Cette revue intégrative de la littérature avait pour but de cerner les possibilités de recherche en sciences infirmières concernant la gestion des symptômes aigus du cancer des patients externes dans ...les centres de soins d’urgence en cancérologie. Les patients aux prises avec des symptômes aigus du cancer (ex. fièvre, troubles gastro-intestinaux ou douleur non soulagée) venant d’un milieu de soins externes sollicitent principalement sur les services des urgences pour se faire évaluer et traiter. Cependant, ce modèle de soins n’est plus viable et fait ressortir les inefficacités du système de soins de santé. Les centres de soins d’urgence en cancérologie permettent aux patients qui présentent ces symptômes d’être traités par des spécialistes en oncologie au sein de centres de cancérologie pour patients externes. Malheureusement, les rares travaux de recherche sur les centres de soins d’urgence en cancérologie, tant sur le plan opérationnel qu’expérimental, rendent difficile l’adoption de ce nouveau modèle de soins par d’autres. Voici les questions centrales qui ont guidé cette revue intégrative : 1) Quel est l’état de la science concernant les centres de soins d’urgence en cancérologie, et quelles sont les différences si on les compare aux services d’urgences en matière de traitement prodigué aux patients externes présentant des symptômes aigus du cancer? 2) Où sont les centres de soins d’urgences en cancérologie dans le monde, et que sait-on de leurs activités cliniques et modèles de dotation?
Aqueous rechargeable zinc–manganese dioxide batteries show great promise for large‐scale energy storage due to their use of environmentally friendly, abundant, and rechargeable Zn metal anodes and ...MnO2 cathodes. In the literature various intercalation and conversion reaction mechanisms in MnO2 have been reported, but it is not clear how these mechanisms can be simultaneously manipulated to improve the charge storage and transport properties. A systematical study to understand the charge storage mechanisms in a layered δ‐MnO2 cathode is reported. An electrolyte‐dependent reaction mechanism in δ‐MnO2 is identified. Nondiffusion controlled Zn2+ intercalation in bulky δ‐MnO2 and control of H+ conversion reaction pathways over a wide C‐rate charge–discharge range facilitate high rate performance of the δ‐MnO2 cathode without sacrificing the energy density in optimal electrolytes. The Zn‐δ‐MnO2 system delivers a discharge capacity of 136.9 mAh g−1 at 20 C and capacity retention of 93% over 4000 cycles with this joint charge storage mechanism. This study opens a new gateway for the design of high‐rate electrode materials by manipulating the effective redox reactions in electrode materials for rechargeable batteries.
Rational manipulation of the charge‐storage mechanism of aqueous rechargeable Zn–MnO2 batteries is demonstrated through the use of a layered δ‐MnO2 cathode. Nondiffusion control of pseudocapacitance‐like Zn2+ intercalation in bulky δ‐MnO2, followed by control of the H+ conversion reaction pathway over a wide C‐rate charge–discharge range facilitates high rate and a long lifetime of δ‐MnO2 cathodes.
Rapidly growing energy demand from China's transportation sector in the last two decades have raised concerns over national energy security, local air pollution, and carbon dioxide (CO2) emissions, ...and there is broad consensus that China's transportation sector will continue to grow in the coming decades. This paper explores the future development of China's transportation sector in terms of service demands, final energy consumption, and CO2 emissions, and their interactions with global climate policy. This study develops a detailed China transportation energy model that is nested in an integrated assessment model—Global Change Assessment Model (GCAM)—to evaluate the long-term energy consumption and CO2 emissions of China's transportation sector from a global perspective. The analysis suggests that, without major policy intervention, future transportation energy consumption and CO2 emissions will continue to rapidly increase and the transportation sector will remain heavily reliant on fossil fuels. Although carbon price policies may significantly reduce the sector's energy consumption and CO2 emissions, the associated changes in service demands and modal split will be modest, particularly in the passenger transport sector. The analysis also suggests that it is more difficult to decarbonize the transportation sector than other sectors of the economy, primarily owing to its heavy reliance on petroleum products.
•Transport sector in China are analyzed from a global perspective.•Passenger transport turnover reduction and modal shifts is less sensitive to carbon price.•Bio-fuel, electricity and H2 will play an important role for carbon mitigation in transport sector.•The transport sector is more difficult to decarbonize than other sectors.
