Search

Abstract Background Malnutrition in the elderly places a significant burden on healthcare, social, and aged-care systems, yet it often remains undiagnosed and untreated. This study aims to evaluate family physicians' knowledge and attitudes towards the diagnosis and treatment of malnutrition in the elderly. Methods Based on a literature review, an online questionnaire was developed, comprised of seven knowledge-related items and eight attitude-related questions regarding malnutrition in elderly populations. We also assessed the feasibility of including two malnutrition screening questions in regular clinic visits for individuals aged ≥ 70 years. Results Surveys were completed by 126 physicians (35% response rate), mean age 47.2 ± 12.6 years; 15.6 ± 12.5 years of practice; 67% females; and 92% board-certified family physicians. Moreover, 77.6% agreed that diagnosing malnutrition is important in patients with decreased appetite. Most respondents demonstrated knowledge of nutritional screening principles (63.5%) and recognized that even obese elderly individuals could be malnourished (83.2%). There was partial agreement (60%) that normal BMI values in the elderly differ from those in younger populations. Almost complete agreement was seen for incorporating two nutritional status questions in medical visits (91%), with physicians expressing willingness to receive training in malnutrition identification and screening tools. Despite challenges such as time constraints and limited knowledge, participants were open to conducting biannual malnutrition risk screening for elderly patients. Conclusion We recommend malnutrition screening in primary care followed by malnutrition diagnosis and referral of malnourished patients to the proper intervention.

(1) Background: This paper examines the elements essential to effective teacher professional development (TPD) and the relationship between various professional environmental factors (professional learning community perceptions, self-efficacy, professional identity, principal's transformation leadership patterns), TDP in primary education schools, and TDP prediction. (2) Methods: Data were collected during the 2020 school year from 412 teachers in primary education schools in five Israeli districts. The professional learning community, self-efficacy, professional identity, transformation leadership patterns, and TPD scales were used to collect data. Descriptive statistics, Pearson moment-product correlation, and multiple regression analysis were used for data analysis. (3) Results: Overall, participants' TPD was high (4.12 ± 0.83). Statistically significant correlations were observed between TPD and four independent variables (0.41-0.64; p < 0.0001). No significant associations were seen between TPD and work-related characteristics. TPD differences were observed in participants with different educational levels (F = 4.63; p = 0.003). Higher TPD levels were predicted by perceptions of the principal's transformation leadership patterns, self-efficacy, the professional learning community, and education (F-ratio = 57.85; adjusted R2 = 0.50; p < 0.001). Conclusions: The present study attests to the importance of the school principal's leadership patterns for TPD, alongside the contribution of self-efficacy, professional learning community, and professional identity.

As dores e os amores sofridos são o tema dos poemas de Juliana Maria Hilel que descrevem fatos históricos sobre dores e conflitos, que deixam marcas viscerais em toda a sociedade. Os seus versos têm muito sangue e gritos de luta em seus versos, erguendo bandeiras contra preconceitos e violências sociais. Para Juliana Hilel, as portas para a arte ainda são muito fechadas, é preciso levar nossa voz onde é possível se fazer ouvir.

Abstract Culture-adapted human mesenchymal stromal cells (hMSCs) are appealing candidates for regenerative medicine applications. However, these cells implanted in lesions as single cells or tissue constructs encounter an ischemic microenvironment responsible for their massive death post-transplantation, a major roadblock to successful clinical therapies. We hereby propose a paradigm shift for enhancing hMSC survival by designing, developing, and testing an enzyme-controlled, nutritive hydrogel with an inbuilt glucose delivery system for the first time. This hydrogel, composed of fibrin, starch (a polymer of glucose), and amyloglucosidase (AMG, an enzyme that hydrolyze glucose from starch), provides physiological glucose levels to fuel hMSCs via glycolysis. hMSCs loaded in these hydrogels and exposed to near anoxia (0.1% pO2) in vitro exhibited improved cell viability and angioinductive functions for up to 14 days. Most importantly, these nutritive hydrogels promoted hMSC viability and paracrine functions when implanted ectopically. Our findings suggest that local glucose delivery via the proposed nutritive hydrogel can be an efficient approach to improve hMSC-based therapeutic efficacy.

