Participant retention in follow-up studies of intensive care unit survivors - A scoping review.

OBJECTIVE: To synthesize participant retention data and related reporting in studies evaluating post-hospital outcomes of survivors of critical illness after an intensive care unit (ICU) stay. REVIEW METHOD USED: A synthesis of literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. DATA SOURCES: PubMed, EMBASE, PsycINFO, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Controlled Trials Registry. Hand searched reference lists and personal files of relevant narrative and systematic review articles. REVIEW METHODS: Articles were screened by pairs of independent reviewers. Similarly, data were abstracted by pairs of data collectors, with conflicts resolved by consensus or by a third reviewer. RESULTS: We included 243 publications, from 225 unique studies of 87,602 participants. Participant retention could not be calculated for any time-points in 13% of studies nor in 22% of all follow-up time-points. Retention ranged from 18-100%. When compared to follow-up before 1-month, retention at each later timepoint was not significantly different. Age and sex were not associated with retention and more recent studies had decreased retention (odds ratio: 0.94 [95% confidence interval: 0.92-0.96; p < 0.001]). Reporting of retention-related study methodology was inconsistent. CONCLUSION: Retention rate could not be calculated for 22% of study follow-up time-points, with retention at the remaining time-points generally being high (≥85%), but with high variability (18% - 100%). ICU survivorship research could be improved via: (i) more detailed guidance on reporting participant retention, and (ii) use of existing resources and best practices to facilitate better study design and to improve participant retention to preserve statistical power and reduce selection bias.

Citrus sinensis Peel Oil Extraction and Evaluation as an Antibacterial and Antifungal Agent.

Throughout the tropical and subtropical climates, the genus Citrus can be found. The current study was conducted to extract the Citrus sinensis peel oil and evaluate its antibacterial, antifungal and antiparasitic potential. Petroleum ether was used to extract the C. sinensis peel oil through a Soxhlet apparatus. The antimicrobial and antifungal potential was determined via agar well diffusion method and minimum inhibitory concentrations (MIC) were calculated (test bacterial strains: Staphylococcus aureus, Escherichia coli and Streptococcus agalactiae; test fungal strains: Aspergillus flavus, Aspergillus niger, Altrnaria alternata). Antiparasitic activity against Leishmaniatropica was determined following standard protocol using amphotericin-B as positive and Dimethyl Sulfoxide (DMSO) as a negative control and the percentage inhibition was calculated. The oil extracted was brownish yellow with a tangy smell, water-insoluble, density (0.778 g/cm3) and specific gravity (0.843 g/cm). In antibacterial activity, the diameter of the zone of inhibition was maximum against E. coli (14 mm) and minimum for S. agalactiae (10 mm). While in antifungal activity diameter of the zone of inhibition was maximum against A. flavus (12.5 mm) and minimum for A. alternata (8.6 mm). S. agalactiae exhibited the minimum MIC value (6 mg/mL) and in fungal strains A. alternata exhibited the minimum value (2 mm). Citrus sinensis peel oil displayed antileishmanial efficiency of 60% at 50 µg/mL concentration after 48 h of incubation. C. sinensis peel oil demonstrated antimicrobial capabilities, implying that it could be used as a natural preservative in food or as an effective treatment against a variety of pathogenic organisms. Industries should extract oil from the waste of citrus fruits which will be beneficial from an economic point of view.

Post-intensive care syndrome (PICS): recent updates.

An increasing number of patients are surviving critical illness, but some experience new or worsening long-lasting impairments in physical, cognitive and/or mental health, commonly known as post-intensive care syndrome (PICS). The need to better understand and improve PICS has resulted in a growing body of literature exploring its various facets. This narrative review will focus on recent studies evaluating various aspects of PICS, including co-occurrence of specific impairments, subtypes/phenotypes, risk factors/mechanisms, and interventions. In addition, we highlight new aspects of PICS, including long-term fatigue, pain, and unemployment.

Impact of a multifaceted early mobility intervention for critically ill children - the PICU Up! trial: study protocol for a multicenter stepped-wedge cluster randomized controlled trial.

