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1.
Br J Nurs ; 30(7): 404-408, 2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33830800

RESUMO

The coronavirus pandemic has brought about an economic and healthcare crisis. This has resulted in delays in virtually all areas of patient care and has forced clinicians to review and adapt their processes, in order to ensure patients continue to have access to timely and effective services. In the author's local Trust, this manifested in altered protocols, developed in order to maintain patient and staff safety while conducting invasive and potentially virus-spreading investigations. A new (temporary) standard operating procedure was developed in conjunction with Cancer Alliance South West to introduce the quantitative faecal immunochemical test (qFIT) as an indicator for diagnostic testing after the majority of diagnostic services were suspended or drastically reduced. Patients would then have their investigation(s) deferred on the basis of a negative result (<10 mcg Hb/g). This cohort (n=120) were revisited once diagnostic services were resumed and referred for CT examination. Audits carried out on the data showed that nine cancers had been identified in the negative qFIT population (lung, prostate, breast, bladder, small bowel carcinoid, oesophageal and three occurrences of caecal carcinoma. This article provides an overview of the experiences and outcomes of a colorectal 2-week-wait service in response to this global pandemic and how this experience will shape the service in the future.


Assuntos
Neoplasias Colorretais/diagnóstico , Sangue Oculto , Encaminhamento e Consulta/organização & administração , Listas de Espera , Estudos de Coortes , Humanos
3.
Washington, D.C.; OPS; 2021-04-26. (OPS/HSS/MT/21-0005).
em Espanhol | PAHO-IRIS | ID: phr-53794

RESUMO

Mejorar el acceso a los medicamentos y otras tecnologías sanitarias seguros, eficaces y de calidad es una prioridad esencial de la salud pública y un requisito fundamental para el logro de la salud universal. Los sistemas regulatorios nacionales cumplen una función clave en el sistema de salud de un país al supervisar la seguridad, la calidad y la eficacia de todas las tecnologías sanitarias, como los fármacos, las vacunas, la sangre y los productos sanguíneos, y los dispositivos médicos. El objetivo del informe Fortalecimiento de los sistemas regulatorios en la Región de las Américas: enseñanzas obtenidas de las autoridades regulatorias nacionales de referencia regional es que se comprenda mejor el panorama regulatorio en la Región de las Américas, con un interés especial en las autoridades regulatorias nacionales de referencia en América Latina. En este resumen se presentan los datos y análisis correspondientes a las funciones regulatorias esenciales y las bases del sistema a fin de comprender las prácticas actuales, reconocer algunas cuestiones importantes y formular una serie de recomendaciones para la acción. Se proporciona además un panorama sobre las perspectivas del mercado y los mecanismos de integración económica en la Región, y su influencia sobre la política regulatoria y el comercio farmacéutico.


Assuntos
Sistemas de Saúde , Serviços de Saúde , Acesso a Medicamentos Essenciais e Tecnologias em Saúde , Qualidade da Assistência à Saúde , Infecções por Coronavirus , Coronavirus , Infecções por Coronavirus , Betacoronavirus
4.
Rev. bras. med. esporte ; 27(spe): 28-30, Mar. 2021. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1156142

RESUMO

ABSTRACT In the environment of rapid social and economic development, the reform of medical informatization is constantly advancing, and the residents pay more and more attention to their own health status while improving their living standards. The traditional medical service system has some disadvantages in providing real-time, cross regional, long-term and easy-to-operate health services, which has become increasingly inadequate to meet the health needs of users. In order to solve the problem of difficulty in seeing a doctor caused by limited medical resources, and to carry out real-time health monitoring for a large number of groups suffering from chronic diseases and sub-health groups, this study conducted in-depth analysis and experimental exploration on the human remote mobile medical information collection method based on the Internet of things and intelligent algorithm. It established the information collection section by using KbaC clustering algorithm based on ant colony point system which, combined with a comparative study on the health indicators of related groups, has successfully proved that the Internet of things technology and intelligent algorithm for medical information collection and follow-up medical services are of certain positive significance, based on the Internet of things and other related technologies of human remote medical information collection system that can accurately and timely detect the patient's blood pressure, blood sugar and other health data, and then provide corresponding medical services.


RESUMO No ambiente de rápido desenvolvimento do nível social e econômico, a reforma da informatização médica está constantemente avançando, e os residentes prestam cada vez mais atenção ao seu próprio estado de saúde, melhorando ao Mesmo tempo seu padrão de vida. O sistema tradicional de serviços médicos tem algumas desvantagens em fornecer serviços de saúde em tempo real, transfronteiriços, de longo prazo e fáceis de operar, o que vem se tornando cada vez mais inadequado para satisfazer as necessidades de saúde dos usuários. A fim de resolver o problema a da dificuldade em consultar um médico por devido a recursos médicos limitados, e para realizar a monitorização da saúde em tempo real para um grande número de grupos que sofrem de doenças crônicas e subgrupos de saúde, este estudo conduziu uma análise aprofundada e uma exploração experimental sobre o método de coleta de informações médicas móvel à distância humana baseado na Internet das coisas e algoritmo inteligente. Estabeleceu a seção de coleta de informações utilizando o algoritmo de clustering KbaC baseado no sistema de pontos de colônias de formigas que, juntamente com um estudo comparativo sobre os indicadores de saúde dos Grupos conexos, conseguiu provar que a tecnologia da Internet das coisas e o algoritmo inteligente para a coleta de informações médicas e acompanhamento dos serviços médicos têm certa relevância positiva baseada na Internet das coisas e outras tecnologias relacionadas ao sistema de coleta de informações médicas remotas humanas, podendo detectar com precisão e tempo hábil a pressão arterial do paciente, a glicose e outros dados de saúde, e, em seguida, fornecer o serviço médico correspondente.