Treatments for immune thrombocytopenic purpura (ITP) providing durable platelet responses without continued dosing are limited. Whereas complete responses (CRs) to B-cell depletion in ITP usually ...last for 1 year in adults, partial responses (PRs) are less durable. Comparable data do not exist for children and 5-year outcomes are unavailable. Patients with ITP treated with rituximab who achieved CRs and PRs (platelets > 150 × 109/L or 50-150 × 109/L, respectively) were selected to be assessed for duration of their response; 72 adults whose response lasted at least 1 year and 66 children with response of any duration were included. Patients had baseline platelet counts < 30 × 109/L; 95% had ITP of > 6 months in duration. Adults and children each had initial overall response rates of 57% and similar 5-year estimates of persisting response (21% and 26%, respectively). Children did not relapse after 2 years from initial treatment whereas adults did. Initial CR and prolonged B-cell depletion predicted sustained responses whereas prior splenectomy, age, sex, and duration of ITP did not. No novel or substantial long-term clinical toxicity was observed. In summary, 21% to 26% of adults and children with chronic ITP treated with standard-dose rituximab maintained a treatment-free response for at least 5 years without major toxicity. These results can inform clinical decision-making.
Given the complexities of the healthcare environment, efforts to develop standardized handoff practices have led to widely varying manifestations of handoff tools. A systematic review of the ...literature on handoff evaluation studies was performed to investigate the nature, methodological, and theoretical foundations underlying the evaluation of handoff tools and their adequacy and appropriateness in achieving standardization goals.
We searched multiple databases for articles evaluating handoff tools published between 1 February 1983 and 15 June 2012. The selected articles were categorized along the following dimensions: handoff tool characteristics, standardization initiatives, methodological framework, and theoretical perspectives underlying the evaluation.
Thirty-six articles met our inclusion criteria. Handoff evaluations were conducted primarily on electronic tools (64%), with a more recent focus on electronic medical record-integrated tools (36% since 2008). Most evaluations centered on intra-departmental tools (95%). Evaluation studies were quasi-experimental (42%) or observational (50%), with a major focus on handoff-related outcome measures (94%) using predominantly survey-based tools (70%) with user satisfaction metrics (53%). Most of the studies (81%) based their evaluation on aspects of standardization that included continuity of care and patient safety.
The nature, methodological, and theoretical foundations of handoff tool evaluations varied significantly in terms of their quality and rigor, thereby limiting their ability to inform strategic standardization initiatives. Future research should utilize rigorous, multi-method qualitative and quantitative approaches that capture the contextual nuances of handoffs, and evaluate their effect on patient-related outcomes.
Necrotising enterocolitis (NEC) is one of the most common and often fatal intestinal disorders in preterm infants. Markers to identify at-risk infants as well as therapies to prevent and treat NEC ...are limited and urgently needed. NEC incidence is significantly lower in breast-fed compared with formula-fed infants. Infant formula lacks human milk oligosaccharides (HMO), such as disialyllacto-N-tetraose (DSLNT), which prevents NEC in neonatal rats. However, it is unknown if DSLNT also protects human preterm infants.
We conducted a multicentre clinical cohort study and recruited 200 mothers and their very low birthweight infants that were predominantly human milk-fed. We analysed HMO composition in breast milk fed to infants over the first 28 days post partum, matched each NEC case with five controls and used logistic regression and generalised estimating equation to test the hypothesis that infants who develop NEC receive milk with less DSLNT than infants who do not develop NEC.
Eight infants in the cohort developed NEC (Bell stage 2 or 3). DSLNT concentrations were significantly lower in almost all milk samples in NEC cases compared with controls, and its abundance could identify NEC cases prior to onset. Aggregate assessment of DSLNT over multiple days enhanced the separation of NEC cases and control subjects.
DSLNT content in breast milk is a potential non-invasive marker to identify infants at risk of developing NEC, and screen high-risk donor milk. In addition, DSLNT could serve as a natural template to develop novel therapeutics against this devastating disorder.
In the current study, flood risk assessment of densely populated coastal urban Surat City, on the bank of the lower Tapi River in India, was conducted by combining the hydrodynamic model-based flood ...hazard and often neglected socioeconomic vulnerability. A two-dimensional (2D) hydrodynamic (HD) model was developed using physically surveyed topographic data and the existing land use land cover (LULC) of the study area (5248 km2). The satisfactory performance of the developed model was ascertained by comparing the observed and simulated water levels/depths across the river and floodplain. The 2D HD model outputs with geographic information system (GIS) applications were further used to develop probabilistic multiparameter flood hazard maps for coastal urban city. During a 100-year return period flood (Peak discharge = 34,459 m3/s), 86.5% of Surat City and its outskirt area was submerged, with 37% under the high hazard category. The north and west zones are the worst affected areas in Surat City. The socioeconomic sensitivity and adaptive capacity indicators were selected at the city's lowest administrative (ward) level. The socioeconomic vulnerability was evaluated by employing the robust data envelopment analysis (DEA) technique. Fifty-five of 89 wards in Surat City, covering 60% of the area under the jurisdiction of the Municipal Corporation, are highly vulnerable. Finally, the flood risk assessment of the city was conducted using a bivariate technique describing the distinctive contribution of flood hazard and socioeconomic vulnerability to risk. The wards adjoining the river and creek are at high flood risk, with an equal contribution of hazard and vulnerability. The ward-level hazard, vulnerability, and risk assessment of the city will help local and disaster management authorities to priorities high risk areas while planning flood management and mitigation strategies.
