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To address gaps in bereavement services in the UK, a national charity offered free access to Grief Coach, a 12-month text message-based grief support program. To assess the feasibility and acceptability of the approach, this study examined program reach, retention, and user satisfaction. Over 4000 grievers enrolled in the program over 13.5 months; 6- and 12-month retention rates were 87.8% and 83.2%. Among individuals responding to a satisfaction survey (response rate = 55.9%), 94.8% rated the program as moderately or very helpful and 95.4% said it contributed to their sense of being supported in their grief. Common themes emerging from a qualitative analysis of the written comments were how the program helped with coping with the pain of grief and user appreciation of the program. Grief Coach may be a promising component of high-quality grief support to meet the needs of grieving people in the UK.
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OBJECTIVES: To define the baseline characteristics of long-term tube-fed (TF) single ventricle patients, investigate associations between long-term enteral tube feeding and growth, and determine associations with long-term outcomes after Fontan procedure. STUDY DESIGN: We performed a retrospective cohort study of patients in the Australia and New Zealand Fontan Registry undergoing treatment at the Royal Children's Hospital, the Children's Hospital at Westmead, Royal Melbourne Hospital, and Royal Prince Alfred Hospital from 1981 to 2018. Patients were defined as TF or non-tube-fed (NTF) based on enteral tube feeding at the age of 90 days. Feeding groups were compared regarding body mass index (BMI) trajectory, BMI at last follow-up, and long-term incidence of severe Fontan failure. RESULTS: Of 390 patients (56 [14%] TF, 334 [86%] NTF), TF was associated with right ventricular dominance, hypoplastic left heart syndrome, Norwood procedure, increased procedures prior to Fontan, extracardiac conduit Fontan, Fontan fenestration, and atrioventricular valve repair/replacement. TF patients were less likely to be in the higher compared with lowest 0-6 month BMI trajectory (P < .01; P = .03), had lower 6 month weight-for-age z-scores (P < .01) and length-for-age z-scores (P = .01). TF were less likely to be overweight/obese at pediatric follow-up (hazard ratio [HR] = 0.31, 95% CI: 0.12-0.80; P = .02) and more likely to be underweight at adult follow-up (HR = 16.51; 5% CI: 2.70-101.10; P < .01). TF compared with NTF was associated with increased risk of severe Fontan failure (HR = 4.13; 95% CI = 1.65-10.31; P < .01). CONCLUSIONS: Prolonged infant enteral tube feeding is an independent marker of poor growth and adverse clinical outcomes extending long-term post-Fontan procedure.
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Procedimiento de Fontan , Cardiopatías Congénitas , Síndrome del Corazón Izquierdo Hipoplásico , Corazón Univentricular , Adulto , Niño , Humanos , Lactante , Estudios Retrospectivos , Nutrición Enteral , Resultado del Tratamiento , Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Procedimiento de Fontan/efectos adversos , Cardiopatías Congénitas/cirugía , Cardiopatías Congénitas/etiologíaRESUMEN
Krypton chloride (KrCl*) excimer ultraviolet (UV) light may provide advantages for contaminant degradation compared to conventional low-pressure (LP) UV. Direct and indirect photolysis as well as UV/hydrogen peroxide-driven advanced oxidation (AOP) of two chemical contaminants were investigated in laboratory grade water (LGW) and treated secondary effluent (SE) for LPUV and filtered KrCl* excimer lamps emitting at 254 and 222 nm, respectively. Carbamazepine (CBZ) and N-nitrosodimethylamine (NDMA) were chosen because of their unique molar absorption coefficient profiles, quantum yields (QYs) at 254 nm, and reaction rate constants with hydroxyl radical. Quantum yields and molar absorption coefficients at 222 nm for both CBZ and NDMA were determined, with measured molar absorption coefficients of 26â¯422 and 8170 M-1 cm-1, respectively, and QYs of 1.95 × 10-2 and 6.68 × 10-1 mol Einstein-1, respectively. The 222 nm irradiation of CBZ in SE improved degradation compared to that in LGW, likely through promotion of in situ radical formation. AOP conditions improved degradation of CBZ in LGW for both UV LP and KrCl* sources but did not improve NDMA decay. In SE, photolysis of CBZ resulted in decay similar to that of AOP, likely due to the in situ generation of radicals. Overall, the KrCl* 222 nm source significantly improves contaminant degradation compared to that of 254 nm LPUV.