RESUMEN En un entorno de rápido desarrollo social y económico, la reforma de la informatización médica avanza constantemente y las personas prestan cada vez más atención a su estado de salud mientras mejoran su nivel de vida. El sistema de servicio médico tradicional tiene deficiencias en la prestación de servicios de salud en tiempo real, transregionales, a largo plazo y fáciles de operar, los que se han vuelto cada vez más inadecuados para satisfacer las necesidades de salud de los usuarios. Este estudio realizó un análisis con el objetivo de resolver la dificultad para consultar al médico debido a la limitación de los recursos, y de realizar un seguimiento de la salud en tiempo real de un gran número de grupos que padecen enfermedades crónicas. Dicho trabajo realizó un análisis en profundidad y de exploración experimental acerca del método de recopilación de información médica humana móvil remoto basado en Internet de las cosas y el algoritmo inteligente. Estableció la sección de recopilación de información utilizando el algoritmo de agrupación KbaC basado en el sistema de puntos de colonia de hormigas. Esto, combinado con un estudio comparativo sobre los indicadores de salud de grupos relacionados, ha demostrado con éxito que la tecnología de Internet de las cosas y el algoritmo inteligente para la recopilación y seguimiento de información médica son de importancia positiva, y que pueden detectar de manera precisa y oportuna la presión arterial, el azúcar en sangre y otros datos de salud del paciente, para luego proporcionar la atención médica correspondiente.

5.
Trials ; 22(1): 193, 2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33685502

RESUMO

OBJECTIVES: The objective of this trial is to assess whether early antiviral therapy in outpatients with COVID-19 with either favipiravir plus lopinavir/ritonavir, lopinavir/ritonavir alone, or favipiravir alone, is associated with a decrease in viral load of SARS-CoV-2 compared with placebo. TRIAL DESIGN: FLARE is a phase IIA randomised, double-blind, 2x2 factorial placebo-controlled, interventional trial. PARTICIPANTS: This trial is being conducted in the United Kingdom, with Royal Free Hospital, London as the lead site. Participants are non-hospitalised adults with highly suspected COVID-19 within the first 5 days of symptom onset, or who have tested positive with SARS-CoV-2 causing COVID-19 within the first 7 days of symptom onset, or who are asymptomatic but tested positive for SARS-CoV-2 for the first time within the last 48 hours. Inclusion criteria are as follows: 1. Any adult with the following: Symptoms compatible with COVID-19 disease (Fever >37.8°C on at least one occasion AND either cough and/ or anosmia) within the first 5 days of symptom onset (date/time of enrolment must be within the first 5 days of symptom onset) OR ANY symptoms compatible with COVID-19 disease (may include, but are not limited to fever, cough, shortness of breath, malaise, myalgia, headache, coryza) and tested positive for SARS-CoV-2 within the first 7 days of symptom onset) (date/time of enrolment must be within the first 7 days of symptom onset) OR no symptoms but tested positive for SARS-CoV-2 within the last 48 hours (date/time of test must be within 48 hours of enrolment) 2. Male or female aged 18 years to 70 years old inclusive at screening 3. Willing and able to take daily saliva samples 4. Able to provide full informed consent and willing to comply with trial-related procedures Exclusion criteria are as follows: 1. Known hypersensitivity to any of the active ingredients or excipients in favipiravir and matched placebo, and in lopinavir/ritonavir and matched placebo (See Appendix 2) 2. Chronic liver disease at screening (known cirrhosis of any aetiology, chronic hepatitis (e.g. autoimmune, viral, steatohepatitis), cholangitis or any known elevation of liver aminotransferases with AST or ALT > 3 X ULN)* 3. Chronic kidney disease (stage 3 or beyond) at screening: eGFR < 60 ml/min/1.73m2 * 4. HIV infection, if untreated, detectable viral load or on protease inhibitor therapy 5. Any clinical condition which the investigator considers would make the participant unsuitable for the trial 6. Concomitant medications known to interact with favipiravir and matched placebo, and with lopinavir/ritonavir and matched placebo, and carry risk of toxicity for the participant 7. Current severe illness requiring hospitalisation 8. Pregnancy and/ or breastfeeding 9. Eligible female participants of childbearing potential and male participants with a partner of childbearing potential not willing to use highly effective contraceptive measures during the trial and within the time point specified following last trial treatment dose. 10. Participants enrolled in any other interventional drug or vaccine trial (co-enrolment in observational studies is acceptable) 11. Participants who have received the COVID-19 vaccine *Considering the importance of early treatment of COVID-19 to impact viral load, the absence of known chronic liver/ kidney disease will be confirmed verbally by the participant during pre-screening and Screening/Baseline visit. Safety blood samples will be collected at Screening/Baseline visit (Day 1) and test results will be examined as soon as they become available and within 24 hours. INTERVENTION AND COMPARATOR: Participants will be randomised 1:1:1:1 using a concealed online minimisation process into one of the following four arms: Arm 1: Favipiravir + Lopinavir/ritonavir Oral favipiravir at 1800mg twice daily on Day 1, followed by 400mg four (4) times daily from Day 2 to Day 7 PLUS lopinavir/ritonavir at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7. Arm 2: Favipiravir + Lopinavir/ritonavir placebo Oral favipiravir at 1800mg twice daily on Day 1, followed by 400mg four (4) times daily from Day 2 to Day 7 PLUS lopinavir/ritonavir matched placebo at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7. Arm 3: Favipiravir placebo + Lopinavir/ritonavir Oral favipiravir matched placebo at 1800mg twice daily on Day 1, followed by 400mg four (4) times daily from Day 2 to Day 7 PLUS lopinavir/ritonavir at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7. Arm 4: Favipiravir placebo + Lopinavir/ritonavir placebo Oral favipiravir matched placebo at 1800mg twice daily on Day 1, followed by 400mg four (4) times daily from Day 2 to Day 7 PLUS lopinavir/ritonavir matched placebo at 400mg/100mg twice daily on Day 1, followed by 200mg/50mg four (4) times daily from Day 2 to Day 7. MAIN OUTCOMES: The primary outcome is upper respiratory tract viral load at Day 5. SECONDARY OUTCOMES: Percentage of participants with undetectable upper respiratory tract viral load after 5 days of therapy Proportion of participants with undetectable stool viral load after 7 days of therapy Rate of decrease in upper respiratory tract viral load during 7 days of therapy Duration of fever following commencement of trial medications Proportion of participants with hepatotoxicity after 7 days of therapy Proportion of participants with other medication-related toxicity after 7 days of therapy and 14 days post-randomisation Proportion of participants admitted to hospital with COVID-19 related illness Proportion of participants admitted to ICU with COVID-19 related illness Proportion of participants who have died with COVID-19 related illness Pharmacokinetic and pharmacodynamic analysis of favipiravir Exploratory: Proportion of participants with deleterious or resistance-conferring mutations in SARS-CoV-2 RANDOMISATION: Participants will be randomised 1:1:1:1 using a concealed online minimisation process, with the following factors: trial site, age (≤ 55 vs > 55 years old), gender, obesity (BMI <30 vs ≥30), symptomatic or asymptomatic, current smoking status (Yes = current smoker, No = ex-smoker, never smoker), ethnicity (Caucasian, other) and presence or absence of comorbidity (defined as diabetes, hypertension, ischaemic heart disease (including previous myocardial infarction), other heart disease (arrhythmia and valvular heart disease), asthma, COPD, other chronic respiratory disease). BLINDING (MASKING): Participants and investigators will both be blinded to treatment allocation (double-blind). NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 240 participants, 60 in each arm. TRIAL STATUS: Protocol version 4.0 dated 7th January 2021. Date of first enrolment: October 2020. Recruitment is ongoing, with anticipated finish date of 31st March 2021. TRIAL REGISTRATION: The FLARE trial is registered with Clinicaltrials.gov, trial identifying number NCT04499677 , date of registration 4th August 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Assuntos
Amidas/uso terapêutico , Antivirais/uso terapêutico , Lopinavir/uso terapêutico , Pirazinas/uso terapêutico , Ritonavir/uso terapêutico , Carga Viral , Assistência Ambulatorial , Ensaios Clínicos Fase II como Assunto , Método Duplo-Cego , Combinação de Medicamentos , Quimioterapia Combinada , Intervenção Médica Precoce , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reino Unido
6.
J Med Internet Res ; 23(4): e24552, 2021 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-33769945

