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The need for hollow microneedle arrays is important for both drug delivery and wearable sensor applications; however, their fabrication poses many challenges. Hollow metal microneedle arrays residing on a flexible metal foil substrate were created by combining additive manufacturing, micromolding, and electroplating approaches in a process we refer to as electromolding. A solid microneedle with inward facing ledge was fabricated with a two photon polymerization (2PP) system utilizing laser direct write (LDW) and then molded with polydimethylsiloxane. These molds were then coated with a seed layer of Ti/Au and subsequently electroplated with pulsed deposition to create hollow microneedles. An inward facing ledge provided a physical blocking platform to restrict deposition of the metal seed layer for creation of the microneedle bore. Various ledge sizes were tested and showed that the resulting seed layer void could be controlled via the ledge length. Mechanical properties of the PDMS mold was adjusted via the precursor ratio to create a more ductile mold that eliminated tip damage to the microneedles upon removal from the molds. Master structures were capable of being molded numerous times and molds were able to be reused. SEM/EDX analysis showed that trace amounts of the PDMS mold were transferred to the metal microneedle upon removal. The microneedle substrate showed a degree of flexibility that withstood over 100 cycles of bending from side to side without damaging. Microneedles were tested for their fracture strength and were capable of puncturing porcine skin and injecting a dye.
Despite significant needs, patients with chronic obstructive pulmonary disease (COPD) make limited use of palliative care, in part because the current models of palliative care do not address their key concerns.
Our aim was to develop a tailored model of palliative care for patients with COPD and their family caregivers.
Based on information gathered within a program of studies (qualitative research exploring experiences, a cohort study examining service use), an expert advisory committee evaluated and integrated data, developed responses, formulated principles to inform care, and made recommendations for practice. The informing studies were conducted in two Australian states: Victoria and South Australia.
A series of principles underpinning the model were developed, including that it must be: (1) focused on patient and caregiver; (2) equitable, enabling access to components of palliative care for a group with significant needs; (3) accessible; and (4) less resource-intensive than expansion of usual palliative care service delivery. The recommended conceptual model was to have the following features: (a) entry to palliative care occurs routinely triggered by clinical transitions in care; (b) care is embedded in routine ambulatory respiratory care, ensuring that it is regarded as “usual” care by patients and clinicians alike; (c) the tasks include screening for physical and psychological symptoms, social and community support, provision of information, and discussions around goals and preferences for care; and (d) transition to usual palliative care services is facilitated as the patient nears death.
Significance of results:
Our proposed innovative and conceptual model for provision of palliative care requires future formal testing using rigorous mixed-methods approaches to determine if theoretical propositions translate into effectiveness, feasibility, and benefits (including economic benefits). There is reason to consider adaptation of the model for the palliative care of patients with other nonmalignant conditions.
A modeling method to extract the mechanical properties of ultra-thin films (10–100 nm thick) from experimental data generated by indentation of freestanding circular films using a spherical indenter is presented. The relationship between the mechanical properties of the film and experimental parameters including load, and deflection are discussed in the context of a constitutive material model, test variables, and analytical approaches. Elastic and plastic regimes are identified by comparison of finite element simulation and experimental data.
Approximately half of the variation in wellbeing measures overlaps with variation in personality traits. Studies of non-human primate pedigrees and human twins suggest that this is due to common genetic influences. We tested whether personality polygenic scores for the NEO Five-Factor Inventory (NEO-FFI) domains and for item response theory (IRT) derived extraversion and neuroticism scores predict variance in wellbeing measures. Polygenic scores were based on published genome-wide association (GWA) results in over 17,000 individuals for the NEO-FFI and in over 63,000 for the IRT extraversion and neuroticism traits. The NEO-FFI polygenic scores were used to predict life satisfaction in 7 cohorts, positive affect in 12 cohorts, and general wellbeing in 1 cohort (maximal N = 46,508). Meta-analysis of these results showed no significant association between NEO-FFI personality polygenic scores and the wellbeing measures. IRT extraversion and neuroticism polygenic scores were used to predict life satisfaction and positive affect in almost 37,000 individuals from UK Biobank. Significant positive associations (effect sizes <0.05%) were observed between the extraversion polygenic score and wellbeing measures, and a negative association was observed between the polygenic neuroticism score and life satisfaction. Furthermore, using GWA data, genetic correlations of -0.49 and -0.55 were estimated between neuroticism with life satisfaction and positive affect, respectively. The moderate genetic correlation between neuroticism and wellbeing is in line with twin research showing that genetic influences on wellbeing are also shared with other independent personality domains.
