The impact of the Covid-19 pandemic on North American milk banks

This study aims to understand the impact of the Covid-19 pandemic on human milk banking services in North America, with a focus on the United States. We triangulated questionnaire data with interviews and text-based website data. Of the 30 human milk bank services from which data were obtained, the majority faced substantial internal organization change in terms of staffing and protocols and experienced financial hardship in particular because of decreases in donor human milk orders. At the same time, most banks reported an increase in their numbers of donors and in the volume of milk collected. These results show that the pandemic significantly affected the way in which many North American milk banks operate, some lactating mothers donate their milk and, at least during the first few months of the crisis, certain hospitals' donor human milk ordering patterns changed. It suggests in particular that stay-at-home orders and the turn to remote work created the potential for a surge in human milk available for donation as a number of parents no longer needed their surplus for their own children. Legal and policy reform should focus on replicating the positive effects of the pandemic on breastfeeding by guaranteeing paid parental leave and flexible work conditions. Initiatives should also aim at counteracting its negative effects by mandating the insurance coverage of donor human milk, supporting milk banks financially and, more generally, integrating lactation and human milk banking services within the health system

Predicción usando Machine Learning del estado del biomarcador genético Metil guanina metil transferasa (MGMT) para el tratamiento de tumores cerebrales

Incluye bibliografía y anexos.El siguiente trabajo final se sitúa en el contexto general de la aplicación de algoritmos de aprendizaje automático en el ámbito de la salud. Un tumor maligno en el cerebro es una afección potencialmente mortal. Conocido como glioblastoma, es la forma más común de cáncer cerebral en adultos y la que tiene el peor pronóstico, con una media de supervivencia de menos de un año. En este trabajo se aborda el problema de la predicción de información genética, estudiando el contexto del estado del arte en radiogenómica y su aplicación concreta en la predicción de la metilación del gen MGMT. El gen MGMT está localizado en el cromosoma 10q26 y codifica para una enzima reparadora del ADN que remueve grupos alquilo en la posición O de la guanina. Estos grupos O alquilos en la guanina, producen que las hebras de ADN se rompan y las bases no se acoplen, induciendo la apoptosis o muerte celular. El gen MGMT protege a las células normales de arcinógenos. Actualmente, el análisis genético del cáncer requiere cirugía para extraer una muestra de tejido. Luego puede tomar varias semanas determinar la caracterización genética del tumor. Dependiendo de los resultados y el tipo de terapia inicial elegida, puede ser necesaria una cirugía posterior. Si se pudiera desarrollar un método preciso para predecir la genética del cáncer a través de imágenes (es decir, mediante lo que se conoce como “radiogenómica“) se podría minimizar el número de cirugías y refinar el tipo de terapia requerida

Differential behaviour of distinct motoneuron pools that innervate the triceps surae

It has been shown that when humans lean in various directions, the central nervous system (CNS) recruits different motoneuron pools for task completion; common units that are active during different leaning directions, and unique units that are active in only one leaning direction. We used high-density surface electromyography (HD-sEMG) to examine if motor unit (MU) firing behaviour was dependent on leaning direction, muscle (medial and lateral gastrocnemius; soleus), limits of stability, or whether a MU is considered common or unique. Fourteen healthy participants stood on a force platform and maintained their center of pressure in five different leaning directions. HD-sEMG recordings were decomposed into MU action potentials and the average firing rate (AFR), coefficient of variation (CoVISI) and firing intermittency were calculated on the MU spike trains. During the 30-90º leaning directions both unique units and common units had higher firing rates (F = 31.31, p \u3c 0.0001). However, the unique units achieved higher firing rates compared to the common units (mean estimate difference = 3.48 Hz, p \u3c 0.0001). The CoVISI increased across directions for the unique units but not for the common units (F = 23.65. p \u3c 0.0001). Finally, intermittent activation of MUs was dependent on the leaning direction (F = 11.15, p \u3c 0.0001), with less intermittent activity occurring during diagonal and forward-leaning directions. These results provide evidence that the CNS can preferentially control separate motoneuron pools within the ankle plantarflexors during voluntary leaning tasks for the maintenance of standing balance

