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Abstract Background With a median age at diagnosis of 70, lung cancer remains a significant public health challenge for older Americans. Surgery is a key component in treating most patients with non-metastatic lung cancer. These patients experience postoperative pain, fatigue, loss of respiratory capacity, and decreased physical function. Data on quality of life (QOL) in older adults undergoing lung cancer surgery is limited, and few interventions are designed to target the needs of older adults and their family caregivers (FCGs). The primary aim of this comparative effectiveness trial is to determine whether telephone-based physical activity coaching before and after surgery will be more beneficial than physical activity self-monitoring alone for older adults and their FCGs. Methods In this multicenter comparative effectiveness trial, 382 older adults (≥ 65 years) with lung cancer and their FCGs will be recruited before surgery and randomized to either telephone-based physical activity coaching or physical activity self-monitoring alone. Participants allocated to the telephone-based coaching comparator will receive five telephone sessions with coaches (1 pre and 4 post surgery), an intervention resource manual, and a wristband pedometer. Participants in the self-monitoring only arm will receive American Society of Clinical Oncology (ASCO) physical activity information and wristband pedometers. All participants will be assessed at before surgery (baseline), at discharge, and at days 30, 60, and 180 post-discharge. The primary endpoint is the 6-minute walk test (6MWT) at 30 days post-discharge. Geriatric assessment, lower extremity function, self-reported physical function, self-efficacy, and QOL will also be assessed. Discussion The trial will determine whether this telephone-based physical activity coaching approach can enhance postoperative functional capacity and QOL outcomes for older adults with lung cancer and their FCGs. Trial results will provide critical findings to inform models of postoperative care for older adults with cancer and their FCGs. Trial Registration ClinicalTrials.gov Identifier: NCT06196008.

The use of cerium oxide nanoparticles as a corrosion inhibitor for the CO2 corrosion of LDX 2101 duplex stainless steel has been evaluated using potentiodynamic polarization curves, linear polarization resistance and electrochemical impedance spectroscopy tests. Polarization curves have shown that CeO2 nanoparticles behaved as an efficient mixed type of inhibitor, with an efficiency that increases with its concentration reaching a maximum value when 600 ppm of nanoparticles were added. CeO2 nanoparticles were chemically adsorbed onto the steel surface according to a Langmuir type of adsorption isotherm. A passive layer was formed by the addition of CeO2 nanoparticles with lower passive current density and higher pitting potential values than those obtained without these nanoparticles. Corrosion current density decreased whereas the polarization resistance increased by two orders of magnitude in both cases with the addition of the nanoparticles. Similarly, the double layer capacitance was decreased due to the adsorption of the nanoparticles. Steel was susceptible to pitting type of corrosion, but its number and diameter decreased with the nanoparticles.

Abstract Background Menstrual Regulation (MR) has been legal in Bangladesh since 1979 in an effort to reduce maternal mortality from unsafe abortion care. However, access to high-quality and patient-centered MR care remains a challenge. This analysis aimed to explore what clients know before going into care and the experience itself across a variety of service delivery sites where MR care is available. Methods We conducted 26 qualitative semi-structured interviews with MR clients who were recruited from three different service delivery sites in Dhaka, Bangladesh from January to March 2019. Interviews explored client expectations and beliefs about MR care, the experience of the care they received, and their perception of the quality of that care. We conducted a thematic content analysis using a priori and emergent codes. Results Clients overall lacked knowledge about MR care and held fears about the damage to their bodies after receiving care. Despite their fears, roughly half the clients held positive expectations about the care they would receive. Call center clients felt the most prepared by their provider about what to expect during their MR care. During counseling sessions, providers at in-facility locations reinforced the perception of risk of future fertility as a result of MR and commonly questioned clients on their need for MR services. Some even attempted to dissuade nulliparous women from getting the care. Clients received this type of questioning throughout their time at the facilities, not just from their medical providers. The majority of clients perceived their care as good and rationalized these comments from their providers as coming from a caring place. However, a handful of clients did report bad care and negative feelings about their interactions with providers and other clinical staff. Conclusion Providers and clinical staff can play a key role in shaping the experience of clients accessing MR care. Training on accurate knowledge about the safety and effectiveness of MR, and the importance of client communication could help improve client knowledge and person-centered quality of MR care.

