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Effectiveness and safety of mechanical thrombectomy for acute ischaemic stroke in Latin American countries: A systematic review
Get PDFYesTo describe the use, effectiveness, and safety outcomes of mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in Latin American countries.
Studies reporting MT outcomes for AIS in Latin America were identified in CINAHL, MEDLINE, Web of Science, SciELO, EMBASE, and LILACS databases. Synthesis was conducted according to effectiveness (recanalization rates) and safety measures (mortality and functional independence at 90 days).
Seventeen studies were included, mainly from public and university hospitals. MT utilization varied from 2.6% to 50.1%, while successful recanalization ranged from 63% to 95%. Functional independence 90 days after stroke (a modified Rankin scale score of 0 to 2) was achieved in less than 40% across most studies. Mortality rates were below 30%; studies with posterior circulation strokes reported higher mortality rates. The randomized trial reported better health outcomes for functional independence among patients in the MT group (OR 2.28; 95% CI, 1.41 - 3.69), favoring MT over standard care.
The included studies had great methodological heterogeneity due to differences in study design, the MT time window, and stroke location. The only randomized trial showed improved functional independence and lower mortality rates with MT than with standard care. The rest of the studies reported similar findings to available literature. Efforts to improve stroke care are reflected in improved patient outcomes in the region. Future studies should consider standard time window criteria and reduce the risk of bias by including representative samples and comparison groups
DNA dioxygenases Tet2/3 regulate gene promoter accessibility and chromatin topology in lineage-specific loci to control epithelial differentiation
Get PDFYesExecution of lineage-specific differentiation programs requires tight coordination between many regulators including Ten-eleven translocation (TET) family enzymes, catalyzing 5-methylcytosine oxidation in DNA. Here, by using Keratin 14–Cre–driven ablation of Tet genes in skin epithelial cells, we demonstrate that ablation of Tet2/Tet3 results in marked alterations of hair shape and length followed by hair loss. We show that, through DNA demethylation, Tet2/Tet3 control chromatin accessibility and Dlx3 binding and promoter activity of the Krt25 and Krt28 genes regulating hair shape, as well as regulate interactions between the Krt28 gene promoter and distal enhancer. Moreover, Tet2/Tet3 also control three-dimensional chromatin topology in Keratin type I/II gene loci via DNA methylation–independent mechanisms. These data demonstrate the essential roles for Tet2/3 in establishment of lineage-specific gene expression program and control of Dlx3/Krt25/Krt28 axis in hair follicle epithelial cells and implicate modulation of DNA methylation as a novel approach for hair growth control.This work was supported by the National Institutes of Health grant 5R01 AR075776 (V.A.B. and A.A.S.) and grant 5R01 AR071727 (V.A.B. and A.A.S.) and the National Science Foundation of China (G.-L.X.).Research Development Fund Publication Prize Award winner, Dec 2022
A qualitative analysis of stressors affecting 999 ambulance call handlers' mental health and well-being
Get PDFYesPurpose
The 999 ambulance call handler is critical in responding to emergency patient treatment; however, the call handlers are often a hidden component of the healthcare workforce and an under-researched group. The objective of this study is to understand stress triggers experienced by 999 ambulance call handlers that could lead to burnout and examine personal and organisational mechanisms and strategies which reduced the risk of burnout.
Design/methodology/approach
A single interview case study approach applying qualitative methods was undertaken. Participants were identified through a purposive sample of 999 ambulance call handlers with the Yorkshire Ambulance Service National Health Service Trust (UK). Participants were interviewed via telephone between July 2019 and September 2019.
Findings
In total, 18 staff participated in this study. Societal factors including public incivility and media representation and organisational factors, such as a demanding environment, lack of appreciation and career progression, training issues and protocols were key stressors. Organisational well-being services were helpful for some, but for others lacked accessibility and appropriateness. Positive public feedback and speaking with peers bolstered well-being. 999 ambulance call handlers suggested that sufficient breaks, co-design or feeding back on training and protocols and creating more informal opportunities to discuss ongoing everyday stressors as methods to reduce stress and burnout.
