Aleksandra Korzeniewska-Eksterowicz, Hanna Moczulska, Mariusz Grzesiak
et al.
Abstract Background The parents with a diagnosis of life-limiting fetal condition should receive medical information about the nature of defect, prognosis, possibilities of care and obstetric complications and receive psychological, spiritual, legal support. In our model of care, the perinatal hospice - functioning outside the hospital structure - offers a multidisciplinary support and coordinates care in close cooperation with hospitals. The aims of study are: analysis of the birth outcome in patients with life-limiting fetal conditions, perinatal palliative care model evaluation and analysis of factors affecting earlier contact of patients with perinatal hospice. Methods We conducted retrospective reviews of medical records of perinatal hospice patients in 2014–2020. The study population was divided into two groups. Group 1 comprised deliveries which ended with the birth of a living newborn; Group 2: pregnancies with intrauterine fetal death and death during delivery. Separately, we analysed patients who underwent cesarean birth. Results Out of 72 families, 68 decided to continue pregnancy. The most common diagnoses were trisomies 18 and 13. In 47 cases, deliveries resulted in a live-born newborn; in 21 pregnancies, fetal death occurred. Nineteen pregnancies were delivered via cesarean on obstetric indications. The time interval from diagnosis to first palliative consultation was, on average, 48 days in group 1 vs. 33 in group 2. Women with stillbirths contacted the hospice at an earlier stage of pregnancy (p = 0.0469), and multidisciplinary team consultation in the hospital took place earlier (p = 0.0045) and in a shorter time interval from the first consultation in hospice (p = 0.0298). Patients who were older and lived in large cities contacted hospice earlier. Conclusion System solutions should be considered, obliging the physician to refer the pregnant woman to a perinatal palliative care program. Shortening the interval between diagnosis and palliative care consultation would allow for more effective professional support and more time to prepare the parents for losing a child.
O objetivo deste estudo foi analisar a associação entre a motivação e vários aspectos da prática de exercício físico (EF) em indivíduos que mantiveram a perda de massa corporal, e explorar o papel do gênero. A amostra foi constituída por 253 participantes, foram avaliadas as suas características sociodemográficas, a composição corporal, o EF, a motivação geral e específica para o exercício, com instrumentos validados. Utilizou-se o teste t-de student para comparar as diversas variáveis entre os participantes. Para analisar a associação entre as variáveis motivacionais e os diferentes aspectos do EF, utilizou-se o coeficiente de correlação de Pearson. Foram ainda criados tercis para as variáveis motivacionais e posteriormente comparadas as médias dos vários aspectos do EF, através do teste da ANOVA one-way. Observaram-se diferenças entre gêneros no que respeita à intensidade, duração e dispêndio energético e na maioria das variáveis motivacionais, favorecendo o gênero masculino. Identificaram-se associações positivas entre as variáveis motivacionais relacionadas com o EF, nomeadamente a motivação intrínseca e as regulações de ordem mais autônoma, e os diferentes aspectos do EF, na amostra total e no gênero feminino (p < 0,05). Em indivíduos com sucesso na manutenção da perda de massa corporal, particularmente nas mulheres, motivações mais autônomas para o EF associaram-se a maior prática de EF. Essas conclusões são significativas para programas de perda de massa corporal e promoção de saúde, indicando que a motivação autônoma pode ser um fator de sucesso na manutenção da massa corporal.
Siri Aas Smedemark, Christian B. Laursen, Dorte Ejg Jarbøl
et al.
Abstract Background Delayed recognition of acute disease among older adults hinders timely management and increases the risk of hospital admission. Point-of-Care testing, including Focused Lung Ultrasound (FLUS) and in-home analysis of biological material, may support clinical decision-making in suspected acute respiratory disease. The aim of this study was to pilot test the study design for a planned randomised trial, investigate whether in-home extended use of point-of-care testing is feasible, and explore its’ potential clinical impact. Methods A non-randomised pilot and feasibility study was conducted during September–November 2021 in Kolding Municipality, Denmark. A FLUS-trained physician accompanied an acute community nurse on home-visits to citizens aged 65 + y with signs of acute respiratory disease. The acute community nurses did a clinical assessment (vital signs, capillary C-reactive protein and haemoglobin) and gave a presumptive diagnosis. Subsequently, the physician performed FLUS, venipuncture with bedside analysis (electrolytes, creatinine, white blood cell differential count), nasopharyngeal swab (PCR for upper respiratory pathogens), and urine samples (flow-cytometry). Primary outcomes were feasibility of study design and extended point-of-care testing; secondary outcome was the potential clinical impact of extended point-of-care testing. Results One hundred consecutive individuals were included. Average age was 81.6 (SD ± 8.4). Feasibility of study design was acceptable, FLUS 100%, blood-analyses 81%, PCR for upper respiratory pathogens 79%, and urine flow-cytometry 4%. In addition to the acute community nurse’s presumptive diagnosis, extended point-of-care testing identified 34 individuals with a condition in need of further evaluation by a physician. Conclusion Overall, in-home assessments with extended point-of-care testing are feasible and may aid to identify and handle acute diseases in older adults.
