8,119 research outputs found

    Subcritical water extraction of essential oils and plant oils

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    Subcritical water extraction is a green technology with interesting advantages in relation to the possibility of processing fresh raw materials to sustainably obtain natural valuable products. The potential of this technology for the aqueous extraction of lipophilic fractions from plant biomass is well known and has recently attracted renewed interest. This review presents an update of the advances on the extraction of two valuable types of lipophilic products, essential oils and vegetal lipids from various plant biomasses. It also emphasizes the effect of process variables as particle size, time, liquid to solid ratio, pressure and temperature as well as the operation tunability to select optimal conditions for different solutes. The optimal operation conditions play a key role to efficiently recover these natural products with potential applications in cosmetic, food, agricultural and pharmaceutical/medical industries

    Supporting self-management for patients with Interstitial Lung Diseases: Utility and acceptability of digital devices.

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    This is the final version. Available from Public Library of Science via the DOI in this record. Data Availability Statement: The fully de-identified research data supporting this publication are openly available as S1 Data and at 10.6084/m9. figshare.24569851.INTRODUCTION: Patients diagnosed with Interstitial Lung Diseases (ILD) use devices to self-monitor their health and well-being. Little is known about the range of devices, selection, frequency and terms of use and overall utility. We sought to quantify patients' usage and experiences with home digital devices, and further evaluate their perceived utility and barriers to adaptation. METHODS: A team of expert clinicians and patient partners interested in self-management approaches designed a 48-question cross-sectional electronic survey; specifically targeted at individuals diagnosed with ILD. The survey was critically appraised by the interdisciplinary self-management group at Royal Devon University Hospitals NHS Foundation Trust during a 6-month validation process. The survey was open for participation between September 2021 and December 2022, and responses were collected anonymously. Data were analysed descriptively for quantitative aspects and through thematic analysis for qualitative input. RESULTS: 104 patients accessed the survey and 89/104 (86%) reported a diagnosis of lung fibrosis, including 46/89 (52%) idiopathic pulmonary fibrosis (IPF) with 57/89 (64%) of participants diagnosed >3 years and 59/89 (66%) female. 52/65(80%) were in the UK; 33/65 (51%) reported severe breathlessness medical research council MRC grade 3-4 and 32/65 (49%) disclosed co-morbid arthritis or joint problems. Of these, 18/83 (22%) used a hand- held spirometer, with only 6/17 (35%) advised on how to interpret the readings. Pulse oximetry devices were the most frequently used device by 35/71 (49%) and 20/64 (31%) measured their saturations more than once daily. 29/63 (46%) of respondents reported home-monitoring brought reassurance; of these, for 25/63 (40%) a feeling of control. 10/57 (18%) felt it had a negative effect, citing fluctuating readings as causing stress and 'paranoia'. The most likely help-seeking triggers were worsening breathlessness 53/65 (82%) and low oxygen saturation 43/65 (66%). Nurse specialists were the most frequent source of help 24/63 (38%). Conclusion: Patients can learn appropriate technical skills, yet perceptions of home-monitoring are variable; targeted assessment and tailored support is likely to be beneficial.Health Education Englan

    Perceptions of health: (dis)integration and (mis)integration of refugees in Nairobi, Kenya

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    This article utilizes 40 in-depth interviews of healthcare workers (HCWs) including Kenyan nurses, medical doctors, psychologists, pharmacists, refugee NGO officers, and others based in Nairobi who come in professional contact with Congolese and Somali refugees on a regular basis. They were asked to describe barriers to healthcare, care seeking behaviors, and pathways to care that refugees experience. These responses are juxtaposed with 60 life-history interviews, exploring the same topics with Congolese and Somali refugees living in Kawangware and Eastleigh estates. In short, this article argues that refugees and HCWs have a shared understanding of the barriers to healthcare for displaced people, such as poverty, refugee documentation issues, and inadequacy of Nairobi’s healthcare system for marginalized populations. However, there is a significant disconnect in perspectives for how healthcare integration should take place regarding major causes of ill health, such as malnutrition and poor hygiene. Refugees understand oppression as a primary structural determinant of health, whereas many HCWs take an individualized view, advocating for modifications of knowledge and behaviors of refugees rather than adjusting structural issues. This is reflective of larger processes, whereby refugees are actively “(dis)integrated” by state and society and are observed by many Kenyans as “(mis)integrating,” or integrating “wrongly” or “badly,” which has major implications for how to shape possible policy interventions