BACKGROUND: Over 50% of all critically ill children develop preventable intensive care unit-acquired morbidity. Early and progressive mobility is associated with improved outcomes in critically ill adults including shortened duration of mechanical ventilation and improved muscle strength. However, the clinical effectiveness of early and progressive mobility in the pediatric intensive care unit has never been rigorously studied. The objective of the study is to evaluate if the PICU Up! intervention, delivered in real-world conditions, decreases mechanical ventilation duration (primary outcome) and improves delirium and functional status compared to usual care in critically ill children. Additionally, the study aims to identify factors associated with reliable PICU Up! delivery. METHODS: The PICU Up! trial is a stepped-wedge, cluster-randomized trial of a pragmatic, interprofessional, and multifaceted early mobility intervention (PICU Up!) conducted in 10 pediatric intensive care units (PICUs). The trial's primary outcome is days alive free of mechanical ventilation (through day 21). Secondary outcomes include days alive and delirium- and coma-free (ADCF), days alive and coma-free (ACF), days alive, as well as functional status at the earlier of PICU discharge or day 21. Over a 2-year period, data will be collected on 1,440 PICU patients. The study includes an embedded process evaluation to identify factors associated with reliable PICU Up! delivery. DISCUSSION: This study will examine whether a multifaceted strategy to optimize early mobility affects the duration of mechanical ventilation, delirium incidence, and functional outcomes in critically ill children. This study will provide new and important evidence on ways to optimize short and long-term outcomes for pediatric patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT04989790. Registered on August 4, 2021.

Dyslipidemia and impaired liver function biomarkers in patients with hepatitis B liver cirrhosis.

Objective: This study was conducted to determine changes in lipid metabolism and liver enzyme status among HBV-positive patients with liver cirrhosis. Methods: A total of 300 HBV-positive patients with liver cirrhosis and 200 healthy controls were included in this case-control study. The patients were recruited from several tertiary care hospitals in Lahore from March to October 2021. Their blood samples were collected and analyzed for HBsAg, HBeAg, liver function biomarkers, and serum lipids. Liver cirrhosis was confirmed by ultrasonography and liver biopsy. The data were analyzed with chi-square test, Student's t-test, logistic regression, and ROC curve analysis. Results: Serum liver function biomarkers were significantly higher, and serum lipid levels were substantially lower, in HBV-infected patients with liver cirrhosis than in controls. No significant associations of sex and age with dyslipidemia were observed in patients with cirrhosis. Grading and staging scores for liver cirrhosis were negatively associated with total cholesterol levels. Moreover, sex and high levels of liver enzymes were significant risk factors associated with dyslipidemia in HBV-positive patients with liver cirrhosis. The optimum cut-off values of liver enzymes and serum lipids for the prognosis of liver cirrhosis exceeded normal ranges. Conclusion: Serum lipid concentrations may serve as a clinical index to assess liver damage in HBV-positive patients.

Effects of thoracic spinal thrust manipulation for the management of shoulder impingement syndrome: Systematic review.

OBJECTIVE: To determine the effectiveness of thoracic spinal thrust manipulation for shoulder impingement syndrome in the improvement of pain, range of motion and functional outcomes. METHODS: The systematic review was conducted by 2 researchers independently using search strategy developed for different databases, including Cochrane Central register of control trials, PubMed, Pedro and MEDLINE, for relevant articles published between 2008 and 2020. The search strategy was designed for each database by combining the key terms and Boolean operators related to the review's objective. RESULTS: Of the 312 studies identified, 14(4.5%) were included. Of them, 4(28.6%) were in favour of thoracic thrust manipulation, 8(57.2%) did not support thoracic thrust manipulation as the sole treatment and 2(14.3%) favoured thoracic thrust manipulation along with exercises. CONCLUSIONS: Studies indicated immediate improvement in range of motion as well as pain after thrust manipulation, but others reported no such clinical difference. Manipulation should be combined with other exercise therapy to ensure some clinical improvement.

Microfluidic Fabrication and Applications of Microgels and Hybrid Microgels.

