Development and evaluation of a concise nurse-driven non-pharmacological delirium reduction workflow for hospitalized patients: An interrupted time series study.

We created a concise nurse-driven delirium reduction workflow with the aim of reducing delirium rates and length of stay for hospitalized adults. Our nurse-driven workflow included five evidence-based daytime "sunrise" interventions (patient room lights on, blinds up, mobilization/out-of-bed, water within patient's reach and patient awake) and five nighttime "turndown" interventions (patient room lights off, blinds down, television off, noise reduction and pre-set bedtime). Interventions were also chosen because fidelity could be quickly monitored twice daily without patient interruption from outside the room.

Hyaluronic acid-British anti-Lewisite as a safer chelation therapy for the treatment of arthroplasty-related metallosis.

Cobalt-containing alloys are useful for orthopedic applications due to their low volumetric wear rates, corrosion resistance, high mechanical strength, hardness, and fatigue resistance. Unfortunately, these prosthetics release significant levels of cobalt ions, which was only discovered after their widespread implantation into patients requiring hip replacements. These cobalt ions can result in local toxic effects-including peri-implant toxicity, aseptic loosening, and pseudotumor-as well as systemic toxic effects-including neurological, cardiovascular, and endocrine disorders.

A prospective single-center study evaluating the efficacy of the stomach, intestinal, and pylorus-sparing procedure.

Background: The stomach, intestinal, and pylorus-sparing (SIPS) procedure is a single-anastomosis duodeno-intestinal bypass used in obesity management.

Objective: Weight and metabolic outcomes in patients with severe obesity who underwent the SIPS procedure were evaluated in a community hospital-based study.

Setting: Community hospital.

Ultra-low binder content 3D printed calcium phosphate graphene scaffolds as resorbable, osteoinductive matrices that support bone formation in vivo.

Bone regenerative engineering could replace autografts; however, no synthetic material fulfills all design criteria. Nanocarbons incorporated into three-dimensional printed (3DP) matrices can improve properties, but incorporation is constrained to low wt%. Further, unmodified nanocarbons have limited osteogenic potential.

Outcomes Following Implementation of a Hospital-Wide, Multicomponent Delirium Care Pathway.

Background: Delirium is associated with poor clinical outcomes that could be improved with targeted interventions.

Objective: To determine whether a multicomponent delirium care pathway implemented across seven specialty nonintensive care units is associated with reduced hospital length of stay (LOS). Secondary objectives were reductions in total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use.

The Blanket Effect: How Turning the World Upside Down Reveals the Nature of Graphene Oxide Cytocompatibility.

Extensive cytocompatibility testing of 2D nanocarbon materials including graphene oxide (GO) has been performed, but results remain contradictory. Literature has yet to account for settling-although sedimentation is visible to the eye and physics suggests that even individual graphenic flakes will settle. To investigate settling, a series of functional graphenic materials (FGMs) with differing oxidation levels, functionalities, and physical dimensions are synthesized.

Bioactive, Ion-Releasing PMMA Bone Cement Filled with Functional Graphenic Materials.

Graphene oxide and functionalized graphenic materials (FGMs) have promise as platforms for imparting programmable bioactivity to poly(methyl methacrylate) (PMMA)-based bone cement. To date, however, graphenic fillers have only been feasible in PMMA cements at extremely low loadings, limiting the bioactive effects. At higher loadings, graphenic fillers decrease cement strength by aggregating and interfering with curing process.

Injectable amine functionalized graphene and chondroitin sulfate hydrogel with potential for cartilage regeneration.

Damaged cartilage does not readily heal and often requires surgical intervention that only modestly improves outcomes. A synthetic material that could be injected and covalently crosslinked in situ to form a bioactive, mechanically robust scaffold that promotes stem cell chondrogenic differentiation holds promise for next-generation treatment of cartilage lesions. Here, Johnson-Claisen rearrangement chemistry was performed on graphene oxide (GO) to enable functionalization with a primary amine covalently bound to the graphenic backbone through a chemically stable linker.

Polyester functional graphenic materials as a mechanically enhanced scaffold for tissue regeneration.

