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BACKGROUND: Transversus abdominis and its aponeurotic attachment to the lumbar transverse processes via the middle layer of lumbar fascia are of proposed clinical and biomechanical importance. Moderate traction on these structures (simulating submaximal contraction of transversus abdominis) is reported to influence segmental motion, but their tensile capacity is unknown and the effects of sudden, maximal traction on these attachments and the transverse processes are uncertain. METHODS: In 15 embalmed cadaver abdomens, the middle layer of lumbar fascia was isolated, gripped and rapid tension applied in either a lateral or posteroanterior direction (simulating forces that may produce avulsion and traumatic fractures). Peak forces prior to tissue failure were recorded and the gross effects of traction documented. FINDINGS: Lumbar transverse process fractures were produced in all specimens; by transverse traction in 50% of tests and posteroanterior force in 80%. In the remainder the middle layer of lumbar fascia was torn. Mean transverse and posteroanterior peak forces reached in the middle layer of lumbar fascia prior to failure were 82 N (range 20-190 N) and 47 N (range 25-70 N), respectively. INTERPRETATION: The middle layer of lumbar fascia can transmit substantial tensile forces to lumbar vertebrae, capable of transverse process fracture under experimental conditions. Tensile capacity is likely to be even greater in-vivo. This suggests transversus abdominis and the middle layer of lumbar fascia can strongly influence vertebral motion, should be incorporated in biomechanical models of the spine and considered as potential contributors to transverse process fractures by avulsion. [ABSTRACT FROM AUTHOR]

Chronic groin pain is a common complaint for athletes participating in sports that involve repetitive sprinting, kicking or twisting movements, such as Australian Rules football, soccer and ice hockey. It is frequently a multifactorial condition that presents a considerable challenge for the treating sports medicine practitioner. To better understand the pathogenesis of chronic groin pain in athletes, a precise anatomical knowledge of the pubic symphysis and surrounding soft tissues is required. Several alternative descriptions of pubic region structures have been proposed. Traditionally, chronic groin pain in athletes has been described in terms of discrete pathology requiring specific intervention. While this clinical reasoning may apply in some cases, a review of anatomical findings indicates the possibility of multiple pathologies coexisting in athletes with chronic groin pain. An appreciation of these alternative descriptions may assist sports medicine practitioners with diagnostic and clinical decision-making processes. The purpose of this literature review is to reappraise the anatomy of the pubic region, considering findings from cadaveric dissection and histology studies, as well as those from diagnostic imaging studies in athletes. [ABSTRACT FROM AUTHOR]

The emerging concept of recovery in mental health is often only loosely defined, but appears to be influenced more by specific human values and beliefs, than scientific research and 'evidence'. As a contribution to the further development of the philosophical basis of the concept of recovery, this paper reviews the discrete assumptions of the Tidal Model, describes the development of the Model's value base - the 10 Commitments - and illustrates the 20 Tidal Competencies, which aim to generate practice-based evidence for the process of recovery. [ABSTRACT FROM AUTHOR]

The concept of recovery is an important part of contemporary mental health services. During the past 5 years, Tidal Model projects, focused on developing the recovery attitude within nursing practice, have been established in several different countries. The Tidal model emphasizes 10 philosophical assumptions the 'Ten Commitments,' that are central to recovery-focused practice. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Biomechanical study of unembalmed human lumbar segments. OBJECTIVE: To investigate the effects of tensioning the lumbar fasciae (transversus abdominis [TrA]) aponeurosis) on segment stiffness during flexion and extension. SUMMARY OF BACKGROUND DATA: Animal and human studies suggest that TrA may influence intersegmental movement via tension in the middle and posterior layers of lumbar fasciae (MLF, PLF). METHODS: Compressive flexion and extension moments were applied to 17 lumbar segments from 9 unembalmed cadavers with 20 N lateral tension of the TrA aponeurosis during: 1) 'static' tests: load was compared when fascial tension was applied during static compressive loads into flexion-extension; 2) 'cyclic loading' tests: load, axial displacement, and stiffness were compared during repeated compressive loading cycles into flexion-extension. After testing, the PLF was incised to determine the tension transmitted by each layer. RESULTS: At all segments and loads (<200 N), fascial tension increased resistance to flexion loads by approximately 9.5 N. In 15 of 17, fascial tension decreased resistance to extension by approximately 6.6 N. Fascial tension during cyclic flexion loading decreased axial displacement by 26% at the onset of loading (0-2 N) and 2% at 450 N (13 of 17). During extension loading, fascial tension increased displacement at the onset of loading (10 of 17) by approximately 23% and slightly (1%) decreased displacement at 450 N. Segment stiffness was increased by 6 N/mm in flexion (44% at 25 N) and decreased by 2 N/mm (8% at 25 N) in extension. More than 85% of tension was transmitted through the MLF. CONCLUSIONS: Tension on the lumbar fasciae simulating moderate contraction of TrA affects segmental stiffness, particularly toward the neutral zone. [ABSTRACT FROM AUTHOR]

