Objectives
To define a set of indicators that could be used to improve quality in intensive care medicine.
Methodology
An European Society of Intensive Care Medicine Task Force on Quality and Safety ...identified all commonly used key quality indicators. This international Task Force consisted of 18 experts, all with a self-proclaimed interest in the area. Through a modified Delphi process seeking greater than 90% consensual agreement from this nominal group, the indicators were then refined through a series of iterative processes.
Results
A total of 111 indicators of quality were initially found, and these were consolidated into 102 separate items. After five discrete rounds of debate, these indicators were reduced to a subset of nine that all had greater than 90% agreement from the nominal group. These indicators can be used to describe the structures (3), processes (2) and outcomes (4) of intensive care. Across this international group, it was much more difficult to obtain consensual agreement on the indicators describing processes of care than on the structures and outcomes.
Conclusion
This document contains nine indicators, all of which have a high level of consensual agreement from an international Task Force, which could be used to improve quality in routine intensive care practice.
Energy is a vital input for social and economic development. As a result of the generalization of agricultural, industrial and domestic activities the demand for energy has increased remarkably, ...especially in emergent countries. This has meant rapid grower in the level of greenhouse gas emissions and the increase in fuel prices, which are the main driving forces behind efforts to utilize renewable energy sources more effectively, i.e. energy which comes from natural resources and is also naturally replenished. Despite the obvious advantages of renewable energy, it presents important drawbacks, such as the discontinuity of generation, as most renewable energy resources depend on the climate, which is why their use requires complex design, planning and control optimization methods. Fortunately, the continuous advances in computer hardware and software are allowing researchers to deal with these optimization problems using computational resources, as can be seen in the large number of optimization methods that have been applied to the renewable and sustainable energy field. This paper presents a review of the current state of the art in computational optimization methods applied to renewable and sustainable energy, offering a clear vision of the latest research advances in this field.
The main functions of spermatozoa required for fertilization are dependent on the energy status and metabolism. AMP-activated kinase, AMPK, acts a sensor and regulator of cell metabolism. As AMPK ...studies have been focused on somatic cells, our aim was to investigate the expression of AMPK protein in spermatozoa and its possible role in regulating motility. Spermatozoa from boar ejaculates were isolated and incubated under different conditions (38,5°C or 17°C, basal medium TBM or medium with Ca(2+) and bicarbonate TCM, time from 1-24 hours) in presence or absence of AMPK inhibitor, compound C (CC, 30 µM). Western blotting reveals that AMPK is expressed in boar spermatozoa at relatively higher levels than in somatic cells. AMPK phosphorylation (activation) in spermatozoa is temperature-dependent, as it is undetectable at semen preservation temperature (17°C) and increases at 38,5°C in a time-dependent manner. AMPK phosphorylation is independent of the presence of Ca(2+) and/or bicarbonate in the medium. We confirm that CC effectively blocks AMPK phosphorylation in boar spermatozoa. Analysis of spermatozoa motility by CASA shows that CC treatment either in TBM or in TCM causes a significant reduction of any spermatozoa motility parameter in a time-dependent manner. Thus, AMPK inhibition significantly decreases the percentages of motile and rapid spermatozoa, significantly reduces spermatozoa velocities VAP, VCL and affects other motility parameters and coefficients. CC treatment does not cause additional side effects in spermatozoa that might lead to a lower viability even at 24 h incubation. Our results show that AMPK is expressed in spermatozoa at high levels and is phosphorylated under physiological conditions. Moreover, our study suggests that AMPK regulates a relevant function of spermatozoa, motility, which is essential for their ultimate role of fertilization.
