Person-centred decisions in emergency care for older people living with frailty: principles and practice.

Older people living with frailty are frequent users of emergency care and have multiple and complex problems. Typical evidence-based guidelines and protocols provide guidance for the management of single and simple acute issues. Meanwhile, person-centred care orientates interventions around the perspectives of the individual. Using a case vignette, we illustrate the potential pitfalls of applying exclusively either evidence-based or person-centred care in isolation, as this may trigger inappropriate clinical processes or place undue onus on patients and families. We instead advocate for delivering a combined evidence-based, person-centred approach to healthcare which considers the person's situation and values, apparent problem and available options.

What do speech pathology students gain from virtual patient interviewing? A WHO International Classification of Functioning Disability and Health (ICF) analysis.

Background: Virtual patients have an established place in medical education but do virtual patient interviews train holistic clinicians or just diagnosticians? This study explored speech pathology students' virtual patient interviews using WHO International Classification of Functioning Disability and Health (ICF). Methods: Eighteen speech pathology students in their final year of training participated. Students interviewed virtual patients with dysphagia (swallowing difficulties) as part of their curriculum. Student questions and patient responses were coded using established ICF coding. Codes were tallied and compared under categories of body structures, body functions, activities/participation and environmental factors. Flesch Reading Ease was calculated as a measure of health literacy. Results: Conversational turns primarily focused on the ICF component-activity and participation in both student questions and virtual patient responses: 0.03% body structures, 30% body functions-swallowing, 7% body functions-associated, 43% activities/participation and 19% environmental factors. Personal factors such as gender, ethnicity, age or socio-economic situation were not mentioned by student or patient. Patients commented on social impact on self and/or family, sometimes in the absence of targeted student questions. Student and virtual patient Flesch Reading Ease scores were congruent. Conclusion: Speech pathology students naturally matched their virtual patient's health-literacy level and asked a range of medical and daily living questions. Virtual patients readily offered social impact information to student questions. Computer science: healthcare teams should consider creating virtual patients who challenge students to practise asking sensitive questions and in doing so develop holistic thinkers with competent communication skills.

Toxicity and oxidative stress induced by semiconducting polymer dots in RAW264.7 mouse macrophages.

The rapid development and acceptance of PDots for biological applications depends on an in depth understanding of their cytotoxicity. In this paper, we performed a comprehensive study of PDot cytotoxicity at both the gross cell effect level (such as cell viability, proliferation and necrosis) and more subtle effects (such as redox stress) on RAW264.7 cells, a murine macrophage cell line with high relevance to in vivo nanoparticle disposition. The redox stress measurements assessed were inner mitochondrial membrane lipid peroxidation (nonyl-acridine orange, NAO), total thiol level (monobromobimane, MBB), and pyridine nucleotide redox status (NAD(P)H autofluorescence). Because of the extensive work already performed with QDots on nanotoxicity and also because of their comparable size, QDots were chosen as a comparison/reference nanoparticle for this study. The results showed that PDots exhibit cytotoxic effects to a much lesser degree than their inorganic analogue (QDots) and are much brighter, allowing for much lower concentrations to be used in various biological applications. In addition, at lower dose levels (2.5 nM to 10 nM) PDot treatment resulted in higher total thiol level than those found with QDots. At higher dose levels (20 nM to 40 nM) QDots caused significantly higher thiol levels in RAW264.7 cells, than was seen with PDots, suggesting that QDots elicit compensation to oxidative stress by upregulating GSH synthesis. At the higher concentrations of QDots, NAD(P)H levels showed an initial depletion, then repletion to a level that was greater than vehicle controls. PDots showed a similar trend but this was not statistically significant. Because PDots elicit less oxidative stress and cytotoxicity at low concentrations than QDots, and because they exhibit superior fluorescence at these low concentrations, PDots are predicted to have enhanced utility in biomedical applications.

Yellow Fluorescent Semiconducting Polymer Dots with High Brightness, Small Size, and Narrow Emission for Biological Applications.

Cross-linked polymer dots with intense and narrow yellow emission were designed using boron-dipyrromethene (BODIPY) polymer as the acceptor and poly[9,9-dioctylfluorenyl-2,7-diyl-co-1,4-benzo-{2,1'-3}-thiadiazole] (PFBT) polymer as the donor. The emission fwhm's of the polymer dots (Pdots) were 37 nm. CL-BODIPY 565 Pdots were about 5 times brighter than commercial quantum dots (Qdots) 565 under identical experimental conditions. Specific cellular targeting indicated that the small, bright, and narrow emissive CL-BODIPY 565 Pdots are promising probes for biological applications.

A versatile method for generating semiconducting polymer dot nanocomposites.

This paper describes a method, based on co-precipitation, for generating small semiconducting polymer dot (Pdot) nanocomposites, which contain either gold or iron oxide nanoparticles within the Pdot matrix. We demonstrate the utility of Pdot-Au nanoparticles (Au-NP-Pdots) in dual-modality imaging in which co-localization of fluorescence from Pdot and scattering from Au was used to identify Au-NP-Pdot probes for downstream single-particle tracking and cellular imaging. We also demonstrate the potential of employing Pdot-FeO(x) nanoparticles (FeO(x)-NP-Pdots) for both sample preparation, where cells tagged with FeO(x)-NP-Pdots were isolated using an external magnet, and cellular imaging and detection, owing to the intense fluorescence from Pdots. The method we present here should be generalizable to the formation of other Pdot nanocomposites for creating the next generation of multi-functional Pdot probes.

A compact and highly fluorescent orange-emitting polymer dot for specific subcellular imaging.

We demonstrate a new compact CN-PPV dot, which emits in the orange wavelength range with high brightness. The small particle size, high brightness, and the ability to highly specifically target subcellular structures make the CN-PPV dots promising probes for biological imaging and bioanalytical applications.

