Careful Observation Research Articles

Combined evaluation of liver and kidney function improves prediction of clinical outcome in patients with chronic heart failure and reduced ejection fraction

Abstract Background/Introduction The liver and the kidneys are important organs for body homeostasis and are both affected by heart failure (HF) either by systemic venous congestion or hypoperfusion. Purpose We aimed to verify whether the Model for End-stage Liver Disease eXcluding International normalized ratio (MELD-XI), as well as a combination of cholestatic liver and kidney function tests carry prognostic value in patients with chronic HF with reduced ejection fraction (HFrEF). The liver parameters included alkaline phosphatase (ALP), gamma glutamyl-transpeptidase (GGT), and total bilirubin, while kidney parameters consisted of eGFR and the tubular damage markers urinary N-acetyl-beta-D-glucosaminidase (NAG) and kidney injury molecule (KIM)-1. Methods We categorized 250 patients with HFrEF on the basis of baseline biomarker levels. We assumed elevated NT-proBNP indicates hemodynamic congestion necessary to induce congestive liver or kidney dysfunction. Thus, in every organ damage category, NT-proBNP level above median was incorporated, next to any 2 out of 3: ALP, GGT or total bilirubin above median for liver dysfunction; any 2 out of 3 NAG or KIM-1 above median or eGFR below median for kidney dysfunction; or coexistence of liver and kidney dysfunction as defined above. Additionally, a subgroup of patients with both NT-proBNP and MELD-XI above the median was analyzed. The primary endpoint was a composite of cardiovascular death, heart transplantation, LVAD implantation, and hospitalization for acute or worsened HF, whichever occurred first. Univariable and multivariable Cox proportional hazard regression models were used. Results Median (Q1-Q3) age of the study population was 68 (58-76) years; 184 (74%) were men, 62 (25%) in NYHA class III or IV, and mean left ventricular ejection fraction (LVEF) was 31±9%. During a median (Q1-Q3) follow-up of 2.2 (1.4-2.5) years, 66 (26%) patients reached the primary endpoint. We observed that liver dysfunction, kidney dysfunction or their coexistence was associated with significantly higher risk of reaching the primary endpoint (HR 3.54, 95% CI 1.75–7.16; HR 1.85, 95% CI 1.00–3.41; HR 2.52, 95% CI 1.03–6.11 respectively) in the clinically adjusted model (Table 1). Higher MELD-XI was associated with higher risk of reaching the primary endpoint in an unadjusted model but not in a clinically adjusted model. Figure 1 presents event-free survival probability of patients falling into organ dysfunction categories. Conclusions Our results show that markers of cholestatic liver function and kidney function predict unfavorable clinical outcome and provide better prognostic value in chronic HFrEF patients than the MELD-XI alone. Thus, screening for liver and kidney damage may help identify high-risk patients in whom more careful observation and individualized therapy is warranted.Fig 1.Event-free survival probability

Bilateral Idiopathic Neuroretinitis

Background/Objectives: Neuroretinitis (NR) is a rare inflammatory condition characterized by sudden vision loss, optic disc edema and macular star appearance predominantly affecting individuals in their third and fourth decades of life. Methods: This paper describes the case of 33-year-old Caucasian man with no significant medical history complaining of decreased vision for about a week. Results: The ophthalmological exam revealed best-corrected visual acuity (BCVA) for the right eye (RE) of 0.8 (decimal notation) and of 0.9 for the left eye (LE). Intraocular pressure (IOP) was 20 mmHg in RE and 18 mmHg in LE. Slit-lamp examination of both eyes (OU) showed no evidence of intraocular inflammation in the anterior chamber or vitreous cavity. Examination of the posterior pole of the right eye showed bilateral papilledema with an incomplete macular fan pattern. Conclusions: Despite extensive laboratory tests, including serologic and imaging investigations, a definitive etiology remained unclear. It is very important to differentiate NR from other optic nerve disorders, requiring careful clinical evaluation and observation of the evolution of symptoms.

