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Background Inappropriate hospital admissions compromise the efficiency of the health care system. This work analyzes, for the first time, the prevalence of inappropriate admission and its association with clinical and epidemiological patient characteristics. Objectives To estimate the prevalence, associated risk factors, and economic impact of inappropriate hospital admissions. Design and Participants This was a cross-sectional observational study of all hospitalized patients in a high complexity hospital of over 901 beds capacity in Spain. The prevalence of inappropriate admission and its causes, the association of inappropriateness with patients’ intrinsic risk factors (IRFs), and associated financial costs were analyzed with the Appropriateness Evaluation Protocol in a multivariate model. Main Measures and Key Results A total of 593 patients were analyzed, and a prevalence of inappropriate admissions of 11.9% (95% CI: 9.5 to 14.9) was found. The highest number of IRFs for developing health care-related complications was associated with inappropriateness, which was more common among patients with 1 IRF (OR [95% CI]: 9.68 [3.6 to 26.2.] versus absence of IRFs) and among those with surgical admissions (OR [95% CI]: 1.89 [1.1 to 3.3] versus medical admissions). The prognosis of terminal disease reduced the risk (OR [95% CI]: 0.28 [0.1 to 0.9] versus a prognosis of full recovery based on baseline condition). Inappropriate admissions were responsible for 559 days of avoidable hospitalization, equivalent to €17,604.6 daily and €139,076.4 in total, mostly attributable to inappropriate emergency admissions (€96,805.3). Conclusions The prevalence of inappropriate admissions is similar to the incidence found in previous studies and is a useful indicator in monitoring this kind of overuse. Patients with a moderate number of comorbidities were subject to a higher level of inappropriateness. Inappropriate admission had a substantial and avoidable financial impact.

The entry mode decision is a critical topic in international business. Several studies have tested the antecedents of entry mode choices and compared the outcomes after entry. However, the results reported in these studies are contradictory and difficult to explain. Furthermore, the reviews using qualitative approaches cannot statistically combine empirical results and fail to fully discuss these relationships. Additionally, the mediating effects remain unexamined in the existing studies. Drawing upon transaction cost economics and the resource-based view, this paper presents a meta-analysis that combines entry mode choices, antecedents and post-entry outcomes to address these issues. This meta-analysis is based on 1499 effect sizes from 230 published empirical studies. This study focuses on 15 antecedents as well as post-entry performance and survival of entry mode choices. In addition to bivariate relationships (i.e. how a single antecedent affects entry mode choices), the paper uses meta-analytic structural equation modelling to analyse the mediating effects of entry mode choices on the antecedent - outcome relationship.

Abstract: COVID-19 is a multisystem disease caused by SARS-CoV-2 and is associated with an imbalance between the coagulation and fibrinolytic systems. Overall, hypercoagulation, hypofibri-nolysis and fibrin-clot resistance to fibrinolysis predispose patients to thrombotic and thromboem-bolic events. In the lungs, the virus triggers alveolar and interstitial fibrin deposition, endothelial dysfunction, and pulmonary intravascular coagulation, all events intrinsically associated with the activation of inflammation and organ injury. Adding to the pathogenesis of COVID-19, there is a positive feedback loop by which local fibrin deposition in the lungs can fuel inflammation and con-sequently dysregulates coagulation, a process known as immunothrombosis. Therefore, fibrinolysis plays a central role in maintaining hemostasis and tissue homeostasis during COVID-19 by cleaning fibrin clots and controlling feed-forward products of coagulation. In addition, components of the fi-brinolytic system have important immunomodulatory roles, as evidenced by studies showing the contribution of Plasminogen/Plasmin (Plg/Pla) to the resolution of inflammation. Herein, we review clinical evidence for the dysregulation of the fibrinolytic system and discuss its contribution to thrombosis risk and exacerbated inflammation in severe COVID-19. We also discuss the current concept of an interplay between fibrinolysis and inflammation resolution, mirroring the well-known crosstalk between inflammation and coagulation. Finally, we consider the central role of the Plg/Pla system in resolving thromboinflammation, drawing attention to the overlooked consequences of COVID-19-associated fibrinolytic abnormalities to local and systemic inflammation.

Massive rotator cuff tears can lead to large cysts, extending from the subacromial space through the acromioclavicular joint into a subcutaneous cyst, with a typical “geyser sign” on magnetic resonance imaging (MRI). To our knowledge, no cases of transdeltoid pseudo-cyst as first manifestation of septic arthritis have ever been reported.A 79-year-old female presented to the Emergency Department (ED) with a two-day evolution of a painful tumefaction over her right shoulder. She had been admitted to the ED 16 days before, after being bitten by a dog. Tumefaction drainage revealed a total cell count of 50320 cells/mL. MRI revealed glenohumeral joint cavity’s fluid “decompression” through the deltoid. Septic arthritis was presumed as the cause of the pseudo-cyst, configuring a “pseudo-geyser sign” on MRI.Septic arthritis is an orthopedic emergency, whose early diagnosis, ED referral and treatment are crucial.

