Quantitative determination of deformation by sliding wear,

SUMMARY On the basis of a model, equations have been derived to define for true shearing, the effective deformation from the deflection of the grain boundaries and from the change of grain thicknesses. A linear intercept method was developed for the direct measurement of grain thickness. The theory has been checked by sliding OFHC copper against steel SAE 1045 under conditions of true shearing. The theory may be applied to other processes besides wear where substantial deformation occurs

Het geriatrisch model als inspiratiebron

Inleiding Met het dichterbij komen van het moment waarop de vergrijzing in ons land haar hoogtepunt gaat bereiken, neemt ook de belangstelling voor de toekomstige vormgeving van de medische ouderenzorg snel toe. Illustratief in dit opzicht is bijvoorbeeld de scenariostudie die recentelijk in opdracht van het Capaciteitsorgaan is uitgevoerd.1 Eveneens illustratief is het voornemen van de KNMG om de medische zorg voor ouderen in 2008 prominent op de agenda te zetten.2 Algemeen wordt aangenomen dat ouderen steeds langer en zo actief en zelfstandig mogelijk thuis zullen willen blijven wonen. Voorspelbaar is echter ook dat het aantal kwetsbare ouderen met complexe zorgvragen de komende jaren aanzienlijk zal toenemen. Daarbij worden in veel toekomstbeschouwingen vooral de regie en de coördinatie van de medische zorg voor de risicogroepen onder ouderen als een belangrijk knelpunt aangemerkt. Alle reden dus voor de betrokken beroepsgroepen om samenwerkingsvormen te ontwikkelen waarmee adequaat op de voorziene kwalitatieve en kwantitatieve problemen kan worden ingespeeld. Alle reden ook om daarbij optimaal gebruik te maken van de op ervaringen gefundeerde inzichten die de oorspronkelijke pioniers op dit terrein, te weten de klinisch geriaters, de afgelopen halve eeuw hebben ontwikkeld

Outcome of Colonic Surgery in Elderly Patients with Colon Cancer

Introduction. Colonic cancer is one of the most commonly diagnosed malignancies and most often occurs in patients aged 65 years or older. Aim. To evaluate the outcome of colonic surgery in the elderly in our hospital and to compare five-year survival rates between the younger and elderly patients. Methods. 207 consecutive patients underwent surgery for colon cancer. Patients were separated in patients younger than 75 and older than 75 years. Results. Elderly patients presented significantly more (P < .05) as a surgical emergency, had a longer duration of admission and were more often admitted to the ICU (P < .01). Also, elderly patients had significant more co-morbidities, especially cardiovascular pathology (P < .01). Post-operative complications were seen more often in the elderly, although no significant difference was seen in anastomotic leakage. The five-year survival rate in the younger group was 62% compared with 36% in the elderly (P < .05). DFS was 61% in the younger patients compared with 32% in the elderly (P < .05). Conclusion. Curative resection of colonic carcinoma in the elderly is well tolerated and age alone should not be an indication for less aggressive therapy. However, the type and number of co-morbidities influence post-operative mortality and morbidity

Characterization of the Soluble Nanoparticles Formed through Coulombic Interaction of Bovine Serum Albumin with Anionic Graft Copolymers at Low pH

A static light scattering (SLS) study of bovine serum albumin (BSA) mixtures with two anionic graft copolymers of poly (sodium acrylate-co-sodium 2-acrylamido-2-methyl-1-propanesulphonate)-graft-poly (N, N-dimethylacrylamide), with a high composition in poly (N, N-dimethylacrylamide) (PDMAM) side chains, revealed the formation of oppositely charged complexes, at pH lower than 4.9, the isoelectric point of BSA. The core-corona nanoparticles formed at pH = 3.00, were characterized. Their molecular weight and radius of gyration were determined by SLS, while their hydrodynamic radius was determined by dynamic light scattering. Small angle neutron scattering measurements were used to determine the radius of the insoluble complexes, comprising the core of the particles. The values obtained indicated that their size and aggregation number of the nanoparticles, were smaller when the content of the graft copolymers in neutral PDMAM side chains was higher. Such particles should be interesting drug delivery candidates, if the gastrointestinal tract was to be used

Third-hand smoking: indoor measurements of concentration and sizes of cigarette smoke particles after resuspension

International audienc

Successful control of a hospital-wide outbreak of OXA-48 producing Enterobacteriaceae in the Netherlands, 2009 to 2011

