Presence Detection with Bluetooth Low Energy: A Review and Experiment

Bluetooth is one of the most ubiquitous technologies in smart phone today and its prominence in other devices is rising rapidly. It has become the De Facto technology used when there is need for device-to-device communication. However, the evolving standard has much more to offer. Bluetooth can power many applications due to capabilities. A key metric of Bluetooth is the Received Signal Strength Indicator (RSSI) and depending on the readings one can infer locality. This study evaluates existing research that attempts localization implemented using the Bluetooth protocol and the metrics that power those applications. A proof-of-concept software is developed to further investigate the feasibility of presence detection using Bluetooth Low Energy without connection to a device.&nbsp

Formulation of pH-responsive lipid-polymer hybrid nanoparticles for co-delivery and enhanced antibacterial activity of 18β-glycyrrhetinic acid and vancomycin against MRSA.

Masters Degree. University of KwaZulu-Natal, Durban.Background: Due to the rise in antimicrobial resistance and the challenges accompanied by conventional antibiotic dosage forms, there is a need for developing drug delivery systems that enhance, protect and potentiate the current antibiotics in the market. Furthermore, natural derivatives from plants have proven to be potent antimicrobial agents. Therefore, their combination with antibiotics could be effective in overcoming antimicrobial resistance. Aim: The aim of this study was to co-deliver vancomycin and 18β-glycyrrhetinic acid via pH-responsive lipid-polymer hybrid nanoparticles (VCM-GAPAH-LPHNPs) formulated from polyallylamine and oleic acid (OA) and to explore its potential for enhanced activity and targeted delivery. Methods: Molecular dynamics and stability studies were used to determine the stability of the oil and water phases independently as well as VCM-GAPAH-LPHNPs as a complex. VCM-GAPAH-LPHNPs were prepared using the micro-emulsion technique. The size, polydispersity index and zeta potential of VCM-GAPAH-LPHNPs were determined using the dynamic light scattering technique. Transmission electron microscopy analysis was conducted to determine the morphology of VCM-GAPAH-LPHNPs. The entrapment efficiency and drug loading were determined using the ultrafiltration method. Differential scanning calorimetry was used to determine the thermal profiles of VCM-GAPAH-LPHNPs and its components. In vitro drug release studies were performed using the dialysis bag technique. Drug release kinetics were analysed using the DDSolver program. Cytotoxicity of VCM-GAPAH-LPHNPs were determined using the MTT assay. Haemolysis of VCM-GAPAH-LPHNPs were performed at different concentrations using sheep blood. In vitro antibacterial activity of VCM-GAPAH-LPHNPs were determined against SA and methicillin-resistant Staphylococcus aureus (MRSA) at pH 6 and 7.4. Time killing assay was performed using the plate colony count method. MRSA biofilm study was performed using the crystal violet assay. Results: Molecular dynamics indicated VCM-GAPAH-LPHNPs to be stable. VCM-GAPAH-LPHNPs were successfully prepared using the micro-emulsion technique. VCM-GAPAH-LPHNPs size, polydispersity index, zeta potential and encapsulation efficiency were found to be 198.4 ± 0.302 nm, 0.255 ± 0.003, - 3.8 ± 0.335 mV and 69.46 ± 2.52 % respectively. Thermal profiles of lyophilized VCM-GAPAH-LPHNPs showed transformation from crystallization to amorphous form. In vitro drug release studies revealed that VCM-GAPAH-LPHNPs released 60% of VCM after 24 h whereas bare VCM released 90% of VCM after 24 h hence VCM-GAPAH-LPHNPs showed sustained drug release compared to bare VCM. At pH 6 VCM-GAPAH-LPHNPs released 82% of VCM after 24 h whereas at pH 7.4 VCM-GAPAH-LPHNPs released 60% of VCM after 24 h indicating VCM-GAPAH-LPHNPs had a faster drug release at pH 6 compared to pH 7.4. The Weibull model was considered the best fit model for VCM-GAPAH-LPHNPs. The MTT assay revealed 75% > cell viability which indicated VCM-GAPAH-LPHNPs to be non-cytotoxic. At 0.5 mg/ml VCM-GAPAH-LPHNPs showed < 1% haemolysis. Stability studies at 4 °C and room temperature indicated VCM-GAPAH-LPHNPs to be stable. In vitro antibacterial activity against MRSA treated with VCM-GAPAH-LPHNPs demonstrated a 16-fold lower minimum inhibitory concentration than bare VCM at acidic conditions. The time-killing assay study at 12 h revealed that VCM-GAPAH-LPHNPs eliminated 100% of MRSA cells whereas bare VCM eliminated 55% of MRSA cells. The crystal violet assay analysis revealed VCM-GAPAH-LPHNPs ability to eliminate MRSA biofilms. Conclusion: VCM-GAPAH-LPHNPs could effectively treat MRSA infections at a faster rate as compared to bare VCM. Therefore, this novel pH-responsive LPHNPs may serve as a promising nanocarrier for enhancing antibiotic delivery and antibacterial activity

