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[Display omitted] Atopic dermatitis (AD) is a common skin condition with multiple topical treatment options, but uncertain comparative effects. We sought to systematically synthesize the benefits and harms of AD prescription topical treatments. For the 2023 American Academy of Allergy, Asthma & Immunology and American College of Allergy, Asthma, and Immunology Joint Task Force on Practice Parameters AD guidelines, we searched MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, ICTRP, and GREAT databases to September 5, 2022, for randomized trials addressing AD topical treatments. Paired reviewers independently screened records, extracted data, and assessed risk of bias. Random-effects network meta-analyses addressed AD severity, itch, sleep, AD-related quality of life, flares, and harms. The Grading of Recommendations Assessment, Development and Evaluation approach informed certainty of evidence ratings. We classified topical corticosteroids (TCS) using 7 groups—group 1 being most potent. This review is registered in the Open Science Framework (https://osf.io/q5m6s). The 219 included trials (43,123 patients) evaluated 68 interventions. With high-certainty evidence, pimecrolimus improved 6 of 7 outcomes—among the best for 2; high-dose tacrolimus (0.1%) improved 5—among the best for 2; low-dose tacrolimus (0.03%) improved 5—among the best for 1. With moderate- to high-certainty evidence, group 5 TCS improved 6—among the best for 3; group 4 TCS and delgocitinib improved 4—among the best for 2; ruxolitinib improved 4—among the best for 1; group 1 TCS improved 3—among the best for 2. These interventions did not increase harm. Crisaborole and difamilast were intermediately effective, but with uncertain harm. Topical antibiotics alone or in combination may be among the least effective. To maintain AD control, group 5 TCS were among the most effective, followed by tacrolimus and pimecrolimus. For individuals with AD, pimecrolimus, tacrolimus, and moderate-potency TCS are among the most effective in improving and maintaining multiple AD outcomes. Topical antibiotics may be among the least effective. [ABSTRACT FROM AUTHOR]

The landscape values reflect the user's preferences related to the landscape. It represents a genuine key in marina managing processes. However, there is no economic value of how much these intangibles represent within the marina management. This study estimated the monetary value associated with landscape intangibles in marinas by combining the hedonic pricing method (HPM) and the valuation of Marina del Este in the coastal locality of La Herradura in Almuñécar, Granada, Spain. The real estate data price of houses sold during 2023, from real estate data, was used as the dependent variable, and house structural, location, and neighborhood served as independent variables. Results showed that coastal residents considered proximity to the beach and expanded sea views two of the most important factors when buying a house. Other amenities related to landscape intangibles were quietness and exclusivity. Comparing the market with intrinsic value at nearby properties, the marina value can be estimated through a direct comparison approach and, hence, obtaining an estimation of the landscape intangibles' contribution to the marina's valuation. They can represent a value of €2,386,736.87, representing 7.91% of the marina's value. Findings can help marina management quantify the value loss of the marina if they are not considered. They also allow landscape policymakers to determine the economic impact of landscape policies. Maintaining the landscape and its values in the marina is an effective way to preserve an attractive environment for users and visitors, and it can be an effective way to make the marina a lively destination that not only offers environmental benefits but also creates economic opportunities. • This study addresses the preferences in amenities when buying a coastal apartment, including those related to landscape intangibles. • Coastal residents positively valued the proximity to the beach and wide seafronts. Related to landscape intangibles, other amenities considered were quietness and exclusivity. • The landscape intangible value can be obtained from the difference between market and intrinsic value. Translated to a marina valuation and applying a direct comparison approach, an estimation of the influence of these intangible values can be obtained, resulting in €2,386,736.87. • Landscape intangibles have a significant economic value to marina management (7.94%). • Implementing this method allows marina managers to quantify the loss of the marina's value if these intangibles are not considered. Also, policymakers can determine the economic impact of landscape policies. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD, eczema) is driven by a combination of skin barrier defects, immune dysregulation, and extrinsic stimuli such as allergens, irritants, and microbes. The role of environmental allergens (aeroallergens) in triggering AD remains unclear. We systematically synthesized evidence regarding the benefits and harms of allergen immunotherapy (AIT) for AD. As part of the 2022 American Academy of Allergy, Asthma & Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters AD Guideline update, we searched the MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Global Resource for Eczema Trials, and Web of Science databases from inception to December 2021 for randomized controlled trials comparing subcutaneous immunotherapy (SCIT), sublingual immunotherapy (SLIT), and/or no AIT (placebo or standard care) for guideline panel–defined patient-important outcomes: AD severity, itch, AD-related quality of life (QoL), flares, and adverse events. Raters independently screened, extracted data, and assessed risk of bias in duplicate. We synthesized intervention effects using frequentist and Bayesian random-effects models. The GRADE approach determined the quality of evidence. Twenty-three randomized controlled trials including 1957 adult and pediatric patients sensitized primarily to house dust mite showed that add-on SCIT and SLIT have similar relative and absolute effects and likely result in important improvements in AD severity, defined as a 50% reduction in SCORing Atopic Dermatitis (risk ratio [95% confidence interval] 1.53 [1.31-1.78]; 26% vs 40%, absolute difference 14%) and QoL, defined as an improvement in Dermatology Life Quality Index by 4 points or more (risk ratio [95% confidence interval] 1.44 [1.03-2.01]; 39% vs 56%, absolute difference 17%; both outcomes moderate certainty). Both routes of AIT increased adverse events (risk ratio [95% confidence interval] 1.61 [1.44-1.79]; 66% with SCIT vs 41% with placebo; 13% with SLIT vs 8% with placebo; high certainty). AIT's effect on sleep disturbance and eczema flares was very uncertain. Subgroup and sensitivity analyses were consistent with the main findings. SCIT and SLIT to aeroallergens, particularly house dust mite, can similarly and importantly improve AD severity and QoL. SCIT increases adverse effects more than SLIT. These findings support a multidisciplinary and shared decision-making approach to optimally managing AD. [Display omitted] [ABSTRACT FROM AUTHOR]