The indigenous Christian population of the West Bank is a shrinking, historically fragmented community whose contribution to civil society outweighs its small size. The theme of this essay is these Christians’ unique contribution in a context that nevertheless seems set to squeeze them increasingly out of their homeland. We say “squeeze,” as the major sources of pressure arise from two directions, both Jewish and Muslim. From the Jewish side, the challenge arises from the consequences of the Israeli occupation of the West Bank. From the Muslim side, the challenge arises from the growing influence of the radical Islamic movements. Corruption within the Palestinian Authority (PA) also appears to have created an economic and social situation in the country that many Palestinian Christians refuse to tolerate, choosing instead to vote with their feet.
Much has been written on this topic, and it is not our purpose to provide a synthesis of the secondary literature. Within the framework of Georgetown's Christianity and Freedom Project, our mandate is to provide fresh fieldwork on the current situation, situated within a broader grasp of the contemporary scenario.
As such, the paper is set out as follows: A brief introduction by Phil Sumpter will provide the historical, social, and political context. The next section, authored by Duane Miller, will describe the findings of our fieldwork, which is the prime focus of this essay. This fieldwork is based on a two-week sojourn in the West Bank, where we interviewed representatives of the various traditional churches about the challenges their communities face and the responses that are being provided. In both sections, the authors have been in dialogue with one another so that our ideas have been mutually influential.
OVERVIEW: INDIGENOUS CHRISTIANITY IN THE CONTEMPORARY WEST BANK
The decisive event that has shaped the contemporary context is the war of 1948, called the War of Independence by (Jewish) Israelis and the Catastrophe (al Nakba) by Palestinians. In short, the General Assembly of the United Nations had adopted a proposal for the political future of the region in 1947, which envisioned the existence of two states side by side, an Arab state and a Jewish one (the Jews were to receive some 55 percent of the country [much of the allotted area being desert] and the Arabs about 40 percent).
Inpatient length of stay (LOS) has been used as a measure of hospital quality and efficiency. Patients with Clostridium difficile infections (CDI) have longer LOS.
To describe the relationship between hospital CDI incidence and the LOS of patients without CDI.
Retrospective cohort analysis.
We predicted average LOS for patients without CDI at both the hospital and patient level using hospital CDI incidence. We also controlled for hospital characteristics (eg, bed size) and patient characteristics (eg, comorbidities, age).
Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2009–2011.
The Nationwide Inpatient Sample includes patients from a 20% sample of all nonfederal US hospitals.
Inpatient LOS was significantly longer (P<.001) at hospitals with greater CDI incidence at both the hospital and individual level. At a hospital level, a percentage point increase in the CDI incidence rate was associated with more than an additional day’s stay (between 1.19 and 1.61 days). At the individual level, controlling for all observable variables, a percentage point increase in the CDI incidence rate at their hospital was also associated with longer LOS (between 0.6 and 1.05 additional days). Hospital CDI incidence had a larger impact on LOS than many other commonly used predictors of LOS.
CDI rates are a predictor of LOS in patients without CDI at an individual and institutional level. CDI rates are easy to measure and report and thus may provide an important marker for hospital efficiency and/or quality.
Infect. Control Hosp. Epidemiol. 2016;37(4):404–410
Hospital environments influence healthcare-associated infection (HAI) patterns, but the role of evidenced-based design (EBD) and residual bacterial DNA (previously thought to be clinically inert) remain incompletely understood.
In a newly built EBD hospital, we used culture-based and culture-free (molecular) assays, pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing (WGS) to determine: (1) patterns of environmental contamination with target organisms (TOs) and multidrug-resistant (MDR) target organisms (MDR-TOs); (2) genetic relatedness between environmentally isolated MDR-TO and those from HAIs; and (3) correlation between surface contamination and HAIs.
