Readiness for Insulin Pump Use in Pediatric Type I Diabetes: A Quality Improvement Project

Background: Insulin pumps are essential in the management of type 1 diabetic pediatric patients because of their versatility in meeting the developmental needs of childhood and adolescence. Summary of the Evidence: There is lack of evidence for standardized pump initiation program in pediatric patients (ADA, 2019). Moreover, adverse events from insulin pump misuse, such as diabetic ketoacidosis, arise from lack of anticipatory guidance of pump management and troubleshooting (Evert et al., 2016; Grunberger et al., 2014, Wheeler et al, 2014). Project Purpose: The purpose of this quality improvement (QI) project was to reduce and prevent adverse outcomes of insulin pumps secondary to an inefficient initiation process, management, and patient/family understanding. Project Objectives: Objectives of this QI were: the implementation of a streamlined initiation process, assessment of patient knowledge through an additional education session including a pre-and post-test patient skills questionnaire, and to decrease adverse effects related to new insulin pump use. Results: 100% staff education was achieved, 67.5% of patients/families attended the new education session achieving an average score of 80% or higher on the skills questionnaire, and adverse effects related to new insulin pump usage decreased from a rate of 66% to 50% after implementation. Implications for Practice: Use of practice guidelines to implement a structured process for insulin pump initiation is a cost-effective strategy to promote patient ownership, improve patient knowledge, lower potential costs of clinic or hospital visits for adverse effects, and guide provider oversight in effective use of technology to improve patient outcomes and decrease barriers to care

Correlation of Watch Antibiotic Consumption with a Gram-negative Bacteria Resistance: Analysis at a Country Level

Introduction: Bacterial antimicrobial resistance (AMR) to the antibiotics (ATB) has severe consequences for human health. The excess ATB consumption is one of the main causes of AMR. One of the World Health Organizations main objective in AMR control strategy is to limit the ATB irrational use, that is why, it proposed to classify the ATB in three groups: “Access”, “Watch”, and “Reserve”, being the latter two preserved for certain situations. The present work aims to know the level of ATB consumption and its correlation with the Gram-negative resistance in Argentina. Materials and Methods: Gram-negative bacteria resistance to “watch” the ATB groups (cephalosporins/carbapenem/fluoroquinolones) were explored for Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Antibiotic consumption was expressed by the defined daily dose/1000 inhabitants for each ATB for one year period (2018). Resistance/consumption ratio was obtained by calculating the “R” for each region of the country, comparing them with the other countries. Results: E. coli resistance to 3rd generation cephalosporines was 8.68% and 16.51% in urine (U) and blood (B) samples, respectively, while to carbapenems was 0.08% (U) and 0.36% (B). Resistance of K. pneumoniae to 3 GC was 39.78% (U) and 52.45% (B) while to carbapenem was 9.03% (U) and 17.46% (B). P. aeruginosa resistance to fluoroquinolone and to carbapenems was 29.7% (U)/26.4% (B) and 17.7% (U)/19.9% (B), respectively. The resistance/consumption ratio was heterogenous within the country. Most of the populated areas patterns had similarities with the one observed in the less developed countries (mild-high resistance/mild-high consumption), while the ratio found in less densely populated areas, mimicked countries with the most rational use of ATB. Conclusion: In Argentina, Gram-negative bacteria showed overall high/mild resistance levels against the “Watch” ATB groups, with a largely variations among each region.Fil: Boni, Silvia. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; ArgentinaFil: Marin, Gustavo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Campaña, Laura. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; ArgentinaFil: Marin, Lupe. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Marin, G.. Universidad Nacional de La Plata. Facultad de Ciencias Médicas; ArgentinaFil: Risso Patron, Soledad. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; ArgentinaFil: Gabriel, Fernanda. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; ArgentinaFil: Corso, Alejandra. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; ArgentinaFil: Garay, Valeria. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; ArgentinaFil: Limeres, Manuel. Ministerio de Salud. Administración Nacional de Medicamentos, Alimentos y Tecnología Médica; Argentin

Open and Collaborative Developments

Experimentation with radically open and collaborative ways of producing knowledge and material artefacts can be found everywhere, from the free/libre and open-source software movement to citizen science initiatives, and from community-based fabrication laboratories and makerspaces to the production of open-source scientific hardware. Spurred on by the widespread availability of networked digital infrastructure, what such initiatives share in common is the (re)creation of knowledge commons, and an attempt to redistribute innovative agency across a broad array of actors. In this working paper we reflect on what these emerging practices might mean for helping to cultivate more equitable and sustainable patterns of global development. For many commentators and activists such initiatives promise to radically alter the ways in which we produce knowledge and material artefacts – in ways that are far more efficient, creative, distributed, decentralised, and democratic. Such possibilities are intriguing, but also not without critical challenges. We argue that key to appreciating if and how collaborative, commons-based production can fulfil such promises and contribute to more equitable and sustainable patterns of development, are a series of challenges concerning the knowledge politics and political economy of the new practices. We ask: what depths and forms of participation are being enabled through the new practices? In what sense does openness translate into the ability to use knowledge? Who is able to influence and control open and collaborative production? Who is able to allocate resources to, and to capture benefits from, the new initiatives? And will open and collaborative forms of production create new relations with, or even transform, markets, states, and civil society, or will they be captured by sectional interests?ESR