Senior lecturers/lecturers in mental health nursing (11 in round one, nine in round two, and eight in the final round) participated in a three-round Delphi study into the teaching of health care ethics (HCE) to students of nursing. The participants were drawn from six (round one) and four (round three) UK universities. Information was gathered on the organization, methods used and content of HCE modules. Questionnaire responses were transcribed and the content analysed for patterns of interest and areas of convergence or divergence. Findings include: the majority (72.8%) of the sample believed that insufficient time was allocated to the teaching of HCE; case studies were considered a popular, although problematic, teaching method; the 'four principles' approach was less than dominant in the teaching of HCE; and virtue ethics was taught by only 36.4% of the participants. The Delphi technique proved adequate and worth while for the purposes of this study. Further empirical research could aim to replicate or contradict these findings, using a larger sample and recruiting more university departments. Reflection is required on several issues, including the depth and breadth to which ethics theory and, more controversially, meta-ethics, are taught to nursing students. [ABSTRACT FROM AUTHOR]

The findings of a pilot telephone survey of senior nurses' views of multidisciplinary teamwork (MDT) practice in 26 acute psychiatric admission wards within the ambit of one English health authority are reported. The survey was conducted in two stages. The first stage focused on obtaining the senior nurse's general perceptions of the organization of the work of the multidisciplinary team, and in the second stage more detailed responses to the original questions were obtained. The findings suggest that the composition and operations of the acute ward team are limited, and the relationship between the MDT and patients and their families do not entirely support the concept of increased collaboration with patients and their families. The findings are discussed within the context of the perceived crisis in acute psychiatric care in England and the ambitions for more egalitarian 'mental health' services. [ABSTRACT FROM AUTHOR]

A three-round Delphi study was conducted to gather data on ethical reasoning among psychiatric nurses (N = 26 in round one (R1), decreasing to N = 14 in the final round (R3)). Transcripts of questionnaires were carefully read and compared. Responses were manually sorted into categories, themes and patterns of interest. Eight debates emerged from the data. This article discusses two in detail: the nature of moral virtues and the meaning of compassion in psychiatric nursing. A sympathetic overview of virtue ethics is also provided. The nurses' responses included a lot of virtue terms, such as, 'honest', 'fair', and 'care'. However, 'nurses' moral virtues' was ranked low in importance as a notion invoked in ethical decision making in the round-one ranking exercise. Only half of the sample believed that the moral character of a psychiatric nurse is important in ethical decision-making. Further, most of the round-one sample thought the virtues could not be acquired. Compassion was identified as crucial to psychiatric nursing and the nurse-client relationship, though, as expected, many diverse meanings were attributed to this notion. While the Delphi method proved adequate for our purposes, problems with regard to accurately understanding the respondents' intended meanings highlighted a major weakness of this technique, in common with other methods relying on questionnaires. Further inquiry is needed regarding the role of moral virtues and virtue ethics in both psychiatric nursing and nurse education. [ABSTRACT FROM AUTHOR]

Current mental health practice and legislation is influenced significantly by the ill-defined concept of serious mental illness (SMI). Although the concept of SMI originally appeared to include a consideration of a range of forms of mental illness, including dementias, by custom and practice the term has come to mean, often, only people with a psychotic diagnosis. This paper reviews the influence of the term SMI, considering the way older people, younger people and other subgroups within the 'adult' population have been marginalized by the narrow definition of the concept. The paper concludes with a consideration of some of the ethical implications of mental health nurses focusing on an ill-defined 'illness' grouping, and the impact that such a narrow focus might have on the ambition to establish 'health for all by the year 2000'. [ABSTRACT FROM AUTHOR]

Psychiatric nurses in the United Kingdom (UK) have begun to reattend to people with 'serious and enduring mental illness'. At the same time research in the USA and UK has refocused much of its attention on neuroscientific theories and models of serious mental illness. Psychiatric nurses are being encouraged to consider the value of biomedical explanations of serious illness, such as schizophrenia, and to accomodate these theories and models in the practice of nursing. This paper will examine the challenge of the biomedical approach for the continued development of psychiatric nursing theory and practice. It is proposed that psychiatric nursing needs to develop further its own 'proper focus', if it is to survive as a key player in the health care field of the 21st century. [ABSTRACT FROM AUTHOR]

The preparation of the registered mental nurse (RMN) student to care for people with affective disorder was examined in two studies involving the training programme of the National Board for Scotland. In the first study, the sample curriculum, which was prepared in 1978 and which represents the rudimentary basis of the present eight modules of training, was analysed by the author. In the second study, examination questions citing affective disorder were drawn from the final examination papers of the years 1976-1985. These were analysed by the author to isolate their 'key characteristics'. The same questions were subsequently analysed by a panel of judges to identify their ideological orientation, in terms of accepted models of mental disorder. Both studies suggested that students were prepared to fulfil a subordinate role. The content of the outline syllabus from 1978 emphasized the preparation of the nurse to support medical staff through 'medical-expressive' forms of care. Specific reference to non-medical care was distinguished by a lack of definition and a simplistic attitude towards assessment and care-planning. The examination questions also favoured a clinical-somatic, or medical, orientation to care, over any other discrete form of psychosocial nursing. The past decade has been distinguished by interest in individualized care, psychosocial and person-centred models of nursing practice. These approaches to care appear to have much to offer the care of people with affective disorder. These studies question the extent to which such an interest exerts influence over the syllabus and examination system. [ABSTRACT FROM AUTHOR]

