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Enhancing the value of clinical networks for rare diseases
No full textHealthcare networks for rare diseases are developing around the world, concentrating expertise and knowledge from China and Japan to the United States and across Europe. Networked care is scaling up as an effective model of care for rare diseases, with prevention, diagnosis, care and treatment administered locally, informed by the body of knowledge and expertise from the whole network. Now, as the United Nations encourages the development of rare disease networks in all countries, it is timely to reflect on the key characteristics of an effective network. This article aims to identify the core themes needed for a clinical network to be healthy. This article drawing on experience from existing networks through a series of semi-structured interviews, insights from leaders of existing networks are then triangulated with the published evidence. The review aims to identify the themes that allow a clinical network to be effective and flourish. Healthcare networks are best understood as learning systems to generate collaborative knowledge used to inform the best possible care. Six themes are consistently reported in the literature and leaders’ experience: Trust, Communication, Leadership, Learning, Diversity and Resources. Learning together is a key element of the success of effective networks and is most effective when networks are professionally multi-cultural and diverse, including the voices of people living with a rare disease. Patient representative involvement is fundamental to network collaboration and is recognized as a key aspect of early successes. Clinical leadership is critical to providing legitimacy and trust, creating a common identity and promoting collaboration. Networks take time, resources and coordination to develop. Although in-kind support and voluntary contributions of network members are important, inadequate resourcing is a critical barrier to the long-term sustainability and effectiveness of networks. This review explores the core themes of effective networks. Through harnessing digital solutions that enable experts to coordinate care virtually across a clinical network, healthcare for people living with a rare disease is evolving to meet their complex needs. However, payment models to finance these models of care still lag behind innovative healthcare delivery models
Enhanced electromechanical conversion via in situ grown CsPbBr3 nanoparticle/poly(vinylidene fluoride) fiber composites for physiological signal monitoring
No full textMechanical energy conversion based on the piezoelectric principle has received significant attention due to its promising applications in sustainable power supply systems and sensor technology. Ferroelectric poly(vinylidene fluoride) (PVDF) combines the advantages of both good electromechanical coupling and easy processability, yet its low piezoelectric coefficient limits its output performance and it thus cannot meet the increasing requirements for power generation and sensing. Here, inorganic metal halide perovskite CsPbBr3 (CPB) nanoparticles are incorporated into PVDF fibers via an electrospinning technique, where an in situ crystallization and growth process of the CPB nanoparticles is established. Both the CPB nanoparticles and PVDF fibers are poled by the electric field during the electrospinning process, which promotes the formation of the polar phase of PVDF and distortion of the CPB lattice, resulting in greatly enhanced piezoelectric performance for the CPB/PVDF composites. The output performance under the external force of a flexible generator developed from electrospun CPB/PVDF films is significantly enhanced compared with the neat PVDF film, with an 8.4 times higher maximum open circuit voltage value. Furthermore, the measurements on the microscopic piezoelectric responses unambiguously reveal that the increased polar phase mainly contributes to the enhanced electromechanical coupling. The functions of the CPB/PVDF films as physiological signal monitoring sensors are determined and they demonstrate their potential applications as flexible piezoelectric generators and electronics for wearable health monitoring
Recent advances in photocatalytic renewable energy production
No full textThe development of green and renewable energy is becoming increasingly more important in reducing environmental pollution and controlling CO2 discharge. Photocatalysis can be utilized to directly convert solar energy into chemical energy to achieve both the conversion and storage of solar energy. On this basis, photocatalysis is considered to be a prospective technology to resolve the current issues of energy supply and environmental pollution. Recently, several significant achievements in semiconductor-based photocatalytic renewable energy production have been reported. This review presents the recent advances in photocatalytic renewable energy production over the last three years by summarizing the typical and significant semiconductor-based and semiconductor-like photocatalysts for H2 production, CO2 conversion and H2O2 production. These reactions demonstrate how the basic principles of photocatalysis can be exploited for renewable energy production. Finally, we conclude our review of photocatalytic renewable energy production and provide an outlook for future related research
