Microstructural and micromechanical characteristics of composite osteoconductive coatings deposited by the atmospheric pressure plasma technique.

Long-term placement of facial implants requires avoiding the formation of fibrous tissue capsules around the artificial material by creating osteoconductive properties of the surface. Most promising approach is the deposition coatings made of materials very similar to bone mineral components, that is, calcium phosphates such as hydroxyapatite (HAp). As part of the research work, an innovative, cost-effective atmospheric pressure plasma deposition (APPD) system was used as a low-temperature coating technology for generating the HAp coatings deposition. Full microstructural characterisation of the coatings using SEM and TEM techniques was carried out in the work. It has been shown that the fully crystalline HAp powder undergoes a transformation during the coatings deposition and the material had a quasi-sintered structure after deposition. The crystalline phase content increased at the coating/substrate interface, while the surface of the HAp was amorphous. This is a very beneficial phenomenon due to the process of bioresorption. The amorphous phase undergoes much faster biodegradation than the crystalline one. In order to increase the bioactivity of the HAp, Zn particles were introduced on the surface of the coating. The TEM microstructural analysis in conjunction with the qualitative analysis of the EDS chemical composition showed that the binding of the Zn particles within the HAp matrix had diffusive character, which is very favourable from the point of view of the quality of the adhesion and the bioactivity of the coating. In the case of such a complex structure and due to its very porous nature, micromechanical analysis was carried out in situ in SEM, that is, by microhardness measurements of both the HAp matrix and the Zn particle. It was shown that the average value of HAp microhardness was 4.395 GPa ± 0.08, while the average value of Zn microhardness was 1.142 GPa ± 0.02.

Wear mechanisms description in nanoscale by SEM/TEM of multilayer Zr/ZrN coatings in dependence on phases ratio.

As a result of loading with an external force during the wear process, coating deforms uniformly. After a certain limit load is exceeded, coating deformation is localised through the formation of the so-called shear bands. It has been showed experimentally the process of shear bands formation. The microstructural characterisation before and after the mechanical tests was performed using scanning and transmission electron microscopy (SEM and TEM) on cross-sections of the samples. The analysis indicated that in the case of multilayer coatings where the ratio of the metallic to the ceramic phase is 1:1, the shear bands are formed at an angle of 45°. With a greater proportion of the ceramic phase to metallic (ratio 1:2), the shear band changed the shear angle from ∼45° to ∼90°. Mechanical in situ tests were carried out in the chambers of SEM and TEM. The scratch tests in the SEM were done with the simultaneous observation of the phenomena occurring on the surface of the tested materials showed that at a scratch force of 0.04 N, the additional outer a-C:H layer was damaged, which was shown in the form of a fault in the force-displacement diagram, and in the form of splits visible in the SEM image. However, the application of this additional layer had a positive effect on the wear mechanism of the entire coating structure. The test also indicated that in the case of coatings with phases ratio 1:2 and 1:4 (metallic to ceramic), the characteristics of the brittle material were demonstrated, unlike the coating with a 1:1 phase ratio, where plastic properties predominated. However, for the 1:2 phase ratio coating, the chip was more ductile than for the chip formed when testing a 1:4 phase ratio coating. For in situ mechanical testing in the TEM, a straining holder was used. The test showed that the shear band angle for a 1:1 ratio coating has changed from 45° to 90° due to the different direction of force interaction.

Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions.

The health care delivery system in the United States, structured to provide single-disease care, presents unique challenges for patients with complex physical and psychiatric comorbidities. Patients in these populations are often referred to multiple specialty clinics, encounter little continuity of care or collaboration among their providers, incur high health care costs, and experience poor treatment outcomes. Given these barriers, questions remain about the extent to which siloed and fragmented care, as opposed to the complex nature of the illnesses themselves, contribute to poor outcomes. If given the opportunity to receive well-integrated, consistent, and personalized care, can patients with historically difficult-to-treat comorbid medical and mental illnesses make progress? This article describes an innovative model of care called functional rehabilitation that is designed to address existing barriers in treatment. The functional rehabilitation program seeks to disrupt the escalating effects of interacting comorbidities by offering highly collaborative treatment from a small team of clinicians, personalized interventions using a shared decision-making framework, multipronged treatment options, colocation in a large hospital system, and significant 1:1 time with patients. The article includes a case example with longitudinal outcome data that illustrates how progress can be made with appropriate programmatic supports. Future research should examine the cost-effectiveness of this model of care.

Effect of the mechanical properties of carbon-based coatings on the mechanics of cell-material interactions.