Contemporary nursing concepts of care for people with affective disorder are a function, at least in part, of the available nursing literature. Cormack suggested that the literature could be defined in terms of 'prescriptions of care' and 'descriptions of care'. This review summarizes some of the best-known British and North American nursing texts of the last 30 years in an effort to identify the views of affective disorder used by authors and the main strategies recommended or described in relation to the care of people with such disorders. Some of the 'descriptive' studies reported in Britain over the past decade which highlight the nurses' orientation to care and methods used, are similarly evaluated. The trend away from reliance upon traditional intrapsychic concepts in favour of more eclectic approaches is acknowledged. However, many prescriptions for care fail to indicate whether or not research support exists for specific orientations to care. Also, given the size of the population, the number of published descriptive accounts, especially research reports, related to the care of people with affective disorder are a cause for concern. The review suggests a need for nurses to develop, research and report conceptual models of nursing for the care of the person with affective disorder. [ABSTRACT FROM AUTHOR]

Nanomaterials show great promise for cancer treatment. Nonetheless, most nanomaterials lack selectivity for cancer cells, damaging healthy ones. Cerium dioxide (ceria, CeO 2 ) nanoparticles have been shown to exert selective toxicity toward cancer cells due to the redox modulating properties they display as their size decreases. However, these particles suffer from poor suspension stability. The efficacy of CeO 2 nanoparticles for cancer treatment is hampered by their innate high surface energy, which leads to particle agglomeration and, consequently, reactivity loss. This effect increases as particle size decreases; as such, quantum dots (QDs) suffer most from this phenomenon. In this study, it is proposed that silicon dioxide (silica, SiO 2 ) nanoparticles can provide an inert platform for surface encrusted CeO 2 QDs and that the resulting nanocomposite (hereafter QD CeO 2 /SiO 2 ) not only will exhibit negligible agglomeration compared with CeO 2 alone but also will improve the modulation of reactive oxygen species (ROS) leading to selective reduction of human A375 melanoma cell proliferation. The SiO 2 nanoparticles had a bimodal size distribution with median particle size of 66 and 168 nm, while the CeO 2 quantum dots encrusted on their surface had a size of 3.2 nm. An elevated Ce 3+ /Ce 4+ ratio led to the QD CeO 2 /SiO 2 nanocomposite displaying synergistic superoxide dismutase- and catalase-like activity, favoring the accumulation of ROS at pH 6.5 which translated into QD CeO 2 /SiO 2 exerting selective oxidative stress in, and toward, the melanoma cells. Treatment with 50 μg mL -1 QD CeO 2 /SiO 2 significantly reduced cell proliferation by 27% compared to untreated control cells in the colony formation assay. Treatment with either SiO 2 or CeO 2 alone did not affect the cell proliferation. These results highlight the benefit of dispersing CeO 2 QDs on the surface of core nanoparticles and the resulting enhancement of selective redox reactivity and proliferation arrest when compared to CeO 2 nanoparticles alone. Furthermore, the method employed here to encrust CeO 2 QDs could lead to the facile synthesis of new nanocomposites with enhanced control of ROS activity, not only for in vitro studies using other cancer cell lines of interest but also in animal models and perhaps leading to clinical trials in melanoma patients.

We sought to determine whether Pneumocystis jirovecii pneumonia prophylaxis with sulfamethoxazole-trimethoprim (SMX-TMP) is associated with an increased frequency of acute hemolytic anemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency versus non-G6PD-deficient controls in a pediatric oncology population. There was no statistically significant difference in change in hemoglobin or transfusion requirements after starting SMX-TMP between groups. These findings suggest no increased risk of acute hemolytic anemia with SMX-TMP administered at prophylaxis doses in patients with G6PD deficiency., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Blinatumomab is a bispecific T-cell engager administered as a 28-day continuous infusion. Infusions can be associated with interruptions requiring support from clinical staff, but the frequency of interventions with outpatient blinatumomab has not been characterized. This study is a single-center, retrospective review of patients who received blinatumomab between December 3, 2014 and October 31, 2021 to determine frequency and type of interventions. Forty patients received blinatumomab for 69 cycles. Clinical staff intervention was required in 31 (45%) cycles, only six (8.7%) cycles needed readmission. Management of outpatient blinatumomab infusions requires education and training of clinical staff and caregivers to quickly troubleshoot interruptions., (© 2024 Wiley Periodicals LLC.)

Introduction: Diffuse alveolar hemorrhage (DAH) is a devastating disease process with 50-100% mortality in oncology and hematopoietic cell transplant (HCT) recipients. High concentrations of tissue factors have been demonstrated in the alveolar wall in acute respiratory distress syndrome and DAH, along with elevated levels of tissue factor pathway inhibitors. Activated recombinant factor VII (rFVIIa) activates the tissue factor pathway, successfully overcoming the tissue factor pathway inhibitor (TFPI) inhibition of activation of Factor X. Intrapulmonary administration (IP) of rFVIIa in DAH is described in small case series with successful hemostasis and minimal complications., Methods: We completed a single center retrospective descriptive study of treatment with rFVIIa and outcomes in pediatric oncology and HCT patients with pulmonary hemorrhage at a quaternary hematology/oncology hospital between 2011 and 2019. We aimed to assess the safety and survival of patients with pulmonary hemorrhage who received of IP rFVIIa., Results: We identified 31 patients with pulmonary hemorrhage requiring ICU care. Thirteen patients received intrapulmonary rFVIIa, while eighteen patients did not. Overall, 13 of 31 patients (41.9%) survived ICU discharge. ICU survival (n=6) amongst those in the IP rFVIIa group was 46.2% compared to 38.9% (n=7) in those who did not receive IP therapy (p=0.69). Hospital survival was 46.2% in the IP group and 27.8% in the non-IP group (p=0.45). There were no adverse events noted from use of IP FVIIa., Conclusions: Intrapulmonary rFVIIa can be safely administered in pediatric oncology patients with pulmonary hemorrhage and should be considered a viable treatment option for these patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Hurley, McArthur, Gossett, Hall, Barker, Hijano, Hines, Kang, Rains, Srinivasan, Suliman, Qudeimat and Ghafoor.)

