Development of 'gastrostomy tube - is it for me?', a web-based patient decision aid for people living with motor neurone disease considering having a gastrostomy tube placed.

Objective: To develop and pilot a web-based patient decision aid (PDA) to support people living with motor neurone disease (plwMND) considering having a gastrostomy tube placed. Methods: In Phase 1, content and design were informed by semi-structured interviews, literature reviews and a prioritization survey. In Phase 2, the prototype PDA was tested with users and developed iteratively with feedback from surveys and 'think-aloud' interviews. Phase 1 and 2 participants were plwMND, carers and healthcare professionals (HCPs). In Phase 3, the PDA was evaluated by plwMND using validated questionnaires and HCPs provided feedback in focus groups. Results: Sixteen plwMND, 16 carers and 25 HCPs took part in Phases 1 and 2. Interviews and the literature review informed a prioritization survey with 82 content items. Seventy-seven per cent (63/82) of the content of the PDA was retained. A prototype PDA, which conforms to international standards, was produced and improved during Phase 2. In Phase 3, 17 plwMND completed questionnaires after using the PDA. Most plwMND (94%) found the PDA completely acceptable and would recommend it to others in their position, 88% had no decisional conflict, 82% were well prepared and 100% were satisfied with their decision-making. Seventeen HCPs provided positive feedback and suggestions for use in clinical practice. Conclusion: Gastrostomy Tube: Is it for me? was co-produced with stakeholders and found to be acceptable, practical and useful. Freely available from the MND Association website, the PDA is a valuable tool to support the shared decision-making process for gastrostomy tube placement.

Prevalence and impact of antimicrobial resistance in gastrointestinal infections: A review.

Antimicrobial resistance has become a worldwide problem due to its excessive increase in recent years. The aim of the present review was to bring together data from different articles describing the levels of antimicrobial resistance in the most common gastrointestinal infections reported across the globe. The literature search was carried out in Google Scholar, Medline, Embase, and Pubmed, with the terms "antimicrobial resistance", "resistance in gastrointestinal disorders", and "resistance in amoebiasis", in Spanish and English. Mexican treatment guidelines and consensuses from 2017 to the present were utilized. Publications from the last ten years were chosen to describe the level of resistance. They had adequate sample sizes, the Material and Methods sections were precise, and they included multicenter studies, national and international consensuses, meta-analyses, systematic reviews, and extensive texts. The final number of articles was 51. The microorganisms that demonstrated the highest percentage of resistance were Helicobacter pylori (metronidazole 50%-80%, clarithromycin 20%-40%, and levofloxacin 30%-35%), Clostridioides difficile (clindamycin 8.3%-100%, cephalosporines 51%), Campylobacter jejuni and Campylobacter coli (fluoroquinolones 85%), Escherichia coli (ampicillin 76.5%), Entamoeba histolytica (metronidazole 50%), and bacterial peritonitis (third-generation cephalosporines 40%, methicillin 85%). Antimicrobial resistance is reaching elevated percentages, making it necessary to evaluate the situation of each patient, to successfully treat gastrointestinal infections.

Observational study of the relationship between nurse staffing levels and compliance with mandatory nutritional assessments in hospital.

BACKGROUND: In the UK, it is recommended that hospital patients have their nutritional status assessed within 24 h of admission using the Malnutrition Universal Screening Tool (MUST). The present study aimed to examine the association between nurse staffing levels and missed nutritional status assessments. METHODS: A single-centre, retrospective, observational study was employed using routinely collected MUST assessments from 32 general adult hospital wards over 2 years, matched to ward nurse staffing levels. We used mixed-effects logistic regression to control for ward characteristics and patient factors. RESULTS: Of 43 451 instances where staffing levels could be linked to a patient for whom an assessment was due, 21.4% had no MUST score recorded within 24 h of admission. Missed assessments varied between wards (8-100%). There was no overall association between registered nurse staffing levels and missed assessments; although higher admissions per registered nurse were associated with more missed assessments [odds ratio (OR) = 1.09, P = 0.005]. Higher healthcare assistant staffing was associated with lower rates of missed assessments (OR = 0.80, P < 0.001). There was a significant interaction between registered nurses and healthcare assistants staffing levels (OR = 0.97, P = 0.011). CONCLUSIONS: Despite a written hospital policy requiring a nutritional assessment within 24 h of admission, missed assessments were common. The observed results show that compliance with the policy for routine MUST assessments within 24 h of hospital admission is sensitive to staffing levels and workload. This has implications for planning nurse staffing.

Modeling LED street lighting.

