The spillover effect of school suspensions on adolescents' classroom climate perceptions and academic achievement

Proponents of exclusionary discipline claim that removing disruptive peers from the classroom benefits well-behaved students. Given educators' increasingly widespread use of suspensions in response to adolescents' minor behavioral infractions (e.g., dress code violations, backtalk), it is critical that we examine whether this theory translates into practice. Using two independent samples (Study 1: N = 1305 adolescents enrolled in 64 math classrooms; Mage = 13.00 years, range = 10-16; 53% White, 41% Black, 6% Other race; 50% girls; 64% economically disadvantaged. Study 2: N = 563 adolescents enrolled in 40 science classrooms; Mage = 12.83 years, range = 10-16; 55% White, 40% Black, 5% Other race; 51% girls; 62% economically disadvantaged), we adopted a two-study approach to examine the mediational role of classroom climate perceptions in the link between classroom-level suspension rates for minor infractions and adolescents' math and science achievement. Results indicated that high classroom-level rates of suspensions for minor infractions were associated with poor academic outcomes among suspended students as well as their non-suspended classmates. Students' classroom climate perceptions mediated the links between classroom suspension rates and non-suspended students' academic outcomes. Shifting away from strict and punitive disciplinary schedules may grant school-based adults the ability to create classroom climates more attuned to adolescents' developmental and learning needs.

Stably suspended SiO2-supported CdS photocatalyst for a promising organic pollutant degradation in the absence of mechanical stirring

Even with solar-activatable photocatalyst, incommensurable energy input for stirring is still required to overcome the transport limitations in powder-photocatalysis. To counter this, a novel concept of auto-suspending photocatalyst based on SiO2/CdS was proposed to enable promising photo-activity even under stirring-free condition. Functionally-speaking, CdS would act as photoreaction-driver while SiO2 endows sufficient buoyance for suspension-stabilization during stirring-free photocatalysis. In photoreactions degrading methylene blue for theoretical demonstration, SiO2/CdS_0.3 promises only 4.57% activity reduction in non-stirred photoreaction, enabling 15.26% of methylene blue decolorization comparing to 15.99% of stirred-photoreaction under visible light irradiation. This could be ascribed to the slow settling tendency of SiO2/CdS_0.3, evading severe light-shielding under stacked condition. Also, its rightly-exposed SiO2 surface permits 'adsorb-and-degrade' mechanism, thereby overcoming the sluggish surface transport across thick boundary layer. Contrarily, photocatalyst with quintuple CdS content (SiO2/CdS_1.5) exhibits largest activity reduction (31.47%), reasoned by its quick-settling tendency. Overall, current study provides new perspectives to photocatalysis-community. The success elimination of mechanical stirring from photocatalysis promises significant energy-saving (19.1-136 kW/m3), thus consenting better practicality for solar energy-harvesting and environmental protection.

Resilience of the Dutch HPV-based cervical screening programme during the COVID-19 pandemic

OBJECTIVES

Organisation of a screening programme influences programme resilience to a disruption as COVID-19. Due to COVID-19, the Dutch human papillomavirus-based cervical screening programme was temporarily suspended. Afterwards, multiple measures have been taken to catch-up participation. This study aimed to investigate programme resilience by examining the effect of COVID-19 and programme measures taken on participation in cervical screening.

STUDY DESIGN

Observational cohort study.

METHODS

Data from the national screening registry and Dutch nationwide pathology databank (Palga) were used on invitations and follow-up in 2018/2019 (pre-COVID) and 2020 (COVID). Sending invitations, reminders and self-sampling kits were suspended from March to July 2020. Main outcome measures include distribution of participant characteristics (age, region and screening history), participation rates by age and region, time between invitation and participation (i.e. response time) and self-sampling use per month.

RESULTS

Participation rate was significantly lower in 2020 (49.8%) compared to 2018/19 (56.8%, P < 0.001), in all ages and regions. Compared to 2018/19, participation rates decreased most in women invited from January to March 2020 (-6.7%, -9.1% and -10.4%, respectively). From August, participation rates started to recover (difference between -0.8% and -2.7%). Median response time was longer in February and March (2020: 143 and 173 days; 2018/19: 53 and 55 days) and comparable from July onwards (median difference 0-6 days). Self-sampling use was higher in 2020 (16.3%) compared to 2018/19 (7.6%).

CONCLUSIONS

The pandemic impacted participation rates in the Dutch cervical screening programme, especially of women invited before the programme pause. Implementation of self-sampling in national cervical screening programmes could increase participation rates and could serve as an alternative screening method in times of exceptional health care circumstances, such as a pandemic. Due to the well-organised programme and measures taken to catch-up participation, the impact of COVID-19 on the screening programme remained small.

Deposition and alignment of fiber suspensions by dip coating

HYPOTHESIS

The dip coating of suspensions made of monodisperse non-Brownian spherical particles dispersed in a Newtonian fluid leads to different coating regimes depending on the ratio of the particle diameter to the thickness of the film entrained on the substrate. In particular, dilute particles dispersed in the liquid are entrained only above a threshold value of film thickness. In the case of anisotropic particles, in particular fibers, the smallest characteristic dimension will control the entrainment of the particle. Furthermore, it is possible to control the orientation of the anisotropic particles depending on the substrate geometry. In the thick film regime, the Landau-Levich-Derjaguin model remains valid if one account for the change in viscosity.

EXPERIMENT

To test the hypotheses, we performed dip-coating experiments with dilute suspensions of non-Brownian fibers with different length-to-diameter aspect ratios. We characterize the number of fibers entrained on the surface of the substrate as a function of the withdrawal velocity, allowing us to estimate a threshold capillary number below which all the particles remain in the liquid bath. Besides, we measure the angular distribution of the entrained fibers for two different substrate geometries: flat plates and cylindrical rods. We then measure the film thickness for more concentrated fiber suspensions.

FINDINGS

The entrainment of the fibers on a flat plate and a cylindrical rod is primarily controlled by the smaller characteristic length of the fibers: their diameter. At first order, the entrainment threshold scales similarly to that of spherical particles. The length of the fibers only appears to have a minor influence on the entrainment threshold. No preferential alignment is observed for non-Brownian fibers on a flat plate, except for very thin films, whereas the fibers tend to align themselves along the axis of a cylindrical rod for a large enough ratio of the fiber length to the radius of the cylindrical rod. The Landau-Levich-Derjaguin law is recovered for more concentrated suspension by introducing an effective capillary number accounting for the change in viscosity.

The role epiphytes play in particle capture of seagrass canopies

Seagrass epiphytic communities act as ecological indicators of the quality status of vegetated coastal environments. This study aims to determine the effect leaf epiphytes has on the sediment capture and distribution from outside sources. Thirteen laboratory experiments were conducted under a wave frequency of 0.5 Hz. Three epiphyte models were attached to a Zostera marina canopy of 100 plants/m2 density. The sediment deposited to the seabed, captured by the epiphytic leaf surface, and remaining in suspension within the canopy were quantified. This study demonstrated that the amount of epiphytes impacts on the sediment stocks. Zostera marina canopies with high epiphytic areas and long effective leaf heights may increase the sediment captured on the epiphyte surfaces. Also, reducing suspended sediment and increasing the deposition to the seabed, therefore enhancing the clarity of the water column. For largest epiphytic areas, a 34.5% increase of captured sediment mass is observed. The sediment trapped on the leaves can be 10 times greater for canopies with the highest epiphytic areas than those without epiphytes. Therefore, both the effective leaf length and the level of epiphytic colonization are found to determine the seagrass canopy ability at distributing sediment.

Risk of school exclusion among adolescents receiving social care or special educational needs services: A whole-population administrative data cohort study

BACKGROUND

Exclusion from school is associated with health, well-being and social detriments and disproportionately affects vulnerable children. No study in England has examined the total cumulative risk of exclusion across secondary school among children with a history of children's social care (CSC) or special educational needs (SEN).

OBJECTIVE

To assess the risk of any secondary school exclusion among adolescents receiving CSC or SEN services compared with their peers.

METHODS

An administrative data cohort study comparing children in English state schools (n = 1,031,500) with no history of CSC or SEN provision with children who had received different levels of CSC and SEN in combination. Outcomes were proportions of students with any fixed-term or permanent exclusion in years 7 to 9 (age 11 to 14) and years 10 to 11 (age 14 to 16).

