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1.
Chem Soc Rev ; 53(5): 2435-2529, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38294167

RESUMO

Penetrant-induced plasticization has prevented the industrial deployment of many polymers for membrane-based gas separations. With the advent of microporous polymers, new structural design features and unprecedented property sets are now accessible under controlled laboratory conditions, but property sets can often deteriorate due to plasticization. Therefore, a critical understanding of the origins of plasticization in microporous polymers and the development of strategies to mitigate this effect are needed to advance this area of research. Herein, an integrative discussion is provided on seminal plasticization theory and gas transport models, and these theories and models are compared to an exhaustive database of plasticization characteristics of microporous polymers. Correlations between specific polymer properties and plasticization behavior are presented, including analyses of plasticization pressures from pure-gas permeation tests and mixed-gas permeation tests for pure polymers and composite films. Finally, an evaluation of common and current state-of-the-art strategies to mitigate plasticization is provided along with suggestions for future directions of fundamental and applied research on the topic.

2.
J Clin Invest ; 133(24)2023 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-38099496

RESUMO

Cell therapies such as tumor-infiltrating lymphocyte (TIL) therapy have shown promise in the treatment of patients with refractory solid tumors, with improvement in response rates and durability of responses nevertheless sought. To identify targets capable of enhancing the antitumor activity of T cell therapies, large-scale in vitro and in vivo clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 screens were performed, with the SOCS1 gene identified as a top T cell-enhancing target. In murine CD8+ T cell-therapy models, SOCS1 served as a critical checkpoint in restraining the accumulation of central memory T cells in lymphoid organs as well as intermediate (Texint) and effector (Texeff) exhausted T cell subsets derived from progenitor exhausted T cells (Texprog) in tumors. A comprehensive CRISPR tiling screen of the SOCS1-coding region identified sgRNAs targeting the SH2 domain of SOCS1 as the most potent, with an sgRNA with minimal off-target cut sites used to manufacture KSQ-001, an engineered TIL therapy with SOCS1 inactivated by CRISPR/Cas9. KSQ-001 possessed increased responsiveness to cytokine signals and enhanced in vivo antitumor function in mouse models. These data demonstrate the use of CRISPR/Cas9 screens in the rational design of T cell therapies.


Assuntos
Sistemas CRISPR-Cas , Neoplasias , Humanos , Animais , Camundongos , RNA Guia de Sistemas CRISPR-Cas , Linfócitos do Interstício Tumoral , Imunoterapia Adotiva , Neoplasias/genética , Edição de Genes , Proteína 1 Supressora da Sinalização de Citocina/genética
3.
Nano Lett ; 23(15): 7062-7069, 2023 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-37522917

RESUMO

Nonaqueous fluidic transport and ion solvation properties under nanoscale confinement are poorly understood, especially in ion conduction for energy storage and conversion systems. Herein, metal-organic frameworks (MOFs) and aprotic electrolytes are studied as a robust platform for molecular-level insights into electrolyte behaviors in confined spaces. By employing computer simulations, along with spectroscopic and electrochemical measurements, we demonstrate several phenomena that deviate from the bulk, including modulated solvent molecular configurations, aggregated solvation structures, and tunable transport mechanisms from quasi-solid to quasi-liquid in functionalized MOFs. Technologically, taking advantage of confinement effects may prove useful for addressing stability concerns associated with volatile organic electrolytes while simultaneously endowing ultrafast transport of solvates, resulting in improved battery performance, even at extreme temperatures. The molecular-level insights presented here further our understanding of structure-property relationships of complex fluids at the nanoscale, information that can be exploited for the predictive design of more efficient electrochemical systems.

