Sociodemographic, Health, and Caregiving Patterns of Aging Caregivers in Oregon: Gender Comparisons and the Role of Leisure Activities.

Recent studies have projected an increase in aging informal caregivers who are often dealing with their frailty. However, little is known about their health, caregiving factors, or coping resources that promote health. Informed by lifespan perspective and health behavior models, this study examined the gender differences in health and caregiving profiles of aging informal caregivers and investigated the association between leisure activity and unhealthy days. A sample of 565 informal caregivers (>50 years) was drawn from the Oregon version of the 2017 Behavioral Risk Factor Surveillance System. Descriptive analyses revealed that the caregivers were mainly women between 60 and 69, White non-Hispanic, married, college graduates, retired and healthinsured. Negative binomial regression showed that leisure activities were related to fewer odds of reporting unhealthy days for most comparison scenarios. Findings emphasize the importance of accounting for group differences and similarities in understanding health and caregiving factors among informal caregivers.

Economic and social drivers of antibiotic dispensing practices among community pharmacies in Nepal.

OBJECTIVE: To assess economic and social drivers of dispensing antibiotics without prescription by community pharmacies in Nepal. METHOD: A survey was conducted among 111 pharmacy owners and managers in five districts. Information on demographic and economic characteristics of the pharmacies (e.g. revenue and profits from antibiotics) and their inclination to sell antibiotics without a physician's prescription under various scenarios (e.g. diarrhoea in a child) was collected. Univariate analysis was conducted to assess the demographic and economic characteristics. Bivariate analysis was conducted to examine the relationship between dispensing antibiotics without prescription and economic and social factors. RESULTS: Azithromycin and amoxicillin were the most commonly dispensed antibiotics. The proportions of pharmacies reporting that they would 'most likely' or 'likely' dispense antibiotics without prescription to adult patients ranged from 36.9% (sore throat) to 67.6% (cough). The proportions for paediatric patients ranged from 62.2% (sore throat) to 80.2% (cough or diarrhoea). There was no consistent relationship between the likelihood of dispensing antibiotics and revenues, profits or the number of patients. Instead, dispensing behaviour was influenced by the pressure from the patient; the respondents were more likely to dispense antibiotics when the patient specifically asked for 'an antibiotic' rather than for 'a medicine', and 68.5% respondents ranked 'customer satisfaction' as the most important factor motivating their work. CONCLUSIONS: In Nepal, inappropriate sale of antibiotics by community pharmacists is high, particularly for paediatric patients. Additional research is needed to establish key drivers of this behaviour and to help design effective approaches to reducing AMR.

An attempt to treat Hoffa fractures under arthroscopy: A case report.

We treated a 15-year-old female patient with fracture of the post-lateral femoral condyle and the bone shifted in front of the knee. Considering that the traditional surgical approach has the shortcomings of significant trauma and poor prognosis, we designed an arthroscopic procedure, which achieved satisfactory short-term efficacy, effectively reduced and fixed the fractures, avoided damage to vascular nerves, and maximally reduced the trauma caused by surgery itself.

Current development of severe acute respiratory syndrome coronavirus 2 neutralizing antibodies (Review).

The coronavirus disease 2019 pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) seriously affected global public health security. Studies on vaccines, neutralizing antibodies (NAbs) and small molecule antiviral drugs are currently ongoing. In particular, NAbs have emerged as promising therapeutic agents due to their well­defined mechanism, high specificity, superior safety profile, ease of large­scale production and simultaneous application for both prevention and treatment of viral infection. Numerous NAb therapeutics have entered the clinical research stages, demonstrating promising therapeutic and preventive effects. These agents have been used for outbreak prevention and control under urgent authorization processes. The present review summarizes the molecular targets of SARS­CoV­2­associated NAbs and screening and identification techniques for NAb development. Moreover, the current shortcomings and challenges that persist with the use of NAbs are discussed. The aim of the present review is to offer a reference for the development of NAbs for any future emergent infectious diseases, including SARS­CoV­2.

Calibrating stochastic traffic simulation models for safety and operational measures based on vehicle conflict distributions obtained from aerial and traffic camera videos.

