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Nonsurgical root canal retreatment (NS-RCRT) becomes necessary when primary endodontic procedures fail. This study evaluates the efficacy of NS-RCRT using 2% chlorhexidine gel and foraminal enlargement techniques, aiming to assess whether these approaches enhance periapical healing outcomes and success rates compared to traditional NS-RCRT techniques reported in the literature. This retrospective cohort study analyzed 120 teeth diagnosed with persistent apical periodontitis, from 80 patients who underwent NS-RCRT between January 2014 and December 2018 at a specialist's private practice. Data were collected following the Preferred Reporting Items for Observational Studies in Endodontics 2023 guidelines. Periapical healing was evaluated using digital periapical radiographs by three calibrated examiners. The outcome of the treatment was analyzed through descriptive statistics and bivariate analyses, including the Chi-Square and Fisher's Exact tests. Treatment outcomes were deemed successful if they showed complete or incomplete repair and unsuccessful if no repair was observed. The average follow-up period was 30 months. Under loose criteria, 92.50% (n = 111) of the teeth were categorized as successful, and 7.5% (n = 9) as unsuccessful. Bivariate analysis indicated that the radiographic restoration of apical transportation was the only factor that significantly influenced the outcome. NS-RCRT performed in a single visit using the foraminal enlargement technique and 2% chlorhexidine gel demonstrated high success rates and may be an effective alternative to tooth extraction. This method promoted periapical healing and could significantly improve NS-RCRT protocols. Further prospective studies are recommended to corroborate these findings. [ABSTRACT FROM AUTHOR]

This article provides an in-depth review of mobile applications designed to assist individuals with visual and mobility impairments, highlighting how technological advancements enhance independence and quality of life. It examines four key applications: Be My Eyes, which connects visually impaired users with volunteers and integrates AI for real-time visual assistance; TapTapSee, which uses image recognition to provide verbal descriptions of objects; Wheelmap, a crowdsourced platform for locating wheelchair-accessible places; and iAccess Life, which allows users to rate and review the accessibility of public spaces. The review highlights the overall impact of these innovations and acknowledges the potential for further development and improvement. [ABSTRACT FROM AUTHOR]

Gamification, the integration of game-design elements into non-game contexts, has gained significant traction in the development of mobile applications across various sectors, including health, education, commerce, and environmental sustainability. This article explores the effectiveness, benefits, challenges, and future directions of Gamification in mobile apps. By enhancing user engagement, motivation, and loyalty, Gamification has demonstrated substantial benefits, as evidenced by successful applications like Duolingo, Nike+ Run Club, and mHealth solutions. However, the approach is not without its challenges, including ethical concerns, privacy issues, and the potential for negative outcomes like excessive competition and stress. The article highlights the need for continuous innovation and thoughtful design to address these challenges and maximize the potential of Gamification. Future research should focus on incorporating advanced technologies, personalized elements, and data-driven strategies to ensure that Gamification continues to provide meaningful value in mobile app development. The findings suggest that, with careful implementation, Gamification can be a powerful tool for transforming user experiences and achieving positive outcomes in a variety of contexts. [ABSTRACT FROM AUTHOR]

Y-Balance Test (YBT) assesses postural stability. When is applied to patients after anterior cruciate ligament reconstruction (ACLR), it is not clear which variables influence its result. To connect YBT and postural stability, quadriceps, hamstring, and gluteus complex muscle strength, ankle dorsiflexion range of motion (ADFROM). Cross-sectional. Fifty-nine participants (52 males and 7 females) with ACLR ≥6 months were evaluated. YBT anterior, posterolateral, posteromedial, and composite, isokinetic peak torque of the knee, strength of the gluteal complex with Hip Stability Isometric Test, ADFROM with Weight-Bearing Lunge Test, postural stability with Stability Index of Biodex Balance System® were applied. In the ACLR limb, the multivariate regression linear models pointed out an association between the quadriceps muscle strength and ADFRM with anterior, posteromedial and composite reaches (R2 = 0.30; 0.23; 0.26). Hamstring muscle strength and ADFRM with posterolateral (R2 = 0.13). In the uninjured limb, overall stability index and ADFRM with anterior reach (R2 = 0.25), strength of gluteal complex with posteromedial (R2 = 0.31), hamstring muscle strength, Overall and lateromedial stability indexes with posterolateral (R2 = 0.20), hamstring muscle strength, Overall stability index, ADFRM and strength of gluteal complex with composite (R2 = 0.32). The quadriceps muscle strength and ADFRM are important variables for YBT performance in the ACLR limb. In the uninjured limb, ADFROM, the strength of the gluteal complex and hamstring, overall and lateromedial stability indexes are associated with YBT performance. We question the utility of the YBT to measure postural stability given the lack of association with other postural stability measures. • Quadriceps muscle strength is correlated with anterior, posteromedial, and composite performance in ACLR limb. • Knee flexion strength is correlated with posterolateral reach of YBT in both limbs. • Dorsiflexion range of motion is correlated with all reach of YBT in ACLR limb. • Hip muscle strength is correlated with posteromedial, and composite reaches of the uninjured limb. • Postural stability is not correlated with the YBT performance of the ACLR limb. [ABSTRACT FROM AUTHOR]

The aim of the present study was to assess functional performance and perceived fatigue post-COVID-19 in asymptomatic or mildly symptomatic patients. A cross-sectional prospective study was conducted of 1448 individuals who were evaluated for perceived fatigue, functional capacity, handgrip strength, physical activity level, pain and dyspnea. IgG anti-SARS-CoV-2 nucleocapsid serology results and self-declared symptoms were used to classify patients into three study groups: SARS-CoV-2 seronegative, asymptomatic SARS-CoV-2 seropositive and mild infection SARS-CoV-2 seropositive. Participants with a history of moderate or severe COVID-19 were excluded from the analysis. Chi-square test and Kruskal Wallis were used to test for associations between variables. Poisson regression with robust variance was performed for perceived fatigue outcome. Statistical significance was defined as p < 0.05. Measurements for physical performance, body pain or dyspnea between the three study groups were similar. However, a significant difference was observed in reported fatigue between the study groups. Poisson crude and adjusted models confirmed an association between SARS-CoV-2 exposure and presence of perceived fatigue among the asymptomatic and symptomatic mild COVID-19 groups (PR = 1.33 [95%CI:1.09,1.61], P = 0.004 and PR = 1.26 [95%CI:1.03,1.53], P = 0.026), respectively. Upon review, although seropositive SARS-CoV-2 individuals presented a higher prevalence of perceived fatigue, their physical performance was equal to that of the seronegative group. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic exacerbated pain and joint mobility outcomes in patients with temporomandibular disorders (TMD), being that effective treatments are of clinical interest. We aimed to evaluate the effects of manual therapy (MT) and dry needling (DN), compared to cognitive-behavioral therapy/control (CO), on pain, articular mobility, and fear of COVID-19 in patients with TMD. Sixty participants with myofascial TMD were randomly assigned to three groups: MT, DN, and CO. Participants received four weeks of treatment (30 min per week). The participants completed the Fear of COVID- 19 Scale, the Visual Analog Scale, and mandibular mobility was assessed. Data were collected before the intervention (T1), after the last treatment session (T2), and 30 days after the end of treatment (T3). The data were analyzed using two-way Mixed-Design ANOVA, considering the group effect (DN x MT x CO), time (T1, T2, and T3), and the interaction time × group in the observed variance of outcomes. We observed an interaction effect of time × group for maximum mouth opening, protrusion, and pain. The maximum mouth opening increased in the DN and MT groups (p = 0.005), while protrusion increased in the DN group (p = 0.007; test power = 97%, large effect size). A decrease in pain scores over time was observed in the DN and MT groups (p < 0.001; test power>99%, large effect size). The fear of COVID-19 score decreased in the DN and MT groups after 30 days (p = 0.033). DN and MT improve pain, joint mobility, and fear of COVID-19 in patients with TMD. • Dry Needling and manual therapy attenuated perceived pain in patients with TMD. • Dry Needling improved mandibular joint mobility. • Fear of COVID-19 was reduced in patients treated with DN and MT. [ABSTRACT FROM AUTHOR]

