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Home care for hematopoietic stem cell transplants (HSCTs), an alternative to traditional inpatient or outpatient recovery programs, is safe and feasible but may place greater demand on full-time caregivers. The goal of this study was to characterize the experiences of caregivers in a newly piloted homebound HSCT program as a means of identifying unmet needs and ensuring adequate support.
A qualitative approach was utilized. Participants created self-recorded video diaries guided by open-ended prompts at designated time points throughout recovery and participated in a single follow-up interview within four weeks post-discharge. Diaries and interviews were transcribed, analyzed, and coded to identify recurrent ideas and themes.
Data were collected from 12 caregivers of homebound HSCT patients. Thematic content analysis yielded four themes: facilitators (external support, sense of normalcy, and patient wellness), challenges (difficulties with transplant care instructions, managing the patient's physical and emotional health, and caregiver psychological distress), roles in recovery (caregiving responsibilities), and analysis of homebound experience (positive outcomes and suggestions for improvement).
Significance of results
Caregivers perceived the homebound program as offering high-quality medical care in a setting that provided a sense of normalcy, privacy, and greater level of oversight. Unmet needs included lacking preparedness in completing nursing responsibilities and handling caregiver and patient distress. While the homebound program was preferred to routine hospital care, psychotherapeutic support and programming to improve caregiver preparedness in a homebound HSCT recovery program is indicated.
Aripiprazole is the firstborn of the new dynasty of antipsychotic called third generation or neuromodulator of dopamine-serotonin system. It has proven to be an effective and well-tolerated antipsychotic. Dual Pathology represents the presence of comorbidity between mental illness and substance use disorders. It is an under-diagnosed problem and it is increasing frequency.
The aim of this study was to determine and describe the clinical profile of the patients admitted to the Dual Pathology Unit (UPD) at The Montalvos Hospital (Part of Salamanca University Teaching Hospital, Spain) treated with oral Aripiprazole.
Descriptive, observational, retrospective study of a sample of patients admitted to the UPD to which oral aripiprazole was prescribed during hospitalization. A number of sociodemographic, clinical, and treatment-related variables are described.
From a sample of 25 patients and according to DSM-5 criteria (APA, 2013) main diagnoses were: 14 cases of substance-induced psychotic disorder, 3 cases of schizophrenia; 3 cases of schizoaffective disorder; 2 cases of bipolar disorder; 1 case of schizophreniform disorder; 1 case of borderline personality disorder; 1 case of personality syndrome. The most used drugs before the admittance were cocaine, cannabis and opioids. The average dose of aripiprazole was 9 mg and no side effects or drug interactions were reported.
Apart from its well known efficacy in treament of psychosis, oral aripiprazole may be a first line treatment for Dual diagnosis patients, specially those with problems of non-compliance, due to high level prolactine side effects.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Age-related hearing loss (ARHL) is a sensory impairment, with a dramatic increase in its incidence, which is caused by genetic and environmental factors such as noise and ototoxic drugs. Recent studies correlated ARHL to elevated plasma homocysteine (Hcy) by folate deficiency, suggesting that reduction of Hcy levels by folate supplementation could potentially ameliorate ARHL.
Hyperhomocysteinemia (HHcy), a status that contributes to ARHL, may also arise from malfunction of Hcy remethylation by betaine homocysteine S-methyltransferases (BHMTs) and methionine synthase in the methionine cycle. The expression and/or activity of these enzymes may be altered by ototoxic drugs, including paracetamol (APAP).
To determine the effect of APAP in cochlear morphology and function of control and Bhmt-/- mice, and to analyze putative preventive effects of folic acid (FA) supplementation.
Materials and Methods
Two-month-old Bhmt-/- mice (n = 47), with greater dependence on folate metabolism for Hcy remethylation, and Bhmt + / + mice (n = 42) were fed control or FA supplemented diets for 30 days. The last day APAP (250 mg/kg) or placebo were injected intraperitoneally.
Hearing was evaluated by recording auditory brainstem responses (ABR) at the beginning of the experiment and after treatments. Picrosirius red staining was used for evaluation of the cochlear lateral wall cytoarchitecture. Plasma and hepatic metabolite levels were determined by HPLC or on Spinlab 100® autoanalyzer.
Loss of Bhmt expression induced HHcy, but an impact on hearing acuity was not observed. Acute APAP administration did not induce ABR threshold shifts. However, following ototoxic treatment, changes of 5–17% in the areas of the stria vascularis and spiral ligament were detected between Bhmt-/- mice under different dietary treatments; cochlear structures of Bhmt-/- mice receiving APAP plus FA supplementation resemble those of the control group. APAP increases susceptibility to ototoxic damage in the presence of HHcy.