4.
PLoS One ; 18(4): e0282183, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37053231

RESUMO

It is widely acknowledged that social network support plays an important role in the quality of life and illness management of breast cancer survivors. However, the factors and processes that enable and sustain such support are less well understood. This paper reports baseline findings from a prospective UK national cohort of 1,202 women with breast cancer (aged <50 years at diagnosis), recruited before starting treatment, conducted in 2016-2019. Descriptive, univariate and multivariate regression analyses explored associations between the individual, and network member characteristics, and the type of support provided. Social network members provided a substantial level of illness-related, practical and emotional support. Highest contribution was provided by friends, followed by close family members. The social network members of women who did not have a partner provided a higher level of support than those in networks with a partner. Women without higher education were more reliant on close family members than those with higher education, and this was more so for women without a partner. Women with higher education without a partner were more reliant on friends and were overall best supported. Women without higher education who did not have a partner were overall least well supported. They had much smaller networks, were highly reliant on close family members, and on high level contributions from all network members. There is a need to develop network-based interventions to support people with a cancer diagnosis, prioritising support for the groups identified as most at risk. Interventions that support engagement with existing network members during treatment, and those that help extend such networks after treatment, are likely to be of benefit. A network perspective can help to develop tailored support and interventions by recognising the interactions between network and individual level processes.


Assuntos
Neoplasias da Mama , Autogestão , Humanos , Feminino , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Neoplasias da Mama/psicologia , Qualidade de Vida/psicologia , Estudos Prospectivos , Apoio Social , Rede Social
5.
BMJ Open ; 12(12): e051936, 2022 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-36564115

RESUMO

OBJECTIVE: To investigate monthly prescription refills for common immunosuppressive/immunomodulatory therapy (sulfasalazine, hydroxychloroquine, azathioprine, methotrexate, leflunomide) prescriptions in England during the complete first wave of the COVID-19 pandemic. Secondary analysis examined unit cost analysis and regional use. DESIGN AND SETTING: A national cohort of community-based, primary care patients who anonymously contribute data to the English Prescribing Dataset, dispensed in the community in England, were included. Descriptive statistics and interrupted time series analysis over 25 months (14 months before, 11 months after first lockdown) were evaluated (January 2019 to January 2021, with March 2020 as the cut-off point). OUTCOME MEASURES: Prescription reimbursement variance in period before the pandemic as compared with after the first lockdown. RESULTS: Fluctuation in monthly medicines use is noted in March 2020: a jump is observed for hydroxychloroquine (Mann-Whitney, SE 14.652, standardised test statistic 1.911, p value=0.059) over the study period. After the first lockdown, medicines use fluctuated, with wide confidence intervals. Unit-cost prices changed substantially: sulfasalazine 33% increase, hydroxychloroquine 98% increase, azathioprine 41% increase, methotrexate 41% increase, leflunomide 20% decrease. London showed the least quantity variance, suggesting more homogeneous prescribing and patient access compared with Midlands and East of England, suggesting that some patients may have received medication over/under requirement, representing potential resource misallocation and a proxy for adherence rates. Changepoint detection revealed four out of the five medicines' use patterns changed with a strong signal only for sulfasalazine in March/April 2020. CONCLUSIONS: Findings potentially present lower rates of adherence because of the pandemic, suggesting barriers to care access. Unit price increases are likely to have severe budget impacts in the UK and potentially globally. Timely prescription refills for patients taking immunosuppressive/immunomodulatory therapies are recommended. Healthcare professionals should identify patients on these medicines and assess their prescription-day coverage, with planned actions to flag and follow-up adherence concerns in patients.


Assuntos
COVID-19 , Pandemias , Humanos , Hidroxicloroquina/uso terapêutico , Fatores de Tempo , Azatioprina , Leflunomida , Metotrexato , Sulfassalazina , Controle de Doenças Transmissíveis , Prescrições de Medicamentos
6.
ACS Appl Mater Interfaces ; 14(42): 47706-47715, 2022 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-36239697