To describe the study design, and the distal and proximal influences on oral health reported in the national demographic and health survey (DHS) of the Kingdom of Saudi Arabia (KSA) in 2017. The 2017 KSA DHS used an innovative multistage stratified random-sampling technique to select the population sample by using primary health care centers' (PHCs) catchment areas as the primary sampling unit. Over 45,000 household heads plus a family member were interviewed. A conceptual framework for distal and proximal oral health influences specific to the KSA was adapted based on the oral health surveillance model. Cross-tabulation and Chi-square tests were performed with consideration for sample weights to provide estimates representative for the KSA population. Frequencies and weighted percentages for each variable reflecting each construct were reported. The total number of individuals included in the analysis was n = 55,511, ages ranging between 2 and > 65 years. Lack of dental care when needed was reported for 22.5 % of the population (males = 20.8 %/females = 24.7 %). Proportion of population from Central, West, East, South, and North regions who reported available dental care services when needed was 62.3 %, 58.0 %, 58.9 %, 62.3 %, and 60.1 %, respectively. PHCs were the most regular source for dental care (55.1 %). In total, 48.3 % visited the dentist at least once last year (males = 49.4 % /females = 46.8 %). Dental pain was the most common reason for last dental visit (69.0 %), while only 6.4 % reported visited the dentist for routine visit. Only 15.3 % reported brushing their teeth at least twice per day (males = 14.6 % /females = 16.4 %). Two major oral health influences previously reported to have a significant negative influence on oral health, namely, limited routine dental check-up visits and inadequate oral hygiene, were present among KSA residents. Further inferential study is needed to investigate such influence on oral health status within the KSA population. [ABSTRACT FROM AUTHOR]

Objective: We aimed to assess the presence of residual liver stiffness in preeclampsia 45 days after delivery.Study Design: This was a longitudinal case-control study to assess the association between residual liver stiffness, measured 45 days postpartum, and hypertensive disorders of pregnancy. Cases were obstetric patients admitted with hypertension during pregnancy (preeclampsia with and without severe features, or HELLP syndrome) between June 2019 and September 2021. Controls were obstetric patients with similar ages, social status, gestational age (assessed by the first-trimester ultrasound), and geographical areas between the same period. A 2:1 case-control match was considered.Main Outcome Measures: We recorded blood pressure and laboratory tests during the hospital stay. We measured the residual liver stiffness in preeclampsia participants and controls 45 days after delivery.Results: We recruited 99 hypertensive patients and 46 control patients. The residual liver stiffness was higher in hypertensive cases than controls (4.6 [3.9-5.3] kPa vs. 4.0 [3.2-5.2] kPa; p = 0.039). Linear regression results showed that systolic and diastolic blood pressures and alanine aminotransferase positively correlated with liver stiffness values (p < 0.01).Conclusions: Preeclampsia and disease severity were associated with residual liver stiffness. Prospective studies should further evaluate the clinical implications of these findings. [ABSTRACT FROM AUTHOR]