    Nucleoplasty:A new treatment option for cervical radicular pain due to a disc herniation

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    MOVEing Microorganisms:The effect of the built environment of the hospital and screening strategies on microbial safety

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    In this dissertation the results of the MOVE study are described, which determined if the transition to solely single-occupancy rooms in the new hospital building of the Erasmus MC contributed to a microbial safer hospital. Additionally, the effect of screenings methods for MDRO at admission of patients was evaluated

    A triple-masked, two-center, randomized parallel clinical trial to assess the superiority of eight weeks of grape seed flour supplementation against placebo for weight loss attenuation during perioperative period in patients with cachexia associated with colorectal cancer: a study protocol

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    BackgroundProgressive, involuntary weight and lean mass loss in cancer are linked to cachexia, a prevalent syndrome in gastrointestinal malignancies that impacts quality of life, survival and postoperative complications. Its pathophysiology is complex and believed to involve proinflammatory cytokine-mediated systemic inflammation resulting from tumor-host interaction, oxidative stress, abnormal metabolism and neuroendocrine changes. Therapeutic options for cachexia remain extremely limited, highlighting the need for clinical research targeting new interventions. Thus, this study primarily assesses the effects of grape-seed flour (GSF), rich in polyphenols and fibers, for attenuating perioperative weight loss in colorectal cancer.MethodsThis is a dual-center, triple-masked, placebo-controlled, parallel-group, phase II, randomized clinical trial designed to investigate GSF supplementation in subjects with pre- or cachexia associated with colorectal cancer during the perioperative period. Eighty-two participants will receive 8g of GSF or cornstarch (control) for 8 weeks. Assessments are scheduled around surgery: pre-intervention (4 weeks prior), day before, first week after, and post-intervention (4 weeks later). The primary endpoint is the difference in body weight mean change from baseline to week 8. The secondary endpoints describe the harms from 8-week supplementation and assess its superiority to improve body composition, post-surgical complications, quality of life, anorexia, fatigue, gastrointestinal symptoms, and handgrip strength. The study will also explore its effects on gut bacteria activity and composition, systemic inflammation, and muscle metabolism.DiscussionThe current trial addresses a gap within the field of cancer cachexia, specifically focusing on the potential role of a nutritional intervention during the acute treatment phase. GSF is expected to modulate inflammation and oxidative stress, both involved in muscle and intestinal dysfunction. The research findings hold substantial implications for enhancing the understanding about cachexia pathophysiology and may offer a new clinical approach to managing cachexia at a critical point in treatment, directly impacting clinical outcomes.Trial registrationThe Brazilian Registry of Clinical Trials (ReBEC), RBR-5p6nv8b; UTN: U1111-1285-9594. Prospectively registered on February 07, 2023

    Musculoskeletal complaints in primary care:Constraining healthcare costs, rethinking the deployment of healthcare professionals

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    Worldwide policy makers are challenged to account for rising healthcare costs and increased healthcare demand. Also, in the Netherlands there is a growing concern how to maintain high-quality and accessible care while keeping costs in check. Access to care is under pressure as the demand for care is rising fast, due to an aging population and an increasing number of chronically ill people. Not only at the policy level, but also in clinical practice challenges exist. The workload in the health care sector is high, causing health workers, such as general practitioners (GPs), to leave this sector. To keep costs in check available resources need be allocated as efficiently as possible. A good starting point for evaluating healthcare costs may be assessing large patient groups that are responsible for high resource use and costs, such as patients with musculoskeletal conditions treated in general practice. Another point may be identifying prognostic factors for higher healthcare costs. Besides lowering costs, it is also of importance to keep GP care accessible by lowering GPs’ workload. One of the ways to address GPs’ high workload is task reallocation. Internationally, positive effects have been found for an Advanced Physiotherapy Practitioner (APP) model of care, in which APPs take over tasks from a physician in the care for patients with musculoskeletal conditions. This model of care could potentially be of value in reducing the workload of Dutch GPs and keeping GP care accessible. Besides lowering healthcare cost and decreasing GPs’ workload maintaining good quality care is essential. One of the most widely used Patient Reported Outcome Measures (PROMs) in assessing quality of healthcare is the EQ-5D, a preference-based measurement instrument that measures health related quality of life and is used to estimate utility values that represent the preferences of the general population of a country for given health states. These utility values are needed for estimating Quality-Adjusted Life-Years (QALYs) in cost effectiveness analysis. However, quality-of-life measurements are generally not available when data are collected for clinical purposes, such as data from GP electronic medical records. Therefore, researchers are exploring ways to estimate EQ-5D based utility values by means of outcomes on other available health related outcome measures. This thesis aimed to explore some of the challenges in Dutch primary care by evaluating 1) healthcare utilization and associated cost of GP-guided care in patients with musculoskeletal complaints, 2) the introduction of an APP model of care, and 3) different approaches to estimate missing EQ-5D based utility values

