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1.
Nutrients ; 13(8)2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34444951

RESUMO

The COVID-19 pandemic restrictions sent college students online and off campus, potentially reducing access to healthy food. The objective of this cross-sectional, internet-based study was to use qualitative and quantitative survey methods to evaluate whether COVID-19 pandemic restrictions in Texas, USA affected college students' ability to buy food, how/what they shopped for, how they prepared food, what they ate, how they felt about eating, and overall dietary quality (assessed using Healthy Eating Index [HEI] scores). Survey responses from 502 students (87.5% female; 59.6% nonwhite, mean age 27.5 ± 0.4 years, >50% graduate students) were analyzed. The qualitative analysis of open-ended questions revealed 110 codes, 17 subthemes, and six themes. Almost all students experienced changes in at least one area, the most common being changes in shopping habits. Participants with low or very low food security had lower HEI scores compared to food secure students (p = 0.047). Black students were more likely to report changes in their ability to buy food (p = 0.035). The COVID-19 restrictions varied in their impact on students' ability to access sufficient healthy food, with some students severely affected. Thus, universities should establish procedures for responding to emergencies, including identifying at-risk students and mobilizing emergency funds and/or food assistance.


Assuntos
COVID-19/epidemiologia , Dieta Saudável/estatística & dados numéricos , Dieta/estatística & dados numéricos , Adulto , COVID-19/psicologia , Estudos Transversais , Dieta/psicologia , Dieta/normas , Dieta Saudável/psicologia , Estudos de Avaliação como Assunto , Comportamento Alimentar , Feminino , Assistência Alimentar , Segurança Alimentar , Humanos , Masculino , Pandemias , SARS-CoV-2/isolamento & purificação , Estudantes , Texas/epidemiologia , Universidades/estatística & dados numéricos
2.
J Comput Assist Tomogr ; 45(3): 452-457, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297514

RESUMO

OBJECTIVE: The aim of this study was to evaluate dual-energy computed tomography (CT) virtual noncalcium (VNCa) technique as a means of quantifying osteoporosis. METHODS: Dual-energy CT scans were obtained prospectively, targeting lumbar regions of 55 patients with chronic low back pain. A standard quantitative CT (QCT) phantom was positioned at the waist during each procedure, using proprietary software (QCT Pro; Mindways, Tex) to measure bone mineral density (BMD) in each vertebral body. Vendor dual-energy analytic software was altered with a specially modified configuration file to produce a "Virtual Non Calcium" or "VNCa" output, as such output variables were remapped to produce the following calcium values rather than iodine, yielding the following QCT parameters: CT value of calcium (originally "contrast media" [CM]), CT value of mixed energy imaging (regular CT value [rCT]), calcium density (originally "contrast agent density" [CaD]), and fat fraction (FF). Pearson test served to assess correlations between BMD and these parameters. Multiple linear regression analysis was applied to construct an equation for generating regressive BMD (rBMD) values. In gauging diagnostic accuracies, the criterion-standard BMD cutoff point (<80 mg/cm3) was adopted for QCT, whereas the rBMD threshold was defined by receiver operating characteristic curve. RESULTS: Contrast media, rCT, CaD, and FF values (reflecting CT value of calcium, regular CT value, calcium density, and fat fraction, respectively) significantly correlated with BMD (r values: 0.885, 0.947, 0.877, and 0.492, respectively; all P < 0.01). Contrast media, CaD, and FF showed independent associations with BMD; the regressive equation was formulated as follows: rBMD = 54.82 - 0.19 × CM + 20.03 × CaD - 1.24 × FF. The area under the curve of rBMD in diagnosing osteoporosis was 0.966 ± 0.009 (P < 0.01). At an rBMD threshold of less than 81.94 mg/cm3, sensitivity and specificity were 90.0% and 92.0%, respectively. CONCLUSIONS: Dual-energy CT VNCa technique may constitute a valid alternative method for quantifying the mineral content and marrow fat composition of bone in diagnostic assessments of osteoporosis.


Assuntos
Osteoporose/diagnóstico por imagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Densidade Óssea , Meios de Contraste , Estudos de Avaliação como Assunto , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Imagens de Fantasmas , Estudos Prospectivos , Sensibilidade e Especificidade , Software
3.
Cochrane Database Syst Rev ; 7: CD013384, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34309831