RESUMO

BACKGROUND: Telemedicine use in chronic disease management has markedly increased during health emergencies due to COVID-19. Diabetes and technologies supporting diabetes care, including glucose monitoring devices, software analyzing glucose data, and insulin delivering systems, would facilitate remote and structured disease management. Indeed, most of the currently available technologies to store and transfer web-based data to be shared with health care providers. OBJECTIVE: During the COVID-19 pandemic, we provided our patients the opportunity to manage their diabetes remotely by implementing technology. Therefore, this study aimed to evaluate the effectiveness of 2 virtual visits on glycemic control parameters among patients with type 1 diabetes (T1D) during the lockdown period. METHODS: This prospective observational study included T1D patients who completed 2 virtual visits during the lockdown period. The glucose outcomes that reflected the benefits of the virtual consultation were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability. This metric was generated using specific computer programs that automatically upload data from the devices used to monitor blood or interstitial glucose levels. If needed, we changed the ongoing treatment at the first virtual visit. RESULTS: Among 209 eligible patients with T1D, 166 completed 2 virtual visits, 35 failed to download glucose data, and 8 declined the visit. Among the patients not included in the study, we observed a significantly lower proportion of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) users (n=7/43, 16% vs n=155/166, 93.4% and n=9/43, 21% vs n=128/166, 77.1%, respectively; P<.001) compared to patients who completed the study. TIR significantly increased from the first (62%, SD 18%) to the second (65%, SD 16%) virtual visit (P=.02); this increase was more marked among patients using the traditional meter (n=11; baseline TIR=55%, SD 17% and follow-up TIR=66%, SD 13%; P=.01) than among those using CGM, and in those with a baseline GMI of ≥7.5% (n=46; baseline TIR=45%, SD 15% and follow-up TIR=53%, SD 18%; P<.001) than in those with a GMI of <7.5% (n=120; baseline TIR=68%, SD 15% and follow-up TIR=69%, SD 15%; P=.98). The only variable independently associated with TIR was the change of ongoing therapy. The unstandardized beta coefficient (B) and 95% CI were 5 (95% CI 0.7-8.0) (P=.02). The type of glucose monitoring device and insulin delivery systems did not influence glucometric parameters. CONCLUSIONS: These findings indicate that the structured virtual visits help maintain and improve glycemic control in situations where in-person visits are not feasible.