Recommendations for different types of bathing to prevent central line-associated bloodstream infections (CLABSI) are still divergent. The objective of this study was to verify whether bed bathing with wipes impregnated with 2% chlorhexidine (CHG) compared to conventional bed bathing is more effective in preventing CLABSI. Systematic review of the literature by consulting the electronic databases PubMed/Medline, Embase, CINAHL, Scopus, and Web of Science from the date of inception until July 1, 2023, with no language or time restrictions. A total of 84,462 studies were examined, of which 6 were included in the meta-analysis. Data from 20,188 critical care patients included in primary studies were analyzed. The meta-analysis found that bed bathing with wipes impregnated with 2% CHG reduced the risk of CLABSI by 48% compared to conventional bed bathing (risk ratio 0.52; 95% confidence interval, 0.37-0.73), and this is moderate-quality evidence. The reduction in length of stay in the intensive care unit and length of hospital stay as well as the risk of death were not significantly different between the study groups. Whether bed bathing with 2% CHG-impregnated wipes increases the occurrence of skin reactions is unclear. This meta-analysis provides moderate-quality evidence that daily bathing with 2% CHG-impregnated wipes is safe and helps prevent CLABSI among adult intensive care unit patients. • CHG-impregnated wipes reduce CLABSI risk by 48%. • Moderate-quality evidence supports daily CHG bathing. • No significant impact on skin allergies. [ABSTRACT FROM AUTHOR]

The quality management of services and products in health institutions covers several areas such as health education, access to information on prevention programs, disease tracking, professional training, availability of diagnostic equipment and therapeutic resources available, which demonstrates the importance that this management has to ensure an efficient administration. To ensure excellence, institutions are generally subjected to audit processes that provides guidance for the implementation of a management system that meets the requirements defined with the aim of improving the quality of the services. Health Organization's quality management system includes a comprehensive biannual audit program in terms of both requirements and services. However, all registration is done with Excel which is a rudimentary tool that implies unnecessary manual work by the responsible employees. Taking this into account and considering the relevance of the audit, an audit platform was built to improve the efficiency of this process. The platform has three different layers: client, server and database and after analyzing the popularity, community and performance of some technologies, the ones chosen for this application were React, Node.js and PostgreSQL. The developed platform includes professional's authentication, an audit calendar, data grids to consult data relevant for the audits, the audit grids for the audit teams to fulfill during the process and audit reports. [ABSTRACT FROM AUTHOR]

Hepatic cirrhosis represents an advanced stage of fibrosis in the liver, resulting from various conditions such as hepatitis and chronic alcoholism. This article uses data from the Mayo Clinic's clinical trial on primary bile cirrhosis carried out between 1974 and 1984. Rapid and accurate identification of the condition is crucial for the implementation of effective interventions, capable of mitigating liver damage and preventing complications, especially in the early stages of the disease. The focus of the research is the evaluation of Data Mining (DM) techniques, using clinical data, to predict survival outcomes in patients with cirrhosis. The study uses the CRISP-DM methodology, analysing different classification algorithms, including k-Nearest Neighbours, Random Forest, Decision Trees, Gradient Boosting and Naive Bayes. The effectiveness of the model is evaluated, highlighting the Random Forest with Holdout Sampling and a ratio of 0.7, whose performance averages around 80%. The nominal attributes were also analysed in order to discover possible patterns of association. [ABSTRACT FROM AUTHOR]

At the Polytechnic of Viseu (PV) [1] , the number of students has been increasing [2] , and it is hoped that this trend continues, for the sake of the literacy of the population that serves in its area of coverage and for the reduction of the desertification of the interior region in which is inserted. In the case of Students with Specific Educational Needs (SSEN) who attend the PV (SSENPV), it is extremely important to develop procedures that minimize the anxiety brought about by change for these students, as well as to facilitate their adaptation, to make the period of permanence in Higher Education (HE) an inclusive period, generating well-being, promoting academic success, and facilitating the transition to active life. To combat this phenomenon and since the PV is a Higher Education Institution (HEI) that is guided by equity in its community, in particular the student community, the SSENPV census is a crucial measure insofar as it is necessary to implement procedures, which must respect and obey individual specificities. It is also intended that, regarding access to information on the platform, it will allow reducing asymmetries between students as well as access to services. To respond to this reality, within the scope of the Inova & Includes project. IPV I2 [3] , a group of researchers, in partnership with the degree course in Computer Engineering at the Superior School of Technology and Management of Viseu (ESTGV) – curricular unit of "Project", developed an integrated management platform for SSENPV. This platform, which is intended to be a contribution to true equity in education in the PV, is based on the support of social impact in different dimensions, which translates into the implementation of the following profiles: • Informative Profile: dissemination of legislation and other relevant information on Specific Educational Needs (SEN), ensuring centralized and accessible information management and streamlining procedures and support measures. • Academic Profile: registration and updating of data on the SSENPV. • Technical Evaluation and Follow-up Profile: registration of the SSENPV procedural evaluation, with automatic sending of technical evaluations to authorized users. [ABSTRACT FROM AUTHOR]

Healthcare facilities use huge quantities of real-time and analytical data to discover meaningful information from patient clinical lab results. Advanced analytics and machine learning algorithms help doctors identify and treat patients more accurately. Accurate models must be trained, tested, and validated with enough data. New real-time data allows healthcare practitioners to quickly and accurately analyse patient demands. Healthcare organizations can improve patient care and outcomes through knowledge discovery. The goal of this effort is to develop a real-time data repository based on patient clinical exams. This collection feeds real-time monitoring panels and machine or deep learning algorithms that forecast patient progression from clinical lab results. Integrate HL7 messages from diverse sources, preprocess them, and add them to an API-accessible data warehouse. In conclusion, the proposed method creates an international-standard data warehouse. This data warehouse can increase healthcare decision-making accuracy and efficacy when utilised with machine learning models, improving patient care and outcomes through more personalised treatment options. [ABSTRACT FROM AUTHOR]

