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1.
Diabet Med ; : e14678, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34432914

RESUMO

AIMS: To review and synthesise the contemporary qualitative evidence, relating to the individual, healthcare professional and system-level barriers and facilitators to injectable therapies in people with type 2 diabetes, and evaluate (using an intersectional approach to explore the diverse perspectives of different identities) whether views have changed with treatment and guideline advancements. METHODS: A meta-ethnography approach used. Eight databases searched from the years 2006 (GLP-1 analogues introduced) to February 2021. Study selection (using a pre-defined inclusion criteria), quality appraisal and data extraction, conducted independently by two reviewers. RESULTS: Screened 7143 abstracts, assessed 93 full-text papers for eligibility and included 42 studies-using data from 818 individuals with type 2 diabetes and 160 healthcare professionals. Studies covered a diverse range of views from healthcare professionals and individuals, including those relating to older adults and people from ethnic migrant backgrounds, and 10 studies rated moderate to strong research value. Key themes abstracted: barriers (physical/psychological/social) and facilitators (motivation/capability/opportunity). CONCLUSIONS: The first synthesis of contemporary qualitative data to adopt an intersectionality approach and explore diverse views relating to barriers and facilitators that influence engagement with injectable treatments for type 2 diabetes. A model is presented to help patients, health practitioners and policy makers identify barriers and facilitators and understand the complex interplay of physical, psychological and social factors involved when prescribing injectable therapies. Despite advances in injectable treatments and guidelines, findings highlight the many barriers that still exist and show how strongly held culturally-specific health beliefs of people from diverse socio-economic and ethnic backgrounds can become substantial obstacles to treatment.

2.
Sensors (Basel) ; 21(16)2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34450841

RESUMO

Visual simultaneous location and mapping (SLAM) using RGB-D cameras has been a necessary capability for intelligent mobile robots. However, when using point-cloud map representations as most RGB-D SLAM systems do, limitations in onboard compute resources, and especially communication bandwidth can significantly limit the quantity of data processed and shared. This article proposes techniques that help address these challenges by mapping point clouds to parametric models in order to reduce computation and bandwidth load on agents. This contribution is coupled with a convolutional neural network (CNN) that extracts semantic information. Semantics provide guidance in object modeling which can reduce the geometric complexity of the environment. Pairing a parametric model with a semantic label allows agents to share the knowledge of the world with much less complexity, opening a door for multi-agent systems to perform complex tasking, and human-robot cooperation. This article takes the first step towards a generalized parametric model by limiting the geometric primitives to a planar surface and providing semantic labels when appropriate. Two novel compression algorithms for depth data and a method to independently fit planes to RGB-D data are provided, so that plane data can be used for real-time odometry estimation and mapping. Additionally, we extend maps with semantic information predicted from sparse geometries (planes) by a CNN. In experiments, the advantages of our approach in terms of computational and bandwidth resources savings are demonstrated and compared with other state-of-the-art SLAM systems.


Assuntos
Compressão de Dados , Semântica , Algoritmos , Humanos , Redes Neurais de Computação
4.
Comput Med Imaging Graph ; 89: 101884, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33676139

RESUMO

High energy impacts at joint locations often generate highly fragmented, or comminuted, bone fractures. Current approaches for treatment require physicians to decide how to classify the fracture within a hierarchy fracture severity categories. Each category then provides a best-practice treatment scenario to obtain the best possible prognosis for the patient. This article identifies shortcomings associated with qualitative-only evaluation of fracture severity and provides new quantitative metrics that serve to address these shortcomings. We propose a system to semi-automatically extract quantitative metrics that are major indicators of fracture severity. These include: (i) fracture surface area, i.e., how much surface area was generated when the bone broke apart, and (ii) dispersion, i.e., how far the fragments have rotated and translated from their original anatomic positions. This article describes new computational tools to extract these metrics by computationally reconstructing 3D bone anatomy from CT images with a focus on tibial plafond fracture cases where difficult qualitative fracture severity cases are more prevalent. Reconstruction is accomplished within a single system that integrates several novel algorithms that identify, extract and piece-together fractured fragments in a virtual environment. Doing so provides objective quantitative measures for these fracture severity indicators. The availability of such measures provides new tools for fracture severity assessment which may lead to improved fracture treatment. This paper describes the system, the underlying algorithms and the metrics of the reconstruction results by quantitatively analyzing six clinical tibial plafond fracture cases.

