Communication with patients using negative wound pressure therapy and their adherence to treatment

Objective: Wound healing is a normal physiological process which is moderated by biological and social factors. However, delayed healing is common amongst older people and in those with long term conditions. The purpose of this study was to explore the challenges of communication between patients and professionals and adherence to treatment for chronic wounds when using negative wound pressure therapy (NPWT). Methods: Twenty-four participants, took part in face to face semi-structured interviews. Specific features of the NPWT device were the priority for discussion although we also explored other factors central to communication and adherence. Results: Data saturation was achieved during the analysis. We found that patients require on-going support to understand complex and often protracted treatment and this is particularly important when specialist technology is used. A distinction was highlighted between those who decided not to adhere with therapy and those who did so unintentionally. Participants faced difficulties in their communications with professionals and in ensuring their needs were listened to and addressed. Conclusions: Further research is needed to achieve a better understanding of this distinction and to evaluate interventions which can sustain adherence behaviours. Further exploration of how to establish concordant patient / professional communications is warranted

Anti-phospholipid-antibodies in patients with relapsing polychondritis

Relapsing polychondritis (RP) is an extremly rare multisystemic disease thought to be of autoimmune origin. In order to assess if RP is associated with anti-phospholipid antibodies (aPL), clinical data and sera of 21 patients with RP were collected in a multicentre study. Concentration of anti-cardiolipin antibodies (aCL) (IgG-, IgM-and IgA-isotypes), anti-phosphatidylserine-antibodies (aPS) (IgG-and IgM-isotypes) and anti-β-2-glycoprotein I-antibodies (aβ2 GPI) were measured by ELISA. In eight patients aCL were found to be elevated. One patient had elevated aPS. No patient had elevated aβ2 GPI. No patient had clinical signs and symptoms of a aPL syndrome. Interestingly, the two RP patients with the highest aPL had concomitant systemic lupus erythematosus (SLE). Therefore the presence of elevated aPL in RP is probably more closely related to an associated SLE than to RP itself. There is no convincing evidence that aPL are associated with RP

The concept of chronic edema - a neglected public health issue and an international response – the LIMPRINT study

Lymphedema has always been a neglected global health care problem. A central requirement for the development of any chronic disease is the clear use of public health definitions that can be used internationally to define populations. The term “lymphedema” has historically been defined as either primary, resulting from failure of lymphatic development, or secondary, following damage to the lymphatics (e.g., cancer treatment, injury, or filariasis). Attempts to integrate causes of edema arising from damage to the venous system or the effects of gravity, immobility, and systemic disease have rarely been integrated. More recently, the prominent role of the lymphatics in tissue fluid homeostasis in all forms of chronic edema has been recognized. These advances led to the development of the term: “Chronic edema: a broad term used to describe edema, which has been present for more than three months.” It can be considered an umbrella term that includes not only conventional “lymphedema” but also chronic swelling, which may have a more complex cause. This definition has been adapted in the international epidemiology study (LIMPRINT) that identified people throughout the health and social care systems in participating countries. Clearer definitions will allow for examination of this important public health problem that is likely to escalate given the projections of an aging population with multiple comorbidities. It will be possible to define both the hidden mortality and morbidity associated with complications, such as cellulitis and the impact on health-related quality of life. This evidence is urgently required to lobby for increased resource and effective health care in an increasingly competitive health care arena in which more established conditions have greater priority and funding

Electrowetting of liquid marbles

Electrowetting of water drops on structured superhydrophobic surfaces are known to cause an irreversible change from a slippy (Cassie-Baxter) to a sticky (Wenzel) regime. An alternative approach to using a water drop on a superhydrophobic surface to obtain a non-wetting system is to use a liquid marble on a smooth solid substrate. A liquid marble is a droplet coated in hydrophobic grains, which therefore carries its own solid surface structure as a conformal coating. Such droplets can be considered as perfect non-wetting systems having contact angles to smooth solid substrates of close to 180 degrees. In this work we report the electrowetting of liquid marbles made of water coated with hydrophobic lycopodium grains and show that the electrowetting is completely reversible. Marbles are shown to return to their initial contact angle for both ac and dc electrowetting and without requiring a threshold voltage to be exceeded. Furthermore, we provide a proof-of-principle demonstration that controlled motion of marbles on a finger electrode structure is possible

LIMPRINT - health-related quality of life in adult patients with chronic edema

Background: Chronic edema is a condition posing a high burden on patients. The primary aim of the study was to assess the health-related quality of life (QoL) of adult patients living with chronic edema. Methods and Results: As part of an international, multicenter, prospective study, we prospectively assessed the health-related QoL of adult patients living with a chronic edema using a disease-specific tool and a generic one. In total, 1094 patients were included, aged 57 years on average. The average EQ-5D and LYMQOL visual analogue scale (VAS) scores were equal to 63.6 (SD = 20.2) and 6.3 (SD = 2.0), respectively. After adjustment, the EQ-5D VAS was explained by LYMQOL VAS (β = 7.85; p < 0.001), age (β = −0.08; p = 0.02), obesity (β = −1.89; p = 0.001), and male gender (β = 3.32; p = 0.002). As for the LYMQOL VAS, it was independently associated with EQ-5D VAS (β = 0.07; p < 0.001), LYMQOL function (β = −0.21; p < 0.001), and LYMQOL mood (β = −0.49; p < 0.001). Conclusion: This study confirms that patients living with a chronic edema experience a poor disease-specific and generic health-related QoL