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Contaminantes Químicos del Agua , Purificación del Agua , Dimetilnitrosamina , Contaminantes Químicos del Agua/metabolismo , Oxidación-Reducción , Carbamazepina , Rayos Ultravioleta , Fotólisis , Peróxido de Hidrógeno , Purificación del Agua/métodosRESUMEN
U.S. Medicare-certified hospices must provide bereavement care to family members for 13 months following a patient's death. This manuscript describes Grief Coach, a text message program that delivers expert grief support and can assist hospices in meeting the bereavement care mandate. It also describes the first 350 Grief Coach subscribers from hospice and the results of a survey of active subscribers (n = 154) to learn whether and how they found the program helpful. The 13-month program retention rate was 86%. Among survey respondents (n = 100, response rate = 65%), 73% rated the program as very helpful, and 74% rated it as contributing to their sense of being supported in their grief. Grievers aged 65+ and males gave the highest ratings. Respondents' comments identify key intervention content that they found helpful. These findings suggest that Grief Coach may be a promising component of hospice grief support programming to meet the needs of grieving family members.
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The effectiveness of UV-based advanced oxidation processes (UV-AOPs) in degrading trace organic contaminants (TrOCs) can be significantly influenced by the ubiquitous presence of nitrate (NO3-) and nitrite (NO2-) in water and wastewater. Indeed, NO3-/NO2- can play multiple roles of NO3-/NO2- in UV-AOPs, leading to complexities and conflicting results observed in existing research. They can inhibit the degradation of TrOCs by scavenging reactive species and/or competitively absorbing UV light. Conversely, they can also enhance the elimination of TrOCs by generating additional â¢OH and reactive nitrogen species (RNS). Furthermore, the presence of NO3-/NO2- during UV-AOP treatment can affect the transformation pathways of TrOCs, potentially resulting in the nitration/nitrosation of TrOCs. The resulting nitro(so)-products are generally more toxic than the parent TrOCs and may become precursors of nitrogenous disinfection byproducts (N-DBPs) upon chlorination. Particularly, since the impact of NO3-/NO2- in UV-AOPs is largely due to the generation of RNS from NO3-/NO2- including NOâ¢, NO2â¢, and peroxynitrite (ONOO-/ONOOH), this review covers the generation, properties, and detection methods of these RNS. From kinetic, mechanistic, and toxicologic perspectives, future research needs are proposed to advance the understanding of how NO3-/NO2- can be exploited to improve the performance of UV-AOPs treating TrOCs. This critical review provides a comprehensive framework outlining the multifaceted impact of NO3-/NO2- in UV-AOPs, contributing insights for basic research and practical applications of UV-AOPs containing NO3-/NO2-.
