Systematic review and meta-analysis. small intestinal bacterial overgrowth in chronic pancreatitis

BACKGROUND: Evidence on small intestinal bacterial overgrowth (SIBO) in patients with chronic pancreatitis (CP) is conflicting. AIM: The purpose of this study was to perform a systematic review and meta-analysis on the prevalence of SIBO in CP and to examine the relationship of SIBO with symptoms and nutritional status. METHODS: Case-control and cross-sectional studies investigating SIBO in CP patients were analysed. The prevalence of positive tests was pooled across studies, and the rate of positivity between CP cases and controls was calculated. RESULTS: In nine studies containing 336 CP patients, the pooled prevalence of SIBO was 36% (95% confidence interval (CI) 17-60%) with considerable heterogeneity (I2 = 91%). A sensitivity analysis excluding studies employing lactulose breath test gave a pooled prevalence of 21.7% (95% CI 12.7-34.5%) with lower heterogeneity (I2 = 56%). The odds ratio for a positive test in CP vs controls was 4.1 (95% CI 1.6-10.4) (I2 = 59.7%). The relationship between symptoms and SIBO in CP patients varied across studies, and the treatment of SIBO was associated with clinical improvement. CONCLUSIONS: One-third of CP patients have SIBO, with a significantly increased risk over controls, although results are heterogeneous, and studies carry several limitations. The impact of SIBO and its treatment in CP patients deserve further investigation

Impact of Time-Varying Treatment Exposures on the Risk of Venous Thromboembolism in Multiple Myeloma

Multiple myeloma (MM) has one of the highest risks of venous thromboembolism (VTE) of all cancers due to pathologic changes and treatment-related exposures. This study assessed the one-year incidence of VTE in newly diagnosed MM and to determine the baseline and time-varying treatment-related factors associated with VTE risk in a U.S.-based cohort. MM patients were identified and age, gender, and baseline comorbidities were determined. Treatment-related exposures included thalidomide derivatives (IMIDs), proteasome inhibitors, cytotoxic chemotherapy, steroids, erythropoietin-stimulating agents (ESAs), stem cell transplants (SCT), hospitalizations, infection, and central venous catheters (CVC). Multiple statistical models were used including a baseline competing risks model, a time-varying exposure Cox proportional hazard (CPH) model, and a case-time-control analysis. The overall incidence of VTE was 107.2 per 1000 person-years with one-half of the VTEs occurring in the first 90 days. The baseline model showed that increasing age, heart failure, and hypertension were associated with one-year incidence of VTE. MM-specific IMID treatment had lower than expected associations with VTE based on prior literature. Instead, exposure to ESAs, SCT, CVC, and infection had higher associations. Based on these results, VTE risk in MM may be less straightforward than considering only chemotherapy exposures, and other treatment-related exposures should be considered to determine patient risk

Can hypnotic suggestibility be measured online?

Hypnosis and hypnotic suggestions are gradually gaining popularity within the consciousness community as established tools for the experimental manipulation of illusions of involuntariness, hallucinations and delusions. However, hypnosis is still far from being a widespread instrument; a crucial hindrance to taking it up is the amount of time needed to invest in identifying people high and low in responsiveness to suggestion. In this study, we introduced an online assessment of hypnotic response and estimated the extent to which the scores and psychometric properties of an online screening differ from an offline one. We propose that the online screening of hypnotic response is viable as it reduces the level of responsiveness only by a slight extent. The application of online screening may prompt researchers to run large-scale studies with more heterogeneous samples, which would help researchers to overcome some of the issues underlying the current replication crisis in psychology

Perencanaan Alternatif Desain Jembatan Jurang Gempal Kabupaten Wonogiri

Pokoh and Jurang Gempal bridge are the bridges that are located on Wonogiri – Ngadirojo roads crossing over Bengawan Solo river connecting Wonogiri Regency and Ponorogo Regency/Pacitan Regency. But in the past 10 years, only one bridge operates and that is Pokoh Bridge. This is caused by the condition of Jurang Gempal Bridge that is no longer adequate since it was built in the colonial era, some parts of the construction aren\u27t function properly. With only one bridge that is operating, it oftenly lead to a high traffic density on traffic hours. Thus, the re-operating of Jurang Gempal Bridge can be the solution of this traffic density problem that occurred. However, there is a need to do a total change on the bridge construction by seeing the existing condition and the age of the bridge that is already too old. Jurang Gempal Bridge was planned to be located in the existing location that is 2x60 meter in bridge length. The upper structure of this bridge is using steel frame that is 9.0 meter in width (2x3.5 meter vehicle floor and 2x1.0 meter sidewalk) and 6.0 meter in height. Meanwhile, the sub-structure of this bridge is using an abutment that the height is 7.0 meter and a pier that is 9.0 meter in height. The hard soil that is positioned in 10 meter depth is the kind of a sand soil so the Bored Pile is used as the foundation of this Jurang Gempal Bridge