A total of 1,273 high-touch surfaces were swabbed before and after terminal cleaning during 77 room visits. Of the 2,546 paired swabs, 47% had cultivable biomaterial and 42% had PCR-amplifiable DNA. The ratios of TOs detected to surfaces assayed were 85 per 1,273 for the culture-based method and 106 per 1,273 for the PCR-based method. Sinks, toilet rails, and bedside tables most frequently harbored biomaterial. Although cleaned surfaces were less likely to have cultivable TOs than precleaned surfaces, they were not less likely to harbor bacterial DNA. The rate of MDR-TOs to surfaces swabbed was 0.1% (3/2546). Although environmental MDR-TOs and MDR-TOs from HAIs were genetically related by PFGE, WGS revealed that they were unrelated. Environmental levels of cultivable Enterococcus spp. and E. coli DNA were positively correlated with infection incidences (P<.04 and P<.005, respectively).
MDR-TOs were rarely detected during surveillance and were not implicated in HAIs. The roles of environmental DNA and EBD, particularly with respect to water-associated fixtures or the potential suppression of cultivable environmental MDR-TOs, warrant multicenter investigations.
Infect Control Hosp Epidemiol 2015;36(10):1130–1138
Environmental offsetting involves compensating for the residual adverse impacts of an action on the environment by generating an equivalent benefit elsewhere. As the prevalence of environmental offsetting grows, so does the challenge of translating no-net-loss goals to workable policy. From 2011–2012, the Australian Government developed an Environmental Offsets Policy and an accompanying metric (the Offsets Assessment Guide) to support decision making about offset requirements under the Environment Protection and Biodiversity Conservation Act 1999. Through extensive stakeholder consultation and in collaboration with academic researchers, the Guide was developed with the aim of accounting appropriately for ecological equivalence in a transparent and flexible manner. This paper outlines the Australian Government's environmental offset policy development process, and describes the approach adopted for evaluating the suitability of proposed offsets in meeting the policy goals. The Guide explicitly estimates the extent to which an offset will improve the target biota and/or avert future losses, the degree of confidence that the offset will be implemented successfully, and the time it will take to deliver a conservation benefit. Since implementation of the Environmental Offsets Policy and the Guide, there has been a shift in focus from estimating offset requirements based on simplistic area ratios, toward directly evaluating the components of an offset action that determine its environmental performance. Achieving a balance between scientific robustness and policy workability is an ongoing challenge. The Environmental Offsets Policy and Guide represent an important step towards consistency and transparency in environmental offset decision-making.
During the course of the nineteenth century Watt's chemical work and its importance to his improvements of the steam engine were effectively obscured. There was a significant disjunction between public characterizations of Watt in the late eighteenth and very early nineteenth centuries and those extant by the early twentieth. As Watt's early reputation developed and grew, contemporary sources frequently identified him as a chemist and recognized the relevance of his chemical work to the steam engine improvements. By the early twentieth century, however, Watt's chemistry had passed from view. This is readily seen in the events and publications that celebrated the one-hundredth anniversary of his death in 1919 and the two hundredth anniversary of his birth in 1936. So, by some process, during the course of the nineteenth century the recognition of the chemical basis of Watt's steam engine improvements, especially of the first phase of them involving the separate condenser, evaporated. What was that process?
A central element in this process was the ‘water controversy’ concerning whether Watt, Cavendish or Lavoisier should be recognized as the discoverer of the compound nature of water. I have examined this controversy, and the forces that drove it, in considerable detail elsewhere. In this chapter I focus on the way in which the controversy, together with Watt's ‘self-fashioning’ in the later years of his life, radically transformed Watt's chemical reputation and in particular determined the extent to which he was recognized as a chemist at all.
Watt engaged in considerable recasting of his achievement in the years between about 1800 and his death in 1819. During the very early nineteenth century important investigations were being conducted which began to question the material theory of heat, and, even more acutely, the role of heat as a chemical substance. These were key ideas upon which Watt had built his original understanding of steam and of the steam engine. More particularly, from around 1790, a number of investigators, including Agustin de Bétancourt, Gaspard de Prony and John Dalton, conducted and published steam experiments, which in terms of methods, results and interpretation presented challenges to Watt's own.
There are two ways in which the centrality of the chemistry of heat, water and steam to Watt's steam engine improvements can be discerned. One, which will be pursued later in this chapter, is to reconstruct in a technical sense – building on what we now know about Watt's chemistry – the conceptual world in which, and through which, Watt's thinking about the steam engine took place. A second is to gain an appreciation of what we might call the ‘ecology of steam’. By this I mean the broader chemical cosmology, embracing meteorology and geology, of which steam and the steam engine were a part, for Watt and his contemporaries. I start with the wider chemical picture.