Background: The fibularis longus (FL) muscle is larger in volume than fibularis brevis (FB) and is therefore claimed to be the stronger evertor of the two. Clinical observation of FL and FB tendon rupture show that injury to the FB has a serious negative effect on hindfoot eversion. This implies that the FB is the stronger and more important evertor. The strength of a muscle is not purely based on its volume, and the observed discrepancy between the FB and FL may be due to differences in muscle architecture. This study compares the muscle architecture of FL with FB., Methods: Sixteen legs from eight formaldehyde-fixed human specimens, mean age 83 (range 72-89) years, were dissected. The volume, fibre lengths and fibre pennation angles for both muscles were measured and the physiological cross-sectional area (PCSA) was calculated., Results: The FL was always larger than the FB, with an individual difference in volume that varied from 1.4 to 4.6 times larger with a mean difference of 17 ml (95% CI 14-20; p < 0.001). Mean fibre lengths were 9 mm (95% CI 2-16; p = 0.015) longer in FL than in FB. The mean pennation angle was 9.6 degrees in FL and 8.8 degrees in FB, this difference was not significant (p = 0.32). The mean PCSA for FL was 3 cm 2 (95% CI 2-4) larger than for FB (p < 0.001)., Conclusions: With our sample set, the hypothesis that the muscle architecture can explain the clinical discrepancy between the FL and FB, was not supported. The difference in hindfoot eversion might instead depend on the different moment arms of FL and FB and the effect forefoot abduction has on hindfoot eversion., (© 2024. The Author(s).)

An experimental platform is reported that allows for the online characterization of photochemical reactions by coupling a continuous flow photoreactor, equipped with LED light irradiation and a dual-tipped ESI source, directly to a mass spectrometer with electrospray ionization. The capabilities of this platform are demonstrated with two classes of photoreactions: (1) the photopolymerization of methyl methacrylate and (2) photocatalyzed alkyne insertion into a 1,2,3-benzotriazinone. The online technique provides rapid information to inform the underlying photochemical mechanism and evaluate the overall photochemistry.

The current study investigates the therapeutic and optical properties of bismuth oxide (Bi 2 O 3 ) particles for selective melanoma therapy and prevention. The Bi 2 O 3 particles were prepared using a standard precipitation method. The Bi 2 O 3 particles induced apoptosis in human A375 melanoma cells but not human HaCaT keratinocytes or CCD-1090Sk fibroblast cells. This selective apoptosis appears to be associated with a combination of factors: increased particle internalization (2.29 ± 0.41, 1.16 ± 0.08 and 1.66 ± 0.22-fold of control) and enhanced production of reactive oxygen species (ROS) (3.4 ± 0.1, 1.1 ± 0.1 and 2.05 ± 0.17-fold of control) in A375 cells compared to HaCaT and CCD-1090SK cells, respectively. As a high-Z element, bismuth is also an excellent contrast agent for computer tomography, which renders Bi 2 O 3 a theranostic material. Moreover, Bi 2 O 3 displays high UV absorption and low photocatalytic activity compared to other semiconducting metal oxides, which opens further potential fields of application as a pigment or as an active ingredient in sunscreens. Overall, this study demonstrates the multifunctional properties of Bi 2 O 3 particles surrounding the treatment and prevention of melanoma., (© 2023 The Authors. Journal of Biomedical Materials Research Part A published by Wiley Periodicals LLC.)

Discussion continues over various aspects of sunscreen science: regulation, test methods, sun protection factor (SPF), labelling claims, potentially harmful components, among others. In this paper the UV transmission properties of a number of commercial sunscreens have been determined at constant sunscreen film thickness under different local UV Index conditions. The data demonstrate difficulties facing the public and the sunscreen industry as a whole, even though SPF values and other data stated on the sunscreen packaging are assumed to be correct according to standard testing methods. This work has shown that at realistic application rates the critical factors are the intensity of the incident solar radiation and the accumulated erythema UV dose transmitted over time. In one example, on 'Extreme' UV Index days, an SPF 30 sunscreen under test transmitted one minimal erythema dose (MED) of UV in only 35 min. In another example, although it should not, in theory, transmit one MED until several hours of exposure, this level was reached in 1 h by an SPF 50 sunscreen under these typical Australian summer conditions (UV Index 12) in Wollongong, NSW (34.4°S). Such properties could have severe consequnces if these sunscreens were used by individuals with Fitzpatrick Skin Type 1, organ transplant recipients or other immuno-compromised individuals., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Extended half-life (EHL) factor VIII (FVIII) products may decrease the burden of prophylactic treatment in haemophilia A by reducing infusion frequency. However, these products still exhibit wide inter-patient variability and benefit from pharmacokinetic (PK) tailoring., Objective: Identify limited sampling strategies for rFVIIIFc, an EHL FVIII product, that produce accurate estimates of PK parameters and relevant troughs., Methods: We performed a limited sampling analysis on simulated populations of adults, adolescents, and children based on published population PK data. Sampling strategies were evaluated by comparing the error in estimates of half-life, clearance, and trough levels, to a full 6-sample design. Furthermore, we assessed the impact of incorporating knowledge about prior doses, and the day of the PK study within the regimen. We also evaluated the potential inappropriate dose adjustment rate (IDAR) among the modelled sampling strategies., Results: Many sampling strategies, including several 2-sample designs, accurately predicted the PK and exposure measures (median absolute error <10%). When samples are only collected during a single visit (i.e., predose + peak), inclusion of prior dose information reduces median half-life error from >20% to ~5% for adults/adolescents. In this same scenario, appropriate scheduling of the PK study decreases likelihood of unmeasurable predose samples, reducing median error on the 72-h trough from 25% to <12% in the youngest population., Conclusions: The PK of rFVIIIFc can be accurately estimated using only peak and trough samples, provided that knowledge of prior doses is incorporated and the PK study is planned on an appropriate day within the dosing regimen., (© 2021 John Wiley & Sons Ltd.)