Smart microgels have gained much attention because of their wide range of applications in the field of biomedical, environmental, nanotechnological and catalysis sciences. Most of the applications of microgels are strongly affected by their morphology, size and size distribution. Various methodologies have been adopted to obtain polymer microgel particles. Droplet microfluidic techniques have been widely reported for the fabrication of highly monodisperse microgel particles to be used for various applications. Monodisperse microgel particles of required size and morphology can be achieved via droplet microfluidic techniques by simple polymerization of monomers in the presence of suitable crosslinker or by gelation of high molecular weight polymers. This report gives recent research progress in fabrication, characterization, properties and applications of microgel particles synthesized by microfluidic methods.

Efficacy of marigold (Tagetes erecta L.) for the treatment of tannery and surgical industry wastewater under citric acid amendment: a lab scale study.

Contamination of land and aquatic ecosystems with heavy metals (HMs) is a global issue having the persistent potential to damage the quality of food and water. In the present study, Tagetes erecta L. plants were used to assess their potential to uptake HMs from wastewater. Plants were grown in soil for 20 days and then transplanted in hydroponic system containing Hoagland nutrient solution. After more than 15 days of growth, plants were then subjected to wastewater from tannery and surgical industries in different concentrations ranging from 25 to 100% in combination of citric acid (5 and 10 mM). After 6 weeks of treatment, plants were collected and segmented into roots, stem, and leaves for characterizing the morphological properties including plant height, roots length, fresh and dry mass of roots, stem, and leaves. For evaluation of the effect of wastewater on the plants, photosynthetic pigments; soluble proteins; reactive oxygen species (ROS); antioxidant enzymes SOD, POD, CAT, and APX; and metal accumulation were analyzed. Application of industrial wastewater revealed a significant effect on plant morphology under wastewater treatments. Overall growth and physiological attributes of plant decreased, and metal accumulation enhanced with increasing concentration of wastewater. Similarly, the production of ROS and antioxidant enzymes were also increased. Chlorophyll, protein content, and enzyme production enhanced with CA (5 and 10 mM) mediation; however, ROS production and EL were reduced. Metals analysis showed that the maximum accumulation of Pb was in roots, while Cr and Ni in the stem which further increased under CA mediation. Overall, the metal accumulation ability was in the order of Pb > Ni > Cr under CA.

Effects of task oriented rehabilitation of upper extremity after stroke: A systematic review.

OBJECTIVE: To explore the current scientific evidence on the effects of task-oriented rehabilitation programme of upper extremity post-stroke. METHODS: The systematic review comprised studies from 2012 to August 2020 which were both Hand-searched and explored on Cochrane, PubMed, PEDro and MEDLINE databases with authentic search techniques using population-intervention-control-outcomes format and Boolean operator. Randomised controlled trials on the use of task-oriented training for the improvement of upper extremity functional outcomes in subjects with stroke were shortlisted and reviewed. The risk bias tool was used to evaluate the biasness in the studies and the PEDro scale was used to evaluate the methodological quality of the studies. RESULTS: Of the 28 articles assessed, 16(%) were included for detailed review. All studies varied significantly with PEDro scores between 6 and 10. There were 12(75%) high-quality studies and 4(25%) fell in fair category. All the studies showed significant results in the improvement of upper extremity after stroke through task-oriented training rehabilitation (p<0.05). CONCLUSIONS: Evidence supports the beneficial effects of task-oriented rehabilitation for the improvement of upper extremity functions post-stroke.

Role of virtual reality and active video games in motor and executive functions in cerebral palsy: A systematic review.

OBJECTIVE: To explore current evidence on the role of virtual reality and active video games in motor and executive functions compared to conventional physical therapies in cerebral palsy patients. METHODS: The systematic review was conducted at the University Institute of Physical Therapy, Lahore, Pakistan, and comprised search on MEDLINE via PubMed, Pedro and Cochrane Central related to randomised and clinical controlled trials published from 2005 to 2020. For critical appraisal of the studies, the Pedro tool was used, while methodological quality assessment was done using the Cochrane risk of bias tool. RESULTS: Of the 15 articles reviewed, 14(93.3%) reported significant effect of virtual reality and active video games on motor functions. Critical appraisal found the quality of the studies from fair to high. Low risk was found in 4(26.7%) articles in terms of selection, 3(20%) allocation, 6(40%) detection, and 8(53.3%) had attrition bias. Unclear risk was reported in the performance and reporting bias domain in all the 15(100%) articles. CONCLUSIONS: Virtual reality games cannot be used as a substitute for therapy, but along with the conventional physical therapy, they are very effective and produce significant changes in motor functions in cerebral palsy patients. As for executive functions, more research needs to be done to determine the impact of these games at a higher level of brain.

