Incorporating self-assembly into robocasting for applications in hard tissue engineering

High cost coupled with limited supply of hard tissue substitutes make necessary the development of synthetic biomaterials, as well as economical and reproducible manufacturing techniques that can be easily scaled up. Multiple and often conflicting requirements have so far impeded the application of polymer/ceramic composites in large load-bearing defects. Although porosity is a crucial biological requirement, it has a detrimental effect on their mechanical performance. This thesis emphasizes upon methods for structuring bioceramic materials at different orders of magnitude - termed structural hierarchy. In bones, this constitutes the main mechanism contributing to their remarkable strength and fracture resistance. This can be achieved through combining AM with physical processes that cause the material to self-assemble into various configurations during or following its deposition. The first part of this research explores the potential of Low-Temperature Deposition Modelling (LDM) in fabricating scaffolds with tailorable bimodal porosity. More specifically, LDM is treated as a hybrid technique, in which robocasting is combined with freezing-induced self-assembly. For the purposes of this study, a highly versatile and economical print-head was fabricated that can be operated at ambient temperatures down to -20oC. In addition, a highly thixotropic β-TCP paste formulation of high water content (80% v/v) was developed that takes advantage of a synergy existing between Sodium Alginate and Xanthan Gum. The findings suggest that chamber temperature and water content have the most marked effect on pore morphology. Ordered micro-architectures comprising lamellar pores with a high degree of alignment were obtained at low freezing rates (-5oC). Most importantly, this research evidences for the first time that their direction is not only dictated by toolpath geometry, but also by the ice structure in preceding layers (epitaxy). The second part of this thesis demonstrates the combination of robocasting with a heating process to produce planar hollow-tube lattices that can be manipulated into various configurations. This technique makes use of a novel Sodium Alginate-based β-TCP slurry reinforced with cellulose nano-fibrils. When heated rapidly, it forms hollow-shell structures, which can be cross-linked in Ca2+-rich solutions to produce flexible yet strong particle-reinforced gels. Optimal results were achieved at 3 and 4% w/w alginate content, where the paste’s loss tangent reaches its maximum value. This research demonstrates that such combinational approaches to AM can successfully produce hard tissue substitutes that exhibit multiple levels of structural hierarchy. This constitutes a first step towards achieving biomimetic bone scaffolds with superior mechanical performance

The rotational stiffness of cross-laminated timber half-lap joints

Half-lap joints in cross-laminated timber are often conservatively assumed to have no rotational stiffness, preventing applications where the cross-joint stiffness could be utilised. The stiffness of a typical half-lap joint was derived from static four point bend tests, with experiments carried out through a combination of laboratory testing and finite element modelling. A simplified calculation method was developed to predict the rotational stiffness from the joint configuration and material properties. This was incorporated into a spreadsheet design tool for use by the industry partner

Implementation of a training program to increase knowledge, improve attitudes and reduce nursing care omissions towards patients with dementia in hospital settings: a mixed-method study protocol

Introduction There is an evidence showing that when nurses have to allocate their time because of a lack of resources, older patients and especially those with dementia have a secondary care priority. The purpose of this study is to advance the level of knowledge, promote positive attitudes of nurses and reduce care deficits towards people with dementia through the implementation of a training programme. The programme will be enriched by an observational study of the care of patients with dementia to identify areas of missed care.Method and analysis This study will follow a mixed methodology consisting of three stages: (1) evaluation of the level of nurses' knowledge and attitudes towards dementia care through the use of structured questionnaires, (2) observational study to evaluate nursing care in hospital settings, in order to detect any missed care and (3) quasi-experimental study, with a before-and-after design, through the implementation of the training programme in order to increase nurses knowledge, improve attitudes and consequently to promote care for patients with dementia. The data will be analysed with descriptive and inferential statistics with the use of the SPSS V.24.0 and with content analysis as regard to the observational data.Ethics and dissemination The protocol was approved by the National Bioethics committee and other local committees (EEBK: 2018.01.02). The participants will give their informed consent and the anonymity and confidentiality. Also, the protection of data will be respected. The results of the study will be disseminated in peer-reviewed international journals and conferences. If the intervention is successful, the training package will be given to the continuous education unit of the National Professional Association in order to be used on a regular basis

Clinical Studies of Nonpharmacological Methods to Minimize Salivary Gland Damage after Radioiodine Therapy of Differentiated Thyroid Carcinoma: Systematic Review