The purpose of this study was to measure and compare coronectomy versus extraction in patients at increased risk for inferior alveolar nerve (IAN) injuries associated with third molar removal in terms of IAN injury and other complications. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist. We conducted a comprehensive literature search across six databases and the gray literature from July 15 to August 01, 2022. We employed Rayyan software to identify and remove duplicate articles to ensure data integrity. Our research followed the strategy patient (P), intervention (I), comparison (C), outcome (O), and study (S): (P) patients needing lower third molar surgery at higher risk of IAN injury; (I) surgery options, coronectomy or complete extraction; (C) comparisons included reduced risks of nerve injuries, postoperative complications (pain, infection, alveolitis), and increased risks of reoperation, root migration, and extraction; (O) desired outcomes were preventing nerve injuries and reducing other surgical complications; and (S) observational study designs (cohort, case-control). Excluded from consideration were studies involving teeth other than lower third molars, as well as reviews, letters, conference summaries, and personal opinions. To gauge the certainty of evidence, we employed the Grading of Recommendation, Assessment, Development, and Evaluation instrument, selecting the most current papers with the highest levels of evidence for inclusion. The primary outcome variable of our study centered on evaluating the incidence of IAN injury, and secondly, the lingual nerve (LN) injury, the postoperative pain, infection, localized alveolitis, the necessity for surgical reintervention, root migration, and extraction. These assessments were carried out with respect to their chosen operative technique for managing third molars, either coronectomy or extraction, as predictor variables. We also considered covariates such as age, gender, and the presence of systemic diseases in our analysis to account for potential confounding factors. The pooled data underwent rigorous analysis utilizing an inverse variance method with both random and fixed effect models by the "metabin" function in the R program's meta-package. Additionally, we assessed the risk of bias in the selected studies by utilizing the Joanna Briggs Institute's Critical Appraisal Checklist for Studies Reporting Prevalence Data and the Critical Appraisal Checklist for Case Reports. Of the 1,017 articles found, after applying the inclusion and exclusion criteria, 42 were included in this study (29 cohort and 13 case-control studies), including 3,095 patients from 18 countries. The meta-analysis showed that coronectomy reduced the risk of IAN injury [OR (Odds Ratio): 0.14; 95% CI (confidence intervals): 0.06-0.30; I2 (inconsistency index) = 0%; P =.0001], postoperative pain (OR: 0.97; 95% CI: 0.33-2.86; I2 = 81%; P =.01), and alveolitis (OR: 0.38; 95% CI: 0.13-1.09; I2 = 32.2%; P =.01) when compared to complete tooth extraction. However, it also highlighted a greater risk of reintervention (OR: 5.38; 95% CI: 1.14-25.28; I2 = 0.0%; P =.01). This study has demonstrated that coronectomy is associated with a decreased risk for IAN injury and decreased pain and localized alveolitis when compared to complete tooth extraction. However, it is essential to acknowledge the higher likelihood of requiring reintervention with coronectomy. Therefore, clinicians should carefully consider the advantages and potential drawbacks of both techniques and tailor their choices to the unique clinical circumstances of each patient. [ABSTRACT FROM AUTHOR]

• Resistance training with progressive intensity has a positive effect on diagnostic parameters for sarcopenia in healthy older adults after 12 weeks of intervention. • There was an increase in isometric and dynamic muscle strength in the upper limbs. • There was an improvement in physical performance and body composition of the elderly in the intervention group. • There was maintenance of muscle mass index and gait speed after the intervention period. The objective of this study was to evaluate the effects of 12 weeks of resistance training (RT) with progressive intensity on factors associated with sarcopenia in older individuals. A cross-sectional study was conducted with 74 participants (64.27 ± 7.06-y-old) who were divided into a control group (n = 37) and an intervention group (n = 37). The intervention group underwent 12 weeks of RT three times a week, with an initial training of 60% and final training of 85% of one-repetition maximum (1RM). Both groups were evaluated before and after the 12-week training period to assess improvements in strength and physical performance. The intervention group showed an increase in physical performance, as evidenced by a reduction in the time to perform the Timed Up and Go (TUG) test (p < 0.01) and the Five Times Sit to Stand Test (p < 0.01). Furthermore, the RT proved to be efficient for increasing hand grip and overall muscular strength, as confirmed through the 1RM test. However, the muscle mass index (MMI) and walking speed did not show any significant alterations in both groups. In conclusion, 12 weeks of RT with progressive intensity has a positive effect on the diagnostic parameters of sarcopenia, leading to improvements in physical performance and muscular strength while maintaining the MMI. [ABSTRACT FROM AUTHOR]

Analyze whether the effects of lower limb resistance training on pain and self-reported function were associated with the exercise volume prescribed for women with patellofemoral pain (PFP). A systematic search was undertaken in four databases from inception to May 2023. Eligible trials examined the effects of resistance training programs on pain (visual analogue scale or numerical pain scale) and function (Anterior Knee Pain Scale) in women with PFP. Meta-analysis was undertaken with a random-effects model. The association of resistance training volume-related variables with mean difference effects on pain and function were tested by exploratory univariable meta-regression models. From 1,404 estudies retained for screening after duplicate removals, 16 studies (579 patients) were included. Changes in knee pain were inversely associated with weekly training frequency (β = 0.5 ± 0.2, P = 0.012). No associations were found between the amount of resistance exercise prescribed per session or per week and effects on pain. Changes in function were associated with the number of sets per week (β = 0.1 ± 0.1, P = 0.044) and number of sets per session (β = 0.6 ± 0.2, P < 0.001) over the intervention. Most favorable results were achieved with 17 to 27 sets per session and >45 sets per week. The amount of prescribed resistance exercise does not seem to be critical for pain reduction in women with PFP. However, our findings support a dose-response effect in terms of improving function. • Pain reduction had no clear association with the amount of resistance exercise. • There was a dose-response effect for enhancement of self-reported function. • Most favorable outcomes were achieved with 17–27 sets per session. [ABSTRACT FROM AUTHOR]

This retrospective cohort study aimed to estimate the success rate (SR) of primary root canal treatment on teeth with a diagnosis of pulp necrosis (PN) and asymptomatic apical periodontitis (AAP) when using 2% chlorhexidine gel as an auxiliary chemical substance and foraminal enlargement instrumentation technique. This study evaluated 178 patients with 206 teeth submitted to primary root canal treatment performed by graduate residents in endodontics. The inclusion criteria were patients who underwent treatment over a period of 1–7 years on teeth with a diagnosis of PN and AAP. The SR was evaluated clinically and radiographically and categorized considering strict (complete resolution of the periradicular lesion) or loose (reduction in the size of the existing periradicular lesion) criteria. Cases of clinical and/or radiographic absence of repair were classified as a failure. Two calibrated examiners independently assessed treatment outcomes using ImageJ software (National Institutes of Health, Bethesda, MD). The SRs were 81.1% (95% confidence interval, 75.7%–86.4%) and 87.4% (95% confidence interval, 82.8%–91.9%) when considering the strict or loose criteria, respectively. Females had a higher SR when strict criteria were applied. Also, the SR was significantly reduced when there was an increase in the patient's age. Teeth with a diagnosis of PN and AAP and treated with 2% chlorhexidine gel and foraminal enlargement achieved substantial SR. Sex and age were prognostic factors that played a significant role in the SR. Future randomized controlled trials should further investigate the effects of foraminal enlargement and 2% chlorhexidine gel as an auxiliary chemical substance. [ABSTRACT FROM AUTHOR]