5.
J Vasc Access ; : 1129729821998835, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673743

RESUMO

Here we describe the use of a VBX balloon expandable stent-graft (WL Gore, Flagstaff, AZ, USA) to treat a right brachiocephalic vein stenosis in a haemodialysis patient prior to ipsilateral upper limb arterio-venous (AV) fistula formation. Balloon expandable stent-grafts are unsuitable for treating peripheral fistula stenoses due to their susceptibility of being crushed. The right brachiocephalic vein is both relatively short in comparison to the left and is less susceptible to extrinsic compression and the use of such a device to treat stenosis here allows for very accurate placement and restoration of luminal diameter. The advantages and disadvantages of using these devices in haemodialysis access circuits are also discussed herein, in what we believe to be the first report of the application of a dedicated commercially available balloon expandable stent graft in a haemodialysis patient.

6.
Can Vet J ; 62(1): 51-54, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33390599

RESUMO

This study aimed to validate a point-of-care polymerase chain reaction (PCR) assay for detection of Streptococcus equi subsp. equi (S. equi) in rostral nasal swabs from horses with suspected acute strangles and to compare the results against the molecular gold standard of quantitative polymerase chain reaction (qPCR). Two hundred thirty-two individual swabs of rostral nasal passages were characterized by qPCR as S. equi positive, S. equi subsp. zooepidemicus (S. zooepidemicus) positive, or S. equi and S. zooepidemicus negative. The specificity and sensitivity of the point-of-care PCR assay were 89% and 84%, respectively. The limits of detection of the qPCR assay and the point-of-care PCR analyzer were 3 and 277 eqbE target genes of S. equi, respectively. Overall agreement and short turnaround time make the point-of-care PCR assay a potential molecular diagnostic platform that will enhance the capability of equine veterinarians to timely support a diagnosis of strangles and institute proper biosecurity protocols.


Assuntos
Doenças dos Cavalos , Infecções Estreptocócicas , Streptococcus equi , Animais , Doenças dos Cavalos/diagnóstico , Cavalos , Sistemas Automatizados de Assistência Junto ao Leito , Reação em Cadeia da Polimerase/veterinária , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/veterinária , Streptococcus , Streptococcus equi/genética
9.
Diabetes Care ; 43(8): 1893-1901, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32430457

RESUMO

OBJECTIVE: Tight, targeted control of modifiable cardiovascular risk factors can reduce cardiovascular complications and mortality in individuals with type 2 diabetes mellitus (T2DM) and microalbuminuria. The effects of using an electronic "prompt" with a treatment algorithm to support a treat-to-target approach has not been tested in primary care. RESEARCH DESIGN AND METHODS: A multicenter, cluster-randomized trial was conducted among primary care practices across Leicestershire, U.K. The primary outcome was the proportion of individuals achieving systolic and diastolic blood pressure (<130 and <80 mmHg, respectively) and total cholesterol (<3.5 mmol/L) targets at 24 months. Secondary outcomes included proportion of individuals with HbA1c <58 mmol/mol (<7.5%), changes in prescribing, change in the albumin-to-creatinine ratio, major adverse cardiovascular events, cardiovascular mortality, and coding accuracy. RESULTS: A total of 2,721 individuals from 22 practices, mean age 63 years, 41% female, and 62% from black and minority ethnic groups completed 2 years of follow-up. There were no significant differences in the proportion of individuals achieving the composite primary outcome, although the proportion of individuals achieving the prespecified outcome of total cholesterol <4.0 mmol/L (odds ratio 1.24; 95% CI 1.05-1.47; P = 0.01) increased with intensive intervention compared with control. Coding for microalbuminuria increased relative to control (odds ratio 2.05; 95% CI 1.29-3.25; P < 0.01). CONCLUSIONS: Greater improvements in composite cardiovascular risk factor control with this intervention compared with standard care were not achieved in this cohort of high-risk individuals with T2DM. However, improvements in lipid profile and coding can benefit patients with diabetes to alter the high risk of atherosclerotic cardiovascular events. Future studies should consider comprehensive strategies, including patient education and health care professional engagement, in the management of T2DM.


