Search

OBJECTIVES:. We sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics. DESIGN:. We analyzed prospectively collected data from the Adaptive COVID-19 Treatment Trial. National Early Warning Score was collected daily during the trial, Modified Early Warning Score was calculated, and age applied to both scores. We assessed prognostic value for the end points of recovery, mechanical ventilation, and death for score at enrollment, average, and slope of score over the first 48 hours. SETTING:. A multisite international inpatient trial. PATIENTS:. A total of 1,062 adult nonpregnant inpatients with severe coronavirus disease 2019 pneumonia. INTERVENTIONS:. Adaptive COVID-19 Treatment Trial 1 randomized participants to receive remdesivir or placebo. The prognostic value of predictive scores was evaluated in both groups separately to assess for differential performance in the setting of remdesivir treatment. MEASUREMENTS AND MAIN RESULTS:. For mortality, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.60–0.68), and improved with addition of age (c-index, 0.66–0.74). For recovery, baseline National Early Warning Score and Modified Early Warning Score demonstrated somewhat better prognostic ability (c-index, 0.65–0.69); however, National Early Warning Score+age and Modified Early Warning Score+age further improved performance (c-index, 0.68–0.71). For deterioration, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.59–0.69) and improved with addition of age (c-index, 0.63–0.70). All prognostic performance improvements due to addition of age were significant (p < 0.05). CONCLUSIONS:. In the Adaptive COVID-19 Treatment Trial 1 cohort, National Early Warning Score and Modified Early Warning Score demonstrated moderate prognostic performance in patients with severe coronavirus disease 2019, with improvement in predictive ability for National Early Warning Score+age and Modified Early Warning Score+age. Area under receiver operating curve for National Early Warning Score and Modified Early Warning Score improved in patients receiving remdesivir versus placebo early in the pandemic for recovery and mortality. Although these scores are simple and readily obtainable in myriad settings, in our data set, they were insufficiently predictive to completely replace clinical judgment in coronavirus disease 2019 and may serve best as an adjunct to triage, disposition, and resourcing decisions.

The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exhibits reduced susceptibility to vaccine-induced neutralizing antibodies, requiring a boost to generate protective immunity. We assess the magnitude and short-term durability of neutralizing antibodies after homologous and heterologous boosting with mRNA and Ad26.COV2.S vaccines. All prime-boost combinations substantially increase the neutralization titers to Omicron, although the boosted titers decline rapidly within 2 months from the peak response compared with boosted titers against the prototypic D614G variant. Boosted Omicron neutralization titers are substantially higher for homologous mRNA vaccine boosting, and for heterologous mRNA and Ad26.COV2.S vaccine boosting, compared with homologous Ad26.COV2.S boosting. Homologous mRNA vaccine boosting generates nearly equivalent neutralizing activity against Omicron sublineages BA.1, BA.2, and BA.3 but modestly reduced neutralizing activity against BA.2.12.1 and BA.4/BA.5 compared with BA.1. These results have implications for boosting requirements to protect against Omicron and future variants of SARS-CoV-2. This trial was conducted under ClincalTrials.gov: NCT04889209.

Bacterial vaginosis is a prevalent women's health issue that affects millions of women worldwide every year; however, current treatments are often messy, inconvenient, and ineffective. Therefore, we developed a new hyaluronic acid-based film to deliver metronidazole that would be more effective, more convenient, and at a pH similar to that of the normal vaginal environment. Films were made by crosslinking modified hyaluronic acid to create a hydrogel, in which metronidazole or metronidazole benzoate and methylcellulose were incorporated, and the hydrogel was dried to a thin film. Through release testing, coupled with assessments of handleability, tensile strength, and mucoadhesion, it was determined that the films have the potential to remain in the vaginal environment for an extended time period and gradually release the drug for at least 6 days, which is a typical treatment length. As such, the films present a viable alternative to current treatment methods, allowing for both easy handling and a single treatment while eliminating the issues of pH and overall inconvenience.