RESUMO

All-solid-state batteries have recently gained considerable attention due to their potential improvements in safety, energy density, and cycle-life compared to conventional liquid electrolyte batteries. Sodium all-solid-state batteries also offer the potential to eliminate costly materials containing lithium, nickel, and cobalt, making them ideal for emerging grid energy storage applications. However, significant work is required to understand the persisting limitations and long-term cyclability of Na all-solid-state-based batteries. In this work, we demonstrate the importance of careful solid electrolyte selection for use against an alloy anode in Na all-solid-state batteries. Three emerging solid electrolyte material classes were chosen for this study: the chloride Na2.25Y0.25Zr0.75Cl6, sulfide Na3PS4, and borohydride Na2(B10H10)0.5(B12H12)0.5. Focused ion beam scanning electron microscopy (FIB-SEM) imaging, X-ray photoelectron spectroscopy (XPS), and electrochemical impedance spectroscopy (EIS) were utilized to characterize the evolution of the anode-electrolyte interface upon electrochemical cycling. The obtained results revealed that the interface stability is determined by both the intrinsic electrochemical stability of the solid electrolyte and the passivating properties of the formed interfacial products. With appropriate material selection for stability at the respective anode and cathode interfaces, stable cycling performance can be achieved for Na all-solid-state batteries.

7.
JACS Au ; 2(7): 1610-1615, 2022 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-35911464

RESUMO

Bottlebrush polymers with flexible backbones and rigid side chains have shown ultrahigh CO2 permeability and plasticization resistance for membrane-based gas separations. To date, this class of polymers has only been studied with polydisperse side chains. Herein, we report gas transport properties of a methoxy (OMe) functionalized polymer synthesized via ring-opening metathesis polymerization (ROMP) with uniform side-chain lengths ranging from n = 2 to 5 repeat units to elucidate the role of both side-chain length and dispersity on gas transport properties and plasticization resistance. As side-chain length increased, both Brunauer-Emmett-Teller (BET) surface area and gas permeability increased with minimal losses in gas selectivity. Increased plasticization resistance was also observed with increasing side-chain length, which can be attributed to increased interchain rigidity from longer side chains. Controlling the side-chain length provides an effective strategy to rationally control and optimize the performance of ROMP polymers for CO2-based gas separations.

8.
Br J Gen Pract ; 72(720): e528-e537, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35256384

RESUMO

BACKGROUND: Disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate and azathioprine, are commonly used to treat rheumatoid arthritis (RA) and inflammatory bowel disease (IBD). Blood-test safety monitoring is mainly undertaken in primary care. Normal blood results are common. AIM: To determine the frequency and associations of persistently normal blood tests in patients with RA prescribed methotrexate, and patients with IBD prescribed azathioprine. DESIGN AND SETTING: Two-year retrospective study of a cohort taken from an electronic pseudonymised primary care/laboratory database covering >1.4 million patients across Hampshire, UK. METHOD: Patients with RA and IBD, and associated methotrexate and azathioprine prescriptions, respectively, were identified. Tests and test thresholds recommended by the National Institute for Health and Care Excellence were applied. Persistent normality was defined as no abnormalities of any tests nor alanine aminotransferase (ALT), white blood count (WBC), neutrophils, and estimated glomerular filtration rate (eGFR) individually. Logistic regression was used to identify associations with test normality. RESULTS: Of 702 265 adults, 7102 had RA and 8597 had IBD. In total, 3001 (42.3%) patients with RA were prescribed methotrexate and 1162 (13.5%) patients with IBD were prescribed azathioprine; persistently normal tests occurred in 1585 (52.8%) and 657 (56.5%) of the populations, respectively. In patients with RA on methotrexate, 585 (19.5%) had eGFR, 219 (7.3%) ALT, 217 (7.2%) WBC, and 202 (6.7%) neutrophil abnormalities. In patients with IBD on azathioprine, 138 (11.9%) had WBC, 88 (7.6%) eGFR, 72 (6.2%) ALT, and 65 (5.6%) neutrophil abnormalities. Those least likely to have persistent test normality were older and/or had comorbidities. CONCLUSION: Persistent test normality is common when monitoring these DMARDs, with few hepatic or haematological abnormalities. More stratified monitoring approaches should be explored.


