DVT Surveillance Program in the ICU: Analysis of Cost-Effectiveness

Background Venous Thrombo-embolism (VTE – Deep venous thrombosis (DVT) and/or pulmonary embolism (PE) – in traumatized patients causes significant morbidity and mortality. The current study evaluates the effectiveness of DVT surveillance in reducing PE, and performs a cost-effectiveness analysis. Methods All traumatized patients admitted to the adult ICU underwent twice weekly DVT surveillance by bilateral lower extremity venous Duplex examination (48-month surveillance period – SP). The rates of DVT and PE were recorded and compared to the rates observed in the 36-month pre-surveillance period (PSP). All patients in both periods received mechanical and pharmacologic prophylaxis unless contraindicated. Total costs – diagnostic, therapeutic and surveillance – for both periods were recorded and the incremental cost for each Quality Adjusted Life Year (QALY) gained was calculated. Results 4234 patients were eligible (PSP – 1422 and SP – 2812). Rate of DVT in SP (2.8%) was significantly higher than in PSP (1.3%) – p Conclusions Surveillance of traumatized ICU patients increases DVT detection and reduces PE incidence. Costs in terms of QALY gained compares favorably with other interventions accepted by society

Exposición natural y envejecimiento acelerado de polietilenos para invernaderos, en diferentes condiciones climáticas

p.221-228Se evaluaron las propiedades mecánicas y ópticas de cuatro films de polietileno durante tres años de envejecimiento natural a la intemperie y mil horas de envejecimiento acelerado en laboratorio. Se expusieron en Yavi (Jujuy, Argentina) y se siguieron las normas A.S.T.M. Se correlacionaron los resultados obtenidos a la intemperie con los de envejecimiento acelerado para predecir la vida útil de un plástico, en condiciones climáticas similares, realizando sólo ensayos de laboratorio. Se observó que las propiedades mecánicas alcanzan más rápido las condiciones de envejecimiento y, por lo tanto, son mas relevantes para caracterizar el comportamiento de los mismos. Se analizaron las propiedades en función de la radiación solar y la precipitación acumulada, para independizarse de las variaciones climáticas. En Yavi la duración de los plásticos fue mayor que en Buenos Aires (Capital Federal, Argentina), en el mismo período. Se concluye que aunque la radiación en Yavi es elevada, el menor deterioro de los films probablemente sea por la baja precipitación y ausencia de contaminación

Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States

Background Transgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision. Methods In 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings. Results Of 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost. Conclusions These data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting

Circulating extracellular vesicles and particles derived from adipocytes : the potential role in spreading microRNAs associated with cellular senescence

Aging is associated with adipose tissue dysfunction and is recognized as a risk factor for shortened life span. Considering that in vitro findings have shown the involvement of microRNA in extracellular vesicles and particles (EVPs) on senescence, we hypothesized that circulating EVPs derived from adipocytes can be involved in the aging process via their microRNA cargo. We aimed to determine the microRNA profiles of circulating EVPs derived from adipocytes (FABP4+) from aged and young adult animals and to perform in silico prediction of their downstream signaling effects. Plasma was obtained from Wistar rats (3 and 21 months old), and adipocyte-derived EVPs were isolated using the commercially available kit. Fatty acid-binding protein 4 (FABP4) was used for adipocyte-derived EVPs isolation; microRNA isolation and microarray expression analysis were performed. The analysis revealed 728 miRNAs, 32 were differentially between groups (p < 0.05; fold change ≥ |1.1|), of which 15 miRNAs were upregulated and 17 were downregulated in circulating EVPs from aged animals compared to young adults. A conservative filter was applied, and 18 microRNAs had experimentally validated and highly conserved predicted mRNA targets, with a total of 2,228 mRNAs. Canonical pathways, disease and functions, and upstream regulator analyses were performed using IPA-QIAGEN, allowing a global and interconnected evaluation. IPA categories impacted negatively were cell cycle, cellular development, cellular growth and proliferation, and tissue development, while those impacted positively were “digestive system cancer” and “endocrine gland tumor.” Interestingly, the upregulated miR-15-5p targets several cyclins, such as CCND1 and CCND2, and miR-24-3p seems to target CDK4 (cyclin-dependent kinase 4); then potentially inhibiting their expression, both miRNAs can induce a negative regulation of cell cycle progression. In contrast, silencing of negative cell cycle checkpoint regulators, such as p21 and p16, can be predicted, which can induce impairment in response to genotoxic stressors. In addition, predicted targets, such as SMAD family members, seem to be involved in the positive control of digestive and endocrine tumors. Taken together, this exploratory study indicates that miRNA signature in circulating adipocyte-derived EVPs may be involved with the double-edged sword of cellular senescence, including irreversible proliferation arrest and tissue-dependent cancer, and seems to be suitable for further validation and confirmatory studies

