization of the resulting scaffolds. Cell counts were performed in hematoxylin and eosin-stained sections, and type I and II collagen expression was evaluated using immunohistochemistry. Significant increase in cell number in activated platelet-rich plasma/stabilized porous chitosan was found compared with stabilized porous chitosan scaffolds. Chondrocytes grown on stabilized porous chitosan expressed high levels of type I collagen but type II was not detectable, whereas cells grown on activated platelet rich plasma/stabilized porous chitosan scaffolds expressed high levels of type II collagen and type I was almost undetectable. In summary, activated platelet-rich plasma increases nesting and induces the differentiation of chondrocytes cultured on stabilized porous chitosan scaffolds.

  11. Growth factor stimulation improves the structure and properties of scaffold-free engineered auricular cartilage constructs.

    Directory of Open Access Journals (Sweden)

    Renata G Rosa

    Full Text Available The reconstruction of the external ear to correct congenital deformities or repair following trauma remains a significant challenge in reconstructive surgery. Previously, we have developed a novel approach to create scaffold-free, tissue engineering elastic cartilage constructs directly from a small population of donor cells. Although the developed constructs appeared to adopt the structural appearance of native auricular cartilage, the constructs displayed limited expression and poor localization of elastin. In the present study, the effect of growth factor supplementation (insulin, IGF-1, or TGF-β1 was investigated to stimulate elastogenesis as well as to improve overall tissue formation. Using rabbit auricular chondrocytes, bioreactor-cultivated constructs supplemented with either insulin or IGF-1 displayed increased deposition of cartilaginous ECM, improved mechanical properties, and thicknesses comparable to native auricular cartilage after 4 weeks of growth. Similarly, growth factor supplementation resulted in increased expression and improved localization of elastin, primarily restricted within the cartilaginous region of the tissue construct. Additional studies were conducted to determine whether scaffold-free engineered auricular cartilage constructs could be developed in the 3D shape of the external ear. Isolated auricular chondrocytes were grown in rapid-prototyped tissue culture molds with additional insulin or IGF-1 supplementation during bioreactor cultivation. Using this approach, the developed tissue constructs were flexible and had a 3D shape in very good agreement to the culture mold (average error <400 µm. While scaffold-free, engineered auricular cartilage constructs can be created with both the appropriate tissue structure and 3D shape of the external ear, future studies will be aimed assessing potential changes in construct shape and properties after subcutaneous implantation.

  12. Paclitaxel improves outcome from traumatic brain injury

    OpenAIRE

    Cross, Donna J.; Garwin, Gregory G.; Cline, Marcella M.; Richards, Todd L.; Yarnykh, Vasily; Mourad, Pierre D.; Ho, Rodney J.Y.; Minoshima, Satoshi

    2015-01-01

    Pharmacologic interventions for traumatic brain injury (TBI) hold promise to improve outcome. The purpose of this study was to determine if the microtubule stabilizing therapeutic paclitaxel used for more than 20 years in chemotherapy would improve outcome after TBI. We assessed neurological outcome in mice that received direct application of paclitaxel to brain injury from controlled cortical impact (CCI). Magnetic resonance imaging was used to assess injury-related morphological changes. Ca...

  13. Concave Pit-Containing Scaffold Surfaces Improve Stem Cell-Derived Osteoblast Performance and Lead to Significant Bone Tissue Formation

    Science.gov (United States)

    Cusella-De Angelis, Maria Gabriella; Laino, Gregorio; Piattelli, Adriano; Pacifici, Maurizio; De Rosa, Alfredo; Papaccio, Gianpaolo

    2007-01-01

    Background Scaffold surface features are thought to be important regulators of stem cell performance and endurance in tissue engineering applications, but details about these fundamental aspects of stem cell biology remain largely unclear. Methodology and Findings In the present study, smooth clinical-grade lactide-coglyolic acid 85:15 (PLGA) scaffolds were carved as membranes and treated with NMP (N-metil-pyrrolidone) to create controlled subtractive pits or microcavities. Scanning electron and confocal microscopy revealed that the NMP-treated membranes contained: (i) large microcavities of 80–120 µm in diameter and 40–100 µm in depth, which we termed primary; and (ii) smaller microcavities of 10–20 µm in diameter and 3–10 µm in depth located within the primary cavities, which we termed secondary. We asked whether a microcavity-rich scaffold had distinct bone-forming capabilities compared to a smooth one. To do so, mesenchymal stem cells derived from human dental pulp were seeded onto the two types of scaffold and monitored over time for cytoarchitectural characteristics, differentiation status and production of important factors, including bone morphogenetic protein-2 (BMP-2) and vascular endothelial growth factor (VEGF). We found that the microcavity-rich scaffold enhanced cell adhesion: the cells created intimate contact with secondary microcavities and were polarized. These cytological responses were not seen with the smooth-surface scaffold. Moreover, cells on the microcavity-rich scaffold released larger amounts of BMP-2 and VEGF into the culture medium and expressed higher alkaline phosphatase activity. When this type of scaffold was transplanted into rats, superior bone formation was elicited compared to cells seeded on the smooth scaffold. Conclusion In conclusion, surface microcavities appear to support a more vigorous osteogenic response of stem cells and should be used in the design of therapeutic substrates to improve bone repair and

  14. Delivery of dimethyloxallyl glycine in mesoporous bioactive glass scaffolds to improve angiogenesis and osteogenesis of human bone marrow stromal cells.

    Science.gov (United States)

    Wu, Chengtie; Zhou, Yinghong; Chang, Jiang; Xiao, Yin

    2013-11-01

    suggest that the controllable delivery of DMOG in MBG scaffolds can mimic a hypoxic microenvironment, which not only improves the angiogenic capacity of hBMSC, but also enhances their osteogenic differentiation. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  15. Stabilization of porous chitosan improves the performance of its association with platelet-rich plasma as a composite scaffold

    Energy Technology Data Exchange (ETDEWEB)

    Shimojo, A.A.M., E-mail: lshimojo51@gmail.com; Perez, A.G.M.; Galdames, S.E.M.; Brissac, I.C.S.; Santana, M.H.A.

    2016-03-01

    This study offers innovative perspectives for optimizing of scaffolds based on correlation structure–function aimed the regenerative medicine. Thus, we evaluated in vitro performance of stabilized porous chitosan (SPCHTs) associated with activated platelet-rich plasma (aP-PRP) as a composite scaffold for the proliferation and osteogenic differentiation of human adipose-derived mesenchymal stem cells (h-AdMSCs). The porous structure of chitosan (PCHT) was prepared similarly to solid sponges by controlled freezing (− 20 °C) and lyophilization of a 3% (w/v) chitosan solution. Stabilization was performed by treating the PCHT with sodium hydroxide (TNaOH), an ethanol series (TEtOH) or by crosslinking with tripolyphosphate (CTPP). The aP-PRP was obtained from the controlled centrifugation of whole blood and activated with autologous serum and calcium. Imaging of the structures showed fibrin networks inside and on the surface of SPCHTs as a consequence of electrostatic interactions. SPCHTs were non-cytotoxic, and the porosity, pore size and Young's modulus were approximately 96%, 145 μm and 1.5 MPa for TNaOH and TEtOH and 94%, 110 μm and 1.8 MPa for CTPP, respectively. Stabilization maintained the integrity of the SPCHTs for at least 10 days of cultivation. SPCHTs showed controlled release of the growth factors TGF-β1 and PDGF-AB. Although generating different patterns, all of the stabilization treatments improved the proliferation of seeded h-AdMSCs on the composite scaffold compared to aP-PRP alone, and differentiation of the composite scaffold treated with TEtOH was significantly higher than for non-stabilized PCHT. We conclude that the composite scaffolds improved the in vitro performance of PRP and have potential in regenerative medicine. - Highlights: • Stabilization maintains the integrity of the chitosan scaffolds for at least 10 days. • Fibrin networks on the chitosan scaffolds were referred to electrostatic interactions. • Stabilized chitosan

  16. Orthogeriatric care: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Tarazona-Santabalbina FJ

    2016-06-01

    Full Text Available Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. Keywords: hip fractures, geriatric assessment, orthogeriatric care, recovery of function, mortality

  17. Improving bone marrow stromal cell attachment on chitosan/hydroxyapatite scaffolds by an immobilized RGD peptide

    Energy Technology Data Exchange (ETDEWEB)

    Qu Zhiwei; Yan Jinglong; Zhuang Jinpeng [Fourth Department of Orthopedics, First Hospital Affiliated to Harbin Medical University, Harbin 150081 (China); Li Baoqiang [Institutes for Advanced Ceramics, Harbin Institute of Technology, Harbin 150001 (China); Huang Yanming, E-mail: quzhiwei2@163.co [First Department of Orthopedics, Heilongjiang Prevention and Treatment of Infectious Diseases Hospital, Harbin 150500 (China)

    2010-12-15

    Ample cell adhesion to scaffolds is essential for effective bone tissue engineering. Chitosan/hydroxyapatite (CS/HA) scaffolds with channel-shaped and spherically shaped pore morphologies were prepared via in situ compositing hybridization in combination with lyophilization. The sizes of channel-shaped and spherically shaped pores of the CS/HA scaffolds were 150-650 {mu}m and 3-15 {mu}m, respectively. The RGD peptide (Arg-Gly-Asp) was bound to the surface of CS/HA scaffolds via physical adsorption. More than 63% of RGD present in a PBS solution spontaneously adsorbed onto CS/HA scaffolds. High numbers of viable bone marrow stromal cells (BMSCs) were observed by confocal and fluorescence microscopy for cells cultured on CS/HA scaffolds with and without RGD for 3 days. BMSCs on CS/HA scaffolds with RGD (RGD-CS/HA) were incubated for 4 h under standard culture conditions, and the degree of cell adhesion was calculated. Cell adhesion to RGD-CS/HA scaffolds with different RGD concentrations was 71.6% and 80.7%, respectively. This was 30.9% and 47.5% higher than adhesion to the CS/HA scaffold without RGD, respectively. BMSCs cultured on the scaffolds for 14 days with osteogenic supplements expressed 103% higher alkaline phosphatase on the RGD-CS/HA scaffold (0.001 97 {+-} 0.000 31 U/L/ng), than on the unmodified scaffold (0.000 97 {+-} 0.000 25 U/L/ng) (p < 0.01), indicating that a RGD peptide significantly promotes osteogenic differentiation of BMSCs on CS/HA scaffolds. The results of this study indicate that RGD-CS/HA scaffolds promote initial cell adhesion, spread and differentiation toward an osteogenic phenotype.

  18. Improving the finite element model accuracy of tissue engineering scaffolds produced by selective laser sintering.

    Science.gov (United States)

    Lohfeld, S; Cahill, S; Doyle, H; McHugh, P E

    2015-01-01

    In bone tissue engineering, both geometrical and mechanical properties of a scaffold play a major part in the success of the treatment. The mechanical stresses and strains that act on cells on a scaffold in a physiological environment are a determining factor on the subsequent tissue formation. Computational models are often used to simulate the effect of changes of internal architectures and external loads applied to the scaffold in order to optimise the scaffold geometry for the prospective implantation site. Finite element analysis (FEA) based on computer models of the scaffold is a common technique, but would not take into account actual inaccuracies due to the manufacturing process. Image based FEA using CT scans of fabricated scaffolds can provide a more accurate analysis of the scaffold, and was used in this work in order to accurately simulate and predict the mechanical performance of bone tissue engineering scaffolds, fabricated using selective laser sintering (SLS), with a view to generating a methodology that could be used to optimise scaffold design. The present work revealed that an approach that assumes isotropic properties of SLS fabricated scaffolds will lead to inaccurate predictions of the FE model. However, a dependency of the grey value of the CT scans and the mechanical properties was discovered, which may ultimately lead to accurate FE models without the need of experimental validation.

  19. Nursing informatics, outcomes, and quality improvement.

    Science.gov (United States)

    Charters, Kathleen G

    2003-08-01

    Nursing informatics actively supports nursing by providing standard language systems, databases, decision support, readily accessible research results, and technology assessments. Through normalized datasets spanning an entire enterprise or other large demographic, nursing informatics tools support improvement of healthcare by answering questions about patient outcomes and quality improvement on an enterprise scale, and by providing documentation for business process definition, business process engineering, and strategic planning. Nursing informatics tools provide a way for advanced practice nurses to examine their practice and the effect of their actions on patient outcomes. Analysis of patient outcomes may lead to initiatives for quality improvement. Supported by nursing informatics tools, successful advance practice nurses leverage their quality improvement initiatives against the enterprise strategic plan to gain leadership support and resources.

  20. Can life coaching improve health outcomes?

    DEFF Research Database (Denmark)

    Ammentorp, Jette

    26. Ammentorp J, Uhrenfeldt L, Angel F, Ehrensvärd, Carlsen E, Kofoed P-E. Can life coaching improve health outcomes? – A systematic review of intervention studies. Poster presented at the International Conference on Communication in Healthcare, Montreal Canada, 30 Sept 2013.......26. Ammentorp J, Uhrenfeldt L, Angel F, Ehrensvärd, Carlsen E, Kofoed P-E. Can life coaching improve health outcomes? – A systematic review of intervention studies. Poster presented at the International Conference on Communication in Healthcare, Montreal Canada, 30 Sept 2013....

  1. Do municipal mergers improve fiscal outcomes?

    DEFF Research Database (Denmark)

    Hansen, Sune Welling; Houlberg, Kurt; Pedersen, Lene Holm

    2014-01-01

    relationship between municipal mergers and fiscal outcomes is analysed. Measured on the balance between revenues and expenses, liquid assets and debts, municipal mergers improve the fiscal outcomes of the municipalities in a five-year perspective, although the pre-reform effects tend to be negative....... For liquidity and debt, however, the improvement only entails re-establishing the levels prior to the reform. The testing ground is the recent mergers of Danish municipalities, which, it is argued, constitute a quasi-experiment. This forms the basis of a Difference-in-Difference design, allowing the alleviation...

  2. Bi-layer collagen/microporous electrospun nanofiber scaffold improves the osteochondral regeneration.

    Science.gov (United States)

    Zhang, Shufang; Chen, Longkun; Jiang, Yangzi; Cai, Youzhi; Xu, Guowei; Tong, Tong; Zhang, Wei; Wang, Linlin; Ji, Junfeng; Shi, Peihua; Ouyang, Hong Wei

    2013-07-01

    An optimal scaffold is crucial for osteochondral regeneration. Collagen and electrospun nanofibers have been demonstrated to facilitate cartilage and bone regeneration, respectively. However, the effect of combining collagen and electrospun nanofibers on osteochondral regeneration has yet to be evaluated. Here, we report that the combination of collagen and electrospun poly-l-lactic acid nanofibers synergistically promotes osteochondral regeneration. We first fabricated bi-layer microporous scaffold with collagen and electrospun poly-l-lactic acid nanofibers (COL-nanofiber). Mesenchymal stem cells were cultured on the bi-layer scaffold and their adhesion, proliferation and differentiation were examined. Moreover, osteochondral defects were created in rabbits and implanted with COL-nanofiber scaffold. Cartilage and subchondral bone regeneration were evaluated at 6 and 12weeks after surgery. Compared with COL scaffold, cells on COL-nanofiber scaffold exhibited more robust osteogenic differentiation, indicated by higher expression levels of OCN and runx2 genes as well as the accumulation of calcium nodules. Furthermore, implantation of COL-nanofiber scaffold seeded with cells induced more rapid subchondral bone emergence, and better cartilage formation, which led to better functional repair of osteochondral defects as manifested by histological staining, biomechanical test and micro-computed tomography data. Our study underscores the potential of using the bi-layer microporous COL-nanofiber scaffold for the treatment of deep osteochondral defects. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  3. Functionalized Scaffold-mediated Interleukin 10 Gene Delivery Significantly Improves Survival Rates of Stem Cells In Vivo

    Science.gov (United States)

    Holladay, Carolyn; Power, Karen; Sefton, Michael; O'Brien, Timothy; Gallagher, William M.; Pandit, Abhay

    2011-01-01

    While stem cell transplantation could potentially treat a variety of disorders, clinical studies have not yet demonstrated conclusive benefits. This may be partly because transplanted stem cells have low survival rates, potentially due to host inflammation. The system described herein used two different gene therapy techniques to improve retention of rat mesenchymal stem cells. In the first, stem cells were transfected with interleukin-10 (IL-10) before being loaded into a collagen scaffold. In the second, unmodified stem cells were loaded into a collagen scaffold along with polymer-complexed IL-10 plasmids. The scaffolds were surgically implanted into the dorsum of syngeneic rats. At each endpoint, the scaffolds were explanted and cell retention, IL-10 level and inflammatory response were quantified. All treatment groups had statistically significant increases in cell retention after 7 days, but the group treated with 2 µg of IL-10 polyplexes had a significant improvement even at 21 days. This cell retention was associated with increased IL-10 and decreased levels of proinflammatory cytokines and apoptosis. The primary effect on the inflammatory response appeared to be on macrophage differentiation, encouraging the regulatory phenotype over the cytotoxic lineage. Improving cell survival may be an important step toward realization of the therapeutic potential of stem cells. PMID:21266957

  4. Rethinking Ovarian Cancer: Recommendations for Improving Outcomes

    Science.gov (United States)

    Vaughan, Sebastian; Coward, Jermaine I.; Bast Jr., Robert C.; Berchuck, Andy; Berek, Jonathan S.; Brenton, James D.; Coukos, George; Crum, Christopher C.; Drapkin, Ronny; Etemadmoghadam, Dariush; Friedlander, Michael; Gabra, Hani; Kaye, Stan B.; Lord, Chris J.; Lengyel, Ernst; Levine, Douglas A.; McNeish, Iain A.; Menon, Usha; Mills, Gordon B.; Nephew, Kenneth P.; Oza, Amit M.; Sood, Anil K.; Stronach, Euan A.; Walczak, Henning; Bowtell, David D.; Balkwill, Frances R.

    2012-01-01

    There have been major advances in our understanding of the cellular and molecular biology of the human malignancies collectively referred to as ovarian cancer. At a recent Helene Harris Memorial Trust meeting, an international group of researchers considered actions that should be taken to improve the outcome for women with ovarian cancer. Nine major recommendations are outlined in this Perspective. PMID:21941283

  5. Preoperative exercise training to improve postoperative outcomes

    NARCIS (Netherlands)

    Valkenet, K.|info:eu-repo/dai/nl/413984141

    2017-01-01

    It is common knowledge that better preoperative physical fitness is associated with better postoperative outcomes. However, as a result of aging of the population and improved surgical and anaesthesia techniques, the proportion of frail patients with decreased physical fitness levels undergoing

  6. Do Written Asthma Action Plans Improve Outcomes?

    Science.gov (United States)

    Kelso, John M

    2016-03-01

    With appropriate management, children with asthma should expect few symptoms, no limits on activity, rare exacerbations, and normal lung function. Appropriate education of parents and other caregivers of children with asthma has clearly been shown to help achieve these goals. Although recommended in asthma guidelines, providing written asthma action plans does not improve outcomes beyond asthma education alone.

  7. Mechanical properties' improvement of a tricalcium phosphate scaffold with poly-l-lactic acid in selective laser sintering.

    Science.gov (United States)

    Liu, Defu; Zhuang, Jingyu; Shuai, Cijun; Peng, Shuping

    2013-06-01

    To improve the mechanical properties of a scaffold fabricated via selective laser sintering (SLS), a small amount (0.5-3 wt%) of poly-l-lactic acid (PLLA) is added to the β-tricalcium phosphate (β-TCP) powder. The fracture toughness of the scaffold prepared with the mixture powder containing 1 wt% PLLA increases by 18.18% and the compressive strength increases by 4.45% compared to the scaffold prepared from the β-TCP powder. The strengthening and toughening is related to the enhancement of β-TCP sintering characteristics via introducing a transient liquid phase in SLS. Moreover, the microcracks caused by the volume expansion due to the β-α phase transformation of TCP are reduced because of the PLLA inhibition function on the phase transformation. However, PLLA additive above 1 wt% would lead to a PLLA residue which will decrease the mechanical properties. The experimental results show that PLLA is an effective sintering aid to improve the mechanical properties of a TCP scaffold.

  8. Synergistic effect of dual-functionalized fibrous scaffold with BCP and RGD containing peptide for improved osteogenic differentiation.

    Science.gov (United States)

    Shin, Young Min; Jo, Sun-Young; Park, Jong-Seok; Gwon, Hui-Jeong; Jeong, Sung In; Lim, Youn-Mook

    2014-08-01

    Over the last decade, bone tissue engineering scaffolds have been advanced owing to the bioceramic incorporation and biomimetic modification. In this report, a dual-functional fibrous scaffold with a bioceramic and biomolecule is developed, and a combined effect of a dual-modification is investigated. Biphasic calcium phosphate (BCP) is incorporated in electrospun poly (L-lactide) scaffolds, and Arg-Gly-Asp (RGD) peptide is then conjugated through the graft polymerization of acrylic acid by γ-ray irradiation. The scaffolds exhibit the intrinsic properties of BCP as well as RGD peptide, and only RGD peptide improves an adhesion and proliferation of the human mesenchymal stem cell. However, alkaline phosphatase activity and calcium formation are synergistically improved by the BCP and RGD peptide indicating that a favorable microenvironment is constructed for bone formation. Therefore, this combination strategy with bioceramic and biomolecule can be a useful tool for the bone tissue engineering. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  9. Improved regeneration potential of fibroblasts using ascorbic acid-blended nanofibrous scaffolds.

    Science.gov (United States)

    Sridhar, Sreepathy; Venugopal, Jayarama Reddy; Ramakrishna, Seeram

    2015-11-01

    Two-dimensional scaffolds, three-dimensional scaffolds, and dermal substitutes are extensively used for biomedical applications in skin tissue regeneration. Not much explored synthetic polymers, like poly(l-lactic acid)-co-poly-(ε-caprolactone) (PLACL), natural polymers, like silk fibroin (SF), and active inducing agents, such as ascorbic acid (AA) and tetracycline hydrochloride (TCH), represent a favorable matrix for fabricating dermal substitutes to engineer artificial skin for wound repair. The profligate nature of residing skin cells near the wound site is a paramount to survival and also regulating stem cells and other cellular networks and mechanical forces. PLACL/SF/TCH/AA nanofibrous scaffolds were fabricated by electrospinning and characterized for fiber morphology, membrane porosity, wettability, and significant subchains using Fourier transform infrared spectroscopy for culturing human-derived dermal fibroblasts. The PLACL, PLACL/SF, PLACL/SF/TCH, and PLACL/SF/TCH/AA scaffolds obtained diameters between 250 and 340 nm. The secretion of collagen by the laboratory-grown fibroblasts over the AA-blended scaffolds was found to be significantly higher compared with that of other scaffolds. The obtained results positively prove that introduction of naturally secreting compounds (AA) by the cells into the nanofibrous scaffolds will favor cell's microenvironment and eventually leads to complete tissue regeneration. © 2015 Wiley Periodicals, Inc.

  10. Do designated trauma systems improve outcome?

    Science.gov (United States)

    Lansink, Koen W W; Leenen, Luke P H

    2007-12-01

    Trauma systems are introduced world wide with the goal to improve survival and outcome of the injured patient. This review is focused on the influence of trauma systems on the survival and outcome of injured patients. Large population-based studies have been published over the last 2 years strengthening the hypothesis that trauma systems indeed improve survival rates in injured patients. Mortality was reduced by 15-25% when severely injured patients were treated at a trauma center. Although 'inclusive' trauma systems have been advocated since 1991 only recently did the first population-based study prove that 'inclusive' trauma systems do better than 'exclusive' trauma systems. Because further improvements in survival in mature trauma systems are likely to be small, more focus should be given to quality of life studies, rather than to survival in trauma system evaluation. Trauma systems indeed improve survival rates in injured patients. Inclusive trauma systems do better than exclusive trauma systems. More attention should be given to quality of outcome.

  11. Improving Acquisition Outcomes with Contextual Ambidexterity

    DEFF Research Database (Denmark)

    Meglio, Olimpia; King, David R.; Risberg, Annette

    2015-01-01

    The results of research on mergers and acquisitions often point to a need to improve acquisition outcomes and lessen the organizational turmoil that can often follow integration efforts. We assert that viewing acquisition integration through the lens of contextual ambidexterity may improve...... acquisition outcomes in two ways: by providing an integrated solution to the economic and social tensions in acquisitions, and by enabling managers to effectively confront the competing needs of task and human integration. We also posit that by building on contextual ambidexterity, we can extend...... the possibilities for both research and practice regarding task and human integration in acquisitions. We also emphasize the role of an integration manager and integration mechanisms in enabling contextual ambidexterity for successful acquisition integration. Finally, we identify implications for research...

  12. Metacognition Modules: A Scaffolded Series of Online Assignments Designed to Improve Students’ Study Skills

    Directory of Open Access Journals (Sweden)

    Jean A. Cardinale

    2017-05-01

    Full Text Available Many first-year biology students begin college with high aspirations but limited skills in terms of those needed for their success. Teachers are increasingly focused on students’ lack of metacognitive awareness combined with students’ inability to self-regulate learning behaviors. To address this need, we have designed a series of out-of-class assignments to provide explicit instruction on memory and learning. Our metacognition modules consist of six video assignments with reflective journaling prompts, allowing students to explore the relationship between the learning cycle, neuroplasticity, memory function, expert and novice thinking, and effective study strategies. By setting lessons on improving study behavior within a biological context, we help students grasp the reason for changing their behavior based on an understanding of biological functions and their application to learning. Students who complete these scaffolded journaling assignments show a shift toward a growth mindset and a consistent ability to evaluate the efficacy of their own study behaviors. In this article, we discuss the modules and student assignments, as well as provide in depth support for faculty who wish to adopt the modules for their own courses.

  13. Metacognition Modules: A Scaffolded Series of Online Assignments Designed to Improve Students’ Study Skills†

    Science.gov (United States)

    Cardinale, Jean A.; Johnson, Bethany C.

    2017-01-01

    Many first-year biology students begin college with high aspirations but limited skills in terms of those needed for their success. Teachers are increasingly focused on students’ lack of metacognitive awareness combined with students’ inability to self-regulate learning behaviors. To address this need, we have designed a series of out-of-class assignments to provide explicit instruction on memory and learning. Our metacognition modules consist of six video assignments with reflective journaling prompts, allowing students to explore the relationship between the learning cycle, neuroplasticity, memory function, expert and novice thinking, and effective study strategies. By setting lessons on improving study behavior within a biological context, we help students grasp the reason for changing their behavior based on an understanding of biological functions and their application to learning. Students who complete these scaffolded journaling assignments show a shift toward a growth mindset and a consistent ability to evaluate the efficacy of their own study behaviors. In this article, we discuss the modules and student assignments, as well as provide in depth support for faculty who wish to adopt the modules for their own courses. PMID:28904648

  14. Metacognition Modules: A Scaffolded Series of Online Assignments Designed to Improve Students' Study Skills.

    Science.gov (United States)

    Cardinale, Jean A; Johnson, Bethany C

    2017-01-01

    Many first-year biology students begin college with high aspirations but limited skills in terms of those needed for their success. Teachers are increasingly focused on students' lack of metacognitive awareness combined with students' inability to self-regulate learning behaviors. To address this need, we have designed a series of out-of-class assignments to provide explicit instruction on memory and learning. Our metacognition modules consist of six video assignments with reflective journaling prompts, allowing students to explore the relationship between the learning cycle, neuroplasticity, memory function, expert and novice thinking, and effective study strategies. By setting lessons on improving study behavior within a biological context, we help students grasp the reason for changing their behavior based on an understanding of biological functions and their application to learning. Students who complete these scaffolded journaling assignments show a shift toward a growth mindset and a consistent ability to evaluate the efficacy of their own study behaviors. In this article, we discuss the modules and student assignments, as well as provide in depth support for faculty who wish to adopt the modules for their own courses.

  15. Genetically engineered mesenchymal stromal cells produce IL-3 and TPO to further improve human scaffold-based xenograft models.

    Science.gov (United States)

    Carretta, Marco; de Boer, Bauke; Jaques, Jenny; Antonelli, Antonella; Horton, Sarah J; Yuan, Huipin; de Bruijn, Joost D; Groen, Richard W J; Vellenga, Edo; Schuringa, Jan Jacob

    2017-07-01

    Recently, NOD-SCID IL2Rγ -/- (NSG) mice were implanted with human mesenchymal stromal cells (MSCs) in the presence of ceramic scaffolds or Matrigel to mimic the human bone marrow (BM) microenvironment. This approach allowed the engraftment of leukemic samples that failed to engraft in NSG mice without humanized niches and resulted in a better preservation of leukemic stem cell self-renewal properties. To further improve our humanized niche scaffold model, we genetically engineered human MSCs to secrete human interleukin-3 (IL-3) and thrombopoietin (TPO). In vitro, these IL-3- and TPO-producing MSCs were superior in expanding human cord blood (CB) CD34 + hematopoietic stem/progenitor cells. MLL-AF9-transduced CB CD34 + cells could be transformed efficiently along myeloid or lymphoid lineages on IL-3- and TPO-producing MSCs. In vivo, these genetically engineered MSCs maintained their ability to differentiate into bone, adipocytes, and other stromal components. Upon transplantation of MLL-AF9-transduced CB CD34 + cells, acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) developed in engineered scaffolds, in which a significantly higher percentage of myeloid clones was observed in the mouse compartments compared with previous models. Engraftment of primary AML, B-cell ALL, and biphenotypic acute leukemia (BAL) patient samples was also evaluated, and all patient samples could engraft efficiently; the myeloid compartment of the BAL samples was better preserved in the human cytokine scaffold model. In conclusion, we show that we can genetically engineer the ectopic human BM microenvironment in a humanized scaffold xenograft model. This approach will be useful for functional study of the importance of niche factors in normal and malignant human hematopoiesis. Copyright © 2017 ISEH - International Society for Experimental Hematology. All rights reserved.

  16. 3-Year Clinical Outcomes With Everolimus-Eluting Bioresorbable Coronary Scaffolds: The ABSORB III Trial.

    Science.gov (United States)

    Kereiakes, Dean J; Ellis, Stephen G; Metzger, Christopher; Caputo, Ronald P; Rizik, David G; Teirstein, Paul S; Litt, Marc R; Kini, Annapoorna; Kabour, Ameer; Marx, Steven O; Popma, Jeffrey J; McGreevy, Robert; Zhang, Zhen; Simonton, Charles; Stone, Gregg W

    2017-12-12

    The Absorb everolimus-eluting poly-L-lactic acid-based bioresorbable vascular scaffold (BVS) provides early drug delivery and mechanical support functions similar to metallic drug-eluting stents (DES), followed by complete bioresorption in approximately 3 years with recovery of vascular structure and function. The ABSORB III trial demonstrated noninferior rates of target lesion failure (cardiac death, target vessel myocardial infarction [TVMI], or ischemia-driven target lesion revascularization) at 1 year in 2,008 patients with coronary artery disease randomized to BVS versus cobalt-chromium everolimus-eluting stents (EES). This study sought to assess clinical outcomes through 3 years following BVS implantation. Clinical outcomes from the ABSORB III trial were analyzed by randomized treatment assignment cumulative through 3 years, and between 1 and 3 years. The primary composite endpoint of target lesion failure through 3 years occurred in 13.4% of BVS patients and 10.4% of EES patients (p = 0.06), and between 1 and 3 years in 7.0% versus 6.0% of patients, respectively (p = 0.39). TVMI through 3 years was increased with BVS (8.6% vs. 5.9%; p = 0.03), as was device thrombosis (2.3% vs. 0.7%; p = 0.01). In BVS-assigned patients, treatment of very small vessels (those with quantitatively determined reference vessel diameter device thrombosis. Longer-term clinical follow-up is required to determine whether bioresorption of the polymeric scaffold will influence patient prognosis. (ABSORB III Randomized Controlled Trial [RCT] [ABSORB-III]; NCT01751906). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. Production and characterization of chitosan/gelatin/β-TCP scaffolds for improved bone tissue regeneration

    Energy Technology Data Exchange (ETDEWEB)

    Serra, I.R.; Fradique, R.; Vallejo, M.C.S.; Correia, T.R.; Miguel, S.P.; Correia, I.J., E-mail: icorreia@ubi.pt

    2015-10-01

    Recently, bone tissue engineering emerged as a viable therapeutic alternative, comprising bone implants and new personalized scaffolds to be used in bone replacement and regeneration. In this study, biocompatible scaffolds were produced by freeze-drying, using different formulations (chitosan, chitosan/gelatin, chitosan/β-TCP and chitosan/gelatin/β-TCP) to be used as temporary templates during bone tissue regeneration. Sample characterization was performed through attenuated total reflectance-Fourier transform infrared spectroscopy, X-ray diffraction and energy dispersive spectroscopy analysis. Mechanical characterization and porosity analysis were performed through uniaxial compression test and liquid displacement method, respectively. In vitro studies were also done to evaluate the biomineralization activity and the cytotoxic profile of the scaffolds. Scanning electron and confocal microscopy analysis were used to study cell adhesion and proliferation at the scaffold surface and within their structure. Moreover, the antibacterial activity of the scaffolds was also evaluated through the agar diffusion method. Overall, the results obtained revealed that the produced scaffolds are bioactive and biocompatible, allow cell internalization and show antimicrobial activity against Staphylococcus aureus. Such, make these 3D structures as potential candidates for being used on the bone tissue regeneration, since they promote cell adhesion and proliferation and also prevent biofilm development at their surfaces, which is usually the main cause of implant failure. - Highlights: • Production of 3D scaffolds composed by chitosan/gelatin/β-TCP by freeze-drying for bone regeneration • Physicochemical characterization of the bone substitutes by SEM, FTIR, XRD and EDS • Evaluation of the cytotoxic profile and antibacterial activity of the 3D structures through in vitro assays.

  18. Improved seeding of chondrocytes into polyglycolic acid scaffolds using semi-static and alginate loading methods.

    Science.gov (United States)

    Shahin, Kifah; Doran, Pauline M

    2011-01-01

    Cell seeding and attachment in three-dimensional scaffolds is a key step in tissue engineering with implications for cell differentiation and tissue development. In this work, two new seeding methods were investigated using human chondrocytes and polyglycolic acid (PGA) fibrous mesh scaffolds. A simple semi-static seeding method using culture plates and tissue flasks was developed as an easy-to-perform modification of static seeding. An alginate-loading method was also studied, using alginate hydrogel as an adjuvant for entrapping cells within PGA scaffolds. Both the semi-static and PGA-alginate methods produced more homogeneous cell distributions than conventional static and dynamic seeding. Using 20 × 10(6) cells, whereas the seeding efficiency for static seeding was only 52%, all other techniques produced seeding efficiencies of ≥ 90%. With 40 × 10(6) cells, the efficiency of semi-static seeding declined to 74% while the dynamic and PGA-alginate methods retained their ability to accommodate high cell numbers. The seeded scaffolds were cultured in recirculation bioreactors to determine the effect of seeding method on cartilage production. Statically seeded scaffolds did not survive the 5-week cultivation period. Deposition of extracellular matrix in scaffolds seeded using the semi-static and PGA-alginate methods was more uniform compared with scaffolds seeded using the dynamic method. The new semi-static and PGA-alginate seeding methods developed in this work are recommended for tissue engineering because they provide substantial benefits compared with static seeding in terms of seeding efficiency, cell distribution, and cartilage deposition while remaining simple and easy to execute. Copyright © 2010 American Institute of Chemical Engineers (AIChE).

  19. Impact of lesion calcification on angiographic outcomes after Absorb everolimus-eluting bioresorbable vascular scaffold implantation: An observation from the ABSORB Japan trial

    NARCIS (Netherlands)

    Ohya, M. (Masanobu); K. Kadota (Kazushige); Y. Sotomi (Yohei); K. Kozuma (Ken); K. Tanabe (Kengo); Uematsu, M. (Masaaki); Kawasaki, T. (Tomohiro); Morino, Y. (Yoshihiro); Tobaru, T. (Tetsuya); Nakao, K. (Koichi); Tachibana, K. (Kouichi); Kishi, K. (Koichi); Shibata, Y. (Yoshisato); S. Ying (Shihwa); Kusano, H. (Hajime); G.W. Stone (Gregg); J.J. Popma (Jeffrey); Y. Onuma (Yoshinobu); P.W.J.C. Serruys (Patrick); T. Kimura (Takeshi)

    2017-01-01

    textabstractAims: We aimed to investigate the impact of lesion calcification on angiographic outcomes after Absorb everolimus-eluting bioresorbable vascular scaffold (BVS) implantation in comparison with those after cobalt-chromium everolimus-eluting stent (CoCr-EES) implantation. Methods and

  20. Improving Information Technology Curriculum Learning Outcomes

    Directory of Open Access Journals (Sweden)

    Derrick L Anderson

    2017-06-01

    The case study research methodology has been selected to conduct the inquiry into this phenomenon. This empirical inquiry facilitates exploration of a contemporary phenomenon in depth within its real-life context using a variety of data sources. The subject of analysis will be two Information Technology classes composed of a combination of second year and third year students; both classes have six students, the same six students. Contribution It is the purpose of this research to show that the use of improved approaches to learning will produce more desirable learning outcomes. Findings The results of this inquiry clearly show that the use of the traditional behaviorist based pedagogic model to achieve college and university IT program learning outcomes is not as effective as a more constructivist based andragogic model. Recommendations Instruction based purely on either of these does a disservice to the typical college and university level learner. The correct approach lies somewhere in between them; the most successful outcome attainment would be the product of incorporating the best of both. Impact on Society Instructional strategies produce learning outcomes; learning outcomes demonstrate what knowledge has been acquired. Acquired knowledge is used by students as they pursue professional careers and other ventures in life. Future Research Learning and teaching approaches are not “one-size-fits-all” propositions; different strategies are appropriate for different circumstances and situations. Additional research should seek to introduce vehicles that will move learners away from one the traditional methodology that has been used throughout much of their educational careers to an approach that is better suited to equip them with the skills necessary to meet the challenges awaiting them in the professional world.

  1. Affibody scaffolds improve sesquiterpene production in Saccharomyces cerevisiae

    DEFF Research Database (Denmark)

    Tippmann, Stefan; Anfelt, Josefine; David, Florian

    2017-01-01

    Enzyme fusions have been widely used as a tool in metabolic engineering to increase pathway efficiency by reducing substrate loss and accumulation of toxic intermediates. Alternatively, enzymes can be co-localized through attachment to a synthetic scaffold via non-covalent interactions. Here we d...

  2. Do palliative consultations improve patient outcomes?

    Science.gov (United States)

    Casarett, David; Pickard, Amy; Bailey, F Amos; Ritchie, Christine; Furman, Christian; Rosenfeld, Ken; Shreve, Scott; Chen, Zhen; Shea, Judy A

    2008-04-01

    To determine whether inpatient palliative consultation services improve outcomes of care. Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life. Five VA Medical Centers or their affiliated nursing homes and outpatient clinics. Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey. The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well-being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items). Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62-66) versus 54 (95% CI=51-56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (beta=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support. Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.

  3. Using Teams to Improve Outcomes and Performance.

    Science.gov (United States)

    Ulrich, Beth; Crider, Nancy Manning

    2017-01-01

    Mastering the use of teams in healthcare organizations can maximize outcomes and optimize the use of resources. Most work in healthcare organizations is done by teams, whether it's the clinical team taking care of patients on a unit, the leadership team accountable for operations of the organization, or a team formed to solve a specific problem, improve quality, or plan an event. Effective teams make organizations successful; ineffective teams can create more problems than they solve. This article describes how to successfully use the power of teams within the healthcare setting, create and develop teams, be a team leader or member, create conditions for team effectiveness and high performance, and provide team training. Copyright© by the American Nephrology Nurses Association.

  4. Bone regeneration in 3D printing bioactive ceramic scaffolds with improved tissue/material interface pore architecture in thin-wall bone defect.

    Science.gov (United States)

    Shao, Huifeng; Ke, Xiurong; Liu, An; Sun, Miao; He, Yong; Yang, Xianyan; Fu, Jianzhong; Liu, Yanming; Zhang, Lei; Yang, Guojing; Xu, Sanzhong; Gou, Zhongru

    2017-04-12

    Three-dimensional (3D) printing bioactive ceramics have demonstrated alternative approaches to bone tissue repair, but an optimized materials system for improving the recruitment of host osteogenic cells into the bone defect and enhancing targeted repair of the thin-wall craniomaxillofacial defects remains elusive. Herein we systematically evaluated the role of side-wall pore architecture in the direct-ink-writing bioceramic scaffolds on mechanical properties and osteogenic capacity in rabbit calvarial defects. The pure calcium silicate (CSi) and dilute Mg-doped CSi (CSi-Mg6) scaffolds with different layer thickness and macropore sizes were prepared by varying the layer deposition mode from single-layer printing (SLP) to double-layer printing (DLP) and then by undergoing one-, or two-step sintering. It was found that the dilute Mg doping and/or two-step sintering schedule was especially beneficial for improving the compressive strength (∼25-104 MPa) and flexural strength (∼6-18 MPa) of the Ca-silicate scaffolds. The histological analysis for the calvarial bone specimens in vivo revealed that the SLP scaffolds had a high osteoconduction at the early stage (4 weeks) but the DLP scaffolds displayed a higher osteogenic capacity for a long time stage (8-12 weeks). Although the DLP CSi scaffolds displayed somewhat higher osteogenic capacity at 8 and 12 weeks, the DLP CSi-Mg6 scaffolds with excellent fracture resistance also showed appreciable new bone tissue ingrowth. These findings demonstrate that the side-wall pore architecture in 3D printed bioceramic scaffolds is required to optimize for bone repair in calvarial bone defects, and especially the Mg doping wollastontie is promising for 3D printing thin-wall porous scaffolds for craniomaxillofacial bone defect treatment.

  5. Improving osteointegration and osteogenesis of three-dimensional porous Ti6Al4V scaffolds by polydopamine-assisted biomimetic hydroxyapatite coating.

    Science.gov (United States)

    Li, Yong; Yang, Wei; Li, Xiaokang; Zhang, Xing; Wang, Cairu; Meng, Xiangfei; Pei, Yifeng; Fan, Xiangli; Lan, Pingheng; Wang, Chunhui; Li, Xiaojie; Guo, Zheng

    2015-03-18

    Titanium alloys with various porous structures can be fabricated by advanced additive manufacturing techniques, which are attractive for use as scaffolds for bone defect repair. However, modification of the scaffold surfaces, particularly inner surfaces, is critical to improve the osteointegration of these scaffolds. In this study, a biomimetic approach was employed to construct polydopamine-assisted hydroxyapatite coating (HA/pDA) onto porous Ti6Al4V scaffolds fabricated by the electron beam melting method. The surface modification was characterized with the field emission scanning electron microscopy, energy dispersive spectroscopy, water contact angle measurement, and confocal laser scanning microscopy. Attachment and proliferation of MC3T3-E1 cells on the scaffold surface were significantly enhanced by the HA/pDA coating compared to the unmodified surfaces. Additionally, MC3T3-E1 cells grown on the HA/pDA-coated Ti6Al4V scaffolds displayed significantly higher expression of runt-related transcription factor-2, alkaline phosphatase, osteocalcin, osteopontin, and collagen type-1 compared with bare Ti6Al4V scaffolds after culture for 14 days. Moreover, microcomputed tomography analysis and Van-Gieson staining of histological sections showed that HA/pDA coating on surfaces of porous Ti6Al4V scaffolds enhanced osteointegration and significantly promoted bone regeneration after implantation in rabbit femoral condylar defects for 4 and 12 weeks. Therefore, this study provides an alternative to biofunctionalized porous Ti6Al4V scaffolds with improved osteointegration and osteogenesis functions for orthopedic applications.

  6. HA/TCP compounding of a porous CaP biomaterial improves bone formation and scaffold degradation--a long-term histological study.

    Science.gov (United States)

    Schopper, Christian; Ziya-Ghazvini, Farzad; Goriwoda, Walter; Moser, Doris; Wanschitz, Felix; Spassova, Else; Lagogiannis, Georgios; Auterith, Alexandra; Ewers, Rolf

    2005-07-01

    In the present study, two biphasic calcium phosphate biomaterials (BCP) with HA/TCP ratios of 50/50 and 30/70 were obtained from a pure HA biomaterial. The biomaterials which showed the same three-dimensional geometry were implanted into corticocancellous costal defects of sheep. In the specimens of all three biomaterials, abundant bone formation, mineral dissolution from the biomaterial scaffolds, and active cellular resorption of the scaffolds was present after 6 and 12 months. Backscattered electron microscopy showed bone invasion into the pores of the scaffolds and micromechanical interlocking at the bone/biomaterial interface without intervening soft tissue. The pattern of bone formation and scaffold resorption was different for cortical and cancellous bone. No time-based effect, however, was observed. Overall, the BCP biomaterials had formed significantly more bone than the HA biomaterial. Also, scaffold resorption, which was followed by a replacement with newly formed bone, was significantly higher in the BCP biomaterials. Although no significant differences were observed between both BCP biomaterials, the present study had confirmed the assumption that HA/TCP compounding was suitable to improve bone formation and scaffold resorption in the investigated biomaterials and at the same time maintain the osteoconductive properties of the scaffolds. Copyright 2005 Wiley Periodicals, Inc.

  7. Can Probiotics Improve Your Surgical Outcomes?

    Science.gov (United States)

    Ward, Tina; Nichols, Misty; Nutter, Julie

    2016-01-01

    Despite ongoing advances in medical technology, postoperative infections and infectious complications continue to be a significant cause of morbidity and mortality. Surgical trauma and prophylactic antibiotics disrupt the balance of the intestinal microbiota and barrier function of the gut, potentiating an enhanced inflammatory response and further immune system depression. With the increasing costs of health care and emergence of multidrug-resistant bacteria, alternative approaches must be explored. Many clinical studies have demonstrated that the use of probiotics, prebiotics, or a combination of both (synbiotics) as a part of innovative strategies can improve outcomes of elective abdominal and gastrointestinal surgical procedures. It has been demonstrated that probiotics play a role in gut barrier improvement and immunomodulation. However, it is evident that additional research is needed including larger, multicenter, randomized controlled trials to validate the safety and efficacy of their use in surgical patients. The purpose of this article is to discuss background of probiotic use in abdominal/gastrointestinal surgery, risk and benefits, clinical relevance for health care providers, and further implications for research.

  8. THE USE OF SCAFFOLDING TECHNIQUE TO IMPROVE THE STUDENTS’ COMPETENCE IN WRITING GENRE-BASED TEXTS

    Directory of Open Access Journals (Sweden)

    Sri Mulatsih

    2011-04-01

    Full Text Available Dalam menulis teks yang bersifat genre-based, para mahasiswa masih mengalami kesulitan, khususnya tentang bagaimana mengembangkan ide, membangun sturktur tematik yang benar, dan menggunakan cirri lexico-grammar pada teks. Untuk mengatasi masalah itu the scaffolding technique dibutuhkan dalam kelas Writing. Teknik itu diberikan untuk membantu para mahasiswa menulis sebuah teks, termasuk, persiapan, presentasi dan refleksi. 25 mahasiswa Fakultas Bahasa & Sastra, Dian Nuswantoro, dipilih untuk diberi pengarahan dan diminta untuk menulis teks genre-based dalam bahasa Inggris. Siklusnya diulang tiga kali. Hasilnya menunjukkan peningkatan yang signifikan pada kompetensi menulis teks yang bersifat genre-based itu.   Keywords    :    Genre-Based Writing, Scaffolding Technique, Students’ competence, Texts, Teaching.

  9. Helping Students with Cognitive Disabilities Improve Social Writing Skills through Email Modeling and Scaffolding

    Science.gov (United States)

    Wang, Xiao-lei; Eberhard, Dominique; Voron, Mike; Bernas, Ronan

    2016-01-01

    The purpose of this study is to examine the effects of email modeling and scaffolding on the social writing quality of students with cognitive disabilities. Ten students from a university-affiliated lab school (mean age = 19.3; SD = 1.2) with an average of IQ of 55.30 (SD = 5.98) and 10 teacher candidates in a university teacher education…

  10. Porcine Bone Scaffolds Adsorb Growth Factors Secreted by MSCs and Improve Bone Tissue Repair

    Directory of Open Access Journals (Sweden)

    Eitan Mijiritsky

    2017-09-01

    Full Text Available An ideal tissue-engineered bone graft should have both excellent pro-osteogenesis and pro-angiogenesis properties to rapidly realize the bone regeneration in vivo. To meet this goal, in this work a porcine bone scaffold was successfully used as a Trojan horse to store growth factors produced by mesenchymal stem cells (MSCs. This new scaffold showed a time-dependent release of bioactive growth factors, such as vascular endothelial growth factor (VEGF and basic fibroblast growth factor (bFGF, in vitro. The biological effect of the growth factors-adsorbed scaffold on the in vitro commitment of MSCs into osteogenic and endothelial cell phenotypes has been evaluated. In addition, we have investigated the activity of growth factor-impregnated granules in the repair of critical-size defects in rat calvaria by means of histological, immunohistochemical, and molecular biology analyses. Based on the results of our work bone tissue formation and markers for bone and vascularization were significantly increased by the growth factor-enriched bone granules after implantation. This suggests that the controlled release of active growth factors from porcine bone granules can enhance and promote bone regeneration.

  11. Synthetic protein scaffolds based on peptide motifs and cognate adaptor domains for improving metabolic productivity

    Directory of Open Access Journals (Sweden)

    Anselm H.C. Horn

    2015-11-01

    Full Text Available The efficiency of many cellular processes relies on the defined interaction among different proteins within the same metabolic or signaling pathway. Consequently, a spatial colocalization of functionally interacting proteins has frequently emerged during evolution. This concept has been adapted within the synthetic biology community for the purpose of creating artificial scaffolds. A recent advancement of this concept is the use of peptide motifs and their cognate adaptor domains. SH2, SH3, GBD, and PDZ domains have been used most often in research studies to date. The approach has been successfully applied to the synthesis of a variety of target molecules including catechin, D-glucaric acid, H2, hydrochinone, resveratrol, butyrate, gamma-aminobutyric acid, and mevalonate. Increased production levels of up to 77-fold have been observed compared to non-scaffolded systems. A recent extension of this concept is the creation of a covalent linkage between peptide motifs and adaptor domains, which leads to a more stable association of the scaffolded systems and thus bears the potential to further enhance metabolic productivity.

  12. Biomimetic scaffolds containing nanofibers coated with willemite nanoparticles for improvement of stem cell osteogenesis

    Energy Technology Data Exchange (ETDEWEB)

    Ramezanifard, Rouhallah [Department of Biotechnology, College of Science, University of Tehran, Tehran (Iran, Islamic Republic of); Seyedjafari, Ehsan, E-mail: seyedjafari@ut.ac.ir [Department of Biotechnology, College of Science, University of Tehran, Tehran (Iran, Islamic Republic of); Ardeshirylajimi, Abdolreza [Department of Stem Cell Biology, Stem Cell Technology Research Center, Tehran (Iran, Islamic Republic of); Soleimani, Masoud [Department of Hematology, Faculty of Medical Science, Tarbiat Modares University, Tehran (Iran, Islamic Republic of)

    2016-05-01

    Nowadays, discovering osteogenesis stimulating effectors is one of the major topics in bone tissue engineering and regenerative medicine. In this study, the proliferation rate and osteogenic differentiation potency of adipose-derived mesenchymal stem cells (AT-MSCs) cultured on poly (L-lactide acid) (PLLA) and willemite-coated PLLA were investigated by MTT assay and common osteogenic markers such as alkaline phosphatase (ALP) activity, calcium mineral deposition and bone-related genes expression. Willemite-coated PLLA showed a higher proliferation support to AT-MSCs in comparison to PLLA and TCPS. During the period of study, AT-MSCs cultured on willemite-coated PLLA scaffolds exhibited the greatest ALP activity and mineralization. Gene expression analysis demonstrated that the highest expression of four important osteogenic-related genes, osteonectin, Runx2, collagen type 1 and osteocalcin was observed in stem cells cultured on willemite-coated PLLA nanofibrous scaffolds. According to the results, willemite-coated PLLA could be a suitable substrate to support the proliferation and osteogenic differentiation of stem cells and holds promising potential for bone tissue engineering and regenerative medicine applications. - Highlights: • Biodegradable PLLA eletrospun nanofibrous scaffold was prepared. • PLLA nanofibers were treated with plasma and coated with willemite nanoparticles. • MSC on willemite-coated PLLA showed greater osteogenic differentiation than those on uncoated PLLA and TCPS. • Willemite-coated nanofibers hold promising potential for bone tissue engineering application.

  13. Chitosan nanofiber scaffold improves bone healing via stimulating trabecular bone production due to upregulation of the Runx2/osteocalcin/alkaline phosphatase signaling pathway.

    Science.gov (United States)

    Ho, Ming-Hua; Yao, Chih-Jung; Liao, Mei-Hsiu; Lin, Pei-I; Liu, Shing-Hwa; Chen, Ruei-Ming

    2015-01-01

    Osteoblasts play critical roles in bone formation. Our previous study showed that chitosan nanofibers can stimulate osteoblast proliferation and maturation. This translational study used an animal model of bone defects to evaluate the effects of chitosan nanofiber scaffolds on bone healing and the possible mechanisms. In this study, we produced uniform chitosan nanofibers with fiber diameters of approximately 200 nm. A bone defect was surgically created in the proximal femurs of male C57LB/6 mice, and then the left femur was implanted with chitosan nanofiber scaffolds for 21 days and compared with the right femur, which served as a control. Histological analyses revealed that implantation of chitosan nanofiber scaffolds did not lead to hepatotoxicity or nephrotoxicity. Instead, imaging analyses by X-ray transmission and microcomputed tomography showed that implantation of chitosan nanofiber scaffolds improved bone healing compared with the control group. In parallel, microcomputed tomography and bone histomorphometric assays further demonstrated augmentation of the production of new trabecular bone in the chitosan nanofiber-treated group. Furthermore, implantation of chitosan nanofiber scaffolds led to a significant increase in the trabecular bone thickness but a reduction in the trabecular parameter factor. As to the mechanisms, analysis by confocal microscopy showed that implantation of chitosan nanofiber scaffolds increased levels of Runt-related transcription factor 2 (Runx2), a key transcription factor that regulates osteogenesis, in the bone defect sites. Successively, amounts of alkaline phosphatase and osteocalcin, two typical biomarkers that can simulate bone maturation, were augmented following implantation of chitosan nanofiber scaffolds. Taken together, this translational study showed a beneficial effect of chitosan nanofiber scaffolds on bone healing through stimulating trabecular bone production due to upregulation of Runx2-mediated alkaline

  14. Chitosan nanofiber scaffold improves bone healing via stimulating trabecular bone production due to upregulation of the Runx2/osteocalcin/alkaline phosphatase signaling pathway

    Science.gov (United States)

    Ho, Ming-Hua; Yao, Chih-Jung; Liao, Mei-Hsiu; Lin, Pei-I; Liu, Shing-Hwa; Chen, Ruei-Ming

    2015-01-01

    Osteoblasts play critical roles in bone formation. Our previous study showed that chitosan nanofibers can stimulate osteoblast proliferation and maturation. This translational study used an animal model of bone defects to evaluate the effects of chitosan nanofiber scaffolds on bone healing and the possible mechanisms. In this study, we produced uniform chitosan nanofibers with fiber diameters of approximately 200 nm. A bone defect was surgically created in the proximal femurs of male C57LB/6 mice, and then the left femur was implanted with chitosan nanofiber scaffolds for 21 days and compared with the right femur, which served as a control. Histological analyses revealed that implantation of chitosan nanofiber scaffolds did not lead to hepatotoxicity or nephrotoxicity. Instead, imaging analyses by X-ray transmission and microcomputed tomography showed that implantation of chitosan nanofiber scaffolds improved bone healing compared with the control group. In parallel, microcomputed tomography and bone histomorphometric assays further demonstrated augmentation of the production of new trabecular bone in the chitosan nanofiber-treated group. Furthermore, implantation of chitosan nanofiber scaffolds led to a significant increase in the trabecular bone thickness but a reduction in the trabecular parameter factor. As to the mechanisms, analysis by confocal microscopy showed that implantation of chitosan nanofiber scaffolds increased levels of Runt-related transcription factor 2 (Runx2), a key transcription factor that regulates osteogenesis, in the bone defect sites. Successively, amounts of alkaline phosphatase and osteocalcin, two typical biomarkers that can simulate bone maturation, were augmented following implantation of chitosan nanofiber scaffolds. Taken together, this translational study showed a beneficial effect of chitosan nanofiber scaffolds on bone healing through stimulating trabecular bone production due to upregulation of Runx2-mediated alkaline

  15. Functional dysphonia: strategies to improve patient outcomes

    Directory of Open Access Journals (Sweden)

    Behlau M

    2015-12-01

    Full Text Available Mara Behlau, Glaucya Madazio, Gisele Oliveira Voice Department, Centro de Estudos da Voz – CEV, São Paulo, Brazil Abstract: Functional dysphonia (FD refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient's perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient's recovery. An

  16. Nano SiO2 and MgO improve the properties of porous β-TCP scaffolds via advanced manufacturing technology.

    Science.gov (United States)

    Gao, Chengde; Wei, Pingpin; Feng, Pei; Xiao, Tao; Shuai, Cijun; Peng, Shuping

    2015-03-25

    Nano SiO2 and MgO particles were incorporated into β-tricalcium phosphate (β-TCP) scaffolds to improve the mechanical and biological properties. The porous cylindrical β-TCP scaffolds doped with 0.5 wt % SiO2, 1.0 wt % MgO, 0.5 wt % SiO2 + 1.0 wt % MgO were fabricated via selective laser sintering respectively and undoped β-TCP scaffold was also prepared as control. The phase composition and mechanical strength of the scaffolds were evaluated. X-ray diffraction analysis indicated that the phase transformation from β-TCP to α-TCP was inhibited after the addition of MgO. The compressive strength of scaffold was improved from 3.12 ± 0.36 MPa (β-TCP) to 5.74 ± 0.62 MPa (β-TCP/SiO2), 9.02 ± 0.55 MPa (β-TCP/MgO) and 10.43 ± 0.28 MPa (β-TCP/SiO2/MgO), respectively. The weight loss and apatite-forming ability of the scaffolds were evaluated by soaking them in simulated body fluid. The results demonstrated that both SiO2 and MgO dopings slowed down the degradation rate and improved the bioactivity of β-TCP scaffolds. In vitro cell culture studies indicated that SiO2 and MgO dopings facilitated cell attachment and proliferation. Combined addition of SiO2 and MgO were found optimal in enhancing both the mechanical and biological properties of β-TCP scaffold.

  17. Nano SiO2 and MgO Improve the Properties of Porous β-TCP Scaffolds via Advanced Manufacturing Technology

    Directory of Open Access Journals (Sweden)

    Chengde Gao

    2015-03-01

    Full Text Available Nano SiO2 and MgO particles were incorporated into β-tricalcium phosphate (β-TCP scaffolds to improve the mechanical and biological properties. The porous cylindrical β-TCP scaffolds doped with 0.5 wt % SiO2, 1.0 wt % MgO, 0.5 wt % SiO2 + 1.0 wt % MgO were fabricated via selective laser sintering respectively and undoped β-TCP scaffold was also prepared as control. The phase composition and mechanical strength of the scaffolds were evaluated. X-ray diffraction analysis indicated that the phase transformation from β-TCP to α-TCP was inhibited after the addition of MgO. The compressive strength of scaffold was improved from 3.12 ± 0.36 MPa (β-TCP to 5.74 ± 0.62 MPa (β-TCP/SiO2, 9.02 ± 0.55 MPa (β-TCP/MgO and 10.43 ± 0.28 MPa (β-TCP/SiO2/MgO, respectively. The weight loss and apatite-forming ability of the scaffolds were evaluated by soaking them in simulated body fluid. The results demonstrated that both SiO2 and MgO dopings slowed down the degradation rate and improved the bioactivity of β-TCP scaffolds. In vitro cell culture studies indicated that SiO2 and MgO dopings facilitated cell attachment and proliferation. Combined addition of SiO2 and MgO were found optimal in enhancing both the mechanical and biological properties of β-TCP scaffold.

  18. Autologous tendon-derived cell-seeded nanofibrous scaffolds improve rotator cuff repair in an age-dependent fashion.

    Science.gov (United States)

    Huegel, Julianne; Kim, Dong Hwa; Cirone, James M; Pardes, Adam M; Morris, Tyler R; Nuss, Courtney A; Mauck, Robert L; Soslowsky, Louis J; Kuntz, Andrew F

    2017-06-01

    Rotator cuff tendon tears are one of the most common shoulder pathologies, especially in the aging population. Due to a poor healing response and degenerative changes associated with aging, rotator cuff repair failure remains common. Although cell-based therapies to augment rotator cuff repair appear promising, it is unknown whether the success of such a therapy is age-dependent. We hypothesized that autologous cell therapy would improve tendon-to-bone healing across age groups, with autologous juvenile cells realizing the greatest benefit. In this study, juvenile, adult, and aged rats underwent bilateral supraspinatus tendon repair with augmentation of one shoulder with autologous tendon-derived cell-seeded polycaprolactone scaffolds. At 8 weeks, shoulders treated with cells in both juvenile and aged animals exhibited increased cellularity, increased collagen organization, and improved mechanical properties. No changes between treated and control limbs were seen in adult rats. These findings suggest that cell delivery during supraspinatus repair initiates earlier matrix remodeling in juvenile and aged animals. This may be due to the relative "equilibrium" of adult tendon tissue with regards to catabolic and anabolic processes, contrasted with actively growing juvenile tendons and degenerative aged tendons. This study demonstrates the potential for autologous cell-seeded scaffolds to improve repairs in both the juvenile and aged population. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1250-1257, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  19. Improving adherence and outcomes in diabetic patients

    Directory of Open Access Journals (Sweden)

    Joshi R

    2017-02-01

    Full Text Available Renu Joshi, Disha Joshi, Pramil Cheriyath Department of Endocrinology, Pinnacle Health Hospitals, Harrisburg, PA, USA Objective: Nonadherence in diabetes is a problem leading to wasted resources and preventable deaths each year. Remedies for diminishing nonadherence are many but marginally effective, and outcomes remain suboptimal. Aim: The aim of this study was to test a new iOS “app”, PatientPartner. Derived from complexity theory, this novel technology has been extensively used in other fields; this is the first trial in a patient population. Methods: Physicians referred patients who were “severely non-adherent” with HbA1c levels >8. After consent and random assignment (n=107, subjects in the intervention group were immersed in the 12-min PatientPartner game, which assesses and trains subjects on parameters of thinking that are critical for good decision making in health care: information management, stress coping, and health strategies. The control group did not play PatientPartner. All subjects were called each week for 3 weeks and self-reported on their medication adherence, diet, and exercise. Baseline and 3-month post-intervention HbA1c levels were recorded for the intervention group.Results: Although the control group showed no difference on any measures at 3 weeks, the intervention group reported significant mean percentage improvements on all measures: medication adherence (57%, standard deviation [SD] 18%–96%, SD 9, diet (50%, SD 33%–75%, SD 28, and exercise (29%, SD 31%–43%, SD 33. At 3 months, the mean HbA1c levels in the intervention group were significantly lower (9.6 than baseline (10.7. Conclusion: Many programs to improve adherence have been proved to be expensive and marginally effective. Therefore, improvements from the single use of a 12-min-long “app” are noteworthy. This is the first ever randomized, controlled trial to demonstrate that an “app” can impact the gold standard biological marker, HbA1c

  20. Postterm pregnancy: how can we improve outcomes?

    Science.gov (United States)

    Caughey, Aaron B; Snegovskikh, Victoria V; Norwitz, Errol R

    2008-11-01

    Postterm pregnancy is defined as one which has progressed to 42 0/7 weeks or beyond. The most common reason to be diagnosed with a postterm pregnancy is inaccurate pregnancy dating, but it is also associated with obesity, nulliparity, and a prior history of postterm pregnancy. The rate of postterm pregnancy appears to be decreasing whether due to improved pregnancy dating or an increase in induction of labor. Postterm pregnancy is associated with both maternal and neonatal morbidity and fetal and neonatal mortality; similarly pregnancies beyond 41 weeks' gestation are associated with increases in these perinatal complications. Prevention of postterm pregnancies may include stripping or sweeping the membranes and unprotected coitus. Management of such pregnancies may include induction of labor and fetal antenatal monitoring. Individual patient management should involve careful counseling regarding the risks and benefits of each of the components of care. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader should be able to recall the increasing risks of poor outcomes associated with prolonged pregnancy, demonstrate knowledge regarding gestational dating and use of cervical ripening agents in their care of pregnant women, and use evidence-based information when counseling their term patients regarding postterm pregnancy management.

  1. Platelet lysate coating on scaffolds directly and indirectly enhances cell migration, improving bone and blood vessel formation.

    Science.gov (United States)

    Leotot, Julie; Coquelin, Laura; Bodivit, Gwellaouen; Bierling, Philippe; Hernigou, Philippe; Rouard, Helene; Chevallier, Nathalie

    2013-05-01

    Suitable colonization and vascularization of tissue-engineered constructs after transplantation represent critical steps for the success of bone repair. Human platelet lysate (hPL) is composed of numerous growth factors known for their proliferative, differentiative and chemo-attractant effects on various cells involved in wound healing and bone growth. The aim of this study was to determine whether the delivery of human mesenchymal stromal cells (hMSC) seeded on hPL-coated hydroxyapatite/β-tricalcium phosphate (HA/β-TCP) scaffolds could enhance vascularization and bone formation, as well as to investigate the mechanisms by which hMSC participate in tissue regeneration. Our study demonstrates that hPL can be coated on HA/β-TCP scaffolds, which play direct and indirect effects on implanted and/or resident stem cells. Effectively, we show that hPL coating directly increases chemo-attraction to and adhesion of hMSC and endothelial cells on the scaffold. Moreover, we show that hPL coating induces hMSC to produce and secrete pro-angiogenic proteins (placental growth factor and vascular endothelial growth factor) which allow the proliferation and specific chemo-attraction of endothelial cells in vitro, thus improving in vivo neovascularization and new bone formation. This study highlights the potential of functionalizing biomaterials with hPL and shows that this growth factor combination can have synergistic effects leading to enhanced bone and blood vessel formation. Copyright © 2013 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  2. Improving Outcomes for Workers with Mental Retardation

    Science.gov (United States)

    Fornes, Sandra; Rocco, Tonette S.; Rosenberg, Howard

    2008-01-01

    This research presents an analysis of factors predicting job retention, job satisfaction, and job performance of workers with mental retardation. The findings highlight self-determination as a critical skill in predicting the three important employee outcomes. The study examined a hypothesized job retention model and the outcome of the three…

  3. Developmental Scaffolding

    DEFF Research Database (Denmark)

    Giorgi, Franco; Bruni, Luis Emilio

    2015-01-01

    into a functionally coordinate unit. A genetic scaffolding accounts for the inherited invariance of pattern formation during the embryo’s growth. At higher level, cells behave as agents endowed with the capacity to interpret any scaffolding variation as signs. The full hierarchy of a multi-level scaffolding...

