This article introduces a new and unobtrusive wearable monitoring device based on electrodermal activity (EDA) to be used in health-related computing systems. This paper introduces the description of ...the wearable device capable of acquiring the EDA of a subject in order to detect his/her calm/distress condition from the acquired physiological signals. The lightweight wearable device is placed in the wrist of the subject to allow continuous physiological measurements. With the aim of validating the correct operation of the wearable EDA device, pictures from the International Affective Picture System are used in a control experiment involving fifty participants. The collected signals are processed, features are extracted and a statistical analysis is performed on the calm/distress condition classification. The results show that the wearable device solely based on EDA signal processing reports around 89% accuracy when distinguishing calm condition from distress condition.
•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.
The role of different DC subsets in priming and maintenance of immunity against Leishmania major (L. major) infection is debated. The transcription factor basic leucine zipper transcription factor, ...ATF‐like 3 (Batf3) is essential for the development of mouse CD103+ DCs and some functions of CD8α+ DCs. We found that CD103+ DCs were significantly reduced in the dermis of Batf3‐deficient C57BL/6 mice. Batf3−/− mice developed exacerbated and unresolved cutaneous pathology following a low dose of intradermal L. major infection in the ear pinnae. Parasite load was increased 1000‐fold locally and expanded systemically. Batf3 deficiency did not affect L. major antigen presentation to T cells, which was directly exerted by CD8α− conventional DCs (cDCs) in the skin draining LN. However, CD4+ T‐cell differentiation in the LN and skin was skewed to nonprotective Treg‐ and Th2‐cell subtypes. CD103+ DCs are major IL‐12 producers during L. major infection. Local Th1 immunity was severely hindered, correlating with impaired IL‐12 production and reduction in CD103+ DC numbers. Adoptive transfer of WT but not IL‐12p40−/− Batf3‐dependent DCs significantly improved anti‐L. major response in infected Batf3−/− mice. Our results suggest that IL‐12 production by Batf3‐dependent CD103+ DCs is crucial for maintenance of local Th1 immunity against L. major infection.
In this paper, a three-dimensional cancer model was considered using the Caputo-Fabrizio-Caputo and the new fractional derivative with Mittag-Leffler kernel in Liouville-Caputo sense. Special ...solutions using an iterative scheme via Laplace transform, Sumudu-Picard integration method and Adams-Moulton rule were obtained. We studied the uniqueness and existence of the solutions. Novel chaotic attractors with total order less than three are obtained.
We report the nationwide experience with solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients diagnosed with coronavirus disease 2019 (COVID‐19) in Spain until 13 ...July 2020. We compiled information for 778 (423 kidney, 113 HSCT, 110 liver, 69 heart, 54 lung, 8 pancreas, 1 multivisceral) recipients. Median age at diagnosis was 61 years (interquartile range IQR: 52‐70), and 66% were male. The incidence of COVID‐19 in SOT recipients was two‐fold higher compared to the Spanish general population. The median interval from transplantation was 59 months (IQR: 18‐131). Infection was hospital‐acquired in 13% of cases. No donor‐derived COVID‐19 was suspected. Most patients (89%) were admitted to the hospital. Therapies included hydroxychloroquine (84%), azithromycin (53%), protease inhibitors (37%), and interferon‐β (5%), whereas immunomodulation was based on corticosteroids (41%) and tocilizumab (21%). Adjustment of immunosuppression was performed in 85% of patients. At the time of analysis, complete follow‐up was available from 652 patients. Acute respiratory distress syndrome occurred in 35% of patients. Ultimately, 174 (27%) patients died. In univariate analysis, risk factors for death were lung transplantation (odds ratio OR: 2.5; 95% CI: 1.4‐4.6), age >60 years (OR: 3.7; 95% CI: 2.5‐5.5), and hospital‐acquired COVID‐19 (OR: 3.0; 95% CI: 1.9‐4.9).
