NMR analysis of Nile Blue (C I Basic Blue 12) and Thionine (C I 52000) in solution

The dyes Nile Blue (C I Basic Blue 12) and Thionine (C I 52000) were examined in both ionic and neutral forms in different solvents using NMR and UV-visible spectroscopy to firmly establish the structures of the molecules and to assess the nature and extent of their aggregation H-1 and C-13 NMR assignments and chemical shift data were used together with nuclear Overhauser effect information to propose a self-assembly structure These data were supplemented with variable temperature dilution and diffusion-based experimental results using H-1 NMR spectroscopy thereby enabling extended aggregate structures to be assessed in terms of the relative strength of self-association and the extent to which extended aggregates could form (C) 2010 Elsevier Ltd All rights reserved

Community Care Services for the Mentally Ill

In this study a broadly representative sample of clients in the City of Westminster, receiving Care in the Community for reasons of mental ill-health, were interviewed regarding their experiences of, and levels of satisfaction with, services provided. The results reveal the vulnerability of services users, the benefits of community care, the high regard the majority have for their helpers, the limitations imposed by scarce resources, and the negative effects of only loose co-ordination between health and social services. Respondents also provide a rich source of data on how services might be improved.

Vitamin D binding protein isoforms as candidate predictors of disease extension in childhood arthritis

Introduction: Juvenile idiopathic arthritis (JIA) comprises a poorly understood group of chronic autoimmune diseases with variable clinical outcomes. We investigated whether the synovial fluid (SF) proteome could distinguish a subset of patients in whom disease extends to affect a large number of joints.

Methods: SF samples from 57 patients were obtained around time of initial diagnosis of JIA, labeled with Cy dyes and separated by two-dimensional electrophoresis. Multivariate analyses were used to isolate a panel of proteins which distinguish patient subgroups. Proteins were identified using MALDI-TOF mass spectrometry with expression verified by immunochemical methods. Protein glycosylation status was confirmed by hydrophilic interaction liquid chromatography.

Results: A truncated isoform of vitamin D binding protein (VDBP) is present at significantly reduced levels in the SF of oligoarticular patients at risk of disease extension, relative to other subgroups (p < 0.05). Furthermore, sialylated forms of immunopurified synovial VDBP were significantly reduced in extended oligoarticular patients (p < 0.005).

Conclusion: Reduced conversion of VDBP to a macrophage activation factor may be used to stratify patients to determine risk of disease extension in JIA patients.

Social work education and political conflict: preparing students to address the needs of victims and survivors of the Troubles in Northern Ireland

This paper reports on the evaluation of a European PEACE III sponsored teaching and learning project that was designed to enable social work students to better understand the needs of victims and survivors of the conflict in Northern Ireland. The paper begins with an introduction to policy, practice and educational contexts before reviewing the literature on social work, conflict and trauma. It also summarises key, innovative pedagogical approaches used in the teaching, including the use of ground rules, teaching teams consisting of lecturer and service user dyads, learning exercises and case studies. The paper then explains the evaluation methodology. This involved two surveys which returned 144 student and 34 practice teacher questionnaires. The findings revealed that
students were generally committed to this form of teaching and engagement with victims and survivors of the conflict, although some students reported that their attitudes towards this subject had were not changed. Some students also discussed how the conflict had affected their lives and the lives of families and friends; it is argued that such biographical details are crucial in developing new pedagogical approaches in this area.
Practice teachers who supervised some of these students on placement reported general levels of satisfaction with preparedness to work with conflict related situations but were less convinced that organisations were so committed. The paper concludes with a discussion of the study limitations and a recommendation for more robust methods of teaching and evaluation in this area of social work education and practice.

Preferences for place of care and place of death among informal caregivers of the terminally ill

Objectives: (1) To determine informal caregivers perceptions about place of care and place of death; and (2) to identify variables associated with a home death among terminally ill individuals who received in-home support services in a publicly funded home care system. Participants and design: A total of 216 informal caregivers participated in a bereavement interview. Data collection included care recipient and informal caregiver characteristics, the use of and satisfaction with community services, and preferences about place of death. Results: Most caregivers reported that they and the care recipient had a preferred place of death (77 and 68%, respectively) with over 63% reporting home as the preferred place of death. Caregivers had a greater preference for an institutional death (14%) than care recipients (4.7%). While 30% of care recipients did not die in their preferred location, most caregivers (92%) felt, in retrospect, that where the care recipient died was the appropriate place of death. Most caregivers reported being satisfied with the care that was provided. The odds of dying at home were greater when the care recipient stated a preference for place of death (OR: 2.92; 95% CI: 1.25, 6.85), and the family physician made home visits during the care recipients last month of life (Univariate odds ratios (OR): 4.42; 95% CI: 1.46, 13.36). Discussion: The ethic of self-control and choice for the care recipient must be balanced with consideration for the well being of the informal caregiver and responsiveness of the community service system. © 2005 Edward Arnold (Publishers) Ltd.

