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The effects of palliative care (PC) consultation on patient costs and hospitalization metrics in the adult trauma population are unclear.We interrogated our Level I trauma center databases from 1/1/19 to 3/31/21 for patients age ≥18 admitted to the trauma service. Patients undergoing PC consult were matched using propensity scoring to those without PC consultation based on age, admission Glasgow Coma Scale score, Injury Severity Score and Head Abbreviated Injury Scale. Total costs, total cost per day, hospital length of stay (LOS), ICU LOS, intubation days, discharge disposition, and rates of nephrology consultation and tracheostomy/feeding tube placements were compared.140 unique patients underwent PC consultation and were matched to a group not receiving PC consult during the same period. Median total costs in the PC cohort were $39,532 compared to $70,330 in the controls (p0.01). Median costs per day in the PC cohort were $3,495 vs $17,970 in the controls (p0.01). Median costs per ICU day in the PC cohort were $3,774 vs $17,127 in the controls (p0.01). Mean hospital LOS (15.7 vs 7 days), ICU LOS (7.9 vs 2.9 days), and ventilator days (5.1 vs 1.5) were significantly higher in the PC cohort (all p0.01). Rates of nephrology consultation (8.6 vs 2.1%, p = 0.03) and tracheostomy/feeding tube placements (12.1 vs 1.4%, p0.01) were also higher in the PC group. Patients were more likely to discharge to hospice if they received a PC consult (33.6 vs 2.1%, p0.01). Mean time to PC consult was 7.2 days (range 1 hour to 45 days). LOS post-consult correlated positively with time to PC consultation (r = 0.27, p0.01).Expert PC services are known to alleviate suffering and avert patient goal- and value-incongruent care. While trauma patients demand significant resources, PC consultation offered in concordance with life-sustaining interventions is associated with significant savings to patients and the healthcare system. Given the correlation between LOS following PC consult and time to PC consult, savings may be amplified by earlier PC consultation in appropriate patients.

This paper discusses selected glassware from the ecclesiastical and funerary complex of Fondo Giuliano in Vaste (4th-6th century) and from the abandoned medieval village of Apigliano (second phase 7th-11th century). Coupling the results of morpho-typological, contextual and comparative analysis with other data, we attempt to reconstruct the dynamics of production and importation and the trade network. The compositional analysis of the finds, carried out by LA-ICP-MS at IRAMAT-CEB in Orléans, reveals the use of natron glass throughout the period investigated, without the use of soda-ash glass. The recycling of cullet and the import of raw glass or finished products from Egypt and Asia Minor prove to be the two recognised supply channels. This suggests the maintenance of large-scale contacts for the importation of glass throughout the 5th to 11th century, even outside of non-urban centres such as those examined.

The term food losses and waste (FLW) distinguishes between food losses occurring in the supply chain versus food waste; generated in the distribution and final consumption. The composition of the FLW comprises carbohydrates, lipids, and proteins, representing an economic alternative to be used as raw material in different bioprocesses that might generate value-added products. Different authors have proposed that the key solution for the food industry resides in finding the appropriate approaches to valorize the FLWs. Obtaining high value-added products from FLWs aligns with the current concept of sustainable development aiming to achieve food security, environmental protection, and energy efficiency. This chapter makes a compilation of main studies to quantify and valorize FLW within a circular bioeconomy.

Infant hydrocephalus poses a severe global health burden; 80% of cases occur in the developing world where patients have limited access to neurosurgical care. Surgical treatment combining endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC), first practiced at CURE Children’s Hospital of Uganda (CCHU), is as effective as standard ventriculoperitoneal shunt (VPS) placement while requiring fewer resources and less post-operative care. Although treatment focuses on controlling ventricle size, this has little association with treatment failure or long-term outcome. This study aims to monitor the progression of hydrocephalus and treatment response, and investigate the association between cerebral physiology, brain growth, and neurodevelopmental outcomes following surgery. We will enroll 300 infants admitted to CCHU for treatment. All patients will receive pre/post-operative measurements of cerebral tissue oxygenation (SO2), cerebral blood flow (CBF), and cerebral metabolic rate of oxygen consumption (CMRO2) using frequency-domain near-infrared combined with diffuse correlation spectroscopies (FDNIRS-DCS). Infants will also receive brain imaging, to monitor tissue/ventricle volume, and neurodevelopmental assessments until two years of age. This study will provide a foundation for implementing cerebral physiological monitoring to establish evidence-based guidelines for hydrocephalus treatment. This paper outlines the protocol, clinical workflow, data management, and analysis plan of this international, multi-center trial.