Determinants of research use in clinical decision making among physical therapists providing services post-stroke: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Despite evidence of the benefits of research use in post-acute stroke rehabilitation where compliance with clinical practice guidelines has been associated with functional recovery and patient satisfaction, the rate of reliance on the research literature in clinical decision making among physical therapists is low. More research examining factors that motivate physical therapists to consider research findings in neurological practice is needed to inform efforts to intervene. The objective of this study was to identify practitioner, organizational, and research characteristics associated with research use among physical therapists providing services post-stroke.</p> <p>Methods</p> <p>A cross-sectional mail survey of physical therapists providing services to people with stroke in Ontario, Canada was conducted. The survey questionnaire contained items to evaluate practitioner and organizational characteristics and perceptions of research considered to influence evidence-based practice (EBP), as well as the frequency of using research evidence in clinical decision making in a typical month. Ordinal regression was used to identify factors associated with research use.</p> <p>Results</p> <p>The percentage of respondents reporting research use in clinical decision making 0 to 1, 2 to 5, or 6+ times in a typical month was 33.8%, 52.9%, and 13.3%, respectively (n = 263). Academic preparation in the principles of EBP, research participation, service as a clinical instructor, self-efficacy to implement EBP, a positive attitude towards research, perceived organizational support of research use, and Internet access to bibliographic databases at work were each associated with research use and placed in the final regression model. In the final model (n = 244), academic preparation in EBP, EBP self-efficacy, agreement that research findings are useful, and research participation each remained significantly associated with research use after adjusting for the effects of the other variables in the model.</p> <p>Conclusions</p> <p>A third of therapists rarely use research evidence in clinical decision making. Education in the principles of EBP, EBP self-efficacy, a positive attitude towards research, and involvement in research at work may promote research use in neurological physical therapy practice. Future research is needed to confirm these findings and to determine the type of research participation that may promote research use.</p

Measuring patient perceptions about osteoporosis pharmacotherapy

Abstract Background Adherence to osteoporosis pharmacotherapy is poor, and linked with patient perceptions of the benefits of, and barriers to taking these treatments. To better understand the association between patient perceptions and osteoporosis pharmacotherapy, we generated thirteen items that may tap into patient perceptions about the benefits of, and barriers to osteoporosis treatment; and included these items as part of a standardized telephone interview of women aged 65–90 years (n = 871). The purpose of this paper is to report the psychometric evaluation of our scale. Findings Upon detailed analysis, six of the thirteen items were omitted: four redundant, one did not correlate well with any other item and one factorial complex. From the remaining seven items, two distinct unidimensional domains emerged (variance explained = 78%). Internal consistency of the 5-item osteoporosis drug treatment benefits domain was good (Cronbach's alpha = 0.88), and was supported by construct validity; women reporting a physician-diagnosis or taking osteoporosis pharmacotherapy had higher osteoporosis treatment benefit scores compared to those reporting no osteoporosis diagnosis or treatment respectively. Because only two items were identified as tapping into treatment barriers, we recommend they each be used as a separate item assessing potential barriers to adherence to osteoporosis pharmacotherapy, rather than combined into a single scale. Conclusion The 5-item osteoporosis drug treatment benefits scale may be useful to examine perceptions about the benefits of osteoporosis pharmacotherapy. Further research is needed to develop scales that adequately measure perceived barriers to osteoporosis pharmacotherapy

Self-management interventions to improve skin care for pressure ulcer prevention in people with spinal cord injuries: A systematic review protocol

Background: Pressure ulcers are a serious, common, lifelong, and costly secondary complication of spinal cord injury (SCI). Community-dwelling people with a SCI can prevent them with appropriate skin care (i.e. pressure relieving activities, skin checks). Adherence to skin care remains suboptimal however, and self-management interventions that focus on improving this have been designed. Little is known on their content, effectiveness, or theoretical basis. The aim of the proposed systematic review is to synthesize the literature on self-management interventions to improve skin care in people with a SCI. Specific objectives are to describe these interventions in relation to their content, effectiveness, theory base, and adherence to reporting guidelines for intervention description. Methods: The search strategy will combine an electronic search of nine bibliographic databases (MEDLINE, Embase, PsycInfo, CENTRAL, CINAHL, Rehabdata, CIRRIE, PEDro, ERIC) and two trial registers with a manual search of relevant reference lists. Predefined eligibility criteria will be applied in a two-phase selection process involving title and abstract screening, followed by full-text screening. A data extraction spreadsheet will be applied to included papers. Intervention content will be coded using two taxonomies (behaviour change taxonomy; PRISMS self-management support taxonomy). A validated tool (Theory Coding Scheme) and the Template for Intervention Description and Replication (TIDieR) will be used to examine theoretical basis and assess adherence to reporting guidelines for intervention description. A small number of heterogeneous studies are likely to be included in this review therefore a narrative synthesis is planned. Discussion: This systematic review will help identify the gaps and priorities to guide future research activities in this area. Systematic review registration: PROSPERO CRD4201603319