  4. Two-year clinical outcomes of patients treated with overlapping absorb scaffolds: An analysis of the ABSORB EXTEND single-arm study.

    Science.gov (United States)

    Costa, J Ribamar; Abizaid, Alexandre; Bartorelli, Antonio L; Whitbourn, Robert; Serruys, Patrick W; Smits, Pieter C

    2017-10-10

    Preclinical data showed that overlapping (OVP) scaffolds might result in delayed healing and strut coverage compared to nonOVP scaffold segments. Furthermore, OVP in patients could result in increased periprocedure myocardial infarction (MI) rate secondary to side branch occlusion; however, little is known whether this may have an impact on long-term clinical outcomes. ABSORB EXTEND is a prospective, single-arm, open-label clinical study in which 812 patients were enrolled at 56 sites. In this study, we compared the immediate and 2-year clinical outcomes of patients with OVP scaffolds (n = 115) to those of patients with nonOVP scaffolds (n = 697). The primary objective was the comparison of major adverse cardiac event (MACE) (cardiac death, MI and ischemic-driven target lesion revascularization [TLR]) and scaffold thrombosis (ST) rates up to 2 years. Baseline clinical and angiographic characteristics were comparable between cohorts except for longer lesions in the OVP patients as expected (16.7 ± 7.3 vs. 11.6 ± 4.4 mm, P < 0.0001), higher lesion complexity (B2) and numerically smaller vessel size. In-hospital, there was a marked increase in MACE in the OVP cohort (7.0 vs. 0.9%, P = 0.002), exclusively driven by a higher rate of periprocedure MI (7.0 vs. 0.9%, P = 0.002). Long-term MACE did not significantly differ between groups (10.4% in the OVP cohort vs. 6.6% in the no-OVP group, P = 0.1) with comparable rates of cardiac death (0.9 vs. 1.2%, P = 1.0) and ischemia-driven TLR (1.7 vs. 2.5%, P = 1.0). Cumulative incidence of MI was higher in the OVP cohort (7.8 vs. 3.0%, P = 0.02). Of note, the rate of MI between hospital discharge and 2-year follow-up was lower in the OVP cohort (0.8 vs. 2.1%, P = 0.04). Cumulative incidence of definite/probable ST was relatively low and comparable between groups (1.8 vs. 1.5%, P = 0.7). In this low-to-moderate complex population treated with the ABSORB scaffold the OVP group

  5. Macrophage interactions with polylactic acid and chitosan scaffolds lead to improved recruitment of human mesenchymal stem/stromal cells: a comprehensive study with different immune cells

    Science.gov (United States)

    Quelhas, Pedro

    2016-01-01

    Despite the importance of immune cell–biomaterial interactions for the regenerative outcome, few studies have investigated how distinct three-dimensional biomaterials modulate the immune cell-mediated mesenchymal stem/stromal cells (MSC) recruitment and function. Thus, this work compares the response of varied primary human immune cell populations triggered by different model scaffolds and describes its functional consequence on recruitment and motility of bone marrow MSC. It was found that polylactic acid (PLA) and chitosan scaffolds lead to an increase in the metabolic activity of macrophages but not of peripheral blood mononuclear cells (PBMC), natural killer (NK) cells or monocytes. PBMC and NK cells increase their cell number in PLA scaffolds and express a secretion profile that does not promote MSC recruitment. Importantly, chitosan increases IL-8, MIP-1, MCP-1 and RANTES secretion by macrophages while PLA stimulates IL-6, IL-8 and MCP-1 production, all chemokines that can lead to MSC recruitment. This secretion profile of macrophages in contact with biomaterials correlates with the highest MSC invasion. Furthermore, macrophages enhance stem cell motility within chitosan scaffolds by 44% but not in PLA scaffolds. Thus, macrophages are the cells that in contact with engineered biomaterials become activated to secrete bioactive molecules that stimulate MSC recruitment. PMID:27628173

  6. Development of novel electrospun nanofibrous scaffold from P. ricini and A. mylitta silk fibroin blend with improved surface and biological properties

    Energy Technology Data Exchange (ETDEWEB)

    Panda, N.; Bissoyi, A.; Pramanik, K.; Biswas, A., E-mail: amitb79@gmail.com

    2015-03-01

    scaffold showed improved cell adhesion and proliferation property. • The expression of CD44 and CD29 over the MSC grown over this is substantially higher than BM. • The metabolic activity of MSC grown over this scaffold is greater than those from BM.

  7. Functional improvement following implantation of a microstructured, type-I collagen scaffold into experimental injuries of the adult rat spinal cord.

    Science.gov (United States)

    Altinova, Haktan; Möllers, Sven; Führmann, Tobias; Deumens, Ronald; Bozkurt, Ahmet; Heschel, Ingo; Damink, Leon H H Olde; Schügner, Frank; Weis, Joachim; Brook, Gary A

    2014-10-17

    The formation of cystic cavitation following severe spinal cord injury (SCI) constitutes one of the major barriers to successful axonal regeneration and tissue repair. The development of bioengineered scaffolds that assist in the bridging of such lesion-induced gaps may contribute to the formulation of combination strategies aimed at promoting functional tissue repair. Our previous in vitro investigations have demonstrated the directed axon regeneration and glial migration supporting properties of microstructured collagen scaffold that had been engineered to possess mechanical properties similar to those of spinal cord tissues. Here, the effect of implanting the longitudinally orientated scaffold into unilateral resection injuries (2mm long) of the mid-cervical lateral funiculus of adult rats has been investigated using behavioural and correlative morphological techniques. The resection injuries caused an immediate and long lasting (up to 12 weeks post injury) deficit of food pellet retrieval by the ipsilateral forepaw. Implantation of the orientated collagen scaffold promoted a significant improvement in pellet retrieval by the ipsilateral forepaw at 6 weeks which continued to improve up to 12 weeks post injury. In contrast, implantation of a non-orientated gelatine scaffold did not result in significant functional improvement. Surprisingly, the improved motor performance was not correlated with the regeneration of lesioned axons through the implanted scaffold. This observation supports the notion that biomaterials may support functional recovery by mechanisms other than simple bridging of the lesion site, such as the local sprouting of injured, or even non-injured fibres. Copyright © 2014 Elsevier B.V. All rights reserved.

  8. Pharmacist Intervention to Improve Outcome of Tuberculosis ...

    African Journals Online (AJOL)

    The relationship between the treatment outcomes, and the age and sex was determined using both logistic regression and relative risk analyses. ... In conclusion, a TB treatment success rate greater than the World Health Organisation minimum target of 85% success rate in TB management has been achieved in DOTS ...

  9. GDNF Schwann cells in hydrogel scaffolds promote regional axon regeneration, remyelination and functional improvement after spinal cord transection in rats.

    Science.gov (United States)

    Chen, Bingkun K; Madigan, Nicolas N; Hakim, Jeffrey S; Dadsetan, Mahrokh; McMahon, Siobhan S; Yaszemski, Michael J; Windebank, Anthony J

    2017-03-10

    Positively-charged oligo[poly(ethylene glycol)fumarate] (OPF+ ) is a biodegradable hydrogel used for spinal cord injury repair. We compared scaffolds containing primary Schwann cells (SCs) to scaffolds delivering SCs genetically modified to secrete high concentrations of glial cell-derived neurotrophic factor (GDNF). Multichannel OPF+ scaffolds loaded with SCs or GDNF-SCs were implanted into transected rat spinal cords for 4 weeks. GDNF-SCs promoted regeneration of more axons into OPF+ scaffolds (2773.0 ± 396.0) than primary SC OPF+ scaffolds (1666.0 ± 352.2) (p = 0.0491). This increase was most significant in central and ventral-midline channels of the scaffold. Axonal remyelination was quantitated by stereologic analysis. Increased myelination of regenerating axons was observed in the GDNF-SC group. Myelinating cell and axon complexes were formed by host SCs and not by implanted cells or host oligodendrocytes. Fast Blue retrograde tracing studies determined the rostral-caudal directionality of axonal growth. The number of neurons that projected axons rostrally through the GDNF-SC scaffolds was higher (7929 ± 1670) than in animals with SC OPF+ scaffolds (1069 ± 241.5) (p OPF+ scaffolds partially recovered locomotor function at weeks 3 and 4 following surgery. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  10. [Improvement of blood compatibility of small intestinal submucosa used as engineering vascular scaffolds by nano-bionic surface modification].

    Science.gov (United States)

    Han, Ben-song; Fan, Cun-yi; Liu, Sheng-he

    2006-08-08

    To investigate the effects of nano-bionic surface modification in improving the blood compatibility of small intestinal submucosa (SIS) used as engineering vascular scaffolds. SIS films were obtained from pig and underwent nano-bionic surface modification with plasma initiation technique. Scanning electron microscopy (SEM) was used to observe the morphological features, including water contact angle, of the SIS films after nano-bionic surface modification. Modified SIS films were immersed into human platelet-rich plasma for 10 s and then observed for the adhesion of platelet on the surface thereof. Another modified SIS films were immersed into anticoagulant human blood to test the prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT). Twenty dogs were randomly divided into 2 equal groups to undergo cutting of bilateral femoral arteries and anastomosis with tube-like scaffolds made of modified or un-modified SIS films. Color Doppler ultrasonography was used to examine the blood flow 1, 3, and 6 weeks after operation. The dogs were killed in batches 2 and 6 weeks after operation to take out the SIS vessels to observe the existence of mural thrombus and undergo microscopy. SEM showed island-like and groove-like surface morphology in the modified SIS films, and the water contact angle decreased from 105.3 degrees to 62.0 degrees. After treatment by anticoagulant human blood the PT, APTT, and TT of the modified SIS films increased from 30.5 s, 9.8 s, and 13.6 s to 81.5 s, 39.6 s, and 50.2 s respectively. SEM showed that the number of adhering platelets was less on the surface of the modified SIS films than on the surface of un-modified SIS films. Animal experiment showed that 4 blood vessels anastomosed with un-modified SIS tube became completely thrombosed within 3 hours, and the other 6 became completely thrombosed 3 days later, and the 10 blood vessels anastomosed with modified SIS tube remained patent till 6 weeks after

  11. Network information improves cancer outcome prediction.

    Science.gov (United States)

    Roy, Janine; Winter, Christof; Isik, Zerrin; Schroeder, Michael

    2014-07-01

    Disease progression in cancer can vary substantially between patients. Yet, patients often receive the same treatment. Recently, there has been much work on predicting disease progression and patient outcome variables from gene expression in order to personalize treatment options. Despite first diagnostic kits in the market, there are open problems such as the choice of random gene signatures or noisy expression data. One approach to deal with these two problems employs protein-protein interaction networks and ranks genes using the random surfer model of Google's PageRank algorithm. In this work, we created a benchmark dataset collection comprising 25 cancer outcome prediction datasets from literature and systematically evaluated the use of networks and a PageRank derivative, NetRank, for signature identification. We show that the NetRank performs significantly better than classical methods such as fold change or t-test. Despite an order of magnitude difference in network size, a regulatory and protein-protein interaction network perform equally well. Experimental evaluation on cancer outcome prediction in all of the 25 underlying datasets suggests that the network-based methodology identifies highly overlapping signatures over all cancer types, in contrast to classical methods that fail to identify highly common gene sets across the same cancer types. Integration of network information into gene expression analysis allows the identification of more reliable and accurate biomarkers and provides a deeper understanding of processes occurring in cancer development and progression. © The Author 2012. Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  12. An anisotropically and heterogeneously aligned patterned electrospun scaffold with tailored mechanical property and improved bioactivity for vascular tissue engineering.

    Science.gov (United States)

    Xu, He; Li, Haiyan; Ke, Qinfei; Chang, Jiang

    2015-04-29

    The development of vascular scaffolds with controlled mechanical properties and stimulatory effects on biological activities of endothelial cells still remains a significant challenge to vascular tissue engineering. In this work, we reported an innovative approach to prepare a new type of vascular scaffolds with anisotropically and heterogeneously aligned patterns using electrospinning technique with unique wire spring templates, and further investigated the structural effects of the patterned electrospun scaffolds on mechanical properties and angiogenic differentiation of human umbilical vein endothelial cells (HUVECs). Results showed that anisotropically aligned patterned nanofibrous structure was obtained by depositing nanofibers on template in a structurally different manner, one part of nanofibers densely deposited on the embossments of wire spring and formed cylindrical-like structures in the transverse direction, while others loosely suspended and aligned along the longitudinal direction, forming a three-dimensional porous microstructure. We further found that such structures could efficiently control the mechanical properties of electrospun vascular scaffolds in both longitudinal and transverse directions by altering the interval distances between the embossments of patterned scaffolds. When HUVECs were cultured on scaffolds with different microstructures, the patterned scaffolds distinctively promoted adhesion of HUVECs at early stage and proliferation during the culture period. Most importantly, cells experienced a large shape change associated with cell cytoskeleton and nuclei remodeling, leading to a stimulatory effect on angiogenesis differentiation of HUVECs by the patterned microstructures of electrospun scaffolds, and the scaffolds with larger distances of intervals showed a higher stimulatory effect. These results suggest that electrospun scaffolds with the anisotropically and heterogeneously aligned patterns, which could efficiently control the

  13. Improving STEM Student Learning Outcomes with GIS

    Science.gov (United States)

    Montgomery, W. W.

    2013-12-01

    Longitudinal data collection initiated a decade ago as part of a successful NSF-CCLI grant proposal has resulted in a large - and growing - sample (200+) of students who report on their perceptions of self-improvement in Technology, Critical Thinking, and Quantitative Reasoning proficiencies upon completion of an introductory (200-level) GIS course at New Jersey City University, a Hispanic-Serving and Minority Institution in Jersey City, NJ. Results from student satisfaction surveys indicate that, not surprisingly, 80% of respondents report improved confidence in Technology Literacy. Critical Thinking proficiency is judged to be significantly improved by 60% of respondents. On the other hand, Quantitative Reasoning proficiency confidence is improved in only 30% of students. This latter finding has prompted the instructor to search for more easily recognizable (to the student) ways of embedding quantitative reasoning into the course, as it is obvious to any GIS professional that there is an enormous amount of quantitative reasoning associated with this technology. A second post-course questionnaire asks students to rate themselves in these STEM proficiency areas using rubrics. Results mirror those from the self-satisfaction surveys. On a 5-point Likkert scale, students tend to see themselves improving about one letter grade on average in each proficiency area. The self-evaluation rubrics are reviewed by the instructor and are judged to be accurate for about 75% of the respondents.

  14. Clinical auditing to improve patient outcomes

    Directory of Open Access Journals (Sweden)

    David Yorston

    2010-12-01

    Full Text Available Clinical audit is about measuring the quality of care we provide against relevant standards. If we are failing to meet these standards, the audit should help us understand the factors that are causing us to fail, so that we can set priorities and make improvements.

  15. Improving Learning Outcome Using Six Sigma Methodology

    Science.gov (United States)

    Tetteh, Godson A.

    2015-01-01

    Purpose: The purpose of this research paper is to apply the Six Sigma methodology to identify the attributes of a lecturer that will help improve a student's prior knowledge of a discipline from an initial "x" per cent knowledge to a higher "y" per cent of knowledge. Design/methodology/approach: The data collection method…

  16. Improved cellular infiltration into nanofibrous electrospun cross-linked gelatin scaffolds templated with micrometer-sized polyethylene glycol fibers

    Energy Technology Data Exchange (ETDEWEB)

    Skotak, Maciej [Biomechanics, Biomaterials and Biomedicine Instrumentation Facility, College of Engineering, University of Nebraska-Lincoln, NE 68588-0642 (United States); Ragusa, Jorge; Gonzalez, Daniela; Subramanian, Anuradha, E-mail: asubramanian2@unl.edu [Department of Chemical and Biomolecular Engineering, University of Nebraska-Lincoln, NE 68588-0643 (United States)

    2011-10-15

    Gelatin-based nanofibrous scaffolds with a mean fiber diameter of 300 nm were prepared with and without micrometer-sized polyethylene glycol (PEG) fibers that served as sacrificial templates. Upon fabrication of the scaffolds via electrospinning, the gelatin fibers were crosslinked with glutaraldehyde, and the PEG templates were removed using tert-butanol to yield nanofibrous scaffolds with pore diameters ranging from 10 to 100 {mu}m, as estimated with mercury intrusion porosimetry. Non-templated gelatin-based nanofibrous matrices had an average pore size of 1 {mu}m. Fibroblasts were seeded onto both types of the gelatin-based nanofibrous surfaces and cultured for 14 days. For comparative purposes, chitosan-based and polyurethane-based macroporous scaffolds with pore sizes of 100 and 170 {mu}m, respectively, were also included. The number of cells as a function of the depth into the scaffold was judged and quantitatively assessed using nuclei staining. Cell penetration up to a depth of 250 and 90 {mu}m was noted in gelatin scaffolds prepared with sacrificial templates and gelatin-only nanofibrous scaffolds. Noticeably, scaffold preparation protocol presented here allowed the structural integrity to be maintained even with high template content (95%) and can easily be extended toward other classes of electrospun polymer matrices for tissue engineering.

  17. Three dimensional printing of calcium sulfate and mesoporous bioactive glass scaffolds for improving bone regeneration in vitro and in vivo

    Science.gov (United States)

    Qi, Xin; Pei, Peng; Zhu, Min; Du, Xiaoyu; Xin, Chen; Zhao, Shichang; Li, Xiaolin; Zhu, Yufang

    2017-02-01

    In the clinic, bone defects resulting from infections, trauma, surgical resection and genetic malformations remain a significant challenge. In the field of bone tissue engineering, three-dimensional (3D) scaffolds are promising for the treatment of bone defects. In this study, calcium sulfate hydrate (CSH)/mesoporous bioactive glass (MBG) scaffolds were successfully fabricated using a 3D printing technique, which had a regular and uniform square macroporous structure, high porosity and excellent apatite mineralization ability. Human bone marrow-derived mesenchymal stem cells (hBMSCs) were cultured on scaffolds to evaluate hBMSC attachment, proliferation and osteogenesis-related gene expression. Critical-sized rat calvarial defects were applied to investigate the effect of CSH/MBG scaffolds on bone regeneration in vivo. The in vitro results showed that CSH/MBG scaffolds stimulated the adhesion, proliferation, alkaline phosphatase (ALP) activity and osteogenesis-related gene expression of hBMSCs. In vivo results showed that CSH/MBG scaffolds could significantly enhance new bone formation in calvarial defects compared to CSH scaffolds. Thus 3D printed CSH/MBG scaffolds would be promising candidates for promoting bone regeneration.

  18. Massive panniculectomy results in improved functional outcome.

    Science.gov (United States)

    Evans, Chadrick; Debord, James; Howe, Heather; Marshall, John Stephen; Rossi, Thomas; Owolabi, Michael

    2014-03-01

    Panniculus morbidus is a large abdominal apron found in morbidly obese patients. This condition creates a vicious cycle of weight gain and functional incapacity. Our study assessed the functional improvement in patients undergoing massive panniculectomy. A retrospective review of panniculectomies performed from 1994 to 2012 was conducted. Twenty-seven patients with resections >20 lbs were selected. Data on demographics, operative details, complications, and pre- and postoperative functional capacity (using the Steinbrocker Functional Classification) were collected. The preoperative mean body mass index was 58 kg/m(2), with a mean resection weight of 33 lbs. The overall complication rate was 74%. A statistically significant improvement in functional capacity (preop mean 3.7 vs postop mean 2.0; P massive panniculectomy is often the only treatment available. Our data suggest that massive panniculectomy is a viable option for patients functionally incapacitated by panniculus morbidus. Published by Elsevier Inc.

  19. Multimodal strategies to improve surgical outcome

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Wilmore, Douglas W

    2002-01-01

    anesthesia in elective operations, and pilot studies of fast track surgical procedures using the multimodality approach. RESULTS: The introduction of newer approaches to perioperative care has reduced both morbidity and mortality in surgical patients. In the future, most elective operations will become day...... pathophysiology and implementation of care regimes to reduce the stress of an operation, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Developments and improvements of multimodal interventions within the context of "fast...

  20. Higher powered magnification improved endodontic surgery outcomes.

    Science.gov (United States)

    Levenson, David

    2012-01-01

    Medline, Embase and PubMed databases were searched together with hand-searches of a range of journals (Journal of Endodontics, International Endodontic Journal, Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics, Journal of Oral and Maxillofacial Surgery, International Journal of Oral and Maxillofacial Surgery). Clinical studies in several languages (English, French, German, Italian and Spanish) with a minimum follow-up of six months evaluated using clinical and radiographic examination included. Assessment and data abstraction were carried out independently. Weighted pooled success rates and relative risk assessment between TRS and EMS were calculated and a meta-analysis was carried out using a random effects model. Fourteen studies met the inclusion criteria. Weighted pooled success rates calculated from extracted raw data showed an 88% positive outcome for CRS (95% confidence interval [CI], 0.8455-0.9164) and 94% for EMS (95% CI, 0.8889-0.9816). This difference was statistically significant (P magnification rendered by the dental operating microscope or the endoscope.

  1. Addition of MgO nanoparticles and plasma surface treatment of three-dimensional printed polycaprolactone/hydroxyapatite scaffolds for improving bone regeneration.

    Science.gov (United States)

    Roh, Hee-Sang; Lee, Chang-Min; Hwang, Young-Hyoun; Kook, Min-Suk; Yang, Seong-Won; Lee, Donghun; Kim, Byung-Hoon

    2017-05-01

    Magnesium (Mg) plays an important role in the body in mediating cell-extracellular matrix interactions and controlling bone apatite structure and density. Hydroxyapatite (HAp) has been used for osteoconductive bone replacement because of its good compressive strength and biocompatibility. The object of this study is to investigate the effects of adding Magnesium oxide (MgO) nanoparticles to polycaprolactone (PCL)/HAp composites and treating PCL/HAp/MgO scaffolds with oxygen and nitrogen plasma. The 3D PCL/HAp/MgO scaffolds were fabricated using a 3D bioextruder. PCL was mixed with 1-15wt% of MgO and HAp. The scaffolds were treated with oxygen and nitrogen plasma under anisotropic etching conditions to improve the bioactivity. The plasma-treated surfaces were analyzed by X-ray photoelectron spectroscopy, scanning electron microscopy, and atomic force microscopy. In addition, the proliferation and differentiation of pre-osteoblast (MC3T3-E1) cells were examined by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and alkaline phosphatase activity. Cell mineralization within the produced scaffolds was analyzed by the quantification of alizarin stainings. The addition of MgO/HAp nanoparticles and plasma treatment enhanced the adhesion, proliferation, and differentiation of MC3T3-E1 cells in the PCL scaffolds. Hence, changes in physical surface morphology and surface chemical properties of the 3D scaffold by plasma treatment can affect the behavior of MC3T3-E1 cells. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. Improving Outcomes of Neuroprotection by Minocycline

    Science.gov (United States)

    Xue, Mengzhou; Mikliaeva, Elena I.; Casha, Steve; Zygun, David; Demchuk, Andrew; Yong, V. Wee

    2010-01-01

    Minocycline ameliorates deficits in models of acute and chronic neurological diseases, but many publications do not replicate these results. We tested the hypothesis that a key factor in achieving neurological benefits is the exposure of neural cells to local high concentrations of minocycline. This hypothesis was evaluated by using human neurons in culture and in a mouse model of intracerebral hemorrhage (ICH). In culture, neurons were very vulnerable to blood-induced toxicity, with 60% lost within 24 hours in an environment of 5% blood in culture medium. Minocycline reduced blood-induced neurotoxicity in a concentration-dependent manner. In vivo, the introduction of blood into the striatum of mice to simulate ICH resulted in a massive lesion by 24 hours. When minocycline was mixed with the blood used to inflict ICH, the resulting extent of neuropathology was significantly less than that achieved with intraperitoneal administration of medication. The combination of intracerebral and intraperitoneal minocycline improved neuroprotection compared with either alone. We then delayed minocycline treatment and injected it into the hematoma 1 hour after ICH. We found greater alleviation of brain damage and neuronal death with increasing concentrations of minocycline injected locally, which was reflected in limited behavioral and histological recovery. We conclude that the prospect of neuroprotection with minocycline is improved by high concentrations of minocycline delivered locally into the central nervous system with supplementation from systemic administration. PMID:20110416

  3. Challenges in designing appropriate scaffolding to improve students' representational consistency: The case of a Gauss's law problem

    Science.gov (United States)

    Maries, Alexandru; Lin, Shih-Yin; Singh, Chandralekha

    2017-12-01

    Prior research suggests that introductory physics students have difficulty with graphing and interpreting graphs. Here, we discuss an investigation of student difficulties in translating between mathematical and graphical representations for a problem in electrostatics and the effect of increasing levels of scaffolding on students' representational consistency. Students in calculus-based introductory physics were given a typical problem that can be solved using Gauss's law involving a spherically symmetric charge distribution in which they were asked to write a mathematical expression for the electric field in various regions and then plot the electric field. In study 1, we found that students had great difficulty in plotting the electric field as a function of the distance from the center of the sphere consistent with the mathematical expressions in various regions, and interviews with students suggested possible reasons which may account for this difficulty. Therefore, in study 2, we designed two scaffolding interventions with levels of support which built on each other (i.e., the second scaffolding level built on the first) in order to help students plot their expressions consistently and compared the performance of students provided with scaffolding with a comparison group which was not given any scaffolding support. Analysis of student performance with different levels of scaffolding reveals that scaffolding from an expert perspective beyond a certain level may sometimes hinder student performance and students may not even discern the relevance of the additional support. We provide possible interpretations for these findings based on in-depth, think-aloud student interviews.

  4. Teleoncology: improving patient outcome through coordinated care.

    Science.gov (United States)

    Murad, M Faisal; Ali, Qasim; Nawaz, Tariq; Zia, Naeem; Jehan, Farhat; Rafiq, Azhar; Merrell, Ronald C; Zafar, Asif

    2014-04-01

    There are few specialized oncology centers in Pakistan. Teleoncology was introduced for weekly tumor case meetings between the surgery departments of Holy Family Hospital and NORI Hospital using videoconferencing. The team of surgeons, radiologists, and histopathologists of Holy Family Hospital and the oncologists from NORI Hospital are now conducting joint regular multidisciplinary meetings weekly for the well-being of patients of the area. The purpose of this study is to describe the infrastructure, consultative process, technical aspects, and initial evaluation of these meetings. The surgical oncology patients are discussed every Friday morning since November 2009. A standardized format was adopted for case discussion in these multidisciplinary meetings. The postgraduate trainee presents the case from either side followed by management plan discussion. The oncologists may request a discussion to plan an intervention at Holy Family Hospital, or the surgeons at Holy Family Hospital may present a case that would benefit from multidisciplinary skills. In total, 264 patients were discussed. The mean age of the patients was 51±16.2 years. In 43% of the patients, the joint treatment strategy was refined from the initial proposed treatment. Breast and gastrointestinal tract malignancies were the most common cases, followed by endocrine and skin and soft tissue tumors. Teleoncology services can be extended easily with little addition to existing infrastructure but significantly reduce the stress for families as they deal with this challenging disease. Moreover, they improve the clinical evaluation and management strategies.

  5. A PEGylated platelet free plasma hydrogel based composite scaffold enables stable vascularization and targeted cell delivery for volumetric muscle loss.

    Science.gov (United States)

    Aurora, Amit; Wrice, Nicole; Walters, Thomas J; Christy, Robert J; Natesan, Shanmugasundaram

    2018-01-01

    Extracellular matrix (ECM) scaffolds are being used for the clinical repair of soft tissue injuries. Although improved functional outcomes have been reported, ECM scaffolds show limited tissue specific remodeling response with concomitant deposition of fibrotic tissue. One plausible explanation is the regression of blood vessels which may be limiting the diffusion of oxygen and nutrients across the scaffold. Herein we develop a composite scaffold as a vasculo-inductive platform by integrating PEGylated platelet free plasma (PFP) hydrogel with a muscle derived ECM scaffold (m-ECM). In vitro, adipose derived stem cells (ASCs) seeded onto the composite scaffold differentiated into two distinct morphologies, a tubular network in the hydrogel, and elongated structures along the m-ECM scaffold. The composite scaffold showed a high expression of ITGA5, ITGB1, and FN and a synergistic up-regulation of ang1 and tie-2 transcripts. The in vitro ability of the composite scaffold to provide extracellular milieu for cell adhesion and molecular cues to support vessel formation was investigated in a rodent volumetric muscle loss (VML) model. The composite scaffold delivered with ASCs supported robust and stable vascularization. Additionally, the composite scaffold supported increased localization of ASCs in the defect demonstrating its ability for localized cell delivery. Interestingly, ASCs were observed homing in the injured muscle and around the perivascular space possibly to stabilize the host vasculature. In conclusion, the composite scaffold delivered with ASCs presents a promising approach for scaffold vascularization. The versatile nature of the composite scaffold also makes it easily adaptable for the repair of soft tissue injuries. Decellularized extracellular matrix (ECM) scaffolds when used for soft tissue repair is often accompanied by deposition of fibrotic tissue possibly due to limited scaffold vascularization, which limits the diffusion of oxygen and nutrients

  6. Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion

    DEFF Research Database (Denmark)

    Videbaek, Tina S; Christensen, Finn B; Soegaard, Rikke

    2006-01-01

    was found. CONCLUSION: Circumferential lumbar fusion demands more extensive operative resources compared with posterolateral lumbar fusion. However, 5 to 9 years after surgery, the circumferentially fused patients had a significantly improved outcome compared with those treated by means of posterolateral......-36 instrument, and the Low Back Pain Rating Scale. All measures assessed the endpoint outcomes at 5 to 9 years after surgery. RESULTS: The available response rate was 93%. The circumferential group showed a significantly better improvement (P

  7. Role of Video Games in Improving Health-Related Outcomes

    Science.gov (United States)

    Primack, Brian A.; Carroll, Mary V.; McNamara, Megan; Klem, Mary Lou; King, Brandy; Rich, Michael O.; Chan, Chun W.; Nayak, Smita

    2012-01-01

    Context Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it may also be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes. Evidence acquisition Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source), sample data (e.g., number of study participants, demographics), intervention and control details, outcomes data, and quality measures were abstracted independently by two researchers. Evidence synthesis Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with

  8. Boron containing poly-(lactide-co-glycolide) (PLGA) scaffolds for bone tissue engineering

    Energy Technology Data Exchange (ETDEWEB)

    Doğan, Ayşegül; Demirci, Selami [Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University 34755 Istanbul (Turkey); Bayir, Yasin [Department of Biochemistry, Faculty of Pharmacy, Ataturk University, 25240, Erzurum (Turkey); Halici, Zekai [Department of Pharmacology, Faculty of Medicine, Ataturk University, 25240, Erzurum (Turkey); Karakus, Emre [Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Ataturk University, 25240, Erzurum (Turkey); Aydin, Ali [Department of Orthopedics and Traumatology, Faculty of Medicine, Ataturk University, 25240, Erzurum (Turkey); Cadirci, Elif [Department of Pharmacology, Faculty of Pharmacy, Ataturk University, 25240, Erzurum (Turkey); Albayrak, Abdulmecit [Department of Pharmacology, Faculty of Medicine, Ataturk University, 25240, Erzurum (Turkey); Demirci, Elif [Department of Pathology, Faculty of Medicine, Ataturk University, 25240, Erzurum (Turkey); Karaman, Adem [Department of Radiology, Faculty of Medicine, Ataturk University, 25240, Erzurum (Turkey); Ayan, Arif Kursat [Department of Nuclear Medicine, Faculty of Medicine, Ataturk University, 25240, Erzurum (Turkey); Gundogdu, Cemal [Department of Pathology, Faculty of Medicine, Ataturk University, 25240, Erzurum (Turkey); Şahin, Fikrettin, E-mail: fsahin@yeditepe.edu.tr [Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University 34755 Istanbul (Turkey)

    2014-11-01

    Scaffold-based bone defect reconstructions still face many challenges due to their inadequate osteoinductive and osteoconductive properties. Various biocompatible and biodegradable scaffolds, combined with proper cell type and biochemical signal molecules, have attracted significant interest in hard tissue engineering approaches. In the present study, we have evaluated the effects of boron incorporation into poly-(lactide-co-glycolide-acid) (PLGA) scaffolds, with or without rat adipose-derived stem cells (rADSCs), on bone healing in vitro and in vivo. The results revealed that boron containing scaffolds increased in vitro proliferation, attachment and calcium mineralization of rADSCs. In addition, boron containing scaffold application resulted in increased bone regeneration by enhancing osteocalcin, VEGF and collagen type I protein levels in a femur defect model. Bone mineralization density (BMD) and computed tomography (CT) analysis proved that boron incorporated scaffold administration increased the healing rate of bone defects. Transplanting stem cells into boron containing scaffolds was found to further improve bone-related outcomes compared to control groups. Additional studies are highly warranted for the investigation of the mechanical properties of these scaffolds in order to address their potential use in clinics. The study proposes that boron serves as a promising innovative approach in manufacturing scaffold systems for functional bone tissue engineering. - Highlights: • Boron containing PLGA scaffolds were developed for bone tissue engineering. • Boron incorporation increased cell viability and mineralization of stem cells. • Boron containing scaffolds increased bone-related protein expression in vivo. • Implantation of stem cells on boron containing scaffolds improved bone healing.

  9. Surface modification of biphasic calcium phosphate scaffolds by non-thermal atmospheric pressure nitrogen and air plasma treatment for improving osteoblast attachment and proliferation

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yu-Ri [Department and Research Institute of Dental Biomaterials and Bioengineering, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752 (Korea, Republic of); Research Center for Orofacial Hard Tissue Regeneration, College of Dentistry, Yonsei University, Seoul 120-752 (Korea, Republic of); Kwon, Jae-Sung [Research Center for Orofacial Hard Tissue Regeneration, College of Dentistry, Yonsei University, Seoul 120-752 (Korea, Republic of); Song, Doo-Hoon [Department and Research Institute of Dental Biomaterials and Bioengineering, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752 (Korea, Republic of); Research Center for Orofacial Hard Tissue Regeneration, College of Dentistry, Yonsei University, Seoul 120-752 (Korea, Republic of); Choi, Eun Ha [Plasma Bioscience Research Center Kwangwoon University, Seoul 139-701, 447-1 Wokgye-Dong, Nowon-Gu, Seoul (Korea, Republic of); Lee, Yong-Keun [Department and Research Institute of Dental Biomaterials and Bioengineering, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752 (Korea, Republic of); Kim, Kyoung-Nam [Department and Research Institute of Dental Biomaterials and Bioengineering, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752 (Korea, Republic of); Research Center for Orofacial Hard Tissue Regeneration, College of Dentistry, Yonsei University, Seoul 120-752 (Korea, Republic of); Kim, Kwang-Mahn, E-mail: kmkim@yuhs.ac [Department and Research Institute of Dental Biomaterials and Bioengineering, College of Dentistry, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752 (Korea, Republic of); Research Center for Orofacial Hard Tissue Regeneration, College of Dentistry, Yonsei University, Seoul 120-752 (Korea, Republic of)

    2013-11-29

    Surface modifications induced by non-thermal plasma have been used extensively in biomedical applications. The attachment and proliferation of osteoblast cells are important in bone tissue engineering using scaffolds. Hence the effect of non-thermal plasma on hydroxyapatite/β-tri-calcium phosphate (HA/β-TCP) scaffolds in terms of improving osteoblast attachment and proliferation was investigated. Experimental groups were treated with non-thermal plasma for 10 min and 20 min and a control group was not treated with non-thermal plasma. For surface chemistry analysis, X-ray photoelectron spectroscopy (XPS) analysis was carried out. The hydrophilicity was determined from contact angle measurement on the surface. Atomic force microscopy analysis (AFM) was used to test the change in surface roughness and cell attachment and proliferation were evaluated using MC3T3-E1 osteoblast cells. XPS spectra revealed a decreased amount of carbon on the surface of the plasma-treated sample. The contact angle was also decreased following plasma treatment, indicating improved hydrophilicity of plasma-treated surfaces compared to the untreated disc. A significant increase in MC3T3E-1 cell attachment and proliferation was noted on plasma-treated samples as compared to untreated specimens. The results suggest that non-thermal atmospheric pressure nitrogen and air plasma treatments provide beneficial surface characteristics on HA/β-TCP scaffolds. - Highlights: ► Non-thermal plasma increased OH- and decreased C on biphasic scaffold. ► Non-thermal plasma had no effect on surface roughness. ► Non-thermal plasma resulted in hydrophilic surface. ► Non-thermal plasma resulted in better cell attachment and proliferation. ► Non-thermal plasma treatment on biphasic scaffold is useful for tissue engineering.

  10. Metformin and improved treatment outcomes in radiation therapy - A review.

    Science.gov (United States)

    Samsuri, Nur Atiqah Binte; Leech, Michelle; Marignol, Laure

    2017-04-01

    Metformin, a primary treatment for diabetes mellitus (DM) patients, is associated with improved outcomes for diabetic cancer patients fuelling further investigation on its mechanisms of action. The radiosensitising properties of metformin are increasingly reported in pre-clinical studies. This review discusses whether metformin should be offered to radiotherapy (RT) cancer patients as a means to improve their treatment outcomes. A database search was conducted for articles published with metformin as the main intervention between 2010 and 2016. Three groups of RT cancer patients were analysed: diabetic patients using metformin, diabetic patients not using metformin and non-diabetic patients not using metformin. Data on survival and recurrence metrics were extracted. Thirteen studies were included. Conflicting evidence exists with regards to the impact of metformin administration on recurrence and survival outcomes following radiotherapy. Three studies reported improved tumour response determined by recurrence rates while five studies did not observe differences or metformin use was not the associated reason. One study revealed inconsistent tumour response results. Metformin was reported as improving survival outcomes in 2 studies and not improving outcomes in 5 studies. 4 studies showed indefinite results. Although metformin may improve tumour response in the non-randomized, retrospective studies analysed, it may not necessarily confer survival benefits. Future prospective and randomised trials are required to translate the positive impact of metformin documented in pre-clinical and retrospective studies into improve management of RT cancer patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Long-term clinical outcomes for bifurcation treatment using a provisional T-stenting and double proximal optimization technique with Absorb bioresorbable scaffolds

    Directory of Open Access Journals (Sweden)

    Р. Д. Иванченко

    2017-04-01

    Full Text Available Aim. The article presents long-term outcomes of treatment of coronary artery bifurcation lesions by using bioresorbable vascular scaffolds and provisional T-stenting combined with double proximal optimization. Methods. 14 patients aged 44-80 years (mean age 61±6 years including 8 (57.14 % males underwent endovascular treatment of coronary artery bifurcation lesions by using Absorb bioresorbable vascular scaffolds (BVS. Clinical/instrumental analysis was carried out after 23.7±4.12 months. Angiographic examination was performed in 12 cases (85.71 %. 7 patients (50 % underwent optical coherent tomography. Results. 11 patients (78.57 were free of angina during long-term follow-up. 1 patient (7.14 % developed BVS thrombosis and received a drug-eluting stent. A neointimal layer of the main branch increased during long-term follow-up to 29.23±7.82%, that of the lateral branch – up to 19.2±7.48%. Optical coherence tomography (OCT shows that all strata are fully covered with neointima, the number of strata with malappositions is minimal and the loss of the main branch diameter (16.9±4.9% is insignificant. Conclusion. The use of Absorb bioresorbable vascular scaffolds implanted by means of provisional T-stenting combined with double proximal optimization when treating coronary artery bifurcation lesions is a safe and efficient procedure.Received 2 February 2017. Accepted 10 March 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

  12. Using Augmented Reality and Knowledge-Building Scaffolds to Improve Learning in a Science Museum

    Science.gov (United States)

    Yoon, Susan A.; Elinich, Karen; Wang, Joyce; Steinmeier, Christopher; Tucker, Sean

    2012-01-01

    Although learning science in informal non-school environments has shown great promise in terms of increasing interest and engagement, few studies have systematically investigated and produced evidence of improved conceptual knowledge and cognitive skills. Furthermore, little is known about how digital technologies that are increasingly being used…

  13. Using Scaffolded Rubrics to Improve Peer Assessment in a MOOC Writing Course

    Science.gov (United States)

    Ashton, Scott; Davies, Randall S.

    2015-01-01

    This study explored the value of using a "guided rubric" to enable students participating in a massive open online course in writing to produce more reliable assessments of their fellow students' writing. To test the assumption that training students to assess will improve their ability to provide quality feedback, a multivariate…

  14. Boron containing poly-(lactide-co-glycolide) (PLGA) scaffolds for bone tissue engineering.

    Science.gov (United States)

    Doğan, Ayşegül; Demirci, Selami; Bayir, Yasin; Halici, Zekai; Karakus, Emre; Aydin, Ali; Cadirci, Elif; Albayrak, Abdulmecit; Demirci, Elif; Karaman, Adem; Ayan, Arif Kursat; Gundogdu, Cemal; Sahin, Fikrettin

    2014-11-01

    Scaffold-based bone defect reconstructions still face many challenges due to their inadequate osteoinductive and osteoconductive properties. Various biocompatible and biodegradable scaffolds, combined with proper cell type and biochemical signal molecules, have attracted significant interest in hard tissue engineering approaches. In the present study, we have evaluated the effects of boron incorporation into poly-(lactide-co-glycolide-acid) (PLGA) scaffolds, with or without rat adipose-derived stem cells (rADSCs), on bone healing in vitro and in vivo. The results revealed that boron containing scaffolds increased in vitro proliferation, attachment and calcium mineralization of rADSCs. In addition, boron containing scaffold application resulted in increased bone regeneration by enhancing osteocalcin, VEGF and collagen type I protein levels in a femur defect model. Bone mineralization density (BMD) and computed tomography (CT) analysis proved that boron incorporated scaffold administration increased the healing rate of bone defects. Transplanting stem cells into boron containing scaffolds was found to further improve bone-related outcomes compared to control groups. Additional studies are highly warranted for the investigation of the mechanical properties of these scaffolds in order to address their potential use in clinics. The study proposes that boron serves as a promising innovative approach in manufacturing scaffold systems for functional bone tissue engineering. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Poly-ε-caprolactone scaffold and reduced in vitro cell culture: beneficial effect on compaction and improved valvular tissue formation.

    Science.gov (United States)

    Brugmans, Marieke M C P; Driessen-Mol, Anita; Rubbens, Mirjam P; Cox, Martijn A J; Baaijens, Frank P T

    2015-12-01

    Tissue-engineered heart valves (TEHVs), based on polyglycolic acid (PGA) scaffolds coated with poly-4-hydroxybutyrate (P4HB), have shown promising in vivo results in terms of tissue formation. However, a major drawback of these TEHVs is compaction and retraction of the leaflets, causing regurgitation. To overcome this problem, the aim of this study was to investigate: (a) the use of the slowly degrading poly-ε-caprolactone (PCL) scaffold for prolonged mechanical integrity; and (b) the use of lower passage cells for enhanced tissue formation. Passage 3, 5 and 7 (P3, P5 and P7) human and ovine vascular-derived cells were seeded onto both PGA-P4HB and PCL scaffold strips. After 4 weeks of culture, compaction, tissue formation, mechanical properties and cell phenotypes were compared. TEHVs were cultured to observe retraction of the leaflets in the native-like geometry. After culture, tissues based on PGA-P4HB scaffold showed 50-60% compaction, while PCL-based tissues showed compaction of 0-10%. Tissue formation, stiffness and strength were increased with decreasing passage number; however, this did not influence compaction. Ovine PCL-based tissues did render less strong tissues compared to PGA-P4HB-based tissues. No differences in cell phenotype between the scaffold materials, species or cell passage numbers were observed. This study shows that PCL scaffolds may serve as alternative scaffold materials for human TEHVs with minimal compaction and without compromising tissue composition and properties, while further optimization of ovine TEHVs is needed. Reducing cell expansion time will result in faster generation of TEHVs, providing more rapid treatment for patients. Copyright © 2013 John Wiley & Sons, Ltd.

  16. Challenges in designing appropriate scaffolding to improve students’ representational consistency: The case of a Gauss’s law problem

    Directory of Open Access Journals (Sweden)

    Alexandru Maries

    2017-08-01

    Full Text Available Prior research suggests that introductory physics students have difficulty with graphing and interpreting graphs. Here, we discuss an investigation of student difficulties in translating between mathematical and graphical representations for a problem in electrostatics and the effect of increasing levels of scaffolding on students’ representational consistency. Students in calculus-based introductory physics were given a typical problem that can be solved using Gauss’s law involving a spherically symmetric charge distribution in which they were asked to write a mathematical expression for the electric field in various regions and then plot the electric field. In study 1, we found that students had great difficulty in plotting the electric field as a function of the distance from the center of the sphere consistent with the mathematical expressions in various regions, and interviews with students suggested possible reasons which may account for this difficulty. Therefore, in study 2, we designed two scaffolding interventions with levels of support which built on each other (i.e., the second scaffolding level built on the first in order to help students plot their expressions consistently and compared the performance of students provided with scaffolding with a comparison group which was not given any scaffolding support. Analysis of student performance with different levels of scaffolding reveals that scaffolding from an expert perspective beyond a certain level may sometimes hinder student performance and students may not even discern the relevance of the additional support. We provide possible interpretations for these findings based on in-depth, think-aloud student interviews.

  17. Scaffolds for partial meniscal replacement: an updated systematic review.

    Science.gov (United States)

    Papalia, Rocco; Franceschi, Francesco; Diaz Balzani, Lorenzo; D'Adamio, Stefano; Maffulli, Nicola; Denaro, Vincenzo

    2013-01-01

    Meniscectomy, a most common orthopaedic procedure, results in increased contact area of the articular surfaces of tibia and femur leading to early osteoarthritis. We systematically review the literature on clinical outcomes following partial meniscal replacement using different scaffolds. We performed a comprehensive search of Medline, CINAHL, Embase and the Cochrane Central Registry of Controlled Trials. The reference lists of the selected articles were then examined by hand. Only studies focusing on investigation of clinical outcomes on patients undergoing a partial meniscal replacement using a scaffold were selected. We then evaluated the methodological quality of each article using the Coleman methodology score (CMS), a 10 criteria scoring list assessing the methodological quality of the selected studies (CMS). Fifteen studies were included, all prospective studies, but only 2 were randomized controlled trials. Biological scaffolds were involved in 12 studies, 2 studies investigated synthetic scaffolds, whereas 1 remaining article presented data from the use of both classes of device. The mean modified CMS was 64.6. Several demographic and biomechanical factors could influence the outcomes of this treatment modality. Partial replacement using both classes of scaffolds achieves significant and encouraging improved clinical results when compared with baseline values or with controls when present, without no adverse reaction related to the device. There is a need for more and better designed randomized trials, to confirm with a stronger level of evidence the promising preliminary results achieved by the current research.

  18. Patients' expectations of therapeutic improvement and their outcomes.

    Science.gov (United States)

    Bloch, S; Bond, G; Qualls, B; Yalom, I; Zimmerman, E

    1976-12-01

    The authors studied the relationship between patients' expectations of therapeutic improvement and their actual outcomes after 8 and 12 months of group psychotherapy. Using patients' self-evaluations and assessments by therapists and independent judges, they found a positive relationship between expectations and outcomes only when assessments were derived from patients. The authors discuss the possibility of a continuing expectational set in patients toward psychotherapy.

  19. Improved dimensional stability with bioactive glass fibre skeleton in poly(lactide-co-glycolide) porous scaffolds for tissue engineering.

    Science.gov (United States)

    Haaparanta, Anne-Marie; Uppstu, Peter; Hannula, Markus; Ellä, Ville; Rosling, Ari; Kellomäki, Minna

    2015-11-01

    Bone tissue engineering requires highly porous three-dimensional (3D) scaffolds with preferable osteoconductive properties, controlled degradation, and good dimensional stability. In this study, highly porous 3D poly(d,l-lactide-co-glycolide) (PLGA) - bioactive glass (BG) composites (PLGA/BG) were manufactured by combining highly porous 3D fibrous BG mesh skeleton with porous PLGA in a freeze-drying process. The 3D structure of the scaffolds was investigated as well as in vitro hydrolytic degradation for 10weeks. The effect of BG on the dimensional stability, scaffold composition, pore structure, and degradation behaviour of the scaffolds was evaluated. The composites showed superior pore structure as the BG fibres inhibited shrinkage of the scaffolds. The BG was also shown to buffer the acidic degradation products of PLGA. These results demonstrate the potential of these PLGA/BG composites for bone tissue engineering, but the ability of this kind of PLGA/BG composites to promote bone regeneration will be studied in forthcoming in vivo studies. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. How to improve long-term outcome after liver transplantation?

    Science.gov (United States)

    Durand, François

    2018-02-01

    The outcome of liver transplantation has markedly improved in the last 3 decades. Although early post-transplantation outcomes have improved over time, this is not true of the long-term outcome. The majority of late deaths are not related to graft dysfunction, and with the advent of new antiviral agents, recurrence of hepatitis B and hepatitis C after transplantation may no longer represent a source of graft loss and patient's death in the long term. The complications of metabolic syndrome may represent an increasing source of morbidity and mortality after transplantation. This study discusses these modifiable factors associated with late mortality to improve the long-term results of transplantation. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  1. Lean Participative Process Improvement: Outcomes and Obstacles in Trauma Orthopaedics

    Science.gov (United States)

    New, Steve; Hadi, Mohammed; Pickering, Sharon; Robertson, Eleanor; Morgan, Lauren; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter

    2016-01-01

    Objectives To examine the effectiveness of a “systems” approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches. Setting A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control. Participants All staff involved in surgical procedures in both theatres. Interventions A one-day “lean” training course delivered by an experienced specialist team was followed by support and assistance in developing a 6 month improvement project. Clinical staff selected the subjects for improvement and designed the improvements. Outcome Measures We compared technical and non-technical team performance in theatre using WHO checklist compliance evaluation, “glitch count” and Oxford NOTECHS II in a sample of directly observed operations, and patient outcome (length of stay, complications and readmissions) for all patients. We collected observational data for 3 months and clinical data for 6 months before and after the intervention period. We compared changes in measures using 2-way analysis of variance. Results We studied 576 cases before and 465 after intervention, observing the operation in 38 and 41 cases respectively. We found no significant changes in team performance or patient outcome measures. The intervention theatre staff focused their efforts on improving first patient arrival time, which improved by 20 minutes after intervention. Conclusions This version of “lean” system improvement did not improve measured safety processes or outcomes. The study highlighted an important tension between promoting staff ownership and providing direction, which needs to be managed in “lean” projects. Space and time for staff to conduct improvement activities are important for success. PMID:27124012

  2. Improved Neural Regeneration with Olfactory Ensheathing Cell Inoculated PLGA Scaffolds in Spinal Cord Injury Adult Rats

    Directory of Open Access Journals (Sweden)

    Changxing Wang

    2017-03-01

    Full Text Available Background/Aims: Every year, around the world, between 250000 and 500000 people suffer from spinal cord injury (SCI. This study investigated the potential for poly (lactic-co-glycolic acid (PLGA complex inoculated with olfactory ensheathing cells (OECs to treat spinal cord injury in a rat model. Methods: OECs were identified by immunofluorescence based on the nerve growth factor receptor (NGFR p75. The Basso, Beattie, and Bresnahan (BBB score, together with an inclined plane (IP test were used to detect functional recovery. Nissl staining along with the luxol fast blue (LFB staining were independently employed to illustrate morphological alterations. More so, immunofluorescence labeling of the glial fibrillary acidic protein (GFAP and the microtubule-associated protein-2 (MAP-2, representing astrocytes and neurons respectively, were investigated at time points of weeks 2 and 8 post-operation. Results: The findings showed enhanced locomotor recovery, axon myelination and better protected neurons post SCI when compared with either PLGA or untreated groups (P < 0.05. Conclusion: PLGA complexes inoculated with OECs improve locomotor functional recovery in transected spinal cord injured rat models, which is most likely due to the fact it is conducive to a relatively benevolent microenvironment, has nerve protective effects, as well as the ability to enhance remyelination, via a promotion of cell differentiation and inhibition of astrocyte formation.

  3. Low-Temperature Additive Manufacturing of Biomimic Three-Dimensional Hydroxyapatite/Collagen Scaffolds for Bone Regeneration.

    Science.gov (United States)

    Lin, Kai-Feng; He, Shu; Song, Yue; Wang, Chun-Mei; Gao, Yi; Li, Jun-Qin; Tang, Peng; Wang, Zheng; Bi, Long; Pei, Guo-Xian

    2016-03-23

    Low-temperature additive manufacturing (AM) holds promise for fabrication of three-dimensional (3D) scaffolds containing bioactive molecules and/or drugs. Due to the strict technical limitations of current approaches, few materials are suitable for printing at low temperature. Here, a low-temperature robocasting method was employed to print biomimic 3D scaffolds for bone regeneration using a routine collagen-hydroxyapatite (CHA) composite material, which is too viscous to be printed via normal 3D printing methods at low temperature. The CHA scaffolds had excellent 3D structure and maintained most raw material properties after printing. Compared to nonprinted scaffolds, printed scaffolds promoted bone marrow stromal cell proliferation and improved osteogenic outcome in vitro. In a rabbit femoral condyle defect model, the interconnecting pores within the printed scaffolds facilitated cell penetration and mineralization before the scaffolds degraded and enhanced repair, compared to nonprinted CHA scaffolds. Additionally, the optimal printing parameters for 3D CHA scaffolds were investigated; 600-μm-diameter rods were optimal in terms of moderate mechanical strength and better repair outcome in vivo. This low-temperature robocasting method could enable a variety of bioactive molecules to be incorporated into printed CHA materials and provides a method of bioprinting biomaterials without compromising their natural properties.

  4. Scaffolded biology.

    Science.gov (United States)

    Minelli, Alessandro

    2016-09-01

    Descriptions and interpretations of the natural world are dominated by dichotomies such as organism vs. environment, nature vs. nurture, genetic vs. epigenetic, but in the last couple of decades strong dissatisfaction with those partitions has been repeatedly voiced and a number of alternative perspectives have been suggested, from perspectives such as Dawkins' extended phenotype, Turner's extended organism, Oyama's Developmental Systems Theory and Odling-Smee's niche construction theory. Last in time is the description of biological phenomena in terms of hybrids between an organism (scaffolded system) and a living or non-living scaffold, forming unit systems to study processes such as reproduction and development. As scaffold, eventually, we can define any resource used by the biological system, especially in development and reproduction, without incorporating it as happens in the case of resources fueling metabolism. Addressing biological systems as functionally scaffolded systems may help pointing to functional relationships that can impart temporal marking to the developmental process and thus explain its irreversibility; revisiting the boundary between development and metabolism and also regeneration phenomena, by suggesting a conceptual framework within which to investigate phenomena of regular hypermorphic regeneration such as characteristic of deer antlers; fixing a periodization of development in terms of the times at which a scaffolding relationship begins or is terminated; and promoting plant galls to legitimate study objects of developmental biology.

  5. Are we winning? Improving perinatal outcomes at a deeply rural ...

    African Journals Online (AJOL)

    Are we winning? Improving perinatal outcomes at a deeply rural district hospital in South Africa. CB Gaunt. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.7196/SAMJ.3699 · AJOL African Journals Online. HOW TO ...

  6. PEOT/PBT based scaffolds with low mechanical properties improve cartilage repair tissue formation in osteochondral defects

    NARCIS (Netherlands)

    Jansen, Edwin J. P.; Pieper, Jeroen; Gijbels, Marion J. J.; Guldemond, Nick A.; Riesle, Jens; Van Rhijn, Lodewijk W.; Bulstra, Sjoerd K.; Kuijer, Roel

    The aim of our Study was to compare the healing response of biomechanically and biochemically different scaffolds in osteochondral defects created in rabbit medial femoral condyles. A block copolymer comprised of poly(ethylene oxide terephthalate) and poly(butylene terephthalate) was used to prepare

  7. A Novel MgO-CaO-SiO2 System for Fabricating Bone Scaffolds with Improved Overall Performance

    Directory of Open Access Journals (Sweden)

    Hang Sun

    2016-04-01

    Full Text Available Although forsterite (Mg2SiO4 possesses good biocompatibility and suitable mechanical properties, the insufficient bioactivity and degradability hinders its further application. In this study, a novel MgO-CaO-SiO2 system was developed by adding wollastonite (CaSiO3 into Mg2SiO4 to fabricate bone scaffolds via selective laser sintering (SLS. The apatite-forming ability and degradability of the scaffolds were enhanced because the degradation of CaSiO3 could form silanol groups, which could offer nucleation sites for apatite. Meanwhile, the mechanical properties of the scaffolds grew with increasing CaSiO3 to 20 wt %. It was explained that the liquid phase of CaSiO3 promoted the densification during sintering due to its low melting point. With the further increase in CaSiO3, the mechanical properties decreased due to the formation of the continuous filling phase. Furthermore, the scaffolds possessed a well-interconnected porous structure and exhibited an ability to support cell adhesion and proliferation.

  8. Sustained improvement in nutritional outcomes at two paediatric cystic fibrosis centres after quality improvement collaboratives.

    Science.gov (United States)

    Savant, Adrienne P; Britton, LaCrecia J; Petren, Kristofer; McColley, Susanna A; Gutierrez, Hector H

    2014-04-01

    To describe the characteristics of sustained improved nutritional outcomes through the use of quality improvement (QI) methodology. Retrospective analysis of a QI intervention in two institutions, implemented as part of larger national collaboratives. Paediatric cystic fibrosis (CF) programmes in academic centres in Alabama and Illinois. All paediatric patients enrolled in the CF Foundation (CFF) Patient Data Registry were included. Improved and sustained nutrition outcomes occurred through implementation of the CFF practice guidelines for CF nutrition management via care delivery processes, nutritional interventions, team engagement and data display. Mean body mass index (BMI) percentile, percentage of patients less than 50th percentile and percentage less than 10th percentile for all patients aged 2-20 years were tracked through run charts and statistical process control charts. Mann-Whitney U and χ(2) tests were used to determine significance between each centre and national outcomes. Each centre achieved rapid improvement in mean BMI percentile in patients, one centre rising from the 40th percentile in 2001 to the 49th percentile in 2003, the other rising from the 37th percentile in 2003 to the 45th percentile in 2004. These centres have also maintained improved nutritional outcomes, so that they were at the 60th and 55th percentiles, respectively, in 2011. Sustained improvement was accomplished through QI methodology, use of data as a driver for improvement and a change in culture. Participation in collaboratives led to improved nutrition outcomes while a strong culture of QI facilitated sustained improvement.

  9. Immobilization of FLAG-Tagged Recombinant Adeno-Associated Virus 2 onto Tissue Engineering Scaffolds for the Improvement of Transgene Delivery in Cell Transplants.

    Science.gov (United States)

    Li, Hua; Zhang, Feng-Lan; Shi, Wen-Jie; Bai, Xue-Jia; Jia, Shu-Qin; Zhang, Chen-Guang; Ding, Wei

    2015-01-01

    The technology of virus-based genetic modification in tissue engineering has provided the opportunity to produce more flexible and versatile biomaterials for transplantation. Localizing the transgene expression with increased efficiency is critical for tissue engineering as well as a challenge for virus-based gene delivery. In this study, we tagged the VP2 protein of type 2 adeno-associated virus (AAV) with a 3×FLAG plasmid at the N-terminus and packaged a FLAG-tagged recombinant AAV2 chimeric mutant. The mutant AAVs were immobilized onto the tissue engineering scaffolds with crosslinked anti-FLAG antibodies by N-succinimidyl-3-(2-pyridyldithiol) propionate (SPDP). Cultured cells were seeded to scaffolds to form 3D transplants, and then tested for viral transduction both in vitro and in vivo. The results showed that our FLAG-tagged AAV2 exerted similar transduction efficiency compared with the wild type AAV2 when infected cultured cells. Following immobilization onto the scaffolds of PLGA or gelatin sponge with anti-FLAG antibodies, the viral mediated transgene expression was significantly improved and more localized. Our data demonstrated that the mutation of AAV capsid targeted for antibody-based immobilization could be a practical approach for more efficient and precise transgene delivery. It was also suggested that the immobilization of AAV might have attractive potentials in applications of tissue engineering involving the targeted gene manipulation in 3D tissue cultures.

  10. Immobilization of FLAG-Tagged Recombinant Adeno-Associated Virus 2 onto Tissue Engineering Scaffolds for the Improvement of Transgene Delivery in Cell Transplants.

    Directory of Open Access Journals (Sweden)

    Hua Li

    Full Text Available The technology of virus-based genetic modification in tissue engineering has provided the opportunity to produce more flexible and versatile biomaterials for transplantation. Localizing the transgene expression with increased efficiency is critical for tissue engineering as well as a challenge for virus-based gene delivery. In this study, we tagged the VP2 protein of type 2 adeno-associated virus (AAV with a 3×FLAG plasmid at the N-terminus and packaged a FLAG-tagged recombinant AAV2 chimeric mutant. The mutant AAVs were immobilized onto the tissue engineering scaffolds with crosslinked anti-FLAG antibodies by N-succinimidyl-3-(2-pyridyldithiol propionate (SPDP. Cultured cells were seeded to scaffolds to form 3D transplants, and then tested for viral transduction both in vitro and in vivo. The results showed that our FLAG-tagged AAV2 exerted similar transduction efficiency compared with the wild type AAV2 when infected cultured cells. Following immobilization onto the scaffolds of PLGA or gelatin sponge with anti-FLAG antibodies, the viral mediated transgene expression was significantly improved and more localized. Our data demonstrated that the mutation of AAV capsid targeted for antibody-based immobilization could be a practical approach for more efficient and precise transgene delivery. It was also suggested that the immobilization of AAV might have attractive potentials in applications of tissue engineering involving the targeted gene manipulation in 3D tissue cultures.

  11. Improved small molecule drug release from in situ forming poly(lactic-co-glycolic acid) scaffolds incorporating poly(β-amino ester) and hydroxyapatite microparticles

    Science.gov (United States)

    Fisher, Paul D.; Palomino, Pablo; Milbrandt, Todd A.; Hilt, J. Zach; Puleo, David A.

    2014-01-01

    In situ forming implants are an attractive choice for controlled drug release into a fixed location. Currently, rapidly solidifying solvent exchange systems suffer from a high initial burst, and sustained release behavior is tied to polymer precipitation and degradation rate. The present studies investigated addition of hydroxyapatite (HA) and drug-loaded poly(β-amino ester) (PBAE) microparticles to in situ forming poly(lactic-co-glycolic acid) (PLGA)–based systems to prolong release and reduce burst. PBAEs were synthesized, imbibed with simvastatin (osteogenic) or clodronate (anti-resorptive), and then ground into microparticles. Microparticles were mixed with or without HA into a PLGA solution, and the mixture was injected into buffer, leading to precipitation and creating solid scaffolds with embedded HA and PBAE microparticles. Simvastatin release was prolonged through 30 days, and burst release was reduced from 81% to 39% when loaded into PBAE microparticles. Clodronate burst was reduced from 49% to 32% after addition of HA filler, but release kinetics were unaffected after loading into PBAE microparticles. Scaffold dry mass remained unchanged through day 15, with a pronounced increase in degradation rate after day 30, while wet scaffolds experienced a mass increase through day 25 due to swelling. Porosity and pore size changed throughout degradation, likely due to a combination of swelling and degradation. The system offers improved release kinetics, multiple release profiles, and rapid solidification compared to traditional in situ forming implants. PMID:24903524

  12. Improving osteogenesis of three-dimensional porous scaffold based on mineralized recombinant human-like collagen via mussel-inspired polydopamine and effective immobilization of BMP-2-derived peptide.

    Science.gov (United States)

    Zhou, Jing; Guo, Xiaodong; Zheng, Qixin; Wu, Yongchao; Cui, Fuzai; Wu, Bin

    2017-04-01

    An ideal bone substitute should be biocompatible, biodegradable, osteoinductive and osteoconductive. In our previous work, we fabricated a three-dimensional porous scaffold based on mineralized recombinant human-like collagen, nano-hydroxyapatite/recombinant human-like collagen/poly(lactic acid) (nHA/RHLC/PLA). Like other HA/collagen scaffolds, the nHA/RHLC/PLA scaffold lacked osteoinductive bioactivity. The purpose of the present study was to develop a polydopamine (pDA)-assisted BMP-2-derived peptide (designated as P24) surface modification strategy for improving the osteogenesis of the nHA/RHLC/PLA scaffold. The immobilization efficiency and release kinetics of P24, and in vitro osteoinductive activity of the nHA/RHLC/PLA-pDA-P24 scaffold were examined. The in vivo osteoinductive activity of the scaffold was evaluated usinga rat criticalsize calvarial defect model. Our results showed that pDA-assisted surface modification could more efficiently mediate the immobilization of P24 peptide onto the scaffold surfaces than physical adsorption. The in vitro release study showed that the P24 peptide was released slowly and steadily from the nHA/RHLC/PLA-pDA-P24 scaffold in a sustained manner, with a short initial burst release only during the first day, while the physisorbed nHA/RHLC/PLA-P24 group showed a sharp burst P24 release followed by a plateau phase. In vitro osteogenesis assay, the ALP activitiy and mRNA expression of osteo-specific markers of rat-derived mesenchymal stem cells (rMSCs) in the nHA/RHLC/PLA-pDA-P24 group were significantly higher than those of the nHA/RHLC/PLA-P24 and non-P24-loaded nHA/RHLC/PLA groups. In vivo, three-dimensional CT evaluation and histological examination demonstrated the nHA/RHLC/PLA-pDA-P24 scaffolds significantly enhanced bone regeneration of rat cranial defects to a much greater extent than physisorbed nHA/RHLC/PLA-P24 and non-P24-loaded nHA/RHLC/PLA scaffolds. Our findings indicated that the pDA-assisted surface modification

  13. Splenectomy Does Not Improve Long-Term Outcome After Stroke.

    Science.gov (United States)

    Zierath, Dannielle; Shen, Angela; Stults, Astiana; Olmstead, Theresa; Becker, Kyra J

    2017-02-01

    Immune responses to brain antigens after stroke contribute to poor outcome. We hypothesized that splenectomy would lessen the development of such responses and improve outcome. Male Lewis rats (275-350 g) underwent 2-hour middle cerebral artery occlusion immediately after splenectomy or sham splenectomy. Animals were survived to 4 weeks (672 hrs), and immune responses to myelin basic protein determined at euthanasia. Infarct volume was determined in a subset of animals euthanized at 72 hours. Behavioral outcomes were assessed to 672 hours. Splenectomy was associated with worse neurological scores early after stroke, but infarct size at 72 hours was similar in both groups. Behavioral outcomes and immune responses to myelin basic protein were also similar among splenectomized and sham-operated animals 672 hours after middle cerebral artery occlusion. Splenectomy did not alter the immune responses to brain antigens or improve outcome after stroke. Differences between this study and other studies of splenectomy and stroke are examined. © 2017 American Heart Association, Inc.