Made available in DSpace on 2022-04-29T08:36:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-12-01 Paper electronics has emerged as an ecofriendly, light, low-cost, and recyclable material for the fabrication of flexible and printed transistors. In this study, we present fully printed organic electrochemical transistors using an active layer of PEDOT:PSS, carbon electrodes, cellulose-based electrolyte, and three different papers as substrates: bond, vegetal, and Lumi Silk, relating the electrical properties to the different morphologies of the paper surfaces. Each paper presents different regularity, diffusion capabilities, and roughness, with significant influence on the transistor performance. The more organized and smooth the surface, the better the electrical characteristics, the best of these being the Lumi Silk, with higher I on/I off ratio of 46, on-current of 8.3 10-5 A, V on of 1.3 V, and power gain of 43.5 dB associated with ultra-low hysteresis of 0.1 V, high transconductance of -57.3 μS, and suitablity for flexible electronics and sensors applications. S o Paulo State University - UNESP Faculty of Science and Technology (FCT) Physics Department, SP Universidade NOVA de Lisboa and CEMOP-UNINOVA Faculty of Science and Technology (FCT) CENIMAT/I3N Department of Materials Science S o Paulo State University - UNESP Faculty of Science and Technology (FCT) Physics Department, SP

Disintegrins are low molecular weight cysteine-rich proteins (4–14 kDa) that are isolated mainly from viperid snake venom. Due to their potential as lead compounds for binding and blocking integrin receptors, snake venom disintegrins have become one of the most studied venom protein families. The aim of this study was to obtain disintegrins from C. totonacus venom and evaluate their capability to bind and block integrin receptors. The C. totonacus disintegrin fraction (totonacin) represents two disintegrin isoforms obtained from C. totonacus venom. These disintegrins showed extracellular-matrix (ECM) protein adhesion and migration inhibitory effects on MDA-MB-231 and HMEC-1 cells. Totonacin (3 μM) inhibited MDA-MB-231 cell adhesion to the ECM proteins, fibronectin, vitronectin, and laminin by 31.2, 44.0, and 32.1, respectively. Adhesion inhibition to fibronectin, vitronectin, and laminin observed on HMEC-1 cells was 42.8, 60.8, and 51%, respectively. In addition, totonacin (3 μM) significantly inhibited MDA-MB-231 and HMEC-1 cell migration (41.4 and 48.3%, respectively). Totonacin showed more potent cell adhesion inhibitory activity toward vitronectin in both cell lines. These results suggest a major affinity of totonacin toward αVβ3, α8β1, αVβ5, αVβ1, and αIIbβ3 integrins. In addition, the inhibitory effect observed on MDA-MB-231 and HMEC-1 cell migration reinforces the evidence of an interaction between these disintegrins and αVβ3 integrin, which plays a key role in migration and angiogenesis.

Thanks Analytical Sociology, the concept of mechanism occupies a central place in contemporary sociology. Its intuitive and spontaneous use, however, characterized a part of empirical social research in the past, especially that developed by Paul F. Lazarsfeld and Robert K. Merton at Columbia University in the 1940’s and 1950’s. In this article, our aim is to explore a possible connection between these two research traditions, using the methodological tool of computational simulation. Specifically, the article discusses two hypotheses formulated by Lazarsfeld and Merton: the hypothesis of gratification, resulting from the duration of social interaction, and the hypothesis of formation of new social ties after a friendship breakup. Therefore, we implement four scenarios, each representing a specific combination of hypotheses. The results allow us to clearly observe four different emerging social patterns that are generated from the micro level by the interaction between individual agents who follow the mechanisms inspired by the original formulation of the theory. Through thes simulations, we can examine the unexpected effects - on a system of action - caused by the introduction of Lazarsfeld and Merton’s hypotheses