An inpatient rehabilitation model of care targeting patients with cognitive impairment

BACKGROUND: The course and outcomes of hip fracture patients are often complicated by the presence of dementia and delirium, referred to as cognitive impairment (CI), which limits access to in-patient rehabilitation. In response to this concern, members of our team developed and piloted an in-patient rehabilitation model of care (Patient-Centred Rehabilitation Model; PCRM) targeting patients with hip fracture and CI (PCRM-CI). We are now conducting a 3-year study comparing an inpatient rehabilitation model of care for community dwelling individuals with hip fracture and CI (PCRM-CI) to usual care to determine whether it results in improved mobility at the time of discharge from inpatient rehabilitation. METHODS/DESIGN: A non-equivalent pre-post design is being used to evaluate the PCRM-CI compared to usual care. All community dwelling (private home or retirement home) patients following a hip fracture are eligible to participate. Recruitment of both cohorts is taking place at two facilities. Target accrual is 70 hip fracture patients in the PCRM-CI cohort and 70 patients in the usual care cohort. We are also recruiting 70 health care providers (HCPs), who are being trained to implement the PCRM-CI, and their unit managers. Patient data are collected at baseline, discharge, and 6 months post-discharge from an inpatient rehabilitation program. Evaluations include mobility, physical function, and living arrangement. Additional outcome variables are being collected from medical records and from the patients via their proxies. Data on the prevalence and severity of dementia and delirium are being collected. Staff data are collected at baseline and one year after implementation of the model to determine change in staff knowledge and attitudes toward patients with hip fracture and CI. Bi-monthly semi-structured interviews with unit managers have been conducted to examine factors and barriers influencing the model implementation. Data collection began in 2009 and is expected to be completed in 2012. The control cohort of 70 patients has been recruited, and 45 patients have been accrued to the intervention group to date. DISCUSSION: Evaluation of this model of care is timely given the increasing proportion of persons with cognitive impairment and hip fractures. TRIAL REGISTRATION: The study is registered at http://clinicaltrials.gov, Identifier NCT01566136

Appropriate Osteoporosis Treatment by Family Physicians inResponse to FRAX vs CAROC Reporting: Results Froma Randomized Controlled Trial

© 2014 The International Society for Clinical Densitometry. Canadian guidelines recommend either the FRAX or the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) fracture risk assessment tools to report 10-yr fracture risk as low (20%). It is unknown whether one reporting system is more effective in helping family physicians (FPs) identify individuals who require treatment. Individuals ≥50yr old with a distal radius fracture and no previous osteoporosis diagnosis or treatment were recruited. Participants underwent a dual-energy x-ray absorptiometry scan and answered questions about fracture risk factors. Participants\u27 FPs were randomized to receive either a FRAX report or the standard CAROC-derived bone mineral density report currently used by the institution. Only the FRAX report included statements regarding treatment recommendations. Within 3 mo, all participants were asked about follow-up care by their FP, and treatment recommendations were compared with anosteoporosis specialist. Sixty participants were enrolled (31 to FRAX and 29 to CAROC). Kappa statistics of agreement in treatment recommendation were 0.64 for FRAX and 0.32 for bone mineral density. The FRAX report was preferred by FPs and resulted in better postfracture follow-up and treatment that agreed more closely with a specialist. Either the clear statement of fracture risk or the specific statement of treatment recommendations on the FRAX report may have supported FPs to make better treatment decisions

Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial

SUMMARY: We conducted a cluster randomized trial evaluating the effect of a centralized coordinator who identifies and follows up with fracture patients and their primary care physicians about osteoporosis. Compared with controls, intervention patients were five times more likely to receive BMD testing and two times more likely to receive appropriate management. INTRODUCTION: To determine if a centralized coordinator who follows up with fracture patients and their primary care physicians by telephone and mail (intervention) will increase the proportion of patients who receive appropriate post-fracture osteoporosis management, compared to simple fall prevention advice (attention control). METHODS: A cluster randomized controlled trial was conducted in small community hospitals in the province of Ontario, Canada. Hospitals that treated between 60 and 340 fracture patients per year were eligible. Patients 40 years and older presenting with a low trauma fracture were identified from Emergency Department records and enrolled in the trial. The primary outcome was ‘appropriate’ management, defined as a normal bone mineral density (BMD) test or taking osteoporosis medications. RESULTS: Thirty-six hospitals were randomized to either intervention or control and 130 intervention and 137 control subjects completed the study. The mean age of participants was 65 ± 12 years and 69% were female. The intervention increased the proportion of patients who received appropriate management within 6 months of fracture; 45% in the intervention group compared with 26% in the control group (absolute difference of 19%; adjusted OR, 2.3; 95% CI, 1.3–4.1). The proportion who had a BMD test scheduled or performed was much higher with 57% of intervention patients compared with 21% of controls (absolute difference of 36%; adjusted OR, 4.8; 95% CI, 3.0–7.0). CONCLUSIONS: A centralized osteoporosis coordinator is effective in improving the quality of osteoporosis care in smaller communities that do not have on-site coordinators or direct access to osteoporosis specialists

Predictors of locating women six to eight years after contact: internet resources at recruitment may help to improve response rates in longitudinal research

<p>Abstract</p> <p>Background</p> <p>The ability to locate those sampled has important implications for response rates and thus the success of survey research. The purpose of this study was to examine predictors of locating women requiring tracing using publicly available methods (primarily Internet searches), and to determine the additional benefit of vital statistics linkages.</p> <p>Methods</p> <p>Random samples of women aged 65–89 years residing in two regions of Ontario, Canada were selected from a list of those who completed a questionnaire between 1995 and 1997 (n = 1,500). A random sample of 507 of these women had been searched on the Internet as part of a feasibility pilot in 2001. All 1,500 women sampled were mailed a newsletter and information letter prior to recruitment by telephone in 2003 and 2004. Those with returned mail or incorrect telephone number(s) required tracing. Predictors of locating women were examined using logistic regression.</p> <p>Results</p> <p>Tracing was required for 372 (25%) of the women sampled, and of these, 181 (49%) were located. Predictors of locating women were: younger age, residing in less densely populated areas, having had a web-search completed in 2001, and listed name identified on the Internet prior to recruitment in 2003. Although vital statistics linkages to death records subsequently identified 41 subjects, these data were incomplete.</p> <p>Conclusion</p> <p>Prospective studies may benefit from using Internet resources at recruitment to determine the listed names for telephone numbers thereby facilitating follow-up tracing and improving response rates. Although vital statistics linkages may help to identify deceased individuals, these may be best suited for post hoc response rate adjustment.</p

What matters to program partners when implementing a community-based exercise program for people post-stroke? A theory-based qualitative study and cost analysis

BackgroundCommunity-based exercise programs integrating a healthcare-community partnership (CBEP-HCP) can facilitate lifelong exercise participation for people post-stroke. Understanding the process of implementation from multiple perspectives can inform strategies to promote program sustainability.PurposeTo explore stakeholders' experiences with undertaking first-time implementation of a group, task-oriented CBEP-HCP for people post-stroke and describe associated personnel and travel costs.MethodsWe conducted a descriptive qualitative study within a pilot randomized controlled trial. In three cities, trained fitness instructors delivered a 12-week CBEP-HCP targeting balance and mobility limitations to people post-stroke at a recreation centre with support from a healthcare partner. Healthcare and recreation managers and personnel at each site participated in semi-structured interviews or focus groups by telephone post-intervention. Interviews and data analysis were guided by the Consolidated Framework of Implementation Research and Theoretical Domains Framework, for managers and program providers, respectively. We estimated personnel and travel costs associated with implementing the program.ResultsTwenty individuals from three sites (4 recreation and 3 healthcare managers, 7 fitness instructors, 3 healthcare partners, and 3 volunteers) participated. We identified two themes related to the decision to partner and implement the program: (1) Program quality and packaging, and cost-benefit comparisons influenced managers' decisions to partner and implement the CBEP-HCP, and (2) Previous experiences and beliefs about program benefits influenced staff decisions to become instructors. We identified two additional themes related to experiences with training and program delivery: (1) Program staff with previous experience and training faced initial role-based challenges that resolved with program delivery, and (2) Organizational capacity to manage program resource requirements influenced managers' decisions to continue the program. Participants identified recommendations related to partnership formation, staff/volunteer selection, training, and delivery of program activities. Costs (in CAD) for first-time program implementation were: healthcare partner ($680); fitness coordinators and instructors ($3,153); and participant transportation (personal vehicle: $283; public transit:$110).ConclusionDuring first-time implementation of a CBEP-HCP, healthcare and hospital managers focused on cost, resource requirements, and the added-value of the program, while instructors and healthcare partners focused on their preparedness for the role and their ability to manage individuals with balance and mobility limitations. Trial Registration: ClinicalTrials.gov, NCT03122626. Registered April 17, 2017—Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT0312262