Greyston

Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatrics Research, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Arbaje and Ms Greyson); and Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, and Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Arbaje). Correspondence: Alicia I. Arbaje, MD, MPH, PhD, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Center Tower, Seventh Floor, Baltimore, MD 21224 ([email protected]). The authors declare no conflicts of interest.

Polymer nanofibers have the ability to replace expensive materials, such as metals, ceramics and composites, in specific areas, such as heat exchangers, energy storage and biomedical applications. These properties have caused polymer nanofibers to be explored as solutions to a growing list of thermal management problems, driving an even greater need to better measure and understand the thermal properties of these nanofibers. This study intends to further the understanding of the thermal properties of polymer nanofibers through the use of a novel Probe-to-Probe measurement method. Polycaprolactone nanofibers fabricated using the electrospinning method can be easily collected and loaded into a traditional atomic force microscope through a mechanical design for thermal measurement. This Probe-to-Probe method demonstrates the ability to accurately measure the thermal boundary conditions about a polymer nanofiber with a heating prong temperature up to 400 C and assists in characterizing its thermal properties.

The effects of beef substitution with crimini or white mushrooms (Agaricus bisporus) on the flavor profiles of carne asada and beef taco blends were measured with a descriptive analysis panel. Sensory mitigation of sodium reduction through the incorporation of mushrooms was also investigated in the taco blends. The substitution of beef with mushrooms in the carne asada did not alter the overall flavor strength of the dish, but the incorporation of 50% or 80% ground mushroom in the beef taco blend did enhance its overall flavor as well as mushroom, veggie, onion, garlic and earthy flavors, and umami and sweet tastes. Overall flavor intensity of the 25% reduced-salt version of the 80% mushroom taco blend matched that of the full-salt versions of the 100% and 50% beef formulations, thus indicating that the substitution of 80% of the meat with mushrooms did mitigate the 25% sodium reduction in terms of the overall flavor impact of the dish, even if it did not quite compensate for the reduction in salty taste. This proof-of-concept study for the Healthy Flavors Research Initiative indicates that because of their flavor-enhancing umami principles, mushrooms can be used as a healthy substitute for meat and a mitigating agent for sodium reduction in meat-based dishes without loss of overall flavor.

A linear time-invariant model based on statistical time series analysis in the Fourier domain for single subjects is further developed and applied to functional MRI (fMRI) blood-oxygen level-dependent (BOLD) multivariate data. This methodology was originally developed to analyze multiple stimulus input evoked response BOLD data. However, to analyze clinical data generated using a repeated measures experimental design, the model has been extended to handle multivariate time series data and demonstrated on control and alcoholic subjects taken from data previously analyzed in the temporal domain. Analysis of BOLD data is typically carried out in the time domain where the data has a high temporal correlation. These analyses generally employ parametric models of the hemodynamic response function (HRF) where prewhitening of the data is attempted using autoregressive (AR) models for the noise. However, this data can be analyzed in the Fourier domain. Here, assumptions made on the noise structure are less restrictive, and hypothesis tests can be constructed based on voxel-specific nonparametric estimates of the hemodynamic transfer function (HRF in the Fourier domain). This is especially important for experimental designs involving multiple states (either stimulus or drug induced) that may alter the form of the response function.

The focus on recovery for persons with severe and persistent mental illness is leading state psychiatric hospitals to transform their method of care delivery. This article describes a quality improvement project involving a hospital's administration and multidisciplinary state-university affiliation that collaborated in the development and implementation of a nursing care delivery model in a state psychiatric hospital. The quality improvement project team instituted a new model to promote the hospital's vision of wellness and recovery through utilization of the therapeutic relationship and greater clinical accountability. Implementation of the model was accomplished in 2 phases: first, the establishment of a structure to lay the groundwork for accountability and, second, the development of a mechanism to provide a clinical supervision process for staff in their work with clients. Effectiveness of the model was assessed by surveys conducted at baseline and after implementation. Results indicated improvement in clinical practices and client living environment. As a secondary outcome, these improvements appeared to be associated with increased safety on the units evidenced by reduction in incidents of seclusion and restraint. Restructuring of the service delivery system of care so that clients are the center of clinical focus improves safety and can enhance the staff's attention to work with clients on their recovery. The role of the advanced practice nurse can influence the recovery of clients in state psychiatric hospitals. Future research should consider the impact on clients and their perceptions of the new service models.

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In recent years the collection of tropical marine organisms for the aquarium trade has become perceived as an activity with an unsustainable history as well as obvious potential for rehabilitation through resource-based fisheries management and consumer-oriented product certification. In the case of Puerto Rico, collection of ornamentals has existed for decades, though unregulated due to a weak fisheries law dating from the 1930's. The new Fisheries Law 278 of 1998 enabled new regulatory approaches for marine ornamentals, which were met with serious challenges rooted in (1) an information gap concerning the fishery regarding participant numbers, collection methods and export volumes, and (2) the absence of consultation of fishers by agency regulators. The information gap led to worst-case assumptions of impact by regulators, and a closure of the fishery, which set the stage for threatening personal confrontations and lawsuits, the latter leading to de facto resource management by judicial order. To redress these issues and move management back into the arena of science and public policy, regulators have initiated a three-phase program: (1) characterize fisher numbers, methods and exports, (2) describe populations and biology of commercial species, and (3) propose appropriate fisheries management approaches. This paper describes only the first phase of this program.

To evaluate the efficacy of a newly developed biomaterial, hydroxyapatite cement, for use in frontal sinus and anterior craniofacial skeletal reconstruction. A nonrandomized patient cohort that was compared with historical controls of standard treatment with methyl methacrylate implants. Craniofacial reconstructive surgery services at 3 referral health care centers. Eligible patients had frontal-cranial defects limited to a maximum size of 25 cm2. Patients were randomly selected volunteers with preexistent, acute traumatic or acute surgically induced defects of the frontal sinus and anterior craniofacial skeleton. All patients provided informed consent, and the study was approved by the 3 institutional review boards. Forty patients underwent reconstruction of defects of the anterior craniofacial region, and 38 of these patients were evaluable at 24 months. Hydroxyapatite cement was used to reconstruct full-thickness anterior craniofacial skull defects. Standard surgical techniques were used to place all implants. The primary outcome measurement was maintenance of implant volume determined at 24 months by computed tomography and clinical examination. Secondary outcome measures included incidence of complications and infections necessitating implant removal. Of the 38 evaluable patients, 31 had successful reconstructions at the end of the study, for an overall success of 82% for frontal sinus and frontofacial region reconstruction. Seven patients underwent explantation, 5 for surgical access to the site. Two implants were removed because of infection in the wound, for an overall incidence of approximately 5%. Explant biopsy specimens confirmed implant osseointegration and vascularization. Hydroxyapatite cement successfully reconstructs full-thickness defects of the frontal sinus and frontofacial region at 24 months. Hydroxyapatite cement appears to be superior to acrylic implants for frontal-cranial reconstruction and by allowing implant osseointegration with improved biocompatibility.