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BACKGROUND: Rising health care costs and consequent increases in Medicare reimbursements have led to many payment reforms over the years. Implementation of the prospective payment system (PPS) for hospitals in 1983 incentivized hospitals to either purchase skilled nursing facilities (SNFs) or utilize their excess capacity to establish one within the hospital. With PPS reimbursement being applied to SNFs in 1998, prior monetary incentives for hospitals to own an SNF disappeared. However, despite the reduction in numbers, many hospitals continued to operate their hospital-based skilled nursing facilities (HBSNFs). PURPOSE: This study examines the organizational and market-level factors associated with the survival of HBSNFs using the population ecology of organizations framework. METHODOLOGY: Using American Hospital Association survey data, event histories of all U.S. acute care hospitals with an open HBSNF in 1998 were plotted to examine if a hospital closed its HBSNF during a 22-year period (1998-2020). The primary independent variables included hospital size, ownership, total margin, market competition, and Medicare Advantage penetration. The independent and control variables were lagged by 1 year. Cox regressions were conducted to estimate the hazard ratios capturing the risk of HBSNF closure. RESULTS: The results showed that HBSNFs located in large, not-for-profit hospitals and those operating in less competitive markets had greater odds of surviving. PRACTICE IMPLICATIONS: The HBSNF administrators of small, for-profit hospitals and those operating in highly competitive markets could utilize the findings of this study to judiciously allocate slack resources to their HBSNFs to keep those open given the current emphasis on continuity of care by regulatory bodies.
Subject(s)
Prospective Payment System , Skilled Nursing Facilities , Skilled Nursing Facilities/organization & administration , Humans , United States , Medicare , Economic Competition , Hospitals/statistics & numerical data , OwnershipABSTRACT
BACKGROUND: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is a major cause of morbidity and mortality. Although mechanical circulatory support (MCS) is an increasingly utilized therapeutic option in AMI-CS, studies evaluating the efficacy and safety of different forms of MCS have yielded conflicting results. This systematic review and meta-analysis aims to evaluate the safety and efficacy of different forms of MCS. METHODS: A database search was performed for studies reporting on the association of different forms of MCS with clinical outcomes in patients with AMI-CS. The primary efficacy endpoints were short term (≤30 days) and long term (>30 days) all-cause mortality. Secondary efficacy endpoints included recurrent AMI, cardiovascular (CV) mortality, device-related limb complications, moderate to severe bleeding events, and cerebrovascular accidents (CVA). RESULTS: 2752 patients with AMI-CS met inclusion criteria. Results were available comparing ECMO to other MCS or medical therapy alone, comparing IABP to medical therapy alone, and comparing pLVAD to IABP. Use of ECMO was not associated with lower risk of 30-day or long-term mortality compared to pVAD or standard medical therapy with or without IABP placement but was associated with higher risk of device-related limb complications and moderate to severe bleeding compared to pVAD. IABP use was not associated with a lower risk of 30 day or long-term mortality but was associated with higher risk of recurrent AMI and moderate to severe bleeding compared to medical therapy. Compared to IABP, pVAD use was associated with lower risk of CV mortality but not recurrent AMI. pVAD was associated with a higher risk of device-related limb complications and moderate to severe bleeding compared to IABP use. CONCLUSION: Use of ECMO or IABP in patients with AMI-CS is not associated with significant improvement in mortality. pVAD is associated with a lower risk of CV mortality. All MCS types are associated with increased risk of complications. Additional high-quality studies are needed to determine the optimal MCS therapy for patients with AMI-CS.
