Vestcrowley6083
The objective of this study is to characterize opioid intensity in the intensive care unit (ICU) and its association with opioid utilization across care transitions.
This is a prospective cohort study. Medically ill ICU patients with complete medication histories who survived to discharge were included. Opioid intensity was characterized based on IV morphine milligram equivalents (IV MME). Primary outcomes were opioid prescribing upon ICU and hospital discharge.
Opioids were prescribed to 34.1% and 31.1% of patients upon ICU and hospital discharge. Within the ≥50 mean IV MME/ICU day cohort, 64.7% of patients received opioids after ICU discharge compared to 45.8% and 13.6% in the 1-49 mean IV MME/ICU day and no opioid groups (
< .05). Within the ≥50 mean IV MME/ICU day cohort, 70.6% of patients were prescribed opioids after hospitalization compared to 37.3% and 13.6% of patients who received less or no opioids. (
< .05). Within the ≥50 mean IV MME/ICU day cohort, 29.4% of patients were opioid naïve and discharged with an opioid, which is over double compared to patients with lower opioid requirements (
< .05).
Patients with higher mean daily ICU opioid requirements had increased opioid prescribing across care transitions despite preadmission opioid use.
Patients with higher mean daily ICU opioid requirements had increased opioid prescribing across care transitions despite preadmission opioid use.
Mask wearing to mitigate the spread of COVID-19 and other viral infections may raise concerns on the effects of face masks on breathing and cardiopulmonary health. Non-evidence-based apprehensions may limit the use of masks in public.
We will assess the parameters related to heart and lung physiology between healthy male and female adults exposed to wearing face masks (or not) under conditions of rest and graded exercise.
We performed a cross-sectional study including 20 male and 20 female adults who met our inclusion criteria. Adults with underlying respiratory and cardiac conditions were excluded. Physiologic parameters were measured while the participants underwent three activity levels (10min each) in a randomly assigned order rest, walking, and stair climbing. Each activity level was conducted under three mask conditions no mask, surgical mask, and N95 respirator. Heart rate (HR) and blood oxygen saturation (SpO
) were recorded via pulse oximeter after each activity. Perceived exertion was recorded utilizing a Borg 15-point scale. A mixed-effects analysis of variance (ANOVA) was utilized to interpret the results.
A significant increase in perceived exertion was reported for N95 users (p<0.0001). There was also a significant increase in mean HR for N95 users in comparison to no-mask users (p=0.0031). The mean SpO
in females was higher than males under rest and walking conditions (p=0.0055). There was no change in SpO
between mask type overall, nor between mask type vs. exercise intensity, nor between mask type and sex.
Our findings provide evidence that surgical masks and N95 respirators do not influence SpO
at rest or during exercise.
Our findings provide evidence that surgical masks and N95 respirators do not influence SpO2 at rest or during exercise.
The sense of guilt in informal caregivers has been associated with lower levels of overall life-satisfaction, an increase in feelings of overwork, stress, and health problems, including anxiety and depression. Even though women who care for dependent relatives have higher levels of feelings of guilt than male caregivers, little research has been done on the dynamics of guilt from a gender perspective. This study examines the dynamics of this moral emotion in women caregivers' psychosocial health.
This study is based on semi-structured interviews with nineteen Spanish women who are informal caregivers looking after dependent family members. The interviews were subsequently transcribed and subjected to thematic analysis.
Three themes emerged from qualitative analysis first, doing more for the people being cared for than for oneself; secondly, being demanding on oneself; and thirdly, controlling one's own desires.
The results show dynamics of self-control that seem to function as mechanisms for the women caregivers to avoid feelings of guilt, but at the price of taking on greater caring responsibilities, denying their own desires, and endangering their psychosocial health. We consider that intervention to help women reduce anticipatory guilt is essential, as these feelings put women caregivers' psychosocial health at risk.
The results show dynamics of self-control that seem to function as mechanisms for the women caregivers to avoid feelings of guilt, but at the price of taking on greater caring responsibilities, denying their own desires, and endangering their psychosocial health. We consider that intervention to help women reduce anticipatory guilt is essential, as these feelings put women caregivers' psychosocial health at risk.
This study investigated the use of human performance modeling (HPM) approach for prediction of driver behavior and interactions with in-vehicle technology.
HPM has been applied in numerous human factors domains such as surface transportation as it can quantify and predict human performance; however, there has been no integrated literature review for predicting driver behavior and interactions with in-vehicle technology in terms of the characteristics of methods used and variables explored.
A systematic literature review was conducted using Compendex, Web of Science, and Google Scholar. As a result, 100 studies met the inclusion criteria and were reviewed by the authors. Model characteristics and variables were summarized to identify the research gaps and to provide a lookup table to select an appropriate method.
The findings provided information on how to select an appropriate HPM based on a combination of independent and dependent variables. The review also summarized the characteristics, limitations, applications, modeling tools, and theoretical bases of the major HPMs.
