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Background/Objectives: Transitions to and from Emergency Departments (EDs) can be detrimental to long-term care (LTC) residents and burden the healthcare system. While reducing avoidable transfers is imperative, various terms are used interchangeably including inappropriate, preventable, or unnecessary transitions. Our study objectives were to develop a conceptual definition of avoidable LTC-ED transitions and to verify the level of stakeholder agreement with this definition. Methods: The EXamining Aged Care Transitions study adopted an exploratory sequential mixed-method design. The study was conducted in 2015-2016 in 16 LTC facilities, 1 ED, and 1 Emergency Medical Service (EMS) in a major urban center in western Canada. Phase 1 included 80 participants, (healthcare aides, licensed practical nurses, registered nurses, LTC managers, family members of residents, and EMS staff). We conducted semistructured interviews (n = 25) and focus groups (n = 19). In Phase 2, 327 ED staff, EMS staff, LTC staff, and medical directors responded to a survey based on the qualitative findings. Results: Avoidable transitions were attributed to limited resources in LTC, insufficient preventive care, and resident or family wishes. The definition generated was: A transition of an LTC resident to the ED is considered avoidable if: (a) Diagnostic testing, medical assessment, and treatment can be accessed in a timely manner by other means; (b) the reasons for a transfer are unclear and the transition would increase the disorientation, pain, or discomfort of a resident, outweighing a clear benefit of a transfer; and (c) the transition is against the wishes expressed by the resident over time, including through informal and undocumented conversations. There was a high level of agreement with the definition across the four participant groups. Conclusions and Implications: To effectively reduce LTC resident avoidable transitions, stakeholders must share a common definition. Our conceptual definition may significantly contribute to improved care for LTC residents.

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Even though the influence of the printing direction on the mechanical properties of 3D-printed samples by fused filament fabrication is established in the literature, very little is known about mechanical and electrical coupling. In this study, electrically conductive polylactic acid filled with carbon black particles undergoes monotonic and repeated progressive tensile loading to better understand the influence of the printing direction on the electro-mechanical properties of three-dimensional-printed samples. The objective is to analyse the electro-mechanical behaviour of this composite for its potential application as an actuator. The classical laminate theory is also applied to evaluate the relevance of this theory in predicting the mechanical characteristics of this material. In addition, a comprehensive damage analysis is performed using acoustic emission, infrared thermography, scanning electron microscopy, and X-ray microcomputed tomography imaging. Results show that the degradation of the mechanical and electrical properties is highly influenced by the printing direction. The appearance and development of crazes in 0° filaments are highlighted and quantified. The conclusions drawn by this study underline the interest in using longitudinal and unidirectional printing directions to improve the conductive path within the samples. Furthermore, the evolution of the resistance throughout the experiments emphasizes the need to control the implemented voltage in the design of future electro-thermally triggered actuators.

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Development of wearable sensing platforms is essential for the advancement of continuous health monitoring and point-of-care testing. Eccrine sweat pH is an analyte that can be noninvasively measured and used to diagnose and aid in monitoring a wide range of physiological conditions. Surface-enhanced Raman scattering (SERS) offers a rapid, optical technique for fingerprinting of biomarkers present in sweat. In this paper, a mechanically flexible, nanofibrous, SERS-active substrate was fabricated by a combination of electrospinning of thermoplastic polyurethane (TPU) and Au sputter coating. This substrate was then investigated for suitability toward wearable sweat pH sensing after functionalization with two commonly used pH-responsive molecules, 4-mercaptobenzoic acid (4-MBA), and 4-mercaptopyridine (4-MPy). The developed SERS pH sensor was found to have good resolution (0.14 pH units for 4-MBA; 0.51 pH units for 4-MPy), with only 1 µL of sweat required for a measurement, and displayed no statistically significant difference in performance after 35 days (p = 0.361). Additionally, the Au/TPU nanofibrous SERS pH sensors showed fast sweat-absorbing ability as well as good repeatability and reversibility. The proposed methodology offers a facile route for the fabrication of SERS substrates which could also be used to measure a wide range of health biomarkers beyond sweat pH.

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Powder epoxy composites have several advantages for the processing of large composite structures, including low exotherm, viscosity and material cost, as well as the ability to carry out separate melting and curing operations. This work studies the mode I and mixed-mode toughness, as well as the in-plane mechanical properties of unidirectional stitched glass and carbon fibre reinforced powder epoxy composites. The interlaminar fracture toughness is studied in pure mode I by performing Double Cantilever Beam tests and at 25% mode II, 50% mode II and 75% mode II by performing Mixed Mode Bending testing according to the ASTM D5528-13 test standard. The tensile and compressive properties are comparable to that of standard epoxy composites but both the mode I and mixed-mode toughness are shown to be significantly higher than that of other epoxy composites, even when comparing to toughened epoxies. The mixed-mode critical strain energy release rate as a function of the delamination mode ratio is also provided. This paper highlights the potential for powder epoxy composites in the manufacturing of structures where there is a risk of delamination.

