Aims: To evaluate and compare the wound healing process following osteotomies performed with either conventional rotary burs or piezoelectric surgery in a rabbit model mimicking access to the maxillary sinus cavity for sinus floor augmentation. Materials and methods: On the nasal bone of 16 adult New Zealand white rabbits, two types of osteotomy window defects of nasal cavities were marked to critical size with a Trephine drill (ø 5 mm) and then prepared with either a conventional rotary bur or piezo-surgery (PIEZOSURGERY® Insert OT5 of PIEZOSURGERY® 3 unit, Mectron s.p.a., Genova, Italy). The defects were covered with a resorbable membrane (Bio-Gide®, Geistlich Pharma AG, Wohusen LU, Switzerland). Four animals were sacrificed at one, two, three and five weeks after surgical procedure, respectively. Histological and morphometric evaluations were performed to assess the volumetric density of various tissue components: the blood clot (BC), vascularized structures (VS), provisional matrix (PM), osteoid, mineralized bone (MB), bone debris (BD), residual tissue, old bone (OB). Results: at the 1 week, more BC detected after piezo- surgical preparation. However, the difference did not reach statistical significance. A tendency of higher proportions of osteoid in the conventional bur defects was noted, but not statistically significant. Significantly more BD was found in the conventionally compared to the piezo-surgically prepared defects. At two weeks, new bone formation was noted, and the process of modeling of the newly formed bone had started. More MB was detected in the defect prepared by piezo-surgery than by conventional bur, but without any statistically significant difference. In the marginal areas of defect, slightly more osteoblasts (Obl) were present in piezo-surgically prepared defect than in conventional prepared defect, although there is no significant difference. At 3 week, a newly formed hard tissue bridge mainly composed of woven bone was seen. A high volumetric density of mineralized bone (MB) presented in all the specimens, At the 5 week, the defects were completely filled with newly formed bone. Conclusion: the defect prepared by piezo-surgery showed a significantly decreased proportion of bone debris at one week compared to conventional rotary bur defect. Increased volumetric densities of mineralized bone were observed in the piezo-surgical compared to the conventional bur defect after two weeks, although not statistically significant. Irrespective of the preparation modality of the defect performed, the defect was almost filled with newly formed bone at three weeks. At five weeks, complete regeneration of the calvaria defects was achieved. / published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

Introduktion: Sjuksköterskor idag står inför en växande patientgrupp med diabetes, som har svårläkta fotsår. Patienterna finns i alla vårdformer som primärvård, specialistvård och kommunal hälso- och sjukvård. För att patienten ska kunna upprätthålla en god livskvalitet och ett bra socialt liv krävs det en säker och snabb sårläkning. Syfte: Arbetets syfte var att beskriva vad som påverkar sårläkning hos patienter med diabetes och svårläkt fotsår, vid undertrycksbehandling. Metod: Denna litteraturstudie har utgått ifrån Polit och Becks (2012) niostegsmodell. Sökningarna har gjorts i CINAHL och PubMed. Kvalitetsgranskning gjordes som resulterade i tio kvantitativa vetenskapliga artiklar. Artiklarnas resultatdel analyserades och grupperades utifrån syftet och efter gemensamma områden.  Resultat: Resultatet i litteraturstudien delades in i två kategorier: sårstatus och behandlingstid. I resultatet framkom att undertrycksbehandling sågs som mer effektiv behandlingsmetod än konventionell fuktighetsbevarande sårbehandling. Volym och sårdjup minskade mer effektivt vid undertrycksbehandling än med konventionell fuktig sårbehandling. Slutsats: Litteraturstudien visar att undertrycksbehandling kan bidra till snabbare sårläkning hos diabetiker med svårläkt fotsår. Alla studier valde mätvärden som storlek, djup och typ av vävnad för att beskriva sårstatus. Behandlingstiden varierade i studierna. Det visade sig även att det vetenskapliga underlaget var begränsat.