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Contaminantes Químicos del Agua , Purificación del Agua , Nitritos , Nitratos , Rayos Ultravioleta , Dióxido de Nitrógeno , Contaminantes Químicos del Agua/análisis , Purificación del Agua/métodos , Peróxido de Hidrógeno , Compuestos Orgánicos , Oxidación-ReducciónRESUMEN
BACKGROUND: Anti-MDA5 (Melanoma differentiation-associated protein-5) positive dermatomyositis (MDA5+-DM) is characterised by rapidly progressive interstitial lung disease (ILD) and high mortality. MDA5 is an RNA sensor and a key pattern recognition receptor for the SARS-CoV-2 virus. METHODS: This is a retrospective observational study of a surge in MDA5 autoimmunity, as determined using a 15 muscle-specific autoantibodies (MSAs) panel, between Janurary 2018 and December 2022 in Yorkshire, UK. MDA5-positivity was correlated with clinical features and outcome, and regional SARS-CoV-2 positivity and vaccination rates. Gene expression patterns in COVID-19 were compared with autoimmune lung disease and idiopathic pulmonary fibrosis (IPF) to gain clues into the genesis of the observed MDA5+-DM outbreak. FINDINGS: Sixty new anti-MDA5+, but not other MSAs surged between 2020 and 2022, increasing from 0.4% in 2019 to 2.1% (2020), 4.8% (2021) and 1.7% (2022). Few (8/60) had a prior history of confirmed COVID-19, peak rates overlapped with regional SARS-COV-2 community positivity rates in 2021, and 58% (35/60) had received anti-SARS-CoV-2 vaccines. 25/60 cases developed ILD which rapidly progression with death in 8 cases. Among the 35/60 non-ILD cases, 14 had myositis, 17 Raynaud phenomena and 10 had dermatomyositis spectrum rashes. Transcriptomic studies showed strong IFIH1 (gene encoding for MDA5) induction in COVID-19 and autoimmune-ILD, but not IPF, and IFIH1 strongly correlated with an IL-15-centric type-1 interferon response and an activated CD8+ T cell signature that is an immunologic hallmark of progressive ILD in the setting of systemic autoimmune rheumatic diseases. The IFIH1 rs1990760TT variant blunted such response. INTERPRETATION: A distinct pattern of MDA5-autoimmunity cases surged contemporaneously with circulation of the SARS-COV-2 virus during COVID-19. Bioinformatic insights suggest a shared immunopathology with known autoimmune lung disease mechanisms. FUNDING: This work was supported in part by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), and in part by the National Institutes of Health (NIH) grant R01-AI155696 and pilot awards from the UC Office of the President (UCOP)-RGPO (R00RG2628, R00RG2642 and R01RG3780) to P.G. S.S was supported in part by R01-AI141630 (to P.G) and in part through funds from the American Association of Immunologists (AAI) Intersect Fellowship Program for Computational Scientists and Immunologists.
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Autoanticuerpos , Autoinmunidad , COVID-19 , Helicasa Inducida por Interferón IFIH1 , Enfermedades Pulmonares Intersticiales , SARS-CoV-2 , Humanos , COVID-19/inmunología , Helicasa Inducida por Interferón IFIH1/genética , Helicasa Inducida por Interferón IFIH1/inmunología , Enfermedades Pulmonares Intersticiales/inmunología , Enfermedades Pulmonares Intersticiales/genética , SARS-CoV-2/inmunología , Masculino , Femenino , Persona de Mediana Edad , Autoanticuerpos/inmunología , Anciano , Estudios Retrospectivos , Pandemias , Dermatomiositis/inmunología , Dermatomiositis/genética , AdultoRESUMEN
Purpose: Following medial epicondyle fractures, a subset of pediatric patients has persistent limitations in elbow motion. This study soughted to understand the patient characteristics of this group and to assess the effectiveness of intensive therapy and ulnar nerve transposition in improving elbow range of motion and patient-reported outcomes. Methods: A cohort of 31 pediatric patients with stiffness after elbow trauma was narrowed to 8 pediatric patients (7 female) ranging in age from 9 to 14 years, who were diagnosed with medial epicondyle fractures and underwent intensive therapy and ulnar nerve transposition with or without elbow joint release. We collected demographic and objective data as well as subjective data including Patient-Reported Outcome Measurement Information System (PROMIS) scores before and after ulnar nerve transposition. Results: Following initial intensive therapy, elbow range of motion improved by an average of 56°, and 7 of the 8 patients reached a functional motion arc of 100°. Subsequently, following ulnar nerve surgery with or without elbow release, motion improved by an average of 22°, and 5 of the 8 patients demonstrated improvement from this intervention. Surgery led to improvements in subjective outcomes with an improvement in PROMIS mobility scores by an average of 9 points, pain interference by 6 points, and upper extremity scores by 3 points. Based on a previously determined minimally important difference of three points, these indicate significant clinical improvements. Conclusions: A subset of pediatric patients with persistent stiffness following medial epicondyle fractures may benefit from additional interventions, including intensive therapy, transposition of the ulnar nerve, and open capsular release. However, not all patients were improved after ulnar nerve surgery, and the identification and treatment of ulnar nerve irritability may not fully resolve preoperative symptoms in all patients. Type of study/level of evidence: Therapeutic IV.
