The quality of care experienced was notably similar and very positive.

There was a significantly greater burden on physical health among pregnant women with COVID-19. Mental health and psychological status were similar in both groups. High quality of care during a pandemic is possible to deliver in a maternity setting, irrespective of COVID-19 status.

There was a significantly greater burden on physical health among pregnant women with COVID-19. Mental health and psychological status were similar in both groups. High quality of care during a pandemic is possible to deliver in a maternity setting, irrespective of COVID-19 status.

The extant literature is inconsistent over whether manic symptoms in first-episode psychosis (FEP) impact on its development and trajectory. This study addressed the following (1) Does Duration of Untreated Illness (DUI) and Duration of Untreated Psychosis (DUP) differ between FEP patients with and without manic symptoms? (2) Do manic symptoms in FEP have an impact on time to remission over 1year?

We used data from the National EDEN study, a longitudinal cohort of patients with FEP accessing early intervention services (EIS) in England, which measured manic, positive and negative psychotic symptoms, depression and functioning at service entry and 1year. Data from 913 patients with FEP (639 without manic symptoms, 237 with manic symptoms) were analysed using both general linear modelling and survival analysis.

Compared to FEP patients without manic symptoms, those with manic symptoms had a significantly longer DUI, though no difference in DUP. At baseline, people with manic symptoms had higher levels of positive and negative psychotic symptoms, depression and worse functioning. At 12months, people with manic symptoms had significantly poorer functioning and more positive psychotic symptoms. The presence of manic symptoms delayed time to remission over 1year. There was a 19% reduced rate of remission for people with manic symptoms compared to those without.

Manic symptoms in FEP are associated with delays to treatment. This poorer trajectory persists over 1year. They appear to be a vulnerable and under-recognised group for poor outcome and need more focussed early intervention treatment.

Manic symptoms in FEP are associated with delays to treatment. This poorer trajectory persists over 1 year. They appear to be a vulnerable and under-recognised group for poor outcome and need more focussed early intervention treatment.

Sepsis is common, deadly, and a major challenge to treat. Quinolones added to beta-lactam antibiotics are currently recommended as a second-line empiric regimen in sepsis, but the evidence regarding their benefits and harms is unclear.

To assess the benefits and harms of adding quinolones to standard care for sepsis.

We conducted a systematic review of randomized clinical trials with meta-analysis and Trial Sequential Analysis. We searched CENTRAL, MEDLINE, Embase, LILACS, SCI-Expanded, and BIOSIS.

Randomized clinical trials assessing the effects of adding any quinolone to standard care for children and adults with sepsis.

Two independent reviewers screened studies and extracted data. The certainty of the evidence was assessed by GRADE.

We included three trials randomizing 995 adults. All trials were at overall „high risk of bias.” All trials compared a quinolone (moxifloxacin, levofloxacin, or ciprofloxacin) and a beta-lactam antibiotic versus the same beta-lactam antibiotic. We found no evidence of an effect of adding quinolones to beta-lactam antibiotics when assessing all-cause mortality (RR 1.07, 95% CI 0.86 to 1.33; 2 trials; 915 participants; very low certainty of evidence) and serious adverse events (RR 1.00, 95% CI 0.67 to 1.50; 977 participants; two trials; very low certainty of evidence). No trials reported on quality of life.

The effects of adding quinolones to beta-lactam antibiotics for the treatment of sepsis were unclear for all outcomes. Additional trial data are warranted to support the recommendation of empirical use of quinolones for sepsis.