Originality/value
This paper explores a previously under researched area on stressors and potential burnout in 999 call handlers. This paper highlights the need for improved organisational support services and appropriate public and sector peer recognition of the role of ambulance 999 ambulance call handlers.This research was funded by the University of Bradford Research Development Fund. This research was supported by Yorkshire Ambulance Service NHS Trust, and the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC)
Flexible design and operation of multi-stage reverse osmosis desalination process for producing different grades of water with maintenance and cleaning opportunity
Get PDFYesThe use of Reverse Osmosis (RO) process in seawater desalination to provide high-quality drinking water is progressively increased compared to thermal technologies. In this paper, multistage spiral wound RO desalination process is considered. Each stage consists of several pressure vessels (PVs) organised in parallel with membrane modules in each PV being organised in series. This allows disconnecting a set of PVs and membrane modules depending on the requirement of cleaning and maintenance. While this flexibility offers the opportunity of generating several RO configurations, we presented only four such configurations of the RO system and analysed them via simulation and optimisation. Production of different grades of water catering different needs of a city is also considered for each of these configurations. The optimisation has resulted in the optimal operating conditions, which maximises the water productivity and minimises the specific energy consumption of the proposed configurations for a given water grade in terms of salinity. For instance, the results indicate that the proposed RO networks can produce drinking water of 500 ppm salinity with a minimum specific energy consumption of 3.755 kWh/m3. The strategy offers the production of different grades of water without plant shutdown while maintaining the membrane modules throughout the year.The use of Reverse Osmosis (RO) process in seawater desalination to provide high-quality drinking water is progressively increased compared to thermal technologies. In this paper, multistage spiral wound RO desalination process is considered. Each stage consists of several pressure vessels (PVs) organised in parallel with membrane modules in each PV being organised in series. This allows disconnecting a set of PVs and membrane modules depending on the requirement of cleaning and maintenance. While this flexibility offers the opportunity of generating several RO configurations, we presented only four such configurations of the RO system and analysed them via simulation and optimisation. Production of different grades of water catering different needs of a city is also considered for each of these configurations. The optimisation has resulted in the optimal operating conditions, which maximises the water productivity and minimises the specific energy consumption of the proposed configurations for a given water grade in terms of salinity. For instance, the results indicate that the proposed RO networks can produce drinking water of 500 ppm salinity with a minimum specific energy consumption of 3.755 kWh/m3. The strategy offers the production of different grades of water without plant shutdown while maintaining the membrane modules throughout the year
Expansion of the 4-(Diethylamino)benzaldehyde Scaffold to Explore the Impact on Aldehyde Dehydrogenase Activity and Antiproliferative Activity in Prostate Cancer
Get PDFYesAldehyde dehydrogenases (ALDHs) are overexpressed in various tumor types including prostate cancer and considered a potential target for therapeutic intervention. 4-(Diethylamino)benzaldehyde (DEAB) has been extensively reported as a pan-inhibitor of ALDH isoforms, and here, we report on the synthesis, ALDH isoform selectivity, and cellular potencies in prostate cancer cells of 40 DEAB analogues; three analogues (14, 15, and 16) showed potent inhibitory activity against ALDH1A3, and two analogues (18 and 19) showed potent inhibitory activity against ALDH3A1. Significantly, 16 analogues displayed increased cytotoxicity (IC50 = 10-200 μM) compared with DEAB (>200 μM) against three different prostate cancer cell lines. Analogues 14 and 18 were more potent than DEAB against patient-derived primary prostate tumor epithelial cells, as single agents or in combination treatment with docetaxel. In conclusion, our study supports the use of DEAB as an ALDH inhibitor but also reveals closely related analogues with increased selectivity and potency.S12-027/PCUK_/Prostate Cancer UK/United Kingdo
Precarity as a Migrant Family Tradition
Get PDFYesGrowing up mixed race, it is hard to ignore the stark differences between the maternal and paternal sides of the family. The migrants of my dad's side of the family, journeying from places such as Norway and Ireland, settled down in New York and remained close to each other. As a child, most of my paternal family members lived less than 30 minutes away, with my paternal grandparents living on the ground floor of my childhood home. In contrast, my maternal side of the family scattered once migrated from China-with our closest family members on the West Coast of the United States, and others located in the settler-occupied territories known as Canada and Australia. Their locations were constantly shifting and moving-to the extent that it took nearly three decades for me to finally meet all of my maternal family members. It did not take long for me to understand that putting down "permanent roots" was not a Lee family trait
The Chemerin-CMKLR1 Axis is Functionally important for Central Regulation of Energy Homeostasis