Vdc framework proposal for curtain wall construction process optimization

A building is made up of structural and non-structural elements. Among these are the curtain wall systems. The curtain walls are glazed elements that can cover the building façade entirely and provide thermal and enclosure properties. Despite its use worldwide, some challenges have been identified in the construction process related to transportation, communication between the stakeholders, and the installation itself. A VDC framework is proposed to overcome these challenges, including an implementation workflow and an interrelationship map between the VDC components. This study specialized on a multiuse 12,000 m2 building under construction in Lima, Peru, resulting in an optimized proposal for curtain wall construction, compared to the traditional construction flow

Milk-derived bioactive peptides exhibit antioxidant activity through the Keap1-Nrf2 signaling pathway

Abstract Bioactive peptides are relevant nutritional factors that exhibit many functions including antioxidant, antihypertensive, anticancer and antimicrobial properties. In this paper, four synthetic peptides ARHPHPHLSFM (A-11-M), AVPYPQR (A-7-R), NPYVPR (N-6-R) and KVLPVPEK (K-8-K) with sequences present in milk proteins were examined for their antioxidant properties. The compounds show moderate free radical scavenging activity in the ABTS and crocin assays (A-7-R and N-6-R) and lipid peroxidation inhibition in Caco-2 cells (N-6-R and K-8-K). All peptides, in particular K-8-K, activate the Keap1-Nrf2 system by allowing the translocation of the transcription factor Nrf2 from the cytosol to nucleus. This activation triggers the overexpression of the antioxidant enzymes Trx1, TrxR1, GR, NQO1 and SOD1. Furthermore, molecular modeling shows that K-8-K is able to hinder the interaction of Nrf2 with Keap1. The reported results show that the antioxidant action in cells of these bioactive peptides is mostly due to the activation of Keap1-Nrf2 signaling pathway

Identification of New Peptides from Fermented Milk Showing Antioxidant Properties: Mechanism of Action

Due to their beneficial properties, fermented foods are considered important constituents of the human diet. They also contain bioactive peptides, health-promoting compounds studied for a wide range of effects. In this work, several antioxidant peptides extracted from fermented milk proteins were investigated. First, enriched peptide fractions were purified and analysed for their antioxidant capacity in vitro and in a cellular model. Subsequently, from the most active fractions, 23 peptides were identified by mass spectrometry MS/MS), synthesized and tested. Peptides N-15-M, E-11-F, Q-14-R and A-17-E were selected for their antioxidant effects on Caco-2 cells both in the protection against oxidative stress and inhibition of ROS production. To define their action mechanism, the activation of the Kelch-like ECH-associated protein 1/nuclear factor erythroid 2-related factor 2(Keap1/Nrf2) pathway was studied evaluating the translocation of Nrf2 from cytosol to nucleus. In cells treated with N-15-M, Q-14-R and A-17-E, a higher amount of Nrf2 was found in the nucleus with respect to the control. In addition, the three active peptides, through the activation of Keap1/Nrf2 pathway, led to overexpression and increased activity of antioxidant enzymes. Molecular docking analysis confirmed the potential ability of N-15-M, Q-14-R and A-17-E to bind Keap1, showing their destabilizing effect on Keap1/Nrf2 interaction

FISH mapping of Philadelphia negative BCR/ABL1 positive CML

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Combatting Sedentary Behaviors by Delivering Remote Physical Exercise in Children and Adolescents with Obesity in the COVID-19 Era: A Narrative Review

The coexistence of childhood obesity (or its risk) and COVID-19 pandemic put children and adolescents in greater risk to develop respiratory and cardiovascular diseases. In fact, the restrictions introduced to limit the spread of the virus had detrimental effects on various lifestyle components, especially in young population. This resulted in augmented levels of physical inactivity and sedentary behaviors and a reduced time spent in play outdoors or sport practices. Contrariwise, the increased use of technology led clinicians, teachers, and trainers to maintain relations with obese children/adolescents so as to reduce sedentary behaviors and the associated health risks. This narrative review aims to describe the role of Telehealth and Tele-exercise as useful tools in the management of pediatric obesity during COVID-19 pandemic. Telehealth and Tele-exercise were effective in promoting self-monitoring and behavioral changes, including adherence to exercise training programs in children and adolescents. Moreover, tele-exercise platforms such as applications or exergames allowed flexible scheduling, limiting the infection risks

Mitochondrial Alterations Induced by the p13II Protein of Human T-cell Leukemia Virus Type 1 CRITICAL ROLE OF ARGININE RESIDUES

Abstract Human T-cell leukemia virus type 1 encodes a number of "accessory" proteins of unclear function; one of these proteins, p13II, is targeted to mitochondria and disrupts mitochondrial morphology. The present study was undertaken to unravel the function of p13II through (i) determination of its submitochondrial localization and sequences required to alter mitochondrial morphology and (ii) an assessment of the biophysical and biological properties of synthetic peptides spanning residues 9–41 (p139–41), which include the amphipathic mitochondrial-targeting sequence of the protein. p139–41 folded into an α helix in micellar environments. Fractionation and immunogold labeling indicated that full-length p13II accumulates in the inner mitochondrial membrane. p139–41 induced energy-dependent swelling of isolated mitochondria by increasing inner membrane permeability to small cations (Na+, K+) and released Ca2+ from Ca2+-preloaded mitochondria. These effects as well as the ability of full-length p13II to alter mitochondrial morphology in cells required the presence of four arginines, forming the charged face of the targeting signal. The mitochondrial effects of p139–41 were insensitive to cyclosporin A, suggesting that full-length p13II might alter mitochondrial permeability through a permeability transition pore-independent mechanism, thus distinguishing it from the mitochondrial proteins Vpr and X of human immunodeficiency virus type 1 and hepatitis B virus, respectively