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Mean number of patients identified per day to receive stewardship was 13, and 18.6 potential interventions per day were identified. Based on results of this pilot, pharmacist-led identification of inpatients warranting pain and opioid stewardship is feasible at our institution.By preventing infectious diseases, vaccines contribute substantially to public health. Besides, they offer great opportunities to investigate human immune responses. This is particularly true for live-attenuated virus vaccines which cause resolving acute infections and induce robust immunity. The fact that one can precisely schedule the time-point of vaccination enables complete characterization of the immune response over time, short-term and over many years. The live-attenuated Yellow Fever virus vaccine strain YF-17D was developed in the 1930's and gave rise to the 17D-204 and 17DD vaccine sub-strains, administered to over 600 million individuals worldwide. YF vaccination causes a systemic viral infection, which induces neutralizing antibodies that last for a lifetime. It also induces a strong T cell response resembling the ones of acute infections, in contrast to most other vaccines. In spite of its use since 1937, learning how YF vaccination stimulates such strong and persistent immune responses has gained substantial knowledge only in the last decades. Here we summarize the current state of knowledge on the immune response to YF vaccination, and discuss its contribution as a human model to address complex questions on optimal immune responses.

We quantified the association between public compliance with social distancing measures and the spread of SARS-CoV-2 during the first wave of the epidemic (March-May 2020) in 5 states that accounted for half of the total number of COVID-19 cases in the United States.

We used data on mobility and number of COVID-19 cases to longitudinally estimate associations between public compliance, as measured by human mobility, and the daily reproduction number and daily growth rate during the first wave of the COVID-19 epidemic in California, Illinois, Massachusetts, New Jersey, and New York.

The 5 states mandated social distancing directives during March 19-24, 2020, and public compliance with mandates started to decrease in mid-April 2020. As of May 31, 2020, the daily reproduction number decreased from 2.41-5.21 to 0.72-1.19, and the daily growth rate decreased from 0.22-0.77 to -0.04 to 0.05 in the 5 states. The level of public compliance, as measured by the social distancing index (SDI) and daily encounter-density change, was high at the early stage of implementation but decreased in the 5 states. The SDI was negatively associated with the daily reproduction number (regression coefficients range, -0.04 to -0.01) and the daily growth rate (from -0.009 to -0.01). The daily encounter-density change was positively associated with the daily reproduction number (regression coefficients range, 0.24 to 1.02) and the daily growth rate (from 0.05 to 0.26).

Social distancing is an effective strategy to reduce the incidence of COVID-19 and illustrates the role of public compliance with social distancing measures to achieve public health benefits.

