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Purpose Enhanced recovery after surgery (ERAS) programs comprise bundles of evidence-based recommendations designed to reduce physiological stress and support early return of function after surgery. In this study, we sought to investigate the barriers and facilitators of successful implementation of ERAS in a major safety-net hospital. Design Our ERAS program has been designed as a quality improvement pilot project in prospective fashion with a real-time feedback loop. The program is designed to address established culture of safety-net hospitals. Methods An extensive multidisciplinary team investigated the barriers to success for three different levels of program stakeholders: providers, patients, and the facility. After a systematic review of these barriers, solutions were offered and implemented in a multidisciplinary care model with special attention to outcomes and continuous feedback. The findings are summarized in a grid format for better understanding and implementation ease. Findings Patients (N = 198) were enrolled in an ERAS program in a nonrandomized fashion during the pilot period of October 2017 to August 2018. ERAS cohort of patients’ outcomes were then compared with those of 20,328 non-ERAS patients. The ERAS group had less complication with shorter length of stay compared with their non-ERAS counterparts. Furthermore, it has cost less to take care of these patients. Interestingly, this decrease was not achieved by a reciprocal increase in subsequent readmission or reoperation rates. Conclusions Unique barriers exist when implementing an ERAS protocol in a safety-net hospital. These barriers can be overcome to improve the quality of care at a decreased cost. We have provided a grid to facilitate the implementation process.

Background Based on the anti-inflammatory and anti-oxidant properties of kaempferol and apigenin, we hypothesized that co-injection of these phytochemicals would increase the effectiveness of cell therapy in knee osteoarthritic rats. Methods Anterior cruciate ligament transection (ACLT) was used to induce osteoarthritis (OA). Animals were treated by weekly intra-articular injections of kaempferol (10 or 20 μM) and/or isolated MSCs from synovial membrane (SMMSCs) (3 × 106 cells), a mixture of apigenin (0.1 μM) and kaempferol alone or SMMSCs, hyaluronic acid or PBS (group size n = 6), for three weeks. After three months, the levels of IL-1β, tumor necrosis factor alpha (TNF-α), superoxide dismutase (SOD) and malondialdehyde (MDA) were measured in the cartilage homogenate. Furthermore, relative expressions of collagen II2a1, aggrecan, IL-1β, TNF-α, inducible nitric oxide synthase (iNOS), SOX-9, MMP-3 and MMP-13 were assessed using real-time PCR. Radiological evaluation, before/after treatments, and histopathological assessments were carried out to evaluate the knees. Results Non-toxic concentrations of kaempferol and apigenin determined to be 10, 20 μM and 0.1, 0.3 μM, respectively. In comparison with the OA group, the levels of TNF-α, IL-1β and MDA significantly decreased in OA + MSCs + kaempferol + apigenin group and a significant increase in SOD level was observed. The levels of MMP-13, MMP-3, TNF-α, IL-1β, iNOS were significantly decreased in the groups of OA + MSCs + A0.1 μM + K10 μM and OA + MSCs + K20 μM. Co-treatment of kaempferol and apigenin increased the gene expression levels of collagen IIa1, aggrecan and SOX-9 genes. Conclusion We showed that kaempferol and apigenin potentially increase the efficiency of OA cell therapy in the rat model of ACLT-induced OA.

The study focuses on the evaluation of the engineering properties of modified drilling waste materials (MDWMs) as base course materials in roadway construction. This goal was accomplished by two main laboratory test evaluations of the MDWMs which are the basic material characterization and the performance evaluation of base course material. Material characterization results of the MDWMs indicate that they are relatively high pH, low plastic, and clay sand materials, mainly consisting of quartz and barite and belonging to Grade 4 category in Texas Department of Transportation (TxDOT) Item 247 Flexible Base Aggregate. The unconfined compressive strength (UCS), triaxial compressive strength, indirect tensile strength, moisture susceptibility, and seismic modulus test data show that the untreated MDWM is lower than many of these requirements and is not a granular base material when compared with the typical base course requirements identified in the Item 247. However, evaluation of the MDWMs with 3% cement treatment in the laboratory showed good performance without sacrificing their abilities as proper base course materials and satisfied the requirements of Class M base as per TxDOT Item 276. However, it may be necessary that the quality control of this material be monitored in order to achieve consistent moisture content and gradation. Moreover, further work to establish optimum stabilizer content and type would be recommended for this material.

In this paper, a consensus filter based distributed variational Bayesian (CFBDVB) algorithm is developed for distributed density estimation. Sensor measurements are assumed to be statistically modeled by a finite mixture model for which the CFBDVB algorithm is used to estimate the parameters, including means, covariances and weights of components. This algorithm is based on three steps: (1) calculating local sufficient statistics at every node, (2) estimating a global sufficient statistics vector using a consensus filter, (3) updating parameters of the finite mixture model based on the global sufficient statistics vector. Scalability and robustness are two advantages of the proposed algorithm. Convergence of the CFBDVB algorithm is also proved using Robbins–Monro stochastic approximation method. Finally, to verify performance of CFBDVB algorithm, we perform several simulations of sensor networks. Simulation results are very promising.