The development and validation of the LIMPRINT methodology

The acronym Limprint stands for Lymphoedema IMpact and Prevalence-INTernational and was run under the auspices of the International Lymphoedema Framework (ILF) a charity dedicated to improving provision of care globally. The primary aim was to identify the number of people with chronic oedema (chronic oedema present for > 3months and due to a range of underlying aetiologies and associated risk factors) within diverse health services in 9 participating countries and to determine its impact using validated methods. An international protocol and sampling framework, online data capture system and standard operating procedures were adopted. An international consensus was used to create a core data tool that covered 13 domains. Specialist data on demographics and disability, details of swelling, wounds, cancer and health related quality of life were also available for sites. The study protocol was designed to allow flexibility in the types of studies undertaken within complex health care systems. All cases were confirmed using the modified pitting test. Sensitivity and specificity for this method were determined in Japanese and European populations. Following confirmation of a chronic oedema case Lymphologists defined whether it was a primary of secondary form. The study was designed to provide robust evidence that chronic oedema is an important and unrecognised public health problem in health services with significant morbidity. Without evidence of the size and complexity it will remain considered a rare phenomenon and people affected will be denied access to appropriate treatment that would allow them to have fulfilled and productive lives

A Study Using Visual Art Methods to Explore the Perceptions and Barriers of Self-Management in Children and Adolescents with Lymphedema

Background: The aims of this study were to explore, using visual art methodology, how children and adolescents perceive their lymphedema and conceptualize the barriers and enablers in self-management and to explore the role of an educational camp in promoting self-efficacy.Methods: Participants (speaking English, French, and Italian) were recruited during an educational camp for children with lymphedema. Children and adolescents used different methodologies to depict living and self-managing their condition. Younger children (aged 5–12 years) drew pictures, and all children and adolescents (aged 5–18 years) were given cameras and asked to take photographs that depicted their experience of learning self-management of their condition during the camp. Rose's critical visual methodology framework was used for analysis.Results: Analysis of the data produced five categories: Normal versus altered childhood, living with lymphedema; perceptions of lymphedema and self-care in younger children; adolescents' perception of living and managing lymphedema; learning self-efficacy; and insights into cultural differences in self-care.Conclusions: The study has shown that self-management is complex. Children and adolescents face many daily challenges and frustrations in managing their condition in addition to the normal challenges of development and growth that impact on: home life, time with friends, school activities, and relationships. Children expressed a deep longing for cure and a recognition that their lives were altered by having the condition that led to limitations in sport and wearing fashionable clothes and shoes. The importance of relationships with professionals was critical as was the experience of meeting and learning with other children through the camp experience. Attempts to simplify self-management techniques would appear to be a key priority as would a greater understanding of the self-beliefs young people have of their ability to influence and control their condition and its impact on their life

A study to explore the professional conceptualization and challenges of self-management in children and adolescents with lymphedema

Background: The aim of this study was to explore the professional experience of caring for children and adolescents with lymphedema and to explore the way in which they understand and implement self-management strategies and the influence of their own self-efficacy beliefs on this process. Methods and Results: Participants were recruited during an educational camp for children with lymphedema. Three individual semistructured focus groups were undertaken in English, French, and Italian with simultaneous translation. Data were analyzed using interpretative phenomenological analysis (IPA). Analysis of the data produced three superordinate themes: professional concepts of self-management, professional practice, and redefining the cornerstone of lymphedema care. An additional seven subthemes were as follows: readiness to self-management, professional perspectives on self-management, defining success and treatment failure, emotional burden, traditional views on complex decongestive therapy, new ways to practice, and sole practitioner versus multidisciplinary teams. Conclusions: The purpose of the study was to explore the challenges professionals face when introducing self-management to children and adolescents with lymphedema and their parents and to explore their own sense of self-efficacy in approaching this. The research allowed in-depth discussion about the ways they conceptualize self-management and faced professional challenges. The research highlighted the need to define what is considered an acceptable outcome within a complex and uncertain condition and the self-management strategies that are needed to support this

Математична залежність точності верстатних пристроїв від їх ступеня гнучкості

Підвищення конкурентоспроможності продукції, що виробляється невеликими підприємствами, забезпечується шляхом скорочення витрат на проектування та виготовлення технологічної оснастки для свердлильно- фрезерно-розточувальних операцій. Це стає можливим за рахунок використання гнучких верстатних пристроїв (ВП), що мають можливість переналагодження у заданому діапазоні розмірів заготовки шляхом регулювання установлювально-затискних елементів

Spallative ablation of dielectrics by X-ray laser

Short laser pulse in wide range of wavelengths, from infrared to X-ray, disturbs electron-ion equilibrium and rises pressure in a heated layer. The case where pulse duration $\tau_L$ is shorter than acoustic relaxation time $t_s$ is considered in the paper. It is shown that this short pulse may cause thermomechanical phenomena such as spallative ablation regardless to wavelength. While the physics of electron-ion relaxation on wavelength and various electron spectra of substances: there are spectra with an energy gap in semiconductors and dielectrics opposed to gapless continuous spectra in metals. The paper describes entire sequence of thermomechanical processes from expansion, nucleation, foaming, and nanostructuring to spallation with particular attention to spallation by X-ray pulse