Search

Continuity of care is considered a key metric of quality healthcare. Yet, continuity of care in adults aging with congenital disability and the factors that contribute to care continuity are largely unknown. Using data from a national private administrative health claims database in the United States (2007-2018). we examined continuity of care in 8596 adults (mean age 48.6 years) with cerebral palsy or spina bifida. Logistic regression models analyzed how proximity to health care facilities, availability of care providers, and community socioeconomic context were associated with more continuous care. We found that adults aging with cerebral palsy or spina bifida saw a variety of different physician specialty types and generally had discontinuous care. Individuals who lived in areas with more hospitals and residential care facilities received more continuous care than those with limited access to these resources. Residence in more affluent areas was associated with receiving more fragmented care. Findings suggest that over and above individual factors, community healthcare resources and socioeconomic context serve as important factors to consider in understanding continuity of care patterns in adults aging with cerebral palsy or spina bifida., Competing Interests: Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Antibacterial coating is necessary to prevent biofilm-forming bacteria from colonising medical tools causing infection and sepsis in patients. The recent coating strategies such as immobilisation of antimicrobial materials and low-pressure plasma polymerisation may require multiple processing steps involving a high-vacuum system and time-consuming process. Some of those have limited efficacy and durability. Here, we report a rapid and one-step atmospheric pressure plasma polymerisation (APPP) of D-limonene to produce nano-thin films with hydrophobic-like properties for antibacterial applications. The influence of plasma polymerisation time on the thickness, surface characteristic, and chemical composition of the plasma-polymerised films was systematically investigated. Results showed that the nano-thin films deposited at 1 min on glass substrate are optically transparent and homogenous, with a thickness of 44.3 ± 4.8 nm, a smooth surface with an average roughness of 0.23 ± 0.02 nm. For its antimicrobial activity, the biofilm assay evaluation revealed a significant 94% decrease in the number of Escherichia coli ( E. coli ) compared to the control sample. More importantly, the resultant nano-thin films exhibited a potent bactericidal effect that can distort and rupture the membrane of the treated bacteria. These findings provide important insights into the development of bacteria-resistant and biocompatible coatings on the arbitrary substrate in a straightforward and cost-effective route at atmospheric pressure.

Prenatal environmental exposures that have been shown to induce oxidative stress (OS) during pregnancy, such as smoking and alcohol consumption, are risk factors for the onset of schizophrenia and other neurodevelopmental disorders (NDDs). While the OS role in the etiology of neurodegenerative diseases is well known, its contribution to the genomic dysregulation associated with psychiatric disorders is less well defined. In this study we used the SH-SY5Y cell line and applied RNA-sequencing to explore transcriptomic changes in response to OS before or during neural differentiation. We observed differential expression of many genes, most of which localised to the synapse and were involved in neuronal differentiation. These genes were enriched in schizophrenia-associated signalling pathways, including PI3K/Akt, axon guidance, and signalling by retinoic acid. Interestingly, circulatory system development was affected by both treatments, which is concordant with observations of increased prevalence of cardiovascular disease in patients with NDDs. We also observed a very significant increase in the expression of immunity-related genes, supporting current hypotheses of immune system involvement in psychiatric disorders. While further investigation of this influence in other cell and animal models is warranted, our data suggest that early life exposure to OS has a disruptive influence on neuronal gene expression that may perturb normal differentiation and neurodevelopment, thereby contributing towards overall risk for developing psychiatric diseases.

Heavy metal ions have a toxic and negative influences on the environment and human health even at low concentrations and need to be removed from wastewater. Chitosan and graphene oxide are suitable nano plate adsorbents with high adsorption potential because of their π-π interaction, and they are available functional groups that interact with other elements. In this study, graphene oxide was coated with silica to enhance the hydrophilicity of the adsorbent. Subsequently, the adsorbent was functionalised by various amounts of chitosan to improve the Pb(II) removal. The adsorbent was analysed using transmission electron microscopy (TEM), Raman, Fourier-transform infrared spectroscopy (FT-IR), scanning electron microscope (SEM), and mapping analysis techniques. An investigation of the influences of the initial concentration of Pb(II), pH and contact time were included to obtain the optimum amount of adsorption. The range of the initial Pb(II) concentration studied was from 10 to 120 mg/L. The pH factor ranged from 3 to 8 with contact time from 0 to 140 min. Freundlich, Temkin and Langmuir isotherm models were fit to the results, and a pseudo-second-order kinetic model was found to provide a good fit as well. The maximum Pb(II) removal capacity achieved was 256.41 (+/- 4%) mg/g based on Langmuir isotherms.

