A content analysis on the perceptions of LGBTQ+ (centred) health care on Twitter.

BACKGROUND: LGBTQ+ individuals have experienced many barriers to receiving quality health care, but the worldwide implementation of person-centred care should make a positive change. However, as forthright disclosures are difficult to find using traditional methods, novel approaches should be utilized to uncover opinions and experiences on LGBTQ+ health care. Twitter could be a place where people post on this topic. AIM: This study aimed to explore tweets mentioning LGBTQ+ (centred) health care. METHODS: The methods consisted of an explorative qualitative content analysis of tweets. The tweets were collected between 26 February and 30 March 2021, resulting in 2524 tweets of which 659 were relevant for content analysis. RESULTS: The results showed an excess of political tweets involving LGBTQ+ health care. Many tweets included general statements on the need for LGBTQ+ health care. The few tweets on personal experiences in LGBTQ+ health care showed the overwhelming need for quality care that has been made difficult by political developments. CONCLUSION: Most tweets were made to inform others of the necessity of quality health care for LGBTQ+ individuals, but the utilization of person-centred care is hardly noticeable. PUBLIC CONTRIBUTION: This study was conducted with the involvement of a public partner (second author) who contributed to the design, data analyses and writing of the paper. Moreover, this study involves the analysis of data provided by the public and published on social media.

Emergency Endovascular Management of a Symptomatic Pseudoaneurysm of the Left Subclavian Artery Ostium Using a Combination of an Abdominal Aortic Stent-Graft Extension Cuff and a Periscope Stent Graft.

A pseudoaneurysm located at the subclavian artery ostium is an infrequent but life-threatening pathology that usually requires major thoracic surgery with a high risk of mortality and morbidity. Endovascular therapy applied to the aortic arch branches is a recent alternative technique, which is still in its early stages because dedicated endovascular devices for the aortic arch are lacking. In this article, we present the emergency endovascular management of a symptomatic pseudoaneurysm of the left subclavian artery ostium which was presumably secondary to an atherosclerotic plaque rupture. Endovascular exclusion required a combination of an abdominal aortic stent-graft extension cuff, which was placed via a retroperitoneal iliac access, and a subclavian artery periscope stent graft.

Mobile Decision Support Tool for Emergency Departments and Mass Casualty Incidents (EDIT): Initial Study.

BACKGROUND: Chemical exposures pose a significant threat to life. A rapid assessment by first responders and emergency nurses is required to reduce death and disability. Currently, no informatics tools exist to process victims of chemical exposures efficiently. The surge of patients into a hospital emergency department during a mass casualty incident creates additional stress on an already overburdened system, potentially placing patients at risk and challenging staff to process patients for appropriate care and treatment efficacy. Traditional emergency department triage models are oversimplified during highly stressed mass casualty incident scenarios in which there is little margin for error. Emerging mobile technology could alleviate the burden placed on nurses by allowing the freedom to move about the emergency department and stay connected to a decision support system. OBJECTIVE: This study aims to present and evaluate a new mobile tool for assisting emergency department personnel in patient management and triage during a chemical mass casualty incident. METHODS: Over 500 volunteer nurses, students, and first responders were recruited for a study involving a simulated chemical mass casualty incident. During the exercise, a mobile application was used to collect patient data through a kiosk system. Nurses also received tablets where they could review patient information and choose recommendations from a decision support system. Data collected was analyzed on the efficiency of the app to obtain patient data and on nurse agreement with the decision support system. RESULTS: Of the 296 participants, 96.3% (288/296) of the patients completed the kiosk system with an average time of 3 minutes, 22 seconds. Average time to complete the entire triage process was 5 minutes, 34 seconds. Analysis of the data also showed strong agreement among nurses regarding the app's decision support system. Overall, nurses agreed with the system 91.6% (262/286) of the time when it came to choose an exposure level and 84.3% (241/286) of the time when selecting an action. CONCLUSIONS: The app reliably demonstrated the ability to collect patient data through a self-service kiosk system thus reducing the burden on hospital resources. Also, the mobile technology allowed nurses the freedom to triage patients on the go while staying connected to a decision support system in which they felt would give reliable recommendations.

Giant Symptomatic Aneurysm Secondary to Hereditary Hemorrhagic Telangiectasia of a Main Hepatic Artery with Aberrant Origin in Superior Mesenteric Artery.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a rare disease consistent in vascular dysplasias affecting different organs. Liver involvement includes telangiectases, arteriovenous shunting, and ischemic cholangitis, and its prevalence ranges from 8% to 31%. Spontaneous pseudoaneurysms have never been reported associated to HHT. Several variations in the origin of the main hepatic artery (MHA) have been described in large radiological series and can be found in around 4% of general population. METHODS: A 64-year-old woman with history of HHT was diagnosed of acute symptomatic saccular aneurysm involving the MHA. The associated portovenous fistulae suggested that liver perfusion could be impaired if embolization of the MHA without revascularization was performed. Because of an aberrant origin on the superior mesenteric artery, a hybrid procedure was designed, consistent on endovascular exclusion of the MHA associated with a surgical aortic-hepatic bypass graft. RESULTS: Angio computed tomography (Angio CT) was performed at discharge, 1 month, and 6 months after intervention, revealed complete exclusion of the aneurysm, which reduced 50% in diameter after 6 months. Aneurysms of the MHA can be associated with HHT when intrahepatic arteriovenous fistulae are present. This complication is rare, and the reported cases have been treated by surgical and totally endovascular procedures. The confluence of this very rare condition with an uncommon vascular anatomy makes this a unique case that required the design of a customized intervention. CONCLUSIONS: Hybrid procedures are useful to treat conditions that cannot be solved with standard interventions. Longer series of cases with long-term surveillance are needed to asses the results of these techniques in these complex pathology.

