Search

The COVID-19 pandemic has spread rapidly and caused significant damage to global public health as well as the economy. While the race of vaccine development witnessed a spectacular breakthrough with the introduction of highly effective vaccines such as BNT162b2, mRNA-1273, or AZD1222, no specific drug for COVID-19 treatment has been discovered yet. Recently, repurposing drugs classified into three main groups of mechanisms, including antivirus, anti-SARS-CoV-2 antibodies, and immunomodulators, are investigated. As a result, Remdesivir and six other drugs are authorized by the Food and Drug Administration (FDA) to treat patients infected by the SARS-CoV-2. This work aims to highlight that, besides vaccines, COVID-19 drugs should get more attention and be considered as one of the most promising strategies to safely coexist with the SARS-CoV-2 virus in the new normal status and for the mutations of the virus, such as the omicron variant. [ J Adv Biotechnol Exp Ther 2022; 5(1.000): 241-246]

Sepsis is the most common cause of in-hospital deaths, especially from low-income and lower-middle-income countries (LMICs). This study aimed to investigate the mortality rate and associated factors from sepsis in intensive care units (ICUs) in an LMIC. We did a multicenter cross-sectional study of septic patients presenting to 15 adult ICUs throughout Vietnam on the 4 days representing the different seasons of 2019. Of 252 patients, 40.1% died in hospital and 33.3% died in ICU. ICUs with accredited training programs (odds ratio, OR: 0.309; 95% confidence interval, CI 0.122–0.783) and completion of the 3-h sepsis bundle (OR: 0.294; 95% CI 0.083–1.048) were associated with decreased hospital mortality. ICUs with intensivist-to-patient ratio of 1:6 to 8 (OR: 4.533; 95% CI 1.621–12.677), mechanical ventilation (OR: 3.890; 95% CI 1.445–10.474) and renal replacement therapy (OR: 2.816; 95% CI 1.318–6.016) were associated with increased ICU mortality, in contrast to non-surgical source control (OR: 0.292; 95% CI 0.126–0.678) which was associated with decreased ICU mortality. Improvements are needed in the management of sepsis in Vietnam such as increasing resources in critical care settings, making accredited training programs more available, improving compliance with sepsis bundles of care, and treating underlying illness and shock optimally in septic patients.

Fresh postharvest green asparagus rapidly deteriorate due to its senescence process and high transpiration rate. This thesis aims to utilize the available sources of carrageenan and alginate for combining with pure chitosan coating solution, thus create a new multi-component coating that can overcome the limitations of pure chitosan coating, and show more effective in maintaining the quality of postharvest green asparagus. The gel solution ratio 2:1 (v/v) of chitosan 1% (w/v) and alginate 0.2% (w/v), had ability to prolong shelf-life of asparagus for 3 days (from weight loss point of view) and 7 days (from visual quality point of view) compared to control sample. The weight loss was less than about 12% and also ensured lower firmness change, maintained higher chlorophyll content, exhibiting better quality of asparagus compared to control and chitosan coated sample. The chitosan-alginate (2:1 v/v) coated asparagus achieved highest sensory score in day 7 and 14 of storage and lowest total aerobic growth in 14 days of storage at 4 ºC. The coating biofilm of chitosan-alginate could be considered as the new multi-component edible coating which showed high effectiveness in quality preservation and shelf-life extension of asparagus.

