Search

© 2021 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/), Heart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients' functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members' clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks., A insuficiência cardíaca (IC) com fração de ejeção reduzida (ICFEr) está associada a níveis elevados de hospitalização e mortalidade. A ICFEr também tem um impacto negativo na capacidade funcional e na qualidade de vida dos doentes, bem como na despesa em saúde. Nos últimos anos, surgiram novos medicamentos modificadores do prognóstico da ICFEr, originando um intenso debate na comunidade científica internacional em relação a uma mudança de paradigma para o tratamento da ICFEr. Neste artigo, relatamos a contribuição de um painel de especialistas portugueses em IC para o debate em curso. Com base na evidência clínica publicada mais recentemente e no julgamento clínico dos membros do painel, três princípios-chave são destacados: (i) sacubitril/valsartan deve ser preferido como terapia de primeira linha para a ICFEr, em vez de um inibidor da enzima de conversão da angiotensina ou um bloqueador do recetor da angiotensina; (ii) os quatro medicamentos básicos para a ICFEr são o inibidor do recetor da angiotensina e da neprilisina, os agentes bloqueadores beta-adrenérgicos, os antagonistas do recetor mineralocorticoide e os inibidores do cotransportador sódio-glucose 2, independentemente da presença de diabetes mellitus tipo 2; (iii) essas quatro classes de medicamentos para a ICFEr devem ser rapidamente introduzidas num período curto de 4-6 semanas, seguindo um protocolo de segurança, e depois tituladas durante as oito semanas seguintes.

Objective: Registries are important data sources for randomised controlled trials (RCTs), but reporting of how they are used may be inadequate. The objective was to describe the current adequacy of reporting of RCTs using registries. Study Design and Setting: We used a database of trials using registries from a scoping review supporting the development of the 2021 CONSORT extension for Trials Conducted Using Cohorts and Routinely Collected Data (CONSORT-ROUTINE). Reporting completeness of 13 CONSORT-ROUTINE items was assessed. Results: We assessed reports of 47 RCTs that used a registry, published between 2011 and 2018. Of the 13 CONSORT-ROUTINE items, 6 were adequately reported in at least half of reports (2 in at least 80%). The 7 other items were related to routinely collected data source eligibility (32% adequate), data linkage (8% adequate), validation and completeness of data used for outcome assessment (8% adequate), validation and completeness of data used for participant recruitment (0% adequate), participant flow (9% adequate), registry funding (6% adequate) and interpretation of results in consideration of registry use (25% adequate). Conclusion: Reporting of trials using registries was often poor, particularly details on data linkage and quality. Better reporting is needed for appropriate interpretation of the results of these trials. Keywords: registries, CONSORT, CONSORT-ROUTINE, randomised controlled trials, reporting guideline, routinely collected data Running Title: Completeness and Transparency of Reporting of RCTs using Registries

When academics’ opinions, which are published in academic journals as letters to the editor or commentaries, are retracted based on sensitivities and objections that are raised for example on social media, there needs to be a reflection on what this might represent. On one hand, an opinion is precisely that, i.e., a subjective and biased view about an issue. Those views might even be radical, unpopular, or insensitive, but ultimately approved by editors for publication nonetheless. To maintain a truly sustainable scholarly discourse, the best academic way to counter such opinions is by allowing disagreeing voices to express themselves, also as letters to the editor or commentaries. Pressure-induced retractions of opinions not only stifle academic debate, they send the message that opinions need to be moderated and standardized to meet a publishing market that is being increasingly driven by legal parameters, political correctness, as well as business and commercial values rather than academic ones. In an environment of restrictive academic freedom, what emerges is an academia in which the way things are said, tone, and the sensitivity of those that might be affected are given greater weight than the message itself. By cherry-picking parts of the message that detractors or critics might disagree with, the original message may be drowned out by the noise of the objectors. The struggle of academics to liberally voice their opinions in the scholarly publishing realm, and to preserve those opinions, has never been more acute in this age of misinformation and radicalism fueled by polarized social and mass media. Is the politicization and/or commercialization of academia, alongside the retraction of opinions, stifling open and healthy academic debate, or expressing itself as the retraction of opinions, and does this represent a distinct form of “cancel culture” in academia and academic publishing?

IMPORTANCE: Exercise therapies are advocated in osteoarthritis (OA) clinical guidelines. However, challenges to accessing exercise may be limiting widespread uptake. OBJECTIVE: To evaluate the effects of a self-directed web-based strengthening exercise and physical activity program supported by automated behavior-change text messages on knee pain and function for people with knee OA. DESIGN, SETTING, AND PARTICIPANTS: The participant-blinded and assessor-blinded randomized clinical trial enrolled 206 people who met clinical criteria for knee OA in communities across Australia from July 2018 to August 2019, with follow-up taking place at 24 weeks. INTERVENTIONS: The control group was given access to a custom-built website with information on OA and the importance of exercise and physical activity. The intervention group was given access to the same information plus a prescription for a 24-week self-directed strengthening regimen and guidance to increase physical activity, supported by automated behavior-change text messages encouraging exercise adherence. MAIN OUTCOMES AND MEASURES: Primary outcomes were change in overall knee pain (numeric rating scale, 0-10) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0-68) over 24 weeks. Secondary outcomes were another knee pain measure, sport and recreation function, quality of life, physical activity, self-efficacy, overall improvement, and treatment satisfaction. RESULTS: Of 206 participants, 180 (87%; mean [SD] age, 60 [8.4] years; 109 [61%] women) completed both 24-week primary outcomes. The intervention group showed greater improvements in overall knee pain (mean difference, 1.6 units; 95% CI, 0.9-2.2 units; P

Objective Clinicians may use implicit or explicit motor learning approaches to facilitate motor learning of patients with stroke. Implicit motor learning approaches have shown promising results in healthy populations. The purpose of this study was to assess whether an implicit motor learning walking intervention is more effective compared with an explicit motor learning walking intervention delivered at home regarding walking speed in people after stroke in the chronic phase of recovery. Methods This randomized, controlled, single-blind trial was conducted in the home environment. The 79 participants, who were in the chronic phase after stroke (age = 66.4 [SD = 11.0] years; time poststroke = 70.1 [SD = 64.3] months; walking speed = 0.7 [SD = 0.3] m/s; Berg Balance Scale score = 44.5 [SD = 9.5]), were randomly assigned to an implicit (n = 38) or explicit (n = 41) group. Analogy learning was used as the implicit motor learning walking intervention, whereas the explicit motor learning walking intervention consisted of detailed verbal instructions. Both groups received 9 training sessions (30 minutes each), for a period of 3 weeks, targeted at improving quality of walking. The primary outcome was walking speed measured by the 10-Meter Walk Test at a comfortable walking pace. Outcomes were assessed at baseline, immediately after intervention, and 1 month postintervention. Results No statistically or clinically relevant differences between groups were obtained postintervention (between-group difference was estimated at 0.02 m/s [95% CI = −0.04 to 0.08] and at follow-up (between-group difference estimated at −0.02 m/s [95% CI = −0.09 to 0.05]). Conclusion Implicit motor learning was not superior to explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery. Impact To our knowledge, this is the first study to examine the effects of implicit compared with explicit motor learning on a functional task in people after stroke. Results indicate that physical therapists can use (tailored) implicit and explicit motor learning strategies to improve walking speed in people after stroke who are in the chronic phase of recovery.