Nanoparticulate titanium dioxide (TiO 2 ) is widely used in cosmetic products and sunscreens. However, primarily due to their photocatalytic activity, some TiO 2 products have been shown to be cytotoxic. Thus, the aim of this study was to reduce the photoactivity and consequent cytotoxicity of TiO 2 nanoparticles. As such, in this work, yttrium oxide (Y 2 O 3 ) was deposited onto TiO 2 , at 5% and 10% Y/Ti weight ratio, via a hydrothermal method. The nanocomposites produced, TiO 2 @Y 2 O 3 5 and 10 wt%, were characterised to assess their physical, photochemical and toxicological properties. These materials exhibit a uniform yttria coating, enhanced UV attenuation in the 280-350 nm range and significantly reduced photoactivity compared with a pristine commercial TiO 2 sample (Degussa Aeroxide® P25). Furthermore, the comparative cytotoxicity and photo-cytotoxicity of these materials to a human keratinocyte cell line (HaCaT), was assessed using a colorimetric tetrazolium salt (MTS) assay. Following 24-hour incubation with cells, both Y 2 O 3 loadings exhibited improved biocompatibility with HaCaT cells, compared to the pristine TiO 2 sample, under all subsequent test conditions. In conclusion, the results highlight the potential of these materials for use in products, applied topically, with sun protection in mind., Competing Interests: Declaration of Competing Interest The authors declare no competing financial interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Nanotechnology has the potential to bring about revolutionary changes in manufacturing products, including sunscreens. However, a knowledge gap between benefits and detriments of engineered nano-materials used in sunscreens exists, which gives rise to safety concerns. This article is concerned with the protection of consumers without impairing the embellishment of this promising technology. It is widely argued that the harm associated with nano-sunscreens may only occur under certain conditions related mainly to users skin vulnerability, which can be avoided by informed and careful use of such a product. We thus recognize the need for fostering the growth of nanotech simultaneously with preventing potential harm. We revisit the Australian sunscreens regulatory policies, which embrace a "wait and see" approach, through the lens of regulatory policies in the European Union (EU) that are influenced by a "precautionary principle." We highlight the importance of informing consumers about the sunscreen they are using and recommend that product labels should disclose the presence of nano-ingredients in line with the EU disclosure requirements. This will allow users to carefully apply the product in order to avoid any potential harm and to protect manufacturers from possible costly litigation in future. This can be achieved through a combined collaborative effort of regulators, supply chain entities, and end users.

Study Design: Biomechanical experiment., Objective: The aims of the present study were to test the effect of fascial tension on lumbar segmental axial rotation and lateral flexion and the effect of the angle of fascial attachment., Summary of Background Data: Tension in the middle layer of lumbar fascia has been demonstrated to affect mechanical properties of lumbar segmental flexion and extension in the neutral zone. The effect of tension on segmental axial rotation and lateral flexion has, however, not been investigated., Methods: Seven unembalmed lumbar spines were divided into segments and mounted for testing. A 6 degree-of-freedom robotic testing facility was used to displace the segments in each anatomical plane (flexion-extension, lateral bending, and axial rotation) with force and moment data recorded by a load cell positioned beneath the test specimen. Tests were performed with and without a 20 N fascia load and the subsequent forces and moments were compared. In addition, forces and moments were compared when the specimens were held in a set position and the fascia loading angle was varied., Results: A fascial tension of 20 N had no measurable effect on the forces or moments measured when the specimens were displaced in any plane of motion (P > 0.05). When 20 N of fascial load were applied to motion segments in a set position small segmental forces and moments were measured. Changing the angle of the fascial load did not significantly alter these measurements., Conclusion: Application of a 20 N fascial load did not produce a measureable effect on the mechanics of a motion segment, even though it did produce small measurable forces and moments on the segments when in a fixed position. Results from the present study are inconsistent with previous studies, suggesting that further investigation using multiple testing protocols and different loading conditions is required to determine the effects of fascial loading on spinal segment behavior., Level of Evidence: N/A.

Microbial colonization of prepainted steel, commonly used in roofing applications, impacts their aesthetics, durability, and functionality. Understanding the relevant organisms and the mechanisms by which colonization occurs would provide valuable information that can be subsequently used to design fouling prevention strategies. Here, next-generation sequencing and microbial community finger printing (T-RFLP) were used to study the community composition of microbes colonizing prepainted steel roofing materials at Burrawang, Australia and Kapar, Malaysia over a 52-week period. Community diversity was low and was dominated by Bacillus spp., cyanobacteria, actinobacteria, Cladosporium sp., Epicoccum nigrum, and Teratosphaeriaceae sp. Cultivation-based methods isolated approximately 20 different fungi and bacteria, some of which, such as E. nigrum and Cladosporium sp., were represented in the community sequence data. Fluorescence in situ hybridization imaging showed that fungi were the most dominant organisms present. Analysis of the sequence and T-RFLP data indicated that the microbial communities differed significantly between locations and changed significantly over time. The study demonstrates the utility of molecular ecology tools to identify and characterize microbial communities associated with the fouling of painted steel surfaces and ultimately can enable the targeted development of control strategies based on the dominant species responsible for fouling., (© 2016 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.)