The study provided a summary of state-of-the-art on the use of HPM to model driver behavior and use of in-vehicle technology. We provided a table that can assist researchers to find an appropriate modeling approach based on the study independent and dependent variables.
The findings of this study can facilitate the use of HPM in surface transportation and reduce the learning time for researchers especially those with limited modeling background.
The findings of this study can facilitate the use of HPM in surface transportation and reduce the learning time for researchers especially those with limited modeling background.
In the NEAT022 trial, virologically suppressed persons with HIV at high cardiovascular risk switching from protease inhibitors to dolutegravir either immediately (DTG-I) or after 48 weeks (DTG-D) showed non-inferior virological suppression and significant lipid and CVD risk reductions on switching to dolutegravir relative to continuing protease inhibitors.
Post-hoc analysis. selleck kinase inhibitor Major endpoints were 48-week and 96-week weight and body mass index (BMI) changes. Factors associated with weight/BMI changes within the first 48 weeks of DTG exposure, proportion of participants by category of percent weight change, proportions of BMI categories over time, and impact on metabolic outcomes were also assessed.
Between May/2014 and November/2015, 204 (DTG-I) and 208 (DTG-D) participants were included. Weight significantly increased (mean +0.810 kg DTG-I arm, and +0.979 kg DTG-D arm) in the first 48 weeks post-switch, but remained stable from 48 to 96 weeks in DTG-I arm. Switching from darunavir, white race, total-to-HDL cholesterol ratio <3.7, and normal/underweight BMI were independently associated with higher weight/BMI gains. The proportion of participants with ≥5% weight change increased similarly in both arms over time. The proportions of BMI categories, use of lipid-lowering drugs, diabetes and/or use of antidiabetic agents, and hypertension and/or use of antihypertensive agents did not change within or between arms at 48 and 96 weeks.
Switching from protease inhibitors to dolutegravir in persons with HIV with high cardiovascular risk led to modest weight gain limited to the first 48 weeks which involved preferentially normal-weight or underweight persons and was not associated with negative metabolic outcomes.
Switching from protease inhibitors to dolutegravir in persons with HIV with high cardiovascular risk led to modest weight gain limited to the first 48 weeks which involved preferentially normal-weight or underweight persons and was not associated with negative metabolic outcomes.
Postoperative restenosis frequently occurs in intracranial atherosclerotic disease (ICAD) patients after drug-coated balloon (DCB) treatment. However, high-risk plaques associated with postoperative restenosis remain to be explored.
To assess whether high-resolution vessel wall MRI (HR-VWI) contributes to the identification of high-risk plaques associated with postoperative restenosis before DCB treatment.
Retrospective.
A total of 70 patients with ICAD who underwent DCB treatment.
3.0 T; magnetic resonance angiography, HR-VWI.
All patients underwent HR-VWI examination prior to DCB treatment. Digital subtraction angiography (DSA) measurement was assessed 6 months (±1 month) after operation to determine the vessel restenosis, classifying patients into three groups of no stenosis, mild stenosis (<50%), and restenosis (>50%). Clinical factors and HR-VWI characteristics, including vessel and lumen area at maximal lumen narrowing (MLN), plaque area and length, degree of stenosis, plaque burden, rwed that plaque length and enhancement amplitude were independent prognostic factors of postoperative restenosis.
HR-VWI has the potential to identify high-risk plaques in ICAD patients before DCB treatment.
4 TECHNICAL EFFICACY Stage 2.
4 TECHNICAL EFFICACY Stage 2.The growing interest in new classes of anti-cancer agents, such as molecularly-targeted therapies and immunotherapies with modes of action different from those of cytotoxic chemotherapies, has changed the dose-finding paradigm. In this setting, the observation of late-onset toxicity endpoints may be precluded by treatment and trial discontinuation due to disease progression, defining a competing event to toxicity. Trial designs where dose-finding is modeled in the framework of a survival competing risks model appear particularly well-suited. We aim to provide a phase I/II dose-finding design that allows dose-limiting toxicity (DLT) outcomes to be delayed or unobserved due to competing progression within the possibly long observation window. The proposed design named the Survival-continual reassessment method-12, uses survival models for right-censored DLT and progression endpoints. In this competing risks framework, cause-specific hazards for DLT and progression-free of DLT were considered, with model parameters estimated using Bayesian inference. It aims to identify the optimal dose (OD), by minimizing the cumulative incidence of disease progression, given an acceptable toxicity threshold. In a simulation study, design operating characteristics were evaluated and compared to the TITE-BOIN-ET design and a nonparametric benchmark approach. The performance of the proposed method was consistent with the complexity of scenarios as assessed by the nonparametric benchmark. We found that the proposed design presents satisfying operating characteristics in selecting the OD and safety.