More than two-thirds of pregnant women experience low back pain during pregnancy. This condition increases with advancing pregnancy, interfering with work, daily activities and sleep. To assess the efficacy of the Pilates method in comparison to prenatal care on the control of lower back pain in pregnant women. Electronic searches were carried out with no language or year of publication restriction in the databases Medline via Pubmed, Embase, CINAHL, LILACS, PEDro, and SPORTDiscus on 20 March 2021. The keywords "Pilates" and "Pregnancy" were applied and the search strategies, adapted to each databank. Randomized clinical trials with pregnant women with muscle pain symptoms and Pilates as an intervention method in comparison to conventional prenatal care were considered. two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The critical evaluation was done using the Risk of Bias tool assess the quality and GRADE to assess the certainty of evidence. We conducted a meta-analysis for the main outcome "pain". through our searches, 687 papers were identified, but only two fulfilled the inclusion criteria and were included in this review. Only two studies compared Pilates with a control group without physical exercise for pain in the short term. In the meta-analysis, there was a significant difference for pain in the comparison between the Pilates group and the control group without exercise; the mean difference (MD) was −23.09 (95% CI), from −31.07 to −15.10, p = 0.001, for 65 individuals (33 in the Pilates group and 32 in the conventional group). Limitation found was the lack of blinding of therapists and participants and the small sample size of individual studies. In addition, no adverse effects were reported. There is moderate-quality evidence that Pilates exercise may reduce pregnancy-related low-back pain more than usual prenatal or no exercise. Prospero registration number CRD42021223243. [ABSTRACT FROM AUTHOR]

Currently, the efficient planning of resources in hospitals present a responsibility of extreme importance in the management of the various clinical units. In Intensive Care Unit (ICU), a hospital service where patients require constant observation and control, considering the high costs incurred with hospitalized patients, the optimization of these factors assumes an extremely important role. Given its unpredictability, this study focused on a characterization of this unit, identifying existing patterns, during a 5-year period, 2017 to 2021, at the Centro Hospitalar do Tâmega e Sousa (CHTS), providing a set of useful information crucial for decision making. Additionally, a prediction of future ICU admissions is performed using time series and Machine Learning (ML) models. However, the models did not reveal a predictive ability with an adequate level of reliability. [ABSTRACT FROM AUTHOR]

Currently, evidence is lacking for disease specific patient reported outcome measures (PROMs) for use in atherosclerotic carotid artery stenosis (either symptomatic or asymptomatic) submitted to carotid endarterectomy (CEA). This study aimed to obtain expert consensus on the most important items to include in a PROM designed to capture the impact of atherosclerotic carotid artery stenosis and its treatment on health related quality of life. A three round modified Delphi consensus study was performed. A mixed expert Delphi panel of doctors (international panel of dedicated vascular surgeons and neurologists) and patients (either symptomatic or asymptomatic patients meeting criteria for carotid artery revascularisation) was implemented. The aim was to obtain pre-defined consensus on items in four pre-defined domains: generic, quality of life, symptom related, and treatment related. Consensus was reached in rounds two and three with > 70% overall expert agreement. The experts agreed on 23 items (out of 49) which were distributed as follows: five in the generic, six in the quality of life, six in the symptom, and six in the treatment related domain. Interestingly, comparing the items that reached consensus in this study, with the generic and disease specific PROMs previously used in carotid artery disease investigation, the only constant items were "difficulty with walking" and "ability to perform daily activities" included in the symptom domain. Considering the items that reached expert consensus in the additional domains, emphasis was given to the impact of the diagnosis, treatment and follow up, and to fear or concern "about the future" and "about severe stroke". In the treatment domain emphasis was also attained on the side effects, long term patient satisfaction, and on the information provided regarding treatment options. As hard clinical outcomes become increasingly rare, assessment of the impact of CEA becomes increasingly difficult. The consensus reached provides a newly defined disease specific PROM that warrants independent validation in specific populations in the future. [ABSTRACT FROM AUTHOR]

• Our aim was the minimum valproate dose effective in genetic generalized epilepsies. • In a retrospective series, 169/225 (75%) patients had seizure control with VPA. • The effective VPA dose in monotherapy was up to 700 mg/d in multivariate analyses. • For patients in polytherapy, the most effective daily VPA dose was up to 1800 mg. Sodium valproate (VPA) is the most effective antiseizure medication (ASM) in genetic generalized epilepsies (GGEs). However, the frequent adverse effects and the high risk inflicted on the exposed offspring make it imperative to search for the lowest daily VPA dose able to control seizures for most patients. In the current published series, the VPA value of <1000 mg was the most adopted. This study aims to provide a cutoff VPA value below which a given daily dose can be considered a low dose in patients with GGEs. This retrospective, observational cohort study included patients with clinical and electroencephalographic diagnoses of GGEs based on the ILAE criteria. Patients were followed up for at least two years using VPA in mono- or polytherapy. Clinical data, VPA dose, and associated ASMs were analyzed. Adverse effects were also evaluated. We related seizure control to VPA doses through uni- and multivariate statistical analyses. From 225 patients, 169 (75%) had good seizure control, with most (60%) receiving monotherapy. The cutoff daily VPA dose capable of distinguishing these patients from those without seizure control was up to 1000 mg (p = 0.006) in univariate analyses and up to 700 mg in multivariate analyses. For patients in polytherapy, the cutoff was up to 1750 mg and 1800 mg in uni- and multivariate analyses, respectively. The lowest daily VPA dose in monotherapy able to control seizures for most GGE patients was up to 700 mg, a value that can be used as a low dose criterion in studies assessing the therapeutic VPA ranges. Patients using higher VPA doses or in polytherapy present a lower probability of seizure control. [ABSTRACT FROM AUTHOR]

There is a problem with collecting information in healthcare services as it is scattered among various sources. This leads to potential impact on patient care focus. To address this issue, a Business Intelligence platform was developed and implemented at the Centre for Surgical Treatment of Obesity at Centro Hospitalar do Tâmega e Sousa. The platform developed enables knowledge extraction and aids healthcare professionals to easily access helpful information and perform better decisions, specifically in regards to the growing global concern of obesity and the increasing prevalence of bariatric surgery. [ABSTRACT FROM AUTHOR]

Shoulder pathologies are prevalent and reduce the quality of life. Due to the shoulder joint's complexity, healthcare professionals face challenges to evaluate, diagnose, and treat these pathologies. On the other hand, the acquisition, presentation, and analysis of patient data in healthcare is complex and hindered by the absence of standardization and interoperability in Database Management Systems. Hence, in this study, we propose a web platform based on openEHR structures that incorporates user interface forms for registering patient physical examinations. The benefits of implementing this approach include structured and standardized data collection, and better communication and information exchange between different systems. [ABSTRACT FROM AUTHOR]

Interoperability of clinical data remains an issue in healthcare despite technology advancements. FHIR, Fast Healthcare Interoperability Resources, is a standard for electronic exchange of healthcare data that is built on web standards, flexible, user-friendly and easy to implement. This research aims to assess FHIR's potential as a solution for interoperability by identifying critical components of FHIR that can improve interoperability and bridge the gap between healthcare systems and sources of clinical data. By leveraging FHIR as a standard, healthcare professionals are able to more effectively communicate and access patient information leading to better patient care and more efficient clinical operations. [ABSTRACT FROM AUTHOR]