Assuntos
Albuminúria/terapia , Diabetes Mellitus Tipo 2/terapia , Educação Médica Continuada/métodos , Pessoal de Saúde/educação , Planejamento de Assistência ao Paciente , Software , Adulto , Idoso , Idoso de 80 Anos ou mais , Albuminúria/sangue , Albuminúria/complicações , Albuminúria/fisiopatologia , Algoritmos , Pressão Sanguínea/fisiologia , Análise por Conglomerados , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/fisiopatologia , Angiopatias Diabéticas/terapia , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/fisiopatologia , Nefropatias Diabéticas/terapia , Grupos Étnicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/métodos , Resultado do Tratamento , Reino Unido/epidemiologia
10.
Front Physiol ; 11: 124, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32153425

RESUMO

The incidence of diabetes and its association with increased cardiovascular disease risk represents a major health issue worldwide. Diabetes-induced hyperglycemia is implicated as a central driver of responses in the diabetic heart such as cardiomyocyte hypertrophy, fibrosis, and oxidative stress, termed diabetic cardiomyopathy. The onset of these responses in the setting of diabetes has not been studied to date. This study aimed to determine the time course of development of diabetic cardiomyopathy in a model of type 1 diabetes (T1D) in vivo. Diabetes was induced in 6-week-old male FVB/N mice via streptozotocin (55 mg/kg i.p. for 5 days; controls received citrate vehicle). At 2, 4, 8, 12, and 16 weeks of untreated diabetes, left ventricular (LV) function was assessed by echocardiography before post-mortem quantification of markers of LV cardiomyocyte hypertrophy, collagen deposition, DNA fragmentation, and changes in components of the hexosamine biosynthesis pathway (HBP) were assessed. Blood glucose and HbA1c levels were elevated by 2 weeks of diabetes. LV and muscle (gastrocnemius) weights were reduced from 8 weeks, whereas liver and kidney weights were increased from 2 and 4 weeks of diabetes, respectively. LV diastolic function declined with diabetes progression, demonstrated by a reduction in E/A ratio from 4 weeks of diabetes, and an increase in peak A-wave amplitude, deceleration time, and isovolumic relaxation time (IVRT) from 4-8 weeks of diabetes. Systemic and local inflammation (TNFα, IL-1ß, CD68) were increased with diabetes. The cardiomyocyte hypertrophic marker Nppa was increased from 8 weeks of diabetes while ß-myosin heavy chain was increased earlier, from 2 weeks of diabetes. LV fibrosis (picrosirius red; Ctgf and Tgf-ß gene expression) and DNA fragmentation (a marker of cardiomyocyte apoptosis) increased with diabetes progression. LV Nox2 and Cd36 expression were elevated after 16 weeks of diabetes. Markers of the LV HBP (Ogt, Oga, Gfat1/2 gene expression), and protein abundance of OGT and total O-GlcNAcylation, were increased by 16 weeks of diabetes. This is the first study to define the progression of cardiac markers contributing to the development of diabetic cardiomyopathy in a mouse model of T1D, confirming multiple pathways contribute to disease progression at various time points.

11.
Int Angiol ; 39(1): 3-16, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31814378

RESUMO

The aim of this manuscript was to establish a consensus for the management of acute and chronic venous obstruction among specialists in the UK. Specialist physicians representing vascular surgery, interventional radiology and hematology were invited to 3 meetings to discuss management of acute and chronic iliofemoral obstruction. The meetings outlined controversial areas, included a topic-by-topic review; and on completion reached a consensus when greater than 80% agreement was reached on each topic. Physicians from 19 UK hospitals agreed on treatment protocols and highlighted areas that need development. Potential standard treatment algorithms were created. It was decided to establish a national registry of venous patients led by representatives from the treating multidisciplinary teams. Technical improvements have facilitated invasive treatment of patients with acute and chronic venous obstruction; however, the evidence guiding treatment is weak. Treatment should be conducted in centers with multi-disciplinary input; robust, coordinated data collection; and regular outcome analysis to ensure safe and effective treatment and a basis for future evolvement.