Copyright © 2022 The Authors. As innovation is inherently risky and uncertain, it is common for firms to suspend or abandon new product/service development projects that cannot achieve pre-defined objectives. Multiple cases exist where firms have attempted to resume the development of an innovative product or service after previously suspending or abandoning it prior to completion. Research on this important innovation recycling activity is surprisingly scarce, despite its critical role in mitigating risk in the context of high environmental uncertainty. We draw our inferences from Sub-Saharan Africa (SSA), where innovation resources are relatively limited and environmental uncertainty and institutional voids prevail, a context that encourages the use of innovation recycling. This study examines how innovation recycling influences a firm's innovation ability and the moderating impact of innovation sourcing modes using a knowledge-based view of the firm and arguments from transaction cost economics. We retrieved data from the World Bank Enterprise Survey and the Innovation Follow-up Survey of 1076 firms located in eight SSA countries (Ghana, Malawi, Namibia, South Sudan, Sudan, Tanzania, Uganda, and Zambia) spanning from 2011 to 2014 to test our conceptual model. Our findings show that (1) innovation recycling has a positive influence on a firm's innovation ability and (2) this relationship is moderated by different innovation sourcing modes. These findings enrich the theory and imply that firms operating in developing countries need to develop innovation recycling by focusing on sourcing knowledge within, rather than across, firm boundaries.

International audience; There are strong links between heritage and the environment yet, heritage is not fully included in existing ecosystem-based frameworks. Different understandings of heritage values exist, and heritage values are not yet related to key value categories in environmental values research.To address this gap and facilitate a common values-based approach, we develop a novel framework that links heritage and environmental values. First, we expand the understanding of heritage values by linking heritage to key environmental value categories. We then use the Life Framework of Values to show how heritage features in the different ways in which people relate to the world.The resulting heritage values framework is operationalised by applying it to six case examples drawn from participatory research on the governance of European coastal and maritime heritage.We found that the environment was not only considered to be a setting for heritage but was itself valued as heritage in different ways; that heritage is not extrinsic to the environment but is also a way in which people see meaning in the environment; and that multiple value frames and types were involved in shaping this perspective. The results highlight important discrepancies between stakeholders' perspectives and existing management approaches.Applying the framework shows the ways in which heritage and nature are entwined by providing a structure for elucidating what can be valued as heritage, what values can inform heritage values and how heritage values feature in human–nature relations.

Este artigo apresenta o desenvolvimento de um projeto de bancada didática de hidráulica simples e de baixo custo, iniciado por meio da necessidade adquirida pela Faculdade de Tecnologia SENAI Roberto Mange ligada ao trabalho de conclusão de curso dos acadêmicos de Tecnólogo de Manutenção Industrial. O projeto enfatiza a importância da execução de atividade práticas em conjunto com as aulas teóricas durante a graduação.Além da descrição dos materiais e métodos utilizados, apresentam- se os resultados e discussões provenientes das comparações orçamentárias. A conclusão deste trabalho é positiva, pois se apresenta uma proposta que atende melhor aos cursos de graduação com melhor relação custo-benefício.

Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation is currently described as a mainstay when it comes to treatment of cardiac patients (pts), mainly ischemic heart disease. Despite this, referral and implementation suffered a decrease amidst covid outbreak. Purpose To describe, in a cardiac rehabilitation center, the real life data regarding programme effects during covid pandemic and after the release of most sanitary measures. Methods Prospective cohort study which included consecutive pts who were participating in a center-based CR program lasting 8-12 weeks from 2019 to 2021. The CR program included initial evaluation by cardiologist and rehabilitation specialist with collection of clinical characteristics, three times weekly supervised exercise sessions, appointment with rehabilitation nurse, nutritionist and psychologist and educational sessions. Lab tests, echocardiogram and CPET were done before and after completion of the program. Results We analyzed 349 patients, mean age 60 ± 11,14 years, 83% male, most of them referred because of ischemic heart disease (83,6%), followed by valvular heart disease (7,0%). Mean ejection fraction was 48,4 ± 12,8 and most patients were in NYHA class II (65,1%). After program completion we noticed a clear benefit regarding functional class (NYHA before and after CRP: NYHA I 25,7% vs 63,7%; NYHA II 65,1% vs 34,5%; NYHA III 9,2% vs 1,9%; p Conclusions Despite constraints in CR programs during the pandemic, the long term data shows that maintaining such programs has an important effect when it comes to risk factor control and clinical improvement.

