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One metabolic equivalent (MET) is equal to resting oxygen consumption. The average value for one MET in humans is widely quoted as 3.5ml/kg/min. However this value was derived from a single male participant at the end of the nineteenth century and has become canonical. Several small studies have identified varied estimates of one MET from widely varying populations. The ability of a patient to complete 4 METS (or 14mls/kg/min) is considered an indicator of their fitness to proceed to surgery.

The study aimed to define a typical value of one MET from a real-world patient population, as well as determine factors that influenced the value.

A database of cardiopulmonary exercise tests (CPET) tests was interrogated to find total of 1847 adult patients who had undergone CPET testing in the previous 10 years. From this database, estimates of oxygen consumption (VO

) at rest and at the anaerobic threshold and a number of other variables were obtained. The influence of age, body mass index (BMI), sex and the use of beta blockers was tested.

The median resting VO

at rest was 3.6ml/kg/min (IQR 3.0-4.2). Neither sex nor age greater than 65 years nor the use of beta blockers produced a significant difference in resting VO

, while those with a BMI greater than 25 had a significantly lower VO

at rest (3.4ml/kg/min vs 4.0ml/kg/min, p <0.001).

The estimate of 3.6ml/kg/min for resting VO

presented here is consistent with the previous literature, despite this being the first large study of its kind. This estimate can be safely used for pre-operative risk stratification. This article is protected by copyright. All rights reserved.

The estimate of 3.6ml/kg/min for resting VO2 presented here is consistent with the previous literature, despite this being the first large study of its kind. This estimate can be safely used for pre-operative risk stratification. This article is protected by copyright. All rights reserved.This study analysed whether Situation-Background-Assessment-Recommendation (SBAR) simulation, which uses a flipped learning method, improves undergraduate nursing students' academic performance and core competencies when applied in the mental health nursing practicum, as compared with traditional in-person simulations. To this end, a retrospective survey was employed. A group of 37 students who participated in the flipped learning-based SBAR simulation practicum was compared with a group of 37 students who participated in the practicum using a traditional learning method, in terms of their academic performance and core competencies. The 90-h practicum included four three-hour SBAR simulation sessions. Students were assessed at baseline, immediately after the two-week practicum, and four weeks later. The effects of group, time, and group-by-time interactions between the groups were verified using generalized estimating equations with an autoregressive correlation structure. Data were collected between March and July 2017, in South Korea. The results indicated that SBAR simulation significantly improved nursing students' communication performance compared with the traditional learning method. Delamanid order The clinical practicum based on SBAR improved core competencies at the post-practicum and four weeks later. In conclusion, the application of the flipped learning-based SBAR simulation can improve nursing students' communication skills and can be utilized as an effective teaching method to promote higher order competencies to apply, analyse, and evaluate knowledge beyond simple understanding and information recall. This study has addressed how academic performance and core competencies in nursing can be improved through SBAR simulation using a flipped learning method and shown its positive impact on nursing students' communication skills and higher order competencies.

Rheumatoid arthritis (RA) is a common autoimmune disease where methotrexate is widely used as first-line therapy. The combination of RA and methotrexate are associated with lymphoproliferative disorders. RA patients with Epstein-Barr virus (EBV) have impaired T-lymphocyte function, thus allowing an overgrowth of EBV-positive lymphoblastoid cells. We examined the association of EBV with lymphoproliferative disorders in immunosuppressed RA patients, particularly those treated with methotrexate.

We reported two cases of RA patient with long-term methotrexate treatment who subsequently developed EBV-positive lymphoproliferative disorder, followed by a review of the relevant literature.

Compared with normal population, RA patients have a higher risk of lymphoma with diffused large B-cell lymphoma the most common subtype. Methotrexate withdrawal can lead to lymphoma regression. Other biological therapies, such as abatacept and tocilizumab, are not associated with increased EBV-positive lymphoma diagnosis in RA patients.

The association between EBV, lymphoma and methotrexate highlight the need to consider reducing or stopping methotrexate in patients that have had stable RA for many years. This article is protected by copyright. All rights reserved.

The association between EBV, lymphoma and methotrexate highlight the need to consider reducing or stopping methotrexate in patients that have had stable RA for many years. This article is protected by copyright. All rights reserved.

Psoriasis, a chronic inflammatory skin disease, is associated with altered intestinal microbiota. Here, we investigated the ameliorative effect of Leuconostoc mesenteroides NTM048 strain in imiquimod (IMQ)-induced psoriasis in mice.

