Nanoporous hybrid core–shell nanoparticles for sequential release

In this article, a new type of core–shell nanoparticle is introduced. In contrast to most reported core–shell systems, the particles presented here consist of a porous core as well as a porous shell using only non-metal materials. The core–shell nanoparticles were successfully synthesized using nanoporous silica nanoparticles (NPSNPs) as the starting material, which were coated with nanoporous phenylene-bridged organosilica, resulting in a total particle diameter of about 80 nm. The combination of a hydrophilic nanoporous silica core and a more hydrophobic nanoporous organosilica shell provides regions of different chemical character and slightly different pore sizes within one particle. These different properties combined in one particle enable the selective adsorption of guest molecules at different parts of the particle depending on the molecular charge and polarity. On the other hand, the core–shell make-up of the particles provides a sequential release of guest molecules adsorbed at different parts of the nanoparticles. As a proof of concept, loading and release experiments with dyes were performed using non polar fluorescein and polar and charged methylene blue as model guest molecules. Non polar fluorescein is mostly adsorbed on the hydrophobic organosilica shell and therefore quickly released whereas the polar methylene blue, accumulated in the hydrophilic silica core, is only released subsequently. This occurs in small doses for an extended time corresponding to a sustained release over at least one year, controlled by the organosilica shell which acts as a diffusion barrier. An initial experiment with two drugs — non polar ibuprofen and polar and charged procaine hydrochloride — has been carried out as well and shows that the core–shell nanoparticles presented here can also be used for the sequential release of more relevant combinations of molecules

The Manchester Triage System (MTS): a score for emergency management of patients with acute gastrointestinal bleeding

Background Suspected gastrointestinal (GI) bleeding is a common initial diagnosis in emergency departments. Despite existing endoscopic scores to estimate the risk of GI bleeding, the primary clinical assessment of urgency can remain challenging. The 5-step Manchester Triage System (MTS) is a validated score that is often applied for the initial assessment of patients presenting in emergency departments. Methods All computer-based records of patients who were admitted between January 2014 and December 2014 to our emergency department in a tertiary referral hospital were analyzed retrospectively. The aim of our retrospective analysis was to determine if patient triage using the MTS is associated with rates of endoscopy and with presence of active GI bleeding. Results In summary, 5689 patients with a GI condition were treated at our emergency department. Two hundred eighty-four patients (4.9 %) presented with suspected GI bleeding, and 165 patients (58 %) received endoscopic diagnostic. Endoscopic intervention for hemostasis was needed in 34 patients (21 %). In patients who underwent emergency endoscopy, triage into MTS categories with higher urgency was associated with higher rates of endoscopic confirmation of suspected GI bleeding (79 % of patients with MTS priority levels 1 or 2, 53 % in level 3 patients, and 40 % in levels 4 or 5 patients; p = 0.024). Conclusions The MTS is an established tool for triage in emergency departments and could have a potential to guide early clinical decision-making with regards to urgency of endoscopic evaluation in patients with suspected GI bleeding

Technical Summary

�Mitigation�, in the context of climate change, is a human intervention to reduce the sources or enhance the sinks of greenhouse gases (GHGs). One of the central messages from Working Groups I and II of the Intergovernmental Panel on Climate Change (IPCC) is that the consequences of unchecked climate change for humans and natural ecosystems are already apparent and increasing. The most vulnerable systems are already experiencing adverse effects. Past GHG emissions have already put the planet on a track for substantial further changes in climate, and while there are many uncertainties in factors such as the sensitivity of the climate system many scenarios lead to substantial climate impacts, including direct harms to human and ecological well-being that exceed the ability of those systems to adapt fully. Because mitigation is intended to reduce the harmful effects of climate change, it is part of a broader policy framework that also includes adaptation to climate impacts. Mitigation, together with adaptation to climate change, contributes to the objective expressed in Article 2 of the United Nations Framework Convention on Climate Change (UNFCCC) to stabilize �greenhouse gas concentrations in the atmosphere at a level to prevent dangerous anthropogenic interference with the climate system [�] within a time frame sufficient to allow ecosystems to adapt [�] to ensure that food production is not threatened and to enable economic development to proceed in a sustainable manner�. However, Article 2 is hard to interpret, as concepts such as �dangerous� and �sustainable� have different meanings in different decision contexts (see Box TS.1). Moreover, natural science is unable to predict precisely the response of the climate system to rising GHG concentrations nor fully understand the harm it will impose on individuals, societies, and ecosystems. Article 2 requires that societies balance a variety of considerations�some rooted in the impacts of climate change itself and others in the potential costs of mitigation and adaptation