Rethinking asexuality: the enigmatic case of functional sexual genes in Lepraria (Stereocaulaceae)

BackgroundThe ubiquity of sex across eukaryotes, given its high costs, strongly suggests it is evolutionarily advantageous. Asexual lineages can avoid, for example, the risks and energetic costs of recombination, but suffer short-term reductions in adaptive potential and long-term damage to genome integrity. Despite these costs, lichenized fungi have frequently evolved asexual reproduction, likely because it allows the retention of symbiotic algae across generations. The lichenized fungal genus Lepraria is thought to be exclusively asexual, while its sister genus Stereocaulon completes a sexual reproductive cycle. A comparison of sister sexual and asexual clades should shed light on the evolution of asexuality in lichens in general, as well as the apparent long-term maintenance of asexuality in Lepraria, specifically.ResultsIn this study, we assembled and annotated representative long-read genomes from the putatively asexual Lepraria genus and its sexual sister genus Stereocaulon, and added short-read assemblies from an additional 22 individuals across both genera. Comparative genomic analyses revealed that both genera were heterothallic, with intact mating-type loci of both idiomorphs present across each genus. Additionally, we identified and assessed 29 genes involved in meiosis and mitosis and 45 genes that contribute to formation of fungal sexual reproductive structures (ascomata). All genes were present and appeared functional in nearly all Lepraria, and we failed to identify a general pattern of relaxation of selection on these genes across the Lepraria lineage. Together, these results suggest that Lepraria may be capable of sexual reproduction, including mate recognition, meiosis, and production of ascomata.ConclusionsDespite apparent maintenance of machinery essential for fungal sex, over 200 years of careful observations by lichenologists have produced no evidence of canonical sexual reproduction in Lepraria. We suggest that Lepraria may have instead evolved a form of parasexual reproduction, perhaps by repurposing MAT and meiosis-specific genes. This may, in turn, allow these lichenized fungi to avoid long-term consequences of asexuality, while maintaining the benefit of an unbroken bond with their algal symbionts.

Metabolic acidosis in patients with diabetes 2 undergoing cardiac surgery: The impact of SGLT2 inhibitor use: a retrospective cohort study.

Sodium-glucose cotransporter 2 inhibitors (SGLT2-i) lower blood sugar and reduce cardiovascular events and kidney failure. However, there have been increasing reports of euglycaemic diabetic ketoacidosis (eDKA) linked to SGLT2-i medicines. Investigating the association between SGLT2-i use and the incidence of metabolic acidosis in patients with type 2 diabetes undergoing cardiac surgery. A retrospective observational cohort study comprising 121 patients, with 38 in the SGLT2-i group and 83 in the control group. A 2-year period at Haukeland University Hospital, a tertiary regional hospital in Western Norway. Patients with type 2 diabetes undergoing cardiac surgery. Collection of clinical and laboratory data, including acid/base balance parameters, surgery details and SGLT2-i use. Base excess and anion gap measurements as indicators of ketosis development. A subgroup analysis in patients without renal failure (glomerular filtration rate > 60 ml min-1 m-2). Lower base excess levels and increased anion gaps were observed in the SGLT2-i group compared with controls at various time points postoperatively, with no significant differences in serum lactate levels.Twelve hours postoperatively, 41% of SGLT2-i patients without renal failure had a base excess -3 mmol l-1 or less after correction for serum lactate (indicating ketosis) compared with only 8% in the control group (P < 0.001). The anion gap was elevated in the SGLT2-i group compared to the control group at 12 h postoperatively (P = 0.018).Multivariable regression analysis identified SGLT2-i use as an independent factor associated with a lower base excess after correction for lactate levels (P < 0.001). Cessation of SGLT2-i medication did not correlate with the degree of acidosis. While taking SGLT2 inhibitors, diabetic patients undergoing heart surgery are at an increased risk of ketosis and possibly metabolic acidosis. This emphasises the importance of careful observation and effective treatment strategies within this group.

