RESUMEN
Knowledge of element concentrations in botanical extracts is relevant to assure consumer protection given the increased interest in plant-based ingredients. This study demonstrates successful multi-element investigations in order to address the lack of comprehensive profiling data for botanical extracts, while reporting for the first time the metallomic profile(s) of arnica, bush vetch, sweet cicely, yellow rattle, bogbean, rock-tea and tufted catchfly. Key element compositions were quantified using a validated HR-ICP-SFMS method (µg kg-1) and were found highly variable between the different plants: Lithium (18-3964); Beryllium (3-121); Molybdenum (75-4505); Cadmium (5-325); Tin (6-165); Barium (747-4646); Platinum (2-33); Mercury (5-30); Thallium (3-91); Lead (12-4248); Bismuth (2-30); Titanium (131-5827); Vanadium (15-1758); Chromium (100-4534); Cobalt (21-652); Nickel (230-6060) and Copper (1910-6340). Compendial permissible limits were not exceeded. Overall, no evidence of a health risk to consumers could be determined from consumption of the investigated plants at reasonable intake rates. Mathematical risk modelling (EDI, CDI, HQ, HI) estimated levels above safe oral thresholds only for Cd (16%) and Pb (8%) from higher intakes of the respective plant-derived material. Following high consumption of certain plants, 42% of the samples were categorised as potentially unsafe due to cumulative exposure to Cu, Cd, Hg and Pb. PCA suggested a potential influence of post-harvest processing on Cr, Ti and V levels in commercially-acquired plant material compared to wild-collected and farm-grown plants. Moreover, a strong correlation was observed between Pb-Bi, Be-V, Bi-Sn, and Tl-Mo occurrence. This study may support future research by providing both robust methodology and accompanying reference profile(s) suitable for the quality evaluation of essential elements and/or metal contaminants in botanical ingredients.
Asunto(s)
Cadmio , Plomo , Mercurio , Bario , Berilio/análisis , Bismuto , Cadmio/análisis , Cromo/análisis , Cobalto , Cobre , Litio , Mercurio/análisis , Molibdeno , Níquel/análisis , Platino (Metal) , Medición de Riesgo , Té , Talio , Estaño , Titanio , Vanadio/análisisRESUMEN
A method has been developed, optimised and validated to analyse protein powder supplements on an inductively coupled plasma-sector field mass spectrometer (ICP-SFMS), with reference to ICH Guideline Q2 Validation of Analytical Procedures: Text and Methodology. This method was used in the assessment of twenty-one (n = 21) elements (Al, Au, Ba, Be, Bi, Cd, Co, Cr, Cu, Fe, Hg, Li, Mg, Mn, Mo, Pb, Pt, Sn, Ti, Tl, V) to evaluate the safety of thirty-six (n = 36) protein powder samples that were commercially available in the Irish marketplace in 2016/2017. Using the determined concentrations of elements in samples (µg·kg-1), a human health risk assessment was carried out to evaluate the potential carcinogenic and other risks to consumers of these products. While the concentrations of potentially toxic elements were found to be at acceptable levels, the results suggest that excessive and prolonged use of some of these products may place consumers at a slightly elevated risk for developing cancer or other negative health impacts throughout their lifetimes. Thus, the excessive use of these products is to be cautioned, and consumers are encouraged to follow manufacturer serving recommendations.
Asunto(s)
Espectrometría de Masas/métodos , Polvos/química , Proteínas/química , Análisis Espectral/métodos , Humanos , Irlanda , Metales , Medición de Riesgo , Oligoelementos/químicaRESUMEN
AIM AND OBJECTIVES: To examine the needs and perspectives regarding healthcare transition for adolescents and young adults (AYAs) with the following long-term conditions: diabetes, cystic fibrosis and congenital heart disease. BACKGROUND: Transition of AYAs within healthcare services has become increasingly important as more children are surviving into adulthood with long-term conditions. Yet, limited empirical evidence exists regarding transition experiences. DESIGN: Qualitative study fulfilling the completed consolidated criteria for reporting qualitative studies criteria (see Appendix S1). METHODS: Semi-structured interviews with AYAs aged 14-25 years (n = 47), parents (n = 37) and health professionals (n = 32), which was part of a larger mixed-methods study. Sample was recruited from two children's hospitals and four general hospitals in Ireland. RESULTS: Transfer occurred between the ages of 16-early 20s years depending on the service. None of the hospitals had a transition policy, and transition practices varied considerably. Adolescents worried about facing the unknown, communicating and trusting new staff and self-management. The transition process was smooth for some young adults, while others experienced a very abrupt transfer. Parents desired greater involvement in the transition process with some perceiving a lack of recognition of the importance of their role. In paediatric services, nurses reported following-up adolescents who struggled with treatment adherence and clinic attendance, whereas after transfer, little effort was made to engage young adults if there were lapses in care, as this was generally considered the young adults' prerogative. CONCLUSIONS: The amount of preparation and the degree to which the shift in responsibility had occurred prior to transition appeared to influence successful transition for AYAs and their parents. RELEVANCE TO CLINICAL PRACTICE: Nurses in collaboration with the multidisciplinary team can help AYAs develop their self-management skills and guide parents on how to relinquish responsibility gradually prior to transition.
