In the title 1:2 co-crystal, C
10
H
9
N
2
+
·(C
6
H
7.75
O
6
·C
6
H
7.25
O
6
)
−
, L-ascorbic acid (LAA) and 4,4′-bipyridine (BPy) co-crystallize in the chiral space group
P
2
1
with two molecules of ...LAA, and one molecule of bpy in the asymmetric unit. The structure was modeled in two parts due to possible proton transfer from LAA to the corresponding side of the bpy molecule having an occupancy of approximately 0.25 and part 2 with an occupancy of approximately 0.75. In this structure, LAA forms hydrogen bonds with neighboring LAA molecules, forming extended sheets of LAA molecules which are bridged by bpy molecules. A comparison to a related and previously published co-crystal of LAA and 3-bromo-4-pyridone is presented.
In the title 1:2 co-crystal, C
H
N
·(C
H
O
·C
H
O
)
, l-ascorbic acid (LAA) and 4,4'-bi-pyridine (BPy) co-crystallize in the chiral space group
2
with two mol-ecules of LAA, and one mol-ecule of bpy ...in the asymmetric unit. The structure was modeled in two parts due to possible proton transfer from LAA to the corresponding side of the bpy mol-ecule having an occupancy of approximately 0.25 and part 2 with an occupancy of approximately 0.75. In this structure, LAA forms hydrogen bonds with neighboring LAA mol-ecules, forming extended sheets of LAA mol-ecules which are bridged by bpy mol-ecules. A comparison to a related and previously published co-crystal of LAA and 3-bromo-4-pyridone is presented.
Banking decision-support systems place enormous loads on the hardware and database platforms that support them. Treasury Services Corp. has developed applications for open client/server platforms ...featuring very powerful servers networked to PC workstations. To ensure that its systems are fully operational and completely stable upon delivery, Treasury Services first implements them on the same types of platforms as its clients at its Santa Monica, California, headquarters. The company will soon be installing a Cray Superserver 6400 with 32 processors, 4GB RAM, and 100 GB of disk storage to evaluate the capabilities and cost-effectiveness of current supercomputer technology for decision support in the financial services.
Sleep duration and adolescent obesity Mitchell, Jonathan A; Rodriguez, Daniel; Schmitz, Kathryn H ...
Pediatrics (Evanston)
131, Issue:
5
Journal Article
Peer reviewed
Open access
Short sleep has been associated with adolescent obesity. Most studies used a cross-sectional design and modeled BMI categories. We sought to determine if sleep duration was associated with BMI ...distribution changes from age 14 to 18.
Adolescents were recruited from suburban high schools in Philadelphia when entering ninth grade (n = 1390) and were followed-up every 6 months through 12th grade. Height and weight were self-reported, and BMIs were calculated (kg/m(2)). Hours of sleep were self-reported. Quantile regression was used to model the 10th, 25th, 50th, 75th, and 90th BMI percentiles as dependent variables; study wave and sleep were the main predictors.
BMI increased from age 14 to 18, with the largest increase observed at the 90th BMI percentile. Each additional hour of sleep was associated with decreases in BMI at the 10th (-0.04; 95% confidence interval CI: -0.11, 0.03), 25th (-0.12; 95% CI: -0.20, -0.04), 50th (-0.15; 95% CI: -0.24, -0.06), 75th (-0.25; 95% CI: -0.38, -0.12), and 90th (-0.27; 95% CI: -0.45, -0.09) BMI percentiles. The strength of the association was stronger at the upper tail of the BMI distribution. Increasing sleep from 7.5 to 10.0 hours per day at age 18 predicted a reduction in the proportion of adolescents >25 kg/m(2) by 4%.
More sleep was associated with nonuniform changes in BMI distribution from age 14 to 18. Increasing sleep among adolescents, especially those in the upper half of the BMI distribution, may help prevent overweight and obesity.
Objective:
Previous research has examined the association between screen time and average changes in adolescent body mass index (BMI). Until now, no study has evaluated the longitudinal relationship ...between screen time and changes in the BMI distribution across mid to late adolescence.
Design and Methods:
Participants (n = 1,336) were adolescents who were followed from age 14 to age 18 and surveyed every 6 months. Time spent watching television/videos and playing video games was self‐reported (<1 h day−1, 1 h day−1, 2 h day−1, 3 h day−1, 4 h day−1, or 5+ h day−1). BMI (kg m−2) was calculated from self‐reported height and weight. Longitudinal quantile regression was used to model the 10th, 25th, 50th, 75th, and 90th BMI percentiles as dependent variables. Study wave and screen time were the main predictors, and adjustment was made for gender, race, maternal education, hours of sleep, and physical activity.
Results:
Increases at all the BMI percentiles over time were observed, with the greatest increase observed at the 90th BMI percentile. Screen time was positively associated with changes in BMI at the 50th (0.17, 95% CI: 0.06, 0.27), 75th (0.31, 95% CI: 0.10, 0.52), and 90th BMI percentiles (0.56, 95% CI: 0.27, 0.82). No associations were observed between screen time and changes at the 10th and 25th BMI percentiles.