Assuntos
Antirreumáticos , Artrite Reumatoide , Doenças Inflamatórias Intestinais , Adulto , Antirreumáticos/efeitos adversos , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Azatioprina/efeitos adversos , Estudos de Coortes , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Metotrexato/efeitos adversos , Estudos Retrospectivos
9.
BJGP Open ; 6(1)2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34732389

RESUMO

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for pain and inflammation. NSAID complications include acute kidney injury (AKI), causing burden to patients and health services through increased morbidity, mortality, and hospital admissions. AIM: To measure the extent of NSAID prescribing in an adult population, the degree to which patients with potential higher risk of AKI were exposed to NSAIDs, and to quantify their risk of AKI. DESIGN & SETTING: Retrospective 2-year closed-cohort study. METHOD: A retrospective cohort of adults was identified from a pseudonymised electronic primary care database in Hampshire, UK. The cohort had clinical information, prescribing data, and complete GP- and hospital-ordered biochemistry data. NSAID exposure (minimum one prescription in a 2-month period) was categorised as never, intermittent, and continuous, and first AKI using the national AKI e-alert algorithm. Descriptive statistics and logistic regression were used to explore NSAID prescribing patterns and AKI risk. RESULTS: The baseline population was 702 265. NSAID prescription fell from 19 364 (2.8%) to 16 251 (2.4%) over 2 years. NSAID prescribing was positively associated with older age, female sex, greater socioeconomic deprivation, and certain comorbidities (diabetes, hypertension, osteoarthritis, and rheumatoid arthritis) and negatively with cardiovascular disease (CVD) and heart failure. Among those prescribed NSAIDs, AKI was associated with older age, greater deprivation, chronic kidney disease (CKD), CVD, heart failure, diabetes, and hypertension. CONCLUSION: Despite generally good prescribing practice, NSAID prescribing was identified in some people at higher risk of AKI (for example, patients with CKD and older) for whom medication review and NSAID deprescribing should be considered.

10.
Sci Rep ; 11(1): 15077, 2021 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-34302002

RESUMO

Quantitative in vivo monitoring of cell biodistribution offers assessment of treatment efficacy in real-time and can provide guidance for further optimization of chimeric antigen receptor (CAR) modified cell therapy. We evaluated the utility of a non-invasive, serial 89Zr-oxine PET imaging to assess optimal dosing for huLym-1-A-BB3z-CAR T-cell directed to Lym-1-positive Raji lymphoma xenograft in NOD Scid-IL2Rgammanull (NSG) mice. In vitro experiments showed no detrimental effects in cell health and function following 89Zr-oxine labeling. In vivo experiments employed simultaneous PET/MRI of Raji-bearing NSG mice on day 0 (3 h), 1, 2, and 5 after intravenous administration of low (1.87 ± 0.04 × 106 cells), middle (7.14 ± 0.45 × 106 cells), or high (16.83 ± 0.41 × 106 cells) cell dose. Biodistribution (%ID/g) in regions of interests defined over T1-weighted MRI, such as blood, bone, brain, liver, lungs, spleen, and tumor, were analyzed from PET images. Escalating doses of CAR T-cells resulted in dose-dependent %ID/g biodistributions in all regions. Middle and High dose groups showed significantly higher tumor %ID/g compared to Low dose group on day 2. Tumor-to-blood ratios showed the enhanced extravascular tumor uptake by day 2 in the Low dose group, while the Middle dose showed significant tumor accumulation starting on day 1 up to day 5. From these data obtained over time, it is apparent that intravenously administered CAR T-cells become trapped in the lung for 3-5 h and then migrate to the liver and spleen for up to 2-3 days. This surprising biodistribution data may be responsible for the inactivation of these cells before targeting solid tumors. Ex vivo biodistributions confirmed in vivo PET-derived biodistributions. According to these studies, we conclude that in vivo serial PET imaging with 89Zr-oxine labeled CAR T-cells provides real-time monitoring of biodistributions crucial for interpreting efficacy and guiding treatment in patient care.