This paper reviews the scientific production of renewable energies, namely, solar, wind, biomass, hydropower and geothermal, from 1979 to 2009. The production of all the countries in the world is ...analysed, paying particular attention to renewable energies and research institutions. The production of scientific research for each type of energy is represented on world maps to show the degree of relationship between this research and the resources of these energies. It is observed that biomass is the most studied, both by number of publications, with 56% of the publications on renewable energy, and by geographical distribution. The next in importance by number of publications is solar energy (26%). The countries investigating solar energy, however, are not necessarily those with the greatest availability of this resource. Wind is the third positioned in publication (11%). Wind is being investigated by countries that most have implemented this type of energy production. Hydro and geothermal energies are also investigated by countries with great abundance of this resource. It is observed that research on renewable energy is highly concentrated in a few countries (12 or 14, depending on the energy type), accounting for between 70 and 80% of scientific production. The role of the USA as a leader in research in all renewable energies studies is emphasised. NASA is the leading institution for solar and wind energy, the Chinese Academy of Sciences leads in hydropower and biomass, and the U.S. Geological Survey leads in geothermal energy.
Artificial insemination with cryopreserved spermatozoa is a major assisted reproductive technology in many species. In horses, as in humans, insemination with cryopreserved sperm is associated with ...lower pregnancy rates than those for fresh sperm, however, direct effects of sperm cryopreservation on the development of resulting embryos are largely unexplored. The aim of this study was to investigate differences in gene expression between embryos resulting from fertilization with fresh or cryopreserved sperm. Embryos were obtained at 8, 10 or 12 days after ovulation from mares inseminated post-ovulation on successive cycles with either fresh sperm or frozen-thawed sperm from the same stallion, providing matched embryo pairs at each day. RNA was isolated from two matched pairs (4 embryos) for each day, and cDNA libraries were built and sequenced. Significant differences in transcripts per kilobase million (TPM) were determined using (i) genes for which the expression difference between treatments was higher than 99% of that in the random case (P < 0.01), and (ii) genes for which the fold change was ≥ 2, to avoid expression bias in selection of the candidate genes. Molecular pathways were explored using the DAVID webserver, followed by network analyses using STRING, with a threshold of 0.700 for positive interactions. The transcriptional profile of embryos obtained with frozen-thawed sperm differed significantly from that for embryos derived from fresh sperm on all days, showing significant down-regulation of genes involved in biological pathways related to oxidative phosphorylation, DNA binding, DNA replication, and immune response. Many genes with reduced expression were orthologs of genes known to be embryonic lethal in mice. This study, for the first time, provides evidence of altered transcription in embryos resulting from fertilization with cryopreserved spermatozoa in any species. As sperm cryopreservation is commonly used in many species, including human, the effect of this intervention on expression of developmentally important genes in resulting embryos warrants attention.
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•Synthesis and characterization of PPy-NTs decorated with gold nanoparticles.•Study of the influence of gold nanoparticles on stability.•Development of a flexible solid-state ...supercapacitor based on PPy-NTs and AuNPs.
Flexible solid-state supercapacitors (FSSCs) have becoming of great interest due to the increasing energy demand of the modern world. Many studies are focusing on the development of different materials for supercapacitor electrodes, however, the combination of high specific capacitance, high stability and low cost in a single material is still a challenge. Herein, we report the fabrication of a FSSC based on a hybrid material of polypyrrole nanotubes (PPy-NTs) and gold nanoparticles (AuNPs). The materials were characterized by scanning and transmission electron microscopies and energy dispersive X-ray spectroscopy and they were also electrochemically characterized in aqueous 1 mol L−1 H2SO4 solution. The FSSC was assembled using a poly(vinyl alcohol) and sodium alginate gel electrolyte and the results showed a high specific capacitance, high stability over 2000 galvanostatic charge/discharge cycles (88%) and good electrochemical performance under bending. The results indicate the great potential to use PPy-NTs/AuNPs hybrid material in flexible all-solid-state symmetric devices.
Previous evidence synthesis has suggested diabetes mellitus (DM) worsens tuberculosis (TB) treatment outcomes. However, these reviews are limited by the number, robustness and conflicting results ...among the studies included. We conducted a systematic review to update earlier analyses and explore heterogeneity among studies.
MEDLINE, EMBASE, AIM, LILACS, IMEMR, IMSEAR and WPRIM were searched between 1 January 1980 and 23 July 2018 unrestricted by language or region. All cohort and case-control studies investigating the difference in TB treatment outcomes amongst TB-DM patients compared to those with TB alone were included. Two reviewers independently assessed titles, abstracts, and extracted data. Culture conversion at two/three months, all-cause mortality, treatment failure, relapse and multidrug-resistant TB (MDR-TB) were evaluated using random effects meta-analysis with generic inverse variance. Heterogeneity was explored using subgroup analyses and meta-regression.
