Cross-linked quaternised Poly(2,6-dimethyl-1,4-Phenylene Oxide) (QPPO)-based membranes were prepared via Friedel-Crafts reactions using SnCl4 catalyst, 1,3,5-trioxane and chlorotrimethylsilane as ...environmentally-friendly chloromethylating reagents. New equations to calculate the degree of chloromethylation (DC) and cross-linking degree (CLD) were proposed. Ionic conductivity of 133 mS cm−1 at 80 °C was obtained, one of the highest reported for QPPO based membranes. We have compared QPPO to chloromethylated polystyrene-b-poly(ethylene/butylene)-b-polystyrene (SEBS) ionomer and report on the importance of ionomer-membrane interaction as well as the trade-off between swelling ratio and conductivity on performance and mechanical stability of AEM water electrolyser. Exsitu stability testing after 500 h in 1 M KOH showed membranes retained up to 94% of their original IEC. QPPO was employed as both membranes and ionomers in electrolyser tests. QPPO membranes exhibited area specific resistance of 104 mΩ cm−2 and electrolyser current density of 814 mA cm−2 at 2.0 V in 0.1 M NaOH solution at 40 °C.
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•New equations to calculate the degree of chloromethylation (DC) and cross-linking degree (CLD).•Synthesis and fabrication of self-crosslinking PPO based AEM with ionic conductivity >0.13 S cm−1.•Electrolyser current density of 814 mA cm−2 at 2.0 V at 40 °C.•Area specific resistance of 104 mΩ cm−2 in 0.1 M NaOH solution at 40 °C.
Consumer wearable devices may be a helpful method of assessing sleep, but validation is required for their use in clinical practice. Our aim was to validate two models of Fitbit sleep trackers that ...rely on both accelerometer and heart rate sensors against polysomnography in participants with obstructive sleep apnea (OSA).
Participants were adults presenting with symptoms of OSA and attending our outpatient sleep clinic. A polysomnography (PSG) was applied to all participants at the same time they were wearing a Fitbit sleep tracker. Using paired t tests and Bland-Altman plots, we compared the sleep measures provided by the wearable devices with those obtained by PSG. Since Fitbit devices' automatic detection of sleep start time can cause bias, we performed a correction using Huber loss function-based linear regression and a leave-one-out strategy.
Our sample consisted of 65 patients. Diagnosis of OSA was confirmed on 55 (84.6%). There were statistically significant differences between PSG and Fitbit measures for all sleep outcomes but rapid eye movement sleep. Fitbit devices overestimated total sleep time, and underestimated wake after sleep onset and sleep onset latency. After correction of bias, Fitbit-delivered measures of sleep onset latency did not significantly differ of those provided by PSG.
Fitbit wearable devices showed an acceptable sensitivity but poor specificity. Consumer sleep trackers still have insufficient accuracy for clinical settings, especially in clinical populations. Solving technical issues and optimizing clinically-oriented features could make them apt for their use in clinical practice in a nondistant future.
Sleep disturbances and suicidal behaviour are highly prevalent phenomena, representing with a significant burden to society. Sleep has been acknowledged as a potential biomarker for suicidal ...behaviour. Over the past decade several studies have explored the association between sleep problems and suicidal behaviour. This area has attracted a growing research interest, hence updated information is needed. We therefore present a wide-scope review of the literature summarizing the most relevant studies on epidemiological and theoretical issues underlying this association. Implications of these findings for clinical practice and future research are discussed.
We performed a systematic search of PubMed and Embase databases up to October 2018 to identify studies exploring the association between sleep and suicide. Sixty-five articles met the selection criteria, thus they were included in the review.
There was a significant and independent association between sleep disturbances and suicide risk. Psychiatric disorders, sleep deprivation-induced neurocognitive deficits, emotional dysregulation, alterations in circadian rhythms, and negative feelings, among other factors, contributed to this relationship. Sleep loss may lead to higher levels of impulsivity, thus increasing unplanned suicidal behaviour. Sleep disturbances may therefore predict suicidal behaviour, hence becoming a potential therapeutic target.