ObjectivesTo compare the accuracy of the SOFA and APACHE II scores in predicting mortality among ICU patients with sepsis in an LMIC.DesignA multicentre, cross-sectional study.SettingA total of 15 adult ICUs throughout Vietnam.ParticipantsWe included all patients aged ≥ 18 years who were admitted to ICUs for sepsis and who were still in ICUs from 00:00 hour to 23:59 hour of the specified study days (i.e., 9thJanuary, 3rdApril, 3rdJuly, and 9thOctober of the year 2019).Primary and secondary outcome measuresThe primary outcome was hospital all-cause mortality (hospital mortality). We also defined the secondary outcome as all-cause deaths in the ICU (ICU mortality).ResultsOf 252 patients, 40.1% died in hospitals, and 33.3% died in ICUs. SOFA (AUROC: 0.688 [95% CI: 0.618-0.758]; cut-off value ≥ 7.5; PAUROCAUROCAUROCAUROCConclusionsIn this study, SOFA and APACHE II scores were worthwhile in predicting mortality among ICU patients with sepsis. However, due to better discrimination for predicting ICU mortality, the SOFA was preferable to the APACHE II score in predicting mortality.Clinical trials registry – India: CTRI/2019/01/016898Strengths and limitations of this studyAn advantage of the present study was data from multi centres, which had little missing data.Due to the absence of a national registry of intensive care units (ICUs) to allow systematic recruitment of units, we used a snowball method to identify suitable units, which might have led to the selection of centres with a greater interest in sepsis management.Due to the study’s real-world nature, we did not make a protocol for microbiological investigations. Moreover, we mainly evaluated resources utilized in ICUs; therefore, the data detailing the point-of-care testing and life-sustaining treatments were not available. Additionally, to improve the feasibility of conducting the study in busy ICUs, we opted not to collect data on antibiotic resistance and appropriateness.Due to our independent variables (e.g., SOFA score that was greater than or equal to the cut-off value) that might be associated with primary outcome only measured upon ICU admission, the mixed-effects logistic regression model could not be used to predict discrete outcome variables measured at two different times, i.e., inside and outside the ICU settings.Although the sample size was large enough, the confidence interval was slightly wide (±6.03%), which might influence the normal distribution of the sample.

Background and Objectives:Transitioning to a nursing home (NH) is a major life event for 1.4 million NH residents in the United States. Most post-acute NH admissions plan for rehabilitation and discharge home, but with nearly 70% of NH residents being palliative care (PC) eligible, many evolve into long-term placements secondary to poor health and associated decline in function and/or cognition. This article describes the perceptions of NH PC-eligible residents and families transitioning to life in a NH.Methods:Residents at 3 NHs in Northern California (N = 228) were screened for PC eligibility. A convenience sample of PC-eligible residents and their family members (n = 28) participated in qualitative interviews that explored the experience of living as a NH resident with serious illness. Data were analyzed using grounded theory methodology.Results:Our study provides insights into the experiences of transitioning to a NH from the perspectives of PC-eligible residents and their families. These data describe how PC-eligible residents and their families experienced disempowerment as they perceived being left out of decisions to go to a NH, loss of autonomy once at the NH, dealt with the realization that they would not be going home, and described perceived barriers to going home.Discussion and Implications:The inclusive and person-centered model of care that PC provides naturally empowers residents and family members. Adequate provision of PC services, together with changes in policy related to NH culture and benefit management, could improve the experience of transitioning to a nursing home.

Background: Cognitive impairment, including dementia, is frequently under-detected in primary care. The Consortium for Detecting Cognitive Impairment, including Dementia (DetectCID) convenes three multidisciplinary teams that are testing novel paradigms to improve the frequency and quality of patient evaluations for detecting cognitive impairment in primary care and appropriate follow-up. Objective: Our objective was to characterize the three paradigms, including similarities and differences, and to identify common key lessons from implementation. Methods: A qualitative evaluation study with dementia specialists who were implementing the detection paradigms. Data was analyzed using content analysis. Results: We identified core components of each paradigm. Key lessons emphasized the importance of engaging primary care teams, enabling primary care providers to diagnose cognitive disorders and provide ongoing care support, integrating with the electronic health record, and ensuring that paradigms address the needs of diverse populations. Conclusion: Approaches are needed that address the arc of care from identifying a concern to post-diagnostic management, are efficient and adaptable to primary care workflows, and address a diverse aging population. Our work highlights approaches to partnering with primary care that could be useful across specialties and paves the way for developing future paradigms that improve differential diagnosis of symptomatic cognitive impairment, identifying not only its presence but also its specific syndrome or etiology.