Social distancing is an effective strategy to reduce the incidence of COVID-19 and illustrates the role of public compliance with social distancing measures to achieve public health benefits.Introduction Endoscopic submucosal dissection (ESD) is a less invasive local treatment for early gastric cancer (EGC).Areas covered Japanese guidelines have recently expanded the endoscopic treatment indications for EGC. ESD is sometimes performed for lesions with a relative indication that has not previously been considered for ESD. ESD procedures are technically difficult, especially for larger and more invasive lesions. Complete resection and accurate histological assessment of EGC lesions are essential to evaluate endoscopic curability. Various endoscopic instruments, including three types of endoscopic knives and specific hemostatic forceps, have been developed, and endoscopic techniques, including the traction method, have been modified to simplify the procedure.Expert opinion An insulated-tip knife with large tissue contact allows us to perform faster incisions, while a needle-type knife with minimal tissue contact allows us to perform precise incisions. Furthermore, a scissor-type knife with grasping tissues allows us to perform more secure incision. The traction method enables the operator to proceed with submucosal dissection procedures. In cases with small lesions, snaring can be used, as well as knife dissection. Understanding the features of each endoscopic instrument and technique is essential because appropriate selection and usage contribute to successful and safe ESD procedures.Chaplains frequently serve on ethics committees, as ethics consultants, and as Institutional Review Board (IRB) members in hospitals. However, little is known about how Clinical Pastoral Education (CPE) residents are trained in ethics and whether this training is appropriate or adequate for chaplains' subsequent work in health care settings. We created a survey to canvas 222 CPE residency programs in the United States accredited by the ACPE The Standard for Spiritual Care (ACPE) to inquire about the prevalence of ethics curricula within residency programs, the educational structure of ethics curricula, and challenges associated with teaching ethics within CPE. We received a total of 84 responses for a 38% response rate. Of these, three-quarters of the programs had a required ethics curriculum, another 10% were in the process of developing one, and 18% had none. There was a great deal of variability in the ethics curricula among the different programs. Developing guidelines for a standardized ethics curriculum could help healthcare chaplains provide more effective service on ethics committees, as ethics consultants, and as IRB members.Background The regenerative efficacy of platelet-derived products has been recently investigated in the treatment of pelvic floor disorders (PFDs). We aimed to synthesize the current evidence of platelet-rich plasma (PRP) products used in urogynaecological disorders including vaginal atrophy, pelvic organ prolapse (POP), urinary incontinence, vaginal fistulas and vaginal mesh exposure. Methods A meticulous search of the currently available literature on the use of PRP for the management of PFDs was performed using 3 electronic databases. Results PRP could be a feasible alternative modality for the management of vaginal atrophy with favourable outcomes in vaginal atrophy parameters and patients' satisfaction, especially when hormone therapy is contraindicated. In patients with POP, an increase in collagen concentration after PRP application was observed while the use of PRP resulted in improvement of stress urinary incontinence symptoms. A considerable proportion of vesicovaginal fistulas were treated after application of PRP-based injections. Conclusions There is only limited evidence of the use of PRP for PFDs. Platelet-rich plasma appears to be a promising, easy to apply, cost-effective and feasible alternative therapeutic modality for the management of various urogynaecological disorders. Future randomized trials are needed to confirm the efficacy of PRP in the treatment of urogynaecological disorders.The biogenic monoamine octopamine (OA) is a crucial regulator of invertebrate physiology and behavior. Since its discovery in the 1950s in octopus salivary glands, OA has been implicated in many biological processes among diverse invertebrate lineages. It can act as a neurotransmitter, neuromodulator and neurohormone in a variety of biological contexts, and can mediate processes including feeding, sleep, locomotion, flight, learning, memory, and aggression. Here, we focus on the roles of OA in female reproduction in insects. OA is produced in the octopaminergic neurons that innervate the female reproductive tract (RT). It exerts its effects by binding to receptors throughout the RT to generate tissue- and region-specific outcomes. OA signaling regulates oogenesis, ovulation, sperm storage, and reproductive behaviors in response to the female's internal state and external conditions. Mating profoundly changes a female's physiology and behavior. CCT128930 purchase The female's OA signaling system interacts with, and is modified by, male molecules transferred during mating to elicit a subset of the post-mating changes. Since the role of OA in female reproduction is best characterized in the fruit fly Drosophila melanogaster, we focus our discussion on this species but include discussion of OA in other insect species whenever relevant. We conclude by proposing areas for future research to further the understanding of OA's involvement in female reproduction in insects.Behind the coronavirus headlines the year 2020 set multiple extreme weather records, including unprecedented wildfires in Australia and California, massive flooding in China, and back-to-back hurricanes in Central America. The impacts on the well-being of local populations have been devastating. We reviewed these extreme weather events, together with the year's newly published climate and health science reports, and identified three important themes for building health resilience in the decade ahead (1) preparing for greater magnitude and intensity of climate hazards, extreme events, and population health impacts; (2) better anticipating cascading and compound impacts on population well-being, particularly for the most vulnerable; and (3) identifying appropriate, effective preparedness tools and strategies. While decarbonizing the economy is the urgent goal to protect both human and planetary health from a changing climate, 2020 demonstrates that recognizing the likely magnitude and complexity of future extreme weather events, and preparing local public health agencies and communities with the knowledge and tools to respond to them, will be essential in this critical decade.

Benefits of community participation and physical activity for the health and wellbeing of older adults are well documented. This review aims to answer the question; "How is community participation considered for older adults in the transition from hospital to home?"

This scoping review searched key databases using subject headings and keywords. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria were adults aged ≥60 years, transitioning from hospital to home, reporting on community participation, inclusive of leisure activities, social activities, and physical activity.

Of 2206 initial unique articles, 19 met inclusion criteria. Articles covered a range of diagnoses, most frequently stroke, hip replacement, or fracture. Numerous measures of community participation were reported, identifying "low" and "reduced" community participation in ten studies. Measures of physical activity, health-related quality of life, sleep quality, and loneliness were variable. Five to promoting community participation in transition care services for older people. Older adults need information to prepare for returning home from hospital and to regain valued leisure and social activities for health-related quality of life.IMPLICATIONS FOR REHABILITATIONCommunity participation is an important component of healthy ageing which health professionals should consider beyond discharge.Levels of mobility and endurance should be considered in terms of facilitating community participation for older adults.Transition care services should provide adequate information to prepare individuals expectations of returning home following hospital stay, whilst attempting to maintain valued leisure and social activities.