Nurse performed bladder ultrasound: a clinical quality improvement initiative.

Background: Bladder ultrasound (BUS) provides an accurate measurement of post-void residual (PVR) volume and bladder assessment. Access to BUS is dependent on practitioner availability with delays resulting in poor symptom management, delayed discharge and dissatisfaction. Developing nursing practice to perform BUS can address these patient's needs.Aims: Through a quality improvement initiative the aims were (1) to develop theoretical knowledge and practical competence of nurses to perform BUS, (2) to evaluate nursing activity in relation to BUS, (3) to evaluate stakeholders perceptions of the initiative.Methods: Based on the Deming Plan-Do-Study-Act (PDSA) cycle, an interprofessional team was created and a theoretical/practical based education program was devised. Activity in relation to the nurse-performed BUS was collected and analysed descriptively. Stakeholder perceptions were evaluated via patient and physician questionnaires subject to descriptive analysis and a focus group with nurses analysed descriptively.Results: The team developed a training program to perform BUS, certifying 11 nurses. Investigation of nursing activity related to BUS (n = 202) showed its use for PVR evaluation, and symptom and catheter assessment. It aided decision-making and nurse-physician communication. Stakeholders were satisfied with the initiative. Patients (n = 30) felt nurses were competent, clearly explaining the procedure, results and inspiring confidence. Physicians (n = 2) saw BUS as enhancing efficiency and care quality, while nurses (n = 7) felt this new skill enhanced nursing care providing a more holistic approach. Team reflection on the results of the evaluation confirmed BUS utility and activity, while nurses requested continuing education and a post-certification refresher course.Conclusion: Through reflection on clinical practice areas for improvement to enhance patient care were identified by the nursing team. Application of the PDSA cycle provided a structured approach to guide the quality improvement initiative. Improvements in nursing care and patient care processes have been observed and this has been a positive experience for stakeholders.

Current developments in elastic and acoustic metamaterials science.

The concept of metamaterial recently emerged as a new frontier of scientific research, encompassing physics, materials science and engineering. In a broad sense, a metamaterial indicates an engineered material with exotic properties not found in nature, obtained by appropriate architecture either at macro-scale or at micro-/nano-scales. The architecture of metamaterials can be tailored to open unforeseen opportunities for mechanical and acoustic applications, as demonstrated by an impressive and increasing number of studies. Building on this knowledge, this theme issue aims to gather cutting-edge theoretical, computational and experimental studies on elastic and acoustic metamaterials, with the purpose of offering a wide perspective on recent achievements and future challenges.This article is part of the theme issue, 'Current developments in elastic and acoustic metamaterials science (Part 2)'.

Elastic metasurfaces for Scholte-Stoneley wave control.

In this work, we investigate the dynamics of Scholte-Stoneley waves (SSWs) travelling along elastic metasurfaces, e.g. thin resonant structures embedding mechanical oscillators, placed at the interface between solid and fluid. To this purpose, an analytical dispersion law, valid in the long-wavelength regime, is derived and used to reveal the hybridization of SSWs with the collective resonance of the mechanical oscillators and the conversion of SSWs into leaky modes within the fluid. The analytical predictions are validated through numerical simulations that include both dispersive and harmonic analysis. Our findings disclose the capabilities of elastic metasurfaces in filtering, trapping and converting SSWs along fluid-solid interfaces, thus supporting the design of novel devices for solid-fluid interaction across various engineering applications, including microfluidics. This article is part of the theme issue 'Current developments in elastic and acoustic metamaterials science (Part 1)'.

Guiding near-source elastic waves in a semi-infinite medium.

In this work, we propose elastic metamaterials with phase discontinuities to steer the propagation of near-source bulk waves in a semi-infinite elastic medium. Our design exploits an array of embedded subwavelength resonators with tailored masses to attain a complete phase shift spanning [Formula: see text]. This phase control allows for diverse wave functionalities, such as directional refraction and energy focusing. Through the use of dispersion diagrams and the generalized Snell's law, along with a multiple scattering formulation, we analytically demonstrate the effectiveness of our design in achieving the desired wavefront manipulation. The proposed design has the potential to advance the field of guiding elastic waves using metamaterials and find practical applications in areas such as isolating ground-borne vibrations in densely urbanized regions and energy harvesting. This article is part of the theme issue 'Current developments in elastic and acoustic metamaterials science (Part 1)'.