Conclusions:
Positive associations between screen time and changes in the BMI at the upper tail of the BMI distribution were observed. Therefore, lowering screen time, especially among overweight and obese adolescents, could contribute to reducing the prevalence of adolescent obesity.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Hospital admissions for non-coronavirus disease 2019 (COVID-19) pathology have decreased significantly. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in ...hospital and the subsequent risk of mortality.
To identify patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection (NC)) and their risk of mortality compared to those with community-acquired COVID-19 (CAC) infection.
The COPE-Nosocomial Study was an observational cohort study. The primary outcome was the time to all-cause mortality (estimated with an adjusted hazard ratio (aHR)), and secondary outcomes were day 7 mortality and the time-to-discharge. A mixed-effects multivariable Cox's proportional hazards model was used, adjusted for demographics and comorbidities.
The study included 1564 patients from 10 hospital sites throughout the UK, and one in Italy, and collected outcomes on patients admitted up to April 28th, 2020. In all, 12.5% of COVID-19 infections were acquired in hospital; 425 (27.2%) patients with COVID died. The median survival time in NC patients was 14 days compared with 10 days in CAC patients. In the primary analysis, NC infection was associated with lower mortality rate (aHR: 0.71; 95% confidence interval (CI): 0.51–0.98). Secondary outcomes found no difference in day 7 mortality (adjusted odds ratio: 0.79; 95% CI: 0.47–1.31), but NC patients required longer time in hospital during convalescence (aHR: 0.49, 95% CI: 0.37–0.66).
The minority of COVID-19 cases were the result of NC transmission. No COVID-19 infection comes without risk, but patients with NC had a lower risk of mortality compared to CAC infection; however, caution should be taken when interpreting this finding.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract
A teledermatology service for skin lesions was commenced in January 2021 initially as a pilot scheme with six general practices and one dermatology department in a metropolitan area; to ...date, 70% of the city practices have since been on-boarded. Many 2-week wait (2WW) referrals are made not just for suspected skin cancer, but also for cases where there is diagnostic uncertainty and secondary care opinion/reassurance sought. The aim of the service was to embed a fully integrated information technology solution to facilitate single skin lesion triage in an attempt to help to address the 2WW capacity issues in secondary care. The referring general practitioners (GPs) were provided with a mobile phone adaptor attachment and dermatoscope to obtain images of the index lesion in question. A proforma that includes a concise history of the lesion and clinical impression is completed. The GPs were encouraged to use this triage service but could also refer directly to the 2WW service if concerned. The consultant then provided advice and guidance with a menu of triage outcomes, including upgrade to a 2WW appointment. We reviewed the referrals received via this skin lesion pathway and numbers of cases converted to a 2WW appointment from 12 April to 1 December 2022 as a snapshot of the service. We aimed to determine factors from the referral that prompted the conversion. There were 1201 skin lesion referrals, and 299 cases were converted to 2WW (24.9% of the cohort). In 93 of 299 referrals, the GP’s impression was possible squamous cell carcinoma or melanoma. In 137 of 299 cases, the GP had not provided a clinical impression. In 70 of 299 referrals, the GP’s clinical impression correlated with the dermatology’s impression based on the dermatoscopic images. In 44 cases, the clinician’s impression based on the image was of a benign lesion; however, we noted that a more cautious approach was adopted by some clinicians who triaged to 2WW if there was any diagnostic uncertainty. After face-to-face review, 159 of 299 were listed for biopsy or excision. Some factors identified that limited diagnostic accuracy included poor image quality and some referrals contained multiple lesions, causing confusion. This skin lesion triage service appears to support the idea that photographic triage could reduce the burden of 2WW face-to-face referrals. Areas for improvement identified include ensuring that the referrer provides a concise history and clinical impression, the use of gel for dermatoscopic images and feedback when images are not of adequate quality. In the future, it may be necessary to consider photographic hubs to standardize referral photographic quality.
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BFBNIB, FZAB, GIS, IJS, KILJ, OILJ, SBCE, SBMB, UPUK
Investigate if integrated exercise and psychosocial (EP) interventions effect self-efficacy to manage pain and self-efficacy for physical functioning compared to alternate interventions, usual care, ...waitlists and attention controls for individuals with chronic low back pain (CLBP).
MEDLINE, Embase, CINAHL, Web of Science, PsychINFO, PEDro, and Cochrane Library were searched. Included randomized controlled trials utilized an EP intervention for CLBP and measured self-efficacy. Independent reviewers screened abstracts, reviewed full-texts, extracted data, and assessed risk of bias. GRADE, synthesis without meta-analysis, and ranges of effects (Hedges' g) were used.