Over the past few years, what might not unreasonably be described as a true revolution has taken place in the field of machine vision, radically altering the way many things had previously been done and offering new and exciting opportunities for those able to quickly embrace and master the new techniques. Rapid developments in machine learning, largely enabled by faster GPU-equipped computing hardware, has facilitated an explosion of machine vision applications into hitherto extremely challenging or, in many cases, previously impossible to automate industrial tasks. Together with developments towards an internet of things and the availability of big data, these form key components of what many consider to be the fourth industrial revolution. This transformation has dramatically improved the efficacy of some existing machine vision activities, such as in manufacturing (e.g. inspection for quality control and quality assurance), security (e.g. facial biometrics) and in medicine (e.g. detecting cancers), while in other cases has opened up completely new areas of use, such as in agriculture and construction (as well as in the existing domains of manufacturing and medicine). Here we will explore the history and nature of this change, what underlies it, what enables it, and the impact it has had - the latter by reviewing several recent indicative applications described in the research literature. We will also consider the continuing role that traditional or classical machine vision might still play. Finally, the key future challenges and developing opportunities in machine vision will also be discussed.

Energy management is the most prominent means of improving energy efficiency, and improved energy efficiency constitutes the cornerstone in decarbonization. For successful industrial energy management, defining accurate energy performance indicators (EnPIs) is essential. Energy-intensive industries have previously been found to have an improvement potential regarding the current monitoring of EnPIs, especially at process level. While general models for developing and implementing EnPIs exist, manufacturing industries are diverse in terms of their production processes, which is why industry-tailored models for EnPI development are needed. One major outcome of this paper is a unique model specifically tailored for kraft pulp mills. The model derives from a practice-based approach for EnPI development, building on real-life experiences from a Swedish group of companies. This paper’s developed model, and the validation of the EnPIs, further increase the understanding of the kraft pulp industry’s processes and how to apply descriptive and explanatory indicators. The developed model can potentially be generalized to other sectors. Funding: Swedish Environmental Protection Agency; Swedish Agency for Marine and Water Management [802-0082-17]

The biotechnological use of xylans and xylanases has grown remarkably. Xylanases have stimulated great interest due to their potential application in several industries. Over the years the number of possible applications of xylanases in the pulp and paper industry has increased steadily, and several applications have been commercialized. Xylanases are being used for prebleaching pulp, modifying fiber, deinking, dedarking, and producing dissolving grade pulp. Apart from its use in the pulp and paper industry, xylanases are also used as food additives to poultry; in wheat flour for improving dough handling and quality of baked products; for the extraction of coffee, plant oils, and starch; in the improvement of nutritional properties of agricultural silage and grain feed; in combination with pectinase and cellulase for clarification of fruit juices; and in the degumming of plant fiber sources such as flax, hemp, jute, and ramie. Use of xylanases could greatly improve the overall economics of processing lignocellulosic materials for the generation of liquid fuels and chemicals. Xylanase and cellulase, together with pectinases, account for 20% of the world enzyme market.

The number of households experiencing fuel poverty is thought to have risen by at least 600,000 in the UK because of the ongoing Covid-19 pandemic. The concentration of fuel poor households in poor quality, energy inefficient accommodation that they have little power to improve means they are particularly negatively affected by the retreat into the home brought about by successive lockdowns and restrictions. For many such households, the home is not the place of sanctuary that it needs to be at a time like this. However, our empirical research into the lived experiences of fuel poverty reveals additional consequences for fuel poor households, chiefly associated with restricted access to third spaces and other disruptions to their usual coping strategies. Based on our evidence, we highlight three key considerations for policy on fuel poverty in the era of Covid-19: the need to rapidly upgrade the energy performance of the existing housing stock; the need to address the additional financial hardship faced by fuel poor households; and the need to prioritise access to third spaces and high-quality public spaces while restrictions last. This paper develops the concept of energy poverty by considering the role of spaces outside the home as part of the overall experience of energy poverty and the range of ways in which policy makers can mitigate its impacts.

In recent years renewable and cleaner fuel for diesel engines are compulsory due to depletion of fossil fuel. Various types of bio-based fuels are investigated by the researchers. Biodiesel is anticipated as potential contenders of diesel fuel. Though it is possible to utilize pure biodiesel in diesel engines, some burdens like higher density, lower cetane number and lesser calorific value hinder it from replacing conventional diesel completely. Therefore, using blends with biofuels in diesel engines has a preference. Thus, this paper reviews two different approaches on the role of nanoparticles on biofuel production and effects of nanoparticles in biodiesel–diesel fuel blends on performance, combustion analysis and emission characteristics of diesel engines. Wide range of results from previous research studies with potential and application of nanoparticles in bioethanol production, the effect of the addition of nanoparticles into diesel fuel with different biofuels ratios are collected in this review study. There are different engine performances enhancing methods surveyed. Nanoparticles can be utilized in the production of biofuels from feedstock pre-treatment to chemical reaction as catalysts. It was observed from the overall results that by adding nanoparticles, there was a significant reduction in the brake specific fuel consumption about 20% to 23% as compared with biodiesel–diesel blends with and without alcohol as additives. Besides as nanoparticles possess high thermal conductivity, the addition of nanoparticles enhanced the process of combustion and increases the brake power about 2.5% to 4%. Emission results showed that in most reviews, NO x emission is increased by up to 55%, while HC, CO and PM are decreased significantly. It was concluded from the study that a diesel engine could be effectively run and give better performance and effective regulated emissions on the application of added nanoparticles with biodiesel and their blends as fuel in a CI engine.

The organic matter present in six industrial wastewaters (pulp and paper mill, brewery, textile, dairy, slaughterhouse effluents and a municipal landfill leachate) has been studied in this work using three analytical techniques: excitation-emission matrix fluorescence (EEMF), proton nuclear magnetic resonance spectroscopy (1H NMR) and Fourier transform infrared spectroscopy (FTIR). The pulp and paper mill effluent shows characteristic signals of the presence of lignins, carbohydrates and carboxylic acids, as well as sulfate, carbonate and sulfonates (coming from surfactants used in the cleaning of tanks). The main constituents of the brewery effluent are peptides and proteins coming mainly from spent yeast and diatomite filters (the presence of the latter was confirmed by Sisingle bondO bands in the FTIR spectrum). The municipal landfill leachate is characterized by the majority presence of humic substances (typical of an old landfill) and a residual presence of small peptides, amino acids and carboxylic acids. Additionally, several inorganic compounds were identified by FTIR, such as nitrate, sulfate, phosphate and cyanide ions. The textile effluent from a cotton-based industry contains carbohydrates, carboxylic acids and sulfonates, which can act as auxochromes in the textile industry. The dairy effluent comprises amino acids and small peptides coming from the biodegradation of milk and whey in addition to carbohydrates (lactose) and carboxylic acids (mainly lactic acid). The presence of tyrosine-like peaks B in the EEMF spectrum of the slaughterhouse effluent indicates the existence of small peptides and amino acids coming from the biodegradation of blood proteins. Additionally, residual glucose, fatty acids, phosphate and sulfate were also identified in this effluent.

