BackgroundPaediatric Early Warning Systems (PEWSs) improve identification of deterioration, however, their sustainability has not been studied. Sustainability is critical to maximise impact of ...interventions like PEWS, particularly in low-resource settings. This study establishes the reliability and validity of a Spanish-language Clinical Sustainability Assessment Tool (CSAT) to assess clinical capacity to sustain interventions in resource-limited hospitals.MethodsParticipants included PEWS implementation leadership teams of 29 paediatric cancer centres in Latin America involved in a collaborative to implement PEWS. The CSAT, a sustainability assessment tool validated in high-resource settings, was translated into Spanish and distributed to participants as an anonymous electronic survey. Psychometric, confirmatory factor analysis (CFA), and multivariate analyses were preformed to assess reliability, structure and initial validity. Focus groups were conducted after participants reviewed CSAT reports to assess their interpretation and utility.ResultsThe CSAT survey achieved an 80% response rate (n=169) with a mean score of 4.4 (of 5; 3.8–4.8 among centres). The CSAT had good reliability with an average internal consistency of 0.77 (95% CI 0.71 to 0.81); and CFAs supported the seven-domain structure. CSAT results were associated with respondents’ perceptions of the evidence for PEWS, its implementation and use in their centre, and their assessment of the hospital culture and implementation climate. The mean CSAT score was higher among respondents at centres with longer time using PEWS (p<0.001). Focus group participants noted the CSAT report helped assess their centre’s clinical capacity to sustain PEWS and provided constructive feedback for improvement.ConclusionsWe present information supporting the reliability and validity of the CSAT tool, the first Spanish-language instrument to assess clinical capacity to sustain evidence-based interventions in hospitals of variable resource levels. This assessment demonstrates a high capacity to sustain PEWS in these resource-limited centres with improvement over time from PEWS implementation.
A previous report on 814 patients who were coronavirus disease 2019 (COVID-19) positive provided preliminary therapeutic efficacy evidence with interferon-α2b (IFN-α2b) in Cuba, from March 11 to ...April 14, 2020. This study re-evaluates the effectiveness of IFN-α2b during the period from March 11 to June 17, 2020. Patients received a combination of oral antivirals (lopinavir/ritonavir and chloroquine) with intramuscular or subcutaneous administration of IFN-α2b. The primary endpoint was the proportion of patients discharged from the hospital; the secondary endpoint was the case fatality rate, and several outcomes related to time variables were also evaluated. From March 11 to June 17, 2,295 patients had been confirmed to be severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive in Cuba, 2,165 were treated with Heberon
Alpha R, and 130 received the approved protocol without IFN. The proportion of fully recovered patients was higher in the IFN-treated compared with the non-IFN-treated group. Prior IFN treatment decreases the likelihood of intensive care and increases the survival after severe or critical diseases. Benefits of IFN were significantly supported by time variables analyzed. This second report confirmed our preliminary evidence about the therapeutic effectiveness of IFN-α2b in SARS-CoV-2 infection and postulated Heberon Alpha R as the main component within antiviral drugs used in the Cuban protocol COVID-19.
Baroreflex activation therapy (BAT) is a possible adjuvant treatment for patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy and ...may be an alternative therapy in patients with contraindications or drug intolerance. Our aim was to evaluate the efficacy and safety of BAT in patients with HFrEF. The protocol for this study was registered with PROSPERO (CRD42022349175). Searches were conducted using MEDLINE, preMedLine (via PubMed), EMBASE, Cochrane Library, Web of Science, Trip Medical Database, WHO International Clinical Trials Registry, and ClinicalTrials.gov. We included randomized controlled trials that compared the effects of BAT with pharmacological treatment. We assessed the risk of bias of each study using the Cochrane RoB2 tool and the certainty of the results using the GRADE approach. We performed a meta-analysis of treatment effects using a fixed-effects or random-effects model, depending on the heterogeneity observed. Two studies were included in the meta-analysis (HOPE4HF and BeAT-HF). The results showed that BAT led to statistically significant improvements in New York Heart Association functional class (relative risk 2.13; 95% confidence interval CI, 1.65 to 2.76), quality of life (difference in means -16.97; 95% CI -21.87 to -12.07), 6 min walk test (difference in means 56.54; 95% CI 55.67 to 57.41) and N-terminal probrain natriuretic peptide (difference in means -120.02; 95% CI -193.58 to -46.45). The system- and procedure-related complication event-free rate varied from 85.9% to 97%. The results show that BAT is safe and improves functional class, quality of life and congestion in selected patients with HFrEF. Further studies and long-term follow-up are needed to assess efficacy in reducing cardiovascular events and mortality.
The biomethane accumulation of several combinations of whey and sugarcane molasses, inoculated with sludge from a treatment facility of one of the dairy enterprises of the Imbabura province in ...Ecuador, was assessed in the current experiment at a constant COD0/VSin ratio of 0.5. The whey/molasses (W:M) ratios for each treatment were (in % (m/m)) 0:100, 25:75, 50:50, 75:25, and 100:0, with a constant temperature of 37 °C and an initial pH adjustment of 7.5. Half a litre of total mixes was used for each treatment in duplicate. Six kinetic models were evaluated to account biomethane accumulation in anaerobic co-digestion processes in batch of whey and sugarcane molasses. Five of these have been tested by other researchers, and one was developed by modifying a first-order model to consider changes in the biomethane accumulation profile. This proposed model, along with the modified two-phase Gompertz model, resulted in the ones that were best able to adjust the experimental data, obtaining in all cases an R2 ≥ 0.949, indicating the accuracy of both models. In addition, the proposed here model has five parameters, one less than the modified two-phase Gompertz model, making it more straightforward and robust.
