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Este estudio tuvo como objetivo estimar la incidencia general y anual estandarizada por edad de la embolia pulmonar (EP) relacionada con el embarazo en España de 2016 a 2021, explorar la distribución de los eventos de la EP durante el embarazo y el período posparto, identificar posibles factores de riesgo y estimar las tasas de mortalidad durante el ingreso hospitalario.

Background: Cardiovascular disease is the leading cause of morbidity and mortality among patients with diabetes, and for this reason, all guidelines for CV risk management provide the same targets in controlling traditional CV risk factors in patients with type 1 or type 2 diabetes at equal CV risk class. Aim of our study was to evaluate and compare CV risk management in patients with type 1 and type 2 diabetes included in AMD Annals Database paying particular attention to indicators of clinical inertia. Methods: This was a multicenter, observational, retrospective study of AMD Annals Database during year 2022. Patients with diabetes were stratified on the basis of their cardiovascular risk, according to ESC-EASD guidelines. The proportion of patients not treated with lipid-lowering despite LDL cholesterol > to 100 mg/dl or the proportion of patients not treated with antihypertensive drug despite BP > 140/90 mmhg and proportion of patients with proteinuria not treated with angiotensin converting enzyme inhibitors or angiotensinogen receptor blockers (ACE/ARBs) were considered indicators of clinical inertia. The proportion of patients reaching at the same time HbA1c < 7% LDL < 70 mg/dl and BP < 130/80 mmhg were considered to have good multifactorial control. Overall quality of health care was evaluated by the Q-score. Results: Using the inclusion criteria and stratifying patients by ESC/EASD Cardiovascular Risk categories, we included in the analysis 118.442 patients at High Cardiovascular risk and 416.246 patients at Very High Cardiovascular risk. The proportion of patients with good multifactorial risk factor control was extremely low in both T1D and T2D patients in each risk class. At equal risk class, the patients with T1D had lower proportion of subjects reaching HbA1c, LDL, or Blood Pressure targets. Indicators of clinical inertia were significantly higher compared with patients with T2D at equal risk class. Data regarding patients with albuminuria not treated with RAAS inhibitors were available only for those at Very High risk and showed that the proportion of patients not treated was again significantly higher in patients with T1DM. Conclusions: In conclusion, this study provides evidence of wide undertreatment of traditional cardiovascular risk factors among patients with diabetes included in AMD Annals Database. Undertreatment seems to be more pronounced in individuals with T1D compared to those with T2D and is frequently due to clinical inertia.

To determine if electronic medical record (EMR) changes and implementation of a study on firearm storage practices changed identification of firearm exposure in children presenting to a pediatric emergency department (PED) with mental health complaints. We also sought to determine the accuracy of information collected on firearm storage practices.Retrospective study of EMR documentation of firearm exposure in PED patients with mental health complaints from January 20, 2015 until November 20, 2017. EMR changes occurred on January 20, 2016 and the firearms study began on February 13, 2016. The primary outcome was documentation of firearm exposure. Secondary outcomes were documentation of unsafe firearm storage practices. We also examined differences between clinical and research documentation of unsafe firearm storage practices post-intervention. We compared groups using descriptive statistics and chi-squared tests. We used statistical process control to examine the relationship between interventions and changes in outcomes.5582 encounters were examined. Identification of firearm exposure increased from 11 to 17% postintervention. Identification of unsafe storage practices increased from 1.9% to 4.4% across all encounters. Special cause variation in both metrics occurred concurrently with the interventions. Postintervention, unsafe firearms storage practices in firearm owning families were under-identified (39% identified as not triple-safe in clinical data vs 75% in research data).EMR changes and implementation of a firearms study improved identification of firearm exposure and unsafe storage practices in families of PED patients being evaluated for mental health complaints. However, unsafe storage practices continued to be under-identified in firearm-owning families.

In the near future, this scenario could become reality. Additive manufacturing (AM), also known as 3D printing, could enable future agile operating concepts. AM has the ability to significantly shorten [...]

The Lachman test is more accurate diagnostically than the anterior drawer test, although it's used less often. The newer lever sign test may prove useful in primary care. CASE * [...]

ABSTRACTBackground and ContextComputational thinking (CT) is a critical part of computing education in middle school. The existing practices of collaboration and collaborative design activities at this education level pairs well with CT practices, but this interaction has previously been under-explored in the existing literature.ObjectiveIn this study, we investigate whether students can learn CT through collaborative design activities and what patterns emerge over time and across instructional phases.MethodWe coded 6.3 hours of video observations for CT practices to create visualizations of 10-second segments of middle school students programming together. We use these visualizations to unpack nuances regarding how students demonstrate CT practices. Additionally, we provide three vignettes to highlight the interactions between students within and across the three instructional phases.FindingsThe findings suggest that middle school students can learn CT concepts and practices through collaborative design activities. The results demonstrate the patterns of CT practices and detail the transitions between each CT practice over time within a small group.ImplicationsThis study applies novel analysis techniques on student interaction data to examine CT through collaborative design. By bridging a CT framework with collaborative design activities, this study enhances the understanding of CT in collaborating, learning, and creating computing project-based designs.

