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Introduction: Appetitive traits are influenced by the interplay between genetic and environmental factors. This study aimed to explore the relationship between gene polymorphisms involved in the regulation of energy balance and food reward and appetitive traits in young Mexican subjects. Methods: This cross-sectional study involved 118 university freshman undergraduates who completed the Adult Eating Behaviour Questionnaire for Spanish speakers (AEBQ-Esp) to assess their appetitive traits. A real-time PCR system was employed to determine gene polymorphisms involved in energy balance (LEP rs7799039, MC4R rs17782313, FTO rs9939609, GHRL rs696217), and reward system (DRD2/ANKK1 Taq1A rs1800497 and COMT rs4680). Results: The mean age of participants was 20.14 ± 3.95 years, 71.2% were women and their mean BMI was 23.52 ± 4.05 kg/m2. COMT Met allele carriers presented a significantly higher "Emotional overeating" mean score than Val allele carriers (2.63 ± 0.70 vs. 2.23 ± 0.70, p = 0.028). The MC4R CC + CT genotype correlated positively with "Emotional overeating" (Phi = 0.308, p = 0.01). The COMT MetMet+MetVal genotype correlated with higher "Emotional overeating" (r = 0.257, p = 0.028; Phi = 0.249, p = 0.033). The protective genotype FTO TT correlated positively with "Emotional undereating" (Phi = 0.298, p = 0.012). Carriers of the risk genotype MC4R CC + CT presented a higher risk of "Emotional overeating" than TT carriers (OR = 2.4, 95% CI 1.3-4.8, p = 0.034). Carriers of the risk genotype COMT MetMet+MetVal (OR = 3.4, 95% CI 1.1-10.3, p = 0.033), were associated with a higher risk of "Emotional overeating" than ValVal carriers. The protective FTO genotype TT was associated with "Emotional undereating" (OR = 1.8, 95% CI 1.1-9.1, p = 0.014). Discussion: The study found a relationship between the protective genotypes of FTO TT and "Emotional undereating" and risk genotypes of COMT Met/Met+Met/Val and MC4R CC + CT with "Emotional overeating." These genetic factors may increase weight gain by enhancing hedonic food consumption and reducing satiety control. Future studies should focus on replication studies in ethnically diverse young adults and life stages to explore the relationship between polymorphisms and appetitive traits and weight. This will help tailor personalized nutrigenetic strategies to counteract disordered eating patterns leading to obesity and associated co-morbidities.
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Resumo: Esta tese compõe o projeto de pesquisa e desenvolvimento tecnológico "Difusão e adoção do Programa Fall TIPS: engajamento de pacientes, profissionais e liderança clínica para a prevenção de quedas em ambiente hospitalar. Está ligada à linha de Pesquisa de Gerenciamento de Serviços de Saúde e Enfermagem do Programa de Pós-Graduação em Enfermagem (PPGENF) da UFPR e teve por objetivo elaborar e validar um modelo teórico, modelo lógico e matriz de análise e julgamento do Programa Fall TIPS, em sua adaptação pioneira ao cenário brasileiro. O programa,baseado em evidências, está implantado em mais de 125 instituições de saúde no mundo, e é sustentado por mais de uma década de pesquisas. Ao utilizar-se de estratégias multimodais para a prevenção de quedas hospitalares, consiste em um conjunto de ferramentas e instrumentos. Seu diferencial está no engajamento de profissionais de saúde, pacientes e acompanhantes no desenvolvimento e execução, em conjunto, de um plano personalizado para prevenção de quedas entre pacientes internados. Trata-se de um estudo de avaliabilidade (EA), realizado em um hospital público e de ensino, na cidade de Curitiba, no Paraná, no período de 2021 a 2023. Utilizou-se o referencial de Trevisan e Walser mediante componentes como: definição do foco do estudo de avaliabilidade; desenvolvimento de uma teoria inicial do programa; coleta de feedback sobre a teoria do programa; e considerações sobre os usos do estudo de avaliabilidade. Contou com uma etapa documental e outra participativa. Na etapa documental foram analisadas legislações, diretrizes e publicações sobre segurança do paciente, prevenção de quedas e sobre o Programa Fall TIPS. A etapa participativa foi resultante de oficinas, junto a 15 profissionais de saúde ligados a um hospital público e de ensino, indicados pela gestão hospitalar. Posteriormente, os construtos provenientes foram validados, em oficinas, por três enfermeiras ligadas à docência e assistência, convidadas por suas atuações em avaliação, segurança do paciente e gestão de riscos assistenciais, além de conhecimentos prévios sobre o Programa Fall TIPS. Os dados da etapa documental foram analisados à luz de pontos-chave sobre o programa e sobre o problema que se propõe a enfrentar. Os dados oriundos das oficinas junto a profissionais de saúde e informantes-chave foram analisados por Análise de Conteúdo, mediante categorias de análise previamente definidas: contextos interno e externo à instituição hospitalar, recursos, objetivos, atividades, produtos, resultados, impacto, metas e questões ligadas à execução do programa em instituições de saúde. O estudo possibilitou melhor conhecimento do programa e da temática prevenção de quedas hospitalares. Ainda, ao ser disponibilizado em website brasileiro do programa, isso contribuirá para a disseminação do programa, adoção por profissionais de saúde e instituições de saúde interessadas e condução de processos avaliativos.