Exercise can reduce the incidence of stress-related mental diseases, such as depression and anxiety. Control group was neither exposed to CVMS nor TRE (noCVMS/noTRE). Females were tested and levels of serum17-beta-oestradiol (E2), estrogen receptors α immunoreactive neurons (ERα-IRs), estrogen receptors β immunoreactive neurons (ERβ-IRs) and oxytocin immunoreactive neurons (OT-IRs) were measured. The results showed there’s increased anxiety-like behaviors for mice from CVMS/noTRE, CVMS/higher speed TRE (CVMS/HTRE) and noCVMS/HTRE groups when they were put in open field and elevated maze tests. They had lower serum E2 levels than mice from CVMS/low-moderate speed TRE (CVMS/LMTRE), noCVMS/LMTRE and noCVMS/noTRE groups. The three groups of CVMS/noTRE, CVMS/HTRE and noCVMS/HTRE mice had more ERα-IRs and less ERβ-IRs in the medial preoptic area (mPOA), bed nucleus of the stria terminalis (BNST) and medial amygdala (MeA), hypothalamic paraventricular nucleus (PVN) and supraoptic nucleus (SON). The number of OT-IRs in PVN and SON of CVMS/noTRE, CVMS/HTRE and noCVMS/HTRE mice was also lower than that of mice from CVMS/LMTRE, noCVMS/LMTRE and noCVMS/noTRE groups. Interestingly, CVMS/LMTRE and noCVMS/LMTRE mice were similar to noCVMS/noTRE mice in that they did not show anxiety, while CVMS/HTRE and noCVMS/HTRE mice did not, which were similar to the mice in CVMS/noTRE. We propose that LMTRE instead of HTRE changes the serum concentration of E2. ERβ/ERα ratio and OT level in the brain may be responsible for the decrease in anxiety-like behavior in female mice exposed to anxiety-inducing stress conditions., Highlights • CVMS/LMTRE did not show anxiety. • noCVMS/LMTRE did not show anxiety. • ERβ/ERα ratio decreas anxiety. • OT decreas anxiety.

Probiotics that regulate the microbiome-gut-brain axis and provide mental health benefits to the host are referred to as psychobiotics. Preclinical studies have demonstrated psychobiotic effects on early life stress-induced anxiety- and depression-related behavior in rodents; however, the specific mechanisms remain ill-defined. In the current study, we investigated the effects of probiotic supplementation on neurobiological responses to chronic stress in adult male Long-Evans rats. Twenty-four rats were randomly assigned to probiotic (PB) or vehicle control (VEH) groups, then to either chronic unpredictable stress (CUS) or no-stress control (CON) conditions within each group (n = 6/subgroup). We hypothesized that PB supplementation would reduce markers of anxiety and enhance emotional resilience, especially in the CUS animals. In the cognitive uncertainty task, a nonsignificant trend was observed indicating that the PB-supplemented animals spent more time oriented toward the food reward than VEH animals. In the open-field task, CUS-PB animals spent more time in the center of the arena than CUS-VEH animals, an effect not observed between the two CON groups. In the swim task, the PB animals, regardless of stress assignment, exhibited increased floating, suggesting a conserved response in a challenging context. Focusing on the endocrine measures, higher dehydroepiandrosterone (DHEA)-to-corticosterone fecal metabolite ratios, a correlate of emotional resilience, were observed in PB animals. Further, PB animals exhibited reduced microglia immunoreactivity in the basolateral amygdala, possibly indicating a neuroprotective effect of PB supplements in this rodent model. These results provide evidence that PB supplementation interacts with stress exposure to influence adaptive responses associated with endocrine, neural, and behavioral indices of anxiety.

Purpose The purpose of this study is to examine the effects of fatigue on muscular performance, oxygenation saturation, and cognition following acute hypoxic exposure at Normoxia, Moderate Hypoxia (MH), and Severe Hypoxia (SH). Methods Twelve males performed 3 sets of leg extensions to failure under Normoxia (FiO2: 21%), MH (Fi02: 15.4%), and SH (Fi02: 12.9%). Heart rate, peripheral oxygenation saturation, total saturation index, psychomotor vigilance testing reaction time, psychomotor vigilance error rate, maximum strength, and repetitions to failure were measured throughout each visit. Results The primary findings indicated that MH and SH resulted in significant decreases in psychomotor vigilance test performance (MH: 388.25–427.17 ms, 0.41–0.33 error rate; SH: 398.17–445.42 ms reaction time, 0.25–1.00 error rate), absolute muscle tissue oxygen saturation (Abs-StO2) (MH:67.22% compared to SH:57.56%), but similar muscular strength, heart rate, and patterns of muscle tissue oxygen saturation responses (StO2%) during fatigue when compared to Normoxia. There was an acute decrease in the ability to remain vigilant and/or respond correctly to visual stimuli as indicated by the worsened reaction time (PVTRT) during MH (FiO2: 15.4%) and increased PVTRT and error rate (PVTE) during SH (FiO2: 12.9%) conditions. Conclusions Acute hypoxic exposure in the current study was not a sufficient stimuli to elicit hypoxic-related changes in HR, muscular strength (1-RM), or repetitions to failure. The SpO2 responses were hypoxic-level dependent with increasing levels of hypoxia resulting in greater and more sustained reductions in SpO2. The combined SpO2 and StO2 responses at MH and SH suggested a balance between the muscles metabolic demand remaining lower than the muscle oxygen diffusion capacity. During the SH condition, Abs-StO2 suggested greater metabolic stress than Normoxia and MH conditions during the fatiguing leg extensions. The patterns of responses for StO2% during the three sets of leg press to failure indicated that exercise is a more potent influencer to muscle oxygenation status than hypoxic conditions (FiO2: 15.4 and 12.9%)., Graphical abstract Image 1, Highlights • Moderate Hypoxia (FiO2: 15.4%) coupled with fatigue resulted in a decrease in reaction time. • Severe Hypoxia (FiO2: 12.9%) coupled with fatigue resulted in increased error rate and a decrease in reaction time. • Fatigue was the primary influencer on heart rate, muscular strength, and muscular endurance and not hypoxic exposure. • Severe Hypoxia (FiO2: 12.9%) resulted in greatly reduced muscle tissue oxygenation saturation before and after fatigue.

In the current study, we aimed to investigate the network structure of COVID-19 symptoms and its related psychiatric symptoms, using a network approach. Specifically, we examined how COVID-19 symptoms relate to psychiatric symptoms and highlighted potential pathways between COVID-19 severity and psychiatric symptoms. With a sample of six hundred seventy-five recovered COVID-19 patients recruited 1 month after hospital discharge, we respectively integrated COVID-19 symptoms with PTSD, depression, and anxiety symptoms and analyzed the three network structures. In all three networks, COVID-19 severity and ICU admission are not linked directly to COVID-19 symptoms after hospitalization, while COVID-19 severity (but not ICU admission) is linked directly to one or more psychiatric symptoms. Specific pathways between COVID-19 symptoms and psychiatric symptoms were discussed. Finally, we used directed acyclic graph estimation to show potential causal effects between COVID-19 related variables and demographic characteristics.