  14. Outcomes and computed tomography scan follow-up of bioresorbable vascular scaffold for the percutaneous treatment of chronic total coronary artery occlusion.

    Science.gov (United States)

    Ojeda, Soledad; Pan, Manuel; Romero, Miguel; Suárez de Lezo, Javier; Mazuelos, Francisco; Segura, José; Espejo, Simona; Morenate, Carmen; Blanco, Marta; Martín, Pedro; Medina, Alfonso; Suárez de Lezo, José

    2015-06-01

    Everolimus-eluting bioresorbable vascular scaffold (BVS) implantation in chronic total occlusion (CTO) could provide theoretical advantages at follow-up compared with metallic stents. This study aimed to assess the feasibility of BVS use for the percutaneous treatment of CTO by analyzing clinical outcomes and patency at midterm follow-up. From February 2013 to June 2014, 42 patients with 46 CTOs were treated by BVS implantation. Once the guidewire reached the distal lumen, all the occluded segments were predilated. Postdilation was performed in all patients. A multislice computed tomography was scheduled for all patients at 6 months. The mean age was 58 ± 9 years, 41 (98%) were men and 14 (33%) diabetic. The target vessel was predominantly the left anterior descending artery (22, 48%). According to the Japanese-CTO score, 21 CTOs (46%) were difficult or very difficult. Most cases were treated with an anterograde strategy (34 lesions, 74%). A hybrid procedure with a drug-eluting stent at the distal segment was the applied treatment in 7 CTOs (15%). The mean scaffold length was 43 ± 21 mm. Technical success was achieved in 45 lesions (98%), and 1 patient (2.4%) presented a non-Q periprocedural myocardial infarction. Re-evaluation was obtained in all patients at 6 ± 1 months. Two re-occlusions and a focal restenosis were identified. After 13 ± 5 months of follow-up, there were 2 repeat revascularizations (4.8%). Neither death nor myocardial infarction was documented. In conclusion, BVS for CTO seems to be an interesting strategy with a high rate of technical success and low rate of cardiac events at midterm follow-up in selected patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Scaffolding for Argumentation in Hypothetical and Theoretical Biology Concepts

    Science.gov (United States)

    Weng, Wan-Yun; Lin, Yu-Ren; She, Hsiao-Ching

    2017-01-01

    The present study investigated the effects of online argumentation scaffolding on students' argumentation involving hypothetical and theoretical biological concepts. Two types of scaffolding were developed in order to improve student argumentation: continuous scaffolding and withdraw scaffolding. A quasi-experimental design was used with four…

  16. Application of Six Sigma towards improving surgical outcomes.

    Science.gov (United States)

    Shukla, P J; Barreto, S G; Nadkarni, M S

    2008-01-01

    Six Sigma is a 'process excellence' tool targeting continuous improvement achieved by providing a methodology for improving key steps of a process. It is ripe for application into health care since almost all health care processes require a near-zero tolerance for mistakes. The aim of this study is to apply the Six Sigma methodology into a clinical surgical process and to assess the improvement (if any) in the outcomes and patient care. The guiding principles of Six Sigma, namely DMAIC (Define, Measure, Analyze, Improve, Control), were used to analyze the impact of double stapling technique (DST) towards improving sphincter preservation rates for rectal cancer. The analysis using the Six Sigma methodology revealed a Sigma score of 2.10 in relation to successful sphincter preservation. This score demonstrates an improvement over the previous technique (73% over previous 54%). This study represents one of the first clinical applications of Six Sigma in the surgical field. By understanding, accepting, and applying the principles of Six Sigma, we have an opportunity to transfer a very successful management philosophy to facilitate the identification of key steps that can improve outcomes and ultimately patient safety and the quality of surgical care provided.

  17. Characterizing the macro and micro mechanical properties of scaffolds for rotator cuff repair.

    Science.gov (United States)

    Smith, Richard D J; Zargar, Nasim; Brown, Cameron P; Nagra, Navraj S; Dakin, Stephanie G; Snelling, Sarah J B; Hakimi, Osnat; Carr, Andrew

    2017-11-01

    Retearing after rotator cuff surgery is a major clinical problem. Numerous scaffolds are being used to try to reduce retear rates. However, few have demonstrated clinical efficacy. We hypothesize that this lack of efficacy is due to insufficient mechanical properties. Therefore, we compared the macro and nano/micro mechanical properties of 7 commercially available scaffolds to those of the human supraspinatus tendons, whose function they seek to restore. The clinically approved scaffolds tested were X-Repair, LARS ligament, Poly-Tape, BioFiber, GraftJacket, Permacol, and Conexa. Fresh frozen cadaveric human supraspinatus tendon samples were used. Macro mechanical properties were determined through tensile testing and rheometry. Scanning probe microscopy and scanning electron microscopy were performed to assess properties of materials at the nano/microscale (morphology, Young modulus, loss tangent). None of the scaffolds tested adequately approximated both the macro and micro mechanical properties of human supraspinatus tendon. Macroscale mechanical properties were insufficient to restore load-bearing function. The best-performing scaffolds on the macroscale (X-Repair, LARS ligament) had poor nano/microscale properties. Scaffolds approximating tendon properties on the nano/microscale (BioFiber, biologic scaffolds) had poor macroscale properties. Existing scaffolds failed to adequately approximate the mechanical properties of human supraspinatus tendons. Combining the macroscopic mechanical properties of a synthetic scaffold with the micro mechanical properties of biologic scaffold could better achieve this goal. Future work should focus on advancing techniques to create new scaffolds with more desirable mechanical properties. This may help improve outcomes for rotator cuff surgery patients. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. Clinical outcomes following "off-label" versus "established" indications of bioresorbable scaffolds for the treatment of coronary artery disease in a real-world population.

    Science.gov (United States)

    Miyazaki, Tadashi; Ruparelia, Neil; Kawamoto, Hiroyoshi; Figini, Filippo; Latib, Azeem; Colombo, Antonio

    2016-04-20

    Our aim was to investigate one-year outcomes in patients treated with bioresorbable scaffolds (BRS) for "off-label" versus currently "established" indications. Consecutive patients treated with BRS between May 2012 and September 2014 in two centres were retrospectively recruited. Patients who met inclusion criteria as defined by the ABSORB III study were allocated to the established indication group (ESTG; 21 patients with 35 lesions) and the remaining patients to the off-label group (OFLG; 168 patients with 225 lesions). Target vessel failure (TVF) and ischaemia-driven target lesion revascularisation (id-TLR) at one year were evaluated in both groups. Patients in the OFLG had a higher prevalence of diabetes mellitus and longer lesion length. Predilatation, post-dilatation and intracoronary imaging were conducted in the majority of patients. At one-year follow-up, TVF (0% vs. 7.8%, p=0.32) and id-TLR (0% vs. 4.5%, p=0.31) occurred only in the OFLG with no adverse events in the ESTG. Definite stent thrombosis occurred in two OFLG patients (1.3%). In a real-world setting, the majority (88.9%) of patients were treated with BRS for off-label indications. Off-label use of BRS appears to be associated with an acceptable occurrence of outcomes considering the greater complexity of this patient group.

  19. Interdisciplinary ICU Cardiac Arrest Debriefing Improves Survival Outcomes

    Science.gov (United States)

    Wolfe, Heather; Zebuhr, Carleen; Topjian, Alexis A.; Nishisaki, Akira; Niles, Dana E.; Meaney, Peter A.; Boyle, Lori; Giordano, Rita T.; Davis, Daniela; Priestley, Margaret; Apkon, Michael; Berg, Robert A.; Nadkarni, Vinay M.; Sutton, Robert M.

    2014-01-01

    Objective In-hospital cardiac arrest is an important public health problem. High-quality resuscitation improves survival but is difficult to achieve. Our objective is to evaluate the effectiveness of a novel, interdisciplinary, postevent quantitative debriefing program to improve survival outcomes after in-hospital pediatric chest compression events. Design, Setting, and Patients Single-center prospective interventional study of children who received chest compressions between December 2008 and June 2012 in the ICU. Interventions Structured, quantitative, audiovisual, interdisciplinary debriefing of chest compression events with front-line providers. Measurements and Main Results Primary outcome was survival to hospital discharge. Secondary outcomes included survival of event (return of spontaneous circulation for ≥ 20 min) and favorable neurologic outcome. Primary resuscitation quality outcome was a composite variable, termed “excellent cardiopulmonary resuscitation,” prospectively defined as a chest compression depth ≥ 38 mm, rate ≥ 100/min, ≤ 10% of chest compressions with leaning, and a chest compression fraction > 90% during a given 30-second epoch. Quantitative data were available only for patients who are 8 years old or older. There were 119 chest compression events (60 control and 59 interventional). The intervention was associated with a trend toward improved survival to hospital discharge on both univariate analysis (52% vs 33%, p = 0.054) and after controlling for confounders (adjusted odds ratio, 2.5; 95% CI, 0.91–6.8; p = 0.075), and it significantly increased survival with favorable neurologic outcome on both univariate (50% vs 29%, p = 0.036) and multivariable analyses (adjusted odds ratio, 2.75; 95% CI, 1.01–7.5; p = 0.047). Cardiopulmonary resuscitation epochs for patients who are 8 years old or older during the debriefing period were 5.6 times more likely to meet targets of excellent cardiopulmonary resuscitation (95% CI, 2.9–10

  20. Family interventions to improve diabetes outcomes for adults

    Science.gov (United States)

    Baig, Arshiya A.; Benitez, Amanda; Quinn, Michael T.; Burnet, Deborah L.

    2015-01-01

    Diabetes self-care is a critical aspect of disease management for adults with diabetes. Since family members can play a vital role in a patient’s disease management, involving them in self-care interventions may positively influence patients’ diabetes outcomes. We systematically reviewed family-based interventions for adults with diabetes published from 1994 to 2014 and assessed their impact on patients’ diabetes outcomes and the extent of family involvement. We found 26 studies describing family-based diabetes interventions for adults. Interventions were conducted across a range of patient populations and settings. The degree of family involvement varied across studies. We found evidence for improvement in patients’ self-efficacy, perceived social support, diabetes knowledge, and diabetes self-care across the studies. Owing to the heterogeneity of the study designs, types of interventions, reporting of outcomes, and family involvement, it is difficult to determine how family participation in diabetes interventions may affect patients’ clinical outcomes. Future studies should clearly describe the role of family in the intervention, assess quality and extent of family participation, and compare patient outcomes with and without family involvement. PMID:26250784

  1. Multidisciplinary in-hospital teams improve patient outcomes: A review

    OpenAIRE

    Epstein, Nancy E.

    2014-01-01

    Background: The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Methods: Acting like "well-oiled machines," multidisciplinary in-hospital teams include "staff" from different levels of the treatment pyramid (e.g. staff including nurses′ aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the "silo effect" by enhancing communication...

  2. Improving outcomes of first-episode psychosis: an overview.

    Science.gov (United States)

    Fusar-Poli, Paolo; McGorry, Patrick D; Kane, John M

    2017-10-01

    Outcomes of psychotic disorders are associated with high personal, familiar, societal and clinical burden. There is thus an urgent clinical and societal need for improving those outcomes. Recent advances in research knowledge have opened new opportunities for ameliorating outcomes of psychosis during its early clinical stages. This paper critically reviews these opportunities, summarizing the state-of-the-art knowledge and focusing on recent discoveries and future avenues for first episode research and clinical interventions. Candidate targets for primary universal prevention of psychosis at the population level are discussed. Potentials offered by primary selective prevention in asymptomatic subgroups (stage 0) are presented. Achievements of primary selected prevention in individuals at clinical high risk for psychosis (stage 1) are summarized, along with challenges and limitations of its implementation in clinical practice. Early intervention and secondary prevention strategies at the time of a first episode of psychosis (stage 2) are critically discussed, with a particular focus on minimizing the duration of untreated psychosis, improving treatment response, increasing patients' satisfaction with treatment, reducing illicit substance abuse and preventing relapses. Early intervention and tertiary prevention strategies at the time of an incomplete recovery (stage 3) are further discussed, in particular with respect to addressing treatment resistance, improving well-being and social skills with reduction of burden on the family, treatment of comorbid substance use, and prevention of multiple relapses and disease progression. In conclusion, to improve outcomes of a complex, heterogeneous syndrome such as psychosis, it is necessary to globally adopt complex models integrating a clinical staging framework and coordinated specialty care programmes that offer pre-emptive interventions to high-risk groups identified across the early stages of the disorder. Only a

  3. Equity and improvement in outcome of breast cancer in Denmark

    DEFF Research Database (Denmark)

    Andreasen, A H; Mouridsen, H T; Andersen, K W

    1994-01-01

    The trend in the prognosis for female breast cancer patients was investigated by comparing Kaplan-Meier survival curves of different patient cohorts diagnosed during the period 1948-87. The study is based on 71,448 patients from the Danish Cancer Registry. The cohorts were defined by age at diagn...... and not only brought about therapeutic improvements in breast cancer treatment in Denmark, but also ensured equity in the outcome on a national scale....

  4. Improving patient and staff outcomes using practice development.

    Science.gov (United States)

    Hennessey, Catherine Elizabeth; Fry, Margaret

    2016-10-10

    Purpose The purpose of this paper is to examine the impact of a practice development program, "Essentials of Care" (EOC), on patient and staff outcomes, workplace culture and service delivery. Design/methodology/approach A descriptive study design was used to explore the impact of EOC in a district hospital rehabilitation ward. EOC focuses on embedding a person-centered culture within clinical areas and is structured from practice development methodologies. EOC was implemented in a metropolitan district hospital rehabilitation, older person 20-bed, ward. Findings Two projects were implemented during EOC. These projects led to nine significant patient and staff outcomes for medication and continence care practices. Outcomes included a reduction in older person complaints by 80 percent, pressure injuries by 62 percent, ward multi resistant staphylococcus aureus infection rates by 50 percent, clinical incidents by 22 percent, older person falls by 14 percent (per 1,000 bed days) and nursing sick leave by 10 percent. There was also a 13 percent improvement in the post nursing workplace satisfaction survey. Research limitations/implications This is a single site study and findings may not be suitable for generalizing across ward settings and broader population groups. Originality/value The EOC program led to significant improvements for and in clinical practices, staff satisfaction and ward culture. Specifically, the EOC program also identified significant cost savings and brought together the healthcare team in a cohesive and integrated way not previously experienced by staff. Practice development strategies can champion service quality improvement, optimal patient outcomes and consistency within healthcare.

  5. Semiotic scaffolding

    DEFF Research Database (Denmark)

    Hoffmeyer, Jesper

    2015-01-01

    implies that genes do not control the life of organisms, they merely scaffold it. The nature-nurture dynamics is thus far more complex and open than is often claimed. Contrary to physically based interactions, semiotic interactions do not depend on any direct causal connection between the sign vehicle......Life processes at all levels (from the genetic to the behavioral) are coordinated by semiotic interactions between cells, tissues, membranes, organs, or individuals and tuned through evolution to stabilize important functions. A stabilizing dynamics based on a system of semiotic scaffoldings...... (the representamen) and the effect. Semiotic interaction patterns therefore provide fast and versatile mechanisms for adaptations, mechanisms that depend on communication and “learning” rather than on genetic preformation. Seen as a stabilizing agency supporting the emergence of higher-order structure...

  6. Improving the efficiency of psychological treatment using outcome feedback technology.

    Science.gov (United States)

    Delgadillo, Jaime; Overend, Karen; Lucock, Mike; Groom, Martin; Kirby, Naomi; McMillan, Dean; Gilbody, Simon; Lutz, Wolfgang; Rubel, Julian A; de Jong, Kim

    2017-12-01

    This study evaluated the impact of applying computerized outcome feedback (OF) technology in a stepped care psychological service offering low and high intensity therapies for depression and anxiety. A group of therapists were trained to use OF based on routine outcome monitoring using depression (PHQ-9) and anxiety (GAD-7) measures. Therapists regularly reviewed expected treatment response graphs with patients and discussed cases that were "not on track" in clinical supervision. Clinical outcomes data were collected for all patients treated by this group (N = 594), six months before (controls = 349) and six months after the OF training (OF cases = 245). Symptom reductions in PHQ-9 and GAD-7 were compared between controls and OF cases using longitudinal multilevel modelling. Treatment duration and costs were compared using MANOVA. Qualitative interviews with therapists (N = 15) and patients (N = 6) were interpreted using thematic analysis. OF technology was generally acceptable and feasible to integrate in routine practice. No significant between-group differences were found in post-treatment PHQ-9 or GAD-7 measures. However, OF cases had significantly lower average duration and cost of treatment compared to controls. After adopting OF into their practice, this group of therapists attained similar clinical outcomes but within a shorter space of time and at a reduced average cost per treatment episode. We conclude that OF can improve the efficiency of stepped care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. The standardized surgical approach improves outcome of gallbladder cancer

    Directory of Open Access Journals (Sweden)

    Igna Dorian

    2007-05-01

    Full Text Available Abstract Background The objective of this study was to examine the extent of surgical procedures, pathological findings, complications and outcome of patients treated in the last 12 years for gallbladder cancer. Methods The impact of a standardized more aggressive approach compared with historical controls of our center with an individual approach was examined. Of 53 patients, 21 underwent resection for cure and 32 for palliation. Results Overall hospital mortality was 9% and procedure related mortality was 4%. The standardized approach in UICC stage IIa, IIb and III led to a significantly improved outcome compared to patients with an individual approach (Median survival: 14 vs. 7 months, mean+/-SEM: 26+/-7 vs. 17+/-5 months, p = 0.014. The main differences between the standardized and the individual approach were anatomical vs. atypical liver resection, performance of systematic lymph dissection of the hepaticoduodenal ligament and the resection of the common bile duct. Conclusion Anatomical liver resection, proof for bile duct infiltration and, in case of tumor invasion, radical resection and lymph dissection of the hepaticoduodenal ligament are essential to improve outcome of locally advanced gallbladder cancer.

  8. Improving outcomes in older people undergoing elective surgery.

    Science.gov (United States)

    Dhesi, J

    2010-12-01

    Older people have much to gain from surgery, but pose a significant challenge not only in emergency surgery but also in elective surgery. Despite significant progress in the care of older surgical patients, they remain more likely to 'fail' pre-assessment and have higher rates of post-operative complications than younger people. The evidence suggests that this is a consequence of age-related increases in co-morbidities and reduction in physiological reserve. Numerous studies have demonstrated improvements in outcome when individual co-morbidities are appropriately assessed and optimised. However, current models of care do not allow for the translation of this evidence into routine clinical practice, particularly in those with complex co-morbidities and functional dependence. This article explores the reasons for poor outcome in older people and describes an alternative model of care for the older elective surgical patient.

  9. Metformin and ageing: improving ageing outcomes beyond glycaemic control.

    Science.gov (United States)

    Valencia, Willy Marcos; Palacio, Ana; Tamariz, Leonardo; Florez, Hermes

    2017-09-01

    In a world where the population is ageing, there is growing interest and demand for research evaluating strategies that address the ageing process. After 60 years of successful use of metformin in our pharmaceutical armamentarium, we are learning that, beyond improving glycaemic control, metformin may have additional mechanisms and pathways of action that need further study. Although, metformin's effect on clinical ageing outcomes may still be considered speculative, the findings from studies into cellular and animal models and from observational and pilot human studies support the existence of beneficial effects on ageing. At present, progress for human research, using randomised clinical trials to evaluate metformin's clinical impact, has just started. Here, we present a review on the ageing process and the mechanisms involved, and the role that metformin may have to counter these. We go on to discuss the upcoming large randomised clinical trials that may provide insight on the use of metformin for ageing outcomes beyond glycaemic control.

  10. Community to clinic navigation to improve diabetes outcomes

    Directory of Open Access Journals (Sweden)

    Nancy E. Schoenberg

    2017-03-01

    Full Text Available Rural residents experience rates of Type 2 Diabetes Mellitus (T2DM that are considerably higher than their urban or suburban counterparts. Two primary modifiable factors, self-management and formal clinical management, have potential to greatly improve diabetes outcomes. “Community to Clinic Navigation to Improve Diabetes Outcomes,” is the first known randomized clinical trial pilot study to test a hybrid model of diabetes self-management education plus clinical navigation among rural residents with T2DM. Forty-one adults with T2DM were recruited from two federally qualified health centers in rural Appalachia from November 2014–January 2015. Community health workers provided navigation, including helping participants understand and implement a diabetes self-management program through six group sessions and, if needed, providing assistance in obtaining clinic visits (contacting providers' offices for appointments, making reminder calls, and facilitating transportation and dependent care. Pre and post-test data were collected on T2DM self-management, physical measures, demographics, psychosocial factors, and feasibility (cost, retention, and satisfaction. Although lacking statistical significance, some outcomes indicate trends in positive directions, including diet, foot care, glucose monitoring, and physical health, including decreased HbA1c and triglyceride levels. Process evaluations revealed high levels of satisfaction and feasibility. Due to the limited intervention dose, modest program expenditures (~$29,950, and a severely affected population most of whom had never received diabetes education, outcomes were not as robust as anticipated. Given high rates of satisfaction and retention, this culturally appropriate small group intervention holds promise for hard to reach rural populations. Modifications should include expanded recruitment venues, sample size, intervention dosage and longer term assessment.

  11. Three-dimensional elastomeric scaffolds designed with cardiac-mimetic structural and mechanical features.

    Science.gov (United States)

    Neal, Rebekah A; Jean, Aurélie; Park, Hyoungshin; Wu, Patrick B; Hsiao, James; Engelmayr, George C; Langer, Robert; Freed, Lisa E

    2013-03-01

    Tissue-engineered constructs, at the interface of material science, biology, engineering, and medicine, have the capacity to improve outcomes for cardiac patients by providing living cells and degradable biomaterials that can regenerate the native myocardium. With an ultimate goal of both delivering cells and providing mechanical support to the healing heart, we designed three-dimensional (3D) elastomeric scaffolds with (1) stiffnesses and anisotropy mimicking explanted myocardial specimens as predicted by finite-element (FE) modeling, (2) systematically varied combinations of rectangular pore pattern, pore aspect ratio, and strut width, and (3) structural features approaching tissue scale. Based on predicted mechanical properties, three scaffold designs were selected from eight candidates for fabrication from poly(glycerol sebacate) by micromolding from silicon wafers. Large 20×20 mm scaffolds with high aspect ratio features (5:1 strut height:strut width) were reproducibly cast, cured, and demolded at a relatively high throughput. Empirically measured mechanical properties demonstrated that scaffolds were cardiac mimetic and validated FE model predictions. Two-layered scaffolds providing fully interconnected pore networks were fabricated by layer-by-layer assembly. C2C12 myoblasts cultured on one-layered scaffolds exhibited specific patterns of cell elongation and interconnectivity that appeared to be guided by the scaffold pore pattern. Neonatal rat heart cells cultured on two-layered scaffolds for 1 week were contractile, both spontaneously and in response to electrical stimulation, and expressed sarcomeric α-actinin, a cardiac biomarker. This work not only demonstrated several scaffold designs that promoted functional assembly of rat heart cells, but also provided the foundation for further computational and empirical investigations of 3D elastomeric scaffolds for cardiac tissue engineering.

  12. Leveraging Behavioral Economics to Improve Heart Failure Care and Outcomes.

    Science.gov (United States)

    Chang, Leslie L; DeVore, Adam D; Granger, Bradi B; Eapen, Zubin J; Ariely, Dan; Hernandez, Adrian F

    2017-08-22

    Behavioral challenges are often present in human illness, so behavioral economics is increasingly being applied in healthcare settings to better understand why patients choose healthy or unhealthy behaviors. The application of behavioral economics to healthcare settings parallels recent shifts in policy and reimbursement structures that hold providers accountable for outcomes that are dependent on patient behaviors. Numerous studies have examined the application of behavioral economics principles to policy making and health behaviors, but there are limited data on applying these concepts to the management of chronic conditions, such as heart failure (HF). Given its increasing prevalence and high associated cost of care, HF is a paradigm case for studying novel approaches to improve health care; therefore, if we can better understand why patients with HF make the choices they do, then we may be more poised to help them manage their medications, influence daily behaviors, and encourage healthy decision making. In this article, we will give a brief explanation of the core behavioral economics concepts that apply to patients with HF. We will also examine how to craft these concepts into tools such as financial incentives and social networks that may improve the management of patients with HF. We believe that behavioral economics can help us understand barriers to change, encourage positive behaviors, and offer additional approaches to improving the outcomes of patients with HF. © 2017 American Heart Association, Inc.

  13. Housing improvements for health and associated socio-economic outcomes.

    Science.gov (United States)

    Thomson, Hilary; Thomas, Sian; Sellstrom, Eva; Petticrew, Mark

    2013-02-28

    The well established links between poor housing and poor health indicate that housing improvement may be an important mechanism through which public investment can lead to health improvement. Intervention studies which have assessed the health impacts of housing improvements are an important data resource to test assumptions about the potential for health improvement. Evaluations may not detect long term health impacts due to limited follow-up periods. Impacts on socio-economic determinants of health may be a valuable proxy indication of the potential for longer term health impacts. To assess the health and social impacts on residents following improvements to the physical fabric of housing. Twenty seven academic and grey literature bibliographic databases were searched for housing intervention studies from 1887 to July 2012 (ASSIA; Avery Index; CAB Abstracts; The Campbell Library; CINAHL; The Cochrane Library; COPAC; DH-DATA: Health Admin; EMBASE; Geobase; Global Health; IBSS; ICONDA; MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; NTIS; PAIS; PLANEX; PsycINFO; RIBA; SCIE; Sociological Abstracts; Social Science Citations Index; Science Citations Index expanded; SIGLE; SPECTR). Twelve Scandinavian grey literature and policy databases (Libris; SveMed+; Libris uppsök; DIVA; Artikelsök; NORART; DEFF; AKF; DSI; SBI; Statens Institut for Folkesundhed; Social.dk) and 23 relevant websites were searched. In addition, a request to topic experts was issued for details of relevant studies. Searches were not restricted by language or publication status. Studies which assessed change in any health outcome following housing improvement were included. This included experimental studies and uncontrolled studies. Cross-sectional studies were excluded as correlations are not able to shed light on changes in outcomes. Studies reporting only socio-economic outcomes or indirect measures of health, such as health service use, were excluded. All housing improvements which

  14. DNA vaccine with discontinuous T-cell epitope insertions into HSP65 scaffold as a potential means to improve immunogenicity of multi-epitope Mycobacterium tuberculosis vaccine.

    Science.gov (United States)

    Wu, Manli; Li, Min; Yue, Yan; Xu, Wei

    2016-09-01

    DNA-based vaccine is a promising candidate for immunization and induction of a T-cell-focused protective immune response against infectious pathogens such as Mycobacterium tuberculosis (M. tb). To induce multi-functional T response against multi-TB antigens, a multi-epitope DNA vaccine and a 'protein backbone grafting' design method is adopted to graft five discontinuous T-cell epitopes into HSP65 scaffold protein of M. tb for enhancement of epitope processing and immune presentation. A DNA plasmid with five T-cell epitopes derived from ESAT-6, Ag85B, MTB10.4, PPE25 and PE19 proteins of H37Rv strain of M. tb genetically inserted into HSP65 backbone was constructed and designated as pPES. After confirmation of its in vitro expression efficiency, pPES DNA was i.m. injected into C57BL/6 mice with four doses of 50 µg DNA followed by mycobacterial challenge 4 weeks after the final immunization. It was found that pPES DNA injection maintained the ability of HSP65 backbone to induce specific serum IgG. ELISPOT assay demonstrated that pPES epitope-scaffold construct was significantly more potent to induce IFN-γ(+) T response to five T-cell epitope proteins than other DNA constructs (with epitopes alone or with epitope series connected to HSP65), especially in multi-functional-CD4(+) T response. It also enhanced granzyme B(+) CTL and IL-2(+) CD8(+) T response. Furthermore, significantly improved protection against Mycobacterium bovis BCG challenge was achieved by pPES injection compared to other DNA constructs. Taken together, HSP65 scaffold grafting strategy for multi-epitope DNA vaccine represents a successful example of rational protein backbone engineering design and could prove useful in TB vaccine design. © 2016 The Societies and John Wiley & Sons Australia, Ltd.

  15. Constructing scientific explanations through premise-reasoning-outcome (PRO): an exploratory study to scaffold students in structuring written explanations

    Science.gov (United States)

    Tang, Kok-Sing

    2016-06-01

    This paper reports on the design and enactment of an instructional strategy aimed to support students in constructing scientific explanations. Informed by the philosophy of science and linguistic studies of science, a new instructional framework called premise-reasoning-outcome (PRO) was conceptualized, developed, and tested over two years in four upper secondary (9th-10th grade) physics and chemistry classrooms. This strategy was conceptualized based on the understanding of the structure of a scientific explanation, which comprises three primary components: (a) premise - accepted knowledge that provides the basis of the explanation, (b) reasoning - logical sequences that follow from the premise, and (c) outcome - the phenomenon to be explained. A study was carried out to examine how the PRO strategy influenced students' written explanations using multiple data sources (e.g. students' writing, lesson observations, focus group discussions). Analysis of students' writing indicates that explanations with a PRO structure were graded better by the teachers. In addition, students reported that the PRO strategy provided a useful organizational structure for writing scientific explanations, although they had some difficulties in identifying and using the structure. With the PRO as a new instructional tool, comparison with other explanation frameworks as well as implications for educational research and practice are discussed.

  16. Comparison of early clinical outcomes between ABSORB bioresorbable vascular scaffold and everolimus-eluting stent implantation in a real-world population.

    Science.gov (United States)

    Costopoulos, Charis; Latib, Azeem; Naganuma, Toru; Miyazaki, Tadashi; Sato, Katsumasa; Figini, Filippo; Sticchi, Alessandro; Carlino, Mauro; Chieffo, Alaide; Montorfano, Matteo; Colombo, Antonio

    2015-01-01

    To compare the early clinical outcomes between ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, CA) and cobalt chromium everolimus-eluting stents in real-world patients with mostly complex disease. BVS represents the most interesting development in the drug-eluting stent field over recent years with promising results emerging from clinical trials. Available data however on the use of the ABSORB in real-world patients is limited. All patients (n = 92) treated with BVS and 1296 patients treated with EES were included in this study. Propensity score matching was performed to adjust for differences in baseline clinical characteristics, yielding 92 patient pairs (BVS = 92 patients with 137 lesions and EES = 92 patients with 124 lesions). Clinical outcomes were examined between the 2 groups at 6-months. In both groups, most lesions were classified as either B2 or C (83.9% vs. 77.4%, P = 0.19). Predilatation (97.8% vs. 75.8%, P < 0.01) as well as postdilation (99.3% vs. 77.4%, P < 0.01) was more common in the BVS group. Clinical outcomes at 6-months were similar between the two groups with respect to both target lesion revascularization (3.3% vs. 5.4%, P = 0.41) and major adverse cardiac events (defined as the composite of target vessel revascularization, follow-up myocardial infraction and all-cause death) (3.3% vs. 7.6%, P = 0.19). ABSORB BVS for the treatment of complex lesions appears to be associated with good procedural and early clinical outcomes similar to those observed with conventional drug-eluting stents. Larger studies with long-term follow-up are required in order to fully assess the role of BVS in the treatment of such lesions and how this compares with that of conventional stents. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

  17. Improving Outcomes for Older women with Gynaecological Malignancies

    Science.gov (United States)

    Dumas, Lucy; Ring, Alistair; Butler, John; Kalsi, Tania; Harari, Danielle; Banerjee, Susana

    2018-01-01

    The incidence of most gynaecological malignancies rises significantly with increasing age. With an ageing population, the proportion of women over the age of 65 with cancer is expected to rise substantially over the next decade. Unfortunately, survival outcomes are much poorer in older patients and evidence suggests that older women with gynaecological cancers are less likely to receive current standard of care treatment options. Despite this, older women are under-represented in practice changing clinical studies. The evidence for efficacy and tolerability is therefore extrapolated from a younger; often more fit population and applied to in every day clinical practice to older patients with co-morbidities. There has been significant progress in the development of geriatric assessment in oncology to predict treatment outcomes and tolerability however there is still no clear evidence that undertaking a geriatric assessment improves patient outcomes. Clinical trials focusing on treating older patients are urgently required. In this review, we discuss the evidence for treatment of gynaecological cancers as well as methods of assessing older patients for therapy. Potential biomarkers of ageing are also summarised. PMID:27664393

  18. Improved outcomes in pediatric liver transplantation for acute liver failure.

    Science.gov (United States)

    Miloh, Tamir; Kerkar, Nanda; Parkar, Sanobar; Emre, Sukru; Annunziato, Rachel; Mendez, Carlos; Arnon, Ronen; Suchy, Frederick; Rodriguez-Laiz, Gonzalo; Del Rio Martin, Juan; Sturdevant, Mark; Iyer, Kishore

    2010-11-01

    OLT is a life-saving option for ALF. To evaluate our outcomes in pediatric OLT for ALF. Retrospective review of our data between 1992 and 2007. Of 142 children with ALF, 126 were listed, of which 40 spontaneously improved, nine died, and 77 underwent OLT (median waiting time four days). Fifty-three children received deceased donor grafts (34 whole and 19 split grafts), and there were 24 living donor grafts. The one- and five-yr patient survival was 87% and 80%, and graft survival 83% and 79%, respectively. Thirteen patients died after OLT, and there were nine retransplants in seven patients. Patient weight, length of stay, creatinine, and infection were significantly associated with death; increased weight and black ethnicity were associated with graft loss on univariate analysis, but not on multivariate analysis. There were no significant differences in patient survival (one and five yr), graft loss, or other complications between the groups. We report the largest single-center study of OLT in pediatric ALF, demonstrating no difference in outcomes between different graft types. Our liberal use of segmental grafts may allow earlier OLT in this high-risk cohort and contribute to our excellent outcomes. © 2010 John Wiley & Sons A/S.

  19. Decellularized Human Dental Pulp as a Scaffold for Regenerative Endodontics.

    Science.gov (United States)

    Song, J S; Takimoto, K; Jeon, M; Vadakekalam, J; Ruparel, N B; Diogenes, A

    2017-06-01

    Teeth undergo postnatal organogenesis relatively late in life and only complete full maturation a few years after the crown first erupts in the oral cavity. At this stage, development can be arrested if the tooth organ is damaged by either trauma or caries. Regenerative endodontic procedures (REPs) are a treatment alternative to conventional root canal treatment for immature teeth. These procedures rely on the transfer of apically positioned stem cells, including stem cells of the apical papilla (SCAP), into the root canal system. Although clinical success has been reported for these procedures, the predictability of expected outcomes and the organization of the newly formed tissues are affected by the lack of an available suitable scaffold that mimics the complexity of the dental pulp extracellular matrix (ECM). In this study, we evaluated 3 methods of decellularization of human dental pulp to be used as a potential autograft scaffold. Tooth slices of human healthy extracted third molars were decellularized by 3 different methods. One of the methods generated the maximum observed decellularization with minimal impact on the ECM composition and organization. Furthermore, recellularization of the scaffold supported the proliferation of SCAP throughout the scaffold with differentiation into odontoblast-like cells near the dentinal walls. Thus, this study reports that human dental pulp from healthy extracted teeth can be successfully decellularized, and the resulting scaffold supports the proliferation and differentiation of SCAP. The future application of this form of an autograft in REPs can fulfill a yet unmet need for a suitable scaffold, potentially improving clinical outcomes and ultimately promoting the survival and function of teeth with otherwise poor prognosis.

  20. Interprofessional collaboration to improve professional practice and healthcare outcomes.

    Science.gov (United States)

    Reeves, Scott; Pelone, Ferruccio; Harrison, Reema; Goldman, Joanne; Zwarenstein, Merrick

    2017-06-22

    Poor interprofessional collaboration (IPC) can adversely affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes. To assess the impact of practice-based interventions designed to improve interprofessional collaboration (IPC) amongst health and social care professionals, compared to usual care or to an alternative intervention, on at least one of the following primary outcomes: patient health outcomes, clinical process or efficiency outcomes or secondary outcomes (collaborative behaviour). We searched CENTRAL (2015, issue 11), MEDLINE, CINAHL, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform to November 2015. We handsearched relevant interprofessional journals to November 2015, and reviewed the reference lists of the included studies. We included randomised trials of practice-based IPC interventions involving health and social care professionals compared to usual care or to an alternative intervention. Two review authors independently assessed the eligibility of each potentially relevant study. We extracted data from the included studies and assessed the risk of bias of each study. We were unable to perform a meta-analysis of study outcomes, given the small number of included studies and their heterogeneity in clinical settings, interventions and outcomes. Consequently, we summarised the study data and presented the results in a narrative format to report study methods, outcomes, impact and certainty of the evidence. We included nine studies in total (6540 participants); six cluster-randomised trials and three individual randomised trials (1 study randomised clinicians, 1 randomised patients, and 1 randomised clinicians and patients). All studies were conducted in high-income countries (Australia, Belgium, Sweden, UK and USA) across primary, secondary, tertiary and community care settings and had a follow-up of up to 12

  1. Infection-resistant MRI-visible scaffolds for tissue engineering applications

    Directory of Open Access Journals (Sweden)

    Morteza Mahmoudi

    2016-06-01

    Full Text Available Tissue engineering utilizes porous scaffolds as template to guide the new tissue growth. Clinical application of scaffolding biomaterials is hindered by implant-associated infection and impaired in vivo visibility of construct in biomedical imaging modalities. We recently demonstrated the use of a bioengineered type I collagen patch to repair damaged myocardium.By incorporating superparamagnetic iron oxide nanoparticles into this patch, here, we developed an MRI-visible scaffold. Moreover, the embedded nanoparticles impeded the growth of Salmonella bacteria in the patch. Conferring anti-infection and MRI-visible activities to the engineered scaffolds can improve their clinical outcomes and reduce the morbidity/mortality of biomaterial-based regenerative therapies.

  2. Have Outcomes of Incisional Hernia Repair Improved With Time?

    Science.gov (United States)

    Flum, David R.; Horvath, Karen; Koepsell, Thomas

    2003-01-01

    Objective To determine if certain outcomes of incisional hernia repair have improved in recent eras. Summary Background Data Technological developments have been reported to improve outcomes in the repair of abdominal wall incisional hernias. Methods This retrospective, population-based cohort study was conducted using a 1987 to 1999 Washington hospital discharge database. Subjects were all Washington state residents assigned ICD9 procedure codes for incisional hernia repair with or without synthetic material (mesh). Main outcome measure was the rate of reoperative incisional hernia repair, length of hospitalization, and hospital charges based on the use of synthetic material and the era of operative repair (before and after 1995). Results A total of 10,822 Washington state patients underwent incisional hernia repair (mean age 58.7 ± 15.6, 64% female). Of patients undergoing incisional hernia repair, 12.3% underwent at least one subsequent reoperative incisional hernia repair within the first 5 years after initial repair (23.1% at 13 years follow-up). The 5-year reoperative rate was 23.8% after the first reoperation, 35.3% after the second, and 38.7% after the third. The use of synthetic mesh in incisional hernia repairs increased from 34.2% in 1987 to 65.5% in 1999. When controlling for age, sex, comorbidity index of the patient, year of the initial procedure, and hospital descriptors (rural location, nonprofit and teaching status), the hazard for recurrence was 24.1% higher if no mesh was used compared to the hazard if mesh was used. After similar adjustment, no differences were found in the hazard of reoperation based on the era of the operative repair. Mean length of stay for procedures performed after 1995 was 4.9 days compared to 4.8 days in preceding eras. Conclusions Incisional hernia repair is associated with high cumulative rates of reoperative repairs. The expectation that important measures of adverse outcome have improved in recent eras is not

  3. Automated quantitative assessment of three-dimensional bioprinted hydrogel scaffolds using optical coherence tomography

    Science.gov (United States)

    Wang, Ling; Xu, Mingen; Zhang, LieLie; Zhou, QingQing; Luo, Li

    2016-01-01

    Reconstructing and quantitatively assessing the internal architecture of opaque three-dimensional (3D) bioprinted hydrogel scaffolds is difficult but vital to the improvement of 3D bioprinting techniques and to the fabrication of functional engineered tissues. In this study, swept-source optical coherence tomography was applied to acquire high-resolution images of hydrogel scaffolds. Novel 3D gelatin/alginate hydrogel scaffolds with six different representative architectures were fabricated using our 3D bioprinting system. Both the scaffold material networks and the interconnected flow channel networks were reconstructed through volume rendering and binarisation processing to provide a 3D volumetric view. An image analysis algorithm was developed based on the automatic selection of the spatially-isolated region-of–interest. Via this algorithm, the spatially-resolved morphological parameters including pore size, pore shape, strut size, surface area, porosity, and interconnectivity were quantified precisely. Fabrication defects and differences between the designed and as-produced scaffolds were clearly identified in both 2D and 3D; the locations and dimensions of each of the fabrication defects were also defined. It concludes that this method will be a key tool for non-destructive and quantitative characterization, design optimisation and fabrication refinement of 3D bioprinted hydrogel scaffolds. Furthermore, this method enables investigation into the quantitative relationship between scaffold structure and biological outcome. PMID:27231597

  4. Improving outcome of trauma patients by implementing patient blood management.

    Science.gov (United States)

    Füllenbach, Christoph; Zacharowski, Kai; Meybohm, Patrick

    2017-04-01

    Patient blood management aims to improve patient outcome and safety by reducing the number of unnecessary red blood cell transfusions and vitalizing patient-specific anemia reserves. While this is increasingly recognized as best clinical practice in elective surgery, the implementation in the setting of trauma is restrained because of typically nonelective (emergency) surgery and, in specific circumstances, allogeneic blood transfusions as life-saving therapy. Viscoelastic diagnostics allow a precise identification of trauma-induced coagulopathy. A coagulation factor concentrate-based therapy is increasingly recognized as a fast and effective concept to correct coagulopathy and minimize blood loss. Using smaller tubes has a great potential to reduce the severity of phlebotomy-induced anemia. Washed cell salvage may reduce the number of allogeneic blood transfusions. Intravenous iron (with or without erythropoietin) may result in an increase of hemoglobin levels and reduced red blood cell transfusion requirements. Although a restrictive transfusion strategy is recommended in general, a target hemoglobin level of 7-9 g/dl is recommended in acute bleeding patients. In the setting of trauma, options to avoid unnecessary blood loss and reduce blood transfusion are manifold. These are likely to improve safety and outcome of trauma patients while potentially reducing therapeutic costs.

  5. Mini incision open pyeloplasty - Improvement in patient outcome

    Directory of Open Access Journals (Sweden)

    Vishwajeet Singh

    2015-10-01

    Full Text Available ABSTRACT Purpose: To assess the subjective and objective outcomes of mini-incision dismembered Anderson-Hynes pyeloplasty in the treatment of primary ureteropelvic junction obstruction (UPJO. Materials and Methods: Between January 2008 to January 2013, Anderson-Hynes pyeloplasty was performed in 71 patients diagnosed with primary UPJO. Small subcostal muscle splitting incision was used in all cases. Sixteen patients with renal calculi underwent concomitant pyelolithotomy. Subjective outcome was assessed using visual pain analogue score (VAS. For objective assessment, the improvement in differential renal function (DRF and radio-tracer wash out time (T1/2 on Tc-99m DTPA scan and decrease in hydronephrosis (HDN on renal ultrasound (USG and urography (IVU were assessed. Results: Mean incision length was 5.2 cm. The average operating time and postoperative hospital stay was 63 (52-124 minutes and 2.5 (2–6 days respectively. Concomitant renal calculi were successfully removed in all the patients. Overall complication rates were 8.4% and overall success rate was 98.6% at median follow-up of 16 months. There was significant improvement in pain score (p=0.0001 and significant decrease in HDN after the procedure. While preoperative mean T1/2 was 26.7±6.4 minutes, postoperative half-time decreased to 7.8±4.2 minutes at 6 months and to 6.7±3.3 minutes at 1 year. Mean pre-operative DRF was 26.45% and it was 31.38% and 33.19% at 6 months and 1 year respectively. Conclusions: Mini-incision pyeloplasty is a safe and effective technique with combined advantage of high success rates of standard open pyeloplasty with decreased morbidity of laparoscopic approach. Excellent functional and objective outcomes can be achieved without extra technical difficulty.

  6. Mebiolgel, a thermoreversible polymer as a scaffold for three dimensional culture of Huh7 cell line with improved hepatocyte differentiation marker expression and HCV replication.

    Science.gov (United States)

    Rajalakshmy, A R; Malathi, J; Madhavan, H N; Samuel, J K A

    2015-01-01

    A novel three dimensional (3D) culture system purely synthesised from co-polymer which is free from biological contamination for Huh7 cell cultivation and hepatitis C virus (HCV) replication has been attempted. Mebiolgel, a thermo-reversible gelation polymer was used as a 3D scaffold for culturing Huh7, a liver carcinoma cell line used in our study. The 3D culture of the cells were infected with cell culture derived HCV. The scaffold supported the cell growth as 3D spheroids for up to 63 days. Moreover mebiolgel was found to be improving the hepatocyte differentiation of Huh7 cells at the transcript level. Three dimensional culture was susceptible for HCV infection, and this was confirmed by detecting the HCV replication intermediate viral core antigen. Mebiolgel based culture system was proven to be suited for 3D culture of Huh7 cells by improvising liver specific genotypic expression and was susceptible for HCV replication. Since mebiolgel based Huh 7 express better hepatocyte differentiation markers genotypically, this can be implemented as an alternate for primary hepatocytes in studies such as viral isolation from patient serum.

  7. Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

    Science.gov (United States)

    Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

    2015-01-01

    While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. PMID:26178332

  8. Improvement in Outcomes of Major Obstetric Hemorrhage Through Systematic Change.

    Science.gov (United States)

    Skupski, Daniel W; Brady, David; Lowenwirt, Isaac P; Sample, Jason; Lin, Stephanie N; Lohana, Rahul; Eglinton, Gary S

    2017-10-01

    To report the outcomes over 14 years of sustained systematic institutional focus on the care of women with major obstetric hemorrhage, defined as estimated blood loss greater than 1,500 mL. A retrospective cohort study of women with major obstetric hemorrhage at our hospital from 2000 to 2014 compares baseline conditions (age, multiparity, prior cesarean delivery, morbidly adherent placenta), morbidity (lowest mean temperature, lowest mean pH, coagulopathy, hysterectomy), and mortality among three time periods (period 1=January 2000 to December 2001, period 2=January 2002 to August 2005, period 3=September 2005 to December 2014). We also describe the systematic changes that helped to sustain our improved outcomes. During the three time periods, there were 5,811, 12,912, and 38,971 births; the rate of major obstetric hemorrhage increased over these periods: 2.1, 3.8 and 5.3 cases per 1,000 births, respectively. Two deaths from hemorrhage occurred in period 1 and none thereafter. Among women who experienced massive hemorrhage, morbidity significantly improved in each successive period: median lowest pH increased from 7.23 to 7.34 to 7.35 (periods 2 and 3 significantly higher than period 1), median lowest maternal temperature (°C) improved, 35.2 to 36.1 to 36.4 (all difference significant), and the rate of coagulopathy decreased, 58.3% to 28.6% to 13.2% (period 3 significantly lower than periods 1 and 2) (all P values obstetric rapid response team, instituted a massive transfusion protocol and use of uterine balloon tamponade, and promoted a culture of safety in two ways-through more intensive education regarding hemorrhage and escalation (encouraging all staff to contact senior leaders). A sustained level of patient safety is achievable when treating major obstetric hemorrhage, as shown by a progressive decrease in morbidity despite increasing rates of hemorrhage.

  9. Can preschool improve child health outcomes? A systematic review.

    Science.gov (United States)

    D'Onise, Katina; Lynch, John W; Sawyer, Michael G; McDermott, Robyn A

    2010-05-01

    Early childhood development interventions (ECDIs) have the potential to bring about wide ranging human capital benefits for children through to adulthood. Less is known, however, about the potential for such interventions to improve population health. The aim of this study was to examine the evidence for child health effects of centre-based preschool intervention programs for healthy 4 year olds, beyond the preschool years. Medline, Embase, ERIC, Psych Info, Sociological Abstracts, the Cochrane Library, C2-SPECTR and the Head Start database were searched using terms relating to preschool and health from 1980 to July 2008, limited to English language publications. Reference lists and the journal Child Development were hand searched for eligible articles missed by the electronic search. There were 37 eligible studies identified. The reviewed studies examined a range of interventions from centre-based preschool alone, to interventions also including parenting programs and/or health services. The study populations were mostly sampled from populations at risk of school failure (76%). Only eight of the 37 studies had a strong methodological rating, 15 were evaluated as at moderate potential risk of bias and 14 as at high potential risk of bias. The review found generally null effects of preschool interventions across a range of health outcomes, however there was some evidence for obesity reduction, greater social competence, improved mental health and crime prevention. We conclude that the great potential for early childhood interventions to improve population health across a range of health outcomes, as anticipated by policy makers worldwide, currently rests on a rather flimsy evidence base. Given the potential and the increasingly large public investment in these interventions, it is imperative that population health researchers, practitioners and policy makers worldwide collaborate to advance this research agenda. Copyright 2010 Elsevier Ltd. All rights reserved.

  10. External inspection of compliance with standards for improved healthcare outcomes.

    Science.gov (United States)

    Flodgren, Gerd; Gonçalves-Bradley, Daniela C; Pomey, Marie-Pascale

    2016-12-02

    Inspection systems are used in healthcare to promote quality improvements (i.e. to achieve changes in organisational structures or processes, healthcare provider behaviour and patient outcomes). These systems are based on the assumption that externally promoted adherence to evidence-based standards (through inspection/assessment) will result in higher quality of healthcare. However, the benefits of external inspection in terms of organisational-, provider- and patient-level outcomes are not clear. This is the first update of the original Cochrane review, published in 2011. To evaluate the effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour and patient outcomes. We searched the following electronic databases for studies up to 1 June 2015: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Database of Abstracts of Reviews of Effectiveness, HMIC, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. There was no language restriction and we included studies regardless of publication status. We also searched the reference lists of included studies and contacted authors of relevant papers, accreditation bodies and the International Organization for Standardization (ISO), regarding any further published or unpublished work. We also searched an online database of systematic reviews (PDQ-evidence.org). We included randomised controlled trials (RCTs), non-randomised trials (NRCTs), interrupted time series (ITSs) and controlled before-after studies (CBAs) evaluating the effect of external inspection against external standards on healthcare organisation change, healthcare professional behaviour or patient outcomes in hospitals, primary healthcare organisations and other community-based healthcare organisations. Two review authors independently applied eligibility criteria, extracted data and assessed the

  11. The readability of psychosocial wellness patient resources: improving surgical outcomes.

    Science.gov (United States)

    Kugar, Meredith A; Cohen, Adam C; Wooden, William; Tholpady, Sunil S; Chu, Michael W

    2017-10-01

    Patient education is increasingly accessed with online resources and is essential for patient satisfaction and clinical outcomes. The average American adult reads at a seventh grade level, and the National Institute of Health (NIH) and the American Medical Association (AMA) recommend that information be written at a sixth-grade reading level. Health literacy plays an important role in the disease course and outcomes of all patients, including those with depression and likely other psychiatric disorders, although this is an area in need of further study. The purpose of this study was to collect and analyze written, online mental health resources on the Veterans Health Administration (VA) website, and other websites, using readability assessment instruments. An internet search was performed to identify written patient education information regarding mental health from the VA (the VA Mental Health Website) and top-rated psychiatric hospitals. Seven mental health topics were included in the analysis: generalized anxiety disorder, bipolar, major depressive disorder, posttraumatic stress disorder, schizophrenia, substance abuse, and suicide. Readability analyses were performed using the Gunning Fog Index, the Flesch-Kincaid Grade Level, the Coleman-Liau Index, the SMOG Readability Formula, and the Automated Readability Index. These scores were then combined into a Readability Consensus score. A two-tailed t-test was used to compare the mean values, and statistical significance was set at P health topics analyzed. The VA mental health website (http://www.mentalhealth.va.gov) had a significantly higher readability consensus than six of the top psychiatric hospitals (P health information on all websites analyzed was 9.52. Online resources for mental health disorders are more complex than recommended by the NIH and AMA. Efforts to improve readability of mental health and psychosocial wellness resources could benefit patient understanding and outcomes, especially in

  12. Valuing preferences over stormwater management outcomes including improved hydrologic function

    Science.gov (United States)

    LondoñO Cadavid, Catalina; Ando, Amy W.

    2013-07-01

    Stormwater runoff causes environmental problems such as flooding, soil erosion, and water pollution. Conventional stormwater management has focused primarily on flood reduction, while a new generation of decentralized stormwater solutions yields ancillary benefits such as healthier aquatic habitat, improved surface water quality, and increased water table recharge. Previous research has estimated values for flood reduction from stormwater management, but no estimates exist for the willingness to pay (WTP) for some of the other environmental benefits of alternative approaches to stormwater control. This paper uses a choice experiment survey of households in Champaign-Urbana, Illinois, to estimate the values of several attributes of stormwater management outcomes. We analyzed data from 131 surveyed households in randomly selected neighborhoods. We find that people value reduced basement flooding more than reductions in yard or street flooding, but WTP for basement flood reduction in the area only exists if individuals are currently experiencing significant flooding themselves. Citizens value both improved water quality and improved hydrologic function and aquatic habitat from runoff reduction. Thus, widespread investment in low impact development stormwater solutions could have very large total benefits, and stormwater managers should be wary of policies and infrastructure plans that reduce flooding at the expense of water quality and aquatic habitat.

  13. Improved facial outcome assessment using a 3D anthropometric mask.

    Science.gov (United States)

    Claes, P; Walters, M; Clement, J

    2012-03-01

    The capacity to process three-dimensional facial surfaces to objectively assess outcomes of craniomaxillofacial care is urgently required. Available surface registration techniques depart from conventional facial anthropometrics by not including anatomical relationship in their analysis. Current registrations rely on the manual selection of areas or points that have not moved during surgery, introducing subjectivity. An improved technique is proposed based on the concept of an anthropometric mask (AM) combined with robust superimposition. The AM is the equivalent to landmark definitions, as used in traditional anthropometrics, but described in a spatially dense way using (∼10.000) quasi-landmarks. A robust superimposition is performed to align surface images facilitating accurate measurement of spatial differences between corresponding quasi-landmarks. The assessment describes magnitude and direction of change objectively and can be displayed graphically. The technique was applied to three patients, without any modification and prior knowledge: a 4-year-old boy with Treacher-Collins syndrome in a resting and smiling pose; surgical correction for hemimandibular hypoplasia; and mandibular hypoplasia with staged orthognathic procedures. Comparisons were made with a reported closest-point (CP) strategy. Contrasting outcomes were found where the CP strategy resulted in anatomical implausibility whilst the AM technique was parsimonious to expected differences. Copyright © 2011 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  14. Does post-cardiac surgery magnesium supplementation improve outcome?

    Science.gov (United States)

    Carrió, Maria L; Ventura, Josep L; Javierre, Casimiro; Rodríguez-Castro, David; Farrero, Elisabet; Torrado, Herminia; Badia, Maria B; Granados, Jorge

    2012-12-01

    Hypomagnesemia has been linked with increased morbidity and mortality in critically ill patients. Since the condition is common after cardiopulmonary bypass surgery, the objective of this study was to determine whether magnesium supplementation in the immediate postoperative period may improve outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. This prospective, randomized, double-blind, placebo-controlled study was conducted in a third-level, cardiac surgery intensive care unit (ICU) at a university hospital. Two hundred and sixteen patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomized to receive either an intravenous bolus of 1.5 g of magnesium sulphate followed by an infusion of 12 g of the same salt in 24 h (105 patients), or placebo (111 patients) administered according to the same schedule as the treatment group. No significant differences were found either in the primary end point (hours of intubation) or in the secondary end points (length of inotropic support, new atrial fibrillation, ventricular tachycardia or ventricular fibrillation, length of intensive care unit stay, or ICU or hospital mortality). Hypomagnesemia was present in 12% of patients on admission to the intensive care unit. The magnesium group had a greater need for pacemaker stimulation. In conclusion, under the conditions of the present study, magnesium supplementation after cardiac surgery with cardiopulmonary bypass does not favourably affect clinical outcomes.

  15. Adaptive Programming Improves Outcomes in Drug Court: An Experimental Trial.

    Science.gov (United States)

    Marlowe, Douglas B; Festinger, David S; Dugosh, Karen L; Benasutti, Kathleen M; Fox, Gloria; Croft, Jason R

    2012-04-01

    Prior studies in Drug Courts reported improved outcomes when participants were matched to schedules of judicial status hearings based on their criminological risk level. The current experiment determined whether incremental efficacy could be gained by periodically adjusting the schedule of status hearings and clinical case-management sessions in response to participants' ensuing performance in the program. The adjustments were made pursuant to a priori criteria specified in an adaptive algorithm. Results confirmed that participants in the full adaptive condition (n = 62) were more than twice as likely as those assigned to baseline-matching only (n = 63) to be drug-abstinent during the first 18 weeks of the program; however, graduation rates and the average time to case resolution were not significantly different. The positive effects of the adaptive program appear to have stemmed from holding noncompliant participants more accountable for meeting their attendance obligations in the program. Directions for future research and practice implications are discussed.

  16. How to improve outcome in surgery for Proximal Hypospadias?

    Science.gov (United States)

    Qureshi, Abdul Hafeez; Zaidi, Syed Zafar

    2016-02-01

    To evaluate the role of subdartos fascial tissue as watertight layer in improving outcome for 2-stage proximal hypospadias surgery. The experimental study was conducted at the Department of Urology, Indus Hospital, Karachi, and comprised an audit of patients with proximal hypospadias who underwent surgery from July 1, 2007, to December 31, 2011. The initial two-stage repair of proximal hypospadias led to a high rate of urethrocutanous fistula formation (Group A), and, thus, a modification was introduced and subdartos facial double layer was applied over the urethral suture line (Group B). The results were compared regarding age, type of hypospadias, graft failure and urethrocutanous fistula in these patients. There were 27 patients in Group A and 16(59.3%) of them ended up having urethrocutanous fistula. Group B had 25 patients and only 2(8%) had fistula formation. The application of dartos facial flap waterproofing layer reduced fistula rate.

  17. Physiotherapy in cystic fibrosis: optimising techniques to improve outcomes.

    Science.gov (United States)

    Rand, S; Hill, L; Prasad, S A

    2013-12-01

    Optimisation of physiotherapy techniques to improve outcomes is an area of cystic fibrosis (CF) care, which has developed considerably over the last two decades. With the introduction of newborn screening and an increase in median life expectancy, the management of individuals with CF has needed to adapt to a more dynamic and individualised approach. It is essential that CF physiotherapy management reflects the needs of a changing cohort of paediatric CF patients and it is no longer justifiable to adopt a 'blanket' prescriptive approach to care. The areas of physiotherapy management which are reviewed and discussed in this paper include inhalation therapy, airway clearance techniques, the management of newborn screened infants, physical activity and exercise. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Equity and improvement in outcome of breast cancer in Denmark

    DEFF Research Database (Denmark)

    Andreasen, A H; Mouridsen, H T; Andersen, K W

    1994-01-01

    in other parts of Denmark. For patients diagnosed in 1978-87 the prognosis, however, reached an equal level in all parts of the country. Thus, it is reasonable to assume that the national programme introduced in 1977 by the Danish Breast Cancer Cooperative Group (DBCG) has played an important role......The trend in the prognosis for female breast cancer patients was investigated by comparing Kaplan-Meier survival curves of different patient cohorts diagnosed during the period 1948-87. The study is based on 71,448 patients from the Danish Cancer Registry. The cohorts were defined by age...... and not only brought about therapeutic improvements in breast cancer treatment in Denmark, but also ensured equity in the outcome on a national scale....

  19. Does administering albumin to postoperative gastroschisis patients improve outcome?

    Directory of Open Access Journals (Sweden)

    Ana Cristina A. Tannuri

    Full Text Available OBJECTIVES: Newborns who undergo surgery for gastroschisis correction may present with oliguria, anasarca, prolonged postoperative ileus, and infection. New postoperative therapeutic procedures were tested with the objective of improving postoperative outcome. PATIENTS AND METHODS: One hundred thirty-six newborns participated in one of two phases. Newborns in the first phase received infusions of large volumes of crystalloid solution and integral enteral formula, and newborns in the second phase received crystalloid solutions in smaller volumes, with albumin solution infusion when necessary and the late introduction of a semi-elemental diet. The studied variables were serum sodium and albumin levels, the need for albumin solution expansion, the occurrence of anasarca, the length of time on parenteral nutrition, the length of time before initiating an enteral diet and reaching a full enteral diet, orotracheal intubation time, length of hospitalization, and survival rates. RESULTS: Serum sodium levels were higher in newborns in the second phase. There was a correlation between low serum sodium levels and orotracheal intubation time; additionally, low serum albumin levels correlated with the length of time before the initiation of an oral diet and the time until a full enteral diet was reached. However, the discharge weights of newborns in the second phase were higher than in the first phase. The other studied variables, including survival rates (83.4% and 92.0%, respectively, were similar for both phases. CONCLUSIONS: The administration of an albumin solution to newborns in the early postoperative period following gastroschisis repair increased their low serum sodium levels but did not improve the final outcome. The introduction of a semi-elemental diet promoted an increase in body weight at the time of discharge.

  20. Crystalline orientation control using self-assembled TiO2 nanosheet scaffold to improve CH3NH3PbI3 perovskite solar cells

    Science.gov (United States)

    Maitani, Masato M.; Satou, Hirokazu; Ohmura, Aoi; Tsubaki, Shuntaro; Wada, Yuji

    2017-08-01

    In perovskite solar cells with an organic inorganic hybrid metal halide perovskite crystalline semiconductor as the active layer, the properties of the n-type semiconductor scaffold, the materials used, and the morphology, wettability, and surface reactivity of the cells are important decisive factors affecting the overall device efficiency of the perovskite solar cells. We control the orientation of anatase titania nanosheets by a self-assembly technique to create the ordered mesoporous scaffolds with ordered voids. Differences between nanosheet orientations in each mesoporous scaffold indicate differences in the photoelectric properties of CH3NH3PbI3 perovskite crystals embedded in each scaffold. Although each scaffold consists of the same anatase TiO2 nanosheets, the properties of the solar cells are affected by the oxide scaffold nanomorphology, which determines the growth orientation of CH3NH3PbI3 perovskite crystals that affects the solar cell properties.

  1. Improved prediction of breast cancer outcome by identifying heterogeneous biomarkers.

    Science.gov (United States)

    Choi, Jonghwan; Park, Sanghyun; Yoon, Youngmi; Ahn, Jaegyoon

    2017-11-15

    Identification of genes that can be used to predict prognosis in patients with cancer is important in that it can lead to improved therapy, and can also promote our understanding of tumor progression on the molecular level. One of the common but fundamental problems that render identification of prognostic genes and prediction of cancer outcomes difficult is the heterogeneity of patient samples. To reduce the effect of sample heterogeneity, we clustered data samples using K-means algorithm and applied modified PageRank to functional interaction (FI) networks weighted using gene expression values of samples in each cluster. Hub genes among resulting prioritized genes were selected as biomarkers to predict the prognosis of samples. This process outperformed traditional feature selection methods as well as several network-based prognostic gene selection methods when applied to Random Forest. We were able to find many cluster-specific prognostic genes for each dataset. Functional study showed that distinct biological processes were enriched in each cluster, which seems to reflect different aspect of tumor progression or oncogenesis among distinct patient groups. Taken together, these results provide support for the hypothesis that our approach can effectively identify heterogeneous prognostic genes, and these are complementary to each other, improving prediction accuracy. https://github.com/mathcom/CPR. jgahn@inu.ac.kr. Supplementary data are available at Bioinformatics online.

  2. The hidden third: improving outcome in treatment-resistant depression.

    Science.gov (United States)

    Schlaepfer, Thomas E; Agren, Hans; Monteleone, Palmiero; Gasto, Cristobal; Pitchot, William; Rouillon, Frederick; Nutt, David J; Kasper, Siegfried

    2012-05-01

    Treatment-resistant depression (TRD) presents many challenges for both patients and physicians. This review aims to evaluate the current status of the field of TRD and reflects the main findings of a consensus meeting held in September 2009. Literature searches were also conducted using PubMed and EMBASE. Abstracts of the retrieved articles were reviewed independently by the authors for inclusion. Evaluation of the clinical evidence in TRD is complicated by the absence of a validated definition, and there is a need to move away from traditional definitions of remission based on severity of symptoms to one that includes normalisation of functioning. One potential way of improving treatment of TRD is through the use of predictive biomarkers and clinical variables. The advent of new treatments may also help by focusing on neurotransmitters other than serotonin. Strategies such as the switching of antidepressants, use of combination therapy with lithium, atypical antipsychotics and other pharmacological agents can improve outcomes, and techniques such as deep brain stimulation and vagus nerve stimulation have shown promising early results. Despite consistent advances in the pharmacotherapy of mood disorders in the last decade, high rates of TRD are still a challenging aspect of overall management.

