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Objective: The aim of this study was to explore cardiac nurses’ experiences with a comprehensive web-based intervention for patients with an implantable cardioverter defibrillator. Methods: We conducted an explorative qualitative study based on individual semi-structured interviews with 9 cardiac nurses from 5 Danish university hospitals. Results: We found one overall theme: “Between traditional nursing and modern eHealth”. This theme was derived from the following six categories: (1) comprehensive content in the intervention, (2) patient-related differences in engagement, (3) following the protocol is a balancing act, (4) online communication challenges patient contact, (5) professional collaboration varies, and (6) an intervention with potential. Cardiac nurses were positive towards the web-based intervention and believe it holds a large potential. However, they felt challenged by not having in-person and face-to-face contact with patients, which they found valuable for assessing patients’ wellbeing and psychological distress. Conclusion: Specific training in eHealth communication seems necessary as web-based care entails a shift in the nursing role and requires a different way of communication.InnovationFocusing on the user experience in web-based care from the perspective of cardiac nurses is innovative, and by applying implementation science this leads to new knowledge to consider when developing and implementing web-based care.

En enero-febrero de 2022 se publicó el último consenso de recomendaciones de vacunas en adultos con enfermedades reumáticas inflamatorias crónicas autoinmunes (ERICA), realizado en conjunto con expertos de la Sociedad Argentina de Reumatología y la Sociedad Argentina de Infectología (SAR/SADI) A modo de addendum del mismo, desarrollamos las recomendaciones para la inmunización con la vacuna recombinante para herpes zóster (VRHZ) en la población de pacientes con ERICA. En el último año, en Argentina, se aprobó la vacuna para el virus varicela zóster, vacuna inactivada de subunidades, recombinante, que contiene la glicoproteína E del virus de la varicela zóster junto con el sistema adyuvante AS0I. La misma demostró una alta eficacia y seguridad en la población inmunocompetente, así como en poblaciones de pacientes con inmunocompromiso. Por este motivo, en conjunto con un grupo de infectólogos expertos, desarrollamos las recomendaciones para el uso de esta vacuna en la población de pacientes con ERICA. Este documento se divide en dos partes. En la primera, figuran las recomendaciones de vacunación en distintos escenarios de presentación habitual en la práctica diaria. Se realizó una revisión bibliográfica y un consenso de expertos para los puntos que contaban con menor evidencia. La segunda parte consiste en seis recomendaciones desarrolladas a través de la metodología GRADE. Se analizó la evidencia en la población de pacientes con ERICA, con o sin tratamiento inmunosupresor, observándose una respuesta de la vacuna VRHZ aceptable, tanto humoral como celular, y demostrando ser segura en esta población de pacientes. Por otro lado, se comprobó una alta eficacia/efectividad en prevenir episodios de herpes zóster y neuralgia posherpética, así como una mayor eficacia/efectividad que la vacuna a virus vivo atenuado. En conclusión, en base a la evidencia disponible, este panel de expertos recomienda la vacuna VRHZ en pacientes con ERICA, independientemente de que hayan recibido previamente la vacuna a virus vivo atenuado contra el herpes zóster, ya que es segura, efectiva y, por el momento, tampoco se asoció a reactivación/brote de la enfermedad de base.

Protecting crops against pests is a major issue in the current agricultural production system. In particular, assessing the risk to crops can promote integrated pest management (IPM) strategies that encourage natural control mechanisms and advocate the use of pesticides as a last resort. In this study, we focused on wireworms, major soil-dwelling insect pests inflicting severe economic damage on various crops (including maize, potatoes and cereals) across Europe and North America. We have developed an original hierarchical Bayesian model that explicitly accounts for biological knowledge and uncertainty in field observations, rather than relying solely on statistical correlations, to predict the level of wireworm infestation. The model was calibrated and validated using a substantial dataset originating from an agro-environmental survey carried out over three consecutive years (2012–2014) in France, which provides the wireworm abundance in 419 maize fields, together with information on the landscape context, field history, weather conditions, soil characteristics and farming practices associated to each field. Model outcomes show good agreement with current knowledge from literature and field expertise in terms of the effects of variables on wireworm abundance, and provide fairly good predictive capacity. Subsequently, the model was encapsulated as a software (R shiny application) to predict the risk of wireworm infestation in any field of interest, and can be used by farmers or agricultural advisors as a decision support system for the implementation of IPM strategies. The conceptual framework that we implemented can be adapted to a wide range of similar situations involving other crops and pests.

