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Current impact in the treatment of advanced hepatocellular carcinoma: The challenge remains
No full textHepatocellular carcinoma remains a significant cause of mortality worldwide, particularly among patients with liver cirrhosis. In most cases, surveillance in cirrhotic patients is neglected, leading to a diagnosis when the neoplasm is at an advanced stage. Within this context, Zhou carried out a network meta-analysis to demonstrate the effectiveness of hepatic arterial infusion chemotherapy, concluding that it is a superior approach compared to sorafenib and transarterial chemoembolization in the treatment of advanced hepatocellular carcinoma. Unfortunately, the meta-analysis in question lacks methodological rigor, preventing the authors from making more definitive assertions. Additionally, we understand that transarterial chemoembolization, when properly indicated, is a highly effective therapeutic option, and that sorafenib, given the results of new therapies based on immune checkpoint inhibitors, is no longer the recommended drug for the treatment of these patients. Therefore, we believe the use of hepatic arterial infusion chemotherapy is increasingly limited and lacks strong scientific support
Financial toxicity amongst cancer patients and survivors: a comparative study of the United Kingdom and United States
No full textBackgroundThe study investigated the experiences of financial toxicity (FT) amongst cancer patients/survivors in the United Kingdom (UK) and the United States (USA/US).MethodsSix hundred cancer patients/survivors residing in the UK (n = 319) or USA/US (n = 281) completed an online cross-sectional survey using the COmprehensive Score for financial Toxicity (COST)—a validated measure of FT. Severity of FT was defined as ‘no’ (COST scores ≥ 26), ‘mild’ (14–25), and ‘moderate/severe’ (0–13).ResultsThirty-four percent of UK participants faced FT which was significantly lower compared to the USA/US at 55% (crude OR = 2.44, 95% CI 1.73–3.42). An ordered logistic regression model showed that in the USA/US, being 65 + years old (adjusted OR = 0.19, 95% CI 0.07–0.48), retired (aOR = 0.26, 95% CI 0.09–0.75), and having a higher household income (aOR ranged 0.03–0.19) decreased the risk of FT, whilst being female increased the risk (aOR = 1.83, 95% CI 1.01–3.32). In the UK, age and sex did not have an effect, but higher income and being retired showed an identical pattern compared to the US.ConclusionsFT was less prevalent and less severe in the UK, compared to the USA/US. The high prevalence of FT underscores the need to provide an additional level of protection to the most vulnerable groups than is currently offered in either country
Charting circumstellar chemistry of carbon-rich asymptotic giant branch stars. II. Abundances and spatial distributions of CS
No full textContext. The circumstellar envelopes (CSEs) of asymptotic giant branch (AGB) stars harbour a rich variety of molecules and are sites of complex chemistry. Our current understanding of the circumstellar chemical processes of carbon-rich AGB stars is predominantly based on observations of a single star, IRC +10 216, often regarded as an archetypical carbon star.Aims. We aim to estimate stellar and circumstellar properties for five carbon stars, and constrain their circumstellar CS abundances. This study compares the CS abundances among the sources, informs circumstellar chemical models, and helps to assess if IRC+10 216 is a good representative of the physics and chemistry of carbon star CSEs.Methods. We modelled the spectral energy distributions (SEDs) and CO line emission to derive the stellar and outflow properties. Using these, we then retrieved CS abundance profiles with detailed radiative transfer modelling, imposing spatial and excitation constraints from ALMA and single-dish observations.Results. We obtain good fits to the SEDs and CO lines for all sources and reproduce the CS line emission across various transitions and apertures, yielding robust estimates of the CS abundance profiles. Peak CS fractional abundances range from 1×10−6−4×10−6, with e-folding radii of 1.8×1016−6.8×1016 cm. We also derive reliable 12C/13C and 32S/34S ratios from CS isotopologue modelling.Conclusions. Our results refine previous single-dish CS abundance estimates and improve the relative uncertainty on the CS e-folding radius for IRAS 07454-7112 by a factor of ~2.5. Chemical models reproduce our estimates of the CS radial extent, corroborating the CS photodissociation framework used therein. We find no significant differences between the derived CS abundance profiles for IRC +10 216 and the rest of the sample, apart from the expected density-driven variations.<br/
Device-based measurement of physical activity and sedentary behaviour after critical illness: A scoping review
