Values, preferences and goals identified during shared decision making between critically ill patients and their doctors

Objective: Examine values, preferences and goals elicited by doctors following goals-of-care (GOC) discussions with critically ill patients who had life-limiting illnesses. Design: Descriptive qualitative study using four-stage latent content analysis. Setting: Tertiary intensive care unit (ICU) in South Western Victoria. Participants: Adults who had life-limiting illnesses and were admitted to the ICU with documented GOC, between October 2016 and July 2018. Intervention: The iValidate program, a shared decision-making clinical communication education and clinical support program, for all ICU registrars in August 2015. Main outcome measures: Matrix of themes and subthemes categorised into values, preferences and goals. Results: A total of 354 GOC forms were analysed from 218 patients who had life-limiting illnesses and were admitted to the ICU. In the categories of values, preferences and goals, four themes were identified: connectedness and relational autonomy, autonomy of decision maker, balancing quality and quantity of life, and physical comfort. The subthemes — relationships, sense of place, enjoyment of activities, independence, dignity, cognitive function, quality of life, longevity and physical comfort — provided a matrix of issues identified as important to patients. Relationship, place, independence and physical comfort statements were most frequently identified; longevity was least frequently identified. Conclusion: Our analysis of GOC discussions between medical staff and patients who had life-limiting illnesses and were admitted to the ICU, using a shared decision-making training and support program, revealed a framework of values, preferences and goals that could provide a structure to assist clinicians to engage in shared decision making.</jats:p

Kinetics of Light-Induced Concentration Patterns in Transparent Polymer Solutions

When exposed to weak visible laser light, solutions of common polymers like poly­(isoprene) and poly­(butadiene) respond by local concentration variations, which in turn lead to refractive index changes. Various micropatterns have been recently reported, depending mostly on the solvent environment and the irradiation conditions. Here, we focused on the simpler case of single polymer-rich filaments and we employed phase contrast microscopy to systematically investigate the influence of laser illumination and material parameters on the kinetics of the optically induced local concentration increase in the polydiene solutions. The refractive index contrast of the formed filaments increased exponentially with the laser illumination time. The growth rate exhibited linear dependence on the laser power and increased with polymer chain length in semidilute solutions in good solvents. On the contrary, the kinetics of the formed filaments appeared to be rather insensitive to the polymer concentration. Albeit the origin of the peculiar light field-polymer concentration coupling remains yet elusive, the new phenomenology is considered necessary for the elucidation of its mechanism

Wormlike core-shell nanoparticles formed by co-assembly of double hydrophilic block polyelectrolyte with oppositely charged fluorosurfactant

Formation of polyelectrolyte–surfactant complexes (PE–S) between an anionic polyelectrolyte, poly(sodium 2-sulfamate-3-carboxylate isoprene)-block-poly(ethylene oxide) (PSCI-PEO) and a cationic fluorosurfactant, N-(3,3,4,4,5,5,6,6,7,7,8,8,9,9,10,10,10-heptadecafluorodecyl) pyridinium chloride (HFDPCl) was studied in alkaline aqueous solutions by static, dynamic and electrophoretic light scattering. The structure of the formed PE–S nanoparticles was investigated by SAXS, cryogenic transmission electron microscopy and atomic force microscopy. The results show that the tendency of the fluorosurfactant to form elongated threadlike micelles drives the PE–S co-assembly to a flexible core–shell cylindrical morphology with the core of the PE–S and the shell of the PEO blocks. Unlike other PE–S systems involving double hydrophilic polyelectrolytes, well-defined core–shell particles exist only in the narrow range of HFDPCl-to-PSCI unit stoichiometric ratios corresponding to zero ζ-potential of the aggregates

Epoxidized rosin acids as co-precursors for epoxy resins

A series of novel epoxy resins were prepared from chemically modified rosin, mainly constituted of abietic acid, diglycidyl ether of bisphenol-A (DGEBA) in different percentages as co-reactants, and isophorone diamine as cross-linking agent. Reactive epoxide groups were introduced in the structure of this common pine tree derivative. The chemical structures of various epoxidized rosin acids precursors were confirmed by NMR spectroscopy. Differential scanning calorimetry and dynamic mechanical analysis were used to determine the glass transition temperature and the elastic modulus of the cured epoxy resins. Relatively rigid materials with thermo-mechanical properties depending on the structure of rosin acid derivatives and their ratios with DGEBA were obtained. Epoxy precursors based on renewable rosin can be efficiently used as co-additives of DGEBA for epoxy products