Genetic basis of cardiovascular aging is at the core of human longevity
No full textAging is an archetypical complex process influenced by genetic and environmental factors. Genetic variants impart a gradient of effect sizes, albeit the effect sizes seem to be skewed toward those with small effect sizes. On one end of the spectrum are the rare monogenic premature aging syndromes, such as Hutchinson Gilford Progeria Syndrome, whereby single nucleotide changes lead to rapidly progressive premature aging. On the end of the spectrum is the complex, slowly progressive process of living to an arbitrary-defined old age, i.e., longevity. Whereas the genetic basis of rare premature aging syndromes has been elucidated, only a small fraction of the genetic determinants of longevity and life span, time from birth to death, have been identified. The latter point to the complexity of the process and involvement of myriad of genetic and non-genetic factors and hence, the diluted effect of each determinant on longevity. The genetic discoveries point to the involvement of the DNA damage and activation of the DNA damage response pathway, particularly in the premature aging syndromes. Likewise, the insulin/insulin-like growth factor 1/mTOR/FOXO pathways have emerged as major regulators of life span. A notable fraction of the genetic variants that are associated with life span is also associated with age-related cardiovascular diseases, such as coronary artery disease and dyslipidemia, which places cardiovascular aging at the core of human life span. The clinical impact of the discoveries pertains to the identification of the pathways that are involved in life span, which might serve as targets of interventions to prevent, slow, and even possibly reverse aging
Cellular aging and rejuvenation in ischemic heart disease: a translation from basic science to clinical therapy
No full textIschemic heart disease and heart failure (HF) remain the leading causes of death worldwide. The inability of the adult heart to regenerate itself following ischemic injury and subsequent scar formation may explain the poor prognosis in these patients, especially when necrosis is extensive and leads to severe left ventricular dysfunction. Under physiological conditions, the crosstalk between cardiomyocytes and cardiac interstitial/vascular cells plays a pivotal role in cardiac processes by limiting ischemic damage or promoting repair processes, such as angiogenesis, regulation of cardiac metabolism, and the release of soluble paracrine or endocrine factors. Cardiovascular risk factors are the main cause of accelerated senescence of cardiomyocytes and cardiac stromal cells (CSCs), causing the loss of their cardioprotective and repairing functions. CSCs are supportive cells found in the heart. Among these, the pericytes/mural cells have the propensity to differentiate, under appropriate stimuli in vitro, into adipocytes, smooth muscle cells, osteoblasts, and chondroblasts, as well as other cell types. They contribute to normal cardiac function and have an antifibrotic effect after ischemia. Diabetes represents a condition of accelerated senescence. Among the new pharmacological armamentarium with hypoglycemic effect, gliflozins have been shown to reduce the incidence of HF and re-hospitalization, probably through the anti-remodeling and anti-senescent effect on the heart, regardless of diabetes. Therefore, either reducing the senescence of CSC or removing senescent cells from the infarcted heart could represent future antisenescence strategies capable of preventing the deterioration of heart function leading to HF
Deep transfer learning benchmark for plastic waste classification
No full textMillions of people throughout the world have been harmed by plastic pollution. There are microscopic pieces of plastic in the food we eat, the water we drink, and even the air we breathe. Every year, the average human consumes 74,000 microplastics, which has a significant impact on their health. This pollution must be addressed before it has a significant negative influence on the population. This research benchmarks six state-of-the-art convolutional neural network models pre-trained on the ImageNet Dataset. The models Resnet-50, ResNeXt, MobileNet_v2, DenseNet, SchuffleNet and AlexNet were tested and evaluated on the WaDaBa plastic dataset, to classify plastic types based on their resin codes by integrating the power of transfer learning. The accuracy and training time for each model has been compared in this research. Due to the imbalance in the data, the under-sampling approach has been used. The ResNeXt model attains the highest accuracy in fourteen minutes
Gut microbiota signatures and modulation in irritable bowel syndrome