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BACKGROUND AND IMPORTANCE: Suboptimal acute pain care has been previously reported to be associated with demographic characteristics. OBJECTIVES: The aim of this study was to assess a healthcare system's multi-facility database of emergency attendances for abdominal pain, to assess for an association between demographics (age, sex, and ethnicity) and two endpoints: time delay to initial analgesia (primary endpoint) and selection of an opioid as the initial analgesic (secondary endpoint). DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational study assessed four consecutive months' visits by adults (≥18 years) with a chief complaint of abdominal pain, in a UK National Health Service Trust's emergency department (ED). Data collected included demographics, pain scores, and analgesia variables. OUTCOME MEASURES AND ANALYSIS: Categorical data were described with proportions and binomial exact 95% confidence intervals (CIs). Continuous data were described using median (with 95% CIs) and interquartile range (IQR). Multivariable associations between demographics and endpoints were executed with quantile median regression (National Health Service primary endpoint) and logistic regression (secondary endpoint). MAIN RESULTS: In 4231 patients, 1457 (34.4%) receiving analgesia had a median time to initial analgesia of 110â min (95% CI, 104-120, IQR, 55-229). The univariate assessment identified only one demographic variable, age decade ( P = 0.0001), associated with the time to initial analgesia. Association between age and time to initial analgesia persisted in multivariable analysis adjusting for initial pain score, facility type, and time of presentation; for each decade increase the time to initial analgesia was linearly prolonged by 6.9â min (95% CI, 1.9-11.9; P = 0.007). In univariable assessment, time to initial analgesia was not associated with either detailed ethnicity (14 categories, P = 0.109) or four-category ethnicity ( P = 0.138); in multivariable analysis ethnicity remained non-significant as either 14-category (all ethnicities' P ≥ 0.085) or four-category (all P ≥ 0.138). No demographic or operational variables were associated with the secondary endpoint; opioid initial choice was associated only with pain score ( P = 0.003). CONCLUSION: In a consecutive series of patients with abdominal pain, advancing age was the only demographic variable associated with prolonged time to initial analgesia. Older patients were found to have a linearly increasing, age-dependent risk for prolonged wait for pain care.
Subject(s)
Abdominal Pain , Emergency Service, Hospital , Humans , Abdominal Pain/therapy , Male , Female , Emergency Service, Hospital/statistics & numerical data , Retrospective Studies , Middle Aged , Adult , Aged , Age Factors , United Kingdom , Time-to-Treatment/statistics & numerical data , Pain Measurement , Time Factors , Analgesics, Opioid/therapeutic use , Pain Management/methodsABSTRACT
The ever-growing threats in cybersecurity growing with the rapid development of quantum computing, necessitates the development of robust and quantum-resistant cryptographic systems. This paper introduces a novel cryptosystem, Public Key Cryptosystem based on Systematic Polar Encoding (PKC-SPE), based on the combination of systematic polar encoding and public-key cryptographic principles. The Systematic Polar Encoding (SPE), derived from the well-established field of polar codes, serves as the foundation for this proposed cryptographic scheme. Here, we have used MATLAB Software to introduce and implement the PKC-SPE Cryptosystem. The paper examines key generation, encryption, and decryption algorithms, providing insights into the adaptability and efficiency of systematic polar encoding in public-key cryptography. We assess the efficiency of the PKC-SPE Cryptosystem in three aspects: key size, computational complexity, and system implementation timings. In addition, we compare the PKC-SPE Cryptosystem with PKC-PC cryptosystem and find that it has reduced key sizes ( P r = 0.8436 kbytes). The results obtained through simulations validate the effectiveness of the proposed cryptosystem and highlighting its potential for integration into real-world communication systems. Thus, in the paradigm shift to quantum computing, the PKC-SPE cryptosystem emerges as a promising candidate to secure digital communication in the quantum computing era.
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In surveys conducted from 2020 to 2022, five leaf samples each from symptomatic Agele marmelos trees and seedlings, along with five samples from asymptomatic trees and seedlings, were collected in Ayodhya, Uttar Pradesh, India. The DNA extraction from all the samples was subjected to nested PCR assays, using the universal phytoplasma-specific primers set (P1/P7 followed by R16F2n/R16R2). The resulting 1.2 kb amplified products were observed in all the symptomatic samples but not in the asymptomatic samples. Bael phytoplasma strain sequences from the trees and seedlings were found 100% identical within themselves and only two representative sequences (one each from tree and seedling) were deposited in GenBank (NCBI) as PP415872 (AmA-1) and PP415873 (AmA-2). BLASTn searches revealed the maximum (100%) sequence identity with a phytoplasma strain from murraya little leaf strain of Faizabad (GenBank Acc.no. OP984129) and lowest (99.84%) with arecanut crown choking of Shimoga (GenBank Acc. no. OM417502) from Karnataka. Phylogenetic analysis clustered the bael phytoplasma isolates with peanut witches' broom group phytoplasma strains. Virtual RFLP analysis confirmed their identity as 'Ca. P. australasiaticum', a 16SrII-D subgroup strain. This study presents the first identification of a phytoplasma strain in A. marmelos, emphasizing its potential threat to fruit crops and the need for vigilance in nursery practices to prevent further dissemination.