The authors report the Spanish nationwide experience with solid organ and hematopoietic stem cell transplant recipients diagnosed with COVID‐19, revealing a higher incidence and more aggressive course of infection than in the general population.
Composting involves the selection of a microbiota capable of resisting the high temperatures generated during the process and degrading the lignocellulose. A deep understanding of the thermophilic ...microbial community involved in such biotransformation is valuable to improve composting efficiency and to provide thermostable biomass-degrading enzymes for biorefinery. This study investigated the lignocellulose-degrading thermophilic microbial culturome at all the stages of plant waste composting, focusing on the dynamics, enzymes, and thermotolerance of each member of such a community. The results revealed that 58% of holocellulose (cellulose plus hemicellulose) and 7% of lignin were degraded at the end of composting. The whole fungal thermophilic population exhibited lignocellulose-degrading activity, whereas roughly 8–10% of thermophilic bacteria had this trait, although exclusively for hemicellulose degradation (xylan-degrading). Because of the prevalence of both groups, their enzymatic activity, and the wide spectrum of thermotolerance, they play a key role in the breakdown of hemicellulose during the entire process, whereas the degradation of cellulose and lignin is restricted to the activity of a few thermophilic fungi that persists at the end of the process. The xylanolytic bacterial isolates (159 strains) included mostly members of Firmicutes (96%) as well as a few representatives of Actinobacteria (2%) and Proteobacteria (2%). The most prevalent species were
Bacillus licheniformis
and
Aeribacillus pallidus
. Thermophilic fungi (27 strains) comprised only four species, namely
Thermomyces lanuginosus
,
Talaromyces thermophilus
,
Aspergillus fumigatus
, and
Gibellulopsis nigrescens
, of whom
A. fumigatus
and
T. lanuginosus
dominated. Several strains of the same species evolved distinctly at the stages of composting showing phenotypes with different thermotolerance and new enzyme expression, even not previously described for the species, as a response to the changing composting environment. Strains of
Bacillus thermoamylovorans
,
Geobacillus thermodenitrificans
,
T. lanuginosus
, and
A. fumigatus
exhibiting considerable enzyme activities were selected as potential candidates for the production of thermozymes. This study lays a foundation to further investigate the mechanisms of adaptation and acquisition of new traits among thermophilic lignocellulolytic microorganisms during composting as well as their potential utility in biotechnological processing.
Introduction
The VELOUR study evaluated the efficacy and safety of adding aflibercept to FOLFIRI (fluorouracil, leucovorin, irinotecan) in second‐line therapy for metastatic colorectal cancer (mCRC). ...However, a nomogram that can stratify patients according to prognosis is unavailable, and the frequency and effect of the pragmatic use of modified schedules in actual practice remains unknown.
Method
The sample consists of 250 patients with mCRC treated with aflibercept and irinotecan‐based chemotherapy at nine Spanish academic centers between January 2013 and September 2015. The result of a Cox proportional hazards model regression for overall survival (OS), adjusted for covariates available in daily practice, was represented as a nomogram and web‐based calculator. Harrell's c‐index was used to assess discrimination.
Results
The prognostic nomogram for OS includes six variables: Eastern Cooperative Oncology Group performance status, tumor location, number of metastatic sites, mutational status, better response to previous treatment(s), and carcinoembryonic antigen. The model is well calibrated and has acceptable discriminatory capacity (optimism‐corrected c‐index, 0.723; 95% confidence interval CI, 0.666–0.778). Median OS was 6.1 months (95% CI, 5.1–8.8), 12.4 months (95% CI, 9.36–14.8), and 22.9 months (95% CI, 16.6–not reached) for high‐, intermediate‐, and low‐risk groups, respectively. Age, comorbidity, or use of modified FOLFIRI regimens did not affect prognosis in this series. Grade 3–4 adverse events were less common following modified schedules. The admission rate because of toxicity was higher in ≥65 years (9.7% vs. 19.6%; odds ratio, 2.26; p = .029).
