Branched chain amino acids (BCAA) are among nutrients strongly linked with insulin sensitivity (IS) measures. We investigated the effects of a chronic increase of BCAA intake on IS in two groups of ...healthy subjects differing in their basal consumption of BCAA, that is, vegans and omnivores.
Eight vegans and eight matched omnivores (five men and three women in each group) received 15 g (women) or 20 g (men) of BCAA daily for 3 months. Anthropometry, blood analyses, glucose clamp, arginine test, subcutaneous abdominal adipose tissue (AT) and skeletal muscle (SM) biopsies (mRNA levels of selected metabolic markers, respiratory chain (RC) activity) were performed at baseline, after the intervention and after a 6 month wash-out period.
Compared with omnivores, vegans had higher IS at baseline (GIR, glucose infusion rate: 9.6±2.4 vs 7.1±2.4 mg/kg/min, 95% CI for difference: 0.55 to 5.82) that declined after the intervention and returned to baseline values after the wash-out period (changes in GIR with 95% CI, 3-0 months: -1.64 -2.5; -0.75 and 9-3 months: 1.65 0.75; 2.54 mg/kg/min). No such change was observed in omnivores. In omnivores the intervention led to an increased expression of lipogenic genes (DGAT2, FASN, PPARγ, SCD1) in AT. SM RC activity increased in both groups.
Negative impact of increased BCAA intake on IS was only detected in vegans, that is, subjects with low basal amino acids/BCAA intake, which appear to be unable to induce sufficient compensatory changes within AT and SM on a BCAA challenge.
Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to ...prevent HAIs, but economic evaluations are needed to determine which are most appropriate.
To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach.
A health economic evaluation assessed the financial results of the QI initiative ‘Saúde em Nossas Mãos’ (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative.
The aggregated ACs calculated for each HAI from these 13 ICUs – US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs – were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%.
Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.
ABCG5 (G5) and ABCG8 (G8) are ATP-binding cassette (ABC) transporters that limit intestinal absorption and promote biliary
excretion of neutral sterols. Mutations in either ABCG5 or ABCG8 result in ...an identical clinical phenotype, suggesting that these two half-transporters function as heterodimers. Expression
of both G5 and G8 is required for either protein to be transported to the plasma membrane of cultured cells. In this paper
we used immunofluorescence microscopy to confirm, in vivo , that G5 is localized to the apical membranes of mouse enterocytes and hepatocytes. Other ABC half-transporters function
as homodimers or as heterodimers with other subfamily members. To determine whether G5 or G8 complex with other ABCG half-transporters,
we co-expressed G1, G2, and G4 with either G5 or G8 in cultured cells. G1, G2, and G4 co-immunoprecipitated with G5, and G4
co-immunoprecipitated with G8, but the putative dimers were retained in the endoplasmic reticulum (ER). Adenovirus-mediated
expression of either G5 or G8 in the liver of G5G8 null mice resulted in ER retention of the expressed proteins and no increase
in biliary cholesterol. In contrast, co-expression of G5 and G8 resulted in transit of the proteins out of the ER and a 10-fold
increase in biliary cholesterol concentration. Finally, adenoviral expression of G2 in the presence or absence of G5 or G8
failed to promote sterol excretion into bile. These experiments indicate that G5 and G8 function as obligate heterodimers
to promote sterol excretion into bile.