Perioperative intervention of dysphagia rehabilitation team is effective in older adults with gastric cancer: An inverse probability weighting analysis

IntroductionThis study aimed to evaluate the efficacy of perioperative dysphagia rehabilitation in older adult patients diagnosed with gastric cancer who underwent gastrectomy. Materials and methodsThis retrospective study included 149 patients over 80 years who underwent gastrectomies between January 2000 and December 2020. The patients were divided into two groups based on the intervention of the dysphagia rehabilitation team (DRT group: n = 101) and the non-intervention control group (C group: n = 48). Inverse probability weighting (IPW) analysis was used to reduce bias caused by potential confounding. ResultsThe incidence of overall complications was significantly lower in the DRT group (odds ratio [OR]; 0.27[0.08–0.93]), among which the incidence of postoperative pneumonia (OR; 0.07[0.01–0.43]) and aspiration pneumonia (OR; 0.05[0.01–0.44] was significantly reduced. Ten patients developed postoperative pneumonia; seven were in the C group, and three were in DRT group. Sixty percent of these patients had preoperative comorbidities related to the respiratory system. Regarding the time of onset of aspiration pneumonia, two patterns were observed: onset within a short period after surgery and onset after the start of eating. In contrast, five patients underwent preoperative dysphagia rehabilitation in the DRT group. Among them, postoperative aspiration pneumonia was prevented in four patients, and the others were prevented from severe pneumonitis by the intervention of the dysphagia rehabilitation team. DiscussionPerioperative intervention in dysphagia rehabilitation is not only associated with reduced postoperative pneumonia but also creates awareness in the medical staff and promotes careful observation of swallowing in patients, thereby controlling the incidence of postoperative pneumonia. The perioperative intervention of the dysphagia rehabilitation team is useful for older adult patients with gastric cancer.

Early gesture development as a predictor of autism spectrum disorder in elevated-likelihood infants of ASD

BackgroundGesture difficulties have been reported in later-born siblings of children with autism spectrum disorder (ASD). Careful observation of gesture development during the first two years of children at elevated likelihood (EL) of developing ASD may identify behavioral indicators that facilitate early diagnosis.MethodsThis study enrolled 47 EL infants and 27 low-likelihood (LL) infants to explore gesture developmental trajectories and the predictive value of gesture to expedite the early detection of core characteristics of ASD. Gesture frequency, communication function, and integration ability were observed and coded from a semi-structured assessment administered longitudinally across 9–19 months of age. We conducted the Autism Diagnostic Observation Schedule assessment at 18–19 months for ASD’s core characteristics.ResultsThe development of joint attention (JA) gestures was slower in the EL than in the LL group. The trajectories of the two groups began to diverge at 14–18 months. Children who reached the diagnostic cutoff point for ASD showed reductions in social interaction gestures at 12–13 months, in gestures integrated with any two communication skills (G-M) at 15–16 months; and in gestures integrated with eye contact (G-E) at 18–19 months. Overall gesture and G-M integration were associated with an overall ADOS communication and social interaction score.ConclusionsThe developmental trajectories of JA gestures of EL and LL children differed. G-M gestures represent early indicators that may be a predictor of ASD.

Six Basic Rules of Palliative Care and Their Buddhist Counterparts.

As healthcare workers in palliative care, every day brings its share of awfulness and beauty, suffering and connection, meaning and cynicism. Without a way to support ourselves, we cannot help our patients, let alone one another. But how do we cope? Despite the unpredictability inherent in our work, we can discern certain patterns that offer an approach for dealing with these stressors. These patterns can be summarized into six simple rules of palliative care-rules that are coterminous with the teachings of Buddhism. Recognizing the synergy between our role in palliative care and ancient observations about dealing with life's difficulties can help us with the stress of providing conscientious care within a system that relentlessly tries to stop us from doing so. Such considerations offer one of many paths we might choose to cope with this challenging work.

Life: An emergent property that passively qualifies matter or a purposive agency that actively controls matter?

Despite its abundance, life continues to be a mind-boggling mystery. Physical entities are made of matter-energy, and thus they are ontologically objective. The properties that emerge on a physical entity and characterize it are ontologically subjective and thus nonphysical. Emergent properties routinely appear on physical entities during assembly out of nowhere and disappear during disassembly. We can engineer the manifestation of desired properties by manipulating matter, but we seem to have no control over agencies. Agencies are characterized by causal power and thus the capacity to cause changes. Ontologically, agencies have primacy and supremacy. Unlike properties, agencies go beyond passively qualifying matter: they actively control matter. Many agencies can be identified in nature, such as the familiar agency of physics, comprised of the laws and forces of physics and controls the physical entities, and the quantum field agency which converts quanta of energy concisely into particles with a distinctive set of properties. In this paper it is discussed, based on careful observations, plausibility, logical consistency, and reasoned arguments, that enigmatic life is best characterized as a purposive agency that actively subjugates and controls matter rather than an emergent property that passively qualifies matter.

