A pilot study (NCT00316563) to determine if delta-9-tetrahydrocannabinol (THC) can improve taste and smell (chemosensory) perception as well as appetite, caloric intake, and quality of life (QOL) for ...cancer patients with chemosensory alterations.
Adult advanced cancer patients, with poor appetite and chemosensory alterations, were recruited from two sites and randomized in a double-blinded manner to receive either THC (2.5 mg, Marinol®; Solvay Pharma Inc., n = 24) or placebo oral capsules (n = 22) twice daily for 18 days. Twenty-one patients completed the trial. At baseline and posttreatment, patients completed a panel of patient-reported outcomes: Taste and Smell Survey, 3-day food record, appetite and macronutrient preference assessments, QOL questionnaire, and an interview.
THC and placebo groups were comparable at baseline. Compared with placebo, THC-treated patients reported improved (P = 0.026) and enhanced (P < 0.001) chemosensory perception and food ‘tasted better’ (P = 0.04). Premeal appetite (P = 0.05) and proportion of calories consumed as protein increased compared with placebo (P = 0.008). THC-treated patients reported increased quality of sleep (P = 0.025) and relaxation (P = 0.045). QOL scores and total caloric intake were improved in both THC and placebo groups.
THC may be useful in the palliation of chemosensory alterations and to improve food enjoyment for cancer patients.
Staphylococcus epidermidis bone and joint infections (BJIs) on material are often difficult to treat. The activity of delafloxacin has not yet been studied on S. epidermidis in this context. The aim ...of this study was to assess its in vitro activity compared with other fluoroquinolones, against a large collection of S. epidermidis clinical strains.
We selected 538 S. epidermidis strains isolated between January 2015 and February 2023 from six French teaching hospitals. One hundred and fifty-two strains were ofloxacin susceptible and 386 were ofloxacin resistant. Identifications were performed by MS and MICs were determined using gradient concentration strips for ofloxacin, levofloxacin, moxifloxacin and delafloxacin.
Ofloxacin-susceptible strains were susceptible to all fluoroquinolones. Resistant strains had higher MICs of all fluoroquinolones. Strains resistant to ofloxacin (89.1%) still showed susceptibility to delafloxacin when using the Staphylococcus aureus 2021 CA-SFM/EUCAST threshold of 0.25 mg/L. In contrast, only 3.9% of the ofloxacin-resistant strains remained susceptible to delafloxacin with the 0.016 mg/L S. aureus breakpoint according to CA-SFM/EUCAST guidelines in 2022. The MIC50 was 0.094 mg/L and the MIC90 was 0.38 mg/L.
We showed low delafloxacin MICs for ofloxacin-susceptible S. epidermidis strains and a double population for ofloxacin-resistant strains. Despite the absence of breakpoints for S. epidermidis, delafloxacin may be an option for the treatment of complex BJI, including strains with MICs of ≤0.094 mg/L, leading to 64% susceptibility. This study underlines the importance for determining specific S. epidermidis delafloxacin breakpoints for the management of BJI on material.
High accuracy localization is easily obtained in an exterior context with GPS, but the development of indoor positioning systems remains a challenge. The GPS signals, by nature, cannot penetrate ...walls thus preventing this technology to provide any service indoor. This paper proposes a practical implementation of an accurate Indoor Positioning System based on Bluetooth Low Energy technology to ensure a low power, efficient and easy to setup infrastructure. It is available on any current Smartphone and requires no extra devices for the user. We use a fusion of the inertial sensors available on the device to output a precise and drift-free estimation of the user displacement, leverage this information with iBeacon radio signals used as anchors to readjust the path if needed and process all these inputs in a Particle Filter. We augmented the Fingerprinting-based likelihood calculation of the particles position’s with a unique simulation of the particle’s theoretical RSSI and also reduced the number of particles to better fit within the bounds of the computational capabilities of mobile devices. The experiment was conducted in a 400 m2 open space and yielded positive results as a first attempt in accurate indoor localization and proved to be viable in an indoor context.