Abstract Background Binge-eating disorder) BED) is the most common eating disorder in the United-States. Daily, orally administered topiramate has shown BED treatment efficacy, with two major limitations: frequent and severe side effects and slow time-to-effect. SipNose is a novel non-invasive intranasal direct nose-to-brain drug delivery platform that delivers drugs to the central nervous system consistently and rapidly. Herein, we study a SipNose-topiramate combination product, as an acute “as needed” (PRN) solution for BED management. Methods First, SipNose-topiramate’s pharmacokinetics (PK) and safety was evaluated. The second part aimed to demonstrate its PRN-treatment feasibility in terms of usability and potential efficacy in reducing the number of binge-eating events. Twelve BED patients were studied over three time periods; 2-weeks of baseline monitoring [BL], 8-weeks of treatment [TX], and 2-weeks of follow up [FU]. Results The PK profile showed peak plasma levels at 90 min post-administration, a t1/2 > 24 h and consistent topiramate delivery with no adverse events. In the second part, 251 treatments were self-administered by the patient participants. There was a significant reduction from baseline to treatment periods in mean weekly binge-eating events and binge-eating event days per week. This was maintained during the follow up period. Efficacy was corroborated by improved patient illness severity scales. There were no adverse events associated with any administered treatments. Patients were exposed to less drug when compared with accepted oral dosing. Conclusions This study introduces a SipNose-topiramate drug-device combination as a potentially safe, effective, and controlled method for BED management. Its findings introduce a potential approach to BED management both as an intranasal and as a PRN therapy for reducing binge-eating events, with a large-scale reduction in patient drug exposure and side effects and with improved patient quality of life. Further studies are needed with larger patient populations to establish SipNose-topiramate as a mainstream treatment for BED. Trial registration: Registration number and date of registration of the clinical studies reported in this article are as follows: 0157-18-HMO, August 15th 2018 and 6814-20-SMC, December 2nd 2020.

Current literature lacks structured methodologies for analyzing medical technologies’ impact from the patient-centered care perspective. This study introduces, applies and validates ‘Patient-Centered Care Impact Analysis’ (PCIA) as a method for identifying patient-centered care associated demands and expectations for a particular technology and assessing its compliance with these demands. PCIA involves five stages: (1) demand identification, (2) ranking demands’ impact magnitude, (3) scoring demand compliance (DC), (4) demand priority (DP) assignment based on impact magnitude and compliance, (5) generating a summative impact priority number (IPN). PCIA was performed as a comparative assessment of two central nervous system (CNS) drug-delivery platforms; SipNose, a novel noninvasive Direct-Nose-to-Brain (DNTB), vs. the standard-of-care invasive intrathecal/intracerebroventricular injection (Invasive I/I). Study participants included a ranking team (RT) without experience with the SipNose technology that based their scoring on experimental data; and a validation team (VT) experienced with the SipNose platform. All had experience with, or knowledge of, InvasiveI/I. Demand identification and impact magnitude were performed by one content and one assessment expert. Each participant assessed each technology’s DC. DP scores, IPN’s and IPN DNTB:InvasiveI/I ratios were generated for each technology, for each team, based on DC and summative DP scores, respectively. Both teams assigned DNTB higher DC scores, resulting in higher DNTB DP, IPN scores and DNTB:InvasiveI/I IPN ratios. Lack of difference between team assessments of DP and IPN ratio validate PCIA as an assessment tool capable of predicting patient-centered clinical care quality for a new technology. The significant differences between the platforms highlight SipNose’s patient-care centered advantages as an effective CNS drug-delivery platform.

Abstract Over the last two decades, variable‐speed wind turbines (VSWTs) have gradually replaced conventional generation. However, the variable and stochastic nature of wind speed may lead to large frequency deviations, especially in isolated power systems with high wind energy integration, where this integration causes a lack of inertia. This paper proposes a hybrid hydro‐wind‐flywheel frequency control strategy for isolated power systems with 100% renewable energy generation, considering both variable wind and a generator tripping. VSWTs and flywheels include a conventional inertial frequency control. The frequency control strategy involves VSWTs rotational speed and State of Charge (SOC) of flywheels variations that may affect the wear and tear of mechanical elements and reduce the efficiency of the frequency control action. The hydro‐power controller also tracks the VSWTs' rotational speed deviation and the flywheel SOC to modify the generated power accordingly. This hybrid frequency strategy significantly reduces frequency excursions, the rotational speed deviations of VSWTs and the SOC of flywheels. To reduce the hydro‐power plants' wear, an additional control strategy is proposed by the authors and evaluated. Results from a case study based on an isolated power system located in El Hierro (Canary Islands, Spain) are included, and extensively discussed in the paper.

The efficient use of the photovoltaic power requires a good estimation of the PV generation. That is why the use of good techniques for forecast is necessary. In this research paper, Long Short-Term Memory, Bidirectional Long Short-Term Memory and the Temporal convolutional network are studied in depth to forecast the photovoltaic power, voltage and efficiency of a 1320 Wp amorphous plant installed in the Technology Support Centre in the University Rey Juan Carlos, Madrid (Spain). The accuracy of these techniques are compared using experimental data along one year, applying 1 timestep or 15 min and 96 step times or 24 h, showing that TCN exhibits outstanding performance, compared with the two other techniques. For instance, it presents better results in all forecast variables and both forecast horizons, achieving an overall Mean Squared Error (MSE) of 0.0024 for 15 min forecasts and 0.0058 for 24 h forecasts. In addition, the sensitivity analyses for the TCN technique is performed and shows that the accuracy is reduced as the forecast horizon increases and that the 6 months of dataset is sufficient to obtain an adequate result with an MSE value of 0.0080 and a coefficient of determination of 0.90 in the worst scenarios (24 h of forecast).