Assuntos
Veia Femoral , Veia Ilíaca , Equipe de Assistência ao Paciente/normas , Trombose Venosa/terapia , Doença Aguda , Cateterismo , Doença Crônica , Consenso , Gerenciamento Clínico , Humanos , Seleção de Pacientes , Radiografia Intervencionista , Terapia Trombolítica , Reino Unido
12.
Front Physiol ; 10: 1395, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31798462

RESUMO

The increasing burden of heart failure globally can be partly attributed to the increased prevalence of diabetes, and the subsequent development of a distinct form of heart failure known as diabetic cardiomyopathy. Despite this, effective treatment options have remained elusive, due partly to the lack of an experimental model that adequately mimics human disease. In the current study, we combined three consecutive daily injections of low-dose streptozotocin with high-fat diet, in order to recapitulate the long-term complications of diabetes, with a specific focus on the diabetic heart. At 26 weeks of diabetes, several metabolic changes were observed including elevated blood glucose, glycated haemoglobin, plasma insulin and plasma C-peptide. Further analysis of organs commonly affected by diabetes revealed diabetic nephropathy, underlined by renal functional and structural abnormalities, as well as progressive liver damage. In addition, this protocol led to robust left ventricular diastolic dysfunction at 26 weeks with preserved systolic function, a key characteristic of patients with type 2 diabetes-induced cardiomyopathy. These observations corresponded with cardiac structural changes, namely an increase in myocardial fibrosis, as well as activation of several cardiac signalling pathways previously implicated in disease progression. It is hoped that development of an appropriate model will help to understand some the pathophysiological mechanisms underlying the accelerated progression of diabetic complications, leading ultimately to more efficacious treatment options.

13.
JMIR Res Protoc ; 7(6): e152, 2018 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-29884609

RESUMO

BACKGROUND: Adherence to evidence-based cardiovascular risk factor targets in patients with type 2 diabetes and microalbuminuria has shown long-term reduction in mortality and morbidity. Strategies to achieve such adherence have been delivered at individual patient level and are not cost-effective. Health care professional-level intervention has the potential to promote better adherence at lower cost. OBJECTIVE: The aim of this study was to assess the effectiveness of a multifactorial technology-driven intervention comprising health care professional training, a software prompt installed on practice systems, clinician email support, and enhanced performance and feedback reporting. METHODS: A cluster randomized trial will be performed where the primary outcome is the proportion of eligible patients meeting tight cardiovascular risk factor targets, including systolic and diastolic blood pressure (BP; BP<130/80 mm Hg) and total cholesterol (TC; TC<3.5 mmol/L) at 24 months. Secondary outcomes include proportion of patients with glycated hemoglobin (HbA1c) <58 mmol/mol (7.5%), change in medication prescribing, changes in microalbuminuria and renal function (estimated glomerular filtration rate, eGFR), incidence of major adverse CV events and mortality, and coding accuracy. Cost-effectiveness of the intervention will also be assessed. RESULTS: Among 2721 eligible patients, mean age was 62.9 (SD 10.0) years, and duration of diabetes was 10.46 (SD 7.22) years. Mean HbA1c was 59.3 (SD 17.4) mmol/mol; mean systolic and diastolic BP (mm Hg) were 134.3 (SD 14.6) and 76.1 (SD 9.5) mm Hg, respectively; and mean TC was 4.1 (SD 0.98) mmol/L. Overall, 131 out of 2721 (4.81%) patients achieved all 3 "tight" cardiovascular risk factor targets. Cardiovascular risk factor burden increased two-fold in those with eGFR<60 mL/min/1.73 m2 compared with those with eGFR≥60 mL/min/1.73 m2. Prevalence of microalbuminuria was 22.76%. In total, 1076 out of 2721 (39.54%) patients were coded for microalbuminuria or proteinuria on their primary care medical record. CONCLUSIONS: The general practitioner prompt study is the largest UK primary care-based, technology-driven, randomized controlled trial to support intensive intervention in high-risk group of multiethnic individuals with type 2 diabetes and microalbuminuria. This paper provides contemporary estimates for prevalent cardiovascular disease and adherence to evidence-based cardiovascular risk factor targets at baseline in a population with type 2 diabetes and microalbuminuria. The main trial results, including cost-effectiveness data, will be submitted for publication in 2018. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number ISRCTN14918517; http://www.isrctn.com/ISRCTN14918517 (Archived by WebCite at http://www.webcitation.org/6zqm53wNA). REGISTERED REPORT IDENTIFIER: RR1-10.2196/9588.