This study evaluated the engagement of staff regarding infectious healthcare waste management, in two case-study universities in Tunisia. Using a questionnaire survey, it was found that the most significant reported factors that influenced engagement were the availability of technical sheets and posters, training and education programs, and the age range of the staff. While there was some accordance with the Tunisian Decree application n ° 2008-2745 of July 28th, 2008, as well as international guidelines and best practice (e.g. the use of color coded bins, waste management teams, and infection control measures), there were also limitations in the provision of training. This limitation in training and, to a lesser extent, awareness impacted on the beliefs about infectious healthcare waste management of staff and their practices. Recommendations for addressing these issues are suggested.

Biomaterials in conjunction with stem cell therapy have recently attracted attention as a new therapeutic approach for myocardial infarction (MI), with the aim to solve the delivery challenges that exist with transplanted cells. Self-assembling peptide (SAP) hydrogels comprise a promising class of synthetic biomaterials with cardiac-compatible properties such as mild gelation, injectability, rehealing ability, and potential for sequence modification. Herein, we developed an SAP hydrogel composed of a self-assembling gel-forming core sequence (RADA) modified with SDKP motif with pro-angiogenic and anti-fibrotic activity to be used as a cardioprotective scaffold. The RADA-SDKP hydrogel was intramyocardially injected into the infarct border zone of a rat model of MI induced by left anterior descending artery (LAD) ligation as a cell-free or a cell-delivering scaffold for bone marrow mesenchymal stem cells (BM-MSCs). The left ventricular ejection fraction (LVEF) was markedly improved after transplantation of either free hydrogel or cell-laden hydrogel. This cardiac functional repair coincided very well with substantially lower fibrotic tissue formation, expanded microvasculature, and lower inflammatory response in the infarct area. Interestingly, BM-MSCs alone or in combination with hydrogel could not surpass the cardiac repair effects of the SDKP-modified SAP hydrogel. Taken together, we suggest that the RADA-SDKP hydrogel can be a promising cell-free construct that has the capability for functional restoration in the instances of acute myocardial infarction (AMI) that might minimize the safety concerns of cardiac cell therapy and facilitate clinical extrapolation., Competing Interests: The authors declare no conflict of interest.

Quorum quenching (QQ), the enzymatic degradation of N -acyl homoserine lactones (AHLs), has been suggested as a promising strategy to control bacterial diseases. In this study, 10 AHL-degrading bacteria isolated from the intestine of barramundi were identified by 16S rDNA sequencing. They were able to degrade both short and long-chain AHLs associated with several pathogenic Vibrio species (spp.) in fish, including N -[(RS)-3-Hydroxybutyryl]-l-homoserine lactone (3-oh-C 4 -HSL), N -Hexanoyl-l-homoserine lactone (C 6 -HSL), N -(β-Ketocaproyl)-l-homoserine lactone (3-oxo-C 6 -HSL), N -(3-Oxodecanoyl)-l-homoserine lactone (3-oxo-C 10 -HSL), N -(3-Oxotetradecanoyl)-l-homoserine lactone (3-oxo-C 14 -HSL). Five QQ isolates (QQIs) belonging to the Bacillus and Shewanella genera, showed high capacity to degrade both synthetic AHLs as well as natural AHLs produced by Vibrio harveyi and Vibrio alginolyticus using the well-diffusion method and thin-layer chromatography (TLC). The genes responsible for QQ activity, including aiiA , ytnP, and aaC were also detected. Analysis of the amino acid sequences from the predicted lactonases revealed the presence of the conserved motif HxHxDH. The selected isolates were further characterized in terms of their probiotic potentials in vitro. Based on our scoring system, Bacillus thuringiensis QQ1 and Bacillus cereus QQ2 exhibited suitable probiotic characteristics, including the production of spore and exoenzymes, resistance to bile salts and pH, high potential to adhere on mucus, appropriate growth abilities, safety to barramundi, and sensitivity to antibiotics. These isolates, therefore, constitute new QQ probiotics that could be used to control vibriosis in Lates calcalifer .