Abstract Seagrasses are undergoing widespread loss due to anthropogenic pressure and climate change. Since 1960, the Mediterranean seascape lost 13–50% of the areal extent of its dominant and endemic seagrass-Posidonia oceanica, which regulates its ecosystem. Many conservation and restoration projects failed due to poor site selection and lack of long-term monitoring. Here, we present a fast and efficient operational approach based on a deep-learning artificial intelligence model using Sentinel-2 data to map the spatial extent of the meadows, enabling short and long-term monitoring, and identifying the impacts of natural and human-induced stressors and changes at different timescales. We apply ACOLITE atmospheric correction to the satellite data and use the output to train the model along with the ancillary data and therefore, map the extent of the meadows. We apply noise-removing filters to enhance the map quality. We obtain 74–92% of overall accuracy, 72–91% of user’s accuracy, and 81–92% of producer’s accuracy, where high accuracies are observed at 0–25 m depth. Our model is easily adaptable to other regions and can produce maps in in-situ data-scarce regions, providing a first-hand overview. Our approach can be a support to the Mediterranean Posidonia Network, which brings together different stakeholders such as authorities, scientists, international environmental organizations, professionals including yachting agents and marinas from the Mediterranean countries to protect all P. oceanica meadows in the Mediterranean Sea by 2030 and increase each country’s capability to protect these meadows by providing accurate and up-to-date maps to prevent its future degradation.

English teachers should write and share their writing. The authors analyze how composing sonnets added to understanding of poetic genre, literary terminology, and state standards. This article argues on behalf of more creative writing in English language arts and explains the benefits of teachers and students sharing their writing.

Objective This qualitative study aimed to identify person-centred domains that would contribute to the definition and measurement of abortion quality of care based on the perceptions, experiences and priorities of people seeking abortion.Methods We conducted interviews with people seeking abortion aged 15–41 who obtained care in Argentina, Bangladesh, Ethiopia or Nigeria. Participants were recruited from hospitals, clinics, pharmacies, call centres and accompaniment models. We conducted thematic analysis and quantified key domains of quality identified by the participants.Results We identified six themes that contributed to high-quality abortion care from the clients’ perspective, with particular focus on interpersonal dynamics. These themes emerged as participants described their abortion experience, reflected on their interactions with providers and defined good and bad care. The six themes included (1) kindness and respect, (2) information exchange, (3) emotional support, (4) attentive care throughout the process, (5) privacy and confidentiality and (6) prepared for and able to cope with pain.Conclusions People seeking abortion across multiple country contexts and among various care models have confirmed the importance of interpersonal care in quality. These findings provide guidance on six priority areas which could be used to sharpen the definition of abortion quality, improve measurement, and design interventions to improve quality.

The corrosion behavior of 1018 carbon steel in LiCl/H2O mixtures has been evaluated by using potentiodynamic polarization curves, electrochemical noise and electrochemical impedance spectroscopy techniques. Two different concentrations of LiCl were employed, namely 35 and 40 wt. %, and the testing temperatures included 25, 35 and 70 °C. It was found that the steel showed a passive zone; the corrosion current density value increased with an increase in the solution temperature and concentration. The pitting potential value decreased with an increase in the testing temperature and the solution concentration. The corrosion process was under charge transfer control. This mechanism was unaltered either by the solution temperature or concentration. The charge transfer resistance value decreased with an increase in both the solution temperature and concentration. A localized, pitting type of corrosion dominated the corrosion morphology at 25 and 35 °C, whereas at 70 °C, the main type of attack was a mixed type of corrosion.