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We provide fresh estimates of a change in the nationwide prevalence of mental health symptoms among US children during the COVID-19 pandemic using National Health Interview Survey data (2019-22) on children aged 2-17 years (n = 27,378; age subgroups 2-5, 6-11, and 12-17) to assess overall mental distress and 19 specific outcomes related to developmental, communicative, cognitive, affective, and behavioral domains. Raw and adjusted (for socio-demographics) linear regressions estimated the change in prevalence for each outcome between 2019 (baseline year) and three succeeding years (2020-2022). Summary scores for mental distress rose between 2019 and 2020 (1.01 to 1.18 points, range of 0-15), declined slightly in 2021 (1.09), and climbed sharply again in 2022 (1.25). The declines primarily affected adolescents (1.11 at baseline, 1.24 in 2020, 1.30 in 2021, and 1.49 in 2022). Specific outcomes belonging to all domains of mental health showed similar increases in prevalence. US children suffered significant erosion of mental health during the COVID-19 pandemic that continued into 2022. Expansion of mental health programs aimed at school-going children will likely be needed to respond effectively to the ongoing crisis.
Subject(s)
COVID-19 , Mental Disorders , Child , Adolescent , Humans , Mental Health , Pandemics , COVID-19/epidemiology , Mental Disorders/epidemiology , PrevalenceABSTRACT
Introduction: The objective of this study was to search existing literature on nerve reconstruction surgery in patients with obstetric brachial plexus palsy to determine whether treatment with supraclavicular exploration and nerve grafting produced better elbow flexion outcomes compared to intercostal nerve transfer. Methods: This study was a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Individual Patient Data guidelines. A systematic search was conducted using multiple databases. An ordinal regression model was used to analyze the effect of using supraclavicular exploration and nerve grafting or intercostal nerve on elbow flexion with the two scores measured: elbow flexion Medical Research Council scores and Toronto active movements scale scores for elbow flexion. Results: A final patient database from 6 published articles consisted of 83 supraclavicular exploration and nerve grafting patients (73 patients with Medical Research Council and 10 patients with Toronto score) and 7 published articles which consisted of 131 intercostal nerve patients (84 patients with Medical Research Council and 47 patients with Toronto scores). Patients who underwent supraclavicular exploration and nerve grafting presented with an average Medical Research Council score of 3.9 ± 0.72 and an average Toronto score of 6.2 ± 2.2. Patients who underwent intercostal nerve transfer presented with an average Medical Research Council score of 3.9 ± 0.71 and an average Toronto score of 6.4 ± 1.2. There was no statistical difference between supraclavicular exploration and nerve grafting and intercostal nerve transfer when utilizing Medical Research Council elbow flexion scores (ordinal regression: 0.3821, standard error: 0.4590, p = 0.2551) or Toronto Active Movement Scale score for elbow flexion (ordinal regression: 0.7154, standard error: 0.8487, p = 0.2188). Conclusion: Regardless of surgical intervention utilized (supraclavicular exploration and nerve grafting or intercostal nerve transfers), patients had excellent outcomes for elbow flexion following obstetric brachial plexus palsy when utilizing Medical Research Council or Toronto scores for elbow flexion. The difference between these scores was not statistically significant. Type of study/Level of evidence: Therapeutic Study: Investigating the Result of Treatment/level III.
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We report an unusual case presentation of a patient with necrotic tissue changes of the right second and third fingers, found to have myeloid sarcoma with Staphylococcus-positive tenosynovitis and underlying acute myeloid leukemia, to highlight the importance of comprehensive evaluation in patients with atypical wounds.