Kajian Reaktivasi Jalur Lintas Cabang Daerah Operasional IV (Daop IV)

The Central Java government was planning to reoperate unused railway, considering the road traffic that was increasing rapidly in Central Java. Today, Central Java region has 663 km of unoperated railway. Most of it was located in the 4th operational region (DAOP IV). This research was planned to make a priority scales about railways which had some potensial to reopen and its properness financially. The activating priority scales which was used in this operation based on analytical demand and analytical supply. Analytical demand consists of the traffic rate and the amount of passenger\u27s movements at the OD datas. Whereas, analytical supply consists of analytical techniques seen from field conditions such as terrain availability, tools or places conditions, and accessibility. The results shows that unoperated track between Semarang-Demak-Purwodadi-Blora-Cepu has the most potencial to reactivate again for passengers purpose. On the other hand, unoperated track which goes to Tanjung Emas Harbour also become the most potencial track to reactivate considering increasing activities in this harbour. Based on the analytical results, there were two passenger\u27s scenarios for shifting the use of train transport, optimisstic scenario and pessimistic scenario. The optimisstic scenario was estimated to had 5058 passengers/day. While, the pessimistic scenario was estimated to had 1759 passengers/day. In order to reactivate the unoperated track between Semarang-Demak-Purwodadi-Blora-Cepu, a new construction was needed. It was because some of the old constructions were vanished and the railway type was very tiny, which were R.25 and R.33 type. All of those things above made this project highly cost, not to mention tools and operational funds to spend for its. From the financial view, the analytical result shows that NPV value was positive, BCR > 1, so it was good enough to reactivated. But, looking at the FIRR results, Semarang-Purwodadi track is the best option, considering its value is 5,69%, while for Semarang-Demak track is only 3,49%, and for Semarang-Cepu track is only 3,47%. For a better result, reactivation process of this track need to consider surrounding area within the track. Also, it needs better knowledge to understand commodity and region potential in order to raise the incomes

Perencanaan Penggantian Jembatan Tinjomoyo Kota Semarang

The purpose of planning the replacement of the bridge is the first Tinjomoyo to the facilitate public access Tinjomoyo an increasingly crowded, and then to replace the steel bridge that was damaged because there is no control of the government for the cost of care is expensive and prone to corrosions and there fore the government has an alternative to replace the bridge permanently by using concrete bridge or concrete because of soil condition in the area tinjomoyo including hard ground and there fore the selection of the palm of shallow foundation and wells as a load – bearing, but it is not concrete in terms of treatment need special care such as steel concrete bridge corrosions. Event not experience in bridge construction is needed time of 32 weeks

Patients’ Attitudes Toward Deprescribing and Their Experiences Communicating with Clinicians and Pharmacists

Purpose: Developing effective deprescribing interventions relies on understanding attitudes, beliefs, and communication challenges of those involved in the deprescribing decision-making process, including the patient, the primary care clinician, and the pharmacist. The objective of this study was to assess patients’ beliefs and attitudes and identify facilitators of and barriers to deprescribing. Methods: As part of a larger study, we recruited patients ⩾18years of age taking ⩾3 chronic medications. Participants were recruited from retail pharmacies associated with the University of Kentucky HealthCare system. They completed an electronic survey that included demographic information, questions about communication with their primary care clinician and pharmacists, and the revised Patients’ Attitudes Toward Deprescribing (rPATD) questionnaire. Results: Our analyses included 103 participants (n=65 identified as female and n=74 as White/Caucasian) with a mean age of 50.4years [standard deviation (SD)=15.5]. Participants reported taking an average of 8.4 daily medications (SD=6.1). Most participants reported effective communication with clinicians and pharmacists (66.9%) and expressed willingness to stop one of their medications if their clinician said it was possible (83.5%). Predictors of willingness to accept deprescribing were older age [odds ratio (OR)=2.99, 95% confidence interval (CI)=1.45–6.2], college/graduate degree (OR=55.25, 95% CI=5.74–531.4), perceiving medications as less appropriate (OR=8.99, 95% CI=1.1–73.62), and perceived effectiveness of communication with the clinician or pharmacist (OR=4.56, 95% CI=0.85–24.35). Conclusion: Adults taking ⩾3 chronic medications expressed high willingness to accept deprescribing of medications when their doctor said it was possible. Targeted strategies to facilitate communication within the patient–primary care clinician–pharmacist triad that consider patient characteristics such as age and education level may be necessary ingredients for developing successful deprescribing interventions