RESULTS

Overall, 13 % of children were excluded at least once across years 7 to 11. CSC exposure was associated with exclusion risk: 32 % of children in need (or formerly in need) and 40 % of current or former children looked after and those subject to child protection plans were excluded at least once across years 7 to 11, compared to 12 % of the non-exposed group. After adjusting for confounders, children with SEN history were more at risk of exclusion, regardless of CSC exposure category (except for exclusions among children looked after during years 10 to 11). Rates of exclusion varied significantly between local authorities.

CONCLUSIONS

Large inequalities in school exclusion rates between CSC-exposed and unexposed children were observed, with even higher rates observed for children with SEN history. These inequalities undermine the right to education of these vulnerable groups of children.

50-year history and perspective on biomechanics of swimming microorganisms: Part II. Collective behaviours

The paired review papers in Parts I and II describe the 50-year history of research on the biomechanics of swimming microorganisms and its prospects in the next 50 years. Parts I and II are divided not by the period covered, but by the content of the research: Part I explains the behaviours of individual microorganisms, and Part II explains collective behaviour. In the 1990s, the description of microbial suspensions as a continuum progressed, and macroscopic flow structures such as bioconvection were analysed. The continuum model was later extended to analyse various phenomena such as flow induced trapping of microorganisms and accumulation of cells at interfaces. In the 2000s, the collective behaviour of swimming microorganisms came into the limelight, and physicists as well as biomechanics researchers carried out many studies probing microorganism collectivity. In particular, research on the turbulence-like flow structure of dense bacterial suspensions has led to dramatic developments in the field of microbial biomechanics. Efforts to bridge the cellular scale to the macroscopic scale by extracting macroscopic physical quantities from the microstructure of cell suspensions are also underway. This Part II reviews these collective behaviours of swimming microorganisms and discusses future prospects of the field.

Calcipotriene and Betamethasone Dipropionate PAD-Cream Demonstrates Greater Treatment Efficacy in Patients with Moderate-to-Severe Psoriasis Compared to Topical Suspension/Gel: A Subgroup Analysis of Two Phase 3 Studies

INTRODUCTION

Psoriasis ranges from mild to severe with the majority of patients having mild disease. Mild to moderate disease is often treated with topical therapies while photo-, oral, and biologic therapies are generally reserved for moderate-to-severe disease. There is a strong scientific rationale for the combination of calcipotriene (CAL) and betamethasone dipropionate (BDP) with respect to mode of action, efficacy, and safety and CAL/BDP has shown an inhibitory effect on key pathogenic cytokines in psoriasis including tumor necrosis factor-α, interleukin (IL)-17, and IL-23.

METHODS

The objective of this pooled post hoc analysis is to investigate the efficacy of CAL/BDP polyaphron dispersion (PAD)-cream in subgroups of patients with moderate-to-severe psoriasis from two completed phase 3 studies conducted in the USA and Europe.

RESULTS

The proportion of patients achieving Physician Global Assessment (PGA) treatment success as well as a modified Psoriasis Area and Severity Index (mPASI)75 response was higher in the subgroup with a body surface area > 10% and mPASI > 10 and Dermatology Life Quality Index > 10 at baseline compared to the overall patient population. Furthermore, the numerical difference in treatment efficacy between CAL/BDP PAD-cream and CAL/BDP topical suspension/gel increased in patient subgroups with higher baseline severity. Similar patterns were shown for the patient-reported outcomes.

CONCLUSION

In this subgroup analysis, patients who had higher disease severity at baseline achieved greater efficacy than the total patient population when treated with 8 weeks of CAL/BDP PAD-cream as compared to a currently marketed active comparator. Additionally, as indicated by this analysis, CAL/BDP PAD-cream treatment may also be more convenient and less greasy, which may reduce the burden of daily treatment and improve adherence to therapy.

TRIAL REGISTRATION

NCT03308799 and NCT03802344.

Drying behaviour and visualization of surfactants after co-spray drying of surfactant-stabilized aqueous suspensions

Surfactants are widely used in many industries as dispersants or flocculants for suspensions. As the addition of low concentrations of surfactant is sufficient to execute their effect, they barely alter the formulation composition. In this research it was examined whether surfactants, in particular polysorbate 80 (PS80), were suitable as suspension stabilizers for co-spray drying of drug-filler combinations. Therefore, their drying behaviour at different process and formulation settings was studied and mapped by means of fluorescently labelled PS80. Co-spray drying of 10% w/w aqueous suspensions stabilized with 0.1% w/w PS80 resulted in excessive loss of sticky powder in the conical lower part of the drying chamber and the powder conveyor ducts. Up to 16% of powder was lost in the first transporter (i.e. the first part of the conveyor ducts). The amount of powder deposited in the first transporter, and by extension the stickiness of the recovered powder, was correlated with the presence of PS80 on the surface of the spray dried particles. Redistribution of free surfactant molecules during droplet drying depended on the process and formulation parameters. Enrichment of PS80 at the particle surface was most pronounced after co-spray drying of liquid feedstocks with low suspended fraction at process conditions favouring rapid droplet drying.

Precellys® Evolution Homogenizer - a versatile instrument for milling, mixing, and amorphization of drugs in preformulation

The aim of this work was the evaluation and introduction of the Bertin Precellys® Evolution homogenizer with Cryolys® as a valuable and versatile tool for the improvement of workflows in the preformulation phase of drug development. The presented pilot experiments indicate that the instrument can be applied for (1) screening of appropriate vehicles for the generation of micro- and nano suspensions, (2) small-scale manufacturing of suspension formulations for preclinical animal studies, (3) drug amorphization and identification of appropriate excipients for amorphous systems, and (4) preparation of homogenous powder blends. The instrument allows the rapid, parallel, and compound-sparing screening of formulation approaches and small-scale formulation manufacturing, in particular for low solubility compounds. For the characterization of generated formulations, miniaturized methods are introduced such as a screening tool for suspension sedimentation and redispersion and a non-sink dissolution model in biorelevant media in microtiter plates. This work summarizes exploratory, proof-of-concept studies and opens up new opportunities for more extended studies with this instrument in various application areas.

Spatial sedimentation and plant captured sediment within seagrass patches

Habitat degradation in coastal ecosystems has resulted in the fragmentation of coastal aquatic vegetation and compromised their role in supplying essential ecological services such as trapping sediment or sequestering carbon. Fragmentation has changed seagrass architecture by decreasing the density of the canopy or engendering small patches of vegetated areas. This study aims to quantify the role different patch sizes of vegetation with different canopy densities have in the spatial distribution of sediment within a patch. To this aim, two canopy densities, four different patch lengths, and two wave frequencies were considered. The amounts of sediment deposited onto the bed, captured by plant leaves, remaining in suspension within the canopy, and remaining in suspension above the canopy were used to understand the impact hydrodynamics has on sediment distribution patterns within seagrass patches. In all the cases studied, patches reduced the suspended sediment concentrations, increased the capture of particles in the leaves, and increased the sedimentation rates to the bed. For the lowest wave frequency studied (0.5 Hz), the sediment deposited to the bottom was enhanced at canopy edges, resulting in spatial heterogeneous sedimentation patterns. Therefore, restoration and preservation of coastal aquatic vegetation landscapes can help face future climate change scenarios where an increase in sedimentation can help mitigate predicted sea level rise in coastal areas.

An Examination of Suspension & Expulsion in Community Childcare Centers Two Years into the COVID-19 Pandemic

Suspension and expulsion have been documented concerns in childcare centers throughout the United States for nearly 20 years. This study examined suspension and expulsion practices in community childcare centers two years into the COVID-19 pandemic (May 2022). Survey data from 131 administrators of community childcare programs were analyzed. It was found that at least 67 individual children were reported expelled across 131 programs, a rate similar to pre-pandemic rates and higher than rates at the height of the pandemic. For suspension, 136 individual children were suspended from early learning programs during this time; a rate almost double pre-pandemic levels. Factors (availability of support, prior suspensions, suggesting the program is not a match, reported turnover, waiting lists, enrollment capacity, administrator reported stress, and teacher perceived stress) were examined to determine if they predicted expulsion. None of these factors significantly predicted expulsion. These results and their limitations and implications are discussed.