Educación, pensamiento complejo y ciudad: La categoría de comunidad en la crónica Medellín, bajo el milagro de la media luz (1983) de Juan José Hoyos Naranjo

In the following reflection article, whose connotation is educational; it is considered to address the analysis of the chronicle “Medellín, under the miracle of the half light” (1993) by the writer Juan José Hoyos Naranjo. The chronicle presents a narrative impregnated with orality and marked by complex discursive procedures. In that sense, said analysis will focus on education from the Morinian thought and the concept of community. Hoyos’ work intertwines enjoyment and nostalgia, offering a deep understanding of how communities have intervened in the transformations of Medellín. As a careful observer of his city, Hoyos uses everyday elements such as bars, objects and the urban environment to capture the essence of Medellín and outline the profile of the urban subject. His critical approach exposes both public and biographical aspects, especially his experience as a journalist in the 1980s, a period in which he faced, as a reporter, the power dynamics of drug trafficking and the drastic urban changes of the city. This chronicle not only documents these events, but also derives from his journalistic work, consolidating itself as a piece that merges his professional career with a critical and personal vision of the evolution of Medellín. Aspect that is expanded in the perspective of Complex thinking with a focus on the category of community.

Adherence to Evidence-Based Guidelines and ImplicationsWhen Designing Electronic Documentation for Urinary Catheters.

The aim of this study was to investigate the point prevalence and the rate of adherence to evidence-based guidelines for patients who had indwelling urinary catheters in three Australian acute care hospitals. A cross-sectional observational design was used. A multisite cross-sectional observational design was utilised in three acute hospitals across Australia. Data were collected from each site in a single day directly from observation of the patient, the bedside notes and medical records. The data collected included observations of clinical care and scrutiny of the documentation of the insertion details and catheter care using best practice guidelines. Of the 1730 patients audited, 47% were female. The mean point prevalence of catheters insitu across three sites was 12.9%. Correct documentation compliance was reported to be, on average, 40%. Documentation was significantly better when a template was available to guide information recorded: this was regardless of whether it was hard copy or electronic. Overall, clinical care compliance with best practices was 77%. Of note for improvement was the fixing of the urinary catheter to the thigh in highly dependent patients. It was identified that there is a need for improvement across all three sites: specifically regarding securement of the urinary catheter to the patient's thigh within the ICU. In addition, it was identified that there is a need for documentation of the urine bag change in ward areas. Documentation may be improved by incorporating templates into healthcare documentation systems in the future. Further work is needed to ensure nurses are aware of the adverse effects of urinary catheters and thus, the need to adhere to best practice guidelines. There has been no patient or public contribution. We have adhered to the STROBE guidelines for reporting.

Prevalence of postpartum complications and associated factors among postpartum women in Uganda, a cross-sectional study

BackgroundPostnatal care exhibits the lowest coverage levels in the obstetric continuum of care. The highest rates of maternal and newborn morbidity and mortality occur within 24 h of birth. Assessment of women in this time period could improve the detection of postpartum complications and maternal outcomes. This study determined the patterns of maternal assessment and the factors associated with postpartum complications.MethodsThis was a cross-sectional study involving observations of immediate postpartum care provided to women following uncomplicated vaginal births at three health facilities in Mpigi and Butambala districts (Uganda) from November 2020 to January 2021. Data were collected using an observation checklist and a data abstraction form for maternal and newborn social demographic data. The collected data were analyzed using Stata version 14.0. Maternal assessment patterns were summarized as frequencies, and the prevalence of postpartum complications was calculated. Logistic regression analysis was performed at both bivariate and multivariate levels to identify factors associated with developing postpartum complications among these women.ResultsWe observed 263 women receiving care at three health facilities in the immediate postpartum period. The level of maternal assessments was very low at 9/263 (3.4%), 29/263(11%) and 10(3.8%) within the first two hours, at three hours and at the fourth hour, respectively. The prevalence of postpartum complications was 37/263 (14.1%), with 67.6% experiencing postpartum hemorrhage (PPH), 13.5% having perineal tears, and 10.8% having cervical tears. Mothers who did not undergo a postpartum check in the first three hours (p = 0.001), those who were discharged after 24 h (p = 0.038), and those who were transferred to the postpartum ward after two hours (p = 0.001) were more likely to have developed postpartum complications.ConclusionThe maternal assessment patterns observed in the population were suboptimal. Women who were not assessed at the third hour and those transferred after two hours to the postnatal ward were more likely to have developed postpartum complications.

