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1
Gudiel, Hugo. "La revelación del misterio de la Trinidad en Xavier Zubiri." Revista Latinoamericana de Teología 27, no. 81 (2010): 343–73. http://dx.doi.org/10.51378/rlt.v27i81.4879.
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Hoppe, Jens, and Andreas Maisch. "Rezension von: Maisch, Andreas, Mayer Seligmann, Judt zu Unterlimpurg." Württembergisch Franken 87 (February 10, 2023): 291–93. http://dx.doi.org/10.53458/wfr.v87i.5385.
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Andreas Maisch, Mayer Seligmann, Judt zu Unterlimpurg. Juden in Schwäbisch Hall und Steinbach 1688-1802 (Veröffentlichungen des Stadtarchivs Schwäbisch Hall, Heft 14), Schwäbisch Hall (Stadtarch iv) 2001. 373 S. 81 Abb.
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Mitchell, IR, C. Meyer, and WA Krueger. "Deep fascia of the foot. Anatomical and clinical considerations." Journal of the American Podiatric Medical Association 81, no. 7 (1991): 373–78. http://dx.doi.org/10.7547/87507315-81-7-373.
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The deep fascia of the foot lies beneath the subcutaneous tissue and surrounds the intrinsic foot muscles. Depending on its location, the composition of the deep fascia varies. In some areas it is thin, while in other areas it is greatly thickened to form retinacula and the plantar aponeurosis. Selected clinical considerations that relate to the deep fascia of the foot are described. These include the following: plantar fasciitis, infection, compartment syndrome, calcaneal fracture, and neuroma.
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Eiben, Ottó G. "Quality assurance and the freedom of research: Dillemata and approaches." Zeitschrift für Morphologie und Anthropologie 81, no. 3 (1997): 373–82. http://dx.doi.org/10.1127/zma/81/1997/373.
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VEZINHET, FRANCOISE, M. ROGER, MONIQUE PELLECUER, and P. GALZY. "Genetic Control of some Metabolic Modifications during the Sporulation of Saccharomyces cerevisiae Hansen." Microbiology 81, no. 2 (2000): 373–82. http://dx.doi.org/10.1099/00221287-81-2-373.
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Summary: The biochemical modifications of two yeast strains, a/α and α/α, have been studied during incubation in a sporulation medium. The increases in dry cell weight, protein, carbohydrate and lipid contents, as well as the variation in respiration rate are quite similar for the two strains. Mating type gene control of sporulation is discussed.
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Haberlandt, Uwe, and Christian Berndt. "The value of weather radar data for the estimation of design storms – an analysis for the Hannover region." Proceedings of the International Association of Hydrological Sciences 373 (May 12, 2016): 81–85. http://dx.doi.org/10.5194/piahs-373-81-2016.
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Abstract. Pure radar rainfall, station rainfall and radar-station merging products are analysed regarding extreme rainfall frequencies with durations from 5 min to 6 h and return periods from 1 year to 30 years. Partial duration series of the extremes are derived from the data and probability distributions are fitted. The performance of the design rainfall estimates is assessed based on cross validations for observed station points, which are used as reference. For design rainfall estimation using the pure radar data, the pixel value at the station location is taken; for the merging products, spatial interpolation methods are applied. The results show, that pure radar data are not suitable for the estimation of extremes. They usually lead to an overestimation compared to the observations, which is opposite to the usual behaviour of the radar rainfall. The merging products between radar and station data on the other hand lead usually to an underestimation. They can only outperform the station observations for longer durations. The main problem for a good estimation of extremes seems to be the poor radar data quality.
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Burkholder, Mark A. "Grandeur et misère de l’office: Les officiers de finances de Nouvelle-Espagne XVIIe–XVIIIe siècles." Hispanic American Historical Review 81, no. 2 (2001): 373–74. http://dx.doi.org/10.1215/00182168-81-2-373.
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Walbank, Michael B. "Notes on Attic Decrees." Annual of the British School at Athens 85 (November 1990): 435–47. http://dx.doi.org/10.1017/s0068245400015781.
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Several fragments of 4th-century BC Athenian decree-inscriptions are discussed. Joins are made betweenIGii2. 13a and 68 andHesperia, 40, no. 3;IGii2. 257 and 300; 242 and 373; 407 andSEG32. 94;IGii2. 309 and 552; 530 and 590. Attributed to the same stele, but not joining, areIGii2. 139 and 289; 277 and 428; 540a andSEG24. 117;IGii2. 540b andHesperia, 21, no. 17;IGii2. 286 and 625; 414a and 403; 398a (+ 438) and 612; 484 and 558; 489 and 532; 495 and 709; 405 andHesperia, 4, no. 32. Other decrees discussed, mainly in light of the work of A.S. Henry on the formulae of Athenian decrees, areIGii2. 44; 81; 121; 129; 147; 154; 155; 156; 285+ 414d; 321; 335; 364; 406; 416; 1001; andSEG21. 362 and 25. 85.
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Chaudhuri, Reaz A. "Corrigendum to: “Weakening effects of internal part-through elliptic holes in homogeneous and laminated composite plates” [Compos. Struct. 81 (2007) 362–373]." Composite Structures 88, no. 1 (2009): 166. http://dx.doi.org/10.1016/j.compstruct.2008.08.005.
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González-Mingueza, Carlos, and Francisco Muñoz-Gutiérrez. "Retraction notice to “Wind prediction using Weather Research Forecasting Model (WRF): A case study in Peru” [Energy Convers Manage 81 (2014) 363–373]." Energy Conversion and Management 88 (December 2014): 1076. http://dx.doi.org/10.1016/j.enconman.2014.09.054.
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Beckmann, U., I. Baldwin, M. Durie, A. Morrison, and L. Shaw. "Problems Associated with Nursing Staff Shortage: An Analysis of the First 3600 Incident Reports Submitted to the Australian Incident Monitoring Study (AIMS-ICU)." Anaesthesia and Intensive Care 26, no. 4 (1998): 396–400. http://dx.doi.org/10.1177/0310057x9802600410.
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Although many studies have attempted to define appropriate nursing staff levels, allocation and patient dependency, minimal data is available on the effect of nursing staff shortage (NSS) on quality of care provided in intensive care. This study aimed to identify incidents associated with staff shortage as reported to the Australian Incident Monitoring Study-ICU (AIMS-ICU) project and to assess their estimated effect on patient outcome. A search of narrative keywords and contributing factors identified 89 nursing staff shortage incidents (NSS-INCIDENTS) and 373 incidents involving nursing staff shortage contributing factors (NSS-CF). NSS resulted from inappropriate rostering for current patient load (81%) and inability to respond to increased unit activity (19%). Most frequent associated incidents included problems with: drug administration/documentation (47), patient supervision (20), set-up of ventilators/ equipment (16), and accidental extubation (14). Undesirable patient outcomes included: major physiological change (22%), patient/relative dissatisfaction (12%), and physical injury (3%). This study suggests that inadequate staffing results in incidents and compromised patient safety.
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López-Ocaña, Gaspar, Mario José Romellón-Cerino, and Nancy Estrada-Pérez. "Removal and kinetics of basic pollutants in serially constructed wetlands." Renewable Energy, Biomass & Sustainability 3, no. 1 (2022): 24–34. http://dx.doi.org/10.56845/rebs.v3i1.32.
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In this research, the spatial distribution and kinetic coefficient of basic pollutants in the artificial wetlands (CW) of the DACBiol-UJAT wastewater treatment plant were evaluated. It consists of a sump-settler and two identical modules with HA in series 8.3 m long, 2.5 m wide and 0.5 m long. In both trains, the first HA is subsurface flow (SSFCW) with Pontederia cordata (tule) species, the second HA is free flow (FFCW) with Thalia geniculata (popal) and the last HAFL with Sagittaria lancifolia (dovetail). The characterization of the support medium, water quality (inlet, outlet and internal points), modeling of the spatial distribution and kinetics of color degradation, turbidity and COD were carried out. Both trains operated with a 3-day HRT with a Qmed of 8.9 ± 3.4 m3/day. The quality of the inlet water of train 1 presents an average turbidity of 72.3 UTN, color of 1340.0 UC and COD with 373 mg/L, likewise at the entrance of train 2 the average turbidity is 69.6 UTN, color of 1,190.3 UC and COD with 373 mg/L. The degradation kinetic constant was estimated in train 1 at -0.52 days-1 for turbidity, -0.32 days-1 for color and -0.58 days-1 for COD, for train 2 of -0.47 days-1 for turbidity, -0.24 days-1 for color and -0.49 days-1 for COD. The removal efficiency for turbidity in train 1 was 65.6% and train 2 was 67.9%, for the apparent color in train 1 it was 48.8% and train 2 was 58.3% and in COD in train 1 it was 81% and for train 2 of 76%. The maximum permissible COD limit according to PROY-NOM-001-SEMARNAT-2017 is met, which is 150 mg/L.
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BARTINGTON, S. E., C. PECKHAM, D. BROWN, H. JOSHI, and C. DEZATEUX. "Feasibility of collecting oral fluid samples in the home setting to determine seroprevalence of infections in a large-scale cohort of preschool-aged children." Epidemiology and Infection 137, no. 2 (2008): 211–18. http://dx.doi.org/10.1017/s0950268808000927.
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SUMMARYOral fluid is a non-invasive biological sample, which can be returned by post, making it suitable for large-scale epidemiological studies in children. We report our experience of oral fluid collection from 14 373 preschool-aged children in the UK Millennium Cohort Study. Samples were collected by mothers in the home setting following the guidance of trained interviewers, and posted to the laboratory. Samples were received from 11 698 children (81·4%). Children whose mothers were of Black Caribbean ethnicity and who lived in non-English-speaking households were less likely to provide a sample, and those with a maternal history of asthma more likely to provide a sample [adjusted risk ratio (95% CI) 0·85 (0·73–0·98), 0·87 (0·77–0·98) and 1·03 (1·00–1·05) respectively]. Collection of oral fluid samples is feasible and acceptable in large-scale child cohort studies. Formal interpreter support may be required to increase participation rates in surveys that collect biological samples from ethnic minorities.
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Romellón-Cerino, Mario José, Nancy Estrada-Pérez, and Gaspar López-Ocaña. "Remoción y cinética de contaminantes básicos en humedales artificiales en serie." Tendencias en energías renovables y sustentabilidad 1, no. 1 (2022): 108–18. http://dx.doi.org/10.56845/terys.v1i1.123.
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En la presente investigación se evaluó la distribución espacial y coeficiente cinético de contaminantes básicos en los humedales artificiales (HA) de la planta de tratamiento de aguas residuales de la DACBiol-UJAT. Esta consta de cárcamo-sedimentador y dos módulos idénticos con HA en serie de 8.3 m de largo, 2.5 m ancho y 0.5 m de tirante. En ambos trenes el primer HA es de flujo subsuperficial (HAFS) con especie Pontederia cordata (tule), el segundo HA es flujo libre (HAFL) con Thalia geniculata (popal) y el último HAFL con Sagittaria lancifolia (cola de pato). Se realizó la caracterización del medio de soporte, calidad del agua (entrada, salida y puntos internos), modelado de la distribución espacial y cinética de degradación de color, turbiedad y DQO. Ambos trenes operaron con un TRH de 3 días con un Qmed de 8.9±3.4 m3/día. La calidad del agua de entrada del tren 1 presenta una turbiedad promedio de 72.3 UTN, color de 1340.0 UC y DQO con 373 mg/L, así mismo en la entrada del tren 2 la turbiedad promedio es de 69.6 UTN, color de 1,190.3 UC y DQO con 373 mg/L. La constante cinética de degradación se estimó en el tren 1 en 0.52 dias-1 para turbiedad, 0.32 dias-1 para color y 0.58 dias-1 para DQO, para el tren 2 de -0.47 días-1 para turbiedad, -0.24 dias-1 para color y -0.49 dias-1 para DQO. La eficiencia de remoción para turbiedad en el tren 1 fue de 65.6% y el tren 2 de 67.9%, para el color aparente en el tren 1 de 48.8% y tren 2 de 58.3% y en DQO en el tren 1 de 81% y para el tren 2 de 76%. Se cumple con el límite máximo permisible de DQO de acuerdo al PROY-NOM-001-SEMARNAT-2017 que es de 150 mg/L.
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Harraqui, Khouloud, Dia Eddine Oudghiri, Zineb Hannoun, et al. "Frequency of Metabolic Syndrome and Study of Anthropometric, Clinical and Biological Characteristics in Peri- and Postmenopausal Women in the City of Ksar El Kebir (Northern Morocco)." International Journal of Environmental Research and Public Health 19, no. 10 (2022): 6109. http://dx.doi.org/10.3390/ijerph19106109.
