Modulated Properties of Fully Absorbable Bicomponent Meshes

Current meshes used for soft-tissue repair are mostly composed of single component, nonabsorbable yarn constructions, limiting the ability to modulate their properties. This situation has left the majority of soft tissue repair load-bearing applications to suffer distinctly from undesirable features associated, in part, with mesh inability to (1) possess short-term stiffness to facilitate tissue stability during the development of wound strength; (2) gradually transfer the perceived mechanical load as the wound builds mechanical integrity; and (3) provide compliance with load transfer to the remodeling and maturing mesh/tissue complex. The likelihood of long-term complications is reduced for fully absorbable systems with degradation and absorption at the conclusion of their intended functional performance. The primary goal of this dissertation was to develop and characterize a fully absorbable bicomponent mesh (ABM) for hernia repair which can modulate biomechanical and physical properties to work with the expected needs of the wound healing process. The first study reviewed the current state of hernioplasty and proposed the subject device. The second study investigated different knitting technologies to establish a mesh construction which temporally modulated properties. To this end, a novel construction using warp knitting was developed where two degradable copolyester yarns with different degradation profiles were coknit into an initially interdependent knit construction. The developed knit construction provided an initial high level of structural stiffness; however, upon degradation of the fast-degrading yarn the mesh comprised of the slow-degrading yarn was liberated and affords high compliance. In the third study, the segmented, triaxial, high-glycolide copolyester used as the fast-degrading yarn was optimized to retain strength for greater than 18 days. As such, the ABM physical and biomechanical transition was designed to temporally coincide with the expected commencement of wound strength. The fourth study investigated the in vivo tissue response and integration of the developed degradable copolyester yarns in a novel construct to simulate the ABM. Results indicated a strong initial inflammatory response which resolved quickly and an integration process that produced a dense, compacted, and oriented collagen capsule around the implant during the transition phase. For the final study, the clinically-relevant biomechanical properties of two different ABM constructions were compared against traditional hernia meshes. Using a novel synthetic in vitro simulated mesh/tissue complex, the ABM were found to provide significantly greater early stability, subsequent biomechanics that approximated that of the abdominal wall, and evidence of restoring endogenous tension to the surrounding tissue. These results were in marked contrast to traditional hernia meshes which showed stress shielding and significantly greater stiffness than the abdominal wall

Coronary arteriographic findings in black patients and risk markers for coronary artery disease

Coronary arteriographic results are reported in 1535 black patients: 751 men (mean age 57 +/- 11) and 784 women (mean age 59 +/- 11). Among the black men 19%, 15%, 21%, and 4% had single-, double-, and triple-vessel and left main disease, respectively. Among the black women there were 12%, 10%, 15%, and 3% with similar involvement. Logistic regression models showed that most of the recognized risk factors were positively correlated with significant (at least one artery with >/= 50% stenosis) coronary disease, but a history of hypertension was not a significant independent predictor in either sex. ECG evidence of previous infarction increased the odds of detecting significant coronary disease by the greatest amount when controlling for other significant risk markers in women. In men both previous infarction and atypical pain (negative) were equally important. This study confirms but does not explain previous reports that have revealed less than expected angiographic evidence of significant coronary artery disease in black compared with white persons

Engaging at-Risk Patients In a Safety Planning Intervention: A Program Evaluation of Zero Suicide in a Psychiatric Emergency Department

Suicide remains a public health issue and suicide care needs to be an integral part ofhealthcare delivery. In studies looking at medical system use patterns of people who die bysuicide, evidence demonstrates that these patients do indeed seek medical and or psychiatriccare in the year before their death. Specific to emergency department (ED) visits, researchstudies found that 7% of all patients who died by suicide were seen at an ED within a week oftheir death, while 14% were seen within a month, and 43.8% within the previous year. ZeroSuicide, a framework for suicide prevention, is based on the premise that there is no acceptablenumber of suicides, and that the healthcare industry needs to address this issue with evidence-based practices to achieve this goal. This project aimed to conduct a program evaluation of thecurrent state of Zero Suicide implementation of safety planning in the Atrium Health PsychiatricED at Behavioral Health-Charlotte using the CDC Model. Assessment methods included chartreview of high and moderate-risk patients seen in the ED over 3 months, evaluation ofeducational offerings and staff adherence, a survey of knowledge and attitudes of current staffregarding ZS and safety planning, and comparison of current versus ideal state of EMRutilization to promote safety planning in the ED. Using data collected from March 1 to May 31,2024, 457 ED adult patients screened as either high or moderate risk for suicide on the Columbia Suicide Severity Rating Scale (C-SSRS) were discharged from either the ED orObservation (OBS) units. Safety planning, using the Stanley-Brown Suicide Safety Planning tool,was conducted with 22.5% of these patients. Discharge location was closely correlated withwhether a patient received a safety plan, with OBS patients having received a safety plan in75% of cases in contrast to just 1.2% of ED discharges. Findings from policy review, staffevaluation (survey and meetings/shadowing), EMR review, and educational assessmentsindicated multiple gaps in implementation and identified opportunities for improved suicidecare in the ED.Doctor of Nursing Practic