Proper calibration process is of considerable importance for traffic safety evaluations using simulation models. Allowing for a pure with and without comparison under identical circumstances that is not directly testable in the field, microsimulation-based approach has drawn considerable attention for the performance evaluation of emerging technologies, such as connected vehicle (CV) safety applications. Different from the traditional approaches to evaluate mobility impacts, safety evaluations of such applications demand the simulation models to be well calibrated to match real-world safety conditions. This paper proposes a novel calibration framework which combines traffic conflict techniques and multi-objective stochastic optimization so that the operational and safety measures can be calibrated simultaneously. The conflict distribution of different severity levels categorized by time-to-collision (TTC) is applied as the safety performance measure. Simultaneous perturbation stochastic approximation (SPSA) algorithm, which can efficiently approximate the gradient of the multi-objective stochastic loss function, is used for model parameters optimization that minimizes the total simulation error of both operational and safety performance measures. The proposed calibration methodology is implemented using an open-source software SUMO on a simulation network of the Flatbush Avenue corridor in Brooklyn, NY. 17 key parameters are calibrated using the SPSA algorithm and are compared with the real-world traffic conflicts extracted using vehicle trajectories from 14 h' high-resolution aerial and traffic surveillance videos. Representative days are identified to create variation envelopes for performance measures. Four acceptability criteria, including control for time-variant outliers and inliers, bounded dynamic absolute and system errors are adopted for results analysis. The results show that the calibrated parameters can significantly improve the performance of the simulation model to represent real-world safety conditions (i.e., traffic conflicts) as well as operational conditions. The case study also demonstrates the usefulness of aerial imagery and the applicability of the proposed model calibration framework, so the calibrated model can be used to evaluate the safety benefits of CV applications more accurately.

Complete Endovascular Repair for Abdominal Aortic Aneurysm With Concomitant Aorto-Left Retroaortic Renal Vein Fistula.

BACKGROUND: Abdominal aortic aneurysm (AAA) with concomitant aorto-retroarotic left renal vein fistula (ALRVF) is an extremely rare clinical condition. With the recent development of endovascular techniques, repair of such conditions with a complete minimal invasive approach is now possible. We reported here a case of endovascular repair of AAA with concomitant ALRVF. CASE PRESENTATION: A 62-year-old gentleman presenting with AAA and concomitant ALRVF underwent complete endovascular repair, including an endovascular aortic aneurysm repair (EVAR) with bifurcated aortic graft as well as embolization of the aneurysm sac and deployment of a covered stent in the left retroarotic renal vein to achieve sealing of the arterial-venous fistula. The patient required no blood transfusion and no ICU stay. He has been followed up closely for 4 years and has been well clinically. Aneurysm sac size has remained stable. CONCLUSIONS: Endovascular repair can be a safe and reliable surgical alternative to treat AAA with concomitant ALRVF. But long-term follow up and more clinical data are required to verify the durability of endovascular repair for such conditions.

A functional approach for characterizing safety risk of signalized intersections at the movement level: An exploratory analysis.

Safety evaluation of signalized intersections is often conducted by developing statistical and data-driven methods based on data aggregated at certain temporal and spatial levels (e.g., yearly, hourly, or per signal cycle; intersection or approach leg). However, such aggregations are subject to a major simplification that masks the underlying spatio-temporal safety risk patterns within the data aggregation levels. Consequently, high-resolution analysis such as safety risk within signal cycles and at traffic movement level cannot be performed. This study contributes to the literature by proposing a new functional data analysis (FDA) approach for a novel characterization of safety risk patterns of signalized intersections. Functional data smoothing methods that can mitigate overfitting and account for the nonnegative characteristics of safety risk are proposed to model the time series of safety risk within signal cycles at the traffic movement level. Functional analysis of variance method (FANOVA) that can compare the group level differences of functional curves is used to test differences of safety risk functions among different traffic movements. A typical signalized intersection with representative signal types and channelizations is selected as the study location and approximately 1-hour traffic video data recorded by an unmanned aerial vehicle are used to extract traffic conflicts. New movement-level safety risk patterns are characterized based on the safety risk functions that can reveal the temporal distribution of risk within signal cycles. Most of the tested traffic movements have significantly distinct functional risk patterns according to the FANOVA results while risk patterns for most of the traffic movements cannot be differentiated based on the data aggregated at the cycle and approach levels. The proposed functional approach has the potential to be used for facilitating proactive safety management, calibrating microsimulation models for safety evaluation, and optimizing signal timing while considering traffic safety at more disaggregated levels.

Human urinary kallidinogenase combined with edaravone in treating acute ischemic stroke patients: A meta-analysis.