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This study aimed to determine the frequency of metabolic syndrome and to identify its predictive factors in peri- and post-menopausal women in the city of Ksar El Kebir, in northern Morocco. A total of 373 peri- and post-menopausal women between 45 and 64 years old participated in the study. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) definition. Body mass index (BMI) was calculated to assess the degree of obesity in women; anthropometric, clinical and biological parameters were collected during interviews. The mean ages of peri- and postmenopausal women were 48.84 ± 2.4 years and 56.65 ± 4.29 years, respectively. Postmenopausal women had higher means of anthropometric and biological parameters than peri-menopausal women. We also noted a predominance of metabolic syndrome in postmenopausal women (n = 158) compared to peri-menopausal women (n = 81). Waist circumference was the predominant marker in the subjects studied, whereas triglycerides were the lower marker. In the overall population, the incidence of metabolic syndrome and its associated factors were higher in postmenopausal women than in peri-menopausal women, from which it can be concluded that post menopause may be a predictor of metabolic syndrome.
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Zagar, Robert John, Kenneth G. Busch, William M. Grove, and John Russell Hughes. "Summary of Studies of Abused Infants and Children Later Homicidal, and Homicidal, Assaulting later Homicidal, and Sexual Homicidal Youth and Adults." Psychological Reports 104, no. 1 (2009): 17–45. http://dx.doi.org/10.2466/pr0.104.1.17-45.
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To study the risks of abuse, violence, and homicide, 5 studies of groups at risk for violence are summarized. 192 Abused Infants, 181 Abused Children, 127 Homicidal Youth, 425 Assaulters, 223 Rapists, and 223 Molesters were randomly selected and tracked in court, probation, medical, and school records, then compared with carefully matched groups of Controls and (in older groups) Nonviolent Delinquents. In adolescence or adulthood, these groups were classified into Later Homicidal ( N = 234), Later Violent or Nonviolent Delinquent, and Later Nondelinquent subgroups for more detailed comparisons. Shao's bootstrapped logistic regressions were applied to identify risks for commission of homicide. Significant predictors for all homicidal cases in these samples were number of court contacts, poorer executive function, lower social maturity, alcohol abuse, and weapon possession. Predictors for the 373 Abused cases (Infants and Children) were court contacts, injury, burn, poisoning, fetal substance exposure, and parental alcohol abuse. Predictors for the 871 Violent Delinquent cases (Assaulters, Rapists, Molesters) were court contacts, poorer executive function, and lower social maturity. Accuracies of prediction from the regressions ranged from 81% for homicidal sex offenders to 87 to 99% for other homicidal groups.
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Weidemann, Sören, Pauline Gagelmann, Natalia Gorbokon, et al. "Mesothelin Expression in Human Tumors: A Tissue Microarray Study on 12,679 Tumors." Biomedicines 9, no. 4 (2021): 397. http://dx.doi.org/10.3390/biomedicines9040397.
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Mesothelin (MSLN) represents an attractive molecule for targeted cancer therapies. To identify tumors that might benefit from such therapies, tissue microarrays including 15,050 tumors from 122 different tumor types and 76 healthy organs were analyzed for MSLN expression by immunohistochemistry. Sixty-six (54%) tumor types showed at least occasional weak staining, including 50 (41%) tumor types with at least one strongly positive sample. Highest prevalence of MSLN positivity had ovarian carcinomas (serous 97%, clear cell 83%, endometrioid 77%, mucinous 71%, carcinosarcoma 65%), pancreatic adenocarcinoma (ductal 75%, ampullary 81%), endometrial carcinomas (clear cell 71%, serous 57%, carcinosarcoma 50%, endometrioid 45%), malignant mesothelioma (69%), and adenocarcinoma of the lung (55%). MSLN was rare in cancers of the breast (7% of 1138), kidney (7% of 807), thyroid gland (1% of 638), soft tissues (0.3% of 931), and prostate (0 of 481). High expression was linked to advanced pathological tumor (pT) stage (p < 0.0001) and metastasis (p < 0.0001) in 1619 colorectal adenocarcinomas, but unrelated to parameters of malignancy in 1072 breast-, 386 ovarian-, 174 lung-, 757 kidney-, 171 endometrial-, 373 gastric-, and 925 bladder carcinomas. In summary, numerous important cancer types with high-level MSLN expression might benefit from future anti-MSLN therapies, but MSLN’s prognostic relevance appears to be limited.
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Rosso, Roberta, Marta D’Alonzo, Valentina Elisabetta Bounous, et al. "Adherence to Adjuvant Endocrine Therapy in Breast Cancer Patients." Current Oncology 30, no. 2 (2023): 1461–72. http://dx.doi.org/10.3390/curroncol30020112.
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Background: Adjuvant endocrine therapy (AET) reduces breast cancer recurrence and mortality of women with hormone-receptor-positive tumors, but poor adherence remains a significant problem. The aim of this study was to analyze AET side effects and their impact on adherence to treatment. Methods: A total of 373 breast cancer patients treated with AET filled out a specific questionnaire during their follow up visits at the Breast Unit of our Centre. Results: Side effects were reported by 81% of patients, 84% of those taking tamoxifen and 80% of those taking aromatase inhibitors (AIs). The most common side effect in the tamoxifen group was hot flashes (55.6%), while in the AI group it was arthralgia (60.6%). The addition of GnRH agonists to both tamoxifen and AI significantly worsened all menopausal symptoms. Overall, 12% of patients definitively discontinued AET due to side effects, 6.4% during the first 5 years and 24% during extended therapy. Patients who had previously received chemotherapy or radiotherapy reported a significantly lower discontinuation rate. Conclusions: AET side effects represent a significant problem in breast cancer survivors leading to irregular assumption and discontinuation of therapy. Adherence to AET may be improved by trustful patient–physician communication and a good-quality care network.
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Boongird, Sarinya, Chavachol Setthaudom, Rungthiwa Kitpermkiat, et al. "Durability of Humoral and Cellular Immunity after an Extended Primary Series with Heterologous Inactivated SARS-CoV-2 Prime-Boost and ChAdOx1 nCoV-19 in Dialysis Patients (ICON3)." Vaccines 10, no. 7 (2022): 1064. http://dx.doi.org/10.3390/vaccines10071064.
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The durability of a three-dose extended primary series of COVID-9 vaccine in dialysis patients remains unknown. Here, we assessed dynamic changes in SARS-CoV-2-specific humoral and cell-mediated immunity at baseline, 3 months, and 6 months after the extended primary series in 29 hemodialyzed (HD), 28 peritoneal dialyzed (PD) patients, and 14 healthy controls. Participants received two doses of inactivated SARS-CoV-2 vaccine followed by a dose of ChAdOx1 nCoV-19 vaccine. At 6 months, median anti-RBD IgG titers (IQR) significantly declined from baseline in the HD (1741 (1136–3083) BAU/mL vs. 373 (188–607) BAU/mL) and PD (1093 (617–1911) BAU/mL vs. 180 (126–320) BAU/mL) groups, as did the mean percent inhibition of neutralizing antibodies (HD: 96% vs. 81%; PD: 95% vs. 73%) (all p < 0.01). Age and post-vaccination serological response intensity were predictors of early humoral seroprotection loss. In contrast, cell-mediated immunity remained unchanged. In conclusion, humoral immunity declined substantially in dialysis patients, while cell-mediated immunity remained stable 6 months after the extended heterologous primary series of two inactivated SARS-CoV-2/ChAdOx1 nCoV-19 vaccine. A booster dose could be considered in dialysis patients 3 months after this unique regimen, particularly in the elderly or those with a modest initial humoral response.
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Abraldes, J. Arturo, Ricardo J. Fernandes, Núria Rodríguez, and Ana Sousa. "Is Rescuer Cardiopulmonary Resuscitation Jeopardised by Previous Fatiguing Exercise?" International Journal of Environmental Research and Public Health 17, no. 18 (2020): 6668. http://dx.doi.org/10.3390/ijerph17186668.
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Survival outcomes increase significantly when cardiopulmonary resuscitation (CPR) is provided correctly, but rescuer’s fatigue can compromise CPR delivery. We investigated the effect of a 100-m maximal run on CPR and physiological variables in 14 emergency medical technicians (age 29.2 ± 5.8 years, height 171.2 ± 1.1 cm and weight 73.4 ± 13.1 kg). Using an adult manikin and a compression-ventilation ratio of 30:2, participants performed 4-min CPR after 4-min baseline conditions (CPR) and 4-min CPR after a 100-m maximal run carrying emergency material (CPR-run). Physiological variables were continuously measured during baseline and CPR conditions using a portable gas analyzer (K4b2, Cosmed, Rome, Italy) and analyzed using two HD video cameras (Sony, HDR PJ30VE, Japan). Higher VO2 (14.4 ± 2.1 and 22.0 ± 2.5 mL·kg−1·min−1) and heart rate (123 ± 17 and 148 ± 17 bpm) were found for CPR-run. However, the compression rate was also higher during the CPR-run (373 ± 51 vs. 340 ± 49) and between every three complete cycles (81 ± 9 vs. 74 ± 14, 99 ± 14 vs. 90 ± 10, 99 ± 10 vs. 90 ± 10, and, 101 ± 15 vs. 94 ± 11, for cycle 3, 6, 9 and 12, respectively). Fatigue induced by the 100-m maximal run had a strong impact on physiological variables, but a mild impact on CPR emergency medical technicians’ performance.
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Aldakheel, Dakheel, Mir Sadat Ali, Abdullah Alothman, et al. "Epidemiology of traumatic spinal fractures in patients aged 50 years or less at a center in Saudi Arabia from 2005 to 2016." F1000Research 12 (July 13, 2023): 819. http://dx.doi.org/10.12688/f1000research.133527.1.
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Background: We retrospectively reviewed traumatic spinal fractures (TSFs), including their mechanisms of injury and associated injuries in patients aged ≤50 years admitted to our center over a period of 11 years. Our secondary objective was to investigate whether spine injuries have decreased since the introduction of new transportation-related legislation applications. Methods: Between 2005 and 2016, all patients admitted to the hospital due to TSFs, including cervical, thoracic, and lumbar spinal fractures, who were aged ≤50 years were included in this study. Patient demographics, mechanism of injury, associated injuries, hospital stay duration, treatment, complications, and mortalities were reviewed and analyzed. Results: Altogether, 373 patients (81% male; 19% female; median age, 28 years) were included in the study, and 579 spinal fractures were identified. The lumbar spine was the most affected part. The most common injury mechanism was motor vehicle accidents (MVA) (69.7%), followed by falls (26.8%). Neurological injuries were detected in 9.4% of patients. Associated injuries were observed in 45.3% of patients, and 33.6% of patients were surgically treated. Thoracic injuries and lower limb fractures were the most common injuries, and the postoperative complication rate was 3.9%. Conclusions: Although there was a significant decrease in TSFs after the speed control legislation over the study period, MVA and falls remained the most common causes of spinal injuries. Associated injuries, operated patients, and female sex were all associated with a prolonged hospital stay.
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Nicholson, Maribeth R., Erin Alexander, Mark Bartlett, et al. "2092 A multicenter study of fecal microbiota transplantation for Clostridium difficile infection in children." Journal of Clinical and Translational Science 2, S1 (2018): 64. http://dx.doi.org/10.1017/cts.2018.237.
