It is particularly difficult for healthcare providers to deliver optimal medical care to multimorbid middle-aged persons because patients' professional activities, family lives, and other everyday ...responsibilities hinder them from making necessary lifestyle changes. Our aim was to find out how patients and healthcare providers view and manage the problems of dealing with multimorbidity in middle age. This qualitative study consisted of three steps. First, we conducted semi-structured in-depth interviews with 15 purposively sampled middle-aged persons living with multimorbidity to explore the experiences of care in the context of their leisure time, family lives, and work. Second, further individual interviews were carried out to find out the views of 14 healthcare providers. Third, the results of the interviews with patients and healthcare providers were presented to and discussed with four healthcare providers at an interprofessional workshop. Interview data was coded using an inductive-deductive approach and analyzed using content analysis. While patients reflected on challenges in several life domains, healthcare providers differentiated between levels of challenges. Both shared recommendations for better care including i) helping patients cope, ii) providing relief in activities of daily living, iii) continuity of care, iv) interprofessional cooperation, v) health promotion/prevention, vi) expansion of health services and vii) general system-level changes. Furthermore, the healthcare provider workshop highlighted the importance of increasing patient-centeredness, reducing complexity through a care coordinator and promoting interprofessional cooperation/networking. To further improve the care of patients living with multimorbidity, barriers to managing multiple chronic conditions and facilitators to navigating complex care scenarios should be explored not only for people beyond working age, but for individuals in their mid-life specifically.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A large body of evidence suggests that self-management interventions (SMIs) may improve outcomes in chronic obstructive pulmonary disease (COPD). However, accurate comparisons of the relative ...effectiveness of SMIs are challenging, partly due to heterogeneity of outcomes across trials and uncertainty about the importance of these outcomes for patients. We aimed to develop a core set of patient-relevant outcomes (COS) for SMIs trials to enhance comparability of interventions and ensure person-centred care.
We undertook an innovative approach consisting of four interlinked stages: i) Development of an initial catalogue of outcomes from previous EU-funded projects and/or published studies, ii) Scoping review of reviews on patients and caregivers' perspectives to identify outcomes of interest, iii) Two-round Delphi online survey with patients and patient representatives to rate the importance of outcomes, and iv) Face-to-face consensus workshop with patients, patient representatives, health professionals and researchers to develop the COS.
From an initial list of 79 potential outcomes, 16 were included in the COS plus one supplementary outcome relevant to all participants. These were related to patient and caregiver knowledge/competence, self-efficacy, patient activation, self-monitoring, adherence, smoking cessation, COPD symptoms, physical activity, sleep quality, caregiver quality of life, activities of daily living, coping with the disease, participation and decision-making, emergency room visits/admissions and cost effectiveness.
The development of the COPD COS for the evaluation of SMIs will increase consistency in the measurement and reporting of outcomes across trials. It will also contribute to more personalized health care and more informed health decisions in clinical practice as patients' preferences regarding COPD outcomes are more systematically included.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Exosomes are small extracellular vesicles that can be obtained from several body fluids such as blood and urine. Since these vesicles can carry biomarkers and other cargo, they have application in ...healthcare diagnostics and therapeutics, such as liquid biopsies and drug delivery. Yet, their identification and separation from a sample remain challenging due to their high degree of heterogeneity and their co‐existence with other bioparticles. In this contribution, we review the state‐of‐the‐art on electrical techniques and methods to displace, selectively trap/isolate, and detect/characterize exosomes in microfluidic devices. Although there are many reviews focused on exosome separation using benchtop equipment, such as ultracentrifugation, there are limited reviews focusing on the use of electrical phenomena in microfluidic devices for exosome manipulation and detection. Here, we highlight contributions published during the past decade and present perspectives for this research field for the near future, outlining challenges to address in years to come.
Half the US population uses drugs with anticholinergic properties. Their potential harms may outweigh their benefits. Amitriptyline is among the most frequently prescribed anticholinergic medicinal ...products, is used for multiple indications, and rated as strongly anticholinergic. Our objective was to explore and quantify (anticholinergic) adverse drug reactions (ADRs) in patients taking amitriptyline vs. placebo in randomized controlled trials (RCTs) involving adults and healthy individuals.
