Prevention of ventilator-associated pneumonia through care bundles: A systematic review and meta-analysis

Hospital-acquired pneumonia; Prevention; Quality improvement interventionNeumonía adquirida en el hospital; Prevención; Intervención de mejora de la calidadPneumònia adquirida a l'hospital; Prevenció; Intervenció de millorar de la qualitatBackground Ventilator-associated pneumonia (VAP) represents a common hospital-acquired infection among mechanically ventilated patients. We summarized evidence concerning ventilator care bundles to prevent VAP. Methods A systematic review and meta-analysis were performed. Randomized controlled trials and controlled observational studies of adults undergoing mechanical ventilation (MV) for at least 48 h were considered for inclusion. Outcomes of interest were the number of VAP episodes, duration of MV, hospital and intensive care unit (ICU) length of stay, and mortality. A systematic search was conducted in the MEDLINE, the Cochrane Library, and the Web of Science between 1985 and 2022. Results are reported as odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The PROSPERO registration number is CRD42022341780. Results Thirty-six studies including 116,873 MV participants met the inclusion criteria. A total of 84,031 participants underwent care bundles for VAP prevention. The most reported component of the ventilator bundle was head-of-bed elevation (n=83,146), followed by oral care (n=80,787). A reduction in the number of VAP episodes was observed among those receiving ventilator care bundles, compared with the non-care bundle group (OR=0.42, 95% CI: 0.33, 0.54). Additionally, the implementation of care bundles decreased the duration of MV (MD=−0.59, 95% CI: −1.03, −0.15) and hospital length of stay (MD=−1.24, 95% CI: −2.30, −0.18) in studies where educational activities were part of the bundle. Data regarding mortality were inconclusive. Conclusions The implementation of ventilator care bundles reduced the number of VAP episodes and the duration of MV in adult ICUs. Their application in combination with educational activities seemed to improve clinical outcomes.This work was supported by CIBERES, Instituto de Salud Carlos III, Madrid, Spain (grant number: Fondos FEDER: CB06-06-036)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Action Mechanisms of Curcumin in Alzheimer’s Disease and Its Brain Targeted Delivery

AD is a chronic neurodegenerative disease. Many different signaling pathways, such as Wnt/β-catenin, Notch, ROS/JNK, and PI3K/Akt/mTOR are involved in Alzheimer’s disease and crosstalk between themselves. A promising treatment involves the uses of flavonoids, and one of the most promising is curcumin; however, because it has difficulty permeating the blood–brain barrier (BBB), it must be encapsulated by a drug carrier. Some of the most frequently studied are lipid nanocarriers, liposomes, micelles and PLGA. These carriers are further conjugated with brain-targeting agents such as lactoferrin and transferrin. In this review paper, curcumin and its therapeutic effects, which have been examined in vivo, are analyzed and then the delivery systems to the brain are addressed. Overall, the analysis of the literature revealed great potential for curcumin in treating AD and indicated the challenges that require further research

Rheological and Mechanical Properties of Thermoresponsive Methylcellulose/Calcium Phosphate-Based Injectable Bone Substitutes

In this study, a novel injectable bone substitute (IBS) was prepared by incorporating a bioceramic powder in a polymeric solution comprising of methylcellulose (MC), gelatin and citric acid. Methylcellulose was utilized as the polymeric matrix due to its thermoresponsive properties and biocompatibility. 2.5 wt % gelatin and 3 wt % citric acid were added to the MC to adjust the rheological properties of the prepared IBS. Then, 0, 20, 30 and 50 wt % of the bioceramic component comprising tetracalcium phosphate/hydroxyapatite (TTCP/HA), dicalcium phosphate dehydrate (DCPD) and calcium sulfate dehydrate (CSD) were added into the prepared polymeric component. The prepared IBS samples had a chewing gum-like consistency. IBS samples were investigated in terms of their chemical structure, rheological characteristics, and mechanical properties. After that, in vitro degradation studies were carried out by measurement of pH and % remaining weight. Viscoelastic characteristics of the samples indicated that all of the prepared IBS were injectable and they hardened at approximately 37 °C. Moreover, with increasing wt % of the bioceramic component, the degradation rate of the samples significantly reduced and the mechanical properties were improved. Therefore, the experimental results indicated that the P50 mix may be a promising candidates to fill bone defects and assist bone recovery for non-load bearing applications

Cobalt Oxide-Decorated on Carbon Derived from Onion Skin Biomass for Li-Ion Storage Application

Onion waste, particularly onion skin, is a widely generated waste material, and harnessing its potential for energy storage aligns with sustainable development goals. Despite the high specific surface area exhibited by biocarbon derived from onion skin, its Li-ion storage performance is not desirable. In this study, biocarbon derived from purple onion skin serves as the substrate for accommodating cobalt oxide (Co3O4) through a hydrothermal method, employing Co(NO3)2·6H2O at various concentrations, and with and without prior activation using KOH treatment. The resulting samples undergo comprehensive analyses, including phase, morphological, surface, and electrochemical characterizations. The Co3O4 decoration on activated carbon derived from onion skin, synthesized using Co(NO3)2·6H2O at a concentration of 1 M, reveals a porous structure with a surface area of 702 m2/g, featuring predominant pore sizes of less than 5 nm. Significantly, the Li-ion storage performance of this sample surpasses that of alternative samples, demonstrating a remarkable reversible capacity of 451 mAh/g even after 500 cycles at an elevated current density of 2000 mAh/g. The charge transfer resistance of the sample (110.3 Ω) is found to be substantially lower than that of the sample prepared using carbonized onion skin biomass without activation. This research introduces an innovative approach leveraging onion skin waste as a template for Co3O4 decoration, thereby fabricating high-performance anodes for lithium-ion batteries