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition characterised by shortness of breath, cough and recurrent exacerbations. People with COPD often live with one or more co-existing long-term health conditions (comorbidities). People with more severe COPD often have a higher number of comorbidities, putting them at greater risk of morbidity and mortality. OBJECTIVES: To assess the effectiveness of any single intervention for COPD adapted or tailored to their comorbidity(s) compared to any other intervention for people with COPD and one or more common comorbidities (quantitative data, RCTs) in terms of the following outcomes: Quality of life, exacerbations, functional status, all-cause and respiratory-related hospital admissions, mortality, pain, and depression and anxiety. To assess the effectiveness of an adapted or tailored single COPD intervention (simple or complex) that is aimed at changing the management of people with COPD and one or more common comorbidities (quantitative data, RCTs) compared to usual care in terms of the following outcomes: Quality of life, exacerbations, functional status, all-cause and respiratory-related hospital admissions, mortality, pain, and depression and anxiety. To identify emerging themes that describe the views and experiences of patients, carers and healthcare professionals when receiving or providing care to manage multimorbidities (qualitative data). SEARCH METHODS: We searched multiple databases including the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, and CINAHL, to identify relevant randomised and qualitative studies. We also searched trial registries and conducted citation searches. The latest search was conducted in January 2021. SELECTION CRITERIA: Eligible randomised controlled trials (RCTs) compared a) any single intervention for COPD adapted or tailored to their comorbidity(s) compared to any other intervention, or b) any adapted or tailored single COPD intervention (simple or complex) that is aimed at changing the management of people with COPD and one or more comorbidities, compared to usual care. We included qualitative studies or mixed-methods studies to identify themes. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods for analysis of the RCTs. We used Cochrane's risk of bias tool for the RCTs and the CASP checklist for the qualitative studies. We planned to use the Mixed Methods Appraisal tool (MMAT) to assess the risk of bias in mixed-methods studies, but we found none. We used GRADE and CERQual to assess the quality of the quantitative and qualitative evidence respectively. The primary outcome measures for this review were quality of life and exacerbations. MAIN RESULTS: Quantitative studies We included seven studies (1197 participants) in the quantitative analyses, with interventions including telemonitoring, pulmonary rehabilitation, treatment optimisation, water-based exercise training and case management. Interventions were either compared with usual care or with an active comparator (such as land-based exercise training). Duration of trials ranged from 4 to 52 weeks. Mean age of participants ranged from 64 to 72 years and COPD severity ranged from mild to very severe. Trials included either people with COPD and a specific comorbidity (including cardiovascular disease, metabolic syndrome, lung cancer, head or neck cancer, and musculoskeletal conditions), or with one or more comorbidities of any type. Overall, we judged the evidence presented to be of moderate to very low certainty (GRADE), mainly due to the methodological quality of included trials and imprecision of effect estimates. Intervention versus usual care Quality of life as measured by the St George's Respiratory Questionnaire (SGRQ) total score may improve with tailored pulmonary rehabilitation compared to usual care at 52 weeks (mean difference (MD) -10.85, 95% confidence interval (CI) -12.66 to -9.04; 1 study, 70 participants; low-certainty evidence). Tailored pulmonary rehabilitation is likely to improve COPD assessment test (CAT) scores compared with usual care at 52 weeks (MD -8.02, 95% CI -9.44 to -6.60; 1 study, 70 participants, moderate-certainty evidence) and with a multicomponent telehealth intervention at 52 weeks (MD -6.90, 95% CI -9.56 to -4.24; moderate-certainty evidence). Evidence is uncertain about effects of pharmacotherapy optimisation or telemonitoring interventions on CAT improvement compared with usual care. There may be little to no difference in the number of people experiencing exacerbations, or mean exacerbations with case management compared with usual care (OR 1.09, 95% CI 0.75 to 1.57; 1 study, 470 participants; very low-certainty evidence). For secondary outcomes, six-minute walk distance (6MWD) may improve with pulmonary rehabilitation, water-based exercise or multicomponent interventions at 38 to 52 weeks (low-certainty evidence). A multicomponent intervention may result in fewer people being admitted to hospital at 17 weeks, although there may be little to no difference in a telemonitoring intervention. There may be little to no difference between intervention and usual care for mortality. Intervention versus active comparator We included one study comparing water-based and land-based exercise (30 participants). We found no evidence for quality of life or exacerbations. There may be little to no difference between water- and land-based exercise for 6MWD (MD 5 metres, 95% CI -22 to 32; 38 participants; very low-certainty evidence). Qualitative studies One nested qualitative study (21 participants) explored perceptions and experiences of people with COPD and long-term conditions, and of researchers and health professionals who were involved in an RCT of telemonitoring equipment. Several themes were identified, including health status, beliefs and concerns, reliability of equipment, self-efficacy, perceived ease of use, factors affecting usefulness and perceived usefulness, attitudes and intention, self-management and changes in healthcare use. We judged the qualitative evidence presented as of very low certainty overall. AUTHORS' CONCLUSIONS: Owing to a paucity of eligible trials, as well as diversity in the intervention type, comorbidities and the outcome measures reported, we were unable to provide a robust synthesis of data. Pulmonary rehabilitation or multicomponent interventions may improve quality of life and functional status (6MWD), but the evidence is too limited to draw a robust conclusion. The key take-home message from this review is the lack of data from RCTs on treatments for people living with COPD and comorbidities. Given the variation in number and type of comorbidity(s) an individual may have, and severity of COPD, larger studies reporting individual patient data are required to determine these effects.