Primary care micro-teams: a protocol for an international systematic review to describe and examine the opportunities and challenges of implementation for patients and healthcare professionals

Introduction: There has been a recent trend towards creating larger primary care practices with the assumption that interdisciplinary teams can deliver improved and more cost-effective services to patients with better accessibility. Micro-teams have been proposed to mitigate some of the potential challenges with practice expansion, including continuity of care. We aim to review the available literature to improve understanding of how micro-teams are described and the opportunities which primary care micro-teams can provide for practice staff and patients and limitations to their introduction and implementation. Our review asks: how is micro-team implementation described? What are the experiences of healthcare professionals and patients concerning micro-teams in primary care? What are the reported implications of micro-teams for patient care? // Methods and analysis: CINAHL, Cochrane Library, Embase, MEDLINE and Scopus will be searched for studies in English. Grey literature will be sourced from Google Scholar, government websites, CCG websites, general practice directives and strategies with advice from stakeholders. Included studies will give evidence regarding the implementation of micro-teams. Data will be synthesised using framework analysis. We will use iterative stakeholder and public and patient participation to embed the perspectives of those whom micro-teams could impact. Included studies will be quality assessed using the Mixed Methods Appraisal Tool. The quality assessment will not be used to exclude any evidence but rather to develop a narrative discussion evaluating included literature. // Ethics and dissemination: Ethical approval will not be necessary for this systematic review as there will only be a secondary analysis of data already available in scientific databases and the grey literature. This protocol has been submitted for registration to be made available on a review database (PROSPERO). Findings will be disseminated widely through peer-reviewed publication and in various media, for example, conferences, congresses or symposia

Structural Transition in a Fluid of Spheroids: A Low-Density Vestige of Jamming

A thermodynamically equilibrated fluid of hard spheroids is a simple model of liquid matter. In this model, the coupling between the rotational degrees of freedom of the constituent particles and their translations may be switched off by a continuous deformation of a spheroid of aspect ratio t into a sphere (t=1). We demonstrate, by experiments, theory, and computer simulations, that dramatic nonanalytic changes in structure and thermodynamics of the fluids take place, as the coupling between rotations and translations is made to vanish. This nonanalyticity, reminiscent of a second-order liquid-liquid phase transition, is not a trivial consequence of the shape of an individual particle. Rather, free volume considerations relate the observed transition to a similar nonanalyticity at t=1 in structural properties of jammed granular ellipsoids. This observation suggests a deep connection to exist between the physics of jamming and the thermodynamics of simple fluids. © 2016 American Physical Society

Opportunities, challenges and implications of primary care micro-teams for patients and healthcare professionals: an international systematic review

Background: There has been a recent trend, both in the UK and internationally, towards creating larger primary care practices with the assumption that interdisciplinary teams can increase patient accessibility and provide more cost-effective, efficient services. Micro-teams have been proposed to mitigate some of the potential challenges with practice expansion, including continuity of care. / Aim: Review the available literature to examine how micro-teams are described and the opportunities which primary care micro-teams can provide for practice staff and patients and limitations to their introduction and implementation. / Design and setting: International Systematic review of studies published in English. / Method: A Framework analysis was used to synthesise the literature. Databases and grey literature were searched. Studies were included if they provided evidence regarding the implementation of micro-teams in primary care. We worked with a PPI co-author and conducted stakeholder discussions to those with and without experience in micro-team implementation. / Results: The majority of the 24 included studies discussed empirical data from healthcare professionals, describing the implementation of micro-teams. Results include the characteristics of the literature; how micro-teams have been described; the range of ways micro-teams have been implemented; reported outcomes and experiences of patients and staff. / Conclusion: The organisation of primary care has the potential to impact the nature and quality of patient care, safety and outcomes. This review contributes to current debates surrounding care delivery and how this can impact the experiences and outcomes of patients and staff. The analysis identifies several key opportunities and challenges for future research, policy and practice