Liver Transplant From Controlled Cardiac Death Donors Using Normothermic Regional Perfusion: Comparison With Liver Transplants From Brain Dead Donors

Background

Liver transplantation from donors after either controlled or uncontrolled cardiac death (DCD) is associated with considerable rates of primary nonfunction (PNF) and ischemic cholangiopathy (IC). Normothermic regional perfusion (NRP) could significantly reduce such rates.

Proximal External Aortic Compression for Life-Threatening Abdominal-Pelvic and Junctional Hemorrhage: An Ultrasonographic Study in Adult Volunteers

Introduction: Following life-threatening junctional trauma, the goal is to limit blood loss while expediting transfer to operative rescue. Unfortunately, life-threatening abdominal-pelvic or junctional hemorrhage is often not amenable to direct compression and few temporizing strategies are available beyond hemostatic dressings, hypotensive resuscitation, and balanced transfusion. Objectives: In this study, we evaluated proximal external aortic compression to arrest blood flow in healthy adult men. Methods: This was a simulation trial of proximal external aortic compression, for life-threatening abdominal-pelvic and junctional hemorrhage, in a convenience sample of healthy adult male volunteers. The primary end points were cessation of femoral blood flow as assessed by pulse wave Doppler ultrasound at the right femoral artery, caudal to the inguinal ligament. Secondary end points were discomfort and negative sequelae. Results: Aortic blood flow was arrested in 12 volunteers. Median time to blood flow cessation was 12.5?seconds. Median reported discomfort was 5 out of 10. No complications or negative sequelae were reported. Conclusion: This trial suggests that it may be reasonable to attempt temporization of major abdominal-pelvic and junctional hemorrhage using bimanual proximal external aortic compression. In the absence of immediate alternatives for this dangerous and vexing injury pattern, there appear to be few downsides to prehospital proximal external aortic compression while concomitantly expediting definite care.     

Enabling the return-to-work process among people with affective disorders: A multiple-case study

Background: The Individual Enabling and Support (IES) model is an adapted, supported employment program developed to meet motivational, cognitive and time-use needs of people with affective disorders. Vocational programs for this target group have been developed but more knowledge is needed about the important characteristics and perceived usefulness of the programs. The aim of this study was to illustrate the IES model and process from multiple perspectives.

Methods: Five participants were included in this multiple-case study. The material comprised interviews with participants, intervention documents, memos and interviews with employment specialists. Within and cross-case analyzes and an analytical generalization were performed.

Results: The cases illustrated different IES processes, and the theme; Enabling engagement in return to work (RTW) was formulated. Continuous support from the employment specialist and a focus on personal resources and motivation were essential to overcome low self-confidence regarding RTW. Motivational, cognitive and time-use strategies gave an opportunity to learn new behavior and coping strategies for job seeking, getting employed and working.

Conclusion: Providing a combination of these strategies integrated with supported employment could promote self-efficacy and engagement in the RTW process among people on sick leave due to an affective disorder.     

Knowledge,attitude and practice of physical activity promotion among physiotherapists in India during COVID 19

IntroductionCoronavirus disease (COVID-19) pandemic and the nationwide lockdown has increased sedentary time and physical inactivity. Physiotherapists are one of the essential health professionals who are actively involved in promoting physical activities. The study objectives included assessing knowledge of physical activity guidelines, physiotherapist attitude towards involvement in physical activities and practice of routine physical activity assessment, and its promotion among physiotherapists in India during COVID-19.MethodIn this cross-sectional survey study, the study tool was prepared using Google Forms. It consisted of sixteen questions on knowledge, attitude, and practice of physical activities among physiotherapists. Study participants were physiotherapists with a minimum of a bachelor's degree qualification and practicing in India.ResultsOne hundred and eighty responses were received from sixteen states of India. The average age of respondents was 28 years, and the average work experience of five years. This study found that only 19% of physiotherapists could give the correct answer in all three domains of WHO PA guidelines. 70% of physiotherapists found with an appropriate attitude as they met the 150 min of moderate PA per week. 68% reported that they promote physical activities in routine practice.ConclusionThis study suggested the majority of physiotherapists perform physical activity assessment and promotion in routine practice in India. Most of them have an appropriate attitude towards physical activity, but very few physiotherapists have adequate knowledge of WHO physical activity guidelines. Physiotherapists should actively promote physical activities in routine practice to reduce the impairment due to physical inactivity especially during the Corona virus disease pandemic in India. Efforts should be made to increase the physical activity awareness in terms of knowledge of WHO physical activity guidelines, different assessment, and promotion strategies.     

Midterm Outcomes of the Dissected Aorta Repair Through Stent Implantation Trial

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Enablers and inhibitors: A review of the situation regarding mHealth adoption in low- and middle-income countries

Objective

The objective of this review is to identify enabling and inhibiting factors for mHealth adoption in low resource settings, by giving emphasis on the stakeholders representing the caregiving side. Another objective of this study is to support implementation agencies (governmental and non-governmental) in designing scalable mHealth interventions.

Prediction of Human Brain Penetration of P-glycoprotein and Breast Cancer Resistance Protein Substrates Using In Vitro Transporter Studies and Animal Models

Four P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) substrates with human cerebrospinal fluid (CSF) concentrations and preclinical neuropharmacokinetics were used to assess in vitro–in vivo extrapolation of brain penetration in preclinical species and the ability to predict human brain penetration. Unbound brain (C_b,u), unbound plasma (C_p,u), and CSF compound concentrations (C_CSF) were measured in rats and nonhuman primates (NHPs), and the unbound partition coefficients (C_b,u/C_p,u and C_CSF/C_p,u) were used to assess brain penetration. The results indicated that for P-gp and BCRP dual substrates, brain penetration was severally impaired in all species. In comparison, for P-gp substrates that are weak or non-BCRP substrates, improved brain penetration was observed in NHPs and humans than in rats. Overall, NHP appears to be more predictive of human brain penetration for P-gp substrates with weak or no interaction with BCRP than rat. Although C_CSF does not quantitatively correspond to C_b,u for efflux transporter substrates, it is mostly within 3-fold higher of C_b,u in rat and NHP, suggesting that C_CSF can be used as a surrogate for C_b,u. Taken together, a holistic approach including both in vitro transporter and in vivo neuropharmacokinetics data enables a better estimation of human brain penetration of P-gp/BCRP substrates.