Finding a way to efficiently utilize this bio-waste resource is a great challenge due to the depletion of traditional fossil fuels and the environmental impact associated to their use. Rice straw is considered as one of the main cereal straws. It is produced in many countries every year in substantial amounts and it has a high ash content and low protein content. Usually, rice straw is burned by farmers causing many adverse effects on the environment and public health. This research investigates the process synthesis of furfural production through the acid-hydrolysis of rice straws. Furfural is a strategic bio-renewable chemical and has gained attention due to its possibility to produce biofuels and bio chemicals. Aspen Plus® simulation package is employed for process simulation, sizing, and analysis. Results of simulations are validated against an experimental work. Optimization through manipulation of several parameters including acid concentration, reaction temperature, acid/rice straw ratio, catalyst concentration, and type of acid to maximize the furfural yield and reaction conversion. A complete flow sheet is synthesized and sensitivity analysis is studied to reach an optimum process concerning environment and economics. The amount of furfural obtained as a final product from the process represents a yield of 73% per 100 kg/hr of rice straw processed.

Familial Adenomatous Polyposis (FAP) is an autosomal dominant disorder caused by mutation of the APC gene presenting with numerous colorectal adenomatous polyps and a near 100% risk of colon cancer. Preliminary research findings from our group indicate that FAP patients experience significant deficits across many cognitive domains. In the current study, fMRI brain metrics in a FAP population and matched controls were used to further the mechanistic understanding of reported cognitive deficits. This research identified and characterized any possible differences in resting brain networks and associations between neural network changes and cognition from 34 participants (18 FAP patients, 16 healthy controls). Functional connectivity analysis was performed using FSL with independent component analysis (ICA) to identify functional networks. Significant differences between cases and controls were observed in 8 well-established resting state networks. With the addition of an aggregate cognitive measure as a covariate, these differences were virtually non-existent, indicating a strong correlation between cognition and brain activity at the network level. The data indicate robust and pervasive effects on functional neural network activity among FAP patients and these effects are likely involved in cognitive deficits associated with this disease.

Background Analysis of fluid metabolites has the potential to provide insight into the neuropathophysiology of injury in patients with traumatic brain injury (TBI). Objective Using a 1H nuclear magnetic resonance (NMR)-based quantitative metabolic profiling approach, this study determined (1) if urinary metabolites change during recovery in patients with mild to severe TBI; (2) whether changes in urinary metabolites correlate to injury severity; (3) whether biological pathway analysis reflects mechanisms that mediate neural damage/repair throughout TBI recovery. Methods Urine samples were collected within 7 days and at 6-months post-injury in male participants (n = 8) with mild-severe TBI. Samples were analyzed with NMR-based quantitative spectroscopy for metabolomic profiles and analyzed with multivariate statistical and machine learning-based analyses. Results Lower levels of homovanillate (R = −0.74, p ≤ 0.001), L-methionine (R = −0.78, p, Highlights • NMR-based metabolomics of urine can identify metabolic fingerprints associated with functional recovery following TBI. • Metabolic profiles in urine correlate to injury severity. • Biological pathway analysis reflects mechanisms that mediate neural damage and repair processes throughout recovery. • Metabolomics provides insight into the neuropathophysiology of injury in TBI patients.

The textile industry is mainly concerned with the development, production, and sale of yarns, fabrics, and clothing. Raw materials can be natural or synthesized using industrial chemicals. The textile industry is the largest industry in the world and contributes significantly to gross domestic product (GDP). The textile process uses up to 10,000 dyes with an annual production of approximately 7 × 105 tons, mainly used in the textile, paper, food, and pharmaceutical industries. A large amount of water was used in the cleaning process, which led to the pollution of surface wells and groundwater resources. The toxicity and carcinogenic effects of raw water are well known, and scientists are investigating various methods to safely detoxify and discolor fiber dyes in industrial wastewater. This chapter discusses various biological methods for removing fiber dyes from wastewater to reduce pollution and improve fragile ecosystems. This chapter will cover conventional physical and chemical approaches with their merits and demerits, microbial methods using bacteria, fungi, algae, and viruses to treat dyes in textile effluent, enzymatic approaches to treat textile effluent for degradation of different dyes and future perspectives of these techniques.

Dyes are colored compounds that when applied to a material provides color with or without a change in its chemical structure. Substance bearing coloring capacity has widespread applications in textile, pharmaceutical, food, cosmetics, plastics, photographic, and paper industries, etc. The disposal of wastewater from dyes industries to nearby water bodies contaminates the water and foist harmful effects on human life as well as aquatic animals, thereby upsetting the environment. In particular, the textile wastewater can be regarded as the most polluting of all the industrial sectors as it consumes a large volume of water during the dyeing and finishing process in the industries. Based on the increased demand for textile products, textile effluents have a crucial role in causing severe pollution to environment. Besides this, the hazardous impact of untreated textiles is also of great concern. Owing to the growing awareness and environmental impact, the decolorization, and detoxification of the industrial dye effluents are essential before it is disposed to the nearby water bodies. Several methods have been introduced for the detoxification of textile dyes, namely, (1) physical; (2) chemical; and (3) biological. Among all the established process for the decolorization of the textile dyes, the biological approach has gained considerable attention because of its economic viability, eco-friendliness, and broad applicability to a variety of dyes. In this chapter, a brief description of the decolorization of textile dyes from wastewater treatment has been discussed. The chapter starts with a brief outline of dye pollution, classification of textile dyes, and their environmental impact, treatment option for dye effluents such as physio-chemical method, and biological method. The chapter primarily focuses on the decolorization of textile dyes by biological methods, which include (1) fungal; (2) bacterial; (3) aerobic and anaerobic; (4) algae; (5) enzymatic; and (6) biosorption. Detailed information regarding the decolorization of textile dyes by various biological methods is briefly disclosed.

Objective Sprint-interval training (SIT) and intermittent fasting are effective independent methods in achieving clinical health outcomes. However, the impact of both modalities when performed concurrently is unclear. The aim of this study was to compare the effects of 6 weeks of SIT performed in the fasted versus fed state on physiological and clinical health markers in healthy adults. Methods. Thirty recreationally-active participants were equally randomised into either the fasted (FAS; 4 males, 11 females) or the fed (FED; 6 males, 9 females) group. For all exercise sessions, FAS participants had to fast ≥10 h prior to exercising while FED participants had to consume food within 3 h to exercise. All participants underwent three sessions of SIT per week for 6 weeks. Each session consists of repeated bouts of 30-s Wingate Anaerobic cycle exercise. Pre- and post-training peak oxygen uptake (VO2peak), isokinetic leg strength, insulin sensitivity, blood pressure and serum lipid levels were assessed. Results. There were no differences in baseline physiological and clinical measures between both groups (all p > 0.05). VO2peak improved by 6.0 ± 8.8% in the FAS group and 5.3 ± 10.6% in the FED group (both p 0.05). A similar pattern of results was seen for knee flexion maximum voluntary contraction at 300°·s−1. SIT training in either fasted or fed state had no impact on insulin sensitivity (both p > 0.05). There was significant reduction in diastolic blood pressure (8.2 ± 4.2%) and mean arterial pressure (7.0 ± 3.2%) in the FAS group (both p 0.05). Conclusion. VO2peak and leg strength improved with SIT regardless of whether participants trained in the fasted or fed state. Chronic SIT in the fasted state may potentially reduce blood pressure to a greater extent than the same chronic SIT in the fed state., Highlights • SIT in the fasted state leads to a significant decrease in blood pressure. • VO2peak and leg strength improves with SIT, regardless of nutrition status. • SIT, performed in fasted or fed state, does not improve insulin sensitivity, body fat percentage or lipid profile.