Assuntos
Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Viés , Administração de Caso , Causas de Morte , Comorbidade , Intervalos de Confiança , Progressão da Doença , Estudos de Avaliação como Assunto , Exercício Físico , Humanos , Pessoa de Meia-Idade , Razão de Chances , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/reabilitação , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Telemedicina , Fatores de Tempo , Teste de Caminhada
4.
J Foot Ankle Res ; 14(1): 46, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193240

RESUMO

BACKGROUND: In response to the COVID-19 pandemic, populations were advised to remain at home to control viral spread. Government-mandated restrictions on free movement affected individuals' engagement with physical activity, with reported increases leading to biopsychosocial health benefits and conversely increased sedentary behaviour leading to poorer health. Good foot health is key to enabling physical activity and maximal participation in activities of occupation and daily living. METHODS: A population-based cross-sectional study was performed, using a web-based platform. Quantitative and qualitative data were captured through responses to closed and open survey questions. Anybody with a foot health condition was eligible to participate in the online survey. Links were sent through professional networks, support groups and charities, using a snowball strategy to maximise participation. RESULTS: Two hundred fifty-five respondents completed the survey. Most (n = 193, 75.69%) reported an ongoing foot pain or problem that had been present for 4 weeks or longer, whilst 49 respondents (19.22%) noted a new pain or problem. Pain was the most frequently reported symptom (n = 139, 54.51%), whilst change in appearance of the foot was also commonly reported (n = 122, 47.84%), often alongside the observable presence of swelling. Musculoskeletal foot symptoms were frequently reported (n = 123, 48%), and were significantly associated with reported reduced physical activity (X2 = 6.61, p = 0.010). Following qualitative analysis five themes and 11 subthemes emerged, informed by 49 independent codes. A central theme of lockdown disrupting support networks, both formal (healthcare providers) and informal (friends or family members) emerged. The 5 sub-themes were: 1. foot pain is a constant companion, 2. self-care, 3. 'cope or crumble' scenarios, 4. future intent to access healthcare and 5. reduced ability to undertake physical activity. CONCLUSIONS: Pain was the most frequently reported foot problem during COVID-19 lockdown restriction. Lockdown restrictions disrupted support networks integral to maintaining foot health. Poor foot health impacted people's ability to remain physically active. Complaints previously considered relatively 'minor' such as support for skin and nail care, were found to be exacerbated by restricted support networks, leading to greater negative impact.


Assuntos
COVID-19/prevenção & controle , Exercício Físico/psicologia , Pé/patologia , Dor Musculoesquelética/epidemiologia , Isolamento Social/psicologia , Atividades Cotidianas/psicologia , Adulto , Idoso , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Controle de Doenças Transmissíveis/estatística & dados numéricos , Estudos Transversais , Estudos de Avaliação como Assunto , Feminino , Regulamentação Governamental , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Participação do Paciente , SARS-CoV-2/genética , Comportamento Sedentário , Autocuidado/psicologia , Grupos de Autoajuda/organização & administração , Inquéritos e Questionários
5.
Br J Radiol ; 94(1125): 20210115, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34111973

RESUMO

OBJECTIVE: To assess the value of non-contrast MRI features for characterisation of uterine leiomyosarcoma (LMS) and differentiation from atypical benign leiomyomas. METHODS: This study included 57 atypical leiomyomas and 16 LMS which were referred pre-operatively for management review to the specialist gynaeoncology multidisciplinary team meeting. Non-contrast MRIs were retrospectively reviewed by five independent readers (three senior, two junior) and a 5-level Likert score (1-low/5-high) was assigned to each mass for likelihood of LMS. Evaluation of qualitative and quantitative MRI features was done using uni- and multivariable regression analysis. Inter-reader reliability for the assessment of MRI features was calculated by using Cohen's κ values. RESULTS: In the univariate analysis, interruption of the endometrial interface and irregular tumour shape had the highest odds ratios (ORs) (64.00, p < 0.001 and 12.00, p = 0.002, respectively) for prediction of LMS. Likert score of the mass was significant in prediction (OR, 3.14; p < 0.001) with excellent reliability between readers (ICC 0.86; 95% CI, 0.76-0.92). The post-menopausal status, interruption of endometrial interface and thickened endometrial stripe were the most predictive independent variables in multivariable estimation of the risk of leiomyosarcoma with an accuracy of 0.88 (95%CI, 0.78-0.94). CONCLUSION: At any level of expertise as a radiologist reader, the loss of the normal endometrial stripe (either thickened or not seen) in a post-menopausal patient with a myometrial mass was highly likely to be LMS. ADVANCES IN KNOWLEDGE: This study demonstrates the potential utility of non-contrast MRI features in characterisation of LMS over atypical leiomyomas, and therefore influence on optimal management of these cases.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Leiomiossarcoma/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Neoplasias Uterinas/diagnóstico por imagem , Adulto , Idoso , Diagnóstico Diferencial , Estudos de Avaliação como Assunto , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Útero/diagnóstico por imagem
6.
Br J Radiol ; 94(1125): 20210054, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34111974