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Developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) are common hip pathologies and important risk factors for osteoarthritis, yet the disease mechanisms differ. DDH involves deficient femoral head coverage and a shortened abductor moment arm, so this study hypothesized that the cross-sectional area (CSA) of the gluteus medius/minimus muscle complex and the stabilizing iliocapsularis muscle would be larger in DDH versus FAI, without increased fatty infiltration. A longitudinal cohort identified prearthritic patients with DDH or FAI who underwent imaging before surgery. Patients with DDH and FAI (Cam, Pincer, or Mixed) were 1:1 matched based on age, sex, and body mass index. Magnetic resonance imaging was used to measure the gluteus medius/minimus complex and iliocapsularis in two transverse planes. Amira software was used to quantify muscle and noncontractile tissue. Paired samples t-tests were performed to compare muscle size and composition (p < 0.05). There were no differences in the iliocapsularis muscle. Patients with DDH had significantly larger CSA of the gluteus medius/minimus complex at both transverse planes, and the noncontractile tissue proportion did not differ. The mean difference in overall muscle CSA at the anterior inferior iliac spine was 4.07 ± 7.4 cm2 (p = 0.005), with an average difference of 12.1%, and at the femoral head this was 2.40 ± 4.37 cm2 (p = 0.004), with an average difference of 20.2%. This study reports a larger CSA of the gluteus medius/minimus muscle complex in DDH compared to FAI, without a difference in noncontractile tissue, indicating increased healthy muscle in DDH.
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Displasia del Desarrollo de la Cadera , Pinzamiento Femoroacetabular , Luxación Congénita de la Cadera , Humanos , Pinzamiento Femoroacetabular/cirugía , Luxación Congénita de la Cadera/patología , Imagen por Resonancia Magnética , Músculo Esquelético/patologíaRESUMEN
This study aimed to (1) measure acetabular sector angle (ASA) from proximal to distal positions along the axial femoral head axis, (2) identify acetabular deficiency patterns, and (3) correlate ASA at different axial positions with other radiological measurements in acetabular dysplasia. We identified 30 hips with dysplasia (lateral center edge angle [LCEA] <20°) and 30 hips without dysplasia (LCEA >25°) from a retrospective cohort. Anterior and posterior ASA (AASA, PASA) were measured in the axial computed tomography plane through the femoral head center (equatorial) and two axial positions above the equatorial line (intermediate and proximal). Deficiency patterns were identified using ASA cut-off values determined from receiver operating characteristic curves. Pearson's coefficients were used for correlations. Compared to non-dysplastic hips, AASA in dysplastic hips was significantly smaller in all levels: equatorial (46.1 ± 7.3 vs. 54.9 ± 8.5,° p < 0.001), intermediate (62.1 ± 11.2 vs. 69.0 ± 10.6,° p = 0.02), and proximal (102.9 ± 14.2 vs. 128.3 ± 23.0,° p < 0.001). According to proximal ASA (Pro-ASA) cut-off values in dysplastic hips, global deficiency was most prevalent (19/30, 63.3%), followed by anterior (6/30, 20%) and posterior (3/30, 10%) deficiency. There were strong correlations between acetabular anteversion and Eq-AASA (r = -0.74, p < 0.001) and LCEA and pro-PASA (r = 0.82, p < 0.001). Clinical significance: Acetabular sector angle provides insight into acetabular morphology and patterns of deficiency, providing essential information for precise acetabular reorientation.
