•Critical care nurses have had to perform tasks for which they have not received proper training.•Nurses have had to manage the fear of becoming infected and spreading it to their families.•Moral ...suffering and emotional exhaustion are major consequences of front-line care.•Heavy workloads, high patient-nurse ratios, and lack of rest are causing exhaustion among nurses.
The COVID-19 pandemic is a public health challenge that puts health systems in a highly vulnerable situation. Nurses in critical care units (CCUs) and hospital emergency services (HESs) have provided care to patients with COVID-19 under pressure and uncertainty.
To identify needs related to safety, organisation, decision-making, communication and psycho-socio-emotional needs perceived by critical care and emergency nurses in the region of Madrid, Spain, during the acute phase of the epidemic crisis.
This is a cross-sectional study (the first phase of a mixed methods study) with critical care and emergency nurses from 26 public hospitals in Madrid using an online questionnaire.
The response rate was 557, with 37.5% reporting working with the fear of becoming infected and its consequences, 28.2% reported elevated workloads, high patient-nurse ratios and shifts that did not allow them to disconnect or rest, while taking on more responsibilities when managing patients with COVID-19 (23.9%). They also reported deficiencies in communication with middle management (21.2%), inability to provide psycho-social care to patients and families and being emotionally exhausted (53.5%), with difficulty in venting emotions (44.9%).
Critical care and emegency nurses may be categorised as a vulnerable population. It is thus necessary to delve deeper into further aspects of their experiences of the pandemic.
Summary Background Bortezomib plus melphalan and prednisone (VMP) is significantly better than melphalan plus prednisone alone for elderly patients with untreated multiple myeloma; however, toxic ...effects are high. We investigated a novel and less intensive bortezomib-based regimen to maintain efficacy and to reduce toxic effects. Methods Between March, 2006, and October, 2008, 260 patients with untreated multiple myeloma, 65 years and older, from 63 Spanish centres, were randomly assigned to receive six cycles of VMP (n=130) or bortezomib plus thalidomide and prednisone (VTP; n=130) as induction therapy, consisting of one cycle of bortezomib twice per week for 6 weeks (1·3 mg/m2 on days 1, 4, 8, 11, 22, 25, 29, and 32), plus either melphalan (9 mg/m2 on days 1–4) or daily thalidomide (100 mg), and prednisone (60 mg/m2 on days 1–4). The first cycle was followed by five cycles of bortezomib once per week for 5 weeks (1·3 mg/m2 on days 1, 8, 15, and 22) plus the same doses of melphalan plus prednisone and thalidomide plus prednisone. 178 patients completed the six induction cycles and were randomly assigned to maintenance therapy with bortezomib plus prednisone (n=87) or bortezomib plus thalidomide (n=91), consisting of one conventional cycle of bortezomib for 3 weeks (1·3 mg/m2 on days 1, 4, 8, and 11) every 3 months, plus either prednisone (50 mg every other day) or thalidomide (50 mg per day), for up to 3 years. Treatment codes were generated with a computerised random number generator, and neither participants nor study personnel were masked to treatment. The primary endpoint was response rate in induction and maintenance phases. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov , number NCT00443235. Findings In the induction phase, 105 (81%) patients in the VTP group and 104 (80%) in the VMP group achieved partial responses or better (p=0·9), including 36 (28%) and 26 (20%) complete remissions, respectively (p=0·2). Treatment with VTP resulted in more serious adverse events (40 31% vs 20 15%, p=0·01) and discontinuations (22 17% vs 15 12%, p=0·03) than did treatment with VMP. The most common toxicities (grade 3 or worse) were infections (one 1% in the VTP group vs nine 7% in the VMP group), cardiac events (11 8% vs 0), and peripheral neuropathy (nine 7% vs 12 9%). After maintenance therapy, the complete remission rate was 42% (40 44% patients in complete remission in the bortezomib plus thalidomide group, 34 39% in the bortezomib plus prednisone group). No grade 3 or worse haematological toxicities were recorded during maintenance therapy; two (2%) patients in the bortezomib plus prednisone group and six (7%) in the bortezomib plus thalidomide group developed peripheral neuropathy. Interpretation Reduced-intensity induction with a bortezomib-based regimen, followed by maintenance, is a safe and effective treatment for elderly patients with multiple myeloma. Funding Pethema (Spanish Program for the Treatment of Hematologic Diseases).