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•A 2D HD model has been developed for the lower Tapi basin, India, and its performance is evaluated from past flood events.•Probabilistic multiparameter flood hazard obtained through 2D HD model output and GIS application.•Ward-level socioeconomic vulnerability is computed using census-based indicators and the robust DEA technique.•A bivariate risk technique is used to develop flood risk maps by integrating flood hazard and socioeconomic vulnerability.•Developed flood risk maps helpful in identifying and prioritizing high risk areas.
Neutrophils are a vital component of immune protection, yet in cancer they may promote tumour progression, partly by generating reactive oxygen species (ROS) that disrupts lymphocyte functions. ...Metabolically, neutrophils are often discounted as purely glycolytic. Here we show that immature, c-Kit
neutrophils subsets can engage in oxidative mitochondrial metabolism. With limited glucose supply, oxidative neutrophils use mitochondrial fatty acid oxidation to support NADPH oxidase-dependent ROS production. In 4T1 tumour-bearing mice, mitochondrial fitness is enhanced in splenic neutrophils and is driven by c-Kit signalling. Concordantly, tumour-elicited oxidative neutrophils are able to maintain ROS production and T cell suppression when glucose utilisation is restricted. Consistent with these findings, peripheral blood neutrophils from patients with cancer also display increased immaturity, mitochondrial content and oxidative phosphorylation. Together, our data suggest that the glucose-restricted tumour microenvironment induces metabolically adapted, oxidative neutrophils to maintain local immune suppression.
To study the incidence of sepsis and neonatal intensive care unit (NICU) costs as a function of the human milk (HM) dose received during the first 28 days post birth for very low birth weight (VLBW) ...infants.
Prospective cohort study of 175 VLBW infants. The average daily dose of HM (ADDHM) was calculated from daily nutritional data for the first 28 days post birth (ADDHM-Days 1-28). Other covariates associated with sepsis were used to create a propensity score, combining multiple risk factors into a single metric.
The mean gestational age and birth weight were 28.1 ± 2.4 weeks and 1087 ± 252 g, respectively. The mean ADDHM-Days 1-28 was 54 ± 39 ml kg(-1) day(-1) (range 0-135). Binary logistic regression analysis controlling for propensity score revealed that increasing ADDHM-Days 1-28 was associated with lower odds of sepsis (odds ratio 0.981, 95% confidence interval 0.967-0.995, P=0.008). Increasing ADDHM-Days 1-28 was associated with significantly lower NICU costs.
A dose-response relationship was demonstrated between ADDHM-Days 1-28 and a reduction in the odds of sepsis and associated NICU costs after controlling for propensity score. For every HM dose increase of 10 ml kg(-1) day(-1), the odds of sepsis decreased by 19%. NICU costs were lowest in the VLBW infants who received the highest ADDHM-Days 1-28.
Self-monitoring is the strongest predictor of success in lifestyle interventions for obesity. In this secondary analysis of the GoalTracker trial, we describe outcomes of consistently self-monitoring ...in a standalone weight loss intervention. The 12-week intervention focused on daily self-monitoring of diet and/or body weight in a commercial app (MyFitnessPal). Participants (
N
= 100; 21–65 years; BMI 25–45 kg/m
2
) were categorized as Consistent Trackers if they tracked ≥ 6 out of 7 days for at least 75% of the targeted weeks. One-fourth of participants were Consistent Trackers. This subset was more likely to be married or living with a partner, be non-Hispanic White, and have higher health literacy than Inconsistent Trackers (
p
s < .05). Consistent tracking was associated with greater weight change than inconsistent tracking at 1 month (mean difference 95% CI − 1.11 kg − 2.12, − 0.10), 3 months (− 2.42 kg − 3.80, − 1.04), and 6 months (− 2.13 kg − 3.99, − 0.27). Over 3 times as many Consistent Trackers as Inconsistent Trackers achieved ≥ 5% weight loss at 3 months (48 vs. 13%) and at 6 months (54 vs. 15%;
p
s < .001). Though causality cannot be determined by the present study, tracking weight and/or diet nearly every day per week for 12 weeks in a commercial app may serve as an effective strategy for weight loss. Strategies are needed to promote greater consistency in tracking.
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