Traditional metal implants such as titanium, cobalt, and chromium have found wide utility in medicine; however, these come with a risk of toxicity. To overcome metal-related toxicity and enable degradability, polyesters including polycaprolactone (PCL), polylactic acid (PLA), and polyglycolic acid (PGA) show promise for the replacement of various biomedical applications of metals due to their accepted biocompatibility and FDA approval. However, polyesters are less stiff than their metallic counterparts, limiting their application to non-load bearing injury sites, such as fixation hardware for fingers.

Covalent conjugation of bioactive peptides to graphene oxide for biomedical applications.

Graphene is a valuable material in biomedical implant applications due to its mechanical integrity, long-range order, and conductivity; but graphene must be chemically modified to increase biocompatibility and maximize functionality in the body. Here, we developed a foundational synthetic method for covalently functionalizing a reduced GO with bioactive molecules, focusing on synthetic peptides that have shown osteogenic or neurogenic capability as a prototypical example. X-ray photoelectron spectroscopy provides evidence that the peptide is covalently linked to the graphenic backbone.

Functional Graphenic Materials That Seal Condenser Tube Leaks in Situ.

Undesirable condenser tube leaks frequently occur in power plants, resulting in reduced power output, increased burden on downstream systems, and substantial revenue losses. Current techniques such as wood flour provide temporary in situ remediation but lack adhesive properties to form stable seals. Here, we report the development of in situ sealants for long-term defect repair.

Phosphate graphene as an intrinsically osteoinductive scaffold for stem cell-driven bone regeneration.

Synthetic, resorbable scaffolds for bone regeneration have potential to transform the clinical standard of care. Here, we demonstrate that functional graphenic materials (FGMs) could serve as an osteoinductive scaffold: recruiting native cells to the site of injury and promoting differentiation into bone cells. By invoking a Lewis acid-catalyzed Arbuzov reaction, we are able to functionalize graphene oxide (GO) to produce phosphate graphenes (PGs) with unprecedented control of functional group density, mechanical properties, and counterion identity.

Covalently-controlled drug delivery via therapeutic methacrylic tissue adhesives.

Medical cyanoacrylate adhesives have the potential to eliminate the need for sutures but face challenges to widespread implementation due to their brittleness and release of formaldehyde upon degradation. To overcome these limitations, we used molecular design to create therapeutic methacrylic (TMA) monomers to impart tunable mechanical properties, decreased formaldehyde release, and covalently-controlled bioactivity to commercial cyanoacrylate adhesives. The small molecule therapeutics ibuprofen, acetaminophen, and benzocaine were covalently tethered to the carbonyl of methacrylate using anhydride, ester, and amide bonds.

Dispersed single wall carbon nanotubes do not impact mitochondria structure or function, but technical issues during analysis could yield incorrect results.

Mitochondria are the organelles of cells that generate a majority of the cell's energy through ATP and are involved in programmed cell death through apoptosis. An understanding of non-specific targeting of nanomaterials, including single wall carbon nanotubes (SWCNTs), to organelles is important in trying to modulate cell function or determine the cellular toxicity with long term exposure. Here, we examine the impact of SWCNTs dispersed with Pluronic F127 and protein on mitochondria using a battery of standard tests.

In It for the Long Haul: The Cytocompatibility of Aged Graphene Oxide and Its Degradation Products.

Synthetic biomaterials are poised to transform medicine; however, current synthetic options have yet to ideally recapitulate the desirable properties of native tissue. Thus, the development of new synthetic biomaterials remains an active challenge. Due to its excellent properties, including electrical conductivity, water dispersibility, and capacity for functionalization, graphene oxide (GO) holds potential for myriads of applications, including biological devices.

Graphene oxide as a scaffold for bone regeneration.

Graphene oxide (GO), the oxidized form of graphene, holds great potential as a component of biomedical devices, deriving utility from its ability to support a broad range of chemical functionalities and its exceptional mechanical, electronic, and thermal properties. GO composites can be tuned chemically to be biomimetic, and mechanically to be stiff yet strong. These unique properties make GO-based materials promising candidates as a scaffold for bone regeneration.

Delivering Single-Walled Carbon Nanotubes to the Nucleus Using Engineered Nuclear Protein Domains.