No full textIrritable bowel syndrome (IBS) affects approximately one tenth of the general population and is characterized by abdominal pain associated with abnormalities in bowel habits. Visceral hypersensitivity, abnormal intestinal motor function, mucosal immune activation, and increased intestinal permeability concur to its pathophysiology. Psychological factors can influence symptom perception at the central nervous system level. In addition, recent evidence suggests that dysbiosis may be a key pathophysiological factor in patients with IBS. Increasing understanding of the pathophysiological mechanisms translates into new and more effective therapeutic approaches. Indeed, in line with this evidence, IBS therapies nowadays include agents able to modulate gut microbiota function and composition, such as diet, prebiotics, probiotics, and antibiotics. In addition, in the last decade, an increasing interest in fecal microbiota transplantation has been paid. An in-depth understanding of the intestinal microenvironment through accurate faucal microbiota and metabolite analysis may provide valuable insights into the pathophysiology of IBS, finally shaping new tailored IBS therapies
Carbon footprints and land-use systems
No full textCarbon Footprint (CFP) refers to the emission of all greenhouse gases (GHGs) during a given period by any activity or entity. The standard unit for measuring it is the carbon dioxide equivalent (CO2eq), such that the impact of each GHG is expressed in terms of the amount of CO2 that would create the same amount of warming. It is widely recognized that the 2020 global value for average per capita CFP (estimated as 4.47 Mg CO2eq) is not sustainable and that it must be reduced to < 2 Mg CO2eq if global warming is to be limited to 20C. Recent estimates show that 31% of human-caused GHG emissions originate from the world’s agri-food systems, the major sources being deforestation, livestock production (from enteric fermentation and manure), food waste disposal, and fossil fuel use (by farms and the food-retail sector). Land application of chemicals such as fertilizers, weedicides, and insecticides is the most significant factor in the AFOLU (agriculture, forestry, and other land-use) sector. Enhancement of the natural process of terrestrial C sequestration in soil and vegetation is a widely recognized approach to reducing the AFOLU sector CFP. The adoption of multispecies agroforestry systems with nitrogen-fixing trees is a promising strategy for accomplishing this goal. Another is integrated silvopastoral systems that combine animal production with deep-rooted grass and trees that could counteract the GHG emission through enteric fermentation in animals with enhanced soil C sequestration
Perspectives on carbon footprint of agricultural land-use in Brazil
No full textBrazil is one of the main producers in the agricultural and forestry sector worldwide, with production systems based on high consumption of inputs that contribute to high levels of greenhouse gas (GHG) emissions. This paper presents an analysis of the scenario of national GHG emissions and carbon footprints in the major production systems of agriculture, including livestock production and forestry, and the potential for soil carbon storage as a mitigation strategy under these systems. The main sources of national GHG emissions are beef cattle due to enteric fermentation and the management of agricultural soils through the use of nitrogen fertilizers. The increasing adoption of low-carbon agriculture has led to a reduction in the carbon footprint through no-till technologies, agrosilvopastoral systems, N2 fixation, and tree plantations. These technologies deserve to be increasingly disseminated to generate economic opportunities leading to financial gains from the commercialization of carbon credits and payment for environmental services
Carbon footprints, informed consumer decisions and shifts towards responsible agriculture, forestry, and other land uses?
No full textThe urgent global reduction of greenhouse gas emissions depends on political commitments to common but differentiated responsibility. Carbon footprints as a metric of attributable emissions reflect individually determined contributions within, and aggregated national contributions between, countries. Footprints per unit product (e.g., of food, feed, fuel, or fiber) require a lifecycle analysis and support individual decisions on consumption and lifestyles. This perspective presents a framework for analysis that connects the various operationalizations and their use in informing consumer and policy decisions. Footprints show geographical variation and are changing as part of political-economic and social-ecological systems. Articulation of footprints may trigger further change. Carbon footprints partially correlate with water and biodiversity footprints as related ecological footprint concepts. The multifunctionality of land use, as a solution pathway, can be reflected in aggregated footprint metrics. Credible footprint metrics can contribute to change but only if political commitments and social-cultural values and responsibilities align
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