Pancreatic cancer is one of the harshest and most challenging cancers to treat, often labeled as incurable. Chemotherapy continues to be the most popular treatment yet yields a very poor prognosis. The main barriers such as inefficient drug penetration and drug resistance, have led to the development of drug carrier systems. The benefits, ease of fabrication and modification of liposomes render them as ideal future drug delivery systems. This review delves into the versatility of liposomes to achieve various mechanisms of treatment for pancreatic cancer. Not only are there benefits of loading chemotherapy drugs and targeting agents onto liposomes, as well as mRNA combined therapy, but liposomes have also been exploited for immunotherapy and can be programmed to respond to photothermal therapy. Multifunctional liposomal formulations have demonstrated significant pre-clinical success. Functionalising drug-encapsulated liposomes has resulted in triggered drug release, specific targeting, and remodeling of the tumor environment. Suppressing tumor progression has been achieved, due to their ability to more efficiently and precisely deliver chemotherapy. Currently, no multifunctional surface-modified liposomes are clinically approved for pancreatic cancer thus we aim to shed light on the trials and tribulations and progress so far, with the hope for liposomal therapy in the future and improved patient outcomes. Considering that conventional treatments for pancreatic cancer are highly associated with sub-optimal performance and systemic toxicity, the development of novel therapeutic strategies holds outmost relevance for pancreatic cancer management. Liposomes are being increasingly considered as promising nanocarriers for providing not only an early diagnosis but also effective, highly specific, and safer treatment, improving overall patient outcome. This manuscript is the first in the last 10 years that revises the advances in the application of liposome-based formulations in bioimaging, chemotherapy, phototherapy, immunotherapy, combination therapies, and emergent therapies for pancreatic cancer management. Prospective insights are provided regarding several advantages resulting from the use of liposome technology in precision strategies, fostering new ideas for next-generation diagnosis and targeted therapies of pancreatic cancer. [Display omitted] [ABSTRACT FROM AUTHOR]

Retroperitoneal fibrosis is a proliferative disease of fibroblasts with a still unclear appearance and low incidence. The clinical manifestations are nonspecific and appear late, pain is the most common symptom present. Elevated serum IgG4 levels are observed in up to 60 % of the patients and the main goal of treating this condition is to preserve kidney function. We present a case of an asymptomatic 34-year-old man. A poorly defined mass in the pre-aortic, pre-caval and right rim regions with possible malignancy was observed. After 3 biopsies, it was treated as low-grade follicular lymphoma with chemotherapy. With new growth after 1 year, right radical nephrectomy was performed to resect the lesion. Pathology showed that it was advanced retroperitoneal fibrosis with negative IgG4. RPF usually presents as an irregular mass of periaortic tissue that frequently has malignancy as a risk factor and may be associated with high levels of IgG4. Most of the time, the disease is asymptomatic. When the patient presents symptoms, pain is the most common, although late. Its diagnosis is made by imaging and histopathological exams. Treatment varies according to the progression of the disease, but aims to try to preserve renal function. RPF is a disease characterized by the accumulation of fibroblasts in the abdominal region with an etiology that has not yet been fully discovered, which can present in several ways, generally identified by imaging exams and can be treated individually depending on the invasiveness of the disease. • Retroperitoneal fibrosis is characterized by the accumulation of fibroblasts in abdominal region • The main goal of treating RPF is to preserve kidney function • The clinical manifestations of RPF are nonspecific and appear late. Pain is the most common symptom • Our case presents an asymptomatic mass, that after 3 biopsies was treated as lymphoma with chemotherapy. With new growth after 1 year, the lesion was removed by radical nephrectomy. [ABSTRACT FROM AUTHOR]

The renin angiotensin system (RAS) has been studied for its effects on various neurological disorders. The identification of functional receptors for Ang-(1–7) and Ang II peptides in astrocytes highlights the physiological modulation and the important role of these cells in the central nervous system. The present study aims to understand the role of RAS peptides, particularly Ang-(1–7) and Ang II, in the secretion of trophic factors by astrocytes and their effects on hippocampal neurons. We used primary cultures of astrocytes and neurons from the hippocampus of either sex neonate of Wistar strain rats. In the present study, we demonstrated that the treatment of astrocytes with Ang-(1–7) acts on the modulation of these cells, inducing reactive astrogliosis, identified through the increase in the expression of GFAP. Furthermore, we obtained a conditioned medium from astrocytes treated with Ang-(1–7), which in addition to promoting the secretion of neurotrophic factors essential for neuronal-glial interactions that are fundamental for neuritogenesis and neuronal survival, showed a neuroprotective effect against glutamatergic excitotoxicity. In turn, Ang II does not exhibit the same effects on astrocyte modulation, exacerbating deleterious effects on brain RAS. Neuron-astrocyte interactions have been shown to be an integral part of the central effects mediated by RAS, and this study has significantly contributed to the understanding of the biochemical mechanisms involved in the functioning of this system. [ABSTRACT FROM AUTHOR]

There has been a marked increase in fishers' participation in fisheries science and management processes. If inappropriate or uncareful, science that over relies on low level participation can backfire and lead to fishers' research fatigue: a state of emotional and psychological exhaustion that causes fishers to refuse further participation. This study aims to examine how research fatigue has emerged in Azorean small-scale fisheries, and to provide suggestions that address the determinants of research fatigue in the Azores and comparable small-scale fisheries contexts. Group discussions between researchers and fisher representatives provided extracts on fishers' frustrations with participating in science, which underwent two rounds of thematic analysis. Drivers of fatigue found in the Azores related to lack of dialogue, fishers' distrust of stakeholders, the opacity of science, tiredness from being consulted, and fisher associations' inability to handle participation requests. Data also connected to the main drivers of research fatigue in transdisciplinary literature, namely concentration, burdensomeness and usefulness of research. Researchers should avoid over-researching small-scale fishers, envision less burdensome participation, and ensure that fishers perceive participation as useful and aligned with their interests. The Azores highlights how low engagement levels, large geographical distances, poor science outreach, and administrative overload can contribute to research fatigue. Ultimately, fisheries researchers should understand how participation impacts the distinct determinants of research fatigue and take precautions to minimise those impacts, or risk nonparticipation from their fisher communities. [ABSTRACT FROM AUTHOR]