The growth of silver chloride nanoparticles within the pore channels of functionalized SBA-15 mesoporous was achieved by sequential dipping steps in alternating bath of potassium chloride and silver nitrate under ultrasound irradiation at p H=9. The effects of sequential dipping steps in growth of the AgCl nanoparticles have been studied. The growth and formation of AgCl nanoparticles inside the sulfonated SBA-15 were characterized by X-ray diffraction (XRD), Fourier transformation infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Antibacterial activity of the synthesized materials was investigated against Escherichia coli ( E . coli ) using the conventional diffusion-disc method. The materials showed high antibacterial activity.

This study was done to investigate the effects of opioid and nitrergic systems on depression in an experimental model of cholestasis in mice, since elevated levels of these substances are seen in cholestatic subjects. Bile duct ligated (BDL) and sham-operated mice were forced to swim individually and the immobility time in the last 4 min of the 6 min test was evaluated to determine the effects of cholestasis on depression. To assess the possible involvement of endogenous opioids and nitric oxide (NO), effective and sub-effective doses of naltrexone an antagonist of opioid receptors, and N-nitro-l-arginine methyl ester (L-NAME) a non-specific NO synthase inhibitor, were administrated acutely and chronically to BDL and Sham-operated mice and then their immobility time was measured in forced swimming test (FST). The immobility time significantly decreased after bile-duct ligation. Naltrexone and L-NAME significantly reversed antidepressant like effect of cholestasis. Co-administration of sub-effective doses of naltrexone and L-NAME also reversed antidepressant effect in FST in chronic administration. But acute drug administration did not reverse the anti-depressant effect of cholestasis. We have shown that elevated levels of endogenous opioids and NO in cholestatic mice induce an anti depressant like effect, causing a reduction in the mice immobility time in FST. And the study also showed the predominant effect of opioid system and NO modulation of that in anti-depressant like effect of cholestasis.

Noble metals nanostructures, particularly silver, have attracted much attention in the fields of electronics, chemistry, physics, biology and medicine due to their unique properties which are strongly dependent on the size and shape of metal nanomaterials. This study discusses on silver nanostructures with different geometries including wire, cube, sphere and triangle prepared using solution-phase method and applied for antibacterial activities. X-ray diffraction (XRD), Ultra Violet Visible (UV-Vis) spectroscopy, Dynamic Light Scattering (DLS) and electron microscopy studies of different types of silver nanostructures revealed distinct optical and structural properties of an individual silver nanostructure. We have also evaluated the antibacterial activity of different shapes of silver nanostructures against Escherichia coli (E.coli), Bacillus and Staphylococcus. Results presents shape dependent antimicrobial activity of silver nanostructures.

Background and study aims Recent findings introduced APOBEC3G (A3G) as a host factor that blocks viral replication. It induces G to A hypermutations in viral DNA at the step of reverse transcription and in response to interferon. This study aimed to investigate the expression of liver A3G protein in association with both replication of hepatitis B virus (HBV) and frequency of G to A mutations in BCP (basal core promoter)-PC (pre-core) region. Patients and methods Fifty-one liver biopsies of naive chronic hepatitis B (CHB) patients enrolled for the expression of A3G were done by immunohistochemistry (IHC) standard method. The presence of HBV DNA and sequences of BCP-PC region at the time of liver biopsy was investigated in all patients. Results Among 34 patients with detectable HBV DNA, 31 carried 1–5 G to A mutations in the BCP-PC region. IHC results showed that the expression level of A3G in CHB patients’ liver was very low. Of all patients, A3G is expressed in three undetectable HBV DNA subjects and a patient with 2.24 × 10 4 copies ml −1 of HBV DNA. G to A mutated residues were indicated at positions 1727, 1757 and 1896 of the HBV genome of this patient. Conclusion This study indicates that despite very low levels of both A3G in liver and the number of positive subjects, A3G has a potential role to restrict the in vivo replication of HBV.

Warm mix asphalt (WMA) materials are asphalt mixtures fabricated with recently developed technologies designed to reduce the temperatures required to produce and compact traditional hot mix asphalt (HMA) mixtures. This study evaluates the moisture susceptibility of three WMA mixtures. The analysis is based on a viscoelastic-fracture model, which input parameters include results from the relaxation modulus and the Dynamic Mechanical Analyzer (DMA) test conducted on specimens representing the fine matrix portion of the actual mixtures, and from surface free energy tests. The results suggest that moisture caused more damage in two out of the three evaluated WMA fine mixtures in comparison to the damage observed in the control-HMA specimens. The results also reveal that the analysis should include not only the reduction caused by moisture of certain selected performance parameters, but the actual values of these parameters.