The effects of adding quinolones to beta-lactam antibiotics for the treatment of sepsis were unclear for all outcomes. Additional trial data are warranted to support the recommendation of empirical use of quinolones for sepsis.The aim of the study is to interpret the effects of air-impingement jet drying (AIJD) on drying kinetics, color, polyphenols, and antioxidation ability of Boletus aereus slices. Page model was most suitable for expressing and predicting AIJD curves of B. aereus slices. The moisture-effective diffusion coefficient of AIJD ranged from 7.8876 × 10-10 to 2.1426 × 10-9 m2 /s, and AIJD also showed high efficiency due to its low activation energy (45.37 kJ/mol). AIJD is better for B. aereus slices than hot air drying (HAD) in accelerating the drying rate (DR) and shortening drying time, and maintaining color. p-hydroxybenzoic acid, protocatechuic acid, and rutin were identified in B. aereus slices by ultra high-performance liquid chromatography coupled with triple quadrupole mass spectrometry (UHPLC-QqQ-MS). Total polyphenols, flavanone, phenolic acids, and antioxidant activities were significantly lower in dried B. aereus slices than those in fresh B. aereus slices. In AIJD, drying temperature had the greatest effect on the quality of B. aereus slices, and AIJD at 50 °C is the optimum drying condition for B. aereus slices. PRACTICAL APPLICATION Boletus aereus occurs in many countries all over the world. In this paper, the effect of AIJD on color, polyphenols, and antioxidation ability in B. aereus slices and its drying kinetics were studied. AIJD is an efficient drying method for B. aereus by decreasing its drying time, increasing DR, and protecting the color of B. aereus. These findings have provided important reference basis for people to have a better understanding of AIJD method, which was used to dry B. aereus. This study also provides a new technique for drying B. aereus, which could improve dry efficiency and reduce drying cost.Divorce has received scant attention in Iran, despite the problems that arise for individuals and families and in social life. The present study aimed to find the divorce process of the Iranian couples among whom the woman was the divorce initiator. For this purpose, interviews were conducted, using the grounded theory method, with 34 Iranian divorcing men and women (women initiating a divorce and their spouses) to investigate their divorce experience. The results revealed that the psychological, communication, cultural, and social factors involved in the divorce phenomenon were observed in five stages (1) emergence of thinking about divorce, (2) hesitation on stay, (3) difficult decision-making, (4) separation, and (5) legal action. Despite more restrictive laws and more complicated social conditions for women initiating divorce than men, the number of women initiating the divorce is increasing in the changing cultural context of Iran. Therefore, we hope that our results on the divorce process help couples, families, and especially professionals plan preventive measures and develop clinical interventions targeting marriage and marital relationships.The Cardiff Acne Disability Index (CADI) is a questionnaire designed to measure the quality of life (QoL) of teenagers and young adults with acne. It has been used clinically and within therapeutic research globally. This review aims to appraise all published data regarding the clinical and research experience of CADI, its psychometric properties and validation, from its publication in 1992 until September 2020, into a single reference source. A literature search was conducted using Medline via Ovid, PubMed, EBSCOhost, Web of Science and Scopus. All full articles in the English language were included. Ninety-six clinical studies were identified and analysed. The CADI has been used in 44 different countries, including four multinational studies, and has validated translations in 25 languages. Twenty-nine therapeutic interventions have used CADI, demonstrating its responsiveness to change. Fourteen studies have assessed reliability through test-retest and internal consistency studies. Fifty-seven studies have demonstrated aspects of its validity through correlation to other measures and five studies have investigated the dimensionality of CADI. There is evidence of high internal consistency, test-retest reliability, responsiveness to change and significant correlation with other objective measures. The minimal clinically important difference and validated score meaning bands have not yet been reported. This information is needed to improve the interpretability of CADI scores for clinical use and in research. The authors of CADI have also rephrased question two of the measure to ensure inclusivity.Virgin coconut oil (VCO), an edible oil prepared from fresh coconut kernel by natural or mechanical means without undergoing chemical refining, has been in the limelight of research as functional food oil. The phenolic components in VCO have been accredited with these pharmacological benefits. The present study compared the phenolic constituents of freshly prepared fermentation processed (FVCO) and hot-pressed VCO (HVCO) and their anti-inflammatory efficacies. The biochemical analysis documented quantitative variation in the phenolic content, being higher in HVCO than FVCO (40.03 ± 5.8 µg and 25.55 ± 5.8 µg/mL of oil, respectively). In vitro studies observed nitric oxide radical scavenging efficacy (IC50 value of 14.84 ± 0.81 µg/mL) for HVCO polyphenols, which shows higher inhibition efficacy than FVCO (29.41 ± 1.7 µg/mL). In dextran and formalin mediated acute and chronic inflammation in mice, HVCO displayed more protective efficacy (40.5 and 46.4% inhibition) than FVCO (33.3 and 43.8% inhibition), which is similar to the standard diclofenac (55.6 and 59.8% inhibition). The study, thus, concludes that compared to FVCO, HVCO is a more active anti-inflammatory agent. PRACTICAL APPLICATION Virgin coconut oil, a widely used edible oil in South Asian countries, has been shown to have health benefits possibly exerted by the natural phenolics it contains. However, different modes of preparations of VCO determine the phenolic combinations and efficacy as well. Our study compared two different VCO preparations and suggests that the VCO prepared by the traditional way (HVCO) is pharmacologically potent than that prepared by simple fermentation process (FVCO) in reducing inflammation. The efficacy is attributed to the variations in phenolic profile revealed by LC-MS analysis. Hence, the current study suggests HVCO as a potential food supplement that can reduce the incidence of degenerative diseases.Keratoacanthoma (KA) is a common skin tumour that remains controversial regarding classification, epidemiology, diagnosis, prognosis and management. Classically, a KA manifests as a rapidly growing, well-differentiated, squamoid lesion with a predilection for sun-exposed sites in elderly people and a tendency to spontaneously regress. Historically, KAs have been considered a variant of cutaneous squamous cell carcinoma (cSCC) and are often reported as KA-type cSCC. However, the penchant for regression has led many to categorize KAs as biologically benign tumours with distinct pathophysiological mechanisms from malignant cSCC. The clinical and histopathological similarities between KA and cSCC, particularly the well-differentiated variant of cSCC, have made definitive differentiation difficult or impossible in many cases. The ambiguity between entities has led to the general recommendation for surgical excision of KAs to ensure a potentially malignant cSCC is not left untreated. This current standard creates unnecessary surgical morbidity and financial strain for patients, especially the at-risk elderly population.