The paper presents an influence of the surface mechanical properties of thin-film materials on blood cell adhesion under shear stress conditions. Physical vapour deposited (PVD) coatings i.e. hydrogenated amorphous carbon (a-C:H) doped with nitrogen or silicon have been investigated. The mechanical properties of materials, namely their microhardness and Young's modulus were measured using indentation test with Rockwell indenter. The adhesion efficiency of blood cells in dynamic conditions were analysed using a radial flow chamber. Red blood cells (RBC) were used as representative cells to analyse cell-material interactions. The biomaterial examinations were performed under physiological flow conditions at the single-cell level. The 3D FVM (finite volume method) model of multi-phase radial flow test was developed to reproduce the physical test and to predict distributions of shear stresses and velocity during blood washout with PBS. Cell-material interactions were found to be strongly associated with the mechanical properties of the thin-film material. The decrease in the hardness of the coatings translated into a weaker cell - material interactions.

Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective.

As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients' home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients' home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter.

Influence of surface modification of Ti6Al7Nb alloy on adhesion of poly (lactide-co-glycolide) coating (PLGA).

The paper presents the results of studies on the influence of surface topography and wettability of a Ti6Al7Nb alloy substrate on the adhesion of a PLGA coating. The alloy surface was modified using a mechanical pre-treatment including: grinding, vibration treatment, mechanical polishing, sandblasting and anodic oxidation. The polymer coating was applied to the metal substrate by a dip-coating method. The scope of the research included microscopic observations of the substrate and polymer coating using SEM and acoustic microscopy. In addition, studies on the wettability and topography of the polymer coating and the metal substrate, the thickness of the polymer coating as well as qualitative and quantitative testing of the adhesion of the polymer coating to the substrate were carried out. Coating adhesion tests were conducted for samples in the initial state and after 6 weeks exposure to Ringer's solution. Analysis of the results indicates the influence of the method used to modify the metal substrate on its topography and wettability. These parameters affect the thickness of the obtained polymer coating. Regardless the parameters of the metal substrate, a qualitative analysis of the adhesion of the coating applied to the substrate of the Ti6Al7Nb alloy did not show any delamination for both samples exposed and non-exposed to Ringer's solution. On the other hand, quantitative scratch-test studies showed different adhesion of the polymer coating to the substrate depending on the surface topography obtained by various modification methods. The cytotoxicity test conducted by the indirect method using extracts confirmed that the surface modification does not affect cell growth. The complex methods of surface pre-treatment of the alloy together with the kind of polymer selected for the study allowed to develop well adhered PLGA layers on Ti6Al7Nb intended for short term implants. The lack of delamination of the layer during 6 weeks was proved, what allows for maintaining the protection function of the layer during this period and contribute to improving biocompatibility.

Association between undiagnosed hypertension and microalbuminuria in South Asians without known diabetes.

Data suggest increased rates of chronic kidney disease (CKD) in those with undiagnosed hypertension (HTN). Our study aimed to determine the prevalence of CKD in undiagnosed hypertensives in a previously unreported subgroup of individuals of South Asian ethnicity. We analysed data from subjects in the ADDITION-Leicester study, a UK based multiethnic, community diabetes screening study. Standard definitions included: HTN-mean recorded BP of ⩾140/90 mm Hg, CKD stage 3 and above-estimated glomerular filtration rate (eGFR) <60 ml min(-1) per 1.73 m2 and microalbuminuria as albumin creatinine ratio ⩾3 mg mmol(-1). Logistic regression was performed with age, gender and body mass index (kg m(-2)) as co-variates. 6082 individuals (52.5% female, mean age, 57.2 years; White European, 77.8% and South Asian, 22.0%), 31.1% had undiagnosed HTN. Overall, individuals with undiagnosed HTN compared with normotensives had an odds ratio for microalbuminuria of 2.24 (95% confidence interval (CI): 1.72-2.94). For South Asians, the odds ratio was 3.81. (95% CI: 2.24-6.47) for microalbuminuria with a trend towards an eGFR<60 ml min(-1) per 1.73 m2. Future studies should consider intensified screening for HTN to refine the population suitable for CKD screening, particularly in the South Asian ethnic group.

A retrospective review of digit span-related effort indicators in probable Alzheimer's disease patients.

There has been extensive research on the use of both stand-alone and embedded measures of effort in neuropsychological testing; however, relatively few studies have reported on their utility in the context of dementia. Previous studies that have examined the specificity of traditionally used cut-scores on embedded measures of effort with dementia samples have largely found high rates of false positive errors. The present study examined the specificity of several Digit Span derived embedded measures of effort in a large clinical sample of patients with probable Alzheimer's disease stratified by level of dementia severity. Of the measures that were examined, only the Vocabulary - Digit Span score demonstrated promising specificity through the moderate level of dementia severity. All of the remaining indices, including Reliable Digit Span, Digit Span Age-Corrected Scaled Score, and Longest Digits Forward (1 & 2 Trials), yielded unacceptable rates of false positive errors as dementia severity increased. The implications for these findings are discussed, including the limitations of importing methods of assessing effort from one sample to another.