Purpose. To systematically review clinical studies examining the effectiveness of nonpharmacological methods to prevent/minimize salivary gland damage due to radioiodine treatment of differentiated thyroid carcinoma (DTC). Methods. Reports on relevant trials were identified by searching the PubMed, CINHAL, Cochrane, and Scopus electronic databases covering the period 01/2000-10/2015. Inclusion/exclusion criteria were prespecified. Search yielded eight studies that were reviewed by four of the present authors. Results. Nonpharmacological methods used in trials may reduce salivary gland damage induced by radioiodine. Sialogogues such as lemon candy, vitamin E, lemon juice, and lemon slice reduced such damage significantly (p < 0.0001, p < 0.05, p < 0.10, and p < 0.05, resp.). Parotid gland massage also reduced the salivary damage significantly (p < 0.001). Additionally, vitamin C had some limited effect (p = 0.37), whereas no effect was present in the case of chewing gum(p = 0.99). Conclusion. The review showed that, among nonpharmacological interventions, sialogogues and parotid gland massage had the greatest impact on reducing salivary damage induced by radioiodine therapy of DTC. However, the studies retrieved were limited in number, sample size, strength of evidence, and generalizability. More randomized controlled trials of these methods with multicenter scope and larger sample sizes will provide more systematic and reliable results allowing more definitive conclusions

Skills and practices of European orthopedic nurses in empowering patient education

Purpose: This study provides an overview of the self-defined skills and practices of European orthopedic nurses in empowering patient education. Nurses themselves have highlighted the necessity to enhance their own skills, but possibilities for further education have been limited. Methods: The data (n = 317 nurses) from a structured survey were collected during the years 2009–2012 in seven European countries with an EPNURSE—questionnaire (Empowering Patient Education from the point of view of Nurses). Results: Nurses considered patient education as an important part of their work and evaluated their own skills as good. However, their patient education practices were based more on practices on their ward and their own experience than on further education or evidence-based knowledge. On the other hand, lack of time for patient education and experienced overload were the major barriers experienced by nurses. Implications for Practice: Further education of orthopedic nurses in empowering evidence-based patient education is highly needed. Nurse leaders need to acknowledge the strong need for supporting nurses within clinical practice, improve their evidence-based knowledge and support practices that prioritize patient education within the hospital environment. Further international collaboration in nursing research and health-care organizations is desirable to reach these patient educational goals in clinical nursing practice.</p

In-hospital informal caregivers' needs as perceived by themselves and by the nursing staff in Northern Greece: A descriptive study

<p>Abstract</p> <p>Background</p> <p>Informal care is common in many countries, especially in Greece, where families provide care in hospitals. Health education and informational needs are important factors for family members which are often underestimated by nursing staff. The aim of this study was to compare the perceptions of the nurses and the in-hospital informal caregivers about the in-hospital informal caregivers' knowledge and informational needs, as well as the factors that influence these perceptions.</p> <p>Methods</p> <p>This was a non-experimental descriptive study conducted in three general hospitals in Greece. The sample consisted of 320 nurses and 370 in-hospital informal caregivers who completed questionnaires. Descriptive statistics were analyzed using t-tests; group comparisons were conducted using ANOVA.</p> <p>Results</p> <p>The score of the questionnaire for health education and informational needs was significantly greater for informal caregivers (57.1 ± 6.9 and 26.6 ± 2.8) than for nurses (53.4 ± 5.7 and 22.4 ± 3.1) (p < 0.001). For the nursing staff, the factors that influence the informational needs of patients' caregivers were <it>level of education </it>and <it>working experience</it>, while for the caregivers the <it>level of education </it>was independently associated with the score for the health education needs. Finally, <it>age, marital status</it>, and <it>level of education </it>of informal caregivers' were independently associated with informational needs.</p> <p>Conclusions</p> <p>The in-hospital informal caregivers perceived that they have more educational and informational needs than the nurses did. The findings of this study also show that the nursing staff has to identify the needs of in-hospital informal caregivers in order to be able to meet these needs.</p

The Impact of Dementia on Women Internationally: an Integrative Review

Women are disproportionately affected by dementia, both in terms of developing dementia and becoming caregivers. We conducted an integrative review of English language literature of the issues affecting women in relation to dementia from an international perspective. The majority of relevant studies were conducted in high income countries, and none were from low-income countries. The effects of caregiving on health, wellbeing and finances are greater for women; issues facing women, particularly in low and middle-income countries need to be better understood. Research should focus on building resilience to help people adjust and cope long term

Social learning against data falsification in sensor networks

Sensor networks generate large amounts of geographically-distributed data. The conventional approach to exploit this data is to first gather it in a special node that then performs processing and inference. However, what happens if this node is destroyed, or even worst, if it is hijacked? To explore this problem, in this work we consider a smart attacker who can take control of critical nodes within the network and use them to inject false information. In order to face this critical security thread, we propose a novel scheme that enables data aggregation and decision-making over networks based on social learning, where the sensor nodes act resembling how agents make decisions in social networks. Our results suggest that social learning enables high network resilience, even when a significant portion of the nodes have been compromised by the attacker