Academic literature on the topic 'NHRD standard'

Multiple myeloma (MM) is a malignancy of the antibody producing plasma cell, which exhibits a high degree of genetic diversity between patients. As genetic analysis technologies have improved so has our understanding of the diverse genetic phenotypes underlying the disease. The MMRF CoMMpass study (NCT01454297) is using whole genome (WGS), exome (WES), and RNA (RNAseq) sequencing to provide a precise characterization of each patient before and after therapy. However, these advanced assays are not widely available to patients today limiting the utility of many observations to a small population of patients. To expand the utility of the data set to a broader patient population we focused on DNA copy number (CN) phenotypes that can be identified by the standard FISH assays widely used in the field. To discover potential underlying phenotypes of myeloma beyond the known dichotomy of hyperdiploid (HRD) and non-hyperdiploid (NHRD) karyotypes, unsupervised consensus clustering was performed on 871 patients with CN profiles from WGS. Given the limited dynamic range of CN values, a Monte Carlo reference-based consensus clustering algorithm, M3C, was used to limit potential overfitting issues. Three independent replicates of this procedure identified an optimal solution of eight subtypes with no more than 6 patients having different class assignments between replicates. The eight CN subtypes consisted of five HRD and three NHRD subtypes and were annotated based on common CN features. The HRD classic subtype had ubiquitous CN gains, trisomies, of classic HRD chromosomes, 3, 5, 7, 9, 11, 15, and 19. The remaining HRD subtypes were annotated based on deviations from the classic HRD phenotype. The HRD, ++15 subtype phenocopies classic HRD except tetrasomy, not trisomy, is observed on chr15. Two groups of HRD patients were identified lacking CN gains of chr7 which are split into two distinct subtypes: the HRD, diploid 7 subtype, which lacked gains of chr7; and the HRD diploid 3, 7 subtype lacking trisomies of both chr3 and chr7. This suggest some relationship between chromosomes 3 and 7 where trisomy 7 is not tolerated in the absence of trisomy 3. Finally, the HRD, +1q, diploid 11, -13 subtype had gains of the classic HRD chromosomes except chr11 with gains of chr1q and loss of chr13. This subtype suggests trisomy 11 is essential for an HRD phenotype but it can be phenocopied by the combination of 1q gains and 13 loss. Within the NHRD subtypes, the diploid subtype is almost devoid of CN abnormalities less a common gain of 11q initiating at the breakpoint the t(11;14) event, which is almost universally observed in this subtype. Unlike the diploid subtype, the remaining NHRD subtypes have more complex CN profiles with the -13 subtype defined by monosomy 13, and the +1q/-13 subtype defined by gains of 1q and monosomy 13. Outcome analyses of the CN subtypes identified in CoMMpass revealed that both HRD and NHRD patients with gains of chr1q and loss of chr13 exhibited poor PFS and OS outcomes as compared to patients in other CN subtypes. Interestingly, the PFS curves split into three groups with a good risk group defined by the HRD classic and HRD ++15 subtypes. a high-risk group defined by 1q gain and monosomy 13 regardless of ploidy phenotype, and an intermediate group with all other subtypes. The distribution of HRD patients into these three outcome groups highlights the danger of assuming all HRD myeloma patients will have similar outcomes. Patients in the HRD, +1q, diploid 11, -13 subtype exhibited poor OS outcomes (median = 56 months) as compared to patients in the HRD, ++15 (p<0.01), HRD, classic (median = 65 months, p<0.05), diploid (p<0.01), and -13 (p<0.05) subtypes. Patients in the +1q, -13 subtype also exhibited poor OS outcomes (median = 57 months) as compared to patients in the diploid (p<0.01), -13 (p<0.05), HRD classic (p<0.05), and HRD, ++15 (p<0.01) subtypes. Overall, both HRD and NHRD patients with gain of 1q and loss of chr13 exhibit poor outcome as compared to patients with other genetic backgrounds (HR = 1.928, 95% CI = 1.435 - 2.59, p<0.001). Further, the observation that NHRD patients in the +1q, -13 subtype exhibit poor OS outcomes as compared to NHRD patients in the -13 subtype highlights the importance of 1q gains in determining patient prognosis. These results can easily be translated into clinics around the world by matching existing FISH data to each of these groups until more advanced testing is common practice. Disclosures Lonial: BMS: Consultancy; GSK: Consultancy; Karyopharm: Consultancy; Genentech: Consultancy; Janssen: Consultancy, Research Funding; Celgene Corporation: Consultancy, Research Funding; Takeda: Consultancy, Research Funding; Amgen: Consultancy.