In situ nanomechanical testing in focused ion beam and scanning electron microscopes.

The recent interest in size-dependent deformation of micro- and nanoscale materials has paralleled both technological miniaturization and advancements in imaging and small-scale mechanical testing methods. Here we describe a quantitative in situ nanomechanical testing approach adapted to a dual-beam focused ion beam and scanning electron microscope. A transducer based on a three-plate capacitor system is used for high-fidelity force and displacement measurements. Specimen manipulation, transfer, and alignment are performed using a manipulator, independently controlled positioners, and the focused ion beam. Gripping of specimens is achieved using electron-beam assisted Pt-organic deposition. Local strain measurements are obtained using digital image correlation of electron images taken during testing. Examples showing results for tensile testing of single-crystalline metallic nanowires and compression of nanoporous Au pillars will be presented in the context of size effects on mechanical behavior and highlight some of the challenges of conducting nanomechanical testing in vacuum environments.

Does PTSD impair cognition beyond the effect of trauma?

This systematic review analyzed data from studies examining memory and cognitive function in subjects with posttraumatic stress disorder (PTSD), compared with subjects exposed to trauma (but without PTSD). Based on analysis of 21 articles published in English from 1968 to 2009, the conclusion is that individuals with PTSD, particularly veterans, show signs of cognitive impairment when tested with neuropsychological instruments, more so than individuals exposed to trauma who do not have PTSD.

Microstructure and biocompatibility of titanium oxides produced on nitrided surface layer under glow discharge conditions.

The disadvantages of titanium implants are their low wear resistance and the release of titanium elements into surrounding tissue. These can be eliminated by modifying the surface by surface engineering methods, among them nitriding under glow discharge conditions which allow to produce diffusive surface layers. Their combining with an oxide layer might be valuable for biological events occurring at the bone implant interface. The aim of this study was to enhance the titanium biomaterial performance via combining nitriding and oxidizing treatments in one process under glow discharge conditions. The oxynitrided surface layers were produced at 680 degrees C. The obtained layer was TiO + TiN + Ti2N + alphaTi(N) type and about 4-microm thick and was of diffusive character. This layer significantly increased wear resistance and slightly corrosion resistance compared to that of the reference titanium alloy. The produced titanium oxide was about 400-nm thick and built from fine crystallites. This oxide exhibits bioactivity in SBF (simulated body fluid). Osteoblasts of Saos-2 line incubated on this surface exhibited good adhesion and proliferation and ALP release comparable with cells cultured on the reference titanium alloy and TiN + Ti2N + alphaTi(N) surface layers. A quantitative analysis of blood platelets adhering to this layer revealed their highest amount in comparison to that on both the nitrided surface layer and titanium alloy. The presented study provided a simple and reproducible method of combining oxidizing and nitriding under glow discharge in one process. Experimental data in vitro suggests that titanium alloy oxynitriding under low temperatures at glow discharge conditions improves titanium alloy properties and biocompatibility and tissue healing. Therefore, the layer of TiO + TiN +Ti2N + alphaTi(N) type could be valuable for long-term bone implants.

Species differences in the pharmacokinetics and metabolism of reparixin in rat and dog.

The pharmacokinetics and metabolism of reparixin (formerly repertaxin), a potent and specific inhibitor of the chemokine CXCL8, were investigated in rats and dogs after intravenous administration of [14C]-reparixin L-lysine salt. Protein binding of reparixin was investigated in vitro in rat, dog, rabbit, cynomolgus monkey and human plasma. Plasma protein binding of reparixin was >99% in the laboratory animals and humans up to 50 microg ml-1, but lower at higher concentrations. Although radioactivity was rapidly distributed into rat tissues, Vss was low (about 0.15 l kg-1) in both rat and dog. Nevertheless, reparixin was more rapidly eliminated in rats (t1/2 approximately 0.5 h) than in dogs (t1/2 approximately 10 h). Systemic exposure in dog was due primarily to parent drug, but metabolites played a more prominent role in rat. Oxidation of the isobutyl side-chain was the major metabolic pathway in rat, whereas hydrolysis of the amide bond predominated in dog. Urinary excretion, which accounted for 80-82% of the radioactive dose, was the major route of elimination in both species, and biotransformation of reparixin was complete before excretion.

Viscous water meniscus under nanoconfinement.

A dramatic transition in the mechanical properties of water is observed at the nanometer scale. For a water meniscus formed between two hydrophilic surfaces in the attractive region, with < or = 1 nm interfacial separation, the measured viscosity is 7 orders of magnitude greater than that of bulk water at room temperature. Grand canonical Monte Carlo simulations reveal enhancement in the tetrahedral structure and in the number of hydrogen bonds to the surfaces as a source for the high viscosity; this results from a cooperative effect of hydrogen bonding of water molecules to both hydrophilic surfaces.

