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General practitioners’ perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study
Get PDFWith the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs’ perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June–September 2020. GPs’ perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients’ preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure
Cryopreservation of Endangered Ornamental Plants and Fruit Crops from Tropical and Subtropical Regions
Get PDFHorticultural crops comprise various economic species extending from fruits, nuts, vegetables, spices and condiments, ornamentals, aromatic, and medicinal plants. Ornamental and fruit plants are produced mainly for their nutritional and aesthetic values, respectively. Unfortunately, many tropical and subtropical species are in danger of extinction because of climate change and (a)biotic stresses. It is imperative to preserve the germplasms of these species for the present and future genetic improvement programs. Cryopreservation, i.e., maintenance of tissues at the ultralow temperature of liquid nitrogen, is a promising long-term preservation technique, alternative to seed or in vitro banks, which can be applied for both vegetatively and generatively (through seeds) propagated crops, including those with recalcitrant seeds. It is a technology of choice not only for the preservation of plant biodiversity but also for virus elimination in the proficient administration of large-scale micropropagation. The main advantages of cryopreservation are the lowering of in vitro culture expenditures, needed space, contamination risk, and operator errors. However, tropical species are temperature delicate and one of the foremost challenging issues is preconditioning treatments that stimulate physiological reactions to sufficiently enhance tolerance to dehydration and cryogenic procedures. In recent years, several cryopreservation methods based on encapsulation-vitrification, droplet-vitrification, the use of aluminum cryo-plates, and cryo-mesh have been established. Combined cryo-techniques, gene/DNA conservation, as well as studies on perceiving bio-molecular events and exploring the multistage process from the beginning to end of cryopreservation are receiving more emphasis. The development of cryobiomics delivers a conceptual framework to assess the significance of cell signaling mechanisms on cellular functions, the influence of cryoinjury factors on sample viability, and the implications for genetic stability following cryo-storage. The aim of this mini-review article is to provide a succinct synthesis of the developed cryogenic procedures and their use for the storage and exchange of genetic resources of tropical and subtropical horticultural crops, particularly fruit crops and ornamental plants under the threat of extinction
Utility of Bruton’s Tyrosine Kinase Inhibitors in Light Chain Amyloidosis Caused by Lymphoplasmacytic Lymphoma (Waldenström’s Macroglobulinemia)
Get PDFOf the variety of immunoglobulin related amyloidosis (AL), immunoglobulin M (IgM) related AL represents only 6 to 10% of affected patients, and the majority of these cases are associated with underlying non-Hodgkin’s Lymphoma including Waldenström’s macroglobulinemia (WM). Ibrutinib, acalabrutinib, and zanubrutinib are Bruton tyrosine kinase (BTK) inhibitors approved for certain indolent B cell non-Hodgkin’s lymphoma (NHL). BTK is a nonreceptor kinase involved in B-cell survival, proliferation, and interaction with the microenvironment. We retrospectively evaluated the tolerability and effectiveness of BTK inhibitors ibrutinib and acalabrutinib therapy in (n = 4) patients with IgM-related AL amyloidosis with underlying WM. Treatment was well tolerated with both hematologic and organ response in patients with AL amyloidosis in the setting of WM. Atrial fibrillation led to the discontinuation of ibrutinib in one patient, and acalabrutinib caused significant thumb hematoma needing dose reduction in another patient. All patients evaluated had the MYD88 mutation. This may explain the good response to BTK inhibitors therapy in our series. BTK inhibitors should be further investigated in larger prospective studies for treatment of AL amyloidosis in patients with lymphoplasmacytic lymphoma/WM
Diversified and Sustainable Business Strategy of Smallholder Farmers in the Suburbs of Taiwan
Get PDFaiwan’s smallholder farmers are transforming into a diversified business model to respond to the transformation of economic structures and the demand for sightseeing and recreation. On that account, it is urgent and valuable at the research level to develop diversified and sustainable business strategies and models for smallholder farmers. There are two goals in this study. First of all, the study formulated the indicators of diversified and sustainable business strategies for smallholder farmers in Taiwan’s suburbs. Second, the study measured the relevant weights of these indicators from the perspectives of experts. The qualitative and quantitative Analytic Hierarchy Process (AHP) was applied in the study, with Taiwan’s agricultural experts being our main subjects to establish the indicators and models for diversified and sustainable business strategies based on their opinions. According to the research results, there were 6 criteria and 25 sub-criteria for smallholder farmers in terms of diversified and sustainable business strategies, among which, catering services topped other criteria; food health and safety outweighed other sub-criteria of diversified and sustainable business strategies for smallholder farmers. The greatest contribution of the study is the establishment of the indicators and models of diversified and sustainable strategies for smallholder farmers in Taiwan’s suburbs and the discovery that catering service can be an important orientation of diversified and sustainable business strategies for smallholder farmers in Taiwan’s suburbs