Abstract: This thesis entails the project of research and technological development "Dissemination and adoption of the Fall TIPS Program": engagement of patients, professionals and clinical leadership for fall prevention within hospital settings". It is connected with the line of research of Health and Nursing Services Management of the Postgraduation Program in Nursing at the Federal University of Paraná (PPGENF- UFPR). It aimed to elaborate and validate a theoretical model, logic model and matrix of analysis and judgement of the Fall TIPS Program in its pioneer adaptation to the Brazilian setting. The evidence-based program has been implemented in over 125 health institutions worldwide, and it is supported by over a decade of research. It consists of a set of tools and instruments by using multimodal strategies for hospital fall prevention. Its differential lies in the engagement of health professionals, patients and their companions in the joint development and execution of a personalized fall prevention plan among hospitalized patients. It is an availability study (AS) conducted in a public teaching hospital in the city of Curitiba, Paraná State Brazil from 2021 to 2023. Trevisan and Walser's theoretical framework was used by means of components as follows: definition of the focus of the availability study; development of an initial theory of the program; feedback collection on the program theory; and considerations on the use of the availability study. It comprised documentary and participating steps. In the documentary step, legislations, guidelines and publications on patient safety, fall prevention, and on the Fall TIPS Program were analyzed. The participating step resulted from workshops with 15 health professionals from the public teaching hospital, appointed by the hospital management. Subsequently, the resulting constructs were validated, during the workshops, by three teaching and health care nurses, invited by their performance in assessment, patient's safety and management of health care hazards, in addition to their previous knowledge on the Fall TIPS Program. The data from the documentary step were analyzed in light of the key points on the program and on the aimed problem. The data gathered from the workshops with the health professionals and key informants were analyzed by the Content Analysis, by means of previously defined analysis categories, as follows: internal and external contexts to the hospital institution; resources, objectives, activities, products, results, impact, goals and questions related to the program execution within health institutions. The study enabled better knowledge of the program and the thematics of hospital fall prevention. In addition, the release of the program in its Brazilian website will contribute to the dissemination and adoption of the program by health professionals and interested health institutions, with the execution of evaluation processes.
Subject(s)
Humans , Male , Female , Risk Management , Accidental Falls , Program Evaluation , Patient Safety , Work Engagement , HospitalsABSTRACT
Hybrid materials have been studied because in these materials the properties of organic components, such as elasticity and biodegradability, could be combined with the properties of inorganic components, such as good biological response, thereby transforming them into a single material with improved properties. In this work, Class I hybrid materials based on polyester-urea-urethanes and titania were obtained using the modified sol-gel method. This was corroborated using the FT-IR and Raman techniques which highlighted the formation of hydrogen bonds and the presence of Ti-OH groups in the hybrid materials. In addition, the mechanical and thermal properties and degradability were measured using techniques, such as Vickers hardness, TGA, DSC, and hydrolytic degradation; these properties could be tailored according to hybridization between both organic and inorganic components. The results show that Vickers hardness increased by 20% in hybrid materials as compared to polymers; also, the surface hydrophilicity increases in the hybrid materials, improving their cell viability. Furthermore, cytotoxicity in vitro test was carried out using osteoblast cells for intended biomedical applications and they showed non-cytotoxic behavior.