BHMT plays a central role in cochlear methionine metabolism. FA supplementation modulates Hcy levels, contributing to a proper remethylation status that prevents ARHL.
To analyse the Nutritional Knowledge Test (NKT) using Item Response Theory (ITR) analysis and to assess the construct validity of the Nutritional Knowledge Scale (NKTS) and its associations with adolescent food group consumption and nutritional biomarkers.
Multicentre investigation conducted in ten European cities.
Adolescents aged 12·5–17·5 years (n 3215) who completed over 75 % of the NKT.
Factor analysis indicated that the NKT can be analysed with a one-dimensional model. Eleven out of twenty-three items from the NKT presented adequate parameters and were selected to be included in the NKTS. Nutrition knowledge was positively associated with consumption of fruits, cereals, dairy products, pulses, meat and eggs, and fish, as well as with blood concentrations of vitamin C, β-carotene, n-3 fatty acids, holo-transcobalamin, cobalamin and folate; nutrition knowledge was negatively associated with intake of olives and avocado, alcohol and savoury snacks.
The NKTS assessed nutritional knowledge adequately and it is proposed as a new tool to investigate this subject in future studies.
Bovine leukaemia virus (BLV) is the causative agent of enzootic bovine leucosis, which has been reported worldwide. BLV has been found recently in human tissue and it could have a significant impact on human health. A possible hypothesis regarding viral entry to humans is through the consumption of infected foodstuffs. This study was aimed at detecting the presence of BLV DNA in raw beef and fresh milk for human consumption. Nested PCR directed at the BLV gag gene (272 bp) was used as a diagnostic test. PCR products were confirmed by Sanger sequencing. Forty-nine per cent of the samples proved positive for the presence of proviral DNA. This is the first study highlighting the presence of the BLV gag gene in meat products for human consumption and confirms the presence of the viral DNA in raw milk, as in previous reports. The presence of viral DNA in food products could suggest that viral particles may also be found. Further studies are needed to confirm the presence of infected viral particles, even though the present findings could represent a first approach to BLV transmission to humans through foodstuff consumption.
Positive Deviance (PD) is a process to achieve a social and cultural change. This strategy has been used for the control of methicillin-resistant Staphylococcus aureus (MRSA) infection in some health institutions in the United States, but has rarely been adopted in institutions from developing countries where resources are limited. We describe our experience of PD in the control of healthcare-associated infections (HAIs) due to MRSA in a Colombian hospital with the aim of reducing HAI rates through a cultural change in processes. A time-series study was conducted based on the MRSA-HAI rate and the number of months with zero MRSA infections before and after application of PD (2001–2012). On comparing the pre-intervention and intervention periods, the mean overall rates of MRSA-HAI was 0·62 and 0·36, respectively (P = 0·0005); the number of months with zero MRSA-HAIs were 3/70 and 12/74 (odds ratio 0·264, 95% confidence interval 0·078–0·897); the percentage of MRSA-HAIs was 53·2% and 41·0%. These results are consistent with other published data. Implementation of PD was associated with a significant reduction of MRSA-HAIs, it did not involve high costs and the changes have been lasting.
This paper inquires into the effects of an emerging multipolar world upon economic regionalism. While IR scholarship has been making a strong case for the regionalization of world politics after the end of the Cold War, the fact that most of the rising powers are also the sole regional powers of their home regions has led some scholars to argue that the advent of multipolarity can only strengthen this general trend towards a more regionalized international order. In this contribution, I challenge these arguments by proposing an alternative way of thinking about how multipolarity is developing. The implications of this interpretation are that the emergence of multipolarity may actually generate powerful centrifugal forces within regions, which would have adverse effects on well-known forms of complex economic regionalism that diverse regional groupings have been implementing thus far. This applies particularly to the global south, where intraregional economic interdependencies tend to be weak. The proposition is tested through a case study and by examining empirical findings across several world regions.
This book gathers together the lectures and practical sessions imparted during the XXIVth Canary Islands Winter School of Astrophysics, held at Puerto de la Cruz, Tenerife (4–16 November 2012).
The basic phenomena of gravitational lenses, light deflection and time dilation by gravitational fields, are two essential predictions of Einstein's General Theory of Relativity. Both effects played a prominent role in the classical tests of General Relativity through famous experiments such as the deflection of light by the Sun measured by Eddington during the 1919 solar eclipse and the radar time delays first measured by Shapiro from the echoes of planets and space probes in the Solar System. Owing to rapid developments in technology, these once exotic and difficult-to-measure effects can nowadays be tested millions of times per second with a very popular device, the GPS (gravitational lensing in everyday life). The present and future importance of gravitational lenses is therefore no longer related exclusively to fundamental General Relativity but also (this is our motivation) to its use in probing the properties of astrophysical objects and of the Universe itself.