Background:Patients who are well informed and motivated are more likely to utilize health services, thus, it improves adherence to medication. Hence, this audit aimed to improve the patient experience on treatment services at the National Hospital for Respiratory Diseases (NHRD), Welisara, Sri Lanka. Methods:Patients admitted from 15th August 2021 to 25th February 2022 to the NHRD and diagnosed with COVID-19 and tuberculosis (TB) co-infection were included. Twnety-two (22) process indicators were used and data were collected using a pretested self-administered questionnaire.Sixty-percent of thepatients had a good experience for each service received was the standard. Data were presented as frequency distributions and mean with their standard deviation (SD). Informed written consent was obtained prior to the data collection. Results: Out of 60 patients who were diagnosed with SARS-CoV-2 and TB co-infection, 59 were responded (response rate was 98.3%). A majority were males (n=47, 79.7%) and belonged to 41 to 60 age category (n=29, 49.2%). Ten indicators did not meet the standard. The highest experience was shown in perceived waiting time (mean 86.8, SD ± 8.8) and the lowest experience was shown in perceived time spent with the health care provider (mean 57.9, SD ± 11.8). More than half (n=31, 52.5%) of the patients reported overall good experiences on treatment services. However, age and gender did not show any significant relationship with the good experience of treatment services received (p>0.05). Conclusion: This audit shows the marginally good experience of treatment services received, but highlight areas such as time to discuss with the doctor, instructions on treatment given by the doctor and information given on available services on continuation of TB treatment are needed much improvement even in the pandemic situation.

Introduction: The prevalence of stunting in children under two years old is high in developing country. Stunting in the early of life has many negative health consequences in later life, while the positive view is stunting could be prevent earlier by detecting a predisposing factors in intrauterine and extrauterine periode. Anthropometry of intrauterine predisposing factors (IntraPF) and Extrauterine predisposing factors (ExtraPF) could detect growth retardation. These study aim was to prove that there were significant different of IntraPF and ExtraPF between stunting and non stunting children aged 6-24 months.Methods: This comparative cross sectional study was nested to (Bogor longitudinal study on child growth and development (BLSCGD) held by National Health Research and Development (NHRD), Health Ministry of Indonesia. Subjects who defined as stunting if their height for age was more than two standard deviations below the WHO Child Growth standards median. There were 38 stunting and 46 non-stunting aged 6-24 months who met the study criteria. Independent variable was (1)IntraPF follow as maternal height, weight and length of neonatal, (2)ExtraPF: weight gain and body length gain at first six months of neonatal. Primary and secondary data collection was carried out from July 2017 to Februari 2018, held at the BLSCGD. All of body measurement using WHO standard. Appropriate statistical analysis was used to compare the stunting and non-stunting groups with a significance limit of p <0.05.Results: Statistical analysis tests showed that: significantly different and lower IntraPF in the stunting group was maternal height, birth weight and length of the subjects compare to non-stunting and there were significant different and lower of ExtraPF follow as weight gain in the first six months, average weight gain per month in the first six months, increase in body length in the first six months, average increase in body length every month in the first six monthssignificantly lower in stunting children compare to non stunting children.Conclusion: The antropometric of intrauterine, extrauterine predisposing factors have been showed to have an impact on the child's height. It is important to monitor the anthropometry of the mother before pregnancy and provide nutritional interventions in the first 1000 days

ABSTRACT. Mild hyperhomocysteinemia, a putative risk factor for arteriosclerotic outcomes, is seen in >85% of hemodialysis patients. Therapeutic strategies, including pharmacologic-dose B vitamin supplementation and “high-flux” or “super-flux” hemodialysis, have consistently failed to normalize total homocysteine (tHcy) levels in these patients. Predialysis plasma tHcy levels in 23 patients who were undergoing nocturnal hemodialysis (NHD) six or seven nights/wk were compared with those in 31 patients from the same Canadian dialysis unit who were undergoing chronic standard hemodialysis (SHD) (all <65 yr of age, undergoing thrice-weekly treatments). The SHD patients were similar to typical North American chronic hemodialysis patients with respect to B vitamin status and albumin, creatinine, and tHcy levels. Geometric mean tHcy levels for the NHD patients were significantly lower (12.7 versus 20.0 μM, P < 0.0001), as was the prevalence of mild-to-moderate hyperhomocysteinemia (>12 μM; NHD, 57%; SHD, 94%; P = 0.002). Analysis of covariance adjusted for plasma folate, vitamin B12, and pyridoxal 5′-phosphate levels, age, and gender confirmed that NHD was independently associated with 6.0 μM lower geometric mean tHcy levels (P = 0.001). It is concluded that tHcy levels are significantly lower among NHD patients, compared with SHD patients. Clinical trials will be necessary to confirm that NHD is effective in reducing tHcy levels among patients with dialysis-dependent end-stage renal disease.