The Ecology of Steam: Meteorology, Geology and The Botanic Garden
Newcomen engines are known as ‘atmospheric’ engines. This is because the drive on the piston is provided by the atmosphere working against the partial vacuum created in the cylinder by the condensation of the steam. But there was, and is, a deeper sense in which steam engines were atmospheric engines even when Watt put the steam itself to work in driving the piston. The engines were seen as trading on processes that were ubiquitous in the natural world and responsible for other atmospheric and geological phenomena. Meteorological and geological understandings were thus important to the science of heat and steam that underpinned the steam engine. Those who thought about steam and the steam engine sought, and found, coherences between phenomena in the realm of engines, meteorology and geology. Indeed, I suggest that a steam engine was sometimes thought of as a kind of local corralling of the wild forces of nature. In the twentieth century nuclear physicists sometimes spoke about the act of deploying nuclear forces to provide energy via nuclear reactors as ‘twisting the tail of the dragon’. I believe that the same sense of domesticating a wild phenomenon attended eighteenth-century steam engine technology. The steam engine in the eighteenth-century landscape was, not just aesthetically, but also ecologically, part of what went on around it.
The chemists of the nineteenth century did not embrace Watt as one of their number, but the case was very different with its engineers. In fact not only did the engineers ‘pull’ Watt into their company but the chemists, and other elite scientists, as we saw, ‘pushed’ him in that direction. Watt was, according to the likes of James David Forbes, an indifferent chemist but a ‘profound’ engineer. He was characterized as a ‘philosophical engineer’ because of his understanding, command and use of physical law.
My argument in this chapter is that Watt was made into an ‘engineer’ in the nineteenth century – perhaps it would be better to say ‘engineers’ since he was constructed as multiple manifestations of the type during that period. The implication of this process of construction is that Watt was not an engineer in the late eighteenth century, during his own lifetime. To divest Watt of the status of engineer may seem perverse and I do not mean this literally. His contemporaries often referred to Watt, and he designated himself, as an engineer. Indeed, ‘James Watt, Engineer’ was the extended identifier that he used in his published papers in the Philosophical Transactions of the Royal Society of London. His collaborative publication on pneumatic medicine with Thomas Beddoes used the same phrase on the title page. But it is only apparently perverse to problematize this self-identification because the term ‘engineer’ underwent a remarkable evolution from the mid-eighteenth century to the end of the nineteenth. In understanding Watt's self-designation as ‘engineer’ we need to understand, I suggest, what that term meant in his own time. Having done that we can then comprehend something of the way that Watt habitually presented himself to the world, and how he sought to negotiate the ambiguous status that ‘engineer’ then brought with it. For Watt was no ordinary engineer, and he and his friends wanted to make that clear.
James Watt was certainly a ‘man o’ pairts’, but he was also a coherent whole. For too long our historical understanding of him has emphasized the many parts, seeing the whole only dimly, if at all. By pursuing the links between his practical and theoretical work I have tried to set this to rights. Watt was an engineer. He was certainly an expert, as J. D. Forbes put it in his discussions of these questions, at contrivance. Forbes admired Watt's invention of the parallel motion as showing Watt's genius for contrivance, but he argued that this in itself would never have been the basis for ‘reputation’. Watt's reputation derived from his quality as a philosophic engineer. I have argued that what gave his engineering its philosophic quality or dimension was largely chemical in character. Watt was a chemist, whose chemistry of heat provided the philosophical dimension to his engineering. That philosophical dimension was very different from the equivalent dimension of what became known in the mid-nineteenth century as ‘engineering science’. In engineering science heat was understood as a form of energy, convertible into other forms according to the fundamental laws of thermodynamics. All this was foreign to the intellectual world that Watt inhabited. However, because Watt was adopted as an icon and founding father of their field, the engineering scientists of the nineteenth century were not averse to smoothing over some of the differences between his world and theirs. Watt the chemist and engineer became Watt the mechanical engineer.
In my early chapters I showed how popular representation of Watt, which became a minor industry itself in the nineteenth century, presented the mechanical Watt. This was a natural and easy thing to do given the association of Watt in the popular mind with contrivance. The products of that genius for contrivance, or so it seemed, were everywhere in Victorian Britain, the engines, the linkage and control mechanisms to convert the power of those engines into useful work, the indicators designed to monitor, measure and adjust their performance.