Il tratto temperamentale diBehavioralInhibition(BI:Kagan et al.,1987) è un fattore di rischio per problematiche internalizzantiin infanzia e disturbi ansiosi in adolescenza(Clauss et al.,2012). Tradizionalmente, la BI è considerata un costrutto unidimensionale, caratterizzato nel bambino dapreoccupazione e paura di fronte sia a nuove persone sia a nuovi oggetti o situazioni. Recentemente, alcuni autori(Kertes et al.,2009; Dyson et al.,2011)hanno sostenuto l’idea di BI come costrutto multidimensionale, tale per cui un bambino può risultare inibito nell’interazione con l’estraneo senza mostrare comportamenti inibiti in presenza di oggetti nuovi, o viceversa. L’importanza di definire la natura del costrutto deriva dall’idea che le implicazioni psicopatologiche del tratto possano essere più specifiche di una componente piuttosto che di un’altra.Obiettivi del presente studio sono:1) indagare, longitudinalmente e trasversalmente, se BI sociale e BI non sociale siano tra loro correlate;2) verificare se i bambini con BI sociale e i bambini con BI non sociale mostrino un maggiore rischio di problematicheinternalizzanti rispetto ai coetanei non inibiti. Il campione è costituito da 24 bambini frequentanti una scuola dell’Infanzia e dalla loro insegnante. L’assessment di BI sociale e non, attraverso procedure osservative standardizzate(LAB-TAB: Goldsmith et al.,1999), viene ripetuto in 3 momenti successivi nel tempo (gennaio-giugno 2014-gennaio 2015). Gli strumenti compilati dall’insegnante sono: Children’sBehaviorQuestionnaire SF (CBQ SF-Putnam&Rothbart,2006) per il profilo temperamentale del bambino eChild BehaviorChecklist 1.5/5 yrs(CBCL:Achenbach,2000) per l’individuazione di problematiche internalizzanti. BI sociale e BI non sociale risultanoaltamente correlate(p

The World Health Organization (2003) stated that there is growing evidence that changes in the global climate will have profound effects on the well-being of citizens in countries throughout the world. The “business as usual” frame of mind in dealing with this phenomenon is no longer feasible. Rather, there is a great need for a “sense of urgency” to empower and actively involve every individual to adapt and to mitigate the worsening of climate change. A great number of studies show that the leadership of the educational system in developed countries for more than 2 decades has been successful in promoting environmental sustainability. Some of these studies are reviewed and documented in this paper so that vulnerable countries may learn and benchmark from their experiences. Keywords - Education, sustainable development, climate change

This study explored the progress in the achievement of the Millennium Development Goals 4 and five (5) fifteen years after it was agreed upon as health targets among member countries of the United Nations. Through literature review and data mining process, the following data of the Western Pacific Region’s lower and middle-income countries were scrutinized: 1) infant and child health situation in terms of percentage reduction in both infant and under-five mortality rates for the past 25 years and proportion of one-year-old children immunized against measles; 2) maternal health situation in terms of current maternal mortality ratio and its percentage reduction, proportion of births attended by skilled health personnel and percentage of antenatal care coverage; and 3) health care delivery system in terms of health expenditure as percentage of the country’s gross domestic products, presence of health infrastructures, and members of the health workforce. Results revealed that for infant mortality, those countries with a population of more than 250,000 fared well as compared to the smaller Pacific islands with a population of less than 250,000. For under-5 mortality rate, almost all of the LMICs did not meet the target. However, the majority of these countries met the target on the provision of measles immunization on time. For maternal health, the smaller Pacific islands fared well compared to the bigger countries. The majority of the LMICs performed poorly in this variable. Thus, most of the Region’s LMICs somehow almost achieved MDG4 (infant and child health) but are still far from achieving MDG5 (maternal health) on time. Lastly, the smaller Pacific islands again had a better status in all indicators of the healthcare delivery system (health expenditure, number of hospitals and health worker density ratio) as compared to the bigger countries. These indicators are considered crucial towards achieving the MDG targets and must, therefore, be addressed if they want to improve maternal health in the Region. Keywords: Infant and child health, maternal health, healthcare delivery system, Western Pacific Region