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Luxación Congénita de la Cadera , Luxación de la Cadera , Humanos , Estudios Retrospectivos , Cabeza Femoral/diagnóstico por imagen , Acetábulo/diagnóstico por imagen , Luxación de la Cadera/diagnóstico por imagen , Articulación de la CaderaRESUMEN
Concerns over human health risks associated with chemical contaminants (micropollutants) in drinking waters are rising due to the increased use of reclaimed water or water supplies impacted by upstream wastewater discharges. Ultraviolet (UV)-driven advanced oxidation processes (UV-AOPs) using radiation sources that emit at 254 nm have been developed as advanced treatments to degrade contaminants, while those UV-AOPs can be improved towards higher radical yields and lower byproduct formation. Several previous studies have suggested that Far-UVC radiation (200-230 nm) is a promising radiance source to drive UV-AOPs because the direct photolysis of micropollutants and production of reactive species from oxidant precursors can both be improved. In this study, we summarize from the literature the photodecay rate constants of five micropollutants by direct UV photolysis, which are higher at 222 than 254 nm. We experimentally determine the molar absorption coefficients at 222 and 254 nm of eight oxidants commonly used in water treatment and present the quantum yields of the oxidant photodecay. Our experimental results also show that the concentrations of HO·, Cl·, and ClO· generated in the UV/chlorine AOP can be increased by 5.15-, 15.76-, and 2.86-fold, respectively, by switching the UV wavelength from 254 to 222 nm. We also point out the challenges of applying Far-UVC for micropollutant abatement in water treatment, including the strong light screening effect of matrix components (e.g., carbonate, nitrate, bromide, and dissolved organic matter), the formation of byproducts via new reaction pathways, and the needs to improve the energy efficiency of the Far-UVC radiation sources.
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Contaminantes Químicos del Agua , Purificación del Agua , Humanos , Aguas Residuales , Oxidación-Reducción , Cloro , Oxidantes , Purificación del Agua/métodos , Rayos Ultravioleta , Peróxido de HidrógenoRESUMEN
Background: Though traumatic digital amputations are common, outcomes data are scarce. The FRANCHISE study clarified functional outcomes after digital amputation, but little information is available regarding mental health outcomes. The aims of this study were to document patient-reported mental health outcomes after traumatic digital amputation, elucidate the relationship between mental health and functional outcomes, and determine which patient/injury attributes conferred risk of unfavorable mental health outcomes. Methods: This was a descriptive, retrospective study of 77 patients with history of single digit, non-thumb traumatic amputation. Eligible patients completed Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity, Pain Interference, Anger, Anxiety, and Depression computer adaptive tests, and a short questionnaire recorded handedness, demographics, and worker's compensation status. Results: Correlation across the 3 PROMIS mental health domains (Anger, Anxiety, Depression) was uniformly strong and statistically significant. Correlation between the PROMIS mental health and functional (Upper Extremity and Pain Interference) scores was statistically significant but much weaker. Multivariable analysis revealed younger age and a worker's compensation claim had independent statistically significant predictive value for worse PROMIS Anger, Anxiety, and Depression scores. Female sex was also found to independently predict PROMIS Anxiety. Conclusions: By identifying patients at increased risk for feelings of anger, anxiety, and depression after digital amputation, anticipatory counseling can be provided. Anger, anxiety, and depression are very likely to coexist in the same patient; when responding to a patient who exhibits 1 element of this triad, the surgeon should be aware that the other 2 elements are likely to be present, even if not obvious.
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The purpose of this study was to quantify the stigma associated with digital amputation and examine factors associated with it. One hundred and sixty-four digital amputees completed the Neurological Quality of Life-Stigma questionnaire and a battery of Patient-Reported Outcome Measurement Information System instruments. Multivariable analysis examined factors associated with stigma experience. The mean observed stigma score of 47 (SD 8, range 36-64) was similar to the mean value of the normal population. Younger age, a worker's compensation claim and depression were each independently associated with a more severe experience of stigma after digital amputation. Socioeconomic variables, anatomical details and mechanism of injury were not independently associated with stigma. Digital amputation is not highly stigmatizing overall. Surgeons should consider referring at-risk patients to a mental health provider for support during the coping and adjustment process after amputation.Level of evidence: III.