Undiagnosed and uncontrolled hypertension in rural African adults:A scoping review protocol of primary health care interventions

INTRODUCTION: Non-communicable diseases cause 74% of global deaths, with cardiovascular diseases as the major contributor. Hypertension, a primary risk factor for cardiovascular disease, is highly prevalent in Africa. Diagnosis, treatment and control rates are notably limited in rural areas. This limitation results in increased risks of premature mortality and complications such as stroke due to socioeconomic, cultural and geographical challenges. Progress in African countries enhancing hypertension services through primary health care interventions exists. However, a comprehensive review of all primary health care interventions addressing undiagnosed and uncontrolled hypertension in rural African settings is lacking. This scoping review aims to categorise primary health care interventions targeting undiagnosed and uncontrolled hypertension in rural African adults. Intervention components will be mapped to the four stages outlined in the hypertension care cascade to develop a pilot intervention logic model for rural African adults with hypertension.METHOD AND ANALYSIS: The scoping review protocol will adhere to the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Studies considered for inclusion will include any intervention delivered by any healthcare provider in a rural African primary care setting targeting any stage of hypertension care. Eight databases will be searched without date restrictions, supplemented by grey literature and reference list searches. A two-stage screening process (title/abstract and full text) will determine evidence source eligibility. All eligible sources of evidence will be extracted, charted and evaluated using the Template for Intervention Description and Replication checklist. A pilot logic model categorising and mapping interventions to the four stages of the hypertension care cascade will be visually presented and analysed using narrative synthesis.ETHICS AND DISSEMINATION: No primary data will be collected; therefore, ethics approval is not required. Findings will be disseminated to local health authorities in Ghana and other African Regions and through national and international conferences and publications in peer-reviewed journals.</p

An Empirical Investigation of the Significant Others Concept

This study, following a Social Psychological approach to the study of human behavior, as attempted to (1) develop an objective instrument for identifying “significant others” and (2) present some evidence concerning the validity and reliability of this measuring instrument. Attention is focused especially on the adolescent pattern of “significant others” relations emphasizing the role of parents as “significant others.” A sociometric technique, being both objective and flexible has been used in this study. For these reasons, this research study presents evidence concerning the theoretical validity and reliability of an objective test of interpersonal relations based on this form of measurement. It is hypothesized that a lack of “significant others” relations to others will lead to disturbances in self-conception and behavior. Results of this study present considerable evidence which points to the strong probability that the significant others measure which has been developed is a reliable and valid one. The lack of a strong positive relationship to parents was also found to be associated with disturbances in self-conception indicating the potential important of the concept of “significant others” for understanding juvenile behavior problems

Elizabeth Roberts and the Legacy of the Working Class Oral History Archive

In 2014, the Regional Heritage Centre (RHC) of Lancaster University embarked on an ambitious project to digitise the transcripts of three significant oral history projectsm carried out by Elizabeth Roberts, and latterly by her colleague Lucinda McCray Beier, in the 1970s and 1980s. Focusing on the recollections of family and social life in Barrow-in-Furness, Lancaster and Preston from 1890 to 1940 and 1940 to 1970, the collection of 584 interviews with over 260 respondents – totalling three million words – was renamed the Elizabeth Roberts Working Class Oral History Archive. Incorporating the original indices and biographical details of each (anonymised) respondent, it offers a rich resource for historians of working-class life in NorthWest England, and of social history more broadly. The index includes topics ranging from abortions to world war experiences (although the wars were seldom the focus of discussion) through fairs and ice cream. Popular digital searches include such themesas accidents, schools, weavers, family planning and pace egging. Contained in the interviews is vital information about long-lived customs that are now dying out from our communal memory

Predicting risk for Alcohol Use Disorder using longitudinal data with multimodal biomarkers and family history: a machine learning study.