We searched electronic databases from their inception until 09/2022, and clinical trial registries from their inception until 09/2022. We also performed manual reference searches. Two independent reviewers selected RCTs with ≥100 participants of ≥18 years, that compared amitriptyline (taken orally) versus placebo for all indications. No language restrictions were applied. One reviewer extracted study data, ADRs, and assessed study quality, which two others verified. The primary outcome was frequency of anticholinergic ADRs as a binary outcome (absolute number of patients with/without anticholinergic ADRs) in amitriptyline vs. placebo groups.
Twenty-three RCTs (mean dosage 5mg to 300mg amitriptyline/day) and 4217 patients (mean age 40.3 years) were included. The most frequently reported anticholinergic ADRs were dry mouth, drowsiness, somnolence, sedation, fatigue, constitutional, and unspecific anticholinergic ADRs. Random-effects meta-analyses showed anticholinergic ADRs had a higher odd's ratio for amitriptyline versus placebo (OR = 7.41; 95% CI, 4.54 to 12.12). Non-anticholinergic ADRs were as frequent for amitriptyline as placebo. Meta-regression analysis showed anticholinergic ADRs were not dose-dependent.
The large OR in our analysis shows that ADRs indicative of anticholinergic activities can be attributed to amitriptyline. The low average age of participants in our study may limit the generalizability of the frequency of anticholinergic ADRs in older patients. A lack of dose-dependency may reflect limited reporting of the daily dosage when the ADRs occurred. The exclusion of small studies (<100 participants) decreased heterogeneity between studies, but may also have reduced our ability to detect rare events. Future studies should focus on older people, as they are more susceptible to anticholinergic ADRs.
PROSPERO: CRD42020111970.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
RNA-binding proteins (RBPs) are essential for post-transcriptional regulation of gene expression. Recent high-throughput screens have dramatically increased the number of experimentally identified ...RBPs; however, comprehensive identification of RBPs within living organisms is elusive. Here we describe the repertoire of 765 and 594 proteins that reproducibly interact with polyadenylated mRNAs in Saccharomyces cerevisiae and Caenorhabditis elegans, respectively. Furthermore, we report the differential association of mRNA-binding proteins (mRPBs) upon induction of apoptosis in C. elegans L4-stage larvae. Strikingly, most proteins composing mRBPomes, including components of early metabolic pathways and the proteasome, are evolutionarily conserved between yeast and C. elegans. We speculate, on the basis of our evidence that glycolytic enzymes bind distinct glycolytic mRNAs, that enzyme-mRNA interactions relate to an ancient mechanism for post-transcriptional coordination of metabolic pathways that perhaps was established during the transition from the early 'RNA world' to the 'protein world'.
Abstract Objectives This study sought to assess the diagnostic impact of stress echocardiography (SE) in patients with suspected low-flow, low-gradient aortic stenosis but normal resting ...transvalvular flow rate. Background SE may help to distinguish between true severe aortic stenosis and pseudosevere aortic stenosis in patients with low aortic valve area (AVA) and mean gradient. However, if rest flow rate is normal, then SE may not confer any additional diagnostic value, irrespective of resting left ventricular ejection fraction (LVEF) and indexed stroke volume (SVi). Methods Sixty-seven patients with suspected low-flow, low-gradient aortic stenosis who underwent SE were retrospectively studied. Following stratification by rest LVEF, SVi, and flow rate—using cutoffs of 50%, 35 ml/m2 , and 200 ml/s, respectively—we tested for significant changes in AVA during SE. Results Mean age was 77 ± 9 years and 60% of patients were male. Mean values for rest variables were as follows: AVA: 0.77 ± 0.12 cm2 ; mean gradient: 27 ± 7 mm Hg; flow rate: 182 ± 37 ml/s; SVi: 32 ± 8 ml/m2 ; and LVEF: 45 ± 15%. During SE, significant increases in AVA were observed regardless of resting LVEF and SVi state. In patients with rest flow rate ≥200 ml/s, AVA did not increase significantly during stress (rest AVA: 0.90 cm2 vs. stress AVA: 0.97 cm2 ; p = 0.11), and positive predictive value for confirming underlying true severe aortic stenosis was 84%. In adjusted analyses, rest flow rate was the only parameter associated with severe AS (odds ratio: 1.05, 95% confidence interval: 1.0 to 1.1; p = 0.002). Conclusions Rest AVA measured under normal flow rate conditions is likely to reflect the true severity of AS and unlikely to change significantly with SE. Flow normalization may only be required in patients with AVA <1 cm2 and mean gradient <40 mm Hg when the rest flow rate is <200 ml/s.