Assuntos
Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Telemedicina , Adulto , Diabetes Mellitus Tipo 1/sangue , Feminino , Humanos , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Masculino , Projetos Piloto , Estudos Prospectivos
7.
Cochrane Database Syst Rev ; 2: CD012707, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33634854

RESUMO

BACKGROUND: To support patient-centred care, healthcare organisations increasingly offer patients access to data stored in the institutional electronic health record (EHR). OBJECTIVES: Primary objective 1. To assess the effects of providing adult patients with access to electronic health records (EHRs) alone or with additional functionalities on a range of patient, patient-provider, and health resource consumption outcomes, including patient knowledge and understanding, patient empowerment, patient adherence, patient satisfaction with care, adverse events, health-related quality of life, health-related outcomes, psychosocial health outcomes, health resource consumption, and patient-provider communication. Secondary objective 1. To assess whether effects of providing adult patients with EHR access alone versus EHR access with additional functionalities differ among patient groups according to age, educational level, or different status of disease (chronic or acute). SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and Scopus in June 2017 and in April 2020. SELECTION CRITERIA: Randomised controlled trials and cluster-randomised trials of EHR access with or without additional functionalities for adults with any medical condition. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. MAIN RESULTS: We included 10 studies with 78 to 4500 participants and follow-up from 3 to 24 months. Nine studies assessed the effects of EHR with additional functionalities, each addressing a subset of outcomes sought by this review. Five studies focused on patients with diabetes mellitus, four on patients with specific diseases, and one on all patients. All studies compared EHR access alone or with additional functionalities plus usual care versus usual care only. No studies assessing the effects of EHR access alone versus EHR access with additional functionalities were identified. Interventions required a variety of data within the EHR, such as patient history, problem list, medication, allergies, and lab results. In addition to EHR access, eight studies allowed patients to share self-documented data, seven offered individualised disease management functions, seven offered educational disease-related information, six supported secure communication, and one offered preventive reminders. Only two studies were at low or unclear risk of bias across domains. Meta-analysis could not be performed, as participants, interventions, and outcomes were too heterogeneous, and most studies presented results based on different adjustment methods or variables. The quality of evidence was rated as low or very low across outcomes. Overall differences between intervention and control groups, if any, were small. The relevance of any small effects remains unclear for most outcomes because in most cases, trial authors did not define a minimal clinically important difference. Overall, results suggest that the effects of EHR access alone and with additional functionalities are mostly uncertain when compared with usual care. Patient knowledge and understanding: very low-quality evidence is available from one study, so we are uncertain about effects of the intervention on patient knowledge about diabetes and blood glucose testing. Patient empowerment: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient empowerment measures. Patient adherence: low-quality evidence from two studies suggests that the intervention may slightly improve adherence to the process of monitoring risk factors and preventive services. Effects on medication adherence are conflicting in two studies; this may or may not improve to a clinically relevant degree. Patient satisfaction with care: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient satisfaction, with conflicting results. Adverse events: two small studies reported on mortality; one of these also reported on serious and other adverse events, but sample sizes were too small for small differences to be detected. Therefore, low-quality evidence suggests that the intervention may have little to no effect on mortality and other adverse events. Health-related quality of life: only very low-quality evidence from one study is available. We are uncertain whether the intervention improves disease-specific quality of life of patients with asthma. Health-related outcomes: low-quality evidence from eight studies suggests that the intervention may have little to no effect on asthma control, glycosylated haemoglobin (HbA1c) levels, blood pressure, low-density lipoprotein or total cholesterol levels, body mass index or weight, or 10-year Framingham risk scores. Low-quality evidence from one study suggests that the composite scores of risk factors for diabetes mellitus may improve slightly with the intervention, but there is uncertainty about effects on ophthalmic medications or intraocular pressure. Psychosocial health outcomes: no study investigated psychosocial health outcomes in a more than anecdotal way. Health resource consumption: low-quality evidence for adult patients in three studies suggests that there may be little to no effect of the intervention on different measures of healthcare use. Patient-provider communication: very low-quality evidence is available from a single small study, and we are uncertain whether the intervention improves communication measures, such as the number of messages sent. AUTHORS' CONCLUSIONS: The effects of EHR access with additional functionalities in comparison with usual care for the most part are uncertain. Only adherence to the process of monitoring risk factors and providing preventive services as well as a composite score of risk factors for diabetes mellitus may improve slightly with EHR access with additional functionalities. Due to inconsistent terminology in this area, our search may have missed relevant studies. As the overall quality of evidence is very low to low, future research is likely to change these results. Further trials should investigate the impact of EHR access in a broader range of countries and clinical settings, including more patients over a longer period of follow-up, as this may increase the likelihood of detecting effects of the intervention, should these exist. More studies should focus on assessing outcomes such as patient empowerment and behavioural outcomes, rather than concentrating on health-related outcomes alone. Future studies should distinguish between effects of EHR access only and effects of additional functionalities, and investigate the impact of mobile EHR tools. Future studies should include information on usage patterns, and consider the potential for widening health inequalities with implementation of EHR access. A taxonomy for EHR access and additional functionalities should be developed to promote consistency and comparability of outcome measures, and facilitate future reviews by better enabling cross-study comparisons.


Assuntos
Registros Eletrônicos de Saúde , Acesso dos Pacientes aos Registros , Adulto , Asma/terapia , Viés , Glicemia/análise , Compreensão , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Registros Eletrônicos de Saúde/estatística & dados numéricos , Glaucoma/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/terapia , Humanos , Hipertensão/terapia , Pessoa de Meia-Idade , Acesso dos Pacientes aos Registros/estatística & dados numéricos , Cooperação do Paciente , Participação do Paciente , Satisfação do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
9.
BMC Infect Dis ; 21(1): 233, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639871

