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ly low levels of physical activity both during and after their SNF stay. Future studies using larger sample sizes should examine physical activity during the SNF to home transition as well as barriers and facilitators to physical activity in post-acute care environments.IMPLICATIONS FOR REHABILITATIONSNF residents in this study demonstrated low levels of physical activity and high rates of sedentary behavior that persisted after discharge home.Interventions to improve physical activity levels in the SNF are sorely needed, and those interventions should include a plan for progressing physical activity after the transition home.Objective measurement of physical activity using activity monitors may prove clinically useful for older adults following hospitalization in the SNF and home settings.Introduction Cholangiocarcinomas (CCAs) are associated with poor survival outcomes, with limited treatment options in the unresectable or metastatic setting. A precision medicine approach to cancer treatment has revealed new therapeutic options that provide an alternative to traditional chemotherapeutic strategies. Isocitrate dehydrogenase 1 (IDH1) mutations are identified in approximately 10-15% of CCAs and may be targeted by ivosidenib, an oral selective inhibitor of mutant IDH1.Areas covered This review will discuss the pathogenesis of IDH1 mutant CCA and the role of ivosidenib in patients with IDH1 mutant CCA. Topics to be covered include the pharmacology, safety and clinical efficacy of ivosidenib in this patient population.Expert opinion Ivosidenib represents a promising treatment option for patients with IDH1 mutant CCA with a favorable side effect profile. Future studies will guide whether this targeted agent may be utilized in combination with other anticancer treatments to improve upon survival outcomes in advanced CCA.Stepping into the world of research can be an overwhelming task, especially for those with relatively little experience, such as medical students. This article aims to provide students with tips for writing and publishing in all fields. The 12 tips are as follows (1) find your why; (2) play to your strengths and be realistic; (3) be well read; (4) revisit missed opportunities; (5) talk to the doctors around you; (6) broaden your horizons; (7) get to grips with the submission process early; (8) pay attention to the details; (9) remember that submission is not the end; (10) the process can't be rushed; (11) consider the alternative paths to presenting research; (12) start writing. This writing is derived from personal experience with supporting evidence and is not designed to be encyclopaedic, simply a reference to help students alleviate any concerns and begin their own journey into the world of research.The International Society for the Study of Xenobiotics (ISSX) New Investigators Group has assembled a global team of emerging scientists to collaboratively compose a series of articles whose topics span the broad field of drug metabolism and will guide both new and established investigators alike. The New Investigator Group Committee members are proud to have provided such an opportunity to many promising early-career scientists from across the globe, and would like to acknowledge each contributor for their efforts.Background Emerging third-generation cephalosporin-resistant Enterobacteriaceae (3GCR-EB) pose global healthcare concern. This study assessed the in-hospital mortality attributed to 3GCR-EB.Methods The study cohort comprised inpatients with community-onset or healthcare-associated infection caused by Enterobacteriaceae in three tertiary-care public hospitals in 2017. In-hospital mortality was compared between 3GCR-EB infected patients and third-generation cephalosporin-susceptible Enterobacteriaceae (3GCS-EB) infected patients using competing risk survival models.Results Of 2,343 study patients (median age 60 years; 45.2% male), 1,481 (63.2%) had 3GCS-EB and 862 (36.8%) 3GCR-EB infection. 494 (57.0%) 3GCR-EB isolates were co-resistant to fluoroquinolones and 15 (1.7%) to carbapenems. In-hospital mortality was similar in 3GCS-EB and 3GCR-EB infections (2.4% vs. Rhapontigenin mw 2.8%; p = 0.601). No increase in the hazard of in-hospital mortality was detected for 3GCR-EB compared to 3GCS-EB infection (sub-distribution hazard ratio [HR] 0.80; 95%CI, 0.41-1.55) adjusting for patient age, sex, intensive care admission, origin of infection and site of infection. Analysis of cause-specific hazards showed that 3GCR-EB infections significantly decreased the daily rate of hospital discharge (cause-specific HR = 0.84; 95%CI, 0.76-0.92) leading to lengthier hospitalizations.Conclusion 3GCR-EB infection per se was not associated with increased in-hospital mortality in this study, but placed significant healthcare burden by increasing the length of hospitalization.
Chronic respiratory disorders are highly prevalent among Australian Aboriginal people living in the Top End Health Service region in the Northern Territory, Australia. Bronchiectasis is a heterogenous disease that features among these chronic respiratory conditions in this population. However, there are sparse comparative data between Aboriginal and non-Aboriginal patients with bronchiectasis from this region.
In this retrospective study, demographics, clinical characteristics and relevant laboratory parameters were compared among adult Aboriginal and non-Aboriginal patients diagnosed with bronchiectasis between 2012 and 2017.