2207 Participants were included (22-studies). EP interventions positively effected self-efficacy to manage pain short-term compared to usual care (range of effects: −0.02, 0.94) and controls (range of effects: 0.69, 0.80) and intermediately compared to usual care (range of effects: 0.11, 0.29); however, no differences were found when compared to alternate interventions. EP interventions positively effected self-efficacy for physical functioning short-term compared to alternate interventions (range of effects: 0.57, 0.71), usual care (range of effects: −0.15, 0.94), and controls (range of effects: 0.31, 0.56), and intermediately compared to alternate interventions (1-study, effect: 0.57) and controls (1-study, effect: 0.56). Conclusions were limited by low to very low-quality-evidence often from risk of bias, imprecision, and clinical/statistical heterogeneity.
EP interventions may be more effective short-term for self-efficacy to manage pain than usual care and waitlists, but not alternate interventions. EP interventions may be effective for self-efficacy for physical functioning at short- and intermediate-term compared to alternate interventions, usual care, waitlist and attention controls. Considerations for future research include methods for blinding and measurement of self-efficacy for physical functioning.
•Exercise and psychosocial interventions may promote self-efficacy to manage pain.•These interventions may promote self-efficacy for physical functioning as well.•Interventions often used cognitive behavioral strategies and addressed fear.•A range of interventions exist and are often delivered by physical therapists.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The COVID-19 pandemic has placed unprecedented strain on health-care systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the prevalence and effect of frailty in ...people with COVID-19 is not known. In the COVID-19 in Older PEople (COPE) study we aimed to establish the prevalence of frailty in patients with COVID-19 who were admitted to hospital and investigate its association with mortality and duration of hospital stay.
This was an observational cohort study conducted at ten hospitals in the UK and one in Italy. All adults (≥18 years) admitted to participating hospitals with COVID-19 were included. Patients with incomplete hospital records were excluded. The study analysed routinely generated hospital data for patients with COVID-19. Frailty was assessed by specialist COVID-19 teams using the clinical frailty scale (CFS) and patients were grouped according to their score (1–2=fit; 3–4=vulnerable, but not frail; 5–6=initial signs of frailty but with some degree of independence; and 7–9=severe or very severe frailty). The primary outcome was in-hospital mortality (time from hospital admission to mortality and day-7 mortality).
Between Feb 27, and April 28, 2020, we enrolled 1564 patients with COVID-19. The median age was 74 years (IQR 61–83); 903 (57·7%) were men and 661 (42·3%) were women; 425 (27·2%) had died at data cutoff (April 28, 2020). 772 (49·4%) were classed as frail (CFS 5–8) and 27 (1·7%) were classed as terminally ill (CFS 9). Compared with CFS 1–2, the adjusted hazard ratios for time from hospital admission to death were 1·55 (95% CI 1·00–2·41) for CFS 3–4, 1·83 (1·15–2·91) for CFS 5–6, and 2·39 (1·50–3·81) for CFS 7–9, and adjusted odds ratios for day-7 mortality were 1·22 (95% CI 0·63–2·38) for CFS 3–4, 1·62 (0·81–3·26) for CFS 5–6, and 3·12 (1·56–6·24) for CFS 7–9.
In a large population of patients admitted to hospital with COVID-19, disease outcomes were better predicted by frailty than either age or comorbidity. Our results support the use of CFS to inform decision making about medical care in adult patients admitted to hospital with COVID-19.
None.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Crohn's disease (CD) is a complex disorder resulting from the interaction of intestinal microbiota with the host immune system in genetically susceptible individuals. The largest meta-analysis of ...genome-wide association to date identified 71 CD-susceptibility loci in individuals of European ancestry. An important epidemiological feature of CD is that it is 2-4 times more prevalent among individuals of Ashkenazi Jewish (AJ) descent compared to non-Jewish Europeans (NJ). To explore genetic variation associated with CD in AJs, we conducted a genome-wide association study (GWAS) by combining raw genotype data across 10 AJ cohorts consisting of 907 cases and 2,345 controls in the discovery stage, followed up by a replication study in 971 cases and 2,124 controls. We confirmed genome-wide significant associations of 9 known CD loci in AJs and replicated 3 additional loci with strong signal (p<5×10⁻⁶). Novel signals detected among AJs were mapped to chromosomes 5q21.1 (rs7705924, combined p = 2×10⁻⁸; combined odds ratio OR = 1.48), 2p15 (rs6545946, p = 7×10⁻⁹; OR = 1.16), 8q21.11 (rs12677663, p = 2×10⁻⁸; OR = 1.15), 10q26.3 (rs10734105, p = 3×10⁻⁸; OR = 1.27), and 11q12.1 (rs11229030, p = 8×10⁻⁹; OR = 1.15), implicating biologically plausible candidate genes, including RPL7, CPAMD8, PRG2, and PRG3. In all, the 16 replicated and newly discovered loci, in addition to the three coding NOD2 variants, accounted for 11.2% of the total genetic variance for CD risk in the AJ population. This study demonstrates the complementary value of genetic studies in the Ashkenazim.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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