Get PDFYesChemerin is an adipokine involved in inflammation, adipogenesis, angiogenesis and energy metabolism, and has been hypothesized as a link between obesity and type II diabetes. In humans affected by obesity, chemerin gene expression in peripheral tissues and circulating levels are elevated. In mice, plasma levels of chemerin are upregulated by high-fat feeding and gain and loss of function studies show an association of chemerin with body weight, food intake and glucose homeostasis. Therefore, chemerin is an important blood-borne mediator that, amongst its other functions, controls appetite and body weight. Almost all studies of chemerin to date have focused on its release from adipose tissue and its effects on peripheral tissues with the central effects largely overlooked. To demonstrate a central role of chemerin, we manipulated chemerin signaling in the hypothalamus, a brain region associated with appetite regulation, using pharmacological and genetic manipulation approaches. Firstly, the selective chemerin receptor CMKLR1 antagonist α-NETA was administered i.c.v. to rats to test for an acute physiological effect. Secondly, we designed a short-hairpin-RNA (shRNA) lentivirus construct targeting expression of CMKLR1. This shRNA construct, or a control construct was injected bilaterally into the arcuate nucleus of male Sprague Dawley rats on high-fat diet (45%). After surgery, rats were maintained on high-fat diet for 2 weeks and then switched to chow diet for a further 2 weeks. We found a significant weight loss acutely and inhibition of weight gain chronically. This difference became apparent after diet switch in arcuate nucleus-CMKLR1 knockdown rats. This was not accompanied by a difference in blood glucose levels. Interestingly, appetite-regulating neuropeptides remained unaltered, however, we found a significant reduction of the inflammatory marker TNF-α suggesting reduced expression of CMKLR1 protects from high-fat diet induced neuroinflammation. In white and brown adipose tissue, mRNA expression of chemerin, its receptors and markers of adipogenesis, lipogenesis and brown adipocyte activation remained unchanged confirming that the effects are driven by the brain. Our behavioral analyses suggest that knockdown of CMKLR1 had an impact on object recognition. Our data demonstrate that CMKLR1 is functionally important for the central effects of chemerin on body weight regulation and neuroinflammation.This work was funded in part by the Academy of Medical Sciences, the Wellcome Trust, the Government of Business, Energy and Industrial Strategy and the British Heart Foundation and Diabetes United Kingdom [SBF004/1063] (GH), the Society for Endocrinology Equipment Grant (GH, RD), the University of Bradford (GH, KP, SK) and Nottingham Trent University (RD)
Entrepreneurial strategic posture and new technology ventures in an emerging economy
Get PDFYesPurpose: Although start-ups have gained increasing scholarly attention, we lack sufficient understanding of their entrepreneurial strategic posture (ESP) in emerging economies. The purpose of this study is to examine the processes of ESP of new technology venture start-ups (NTVs) in an emerging market context. Design/methodology/approach: In line with grounded theory guidelines and the inductive research traditions, the authors adopted a qualitative approach involving 42 in-depth semi-structured interviews with Ghanaian NTV entrepreneurs to gain a comprehensive analysis at the micro-level on the entrepreneurs' strategic posturing. A systematic procedure for data analysis was adopted. Findings: From the authors' analysis of Ghanaian NTVs, the authors derived a three-stage model to elucidate the nature and process of ESP Phase 1 spotting and exploiting market opportunities, Phase II identifying initial advantages and Phase III ascertaining and responding to change. Originality/value: The study contributes to advancing research on ESP by explicating the process through which informal ties and networks are utilised by NTVs and NTVs' founders to overcome extreme resource constraints and information vacuums in contexts of institutional voids. The authors depart from past studies in demonstrating how such ties can be harnessed in spotting and exploiting market opportunities by NTVs. On this basis, the paper makes original contributions to ESP theory and practice
Investigating the themes in supply chain finance: the emergence of blockchain as a disruptive technology
No full textYesBlockchain has gained momentum as a disruptive technology in supply chain management against its introduction as a finance-related instrument. Nevertheless, the developing academic understanding and the limited practical implications lead to insufficient insights into the use of blockchain technology, particularly in the supply chain finance (SCF) domain. Thus, the expected potential of blockchain technology remains underexplored. Accordingly, this study explicates this situation by examining the extant literature findings and web-based big data that can provide evidence about the real needs in supply chains, and investigating how blockchain emerges as a disruptive SCF-oriented technology. The study employs a web analytics method, Search Engine Results Page (SERP) analysis which considers the trends in blockchain technology use and the interactions between blockchain, supply chain and finance appearing in Google searches. The SERP method examined real-time clicks, web traffics and most commonly asked questions about blockchain. The SERP findings revealed that the interest in blockchain technology neither focused on finance nor data privacy as emphasised in the literature but mainly on the benefits of increasing digitalisation and efficiency in supply chains. The results offered practical implications for capturing recent blockchain- and supply chain-related trends and designing more digital and efficient supply chains
Researching nurses' use of digital technology during the COVID-19 pandemic
No full textYesThe adoption of digital technology by nurses accelerated during the coronavirus disease 2019 (COVID-19) pandemic. However, not all nurses were familiar with the various digital systems used in their organisations and there were reports of digital technology not being fit for purpose. This article describes a service evaluation that used an online survey to obtain nurses' feedback on the digital systems used to support patient care during the pandemic. Fifty-five respondents provided details about 85 separate digital systems. The usability of these systems varied significantly across technology types, while barriers to their use included nurses' lack of digital literacy and inadequate access to IT infrastructure. However, most of the nurse respondents felt that digital technology had supported effective patient care during the COVID-19 pandemic