Insufficient attention towards caregivers has resulted in the emergence of psychological and health complaints. Affliction tethers more towards spouses as compared to parents and females as compared to males. The role of sibling care givers was found to be no different from parents or spouses. Marital relationships were found to suffer the most, with the caregiver leaving the traumatic brain injury (TBI) patient in his time of need. The Brief Symptom Inventory (BSI) and family assessment device (FAD) predicted a correlation between patient variables and caregiver discontent. The Blacks/Hispanics proved to cope better with stress and their caregiver roles as compared to Whites. Time elapsed since the injury was found to relieve distress, while the surprising severity of the injury has no recorded impact. Social support or rather a lack of it has been seen to have an impact on family homeostasis, which can further be deteriorated by substance abuse by the patient. The therapeutic intervention found to be most advantageous was the D'Zurilla and Nezu social problem-solving model. Current evidence suggests that emphasis should be given on proper education and encouragement of caregivers before discharge of TBI patients from hospital to reduce the incidence of stressors. Additionally, counseling sessions should be led by professionally led support groups for dealing with psychological symptoms and peer-led group to eliminate social insecurities of caregivers.
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Employing floating treatment wetlands (FTWs) and constructed wetlands (CWs) is one of the most eco-friendly strategies for the bioremediation of water contaminants. Here, the efficiency of FTWs and CWs was compared for the degradation of phenanthrene-contaminated water for the first time. The FTWs and CWs were established by vegetated Phragmites australis in phenanthrene (1000 mg L−1)-contaminated water. Both wetlands were augmented with a bacterial consortium of four bacterial strains: Burkholderia phytofirmans PsJN, Pseudomonas anguiliseptica ITRI53, Arthrobacter oxydans ITRH49, and Achromobacter xylosoxidans ITSI70. Overall, the wetlands removed 91–93% of the phenanthrene whilst the augmentation of the bacterial strains had a synergistic effect. In comparison, the CWs showed a better treatment efficiency, with a 93% reduction in phenanthrene, a 91.7% reduction in the chemical oxygen demand, an 89% reduction in the biochemical oxygen demand, and a 100% reduction in toxicity. The inoculated bacteria were found growing in the shoots, roots, and water of both wetlands, but were comparatively better adapted to the CWs when compared with the FTWs. Similarly, the plants vegetated in the CWs exhibited better growth than that observed in the FTWs. This study revealed that the FTWs and CWs vegetated with P. australis both had promising potential for the cost-effective bioremediation of phenanthrene-contaminated water.
Triple negative breast cancer (TNBC) has a higher mRNA expression of programmed cell death ligand 1 (PD-L1) which is a ligand to programmed cell death protein 1 (PD-1). The binding of the ligand leads to suppressed activity of T-cell-mediated immune response against cancer cells. The approval of anti-PD-L1 drugs including pembrolizumab and atezolizumab in subgroups of TNBC offer potential improvement to the current treatment regimens available for TNBC. We conducted a meta-analysis to review the efficacy of pembrolizumab and atezolizumab for the treatment of TNBC in both adjuvant and neo-adjuvant settings. A systematic strategy was used as per the PRISMA 2020 statement. All statistical analyses were conducted using Review Manager 5.4. Outcome measures included objective response rate, progression free survival, overall survival in adjuvant therapy groups, and pathological complete response rates in neoadjuvant groups. Six clinical trials were included. For adjuvant therapies, the ORR (OR=1.26, P = 0.04) of Atezolizumab/Pembrolizumab plus chemotherapy was higher in intention to treat (ITT) arms than the placebo groups in TNBC. A positive effect size was found for PFS in the ITT arms (Cohen’s d = 1.55, P<0.001). The Atezolizumab plus chemotherapy group had a positive effect size for OS compared to the control groups (Cohen’s d = 0.52, P<0.001). In the neo-adjuvant setting, patients in ITT arms had higher pCR rates as compared to the control groups (OR= 1.61, P = 0.001). Our findings collate evidence of pembrolizumab and atezolizumab as a viable treatment option among patients with TNBC with PDL1+ subgroups deriving benefits.
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