The release of high amount of nitrogen and phosphorous from agricultural, municipal and industrial sewage into natural water body is the major source of eutrophication in aquatic ecosystems. This leads to the depletion of oxygen, cyanobacteria bloom and proliferation of aquatic weed plants, and destruction of water ecosystem. Therefore, effective treatment of municipal wastewater is crucial prior to discharge into natural water bodies in order to prevent pollution, and to meet the wastewater acceptable limits set by government and Environmental Protection Agencies. The present study evaluates the performance of varying weight of S. molesta plants in phytoremediation of treated domestic wastewater samples for 14 days at 24 h retention time. Physicochemical analysis such as turbidity, phosphate, ammoniacal nitrogen and nitrate tests were conducted on the wastewater samples according to spectrophotometric methods. Also, S. molesta plants were harvested once in a week and the relative growth rate (RGR) was calculated. The outcome of the study indicated that the treated domestic wastewater from the sewage treatment plant contains pollutants that stimulates the growth of S. molesta plants. Similarly, the highest reduction efficiency of up to 97.7%, 99.7%, 99% and 90.6% was observed for turbidity, phosphate, ammoniacal nitrogen and nitrate, respectively. In addition, the outcome of the study also demonstrated that S. molesta plants with the highest weight (280 g) were more efficient in removal of the excess nutrient present in the influent samples. Furthermore, the free energy content in the wastewater provided a suitable consortium for the plant cultivation and growth. Therefore, this method can be used for lab-scale production of wastewater-based biomass for the generation of biofuels.

Purpose The present study examined acute normobaric hypoxic exposure on the number of repetitions to failure, electromyographic (EMG) repetition duration (Time), EMG root mean square (RMS) and EMG mean power frequency (MPF) during biceps brachii (BB) dynamic constant external resistance (DCER) exercise. Methods Thirteen subjects performed two sets of fatiguing DCER arm curl repetitions to failure at 70% of their one repetition maximum under normoxic (NH), moderate hypoxia FiO2 = 15% (MH) and severe hypoxia FiO2 = 13% (SH). Electromyography of the BB was analyzed for EMG Time, EMG RMS, and EMG MPF. Repetitions were selected as 25%, 50%, 75%, and 100% of total repetitions (%Fail) completed. Pulse oximetry (SpO2) was measured pre-and post-fatigue. Results There was no significant three-way (Condition x Set x %Fail) or two-way (Condition x Set) interaction for any variable. The number of repetitions to failure significantly decreased from (mean ± SEM) 18.2 ± 1.4 to 9.5 ± 1.0 with each Set. In addition, EMG Time increased (25% 75%>100%), and EMG MPF decreased (75% > 100%) as a result of fatiguing exercise. SpO2 was lower during MH (Δ5.3%) and SH (Δ9.2%) compared to NH and as a result of fatiguing exercise increased only in MH (Δ2.1%) and SH (Δ5.7%). Conclusion The changes in BB EMG variables indicated exercise caused myoelectric manifestations of fatigue, however, acute moderate or severe hypoxia had no additional influence on the rate of fatigue development or neuromuscular parameters., Highlights • Acute MH (FiO2 15%) and SH (FiO2 14%) did not alter the muscle contractile process. • Arm curl repetitions to failure decreased MU recruitment and conduction velocity. • EMG fatigue analysis, hypoxia and arm curls to failure, EMG RMS, EMG MPF and Time. • SpO2 was lower at MH and SH which increased following fatiguing exercise.

This paper compares the relative frequency of zoonotic disease emergence associated with food animals versus emergence from other animal sources and explores differences in disease characteristics and drivers of emergence between the two sources. It draws on a published compilation of 202 Emerging Infectious Zoonotic Disease (EIZD) events for the period 1940–2004. Of the 202 zoonotic EID events in the dataset, 74 (36.6%) were associated with animals kept for food production, which acted as reservoir for the zoonotic pathogen in 64 events and as intermediate / amplifying host in 8 events. Significant differences exist both in the characteristics of the causal agents and the drivers of emergence of zoonotic diseases from food animals and non-food animals. However, the prevailing policy debate on prevention, detection and control of EIZDs largely focuses on diseases of non-food animal origin (wildlife), neglecting the role of food animals. Policies and investments that ensure appropriate veterinary public health measures along and within food animal value chains are essential to mitigate the global risk of EIZDs, particularly in developing regions where the livestock sector is experiencing rapid growth and structural transformation., Highlights • Over 36% of emerging infectious zoonotic diseases (EIZDs) are associated with animals kept for food production. • The prevailing policy debate on managing EIZDs largely focuses on diseases of non-food animal origin (wildlife) • The causal agents and drivers of emergence of zoonotic diseases from food animals and non-food animals are significantly different. • Policies that ensure appropriate veterinary public health measures are essential to mitigate the global risk of EIZDs.

Biodiesel is considered as a potential substitute for fossil fuel due to its renewability, sustainability, environmentally friendliness, and biodegradability, especially with comparable fuel properties to diesel. The chemocatalytic production of biodiesel from plant oils is widely used in industrial production due to its low cost and high conversion rate. However, the disadvantages are high energy consumption and environmentally unfriendly processing such as chemical catalysts, downstream technology and simultaneously produced waste. Therefore, in the past decade, enzyme-catalyzed biodiesel has attracted more attentions due to its sustainability and environmental friendliness. High-cost, enzyme stability and reusability are the main obstacles to the large-scale industrial development of microbial biodiesel. This review first showcases the state-of-the-art of microbial biodiesel production, including (1) lipid accumulation of oleaginous microorganisms from pretreated lignocellulose biomass, and (2) production of biodiesel from microbial oils via transesterification by immobilized lipase. Also, the technological challenges and future developmental trends are discussed, with the goal of providing the possibility of more economical large-scale industrial production. This paper provides opportunities for the sustainable and eco-friendly production of enzymatic biodiesel in the future.