Electrospun UV-cross-linked polyvinylpyrrolidone fibers modified with polycaprolactone/polyethersulfone microspheres for drug delivery

Electrospun fibers, often used as drug delivery systems, have two drawbacks - in the first stage of their action a sudden active substance burst release occurs and they have a relatively small capacity for a drug. In this work the fibers are modified by the addition of drug-loaded microspheres acting as micro-containers for the drug and increasing the total drug capacity of the system. Its release from such a structure is slowed down by placing the microspheres inside the fibers so they are covered with an outer layer of fiber-forming polymer. The work presents a new method (microsphere suspension electrospinning) of obtaining polyvinylpyrrolidone fibers cross-linked with UV light modified with polycaprolactone/polyethersulphone microspheres loaded with active substance - rhodamine 640 as a marker or ampicillin as a drug example. The influence of UV-cross-linking time and the microspheres addition on the degradation, mechanical strength and transport properties of fibrous mats was investigated. The mats were insoluble in water, in some cases mechanically stronger, their drug capacity was increased and the burst effect was eliminated. The antibacterial properties of ampicillin-loaded mats were confirmed. The product of proposed suspension electrospinning process has application potential as a drug delivery system.

Pharmacokinetic evaluation of poorly soluble compounds formulated as nano- or microcrystals after intraperitoneal injection to mice

Intraperitonial (i.p.) delivery during initial stages of drug discovery can allow efficacy readouts for compounds which have suboptimal pharmacokinetics (PK) due to poor physiochemical properties and/or oral bioavailability. A major limitation for widespread use of i.p. administration is the paucity of published data and unclear mechanisms of absorption, particularly when using complex formulations. The aim of the present study was to investigate the PK of poorly soluble compounds with low oral bioavailability when administered i.p. as crystalline nano- and microsuspensions. Three compounds, with varying aqueous solubility (2, 7, and 38 µM, at 37 °C), were dosed to mice at 10 and 50 mg/kg. In vitro dissolution confirmed that nanocrystals dissolved faster than microcrystals and hence were expected to result in higher exposure after i.p. dosing. Surprisingly, the increase in dissolution rate with decrease in particle size did not result in higher in vivo exposure. In contrast, the microcrystals showed higher exposure. The potential of smaller particles to promote access to the lymphatic system is hypothesized and discussed as one plausible explanation. The present work demonstrates the importance of understanding physicochemical properties of drug formulations in the context of the microphysiology at the delivery site and how that knowledge can be leveraged to alter systemic PK.

Synthesis and effect of CoCuFeNi high entropy alloy nanoparticles on seed germination, plant growth, and microorganisms inactivation activity

Implementation of nanotechnology in agriculture is of interest primarily to improve the growth and productivity of crops, and to minimize the use of traditional expensive chemical fertilizers. This work presents a simple energy-conservative approach for the synthesis of CoCuFeNi high entropy alloy nanoparticles (HEA-NPs) capable of forming a stable suspension with a concentration of 0.3 g/L. The size, composition, and morphology of the nanoparticles were analyzed by XRD, SEM, TEM, and EDS. Obtained HEA-NPs were characterized by fine crystallinity with an average size of 25 nm. The investigated suspensions of HEA-NPs were tested for seeds germination and plants growth. The use of suspension of CoCuFeNi HEA-NPs for plant irrigating together with ordinary water showed positive results in plant biostimulation, which resulted in the plant height up to 12% for watercress and up to 50% for oil radish. CoCuFeNi HEA-NPs showed nice inactivation activity for Pseudomonas aeruginosa that was comparable for the use of Tetracycline.

Drug Product Characterization of High Concentration Non-Aqueous Protein Powder Suspensions

High concentration protein formulations for subcutaneous injection represent a substantial number of development projects in the pharmaceutical industry. Such concentrated aqueous protein solutions face some specific challenges such as increased viscosity and aggregation propensity. Protein powder suspensions in non-aqueous vehicles could be an alternative providing lower viscosity than the respective aqueous solution. The choice of potential suspension vehicles is limited as traditional non-aqueous liquids, such as oils, show an inherent high viscosity. We studied suspensions prepared by dispersing spray-dried protein powder in different vehicles including sesame oil and medium chain triglycerides, as well as fluorinated and semifluorinated alkanes. We found, that semifluorinated alkanes enable formulations with high concentrations up to 280 mg/ml monoclonal antibody with a low viscosity of less than 10 mPa·s and low injection forces. The glide force of suspensions containing 210 mg/ml protein was not affected by the particle size of the spray-dried powders with medians ranging from 1 to 14 µm. In contrast, suspensions prepared with cryo-milled powder showed markedly higher viscosities and were not injectable at the same concentration. Protein powder suspensions were syringeable using a 25G needle. Vial filling using a peristaltic pump was possible and lead to a uniform filling. Sedimentation of the suspension was slow and does not lead to challenges upon vial filling during manufacturing or transfer of the suspension into syringes. Thus, we could show that dispersions of spray-dried protein powders in non-aqueous vehicles, such as semifluorinated alkanes, are a promising alternative to aqueous protein solutions at high concentrations.

Chemical and Process Parameters Influencing Gelling during Pharmaceutical Wet Media Milling

Attributed with improved patient adherence, reduced dosing frequency, and potential for reduced side effects, long-acting therapeutics (including suspension formulations) have increased in popularity as a novel dosage form. Yet, although there are appreciable patient benefits for suspension formulations, the complex top-down manufacturing process train may be derailed with unanticipated outcomes. One such outcome is a sharp increase in suspension viscosity, referred to as gelling. The scope of this commentary is a comprehensive roadmap of the literature associated with the gelling phenomenon during suspension manufacture when wet bead milling is used as the manufacturing modality. The article will examine case studies that highlight attributable parameters including formulation, process, and operator actions that directly correlate with observed manufacturing outcomes. Scientifically validated terminology and carefully selected analytical characterization of the resultant gel product have been identified as avenues for increased understanding and awareness for improved manufacturing outcomes.

Mechanically and physiologically optimizing prosthetic elevated vacuum systems in people with transtibial amputation: a pilot study

Introduction

The most suitable elevated vacuum (EV) pressure may differ for each individual prosthesis user depending on suspension needs, socket fit, prosthetic components, and health. Mechanical and physiological effects of EV were evaluated in an effort to determine the optimal vacuum pressure for three individuals.

Methods

Instrumented EV sockets were created based on the participants' regular EV sockets. Inductive distance sensors were embedded into the wall of the socket at select locations to measure limb movement relative to the socket. Each participant conducted an activity protocol while limb movement, limb fluid volume, and user-reported comfort were measured at various socket vacuum pressure settings.

Results

Increased socket vacuum pressure resulted in reduced limb-socket displacement for each participant; however, 81-93% of limb movement was eliminated by a vacuum pressure setting of 12 (approximately -9 inHg). Relative limb-socket displacement by sensor location varied for each participant, suggesting distinct differences related to socket fit or residual limb tissue content. The rate of limb fluid volume change and the change in socket comfort did not consistently differ with socket vacuum pressure, suggesting a more complex relationship unique to each individual.

Conclusions

Practitioners may use individual responses to optimize socket vacuum pressure settings, balancing mechanical and physiological effects of EV for improved clinical outcomes.

Use of antimicrobial agents in actively dying inpatients after suspension of life-sustaining treatments: Suggestion for antimicrobial stewardship

BACKGROUND

The role of antimicrobial treatment in end-of-life care has been controversial, whether antibiotics have beneficial effects on comfort and prolonged survival or long-term harmful effects on increasing antimicrobial resistance. We assessed the use of antimicrobial agents and factors associated with de-escalation in inpatients who suspended life-sustaining treatments (SLST) and immediately died.

METHODS

We included 1296 (74.7%) inpatients who died within 7 days after SLST out of 1734 patients who consented to SLST on their own or family's initiative following a decision by two physicians, observing the "Life-sustaining Treatment Decision Act" between January 2020 and December 2020 at two teaching hospitals. De-escalation was defined as changing to narrower spectrum anti-bacterial drugs or stopping ≥ one antibiotic of combined treatment.