Highlights ► Univariate spectral and complexity EEG measurements presented significant but age-dependent differences between attention deficit hyperactive disorder (ADHD) subjects and healthy ...controls. ► ADHDs are better discriminated from controls by using inter-hemispheric interdependence measures computed from a few single EEG channel pairs than by using the corresponding inter-hemispheric averages. ► Using a reduced set of EEG channels and two inter-hemispheric interdependence measures at rest might help in ADHD diagnosis in a broad age range.
A prospective observational study was conducted for assessing the therapeutic efficacy of interferon (IFN)-α2b in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ...during the first month after the coronavirus disease 2019 (COVID-19) outbreak began in Cuba. From March 11th to April 14th, 814 patients were confirmed SARS-CoV-2 positive in Cuba. Seven hundred sixty-one (93.4%) were treated with a combination of oral antivirals (lopinavir/ritonavir and chloroquine) with intramuscular administration of IFN-α2b (Heberon
Alpha R, Center for Genetic Engineering and Biotechnology, Havana, Cuba), 3 times per week, for 2 weeks. Fifty-three patients received the approved COVID protocol without IFN treatment. The proportion of patients discharged from hospital (without clinical and radiological symptoms and nondetectable virus by real-time polymerase chain reaction) was higher in the IFN-treated compared with the non-IFN treated group (95.4% vs. 26.1%,
< 0.01). The case fatality rate (CFR) for all patients was 2.95%, and for those patients who received IFN-α2b the CFR was reduced to 0.92. Intensive care was required for 82 patients (10.1%), 42 (5.5%) had been treated with IFN. This report provides preliminary evidence for the therapeutic effectiveness of IFN-α2b for COVID-19 and suggests that the use of Heberon Alpha R may contribute to complete recovery of patients.
Highlights • Variability of connectivity reflects the ADHD status better than connectivity itself. • Enhanced variability of nonlinear EEG connectivity characterizes ADHD at rest. • Changes between ...states only occur in variability of theta band connectivity for ADHD.
Acute Stanford A aortic dissection rarely makes a transition to the chronic state naturally, due to its high mortality. We present a rare case of chronic Stanford A aortic dissection post surgery, in ...a patient who remained stable for more than 1 year, and subsequently presented chest pain.
La disección aórtica Stanford A aguda rara vez hace una transición al estado crónico de forma natural, por su elevada mortalidad. Presentamos un caso raro de disección aórtica Stanford A crónica post cirugía, en un paciente que permaneció estable por más de 1 año, y posteriormente presentó dolor torácico.
El estudio buscó establecer la relación entre las habilidades del pensamiento y de sus factores con el rendimiento académico en un grupo de ingresantes universitarios de las carreras de Ingeniería y ...Arquitectura. La muestra total fue de 113 participantes, con la que se hicieron todos los análisis referentes a las habilidades del pensamiento, distribución de factores y niveles. El análisis de relación entre rendimiento académico y habilidades del pensamiento se realizó con 98 participantes que contaban con los promedios finales de notas. Los resultados muestran que los participantes se distribuyen mayoritariamente en el nivel Normal Inferior al Normal y la existencia de una asociación positiva moderada con el rendimiento académico. No se encontraron diferencias de acuerdo al género, edad y/o especialidad.
A high body mass index increases the risk of severe pancreatitis and associated mortality. Our aims were: (1) To determine whether obesity affects the release of extracellular nucleosomes in patients ...with pancreatitis; (2) To determine whether pancreatic ascites confers lipotoxicity and triggers the release of extracellular nucleosomes in lean and obese rats.
DNA and nucleosomes were determined in plasma from patients with mild or moderately severe acute pancreatitis either with normal or high body mass index (BMI). Lipids from pancreatic ascites from lean and obese rats were analyzed and the associated toxicity measured in vitro in RAW 264.7 macrophages. The inflammatory response, extracellular DNA and nucleosomes were determined in lean or obese rats with pancreatitis after peritoneal lavage.
Nucleosome levels in plasma from obese patients with mild pancreatitis were higher than in normal BMI patients; these levels markedly increased in obese patients with moderately severe pancreatitis vs. those with normal BMI. Ascites from obese rats exhibited high levels of palmitic, oleic, stearic, and arachidonic acids. Necrosis and histone 4 citrullination-marker of extracellular traps-increased in macrophages incubated with ascites from obese rats but not with ascites from lean rats. Peritoneal lavage abrogated the increase in DNA and nucleosomes in plasma from lean or obese rats with pancreatitis. It prevented fat necrosis and induction of HIF-related genes in lung.
Extracellular nucleosomes are intensely released in obese patients with acute pancreatitis. Pancreatitis-associated ascitic fluid triggers the release of extracellular nucleosomes in rats with severe pancreatitis.
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