  3. Social protection: potential for improving HIV outcomes among adolescents

    Directory of Open Access Journals (Sweden)

    Lucie D Cluver

    2015-12-01

    Full Text Available Introduction: Advances in biomedical technologies provide potential for adolescent HIV prevention and HIV-positive survival. The UNAIDS 90–90–90 treatment targets provide a new roadmap for ending the HIV epidemic, principally through antiretroviral treatment, HIV testing and viral suppression among people with HIV. However, while imperative, HIV treatment and testing will not be sufficient to address the epidemic among adolescents in Southern and Eastern Africa. In particular, use of condoms and adherence to antiretroviral therapy (ART remain haphazard, with evidence that social and structural deprivation is negatively impacting adolescents’ capacity to protect themselves and others. This paper examines the evidence for and potential of interventions addressing these structural deprivations. Discussion: New evidence is emerging around social protection interventions, including cash transfers, parenting support and educational support (“cash, care and classroom”. These interventions have the potential to reduce the social and economic drivers of HIV risk, improve utilization of prevention technologies and improve adherence to ART for adolescent populations in the hyper-endemic settings of Southern and Eastern Africa. Studies show that the integration of social and economic interventions has high acceptability and reach and that it holds powerful potential for improved HIV, health and development outcomes. Conclusions: Social protection is a largely untapped means of reducing HIV-risk behaviours and increasing uptake of and adherence to biomedical prevention and treatment technologies. There is now sufficient evidence to include social protection programming as a key strategy not only to mitigate the negative impacts of the HIV epidemic among families, but also to contribute to HIV prevention among adolescents and potentially to remove social and economic barriers to accessing treatment. We urge a further research and programming agenda

  4. Improvement of antibacterial activity of some sulfa drugs through linkage to certain phthalazin-1(2H)-one scaffolds.

    Science.gov (United States)

    Ibrahim, Hany S; Eldehna, Wagdy M; Abdel-Aziz, Hatem A; Elaasser, Mahmoud M; Abdel-Aziz, Marwa M

    2014-10-06

    RAB1 5 is a lead antibacterial agent in which trimethoprim is linked to phthalazine moiety. Similarly, our strategy in this research depends on the interconnection between some sulfa drugs and certain phthalazin-1(2H)-one scaffolds in an attempt to enhance their antibacterial activity. This approach was achieved through the combination of 4-substituted phthalazin-1(2H)-ones 9a, b or 14a, b with sulfanilamide 1a, sulfathiazole 1b or sulfadiazine 1c through amide linkers 6a, b to produce the target compounds 10a-d and 15a-e, respectively. The antibacterial activity of the newly synthesized compounds showed that all tested compounds have antibacterial activity higher than that of their reference sulfa drugs 1a-c. Compound 10c represented the highest antibacterial activity against Gram-positive bacteria Streptococcus pneumonia and Staphylococcus aureus with MIC = 0.39 μmol/mL. Moreover, compound 10d displayed excellent antibacterial activity against Gram-negative bacteria Escherichia coli and Salmonella typhimurium with MIC = 0.39 and 0.78 μmol/mL, respectively. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. Which postoperative complications matter most after bariatric surgery? Prioritizing quality improvement efforts to improve national outcomes.

    Science.gov (United States)

    Daigle, Christopher R; Brethauer, Stacy A; Tu, Chao; Petrick, Anthony T; Morton, John M; Schauer, Philip R; Aminian, Ali

    2018-01-12

    National quality programs have been implemented to decrease the burden of adverse events on key outcomes in bariatric surgery. However, it is not well understood which complications have the most impact on patient health. To quantify the impact of specific bariatric surgery complications on key clinical outcomes. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Data from patients who underwent primary bariatric procedures were retrieved from the MBSAQIP 2015 participant use file. The impact of 8 specific complications (bleeding, venous thromboembolism [VTE], leak, wound infection, pneumonia, urinary tract infection, myocardial infarction, and stroke) on 5 main 30-day outcomes (end-organ dysfunction, reoperation, intensive care unit admission, readmission, and mortality) was estimated using risk-adjusted population attributable fractions. The population attributable fraction is a calculated measure taking into account the prevalence and severity of each complication. The population attributable fractions represents the percentage reduction in a given outcome that would occur if that complication were eliminated. In total, 135,413 patients undergoing sleeve gastrectomy (67%), Roux-en-Y gastric bypass (29%), adjustable gastric banding (3%), and duodenal switch (1%) were included. The most common complications were bleeding (.7%), wound infection (.5%), urinary tract infection (.3%), VTE (.3%), and leak (.2%). Bleeding and leak were the largest contributors to 3 of 5 examined outcomes. VTE had the greatest effect on readmission and mortality. This study quantifies the impact of specific complications on key surgical outcomes after bariatric surgery. Bleeding and leak were the complications with the largest overall effect on end-organ dysfunction, reoperation, and intensive care unit admission after bariatric surgery. Furthermore, our findings suggest that an initiative targeting reduction of post-bariatric surgery

  6. Strontium-containing mesoporous bioactive glass scaffolds with improved osteogenic/cementogenic differentiation of periodontal ligament cells for periodontal tissue engineering.

    Science.gov (United States)

    Wu, Chengtie; Zhou, Yinghong; Lin, Chucheng; Chang, Jiang; Xiao, Yin

    2012-10-01

    To achieve the ultimate goal of periodontal tissue engineering, it is of great importance to develop bioactive scaffolds which can stimulate the osteogenic/cementogenic differentiation of periodontal ligament cells (PDLCs) for the favorable regeneration of alveolar bone, root cementum and periodontal ligament. Strontium (Sr) and Sr-containing biomaterials have been found to induce osteoblast activity. However, there has been no systematic report about the interaction between Sr or Sr-containing biomaterials and PDLCs for periodontal tissue engineering. The aims of this study were to prepare Sr-containing mesoporous bioactive glass (Sr-MBG) scaffolds and investigate whether the addition of Sr could stimulate osteogenic/cementogenic differentiation of PDLCs in a tissue-engineering scaffold system. The composition, microstructure and mesopore properties (specific surface area, nanopore volume and nanopore distribution) of Sr-MBG scaffolds were characterized. The proliferation, alkaline phosphatase (ALP) activity and osteogenesis/cementogenesis-related gene expression (ALP, Runx2, Col I, OPN and CEMP1) of PDLCs on different kinds of Sr-MBG scaffolds were systematically investigated. The results show that Sr plays an important role in influencing the mesoporous structure of MBG scaffolds in which high contents of Sr decreased the well-ordered mesopores as well as their surface area/pore volume. Sr(2+) ions could be released from Sr-MBG scaffolds in a controlled way. The incorporation of Sr into MBG scaffolds has significantly stimulated ALP activity and osteogenesis/cementogenesis-related gene expression of PDLCs. Furthermore, Sr-MBG scaffolds in a simulated body fluid environment still maintained excellent apatite-mineralization ability. The study suggests that the incorporation of Sr into MBG scaffolds is a viable way to stimulate the biological response of PDLCs. Sr-MBG scaffolds are a promising bioactive material for periodontal tissue-engineering applications

  7. Better IVF outcomes following improvements in laboratory air quality.

    Science.gov (United States)

    Khoudja, Rabea Youcef; Xu, Yanwen; Li, Tao; Zhou, Canquan

    2013-01-01

    It has been proved that air quality is crucial for the success of IVF because of the presence of volatile organic compounds (VOCs), microbes, and perfumes, all of which can be harmful to embryo development in vitro. Therefore IVF laboratories are equipped with high efficiency particulate air (HEPA), and activated carbon filters plus positive pressure for air particulate control, with or without CODA system. Here we introduce a new technology using specially treated Honeycomb matrix media aligned in the Landson ™ series system for our laboratory air purification and its impact on IVF outcome. Air samples were collected outside and inside the laboratory, and intra-incubator at three different time points, before and after changing carbon filters and after Landson system installation, and we correlated air compounds measure variation with IVF outcome from 1403 cycles. An improvement of air quality was confirmed with passages of total VOCs from 0.42 mg/m(3), 30.48 mg/m(3), 9.62 mg/m3, to 0.1 mg/m(3), 2.5 mg/m(3), 2.19 mg/m(3) through 0.07 mg/m(3), 0.16 mg/m(3), 0.29 mg/m(3), outside the laboratory, inside laboratory and intra-incubator respectively at three separated air sampling times. A clear decrease was observed in some VOCs such as formaldehyde, ethylene, acethylene, propylene, SO2, pentane, NOx, benzene, Hallon-1211, CFC and alcohol. At the same time a significant difference (Psystem installation and the first testing time TT1 before carbon filter change in fertilization rate 83.7 % vs 70.1 %, embryo cleavage rate 97.35 % vs 90.8 %, day 5 blastocyst formation rate 51.1 % vs 41.7 %, and pregnancy/implantation rates 54.6 %, 34.4 % vs 40.6 %, 26.4 %. Air purification by the new technology of Landson ™ series significantly improved IVF laboratory air quality, and embryo quality, thus increased pregnancy and implantation rates.

  8. A switchable positive and negative air pressure device for efficient and gentle handling of nanofiber scaffolds

    Science.gov (United States)

    Hotaling, Nathan A.; Khristov, Vladimir; Maminishkis, Arvydas; Bharti, Kapil; Simon, Carl G.

    2017-10-01

    A scaffold handling device (SHD) has been designed that can switch from gentle suction to positive pressure to lift and place nanofiber scaffolds. In tissue engineering laboratories, delicate fibrous scaffolds, such as electrospun nanofiber scaffolds, are often used as substrates for cell culture. Typical scaffold handling procedures include lifting the scaffolds, moving them from one container to another, sterilization, and loading scaffolds into cell culture plates. Using tweezers to handle the scaffolds can be slow, can damage the scaffolds, and can cause them to wrinkle or fold. Scaffolds may also acquire a static charge which makes them difficult to put down as they cling to tweezers. An SHD has been designed that enables more efficient, gentle lifting, and placement of delicate scaffolds. Most of the parts to make the SHD can be purchased, except for the tip which can be 3D-printed. The SHD enables more reliable handling of nanofiber scaffolds that may improve the consistency of biomanufacturing processes.

  9. Partnering with diabetes educators to improve patient outcomes

    Directory of Open Access Journals (Sweden)

    Burke SD

    2014-02-01

    Full Text Available Sandra D Burke,1,2 Dawn Sherr,3 Ruth D Lipman3 1American Association of Diabetes Educators, Chicago, IL, USA; 2University of Illinois at Chicago College of Nursing, Urbana, IL, USA; 3Science and Practice, American Association of Diabetes Educators, Chicago, IL, USA Abstract: Diabetes is a chronic, progressive disease that affects millions worldwide. The paradigm of diabetes management has shifted to focus on empowering the person with diabetes to manage the disease successfully and to improve their quality of life. Diabetes self-management education is a collaborative process through which people with diabetes gain the knowledge and skills needed to modify their behavior and to self-manage successfully the disease and its related conditions. Diabetes educators are health care professionals who apply in-depth knowledge and skills in the biological and social sciences, communication, counseling, and pedagogy to enable patients to manage daily and future challenges. Diabetes educators are integral in providing individualized education and promoting behavior change, using a framework of seven self-care behaviors known as the AADE7 Self-Care Behaviors™, developed by the American Association of Diabetes Educators. The iterative process of promoting behavior change includes assessment, goal setting, planning, implementation, evaluation, and documentation. Diabetes educators work as part of the patient's health care team to engage with the patient in informed, shared decision making. The increasing prevalence of diabetes and the growing focus on its prevention require strategies for providing people with knowledge, skills, and strategies they need and can use. The diabetes educator is the logical facilitator of change. Access to diabetes education is critically important; incorporating diabetes educators into more and varied practice settings will serve to improve clinical and quality of life outcomes for persons with diabetes. Keywords: diabetes

  10. [Do critical pathways improve outcomes of patients with cardiac failure?].

    Science.gov (United States)

    Barbieri, Antonietta; Milan, Erika; Cattaneo, Maria Grazia; Faggian, Fabrizio; Panella, Massimiliano

    2011-01-01

    Cardiac failure represents an important public health problem and despite recent clinical, diagnostic and therapeutic advances, the incidence and prevalence of this syndrome show a steady increase. In view of this, the authors conducted a meta-analysis to evaluate the effect of critical pathways in the management of patients with cardiac failure when compared with standard care. The impact of critical pathways on the following outcomes were evaluated: hospital mortality, mortality at six months, mean length of hospital stay, direct costs, readmission rates at one, three and six months. The following databases were consulted: Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. The research was limited to articles published between January 1975 and June 2010. Methodological quality of studies was evaluated by the Jadad method (for RCTs, cRCT, CCT) and the New Castle Ottawa Scale for case-control and cohort studies. Data analysis was performed by using the statistical methods described in the Cochrane Collaboration guidelines. Meta-analyses were performed using RevMan software version 5. Eleven studies were included in the meta-analysis (5,460 patients). A lower mortality (hospital mortality and mortality at 6 months) was observed in the critical pathways group compared to the group treated with standard care. A positive impact of critical pathways was also observed in length of stay, direct costs, readmission after one, three and six months. Critical pathways can improve the quality of care provided to patients with cardiac failure. Further studies are needed to evaluate which mechanisms within the care pathways can truly improve the quality of care.

  11. Caregiver-mediated exercises for improving outcomes after stroke.

    Science.gov (United States)

    Vloothuis, Judith Dm; Mulder, Marijn; Veerbeek, Janne M; Konijnenbelt, Manin; Visser-Meily, Johanna Ma; Ket, Johannes Cf; Kwakkel, Gert; van Wegen, Erwin Eh

    2016-12-21

    Stroke is a major cause of long-term disability in adults. Several systematic reviews have shown that a higher intensity of training can lead to better functional outcomes after stroke. Currently, the resources in inpatient settings are not always sufficient and innovative methods are necessary to meet these recommendations without increasing healthcare costs. A resource efficient method to augment intensity of training could be to involve caregivers in exercise training. A caregiver-mediated exercise programme has the potential to improve outcomes in terms of body function, activities, and participation in people with stroke. In addition, caregivers are more actively involved in the rehabilitation process, which may increase feelings of empowerment with reduced levels of caregiver burden and could facilitate the transition from rehabilitation facility (in hospital, rehabilitation centre, or nursing home) to home setting. As a consequence, length of stay might be reduced and early supported discharge could be enhanced. To determine if caregiver-mediated exercises (CME) improve functional ability and health-related quality of life in people with stroke, and to determine the effect on caregiver burden. We searched the Cochrane Stroke Group Trials Register (October 2015), CENTRAL (the Cochrane Library, 2015, Issue 10), MEDLINE (1946 to October 2015), Embase (1980 to December 2015), CINAHL (1982 to December 2015), SPORTDiscus (1985 to December 2015), three additional databases (two in October 2015, one in December 2015), and six additional trial registers (October 2015). We also screened reference lists of relevant publications and contacted authors in the field. Randomised controlled trials comparing CME to usual care, no intervention, or another intervention as long as it was not caregiver-mediated, aimed at improving motor function in people who have had a stroke. Two review authors independently selected trials. One review author extracted data, and assessed

  12. Improving conservation outcomes with insights from local experts and bureaucracies.

    Science.gov (United States)

    Haenn, Nora; Schmook, Birgit; Reyes, Yol; Calmé, Sophie

    2014-08-01

    We describe conservation built on local expertise such that it constitutes a hybrid form of traditional and bureaucratic knowledge. Researchers regularly ask how local knowledge might be applied to programs linked to protected areas. By examining the production of conservation knowledge in southern Mexico, we assert local expertise is already central to conservation. However, bureaucratic norms and social identity differences between lay experts and conservation practitioners prevent the public valuing of traditional knowledge. We make this point by contrasting 2 examples. The first is a master's thesis survey of local experts regarding the biology of the King Vulture (Sarcoramphus papa) in which data collection took place in communities adjacent to the Calakmul Biosphere Reserve. The second is a workshop sponsored by the same reserve that instructed farmers on how to monitor endangered species, including the King Vulture. In both examples, conservation knowledge would not have existed without traditional knowledge. In both examples, this traditional knowledge is absent from scientific reporting. On the basis of these findings, we suggest conservation outcomes may be improved by recognizing the knowledge contributions local experts already make to conservation programming. © 2014 Society for Conservation Biology.

  13. Diaphyseal humeral fractures and intramedullary nailing: Can we improve outcomes?

    Science.gov (United States)

    Garnavos, Christos

    2011-01-01

    While intramedullary nailing has been established as the treatment of choice for diaphyseal fractures of the femur and tibia, its role in the management of diaphyseal humeral fractures remains controversial. The reasons include not only the complicated anatomy and unique biomechanical characteristics of the arm but also the fact that surgical technique and nail designs devised for the treatment of femoral and tibial fractures are being transposed to the humerus. As a result there is no consensus on many aspects of the humeral nailing procedure, e.g., the basic nail design, nail selection criteria, timing of the procedure, and the fundamental principles of the surgical technique (e.g., antegrade/retrograde, reamed/unreamed, and static/dynamic). These issues will be analyzed and discussed in the present article. Proposals aiming to improve outcomes include the categorization of humeral nails in two distinct groups: “fixed” and “bio”, avoidance of reaming for the antegrade technique and utilization of “semi-reaming” for the retrograde technique, guidelines for reducing complications, setting the best “timing” for nailing and criteria for selecting the most appropriate surgical technique (antegrade or retrograde). Finally, suggestions are made on proper planning and conducting clinical and biomechanical studies regarding the use of intramedullary nailing in the management of humeral shaft fractures. PMID:21559099

  14. Diaphyseal humeral fractures and intramedullary nailing: Can we improve outcomes?

    Directory of Open Access Journals (Sweden)

    Christos Garnavos

    2011-01-01

    Full Text Available While intramedullary nailing has been established as the treatment of choice for diaphyseal fractures of the femur and tibia, its role in the management of diaphyseal humeral fractures remains controversial. The reasons include not only the complicated anatomy and unique biomechanical characteristics of the arm but also the fact that surgical technique and nail designs devised for the treatment of femoral and tibial fractures are being transposed to the humerus. As a result there is no consensus on many aspects of the humeral nailing procedure, e.g., the basic nail design, nail selection criteria, timing of the procedure, and the fundamental principles of the surgical technique (e.g., antegrade/retrograde, reamed/unreamed, and static/dynamic. These issues will be analyzed and discussed in the present article. Proposals aiming to improve outcomes include the categorization of humeral nails in two distinct groups: "fixed" and "bio", avoidance of reaming for the antegrade technique and utilization of "semi-reaming" for the retrograde technique, guidelines for reducing complications, setting the best "timing" for nailing and criteria for selecting the most appropriate surgical technique (antegrade or retrograde. Finally, suggestions are made on proper planning and conducting clinical and biomechanical studies regarding the use of intramedullary nailing in the management of humeral shaft fractures.

  15. Interprofessional Collaborative Practice to Improve Patient Outcomes: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Jennifer Styron

    2014-06-01

    Full Text Available This project focused on a pilot project implemented during the 2013-2014 academic year. The overall purpose was to facilitate interprofessional collaborative practice innovations through the development of leadership, core competencies, and the use of technology, especially among nurses. Nursing, medicine, and physician assistant students were educated on the IOM competencies for interprofessional teams and the core competencies identified by the Interprofessional Education Collaborative Expert Panel [1] to develop knowledge, skills, and attitudes needed to practice in the collaborative practice environments. The project addressed four goals: Develop faculty expertise and leadership in interprofessional collaborative practice to provide a current, high quality education to nursing, physician assistant, and medical students; Implement a culturally responsive and respectful collaborative interprofessional practice curriculum to prepare nurses, physician assistants, and medical students to deliver high quality, efficient, team-based care in a dynamically evolving environment; Focus interprofessional collaborative practice education on models and practices that lead to improvement in patient outcomes; and Evaluate the program and disseminate best practices. Findings from this pilot include strategies to engage different health professions' students and faculty, partnering with community agencies, building an effective interprofessional team to guide the project, and seeking funding for extension and expansion of the offerings.

  16. Surface modification of PCL-TCP scaffolds improve interfacial mechanical interlock and enhance early bone formation : An in vitro and in vivo characterization

    NARCIS (Netherlands)

    Yeo, A.; Wong, W. J.; Khoo, H. H.; Teoh, S. H.

    Pretreatment of polycaprolactone-20% tricalcium phosphate (PCL-TCP) scaffolds under alkaline conditions can be utilized to alter surface characteristics for enhanced early bone formation. PCL-TCP scaffolds were treated with sodium hydroxide (NaOH) at various time intervals (group A: untreated, group

  17. Exercise for improving outcomes after osteoporotic vertebral fracture

    Science.gov (United States)

    Giangregorio, Lora M; MacIntyre, Norma J; Thabane, Lehana; Skidmore, Carly J; Papaioannou, Alexandra

    2016-01-01

    physical therapy interventions with placebo/non-exercise/non-active physical therapy interventions or no intervention implemented in individuals with a history of vertebral fracture and evaluating the outcomes of interest. Data collection and analysis Two review authors independently selected trials and extracted data using a pre-tested data abstraction form. Disagreements were resolved by consensus, or third party adjudication. The Cochrane Collaboration’s tool for assessing risk of bias was used to evaluate each study. Studies were grouped according to duration of follow-up (i.e., a) four to 12 weeks; b) 16 to 24 weeks; and c) 52 weeks); a study could be represented in more than one group depending on the number of follow-up assessments. For continuous data, we report mean differences (MDs) of the change or percentage change from baseline. Data from two studies were pooled for one outcome using a fixed-effect model. Main results Seven trials (488 participants, four male participants) were included. Substantial variability across the seven trials prevented any meaningful pooling of data for most outcomes. No trials assessed the effect of exercise on incident fractures, adverse events or incident falls. Individual trials reported that exercise could improve pain, performance on the Timed Up and Go test, walking speed, back extensor strength, trunk muscle endurance, and quality of life. However, the findings should be interpreted with caution given that there were also reports of no significant difference between exercise and control groups for pain, Timed Up and Go test performance, trunk extensor muscle strength and quality of life. Pooled analyses from two studies revealed a significant between-group difference in favour of exercise for Timed Up and Go performance (MD −1.13 seconds, 95% confidence interval (CI) −1.85 to −0.42, P = 0.002). Individual studies also reported no significant between-group differences for posture or bone mineral density. Adherence to

  18. Exercise for improving outcomes after osteoporotic vertebral fracture.

    Science.gov (United States)

    Giangregorio, Lora M; Macintyre, Norma J; Thabane, Lehana; Skidmore, Carly J; Papaioannou, Alexandra

    2013-01-31

    /non-exercise/non-active physical therapy interventions or no intervention implemented in individuals with a history of vertebral fracture and evaluating the outcomes of interest. Two review authors independently selected trials and extracted data using a pre-tested data abstraction form. Disagreements were resolved by consensus, or third party adjudication. The Cochrane Collaboration's tool for assessing risk of bias was used to evaluate each study. Studies were grouped according to duration of follow-up (i.e., a) four to 12 weeks; b) 16 to 24 weeks; and c) 52 weeks); a study could be represented in more than one group depending on the number of follow-up assessments. For continuous data, we report mean differences (MDs) of the change or percentage change from baseline. Data from two studies were pooled for one outcome using a fixed-effect model. Seven trials (488 participants, four male participants) were included. Substantial variability across the seven trials prevented any meaningful pooling of data for most outcomes. No trials assessed the effect of exercise on incident fractures, adverse events or incident falls. Individual trials reported that exercise could improve pain, performance on the Timed Up and Go test, walking speed, back extensor strength, trunk muscle endurance, and quality of life. However, the findings should be interpreted with caution given that there were also reports of no significant difference between exercise and control groups for pain, Timed Up and Go test performance, trunk extensor muscle strength and quality of life. Pooled analyses from two studies revealed a significant between-group difference in favour of exercise for Timed Up and Go performance (MD -1.13 seconds, 95% confidence interval (CI) -1.85 to -0.42, P = 0.002). Individual studies also reported no significant between-group differences for posture or bone mineral density. Adherence to exercise varied across studies. The risk of bias across all studies was variable; low risk across most domains in four

  19. Aortic Center: specialized care improves outcomes and decreases mortality

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    Marcela da Cunha Sales

    2014-12-01

    Full Text Available Objective: To compare in-hospital outcomes in aortic surgery in our cardiac surgery unit, before and after foundation of our Center for Aortic Surgery (CTA. Methods: Prospective cohort with non-concurrent control. Foundation of CTA required specialized training of surgical, anesthetic and intensive care unit teams, routine neurological monitoring, endovascular and hybrid facilities, training of the support personnel, improvement of the registry and adoption of specific protocols. We included 332 patients operated on between: January/2003 to December/2007 (before-CTA, n=157, 47.3%; and January/2008 to December/2010 (CTA, n=175, 52.7%. Baseline clinical and demographic data, operative variables, complications and in-hospital mortality were compared between both groups. Results: Mean age was 58±14 years, with 65% male. Group CTA was older, had higher rate of diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular procedures, and aneurysms. In the univariate analysis, CTA had lower mortality (9.7 vs. 23.0%, P=0.008, which occurred consistently across different diseases and procedures. Other outcomes which were reduced in CTA included lower rates of reinterventions (5.7 vs 11%, P=0.046, major complications (20.6 vs. 33.1%, P=0.007, stroke (4.6 vs. 10.9%, P=0.045 and sepsis (1.7 vs. 9.6%, P=0.001, as compared to before-CTA. Multivariable analysis adjusted for potential counfounders revealed that CTA was independently associated with mortality reduction (OR=0.23, IC 95% 0.08 – 0.67, P=0.007. CTA independent mortality reduction was consistent in the multivariable analysis stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 – 0.98, P=0.048; dissection, OR=0.31, CI 95% 0.09 – 0.99, P=0.049 and by procedure (hybrid, OR=0.07, CI 95% 0.007 – 0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 – 0.904, P=0.037. Additional multivariable predictors of in-hospital mortality included creatinine (OR=1.7 [1.1-2.6], P=0.008, urgent

  20. Applying Quality Improvement into Systems-based Learning to Improve Diabetes Outcomes in Primary Care.

    Science.gov (United States)

    Moreo, Kathleen; Sapir, Tamar; Greene, Laurence

    2015-01-01

    In the U.S., where the prevalence of type 2 diabetes has reached epidemic proportions, many patients with this disease are treated by primary care physicians in community-based systems, including accountable care organisations (ACOs). To address gaps in the quality of diabetes care, national quality measures have been established, including patient-centered measures adopted by the Centers for Medicare and Medicaid Services for its Shared Savings Program for ACOs. From a patient-centered perspective, high-quality diabetes care depends on effective communication between clinicians and patients, along with patient education and counseling about medications and lifestyle. We designed and implemented a quality improvement (QI) program for 30 primary care physicians treating patients with type 2 diabetes in three structurally similar but geographically diverse ACOs. Retrospective chart audits were conducted before (n = 300) and after (n = 300) each physician participated in accredited continuing medical education (CME) courses that focused on QI strategies. Randomly selected charts were audited to measurably assess essential interventions for improved outcomes in type 2 diabetes including the physicians' documentation of patient counseling and assessment of side effects, and patients' medication adherence status and changes in hemoglobin A1C (A1C) and body mass index (BMI). Paced educational interventions included a private performance improvement Internet live course conducted for each physician, small-group Internet live courses involving peer discussion, and a set of enduring materials, which were also multi-accredited for all clinicians in the physician's practice. Continual improvement cycles were guided by analysis of the baseline chart audits, quantitative survey data, and qualitative feedback offered by participants. To extend the benefit of the education, the enduring materials were offered to the interprofessional team of clinicians throughout the U.S. who did

  1. Scaffolder - software for manual genome scaffolding

    Directory of Open Access Journals (Sweden)

    Barton Michael D

    2012-05-01

    Full Text Available Abstract Background The assembly of next-generation short-read sequencing data can result in a fragmented non-contiguous set of genomic sequences. Therefore a common step in a genome project is to join neighbouring sequence regions together and fill gaps. This scaffolding step is non-trivial and requires manually editing large blocks of nucleotide sequence. Joining these sequences together also hides the source of each region in the final genome sequence. Taken together these considerations may make reproducing or editing an existing genome scaffold difficult. Methods The software outlined here, “Scaffolder,” is implemented in the Ruby programming language and can be installed via the RubyGems software management system. Genome scaffolds are defined using YAML - a data format which is both human and machine-readable. Command line binaries and extensive documentation are available. Results This software allows a genome build to be defined in terms of the constituent sequences using a relatively simple syntax. This syntax further allows unknown regions to be specified and additional sequence to be used to fill known gaps in the scaffold. Defining the genome construction in a file makes the scaffolding process reproducible and easier to edit compared with large FASTA nucleotide sequences. Conclusions Scaffolder is easy-to-use genome scaffolding software which promotes reproducibility and continuous development in a genome project. Scaffolder can be found at http://next.gs.

  2. Morning versus evening induction of labour for improving outcomes.

    Science.gov (United States)

    Bakker, Jannet J H; van der Goes, Birgit Y; Pel, Maria; Mol, Ben Willem J; van der Post, Joris A M

    2013-02-28

    Induction of labour is a common intervention in obstetric practice. Traditionally, in most hospitals induction of labour with medication starts early in the morning, with the start of the working day for the day shift. In human and animal studies spontaneous onset of labour is proven to have a circadian rhythm with a preference for start of labour in the evening. Moreover, when spontaneous labour starts in the evening, the total duration of labour and delivery shortens and fewer obstetric interventions are needed. Based on these observations one might assume that starting induction of labour in the evening, in harmony with the circadian rhythm of natural birth, is more beneficial for both mother and child. To assess whether induction of labour starting in the evening, coinciding with the endogenous circadian rhythm, improves the outcome of labour compared with induction of labour starting in the early morning, organised to coincide with office hours. We contacted the Trials Search Co-ordinator to search the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2012). In addition, we searched MEDLINE (1966 to 16 February 2012) and EMBASE (1980 to 16 February 2012). We included all published and unpublished randomised controlled trials. We excluded trials that employed quasi-random methods of treatment allocation. Two review authors independently assessed trials for inclusion and risk of bias. Two review authors independently extracted data. Data were checked for accuracy. Where necessary, we contacted study authors for additional information. The search resulted in 2693 articles that we screened on title and abstract for eligibility.Thirteen studies were selected for full text assessment. We included three randomised trials involving 1150 women. Two trials compared the administration of prostaglandins in the morning versus the evening in women with an unfavourable cervix, and one trial compared induction of labour in the morning versus the evening

  3. Can pegylated interferon improve the outcome of polycythemia vera patients?

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    Elena Crisà

    2017-01-01

    Full Text Available Abstract Pegylated interferon (peg-IFN was proven by phase II trials to be effective in polycythemia vera (PV; however, it is not clear whether it could improve patient outcome compared to hydroxyurea (HU. Here, we present an observational study on 65 PV patients aged 65 years or younger, who received either peg-IFN (30 or HU (35 according to the physician choice. Median follow-up was 75 months. The two cohorts were comparable for patient and disease characteristics. Eighty-seven percent of the patients treated with peg-INF responded, with a CR rate of 70% as compared to 100 and 49% with HU, respectively. Discontinuation rate was similar in the two groups (20% in peg-IFN vs 17% in HU. JAK2 allele burden was monitored in peg-INF arm only, and a reduction was observed in 88% of the patients. No thrombotic events were observed during peg-IFN treatment compared to three on HU. Disease progression to myelofibrosis or acute myeloid leukemia occurred to a patient only in peg-INF, compared to three in HU. Overall, three second malignancies were observed during the study, two in patients who received HU only, and one in a patient largely treated HU who received also peg-IFN for 3 months. Overall survival was significantly better for peg-IFN patients compared to HU, p = 0.027. Our study, albeit limited by small patient and event number and lack of randomization, confirms the efficacy of peg-INF in PV and shows a significant survival advantage for peg-INF-treated patients. Waiting for confirming data from the ongoing phase III trials, our study can support peg-INF as a first-line treatment option for PV, at least for younger patients.

  4. Improving safety outcomes in the epilepsy monitoring unit.

    Science.gov (United States)

    Atkinson, Marie; Hari, Karthika; Schaefer, Kimberly; Shah, Aashit

    2012-03-01

    Long term video electroencephalography (EEG) in epilepsy monitoring units (EMU) is used to diagnose and treat patients with epilepsy. Injury occurs in the EMU, including reports of death. No standardized patient safety protocols exist. Our objective is to determine the frequency and contributing factors to injury in the EMU. We reviewed medical records and video EEG of patients with epilepsy admitted to our EMU from December 1, 2008 to June 1, 2009. Data was collected on seizure type, onset, length, and frequency. Seizure related falls, injury, and adverse events were recorded. Data regarding the physical environment and treatment during seizures were analyzed too. 20 patients with 170 seizures were collected. Of the 170 total seizures captured, only 1 injury (0.6%) and 6 falls occurred (3.5%). 5 of the 6 falls were related to patients being ambulatory. No seizures resulted in prolonged stay. Of the 170 seizures captured, other adverse events included 1 status epilepticus (0.6%), 2 postictal aggression (1.2%), 4 objects in mouth (2.4%), 14 ambulatory at seizure onset (8.2%) and 5 postictal ambulation from bed (2.9%). Staff responded to 69 out of 170 seizures (40.6%). Of the 101 seizures without staff response, 57 seizures were electrographic without seizure detection software or push button activation. Falls and adverse events that can lead to injury occur in the EMU, yet the degree of actual injury is minimal. To improve safety outcomes, standardized protocols with appropriate outlined nursing care and procedures for continuous monitoring of patients by staff need to be employed. Copyright © 2011 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  5. Smoking cessation strategies for patients with asthma: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Perret JL

    2016-06-01

    Full Text Available Jennifer L Perret,1–3 Billie Bonevski,4 Christine F McDonald,2,3,5 Michael J Abramson6,7 1Allergy and Lung Health Unit, The University of Melbourne, Melbourne, VIC, 2Institute for Breathing & Sleep, Melbourne, VIC, 3Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, VIC, 4School of Medicine & Public Health, University of Newcastle, NSW, 5Department of Medicine, The University of Melbourne, Melbourne, VIC, 6School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, 7Allergy, Immunology & Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia Abstract: Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as “lung age” should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large

  6. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia

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    Norbert eMayer-Amberg

    2016-01-01

    Full Text Available The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various healthcare service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The current work is a quality monitoring report of a novel care setting, called Integrated Care Initiative Schizophrenia. It has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialised nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient’s departments and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarised in a quality monitoring report. In addition, standardised patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre-post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented integrated care initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia.

  7. Improving health outcomes with better patient understanding and education

    Directory of Open Access Journals (Sweden)

    Robert John Adams

    2010-10-01

    Full Text Available Robert John AdamsThe Health Observatory, The Queen Elizabeth Hospital Campus, The University of Adelaide, Woodville, South Australia, AustraliaAbstract: A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual’s competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly

  8. Improving the Outcomes for College Students Transferring to University

    Science.gov (United States)

    Carter, Irene; Coyle, James P.; Leslie, Donald R.

    2009-01-01

    The authors discuss the challenges of transferring from college to university programs. Following consideration of the practices associated with transferring credits and creating articulation agreements, the authors suggest the use of learning outcomes. Noting the challenges, as well as the benefits, they propose using learning outcomes as an…

  9. Improvement of Cell Permeability of Human Neuronal Nitric Oxide Synthase Inhibitors Using Potent and Selective 2-Aminopyridine-Based Scaffolds with a Fluorobenzene Linker.

    Science.gov (United States)

    Do, Ha T; Wang, Heng-Yen; Li, Huiying; Chreifi, Georges; Poulos, Thomas L; Silverman, Richard B

    2017-11-22

    Inhibition of neuronal nitric oxide synthase (nNOS) is a promising therapeutic approach to treat neurodegenerative diseases. Recently, we have achieved considerable progress in improving the potency and isoform selectivity of human nNOS inhibitors bearing a 2-aminopyridine scaffold. However, these inhibitors still suffered from too low cell membrane permeability to enter into CNS drug development. We report herein our studies to improve permeability of nNOS inhibitors as measured by both PAMPA-BBB and Caco-2 assays. The most permeable compound (12) in this study still preserves excellent potency with human nNOS (Ki = 30 nM) and very high selectivity over other NOS isoforms, especially human eNOS (hnNOS/heNOS = 2799, the highest hnNOS/heNOS ratio we have obtained to date). X-ray crystallographic analysis reveals that 12 adopts a similar binding mode in both rat and human nNOS, in which the 2-aminopyridine and the fluorobenzene linker form crucial hydrogen bonds with glutamate and tyrosine residues, respectively.

  10. Improved preparation of acellular nerve scaffold and application of PKH26 fluorescent labeling combined with in vivo fluorescent imaging system in nerve tissue engineering.

    Science.gov (United States)

    Zhao, Bin; Sun, Xiaolei; Li, Xiulan; Yang, Qiang; Li, Yanjun; Zhang, Yang; Li, Bing; Ma, Xinlong

    2013-11-27

    Acellular nerve scaffold has been widely used for peripheral nerve defect treatment. However, the structure of traditional acellular nerve scaffold is dense; the interval porosity and void diameter are too small to meet the requirement of cell seeding, which limits the application. This study was designed to prepare a novel acellular nerve scaffold by the technique of hypotonic buffer combined with freeze-drying, and use PKH26 fluorescent labeling combined with in vivo fluorescent imaging system to evaluate the biological behavior of tissue-engineered nerve in vitro and in vivo. According to light and electron microscopy, the scaffold, which microarchitecture was similar to the fibrous framework of rabbit sciatic nerves, was cell-free and rich in laminin, collagen I and collagen III. In vitro experiment showed that the novel acellular nerve scaffold could provide a 3-D environment to support the attachment, proliferation and migration of adipose-derived stem cells (ADSCs). ADSCs labeled with fluorescent dye PKH26 were then seeded on scaffolds and implanted subcutaneously into nude mice. After 4 weeks, nerve-like tissue rounded by vessels formed. Cells in the tissue seemed to confirm that they originated from the labeled ADSCs, as confirmed by in vivo fluorescent imaging. In conclusion, the prepared novel acellular nerve scaffold can be used as a new kind of nerve scaffold material, which is more conducible for seeding cells; And PKH26 fluorescent labeling and in vivo fluorescent imaging can be useful for cell tracking and analyzing cell-scaffold constructs in vivo. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. Fabrication of three-dimensional bioplotted hydrogel scaffolds for islets of Langerhans transplantation.

    Science.gov (United States)

    Marchioli, G; van Gurp, L; van Krieken, P P; Stamatialis, D; Engelse, M; van Blitterswijk, C A; Karperien, M B J; de Koning, E; Alblas, J; Moroni, L; van Apeldoorn, A A

    2015-05-28

    In clinical islet transplantation, allogeneic islets of Langerhans are transplanted into the portal vein of patients with type 1 diabetes, enabling the restoration of normoglycemia. After intra-hepatic transplantation several factors are involved in the decay in islet mass and function mainly caused by an immediate blood mediated inflammatory response, lack of vascularization, and allo- and autoimmunity. Bioengineered scaffolds can potentially provide an alternative extra-hepatic transplantation site for islets by improving nutrient diffusion and blood supply to the scaffold. This would ultimately result in enhanced islet viability and functionality compared to conventional intra portal transplantation. In this regard, the biomaterial choice, the three-dimensional (3D) shape and scaffold porosity are key parameters for an optimal construct design and, ultimately, transplantation outcome. We used 3D bioplotting for the fabrication of a 3D alginate-based porous scaffold as an extra-hepatic islet delivery system. In 3D-plotted alginate scaffolds the surface to volume ratio, and thus oxygen and nutrient transport, is increased compared to conventional bulk hydrogels. Several alginate mixtures have been tested for INS1E β-cell viability. Alginate/gelatin mixtures resulted in high plotting performances, and satisfactory handling properties. INS1E β-cells, human and mouse islets were successfully embedded in 3D-plotted constructs without affecting their morphology and viability, while preventing their aggregation. 3D plotted scaffolds could help in creating an alternative extra-hepatic transplantation site. In contrast to microcapsule embedding, in 3D plotted scaffold islets are confined in one location and blood vessels can grow into the pores of the construct, in closer contact to the embedded tissue. Once revascularization has occurred, the functionality is fully restored upon degradation of the scaffold.

  12. Hemocompatible surface of electrospun nanofibrous scaffolds by ATRP modification

    Energy Technology Data Exchange (ETDEWEB)

    Yuan, Wenjie [School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072 (China); Feng, Yakai, E-mail: yakaifeng@hotmail.com [School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072 (China); Key Laboratory of Systems Bioengineering of Ministry of Education, Tianjin University, Tianjin 300072 (China); Tianjin University-Helmholtz-Zentrum Geesthacht, Joint Laboratory for Biomaterials and Regenerative Medicine, Weijin Road 92, 300072 Tianjin (China); Wang, Heyun [School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072 (China); School of Chemistry and Chemical Engineering, Shihezi University, Shihezi 832002 (China); Yang, Dazhi [School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072 (China); An, Bo [Department of Orthopedics, Affiliated Hospital of Logistics University of Chinese People' s Armed Police Force, Tianjin 300162 (China); Zhang, Wencheng [Department of Physiology and Pathophysiology, Logistics University of Chinese People' s Armed Police Force, Tianjin 300162 (China); Khan, Musammir [School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072 (China); Guo, Jintang [School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072 (China); Tianjin University-Helmholtz-Zentrum Geesthacht, Joint Laboratory for Biomaterials and Regenerative Medicine, Weijin Road 92, 300072 Tianjin (China)

    2013-10-15

    The electrospun scaffolds are potential application in vascular tissue engineering since they can mimic the nano-sized dimension of natural extracellular matrix (ECM). We prepared a fibrous scaffold from polycarbonateurethane (PCU) by electrospinning technology. In order to improve the hydrophilicity and hemocompatibility of the fibrous scaffold, poly(ethylene glycol) methacrylate (PEGMA) was grafted onto the fiber surface by surface-initiated atom transfer radical polymerization (SI-ATRP) method. Although SI-ATRP has been developed and used for surface modification for many years, there are only few studies about the modification of electrospun fiber by this method. The modified fibrous scaffolds were characterized by SEM, Fourier transform infrared (FTIR), and X-ray photoelectron spectroscopy (XPS). The scaffold morphology showed no significant difference when PEGMA was grafted onto the scaffold surface. Based on the water contact angle measurement, the surface hydrophilicity of the scaffold surface was improved significantly after grafting hydrophilic PEGMA (P = 0.0012). The modified surface showed effective resistance for platelet adhesion compared with the unmodified surface. Activated partial thromboplastin time (APTT) of the PCU-g-PEGMA scaffold was much longer than that of the unmodified PCU scaffold. The cyto-compatibility of electrospun nanofibrous scaffolds was tested by human umbilical vein endothelial cells (HUVECs). The images of 7-day cultured cells on the scaffold surface were observed by SEM. The modified scaffolds showed high tendency to induce cell adhesion. Moreover, the cells reached out pseudopodia along the fibrous direction and formed a continuous monolayer. Hemolysis test showed that the grafted chains of PEGMA reduced blood coagulation. These results indicated that the modified electrospun nanofibrous scaffolds were potential application as artificial blood vessels. Highlights: • Electrospun nanofibrous scaffolds were successfully

  13. Improving energy audit process and report outcomes through planning initiatives

    Science.gov (United States)

    Sprau Coulter, Tabitha L.

    Energy audits and energy models are an important aspect of the retrofit design process, as they provide project teams with an opportunity to evaluate a facilities current building systems' and energy performance. The information collected during an energy audit is typically used to develop an energy model and an energy audit report that are both used to assist in making decisions about the design and implementation of energy conservation measures in a facility. The current lack of energy auditing standards results in a high degree of variability in energy audit outcomes depending on the individual performing the audit. The research presented is based on the conviction that performing an energy audit and producing a value adding energy model for retrofit buildings can benefit from a revised approach. The research was divided into four phases, with the initial three phases consisting of: 1.) process mapping activity - aimed at reducing variability in the energy auditing and energy modeling process. 2.) survey analysis -- To examine the misalignment between how industry members use the top energy modeling tools compared to their intended use as defined by software representatives. 3.) sensitivity analysis -- analysis of the affect key energy modeling inputs are having on energy modeling analysis results. The initial three phases helped define the need for an improved energy audit approach that better aligns data collection with facility owners' needs and priorities. The initial three phases also assisted in the development of a multi-criteria decision support tool that incorporates a House of Quality approach to guide a pre-audit planning activity. For the fourth and final research phase explored the impacts and evaluation methods of a pre-audit planning activity using two comparative energy audits as case studies. In each case, an energy audit professionals was asked to complete an audit using their traditional methods along with an audit which involved them first

  14. Integrating mental health and addictions services to improve client outcomes.

    Science.gov (United States)

    Peterson, Ashley L

    2013-10-01

    Substance use disorders are highly prevalent among adults with mental health disorders. In many health service delivery areas, mental health and addictions services are delivered separately. However, current best practices indicate that integration of mental health and addictions services can lead to better outcomes for clients with co-occurring disorders, including fewer hospitalizations. Service integration in the community can occur in many ways, including full or partial program integration. While the delivery of mental health and addictions services must be responsive to the needs of the local community, fully integrated programs have the strongest evidence base for positive client outcomes.

  15. Lumbosacral Corsets Improve the Outcome of Patients with Non ...

    African Journals Online (AJOL)

    The use of corset as a physical therapy for non-specific acute LBP has not been clearly supported with scientific evidence. However, it is commonly prescribed for this category of patients. It is important to assess the effect of this modality on the outcome of patients with non- specific acute LBP. Methods: This study aimed to ...

  16. Caregiver-mediated exercises for improving outcomes after stroke

    NARCIS (Netherlands)

    Vloothuis, Judith D.M.; Mulder, Marijn; Veerbeek, Janne M.; Konijnenbelt, Manin; Visser-Meily, Johanna M.A.; Ket, Johannes C.F.; Kwakkel, Gert; van Wegen, Erwin E.H.

    2016-01-01

    Background: Stroke is a major cause of long-term disability in adults. Several systematic reviews have shown that a higher intensity of training can lead to better functional outcomes after stroke. Currently, the resources in inpatient settings are not always sufficient and innovative methods are

  17. Implementation of a clinical pathway may improve alcohol treatment outcome

    DEFF Research Database (Denmark)

    Nielsen, Anette Søgaard; Nielsen, Bent

    2015-01-01

    This article describes the design, implementation, and evaluation of a clinical pathway system in a two-cohort quasi-experimental study before and after implementation, controlling for confounders. The main outcome measures were retention in care and sensible alcohol use (defined as abstinent...

  18. Improved Outcome of Fracture Treatment by Early Operative ...

    African Journals Online (AJOL)

    orthopaedic wards, operating rooms and the physiOtherapy unit of all patients admitted were reviewed retrospectively. Two years, I997 and I998 were analysed for age, sex, type of treatment and quality of outcome. A total of247 admissions into orthopaedic wards were made in I997 leading to 79 major operations, 20 of ...

  19. Improved Outcome of Fracture Treatment by Early Operative ...

    African Journals Online (AJOL)

    Hospital records in the orthopaedic wards, operating rooms and the physiotherapy unit of all patients admitted were reviewed retrospectively. Two years, 1997 and 1998 were analysed for age, sex, type of treatment and quality of outcome. A total of 247 admissions into orthopaedic wards were made in 1997 leading to 79 ...

  20. Improved outcome after relapse in children with acute myeloid leukaemia

    DEFF Research Database (Denmark)

    Abrahamsson, Jonas; Clausen, Niels; Gustafsson, Göran

    2007-01-01

    In the Nordic Society for Paediatric Haematology and Oncology paediatric study acute myeloid leukaemia (AML) 93, event-free survival was 50% and overall survival was 66%, indicating that many patients were cured following relapse. Factors influencing outcome in children with relapsed AML were...... were duration of first complete remission (CR1) and stem cell transplantation (SCT) in CR1. In early relapse (

  1. High-Leverage Leadership: Improving Outcomes in Educational Settings

    Science.gov (United States)

    Mongon, Denis; Chapman, Christopher

    2011-01-01

    Globalisation of world trade, international media, technological innovation and social change are creating opportunities and challenges that today's pupils will inherit and build on. A pupil's academic, technical and social capacity will define their success or failure. Therefore, educational outcomes and well-being for young people across…

  2. The Relationship between School Leadership and School Improvement Outcomes.

    Science.gov (United States)

    Silins, Halia C.

    This paper tests the degree of overlap between operational definitions of transformational and transactional leadership, the nature of the relationships between the constructs of transformational and transactional leadership, and specified outcomes in an empirically derived data set by the application of two forms of analysis. Based on Bass's…

  3. A Meta-Analysis of Educational Data Mining on Improvements in Learning Outcomes

    Science.gov (United States)

    AlShammari, Iqbal A.; Aldhafiri, Mohammed D.; Al-Shammari, Zaid

    2013-01-01

    A meta-synthesis study was conducted of 60 research studies on educational data mining (EDM) and their impacts on and outcomes for improving learning outcomes. After an overview, an examination of these outcomes is provided (Romero, Ventura, Espejo, & Hervas, 2008; Romero, "et al.", 2011). Then, a review of other EDM-related research…

  4. Scaffolding in the Teaching of Writing Discussion Texts Based on SFL Genre-based Approach

    Directory of Open Access Journals (Sweden)

    Eva Fitriani Syarifah

    2015-12-01

    Full Text Available Writing in a second or foreign language seems to be the most difficult language skill for language learners to acquire (Laksmi, 2006; Lestari, 2008; Negari, 2011. Some scholars proposed the implementation of SFL – genre based approach in teaching writing (Derewianka, 1990; Rothery, 1996. However, SFL genre based approach seems to be product or teaching outcomes oriented (Ahn, 2012; Emilia, 2011. Therefore, the concept of scaffolding in which possible supports the process of students‟ individual development is important to be emerged in the teaching stages of SFL – GBA (Bodrova & Leong, 1998; Mulatsih, 2011. As a result, This study focuses on the issue of scaffoldings in the teaching of writing discussion texts based on SFL – Genre Based Approach. It particularly aims to investigate how scaffolding processes are implemented in the teaching of writing discussion texts based on SFL-GBA and how they improve the students‟ writing performance. The data rely on teaching and learning process in a classroom with six students in a tertiary level as the focus participants. The method used in the data analysis adopted a qualitative design with reference especially to the theory of the scaffolding and SFL-GBA. The results of analysis show that scaffolding processes are implemented in terms of macro and micro scaffoldings and able to improve the students‟ writing performance specifically in terms of social function, schematic structures, and language features of discussion genre. It is recommended that future related research should be conducted in more diverse of educational settings to see how scaffoldings are implemented in a variety of teaching practices.

  5. Effects of cell-attachment and extracellular matrix on bone formation in vivo in collagen-hydroxyapatite scaffolds.

    Directory of Open Access Journals (Sweden)

    Max M Villa

    Full Text Available Cell-based tissue engineering can be used to replace missing or damaged bone, but the optimal methods for delivering therapeutic cells to a bony defect have not yet been established. Using transgenic reporter cells as a donor source, two different collagen-hydroxyapatite (HA scaffolds, and a critical-size calvarial defect model, we investigated the effect of a cell-attachment period prior to implantation, with or without an extracellular matrix-based seeding suspension, on cell engraftment and osteogenesis. When quantitatively compared, the in-house scaffold implanted immediately had a higher mean radiopacity than in-house scaffolds incubated overnight. Both scaffold types implanted immediately had significantly higher area fractions of donor cells, while the in-house collagen-HA scaffolds implanted immediately had higher area fractions of the mineralization label compared with groups incubated overnight. When the cell loading was compared in vitro for each delivery method using the in-house scaffold, immediate loading led to higher numbers of delivered cells. Immediate loading may be preferable in order to ensure robust bone formation in vivo. The use of a secondary ECM carrier improved the distribution of donor cells only when a pre-attachment period was applied. These results have improved our understanding of cell delivery to bony defects in the context of in vivo outcomes.

  6. Implementation of a clinical pathway may improve alcohol treatment outcome

    DEFF Research Database (Denmark)

    Nielsen, Anette Søgaard; Nielsen, Bent

    2015-01-01

    a structured intake, a referral and independent follow-up system, checklists, audit, and feedback, there was no change in length of stay, but significantly more patients had a good clinical outcome (stopped or moderated their consumption) at the end of treatment (OR = 1.9; 1.2–3.1). The study documents......This article describes the design, implementation, and evaluation of a clinical pathway system in a two-cohort quasi-experimental study before and after implementation, controlling for confounders. The main outcome measures were retention in care and sensible alcohol use (defined as abstinent...... or drinking no more than 21 standard drinks per week). Patients with harmful alcohol use or dependence as their primary problem who were seeking psychosocial treatment at one of four alcohol clinics in Denmark participated in the study. After implementation of the clinical pathway system, which incorporated...

  7. Titanate nanotube coatings on biodegradable photopolymer scaffolds

    Energy Technology Data Exchange (ETDEWEB)

    Beke, S., E-mail: szabolcs.beke@iit.it [Department of Nanophysics, Istituto Italiano di Tecnologia, via Morego 30, 16163 Genova (Italy); Kőrösi, L. [Department of Biotechnology, Nanophage Therapy Center, Enviroinvest Corporation, Kertváros u. 2, H-7632, Pécs (Hungary); Scarpellini, A. [Department of Nanochemistry, Istituto Italiano di Tecnologia, via Morego 30, 16163 Genova (Italy); Anjum, F.; Brandi, F. [Department of Nanophysics, Istituto Italiano di Tecnologia, via Morego 30, 16163 Genova (Italy)

    2013-05-01

    Rigid, biodegradable photopolymer scaffolds were coated with titanate nanotubes (TNTs) by using a spin-coating method. TNTs were synthesized by a hydrothermal process at 150 °C under 4.7 bar ambient pressure. The biodegradable photopolymer scaffolds were produced by mask-assisted excimer laser photocuring at 308 nm. For scaffold coating, a stable ethanolic TNT sol was prepared by a simple colloid chemical route without the use of any binding compounds or additives. Scanning electron microscopy along with elemental analysis revealed that the scaffolds were homogenously coated by TNTs. The developed TNT coating can further improve the surface geometry of fabricated scaffolds, and therefore it can further increase the cell adhesion. Highlights: ► Biodegradable scaffolds were produced by mask-assisted UV laser photocuring. ► Titanate nanotube deposition was carried out without binding compounds or additives. ► The titanate nanotube coating can further improve the surface geometry of scaffolds. ► These reproducible platforms will be of high importance for biological applications.

  8. Antenatal management of gestational diabetes mellitus can improve neonatal outcomes.

    Science.gov (United States)

    Au, Cheryl Pui Yan; Raynes-Greenow, Camille H; Turner, Robin M; Carberry, Angela E; Jeffery, Heather E

    2016-03-01

    Pregnancies complicated with gestational diabetes mellitus (GDM) are at a higher risk for caesarean and instrumental deliveries as well as adverse neonatal outcomes such as fetal overgrowth, hypoglycaemia and neonatal intensive care admission. Our primary objective was to describe neonatal outcomes in a sample that included term infants of both GDM mothers and mothers with normal glucose tolerance (NGT). this cross-sectional study included 599 term babies born between September and October 2010 at Royal Prince Alfred Hospital, Sydney, Australia. Maternal and neonatal data were collected from medical records and a questionnaire. Glycaemic control data was based on third trimester HbA1c levels and self-monitoring blood glucose levels (BGL). Univariate associations between GDM status and maternal demographic factors, as well as pregnancy outcomes, were estimated using χ(2) tests and t-tests, as appropriate. of 599 babies, 67(11%) were born to GDM mothers. GDM mothers were more likely to be overweight/obese and of Asian ethnicity. Good glycaemic control was achieved in most GDM mothers. GDM babies were more likely to have been induced (p=0.013) and delivered earlier than non-GDM mothers (p<0.001), and they were also more likely to be breastfed within one hour of birth. in this study, GDM infants were more likely to be induced and delivered earlier but otherwise they did not have significantly different neonatal outcomes compared to infants of NGT mothers. This can be attributed to the good GDM control by lifestyle modification and insulin if necessary. The role of labour induction in GDM pregnancies should be further investigated. Midwives have an important role in maternal education during pregnancy and in the postnatal period. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Editorial: Improving cataract outcomes through good postoperative care

    Directory of Open Access Journals (Sweden)

    Nick Astbury

    2016-10-01

    Full Text Available Cataract surgery is one of the most successful and frequently performed operations worldwide, and yet cataract remains the commonest cause of global blindness. This is in part due to the shortage and uneven distribution of trained personnel in some countries. More worryingly, a high rate of cataract blindness also reflects poor visual outcomes after surgery, as has been documented in many RAAB (rapid assessment of avoidable blindness studies.

  10. Evolution?informed modeling improves outcome prediction for cancers

    OpenAIRE

    Liu, Li; Chang, Yung; Yang, Tao; Noren, David P; Long, Byron; Kornblau, Steven; Qutub, Amina; Ye, Jieping

    2016-01-01

    Abstract Despite wide applications of high?throughput biotechnologies in cancer research, many biomarkers discovered by exploring large?scale omics data do not provide satisfactory performance when used to predict cancer treatment outcomes. This problem is partly due to the overlooking of functional implications of molecular markers. Here, we present a novel computational method that uses evolutionary conservation as prior knowledge to discover bona fide biomarkers. Evolutionary selection at ...

  11. 77 FR 32959 - Request for Information on Strategies for Improving Outcomes for Disconnected Youth

    Science.gov (United States)

    2012-06-04

    ..., unemployment, or underemployment. Disconnected youth are not a homogenous group. Disconnected youth struggle... Request for Information on Strategies for Improving Outcomes for Disconnected Youth AGENCY: Office of... Partnership Pilots'' that would improve outcomes for disconnected youth. In order to inform the Administration...

  12. Does a continuous feedback system improve psychotherapy outcome?

    Science.gov (United States)

    Reese, Robert J; Norsworthy, Larry A; Rowlands, Steve R

    2009-12-01

    Using outcome data on a continual basis to monitor treatment progress has been identified as a way to enhance psychotherapy outcome. The purpose of this study was to investigate the use of a continuous feedback assessment system, the Partners for Change Outcome Management System (PCOMS; Miller & Duncan, 2004). Findings from 2 client samples that attended individual therapy at a university counseling center (N = 74) or a graduate training clinic (N = 74) indicated that clients who used PCOMS with their therapists (feedback condition) demonstrated statistically significant treatment gains when compared to clients receiving treatment as usual (no-feedback condition). Clients using PCOMS were also more likely to experience reliable change and in fewer sessions. A survival analysis demonstrated that approximately 50% of the clients in the feedback condition demonstrated reliable change after the 7th (graduate training clinic) or 9th session (university counseling center). Further findings, limitations of the study and ideas for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  13. Improving Outcomes in the Nigeria Healthcare Sector through Public ...

    African Journals Online (AJOL)

    PPP) model in the Country's healthcare sector. Public - Private Interaction offers opportunity of leveraging private sector investment in the sector and further enhances improvements in service delivery as well as increases access to quality ...

  14. Combining Chemotherapy with Bevacizumab Improves Outcomes for Ovarian Cancer Patients

    Science.gov (United States)

    Results from two phase III randomized clinical trials suggest that, at least for some patients with ovarian cancer, adding the antiangiogenesis agent bevacizumab to chemotherapy increases the time to disease progression and may improve survival.

  15. Pregnancy after bariatric surgery: improving outcomes for mother and child

    Directory of Open Access Journals (Sweden)

    González I

    2016-12-01

    Full Text Available Irene González,1 Albert Lecube,2 Miguel Ángel Rubio,3 Pedro Pablo García-Luna4 1Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de Huelva, Huelva, Spain; 2Endocrinology and Nutrition Department, Arnau de Vilanova University Hospital, Lleida Biomedicine Research Institute (IRB-Lleida, CIBER in Diabetes and Associated Metabolic Disorders (CIBERDEM, Lleida University, Lleida, Spain; 3Endocrinology and Nutrition Department, Hospital Clínico San Carlos, IDISSC, Madrid, Spain; 4Endocrinology and Nutrition Department, Hospitales Universitarios Virgen del Rocío, Seville, Spain Abstract: The significant increase in the prevalence of obesity has led to an increase in the number of obese women who become pregnant. In this setting, in recent years, there has been an exponential rise in the number of bariatric procedures, with approximately half of them performed in women of childbearing age, and a remarkable surge in the number of women who become pregnant after having undergone bariatric surgery (BS. These procedures entail the risk of nutritional deficiencies, and nutrition is a crucial aspect during pregnancy. Therefore, knowledge and awareness of the consequences of these techniques on maternal and fetal outcomes is essential. Current evidence suggests a better overall obstetric outcome after BS, in comparison to morbid obese women managed conservatively, with a reduction in the prevalence of gestational diabetes mellitus, pregnancy-associated hypertensive disorders, macrosomia, and congenital defects. However, the risk of potential maternal nutritional deficiencies and newborns small for gestational age cannot be overlooked. Results concerning the incidence of preterm delivery and the number of C-sections are less consistent. In this paper, we review the updated evidence regarding the impact of BS on pregnancy. Keywords: bariatric surgery, pregnancy, maternal and fetal outcomes, gestational diabetes mellitus, small for

  16. Predictors of improvement in observed functional ability in patients with fibromyalgia as an outcome of rehabilitation

    DEFF Research Database (Denmark)

    Amris, Kirstine; Luta, George; Christensen, Robin

    2016-01-01

    Widespread Pain (the IMPROvE study); a randomized controlled trial including 191 females with fibromyalgia randomized (1:1) to rehabilitation or a waiting list. The primary outcome was observed activities of daily living ability evaluated with the Assessment of Motor and Process Skills (AMPS) 6 months post......OBJECTIVE: To investigate predictors of improvement in observed ability to manage activities of daily living as an outcome of rehabilitation in fibromyalgia. METHODS: Exploratory analyses used data from the Interdisciplinary Rehabilitation and Evaluation Programme for Patients with Chronic...... specialized rehabilitation when the outcome of interest is improvement in observed activity of daily living ability....

  17. Bio-nanocapsule-based scaffold improves the sensitivity and ligand-binding capacity of mammalian receptors on the sensor chip.

    Science.gov (United States)

    Iijima, Masumi; Yoshimoto, Nobuo; Niimi, Tomoaki; Maturana, Andrés D; Kuroda, Shun'ichi

    2016-06-01

    Mammalian receptors are recognized as target molecules for drug discovery, and chemical libraries have been screened for both potential antagonists and agonists mainly by ligand-binding assays using immobilized receptors. A bio-nanocapsule (BNC) of approximately 30 nm that displays a tandem form of the protein A-derived immunoglobulin G (IgG) Fc-binding Z domains (denoted as ZZ-BNC) has been developed for both clustering and oriented immobilization of IgGs on the solid phase of immunosensors. In this study, human IgG1 Fc-fused vascular endothelial growth factor (VEGF) receptor was immobilized through ZZ-BNC on the sensor chip of quartz crystal microbalance (ZZ-BNC-coating). When compared with direct adsorption and protein A-coating, the sensor chip showed higher sensitivity (∽46- and ∽165-fold, respectively) and larger ligand-binding capacity (∽4- and ∽18-fold, respectively). Furthermore, the number of VEGF molecules bound to its receptor increased from 0.20 (direct adsorption) to 2.06 by ZZ-BNC-coating, strongly suggesting that ZZ-BNC reduced the steric hindrance near ligand recognition sites through oriented immobilization. Similarly, the sensitivity and ligand-binding capacity of leptin and prolactin receptors were both enhanced at a level comparable to that observed for the VEGF receptor. Thus, the combination of ZZ-BNC and Fc-fused receptors could significantly improve the function of ligand-binding assays. Copyright © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  18. Synergistic Effect of Carbon Nanotubes and Graphene on Diopside Scaffolds.

    Science.gov (United States)

    Liu, Tingting; Wu, Ping; Gao, Chengde; Feng, Pei; Xiao, Tao; Deng, Youwen; Shuai, Cijun; Peng, Shuping

    2016-01-01

    A synergetic effect between carbon nanotubes (CNTs) and graphene on diopside (Di) scaffolds was demonstrated. 3D network architecture in the matrix was formed through the 1D CNTs inlaid among the 2D graphene platelets (GNPs). The mechanical properties of the CNTs/GNPs/Di scaffolds were significantly improved compared with the CNTs/Di scaffolds and GNPs/Di scaffolds. In addition, the scaffolds exhibited excellent apatite-forming ability, a modest degradation rate, and stable mechanical properties in simulated body fluid (SBF). Moreover, cell culturing tests indicated that the scaffolds supported the cells attachment and proliferation. Taken together, the CNTs/GNPs/Di scaffolds offered great potential for bone tissue engineering.

  19. Pregnancy after bariatric surgery: improving outcomes for mother and child.

    Science.gov (United States)

    González, Irene; Lecube, Albert; Rubio, Miguel Ángel; García-Luna, Pedro Pablo

    2016-01-01

    The significant increase in the prevalence of obesity has led to an increase in the number of obese women who become pregnant. In this setting, in recent years, there has been an exponential rise in the number of bariatric procedures, with approximately half of them performed in women of childbearing age, and a remarkable surge in the number of women who become pregnant after having undergone bariatric surgery (BS). These procedures entail the risk of nutritional deficiencies, and nutrition is a crucial aspect during pregnancy. Therefore, knowledge and awareness of the consequences of these techniques on maternal and fetal outcomes is essential. Current evidence suggests a better overall obstetric outcome after BS, in comparison to morbid obese women managed conservatively, with a reduction in the prevalence of gestational diabetes mellitus, pregnancy-associated hypertensive disorders, macrosomia, and congenital defects. However, the risk of potential maternal nutritional deficiencies and newborns small for gestational age cannot be overlooked. Results concerning the incidence of preterm delivery and the number of C-sections are less consistent. In this paper, we review the updated evidence regarding the impact of BS on pregnancy.