Introduction: To determine the association between both abnormal individual vital signs and abnormal vital sign groups in the emergency department, and undesirable patient outcomes: hospital admission, medical emergency team calls and death. Method: We undertook a prospective cohort study in a tertiary referral emergency department (February–May 2015). Vital signs were collected prospectively in the emergency department and undesirable outcomes from the medical records. The primary outcomes were undesirable outcomes for individual vital signs (multivariate logistic regression) and vital sign groups (univariate analyses). Results: Data from 1438 patients were analysed. Admission was associated with tachycardia, tachypnoea, fever, ≥1 abnormal vital sign on admission to the emergency department, ≥1 abnormal vital sign at any time in the emergency department, a persistently abnormal vital sign, and vital signs consistent with both sepsis (tachycardia/hypotension/abnormal temperature) and pneumonia (tachypnoea/fever) (p Conclusion: Abnormal vital sign groups are generally superior to individual vital signs in predicting undesirable outcomes. They could inform best practice management, emergency department disposition, and communication with the patient and family.

Objective The aim of this study was to determine patient satisfaction with procedural sedation as a function of nature of the procedure and depth of sedation. Method We undertook a prospective observational study of adult patients who received procedural sedation in two EDs (20 month period). The level of sedation was determined by an investigator, using the Observers Assessment of Anaesthesia/Sedation Scale (1 = awake to 6 = no response to noxious stimuli). Patient satisfaction was measured with the Iowa Satisfaction with Anaesthesia Scale after full recovery. This was self-administered, comprised 11 items (e.g. ‘I felt pain’) and has a score range of −3 (poor satisfaction) to +3 (very satisfied). Results A total of 163 patients were enrolled (51.2% men, mean age 50.7 years). The median (interquartile range) satisfaction score was 2.7 (0.7). Patient satisfaction was lower among patients who had orthopaedic procedures (median 2.6 vs 2.8, P

Objective To determine the patient and clinical variables associated with administration of any analgesia, nurse-initiated analgesia (NIA, prescribed and administered by a nurse) and early analgesia (within 30 min of presentation). Methods We undertook a retrospective cohort study of patients who presented to a metropolitan ED in Melbourne, Australia, during July and August, 2013. The ED has an established NIA programme. Patients were included if they were aged 18 years or more and presented with a painful complaint. The study sample was randomly selected from a list of all eligible patients. Data were extracted electronically from the ED records and by explicit extraction from the medical record. Logistic regression models were constructed to assess associations with the three binary study end points. Results 1289 patients were enrolled. Patients were less likely to receive any analgesia if they presented 08:00–15:59 hours (OR 0.67, 95% CI 0.46 to 0.98) or 16:00–24:00 hours (OR 0.55, 95% CI 0.37 to 0.80) were triage category 5 (OR 0.20, 95% CI 0.08 to 0.49) or required an interpreter (OR 0.34, 95% CI 0.14 to 0.86). Patients were less likely to receive NIA or early analgesia if they were aged 56 years or more (OR 0.70 and 0.63; OR 0.57 and 0.21, respectively) or if they had received ambulance analgesia (OR 0.59, 95% CI 0.36 to 0.95; OR 0.38, 95% CI 0.20 to 0.74, respectively). Conclusions Patients who present during the daytime, have a triage category of 5 or require an interpreter are less likely to receive analgesia. Older patients and those who received ambulance analgesia are less likely to receive NIA or early analgesia.

Objective We aimed to provide pain advice (‘The treatment of pain is very important and be sure to tell the staff when you have pain’) as an intervention and evaluate its effect upon patient satisfaction. The purpose of this pilot trial was to ensure the design and methods of a future trial are sound, practicable and feasible. Method We undertook a pilot, randomised, controlled, clinical intervention trial in a single ED. The control arm received standard care. The intervention arm received standard care plus pain advice from an independent investigator. All patients and treating ED staff were blinded to patient enrolment. Patient satisfaction with their pain management (six-point ordinal scale) was measured 48 h post-ED discharge, by a blinded researcher. The primary outcome was satisfaction with pain management. Results Of the 280 and 275 patients randomised to the control and intervention arms, respectively, 196 and 215 had complete data, respectively. 77.6% (152/196) and 88.8% (191/215) of patients reported being provided with pain advice, respectively (difference 11.3% (95% CI 3.6 to 19.0)). The intervention was associated with absolute and relative increases in patient satisfaction of 6.3% and 14.2%, respectively. 91.3% (179/196) and 76.3% (164/215) of patients who were/were not very satisfied reported having received ‘pain advice’ (difference 15.0% (95% CI 7.6 to 22.5)). Conclusions The intervention to provide pain advice resulted in a non-significant increase in patient satisfaction. A larger multicentre trial is feasible and is recommended to further explore the effects of provision of pain advice. Trial registration number ACTRN12615000097549.