Background. Little is known about the functional performance of patients after revision total hip arthroplasty with major acetabular bone impaction grafting. In general, these patients are assumed to perform worse due to a more advanced stage of periarticular tissue degeneration and multiple surgeries compared with patients with primary total hip arthroplasty (THA). Objective. The main purpose of this study was to quantify the differences in performance of the sit-to-stand (STS) movement between patients with primary THA and patients with revision THA. Design and Methods. In this study, the STS movement was analyzed kinematicany (knee and hip angular extension velocity) and kinetically (loading symmetry ratio). Ten patients after primary THA and 10 patients after revision THA with acetabular bone impaction grafting were compared using these 3 rising parameters. Results. The patients with revision THA performed the STS movement comparably to the patients with primary THA; there were no differences in knee and hip velocity or leg asymmetry during rising. Limitations. The study focused only on kinetic and kinematic aspects, and only patients who were satisfied with their THA were involved. Conclusions. This study showed that patients after a revision THA with acetabular bone impaction grafting and cement did not perform the STS movement differently, either kinematically or kinetically, compared with patients with a primary THA., The total hip replacement, or total hip arthroplasty (THA), has been designated 'the operation of the 20th century.' (1) The THA is indeed a successful treatment for hip osteoarthritis (OA), [...]

In the 17th century, Philadelphia's founder William Penn envisioned it as a 'green country towne,' even naming its streets after walnut, chestnut, and cherry trees. Today, it is home to [...]

Background. Functional recovery of patients after a total knee arthroplasty (TKA) usually is measured with questionnaires. However, these self-report measures assess the patient's perspective on his or her ability to perform a task. Performance-based tests are needed to assess the patient's actual ability to perform a task. Objective. The main purpose of this study was to quantify improvement in performance of the sit-to-stand movement of patients with a TKA. Design and Methods. In this prospective study of 16 patients with end-stage knee osteoarthritis followed by a TKA, the maximal knee angular extension velocity and amount of unloading (shifting weight) of the affected leg during the sit-to-stand movement and the visual analog scale score for pain were assessed preoperatively and 6 months and 1 year postoperatively. These data were compared with data for a control group of individuals who were healthy (n=27). Results. Before surgery, the participants in the TKA group unloaded their affected leg, but within 6 months after implantation, the affected leg was almost fully loaded again and comparable to the loading symmetry ratio of the control group. Furthermore, knee extension velocity also had increased, but remained lower than that of the control group. The changes in knee extension velocity took place during the first 6 months, after which a plateau was visible. Limitations. A potential limitation of the study design was that the patients were not perfectly matched with the control subjects. Conclusions. Implantation of a total knee prosthesis partly improved performance of the sit-to-stand movement. Participants in the TKA group could fully load their operated leg, but they could not generate enough knee angular velocity during rising compared with the control group., In general, pain and function are the predominant factors in the evaluation of recovery after total knee arthroplasty (TKA). (1,2) Great reductions in pain are common (3) and can easily [...]

Many countries have installed horizontal large-scale wind turbine (HLSWT) farms for green generation of electricity but unknowing the long-term consequences of this technology. Recent publications have demonstrated that HLSWT can contribute to weather changes and surface warming increasing precipitation rates. Horizontal household small wind turbines (HHSWTs) have been proposed as a sustainable option to reduce the environmental impact in the generation of electricity by wind energy conversion. However, some issues related to the sustainability and high initial costs of blades materials and processing techniques should be overcome to become HHSWT accessible for the population. In this work, an automated computer-aided design process is supplied for the creation of aerodynamically optimized, monolithic, low-cost and sustainable blades for HHSWT. The procedure presented takes into consideration the environmental conditions of the placement area of the windmill, and it is applicable to obtain blades of any length and with any targeted output power.

The ability to perceive and produce a beat is believed to be universal in humans, but individual ability varies. The current study examined four factors that may influence beat perception and production capacity: 1) expertise: music or dance, 2) training style: percussive or nonpercussive, 3) stimulus modality: auditory or visual, and 4) movement type: finger-tap or whole-body bounce. Experiment 1 examined how expertise and training style influenced beat perception and production performance using an auditory beat perception task and a finger-tapping beat production task. Experiment 2 used a similar sample with an audiovisual variant of the beat perception task, and a standing knee-bend (bounce) beat production task to assess whole-body movement. The data showed that: 1) musicians were more accurate in a finger-tapping beat synchronization task compared to dancers and controls, 2) training style did not significantly influence beat perception and production, 3) visual beat information did not benefit any group, and 4) beat synchronization in a full-body movement task was comparable for musicians and dancers; both groups outperformed controls. The current study suggests that the type of task and measured response interacts with expertise, and that expertise effects may be masked by selection of nonoptimal response types.