DISSEMINATION, IMPLEMENTATION, AND IMPACT Breton, M.; Ann Smithman, M.; Lamoureux‐Lamarche, C. ...
Health services research,
08/2020, Letnik:
55, Številka:
S1
Journal Article
Recenzirano
Research Objective
Effective health innovations are rarely scaled‐up—missing countless opportunities to improve health systems. Yet, little evidence exists on strategies to support large scale ...implementation of proven innovations. eConsult is an asynchronous online platform connecting primary care providers to specialists to discuss patients’ care, that improves access, patient experience, provider satisfaction, and reduces costs. eConsult services have been implemented in 16 countries, most widely in the United States and Canada. In Canada, each province has a single payer health system with universal coverage and efforts to scale‐up eConsult are underway in several provinces, with over 75 000 eConsult cases completed across the country thus far. This provides a unique opportunity to understand the strategies used to support scale‐up of this type of innovation across a range of contexts. Our objective is to present the strategies used to scale‐up eConsult in multiple jurisdictions.
Study Design
We conducted a multiple case study, where the cases were four Canadian provinces at varying stages of scaling‐up eConsult (Ontario, Quebec, Newfoundland and Labrador and Manitoba). Our data sources include document review (e.g., meeting minutes, reports, websites, presentations), meeting observations where provincial scale‐up of eConsult is discussed (
n
= 26), semi‐structured interviews (
n
= 25) and focus groups (
n
= 2). We conducted deductive and inductive thematic analysis using Milat et al.’s scaling‐up conceptual framework (2016) to identify strategies and emerging themes.
Population Studied
Our study was conducted with key stakeholders (e.g., patients, family physicians, specialists, policy makers, decision makers) involved in the scaling‐up of eConsult in four Canadian provinces.
Principal Findings
We identified 6 common strategies used to support scaling‐up of eConsult in Canada : (a) Linking eConsult to research has helped develop and improve the innovation (e.g., technological infrastructure), establishing rigorous evidence to support the rationale for scaling‐up provincially, and maintaining eConsult activities during the scaling‐up process through funding and other resources; (b) building on a “coalition of the willing” by engaging partners who believe in the innovation and are willing to support it; (c) having physicians (both primary care and specialists) lead and adapt the innovation to their practice contexts, and relying on physician champions to help spread and scale the innovation; (d) engaging patient partners to strengthen the case to scale‐up eConsult through compelling patient stories and help drive scaling‐up efforts; (e) creating a “buzz” by engaging stakeholders across Canada, getting endorsements from organizations with influence, holding an annual national eConsult policy forum, presenting at various events, and building on other provinces’ experiences and expertise to help catalyze scale‐up efforts; (f) keeping the innovation simple to avoid becoming side‐tracked by peripheral challenges thus facilitating widespread adoption by physicians.
Conclusions
These strategies have been used in a range of contexts across Canada and are perceived by stakeholders as instrumental in scaling‐up efforts to date. The next step of this study is to foster cross‐level and cross‐jurisdictional knowledge exchange between key stakeholders.
Implications for Policy or Practice
This provides a new real‐world understanding of how stakeholders have tackled the challenges of scaling‐up eConsult and may be useful to inform future scaling‐up efforts for eConsult and similar innovations.
Primary Funding Source
Canadian Institutes of Health Research.
In this paper, a control strategy is described that increases the longevity of degraded Electric Vehicle (EV) batteries used in off-grid stationary-storage applications. The control strategy relies ...on battery impedance data measured using online Electrochemical Impedance Spectroscopy (EIS) to determine the time-varying degradation rates and electrical models for each battery module. The power-mix between battery modules at different State-of-Health (SOH) is set by the controller to reduce the rate of total capacity fade. A photovoltaic (PV) energy generation curtailing technique is used to reduce the battery charge rates in order to further reduce degradation. In simulation, the control strategy is shown to increase the battery system lifetime by an average of 56%. Experimental validation of the control strategy is performed using two custom 3.85kWh battery modules, and an online EIS system is demonstrated.
