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BACKGROUND: Therapeutic inertia describes a failure to establish appropriate treatment targets and escalate treatment to achieve those targets. This inertia can be measured, and evidence of this inertia is present in approximately one-third of diabetes management consultations. This inertia describes a failure in the system to produce change, rather than assigning fault to the physician or patient. OBJECTIVE: This article discusses the importance of reducing therapeutic inertia in type 2 diabetes and focusing on reducing overall cardiovascular risk. DISCUSSION: This article discusses approaches to reducing treatment inertia in type 2 diabetes (ie identify the problem, get permission, set goals, measure progress and alter treatment to reach those goals). The treat-to-target methodology, the STABLE (Smoking cessation, Target organ involvement, HbA1c, Blood pressure, Lipid profile, Energy balance) acronym and practical approaches are described.
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Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/terapia , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/terapia , Hemoglobina Glucada/análisisRESUMEN
Snow leopards (Panthera uncia) are elusive predators inhabiting high-altitude and mountainous rugged habitats. The current study was conducted in the Yanchiwan National Nature Reserve, Gansu Province, China, to assess the habitat suitability of snow leopards and identify key environmental factors inducing their distribution. Field data collected between 2019 and 2022 through scat sampling and camera trapping techniques provided insights into snow leopard habitat preferences. Spatial distribution and cluster analyses show distinct hotspots of high habitat suitability, mostly concentrated near mountainous landscapes. While altitude remains a critical determinant, with places above 3300 m showing increased habitat suitability, other factors such as soil type, human footprint, forest cover, prey availability, and human disturbance also play important roles. These variables influence ecological dynamics and are required to assess and manage snow leopard habitats. The MaxEnt model has helped us to better grasp these issues, particularly the enormous impact of human activities on habitat suitability. The current study highlights the importance of altitude in determining snow leopard habitat preferences and distribution patterns in the reserve. Furthermore, the study underscores the significance of considering elevation in conservation planning and management strategies for snow leopards, particularly in mountainous regions. By combining complete environmental data with innovative modeling tools, this study not only improves local conservation efforts but also serves as a model for similar wildlife conservation initiatives around the world. By understanding the environmental factors driving snow leopard distribution, conservation efforts can be more efficiently directed to ensure the long-term survival of this endangered species. This study provides valuable insights for evidence-based conservation efforts to safeguard the habitats of snow leopards amidst emerging anthropogenic pressure and environmental fluctuations.
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In this study, hydrogel beads were fabricated using alginate (Algt) polymer containing dispersed nickel phthalocyanine (NTC) nanomaterial. The viscous solution of Algt and NTC was poured dropwise into a divalent Ca2+ ions, resulting in the formation of hydrogel beads known as NTC@Algt-BDs. The surface of the NTC@Algt-BDs was further modified by coating them with different types of metal ions, yielding metal-coated M+/NTC@Algt-BDs. The adsorbed metal ions i.e., Cu+2, Ag+, Ni+2, Co+2, and Fe+3 were subsequently reduced to zero-valent metal nanoparticles (M0) by NaBH4. The prepared beads were characterized using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS). Initially, M0/NTC@Algt-BDs were examined for the catalytic reduction of 4-nitrophenol (4-NP) to 4-aminophenol (4-AP). Among them, Cu0/NTC@Algt-BDs catalyst exhibited the highest reduction rate and therefore, investigated for reduction of different nitrophenols (NPs) and dyes, including 2-nitrophenol (2-NP), 2,6-dinitrophenol (2,6-DNP), methyl orange (MO), potassium ferrocyanide (PFC), congo red (CR), and acridine orange (ArO). The highest reduction rates of 2.019 and 1.394 min-1 were observed for MO and 2-NP, respectively. Furthermore, the fabricated catalysts were employed for the efficient production of H2 gas by NaBH4 methanolysis. Among which the Ag0/NTC@Algt-BDs catalyst showed excellent catalytic production of H2 gas, exhibiting the lowest activation energy (Ea) of 25.169 kJ/mol at ambient temperature. Furthermore, the impact of NaBH4 amount, and catalyst dosage on the reduction of 2-NP and H2 gas production was conducted whereas the effect of temperature on methanolysis of NaBH4 for evolution of H2 gas was studied. The amount of H2 gas was confirmed by GC-TCD system. Additionally, the recyclability of the catalyst was investigated, as it garnered significant research interest.