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OBJECTIVES/SPECIFIC AIMS: Clostridium difficile infection (CDI) is the most common cause of antibiotic-associated diarrhea and an increasingly common infection in children in both hospital and community settings. Between 20% and 30% of pediatric patients will have a recurrence of symptoms in the days to weeks following an initial infection. Multiple recurrences have been successfully treated with fecal microbiota transplantation (FMT), though the body of evidence in pediatric patients is limited primarily to case reports and case series. The goal of our study was to better understand practices, success, and safety of FMT in children as well as identify risk factors associated with a failed FMT in our pediatric patients. METHODS/STUDY POPULATION: This multicenter retrospective analysis included 373 patients who underwent FMT for CDI between January 1, 2006 and January 1, 2017 from 18 pediatric centers. Demographics, baseline characteristics, FMT practices, C. difficile outcomes, and post-FMT complications were collected through chart abstraction. Successful FMT was defined as no recurrence of CDI within 60 days after FMT. Of the 373 patients in the cohort, 342 had known outcome data at two months post-FMT and were included in the primary analysis evaluating risk factors for recurrence post-FMT. An additional six patients who underwent FMT for refractory CDI were excluded from the primary analysis. Unadjusted analysis was performed using Wilcoxon rank-sum test, Pearson χ2 test, or Fisher exact test where appropriate. Stepwise logistic regression was utilized to determine independent predictors of success. RESULTS/ANTICIPATED RESULTS: The median age of included patients was 10 years (IQR; 3.0, 15.0) and 50% of patients were female. The majority of the cohort was White (89.0%). Comorbidities included 120 patients with inflammatory bowel disease (IBD) and 14 patients who had undergone a solid organ or stem cell transplantation. Of the 336 patients with known outcomes at two months, 272 (81%) had a successful outcome. In the 64 (19%) patients that did have a recurrence, 35 underwent repeat FMT which was successful in 20 of the 35 (57%). The overall success rate of FMT in preventing further episodes of CDI in the cohort with known outcome data was 87%. Unadjusted predictors of a primary FMT response are summarized. Based on stepwise logistic regression modeling, the use of fresh stool, FMT delivery via colonoscopy, the lack of a feeding tube, and a lower number of CDI episodes before undergoing FMT were independently associated with a successful outcome. There were 20 adverse events in the cohort assessed to be related to FMT, 6 of which were felt to be severe. There were no deaths assessed to be related to FMT in the cohort. DISCUSSION/SIGNIFICANCE OF IMPACT: The overall success of FMT in pediatric patients with recurrent or severe CDI is 81% after a single FMT. Children without a feeding tube, who receive an early FMT, FMT with fresh stool, or FMT via colonoscopy are less likely to have a recurrence of CDI in the 2 months following FMT. This is the first large study of FMT for CDI in a pediatric cohort. These findings, if confirmed by additional prospective studies, will support alterations in the practice of FMT in children.
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Linker, David T., Tasha B. Murphy, and Ali H. Mokdad. "Selective screening for atrial fibrillation using multivariable risk models." Heart 104, no. 18 (2018): 1492–99. http://dx.doi.org/10.1136/heartjnl-2017-312686.
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ObjectiveAtrial fibrillation can lead to stroke if untreated, and identifying those at higher risk is necessary for cost-effective screening for asymptomatic, paroxysmal atrial fibrillation. Age has been proposed to identify those at risk, but risk models may provide better discrimination. This study compares atrial fibrillation risk models with age for screening for atrial fibrillation.MethodsNine atrial fibrillation risk models were compared using the Atherosclerosis Risk in Communities study (11 373 subjects, 60.0±5.7 years old). A new risk model (Screening for Asymptomatic Atrial Fibrillation Events—SAAFE) was created using data collected in the Monitoring Disparities in Chronic Conditions study (3790 subjects, 58.9±15.3 years old). The primary measure was the fraction of incident atrial fibrillation subjects who should receive treatment due to a high CHA2DS2-VASc score identified when screening a fixed number equivalent to the age criterion. Secondary measures were the C statistic and net benefit.ResultsFive risk models were significantly better than age. Age identified 71 (61%) of the subjects at risk for stroke who subsequently developed atrial fibrillation, while the best risk model identified 96 (82%). The newly developed SAAFE model identified 95 (81%), primarily based on age, congestive heart failure and coronary artery disease.ConclusionsUse of a risk model increases identification of subjects at risk for atrial fibrillation. One of the best performing models (SAAFE) does not require an ECG for its application, so that it could be used instead of age as a screening criterion without adding to the cost.
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Марголис, А. А., М. Г. Сорокова, А. А. Шведовская та Н. П. Радчикова. "Разработка и стандартизация опросника «Шкала отношения к вакцинации от COVID-19»". Психология. Журнал Высшей школы экономики 19, № 3 (2022): 454–74. http://dx.doi.org/10.17323/1813-8918-2022-3-454-474.
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Представлены результаты исследования по разработке и стандартизации опросника «Шкала отношения к вакцинации от COVID-19» («COVID-19 vaccine attitude scale», COVID-19 VAS). Выборку исследования составили 1965 студентов бакалавриата, специалитета и магистратуры в возрасте от 16 до 60 лет, из них женщин 1592 (81%), мужчин 373 (19%), средний возраст M = 24.7, SD = 8.4, Me = 21.0. База исследования — ФГБОУ ВО «Московский государственный психолого-педагогический университет». В структуру опросника вошли пять шкал, выделенные методом эксплораторного факторного анализа: шкала 1 «Польза вакцинации от COVID-19 для человека и общества», шкала 2 «Страх побочных эффектов вакцинации от COVID-19 и недоверие к информации о безопасности вакцинирования», шкала 3 «Отрицание опасности коронавируса и надежда на естественный иммунитет», шкала 4 «Уверенность в серьезных негативных последствиях вакцины от коронавируса» и шкала 5 «Неверие в доказанность эффективности российских вакцин на международном уровне». Статистически доказана конструктная валидность опросника. Конфирматорный факторный анализ показал удовлетворительное соответствие эмпирических данных структуре опросника. Шкалы коррелируют между собой на среднем уровне, направления связей соответствуют ожидаемым. Статистически подтверждена высокая внутренняя надежность всех шкал с помощью коэффициента a Кронбаха. Подтверждена удовлетворительная конвергентная валидность соответствующих шкал опросника «Шкала отношения к вакцинации от COVID-19» с естественно-научной грамотностью, интеллектом и страхом заболевания COVID-19. Все корреляции слабые, но теоретически ожидаемые и объяснимые. Статистически доказана дифференциальная валидность. Рассчитаны станайны. Опросник может быть рекомендован для применения в студенческой среде в целях подготовки, проведения и оценки результативности просветительских мероприятий по профилактике вакцинирования от COVID-19.
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Senarathne, S. M. A. C. U., S. M. V. G. A. P. Samarakoon, and D. C. K. Illeperuma. "Rambutan (<em>Nephelium lappaceum</em> L.) Fruit Peel: Possibility of Extraction and Incorporation of the Microencapsulated Crude Extract in Product Development." Tropical Agriculturist 171, no. 2 (2023): 51–62. https://doi.org/10.4038/ta.v171i2.29.
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‘Malwane’ rambutan cultivar is popular due to its attractive reddish color peel and easily separable thick flesh. High consumption of rambutan has led to accumulation of a considerable amount of the peel, which contains anthocyanin and other bioactive compounds. Thus, the objective of the present study was to explore the possibility of extracting and using microencapsulated extract obtained from rambutan peel in product development. The frozen peels were extracted with water at 50 °C, microencapsulated using maltodextrin, and spray-dried to a powder (MESP). Physicochemical parameters of water extract of frozen peels (WEFP) and MESP were studied. Pasta and Jelly were carefully made using the MESP and assess the effectiveness of incorporating MESP. The Total Polyphenolic Content of the WEFP was 24.52 ± 0.47 mg mL-1, amounting to 12.3% (g g-1) of the frozen peel. Anthocyanin Content of 24.76 ± 0.04 μg g-1, TPC of 373 ± 7 mg g-1, Antioxidant Activity of 81%, Moisture Content of 7.8 ± 0.0%, and water activity of 0.41 ± 0.004 were observed for the MESP. The incorporation of the MESP in pasta imparted a reddish color, not changed during boiling of the finished product. This indicates the ability of MESP to impart color in starch-based products processed at high temperatures and re-constituted in boiling water. However, coagulation and darkening of color were evident with jelly. The results of this study revealed the potential of utilizing discarded rambutan peels.
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Hosokawa, Isamu, Ryota Higuchi, Yuki Homma, et al. "A multicenter study on adjuvant chemotherapy of S-1 versus observation for resected perihilar cholangiocarcinoma." Journal of Clinical Oncology 41, no. 16_suppl (2023): e16201-e16201. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.e16201.
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e16201 Background: The prognosis of perihilar cholangiocarcinoma (PHC) is poor even after curative resection. The efficacy of adjuvant S-1 chemotherapy for resected PHC is unclear. This study aimed to assess the efficacy of adjuvant S-1 chemotherapy after major hepatectomy for PHC. Methods: Consecutive patients with PHC who underwent major hepatectomy (hemihepatectomy or trisectionectomy extending to segment 1 with extrahepatic bile duct resection) at three high-volume centers in Japan from 2007 to 2020 were retrospectively evaluated. Patients with Clavien-Dindo grade V complications, pStage I or IVB disease, and those who underwent adjuvant radiation therapy were excluded from analysis. Propensity score matching analysis was performed to compare the disease-specific survival (DSS) of patients who underwent adjuvant S-1 chemotherapy with those who underwent observation. Results: Of 480 patients, 373 were eligible for the study, 81 of whom underwent adjuvant S-1 chemotherapy, and 146 underwent observation. In the global cohort, DSS in the S-1 and observation groups were similar ( P = 0.18). In the matched cohort as well (S-1: n=44, Observation: n=44), DSS was similar between the S-1 and observation groups ( P = 0.09). On multivariate analysis, performance of percutaneous biliary drainage, CA19-9 levels at operation ≥ 300 U/ml, and lymph node (LN) metastasis were independent predictors of poor survival following major hepatectomy for PHC. In subgroup analysis of patients with LN metastasis, DSS in the S-1 group was better than in the observation group ( P = 0.001). Conclusions: Adjuvant S-1 chemotherapy after major hepatectomy might be effective in PHC patients with LN metastasis.
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SHSM, Hadi, Usama A. Fahmy, Nabil A. Alhakamy, Mohd G. Khairul-Asri, and Omar Fahmy. "Neoadjuvant Therapy Using Checkpoint Inhibitors before Radical Cystectomy for Muscle Invasive Bladder Cancer: A Systematic Review." Journal of Personalized Medicine 11, no. 11 (2021): 1195. http://dx.doi.org/10.3390/jpm11111195.
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Background: Neoadjuvant chemotherapy is the standard of care before radical cystectomy for muscle invasive bladder cancer. Recently, checkpoint inhibitors have been investigated as a neoadjuvant treatment after the reported efficacy of checkpoint inhibitors in metastatic urothelial carcinoma. Objectives: The aim of this systematic review is to investigate the role of checkpoint inhibitors as a neoadjuvant treatment for muscle invasive bladder cancer before radical cystectomy. Methods: Based on the PRISMA statement, a systematic review of the literature was conducted through online databases and the American Society of Clinical Oncology (ASCO) Meeting Library. Suitable publications were subjected to full-text assessment. The primary outcome of this review was to identify the impact of neoadjuvant immunotherapy on the oncological outcomes and survival benefits. Results: From the retrieved 254 results, 8 studies including 404 patients were included. Complete response varied between 30% and 50%. Downstaging varied between 50% and 74%. ≥Grade 3 AEs were recorded in 8.6% of patients who received monotherapy with either Atezolizumab or Pembrolizumab. In patients who received combination treatment, the incidence of ≥Grade 3 AEs was 16.3% for chemoimmunotherapy and 36.5% for combined immunotherapy. A total of 373 patients (92%) underwent radical cystectomy. ≥Grade 3 Clavien-Dindo surgical complications were reported in 21.7% of the patients. One-year overall survival (OS) and relapse-free survival (RFS) varied between 81% and 92%, and 70% and 88%, respectively. Conclusion: The evidence on the use of immune checkpoint inhibitors in the setting of pre-radical cystectomy is quite limited, with noted variability within published trials. Combination with chemotherapy or another checkpoint inhibitor may boost response, although prospective studies with extended follow-up are needed to report on the survival advantages.
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Twist, Craig, Jamie Highton, Matthew Daniels, Nathan Mill, and Graeme Close. "Player Responses to Match and Training Demands During an Intensified Fixture Schedule in Professional Rugby League: A Case Study." International Journal of Sports Physiology and Performance 12, no. 8 (2017): 1093–99. http://dx.doi.org/10.1123/ijspp.2016-0390.
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Player loads and fatigue responses are reported in 15 professional rugby league players (24.3 ± 3.8 y) during a period of intensified fixtures. Repeated measures of internal and external loads, perceived well-being, and jump flight time were recorded across 22 d, comprising 9 training sessions and matches on days 5, 12, 15, and 21 (player exposure: 3.6 ± 0.6 matches). Mean training loads (session rating of perceived exertion × duration) between matches were 1177, 1083, 103, and 650 AU. Relative distance in match 1 (82 m/min) and match 4 (79 m/min) was very likely lower in match 2 (76 m/min) and likely higher in match 3 (86 m/min). High-intensity running (≥5.5 m/s) was likely to very likely lower than match 1 (5 m/min) in matches 2–4 (2, 4, and 3 m/min, respectively). Low-intensity activity was likely to very likely lower than match 1 (78 m/min) in match 2 (74 m/min) and match 4 (73 m/min) but likely higher in match 3 (81 m/min). Accumulated accelerometer loads for matches 1–4 were 384, 473, 373, and 391 AU, respectively. Perceived well-being returned to baseline values (~21 AU) before all matches but was very likely to most likely lower the day after each match (~17 AU). Prematch jump flight times were likely to most likely lower across the period, with mean values of 0.66, 0.65, 0.62, and 0.64 s before matches 1–4, respectively. Across a 22-d cycle with fixture congestion, professional rugby league players experience cumulative neuromuscular fatigue and impaired match running performance.