La declaración PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), publicada en 2009, se diseñó para ayudar a los autores de revisiones sistemáticas a documentar de manera transparente el porqué de la revisión, qué hicieron los autores y qué encontraron. Durante la última década, ha habido muchos avances en la metodología y terminología de las revisiones sistemáticas, lo que ha requerido una actualización de esta guía. La declaración prisma 2020 sustituye a la declaración de 2009 e incluye una nueva guía de presentación de las publicaciones que refleja los avances en los métodos para identificar, seleccionar, evaluar y sintetizar estudios. La estructura y la presentación de los ítems ha sido modificada para facilitar su implementación. En este artículo, presentamos la lista de verificación PRISMA 2020 con 27 ítems, y una lista de verificación ampliada que detalla las recomendaciones en la publicación de cada ítem, la lista de verificación del resumen estructurado PRISMA 2020 y el diagrama de flujo revisado para revisiones sistemáticas. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews. Full English text available from : www.revespcardiol.org/en [ABSTRACT FROM AUTHOR]

Few studies have reported on the use of continuous glucose monitoring (CGM) during the Covid-19 pandemic. We aimed to examine glycemic control metrics using flash glucose monitoring during insulin treatment and the clinical outcome in hospitalized patients with COVID-19. Prospective, single-center cohort of adult patients diagnosed with type 2 diabetes or hyperglycemia and COVID-19 infection treated with basal bolus insulin regimen. Glycemic control was assessed with the use of intermittent Freestyle Libre flash glucose monitoring during the hospital stay. Outcome of interest were time in range [TIR], time above [TAR] and below [TBR] range, glycemic variability [coefficient of variation [% CV]), and differences in a composite of complications including ICU admission, acute respiratory distress syndrome (ARDS) and acute kidney injury. A total of 60 patients were included (44 known diabetes and 16 new onset hyperglycemia). In total 190,080 data points of CGM were available, of which 72.5% of values were within the target area [TIR (70–180 mg/dL)], 22% TAR (>180 mg/dL), and 3% were TBR (<70 mg/dL). During treatment, the coefficient of variation (% CV) was 30%. There were no association with TIR, but patients with TAR >180 mg/dl had higher rates of a composite of complications (22.5% vs 16%, p = 0.04). Basal bolus insulin regimen was safe and effective in achieving inpatient glycemic control in most patients with COVID-19. The association between TAR and complications indicates the need for improved inpatient glycemic control in hospitalized patients with COVID-19. • Continuous Glucose Monitoring correlates well with point-of-care capillary glucose in hospitalized patients with diabetes. • We describe an association between time above range and COVID-19 complications in patients with no history of diabetes. • There is a need for close glucose monitoring and tight glycemic control in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Cyber-Physical Machine Tools (CPMT) are becoming ubiquitous parts of manufacturing sectors. CPMT offer immense potentials in the current CNC machine tool through integrating the machine tool and the machining process using computation and networking to enhance interconnection and autonomy. This study contributes to literature by presenting a variety of MTConnect applications in facilitating the decision making process at different production levels. We do this through addressing the challenges of data communication and management with CNC machine tool. Using the MTConnect protocol, we gathered near real-time data from a CNC machine. Next, the collected data are utilized to develop a local monitoring system that facilitates the decision-making process with applications on: i) production planning, ii) preventive maintenance, and iii) energy consumption analysis. In each application, various analyses and visualization techniques are presented to show the capabilities of the decision support system (DSS) for the operator. Finally, the advantages of the local DSS to improve the interoperability of the CNC through MTConnect are discussed. [ABSTRACT FROM AUTHOR]