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The growth of additive manufacturing processes has enabled the production of complex and smart structures. These fabrication techniques have led research efforts to focus on the application of cellular materials, which are known for their thermal and mechanical benefits. Herein, we studied the mechanical behavior of stainless-steel (AISI 316L) lattice structures both experimentally and computationally. The lattice architectures were body-centered cubic, hexagonal vertex centroid, and tetrahedron in two cell sizes and at two different rotation angles. A preliminary computational study assessed the deformation behavior of porous cylindrical samples under compression. After the simulation results, selected samples were manufactured via laser powder bed fusion. The results showed the effects of the pore architecture, unit cell size, and orientation on the reduction in the mechanical properties. The relative densities between 23% and 69% showed a decrease in the bulk material stiffness up to 93%. Furthermore, the different rotation angles resulted in a similar porosity level but different stiffnesses. The simulation analysis and experimental results indicate that the variation in the strut position with respect to the force affected the deformation mechanism. The tetrahedron unit cell showed the smallest variation in the elastic modulus and off-axis displacements due to the cell orientation. This study collected computational and experimental data for tuning the mechanical properties of lattice structures by changing the geometry, size, and orientation of the unit cell.
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Personalized gamification aims to address shortcomings of the one-size-fits-all (OSFA) approach in improving students' motivations throughout the learning process. However, studies still focus on personalizing to a single user dimension, ignoring multiple individual and contextual factors that affect user motivation. Unlike prior research, we address this issue by exploring multidimensional personalization compared to OSFA based on a multi-institution sample. Thus, we conducted a controlled experiment in three institutions, comparing gamification designs (OSFA and Personalized to the learning task and users' gaming habits/preferences and demographics) in terms of 58 students' motivations to complete assessments for learning. Our results suggest no significant differences among OSFA and Personalized designs, despite suggesting user motivation depended on fewer user characteristics when using personalization. Additionally, exploratory analyses suggest personalization was positive for females and those holding a technical degree, but negative for those who prefer adventure games and those who prefer single-playing. Our contribution benefits designers, suggesting how personalization works; practitioners, demonstrating to whom the personalization strategy was more or less suitable; and researchers, providing future research directions. Supplementary Information: The online version contains supplementary material available at 10.1007/s40593-022-00326-x.
ABSTRACT
In this work, polyamide 6 (PA6) properties were tailored and improved using a maleic anhydride-grafted acrylonitrile-butadiene-styrene terpolymer (ABS-MA). The PA6/ABS-MA blends were prepared using a co-rotational twin-screw extruder. Subsequently, the extruded pellets were injection-molded. Blends were characterized by torque rheometry, the Molau test, Fourier transform infrared spectroscopy (FTIR), impact strength, tensile strength, Heat Deflection Temperature (HDT), Differential Scanning Calorimetry (DSC), Thermogravimetry (TG), Contact Angle, Scanning Electron Microscopy (SEM), and water absorption experiments. The most significant balance of properties, within the analyzed content range (5, 7.5, and 10 wt.%), was obtained for the PA6/ABS-MA (10%) blend, indicating that even low concentrations of ABS-MA can improve the properties of PA6. Significant increases in impact strength and elongation at break have been achieved compared with PA6. The elastic modulus, tensile strength, HDT, and thermal stability properties of the PA6/ABS-MA blends remained at high levels, indicating that maleic anhydride interacted with amine end-groups of PA6. Torque rheometry, the Molau test, and SEM analysis suggested interactions in the PA6/ABS-MA system, confirming the high properties obtained. Additionally, there was a decrease in water absorption and the diffusion coefficient of the PA6/ABS-MA blends, corroborating the contact angle analysis.