Current developments in elastic and acoustic metamaterials science.

The concept of metamaterial recently emerged as a new frontier of scientific research, encompassing physics, materials science and engineering. In a broad sense, a metamaterial indicates an engineered material with exotic properties not found in nature, obtained by appropriate architecture either at macro-scale or at micro-/nano-scales. The architecture of metamaterials can be tailored to open unforeseen opportunities for mechanical and acoustic applications, as demonstrated by an impressive and increasing number of studies. Building on this knowledge, this theme issue aims to gather cutting-edge theoretical, computational and experimental studies on elastic and acoustic metamaterials, with the purpose of offering a wide perspective on recent achievements and future challenges. This article is part of the theme issue 'Current developments in elastic and acoustic metamaterials science (Part 1)'.

Right ventricle involvement in patients with breast cancer treated with chemotherapy.

BACKGROUND: Anthracyclines can cause left ventricular (LV) dysfunction. There is little data about right ventricular (RV) damage during chemotherapy. AIM: This study aimed to investigate the toxic effects of chemotherapy, analyzing its impact on right ventricular function. MATERIAL AND METHODS: A prospective study was conducted, enrolling 83 female patients (55 ± 11 years old) affected by breast cancer treated with anthracyclines. Cardiological evaluation, HFA risk score assessment and comprehensive echocardiogram, including speckle tracking analysis and 3D analysis, were performed before starting chemotherapy (T0) and at 3 (T1), 6 (T2) and 12 months (T3) after beginning treatment. RV function was assessed with tricuspid annular plane excursion (TAPSE), S' wave of the tricuspid annulus, fractional area change (FAC), RV global longitudinal strain (RV-GLS), free wall strain (RV-FWLS) and RV 3D ejection fraction (RV-3DEF). Subclinical LV CTRCD was defined as a reduction of GLS > 15% compared to baseline. Subclinical RV cardiotoxicity was defined as the co-presence of a relative decrease of 10% from baseline in RV-3DEF and a relative reduction of 15% from baseline RV-FWLS. RESULTS: After chemotherapy, we found a significant reduction in 2D-LVEF (p = < 0.001) and 3D-LVEF (p = < 0.001), in LV-GLS and RVLS (p = < 0.001), in FAC and TAPSE, also RV-3DEF reduced significantly (p = 0.002). 39% of patients developed LV subclinical CTRCD; 28% of patients developed RV subclinical cardiotoxicity. LV and RV changes occurred concomitantly, and no RV echocardiographic parameters were found to predict the development of LV CTRCD and vice-versa. CONCLUSION: After anthracyclines-based chemotherapy, LV and RV subclinical damage occurs, and it can be detected early by speckle-tracking and 3D echocardiography.

Mechanical Hemolytic Anemia Associated With Mitral Valve Repair: A Case Report With Literature Review.

Hemolytic anemia could be caused by several conditions, depending on intrinsic or extrinsic defects of the erythrocyte. The latter group includes mechanical intravascular hemolysis, generally related to malfunctioning prosthetic heart valves or, rarely, heart valves repair. We describe a case of a child with Down syndrome, who developed hemolytic anemia after mitral valve repair. We observed that this condition is a rare complication in pediatrics, with only 7 cases reported in literature. Mechanical hemolysis should always be considered in the differential diagnosis of a new-onset hemolytic anemia, especially in patients with valvular heart disease, undergoing cardiac surgery.

Experiences and Needs of Patients, Caregivers and Nurses during the COVID-19 Pandemic: Study Protocol for a Mixed-Methods Multicentre Study.