14.
Comput Med Imaging Graph ; 66: 14-27, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29510320

RESUMO

This paper presents a novel method to segment bone fragments imaged using 3D Computed Tomography (CT). Existing image segmentation solutions often lack accuracy when segmenting internal trabecular and cancellous bone tissues from adjacent soft tissues having similar appearance and often merge regions associated with distinct fragments. These issues create problems in downstream visualization and pre-operative planning applications and impede the development of advanced image-based analysis methods such as virtual fracture reconstruction. The proposed segmentation algorithm uses a probability-based variation of the watershed transform, referred to as the Probabilistic Watershed Transform (PWT). The PWT uses a set of probability distributions, one for each bone fragment, that model the likelihood that a given pixel is a measurement from one of the bone fragments. The likelihood distributions proposed improve upon known shortcomings in competing segmentation methods for bone fragments within CT images. A quantitative evaluation of the bone segmentation results is provided that compare our segmentation results with several leading competing methods as well as human-generated segmentations.


Assuntos
Osso e Ossos/diagnóstico por imagem , Imageamento Tridimensional/métodos , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Humanos
15.
J Vasc Interv Radiol ; 28(10): 1417-1421, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28789817

RESUMO

PURPOSE: To determine effectiveness of the VIABAHN (W.L. Gore & Associates, Flagstaff, Arizona) stent graft to treat cephalic arch stenosis in patients with dysfunctional brachiocephalic arteriovenous fistulas after inadequate venoplasty response. MATERIALS AND METHODS: Between 2012 and 2015, patients with failed venoplasty of symptomatic cephalic arch stenosis received a VIABAHN stent graft. Follow-up venography was performed at approximately 3, 6, and 12 months. Data were retrospectively analyzed with patency estimated using Kaplan-Meier and log-rank methodology. There were 39 patients included. RESULTS: Technical and clinical success was 100%. Primary target lesion patency was 85% (95% confidence interval [CI], 69%-93%), 67% (95% CI, 50%-80%), and 42% (95% CI, 25%-57%) at 3, 6, and 12 months. There was no significant difference in patency with regard to sex or age (P = .8 and P = .6, respectively). Primary assisted patency was 95% (95% CI, 82%-99%) at 3, 6, and 12 months. Access circuit primary patency was 85% (95% CI, 69%-93%), 67% (95% CI, 50%-80%), and 42% (95% CI, 25%-57%) at 3, 6, and 12 months. There was no significant difference in patency between patients with the stent graft as the first treatment episode in the cephalic arch and those that had previous intervention at this site (P = .98). There were 48 repeat venoplasty procedures performed in the cephalic arch to maintain patency, including 7 repeat VIABAHN insertions. No complications were encountered. CONCLUSIONS: The VIABAHN stent graft is a safe, effective, and durable device for treating cephalic arch stenosis when venoplasty fails.


Assuntos
Derivação Arteriovenosa Cirúrgica , Implante de Prótese Vascular/métodos , Tronco Braquiocefálico , Oclusão de Enxerto Vascular/cirurgia , Diálise Renal , Stents , Adolescente , Adulto , Idoso , Prótese Vascular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
16.
BJR Case Rep ; 3(4): 20170025, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-30363221

RESUMO

Ascites is well-documented sequelae of liver cirrhosis with significant impact on survival in this group of patients. Among the many established management strategies for the same is the use of an implantable mechanical device, called alfapump® (Sequana Medical, Zurich, Switzerland), that removes ascitic fluid by pumping it from the peritoneal cavity to the urinary bladder. Until recently, this device has been surgically placed under general anaesthesia. We describe successful interventional radiological implantation under conscious sedation in three patients with minimal complications. This device can serve as an alternative to transjugular intrahepatic portosystemic shunt for the management of refractory ascites; however, further studies are required to understand the device better.

17.
J Diabetes Res ; 2016: 8107108, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27703985

RESUMO

Aims. To apply and assess the suitability of a model consisting of commonly used cross-cultural translation methods to achieve a conceptually equivalent Gujarati language version of the Leicester self-assessment type 2 diabetes risk score. Methods. Implementation of the model involved multiple stages, including pretesting of the translated risk score by conducting semistructured interviews with a purposive sample of volunteers. Interviews were conducted on an iterative basis to enable findings to inform translation revisions and to elicit volunteers' ability to self-complete and understand the risk score. Results. The pretest stage was an essential component involving recruitment of a diverse sample of 18 Gujarati volunteers, many of whom gave detailed suggestions for improving the instructions for the calculation of the risk score and BMI table. Volunteers found the standard and level of Gujarati accessible and helpful in understanding the concept of risk, although many of the volunteers struggled to calculate their BMI. Conclusions. This is the first time that a multicomponent translation model has been applied to the translation of a type 2 diabetes risk score into another language. This project provides an invaluable opportunity to share learning about the transferability of this model for translation of self-completed risk scores in other health conditions.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Emigrantes e Imigrantes , Medição de Risco/métodos , Adulto , Índice de Massa Corporal , Competência Cultural , Feminino , Humanos , Índia/etnologia , Masculino , Pessoa de Meia-Idade , Traduções , Reino Unido
18.
J Am Board Fam Med ; 29(6): 775-784, 2016 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-28076261