  20. Pregnancy after bariatric surgery: improving outcomes for mother and child

    Science.gov (United States)

    González, Irene; Lecube, Albert; Rubio, Miguel Ángel; García-Luna, Pedro Pablo

    2016-01-01

    The significant increase in the prevalence of obesity has led to an increase in the number of obese women who become pregnant. In this setting, in recent years, there has been an exponential rise in the number of bariatric procedures, with approximately half of them performed in women of childbearing age, and a remarkable surge in the number of women who become pregnant after having undergone bariatric surgery (BS). These procedures entail the risk of nutritional deficiencies, and nutrition is a crucial aspect during pregnancy. Therefore, knowledge and awareness of the consequences of these techniques on maternal and fetal outcomes is essential. Current evidence suggests a better overall obstetric outcome after BS, in comparison to morbid obese women managed conservatively, with a reduction in the prevalence of gestational diabetes mellitus, pregnancy-associated hypertensive disorders, macrosomia, and congenital defects. However, the risk of potential maternal nutritional deficiencies and newborns small for gestational age cannot be overlooked. Results concerning the incidence of preterm delivery and the number of C-sections are less consistent. In this paper, we review the updated evidence regarding the impact of BS on pregnancy. PMID:28008286

  1. Improving Early Grade Reading Outcomes: Aprender a Ler in Mozambique.

    Science.gov (United States)

    Burchfield, Shirley; Hua, Haiyan; Noyes, David; van de Waal, Willem

    2017-03-01

    The Government of Mozambique has long struggled to improve the low reading levels of children in early grades. With funding from the U.S. Agency for International Development (USAID) in 2012, World Education collaborated with the Ministry of Education and Human Development (MINEDH) to improve reading by developing a research-based reading intervention and testing it in two provinces. This article examines student reading performance from cohorts of second and third graders before and after a 1-year intervention compared to that of a control group and identifies factors required for successful scale-up. © 2017 Wiley Periodicals, Inc.

  2. Linking residency training effectiveness to clinical outcomes: a quality improvement approach.

    Science.gov (United States)

    Buckley, John D; Joyce, Barbara; Garcia, Audwin Joseph; Jordan, Jack; Scher, Eric

    2010-05-01

    The Accreditation Council for Graduate Medical Education (ACGME)'s Outcome Project requires training programs to use external measures such as quality of care indicators to assess their effectiveness. A practical, quality improvement (QI) process was implemented at Henry Ford Hospital to enhance the training program's educational effectiveness and clinical outcomes. A QI process consisting ofa modified Plan-Do-Study-Act (PDSA) cycle was applied to residency and fellowship curricula in a medical intensive care unit (MICU). The PDSA activities focused on improving clinical outcomes but also outlined educational goals for residents and fellows, defined teaching methods, and determined assessment methods for the ACGME curricula. The improvement process linked clinical outcomes to specific competency-based educational objectives. Residents and fellows received instruction on QI and applied the new curricula to their clinical training in the MICU. Two of seven MICU clinical outcomes demonstrated initial performance below national benchmarks: iatrogenic pneumothorax rate and sepsis-specific mortality. During the QI process, clinical outcomes in both areas improved. Training program directors used the MICU clinical outcomes as indicators of their programs' educational effectiveness. They also assessed individual trainee performance in QI initiatives through direct observation and review of their written summaries of these projects. Training programs can use hospital-tracked clinical outcomes to analyze their educational strengths and weaknesses and accordingly to enhance their educational curricula. Linking competency-based learning objectives for trainees to the clinical outcomes of their patients can improve physician education and patient care.

  3. Learning - the only way to improve health-care outcomes.

    Science.gov (United States)

    Waldman, J Deane; Yourstone, Steven A

    2007-11-01

    Attempts to improve health care have generally failed. Systems analysis urges addressing processes, such as learning, rather than isolated parts of a system. We apply learning curve theory to health care and then explicate the process of learning. Specific recommendations involve how we learn (and unlearn), who should learn, and what should be learned.

  4. A rare cause of severe hepatomegaly with an improving outcome

    DEFF Research Database (Denmark)

    Godskesen, Line Elberg; Abildgaard, Niels; Kjeldsen, Jens

    2014-01-01

    ) amyloidosis and bone marrow showed multiple myeloma (MM). The patient was treated with drugs of choice cyclophosphamide, bortezomib and dexamethasone. He responded well to the treatment and so far achieved partial response. Previously MM was associated with poor prognosis but due to improved treatment for AL...

  5. Cognitive behavioral therapy for suicidal behaviors: improving patient outcomes

    Science.gov (United States)

    Mewton, Louise; Andrews, Gavin

    2016-01-01

    This systematic review provides an overview of the effectiveness of cognitive behavioral therapy (CBT) in reducing suicidal cognitions and behavior in the adult population. We identified 15 randomized controlled trials of CBT for adults (aged 18 years and older) that included suicide-related cognitions or behaviors as an outcome measure. The studies were identified from PsycINFO searches, reference lists, and a publicly available database of psychosocial interventions for suicidal behaviors. This review identified some evidence of the use of CBT in the reduction of both suicidal cognitions and behaviors. There was not enough evidence from clinical trials to suggest that CBT focusing on mental illness reduces suicidal cognitions and behaviors. On the other hand, CBT focusing on suicidal cognitions and behaviors was found to be effective. Given the current evidence, clinicians should be trained in CBT techniques focusing on suicidal cognitions and behaviors that are independent of the treatment of mental illness. PMID:27042148

  6. Toward improved public health outcomes from urban nature.

    Science.gov (United States)

    Shanahan, Danielle F; Lin, Brenda B; Bush, Robert; Gaston, Kevin J; Dean, Julie H; Barber, Elizabeth; Fuller, Richard A

    2015-03-01

    There is mounting concern for the health of urban populations as cities expand at an unprecedented rate. Urban green spaces provide settings for a remarkable range of physical and mental health benefits, and pioneering health policy is recognizing nature as a cost-effective tool for planning healthy cities. Despite this, limited information on how specific elements of nature deliver health outcomes restricts its use for enhancing population health. We articulate a framework for identifying direct and indirect causal pathways through which nature delivers health benefits, and highlight current evidence. We see a need for a bold new research agenda founded on testing causality that transcends disciplinary boundaries between ecology and health. This will lead to cost-effective and tailored solutions that could enhance population health and reduce health inequalities.

  7. Digital audio recordings improve the outcomes of patient consultations

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Holst, René

    2017-01-01

    OBJECTIVES: To investigate the effects on patients' outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL). METHODS: This is a three-armed randomised controlled cluster trial. One group of patients received standard care......, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires....... RESULTS: A total of 4349 patients participated in the study. DAR significantly increased the probability of fulfilling the participants' self-perceived information needs by 4.1% to 6.3%, particularly with regard to test results (OR=1.41, 95%CI: 1.14-1.74, p=0.001) and treatment options (OR=1.39, 95%CI: 1...

  8. Sexuality and fertility in men with hypospadias; improved outcome.

    Science.gov (United States)

    Örtqvist, L; Fossum, M; Andersson, M; Nordenström, A; Frisén, L; Holmdahl, G; Nordenskjöld, A

    2017-03-01

    The aim of this study was to investigate sexual function and fertility in adult men born with hypospadias. Patients born with hypospadias, age-matched controls, and a group of circumcised men completed a questionnaire constructed to reflect their psychosexual situation and fertility. Core gender identity, sexual orientation, and gender role behavior was also assessed. 167 patients [63% distal, 24% mid shaft and 13% proximal, mean age 34 (19-54) years], 169 controls from the general population [mean age 33 (19-48) years] and 47 controls circumcised because of phimosis (mean age 26 [19-44]) participated and completed the questionnaire. There were no differences in having a partner, reported fertility, age at sexarche (mean age 17.8), number of sex partners or sexual interest between the patients and controls. More patients than controls reported anejaculation. Reported glanular sensitivity was lower in hypospadias patients and circumcised controls compared with non-circumcised controls. The odds of being satisfied with their sexual life increased with a higher penile perception score in patients (OR = 1.54, p = 0.01). There was no association with penile length. Sexual orientation, core gender identity and gender role behavior were sex-typical in both patients and controls. Patients with proximal hypospadias had a lower reported fertility, experienced anejaculation more often, and were less satisfied with their sexual life. Men born with hypospadias have a good long-term outcome concerning sexual function and fertility. Men born with proximal hypospadias have a more impaired outcome concerning both sexual function and fertility. As satisfaction with genital appearance is important for sexual life satisfaction, clinical, and psychological follow-up into adulthood is especially important in boys born with proximal hypospadias. © 2016 American Society of Andrology and European Academy of Andrology.

  9. Fabrication of functional PLGA-based electrospun scaffolds and their applications in biomedical engineering

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Wen, E-mail: wenzhao@nwpu.edu.cn [Key Laboratory for Space Biosciences and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi' an, Shaanxi (China); Li, Jiaojiao; Jin, Kaixiang; Liu, Wenlong [Key Laboratory for Space Biosciences and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi' an, Shaanxi (China); Qiu, Xuefeng [Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei (China); Li, Chenrui [Key Laboratory for Space Biosciences and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi' an, Shaanxi (China)

    2016-02-01

    Electrospun PLGA-based scaffolds have been applied extensively in biomedical engineering, such as tissue engineering and drug delivery system. Due to lack of the recognition sites on cells, hydropholicity and single-function, the applications of PLGA fibrous scaffolds are limited. In order to tackle these issues, many works have been done to obtain functional PLGA-based scaffolds, including surface modifications, the fabrication of PLGA-based composite scaffolds and drug-loaded scaffolds. The functional PLGA-based scaffolds have significantly improved cell adhesion, attachment and proliferation. Moreover, the current study has summarized the applications of functional PLGA-based scaffolds in wound dressing, vascular and bone tissue engineering area as well as drug delivery system. - Highlights: • We summarize the strategies to functionalize PLGA-based electrospun scaffolds. • The applications of PLGA-based scaffolds in biomedical engineering are concluded. • The future challenges and opportunities of PLGA-based scaffolds are proposed.

  10. Need for better diabetes treatment for improved renal outcome

    DEFF Research Database (Denmark)

    Rossing, Peter; de Zeeuw, Dick

    2011-01-01

    Diabetic nephropathy has become a worldwide epidemic accounting for approximately one-third of all cases of end-stage renal disease. The problem is expected to grow, as the prevalence of diabetes is expected to increase from 285 million patients at present to 438 million patients in the year 2030......, with increasing prevalence of diabetes particularly in Asia, and a global prevalence of microalbuminuria of ∼ 40%. This will have a major societal impact because of the enormous financial burden of renal replacement therapy and the invalidating character of this disease. Improved management of diabetes is clearly...... required, including improved glycemic control to avoid initiation of diabetic nephropathy, particularly in high-risk patients. Recently, the benefits of strict glycemic control on micro- and macrovascular complications have been questioned despite the clear association in observational studies between...

  11. Improving Pharmacy Student Communication Outcomes Using Standardized Patients.

    Science.gov (United States)

    Gillette, Chris; Rudolph, Michael; Rockich-Winston, Nicole; Stanton, Robert; Anderson, H Glenn

    2017-08-01

    Objective. To examine whether standardized patient encounters led to an improvement in a student pharmacist-patient communication assessment compared to traditional active-learning activities within a classroom setting. Methods. A quasi-experimental study was conducted with second-year pharmacy students in a drug information and communication skills course. Student patient communication skills were assessed using high-stakes communication assessment. Results. Two hundred and twenty students' data were included. Students were significantly more likely to have higher scores on the communication assessment when they had higher undergraduate GPAs, were female, and taught using standardized patients. Similarly, students were significantly more likely to pass the assessment on the first attempt when they were female and when they were taught using standardized patients. Conclusion. Incorporating standardized patients within a communication course resulted in improved scores as well as first-time pass rates on a communication assessment than when using different methods of active learning.

  12. Peritransplant Treg-Based Immunomodulation to Improve VCA Outcomes

    Science.gov (United States)

    2017-10-01

    beyond the bounds of science, engineering, and the academic world on areas such as: • improving public knowledge, attitudes, skills, and abilities...or its direction. If not previously reported in writing , provide the following additional information or state, “Nothing to Report,” if applicable...Nothing to Report.” Describe partner organizations – academic institutions, other nonprofits, industrial or commercial firms, state or local governments

  13. Improved outcome in solitary bone plasmacytomata with combined therapy.

    Science.gov (United States)

    Avilés, A; Huerta-Guzmán, J; Delgado, S; Fernández, A; Díaz-Maqueo, J C

    1996-09-01

    Solitary bone plasmacytoma (SBP) is a rare presentation of plasma cell dyscrasias. Radiotherapy has been considered the treatment of choice, however, most patients will develop multiple myeloma, 3 to 10 years after initial diagnosis and treatment. No innovations have been introduced in the treatment of SBP in the last 30 years. We began a prospective clinical trial to assess the efficacy and toxicity of adjuvant chemotherapy with low doses of melphalan and prednisone administered to patients with SBP after radiation therapy in an attempt to improve the disease-free survival and overall survival. Between 1982 and 1989, 53 patients with SBP were randomly assigned to be treated with either local radiotherapy with doses ranged from 4000 to 5000 cGy to achieve local control of disease (28 patients) or the same radiotherapy schedule followed by melphalan and prednisone given every 6 weeks for 3 years (25 patients). After a median follow-up of 8.9 years, disease-free survival and overall survival were improved in patients who were treated with combined therapy, 22 patients remain alive and free of disease in the combined treatment group compared to only 13 patients in the radiotherapy group (p radiotherapy in patients with SBP improved duration of remission and survival without severe side-effects. However, as with other studies in SBP, the group was too small to draw definitive conclusions and more controlled clinical trials are necessary to define the role of this therapeutic approach in patients with SBP.

  14. Improving Clinical Outcomes for Patients With Class III Heart Failure.

    Science.gov (United States)

    Shapiro, Melissa; Bires, Angela Macci; Waterstram-Rich, Kristen; Cline, Thomas W

    Heart failure (HF) is a serious medical problem in the United States and is placing a financial strain on the health care system. It is the leading cause of mortality and as the overall incidence continues to increase, so does the economic impact on the health care system. Innovative treatment options, in the form of disease management programs and implantable cardiac devices, such as the CorVue capable implantable cardioverter defibrillator (ICD) pacemaker, offer the promise of an enhanced quality of life and reduced mortality. Even with these advances, HF continues to be a challenge. Studies reviewing HF management programs have shown promising results. However, more studies are needed to determine which combination of HF management interventions has the greatest financial impact and yields the best patient outcomes. The objective of the research study was to compare 30-day readmission rates of patients implanted with the CorVue capable ICD pacemaker with patients with congestive heart failure (CHF) with no implanted device. The aim of the research focused on the usefulness of intrathoracic impedance monitoring alerts in guiding empirical treatment of patients with CHF to prevent HF readmissions. Methodology included a retrospective medical chart review, comparing 30-day readmission events among patients with class III CHF who received home health intervention with similar patients implanted with the CorVue ICD.

  15. Does residential mobility improve educational outcomes? Evidence from the Netherlands.

    Science.gov (United States)

    Haelermans, Carla; De Witte, Kristof

    2015-07-01

    This paper explores the impact of residential mobility on educational outcomes. By considering a large Dutch city with substantial internal residential mobility, we examine how residential mobility influences the decision of students to drop out of school. The paper exploits a rich administrative dataset with extensive information on educational, individual, family, housing and moving characteristics of students. It combines a matching design with a multivariate regression analysis, such that the evaluation draws on a well-comparable control group for the treated students. Accounting for individual, family, educational, neighborhood and housing characteristics, as well as for school and year fixed effects, we observe that residential mobility increases the probability of school dropout in the first few years after moving. The estimated effect changes, however, to a lower risk of early school leaving after an initial period, and then changes again to a higher risk after 6years. This effect remains, regardless the level of education the students attended, or whether the student moves to a better or a worse neighborhood. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Evolution-informed modeling improves outcome prediction for cancers.

    Science.gov (United States)

    Liu, Li; Chang, Yung; Yang, Tao; Noren, David P; Long, Byron; Kornblau, Steven; Qutub, Amina; Ye, Jieping

    2017-01-01

    Despite wide applications of high-throughput biotechnologies in cancer research, many biomarkers discovered by exploring large-scale omics data do not provide satisfactory performance when used to predict cancer treatment outcomes. This problem is partly due to the overlooking of functional implications of molecular markers. Here, we present a novel computational method that uses evolutionary conservation as prior knowledge to discover bona fide biomarkers. Evolutionary selection at the molecular level is nature's test on functional consequences of genetic elements. By prioritizing genes that show significant statistical association and high functional impact, our new method reduces the chances of including spurious markers in the predictive model. When applied to predicting therapeutic responses for patients with acute myeloid leukemia and to predicting metastasis for patients with prostate cancers, the new method gave rise to evolution-informed models that enjoyed low complexity and high accuracy. The identified genetic markers also have significant implications in tumor progression and embrace potential drug targets. Because evolutionary conservation can be estimated as a gene-specific, position-specific, or allele-specific parameter on the nucleotide level and on the protein level, this new method can be extended to apply to miscellaneous "omics" data to accelerate biomarker discoveries.

  17. Cognitive behavioral therapy for suicidal behaviors: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Mewton L

    2016-03-01

    Full Text Available Louise Mewton,1 Gavin Andrews2 1National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, 2Clinical Research Unit for Anxiety and Depression (CRUfAD, St Vincent's Hospital, Sydney, NSW, Australia Abstract: This systematic review provides an overview of the effectiveness of cognitive behavioral therapy (CBT in reducing suicidal cognitions and behavior in the adult population. We identified 15 randomized controlled trials of CBT for adults (aged 18 years and older that included suicide-related cognitions or behaviors as an outcome measure. The studies were identified from PsycINFO searches, reference lists, and a publicly available database of psychosocial interventions for suicidal behaviors. This review identified some evidence of the use of CBT in the reduction of both suicidal cognitions and behaviors. There was not enough evidence from clinical trials to suggest that CBT focusing on mental illness reduces suicidal cognitions and behaviors. On the other hand, CBT focusing on suicidal cognitions and behaviors was found to be effective. Given the current evidence, clinicians should be trained in CBT techniques focusing on suicidal cognitions and behaviors that are independent of the treatment of mental illness. Keywords: suicidal behaviors, suicidal cognitions, CBT

  18. Diabetic microvascular complications: possible targets for improved macrovascular outcomes

    Directory of Open Access Journals (Sweden)

    Bijan Roshan

    2010-12-01

    Full Text Available John A D’Elia1, George Bayliss1,2, Bijan Roshan1, Manish Maski1, Ray E Gleason1, Larry A Weinrauch11Renal Unit, Joslin Diabetes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 2Department of Medicine, Rhode Island Hospital, Alpert School of Medicine, Brown University, Providence, RI, USAAbstract: The results of recent outcome trials challenge hypotheses that tight control of both glycohemoglobin and blood pressure diminishes macrovascular events and survival among type 2 diabetic patients. Relevant questions exist regarding the adequacy of glycohemoglobin alone as a measure of diabetes control. Are we ignoring mechanisms of vasculotoxicity (profibrosis, altered angiogenesis, hypertrophy, hyperplasia, and endothelial injury inherent in current antihyperglycemic medications? Is the polypharmacy for lowering cholesterol, triglyceride, glucose, and systolic blood pressure producing drug interactions that are too complex to be clinically identified? We review angiotensin–aldosterone mechanisms of tissue injury that magnify microvascular damage caused by hyperglycemia and hypertension. Many studies describe interruption of these mechanisms, without hemodynamic consequence, in the preservation of function in type 1 diabetes. Possible interactions between the renin–angiotensin–aldosterone system and physiologic glycemic control (through pulsatile insulin release suggest opportunities for further clinical investigation.Keywords: angiotensin-converting enzyme inhibitor, pulsatile insulin, diabetic nephropathy, cardiac autonomic neuropathy, podocytes, beta cells 

  19. Mesenchymal Stem Cells and Platelet Gel Improve Bone Deposition within CAD-CAM Custom-Made Ceramic HA Scaffolds for Condyle Substitution

    Science.gov (United States)

    Ciocca, L.; Donati, D.; Ragazzini, S.; Dozza, B.; Rossi, F.; Fantini, M.; Spadari, A.; Romagnoli, N.; Landi, E.; Tampieri, A.; Piattelli, A.; Iezzi, G.; Scotti, R.

    2013-01-01

    Purpose. This study evaluated the efficacy of a regenerative approach using mesenchymal stem cells (MSCs) and CAD-CAM customized pure and porous hydroxyapatite (HA) scaffolds to replace the temporomandibular joint (TMJ) condyle. Methods. Pure HA scaffolds with a 70% total porosity volume were prototyped using CAD-CAM technology to replace the two temporomandibular condyles (left and right) of the same animal. MSCs were derived from the aspirated iliac crest bone marrow, and platelets were obtained from the venous blood of the sheep. Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Sheep were sacrificed 4 months postoperatively. The HA scaffolds were explanted, histological specimens were prepared, and histomorphometric analysis was performed. Results. Analysis of the porosity reduction for apposition of newly formed bone showed a statistically significant difference in bone formation between condyles loaded with MSC and condyles without (P condyles with and without MSCs (P condyle with MSCs showed greater bone formation. Conclusion. The split-mouth design confirmed an increment of bone regeneration into the HA scaffold of up to 797% upon application of MSCs. PMID:24073409

  20. PLLA scaffolds surface-engineered via poly (propylene imine) dendrimers for improvement on its biocompatibility/controlled pH biodegradability

    Science.gov (United States)

    Ganjalinia, Atiyeah.; Akbari, Somaye.; Solouk, Atefeh.

    2017-02-01

    Novel aminolyzed Poly (L) Lactic Acid (PLLA) films and electrospun nanofibrous scaffolds were fabricated and characterized as potential substrates for tissue engineering. The second generation polypropylene imine dendrimer (PPI-G2) was used as the aminolysis agent to functionalize the inert surface of PLLA substrates directly without any pre-modification process. The effect of the solvent type, G2 concentration, reaction temperature and time were studied by following weight reduction percentage, FTIR and contact angle measurements due to determined optimum conditions. In addition, the modified scaffolds abbreviated by PLLA/G2 were analyzed using mechanical properties, SEM images and dye assays as host-guest modeling. The results indicate that under the 0.5 (wt.%) G2 concentration, ethanol as the solvent, room temperature and 4 h of treatment, the optimum conditions were obtained. It was shown that the hydrophilic properties of PLLA/G2 were greatly enhanced. Also, pH value analysis revealed that after 4 weeks, the biodegradation of PLLA caused massive immune cells infusion and inflammation in the medium through increasing the acidic rate by secretion the lactic acid, whereas the PLLA/G2 scaffolds greatly reduced and stabilize the acidic rate through aminolysis reaction. Finally, promoted cell adhesion and viability underlined the favorable properties of PLLA/G2 scaffolds as a biodegradable biomaterial for biomedical implants.

  1. Mesenchymal Stem Cells and Platelet Gel Improve Bone Deposition within CAD-CAM Custom-Made Ceramic HA Scaffolds for Condyle Substitution

    Directory of Open Access Journals (Sweden)

    L. Ciocca

    2013-01-01

    Full Text Available Purpose. This study evaluated the efficacy of a regenerative approach using mesenchymal stem cells (MSCs and CAD-CAM customized pure and porous hydroxyapatite (HA scaffolds to replace the temporomandibular joint (TMJ condyle. Methods. Pure HA scaffolds with a 70% total porosity volume were prototyped using CAD-CAM technology to replace the two temporomandibular condyles (left and right of the same animal. MSCs were derived from the aspirated iliac crest bone marrow, and platelets were obtained from the venous blood of the sheep. Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Sheep were sacrificed 4 months postoperatively. The HA scaffolds were explanted, histological specimens were prepared, and histomorphometric analysis was performed. Results. Analysis of the porosity reduction for apposition of newly formed bone showed a statistically significant difference in bone formation between condyles loaded with MSC and condyles without (P<0.05. The bone ingrowth (BI relative values of split-mouth comparison (right versus left side showed a significant difference between condyles with and without MSCs (P<0.05. Analysis of the test and control sides in the same animal using a split-mouth study design was performed; the condyle with MSCs showed greater bone formation. Conclusion. The split-mouth design confirmed an increment of bone regeneration into the HA scaffold of up to 797% upon application of MSCs.

  2. Team function in obstetrics to reduce errors and improve outcomes.

    Science.gov (United States)

    Nielsen, Peter; Mann, Susan

    2008-03-01

    Crew resource management (CRM), adapted from aviation for the practice of medicine, offers the potential of reducing medical errors, increasing employee retention, and improving patient satisfaction. CRM, however, requires a culture that promotes teamwork and acceptance of new concepts. Leadership is needed to transform the culture, as well as to train, coach, and sustain the behavior CRM demands. Culture change can be fostered through teamwork activities that, when made part of a daily routine, provides the basis for modeling teamwork skills and sets the stage for sustained culture change. New tools are available to measure processes as well as patient and staff satisfaction.

  3. Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?

    Science.gov (United States)

    Jindal, Manila; Zheng, Chaoyi; Quadri, Humair S; Ihemelandu, Chukwuemeka U; Hong, Young K; Smith, Andrew K; Dudeja, Vikas; Shara, Nawar M; Johnson, Lynt B; Al-Refaie, Waddah B

    2017-08-01

    Centralization of complex surgical care has led patients to travel longer distances. Emerging evidence suggested a negative association between increased travel distance and mortality after pancreatectomy. However, the reason for this association remains largely unknown. We sought to unravel the relationships among travel distance, receiving pancreatectomy at high-volume hospitals, delayed surgery, and operative outcomes. We identified 44,476 patients who underwent pancreatectomy for neoplasms between 2004 and 2013 at the reporting facility from the National Cancer Database. Multivariable analyses were performed to examine the independent relationships between increments in travel distance mortality (30-day and long-term survival) after adjusting for patient demographics, comorbidity, cancer stage, and time trend. We then examined how additional adjustment of procedure volume affected this relationship overall and among rural patients. Median travel distance to undergo pancreatectomy increased from 16.5 to 18.7 miles (p for trend distance was associated with delayed pancreatectomy, it was also related to higher odds of receiving pancreatectomy at a high-volume hospital and lower postoperative mortality. In multivariable analysis, difference in mortality among patients with varying travel distance was attenuated by adjustment for procedure volume. However, longest travel distance was still associated with a 77% lower 30-day mortality rate than shortest travel among rural patients, even when accounting for procedure volume. Our large national study found that the beneficial effect of longer travel distance on mortality after pancreatectomy is mainly attributable to increase in procedure volume. However, it can have additional benefits on rural patients that are not explained by volume. Distance can represent a surrogate for rural populations. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Regional anesthesia for the trauma patient: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Gadsden J

    2015-08-01

    Full Text Available Jeff Gadsden, Alicia Warlick Department of Anesthesiology, Duke University, Durham, NC, USA Abstract: Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile. Keywords: trauma, injury, nerve block, regional anesthesia, outcomes

  5. Improvement of perinatal outcome in diabetic pregnant women.

    Science.gov (United States)

    Szilagyi, A; Szabo, I

    2001-01-01

    Obstetrical and perinatal outcomes in newborns of diabetic pregnant women depend on metabolic control and fetal surveillance during pregnancy. The effects of fetal surveillance on perinatal mortality and morbidity was analyzed in diabetic pregnant women with appropriate glucose control in our regional center for diabetes and pregnancy. 480 deliveries complicated by frank or gestational diabetes occurred in our Department in the period of 1988-1999. Perinatal mortality and morbidity, prevalence of premature deliveries, methods of fetal surveillance, options for respiratory distress syndrome (RDS) profilaxis, cesarean section rate, timing of delivery and its indications and occurrence of malformations have been analyzed. It was found that malformation rate and perinatal mortality may be reduced to even lower level than that of in healthy pregnant women by appropriate glucose control and by using the latest methods of intrauterine fetal surveillance including cardiotocography (non stress test and oxytocin challenge test), doppler fetal artery velocimetry and fetal pulse oximetry. Timing of delivery was needed in 35% of the cases with IDDM and 15% of gestational diabetes due to chronic placental insufficiency. If labour induction was needed before the 38 weeks, amniocentesis was performed to test fetal lung maturity. Direct fetal glucocorticoid administration was used to enhance fetal lung maturation in 14 cases. C-section rate was slightly higher than that of in non diabetic pregnant women. Our perinatal morbidity data (macrosomia, hyperbilirubinemia, hypoglycemia, injuries, infections) are comparable with the data from the literature. Although perinatal mortality with the help of thorough fetal surveillance is even better in diabetic pregnant women than in non diabetic patients, future eye should be focused on factors affecting perinatal morbidity, because it is still higher than in newborns of healthy mothers.

  6. Improved ischemic stroke outcome prediction using model estimation of outcome probability: the THRIVE-c calculation.

    Science.gov (United States)

    Flint, Alexander C; Rao, Vivek A; Chan, Sheila L; Cullen, Sean P; Faigeles, Bonnie S; Smith, Wade S; Bath, Philip M; Wahlgren, Nils; Ahmed, Niaz; Donnan, Geoff A; Johnston, S Claiborne

    2015-08-01

    The Totaled Health Risks in Vascular Events (THRIVE) score is a previously validated ischemic stroke outcome prediction tool. Although simplified scoring systems like the THRIVE score facilitate ease-of-use, when computers or devices are available at the point of care, a more accurate and patient-specific estimation of outcome probability should be possible by computing the logistic equation with patient-specific continuous variables. We used data from 12 207 subjects from the Virtual International Stroke Trials Archive and the Safe Implementation of Thrombolysis in Stroke - Monitoring Study to develop and validate the performance of a model-derived estimation of outcome probability, the THRIVE-c calculation. Models were built with logistic regression using the underlying predictors from the THRIVE score: age, National Institutes of Health Stroke Scale score, and the Chronic Disease Scale (presence of hypertension, diabetes mellitus, or atrial fibrillation). Receiver operator characteristics analysis was used to assess model performance and compare the THRIVE-c model to the traditional THRIVE score, using a two-tailed Chi-squared test. The THRIVE-c model performed similarly in the randomly chosen development cohort (n = 6194, area under the curve = 0·786, 95% confidence interval 0·774-0·798) and validation cohort (n = 6013, area under the curve = 0·784, 95% confidence interval 0·772-0·796) (P = 0·79). Similar performance was also seen in two separate external validation cohorts. The THRIVE-c model (area under the curve = 0·785, 95% confidence interval 0·777-0·793) had superior performance when compared with the traditional THRIVE score (area under the curve = 0·746, 95% confidence interval 0·737-0·755) (P computing the logistic equation with patient-specific continuous variables in the THRIVE-c calculation, outcomes at the individual patient level are more accurately estimated. Given the widespread availability of

  7. Improving sleep: outcomes from a worksite healthy sleep program.

    Science.gov (United States)

    Steffen, Mark W; Hazelton, Angela C; Moore, Wendy R; Jenkins, Sarah M; Clark, Matthew M; Hagen, Philip T

    2015-01-01

    Unhealthy and inadequate sleep is a common and significant problem impacting absenteeism, presenteeism, health, and productivity. This study aimed at analyzing the effect of a worksite-based healthy sleep program. Retrospective analysis of 53 adult members of a worksite wellness center who participated in an 8-week healthy sleep program and completed pre- and postintervention health behavior questionnaires. Following the intervention participants felt significantly more rested, more confident in their ability to deal with sleep problems, and more knowledgeable about sleep. In addition, they reported a reduction in their stress level, improved quality of life, and increase energy level. These results support the effectiveness of worksite programs designed to promote healthy sleep. Future randomized studies are needed to further investigate the effectiveness and optimal delivery of healthy sleep promotion.

  8. Managing congenital hyperinsulinism: improving outcomes with a multidisciplinary approach

    Directory of Open Access Journals (Sweden)

    Ackermann AM

    2015-07-01

    Full Text Available Amanda M Ackermann, Andrew A Palladino Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA Abstract: Congenital hyperinsulinism (CHI is the most common cause of persistent hypoglycemia in pediatric patients and is associated with significant risk of hypoglycemic seizures and developmental delays. CHI results from mutations in at least nine genes that play a role in regulating beta-cell insulin secretion. Thus, patients with CHI have dysregulated insulin secretion that is unresponsive to blood glucose level. Each different genetic etiology of CHI is associated with particular clinical characteristics that affect management decisions. Given the broad phenotypic spectrum and relatively rare prevalence of CHI, it is important that patients with CHI be evaluated by clinicians experienced with CHI and the multiple subspecialty services that are necessary for the management of the disorder. In this review, we summarize the pathophysiology and genetic causes of CHI and then focus primarily on the most common genetic cause (mutations in the ATP-gated potassium [KATP] channel for further discussion of diagnosis, medical and surgical management, and potential acute and chronic complications. We provide insight from relevant published studies and reports, in addition to anecdotal information from our center’s clinical experience in caring for over 400 patients with CHI. Careful assessment of each patient’s individual pathophysiology is necessary to determine the appropriate treatment regimen, and continued close follow-up and monitoring of disease- and treatment-related complications are essential. Although significant improvements have been made in the past several years with regard to diagnosis and management, given the continued high morbidity rate in patients with CHI, improved diagnostic techniques and new therapeutic options would be welcomed. Keywords: hypoglycemia, hyperinsulinism, beta

  9. ASTM International Workshop on Standards & Measurements for Tissue Engineering Scaffolds

    Science.gov (United States)

    Simon, Carl G.; Yaszemski, Michael J.; Ratcliffe, Anthony; Tomlins, Paul; Luginbuehl, Reto; Tesk, John A.

    2016-01-01

    The “Workshop on Standards & Measurements for Tissue Engineering Scaffolds” was held on May 21, 2013 in Indianapolis, IN and was sponsored by the ASTM International (ASTM). The purpose of the workshop was to identify the highest priority items for future standards work for scaffolds used in the development and manufacture of tissue engineered medical products (TEMPs). Eighteen speakers and 78 attendees met to assess current scaffold standards and to prioritize needs for future standards. A key finding was that the ASTM TEMPs subcommittees (F04.41-46) have many active “guide” documents for educational purposes, but that few standard “test methods” or “practices” have been published. Overwhelmingly, the most clearly identified need was standards for measuring the structure of scaffolds, followed by standards for biological characterization, including in vitro testing, animal models and cell-material interactions. The third most pressing need was to develop standards for assessing the mechanical properties of scaffolds. Additional needs included standards for assessing scaffold degradation, clinical outcomes with scaffolds, effects of sterilization on scaffolds, scaffold composition and drug release from scaffolds. Discussions also highlighted the need for additional scaffold reference materials and the need to use them for measurement traceability. Finally, dialogue emphasized the needs to promote the use of standards in scaffold fabrication, characterization, and commercialization and to assess the use and impact of standards in the TEMPs community. Many scaffold standard needs have been identified and focus should now turn to generating these standards to support the use of scaffolds in TEMPs. PMID:25220952

  10. Assessment and support during early labour for improving birth outcomes.

    Science.gov (United States)

    Kobayashi, Shinobu; Hanada, Nobutsugu; Matsuzaki, Masayo; Takehara, Kenji; Ota, Erika; Sasaki, Hatoko; Nagata, Chie; Mori, Rintaro

    2017-04-20

    The progress of labour in the early or latent phase is usually slow and may include painful uterine contractions. Women may feel distressed and lose their confidence during this phase. Support and assessment interventions have been assessed in two previous Cochrane Reviews. This review updates and replaces these two reviews, which have become out of date. To investigate the effectiveness of assessment and support interventions for women during early labour.In order to measure the effectiveness of the interventions, we compared the duration of labour, the rate of obstetrical interventions, and the rate of other maternal or neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (31 October 2016) and reference lists of retrieved studies. Randomised controlled trials of any assessment or support intervention in the latent phase of labour. We planned to include cluster-randomised trials if they were eligible. We did not include quasi-randomised trials. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We resolved any disagreement by discussion or by involving a third assessor. The quality of the evidence was assessed using the GRADE approach. We included five trials with a total of 10,421 pregnant women in this review update. The trials were conducted in the UK, Canada and America. The trials compared interventions in early labour versus usual care. We examined three comparisons: early labour assessment versus immediate admission to hospital; home visits by midwives versus usual care (telephone triage); and one-to-one structured midwifery care versus usual care. These trials were at moderate- risk of bias mainly because blinding women and staff to these interventions is not generally feasible. For important outcomes we assessed evidence using

  11. [PROGRESS IN BIOLOGICAL TISSUE ENGINEERING SCAFFOLD MATERIALS].

    Science.gov (United States)

    Wei, Xiaojuan; Xi, Tingfei; Zheng, Yufeng

    2014-06-01

    To analyze the progress in biological tissue engineering scaffold materials and the clinical application, as well as product development status. Based on extensive investigation in the status of research and application of biological tissue engineering scaffold materials, a comprehensive analysis was made. Meanwhile, a detailed analysis of research and product development was presented. Considerable progress has been achieved in research, products transformation, clinical application, and supervision of biological scaffold for tissue engineering. New directions, new technology, and new products are constantly emerging. With the continuous progress of science and technology and continuous improvement of life sciences theory, the new direction and new focus still need to be continuously adjusted in order to meet the clinical needs. From the aspect of industrial transformation feasibility, acellular scaffolds and extracellular matrix are the most promising new growth of both research and product development in this field.

  12. Biomimetic nanoclay scaffolds for bone tissue engineering

    Science.gov (United States)

    Ambre, Avinash Harishchandra

    Tissue engineering offers a significant potential alternative to conventional methods for rectifying tissue defects by evoking natural regeneration process via interactions between cells and 3D porous scaffolds. Imparting adequate mechanical properties to biodegradable scaffolds for bone tissue engineering is an important challenge and extends from molecular to macroscale. This work focuses on the use of sodium montmorillonite (Na-MMT) to design polymer composite scaffolds having enhanced mechanical properties along with multiple interdependent properties. Materials design beginning at the molecular level was used in which Na-MMT clay was modified with three different unnatural amino acids and further characterized using Fourier Transform Infrared (FTIR) spectroscopy, X-ray diffraction (XRD). Based on improved bicompatibility with human osteoblasts (bone cells) and intermediate increase in d-spacing of MMT clay (shown by XRD), 5-aminovaleric acid modified clay was further used to prepare biopolymer (chitosan-polygalacturonic acid complex) scaffolds. Osteoblast proliferation in biopolymer scaffolds containing 5-aminovaleric acid modified clay was similar to biopolymer scaffolds containing hydroxyapatite (HAP). A novel process based on biomineralization in bone was designed to prepare 5-aminovaleric acid modified clay capable of imparting multiple properties to the scaffolds. Bone-like apatite was mineralized in modified clay and a novel nanoclay-HAP hybrid (in situ HAPclay) was obtained. FTIR spectroscopy indicated a molecular level organic-inorganic association between the intercalated 5-aminovaleric acid and mineralized HAP. Osteoblasts formed clusters on biopolymer composite films prepared with different weight percent compositions of in situ HAPclay. Human MSCs formed mineralized nodules on composite films and mineralized extracellular matrix (ECM) in composite scaffolds without the use of osteogenic supplements. Polycaprolactone (PCL), a synthetic polymer, was

  13. Bone Marrow-Derived Mesenchymal Stromal Cells Enhanced by Platelet-Rich Plasma Maintain Adhesion to Scaffolds in Arthroscopic Simulation.

    Science.gov (United States)

    Hoberman, Alexander R; Cirino, Carl; McCarthy, Mary Beth; Cote, Mark P; Pauzenberger, Leo; Beitzel, Knut; Mazzocca, Augustus D; Dyrna, Felix

    2017-11-13

    To assess the response of bone marrow-derived mesenchymal stromal cells (bMSCs) enhanced by platelet-rich plasma (PRP) in the setting of a normal human tendon (NHT), a demineralized bone matrix (DBM), and a fibrin scaffold (FS) with simulated arthroscopic mechanical washout stress. Bone marrow was aspirated from the humeral head and concentrated. BMSCs were counted, plated, and grown to confluence. Cells were seeded onto 3 different scaffolds: (1) NHT, (2) DBM, and (3) FS. Each scaffold was treated with a combination of (+)/(-) PRP and (+)/(-) arthroscopic washout simulation. A period of 60 minutes was allotted before arthroscopic washout. Adhesion, proliferation, and differentiation assays were performed to assess cellular activity in each condition. Significant differences were seen in mesenchymal stromal cell adhesion, proliferation, and differentiation among the scaffolds. DBM and FS showed superior results to NHT for cell adhesion, proliferation, and differentiation. PRP significantly enhanced cellular adhesion, proliferation, and differentiation. Arthroscopic simulation did not significantly decrease bMSC adhesion. We found that the type of scaffold impacts bMSCs' behavior. Both scaffolds (DBM and FS) were superior to NHT. The use of an arthroscopic simulator did not significantly decrease the adhesion of bMSCs to the scaffolds nor did it decrease their biologic differentiation potential. In addition, PRP enhanced cellular adhesion, proliferation, and differentiation. Improved healing after tendon repair can lead to better clinical outcomes. BMSCs are attractive for enhancing healing given their accessibility and regenerative potential. Application of bMSCs using scaffolds as cell carriers relies on arthroscopic feasibility. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  14. The dynamics of scaffolding

    NARCIS (Netherlands)

    Van Geert, P. L. C.; Steenbeek, H.W.

    2005-01-01

    In this article we have reinterpreted a relatively standard definition of scaffolding in the context of dynamic systems theory. Our main point is that scaffolding cannot be understood outside the context of a dynamic approach of learning and (formal or informal) teaching. We provide a dynamic

  15. Scaffolding students’ assignments

    DEFF Research Database (Denmark)

    Slot, Marie Falkesgaard

    2013-01-01

    This article discusses scaffolding in typical student assignments in mother tongue learning materials in upper secondary education in Denmark and the United Kingdom. It has been determined that assignments do not have sufficient scaffolding end features to help pupils understand concepts and build...

  16. Customized Care: An intervention to Improve Communication and health outcomes in multimorbidity

    Directory of Open Access Journals (Sweden)

    Marsha N. Wittink

    2016-12-01

    Conclusions: With better communication about everyday challenges, patients and PCPs can have more informed discussions about health care options that positively influence patient outcomes. We expect that Customized Care will improve patient-PCP communication about day-to-day challenges, which can lead to better health outcomes.

  17. Drug Does Not Improve Set of Cardiovascular Outcomes for Diastolic Heart Failure

    Science.gov (United States)

    ... not improve set of cardiovascular outcomes for diastolic heart failure NIH-supported study finds drug does appear to reduce hospitalizations for diastolic heart failure. A drug that blocks the action of a ...

  18. High-risk bladder cancer: improving outcomes with perioperative chemotherapy

    Directory of Open Access Journals (Sweden)

    Daniel Y.C. Heng

    2011-12-01

    Full Text Available Despite treatment with radical cystectomy and pelvic lymph node dissection, muscle invasive bladder cancer has a relapse rate of 50%. Patients can develop regionally advanced or metastatic disease that ultimately leads to death. The addition of neoadjuvant or adjuvant chemotherapy to reduce the risk of relapse and death has been extensively studied over the past two decades. Two contemporary trials coupled with a recent meta-analysis evaluating neoadjuvant chemotherapy demonstrated a modest but real improvement in overall survival. This has made neoadjuvant chemotherapy a standard of care. Clinical trials evaluating adjuvant chemotherapy in patients with high-risk disease have been plagued with statistical flaws and have, therefore, been unable to define the survival impact of this approach. It is hoped that ongoing adjuvant trials that are powered to detect small but meaningful clinical differences will clarify the benefit of chemotherapy after cystectomy. Since there are theoretical advantages and disadvantages to each of these approaches, both are widely used in North America. The evidence behind each approach and potential future developments in this field will be described.

  19. Machine perfusion for improving outcomes following renal transplant: current perspectives

    Directory of Open Access Journals (Sweden)

    Cannon RM

    2016-03-01

    Full Text Available Robert M Cannon,1 Glen A Franklin1,2 1The Hiram C Polk Jr MD Department of Surgery, University of Louisville, 2Kentucky Organ Donor Affiliates, Louisville, KY, USAAbstract: There is a disparity between the number of kidneys available for transplantation and the number of patients awaiting an organ while on dialysis. The current kidney waiting list in the US contains more than 100,000 patients. This need has led to the inclusion of older donors with worsening renal function, as well as greater utilization of kidneys from non-heartbeating (donation after cardiac death donors. Coinciding with this trend has been a growing interest in technology to improve the function of these more marginal organs, the most important of which currently is machine perfusion (MP of donated kidneys after procurement. While this technology has no standard guidelines currently for comprehensive use, there are many studies that demonstrate higher organ yield and function after a period of MP. Particularly with the older donor and during donation after cardiac death cases, MP may offer some significant benefits. This manuscript reviews all of the current literature regarding MP and its role in renal transplantation. We will discuss both the experience in Europe and the US using machine perfusion for donated kidneys.Keywords: machine perfusion, renal transplantation, kidney pumping, renal failure, organ donation

  20. Research Priorities to Improve Future Environmental Water Outcomes

    Directory of Open Access Journals (Sweden)

    Avril C. Horne

    2017-12-01

    Full Text Available Significant progress in environmental flow management has occurred in recent years due to several factors. These include governments committing to environmental flow programs, significant progress in scientific understanding, and environmental flow assessment methods that are cognizant of stakeholder participation and co-design. However, there remain key challenges facing environmental water management. In this paper, we report on a horizon scanning exercise that identified the questions, which, if answered, would deliver much needed progress in the field of environmental water management. We distributed an online survey to ask researchers and practitioners in the field of environmental water management to identify the key questions. The authors then consolidated 268 submitted questions and organized them into key themes. The consolidated list was presented to a workshop of environmental water researchers and practitioners, where attendees were asked to review the questions, vote on the most important, and provide feedback on gaps, issues, or overlaps. The breadth of issues facing environmental water management is captured by the six key themes into which questions were classified: (1 Ecological knowledge and environmental flow assessment methods, (2 Adaptive management, (3 Integrated management and river objectives, (4 Knowledge transfer: applying best practice in a global context, (5 Community knowledge and engagement, and (6 Active management. These questions provide a roadmap for research and management innovations that will improve the effectiveness of environmental flows programs.

  1. Does Professional Development of Preschool Teachers Improve Child Socio-Emotional Outcomes?

    DEFF Research Database (Denmark)

    Jensen, Bente; Jensen, Peter; Rasmussen, Astrid Würtz

    From 2011 to 2013 a randomized controlled trial has been run in Danish preschools to obtain evidence on improvements of early childhood education by providing training to the preschool teachers. The purpose of the intervention is to improve child socio-emotional outcomes (measured by SDQ), especi......From 2011 to 2013 a randomized controlled trial has been run in Danish preschools to obtain evidence on improvements of early childhood education by providing training to the preschool teachers. The purpose of the intervention is to improve child socio-emotional outcomes (measured by SDQ...

  2. Role of video games in improving health-related outcomes: a systematic review.

    Science.gov (United States)

    Primack, Brian A; Carroll, Mary V; McNamara, Megan; Klem, Mary Lou; King, Brandy; Rich, Michael; Chan, Chun W; Nayak, Smita

    2012-06-01

    Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it also may be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes. Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source); sample data (e.g., number of study participants, demographics); intervention and control details; outcomes data; and quality measures were abstracted independently by two researchers. Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with appropriate rigor will help build evidence in this

  3. In vitro evaluation of decellularized ECM-derived surgical scaffold biomaterials.

    Science.gov (United States)

    Luo, Xiao; Kulig, Katherine M; Finkelstein, Eric B; Nicholson, Margaret F; Liu, Xiang-Hong; Goldman, Scott M; Vacanti, Joseph P; Grottkau, Brian E; Pomerantseva, Irina; Sundback, Cathryn A; Neville, Craig M

    2017-04-01

    Decellularized extracellular matrix (ECM) biomaterials are increasingly used in regenerative medicine for abdominal tissue repair. Emerging ECM biomaterials with greater compliance target surgical procedures like breast and craniofacial reconstruction to enhance aesthetic outcome. Clinical studies report improved outcomes with newly designed ECM scaffolds, but their comparative biological characteristics have received less attention. In this study, we investigated scaffolds derived from dermis (AlloDerm Regenerative Tissue Matrix), small intestinal submucosa (Surgisis 4-layer Tissue Graft and OASIS Wound Matrix), and mesothelium (Meso BioMatrix Surgical Mesh and Veritas Collagen Matrix) and evaluated biological properties that modulate cellular responses and recruitment. An assay panel was utilized to assess the ECM scaffold effects upon cells. Results of the material-conditioned media study demonstrated Meso BioMatrix and OASIS best supported cell proliferation. Meso BioMatrix promoted the greatest migration and chemotaxis signaling, followed by Veritas and OASIS; OASIS had superior suppression of cell apoptosis. The direct adhesion assay indicated that AlloDerm, Meso BioMatrix, Surgisis, and Veritas had sidedness that affected cell-material interactions. In the chick chorioallantoic membrane assay, Meso BioMatrix and OASIS best supported cell infiltration. Among tested materials, Meso BioMatrix and OASIS demonstrated characteristics that facilitate scaffold incorporation, making them promising choices for many clinical applications. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 585-593, 2017. © 2015 Wiley Periodicals, Inc.

  4. Patient profile and periprocedural outcomes of bioresorbable vascular scaffold implantation in comparison with drug-eluting and bare-metal stent implantation. Experience from ORPKI Polish National Registry 2014–2015

    Directory of Open Access Journals (Sweden)

    Łukasz Rzeszutko

    2016-11-01

    Full Text Available Introduction: There are limited data on the comparison of bioresorbable vascular scaffold (BVS and drug-eluting stent (DES/bare-metal stent (BMS implantation in an unselected population of patients with coronary artery disease. Aim : To compare the periprocedural outcomes and patient profile of BVS and DES/BMS implantation in an all-comer population from the ORPKI Polish National Registry. Material and methods: A total of 141,324 consecutive patients from 151 invasive cardiology centers in Poland were included in this prospective registry between January 2014 and June 2015. Periprocedural data on patients with at least one BVS (Absorb, Abbott Vascular, Santa Clara, CA, USA, DES or BMS (all available types implantation in de novo lesions during index percutaneous coronary intervention for stable angina (SA or acute coronary syndrome were collected. Results : Bioresorbable vascular scaffold was the most often used in patients with SA, in single-vessel disease and in younger male patients. Bioresorbable vascular scaffold implantation was significantly more often associated with periprocedural administration of ticagrelor/prasugrel (6.8% vs. 3.6%; p = 0.001 and use of intravascular ultrasound and optical coherence tomography in comparison with the DES/BMS group (2.8% vs. 0.6% and 1.8% vs. 0.1%, respectively; p = 0.001 for both. The incidence of periprocedural death was significantly lower in the BVS group than the DES/BMS group (0.04% vs. 0.32%; p = 0.02, but this difference was no longer significant after adjustment for covariates. On the other hand, coronary artery perforation occurred significantly more often during BVS delivery (0.31% vs. 0.12%; p = 0.01, and BVS implantation was identified as an independent predictor of coronary artery perforation in multivariate logistic regression analysis (OR = 6.728, 95% CI: 2.394–18.906; p = 0.001. Conclusions : Patients treated with BVS implantation presented an acceptable safety and efficacy profile in

  5. Platlet Rich Plasma (PRP) Improves Fat Grafting Outcomes.

    Science.gov (United States)

    Modarressi, Ali

    2013-01-01

    Autologous fat transfer offers many qualities of a ideal soft tissue filler. Main advantages of fat grafting ensue from the fact that the lipoaspirate tissue is an abundant source of regenerative pluripotential cells. However, the reported rates of fat cell survival vary greatly in the medical literature (10-90%). Different techniques of harvesting, processing, and reinjecting the fat cells are so claimed to be responsible for these differences, without any agreement concerning the best way to process. To address this important disadvantage, we propose the addition of autologous platelet rich plasma (PRP) which is known as a natural reservoir of growth factors stimulating tissue repair and regeneration. This approach is completely autologous and immediately employed without any type of preconditioning. Platelets rich plasma (PRP) preparation included bleeding of 8 ml of blood from patient's peripheral vein in Regen Lab© tubes containing sodium citrate anticoagulant. The whole blood was centrifugated at 1500 g during 3 min. As Regen-tubes contained a special gel separator, 99 % of red blood cells were discarded from the plasma at the bottom of the gel, and >90% of platelets were harvested in 4 ml of plasma on the top of the gel, called the platelet-rich plasma (PRP). The purified fat prepared by Coleman technique was mixed with different amount of PRP for in vitro, in vivo (mice) and clinical experiments: >50% of PRP for skin rejuvenation, superficial scars correction, infraorbital region, ..., and for 20% of PRP with 80% of purified fat for deep filler indication (nasolabial folds, lips, or soft tissue defect). In vitro studies demonstrated that PRP increased fat cells survival rate and stem cells differentiation. Animal models showed that fat graft survival rate was significantly increased by addition of PRP. Several clinical cases confirmed the improvement of wound healing and fat grafting survival in facial reconstruction and aesthetic cases by association of

  6. The Boston type I keratoprosthesis: improving outcomes and expanding indications.

    Science.gov (United States)

    Aldave, Anthony J; Kamal, Khairidzan M; Vo, Rosalind C; Yu, Fei

    2009-04-01

    To report the usefulness of the Boston type I keratoprosthesis (Massachusetts Eye and Ear Infirmary, Boston, MA) in the management of corneal opacification, corneal limbal stem cell failure, or both in a large single-surgeon series. Retrospective review of consecutive clinical case series. All patients undergoing keratoprosthesis implantation by a single surgeon (AJA) between May 1, 2004, and May 31, 2008. Data were collected regarding the preoperative characteristics of each eye undergoing keratoprosthesis implantation, the surgical procedure(s) performed, and the postoperative course. Statistical analysis was performed to identify factors influencing the incidence and severity of postoperative complications. Interval visual acuities, keratoprosthesis retention, and significant postoperative complications. Fifty-seven keratoprosthesis procedures were performed in 50 eyes of 49 patients. The primary indication for surgery was repeat corneal transplantation failure (68%), although no prior corneal surgery had been performed in 16% of eyes. Preoperative visual acuity was 20/200 or worse in all eyes, with 88% of eyes having preoperative vision of counting fingers, hand movements, or light perception. The percentage of eyes with postoperative visual acuity of 20/100 or better was 67% at 6 months (n = 45), 75% at 1 year (n = 28), 69% at 2 years (n = 13), and 100% at 3 years (n = 7). In the 31% of patients in whom preoperative vision in the contralateral eye was 20/50 or better, the postoperative vision in the operative eye improved to 20/50 or better in 47% at the last follow-up (average, 18 months; range, 4-49 months). The overall keratoprosthesis retention rate was 84% at an average follow-up of 17 months (79 person-years of follow-up), with 100% retention in 8 eyes with no history of prior corneal transplantation (14.8 person-years of follow-up). The most common postoperative complications were retroprosthetic membrane formation (22 eyes) and persistent epithelial

  7. Ethnicity Moderates the Outcomes of Self-Enhancement and Self-Improvement Themes in Expressive Writing

    Science.gov (United States)

    Tsai, William; Lau, Anna S.; Niles, Andrea N.; Coello, Jordan; Lieberman, Matthew D.; Ko, Ahra C.; Hur, Christopher; Stanton, Annette L.

    2014-01-01

    The current study examined whether writing content related to self-enhancing (viz., downward social comparison and situational attributions) and self-improving (viz., upward social comparison and persistence) motivations were differentially related to expressive writing outcomes among 17 Asian American and 17 European American participants. Content analysis of the essays revealed no significant cultural group differences in the likelihood of engaging in self-enhancing vs. self-improving reflections on negative personal experiences. However, cultural group differences were apparent in the relation between self-motivation processes and changes in anxiety and depressive symptoms at 3-month follow-up. Among European Americans, writing that reflected downward social comparison predicted positive outcomes, whereas persistence writing themes were related to poorer outcomes. For Asian Americans, writing about persistence was related to positive outcomes, whereas downward social comparison and situational attributions predicted poorer outcomes. Findings provide evidence suggesting culturally distinct mechanisms for the effects of expressive disclosure. PMID:25111547

  8. Brachial plexus surgery: the role of the surgical technique for improvement of the functional outcome

    Directory of Open Access Journals (Sweden)

    Leandro Pretto Flores

    2011-08-01

    Full Text Available OBJECTIVE: The study aims to demonstrate the techniques employed in surgery of the brachial plexus that are associated to evidence-based improvement of the functional outcome of these patients. METHOD: A retrospective study of one hundred cases of traumatic brachial plexus injuries. Comparison between the postoperative outcomes associated to some different surgical techniques was demonstrated. RESULTS: The technique of proximal nerve roots grafting was associated to good results in about 70% of the cases. Significantly better outcomes were associated to the Oberlin's procedure and the Sansak's procedure, while the improvement of outcomes associated to phrenic to musculocutaneous nerve and the accessory to suprascapular nerve transfer did not reach statistical significance. Reinnervation of the hand was observed in less than 30% of the cases. CONCLUSION: Brachial plexus surgery renders satisfactory results for reinnervation of the proximal musculature of the upper limb, however the same good outcomes are not usually associated to the reinnervation of the hand.

  9. Health Care Improvement and Continuing Interprofessional Education: Continuing Interprofessional Development to Improve Patient Outcomes

    Science.gov (United States)

    Wilcock, Peter M.; Janes, Gillian; Chambers, Alison

    2009-01-01

    Health care improvement and continuing professional education must be better understood if we are to promote continuous service improvement through interprofessional learning in the workplace. We propose that situating interprofessional working, interprofessional learning, work-based learning, and service improvement within a framework of social…

  10. The theory of music, mood and movement to improve health outcomes.

    Science.gov (United States)

    Murrock, Carolyn J; Higgins, Patricia A

    2009-10-01

    This paper presents a discussion of the development of a middle-range nursing theory of the effects of music on physical activity and improved health outcomes. Due to the high rate of physical inactivity and the associated negative health outcomes worldwide, nurses need new evidence-based theories and interventions to increase physical activity. The theory of music, mood and movement (MMM) was developed from physical activity guidelines and music theory using the principles of statement and theory synthesis. The concepts of music, physical activity and health outcomes were searched using the CINAHL, MEDLINE, ProQuest Nursing and Allied Health Source, PsycINFO and Cochrane Library databases covering the years 1975-2008. The theory of MMM was synthesized by combining the psychological and physiological responses of music to increase physical activity and improve health outcomes. It proposes that music alters mood, is a cue for movement, and makes physical activity more enjoyable leading to improved health outcomes of weight, blood pressure, blood sugar and cardiovascular risk factor management, and improved quality of life. As it was developed from the physical activity guidelines, the middle-range theory is prescriptive, produces testable hypotheses, and can guide nursing research and practice. The middle-range theory needs to be tested to determine its usefulness for nurses to develop physical activity programmes to improve health outcomes across various cultures.

  11. Trial protocol OPPTIMUM– Does progesterone prophylaxis for the prevention of preterm labour improve outcome?

    Directory of Open Access Journals (Sweden)

    Norman Jane E

    2012-08-01

    Full Text Available Abstract Background Preterm birth is a global problem, with a prevalence of 8 to 12% depending on location. Several large trials and systematic reviews have shown progestogens to be effective in preventing or delaying preterm birth in selected high risk women with a singleton pregnancy (including those with a short cervix or previous preterm birth. Although an improvement in short term neonatal outcomes has been shown in some trials these have not consistently been confirmed in meta-analyses. Additionally data on longer term outcomes is limited to a single trial where no difference in outcomes was demonstrated at four years of age of the child, despite those in the “progesterone” group having a lower incidence of preterm birth. Methods/Design The OPPTIMUM study is a double blind randomized placebo controlled trial to determine whether progesterone prophylaxis to prevent preterm birth has long term neonatal or infant benefit. Specifically it will study whether, in women with singleton pregnancy and at high risk of preterm labour, prophylactic vaginal natural progesterone, 200 mg daily from 22 – 34 weeks gestation, compared to placebo, improves obstetric outcome by lengthening pregnancy thus reducing the incidence of preterm delivery (before 34 weeks, improves neonatal outcome by reducing a composite of death and major morbidity, and leads to improved childhood cognitive and neurosensory outcomes at two years of age. Recruitment began in 2009 and is scheduled to close in Spring 2013. As of May 2012, over 800 women had been randomized in 60 sites. Discussion OPPTIMUM will provide further evidence on the effectiveness of vaginal progesterone for prevention of preterm birth and improvement of neonatal outcomes in selected groups of women with singleton pregnancy at high risk of preterm birth. Additionally it will determine whether any reduction in the incidence of preterm birth is accompanied by improved childhood outcome. Trial

  12. Immediate and midterm outcomes following primary PCI with bioresorbable vascular scaffold implantation in patients with ST-segment myocardial infarction: insights from the multicentre "Registro ABSORB Italiano" (RAI registry).

    Science.gov (United States)

    Ielasi, Alfonso; Cortese, Bernardo; Varricchio, Attilio; Tespili, Maurizio; Sesana, Marco; Pisano, Francesco; Loi, Bruno; Granata, Francesco; Moscarella, Elisabetta; Silva Orrego, Pedro; La Vecchia, Luigi; Steffenino, Giuseppe

    2015-06-01

    In this multicentre prospective registry we sought to evaluate the immediate and midterm clinical outcomes following single or multiple overlapping bioresorbable vascular scaffold (BVS) implantation in the STEMI setting. A prospective cohort analysis was performed on all STEMI patients who underwent primary PCI with BVS implantation. Between December 2012 and February 2014, 1,232 STEMI patients underwent primary PCI at the participating centres. Of these, 74 (6.0%) received a BVS, 18 (24.3%) of them were multiple and overlapping. Procedural success was obtained in 72 (97.3%) cases without differences between the groups (overlapping BVS 100% vs. single BVS 96.4%, p=0.5). One patient experienced a reinfarction due to subacute BVS thrombosis which was successfully managed with balloon-only PCI while the other patient had a "slow-flow" phenomenon (final TIMI flow 2). At six-month follow-up, two non-fatal MI (2.7%), three target lesion revascularisations (4.1%), and one subacute BVS thrombosis were reported in three patients (one [5.6%] overlapping BVS and two [3.6%] in the single BVS group, p=0.5). All the events were successfully managed with re-PCI. BVS implantation in STEMI patients can be successfully performed with a high procedural success rate and encouraging midterm outcomes. Larger randomised trials and longer follow-up are needed to assess the potential clinical benefit of BVS versus new-generation DES in this setting.

  13. Graphene based scaffolds on bone tissue engineering.

    Science.gov (United States)

    Shadjou, Nasrin; Hasanzadeh, Mohammad; Khalilzadeh, Balal

    2017-11-02

    Tissue engineering has been emerging as a valid approach to the current therapies for bone regeneration/substitution. Tissue-engineered bone constructs have the potential to alleviate the demand arising from the shortage of suitable autograft and allograft materials for augmenting bone healing. Scaffolds play a central role in tissue engineering research, they not only provide as structural support for specific cells but also provide as the templates to guide new tissue growth and construction. In this survey we describe application of graphene based nano-biomaterials for bone tissue engineering. In this article, application of different graphene based materials on construction of manufacture scaffolds for bone tissue engineering was discussed. It begins by giving the reader a brief background on tissue engineering, followed by a comprehensive description of all the relevant components of graphene based materials, going from materials to scaffolds and from cells to tissue engineering strategies that will lead to "engineered" bone. In this survey, more recent studies on the effects of graphene on surface modifications of scaffold materials was discused. The ability of graphene to improve the biological properties of scaffold materials, and its ability to promote the adhesion, proliferation, and osteoblasts have been demonstrated in several studies which we discuss in this survey article. We further highlight how the properties of graphene are being exploited for scaffolds in bone tissue engineering, comprehensively surveying recent experimental works featuring graphene and graphene derivatives. Bone tissue engineering, for the purpose of this survey, is the use of a scaffolding material to either induce formation of bone from the surrounding tissue or to act as a carrier or template for implanted bone cells or other agents. Materials used as bone tissue-engineered scaffolds may be injectable or rigid, the latter requiring an operative implantation procedure.

  14. Evaluating a New and Aspiring County Extension Director Leadership Education Program: Determining Outcomes and Needed Improvements

    Science.gov (United States)

    Jayaratne, K. S. U.; Owen, Mitchel; Jones, David

    2010-01-01

    This leadership education evaluation study explored the leadership development outcomes of potential county extension directors and the ways to improve the program. The leadership education program aimed to improve participants' leadership abilities in understanding self, building relationships and managing resources. The analysis of quantitative…

  15. A Measurement Feedback System (MFS) Is Necessary to Improve Mental Health Outcomes

    Science.gov (United States)

    Bickman, Leonard

    2008-01-01

    The importance of measurement feedback system (MFS) for the improvement of mental health services for youths is discussed. As feedback obtained from clients and families is subject to distortions, a standardized MFS including clinical processes, contexts, outcomes, and feedback to clinicians and supervisors is necessary for improvement in quality…

  16. Improving diabetes patient outcomes: framing research into the chronic care model.

    Science.gov (United States)

    Dancer, Susan; Courtney, Maureen

    2010-11-01

    To review recent research findings that improve outcomes for type 2 diabetes mellitus (T2DM) patients and frame them within the chronic care model (CCM). Published research studies and research reviews from multiple computerized databases were examined regarding care of patients with T2DM. Improving outcomes for patients with chronic diseases such as T2DM is a healthcare system imperative. Disease management must shift from an incomplete and scattered focus on episodic care to a comprehensive model of care such as offered by the CCM. This model emphasizes the essential elements of health organization, clinical information systems, decision support, delivery system design, self-management support, and community required to effectively improve care for these patients. Understanding the comprehensive elements needed for quality chronic disease care is essential to improving outcomes. As new interventions for improving T2DM outcomes become available, the nurse practitioner (NP) must be able to evaluate these as they relate to elements of care that comprise the CCM. Framing new research interventions into this model allows the NP to assume a multifaceted leadership role in improving the care and outcomes of these patients. ©2010 The Author(s) Journal compilation ©2010 American Academy of Nurse Practitioners.