Introduction: This study investigates the management of hip fractures in a German maximum care hospital and compares these data to evidence-based standard and practice in 180 hospitals participating in the UK National Hip Fracture Database (NHFD) and 16 hospitals participating in the Irish Hip Fracture Database (IHFD). This is the first study directly comparing the management of hip fractures between 3 separate health-care systems within Europe. Methods: Electronic medical data were collected retrospectively describing the care pathway of elderly patients with a hip fracture admitted to a large trauma unit in the south of Germany “University Hospital Freiburg” (UHF). The audit evaluated demographics, postoperative outcome, and the adherence to the 6 “Blue Book” standards of care. These data were directly compared with the data from the UK NHFD and the IHFD acquired from 180 and 16 hospitals, respectively. Results: At 36 hours, 95.8% of patients had received surgery in UHF, compared to 71.5% in the NHFD and 58% of patients in the IHFD. The rate of in-hospital mortality was 4.7% compared to 7.1% in the NHFD and 5% in the IHFD. The mean average acute length of stay was 13.4 days compared to 16.4 days in the NHFD and 20 days in the IHFD. Reoperation rates are 3.3% compared to 1% in the NHFD and 1.1% in the IHFD; 50.5% of patients were discharged on bone protection medication, compared to 47% in the IHFD and 79.3% in the UK NHFD. Discussion: Despite uniformly acknowledged evidence-based treatment guidelines, the management of hip fractures remains heterogeneous within Europe. Conclusion: These data show that different areas of the hip fracture care pathway in Germany, England, and Ireland, respectively, show room for improvement in light of the growing socioeconomic burden these countries are expected to face.

The last decade has seen the rise of a potentially significant development in the Asia-Pacific region in regard to human rights—the establishment of National Human Rights Institutions (particularly Human Rights Commissions) in numerous States.2 National Human Rights Commissions (hereafter NHRC) established in compliance with United Nations standards have been established in Australia, Fiji, India, Indonesia, Malaysia, Mongolia, Nepal, New Zealand, Philippines, Republic of Korea, Sri Lanka, and Thailand.3 In many of these States, however, human rights abuses are still widespread and serious. The establishment of NHRC, which generally do not have the power to make enforceable decisions, could easily be derided as an attempt by governments to create a fac.ade of respect for human rights while failing to take the enforcement of those rights seriously.4 While this criticism has a degree of validity, NHRC have played a constructive, if limited role, in the promotion and protection of human rights in the Asia-Pacific region.

The pandemic of Coronavirus Disease 2019 (COVID-19) has created paradoxically a good opportunity globally to conduct research in the field of health and social science, and a Lower Middle-Income Country (LMIC) like Nepal is not an exception in this regard. During this ongoing pandemic, the Ethical Review Board (ERB) of Nepal Health Research Council (NHRC) has received numerous research proposals regarding COVID-19. As its main responsibility is to ensure participants’ safety, at the same time maintaining the scientific standard of research, the ERB has meticulously gone through all the proposals received so far. During this situation of a health emergency, the ERB of NHRC has had a different experience compared to the usual time. Its strength, weakness, opportunities, and threats have been like never before.