A new structural concept in moulded fixed ankle foot orthoses and comparison of the bending stiffness of four constructions.

There are many reasons why a rigid ankle foot orthosis (AFO) may be prescribed. In some cases it is desirable that the rigidity is sufficient to maintain a constant ankle position throughout the gait cycle. There is a need to determine a design of cosmetic, lightweight AFO that provides the necessary stiffness whilst being acceptable to the patient, encouraging continued wear with the resultant benefits. This paper describes an investigation of AFO resistance to dorsiflexion, comparing the stiffness of an AFO with forward trim lines, two designs of reinforced AFOs and an AFO with forward trim lines and an external ankle strap. One reinforced AFO had corrugations moulded in the polypropylene around the ankle, the other had carbon fibre inserts attached to the inside of the polypropylene. The emphasis was on testing the mechanical stiffness of the four AFO designs: the test procedure did not mimic the patterns of AFO loading during gait. Each design was tested in the same manner by the same examiner. The AFO with forward trimlines and an ankle strap displayed similar stiffness to the carbon fibre reinforced AFO and both were stiffer than the other two designs.

Comparison of rocking edge spacing for two common designs of swivel walkers.

Two commonly used designs of swivel walker are the Consort 800 and the ORLAU 1000. This paper examines how the footplate rocking edge spacing varies between these two designs and then considers how lateral stability might be influenced if reduced separation is introduced to facilitate ambulation for less able users. In general it is shown that there should be no obstacles to such variation on the part of an orthotist thereby improving access to these devices and function for disabled individuals.

Evaluation of dental arch reproduction using three-dimensional optical digitization.

STATEMENT OF PROBLEM: Numerous investigations have been done to determine the most accurate method to reproduce a dental arch. Investigations have used different definitive cast configurations, materials, and measuring techniques to evaluate dimensional change, leaving clinicians undecided as to the most accurate method to reproduce a dental arch. PURPOSE OF STUDY: The purpose of this investigation was to evaluate the effect of impression tray selection on accuracy of reproductions of a dental arch using a 3-dimensional optical digitizer. MATERIALS AND METHODS: Impressions were made of a stone cast of a dental arch using vinyl polysiloxane impression material in custom and stock impression trays (n=12). Custom trays, designed with full palatal coverage, were fabricated on a separate standard stone cast using 2 layers of pink baseplate wax as the spacer and tissue stops on 1 anterior tooth and both first molar teeth. Impressions were poured with type IV gypsum and allowed to set with the tray inverted (n=5) or not inverted (n=5). The standard cast and resulting casts were digitized using an optical digitizer. Custom software was used to align and process the 3-dimensional images created by the digitizer. Each image was superimposed onto the standard cast image, curves were created of the percent of points less than a defined distance between the 2 superimposed images, and the area under the curve was calculated. A weighted average area was calculated for each cast, and these values were analyzed using a 2-way ANOVA (alpha=.05). RESULTS: The main effect of tray type, laboratory setting technique, and the interaction between these 2 characteristics was analyzed. None of these effects was significant. CONCLUSION: The differences in accuracy of reproductions of a dental arch, regardless of the impression and laboratory techniques, were not significant when evaluated using a 3-dimensional optical digitizer.

Population genetics of wolf spiders of fragmented habitat in the wheat belt of New South Wales.

Possible effects of habitat fragmentation on the population genetics of a species of wolf spider (Lycosidae) from remnant Callitris woodland in the wheat belt of central western New South Wales in Australia are examined. Single-strand conformational analysis of mitochondrial cytochrome oxidase (subunit 1) was used to characterize the haplotypes of 295 spiders in six blocks each of four woodland sites. DNA sequences were collected from 119 of these spiders to confirm haplotype scoring, allow phylogeny estimation and permit calculation of sequence-based statistics. Intra-block tests do not suggest widespread effects of fragmentation. Genetic diversity is high in all blocks, with 25 haplotypes being identified. Nucleotide diversity is relatively low, as all of the haplotypes are closely related. One block had a significantly low value for the Ewens/Watterson test of neutrality and one block's value was nearly significantly high. Two blocks had nearly significant values of the Harpending Raggedness Index testing for recent population bottlenecks. No other intrablock tests approach significance. Interpopulation comparisons show significant nonhomogeneity of haplotype frequencies globally and in all pairwise comparisons. Relationships between woodland blocks based on haplotype frequencies are discordant with geographical proximity. Haplotype distribution patterns suggest that population structuring existed prior to fragmentation. We develop two measures of genetic distinctiveness to identify subpopulations of interest for conserving evolutionary processes in a species' regional population. One is based on the sum of pairwise FST values and one on the spatial distribution of genetic variation. High values of the measure suggest a subpopulation might have been recently perturbed and low values that it is relatively undisturbed. The two measures identify different blocks as being of particular interest.