Abstract Background Severe clinical pictures and sequelae of COVID‐19 disease are immune mediated and characterized by a ‘cytokine storm’. Skeletal muscle has emerged as a potent regulator of immune system function. The aim of the present study is to define the prevalence of sarcopenia among COVID‐19 survivors and the negative impact of sarcopenia on the post‐acute COVID‐19 syndrome and its related risk factors. Methods A total of 541 subjects recovered from COVID‐19 disease were enrolled in the Gemelli Against COVID‐19 Post‐Acute Care between April 2020 and February 2021. They underwent a multidisciplinary clinical evaluation and muscle strength and physical performance assessment. Results Mean age was 53.1 years (SD 15.2, range from 18 to 86 years), and 274 (51%) were women. The prevalence of sarcopenia was 19.5%, and it was higher in patients with a longer hospital stay and lower in patients who were more physically active and had higher levels of serum albumin. Patients with sarcopenia had a higher number of persistent symptoms than non‐sarcopenic patients (3.8 ± 2.9 vs. 3.2 ± 2.8, respectively; P = 0.06), in particular fatigue, dyspnoea, and joint pain. Conclusions Sarcopenia identified according to the EWGSOP2 criteria is high in patients recovered from COVID‐19 acute illness, particularly in those who had experienced the worst clinical picture reporting the persistence of fatigue and dyspnoea. Our data suggest that sarcopenia, through the persistence of inflammation, could be the biological substrate of long COVID‐19 syndrome. Physical activity, especially if associated with adequate nutrition, seems to be an important protective factor.

Introducción: la enfermedad de Chagas es una de las principales afecciones asociadas con los determinantes sociales de la salud, los estilos de vida y los ambientes saludables, donde las condiciones de pobreza e infraestructura promueven la permanencia del vector. El presente artículo tiene por objetivo analizar los determinantes sociales de la salud relacionados con la prevención y el control de la enfermedad de Chagas para el aporte de conocimiento epidemiológico relevante y la propuesta de políticas públicas que permitan mejorar el abordaje y la atención de este problema sanitario, en favor del compromiso nacional de eliminarlo. Metodología: se desarrolló un estudio, de tipo ecológico-exploratorio con fundamento espacial, de los determinantes sociales de la salud vinculados con la prevención y el control de la enfermedad de Chagas. Para ello, como fuentes de información primaria, se tomaron datos generados por el Ministerio de Salud (MINSA) y el Instituto Nacional de Estadística y Censos (INEC), los cuales se cartografiaron usando SIG; de seguido, se analizaron los patrones espaciales mediante el Índice de Moran. Se diseñó un modelo de regresión lineal binomial negativa. Resultados: de acuerdo con el mejor modelo obtenido, las variables que más explicaron la variación en la probabilidad de enfermar de Chagas fueron el porcentaje de tugurios por cantón, el porcentaje de hogares afectados por la pobreza y el porcentaje de carencias de otros bienes y servicios. El porcentaje de varianza en la probabilidad de enfermar de Chagas, conforme a los determinantes sociales de la salud incluidos en el modelo de regresión, fue del 38 %. Conclusiones: los resultados obtenidos implican una relación entre la enfermedad de Chagas y los determinantes sociales de la salud, especialmente, aquellos ligados a la inequidad y desigualdad. Por tanto, se plantean lineamientos en torno a un registro de información que facilite la vigilancia de la enfermedad. Esto conlleva una identificación o eliminación de un posible subregistro de casos, derivado de la falta de análisis de indicadores de determinantes sociales de la salud.

Introduction: Patients with pulmonary tuberculosis (PTB) disease and positive sputum cultures are the main source of infection. Culture conversion time is inconsistent and defining the length of respiratory isolation is challenging. The objective of this study is to develop a score to predict the length of isolation period. Methods: A retrospective study was carried out to evaluated risk factors associated with persistent positive sputum cultures after 4 weeks of treatment in 229 patients with PTB. A multivariable logistic regression model was used to determinate predictors for positive culture and a scoring system was created based on the coefficients of the final model. Results: Sputum culture was persistently positive in 40.6%. Fever at consultation (1.87, 95% CI:1.02–3.41), smoking (2.44, 95% CI:1.36–4.37), >2 affected lung lobes (1.95, 95% CI:1.08–3.54), and neutrophil-to-lymphocyte ratio > 3.5 (2.22, 95% CI:1.24–3.99), were significantly associated with delayed culture conversion. Therefore, we assembled a severity score that achieved an area under the curve of 0.71 (95% CI:0.64–0.78). Conclusions: In patients with smear positive PTB, a score with clinical, radiological and analytical parameters can be used as a supplemental tool to assist clinical decisions in isolation period.