RESUMO

BACKGROUND: The risk of hepatitis B virus infection among medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions is higher due to frequent exposure to contaminated blood and other body fluids. There is limited evidence on the seroprevalence of hepatitis B among medical waste handlers in eastern Ethiopia. The study was aimed at studying the seroprevalence of Hepatitis B Virus and associated risk factors among medical waste collectors at health facilities of eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted among randomly selected medical waste collectors from public health facilities in eastern Ethiopia from March to June 2018. A pre-tested and well-structured questionnaire was used to collect data on socio-demographic characteristics and hepatitis B infection risk factors. A2.5ml venous blood was also collected, centrifuged and the serum was analyzed for hepatitis B surface antigen using the instant hepatitis B surface antigen kit. Descriptive summary measures were done. Chi-square and Fisher exact tests were used to assess the risk of association. Multivariate logistic regression was conducted with 95% CI and all value at P-value < 0.05 was declared statistically significant. RESULTS: From a total of 260 (97.38%) medical waste collectors participated, HBV was detected in 53 (20.4%) of the participants [95%CI; 15.8, 25.6]. No significant differences were observed in the detection rates of HBV with respect to socio-demographic characteristics. In both bivariate and multivariable logistic regression analysis, being unvaccinated (AOR = 6.35; 95%CI = [2.53-15.96], P = 0.001), history of blood transfusion (receiving) (AOR; 3.54; 95%CI; [1.02-12.24], P = 0.046), history of tattooing (AOR = 2.86; 95%CI = [1.12-7.27], p = 0.03), and history of multiple sexual partner (AOR = 10.28; 95%CI = [4.16-25.38], P = 0.001) remained statistically significantly associated with HBsAg positivity. CONCLUSION: This cross-sectional study identified that HBV infection is high among medical waste collectors in eastern Ethiopia. Immunization and on job health promotion and disease prevention measures should be considered in order to control the risk of HBV infection among medical waste collectors in eastern Ethiopia.


Assuntos
Hepatite B/epidemiologia , Serviço Hospitalar de Limpeza/estatística & dados numéricos , Eliminação de Resíduos de Serviços de Saúde/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Adulto , Centros Comunitários de Saúde/estatística & dados numéricos , Infecção Hospitalar/sangue , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Estudos Transversais , Escolaridade , Etiópia/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hepatite B/sangue , Hepatite B/etiologia , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/isolamento & purificação , Vírus da Hepatite B/fisiologia , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Resíduos de Serviços de Saúde/efeitos adversos , Resíduos de Serviços de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Exposição Ocupacional/análise , Logradouros Públicos/estatística & dados numéricos , Fatores de Risco , Estudos Soroepidemiológicos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
11.
Med Sci Monit ; 27: e929913, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33556045

RESUMO

BACKGROUND Two diagnostic models of prostate cancer (PCa) and clinically significant prostate cancer (CS-PCa) were established using clinical data of among patients whose prostate-specific antigen (PSA) levels are in the gray area (4.0-10.0 ng/ml). MATERIAL AND METHODS Data from 181 patients whose PSA levels were in the gray area were retrospectively analyzed, and the following data were collected: age, digital rectal examination, total PSA, PSA density (PSAD), free/total PSA (f/t PSA), transrectal ultrasound, multiparametric magnetic resonance imaging (mpMRI), and pathological reports. Patients were diagnosed with benign prostatic hyperplasia (BPH) and PCa by pathology reports, and PCa patients were separated into non-clinically significant PCa (NCS-PCa) and CS-PCa by Gleason score. Afterward, predictor models constructed by above parameters were researched to diagnose PCa and CS-PCa, respectively. RESULTS According to the analysis of included clinical data, there were 109 patients with BPH, 44 patients with NCS-PCa, and 28 patients with CS-PCa. Regression analysis showed PCa was correlated with f/t PSA, PSAD, and mpMRI (P<0.01), and CS-PCa was correlated with PSAD and mpMRI (P<0.01). The area under the receiver operating characteristic curves of 2 models for PCa (sensitivity=73.64%, specificity=64.23%) and for CS-PCa (sensitivity=71.41%, specificity=81.82%) were 0.79 and 0.87, respectively. CONCLUSIONS The prediction models had satisfactory diagnostic value for PCa and CS-PCa among patients with PSA in the gray area, and use of these models may help reduce overdiagnosis.


Assuntos
Calicreínas/sangue , Modelos Estatísticos , Antígeno Prostático Específico/sangue , Hiperplasia Prostática/diagnóstico , Neoplasias da Próstata/diagnóstico , Fatores Etários , Idoso , Biópsia/estatística & dados numéricos , Diagnóstico Diferencial , Exame Retal Digital/estatística & dados numéricos , Humanos , Masculino , Sobremedicalização/prevenção & controle , Imageamento por Ressonância Magnética Multiparamétrica/estatística & dados numéricos , Gradação de Tumores , Próstata/diagnóstico por imagem , Próstata/patologia , Hiperplasia Prostática/sangue , Hiperplasia Prostática/patologia , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Curva ROC , Valores de Referência , Estudos Retrospectivos , Medição de Risco/métodos , Ultrassonografia/estatística & dados numéricos
12.
AIDS Patient Care STDS ; 35(2): 39-46, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33571047