While inflammation is an important innate defense mechanism against infection, it can also lead to local tissue damage. The trans signaling pathway of interleukin (IL)-6 is a known mediator of inflammation. We hypothesized that the trans IL-6 signaling pathway is associated with the development of post febrile urinary tract infection (UTI) renal scarring. To compare soluble regulators of trans IL-6 signaling between patients with a history of febrile UTI who do or do not have renal scarring. After IRB-approval, we collected urine samples in pediatric patients with a history of febrile (≥38 °C) UTI (urine culture >50 K uropathogen) with documented presence or absence of renal scarring on imaging. Samples were collected at a time when patients were not actively infected. Enzyme-linked immunosorbent assays were performed on samples for markers of trans IL-6 signaling: IL-6, soluble (s) IL-6 receptor (R), and soluble (s)gp130, a buffer in trans IL-6 signaling. Values were normalized to urine creatinine. Results were analyzed by t -test or Mann–Whitney U. Spearman rank correlation was used. A p-value of <0.05 was considered significant. A total of 50 urines from patients with a history of febrile UTI were collected: 23 with and 27 without scarring. There was no difference between groups regarding age or gender. There was no significant difference in urine IL-6, sIL-6R, or sgp130 between those with and without scarring (Figure). While IL-6 values significantly correlated with sIL-6R and sgp130 in those without renal scarring, IL-6 did not correlate with sgp130 in those with scarring. Ratios of IL-6 to sgp130 and sIL-6R to sgp130 were not different between groups. The inflammatory response generated in response to infection is believed to be largely responsible for the development of renal scarring after UTI. IL-6 is a cytokine known to be induced during UTI with a pro-inflammatory pathway, known as trans signaling. This study investigated for differences in markers of trans IL-6 signaling between patients with a history of febrile UTI with and without renal scarring. There was no significant difference between the absolute values or ratio of these markers between groups. Markers of trans IL-6 signaling are not different between individuals with a history of febrile UTI with and without renal scarring in the non-acute setting. Summary Fig. 1 Urine sample results of trans IL-6 signaling markers in patients with a history of febrile UTI who do not have scarring (NS) compared to those with scarring (S). Summary Fig. 1 [ABSTRACT FROM AUTHOR]

• Broccoli root vesicles showed stability and high entrapment efficiency. • Nanoencapsulation with membrane vesicles provide an efficient system for keratinocytes cell delivery. • Effectivity is probed by penetrating in skin layers. During the last few years, membrane vesicles (as exovesicles) have emerged as potential nanocarriers for therapeutic applications. They are receiving attention due to their proteo-lipid nature, size, biocompatibility and biodegradability. In this work, we investigated the potential use of isolated root plasma membrane vesicles from broccoli plants as nanocarriers. For that, the entrapment efficiency and integrity of the vesicles were determined. Also, the delivery of keratinocytes and penetrability through skin were studied. The results show that the broccoli vesicles had high stability, in relation to their proteins, and high entrapment efficiency. Also, the interaction between the vesicles and keratinocytes was proven by the delivery of an encapsulated fluorescent product into cells and by the detection of plant proteins in the keratinocyte plasma membrane, showing the interactions between the membranes of two species of distinct biological kingdoms. Therefore, these results, together with the capacity of brassica vesicles to cross the skin layers, detected by fluorescent penetration, enable us to propose a type of nanocarrier obtained from natural plant membranes for use in transdermal delivery. [ABSTRACT FROM AUTHOR]

The aim of this clinical trial is to examine whether it is possible to reduce postoperative complications using an individualized perioperative ventilatory strategy versus using a standard lung-protective ventilation strategy in patients scheduled for thoracic surgery requiring one-lung ventilation. International, multicenter, prospective, randomized controlled clinical trial. A network of university hospitals. The study comprises 1,380 patients scheduled for thoracic surgery. The individualized group will receive intraoperative recruitment maneuvers followed by individualized positive end-expiratory pressure (open lung approach) during the intraoperative period plus postoperative ventilatory support with high-flow nasal cannula, whereas the control group will be managed with conventional lung-protective ventilation. Individual and total number of postoperative complications, including atelectasis, pneumothorax, pleural effusion, pneumonia, acute lung injury; unplanned readmission and reintubation; length of stay and death in the critical care unit and in the hospital will be analyzed for both groups. The authors hypothesize that the intraoperative application of an open lung approach followed by an individual indication of high-flow nasal cannula in the postoperative period will reduce pulmonary complications and length of hospital stay in high-risk surgical patients. [ABSTRACT FROM AUTHOR]

In the present investigation, an index for the state of conservation of high Andean wetlands was generated from water, soil, biodiversity, and landscape fragmentation indicators. Said indicators were selected in accordance with recommendations from the bibliography and consultation with experts. Based on a multivariate correlation analysis, indicators were ranked and statistical processing was conducted for the allocation of weights, radial graph construction and data standardization. Subsequently, a formula which integrated the various indicators was applied. Finally, a scale was employed for index determination, range generation, to define each site's state, considering that the closer they were to one, the better the conservation status, and lastly, conservation states were mapped, in accordance with the index determined for each site. [ABSTRACT FROM AUTHOR]