Capillary bridge formation between adjacent surfaces in humid environments is a ubiquitous phenomenon. Capillary forces are important in nature (granular materials, insect locomotion) and in technology (disk drives, adhesion). Although well studied in the equilibrium state, the dynamics of capillary formation merit further investigation. Here, we show that microcantilever crack healing experiments are a viable experimental technique for investigating the influence of capillary nucleation on crack healing between rough surfaces. To demonstrate the effects, a custom micromachine characterization system is built that allows for full environmental control (pressure, humidity, and gas composition) while retaining full micromachine characterization techniques (long working distance interferometry, electrical probe connectivity, actuation scripting capability). The system also includes an effective in situ surface plasma cleaning mechanism. The average spontaneous crack healing velocity, ̅, between plasma-cleaned hydrophilic polycrystalline silicon surfaces of nanoscale roughness is measured. A plot of ̅v versus energy release rate, G, reveals log-linear behavior, while the slope |d[log(v)]/dG| decreases with increasing relative humidity. An interface model that accounts for the nucleation time of water bridges by an activated process is developed to gain insight into the crack healing trends. This methodology enables us to gain insight into capillary bridge dynamics, with a goal of attaining a predictive capability for this important microelectromechanical systems (MEMS) reliability failure mechanism. A variety of alcohol vapors significantly reduce or perhaps eliminate wear in sliding micro-machined contacts. However, these vapors may increase adhesion due to the capillary forces. Equilibrium adhesion energies at various partial pressures are found for n-pentanol (long chain molecule) and ethanol (short chain molecule). For low partial pressures (p/ps=0.3), adhesion energy of n-pentanol is even larger than water.

No description available.

Background: Health care settings are generally regarded as stress inducing environments. Stress can alter the immune response, impair wound healing and create a greater risk for asthma, diabetes, gastrointestinal disorder and myocardial infarction. Beginning in the 1980s and 1990s, there has been increasing interest in healing environments and evidence-based design concepts. Yet, there has been little progress developing healing environments and using evidence-based design for psychiatric inpatient units, a uniquely stressful environment. Psychiatric units today continue to use designs such as caged in outdoor patio areas that resemble facilities that incarcerate rather than facilities which reduce stress and facilitate healing. The purpose of this systematic literature review was to identify design features that are evidence-based which can be used to create an optimal inpatient psychiatric patient room by: (1) analyzing the research literature for evidence of architectural and design elements that could be used in the inpatient psychiatric care setting to reduce stress and improve the well-being; (2) identifying design elements that are consistent with accreditation and licensing standards for inpatient psychiatric units; and (3) designing a psychiatric inpatient room that has evidence-based elements to reduce stress and improve well-being. Methods: A systematic literature review was conducted to identify factors in the inpatient healthcare environment that support an optimal healing environment. The PICO question for this review was what design factors in the inpatient healthcare environment support an optimal healing environment? A search of five databases and a hand search of reference lists were conducted. The search included studies from 1980 to the present, original research conducted on inpatient units with adult patients that investigated an intervention with an outcome that promotes a healing environment. Experimental, quasi-experimental, non-experimental, systematic literature reviews and expert opinions were sought and evaluated using a scale to analyze scientific rigor and research quality. Results: A total of 6,874 articles were identified in the search. Seventy-six articles were eligible for full text screening. After review of the full text, 38 articles were determined to be eligible for evidence analysis. After removing 11 inadmissible articles due to poor quality, 27 articles were included in the final synthesis. The search found research on eight hospital design features which may support optimal healing environments: artwork (n = 7), building configuration (n = 2), finish materials (n = 7), interior details (n = 6), lighting (n = 11), nature and view (n = 8), noise (n = 10), room configuration (n = 6). More than 50% of the research on optimal healing environments used quasi-experimental and non-experimental designs with rare use of experimental research designs. Overall, the quality of the research on optimal healing environments is not high, but results were reasonably consistent across studies. Conclusions: Evidence suggests seven design features for healing inpatient psychiatric environments, including: (a) single rooms, (b) calm, naturalistic and domestic artwork or photographs, (c) east facing windows, (d) plants, (e) acoustic ceiling tiles, (f) patient rooms removed from noise producing unit areas and (g) a window view of nature. These seven recommendations were examined for consistency with existing Arizona statutes and industry standards for behavioral health care environments. Recommendations found to be inconsistent with these statutes and standards were modified to reach congruency with the statutes and guidelines, and then an evidence-based design of a psychiatric inpatient room design was formulated and is illustrated. Future research on interventions to create healing environments at the greatest scientific rigor is needed along with measurement techniques to quantify stress responses to the environment.