RESUMO

Viral suppression and postpartum retention in care have far-reaching health implications for pregnant women living with HIV and their children, yet remain public health challenges. Prenatal care presents a unique opportunity to engage pregnant women in care. The purpose of this study is to evaluate whether group prenatal care is effective in impacting these outcomes for pregnant women living with HIV. A retrospective cohort study was performed of all women living with HIV who obtained prenatal care from a community-based health center between 2013 and 2019. Women who spoke English or Spanish, remained within the system, and had not participated in group prenatal care previously were included. Women self-selected a prenatal care model: 85 selected group care and 109 elected individual care. Group prenatal care followed a standard Centering Pregnancy® curriculum with the addition of HIV-related topics. The primary outcomes of the study were viral suppression (viral load <20 copies/mL) and postpartum retention in care (attending at least one or two visits with HIV primary care within 12 months postpartum). After adjusting for potential confounding factors, women who participated in group prenatal care were significantly more likely to have at least one HIV primary care visit postpartum {adjusted odds ratio (aOR) = 2.71 [95% confidence interval (CI 1.14-6.46)]; p = 0.024}, and had a trend for achieving viral suppression by the time of delivery [aOR = 2.29 (95% CI 0.94-5.55); p = 0.068]. We have demonstrated that group prenatal care for pregnant women living with HIV is feasible and effective, with positive impacts on retention in care and viral suppression, factors that affect long-term outcomes from patients living with HIV.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Serviços de Saúde Comunitária/organização & administração , Infecções por HIV/tratamento farmacológico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações Infecciosas na Gravidez/tratamento farmacológico , Retenção nos Cuidados , Adulto , Criança , Estudos de Coortes , Centros Comunitários de Saúde , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Cuidado Pós-Natal , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Gestantes , Cuidado Pré-Natal , Estudos Retrospectivos , Resposta Viral Sustentada , Texas/epidemiologia , Carga Viral
13.
BMC Infect Dis ; 21(1): 173, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579205

RESUMO

BACKGROUND: Blood cultures are one of the most important tests performed by microbiology laboratories. Many hospitals, particularly in low and middle-income countries, lack either microbiology services or staff to provide 24 h services resulting in delays to blood culture incubation. There is insufficient guidance on how to transport/store blood cultures if delays before incubation are unavoidable, particularly if ambient temperatures are high. This study set out to address this knowledge gap. METHODS: In three South East Asian countries, four different blood culture systems (two manual and two automated) were used to test blood cultures spiked with five common bacterial pathogens. Prior to incubation the spiked blood culture bottles were stored at different temperatures (25 °C, in a cool-box at ambient temperature, or at 40 °C) for different lengths of time (0 h, 6 h, 12 h or 24 h). The impacts of these different storage conditions on positive blood culture yield and on time to positivity were examined. RESULTS: There was no significant loss in yield when blood cultures were stored < 24 h at 25 °C, however, storage for 24 h at 40 °C decreased yields and longer storage times increased times to detection. CONCLUSION: Blood cultures should be incubated with minimal delay to maximize pathogen recovery and timely result reporting, however, this study provides some reassurance that unavoidable delays can be managed to minimize negative impacts. If delays to incubation ≥ 12 h are unavoidable, transportation at a temperature not exceeding 25 °C, and blind sub-cultures prior to incubation should be considered.


Assuntos
Hemocultura/normas , Manejo de Espécimes/normas , Ásia Sudeste , Bactérias/classificação , Bactérias/isolamento & purificação , Hemocultura/estatística & dados numéricos , Serviços de Laboratório Clínico/normas , Serviços de Laboratório Clínico/estatística & dados numéricos , Humanos , Manejo de Espécimes/estatística & dados numéricos , Temperatura , Fatores de Tempo
14.
Horm Metab Res ; 53(3): 191-196, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33530117

RESUMO

Singapore currently has one of highest number of confirmed COVID-19 cases in Southeast Asia. To curb the further spread of COVID-19, Singapore government announced a temporary nationwide lockdown (circuit breaker). In view of restrictions of patients' mobility and the enforcement of safe distancing measures, usual in-person visits were discouraged. Here we describe how diabetes care delivery was ad hoc redesigned applying a telehealth strategy. We describe a retrospective assessment of subjects with diabetes, with and without COVID-19 infection, during the circuit breaker period of 7th April to 1st June 2020 managed through Tan Tock Seng Hospital's telehealth platform. The virtual health applications consisted of telephone consultations, video telehealth visits via smartphones, and remote patient monitoring. The TTSH team intensively managed 298 diabetes patients using a telehealth strategy. The group comprised of (1) 84 inpatient COVID-19 patients with diabetes who received virtual diabetes education and blood glucose management during their hospitalisation and follow-up via phone calls after discharge and (2) 214 (n=192 non-COVID; n=22 COVID-positive) outpatient subjects with suboptimal glycaemic control who received intensive diabetes care through telehealth approaches. Remote continuous glucose monitoring was applied in 80 patients to facilitate treatment adjustment and hypoglycaemia prevention. The COVID-19 pandemic situation mooted an immediate disruptive transformation of healthcare processes. Virtual health applications were found to be safe, effective and efficient to replace current in-person visits.


Assuntos
Diabetes Mellitus , Telemedicina , Automonitorização da Glicemia , /epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Feminino , Humanos , Masculino , Pandemias , Singapura/epidemiologia
15.
Diabetes Metab Syndr ; 15(1): 433-437, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33588200

RESUMO

BACKGROUND AND AIMS: The COVID-19 pandemic has led to a rapid growth in the use of telemedicine for delivery of ambulatory diabetes care. This study evaluated the feasibility of remote HbA1c monitoring via dried blood spot (DBS) testing to support assessment of glycemic control for telemedicine visits and examined clinical and demographic characteristics associated with patient completion of DBS testing. METHODS: Providers could place orders for DBS HbA1c 3 weeks prior to telemedicine visits. Feasibility was assessed by examining DBS completion rates, time to completion, and availability of DBS results prior to telemedicine visits. Chi-square tests and Mann Whitney tests were used to assess whether completion rates were associated with participant characteristics. RESULTS: Of 303 DBS orders placed for telemedicine visits in June 2020, 162 patients completed the DBS test for a completion rate of (53.4%). Average time from collection at home to result being reported was 6.9 (3.8) days. The DBS result was available in 67.6% of patients who completed successful DBS, before the telemedicine clinic visit. HbA1c was lower in the DBS completion group as compared to the non-completion group (8.2% vs. 8.9%, p = 0.01). No other clinical or demographic characteristics were significantly different between the two groups. CONCLUSION: Remote HbA1c monitoring via DBS is feasible and offers an avenue to support assessment of glycemic control for patients seen via telemedicine. Future work should focus on improving clinic and laboratory processes to support remote DBS collection.