Nurse practitioner and physician collaboration in long-term care homes:Survey results

This survey assessed the extent of and satisfaction with collaboration between physicians and nurse practitioners (NPs) working in Ontario long-term care homes. Questionnaires, which included the Measure of Current Collaboration and Provider Satisfaction with Current Collaboration instruments, were mailed to NPs and physicians with whom the NP most frequently worked. The 14 matched-pairs of NPs and physicians reported similar levels of collaboration; however, physicians were significantly more satisfied with collaboration than were NPs (z = -2.67, p = 0.008). The majority of physicians (85%) and NPs (86%) indicated that collaboration was occurring, and 96 per cent of physicians and 79 per cent of NPs were satisfied with their collaboration. About one third of physicians reported that the NP had a negative effect on their income, but their satisfaction with collaboration did not differ from those who reported a positive effect. Overall, these physicians and NPs collaborate in delivering care and are satisfied with their collaboration. © 2009 Canadian Association on Gerontology.

Palliative care nursing in rural and urban community settings:A comparative analysis

Nurses have key roles in the coordination and delivery of community-based palliative care. The purpose of this study was to examine the differences between rural and urban community nurses' delivery of palliative care services. A survey was distributed to 277 nurses employed by a community agency in Ontario, Canada, and a 60% response rate was obtained. Nurses reported spending 27% of their time providing palliative care. Rural and urban nurses had similar roles in palliative care but rural nurses spent more time travelling and were more confident in their ability to provide palliative care. Both groups of nurses reported moderate job satisfaction and moderate satisfaction with the level of interdisciplinary collaboration in their practice. Several barriers to and facilitators of optimal palliative care provision were identified. The study results provide information about the needs of nurses that practise in these settings and may provide a basis for the development of strategies to address these needs.

An outpatient respiratory rehabilitation program:Findings from a community hospital

Objectives: To determine patient satisfaction with a community hospital's respiratory rehabilitation program and to assess changes in patient physical and emotional function and quality of life. Design: Pre- and post-program measures were made on a variety of physiological and psychosocial factors. A modified version of the Chronic Respiratory Disease Questionnaire was administered before and after the 8-week multidisciplinary and comprehensive respiratory rehabilitation program. The post-program questionnaire also included a number of service delivery and patient satisfaction and quality-of-life questions. Setting: Respiratory Rehabilitation Program at St. Joseph's Hospital, a community hospital in Brantford, Ont., in active partnership with the Brant County Lung Association. Brant County is located in Central West Ontario, and has both urban and rural areas and a population of approximately 125 000 people. Participants: Twenty-nine patients, with a diagnosis of moderate to severe chronic obstructive pulmonary disease (COPD) who were referred to the Fall 1997 and Spring 1998 programs, were enrolled in the study. Outcome measures: Changes in physical and emotional function, health knowledge, skills mastery, quality of life and satisfaction with the program. Results: Twenty-one of 29 patients completed the program. Statistically significant and clinically important improvements were found between all pre- and post-program evaluation scores (distance walked, fatigue, dyspnea, emotional function, skills mastery and health knowledge). Participants were very satisfied with the program and felt it improved their quality of life. Conclusion: The positive outcomes reported rom randomized controlled trials of respiratory rehabilitation programs can be achieved in a community hospital setting.

A comparative analysis of the health and wellbeing of cancer survivors to the general population

Background
The population of people surviving cancer is continually increasing and currently cancer survivors represent approximately 3.7% of the American population and 3% of the UK population. There is limited and inconclusive empirical evidence regarding the long-term health and well-being of cancer survivors.

Methods
Two hundred eighty-nine cancer survivors and 262 matched-age and sex patients from the same group of General (primary care) Practices completed postal questionnaires measuring health and well-being, health service utilisation and satisfaction and health care needs.

Main Results
Cancer survivors reported poorer health and well-being and health service utilisation than the general population. Despite this poorer health, the majority of cancer survivors reported satisfaction with services and almost two-thirds of the survivors did not report any needs.