  17. Bioactive Nano-fibrous Scaffold for Vascularized Craniofacial Bone Regeneration

    DEFF Research Database (Denmark)

    Prabha, Rahul Damodaran; Kraft, David Christian Evar; Harkness, Linda

    2017-01-01

    and biocompatibility properties of the new scaffold material. Our results indicate PVA-PCL-HAB scaffolds support attachment and growth of stromal stem cells; (human bone marrow skeletal (mesenchymal) stem cells (hMSC) and dental pulp stem cells (DPSC)). In addition, the scaffold supported in vitro osteogenic...... the limitation of cell penetration of electrospun scaffolds and improve on its osteoconductive nature, in this study, we fabricated a novel electrospun composite scaffold of polyvinyl alcohol (PVA) - poly (ε) caprolactone (PCL) - Bioceramic (HAB), namely, PVA-PCL-HAB. The scaffold prepared by dual...... electrospinning of PVA and PCL with HAB overcomes reduced cell attachment associated with hydrophobic poly (ε) caprolactone (PCL) by combination with a hydrophilic polyvinyl alcohol (PVA) and the bioceramic (HAB) can contribute to enhance osteo-conductivity. We characterized the physicochemical...

  18. Development Scaffolding for Construction of Evaluation Instrument Training Program on The Cognitive Domain For Senior High School Physics Teachers and The Same Level

    Science.gov (United States)

    Arif, W.; Suhandi, A.; Kaniawati, I.; Setiawan, A.

    2017-02-01

    The development of scaffolding for evaluation instrument construction training program on the cognitive domain for senior high school physics teacher and the same level that is specified in the test instrument has been done. This development was motivated by the low ability of the majority of physics teachers in constructing the physics learning achievement test. This situation not in accordance with the demands of Permendiknas RI no. 16 tahun 2007 concerning the standard of academic qualifications and competence of teachers, stating that teachers should have a good ability to develop instruments for assessment and evaluation of process and learning outcomes. Based on the preliminary study results, it can be seen that the main cause of the inability of teachers in developing physics achievement test is because they do not good understand of the indicators for each aspect of cognitive domains. Scaffolding development is done by using the research and development methods formulated by Thiagarajan which includes define, design and develope steps. Develop step includes build the scaffolding, validation of scaffolding by experts and the limited pilot implementations on the training activities. From the build scaffolding step, resulted the scaffolding for the construction of test instruments training program which include the process steps; description of indicators, operationalization of indicators, construction the itemsframework (items scenarios), construction the items stem, construction the items and checking the items. The results of the validation by three validator indicates that the built scaffolding are suitable for use in the construction of physics achievement test training program, especially for novice. The limited pilot implementation of the built scaffolding conducted in training activities attended by 10 senior high school physics teachers in Garut district. The results of the limited pilot implementation shows that the built scaffolding have a medium

  19. Predictors of improvement in observed functional ability in patients with fibromyalgia as an outcome of rehabilitation

    DEFF Research Database (Denmark)

    Amris, Kirstine; Luta, George; Christensen, Robin

    2016-01-01

    OBJECTIVE: To investigate predictors of improvement in observed ability to manage activities of daily living as an outcome of rehabilitation in fibromyalgia. METHODS: Exploratory analyses used data from the Interdisciplinary Rehabilitation and Evaluation Programme for Patients with Chronic...... Widespread Pain (the IMPROvE study); a randomized controlled trial including 191 females with fibromyalgia randomized (1:1) to rehabilitation or a waiting list. The primary outcome was observed activities of daily living ability evaluated with the Assessment of Motor and Process Skills (AMPS) 6 months post...

  20. The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes

    NARCIS (Netherlands)

    Winters, S.; Kool, R. B.; Klazinga, N. S.; Huijsman, R.

    2014-01-01

    To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate

  1. The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes

    NARCIS (Netherlands)

    Winters, S.; Kool, R.B.; Klazinga, N.S.; Huijsman, R.

    2014-01-01

    OBJECTIVE: To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. DESIGN: A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships

  2. IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

    OpenAIRE

    Howarth, Emma; Moore, Theresa HM; Welton, Nicky J.; Lewis, Natalia; Stanley, Nicky; MacMillan, Harriet; Shaw, Alison; Hester, Marianne; Bryden, Peter; Feder, Gene

    2016-01-01

    BackgroundExposure to domestic violence and abuse (DVA) during childhood and adolescence increases the risk of negative outcomes across the lifespan.ObjectivesTo synthesise evidence on the clinical effectiveness, cost-effectiveness and acceptability of interventions for children exposed to DVA, with the aim of making recommendations for further research.Design(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and profes...

  3. Will antirheumatic treatment improve cardiovascular outcomes in patients with rheumatoid arthritis?

    Science.gov (United States)

    Pieringer, Herwig; Pichler, Max; Pohanka, Erich; Hoppe, Uta C

    2014-01-01

    In recent years, the scientific community has gained significant insight into the complex interaction between inflammation and the cardiovascular system in patients with rheumatoid arthritis (RA), which leads to increased cardiovascular (CV) morbidity and mortality in these patients. Our common understanding of this association is that persistent inflammation contributes to the development of premature atherosclerosis. Consequently, the question arises whether control of inflammation with antirheumatic treatment will be able to improve CV outcome. While there are a lot of data that demonstrate improvement of numerous CV surrogate markers in patients treated with virtually all antirheumatic drug classes, there is much less information about the possible translation of these beneficial effects into improved CV outcome. In summary, the published evidence suggests that tumor necrosis factor (TNF) alpha inhibitors may improve CV outcome. The same is true for methotrexate (MTX). However, it is not clear whether MTX works via suppression of inflammation or through drug specific mechanisms. For other traditional disease-modifying antirheumatic drugs and biologic therapies, there are no convincing data for improved CV outcome. Only a few drugs (glucocorticoids and NSAIDs) have been associated with increased CV risk. Treating RA aggressively, as recommended by current guidelines, is likely to have a beneficial effect on CV outcomes.

  4. Improving post-intensive care unit neuropsychiatric outcomes: understanding cognitive effects of physical activity.

    Science.gov (United States)

    Hopkins, Ramona O; Suchyta, Mary R; Farrer, Thomas J; Needham, Dale

    2012-12-15

    Critical illness and its treatment often result in long-term neuropsychiatric morbidities. Consequently, there is a need to focus on means to prevent or ameliorate these morbidities. Animal models provide important data regarding the neurobiological effects of physical activity, including angiogenesis, neurogenesis, and release of neurotrophic factors that enhance plasticity. Studies in noncritically ill patients demonstrate that exercise is associated with increased cerebral blood flow, neurogenesis, and brain volume, which are associated with improved cognition. Clinically, research in both healthy and diseased human subjects suggests that exercise improves neuropsychiatric outcomes. In the critical care setting, early physical rehabilitation and mobilization are safe and feasible, with demonstrated improvements in physical functional outcomes. Such activity may also reduce the duration of delirium in the intensive care unit (ICU) and improve neuropsychiatric outcomes, although data are limited. Barriers exist regarding implementing ICU rehabilitation in routine care, including use of sedatives and lack of awareness of post-ICU cognitive impairments. Further research is necessary to determine whether prior animal and human research, in conjunction with preliminary results from existing ICU studies, can translate into improvements for neuropsychiatric outcomes in critically ill patients. Studies are needed to evaluate biological mechanisms, risk factors, the role of pre-ICU functional level, and the timing, duration, and type of physical activity for optimal patient outcomes.

  5. Tailored deep brain stimulation optimization for improved airway protective outcomes in Parkinson's disease

    Directory of Open Access Journals (Sweden)

    Michelle S. Troche

    2016-09-01

    Full Text Available There is no consensus regarding the effects of deep brain stimulation (DBS surgery on swallowing outcomes in Parkinson's disease (PD. No prospective studies have compared airway protective outcomes following DBS to the subthalamic nucleus (STN versus globus pallidus interna (GPi. A recent retrospective study described swallowing outcomes pre- and post-STN vs. GPi DBS in a cohort of 34 patients with PD. The results revealed that the patients who received GPi DBS maintained their swallowing function post-DBS, while those in the STN group significantly worsened in swallowing safety. As DBS surgery becomes a common management option in PD it is important to understand the impact of DBS on airway protective outcomes; especially given that aspiration pneumonia is the leading cause of death in this population. We present a case report in which optimizing DBS settings with the goal of improving laryngeal function resulted in immediate improvements to swallowing safety.

  6. Construction of CaF2-appended PVA nanofibre scaffold

    Indian Academy of Sciences (India)

    2018-02-02

    Feb 2, 2018 ... Transmission electron microscopy results showed that many CaF2 nanoparticles were well dispersed in the PVA fibre matrix. The water- resistant ability of the scaffold was improved through intermolecular crosslinking of PVA by formaldehyde vapour. This novel material seems to be a promising scaffold for ...

  7. Scaffolds in regenerative endodontics: A review

    Science.gov (United States)

    Gathani, Kinjal M.; Raghavendra, Srinidhi Surya

    2016-01-01

    Root canal therapy has enabled us to save numerous teeth over the years. The most desired outcome of endodontic treatment would be when diseased or nonvital pulp is replaced with healthy pulp tissue that would revitalize the teeth through regenerative endodontics. ‘A search was conducted using the Pubmed and MEDLINE databases for articles with the criteria ‘Platelet rich plasma’, ‘Platelet rich fibrin’, ‘Stem cells’, ‘Natural and artificial scaffolds’ from 1982–2015’. Tissues are organized as three-dimensional structures, and appropriate scaffolding is necessary to provide a spatially correct position of cell location and regulate differentiation, proliferation, or metabolism of the stem cells. Extracellular matrix molecules control the differentiation of stem cells, and an appropriate scaffold might selectively bind and localize cells, contain growth factors, and undergo biodegradation over time. Different scaffolds facilitate the regeneration of different tissues. To ensure a successful regenerative procedure, it is essential to have a thorough and precise knowledge about the suitable scaffold for the required tissue. This article gives a review on the different scaffolds providing an insight into the new developmental approaches on the horizon. PMID:27857762

  8. Mindfulness-Based Stress Reduction Therapy Improves Patient and Caregiver-Reported Outcomes in Cirrhosis

    OpenAIRE

    Bajaj, Jasmohan S; Ellwood, Michael; Ainger, Timothy; Burroughs, Thomas; Fagan, Andrew; Gavis, Edith A; Heuman, Douglas M.; Fuchs, Michael; John, Binu; Wade, James B

    2017-01-01

    Objectives: Patient-reported outcomes such as health-related quality of life (HRQOL) are impaired in cirrhosis due to under-treated mood and sleep disorders, which can adversely impact their caregivers. Mindfulness-based stress reduction (MBSR) can improve patient-reported outcomes (PRO) in non-cirrhotic patients but their impact in cirrhosis is unclear. To evaluate the effect of MBSR and supportive group therapy on mood, sleep and HRQOL in cirrhotic patients and their caregivers. Methods: Ci...

  9. Soy Protein Scaffold Biomaterials for Tissue Engineering and Regenerative Medicine

    Science.gov (United States)

    Chien, Karen B.

    Developing functional biomaterials using highly processable materials with tailorable physical and bioactive properties is an ongoing challenge in tissue engineering. Soy protein is an abundant, natural resource with potential use for regenerative medicine applications. Preliminary studies show that soy protein can be physically modified and fabricated into various biocompatible constructs. However, optimized soy protein structures for tissue regeneration (i.e. 3D porous scaffolds) have not yet been designed. Furthermore, little work has established the in vivo biocompatibility of implanted soy protein and the benefit of using soy over other proteins including FDA-approved bovine collagen. In this work, freeze-drying and 3D printing fabrication processes were developed using commercially available soy protein to create porous scaffolds that improve cell growth and infiltration compared to other soy biomaterials previously reported. Characterization of scaffold structure, porosity, and mechanical/degradation properties was performed. In addition, the behavior of human mesenchymal stem cells seeded on various designed soy scaffolds was analyzed. Biological characterization of the cell-seeded scaffolds was performed to assess feasibility for use in liver tissue regeneration. The acute and humoral response of soy scaffolds implanted in an in vivo mouse subcutaneous model was also investigated. All fabricated soy scaffolds were modified using thermal, chemical, and enzymatic crosslinking to change properties and cell growth behavior. 3D printing allowed for control of scaffold pore size and geometry. Scaffold structure, porosity, and degradation rate significantly altered the in vivo response. Freeze-dried soy scaffolds had similar biocompatibility as freeze-dried collagen scaffolds of the same protein content. However, the soy scaffolds degraded at a much faster rate, minimizing immunogenicity. Interestingly, subcutaneously implanted soy scaffolds affected blood

  10. Debriefing to improve outcomes from critical illness: a systematic review and meta-analysis.

    Science.gov (United States)

    Couper, Keith; Salman, Bilal; Soar, Jasmeet; Finn, Judith; Perkins, Gavin D

    2013-09-01

    Intensive care clinicians play a central role in the co-ordination and treatment of patients that develop life-threatening emergencies. This review evaluates the effect of debriefing after life-threatening emergencies and considers the implications for intensive care training and practice. Studies were identified by searching electronic databases, citation tracking, and contact with subject specialists. Studies evaluating the effect of debriefing after life-threatening emergencies on clinician performance (process) and/or patient outcomes were eligible for inclusion. Study quality was assessed and summarised using the GRADE system. The search identified 2,720 studies. After detailed review, 27 studies were included of which 20 supported the use of debriefing. Debriefing was viewed positively (n = 3), improved learning (n = 1), enhanced non-technical performance (n = 4) and technical performance (n = 16), and improved patient outcomes (n = 2). Four cardiac arrest studies were suitable for meta-analysis. This found evidence of improved resuscitation process outcomes [compression fraction (mean difference 6.80, 95 % CI 4.19-9.40, p debriefing as an educational strategy to improve clinician knowledge and skill acquisition and implementation of those skills in practice. However, the effect of debriefing on long-term patient outcomes is uncertain. There remains a need for further high-quality research, which seeks to identify the optimal method for debriefing delivery and effect on patient outcomes.

  11. Review of family-based approaches to improve postoperative outcomes among bariatric surgery patients.

    Science.gov (United States)

    Vidot, Denise C; Prado, Guillermo; De La Cruz-Munoz, Nestor; Cuesta, Melissa; Spadola, Christine; Messiah, Sarah E

    2015-01-01

    Bariatric surgery must be partnered with postoperative lifestyle modifications for enduring weight loss and related health effects to be fully appreciated. Little is known about how these lifestyle modifications may be affected by the involvement of other family members living in the household; therefore, this review describes current family-based approaches to improving postoperative outcomes in bariatric surgery patients and their families. A MEDLINE search of publications from 1999 to 2014 was conducted in January 2014. Retrieved titles and abstracts were assessed by 2 authors to determine relevance to the topic surrounding family-based approaches to improve postbariatric surgery outcomes. All study designs except case studies were considered if they included some aspect of family as a predictor in relation to improved health outcomes after surgery. Initial searches yielded 650 publications (bariatric surgery+family, n = 193; bariatric surgery+child, n = 338; bariatric surgery+spouse, n = 4; bariatric surgery+social support, n = 115). Two studies met criteria for a family-based approach to improving metabolic outcomes in bariatric patients. Seven studies discussed the impact of bariatric surgery on families. All other studies were excluded for not discussing family-based approaches. Despite limited documentation of family-based approaches on improving health outcomes in patients who underwent bariatric surgery, evidence suggests that such an approach may be advantageous if planned a priori to occur before, during, and after bariatric surgery. Future studies could test the combination of bariatric surgery and a family-based approach for improved metabolic outcomes in both the patient and involved family member(s). Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  12. The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes.

    Science.gov (United States)

    Winters, S; Kool, R B; Klazinga, N S; Huijsman, R

    2014-08-01

    To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate structure, QI activities and performance improvements on indicators. In total, 169 residential care homes for the elderly in the Netherlands. Change between 2007 and 2009 in client-reported and professional indicators. A middle-size corporate structure was associated with QI. The QI activity 'multidisciplinary team meetings' was positively correlated with the indicator 'safety environment' for somatic and psycho-geriatric care. The QI activities 'educational material' and 'direct work instructions' were associated negatively with the indicator 'availability of personnel' for somatic clients, but positively for psycho-geriatric clients. QI activities such as 'health plan activities', 'clinical lessons' and 'financial activities' had no relationship to improved performance. For psycho-geriatric clients mainly organizational QI activities were positively associated with QI. The mediating role of the corporate structure for performing QI activities appeared stronger for the change in client-reported than for professional indicators. This study reveals associations between QI activities and corporate structure and changes in indicator performance. A corporate structure was associated with improvement in client-reported indicators, but less on professional indicators, which assumes a central policy at corporate level with impact on client-reported indicators, in contrast to a more local level approach towards activities that result in QI on professional indicators. Tailoring QI activities at the right managerial level may be important to achieve improvement. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in

  13. Hospital efforts to improve breastfeeding outcomes: becoming baby-friendly in Oklahoma.

    Science.gov (United States)

    Mannel, Rebecca; Bacon, Nancy

    2014-01-01

    A key component of the Preparing for a Lifetime initiative to reduce infant mortality and improve infant outcomes in Oklahoma focuses on improving breastfeeding outcomes. The evidence is well-established on the short and long-term positive health impact of breastfeeding and lactation on both infant and mother. A new collaborative effort was launched in 2012 to support Oklahoma hospitals to achieve designation as a Baby-Friendly hospital, the Becoming Baby-Friendly in Oklahoma project. Baby-Friendly hospitals comply with the evidence-based Ten Steps to Successful Breastfeeding and do not market formula products directly to patients. This article describes the progress of this statewide project.

  14. Bioactivation of titanium dioxide scaffolds by ALP-functionalization

    Directory of Open Access Journals (Sweden)

    A. Sengottuvelan

    2017-06-01

    Full Text Available Three dimensional TiO2 scaffolds are receiving renewed attention for bone tissue engineering (TE due to their biocompatibility and attractive mechanical properties. However the bioactivity of these scaffolds is comparatively lower than that of bioactive glass or hydroxyapatite (HA scaffolds. One strategy to improve bioactivity is to functionalize the surface of the scaffolds using biomolecules. Alkaline phosphatase (ALP was chosen in this study due to its important role in the bone mineralization process. The current study investigated the ALP functionalization of 3D titanium dioxide scaffolds using self-polymerization of dopamine. Robust titanium scaffolds (compressive strength∼2.7 ± 0.3 MPa were produced via foam replica method. Enzyme grafting was performed by dip-coating in polydopamine/ALP solution. The presence of ALP was indirectly confirmed by contact angle measurements and enzymatic activity study. The influence of the enzyme on the bioactivity, e.g. hydroxyapatite formation on the scaffold surface, was measured in simulated body fluid (SBF. After 28 days in SBF, 5 mg ALP coated titania scaffolds exhibited increased hydroxyapatite formation. It was thus confirmed that ALP enhances the bioactivity of titania scaffolds, converting an inert bioceramic in an attractive bioactive system for bone TE.

  15. Microporous Nanofibrous Fibrin-based Scaffolds for Bone Tissue Engineering

    Science.gov (United States)

    Osathanon, Thanaphum; Linnes, Michael L.; Rajachar, Rupak M.; Ratner, Buddy D.; Somerman, Martha J.; Giachelli, Cecilia M.

    2008-01-01

    The fibrotic response of the body to synthetic polymers limits their success in tissue engineering and other applications. Though porous polymers have demonstrated improved healing, difficulty in controlling their pore sizes and pore interconnections has clouded the understanding of this phenomenon. In this study, a novel method to fabricate natural polymer/calcium phosphate composite scaffolds with tightly controllable pore size, pore interconnection, and calcium phosphate deposition was developed. Microporous, nanofibrous fibrin scaffolds were fabricated using sphere-templating methods. Composite scaffolds were created by solution deposition of calcium phosphate on fibrin surfaces or by direct incorporation of nanocrystalline hydroxyapatite (nHA). The SEM results showed that fibrin scaffolds exhibited a highly porous and interconnected structure. Osteoblast-like cells, obtained from murine calvaria, attached, spread and showed a polygonal morphology on the surface of the biomaterial. Multiple cell layers and fibrillar matrix deposition were observed. Moreover, cells seeded on mineralized fibrin scaffolds exhibited significantly higher alkaline phosphatase activity as well as osteoblast marker gene expression compared to fibrin scaffolds and nHA incorporated fibrin scaffolds (0.25 g and 0.5 g). All types of scaffolds were degraded both in vitro and in vivo. Furthermore, these scaffolds promoted bone formation in a mouse calvarial defect model and the bone formation was enhanced by addition of rhBMP-2. PMID:18640716

  16. Does influenza vaccination improve pregnancy outcome? Methodological issues and research needs.

    Science.gov (United States)

    Savitz, David A; Fell, Deshayne B; Ortiz, Justin R; Bhat, Niranjan

    2015-11-25

    Evidence that influenza vaccination during pregnancy is safe and effective at preventing influenza disease in women and their children through the first months of life is increasing. Several reports of reduced risk of adverse outcomes associated with influenza vaccination have generated interest in its potential for improving pregnancy outcome. Gavi, the Vaccine Alliance, estimates maternal influenza immunization programs in low-income countries would have a relatively modest impact on mortality compared to other new or under-utilized vaccines, however the impact would be substantially greater if reported vaccine effects on improved pregnancy outcomes were accurate. Here, we examine the available evidence and methodological issues bearing on the relationship between influenza vaccination and pregnancy outcome, particularly preterm birth and fetal growth restriction, and summarize research needs. Evidence for absence of harm associated with vaccination at a point in time is not symmetric with evidence of benefit, given the scenario in which vaccination reduces risk of influenza disease and, in turn, risk of adverse pregnancy outcome. The empirical evidence for vaccination preventing influenza in pregnant women is strong, but the evidence that influenza itself causes adverse pregnancy outcomes is inconsistent and limited in quality. Studies of vaccination and pregnancy outcome have produced mixed evidence of potential benefit but are limited in terms of influenza disease assessment and control of confounding, and their analytic methods often fail to fully address the longitudinal nature of pregnancy and influenza prevalence. We recommend making full use of results of randomized trials, re-analysis of existing observational studies to account for confounding and time-related factors, and quantitative assessment of the potential benefits of vaccination in improving pregnancy outcome, all of which should be informed by the collective engagement of experts in influenza

  17. Complementary effects of bevacizumab and MMC in the improvement of surgical outcome after glaucoma filtration surgery.

    Science.gov (United States)

    Van Bergen, Tine; Vandewalle, Evelien; Moons, Lieve; Stalmans, Ingeborg

    2015-11-01

    To determine the optimum administration route of bevacizumab after glaucoma filtering surgery (GFS) and to investigate whether a reduced dose of mitomycin-C (MMC) in combination with bevacizumab could improve surgical outcome with a reduced incidence of side-effects. Plasma levels of bevacizumab were determined via ELISA after intracameral (IC), subconjunctival (SC) and intravitreal (IV) injections in mice, subjected to a mouse model of GFS. Application of MMC was compared to bevacizumab (SC, 25 μg) and to the combined use of both adjuvants. Surgical sponges soaked in MMC 0.02% or 0.01% were exposed to the sclera for 1 or 2 min. Treatment outcome was studied by bleb investigation. The three administration routes of bevacizumab equally improved surgical outcome. The VEGF antibody was detected at relatively high levels in plasma shortly after IV injection, whereas it was minimally absorbed after IC and SC injections. Both bevacizumab (SC) and MMC 0.02% (2 min) similarly increased bleb area. As compared to MMC, the combined injection with bevacizumab induced an additional effect on surgical outcome. Exposure of MMC 0.02% for 1 or 2 min together with bevacizumab equally improved surgical outcome, but 2 min application induced corneal toxicity. The combined use of bevacizumab and 1-min MMC 0.01% also improved surgical outcome compared to monotherapy, although to a lesser extent than the combination with 1-min MMC 0.02%. Adjunctive bevacizumab not only enhances the beneficial effect of MMC on surgical outcome, but also allows reducing the administration time of MMC 0.02%, thereby eliminating its toxic effects on the cornea. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  18. Electrospun Polymeric Scaffolds with Enhanced Biomimetic Properties for Tissue Engineering Applications

    OpenAIRE

    Fiorani, Andrea

    2014-01-01

    This PhD Thesis is focused on the development of fibrous polymeric scaffolds for tissue engineering applications and on the improvement of scaffold biomimetic properties. Scaffolds were fabricated by electrospinning, which allows to obtain scaffolds made of polymeric micro or nanofibers. Biomimetism was enhanced by following two approaches: (1) the use of natural biopolymers, and (2) the modification of the fibers surface chemistry. Gelatin was chosen for its bioactive properties and cellu...

  19. Improving patient outcomes with technology and social media in paediatric diabetes.

    Science.gov (United States)

    Ng, Sze May

    2015-01-01

    The UK has the highest number of children and young people with diagnosed Type 1 diabetes mellitus (T1DM) in Europe, but the lowest numbers attaining good diabetes control (1, 2). Novel strategies and incorporation of digital strategies were identified in the team for development to improve overall patient care and outcomes in our population of children and young people with T1DM. Within a dual-site integrated care organisation, 3 digital initiatives were proposed from 2012-2013 to 1) establish Facebook communications with parents/patients, 2) to implement an electronic diabetes information management system (using Twinkle.Net) and 3) to undertake routine uploading of blood glucose meters and insulin pumps (using DIASEND®) with the aim to improve outcomes in paediatric diabetes care. Key objectives for the three initiatives were aimed to optimise the following outcomes: • Reduce HbA1c levels • Decrease emergency admissions, reduce diabetes-related complications and minimise the length of hospital stays • Improve patient satisfaction and communication • Improve efficiencies with mandatory audit submissions • Empower patients, parents, and the multidisciplicnary team with accurate, real-time information. These digital initiatives showed effective use of technology and social media in achieving significant improvements in all the outcomes within the objectives.

  20. Nursing interventions for improving nutritional status and outcomes of stroke patients: descriptive reviews of processes and outcomes.

    Science.gov (United States)

    Perry, Lin; Hamilton, Sharon; Williams, Jane; Jones, Susan

    2013-02-01

    Stroke produces many effects that impact eating. Nutrition is fundamental for recovery and rehabilitation, but the nursing nutritional role and associated outcomes have not been delineated. (1) To identify nursing interventions intended to improve nutritional status and related outcomes of stroke survivors, and (2) To examine the outcomes of identified nursing interventions on nutrition-related outcomes, including dietary intake, functional status, complications, activities of daily living, mortality, and quality of life for stroke survivors. A modified version of Cochrane literature searching and review methods was used to identify studies that described and evaluated nursing nutritional interventions for adult stroke patients in hospital and community settings. A minimum of 10 years content of seven databases and nine journals was searched to March 2011. Findings were presented descriptively. In total 27 papers from 26 studies were included: 5 randomized controlled trials, 5 clinical trials, 6 quasi-experiments, 4 case studies, and 6 qualitative/observational studies. Stroke nursing nutritional care encompassed screening of nutritional status and swallowing function; assessment of nutritional characteristics and preferences; referral; mealtime organization, supervision and monitoring; mealtime assistance and feeding skills. Nurses individualized care, coordinated or managed meal delivery and enteral feeding systems, were responsible for the dining environment and conduct of mealtimes; they taught staff, patients, and carers. There was little indication of integrated or psychosocial nursing nutritional care, or concepts, theories or models of nursing nutritional care. Many interventions were described but not evaluated. Little high quality evidence was of available. This review indicated the parameters of nursing nutritional care, and provided a framework for future research. A functional, supportive, and educational nursing nutritional role was described but

  1. Improving Guideline Compliance in Australia With a National Percutaneous Coronary Intervention Outcomes Registry.

    Science.gov (United States)

    Eccleston, David; Horrigan, Mark; Rafter, Tony; Holt, Geoffrey; Worthley, Stephen G; Sage, Peter; Whelan, Alan; Reid, Christopher; Thompson, Peter L

    2017-02-28

    Secondary prevention strategies after percutaneous coronary intervention (PCI) include statins and dual anti-platelet therapy, however there are significant gaps between guidelines and practice. Contemporary PCI practice requires comprehensive data collection to allow dynamic auditing and benchmarking of key performance and safety indices. Genesis HeartCare is Australia's largest collaborative venture of cardiologists, practising at over 40 public and private hospitals. We hypothesised that measurement and local reporting of data would improve patient outcomes through improving compliance with guideline therapies. Real-time benchmarking via a national clinical quality and outcomes register, the Genesis Cardiovascular Outcomes Registry (GCOR-PCI). GCOR-PCI prospectively collected clinical, procedural, medication and outcomes data for 6720 consecutive patients undergoing PCI from 10 private hospitals across Australia. Key performance outcomes benchmarked against the aggregated study cohort and international standards were reported to individual sites. The main outcome measure was compliance with guideline medications (statins, anti-platelet agents). Early data identified specific practice patterns associated with lower rates of statin therapy post-PCI, which led to changes in practice. Between the first and latest year of data collection there was significant improvement in the rates of statin therapy at discharge (92.1 vs. 94.4% p<0.03) and 12 months post-PCI (87.0 vs. 92.2% p<0.001) and of antiplatelet therapy at 12 months (90.7 vs. 94.3% p<0.001). This large-scale collaboration provides a platform for the development of quality improvement initiatives. Establishment of this clinical quality registry improved patient care by identifying and monitoring gaps in delivery of appropriate therapies, driving key practice change. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New

  2. Relevance of PEG in PLA-based blends for tissue engineering 3D-printed scaffolds.

    Science.gov (United States)

    Serra, Tiziano; Ortiz-Hernandez, Monica; Engel, Elisabeth; Planell, Josep A; Navarro, Melba

    2014-05-01

    Achieving high quality 3D-printed structures requires establishing the right printing conditions. Finding processing conditions that satisfy both the fabrication process and the final required scaffold properties is crucial. This work stresses the importance of studying the outcome of the plasticizing effect of PEG on PLA-based blends used for the fabrication of 3D-direct-printed scaffolds for tissue engineering applications. For this, PLA/PEG blends with 5, 10 and 20% (w/w) of PEG and PLA/PEG/bioactive CaP glass composites were processed in the form of 3D rapid prototyping scaffolds. Surface analysis and differential scanning calorimetry revealed a rearrangement of polymer chains and a topography, wettability and elastic modulus increase of the studied surfaces as PEG was incorporated. Moreover, addition of 10 and 20% PEG led to non-uniform 3D structures with lower mechanical properties. In vitro degradation studies showed that the inclusion of PEG significantly accelerated the degradation rate of the material. Results indicated that the presence of PEG not only improves PLA processing but also leads to relevant surface, geometrical and structural changes including modulation of the degradation rate of PLA-based 3D printed scaffolds. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Group interventions to improve health outcomes: a framework for their design and delivery

    OpenAIRE

    Avenell Alison; Allan Karen; Hoddinott Pat; Britten Jane

    2010-01-01

    Abstract Background Delivering an intervention to a group of patients to improve health outcomes is increasingly popular in public health and primary care, yet "group" is an umbrella term which encompasses a complex range of aims, theories, implementation processes and evaluation methods. We propose a framework for the design and process evaluation of health improvement interventions occurring in a group setting, which will assist practitioners, researchers and policy makers. Methods We revie...

  4. Effects of the architecture of tissue engineering scaffolds on cell seeding and culturing.

    Science.gov (United States)

    Melchels, Ferry P W; Barradas, Ana M C; van Blitterswijk, Clemens A; de Boer, Jan; Feijen, Jan; Grijpma, Dirk W

    2010-11-01

    The advance of rapid prototyping techniques has significantly improved control over the pore network architecture of tissue engineering scaffolds. In this work, we have assessed the influence of scaffold pore architecture on cell seeding and static culturing, by comparing a computer designed gyroid architecture fabricated by stereolithography with a random pore architecture resulting from salt leaching. The scaffold types showed comparable porosity and pore size values, but the gyroid type showed a more than 10-fold higher permeability due to the absence of size-limiting pore interconnections. The higher permeability significantly improved the wetting properties of the hydrophobic scaffolds and increased the settling speed of cells upon static seeding of immortalised mesenchymal stem cells. After dynamic seeding followed by 5 days of static culture gyroid scaffolds showed large cell populations in the centre of the scaffold, while salt-leached scaffolds were covered with a cell sheet on the outside and no cells were found in the scaffold centre. It was shown that interconnectivity of the pores and permeability of the scaffold prolonged the time of static culture before overgrowth of cells at the scaffold periphery occurred. Furthermore, novel scaffold designs are proposed to further improve the transport of oxygen and nutrients throughout the scaffolds and to create tissue engineering grafts with a designed, pre-fabricated vasculature. Copyright © 2010 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  5. Improved implementation of the risk-adjusted Bernoulli CUSUM chart to monitor surgical outcome quality.

    Science.gov (United States)

    Keefe, Matthew J; Loda, Justin B; Elhabashy, Ahmad E; Woodall, William H

    2017-06-01

    The traditional implementation of the risk-adjusted Bernoulli cumulative sum (CUSUM) chart for monitoring surgical outcome quality requires waiting a pre-specified period of time after surgery before incorporating patient outcome information. We propose a simple but powerful implementation of the risk-adjusted Bernoulli CUSUM chart that incorporates outcome information as soon as it is available, rather than waiting a pre-specified period of time after surgery. A simulation study is presented that compares the performance of the traditional implementation of the risk-adjusted Bernoulli CUSUM chart to our improved implementation. We show that incorporating patient outcome information as soon as it is available leads to quicker detection of process deterioration. Deterioration of surgical performance could be detected much sooner using our proposed implementation, which could lead to the earlier identification of problems.

  6. Can life coaching improve health outcomes? - A systematic review of intervention studies

    DEFF Research Database (Denmark)

    Ammentorp, Jette; Uhrenfeldt, Lisbeth; Angel, Flemming

    2013-01-01

    limited number of solid studies, this review can only present tendencies for patient outcomes and a preliminary description of an effective life coaching intervention. The coaching method used in these studies aims to improve self-efficacy and self-empowerment. This may explain why the studies including......BACKGROUND In recent years, coaching has received special attention as a method to improve healthy lifestyle behaviours. The fact that coaching has found its way into healthcare and may provide new ways of engaging the patients and making them accountable for their health, justifies the need...... between health coaching and life coaching. In this review, we will only focus on the latter method and on that basis assess the health related outcomes of life coaching. METHODS Intervention studies using quantitative or qualitative methods to evaluate the outcome of the life coach interventions were...

  7. Integrating Hospital Administrative Data to Improve Health Care Efficiency and Outcomes: “The Socrates Story”

    Science.gov (United States)

    Lawrence, Justin; Delaney, Conor P.

    2013-01-01

    Evaluation of health care outcomes has become increasingly important as we strive to improve quality and efficiency while controlling cost. Many groups feel that analysis of large datasets will be useful in optimizing resource utilization; however, the ideal blend of clinical and administrative data points has not been developed. Hospitals and health care systems have several tools to measure cost and resource utilization, but the data are often housed in disparate systems that are not integrated and do not permit multisystem analysis. Systems Outcomes and Clinical Resources AdministraTive Efficiency Software (SOCRATES) is a novel data merging, warehousing, analysis, and reporting technology, which brings together disparate hospital administrative systems generating automated or customizable risk-adjusted reports. Used in combination with standardized enhanced care pathways, SOCRATES offers a mechanism to improve the quality and efficiency of care, with the ability to measure real-time changes in outcomes. PMID:24436649

  8. Integrating hospital administrative data to improve health care efficiency and outcomes: "the socrates story".

    Science.gov (United States)

    Lawrence, Justin; Delaney, Conor P

    2013-03-01

    Evaluation of health care outcomes has become increasingly important as we strive to improve quality and efficiency while controlling cost. Many groups feel that analysis of large datasets will be useful in optimizing resource utilization; however, the ideal blend of clinical and administrative data points has not been developed. Hospitals and health care systems have several tools to measure cost and resource utilization, but the data are often housed in disparate systems that are not integrated and do not permit multisystem analysis. Systems Outcomes and Clinical Resources AdministraTive Efficiency Software (SOCRATES) is a novel data merging, warehousing, analysis, and reporting technology, which brings together disparate hospital administrative systems generating automated or customizable risk-adjusted reports. Used in combination with standardized enhanced care pathways, SOCRATES offers a mechanism to improve the quality and efficiency of care, with the ability to measure real-time changes in outcomes.

  9. Does training with human patient simulation translate to improved patient safety and outcome?

    Science.gov (United States)

    Shear, Torin D; Greenberg, Steven B; Tokarczyk, Arthur

    2013-04-01

    In this review, we evaluate several articles in an attempt to qualify the effect of human patient simulation in anaesthesia on patient outcome. The recognition of medical error as a significant cause of patient morbidity and mortality has sparked an increased focus on improving healthcare quality and patient safety. Simulation in anaesthesia is a potential tool to help achieve this goal by allowing anaesthesia providers to learn, practice and perfect their craft without a potential harm to patients. It has gained growing traction in the field and is recently a required element in the American Board of Anesthesiology's Maintenance of Certification in Anesthesia programme. Very few studies have evaluated the effect of simulation on patient outcome. To date, one study has demonstrated improved individual clinical performance in anaesthesia after simulation training. Research suggests that simulation-based team training can reduce patient mortality and improve the quality of care as measured by surgical quality improvement measures. Simulation may improve healthcare systems by serving as a tool to detect latent error and drive process improvement. Despite the adoption of simulation, further study is needed to better qualify its effect on patient safety and outcome.

  10. Promoting Professional Inquiry for Improved Outcomes for Students in New Zealand

    Science.gov (United States)

    Timperley, Helen S.; Parr, Judy M.; Bertanees, Cherry

    2009-01-01

    Increasing attention is being paid to professional development as a way to improve outcomes for students but its promise has not always been realised. Broadly speaking, approaches to professional development have either focused on developing better prescriptions for teaching practice or on collaborative reflective inquiry into practice. Neither…

  11. Empowering Communities for Improved Educational Outcomes: Some Evaluation Findings from the World Bank

    Science.gov (United States)

    Nielsen, H. Dean

    2007-01-01

    Community involvement in the management of schools--community empowerment--is a growing phenomenon in the developing world. Many see it as a way to increase the relevance of schools, school attendance, and ultimately to improve learning outcomes. Increasingly, World Bank lending for basic education includes growing support for community…

  12. Does Prison-Based Adult Basic Education Improve Postrelease Outcomes for Male Prisoners in Florida?

    Science.gov (United States)

    Cho, Rosa Minhyo; Tyler, John H.

    2013-01-01

    The authors use administrative data from Florida to determine the extent to which prison-based adult basic education (ABE) improves inmate's postrelease labor market outcomes, such as earnings and employment. Using two nonexperimental comparison groups, the authors find evidence that ABE participation is associated with higher postrelease earnings…

  13. #DDOD Use Case: Improve National Death Registry for use with outcomes research

    Data.gov (United States)

    U.S. Department of Health & Human Services — SUMMARY DDOD use case request to improve National Death Registry for use with outcomes research. WHAT IS A USE CASE? A “Use Case” is a request that was made by the...

  14. Revised Models and Conceptualisation of Successful School Principalship for Improved Student Outcomes

    Science.gov (United States)

    Mulford, Bill; Silins, Halia

    2011-01-01

    Purpose: This study aims to present revised models and a reconceptualisation of successful school principalship for improved student outcomes. Design/methodology/approach: The study's approach is qualitative and quantitative, culminating in model building and multi-level statistical analyses. Findings: Principals who promote both capacity building…

  15. Increased Preclass Preparation Underlies Student Outcome Improvement in the Flipped Classroom

    Science.gov (United States)

    Gross, David; Pietri, Evava S.; Anderson, Gordon; Moyano-Camihort, Karin; Graham, Mark J.

    2015-01-01

    Active-learning environments such as those found in a flipped classroom are known to increase student performance, although how these gains are realized over the course of a semester is less well understood. In an upper-level lecture course designed primarily for biochemistry majors, we examine how students attain improved learning outcomes, as…

  16. School-Based Educational Interventions Can Significantly Improve Health Outcomes in Children with Asthma.

    Science.gov (United States)

    Suwannakeeree, Pussayaban; Deerojanawong, Jitladda; Prapphal, Nuanchan

    2016-02-01

    Lack of asthma knowledge among the pediatric patients and their caregivers contribute to poor asthma control in children. There is no data from Thailand on the health outcomes of school-based educational interventions for asthmatic children. To assess the effectiveness of school-based asthma educational interventions on health outcomes, asthma control, and management in asthmatic children. Forty-seven asthmatic students (6-15 years old), 14 caregivers, and five teachers from the Homkred School participated in the study. Asthma knowledge, workshops on pMDI (pressurized metered dose inhaler) techniques, use of asthma diaries, and self-management plans were provided Pre- and post-tests were administered to assess the asthma knowledge of the asthmatic students, their caregivers, and teachers. Pulmonary function tests (PFT) were used to assess the health outcomes. The controls of asthma and self-management behaviors were assessed at three and six months post-intervention. There were significant improvements of asthma knowledge in all groups (p management behaviors in the asthmatic children improved. The teachers' management of asthmatic attacks during the classes also improved. As a result of this, there were fewer emergency room (ER) visits. School-based educational interventions can significantly improve asthma outcomes in children with asthma. Therefore, the authors highly recommend the use of this intervention.

  17. Outcomes of a Dutch workshop on improvements for the 3Rs in daily practice

    NARCIS (Netherlands)

    Luijk, J. van; Leenaars, M.; Dongen, A.M. van; Vaart, L. van der; Ritskes-Hoitinga, M.

    2012-01-01

    This article describes the outcome of a workshop that was held to generate new ideas to improve the use of the 3R principles in science. The participants of the workshop represented Dutch researchers, Animal Welfare Officers, and members of Animal Ethics Committees from various affiliations,

  18. How Learning and Cognitive Science Can Improve Student Outcomes. Middle School Matters Program No. 1

    Science.gov (United States)

    Graesser, Art; Rodriguez, Gina; Brasiel, Sarah J.

    2013-01-01

    There are research-based principles and practices from the learning and cognitive sciences that can be applied to all content areas in middle grades education to improve student outcomes. Even teachers of courses like Physical Education can consider these strategies for assisting students in remembering rules of sports, different sports…

  19. A Paradigm Shift in Preconception and Interconception Care: Using Every Encounter to Improve Birth Outcomes

    Science.gov (United States)

    Frayne, Daniel J.

    2017-01-01

    As U.S. infant mortality remains relatively unchanged and maternal mortality is rising, it is increasingly clear that service providers need to address many of the modifiable risks that determine birth outcomes prior to pregnancy. Health professionals have promoted preconception care for decades as a way to improve women's and infant's health. Yet…

  20. Unstandardized treatment of electroencephalographic status epilepticus does not improve outcome of comatose patients after cardiac arrest

    NARCIS (Netherlands)

    Hofmeijer, Jeannette; Cloostermans, M.C.; Beishuizen, A.; van Putten, Michel Johannes Antonius Maria

    2014-01-01

    Objective: Electroencephalographic status epilepticus occurs in 9–35% of comatose patients after cardiac arrest. Mortality is 90–100%. It is unclear whether (some) seizure patterns represent a condition in which anti-epileptic treatment may improve outcome, or severe ischemic damage, in which

  1. The role of psycho-education in improving outcome at a general ...

    African Journals Online (AJOL)

    Objective: While psychoeducation has been shown to positively affect outcomes in psychiatric disorders, its utility has been little studied in developing countries. The current study sought to examine the role of psychoeducation at a general psychiatric outpatient clinic in Kampala, Uganda in improving clinic attendance, ...

  2. Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting.

    Science.gov (United States)

    Goldberg, Simon B; Rousmaniere, Tony; Miller, Scott D; Whipple, Jason; Nielsen, Stevan Lars; Hoyt, William T; Wampold, Bruce E

    2016-01-01

    Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time. The present study examined changes in psychotherapists' outcomes over time using a large, longitudinal, naturalistic psychotherapy data set. The sample included 6,591 patients seen in individual psychotherapy by 170 therapists who had on average 4.73 years of data in the data set (range = 0.44 to 17.93 years). Patient-level outcomes were examined using the Outcome Questionnaire-45 and a standardized metric of change (prepost d). Two-level multilevel models (patients nested within therapist) were used to examine the relationship between therapist experience and patient prepost d and early termination. Experience was examined both as chronological time and cumulative patients seen. Therapists achieved outcomes comparable with benchmarks from clinical trials. However, a very small but statistically significant change in outcome was detected indicating that on the whole, therapists' patient prepost d tended to diminish as experience (time or cases) increases. This small reduction remained when controlling for several patient-level, caseload-level, and therapist-level characteristics, as well as when excluding several types of outliers. Further, therapists were shown to vary significantly across time, with some therapists showing improvement despite the overall tendency for outcomes to decline. In contrast, therapists showed lower rates of early termination as experience increased. Implications of these findings for the development of expertise in psychotherapy are explored. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  3. Improving Bariatric Patient Aftercare Outcome by Improved Detection of a Functional Vitamin B12 Deficiency.

    Science.gov (United States)

    Smelt, H J M; Smulders, J F; Said, M; Nienhuijs, S W; Boer, A K

    2016-07-01

    Vitamin B12 deficiency is common after bariatric surgery. Vitamin B12 is a poor predictor of functional vitamin B12 status, since deficiencies might even occur within the reference limits. Therefore, vitamin B12 deficiencies with serum vitamin B12 levels are between 140 and 200 pmol/L remain undetected. Methylmalonic acid (MMA), however, will detect these deficiencies as accumulates due to functional intracellular vitamin B12 deficiencies. MMA is a relative expensive analysis and is therefore not generally available. To lower the costs, we only request MMA when vitamin B12 levels are between these levels. As a result, more biochemical deficiencies are found. However, it was not known whether bariatric patients with vitamin B12 levels between 140 and 200 pmol/L would benefit from supplementation. Bariatric patients with vitamin B12 levels between 140 and 200 pmol/L with (n = 45) and without (n = 45) intramuscular hydroxocobalamin injections were compared. Treated patients showed a significant increase of vitamin B12 levels (P vitamin B12 supplementation are correlated with clinical improvement, patient records were checked for complaints. Complaints were disappeared after treatment, while no improvement was seen in untreated patients. This study shows that all bariatric patients with vitamin B12 levels between 140 and 200 pmol/L benefit clinical and biochemical from vitamin B12 supplementation, regardless the MMA levels.

  4. Association between acute statin therapy, survival, and improved functional outcome after ischemic stroke: the North Dublin Population Stroke Study.

    LENUS (Irish Health Repository)

    2011-04-01

    Statins improve infarct volume and neurological outcome in animal stroke models. We investigated the relationship between statin therapy and ischemic stroke outcome in the North Dublin Population Stroke Study.

  5. Biofunctionalization of polycaprolactone scaffolds with RGD peptides for the better cells integration

    Science.gov (United States)

    Matveeva, V. G.; Seifalian, A. M.; Antonova, L. V.; Velikanova, E. A.; Sergeeva, E. A.; Krivkina, E. O.; Glushkova, T. V.; Kudryavtseva, Yu. A.; Barbarash, O. L.; Barbarash, L. S.

    2016-08-01

    Here we tested in vitro electrospun polycaprolactone (PCL) scaffolds carbodiimide linkage with RGD peptides and their unconjugated counterparts. The scaffolds possessed highly porous structure and were formed by randomly distributed fibers. Orange II staining and ninhydrin test confirmed successful amination of the PCL. For the assessment of cell adhesion, we colonized scaffolds with primary human fibroblasts and counted the number of alive and dead cells. After 6 days of incubation, the number of fibroblasts on the scaffolds modified by RGD peptides significantly exceeded the number on unmodified scaffolds; however, the distribution of the cells on functionalized scaffolds was uneven, possibly due to uneven distribution of RGD peptides. The percentage of dead cells on the scaffolds with RGD peptides was significantly lower compared to their unmodified counterparts. Therefore, conjugation of PCL scaffolds with RGD peptides improves their integration with cells. This can be used in regenerative medicine.

  6. Surface modification of polycaprolactone scaffolds fabricated via selective laser sintering for cartilage tissue engineering.

    Science.gov (United States)

    Chen, Chih-Hao; Lee, Ming-Yih; Shyu, Victor Bong-Hang; Chen, Yi-Chieh; Chen, Chien-Tzung; Chen, Jyh-Ping

    2014-07-01

    Surface modified porous polycaprolactone scaffolds fabricated via rapid prototyping techniques were evaluated for cartilage tissue engineering purposes. Polycaprolactone scaffolds manufactured by selective laser sintering (SLS) were surface modified through immersion coating with either gelatin or collagen. Three groups of scaffolds were created and compared for both mechanical and biological properties. Surface modification with collagen or gelatin improved the hydrophilicity, water uptake and mechanical strength of the pristine scaffold. From microscopic observations and biochemical analysis, collagen-modified scaffold was the best for cartilage tissue engineering in terms of cell proliferation and extracellular matrix production. Chondrocytes/collagen-modified scaffold constructs were implanted subdermally in the dorsal spaces of female nude mice. Histological and immunohistochemical staining of the retrieved implants after 8 weeks revealed enhanced cartilage tissue formation. We conclude that collagen surface modification through immersion coating on SLS-manufactured scaffolds is a feasible scaffold for cartilage tissue engineering in craniofacial reconstruction. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. The fabrication and characterization of biodegradable HA/PHBV nanoparticle-polymer composite scaffolds.

    Science.gov (United States)

    Jack, Kevin S; Velayudhan, Shiny; Luckman, Paul; Trau, Matt; Grøndahl, Lisbeth; Cooper-White, Justin

    2009-09-01

    This study reports the fabrication and characterization of nano-sized hydroxyapatite (HA)/poly(hydroxyabutyrate-co-hydroxyvalerate) (PHBV) polymer composite scaffolds with high porosity and controlled pore architectures. These scaffolds were prepared using a modified thermally induced phase-separation technique. This investigation focuses on the effect of fabrication conditions on the overall pore architecture of the scaffolds and the dispersion of HA nanocrystals within the composite scaffolds. The morphologies, mechanical properties and in vitro bioactivity of the composite scaffolds were investigated. It was noted that the pore architectures could be manipulated by varying phase-separation parameters. The HA particles were dispersed in the pore walls of the scaffolds and were well bonded to the polymer. The introduction of HA greatly increased the stiffness and strength, and improved the in vitro bioactivity of the scaffolds. The results suggest these newly developed nano-HA/PHBV composite scaffolds may serve as an effective three-dimensional substrate in bone tissue engineering.

  8. Composite scaffolds of mesoporous bioactive glass and polyamide for bone repair

    Science.gov (United States)

    Su, Jiacan; Cao, Liehu; Yu, Baoqing; Song, Shaojun; Liu, Xinwei; Wang, Zhiwei; Li, Ming

    2012-01-01

    A bone-implanted porous scaffold of mesoporous bioglass/polyamide composite (m-BPC) was fabricated, and its biological properties were investigated. The results indicate that the m-BPC scaffold contained open and interconnected macropores ranging 400–500 μm, and exhibited a porosity of 76%. The attachment ratio of MG-63 cells on m-BPC was higher than polyamide scaffolds at 4 hours, and the cells with normal phenotype extended well when cultured with m-BPC and polyamide scaffolds. When the m-BPC scaffolds were implanted into bone defects of rabbit thighbone, histological evaluation confirmed that the m-BPC scaffolds exhibited excellent biocompatibility and osteoconductivity, and more effective osteogenesis than the polyamide scaffolds in vivo. The results indicate that the m-BPC scaffolds improved the efficiency of new bone regeneration and, thus, have clinical potential for bone repair. PMID:22679367

  9. Relationship between micro-porosity, water permeability and mechanical behavior in scaffolds for cartilage engineering.

    Science.gov (United States)

    Vikingsson, L; Claessens, B; Gómez-Tejedor, J A; Gallego Ferrer, G; Gómez Ribelles, J L

    2015-08-01

    In tissue engineering the design and optimization of biodegradable polymeric scaffolds with a 3D-structure is an important field. The porous scaffold provide the cells with an adequate biomechanical environment that allows mechanotransduction signals for cell differentiation and the scaffolds also protect the cells from initial compressive loading. The scaffold have interconnected macro-pores that host the cells and newly formed tissue, while the pore walls should be micro-porous to transport nutrients and waste products. Polycaprolactone (PCL) scaffolds with a double micro- and macro-pore architecture have been proposed for cartilage regeneration. This work explores the influence of the micro-porosity of the pore walls on water permeability and scaffold compliance. A Poly(Vinyl Alcohol) with tailored mechanical properties has been used to simulate the growing cartilage tissue inside the scaffold pores. Unconfined and confined compression tests were performed to characterize both the water permeability and the mechanical response of scaffolds with varying size of micro-porosity while volume fraction of the macro-pores remains constant. The stress relaxation tests show that the stress response of the scaffold/hydrogel construct is a synergic effect determined by the performance of the both components. This is interesting since it suggests that the in vivo outcome of the scaffold is not only dependent upon the material architecture but also the growing tissue inside the scaffold׳s pores. On the other hand, confined compression results show that compliance of the scaffold is mainly controlled by the micro-porosity of the scaffold and less by hydrogel density in the scaffold pores. These conclusions bring together valuable information for customizing the optimal scaffold and to predict the in vivo mechanical behavior. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Macromolecular multi-chromophoric scaffolding

    NARCIS (Netherlands)

    Schwartz, E.; Schwartz, Erik; Le Gac, Stephane; le Gac, Severine; Cornelissen, Jeroen Johannes Lambertus Maria; Nolte, Roeland J.M.; Rowan, Alan E.

    2010-01-01

    This critical review describes recent efforts in the field of chromophoric scaffolding. The advances in this research area, with an emphasis on rigid scaffolds, for example, synthetic polymers, carbon nanotubes (CNTs), nucleic acids, and viruses, are presented (166 references).

  11. Scaffolding Advanced Writing through Writing Frames

    Directory of Open Access Journals (Sweden)

    Sara Salehpour

    2014-05-01

    Full Text Available Mastering writing has always proved an almost insurmountable barrier to EFL learners. In an attempt to alleviate problems advanced EFL learners have with writing, this study aimed at investigating the effect of scaffolded instruction through writing frames constructed from extended prefabricated lexical bundles. 40 female advanced English students, selected out of a population of 65, were randomly assigned into experimental and control groups. The participants of both groups were assigned a writing pre-test prior to any instruction, and a writing post-test following the twenty-session scaffolded instruction in both groups. The results revealed that the participants in the experimental group outperformed their counterparts in the control group as a result of the writing frames they were provided with. Overall, it is concluded that scaffolded instruction through writing frames can be a useful means of helping advanced students to improve their writing quality.

  12. Biomimetic Scaffolds for Osteogenesis

    Science.gov (United States)

    Yuan, Nance; Rezzadeh, Kameron S.; Lee, Justine C.

    2015-01-01

    Skeletal regenerative medicine emerged as a field of investigation to address large osseous deficiencies secondary to congenital, traumatic, and post-oncologic conditions. Although autologous bone grafts have been the gold standard for reconstruction of skeletal defects, donor site morbidity remains a significant limitation. To address these limitations, contemporary bone tissue engineering research aims to target delivery of osteogenic cells and growth factors in a defined three dimensional space using scaffolding material. Using bone as a template, biomimetic strategies in scaffold engineering unite organic and inorganic components in an optimal configuration to both support osteoinduction as well as osteoconduction. This article reviews the various structural and functional considerations behind the development of effective biomimetic scaffolds for osteogenesis and highlights strategies for enhancing osteogenesis. PMID:26413557

  13. Semiotic Scaffolding in Mathematics

    DEFF Research Database (Denmark)

    Johansen, Mikkel Willum; Misfeldt, Morten

    2015-01-01

    This paper investigates the notion of semiotic scaffolding in relation to mathematics by considering its influence on mathematical activities, and on the evolution of mathematics as a research field. We will do this by analyzing the role different representational forms play in mathematical...... cognition, and more broadly on mathematical activities. In the main part of the paper, we will present and analyze three different cases. For the first case, we investigate the semiotic scaffolding involved in pencil and paper multiplication. For the second case, we investigate how the development of new...... in both mathematical cognition and in the development of mathematics itself, but mathematical cognition cannot itself be reduced to the use of semiotic scaffolding....

  14. What are the priorities for improving cataract surgical outcomes in Africa? Results of a Delphi exercise.

    Science.gov (United States)

    Buchan, J C; Dean, W H; Foster, A; Burton, M J

    2017-06-20

    The quality of cataract surgery delivered in sub-Saharan Africa (SSA) is a significant constraint to achieving the elimination of avoidable blindness. No published reports from routine SSA cataract services attain the WHO benchmarks for visual outcomes; poor outcomes (improving the quality of cataract surgery in SSA to guide research and eye health programme development. An initial email open-question survey created a ranked list of priorities for improving quality of surgical services. A second-round face-to-face discussion facilitated at a Vision 2020 Research Mentorship Workshop in Tanzania created a refined list for repeated ranking. Seventeen factors were agreed that might form target interventions to promote quality of cataract services. Improved training of surgeons was the top-ranked item, followed by utilisation of biometry, surgical equipment availability, effective monitoring of outcomes of cataract surgery by the surgeon, and well-trained support staff for the cataract pathway (including nurses seeing post-operative cases). Improving the quality of cataract surgery in SSA is a clinical, programmatic and public health priority. In the absence of other evidence, the collective expert opinion of those involved in ophthalmic services regarding the ranking of factors to promote quality improvement, refined through this Delphi exercise, provides us with candidate intervention areas to be evaluated.

  15. Programme Learning Outcomes Assessment and Continuous Quality Improvement in Faculty of Mechanical and Manufacturing, UTHM

    Science.gov (United States)

    Taib, H.; Salleh, S. M.; Zain, B. A. Md; Azlan, M. A.; Mahzan, S.; Hafeez, Z. A.; Ong, P.; Ahmad, S.; N. A Rahman, M.; Nasir, N. F.; Azham Azmi, M.; Rahman, H. A.; Ngali, Z.

    2017-01-01

    This paper describes the assessment and continuous quality improvement of Programme Learning Outcomes (PLOs) in the Faculty of Mechanical Engineering and Manufacturing. PLO is known as an elementary requirement in Outcome Based Education (OBE) system. All PLOs have been mapped with graduate attributes by EAC Manual 2012. Conceptual process for establishing and reviewing PLOs has been explained in the Plan-Check-Do-Act cycle. PLO assessment has been shown in different types which classified as direct and indirect methods. Continuous Quality Improvement has been extracted from a variety of assessment and has been discussed. Seven (7) CQIs are identified using different assessment methods of PLO during years 2013 to 2016 and subsequent improvement actions have been taken by the faculty within three years.

  16. A Post-operative Feeding Protocol to Improve Outcomes for Neonates With Critical Congenital Heart Disease.

    Science.gov (United States)

    Newcombe, Jennifer; Fry-Bowers, Eileen

    Neonates with critical congenital heart disease (CCHD) are vulnerable to malnutrition during the post-operative period due to hypermetabolism and hypercatabolism. To improve nutritional outcomes during hospitalization, a nurse led post-operative enteral feeding protocol was implemented at a large U.S. children's hospital. During an eight-month implementation period, twenty-one neonates met protocol inclusion criteria. Days for neonates to achieve goal caloric feedings (120kcal/kg/day) were decreased. A one-way repeated measures analysis of variance showed serum albumin levels and serial anthropometric measurements improved significantly throughout hospitalization (pnutritional care for neonates with CCHD during the post-operative period is an effective way to improve nutritional outcomes and shorten length of hospital stay. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Ethnicity moderates the outcomes of self-enhancement and self-improvement themes in expressive writing.

    Science.gov (United States)

    Tsai, William; Lau, Anna S; Niles, Andrea N; Coello, Jordan; Lieberman, Matthew D; Ko, Ahra C; Hur, Christopher; Stanton, Annette L

    2015-10-01

    The current study examined whether writing content related to self-enhancing (viz., downward social comparison and situational attributions) and self-improving (viz., upward social comparison and persistence) motivations were differentially related to expressive writing outcomes among 17 Asian American and 17 European American participants. Content analysis of the essays revealed no significant cultural group differences in the likelihood of engaging in self-enhancing versus self-improving reflections on negative personal experiences. However, cultural group differences were apparent in the relation between self-motivation processes and changes in anxiety and depressive symptoms at 3-month follow-up. Among European Americans, writing that reflected downward social comparison predicted positive outcomes, whereas persistence writing themes were related to poorer outcomes. For Asian Americans, writing about persistence was related to positive outcomes, whereas downward social comparison and situational attributions predicted poorer outcomes. Findings provide evidence suggesting culturally distinct mechanisms for the effects of expressive disclosure. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  18. Achievement for All: improving psychosocial outcomes for students with special educational needs and disabilities.

    Science.gov (United States)

    Humphrey, Neil; Lendrum, Ann; Barlow, Alexandra; Wigelsworth, Michael; Squires, Garry

    2013-04-01

    Students with special educational needs and disabilities (SEND) are at a greatly increased risk of experiencing poor psychosocial outcomes. Developing effective interventions that address the cause of these outcomes has therefore become a major policy priority in recent years. We report on a national evaluation of the Achievement for All (AfA) programme that was designed to improve outcomes for students with SEND through: (1) academic assessment, tracking and intervention, (2) structured conversations with parents, and (3) developing provision to improve wider outcomes (e.g. positive relationships). Using a quasi-experimental, pre-test-post-test control group design, we assessed the impact of AfA on teacher ratings of the behaviour problems, positive relationships and bullying of students with SEND over an 18-month period. Participants were 4758 students with SEND drawn from 323 schools across England. Our main impact analysis demonstrated that AfA had a significant impact on all three response variables when compared to usual practice. Hierarchical linear modelling of data from the intervention group highlighted a range of school-level contextual factors and implementation activities and student-level individual differences that moderated the impact of AfA on our study outcomes. The implications of our findings are discussed, and study strengths and limitations are noted. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  19. Major liver resection for hepatocellular carcinoma in the morbidly obese: A proposed strategy to improve outcome

    Directory of Open Access Journals (Sweden)

    Ozaki Claire F

    2008-09-01

    Full Text Available Abstract Background Morbid obesity strongly predicts morbidity and mortality in surgical patients. However, obesity's impact on outcome after major liver resection is unknown. Case presentation We describe the management of a large hepatocellular carcinoma in a morbidly obese patient (body mass index >50 kg/m2. Additionally, we propose a strategy for reducing postoperative complications and improving outcome after major liver resection. Conclusion To our knowledge, this is the first report of major liver resection in a morbidly obese patient with hepatocellular carcinoma. The approach we used could make this operation nearly as safe in obese patients as it is in their normal-weight counterparts.

  20. Improving the estimation of flavonoid intake for study of health outcomes

    Science.gov (United States)

    Dwyer, Johanna T.; Jacques, Paul F.; McCullough, Marjorie L.

    2015-01-01

    Imprecision in estimating intakes of non-nutrient bioactive compounds such as flavonoids is a challenge in epidemiologic studies of health outcomes. The sources of this imprecision, using flavonoids as an example, include the variability of bioactive compounds in foods due to differences in growing conditions and processing, the challenges in laboratory quantification of flavonoids in foods, the incompleteness of flavonoid food composition tables, and the lack of adequate dietary assessment instruments. Steps to improve databases of bioactive compounds and to increase the accuracy and precision of the estimation of bioactive compound intakes in studies of health benefits and outcomes are suggested. PMID:26084477

  1. Arginine as an adjuvant to chemotherapy improves clinical outcome in active tuberculosis

    DEFF Research Database (Denmark)

    Schön, T; Elias, D; Moges, F

    2003-01-01

    NO production, would improve the clinical outcome of TB by increasing NO production. In a randomised double-blind study, patients with smear-positive TB (n = 120) were given arginine or placebo for 4 weeks in addition to conventional chemotherapy. Primary outcomes were sputum conversion, weight gain......, defined as increased weight gain, higher sputum conversion rate and faster reduction of symptoms, such as cough. The arginine level increased after week 2 in the HIV-/TB+ arginine group (100.2 microM (range 90.5-109.9) versus 142.1 microM (range 114.1-170.1)) compared with the HIV-/TB+ placebo group (105...

  2. Bionic Design, Materials and Performance of Bone Tissue Scaffolds

    Directory of Open Access Journals (Sweden)

    Tong Wu

    2017-10-01

    Full Text Available Design, materials, and performance are important factors in the research of bone tissue scaffolds. This work briefly describes the bone scaffolds and their anatomic structure, as well as their biological and mechanical characteristics. Furthermore, we reviewed the characteristics of metal materials, inorganic materials, organic polymer materials, and composite materials. The importance of the bionic design in preoperative diagnosis models and customized bone scaffolds was also discussed, addressing both the bionic structure design (macro and micro structure and the bionic performance design (mechanical performance and biological performance. Materials and performance are the two main problems in the development of customized bone scaffolds. Bionic design is an effective way to solve these problems, which could improve the clinical application of bone scaffolds, by creating a balance between mechanical performance and biological performance.

  3. Bionic Design, Materials and Performance of Bone Tissue Scaffolds.

    Science.gov (United States)

    Wu, Tong; Yu, Suihuai; Chen, Dengkai; Wang, Yanen

    2017-10-17

    Design, materials, and performance are important factors in the research of bone tissue scaffolds. This work briefly describes the bone scaffolds and their anatomic structure, as well as their biological and mechanical characteristics. Furthermore, we reviewed the characteristics of metal materials, inorganic materials, organic polymer materials, and composite materials. The importance of the bionic design in preoperative diagnosis models and customized bone scaffolds was also discussed, addressing both the bionic structure design (macro and micro structure) and the bionic performance design (mechanical performance and biological performance). Materials and performance are the two main problems in the development of customized bone scaffolds. Bionic design is an effective way to solve these problems, which could improve the clinical application of bone scaffolds, by creating a balance between mechanical performance and biological performance.

  4. A brief review of dispensing-based rapid prototyping techniques in tissue scaffold fabrication: role of modeling on scaffold properties prediction.

    Science.gov (United States)

    Li, M G; Tian, X Y; Chen, X B

    2009-09-01

    Artificial scaffolds play vital roles in tissue engineering as they provide a supportive environment for cell attachment, proliferation and differentiation during tissue formation. Fabrication of tissue scaffolds is thus of fundamental importance for tissue engineering. Of the variety of scaffold fabrication techniques available, rapid prototyping (RP) methods have attracted a great deal of attention in recent years. This method can improve conventional scaffold fabrication by controlling scaffold microstructure, incorporating cells into scaffolds and regulating cell distribution. All of these contribute towards the ultimate goal of tissue engineering: functional tissues or organs. Dispensing is typically used in different RP techniques to implement the layer-by-layer fabrication process. This article reviews RP methods in tissue scaffold fabrication, with emphasis on dispensing-based techniques, and analyzes the effects of different process factors on fabrication performance, including flow rate, pore size and porosity, and mechanical cell damage that can occur in the bio-manufacturing process.