RESULTS

90.6% of total patients received anti-bacterial agents, particularly a combination treatment in 60.1% and use of ≥ three drugs in 18.2% of them. Antifungal and antiviral drugs were administered to 12.6% and 3.3% of the patients on SLST, respectively. Antibacterial and antifungal agents were withdrawn in only 8.3% and 1.3% of the patients after SLST, respectively. Anti-bacterial de-escalation was performed in 17.0% of patients, but 43.6% of them received more or broad-spectrum antibiotics after SLST. In multivariate regression, longer hospital stays before SLST, initiation of SLST in the intensive care unit, and cardiovascular diseases were independently associated with anti-bacterial de-escalation after SLST.

CONCLUSIONS

The intervention for substantial antibiotic use in patients on SLST should be carefully considered as antimicrobial stewardship after decision by the will of the patient and proxy.

Analytical potential of total reflection X-ray fluorescence (TXRF) instrumentation for simple determination of major and trace elements in milk powder samples

In this contribution, the analytical potential of total reflection X-ray fluorescence (TXRF) instrumentation has been evaluated for the determination of major and trace elements in milk powder. TXRF allows the possibility of direct analysis of solid suspensions without the need for a digestion process and therefore it can be a potential analytical candidate for simple and cost-effective analysis. A detailed study to select sample preparation and measurements conditions was carried out. Different quantification approaches (including internal standardization and empirical calibration) were also tested. Finally, the developed TXRF methods (W anode) were validated by a strict comparison with the data from the reference methods on a set of twenty-three samples using robust statistics. Results showed that acceptable results can be obtained for K, Ca, Fe and Zn determination if using adequate calibration approaches. Otherwise, only screening results can be obtained for light elements (P and Cl) in milk powder samples.

Determination of trace elements in placenta by total reflection X-ray fluorescence spectrometry: effects of sampling and sample preparation

Placental elemental composition can serve as an indicator for neonatal health. Medical studies aiming at revealing such cause-and-effect relationships or studies monitoring potential environmental influences consist of large sample series to ensure statistically sufficient data. Several analytical techniques have been used to study trace metals in human placenta. However, most techniques require provision of clear liquid sample solutions and therefore time- and reagent-consuming total digestion of biological tissue is necessary. In total reflection X-ray fluorescence spectrometry (TXRF)-a straightforward multielement analytical technique-in contrast suspensions of minute sample amounts can be analyzed directly. Therefore, herein we report on a valid method to prepare homogenous sample suspensions for sustainable and fast TXRF analysis of large sample series. The optimized method requires only 10 mg of powdered placental tissue and 1 mL nitric acid. Suspensions are readily prepared within 30 min and the found mass fractions of major, minor, and trace elements are in good agreement in comparison to analysis of digests. In addition, possible effects on fixation time and the exact sampling location, i.e., maternal vs. fetal side of the placenta, were studied applying this method. Thereby, significant differences for fetal placenta tissue compared to maternal or intermediate tissue were observed revealing accumulation of trace elements in the fetal side of the placenta. Furthermore, considerable depletion of up to 60% mass fraction with longer fixation duration occurred in particular in fetal placenta tissue. These findings help to understand the large ranges of mass fraction of elements in placenta reported in the literature and at the same time indicate the necessity for more systematic investigation of non-homogenous elements distributed in placenta taking sampling and stabilization methods into account.

Following drug degradation and consequent taste deterioration of an oral reconstituted paediatric suspension during dosing interval via electronic tongue

Background

The taste of oral liquid dosage forms is a crucial factor that impacts pediatric patient compliance. Taste of suspensions can be typically evaluated by human volunteers. Recently, the electronic tongue (ET) has been proven as an emerging tool that could be useful to follow up various formulations' properties like taste and composition. This study aimed to evaluate the potential use of ET in assessing the taste deterioration of reconstituted oral suspensions and compare the results obtained with the typical in vivo panel taste method.

Methods

Four commercially available brands of amoxicillin/ clavulanic acid suspensions (one brand and three generic formulations) were reconstituted and stored in refrigerator to assess their taste on a daily basis. The taste of these products was assessed using Alpha-Astree ET and the obtained results were compared with those obtained from an in vivo panel taste assessment using a hedonic panel test (the 5-point hedonic scale).

Results

All evaluated suspensions exhibited similar trends. ET and in vivo analysis indicated low taste scores for all evaluated suspensions immediately after reconstitution, possibly due to the incomplete dissolution of sucrose. The scores for all formulations were higher on day 2, followed by a steady state for the next two days. After that, a significant decay in the scores was observed in the fifth day for all evaluated suspensions. ET results were in excellent agreement with the results obtained via in vivo panel test method.

Conclusion

The ET seems to be promising for testing the taste of pharmaceutical liquid preparations and evaluate possible deterioration upon storage or after reconstitution. It may provide a platform to avoid the involvement of pediatric volunteers in clinical evaluation and can be employed as a quality control tool during manufacturing.

Exposure to family and domestic violence is associated with lower attendance and higher suspension in school children

BACKGROUND

Exposure to family and domestic violence (FDV) in childhood can have a detrimental effect on children's health and social outcomes. However, research on the school outcomes of children exposed to FDV is scant.

OBJECTIVES

To investigate the impact of FDV exposure on school attendance and suspension in Aboriginal and non-Aboriginal children.

METHODS

A population-based retrospective cohort study of school children, in grade 1 to 10, born from 1993 to 2006 in Western Australia (n = 26,743) using linked administrative data. Multivariate logistic regression analysis was used to calculate odds ratios and 95% confidence intervals to determine the association with school attendance and suspension outcomes for children exposed to FDV compared to non-exposed children.

RESULTS

Compared to non-exposed children, children exposed to FDV have an increase of poor school attendance: Aboriginal children adjusted odds ratio (aOR) = 1.91, 95% confidence interval (CI): 1.75-2.07, non-Aboriginal children aOR = 2.42, 95%CI: 2.12-2.75. FDV-exposed children also have an increased risk of school suspension: Aboriginal children aOR = 1.60, 95%CI: 1.47-1.74, non-Aboriginal children aOR = 2.68, 95%CI: 2.35-3.05, compared to non-exposed counterparts.

CONCLUSION

Exposure to FDV is associated with an increased odds of poor school attendance and school suspension. Evidence-based and innovative strategies are needed to support children who are exposed to FDV. This involves responding in ways that does not cause further trauma to children; a restorative and trauma-informed approach is vital.

Factors related to suspension of day-care services: an effective program for older users with declined ambulation to reduce care burden

PURPOSE

Day-care services contribute to maintaining the daily living ability of older people cared for at home. This study aimed to detect factors that could impede the continuation of day-care services.

METHODS

We collected clinical data of 132 older users (age = 82.8 ± 7.5 years; male:female = 49:83) utilizing our day-care center from April 2019 to March 2020. We evaluated age, sex, underlying disease, medication, family background, care level, food texture, physical ability, reasons for frequenting day-care centers, and combined medical/nursing care plans. Participants were divided into two groups: continuation (n = 51) and suspension (n = 81). The collected items were evaluated statistically using the chi-square test, Mann-Whitney test, and unpaired t test. Multivariate logistic analysis (forward-backward stepwise selection method) was added to the statistically significant items. Statistical significance was defined as p < 0.05.

RESULTS

The comparison test detected statistical significance in Parkinson disease/Parkinsonism, pain complaints, day-service use, short-stay service use, day-care center use to reduce care burden, physical ability including ambulation, and availability of the major caregiver (p < 0.05). Day-care service use to reduce care burden (odds ratio 5.646, p < 0.05), use of short-stay and day-care services (odds ratio 4.798, p < 0.05), and low independent ambulation (odds ratio 0.585, p < 0.05) were the likely factors for suspended use (percentage of correct classification = 68.5%).

CONCLUSION

An unreplaceable and effective program for day-service and short-stay services to improve the activities of daily living of older users and reduce care burden is required in day-care centers.

[Resection arthroplasty for thumb basal joint arthritis]

Due to the crucial role of the thumb for gripping, osteoarthritis of the first carpometacarpal joint leads to a substantial impairment of hand function. There are effective nonoperative and joint-preserving surgical treatment options for early stages of the disease. In advanced cases, after exploiting conservative treatment, carpometacarpal thumb arthrodesis or arthroplasty may be indicated in selected cases but trapeziectomy with or without interposition or suspension constitutes the gold standard surgical procedure. This reliably provides favorable results, irrespective of the technique, with pain relief, good physical function, excellent patient global assessment and low complication rates.