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Alginatos , Hidrógeno , Alginatos/química , Catálisis , Hidrógeno/química , Contaminantes Ambientales/química , Indoles/química , Propiedades de Superficie , Nitrofenoles/química , Microesferas , Hidrogeles/química , AdsorciónRESUMEN
The inevitable impacts of climate change have reverberated across ecosystems and caused substantial global biodiversity loss. Climate-induced habitat loss has contributed to range shifts at both species and community levels. Given the importance of identifying suitable habitats for at-risk species, it is imperative to assess potential current and future distributions, and to understand influential environmental factors. Like many species, the Demoiselle crane is not immune to climatic pressures. Khyber Pakhtunkhwa and Balochistan provinces in Pakistan are known wintering grounds for this species. Given that Pakistan is among the top five countries facing devastating effects of climate change, this study sought to conduct species distribution modeling under climate change using data collected during 4 years of field surveys. We developed a Maximum Entropy distribution model to predict the current and projected future distribution of the species across the study area. Future habitat projections for 2050 and 2070 were carried out using two representative concentration pathways (RCP 4.5 and RCP 8.5) under three global circulation models, including HADGEM2-AO, BCC-CSM1-1, and CCSM4. The most influential factors shaping Demoiselle Crane habitat suitability included the temperature seasonality, annual mean temperature, terrain ruggedness index, and human population density, all of which contributed significantly to the suitability (81.3%). The model identified 35% of the study area as moderately suitable (134,068 km2) and highly suitable (27,911 km2) habitat for the species under current climatic conditions. Under changing climate scenarios, our model predicted a major loss of the species' current suitable habitat, with shrinkage and shift towards western-central areas along the Pakistan-Afghanistan boarder. The RCP 8.5, which is the extreme climate change scenario, portrays particularly severe consequences, with habitat losses reaching 65% in 2050 and 85% in 2070. This comprehensive study provides useful insights into the Demoiselle Crane habitat's current and future dynamics in Pakistan.
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INTRODUCTION: The use of continuous positive airway pressure has been shown to improve the tolerance of the apnea test, a critical component of brain death evaluation. The ability to deactivate the apnea backup setting has made apnea testing possible using several conventional mechanical ventilators. Our goal was to evaluate the safety and efficacy of apnea testing performed on mechanical ventilation, compared with the oxygen insufflation technique, for the determination of brain death. METHODS: This was a retrospective study. In 2016, our institution approved a change in policy to permit apnea testing on conventional mechanical ventilation. We examined the records of consecutive adults who underwent apnea testing as part of the brain death evaluation process between 2016 and 2022. Using an apnea test technique was decided at the discretion of the attending physician. Outcomes were successful apnea test and the occurrence of patient instability during the test. This included oxygen desaturation (SpO2) < 90%, hypotension (mean arterial pressure < 65 mm Hg despite titration of vasopressor), cardiac arrhythmia, pneumothorax, and cardiac arrest. RESULTS: Ninety-two adult patients underwent apnea testing during the study period: 58 (63%) with mechanical ventilation, 32 (35%) with oxygen insufflation, and 2 (2%) lacked documentation of technique. Apnea tests could not be completed successfully in 3 of 92 (3%) patients-two patients undergoing the oxygen insufflation technique (one patient with hypoxemia and one patient with hypotension) and one patient on mechanical ventilation (aborted for hemodynamic instability). Hypoxemia occurred in 4 of 32 (12.5%) patients with oxygen insufflation and in zero patients on mechanical ventilation (p = 0.01). Hypotension occurred during 3 of 58 (5%) tests with mechanical ventilation and 4 of 32 (12.5%) tests with oxygen insufflation (p = 0.24). In multivariate analysis, the use of oxygen insufflation was an independent predictor of patient instability during the apnea test (odds ratio 37.74, 95% confidence interval 2.74-520.14). CONCLUSIONS: Apnea testing on conventional mechanical ventilation is feasible and offers several potential advantages over other techniques.
