Notes

Analysis of the True One-Month Using Transportable Listening Devices attending school Students.
The scoping review found a variety of interventions to decrease the utilization of BZD/SHD in hospitals. Multifaceted interventions aimed at patients and healthcare providers that include a combination of education, sleep protocols, and deprescribing may support reductions in BZD/SHD use. Stakeholders also recommended policy and system changes such as computer alerts due to feasibility and workload.With the changing healthcare landscape, evaluating the care provision in ambulatory settings is vital to understand outpatient care. The national surveys such as the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) are valuable resources to pharmacy researchers because of their availability and generalizability. With the recent focus on real-world data, the national surveys are critical in providing practice and policy evidence by evaluating ambulatory care, especially prescribing practices. The use of these surveys requires an understanding of the survey content, scope, complex sampling scheme, and analytical and research considerations. There are several methodological and practical considerations that make these national surveys useful to both novice and seasoned researchers. Although some generalized approaches are available for analyzing the national surveys, there is limited focus on the NAMCS and the NHAMCS. This paper provides an in-depth understanding of the NAMCS/NHAMCS, including methodological considerations for evaluating prescribing practices in ambulatory settings.Vγ9Vδ2+ T cells form part of the innate immune repertoire and are activated by phosphorylated antigens produced by many bacteria and tumors. They have long been suggested as promising targets for anti-tumor therapies, but clinical trials so far have not shown major successes. Several recent discoveries could help to overcome these shortfalls, such as those leading to an improved understanding of the role of butyrophilin molecules BTN2A1 and BTN3A1, in Vγ9Vδ2+ T cell activation. Moreover, we propose that studies suggesting the presence of live bacteria in a variety of tumors (tumor microbiome), indicate that the latter might be harnessed as a source of high affinity bacterial phosphoantigen to trigger or enhance anti-tumor immune responses.
Continuity of carer models present positives and challenges for midwives working in them, and are difficult to sustain.

Research shows midwifery continuity of carer improves perinatal outcomes and experiences, and is considered the optimal model of care.

To synthesise existing research on midwives' experiences of providing continuity of carer and generate further understanding of what sustains them in practice.

Protocol for the review was developed using PRISMA guidelines and registered with PROSPERO. 22 studies were included with original themes and findings extracted using JBI tools and synthesised using meta-ethnographic techniques. GRADE CERQual assessment of review findings showed high confidence.

Midwives identified working in continuity of carer models as both fulfilling and challenging. Professional autonomy and ability to develop meaningful relationships were the most commonly cited positives, while lack of work life balance and conflict with the wider maternity team were the main challenges. 15 studies identified strategies employed by midwives which sustained them in practice.

Midwife experiences of providing continuity are impacted by personal and professional factors. Of paramount importance to sustainability of the model is the support of the wider organisation, and their alignment with principles of person-centred, relational care.

Relational models of care are desired by midwives, service users and are recommended in policy. Relational models of care must be responsive to midwives needs as well as birthing people, and therefore need to be designed and managed by those working in them and supported by the whole organisation to be sustainable.
Relational models of care are desired by midwives, service users and are recommended in policy. Relational models of care must be responsive to midwives needs as well as birthing people, and therefore need to be designed and managed by those working in them and supported by the whole organisation to be sustainable.
Clinical practice guidelines are designed to guide clinicians and consumers of maternity services in clinical decision making, but recommendations are often consensus based and differ greatly between leading organisations.

Breech birth is a divisive clinical issue, however vaginal breech births continue to occur despite a globally high caesarean section rate for breech presenting fetuses. Inconsistencies are known to exist between clinical practice guidelines relating to the management of breech presentation.

The aim of this review was to critically evaluate and compare leading obstetric clinical practice guidelines related to the management of breech presenting fetuses.

Leading obstetric guidelines were purposively obtained for review. Analysis was conducted using the International Centre for Allied Health Evidence (iCAHE) Guideline Quality Checklist and reviewing the content of each guideline.