RESUMO

OBJECTIVES: To investigate the role of quantitative Magnetic Resonance Imaging (MRI) in preoperative assessment of tumour aggressiveness in patients with endometrial cancer, correlating multiple parameters obtained from diffusion and dynamic contrast-enhanced (DCE) MR sequences with conventional histopathological prognostic factors and inflammatory tumour infiltrate. METHODS: Forty-four patients with biopsy-proven endometrial cancer underwent preoperative MR imaging at 3T scanner, including DCE imaging, diffusion-weighted imaging (DWI) and intravoxel incoherent motion imaging (IVIM). Images were analysed on dedicated post-processing workstations and quantitative parameters were extracted: Ktrans, Kep, Ve and AUC from the DCE; ADC from DWI; diffusion D, pseudo diffusion D*, perfusion fraction f from IVIM and tumour volume from DWI. The following histopathological data were obtained after surgery: histological type, grading (G), lympho-vascular invasion (LVI), lymph node status, FIGO stage and inflammatory infiltrate. RESULTS: ADC was significantly higher in endometrioid histology, G1-G2 (low grade), and stage IA. Significantly higher D* were found in endometrioid subptype, negative lymph nodes and stage IA. The absence of LVI is associated with higher f values. Ktrans and Ve values were significantly higher in low grade. Higher D*, f and AUC occur with the presence of chronic inflammatory cells, D * was also able to distinguish chronic from mixed type of inflammation. Larger volume was significantly correlated with the presence of mixed-type inflammation, LVI, positive lymph nodes and stage ≥IB. CONCLUSIONS: Quantitative biomarkers obtained from pre-operative DWI, IVIM and DCE-MR examination are an in vivo representation of the physiological and microstructural characteristics of endometrial carcinoma allowing to obtain the fundamental parameters for stratification into Risk Classes. ADVANCES IN KNOWLEDGE: Quantitative imaging biomarkers obtained from DWI, DCE and IVIM may improve preoperative prognostic stratification in patients with endometrial cancer leading to a more informed therapeutic choice.


Assuntos
Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Imageamento por Ressonância Magnética/métodos , Endométrio/diagnóstico por imagem , Endométrio/patologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Invasividade Neoplásica , Reprodutibilidade dos Testes
7.
Medicine (Baltimore) ; 100(22): e26223, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087901

RESUMO

BACKGROUND: Post-stroke insomnia (PSI) is a highly prevalent complication in patients with stroke. However, there has been no comprehensive systematic review assessing the efficacy and safety of herbal medicine (HM) on PSI. This protocol was developed to conduct a systematic review and meta-analysis to evaluate the evidence related to the efficacy and safety of HM on PSI. METHODS: We will perform a comprehensive electronic search, including Medline, EMBASE, CENTRAL, AMED, CINAHL, PsycARTICLES, and Chinese, Korean, and Japanese databases from their inception to November 2020. This systemic review will include only randomized controlled clinical trials of HM on PSI. The main outcome is the Pittsburgh Sleep Quality Index score. Two researchers will independently screen citations and abstracts, identify full-text articles for inclusion, extract data, and appraise the quality and risk of bias of included studies. A meta-analysis will be conducted using Review Manager 5.4. The evidence quality of each outcome will be appraised according to Grades of Recommendation, Assessment, Development, and Evaluation. RESULTS: This protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-P (PRISMA-P) guidelines to ensure clarity and completeness of reporting in all phases of the systematic review. CONCLUSION: This study will provide evidence regarding the efficacy and safety of HM for the treatment of PSI. ETHICS AND DISSEMINATION: No ethical approval will be needed because data from previously published studies in which informed consent was obtained by primary investigators will be retrieved and analyzed. We will publish this systematic review in a peer-reviewed journal. OSF REGISTRATION DOI: 10.17605/OSF.IO/PEHQZ.


Assuntos
Medicina Herbária/métodos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/etiologia , Acidente Vascular Cerebral/complicações , Gerenciamento de Dados , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Segurança , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Resultado do Tratamento
8.
Int J Mol Sci ; 22(10)2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34065385