INTRODUCTION: Several studies have investigated the efficacy of human urinary kallidinogenase (HUK) combined with edaravone (Eda) in acute ischemic stroke (AIS) patients. Our aim was to provide the best available evidence for clinical practice and further research programs for stroke treatment. METHODS: We searched the online database for paper published between January 2015 and April 2021. We calculated weighted mean difference (WMD) or odds risk (OR) and their corresponding 95% confidence interval (95% CI) of reported outcomes between HUK plus Eda and Eda groups for each study. The random-effect models or fixed-effect models were used to pool the analysis. RESULTS: Thirteen studies with 1242 patients were included. In the pooled analysis, the scores of NIHSS in the HUK plus Eda group were significantly lower than that in patients receiving Eda (WMD = -3.92, 95% CI (-4.82, -3.02), p < .0001). The ADL scores in the HUK plus Eda group were significantly greater than that in patients receiving Eda (WMD = 14.13, 95% CI (10.67, 17.60), p < .0001). Furthermore, HUK plus Eda was associated with a higher rate of total efficacy (OR = 3.97, 95% CI (2.81, 5.59), p < .0001). CONCLUSIONS: HUK combined with Eda provides potential clinical benefits as a treatment for AIS. Further high-quality, large-scale randomized trials are needed to confirm these results.

An Interdisciplinary Nutrition Support Team Improves Clinical and Hospitalized Outcomes of Esophageal Cancer Patients with Concurrent Chemoradiotherapy.

BACKGROUND: The prevalence of malnutrition is very high in patients with cancer. The purpose of this study was to investigate whether or not a nutrition support team (NST) could benefit esophageal cancer patients undergoing chemoradiotherapy (CRT). METHODS: Between June 2012 and April 2014, 50 esophageal cancer patients undergoing concurrent CRT were randomly assigned into two groups: The NST group and the control group. The nutritional statuses of 25 patients in the NST group were managed by the NST. The other 25 patients in the control group underwent the supervision of radiotherapy practitioners. At the end of the CRT, nutritional status, the incidence of complications, and completion rate of radiotherapy were evaluated. Besides, the length of hospital stay (LOS) and the in-patient cost were also compared between these two groups. RESULTS: At the completion of CRF, the nutritional status in the NST group were much better than those in the control group, as evidenced by prealbumin (ALB), transferrin, and ALB parameters (P = 0.001, 0.000, and 0.000, respectively). The complication incidences, including bone marrow suppression (20% vs. 48%, P = 0.037) and complications related infections (12% vs. 44%, P = 0.012), in the NST group were lower and significantly different from the control group. In addition, only one patient in the NST group did not complete the planned radiotherapy while 6 patients in the control group had interrupted or delayed radiotherapy (96% vs. 76%, P = 0.103). Furthermore, the average LOS was decreased by 4.5 days (P = 0.001) and in-patient cost was reduced to 1.26 ± 0.75 thousand US dollars person-times (P > 0.05) in the NST group. CONCLUSIONS: A NST could provide positive effects in esophageal cancer patients during concurrent CRT on maintaining their nutrition status and improving the compliance of CRF. Moreover, the NST could be helpful on reducing LOS and in-patient costs.

[Single midline posterior approach for 360 degree decompression and internal fixation with interbody bone graft fusion for severe thoracolumbar spinal fractures].

OBJECTIVE: To discuss the safety and effectiveness of the single midline posterior approach for 360 degree decompression and instrumented stabilization with interbody bone graft fusion for treatment severe thoracolumbar spinal fractures accompanied with spinal compression. METHODS: From January 2009 to March 2010,5 consecutive cases with severe thoracolumbar spinal fracture of totally 108 spinal fracture cases underwent a single midline posterior approach surgery. There were 2 males and 3 females,aged from 23 to 72 years old. Two cases had both T12 and L1 fractures, and 1 case had L1 fracture. The length of the surgical procedure, estimated intra-operative blood loss, VAS score and dosages of morphine at the first 24 hours after operation, the peri-operative complications were recorded. RESULTS: Five patients were follow-up from 12 to 18 months with an average of 14.6 months. The operative time was 3.1 to 6.2 hours. The blood loss was 1 000 to 2 300 ml. VAS score at the first post-operative 24 hours was 1 to 4. The dosage of morphine of the first post-operative 24 hours was 28.8 to 30.8 mg. The preoperative Frankel/ASIA grade was grade B in 1 case, C in 2 cases, D in 1 case and E in 1 case, the post-operative Frankel/ASIA grade was E in 4 cases and D in case. No serious peri-operative complications were found. CONCLUSION: The single midline posterior approach is a safe and effective surgical approach for 360 degree decompression and instrumented stabilization with interbody bone graft fusion for severe thoracolumbar spinal fractures with less post-operative pains and complications.