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ABSTRACT Growth hormone (GH) deficiency (GHD) in adults is well-characterized and includes abnormal body composition, reduced bone mass, an adverse cardiovascular risk profile, and impaired quality of life. In the early 1990s, it was also shown that patients with hypopituitarism without GH replacement therapy (GHRT) had excess mortality. Today, GHRT has been shown to decrease or reverse the negative effects of GHD. In addition, recent papers have shown that mortality and morbidity are approaching normal in hypopituitary patients with GHD who receive modern endocrine therapy including GHRT. Since the first dose-finding studies, it has been clear that efficacy and side effects differ substantially between patients. Many factors have been suggested as affecting responsiveness, such as sex, age, age at GHD onset, adherence, and GH receptor polymorphisms, with sex and sex steroid replacement having the greatest impact. Therefore, the individual tailoring of GH dose is of great importance to achieve sufficient efficacy without side effects. One group that stands out is women receiving oral estrogen replacement, who needs the highest dose. Serum insulin-like growth factor-1 (IGF-1) is still the most used biochemical biomarker for GH dose titration, although the best serum IGF-1 target is still debated. Patients with GHD due to acromegaly, Cushing's disease, or craniopharyngioma experience similar effects from GHRT as others. Arch Endocrinol Metab. 2019;63(6):592-600
Subject(s)
Humans , Male , Female , Adult , Human Growth Hormone/administration & dosage , Human Growth Hormone/deficiency , Hormone Replacement Therapy/methods , Medication Adherence , Precision Medicine , Quality of Life , Age of OnsetABSTRACT
BACKGROUND: Arabinoxylans (AX) are polysaccharides consisting of a backbone of xyloses with arabinose substituents ester-linked to ferulic acid (FA). The arabinose to xylose ratio (A/X) in AX may vary from 0.3 to 1.1. AX form covalent gels by cross-linking of FA but physical interactions between AX chains also contribute to the network formation. The present study aimed to investigate the rheological and microstructural characteristics of gels based on AX enzymatically modified in A/X. RESULTS: Tailored AX presented A/X ranging from 0.68 to 0.51 and formed covalent gels. Dimers of FA content and elasticity (G') increased from 0.31 to 0.39 g kg-1 AX and from 106 to 164 Pa when the A/X in the polysaccharide decreased from 0.68 to 0.51. Atomic force microscopy images of AX gels showed a sponge-like microstructure at A/X = 0.68, whereas, at lower values, gels presented a more compact microstructure. Scanning electron microscopy analysis of AX gels show an arrangement of different morphology, passing from an imperfect honeycomb (A/X = 0.68) to a flake-like microstructure (A/X = 0.51). CONCLUSION: Lower A/X values favor the aggregation of AX chains resulting in an increase in di-FA content, which improves the rheological and microstructural characteristics of the gel formed. © 2017 Society of Chemical Industry.
Subject(s)
Arabinose/chemistry , Plant Extracts/chemistry , Triticum/chemistry , Xylans/chemistry , Xylose/chemistry , Biocatalysis , Elasticity , Food Handling , Gels/chemistry , Glycoside Hydrolases/chemistry , Laccase , Rheology , ViscosityABSTRACT
ABSTRACT BACKGROUND AND OBJECTIVES: Achieving good clinical practice in the use of opioids as part of a comprehensive pain management regimen can face significant challenges. Despite guidelines from governmental and pain society/organization sources, there are still significant hurdles. A review of some basic tenets of opioid analgesia based on current published knowledge and experiences about this important healthcare imperative is warranted. CONTENT: Consistent with guidelines, the literature supports using the lowest total opioid dose that provides adequate pain control with the fewest adverse effects. Titration (or trial) during opioid initiation is a way of starting low and going slow (and assessing the appropriateness of a specific opioid and formulation). Recognizing that multiple factors contribute to an individual's personal experience of pain, the physical, psychological, social, cultural, spiritual, pharmacogenomic, and behavioral factors of the individual patient should be taken into account (tweaking, or tailoring). Finally, for those patients for whom transition (tapering) from opioid is desired, doing so too rapidly can have negative consequences and minimization of problems during this step can be achieved by proper tapering. CONCLUSION: We conclude that a simultaneously aggressive, yet conservative, approach is advocated in the literature in which opioid therapy is divided into three key steps (the 3 T's): titration (or trial), tweaking (or tailoring), and transition (or tapering). Establishment of the 3 T's along with the application of other appropriate good medical practice and clinical experience/judgment, including non-pharmacologic approaches, can assist healthcare providers in the effort to achieve optimal management of pain.
RESUMO JUSTIFICATIVA E OBJETIVOS: Uma boa prática clínica com o uso de opioides como parte de um regime abrangente de tratamento da dor pode enfrentar desafios significativos. Apesar das diretrizes provenientes de sociedades/organizações não governamentais para o manejo da dor, ainda existem obstáculos significativos. A revisão de alguns princípios básicos da analgesia com opioide com base na experiência e no conhecimento das publicações atuais sobre esse cuidado importante da saúde é justificável. CONTEÚDO: De acordo com as diretrizes, a literatura apoia o uso da dose total mais baixa de opioides que forneça o controle adequado da dor com menos efeitos adversos. A titulação (teste), ao iniciar a administração de um opioide, é uma maneira de começar com uma concentração baixa e ir devagar (avaliar a adequação da fórmula específica de um opioide). O ajuste (individualização) é reconhecer que vários fatores contribuem para a experiência pessoal da dor de um indivíduo, tais como fatores físicos, psicológicos, sociais, culturais, espirituais, farmacogenômicos e comportamentais. Finalmente, para aqueles pacientes nos quais a transição (redução gradual) do opioide é desejada, fazer essa transição muito rapidamente pode ter consequências negativas e é possível minimizar os problemas durante essa etapa por meio de uma redução gradual. CONCLUSÃO: Uma abordagem simultânea, agressiva, porém conservadora, é defendida na literatura em que a terapia com opioides é dividida em três etapas principais (os 3 Ts - em inglês: titration, tailoring, tapering): titulação (teste), ajuste (individualização) e transição (redução gradual). Estabelecer os três Ts, juntamente com a aplicação de outra boa prática médica e experiência/julgamento clínico, incluindo abordagens não farmacológicas, pode ajudar os profissionais de saúde no esforço para alcançar o tratamento ideal da dor.