Objective While complementary medicine use among ED paediatric patients is common, the use of alternative therapies (ATs; physical or spiritual therapies) is unknown. We aimed to determine the 12 month period prevalence and nature of AT use among paediatric patients and parent perceptions of AT use. Methods We undertook a cross-sectional survey of a convenience sample of parents of paediatric patients in three EDs in metropolitan Melbourne, Australia (January–June, 2015). Parents were invited to complete a validated, anonymous, self-administered questionnaire. The main outcomes were AT use by the patient and parent perceptions of ATs. Results A total of 806 parents were enrolled. In the previous 12 months, 393 (48.8%) patients had received at least one AT. There were no gender or ethnicity differences between AT users and non-users. AT use was more common among older patients (P

Money Smart Week (MSW)1 is a time when public organizations join forces with financial innovators to share information on becoming economically healthy. Designed for people of all demographics and socioeconomic levels, the events are free and strictly informative. Public libraries are excellent locations to hold such events, but how does this translate into academic libraries? After all, their primary users have already signaled they are ready and willing to invest in their future. Furthermore, how can a business librarian team up with her College of Business (COB) to supplement library programing? The marriage seems so obvious, right? Serving as the liaison to the COB has provided me the opportunity to support our business-minded individuals and help them materialize visions into growth. Their progress becomes a part of both the library’s and COB faculty’s success stories.

Summary This paper contributes to the study of institutional relationships mediating the exchange and distribution of plant genetic resources (PGR) among farmers. Local systems of seed exchange often consider PGR a public good, the rights to which no one should be excluded from. Community-level institutions and local customs that facilitate the exchange of PGR are built around reducing transaction costs for information and of planting material. This paper draws from collective-action theory and empirical evidence from Uzbekistan to propose a conceptual approach for understanding farmer seed exchange systems. The case study shows how informal and formal institutions and local custom structure the exchange of PGR to be collectively beneficial to farmers.