Conclusions
The majority of cancer survivors do not appear to require additional support services. There is, however, a subgroup of survivors who warrant specialist support, particularly survivors who are older, experience late effects and have had adjuvant treatments. Future research should focus on developing methods that could be used in routine clinical practice to identify ‘at risk’ or vulnerable patients and to provide appropriate and timely support.

A systematic review protocol on the use of online learning and blended learning for teaching clinical skills to undergraduate health professional students

Aim: This paper is a review protocol that will be used to identify, critically appraise and synthesize the best current evidence relating to the use of online learning and blended learning approaches in teaching clinical skills in undergraduate nursing.

Background: Although previous systematic reviews on online learning versus face to face learning have been undertaken (Cavanaugh et al. 2010, Cook et al. 2010), a systematic review on the impact of online learning and blended learning for teaching clinical skills has yet to be considered in undergraduate nursing. By reviewing nursing students’ online learning experiences, systems can potentially be designed to ensure all students’ are supported appropriately to meet their learning needs.

Methods/Design: The key objectives of the review are to evaluate how online-learning teaching strategies assist nursing students learn; to evaluate the students satisfaction with this form of teaching; to explore the variety of online-learning strategies used; to determine what online-learning strategies are more effective and to determine if supplementary face to face instruction enhances learning. A search of the following databases will be made MEDLINE, CINAHL, BREI, ERIC and AUEI. This review will follow the Joanna Briggs Institute guidance for systematic reviews of quantitative and qualitative research.

Conclusion: This review intends to report on a combination of student experience and learning outcomes therefore increasing its utility for educators and curriculum developers involved in healthcare education.

Thermomechanical analyses of ultrasonic welding process using thermal and acoustic softening effects

Ultrasonic welding process is a rapid manufacturing process used to weld thin layers of metal at low temperatures and low energy consumption. Experimental results have shown that ultrasonic welding is a combination of both surface (friction) and volume (plasticity) softening effects. In the presented work, a very first attempt has been made to simulate the ultrasonic welding of metals by taking into account both of these effects (surface and volume). A phenomenological material model has been proposed which incorporates these two effects (i.e. surface and volume). The thermal softening due to friction and ultrasonic (acoustic) softening has been included in the proposed material model. For surface effects a friction law with variable coefficient of friction dependent upon contact pressure, slip, temperature and number of cycles has been derived from experimental friction tests. Thermomechanical analyses of ultrasonic welding of aluminium alloy have been performed. The effects of ultrasonic welding process parameters, such as applied load, amplitude of ultrasonic vibration, and velocity of welding sonotrode on the friction work at the weld interface are being analyzed. The change in the friction work at the weld interface has been explained on the basis of softening (thermal and acoustic) of the specimen during the ultrasonic welding process. In the end, a comparison between experimental and simulated results has been presented showing a good agreement. © 2008 Elsevier Ltd. All rights reserved.

Theoretical and FE analysis of ultrasonic welding of aluminum alloy 3003

Ultrasonic welding (consolidation) process is a rapid manufacturing process that is used to join thin layers of metal at low temperature and low energy consumption. Experimental results have shown that ultrasonic welding is a combination of both surface (friction) and volume (plasticity) softening effects. In the presented work, an attempt has been made to simulate the ultrasonic welding of metals by taking into account these effects (surface and volume). A phenomenological material model has been proposed, which incorporates these two effects (i.e., surface and volume). The thermal softening due to friction and ultrasonic (acoustic) softening has been included in the proposed material model. For surface effects, a friction law with variable coefficient of friction that is dependent on contact pressure, slip, temperature, and number of cycles has been derived from experimental friction tests. The results of the thermomechanical analyses of ultrasonic welding of aluminum alloy have been presented. The goal of this work is to study the effects of ultrasonic welding process parameters, such as applied load, amplitude of ultrasonic oscillation, and velocity of welding sonotrode on the friction work at the weld interface. The change in the friction work at the weld interface has been explained on the basis of softening (thermal and acoustic) of the specimen during the ultrasonic welding process. In the end, a comparison between experimental and simulated results has been presented, showing a good agreement. Copyright © 2009 by ASME.