Background Nursing home residents engage in lower levels of physical activity, primarily remaining seated or lying down, except for routine activities of daily living (ADLs). Since ADLs, particularly toileting, require effort. This study investigated the relationship between physical activity and toileting activity during the daytime among older nursing home residents. Methods The study involved 30 participants, including a group of healthy community-dwelling older individuals and two groups of nursing home residents with independent and non-independent toileting behavior, respectively. The physical activity of participants was measured with an accelerometer, and estimated metabolic equivalents, duration, and amount of physical activity were calculated. Results The amount of physical activity associated with toileting was significantly higher in the independent and non-independent groups than in the community group. Moreover, the amount of non-sedentary physical activity associated with toileting positively affected the amount of non-sedentary physical activity during the daytime. These findings suggest that toileting activity can contribute significantly to the physical activity of older nursing home residents. Conclusion Interventions focusing on improving toileting behavior among nursing home residents may positively impact overall physical activity and functional abilities.
Time-to-collision (TTC) index has been extensively utilized to evaluate rear-end collision risks, but few studies have focused on the special transition process that vehicles change from a safe to a dangerous situation. This study conducts an in-depth analysis of the transition condition of rear-end collisions. Realistic vehicle trajectory data were extracted from the Federal Highway Administration's Next Generation Simulation (NGSIM) datasets. The TTC index was utilized to pinpoint dangerous and transition conditions. A total of 13 types of transition conditions were categorized and a novel indicator, the derivative of TTC (TTCD), is proposed to evaluate changing rate of TTCs. Three types of TTCDs, corresponding to different time point or interval, were further analyzed based on developed regression models. The results indicate that: (1) although theoretically there are a total of 13 types of transition conditions, three types are dominant in practice; (2) the TTCD(t0) values at transition start points are significantly smaller than the TTCD(t1) at end points and the average TTCD(t0,t1), which indicates the quickest change of TTC values, while the TTCD(t1) has the slowest changes of TTC values; and (3) the following vehicle's speed and acceleration rate, and speed difference and acceleration difference between two vehicles have significant effects on TTCDs. The influences are more remarkable of TTCD(t0) than those of TTCD(t1), and the TTCD(t0,t1) always shows the average characteristic. Lastly, corresponding countermeasures are discussed based on findings above.
Hepatocellular carcinoma (HCC) is the sixth most common primary malignancy worldwide, and the third most common cause of death among cancers worldwide. HCC occurs in several pre-existing conditions, including hepatitis C, hepatitis B virus, and non-alcoholic cirrhosis. Egypt used to be the country with the heaviest hepatitis C virus (HCV) burden. The relationship between HCV and HCC is an important research area. In Egypt, HCC is a significant public health problem. A possible cause for the increasing rates of detection of HCC in Egypt is the mass screening program that was carried by the government for detecting and treating HCV. A multidisciplinary approach is now widely applied to HCC management in health centers all over Egypt. Different treatment modalities are available in Egypt, with success rates comparable to global rates. The Egyptian health authorities have made the elimination of HCV from Egypt a special priority, and this approach should lead to a decrease in number of HCC cases in the near future. In this article we review the current situation of HCC in Egypt, including epidemiological aspects, relevant risk factors for HCC development, strategies, and efforts established by health authorities for the screening and prevention of both HCV and HCC in Egypt. We highlight the different modalities for HCC treatment.
The evolution of cost‐effective and reserve‐rich nonprecious metals (NPMs) to replace precious metal electrocatalysts is of significant interest in modern electrocatalysis. The confinement effects in NPM‐based nanoparticles encapsulated in carbon nanoshells have been considered as an emerging and efficient way to special types of electrocatalysts which facilitate electrocatalytic activity and stability, even under rigorous conditions. This review focuses on the unique individual carbon encapsulation for high‐performance design of NPM‐based electrocatalysts, outlining all confinement synthesis methods, mechanistic studies on confinement effects, and the emerging practical reactions. It begins first introducing the synthetic methods for NPM‐based core@carbon shell electrocatalysts, and then follows clarification of the relationship between the fundamental confinement effects and the performance improvement of carbon shell encapsulating NPM‐based electrocatalysts. Further and detailed discussions on the alloying effect, doping effect, and heterojunction effect of the NPM‐based core to alter the electronic situation which affects the electrocatalytic performance are subsequently provided. Finally, the review provides a perspective on challenges and opportunities in future research with respect to both in‐depth theoretical research and potential design concept of such NPM‐based core@carbon shell electrocatalysts.