Conclusion
We have developed and internally validated a prognostic model for use in individuals with colorectal cancer initiating therapy with FOLFIRI‐aflibercept to predict both OS and the effect of pragmatic modifications of the classic regime on efficacy and safety. This can aid in decision making and in designing future trials.
Implications for Practice
In this study, the authors developed and conducted the internal validation of a prognostic nomogram that makes it possible to stratify patients who are eligible for second‐line FOLFIRI‐aflibercept based on their probability of survival. This model was developed in a multicenter sample from nine Spanish hospitals. Furthermore, to increase the study's validity, the practical use of aflibercept in this setting was investigated, including doses or pragmatic modifications. The results suggest that the modified schedules often used in this daily clinical practice‐based patient population are associated with less severe toxicity without apparent detriment to survival endpoints. It is believed that these data complement the information provided by the VELOUR trial and are relevant for the oncologist in treating colon cancer in the second‐line setting.
摘要
介绍。VELOUR 研究对二线治疗中采用 FOLFIRI(氟尿嘧啶、甲酰四氢叶酸、伊立替康)联合阿帕西普治疗转移性结直肠癌 (mCRC) 的疗效和安全性进行了评估。然而，无法用列线图表示根据预后情况对患者进行的分层，且在临床实践中实际使用改良给药方案的频率和效果尚不可知。
方法。样本包括 2013 年 1 月至 2015 年 9 月期间，在西班牙 9 家学术中心接受阿帕西普和基于伊立替康化疗的 250 名mCRC患者。利用 Cox 比例风险回归模型得出的总生存期 (OS) 结果(根据临床实践中可用的协变量进行校正)可用列线图和基于网络的计算器表示。同时，利用 Harrell 的 C 指数来评估区分度。
结果。关于OS的预后列线图中包含六个变量:美国东部肿瘤协作组的体力状态、肿瘤位置、转移部位的数量、突变状态、对先前治疗的较好反应率及癌胚抗原。模型经过准确校准，具有合格的鉴别能力 乐观校正 C 指数为 0.723；95% 置信区间(CI)，0.666–0.778。高风险、中度风险及低风险组的中位OS分别为 6.1 个月(95% CI，5.1–8.8)、12.4 个月(95% CI，9.36–14.8)及 22.9 个月(95% CI，16.6–未达到)。年龄、合并症或使用改良的 FOLFIRI 方案对本组预后无影响。在使用经改良的给药方案后，3‐4 级不良事件较为罕见。在 65 岁(含)以上的患者中，因毒性反应而入院的比率更高(9.7% vs. 19.6%；比值比，2.26；p = 0.029)。
结论。我们开发了一个预后模型并进行了内部验证，此模型可针对启用 FOLFIRI 联合阿帕西普治疗的结直肠癌患者预测其OS及实际改良传统治疗方案对药物疗效和安全性的影响。这有助于制定医疗决策和设计未来的试验。《肿瘤学家》
实践意义:在本研究中，作者编制了一份预后列线图并进行了内部验证，以便能够基于生存概率对符合 FOLFIRI 联合阿帕西普二线治疗的患者进行分层。此模型由 9 家西班牙医院利用多中心样本进行开发。此外，为提高本研究的有效性，我们研究了在此种情况下使用阿帕西普的实际情况，包括剂量或务实性改良。结果表明，经改良的给药方案常用于基于日常临床实践的患者群体中，与较少的严重毒性反应相关，但不会明显损害生存终点。我们认为，这些数据补充了 VELOUR 试验所提供的信息，有助于肿瘤学家研究结肠癌的二线治疗。
This article reports on a prognostic model for use in patients with colorectal cancer initiating therapy with FOLFIRI/aflibercept to predict overall survival and aid in decision making, with the goal of optimizing treatment results in actual patient populations.