Objectives Analyze the diagnostic and prognostic value of the sFlt-1/PlGF ratio in pregnant women with at least one sign/symptom of suspected/diagnosed pre-eclampsia. Methods This retrospective observational study included 170 pregnant women with at least one sign/symptom of pre-eclampsia, who had sFlt-1/PlGF ratio values. The following information was evaluated: pregnant women’s demographic data and clinical history; laboratory data (urine protein/creatinine ratio; sFlt-1/PlGF ratio); signs and symptoms presented; clinical outcome; fetal complications; data related to childbirth. Statistical analysis was performed by R Software Version 3.5.2. Results Among the 170 patients, 78 presented pre-eclampsia. The median sFlt-1/PlGF ratio was significantly higher [143.1 (2.2–2,927.1)] for women who presented pre-eclampsia than for women without pre-eclampsia [33.5 (0.8–400.2)]. The negative predictive value of sFlt-1/PlGF ratio 85 or 110 (for late onset pre-eclampsia) was 76.4 % (95 % CI, 66.2–84.8 %). sFlt-1/PlGF >85 or 110 was associated with pre-eclampsia clinical development, fetal complications, shorter gestational age at birth, higher number of caesarean deliveries and lower birth weight. Conclusions The sFlt-1/PlGF ratio, together with the standard diagnostic criteria, can be used to rule out pre-eclampsia, identify high-risk patients and predict the occurrence of adverse outcomes.

This study analyses how recruiting messages showing commitment to sustainability influence job seekers' perceptions of organisational attractiveness. To address a call from prior research, we propose that organisational prestige mediates the positive relationship between commitment to sustainability and attractiveness. As job seekers from different cultures can have different responses to companies' information, the moderating role of the masculinity dimension of national culture is also examined. In a study of 412 job seekers from four different countries, experimental manipulation was used to assess perceptions of different recruiting messages containing information on business sustainability. Results support the proposed relationships. Theoretical and practical contributions include the integration of signalling and social identity theories to considering a wide variety of mechanisms which show how individuals are attracted to organisations and useful information for helping managers to recruit young talent. Using a sample of young part-time job seekers is a limitation of this work SI

Gouty arthritis (GA) is an inflammatory arthritis triggered by the deposition of monosodium urate monohydrate (MSU) crystals, causing pain, inflammation, and joint damage. Several drugs are currently employed to manage acute flares of GA, but they either have limited effectiveness or induce severe adverse reactions. Ouratea spectabilis is traditionally used in Brazil to treat gastric ulcers and rheumatism. The ethanolic extract of O. spectabilis stems (OSpC) and four biflavanones (ouratein A – D) isolated thereof were evaluated in a murine model of GA induced by the injection of MSU crystals. The underlying mechanism of action of ouratein D was investigated in vitro in cell cultures by measurement of IL-1β levels by ELISA and Western blot analysis. The administration of OSpC (10, 30 or 100 mg/Kg, p. o.) reduced the migration of total inflammatory cells, monocytes, and neutrophils and diminished the levels of IL-1β and CXCL1 in the synovial tissue. Among the tested compounds, only ouratein D (1 mg/Kg) reduced the migration of the inflammatory cells and it was shown to be active up to 0.01 mg/Kg (equivalent to 0.34 nM/Kg, p. o.). Treatment of pre-stimulated THP-1 cells (differentiated into macrophages) or BMDMs with ouratein D reduced the release of IL-1β in both macrophage lines. This biflavanone reduced the activation of caspase-1 (showed by the increase in the cleaved form) in supernatants of cultured BMDMs, evidencing its action in modulating the inflammasome pathway. The obtained results demonstrate the anti-gout properties of O. spectabilis and point out ouratein D as the bioactive component of the assayed extract.

cis-Aconitic acid is a constituent from the leaves of Echinodorus grandiflorus, a medicinal plant traditionally used in Brazil to treat inflammatory conditions, including arthritic diseases. The present study aimed to investigate the anti-arthritic effect of cis-aconitic acid in murine models of antigen-induced arthritis and monosodium urate-induced gout. The possible underlying mechanisms of action was evaluated in THP-1 macrophages. Oral treatment with cis-aconitic acid (10, 30, and 90 mg/kg) reduced leukocyte accumulation in the joint cavity and C-X-C motif chemokine ligand 1 and IL-1β levels in periarticular tissue. cis-Aconitic acid treatment reduced joint inflammation in tissue sections of antigen-induced arthritis mice and these effects were associated with decreased mechanical hypernociception. Administration of cis-aconitic acid (30 mg/kg p. o.) also reduced leukocyte accumulation in the joint cavity after the injection of monosodium urate crystals. cis-Aconitic acid reduced in vitro the release of TNF-α and phosphorylation of IκBα in lipopolysaccharide-stimulated THP-1 macrophages, suggesting that inhibition of nuclear factor kappa B activation was an underlying mechanism of cis-aconitic acid-induced anti-inflammatory effects. In conclusion, cis-aconitic acid has significant anti-inflammatory effects in antigen-induced arthritis and monosodium urate-induced arthritis in mice, suggesting its potential for the treatment of inflammatory diseases of the joint in humans. Additionally, our findings suggest that this compound may contribute to the anti-inflammatory effect previously reported for E. grandiflorus extracts.