Background The simple scoring systems for predicting the outcome of sepsis in intensive care units (ICUs) are few, especially for limited-resource settings. Therefore, this study aimed to evaluate the accuracy of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score in predicting the mortality of ICU patients with sepsis in Vietnam. Methods We did a multicenter cross-sectional study of patients with sepsis (≥18 years old) presenting to 15 adult ICUs throughout Vietnam on the specified days (i.e., 9th January, 3rd April, 3rd July, and 9th October) representing the different seasons of 2019. The primary and secondary outcomes were the hospital and ICU all-cause mortalities, respectively. The area under the receiver operating characteristic curve (AUROC) was calculated to determine the discriminatory ability of the qSOFA score for deaths in the hospital and ICU. The cut-off value of the qSOFA scores was determined by the receiver operating characteristic curve analysis. Upon ICU admission, factors associated with the hospital and ICU mortalities were assessed in univariable and multivariable logistic models. Results Of 252 patients, 40.1% died in the hospital, and 33.3% died in the ICU. The qSOFA score had a poor discriminatory ability for both the hospital (AUROC: 0.610 [95% CI: 0.538 to 0.681]; cut-off value: ≥2.5; sensitivity: 34.7%; specificity: 84.1%; PAUROC = 0.003) and ICU (AUROC: 0.619 [95% CI: 0.544 to 0.694]; cutoff value: ≥2.5; sensitivity: 36.9%; specificity: 83.3%; PAUROC = 0.002) mortalities. However, multivariable logistic regression analyses show that the qSOFA score of 3 was independently associated with the increased risk of deaths in both the hospital (adjusted odds ratio, AOR: 3.358; 95% confidence interval, CI: 1.756 to 6.422) and the ICU (AOR: 3.060; 95% CI: 1.651 to 5.671). Conclusion In our study, despite having a poor discriminatory value, the qSOFA score seems worthwhile in predicting mortality in ICU patients with sepsis in limited-resource settings. Clinical trial registration Clinical trials registry–India: CTRI/2019/01/016898

In this descriptive, qualitative study, we conducted eight focus groups with diverse informal and formal caregivers to explore their experiences/challenges with nursing home (NH) to emergency department (ED) transfers and whether telehealth might be able to mitigate some of those concerns. Interviews were transcribed and analyzed using a grounded theory approach. Transfers were commonly viewed as being influenced by a perceived lack of trust in NH care/capabilities and driven by four main factors: questioning the quality of NH nurses’ assessments, perceptions that physicians were absent from the NH, misunderstandings of the capabilities of NHs and EDs, and perceptions that responses to medical needs were inadequate. Participants believed technology could provide “the power of the visual” permitting virtual assessment for the off-site physician, validation of nursing assessment, “real time” assurance to residents and families, better goals of care discussions with multiple parties in different locations, and family ability to say goodbye.

Background Nearly 70% of nursing home residents are eligible for palliative care, yet few receive formal palliative care outside of hospice. Little is known about nursing home staff attitudes, knowledge, skills, and behaviors related to palliative care. Methods We administered a modified survey measuring attitudes toward death to 146 nursing home staff members, including both clinical and nonclinical staff, from 14 nursing homes. Results Nursing home staff generally reported feeling comfortable caring for the dying, but half believed the end of life is a time of great suffering. Pain control (63%), loneliness (52%), and depression (48%) were the most important issues identified with regard to these patients, and there was ambivalence about the use of strong pain medications and the utility of feeding tubes at the end of life. Top priorities identified for improving palliative care included greater family involvement (43%), education and training in pain control (50%) and in management of other symptoms (37%), and use of a palliative care team (35%) at their facility. Conclusions Findings show there is a need for more palliative care training and education, which should be built on current staff knowledge, skills, and attitudes toward palliative care.