Plain language summary Little is known about how people who have abortions perceive the quality of the care they receive and what aspects of interpersonal interactions with providers matter to them. This qualitative study aimed to understand preferences of people who had abortions at both a reproductive health clinic and with an accompaniment group in Argentina. We interviewed 24 people who obtained abortion care in Buenos Aires and Neuquén, Argentina. We asked them about their preferences for and experiences of abortion care. Then we analyzed the interviews, specifically assessing aspects of interpersonal care based on quality of care frameworks from the literature. Participants described high-quality abortion care as feeling acompañamiento and contención from their providers—terms that imply receiving kind, caring, compassionate and emotionally supportive care throughout their abortions. They described four key elements of interpersonal interactions: attentive communication from providers and accompaniers, clear and understandable information provision, non-judgmental support, and individualized options for pain management. In conclusion, people obtaining abortions in two distinct models of care in Argentina consistently identified receiving compassionate and supportive care throughout an abortion as a key aspect of care. The findings have implications for incorporating people’s perspectives in the development of care guidelines, training of providers, and monitoring and improving of services. This is particularly important as the government of Argentina prepares to expand legal access to abortion.

IntroductionDisrespect and abuse are components of poor quality abortion care. This analysis aimed to understand negative experiences of care from perspectives of abortion clients in public and private facilities in Ethiopia.Study DesignWe conducted 23 in-depth interviews with people who obtained abortion care in Addis Ababa, Ethiopia as well as Aksum and Mekele in Tigray State, Ethiopia. The interviews were coded using a priori and emergent codes and we conducted thematic analysis to understand negative interactions with providers from participant's perspectives.ResultsParticipants experienced denial of abortion services along their pathway to care and attempts by providers to dissuade them prior to providing an abortion. Underlying both the denial and the dissuasion were reports of disrespect and condemnation from providers. Participants described how providers doubted or forced them to justify their reasons for having an abortion, stigmatized them for seeking multiple abortions or later abortions, and ascribed misinformation about abortion safety. Despite reports of denial, dissuasion, and disrespect, abortion clients generally felt that providers had their best interest at heart and were grateful for having access to an abortion.ConclusionsParticipants in Ethiopia experienced providers as gatekeepers to legal abortion services, facing disrespect and judgment at facilities where they sought care. Interventions aimed at increasing awareness of abortion laws such that clients understand their rights and values clarification interventions for providers could help reduce barriers to accessing care and improve the quality of abortion services.

In this investigation, Cu–Ni alloys with different aluminum additions were synthetized under a vacuum atmosphere to reduce the material density. Annealed alloys in a He atmosphere with low aluminum concentration exhibited a coarse dendritic structure, while samples with high aluminum concentration exhibited a refined dendritic structure. Structural defects analyses have shown relatively low vacancy concentrations. Hardness evaluations indicated an increment by approximately 5 times i.e., 370 HVN, more than that for the alloyed samples compared with the as-cast and unalloyed samples. Compression tests have shown a noticeable strengthening improvement (360 MPa), mainly in samples heat treated with 10 at.% Al, while samples with 5 at.% Al showed an acceptable resistance (270 MPa) as well. In general, the sample with 10 at.% Al presented the best performance to be considered as potential structural material.