Single-walled carbon nanotubes (SWCNTs) have great potential for cell-based therapies due to their unique intrinsic optical and physical characteristics. Consequently, broad classes of dispersants have been identified that individually suspend SWCNTs in water and cell media in addition to reducing nanotube toxicity to cells. Unambiguous control and verification of the localization and distribution of SWCNTs within cells, particularly to the nucleus, is needed to advance subcellular technologies utilizing nanotubes.

Distribution of single wall carbon nanotubes in the Xenopus laevis embryo after microinjection.

Single wall carbon nanotubes (SWCNTs) are advanced materials with the potential for a myriad of diverse applications, including biological technologies and large-scale usage with the potential for environmental impacts. SWCNTs have been exposed to developing organisms to determine their effects on embryogenesis, and results have been inconsistent arising, in part, from differing material quality, dispersion status, material size, impurity from catalysts and stability. For this study, we utilized highly purified SWCNT samples with short, uniform lengths (145 ± 17 nm) well dispersed in solution.

Differential sub-cellular processing of single-wall carbon nanotubes via interfacial modifications.

Strategies for cell-specific targeting and delivery of carbon nanotubes have made significant advancements over recent years. However, control of sub-cellular localization, an important criterion for many biomedical applications, remains largely unexplored. In this work, we experimentally demonstrate how different molecules that are used to non-covalently suspend hydrophobic SWCNTs in aqueous conditions also influence cellular processing and localization.

Developing Xenopus embryos recover by compacting and expelling single wall carbon nanotubes.

Single wall carbon nanotubes are high aspect ratio nanomaterials being developed for use in materials, technological and biological applications due to their high mechanical stiffness, optical properties and chemical inertness. Because of their prevalence, it is inevitable that biological systems will be exposed to nanotubes, yet studies of the effects of nanotubes on developing embryos have been inconclusive and are lacking for single wall carbon nanotubes exposed to the widely studied model organism Xenopus laevis (African clawed frog). Microinjection of experimental substances into the Xenopus embryo is a standard technique for toxicology studies and cellular lineage tracing.

Subcellular Partitioning and Analysis of Gd3+-Loaded Ultrashort Single-Walled Carbon Nanotubes.

Magnetic resonance imaging (MRI) is of vast clinical utility, with tens of millions of scans performed annually. Chemical contrast agents (CAs) can greatly enhance the diagnostic potential of MRI, and ∼50% of MRI scans use CAs. However, CAs have significant limitations such as low contrast enhancement, lack of specificity, and potential toxicity.

Actin reorganization through dynamic interactions with single-wall carbon nanotubes.

Single-wall carbon nanotubes (SWCNTs) have been widely used for biological applications in recent years, and thus, it is critical to understand how these inert nanomaterials influence cell behavior. Recently, it has been observed that cellular phenotypes such as proliferation, force generation and growth change upon SWCNT treatment, and SWCNTs directly affect the organization and redistribution of the actin cytoskeleton. However, the interactions between SWCNTs and actin at the molecular level or how this interaction changes actin structure remain largely unknown.

Clinical correlates, outcomes and healthcare costs associated with early mechanical ventilation after kidney transplantation.

Background: Information is lacking on the frequency, clinical implications, and costs of respiratory failure requiring mechanical ventilation after kidney transplantation.

Methods: U.S.

Ten Weeks of Home-Based Exercise Attenuates Symptoms of Chemotherapy-Induced Peripheral Neuropathy in Breast Cancer Patients.

The purpose of this investigation was to determine if a structured, home-based exercise program was beneficial to reduce symptoms of chemotherapy-induced peripheral neuropathy and improve quality of life (QOL). A total of 50 women who are breast cancer survivors and are listed in the Breast Cancer Registry of Greater Cincinnati database were recruited by mail. Participants were initially asked to complete the McGill QOL questionnaire and the Leeds Assessment of Neuropathic Symptoms and Signs, before beginning a 10-week home-based exercise program.

Pig dorsum model for examining impaired wound healing at the skin-implant interface of percutaneous devices.

Percutaneous medical devices are indispensable in contemporary clinical practice, but the associated incidence of low to moderate mortality infections represents a significant economic and personal cost to patients and healthcare providers. Percutaneous osseointegrated prosthetics also suffer from a similar risk of infection, limiting their clinical acceptance and usage in patients with limb loss. We hypothesized that transepidermal water loss (TEWL) management at the skin-implant interface may improve and maintain a stable skin-to-implant interface.