The role of macrophages in the clearance of particles with diameters less than 100 nm (ultrafine or nanoparticles) is not well established, although these particles deposit highly efficiently in peripheral lungs, where particle phagocytosis by macrophages is the primary clearance mechanism. To investigate the uptake of nanoparticles by lung phagocytes, we analyzed the distribution of titanium dioxide particles of 20 nm count median diameter in macrophages obtained by bronchoalveolar lavage at 1 hour and 24 hours after a 1-hour aerosol inhalation. Differential cell counts revealing greater than 96% macrophages and less than 1% neutrophils and lymphocytes excluded inflammatory cell responses. Employing energy-filtering transmission electron microscopy (EFTEM) for elemental microanalysis, we examined 1,594 macrophage profiles in the 1-hour group (n = 6) and 1,609 in the 24-hour group (n = 6). We found 4 particles in 3 macrophage profiles at 1 hour and 47 particles in 27 macrophage profiles at 24 hours. Model-based data analysis revealed an uptake of 0.06 to 0.12% ultrafine titanium-dioxide particles by lung-surface macrophages within 24 hours. Mean (SD) particle diameters were 31 (8) nm at 1 hour and 34 (10) nm at 24 hours. Particles were localized adjacent (within 13-83 nm) to the membrane in vesicles with mean (SD) diameters of 592 (375) nm at 1 hour and 414 (309) nm at 24 hours, containing other material like surfactant. Additional screening of macrophage profiles by conventional TEM revealed no evidence for agglomerated nanoparticles. These results give evidence for a sporadic and rather unspecific uptake of TiO(2)-nanoparticles by lung-surface macrophages within 24 hours after their deposition, and hence for an insufficient role of the key clearance mechanism in peripheral lungs.

Agitated aggressive behavior in late stage dementia occurs in 30 to 50 percent of patients. This behavior often results in the use of chemical and physical restraints (which have a high degree of untoward side effects) and caregiver burnout. Interventions for agitated aggressive behavior are needed that do not have these side effects, which are readily available in nursing homes and are effective and acceptable to caregivers. Environmental psychologists have proposed that natural elements within the environment decrease agitation in the nondemented as well as the demented Since the shower bath is often a time of great agitation in dementia patients, natural elements were used to modify care during the shower bath (n = 31). There was a significant decrease in mean difference scores from baseline to treatments one and two, with the treatment group demonstrating an overall decline in agitated aggressive behavior Additional randomized trials of the effects of natural environments upon agitation and aggression in dementia are needed.

Direct observation and time-study techniques were used with a sample of 25 ambulatory, cognitively impaired subjects drawn from two long-term care settings to evaluate wandering behavior. The purposes of this study were (a) to describe the 24-hour distribution of wandering and direct ambulating cycles, (b) to examine the stability of wandering behavior over a 3-day interval, (c) to evaluate whether wandering during a 2-hour epoch is representative of that of a 24-hour day, and (d) to evaluate whether large-scale integrated (LSI) activity meters can substitute as an index or proxy for direct observation in the study of wandering behavior. Subjects displayed a daily average of 20.1 cycles encompassing 43.9 minutes of wandering ambulation and 28.8 cycles encompassing 40.4 minutes of direct ambulation. Wandering behavior was present in all subjects. However, wandering was highly variable from subject to subject. For a given subject, wandering was only moderately stable over a 3-day interval, but more so than direct ambulation. Similarly, a standard 2-hour epoch was moderately representative of daily wandering ambulation, but more so than for direct ambulation. Finally, LSI meters, when applied at the ankle and worn over longer (24-hr) rather than shorter (2-hr) intervals, are a promising means to index wandering behavior.

Different educational strategies may need to be created to meet the varying needs of postbaccalaureate and post-master's students in DNP programs. [J Nurs Educ. 2017;56(6):364-367.].