After postoperative deaths in children who were prescribed codeine, several pediatric hospitals have removed it from their formularies. These deaths were attributed to atypical cytochrome P450 2D6 (CYP2D6) pharmacogenetics, which is also implicated in poor analgesic response. Because codeine is often prescribed to patients with sickle cell disease and is now the only Schedule III opioid analgesic in the United States, we implemented a precision medicine approach to safely maintain codeine as an option for pain control. Here we describe the implementation of pharmacogenetics-based codeine prescribing that accounts for CYP2D6 metabolizer status. Clinical decision support was implemented within the electronic health record to guide prescribing of codeine with the goal of preventing its use after tonsillectomy or adenoidectomy and in CYP2D6 ultra-rapid and poor metabolizer (high-risk) genotypes. As of June 2015, CYP2D6 genotype results had been reported for 2468 unique patients. Of the 830 patients with sickle cell disease, 621 (75%) had a CYP2D6 genotype result; 7.1% were ultra-rapid or possible ultra-rapid metabolizers, and 1.4% were poor metabolizers. Interruptive alerts recommended against codeine for patients with high-risk CYP2D6 status. None of the patients with an ultra-rapid or poor metabolizer genotype were prescribed codeine. Using genetics to tailor analgesic prescribing retained an important therapeutic option by limiting codeine use to patients who could safely receive and benefit from it. Our efforts represent an evidence-based, innovative medication safety strategy to prevent adverse drug events, which is a model for the use of pharmacogenetics to optimize drug therapy in specialized pediatric populations., (Copyright © 2016 by the American Academy of Pediatrics.)

Attendance at diabetic retinopathy screening in minority ethnic groups, including the South Asian population, is known to be poor. We describe a cluster randomised controlled trial conducted in 10 general practitioner (GP) surgeries in Coventry, UK, during 2007 which aimed to evaluate the use of a Link Worker-delivered intervention to improve attendance. The intervention consisted of a simple telephone reminder with the main outcome measure being attendance at diabetic retinopathy screening. We found a statistically significant difference between mean attendance proportions for intervention (0.89) and control (0.74) practices: difference (95% confidence interval (CI)) 0.15 (0.04-0.27), t = 3.03, p = 0.0162; this difference remained significant when adjusted for previous year's proportions. In this proof-of-concept study, in inner city Coventry, we demonstrated increased attendance at diabetic retinopathy screening by use of a simple Link Worker-implemented telephone call intervention. The use of Link Worker phone calls may be a useful tool to increase attendance for diabetic retinopathy screening in a group with high did-not-attend (DNA) rates and a high prevalence of diabetic retinopathy and visual impairment., (© The Author(s) 2014.)

Biomechanical models predict that recruitment of gluteus maximus (GMax) will exert a compressive force across the sacroiliac joint (SIJ), yet this muscle requires morphologic assessment. The aims of this study were to document GMax's proximal attachments and assess their capacity to generate forces including compressive force at the SIJ. In 11 embalmed cadaver limbs, attachments of GMax crossing the SIJ were dissected and their fascicle orientation, length and attachment volume documented. The physiological cross-sectional area (PCSA) of each attachment was calculated along with its estimated maximum force at the SIJ and lumbar spine. GMax fascicles originated from the gluteus medius fascia, ilium, thoracolumbar fascia, erector spinae aponeurosis, sacrum, coccyx, dorsal sacroiliac and sacrotuberous ligaments in all specimens. Their mean fascicle orientation ranged from 32 to 45° below horizontal and mean length from 11 to 18 cm. The mean total PCSA of GMax was 26 cm(2) (range 16-36), of which 70% crossed the SIJ. The average maximum force predicted to be generated by GMax's total attachments crossing each SIJ was 891 N (range 572-1,215), of which 70% (702 N: range 450-1,009) could act perpendicular to the plane of the SIJ. The capacity of GMax to generate an extensor moment at lower lumbar segments was estimated at 4 Nm (range 2-9.5). GMax may generate compressive forces at the SIJ through its bony and fibrous attachments. These may assist effective load transfer between lower limbs and trunk., (Copyright © 2013 Wiley Periodicals, Inc.)