Purpose. To evaluate the effect of teriparatide (TPTD) on bone mineral density (BMD) and bone markers under clinical practice conditions. To assess whether the results in real-life match those published in clinical trials. Methods. Cross-sectional study of postmenopausal women treated with TPTD for at least 12 months. Results. 264 patients were included in the study. Main characteristics are as follows: age: 68.7 ± 10.2 years, previous fractures: 57.6%, and previously treated with antiresorptive (AR-prior): 79%. All bone turnover markers studied significantly increased after 6 months. CTX and BGP remained high up to 24 months, but total and bone alkaline phosphatase returned to basal values at month 18. There was a significant increase in lumbar spine (LS) BMD after 6 months (+6.2%), with a maximum peak at 24 months (+13%). Femoral neck (FN) and total hip (TH) BMD showed a significant increase later than LS (just at month 12), reaching a maximum peak at month 24 (FN + 7.9% and TH + 5.5%). A significant increase in LS BMD was found from month 6 to month 24 compared to basal in both AR-naïve, and AR-prior patients (+16.7% and +10.5%, respectively), without significant differences between the two groups. Comparable results were found in FN and TH BMD. Main conclusions. As reported in real-life clinical studies, treatment of osteoporotic postmenopausal women with TPTD induced a significant increase in bone turnover markers from month 6 onward and an increase in BMD from months 6–12 with continuous gain up to month 24. The real-life results of our study matched the results of randomized clinical trials. In addition, TPTD induced an increase in BMD, regardless of the previous use of AR.

Class 1 integrons are widespread genetic elements playing a major role in the dissemination of antibiotic resistance. They allow bacteria to capture, express and exchange antibiotic resistance genes embedded within gene cassettes. Acquisition of gene cassettes is catalysed by the class 1 integron integrase, a site-specific recombinase playing a key role in the integron system. In in vitro planktonic culture, expression of intI1 is controlled by the SOS response, a regulatory network which mediates the repair of DNA damage caused by a wide range of bacterial stress, including antibiotics. However, in vitro experimental conditions are far from the real lifestyle of bacteria in natural environments such as the intestinal tract which is known to be a reservoir of integrons. In this study, we developed an in vivo model of intestinal colonization in gnotobiotic mice and used a recombination assay and quantitative real-time PCR, to investigate the induction of the SOS response and expression and activity of the class 1 integron integrase, IntI1. We found that the basal activity of IntI1 was higher in vivo than in vitro. In addition, we demonstrated that administration of a subinhibitory concentration of ciprofloxacin rapidly induced both the SOS response and intI1 expression that was correlated with an increase of the activity of IntI1. Our findings show that the gut is an environment in which the class 1 integron integrase is induced and active, and they highlight the potential role of integrons in the acquisition and/or expression of resistance genes in the gut, particularly during antibiotic therapy.

Compelling evidence supports the therapeutic benefit of extracellular vesicles (EVs). EVs are nanostructures with a lipid bilayer membrane that are secreted by multiple cells, including mesenchymal stromal cells (MSCs), as means of cellular communication. MSC-EVs, resembling their MSC origin, carry protected immunomodulatory and pro-regenerative cargoes to targeted neighboring or distant cells and tissues. Though treatments focused on MSC-EVs have emerged as greatly versatile approaches to modulate multiple inflammatory-related conditions, crucial concerns, including the possibility of increasing therapeutic outcomes by pre-conditioning parental MSCs or engineering derived EVs and clarification of the most relevant mechanisms of action, remain. Here, we summarize the large amount of preclinical research surrounding the modulation of beneficial effects by MSC-EVs.