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Apnea , Muerte Encefálica , Respiración Artificial , Humanos , Muerte Encefálica/diagnóstico , Apnea/terapia , Apnea/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Respiración Artificial/métodos , Adulto , Anciano , Presión de las Vías Aéreas Positiva Contínua/métodos , Insuflación/métodos , OxígenoRESUMEN
Introduction: A patient safety culture primarily refers to the values, beliefs, attitudes, and behaviors within a healthcare setup in a community that assists in prioritizing patient safety and encouraging the reporting of errors and near-misses in that facility. There is a direct impact of patient safety culture on how well patient safety and quality improvement programs work. The aim of this cross-sectional descriptive study was to investigate the practices to improve patient safety culture and adverse event reporting practices among healthcare professionals in a tertiary care hospital located in Mirpur Azad Jammu and Kashmir. Methods: In the non-probability convenience sampling of this cross-sectional study, Divisional Headquarters Teaching Hospital in Mirpur, Azad Kashmir used the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture Hospital Survey to collect data about the perceptions of healthcare professionals regarding patient safety culture within their hospital to assess the trends of patient safety culture by obtaining longitudinal data. A pre-validated questionnaire that has undergone a rigorous trial of testing to maximize the reliability and accuracy of the outcomes was distributed among clinical staff (healthcare professionals who interact with patients on a daily basis, such as nurses, doctors, pharmacists, and laboratory technicians) and administrative staff (medical superintendent, deputy medical superintendent, assistant medical superintendent, heads of departments). Results: A total of 312 questionnaires were returned (response rate, 76%). The study found that the dimension "supervisor/manager expectation and action promoting safety" had the highest positive response rate (65.16%), and "nonpunitive response" had the lowest (27.4%). Higher scores in "nonpunitive response to error" were associated with lower rates of medication errors, pressure ulcers, and surgical site infections, and higher scores in "frequency of event reporting" were associated with lower rates of medication errors, pressure ulcers, falls, hospital-acquired infections, and urinary tract infections. Conclusion: We suggest that in order for hospital staff to continue providing excellent, clinically safe treatment, a well-structured hospital culture promoting patient safety is necessary. Moreover, further study is needed to determine strategies to improve patient safety expertise and awareness, and lower the frequency of adverse occurrences.
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Accurate evaluation of fish stock biomass is essential for effective conservation management and targeted species enhancement efforts. However, this remains challenging owing to limited data availability. Therefore, we present an integrated modeling framework combining catch per unit effort with ensemble species distribution modeling called CPUESDM, which explicitly assesses and validates the spatial distribution of stock biomass for freshwater fish species with limited data, applied to Herzensteinia microcephalus. The core algorithm incorporates the Leslie regression model, ensemble species distribution modeling, and exploratory spatial interpolation techniques. We found that H. microcephalus biomass in the Yangtze River source area yielded an initial estimate of 113.52 tons. Our validation results demonstrate high accuracy with a Cohen's kappa coefficient of 0.78 and root mean square error of 0.05. Furthermore, our spatially-explicit, global, absolute biomass density map effectively identified areas with high and low concentrations of biomass distribution centers. Additionally, this study offers access to the source code, example raw data, and a step-by-step instruction manual for other researchers using field data to explore the application of this model. Our findings can help inform for future conservation efforts around fish stock biomass estimation, especially for endangered species.
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Cyprinidae , Agua Dulce , Animales , Biomasa , Tibet , Peces , China , EcosistemaRESUMEN
Global forest area has declined over the past few years, forest quality has declined, and ecological and environmental events have increased with climate change and human activity. In the context of ecological civilization, forest health issues have received unprecedented attention. By improving forest health, forests can better perform their ecosystem service functions and promote green development. This study was carried out in the WuZhi Shan area of Hainan Tropical Rainforest National Park. We employed a decision tree algorithm, a machine learning technique, for our modeling due to its high accuracy and interpretability. The objective weighted method using criteria of importance through intercriteria correlation (CRITIC) was used to determine forest health classes based on survey and experimental data from 132 forest samples. The results showed that species diversity is the most important metric to measure forest health. An interpretable decision tree machine learning model was proposed to incorporate forest health indicators, providing up to 90% accuracy in the classification of forest health conditions. The model demonstrated a high degree of effectiveness, achieving an average precision of 90%, a recall of 67%, and an F1 score of 70.2% in predicting forest health. The interpretable decision tree classification results showed that breast height diameter is the most important variable in classifying the health status of both primary and secondary forests. This study highlights the importance of using interpretable machine learning methods for the decision-making process. Our work contributes to the scientific underpinnings of sustainable forest development and effective conservation planning.