Conjugate heat transfer and film cooling of a multi-stage cooling scheme

Cooling techniques play a key role in improving efficiency and power output of modern gas turbines. The conjugate technique of film and impingement cooling schemes is considered in this study. The Multi-Stage Cooling Scheme (MSCS) involves coolant passing from inside to outside turbine blade through two stages. The first stage; the coolant passes through first hole to internal gap where the impinging jet cools the external layer of the blade. Finally, the coolant passes through the internal gap to the second hole which has specific designed geometry for external film cooling. The effect of design parameters, such as, offset distance between two-stage holes, gap height, and inclination angle of the first hole, on upstream conjugate heat transfer rate and downstream film cooling effectiveness performance are investigated computationally. An Inconel 617 alloy with variable properties is selected for the solid material. The conjugate heat transfer and film cooling characteristics of MSCS are analyzed across blowing ratios of Br = 1 and 2 for density ratio, 2. This study presents upstream wall temperature distributions due to conjugate heat transfer for different gap design parameters. The maximum film cooling effectiveness with upstream conjugate heat transfer is less than adiabatic film cooling effectiveness by 24–34%. However, the full coverage of cooling effectiveness in spanwise direction can be obtained using internal cooling with conjugate heat transfer, whereas adiabatic film cooling effectiveness has narrow distribution.

Advantages and limitations of navigation-based multicriteria optimization (MCO) for localized prostate cancer IMRT planning

Efficacy of inverse planning is becoming increasingly important for advanced radiotherapy techniques. This study's aims were to validate multicriteria optimization (MCO) in RayStation (v2.4, RaySearch Laboratories, Sweden) against standard intensity-modulated radiation therapy (IMRT) optimization in Oncentra (v4.1, Nucletron BV, the Netherlands) and characterize dose differences due to conversion of navigated MCO plans into deliverable multileaf collimator apertures. Step-and-shoot IMRT plans were created for 10 patients with localized prostate cancer using both standard optimization and MCO. Acceptable standard IMRT plans with minimal average rectal dose were chosen for comparison with deliverable MCO plans. The trade-off was, for the MCO plans, managed through a user interface that permits continuous navigation between fluence-based plans. Navigated MCO plans were made deliverable at incremental steps along a trajectory between maximal target homogeneity and maximal rectal sparing. Dosimetric differences between navigated and deliverable MCO plans were also quantified. MCO plans, chosen as acceptable under navigated and deliverable conditions resulted in similar rectal sparing compared with standard optimization (33.7 ± 1.8Gy vs 35.5 ± 4.2Gy, p = 0.117). The dose differences between navigated and deliverable MCO plans increased as higher priority was placed on rectal avoidance. If the best possible deliverable MCO was chosen, a significant reduction in rectal dose was observed in comparison with standard optimization (30.6 ± 1.4Gy vs 35.5 ± 4.2Gy, p = 0.047). Improvements were, however, to some extent, at the expense of less conformal dose distributions, which resulted in significantly higher doses to the bladder for 2 of the 3 tolerance levels. In conclusion, similar IMRT plans can be created for patients with prostate cancer using MCO compared with standard optimization. Limitations exist within MCO regarding conversion of navigated plans to deliverable apertures, particularly for plans that emphasize avoidance of critical structures. Minimizing these differences would result in better quality treatments for patients with prostate cancer who were treated with radiotherapy using MCO plans.

Mechanisms of DNA Damage Response to Targeted Irradiation in Organotypic 3D Skin Cultures

DNA damage (caused by direct cellular exposure and bystander signaling) and the complex pathways involved in its repair are critical events underpinning cellular and tissue response following radiation exposures. There are limited data addressing the dynamics of DNA damage induction and repair in the skin particularly in areas not directly exposed. Here we investigate the mechanisms regulating DNA damage, repair, intracellular signalling and their impact on premature differentiation and development of inflammatory-like response in the irradiated and surrounding areas of a 3D organotypic skin model. Following localized low-LET irradiation (225 kVp X-rays), low levels of 53BP1 foci were observed in the 3D model (3.8±0.28 foci/Gy/cell) with foci persisting and increasing in size up to 48 h post irradiation. In contrast, in cell monolayers 14.2±0.6 foci/Gy/cell and biphasic repair kinetics with repair completed before 24 h was observed. These differences are linked to differences in cellular status with variable level of p21 driving apoptotic signalling in 2D and accelerated differentiation in both the directly irradiated and bystander areas of the 3D model. The signalling pathways utilized by irradiated keratinocytes to induce DNA damage in non-exposed areas of the skin involved the NF-κB transcription factor and its downstream target COX-2.