The fuel complex variables canopy bulk density and canopy base height are often used to predict crown fire initiation and spread. Direct measurement of these variables is impractical, and they are ...usually estimated indirectly by modelling. Recent advances in predicting crown fire behaviour require accurate estimates of the complete vertical distribution of canopy fuels. The objectives of the present study were to model the vertical profile of available canopy fuel in pine stands by using data from the Spanish national forest inventory plus low-density airborne laser scanning (ALS) metrics. In a first step, the vertical distribution of the canopy fuel load was modelled using the Weibull probability density function. In a second step, two different systems of models were fitted to estimate the canopy variables defining the vertical distributions; the first system related these variables to stand variables obtained in a field inventory, and the second system related the canopy variables to airborne laser scanning metrics. The models of each system were fitted simultaneously to compensate the effects of the inherent cross-model correlation between the canopy variables. Heteroscedasticity was also analyzed, but no correction in the fitting process was necessary. The estimated canopy fuel load profiles from field variables explained 84% and 86% of the variation in canopy fuel load for maritime pine and radiata pine respectively; whereas the estimated canopy fuel load profiles from ALS metrics explained 52% and 49% of the variation for the same species. The proposed models can be used to assess the effectiveness of different forest management alternatives for reducing crown fire hazard.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Wound healing - A literature review Gonzalez, Ana Cristina de Oliveira; Costa, Tila Fortuna; Andrade, Zilton de Araújo ...
Anais brasileiros de dermatología,
09/2016, Letnik:
91, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Regeneration and tissue repair processes consist of a sequence of molecular and cellular events which occur after the onset of a tissue lesion in order to restore the damaged tissue. The exsudative, ...proliferative, and extracellular matrix remodeling phases are sequential events that occur through the integration of dynamic processes involving soluble mediators, blood cells, and parenchymal cells. Exsudative phenomena that take place after injury contribute to the development of tissue edema. The proliferative stage seeks to reduce the area of tissue injury by contracting myofibroblasts and fibroplasia. At this stage, angiogenesis and reepithelialization processes can still be observed. Endothelial cells are able to differentiate into mesenchymal components, and this difference appears to be finely orchestrated by a set of signaling proteins that have been studied in the literature. This pathway is known as Hedgehog. The purpose of this review is to describe the various cellular and molecular aspects involved in the skin healing process.
This study investigated the effects of bilingualism on set‐shifting and working memory in children with autism spectrum disorders (ASD). Bilinguals with ASD were predicted to display a specific ...bilingual advantage in set‐shifting, but not working memory, relative to monolinguals with ASD. Forty 6‐ to 9‐year‐old children participated (20 ASD, 20 typically‐developing). Set‐shifting was measured using a computerized dimensional change card sort (DCCS) task, and by parent report of executive functioning in daily life. Results showed an advantage for bilingual relative to monolingual children with ASD on the DCCS task, but not for set‐shifting in daily life. Working memory was similar for bilinguals and monolinguals with ASD. These findings suggest that bilingualism may mitigate some set‐shifting difficulties in children with ASD.
Few quantitative trait loci have been mapped for resistance to
pv.
in common bean. Two F₂ populations were developed from the host differential UI3 cultivar. The objective of this study was to ...further characterize the resistance to races 1, 5, 7 and 9 of
included in UI3. Using a QTL mapping approach, 16 and 11 main-effect QTLs for pod and primary leaf resistance were located on LG10, explaining up to 90% and 26% of the phenotypic variation, respectively. The homologous genomic region corresponding to primary leaf resistance QTLs detected tested positive for the presence of resistance-associated gene cluster encoding nucleotide-binding and leucine-rich repeat (NL), Natural Resistance Associated Macrophage (NRAMP) and Pentatricopeptide Repeat family (PPR) proteins. It is worth noting that the main effect QTLs for resistance in pod were located inside a 3.5 Mb genomic region that included the
gene, which encodes a protein that has the highest sequence similarity to the
gene of Arabidopsis, and can be considered an important candidate gene for the organ-specific QTLs identified here. These results support that resistance to
from UI3 might result from the immune response activated by combinations of R proteins, and suggest the guard model as an important mechanism in pod resistance to halo blight. The candidate genes identified here warrant functional studies that will help in characterizing the actual defense gene(s) in UI3 genotype.
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