Breakfast and School-Related Outcomes in Children and Adolescents in the US: A Literature Review and its Implications for School Nutrition Policy

PURPOSE OF REVIEW

To identify and review the latest research on the connections between breakfast and school-related outcomes in children and adolescents in the US, and to explore the implications of this research on US school nutrition policy, particularly as it applies to students experiencing or at risk for food insecurity.

RECENT FINDINGS

Although school personnel, parents, and students have positive attitudes about breakfast and its benefits for learning, recent research finds mixed evidence for the role of breakfast in improving objectively measured grades and test scores. Few recent studies examined behavioral outcomes, limiting the ability to draw clear conclusions about breakfast and school behavior. Several studies observed improved attendance with increased school breakfast access and participation, especially when schools offered breakfast at no cost to all students. There are many challenges to studying the connections between breakfast and learning. The recent research on breakfast and academic outcomes is mixed, but there is a growing body of evidence that eliminating fees for both school breakfast and lunch has promise for improving school-related outcomes.

Early adverse childhood experiences and exclusionary discipline in high school

The use of school suspension and expulsion is a widespread phenomenon in American schools (Wallace et al., 2009; Owens and McLanahan, 2020). Yet, much of what we know about these exclusionary practices provide little insight into the personal biographies of the students themselves-specifically their histories of childhood trauma. Using measures of adverse childhood experiences (ACEs), we examine the link between early ACEs (up to age 5) and school suspension/expulsion using the Fragile Families and Child Wellbeing Study (1998-2010) (FFCWS). We find that a child with a cumulative ACE score are almost four times more likely to have been suspended or expelled. Importantly, this negative link persists even when accounting for factors known to be associated with ACEs and school discipline. This work offers new theoretical insight into how we understand discipline in school contexts and suggests the importance of trauma-informed interventions in the American education system.

In Vitro Quantification of Cancer Stem Cells Using a Mammosphere Formation Assay

Cancer stem cells (CSCs) are a small subpopulation of self-renewing cancer cells that are present within tumors. In this chapter, we provide a detailed method for the quantification of CSCs in vitro through mammosphere formation.

Impact of COVID-19 and suspension of colorectal cancer screening on incidence and stage distribution of colorectal cancers in the Netherlands

Many countries had to suspend their colorectal cancer (CRC) screening programme as a result of the COVID-19 pandemic. This eventually may lead to postponed diagnoses of premalignant lesions and CRC, resulting in increased incidence or more advanced CRCs rates. This study aimed to assess the impact of the COVID-19 pandemic on incidence and stage distribution of CRCs in the Netherlands, by monitoring CRC diagnoses and stage distribution in the months before, during and after the first COVID-19 wave. Data on incidence and stage distribution of CRCs of individuals aged 55-75 years in 25 hospitals in the Netherlands were extracted from the Netherlands Cancer Registry. The observed incidence after the suspension (March 2020-December 2020) was compared to the expected incidence in the same period. In the period April to June 2020, we observed the largest decrease in the total incidence of CRC. We found that 48% of the decrease was due to stage I, 23% due to stage II, 23% due to stage III and 5% due to stage IV. After gradually resuming screening mid May 2020, we observed an increase in CRC diagnoses from July 2020 onwards. As of October 2020, the observed number of diagnoses was higher than the expected number. As the decrease was mainly limited to stage I CRCs, it seems that the temporary suspension of the CRC screening programme due to the COVID-19 pandemic will have a minimal long-term impact on stage distribution and CRC mortality.

Dose Uniformity of Loteprednol Etabonate (Submicron) Ophthalmic Gel 0.38% Compared with Prednisolone Acetate Ophthalmic Suspension 1

INTRODUCTION

Loteprednol etabonate (submicron) ophthalmic gel 0.38% (LE SM gel 0.38%) is a corticosteroid formulation designed to retain the nonsettling characteristics of loteprednol etabonate ophthalmic gel 0.5%, but with reduced drug particle size to improve ocular penetration, allowing for reduced dosing frequency. This study compared the dose uniformity of LE SM gel 0.38% with branded and generic prednisolone acetate (PA) 1% suspensions under simulated in-use dosing conditions.

METHODS

Drug concentrations in drops of LE SM gel 0.38% and PA 1% suspensions, expressed from bottles that were shaken or not shaken, were determined during 2 weeks of simulated on-label dosing (LE SM gel 0.38%: three times daily; PA suspensions: four times daily). Sedimentation of drug particles was assessed for each product using dispersion analysis.

RESULTS

The mean (SD) percent declared drug concentration of LE SM gel 0.38% over 2 weeks was 103.2% (1.3%) when the drug was dispensed from shaken bottles and 103.3% (1.5%) when dispensed from unshaken bottles. However, for branded and generic PA suspensions, mean (SD) percent declared concentrations were 102.2% (1.4%) and 98.3% (2.9%), respectively, when dispensed from shaken bottles; and 89.2% (18.6%) and 78.3% (13.5%), respectively, when dispensed from unshaken bottles. Dispersion analysis showed that drug particles in LE SM gel 0.38% remained fully suspended under accelerated sedimentation conditions, whereas both branded and generic PA suspension drug particles settled out of suspension.

CONCLUSIONS

LE SM gel 0.38% delivered the drug consistently at the declared concentration over the entire 2 weeks of simulated in-use dosing conditions, regardless of whether the drug was dispensed from shaken or unshaken bottles. However, both branded and generic PA suspensions required the bottle to be shaken to provide a consistent drug concentration.

Residual limb shear strain during gait is correlated with patient reported outcomes for persons with transfemoral amputation

The purpose of this study was to measure residual limb skin strain and strain rate within the socket during gait in individuals with a transfemoral amputation and to determine if skin strain during gait is related to patient-reported comfort and function. It was hypothesized that greater skin strain and skin strain rate would correlate to worse patient-reported outcomes. It was also hypothesized that skin strain would progressively increase from the distal to the proximal end of the residuum and maximum strain would occur shortly after heel strike. Dynamic biplane radiography (DBR), combined with conventional motion capture, was used to measure skin deformation within the socket during treadmill walking for 10 persons with unilateral transfemoral amputation. The questionnaire for persons with a transfemoral amputation (Q-TFA) was administered to assess prosthetic use, mobility, health problems, and global health. Q-TFA Prosthetic Use score and Problem score were negatively correlated with the peak shear strains in the proximal and distal regions of the residuum, respectively. Maximum shear strain increased progressively from proximal to distal regions of the residual limb. Within-subject variability in shear strain waveforms during gait was 0.7% or less, but between-subject variability was 3.3% to 5.0% shear. This study demonstrates that skin shear within the socket of persons with transfemoral amputation can be measured during gait using DBR and the results suggest that greater skin shear in the proximal region of the socket is related to decreased prosthetic use.

Pharmacokinetics of toltrazuril and its metabolites after oral and parenteral administration of novel oil-based suspension based on micro-environmental pH-modifying solid dispersion in rabbits

Toltrazuril (TOL) is a broad-spectrum anticoccidial drug which is widely used in poultry and livestock. A novel oral suspension based on soybean oil-based TOL micro-environmental pH-modifying solid dispersion (micro pHm SD) and a novel injectable suspension based on white oil-based TOL micro pHm SD were developed, showing high physicochemical stability and high drug release in vitro with good histocompatibility. The present study is to evaluate the pharmacokinetic profiles of TOL and its major metabolites, e.g. toltrazuril sulfoxide (TOLSO) and toltrazuril sulfone (TOLSO₂) in rabbits following oral or subcutaneous administration with these two TOL SD suspensions. The plasma concentrations of TOL, TOLSO and TOLSO₂ were determined by high performance liquid chromatography (HPLC). Plasma concentration-time data were analyzed by a non-compartmental model analysis. The soybean oil-based TOL suspension after single oral administration at 20 mg/kg body weight (bw) significantly increased the plasma concentrations of TOL, TOLSO and TOLSO₂ compared with Baycox® 5 % suspension. Following subcutaneous administration of the white oil-based TOL suspension (20 mg/kg bw), TOL was well absorbed and metabolized more slowly to TOLSO and TOLSO₂, compared with oral administration, resulting in the significantly prolonged residence time in rabbits. The two suspensions significantly improved the relative bioavailability of TOL and its two metabolites, showing their potential usage in the control of coccidian in poultry and livestock.