Assuntos
Neoplasias/diagnóstico por imagem , Neoplasias/metabolismo , Oxiquinolina/metabolismo , Receptores de Antígenos de Linfócitos T/metabolismo , Receptores de Antígenos Quiméricos/metabolismo , Linfócitos T/metabolismo , Zircônio/metabolismo , Animais , Linhagem Celular Tumoral , Masculino , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Tomografia por Emissão de Pósitrons/métodos , Radioisótopos/metabolismo , Distribuição Tecidual/fisiologia
11.
NPJ Prim Care Respir Med ; 31(1): 7, 2021 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-33574260

RESUMO

COPD remains largely undiagnosed or is diagnosed late in the course of disease. We report findings of a specialist outreach programme to identify undiagnosed COPD in primary care. An electronic case-finding algorithm identified 1602 at-risk patients from 12 practices who were invited to attend the clinic. Three hundred and eighty-three (23.9%) responded and 288 were enrolled into the study. Forty-eight (16.6%) had undiagnosed mild and 28 (9.7%) had moderate airway obstruction, meeting spirometric diagnostic criteria for COPD. However, at 12 months only 8 suspected COPD patients (10.6%) had received a diagnostic label in their primary care record. This constituted 0.38% of the total patient population, as compared with 0.31% of control practices, p = 0.306. However, if all patients with airway obstruction received a coding of COPD, then the diagnosis rate in the intervention group would have risen by 0.84%. Despite the low take-up and diagnostic yield, this programme suggests that integrated case-finding strategies could improve COPD recognition.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Humanos , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Espirometria
12.
Angew Chem Int Ed Engl ; 60(12): 6593-6599, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33278319

RESUMO

Gas-separation polymer membranes display a characteristic permeability-selectivity trade-off that has limited their industrial use. The most comprehensive approach to improving performance is to devise strategies that simultaneously increase fractional free volume, narrow free volume distribution, and enhance sorption selectivity, but generalizable methods for such approaches are exceedingly rare. Here, we present an in situ crosslinking and solid-state deprotection method to access previously inaccessible sorption and diffusion characteristics in amine-functionalized polymers of intrinsic microporosity. Free volume element (FVE) size can be increased while preserving a narrow FVE distribution, enabling below-upper bound polymers to surpass the H2 /N2 , H2 /CH4 , and O2 /N2 upper bounds and improving CO2 -based selectivities by 200 %. This approach can transform polymers into chemical analogues with improved performance, thereby overcoming traditional permeability-selectivity trade-offs.

13.
Laryngoscope ; 131(3): 548-552, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32628787

RESUMO

OBJECTIVE: Radiotherapy of head and neck cancer (HNCA) causes dysfunction through radiation-induced fibrosis (RIF). We hypothesize that the degree of cervical fibrosis is associated with swallowing dysfunction. This study evaluated the association between cervical fibrosis and swallowing dysfunction in patients after radiation therapy for HNCA. STUDY DESIGN: Cross sectional study. METHODOLOGY: A convenience sample of patients with dysphagia who were at least 1 year post radiation therapy for HNCA underwent simultaneous cervical ultrasound (US) and video-fluroscopic swallow study (VFSS). US determinants of fibrosis were measurements of sternocleidomastoid fascia (SCMF) thickness bilaterally at the level of the cricoid. Primary and secondary outcome variables on VFSS were pharyngeal constriction ratio, a validated measure of pharyngeal contractility, and penetration aspiration scale (PAS). A qualitative assessment of lateral neck rotation was performed as a functional measure of neck fibrosis. RESULTS: Simultaneous cervical US and VFSS examinations were performed on 18 patients with a history of radiotherapy for HNCA and on eight controls. The mean (±SD) age of the entire cohort (N = 26) was 66 (±10) years. Individuals with a history of radiation had significantly thinner mean SCMF (0.26 [±0.04 mm]) compared to controls (0.48 [±0.06 mm]; P < .05). Individuals with thinner SCMF were more likely to have moderate to severe restriction in lateral neck rotation, a higher PCR, and a higher PAS (P < .05). CONCLUSION: Thinner sternocleidomastoid fascia on ultrasound in patients having undergone radiotherapy for head and neck cancer was associated with reduced lateral neck movement, poorer pharyngeal constriction and greater penetration/aspiration scale. The data suggest that cervical fibrosis is associated with swallowing dysfunction in head and neck cancer survivors and support the notion that, "As the neck goes, so does the swallow." LEVEL OF EVIDENCE: 3. Laryngoscope, 131:548-552, 2021.