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The almond, a commercially important tree nut crop worldwide, is native to the Mediterranean region. Stone fruit trees are affected by at least 14 'Candidatus Phytoplasma' species globally, among which 'Candidatus Phytoplasma asteris' is one of the most widespread phytoplasma infecting Prunus dulcis, causing aster yellows disease. Recently, almond plantations of Nauni region were consistently affected by phytoplasma, as evidenced by visible symptoms, fluorescent microscopic studies and molecular characterization. During several surveys from May to September 2020-2022, almond aster yellows phytoplasma disease showing symptoms such as chlorosis, inward rolling, reddening, scorching and decline with an incidence as high as 40%. Leaf samples were collected from symptomatic almond trees and the presence of phytoplasma was confirmed through fluorescent microscopic studies by employing DAPI (4, 6-diamino-2-phenylindole) that showed distinctive light blue flourescent phytoplasma bodies in phloem sieve tube elements. The presence of phytoplasma in symptomatic almond trees was further confirmed using nested PCR with specific primer pairs followed by amplification of 16S rDNA and 16S-23S rDNA intergenic spacer (IS) fragments. Sequencing and BLAST analysis of expected amplicon of the 16S rDNA gene confirmed that the almond phytoplasma in Himachal Pradesh was identical to the aster yellows group phytoplasma. Phylogenetic analysis of 16S rDNA almond phytoplasma also grouped 'Prunus dulcis' aster yellows phytoplasma within 16SrI-B subgroup showed 94% nucleotide identity with 'Prunus dulcis' phytoplasma PAEs3 and 'Prunus dulcis' phytoplasma PAE28 from Iran. This research presents the first host report of 'Candidatus Phytoplasma asteris' infecting almonds in India, expanding the knowledge of the diversity and distribution of phytoplasma strains affecting almond trees globally.
Subject(s)
Aster Plant , Phytoplasma , Prunus dulcis , Phytoplasma/genetics , Phylogeny , India , Coloring Agents , DNA, RibosomalABSTRACT
BACKGROUND: The study aimed to locate the central myelin and peripheral myelin junction (CNS PNS Junction, CPJ) in trigeminal, facial and vestibulocochlear nerves. METHODS: The cisternal segments of the nerves were cut from the brainstem to the proximal margin of trigeminal ganglia (trigeminal nerve) and internal acoustic meatus (facial and vestibulocochlear nerve) from cadavers. Horizontal sections of H&E stained slides were analysed and histo morphometry was performed. The CPJ was confirmed by immunohistochemistry using monoclonal myelin basic protein antibody. RESULTS: The mean length of the trigeminal, facial and vestibulocochlear nerves were 13.6 ± 3.1 mm, 12.4 ± 1.9 mm and 11.5 ± 2.0 mm respectively; mean length of the centrally myelinated segment at the point of maximum convexity was 4.1 ± 1.5 mm, 3.7 ± 1.6 mm, 3.6 ± 1.4 mm respectively. Six different patterns were observed fortheCPJ.Utilizing the derived values, the CPJwas located at a distance of 18 - 48% and 17 - 61% of the total length of the nerve in all the cases in trigeminal and facial nerve respectively. In vestibulocochlear nerve, it was located at a distance of about 13 - 54% of the total length of the nerve. CONCLUSIONS: The location of the CPJ in the vestibulocochlear nerve was midway between the brainstem and internal acoustic meatus which is a novel observation.For all the nerves, the CPJ was located either at or before the half way along the length of the nerve in huge majority (97%); never crossing the 60% of the nerve length.
Subject(s)
Facial Nerve , Myelin Sheath , Humans , Facial Nerve/anatomy & histology , Trigeminal Nerve , Cadaver , Vestibulocochlear Nerve/anatomy & histologyABSTRACT
The therapeutic strategy employing destabilization of the preformed Aß fibril by various natural compounds, as studied by experimental and computational methods, has been reported significant in curing Alzheimer's disease (AD). However, lycopene (a carotenoid), from terpenes family, needs investigation for its destabilization potential of Aß fibril. The highest antioxidant potential and ability to cross blood brain barrier makes lycopene a preferred choice as drug lead for treating AD. The current study focuses on investigating the destabilization potential and underpinning mechanism of lycopene on different polymorphic forms of Aß fibril via Molecular Dynamics (MD) simulation. The key findings highlight binding of lycopene to the outer surface of the chain F of the fibril (2NAO). Herein G9, K16 and V18 residues were found to be involved in van der Waals with the methyl groups of the lycopene. Additionally, Y10 and F20 residues were observed to interact via π-π interactions with CC bonds of the lycopene. The surface mediated binding of lycopene to the fibril is attributed to the large size and structural rigidity of lycopene along with the bulky size of 2NAO and narrow space of fibrillar cavity. The destabilization of the fibril is evident by breakage of inherent H-bonds and hydrophobic interactions in the presence of one lycopene molecule. The lesser ß-sheet content explains disorganization of the fibril and bars the higher order aggregation curbing neurotoxicity of the fibril. The higher concentration of the lycopene is not found to be linearly correlated with the extent of destabilization of the fibril. Lycopene is also observed to destabilize the other polymorphic form of Aß fibril (2BEG), by accessing the fibrillar cavity and lowering the ß-sheet content. The destabilization observed by lycopene on two major polymorphs of Aß fibril explains its potency towards developing an effective therapeutic approach in treating AD.