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In the catalytic reduction of various environment pollutants, cobalt-doped tin oxide, i.e., Co-SnO2 intercalated gelatin (GL) hydrogel nanocomposite was prepared via direct mixing of Co-SnO2 doped with GL. Then, it was crosslinked internally using formaldehyde within a viscous solution of gelatin polymer, which led to the formation of GL/Co-SnO2 hydrogel nanocomposite. GL/Co-SnO2 hydrogel nanocomposite was fully characterized by using field-emission scanning electron microscopy (FESEM), energy dispersive X-ray spectroscopy (EDX), powder X-ray diffraction (XRD), and attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FTIR). The FESEM images indicate that the Co-SnO2 composite has a spherical structure on the GL matrix while EDX elucidates the elemental composition of each atom in the crosslinked GL/Co-SnO2 hydrogel nanocomposite. The GL/Co-SnO2 nanocomposite was checked for the reduction of various pollutants, including 2-nitro-phenol (2-NP), 2,6-dinitro-phenol (2,6-DNP), 4-nitro-phenol (4-NP), Congo red (CR), and methyl orange (MO) dyes with a strong sodium borohydride (NaBH4) reducing agent. The GL/Co-SnO2 nanocomposite synergistically reduced the MO in the presence of the reducing agent with greater reduction rate of 1.036 min-1 compared to other dyes. The reduction condition was optimized by changing various parameters, such as the catalyst amount, dye concentration, and the NaBH4 amount. Moreover, the GL/Co-SnO2 nanocomposite catalyst can be easily recovered, is recyclable, and revealed minimal loss of nanomaterials.
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Ketoacidosis, a type of high anion gap metabolic acidosis, results from 1 of 3 etiologies: diabetic ketoacidosis, alcoholic ketoacidosis, or starvation ketoacidosis (SKA). In rare instances, young and otherwise healthy lactating women have been found to develop lactation ketoacidosis, a form of SKA, when the high energy requirements of breastfeeding are not met with adequate carbohydrate intake. We present the case of a 29-year-old woman who presented to our emergency department with respiratory distress and headache and was found to have severe lactation ketoacidosis. The patient was treated with infusions of dextrose and bicarbonate in the emergency department and medical intensive care unit. She was discharged without complication 3 days later, after nutrition and lactation consultation. This case highlights both the importance of maintaining a broad differential diagnosis that includes lactation ketoacidosis and performing a careful interview to identify patient populations at risk for this pathology.
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Water pollution reached worrying point due to different dye pollutants which demands an instant solution. One of the best ways to manage water pollutants is their reduction and decolorization to less-toxic and useful compounds. However, reduction process requires an effective, stable, and recyclable catalyst to reduce such pollutants more effectively. Metal nanoparticles (M0) are highly effective catalysts but separation of nanoparticles after reaction is difficult and requires a high-speed centrifugation. If loaded on polymer-beads, they can be easily separated from the reaction-mixture. Hearin, alginate/glycyl leucine (AGL) hybrid-beads were prepared, and copper nanoparticles (Cu0) were grown on it by simple process. M0/AGL bead catalysts were tested toward reducing various toxic compounds. Among all developed composite-beads, the catalytic performance of Cu0/AGL was highest in terms of reduction kinetics. After initial screening for different pollutants, Cu0/AGL was much more effective for MO reduction, thus, all optimized different parameters i.e., catalyst dosage, stability, amount of reducing-agent and recyclability were experimentally determined. The Cu0/AGL showed high-rate constants (kapp) of 0.7566 and 2.9506 min-1 depending on beads content. The reusability of the Cu0/AGL catalysts up to the 7th cycle has been checked. With the use of AGL as support for the Cu nanoparticles, not only the catalytic activity was retained for longer times during reusability, but it helped in their easy separation.
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Contaminantes Ambientales , Nanopartículas del Metal , Purificación del Agua , Alginatos , Cobre , LeucinaRESUMEN
In the present study, a biopolymer nanocomposite hydrogel based on gelatin and tin-doped gadolinium oxide (Sn-Gd2O3@GH) was prepared for the efficient reduction of water pollutants. The method of Sn-Gd2O3@GH preparation consisted of two steps. A Sn-Gd2O3 nanomaterial was synthesized by a hydrothermal method and mixed with a hot aqueous solution (T > 60 °C) of gelatin polymer, followed by cross-linking. Due to the presence of abundant functional groups on the skeleton of gelatin, such as carboxylic acid (-COOH) and hydroxyl (-OH), it was easily cross-linked with formaldehyde. The structure, morphology, and composition of Sn-Gd2O3@GH were further characterized by the FESEM, XRD, EDX, and FTIR techniques. The FESEM images located the distribution of the Sn-Gd2O3 nanomaterial in a GH matrix of 30.06 nm. The XRD patterns confirmed the cubic crystalline structure of Gd2O3 in a nanocomposite hydrogel, while EDS elucidated the elemental composition of pure Sn-Gd2O3 powder and cross-linked the Sn-Gd2O3@GH samples. The synthesized Sn-Gd2O3@GH nanocomposite was used for the removal of different azo dyes and nitrophenols (NPs). It exhibited an efficient catalytic reduction of Congo red (CR) with a reaction rate of 9.15 × 10-1 min-1 with a strong NaBH4-reducing agent. Moreover, the Sn-Gd2O3@GH could be easily recovered by discharging the reduced (colourless) dye, and it could be reused for a fresh cycle.