The value of minimal residual disease (MRD) in multiple myeloma (MM) has been more frequently investigated in transplant-eligible patients than in elderly patients. Because an optimal balance between ...treatment efficacy and toxicity is of utmost importance in patients with elderly MM, sensitive MRD monitoring might be particularly valuable in this patient population. Here, we used second-generation 8-color multiparameter-flow cytometry (MFC) to monitor MRD in 162 transplant-ineligible MM patients enrolled in the PETHEMA/GEM2010MAS65 study. The transition from first- to second-generation MFC resulted in increased sensitivity and allowed us to identify 3 patient groups according to MRD levels: MRD negative (<10−5; n = 54, 34%), MRD positive (between <10−4 and ≥10−5; n = 20, 12%), and MRD positive (≥10−4; n = 88, 54%). MRD status was an independent prognostic factor for time to progression (TTP) (hazard ratio HR, 2.7; P = .007) and overall survival (OS) (HR, 3.1; P = .04), with significant benefit for MRD-negative patients (median TTP not reached, 70% OS at 3 years), and similar poorer outcomes for cases with MRD levels between <10−4 and ≥10−5 vs ≥10−4 (both with a median TTP of 15 months; 63% and 55% OS at 3 years, respectively). Furthermore, MRD negativity significantly improved TTP of patients >75 years (HR, 4.8; P < .001), as well as those with high-risk cytogenetics (HR, 12.6; P = .01). Using second-generation MFC, immune profiling concomitant to MRD monitoring also contributed to identify patients with poor, intermediate, and favorable outcomes (25%, 61%, and 100% OS at 3 years, respectively; P = .01), the later patients being characterized by an increased compartment of mature B cells. Our results show that similarly to transplant candidates, MRD monitoring is one of the most relevant prognostic factors in elderly MM patients, irrespectively of age or cytogenetic risk. This trial was registered at www.clinicaltrials.gov as #NCT01237249.
•MRD monitoring is one of the most relevant prognostic factors in elderly MM patients, irrespective of age or cytogenetic risk.•Second-generation MFC immune profiling concomitant to MRD monitoring also helped to identify patients with different outcomes.
► Comprehensive review of a half-century’s work in non-native speech perception in noise. ► In-depth discussion of the roles of listener type, task and noise. ► Highlights research trends and gaps in ...current knowledge.
If listening in adverse conditions is hard, then listening in a foreign language is doubly so: non-native listeners have to cope with both imperfect signals and imperfect knowledge. Comparison of native and non-native listener performance in speech-in-noise tasks helps to clarify the role of prior linguistic experience in speech perception, and, more directly, contributes to an understanding of the problems faced by language learners in everyday listening situations. This article reviews experimental studies on non-native listening in adverse conditions, organised around three principal contributory factors: the task facing listeners, the effect of adverse conditions on speech, and the differences among listener populations. Based on a comprehensive tabulation of key studies, we identify robust findings, research trends and gaps in current knowledge.
Efficient and early triage of hospitalized Covid-19 patients to detect those with higher risk of severe disease is essential for appropriate case management.
We trained, validated, and externally ...tested a machine-learning model to early identify patients who will die or require mechanical ventilation during hospitalization from clinical and laboratory features obtained at admission. A development cohort with 918 Covid-19 patients was used for training and internal validation, and 352 patients from another hospital were used for external testing. Performance of the model was evaluated by calculating the area under the receiver-operating-characteristic curve (AUC), sensitivity and specificity.
A total of 363 of 918 (39.5%) and 128 of 352 (36.4%) Covid-19 patients from the development and external testing cohort, respectively, required mechanical ventilation or died during hospitalization. In the development cohort, the model obtained an AUC of 0.85 (95% confidence interval CI, 0.82 to 0.87) for predicting severity of disease progression. Variables ranked according to their contribution to the model were the peripheral blood oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio, age, estimated glomerular filtration rate, procalcitonin, C-reactive protein, updated Charlson comorbidity index and lymphocytes. In the external testing cohort, the model performed an AUC of 0.83 (95% CI, 0.81 to 0.85). This model is deployed in an open source calculator, in which Covid-19 patients at admission are individually stratified as being at high or non-high risk for severe disease progression.
This machine-learning model, applied at hospital admission, predicts risk of severe disease progression in Covid-19 patients.