Antimicrobial resistance (AMR) can be highlighted as one of the most significant health concerns among the last decades, for which antimicrobial drug use in food-producing animals has contributed as one of the major drivers. Food-producing animals are one of the most important and rapidly expanding commercial agricultural sectors worldwide but there is currently limited knowledge on the temporal and geographical distribution of scientific research on antimicrobial resistance in food-producing animals. We provide a global overview of the spatial and temporal trends of scientific knowledge on AMR in food-producing animals. Peer-reviewed papers of AMR on food-producing animals were retrieved from the Web of Science, systemized and dissected. The final validated dataset contained 1341 occurrences observations covering the 1957–2018 period. There has been a shift of research efforts, both geographically and temporally, emphasizing regional differences in food animal production and changing practices in the food production industry. It becomes evident that many regions have been poorly surveyed, wherein intensified sampling and testing efforts should be most valuable. This systematization of knowledge will be crucial in helping to determine how to optimally allocate limited resources available for AMR monitor and control, aiding in the prediction where the threat of new resistant infections will be greatest. AMR research in food-producing animals in developing countries is markedly growing, reflecting changes in food animals production systems but also posing a particularly significant threat, not only due to intensive animal production, but also exacerbated by poor sanitation. We highlight that the use of antibiotics in food producing animals is pervasive, calling for urgent action. These findings raise the possibility to finetuning key priorities on AMR global issues., Highlights • This is the first study providing a global overview of the spatial and temporal trends of research related to AMR in food-producing animals. • There is a clear rising interest on AMR research in food-producing animals worldwide but there is a spatial bias. • This study highlights poorly surveyed countries, where intensified sampling efforts are crucial. • Research trends and scientific areas are unearthed that should be invested in and explored in the future.

Highlights • Contact with stigmatized groups is a promising mechanism for reducing bias. • The nature of contact with patients who misuse opioids matters significantly. • Contact with patients who misuse opioids can have negative consequences for physicians. • Consequences occur in physicians who are experiencing stress, burnout, and bias. • Interventions need to consider factors that may reduce the effectiveness of contact., Introduction Prior research suggests that some physicians hold negative attitudes toward patients who misuse opioids and that this serves as a barrier which limits the availability and effectiveness of health care services. Interventions which improve physicians’ attitudes have thus garnered attention, many of which have focused on increasing contact between physicians and patients who misuse opioids. However, drawing on recent literature on intergroup contact, the current paper argues that contact may not have uniformly positive effects on prejudice. Methods We surveyed 408 board-certified physicians in the state of Ohio where many opioid overdose deaths have been concentrated. We used regression to test for interactions between contact and three focal variables, bias, burnout, and stress, on physician willingness to work with patients who misuse opioids. Results The negative relationships between bias, physician burnout, and stress induced by working with patients who misuse opioids and physicians’ willingness to work with this patient population are each exacerbated when contact with patients who misuse opioids is high. Conclusions Although intervention studies have shown promise for the role that increased contact may have in reducing stigma toward patients who misuse opioids, these interventions may not be appropriate for physicians who are experiencing strain or who hold preexisting negative attitudes toward this patient population. Future interventions may need to target bias, burnout, and stress, in addition to facilitating contact, to increase physician willingness to work with these patients.

Porpose The aim of this study was to evaluate, through a meta-analysis, the predictability of Regenerative Endodontic therapies with antibiotic pastes and calcium hydroxide [Ca(OH)2], related to four variables as follows: root dentin wall thickening, apical closure, apical repair and root lengthening. Methods Literature electronic searches were performed in Pubmed - MEDLINE, Scopus and Lilacs-BVS platforms using appropriate search terms, Mesh (Medical Subject Headings), DeCS (Health Sciences Descriptors) and Boolean operators comprising articles published between 2009 and 2020. Thirty-two original indexed papers were included making a total of 758 regenerative endodontic procedures. A descriptive meta-analysis was performed. Results Dentin wall thickening was present in 66% (CI95: 58%–73%) of the cases treated with antibiotic paste, while when Ca(OH)2 was used, a percentage of 53% (CI95: 26%–78%), was obtained. When antibiotic paste was used, apical closure was found in the 66% (CI95: 58%–73%) of the regenerative endodontic procedures, while when Ca(OH)2 was used, 88% (CI95: 80%–93%) of the cases were found to reach apical closure. Root lengthening and apical repair were found satisfactory for both disinfection protocols. Conclusions There could be differences between the two treatments since a higher percentage of root dentin wall thickening was found when using antibiotic pastes, while a higher percentage of apical closure was found when calcium hydroxide was used. Development of more clinical studies would be necessary in order to confirm the observed differences. The proposed approach could provide a useful contribution for endodontists when planning regenerative endodontic procedures, so as to guide decision-making to the best elective treatment and to select the appropriate disinfection method in accordance with preoperative radiographic diagnosis of root development stage, then increasing the predictability of regenerative endodontic treatment and reducing potential risk of root fractures.

Background Arterial stiffness is important because it is associated with adverse cardiovascular events including stroke. Methods that are based on pulse wave velocity have significant limitations in estimating arterial stiffness. The purpose of this paper is to present a novel easy to apply non-invasive method to estimate arterial stiffness that is based on pulse pressure. Methods Two indices to estimate arterial stiffness, (1) arterial stiffness 1 (AS1) and (2) arterial stiffness 2 (AS2) were developed and applied in two National Institutes of Health funded clinical trials, the Systolic Hypertension in the Elderly Program and the Systolic Blood Pressure Intervention Trial. These indices were developed by fitting individual survival models for selected predictor variables to the response, i.e. time to stroke, by selecting the coefficients that were statistically significant at the 0.05 α level after adjusting the variable weights. The indices were derived as the weighted linear combination of the coefficients. Results AS1 and AS2 performed well in two goodness of fit criteria i.e. overall model p-value and concordance correlation. Comparison of Cox models using indices AS1 and AS2 and chronological age indicated that AS1 and AS2 independently predicted the occurrence of stroke at five years better than chronological age. Nearly identical effects were observed when the analyses were limited to Black participants in SPRINT with a concordance correlation of 0.80 and log rank test p-value of 0.007. Conclusion These indices that are derived from pulse pressure predict the occurrence of stroke better than either pulse pressure or chronological age alone and may be used in designing new randomized clinical trials, and possibly incorporated in hypertension and stroke guidelines.

ObjectivesTo estimate the absolute risk of cerebral venous thrombosis (CVT) and portal vein thrombosis (PVT) in the two weeks following a diagnosis of COVID-19, and to assess the relative risks (RR) compared to influenza or the administration of an mRNA vaccine against COVID-19.DesignRetrospective cohort study based on an electronic health records networkSettingLinked records between primary and secondary care centres within 59 healthcare organisations, primarily in the USAParticipantsAll patients with a confirmed diagnosis of COVID-19 between January 20, 2020 and March 25, 2021 were included (N=537,913, mean [SD] age: 46.2 [21.4] years; 54.9% females). Cohorts (matched for age, sex, and race) of participants diagnosed with influenza (N=392,424) or receiving the BNT162b2 or mRNA-1273 vaccine (N=366,869) were used for comparison.Main outcome measuresDiagnosis of CVT (ICD-10 code I67.6) or PVT (ICD-10 code I81) within 2 weeks after a diagnosis of COVID-19.ResultsThe incidence of CVT after COVID-19 diagnosis was 42.8 per million people (95% CI 28.5–64.2) including 35.3 per million (95% CI 22.6–55.2) first diagnoses. This was significantly higher than the CVT incidence in a matched cohort of patients with influenza (RR=3.83, 95% CI 1.56–9.41, PConclusionsThe incidence of CVT and PVT is significantly increased after COVID-19. The data highlight the risk of serious thrombotic events in COVID-19 and can help contextualize the risks and benefits of vaccination in this regard.What is known‐A systematic review of cohort studies suggested an incidence of CVT among hospitalised patients with COVID-19 to be about 800 per million patients. There was evidence of selection, ascertainment, and reporting bias in all included studies.‐The incidence of CVT and PVT among both hospitalised and non-hospitalised patients with COVID-19 is unknown.‐It is unknown if COVID-19 increases the risk of CVT and PVT.What this study addsOur study estimates that the absolute risk of CVT and PVT are respectively 42.8 and 392.3 per million patients (both hospitalised and non-hospitalised) in the 2 weeks after a diagnosis of COVID-19. COVID-19 increases the risk of CVT and PVT compared to patients diagnosed with influenza, and to people who have received a COVID-19 mRNA vaccine.