Due to the sensitivity of the cowpea to water deficit during the dry season in the Amazonian environment, there is a need for studies related to water management and the optimization of annual yield. Thus, the objective was to estimate the crop evapotranspiration (ETc) and the actual evapotranspiration (ETr), whilst also evaluating the effect of different irrigation depths on the yield response factor (Ky) and dry biomass (Kss) of the cowpea cultivar BR3-Tracuateua under edaphoclimatic conditions in the Amazon region. The experiment was carried out in randomized blocks, with six replicates and four treatments: T1 (100% ETc), T2 (50% ETc), T3 (25% ETc), and T4 (0% ETc), commencing in the reproductive phase with a drip irrigation system. The total evapotranspiration recorded for the cowpea cultivar BR3-Tracuateua across the four treatments was 337.5, 284.35, 258.62, and 219.82 mm with an average consumption of 4.6, 3.90, 3.54, and 3.01 mm d-1 for T1, T2, T3, and T4, respectively. The emergence phase showed evaporation rate of 5.19 mm d-1 and the reproductive, vegetative, and senescence ETc phases showed evaporation of 4.87, 4.84, and 3.32 mm d-1, respectively. The flowering stage had the greatest water demand (5.88 mm d-1). There was a significant difference in the crop yield among all treatments, with decreases of 18.91, 33.12 and 57.17% for T2, T3 and T4 in the grain yield, with a Ky of 1.48, and Kss of 2.03, 1.08, and 0.87 for the flowering, grain filling, and physiological maturation stages, respectively. RESUMO Devido à sensibilidade do feijão-caupi ao déficit hídrico no período de estiagem no ambiente amazônico, surge a necessidade de estudos relacionados com a gestão da água e otimização da produção anual por área. Assim, objetivou-se estimar a evapotranspiração da cultura (ETc) e a evapotranspiração real (ETr) e avaliar o efeito de distintas lâminas de irrigação sobre o fator de resposta da produção (Ky) e da biomassa seca (Kss) do feijão-caupi cultivar BR3-Tracuateua nas condições edafoclimáticas da região amazônica. O experimento foi realizado em blocos ao acaso, com seis repetições e quatro tratamentos: T1 (100% ETc), T2 (50% ETc), T3 (25% ETc) e T4 (0% ETc), iniciados na fase reprodutiva com sistema de irrigação por gotejamento. A evapotranspiração total do feijão-caupi cultivar BR3-Tracuateua foi de 337.5, 284.35, 258.62 e 219.82 mm com consumo médio de 4.6, 3.90, 3.54 e 3.01 mm d-1 para T1, T2, T3 e T4, respectivamente. A fase de emergência apresentou evaporação de 5.19 mm d-1 e as fases reprodutiva, vegetativa e senescência ETc média de 4.87, 4.84 e 3.32 mm d-1, respectivamente. O estádio de floração obteve maior demanda hídrica (5.88 mm d-1). Houve diferença significativa na produtividade entre todos os tratamentos com quedas no rendimento dos grãos de 18.91, 33.12 e 57.17% para T2, T3 e T4 com Ky de 1.48 e Kss de 2.03, 1.08 e 0.87 para os estádios de floração, enchimento de grãos e maturação fisiológica, respectivamente.

An ample variety of parasitic associations are found between mollusks and nematodes, in which the mollusks may act as intermediate, paratenic or definitive hosts. Some free-living nematodes, in particular those of the order Rhabditida, are also found frequently in terrestrial mollusks. The present study reviews the results of the parasitological testing on samples of terrestrial mollusks conducted at the Brazilian National Reference Laboratory for Schistosomiasis and Malacology between 2008 and 2021. The samples were supplied primarily by the public health authorities from the different regions of Brazil, but also by research institutions and general population. The mollusks were processed individually and the obtained larvae were identified from their morphology and, whenever necessary, by molecular analysis. A total of 1,919 service orders were registered during the period, including 19,758 mollusk specimens collected from 23 of the 26 Brazilian states, as well as the Federal District, totalizing 145 municipalities. There was a marked predominance of the synanthropic species that are widely distributed in Brazil—Achatina fulica (87.08%), Bulimulus tenuissimus (4.18%), Bradybaena similaris (2.06%), and Sarasinula linguaeformis (1.50%). Of the 16,750 terrestrial mollusks examined, nematodes were recorded in 1,308 service orders, with the predominance of the superfamily Metastrongyloidea, in 616 service orders. They included Angiostrongylus cantonensis, rat lungworm, which was found in 252 samples, and Aelurostrongylus abstrusus in 145 samples. Free-living nematodes were found in 952 samples, Ancylostoma caninum and Cruzia tentaculata (previously identified as Strongyluris sp.) in one and 275 samples, respectively, and other parasites in 210 samples (not identified). The results highlight the diversity of the associations between nematodes and terrestrial mollusks in Brazil, in particular invasive and synanthropic species, with emphasis on the giant African land snail, Achatina fulica. They demonstrate the prominent role of this species of mollusk in the transmission of medically-important nematodes, which affect the health of both humans and animals, in particular eosinophilic meningitis, which is caused by Angiostrongylus cantonensis. This reinforces the need for more studies, and justify the growing demand for information as well as parasitological diagnosis of this mollusk, given its wide distribution in Brazil and its impact as an urban pest.