Exclusionary School Discipline and Delinquent Outcomes: A Meta-Analysis

Excluding students from school remains a common form of punishment despite growing critique of the practice. A disparate research base has impeded the ability to make broader assessments on the association between exclusionary discipline (i.e., suspensions and expulsions) and subsequent behavior. This article synthesizes existing empirical evidence (274 effect sizes from 40 primary studies) examining the relationship between exclusionary discipline and delinquent outcomes, including school misconduct/infractions, antisocial behavior, involvement with the justice system, and risky behaviors. This meta-analysis identifies exclusionary discipline as an important and meaningful predictor of increased delinquency. Additional examinations of potential moderators, including race/ethnicity and type of exclusion, revealed no significant differences, suggesting the harm associated with exclusions is consistent across subgroups. These findings indicate exclusionary discipline may inadvertently exacerbate rather than mollify delinquent behaviors.

Film entrainment and microplastic particles retention during gas invasion in suspension-filled microchannels

Understanding of microplastics transport mechanism is highly important for soil contamination and remediation. The transport behaviors of microplastics in soils are complex and influenced by various factors including soil and particle properties, hydrodynamic conditions, and biota activities. Via a microfluidic experiments we study liquid film entrainment and microplastics transport and retention during two-phase displacement in microchannels with one end connected to the air and the other connected to the liquid with suspended particles. We discover three transport patterns of microplastic particles, ranging from no deposition to particle entrapment and to particle layering within liquid films, depending on the suspension withdrawal rates and the particle volume fraction in the suspension. The general behavior of particle motion is effectively captured by the film thickness evolution which is shown to be dependent on a modified capillary number Ca₀ taking into account the effects of flow velocity, particle volume fraction, and channel shape. We also provide a theoretical prediction of the critical capillary number Ca₀* for particle entrapment, consistent with the experimental results. In addition, the probability of microplastics being dragged into the trailing liquid film near the gas invading front is found to be proportional to both particle volume fraction and the capillary number. This work elucidates the microplastics transport mechanism during unsaturated flow, and therefore is of theoretical and practical importance to understand the contaminant migration in many natural and engineered systems spanning from groundwater sources to water treatment facilities.

Sonochemical activity in ultrasonic reactors under heterogeneous conditions

Due to its physical and chemical effects, ultrasound is widely used for industrial purposes, especially in heterogeneous medium. Nevertheless, this heterogeneity can influence the ultrasonic activity. In this study, the effect of the addition of inert glass beads on the sonochemical activity inside an ultrasonic reactor is investigated by monitoring the formation rate of triiodide, and the ultrasonic power is measured by calorimetry and by acoustic radiation. It was found that the sonochemical activity strongly depends on the surface area of the glass beads in the medium: it decreases above a critical area value (around 10^-2 m²), partly due to wave scattering and attenuation. This result is confirmed for a large range of frequencies (from 20 to 1135 kHz) and glass beads diameters (from 8-12 µm to 6 mm). It was also demonstrated that above a given threshold of the surface area, only part of the supplied ultrasonic power is devoted to chemical effects of ultrasound. Finally, the acoustic radiation power appears to describe the influence of solids on sonochemical activity, contrary to the calorimetric power.

Analytical method development for characterizing ingredient-specific particle size distributions of nasal spray suspension products

Particle size characterization for active pharmaceutical ingredients (APIs) in nasal spray suspension products presents unique challenges because both the API and excipient particles are present in the final dosage form. Currently, an established method is lacking because traditional particle sizing technologies do not distinguish the chemical identity of the particles. In this study, a non-destructive, ingredient-specific particle sizing method was developed for characterization of mometasone furoate (MF) nasal spray suspensions using Morphology Directed Raman Spectroscopy (MDRS). A five-step method development procedure was used in this study: sample preparation, particle imaging and morphology analysis, particle Raman measurements and classification, morphology filter selection, and minimum number of particles determination. Wet dispersion sample preparation method was selected to ensure that the particles were measured in their original suspended state. A training set containing over 10,000 randomly-selected particles, including both the API and excipient particles, was used to gain a comprehensive understanding of particle size, shape, and chemical ID for the nasal spray suspension. Morphology and Raman measurements were performed on each particle in the training set. The measurement results suggested that the aspect ratio and intensity mean filter combination was an appropriate morphology filter setting to selectively target API particles and exclude most of excipient particles. With further optimization of the morphology filter cutoff values and determination of minimal number of particles to be measured, the total measurement time was reduced from 90 hours to 8 hours. The morphologically screening strategy ultimately allowed us to create a time-efficient practical API-specific particle size distribution (PSD) methods for nasal spray suspensions. This study shows that MDRS is a fit for purpose analytical technique for determining ingredient-specific PSDs of the pharmaceutical formulation studied in this work.

Analyzing ophthalmic suspension particle size distributions using laser diffraction: Placebo background subtraction method

The current study demonstrated that the presence of excipients can interfere with the measurement of particle size distribution (PSD), a critical quality attribute of ophthalmic suspensions, by laser diffraction (LD) and that a placebo background subtraction approach can eliminate the impact of excipients on the PSD measurement. Commercially available loteprednol etabonate and brinzolamide ophthalmic suspensions were used as model suspensions. The impact of excipients in these formulations on the LD measurements was determined using a one-factor-at-a-time experimental design approach, using National Institute of Standards and Technology (NIST) traceable polystyrene particle size standards as references. Among the evaluated excipients, polymers containing polyacrylic acid were found to interfere with the PSD analysis by creating the LD signals correspond to particles ranging from a few micrometers to a hundred micrometers in size. As a result, the measured PSD of active pharmaceutical ingredient (API) particles in the formulation overlapped with or superimposed on the excipient PSD signal, leading to erroneous interpretation of the API particle size. Additionally, dispersion of brinzolamide particles in unsaturated solutions led to rapid dissolution of brinzolamide particles during the measurement, resulting in underestimation of the particle size range. Here, a placebo background subtraction approach was developed to eliminate the interference of the excipients. This newly developed LD method was also evaluated using orthogonal methods, including polarized light microscopy and scanning electron microscopy (SEM). The strategy used in this study to eliminate the interference of excipients may also be useful for other heterogeneous dispersions where excipient interference may be of concern.

Milling of poorly soluble crystalline drug compounds to generate appropriate particle sizes for inhaled sustained drug delivery

One of the simplest design concepts of inhaled sustained drug delivery to the lung is to utilize the slow dissolution of drug crystals with poor aqueous solubility. An optimum dissolution rate, and thereby a delivery profile locally in the lung tissue, can be achieved in a reliable way by selecting a compound with an appropriate combination of solubility and particle size. It is in our experience relatively straightforward to manufacture monomodal particle size distributions of poorly soluble drug crystals in the mass median diameter range of either a few micrometers or a few hundred nanometers, but very challenging to manufacture a monomodal distribution in the range intermediate to these two. In this manuscript, we describe an investigation with the objective of generating desired particle sizes in the whole size range from a few micrometers to a few hundred nanometers for inhaled sustained drug delivery, by utilizing Adaptive Focused Acoustic (AFA) milling and planetary bead-milling. By combining the two different milling techniques it was possible to produce two to three distinctly different monomodal or almost monomodal particle size distributions in the desired particle size range of each of the model drug compounds in milligram scale. The dissolution kinetics of the different particle sizes of the model drugs were measured experimentally as well as predicted theoretically, showcasing that the dissolution kinetics can be characterized, predicted and significantly changed in a controlled way by modifying the particle size. For one of the model drugs, it was shown in an in vivo rat study that the inhaled sustained drug delivery profile in the lung tissue could be significantly changed by modifying the particle size of the drug.

Suspension of fertility treatment during the COVID-19 pandemic: views, emotional reactions and psychological distress among women undergoing fertility treatment

RESEARCH QUESTION

What are the views and emotional reactions of patients towards the suspension of fertility treatment during the COVID-19 pandemic, and what are the factors affecting their psychological distress?