Subject(s)
Amyloid beta-Peptides , Molecular Dynamics Simulation , Amyloid beta-Peptides/chemistry , Lycopene , Peptide Fragments/chemistry , Protein Conformation, beta-StrandABSTRACT
The extraneuronally deposited senile plaques, composed of neurotoxic aggregates of Aß fibril, define Alzheimer's disease (AD). Natural compounds have been tested for their destabilization potential on Aß fibril, thereby curing AD. However, the resultant destabilized Aß fibril, needs to be checked for its irreversibility to the native organized state after removal of the ligand. Herein, we assessed the stability of a destabilized fibril after the ligand (ellagic acid represented as REF) is removed from the complex. The study has been conducted via Molecular Dynamics (MD) simulation of 1 µs for both Aß-Water (control) and Aß-REFâ³ (test or REF removed) system. The increased value of RMSD, Rg, SASA, lower ß-sheet content and reduced number of H-bonds explains enhanced destabilization observed in Aß-REFâ³ system. The increased inter-chain distance demonstrates breaking of the residual contacts, testifying the drift of terminal chains from the pentamer. The increased SASA along with the ∆Gps(polar solvation energy) accounts for the reduced interaction amongst residues, and more with solvent molecules, governing irreversibility to native state. The higher Gibb's free energy of the misaligned structure of Aß-REFâ³ ensures irreversibility to the organized structure due to its inability to cross such high energy barrier. The observed stability of the disaggregated structure, despite ligand elimination, establishes the effectiveness of the destabilization technique as a promising therapeutic approach towards treating AD.
Subject(s)
Alzheimer Disease , Molecular Dynamics Simulation , Humans , Amyloid beta-Peptides/chemistry , Ligands , Alzheimer Disease/drug therapy , Protein Conformation, beta-Strand , Peptide Fragments/chemistryABSTRACT
Since 2015 more than 34 biosimilars have been approved by the FDA. This new era of biosimilar competition has stimulated renewed technology development focused on therapeutic protein or biologic manufacturing. One challenge in biosimilar development is the genetic differences in the host cell lines used to manufacture the biologics. For example, many biologics approved between 1994 and 2011 were expressed in murine NS0 and SP2/0 cell lines. Chinese Hamster ovary (CHO) cells, however, have since become the preferred hosts for production due to their increased productivity, ease of use, and stability. Differences between murine and hamster glycosylation have been identified in biologics produced using murine and CHO cells. In the case of monoclonal antibodies (mAbs), glycan structure can significantly affect critical antibody effector function, binding activity, stability, efficacy, and in vivo half-life. In an attempt to leverage the intrinsic advantages of the CHO expression system and match the reference biologic murine glycosylation, we engineered a CHO cell expressing an antibody that was originally produced in a murine cell line to produce murine-like glycans. Specifically, we overexpressed cytidine monophospho-N-acetylneuraminic acid hydroxylase (CMAH) and N-acetyllactosaminide alpha-1,3-galactosyltransferase (GGTA) to obtain glycans with N-glycolylneuraminic acid (Neu5Gc) and galactose-α-1,3-galactose (alpha gal). The resulting CHO cells were shown to produce mAbs with murine glycans, and they were then analyzed by the spectrum of analytical methods typically used to demonstrate analytical similarity as a part of demonstrating biosimilarity. This included high-resolution mass spectrometry, biochemical, as well as cell-based assays. Through selection and optimization in fed-batch cultures, two CHO cell clones were identified with similar growth and productivity criteria to the original cell line. They maintained stable production for 65 population doubling times while matching the glycosylation profile and function of the reference product expressed in murine cells. This study demonstrates the feasibility of engineering CHO cells to express mAbs with murine glycans to facilitate the development of biosimilars that are highly similar to marketed reference products expressed in murine cells. Furthermore, this technology can potentially reduce the residual uncertainty regarding biosimilarity, resulting in a higher probability of regulatory approval and potentially reduced costs and time in development.