Clinical challenges and management of late presenting congenital diaphragmatic hernia mimicking tension pneumothorax in a child: a case report and review of literatures

BackgroundCongenital diaphragmatic hernia(CDH) is a rare congenital anomaly characterized by herniation of abdominal contents into thoracic cavity through a defect in diaphragm. While commonly diagnosed prenatally or in neonatal period, late-presenting CDH can occur and may mimic other thoracic emergencies such as tension pneumothorax, complicating diagnosis and management.Case presentationA two-year old male black child from Ethiopia presented to the emergency department with sudden onset of acute respiratory distress. Initial clinical assessment and chest radiography suggested a diagnosis of tension pneumothorax due to the presence of significant mediastinal shift and apparent pleural air. Despite insertion of chest tube, the child’s condition did not improve, raising suspicion of alternative diagnosis. Careful observation of initial chest x-ray and subsequent chest ultrasound revealed a left sided congenital diaphragmatic hernia with herniation of stomach and intestine into thoracic cavity compressing the left lung and causing mediastinal shift. After the diagnosis of CDH was confirmed, the child was stabilized and emergent surgical repair performed. Postoperative recovery was uneventful, and the child was discharged with no significant long-term complications.ConclusionThis case underscores the importance of considering CDH in the differential diagnosis of acute respiratory distress in a child. It highlights the diagnostic challenges and potential risks of emergency interventions based on initial misdiagnosis. Even if x -ray looks like typical of tension pneumothorax, it showed giant cystic air filled structure pushing the mediastinal structure to contralateral side with loss of left diaphragmatic outline which raised suspicion of congenital cystic lung mass or congenital diaphragmatic hernia. Advanced imaging and high index of suspicion are crucial for accurate diagnosis and timely management, ultimately improving patient outcomes. Consideration of alternative diagnosis when our initial intervention with insertion of chest tube fail to provide symptom improvement in suspected pneumothorax should raise suspicion of congenital diaphragmatic hernia like in our case.

CONTACT: a non-randomised feasibility study of bluetooth-enabled wearables for contact tracing in UK care homes during the COVID-19 pandemic

BackgroundThe need for effective non-pharmaceutical infection prevention measures such as contact tracing in pandemics remains in care homes, but traditional approaches to contact tracing are not feasible in care homes. The CONTACT intervention introduces Bluetooth-enabled wearable devices (BLE wearables) as a potential solution for automated contact tracing. Using structured reports and reports triggered by positive COVID-19 cases in homes, we fed contact patterns and trends back to homes to support better-informed infection prevention decisions and reduce blanket application of restrictive measures. This paper reports on the evaluation of feasibility and acceptability of the intervention prior to a planned definitive cluster randomised trial of the CONTACT BLE wearable intervention.MethodsCONTACT was a non-randomised mixed-method feasibility study over 2 months in four English care homes. Recruitment was via care home research networks, with individual consent. Data collection methods included routine data from the devices, case report forms, qualitative interviews (with staff and residents), field observation of care, and an adapted version of the NoMaD survey instrument to explore implementation using Normalisation Process Theory. Quantitative data were analysed using descriptive statistical methods. Qualitative data were thematically analysed using a framework approach and Normalisation Process Theory. Intervention and study delivery were evaluated against predefined progression criteria.ResultsOf 156 eligible residents, 105 agreed to wear a device, with 102 (97%) starting the intervention. Of 225 eligible staff, 82% (n = 178) participated. Device loss and damage were significant: 11% of resident devices were lost or damaged, ~ 50% were replaced. Staff lost fewer devices, just 6%, but less than 10% were replaced. Fob wearables needed more battery changes than card-type devices (15% vs. 0%). Structured and reactive feedback was variably understood by homes but unlikely to be acted on. Researcher support for interpreting reports was valued. Homes found information useful when it confirmed rather than challenged preconceived contact patterns. Staff privacy concerns were a barrier to adoption. Study procedures added to existing work, making participation burdensome. Study participation benefits did not outweigh perceived burden and were amplified by the pandemic context. CONTACT did not meet its quantitative or qualitative progression criteria.ConclusionCONTACT found a large-scale definitive trial of BLE wearables for contact tracing and feedback-informed IPC in care homes unfeasible and unacceptable — at least in the context of shifting COVID-19 pandemic demands. Future research should co-design interventions and studies with care homes, focusing on successful intervention implementation as well as technical effectiveness.Trial registrationISRCTN registration: 11204126 registered 17/02/2021.