Development of an affirming and customizable electronic survey of sexual and reproductive health experiences for transgender and gender nonbinary people

To address pervasive measurement biases in sexual and reproductive health (SRH) research, our interdisciplinary team created an affirming, customizable electronic survey to measure experiences with contraceptive use, pregnancy, and abortion for transgender and gender nonbinary people assigned female or intersex at birth and cisgender sexual minority women. Between May 2018 and April 2019, we developed a questionnaire with 328 items across 10 domains including gender identity; language used for sexual and reproductive anatomy and events; gender affirmation process history; sexual orientation and sexual activity; contraceptive use and preferences; pregnancy history and desires; abortion history and preferences; priorities for sexual and reproductive health care; family building experiences; and sociodemographic characteristics. Recognizing that the words people use for their sexual and reproductive anatomy can vary, we programmed the survey to allow participants to input the words they use to describe their bodies, and then used those customized words to replace traditional medical terms throughout the survey. This process-oriented paper aims to describe the rationale for and collaborative development of an affirming, customizable survey of the SRH needs and experiences of sexual and gender minorities, and to present summary demographic characteristics of 3,110 people who completed the survey. We also present data on usage of customizable words, and offer the full text of the survey, as well as code for programming the survey and cleaning the data, for others to use directly or as guidelines for how to measure SRH outcomes with greater sensitivity to gender diversity and a range of sexual orientations

Primum Non Nocere in interventional oncology for liver cancer: How to reduce the risk for complications?

: Interventional oncology represents a relatively new clinical discipline based upon minimally invasive therapies applicable to almost every human organ and disease. Over the last several decades, rapidly evolving research developments have introduced a newer generation of treatment devices, reagents, and image-guidance systems to expand the armamentarium of interventional oncology across a wide spectrum of disease sites, offering potential cure, control, or palliative care for many types of cancer patients. Due to the widespread use of locoregional procedures, a comprehensive review of the methodologic and technical considerations to optimize patient selection with the aim of performing a safe procedure is mandatory. This article summarizes the expert discussion and report from the Mediterranean Interventional Oncology Live Congress (MIOLive 2020) held in Rome, Italy, integrating evidence-reported literature and experience-based perceptions as a means for providing guidance on prudent ways to reduce complications. The aim of the paper is to provide an updated guiding tool not only to residents and fellows but also to colleagues approaching locoregional treatments

Family social support, community “social capital” and adolescents’ mental health and educational outcomes: a longitudinal study in England

Purpose To examine the associations between family social support, community “social capital” and mental health and educational outcomes. Methods The data come from the Longitudinal Study of Young People in England, a multi-stage stratified nationally representative random sample. Family social support (parental relationships, evening meal with family, parental surveillance) and community social capital (parental involvement at school, sociability, involvement in activities outside the home) were measured at baseline (age 13–14), using a variety of instruments. Mental health was measured at age 14–15 (GHQ-12). Educational achievement was measured at age 15–16 by achievement at the General Certificate of Secondary Education. Results After adjustments, good paternal (OR = 0.70, 95% CI 0.56–0.86) and maternal (OR = 0.65, 95% CI 0.53–0.81) relationships, high parental surveillance (OR = 0.81, 95% CI 0.69–0.94) and frequency of evening meal with family (6 or 7 times a week: OR = 0.77, 95% CI 0.61–0.96) were associated with lower odds of poor mental health. A good paternal relationship (OR = 1.27, 95% CI 1.06–1.51), high parental surveillance (OR = 1.37, 95% CI 1.20–1.58), high frequency of evening meal with family (OR = 1.64, 95% CI 1.33–2.03) high involvement in extra-curricular activities (OR = 2.57, 95% CI 2.11–3.13) and parental involvement at school (OR = 1.60, 95% CI 1.37–1.87) were associated with higher odds of reaching the educational benchmark. Participating in non-directed activities was associated with lower odds of reaching the benchmark (OR = 0.79, 95% CI 0.70–0.89). Conclusions Building social capital in deprived communities may be one way in which both mental health and educational outcomes could be improved. In particular, there is a need to focus on the family as a provider of support

