The IMPACT (Incident Management of Patients, Actions Centered on Treatment) program: a quality improvement approach for caring for patients initiating long-term hemodialysis.

BACKGROUND: Patients beginning dialysis therapy are at risk of death and illness. The IMPACT (Incident Management of Patients, Actions Centered on Treatment) quality improvement program was developed to improve incident hemodialysis patient outcomes through standardized care. STUDY DESIGN: Quality improvement report. SETTING & PARTICIPANTS: Patients who started hemodialysis therapy between September 2007 and December 2008 at DaVita facilities using the IMPACT program (n = 1,212) constituted the intervention group. Propensity score-matched patients who initiated hemodialysis therapy in the same interval at DaVita facilities not using the IMPACT program (n = 2,424) made up the control group. QUALITY IMPROVEMENT PLAN: IMPACT intervention included a structured intake process and monitoring reports; patient enrollment in a 90-day patient education program and 90-day patient management pathway. OUTCOMES: Mean dialysis adequacy (Kt/V), hemoglobin and albumin levels, percentage of patients using preferred vascular access (arteriovenous fistula or graft), and mortality at each quarter. RESULTS: Compared with the non-IMPACT group, the IMPACT group was associated with a higher proportion of patients dialyzing with a preferred access at 90 days (0.50 [95% CI, 0.47-0.53] vs 0.47 [95% CI, 0.45-0.49]; P = 0.1) and 360 days (0.63 [95% CI, 0.61-0.66] vs 0.48 [95% CI, 0.46-0.50]; P < 0.001) and a lower mortality rate at 90 days (24.8 [95% CI, 19.0-30.7] vs 31.9 [95% CI, 27.1-36.6] deaths/100 patient-years; P = 0.08) and 360 days (17.8 [95% CI, 15.2-20.4] vs 25.1 [95% CI, 20.7-25.2] deaths/100 patient-years; P = 0.01). LIMITATIONS: The study does not determine the care processes responsible for the improved outcomes. CONCLUSIONS: Intense management of incident dialysis patients with the IMPACT quality improvement program was associated with significantly decreased first-year mortality. Focused attention to the care of incident patients is an important part of a dialysis program.

Contagious diseases and tourism: a systematic review based on bibliometric and content analysis methods.

The present study examines the existing knowledge and intellectual structure on contagious diseases and tourism to map the development of the concept through collaborative networks. Utilising the Scopus and Web of Science bibliometric databases, 328 research records were extracted through keyword searching and forward referencing approaches. Based on these records, the study conducted bibliometric and content analysis to diagnose core themes in the field. The present study's findings are helpful for academia and industry to aid their existing knowledge about contagious diseases, particularly its timeline, geographical spread, and development of coherent themes. A rigorous literature review revealed that the scholarly work in the domain of contagious diseases and tourism revolves around four important themes, namely COVID-19, SARS, Crisis management, and Sustainability. The first theme revolves around COVID-19, highlighting about the impact of COVID-19 on different sectors of the TTH industry, countries, stakeholders, and contexts. Also, researchers foresee COVID-19 as a catalyst to reshape the tourism industry. The next group of studies explained the handling of SARS, particularly by Asian countries. The third cluster elaborated on different stages of crisis and strategies adopted by organizations and countries to manage the crisis. Lastly, a handful of studies in the corpus stated that sustainability in tourism needs to be understood beyond saving the environment and aspiring prosperous travel and tourism industry. The study also suggested the scope of future work.

Effect of COVID-19 lockdown on the water quality index of River Gomti, India, with potential hazard of faecal-oral transmission.

The COVID-19 lockdown has been reported as a "ventilator" for the reinstatement of natural resources across the globe. Hence, the present study attempts to evaluate the impact of COVID-19 lockdown on the water quality of River Gomti across its stretch of ~960 km through the assessment of 'Water Quality Index' (WQI). The study also highlights the potential risk of faecal-oral transmission of COVID-19 through intake of river water facing the issue of direct discharge of domestic sewage. A deterioration in the water quality was witnessed at ~69% sampling locations during the lockdown period (May 2020). Interestingly, none of the water samples during the pre-lockdown, lockdown, and post-lockdown periods across the whole stretch belonged to the "excellent" category (WQI<25). The DO levels fell across ~69% and ~88% of the sites during the lockdown and post-lockdown periods, respectively. Moreover, there was an increase in the BOD5 levels across ~69% and 75% of the sites during lockdown and post-lockdown periods, respectively. These findings indicate that the release of sewage without or with partial treatment is a chief contributor of water pollution in the groundwater fed River Gomti. Thereby, highlighting the possible risk of faecal-oral transmission of the corona virus, and creating a major concern for the residents across its stretch. The urban sprawl and riverfront development in Lucknow city also emerge as potential causes of water quality deterioration in River Gomti, considering that the water quality at five sites within the city was under the "unfit" category regardless of the lockdown situation. Thus, the urgent need of management of domestic sewage release into the river and further research on the potential risk of faecal-oral transmission of COVID-19 have been suggested in the study.