S. Naghizadeh, M. Mirghafourvand, Roghaye Mohammadirad
Background During the COVID-19 pandemic, pregnant women bear considerable physical and psychological stress because of their special conditions, which combined with other stress factors such as violence, makes their situation even more critical. This study aimed to investigate the prevalence of domestic violence and its relationship with quality of life in pregnant women during the COVID-19 pandemic. Methods This cross-sectional study was performed with the participation of 250 pregnant women in the obstetrics clinic of 29-Bahman Hospital, Tabriz city. Using a three-part questionnaire consisting of the socio-demographic and obstetrics information, the domestic violence questionnaire developed by WHO, and the SF-12 quality of life questionnaire, the required information was collected. A general linear model was then used to determine the relationship between domestic violence and quality of life, while adjusting the socio-demographic and obstetrics information. Results According to the data, more than one-third of pregnant women (35.2 %) had experienced domestic violence. The most common type of violence experienced was emotional violence (32.8 %), followed by sexual violence (12.4 %), and physical violence (4.8 %). The mean score of the physical health department of quality of life in the group of women exposed to violence (50.21) was lower compared to the unexposed group (53.45), though there was no significant difference between them ( P = 0.25). However, the mean score of the mental health department of quality of life in women exposed to violence (46.27) was significantly lower compared to unexposed women (61.17) ( P < 0.001). Based on the general linear model, the mean score for quality of life in the mental health dimension was significantly higher among unexposed women compared to those exposed to violence (β = 9.3, 95 %CI: 3.5 to 15.0, P = 0.002). Conclusions The findings of this study indicate a high prevalence of domestic violence and its relationship with a low quality of life during the COVID-19 pandemic. Therefore, the findings signify the importance of screening pregnant women in terms of domestic violence in respective centers as well as the necessity of conducting proper interventions to address domestic violence to improve the quality of life in women.
The Mediterranean climate is expected to become warmer and drier during the twenty-first century. Mediterranean Sea response to climate change could be modulated by the choice of the socio-economic scenario as well as the choice of the boundary conditions mainly the Atlantic hydrography, the river runoff and the atmospheric fluxes. To assess and quantify the sensitivity of the Mediterranean Sea to the twenty-first century climate change, a set of numerical experiments was carried out with the regional ocean model NEMOMED8 set up for the Mediterranean Sea. The model is forced by air–sea fluxes derived from the regional climate model ARPEGE-Climate at a 50-km horizontal resolution. Historical simulations representing the climate of the period 1961–2000 were run to obtain a reference state. From this baseline, various sensitivity experiments were performed for the period 2001–2099, following different socio-economic scenarios based on the Special Report on Emissions Scenarios. For the A2 scenario, the main three boundary forcings (river runoff, near-Atlantic water hydrography and air–sea fluxes) were changed one by one to better identify the role of each forcing in the way the ocean responds to climate change. In two additional simulations (A1B, B1), the scenario is changed, allowing to quantify the socio-economic uncertainty. Our 6-member scenario simulations display a warming and saltening of the Mediterranean. For the 2070–2099 period compared to 1961–1990, the sea surface temperature anomalies range from +1.73 to +2.97 °C and the SSS anomalies spread from +0.48 to +0.89. In most of the cases, we found that the future Mediterranean thermohaline circulation (MTHC) tends to reach a situation similar to the eastern Mediterranean Transient. However, this response is varying depending on the chosen boundary conditions and socio-economic scenarios. Our numerical experiments suggest that the choice of the near-Atlantic surface water evolution, which is very uncertain in General Circulation Models, has the largest impact on the evolution of the Mediterranean water masses, followed by the choice of the socio-economic scenario. The choice of river runoff and atmospheric forcing both have a smaller impact. The state of the MTHC during the historical period is found to have a large influence on the transfer of surface anomalies toward depth. Besides, subsurface currents are substantially modified in the Ionian Sea and the Balearic region. Finally, the response of thermosteric sea level ranges from +34 to +49 cm (2070–2099 vs. 1961–1990), mainly depending on the Atlantic forcing.
Herb Howard C. Hernandez, Poh Ling Ong, Philomena Anthony
et al.