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Mileshkin, Linda, Richard Stark, Bruce Day, John F. Seymour, Jerome B. Zeldis, and H. Miles Prince. "Development of Neuropathy in Patients With Myeloma Treated With Thalidomide: Patterns of Occurrence and the Role of Electrophysiologic Monitoring." Journal of Clinical Oncology 24, no. 27 (2006): 4507–14. http://dx.doi.org/10.1200/jco.2006.05.6689.
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Purpose Peripheral neuropathy frequently limits the duration of treatment with thalidomide for patients with multiple myeloma. We assessed the time course of occurrence, possible predictive factors, and the utility of serial nerve electrophysiological studies (NES) for detecting onset of neuropathy. Patients and Methods Seventy-five patients with relapsed/refractory myeloma were enrolled onto a multicenter trial of dose-escalating thalidomide with or without interferon. Patients underwent clinical assessment plus NES at baseline and every 3 months. Time to development of neuropathy according to clinical or NES criteria was compared. Patient and treatment-related factors were compared as predictors of neuropathy. Results Thirty-nine percent had some NES abnormalities at baseline. Patients received thalidomide at a median dose-intensity of 373 mg/d. Thirty-one of 75 patients (41%) developed neuropathy during thalidomide treatment; 11 patients (15%) discontinued treatment with thalidomide due to neuropathy. The actuarial incidence of neuropathy increased from 38% at 6 months to 73% at 12 months, with 81% of responding patients developing this complication. Serial NES did not reliably predict the imminent development of clinical neuropathy requiring thalidomide cessation, nor were patient age, sex, or prior therapy predictive. Patients who developed neuropathy had a longer duration of thalidomide exposure (median, 268 v 89 days; P = .0001). Cumulative dose or dose-intensity received was not predictive. Conclusion The majority of patients will develop peripheral neuropathy given sufficient length of treatment with thalidomide. To minimize the risk of neurotoxicity, therapy should be limited to less than 6 months. Electrophysiologic monitoring provides no clear benefit versus careful clinical evaluation for the development of clinically significant neuropathy.
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Patel, Chinmay, Husam Ghanim, Shreyas Ravishankar та ін. "Prolonged Reactive Oxygen Species Generation and Nuclear Factor-κB Activation after a High-Fat, High-Carbohydrate Meal in the Obese". Journal of Clinical Endocrinology & Metabolism 92, № 11 (2007): 4476–79. http://dx.doi.org/10.1210/jc.2007-0778.
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Abstract Background: Because obesity is associated with chronic oxidative and inflammatory stress, and high-fat, high-carbohydrate meals induce significant oxidative and inflammatory stress in normal subjects, we have now hypothesized that the intake of a high-fat, high-carbohydrate meal would result in a greater and more prolonged oxidative and inflammatory stress in the obese than in normal subjects. Methods: Ten normal-weight and eight obese subjects were given a high-fat, high-carbohydrate meal after an overnight fast. Blood samples were collected at baseline and hourly following the meal for 3 h. Results: Reactive oxygen species generation by mononuclear cells increased significantly by 2 h in both groups but continued to increase significantly at 3 h in the obese subjects, whereas in normal subjects it returned to baseline. Levels of p47phox increased significantly (by 81 ± 26%) at 3 h in obese individuals (P &lt; 0.05), whereas there was no significant change in p47phox in normal subjects. Nuclear factor-κB DNA binding in mononuclear cells increased significantly (by 48 ± 58%, P &lt; 0.036) at 2 h but not at 3 h in normal subjects, whereas in the obese, nuclear factor-κB increased significantly at both 2 and 3 h (by 36 ± 57 and 42 ± 63%, respectively, P &lt; 0.004). Matrix metalloproteinase-9 concentrations were significantly higher in the obese at baseline (580 ± 103.9 vs. 373 ± 30.03 ng/ml, P &lt; 0.05) and increased to significantly greater concentrations after the meal than in the lean subjects. Conclusions: High-fat, high-carbohydrate meals induced a significantly more prolonged and greater oxidative and inflammatory stress in the obese. This may contribute to the increased atherogenic risk in obesity.
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Jhaveri, Komal, Hope S. Rugo, Javier Cortes, et al. "Abstract P2-03-19: Capivasertib-fulvestrant for patients w/ HR-pos/HER2-negative advanced breast cancer who had relapsed or progressed during or after aromatase inhibitor treatment: exploratory analysis of PTEN deficiency by IHC from phase III CAPItello-291 trial." Clinical Cancer Research 31, no. 12_Supplement (2025): P2–03–19—P2–03–19. https://doi.org/10.1158/1557-3265.sabcs24-p2-03-19.
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Abstract Background: In the phase III CAPItello-291 trial in patients with HR-positive/HER2-negative advanced breast cancer (ABC) who had relapsed or progressed during or after aromatase inhibitor (AI) treatment, the addition of capivasertib (a potent, selective pan-AKT inhibitor) to fulvestrant significantly improved progression-free survival (PFS) compared with placebo-fulvestrant in the overall population (hazard ratio: 0.60; 95% confidence interval [CI]: 0.51–0.71; p&lt;0.001) and in patients with PIK3CA/AKT1/PTEN-altered tumors detected by next-generation sequencing (NGS; hazard ratio: 0.50; 95% CI: 0.38–0.65; p&lt;0.001). Previous exploratory analysis also showed consistent PFS benefit across each alteration detected, including in patients with PTEN-altered tumors (n=50; hazard ratio: 0.45; 95% CI: 0.24–0.84). Here, we report a prespecified exploratory analysis of alteration prevalence and PFS in patients with deficient PTEN expression as detected by immunohistochemistry (IHC). Methods: In CAPItello-291, eligible pre-/peri- or postmenopausal women or men with HR-positive/HER2-negative ABC that had recurred or progressed on or after AI treatment with or without a cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) were randomized 1:1 to receive fulvestrant (500 mg intramuscularly on days 1 and 15 of cycle 1, and day 1 of each subsequent 28-day cycle) with either placebo or capivasertib (400 mg twice daily; 4 days on, 3 days off). PIK3CA/AKT1/PTEN alteration status was determined post-randomization using NGS in tumor tissue collected prior to study enrollment. Available samples were processed centrally to determine deficient PTEN protein expression by IHC using the VENTANA® PTEN SP218 antibody and a prespecified cutoff for this study of &lt;10% staining of tumor cells. Hazard ratios for PFS were calculated using Cox proportional hazards models stratified by prior use of CDK4/6i. Data cutoff: August 15, 2022. Results: In total, PTEN results by IHC were obtained from 373/708 (53%) patient tumor samples. Baseline characteristics were broadly balanced between those with and without PTEN testing results. 71/373 (19%) patient tumor samples were identified as PTEN deficient by IHC; of these, 55% (n=39) had PIK3CA/AKT1/PTEN-altered tumors by NGS (26% PIK3CA [PIK3CA only n=15; PIK3CA and PTEN n=4]; 1% AKT1 [AKT only n=1]; 32% PTEN [PTEN only n=19; PIK3CA and PTEN n=4]), 30% (n=21) had PIK3CA/AKT1/PTEN-non-altered tumors by NGS, and 15% (n=11) had unknown NGS results. For tumors PTEN proficient by IHC 302/373 (81%), 164 (55%) were non-altered and 128 (42%) were altered by NGS (107/302, 35% PIK3CA, 6% AKT1, 3% PTEN) and 10 (3%) had unknown NGS result. Within samples with both NGS and IHC data, all samples with homozygous deletions or large rearrangements of PTEN by NGS were PTEN deficient by IHC. In patients with PTEN-deficient tumors by IHC, 34/71 (48%) received capivasertib-fulvestrant and 37/71 (52%) received placebo-fulvestrant. In this group, PFS benefit was observed with capivasertib-fulvestrant versus placebo-fulvestrant: median PFS: 9.3 months versus 3.7 months; hazard ratio: 0.52 (95% CI: 0.28–0.93). Conclusions: In this CAPItello-291 exploratory analysis, 19% of patient tumor samples that were available for central IHC testing were PTEN deficient by IHC. Within this subgroup of PTEN-deficient tumors, over half also had PIK3CA/AKT1/PTEN alterations detected by NGS. In the PTEN-deficient by IHC cohort, PFS benefit was noted with capivasertib-fulvestrant versus placebo-fulvestrant, although results are exploratory. Citation Format: Komal Jhaveri, Hope S. Rugo, Javier Cortes, Mafalda Oliveira, Sacha J. Howell, Florence Dalenc, Henry L. Gomez, Xichun Hu, Petr Krivorotko, Sibylle Loibl, Meena Okera, Yeon Hee Park, Joo-Hyuk Sohn, Masakazu Toi, Eriko Tokunaga, Lyudmila Zhukova, Agostina Nardone, Elza C. de Bruin, Ian Wadsworth, Celina D'Cruz, Nicholas C. Turner. Capivasertib-fulvestrant for patients w/ HR-pos/HER2-negative advanced breast cancer who had relapsed or progressed during or after aromatase inhibitor treatment: exploratory analysis of PTEN deficiency by IHC from phase III CAPItello-291 trial [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-03-19.
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Taqwadin, Abda Syakura, Renni Anggraini, and Luthfi Chaliqi Taufiq. "Evaluasi Geometrik Tikungan di Jalan Medan – Banda Aceh pada STA 81+000 - STA 82+000 dengan Menggunakan Pedoman Desain Geometrik Jalan Tahun 2021." Journal of The Civil Engineering Student 5, no. 3 (2023): 246–52. http://dx.doi.org/10.24815/journalces.v5i3.26857.
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Berdasarkan data kecelakaan lalu lintas di Kabupaten Pidie sepanjang tahun 2022, terdapat 230 kasus kecelakaan lalu lintas. Pada kasus-kasus tersebut terdapat beberapa korban dengan rincian 67 korban meninggal dunia, 2 korban luka berat, dan 550 korban luka ringan. Kecelakaan lalu lintas di Kabupaten Pidie sepanjang tahun 2022 mengalami peningkatan dibandingkan dengan tahun 2021, dimana sepanjang tahun 2021 tercatat sebanyak 212 kasus dengan rincian korban sebanyak 60 korban meninggal dunia, 17 korban luka berat, dan 373 korban luka ringan. Salah satu faktor penyebab terjadinya kecelakaan lalu lintas adalah faktor geometrik jalan, terutama pada tikungan. Penelitian ini bertujuan untuk mengevaluasi kondisi eksisting lengkung horizontal pada dua lengkung yang berdekatan, serta melakukan perencanaan ulang (redesain). Lokasi penelitian yaitu pada Sta 81+000 - Sta 82+000 di jalan nasional Medan-Banda Aceh, Provinsi Aceh. Pengambilan data di lapangan dilakukan dengan menggunakan alat total station untuk mendapatkan koordinat titik-titik pada jalan eksisting terhadap koordinat lokalnya. Perancangan tikungan merujuk pada Pedoman Nomor 13/P/BM/2021 atau disebut juga Pedoman Desain Geometrik Jalan (PDGJ) tahun 2021. Data diolah dan dianalisis menggunakan aplikasi AutoCad Civil 3D untuk mendapatkan kondisi eksisting tikungan dan kondisi redesain tikungan. Hasil dari penelitian ini diperoleh bahwa lengkung horizontal eksisting untuk kedua tikungan melebihi ketentuan minimum (28 meter) dengan menggunakan kecepatan rencana 30 km/jam. Namun, kedua tikungan tersebut tidak dapat menyediakan besaran lengkung peralihan eksisting yang sesuai terhadap lengkung horizontal eksisting masing-masing tikungannya. Superelevasi jalan eksisting juga tidak sesuai dengan PDGJ 2021 karena terdapat beberapa bagian jalan yang memiliki superelevasi melebihi superelevasi maksimum. Kelandaian memanjang jalan sudah sesuai dengan PDGJ 2021 yaitu sebesar 6,4 %, namun panjang kelandaian kritisnya melebihi batasan maksimal yang diatur. Pada perencanaan ulang, tikungan 1 dan 2 eksisiting digabungkan sehingga menciptakan tikungan tunggal. Dari hasil perencanaan ulang yang dilakukan diperoleh lengkung horizontal pada tikungan 1 adalah 60 meter dan pada tikungan 2 adalah 30 meter, lengkung peralihan pada tikungan 1 adalah 30 meter dan pada tikungan 2 adalah 38 meter, superelevasi desain pada tikungan 1 adalah 6,3 % dan pada tikungan 2 adalah 8 %, dan untuk kelandaian memanjang jalan adalah 6 % dengan panjang kelandaian kritis sebesar 360 meter dan panjang jalan adalah 353,01 meter. Diharapkan dengan dilakukan redesain pada kedua tikungan tersebut dapat mengurangi potensi terjadinya kecelakaan.