Liver damage may result from multiple factors in HIV‐infected patients. The availability of reliable noninvasive tools to measure liver fibrosis has permitted the screening of large patient ...populations. Cross‐sectional study of all consecutive HIV outpatients who underwent examination by transient elastometry (FibroScan) at one HIV reference clinic during 2007. Advanced liver fibrosis (ALF) was defined as hepatic stiffness >9.5 kilopascals, which corresponds to Metavir stages F3‐F4 in the liver biopsy. A total of 681 consecutive HIV‐infected patients (64% injecting drug users; mean age 43; 78% male; 98% on antiretroviral therapy) had at least one valid FibroScan evaluation. ALF was diagnosed in 215 (32%) of them. In the univariate analysis, ALF was significantly associated with older age, low CD4 counts, chronic hepatitis C, past alcohol abuse, elevated ALT, high triglycerides, low cholesterol, high homeostasis model assessment (HOMA) index and exposure to didanosine and/or stavudine. In a multivariate model (OR, 95% CI), chronic hepatitis C (2.83, 1.57–5.08), past alcohol abuse (2.26, 1.37–3.74), exposure to didanosine and/or stavudine (1.85, 1.14–3.01), high HOMA index (1.25, 1.04–1.51), older age (1.09, 1.05–1.14) and elevated ALT (1.04, 1.03–1.06) remained as independently associated with ALF. Therefore, in addition to chronic hepatitis C and alcohol abuse, insulin resistance and/or exposure to dideoxy‐nucleosides may contribute to ALF in HIV‐infected patients.
Junction-to-fluid thermal resistivities R '' jf , of two dual-side-soldered insulated gate bipolar transistor (IGBT) modules immersion cooled in a hydrofluoroether C 3 F 7 OCH 3 liquid were measured ...experimentally. R '' jf = 0.040°C·cm 2 /W for 0.144 cm 2 die at a peak heat flux of 1180 W/cm 2 and 55 A, and 0.11 ° C· cm 2 /W for 1.46 cm 2 die at a peak heat flux of 550 W/cm 2 and 305 A. A technique for automatic in situ degassing that would reduce manufacturing cost and permit field servicing of immersion systems that reach subambient pressure when idle showed fluid loss rates of 0.3 g per 100 cm 3 of air vented, roughly 1/100th that expected from an HFC-134a air conditioning system with a similar leak. Experiments to quantify packaging density and fluid requirements suggest that 100 cm 3 of fluid is required to dissipate 1 kW and packaging density is limited only by the electrical bus geometry.
Objectives
Positive effects of mindfulness-based interventions (MBIs) on occupational health have been demonstrated by several systematic review studies during the last two decades. So far, existing ...reviews excluded mindfulness-informed interventions (MIIs) that build on informal approaches or mixed techniques aiming at improving mindfulness indirectly. To address this research gap, the present comprehensive meta-analysis synthesizes the results of RCTs of MBIs and MIIs conducted in various workplace settings.
Method
A systematic literature search was conducted in five electronic databases complemented by manual search. Random-effects models were used to synthesize standardized mean differences (
SMDs
) for 25 outcomes and seven overarching categories of outcomes, and to detect various temporal effects. Meta-regressions were run to elucidate average
SMDs
between mindfulness intervention types and intervention and population characteristics, with the goal of detecting sources of heterogeneity and help guide the selection of the most appropriate mindfulness intervention type.
Results
Based on 91 eligible studies (from 92 publications), including 4927 participants and 4448 controls, the synthesis shows that MBIs and MIIs significantly improve mindfulness (
SMD
= 0.43; 95%-
CI
0.33;0.52), well-being (
SMD
= 0.63; 95%-
CI
0.34;0.93), mental health (
SMD
= 0.67; 95%-
CI
0.48;0.86), stress (
SMD
= 0.72; 95%-
CI
0.54;0.90), resilience (
SMD
= 1.06; 95%-
CI
−0.22;2.34), physical health (
SMD
= 0.45; 95%-
CI
0.32;0.59), and work-related factors (
SMD
= 0.62; 95%-
CI
0.14;1.10). Sensitivity analyses demonstrate a tendency towards smaller effect sizes due to extreme outliers. Effect sizes are stable in short-term follow-up assessments (1-12 weeks) for most outcomes, but not for long-term follow-up assessments (13-52 weeks). Meta-regressions suggest that observable intervention characteristics (e.g., online delivery) and population characteristics (e.g., age of participants), as well as study quality, do not explain the prevalence of heterogeneity in effect sizes.
Conclusions
Generally effective, mindfulness interventions are a useful tool to enhance aspects of employee health. However, because of heterogeneity and risk of bias, studies aiming at high-quality data collection and thorough reporting are necessary to draw firm conclusions.
Preregistration
A protocol of this systematic review was registered with PROSPERO (Registration-No. CRD42020159927).
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