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BACKGROUND: Recent studies found white coats to be reservoirs for bacteria and medical students did not conform to proper hygiene measures when using these white coats. We investigated the knowledge, attitude, and practice (KAP) of medical students toward white coat use in clinical settings (LAUNDERKAP). METHODS: A validated, online-based survey was disseminated to 670 students from four Malaysian medical schools via random sampling. Scores were classified into good, moderate, or poor knowledge and practice, and positive, neutral, or negative attitude. Mann-Whitney U and Kruskal-Wallis tests were used to analyze the relationship between demographic variables and knowledge, attitude, and practice scores. RESULTS: A total of 492/670 students responded (response rate: 73.4%). A majority showed negative attitudes (n = 246, 50%), poor knowledge (n = 294, 59.8%), and moderate practice (n = 239, 48.6%). Senior and clinical year students had more negative attitudes. Male students had higher knowledge, while students from private medical schools and preclinical years had better practice. There was a significant relationship between attitude and practice (r = 0.224, P < .01), as well as knowledge and practice (r = 0.111, P < .05). CONCLUSIONS: The results demonstrate the need for more education to improve medical students' infection control practices. Our results can also guide decision-making among administrators on the role of white coats as part of medical student attire.
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Estudiantes de Medicina , Humanos , Masculino , Estudios Transversales , Conocimientos, Actitudes y Práctica en Salud , Higiene , Proyectos de Investigación , Encuestas y CuestionariosRESUMEN
Globally, thermodynamics explains an increase in atmospheric water vapor with warming of around 7%/°C near to the surface. In contrast, global precipitation and evaporation are constrained by the Earth's energy balance to increase at â¼2-3%/°C. However, this rate of increase is suppressed by rapid atmospheric adjustments in response to greenhouse gases and absorbing aerosols that directly alter the atmospheric energy budget. Rapid adjustments to forcings, cooling effects from scattering aerosol, and observational uncertainty can explain why observed global precipitation responses are currently difficult to detect but are expected to emerge and accelerate as warming increases and aerosol forcing diminishes. Precipitation increases with warming are expected to be smaller over land than ocean due to limitations on moisture convergence, exacerbated by feedbacks and affected by rapid adjustments. Thermodynamic increases in atmospheric moisture fluxes amplify wet and dry events, driving an intensification of precipitation extremes. The rate of intensification can deviate from a simple thermodynamic response due to in-storm and larger-scale feedback processes, while changes in large-scale dynamics and catchment characteristics further modulate the frequency of flooding in response to precipitation increases. Changes in atmospheric circulation in response to radiative forcing and evolving surface temperature patterns are capable of dominating water cycle changes in some regions. Moreover, the direct impact of human activities on the water cycle through water abstraction, irrigation, and land use change is already a significant component of regional water cycle change and is expected to further increase in importance as water demand grows with global population.
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Cambio Climático , Inundaciones , Lluvia , Ciclo Hidrológico , Humanos , TemperaturaRESUMEN
Optimal treatment for advanced cervical cancer after first line chemotherapy remains undefined. Immune checkpoint inhibition with pembrolizumab, a programmed cell death protein 1(PD-1) inhibitor, is under investigation. We analyzed the micro-environmental and molecular genetic profile of tumors from 4 patients with metastatic cervical cancer treated with off-label second-line pembrolizumab in an effort to identify predictive biomarkers. All patients received 2â¯mg/kg of pembrolizumab, 3-weekly until disease progression. Immunohistochemistry(IHC) for PD-1, PD-L1, CD3 and CD8, as well as next generation sequencing (NGS) for 50 cancer-related genes were performed on tumor samples. All patients tolerated treatment well with no discontinuation of treatment due to toxicity. One patient experienced dramatic and prolonged partial response, and remains stable on pembrolizumab with a progression free survival (PFS) of 21â¯months at the time of reporting of this series. Three patients experienced disease progression as best response. In the exceptional responder, there was no tumoral expression of PD-L1, however, combined positive score (CPS) for PD-L1 was 1 and we identified somatic mutations in ERBB4(R612W), PIK3CA(E542K) and RB1(E365K). In 2 patients, despite progressive disease defined by RECIST v1.1, symptom stabilization on pembrolizumab was observed. The tumors of both patients had PD-1 expression in ≥1% of stromal lymphocytes. All patients with response or clinical benefit had CPS for PD-L1â¯≥â¯1. NGS revealed PIK3CA mutations in 3 tumors. Pembrolizumab is a promising therapeutic option in advanced cervical cancer. Further evaluation of biomarkers may guide optimal patient selection.