RESUMO

CONTEXT AND OBJECTIVE: Patient advisory councils (PACs) are a strategy for primary care clinics to engage patients in practice improvement. However, there is scant research on how PACs function. This study aimed to understand how PACs are organized and identify common challenges and perceived benefits of high-functioning PACs. SETTING AND POPULATION: Key informants identified 8 primary care clinics in California with high-functioning PACs. Leaders from each of the 8 clinics nominated 1 clinic staff member and 1 PAC patient member to be interviewed. STUDY DESIGN: Semistructured, one-on-one interviews were conducted at each clinic site or by phone. Interviews were dual-coded using modified grounded theory. Common themes were identified that would be pertinent to the development of future best practices for running PACs. RESULTS: Common characteristics of high-functioning PACs included careful attention to participant recruitment, facilitation strategies guiding diverse personalities toward a common purpose, and assigning accountability for practice improvement projects. Interviewees identified a variety of positive outcomes that ranged from tangible improvements to the waiting area to a more patient-centered staff culture. CONCLUSIONS: PACs show potential for promoting patient-centered practice improvements in primary care. Lessons learned from high-functioning PACs can inform a common set of strategies to assist practices in creating and sustaining effective advisory councils.


Assuntos
Comitês Consultivos/organização & administração , Participação do Paciente , Assistência Centrada no Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade/organização & administração , California , Humanos , Guias de Prática Clínica como Assunto , Relações Profissional-Paciente , Pesquisa Qualitativa
19.
F1000Res ; 4: 51, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25949803

RESUMO

Between 2011 and 2013 the number of recorded malaria cases had more than doubled, and between 2009 and 2013 had increased almost 4-fold in MSF-OCA (Médecins sans Frontières - Operational Centre Amsterdam) programmes in the Democratic Republic of the Congo (DRC). The reasons for this rise are unclear. Incorrect intake of Artemisinin Combination Therapy (ACT) could result in failure to treat the infection and potential recurrence. An adherence study was carried out to assess whether patients were completing the full course of ACT. One hundred and eight malaria patients in Shamwana, Katanga province, DRC were visited in their households the day after ACT was supposed to be completed. They were asked a series of questions about ACT administration and the blister pack was observed (if available). Sixty seven (62.0%) patients were considered probably adherent. This did not take into account the patients that vomited or spat their pills or took them at the incorrect time of day, in which case adherence dropped to 46 (42.6%). The most common reason that patients gave for incomplete/incorrect intake was that they were vomiting or felt unwell (10 patients (24.4%), although the reasons were not recorded for 22 (53.7%) patients). This indicates that there may be poor understanding of the importance of completing the treatment or that the side effects of ACT were significant enough to over-ride the pharmacy instructions. Adherence to ACT was poor in this setting. Health education messages emphasising the need to complete ACT even if patients vomit doses, feel unwell or their health conditions improve should be promoted.

20.
Nat Commun ; 6: 6712, 2015 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-25813699

RESUMO

The origins of fractures in Martian boulders are unknown. Here, using Mars Exploration Rover 3D data products, we obtain orientation measurements for 1,857 cracks visible in 1,573 rocks along the Spirit traverse and find that Mars rock cracks are oriented in statistically preferred directions similar to those compiled herein for Earth rock cracks found in mid-latitude deserts. We suggest that Martian directional cracking occurs due to the preferential propagation of microfractures favourably oriented with respect to repeating geometries of diurnal peaks in sun-induced thermal stresses. A numerical model modified here with Mars parameters supports this hypothesis both with respect to the overall magnitude of stresses as well as to the times of day at which the stresses peak. These data provide the first direct field and numerical evidence that insolation-related thermal stress potentially plays a principle role in cracking rocks on portions of the Martian surface.

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