Orientador: Maria das Graças Conde Caldas Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Estudos da Linguagem Resumo: A força da ficção para pensar o real reside na linguagem. Ao se mostrarem como ficção, Literatura e Jornalismo podem desvencilhar-se da tentativa de mimetizar o real e buscar por novos mundos, novas maneiras de significar o devir, o tempo. Qual seria o potencial de se conceber a realidade como parte de uma política ficcional que dirige e arregimenta os corpos? Poderia o Jornalismo suspender, ainda que momentaneamente, a noção de real, deixando o leitor à deriva, à procura de novas âncoras? Pré-lançada na Festa Internacional Literária de Paraty em agosto de 2006, piauí traz, mesmo que indiretamente, uma reflexão sobre as relações e tensões entre Jornalismo, Literatura, Ficção e Realidade. Livre para pautar os temas de cada edição, sem se basear no enfoque da agenda jornalística hegemônica, sua postura garante espaço para o inusitado tanto em termos de forma quanto de conteúdo. Inserida na área de Estudos Culturais (Hall, 2004, 2007) essa pesquisa analisa o descentramento da identidade e evidencia que o sujeito é afetado pela Cultura, e que é, ao mesmo tempo, um produtor de Cultura. O principal objetivo do estudo é examinar os sentidos envolvidos e revolvidos na linguagem da piauí: Jornalismo, Literatura, Ficção, Realidade, Jornalismo Literário, Cultura, todos eles dançam na instabilidade constitutiva que a publicação propõe e impõe. A escolha do corpus foi realizada pelo método de Amostra Intencional anual e é constituído por cinco edições: a primeira lançada nas bancas (outubro de 2006) e as quatro de aniversário (outubro de 2007, 2008, 2009 e 2010). Juntas elas serão estudadas em detalhe, com a intenção de observar as identidades propostas na publicação. Identidades que ora se resolvem, ora se revolvem na indeterminação. Levando em conta o caráter aberto do objeto (Eco, 2003), as inúmeras possibilidades de entrada e a complexidade da publicação determinaram a busca por metodologias complementares. Análise do Discurso, Semiótica, Análise Literária, Teoria das Representações Sociais, Estudo de Caso, Análise de Conteúdo, todas elas foram percorridas no exercício de estabelecer o perfil metodológico da pesquisa. Ocorre que ao longo da caminhada, alguns de seus recursos de análise foram selecionados, mas me ative ao movimento do cartógrafo, que além de desenhar paisagens em movimento, recorre a recursos de análise que não são unos, inteiriços, fechados em si mesmos, isto é, também estão em movimento, também podem ser cartografados. Por esse motivo assumi o risco de usar recursos de diversas metodologias, por crer que posso passear por elas. A proposta é trabalhar como o cartógrafo, cujo desenho "acompanha e se faz ao mesmo tempo que os movimentos de transformação da paisagem" (Rolnik, 1989: 15). O objeto agora passa a ser chamado de paisagem Abstract: The strength of fiction to think about reality lies in the language. By showing themselves as fiction, Literature and Journalism can get free from the effort of copying what is considered real in order to look for new worlds, new ways to give meaning to the passing time. What would be the potential of conceiving reality as one of the fictional politics that guides and controls the bodies? Could Journalism not take into account, even for a moment, the notion of reality, letting the reader search for new anchors? Pre-released at FLIP, Festa Internacional Literária de Paraty in August 2006, piauí brings even indirectly a deep thought about the relations and tensions among Journalism, Literature, Fiction and Reality. Free to choose its themes at every edition, without basing itself on the hegemonic journalistic agenda, its perspective guarantees space for the unexpected in terms of form and content. As a branch of Cultural Studies (Hall, 2004, 2007) this research analyses the descentered identity and shows that the subject is affected by Culture and is, at the same time, a cultural producer. The most important aim of this study is to exam the meaning involved and revolved in the language of piauí: Journalism, Literature, Fiction, Reality, Literary Journalism, Culture, they all dance in the constitutive instability that the magazine proposes and imposes. The corpus choice was made by using the annual Intentional Sampling and is constituted by five editions: the first one, released at the newsstands (in October 2006) and the other four, when completing its anniversaries (October 2007, 2008, 2009, 2010). They will be studied in deep, with the intention of observing the proposed identities in the publication. Identities that one time resolve themselves by assuming its boundaries, on the other revolve in the indetermination. Considering the open features of the object (Eco, 2003), the several possibilities of entering in the research and also the magazine complexity determined the search for complementary methodologies. Discourse Analysis, Semiotics, Literary Analysis, the Theory of Social Representations, Case Study, all them were seen when establishing the methodological perspective. However, during the process, when walking through them, some of their recourses were chosen, but I really got interested in the cartographer's movement, who more than drawing views in movement looks for analysis resources that are not unified, closed to themselves, I mean, they are in movement too, can also be visited and for this reason I assumed the risk of using resources from different methodologies, because I believe that I can tour through them. The goal is to work as the cartographer, whose drawing route "follow and appear while the changing movements of the sights are going on" (Rolnik, 1989: 15). From now on the object will be called view Mestrado Divulgação Científica e Cultural Mestre em Divulgação Científica e Cultural

Recombinant canarypox virus vectors containing human immunodeficiency virus type 1 (HIV-1) sequences are promising vaccine candidates, as they replicate poorly in human cells. However, when delivered intramuscularly the vaccines have induced inconsistent and in some cases transient antigen-specific cytotoxic T-cell (CTL) responses in seronegative volunteers. An attractive way to enhance these responses would be to target canarypox virus to professional antigen-presenting cells such as dendritic cells (DCs). We studied (i) the interaction between canarypox virus and DCs and (ii) the T-cell responses induced by DCs infected with canarypox virus vectors containing HIV-1 genes. Mature and not immature DCs resisted the cytopathic effects of canarypox virus and elicited strong effector CD8+T-cell responses from chronically infected HIV+individuals, e.g., cytolysis, and secretion of gamma interferon (IFN-γ) and β-chemokines. Furthermore, canarypox virus-infected DCs were >30-fold more efficient than monocytes and induced responses that were comparable to those induced by vaccinia virus vectors or peptides. Addition of exogenous cytokines was not necessary to elicit CD8+effector cells, although the presence of CD4+T cells was required for their expansion and maintenance. Most strikingly, canarypox virus-infected DCs were directly able to stimulate HIV-specific, IFN-γ-secreting CD4 helper responses from bulk as well as purified CD4+T cells. Therefore, these results suggest that targeting canarypox virus vectors to mature DCs could potentially elicit both anti-HIV CD8+and CD4+helper responses in vivo.