Phosphoinositide-3-kinases (PI3Ks) are enzymes involved in signalling and modification of the function of all mammalian cells. These enzymes phosphorylate the 3-hydroxyl group of the inositol ring of phosphatidylinositol, resulting in lipid products that act as second messengers responsible for coordinating many cellular functions, including activation, chemotaxis, proliferation and survival. The identification of the functions that are mediated by a specific PI3K isoform is complex and depends on the specific cell type and inflammatory context. In this chapter we will focus on the role of PI3K isoforms in the context of innate immunity, focusing on the mechanisms by which PI3K signalling regulates phagocytosis, the activation of immunoglobulin, chemokine and cytokines receptors, production of ROS and cell migration, and how PI3K signalling plays a central role in host defence against infections and tissue injury.

Introduction The increase in life expectancy is a reality and cardiovascular disease incidence rises with it. The elderly are fragile patients with high prevalence of multiple comorbidities. Anaemia is one of them and, in most cases, has multifactorial causes. After an acute coronary syndrome (ACS), the thrombotic versus haemorrhagic risks in these patients are hard to balance. Aim The aim of this study is to evaluate prognostic impact of anaemia in the elderly after an ACS. Methods Retrospective analysis of consecutive patients admitted to a single Intensive Coronary Unit between 2009 and 2016 with the diagnosis of ACS. Patients younger than 80 years old were excluded. A complete blood count was collected upon admission and anaemia was defined for haemoglobin values below 12.5mg/dL. Cox regression analysis and Kaplan-Meyer curves were conducted to determine prognostic value of anaemia in this specific population. Multivariate analysis with other comorbidities and antithrombotic therapy was also performed. Results A total of 353 patients (median age of 84.0±6.0 years old; 52.1% males; 51.3% with anaemia) were enrolled. In cox regression analysis, anaemia predicted mortality (HR 1.614; 95% CI 1.199–2.172; P=0.002). In multivariate analysis – including gender, presence of hypertension, diabetes, chronic kidney disease and atrial fibrillation (AF) at admission, anaemia proved to be an independent predictor of mortality (HR 1.521, 95% CI 1.119–2.069, P=0.007). Adding all previous and discharge antithrombotic therapy – antiplatelet inhibition and oral anticoagulants – to the equation, anaemia maintained its prognostic value (HR 2.157; 95% CI 1.130–4.116; P=0.020). Both AF and being discharged from the hospital with ticagrelor also increased mortality risk in these patients (HR 2.188, 95% CI 1.177–4.070, P=0.13 for AF; HR 1.906, 05% CI 1.011–3.594, P=0.046 for ticagrelor at discharge). Conclusions After an ACS, anaemia proved to be an independent predictor of mortality in the elderly. This emphasizes the importance of its adequate aetiology investigation and treatment and careful selection of antithrombotic therapy following an ACS. Funding Acknowledgement Type of funding sources: None.

O desenvolvimento de resiliência econômica é uma das discussões priorizadas nas 5 últimas ocorrências do Fórum Econômico Mundial. Desde a Grande Recessão (2008), diversos trabalhos se dedicaram a definir, mensurar e recuperar fatores que expliquem a diferença entre economias que superam desastres econômicos rapidamente, daquelas que demoram ou precisam de aporte externo. O presente trabalho utiliza bases históricas massivas da ONU para treinar diferentes modelos supervisionados sobre a economia de dezenas de países, apresentando as vantagens de utilizar uma modelagem que considere informações da vizinhança por meio de um grafo dinâmico. Resultados mostram um ganho de até 19% (F1-Score) na previsão de crise e estabilidade

Electrodermal activity (EDA) can be defined as an electrical property of the skin, measured in the palm and sole, related to the level of conductivity, influenced by the sweat level that may depend on various stimuli. Different equipments have been used to capture EDA with high levels of reliability, validity, and responsiveness, however these values vary according to the site of measurement. The increased use of EDA wrist-based systems highlights the need of characterizing the psychometric properties of these kind of systems. The aim of this chapter is to review the validity, reliability, and responsiveness of EDA measurement in the wrist. Previous studies have demonstrated that wrist measurement present low to moderate correlations, against the gold standard systems, with moderate levels of responsiveness, while no study addressed reliability. Wrist EDA measurement could be therefore an acceptable option, however, more studies are demanded not only to assess related values of reliability, as well to best characterize validity and responsiveness measures.