DESIGN

A cross-sectional study conducted in an academic fertility centre. Online questionnaires were distributed between 18 April 2020 and 23 April 2020 to patients whose treatment cycle had been postponed or discontinued. The outcome measures included agreement with the reproductive society guidelines to postpone treatments; willingness to resume treatments, given the choice; patients' emotional reactions; and psychological distress level, measured by the Mental Health Inventory validated scale. A multivariate linear regression was conducted to identify factors associated with psychological distress.

RESULTS

Because of the small number of male respondents, only women were included in the analysis (n = 181). Forty-three per cent expressed disagreement with the guidelines and 82% were willing to resume treatments, given the choice. Sadness and anxiety were the most common emotional reactions expressed towards the guidelines. In the multivariate analysis, COVID-19-related anxiety (B = 0.145, P = 0.04) and disagreement with treatment suspension (B = -0.44, P = 0.001) were found to be significantly associated with patients' psychological distress. Background characteristics of patients did not contribute significantly to their distress.

CONCLUSIONS

Suspension of fertility treatment during the initial phase of the COVID-19 pandemic was associated with patients' negative emotional reactions. Anxiety related to COVID-19 and disagreement with treatment suspension were found to be significantly associated with psychological distress among women undergoing fertility treatment, regardless of their background characteristics. Our findings suggest the need to monitor the mental health of patients and provide psychological support should a shutdown of fertility care re-occur.

Simplified abductor pollicis longus suspension interposition arthroplasty for thumb carpometacarpal joint osteoarthritis

Purpose

The primary treatment goals for advanced-stage thumb carpometacarpal (CMC) joint osteoarthritis are complete pain relief and restoration of thumb strength. The purpose of the present study was to introduce a variation of the abductor pollicis longus (APL) suspension arthroplasty using a single looping of a radial slip from the APL tendon around the flexor carpi radialis (FCR) tendon combined with RegJoint™ interposition and to determine its efficacy in the treatment of thumb CMC joint osteoarthritis.

Methods

Between 2015 and 2017, 21 patients were included. The average age was 60.8 years (range 48–79). The mean follow-up was 27.7 months (range 8–50). Evaluation included pain, radial and palmar abduction, tip pinch and grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score.

Results

Pain averaged 0.3 (range 0–4) at rest and 1.4 (range 0–4) on exertion. The radial and palmar abduction were 97% and 99% compared to the contralateral side. The tip pinch and grip strength were 4.1 kg (range 3–6.5) and 22 kg (range 13.3–40), respectively. The DASH score accounted for 18.5 (range 0.8–41.7).

Conclusion

The modified APL suspension interposition arthroplasty was an efficient and simplified option for the treatment of thumb CMC joint osteoarthritis, with results comparable or better than other published procedures. The APL suspension technique was easy to perform avoiding difficult bone tunneling and incision of the FCR tendon. The RegJoint™ interposition as spacer prevented impingement of the first metacarpal base on the second metacarpal base or the trapezoid bone.

Household food insecurity and preschool suspension/expulsion in the United States

Food insecurity is a serious public health concern, affecting approximately 15 million children in the U.S. alone. Exposure to household food insecurity has been linked to a host of deleterious outcomes among infants and children, including mental and behavioral health outcomes. Even so, scholars have yet to examine the connection between household food insecurity and early experiences of school punishment among preschool-aged children. The current study employs a nationally representative sample of 6100 preschool-aged children from the 2016 National Survey of Children's Health. Difference-of-means t-tests and multivariate logistic regression models examining the link between mild and moderate-to-severe household food insecurity and suspension/expulsion among preschool-aged children were conducted in 2020. All estimates were calculated using sample weights that adjust for nonresponse, probability of selection, and the demographic distribution of the target population (i.e., U.S. children attending preschool in 2016). The findings indicate a robust association between moderate-to-severe household food insecurity and suspension/expulsion among preschool-aged children. This association emerged only among male children, as their risk of suspension/expulsion increased more than 11-fold in the presence of moderate-to-severe food insecurity. Additional analyses revealed that a large portion of this association was attenuated upon accounting for parenting stress and child mental health. Trauma-informed nutrition assistance programming as well as early mental health assessment and consultation may yield collateral benefits in the form of reductions in preschool suspension/expulsion. Given the findings, moreover, future research should consider the role of household food insecurity in contributing to health inequities that perpetuate the school-to-prison pipeline.

Coming to grips with life upside down: how myosin fiber type and metabolic properties of sloth hindlimb muscles contribute to suspensory function

Sloths exhibit almost obligatory suspensory locomotion and posture. These behaviors require both strength and fatigue resistance, although we previously found muscle fiber type characteristics in the forelimbs of sloths that belied these initial expectations. Based on locomotor roles of the forelimbs versus hindlimbs in propulsion and braking, respectively, sloth hindlimb musculature should be adapted for force production and energy savings by a near homogeneous expression of slow myosin heavy chain (MHC) fibers. This hypothesis was tested by determining MHC fiber type (%) distribution and energy metabolism in the hindlimbs of three-toed (B. variegatus, N = 5) and two-toed (C. hoffmanni, N = 3) sloths. A primary expression of the slow MHC-1 isoform was found in the hindlimbs of both species. Slow MHC fiber type (%) was significantly greater in the flexors of B. variegatus, whereas expression of fast MHC-2A fibers was significantly greater in the extensors of C. hoffmannni. MHC-1 fibers were largest in cross-sectional area (CSA) and comprised the greatest %CSA in each muscle sampled from both species. Enzyme assays showed elevated activity for anaerobic enzymes (CK and LDH) compared with low-to-moderate activity for aerobic enzymes (3-HAD and CS), and only CK activity was related to body size. These findings emphasize a joint stabilization role by the hindlimbs during suspension, especially in smaller three-toed sloths, and suggest that larger two-toed sloths could have muscles further modified for greater power output and/or prolonged arboreal maneuvering. Moreover, modifications to muscle metabolism rather than MHC expression may be more reflective of functional adaptation in sloth limbs.

Motion of the residual femur within the socket during gait is associated with patient-reported problems in transfemoral amputees

The purpose of this study was to provide a quantitative description of residual femur motion within the socket during gait and to explore the relationship between residual femur motion and patient-reported comfort and function. It was hypothesized that increased residual bone movement would correlate to worse patient-reported comfort and function. The secondary goals were to assess within-subject step-to-step variability and between-subject variability in residual femur motion within the socket during gait. Dynamic biplane radiography, combined with conventional motion capture, was used to measure residual femur motion within the socket during treadmill walking for 10 unilateral transfemoral amputees. The questionnaire for persons with a transfemoral amputation (Q-TFA) was administered to assess prosthetic use, mobility, health problems, and global health. Increased femur pistoning (proximal-distal translation relative to the socket) correlated with worsening Q-TFA problem and global scores (ρ = 0.741, p = 0.04 and ρ = -0.783, p = 0.02, respectively). Average residual femur rotation ROMs were 7.3°±3.7°, 10.8°±4.4°, and 7.7°±4.8° for anterior tilt, internal-external rotation, and varus-valgus, respectively. Average residual femur translation ROMs were 8.6 mm ± 3.0 mm, 28.4 mm ± 13.9 mm, and 20.4 mm ± 7.2 mm for medial-lateral, pistoning, and anterior-posterior directions, respectively. Within-subject rotational and translational variability during gait averaged 2.8° and 2.0 mm or less, whereas the between-subject variability was up to 9.4° and 18.6 mm, which demonstrates residual femur motion relative to the socket is repeatable within subjects, but inconsistent across subjects during gait. The results suggest residual bone motion within the socket is a potential mechanism behind patient-reported problems and suggests a target for intervention aimed at improving transfemoral amputee quality of life.