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Tanaka, Miho J., Lynne C. Jones, and Jared M. Forman. "Awareness of Anterior Cruciate Ligament Injury-Preventive Training Programs Among Female Collegiate Athletes." Journal of Athletic Training 55, no. 4 (2020): 359–64. http://dx.doi.org/10.4085/1062-6050-150-19.
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Context Neuromuscular training programs can reduce the rate of noncontact anterior cruciate ligament (ACL) injuries, particularly in female athletes. Objective To assess the awareness of, experience with, and factors associated with participation in preventive training programs (PTPs) among female collegiate athletes and their knowledge of ACL injuries. Design Cross-sectional study. Setting National Collegiate Athletic Association (NCAA) sports programs. Patients or Other Participants A total of 440 female NCAA athletes (age = 20 ± 1 years) representing 20 sports during the 2017–2018 academic year. Main Outcome Measure(s) We used a 12-item survey to collect data on each participant's age, sport, position, college, NCAA division, and awareness of and experience with PTPs. We performed descriptive statistics and used odds ratios (ORs) to assess relationships between demographic data and awareness of or interest in PTPs. Results Of the 440 respondents, 85% (n = 373) knew that female athletes were at higher risk for sustaining ACL injuries than male athletes, and 89% (n = 391) knew that ACL injuries were preventable. Thirty-three percent (n = 143) were familiar with the concept of ACL PTPs. Only 15% (n = 64) had ever performed PTPs, but 89% (n = 391) reported they would perform a daily PTP if it could prevent ACL injuries. Fifty-two of the 64 respondents (81%) who had performed PTPs said athletic trainers or coaches oversaw the PTPs. Participants were more likely to be familiar with ACL PTPs if they (OR = 3.5; 95% confidence interval [CI] = 2.0, 5.8) or a teammate (OR = 4.6; 95% CI = 2.1, 9.8) had sustained an ACL injury. Respondents were more willing to perform PTPs if they (OR = 2.3; 95% CI = 0.80, 6.6) or a teammate (OR = 3.4; 95% CI = 1.8, 6.6) had sustained an ACL injury. Conclusions Although 89% of respondents expressed interest in performing daily ACL PTPs, only 15% had performed such programs, and only 33% were familiar with the concept of ACL PTPs.
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Abumayyaleh, Mohammad, Clara Schlettert, Daniel Materzok, et al. "Age Variation in Patients with Troponin Level Elevation Without Obstructive Culprit Lesion or Suspected Myocardial Infarction with Non-Obstructive Coronary Arteries—Long-Term Data Covering over Decade." Journal of Clinical Medicine 13, no. 24 (2024): 7685. https://doi.org/10.3390/jcm13247685.
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Background/Objectives: Troponin level elevation without an obstructive culprit lesion is caused by heterogenous entities. The effect of aging on this condition has been poorly investigated. Methods: After screening 24,775 patients between 2010 and 2021, this study included a total of 373 patients with elevated troponin levels without an obstructive culprit lesion or suspected myocardial infarction with non-obstructive coronary arteries (MINOCAs) categorized into four age groups containing 78 patients (<51 years), 72 patients (51–60 years), 81 patients (61–70 years), and 142 patients (>70 years). This study analyzed the baseline characteristics, the in-hospital complications, in-hospital mortality, and the long-term outcomes. Results: The older patients exhibited a higher rate of major adverse cardiovascular in-hospital events than those of the other age groups (15.4% in the <51-year-old group vs. 36.1% in the 51–60-year-old group vs. 33.3% in the 61–70-year-old group vs. 47.2% in the >70-year-old group; p < 0.001). However, the rate of non-sustained ventricular tachycardia (nsVT) was higher in the 51–60-year-old patients than those of the other age groups (5.6% in the 51–60-year-old group vs. 1.3% in the 61–70-year-old group vs. 0.7% in the >70-year-old group; p = 0.027). At the 11-year follow-up, cardiovascular mortality was higher among the older patients compared to that of the younger patients (3.9% in the 61–70-year-old group vs. 4.2% in the >70-year-old group, p = 0.042), while non-cardiovascular mortality was comparable between the age groups. Conclusions: The older patients with troponin level elevation without an obstructive culprit lesion experienced a higher incidence of major adverse cardiovascular events during hospitalization compared to that of the younger groups. Additionally, higher cardiovascular mortality rates were revealed in the older patients at a long-term follow-up.
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Boga, Márton, Gábor Orbán, Péter Perge, et al. "Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation." Journal of Clinical Medicine 13, no. 7 (2024): 1960. http://dx.doi.org/10.3390/jcm13071960.
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Background: Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is predominantly attributed to pulmonary vein reconnection (PVR). Predictors of AF recurrence have been widely studied; however, data are scarce on procedural parameters that predict chronic PVR. We aimed to study PVR rates and predictors of PVR. Methods: We retrospectively included 100 patients who underwent repeated ablation due to AF recurrence after initial PVI with the CARTO system. PVR was determined during the repeated procedure by electrophysiological evaluation, and initial procedural characteristics predicting PVR were studied, including adherence to the CLOSE protocol, use of high power, first-pass isolation (FPI), and baseline generator impedance (BGI). Results: Thirty-eight patients underwent initial CLOSE-guided PVI, and sixty-two underwent initial non-CLOSE PVI. A repeat procedure was performed 23 ± 16 months after the initial procedure. In total, PVR was found in 192 of 373 PVs (51.5%), and all PVs were isolated in 17/100 (17%) patients. Factors associated with all PVs being isolated were adherence to the CLOSE protocol, a higher power setting, the presence of bilateral FPI, and lower BGI (88% vs. 28%, p < 0.0001; 37.5 W vs. 30 W, p = 0.0276; 88.2% vs. 40.4%, p = 0.0007; and 127.6 Ω vs. 136.6 Ω, p = 0.0027, respectively). In initial procedures with adherence to the CLOSE protocol, the FPI rate was significantly higher (73.7% vs. 25%, p < 0.0001), while there were no significant differences in terms of procedure time and left atrial dwell time (81 vs. 85 min, p = 0.83; and 60 vs. 58 min, p = 0.08, respectively). BGI ≥ 130 Ω (AUC = 0.7403, sensitivity: 77.1%, specificity: 68.8%, p = 0.0032) was associated with a significantly higher probability of PVR (OR = 6.757; p < 0.0001). In multivariable analysis, independent predictors for PVR were non-adherence to the CLOSE protocol and BGI ≥ 130 Ω. Conclusions: Our findings indicate that adherence to the CLOSE protocol and baseline generator impedance < 130 Ω during AF ablation are independent predictors of PVI durability.
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Effendy, John D. Kildea, and Allan H. White. "Lewis-Base Adducts of Group 11 Metal(I) Compounds. LXVIII Synthesis and Structural Systematics of Some 1 : 3 Adducts of Silver(I) Compounds with Triphenylstibine, [(Ph3Sb)3AgX], X = Cl, I, SCN, NCS, CN, ONO2." Australian Journal of Chemistry 50, no. 6 (1997): 587. http://dx.doi.org/10.1071/c96035.
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The syntheses and room-temperature single-crystal X-ray structural characterization of 1 : 3 adducts formed between silver(I) (pseudo-) halides, AgX, and triphenylstibine, SbPh3, are described for X = Cl, I, SCN, NCS, CN, NO3 (1)-(6). The chloride, as its methanol solvate (1a), is isomorphous with the arsine analogue: triclinic, P-1, a 13·373(4), b 14·48(6), c 14·702(3) Å, α 83·49(3), β 87·76(2), γ 76·45(3)°; Z = 2, conventional R on F being 0·046 for No 5514 independent ‘observed’ reflections (I > 3σ(I )). A new form (1b) of the chloride has also been authenticated: monoclinic, P 21/c, a 12·832(2), b 54·24(1), c 18·519(8) Å, β 129·68(3)°; Z = 8 (R 0·065 for No 5672). No bromide has been obtained; the iodide (2) is described as monoclinic, P 21/n, a 19·611(4), b 14·473(6), c 17·74(1) Å, β 98·28(3)°; Z = 4 (R 0·036 for No 6769). The thiocyanate crystallizes from acetonitrile or pyridine as an S-bonded form (3) isomorphous with the arsine analogue: monoclinic, P 21/n, a 19·143(7), b 14·288(5), c 18·694(6) Å, β 98·81(2)°; Z = 4 (R 0·037 for No 4482). From 2-methylpyridine, remarkably, a solvate is obtained in which the thiocyanate is N-bonded (4): triclinic, P-1, a 27·261(5), b 14·767(3), c 13·319(1) Å, α 91·53(1), β 101·58(1), γ 92·29(2)°; Z = 4 (R 0·045 for No 6900). The cyanide is also monoclinic, P 21/n, a 19·442(7), b 14·267(3), c 17·741(6) Å, β 97·63(3)°, z = 4; R 0·057 for No 2487. The unsolvated 1 : 3 nitrate complex (6a) is monoclinic, P 21/n, a 19·602(5), b 14·455(1), c 17·727(2) Å, β 97·19(2)°, Z = 4; R was 0·034 for No 6522. The complex is isomorphous with the arsenic and phosphorus analogues, being mononuclear [(Ph3Sb)3Ag(O2NO)]. The ethanol solvate (6b) is triclinic, P-1, a 13·352(5), b 14·548(9), c 14·701(4) Å, α 81·64(4), β 84·45(3), γ 75·32(4)°, Z = 2; R was 0·058 for No 4702. Ag-Sb range between 2·6980(8) and 2·843(3) Å in the precise determinations; Ag-X are 2·481(4) and 2·52(1) Å (the two chlorides), 2·757(1) (I), 2·533(3) (SCN), 2·21(1) (NCS), 2· 09(3) (CN), 2·377(7) Å (unidentate ONO2)
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Shevchenko, A. V., V. F. Prokofyev, V. I. Konenkov, R. S. Khapaev та V. V. Nimaev. "Polymorphism of vascular endothelial growth factor gene (VEGF) and matrix metalloproteinase (ММР) genes in primary limb lymphedema". Medical Immunology (Russia) 22, № 3 (2020): 497–506. http://dx.doi.org/10.15789/1563-0625-pov-1913.
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Among the reasons of primary lymphedema development, a certain role belongs to genetic factors. The specific molecular products participate in remodeling of blood and lymphatic vascular networks. Vascular endothelial growth factors (VEGFs) are key regulators of endothelial functions of the cells, which are responsible for lympho- and vasculogenesis. Moreover, matrix metalloproteinases (ММР) may act as regulators of both lymphangiogenesis, and angiogenesis. Since the regulatory regions of VEGFA gene, as well as of ММР genes are polymorphic, one may suggest, that their different expression level, determined by these polymorphisms, could be associated with development of swellings typical for lymphedema.We have analyzed gene polymorphisms in two regulatory regions of vascular endothelial growth factor-A VEGF-A (rs 699947 and rs 3025039), and matrix metalloproteinase genes MMP2 (rs 2438650), MMP3 (rs 3025058), MMP9 (rs 3918242), and their combinations in the patients with primary lymphedema.A group of patients with primary lymphedema included 72 subjects (55 women and 17 men) at the age of 18 to 81 years. Control group included 526 inhabitants of Novosibirsk (153 men, 373 women) without chronic diseases, comparable for age with lymphedema patients. We have performed typing of regulatory regions in VEGF (rs 699947, rs 3025039), ММР2 (rs 2438650), ММР3 (rs 3025058), ММР9 genes (rs 3918242). Fifteen complex genotypes have been revealed that were positively associated with disease. Analysis of the gene network topology has outlined the main intergenic interactions upon primary lymphedema development. MMP2 -1306 CC, MMP9 -1562CC and VEGF +936CC arrange the basic knots in the gene network (53% of total interactions). A number of significantly different complex genotypes was revealed at patients with primary lymphedema with normal body mass index (BMI < 25) and obesity (BMI < 30). Hence, frequency of complex genotype VEGF +936 CC: MMP3 -1171 5А6А:MMP9 -1562 CC in the patients with obesity is increased more 5.5-fold compared to the patients with normal BMI.The data obtained may presume a certain value of the analyzed gene polymorphisms in pathogenesis of primary lymphedema. Topological analysis of gene networks allows to study the structural and functional organization of gene-gene interactions for development of approaches to individyal preventive maintenance and therapy of the disease.