The COVID-19 pandemic is a major public health problem with millions of confirmed cases and deaths described. Nurses are among the health care professionals most involved at the front line, caring for those affected by COVID-19. Patients and families have been subjected to a high emotional burden of fear, anxiety, and uncertainty. The COVID-19 pandemic has had a significant impact on the approach to patients, the organisation of care, and communication with patients and their families, all requiring considerable adaptation on the part of nurses and health care professionals. The overall aim of this research was to find out the needs of patients with COVID-19, the nursing interventions provided and their outcomes, and to explore the experiences of the nurses, patients, and caregivers. A mixed method study will be performed with a convergent design. The study was divided into three phases. Quantitative methods involved nurses and patients affected by COVID-19 with a questionnaire. Qualitative methods involved nurses, patients, and caregivers with interviews and finally a quantitative analysis of the nursing documentation of the interviewed patients. We hope that this study will help us to understand and identify the main nursing and support needs expressed by patients and their families at different stages of their illness.

Sequencing radium 223 and other life-prolonging agents in castration-resistant prostate cancer patients.

Background: Radium 223 (RA223) is currently administered as part of a therapeutic sequence with the other life-prolonging agents (LPAs) for metastatic castration-resistant prostate cancer (mCRPC). Patients & methods: We retrospectively reviewed the clinical records of patients who had received at least three LPAs including RA223. Results: Median overall survival (OS) from the start of first-line treatment was 39.8 months, with the patients who completed all six planned courses of RA223 having a longer OS than those who did not (53.2 vs 29.5 months; p < 0.0001). Conclusions: Our study confirms the activity of RA223 regardless of the treatment line in which it is administered and suggests that patient selection plays a central role in maximizing this activity.

Acoustic properties of porous microlattices from effective medium to scattering dominated regimes.

Microlattices are architected materials that allow for an unprecedented control of mechanical properties (e.g., stiffness, density, and Poisson's coefficient). In contrast to their quasi-static mechanical properties, the acoustic properties of microlattices remain largely unexplored. This paper analyzes the acoustic response of periodic millimeter-sized microlattices immersed in water using experiments and numerical simulations. Microlattices are fabricated using high-precision stereolithographic three-dimensional printing in a large variety of porosities and lattice topologies. This paper shows that the acoustic propagation undergoes a frequency dependent transition from a classic poroelastic behaviour that can be described by Biot's theory to a regime that is dominated by scattering effects. Biot's acoustic parameters are derived from direct simulations of the microstructure using coupled fluid and solid finite elements. The wave speeds predicted with Biot's theory agree well with the experimental measures. Within the scattering regime, the signals show a strong attenuation and dispersion, which is characterized by a cut-off frequency. The strong dispersion results in a frequency dependent group velocity. A simplified model of an elastic cylindrical scatterer allows predicting the signal attenuation and dispersion observed experimentally. The results in this paper pave the way for the creation of microlattice materials for the control of ultrasonic waves across a wide range of frequencies.

Patients' self-evaluation of symptoms, signs and compliance to therapy for heart failure surveillance: A pilot study on identification of worsening heart failure.

In patients with chronic heart failure (HF), it is unclear whether self-evaluation of HF-related symptoms and signs may contribute to the surveillance of clinical stability over time or the early identification of worsening HF.   Therefore, HF-related symptoms and signs, and compliance to therapy were investigated by a self-administrated questionnaire in patients hospitalized due to worsening HF (cases) as well in those with stable HF (controls).  The temporal interval of interest for the questionnaire focused on 2 to 7 days before the hospitalization of the control visit.  A method called "classic" extrapolated a surveillance score by 4 questions revealing HF-related symptoms or signs (higher score indicative of more symptoms or sings reported).  Alternatively, 3 additional questions enriched the "classic" questionnaire, including one on whether the health status was perceived as stable, improved or worsening.  The score from "perceived health status"  inquiry was used as "conditional factor" to computed the surveillance score as: conditional factor + [conditional factor X (the sum of the points yielded by the responses to each question on symptoms, sings and compliance to therapy)].  Among 51 patients hospitalized due to worsening HF and 104 with chronic HF (retrospective study), the area under the curve (receiver operating characteristic) discriminating worsening HF was 0.90 by the classic, and 0.96 by the conditional method (both p<0.001), yielding error rates of 2 in 10 by the classic and 1 in 10 by the conditional method.  In a pilot longitudinal study in 37 ambulatory HF patients from a different population source, predicting worsening HF by alternative questionnaires within 12 weeks from the visit yielded consistent results.  In conclusion, patients' self-monitoring symptoms, signs and compliance by a standardized questionnaire and a conditional method for generating relative a score, may be a promising method for HF stability surveillance.