Abstract In the last decade, the world population has become more urban than rural, but the human contact with nature is still a necessity for a proper physical and mental development. The urban green areas are a significant part of the urban heritage, providing fundamental ecosystem services. They give us the possibility of having social and cultural interaction surrounded by nature. Water is usually part of the landscape of these areas. The quality of the recreational water in urban green areas impacts on multiple factors like soil, vegetation, aquatic and terrestrial life and public health. A complete evaluation of this quality requires applying different methodologies simultaneously. Samples were collected at eight sites of Buenos Aires City in order to assess the quality of its recreational water. Results were compared with water quality standards in established legislation and were ranked by the National Sanitation Foundation Water Quality Index (NSF-WQI). Euphotic zone transparency was used as a parameter of the impact on aquatic life, measuring the Secchi depth. A test for fecal coliform bacteria was used as a risk indicator for human health. In accordance with the NSF-WQI ranking, the eight sampling sites have medium or bad water quality. Fifty percent of the sites exceeded the allowed count of coliform bacteria. According to established legislation, five of the studied sites were found to be unsuitable for primary, secondary or passive aquatic activities. Of the remaining sites, two were suitable for passive activities and only one qualified to be suitable for all kinds of aquatic activities. Secchi depth measures reveal a bad water quality for aquatic life at four of the analyzed sites.

Gaucher disease is renowned for extreme phenotypic diversity that does not show consistent genotype/phenotype correlations. In Argentina, a national collaborative group, Grupo Argentino de Diagnóstico y Tratamiento de la Enfermedad de Gaucher, GADTEG, delineated uniformly severe type 1 Gaucher disease manifestations presenting in childhood with large burden of irreversible skeletal disease. Here using Long-Read Single Molecule Real-Time (SMRT) Sequencing of GBA1 locus, we show that the RecNciI allele is highly prevalent and it is associated with severe skeletal manifestations with onset in childhood or in young adults. Additionally, we described novel GBA1 variants not previously described.

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Las fracturas vertebrales son una de las fracturas más comunes relacionadas a la fragilidad ósea y son causa de morbilidad importante. Sin embargo, la epidemiología de las fracturas vertebrales difiere de las fracturas osteoporóticas en otros sitios esqueléticos, ya que solo una tercera parte de las fracturas vertebrales son reconocidas clínicamente y detectadas al realizar una metodología de imagen apropiada, ya que un alto porcentaje presenta FV asintomáticas, las cuales no son detectadas hasta realizar una radiografía simple de columna dorso-lumbar. Por otro lado, la identificación de una fractura vertebral como aguda o crónica, benigna o maligna, hace que el médico tratante presente diferentes estrategias terapéuticas. El objetivo de este artículo de revisión es dar al lector información sobre la epidemiología, los costos, los tipos de fracturas vertebrales, que ocurre con las fracturas vertebrales en las enfermedades reumatológicas, como realizar una evaluación radiográfica de las fracturas vertebrales, la identificación acorde a las diferentes metodologías por imagen, y como es el tratamiento adecuado de las mismas.

Abstract Background In Denmark and other countries, there has been a shift in the management of patients with an implantable cardioverter defibrillator (ICD) with remote device monitoring largely replacing in-hospital visits. Less patient-nurse and patient-physician interaction may lead to gaps in patients’ quality of care and impede patients’ adaptation to living successfully with the ICD. A comprehensive eHealth intervention that include goal-setting, monitoring of symptoms of depression, anxiety, and quality of life, psychological treatment, information provision, supportive tools, online dialogues with nursing staff and access to an online community network, may help fill these gaps and be particularly beneficial to patients who suffer from anxiety and depression. This study will evaluate the effectiveness of the ACQUIRE-ICD care innovation, a comprehensive and interactive eHealth intervention, on patient-reported and clinical outcomes. Methods The ACQUIRE-ICD study is a multicenter, prospective, two-arm, unblinded randomised controlled superiority trial that will enroll 478 patients implanted with a first-time ICD or ICD with cardiac synchronisation therapy (CRT-D) from the six implanting centers in Denmark. The trial will evaluate the clinical effectiveness and cost-effectiveness of the ACQUIRE-ICD care innovation, as add-on to usual care compared with usual care alone. The primary endpoint, device acceptance, assessed with the Florida Patient Acceptance Survey, is evaluated at 12 months’ post implant. Secondary endpoints, evaluated at 12 and 24 months’ post implant, include patient-reported outcomes, return to work, time to first ICD therapy and first hospitalisation, mortality and cost-effectiveness. Discussion The effectiveness of a comprehensive and interactive eHealth intervention that relies on patient-centred and personalised tools offered via a web-based platform targeted to patients with an ICD has not been assessed so far. The ACQUIRE-ICD care innovation promotes and facilitates that patients become active participants in the management of their disease, and as such addresses the need for a more patient-centered disease-management approach. If the care innovation proves to be beneficial to patients, it may not only increase patient empowerment and quality of life but also free up time for clinicians to care for more patients. Trial registration The trial has been registered on https://clinicaltrials.gov/ct2/show/NCT02976961 on November 30, 2016 with registration number [NCT02976961].