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This study reports the development of magnesium alloy/hydroxyapatite-based biodegradable metal matrix composites (BMMCs) through rapid microwave sintering. Magnesium alloy (AZ31) and hydroxyapatite powder were used in four compositions 0, 10, 15 and 20% by weight. Developed BMMCs were characterized to evaluate physical, microstructural, mechanical and biodegradation characteristics. XRD results show Mg and HA as major phases and MgO as a minor phase. SEM results correlate with the XRD findings by identifying the presence of Mg, HA and MgO. The addition of HA powder particles reduced density and increased the microhardness of BMMCs. The compressive strength and Young's modulus increased with increasing HA up to 15 wt.%. AZ31-15HA exhibited the highest corrosion resistance and lowest relative weight loss in the immersion test for 24 h and weight gain after 72 and 168 h due to the deposition of Mg(OH)2 and Ca(OH)2 layers at the sample surface. XRD analysis of the AZ31-15HA sintered sample after an immersion test was carried out and these results revealed the presence of new phases Mg(OH)2 and Ca(OH)2 that could be the reason for enhancing the corrosion resistance. SEM elemental mapping result also confirmed the formation of Mg(OH)2 and Ca(OH)2 at the sample surface, which acted as protective layers and prevented the sample from further corrosion. It showed that the elements were uniformly distributed over the sample surface. In addition, these microwave-sintered BMMCs showed similar properties to the human cortical bone and help bone growth by depositing apatite layers at the surface of the sample. Furthermore, this apatite layer can enhance osteoblast formation due to the porous structure type, which was observed in the BMMCs. Therefore, it is indicative that developed BMMCs can be an artificial biodegradable composite for orthopedic applications.
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BACKGROUND: Pediatric inflammatory bowel disease (IBD) is commonly treated with infliximab in a hospital setting. Utilization of home infusions (HI) is increasing due to insurance mandates, travel time savings, and convenience. We evaluated adverse outcomes (AOs) of infliximab infusions in children with IBD receiving HI compared to hospital-based infusions. METHODS: Children receiving HI between September 2016 and September 2018 were retrospectively matched based on age, race, ethnicity, sex, and disease type to a cohort receiving infliximab at a hospital-based center. A survival analysis evaluated the hazard ratio for AOs in HI relative to hospital-infused children over 2 years. AOs were defined as discontinuation of therapy for clinically relevant reasons, IBD-related hospitalizations, and emergency department visits. RESULTS: We included 102 children (51 pairs) (63% male, 91% White, 92% Crohn disease). Disease location, behavior, growth status, and disease severity were similar between the 2 cohorts. Quiescent disease increased from 3% to 93% after 2 years without cohort differences. At baseline, 94% of HI patients and 88% of controls were on 5 mg/kg every 8 weeks as standard maintenance therapy. Within 2 years, only 19% remained on 5 mg/kg and the remainder required increased dosing or decreased interval. The HI cohort had fewer labs obtained ( P < 0.001), though laboratory values, number of clinic visits, and frequency of AOs were similar. CONCLUSION: Drug durability, AOs, and laboratory values were similar between HI and hospital-based infusions. These findings suggest HI may be as effective as hospital-based infusions, provided a standardized care approach is utilized.
Subject(s)
Gastrointestinal Agents , Inflammatory Bowel Diseases , Humans , Male , Child , Female , Infliximab , Retrospective Studies , Inflammatory Bowel Diseases/drug therapy , Infusions, Intravenous , HospitalsABSTRACT
BACKGROUND: Baclofen can decrease rumination frequency in adults with rumination syndrome. Outcomes of baclofen treatment in children with rumination syndrome have not been described. The aim of this study was to examine the safety and efficacy of baclofen in children with rumination syndrome in combination with behavioral therapy at a single center. METHODS: We performed a retrospective review of children aged 0-18 years with rumination syndrome based on Rome criteria and prescribed baclofen by a pediatric gastroenterologist at the Nationwide Children's Hospital, Columbus, Ohio, USA, between 2012 and 2019. Children without follow-up data or who were prescribed baclofen for other symptoms were excluded. RESULTS: We identified 44 children with rumination syndrome who were prescribed baclofen by a pediatric gastroenterologist. Seventeen either did not have follow-up data or never started the medication. We included 27 patients in the study: 22 (81.5%) female, median age 14.5 years (range 10-18 years) and 100% Caucasian. Twenty patients (74%) received baclofen 5 mg and seven patients (26%) received baclofen 10 mg three times daily. Most patients received behavioral therapy and baclofen simultaneously. Thirteen patients (48%) reported improvement in symptoms, primarily a decrease in rumination frequency, at their first follow-up visit. Regurgitation frequency per week decreased after starting baclofen (p < 0.05). One patient experienced dizziness. No other side effects were reported. CONCLUSION: Nearly half of our patients with rumination syndrome improved after baclofen. It was well tolerated with minimal side effects. This suggests that baclofen in addition to behavioral therapy can improve symptoms of rumination syndrome. Prospective, controlled studies in a larger cohort of children with rumination syndrome are needed to confirm these findings.