Predictive models have succeeded in distinguishing between individuals with Alcohol use Disorder (AUD) and controls. However, predictive models identifying who is prone to develop AUD and the biomarkers indicating a predisposition to AUD are still unclear. Our sample (n = 656) included offspring and non-offspring of European American (EA) and African American (AA) ancestry from the Collaborative Study of the Genetics of Alcoholism (COGA) who were recruited as early as age 12 and were unaffected at first assessment and reassessed years later as AUD (DSM-5) (n = 328) or unaffected (n = 328). Machine learning analysis was performed for 220 EEG measures, 149 alcohol-related single nucleotide polymorphisms (SNPs) from a recent large Genome-wide Association Study (GWAS) of alcohol use/misuse and two family history (mother DSM-5 AUD and father DSM-5 AUD) features using supervised, Linear Support Vector Machine (SVM) classifier to test which features assessed before developing AUD predict those who go on to develop AUD. Age, gender, and ancestry stratified analyses were performed. Results indicate significant and higher accuracy rates for the AA compared with the EA prediction models and a higher model accuracy trend among females compared with males for both ancestries. Combined EEG and SNP features model outperformed models based on only EEG features or only SNP features for both EA and AA samples. This multidimensional superiority was confirmed in a follow-up analysis in the AA age groups (12-15, 16-19, 20-30) and EA age group (16-19). In both ancestry samples, the youngest age group achieved higher accuracy score than the two other older age groups. Maternal AUD increased the model's accuracy in both ancestries' samples. Several discriminative EEG measures and SNPs features were identified, including lower posterior gamma, higher slow wave connectivity (delta, theta, alpha), higher frontal gamma ratio, higher beta correlation in the parietal area, and 5 SNPs: rs4780836, rs2605140, rs11690265, rs692854, and rs13380649. Results highlight the significance of sampling uniformity followed by stratified (e.g., ancestry, gender, developmental period) analysis, and wider selection of features, to generate better prediction scores allowing a more accurate estimation of AUD development

Topical NSAIDs for chronic musculoskeletal pain in adults

Background: Use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) to treat chronic musculoskeletal conditions has become widely accepted because they can provide pain relief without associated systemic adverse events. This review is an update of 'Topical NSAIDs for chronic musculoskeletal pain in adults', originally published in Issue 9, 2012. Objectives: To review the evidence from randomised, double-blind, controlled trials on the efficacy and safety of topically applied NSAIDs for chronic musculoskeletal pain in adults. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and our own in-house database; the date of the last search was February 2016. We also searched the references lists of included studies and reviews, and sought unpublished studies by asking personal contacts and searching online clinical trial registers and manufacturers' web sites. Selection criteria: We included randomised, double-blind, active or inert carrier (placebo) controlled trials in which treatments were administered to adults with chronic musculoskeletal pain of moderate or severe intensity. Studies had to meet stringent quality criteria and there had to be at least 10 participants in each treatment arm, with application of treatment at least once daily. Data collection and analysis: Two review authors independently assessed studies for inclusion and extracted data. We used numbers of participants achieving each outcome to calculate risk ratio and numbers needed to treat (NNT) or harm (NNH) compared to carrier or other active treatment. We were particularly interested to compare different formulations (gel, cream, plaster) of individual NSAIDs. The primary outcome was 'clinical success', defined as at least a 50% reduction in pain, or an equivalent measure such as a 'very good' or 'excellent' global assessment of treatment, or 'none' or 'slight' pain on rest or movement, measured on a categorical scale. Main results: We identified five new studies for this update, which now has information from 10,631 participants in 39 studies, a 38% increase in participants from the earlier review; 33 studies compared a topical NSAID with carrier. All studies examined topical NSAIDs for treatment of osteoarthritis, and for pooled analyses studies were generally of moderate or high methodological quality, although we considered some at risk of bias from short duration and small size. In studies lasting 6 to 12 weeks, topical diclofenac and topical ketoprofen were significantly more effective than carrier for reducing pain; about 60% of participants had much reduced pain. With topical diclofenac, the NNT for clinical success in six trials (2343 participants) was 9.8 (95% confidence interval (CI) 7.1 to 16) (moderate quality evidence). With topical ketoprofen, the NNT for clinical success in four trials (2573 participants) was 6.9 (5.4 to 9.3) (moderate quality evidence). There was too little information for analysis of other individual topical NSAIDs compared with carrier. Few trials compared a topical NSAID to an oral NSAID, but overall they showed similar efficacy (low quality evidence). These efficacy results were almost completely derived from people with knee osteoarthritis. There was an increase in local adverse events (mostly mild skin reactions) with topical diclofenac compared with carrier or oral NSAIDs, but no increase with topical ketoprofen (moderate quality evidence). Reporting of systemic adverse events (such as gastrointestinal upsets) was poor, but where reported there was no difference between topical NSAID and carrier (very low quality evidence). Serious adverse events were infrequent and not different between topical NSAID and carrier (very low quality evidence). Clinical success with carrier occurred commonly - in around half the participants in studies lasting 6 to 12 weeks. Both direct and indirect comparison of clinical success with oral placebo indicates that response rates with carrier (topical placebo) are about twice those seen with oral placebo. A substantial amount of data from completed, unpublished studies was unavailable (up to 6000 participants). To the best of our knowledge, much of this probably relates to formulations that have never been marketed. Authors' conclusions: Topical diclofenac and topical ketoprofen can provide good levels of pain relief beyond carrier in osteoarthritis for a minority of people, but there is no evidence for other chronic painful conditions. There is emerging evidence that at least some of the substantial placebo effects seen in longer duration studies derive from effects imparted by the NSAID carrier itself, and that NSAIDs add to that