RESUMO

In retinitis pigmentosa (RP), one of many possible genetic mutations causes rod degeneration, followed by cone secondary death leading to blindness. Accumulating evidence indicates that rod death triggers multiple, non-cell-autonomous processes, which include oxidative stress and inflammation/immune responses, all contributing to cone demise. Inflammation relies on local microglia and recruitment of immune cells, reaching the retina through breakdowns of the inner blood retinal barrier (iBRB). Leakage in the inner retina vasculature suggests similarly altered outer BRB, formed by junctions between retinal pigment epithelium (RPE) cells, which are crucial for retinal homeostasis, immune response, and privilege. We investigated the RPE structural integrity in three models of RP (rd9, rd10, and Tvrm4 mice) by immunostaining for zonula occludens-1 (ZO-1), an essential regulatory component of tight junctions. Quantitative image analysis demonstrated discontinuities in ZO-1 profiles in all mutants, despite different degrees of photoreceptor loss. ZO-1 interruption zones corresponded to leakage of in vivo administered, fluorescent dextran through the choroid-RPE interface, demonstrating barrier dysfunction. Dexamethasone, administered to rd10 mice for rescuing cones, also rescued RPE structure. Thus, previously undetected, stereotyped abnormalities occur in the RPE of RP mice; pharmacological targeting of inflammation supports a feedback loop leading to simultaneous protection of cones and the RPE.


Assuntos
Retina/fisiopatologia , Epitélio Pigmentado da Retina/fisiopatologia , Retinite Pigmentosa/fisiopatologia , Animais , Dexametasona/farmacologia , Modelos Animais de Doenças , Estudos de Avaliação como Assunto , Inflamação/metabolismo , Inflamação/fisiopatologia , Camundongos , Camundongos Endogâmicos C57BL , Retina/efeitos dos fármacos , Retina/metabolismo , Células Fotorreceptoras Retinianas Cones/efeitos dos fármacos , Células Fotorreceptoras Retinianas Cones/metabolismo , Epitélio Pigmentado da Retina/efeitos dos fármacos , Epitélio Pigmentado da Retina/metabolismo , Células Fotorreceptoras Retinianas Bastonetes/efeitos dos fármacos , Células Fotorreceptoras Retinianas Bastonetes/metabolismo , Vasos Retinianos/efeitos dos fármacos , Vasos Retinianos/metabolismo , Retinite Pigmentosa/metabolismo , Rodopsina/metabolismo , Junções Íntimas/efeitos dos fármacos , Junções Íntimas/metabolismo , Proteína da Zônula de Oclusão-1/metabolismo
9.
Rev. cuba. inform. méd ; 13(1): e412, ene.-jun. 2021. graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1251731

RESUMO

El empleo de las tecnologías de la información y la comunicación en el sector de la salud mejoran considerablemente el funcionamiento de los procesos asistenciales y de gestión médico-administrativa, todo lo cual contribuye a una mayor eficiencia hospitalaria y desempeño competitivo de las instituciones. La presente investigación aborda la problemática existente con el diseño de la infraestructura de red del Centro de Investigaciones Médico Quirúrgicas (CIMEQ), la cual afecta los procesos sustantivos de la institución, como la gestión de pacientes y la trasmisión de imágenes médicas. El objetivo de la investigación es rediseñar la infraestructura de red del CIMEQ, lo que permitirá elevar su rendimiento y seguridad. La investigación tiene un enfoque cuantitativo, con alcance descriptivo, de tipo retrospectivo y diseño experimental, de corte longitudinal. Se emplearon los métodos científicos de modelación y análisis documental. Como resultado se rediseñó la infraestructura de red de área local del CIMEQ, a través de métodos de segmentación que permitieron crear grupos de trabajo de manera dinámica, aprovechar las bondades de los equipos gestionables instalados y la implementación de nuevos cortafuegos. La propuesta de segmentación obtenida, por medio de redes de área local virtual, aplicación de medidas de seguridad a nivel de capa 2 y capa 3 del modelo OSI y la administración del ancho de banda mediante la implementación de calidad de servicio QoS para las aplicaciones que requieran prioridad en el tráfico de la red, mejoró el rendimiento y seguridad de la infraestructura de red del CIMEQ, lo cual impacta en un mayor desempeño competitivo y eficiencia hospitalaria desde el empleo de las tecnologías de la información y la comunicación(AU)


Using of information and communication technologies In the health sector improve considerably the functioning of healthcare processes and medical-administrative management, all of which it contributes to greater hospital efficiency and competitive performance of the institutions. This research addresses the existing problem with the design of the network infrastructure of the Medical Surgical Research Center (CIMEQ), which affects the substantive processes of the institution, such as patient management and the transmission of medical images. The objective of the research is to redesign the CIMEQ network infrastructure, which allows increase its performance and security. The research has a quantitative approach, with a descriptive scope, of a retrospective type and an experimental design, of longitudinal cut. Scientific methods of modeling and documentary analysis were used. As a result, the CIMEQ local area network infrastructure was redesigned, through segmentation methods that allowed dynamic workgroups to be created, take advantage of the benefits of installed manageable equipment and the implementation of new firewalls. The segmentation proposal obtained, through virtual local area networks, application of security measures in the layer 2 and layer 3 of the OSI model and bandwidth management through the implementation of quality of service for applications that require priority in network traffic, improved the performance and security of the CIMEQ network infrastructure, which impacts in a greater competitive performance and hospital efficiency(AU)


