Notes

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Eighty-nine participants were studied (mean age 67 ± 15 years, 38% female, 51% diabetic, median urine output 200 ml/24 h). Serum iFGF23 was reduced at Week 12 compared to baseline (-26.8% [95%CI -39.7, -11.1], p = 0.001), which was sustained at Week 24 (-21.7% [95%CI -35.7, -4.5], p = 0.012). KU-0063794 solubility dmso There was no significant change in serum IS, PCS, fetuin-A, CPP-1, or CPP-2.

The use of a MCO dialyzer over 24 weeks was associated with a sustained reduction in FGF23, while other measured components of the uremic milieu were not significantly altered. Further studies are required to determine whether FGF23 reduction is associated with improved patient outcomes.
The use of a MCO dialyzer over 24 weeks was associated with a sustained reduction in FGF23, while other measured components of the uremic milieu were not significantly altered. Further studies are required to determine whether FGF23 reduction is associated with improved patient outcomes.
Lower gastrointestinal haemorrhage (LGIH) is a challenging phenomenon in a comorbid, elderly population. CT mesenteric angiography (CTMA) allows localisation of the site of haemorrhage, and provides a target for interventional techniques, but the intermittent nature of LGIH makes it challenging to reliably demonstrate extravasation. This study aimed to identify objective factors that may predict scan outcomes.

In this retrospective cohort study, all patients undergoing CTMA for LGIH at Monash Health from January 2011 to December 2019 (n=854) were included. Baseline patient characteristics included age, bowel resection/endoscopic intervention within the past 14days, known bowel malignancy, anticoagulant/antiplatelet use, duration of symptoms, vital signs, transfusion requirements in the past 24h and investigation results (recent haemoglobin levels, platelet count, international normalised ratio and creatinine levels). Univariate analysis was performed, and significant factors were entered into a multivariate model.

The final multivariate model was statistically significant (P<0.001) and consisted of bowel resection/endoscopic intervention within the past 14days (OR=2.15), use of antiplatelet agents (OR=2.03), blood transfusion requirement greater than 3 units per 24h (OR=1.79), systolic blood pressure less than 100mmHg (OR=1.56) and heart rate greater than 100 beats per minute (OR=1.52).

The factors identified above are objective, independently associated with positive scan outcomes, readily available to radiologists and are useful for more judicious patient selection.
The factors identified above are objective, independently associated with positive scan outcomes, readily available to radiologists and are useful for more judicious patient selection.Bartonellae are emerging vector-borne pathogens infecting humans, domestic mammals and wildlife. Ninety-seven red foxes (Vulpes vulpes), 8 European badgers (Meles meles), 6 Eurasian wolves (Canis lupus), 6 European hedgehogs (Erinaceus europaeus), 3 beech martens (Martes foina) and 2 roe deer (Capreolus capreolus) from Italian Nature Conservatory Parks were investigated for Bartonella infection. Several Bartonella species (9.84%; 95% CI 4.55-15.12), including zoonotic ones, were molecularly detected among wolves (83.3%; 95% CI 51-100.00), foxes (4.12%; 95% CI 0.17-8.08), hedgehogs (33.33%; 95% CI 0.00-71.05) and a roe deer. Bartonella rochalimae was the most common Bartonella species (i.e. in 4 foxes and 2 wolves) detected. Candidatus B. merieuxii and B. vinsonii subsp. berkhoffii were identified for the first time in wolves. Furthermore, Bartonella schoenbuchensis was identified in a roe deer and a new clone with phylogenetic proximity to B. clarridgeiae was detected in European hedgehogs. Zoonotic and other Bartonella species were significantly more frequent in Eurasian wolves (p less then .0001), than in other free-ranging wild mammals, representing a potential reservoir for infection in humans and domestic animals.
To evaluate the risk of adverse fetal outcomes after exposure to angiotensin converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) in first trimester of pregnancy, by conducting a systematic review and meta-analysis.

A systematic literature search was conducted using Medline, Embase, Cochrane and PubMed from inception to 25 November 2019. Studies were included if they evaluated pregnancies exposed to ACE-Is or ARBs, reported fetal outcomes, and compared these outcomes with a control group. Pooled odds ratios (ORs) were estimated using inverse variance-weighted random effects model. The protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42020160566).

Studies reporting on 6234 pregnancies exposed to ACE-Is or ARBs, 4104 pregnancies exposed to other oral antihypertensives, and 1,872,733 pregnancies without exposure were included in the meta-analysis. ACE-I or ARB exposed pregnancies, compared to non-exposed controls, had higher riswas independent of underlying maternal hypertension, as those exposed to other antihypertensives did not exhibit a higher risk than healthy controls. Women planning for pregnancy using these medications, including those with diabetic nephropathy, should be counselled appropriately.
Translating research into practice is complex for clinicians, yet essential for high quality patient care. The field of implementation science evolved to address this gap by developing theoretical approaches to guide adoption and sustained implementation of practice changes. Clinicians commonly lack knowledge, time, and resources of how evidence-based practice (EBP) models can guide implementation, contributing to the knowledge-to-practice gap.