A total of 388 adults had radiology-confirmed bronchiectasis and 258 (66%) were Aboriginal. Compared to non-Aboriginal patients, Aboriginal patients were significantly younger (mean age 54 v 67 years), the majority lived in rural and remote communities (80% v 9 %), had higher rates of self-reported smoking (52% v 19%), alcohol consumption (29% v 12%) and co-occurrence of chronic obronchiectasis have significantly poorer outcomes with differing manifestations and higher comorbidities than non-Aboriginal patients. This warrants further studies to identify feasible interventions to reduce this inequity.It is difficult to understand the entire effect of a natural product because such products generally have multiple effects. We propose a strategy to understand these effects effectively by decomposing them with a profile data analysis method we developed. A transcriptome profile data set was obtained from a public database and analyzed. Considering their high similarity in structure and transcriptome profile, we focused on rescinnamine and syrosingopine. Decomposed effects predicted clear differences between the compounds. Two of the decomposed effects, SREBF1 activation and HDAC inhibition, were investigated experimentally because the relationship between these effects and the compounds had not yet been reported. Analyses in vitro validated these effects, and their strength was consistent with predicted scores. Moreover, the number of outliers in decomposed effects per compound was higher in natural products than in drugs in the data set, which is consistent with the nature of the effects of natural products.We have developed a two-dimensional (2D) liquid-crystalline (LC) nanostructured water-treatment membrane showing high virus rejection ability (over 99.99997% for bacteriophage Qβ) and improved water permeation. Polymerizable gemini amphiphiles have been designed and synthesized. They have H-shaped gemini-type structures of thermotropic smectic liquid crystals composed of cationic imidazolium moieties. One of the gemini amphiphiles shows a smectic A phase with an interdigitated bilayer structure. A cross-linked self-standing 2D nanostructured polymer film has been obtained by in situ photopolymerization of the gemini amphiphile in the smectic phase. The length of linkers in gemini amphiphiles affects the formation of LC phases. The 2D nanostructured membrane also showed selective salt rejection.Aryl diazonium salts are versatile building blocks in organic synthesis. In light of the ever-increasing importance of aryl diazonium salts spanning most disciplines of the chemical sciences, we review the recent development of aryl diazonium chemistry over the past seven years (2013-2020). Special emphasis is put on various new transformations involving the generation of radical intermediates via thermal, photochemical, and electrochemical means. Recent advances in the development of transition metal-catalyzed reactions using aryl diazonium salts are also reviewed. Together, these newly developed transformations significantly expand the synthetic chemist's repertoire of aromatic carbon-carbon and carbon-heteroatom bond forming methods using aryl diazonium precursors, providing powerful tools for the synthesis and modification of complex molecular scaffolds.
To derive and validate a predictive algorithm integrating clinical and laboratory parameters to stratify a full-term neonate's risk level of having bacterial meningitis (BM).
A multicentered dataset was categorized into derivation (689 full-term neonates aged ≤28days with a lumbar puncture [LP]) and external validation (383 neonates) datasets. A sequential algorithm with risk stratification for neonatal BM was constructed.
In the derivation dataset, 102 neonates had BM (14.8%). Using stepwise regression analysis, fever, infection source absence, neurological manifestation, C-reactive protein (CRP), and procalcitonin were selected as optimal predictive sets for neonatal BM and introduced to a sequential algorithm. Based on the algorithm, 96.1% of BM cases (98 of 102) were identified, and 50.7% of the neonates (349 of 689) were classified as low risk. The algorithm's sensitivity and negative predictive value (NPV) in identifying neonates at low risk of BM were 96.2% (95% CI 91.7%-98.9%) and 98.9% (95% CI 97.6%-99.6%), respectively. In the validation dataset, sensitivity and NPV were 95.9% (95% CI 91.0%-100%) and 98.8% (95% CI 97.7%-100%).
The sequential algorithm can risk stratify neonates for BM with excellent predictive performance and prove helpful to clinicians in LP-related decision-making.
The sequential algorithm can risk stratify neonates for BM with excellent predictive performance and prove helpful to clinicians in LP-related decision-making.
To better understand how oncology nurses (a) navigate graduate studies; (b) perceive the impact of their academic work on their clinical practice, and vice versa; and (c) engage with clinical settings following graduate work.
Interpretive descriptive cross-sectional survey.
A qualitative exploratory web-based survey exploring integration of graduate studies and clinical nursing practice.
About 87 participants from seven countries responded. 71% were employed in clinical settings, 53% were enrolled in/graduated from Master's programs; 47% were enrolled in/graduated from doctoral programs. Participants had diverse motivations for pursuing graduate studies and improving clinical care. Participants reported graduate preparation increased their ability to provide quality care and conduct research. Lack of time and institutional structures were challenges to integrating clinical work and academic pursuits.
Given the many constraints and numerous benefits of nurses engaging in graduate work, structures and strategies to support hybrid roles should be explored.