Assuntos
Humanos , Infraestrutura Sanitária/normas , Tecnologia da Informação , Epidemiologia Descritiva , Estudos de Avaliação como Assunto
10.
World Neurosurg ; 151: e552-e564, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33933697

RESUMO

BACKGROUND: The demand of thrombectomy treatment for acute ischemic stroke increased dramatically in the United States after the publication of 5 pivotal trials in 2015. The impact of call burden on career satisfaction and burnout in neurointerventionalists has not been explored. METHODS: A qualitative approach was chosen to obtain rich, detailed accounts of physician experiences. From July 2018 to July 2019, we conducted in-depth, semistructured interviews (mean duration, 43 minutes) with 16 academic neurointerventionalists from various institutions in the United States. Participants were chosen from the Society of Neurointerventional Surgery to include multiple specialties, career stages, and geographic locations. Key themes/subthemes were organized into a conceptual model and shown by exemplary quotes. RESULTS: Participants report a diverse range of previously uncharacterized ways in which stroke call responsibilities affect their lives. Unrealistic performance expectations, discipline-based inequalities, poor organizational workflow, limited opportunities for growth and advancement, and lack of control over call conditions are some of the key themes identified. Participants describe a need for interventions that address both the issues of workload stress (i.e., resources for stroke call and administrative work) and their ability to accomplish professional goals (i.e., flexible work arrangements, leadership autonomy support, and organizational value congruence). CONCLUSIONS: The burden of stroke call has strong implications for career satisfaction and burnout in neurointerventionalists. This model can be used by hospitals, departments, and physician groups to better conceptualize conditions that facilitate burnout and attrition. Changes to hospital management practices and culture may be the most productive focal areas for intervention.


Assuntos
Esgotamento Profissional , AVC Isquêmico/cirurgia , Satisfação no Emprego , Neurocirurgiões/psicologia , Estudos de Avaliação como Assunto , Humanos , Trombectomia , Estados Unidos , Carga de Trabalho
14.
BMC Neurol ; 21(1): 143, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789607

RESUMO

BACKGROUND: The 32-item Motor Function Measure (MFM32) is a clinician-reported outcome measure used to assess the functional abilities of individuals with neuromuscular diseases, including those with spinal muscular atrophy (SMA). This two-part study explored the relationship between the functional abilities assessed in the MFM32 and activities of daily living (ADLs) from the perspective of individuals with Type 2 and Type 3 (non-ambulant and ambulant) SMA and their caregivers through qualitative interviews and a quantitative online survey. METHODS: In-depth, semi-structured, qualitative interviews were conducted with individuals with SMA and caregivers from the US. Subsequently, a quantitative online survey was completed by individuals with SMA or their caregivers from France, Germany, Italy, Poland, Spain, Canada, the United States (US) and the UK. In both parts of the study, participants were asked to describe the ADLs considered to be related to the functional abilities assessed in the MFM32. Results from the qualitative interviews informed the content of the quantitative online survey. RESULTS: Qualitative interviews were conducted with 15 adult participants, and 217 participants completed the quantitative online survey. From the qualitative interviews, all of the functional abilities assessed in the patient-friendly MFM32 were deemed as related to one or more ADL. The specific ADLs that participants considered related to the patient-friendly MFM32 items could be grouped into 10 key ADL domains: dressing, mobility/transferring, self-care, self-feeding, reaching, picking up and holding objects, physical activity, writing and technology use, social contact/engagement, toileting and performing work/school activities. These results were confirmed by the quantitative online survey whereby the ADLs reported to be related to each patient-friendly MFM32 item were consistent and could be grouped into the same 10 ADL domains. CONCLUSION: This study provides in-depth evidence from the patient/caregiver perspective supporting the relevance of the patient-friendly MFM32 items to the ADLs of individuals with Type 2 and Type 3 SMA.


Assuntos
Atividades Cotidianas , Atrofia Muscular Espinal , Índice de Gravidade de Doença , Adulto , Cuidadores , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Inquéritos e Questionários
15.
Radiology ; 300(1): 89-97, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33904773