One hundred and four publications were identified. Sixty-four studies including 56 122 individuals with TB-DM and 243 035 with TB, reported on death. Some outcomes showed substantial heterogeneity between studies, which we could not fully explain, though confounding adjustment and country income level accounted for some of the differences. TB-DM patients had higher odds of death (OR 1.88, 95%CI 1.59-2.21) and relapse (OR 1.64, 95%CI 1.29-2.08) compared to TB patients. More limited evidence suggested TB-DM patients had double the risk of developing MDR-TB (OR 1.98, 95%CI 1.51-2.60).
DM is associated with increased risks of poor TB treatment outcomes, particularly mortality, and may increase risk of developing primary MDR-TB. Cost-effectiveness of interventions to enhance TB-DM treatment should be assessed.
With the discovery of local Ca2+ signals in the 1990s the concept of ‘elementary Ca2+ signals’ and ‘fundamental Ca2+ signals’ was developed. While ‘elementary Ca2+signals’ relate to optical signals ...gained by activity of small clusters of Ca2+channels, ‘fundamental signals’ describe such optical signals that arise from opening of single Ca2+channels.
In this review, we discuss (i) concepts of local Ca2+ signals and Ca2+ microdomains, (ii) molecular mechanisms underlying Ca2+ microdomains, (iii) functions of Ca2+ microdomains, and (iv) mathematical modelling of Ca2+ microdomains. We focus on Ca2+ microdomains produced by ORAI channels, D-myo-inositol 1,4,5-trisphosphate receptors, or ryanodine receptors.
In summary, research on local Ca2+ signals in different cell models aims to better understand how cells use the Ca2+ toolkit to produce Ca2+ microdomains as relevant signals for specific cellular responses, but also how local Ca2+ signals as building blocks merge into global Ca2+ signaling.
Background
Pancreatic mucinous cystic neoplasms (MCNs) are rare mucin‐producing cystic tumours defined by the presence of ovarian‐type stroma. MCNs have a malignant potential and thus surgery is ...frequently performed. The aim of this cohort study was to define better the criteria for surgical resection in patients with MCN.
Methods
This multicentre retrospective study included all resected MCNs between 2003 and 2015 in participating centres. Lesions without ovarian‐type stroma were excluded. Patient characteristics, preoperative findings, histopathology findings and follow‐up data were recorded.
Results
The study included 211 patients; their median age was 53 (range 18–82) years, and 202 (95·7 per cent) were women. Median preoperative tumour size was 55 (range 12–230) mm. Thirty‐four of the 211 (16·1 per cent) were malignant, and high‐grade dysplasia (HGD) was found in a further 13 (6·2 per cent). One‐third of MCNs in men were associated with invasive cancer, compared with 15·3 per cent in women. Five cases of malignant transformation occurred in MCNs smaller than 4 cm. All cases of malignancy or HGD were associated with symptoms or features of concern on preoperative cross‐sectional imaging. In multivariable analysis, raised carbohydrate antigen 19‐9 (odds ratio (OR) 10·54, 95 per cent c.i. 2·85 to 218·23; P < 0·001), tumour size (OR 4·23, 3·02 to 11·03; P = 0·001), mural nodules (OR 3·55, 1·31 to 20·55; P = 0·002) and weight loss (OR 3·40, 2·34 to 12·34; P = 0·034) were independent factors predictive of malignant transformation.
Conclusions
Small indeterminate MCNs with no symptoms or features of concern may safely be observed as they have a low risk of malignant transformation.
Low risk in small, asymptomatic mucinous cystic neoplasms
In summary, our study emphasizes that CCP should not be transfused late in the course of disease, when the clinical course is driven by inflammation. Google Scholar Casadevall A, Scharff MD. Serum ...therapy revisited: animal models of infection and development of passive antibody therapy. Development and validation of a treatment benefit index to identify hospitalized patients with COVID-19 who may benefit from convalescent plasma.
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