BackgroundDespite calls for interprofessional teamwork to ensure quality care in healthcare settings, interprofessional teams do not always perform effectively. There is evidence that professional stereotypes inhibit effective interprofessional teamwork, but they haven’t been explored as a phenomenon that impacts team’s performance and quality of care.ObjectivesTo focus on professional stereotypes emerging in interprofessional teams and examine the contingency effects of interprofessional team’s faultlines, professional stereotypes, and leader’s championship behaviors on team’s quality of care.MethodsA cross-sectional nested sample of 59 interprofessional teams and 284 professionals, working in geriatric long-term-care facilities in Israel. Additionally, five to seven of the residents of each facility were randomly sampled to obtain the outcome variable. Data collection employed a multisource (interprofessional team members), multimethod (validated questionnaires and data from residents’ health records) strategy.ResultsThe results indicated that faultlines are not directly harmful to team’s quality of care; instead, they are likely to impact quality of care only when team stereotypes emerge. Furthermore, whereas teams typified by high professional stereotypes require person-oriented championship leadership, for teams typified by low team stereotypes, championship leadership harms the quality of care they provide.ConclusionThese findings have implications for handling interprofessional teams. Practically, leaders must be well-educated to better analyze team members’ needs and maintain the appropriate leadership style.

Abstract Opto-mechanical interactions in guided wave media are drawing great interest in fundamental research and applications. Forward stimulated Brillouin scattering, in particular, is widely investigated in optical fibres and photonic integrated circuits. In this work, we report a comprehensive study of forward stimulated Brillouin scattering over standard, panda-type polarization maintaining fibres. We distinguish between intra-polarization scattering, in which two pump tones are co-polarized along one principal axis, and inter-polarization processes driven by orthogonally polarized pump waves. Both processes are quantified in analysis, calculations and experiment. Inter-modal scattering, in particular, introduces cross-polarization switching of probe waves that is non-reciprocal. Switching takes place in multiple wavelength windows. The results provide a first demonstration of opto-mechanical non-reciprocity of forward scatter in standard fibre. The inter-polarization process is applicable to distributed sensors of media outside the cladding and coating boundaries, where light cannot reach. The process may be scaled towards forward Brillouin lasers, optical isolators and circulators and narrowband microwave-photonic filters over longer sections of off-the-shelf polarization maintaining fibres.

Summary: Background: The current SARS-CoV-2 pandemic created an urgent need for rapid, infection screening applied to large numbers of asymptomatic individuals. To date, nasal/throat swab polymerase chain reaction (PCR) is considered the “gold standard”. However, this is inconducive to mass, point-of-care (POC) testing due to person discomfort during sampling and a prolonged result turnaround. Breath testing for disease specific organic compounds potentially offers a practical, rapid, non-invasive, POC solution. The study compares the Breath of Health, Ltd. (BOH) breath analysis system to PCR's ability to screen asymptomatic individuals for SARS-CoV-2 infection. The BOH system is mobile and combines Fourier-transform infrared (FTIR) spectroscopy with artificial intelligence (AI) to generate results within 2 min and 15 s. In contrast to prior SARS-CoV-2 breath analysis research, this study focuses on diagnosing SARS-CoV-2 via disease specific spectrometric profiles rather than through identifying the disease specific molecules. Methods: Asymptomatic emergency room patients with suspected SARS-CoV-2 exposure in two leading Israeli hospitals were selected between February through April 2021. All were tested via nasal/throat-swab PCR and BOH breath analysis. In total, 297 patients were sampled (mean age 57·08 ± SD 18·86, 156 males, 139 females, 2 unknowns). Of these, 96 were PCR-positive (44 males, 50 females, 2 unknowns), 201 were PCR-negative (112 males, 89 females). One hundred samples were used for AI identification of SARS-CoV-2 distinguishing spectroscopic wave-number patterns and diagnostic algorithm creation. Algorithm validation was tested in 100 proof-of-concept samples (34 PCR-positive, 66 PCR-negative) by comparing PCR with AI algorithm-based breath-test results determined by a blinded medical expert. One hundred additional samples (12 true PCR-positive, 85 true PCR-negative, 3 confounder false PCR-positive [not included in the 297 total samples]) were evaluated by two blinded medical experts for further algorithm validation and inter-expert correlation. Findings: The BOH system identified three distinguishing wave numbers for SARS-CoV-2 infection. In the first phase, the single expert identified the first 100 samples correctly, yielding a 1:1 FTIR/AI:PCR correlation. The two-expert second-phase also yielded 1:1 FTIR/AI:PCR correlation for 97 non-confounders and null correlation for the 3 confounders. Inter-expert correlation was 1:1 for all results. In total, the FTIR/AI algorithm demonstrated 100% sensitivity and specificity for SARS-CoV-2 detection when compared with PCR. Interpretation: The SARS-CoV-2 method of breath analysis via FTIR with AI-based algorithm demonstrated high PCR correlation in screening for asymptomatic individuals. This is the first practical, rapid, POC breath analysis solution with such high PCR correlation in asymptomatic individuals. Further validation is required with a larger sample size. Funding: Breath of Health Ltd, Rehovot, Israel provided study funding.