Frecuencia de alveolitis dentaria y factores que la caracterizan / Dental alveolitis frequency and factors characterizing it

Introducción: la alveolitis dentaria es la complicación postextracción dental más frecuente, caracterizada por un dolor postoperatorio en el alveolo, el cual se incrementa en severidad entre el primer y tercer día; síntoma que obliga al paciente a acudir al servicio estomatológico de inmediato. Objetivo: describir la frecuencia de alveolitis dentaria y los factores que la caracterizan en el área de salud del Policlínico Docente Enrique de los Ángeles Betancourt Nenínger. Materiales y métodos: se realizó un estudio descriptivo, observacional y transversal, en el mencionado policlínico, de septiembre 2012 a septiembre 2013, con 140 pacientes, que después de realizada la exodoncia presentaron esta afección. Se recogió información y procesaron variables sociodemográficas, de caracterización y riesgo de alveolitis. Resultados: el grupo de edad de 35 a 59 años representó el 5,72 %. El sexo femenino, 60 %; la localización mandibular, 51,4 %. El grupo dentario molares, 38,6 %; sin trauma del alveolo, 71,42 %, pero 82,85 % tienen hábito de fumar, y el 60 % no tuvo tratamiento con antibióticos. Conclusiones: se concluyó que el grupo más afectado fue desde la mediana edad hasta el comienzo de la tercera, afectando más a las féminas, la localización mandibular y al grupo dentario molares. El trauma en el alveolo tiene una menor frecuencia, pero el hábito de fumar está relacionado con la mayoría de los afectados, y el tratamiento con antibióticos no influye en la aparición o no de alveolitis.

Background: Dental alveolitis is the most frequent dental post-removal complication, characterized by post-surgery pain in the alveolus, seriously increasing in the first and third day: this symptom makes the patient immediately visit the stomatologic service. Aim: describing dental alveolitis frequency and factors characterizing it in the teaching Policlinic Enrique de los Angeles Betancourt Nenínger. Materials and Methods: a cross-sectional, observational, descriptive study was carried out in the before mentioned policlinic, from September 2012 to September 2013, with 140 patients showing this affection after removal. Information was collected and sociodemographic variables of alveolitis risk and characterization were processed. Outcomes: the 35-59 years age group represented 5.72 %, and the 14-19 years one, 0 % from the total of the removals carried out; the female gender, 60 %; mandibular location, 51.4 %. The dental group molars represented 38.6 %; without alveolar trauma, 71.42 %, but 82.85 of the patients were smokers, and 60 % had not treatment with antibiotics. Conclusions: it was concluded that the most affected age group was the one enclosing people from medium age to elder years, affecting more women, mandibular location and molars. The alveolar trauma is less frequent, but smoking habit is related with most of the affected people, and the treatment with antibiotics does not have influence in the alveolitis appearance or not.

The cofactor preference of glucose-6-phosphate dehydrogenase from Escherichia coli--modeling the physiological production of reduced cofactors.

In Escherichia coli, the pentose phosphate pathway is one of the main sources of NADPH. The first enzyme of the pathway, glucose-6-phosphate dehydrogenase (G6PDH), is generally considered an exclusive NADPH producer, but a rigorous assessment of cofactor preference has yet to be reported. In this work, the specificity constants for NADP and NAD for G6PDH were determined using a pure enzyme preparation. Absence of the phosphate group on the cofactor leads to a 410-fold reduction in the performance of the enzyme. Furthermore, the contribution of the phosphate group to binding of the transition state to the active site was calculated to be 3.6 kcal·mol(-1). In order to estimate the main kinetic parameters for NAD(P) and NAD(P)H, we used the classical initial-rates approach, together with an analysis of reaction time courses. To achieve this, we developed a new analytical solution to the integrated Michaelis-Menten equation by including the effect of competitive product inhibition using the ω-function. With reference to relevant kinetic parameters and intracellular metabolite concentrations reported by others, we modeled the sensitivity of reduced cofactor production by G6PDH as a function of the redox ratios of NAD/NADH (rR(NAD)) and NADP/NADPH (rR(NADP)). Our analysis shows that NADPH production sharply increases within the range of thermodynamically feasible values of rR(NADP), but NADH production remains low within the range feasible for rR(NAD). Nevertheless, we show that certain combinations of rR(NADP) and rR(NAD) sustain greater levels of NADH production over NADPH.

Role of d electrons in Auger neutralization at metal surfaces.

A generalized theory of Auger electron transfer processes in the interaction of ions with metal surfaces, including the previously ignored role of d electrons is presented. It is shown that a correct and accurate description of Auger neutralization has to account for the contribution of d electrons, as this is illustrated on the case of He+ ion neutralization on Ag, where the neglect of these leads to a strong overestimation of ion survival probabilities. Crystal lattice site specific rates are calculated and allow for a correct description of crystal azimuthal effects in neutralization.