This study aimed to investigate the effect of a surfactant on the liquid-liquid phase separation, dissolution, diffusion, and the oral bioavailability of a weakly basic drug (l-tetrahydropalmatine; l-THP) from an amorphous solid dispersion (ASD). The carrier used in the ASD was optimized by the application of casting film, solvent shift, and pH shift methods. The interaction between the optimized carrier (HPMCP) and l-THP was then evaluated by Fourier transform-infrared spectroscopy and powder X-ray diffraction. The impact of the surfactant on ASD prepared by the spray-drying method was evaluated by both in vitro and in vivo studies. The results of in vitro studies, including liquid-liquid phase separation, drug diffusion, and pH-shift dissolution, indicated that the addition of a surfactant at a certain concentration below critical micelle concentration to ASD caused the precipitation of and a reduction in the membrane diffusion of l-THP in pH 6.8. This observation was confirmed in an in vivo study in which the drug concentration of l-THP in rabbit plasma was determined by the LC-MS/MS analysis method. Then the absolute and relative bioavailability of l-THP was calculated from the obtained pharmacokinetic parameters. Specifically, the addition of 1.5% surfactant (Poloxamer 188) to the binary ASD decreased the relative bioavailability of l-THP by approximately 2.4 times compared with the original binary ASD. Besides, the study proved that l-THP had low absolute bioavailability (around 1.24%), and the application of binary ASD was meaningful in enhancing the oral bioavailability of l-THP by around 334.77% compared to the raw material. The study is expected to provide a better understanding of how different dosage forms influence the bioavailability of l-THP, thereby allowing the selection of the optimal approach for this weakly basic drug.

This study examines the effect of land fragmentation on school dropout of children in Vietnam. To address the endogeneity issue, the study proposes an instrumental variable – that is land per capita at the commune level. The study also uses another instrumental variable – the percentage of land plot acquisition before 1993 – to check the robustness of the results. The findings are that higher land fragmentation decreases child school dropout. Land fragmentation has significant impacts on school dropout of children aged 10–15, however, it does not have any impact on school dropout of children aged 6–10. We explain these findings through one particular mechanism – that is women empowerment. A higher level of land fragmentation increases women empowerment in deciding to visit family, friends or relatives, the purchase of daily goods, large purchases, their own health, and their children’s health. A variety of robustness checks corroborate these findings.

Vietnam’s Mekong Delta is formed up with alluvial sediments and accretion over the centuries. The mixed interaction of the river — the sea have formed fertile alluvial soil, with very diverse ecosystems. During more than 300 years of exploitation, we have never had to deal with the fierce impacts of weather, climate change, along with changes from upstream leading to erosion in both estuarines and coastal areas. In recent years, there have been many tropical depressions in the area, storms create strong waves phenomena, storm surges, and changes in the upstream areas, leading to the risk of erosion tends to increase. A numerical modelling and simulation experiment is carried out to assess the impact of anthropogenic such as discharge, sediment load and natural factors such as wave, tide, sea level rise due to climate change or storms to bank erosion on estuaries and coastlines. Erosion and deposition modelling was carried out in the study area under different scenarios, pay attention to storm surges, flowrate in the estuary. The modelling results are controlled and compared with reality, allowing the evaluation of the reliability of the modelling and serving to improve the design quality of the estuarine and coastal areas protection construction.

Use of telehealth to provide NH palliative care(PC) has been extremely limited, only focusing on end-of-life care. No studies have examined how it can be used to proactively deliver PC expertise/support to NH residents, families, and staff. We conducted 6 feasibility tests of telehealth PC in 3 NHs with 19 residents, families, providers and staff (53% female, 47% white, 79% age 50+). None had prior experience with telehealth. 100% were comfortable with the video visit and could see themselves using it in the near future (74% for own care; 90% for family care). 84% strongly believed technology could improve communication between patients/families/providers; 74% strongly believed technology could improve care coordination between NHs and hospitals. 37% rated audio quality fair, 63% good/very good. 47% rated visual quality fair, 47% good/very good. NH telehealth PC is technically feasible and acceptable, providing an innovative opportunity to improve access to needed NH PC services/supports.