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The implications of anthropogenic climate change, human activities and land use change (LUC) on the environment and ecosystem services in the coastal regions of Saudi Arabia were analyzed. Earth observations data was used to drive land use categories between 1970 and 2014. Next, a Markov-CA model was developed to characterize the dynamic of LUC between 2014 and 2100 and their impacts on regions' climate and environment. Non-parametric change point and trend detection algorithms were applied to temperature, precipitation and greenhouse gases data to investigate the presence of anthropogenic climate change. Lastly, climate models were used to project future climate change between 2014 and 2100. The analysis of LUC revealed that between 1970 and 2014, built up areas experienced the greatest growth during the study period, leading to a significant monotonic trend. Urban areas increased by 2349.61km2 between 1970 and 2014, an average increase of >53.4km2/yr. The projected LUC between 2014 and 2100 indicate a continued increase in urban areas and irrigated cropland. Human alteration of land use from natural vegetation and forests to other uses after 1970, resulted in a loss, degradation, and fragmentation, all of which usually have devastating effects on the biodiversity of the region. Resulting in a statistically significant change point in temperature anomaly after 1968 with a warming trend of 0.24°C/decade and a downward trend in precipitation anomaly of 12.2mm/decade. Total greenhouse gas emissions including all anthropogenic sources showed a statistically significant positive trend of 78,090Kt/decade after 1991. This is reflected in the future projection of temperature anomaly between 1900 and 2100 with a future warming trend of 0.19°C/decade. In conclusion, human activities, industrial revelation, deforestation, land use transformation and increase in greenhouse gases had significant implications on the environment and ecosystem services of the study area.
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Cambio Climático , Clima Desértico , Ecosistema , Monitoreo del Ambiente , Agricultura , Biodiversidad , Bosques , Humanos , Arabia Saudita , TemperaturaRESUMEN
WHAT IS KNOWN AND OBJECTIVE: Drug-induced hepatotoxicity is potentially lethal. Liver transplant patients receive a large number of medications and adverse drug reactions, and drug-drug interactions must be closely monitored. CASE SUMMARY: We report a case of a 29-year-old liver transplant patient who suffered liver injury most likely induced by drug interaction between capecitabine and warfarin. Vitamin K1 caused skin rash possibly because of the distribution and metabolism characteristic of the drug in this patient. WHAT IS NEW AND CONCLUSION: Close monitoring and prompt discontinuation of the drugs with high volume of distribution and metabolized through the liver are necessary to avoid drug-drug interaction in liver transplant patients.
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Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Desoxicitidina/análogos & derivados , Fluorouracilo/análogos & derivados , Trasplante de Hígado/métodos , Warfarina/efectos adversos , Adulto , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Anticoagulantes/uso terapéutico , Antimetabolitos Antineoplásicos/administración & dosificación , Antimetabolitos Antineoplásicos/efectos adversos , Antimetabolitos Antineoplásicos/uso terapéutico , Capecitabina , Desoxicitidina/administración & dosificación , Desoxicitidina/efectos adversos , Desoxicitidina/uso terapéutico , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/patología , Interacciones Farmacológicas , Monitoreo de Drogas/métodos , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Fluorouracilo/uso terapéutico , Estudios de Seguimiento , Humanos , Masculino , Distribución Tisular , Vitamina K 1/efectos adversos , Vitamina K 1/farmacocinética , Warfarina/administración & dosificación , Warfarina/uso terapéuticoRESUMEN
Liver steatosis is often observed in different clinical situations. Oncological patients undergoing systemic therapy often develop liver steatosis, which can be diagnosed with normal routine scans such as CT and ultrasound. In this case report, we show that an isolated infiltration of the portal triad with tumor cells could mimic a fatty-like infiltration of the liver. Radiologists and clinicians should be aware of this pitfall and should perform a biopsy in cases of doubt.
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Naphthenic acids, NAs (classical formula C(n)H(2n+z)O(2), where n is the carbon numbers, z represents zero or negative even integers), found in oil sands process waters (OSPWs), are toxic to aquatic environments depending upon several factors such as pH, salinity, molecular size and chemical structure of NAs. Among various available methods, biodegradation seems to be generally the most cost-effective method for decreasing concentrations of NAs (n ≤ 21) and reducing their associated toxicity in OSPW, however the mechanism by which the biodegradation of NAs occurs are poorly understood. Ozonation is superior over biodegradation in decreasing higher molecular weight alkyl branched NAs (preferentially, n ≥ 22, -6 ≥ z ≥ -12) as well as enabling accelerated biodegradation and reducing toxicity. Photolysis (UV at 254 nm) is effective in cleaving higher molecular weight NAs into smaller fragments that will be easier for microorganisms to degrade, whereas photocatalysis can metabolize selective NAs (0 ≥ z ≥ -6) efficiently and minimize their associated toxicity. Phytoremediation is applicable for metabolizing specific NAs (O(2), O(3), O(4), and O(5) species) and minimizing their associated toxicities. Petroleum coke (PC) adsorption is effective in reducing the more structurally complex NAs (preferentially 12 ≥ n ≥ 18 and z = -10, -12) and their toxicity in OSPWs, depending upon the PC content, pH and temperature. Several factors have influence on the degradation of NAs in OSPWs and aquatic environments, which include molecular mass and chemical structure of NAs, sediment structure, temperature, pH, dissolved oxygen, nutrients, and bacteria types.