Buchkaufman8840

The aggregation method used was a weighted linear combination, and the index is rated on a 0 to 1 scale. The ICWM was tested in four municipalities. In all cases, the management was considered inefficient. The proposed tool proved to be effective in evaluating the CWM. In cities where the ICWM was tested, it was possible to identify the significant deficiencies of the CWM and recommend improvement actions to develop more efficient and sustainable management.Background Limited data are available on the prospective relationship between beverage consumption and plasma lipid and lipoprotein concentrations. Two major sources of sugar in the US diet are sugar-sweetened beverages (SSBs) and 100% fruit juices. Low-calorie sweetened beverages are common replacements. Methods and Results Fasting plasma lipoprotein concentrations were measured in the FOS (Framingham Offspring Study) (1991-2014; N=3146) and Generation Three (2002-2001; N=3584) cohorts. Beverage intakes were estimated from food frequency questionnaires and grouped into 5 intake categories. Mixed-effect linear regression models were used to examine 4-year changes in lipoprotein measures, and Cox proportional hazard models were used to estimate hazard ratios for incident dyslipidemia, adjusting for potential confounding factors. We found that regular (>1 serving per day) versus low ( less then 1 serving per month) SSB consumption was associated with a greater mean decrease in high-density lipoprotein cholesterncreased SSB consumption may contribute to the development of dyslipidemia.Background Electronic medical records (EMRs) allow identification of disease-specific patient populations, but varying electronic cohort definitions could result in different populations. We compared the characteristics of an electronic medical record-derived atrial fibrillation (AF) patient population using 5 different electronic cohort definitions. Methods and Results Adult patients with at least 1 AF billing code from January 1, 2010, to December 31, 2017, were included. Based on different electronic cohort definitions, we trained 5 different logistic regression models using a labeled training data set (n=786). Each model yielded a predicted probability; patients were classified as having AF if the probability was higher than a specified cut point. Test characteristics were calculated for each model. These models were then applied to the full cohort and resulting characteristics were compared. In the training set, the comprehensive model (including demographics, billing codes, and natural language processing results) performed best, with an area under the curve of 0.89, sensitivity of 0.90, and specificity of 0.87. Among a candidate population (n=22 000), the proportion of patients identified as having AF varied from 61% in the model using diagnosis or procedure International Classification of Diseases (ICD) billing codes to 83% in the model using natural language processing of clinical notes. Among identified AF patients, the proportion of patients with a CHA2DS2-VASc score ≥2 varied from 69% to 85%; oral anticoagulant treatment rates varied from 50% to 66% depending on the model. Conclusions Different electronic cohort definitions result in substantially different AF study samples. This difference threatens the quality and reproducibility of electronic medical record-based research and quality initiatives.Background Optimal blood pressure in elderly patients after acute myocardial infarction is still a matter of debate. In a prospective observational study, we aimed to identify optimal systolic blood pressure during the 48 first hours after admission for acute myocardial infarction and its prognostic value for cardiovascular mortality. Methods and Results From the Observatoire des Infarctus de Côte d'Or survey, all consecutive patients aged >75 years admitted for an acute myocardial infarction in a coronary care unit from 2012 to 2015 and discharged alive were included (n=814). Exclusion criteria were in-hospital death, cardiogenic shock, and end-stage renal disease. Average systolic blood pressure (aSBP) values over the first 48 hours after admission were recorded, and the population was dichotomized into 2 groups low aSBP group ( less then 125 mm Hg) and control group (aSBP ≥125 mm Hg). When compared with patients without cardiovascular death at 1-year follow-up, patients who died from a cardiovascular cause had higher rate of cardiovascular risks factors, including age, diabetes mellitus, comorbidities, and cardiovascular history. They had higher rates of low body mass index ( less then 21 kg/m2) and more elevated Global Registry of Acute Coronary Events risk score. Patients with aSBP less then 125 mm Hg had a 2-fold risk of 1-year cardiovascular death (47 [12.0%] versus 28 [6.6%]; P=0.008). By multivariable logistic regression analysis, low aSBP (odds ratio [95% CI], 1.91 [1.07-3.41]) remained a strong and independent predictor of 1-year cardiovascular mortality. Conclusions In our large population-based study in elderly patients with acute myocardial infarction, low aSBP was an independent and powerful predictor of 1-year cardiovascular mortality. Early aSBP measurement could help to improve risk stratification. Moreover, our results may suggest an optimal blood pressure target in elderly patients.Paediatric acquired brain injury (ABI) is associated with long-term negative sequelae, and families must continually adapt to meet the needs of the child with ABI and family members. Condition-specific camps may support families in this process. This study explored the experience of camps for children with ABI and their families from the perspective