Background The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and assess the relationship between symptoms and cardiopulmonary impairment at 6 months post-COVID-19. Methods Fifty-eight patients and thirty matched controls (single visit), recruited between 14th March - 25th May 2020, underwent symptom-questionnaires, cardiac and lung magnetic resonance imaging (CMR), cardiopulmonary exercise test (CPET), and spirometry at 3 months following COVID-19. Of them, forty-six patients returned for follow-up assessments at 6 months. • View related content for this article Findings At 2-3 months, 83% of patients had at least one cardiopulmonary symptom versus 33% of controls. Patients and controls had comparable biventricular volumes and function. Native cardiac T1 (marker of fibroinflammation) and late gadolinium enhancement (LGE, marker of focal fibrosis) were increased in patients at 2-3 months. Sixty percent of patients had lung parenchymal abnormalities on CMR and 55% had reduced peak oxygen consumption (pV̇O2) on CPET. By 6 months, 52% of patients remained symptomatic. On CMR, indexed right ventricular (RV) end-diastolic volume (-4·3 mls/m2, P=0·005) decreased and RV ejection fraction (+3·2%, P=0·0003) increased. Native T1 and LGE improved and was comparable to controls. Lung parenchymal abnormalities and peak V̇O2, although better, were abnormal in patients versus controls. 31% had reduced pV̇O2 secondary to symptomatic limitation and muscular impairment. Cardiopulmonary symptoms in patients did not associate with CMR, lung function, or CPET measures. Interpretation In patients, cardiopulmonary abnormalities improve over time, though some measures remain abnormal relative to controls. Persistent symptoms at 6 months post-COVID-19 did not associate with objective measures of cardiopulmonary health. Funding The authors’ work was supported by the NIHR Oxford Biomedical Research Centre, Oxford British Heart Foundation (BHF) Centre of Research Excellence (RE/18/3/34214), United Kingdom Research Innovation and Wellcome Trust. This project is part of a tier 3 study (C-MORE) within the collaborative research programme entitled PHOSP-COVID Post-hospitalization COVID-19 study: a national consortium to understand and improve long-term health outcomes, funded by the Medical Research Council and Department of Health and Social Care/National Institute for Health Research Grant (MR/V027859/1) ISRCTN number 10980107.

Drawing on recent experimental and commercial developments, this review reappraises potential substitute leach reagents for cyanide in the gold mining sector. In addition to extraction, the application of these reagents in the gold processing, pre-treatment and gold purification stages is explored. The main objective here is to discuss how the gold extraction process can be more sustainable, with a view to developing more greener leaching reagents. info:eu-repo/semantics/publishedVersion

Fossil fuels account for 80% of the primary need for energy consumption in the world. The imbalance between the demand and supply promoted the researchers to look at the renewable alternative energy source. Among other renewable energy sources, microalgae have considered as primary and important feedstock to replace fossil-based energy due to their high growth rate and biochemical composition. Algae with 30% of lipid content can generate more amount of biodiesel when compared with other best source of renewable energy. The efficiency of lipid extraction from algae and converting into fatty acid methyl esters is a great task in the biodiesel production process. In this chapter, feedstock selection, harvesting, extraction, and purification processes in improving the efficiency of biodiesel production from microalgae are discussed. Technological development and integrated biorefinery concepts make microalgae a potential source for biodiesel production.

Exploration of renewable resources for industrial sustainability has been the foundation of varied research. Biofuel production from renewable resources is one of these research areas that has grown in past few years. Glycerol (GL), a byproduct of the biodiesel industry, was of commercial value years back. A boom in biodiesel production directly magnified the generation of GL, which was then considered a serious waste, demanding cost and energy for its disposal. Recently, GL’s popularity again gained momentum, when it was explored as a cost-effective, renewable raw material for the synthesis of various molecules of industrial significance. Procedures have been established to alter bioglycerol products with commercial value, which will safeguard the sustainability of the biodiesel and oleochemical industries. One likelihood is to convert glycerol to propanediols (PDs), glycerol carbonate (GC), and epichlorohydrin, which have abundant applications like food additives, and as a raw material in the pharmaceutical and cosmetic industries. As an intermediate, GC is directly employed in numerous industrial applications. The universal market of 1,3-propandiol is growing rapidly due to the growing demand for its high-value derived products. Epichlorohydrin can be employed as a homopolymer or copolymer, solvent, and stabilizer for various productions. An industrial forecast has been done for these biobased molecules for the years 2020–27. The US GL market is evaluated at 750.4 kt in the year 2020. It is anticipated that by the year 2027 the probable market size will be 814.2 kt. The biobased chemical market has boomed in the past few years and is expected to increase at a compound annual growth rate of 16.67% in 2019–27. GL and its derivatives (PD, GC, epichlorohydrin) have an inferred role in bioeconomy.

Background Guillain-Barre syndrome (GBS) is the most prevalent acute autoimmune polyneuropathy, however, the incidence of GBS across China remains undetermined. We conducted the first nationwide study to extrapolate the incidence and mortality rates of GBS across all age groups at a national scale. Methods This study analyzed patient metrics from the National Hospital Quality Monitoring System, a comprehensive administrative database of which incorporate all 1665 tertiary hospitals in mainland China. For all study patients the "Medical Record Homepage" encompasses 346 distinct variables such as demographic characteristics, diagnoses, procedures, expenses, etc., that are systematically recorded from these hospitals by standard protocol. All GBS diagnoses adhered to the National Institute of Neurologic and Communicative Disorders and Stroke (NINCDS) diagnostic criteria and were identified with ICD-10 code (G61•0). Findings From 2016 to 2019, 75,548 hospital admissions for 38,861 GBS patients were identified. The age- and sex-adjusted incidence per 100,000 person-years is 0•698 (95% confidence interval [CI], 0•691-0•705), 0•233(0•225-0•242) in children and 0•829(0•820-0•837) in adults. The male-to-female ratio is 1•49. Peak disease onset was detected in the 70–74 years age group with an incidence of 1•806/100, 000 (95% CI, 1•741-1•870). Recognizable GBS distribution patterns were recognized in the southeastern coastal areas, where the cases of GBS were concentrated in the summer and autumn seasons. Prevalent comorbidities include hypertension (28•8%) and stroke (14•3%). The median length of hospitalization was 13•0 (8•0–18•0) days with a median hospitalization cost of $2371•60 ($1281•80–5463•60). Covering 69•9% of study patients, the Basic Medical Insurance was the most common payment mechanism. From 2016-2019, 426 adults and 13 children died in this study pool, with a hospital mortality rate of 11•2 per 1,000 person-years. Interpretation For the first time, we obtained a national incidence for GBS at 0•233 in children and 0•829 in adults per 100,000 in China. A differential spatiotemporal incidence is presented most southeast coastal areas in the summer and autumn seasons. Funding National Science Foundation of China (91949208, 91642205, and 81830038); Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing.