Permeable friction course (PFC) mixtures constitute one of the best options for surface paving, since they offer advantages (as compared to dense-graded hot mix asphalt) in terms of safety, economy, and environment. However, mix design and evaluation of PFC mixtures still require improvement and standardization to further promote the reliable use of these mixtures. This paper summarizes an extensive literature review focused on the basic aspects integrated in the mix design and evaluation of PFC mixtures. Although substantial advances related to these topics were reported since implementation of PFC mixtures in the 1990’s, there is still a need for integration of several of these advances in an improved mix design procedure. The paper also identifies areas that require additional research, including the optimization of the balance between mixture functionality and durability and replacement of the indirect assessment of these important aspects.

The presented paper investigates the potential for the utilization of unprocessed, as excavated (i.e. unground), stockpiled coal combustion fluidized bed ash in road base course construction. In addition to functioning as a stabilizer of the fines in the stockpiled material, this ash also permits treating the stockpiled ash agglomerates as an aggregate. Both untreated and cement-treated mix designs were evaluated. The laboratory program included unconfined strength measurements, triaxial, volumetric swell, and moisture susceptibility testing protocols performed on cylindrical specimens compacted at their optimum moisture content. The results have shown that, without breaking down the agglomerates by grinding, the unstabilized stockpiled ash possesses very little residual cementitious activity; whereas, if treated with small amounts of cement (3%), it meets the required strength criteria for cement-treated base courses while minimizing the volumetric swell characteristics.

Durability and functionality (i.e., noise reduction effectiveness and drainability) of permeable friction course (PFC) mixtures depend on the characteristics of the air voids (AV) contained in the mixture. This study analyzes the internal structure of PFC mixtures, assessed in terms of AV characteristics; determined using X-ray Computed Tomography and image analysis techniques. Corresponding results showed: (i) heterogeneous distributions of AV in the horizontal direction of both field-compacted mixtures (road cores) and specimens compacted using the Superpave Gyratory Compactor (SGC) and (ii) limitations to compare their vertical AV distributions. Recommendations to reduce the horizontal heterogeneity included using road cores with a minimum 152.4 mm diameter and coring SGC specimens to 101.6 mm in diameter. Implementation of field-compaction control and future analysis of mixtures prepared accordingly was recommended to determine the pattern of vertical AV distribution that should be reproduced in SGC specimens and corresponding modifications required for fabrication of these specimens.

Introduction Hepatic ischemia/reperfusion (I/R) injury leads to free radical generation and acute inflammatory responses that cause liver damage, an important problem for liver transplantation. Pioglitazone is known to protect I/R injury in various tissues; however, the mechanism of cytoprotection is not well understood. This study investigated the effects of pioglitazone administration in a warm hepatic I/R model on tumor necrosis factor (TNF)-α level, tissue injury, and antioxidant enzyme activity. Materials and Methods Eighty wistar strain rats were divided into 4 groups (n = 20): Group 1 sham hosts; Group 2 hepatic I/R; Group 3 hepatic I/R + pioglitazone (10 mg/kg); and Group 4 hepatic I/R + vehicle. Rat livers were subjected to 30 minutes of ischemia followed by 6 hours of reperfusion. After reperfusion rats were humanely killed to obtain liver tissue to study glutathione peroxidase (GPx), superoxide dysmutase (SOD), malondialdehyde (MDA) levels and for histopathologic assessment. TNF-α, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were measured in serum. Results Pioglitazone pretreatment significantly reduced liver enzyme content (ALT, 176.80 ± 13.75 vs 235.28 ± 31.92 and AST, 748.20 ± 79.29 vs 944.85 ± 101.87) and TNF-α level (9:8.60 ± 8.67 vs 138.28 ± 9.99) after I/R compared with the control group. MDA level (3.02 ± 0.37 vs 4.36 ± 0.38) and hepatocytic degeneration were reduced in the pioglitazone-treated group. GPx (2.40 ± 0.25 vs 1.36 ± 0.31) and SOD activity (2.22 ± 0.30 vs 1.40 ± 0.35) were significantly higher in the pioglitazone-treated group compared with the control group. Conclusion The present study showed that pioglitazone administration improved hepatic I/R injury that was associated with enhanced antioxidant enzyme activities and suppression of TNF-α, ALT, and AST levels. Because peroxisome proliferator-activated receptor-γ agonists are widely used to treat diabetic patients, it may be relatively easy to expand their clinical indication. However, further investigations will be required to delineate protective mechanisms by which pioglitazone attenuates hepatic tissue injury after I/R.