Interactions between Social Hierarchy and Some Udder Morphometric Traits upon Colostrum and Milk Physicochemical Characteristics in Crossbred Dairy Goats
Get PDFhe possible relationship between udder morphometric variables (UMVs), chemical quality (CHQ) of both colostrum (CA), and milk (MK), as affected by goat’s social rank (SR) (i.e., low-LSR, or high-HSR), was assessed. In late June, goats (Alpine–Saanen–Nubian x Criollo; n = 38; 25° N) were estrus-synchronized and subjected to a fixed-time artificial insemination protocol. Thereafter, in October, while a behavioral study was performed in confirmed-pregnant goats to define the SR classes (n = 15), live weight (LW), body condition (BCS), and serum glucose (GLUC) were registered on the last day of the behavioral study. The expected kidding date was 25 November. Both the UMVs (i.e., seven dates) and the CHQ (i.e., either one for CA and three times for MK) were collected across time (T). The UMVs involved udder perimeter (UDPER, cm), udder diameter (UDDIA, cm), left-teat (LTPER, cm) and right-teat perimeter (RTPER, cm), left-teat (LTLT, cm) and right-teat length (RTLT, cm), left-teat diameter (LTDIA, cm) and right-teat diameter (RTDIA, cm), and medium suspensory ligament (MSL, cm). The registered CHQ variables for both CA and MK were fat (FAT), protein (PRO), lactose (LAC), nonfat solids (NFS), freezing point (FP), and total solids (TS). The possible effect of SR, T, and the SR × T interaction upon the described response variables was tested. While LW favored the HSR goats (54.6 vs. 48.2 ± 1.7 kg; p 0.05) between SR. An SR × T interaction affected (p FAT, > PRO, and > NFS) during early lactation. Therefore, both social rank (i.e., HSR goats), as well as the temporal transition stage from the last third of pregnancy to the first phase of lactation (i.e., time), operated as important modulators upon both udder architecture and milk quality in crossbred dairy goats under a dry-semiarid production syste
ERAS vs. Traditional Protocol in Patients Who Had Radical Cystectomy with Ileal Conduit: A Retrospective Comparative Analysis of 182 Cases
Get PDFObjective. To examine the effects of ERAS protocol application on hospital stay, postoperative antibiotic use, and gastrointestinal recovery time in radical cystectomy patients with ileal conduit. Materials and Methods. This retrospective study included 182 patients (112 traditional vs. 72 ERAS) who underwent radical cystectomy (RC) with ileal conduit between November 2017 and December 2020. Patients were compared in terms of time to start enteral feeding (SEF), length of hospital stay (LOS), time to first stool, duration of postoperative intravenous antibiotic use, postoperative ileus rate, and serum albumin levels. Results. The traditional and ERAS groups contained 112 and 72 patients, respectively. LOS (14.79 ± 6.44 vs. 10.44 ± 4.64 days, ), first stool time (4.43 ± 2.39 vs. 2.89 ± 1.81 days, ), and duration of postoperative intravenous antibiotic use (8.79 ± 5.17 vs. 4.61 ± 4.90, ) were to be found significantly shorter in the ERAS group. Conclusion. According to the results of this study, the ERAS protocol shortened the length of hospital stay, duration of antibiotic use, and time of first stool in patients who underwent RC with ileal conduit.
1. Introduction
Bladder cancers are the second most common of the genitourinary system. Approximately 20–40% of them are muscle invasive at the time of diagnosis [1]. Radical cystectomy (RC) and pelvic lymph node dissection are standard treatment modalities for muscle-invasive bladder tumors [2]. The primary goal of bladder cancer treatment is to minimize mortality and morbidity while obtaining the best oncological results [3]. Fortunately, morbidity and mortality from RC have decreased in recent years due to advances in surgical technique, anesthesia, and postoperative procedures [4].
Although various methods are used for urinary diversion, the ileal conduit is currently the most preferred method [5]. Early complications such as nausea, vomiting, fever, and ileus have been reported in patients after the ileal conduit procedure, however [6]. These complications affect the length of hospital stay and increase the cost of the operation.
In the past, the lack of a standard protocol in postoperative healthcare resulted in different approaches to patients, such as a postoperative bowel rest period and/or a preoperative bowel cleaning, and pain management decisions differed for each surgeon [7]. Today, enhanced recovery after surgery (ERAS) is in place, which is the concept of multimodal, perioperative interventions to improve postoperative outcomes. ERAS protocol consists of 21 topics that concern the preoperative, intraoperative, and postoperative periods. The protocol is based on anesthesia, analgesia, perioperative fluid management, nutrition, early mobilization, and shortening the healing process by reducing the metabolic trauma caused by surgery [8]. Recently, studies in the field of urological surgery have started with the ERAS protocol. It has been shown that the length of hospital stay (LOS) and the rate of development of ileus are statistically significantly less in patients who underwent the ERAS protocol compared to those using the traditional approach [9–11]. Although more studies are required, no significant difference was observed in terms of anastomotic leaks, peritonitis, or other complications [12].