Introduction Despite the known benefit to patients and families, discussions about goals, values and preferences for medical care in advancing serious illness often do not occur. Many system and clinician factors, such as patient and clinician reticence and shortage of specialty palliative care teams, contribute to this lack of communication. To address this gap, we designed an intervention to promote goals-of-care conversations and palliative care referrals in the hospital setting by using trained palliative care educators and video decision aids. This paper presents the rationale, design and methods for a trial aimed at addressing barriers to goals-of-care conversations for hospitalised adults aged 65 and older and those with Alzheimer’s disease and related Dementias, regardless of age.Methods and analysis The Video Image about Decisions to Improve Ethical Outcomes with Palliative Care Educators is a pragmatic stepped wedge, cluster randomised controlled trial, which aims to improve and extend goals-of-care conversations in the hospital setting with palliative care educators trained in serious illness communication and video decision aids. The primary outcome is the proportion of patients with goals-of-care documentation in the electronic health record. We estimate that over 9000 patients will be included.Ethics and dissemination The Institutional Review Board (IRB) at Boston Medical Center will serve as the single IRB of record for all regulatory and ethical aspects of this trial. BMC Protocol Number: H-41482. Findings will be presented at national meetings and in publications. This trial is registered at ClinicalTrials.gov.Trial registration number NCT04857060; ClinicalTrials.gov

This qualitative study aimed to examine how abortion clients in Nigeria perceive abortion and explore the role their beliefs and fears play in their care-seeking experiences and interactions with providers. Abortion is severely legally restricted in Nigeria but remains common. We conducted in-depth interviews with 25 people who obtained abortion services through three distinct models of care. We coded interview transcripts and conducted thematic analysis. Clients perceived negative attitudes toward abortion in their communities, though clients' own beliefs were more nuanced. Clients recounted a range of fears, and nearly all mentioned worrying that they might die as a result of their abortion. Despite their concerns, clients relied on social networks and word-of-mouth recommendations to identify providers they perceived as trustworthy and safe. Kind and non-judgmental treatment, clear instructions, open communication, and reassurance of privacy and confidentiality by providers alleviated client fears and helped clients feel supported throughout their abortion process. Within restrictive contexts, the mobilization of information networks, provision of high-quality care through innovative models, and personalization of care to individual needs can assuage fears and contribute to reducing stigma and increasing access to safe abortion services.

BackgroundThe COVID-19 pandemic has turned the care model of health systems around the world upside down, causing the abrupt cancellation of face-to-face visits and redirection of the model toward telemedicine. Digital transformation boosts information systems—the more robust they are, the easier it is to monitor the health care system in a highly complex state and allow for more agile and reliable analysis. ObjectiveThe purpose of this study was to analyze diagnoses from primary care visits and distinguish between those that had higher and lower variations, relative to the 2019 and 2020 periods (roughly before and during COVID-19), to identify clinical profiles that may have been most impaired from the least-used diagnostic codes for visits during the pandemic. MethodsWe used a database from the Primary Care Services Information Technologies Information System of Catalonia. We analyzed the register of visits (n=2,824,185) and their International Classification of Diseases (ICD-10) diagnostic codes (n=3,921,974; mean 1.38 per visit), as approximations of the reasons for consultations, at 3 different grouping levels. The data were represented by a term frequency matrix and analyzed recursively in different partitions aggregated according to date. ResultsThe increase in non–face-to-face visits (+267%) did not counterbalance the decrease in face-to-face visits (–47%), with an overall reduction in the total number of visits of 1.36%, despite the notable increase in nursing visits (10.54%). The largest increases in 2020 were visits with diagnoses related to COVID-19 (ICD-10 codes Z20-Z29: 2.540%), along with codes related to economic and housing problems (ICD-10 codes Z55-Z65: 44.40%). Visits with most of the other diagnostic codes decreased in 2020 relative to those in 2019. The largest reductions were chronic pathologies such as arterial hypertension (ICD-10 codes I10-I16: –32.73%) or diabetes (ICD-10 codes E08-E13: –21.13%), but also obesity (E65-E68: –48.58%) and bodily injuries (ICD-10 code T14: –33.70%). Visits with mental health–related diagnostic codes decreased, but the decrease was less than the average decrease. There was a decrease in consultations—for children, adolescents, and adults—for respiratory infections (ICD-10 codes J00-J06: –40.96%). The results show large year-on-year variations (in absolute terms, an average of 12%), which is representative of the strong shock to the health system. ConclusionsThe disruption in the primary care model in Catalonia has led to an explosive increase in the number of non–face-to-face visits. There has been a reduction in the number of visits for diagnoses related to chronic pathologies, respiratory infections, obesity, and bodily injuries. Instead, visits for diagnoses related to socioeconomic and housing problems have increased, which emphasizes the importance of social determinants of health in the context of this pandemic. Big data analytics with routine care data yield findings that are consistent with those derived from intuition in everyday clinical practice and can help inform decision making by health planners in order to use the next few years to focus on the least-treated diseases during the COVID-19 pandemic.