Assuntos
/epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Teste em Amostras de Sangue Seco/métodos , Hemoglobina A Glicada/metabolismo , Telemedicina/métodos , Adaptação Psicológica , Adolescente , Criança , Diabetes Mellitus/diagnóstico , Teste em Amostras de Sangue Seco/tendências , Estudos de Viabilidade , Feminino , Humanos , Masculino , Telemedicina/tendências
16.
Diabetes Res Clin Pract ; 173: 108682, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33539868

RESUMO

BACKGROUND: To minimize the spread of Coronavirus Disease-2019, Saudi Arabia imposed a nationwide lockdown for over 6 weeks. We examined the impact of lockdown on glycemic control in individuals with type 1 diabetes (T1D) using continuous glucose monitoring (CGM); and assessed whether changes in glycemic control differ between those who attended a telemedicine visit during lockdown versus those who did not. MATERIALS AND METHODS: Flash CGM data from 101 individuals with T1D were retrospectively evaluated. Participants were categorized into two groups: Attended a telemedicine visit during lockdown (n = 61) or did not attend (n = 40). Changes in CGM metrics from the last 2 weeks pre-lockdown period (Feb 25 - March 9, 2020) to the last 2 weeks of complete lockdown period (April 7-20, 2020) were examined in the two groups. RESULTS: Those who attended a telemedicine visit during the lockdown period had a significant improvement in the following CGM metrics by the end of lockdown: Average glucose (from 180 to 159 mg/dl, p < 0.01), glycemic management indicator (from 7.7 to 7.2%, p = 0.03), time in range (from 46 to 55%, p < 0.01), and time above range (from 48 to 35%, p < 0.01) without significant changes in time below range, number of daily scans or hypoglycemic events, and other indices. In contrast, there were no significant changes in any of the CGM metrics during lockdown in those who did not attend telemedicine. CONCLUSIONS: A six-week lockdown did not worsen, nor improve, glycemic control in individuals with T1D who did not attend a telemedicine visit. Whereas those who attended a telemedicine visit had a significant improvement in glycemic metrics; supporting the clinical effectiveness of telemedicine in diabetes care.


Assuntos
Glicemia/metabolismo , Controle de Doenças Transmissíveis , Diabetes Mellitus Tipo 1/sangue , Telemedicina , Adolescente , Adulto , Automonitorização da Glicemia/métodos , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/epidemiologia , Surtos de Doenças , Feminino , /normas , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Avaliação de Programas e Projetos de Saúde , Quarentena/métodos , Quarentena/estatística & dados numéricos , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Adulto Jovem
17.
Semin Respir Crit Care Med ; 42(2): 316-326, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33548929

RESUMO

Venous thromboembolism, occlusion of dialysis catheters, circuit thrombosis in extracorporeal membrane oxygenation (ECMO) devices, acute limb ischemia, and isolated strokes, all in the face of prophylactic and even therapeutic anticoagulation, are features of novel coronavirus disease 2019 (COVID-19) coagulopathy. It seems well established at this time that a COVID-19 patient deemed sick enough to be hospitalized, should receive at least prophylactic dose anticoagulation. However, should some hospitalized patients have dosage escalation to intermediate dose? Should some be considered for full-dose anticoagulation without a measurable thromboembolic event and how should that anticoagulation be monitored? Should patients receive postdischarge anticoagulation and with what medication and for how long? What thrombotic issues are related to the various medications being used to treat this coagulopathy? Is antiphospholipid antibody part of this syndrome? What is the significance of isolated ischemic stroke and limb ischemia in this disorder and how does this interface with the rest of the clinical and laboratory features of this disorder? The aims of this article are to explore these questions and interpret the available data based on the current evidence.


Assuntos
Anticoagulantes/administração & dosagem , Trombofilia/tratamento farmacológico , Trombose/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Assistência Ambulatorial , Anticorpos Antifosfolipídeos/imunologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Antivirais/uso terapêutico , /complicações , /terapia , Relação Dose-Resposta a Droga , Combinação de Medicamentos , Duração da Terapia , Glucocorticoides/uso terapêutico , Hospitalização , Humanos , Hidroxicloroquina/uso terapêutico , Imunização Passiva , Lopinavir/uso terapêutico , Ritonavir/uso terapêutico , Terapia Trombolítica , Trombofilia/sangue , Trombofilia/etiologia , Trombose/tratamento farmacológico , Trombose/imunologia , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/imunologia
18.
Poult Sci ; 100(2): 697-706, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33518123