Background The coronavirus disease 2019 (COVID-19) pandemic has spurred the rapid adoption of telemedicine. However, the reproducibility of face-to-face (F2F) versus remote videoconference-based cognitive testing remains to be established. We assessed the reliability and agreement between F2F and remote administrations of the Abbreviated Mental Test (AMT), modified version of the Chinese Mini-Mental State Examination (mCMMSE), and Chinese Frontal Assessment Battery (CFAB) in older adults attending a memory clinic. Methods The participants underwent F2F followed by remote videoconference-based assessment by the same assessor within 3 weeks. Reliability was evaluated using intraclass correlation coefficients (ICC; two-way mixed, absolute agreement), the mean difference between remote and F2F-based assessments using paired-sample t-tests, and agreement using Bland-Altman plots. Results Fifty-six subjects (mean age, 76±5.4 years; 74% mild; 19% moderate dementia) completed the AMT and mCMMSE, of which 30 completed the CFAB. Good reliability was noted based on the ICC values—AMT: ICC=0.80, 95% confidence interval [CI] 0.68–0.88; mCMMSE: ICC=0.80, 95% CI 0.63–0.88; CFAB: ICC=0.82, 95% CI 0.66–0.91. However, remote AMT and mCMMSE scores were higher compared to F2F—mean difference (i.e., remote minus F2F): AMT 0.3±1.1, p=0.03; mCMMSE 1.3±2.9, p=0.001. Significant differences were observed in the orientation and recall items of the mCMMSE and the similarities and conflicting instructions of CFAB. Bland–Altman plots indicated wide 95% limits of agreement (AMT -1.9 to 2.6; mCMMSE -4.3 to 6.9; CFAB -3.0 to 3.8), exceeding the a priori-defined levels of error. Conclusion While the remote and F2F cognitive assessments demonstrated good overall reliability, the test scores were higher when performed remotely compared to F2F. The discrepancies in agreement warrant attention to patient selection and environment optimization for the successful adaptation of telemedicine for cognitive assessment.
The use of transcatheter percutaneous edge-to-edge mitral valve repair with the MitraClip (Abbott) for the treatment of mitral regurgitation has rapidly expanded since it received Food and Drug Administration approval. Currently, patients with more complex mitral valve anatomies are undergoing this procedure with progressively improving clinical outcomes. This review focuses on the advanced steering maneuvers needed for the technical success of the MitraClip procedure and discusses several scenarios where such advanced steering maneuvers may be needed. These include an anterior transseptal puncture, low or high transseptal puncture with unfavorable transseptal height to mitral valve, large gap height, patients with mitral regurgitation due to dehiscence of a prior mitral valve annuloplasty ring, placing multiple/adjacent MitraClips, or redo edge-to-edge mitral valve repair. Knowledge and mastery of such advanced steering maneuvering techniques can allow operators to complete the procedure successfully with low rate of complications even in difficult scenarios.
The Rohingya people are one of the most ill-treated and persecuted refugee groups in the world, having lived in a realm of statelessness for over six generations, and who are still doing so. In recent years, more than 500,000 Rohingyas fled from Myanmar (Burma) to neighboring countries. This article addresses the Rohingya refugee crisis in Bangladesh, with special emphasis on the living conditions of this vulnerable population. We reviewed several documents on Rohingya refugees, visited a registered refugee camp (Teknaf), collected case reports, and conducted a series of meetings with stakeholders in the Cox’s Bazar district of Bangladesh. A total of 33,131 registered Rohingya refugees are living in two registered camps in Cox’s Bazar, and up to 80,000 additional refugees are housed in nearby makeshift camps. Overall, the living conditions of Rohingya refugees inside the overcrowded camps remain dismal. Mental health is poor, proper hygiene conditions are lacking, malnutrition is endemic, and physical/sexual abuse is high. A concerted diplomatic effort involving Bangladesh and Myanmar, and international mediators such as the Organization of Islamic Countries and the United Nations, is urgently required to effectively address this complex situation.
Abstract In this paper, we study a classical two species Lotka–Volterra competition–diffusion–advection system, where the diffusion and advection rates of two competitors are supposed to be proportional. By employing the principal spectral theory, we first establish a key a priori estimate on the co-existence (positive) steady state, which is a powerful tool to link the local and global dynamics. We then further present a complete classification on all possible long-time dynamical behaviors by appealing to the theory of monotone dynamical systems. Lastly, we apply these results to a special situation where two species are competing for the same resources and obtain a sharp criteria in term of certain variable parameters for all kinds of global dynamics. This work gives a positive answer to the conjecture proposed by Lou et al. in [34] by considering a more general model under certain conditions, and also, can be seen as a further development of He and Ni [19] for competition–diffusion system, where we bring new ingredients in the arguments to overcome the difficulty caused by the involvement of advection.
