99 research outputs found

    Effectiveness of motivational interviewing on health-service use and mortality: a secondary outcome analysis of the MOTIVATE-HF trial

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    Aims Intense health-care service use and high mortality are common in heart failure (HF) patients. This secondary analysis of the MOTIVATE-HF trial investigates the effectiveness of motivational interviewing (MI) in reducing health-care service use (e.g. emergency service use and hospitalizations) and all-cause mortality.Methods and results This study used a randomized controlled trial. Patients and caregivers were randomized to Arm 1 (MI for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (control group). Data were collected at baseline and at 3, 6, 9, and 12 months. Face-to-face MI plus three telephone calls were performed in Arms 1 and 2. The sample consisted of 510 patient (median age 74 years, 58% male patients) and caregiver dyads (median age 55 years, 75% female patients). At 12 months, 16.1%, 17%, and 11.2% of patients used health-care services at least once in Arms 1, 2, and 3, respectively, without significant difference. At 3 months, 1.9%, 0.6%, and 5.1% of patients died in Arms 1, 2, and 3, respectively. Mortality was lower in Arm 2 vs. Arm 3 at 3 months [hazard ratio (HR) = 0.112, 95% CI: 0.014-0.882, P = 0.04]; no difference was found at subsequent follow-ups. Mortality was lower in Arm 1 vs. Arm 3 at 3 months but did not reach statistical significance (HR = 0.38, 95% CI: 0.104-1.414, P = 0.15).Conclusion This study suggests that MI reduces mortality in patients with HF if caregivers are included in the intervention. Further studies with a stronger intervention and longer follow-up are needed to clarify the benefits of MI on health-care service use and mortality

    c-di-GMP Turn-Over in Clostridium difficile Is Controlled by a Plethora of Diguanylate Cyclases and Phosphodiesterases

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    Clostridium difficile infections have become a major healthcare concern in the last decade during which the emergence of new strains has underscored this bacterium's capacity to cause persistent epidemics. c-di-GMP is a bacterial second messenger regulating diverse bacterial phenotypes, notably motility and biofilm formation, in proteobacteria such as Vibrio cholerae, Pseudomonas aeruginosa, and Salmonella. c-di-GMP is synthesized by diguanylate cyclases (DGCs) that contain a conserved GGDEF domain. It is degraded by phosphodiesterases (PDEs) that contain either an EAL or an HD-GYP conserved domain. Very little is known about the role of c-di-GMP in the regulation of phenotypes of Gram-positive or fastidious bacteria. Herein, we exposed the main components of c-di-GMP signalling in 20 genomes of C. difficile, revealed their prevalence, and predicted their enzymatic activity. Ectopic expression of 31 of these conserved genes was carried out in V. cholerae to evaluate their effect on motility and biofilm formation, two well-characterized phenotype alterations associated with intracellular c-di-GMP variation in this bacterium. Most of the predicted DGCs and PDEs were found to be active in the V. cholerae model. Expression of truncated versions of CD0522, a protein with two GGDEF domains and one EAL domain, suggests that it can act alternatively as a DGC or a PDE. The activity of one purified DGC (CD1420) and one purified PDE (CD0757) was confirmed by in vitro enzymatic assays. GTP was shown to be important for the PDE activity of CD0757. Our results indicate that, in contrast to most Gram-positive bacteria including its closest relatives, C. difficile encodes a large assortment of functional DGCs and PDEs, revealing that c-di-GMP signalling is an important and well-conserved signal transduction system in this human pathogen

    Bank Leverage Ratios and Financial Stability: A Micro- and Macroprudential Perspective

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    Effect of Vacuum Impregnation Treatments to Improve Quality and Texture of Zucchini (Cucurbita Pepo, L).

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    Vacuum Impregnation (VI) is a non-destructive technology, used to introduce external liquids, in the porous structures of food matrices favored by the action of hydrodynamic mechanism as promoted by pressure changes. Previous studies evidenced the potentiality to apply VI to zucchini [2] but no systematic studies have been carried out yet. Aim of this study was to investigate the effect of VI by using mixed solutions containing structuring ability components (maltodextrins, salt and CaCl2) with on quality and microstructural properties of zucchini. Slices of zucchini (0.5-cm thick) (Cucurbita pepo, L.) were subjected to VI treatments. VI solutions with different solutes composition were investigated: maltodextrines, NaCl and CaCl2 were used to prepare single (1 solute) or mixed (2 and 3 solutes) VI solutions Samples were analysed for total solids, soluble solids, salt and [Ca] content, textural properties (shear force, relaxation test), sensory and microstructure (Cryo-SEM). Mass balance (Solute Gain/Loss, Water Gain/Loss) was also computed. The composition of the VI solution affected mass transfer. A significant change in the textural properties was observed in zucchini processed with VI solutions containing NaCl and MD; the presence of CaCl2 in the VI solution in combination with the other solutes, was able limit the hardness loss and when alone even to determine an hardening effect. Cryo-SEM analysis highlighted a different effect on microstructure of the vegetable tissue due the use of the single or mixed VI solutions. The use of VI mixed solutions made with MD, NaCl and CaCl2 to process zucchini allows to favour solute and water gain while limiting textural and microstructural change

    EFFECT OF PHENOLIC ANTIOXIDANT COMPOUNDS ON THE COLLOIDAL PROPERTIES AND ON THE OXIDATIVE STABILITY OF OLIVE OIL O/W EMULSIONS

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    Oil-in-water (O/W) emulsions are among the main dispersed lipid systems in food. Antioxidants are often used in order to avoid or to reduce the rate of lipid oxidation reactions that, in this case, can be mainly considered as interfacial phenomena. Interaction might take place at this level between the emulsifying agents, antioxidant and the pro-oxidant compounds that affects the colloidal properties of the system and the oxidative stability. 2-Objective i) to study how antioxidant molecules and the interactions between these compounds and emulsifying agents at the interfacial level can modify the colloidal properties of a characterised emulsified system ii) to study the effect of the content and activity of antioxidants on lipid oxidation in emulsified systems over storage time 3- Methods Emulsions were prepared using refined olive oil (20% w/w) and PBS (50mM, pH 7). Gallic acid, catechin and quercetin were chosen as antioxidant compounds while Tween 20 and β-lactoglobulin were used as surface active agents. Surface tension measurements, ξ-sizing and ξ-potential were carried out on model solutions containing the phenolic compounds both alone and in combination with the emulsifying agents. Particle size distribution, bulk rheology, lipid hydroperoxide content, TBAR’s and tryptophan fluorescence determinations were carried out on the emulsified systems over storage time (33 days at 40°C). 4-Results All the antioxidants proved to be slightly surface active with catechin being the most efficient among them. In emulsions, quercetin and catechin concentrations were negatively correlated against droplet size. The antioxidant concentration used to test the emulsions' oxidative stability was set to10-4 M according to colloidal and rheological measurements in order to have the maximum amount of antioxidant solubilised in the system without altering their overall colloidal properties. Gallic acid, despite its partitioning in the water phase, due to its polarity proved to delay both the primary and secondary oxidations and to retard the formation of oxidation products. 5- Significance of the research to the food engineering field This research could find obvious practical application in the development of innovative formulated multi-phased food and beverages as well as nutraceuticals
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