RESUMO

Transportation of poultry is stressful. The transportation of broilers has been well studied, while the transportation of layer pullets from rearing to laying facilities has not been thoroughly evaluated. This experiment aimed to establish the effects of temperature (T)/RH combinations and duration (D) of transport, via a 5 × 2 factorial arrangement of simulated transport conditions using 5 T/RH combinations (21°C with 30% RH [21/30], 21°C with 80% RH [21/80], 30°C with 30% RH [30/30], 30°C with 80% RH [30/80], and -15°C with uncontrolled RH [-15]), and 2 exposure D (4 or 8 h). Pullets (18-19 wk; n = 240) were obtained from 3 commercial farms (N = 3 farms). Pretreatment, birds were orally administered a miniature data logger to record core body temperature (CBT), an initial blood sample was taken (5 birds/replicate), and initial foot T was recorded. Behavior during exposure was video recorded. Following exposure, a final blood sample was taken (analyzed for heterophil to lymphocyte ratio, partial pressure of CO2, total CO2, bicarbonate, and glucose), birds were slaughtered, and data loggers were retrieved. Data were analyzed as a randomized complete block design via Proc Mixed (SAS 9.4) and significance was declared at P ≤ 0.05. There were no interactions observed for the T/RH and D combinations throughout the study. The CBT and foot T were lowest in pullets exposed to -15 compared with all other treatments. Foot T was also highest in pullets exposed to 30/80 compared with -15, 21/30, and 21/80. There was no impact of T/RH on pullet blood physiology. Activity and thermoregulatory behaviors were impacted by the T/RH combinations. Pullets exposed to 30/30 and 30/80 spent the most time panting. Pullets exposed to 30/80 also spent the least amount of time motionless. Duration had minor impacts on pullet CBT, blood physiology, and behavior. These data indicate that as a response to thermal stress, layer pullets were successful at implementing mechanisms to maintain homeostasis.


Assuntos
Comportamento Animal/fisiologia , Galinhas/fisiologia , Transportes , Bem-Estar do Animal , Animais , Fenômenos Fisiológicos Sanguíneos , Temperatura Corporal , Extremidades/fisiologia , Feminino , Umidade , Distribuição Aleatória , Temperatura
19.
Isr Med Assoc J ; 23(2): 89-93, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33595213

RESUMO

BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) have a high rate of cardiovascular disease (CVD). The Mediterranean diet is preferred for CVD prevention. Endothelial dysfunction is demonstrated early in T2DM. OBJECTIVES: To study the effects of dietary intervention of T2DM patients without known CVD on endothelial function and vascular inflammation. METHODS: A prospective study enrolled 22 patients with T2DM. Patients were divided randomly into two groups: an intervention group with 12 patients (55 ± 7 years old, 6 women) and a control group with 10 patients (59 ± 10 years old, 5 women). Clinical evaluation included body mass index (BMI) and endothelial function measured by the flow mediated percent change (FMD%). Fasting blood was drawn on entry to the study and 3 months later, measuring C-reactive protein (CRP), intercellular adhesion molecule-1 (ICAM-1), total cholesterol, triglycerides, and glycosylated hemoglobin (HbA1C%). The intervention was based on weekly telephone calls by a clinical dietitian for 3 months. RESULTS: In the intervention group CRP and ICAM-1 were reduced (from 4.2 ± 3.3 mg/dl to 0.4 ± 0.5 mg/dl, P = 0.01 and from 258.6 ± 98.3 ng/ml to 171.6 ± 47.7 ng/ml, P = 0.004). Endothelial function (FMD%) was improved (from 0.5 ± 8.0% to 9.5 ± 11.5%, P = 0.014). No change was observed in BMI, HbA1C%, total cholesterol, and triglycerides levels in either group. CONCLUSIONS: Patients with T2DM on the Mediterranean diet who received a weekly telephone call for 3 months improved their endothelial function with reduction of markers of inflammation.


Assuntos
Diabetes Mellitus Tipo 2/dietoterapia , Dieta Mediterrânea , Endotélio Vascular/fisiopatologia , Telemedicina , Idoso , Biomarcadores/metabolismo , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Colesterol/sangue , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Triglicerídeos/sangue
20.
Medicine (Baltimore) ; 100(5): e24061, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592858

RESUMO

ABSTRACT: Irisin, a novel myokine, is believed to be the crucial factor in converting white adipose tissue to beige adipose tissue. For this paper, we studied the relationship among irisin and components of metabolic syndrome (MetS), and insulin secretion and resistance in schoolchildren of Taiwan.Subjects receiving routine annual health examination at elementary school were enrolled. Demographic data, anthropometry, MetS components, irisin, and insulin secretion and resistance were collected. Subjects were divided into normal, overweight, and obese groups for evaluation of irisin in obesity. Finally, the relationship between irisin and MetS was analyzed.There were 376 children (179 boys and 197 girls), aged 10.3 ±â€Š1.5 years, were enrolled. In boys, irisin levels were not associated with body mass index percentile, body fat, blood pressure, lipid profiles, insulin secretion or resistance. After adjusting for age, the irisin level in boys was negatively related to fasting plasma glucose (FPG) (r = -0.21, P = .006). In girls, after adjusting for age, the irisin levels were positively related only to FPG (r = 1.49, P = .038). In both genders, irisin levels were similar among normal, overweight, and obese groups, and between subjects with and without MetS.The irisin levels were not associated with MetS in either boys or girls. In girls, circulating irisin levels have a nonsignificant declining trend in overweight and obese girls. However, irisin levels were negatively related to FPG in boys and positively related to FPG in girls. The contrary relationship between irisin and FPG in boys and girls needs further exploration.


Assuntos
Tecido Adiposo/metabolismo , Fibronectinas , Secreção de Insulina/fisiologia , Insulina , Síndrome Metabólica , Sobrepeso , Antropometria/métodos , Determinação da Pressão Arterial/métodos , Índice de Massa Corporal , Criança , Estudos Transversais , Feminino , Fibronectinas/sangue , Fibronectinas/metabolismo , Humanos , Insulina/sangue , Insulina/metabolismo , Resistência à Insulina/fisiologia , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/metabolismo , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Sobrepeso/metabolismo , Serviços de Saúde Escolar/estatística & dados numéricos , Taiwan/epidemiologia
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