Expression Of Bap1 In Clear Cell Renal Cell Carcinoma.

BACKGROUND: BAP1 (BRCA1 associated protein 1 on chromosome 3) is a commonly mutated gene in clear cell renal cell carcinoma. Aim of the study was to evaluate the prognostic significance of BAP1 by immunohistochemistry in clear cell renal cell carcinoma. Methods: It was a descriptive case series in which data was retrospectively collected. Immunohistochemistry was used to evaluate the loss of nuclear expression of BAP1. RESULTS: Loss of BAP1 was observed in 60% of cases of clear cell renal cell carcinoma. 27% of grade 1 tumours, 62% of grade 2 tumours, 65% of grade 3 tumours and 66% of grade 4 tumours showed loss of BAP1. Loss of BAP1 was observed in 54% cases of stage 1 tumours, 72% of stage 2 tumours and 66% of stage 3 tumours. Our study showed loss of BAP1 in 67% of cases with tumour necrosis, in 75% of cases with sarcomatoid features and in 60% of patients with distant metastasis. Conclusion: We conclude that the loss of BAP1 nuclear expression is associated with poor prognostic features. i.e., higher grade, higher stage, tumour necrosis, sarcomatoid features and distant metastasis leading to death of patients.

Effects of High-Energy Extracorporeal Shockwave Therapy on Pain, Functional Disability, Quality of Life, and Ultrasonographic Changes in Patients with Calcified Rotator Cuff Tendinopathy.

Objective: The current trial was designed to evaluate the effects of high-energy shockwave therapy on objective and subjective outcomes among participants with calcified rotator cuff tendinopathy. Methods: This parallel-group, randomized trial consists of 42 patients affected by calcific tendinopathies divided into two groups of 21 participants. Patients having calcified tendinopathy aged between 30 and 65 years with type A or B calcification were selected in the trial after signing the written consent form. Participants in the ESWT+RPT group received eight sessions of shockwaves, while the RPT group was treated by routine physical therapy. About 2000 shockwaves of 0.32 mJ/mm2, 120 Hz per treatment, were given as 12 sessions for the first six weeks (2 sessions/week). Pain intensity and shoulder functional ability, ultrasonographic changes, and quality of life were assessed with the numeric pain rating scale (NPRS), Constant-Murley score (CMS), ultrasonography, and Western Ontario rotator cuff index (WORC). Results: There were significant differences regarding NPRS and CMS between the two groups, at baseline and 6th and 12th weeks after intervention (p < 0.05). Within-group differences also showed statistically significant results after treatment (all p < 0.05). Significant results were seen in the WORC and ultrasonographic results pre- and posttreatment; more significant findings were found in the experimental group as compared to others. Conclusion: High-energy shockwave therapy has been proved to be effective and thus strongly recommended for the management of calcified rotator cuff tendinopathy, improving the pain, functionality, and quality of life of these participants and decreasing the size of calcified deposits. Shockwave therapy is proved to be superior to routine physiotherapy.

Industry 4.0 technology and circular economy practices: business management strategies for environmental sustainability.

Circular economy and Industry 4.0 are two of the most hotly debated topics in recent decades. They gradually attracted the attention of academics, practitioners, and policymakers from around the globe. The current research looks at the impact of Industry 4.0 on circular economy practices and blockchain technology in order to boost firm performance. The closed questionnaire was used to collect cross-sectional data of 330 respondents, and the partial least squares structural equation modeling (PLS-SEM) modeling framework was used to demonstrate the findings of the study. The results show that blockchain technology improves circular economy practices significantly in terms of green manufacturing (GM), recycling and remanufacturing (RR), and green design (GD) in India. In addition, Industry 4.0 has the potential to improve business operations as well as financial performance and environmental performance significantly. As a result, the current research work offers recommendations for businesses to achieve long-term goals by incorporating Industry 4.0 into manufacturing systems.

Assessing the role of financing in sustainable business environment.

