Discharge destination from an acute care for the elderly (ACE) unit

Older adults age 65 and over account for a disproportional number of hospital stays and discharges compared to other age groups. The objective of this paper is to describe placement and characteristics of older patients discharged from an acute care for the elderly (ACE) unit. The study sample consists of 1,351 men and women aged 65 years or older that were discharged from the ACE Unit during a 12-month period. The mean number of discharges per month was 109.2 ± 28.4. Most of the subjects were discharged home or home with home health 841, 62.3%. The oldest elderly and patients who had been admitted from long term care institutions or from skilled nursing facilities to the ACE unit were less likely to return to home

Defectos visuales no corregidos y su relación con molestias musculo esqueléticas en cuello y espalda alta

Objective: To determine the prevalence of uncorrected ocular anomalies and its association with cervicalgias in a group of workers in the industrial sector. Methodology: Descriptive, correlational, cross-sectional study of 83 workers in the production area of ​​a lamp factory in Cali, 2011. Surveys of demographic, labor and previous visual defects were carried out. Undetected visual defects were evaluated with Snellen E optotype and direct internal and external examination to detect structural abnormalities. The presence of musculoskeletal pain in the neck and upper back was evaluated with the Nordic questionnaire. Results: The predominant visual defect was presbyopia (43.4%). The most prevalent musculoskeletal symptom was neck pain (44.6%). A significant association was found between having some visual defect and neck pain (P = 0.041). Conclusions: A relationship was found between visual defects and musculoskeletal discomfort in the neck. Periodic visual examinations are recommended to avoid the appearance of musculoskeletal disease.Objetivo: Determinar la prevalencia de anomalías oculares no corregidas y su asociación con cervicalgias en grupo de trabajadores del sector industrial. Metodología: Estudio descriptivo, correlacional, de corte transversal en 83 trabajadores del área de producción de una fábrica de lámparas en Cali, año 2011. Se realizaron encuestas de datos demográficos, laborales y defectos visuales previos. Los defectos visuales no detectados se evaluaron con, optotipo Snellen E y examen directo interno y externo para detección de anomalías estructurales. La presencia de dolor osteomuscular en cuello y espalda alta se evaluó con el cuestionario nórdico. Resultados: El defecto visual predominante fue presbicia (43,4%). El síntoma osteomuscularde mayor prevalencia fue dolor de cuello (44,6%). Se encontró una asociación significativa entre tener algún defecto visual y dolor en cuello (P=0,041). Conclusiones: Se encontró una relación entre los defectos visuales y molestias osteomusculares en cuello. Se recomienda realizar exámenes visuales periódicos para evitar la aparición de enfermedad osteomusculares

Indoor NO2 air pollution and lung function of professional cooks

Studies ofcooking- generated NO2 effects are rare in occupational epidemiology. in the present study, we evaluated the lung function of professional cooks exposed to NO2 in hospital kitchens. We performed spirometry in 37 cooks working in four hospital kitchens and estimated the predicted FVC, FEV1 and FEF25-75, based on age, sex, race, weight, and height, according to Knudson standards. NO2 measurements were obtained for 4 consecutive days during 4 different periods at 20-day intervals in each kitchen. Measurements were performed inside and outside the kitchens, simultaneously using Palm diffusion tubes. A time/exposure indicator was defined as representative of the cumulative exposure of each cook. No statistically significant effect of NO2 exposure on FVC was found. Each year of work as a cook corresponded to a decrease in predicted FEV1 of 2.5% (P=0.046) for the group as a whole. When smoking status and asthma were included in the analysis the effect of time/exposure decreased about 10% and lost statistical significance. On predicted FEF25-75, a decrease of 3.5% (P=0.035) was observed for the same group and the inclusion of controllers for smoking status and asthma did not affect the effects of time/exposure on pulmonary function parameter. After a 10-year period of work as cooks the participants of the study may present decreases in both predicted FEV1 and FEF25-75 that can reach 20 and 30%, respectively. the present study showed small but statistically significant adverse effects of gas stove exposure on the lung function of professional cooks.Univ São Paulo, Fac Med, Lab Poluicao Atmosfer Expt, BR-01246903 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Med, Disciplina Clin Med,Grp Fisiopatol Pulmonar & Pol, São Paulo, SP, BrazilABC, Fac Med, Dept Saude Coletividade, Santo Andre, SP, BrazilUniv Catolica Santos, Programa Posgrad Saude Coletiva, Santos, SP, BrazilCtr Univ Araraquara, Lab Fisioterapia Cardioresp, Araraquara, SP, BrazilUniv Estadual Paulista, Inst Quim, Araraquara, SP, BrazilHarvard Univ, Sch Publ Hlth, Dept Environm Hlth, Exposure Epidemiol & Risk Program, Boston, MA 02115 USAUniv Santo Amaro, Fac Med, Programa Pediat Ambiental, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Med, Disciplina Clin Med,Grp Fisiopatol Pulmonar & Pol, São Paulo, SP, BrazilWeb of Scienc