Factors influencing healthcare utilization within a free community clinic.

The purpose was to explore the relationship between the presence of a free community clinic and factors associated with utilization of healthcare through a secondary data analysis. Using a descriptive correlational design, results were analyzed to explore relationships between potential utilization of healthcare, identification of a regular source of healthcare, and health insurance status. Most subjects would not seek healthcare if the free community clinic was not available. Subjects with health insurance were significantly more likely to have a regular source of healthcare and seek healthcare in the absence of the free community clinic. Subjects with a regular source of healthcare were significantly more likely to seek healthcare in the absence of the free community clinic. Emergency room utilization was not impacted by regular source of healthcare or health insurance. This study supports the need for free community clinics in areas with high percentages of uninsured, immigrant, and refugee populations.

Body-weight-supported treadmill rehabilitation after stroke.

BACKGROUND: Locomotor training, including the use of body-weight support in treadmill stepping, is a physical therapy intervention used to improve recovery of the ability to walk after stroke. The effectiveness and appropriate timing of this intervention have not been established. METHODS: We stratified 408 participants who had had a stroke 2 months earlier according to the extent of walking impairment--moderate (able to walk 0.4 to <0.8 m per second) or severe (able to walk <0.4 m per second)--and randomly assigned them to one of three training groups. One group received training on a treadmill with the use of body-weight support 2 months after the stroke had occurred (early locomotor training), the second group received this training 6 months after the stroke had occurred (late locomotor training), and the third group participated in an exercise program at home managed by a physical therapist 2 months after the stroke (home-exercise program). Each intervention included 36 sessions of 90 minutes each for 12 to 16 weeks. The primary outcome was the proportion of participants in each group who had an improvement in functional walking ability 1 year after the stroke. RESULTS: At 1 year, 52.0% of all participants had increased functional walking ability. No significant differences in improvement were found between early locomotor training and home exercise (adjusted odds ratio for the primary outcome, 0.83; 95% confidence interval [CI], 0.50 to 1.39) or between late locomotor training and home exercise (adjusted odds ratio, 1.19; 95% CI, 0.72 to 1.99). All groups had similar improvements in walking speed, motor recovery, balance, functional status, and quality of life. Neither the delay in initiating the late locomotor training nor the severity of the initial impairment affected the outcome at 1 year. Ten related serious adverse events were reported (occurring in 2.2% of participants undergoing early locomotor training, 3.5% of those undergoing late locomotor training, and 1.6% of those engaging in home exercise). As compared with the home-exercise group, each of the groups receiving locomotor training had a higher frequency of dizziness or faintness during treatment (P=0.008). Among patients with severe walking impairment, multiple falls were more common in the group receiving early locomotor training than in the other two groups (P=0.02). CONCLUSIONS: Locomotor training, including the use of body-weight support in stepping on a treadmill, was not shown to be superior to progressive exercise at home managed by a physical therapist. (Funded by the National Institute of Neurological Disorders and Stroke and the National Center for Medical Rehabilitation Research; LEAPS ClinicalTrials.gov number, NCT00243919.).

Quantitative in situ attenuated total internal reflection Fourier transform infrared study of the isotherms of poly(sodium 4-styrene sulfonate) adsorption to a TiO2 surface over a range of cetylpyridinium bromide monohydrate concentration.

Quantitative in situ attenuated total internal reflection Fourier transform infrared (ATR FTIR) spectroscopy has been used to study the isotherm of poly(sodium 4-styrene sulfonate), PSS, adsorption to a TiO(2) surface in aqueous solution at a pH of 3.5. The effect of adding surfactant cetylpyridinium bromide monohydrate (CPBM) on the adsorption isotherm of PSS was investigated at CPBM concentrations of 3.60 x 10(-7), 1.02 x 10(-5), and 1.04 x 10(-4) M. The use of in situ ATR FTIR allowed for the calculation of the concentration of both PSS and CPBM at the TiO(2)/water interface over the entire course of all experiments. It was found that the addition of a small amount of CPBM, 3.60 x 10(-7) M, to PSS solutions resulted in 23 +/- 3% less PSS accumulating at the TiO(2)/water interface compared to isotherm studies with no CPBM present. The mole ratio of CPBM to PSS varies from 4 +/- 1 to 1 to 20 +/- 4 to 1 in a stepwise manner as the solution concentration of PSS is increased for solutions with a CPBM concentration of 3.60 x 10(-7). The addition of CPBM at concentrations of 1.02 x 10(-5) and 1.04 x 10(-4) M showed distinct differences in the behavior of the PSS isotherm, but at the highest solution PSS concentrations, the amount of PSS at the TiO(2)/water interface compared to that of PSS solutions with no CPBM added is indistinguishable within the experimental uncertainties. For these higher concentrations of CPBM, both PSS and CPBM appear to come to the TiO(2) surface as aggregates and the mole ratio of CPBM to PSS at the TiO(2)/water interface decreases as the concentration of PSS is increased. For a CPBM concentration of 1.02 x 10(-5) M, the mole ratio of CPBM to PSS changes from 139 +/- 29 to 1 to 33 +/- 7 to 1 as the solution PSS concentration is increased. For a CPBM concentration of 1.04 x 10(-4) M, the mole ratio of CPBM to PSS changes from 630 +/- 130 to 1 to 110 +/- 21 to 1 as the solution PSS concentration is increased. Despite the large differences in the CPBM to PSS mole ratios, the amount of PSS that adsorbs to the surface is statistically indistinguishable for CPBM concentrations of 0, 1.02 x 10(-5), and 1.04 x 10(-4) M, indicating that the structure of the PSS molecules in each of the systems does not significantly change in the presence of CPBM.