Significance: Historically, honey has been regarded as a potent agent in bacterial inhibition and wound healing. An increased prevalence of antibiotic resistant pathogens spurred an initial resurgence in honey's clinical popularity, with it quickly finding a place in wound care and regenerative medicine. However, this renewed usage demanded a need for improved delivery and overall research of its bioactive properties. This review provides an overview of the antibacterial properties and clinical use of honey. Recent Advances: The past and present clinical use of honey is noted, focusing specifically on burns and ulcers, as these are the most common applications of the natural agent. While honey is often used without modification clinically, there are also commercially available products ranging from dressings to gels, which are discussed. Critical Issues: Despite these products growing in popularity, the need for improved delivery and a structure to support wound healing could improve the treatment method. Future Directions: Tissue engineering scaffolds can provide an alternative method of honey delivery with research focusing primarily on electrospun scaffolds, hydrogels, and cryogels. Current studies on these scaffolds are discussed with respect to their advantages and potential for future clinical work. Overall, this review provides a comprehensive overview of the properties of honey, its current use in wound healing, and the potential for future incorporation into tissue-engineered scaffolds to provide an innovative wound healing agent.
IntroductionDeep sedation in critically ill patients is associated with a longer duration of
mechanical ventilation and a prolonged length of stay in the intensive care unit.
Several protocols have been used to improve these outcomes. We implement and
evaluate an analgesia-based, goal-directed, nurse-driven sedation protocol used to
treat critically ill patients who receive mechanical ventilation. MethodsWe performed a prospective, two-phase (before-after), non-randomized multicenter
study that involved 13 intensive care units in Chile. After an observational phase
(observational group, n=155), we designed, implemented and evaluated an
analgesia-based, goal-directed, nurse-driven sedation protocol (intervention
group, n=132) to treat patients who required mechanical ventilation for more than
48 hours. The primary outcome was to achieve ventilator-free days by day 28. ResultsThe proportion of patients in deep sedation or in a coma decreased from 55.2% to
44.0% in the interventional group. Agitation did not change between the periods
and remained approximately 7%. Ventilator-free days to day 28, length of stay in
the intensive care unit and mortality were similar in both groups. At one year,
post-traumatic stress disorder symptoms in survivors were similar in both groups.
ConclusionsWe designed and implemented an analgesia-based, goal-directed, nurse-driven
sedation protocol in Chile. Although there was no improvement in major outcomes,
we observed that the present protocol was safe and feasible and that it resulted
in decreased periods of deep sedation without increasing agitation.
Sedatives were frequently employed and deep sedation was common. Midazolam and fentanyl were the most frequently administered drugs. The use of NMB might be independently associated to greater mortality.
ABSTRACT:The wear resistance of rotary plows operating in a clay loam soil was studied. The degree of damage caused to the soil and the amount of mass lost by the tools were determined in order to establish correlations between the physical properties of the soil and the wear mechanisms acting on the tribosystem. Field tests were carried out in 12 plots and a randomized experimental design with 4 levels, 3 replicas per level and 2 passes per plot was applied. The levels relate to the tillage implements employed: rotary tiller, rotary power harrow, small motorized rotary tiller and control (unaltered soil). The highest mass losses were measured in rotary tiller and rotary power harrow's tools, while the small motorized rotary tiller's tools showed generally lower levels of damage. It was determined that the effective contact time between tool and soil, the rotating speed and the sudden impact forces are the most significant factors affecting the wear resistance in field operations. Thirty days after tillage operation the soil samples were taken from each plot at a mean depth of 100 mm in order to determine bulk density, gravimetric moisture content and percentage of aggregates smaller than 5 mm. No significant differences among the values of these properties were found in the experiments. The wear mechanisms acting on the tools' surface are complex and include 2-body and 3-body abrasion as well as the presence of sudden impact forces.
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