RESUMO

Background Dynamic contrast-enhanced (DCE) photoacoustic (PA) imaging (PAI) is a novel noninvasive imaging modality that uses the differences in optical absorption of oxyhemoglobin and deoxyhemoglobin and may be performed in a dynamic fashion to image the indocyanine green (ICG) pharmacokinetics in the liver. Purpose To determine whether DCE PAI parameters (maximum peak time [Tmax] and half-life [T1/2]) derived from the PA liver function curve correlate with fibrosis determined using histopathologic analysis. Materials and Methods Between June 2020 and October 2020, 28 male mice aged 8 weeks were intraperitoneally injected with carbon tetrachloride solution every 2 days to establish a liver fibrosis model. At the 1st, 4th, and 8th week of modeling, the changes in liver structure were monitored dynamically by using a PA technique. The Tmax and T1/2 of ICG were calculated at different pathologic stages and within a control group. Corresponding liver histopathologic results and blood biochemical data were obtained. Spearman rank correlation was used to evaluate the relationship between the DCE PAI results and histologic scores. Results The PA liver function curve showed that the Tmax and T1/2 varied among groups (mean Tmax: control group, 9 seconds ± 1.8 [standard deviation]; 1 week, 51 seconds ± 4.4; 4 weeks, 73 seconds ± 5.3; 8 weeks, 104 seconds ± 6.6; P < .001) (mean T1/2: control group, 28 seconds ± 6.5; 1 week, 201 seconds ± 12.4; 4 weeks, 285 seconds ± 11; 8 weeks, 318 seconds ± 30.5; P < .001). There was a positive correlation between the dynamic parameters (Tmax and T1/2) and the histopathologic scores; the Spearman ρ ratios for the Sirius red and α-smooth muscle actin (αSMA)-positive areas versus the Tmax were 0.93 and 0.94 (P < .001 for both), and the Spearman ρ ratios for the Sirius red and αSMA-positive areas versus T1/2 were 0.87 and 0.89 (P < .001 for both). Conclusion Dynamic contrast-enhanced photoacoustic imaging demonstrated a higher maximum peak time and half-life in mice with induced fibrosis compared with control mice without fibrosis, and these values correlated with histologic measures of fibrosis. © RSNA, 2021 Online supplemental material is available for this article.


Assuntos
Meios de Contraste/farmacocinética , Aumento da Imagem/métodos , Verde de Indocianina/farmacocinética , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/fisiopatologia , Técnicas Fotoacústicas/métodos , Animais , Modelos Animais de Doenças , Estudos de Avaliação como Assunto , Fígado/diagnóstico por imagem , Fígado/fisiopatologia , Masculino , Camundongos
16.
PLoS One ; 16(4): e0243870, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33891609

RESUMO

Drug shortages frequently and persistently affect healthcare institutions, posing formidable financial, logistical, and ethical challenges. Despite plentiful evidence characterizing the impact of drug shortages, there is a remarkable dearth of data describing current shortage management practices. Hospitals within the same state or region may not only take different approaches to shortages but may be unaware of shortages proximate facilities are facing. Our goal is to explore how hospitals in Michigan handle drug shortages to assess potential need for comprehensive drug shortage management resources. We conducted semi-structured interviews with diverse stakeholders throughout the state to describe experiences managing drug shortages, approaches to recent shortages, openness to inter-institutional engagement, ideas for a shared resource, and potential obstacles to implementation. To solicit additional feedback on ideas for a shared resource gathered from the interviews, we held focus groups with pharmacists, physicians, ethicists, and community representatives. Among participants representing a heterogeneous sample of institutions, three themes were consistent: (1) numerous drug shortage strategies occurring simultaneously; (2) inadequate resources and lead time to proactively manage shortages; and (3) interest in, but varied attitudes toward, a collaborative approach. These data provide insight to help develop and test a shared drug shortage management resource for enhancing fair allocation of scarce drugs. A shared resource may help institutions adopt accepted best practices and more efficiently access or share finite resources in times of shortage.


Assuntos
Preparações Farmacêuticas/provisão & distribuição , Atenção à Saúde/estatística & dados numéricos , Estudos de Avaliação como Assunto , Hospitais/estatística & dados numéricos , Humanos , Colaboração Intersetorial , Michigan , Farmacêuticos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
17.
J Soc Psychol ; 161(4): 477-491, 2021 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-33906584

RESUMO

What mitigates prejudice against migrants in situations of uncertainty? Addressing this question, we explored how individuals with greater COVID-19 concern perceive migrants as a greater threat and show prejudice against them, indirectly through the mechanism of need for cognitive closure and binding moral foundations.This study was conducted in two European countries: Malta and Italy. Six hundred and seventy-six individuals participated in this quantitative study (Malta: N = 204; Italy N = 472). Results from this study showed that the need for cognitive closure and binding moral foundations mediate the relationship between COVID-19 concern and prejudice against migrants in both countries. When testing the three binding moral foundations (loyalty, authority, and purity), the authority foundation seems to be the most consistent predictor.The implications of the findings contribute to theories about how situational uncertainty caused by COVID-19, together with the need for epistemic certainty and binding morality, contribute to increased prejudiced attitudes against migrants.