Multipotent mesenchymal stromal cells (MSC) represent a promising strategy for a variety of medical applications. Although only a limited number of MSC engraft and survive after in vivo cellular infusion, MSC have shown beneficial effects on immunomodulation and tissue repair. This indicates that the contribution of MSC exists in paracrine signaling, rather than a cell-contact effect of MSC. In this review, we focus on current knowledge about tumor necrosis factor (TNF)-stimulated gene-6 (TSG-6) and mechanisms based on extracellular vesicles (EV) that govern long-lasting immunosuppressive and regenerative activity of MSC. In this context, in particular, we discuss the very robust set of findings by Jha and colleagues, and the opportunity to potentially extend their research focus on EV isolated in concentrated conditioned media (CCM) from adipose tissue derived MSC (ASC). Particularly, the authors showed that ASC-CCM mitigated visual deficits after mild traumatic brain injury in mice. TSG-6 knockdown ASC were, then, used to generate TSG-6-depleted CCM that were not able to replicate the alleviation of abnormalities in injured animals. In light of the presented results, we envision that the infusion of much distilled ASC-CCM could enhance the alleviation of visual abnormalities. In terms of EV research, the advantages of using size-exclusion chromatography are also highlighted because of the enrichment of purer and well-defined EV preparations. Taken together, this could further delineate and boost the benefit of using MSC-based regenerative therapies in the context of forthcoming clinical research testing in diseases that disrupt immune system homeostasis.

Las enfermedades de depósito lisosomal (EDL) comprenden un grupo heterogéneo de casi 50 trastornos que son causados por defectos genéticos en una hidrolasa ácida lisosomal, el receptor activador de la proteína, la proteína de membrana, o el transportador, causando la acumulación lisosomal de los sustratos que son específicos para cada trastorno. La acumulación es progresiva y en última instancia, causan el deterioro de la función celular y tisular. Muchos trastornos afectan al sistema nervioso central (SNC) y la mayoría de los pacientes tienen una disminución de la calidad de vida y aumento de la morbi-mortalidad. El diagnóstico debe ser establecido por ensayos de enzimas específicas y análisis de mutación. El objetivo de esta revisión es brindar una guía para pensar en estas enfermedades raras.

Social businesses seek financial, social and even environmental results. Academic knowledge on how such organizations operate, however, has emerged more recently. This article sought to investigate qualitatively the main tensions and dilemmas occurring throughout the history of the Rede Asta, a pioneer social business in direct catalog sales of artisanal products in Brazil. Results indicate the Rede Asta managers have experienced tensions and dilemmas in three of the four categories identified by Smith, Gonin, and Besharov (2013): social and financial performance, organizational aspects and learning. One of the dilemmas involves organizational aspects and learning, since Asta achieves feasibility with two organizations: a nonprofit association and a for-profit corporation. On perceptions of belonging, stakeholders declared they felt they were a part of the organization’s social and environmental goals; some even as activists.

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El remodelado óseo es un proceso continuo que ocurre a través de la vida; en condiciones fisiológicas normales, los osteoblastos están involucrados en la formación del osteoide el cual es mineralizado y reemplaza el hueso en los sitios donde el osteoclasto produjo resorción ósea para mantener la integridad esquelética.