Mice were administered NTM048 for 21days alongside the topical application of IMQ on the dorsal skin for 6 consecutive days. IMQ induced psoriatic symptoms such as erythema and scaling and also upregulated interleukin (IL)-17, a key effector cytokine of psoriasis, in the skin. Supplemental NTM048 suppressed these abnormalities, increased the levels of plasma deoxycholic acid (DCA), a secondary bile acid and altered the faecal microbiota composition, as indicated by the increased abundance of Akkermansia and decreased abundance of Staphylococcus and Streptococcus. Notably, DCA treatment of murine splenocytes reduced IL-17 production.

The NTM048-mediated reduction of psoriasis was shown to involve the downregulation of IL-17 in mouse skin, which was possibly associated with the plasma DCA derived from intestinal microbiota.

Our findings propose not only a novel approach for psoriasis reduction but also a crosstalk between the skin and intestine in psoriasis.

Our findings propose not only a novel approach for psoriasis reduction but also a crosstalk between the skin and intestine in psoriasis.

A third of children admitted to paediatric intensive care units (PICUs) in the United Kingdom (UK) are transported by paediatric critical care transport services (PCCTs). Parents have described the transfer journey as particularly stressful. Critical care nurses have a key role in mitigating the impact of the journey on parents. Evaluating parents' experiences is important to inform service improvements.

Our aim was to describe the development of a new measure of parents' experiences of PCCTs, derived from data collected in the Differences in access to Emergency Paediatric Intensive Care and care during Transport (DEPICT) study.

A descriptive cross-sectional survey was used.

As part of the DEPICT study, a 17-item transport experience questionnaire was developed and given to parents of children transported by PCCTs to 24 UK PICUs during a 12-month period. Analyses included exploratory factor analysis and a validation review by a PCCT stakeholder group.

Families of 1722 children (1798 journeys) completter to improve experience.

Being able to measure experience provides an opportunity to understand how to make services better to improve experience.

Arbuscular mycorrhizal fungi (AMF) are often regarded as non-specific symbionts, but some AMF communities show host preference in various ecosystems including vineyards. Grapevine plants are very responsive to AMF colonization. Although these fungi have potentially significant applications for sustainable agricultural ecosystems, there is a gap in knowledge regarding AMF-grapevine interactions worldwide and especially in New Zealand. This study focused on identifying AMF taxa colonizing grapevines in New Zealand vineyards and investigated the effect of grapevine rootstocks on AMF community diversity and composition.

Denaturing gradient gel electrophoresis (DGGE) and trap cultures were used to characterize the AMF communities. Grapevine roots from three vineyards and nine rootstocks were analysed by DGGE and used in trap cultures for AMF recovery. Trap cultures allowed the recovery of six AMF spore morphotypes that belonged to Ambispora sp., Claroideoglomus sp., Funneliformis sp. and Glomus sp. Bands excised, reamplified and sequenced from the DGGE were assigned to Glomus sp., Rhizophagus sp. and Claroideoglomus sp. The AMF community analyses demonstrated that rootstock significantly (P<0·05) influenced the AMF community composition in all sites.

The study showed that for a comprehensive identification of AMF, both results from trap culture and molecular work were needed and that the rootstock cultivar was the main driver of the arbuscular mycorrhizal community colonizing the roots.

This study provides a firm foundation for future research exploring the beneficial use of AMF in enhancing grapevine production and sustainability.

This study provides a firm foundation for future research exploring the beneficial use of AMF in enhancing grapevine production and sustainability.There are increasing reports of autoimmune and dermatologic sequelae of COVID-19. We describe an otherwise healthy patient with recent history of serious COVID-19 infection who developed post-surgical pyoderma gangrenosum following bilateral reduction mammoplasty and was successfully treated with infliximab, mycophenolic acid, and corticosteroids. We present this case to highlight the lingering systemic proinflammatory effects of COVID-19 infection that may increase the risk of rare autoimmune complications of surgery. As a complete understanding of the long-term effects of COVID-19 is poorly understood, patients with a history of COVID-19 infection should be appropriately counseled to these possible risks when discussing surgery.Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder characterized by the progressive loss of striatal medium spiny neurons. Using a highly efficient protocol for direct reprogramming of adult human fibroblasts with chemically modified mRNA, we report the first generation of HD induced neural precursor cells (iNPs) expressing striatal lineage markers that differentiated into DARPP32+ neurons from individuals with adult-onset HD (41-57 CAG). While no transcriptional differences between normal and HD reprogrammed neurons were detected by NanoString nCounter analysis, a subpopulation of HD reprogrammed neurons contained ubiquitinated polyglutamine aggregates. Importantly, reprogrammed HD neurons exhibited impaired neuronal maturation, displaying altered neurite morphology and more depolarized resting membrane potentials. Reduced BDNF protein expression in reprogrammed HD neurons correlated with increased CAG repeat lengths and earlier symptom onset. This model represents a platform for investigating impaired neuronal maturation and screening for neuronal maturation modifiers to treat HD.