Background: scientific evidence exists to support the claim that either general o regional anesthesia can be safely used for CEA: each of the techniques has either theoretical and practical advantages or drawbacks. Since the issue of whether, for CEA, one anesthetic technique is better than another has not yet been explored by randomized trials, any contribution that could reduce the disadvantages of any of the two approaches may contribute to overcome individual diffidence and visceral antagonism. The proposed approach represents a technical improvement of locoregional CEA technique. Methods: one hundred consecutive patients undergoing elective or urgent primary CEA under locoregional anesthesia were prospectively randomized in two equal size groups. In group 1 traditional (medial) approach to carotid bifurcation was employed; in group 2 the retrojugular approach (RJA) was used. Surgical and anesthesia scores were developed to assess the differences between the two groups in terms of surgical ease, the quality of exposure, patients comfort, level and quality of anesthesia. Results: demographic and clinical characteristics of group 1 and group 2 patients were comparable. No major complication or death was observed in this series. Significant score differences were observed in favour of the retrojugular route. Using this route an improved and wider exposure was obtained, moreover, we achieved a better analgesia, with lesser additional anesthetic doses requirements, a faster approach to the carotid bifurcation, an enhanced patient comfort and a reduced interference on the surgical procedure by deglutition movements. Conclusions: the retrojugular route represents the ideal route for locoregional CEA; this exposure, with respect to the traditional approach, minimizes many of the disadvantages commonly considered as major deterrents of regional anesthesia for carotid surgery. Eur J Vasc Endovasc Surg 26, 250-255 (2003)

The study focused on the improvement of a manual to computerized system for Police Station No.1 in Divisoria, Cagayan de Oro City. It consists of functionally related GUI (application program) and a database. The system consists of a Land-based system for information management and monitoring. Qualitative studies, involving interviews and observations, were used to collect data. The system is designed to help its users organize records and maintain their confidentiality. Also, the system is much easier to apply since the design is relatively simple. Keywords Management, Monitoring, Primary Key, Foreign Key, Technology, Develop, Design.

This study generally assessed the peoples’ vulnerability and coping to climate change. Vulnerability is a function of exposure, sensitivity (risk) and adaptive capacity or coping. This descriptive and analytic study considered the economic, social, and infrastructure and services vulnerabilities, as well as the adaptive capacity (coping) of each country to climate change through data mining. Data gathered went through Principal Components Analysis (PCA), regression and cluster analysis with the aid of the MINITAB Software. Countries were then grouped according to their extent of vulnerability and theories were developed basing on the statistical results. Stepwise regression was likewise conducted to validate the theories generated. Based on the highlighted results of the study: it can be concluded that majority of the countries (98 countries) are moderately vulnerable to climate change. Nonetheless, a third (44 countries) is already highly vulnerable and one country (Nicaragua) is very highly vulnerable to climate change. Inferentially, it can also be concluded that vulnerability to climate change is influenced by human development and environmental protection factors. Keywords - Climate change, vulnerability, mitigation, adaptation

We determined the prevalence of celiac disease in subjects with autoimmune thyroiditis compared with sick and healthy subjects. The screening was performed with IgA-class endomysium antibody, by indirect immunofluorescence using human umbilical cord as the antigenic substrate. Six of the 172 patients with autoimmune thyroiditis were found to be anti-endomysium positive (3.4\%) and five of these underwent intestinal biopsy, which showed total villous atrophy. By contrast, 3 (0.75\%) of 396 patients with nongastroenterologic malignancies and 10 (0.25\%) of 4000 blood donors were found to have celiac disease. The prevalence of autoimmune diseases was significantly higher in patients with both celiac disease and autoimmune thyroiditis than in patients with autoimmune thyroiditis alone (P = 0.01). This study confirms that celiac disease is increased among patients with autoimmune thyroiditis. We suggest that these patients may benefit from screening for celiac disease so as to eliminate symptoms and limit the risk of developing other autoimmune disorders.

This descriptive study explores the health promotion of local migrant workers in a highly urbanized city in Southern Philippines. The respondents were the 164 workers in five of the biggest retail stores in the city. Modified questionnaires, supplemented with focus group discussions, were the main tools employed. Permission to conduct the study was requested from the Department of Labor and Employment and the store management. Written informed consent from the study participants was also sought. Data gathered were then processed using descriptive statistics. Results show that the male and female migrant workers are barely legal, just off their teenage life, attended college, mostly single, belonged to medium-sized families, with fathers either farmers or private employees and mothers who were housewives with no gainful employment. The workers had various physical and mental health problems, as well as poor health-seeking behaviors. The findings have various implications on program planning and policy making in related private and government agencies to promote the health of local migrant workers.