Introducción: el proyecto BIOBADASAR (Registro argentino de eventos adversos con tratamientos biológicos en reumatología) comenzó en agosto de 2010, para recabar información a largo plazo sobre los eventos adversos en tratamientos biológicos en pacientes con enfermedades reumáticas en la práctica clínica cotidiana en Argentina.

The aim of this study was to evaluate the effect of denosumab (Dmab) on bone mineral density (BMD) and bone turnover markers after 1 year of treatment. Additionally, the effect of Dmab in bisphosphonate-naïve patients (BP-naïve) compared to patients previously treated with bisphosphonates (BP-prior) was analyzed. This retrospective study included 425 postmenopausal women treated with Dmab for 1 year in clinical practice conditions in specialized centers from Argentina. Participants were also divided according to previous bisphosphonate treatment into BP-naïve and BP-prior. A control group of patients treated with BP not switched to Dmab matched by sex, age, and body mass index was used. Data are expressed as mean ± SEM. After 1 year of treatment with Dmab the bone formation markers total alkaline phosphatase and osteocalcin were significantly decreased (23.36% and 43.97%, resp.), as was the bone resorption marker s-CTX (69.61%). Significant increases in BMD were observed at the lumbar spine, femoral neck, and total hip without differences between BP-naïve and BP-prior. A better BMD response was found in BP-prior group compared with BP treated patients not switched to Dmab. Conclusion. Dmab treatment increased BMD and decreased bone turnover markers in the whole group, with similar response in BP-naïve and BP-prior patients. A better BMD response in BP-prior patients versus BP treated patients not switched to Dmab was observed.

Background: Low plasma potassium (p-K) is associated with increased risk of malignant arrhythmia and observational studies indicate protective effects of p-K in the upper reference level. However, randomized clinical studies are needed to document whether actively increasing p-K to high-normal levels is possible and safe and improves cardiovascular outcomes.Objective: To investigate if increased p-K reduces the risk of malignant arrhythmia and all-cause death in high-risk patients with a cardiovascular disease treated with an implantable cardioverter defibrillator (ICD) for primary or secondary preventive causes. Secondly, to investigate whether high-normal p-K levels can be safely reached and maintained using already available medications and potassium-rich dietary guidance.Methods: This is a prospective, randomized, and open-labelled study enrolling patient at high-risk of malignant arrhythmias. According to sample size calculations, 1,000 patients will be randomized 1:1 to either an investigational regiment that aims to increase and maintain p-K at high-normal levels (4.5-5.0 mmol/L) or to usual standard of care and followed for an expected four years. The trial will run until a total of 291 events have occurred providing an α = 0.05 and 1-β = 0.80. The composite primary endpoint includes ventricular tachycardia >125 bpm lasting >30 seconds, any appropriate ICD-therapy, and all-cause mortality. At present, 739 patients have been randomized.Conclusions: We present the rationale for the design of the POTCAST trial. The inclusion was initiated 2019 and is expected to be finished 2022. The study will show if easily available treatments to increase p-K may be a new treatment modality to protect against malignant arrythmias. [ABSTRACT FROM AUTHOR]