  5. A brief review of dispensing-based rapid prototyping techniques in tissue scaffold fabrication: role of modeling on scaffold properties prediction

    Energy Technology Data Exchange (ETDEWEB)

    Li, M G; Chen, X B [Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5A9 (Canada); Tian, X Y, E-mail: mil715@mail.usask.c [Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5A9 (Canada)

    2009-09-15

    Artificial scaffolds play vital roles in tissue engineering as they provide a supportive environment for cell attachment, proliferation and differentiation during tissue formation. Fabrication of tissue scaffolds is thus of fundamental importance for tissue engineering. Of the variety of scaffold fabrication techniques available, rapid prototyping (RP) methods have attracted a great deal of attention in recent years. This method can improve conventional scaffold fabrication by controlling scaffold microstructure, incorporating cells into scaffolds and regulating cell distribution. All of these contribute towards the ultimate goal of tissue engineering: functional tissues or organs. Dispensing is typically used in different RP techniques to implement the layer-by-layer fabrication process. This article reviews RP methods in tissue scaffold fabrication, with emphasis on dispensing-based techniques, and analyzes the effects of different process factors on fabrication performance, including flow rate, pore size and porosity, and mechanical cell damage that can occur in the bio-manufacturing process. (topical review)

  6. Bone tissue engineering scaffolding: computer-aided scaffolding techniques.

    Science.gov (United States)

    Thavornyutikarn, Boonlom; Chantarapanich, Nattapon; Sitthiseripratip, Kriskrai; Thouas, George A; Chen, Qizhi

    Tissue engineering is essentially a technique for imitating nature. Natural tissues consist of three components: cells, signalling systems (e.g. growth factors) and extracellular matrix (ECM). The ECM forms a scaffold for its cells. Hence, the engineered tissue construct is an artificial scaffold populated with living cells and signalling molecules. A huge effort has been invested in bone tissue engineering, in which a highly porous scaffold plays a critical role in guiding bone and vascular tissue growth and regeneration in three dimensions. In the last two decades, numerous scaffolding techniques have been developed to fabricate highly interconnective, porous scaffolds for bone tissue engineering applications. This review provides an update on the progress of foaming technology of biomaterials, with a special attention being focused on computer-aided manufacturing (Andrade et al. 2002) techniques. This article starts with a brief introduction of tissue engineering (Bone tissue engineering and scaffolds) and scaffolding materials (Biomaterials used in bone tissue engineering). After a brief reviews on conventional scaffolding techniques (Conventional scaffolding techniques), a number of CAM techniques are reviewed in great detail. For each technique, the structure and mechanical integrity of fabricated scaffolds are discussed in detail. Finally, the advantaged and disadvantage of these techniques are compared (Comparison of scaffolding techniques) and summarised (Summary).

  7. Making tissue engineering scaffolds work. Review: the application of solid freeform fabrication technology to the production of tissue engineering scaffolds.

    Science.gov (United States)

    Sachlos, E; Czernuszka, J T

    2003-06-30

    Tissue engineering is a new and exciting technique which has the potential to create tissues and organs de novo. It involves the in vitro seeding and attachment of human cells onto a scaffold. These cells then proliferate, migrate and differentiate into the specific tissue while secreting the extracellular matrix components required to create the tissue. It is evident, therefore, that the choice of scaffold is crucial to enable the cells to behave in the required manner to produce tissues and organs of the desired shape and size. Current scaffolds, made by conventional scaffold fabrication techniques, are generally foams of synthetic polymers. The cells do not necessarily recognise such surfaces, and most importantly cells cannot migrate more than 500 microm from the surface. The lack of oxygen and nutrient supply governs this depth. Solid freeform fabrication (SFF) uses layer-manufacturing strategies to create physical objects directly from computer-generated models. It can improve current scaffold design by controlling scaffold parameters such as pore size, porosity and pore distribution, as well as incorporating an artificial vascular system, thereby increasing the mass transport of oxygen and nutrients into the interior of the scaffold and supporting cellular growth in that region. Several SFF systems have produced tissue engineering scaffolds with this concept in mind which will be the main focus of this review. We are developing scaffolds from collagen and with an internal vascular architecture using SFF. Collagen has major advantages as it provides a favourable surface for cellular attachment. The vascular system allows for the supply of nutrients and oxygen throughout the scaffold. The future of tissue engineering scaffolds is intertwined with SFF technologies.

  8. The improving outcomes in intermittent exotropia study: outcomes at 2 years after diagnosis in an observational cohort

    Directory of Open Access Journals (Sweden)

    Buck Deborah

    2012-01-01

    Full Text Available Abstract Background The purpose of this study was to investigate current patterns of management and outcomes of intermittent distance exotropia [X(T] in the UK. Methods This was an observational cohort study which recruited 460 children aged Results At follow-up, data were available for 371 children (81% of the original cohort. Of these: 53% (195 had no treatment; 17% (63 had treatment for reduced visual acuity only (pure refractive error and amblyopia; 13% (50 had non surgical treatment for control (spectacle lenses, occlusion, prisms, exercises and 17% (63 had surgery. Only 0.5% (2/371 children developed constant exotropia. The surgically treated group was the only group with clinically significant improvements in angle or NCS. However, 8% (5 of those treated surgically required second procedures for overcorrection within 6 months of the initial procedure and at 6-month follow-up 21% (13 were overcorrected. Conclusions Many children in the UK with X(T receive active monitoring only. Deterioration to constant exotropia, with or without treatment, is rare. Surgery appears effective in improving angle of X(T and NCS, but rates of overcorrection are high.

  9. Synthesizing Results From Empirical Research on Computer-Based Scaffolding in STEM Education: A Meta-Analysis.

    Science.gov (United States)

    Belland, Brian R; Walker, Andrew E; Kim, Nam Ju; Lefler, Mason

    2017-04-01

    Computer-based scaffolding assists students as they generate solutions to complex problems, goals, or tasks, helping increase and integrate their higher order skills in the process. However, despite decades of research on scaffolding in STEM (science, technology, engineering, and mathematics) education, no existing comprehensive meta-analysis has synthesized the results of these studies. This review addresses that need by synthesizing the results of 144 experimental studies (333 outcomes) on the effects of computer-based scaffolding designed to assist the full range of STEM learners (primary through adult education) as they navigated ill-structured, problem-centered curricula. Results of our random effect meta-analysis (a) indicate that computer-based scaffolding showed a consistently positive (ḡ = 0.46) effect on cognitive outcomes across various contexts of use, scaffolding characteristics, and levels of assessment and (b) shed light on many scaffolding debates, including the roles of customization (i.e., fading and adding) and context-specific support. Specifically, scaffolding's influence on cognitive outcomes did not vary on the basis of context-specificity, presence or absence of scaffolding change, and logic by which scaffolding change is implemented. Scaffolding's influence was greatest when measured at the principles level and among adult learners. Still scaffolding's effect was substantial and significantly greater than zero across all age groups and assessment levels. These results suggest that scaffolding is a highly effective intervention across levels of different characteristics and can largely be designed in many different ways while still being highly effective.

  10. Scarring, stem cells, scaffolds and skin repair.

    Science.gov (United States)

    Markeson, Daniel; Pleat, Jonathon M; Sharpe, Justin R; Harris, Adrian L; Seifalian, Alexander M; Watt, Suzanne M

    2015-06-01

    The treatment of full thickness skin loss, which can be extensive in the case of large burns, continues to represent a challenging clinical entity. This is due to an on-going inability to produce a suitable tissue engineered substrate that can satisfactorily replicate the epidermal and dermal in vivo niches to fulfil both aesthetic and functional demands. The current gold standard treatment of autologous skin grafting is inadequate because of poor textural durability, scarring and associated contracture, and because of a paucity of donor sites in larger burns. Tissue engineering has seen exponential growth in recent years with a number of 'off-the-shelf' dermal and epidermal substitutes now available. Each has its own limitations. In this review, we examine normal wound repair in relation to stem/progenitor cells that are intimately involved in this process within the dermal niche. Endothelial precursors, in particular, are examined closely and their phenotype, morphology and enrichment from multiple sources are described in an attempt to provide some clarity regarding the controversy surrounding their classification and role in vasculogenesis. We also review the role of the next generation of cellularized scaffolds and smart biomaterials that attempt to improve the revascularisation of artificial grafts, the rate of wound healing and the final cosmetic and functional outcome. Copyright © 2013 John Wiley & Sons, Ltd.

  11. Using public policy to improve outcomes for asthmatic children in schools.

    Science.gov (United States)

    Lynn, Jewlya; Oppenheimer, Sophie; Zimmer, Lorena

    2014-12-01

    School-based services to improve asthma management need to be accompanied by public policies that can help sustain services, scale effective interventions, create greater equity across schools, and improve outcomes for children. Several national organizations, including the Centers for Disease Control and Prevention, have recommended specific public policies the adoption of which in school settings can improve asthma outcomes for children. Although many states and school districts have adopted some of these policies, adoption is not universal, and implementation is not always successful, leaving inequities in children's access to asthma services and supports. These issues can be addressed by changing public policy. Policy change is a complex process, but it is one that will benefit from greater involvement by asthma experts, including the researchers who generate the knowledge base on what services, supports, and policies have the best outcomes for children. Asthma experts can participate in the policy process by helping to build awareness of the need for school-based asthma policy, estimating the costs associated with policy options and with inaction, advocating for the selection of specific policies, assisting in implementation (including providing feedback), conducting the research that can evaluate the effectiveness of implementation, and ultimately providing information back into the policy process to allow for improvements to the policies. Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  12. Wilms′ tumour in African children: Can an institutional approach improve outcome?

    Directory of Open Access Journals (Sweden)

    Lofty-John Chukwuemeka Anyanwu

    2015-01-01

    Full Text Available Background: The poor outcome for patients with Wilms′ tumour (WT in developing countries has been predicated on late presentation, poverty and low rate of chemotherapeutic access. This study aims to evaluate the effects of an institutionalised approach to improving outcome for patients managed in a tertiary hospital in Nigeria. Materials and Methods: Oncology records of children diagnosed with WT between 2009 and 2013 were analysed for therapy completion and other prognostic parameters. Ensuing data were then compared with those from other centres in Africa. Results: Compared with results from some local and African studies, the therapy completion rate was higher (60% with a survival rate among this group being between 1 and 4 years. No patient was lost to follow-up because of unavailability or unaffordability of cytotoxic agents. Conclusion: This study shows that an institutionalised approach can help to improve access to anti-cancer drugs, reduce the rate of loss to follow-up and thus improve outcome. There is however need to improve on patient-doctor communication, form support groups and establish a WT registry.

  13. Anisotropic silk fibroin/gelatin scaffolds from unidirectional freezing

    Energy Technology Data Exchange (ETDEWEB)

    Asuncion, Maria Christine Tankeh, E-mail: christine.asuncion@u.nus.edu [National University of Singapore, Department of Biomedical Engineering (Singapore); Goh, James Cho-Hong [National University of Singapore, Department of Biomedical Engineering (Singapore); National University of Singapore, Department of Orthopedic Surgery (Singapore); Toh, Siew-Lok [National University of Singapore, Department of Biomedical Engineering (Singapore); National University of Singapore, Department of Mechanical Engineering (Singapore)

    2016-10-01

    Recent studies have underlined the importance of matching scaffold properties to the biological milieu. Tissue, and thus scaffold, anisotropy is one such property that is important yet sometimes overlooked. Methods that have been used to achieve anisotropic scaffolds present challenges such as complicated fabrication steps, harsh processing conditions and toxic chemicals involved. In this study, unidirectional freezing was employed to fabricate anisotropic silk fibroin/gelatin scaffolds in a simple and mild manner. Morphological, mechanical, chemical and cellular compatibility properties were investigated, as well as the effect of the addition of gelatin to certain properties of the scaffold. It was shown that scaffold properties were suitable for cell proliferation and that mesenchymal stem cells were able to align themselves along the directed fibers. The fabricated scaffolds present a platform that can be used for anisotropic tissue engineering applications such as cardiac patches. - Highlights: • Silk/gelatin scaffolds with unidirectional alignment were fabricated using a simple and scalable process • Presence of gelatin in silk resulted to lesser shrinkage, better water retention and improved cell proliferation. • Mesenchymal stem cells were shown to align themselves according to the fiber alignment.

  14. Provider and Patient Directed Financial Incentives to Improve Care and Outcomes for Patients with Diabetes

    Science.gov (United States)

    Lorincz, Ilona S.; Lawson, Brittany C. T.

    2012-01-01

    Incentive programs directed at both providers and patients have become increasingly widespread. Pay-for-performance (P4P) where providers receive financial incentives to carry out specific care or improve clinical outcomes has been widely implemented. The existing literature indicates they probably spur initial gains which then level off or partially revert if incentives are withdrawn. The literature also indicates that process measures are easier to influence through P4P programs but that intermediate outcomes such as glucose, blood pressure, and cholesterol control are harder to influence, and the long term impact of P4P programs on health is largely unknown. Programs directed at patients show greater promise as a means to influence patient behavior and intermediate outcomes such as weight loss; however, the evidence for long term effects are lacking. In combination, both patient and provider incentives are potentially powerful tools but whether they are cost-effective has yet to be determined. PMID:23225214

  15. The Association of Organizational Culture and Quality Improvement Implementation With Neonatal Outcomes in the NICU.

    Science.gov (United States)

    Mahl, Sukhy; Lee, Shoo K; Baker, G Ross; Cronin, Catherine M G; Stevens, Bonnie; Ye, Xiang Y

    2015-01-01

    Studies of adult patient populations suggest that organizational culture is associated with quality improvement (QI) implementation, as well as patient outcomes. However, very little research on organizational culture has been performed in neonatal patient populations. This combined cross-sectional survey and retrospective cohort study assessed employee perceptions of organizational culture and QI implementation within 18 Canadian neonatal intensive care units. The associations between these data and neonatal outcomes in extremely preterm infants (born at culture and QI implementation varied according to occupation and age. Higher hierarchical culture was associated with increased survival without major morbidities (odds ratio, 1.04; 95% confidence interval, 1.01-1.06), as were higher QI implementation scores (odds ratio range, 1.20-1.36 by culture type). Our data suggest that organizational culture, particularly hierarchical culture, and level of QI implementation may play a role in neonatal outcomes. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  16. THE USE OF SERIES IMAGE MEDIA TO IMPROVE CIVICS LEARNING OUTCOMES OF STUDENTS WITH INTELLECTUAL DISABILITYIN

    Directory of Open Access Journals (Sweden)

    Nisa’ul Kasanah

    2017-02-01

    Full Text Available Civics learning is one of the subjects related with daily activities. The purpose of this research is to determain the using of series image media to incrase of outcomes learning the civics subject on schools discipline materials and to determine the increase of outcomes learning the civics subject on schools discipline materials in school to the students with intellectual disability in grade II after given learning with series image media.The approach in this research is a classroom action research (CAR. The conclusion of the study is the use of the series image media in the schools discipline material can improve student learning outcomes. The indicators was the incrased values of the average student and the percentage of successful students from pre action, one cycle to the next cycle, in pre action was 48,75, the first cycle was 56,25 and the second cycle was 86,25.

  17. Scaffolding Reading Comprehension Skills

    Science.gov (United States)

    Salem, Ashraf Atta Mohamed Safein

    2017-01-01

    The current study investigates whether English language teachers use scaffolding strategies for developing their students' reading comprehension skills or just for assessing their comprehension. It also tries to demonstrate whether teachers are aware of these strategies or they use them as a matter of habit. A questionnaire as well as structured…

  18. Presenting Symptoms and Dysphagia Screen Predict Outcome in Mild and Rapidly Improving Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Gadodia, Gaurav; Rizk, Nibal; Camp, Deborah; Bryant, Katja; Zimmerman, Susan; Brasher, Cynthia; Connelly, Kerrin; Dunn, Joshua; Frankel, Michael; Ido, Moges Seymour; Lugtu, James; Nahab, Fadi

    2016-12-01

    There are limited data on which patients not treated with intravenous (IV) tissue-type plasminogen activator (tPA) due to mild and rapidly improving stroke symptoms (MaRISS) have unfavorable outcomes. Acute ischemic stroke (AIS) patients not treated with IV tPA due to MaRISS from January 1, 2009 to December 31, 2013 were identified as part of the Georgia Coverdell Acute Stroke Registry. Multivariable regression analysis was used to identify factors associated with a lower likelihood of favorable outcome, defined as discharge to home. There were 1614 AIS patients who did not receive IV tPA due to MaRISS (median National Institutes of Health stroke scale [NIHSS] 1], of which 305 (19%) did not have a favorable outcome. Factors associated with lower likelihood of favorable outcome included Medicare insurance status (odds ratio [OR]: .53, 95% confidence interval [CI]: .34-.84), arrival by emergency medical services (OR: .46, 95% CI: .29-.73), increasing NIHSS score (per unit OR: .89, 95% CI: .84-.93), weakness as the presenting symptom (OR: .50, 95% CI: .30-.84), and a failed dysphagia screen (OR: .43, 95% CI: .23-.80). During the study period, dysphagia screen identify a subgroup of patients who are more likely to have an unfavorable outcome. Whether IV tPA treatment can improve the outcome in this subgroup of patients needs to be evaluated in a randomized placebo-controlled trial. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Economic Outcomes of Bioresorbable Vascular Scaffolds Versus Everolimus-Eluting Stents in Patients Undergoing Percutaneous Coronary Intervention: 1-Year Results From the ABSORB III Trial.

    Science.gov (United States)

    Baron, Suzanne J; Lei, Yang; Chinnakondepalli, Khaja; Vilain, Katherine; Magnuson, Elizabeth A; Kereiakes, Dean J; Ellis, Stephen G; Stone, Gregg W; Cohen, David J

    2017-04-24

    The purpose of this study was to evaluate the economic impact of the Absorb bioresorbable vascular scaffold compared with the Xience everolimus-eluting stent in patients undergoing percutaneous coronary intervention. The ABSORB III trial (Everolimus-Eluting Bioresorbable Scaffolds for Coronary Artery Disease) demonstrated that the Absorb scaffold was noninferior to the Xience stent with respect to target lesion failure at 1 year. Whether health care costs differ between the Absorb scaffold and the Xience stent is unknown. We performed a prospective health economic study alongside the ABSORB III trial, in which patients undergoing percutaneous coronary intervention for stable or unstable angina were randomized to receive the Absorb scaffold (n = 1,322) or Xience stent (n = 686). Resource use data were collected through 1 year of follow-up. Costs were assessed using resource-based accounting (for procedures), MedPAR data (for other index hospitalization costs), and Medicare reimbursements (for follow-up costs and physician fees). Initial procedural costs were higher with the Absorb scaffold than the Xience stent ($6,316 ± 1,892 vs. $6,103 ± 1,895; p = 0.02), driven mainly by greater balloon catheter use and the higher cost of the scaffold in the Absorb group. Nonetheless, index hospitalization costs ($15,035 ± 2,992 for Absorb vs. $14,903 ± 3,449 for Xience; p = 0.37) and total 1-year costs ($17,848 ± 6,110 for Absorb vs. $17,498 ± 7,411 for Xience; p = 0.29) were similar between the 2 groups. Although initial procedural costs were higher with the Absorb scaffold, there were no differences in total 1-year health care costs between the 2 cohorts. Longer term follow-up is needed to determine whether meaningful cost savings emerge after scaffold resorption. (A Clinical Evaluation of Absorb™ BVS, the Everolimus-Eluting Bioresorbable Vascular Scaffold in the Treatment of Subjects With de Novo Native Coronary Artery Lesions; NCT01751906). Copyright © 2017

  20. Transplantation of Neural Stem Cells Cultured in Alginate Scaffold for Spinal Cord Injury in Rats.

    Science.gov (United States)

    Hosseini, Seyed Mojtaba; Sharafkhah, Ali; Koohi-Hosseinabadi, Omid; Semsar-Kazerooni, Maryam

    2016-08-01

    This study investigated the effects of transplantation of alginate encapsulated neural stem cells (NSCs) on spinal cord injury in Sprague-Dawley male rats. The neurological functions were assessed for 6 weeks after transplantation along with a histological study and measurement of caspase-3 levels. The aim of this study was to discover whether NSCs cultured in alginate transplantation improve recovery from spinal cord injury. Spinal cord injury is one of the leading causes of disability and it has no effective treatment. Spinal cord injury can also cause sensory impairment. With an impetus on using stem cells therapy in various central nervous system settings, there is an interest in using stem cells for addressing spinal cord injury. Neural stem cell is one type of stem cells that is able to differentiate to all three neural lineages and it shows promise in spinal injury treatment. Furthermore, a number of studies have shown that culturing NSCs in three-dimensional (3D) scaffolds like alginate could enhance neural differentiation. The NSCs were isolated from 14-day-old rat embryos. The isolated NSCs were cultured in growth media containing basic fibroblast growth factor and endothelial growth factor. The cells were characterized by differentiating to three neural lineages and they were cultured in an alginate scaffold. After 7 days the cells were encapsulated and transplanted in a rat model of spinal cord injury. Our data showed that culturing in an alginate 3D scaffold and transplantation of the NSCs could improve neurological outcome in a rat model of spinal cord injury. The inflammation scores and lesion sizes and also the activity of caspase-3 (for apoptosis evaluation) were less in encapsulated neural stem cell transplantation cases. Transplantation of NSCs that were cultured in an alginate scaffold led to a better clinical and histological outcome for recovery from spinal cord injury in a rat model.

  1. In vitro evaluation of alginate/halloysite nanotube composite scaffolds for tissue engineering.

    Science.gov (United States)

    Liu, Mingxian; Dai, Libing; Shi, Huizhe; Xiong, Sheng; Zhou, Changren

    2015-04-01

    In this study, a series of alginate/halloysite nanotube (HNTs) composite scaffolds were prepared by solution-mixing and freeze-drying method. HNTs are incorporated into alginate to improve both the mechanical and cell-attachment properties of the scaffolds. The interfacial interactions between alginate and HNTs were confirmed by the atomic force microscope (AFM), transmission electron microscope (TEM) and FTIR spectroscopy. The mechanical, morphological, and physico-chemical properties of the composite scaffolds were investigated. The composite scaffolds exhibit significant enhancement in compressive strength and compressive modulus compared with pure alginate scaffold both in dry and wet states. A well-interconnected porous structure with size in the range of 100-200μm and over 96% porosity is found in the composite scaffolds. X-ray diffraction (XRD) result shows that HNTs are uniformly dispersed and partly oriented in the composite scaffolds. The incorporation of HNTs leads to increase in the scaffold density and decrease in the water swelling ratio of alginate. HNTs improve the stability of alginate scaffolds against enzymatic degradation in PBS solution. Thermogravimetrica analysis (TGA) shows that HNTs can improve the thermal stability of the alginate. The mouse fibroblast cells display better attachment to the alginate/HNT composite than those to the pure alginate, suggesting the good cytocompatibility of the composite scaffolds. Alginate/HNT composite scaffolds exhibit great potential for applications in tissue engineering. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. Pharmacist involvement in improving asthma outcomes in various healthcare settings: 1997 to present.

    Science.gov (United States)

    Benavides, Sandra; Rodriguez, Juan Carlos; Maniscalco-Feichtl, Maria

    2009-01-01

    To evaluate pharmacists' impact on asthma management outcomes in various healthcare settings on the basis of updated guidelines set by the National Heart, Lung, and Blood Institute (NHLBI). A search of MEDLINE (1997-April 2008) and International Pharmaceutical Abstracts (1997-April 2008) was conducted using the MeSH terms asthma, community pharmacy services, pharmacists, pharmacies, clinic, hospital, disease state management, medication therapy management, emergency department, and community. Articles were included if pharmacists participated in the intervention and the report measured outcomes of asthma as defined by symptoms, pulmonary function, asthma severity, quality of life (QOL), or healthcare utilization. Since January 1997, a substantial number of studies have been published examining pharmacists' impact on asthma clinical outcomes. Twenty-five studies were included in this review: 15 were conducted in community pharmacies, 5 in ambulatory clinics, 2 in an in-patient hospital setting, and 3 as various community initiatives. The studies varied in the type of intervention provided and outcomes measured. The most common outcome in community pharmacies was pulmonary function measures, in which all but one trial found improvements. Half of the community pharmacy trials found improvements in asthma severity, 75% found improvements in healthcare utilization, and although some trials found improvements in QOL, 2 trials found decreases in QOL. Ambulatory clinics reported improvements in asthma symptoms and pulmonary function and decreased healthcare utilization. Most trials in the ambulatory care setting reported decreases in QOL postintervention. Trials in the hospital setting most often reported decreases in healthcare utilization. Limitations of the studies, however, included varying definitions of asthma control, methodologies used in the studies, and the lack of long-term follow-up. Future study designs may require larger sample size and measure outcomes that

  3. The "not so simple" ankle fracture: avoiding problems and pitfalls to improve patient outcomes.

    Science.gov (United States)

    Hak, David J; Egol, Kenneth A; Gardner, Michael J; Haskell, Andrew

    2011-01-01

    Ankle fractures are among the most common injuries managed by orthopaedic surgeons. Many ankle fractures are simple, with straightforward management leading to successful outcomes. Some fractures, however, are challenging, and debate arises regarding the best treatment to achieve an optimal outcome. Some patients have medical comorbidities that increase the risk for complications or may require modifications to standard surgical techniques and fixation methods. Several recent investigations have highlighted the pitfalls in accurately reducing syndesmotic injuries. Controversy remains regarding the number and diameter of screws, the duration of weight-bearing limitations, and the need or timing of screw removal. Open reduction may allow more accurate reduction than standard closed methods. Direct fixation of associated posterior malleolus fractures may provide improved syndesmotic stability. Posterior malleolus fractures vary in size and can be classified based on the orientation of the fracture line. As the size of the posterior malleolus fracture fragment increases, the load pattern in the ankle is altered. Direct or indirect reduction and surgical fixation may be required to prevent posterior talar subluxation and restore articular congruency. The supination-adduction fracture pattern is also important to recognize. Articular depression of the medial tibial plafond may require reduction and bone grafting. Optimal fixation requires directing screws parallel to the ankle joint or using a buttress plate. Identifying ankle fractures that may present additional treatment challenges is essential to achieving a successful outcome. A careful review of radiographs and CT scans, a thorough patient assessment, and detailed preoperative planning are needed to improve patient outcomes.

  4. Short Duration Combined Mild Hypothermia Improves Resuscitation Outcomes in a Porcine Model of Prolonged Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Tao Yu

    2015-01-01

    Full Text Available Objective. In this study, our aim was to investigate the effects of combined hypothermia with short duration maintenance on the resuscitation outcomes in a porcine model of ventricular fibrillation (VF. Methods. Fourteen porcine models were electrically induced with VF and untreated for 11 mins. All animals were successfully resuscitated manually and then randomized into two groups: combined mild hypothermia (CH group and normothermia group (NT group. A combined hypothermia of ice cold saline infusion and surface cooling was implemented in the animals of the CH group and maintained for 4 hours. The survival outcomes and neurological function were evaluated every 24 hours until a maximum of 96 hours. Neuron apoptosis in hippocampus was analyzed. Results. There were no significant differences in baseline physiologies and primary resuscitation outcomes between both groups. Obvious improvements of cardiac output were observed in the CH group at 120, 180, and 240 mins following resuscitation. The animals demonstrated better survival at 96 hours in the CH group when compared to the NT group. In comparison with the NT group, favorable neurological functions were observed in the CH group. Conclusion. Short duration combined cooling initiated after resuscitation improves survival and neurological outcomes in a porcine model of prolonged VF.

  5. Edutourism Taka Bonerate National Park through Scientific Approach to Improve Student Learning Outcomes

    Science.gov (United States)

    Hayati, R. S.

    2017-02-01

    This research aim is develop the potential of Taka Bonerate National Park as learning resources through edutourism with scientific approach to improve student learning outcomes. Focus of student learning outcomes are students psychomotor abilities and comprehension on Biodiversity of Marine Biota, Corals Ecosystem, and Conservation topics. The edutourism development products are teacher manual, edutourism worksheet, material booklet, guide’s manual, and Taka Bonerate National Park governor manual. The method to develop edutourism products is ADDIE research and development model that consist of analysis, design, development and production, implementation, and evaluation step. The subjects in the implementation step were given a pretest and posttest and observation sheet to see the effect of edutourism Taka Bonerate National Park through scientific approach to student learning outcomes on Biodiversity of Marine Biota, Corals Ecosystem, and Conservation topics. The data were analyzed qualitative descriptively. The research result is edutourism Taka Bonerate National Park through scientific approach can improve students learning outcomes on Biodiversity of Marine Biota, Corals Ecosystem, and Conservation topics. Edutourism Taka Bonerate National Park can be an alternative of learning method on Biodiversity of Marine Biota, Corals Ecosystem, and Conservation topics.

  6. An e-learning course in medical immunology: does it improve learning outcome?

    Science.gov (United States)

    Boye, Sondre; Moen, Torolf; Vik, Torstein

    2012-01-01

    E-learning is used by most medical students almost daily and several studies have shown e-learning to improve learning outcome in small-scale interventions. However, few studies have explored the effects of e-learning in immunology. To study the effect of an e-learning package in immunology on learning outcomes in a written integrated examination and to examine student satisfaction with the e-learning package. All second-year students at a Norwegian medical school were offered an animated e-learning package in basic immunology as a supplement to the regular teaching. Each student's log-on-time was recorded and linked with the student's score on multiple choice questions included in an integrated end-of-the-year written examination. Student satisfaction was assessed through a questionnaire. The intermediate-range students (interquartile range) on average scored 3.6% better on the immunology part of the examination per hour they had used the e-learning package (p = 0.0046) and log-on-time explained 17% of the variance in immunology score. The best and the less skilled students' examination outcomes were not affected by the e-learning. The e-learning was well appreciated among the students. Use of an e-learning package in immunology in addition to regular teaching improved learning outcomes for intermediate-range students.

  7. Interprofessional Curbside Consults to Develop Team Communication and Improve Student Achievement of Learning Outcomes.

    Science.gov (United States)

    Kirwin, Jennifer; Greenwood, Kristin Curry; Rico, Janet; Nalliah, Romesh; DiVall, Margarita

    2017-02-25

    Objective. To design and implement a series of activities focused on developing interprofessional communication skills and to assess the impact of the activities on students' attitudes and achievement of educational goals. Design. Prior to the first pharmacy practice skills laboratory session, pharmacy students listened to a classroom lecture about team communication and viewed short videos describing the roles, responsibilities, and usual work environments of four types of health care professionals. In each of four subsequent laboratory sessions, students interacted with a different standardized health care professional role-played by a pharmacy faculty member who asked them a medication-related question. Students responded in verbal and written formats. Assessment. Student performance was assessed with a three-part rubric. The impact of the exercise was assessed by conducting pre- and post-intervention surveys and analyzing students' performance on relevant Center for the Advancement of Pharmacy Education (CAPE) outcomes. Survey results showed improvement in student attitudes related to team-delivered care. Students' performance on the problem solver and collaborator CAPE outcomes improved, while performance on the educator outcome worsened. Conclusions. The addition of an interprofessional communication activity with standardized health care professionals provided the opportunity for students to develop skills related to team communication. Students felt the activity was valuable and realistic; however, analysis of outcome achievement from the exercise revealed a need for more exposure to team communication skills.

  8. Improvement in clinical outcomes after dry needling in a patient with occipital neuralgia

    Science.gov (United States)

    Bond, Bryan M.; Kinslow, Christopher

    2015-01-01

    The primary purpose of this case report is to outline the diagnosis, intervention and clinical outcome of a patient presenting with occipital neuralgia. Upon initial presentation, the patient described a four-year history of stabbing neck pain and headaches. After providing informed consent, the patient underwent a total of four dry needling (DN) sessions over a two-week duration. During each of the treatment sessions, needles were inserted into the trapezii and suboccipital muscles. Post-intervention, the patient reported a 32-point change in her neck disability index score along with a 28-point change in her headache disability index score. Thus, it appears that subsequent four sessions of DN over two weeks, our patient experienced meaningful improvement in her neck pain and headaches. To the best of our knowledge, this is the first case report describing DN to successfully improve clinical outcomes in a patient diagnosed with occipital neuralgia. PMID:26136602

  9. Improvement in clinical outcomes after dry needling in a patient with occipital neuralgia.

    Science.gov (United States)

    Bond, Bryan M; Kinslow, Christopher

    2015-06-01

    The primary purpose of this case report is to outline the diagnosis, intervention and clinical outcome of a patient presenting with occipital neuralgia. Upon initial presentation, the patient described a four-year history of stabbing neck pain and headaches. After providing informed consent, the patient underwent a total of four dry needling (DN) sessions over a two-week duration. During each of the treatment sessions, needles were inserted into the trapezii and suboccipital muscles. Post-intervention, the patient reported a 32-point change in her neck disability index score along with a 28-point change in her headache disability index score. Thus, it appears that subsequent four sessions of DN over two weeks, our patient experienced meaningful improvement in her neck pain and headaches. To the best of our knowledge, this is the first case report describing DN to successfully improve clinical outcomes in a patient diagnosed with occipital neuralgia.

  10. Public–private partnerships improve health outcomes in individuals with early stage Alzheimer’s disease

    Science.gov (United States)

    Galvin, James E; Tolea, Magdalena I; George, Nika; Wingbermuehle, Cheryl

    2014-01-01

    Purpose In a collaborative effort between the Missouri Department of Health, Area Agencies on Aging (AAA), Alzheimer Association, and academic researchers, we tested whether early dementia detection and comprehensive care consultations would improve health outcomes in care receivers (CRs) and their family caregivers (FCGs), therefore addressing an important public health concern. Participants and methods A total of 244 community-dwelling older adults screened for early-stage dementia by the AAA field staff were referred to the Alzheimer Association and participated in Project Learn MORE (Missouri Outreach and Referral Expanded) (PLM) – a 2-year, nonrandomized multisite intervention consisting of comprehensive care consultations to improve coping skills. PLM participants were compared against 96 controls receiving the Alzheimer Association’s “usual services” between January 2011 and December 2012. We examined CR and FCG outcomes, including burden, care confidence, and mood, as effects of PLM, on delaying transitions in level of care. Results CRs showed improved knowledge (P=0.002) and reduced depression (P=0.007), while FCGs demonstrated improved knowledge (P=0.003) and ability to identify sources of support for the CR (P=0.032) and for themselves (P=0.043). However, FCGs were more burdened after PLM (P=0.02), due to increased awareness of Alzheimer’s disease. PLM delayed transitions in care (odds ratio [OR] 3.32, 95% confidence level [CI]: 1.25–8.83) with the number needed to treat =6.82. Conclusion PLM was successful in improving detection of incident cases of dementia in the community and in connecting patients and their families with needed services. Our findings support the use of state agencies and community service partners to detect dementia. Early implementation of psychosocial interventions could have significant impact in improving patient- and family-centered outcomes, potentially providing a cost-efficient alternative to pharmacotherapy

  11. Exploring the black box of quality improvement collaboratives: modelling relations between conditions, applied changes and outcomes.

    Science.gov (United States)

    Dückers, Michel L A; Spreeuwenberg, Peter; Wagner, Cordula; Groenewegen, Peter P

    2009-11-17

    Despite the popularity of quality improvement collaboratives (QICs) in different healthcare settings, relatively little is known about the implementation process. The objective of the current study is to learn more about relations between relevant conditions for successful implementation of QICs, applied changes, perceived successes, and actual outcomes. Twenty-four Dutch hospitals participated in a dissemination programme based on QICs. A questionnaire was sent to 237 leaders of teams who joined 18 different QICs to measure changes in working methods and activities, overall perceived success, team organisation, and supportive conditions. Actual outcomes were extracted from a database with team performance indicator data. Multi-level analyses were conducted to test a number of hypothesised relations within the cross-classified hierarchical structure in which teams are nested within QICs and hospitals. Organisational and external change agent support is related positively to the number of changed working methods and activities that, if increased, lead to higher perceived success and indicator outcomes scores. Direct and indirect positive relations between conditions and perceived success could be confirmed. Relations between conditions and actual outcomes are weak. Multi-level analyses reveal significant differences in organisational support between hospitals. The relation between perceived successes and actual outcomes is present at QIC level but not at team level. Several of the expected relations between conditions, applied changes and outcomes, and perceived successes could be verified. However, because QICs vary in topic, approach, complexity, and promised advantages, further research is required: first, to understand why some QIC innovations fit better within the context of the units where they are implemented; second, to assess the influence of perceived success and actual outcomes on the further dissemination of projects over new patient groups.

  12. Exploring the black box of quality improvement collaboratives: modelling relations between conditions, applied changes and outcomes

    Directory of Open Access Journals (Sweden)

    Wagner Cordula

    2009-11-01

    Full Text Available Abstract Introduction Despite the popularity of quality improvement collaboratives (QICs in different healthcare settings, relatively little is known about the implementation process. The objective of the current study is to learn more about relations between relevant conditions for successful implementation of QICs, applied changes, perceived successes, and actual outcomes. Methods Twenty-four Dutch hospitals participated in a dissemination programme based on QICs. A questionnaire was sent to 237 leaders of teams who joined 18 different QICs to measure changes in working methods and activities, overall perceived success, team organisation, and supportive conditions. Actual outcomes were extracted from a database with team performance indicator data. Multi-level analyses were conducted to test a number of hypothesised relations within the cross-classified hierarchical structure in which teams are nested within QICs and hospitals. Results Organisational and external change agent support is related positively to the number of changed working methods and activities that, if increased, lead to higher perceived success and indicator outcomes scores. Direct and indirect positive relations between conditions and perceived success could be confirmed. Relations between conditions and actual outcomes are weak. Multi-level analyses reveal significant differences in organisational support between hospitals. The relation between perceived successes and actual outcomes is present at QIC level but not at team level. Discussion Several of the expected relations between conditions, applied changes and outcomes, and perceived successes could be verified. However, because QICs vary in topic, approach, complexity, and promised advantages, further research is required: first, to understand why some QIC innovations fit better within the context of the units where they are implemented; second, to assess the influence of perceived success and actual outcomes on the

  13. Improving infant outcome with a 10 min Apgar of 0.

    Science.gov (United States)

    Kasdorf, Ericalyn; Laptook, Abbot; Azzopardi, Dennis; Jacobs, Susan; Perlman, Jeffrey M

    2015-03-01

    Asystole at birth and extending through 10 min is rare, with current international recommendations stating it may be appropriate to consider discontinuation of resuscitation in this clinical scenario. These recommendations are based on small case series of both term and preterm infants, where death or abnormal outcome was nearly universal. Study objective was to determine recent outcome of infants with an Apgar score of 0 at 10 min despite cardiopulmonary resuscitation, treated with therapeutic hypothermia or standard treatment, in randomised cooling studies. Outcome studies of infants with an Apgar of 0 at 10 min subsequently resuscitated and treated with hypothermia or standard treatment were reviewed and combined with local outcome data of infants treated with hypothermia. Four recent studies (n=81) and local data (n=9) yielded a total of 90 infants with an Apgar of 0 at 10 min, with 56 treated with hypothermia and 34 controls. Primary outcome of death or abnormal neurodevelopmental outcome (18-24 months) occurred in 73% cooled and 79.5% normothermic infants (p=0.61). Although poor, the outcome for infants with an Apgar of 0 at 10 min of life has improved substantially in recent years. This may be related to treatment with hypothermia, enhanced resuscitation techniques and/or other supportive management. Current recommendations to consider discontinuation of resuscitation without a detectable heart rate at 10 min should consider these findings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Tissue Engineering to Improve Immature Testicular Tissue and Cell Transplantation Outcomes: One Step Closer to Fertility Restoration for Prepubertal Boys Exposed to Gonadotoxic Treatments.

    Science.gov (United States)

    Del Vento, Federico; Vermeulen, Maxime; de Michele, Francesca; Giudice, Maria Grazia; Poels, Jonathan; des Rieux, Anne; Wyns, Christine

    2018-01-18

    Despite their important contribution to the cure of both oncological and benign diseases, gonadotoxic therapies present the risk of a severe impairment of fertility. Sperm cryopreservation is not an option to preserve prepubertal boys' reproductive potential, as their seminiferous tubules only contain spermatogonial stem cells (as diploid precursors of spermatozoa). Cryobanking of human immature testicular tissue (ITT) prior to gonadotoxic therapies is an accepted practice. Evaluation of cryopreserved ITT using xenotransplantation in nude mice showed the survival of a limited proportion of spermatogonia and their ability to proliferate and initiate differentiation. However, complete spermatogenesis could not be achieved in the mouse model. Loss of germ cells after ITT grafting points to the need to optimize the transplantation technique. Tissue engineering, a new branch of science that aims at improving cellular environment using scaffolds and molecules administration, might be an approach for further progress. In this review, after summarizing the lessons learned from human prepubertal testicular germ cells or tissue xenotransplantation experiments, we will focus on the benefits that might be gathered using bioengineering techniques to enhance transplantation outcomes by optimizing early tissue graft revascularization, protecting cells from toxic insults linked to ischemic injury and exploring strategies to promote cellular differentiation.

  15. Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial

    National Research Council Canada - National Science Library

    Hartescu, Iuliana; Morgan, Kevin; Stevinson, Clare D

    2015-01-01

    While high levels of activity and exercise training have been associated with improvements in sleep quality, minimum levels of activity likely to improve sleep outcomes have not been explored. A two...

  16. Prehospital plasma resuscitation associated with improved neurologic outcomes after traumatic brain injury.

    Science.gov (United States)

    Hernandez, Matthew C; Thiels, Cornelius A; Aho, Johnathon M; Habermann, Elizabeth B; Zielinski, Martin D; Stubbs, James A; Jenkins, Donald H; Zietlow, Scott P

    2017-09-01

    Trauma-related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBIs). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improves neurologic function after TBI; however, data in humans are lacking. We retrospectively identified all patients with multiple injuries age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single Level I trauma center from January 2002 to December 2013. Inclusion criteria were prehospital resuscitation with either packed red blood cells (pRBCs) or thawed plasma as sole colloid resuscitation. Patients who died in hospital and those using anticoagulants were excluded. Primary outcomes were Glasgow Outcomes Score Extended (GOSE) and Disability Rating Score (DRS) at dismissal and during follow-up. Of 76 patients meeting inclusion criteria, 53% (n = 40) received prehospital pRBCs and 47% (n = 36) received thawed plasma. Age, gender, injury severity or TBI severity, arrival laboratory values, and number of prehospital units were similar (all p > 0.05). Patients who received thawed plasma had an improved neurologic outcome compared to those receiving pRBCs (median GOSE 7 [7-8] vs. 5.5 [3-7], p plasma had improved functionality compared to pRBCs (median DRS 2 [1-3.5] vs. 9 [3-13], p plasma compared to pRBCs by both median GOSE (8 [7-8] vs. 6 [6-7], p plasma is associated with improved neurologic and functional outcomes at discharge and during follow-up compared to pRBCs alone. These preliminary data support the further investigation and use of plasma in the resuscitation of critically injured TBI patients. Therapeutic, level V.

  17. Follow-up care for breast cancer survivors: improving patient outcomes

    OpenAIRE

    Chopra I; Chopra A

    2014-01-01

    Ishveen Chopra,1 Avijeet Chopra2 1Department of Pharmacy Administration, Duquesne University, Pittsburgh, PA, USA; 2Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT, USA Background: Appropriate follow-up care is important for improving health outcomes in breast cancer survivors (BCSs) and requires determination of the optimum intensity of clinical examination and surveillance, assessment of models of follow-up care such as primary care-based follow-up, an under...

  18. DEVELOPMENT AND IMPROVEMENT OF BUSINESS HIGHER EDUCATION THROUGH IMPLEMENTATION OF STUDENTS LEARNING OUTCOMES ASSESSMENT PLAN (SLOAP

    Directory of Open Access Journals (Sweden)

    Zoran Ivanovski

    2013-03-01

    Full Text Available This study presents new vision how to upgrade business higher education at the Faculty of Economics at University of Tourism and Management in Skopje (UTMS. This paper is result of analyses of best practices of leading higher education institutions as well authors experience in higher education and business education and practice. The UTMS is orientated to introduce best practices and objective standards in order to offer high-quality business education for its students. UTMS has mission for permanent implementation of quality improvement measures as a way to achieve high professional and academic standards and become part of prosperous and respective Universities. In order to achieve this goal, UTMS plan to use additional measures, outcomes assessment as a way to measure institutional effectiveness, as well as effective technique for identifying where changes and improvements are necessary. UTMS has developed Students Learning Outcomes Assessment Plan (SLOAP as a way to reach this goal.Based on permanent analysis of students needs as well as business sector suggestions about desirable level of knowledge, skills and competence of the students from Faculty of Economics, gained from conducted evaluations, UTMS decide to make additional improvement and development of business education. This process have 4 phases: 1 evaluation of students attitude towards curricula and the instructors efficiency, 2preparation of the SLOAP (Student Learning Outcomes Assessment Plan document, 3 implementation of two direct measures from the SLOAP through assessment analysis and action planning, and 4 monitoring changes and improvements made as a result of action planning.The first phase was completed in spring semester 2012, as well as second one with development of Comprehensive Exam and Capstone Course as direct measures. Complete SLOAP also has indirect measures like student satisfaction inventory, course evaluations, alumni, and employers’ surveys, and a

  19. Improvement of medical content in the curriculum of biomedical engineering based on assessment of students outcomes.

    Science.gov (United States)

    Abdulhay, Enas; Khnouf, Ruba; Haddad, Shireen; Al-Bashir, Areen

    2017-08-04

    Improvement of medical content in Biomedical Engineering curricula based on a qualitative assessment process or on a comparison with another high-standard program has been approached by a number of studies. However, the quantitative assessment tools have not been emphasized. The quantitative assessment tools can be more accurate and robust in cases of challenging multidisciplinary fields like that of Biomedical Engineering which includes biomedicine elements mixed with technology aspects. The major limitations of the previous research are the high dependence on surveys or pure qualitative approaches as well as the absence of strong focus on medical outcomes without implicit confusion with the technical ones. The proposed work presents the development and evaluation of an accurate/robust quantitative approach to the improvement of the medical content in the challenging multidisciplinary BME curriculum. The work presents quantitative assessment tools and subsequent improvement of curriculum medical content applied, as example for explanation, to the ABET (Accreditation Board for Engineering and Technology, USA) accredited biomedical engineering BME department at Jordan University of Science and Technology. The quantitative results of assessment of curriculum/course, capstone, exit exam, course assessment by student (CAS) as well as of surveys filled by alumni, seniors, employers and training supervisors were, first, mapped to the expected students' outcomes related to the medical field (SOsM). The collected data were then analyzed and discussed to find curriculum weakness points by tracking shortcomings in every outcome degree of achievement. Finally, actions were taken to fill in the gaps of the curriculum. Actions were also mapped to the students' medical outcomes (SOsM). Weighted averages of obtained quantitative values, mapped to SOsM, indicated accurately the achievement levels of all outcomes as well as the necessary improvements to be performed in curriculum

  20. Improving clinical outcome in patients with intestinal failure using individualised nutritional advice.

    Science.gov (United States)

    Culkin, A; Gabe, S M; Madden, A M

    2009-08-01

    Patients with intestinal failure are required to adhere to a complex regimen. Written information may increase knowledge leading to improvements in clinical outcomes. The present study aimed to evaluate the effectiveness of nutrition advice incorporating the use of a booklet. Each patient completed a questionnaire evaluating their knowledge of the regime and quality of life and kept a diet and gastrointestinal output diary. The diary was assessed and they were given the booklet with a verbal explanation tailored to individual requirements. The booklet explained the causes of intestinal failure, diet and fluid recommendations in relation to intestinal anatomy, information on medications and long-term monitoring. Patients were reassessed at their next appointment using the same tools. The primary endpoint was an improvement in knowledge. Secondary endpoints were an improvement in oral nutritional intake, nutritional status, quality of life and the content of home parenteral nutrition. Forty-eight patients completed the study. Knowledge improved significantly after dietetic intervention in association with the provision of the booklet (P nutrition showed a reduction in parenteral energy (P = 0.02), nitrogen (P = 0.003), volume (P = 0.02) and frequency (P = 0.003). A booklet for patients with intestinal failure in conjunction with personalised dietary counselling improves knowledge and clinical outcomes.

  1. Rosuvastatin improves myocardial and neurological outcomes after asphyxial cardiac arrest and cardiopulmonary resuscitation in rats.

    Science.gov (United States)

    Qiu, Yun; Wu, Yichen; Meng, Min; Luo, Man; Zhao, Hongmei; Sun, Hong; Gao, Sumin

    2017-03-01

    Rosuvastatin, a potent HMG-CoA reductase inhibitor, is cholesterol-lowering drugs and reduce the risk of myocardial infarction and stroke. This study is to explore whether rosuvastatin improves outcomes after cardiac arrest in rats. Male Sprague-Dawley rats were subjected to 8min of cardiac arrest (CA) by asphyxia and randomly assigned to three experimental groups immediately following successful resuscitation: Sham; Control; and Rosuvastatin. The survival, hemodynamics, myocardial function, neurological outcomes and apoptosis were assessed. The 7-d survival rate was greater in the rosuvastatin treated group compared to the Control group (P=0.019 by log-rank test). Myocardial function, as measured by cardiac output and ejection fraction, was significantly impaired after CA and notably improved in the animals treated with rosuvastatin beginning at 60min after return of spontaneous circulation (ROSC) (Pcardiac troponin T and neuron-specific enolase and the caspase-3 activity were significantly decreased in the Rosuvastatin group when compared with the Control group (P<0.05). In conclusion, rosuvastatin treatment substantially improves the 7-d survival rate as well as myocardial function and neurological outcomes after ROSC. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Discharge phone calls: using person-centred communication to improve outcomes.

    Science.gov (United States)

    Eggenberger, Terry; Garrison, Heather; Hilton, Nancy; Giovengo, Karen

    2013-07-01

    This article describes the Clinical Nurse Leader role in implementing person-centred care bundles to improve patient outcomes through an innovative culture of caring. Demonstrating the financial value of introducing the Clinical Nurse Leader role into an organisation is essential for sustainability. Previous authors have established the Clinical Nurse Leaders' influence on patient satisfaction and have suggested that Clinical Nurse Leaders improve the continuity of care after discharge. Descriptive data are shared to illustrate the effectiveness of implementing the patient care bundles and a Clinical Nurse Leader-driven discharge phone call process. Clinical Nurse Leaders who practise from a caring lens are uniquely situated to lead initiatives that drive person-centred care with the goal of reducing readmission rates. Patients who receive person-centred care have an improved perception of the hospital experience and are more likely to return to the facility. Clinical Nurse Leaders establish relationships with patients that increase the likelihood of successful outcomes from the discharge phone call process. Further evaluation of the Clinical Nurse Leader's role and potential impact on patient outcomes is warranted. Clinical Nurse Leaders are uniquely prepared to lead transformational change within an organisation. Clinical Nurse Leader interventions that are developed at the microsystem level in response to problems may have system-wide implications. © 2013 John Wiley & Sons Ltd.

  3. Reciprocal peer review for quality improvement: an ethnographic case study of the Improving Lung Cancer Outcomes Project.

    Science.gov (United States)

    Aveling, Emma-Louise; Martin, Graham; Jiménez García, Senai; Martin, Lisa; Herbert, Georgia; Armstrong, Natalie; Dixon-Woods, Mary; Woolhouse, Ian

    2012-12-01

    Peer review offers a promising way of promoting improvement in health systems, but the optimal model is not yet clear. We aimed to describe a specific peer review model-reciprocal peer-to-peer review (RP2PR)-to identify the features that appeared to support optimal functioning. We conducted an ethnographic study involving observations, interviews and documentary analysis of the Improving Lung Cancer Outcomes Project, which involved 30 paired multidisciplinary lung cancer teams participating in facilitated reciprocal site visits. Analysis was based on the constant comparative method. Fundamental features of the model include multidisciplinary participation, a focus on discussion and observation of teams in action, rather than paperwork; facilitated reflection and discussion on data and observations; support to develop focused improvement plans. Five key features were identified as important in optimising this model: peers and pairing methods; minimising logistic burden; structure of visits; independent facilitation; and credibility of the process. Facilitated RP2PR was generally a positive experience for participants, but implementing improvement plans was challenging and required substantial support. RP2PR appears to be optimised when it is well organised; a safe environment for learning is created; credibility is maximised; implementation and impact are supported. RP2PR is seen as credible and legitimate by lung cancer teams and can act as a powerful stimulus to produce focused quality improvement plans and to support implementation. Our findings have identified how RP2PR functioned and may be optimised to provide a constructive, open space for identifying opportunities for improvement and solutions.

  4. In vitro evaluation of alginate/halloysite nanotube composite scaffolds for tissue engineering

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Mingxian [Department of Materials Science and Engineering, Jinan University, Guangzhou 510632 (China); Dai, Libing [Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital Medical College, Jinan University, Guangzhou 510220 (China); Shi, Huizhe; Xiong, Sheng [Institute of Biomedicine, National Engineering Research Center of Genetic Medicine, Jinan University, Guangzhou 510632 (China); Zhou, Changren, E-mail: tcrz9@jnu.edu.cn [Department of Materials Science and Engineering, Jinan University, Guangzhou 510632 (China)

    2015-04-01

    In this study, a series of alginate/halloysite nanotube (HNTs) composite scaffolds were prepared by solution-mixing and freeze-drying method. HNTs are incorporated into alginate to improve both the mechanical and cell-attachment properties of the scaffolds. The interfacial interactions between alginate and HNTs were confirmed by the atomic force microscope (AFM), transmission electron microscope (TEM) and FTIR spectroscopy. The mechanical, morphological, and physico-chemical properties of the composite scaffolds were investigated. The composite scaffolds exhibit significant enhancement in compressive strength and compressive modulus compared with pure alginate scaffold both in dry and wet states. A well-interconnected porous structure with size in the range of 100–200 μm and over 96% porosity is found in the composite scaffolds. X-ray diffraction (XRD) result shows that HNTs are uniformly dispersed and partly oriented in the composite scaffolds. The incorporation of HNTs leads to increase in the scaffold density and decrease in the water swelling ratio of alginate. HNTs improve the stability of alginate scaffolds against enzymatic degradation in PBS solution. Thermogravimetrica analysis (TGA) shows that HNTs can improve the thermal stability of the alginate. The mouse fibroblast cells display better attachment to the alginate/HNT composite than those to the pure alginate, suggesting the good cytocompatibility of the composite scaffolds. Alginate/HNT composite scaffolds exhibit great potential for applications in tissue engineering. - Highlights: • We fabricated HNTs reinforced alginate composite scaffolds for biomedical applications. • The hydrogen bond interactions between HNTs and alginate are confirmed. • HNTs can significantly enhance the mechanical properties of alginate scaffold. • The scaffolds exhibit a highly porous structure with interconnected pores. • HNTs can improve the cell attachment and proliferation on alginate.

  5. Does addressing gender inequalities and empowering women and girls improve health and development programme outcomes?

    Science.gov (United States)

    Taukobong, Hannah F G; Kincaid, Mary M; Levy, Jessica K; Bloom, Shelah S; Platt, Jennifer L; Henry, Sarah K; Darmstadt, Gary L

    2016-12-01

    This article presents evidence supporting the hypothesis that promoting gender equality and women's and girls' empowerment (GEWE) leads to better health and development outcomes. We reviewed the literature across six sectors-family planning (FP); maternal, newborn and child health (MNCH); nutrition; agriculture; water, sanitation and hygiene; and financial services for the poor-and found 76 studies from low and middle-income countries that met our inclusion criteria. Across these studies, we identified common GEWE variables that emerged repeatedly as significant predictors of sector outcomes. We grouped these variables into 10 thematic categories, which we termed 'gender-related levers'. These levers were then classified by the strength of evidence into Wedges, Foundations and Facilitators. Wedges are gender-related levers that had strong associations with improved outcomes across multiple sectors. They include: 'control over income/assets/resources', 'decision-making power' and 'education'. Elements of these levers overlap, but combined, they encapsulate agency. Increasing female agency promotes equality and broadly improves health and development for women, their families and their communities. The second classification, Foundations, displayed strong, positive associations across FP, MNCH and nutrition. Foundations have a more proximal relationship with sector outcomes and include: 'equitable interpersonal relationships', 'mobility' and 'personal safety'. Finally, the third group of levers, Facilitators, was associated with improved outcomes in two to three sectors and include: 'access to information', 'community groups', 'paid labour' and 'rights'. These levers make it easier for women and girls to achieve their goals and are more traditional elements of development programmes. Overall, gender-related levers were associated with improvements in a variety of health and development outcomes. Furthermore, these associations were cross-sectoral, suggesting that to

  6. Differential aspects between cobalt-chromium everolimus drug-eluting stent and Absorb everolimus bioresorbable vascular scaffold: from bench to clinical use.

    Science.gov (United States)

    Sotomi, Yohei; Suwannasom, Pannipa; Tenekecioglu, Erhan; Tateishi, Hiroki; Abdelghani, Mohammad; Serruys, Patrick W; Onuma, Yoshinobu

    2015-10-01

    Drug-eluting stents have significantly improved the outcomes of percutaneous coronary intervention by substantially reducing in-stent restenosis and stent thrombosis. However, a potential limitation of these stents is the permanent presence of a metallic foreign body within the artery, which may cause vascular inflammation, restenosis, thrombosis, neoatherosclerosis, permanent impairment of the physiological vasomotor function and interference with potential future grafting of the stented segment. Bioresorbable scaffolds have the potential to overcome these limitations as they provide temporary scaffolding and then disappear, liberating the treated vessel from its cage and restoring pulsatility, cyclical strain, physiological shear stress and mechanotransduction. This article presents a comparison between the most widespread bioresorbable vascular scaffold 'Absorb BVS' and second-generation drug-eluting stent (cobalt chromium everolimus-eluting stent) from bench to clinical use.

  7. Design of a bioresorbable polymeric scaffold for osteoblast culture

    Science.gov (United States)

    Ditaranto, Vincent M., Jr.

    Bioresorbable polymeric scaffolds were designed for the purpose of growing rat osteosarcoma cells (ROS 17/2.8) using the compression molding method. The material used in the construction of the scaffolds was a mixture of polycaprolactone (PCL), Hydroxyapatite (HA), Glycerin (GL) and salt (NaCl) for porosity. The concentration of the several materials utilized, was determined by volume. Past research at the University of Massachusetts Lowell (UML) has successfully utilized the compression molding method for the construction of scaffolds, but was unable to accomplish the goal of long term cell survival and complete cellular proliferation throughout a three dimensional scaffold. This research investigated various concentrations of the materials and molding temperatures used for the manufacture of scaffolds in order to improve the scaffold design and address those issues. The design of the scaffold using the compression molding process is detailed in the Method and Materials section of this thesis. The porogen (salt) used for porosity was suspected as a possible source of contamination causing cell apoptosis in past studies. This research addressed the issues for cell survival and proliferation throughout a three dimensional scaffold. The leaching of the salt was one major design modification. This research successfully used ultrasonic leaching in addition to the passive method. Prior to cell culture, the scaffolds were irradiated to 2.75 Mrad, with cobalt-60 gamma radionuclide. The tissue culture consisted of two trials: (1) cell culture in scaffolds cleaned with passive leaching; (2) cell culture with scaffolds cleaned with ultrasonic leaching. Cell survival and proliferation was accomplished only with the addition of ultrasonic leaching of the scaffolds. Analysis of the scaffolds included Scanning Electron Microscopy (SEM), Nikon light microscopy and x-ray mapping of the calcium, sodium and chloride ion distribution. The cells were analyzed by Environmental Scanning

  8. Bifocals Fail to Improve Stereopsis Outcomes in High AC/A Accommodative Esotropia.

    Science.gov (United States)

    Whitman, Mary C; MacNeill, Katelyn; Hunter, David G

    2016-04-01

    To assess whether stereopsis outcomes of patients with accommodative esotropia with high accommodative convergence/accommodation relationship (AC/A) were improved after treatment with bifocal glasses compared with single-vision lenses. Retrospective cohort study. Patients with high AC/A accommodative esotropia; evidence of stereopsis, binocularity (on Worth 4-dot testing), or improvement in near angle with +3.00 D lenses; and at least 4 years of records available for review, who were seen in the Department of Ophthalmology at Boston Children's Hospital between 2006 and 2014. Use of bifocal or single-vision glasses. Charts were reviewed retrospectively. Stereopsis was log transformed for statistical analysis. Linear (for stereopsis) or logistic (for surgery) regression was used to control for confounders. Stereopsis at final follow-up, difference in stereopsis between final and initial visits, and progression to strabismus surgery. Secondary outcomes included final near and distance deviations. Of the 180 patients who met inclusion criteria, 77 used bifocals and 103 used single-vision lenses. Bifocals did not improve stereopsis outcomes compared with single-vision lenses. In both groups, stereopsis was similar at the initial and final visits, with similar improvement in both groups. Children in the bifocal group had a 3.6-fold higher rate of strabismus surgery than children in the single-lens group (P = 0.04.) Additionally, children in the bifocal group had near deviations 4 PD larger than those with single lenses at final follow-up, even after controlling for age and initial deviation (P = 0.02). These results did not change if surgical patients were eliminated or in the subgroup with initial distance deviation of 0 PD in full hyperopic correction. Despite their widespread use, there is no evidence that bifocals improve outcomes in children with accommodative esotropia with high AC/A. In our retrospective review, children with bifocals had higher surgical rates and

  9. Online video improves clinical outcomes in adults with atopic dermatitis: a randomized controlled trial.

    Science.gov (United States)

    Armstrong, April W; Kim, Randie H; Idriss, Nayla Z; Larsen, Larissa N; Lio, Peter A

    2011-03-01

    Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by intense pruritus that causes significant disease and psychosocial burden in patients. Patient education has the potential to improve clinical outcomes and patient knowledge of this condition. We sought to assess the effectiveness of online video education at improving AD knowledge and disease severity compared with a written pamphlet, and to determine the usefulness and appeal of the two educational delivery vehicles. In a randomized controlled trial, 80 participants were randomized to receive either online video-based patient education or written pamphlet education about AD and its management. We assessed AD disease severity using the patient-oriented eczema measure (POEM) scale. AD knowledge was assessed with standardized questionnaires at baseline and after the 12-week intervention. All participants had similar baseline knowledge and AD severity at the beginning of the study. On study completion, improvements in AD knowledge assessed by questionnaire were significantly greater in the video group than the pamphlet group (3.05 vs 1.85, P = .011). Online video-based education resulted in greater improvement in clinical outcome, as measured by POEM, compared with pamphlet-based education (POEM score reduction of 3.30 vs 1.03, P = .0043). Finally, although the usefulness of both interventions was rated equally (P = .77), the online video was significantly more appealing than the pamphlet (P = .0086). This study is limited to AD in adults. Online video for patient education is an effective and appealing tool for improving clinical outcomes in adult patients with AD. Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  10. Are effects of depression management training for General Practitioners on patient outcomes mediated by improvements in the process of care?

    NARCIS (Netherlands)

    van Os, TWDP; van den Brink, RHS; Tiemens, BG; Jenner, JA; van der Meer, K; Ormel, J

    Background: Depression treatment by General Practitioners (GPs) and patient outcomes improved significantly after a comprehensive 20-h training program of GPs. This study examines whether the effects on patient outcomes are caused by the improvements in the process of care. Methods: Seventeen GPs

  11. Kenya's ICT Policy in Practice: The Effectiveness of Tablets and E-Readers in Improving Student Outcomes

    Science.gov (United States)

    Piper, Benjamin; Jepkemei, Evelyn; Kwayumba, Dunston; Kibukho, Kennedy

    2015-01-01

    Kenya is investing in information and communication technology (ICT) to improve children's learning outcomes. However, the literature on ICT is pessimistic about the ability of ICT alone to improve outcomes, and few ICT programs have created the instructional change necessary to increase learning. The Primary Math and Reading (PRIMR) Initiative…

  12. Does Early Decompressive Craniectomy Improve Outcome? Experience from an Active UK Recruiter Centre

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    E. García Vicente

    2013-01-01

    Full Text Available Introduction. The results of the recent DECRA study suggest that although craniectomy decreases ICP and ICU length of stay, it is also associated with worst outcomes. Our experience, illustrated by these two striking cases, supports that early decompressive craniectomy may significantly improve the outcome in selected patients. Case Reports. The first patient, a 20-year-old man who suffered severe brain contusion and subarachnoid haemorrhage after a fall downstairs, with refractory ICP of 35 mmHg, despite maximal medical therapy, eventually underwent decompressive craniectomy. After 18 days in intensive care, he was discharged for rehabilitation. The second patient, a 23-year-old man was found at the scene of a road accident with a GCS of 3 and fixed, dilated pupils who underwent extensive unilateral decompressive craniectomy for refractory intracranial hypertension. After three weeks of cooling, paralysis, and neuroprotection, he eventually left ICU for rehabilitation. Outcomes. Four months after leaving ICU, the first patient abseiled 40 m down the main building of St. Mary’s Hospital to raise money for the Trauma Unit. He has returned to part-time work. The second patient, was decannulated less than a month later and made a full cognitive recovery. A year later, with a titanium skull prosthesis, he is back to part-time work and to playing football. Conclusions. Despite the conclusions of the DECRA study, our experience of the use of early decompressive craniectomy has been associated with outstanding outcomes. We are currently actively recruiting patients into the RESCUEicp trial and have high hopes that it will clarify the role of the decompressive craniectomy in traumatic brain injury and whether it effectively improves outcomes.