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Mileshkin, L. R., R. Stark, B. Day, J. F. Seymour, J. B. Zeldis, and H. M. Prince. "Development of neuropathy in patients (pts) with multiple myeloma (MM) treated with thalidomide (thal)—Patterns of occurrence and the role of electrophysiologic monitoring." Journal of Clinical Oncology 24, no. 18_suppl (2006): 7618. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.7618.
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7618 Background: Given new treatment options for pts with MM, physicians are faced with the dilemma of how best to sequence these drugs in order to optimize efficacy and toxicity. Peripheral neuropathy frequently limits the duration of treatment (Rx) with thal. In this study we assessed the utility of serial nerve electrophysiological studies (NES) to detect the onset of neuropathy, and assessed the time course of occurrence and possible clinical and Rx-related predictive factors. Methods: 75 pts with relapsed/refractory MM were enrolled in a multi-centre trial of thal. In addition to clinical assessment, pts underwent sensory and motor NES at baseline and every 3 months in order to identify neuropathy. We examined the value of baseline and serial NES for development of neuropathy, with time to development of neuropathy according to clinical or NES criteria compared using Kaplan-Meier analysis. Differences between pt and Rx-related variables were compared using a Mann-Whitney U-test or a Fisher’s exact test. Results: Thirty nine percent had some NES abnormalities at baseline. Pts were treated with thal at a median dose intensity of 373 mg/day and followed for a median of 18 months (range 6–26). Thirty-one of the 75 pts (41%) developed neuropathy during thal Rx, with 11 (15%) ceasing thal due to neuropathy. The actuarial incidence of any neuropathy increased from 38% at 6 months to 73% at 12 months with 81% of responding pts developing this complication. The use of NES did not reliably predict the imminent development of clinical neuropathy requiring cessation of thal. Nor were pt age, gender or type of prior therapy (ie vincristine) predictive. Development of neuropathy was related to duration of thal exposure with a median time of 268 days thal in those who developed neuropathy compared to 89 days in those who did not (p = 0.0001). Cumulative dose or dose intensity received were not predictive. Conclusions: The majority of pts will develop peripheral neuropathy given sufficient length of thal Rx and to minimize the risk of neurotoxicity, therapy should be limited to less than six months. NES monitoring provides no clear benefit over careful clinical evaluation for the development of clinically significant neuropathy. [Table: see text]
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Jamshed, Arif, Hassan Iqbal, Raza Hussain, et al. "Induction gemcitabine and cisplatin followed by radiation therapy in advanced loco-regional head and neck cancer." Journal of Clinical Oncology 30, no. 15_suppl (2012): e16043-e16043. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e16043.
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e16043 Background: This retrospective study was performed to evaluate the efficacy and toxicity of induction chemotherapy with gemcitabine and cisplatin (GC) followed by radiation / concomitant chemoradiation (RT/CRT) in advanced loco-regional head and neck cancer (LRHANC). Methods: Between 2005 - 2009, 446 newly diagnosed advanced LRHANC patients were treated with induction GC followed by RT/CRT in our institution. M 69%: F 31%. Median age 50 years (range 18 – 81 years). Site; oral cavity 232 (52%), hypopharynx 45 (10%), nasopharynx 63 (14%), larynx 46 (10%), oropharynx 14 (3%), paranasal sinuses 33 (8%) and others 13 (3%). Histology; squamous cell carcinoma 373 (84%), undifferentiated carcinoma 53 (12%), others 20 (4%). Pre treatment AJCC stage (6th edition); T1-3 N0/N+ 139 (31%), T4 N0/N+ 307 (69%). Induction chemotherapy consisted of cisplatin 75 mg / m2 day 1 and gemcitabine 1 gm / m2 day 1 and 8 every 3 weeks. 383 (86%) patients received 2 cycles of induction GC. CRT with 3 weekly cisplatin 75mg/ m2 was given in 299 (67%) and RT alone in 147 (33%) patients. Radiation doses ranged from 55Gy - 70 Gy in 20 - 35 fractions. Results: Minimum follow-up was 2 years. Response to induction chemotherapy; complete response (CR) 58 (13%), partial response (PR) 315 (71%), stable disease (SD) 55 (12%) and progressive disease (PD) 18 (4%). Response to RT/CRT; CR 293 (66%) and persistent disease at 3 months post radiation in 153 (34%) patients. G3/G4 toxicity on induction GC was anemia 2%/0%, neutropenia 17%/4%, thrombocytopenia 2%/1%, vomiting 5%/1% and diarrhea 5%/1%. G1 transient elevation of ALT/ AST was 17% /11%. G3/4 elevation of creatinine was 2 %/1%. Nine patients (2%) had toxicity related hospital admissions during RT/CRT. The 5-year actuarial overall survival and relapse free survival were 67% and 44% respectively. Local control, regional control and distant control rates were 62%, 50% and 49% respectively. Conclusions: Induction GC followed by RT/CRT is a safe and effective approach in untreated head and neck cancer and merits further evaluation in controlled clinical trials.
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Varmavuo, Ville, Johanna Rimpiläinen, Anne Nihtinen, et al. "Comparison of Post-Transplant Outcomes in Non-Hodgkin Lymphoma (NHL) Patients Mobilized with or without Plerixafor Added to Chemomobilization." Blood 120, no. 21 (2012): 4520. http://dx.doi.org/10.1182/blood.v120.21.4520.4520.
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Abstract Abstract 4520 Background: Plerixafor, a CXCR4 antagonist, is used in a combination with G-CSF with or without chemotherapy to enhance mobilization of hematopoietic stem cells (CD34+) from the bone marrow to circulation. Prior studies have shown that plerixafor may mobilize more primitive stem cells and also have impact on other cell populations too. These changes may have impact in engraftment, immunological reconstitution and post-transplant outcome. However, only limited data are available in regard to effects of plerixafor in post-transplant outcomes. Patients and methods: Eighty-nine patients with non-Hodgkin lymphoma (NHL) were included in this study. The patients received disease-specific chemomobilization (most commonly cytarabine based) with G-CSF. In addition, 33 patients (37 %) received plerixafor because of insufficient mobilization, poor collection yields or late mobilization (plerixafor group). Fifty-six patients served as controls (control group). The median age was 58 years in the plerixafor group and 57 years in the control group (p=0.515). The most common histology was diffuse large B-cell lymphoma in both groups. The proportion of patients beyond CR1 or PR1 was significantly higher (55 % vs. 32%, p=0.046) in the plerixafor group. All patients were treated with a single dose (6 mg) of pegfilgrastim after stem cell infusion. Patients were followed after high-dose chemotherapy in regard to haematopoietic engraftment and outcome. Results: The median amount of collected CD34+ cells was 3.5 × 106 CD34+ cells/kg (range 1.3 – 8.9 × 106 CD34+ cells/kg) in the plerixafor group and 4.2 × 106 CD34+ cells/kg (range 1.9 – 18.6 × 106 CD34+ cells/kg) in the control group (p=0.076). The median number of aphaeresis was two (range 1–5) in both groups (p=0.17). The median neutrophil engraftment was 10 days in both groups (range 8–81 days in the plerixafor group and 8–21 days in the control group). The median time to platelet engraftment was 14 days in both groups (range 10–165 days in the plerixafor group and 10–91 days in the control group). The incidence of neutropenic fever was comparable between the groups (71% vs. 76%, p=0.906). The median follow-up time from ASCT was 373 days (range 5–929 days) in the plerixafor group and 518 days (range 81–1175 days) in the control group (p=0.052). No difference in counts of haemoglobin, leucocytes, lymphocytes or platelets were observed at +1, +3, +6, +12 months except for haemoglobin which was significantly higher in the plerixafor group at +3 months. Progression-free survival (PFS) was 72 % in the plerixafor group and 75 % in the control group (p=0.69). Overall survival (OS) was also comparable between the groups (82 % vs. 84 %, p=0.67). Conclusions: The recovery from ASCT and outcome after ASCT seems to be comparable in lymphoma patients whether plerixafor is used or not. Prospective studies including more detailed characterisation of graft cellular content in regard to CD34+ cell subtypes, T-cell repertoire and NK-cells are needed to assess the impact of mobilization method post-transplant outcome. Disclosures: Jantunen: Genzyme: Has participated in EU Leadership meeting organized by Genzyme as well as Medical Advisory Board meeting organized by Genzyme Other, Honoraria.
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Charissoux, Marie, Pascal Fenoglietto, Norbert Ailleres, et al. "Final results of the Montpellier prostate cancer intensity modulated radiotherapy pilot study." Journal of Clinical Oncology 32, no. 4_suppl (2014): 105. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.105.
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105 Background: Thirteen hundred prostate cancer patients have been treated with Intensity modulated radiotherapy (IMRT) since 2001. We present the final results of the pilot study concerning the first 373 patients with a median follow-up of 72.7 months (range 0 to 130). Methods: All patients received the entire treatment course to a prescribed total dose of 80 Gy. No pelvic irradiation was applied. Androgen ablation therapy was delivered for 6 months and 2 to 3 years in intermediate and high-risk patients, respectively (n=142, 38%). Prostate-specific antigen (PSA) failure was defined as nadir + 2. Toxicity was assessed according to the National Cancer Institute (NCI)/Common Terminology Criteria for Adverse Events (CTCAE) v3.0. Multivariate analysis using the Cox model was performed to assess factors that may impact on PSA relapse. Logistic regression was used to correlate clinical and physical parameters with grade 2 or higher gastro-intestinal and genitourinary toxicities. Results: Median age was 69 (range 40 to 81). One hundred thirty nine (37.3%), 167 (44.8%), and 67 (18%) patients were classified as low (group 1), intermediate (group 2), and high-risk (group 3) patients, respectively. The 5 year biochemical relapse-free survival (5y-biochemical recurrence-free survival [bRFS]) was 85.7% (95% CI, 0.81-0.89). For the three prognostic groups, 5y-bRFS was 91% (95% CI, 0.85-0.95), 82% (95% CI, 0.75-0.87), and 80% (95% CI, 0.67-0.88) for groups 1, 2, and 3, respectively. Multivariate analysis showed that the absence of hormonotherapy in the group 2 and the number of positive biopsies impact on PSA relapse (p=0.04, HR 1.8 and p=0.01, HR 2.13, respectively). The incidence of late grade 2 or higher rectal and urinary toxicities were 10.5% and 12.7%, respectively. The dose received by 50% (D50) of the rectum was the only factor significantly correlated with late grade 2 or higher rectal toxicities (p = 0.04). Similarly, the dose received by 50% (D50) of the bladder was the only factor significantly correlated with late grade 2 or higher bladder side-effects (p = 0.02). Conclusions: IMRT to 80 Gy can provide good to excellent carcinologic results and low late toxicity rates in all prostate cancer subgroups. Hormonotherapy combined to high dose IMRT seems to be a serious option to consider in intermediate-risk patients. Clinical trial information: ICM 2001-13.
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Prasannarani, Tanneru. "Effect of Lead on Growth and Total Proteins Produced In the Culture Filtrate of Different Fungi." Biolife 4, no. 2 (2022): 300–302. https://doi.org/10.5281/zenodo.7317807.