‘Post-race’ racism in the narratives of ‘Brexit’ voters

Although a growing body of scholarship seeks to understand the motivations behind the ‘Brexit’ vote – including that which centralises explorations of racism, nationalism and post-colonialism – little consideration has been given to the ways in which ‘post-race’ racisms underpin the narratives of Leave voters. This article draws on data generated through 13 semi-structured interviews to examine the subtle and subterranean ways in which xeno-racism is articulated in the accounts of some Leave voters in the Greater Manchester city of Salford: a city that saw a higher percentage of the electorate (56.8%) vote to leave the EU than the national average (51.9%). Whilst restricting immigration was a key motivator of Leave voters in our research, interviewees vehemently rejected accusations of racism. Instead, couching their views in seemingly non-racial ways, they framed their concerns about immigration as a ‘legitimate’ response to a victimised whiteness. Thus, in discussing our data, we argue that far from living in a ‘post-racial’ epoch, racisms continue to thrive through new modes of articulation. These new racisms emerge from the shadows at key times, such as the EU Referendum, and refashion themselves in ways that are considered more palatable than the older (explicit) racisms of past

Protocol for the saMS trial (supportive adjustment for multiple sclerosis): a randomized controlled trial comparing cognitive behavioral therapy to supportive listening for adjustment to multiple sclerosis

BackgroundMultiple Sclerosis (MS) is an incurable, chronic, potentially progressive and unpredictable disease of the central nervous system. The disease produces a range of unpleasant and debilitating symptoms, which can have a profound impact including disrupting activities of daily living, employment, income, relationships, social and leisure activities, and life goals. Adjusting to the illness is therefore particularly challenging. This trial tests the effectiveness of a cognitive behavioural intervention compared to supportive listening to assist adjustment in the early stages of MS.MethodsThis is a two arm randomized multi-centre parallel group controlled trial. 122 consenting participants who meet eligibility criteria will be randomly allocated to receive either Cognitive Behavioral Therapy or Supportive Listening. Eight one hour sessions of therapy (delivered over a period of 10 weeks) will be delivered by general nurses trained in both treatments. Self-report questionnaire data will be collected at baseline (0 weeks), mid-therapy (week 5 of therapy), post-therapy (15 weeks) and at six months (26 weeks) and twelve months (52 weeks) follow-up. Primary outcomes are distress and MS-related social and role impairment at twelve month follow-up. Analysis will also consider predictors and mechanisms of change during therapy. In-depth interviews to examine participants’ experiences of the interventions will be conducted with a purposively sampled sub-set of the trial participants. An economic analysis will also take place. DiscussionThis trial is distinctive in its aims in that it aids adjustment to MS in a broad sense. It is not a treatment specifically for depression. Use of nurses as therapists makes the interventions potentially viable in terms of being rolled out in the NHS. The trial benefits from incorporating patient input in the development and evaluation stages. The trial will provide important information about the efficacy, cost-effectiveness and acceptability of the interventions as well as mechanisms of psychosocial adjustment.Trial registrationCurrent Controlled Trials ISRCTN91377356<br/

Personality Traits and Personal Values:A Meta-Analysis

Personality traits and personal values are important psychological characteristics, serving as important predictors of many outcomes. Yet, they are frequently studied separately, leaving the field with a limited understanding of their relationships. We review existing perspectives regarding the nature of the relationships between traits and values and provide a conceptual underpinning for understanding the strength of these relationships. Using 60 studies, we present a meta-analysis of the relationships between the Five-Factor Model (FFM) of personality traits and the Schwartz values, and demonstrate consistent and theoretically meaningful relationships. However, these relationships were not generally large, demonstrating that traits and values are distinct constructs. We find support for our premise that more cognitively based traits are more strongly related to values and more emotionally based traits are less strongly related to values. Findings also suggest that controlling for personal scale-use tendencies in values is advisable