Entrepreneurs create businesses and employment. However, their behaviors might generate negative outcomes. Since external funding for startups is vital and challenging to get, this ecosystem becomes a breeding ground for unethical behaviors. This paper will explore the association between the tolerance to unethical behaviors and the Dark Triad Traits (DT) of personality, as well as the moderator role of being an entrepreneur in this relationship. For that purpose, 84 entrepreneurs and 112 non-entrepreneurs completed a survey comprising the Dirty Dozen Scale to assess the DT and the new Tolerance to Unethical Behaviors in Entrepreneurship (TUBE) scale which was able to distinguish entrepreneurs from non-entrepreneurs. Findings suggest that entrepreneurs show higher levels of Machiavellianism and tolerance to unethical behaviors than non-entrepreneurs.

Li–O₂ battery technology offers large theoretical energy density, considered a promising alternative energy storage technology for a variety of applications. One of the main advances made in recent years is the use of soluble catalysts, known as redox mediators (RM), decreasing the charge overpotential and improving cyclability. Despite its potential, much is still unknown regarding its dynamic, especially over higher loading electrodes, where mass transport may be an issue and the interplay with common impurities in the electrolyte, like residual water. Here we perform for the first time an operando XRD characterization of a DMSO-based LiBr mediated Li–O₂ battery with a high loading electrode based on CNTs aiming to reveal these dynamics and track chemical changes in the electrode. Our results show that, depending on the electrode architecture, the system’s issue can move from catalytic to a mass transfer. We also assess the effect of residual water in the system to better understand the reaction routes. As a result, we observed that with DMSO, the system is even more sensitive to water contamination compared to glyme-based studies reported in the literature. Despite the activity of LiBr on the Li-peroxide oxidation and its contribution to cyclability, with the system and electrode configuration used in this study, we verified that a mass transfer limitation caused a cell “sudden death” caused by clogging after cycling.

Background There are now a growing number of licensed biological therapies for patients with Crohn’s disease (CD) but given the costs of long-term maintenance treatment, as well as some concerns about potential side effects, there has been increasing interest in elective biological treatment discontinuation in selected patients, after a period of sustained remission. Following discontinuation, in cases of relapse, limited but reassuring evidence has suggested that remission may often be regained by retreatment with the same biological agent. Therefore, a concept has emerged where cycles of biological therapy might be used. If this treatment strategy were applied in a subgroup of patients at low-risk of relapse, cycling might allow lower, overall drug exposure but still enable appropriate disease control. However, currently, there remains uncertainty about the benefit-risk balance for using cycles of biological treatment in patients with CD. Methods An expert panel was convened by the European Crohn’s and Colitis Organisation (ECCO) to review the published literature and agree a series of consensus practice positions (CPPs) on the topic of biological treatment cycles (biocycling). An open-call was announced to all ECCO members, following which 15 individuals were selected based on their expertise, and three subgroups were formed. The panel aimed to provide evidence-based guidance to support shared decision-making. Results A total of 14 CPP consensus statements were developed following comprehensive review of the literature. The statements evaluated multiple different aspects of biological treatment discontinuation and cycling, including the risk of relapse after elective treatment discontinuation, predictors of likely relapse or remission, safety, patient preferences and pharmacoeconomic aspects. Discussion and a preliminary voting round took place, with subsequent revision of CPP statements and supporting text, followed by a further meeting with voting to agree on final statements. Conclusion With increasing focus on patient preferences, long-term safety and costs, elective biological treatment discontinuation may be considered for some patients with CD in remission. In cases of relapse, there have been reassuring findings on subsequent retreatment with the same biological agent. However, there is a need for more data to support routine elective treatment discontinuation and cycling in CD, especially for newer biological agents. In particular, randomised, controlled trials comparing biological cycling to current maintenance therapy strategies would be highly informative. Currently, discussions about biological treatment discontinuation and cycling should be individualised, to enable shared decision-making by patients with their clinicians.

To assess the efficacy of washing cloth masks, we simulated SARS-CoV-2 contamination in tricoline fabric and tested decontaminants to reduce viral particles. Viral suspensions using two variants (B.1.1.28 and P.1) were inoculated in these fabrics, and the inactivation kinetics were evaluated after washing with various household disinfection products (Soap powder, Lysoform®, Hypochlorite sodium and 70% Alcohol), rinse numbers, and exposure times. Afterward, the fabrics were washed in sterile water, and viral RNA was extracted and amplified using RT-qPCR. Finally, viral replication in cell cultures was examined. Our findings show that all biocidal treatments successfully disinfected the tissue tested. Some products showed less reduction in viral loads, such as soap powder (1.60 × 104, 1.04 × 103), soap powder and Lysoform® (1.60 × 104, 1.04 × 103), and alcohol 70% (1.02 × 103, 5.91 × 101), respectively. However, when sodium hypochlorite was used, this reduction was significantly increased (viral inactivation in 100% of the washes). After the first wash, the reduction in the number of viral particles was greater for the P.1 variant than for the B.1.1.28 variant (W = 51,759, p < 0.05). In conclusion, the role of sodium hypochlorite in cloth mask disinfection may also have implications for future health emergencies as well as recommendation by WHO.

Nanotechnology for healthcare is coming of age, but automating the design of composite materials poses unique challenges. Although machine learning is supporting groundbreaking discoveries in materials science, new initiatives leveraging learned patterns are required to fully realize the promise of nanodelivery systems and accelerate development pipelines.