Asunto(s)
Enfermedad Crónica/psicología , Personal de Salud/psicología , Padres/psicología , Transición a la Atención de Adultos/organización & administración , Adolescente , Adulto , Niño , Enfermedad Crónica/terapia , Fibrosis Quística/psicología , Fibrosis Quística/terapia , Diabetes Mellitus Tipo 1/psicología , Diabetes Mellitus Tipo 1/terapia , Femenino , Cardiopatías Congénitas/psicología , Cardiopatías Congénitas/terapia , Humanos , Irlanda , Masculino , Relaciones Profesional-Paciente , Investigación Cualitativa , Adulto JovenRESUMEN
As survival increases worldwide, large numbers of young people will need to transition from child to adult cystic fibrosis (CF) services. Little is known about the best method for transitioning patients with CF and which transition programmes yield better outcomes. This paper provides a systematic review of the empirical literature on the outcomes and experiences of transition for young people with CF. Outcomes data were subject to a narrative synthesis and a thematic synthesis of experiences data. Structured transition programmes were associated with increased satisfaction, discussions about transition, self-care and self-advocacy skills, more independence, lower anxiety, and increased self-management and parent management of physiotherapy and nutritional supplementation. Young people's concerns included leaving behind previous caregivers, differences in care provision and infection risks. Lack of preparation was a consistent theme. The two most useful aspects of transition programmes were meeting the adult doctors/CF specialist nurse/team and visiting the adult centre. Young people want education about the differences between services, implications of their condition and self-care management. Structured transition programmes appear to impact positively on experiences but the contribution of the different components of transition programmes is unclear. The absence of high-quality studies indicates the need for more well-designed research.
Asunto(s)
Fibrosis Quística/terapia , Autocuidado , Transición a la Atención de Adultos , Adolescente , Manejo de la Enfermedad , Accesibilidad a los Servicios de Salud , Humanos , Padres , Investigación Cualitativa , Adulto JovenRESUMEN
Tetrodotoxin (TTX), often referred to as the 'puffer fish' poison, is a marine toxin and it has been identified as the agent responsible for many food poisoning incidents around the world. It is a neurotoxin that blocks voltage-gated sodium channels, resulting in respiratory paralysis and even death in severe cases. It is known to occur in many different species of fish and other organisms. The toxin is mainly found in the Southeast Asia region. Worryingly, TTX is starting to appear in European waters. It is suspected that this is a consequence of Lessepsian migration, also known as the Erythrean invasion. Therefore, straightforward and reliable extraction and analytical methods are now urgently required to monitor seafood of European origin for TTX. This paper provides a versatile, dependable and robust method for the analysis of TTX in puffer fish and trumpet shellfish using LC-MS/MS. A three-stage approach was implemented involving: (1) the screening of samples using fast multiple reaction monitoring (MRM) mass spectral analysis to identify quickly positive samples on a triple quadrupole mass spectrometer (QqQMS/MS), the API 3000; (2) a Fourier-transform (FT)-MS full-scan analysis of positive samples to collect qualitative data; and (3) a method with a longer chromatography run to identify and quantitate the positive samples using the QqQMS. The quantitative LC-QqQMS method delivered excellent linearity for solvent-based standards (0.01-7.5 µg ml-1; R2 ≥ 0.9968) as well as for matrix-matched standards (0.05-37.50 µg g-1; R2 ≥ 0.9869). Good inter-day repeatability was achieved for all the relevant analytes with %RSD values (n = 9) ranging from 1.11% to 4.97% over a concentration range of 0.01-7.5 µg ml-1. A sample clean-up procedure for the puffer fish and trumpet shellfish was developed to ensure acceptable and reproducible recoveries to enable accurate and precise determination of TTX in a myriad of tissues types. Blank mackerel matrix was used for the TTX standard spiking studies in order to calculate the recoveries of the toxin during the extraction procedure. The recovery was 61.17% ± 5.42% for the extraction protocol. MS/MS studies were performed on a linear-trap quadruple-Orbitrap mass spectrometer (LTQ-Orbitrap) to obtain high-mass-accuracy data of the target analytes and their characteristic fragment ions in the puffer fish and trumpet shellfish samples. This facilitated identification of TTX and its associated analogues. These high-mass-accuracy studies facilitated the development of a rapid MRM-based quantitative method for TTX determination on the LC-QqQMS.