Antenatal care recommendations and indications for Caesarean Section were relatively consistent between cpact birth mode decision-making in maternity consumers. To respect pregnant women's autonomy and fulfil the legal requirements of consent, clinicians should provide balanced counselling.A mixed culture of probiotics, one from the genus Bacillus and one lactic acid bacterium (LAB), was developed to be used as a feed additive for enhancing growth, innate immunity and disease resistance in Pangasius bocourti. From our earlier work, three probiotic Bacillus species, Bacillus siamensis B44v, Bacillus sp. B51f and Bacillus aerius B81e, and three probiotic LABs, Streptococcus lutetiensis L7c, Lactiplantibacillus paraplantarum (synonym. Lactobacillus paraplantarum) L34b-2 and Lactiplantibacillus plantarum (synonym. Lactobacillus plantarum) L42g, were selected for comparison. These bacteria, which express probiotic properties including bacteriocin-like activity against Aeromonas hydrophila, were subjected to in vivo screening in hybrid catfish (Clarias macrocephalus × Clarias gariepinus). A 30-day feed-trial followed by a challenge test in screening experiments resulted in the prominent B. aerius B81e and L. paraplantarum L34b-2 being selected. A mixture of these bacteria was added to a diet for P. bocourti. After 60-day feeding, the fish fed with mixed probiotics had weight gain, specific growth rate and feed conversion ratio improved significantly (p less then 0.01) when compared to the control. Both humoral and cellular immunity were significantly higher in probiotic-fed fish. Following the 60-day feeding experiment, P. bocourti fed with the diet containing mixed probiotics had a higher survival rate than the control fish after injection with a virulent A. hydrophila. It can be concluded that a combination of B. aerius strain B81e and L. paraplantarum strain L34b-2 markedly improved growth performance, innate immunity and disease resistance of P. bocourti.
To investigate local and systemic outcomes after enucleation, brachytherapy with ruthenium-106, iodine-125, notched and non-notched plaques and transpupillary thermotherapy (TTT) of choroidal melanomas touching the optic disc.

All patients treated for choroidal melanoma touching the optic disc at St. Erik Eye Hospital, Stockholm, Sweden between 1984 and 2015 (n = 165) were included. Retrospective clinicopathological data was collected and 3D dosimetry performed.

Ninety-five patients (58 %) had been treated with ruthenium-106 brachytherapy, 21 (13 %) with iodine-125 brachytherapy and 49 (30 %) with enucleation. Median follow-up was 12.3 years. In simulations, some tumor areas were underdosed with non-notched plaques. Fifty of 116 patients (43 %) underwent a secondary brachytherapy (n = 5), enucleation (n = 29) or TTT (n = 16). In multivariate Cox Regressions, there were no significant differences in the risk for tumor progression or lack of regression between radioisotopes and notched and non-notched plaality.
Prior studies have shown a broad half time (T1/2) interval on MAG3 diuresis renography (DR) that is indeterminate for obstruction. We aimed to refine and sub-divide the indeterminate range and associate it with clinically meaningful outcomes pyeloplasty and pyeloplasty-free survival.

We identified patients <1.5 years-old at presentation with unilateral, isolated moderate to severe hydronephrosis who underwent DR from 2000 to 2016. A logistic regression model was created using T1/2 to predict surgery. An indeterminate range was defined based on patients with <90% probability of pyeloplasty or resolution. This group was sub-divided into three T1/2 intervals 5-20, 21-40, and 41-60min. H2DCFDA Endpoints were pyeloplasty and pyeloplasty free survival. Indications for surgery were loss of differential renal function (DRF), worsening T1/2, family preference, and/or pain.

Among 2025 patients with DR, 704 met criteria (169 were lost to follow up). Of the remaining 535, 218 had pyeloplasties and 317 did not. The Pycan be managed nonoperatively. These patients likely represent the true intermediate risk group and closer follow up is justified.

Initial T1/2 on DR is predictive of future surgery. When drainage is "indeterminate" for obstruction, sub-stratification allows for more accurate prognostication.
Initial T1/2 on DR is predictive of future surgery. When drainage is "indeterminate" for obstruction, sub-stratification allows for more accurate prognostication.
Heart retransplantation (ReHT) is controversial in the current era. The aim of this study was to describe and analyze the results of ReHT in Spain.

We performed a retrospective cohort analysis from the Spanish Heart Transplant Registry from 1984 to 2018. Data were collected on donors, recipients, surgical procedure characteristics, immunosuppression, and survival. The main outcome was posttransplant all-cause mortality or need for ReHT. We studied differences in survival according to indication for ReHT, the time interval between transplants and era of ReHT.

A total of 7592 heart transplants (HT) and 173 (2.3%) ReHT were studied (median age, 52.0 and 55.0 years, respectively). Cardiac allograft vasculopathy was the most frequent indication for ReHT (42.2%) and 59 patients (80.8%) received ReHT >5 years after the initial transplant. Acute rejection and primary graft failure decreased as indications over the study period. Renal dysfunction, hypertension, need for mechanical ventilation or intra-aortic balloon pump and longer cold ischemia time were more frequent in ReHT. Median follow-up for ReHT was 5.8 years. ReHT had worse survival than HT (weighted HR, 1.43; 95%CI, 1.17-1.44; P<.001). The indication of acute rejection (HR, 2.49; 95%CI, 1.45-4.27; P<.001) was related to the worst outcome. ReHT beyond 5 years after initial HT portended similar results as primary HT (weighted HR, 1.14; 95%CI, 0.86-1.50; P<.001).

ReHT was associated with higher mortality than HT, especially when indicated for acute rejection. ReHT beyond 5 years had a similar prognosis to primary HT.
ReHT was associated with higher mortality than HT, especially when indicated for acute rejection. ReHT beyond 5 years had a similar prognosis to primary HT.
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