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<strong>ABSTRACT</strong> Five test fungi <em>Aspergillus flavus, Aspergillus niger, Cladosporium herbarum, Curvularia lunata</em> and <em>Trichoderma viridae</em> were subjected to growth in lead containing basal medium and level of tolerance was determined at 10, 20, 30, 40 and 50ppm Pb concentrations. The growth parameters adopted to study toxicity and physiological responses is the dry weight of fungi and total protein content in their culture filtrate. It was observed that Pb is highly toxic to the fungi it causes inhibition of growth. Maximum reduction in growth was observed in <em>Cladosporium herbarum</em> and <em>Curvularia lunata</em> whereas <em>Trichoderma viridae</em> and <em>Aspergillus niger</em> was found to be resistant as compared to other fungi. Sporulation was decreased in presence of lead. The total protein content at different concentrations was studied. Maximum decrease in protein content of culture filtrate of all test fungi was observed at 40ppm concentration of Pb. <strong>Key words</strong>: Lead, Total Proteins, Fungi, Aspergillus, Pb. <strong>REFERENCES</strong> [1]. Foy, C.D., Chaney, R. L. and White, M.C.: (1978). <em>Annu. Rev. Plant Physiol</em>. 29, 511-566. [2]. Mehera, A. and Farago, M. E.: (1994), <em>Plants and Chemical Elements: Biochemistry, Uptake Tolerance and Toxicity</em>, Farago, M. E. (ed.), VCH Publishers, New York, pp. 31. [3]. Vangronsveld, J. and Clijsters, H. (1994). <em>Plants and chemical Elements: Biochemistry, Uptake, Tolerance and Toxicity , </em>Farago, N. E. (ed), VCH Publishers, New York, pp. 149. [4]. Prasad, M. N. V.: (1997). <em>Plant Ecophysiology</em>, Prasad, N.N.V (ed), John Wiley and sons, Inc., New York, pp. 207 [5]. Lowry, O. H., Rosebrough, N.J., Farr, A. L. and Randall, R. J. (1951). Protein estimation with the Folin Phenol Reagent. [6]. De, A. K.: (1994), <em>Environmental Chemistry</em>, Eiley Eastern Ltd., New Delhi, pp. 81. [7]. Paknikar, K. M., Palnitkar, U. S. and Puranik, P. R. (1993). Biosorption of metals from solution by mycelial waste of <em>Penicillium chrysogenum</em>. Pp. 229-235 In: <em>Biohydrometallurgical Technologies</em>, Vol II. (Ed by A.E. Torma, M. L, Apel and C.L. Brierley. TMS Publ. [8]. Bazzaz, F. A., Rolfr, G.L. and Carlson, R. W.: (1974) <em>Plant Physiol</em>. 32, 373-376.
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Méndez de los Santos, Noemi, and Gaspar López Ocaña. "Zeolitas nativas en el tratamiento de agua residual doméstica." CIBA Revista Iberoamericana de las Ciencias Biológicas y Agropecuarias 10, no. 19 (2021): 1–38. http://dx.doi.org/10.23913/ciba.v10i19.106.
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En esta investigación zeolitas de río y de cerro fueron evaluadas para ver su potencial en el tratamiento de aguas residuales. En primer lugar, se diseñó y construyó un sistema experimental de tres biorreactores de lecho fijo de flujo ascendente (BLFFA) con una altura de 1.5 metros y diámetro de cuatro pulgadas, seguidamente se evaluó el potencial de las zeolitas nativas y una testigo comercial en el tratamiento de aguas residuales. Se arrancaron los BLFFA con un diseño factorial 3 x 3, operando con zeolita de río, zeolita de cerro y zeolita comercial (control), todas con partículas de ¼ de pulgada, utilizando tres diferentes alturas de lecho (0.75, 0.90 y 1.10 m) y tres tiempos de retención hidráulica (6, 12 y 24 horas). Se evaluaron las variables de respuesta mediante un análisis de varianza multifactorial y para discriminar entre las medias se empleó el método de diferencia mínima significativa (LSD) de Fisher (p < 0.05, 95 % de confianza). La zeolita de cerró presentó (promedio, N = 10) las mejores características fisicoquímicas con densidad real y aparente de 2700 y 1470 kg/m3 respectivamente, peso específico de 2240 kg/m3, porosidad de 62 %, absorción de 15.20 %, solubilidad en ácido clorhídrico de 29.96 %, pH de 7.4 y conductividad eléctrica de 70 mS/cm. Al agua residual con las que se desarrollaron los tratamientos se le aplicó previo al experimento un tratamiento primario (rejilla, desarenador, desnatador y fosa séptica) y presentó valores (promedio, N = 9) de temperatura de 25.26 °C, pH de 8.63, sólidos disueltos totales con 950.50 mg/L, color de 1305.10 UC, turbiedad 96.37 UNT y demanda química de oxígeno de 373 mg/L. De las zeolitas evaluadas (N = 81) en el BLFFA, la que presentó el mejor tratamiento fue la zeolita de cerro operando con una altura de lecho de 0.9 m y con 24 horas de tiempo de retención hidráulica; obtuvo las mejores eficiencias de remoción con 71.42 % en sólidos disueltos totales, 84.34 % para turbiedad, 96.33 % para color y 97.28 % para la demanda química de oxígeno. La altura óptima en los BLFFA fue 0.9 m, factor importante de evaluar, ya que a mayor altura se aumentan los costos y las eficiencias no son relevantes para justificar la inversión y a menor altura cae el rendimiento en calidad del agua tratada. En conclusión, las zeolitas nativas cuentan con propiedades idóneas para ser utilizadas en el tratamiento de agua residual doméstica y podemos recomendar la implementación de los BLFFA en el tratamiento secundario de efluentes domésticos en sistemas descentralizados del sureste de México como una alternativa viable en el tratamiento de sus aguas residuales domésticas.
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Çaǧlayan, Çaǧlar, Scott Levin, Aaron Michael Milstone, et al. "Predicting Vancomycin-Resistant Enterococci (VRE) and Carbapenem-Resistant Organism (CRO) Colonization in the Intensive Care Unit." Infection Control & Hospital Epidemiology 41, S1 (2020): s45. http://dx.doi.org/10.1017/ice.2020.527.
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Background: Rapidly identifying patients colonized with multidrug-resistant organisms (MDROs) upon ICU admission is critical to control and prevent the spread of these pathogens in healthcare facilities. Electronic health records (EHR) provide a rich source of data to predict the likelihood of MDRO colonization at admission, whereas surveillance methods are resource intensive and results are not immediately available. Our objectives were (1) to predict VRE and CRO colonization at ICU admission and (2) to identify patient subpopulations at higher risk for colonization with these MDROs. Methods: We conducted a retrospective analysis of patients aged ≥16 years admitted to any of 6 medical or surgical intensive care units (ICU) in the Johns Hopkins Hospital from July 1, 2016, through June 30, 2018. Perirectal swabs were collected at ICU unit admission and were tested for VRE and CRO. Patient demographic data, prior hospitalizations, and preadmission clinical data, including prior medication administration, prior diagnoses, and prior procedures, were extracted to develop prediction models. We employed the machine-learning algorithms logistic regression (LR), random forest (RF), and XGBoost (XG). The sum of sensitivity and specificity (ie, Youden’s index) was selected as the performance metric. Results: In total, 5,033 separate ICU visits from 3,385 patients were included, where 555 (11%) and 373 (7%) admissions tested positive for VRE and CRO, respectively. The sensitivity and specificity of our models for VRE were 78% and 80% with LR, 80% and 82% with RF, and 77% and 87% with XG. Predictions for CRO were not as precise, with LR at 73% and 53%, RF at 81% and 48%, and XG at 69% and 61%. The XG algorithm was the best-performing algorithm for both VRE and CRO. Prior VRE colonization, recent (<180 days) long-term care facility stay, and prior hospitalization >60 days were the key predictors for VRE, whereas the primary predictor for CRO colonization was prior carbapenem use. Conclusions: We demonstrated that EHR data can be used to predict >75% of VRE positive cases with a <15% false-positive rate and ~70% of CRO cases with a <40% false-positive rate. Future studies using larger sample sizes may improve the prediction accuracy and inform model generalizability across sites and thus reduce the risk of transmission of MDROs by rapidly identifying MDRO-colonized patients.Funding: This work was funded by the Centers for Disease Control and Prevention (CDC) Epicenters Program (Grant Number 1U54CK000447) and the CDC MInD-Healthcare Program (Grant Number 1U01CK000536).Disclosures: Aaron Milstone, BD (consulting)
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Olivieri, Daniel J., Ajay K. Gopal, and Manoj P. Menon. "Analyzing Rates of Exclusion Among Patients Living with HIV in U.S.-Based Non-Hodgkin Lymphoma Clinical Trials from 2014-2024." Blood 144, Supplement 1 (2024): 5041. https://doi.org/10.1182/blood-2024-208921.
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Introduction: Human Immunodeficiency Virus (HIV) is a major risk factor for and associated with various aggressive non-Hodgkin B-cell lymphomas (NHL) with an increased relative risk of up to 200-fold among persons living with HIV (PLWH) compared to the general population. Despite this, PLWH are often excluded from clinical trials given concern for drug-drug interactions with anti-retroviral therapy (ART) and immunosuppression. In 2017, the National Comprehensive Care Network (NCCN), the National Cancer Institute (NCI), and the American Society of Clinical Oncology (ASCO)-HIV Working Group advocated for the inclusion of PLWH in all clinical trials. We previously estimated that PLWH were included in approximately one-third of lymphoma-related trials prior to 2018. Herein we analyze the inclusion of PLWH in NHL-related clinical trials after the initial ASCO-HIV Working Group recommendations. Methods: We identified all U.S.-based clinical trials with the keyword “lymphoma” with start dates between 1/1/2014-4/1/2025 using the publicly available National Institute of Health Clinic Trial Database (https://www.clinicaltrials.gov/). We extracted data including clinical trial number, study title, study status, conditions treated, sponsor, collaborators, phase, enrollment number, funder type (i.e., NIH, Industry, or other), start date, time frame (pre-2018 versus post-2018), and CAR-T related study (i.e., yes or no). Each study was individually reviewed and all studies which enrolled adult patients with B-cell NHL subtypes were included in this analysis. We characterized all excluded studies (i.e. pediatric, transplant, solid tumor, non-NHL lymphoma, etc.). Studies that did not specifically delineate whether PLWH were excluded were labeled as being inclusive. Univariate and multivariate analyses were conducted using R software. Purposeful selection of univariate variables with P&lt;0.20 were included in a multivariate regression model. Results: 1,346 clinical trials were captured during the initial search, of which 58% (n=784) met criteria for inclusion in this analysis. PLWH were potentially eligible to participate in 48% of included studies (n=373). Common reasons for exclusion included leukemia-related (n=219, 36%), transplant-related (n=148, 26%), T-cell lymphoma (n=81, 14%), and pediatric-related trials (n=26, 5%). Most studies were actively recruiting (n=377, 48%) or completed (n=180, 23%) and strictly funded by industry (n=369, 47%). Few studies were solely funded by the NIH (n=69, 9%). Studies were most commonly in phase 1 (n=303, 39%) or phase 2 (n=245, 31%) and included aggressive subtypes of non-Hodgkin's lymphoma (n=637, 81%). 380 studies were conducted after 2018; of these 56% (n=211) were inclusive of PLWH in comparison to only 40% (n=162) of studies pre-2018. Study size (p=0.017), start date (p&lt;0.001), funding source (p&lt;0.05), and CAR-T trials (p=0.17) met criteria for inclusion in multivariate analysis. After multivariate adjustment, studies initiated post-2018 (p&lt;0.001), those funded by NIH (p&lt;0.001) and other funding sources (p&lt;0.001) were more likely inclusive of PLWH. In addition, CAR-T trials were more common post-2018 (p&lt;0.001). Conclusion: Nearly half of all U.S. based B-cell NHL clinical trials now include PLWH. The establishment of the ASCO-HIV Working Group in 2017 and subsequent NCCN guidelines may have contributed to this significant increase, along with advocacy from key stakeholders such as the NCI. Although there has been much research demonstrating the safety and efficacy of cytotoxic chemotherapy among PLWH, given the increased use of immunotherapy and targeted therapies, additional research demonstrating the safety profile of these agents is warranted among PLWH. PLWH have a significantly elevated risk of developing aggressive B-cell NHL; efforts to foster inclusion in clinical trials will better enable access to novel therapies, mitigate health disparities, and help reduce stigma among patients, providers, and researchers.
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Dong, L., S. LI, Z. Wu, et al. "SAT0250 CLINICAL CHARACTERISTICS AND THE DISEASE ACTIVITY OF BEHCET’S DISEASE IN CHINA: A STUDY BASED ON SMART SYSTEM OF DISEASE MANAGEMENT (SSDM)." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 1068.1–1068. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1470.