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Over the years, the vaste expansion of plastic manufacturing has dramatically increased the environmental impact of microplastics [MPs] and nanoplastics [NPs], making them a threat to marine and terrestrial biota because they contain endocrine disrupting chemicals [EDCs] and other harmful compounds. MPs and NPs have deleteriouse impacts on mammalian endocrine components such as hypothalamus, pituitary, thyroid, adrenal, testes, and ovaries. MPs and NPs absorb and act as a transport medium for harmful chemicals such as bisphenols, phthalates, polybrominated diphenyl ether, polychlorinated biphenyl ether, organotin, perfluorinated compounds, dioxins, polycyclic aromatic hydrocarbons, organic contaminants, and heavy metals, which are commonly used as additives in plastic production. As the EDCs are not covalently bonded to plastics, they can easily leach into milk, water, and other liquids affecting the endocrine system of mammals upon exposure. The toxicity induced by MPs and NPs is size-dependent, as smaller particles have better absorption capacity and larger surface area, releasing more EDC and toxic chemicals. Various EDCs contained or carried by MPs and NPs share structural similarities with specific hormone receptors; hence they interfere with normal hormone receptors, altering the hormonal action of the endocrine glands. This review demonstrates size-dependent MPs' bioaccumulation, distribution, and translocation with potential hazards to the endocrine gland. We reviewed that MPs and NPs disrupt hypothalamic-pituitary axes, including the hypothalamic-pituitary-thyroid/adrenal/testicular/ovarian axis leading to oxidative stress, reproductive toxicity, neurotoxicity, cytotoxicity, developmental abnormalities, decreased sperm quality, and immunotoxicity. The direct consequences of MPs and NPs on the thyroid, testis, and ovaries are documented. Still, studies need to be carried out to identify the direct effects of MPs and NPs on the hypothalamus, pituitary, and adrenal glands.
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Disruptores Endocrinos , Microplásticos , Animales , Masculino , Plásticos , Semen/química , Disruptores Endocrinos/toxicidad , Disruptores Endocrinos/análisis , Mamíferos , HormonasRESUMEN
The construction of hydropower projects discharges effluents to aquatic bodies. The effluents consist of different chemicals including heavy metals. The current study assessed the effects of effluents discharged from an under-construction hydropower project on the bioaccumulation of heavy metals in the tissues of critically endangered Tor putitora (Hamilton, 1822) in the river Panjkora. The subsequent toxic impacts of higher bioaccumulation of heavy metals on different biochemical, hematological, and serum biochemical profiles were also studied. Different biochemical changes were observed in the tissues of T. putitora including stress biomarkers such as reactive oxygen species, lipid peroxidation, total protein contents, antioxidant enzymes (peroxidase, superoxide dismutase, catalase, reduced glutathione, glutathione reductase, and glutathione-s-transferase), acetylcholinesterase, and whole-body cortisol. The hematotoxic effects were also observed as the count of red blood cells, hematocrit, and hemoglobin decreased whereas the count of white blood cells increased. Serum biochemical analysis revealed that cholesterol, urea, total bilirubin, and glucose concentration increased, whereas total proteins and albumin decreased with an increase in the concentration of heavy metals across the sampling sites. The fish from the river was found to be under severe stress as compared to the fish from the reference site. To mitigate the current scenario, stocking fish in an appropriate amount is suggested. The fish diversity and water quality should be assessed at regular intervals to avoid further deterioration and diversity loss. The safety and conservation of wild fisheries should be ensured by implementing strict environmental protection and fishing laws.
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The birds (class Aves) and bats (order Chiroptera, class Mammalia) are well known natural reservoirs of a diverse range of viruses, including some zoonoses. The only extant volant vertebrates, bats and birds have undergone dramatic adaptive radiations that have allowed them to occupy diverse ecological niches and colonize most of the planet. However, few studies have compared the physiology and ecology of these ecologically, and medically, important taxa. Here, we review convergent traits in the physiology, immunology, flight-related ecology of birds and bats that might enable these taxa to act as viral reservoirs and asymptomatic carriers. Many species of birds and bats are well adapted to urban environments and may host more zoonotic pathogens than species that do not colonize anthropogenic habitats. These convergent traits in birds and bats and their ecological interactions with domestic animals and humans increase the potential risk of viral spillover transmission and facilitate the emergence of novel viruses that most likely sources of zoonoses with the potential to cause global pandemics.