Introducción: BIOBADASAR ((Registro Argentino de Eventos Adversos con Tratamientos Biológicos en Reumatología) comenzó en agosto de 2010. La importancia de este registro es mostrar datos locales que, probablemente, puedan diferir de otros registros. El objetivo es comunicar los resultados del tercer reporte de BIOBADASAR. Métodos: Todos los pacientes con enfermedades reumáticas que requirieron tratamiento con agentes biológicos y pacientes controles sin estos tratamientos fueron incluidos en la base de datos provenientes de 32 centros participando a lo largo de la Argentina. Tres áreas de datos son analizados: características de los pacientes, tratamientos y eventos adversos. El inicio de la carga fue agosto de 2010 y cerró para este análisis en agosto de 2013. Se utilizó software Infostat para el análisis estadístico. Se calcularon porcentajes, riesgos relativos e incidencia persona/año para los eventos adversos. Resultados: Se incorporaron 2356 pacientes (1277 casos y 1079 controles) utilizando 2940 tratamientos. 1862 mujeres (79%) y 494 hombres (21%). La edad promedio fue 54 años (1-90). 1107 pacientes (58%) fueron tratados con agentes biológicos (casos) y 802 (42%) fueron controles. 1829 pacientes tenían artritis reumatoidea y 218 artritis psoriásica entre los diagnósticos principales. El tiempo promedio de la enfermedad fue 9,81 años para los controles y 12,59 para los casos. El biológico más utilizado fue el etanercept (46,7% de los tratamientos) con una mediana de sobrevida al tratamiento de 31 meses seguido de adalimumab con 23,6% de los tratamientos y una mediana de sobrevida de 26,4 meses. La causa más frecuente de interrupción de tratamientos para los casos fue ineficacia (30%) seguido por eventos adversos (26%). La incidencia de eventos adversos serios fue 37/1000 pacientes año en el grupo biológico vs. 5/1000 pacientes año en el grupo control (RR 7,44; IC 5,17-10,7; p

The current study tries a new approach to simulating interactions between waves and seagrass through Smoothed Particle Hydrodynamics (SPH). In this model, the plants are defined as a solid that respects Hooke's law, and are assumed to have direct interaction with the fluid. Given the characteristics of the SPH method, especially in terms of computational time, the dimensions of the simulations were limited. The first goal of the current study was to optimize the approach to avoid reaching certain limits such as the rupture of the simulated plant. Plant movements under waves and/or currents have been studied by several authors in various in-situ , physical, and numerical experiments concerning various vegetation species, thus proving that plant movements can be successfully reproduced by SPH 2D/3D. Manning's roughness coefficient, n , was calculated to confirm that the results were in accordance with what had been measured in flume studies. Even though there is still room for improvement, it is shown that this method can be used to estimate Manning's coefficient for coastal vegetation (seagrass and saltmarsh vegetation) and to greatly improve the modeling and forecasting of coastal erosion and storm surge risks by including the effects of vegetation in integrated models. • A fluid-structure interaction (FSI) in an SPH 2D/3D code was build. • This FSI code was tested and calibrated for a classical test. • This approach was tested on sea grass movement under currents or waves. • The simulations were compared with experimental and field measurements. [ABSTRACT FROM AUTHOR]

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Copyright of Actualizaciones en Osteología is the property of Asociacion Argentina de Osteologia y Metabolismo Mineral and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purpose of this study was to evaluate the frequency of osteoporosis (OP) in patients with Gaucher disease (GD) in Argentina. GD patients from 28 centers were consecutively included from April 2012 to 2014. Bone mineral density (BMD) was determined by dual X-ray absorptiometry in the lumbar spine and the femoral neck or the total proximal femur for patients ≥20 yr of age, and by whole-body scan in the lumbar spine in patients <20 yr of age. In children, mineral density was calculated using the chronological age and Z height. OP diagnosis was determined following adult and pediatric official position of the International Society for Clinical Densitometry. A total of 116 patients were included, of which 62 (53.5%) were women. The median age was 25.8 yr. All patients received enzyme replacement therapy, with a median time of 9.4 yr. Normal BMD was found in 89 patients (76.7%), whereas low bone mass (LBM) or osteopenia was found in 15 patients (13%) and OP in 12 patients (10.3%). The analysis of the pediatric population revealed that 4 patients (9.3%) had LBM and 3 (7%) had OP ( Z -score ≤ −2 + fractures height-adjusted by Z ), whereas in the adult population (n = 73), 11 patients (15%) had LBM or osteopenia and 9 (12.3%) had OP. Bone marrow infiltration and the presence of fractures were significantly correlated with the presence of OP ( p  = 0.04 and <0.001, respectively). This is the first study in Argentina and in the region describing the frequency of OP or LBM in GD patients treated with imiglucerase using the official position of the International Society for Clinical Densitometry. [ABSTRACT FROM AUTHOR]

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Copyright of Actualizaciones en Osteología is the property of Asociacion Argentina de Osteologia y Metabolismo Mineral and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)