The optical bench is one of the most common pieces of laboratory apparatus in modern physics. A source emits photons, alpha particles, neutrons or some other kind of ‘bullets’ that interact with a test object (the target) and are subsequently detected by the observer. This set-up enables the researcher to change and move at will any of the components of the experiment to check hypotheses being tested. Astrophysical sources and targets (planets, stars, galaxies, etc.) are too big and distant for the astronomer to be able to manipulate them. Nevertheless, in certain rare cases a distant source (a star, galaxy, or quasar) appears to be almost aligned with an intervening target (a planet, star, galaxy, or galaxy cluster), thus allowing the observer to measure the deflection of the light rays caused by the gravitational field of the target. This is a gravitational lens system (or simply ‘gravitational lens’), an astronomical optical bench that can be used as a tool to study both the source and the deflecting target.
Gravitational lenses offer the best, and sometimes the only, means of tackling key problems in many fields of astrophysics and cosmology. According to Einstein's theory, the curvature of light-rays increases with mass; gravitational lenses can be used to map the distribution of mass in a Universe in which virtually all matter is dark matter of an unknown nature. Gravitational lensing has significantly improved our knowledge of many astrophysical phenomena, such as exoplanets, galaxies, active galactic nuclei, quasars, clusters, large-scale structure and the Universe itself. All these topics are covered fully in this book, together with two tutorials on lens and microlensing modelling. The future of lensing in relation to large surveys and the anticipated discoveries of thousands more gravitational lenses is also discussed, making this volume an ideal guide for postgraduate students and practising researchers in the use of gravitational lenses as a tool in their investigations.
Relationships between fatty acids (FAs) in plant oils included in goat diets and milk fat C18 isomers were determined by Principal Factor Analysis (PFA). The three first principal factors (PF1, PF2 and PF3) accounted for 64·5% of the total variation in milk FAs contents. Fatty acids with a double bond at carbons 13, 14, 15 or 16 had high (>0·6) and positive loadings for PF1, trans-4 to trans-8 C18:1 for PF2, whereas trans-10 C18:1, trans-11 C18:1 and cis-9 trans-11 C18:2 showed high and positive loadings for PF3. Pearson's correlations supported that PF1, PF2 and PF3 were related to α-linolenic, oleic and linoleic acid intakes, respectively. Our results show that the quantitatively main FAs in plant lipids supplemented to dairy ruminants are often the main cause of the observed changes in milk C18 isomer contents. However, sometimes the observed changes are caused, or at least are influenced, by other FAs present in lower quantities in the plant lipids. Thus, using mixtures of plant oils with differently unsaturated main FAs could be a way of tailoring milk fat composition to a pre-designed pattern.
We study the stability of small amplitude harmonic perturbation at the interface of a gel material surrounded by air. The equations describing the system's dynamics are solved using classical perturbation methods. Assuming that the amplitude decays over time, we establish conditions for the system to return to its equilibrium state. The proposed model includes the effect of the boundary conditions and can be extended to more general situation in which the material is surrounded by an arbitrary fluid.
The effects of two aphidophagous predators, the larvae of Chrysoperla carnea and adults of Adalia bipunctata, on the spread of cucumber mosaic virus (CMV) transmitted in a non-persistent manner by the cotton aphid Aphis gossypii were studied under semi-field conditions. Natural enemies and aphids were released inside insect-proof cages (1 m ×1 m ×1 m) with a central CMV-infected cucumber plant surrounded by 48 healthy cucumber seedlings, and the spatiotemporal dynamics of the virus and vector were evaluated in the short and long term (1 and 5 days) in the presence and absence of the natural enemy. The spatial analysis by distance indices methodology together with other indices measuring the dispersal around a single focus was used to assess the spatial pattern and the degree of association between the virus and its vector. Both natural enemies significantly reduced the number of aphids in the CMV-source plant after 5 days but not after 1 day. The CMV transmission rate was generally low, especially after 1 day, due to the limited movement of aphids from the central CMV-source plant, which increased slightly after 5 days. Infected plants were mainly located around the central virus-infected source plant, and the percentage of aphid occupation and CMV-infected plants did not differ significantly in absence and presence of natural enemies. The distribution patterns of A. gossypii and CMV were only coincident close to the central plant. The complexity of multitrophic interactions and the role of aphid predators in the spread of CMV are discussed.