Implementation and impact of integrated information systems in Albanian SME’s

Abstract This research work analyses how information technology improves business efficiency, creates employment, and fosters economic development. This paper investigates the level of integrated information systems used by small and medium enterprises in Albania. The research philosophy employed in this research work based on the case study method, and researcher interaction has been applied as a technique for data collection. Through careful observation and investigation of practical and real cases, a complete picture of the actual interaction of factors and events are obtained. A self-selection sampling technique was used. Through this technique, cooperation with managers was enabled to recommend possible concrete improvements in the systems or subsystems of information they apply. Results indicate that while information technology adoption is growing, significant barriers such as financial constraints and lack of technical skills persist. The empirical work showed that the firms involved in the study used information systems for different aspects such as sales, accounting, or quality control, but they were not integrated. The lack of the “smart” use of the information systems hampered their efficiency and make them less competitive. By leveraging such systems, SMEs can overcome challenges posed by limited resources and achieve sustainable growth.

Cronkhite-Canada syndrome tends to be accompanied by colorectal cancer: Report of seven cases.

Cronkhite-Canada syndrome (CCS) can be difficult to diagnose. To diagnose CCS, it is important to perform endoscopic examination for patients with chronic diarrhea, check for the presence or absence of polyposis, and evaluate inflammation in the mucosa between the polyps. This study reported seven cases of CCS. The age of the patients, which included four men and three women, ranged 48-72 years, and all patients were Asian. The most common symptom among these patients was chronic diarrhea. Three of the patients had rectal cancer. In two patients, the lesions were detected at an early stage and resected via endoscopic treatment. CCS is associated with a high risk of malignant gastrointestinal lesions, especially rectal cancers, and periodic surveillance endoscopy and careful observation are required.

Approaches to Early Parkinson's Disease Subtyping.

Parkinson's disease (PD) unfolds with pathological processes and neurodegeneration well before the emergence of noticeable motor symptoms, providing a window for early identification. The extended prodromal phase allows the use of risk stratification measures and prodromal markers to pinpoint individuals likely to develop PD. Importantly, a growing body of evidence emphasizes the heterogeneity within prodromal and clinically diagnosed PD. The disease likely comprises distinct subtypes exhibiting diverse clinical manifestations, pathophysiological mechanisms, and patterns of α-synuclein progression in the central and peripheral nervous systems. There is a pressing need to refine the definition and early identification of these prodromal subtypes. This requires a comprehensive strategy that integrates genetic, pathological, imaging, and multi-omics markers, alongside careful observation of subtle motor and non-motor symptoms. Such multi-dimensional classification of early PD subtypes will improve our understanding of underlying disease pathophysiology, improve predictions of clinical endpoints, progression trajectory and medication response, contribute to drug discovery and personalized medicine by identifying subtype-specific disease mechanisms, and facilitate drug trials by reducing confounding effects of heterogeneity. Here we explore different subtyping methodologies in prodromal and clinical PD, focusing on clinical, imaging, genetic and molecular subtyping approaches. We also emphasize the need for refined, theoretical a priori disease models. These will be prerequisite to understanding the biological underpinnings of biological subtypes, which have been defined by large scale data-driven approaches and multi-omics fingerprints.

