Notes

Commercial Winter Insulating material Properties above Sintering Conditions.
Current guidelines for the treatment of asthma and chronic obstructive pulmonary disease overlap (ACO) recommend initial treatment using inhaled corticosteroids (ICSs) plus 1 or more bronchodilators.

To clarify which therapeutic effect is better between the ICS+ long-acting β
agonist (LABA) and ICS+ LABA+ long-acting muscarinic antagonist (LAMA) treatment in patients with ACO.

We conducted a multicenter, 48-week, randomized, noninferiority trial. Patients with ACO were enrolled if they were treated with a moderate to high dose of ICS+ LABA. In total, 303 patients were involved in the present trial, with 149 receiving ICS+ LABA+ LAMA. The primary end point was the time to first exacerbation. Secondary outcomes included changes in FEV
, forced vital capacity, FEV
/forced vital capacity ratio, asthma control, blood eosinophil count, and fractional exhaled nitric oxide.

In the ICS+ LABA treatment group, 29 of 154 patients (18.83%) experienced exacerbation, whereas 28 of 149 patients (18.79%) experienced exacerbation in the ICS+ LABA+ LAMA treatment group. The results of this noninferiority study were ultimately inconclusive (hazard ratio, 1.1; 95% CI, 0.66-1.84). However, the patients treated with the addition of LAMA showed significant improvements in FEV
and forced vital capacity (P < .001). Asthma control did not improve in either group.

Although this study was unable to conclude that ICS+ LABA treatment is not inferior to ICS+ LABA+ LAMA in terms of exacerbation, it is obvious that the ICS+ LABA+ LAMA treatment group had improved lung function in ACO.
Although this study was unable to conclude that ICS + LABA treatment is not inferior to ICS + LABA + LAMA in terms of exacerbation, it is obvious that the ICS + LABA + LAMA treatment group had improved lung function in ACO.
Young children with visual impairments (VIs) are at high risk for mental disorders, due to victimization and subsequent social withdrawal. Children with VIs have been shown to have a poorer self-concept and lower general psychosocial well-being compared with peers without VIs.

The objective of this study was to examine the effectiveness of a serious game to improve psychosocial outcomes in children with VIs.

A randomized controlled trial was conducted to evaluate the effectiveness of the computer game See for children with VIs. The game was developed based on rational-emotive behavioral therapy principles, with the aim of addressing self-concept (academic, social, and general), psychosocial well-being (social inclusion, exclusion, and emotions), and coping strategies (approach, avoidance). Sixty-four children aged 6-8 years were randomized to the intervention group, who played the game, or a control group, who received care-as-usual (CAU).

Our results showed that children with VIs who played the serious game scored significantly higher on academic self-concept and social inclusion compared with the control group. Furthermore, children rated the game positively, suggesting the desirability, validity, and feasibility of the intervention.

The results provide preliminary evidence that a serious game can enhance psychosocial outcomes in children with VIs. This approach might also promote positive educational outcomes, such as academic achievement, and reduce the stigma of therapy for children with VIs. Implications and future directions are discussed.
The results provide preliminary evidence that a serious game can enhance psychosocial outcomes in children with VIs. This approach might also promote positive educational outcomes, such as academic achievement, and reduce the stigma of therapy for children with VIs. Implications and future directions are discussed.
People with developmental disabilities (DD) are a population at high-risk for poor outcomes related to COVID-19. COVID-19-specific risks, including greater comorbidities and congregate living situations in persons with DD compound existing health disparities. With their expertise in care of persons with DD and understanding of basic principles of infection control, DD nurses are well-prepared to advocate for the needs of people with DD during the COVID-19 pandemic.

To assess the challenges faced by nurses caring for persons with DD during the COVID-19 pandemic and how the challenges impact people with DD.

We surveyed 556 DD nurses, from April 6-20, 2020. The 35-item mixed-method survey asked nurses to rate the degree of challenges faced in meeting the care needs of people with DD. We analyzed responses based on presence of COVID-19 in the care setting and geographically. One open-ended question elicited challenges not included in the survey, which we analyzed using manifest content analysis.

Startlingly, nurses reported being excluded from COVID-19 planning, and an absence of public health guidelines specific to persons with DD, despite their high-risk status. Obtaining PPE and sanitizers and meeting social-behavioral care needs were the most highly ranked challenges. COVID-19 impacted nurses' ability to maintain adequate staffing and perform essential aspects of care. No significant geographic differences were noted.