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Brachyuran crab carapaces are protective, impact-resistant exoskeletons with elaborate material microstructures. Though several research efforts have been made to characterise the physical, material and mechanical properties of the crab carapace, there are no studies detailing how crab morphologies might influence impact resistance. The purpose of this paper is to characterise and compare Brachyuran crab carapace morphologies in relation to their impact properties, using opto-digital, experimental and numerical methods. We find that crab carapaces with both extended carapace arc-lengths and deep carapace grooves lose stiffness rapidly under cyclic impact loading, and fail in a brittle manner. Contrarily, carapaces with smaller arc lengths and shallower, more broadly distributed carapace grooves are more effective in dissipating stresses caused by impact throughout the carapace structure. This allows them to retain stiffness for longer, and influences their failure mode, which is ductile (denting), rather than brittle fracture. The findings in this paper provide new bioinspired approaches for the geometrical designs by which means material failure under cyclic impact can be controlled and manipulated.

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In this work, a nozzle-free electrospinning device was built to obtain high-throughput production of silk fibroin-based biocompatible composite fibers with tunable wettability. Synthetic biomaterials tend to present suboptimal cell growth and proliferation, with many studies linking this phenomenon to the hydrophobicity of such surfaces. In this study, electrospun mats consisting of Poly(caprolactone) blended with variant forms of Poly(glycerol sebacate) (PGS) and regenerated silk fibroin were fabricated. The main aim of this work was the development of fiber mats with tunable hydrophobicity/hydrophilicity properties depending on the esterification degree and concentration of PGS. A variation of the conventional protocol used for the extraction of silk fibroin from Bombyx mori cocoons was employed, achieving significantly increased yields of the protein, in a third of the time required via the conventional extraction protocol. By altering the surface properties of the electrospun membranes, the trinary composite biomaterial presented good in vitro fibroblast attachment behavior and optimal growth, indicating the potential of such constructs towards the development of an artificial skin-like platform that can aid wound healing and skin regeneration.

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BACKGROUND AND PURPOSE: The long-acting muscarinic antagonist tiotropium received an indication for the treatment of asthma from the FDA in 2015. METHODS: This paper summarizes much of the published findings on tiotropium and asthma and explores the heterogeneity of the asthma population vis-à-vis recent changes in guidelines for management of COPD. The accompanying case study provides an illustration of how tiotropium might be added to a patient's regimen appropriately. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Tiotropium has been shown in many studies to be beneficial to patients with asthma as an add-on medication. It should be considered as an agent by the clinician managing patients with both allergic and non-allergic asthma.

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BACKGROUND: There is a potential for direct model manufacturing of abdominal aortic aneurysm (AAA) using 3D printing technique for generating flexible semi-transparent prototypes. A patient-specific AAA model was manufactured using fused deposition modelling (FDM) 3D printing technology. A flexible, semi-transparent thermoplastic polyurethane (TPU), called Cheetah Water (produced by Ninjatek, USA), was used as the flexible, transparent material for model manufacture with a hydrophilic support structure 3D printed with polyvinyl alcohol (PVA). Printing parameters were investigated to evaluate their effect on 3D-printing precision and transparency of the final model. ISO standard tear resistance tests were carried out on Ninjatek Cheetah specimens for a comparison of tear strength with silicone rubbers. RESULTS: It was found that an increase in printing speed decreased printing accuracy, whilst using an infill percentage of 100% and printing nozzle temperature of 255 °C produced the most transparent results. The model had fair transparency, allowing external inspection of model inserts such as stent grafts, and good flexibility with an overall discrepancy between CAD and physical model average wall thicknesses of 0.05 mm (2.5% thicker than the CAD model). The tear resistance test found Ninjatek Cheetah TPU to have an average tear resistance of 83 kN/m, higher than any of the silicone rubbers used in previous AAA model manufacture. The model had lower cost (4.50 GBP per model), shorter manufacturing time (25 h 3 min) and an acceptable level of accuracy (2.61% error) compared to other methods. CONCLUSIONS: It was concluded that the model would be of use in endovascular aneurysm repair planning and education, particularly for practicing placement of hooked or barbed stents, due to the model's balance of flexibility, transparency, robustness and cost-effectiveness.

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Emotion regulation is crucial in maintaining healthy psychological well-being, and its dysregulation is often linked to a range of neuropsychiatric disorders including depression. The neurobiological underpinnings of cognitive reappraisal, an emotion regulation strategy, have been shown to include the amygdala and regions of the prefrontal cortex. A novel study by Doré, Weber, and Ochsner (J Neurosci 37: 2580-2588, 2017) has demonstrated that neural activity in these regions during uninstructed visualization of affective stimuli can successfully predict which individuals are more likely to subsequently employ emotion regulation, and under what circumstances.