In recent years, chlamydia trachomatis (CT) screening has been discussed among different scientific boards. However, in Spain, chlamydia screening is offered to women who attend a hospital after sexual assault. We found that 5.1% of 59 cases attending our hospital after sexual assault between January 2017 and December 2019 tested positive for chlamydia infection. The mean age of the cases was 23.3 years. In comparison, screening asymptomatic patients of similar age attending hospital for other reasons have revealed a prevalence of CT of 7%. Hence, since CT is common in asymptomatic individuals as well as victims of sexual assault, we believe that chlamydia screening should also be a priority in asymptomatic patients.

The reaction of sodium 2,4‐di‐tert‐butyl‐6‐(diphenylphos‐phino)phenolate (1, NaOArP) with TiIVCl4(THF)2 in a 2 : 1 molar ratio yielded TiIV(OArP)2Cl2 (2). The reduction of 2 with magnesium gave the dimeric titanium(III) compound [TiIII(OArP)2Cl]2 (3). In the presence of magnesium, compound 2 was found to catalyse the cyclotrimerization, acyclic oligomerisation, and hydrogenation of terminal alkynes. The complexes were characterised by single‐crystal X‐ray diffraction, optical spectroscopy, elemental analysis, and NMR or EPR spectroscopy, respectively. [ABSTRACT FROM AUTHOR]

Introduction Blood transfusion is still common in patients undergoing major cancer surgery. Blood transfusion can be associated with poor prognosis in patients with cancer. Perioperative Care in the Cancer Patient -1 (ARCA-1) aims to assess in a large cohort of patients the current incidence, pattern of practice and associations between perioperative blood transfusions and 1-year survival in patients undergoing major cancer surgery.Methods and analysis ARCA-1 is a prospective international multicentre observational study that will include adult patients scheduled to have major cancer surgical procedures with the intention to cure, and an overnight planned hospital admission. The study will be opened for 1 year for enrolment (7 January 2020–7 February 2021). Each centre will enrol patients for 30 days. The primary endpoint of this study is all-cause mortality 1 year after major cancer surgery. Secondary endpoints are rate of perioperative blood product use, cancer-specific mortality at 1 year and PFSs and 30-day morbidity and mortality.Ethics and dissemination This study was approved by the Institutional Review Board at The University of Texas—MD Anderson Cancer Center. The study results will be published in peer-reviewed journals and disseminated at international conferences.Trial registration number NCT04491409.

A new spirostannole, 1,1′,3,3′-tetrakis(5-methylthiophen-2-yl)-4,4′,5,5′,6,6′,7,7′-octahydro-2,2′-spirobi[benzo[c]stannole] (4), is synthesised and the molecular structure is compared with the optimised geometry from DFT calculations. The highest occupied molecular orbital (HOMO) and lowest unoccupied molecular orbital (LUMO) are twice degenerated and show a small HOMO–LUMO energy gap of 3.2 eV. In addition, cyclic voltammetry measurements are conducted and three redox processes are observed. Absorption and emission spectra show maxima at λabs,max 436 nm and λem,max 533 nm, respectively. Spirostannole 4 is a strongly absorbing material, but an extremely weak emitter in solution at 295.15 K. However, when the solution is cooled from 280 to 80 K, the emission becomes visible. The reaction of spirostannole 4 with methyllithium is monitored by NMR spectroscopy at 238.15 K. The 119Sn{1H} NMR signal shifts from −36.0 (4) to −211.0 ppm, which is indicative of the formation of the lithium pentaorganostannate 5. The complex is thermally instable at 295.15 K, but insights into the molecular structure and electronic behaviour are obtained by DFT and TD-DFT calculations.