Systematic review of the literature in order to obtain the most appropriate endometrial thickness cut-off point for uterine invasive investigation. Systematic review and meta-analysis. Databases evaluation (PUBMED, SCOPUS and EMBASE), with inclusion criteria articles with symptomatic or asymptomatic patients with amenorrhea for more than 12 months, without tamoxifen use, with transvaginal ultrasound evaluation of endometrial thickness and its correlation with the anatomopathological findings of endometrial neoplasm. Methodological quality assessed using the Score of Newcastle – Ottawa tool. The meta-analysis was performed by dividing the groups into symptomatic and asymptomatic patients and the analysis of sensitivity, specificity, positive predictive value, negative predictive value and endometrial thickness cut-off points of endometrial atrophy findings, benign findings or malignant findings was performed. Eligibility criteria were clinical trials and observational studies that contemplated transvaginal ultrasound assessment of endometrial thickness in asymptomatic menopausal patients or postmenopausal vaginal bleeding and correlation with benign or malignant findings identified in invasive procedures of the uterine cavity Not applicable. Thirty one studies eligible for analysis were obtained. Twenty one studies with symptomatic patients, four with asymptomatic patients, three with both and three with patients using hormonal therapy. The results indicate that the endometrial thickness in symptomatic menopausal patients with greater evidence of correlation with neoplastic findings is 5mm, with the sensitivity of 92,9%, specificity 57,5%, positive predictive value 43,0% and negative predictive value 96,0%. No value of endometrial thickness was conclusive for asymptomatic patients or for those using hormone replacement therapy. Further studies are needed to identify an ideal cut-off point for endometrial thickness on transvaginal ultrasound examination to validate endometrial investigation looking for intrauterine neoplasia. In the case of menopausal patients with vaginal bleeding, an endometrial thickness of 5 mm appears to be adequate in identifying patients eligible for invasive uterine investigation. [ABSTRACT FROM AUTHOR]

Thymus vulgaris L. is found all over the world and is cultivated in several countries. It is considered an important medicinal plant with anti-inflammatory and aromatic properties. Its cultivation can suffer from infestation by numerous pathogens, which contributes to lower production. Thus, in 2020, a nematological survey in a vegetable growing area in Jaboticabal, São Paulo, Brazil, detected the presence of galls on the root, indicating that it was Meloidogyne spp. To identify the species, a sample with soil and roots was sent to the laboratory. After the analyzes performed, the species was identified as Meloidogyne javanica. This result was based on the morphological characteristics of the adults and the genetic identification. In the morphological part, the following characteristics were found: Perineal region of females low trapezoidal dorsal arch with two lines in laterals, while males have broader basal nodules with a non-raised labial disk, with the head region not separated from the body. Molecular confirmation was performed by genetic sequencing and sequence characterized amplified regions technique (SCAR). This is the first report of T. vulgaris as a host for M. javanica confirmed by Koch's postulate and several lines of evidence. Based on this report, farmers wishing to grow this vegetable should be aware of plants that are also hosts for this species. [Display omitted] • Meloidogyne javanica was observed on Thymus vulgaris in São Paulo, Brazil. • This is the first report of T. vulgaris as a host for M. javanica. • Thymus vulgaris L. (Lamiaceae) is considered an important medicinal plant. [ABSTRACT FROM AUTHOR]

Focal articular cartilage defects are an important factor that leads to dysfunction of the knee joint. Several different surgical approaches have been tried, most of them showing poor results in the long term. The use of orthobiologics in the context of focal chondral lesion has emerged as a potential tool in the treatment of this condition. In this article, we present a surgical technique for the treatment of focal chondral lesions using a collagen membrane associated with microfragmented adipose tissue graft. [Display omitted] [ABSTRACT FROM AUTHOR]

Cancer is a worldwide epidemic and a leading cause of death. There is a need to find natural solutions for therapy to prevent that outcome. Olive pomace is a known source of bioactive compounds. This work aimed to obtain an olive pomace extract, using an innovative green method, and to assess its chemical composition and the effect of its application in different cancer cell lines. The extract was composed of sugars (28%), minerals (11%), lipids (8%), mostly oleic acid (72%), protein (1%), phenolics (3 g gallic acid equivalents/100 g), hydroxytyrosol (215 mg/100 g), flavonoids (2 g catechin equivalents/100 g), and α-tocopherol (2 mg/100 g). Moreover, 68 phenolics were tentatively identified by UHPLC-ESI-QTOF-MS. The extract significantly reduced the proliferation of the studied cancer cell lines (breast: MCF-7; pancreatic: AsPC-1; and colorectal: HT-29 and Caco-2). It was able to reduce angiogenesis in AsPC-1 cells, presented a cytotoxic effect and increased malondialdehyde levels in HT-29 cells, and decreased growth of Caco-2 cells. These results suggest that this extract can be a source of several compounds which can be used in the formulation of dietary supplements or as a structural basis for antitumoral drugs, but their mechanistic actions still need to be assessed. [ABSTRACT FROM AUTHOR]

This qualitative study was carried out with 10 dyads of patients-family members to explore their perception about psychotic relapses. Data were collected through a semi-structured interview from April to August 2019, in Brazil, and analyzed using the thematic analysis proposed by Braun & Clark. Four main themes emerged from the interviews: (1) defining and describing the psychotic relapses; (2) risk factors for psychotic relapse; (3) protective factors for psychotic relapse; and (4) early warning signs: identification of an episode of psychotic relapse. Exploring the perception of patients with psychotic disorders and their families about relapse is fundamental for the development of relapse risk assessment tools and to guide further research on this topic. • Relapses remain a challenge in the care of individuals with psychotic disorders; • Few qualitative studies were conducted on psychotic relapse; • Qualitative studies help to understand more deeply the phenomenon of relapses; • Our study explored the perceptions of patients and their families about psychotic relapses. [ABSTRACT FROM AUTHOR]

According to the World Health Organization (WHO), more than one billion people in the world are obese, and this number is still increasing. When this disease becomes a high risk to the individual's health and the non-invasive approach does not result in weight loss, it is usual to resort to an invasive intervention, bariatric surgery. Due to all the specifications, as well as the multidisciplinary treatment inherent to this procedure, the need for a specialized environment emerges. In this context, the main objective of this topic focuses on the development of a platform for registration and monitoring of bariatric surgery. For this purpose, a web platform was created, which integrates openEHR forms for the registration of appointments regarding this intervention, and uses openEHR modeling to build the interoperable template. The development of this project aims to provide greater ease and speed in patient care, assisting health professionals in their daily lives. [ABSTRACT FROM AUTHOR]

In Intensive Medicine, the large amount of data that medical professionals are subject to can be overwhelming, leading to the use of techniques and treatments that may not be the most effective in treating patients. Should there be a need to cross planning registries made by doctors and nurses with patients' problems, the situation becomes unmagenable. To support health professionals' decision-making process, and consequently allow health professionals to make informed and timely decisions, by promoting proactive actions, the current study approaches the establishment of a correlation between medical problems and medication and therapies, using association rule mining algorithms, so that physicians can have the correct and timely information regarding patients and consequently, the most appropriate treatments for them in every situation. The main objective is for doctors and nurses to be able to look through problems and have them associated with the most frequently used and reliable therapies and medication, in order to assist patients with the highest healthcare quality. The results of this work corroborate that in order to improve the care provided to Intensive Care Units patients, it is essential to implement intelligent systems that can support hospital staff and assist to provide healthcare more efficiently. [ABSTRACT FROM AUTHOR]