Features of sample preparation techniques in the total-reflection X-ray fluorescence analysis of tea leaves

Tea is a popular drink around the world and contains essential minerals and trace elements for human health. In this study, the analytical capabilities of the total-reflection X-ray fluorescence method (TXRF) were considered for the analysis of tea. Different sample preparation techniques, e.g. suspension, open vessel acid digestion, and microwave acid digestion were examined. The influence of particle size was investigated in the analysis of the suspension of tea samples. Mass-absorption coefficients for the tea matrix and the critical surface density of the specimen were calculated. The data obtained explain the presence of absorption effects in the determination of P, S, Cl, and K in suspensions. The digestion procedure is chosen as an optimal sample preparation technique for the TXRF analysis of tea. Nineteen real tea samples were analyzed using TXRF. The advantages of TXRF have been presented through the comparison of results with the wavelength-dispersive X-ray fluorescence spectrometry method.

Maximum isometric tongue force in patients with obstructive sleep apnoea

Background

Obstructive sleep apnea (OSA) is a sleep disorder with a prevalence of 9–38%. The underlying pathology in OSA is a collapse of the upper airway. Especially in more severely affected patients, this collapse is often located at the level of the tongue base. Therefore, various implantable systems (anchors and ligament techniques) were developed to prevent or overcome this collapse. These systems are exposed to various forces. Different models have been developed to measure these forces and data comparing forces in healthy individuals with OSA patients are rare.

Purpose

Purpose of the study was to evaluate possible differences in tongue forces between healthy individuals and patients with OSA.

Method

To evaluate maximum isometric tongue forces, we conducted a matched pair design study including 20 healthy individuals and 20 patients suffering from OSA. Maximum isometric tongue forces were measured in an anterior/posterior direction with the help of self-designed new device that clamps the tongue.

Results

We could show that the maximum isometric force does not differ significantly in healthy individuals (10.7 ± 5.2N) from patients with OSA (14.4 ± 6.3N).

Conclusion

Currently there are no indications that maximum isometric tongue force does differ in healthy individuals and patients with OSA. Higher, as well as lower, tongue forces in patients with OSA seem not to differ from healthy subjects and therefore may not be needed to consider, in the development of tongue management devices, for OSA patients.

Studies on the in vitro ion exchange kinetics and thermodynamics and in vivo pharmacokinetics of the carbinoxamine-resin complex

The short half-life and bitter taste of carbinoxamine maleate² (CAM) lead to poor compliance by pediatric patients who are being treated for allergic rhinitis. To address these issues, carbinoxamine-resin complexes³ (CRCs) were prepared by ion exchange and then coated with Kollicoat SR 30D. The resultant microencapsulated carbinoxamine-resin complexes⁴ (MCRCs) were dispersed into the medium to obtain the final suspensions. The drug loading kinetics and thermodynamics of CRCs, anti-swelling mechanism of the impregnant in MCRCs, in vitro release, and in vivo pharmacokinetics of the suspensions were systematically evaluated. The drug loading process was found to obey a first-order kinetic process that was spontaneous, entropy-reduced and exothermic, and the diffusion of CAM into the resin was the rate-limiting step. During microencapsulation, the impregnant could create a certain buffer space to control the swelling of CRCs and maintain the coating film intact. The homemade preparations had release behaviors similar to that of the reference in vitro and achieved sustained release in vivo. The low drug loading preparation had a higher relative bioavailability of 109% owing to its faster release and better dispersibility. Therefore, the suspensions based on MCRCs could be successfully applied to treating allergic rhinitis in children.

Intermittent electro field regulated mutualistic interspecies electron transfer away from the electrodes for bioenergy recovery from wastewater

Lately, extracellular electron transfer (EET) is widely disclosed on the surface of the bioelectrodes, and conductive (bio)carriers involved in anaerobic biodegradation/biosynthesis. By electrostimulation, microbial consortia colonize the electrodes and accelerate substrate (waste/wastewater) metabolization on the bioanode or biosynthesize value-added products (methane, acetate, etc.) on the biocathode. However, the connections and contributions of planktonic microbial communities have not been effectually understood. Herein, electromethanogenesis were comprehensively investigated in response to different driving-force modes: intermittent electric field applied by manual on-off or natural solar power and continuous electrical field. Intermittent modes implied preferable electron transfer efficiency, higher methane yield and energy recovery efficiencies from wastewater by the microbes in the bulk solutions. Microbial community analysis revealed that less electroactive microorganisms and acetotrophic methanogens in the bulk solutions were accommodated under the intermittent modes than the continuous electrical field, whereas more fermentative bacteria and hydrogenotrophic methanogens evolved in the intermittent driving modes, implying that the interspecies electron transfer both on and away from the electrodes were favorably regulated. Redundancy and network analysis proved that more complicated ecological interactions were shown in the bulk solutions with the periodic on/off of electrical field. These results hinted that the electrostimulation effectively regulated EET bacteria, even in the bulk solutions, while more efficient electron flow to methane through interspecies electron transfer was developed during the intermittent driving regulation.

Simulation of blood flow in a sudden expansion channel and a coronary artery

In this paper, we numerically simulate the flow of blood in two benchmark problems: the flow in a sudden expansion channel and the flow through an idealized curved coronary artery with pulsatile inlet velocity. Blood is modeled as a suspension (a non-linear complex fluid) and the movement of the red blood cell (RBCs) is modeled by using a concentration flux equation. The viscosity of blood is obtained from experimental data. In the sudden expansion flow, the predicted velocity profiles for two different Reynolds numbers (based on the inlet velocity) agree well with the available experiments; furthermore, the numerical results also show that after the sudden expansion there exists a RBCs depletion region. For the second problem, the idealized curved coronary artery, it is found that the RBCs move towards and concentrate near the inner surface where the viscosity is higher and the shear stress lower; this phenomenon may be related to the atherosclerotic plaque formation which usually occurs on the inside surface of the arteries.

Modeling the mechanics of elevated vacuum systems in prosthetic sockets

Elevated vacuum (EV) is suggested to improve suspension and limb volume management for lower limb prosthesis users. However, few guidelines have been established to facilitate configuration of EV sockets to ensure their safe and proper function. A benchtop model of an EV socket was created to study how prosthetic liner tensile elasticity, socket fit, and socket vacuum pressure affect liner displacement and subsequent pressure on the residual limb. A domed carbon fiber layup was used to represent an EV socket. Inserts were used to simulate various air gaps between the socket and liner. Various prosthetic liner samples were placed under the carbon fiber layup. Liner displacement and the corresponding pressure change underneath the liner were measured as vacuum was applied between the liner sample and socket wall. Tissue vacuum pressure increased linearly with socket vacuum pressure until the liner contacted the socket wall. Predicted tissue vacuum pressure matched well with experimental results. Findings suggest that the effect of vacuum pressure on the residual limb is primarily determined by air gap distance. The developed model may be used to assess effects of EV on residual limb tissues based on an individual's socket fit, liner characteristics, and applied vacuum. Understanding the physiological effects of EV on the residual limb could help practitioners avoid blister formation and improve EV implementation.

Stimulated Raman scattering of light in suspension of diamond microparticles in ethanol and in water

The spectra of stimulated Raman scattering of light in ethanol and in water suspensions containing diamond microparticles with sizes 0.2-0.3 μm were investigated. An excitation radiation source was a pulsed ruby laser with a generation wavelength λ₀ = 694.3 nm, a pulse duration τ_p ≈ 20 ns, a maximum beam energy of E_max = 0.6 J, a spectral width Δν = 0.015 cm^-1, and a beam divergence 3.5·10^-4 rad. For the first time, the observation of stimulated Raman scattering of light at a boson peak in suspension of diamonds microcrystals with close sizes (0.2-0.3 μm) in a liquid is reported. The corresponding spectra were recorded using a Fabry-Perot interferometer. In this case, the frequency shift of the stimulated Stokes Raman scattering depended on the size of the diamond microparticles introduced into the liquid and amounted to ~1 cm^-1. In addition, stimulated Raman scattering by a fundamental optical mode with a frequency shift ν = 1331 cm^-1 was observed. In this case, the Raman spectra were recorded using a small-sized spectrometer with a multi-element receiver, detecting radiation in the range of 200-1000 nm. At a sufficiently high intensity of the exciting radiation, the Stokes and anti-Stokes satellites were simultaneously present in the spectrum of stimulated Raman scattering. The obtained results on stimulated scattering of diamond microparticles in liquids are of interest for estimating the sizes of microcrystals from scattering spectra at a boson peak, as well as for creating a frequency comb of emitters based on stimulated Raman scattering with a large frequency shift.