Inhaled Methoxyflurane Provides Greater Analgesia and Faster Onset of Action Versus Standard Analgesia in Patients With Trauma Pain: InMEDIATE: A Randomized Controlled Trial in Emergency Departments

STUDY OBJECTIVE: The objective of the InMEDIATE study was to evaluate the change in intensity of traumatic pain over the first 20 min in adult patients treated with methoxyflurane versus standard analgesic treatment in Spain. This the first randomized, active-controlled, multicenter trial of methoxyflurane in the emergency setting in Europe. METHODS: This was a randomized, controlled study that enrolled adult patients with acute moderate to severe (score >/=4 on the 11-point Numeric Rating Scale) trauma-associated pain in 14 Spanish emergency departments. Patients were randomized 1:1 to methoxyflurane (up to 2x3 mL) or standard analgesic treatment. Coprimary endpoints were the change from baseline in Numeric Rating Scale pain intensity score during the first 20 minutes of treatment and time to first pain relief. RESULTS: Three hundred five patients were randomized (methoxyflurane 156; standard analgesic treatment 149). Most patients in the standard analgesic treatment group (70%) received intravenous first-step analgesics and 9.4% of patients were treated with opioids. Mean decrease from baseline in Numeric Rating Scale pain intensity score was greater for methoxyflurane than standard analgesic treatment at all points, with a significant treatment difference overall up to 20 minutes (repeated-measures model 2.47 versus 1.39; treatment difference 1.00; 95% confidence interval 0.84 to 1.32). Median time to first pain relief was significantly shorter for methoxyflurane than standard analgesic treatment (3 versus 10 minutes). Methoxyflurane achieved better patient and clinician ratings for pain control and comfort of treatment than standard analgesic treatment and exceeded patient and clinician expectations of treatment in, respectively, 77% and 72% of cases compared with 38% and 19% for standard analgesic treatment. CONCLUSION: These results support consideration of methoxyflurane as a nonnarcotic, easy-to-administer, rapid-acting, first-line alternative to currently available analgesic treatments for trauma pain

Immune biomarkers to predict SARS-CoV-2 vaccine effectiveness in patients with hematological malignancies

There is evidence of reduced SARS-CoV-2 vaccine effectiveness in patients with hematological malignancies. We hypothesized that tumor and treatment-related immunosuppression can be depicted in peripheral blood, and that immune profiling prior to vaccination can help predict immunogenicity. We performed a comprehensive immunological characterization of 83 hematological patients before vaccination and measured IgM, IgG, and IgA antibody response to four viral antigens at day +7 after second-dose COVID-19 vaccination using multidimensional and computational flow cytometry. Health care practitioners of similar age were the control group (n = 102). Forty-four out of 59 immune cell types were significantly altered in patients; those with monoclonal gammopathies showed greater immunosuppression than patients with B-cell disorders and Hodgkin lymphoma. Immune dysregulation emerged before treatment, peaked while on-therapy, and did not return to normalcy after stopping treatment. We identified an immunotype that was significantly associated with poor antibody response and uncovered that the frequency of neutrophils, classical monocytes, CD4, and CD8 effector memory CD127low T cells, as well as naive CD21+ and IgM+D+ memory B cells, were independently associated with immunogenicity. Thus, we provide novel immune biomarkers to predict COVID-19 vaccine effectiveness in hematological patients, which are complementary to treatment-related factors and may help tailoring possible vaccine boosters