Comprehensive analysis of nutritive and toxic metal contents in canned tuna: Implications for safety and consumer health

Ca, Mg, K, Na, Fe, Cu, Mn, Zn, Ni, Cr, As, Cd, Pb and Hg levels of canned tuna fish marketed in Turkey were determined by inductively coupled plasma mass spectrometry. Ca content ranged from 80 to 2930 mg/kg, Mg from 900 to 1910 mg/kg, Na from 5930 to 12130 mg/kg, and K from 6930 to 44340 mg/kg. Fe (4.73–27.34 mg/kg), Cu (0.21 and 0.98 mg/kg), Mn (0.12–0.44 mg/kg), Zn (32–45 mg/kg), Ni (0.88–2.06 mg/kg) and Cr (0.03–0.11 mg/kg) contents of the canned foods did not exceed the provisional tolerable weekly intake limit. Cd was detected in two groups (C4=0.02 mg/kg, C18=0.15 mg/kg), while Pb was found in one group (C10=0.48 mg/kg). As content ranged from 0.27 to 1.75 mg/kg in all groups. Most of the tuna cans contained Hg between 0.046 and 0.099 mg/kg, but the highest concentration was found in sample C4 (0.81 mg/kg). Based on the increased lifetime cancer risk findings, the consumption limits of Group 4 and Group 14 should be limited to around 60 g/week (less for children). As a result of the findings that were obtained from this study careful observations should be followed up for the safer consumption of canned tuna.

Altered Mental Status and Delirium in Pediatric Patients.

Mental status is the collection of an individual's consciousness, perception, emotion, memory, and cognition at a particular point in time, which is inferred by the clinician through careful observation and interaction. The pediatric mental status assessment must be approached with an understanding of cognitive, language, and psychosocial development. Alterations must then be comprehensively and clearly described. Delirium is a phenotypic diagnosis with a specific set of criteria in the DSM and is a serious neurocognitive disorder caused by physiologic changes due to illness, injury, toxins, medications, and/or substances. Recognition of delirium in children is improved by monitoring of predisposing risks and precipitating factors, as well as the regular use of validated pediatric screening tools. Management of delirium is focused on treatment of the underlying etiology, prevention of iatrogenic deliriogenic factors, and patient safety.

Inbreeding and its effect on the gene fund in dog breeding

Aim. Identifying problems and approaches to dog breeding that emphasize the importance of the quality of parents and hereditary factors in determining the offspring's quality. Methods. Theoretical review of inbreeding and its impact on the gene pool in dog breeding, comparing it with outbreeding, and exploring natural selection mechanisms and their influence on animal reproduction. Results. The paper discusses the principles of selecting breeders in dog breeding and provides recommendations for avoiding mating dogs with deficiencies in a particular trait. It also highlights the study of genetic mechanisms and their impact on the inheritance of traits in dogs. Two main breeding methods are considered in animal husbandry – inbreeding and outbreeding. The study findings indicate types of inbreeding and their influence on the genetic homogeneity of the offspring. Conclusions. The breeder must clearly define the type of dog he wants to obtain, specifying desired characteristics such as appearance, health, and temperament. In the initial stages, the breeder must achieve stability in breeding offspring with desired characteristics, creating animals with a typical temperament. After achieving stability, one can begin fine-tuning specific traits by selecting for improvements in breed aspects. A dog should be viewed as a holistic system, striving for overall correctness and balance, paying attention to the interrelation between different aspects. The breeder must ensure the preservation of unique breed characteristics during selection. Effective selection involves careful planning, observation, evaluation, and collaboration with experienced veterinarians and breed specialists.

An attempt at exhausting a place in Shetland: (field)notes from a (very) small island

AbstractIn what follows, I outline the possibility of directly applying Georges Perec's An Attempt at Exhausting a Place in Paris (2010) to the practice of ethnography. Based on 2 weeks of anthropological fieldwork on the remote Shetland Island of Foula, I attempt a translation of Perec's careful observations of an urban square in Paris in the 1970s into the context of an ethnography in this remote, rural location. After outlining the connections between Perec's book and my work as an anthropologist, I provide readers with my “raw” field notes so that they might then draw out their own analysis in the same way that I believe Perec intended his work to be understood.