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The current study evaluated the prevalence of comorbid spasticity and urinary incontinence (UI) in a long-term care facility. Medical history, presence of UI, and activities of daily living (ADL) dependency were obtained from medical records and Minimum Data Set 3.0. Quality of life was assessed with the EuroQoL-5D-5L (EQ-5D). Comorbid spasticity and UI presented in 29% of participants (14 of 49). Participants with spasticity and UI had higher ADL dependency and lower EQ-5D than participants without both conditions (4.9, 95% confidence interval [CI] [1.6, 80.], The current study evaluated the prevalence of comorbid spasticity and urinary incontinence (UI) in a long-term care facility. Medical history, presence of UI, and activities of daily living (ADL) dependency were obtained from medical records and Minimum Data Set 3.0. Quality of life was assessed with the EuroQoL-5D-5L (EQ-5D). Comorbid spasticity and UI presented in 29% of participants (14 of 49). Participants with spasticity and UI had higher ADL dependency and lower EQ-5D than participants without both conditions (4.9, 95% confidence interval [CI] [1.6, 80.], p= 0.003; −0.17, 95% CI [−0.33, 0.00], p= 0.044; respectively). More than one half of participants with lower limb spasticity had severe UI, compared to only 10% without lower limb spasticity (relative risk = 5.5; 95% CI [1.9, 15.9]; p= 0.006). Comorbid spasticity and UI may be common in the long-term care setting and negatively associated with ADL and quality of life. Further investigation is needed to confirm these findings. [Journal of Gerontological Nursing, 46(10), 35–42.]

Reduced BMI is an absolute contraindication for lung transplantation (LTx) at most centers in the United States. The objective of this study was to quantify post-LTx survival of moderate to severely underweight patients with cystic fibrosis (CF) (BMI < 17 kg/m2) in the United States relative to normal-weight recipients with CF and other frequently transplanted patient cohorts.

Supramolecular assembly utilizing simultaneous formation of three pnictogen bonds around a single antimony vertex was explored via X-ray crystallography, solution NMR, and computational chemistry. An arylethynyl (AE) ligand was designed to complement the three electrophilic regions around the Sb compound. Though solution studies reveal large binding constants for individual pyridyl units with the Sb donor, the rigidity and prearrangement of the AE acceptor proved necessary to achieve simultaneous binding of three acceptors to the Sb-centered pnictogen-bond donor. Calculations and X-ray structures suggest that negative cooperativity upon sequential binding of three acceptors to a Sb center limits the utility of triple-pnictogen bonding pyridyl acceptors. These limitations can be negated, however, when positive cooperativity is designed into a complementary acceptor ligand.

Immunocompromised children might be predisposed to serious infections from human coronaviruses (HCoVs), including strains OC43, NL63, HKU1, and 229E; however, the virologic and clinical features of HCoV infection in immunocompromised children have not been compared to those in nonimmunocompromised children.

•AYA HCT patients are at risk for poor psychosocial and clinical outcomes.•AYA HCT patients in a resilience program had lower inflammatory gene expression.•The stress-inflammation axis may be a targetable pathway in the AYA HCT population.

Designing materials to have three unique but predictable thermal expansion axes represents a major challenge. Inorganic materials and hybrid frameworks tend to crystallize in high-symmetry space groups, which necessarily limits this by affording isotropic behavior. On the other hand, molecular organic materials tend to crystallize in lower-symmetry space groups, offering significant opportunity to achieve anisotropic properties. The challenge arises in self-assembling the organic components into a predictable arrangement to afford predictable thermal expansion properties. Here, we demonstrate a design strategy for engineering organic solid-state materials that exhibit anisotropic thermomechanical behaviors. Presented are a series of multicomponent solids wherein one component features a BODPIY core strategically decorated with orthogonal hydrogen- and halogen-bond donor groups. A series of size-matched halogen-bond acceptors are used as the second component in each solid. By matching the molecular dimensions with the interaction strength, we obtained good control over the anisotropic thermal expansion of the molecular materials. Moreover, using shape-size mimicry and propensity for molecular motion, a rare ternary molecular system that is isostructural to the two binary solids was successfully achieved. The diiodo-functionalized BODIPY core in this study has been previously used in photocatalysts, and halogen bonding was hypothesized as a driving force; here, we provide corroborating solution and solid-state evidence of intermolecular halogen bonding in multicomponent solids featuring a 2,6-diiodo BODIPY.

Ulcerative colitis and Crohn’s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn’s and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn’s disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn’s disease, including patients, their families and friends.