On 31 May 2011, after notification of Klebsiella pneumoniae(KP)(OXA-48);(CTX-M-15) in two patients, nosocomial transmission was suspected in a Dutch hospital. Hospital-wide infection control measures and an outbreak investigation were initiated. A total of 72,147 patients were categorised into groups based on risk of OXA-48 colonisation or infection, and 7,527 were screened for Enterobacteriaceae(OXA-48) by polymerase chain reaction (PCR). Stored KP isolates (n=408) were retrospectively tested for OXA-48 and CTX-M-1 group extended-spectrum beta-lactamases (ESBL). 285 KP isolates from retrospective and prospective patient screening were genotyped by amplified fragment length polymorphism (AFLP). 41 isolates harbouring different Enterobacteriaceae species were analysed by plasmid multilocus sequence typing (pMLST). No nosocomial transmission of Enterobacteriaceae(OXA-48) was detected after 18 July 2011. Enterobacteriaceae(OXA-48) were found in 118 patients (KP (n=99), Escherichia coli (n=56), >= 1 Enterobacteriaceae(OXA-48) species (n=52)),of whom 21 had clinical infections. 39/41 (95%) of OXA-48 containing plasmids were identical in pMLST. Minimum inhibitory concentrations (MICs) of KPOXA-48 and E. coli(OXA-48) for imipenem and meropenem ranged from = 16 mg/L, and 153/157 (97%) had MIC >0.25mg/L for ertapenem. AFLP identified a cluster of 203 genetically linked isolates (62 KPOXA-48;(CTX-M15); 107 KPCTX-M-15; 34 KPOXA-48). The 'oldest' KPCTX-M-15 and KPOXA-48 clonal types originated from February 2009 and September 2010, respectively. The last presumed outbreak-related KPOXA-48 was detected in April 2012. Uncontrolled transmission of KP (CTX-M-15) evolved into a nosocomial outbreak of KPOXA-48; CTX-M15 with large phenotypical heterogeneity. Although the outbreak was successfully controlled, the contribution of individual containment measures and of the hospital relocating into a new building just before outbreak notification was impossible to quantify

Counterion adsorption on flexible polyelectrolytes: comparison of theories

Counterion adsorption on a flexible polyelectrolyte chain in a spherical cavity is considered by taking a "permuted" charge distribution on the chain so that the "adsorbed" counterions are allowed to move along the backbone. We compute the degree of ionization by using self-consistent field theory (SCFT) and compare with the previously developed variational theory. Analysis of various contributions to the free energy in both theories reveals that the equilibrium degree of ionization is attained mainly as an interplay of the adsorption energy of counterions on the backbone, the translational entropy of the small ions, and their correlated density fluctuations. Degree of ionization computed from SCFT is significantly lower than that from the variational formalism. The difference is entirely due to the density fluctuations of the small ions in the system, which are accounted for in the variational procedure. When these fluctuations are deliberately suppressed in the truncated variational procedure, there emerges a remarkable quantitative agreement in the various contributing factors to the equilibrium degree of ionization, in spite of the fundamental differences in the approximations and computational procedures used in these two schemes. Nevertheless, since the significant effects from density fluctuations of small ions are not captured by the SCFT, and due to the close agreement between SCFT and the other contributing factors in the more transparent variational procedure, the latter is a better computational tool for obtaining the degree of ionization

The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia

Background: The development and description of interventions to change professional practice are often limited by the lack of an explicit theoretical and empirical basis. We set out to develop an intervention to promote appropriate disclosure of a diagnosis of dementia based on theoretical and empirical work. Methods: We identified three key disclosure behaviours: finding out what the patient already knows or suspects about their diagnosis; using the actual words 'dementia' or 'Alzheimer's disease' when talking to the patient; and exploring what the diagnosis means to the patient. We conducted a questionnaire survey of older peoples' mental health teams (MHTs) based upon theoretical constructs from the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT) and used the findings to identify factors that predicted mental health professionals' intentions to perform each behaviour. We selected behaviour change techniques likely to alter these factors. Results: The change techniques selected were: persuasive communication to target subjective norm; behavioural modelling and graded tasks to target self-efficacy; persuasive communication to target attitude towards the use of explicit terminology when talking to the patient; and behavioural modelling by MHTs to target perceived behavioural control for finding out what the patient already knows or suspects and exploring what the diagnosis means to the patient. We operationalised these behaviour change techniques using an interactive 'pen and paper' intervention designed to increase intentions to perform the three target behaviours. Conclusion : It is feasible to develop an intervention to change professional behaviour based upon theoretical models, empirical data and evidence based behaviour change techniques. The next step is to evaluate the effect of such an intervention on behavioural intention. We argue that this approach to development and reporting of interventions will contribute to the science of implementation by providing replicable interventions that illuminate the principles and processes underlying change.This project is funded by UK Medical Research Council, Grant reference number G0300999. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Jill Francis is funded by the Chief Scientist Office of the Scottish Government Health Directorate. The views expressed in this study are those of the authors