This paper aimed to equip clinicians and other healthcare professionals with implementation science knowledge, confidence, and models to facilitate EBP change in their local setting and ultimately improve healthcare quality, safety, and population health outcomes.

The field of implementation science is introduced, followed by application of three select models. Models are applied to a clinical scenario to emphasize contextual factors, process, implementation strategies, and outcome evaluation. Key attributes, strengths, opportunities, and utilities of each model are presented, along with general resources for selecting and using published criteria to best fit clinical needs. Partnerships between implementation scientists and clinicians are highlighted to facilitate the uptake of evidence into practice.

Knowledge of implementation science can help clinicians adopt high-quality evidence into their practices. Application-oriented approaches can guide clinicians through the EBP processes. Clinicians can partner with researchers in advancing implementation science to continue to accelerate the adoption of evidence and reduce the knowledge-to-action gap.
Knowledge of implementation science can help clinicians adopt high-quality evidence into their practices. Application-oriented approaches can guide clinicians through the EBP processes. Clinicians can partner with researchers in advancing implementation science to continue to accelerate the adoption of evidence and reduce the knowledge-to-action gap.
Radixact Synchrony corrects for target motion during treatment by adjusting the jaw and MLC positions in real time. As the jaws move off axis, Synchrony attempts to adjust for a loss in output due to the un-flattened 6MV beam by increasing the jaw aperture width. The purpose of this work was to assess the impact of the variable-width aperture on delivered dose using measurements and simulations.

Longitudinal beam profile measurements were acquired using an Edge diode with static gantry. Jaw-offset peak, width, and integral factors were calculated for profiles with the jaws in the extreme positions using both variable-width (Synchrony) and fixed-width apertures. Treatment plans with target motion and compensation were compared to planned doses to study the impact of the variable aperture on volumetric dose.

The jaw offset peak factor (JOPF) for the Synchrony jaw settings were 0.964 and 0.983 for the 1.0- and 2.5-cm jaw settings, respectively. These values decreased to 0.925 and 0.982 for the fixed-width ws spend a significant amount of time in the extreme positions. This work investigated the change in delivered dose with jaws in the extreme positions, therefore overall changes in dose due to offset jaws are expected to be less for composite treatment deliveries.Responsive infant feeding is a critical component of childhood obesity prevention. However, there is little guidance for caregivers on how to do this successfully. The first step to developing an intervention to promote responsive feeding is to systematically identify its barriers and enablers. Searches were conducted in CINAHL, Cochrane Library, Medline, Embase, PubMed, PsycINFO, Maternity, and Infant Care from inception to November 2020. All study designs were included if they reported a barrier or enabler to responsive feeding during the first 2 years of life. We used a "best fit" framework synthesis, with the Capacity, Opportunity, Motivation, and Behaviour (COM-B) model. The Mixed Method Appraisal Tool (MMAT) was used to assess study quality. Forty-three studies were included in the review. Barriers (n = 36) and enablers (n = 21) were identified across five COM-B domains psychological capacity, physical and social opportunity, and reflective and automatic motivation. Enablers were recognition of infant feeding cues, feeding knowledge and family and friends. Caregiver attitude toward control of feeding was a barrier, together with health care professional advice about formula feeding and breastfeeding expectation. These barriers and enablers provide a comprehensive evidence base to guide intervention development to improve responsive feeding and prevent obesity across individual and population levels.Inpatient units are a significant element of mental healthcare for children and adolescents with the most severe and challenging clinical presentations. Inpatient input has been associated with substantive and sustained health gains across a range of diagnoses and cannot be fully replaced by intensive community treatment options. The potential benefits and risks associated with an admission should be carefully weighed in all referred individuals and may differ depending on several parameters including the type of unit and aims of admission. Although every effort should be made for admissions to be as efficient and short as possible, access to inpatient care and its extent should continue to be determined by clinical need.
To describe the patterns of personal emergency response systems (PERS) use in a statewide cohort of older Australians.

PERS data from clients enrolled in the Personal Alarm Victoria program between January 2014 and June 2017 were analysed. Alarm activation reasons were extracted, and a medical record audit was performed for a sub-cohort of patients admitted to a local hospital following an alarm event. Descriptive statistics were used.

There were 42,180 clients enrolled during the study (mean age 80years, 80% female, 93% living alone). An ambulance attended 44% of the fall-related events and 81% of events coded as unwell. Activation reasons were distributed equally between a fall and feeling unwell, and a repeating pattern of activation reasons was observed. In our sub-cohort (n=92), the majority of admissions (86%) followed an alarm activation coded as unwell.

We demonstrated recurring patterns associated with the reasons for alarm use.
We demonstrated recurring patterns associated with the reasons for alarm use.
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