Control of Love waves by resonant metasurfaces.

Metasurfaces of mechanical resonators have been successfully used to control in-plane polarized surface waves for filtering, waveguiding and lensing applications across different length scales. In this work, we extend the concept of metasurfaces to anti-plane surface waves existing in semi-infinite layered media, generally known as Love waves. By means of an effective medium approach, we derive an original closed-form dispersion relation for the metasurface. This relation reveals the possibility to control the Love waves dispersive properties by varying the resonators mechanical parameters. We exploit this capability to manipulate the metasurface refractive index and design two gradient index (GRIN) metalenses, i.e. a Luneburg lens and a Maxwell lens. We confirm the performance of the designed lenses using full 3D finite element simulations. Our work demonstrates the possibility of realizing wave control devices for anti-plane waves.

Designing perturbative metamaterials from discrete models.

Identifying material geometries that lead to metamaterials with desired functionalities presents a challenge for the field. Discrete, or reduced-order, models provide a concise description of complex phenomena, such as negative refraction, or topological surface states; therefore, the combination of geometric building blocks to replicate discrete models presenting the desired features represents a promising approach. However, there is no reliable way to solve such an inverse problem. Here, we introduce 'perturbative metamaterials', a class of metamaterials consisting of weakly interacting unit cells. The weak interaction allows us to associate each element of the discrete model with individual geometric features of the metamaterial, thereby enabling a systematic design process. We demonstrate our approach by designing two-dimensional elastic metamaterials that realize Veselago lenses, zero-dispersion bands and topological surface phonons. While our selected examples are within the mechanical domain, the same design principle can be applied to acoustic, thermal and photonic metamaterials composed of weakly interacting unit cells.

Engineered metabarrier as shield from seismic surface waves.

Resonant metamaterials have been proposed to reflect or redirect elastic waves at different length scales, ranging from thermal vibrations to seismic excitation. However, for seismic excitation, where energy is mostly carried by surface waves, energy reflection and redirection might lead to harming surrounding regions. Here, we propose a seismic metabarrier able to convert seismic Rayleigh waves into shear bulk waves that propagate away from the soil surface. The metabarrier is realized by burying sub-wavelength resonant structures under the soil surface. Each resonant structure consists of a cylindrical mass suspended by elastomeric springs within a concrete case and can be tuned to the resonance frequency of interest. The design allows controlling seismic waves with wavelengths from 10-to-100 m with meter-sized resonant structures. We develop an analytical model based on effective medium theory able to capture the mode conversion mechanism. The model is used to guide the design of metabarriers for varying soil conditions and validated using finite-element simulations. We investigate the shielding performance of a metabarrier in a scaled experimental model and demonstrate that surface ground motion can be reduced up to 50% in frequency regions below 10 Hz, relevant for the protection of buildings and civil infrastructures.

Composite 3D-printed metastructures for low-frequency and broadband vibration absorption.

Architected materials that control elastic wave propagation are essential in vibration mitigation and sound attenuation. Phononic crystals and acoustic metamaterials use band-gap engineering to forbid certain frequencies from propagating through a material. However, existing solutions are limited in the low-frequency regimes and in their bandwidth of operation because they require impractical sizes and masses. Here, we present a class of materials (labeled elastic metastructures) that supports the formation of wide and low-frequency band gaps, while simultaneously reducing their global mass. To achieve these properties, the metastructures combine local resonances with structural modes of a periodic architected lattice. Whereas the band gaps in these metastructures are induced by Bragg scattering mechanisms, their key feature is that the band-gap size and frequency range can be controlled and broadened through local resonances, which are linked to changes in the lattice geometry. We demonstrate these principles experimentally, using advanced additive manufacturing methods, and inform our designs using finite-element simulations. This design strategy has a broad range of applications, including control of structural vibrations, noise, and shock mitigation.