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Amputados , Amputación Quirúrgica , Humanos , Calidad de Vida , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Diabetes is a well-established risk factor for severe digital infection, and patients are more likely to require digital amputation for adequate source control. This study aims to identify factors predictive of digital amputation compared with preservation in patients with diabetes who present with surgically treated finger infections. METHODS: Current Procedural Terminology (CPT) and International Classification of Diseases Versions 9 and 10 (ICD-9/10) databases from a single academic medical center were queried to identify patients with type 1 or type 2 diabetes mellitus who underwent surgical treatment in the operating room for treatment of a digital infection from 2010 to 2020. Electronic medical records were reviewed to obtain historical and acute clinical variables at the time of hospital presentation. Bivariate and multivariable regression were used to identify factors associated with amputation. RESULTS: In total, 145 patients (61 digital amputation, 84 digital preservation) met inclusion criteria for this retrospective cohort study. Mean hospital stay was 6 days, and the average patient underwent 2 operations. Multivariable analysis revealed that the presence of osteomyelitis, ipsilateral upper extremity dialysis fistula, end-stage renal disease, and vascular disease each had significant independent predictive value for amputation rather than digital preservation. CONCLUSIONS: Digital amputation is common in the setting of diabetic finger infection. The 4 variables found to independently predict the outcome of amputation can be understood as factors which decrease the likelihood of successful digital salvage and increase the potential consequence of ongoing uncontrolled infection. Further study should focus on clinical factors affecting surgical decision making and how the treatment rendered affects patient outcomes.
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Background Patients with a single ventricle who experience early life growth failure suffer high morbidity and mortality in the perisurgical period. However, long-term implications of poor infant growth, as well as associations between body mass index (BMI) and outcome in adulthood, remain unclear. We aimed to model BMI trajectories of patients with a single ventricle undergoing a Fontan procedure to determine trajectory-based differences in baseline characteristics and long-term clinical outcomes. Methods and Results We performed a retrospective analysis of medical records from patients in the Australia and New Zealand Fontan Registry receiving treatment at the Royal Children's Hospital, The Children's Hospital at Westmead, Royal Melbourne Hospital, and Royal Prince Alfred Hospital from 1981 to 2018. BMI trajectories were modeled in 496 patients using latent class growth analysis from 0 to 6 months, 6 to 60 months, and 5 to 16 years. Trajectories were compared regarding long-term incidence of severe Fontan failure (defined as mortality, heart transplantation, Fontan takedown, or New York Heart Association class III/IV heart failure). Three trajectories were found for male and female subjects at each age group-lower, middle, higher. Subjects in the lower trajectory at 0 to 6 months were more likely to have an atriopulmonary Fontan and experienced increased mortality long term. No association was found between higher BMI trajectory, current BMI, and long-term outcome. Conclusions Poor growth in early life correlates with increased long-term severe Fontan failure. Delineation of distinct BMI trajectories can be used in larger and older cohorts to find optimal BMI targets for patient outcome.
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Procedimiento de Fontan , Cardiopatías Congénitas , Adulto , Australia/epidemiología , Índice de Masa Corporal , Niño , Femenino , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The present study evaluated the effect of a three-week intervention aimed at improving psychological health in university students. Participants included 200 Australian students randomly assigned to an experimental or waitlist control group, with 42 adhering to intervention instructions. Participants in the experimental group read a story about someone who used the natural environment to decrease stress and burnout levels and to increase their perceived satisfaction with life. They were then instructed to spend 20 minutes each week, for three weeks, in any chosen natural environment. Waitlist control participants received intervention instructions three weeks later. Restorativeness was positively associated with life satisfaction and negatively related to stress and burnout. Experimental participants, compared to waitlist control participants, experienced a significant decrease in stress; however, the intervention had no effect on life satisfaction or burnout. More research is still needed to determine the practical significance of nature exposure on university students' psychological health.