No full textIntroductionMeasuring and promoting physical activity could support rehabilitation and recovery after critical illness. In recent years, there has been an emergence of the use of devices to measure both physical activity and sedentary behaviour in this population. Understanding device selection and processes for data analysis could be helpful for future research and practice when used with this population.AimsThe aim of this review was to explore the current use of device-based physical activity instruments to measure physical activity and sedentary behaviour during and following critical illness.MethodsA scoping review was conducted which followed the Arksey and O’Malley (2005) framework. A comprehensive search of four electronic databases (Medline, ProQuest, Scopus and CINAHL) was conducted using pre-agreed search terms. Screening and data extraction was conducted by two independent reviewers. Data were analysed descriptively by summarising and describing results that linked to the review questions.ResultsTwenty-two studies were included; the majority were observational (n=12), with one randomised control trial. Studies covered the continuum from intensive care admission to 18 months post-hospital discharge. A total of 11 devices were used to assess physical activity and sedentary behaviour, and many different processing decisions were used for data analysis. Physical activity levels were low in the intensive care unit and remained low following discharge from intensive care.ConclusionThe use of device-based measurement of physical activity and sedentary behaviour after critical illness is an emerging research area. While several devices are available, this review highlights the need for agreed and standardised protocol(s) to guide the processing and analysis of data. Investment is also needed to support the recovery of physical activity and the reduction of excessive sedentary behaviour following discharge from the hospital
Virtual escape rooms in anatomy education: case studies from two institutions
No full textVirtual escape rooms (ERs) require learners to solve puzzles and answer riddles while trying to "escape" a digital room. While the educational merit of such gamified learning activities continues to be realized, guides on the development of ERs are lacking, as well as student perceptions on how, if, and where they should be integrated into medical curricula. Therefore, the aim of this study was to describe the experiences of building anatomy-themed virtual ERs of differing formats at two separate institutions: Queen's University Belfast (QUB) and Edward Via College of Osteopathic Medicine (VCOM), focusing on abdominal and upper limb anatomy respectively. Google Workspace applications served as the primary platform. 3D models were built using photogrammetry techniques or Virtual Human Dissector software (www.toltech.net) and integrated into the ER. Of 69 students and staff invited at QUB, 9 (13%) participated in the in-person virtual ER in teams of 2-3 (7 medical students, 2 anatomy instructors). Of 27 VCOM medical students invited, 8 (30%) agreed to participate and individually completed VCOM's virtual ER remotely. Anonymous surveys and a focus group revealed the ERs to be enjoyable and engaging and encouraged participants to think about material in a new way while helping them to identify knowledge gaps. Strengths and weaknesses of different designs (linear versus nonlinear), delivery methods (in-person versus remote) and grouping of participants (team-based versus individual) were realized and discussed, revealing opportunities for optimizing the experience. Future studies would benefit from increasing sample sizes to assess the learning gain of such activities
Assessment of the feed additive consisting of choline chloride for all animal species for the renewal of its authorisation (Andrés Pintaluba S.A., Taminco B.V., Balchem Italia S.r.l.)
No full textFollowing a request from the European Commission, EFSA was asked to deliver a scientific opinion on the assessment of the application for the renewal of the authorisation of choline chloride as a nutritional additive for all animal species. The additive is already authorised for use in all animal species (3a890). The applicant provided evidence that the additive currently in the market complies with the existing conditions of authorisation. The EFSA Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) concluded that the use of the feed additive in animal nutrition under the proposed conditions of use remains safe for the target species, the consumers and the environment. Regarding user safety, the FEEDAP Panel concluded that the active substance choline chloride should be considered as a potential skin and respiratory sensitiser; therefore, any exposure via skin or respiratory tract is considered a risk. Although aqueous solutions of up to 70% choline chloride are considered non-irritant to eyes, no conclusion can be reached on the eye irritation potential for more concentrated forms. These conclusions would apply, in principle, to any preparations produced with the active substance. The present application for renewal of the authorisation does not include any modification proposal that would have an impact on the efficacy of the additive and therefore there is no need for re-assessing the efficacy.</p
Safety of a feed additive consisting of Duddingtonia flagrans NCIMB 30336 (BioWorma®) for all grazing animals (International Animal Health Products Pty Ltd)