Prognostic Value of Serum Paraprotein Response Kinetics in Patients With Newly Diagnosed Multiple Myeloma

Response kinetics is not well-established as a prognostic marker in multiple myeloma (MM). We developed a mathematical model to assess the prognostic value of serum monoclonal component (MC) response kinetics during 6 induction cycles in 373 newly diagnosed MM patients. The model calculated a resistance parameter that reflects the stagnation in the response after an initial descent, dividing the patients into two kinetics categories with significantly different progression-free survival (PFS). Introduction: Response kinetics is a well-established prognostic marker in acute lymphoblastic leukemia. The situation is not clear in multiple myeloma (MM) despite having a biomarker for response monitoring (monoclonal component [MC]). Materials and Methods: We developed a mathematical model to assess the prognostic value of serum MC response kinetics during 6 induction cycles, in 373 NDMM transplanted patients treated in the GEM2012Menos65 clinical trial. The model calculated a resistance parameter that reflects the stagnation in the response after an initial descent. Results: Two patient subgroups were defined based on low and high resistance, that respectively captured sensitive and refractory kinetics, with progression-free survival (PFS) at 5 years of 72% and 59% (HR 0.64, 95% CI 0.44-0.93; P =.02). Resistance significantly correlated with depth of response measured after consolidation (80.9% CR and 68.4% minimal residual disease negativity in patients with sensitive vs. 31% and 20% in those with refractory kinetics). Furthermore, it modulated the impact of reaching CR after consolidation; thus, within CR patients those with refractory kinetics had significantly shorter PFS than those with sensitive kinetics (median 54 months vs. NR; P =.02). Minimal residual disease negativity abrogated this effect. Our study also questions the benefit of rapid responders compared to late responders (5-year PFS 59.7% vs. 76.5%, respectively [P <.002]). Of note, 85% of patients considered as late responders were classified as having sensitive kinetics. Conclusion: This semi-mechanistic modeling of M-component kinetics could be of great value to identify patients at risk of early treatment failure, who may benefit from early rescue intervention strategies. (C) 2022 The Authors. Published by Elsevier Inc

The state of the Martian climate

60°N was +2.0°C, relative to the 1981–2010 average value (Fig. 5.1). This marks a new high for the record. The average annual surface air temperature (SAT) anomaly for 2016 for land stations north of starting in 1900, and is a significant increase over the previous highest value of +1.2°C, which was observed in 2007, 2011, and 2015. Average global annual temperatures also showed record values in 2015 and 2016. Currently, the Arctic is warming at more than twice the rate of lower latitudes

Protocolos de estandarización de los datos socioeconómicos y bioculturales, articulados con el programa de evaluación y monitoreo

Este documento define métodos, herramientas y procedimientos para que los investigadores del Instituto Humboldt orienten sus estrategias de trabajo e integren los datos socioeconómicos en el marco de la Infraestructura Institucional de Datos e Información (I2DBogotáCiencias sociales y saberes de la Biodiversida

Kwapa: Gente del río. Estrategias transmedia de impacto social

El PAP Alter Código, período Primavera 2023, trabajó con los dos proyectos que se han venido trabajando en semestres anteriores: el videojuego A Orillas del río y el documental Déjennos pescar. Ambos proyectos parten de la metodología interdisciplinaria y colaborativa con miembros de la comunidad Cucapá para crear representaciones audiovisuales no estigmatizantes, que detonen el sentido de comunidad y refuercen su acervo cultural. El videojuego A Orillas del río es del género point and click, de vista isométrica, el cual está inspirado en el cuento oral tradicional El zorro y el coyote, que busca ser una herramienta lúdica de aprendizaje para reforzar el aprendizaje de la lengua Cucapá en los niños. Los resultados obtenidos fueron el demo del nivel uno (escenas uno y dos); colorimetría, arcos de personajes principales; programación de minijuegos. Dentro del documental ‘Déjennos pescar’ los resultados fueron un montaje, una clasificación del material grabado con transcripciones de audio, mientras que en la parte de estrategia de impacto se creó un manual de uso de redes sociales con colorimetría, tipografía, estilo de voz, tipo de contenido según la red social, para los futuros integrantes del equipo.ITESO, A.C