of children and young people with ABI and their siblings. Semi-structured interviews were conducted with 10 people with ABI (Mage = 23.93, SD = 16.52 years) and 19 siblings of people with ABI (Mage = 14.53, SD = 5.73 years). Using reflexive thematic analysis, the central theme identified was "My safe space," supported by three further themes "Having fun and relaxing," "Making friends," and "Enjoying choices." Camp was a space where the shared understanding and acceptance of ABI created a sense of safety. This was facilitated by enjoying activities, developing friendships with peers who shared the experience of ABI, and having a sense of control through choice availability. Thus, camps appear to offer opportunities to enjoy typical childhood experiences while restoring a sense of security, increasing understanding of ABI and validating attendees' experiences. Camps may, therefore, offer low-cost interventions to support children with ABI and their families.Background Test and Treat has been widely adopted throughout sub-Saharan Africa, whereby all HIV-positive individuals initiate antiretroviral therapy (ART) immediately upon diagnosis and continue for life. However, clients who feel healthy may delay ART initiation, despite being eligible under new treatment guidelines.Objective We examined health care worker (HCW) perceptions and experiences on how feeling healthy positively or negatively influences treatment initiation among HIV-positive clients in Malawi.Methods We conducted 12 focus group discussions with 101 HCWs across six health facilities in Central Malawi. Data were analyzed through constant comparison methods using Atlas.ti7.5.Results Feeling healthy influences perceptions of ART initiation among HIV-positive clients. HCWs described that healthy clients feel that there are few tangible benefits to immediate ART initiation, but numerous risks. Fear of stigma and unwanted disclosure, disruption of daily activities, fear of side effects, and limited knowledge about the benefits of early initiation were perceived by HCWs to deter healthy clients from initiating ART.Conclusion Feeling healthy may exacerbate barriers to ART initiation. Strategies to reach healthy clients are needed, such as chronic care models, differentiated models of care that minimize disruptions to daily activities, and community sensitization on the benefits of early initiation.none.Growing stockpiles of waste oil sludge (WOS) are an outstanding problem worldwide. Self-sustaining Treatment for Active Remediation applied ex situ (STARx) is a treatment technology based on smoldering combustion. Pilot-scale experiments for the STARx Hottpad prove this new concept for the mobile treatment of WOS mixed intentionally with sand or contaminated soil. The experiments also allowed for the calibration and validation of a smoldering propagation numerical model. The model was used to systematically explore the sensitivity of Hottpad performance to system design, operational parameters, and environmental factors. Pilot-scale (~1.5 m width) simulations investigated sensitivity to injected air flux, WOS saturation, heterogeneity of intrinsic permeability, and heterogeneity of WOS saturation. Results reveal that Hottpad design is predicted to be successful for WOS treatment across a wide range of scenarios. The operator can control the rate of WOS destruction and extent of treatment by increasing the air flux injected into the bed. The potential for smoldering channeling to develop was demonstrated for the first time. Under certain conditions, such as WOS saturations of 80%, high heterogeneity of WOS saturations, or moderate to high heterogeneity of soil permeability, smoldering channeling was predicted to accelerate to the point that remedial performance was degraded. Field-scale simulations (~10 m width) predicted successful treatment, with WOS destruction rates an order of magnitude higher than the pilot-scale and treatment times increasing only linearly with bed height. This work is a key step toward the design and effective operation of field STARx Hottpad systems for eliminating WOS.Rationale Excessive angiotensin II (Ang II) levels lead to a pro-fibrotic and hypertrophic milieu that produces deleterious remodeling and dysfunction in hypertension-associated heart failure. Agents that disrupt Ang II-induced cardiac dysfunction may have clinical utility in the treatment of hypertension-associated heart failure. Objective We have examined the potential effect of Celastrol, a bioactive compound derived from the Celastraceae family, on Ang II-induced cardiac dysfunction. Methods and Results In rat primary cardiomyocytes and H9C2 cells, Celastrol attenuates Ang II-induced cellular hypertrophy and fibrotic responses. Proteome microarrays, surface plasmon resonance, competitive binding assays, and molecular simulation were used to identify the molecular target of Celastrol. Our data showed that Celastrol directly binds to and inhibits signal transducer and activator of transcription-3 (STAT3) phosphorylation and nuclear translocation. Functional tests demonstrated that the protection of Celastrol is afforded through targeting STAT3. Overexpression of STAT3 dampens the effect of Celastrol by partially rescuing STAT3 activity. Finally, we investigated the in vivo effect of Celastrol treatment in mice challenged with Ang II and in the Transverse aortic constriction (TAC) model. We show that Celastrol administration protected heart function in Ang II- and TAC-challenged mice by inhibiting cardiac fibrosis and hypertrophy. Conclusions Our studies show that Celastrol inhibits Ang II-induced cardiac dysfunction by inhibiting STAT3 activity.