This work examines the effect of online Expectation Maximization (EM) methods for learning language distributions of unlabeled text data in a streaming environment and its impact on language identification (ID). We show that unsupervised estimation of the language distribution over the test environment improves ID error by up to 40% relative to a mismatched prior scenario. EM-based strategies also improve distribution estimates over a simple maximum likelihood baseline by up to 75% on our largest test set. By introducing online approaches we can achieve maximal ID performance after only a single pass over the data, and achieve our best distribution estimate when compared to the batch approach while processing no more than 25% of the data.

Nearly 70% of nursing home (NH) residents are palliative care eligible, yet few receive formal palliative care (PC) outside of hospice. Little is known about NH staff PC knowledge, attitudes, skills, behaviors relating to death and dying. We administered the Attitudes Towards Death survey to 105 NH staff (49 CNAs, 33 nurses, 23 non-clinical staff) from 14 NHs. NH staff generally feel comfortable caring for the dying, however half believe EOL is a time of great suffering. Pain control (67%), loneliness(54%), and depression(50%) were the most important issues identified in caring for these patients, with ambivalence about possible dangers of strong pain medication and utility of feeding tubes at EOL. Top priorities identified for improving PC/EOL care included: greater family involvement (50%); education/training on pain control (48%) and management of other symptoms (33%); and use of a PC team (34%). Findings provide guidance on how best to target PC education/support.

This study identifies which nursing home residents are eligible for palliative care services, describes their characteristics, and delineates resident and family perceptions regarding symptoms and quality of life.

Background. Nursing home (NH) residents often experience burdensome and unnecessary care transitions, especially towards the end of life. This paper explores provider perspectives on the role that families play in the decision to transfer NH residents to the emergency department (ED).Methods. Multiple stakeholder focus groups (n=35participants) were conducted with NH nurses, NH physicians, nurse practitioners, physician assistants, NH administrators, ED nurses, ED physicians, and a hospitalist. Stakeholders described experiences and challenges with NH resident transfers to the ED. Focus group interviews were recorded and transcribed verbatim. Transcripts and field notes were analyzed using a Grounded Theory approach.Findings. Providers perceive that families often play a significant role in ED transfer decisions as they frequently react to a resident change of condition as a crisis. This sense of crisis is driven by 4 main influences: insecurities with NH care; families being unprepared for end of life; absent/inadequate advance care planning; and lack of communication and agreement within families regarding goals of care.Conclusions. Suboptimal communication and lack of access to appropriate and timely palliative care support and expertise in the NH setting may contribute to frequent ED transfers.

Double aortic aneurysm (DAA) falls under the category of multiple aortic aneurysms. Repair is generally done through staged surgery due to low invasiveness. In this approach, one aneurysm is cured per operation. Therefore, two operations are required for DAA. However, post-first-surgery rupture cases have been reported. Although the problems involved with managing staged surgery have been discussed for more than 30 years, investigation from a hemodynamic perspective has not been attempted. Hence, this is the first computational fluid dynamics approach to the DAA problem. Three idealized geometries were prepared: presurgery, thoracic aortic aneurysm (TAA) cured, and abdominal aortic aneurysm (AAA) cured. By applying identical boundary conditions for flow rate and pressure, the Navier-Stokes equation and continuity equations were solved under the Newtonian fluid assumption. Average pressure in TAA was increased by AAA repair. On the other hand, average pressure in AAA was decreased after TAA repair. Average wall shear stress was decreased at the peak in post-first-surgery models. However, the wave profile of TAA average wall shear stress was changed in the late systole phase after AAA repair. Since the average wall shear stress in the post-first-surgery models decreased and pressure at TAA after AAA repair increased, the TAA might be treated first to prevent rupture.