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Naturaleza , Estrés Psicológico/rehabilitación , Estudiantes/psicología , Universidades , Adulto , Australia/epidemiología , Femenino , Humanos , Masculino , Satisfacción PersonalRESUMEN
Regulators wish to understand whether real world evidence can be used for secondary indications of biologics. Using the secondary indication of adalimumab for ulcerative colitis (UC) as an example, we aimed to replicate the ULTRA-2 randomized controlled trial finding on the effectiveness of adalimumab in patients with UC using realworld data analyses. Adalimumab, a TNF-alpha receptor inhibitor initially approved for Crohn's disease, was approved for moderate to severe UC in 2012. The ULTRA-2 trial had shown improved remission against placebo in patients with UC. Using claims data (2006-2012), we conducted a cohort study of patients with UC who initiated adalimumab and compared them with (i) nonusers and (ii) new users of infliximab using propensity score matching. The coprimary end points were corticosteroid (CS) discontinuation within 8 weeks and 1 year of treatment. We computed hazard ratios (HRs) and 95% confidence intervals (CIs). We identified 398 matched pairs of adalimumab users vs. nonusers and 326 pairs of adalimumab vs. infliximab users. Adalimumab users were 28% more likely to achieve CS-discontinuation compared with nonusers over 1 year (HR = 1.28; 95% CI 0.94-1.73). However, unlike in ULTRA-2, this effect was not observed in the first 8 weeks (HR = 0.79; 95% CI 0.65-0.97). Compared with infliximab, adalimumab initiators showed no incremental benefit over 1 year (HR = 1.08; 95% CI 0.80-1.04), but showed a 22% reduction (HR = 0.78; 95% CI 0.64-0.95) during the first 8 weeks of treatment. In summary, our results highlight opportunities and some limitations of database analysis to identify treatment effects for secondary indications.
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Adalimumab/uso terapéutico , Colitis Ulcerosa/tratamiento farmacológico , Infliximab/uso terapéutico , Inhibidores del Factor de Necrosis Tumoral/uso terapéutico , Adalimumab/efectos adversos , Adulto , Bases de Datos Factuales , Medicina Basada en la Evidencia , Femenino , Humanos , Infliximab/efectos adversos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Inducción de Remisión , Factores de Tiempo , Resultado del Tratamiento , Inhibidores del Factor de Necrosis Tumoral/efectos adversosRESUMEN
In the science and engineering communities, the nanoscience revolution is intensifying. As many types of nanomaterials are becoming more reliably synthesized, they are being used for novel applications in all branches of nanoscience and nanotechnology. Since it is sometimes desirable for single nanomaterials to perform multiple functions simultaneously, multicomponent nanomaterials, such as core-shell, alloyed, and striped nanoparticles, are being more extensively researched. Nanoscientists hope to design multicomponent nanostructures and exploit their inherent multiple functionalities for use in many novel applications. This review highlights recent advances in the synthesis of multisegmented one-dimensional nanorods and nanowires with metal, semiconductor, polymer, molecular, and even gapped components. It also discusses the applications of these multicomponent nanomaterials in magnetism, self-assembly, electronics, biology, catalysis, and optics. Particular emphasis is placed on the new materials and devices achievable using these multicomponent, rather than single-component, nanowire structures.
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Nanoestructuras/química , Electroquímica , Electrones , Metales/química , Nanoestructuras/ultraestructuraRESUMEN
The optical properties of gold rods electrochemically deposited in anodic aluminum oxide templates have been investigated. Homogeneous suspensions of rods with an average diameter of 85 nm and varying lengths of 96, 186, 321, 465, 495, 578, 641, 735, and 1175 nm were fabricated. The purity and dimensions of these rod nanostructures allowed us to observe higher-order multipole resonances for the first time in a colloidal suspension. The experimental optical spectra agree with discrete dipole approximation calculations that have been modeled from the dimensions of the gold nanorods.