Effect of Boron-Doped Mesoporous Bioactive Glass Nanoparticles on C2C12 Cell Viability and Differentiation: Potential for Muscle Tissue Application

Mesoporous bioactive glasses (MBGs) exhibit a high surface area and a highly ordered mesoporous structure. MBGs have potential for both hard and soft tissue engineering applications. MBGs may be doped with biologically active ions to tailor their biological activity. Boron is being widely studied as a dopant of bioactive glasses. Recently, research has demonstrated the potential of boron-containing bioactive glasses for muscle regeneration. In this study, boron-containing MBGs, 10B-MBG and 18B-MBG nanoparticles, were produced by a microemulsion-assisted sol–gel approach for potential muscle regeneration applications. First, X-ray diffraction (XRD), Fourier transform infrared (FTIR), and energy-dispersive X-ray spectroscopy (EDX) analyses were conducted to study the chemical structure and composition of the nanoparticles. To examine the nanoparticle morphology, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) images were analyzed. Both SEM images and particle size distribution determined by dynamic light scattering (DLS) indicated a decrease of the average particle size after boron doping. TEM images indicated a slit-shaped mesoporous structure of nanoparticles for all compositions. The ζ potential was measured, and a negative surface charge was found for all study groups due to the presence of silanol groups. Cytocompatibility and fluorescence microscopy studies were also carried out. The results indicated that low concentrations (0.1 and 1 mg mL–1) of all MBG nanoparticles led to high viability of C2C12 cells. Fluorescence microscopy images indicated that at lower nanoparticle concentrations (0.1 and 1 mg mL–1), C2C12 cells appeared to differentiate into myotubes, which was indicated by a spindle-shaped morphology. For 10 mg mL–1 concentration of nanoparticles, C2C12 cells had a lower aspect ratio (estimated qualitatively by inspection of the images), which implied a lower degree of differentiation. Boron-doped MBG nanoparticles in reduced concentrations are suitable to induce differentiation of C2C12 cells into myotubes, indicating their potential for applications in muscle tissue repair

Orhan Çöplü'nün Çorum haberciliği ve edebiyatına katkısı

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2016.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Özer, Abdürrahim

A Compact Closed-Loop Optogenetics System Based on Artifact-Free Transparent Graphene Electrodes

Electrophysiology is a decades-old technique widely used for monitoring activity of individual neurons and local field potentials. Optogenetics has revolutionized neuroscience studies by offering selective and fast control of targeted neurons and neuron populations. The combination of these two techniques is crucial for causal investigation of neural circuits and understanding their functional connectivity. However, electrical artifacts generated by light stimulation interfere with neural recordings and hinder the development of compact closed-loop systems for precise control of neural activity. Here, we demonstrate that transparent graphene micro-electrodes fabricated on a clear polyethylene terephthalate film eliminate the light-induced artifact problem and allow development of a compact battery-powered closed-loop optogenetics system. We extensively investigate light-induced artifacts for graphene electrodes in comparison to metal control electrodes. We then design optical stimulation module using micro-LED chips coupled to optical fibers to deliver light to intended depth for optogenetic stimulation. For artifact-free integration of graphene micro-electrode recordings with optogenetic stimulation, we design and develop a compact closed-loop system and validate it for different frequencies of interest for neural recordings. This compact closed-loop optogenetics system can be used for various applications involving optogenetic stimulation and electrophysiological recordings

Mechanisms driving online vaccine debate during the COVID-19 pandemic

The prevalence of the anti-vaccine movement in today’s society has become a pressing concern, largely amplified by the dissemination of vaccine skepticism. During the early stages of the COVID-19 pandemic, the vaccination debate sparked controversial debates on social media platforms such as Twitter, which can lead to serious consequences for public health. What determines anti-vax attitudes is an important question for understanding the source of the campaigns and mitigating the misinformation spread. Compared with other countries, Türkiye differentiates itself with high vaccination rates and lack of political support for anti-vaxxers despite its highly polarized political system. Analyzing Turkish Twittersphere, we explore several mechanisms capturing content production and behaviors of accounts within the pro- and anti-vax segments in online vaccine-related discussions. Our findings indicate there is no relation between political stance and anti-vaccine attitude. Both supporters of vaccination (pro-vaxxers) and opponents (anti-vaxxers) can be found across the political spectrum. Moreover, linguistic differences reveal that anti-vaxxers employ more emotional language, while pro-vaxxers express more skepticism. Notably, automated accounts are less prevalent leading to difficulty in assessing genuine support for vaccines, while anti-vaccine bots produce slightly more content. These findings have crucial implications for vaccine policy, emphasizing the importance of understanding diverse language patterns and beliefs among anti-vaxxers and pro-vaxxers to develop effective communication strategies at the national level