Assuntos
Transtornos de Deglutição/etiologia , Deglutição/efeitos da radiação , Estenose Esofágica/etiologia , Pescoço/patologia , Lesões por Radiação/patologia , Idoso , Estudos Transversais , Feminino , Fibrose , Fluoroscopia , Neoplasias de Cabeça e Pescoço/fisiopatologia , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/efeitos da radiação , Lesões por Radiação/complicações , Lesões por Radiação/fisiopatologia , Índice de Gravidade de Doença
14.
Chem Rev ; 120(16): 8161-8266, 2020 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-32608973

RESUMO

Metal-organic frameworks (MOFs) represent the largest known class of porous crystalline materials ever synthesized. Their narrow pore windows and nearly unlimited structural and chemical features have made these materials of significant interest for membrane-based gas separations. In this comprehensive review, we discuss opportunities and challenges related to the formation of pure MOF films and mixed-matrix membranes (MMMs). Common and emerging separation applications are identified, and membrane transport theory for MOFs is described and contextualized relative to the governing principles that describe transport in polymers. Additionally, cross-cutting research opportunities using advanced metrologies and computational techniques are reviewed. To quantify membrane performance, we introduce a simple membrane performance score that has been tabulated for all of the literature data compiled in this review. These data are reported on upper bound plots, revealing classes of MOF materials that consistently demonstrate promising separation performance. Recommendations are provided with the intent of identifying the most promising materials and directions for the field in terms of fundamental science and eventual deployment of MOF materials for commercial membrane-based gas separations.

15.
BMC Pulm Med ; 20(1): 162, 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-32513163

RESUMO

BACKGROUND: Self-Management Support (SMS), refers to the actions taken by individuals to recognise and manage their own health. It is increasingly recognised that individuals with chronic obstructive pulmonary disease (COPD) require additional support with their Self-management. Emerging evidence suggests that the use of a social network intervention can improve health outcomes and increase quality of life. In order to understand the potential benefits of SMS in COPD, the GENIE (Generating Engagement in Network Support) SMS tool was implemented and evaluated in a COPD primary care context. The GENIE intervention is a social networking tool that consists of 3 parts; a concentric circle modelling to map existing social networks; a questions sections to elicit preferences for activities; a map of selected resources is then produced, aligned with the user's interests and suggestions for connections to existing network members and to new resources. METHODS: A pilot, parallel, single blind, block randomised controlled trial. Patients with COPD ranging from mild-very severe were recruited. Participants provided written consent and were then randomised to either the intervention or usual care. The primary aim was to understand the clinical benefit through the analysis of health status, symptom burden and quality of life. The secondary outcome measure was health utilisation. NHS cost differences were reported between groups using the GENIE intervention over usual care. RESULTS: The GENIE pilot results demonstrate maintenance in health status and clinical symptoms with a decrease in anxiety. An overall increase in quality of life was observed, these findings did not reach significance. A cost reduction was demonstrated in inpatient stay with no difference in primary care costs. Overall a cost reduction in NHS service utilisation was indicated in the intervention group. CONCLUSION: This pilot study indicated that using a social network intervention can encourage the development of new social connections and extend existing support networks for COPD patients. Increasing network support in this population is of benefit to both patients and NHS providers in terms of cost reductions and enhancing wellbeing. This broadens the understanding of possible new approaches to SMS in community COPD patients, which could now be investigated in a larger population over a longer period. TRIAL REGISTRATION: Clinical Trials.gov PRS National Library of Medicine. Protocol ID number: 19175, Clinical Trial ID: NCT02935452.