The purpose of this discourse analysis of health promotion and healing practices was to describe their functioning historically through practices of governance and risk in the context of neoliberal society. The results portray a constructed subjectivity (identity) among citizens and residents of contemporary society who enact expected health promotion and healing behaviors.Two series of texts were analyzed from a Foucauldian perspective: the Healthy People series from the U.S. Department of Health and Human Services; and the series on Uninsurance published by the Institute of Medicine. The findings generated five themes that comprise the reality of current illness care system rationalities:First, the U.S. illness care system, functioning through technology of insurance or wealth extraction, is dysfunctional as a comprehensive illness care delivery system.Second, health promotion and healing have been subsumed under illness care--if they are addressed it is only as discrete indices that comprise compliance monitoring.Third, micro determinants of health (such as behavioral patterns, genetic predispositions, social circumstances, shortfalls in medical care, and environmental exposures), while important, continue to be the single focus of illness care in the U.S. Conversely, macro determinants of health, contingent on macro-level economic and political structures, remain unrecognized as having any bearing on health outcomes. Macro determinants of health frame the configuration of the social infrastructure in which micro determinants of health unfold.Fourth, neoliberal ideology in the U.S. continues to be the status quo for illness care.Fifth, constructed health promotion and healing identity for individuals is one of health anomie, a new prudentialism where access to health promotion and healing has to be acquired from outside the venue of illness care.How can we become different from what we have become? While acknowledging the limitations inherent in this current discourse of heath promotion and healing, other alternatives must be explored for betterment of human health and wellbeing--such as a shift toward "care of the self" or "self care" that encompasses an embodiment of an arché health, a health that moves beyond contemporary illness discourses of mind-body, one that defies society's inscription of our subjectivity.

Many researchers have failed to find a relationship between experience and judgment accuracy. In this study the purpose was to understand the relationship between experience and expertise in clinical judgment. Common sense suggests that experienced subjects make better quality judgments, compared to novices. Clinical judgments, however, are ill-structured and characterized by uncertainty; they take place in a dynamic context, with delayed or nonexistent feedback and are difficult to learn. Cognitive operations that translate "cues" (such as risk factors, signs, and symptoms) into judgments are not fully understood. Cognitive constructs (conceptual structure, sensitivity to patterns in data, and judgment process) and individual differences in age, education, and experience were explored to identify their relationship to judgment expertise. Indicators of judgment quality were: accuracy, consistency, latency, confidence, calibration, and knowledge accessibility. In phase 1 of this study, cues were identified that best predicted healing time for 258 surgical patients with abdominal incisions. In Phase 2, the subjects were 36 nurses with a range of experience caring for surgical patients. Generating both quantitative and qualitative data, subjects made judgments about incisional healing on the basis of information from actual patients. Multidimensional scaling was used to reveal conceptual structure, and lens modeling was applied to assess sensitivity to broad patterns. An information board task with think-aloud protocols demonstrated judgment process. The selection of tasks was based on their analysis- or intuition-inducing features, using K. R. Hammond's (1990) cognitive continuum theory. Experience accounted for a only a small proportion of variance in performance, whereas confidence in judgment was more strongly related to experience. Taken together, these findings replicated previous research. Protocol data showed that metacognition, knowledge accessibility, and reflectivity increased with experience. Conceptual structure predicted judgment accuracy under intuitive conditions. Support was found for Dreyfus and Dreyfus' (1986) hypothesized transition in cognition, from deliberate processing of discrete cues, to intuitive processing of patterns of cues encoded in memories for specific cases. This study has theoretical significance by adding to knowledge about clinical judgment, and by increasing understanding of cognitive changes associated with expertise. This study has practical significance in providing direction for the development of teaching methods aimed to increase learning from experience in probabilistic contexts.