Grape pomace was extracted with pressurized hot water at laboratory scale before and after fermentation to explore the effects of fermentation and extraction temperature (50–200 °C) and time (5 and ...30 min) on total extracted antioxidant levels and activity and to determine the content and recovery efficiency of main grape polyphenols, anthocyanins, and tannins. Fermented pomace yielded more total antioxidants (TAs), antioxidant activity, and tannins, than unfermented pomace but fewer anthocyanins. Elevating the extraction temperature increased TA extraction and antioxidant activity. Maximum anthocyanin extraction yields were achieved at 100 °C and at 150 °C for tannins and tannin–anthocyanin adducts. Using higher temperatures and longer extraction times resulted in a sharp decrease of polyphenol extraction yield. Relevant proanthocyanidin amounts were extracted only at 50 and 100 °C. Finally, TA recovery and activity were not directly related to the main polyphenol content when performing pressurized hot water grape pomace extraction.
Abstract Since pioneering work in the early 60s on the development of enzyme electrodes the field of sensors has evolved to different sophisticated technological platforms. Still, for biomedical ...applications, there are key requirements to meet in order to get fast, low-cost, real-time data acquisition, multiplexed and automatic biosensors. Nano-based sensors are one of the most promising healthcare applications of nanotechnology, and prone to be one of the first to become a reality. From all nanosensors strategies developed, Magnetic Relaxation Switches (MRSw) assays combine several features which are attractive for nanomedical applications such as safe biocompatibility of magnetic nanoparticles, increased sensitivity/specificity measurements, possibility to detect analytes in opaque samples (unresponsive to light-based interferences) and the use of homogeneous setting assay. This review aims at presenting the ongoing progress of MRSw technology and its most important applications in clinical medicine.
Inoculating olive plantlets with the arbuscular mycorrhizal fungi (AMF)
Glomus mosseae,
Glomus intraradices or
Glomus claroideum increased plant growth and the ability to acquire nitrogen, ...phosphorus, and potassium from non-saline as well as saline media. AMF-colonized plants also increased in survival rate after transplant. Osmotic stress caused by NaCl supply reduced stem diameter, number of shoots, shoot length and nutrients in olive plants, but AMF colonization alleviated all of these negative effects on growth.
G. mosseae was the most efficient fungus in reducing the detrimental effects of salinity; it increased shoot growth by 163% and root growth by 295% in the non-saline medium, and by 239% (shoot) and by 468% (root) under the saline conditions. AMF colonization enhanced salt tolerance in terms of olive growth and nutrient acquisition. Mycorrhizal olive plants showed the lowest biomass reduction under salinity (34%), while growth was reduced by 78% in control plants. This
G. mosseae effect seems to be due to increased K acquisition; K content was enhanced under salt conditions by 6.4-fold with
G. mosseae, 3.4-fold with
G. intraradices, and 3.7-fold with
G. claroideum. Potassium, as the most prominent inorganic solute, plays a key role in the osmoregulation processes and the highest salinity tolerance of
G. mosseae-colonized olive trees was concomitant with an enhanced K concentration in olive plants.
Maintenance therapy has become a hot field in myeloma, and it may be particularly relevant in elderly patients because the major benefit results from the initial therapy. We report the results of a ...randomized comparison of maintenance with bortezomib plus thalidomide (VT) or prednisone (VP) in 178 elderly untreated myeloma patients who had received 6 induction cycles with bortezomib plus either melphalan and prednisone or thalidomide and prednisone. The complete response (CR) rate increased from 24% after induction up to 42%, higher for VT versus VP (46% vs 39%). Median progression-free survival (PFS) was superior for VT (39 months) compared with VP (32 months) and overall survival (OS) was also longer in VT patients compared with VP (5-year OS of 69% and 50%, respectively) but the differences did not reach statistical significance. CR achievement was associated with a significantly longer PFS (P < .001) and 5-year OS (P < .001). The incidence of G3-4 peripheral neuropathy was 9% for VT and 3% for VP. Unfortunately, this approach was not able to overcome the adverse prognosis of cytogenetic abnormalities. In summary, these maintenance regimens result in a significant increase in CR rate, remarkably long PFS, and acceptable toxicity profile. The trial is registered at www.clinicaltrials.gov as NCT00443235.
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