The human estrogen receptors (hER) are members of the nuclear hormone receptor (NHR) superfamily and represent important drug targets for the pharmaceutical industry. Initially, ligand binding assays were used to identify novel ligands using receptors purified from native tissues. With the advent of molecular cloning techniques, cell-based transactivation assays have been the gold standard for many years of drug discovery. With the elucidation of the structural mechanisms underlying the activation of NHRs, cell-free assays with purified receptors have become important tools to directly assess different binding sites (e.g., the hormone binding site or the cofactor binding site). The available cell-free assays have so far facilitated the study of one binding site at a time. With the introduction of Terbium (Tb3+)–based time-resolved fluorescence energy transfer (TR-FRET), it has become possible to measure 2 different interactions within 1 test tube in parallel. The authors have applied this technology to develop a dual readout system for the simultaneous monitoring of steroid hormone site binding and cofactor peptide recruitment. They took advantage of a commercially available fluorescent tracer as an indicator for classical steroid site binding and designed a novel peptide derived from the peroxisome proliferator-activated receptor gamma coactivator-1a (PGC1a) as an indicator for functional agonistic behavior of a test compound. The established assay is able to differentiate between agonists, antagonists, partial agonists, and compounds binding to the cofactor recruitment site. The IC50 values obtained for a number of reference compounds in the multiplexed assay are in concordance with published data. The simple 1-step mix-and-measure protocol gives excellent quality and robustness and can be miniaturized to 5-µL volume.

2030 vision for the kingdom seeks to promote Bahrain as a healthcare destination. New private hospitals have entered the health service industry. This leads competition to soar. Patient care has become a priority. The need to acquire accreditation for health services rendered by hospitals accentuates the importance of maintaining international standards in term of quality and cost. The purpose of the study is to reflect on the development of ethical resolutions, procedures, policies, and programs to enhance and to improve healthcare by National Health Regulatory Authority (NHRA). The study employs qualitative analysis of literature in relation to the evolution of ethical programs for health professionals in general and for patients at hospitals in Bahrain.

Hazard identification and rating involve the first two of a four-phase natural hazard and risk management (NHRM) system that is being developed to manage natural hazards along linear facilities. In Canada, completing these first two phases is generally straightforward. Baseline data including air photos, geology and topographic maps are readily available; the number and types of hazard exposure are often limited for any given facility; and, the standard of care expected during design and construction is understood and practiced. The NHRM methodology is also being applied on South American pipelines. Greater flexibility is required in obtaining necessary input data. Helicopter and vehicle access are often more limited, and greater reliance must be placed on airphoto interpretation and literature review. Processes of rating hazard exposure are needed for less familiar hazard types, including tsunami, volcanic eruption, and tectonic ground rupture. South American construction and design practices must be accounted for in the rating methodology. Using examples from recently constructed trans Andean pipelines, this paper outlines application of the NHRM system to linear facilities located in areas of diverse hazard exposure and less stringent design and construction practices. Under the broad headings of ‘geotechnical’ and ‘hydrotechnical’ hazards, a methodology for rating eleven different hazard types is outlined. On the geotechnical side, these include tsunami, volcanic eruption, tectonic ground rupture, landslides and debris flows originating off-rights-of-way, and mass movements originating on rights-of-way. Hydrotechnical hazards include scour, degradation, bank erosion, encroachment, and channel abandonment/avulsion.

Pipeline systems must contend with many hazards, of which ground movements such as landslides and washouts represent one type. Under the broader umbrella term, natural hazards, individual ground movement threats can be subdivided into geotechnical and hydrotechnical hazards. A four-phase natural hazard and risk management system (NHRM) is being developed. Although research and development are ongoing, implementation over the past seven years spans approximately 25,000 km of main-line pipeline in North and South America. It complies with CSA requirements for ‘hazard identification’ as well as current standard-of-care guidelines related to case-law in Canada. It is designed as a simple yet reproducible methodology that can be operated by pipeline companies, particularly their field staff. The first two phases of hazard identification/assessment are described here with reference to a recent study of hydrotechnical hazards along the Trans Mountain Pipe Line Co. Ltd. main line from Hinton, Alberta to Kamloops, British Columbia in the mountains of western Canada. The relative hazard ratings generated by the Phase I and II methodology can be integrated into existing risk management methodologies used in the industry. Alternatively, the risk assessment and risk management methodology of the NHRM system can be used as outlined in this paper.

Research projects and infrastructure facilities at universities today face special challenges: on the one hand, an orientation towards supra-regional standard services is required. On the other hand, many projects require research-related services that allow for constructive, adapted and rapid assistance. The initiatives for a National Research Data Infrastructure (NFDI) or National High Performance Computing (NHR) promise solutions to this balancing act, but strong support structures and low-threshold services at the respective universities remain necessary. A change in peoples’ minds is also central to this process: new professional fields with a corresponding culture of recognition and incentive structures, the willingness to react flexibly and agilely to requirements, and the establishment of an enabling culture in which researchers and infrastructure facilities meet at eye level are prerequisites for actively shaping the change towards optimal research support.