Changes in the molecular structure of polymer antioxidants such as hindered amine light stabilisers (HALS) is central to their efficacy in retarding polymer degradation and therefore requires careful monitoring during their in-service lifetime. The HALS, bis-(1-octyloxy-2,2,6,6-tetramethyl-4-piperidinyl) sebacate (TIN123) and bis-(1,2,2,6,6-pentamethyl-4-piperidinyl) sebacate (TIN292), were formulated in different polymer systems and then exposed to various curing and ageing treatments to simulate in-service use. Samples of these coatings were then analysed directly using liquid extraction surface analysis (LESA) coupled with a triple quadrupole mass spectrometer. Analysis of TIN123 formulated in a cross-linked polyester revealed that the polymer matrix protected TIN123 from undergoing extensive thermal degradation that would normally occur at 292°C, specifically, changes at the 1- and 4-positions of the piperidine groups. The effect of thermal versus photo-oxidative degradation was also compared for TIN292 formulated in polyacrylate films by monitoring the in situ conversion of N-CH3 substituted piperidines to N-H. The analysis confirmed that UV light was required for the conversion of N-CH3 moieties to N-H - a major pathway in the antioxidant protection of polymers - whereas this conversion was not observed with thermal degradation. The use of tandem mass spectrometric techniques, including precursor-ion scanning, is shown to be highly sensitive and specific for detecting molecular-level changes in HALS compounds and, when coupled with LESA, able to monitor these changes in situ with speed and reproducibility., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The purpose of this review is to showcase the present capabilities of ambient sampling and ionisation technologies for the analysis of polymers and polymer additives by mass spectrometry (MS) while simultaneously highlighting their advantages and limitations in a critical fashion. To qualify as an ambient ionisation technique, the method must be able to probe the surface of solid or liquid samples while operating in an open environment, allowing a variety of sample sizes, shapes, and substrate materials to be analysed. The main sections of this review will be guided by the underlying principle governing the desorption/extraction step of the analysis; liquid extraction, laser ablation, or thermal desorption, and the major component investigated, either the polymer itself or exogenous compounds (additives and contaminants) present within or on the polymer substrate. The review will conclude by summarising some of the challenges these technologies still face and possible directions that would further enhance the utility of ambient ionisation mass spectrometry as a tool for polymer analysis., (Copyright © 2013 Elsevier B.V. All rights reserved.)

The objectives of this study were to investigate the anatomical relationship between the proximal adductor longus (AL) and rectus abdominis muscles and to determine whether unilateral loading of AL results in strain transmission across the anterior pubic symphysis to the contralateral distal rectus sheath. Bilateral dissections were conducted on 10 embalmed cadavers. Strain transfer across the pubic symphysis was examined on seven of these cadavers. An AL contraction was simulated by applying a controlled load in the direction of its proximal tendinous fibers, and the resultant strain in the contralateral distal rectus sheath was measured using a foil-type surface mounted microstrain gage. Adductor longus attached to the antero-inferior aspect of the pubis. In 18 of the 20 limbs, the proximal attachment of AL was tendinous on its superficial surface and muscular on its deep surface. The proximal AL tendon was found in most instances to have secondary communications with structures such as the contralateral distal rectus sheath, pubic symphysis anterior capsule, ilio-inguinal ligament, and contralateral proximal AL tendon. Despite these consistent anatomical observations, strain measured in the contralateral distal rectus sheath upon unilateral loading of the proximal AL varied considerably between cadavers. Measured strain had an average ± 1SD of 0.23 ± 0.43%. The proximal attachment of AL contributes to an anatomical pathway across the anterior pubic symphysis that is likely required to withstand the transmission of large forces during multidirectional athletic activities. This anatomical relationship may be a relevant factor in explaining the apparent vulnerability of the AL and rectus abdominis attachments to injury., (Copyright © 2012 Wiley Periodicals, Inc.)

Rationale: Polymer-based surface coatings in outdoor applications experience accelerated degradation due to exposure to solar radiation, oxygen and atmospheric pollutants. These deleterious agents cause undesirable changes to the aesthetic and mechanical properties of the polymer, reducing its lifetime. The use of antioxidants such as hindered amine light stabilisers (HALS) retards these degradative processes; however, mechanisms for HALS action and polymer degradation are poorly understood., Methods: Detection of the HALS TINUVIN®123 (bis(1-octyloxy-2,2,6,6-tetramethyl-4-piperidyl) sebacate) and the polymer degradation products directly from a polyester-based coil coating was achieved by liquid extraction surface analysis (LESA) coupled to a triple quadrupole QTRAP® 5500 mass spectrometer. The detection of TINUVIN®123 and melamine was confirmed by the characteristic fragmentation pattern observed in LESA-MS/MS spectra that was identical to that reported for authentic samples., Results: Analysis of an unstabilised coil coating by LESA-MS after exposure to 4 years of outdoor field testing revealed the presence of melamine (1,3,5-triazine-2,4,6-triamine) as a polymer degradation product at elevated levels. Changes to the physical appearance of the coil coating, including powder-like deposits on the coating's surface, were observed to coincide with melamine deposits and are indicative of the phenomenon known as polymer 'blooming'., Conclusions: For the first time, in situ detection of analytes from a thermoset polymer coating was accomplished without any sample preparation, providing advantages over traditional extraction-analysis approaches and some contemporary ambient MS methods. Detection of HALS and polymer degradation products such as melamine provides insight into the mechanisms by which degradation occurs and suggests LESA-MS is a powerful new tool for polymer analysis., (Copyright © 2012 John Wiley & Sons, Ltd.)

The concept of recovery increasingly dominates mental health policy and practice agendas in most Western countries. However, the many, often conflicting, definitions of recovery have led to theoretical and practical confusion. More importantly, the concept clashes with some of the established assumptions of psychiatric/mental health nursing, especially the traditional notion that the person is "ill" and requires "treatment" or some other active "intervention." The implications of recovery for the further development of person-centered care, especially within a globalized form of mental health nursing, are discussed with specific reference to the Tidal Model, an international midrange theory of mental health nursing., (Copyright © 2011. Published by Elsevier Inc.)