Water scarcity in arid and semiarid regions poses problems for agricultural systems, awakening special interest in the development of deficit irrigation strategies to improve water conservation. ...Toward this purpose, farmers and technicians must monitor soil water and soluble nutrient contents in real time using simple, rapid and economical techniques through time and space. Thus, this study aimed to achieve the following: (i) create a model that predicts water and soluble nutrient contents in soil profiles using electrical resistivity tomography (ERT); and (ii) apply the model to different woody crops under different irrigation regimes (full irrigation and regulated deficit irrigation (RDI)) to assess the efficiency of the model. Simple nonlinear regression analysis was carried out on water content and on different ion contents using electrical resistivity data as the dependent variable. A predictive model for soil water content was calibrated and validated with the datasets based on exponential decay of a three-parameter equation. Nonetheless, no accurate model was achieved to predict any soluble nutrient. Electrical resistivity images were replaced by soil water images after application of the predictive model for all studied crops. They showed that under RDI situations, soil profiles became drier at depth while plant roots seemed to uptake more water, contributing to reductions in soil water content by the creation of desiccation bulbs. Therefore, the use of ERT combined with application of the validated predictive model could be a sustainable strategy to monitor soil water evolution in soil profiles under irrigated fields, facilitating land irrigation management.
Since their discovery, toxin-antitoxin (TA) systems have captivated the attention of many scientists. Recent studies have demonstrated that TA systems play a key role in phage inhibition. The aim of ...the present study was to investigate the role of the PemIK (PemK/PemI) type II TA system in phage inhibition by its intrinsic expression in clinical strains of Klebsiella pneumoniae carrying the lncL plasmid, which harbours the carbapenemase OXA-48 and the PemK/PemI TA system. Furthermore, induced expression of the system in an IPTG-inducible plasmid in a reference strain of K. pneumoniae ATCC10031 was also studied. The results showed that induced expression of the whole TA system did not inhibit phage infection, whereas overexpression of the pemK toxin prevented early infection. To investigate the molecular mechanism involved in the PemK toxin-mediated inhibition of phage infection, assays measuring metabolic activity and viability were performed, revealing that overexpression of the PemK toxin led to dormancy of the bacteria. Thus, we demonstrate that the PemK/PemI TA system plays a role in phage infection and that the action of the free toxin induces a dormant state in the cells, resulting in inhibition of phage infections.
The prevalence of stress, anxiety, and depression is a topic of concern for general population but also for the educational context. Consequently, due to the great rates of anxiety, depression, and ...stress problems in undergraduates, the use of a standardized instrument to accurately detect these constructs in the university context is needed. As a result, the present study pretends to examine the psychometric characteristics of the online version of the short Depression, Anxiety, and Stress Scales (DASS-21) in Ecuadorian university sample, including the validation, and the testing of factorial invariance and latent differences analyses based on sex. The total of individuals that formed the sample were 3,060 students (Mage = 22.7, SD = 2.46) from the Central University of Ecuador, and they participated via the internet, fulfilling the 21 items that formed the DASS-21. Regarding the results, the three-factor structure of the online version of the DASS-21 was confirmed by confirmatory factor analysis, adequate internal consistency values and factorial invariance based on sex were confirmed, and no statistically significant latent mean differences in the scale across sex were found. In consequence, the results of the current investigation give a reliable, consistent, and online measure of stress, anxiety, and depression, which could help to assess and treat emotional problems originated among the Ecuadorian university population.
Public Significance Statement
The present study validated a Spanish and online version of the Depression, Anxiety, and Stress Scales (DASS-21) among Ecuadorian university students. The prevalence of depression, anxiety, and stress symptoms in the educational context is high. Consequently, the present study has confirmed the factorial invariance and the nonexistence of statistically significant differences in the latent scores across sex. These findings allow the possibility of measuring the scores of depression, anxiety, and stress without bias in a new reality provoked by the coronavirus disease 2019 (COVID-19) in which paper questionnaires could be replaced by online questionnaires.
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