Angioectasias represents the most frequently found lesion in the small bowel by device-assisted enteroscopy for obscure gastrointestinal bleeding in Western countries. Recurrence of gastrointestinal ...bleeding after angioectasias therapy remains unclear and data regarding the efficacy of additional endoscopic therapeutic sessions to reduce the rebleeding rate is limited.
To evaluate the rebleeding rate in small bowel angioectasias after a second endoscopic treatment with balloon-assisted enteroscopy after an initial bleed during the first endoscopic treatment.
A retrospective double-center study of patients with small-bowel angioectasias undergoing a second enteroscopy treatment due to a first rebleeding episode. The endpoint was rebleeding, defined as the need for a blood transfusion, the presence of overt bleeding or a decrease in hemoglobin ≥ 2 g/dL.
Fifteen of 37 (40.5%) patients with small-bowel angioectasias that underwent a second endoscopic therapy after a first rebleeding episode (n = 15) experienced a second rebleeding episode. Kaplan-Meier curve analysis showed that most rebleeding episodes occurred within the first 12 months of follow-up, resulting in a rebleeding rate of 33.1% at 6 months, 39.1% at 12 months and 52.6% at 24 months.
Despite the high absolute short-term rebleeding rate, further endoscopic treatments may be beneficial due to the effective reduction of rebleeding in a subset of patients.
Sodium oxybate (SXB) was administered for the first time in 1979 in 16 patients with narcolepsy with cataplexy (NT1) that improved up to 20 months.
To evaluate the effect of SXB on daytime sleepiness ...and sleep architecture by video-polysomnography in a sample of 23 NT1 adult patients (13 men, 10 females) treated up to three years. Additional goal was to study the presence of sleep comorbidities.
NT1 patients were diagnosed according to International Classification of Sleep Disorders, third edition. We conducted a longitudinal observational study and a video-polysomnography comparing the sleep parameters of patients treated with an initial nocturnal dose of 4.5 g of SXB after six months (FU-1), one year (FU-2) and three years (FU-3) of uninterrupted treatment. Video-polysomnography parameters were analyzed including apnea-hypopnea and periodic leg movements indexes.
Patients were HLA-DQB1*06:02 positive except a familial case. Thirteen patients (56%) discontinued SXB treatment over the three-year of the study. The two-nightly doses has been one of the reason for discontinuing treatment as well as insufficient compliance, mild or severe side effects, comorbidities and pregnancy. We found significant differences at FU-2 in sleep structure with an increased in stage N2 (p < 0.03) and a higher periodic leg movements index (p < 0.01). At FU-3 we found significant differences in sleep structure with an increase in stage N1 (p = 0.03) and in comorbidities (periodic leg movements and apnea-hypopnea indexes). There was not significant change on daytime sleepiness during the study.
SXB was administered in low-medium doses. Two-nightly doses and sleep fragmentation linked to sleep comorbidities at long-term lead to drug withdrawal.
The objective of this article is to summarize the evolution of the regional commitments of the Pan American Health Organization (PAHO) on health promotion and strategies to improve the health and ...well-being of women, children, adolescents, and older persons. PAHO regional strategies approved by Member States in the last 20 years are used as the main source of information. The article presents the challenges of making health promotion a public health strategy widely applied in the Region of the Americas and the efforts to renew Member States' collective actions. The article also describes current PAHO efforts to include the positive aspects of health (i.e., well-being, optimal development, and functional ability) and the life course approach as opportunities to advance equity. The article reflects on immunization as a public good and the urgency to address the current challenges as a core element of the regional efforts to transform health systems after more than two years of the COVID-19 pandemic.
Double balloon enteroscopy(DBE) is an endoscopic technique broadly used to diagnose and treat small bowel diseases. Among the associated complications of the oral DBE, post-procedure pancreatitis has ...taken the most attention due to its gravity and the thought that it might be associated to the technique itself and anatomical features of the pancreas. However, as the etiology has not been clarified yet, this paper aims to review the published literature and adds new results from a porcine animal model. Biochemical markers, histological sections and the vascular perfusion of the pancreas were monitored in the pig during DBE practice. A reduced perfusion of the pancreas and bowel, the presence of defined hypoxic areas and disseminated necrotic zones were found in the pancreatic tissue of pigs. All these evidences contribute to support a vascular distress as the most likely etiology of the post-DBE pancreatitis.