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La prevalencia de la diabetes mellitus tipo 2 (DM2) se incrementa marcadamente con la edad. El tratamiento antidiabético y los objetivos de control glucémico en el anciano con DM2 deben individualizarse en función de sus características biopsicosociales. En los pacientes de edad avanzada, en los que los beneficios de un tratamiento antidiabético intensivo son limitados, los objetivos básicos deben ser mejorar la calidad de vida, preservar la funcionalidad y evitar los efectos adversos, muy especialmente las hipoglucemias.

Supplemental Digital Content is available in the text.Little is known about current practices in high-value care (HVC) bedside teaching. A lack of instruments for measuring bedside HVC behaviors confounds efforts to assess the impact of curricular interventions. The authors aimed to define observable HVC concepts by developing an instrument to measure the content and frequency of HVC discussions.The authors developed the HVC Rounding Tool in four iterative phases, using Messick’s validity framework. Phases 1 and 2 were designed to collect evidence of content validity, Phases 3 and 4 to collect evidence of response process and internal structure. Phase 1 identified HVC topics within the literature. Phase 2 used a modified Delphi approach for construct definition and tool development. Through two rounds, the Delphi panel narrowed 16 HVC topics to 11 observable items, categorized into three domains (quality, cost, and patient values). Phase 3 involved rater training and creation of a codebook. Phase 4 involved three iterations of instrument piloting. Six trained raters, in pairs, observed bedside rounds during 148 patient encounters in 2016. Weighted kappas for each domain demonstrated improvement from the first to third iteration: Quality increased from 0.65 (95% CI 0.55–0.79) to 1.00, cost from 0.58 (95% CI 0.4–0.75) to 0.96 (95% CI 0.80–1.00), and patient values from 0.41 (95% CI 0.19–0.68) to 1.00. Percent positive agreement for all domains improved from 65.3% to 98.1%. This tool, the first with established validity evidence, addresses an important educational gap for measuring the translation of HVC from theoretical knowledge to bedside practice.

PurposeDiagnosing and treating individuals with cognitive–communication disorders can be challenging. It may seem easier to diagnose the disorder if it is associated with a clear event or diagnosis such as a traumatic brain injury or stroke. Some clinicians may even feel like they are treating the patient “unethically” if there is not a clear preexisting diagnosis or well-known explanation for the disorder. The purpose of this article is to raise awareness of lesser known risks and causes of cognitive–communication impairment—to “think outside the diagnostic box.”ConclusionsRisk factors for cognitive impairment include disorders associated with cardiovascular disease: hypertension, diabetes mellitus, and hyperlipidemia. Other risk factors include obesity, nutrition status, alcohol consumption, and aging. Except aging, all of the risk factors are in some way modifiable. Helping to identify individuals who are at risk for cognitive impairment is an important area of emphasis within assessment and treatment in this population because appropriate medical management and implementation may lead to decreased disease burden on cognitive and communication functions. Speech-language pathologists have a valuable role within the clinical team to identify, refer, and diagnose individuals with cognitive–communication impairment due to multiple medical conditions as well as provide behavioral interventions that contribute to the prevention and management of the cognitive and health consequences.

DNA repair is essential to prevent the cytotoxic or mutagenic effects of various types of DNA lesions, which are sensed by distinct pathways to recruit repair factors specific to the damage type. Although biochemical mechanisms for repairing several forms of genomic insults are well understood, the upstream signalling pathways that trigger repair are established for only certain types of damage, such as double-stranded breaks and interstrand crosslinks. Understanding the upstream signalling events that mediate recognition and repair of DNA alkylation damage is particularly important, since alkylation chemotherapy is one of the most widely used systemic modalities for cancer treatment and because environmental chemicals may trigger DNA alkylation. Here we demonstrate that human cells have a previously unrecognized signalling mechanism for sensing damage induced by alkylation. We find that the alkylation repair complex ASCC (activating signal cointegrator complex) relocalizes to distinct nuclear foci specifically upon exposure of cells to alkylating agents. These foci associate with alkylated nucleotides, and coincide spatially with elongating RNA polymerase II and splicing components. Proper recruitment of the repair complex requires recognition of K63-linked polyubiquitin by the CUE (coupling of ubiquitin conjugation to ER degradation) domain of the subunit ASCC2. Loss of this subunit impedes alkylation adduct repair kinetics and increases sensitivity to alkylating agents, but not other forms of DNA damage. We identify RING finger protein 113A (RNF113A) as the E3 ligase responsible for upstream ubiquitin signalling in the ASCC pathway. Cells from patients with X-linked trichothiodystrophy, which harbour a mutation in RNF113A, are defective in ASCC foci formation and are hypersensitive to alkylating agents. Together, our work reveals a previously unrecognized ubiquitin-dependent pathway induced specifically to repair alkylation damage, shedding light on the molecular mechanism of X-linked trichothiodystrophy.