Aims Classical theory predicts that herbivores impact herb assemblages and soil nitrogen (N) cycling through selective plant consumption and the deposition of N-rich waste, with effects dependent upon ecosystem N availability. Herbivores are predicted to accelerate N cycling when N availability is high and decelerate cycling when availability is low. However, experimental tests of these theories in natural systems are limited and have yielded contradictory results. California’s widespread chaparral shrublands provide a tractable system in which to test these theories. They are prone to periodic crown fire, which temporarily removes living shrub cover, deposits mineral N on soils and allows diverse herbaceous assemblages to dominate the landscape for 3–5 years. Chaparral is also increasingly vulnerable to herbaceous invasion; mammalian herbivory may limit the establishment of non-native herbs in the shrub understory. Methods We implemented a 2-year herbivore-exclosure experiment (Hopland, CA) to assess the impact of mammalian herbivory during early post-fire chaparral succession, both on herbaceous plant assemblages and soil N and C cycling. We predicted that, in high-N post-fire conditions, mammalian herbivory would not demonstrate a strong preference for N-fixing herbs, would accelerate N cycling and would reduce the abundance of non-native herbs. Important Findings Excluding mammalian herbivores increased herb standing biomass by 54%, but changed neither the relative abundance of N-fixing vs. non-N-fixing herbs nor any measure of N or C cycling. Herbivore impacts on nutrient cycling may not be significant over the 2-year time scale of the experiment and physical effects of herbivore activity could have counteracted the influence of plant litter and animal dung/urine inputs. Mammalian herbivores concentrated their feeding on typical non-native herbs, slightly decreasing their relative abundance; however, mammalian herbivory was not sufficient to stem the invasion of chaparral by invasive herbs or alter C and N cycling over the first 2 years after fire.

Inflammation is generally accepted as a component of the host defence system and a protective response in the context of infectious diseases. However, altered inflammatory responses can contribute to disease in infected individuals. Many endogenous mediators that drive the resolution of inflammation are now known. Overall, mediators of resolution tend to decrease inflammatory responses and provide normal or greater ability of the host to deal with infection. In the lung, it seems that pro-resolution molecules, or strategies that promote their increase, tend to suppress inflammation and lung injury and facilitate control of bacterial or viral burden. Here, we argue that the demonstrated anti-inflammatory, pro-resolving, anti-thrombogenic and anti-microbial effects of such endogenous mediators of resolution may be useful in the treatment of the late stages of the disease in patients with COVID-19.

Funding Acknowledgements Type of funding sources: None. Background As heart failure (HF) is a progressive disease, there has been a raising idea that considering the absence of echocardiographic improvement as non-response to cardiac resynchronization therapy (CRT) may not be appropriate. In fact, in some classical echocardiographic non-responders, CRT might have prevented HF deterioration. Purpose Our aim was to compare the composite outcome of death and re-admissions due to HF according to a new classification of CRT response: responders, non-progressors and progressors. Methods We included 144 consecutive patients with HF, left ventricle (LV) ejection fraction < 40% and QRS duration > 120mseg submitted to CRT implantation. Patients were divided into 3 groups according to the variation of LV end-systolic volume (LVESV) at 6-month: ≥15% reduction in LVESV - responders (R); 0–15% reduction in LVESV – non-progressors (NPr); increase in LVESV – progressors (Pr). A long-term follow-up (4.9 ± 2.9 years) was performed targeting mortality and re-admissions due to HF. Results In our population, 78 patients (54.2%) were classified as R, 21 (14.5%) as NPr and 45 (31.3%) as Pr. Baseline comparison between groups is presented in table 1. Compared with R, N-Pr had ischemic aetiology more frequently. The prescription of digoxin was more common in Pr. The Kaplan-Meier curves (figure 1) demonstrate that the composite outcome of death and re-admission due to HF had a lower incidence in R, but was similar between N-Pr and Pr. After adjustment of possible confounders (ischemic aetiology and digoxin use), the type of response to CRT remained as the only predictor of outcomes (OR 0.61; CI 0.41-0.90). 144 Conclusion In our population, patients without progression of HF had a similarly negative prognosis to the ones that deteriorated. Hence, positive LV remodelling, and not only stabilization seems to be necessary to improve long-term prognosis.