In veterinary medicine, calcinosis circumscripta is a morphological diagnosis for which the cause may be known or idiopathic. The aetiology of the lesion must be investigated because the nature of the underlying disease process will dictate appropriate treatment. We present a case of oral calcinosis circumscripta in a cat caused by a wasp sting and associated with moderate unilateral facial oedema. Following corticosteroid therapy and oedema resolution, hyperaemic, circular, firm, elevated lesions were observed on the buccal mucosa and evolved into whitish, slightly elevated multifocal plaques with an irregular surface. As antibiotic and corticosteroid therapy was ineffective, an excisional biopsy was performed after 6 months of lesion development and a diagnosis of calcinosis circumscripta of dystrophic aetiology was made. To our knowledge, this is the first report of calcinosis circumscripta in association with an insect sting in an animal. Insect stings should be included in the differential diagnosis of calcinosis circumscripta in cats. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment and physical frailty are common among older adults and associated with a higher likelihood of adverse health outcomes. These two conditions frequently coexist in the same individual as cognitive frailty, yet few studies have examined the impact of such comorbidity on clinical outcomes or underlying biological mechanisms.Methods: A total of 1,340 older adults (age ≥60 years old) from the Bambui Cohort Study of Ageing, with a total follow-up of 10 years, were included in this study. Frailty was defined by the accumulation of deficit framework and cognitive impairment based on scores on the MMSE less than 22. In addition, serum IL-6 levels were measured by cytometric bead array assay.Results: Individuals classified with cognitive frailty had significantly higher serum IL-6 levels compared to the robust, cognitively unimpaired group. Those with cognitive frailty (aOR = 1.97 [1.18-3.27] and prefrailty and cognitive impairment (aOR = 1.83 [1.24-2.69]) had the highest mortality risk over 10 years of follow-up. Higher IL-6 levels were also independently associated with a higher mortality rate (aOR = 1.37 [1.23-1.54]).Conclusion: Our study shows that cognitive Frailty indicates a vulnerability state and of increasing mortality risk. Our findings also suggested that proinflammatory abnormalities can be viewed as a central phenomenon underlying common age-related problems (e.g., cognitive impairment and Frailty) and outcomes (e.g., mortality). [ABSTRACT FROM AUTHOR]

Pancreatic ductal adenocarcinoma (PDAC) diagnosis can be difficult in a chronic pancreatitis (CP) background, especially in its mass forming presentation. We aimed to assess the accuracy of glypican-1-positive circulating exosomes (GPC1+crExos) to distinguish PDAC from CP versus the state-of-the-art CA 19–9 biomarker. This was a unicentric prospective cohort. Endoscopic ultrasound with fine-needle aspiration or biopsy and blood tests (GPC1+crExos and serum CA 19–9) were performed. The cohort comprised 60 PDAC and 29 CP (7 of which mass forming - MF) patients. Median levels of GPC1+crExos were significantly higher in PDAC (99.7%) versus CP (28.4%; p <0.0001) with an AUROC of 0.96 with 98.3% sensitivity and 86.2% specificity for a cut-off of 45.0% (p <0.0001); this outperforms CA 19–9 AUROC of 0.82 with 78.3% sensitivity and 65.5% specificity at a cut-off of 37 U/mL (p <0.0001). The superiority of% GPC1+crExos over CA 19–99 in differentiating PDAC from CP was observed in both early (stage I) and advanced tumors (stages II-IV). Levels of GPC1+crExos coupled to beads enable differential diagnosis between PDAC and CP including its mass-forming presentation. [ABSTRACT FROM AUTHOR]

The knee extension prone test (KEPT) can be a low-cost and affordable alternative for this assess knee hyperextension deficit. To analyze concurrent validity and reliability of a new method for assessing knee extension prone (knee extension prone test; KEPT). Participants were divided into two groups: Group 1 comprised healthy participants (HG) and Group 2 comprised participants with a history of knee injury (IG). Two examiners performed the following evaluations: (1) lateral knee goniometry, (2) anterior tibial inclinometry, (3) lateral photogrammetry in supine, (4) lateral photogrammetry in prone, and (5) KEPT. Concurrent validity was analyzed by Pearson's linear correlation coefficient (r), and intra- and inter-examiner reliability were analyzed by intraclass correlation coefficient (ICC). KEPT demonstrated good intra-examiner (ICC = 0.85, 95% CI = 0.75–0.89) and excellent inter-examiner (ICC = 0.92, 95% CI = 0.88–0.94) reliability. The standard error of measurement was 0.47° and 1.30° and the minimum detectable change was 2.35° and 6.5° for intra- and inter-examiner agreement, respectively. Concurrent validity of KEPT ranged from moderate to good (r = 0.54–0.78, p < 0.01). KEPT is a valid and reliable method for assessing knee hyperextension deficit in both healthy individuals and patients with knee injuries. • KEPT showed good to excellent intra- and inter-examiner reliability. • KEPT has moderate to good concurrent validity when compared with other methods. • KEPT is a valid and reliable method for assessing knee hyperextension deficit. [ABSTRACT FROM AUTHOR]

Anthropogenic activities have increasingly contaminated aquatic ecosystems worldwide, requiring the development of adequate methods to assess the effects of environmental pollution on aquatic biota. Currently, ecotoxicological research on fish is largely based on in vivo studies, many times using post-mortem fish samples bought in fish markets or obtained through capture-and-release programs. However, such samples provide a narrow window to the cellular and molecular processes that occur to fish upon exposure to pollutants and other toxicants or pathogens. In thi sense, in vitro cell culture systems have been increasingly proven a valuable tool in several research fields, from molecular biology studies to conservation efforts. To date, however, cell cultures obtained from bony fish have been the most studied and with the best-described protocols and models. Elasmobranchs, comprising shark and rays, play important trophic and environmental roles, employed as chemical contamination environmental sentinels, suffering the effects of such contamination due to bioaccumulation and biomagnification processes. For these reasons, the development of new experimental tools to study elasmobranch cellular and molecular responses to environmental stimuli in controlled conditions is highly desirable. However, only some research groups have attempted to develop elasmobranch cell culture protocols to be used in an ecotoxicological context. In this sense, this review discusses the current elasmobranch cell culture scenario, its importance and potential applications in ecotoxicology assessments and conservation actions. [Display omitted] • Elasmobranch cell cultures comprise an alternative for ecotoxicological studies. • Cell culture studies have only been conducted on 17 species, mostly sharks. • Only brain, germ, gonadal, rectal gland, blood and immune cells have been cultured. • Cell cultures allow for insights on elasmobranch biology, physiology and genetics. • Cell cultures can aid captive breeding programs and reintroduction programs. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has caused a severe shortage of personal protective equipment (PPE), especially N95 respirators. Efficient, effective and economically feasible methods for large-scale PPE decontamination are urgently needed.Aims: (1) to develop protocols for effectively decontaminating PPE using vaporized hydrogen peroxide (VHP); (2) to develop novel approaches that decrease set-up and take-down time while also increasing decontamination capacity; (3) to test decontamination efficiency for N95 respirators heavily contaminated by make-up or moisturizers.Methods: We converted a decommissioned Biosafety Level 3 laboratory into a facility that could be used to decontaminate N95 respirators. N95 respirators were hung on metal racks, stacked in piles, placed in paper bags or covered with make-up or moisturizer. A VHP® VICTORY™ unit from STERIS was used to inject VHP into the facility. Biological and chemical indicators were used to validate the decontamination process.Findings: N95 respirators individually hung on metal racks were successfully decontaminated using VHP. N95 respirators were also successfully decontaminated when placed in closed paper bags or if stacked in piles of up to six. Stacking reduced the time needed to arrange N95 respirators for decontamination by approximately two-thirds while almost tripling facility capacity. Make-up and moisturizer creams did not interfere with the decontamination process.Conclusions: Respirator stacking can reduce the hands-on time and increase decontamination capacity. When personalization is needed, respirators can be decontaminated in labelled paper bags. Make up or moisturizers do not appear to interfere with VHP decontamination. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 has stretched the ability of many institutions to supply needed personal protective equipment, especially N95 respirators. N95 decontamination and re-use programmes provide one potential solution to this problem. Unfortunately, a comprehensive evaluation of the effects of decontamination on the fit of various N95 models using a quantitative fit test (QNFT) approach is lacking.Aims: To investigate the effects of up to eight rounds of vaporized hydrogen peroxide (VHP) decontamination on the fit of N95 respirators currently in use in a hospital setting, and to examine if N95 respirators worn by one user can adapt to the face shape of a second user with no compromise to fit following VHP decontamination.Methods: The PortaCount Pro+ Respirator Fit Tester Model 8038 was used to quantitatively define functional integrity, measured by fit, of N95 respirators following decontamination with VHP.Findings: There was an observable downward trend in the functional integrity of Halyard Fluidshield 46727 N95 respirators throughout eight cycles of decontamination with VHP. Functional integrity of 3M 1870 N95 respirators was reduced significantly after the respirator was worn, decontaminated with VHP, and then quantitatively fit tested on a second user. Furthermore, inconsistencies between qualitative fit test and QNFT results were uncovered that may have strong implications on the fit testing method used by institutions.Conclusions: The data revealed variability in the functional integrity of different N95 models after VHP decontamination, and exposed potential limitations of N95 decontamination and re-use programmes. [ABSTRACT FROM AUTHOR]

