Biodegradation of Functionalized Nanocellulose.

Nanocellulose has attracted widespread interest for applications in materials science and biomedical engineering due to its natural abundance, desirable physicochemical properties, and high intrinsic mineralizability (i.e., complete biodegradability). A common strategy to increase dispersibility in polymer matrices is to modify the hydroxyl groups on nanocellulose through covalent functionalization, but such modification strategies may affect the desirable biodegradation properties exhibited by pristine nanocellulose. In this study, cellulose nanofibrils (CNFs) functionalized with a range of esters, carboxylic acids, or ethers exhibited decreased rates and extents of mineralization by anaerobic and aerobic microbial communities compared to unmodified CNFs, with etherified CNFs exhibiting the highest level of recalcitrance. The decreased biodegradability of functionalized CNFs depended primarily on the degree of substitution at the surface of the material rather than within the bulk. This dependence on surface chemistry was attributed not only to the large surface area-to-volume ratio of nanocellulose but also to the prerequisite surface interaction by microorganisms necessary to achieve biodegradation. Results from this study highlight the need to quantify the type and coverage of surface substituents in order to anticipate their effects on the environmental persistence of functionalized nanocellulose.

The use of mobile phone cameras in guiding treatment decisions for laceration care.

OBJECTIVES: Mobile phone technology may be useful in helping to guide medical decisions for lacerations. We examined whether emergency department (ED) provider opinions on which lacerations require repair differed using mobile phone-generated images compared with in-person evaluations. SUBJECTS AND METHODS: Patients presenting to an urban ED for initial and follow-up laceration care were prospectively enrolled. Patients took four mobile phone pictures of their laceration and provided a medical history. Cases were reviewed by ED providers who assessed image quality and made a recommendation about whether the laceration needed repair. The same provider then assessed the patient in-person. Concordant decision-making between mobile phone and in-person assessments was calculated as well as the degree of undertriage. RESULTS: In total, 94 patients were included over an 8-month period. There was complete agreement in 87% of cases (κ statistic=0.65). Of the 13 patients with discrepant decisions, 6 were due to poor image quality, in 3 the images did not properly represent the problem, in 3 others there were historical findings that altered care, and for 1 the image looked worse than the actual injury in-person. In total, 5 of 94 (5%) of cases would have been undertriaged using only the mobile phone recommendation. Median image quality was 6 out of 10 (with 10 being the best) (interquartile range, 4-8). CONCLUSIONS: There are high rates of agreement when providers use mobile phone images to assess lacerations for possible repair in the ED. Image quality is in general good but highly variable and may drive incorrect assessments.

The use of mobile phones for acute wound care: attitudes and opinions of emergency department patients.

There are a significant number of emergency department (ED) visits for lacerations each year. When individuals experience skin, soft tissue, or laceration symptoms, the decision to go to the ED is not always easy on the basis of the level of severity. For such cases, it may be feasible to use a mobile phone camera to submit images of their wound to a remote medical provider who can review and help guide their care choice decisions. The authors aimed to assess patient attitudes toward the use of mobile phone technology for laceration management. Patients presenting to an urban ED for initial care and follow-up visits for lacerations were prospectively enrolled. A total of 194 patients were enrolled over 8 months. Enrolled patients answered a series of questions about their injury and a survey on attitudes about the acceptability of making management decisions using mobile phone images only. A majority of those surveyed agreed that it was acceptable to send a mobile phone picture to a physician for a recommendation and diagnosis. Patients also reported few concerns regarding privacy and security and believe that this technology could be cost effective and convenient. In this study, the majority of patients had favorable opinions of using mobile phones for laceration care. Mobile phone camera images (a) may provide a useful modality for assessment of some acute wound care needs and (b) may decrease ED visits for a high-volume complaint such as acute wounds.