Speedy economy-wide transition to less carbon-intensive energy generations sources needs extra sizable financing on ground-breaking, nevertheless, risky and less carbon-intensive generation sources. Maximizing the maximum non-government financing needs using the appropriate policy tools, however, fiscal strategies and directives have been thoroughly studied, systematic quantifiable indications about the impacts of government explicit financing is inadequate. We equally give an initial measurable calculation of the impact of government explicit financing on non-government financing into conventional electricity generation sources for 22 OECD nations in the year 2001-2018. Applying FGLS and non-dynamic and non-static GMM regressors, we discover that government financing unilaterally has an explicit and nevertheless reliably the most impacts on non-government financing movements compared to feed-in tariffs (FiTs), taxes, and renewable purchase obligations (RPS) in all and regarding wind and solar sources differently. Ramifications for policy geared towards fast-tracking the energy transition are deliberated. We highlighted those important dedications to scale-up wind and solar energy demands organized by financiers such as asset funding. Furthermore, to arrive at the energy crossover to a carbon-free power system, government and non-government financiers have to continue financing and expand their activities in financing studies, demonstration, and initial scale-up. We reveal that the delivery of government finance is directly correlated with non-government funding movements. Furthermore, we postulate that government policy incentives for non-government financing, nevertheless, have impacts of unconventional energy sources share on non-government financing more than those of FiTs. Ultimately, the supply of conventional fuels is a significant impediment to solar energy financing, while the existence of other sources of cleaner energies promotes non-government climate finance.

The dynamics of public spending on sustainable green economy: role of technological innovation and industrial structure effects.

In order to achieve the goal of sustainable green economic development, it is necessary to conduct a comprehensive assessment of the efficiency of the green economy and compare it with emission reductions. The green economy idea is a much-discussed solution to economic growth. Therefore, this study investigated the impact of government spending on the performance of the green economy of various countries under the "Belt and Road" (BRI) initiative project. The data were analyzed using the BRI economy panel data from 2008 to 2018. The generalized method of moments (GMM) was used to estimate the effect of government expenditures on education and research and development (R&D) on green economic performance index (GEE) in BRI countries. The results reveal that during the study period, BRI countries have experienced an upward transition towards green development, except for Pakistan and Bangladesh; their GEE decreased gradually from 2010 to 2018. Further, the findings of the system GMM revealed that both education and R&D have a positive impact on the green economy. Moreover, the compositional and technological effects of the overall sample were verified with the GMM process. Nevertheless, the sub-sample results revealed a heterogeneous impact on countries with a high per capita GDP. Following the results, useful policy measures for promoting sustainable green economic development have been proposed.

A leafy surprise: Case report of male breast malignant phyllodes.

INTRODUCTION AND IMPORTANCE: Phyllodes tumor is a biphasic fibroepithelial tumor which accounts for less than 1% of all breast neoplasms. We aim to raise awareness among clinicians that a male breast lump may be indicative of underlying sinister pathology and therefore, should be investigated thoroughly. CASE PRESENTATION: A 62 year old male presented in clinic with right beast lump for the last 6 weeks. A preoperative diagnosis of spindle cell tumor was made on core needle biopsy. Neoadjuvant chemotherapy was administered in order to downsize the tumor as it was inseparable from underlying muscle. A post-operative diagnosis of malignant phyllodes was made following mastectomy. As the tumor was 1 mm from the deep margin, adjuvant radiotherapy was administered. CLINICAL DISCUSSION: Differential diagnoses of malignant phyllodes include metaplastic carcinomas metastatic/primary sarcomas and fibroadenomas. Metaplastic carcinomas are morphologically heterogeneous and include adenosquamous carcinoma, squamous cell carcinoma and spindle cell carcinoma. In some malignant phyllodes, extensive stromal proliferation can make detection of epithelial component very difficult. This highlights the limitation of core biopsy in establishing an accurate preoperative diagnosis. The standard treatment for phyllodes treatment is surgical resection with margins of 1 cm or more. Adjuvant radiotherapy is used in cases with threatened margins. CONCLUSION: Malignant phyllodes tumor of breast can exist in men, and its accurate pre-operative diagnosis is difficult given the limitations of core biopsy. This case report draws attention to the challenges associated with the diagnosis of this rare condition and highlights the role of different treatment modalities in its management.