• Ballast Water Report compliance kept rising after 2015 and can reach 99.54 % in 2024. • Yet, a higher and more equivalent inspection rate would be expected between areas. • The digitalization of the reports in 2022 allowed more complex automated analysis. • Main ballast water discharges come from the Indo-Pacific Region and Brazil. • The digitalization and the Ballast Water Project will enhance biosecurity assessment. [ABSTRACT FROM AUTHOR]

The contents of essential (Ca, Fe, K, Na, P, and Zn) and potentially toxic inorganic elements (As, Al, Cd, Cr, Cu, Mn, and Pb) in enteral and parenteral nutrition formulas were evaluated by inductively coupled plasma optical emission spectrometry (ICP OES) and graphite furnace atomic absorption spectrometry (GFAAS). A total of 30 enteral formulas, 23 parenteral solution components, and 3 parenteral solutions were analyzed. The elements Ca and K presented the higher contents (72–2918 mg L−1 and 235–2760 mg L−1) while the lowest concentration levels were found for As and Cd (<0.68 µg L−1 and <0.01–0.62 µg L−1) in the studied samples. The validated analytical methods presented an accuracy of 75–116% and RSD values lower than 9.8%. Calcium gluconate and magnesium sulfate, which are used as raw materials in parenteral solution, are potential sources of Al and Mn contamination. A Hazard Quotient (HQ) >1 was obtained for Al (27 ± 1 µg L−1) in one of the parenteral samples, whereas the established limit is 25 µg L−1. Enteral samples were considered safe for consumption regarding the Al, As, and Cd levels. One healing-specific and pediatric formula contained Pb at levels above 0.25 µg kg-day−1, too high for safe consumption. The enteral formulas (pediatric, diabetes-specific, renal-specific, healing-specific, and standard formula with addition of fiber) presented risks in relation to the consumption of Cr and Mn (>250 µg day−1 and >11 mg day−1). The results indicate the need for strict monitoring, considering that these formulations are often the single patient's food source. • The inorganic nutritive potential of enteral and parenteral formulas was evaluated. • Enteral and parenteral formulas are safe for consumption regarding As and Cd. • Calcium gluconate and magnesium sulfate can be contamination source for Al and Mn. • Hazard Quotient >1 for Al, Cr, Mn, and Pb in a few samples, indicating risk. • Macro and microelements levels needs to reviewed in long-term enteral therapy. [ABSTRACT FROM AUTHOR]

This case report presents an unusual multidisciplinary treatment and longitudinal follow-up of a female patient with complete agenesis of the mandibular incisors, diagnosed with Hanhart syndrome. The orthodontic treatment started when aged 11 years and comprised orthodontic traction of the impacted permanent maxillary canine, followed by a Herbst appliance for mesial movement of the mandibular posterior teeth and reduction of the agenesis space. The mandibular canines replaced 2 out of 4 absent incisors, and 1 dental implant was placed between the mandibular right canine and the first premolar. A satisfactory final occlusion was achieved, and the 12-year follow-up showed the stability of results. Multidisciplinary and individualized treatment is important for an adequate rehabilitation of craniofacial patients presenting multiple agenesis. [ABSTRACT FROM AUTHOR]

The environmental field is characterized by a proliferation of concepts that aim to promote new practices and more sustainable development models. It is important to understand whether these concepts achieve their transformative objectives or linger around as empty buzzwords. This paper analyses the concept of ecosystem services, which seeks to promote conservation by capturing the value of the services that nature provides to humans. By analysing its translation into practice and policy in the context of extractivist and commodity-based economies, we reveal its limited transformative potential. Our analysis of three Argentine provinces shows how the concept is not fulfilling its advocates' expectations and has not been able to provide new tools to rethink economic activities in a more environmentally sustainable fashion. By contrast, the concept has been applied in ways that accommodate the local status quo and the interests of hegemonic actors. Future environmental conceptual innovation ought to incorporate deeper awareness of the political and economic conditions that affect a concept's translation into practice and policy. • The concept of ecosystem services is failing to achieve its transformative objectives. • Analysis of its translation into extractivist contexts reveals the concept's limited transformative potential. • Translating this concept into policy in three Argentine provinces has reinforced the unsustainable status quo. • Conceptual innovation should be coupled with political-economic analysis. [ABSTRACT FROM AUTHOR]

Information systems are continuously evolving in nature and complexity. In the healthcare environment, information and information exchange are critical for providing health care at all levels. Hence, the healthcare environment is particularly relevant when discussing IT infrastructure monitoring and disaster prevention since availability and communication are vital for the proper functioning of healthcare units, whether acting in isolation or on a network. This work focuses on understanding what comprises a good monitoring solution, analyzing the monitoring solutions currently available in the optics of a multi-location healthcare environment and, finally, proposing a pervasive and comprehensive conceptual architecture for a monitoring system that is capable of handling such environments. [ABSTRACT FROM AUTHOR]

The strong growth in the number of diabetics in recent years has become a major health concern. The dependence on sugar consumption has caused a rapid growth in the level of diagnoses and in the number of deaths associated. In this context, the project developed allowed a study on how Diabetes can be detected in a timely manner, through the existence of pre-indicators of the disease, defining factors that may determine its onset. For this study, data are collected from Hospital de Santa Luzia (ULSAM), considering aspects such as patient profile, prescribed drugs and previous diagnoses. The results prove that machine learning models using profile data with medical drugs produced the best results, optimizing the predictive ability of Diabetes. [ABSTRACT FROM AUTHOR]