Subject(s)
Humans , Practice Guidelines as Topic , Chronic Pain/drug therapy , Pain Management/methods , Analgesics, Opioid/therapeutic use , Clinical ProtocolsABSTRACT
BACKGROUND AND OBJECTIVES: Achieving good clinical practice in the use of opioids as part of a comprehensive pain management regimen can face significant challenges. Despite guidelines from governmental and pain society/organization sources, there are still significant hurdles. A review of some basic tenets of opioid analgesia based on current published knowledge and experiences about this important healthcare imperative is warranted. CONTENT: Consistent with guidelines, the literature supports using the lowest total opioid dose that provides adequate pain control with the fewest adverse effects. Titration (or trial) during opioid initiation is a way of starting low and going slow (and assessing the appropriateness of a specific opioid and formulation). Recognizing that multiple factors contribute to an individual's personal experience of pain, the physical, psychological, social, cultural, spiritual, pharmacogenomic, and behavioral factors of the individual patient should be taken into account (tweaking, or tailoring). Finally, for those patients for whom transition (tapering) from opioid is desired, doing so too rapidly can have negative consequences and minimization of problems during this step can be achieved by proper tapering. CONCLUSION: We conclude that a simultaneously aggressive, yet conservative, approach is advocated in the literature in which opioid therapy is divided into three key steps (the 3 T's): titration (or trial), tweaking (or tailoring), and transition (or tapering). Establishment of the 3 T's along with the application of other appropriate good medical practice and clinical experience/judgment, including non-pharmacologic approaches, can assist healthcare providers in the effort to achieve optimal management of pain.
Subject(s)
Analgesics, Opioid/therapeutic use , Chronic Pain/drug therapy , Pain Management/methods , Practice Guidelines as Topic , Clinical Protocols , HumansABSTRACT
BACKGROUND AND OBJECTIVES: Achieving good clinical practice in the use of opioids as part of a comprehensive pain management regimen can face significant challenges. Despite guidelines from governmental and pain society/organization sources, there are still significant hurdles. A review of some basic tenets of opioid analgesia based on current published knowledge and experiences about this important healthcare imperative is warranted. CONTENT: Consistent with guidelines, the literature supports using the lowest total opioid dose that provides adequate pain control with the fewest adverse effects. Titration (or trial) during opioid initiation is a way of starting low and going slow (and assessing the appropriateness of a specific opioid and formulation). Recognizing that multiple factors contribute to an individual's personal experience of pain, the physical, psychological, social, cultural, spiritual, pharmacogenomic, and behavioral factors of the individual patient should be taken into account (tweaking, or tailoring). Finally, for those patients for whom transition (tapering) from opioid is desired, doing so too rapidly can have negative consequences and minimization of problems during this step can be achieved by proper tapering. CONCLUSION: We conclude that a simultaneously aggressive, yet conservative, approach is advocated in the literature in which opioid therapy is divided into three key steps (the 3 T's): titration (or trial), tweaking (or tailoring), and transition (or tapering). Establishment of the 3 T's along with the application of other appropriate good medical practice and clinical experience/judgment, including non-pharmacologic approaches, can assist healthcare providers in the effort to achieve optimal management of pain.
ABSTRACT
Apple-peel atresia (or Type-IIIb intestinal atresia) is an unusual type of jejunoileal atresia. They present with jejunal atresia near the ligament of Treitz and a foreshortened small bowel. Many surgical options have been used, but the optimal method of repair remains unclear. We present a case of a newborn with apple-peel intestinal atresia managed by enteroplasty for intestinal lengthening and primary anastomosis.