An anesthesiologist with an allergy to multiple neuromuscular blocking drugs: a new occupational hazard.

We report a case of a final-year anesthesiology trainee who developed a severe allergic reaction to cutaneous exposure of succinylcholine. Intradermal testing was strongly positive to succinylcholine and all the aminosteroid neuromuscular blocking drugs (NMBDs). Specific immunoglobulin E to succinylcholine was also strongly positive. This unusual case of an anesthesiologist acquiring an allergy to an NMBD through occupational exposure has a significant effect on his practice of anesthesia. However, by avoiding operating rooms with a high usage of NMBDs and by wearing personal protective equipment, the anesthesiologist has worked in clinical anesthesia without incident.

Esterase 1 is a novel transcriptional repressor of growth hormone receptor gene expression: a unique noncatalytic role for a carboxyesterase protein.

The pleiotropic actions of GH result from its engagement with the GH receptor (GHR). GHR expression is regulated by free fatty acids (FFA). A cDNA phage expression library was screened to identify a phage clone expressing esterase 1 (ES1) binding to the FFA-response element (FARE), L2-D1, in the murine GHR promoter. Ectopically expressed ES1 inhibited GHR promoter activity via effects at two FARE, L2-D1 and L2-A2. Chromatin immunoprecipitation experiments demonstrated specific association of ES1 with the FARE. Catalytically inactive ES1 retained inhibitory activity on the GHR promoter and excluded the possibility that the effect on the GHR promoter was an indirect effect secondary to ES1's actions on the intracellular metabolism of FFA. Ectopically expressed ES1 inhibited the endogenous GHR mRNA and protein expression in 3T3-F442A preadipocytes. Subcellular fractionation and confocal microscopy established that ES1 localizes both to the cytoplasm and the nucleus. Experiments demonstrated chromosome region maintenance 1-dependent nuclear export and the presence of a functional nuclear export signal in ES1. The domain of ES1 responsible for the effect on the GHR promoter was localized to the C-terminal portion of the protein. The in vivo significance of ES1's effect on GHR expression was suggested by decreased liver GHR mRNA expression in mice on a high-fat diet correlating with increased steady-state abundance of liver ES1 mRNA. Our results identify and characterize ES1 as a novel transcriptional regulator of GHR gene expression, thereby establishing a unique nonenzymatic role for a carboxyesterase and expanding the potential biological roles of this protein superfamily.

Current-dependent anisotropic conductivity of locally assembled silver nanoparticles in hybrid polymer films.

The electrical behaviour of hybrid poly(ethylene terephthalate) films containing localised, percolating networks of silver nanoparticles separated by pure polymer is studied. The films resemble an array of parallel wires in the submicron range and, thus, exhibit anisotropic conductivity. In the high-conductivity direction at low amplitudes, the films show Ohmic behaviour, while at moderate voltage, non-linearity and a decreasing resistance is observed. The samples were found to heat up during the measurements and the deviation from Ohm's law coincides with the Tg of the polymer. Microstructural analysis of the samples revealed an irreversible agglomeration of the particles at moderate voltages leading to the formation of filaments with higher metallic character than the random particle network.

Biomonitoring of lead in atmospheric environment of an urban center of the Ganga Plain, India.

Monitoring of atmospheric lead from the Dalbergia sissoo tree was undertaken at Lucknow urban centre of the Ganga Plain, India. A total of 26 leaf samples were collected in spring, monsoon and winter seasons from 16 sampling sites and was analysed by Atomic Absorption Spectrophotometry method. Lead concentrations were low in spring season, increased in monsoon to winter seasons and range from 2.1 to 28.2 microg/g (dry wt.). This accumulative response of lead in the tree leaves is directly linked with the exposure time of automobile emission that is considered to be the predominant source for it. Highway localities show higher lead concentrations by a factor of 2 as compared to urban localities. Highest concentration was recorded at Sitapur Road (National Highway No. 24) in winter season. A linear quantitative relationship between urban air-lead levels and lead-in-the Dalbergia sissoo leaves is used to infer the qualitative assessment of present day atmospheric lead pollution. Reported results suggest a drastic reduction in mean lead concentration in Lucknow urban air from 1.32 microg/m3 in 1994 to 0.19 microg/m3 in 2002. Similarly, mean lead concentration in the tree leaves during winter season also dropped from 17.9 microg/g in 1994 to 8.1 microg/g in 2004. Despite of increasing urban population, urban area, vehicle population and traffic density, the introduction of unleaded-petrol (vehicular fuel) keeps lead level in the urban environment of Lucknow much lower than the past. Like Lucknow, other urban centres of the Ganga Plain are also on way to the exponential increase in pressure of urbanization. An appropriate urban public transport planning is required to provide healthy atmospheric environment for millions of people especially future young generation.