Potenital pathways for the deactivation of hindered amine light stabilisers (HALS) have been investigated by observing reactions of model compounds--based on 4-substituted derivatives of 2,2,6,6-tetramethylpiperidine-N-oxyl (TEMPO)--with hydroxyl radicals. In these reactions, dilute aqueous suspensions of photocatalytic nanoparticulate titanium dioxide were irradiated with UV light in the presence of water-soluble TEMPO derivatives. Electron spin resonance (ESR) and electrospray ionisation mass-spectrometry (ESI-MS) data were acquired to provide complementary structural elucidation of the odd- and even-electron products of these reactions and both techniques show evidence for the formation of 4-oxo-TEMPO (TEMPONE). TEMPONE formation from the 4-substituted TEMPO compounds is proposed to be initiated by hydrogen abstraction at the 4-position by hydroxyl radical. High-level ab initio calculations reveal a thermodynamic preference for abstraction of this hydrogen but computed activation barriers indicate that, although viable, it is less favoured than hydrogen abstraction from elsewhere on the TEMPO scaffold. If a radical is formed at the 4-position however, calculations elucidate two reaction pathways leading to TEMPONE following combination with either a second hydroxyl radical or dioxygen. An alternate mechanism for conversion of TEMPOL to TEMPONE via an alkoxyl radical intermediate is also considered and found to be competitive with the other pathways. ESI-MS analysis also shows an increased abundance of analogous 4-substituted piperidines during the course of irradiation, suggesting competitive modification at the 1-position to produce a secondary amine. This modification is confirmed by characteristic fragmentation patterns of the ionised piperidines obtained by tandem mass spectrometry. The conclusions describe how reaction at the 4-position could be responsible for the gradual depletion of HALS in pigmented surface coatings and secondly, that modification at nitrogen to form the corresponding secondary amine species may play a greater role in the stabilisation mechanisms of HALS than previously considered.

Detection and characterisation of structural modifications of a hindered amine light stabiliser (HALS) directly from a polyester-based coil coating have been achieved by desorption electrospray ionisation mass spectrometry (DESI-MS) for the first time. In situ detection is made possible by exposing the coating to an acetone vapour atmosphere prior to analysis. This is a gentle and non-destructive treatment that allows diffusion of analyte to the surface without promoting lateral migration. Using this approach a major structural modification of the HALS TINUVIN®123 (bis(1-octyloxy-2,2,6,6-tetramethyl-4-piperidyl) sebacate) was discovered where one N-ether piperidine moiety (N-OC(8)H(17)) is converted to a secondary piperidine (N-H). With the use of 2-dimensional DESI-MS imaging the modification was observed to arise during high curing temperatures (ca. 260 °C) and under simulated physiological conditions (80 °C, full solar spectrum). It is proposed that the secondary piperidine derivative is a result of a highly reactive aminyl radical intermediate produced by N-O homolytic bond cleavage. The nature of the bond cleavage is also suggested by ESR spin-trapping experiments employing α-phenyl-N-tert-butyl nitrone (PBN) in toluene at 80 °C. The presence of a secondary piperidine derivative in situ and the implication of N-OR competing with NO-R bond cleavage suggest an alternative pathway for generation of the nitroxyl radical-an essential requirement in anti-oxidant activity that has not previously been described for the N-ether sub-class of HALS.

Hindered amine light stabilisers (HALS) are the most effective antioxidants currently available for polymer systems in post-production, in-service applications, yet the mechanism of their action is still not fully understood. Structural characterisation of HALS in polymer matrices, particularly the identification of structural modifications brought about by oxidative conditions, is critical to aid mechanistic understanding of the prophylactic effects of these molecules. In this work, electrospray ionisation tandem mass spectrometry (ESI-MS/MS) was applied to the analysis of a suite of commercially available 2,2,6,6-tetramethylpiperidine-based HALS. Fragmentation mechanisms for the [M + H](+) ions are proposed, which provide a rationale for the product ions observed in the MS/MS and MS(3) mass spectra of N-H, N-CH(3), N-C(O)CH(3) and N-OR containing HALS (where R is an alkyl substituent). A common product ion at m/z 123 was identified for the group of antioxidants containing N-H, N-CH(3) or N-C(O)CH(3) functionality, and this product ion was employed in precursor ion scans on a triple quadrupole mass spectrometer to identify the HALS species present in a crude extract from of a polyester-based coil coating. Using MS/MS, two degradation products were unambiguously identified. This technique provides a simple and selective approach to monitoring HALS structures within complex matrices., (2010 John Wiley & Sons, Ltd.)

The anatomy of the middle layer of lumbar fascia (MLF) is of biomechanical interest and potential clinical relevance, yet it has been inconsistently described. Avulsion fractures of the lumbar transverse processes (LxTP's) are traditionally attributed to traction from psoas major or quadratus lumborum (QL), rather than transversus abdominis (TrA) acting via the MLF. This attachment is also absent from many biomechanical models of segmental control. The aims of this study were to document: (1) the morphology and attachments of the MLF and (2) the attachments of psoas and QL to the LxTP's. Eighteen embalmed cadavers were dissected, measuring the thickness, fibre angle and width of the MLF and documenting the attachments of MLF, psoas and QL. The MLF was thicker at the level of the LxTP's than between them (mean 0.62: 0.40 mm). Psoas attached to the anteromedial surface of each process and QL and TrA to its lateral border; QL at its upper and lower corners and TrA (via the MLF) to its tip. In three cadavers, tension applied to the MLF fractured a transverse process. The MLF has a substantial and thickened attachment to the tips of the LxTP's which supports the involvement of TrA in lumbar segmental control and/ or avulsion fracture of the LxTP's.