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Background:Behcet´s disease (BD) is a systemic autoimmune disease that affects multiple organ systems with recurrent oral ulcers, genital ulcers and skin lesions. Behcet´s Disease Current Activity Form (BDCAF) and Electronic Medical Record-based Activity Index (EMRAI) are commonly used internationally to evaluate the disease activity of BD.Objectives:This study aimed to analyze the clinical characteristics, the level of disease activity, and the incidence of anxiety and depression for Chinese BD patients. Patients can perform self-management of disease with SSDM.Methods:SSDM is a series of doctor-patient interactive applications for self-management of patients with chronic diseases. Patients can perform self-assessment with SSDM and upload the data to their authorized doctors. The SSDM patients’ application system integrates the BDCAF and EMRAI into one scoring system. Patients could obtain scores of BDCAF and EMRAI by responding to one questionnaire through SSDM.Results:From Apr 2017 to Jan 2020, 719 BD patients from 166 hospitals used SSDM, with a mean age of 38.97±12.71 (14~81) years old, and median disease duration of 20.8 months. 719 patients performed BDCAF and EMRAI self-assessment 1321 times, 252 patients repeat assessments for 855 times. The mean score of BDCAF and EMRAI are 3.57±2.17 and 3.44±1.90, respectively. The matching degree of the two score was 0.8747.The most common clinical characteristics were oral ulcers (83.73%), ocular symptoms (62.03%), joint pain (50.07%). The comparative study between males and females revealed significant difference in the aspects of epididymitis (10.94% vs 0, p<0.001), genital ulcer (35.09% vs 44.93%, p=0.01), headache (24.15% vs 33.92%, p=0.01) and superficial thrombophlebitis (24.15% vs 33.92%, p=0.01). Table 1.Table 1.Clinical Characteristics of different systems in Chinese BD patients.Presence of clinical characteristicsTotalMalesFemalesP valueOral ulcer83.73% (602)86.42% (229)82.16% (373)0.14Genital ulcer41.31% (297)35.09% (93)44.93% (204)0.01*Epididymitis4.03% (29)10.94% (29)0 (0)<0.001**Erythema29.49% (212)29.43% (78)29.52% (134)0.98Skin lesions26.84% (193)28.68% (76)25.77% (117)0.4Superficial thrombophlebitis30.32% (218)24.15% (64)33.92% (154)0.01*Headache30.32% (218)24.15% (64)33.92% (154)0.01*Joint pain50.07% (360)51.32% (136)49.34% (224)0.61Arthritis14.60% (105)14.72% (39)14.54% (66)0.95Gastrointestinal involvement24.90% (179)27.92% (74)23.13% (105)0.15Ocular symptoms62.03% (446)62.64% (166)61.67% (180)0.79Nervous involvement23.78% (171)25.66% (68)22.69% (103)0.37Vascular involvement15.72% (113)18.11% (48)14.32% (65)0.18*P values are for the comparison between the males and females.Conclusion:Chinese BD patients can effectively perform BDCAF and EMRAI self-assessment with SSDM. The results of the assessment conducted by the two scoring systems are similar. The clinical characteristics of Chinese BD were different depending on gender.Acknowledgments: :Smart system of disease management (SSDM) was developed by Shanghai Gothic Internet Technology Co., Ltd.Disclosure of Interests:None declared
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Chin Koon Siw, K., R. Kandel, G. Rosenfeld, S. Boet, S. Larrigan, and J. D. McCurdy. "A158 THE EFFECTIVENESS AND SAFETY OF HYPERBARIC OXYGEN THERAPY IN INFLAMMATORY BOWEL DISEASE AND ITS ASSOCIATED CONDITIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS." Journal of the Canadian Association of Gastroenterology 4, Supplement_1 (2021): 164–66. http://dx.doi.org/10.1093/jcag/gwab002.156.
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Abstract Background Hyperbaric oxygen therapy (HBOT) corrects tissue hypoxia, mobilizes stem cells and has immunomodulatory effects, all of which are key mechanisms for healing wounds. A number of studies have suggested that HBOT may be effective for healing inflammatory bowel disease (IBD). Aims Our systematic review aimed to quantify the effectiveness and safety of HBOT in IBD and its associated conditions. Methods We performed a proportional meta-analysis. MEDLINE, EMBASE, Web of Knowledge and The Cochrane Central Register of Controlled Trials were systematically searched from inception through November 2020 with no language restriction. We included randomized controlled studies, cohort studies and case series that contained a minimum of three patients and reported effectiveness and/or safety outcomes for HBOT in patients with IBD. Studies were stratified by IBD phenotype and weighted summary estimates with 95% confidence intervals (CI) were calculated for clinical response and remission using random-effects models. Study quality was assessed using the Cochrane risk-of-bias tool for randomized trials and a modified version of the National Institutes of Health (NIH) checklist for observational studies. Results Nineteen studies met our study criteria: 3 randomized controlled trials and 16 case series. The studies reported outcomes for luminal ulcerative colitis (UC) (n=373), luminal Crohn’s disease (CD) (n=250), enterocutaneous fistulae (ECF) (n=21), perianal CD (n=115), pouch disorders (n=60), pyoderma gangrenosum (PG) (n=5) and perianal sinus/metastatic CD (n=7). Rates of clinical response were 86% (95% CI, 66–95%) for luminal UC, 86% (95% CI, 81–90%) for luminal CD, 85% (95% CI, 61–95%) for ECF, 80% (95% CI, 70–87%) for perianal CD, 65% (95% CI, 52–76%) for pouch disorders, 92% (95% CI, 38–99%) for PG and 79% (95% CI, 36–96%) for perianal sinus/metastatic CD. Rates of clinical remission were 87% (95% CI, 10–100%) for luminal UC, 88% for luminal CD (95% CI, 46–98%), 50% for ECF (95% CI, 12–88%), 64% (95% CI, 52–75%) for perianal CD, 31% (95% CI, 16–50%) for pouch disorders, 92% (95% CI, 38–100%) for PG and 65% (95% CI, 10–97%) for perianal sinus/metastatic CD. Of the ten studies that reported on safety of HBOT, 19 patients (10.5%) had minor adverse events and no major event was reported. Study quality was low in the majority of studies due to an absence of comparator arms, inadequate description of interventions, and poorly defined outcomes. Conclusions Limited high-quality evidence suggest that HBOT is safe and associated with high rates of clinical response and remission for luminal IBD, perianal CD and pouch disorders. A well-designed large multicenter randomized controlled trial is warranted to confirm the benefit of HBOT in IBD. doi:10.17605/osf.io/gpz6d Funding Agencies None
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Newgard, Craig D., Shauna Rakshe, Apoorva Salvi, et al. "Changes in Emergency Department Pediatric Readiness and Mortality." JAMA Network Open 7, no. 7 (2024): e2422107. http://dx.doi.org/10.1001/jamanetworkopen.2024.22107.
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ImportanceHigh emergency department (ED) pediatric readiness is associated with improved survival, but the impact of changes to ED readiness is unknown.ObjectiveTo evaluate the association of changes in ED pediatric readiness at US trauma centers between 2013 and 2021 with pediatric mortality.Design, Setting, and ParticipantsThis retrospective cohort study was performed from January 1, 2012, through December 31, 2021, at EDs of trauma centers in 48 states and the District of Columbia. Participants included injured children younger than 18 years with admission or injury-related death at a participating trauma center, including transfers to other trauma centers. Data analysis was performed from May 2023 to January 2024.ExposureChange in ED pediatric readiness, measured using the weighted Pediatric Readiness Score (wPRS, range 0-100, with higher scores denoting greater readiness) from national assessments in 2013 and 2021. Change groups included high-high (wPRS ≥93 on both assessments), low-high (wPRS &amp;lt;93 in 2013 and wPRS ≥93 in 2021), high-low (wPRS ≥93 in 2013 and wPRS &amp;lt;93 in 2021), and low-low (wPRS &amp;lt;93 on both assessments).Main Outcomes and MeasuresThe primary outcome was lives saved vs lost, according to ED and in-hospital mortality. The risk-adjusted association between changes in ED readiness and mortality was evaluated using a hierarchical, mixed-effects logistic regression model based on a standardized risk-adjustment model for trauma, with a random slope–random intercept to account for clustering by the initial ED.ResultsThe primary sample included 467 932 children (300 024 boys [64.1%]; median [IQR] age, 10 [4 to 15] years; median [IQR] Injury Severity Score, 4 [4 to 15]) at 417 trauma centers. Observed mortality by ED readiness change group was 3838 deaths of 144 136 children (2.7%) in the low-low ED group, 1804 deaths of 103 767 children (1.7%) in the high-low ED group, 1288 deaths of 64 544 children (2.0%) in the low-high ED group, and 2614 deaths of 155 485 children (1.7%) in the high-high ED group. After risk adjustment, high-readiness EDs (persistent or change to) had 643 additional lives saved (95% CI, −328 to 1599 additional lives saved). Low-readiness EDs (persistent or change to) had 729 additional preventable deaths (95% CI, −373 to 1831 preventable deaths). Secondary analysis suggested that a threshold of wPRS 90 or higher may optimize the number of lives saved. Among 716 trauma centers that took both assessments, the median (IQR) wPRS decreased from 81 (63 to 94) in 2013 to 77 (64 to 93) in 2021 because of reductions in care coordination and quality improvement.Conclusions and RelevanceAlthough the findings of this study of injured children in US trauma centers were not statistically significant, they suggest that trauma centers should increase their level of ED pediatric readiness to reduce mortality and increase the number of pediatric lives saved after injury.
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Kenneth Sube, Joseph Chol, Louis Ajuot, et al. "The prevalence of road traffic accidents in Juba City, 2018, South Sudan." World Journal of Advanced Research and Reviews 17, no. 2 (2023): 181–88. http://dx.doi.org/10.30574/wjarr.2023.17.2.0001.
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Background: Road traffic accidents remains as one of the leading causes of death and life-long disability worldwide. Objectives: This study aimed to determine the prevalence and associated risk factors for road traffic accidents in Juba, South Sudan. Methods and materials: This are a retrospective study using data from registers at Juba Teaching Hospital and Directorate of Traffic police between 1st January to 31st December 2018. Data were collected, cleaned and entered into a computer database. Statistical analysis was performed using SPSS Version 21 Software. A variable with a p value of <0.05 was considered statistically significant. Results: Out of 7862 patients were recorded in the OPD at Juba Teaching Hospital (JTH), 7.3 % (575/7862) were road traffic accident (RTA) cases. This is at rate of 7313 per 100,000 of the population. Of all the 575 cases of RTA in JTH, 82% (472/575) were males and 18% (103/575) females with age ranging from 9 months to 97yrs and a mean age of 26.9yrs, SD+/-12.53. Most of the patients 37 % (214/575) were of age group 31-40years, with majority 36% (207/575) coming from an unidentified location. Munuki block had the highest 25.2% (145/575) within Juba city council , while areas outside Juba city council had the least 7.5% (43/575). Interestingly most of the patients 44 % (253/575) presented to the OPD at night, while 19 % (111/575) presented in the morning. Most 20 % (113/575) presented to the OPD in May 4 % (23/575). There were no cases in June.Out of 1081 drivers involved in RTA, age group 31-40yrs (37%), 21-30yrs (37%), 21-30yrs (36%), 31-40yrs (42%) and 31-40yrs (31%) had an outcome of car accidents causing death, severe injuries, slight injuries, damage and influenced by alcohol respectively with p=0.015. It was noted that 81% (926/1141) drivers had driving licenses, while 19% (215/1141) driving without licenses. Private cars were associated with the highest outcome;56% causing death, 50% causing slight injuries and 42% causing severe injuries with p=0.01. Unfortunately, 82% of drivers driving under alcohol influence were drivers driving private cars as the highest with p=0.000. Out of the 1472 cars registered, majority were private cars 38% (27/71), 36% (134/373), 47% (222/475) and100% (11/11) were involved in accidents causing death, severe injuries, damage to property and driven under influence of alcohol respectively with p=0.003. Motorcycles reminded leading cause of slight injuries, 39 % (214/542) but also the second leading in causing severe injury 35 % (190/542) as well as damage to property 20 % (96/475). Most of the cars 22% (13/58) caused accidents resulting to death as well as slight injuries 16.8% (67/404) in March; severe injuries 13.3% (39/291) seen in November, where as damage to the property 13.6% (40/296) in February. Accidents due alcohol intoxication 50% (16/32) were seen in January but p=0.58. Conclusion: Road traffic accidents still remain a public health problem in Juba with younger age drivers involved in accidents.
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Cheung, Ka Wang, Tiffany Sin-Tung Au, Joan Kar On Wai, and Mimi Tin-Yan Seto. "Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study." Journal of Medical Internet Research 25 (September 19, 2023): e46663. http://dx.doi.org/10.2196/46663.
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Background Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women’s concerns. Objective This study aimed to assess pregnant women’s attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong. Methods We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women’s preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics. Results The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%). Conclusions Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care.