DD nurses must be involved in public health planning and policy development to ensure that basic care needs of persons with DD are met, and the disproportionate burden of COVID-19 in this vulnerable population is reduced.
DD nurses must be involved in public health planning and policy development to ensure that basic care needs of persons with DD are met, and the disproportionate burden of COVID-19 in this vulnerable population is reduced.In this study, we prepared naringenin (NGN) loaded nanostructured lipid carrier (NGN-NLC) and investigated its characterizations, transepithelial transport, intestinal absorption and inhibitory effects on nonalcoholic fatty liver disease (NAFLD) induced by a methionine choline deficient (MCD) diet in mice. The NGN-NLC, prepared by a method of emulsion-evaporation plus low temperature-solidification, displayed high drug loading capacity of 22.5 ± 1.7%. find more Compared to the NGN crude drug, the NGN-NLC, at an equal NGN dose, improved NGN release rate by 3.5-fold and elevated NGN transepithelial transport and intestinal absorption through enhancing intracellular transport of clathrin pathway and escaping p-gp efflux; at an 8-fold lower NGN dose, showed comparable pharmacokinetic parameters, but elevated liver NGN distribution by 1.5-fold, reduced MCD diet-induced hepatic lipid deposition by 3-fold. These results suggest that the NLC formulation significantly increased the inhibitory effects of NGN on NAFLD because of the improved drug release rate, transepithelial transport and intestinal absorption, and the elevated oral bioavailability and liver NGN distribution.Ultra-small 1-2 nm gold nanoparticles (NP) were conjugated with a poorly-soluble peptide auto-antigen, associated with type 1 diabetes, to modify the peptide pharmacokinetics, following its intradermal delivery. Peptide distribution was characterized, in vivo, after delivery using either conventional intradermal injection or a hollow microneedle device. The poorly-soluble peptide was effectively presented in distant lymph nodes (LN), spleen and draining LN when conjugated to the nanoparticles, whereas peptide alone was only presented in the draining LN. By contrast, nanoparticle conjugation to a highly-soluble peptide did not enhance in vivo distribution. Transfer of both free peptide and peptide-NPs from the skin to LN was reduced in mice lacking lymphoid homing receptor CCR7, suggesting that both are actively transported by migrating dendritic cells to LN. Collectively, these data demonstrate that intradermally administered ultra-small gold nanoparticles can widen the distribution of poorly-soluble auto-antigenic peptides to multiple lymphoid organs, thus enhancing their use as potential therapeutics.
Anastomotic fistula is the most fearsome complication following colorectal surgery. Numerous studies have demonstrated the interest of postoperative CRP assay as an early diagnostic marker. Must the critical threshold for biological inflammatory markers remain the same, whether resection be colic or rectal?

This is a study based on a cohort constituted between 2011 and 2014, including 497 patients with planned colorectal resection. C-reactive protein and pro-calcitonin were measured daily from day before surgery to D4. All postoperative intra-abdominal complications were considered as an anastomotic fistula. Detection thresholds were calculated from the area under the ROC curve.

An intra-abdominal septic complication occurred in 16.9% of the patients having undergone rectal resection vs. 9.9% of those having had colectomy (P=0.03). In the absence of complications there was no significant difference between the two groups in terms of postoperative inflammatory response as determined by either CRP or PCT assay. Following rectal resection, optimal area under the curve (AUC=0.87) corresponds to CRP on D4 for a threshold of 100mg/Lsensitivity 83.3%, NPV 95.3%. For colons with the same CRP at 100mg/L (AUC=0.71) sensitivity 63.6%, NPV 93.9%.

Notwithstanding riskier surgery, the detection threshold for an anastomotic fistula following rectal surgery remains the same CRP>100mg/L at D4.
100mg/L at D4.
Based on the Competency Assessment Tool, herein we developed an assessment instrument suitable to evaluate the implantation of central intravenous devices.

Surgical assessment is based mainly on the subjective impressions of the teacher. Based on the "Competency Assessment Tool" (CAT) developed for the evaluation of technical surgical skills in minimally invasive colorectal resection, we designed an assessment tool suitable to evaluate the implantation of central venous access devices performed by junior surgical trainees.

Four major assessments during the different steps of the intervention were used in this evaluation. Each of these tasks was divided into four sub-domains according to surgical skill. In addition to the CAT score, the apprentices' skills were evaluated using a visual assessment that was quantified using an analogue scale (value from 1 to 10). The candidates were classified into junior and senior trainees depending on the number of procedures they had already performed and on their surgical experience.

71 procedures were evaluated during the study period. Seven senior trainees conducted 43 procedures and five junior trainees performed 28 interventions. The senior trainees had significantly higher CAT scores than junior candidates, and the scores fluctuated according to surgical experience, usually reaching their peak after 10 procedures.

The CAT model is well suited for the assessment of surgical trainees during central venous access device implantation. It enables a close assessment of the learning process and the technical skills of trainees, which helps them improving in a safe, standardized manner.
The CAT model is well suited for the assessment of surgical trainees during central venous access device implantation. It enables a close assessment of the learning process and the technical skills of trainees, which helps them improving in a safe, standardized manner.Introduction The COVID 19 pandemic has affected education at all levels. Surgical fellows have faced unique challenges.
The authors address aspects of Canadian surgical fellowships that have been impacted by the pandemic. These include case volumes, training objectives, funding models, burden of stress and research productivity.

Solutions are proposed including varying the mix of cases to meet objectives, pursuing alternative finance structures and leveraging technology for both research and advancing surgical technique.

These solutions are offered to help mitigate the effects of future pandemics for both current and future surgical fellows.
These solutions are offered to help mitigate the effects of future pandemics for both current and future surgical fellows.
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