Assuntos
Doença Pulmonar Obstrutiva Crônica/terapia , Autogestão/métodos , Rede Social , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida , Método Simples-Cego , Reino Unido
16.
Ann Otol Rhinol Laryngol ; 129(6): 605-610, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31994404

RESUMO

INTRODUCTION: In order to increase junior resident physician proficiency and improve patient safety, simulation-based procedural training courses, or bootcamps, have been become an emerging educational tool. OBJECTIVES: To compare pre- and post-course confidence levels and to assess station efficacy after completion of our single day bootcamp. METHODS: We developed the University of California (UC) Davis otolaryngology bootcamp, a single day course including six cadaveric task trainer stations and four simulations. The six task trainer stations included (1) Epistaxis, (2) Cricothyrotomy/tracheostomy, (3) Peritonsillar abscess/auricular hematoma, (4) Nasal bone reduction/zygoma reduction/lateral canthotomy/canalicular trauma and probing, (5) Local nerve blocks, and (6) Soft tissue reconstruction. The simulations comprised of airway fire during tracheostomy, pediatric respiratory code during airway evaluation, dislodged pediatric tracheostomy tube in the ICU, and angioedema in the emergency department with inability to intubate or ventilate. Junior residents from multiple locoregional institutions were recruited to participate. Pre- and post-course Likert surveys assessing participant confidence and station efficacy were collected and analyzed. RESULTS: There was a statistically significant increase in resident confidence levels for all task trainer stations. All stations had a station efficacy Likert score average of 4 "very effective" or 5 "most effective." CONCLUSION: A multi-institutional, locoregional, simulation-based bootcamp can be a valuable adjunct to junior resident training. It can promote camaraderie, pool limited resources, and may be cost-effective.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Otolaringologia/educação , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Treinamento por Simulação/métodos , Broncoscopia/educação , Cadáver , Educação de Pós-Graduação em Medicina/organização & administração , Endoscopia/educação , Epistaxe/terapia , Feminino , Humanos , Aparelho Lacrimal/cirurgia , Masculino , Osso Nasal/lesões , Bloqueio Nervoso , Abscesso Peritonsilar/cirurgia , Procedimentos de Cirurgia Plástica/educação , Treinamento por Simulação/organização & administração , Fraturas Cranianas/terapia , Traqueostomia/educação , Fraturas Zigomáticas/terapia
17.
Laryngoscope ; 130(4): 1044-1050, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31194274

RESUMO

OBJECTIVES: To characterize the duration of Eustachian tube dysfunction in children with cleft palate compared to those without cleft palate by performing time-to-event analysis on tympanometric data. To determine predictive characteristics of earlier achievement of normal tympanograms in children with cleft palate. METHODS: Longitudinal tympanometric data from a minimum of 10 years at a single center were reviewed for children with cleft palate born in the years 2003 through 2007. Children with cleft lip without cleft palate born in the same years were used as a reference group to compare children with similar length of follow-up. The association between time to sustained normal (type A) tympanograms with patient demographics, clinical characteristics, and otologic history was evaluated using time-to-event analysis and compared with log rank tests. Adjusted and unadjusted hazard ratios were estimated using Cox proportional hazard models. RESULTS: The median age of achieving a type A tympanogram in children with cleft palate was 9.9 years for one and 12.1 years for both ears, compared to 7.1 and 7.4 years in children with cleft lip only (P < 0.0001). On multivariate analysis, clinical characteristics such as the severity of palatal clefting or the presence of a cleft-associated syndrome/sequence were not predictors of a longer time to a type A tympanogram. CONCLUSION: Our results help characterize the observation that there is delayed time to normal Eustachian tube function in children with cleft palate, which is not associated with the degree of palatal clefting. LEVEL OF EVIDENCE: 3b Laryngoscope, 130:1044-1050, 2020.