LED luminaires may deliver precise illumination patterns to control light pollution, comfort, visibility, and light utilization efficiency. Here, we provide simple equations to determine how the light distributes in the streets. In particular, we model the illuminance spatial distribution as a function of Cartesian coordinates on a floor, road, or street. The equations show explicit dependence on the luminary position (pole height and arm length), luminary angle (fixture tilt), and the angular intensity profile (radiation pattern) of the LED luminary. To achieve this, we propose two mathematical representations to model the sophisticated intensity profiles of LED luminaries. Furthermore, we model the light utilization efficiency, illumination uniformity, and veiling luminance of glare due to one or several LED streetlamps.

Digital holographic interferometer using simultaneously three lasers and a single monochrome sensor for 3D displacement measurements.

The use of digital holographic interferometry for 3D measurements using simultaneously three illumination directions was demonstrated by Saucedo et al. (Optics Express 14(4) 2006). The technique records two consecutive images where each one contains three holograms in it, e.g., one before the deformation and one after the deformation. A short coherence length laser must be used to obtain the simultaneous 3D information from the same laser source. In this manuscript we present an extension of this technique now illuminating simultaneously with three different lasers at 458, 532 and 633 nm, and using only one high resolution monochrome CMOS sensor. This new configuration gives the opportunity to use long coherence length lasers allowing the measurement of large object areas. A series of digital holographic interferograms are recorded and the information corresponding to each laser is isolated in the Fourier spectral domain where the corresponding phase difference is calculated. Experimental results render the orthogonal displacement components u, v and w during a simple load deformation.

Simultaneous two-dimensional endoscopic pulsed digital holography for evaluation of dynamic displacements.

An endoscope is used in pulsed digital holography to simultaneously evaluate in-plane and out- of-plane transient and harmonic displacements on a flat metallic plate. The plate is illuminated from two different directions. The optical path for each illumination direction is matched to its corresponding reference beam, but also in such a way that each object-reference beam pair optical path is mismatched such that they are incoherent and can be stored in a single CCD frame. As is typical in these types of interferometric arrangement, two digital holograms are needed to compare two different states of the plate. Each hologram is Fourier transformed and due to the incoherence introduced, two separate spectra are readily identified, each belonging to an object-reference beam pair. On comparing by subtraction the phase obtained from the two pulsed digital holograms, it is possible to gather quantitative in-plane and out-of- plane results from transient and harmonic displacements.

Endoscopic pulsed digital holography for 3D measurements.

A rigid endoscope and three different object illumination source positions are used in pulsed digital holography to measure the three orthogonal displacement components from hidden areas of a harmonically vibrating metallic cylinder. In order to obtain simultaneous 3D information from the optical set up, it is necessary to match the optical paths of each of the reference object beam pairs, but to incoherently mismatch the three reference object beam pairs, such that three pulsed digital holograms are incoherently recorded within a single frame of the CCD sensor. The phase difference is obtained using the Fourier method and by subtracting two digital holograms captured for two different object positions.

Scleroderma with type III glomerulonephritis and MPO-ANCA antibodies in the serum.

Scleroderma is an autoimmune disease characterized by early inflammatory infiltrates followed by fibrosis in the skin and internal organs. CREST is a relatively benign cutaneous variant of scleroderma that features calcinosis, Raynaud's phenomenon, oesophageal dysfunction, sclerodactyly and telangiectases. Glomerulonephritis is a rare association of CREST. We are reporting a patient with CREST who developed glomerulonephritis and had anticentromere and antineutrophil cytoplasmic autoantibodies (ANCA) in her serum.

Detection of surface strain by three-dimensional digital holography.

Three-dimensional digital holography with three object-illuminating beams has been successfully used for the detection of surface strain in metallic objects. The optical setup that uses illuminating beams to irradiate the object from three directions means that all three object surface displacement components, x, y, and z, can be independently calculated and used to find the strain gradients on the surface. The results show the conversion of the complete surface displacement field into a surface strain field. The method is capable of measuring microstrains for out-of-plane surface displacements of less than 10 microm.

Measurement of the concentrations of solutions through chromatic systems.

After a careful check of the response linearity of the spectrophotometer in absorbances and transmittances at wavelengths between 250 and 550 nm with potassium dichromate, the influence of the concentration of solutions on the tristimulus coordinates and the coordinates of the CIE 1931 (Commission Internationale de l'Éclairage) and CIELAB colorimetric systems was analyzed. How to use the value of only some chromatic coordinates to obtain a sample's concentration simultaneously is also shown.