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BACKGROUND: Initiatives to accelerate the adoption and implementation of evidence-based practices benefit from an association with influential individuals and organizations. When opinion leaders advocate or adopt a best practice, others adopt too, resulting in diffusion. We sought to identify existing influence throughout Canada's long-term care sector and the extent to which informal advice-seeking relationships tie the sector together as a network. METHODS: We conducted a sociometric survey of senior leaders in 958 long-term care facilities operating in 11 of Canada's 13 provinces and territories. We used an integrated knowledge translation approach to involve knowledge users in planning and administering the survey and in analyzing and interpreting the results. Responses from 482 senior leaders generated the names of 794 individuals and 587 organizations as sources of advice for improving resident care in long-term care facilities. RESULTS: A single advice-seeking network appears to span the nation. Proximity exhibits a strong effect on network structure, with provincial inter-organizational networks having more connections and thus a denser structure than interpersonal networks. We found credible individuals and organizations within groups (opinion leaders and opinion-leading organizations) and individuals and organizations that function as weak ties across groups (boundary spanners and bridges) for all studied provinces and territories. A good deal of influence in the Canadian long-term care sector rests with professionals such as provincial health administrators not employed in long-term care facilities. CONCLUSIONS: The Canadian long-term care sector is tied together through informal advice-seeking relationships that have given rise to an emergent network structure. Knowledge of this structure and engagement with its opinion leaders and boundary spanners may provide a route for stimulating the adoption and effective implementation of best practices, improving resident care and strengthening the long-term care advice network. We conclude that informal relational pathways hold promise for helping to transform the Canadian long-term care sector.

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BACKGROUND: OPTIC is a mixed method Partnership for Health System Improvement (http://www.cihr-irsc.gc.ca/e/34348.html) study focused on improving care for nursing home (NH) residents who are transferred to and from emergency departments (EDs) via emergency medical services (EMS). In the pilot study we tested feasibility of concurrently collecting individual resident data during transitions across settings using the Transition Tracking Tool (T3). METHODS: The pilot study tracked 54 residents transferred from NHs to one of two EDs in two western Canadian provinces over a three month period. The T3 is an electronic data collection tool developed for this study to record data relevant to describing and determining success of transitions in care. It comprises 800+ data elements including resident characteristics, reasons and precipitating factors for transfer, advance directives, family involvement, healthcare services provided, disposition decisions, and dates/times and timing. RESULTS: Residents were elderly (mean age = 87.1 years) and the majority were female (61.8%). Feasibility of collecting data from multiple sources across two research sites was established. We identified resources and requirements to access and retrieve specific data elements in various settings to manage data collection processes and allocate research staff resources. We present preliminary data from NH, EMS, and ED settings. CONCLUSIONS: While most research in this area has focused on a unidirectional process of patient progression from one care setting to another, this study established feasibility of collecting detailed data from beginning to end of a transition across multiple settings and in multiple directions.

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Sensing skins about 1.5 µm thick made of 40 nanolayers of conductive polymer nanocomposites (CPC) were sprayed layer by layer (sLbL) directly on a PET woven textile to demonstrate their versatility to monitor the deformation of a flexible, rigid and rough substrate such as a commercial boat sail. CPC sensing skins were developed by structuring a 3D carbon nanotubes network into three kinds of amorphous thermoplastic matrices (PMMA, aPS, PC). Adjustable parameters such as the thickness (number of sprayed layers) and the initial resistance of CPC transducers (CNT content relatively to percolation threshold) enabled to tailor both sensitivity and stability of the piezo-resistive responses, so that it was possible to monitor the strain evolution in the elastic domain and damage accumulation over this limit. Polymer matrices were selected after calculation of their χ Flory-Huggins parameters to evaluate their interactions with the PET substrate and solvent of dispersion, and after the comparison of their stress/strain characteristics, particularly their elastic limit. PC-1%CNT was found to be the best candidate satisfying both chemical and physical criteria. Finally, the exponential evolution of the piezo-resistive response of CPC sensing skins on a wide range of deformation (until breakage at ε = 27%), was well fitted with a model based on quantum tunnelling conduction inducing an exponential evolution of resistance with variations of CNT/CNT junction gap from 0.5 to 0.625 nm.

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Leber congenital amaurosis (LCA) is a clinically and genetically heterogeneous severe retinal dystrophy presenting in infancy. To explain the phenotypical variability observed in two affected siblings of a consanguineous pedigree diagnosed with LCA and establish a genotype-phenotype correlation, we screened GUCY2D, RPE65, CRX, AIPL1, and RPGRIP1 for mutations. The more severely affected sibling carried a heterozygous missense mutation in the GUCY2D gene (Ile539Val), which did not segregate with the disease phenotype. Subsequently, a homozygous nonsense mutation (Glu102STOP) in the RPE65 gene was identified in both affected siblings, thus identifying the causative gene. This data provides evidence for the presence of genetic modulation in LCA. It appears that the heterozygous GUCY2D mutation further disrupts the already compromised photoreceptor function resulting in more severe retinal dysfunction in the older sibling. We suggest that the unusual phenotypic variability in these two siblings with LCA is caused by the modifying effect of a heterozygous GUCY2D mutation observed against the disease background of a homozygous RPE65 mutation.

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