Biochemical and objective response to abiraterone acetate withdrawal: incidence and clinical relevance of a new scenario for castration-resistant prostate cancer.

OBJECTIVE: To describe the incidence and clinical relevance of biochemical and objective responses to abiraterone acetate (AA) withdrawal (AAWD) in patients with castration-resistant prostate cancer (CRPC). MATERIALS AND METHODS: Twenty-six patients with progressive CRPC treated with first-line docetaxel-based chemotherapy were administered with AA at the standard dose of 1000 mg/day in combination with prednisone until progression. The patients were regularly followed up during treatment and after AAWD. RESULTS: Nineteen of the 26 patients discontinued AA because of progression. Three of the patients undergoing AAWD experienced a biochemical response, which was accompanied by a metabolic and radiological response as revealed by choline positron emission tomography in 2 cases. CONCLUSION: Regardless of the underlying molecular bases, AAWD response does not occur rarely. It is sometimes long-lasting and accompanied by a metabolic and radiographic improvement. AAWD response should be taken into account when further therapeutic strategies are planned in patients with CRPC with progressive disease during abiraterone therapy.

Transcranial direct current stimulation preconditioning modulates the effect of high-frequency repetitive transcranial magnetic stimulation in the human motor cortex.

Experimental studies emphasize the importance of homeostatic plasticity as a mean of stabilizing the properties of neural circuits. In the present work we combined two techniques able to produce short-term (5-Hz repetitive transcranial magnetic stimulation, rTMS) and long-term (transcranial direct current stimulation, tDCS) effects on corticospinal excitability to evaluate whether and how the effects of 5-Hz rTMS can be tuned by tDCS preconditioning. Twelve healthy subjects participated in the study. Brief trains of 5-Hz rTMS were applied to the primary motor cortex at an intensity of 120% of the resting motor threshold, with recording of the electromyograph traces evoked by each stimulus of the train from the contralateral abductor pollicis brevis muscle. This interventional protocol was preconditioned by 15 min of anodal or cathodal tDCS delivered at 1.5 mA intensity. Our results showed that motor-evoked potentials (MEPs) increased significantly in size during trains of 5-Hz rTMS in the absence of tDCS preconditioning. After facilitatory preconditioning with anodal tDCS, 5-Hz rTMS failed to produce progressive MEP facilitation. Conversely, when 5-Hz rTMS was preceded by inhibitory cathodal tDCS, MEP facilitation was not abolished. These findings may give insight into the mechanisms of homeostatic plasticity in the human cerebral cortex, suggesting also more suitable applications of tDCS in a clinical setting.

Abnormal facilitatory mechanisms in motor cortex of migraine with aura.

Experimental evidence suggests impairment of inhibitory intracortical circuits in migraine, while not much is known about activity of facilitatory intracortical circuits. In the present work we evaluated the effects of high frequency-repetitive transcranial magnetic stimulation (hf-rTMS) on the activity of facilitatory circuits of motor cortex in 18 patients affected by migraine with aura and 18 healthy subjects. Trains of 10 stimuli were applied to the motor cortex at 5-Hz frequency with recording of the EMG traces from the contralateral abductor pollicis brevis muscle (APB). Two intensities of stimulation (110% and 130% of resting motor threshold) were used in order to explore whether motor cortex excitability was differently modulated. Twelve patients underwent hf-rTMS both before and during prophylactic treatment with levetiracetam. Results showed that rTMS delivered at 110% intensity of stimulation at rest had a facilitatory effect on MEP size in untreated patients, while left MEP unchanged in controls. Conversely, when rTMS was applied at 130%, we observed MEP potentiation in healthy subjects and paradoxical MEP inhibition in migraineurs. In treated patients, levetiracetam inhibited MEP size at both 110% and 130% intensity of stimulation. Our findings reveal an opposite response of migraine motor cortex to 5-Hz rTMS when it is delivered at different stimulation intensities, providing evidence of both hyper-responsivity and self-limiting hyperexcitability capacity, in line with studies supporting the concept that under conditions of cortical hyperexcitability inhibitory mechanisms of homeostatic plasticity could be activated.