Funding Acknowledgements Type of funding sources: None. Introduction In recent years it has been proposed the concept of cardiorespiratory optimal point (COP) to best characterize populations who underwent cardiac rehabilitation programmes (CRP). The COP is defined as the minimum ratio between ventilation and oxygen consumption (VE/VO2) obtained during the cardiopulmonary exercise test (CPET) and it has been suggested that COP values > 30 conveyed worse prognosis. Purpose To validate OP as a predictor of events and its correlation with exercise activity and quality of life on the long term. Methods Single center observational study of patients enrolled on CRP - from February 2018 to May 2019 – who did CPET as part of routine evaluation. COP was defined as the lowest point of VE/VO2 ratio. Clinical and laboratorial characteristics were obtained at admission and discharge of CRP. Exercise practice was accessed using IPAQ questionnaire and quality of life was assessed based on a validated inquire - Kansas City Cardiomyopathy Questionnaire (KCCQ-23) – both by phone interview. Results A total of 78 patients (mean age 63.2 ±11.6, 84.6% male) were evaluated and followed for a mean follow-up of 2,68±0,53 years. Main aetiology was ischemic heart disease (86%), followed by dilated cardiomyopathy (5,1%) and valvular heart disease (2,6%). A COP value above 30 correlated with a worse global score in KCC-23 (r =0.283, p = 0.47), and in particular domains such as frequency and severity of symptoms (p = 0.046, r 0.335 and p=0.16, r= 0.4, respectively), quality of life (p=0.039, r= 0.293) and social limitation (p = 0.001, r=0.5). COP also correlated with VO2 peak in basal CPET (p COP failed to predict events or levels of exercise activity on the long term, as evaluated by the IPAQ score. However, COP>30 did seem to correlate with a higher mortality rate on the follow-up although such trend was not statistically significant (possibly due to short follow-up time and sample size). Conclusion COP values > 30 identify patients with worse prognosis, predicting worse quality of life and higher mortality. Although it did not seem to be a good predictor of exercise adherence after CRP.

Funding Acknowledgements Type of funding sources: None. Introduction Due to the covid-19 outbreak, cardiac rehabilitation programs (CRP) underwent most needed adaptions to stay operative. To face all the requests and guarantee sanitary measures, we reduced the duration of the program from about 12 weeks to about 8 weeks, so we could have smaller groups but still respond to all patients who had been referred. However, it is still unclear whether less hours of contact and exercise sessions can achieve the same results as traditional CRP. Objective To analyse the effectiveness of shorter duration CRP on risk factor control and exercise tolerance after concluding the program. Methods Observational single center study including two groups of patients who underwent CRP: one group who had been in 12 weeks-CRP before the pandemic sprout and another group enrolled in an 8-week program after April 2021. Albeit differences in their duration, both CRP had the same structure: observation by cardiologist, physiatrist, specialist nurse, exercise (aerobic and strength exercises) and educational sessions, as well as nutrition and psychologist consultation. Results A total of 114 pts were analysed (mean age 62,4±11,6 years, 85.1% men, 86% with ischemic heart disease). Main comorbidities were hypertension (68,4%), dyslipidaemia (70%) and diabetes (30,7%). 78 pts completed a longer programme with 12 weeks duration while 36 underwent a shorter CRP with 8 weeks. There were no statistically significant differences between both groups regarding population demographics, aetiology, LVEF and co-morbidities. After CRP, there was significant improvement in risk factor control (mainly lipidic profile and weight) and echocardiographic parameters in both groups. We noted an important reduction in LDL levels (85±42.6mg/dL before CRP and 67.68±28.45mg/dL after), approaching the guideline recommended levels ( Exercise tolerance improved similarly in both groups, assessed by the time of exercise stress test: we registered a global increase of 65 ± 1.38s after CRP, with no difference between the two groups (p = 0.157). Conclusion Shorter duration CRP showed similar results concerning risk factor control, echocardiographic LVEF and exercise tolerance improvement, suggesting that they can be an effective alternative when needed.

Given the pandemic situation, there is an urgent need for an accurate test to monitor antibodies anti-SARS-CoV-2, providing crucial epidemiological and clinical information to monitor the evolution of coronavirus disease in 2019 (COVID-19) and to stratify the immunized and asymptomatic population. Therefore, this paper describes a new cellulose-based test strip for rapid and cost-effective quantitative detection of antibodies to SARS-CoV2 virus by colorimetric transduction. For this purpose, Whatman paper was chemically modified with sodium metaperiodate to introduce aldehyde groups on its surface. Subsequently, the spike protein of the virus is covalently bound by forming an imine group. The chemical control of cellulose paper modification was evaluated by Fourier transform infrared spectroscopy, thermogravimetry and contact angle analysis. Colorimetric detection of the antibodies was performed by a conventional staining method using Ponceau S solution as the dye. Color analysis was performed after image acquisition with a smartphone using Image J software. The color intensity varied linearly with the logarithm of the anti-S concentration (from 10 ng/mL to 1 g/mL) in 500-fold diluted serum samples when plotted against the green coordinate extracted from digital images. The test strip was selective in the presence of nucleocapsid antibodies, urea, glucose, and bovine serum albumin with less than 15% interference, and detection of antibodies in human serum was successfully performed. Overall, this is a simple and affordable design that can be readily used for mass population screening and does not require sophisticated equipment or qualified personnel., This project was a financially supported through the project, TecniCov (POCI-01-02B7-FEDER-069745), co-funded by FEDER through COMPETE2020 and Lisboa2020., info:eu-repo/semantics/publishedVersion