Zeinab Rafiee, Maasoumeh Zare Moaiedi, Armita Valizadeh Gorji
et al.
Objective: To evaluate the effect of p-coumaric acid against adriamycin-induced hepatotoxicity in rats.
Methods: The rats were divided into 4 groups. The control group received solvent; the p-coumaric acid group was treated with 100 mg/kg of p-coumaric acid orally for five consecutive days; the adriamycin group was administered with a single dose of adriamycin (15 mg/kg, i.p.), and the p-coumaric acid + adriamycin group was given p-coumaric acid five days before adriamycin administration. Twenty-four hours after the last administration, blood samples were collected for biochemical analysis, and liver tissues were removed for histopathological and immunohistochemistrical studies. Moreover, the levels of tissue lipid peroxidation and enzyme activities of glutathione peroxidase, superoxide dismutase, and catalase in liver tissue were measured.
Results: Treatment with p-coumaric acid protected the liver from the toxicity of adriamycin by attenuating the increase in alkaline phosphatase, alanine transaminase, aspartate transaminase, total bilirubin, total cholesterol, triglyceride, and low-density lipoprotein cholesterol and lessening the decrease in high-density lipoprotein cholesterol and albumin. p-Coumaric acid also raised the levels of glutathione peroxidase, superoxide dismutase, and catalase, as well as decreased lipid peroxidation in liver tissue and hepatic IL- 1β expression. Additionally, histopathological study confirmed the protective effect of p-coumaric acid against liver damage.
Conclusions: p-Coumaric acid can alleviate adriamycin-induced hepatotoxicity.
Babatunde Adewale, Jonathan R Heintz, Christopher F Pastore
et al.
Helminth infections, including hookworms and Schistosomes, can cause severe disability and death. Infection management and control would benefit from identification of biomarkers for early detection and prognosis. While animal models suggest that Trefoil Factor Family proteins (TFF2 and TFF3) and interleukin-33 (IL-33) -driven type 2 immune responses are critical mediators of tissue repair and worm clearance in the context of hookworm infection, very little is known about how they are modulated in the context of human helminth infection. We measured TFF2, TFF3, and IL-33 levels in serum from patients in Brazil infected with Hookworm and/or Schistosomes, and compared them to endemic and non-endemic controls. TFF2 was specifically elevated by Hookworm infection in females, not Schistosoma or co-infection. This elevation was correlated with age, but not worm burden. TFF3 was elevated by Schistosoma infection and found to be generally higher in females. IL-33 was not significantly altered by infection. To determine if this might apply more broadly to other species or regions, we measured TFFs and cytokine levels (IFNγ, TNFα, IL-33, IL-13, IL-1β, IL-17A, IL-22, and IL-10) in both the serum and urine of Nigerian school children infected with S. haematobium. We found that serum levels of TFF2 and 3 were reduced by infection, likely in an age dependent manner. In the serum, only IL-10 and IL-13 were significantly increased, while in urine IFN-γ, TNF-α, IL-13, IL-1β, IL-22, and IL-10 were significantly increased in by infection. Taken together, these data support a role for TFF proteins in human helminth infection.
Arctic medicine. Tropical medicine, Public aspects of medicine
The article discusses the issues of organizing the educational process in conditions of unforeseen freelance influences, such as accidents, terrorist acts, military or interethnic conflicts, fires, drought, epidemiological situation, etc. It is shown that in a market economy, educational institutions — both state and private ones — reoriented themselves from the planned training of specialists to the customer’s demand for educational services. A new demand-oriented approach to the organization of the educational process is proposed, in which the educational process is presented in the form of a chain “seller — product — consumer”. It is shown that from the point of view of the consumer, the safety and efficiency of educational services are among the important requirements in the face of unforeseen freelance influences. A new structural model of the educational system is proposed, which implies the interaction of two subsystems — the educational infrastructure and the educational process. It is shown that the structural reliability of the educational system is an important indicator for ensuring the psychological and physical safety of participants in the educational process. A new mathematical model based on graphs and hypernets is proposed, which takes into account the mapping of the educational process into the educational infrastructure. The concept of “survivability of the educational system” is introduced as the ability of continuous functioning of this system under the influence of various external destabilizing factors. The task of organizing the educational process in emergency situations from the point of view of the consumer is set as the task of building a hypernet of minimum cost and specified reliability.