No full textFollowing a request from the European Commission, the Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) was asked to deliver a scientific opinion on the safety of a feed additive consisting of Duddingtonia flagrans NCIMB 30336 (BioWorma®) for all grazing animals other than dairy bovines, ovines and caprines (namely, grazing animals from the following species: pigs (all categories), rabbits (all categories), horses (all categories) and calves/kids of species in the family Cervidae (deer, etc.) and Camelidae (alpacas, etc)). The safety and efficacy of the additive have already been assessed previously; however, the FEEDAP Panel could not conclude on the safety of the additive for the grazing animals other than dairy bovines, ovines and caprines due to the limitations in the dataset provided. For the current assessment, the applicant referred to the sub-chronic oral toxicity study provided in the previous application. The Panel considered that, since the microorganism is provided in the form of chlamydospores and is very unlikely to germinate during the gastrointestinal passage, the results from the sub-chronic oral toxicity study can be used to support the safety of the additive for the target species. Based on the NOAEL derived from the sub-chronic oral toxicity study, the maximum safe levels calculated are higher than the intake levels, resulting from the recommended use level for all the species. Therefore, the Panel concludes that the additive is safe for all grazing bovines, ovines, caprines, rabbits, horses, cervids, camelids and porcine species at the proposed conditions of use.</p
Safety and efficacy of a feed additive consisting of Bacillus paralicheniformis DSM 33902 and Bacillus subtilis DSM 33903 (Bovacillus™) for dairy cows and other dairy ruminants (Chr. Hansen A/S)
No full textFollowing a request from the European Commission, EFSA was asked to deliver a scientific opinion on the safety and efficacy of Bovacillus™, a product containing viable cells of Bacillus paralicheniformis DSM 33902 and Bacillus subtilis DSM 33903, which is intended to be used as a zootechnical additive (functional group: gut flora stabiliser) in the feed of dairy cows and other dairy ruminants. The trade name is Bovacillus™, and it is intended to be commercialised in two formulations: Bovacillus™ 10, to use in feed, and WS, to use in drinking water. B. paralicheniformis and B. subtilis are considered suitable for the qualified presumption of safety (QPS) approach to safety assessment. The identity of the active agents was established, and compliance with the applicable qualifications confirmed. Therefore, Bacillus paralicheniformis DSM 33902 and Bacillus subtilis DSM 33903 are presumed safe for the target species, consumers of products derived from animals fed the additive and the environment. Since no concerns are expected from the other components of the additive, Bovacillus™ is also considered safe for the target species, consumers and the environment. Bovacillus™ 10 and WS are not skin or eye irritants. Due to the nature of the active agents, both forms of the additive are considered respiratory and skin sensitisers. The Panel concludes that Bovacillus™ has the potential to be efficacious as a zootechnical additive when supplemented in the feed of dairy ruminants at 3.8 × 108 CFU/kg complete feed.</p
Assessment of the feed additives thiamine hydrochloride (3a820) and thiamine mononitrate (3a821) (vitamin B<sub>1</sub>) for all animal species for the renewal of their authorisation (Kaesler Nutrition GmbH)
No full textFollowing a request from the European Commission, EFSA was asked to deliver a scientific opinion on the safety and efficacy of thiamine hydrochloride and thiamine mononitrate (vitamin B1) for the renewal of its authorisation as nutritional feed additives for all animal species. The Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) concluded that thiamine mononitrate and thiamine hydrochloride remain safe for all animal species, consumers and the environment. Regarding the user safety, both thiamine salts are regarded as skin and eye irritants, and skin and respiratory sensitisers. The Panel concluded there is no need for assessing the efficacy of the additives in the context of the renewal of the authorisation.</p
Analysis of shallow water steep waves interaction with a bottom-fixed monopile offshore wind turbine using an implicit Navier-Stokes and experimental model
No full textThe nonlinear interaction of the high-steep waves with a bottom-fixed monopile is studied experimentally and numerically in this research. The predominance of the near-breaking waves in sea-bottom-effect waters where fixed structures such as wind turbines have been located drives the incentive of the endeavour. Hence, viscous fluid kinematics due to the interaction of regular and irregular wave regimes with the monopile is determined by using a three-dimensional viscous numerical model that takes advantage of an implicit finite volume to solve the Reynolds Average Navier–Stokes (RANS) equation. The volume of fluid method is exploited to treat the air–water interface. Moreover, the physical model test is carried out to record wave loads and kinematics of the free surface flow around the monopile. A range of nonlinear waves is considered for experimental and numerical models, from weakly nonlinear waves to near-breaking waves. The accuracy and convergence tests for different mesh sizes are conducted on the numerical model, and the numerical results are compared with the experimental data for verification. To reveal the nonlinearities of the shear force and the bending moment, the spectral analysis is run on the time-history of results. Furthermore, the fidelity of the numerical viscous model is evaluated for different sea states. The analogous study is replicated for a broad range of irregular waves to recognise the higher-order wave loads driven by the inertia forces and the diffraction.<br/