  13. Scaffold library for tissue engineering: a geometric evaluation.

    Science.gov (United States)

    Chantarapanich, Nattapon; Puttawibul, Puttisak; Sucharitpwatskul, Sedthawatt; Jeamwatthanachai, Pongnarin; Inglam, Samroeng; Sitthiseripratip, Kriskrai

    2012-01-01

    Tissue engineering scaffold is a biological substitute that aims to restore, to maintain, or to improve tissue functions. Currently available manufacturing technology, that is, additive manufacturing is essentially applied to fabricate the scaffold according to the predefined computer aided design (CAD) model. To develop scaffold CAD libraries, the polyhedrons could be used in the scaffold libraries development. In this present study, one hundred and nineteen polyhedron models were evaluated according to the established criteria. The proposed criteria included considerations on geometry, manufacturing feasibility, and mechanical strength of these polyhedrons. CAD and finite element (FE) method were employed as tools in evaluation. The result of evaluation revealed that the close-cellular scaffold included truncated octahedron, rhombicuboctahedron, and rhombitruncated cuboctahedron. In addition, the suitable polyhedrons for using as open-cellular scaffold libraries included hexahedron, truncated octahedron, truncated hexahedron, cuboctahedron, rhombicuboctahedron, and rhombitruncated cuboctahedron. However, not all pore size to beam thickness ratios (PO:BT) were good for making the open-cellular scaffold. The PO:BT ratio of each library, generating the enclosed pore inside the scaffold, was excluded to avoid the impossibility of material removal after the fabrication. The close-cellular libraries presented the constant porosity which is irrespective to the different pore sizes. The relationship between PO:BT ratio and porosity of open-cellular scaffold libraries was displayed in the form of Logistic Power function. The possibility of merging two different types of libraries to produce the composite structure was geometrically evaluated in terms of the intersection index and was mechanically evaluated by means of FE analysis to observe the stress level. The couples of polyhedrons presenting low intersection index and high stress level were excluded. Good couples for

  14. Scaffold Library for Tissue Engineering: A Geometric Evaluation

    Directory of Open Access Journals (Sweden)

    Nattapon Chantarapanich

    2012-01-01

    Full Text Available Tissue engineering scaffold is a biological substitute that aims to restore, to maintain, or to improve tissue functions. Currently available manufacturing technology, that is, additive manufacturing is essentially applied to fabricate the scaffold according to the predefined computer aided design (CAD model. To develop scaffold CAD libraries, the polyhedrons could be used in the scaffold libraries development. In this present study, one hundred and nineteen polyhedron models were evaluated according to the established criteria. The proposed criteria included considerations on geometry, manufacturing feasibility, and mechanical strength of these polyhedrons. CAD and finite element (FE method were employed as tools in evaluation. The result of evaluation revealed that the close-cellular scaffold included truncated octahedron, rhombicuboctahedron, and rhombitruncated cuboctahedron. In addition, the suitable polyhedrons for using as open-cellular scaffold libraries included hexahedron, truncated octahedron, truncated hexahedron, cuboctahedron, rhombicuboctahedron, and rhombitruncated cuboctahedron. However, not all pore size to beam thickness ratios (PO : BT were good for making the open-cellular scaffold. The PO : BT ratio of each library, generating the enclosed pore inside the scaffold, was excluded to avoid the impossibility of material removal after the fabrication. The close-cellular libraries presented the constant porosity which is irrespective to the different pore sizes. The relationship between PO : BT ratio and porosity of open-cellular scaffold libraries was displayed in the form of Logistic Power function. The possibility of merging two different types of libraries to produce the composite structure was geometrically evaluated in terms of the intersection index and was mechanically evaluated by means of FE analysis to observe the stress level. The couples of polyhedrons presenting low intersection index and high stress

  15. A brief sleep intervention improves outcomes in the school entry year: a randomized controlled trial.

    Science.gov (United States)

    Quach, Jon; Hiscock, Harriet; Ukoumunne, Obioha Chukwunyere; Wake, Melissa

    2011-10-01

    To determine the feasibility of screening for child sleep problems and the efficacy of a behavioral sleep intervention in improving child and parent outcomes in the first year of schooling. A randomized controlled trial was nested in a population survey performed at 22 elementary schools in Melbourne, Australia. Intervention involved 2 to 3 consultations that covered behavioral sleep strategies for children whose screening results were positive for a moderate/severe sleep problem. Outcomes were parent-reported child sleep problem (primary outcome), sleep habits, psychosocial health-related quality of life, behavior, and parent mental health (all at 3, 6, and 12 months) and blinded, face-to-face learning assessment (at 6 months). The screening survey was completed by 1512 parents; 161 (10.8%) reported a moderate/severe child sleep problem, and 108 of 136 (79.2% of those eligible) entered the trial. Sleep problems tended to resolve more rapidly in intervention children. Sleep problems affected 33% of 54 intervention children versus 43% of 54 control children at 3 months (P = .3), 25.5% vs 46.8% at 6 months (P = .03), and 32% vs 33% at 12 months (P = .8). Sustained sleep-habit improvements were evident at 3, 6, and 12 months (effect sizes: 0.33 [P = .03]; 0.51 [P = .003]; and 0.40 [P = .02]; respectively), and there were initial marked improvements in psychosocial scores that diminished over time (effect sizes: 0.47 [P = .02]; 0.41 [P = .09]; and 0.26 [P = .3]; respectively). Better prosocial behavior was evident at 12 months (effect size: 0.35; P = .03), and learning and parent outcomes were similar between groups. School-based screening for sleep problems followed by a targeted, brief behavioral sleep intervention is feasible and has benefits relevant to school transition.

  16. Thrombus Permeability Is Associated With Improved Functional Outcome and Recanalization in Patients With Ischemic Stroke.

    Science.gov (United States)

    Santos, Emilie M M; Marquering, Henk A; den Blanken, Mark D; Berkhemer, Olvert A; Boers, Anna M M; Yoo, Albert J; Beenen, Ludo F; Treurniet, Kilian M; Wismans, Carrie; van Noort, Kim; Lingsma, Hester F; Dippel, Diederik W J; van der Lugt, Aad; van Zwam, Wim H; Roos, Yvo B W E M; van Oostenbrugge, Robert J; Niessen, Wiro J; Majoie, Charles B

    2016-03-01

    Preclinical studies showed that thrombi can be permeable and may, therefore, allow for residual blood flow in occluded arteries of patients having acute ischemic stroke. This perviousness may increase tissue oxygenation, improve thrombus dissolution, and augment intra-arterial treatment success. We hypothesize that the combination of computed tomographic angiography and noncontrast computed tomography imaging allows measurement of contrast agent penetrating a permeable thrombus, and it is associated with improved outcome. Thrombus and contralateral artery attenuations in noncontrast computed tomography and computed tomographic angiography images were measured in 184 Multicenter Randomized Clinical trial of Endovascular treatment of acute ischemic stroke in the Netherlands (MR CLEAN) patients with thin-slice images. Two quantitative estimators of the thrombus permeability were introduced: computed tomographic angiography attenuation increase (Δ) and thrombus void fraction (ε). Patients were dichotomized as having a pervious or impervious thrombus and associated with outcome, recanalization, and final infarct volume. Patients with Δ≥10.9 HU (n=81 [44%]) and ε≥6.5% (n=77 [42%]) were classified as having a pervious thrombus. These patients were 3.2 (95% confidence interval, 1.7-6.4) times more likely to have a favorable outcome, and 2.5 (95% confidence interval, 1.3-4.8) times more likely to recanalyze, for Δ based classification, and similarly for ε. These odds ratios were independent from intravenous or intra-arterial treatment. Final infarct volume was negatively correlated with both perviousness estimates (correlation coefficient, -0.39 for Δ and -0.40 for ε). This study shows that simultaneous measurement of thrombus attenuation in noncontrast computed tomography and computed tomographic angiography allows for quantification of thrombus perviousness. Thrombus perviousness is strongly associated with improved functional outcome, smaller final infarct

  17. MEASURES TO IMPROVE THE OUTCOME OF ABRUPTIO PLACENTA IN A TERTIARY REFERRAL CENTRE

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    Vijaya

    2015-12-01

    Full Text Available AIM To analyze the outcome of 135 patients admitted with Abruptio Placenta during a period of 9 months managed at Tertiary Referral Centre, Modern Govt. Maternity Hospital, Petalburz, Hyderabad, Telangana State. MATERIALS AND METHODS A study of 135 cases of Abruptio Placenta over a period of 9 months at a tertiary level referral centre. They were analyzed regarding age, parity, socio economic status, period of gestation, antenatal care, management of Abruption and maternal and fetal outcome, and the measures to improve the condition were analyzed. RESULTS Abruptio placenta is a dreadful threat to maternal and fetal life. In our study unbooked cases were 110(81.48%, Hypertension is the main risk factor almost in 90(66.66% cases, 65% of them were between 28-36 weeks of GA, and 6 were grandmultis, 6 cases ended up with HELLP syndrome with DIC. All these 6 cases were near misses, 5 unbooked cases had eclampsia. One case of unbooked eclampsia had abruption DIC and could not be saved as it was the late referral. Total number of vaginal deliveries were 66(48.88% and total no. of abdominal deliveries were 67(49.62% in this LSCS 66 and one hysterotomy. IUD at the time of admission total were 100(74%. CONCLUSION To improve the outcome in Abruptio Placentae Good antenatal care, Educating the patient, Strengthening the Primary Health Centers in identifying the risk factors like Pre-eclampsia thereby avoiding eclampsia. Regular antenatal checkups timely delivery and availability of blood and blood products with good Neonatal care unit will help in improving the outcome of Abruptio.

  18. Implementation of Neurocritical Care Is Associated With Improved Outcomes in Traumatic Brain Injury.

    Science.gov (United States)

    Sekhon, Mypinder S; Gooderham, Peter; Toyota, Brian; Kherzi, Navid; Hu, Vivien; Dhingra, Vinay K; Hameed, Morad S; Chittock, Dean R; Griesdale, Donald E

    2017-07-01

    Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients. We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months. A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS. Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.

  19. Intensive hemodialysis associates with improved pregnancy outcomes: a Canadian and United States cohort comparison.

    Science.gov (United States)

    Hladunewich, Michelle A; Hou, Susan; Odutayo, Ayodele; Cornelis, Tom; Pierratos, Andreas; Goldstein, Marc; Tennankore, Karthik; Keunen, Johannes; Hui, Dini; Chan, Christopher T

    2014-05-01

    Pregnancy is rare in women with ESRD and when it occurs, it is often accompanied by significant maternal and fetal morbidity and even mortality. Preliminary data from the Toronto Nocturnal Hemodialysis Program suggested that increased clearance of uremic toxins by intensified hemodialysis improves pregnancy outcomes, but small numbers and the absence of a comparator group limited widespread applicability of these findings. We compared pregnancy outcomes from 22 pregnancies in the Toronto Pregnancy and Kidney Disease Clinic and Registry (2000-2013) with outcomes from 70 pregnancies in the American Registry for Pregnancy in Dialysis Patients (1990-2011). The primary outcome was the live birth rate and secondary outcomes included gestational age and birth weight. The live birth rate in the Canadian cohort (86.4%) was significantly higher than the rate in the American cohort (61.4%; P=0.03). Among patients with established ESRD, the median duration of pregnancy in the more intensively dialyzed Toronto cohort was 36 weeks (interquartile range, 32-37) compared with 27 weeks (interquartile range, 21-35) in the American cohort (P=0.002). Furthermore, a dose response between dialysis intensity and pregnancy outcomes emerged, with live birth rates of 48% in women dialyzed ≤20 hours per week and 85% in women dialyzed >36 hours per week (P=0.02), with a longer gestational age and greater infant birth weight for women dialyzed more intensively. Pregnancy complications were few and manageable. We conclude that pregnancy may be safe and feasible in women with ESRD receiving intensive hemodialysis. Copyright © 2014 by the American Society of Nephrology.

  20. Improved outcome of bacterial meningitis associated with use of corticosteroid treatment.

    Science.gov (United States)

    Baunbæk-Knudsen, Gertrud; Sølling, Mette; Farre, Annette; Benfield, Thomas; Brandt, Christian T

    2016-04-01

    Background The aim of this study was to evaluate the clinical outcome of patients with bacterial meningitis following the introduction of dexamethasone treatment in Denmark. Methods Adult patients with bacterial meningitis, admitted from 2003-2010 to two different university hospitals, were included retrospectively. Data at clinical presentation, Glasgow outcome scale (GOS), cerebrospinal fluid and blood biochemistry were collected. Relative risk (RR) with 95% confidence interval (CI) was computed by Cox proportional hazard regression analysis. Results One hundred and forty-seven patients were included in the study. The population had a median age of 62 years and 31% had an immunosuppressive co-morbidity. Eighty-nine patients had an unfavourable outcome (GOS score = 1-4). Adjuvant treatment with corticosteroids (RR = 0.48; 95% CI = 0.30-0.76) was associated with a favourable outcome (GOS score = 5), while altered mental status (RR = 2.36; 95% CI = 1.17-4.78) and age (RR = 1.03; 95% CI = 1.01-1.04) per year increment was associated with an unfavourable outcome. Adjuvant corticosteroid treatment did not affect short- or long-term survival. Short-term mortality was influenced by age (RR = 1.06; 95% CI = 1.04-1.09). Long-term mortality was influenced by age (RR = 1.06; 95% CI = 1.03-1.08) and female sex (RR = 1.81; 95% CI = 1.05-3.14). Conclusion This study indicated that adjuvant corticosteroid treatment in acute bacterial meningitis improves the outcome and can safely be administered in an elderly population with high levels of immunosuppressive co-morbidity.

  1. STUDENTS’ FEEDBACK FOR CONTINUOUS QUALITY IMPROVEMENT OF MATERIALS TECHNOLOGY COURSE OUTCOMES VIA TEACHING & SUPERVISION EVALUATION SYSTEM

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    MOHD HUZAIRI JOHARI

    2016-11-01

    Full Text Available Continuous quality improvement (CQI of a program design and curriculum is a mandatory process to ensure the accreditation of engineering programmes. The most inner loop in CQI of a programme is the improvement of outcomes for each course offered in the programme. This paper studied the CQI of the course outcomes (CO of a particular course (Materials Technology via the students’ feedbacks captured in the Teaching & Supervision Evaluation System (TSES. TSES is a system for students to assess the Teaching and Learning (T&L quality of a specific course offered and at the same time also assess the proficiency and efficiency of the Quality Management System (QMS MS ISO 9001:2008 for Undergraduate and Graduate (by course work Study Management. Feedbacks are on General Items (such as course content, infrastructure and apparatus, Faculty and the Lecturers’ T&L Method. The quality of T&L can be improved consistently through this system. In this study, data from five recent years for the Materials Technology course is analysed for the general items, faculty and T&L which involved questions employing a Likert Scale from 1 (Very unsatisfactory to 5 (Very satisfactory for the answers. Feedbacks from the TSES are utilised to improve the conduct of the course in the succeeding session. Results indicate scores achieved in every area have increased through the usage of this system and the CQI cycle at the course level is completed

  2. A review of the effectiveness of agriculture interventions in improving nutrition outcomes.

    Science.gov (United States)

    Berti, Peter R; Krasevec, Julia; FitzGerald, Sian

    2004-08-01

    To review the impact of agriculture interventions on nutritional status in participating households, and to analyse the characteristics of interventions that improved nutrition outcomes. We identified and reviewed reports describing 30 agriculture interventions that measured impact on nutritional status. The interventions reviewed included home gardening, livestock, mixed garden and livestock, cash cropping, and irrigation. We examined the reports for the scientific quality of the research design and treatment of the data. We also assessed whether the projects invested in five types of 'capital' (physical, natural, financial, human and social) as defined in the Sustainable Livelihoods Framework, a conceptual map of major factors that affect people's livelihoods. Most agriculture interventions increased food production, but did not necessarily improve nutrition or health within participating households. Nutrition was improved in 11 of 13 home gardening interventions, and in 11 of 17 other types of intervention. Of the 19 interventions that had a positive effect on nutrition, 14 of them invested in four or five types of capital in addition to the agriculture intervention. Of the nine interventions that had a negative or no effect on nutrition, only one invested in four or five types of capital. Those agriculture interventions that invested broadly in different types of capital were more likely to improve nutrition outcomes. Those projects which invested in human capital (especially nutrition education and consideration of gender issues), and other types of capital, had a greater likelihood of effecting positive nutritional change, but such investment is neither sufficient nor always necessary to effect change.

  3. Using Mobile Phones to Improve Educational Outcomes: An Analysis of Evidence from Asia

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    John-Harmen Valk

    2010-03-01

    Full Text Available Despite improvements in educational indicators, such as enrolment, significant challenges remain with regard to the delivery of quality education in developing countries, particularly in rural and remote regions. In the attempt to find viable solutions to these challenges, much hope has been placed in new information and communication technologies (ICTs, mobile phones being one example. This article reviews the evidence of the role of mobile phone-facilitated mLearning in contributing to improved educational outcomes in the developing countries of Asia by exploring the results of six mLearning pilot projects that took place in the Philippines, Mongolia, Thailand, India, and Bangladesh. In particular, this article examines the extent to which the use of mobile phones helped to improve educational outcomes in two specific ways: 1 in improving access to education, and 2 in promoting new learning. Analysis of the projects indicates that while there is important evidence of mobile phones facilitating increased access, much less evidence exists as to how mobiles promote new learning.

  4. Improving cancer pain control with NCCN guideline-based analgesic administration: a patient-centered outcome.

    Science.gov (United States)

    Janjan, Nora

    2014-09-01

    Improving the control of cancer-related pain (CRP) is a clinical and ethical imperative. Clinical research has documented improved treatment tolerance and survival rates among patients with cancer who have effective pain control. Barriers to CRP control include inadequate patient and physician education. Meta-analyses of patient education studies correlate improvements in CRP control with improved communications with health care providers and the implementation of strategies that assist with adherence to medication schedules. These strategies build patient confidence, allowing better self-management of pain and reduced psychological consequences. For physicians, ample educational resources exist in CRP management. However, in both the inpatient and outpatient settings, compliance with NCCN Clinical Practice Guidelines in Oncology for Adult Cancer Pain continues to be less than 70%, and more than one-third of patients continue to receive inadequate doses of analgesics. Patient-centered outcomes have become an integral end point in health policy, and the nation's medical training, research, and delivery systems are transforming to a value-based accreditation and reimbursement system. Pain control is a significant patient-centered outcome in cancer care, because pain adversely impacts function and affects all domains of quality of life. Agreement is clear on the value of health care interventions that relieve suffering from cancer pain and restore personal dignity. Copyright © 2014 by the National Comprehensive Cancer Network.

  5. Enhanced pyruvate dehydrogenase activity improves cardiac outcomes in a murine model of cardiac arrest.

    Directory of Open Access Journals (Sweden)

    Lin Piao

    Full Text Available Post-ischemic changes in cellular metabolism alter myocardial and neurological function. Pyruvate dehydrogenase (PDH, the limiting step in mitochondrial glucose oxidation, is inhibited by increased expression of PDH kinase (PDK during ischemia/reperfusion injury. This results in decreased utilization of glucose to generate cellular ATP. Post-cardiac arrest (CA hypothermia improves outcomes and alters metabolism, but its influence on PDH and PDK activity following CA are unknown. We hypothesized that therapeutic hypothermia (TH following CA is associated with the inhibition of PDK activity and increased PDH activity. We further hypothesized that an inhibitor of PDK activity, dichloroacetate (DCA, would improve PDH activity and post-CA outcomes.Anesthetized and ventilated adult female C57BL/6 wild-type mice underwent a 12-minute KCl-induced CA followed by cardiopulmonary resuscitation. Compared to normothermic (37°C CA controls, administering TH (30°C improved overall survival (72-hour survival rate: 62.5% vs. 28.6%, P<0.001, post-resuscitation myocardial function (ejection fraction: 50.9±3.1% vs. 27.2±2.0%, P<0.001; aorta systolic pressure: 132.7±7.3 vs. 72.3±3.0 mmHg, P<0.001, and neurological scores at 72-hour post CA (9.5±1.3 vs. 5.4±1.3, P<0.05. In both heart and brain, CA increased lactate concentrations (1.9-fold and 3.1-fold increase, respectively, P<0.01, decreased PDH enzyme activity (24% and 50% reduction, respectively, P<0.01, and increased PDK protein expressions (1.2-fold and 1.9-fold, respectively, P<0.01. In contrast, post-CA treatment with TH normalized lactate concentrations (P<0.01 and P<0.05 and PDK expressions (P<0.001 and P<0.05, while increasing PDH activity (P<0.01 and P<0.01 in both the heart and brain. Additionally, treatment with DCA (0.2 mg/g body weight 30 min prior to CA improved both myocardial hemodynamics 2 hours post-CA (aortic systolic pressure: 123±3 vs. 96±4 mmHg, P<0.001 and 72-hour survival rates

  6. Individual and group based parenting programmes for improving psychosocial outcomes for teenage parents and their children

    Science.gov (United States)

    Barlow, Jane; Smailagic, Nadja; Bennett, Cathy; Huband, Nick; Jones, Hannah; Coren, Esther

    2014-01-01

    Background Parenting programmes are a potentially important means of supporting teenage parents and improving outcomes for their children, and parenting support is a priority across most Western countries. This review updates the previous version published in 2001. Objectives To examine the effectiveness of parenting programmes in improving psychosocial outcomes for teenage parents and developmental outcomes in their children. Search methods We searched to find new studies for this updated review in January 2008 and May 2010 in CENTRAL, MEDLINE, EMBASE, ASSIA, CINAHL, DARE, ERIC, PsycINFO, Sociological Abstracts and Social Science Citation Index. The National Research Register (NRR) was last searched in May 2005 and UK Clinical Research Network Portfolio Database in May 2010. Selection criteria Randomised controlled trials assessing short-term parenting interventions aimed specifically at teenage parents and a control group (no-treatment, waiting list or treatment-as-usual). Data collection and analysis We assessed the risk of bias in each study. We standardised the treatment effect for each outcome in each study by dividing the mean difference in post-intervention scores between the intervention and control groups by the pooled standard deviation. Main results We included eight studies with 513 participants, providing a total of 47 comparisons of outcome between intervention and control conditions. Nineteen comparisons were statistically significant, all favouring the intervention group. We conducted nine meta-analyses using data from four studies in total (each meta-analysis included data from two studies). Four meta-analyses showed statistically significant findings favouring the intervention group for the following outcomes: parent responsiveness to the child post-intervention (SMD −0.91, 95% CI −1.52 to −0.30, P = 0.04); infant responsiveness to mother at follow-up (SMD −0.65, 95% CI −1.25 to −0.06, P = 0.03); and an overall measure of parent

  7. How clinician-patient communication contributes to health improvement: modeling pathways from talk to outcome.

    Science.gov (United States)

    Street, Richard L

    2013-09-01

    Although researchers have long investigated relationships between clinician-patient communication and health outcomes, much of the research has produced null, inconsistent, or contradictory findings. This essay examines challenges in the study of how clinician-patient communication contributes to a patient's health and offers recommendations for future research. Communication may directly impact outcomes, but more often it will have an indirect effect through its influence on intervening variables (e.g., patient understanding, clinician-patient agreement on treatment, adherence to treatment). For example, a patient communication skills intervention may not directly improve pain control for cancer patients. However, it may do so indirectly by activating patients to talk about cancer pain, which prompts the physician to change pain medication, which leads to better pain control. Additionally, communication measurement is complicated because relationships among communication behavior, meaning, and evaluation are complex. Researchers must do more to model pathways linking clinician-patient communication to the outcomes of interest, particularly pathways in which the communication effects are indirect or mediated through other variables. To better explicate how communication contributes to health outcomes, researchers must critically reflect on the assumptions they are making about communication process and choose measures consistent with those assumptions. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Improved outcome of bacterial meningitis associated with use of corticosteroid treatment

    DEFF Research Database (Denmark)

    Baunbæk-Knudsen, Gertrud; Sølling, Mette; Farre, Annette

    2016-01-01

    BACKGROUND: The aim of this study was to evaluate the clinical outcome of patients with bacterial meningitis following the introduction of dexamethasone treatment in Denmark. METHODS: Adult patients with bacterial meningitis, admitted from 2003-2010 to two different university hospitals, were...... (RR = 1.06; 95% CI = 1.04-1.09). Long-term mortality was influenced by age (RR = 1.06; 95% CI = 1.03-1.08) and female sex (RR = 1.81; 95% CI = 1.05-3.14). CONCLUSION: This study indicated that adjuvant corticosteroid treatment in acute bacterial meningitis improves the outcome and can safely...... were included in the study. The population had a median age of 62 years and 31% had an immunosuppressive co-morbidity. Eighty-nine patients had an unfavourable outcome (GOS score = 1-4). Adjuvant treatment with corticosteroids (RR = 0.48; 95% CI = 0.30-0.76) was associated with a favourable outcome...

  9. An Asian perspective on improving outcomes for nasal bone fractures by establishing specific treatment options.

    Science.gov (United States)

    Yi, J S; Kim, M J; Jang, Y J

    2017-02-01

    To report treatment outcomes of patients with different types of nasal bone fracture, following a tailored treatment protocol. The patterns and the severity of the fractures were determined by a preoperative facial photo and nasal bone computed tomography (CT) retrospectively. A tertiary referral centre. We evaluated 129 patients who underwent surgery between March 2002 and January 2014. Patients were subjected to five different treatment methods depending on the severity of injury. Medical records were reviewed to assess rates of complications and revision surgery. Cosmetic and functional (the degree of nasal obstruction) outcomes were measured using the Likert scale from 1 (very dissatisfied, severe obstruction) to 5 (very satisfied, no obstruction). The mean elapsed time from injury to surgery was 14.9 days. The overall treatment failure rate, defined as a deformity that required revision, was 6.2%. The patient satisfaction scores for aesthetic and functional outcomes were 3.9 and 4.6 respectively. The prudent selection of patients with indication for closed reduction, and further specification of variable treatment options for the various degrees of nasal bone fracture, may be helpful in achieving an improved treatment outcome. level IV. © 2016 John Wiley & Sons Ltd.

  10. Home diuretic protocol for heart failure: partnering with home health to improve outcomes and reduce readmissions.

    Science.gov (United States)

    Veilleux, Richard P; Wight, Joseph N; Cannon, Ann; Whalen, Moira; Bachman, David

    2014-01-01

    The management of heart failure (HF) is challenging, with high rates of readmission and no single solution. MaineHealth, a health care system serving southern Maine, has shown initial success with home health nurses partnering with physicians in the management of complex patients with HF using the MaineHealth Home Diuretic Protocol (HDP). To demonstrate that augmented diuretic therapy, both oral and intravenous, an evidence-based treatment for care of patients with HF experiencing fluid retention, can be delivered safely in the home setting using the HDP and can improve outcomes for recently hospitalized patients with HF. In late 2011, the MaineHealth HDP was implemented in two hospitals and in the home health agency serving those hospitals. The patient population included recently hospitalized patients with a diagnosis of advanced HF, eligible for home health services and telemonitoring. Home health nurses reported data on the patients managed using the protocol, including interventions made, physical findings, lab values, and patient disposition after each episode of care. Questionnaires were used to determine patient and clinician satisfaction. Sixty patients meeting the criteria above were enrolled between November 2011 and January 2014. The protocol was initiated 84 times for 30 of these patients. Sixteen patients had multiple activations. The readmission rate was 10% and no adverse outcomes were observed. Clinician and patient satisfaction was 97% or greater. The MaineHealth HDP can be delivered effectively and safely to improve outcomes, reducing readmissions and allowing patients to remain at home.

  11. Using Fetal and Infant Mortality Reviews to improve birth outcomes in an urban community.

    Science.gov (United States)

    Johnson, Teresa S; Malnory, Margaret E; Nowak, Emily W; Kelber, Sheryl

    2011-01-01

    To describe the implementation of a Fetal and Infant Mortality Review (FIMR) in a small urban community to improve perinatal birth outcomes. Descriptive study. Urban community within a Wisconsin city, population 85,000. Between January 1, 2007 and December 31, 2008, all women (N=82) in a targeted five zip-code area within an urban city were identified who experienced a fetal loss >14 weeks, neonatal or infant death (College of Obstetricians and Gynecologists and the Maternal and Child Health Bureau (2008) provided the framework for the systematic review of available records for all fetal and infant deaths during a 2-year period. Based on these findings, targeted evidence-based interventions were implemented. The infant mortality rate was higher in two of the five targeted zip-code areas. The mean ages of women who experienced fetal and infant mortality were in their 20s as opposed to teenage mothers. A higher proportion of Black women experienced fetal/perinatal losses than other race/ethnicities, many of which were related to prematurity. Many social, environmental, and maternal health issues such as poverty, racism, and perception of stress negatively contributed to the general health of women's subsequent birth outcomes. Nurses have the opportunity to promote and improve health to eliminate racial disparities in birth outcomes within their communities. © 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  12. Preoperative sport improves the outcome of lumbar disc surgery: a prospective monocentric cohort study.

    Science.gov (United States)

    Tschugg, Anja; Lener, Sara; Hartmann, Sebastian; Wildauer, Matthias; Löscher, Wolfgang N; Neururer, Sabrina; Thomé, Claudius

    2017-01-13

    A lumbar disc herniation resulting in surgery may be an incisive event in a patient's everyday life. The patient's recovery after sequestrectomy may be influenced by several factors. There is evidence that regular physical activity can lower pain perception and improve the outcome after surgery. For this purpose, we hypothesized that patients performing regular sports prior to lumbar disc surgery might have less pain perception and disability thereafter. Fifty-two participants with a single lumbar disc herniation confirmed on MRI treated by a lumbar sequestrectomy were included in the trial. They were categorized into two groups based on their self-reported level of physical activity prior to surgery: group NS, no regular physical activity and group S, with regular physical activity. Further evaluation included a detailed medical history, a physical examination, and various questionnaires: Visual Analog Scale (VAS), Beck-Depression-Inventory (BDI), Oswestry Disability Index (ODI), Core Outcome Measure Index (COMI), and the EuroQoL-5Dimension (EQ- 5D). Surgery had an excellent overall improvement of pain and disability (p lumbar disc surgery. The importance of sports may have been underestimated for surgical outcomes.

  13. Does non-invasive ventilation associated with chest physiotherapy improve outcome after lung resection?

    Science.gov (United States)

    Freynet, Anne; Falcoz, Pierre-Emmanuel

    2008-12-01

    A best evidence topic was constructed according to a structured protocol. The question addressed was whether the use of non-invasive ventilation (NIV) associated with chest physiotherapy (CPT) is effective in preventing respiratory complications in patients undergoing lung resection surgery. Of the 172 papers found using a report search, five presented the best evidence to answer the clinical question. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the five studies were all in favor of NIV as an adjuvant to CPT for improving outcome after lung resection surgery. Indeed, the interest and benefit has been shown not only in the treatment of postoperative acute respiratory failure, but also in the prevention and treatment of respiratory complications (atelectasis, pneumonia and bronchial congestion). Hence, current evidence shows NIV associated with acute CPT management to be safe and effective in reducing postoperative complications and in improving patient recovery, thus enhancing the choice of available medical care and bettering outcome in lung resection surgery.

  14. Improving work outcomes of dysthymia (persistent depressive disorder) in an employed population.

    Science.gov (United States)

    Adler, David A; Lerner, Debra; Visco, Zachary L; Greenhill, Annabel; Chang, Hong; Cymerman, Elina; Azocar, Francisca; Rogers, William H

    2015-01-01

    To test the effectiveness of a work-focused intervention (WFI) on the work outcomes of employed adults with dysthymia. This subgroup analysis from a randomized controlled trial compares an initial sample of 167 employees (age: ≥45 years), screened for dysthymia using the PC-SAD without current major depressive disorder randomized to WFI (n=85) or usual care (UC) (n=82). Study sites included 19 employers and five additional organizations. Telephone-based WFI counseling (eight, twice monthly 50-min sessions) provided work coaching and modification, care coordination and cognitive behavioral therapy. Adjusted mixed effects models compared the WFI vs. UC group preintervention to 4-month postintervention change in at-work limitations measured by the Work Limitations Questionnaire. Secondary outcome analysis compared the change in self-reported absences and depression symptom severity (Patient Health Questionnaire PHQ-9 scores). Work productivity loss scores improved 43.0% in the WFI group vs. 4.8% in UC (difference in change: Pdepression symptom severity declined 44.2% in WFI vs. 5.3% in UC (difference in change: P<.001). At 4 months, the WFI was more effective than UC on two of the three outcomes. It could be an important mental and functional health improvement resource for the employed dysthymic population. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Modified Early Warning System improves patient safety and clinical outcomes in an academic community hospital

    Directory of Open Access Journals (Sweden)

    Chirag Mathukia

    2015-04-01

    Full Text Available Background and objective: Severe adverse events such as cardiac arrest and death are often heralded by abnormal vital signs hours before the event. This necessitates an organized track and trigger approach of early recognition and response to subtle changes in a patient's condition. The Modified Early Warning System (MEWS is one of such systems that use temperature, blood pressure, pulse, respiratory rate, and level of consciousness with each progressive higher score triggering an action. Root cause analysis for mortalities in our institute has led to the implementation of MEWS in an effort to improve patient outcomes. Here we discuss our experience and the impact of MEWS implementation on patient care at our community academic hospital. Methods: MEWS was implemented in a protocolized manner in June 2013. The following data were collected from non-ICU wards on a monthly basis from January 2010 to June 2014: 1 number of rapid response teams (RRTs per 100 patient-days (100PD; 2 number of cardiopulmonary arrests ‘Code Blue’ per 100PD; and 3 result of each RRT and Code Blue (RRT progressed to Code Blue, higher level of care, ICU transfer, etc.. Overall inpatient mortality data were also analyzed. Results: Since the implementation of MEWS, the number of RRT has increased from 0.24 per 100PD in 2011 to 0.38 per 100PD in 2013, and 0.48 per 100PD in 2014. The percentage of RRTs that progressed to Code Blue, an indicator of poor outcome of RRT, has been decreasing. In contrast, the numbers of Code Blue in non-ICU floors has been progressively decreasing from 0.05 per 100PD in 2011 to 0.02 per 100PD in 2013 and 2014. These improved clinical outcomes are associated with a decline of overall inpatient mortality rate from 2.3% in 2011 to 1.5% in 2013 and 1.2% in 2014. Conclusions: Implementation of MEWS in our institute has led to higher rapid response system utilization but lower cardiopulmonary arrest events; this is associated with a lower mortality

  16. Improving cardiovascular outcomes among Aboriginal Australians: Lessons from research for primary care

    Directory of Open Access Journals (Sweden)

    Sandra C Thompson

    2016-11-01

    Full Text Available Background: The Aboriginal people of Australia have much poorer health and social indicators and a substantial life expectancy gap compared to other Australians, with premature cardiovascular disease a major contributor to poorer health. This article draws on research undertaken to examine cardiovascular disparities and focuses on ways in which primary care practitioners can contribute to reducing cardiovascular disparities and improving Aboriginal health. Methods: The overall research utilised mixed methods and included data analysis, interviews and group processes which included Aboriginal people, service providers and policymakers. Workshop discussions to identify barriers and what works were recorded by notes and on whiteboards, then distilled and circulated to participants and other stakeholders to refine and validate information. Additional engagement occurred through circulation of draft material and further discussions. This report distils the lessons for primary care practitioners to improve outcomes through management that is attentive to the needs of Aboriginal people. Results: Aspects of primordial, primary and secondary prevention are identified, with practical strategies for intervention summarised. The premature onset and high incidence of Aboriginal cardiovascular disease make prevention imperative and require that primary care practitioners understand and work to address the social underpinnings of poor health. Doctors are well placed to reinforce the importance of healthy lifestyle at all visits to involve the family and to reduce barriers which impede early care seeking. Ensuring better information for Aboriginal patients and better integrated care for patients who frequently have complex needs and multi-morbidities will also improve care outcomes. Conclusion: Primary care practitioners have an important role in improving Aboriginal cardiovascular care outcomes. It is essential that they recognise the special needs of their

  17. Improving chronic care delivery and outcomes: the impact of the cystic fibrosis Care Center Network.

    Science.gov (United States)

    Mogayzel, Peter J; Dunitz, Jordan; Marrow, Laura C; Hazle, Leslie A

    2014-04-01

    Cystic fibrosis (CF) is a multisystem, life-shortening genetic disease that requires complex care. To facilitate this expert, multidisciplinary care, the CF Foundation established a Care Center Network and accredited the first care centres in 1961. This model of care brings together physicians and specialists from other disciplines to provide care, facilitate basic and clinical research, and educate the next generation of providers. Although the Care Center Network has been invaluable in achieving substantial gains in survival and quality of life, additional opportunities for improvements in CF care exist. In 1999, analysis of data from the CF Foundation's Patient Registry detected variation in care practices and outcomes across centres, identifying opportunities for improvement. In 2002, the CF Foundation launched a comprehensive quality improvement (QI) initiative to enhance care by assembling national experts to develop a strategic plan to disseminate QI training and processes throughout the Care Center Network. The QI strategies included developing leadership (nationally and within each care centre), identifying best CF care practices, and incorporating people with CF and their families into improvement efforts. The goal was to improve the care for every person with CF in the USA. Multiple tactics were undertaken to implement the strategic plan and disseminate QI training and tools throughout the Care Center Network. In addition, strategies to foster collaboration between care centre staff and individuals with CF and their families became a cornerstone of QI efforts. Today it is clear that the application of QI principles within the CF Care Center Network has improved adherence to clinical guidelines and achievement of important health outcomes.

  18. Kaizen method for esophagectomy patients: improved quality control, outcomes, and decreased costs.

    Science.gov (United States)

    Iannettoni, Mark D; Lynch, William R; Parekh, Kalpaj R; McLaughlin, Kelley A

    2011-04-01

    The majority of costs associated with esophagectomy are related to the initial 3 days of hospital stay requiring intensive care unit stays, ventilator support, and intraoperative time. Additional costs arise from hospital-based services. The major cost increases are related to complications associated with the procedure. We attempted to define these costs and identify expense management by streamlining care through strict adherence to patient care maps, operative standardization, and rapid discharge planning to reduce variability. Utilizing methods of Kaizen philosophy we evaluated all processes related to the entire experience of esophageal resection. This process has taken over 5 years to achieve, with quality and cost being tracked over this time period. Cost analysis included expenses related to intensive care unit, anesthesia, disposables, and hospital services. Quality improvement measures were related to intraoperative complications, in-hospital complications, and postoperative outcomes. The Institutional Review Board approved the use of anonymous data from standard clinical practice because no additional treatment was planned (observational study). Utilizing a continuous process improvement methodology, a 43% reduction in cost per case has been achieved with a significant increase in contribution margin for esophagectomy. The length of stay has been reduced from 14 days to 5. With intraoperative and postoperative standardization the leak rate has dropped from 12% to less than 3% to no leaks in our current Kaizen modification of care in our last 64 patients. Utilizing lean manufacturing techniques and continuous process evaluation we have attempted to eliminate variability, standardized the phases of care resulting in improved outcomes, decreased length of stay, and improved contribution margins. These Kaizen improvements require continuous interventions, strict adherence to care maps, and input from all levels for quality improvements. Copyright © 2011 The

  19. Scaffolding Student Participation in Mathematical Practices

    Science.gov (United States)

    Moschkovich, Judit N.

    2015-01-01

    The concept of scaffolding can be used to describe various types of adult guidance, in multiple settings, across different time scales. This article clarifies what we mean by scaffolding, considering several questions specifically for scaffolding in mathematics: What theoretical assumptions are framing scaffolding? What is being scaffolded? At…

  20. Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby.

    Science.gov (United States)

    Abe, Sarah K; Balogun, Olukunmi O; Ota, Erika; Takahashi, Kenzo; Mori, Rintaro

    2016-02-18

    out in Brazil (36 adolescent mothers) and the USA (16 women) and included women with a low socioeconomic status. A lack of information in the study reports meant that risk of bias could not be adequately assessed (unclear risk of bias for many domains). There were no quantitative data for any of this review's outcomes so meta-analysis was not possible.Neither of the studies reported on the primary outcomes of interest in this review: maternal morbidity (febrile illness, respiratory tract infection, diarrhoea), adverse effects of micronutrients within three days of receiving the supplement, infant mortality (defined as a child dying before completing the first year of age).One study reported qualitatively on maternal anaemia (a secondary outcome of this review) - the study found that multiple-micronutrient supplementation was effective for recuperating from anaemia but there were no data for inclusion in our analyses. Maternal satisfaction was not reported in the included studies. Similarly, none of this review's infant secondary outcomes were reported in the included studies: clinical micronutrient deficiency; morbidity episodes (febrile illness, respiratory tract infection, diarrhoea, other), adverse effects of micronutrients within three days of receiving the supplement. We found no evidence to quantitatively assess the effectiveness of multiple-micronutrient supplementation in improving health outcomes in mother and baby. The results of this review are limited by the small numbers of studies available, small sample sizes and the studies not reporting on the outcomes of interest in this review. There is no evidence to evaluate potential adverse effects of multiple-micronutrient supplements, particularly excess dosages.There is a need for high-quality studies to assess the effectiveness and safety of multiple-micronutrient supplementation for breastfeeding women for improving outcomes for the mother and her baby. Further research should focus on whether multiple

  1. Mechanical and biological effects of infiltration with biopolymers on 3D printed tricalciumphosphate scaffolds.

    Science.gov (United States)

    Cornelsen, Matthias; Probst, Florian Andreas; Schwarz, Christina; Burian, Egon; Tröltzsch, Matthias; Otto, Sven; Saller, Maximilian Michael; Schieker, Matthias; Seitz, Hermann

    2017-09-26

    The aim of this study was to evaluate the influence of infiltrating 3D printed (TCP) scaffolds with different biodegradable polymers on their mechanical and biological properties. 3D printed TCP scaffolds with interconnecting channels measuring 450±50 µm were infiltrated with four different biodegradable copolymers. To determine the average compressive strength, a uniaxial testing system was used. Additionally, scaffolds were seeded with MC3T3 cells and cell viability was assessed by live/dead-assay. Uninfiltrated TCP had an average compression strength of 1.92±0.38 MPa. Mechanical stability was considerably increased in all infiltrated scaffolds up to a maximum of 7.36±0.57 MPa. All scaffolds demonstrated high cell survival rates with a maximum of 94±10 % living cells. In conclusion, infiltration of 3D printed tricalcium phosphate scaffolds with biodegradable polymers significantly improved mechanical properties and biological properties were comparable to those of uninfiltrated TCP scaffolds.

  2. ASTM international workshop on standards and measurements for tissue engineering scaffolds.

    Science.gov (United States)

    Simon, Carl G; Yaszemski, Michael J; Ratcliffe, Anthony; Tomlins, Paul; Luginbuehl, Reto; Tesk, John A

    2015-07-01

    The "Workshop on Standards & Measurements for Tissue Engineering Scaffolds" was held on May 21, 2013 in Indianapolis, IN, and was sponsored by the ASTM International (ASTM). The purpose of the workshop was to identify the highest priority items for future standards work for scaffolds used in the development and manufacture of tissue engineered medical products (TEMPs). Eighteen speakers and 78 attendees met to assess current scaffold standards and to prioritize needs for future standards. A key finding was that the ASTM TEMPs subcommittees (F04.41-46) have many active "guide" documents for educational purposes, but few standard "test methods" or "practices." Overwhelmingly, the most clearly identified need was standards for measuring the structure of scaffolds, followed by standards for biological characterization, including in vitro testing, animal models and cell-material interactions. The third most pressing need was to develop standards for assessing the mechanical properties of scaffolds. Additional needs included standards for assessing scaffold degradation, clinical outcomes with scaffolds, effects of sterilization on scaffolds, scaffold composition, and drug release from scaffolds. Discussions highlighted the need for additional scaffold reference materials and the need to use them for measurement traceability. Workshop participants emphasized the need to promote the use of standards in scaffold fabrication, characterization, and commercialization. Finally, participants noted that standards would be more broadly accepted if their impact in the TEMPs community could be quantified. Many scaffold standard needs have been identified and focus is turning to generating these standards to support the use of scaffolds in TEMPs. © 2014 Wiley Periodicals, Inc.

  3. Educational quality improvement report: outcomes from a revised morbidity and mortality format that emphasised patient safety.

    Science.gov (United States)

    Bechtold, M L; Scott, S; Dellsperger, K C; Hall, L W; Nelson, K; Cox, K R

    2008-04-01

    Although Morbidity and Mortality conferences (MMC) were originally designed to promote quality care through careful analysis of adverse events, focus on individual actions or the fear of incrimination may interfere with identification of system issues contributing to the adverse outcomes. Pre- and post-intervention assessments of participant attitudes toward patient safety and conference redesign were performed utilizing an attitudinal survey. Participants provided a unique identifier for paired-means procedure. A list of contributing factors, recommended solutions, and targeted system improvements was maintained with ongoing progress recorded. Department of Internal Medicine training program at University of Missouri-Columbia, an academic health care center affiliated with the University of Missouri Hospitals and Clinics and the Harry S. Truman Veteran's Administration Hospital. Residents and fellows from the Department of Internal Medicine residency program. (1) Distinguish between culture of blame/shame and patient safety culture, (2) Identify gaps in quality contributing to adverse outcomes, (3) Identify strategies to close gaps, (4) Participate in root cause analysis, demonstrating an ability to review an adverse event and recommend an action plan. An interdisciplinary team modified the internal medicine MMC to emphasize a better understanding of patient safety principles and system-based practice interventions. For each adverse event analyzed, root causes were identified, followed by discussion of system interventions that might prevent future such events. (1) Attitudes of residents and fellows regarding patient safety, as measured on a 20 item, five-point ordinal scale (strongly disagree to strongly agree) survey, (2) System improvements generated from the Patient Safety M&M Conferences (PSMMC), and (3) Attendance at PSMMC. Clinical outcomes: Conference participants offered 121 system improvement recommendations; 39 suggested system interventions were

  4. Money matters: exploiting the data from outcomes research for quality improvement initiatives.

    Science.gov (United States)

    Impellizzeri, Franco M; Bizzini, Mario; Leunig, Michael; Maffiuletti, Nicola A; Mannion, Anne F

    2009-08-01

    In recent years, there has been an increase in studies that have sought to identify predictors of treatment outcome and to examine the efficacy of surgical and non-surgical treatments. In addition to the scientific advancement associated with these studies per se, the hospitals and clinics where the studies are conducted may gain indirect financial benefit from participating in such projects as a result of the prestige derived from corporate social responsibility, a reputational lever used to reward such institutions. It is known that there is a positive association between corporate social performance and corporate financial performance. However, in addition to this, the research findings and the research staff can constitute resources from which the provider can reap a more direct benefit, by means of their contribution to quality control and improvement. Poor quality is costly. Patient satisfaction increases the chances that the patient will be a promoter of the provider to friends and colleagues. As such, involvement of the research staff in the improvement of the quality of care can ultimately result in economic revenue for the provider. The most advanced methodologies for continuous quality improvement (e.g., six-sigma) are data-driven and use statistical tools similar to those utilized in the traditional research setting. Given that these methods rely on the application of the scientific process to quality improvement, researchers have the adequate skills and mind-set to embrace them and thereby contribute effectively to the quality team. The aim of this article is to demonstrate by means of real-life examples how to utilize the findings of outcome studies for quality management in a manner similar to that used in the business community. It also aims to stimulate research groups to better understand that, by adopting a different perspective, their studies can be an additional resource for the healthcare provider. The change in perspective should stimulate

  5. Improving Outcomes in Patients With Bipolar Disorder Through Establishing an Effective Treatment Team

    Science.gov (United States)

    2010-01-01

    A treatment gap exists between the efficacious treatments available for patients with bipolar disorder and the usual care these patients receive. This article reviews the evolution of the collaborative care treatment model, which was designed to address treatment gaps in chronic medical care, and discusses the efficacy of this model when applied to improving outcomes for patients with bipolar disorder in the primary care setting. Key elements of collaborative care include the use of evidence-based treatment guidelines, patient psychoeducation, collaborative decision-making with patients and with other physicians, and supportive technology to facilitate monitoring and follow-up of patient outcomes. Integrating psychiatric and medical health care can assist in achieving the goal of bipolar disorder treatment, which is full functional recovery for patients. PMID:20628504

  6. Improving geriatric trauma outcomes: A small step toward a big problem.

    Science.gov (United States)

    Hammer, Peter M; Storey, Annika C; Bell, Teresa; Bayt, Demetria; Hockaday, Melissa S; Zarzaur, Ben L; Feliciano, David V; Rozycki, Grace S

    2016-07-01

    Because of the unique physiology and comorbidities of injured geriatric patients, specific interventions are needed to improve outcomes. The purpose of this study was to assess the effect of a change in triage criteria for injured geriatric patients evaluated at an American College of Surgeons Level I trauma center. As of October 1, 2013, all injured patients 70 years or older were mandated to have the highest-level trauma activation upon emergency department (ED) arrival regardless of physiology or mechanism of injury. Patients admitted before that date were designated as PRE; those admitted after were designated as POST. The study period was from October 1, 2011, through April 30, 2015. Data collected included demographics, mechanism of injury, hypotension on admission, comorbidities, Injury Severity Score (ISS), ED length of stay (LOS), complications, and mortality. Bivariate and multivariable analyses were used to compare outcomes between the study groups (p management study, level IV.

  7. Quantified-self for obesity: Physical activity behaviour sensing to improve health outcomes

    Directory of Open Access Journals (Sweden)

    Jennifer Murphy

    2015-10-01

    We have shown that it is possible to passively monitor physical activity in a large patient population in a cost-effective way. The results demonstrate that while two thirds of bariatric patients achieved an average of 30 minutes walking per day, this was not of sufficient intensity to gain health-related benefits. Further analysis will examine whether increased activity is associated with successful weight loss outcomes, improved mood and psychological functioning, and increased quality of life. We will also employ machine-learning techniques to identify the factors that are critical for a successful outcome following bariatric surgery. Recruitment will continue to the end of the project (April 2016 and tracking will continue into 2017.

  8. Cold Plasma Reticulation of Shape Memory Embolic Tissue Scaffolds.

    Science.gov (United States)

    Nash, Landon D; Docherty, Nicole C; Monroe, Mary Beth B; Ezell, Kendal P; Carrow, James K; Hasan, Sayyeda M; Gaharwar, Akhilesh K; Maitland, Duncan J

    2016-12-01

    Polyurethane shape memory polymer (SMP) foams are proposed for use as thrombogenic scaffolds to improve the treatment of vascular defects, such as cerebral aneurysms. However, gas blown SMP foams inherently have membranes between pores, which can limit their performance as embolic tissue scaffolds. Reticulation, or the removal of membranes between adjacent foam pores, is advantageous for improving device performance by increasing blood permeability and cellular infiltration. This work characterizes the effects of cold gas plasma reticulation processes on bulk polyurethane SMP films and foams. Plasma-induced changes on material properties are characterized using scanning electron microscopy, uniaxial tensile testing, goniometry, and free strain recovery experiments. Device specific performance is characterized in terms of permeability, platelet attachment, and cell-material interactions. Overall, plasma reticulated SMP scaffolds show promise as embolic tissue scaffolds due to increased bulk permeability, retained thrombogenicity, and favorable cell-material interactions. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  9. Chitosan-collagen/organomontmorillonite scaffold for bone tissue engineering

    Science.gov (United States)

    Cao, Xianshuo; Wang, Jun; Liu, Min; Chen, Yong; Cao, Yang; Yu, Xiaolong

    2015-12-01

    A novel composite scaffold based on chitosan-collagen/organomontmorillonite (CS-COL/OMMT) was prepared to improve swelling ratio, biodegradation ratio, biomineralization and mechanical properties for use in tissue engineering applications. In order to expend the basal spacing, montmorillonite (MMT) was modified with sodium dodecyl sulfate (SDS) and was characterized by XRD, TGA and FTIR. The results indicated that the anionic surfactants entered into interlayer of MMT and the basal spacing of MMT was expanded to 3.85 nm. The prepared composite scaffolds were characterized by FTIR, XRD and SEM. The swelling ratio, biodegradation ratio and mechanical properties of composite scaffolds were also studied. The results demonstrated that the scaffold decreased swelling ratio, degradation ratio and improved mechanical and biomineralization properties because of OMMT.

  10. Brain Injury Biomarkers May Improve the Predictive Power of the IMPACT Outcome Calculator

    Science.gov (United States)

    Mondello, Stefania; Kovacs, Noemi; Sandor, Janos; Gabrielli, Andrea; Schmid, Kara; Tortella, Frank; Wang, Kevin K.W.; Hayes, Ronald L.; Barzo, Pal; Ezer, Erzsebet; Doczi, Tamas; Buki, Andras

    2012-01-01

    Abstract Outcome prediction following severe traumatic brain injury (sTBI) is a widely investigated field of research. A major breakthrough is represented by the IMPACT prognostic calculator based on admission data of more than 8500 patients. A growing body of scientific evidence has shown that clinically meaningful biomarkers, including glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), and αII-spectrin breakdown product (SBDP145), could also contribute to outcome prediction. The present study was initiated to assess whether the addition of biomarkers to the IMPACT prognostic calculator could improve its predictive power. Forty-five sTBI patients (GCS score≤8) from four different sites were investigated. We utilized the core model of the IMPACT calculator (age, GCS motor score, and reaction of pupils), and measured the level of GFAP, UCH-L1, and SBDP145 in serum and cerebrospinal fluid (CSF). The forecast and actual 6-month outcomes were compared by logistic regression analysis. The results of the core model itself, as well as serum values of GFAP and CSF levels of SBDP145, showed a significant correlation with the 6-month mortality using a univariate analysis. In the core model, the Nagelkerke R2 value was 0.214. With multivariate analysis we were able to increase this predictive power with one additional biomarker (GFAP in CSF) to R2=0.476, while the application of three biomarker levels (GFAP in CSF, GFAP in serum, and SBDP145 in CSF) increased the Nagelkerke R2 to 0.700. Our preliminary results underline the importance of biomarkers in outcome prediction, and encourage further investigation to expand the predictive power of contemporary outcome calculators and prognostic models in TBI. PMID:22435839

  11. Temporary closure of colostomy with suture before colostomy takedown improves the postoperative outcomes.

    Science.gov (United States)

    Hu, Wan-Hsiang; Lee, Ko-Chao; Tsai, Kai-Lung; Chen, Hong-Hwa

    2018-01-01

    Temporary loop colostomy is a common surgical procedure used to avoid complications in high-risk distal anastomosis as well as pelvic inflammation. Issues regarding postoperative outcomes of colostomy takedown have been widely discussed in the literature, wound infection especially. Temporary closure of colostomy with suture before takedown was adopted in our study, which provided excellent traction to aid mobilization of stomy and avoided stool spillage to downgrade the wound classification to "clean contamination." We aimed to determine the effects of the procedure on postoperative outcomes. This was a prospective case-control study at a single tertiary medical center. Patients presenting for elective colostomy takedown were included. Allis clamp (n = 50) or silk suture (n = 60) was applied to mobilize the colostomy, and results were compared. Operative time and wound infection rate were measured as primary postoperative outcomes. Univariate and multivariate analyses were used to demonstrate the association between the two groups and outcomes. In univariate analyses, significantly shorter operative time (median = 57 min, p = 0.003) and lower postoperative wound infection rate (3%, p = 0.03) were noted in the group receiving silk suture. Multivariate analyses results showed that silk suture was significantly associated with both operative time (B = - 8.5, p = 0.01) and wound infection (odds ratio = 0.18, p = 0.04). With the advantage of enhancing traction and decreasing contamination, the temporary closure of colostomy with suture improved takedown outcomes, including a shorter operative time and lower wound infection rate.

  12. Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes

    Science.gov (United States)

    Fromer, Len

    2011-01-01

    Current primary care patterns for chronic obstructive pulmonary disease (COPD) focus on reactive care for acute exacerbations, often neglecting ongoing COPD management to the detriment of patient experience and outcomes. Proactive diagnosis and ongoing multifactorial COPD management, comprising smoking cessation, influenza and pneumonia vaccinations, pulmonary rehabilitation, and symptomatic and maintenance pharmacotherapy according to severity, can significantly improve a patient’s health-related quality of life, reduce exacerbations and their consequences, and alleviate the functional, utilization, and financial burden of COPD. Redesign of primary care according to principles of the chronic care model, which is implemented in the patient-centered medical home, can shift COPD management from acute rescue to proactive maintenance. The chronic care model and patient-centered medical home combine delivery system redesign, clinical information systems, decision support, and self-management support within a practice, linked with health care organization and community resources beyond the practice. COPD care programs implementing two or more chronic care model components effectively reduce emergency room and inpatient utilization. This review guides primary care practices in improving COPD care workflows, highlighting the contributions of multidisciplinary collaborative team care, care coordination, and patient engagement. Each primary care practice can devise a COPD care workflow addressing risk awareness, spirometric diagnosis, guideline-based treatment and rehabilitation, and self-management support, to improve patient outcomes in COPD. PMID:22162647

  13. The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes

    Science.gov (United States)

    Maruthur, Nisa; Mathioudakis, Nestoras; Spanakis, Elias; Rubin, Daniel; Zilbermint, Mihail; Hill-Briggs, Felicia

    2017-01-01

    Purpose of Review The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. Recent Findings Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Summary Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies. PMID:28567711

  14. Erythropoietin combined with liposomal amphotericin b improves outcome during disseminated aspergillosis in mice

    Directory of Open Access Journals (Sweden)

    nathalie erousseau

    2014-10-01

    Full Text Available Disseminated aspergillosis is responsible for a high mortality rate despite the use of antifungal drugs. Adjuvant therapies are urgently needed to improve the outcome. The aim of this study was to demonstrate that the cytoprotective effect of erythropoietin combined to amphotericin b can reduce the mortality rate in a murine model of disseminated aspergillosis. After infection with Aspergillus fumigatus, neutropenic mice were randomized to receive vehicle or 7,5 mg/Kg of Liposomal Amphotericin B (LAmB or 7,5 mg/Kg of LAmB combined with 1000 IU/Kg of EPO (16 mice per group. Aspergillus galactomannan and organ cultures were performed to evaluate fungal burden at day 5. Cumulative long-term survival was analyzed at day 12 post-infection according to the Kaplan-Meier method. At day 5, fungal burden was similar between non-treated and treated groups. At day 12, mortality rates were 75 %, 62.5 % and 31 % in control group, LAmB group and EPO/LAmB group, respectively. We observed a significant decreased in mortality using EPO/LAmB combination compared to control group (p < 0.01. LAmB single treatment did not improve the survival rate compared to control group (p = 0.155.Our results provided the first evidence that erythropoietin improved the outcome of mice presenting disseminated aspergillosis when combined with amphotericin b.

  15. A systematic review of economic evaluations of CHW interventions aimed at improving child health outcomes.

    Science.gov (United States)

    Nkonki, L; Tugendhaft, A; Hofman, K

    2017-02-28

    Evidence of the cost-effectiveness of community health worker interventions is pertinent for decision-makers and programme planners who are turning to community services in order to strengthen health systems in the context of the momentum generated by strategies to support universal health care, the post-2015 Sustainable Development Goal agenda.We conducted a systematic review of published economic evaluation studies of community health worker interventions aimed at improving child health outcomes. Four public health and economic evaluation databases were searched for studies that met the inclusion criteria: National Health Service Economic Evaluation Database (NHS EED), Cochrane, Paediatric Economic Evaluation Database (PEED), and PubMed. The search strategy was tailored to each database.The 19 studies that met the inclusion criteria were conducted in either high income countries (HIC), low- income countries (LIC) and/or middle-income countries (MIC). The economic evaluations covered a wide range of interventions. Studies were grouped together by intended outcome or objective of each study. The data varied in quality. We found evidence of cost-effectiveness of community health worker (CHW) interventions in reducing malaria and asthma, decreasing mortality of neonates and children, improving maternal health, increasing exclusive breastfeeding and improving malnutrition, and positively impacting physical health and psychomotor development amongst children.Studies measured varied outcomes, due to the heterogeneous nature of studies included; a meta-analysis was not conducted. Outcomes included disease- or condition -specific outcomes, morbidity, mortality, and generic measures (e.g. disability-adjusted life years (DALYs)). Nonetheless, all 19 interventions were found to be either cost-effective or highly cost-effective at a threshold specific to their respective countries.There is a growing body of economic evaluation literature on cost-effectiveness of CHW

  16. A multi-centre phase IIa clinical study of predictive testing for preeclampsia: improved pregnancy outcomes via early detection (IMPROvED).

    Science.gov (United States)

    Navaratnam, Kate; Alfirevic, Zarko; Baker, Philip N; Gluud, Christian; Grüttner, Berthold; Kublickiene, Karolina; Zeeman, Gerda; Kenny, Louise C

    2013-12-07

    5% of first time pregnancies are complicated by pre-eclampsia, the leading cause of maternal death in Europe. No clinically useful screening test exists; consequentially clinicians are unable to offer targeted surveillance or preventative strategies. IMPROvED Consortium members have pioneered a personalised medicine approach to identifying blood-borne biomarkers through recent technological advancements, involving mapping of the blood metabolome and proteome. The key objective is to develop a sensitive, specific, high-throughput and economically viable early pregnancy screening test for pre-eclampsia. We report the design of a multicentre, phase IIa clinical study aiming to recruit 5000 low risk primiparous women to assess and refine innovative prototype tests based on emerging metabolomic and proteomic technologies. Participation involves maternal phlebotomy at 15 and 20 weeks' gestation, with optional testing and biobanking at 11 and 34 weeks. Blood samples will be analysed using two innovative, proprietary prototype platforms; one metabolomic based and one proteomic based, both of which outperform current biomarker based screening tests at comparable gestations. Analytical and clinical data will be collated and analysed via the Copenhagen Trials Unit. The IMPROvED study is expected to refine proteomic and metabolomic panels, combined with clinical parameters, and evaluate clinical applicability as an early pregnancy predictive test for pre-eclampsia. If 'at risk' patients can be identified, this will allow stratified care with personalised fetal and maternal surveillance, early diagnosis, timely intervention, and significant health economic savings. The IMPROvED biobank will be accessible to the European scientific community for high quality research into the cause and prevention of adverse pregnancy outcome. Trial registration number NCT01891240The IMPROvED project is funded by the seventh framework programme for Research and Technological development of the EU

  17. Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

    Directory of Open Access Journals (Sweden)

    McDermott Robyn

    2010-05-01

    Full Text Available Abstract Background Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE project has facilitated the implementation of modern Continuous Quality Improvement (CQI approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1 explore the factors associated with variation in clinical performance; 2 examine specific strategies that have been effective in improving primary care clinical performance; and 3 work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. Methods/Design The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. Discussion By linking researchers directly to users of research (service providers, managers and policy makers, the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary

  18. Does an increase in modularity improve the outcomes of total shoulder replacement? Comparison across design generations.

    Science.gov (United States)

    Schoch, Bradley; Werthel, Jean-David; Schleck, Cathy; Sperling, John W; Cofield, Robert H

    2015-10-01

    Modularity in total shoulder arthroplasty (TSA) has increased over the past 30 years. Our institution previously showed shoulders treated with modular humeral head/stem arthroplasties had similar outcomes to monoblock designs. Presently, we aim to update clinical follow-up of 2nd generation TSAs and assess how increased modularity affects early outcomes and survivorship across three generations of implants. Between 1997 and 2001, 75 second generation modular TSA's were performed for primary osteoarthritis. Shoulders were followed for a minimum of 2 years or until reoperation, mean 7.4 years. Results were compared with first generation monoblock TSAs and third generation TSAs which offered multiple humeral head shape options to more precisely replicate patient anatomy. Second generation TSAs continue to show significant improvements in pain, elevation and external rotation: 90 % of shoulders were subjectively better at follow-up. Survivorship was estimated to be 89.0 % at 10 years. All generations showed similar pain relief, and improved range of motion and Neer ratings. Survivorship among the 3 groups was similar at 5 years but was estimated to be higher in the 1st generation group at 7 years. More glenoids were radiographically at risk in the 2nd and 3rd generation groups than in the 1st; however, this did not reach significance. With extended mid-term follow-up, second generation anatomic TSA continues to provide improvements in pain and range of motion for primary OA. Implant modularity can facilitate surgery, but similar clinical outcomes can be expected regardless of modularity. Level IV, Treatment study.

  19. Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis

    Science.gov (United States)

    2012-01-01

    Background Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables. Methods A longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index. Results The high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant. Conclusions Despite the adverse contextual conditions and the limitations imposed by the Colombian health

  20. The use of mobile apps to improve nutrition outcomes: A systematic literature review.

    Science.gov (United States)

    DiFilippo, Kristen N; Huang, Wen-Hao; Andrade, Juan E; Chapman-Novakofski, Karen M

    2015-07-01

    We conducted a systematic review to determine if the use of nutrition apps resulted in improved outcomes, including knowledge and behavior, among healthy adults. Using app(s), cellular phone, iPads, mobile phone, mobile telephone, smart phone, mobile and mHealth as search terms with diet, food and nutrition as qualifiers we searched PubMed, CINAHL (January 2008-October 2013) and Web of Science (January 2008-January 2014). Inclusion criteria were peer-reviewed randomized controlled trials, non-controlled trials, and cohort studies published in English that used apps to increase nutrition knowledge or improve behavior related to nutrition. Studies that were descriptive, did not include apps, focused on app development, app satisfaction app feasibility, text messaging, or digital photography were excluded. We evaluated article quality using the Academy of Nutrition and Dietetics Evidence Analysis Manual. Data was extracted for knowledge, behavior and weight change. Our initial search identified 12,010 titles from PubMed, 260 from CINAHL and 4762 from Web of Science; of these, only four articles met all search criteria. Positive quality ratings were given to three articles; only one reported knowledge outcomes (non-significant). All four articles evaluated weight loss and suggested an advantage to using nutrition apps. Behavioral changes in reviewed studies included increased adherence to diet monitoring (p educational interventions. Most apps focus on weight loss with inconsistent outcomes. We conclude that using apps for education needs additional research which includes behavior theory within the app and improved study design. © The Author(s) 2015.

  1. Bone augmentation using a highly porous PLGA/β-TCP scaffold containing fibroblast growth factor-2.

    Science.gov (United States)

    Yoshida, T; Miyaji, H; Otani, K; Inoue, K; Nakane, K; Nishimura, H; Ibara, A; Shimada, A; Ogawa, K; Nishida, E; Sugaya, T; Sun, L; Fugetsu, B; Kawanami, M

    2015-04-01

    Beta-tricalcium phosphate (β-TCP), a bio-absorbable ceramic, facilitates bone conductivity. We constructed a highly porous three-dimensional scaffold, using β-TCP, for bone tissue engineering and coated it with co-poly lactic acid/glycolic acid (PLGA) to improve the mechanical strength and biologi