Assuntos
COVID-19/psicologia , Princípios Morais , Preconceito/psicologia , Migrantes/psicologia , Incerteza , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cognição , Estudos de Avaliação como Assunto , Feminino , Humanos , Itália , Masculino , Malta , Pessoa de Meia-Idade , Preconceito/estatística & dados numéricos , SARS-CoV-2 , Migrantes/estatística & dados numéricos , Adulto Jovem
18.
Eur J Oncol Nurs ; 52: 101948, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33799021

RESUMO

PURPOSE: Lymphoma is a common hematologic malignancy of adolescents and young adults. Cancer survivorship and quality of life are two outcomes studied to measure the types and scope of problems cancer patients experience leading to diagnosis, treatment, and long-term survivorship. This integrative literature review aims to review published literature in the adolescent and young adult lymphoma population, emphasizing cancer survivorship and quality of life outcomes. METHODS: The integrative review framework by Whittemore and Knafl was used as the guideline for this study. A literature search of three relevant health science databases, including PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Ovid Emcare, was completed. RESULTS: Twelve publications were included in the review, including ten quantitative and two qualitative studies. The studies consisted of sample populations from the United States, England, Germany, and the Netherlands; one study was an international, Children's Oncology Group study. The included studies detailed the cancer survivorship and quality of life outcomes of young adults with lymphoma by quantitative retrospective and longitudinal analysis; two studies used descriptive qualitative and grounded theory methods. The limited qualitative and longitudinal research in adolescents and young adults with lymphoma demonstrates a gap in the lived experience of this cancer population and the adherence to long-term survivorship recommendations. CONCLUSION: Future research in adolescents and young adults with lymphoma should employ longitudinal and qualitative designs to examine the quality of life from diagnosis through extended survivorship, and the experiences at diagnosis, treatment, post-treatment, and long-term follow up.


Assuntos
Sobreviventes de Câncer/psicologia , Linfoma/psicologia , Qualidade de Vida , Sobrevivência , Adolescente , Estudos de Avaliação como Assunto , Humanos , Avaliação de Resultados em Cuidados de Saúde , Adulto Jovem
19.
PLoS One ; 16(4): e0249632, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33909612

RESUMO

BACKGROUND: Nine previous meta-analyses have been published to analyze the CYP1A1 T3801C and A2455G polymorphisms with BC risk. However, they did not assess the credibility of statistically significant associations. In addition, many new studies have been reported on the above themes. Hence, we conducted an updated systematic review and meta-analysis to further explore the above issues. OBJECTIVES: To explore the association on the CYP1A1 T3801C and A2455G polymorphisms with BC risk. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (The PRISMA) were used. RESULTS: In this study, there were 63 case-control studies from 56 publications on the CYP1A1 T3801C polymorphism (including 20,825 BC cases and 25,495 controls) and 51 case-control studies from 46 publications on the CYP1A1 A2455G polymorphism (including 20,124 BC cases and 29,183 controls). Overall, the CYP1A1 T3801C polymorphism was significantly increased BC risk in overall analysis, especially in Asians and Indians; the CYP1A1 A2455G polymorphism was associated with BC risk in overall analysis, Indians, and postmenopausal women. However, when we used BFDP correction, associations remained significant only in Indians (CC vs. TT + TC: BFDP < 0.001) for the CYP1A1 T3801C polymorphism with BC risk, but not in the CYP1A1 A2455G polymorphism. In addition, when we further performed sensitivity analysis, no significant association in overall analysis and any subgroup. Moreover, we found that all studies from Indians was low quality. Therefore, the results may be not credible. CONCLUSION: This meta-analysis strongly indicates that there is no significant association between the CYP1A1 T3801C and A2455G polymorphisms and BC risk. The increased BC risk may most likely on account of false-positive results.


Assuntos
Neoplasias da Mama/etiologia , Citocromo P-450 CYP1A1/genética , Predisposição Genética para Doença , Polimorfismo Genético , Neoplasias da Mama/patologia , Estudos de Casos e Controles , Estudos de Avaliação como Assunto , Feminino , Humanos , Fatores de Risco
20.
Plant Sci ; 307: 110892, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33902853

RESUMO

Roots are prominent plant-microbe interaction sites and of great biological relevance for many studies. The root response is of interest when searching for potential systemic resistance inducers. Screening of elicitors often focuses on the oxidative burst, the rapid and transient production of Reactive Oxygen Species (ROS). However, to our knowledge, no high-throughput, sensitive methods have been developed for the quantification of ROS released by roots. Here, we report on the development of an L-012-based chemiluminescence bioassay to quantitatively determine the oxidative burst following elicitation events in roots. Rice and grapevine were used as monocot and dicot models. We demonstrate that chitosan, a recognized elicitor in rice cells, was able to elicit ROS production in rice roots. Chitosan also triggered a strong oxidative burst in grapevine cell suspension cultures, while grapevine roots were not responsive. Although this method is broadly applicable, the L-012 probe requires careful consideration of solvents and plant species. Insufficient extracellular ROS, quenching, and the interference of solvents with the probe can undermine the assay sensitivity.


Assuntos
Produtos Agrícolas/metabolismo , Oryza/metabolismo , Células Vegetais/metabolismo , Raízes de Plantas/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Explosão Respiratória/fisiologia , Vitis/metabolismo , Estudos de Avaliação como Assunto , Luminescência
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