Bioethanol is a biodegradable and high-octane motor fuel derived from cellulosic matter present in plants. Bioethanol production using biomass of second-generation plant lignocellulosic material as a substrate is promising for a pollution-free environment. The most rich, inexpensive, and renewable energy resources for producing bioethanol are the plant biomass of lignocellulosic material. Lignocellulose from second-generation biomass for bioethanol production requires pretreatment using physicochemical, mechanical, chemical, and biological methods. Pretreatment reduces the complex nature of structures into simple monomers and then changes them into bioethanol using ethanol-producing microorganisms. Pretreatment is required mainly to enhance the digestibility of cellulose by increasing enzyme accessibility. The complex nature and ultrastructure of lignocellulosic second-generation biomass involve the linear glucose molecule, which is tightly bounded by the lignin molecule, preventing accessibility of the glucose molecule. Pretreatment removes the lignin molecule and provides access to accessibility of this glucose molecule for ethanol production. To maximize the positive potential of biofuels and minimize their negative impact, proper deployment of a consistent scientific framework is required. Lignocellulosic materials are composed of different types, based on the pretreatment process and conditions that are selected for hydrolysis. This chapter discusses pretreatment methods of lignocellulosic material that optimize ethanol production and the economic perspective of pretreatment.

Microbial contamination of dairy products is often through the release of bacteria from biofilms developing on almost any manufacturing plant surface. The microbial composition varies depending upon the product being manufactured and the environmental conditions in different parts of the dairy manufacturing plant. Microbial contamination of dairy products limits their value. Controlling biofilms through frequent cleaning costs the dairy industry in terms of labour and materials and by limiting the amount of product that can be manufactured. Recent studies on dairy biofilms have provided information on how dairy biofilms develop and suggest some alternative control measures to prevent or delay biofilm growth and reduce product contamination.

Bioethanol production from renewable biomass has gained considerable attention as one of the alternative biofuels to partially replace conventional fuel from fossil fuel feedstock. In recent years, the production of bioethanol from renewable biomass is far yet to be commercialized due to several limitations at upstream and downstream stages during bioethanol production process. Several problems including energy intensive pretreatment, low sugar yield during hydrolysis, and low conversion efficiency of fermentation of sugar are among the major limitations that affect final bioethanol yield. Development of bioprocess operational modes and strain improvement are crucial to ensure the feasibility of future bioethanol production from different renewable biomass feedstocks. Thus, this chapter provides a review on bioethanol production from various types of biomass feedstocks including local food crops, agro-industry wastes residues, and microalgae biomass. In addition, variations in cost-effective hydrolysis and fermentation separate-hydrolysis-fermentation, simultaneous-hydrolysis-fermentation, and consolidated bioprocessing are discussed. The chapter reviews the factors that influence hydrolysis and bioethanol production as well as strain improvement for better sugar metabolisms.

Lignocellulosic biomass as an abundant source of renewable carbon has received ample interest for the production of fuels and chemicals. Reducing recalcitrance of biomass in a cost-effective way is a challenge to commercialize biomass-based technologies. Deep eutectic solvents (DESs) are emerging as a new “green” solvents that have a high potential for biomass processing. This chapter presents background and general information on the subject.

Summary: Background: The high rate of infections among patients admitted to critical care units (CCUs) is associated with high rate of antibiotic consumption, especially broad-spectrum antibiotics. This study is to describe the antibiotics use in CCUs in primary and secondary hospitals in Vietnam, a setting with high burden of antibiotic resistance. Methods: This was a 7-day observational study in 51 CCUs in hospitals from 5 provinces in Vietnam from March to July 2019. Patients aged ≥ 18 years admitted to the participating CCUs was enrolled consecutively. We collected data on patient's demographics, initial diagnosis and antibiotic therapy within the first 24 hours. Antibiotic therapy was classified by the Anatomical Therapeutic Chemical (ATC) Index and the 2019 WHO Access, Watch, Reserve (AWaRe) groups. Findings: Out of 1747 enrolled patients, empirical antibiotic treatments were initiated in 1112 (63.6%) patients. The most frequently prescribed antibiotics were cefotaxime (22.3%), levofloxacin (19%) and ceftazidime (10.8%). Antibiotics were given in 31.5% of patients without diagnosis of infection. Watch and/or Reserve group antibiotic were given in 87.3% of patients and associated with patient's age (aOR 1.01 per 1-year increment, 95%CI 1.00-1.02) and the presence of SIRS on admission (aOR 2.1, 95%CI 1.38-3.2). Interpretation: We observed a high frequency use and a substantial variation in patterns of empirical antibiotic use in the CCUs in Vietnam. It highlights the importance of continuous monitoring antibiotic consumption in CCUs. Funding: None.

Background: A childhood cancer diagnosis and late effects of treatment may affect survivors' possibilities of employment or highly skilled occupations later in life. In this study, we compared the employment and occupational status of childhood cancer survivors with population comparisons and siblings.Methods: In a cohort study based on Nordic registers, we identified 10 461 survivors of childhood cancer diagnosed before age 20 years in Denmark, Finland and Sweden since 1971. Survivors were compared with 48 928 population comparisons matched to survivors by age, sex and geographical region and 12 605 siblings of survivors. Annual outcome information on employment, unemployment, health-related unemployment and occupational position was obtained from the statistical institutes between 1980-2017 and assessed in multivariate logistic regression analyses from age 30 onwards.Findings: By 30 years of age, 9.2% (95% CI, 8.6-9.9%) of survivors were unemployed for health reasons. Childhood cancer survivors had considerably higher odds of health-related unemployment at ages 30, 40 and 50 than population comparisons (ORage30, 2.57; 95% CI, 2.35-2.81) and siblings (ORage30, 2.50; 95% CI, 2.15-2.90). We observed no large difference in unemployment unrelated to health or in occupational position. Health-related unemployment was particularly pronounced among survivors of central nervous system tumours and survivors diagnosed below 15 years of age.Interpretation: Survivors at risk of health-related unemployment should be offered comprehensive survivorship care and interventions for obtaining and maintaining suitable employment.Funding: NordForsk [76111], the Danish Childhood Cancer Foundation [2016-0293], Aarhus University [43239402], the Swedish Childhood Cancer Foundation [PR2020-0130] and [OB2019-0003], Tømrermester Jørgen Holm og Hustru Elisa F. Hansens Mindelegat [20088] and the Swiss National Science Foundation to LM [P2LUP3_175288].