Our study aimed to compare the start time of enteral feeding (SEF), the first stool time, LOS, duration of postoperative antibiotic use, rates of ileus, and serum albumin values of patients with ileal conduit under the ERAS protocol with those who underwent a traditional protocol
Ethnic differences in cardiovascular risk: examining differential exposure and susceptibility to risk factors
Get PDFEthnic differences in cardiovascular disease (CVD) risk have been known for decades, but a systematic exploration of how exposure and susceptibility to risk factors may contribute is lacking. This study aimed to investigate the potential impact of differential exposure and susceptibility between South Asian, Black, and White individuals.
Methods
This is a population-based prospective cohort study of UK Biobank participants with a median follow-up of 11.3 years. The association between ethnic group and CVD risk was studied. Additional risk factors were then adjusted to examine mediations. Moderation analysis was conducted to identify whether risk factors had a stronger association in the ethnic minority groups. Population attributable fractions were also calculated to quantify the relative contributions of risk factors for each ethnic group.
Results
When adjusted for only age and sex, there was a higher risk of CVD among South Asian (n=8815; HR [95% CI] 1.69 [1.59–1.79]) and Black (n=7526; HR [95% CI] 1.12 [1.03–1.22]) compared with White participants (n=434,809). The excess risk of Black participants was completely attenuated following adjustment for deprivation. Compared with White participants, the associations of BMI, triglycerides, and HbA1c with CVD were stronger in South Asians. Adiposity was attributable to the highest proportion of CVD regardless of ethnicity. Smoking had the second largest contribution to CVD among White and Black participants, and HbA1c among South Asian participants.
Conclusions
Adiposity is an important risk factor for CVD regardless of ethnicity. Ethnic inequalities in CVD incidence may be best tackled by targeting interventions according to ethnic differences in risk profiles
Diverse lineages of pathogenic Leptospira species are widespread in the environment in Puerto Rico, USA
Get PDFLeptospirosis, caused by Leptospira bacteria, is a common zoonosis worldwide, especially in the tropics. Reservoir species and risk factors have been identified but surveys for environmental sources are rare. Furthermore, understanding of environmental Leptospira containing virulence associated genes and possibly capable of causing disease is incomplete, which may convolute leptospirosis diagnosis, prevention, and epidemiology.
Methodology/Principal findings
We collected environmental samples from 22 sites in Puerto Rico during three sampling periods over 14-months (Dec 2018-Feb 2020); 10 water and 10 soil samples were collected at each site. Samples were screened for DNA from potentially pathogenic Leptospira using the lipL32 PCR assay and positive samples were sequenced to assess genetic diversity. One urban site in San Juan was sampled three times over 14 months to assess persistence in soil; live leptospires were obtained during the last sampling period. Isolates were whole genome sequenced and LipL32 expression was assessed in vitro.
We detected pathogenic Leptospira DNA at 15/22 sites; both soil and water were positive at 5/15 sites. We recovered lipL32 sequences from 83/86 positive samples (15/15 positive sites) and secY sequences from 32/86 (10/15 sites); multiple genotypes were identified at 12 sites. These sequences revealed significant diversity across samples, including four novel lipL32 phylogenetic clades within the pathogenic P1 group. Most samples from the serially sampled site were lipL32 positive at each time point. We sequenced the genomes of six saprophytic and two pathogenic Leptospira isolates; the latter represent a novel pathogenic Leptospira species likely belonging to a new serogroup
The potential impact of Anopheles stephensi establishment on the transmission of Plasmodium falciparum in Ethiopia and prospective control measures
Get PDFSub-Saharan Africa has seen substantial reductions in cases and deaths due to malaria over the past two decades. While this reduction is primarily due to an increasing expansion of interventions, urbanisation has played its part as urban areas typically experience substantially less malaria transmission than rural areas. However, this may be partially lost with the invasion and establishment of Anopheles stephensi. A. stephensi, the primary urban malaria vector in Asia, was first detected in Africa in 2012 in Djibouti and was subsequently identified in Ethiopia in 2016, and later in Sudan and Somalia. In Djibouti, malaria cases have increased 30-fold from 2012 to 2019 though the impact in the wider region remains unclear.
Methods
Here, we have adapted an existing model of mechanistic malaria transmission to estimate the increase in vector density required to explain the trends in malaria cases seen in Djibouti. To account for the observed plasticity in An. stephensi behaviour, and the unknowns of how it will establish in a novel environment, we sample behavioural parameters in order to account for a wide range of uncertainty. This quantification is then applied to Ethiopia, considering temperature-dependent extrinsic incubation periods, pre-existing vector-control interventions and Plasmodium falciparum prevalence in order to assess the potential impact of An. stephensi establishment on P. falciparum transmission. Following this, we estimate the potential impact of scaling up ITN (insecticide-treated nets)/IRS (indoor residual spraying) and implementing piperonyl butoxide (PBO) ITNs and larval source management, as well as their economic costs
Correction to: Following the science? Comparison of methodological and reporting quality of covid-19 and other research from the first wave of the pandemic
Get PDFThe original article [1] contained an affiliation error for co-author, Dikshyanta Rana which has since been corrected