In modern democratic states, citizen participation is promoted through representative channels. In recent years, at the different institutional and political levels in Spain, some classic parameters ...of democracy have been called into question, such as citizen representation, deliberation, and the responsibility of the rulers towards the citizens. This crisis coincides with a decline in bipartisanship in Spain and the appearance of new parties. Some of this parties championed the regeneration of democracy, committing themselves to encouraging transparency and citizen participation in public management. As local entities are the institutions closest to citizens, both transparency and participation become key elements to comply with these parameters, providing the technologies of information and communication (ICT) with new tools such as websites and portals, which can contribute to strengthening them. This research aims to analyze the use of these channels to promote transparency and citizen participation, by the municipalities of 4 autonomous communities (Catalonia, the Community of Madrid, the Valencian Community, and the Region of Murcia), placing special emphasis on how the left-right axes and old-new parties could influence, along with the population size of the municipalities. The method used consists of a categorical content analysis, based on the Infoparticipa Map indicators and two linear regression models using ordinary least squares. The results and conclusions of the study show that the size of the population and the autonomous community are determining factors in the transparency indices. In addition, the political formations aligned to the left of the ideological spectrum, together with some of the new parties, influence the greater transparency and participation of the websites of the municipalities governed by them.
Esta investigação mede a eficácia das relações com os média em campanhas sobre segurança rodoviária e drogas. Espanha consta entre os países europeus com maior sinistralidade rodoviária por consumo ...de drogas (Instituto Nacional de Toxicología y Ciencias Forenses, 2017) e, em consequência, diversas organizações realizam campanhas de prevenção. Xifra (2011) vincula este tipo de campanhas sociais às relações públicas, já que as relações com os média (Wilcox, Cameron & Xifra, 2012) são fundamentais para o seu efeito, na medida em que amplificam as mensagens (Castillo, 2009) e influenciam a agenda pública (McCombs & Shaw, 1972). Os estudos anteriores sobre este assunto não se debruçaram sobre as campanhas de televisão e de rádio que abordam a toxicodependência e a segurança rodoviária, justificando-se, assim, este trabalho. Para realizar esta investigação utilizou-se uma metodologia de carácter qualitativo e quantitativo que combinou as entrevistas semiestruturadas com líderes de organizações responsáveis pela criação de campanhas de segurança rodoviária (Direção Geral de Tráfego, Fundação de Ajuda contra a Dependência de Drogas e Fundação Mapfre) com o método de medição da exposição à mensagem (Castillo & Álvarez, 2015), o qual inclui a análise da cobertura, do impacto económico e do conteúdo de 10 campanhas veiculadas entre 2011 e 2015. Os resultados mostraram que as campanhas tiveram como objetivos o conhecimento, a consciencialização e a educação, mediante a aposta em estratégias combinadas. Para tal, utilizaram meios de comunicação de massa, em particular a televisão. A educação, a dissuasão e a saúde predominaram nos enquadramentos das campanhas, que privilegiaram a cannabis e o álcool como substâncias perigosas. No que respeita à cobertura mediática destes anúncios, registaram-se 375 informações difundidas em quatro meses. Da análise do seu conteúdo, pode destacar-se o predomínio de mensagens informativas (93%), a sua veiculação em noticiários (56,2% na televisão e 50,6% na rádio) e a atualidade em matéria de acontecimentos. A substância mais tratada é o álcool (90%). Apesar das entrevistas evidenciarem a utilização de meios de massa, em particular a televisão, a baixa cobertura e a escassa continuidade não faz com que o tema esteja presente na agenda mediática ou pública. Além disso, o enquadramento e a tematização que se geraram não foram ao encontro dos objetivos desejados pelas organizações que criaram as campanhas.
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