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Introduction: We present a relationship-centred shared-decision-making (RCSDM) process model to explicate factors that shape decision-making processes during physical medicine and rehabilitation (PMR) encounters among patients, their care partners and practitioners. Existing shared decision-making (SDM) models fall short in addressing the everyday decisions routinely made regarding persons with chronic disabilities who require high levels of support, their care partners and rehabilitation practitioners. In PMR, these everyday decisions are small scale, immediate and in service to a larger therapeutic goal. They can be thought of as micro-decisions and involve multiple practitioners, care partners and patients. How micro-decisions are made in this context is contingent on multiple roles and relationships among these relevant parties. Our model centres on micro-decisions among patients, their care partners and practitioners based on our disorders of consciousness (DoC) research., Methods: To develop our model, we examined peer-reviewed literature in SDM in PMR, chronic disability and person-centeredness; formed collaborations and co-created our constructs with rehabilitation practitioners and with care partners who have lived experience of caring for persons with DoC; analysed emerging empirical data and vetted early versions with expert scientific and clinical audiences. Our model builds from the core tenets of relational autonomy, and scholarship and activism of disability advocates., Findings: Our model conceptualizes four non-hierarchical levels of analysis to understand the process of micro-decision-making in chronic disability and medical rehabilitation: social forces (historical and sociological); roles and relationships (multiple and intersecting); relational dimensions (interactional and contextual) and micro-decision moments (initiation, response and closure)., Discussion: Relationships among patients, their care partners and practitioners are the intersubjective milieu within which decisions are made. Our conceptual model explicates the process of micro-decision-making in PMR., Patient or Public Contribution: Care partners (or caregivers) and rehabilitation practitioners are active members of our team. We work together to develop research projects, collect, analyse and disseminate data. The conceptual model we present in this manuscript was co-created-input from care partners and practitioners on previously collected data became the impetus to develop the RCSDM process model and share co-authorship in this manuscript., (© 2024 The Author(s). Health Expectations published by John Wiley & Sons Ltd.)

Pressure injuries negatively affect patients physically, emotionally, and economically. Studies report that pressure injuries occur in 69% of inpatients who have undergone a surgical procedure while hospitalized. In 2012, we created a nurse-initiated, perioperative pressure injury risk assessment measure for our midwestern, urban, adult teaching hospital. We retrospectively applied the risk assessment to a random sample of 350 surgical patients which validated the measure. The prospective use of the risk assessment and prevention measures in 350 surgical patients resulted in a 60% reduction in pressure injuries compared with the retrospective group. Our findings support the use of a multipronged approach for the prevention of health care-associated pressure injuries in the surgical population, which includes assessment of risk, implementation of evidence-based prevention interventions for at-risk patients, and continuation of prevention beyond the perioperative setting to the nursing care unit., (Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.)

When nuclear magnetic resonance (NMR) spectroscopy is employed for physiological experiments with suspended cells, providing for adequate nutrient and oxygen delivery is particularly important, because the inherent insensitivity of NMR requires that concentrated cell suspensions be used. In addition, it is desirable to be able to manipulate the growth rate of cells during a NMR experiment. To address these concerns, a continuous cell cultivator that provides convective oxygen and nutrient transport has been constructed for NMR experiments. The NMR detector coil is located within the cultivator volume. The location is advantageous because the rapid exchange of cells in and out of the coil leads to a small apparent spin lattice relaxation time, thus allowing for rapid pulsing and fast signal averaging. In this article we present the physical principles on which the cultivator's design is based. (31)P spectra showing the response of continuously cultivated Saccharomyces cerevisiae cultures to a phosphate bolus and growth rate shift are then given., ((c) 1992 John Wiley & Sons, Inc.)

Prior work has demonstrated that the microsin antibiotics are produced by enteric bacteria when the growth medium is depleted of nutrients. Because the control loci could have biotechnical potential, and general stress-response phenomena are of importance to understanding how bacteria survive in natural and bioreactor environments, we examined further the growth rate dependence of gene expression under the control of the microsin B17 promoter. This work entailed performing batch and chemostat growth experiments with a strain of E. coli K-12 containing a mcbA-lacZ gene fusion in the chromosome. Our results indicate that when a culture is presented with excess respiratory substrate, a well defined growth rate exists, below which a significant induction event occurs. However, cultures that are fermenting or highly glycolytic tend to express poorly. Additionally, the utility of the fusion strain was examined by performing fed-batch cultivation experiments. We found that sustained production in a fed-batch reactor can be accomplished by using a straightforward, exponential nutrient feeding profile.