Circular RNAs (circRNAs) are a relatively new class of RNA transcript with high abundance in the mammalian brain. Here, we show that circRNAs expression in differentiated neuroblastoma cells were significantly altered after depolarization with 107 upregulated and 47 downregulated circRNAs. This coincided with a global alteration in the expression of microRNA (miRNA) ( n = 269) and mRNA ( n = 1511) in depolarized cells, suggesting a regulatory axis of circRNA-miRNA-mRNA is involved in the cellular response to neural activity. In support of this, our in silico analysis revealed that the circular transcripts had the capacity to influence mRNA expression through interaction with common miRNAs. Loss-of-function of a highly expressed circRNA, circ-EXOC6B, resulted in altered expression of numerous mRNAs enriched in processes related to the EXOC6B function, suggesting that circRNAs may specifically regulate the genes acting in relation to their host genes. We also found that a subset of circRNAs, particularly in depolarized cells, were associated with ribosomes, suggesting they may be translated into protein. Overall, these data support a role for circRNAs in the modification of gene regulation associated with neuronal activity.

Objective: With the participation of private hospitals in the health system, improving hospital efficiency becomes more important. This study aimed to evaluate the technical efficiency of public and private hospitals in Beijing, China, and analyze the influencing factors of hospitals' technical efficiency, and thus provide policy implications to improve the efficiency of public and private hospitals. Method: This study used a data set of 154-232 hospitals from "Beijing's Health and Family Planning Statistical Yearbooks" in 2012-2017. The data envelopment analysis (DEA) model was employed to measure technical efficiency. The propensity score matching (PSM) method was used for matching "post-randomization" to directly compare the efficiency of public and private hospitals, and the Tobit regression was conducted to analyze the influencing factors of technical efficiency in public and private hospitals. Results: The technical efficiency, pure technical efficiency and scale efficiency of public hospitals were higher than those of private hospitals during 2012-2017. After matching propensity scores, although the scale efficiency of public hospitals remained higher than that of their private counterparts, the pure technical efficiency of public hospitals was lower than that of private hospitals. Panel Tobit regression indicated that many hospital characteristics such as service type, level, and governance body affected public hospitals' efficiency, while only the geographical location had an impact on private hospitals' efficiency. For public hospitals in Beijing, those with lower average outpatient and inpatient costs per capita had better performance in technical efficiency, and bed occupancy rate, annual visits per doctor, and the ratio of doctors to nurses also showed a positive sign with technical efficiency. For private hospitals, the average length of stay was negatively associated with technical efficiency, but the bed occupancy rate, annual visits per doctor, and average outpatient cost were positively associated with technical efficiency. Conclusions: To improve technical efficiency, public hospitals should focus on improving the management standards, including the rational structure of doctors and nurses as well as appropriate reduction of hospitalization expenses. Private hospitals should expand their scale with proper restructuring, mergers, and acquisitions, and pay special attention to shortening the average length of stay and increasing the bed occupancy rate.

Massive improvements in the thermophysical properties of nanofluids over conventional fluids have led to the rapid evolution of using multiwalled carbon nanotubes (MWCNTs) and graphene nanoplatelets (GNPs) in the field of heat transfer. In this study, the heat transfer and entropy generation abilities of MWCNTs/GNPs hybrid nanofluids were explored. Experiments on forced convective flow through a brass microtube with 300 µm inner diameter and 0.27 m in length were performed under uniform heat flux. MWCNTs/GNPs hybrid nanofluids were developed by adding 0.035 wt.% GNPs to MWCNTs water-based nanofluids with mass fractions of 0.075-0.125 wt.%. The range of the Reynolds number in this experiment was maintained at Re = 200-500. Results showed that the conventional approach for predicting the heat transfer coefficient was applicable for microtubes. The heat transfer coefficient increased markedly with the use of MWCNTs and MWCNTs/GNPs nanofluids, with increased pressure dropping by 12.4%. Results further showed a reduction by 37.5% in the total entropy generation rate in microtubes for hybrid nanofluids. Overall, MWCNTs/GNPs hybrid nanofluids can be used as alternative fluids in cooling systems for thermal applications.