The purpose of this study was to compare the effects of two types of stem/progenitor cells on the healing of critical sized bone defects in a rat model. Endothelial progenitor cells (EPCs), a novel cell type with previously demonstrated effects on both osteogenesis and angiogenesis, were compared to both a control group (no cells), and a treatment group of mesenchymal stem cells (MSCs). The hypothesis was that EPCs would demonstrate both superior bone healing and angiogenesis, when compared to MSCs and controls. EPCs, MSCs, or a control carrier were placed in surgically stabilized bone defects in a rat femur and both bone formation and angiogenesis were assessed. EPC treated defects demonstrated significantly more bone formation and angiogenesis at the bone defect site than MSC or control treated defects. These results strongly suggest that EPCs are more effective than MSCs for therapeutic osteogenesis and angiogenesis in a bone defect model.

The purpose of this study was to compare the effects of two types of stem/progenitor cells on the healing of critical sized bone defects in a rat model. Endothelial progenitor cells (EPCs), a novel cell type with previously demonstrated effects on both osteogenesis and angiogenesis, were compared to both a control group (no cells), and a treatment group of mesenchymal stem cells (MSCs). The hypothesis was that EPCs would demonstrate both superior bone healing and angiogenesis, when compared to MSCs and controls. EPCs, MSCs, or a control carrier were placed in surgically stabilized bone defects in a rat femur and both bone formation and angiogenesis were assessed. EPC treated defects demonstrated significantly more bone formation and angiogenesis at the bone defect site than MSC or control treated defects. These results strongly suggest that EPCs are more effective than MSCs for therapeutic osteogenesis and angiogenesis in a bone defect model.

Poly(methacrylic acid -co- methyl methacrylate) beads were previously shown to have a therapeutic effect on wound closure through the promotion of angiogenesis. However, it was unclear how this polymer elicited its beneficial properties. The goal of this thesis was to characterize the host response to MAA beads by identifying molecules of interest involved in MAA-mediated angiogenesis (in comparison to poly(methyl methacrylate) beads, PMMA). Using a model of diabetic wound healing and a macrophage-like cell line (dTHP-1), eight molecules of interest were identified in the host response to MAA beads. Gene and/or protein expression analysis showed that MAA beads increased the expression of Shh, IL-1β, IL-6, TNF-α and Spry2, but decreased the expression of CXCL10 and CXCL12, compared to PMMA and no beads. MAA beads also appeared to modulate the expression of OPN. In vivo, the global gene expression of OPN was increased in wounds treated with MAA beads, compared to PMMA and no beads. In contrast, dTHP-1 decreased OPN gene expression compared to PMMA and no beads, but expressed the same amount of secreted OPN, suggesting that the cells decreased the expression of the intracellular isoform of OPN. Interestingly, MAA beads had no effect on the expression of pro-angiogenic growth factors VEGF, bFGF and PDGF-B in vivo or in vitro, suggesting that MAA beads do not induce angiogenesis by simply increasing the expression of pro-angiogenic factors, but use more subtle mechanisms. It was hypothesized that these mechanisms may involve modulation of toll-like receptor signaling in macrophages interacting with the protein layer adsorbed on to MAA beads, in a manner distinct from PMMA beads and no beads. Taken together, the results suggest that MAA beads promote angiogenesis through increased expression of Shh, decreased expression of CXCL10 and modulation of the expression of OPN, but not through increased expression of typical pro-angiogenic growth factors. The resulting vessel-rich “alternative foreign body reaction” has exciting clinical implications as the polymer itself was found to exert a therapeutic effect in the absence of bioactive components or transplanted cells. Understanding the mechanism could lead to new applications for this material and others designed on similar principles.