    Nucleoplasty:A new treatment option for cervical radicular pain due to a disc herniation

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    Supporting self-management for patients with Interstitial Lung Diseases:Utility and acceptability of digital devices

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    INTRODUCTION: Patients diagnosed with Interstitial Lung Diseases (ILD) use devices to self-monitor their health and well-being. Little is known about the range of devices, selection, frequency and terms of use and overall utility. We sought to quantify patients' usage and experiences with home digital devices, and further evaluate their perceived utility and barriers to adaptation.METHODS: A team of expert clinicians and patient partners interested in self-management approaches designed a 48-question cross-sectional electronic survey; specifically targeted at individuals diagnosed with ILD. The survey was critically appraised by the interdisciplinary self-management group at Royal Devon University Hospitals NHS Foundation Trust during a 6-month validation process. The survey was open for participation between September 2021 and December 2022, and responses were collected anonymously. Data were analysed descriptively for quantitative aspects and through thematic analysis for qualitative input.RESULTS: 104 patients accessed the survey and 89/104 (86%) reported a diagnosis of lung fibrosis, including 46/89 (52%) idiopathic pulmonary fibrosis (IPF) with 57/89 (64%) of participants diagnosed &gt;3 years and 59/89 (66%) female. 52/65(80%) were in the UK; 33/65 (51%) reported severe breathlessness medical research council MRC grade 3-4 and 32/65 (49%) disclosed co-morbid arthritis or joint problems. Of these, 18/83 (22%) used a hand- held spirometer, with only 6/17 (35%) advised on how to interpret the readings. Pulse oximetry devices were the most frequently used device by 35/71 (49%) and 20/64 (31%) measured their saturations more than once daily. 29/63 (46%) of respondents reported home-monitoring brought reassurance; of these, for 25/63 (40%) a feeling of control. 10/57 (18%) felt it had a negative effect, citing fluctuating readings as causing stress and 'paranoia'. The most likely help-seeking triggers were worsening breathlessness 53/65 (82%) and low oxygen saturation 43/65 (66%). Nurse specialists were the most frequent source of help 24/63 (38%). Conclusion: Patients can learn appropriate technical skills, yet perceptions of home-monitoring are variable; targeted assessment and tailored support is likely to be beneficial.</p

    Does a blended learning implementation package enhance HIV index case testing in Malawi? A protocol for a cluster randomised controlled trial

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    Introduction Index case testing (ICT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention services. In Malawi, delivery of ICT has faced challenges due to limited technical capacity of healthcare workers (HCWs) and clinical coordination. Digitisation of training and quality improvement processes presents an opportunity to address these challenges. We developed an implementation package that combines digital and face-to-face modalities (blended learning) to strengthen HCWs ICT skills and enhance quality improvement mechanisms. This cluster randomised controlled trial will assess the impact of the blended learning implementation package compared with the standard of care (SOC) on implementation, effectiveness and cost-effectiveness outcomes.Methods and analysis The study was conducted in 33 clusters in Machinga and Balaka districts, in Southern Malawi from November 2021 to November 2023. Clusters are randomised in a 2:1 ratio to the SOC versus blended learning implementation package. The SOC is composed of: brief face-to-face HCW ICT training and routine face-to-face facility mentorship for HCWs. The blended learning implementation package consists of blended teaching, role-modelling, practising, and providing feedback, and blended quality improvement processes. The primary implementation outcome is HCW fidelity to ICT over 1 year of follow-up. Primary service uptake outcomes include (a) index clients who participate in ICT, (b) contacts elicited, (c) HIV self-test kits provided for secondary distribution, (d) contacts tested and (e) contacts identified as HIV-positive. Service uptake analyses will use a negative binomial mixed-effects model to account for repeated measures within each cluster. Cost-effectiveness will be assessed through incremental cost-effectiveness ratios examining the incremental cost of each person tested.Ethics and dissemination The Malawi National Health Science Research Committee, the University of North Carolina and the Baylor College of Medicine Institutional Review Boards approved the trial. Study findings will be disseminated through peer-reviewed journals and conference presentations.Trial registration number NCT05343390
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