To examine the associations between chronic physical conditions and suicidal ideation and to assess whether associations are mediated by pain, anxiety, depression, post-traumatic stress syndrome ...(PTSS), and functional disability.
The study sample includes 1533 older adults aged 65+ recruited in primary care clinics between 2011-2013 and participating in Quebec's Health Survey on Services "Étude sur la Santé des Aînés-Services" (ESA-S) study. Path analysis was used to assess the associations. The presence of suicidal behaviour was ascertained using 4 questions. PTSS was based on a validated scale for primary care older adults. Anxiety and depression were assessed according to DSM-IV criteria. Pain was self-reported on an ordinal scale and functional disability was based on the presence of disability in 8 dimensions of activities of daily living. The main predictors included a list of 13 physical disorders identified by diagnostic codes. Suicidal ideation was also controlled by a number of socio-demographic and psychosocial factors.
PTSS, depression, and functional disability mediate the association between various chronic conditions and suicidal ideation. Although pain and anxiety are associated with many physical disorders, they did not mediate the association with suicidal ideation.
Chronic physical disorders are associated with suicidal ideation, either directly or indirectly through PTSS, depression, and functional disability. The findings underscore the importance of early identification and management of older patients with specific chronic disorders in primary care as they may be most at risk for suicidal ideation.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Establishing vegetation on disturbed sites in arid environments is difficult due to decreased water availability caused by altered soil properties: depth, compaction, and hydraulic characteristics. ...Plants cope with moisture stress through a combination of traits, including physiological strategies such as anisohydry and isohydry. We used a typical mine restoration substrate in a glasshouse pot experiment to investigate drought tolerance of nine Pilbara region Acacia species classified according to habitat preferences defined by preferred soil type: alluvial (fine textured), sandy, rocky, and generalists without a clear soil preference. Seedlings were examined to (1) determine physiological shoot, and morphological shoot and root traits associated with drought tolerance, and (2) identify if these traits were correlated with species’ soil preferences. Species from alluvial, rocky, and one sandy soil species were more anisohydric. These species had higher stomatal conductance at more negative leaf water potentials. Alluvial soil species had greater total biomass allocation to lateral roots, whereas two coarser textured soil species had high allocation to tap roots. Soil preference was a poor predictor of plant water relations, presumably due to complex soil profiles in nature associated with widely differing hydraulic characteristics, and interactions among plant functional traits influencing water uptake, transport and loss.
•Nine arid Australian Acacia species differed in a range of drought tolerance traits.•Differences in functional traits were poorly related with soil preference.•Trait interactions and soil complexity influence species distributions.•Mechanistic understanding is needed to predict restoration species performance.
Patients who have chemical dependency (CD) are commonly encountered on medical and surgical wards, often for illnesses and injuries sustained as a direct result of their substance abuse. When these ...patients are repeatedly admitted to the hospital in certain states that provide a legal framework to commit chemically dependent persons to a treatment facility, clinicians often wonder whether they should initiate that process. Should consulting psychiatrists choose to initiate the commitment process, they put into motion a resource-intensive, time-consuming mechanism, with uncertain outcomes, both in the courtroom and at the bedside. Petitioning for involuntary commitment to chemical dependency treatment of a patient from medical and surgical services is poorly understood. In this study, we examined a series of patients for whom petitions for judicial commitment in the state of Minnesota were entered over a 12-month period, and evaluated the likelihood of commitment to treatment, the demographics of patients involved, and the outcomes for this series of patients. Three vignettes are presented to illustrate the severity of these patients' illnesses and potential outcomes of the process. We further describe potential limitations of the commitment system and alternatives to CD commitment that could be explored further.
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