Subject(s)
Baclofen , Rumination Syndrome , Adult , Humans , Child , Female , Adolescent , Male , Baclofen/adverse effects , Retrospective Studies , Rumination Syndrome/therapy , Prospective StudiesABSTRACT
The objective of this study was to explore perceptions of online grocery shopping and the online United States Department of Agriculture's (USDA) Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer card (EBT) program among Head Start caregivers. Three focus groups were conducted between December 2019 and January 2020. Most participants hadn't tried online grocery shopping. Concerns included others choosing perishables, receiving wrong items, and inappropriate substitutes. Perceived benefits included saving time, preventing impulse buys, and eating healthier. Results have broad applicability in the current COVID-19 pandemic where online grocery shopping and the online SNAP EBT program have rapidly expanded across the United States.
Subject(s)
COVID-19 , Caregivers , Commerce , Food Assistance , Food Supply , Internet , Humans , COVID-19/epidemiology , Pandemics , Poverty , United States , Supermarkets , Early Intervention, Educational , Focus GroupsABSTRACT
Photocatalysis is one of the most promising methods for producing organic compounds with a renewable source of energy. Two-dimensional covalent organic frameworks (2D COFs) are a type of polymer that has developed as a potential light-harvesting catalyst for artificial photosynthesis with a design-controllable platform that might be developed into a new type of cost-effective and metal-free photocatalyst. Here, we present a two-dimensional covalent organic framework synthesis technique as a low-cost and highly efficient visible light active flexible photocatalyst for C-H bond activation and dopamine regeneration. 2D COF were synthesized from tetramino-benzoquinone (TABQ) and terapthaloyl chloride monomer through condensation polymerization reaction and the resultant photocatalyst have remarkable performance due to its visible light-harvesting capacity, appropriate band gap, and highly organized π-electron channels. The synthesized photocatalyst is capable to convert dopamine into leucodopaminechrome with a higher yield (77.08%) and also capable to activate the C-H bond between 4-nitrobenzenediazonium tetrafluoroborate and pyrrole.
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Accessory cavitated uterine mass (ACUM) is a rare form of developmental mullerian anomaly which causes chronic pelvic pain, dysmenorrhea and infertility in young females. It is a non-communicating, accessory cavity within an otherwise normal uterus, lined by functional endometrium and surrounded by myometrium-like smooth muscle cells which imparts it uterus-like appearance. USG and MRI are the imaging modalities which help in reaching the diagnosis. Knowledge of this entity and awareness of its imaging features can help diagnose this often underdiagnosed and surgically correctable cause of dysmenorrhea.
Subject(s)
Dysmenorrhea , Laparoscopy , Female , Humans , Dysmenorrhea/complications , Dysmenorrhea/surgery , Laparoscopy/adverse effects , Uterus , Pelvic Pain/etiology , MyometriumABSTRACT
Photocatalytic processes triggered by graphene-based photocatalysts under solar light have sparked interest as a new sort of instrument for solar chemical synthesis. Herein we investigated self-assembled graphene quantum dots (GQDs)/NiSe-NiO composite photocatalyst for organic transformation as well as dye degradation. The synthesized GQDs/NiSe-NiO composite photocatalyst has an excellent suitable band gap, high molar extinction coefficient, low toxicity and chemical/thermal stability. The GQDs/NiSe-NiO composite photocatalyst emerges as a new standard for sulfur oxidation and dye degradation reactions under homemade LED light with high yield.