Asunto(s)
Tetrodotoxina/análisis , Animales , Cromatografía Liquida , Peces , Espectrometría de MasasRESUMEN
This review synthesizes the empirical literature on outcomes and experiences of transfer and transition from pediatric to adult care for young people with congenital heart disease. A systematic review of papers published between January 2001 and May 2013 that examined outcomes or experiences of transfer and transition among young people with congenital heart disease was conducted. Data were extracted by two independent reviewers with the outcomes data combined using narrative synthesis and the experiences data integrated using thematic synthesis. Thirteen papers were included in the review: six reported outcomes following transfer, six reported experiences of transfer and transition, and one reported both outcomes and experiences. The review data indicate that high proportions of young people were lost to follow-up or experienced long gaps in care after leaving pediatric cardiology. Factors that protected against loss to follow-up or lapse in care included: beliefs that specialized adult care was necessary; poorer health status; attendance at pediatric appointments without parents; and pediatric referral to an adult congenital heart disease center. Data on experiences highlighted that many young people were unconcerned about transition, but lacked knowledge about their condition and were insufficiently prepared for transfer. In terms of adult services, many young people desired continuity in the quality of care, youth-oriented facilities, a personalized approach, and for their parents to remain involved in their care, but in a secondary, supportive capacity. In conclusion, the high proportions of young people lost to follow-up highlight the need for formal transition programs, which ensure a planned and coordinated transfer. Patients with congenital heart disease need education throughout adolescence about the implications of their condition, the differences between pediatric and adult services, and self-care management.
Asunto(s)
Servicios de Salud del Adolescente , Cardiología/métodos , Cardiopatías Congénitas/terapia , Pediatría/métodos , Evaluación de Procesos, Atención de Salud , Transición a la Atención de Adultos , Adolescente , Adulto , Factores de Edad , Niño , Conocimientos, Actitudes y Práctica en Salud , Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/fisiopatología , Humanos , Perdida de Seguimiento , Cooperación del Paciente , Educación del Paciente como Asunto , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Nursing is experiencing a significant deficit in research capacity needed to meet future global healthcare demands-there is a call to double the number of nurses and healthcare professionals with a doctorate. AIM: The aim of this research was to evaluate the implementation of a national PhD capacity-building program for academic and practice-based nurses and other healthcare professionals in South Africa. METHODS: An implementation science framework was used. Implementation of the program across two national, longitudinal cohorts of participants was studied. Evidence of enablers and barriers to implementation was obtained from multiple data sources, including the curriculum for the program, regular evaluation reports from program participants and program facilitators after each stage of the PhD curriculum delivery, and meeting notes. Supplementary sources included rates of PhD candidate recruitment, retention, and successful completion. RESULTS: Evidence for the presence of enablers for successful implementation was found, including stakeholder consultation and buy-in, leadership, resources, staff capacity, and implementation teams. No evidence of an implementation plan, a supportive organizational culture, or effective ongoing communication at Stage 4 of the implementation process was found. Barriers to implementation included external environmental factors, resistance to change, and vested interests. DISCUSSION: Within the context of a recognized worldwide shortage of nursing scientists, the application of an implementation science framework to evaluate the initial stages of a national PhD development program rollout provided information on how effective implementation can be strengthened and how barriers to success can be overcome.
Asunto(s)
Educación de Postgrado en Enfermería/organización & administración , Investigación en Educación de Enfermería , Adulto , Estudios de Cohortes , Curriculum , Humanos , Cultura Organizacional , Evaluación de Programas y Proyectos de Salud , Criterios de Admisión Escolar , SudáfricaRESUMEN
BACKGROUND: Due to the important role of depression in major illnesses, screening measures for depression are commonly used in medical research. The protocol for managing participants with positive screens is unclear and raises ethical concerns. The aim of this article is to identify and critically discuss the ethical issues that arise when a positive screen for depression is detected, and offer some guidance on managing these issues. DISCUSSION: Deciding on whether to report positive screens to healthcare practitioners is both an ethical and a pragmatic dilemma. Evidence suggests that reporting positive depression screens should only be considered in the context of collaborative care. Possible adverse effects, such as the impact of false-positive results, potentially inappropriate labelling, and potentially inappropriate treatment also need to be considered. If possible, the psychometric properties of the selected screening measure should be determined in the target population, and a threshold for depression that minimises the rate of false-positive results should be chosen. It should be clearly communicated to practitioners that screening scores are not diagnostic for depression, and they should be informed about the diagnostic accuracy of the measure. Research participants need to be made aware of the consequences of the detection of high scores on screening measures, and to be fully informed about the implications of the research protocol. SUMMARY: Further research is needed and the experiences of researchers, participants, and practitioners need to be collated before the value of reporting positive screens for depression can be ascertained. In developing research protocols, the ethical challenges highlighted should be considered. Participants must be agreeable to the agreed protocol and efforts should be made to minimise potentially adverse effects.