Assuntos
Testes de Impedância Acústica/métodos , Fissura Palatina/complicações , Otopatias/etiologia , Tuba Auditiva/fisiopatologia , Previsões , Audição/fisiologia , Membrana Timpânica/diagnóstico por imagem , Criança , Fissura Palatina/diagnóstico , Otopatias/diagnóstico , Otopatias/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Membrana Timpânica/fisiopatologia
18.
Inquiry ; 56: 46958019884190, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31640449

RESUMO

This article provides an economic model on the optimal penalty of health care workplace violence based on health care workplace classification and cost structure, aiming to deter potential offenders. By developing an EIP (externality, identifiability, and preventability) analytical method, we distinguish the characteristics of different workplaces and find that the health care workplace is the combination of externality, low identifiability, and low preventability. Besides the private cost to victims for ordinary workplace violence, the cost structure of health care workplace violence includes social costs like externality-related public safety cost, defensive medicine cost, and specific factors cost. When the optimal penalty corresponding to different levels of health care workplace violence increases, the threshold level of punishable violence decreases after incorporating the social costs into analysis. Our model shows that public safety costs are positively correlated with the importance of health care workplace in the service network, and a higher public safety cost should be matched with a greater optimal penalty.


Assuntos
Pessoal de Saúde , Modelos Econômicos , Saúde Ocupacional , Violência no Trabalho/estatística & dados numéricos , Crime , Hospitais , Humanos , Internacionalidade
19.
ACS Appl Mater Interfaces ; 11(34): 31257-31269, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31362491

RESUMO

Mixed-matrix membranes (MMMs) formed by dispersing metal-organic framework (MOF) particles in polymers have attracted significant attention because these composite systems can potentially surpass the separation performance of pure polymers alone. However, performance improvements are often unrealized because of poor interfacial compatibility between the MOF and the polymer, which results in interfacial defects. From a practical perspective, strategies are needed to address these defects so that MMMs can be deployed in real-world separation processes. From a fundamental perspective, strategies are needed to reliably form defect-free MMMs so that transport models can be applied to estimate pure MOF property sets, thereby enabling the development of robust structure-property relationships. To address these interfacial challenges, we have developed a method to surface-functionalize a UiO-66-NH2 MOF with a nanoscopic shell of covalently tethered 4,4'-(hexafluoroisopropylidene)diphthalic anhydride-Durene oligomers. When combined with a high-molecular-weight polymer of identical chemical structure to that of the imide-functional MOF surface, defect-free MMMs with uniform particle dispersions can be formed. With this technique, both permeabilities and selectivities of select gases in the MMMs were improved at loadings ranging from 5 to 40 wt %. At a 40 wt % loading, CO2 permeability and CO2/CH4 selectivity were enhanced by 48 and 15%, respectively. Additionally, pure MOF permeabilities for H2, N2, O2, CH4, and CO2 were predicted by the Maxwell model.

20.
Adv Mater ; 31(21): e1807871, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30963645

RESUMO

Polymer membranes with ultrahigh CO2 permeabilities and high selectivities are needed to address some of the critical separation challenges related to energy and the environment, especially in natural gas purification and postcombustion carbon capture. However, very few solution-processable, linear polymers are known today that access these types of characteristics, and all of the known structures achieve their separation performance through the design of rigid backbone chemistries that concomitantly increase chain stiffness and interchain spacing, thereby resulting in ultramicroporosity in solid-state chain-entangled films. Herein, the separation performance of a porous polymer obtained via ring-opening metathesis polymerization is reported, which possesses a flexible backbone with rigid, fluorinated side chains. This polymer exhibits ultrahigh CO2 permeability (>21 000 Barrer) and exceptional plasticization resistance (CO2 plasticization pressure > 51 bar). Compared to traditional polymers of intrinsic microporosity, the rate of physical aging is slower, especially for gases with small effective diameters (i.e., He, H2 , and O2 ). This structural design strategy, coupled with studies on fluorination, demonstrates a generalizable approach to create new polymers with flexible backbones and pore-forming side chains that have unexplored promise for small-molecule separations.

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