• Innovate the "structural response sensitivity weight" interdisciplinary model. • Breakthrough in research on super statically indeterminate microscopic lattice. • Assessing 100 years of sustainability data for China's construction industry. • Provides a paradigm for United Nations and regional assessments. Sustainability research in the construction industry is of great strategic significance to the ecological environment of countries worldwide. This paper innovates theoretical models such as "structural response sensitivity weight" through interdisciplinary research on advanced mathematics, engineering science, computer science, environmental management and economic sociology. The model solves the limitations of multi-factor, multi-discrete, multi-constraint and low coupling iteration accuracy. The article shows the robustness of the model through case studies. The research data shows that the construction industry in China will reach its highest life cycle assessment emission peak of 2.73 GT in 2030 and will have harmful emissions of -2.78 GT between 2061 and 2098. The social impact assessment will peak at 4.26 GT in 2048 and harmful emissions of −3.75 GT per year from 2061 to 2098. This research provides a comprehensive research theory system and reference standards for scientific calculation and accurate assessment of the sustainable development of the construction industry in various countries around the world. [ABSTRACT FROM AUTHOR]

Infrastructure is a crucial aspect of promoting worldwide economic integration. However, the construction of infrastructure often results in high energy consumption and substantial emissions of greenhouse gases. Over time, the environment can also cause significant damage to bridges, leading to repeated repairs and replacements that further harm the environment. This research aims to minimize the environmental impact of bridge maintenance over a 100-year lifespan. The study utilizes a three-dimensional dynamic thermo-mechanical optimization model developed through comprehensive research and interdisciplinary collaboration in various fields such as Bibliometrics, Fluid Mechanics, Structural Dynamics, Thermoelectricity, and Damage Mechanics. From examining single crystal structures at a microscopic level to examining system components under extreme temperatures, this study provides a system for reducing environmental pollution. The model's reliability is shown through a case study, demonstrating a reduction of 49.9 million tonnes of emissions, equivalent to 1.91% of total design emissions, over a 100-year maintenance period. This research provides a foundation for future studies and presents an approach for evaluating the environmental impact of long-term temperature changes in structures. • Through literature surveys and multidisciplinary research. • The research establishes a three-dimensional dynamic thermo-solid coupled lattice optimization model. • From the microscopic single crystal structure to the topological coupling research. • The study solved the impact of natural environmental temperature on the environment of mega structures. • The paper had built a high-quality theoretical system. [ABSTRACT FROM AUTHOR]

The four pillars for treatment of heart failure with reduced ejection fraction (HFrEF) patients include angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin-receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker (BB), mineralocorticoid receptor antagonist (MRA) and sodium-glucose cotransporter-2 inhibitor (SGLT2i), unless contraindicated or not tolerated. They should be started or up titrated to maximally tolerated doses recommended in current guidelines. Despite proven benefits and strong guideline recommendations, their use and dosing in routine clinical practice have traditionally fallen below the levels achieved in clinical trials. This analysis seeks to establish medication use and optimal dosage according to the clinical practice guidelines in HFrEF patients included in the RECOLFACA registry during recruitment and after six-month follow-up. Factors that limit its use could be identified in subsequent analysis. The RECOLFACA registry was performed between 2017 and 2019. A descriptive analysis is performed considering the medication used in HFrEF patients (ACE-I/ARB/ARNI, BB, and/or MRA) and their dosage (<50%, 50-100% or 100% of the dosage recommended in guidelines) during recruitment and at 6-month follow-up. SGLT2i are not included in this analysis because were not available during this period. The registry included 2528 patients, and this analysis included 1661 HFrEF patients from this registry. Among these patients 89.4%, 93.4% and 70.1% received ACE-I/ARB/ARNI, BB and ARM respectively during registry recruitment. At six-month follow-up, a decrease in its use was observed (57.9%, 53.3% and 44.2% respectively). Among patients with established medication during registry recruitment, only 10.4%, 16.5% and 4.7% received target doses of ACE-I/ARB/ARNI, BB or ARM respectively, which increased at six-month follow-up in ACE-I/ARB/ARNI and BB group (12.6% and 21.5% respectively) and decreased in ARM group (3.7%) (Figure 1). Less than 1% of patients were simultaneously receiving target doses of ACE-I/ARB/ARNI, BB and MRA during registry. In HFrEF patients included in this registry, the use and dosage of the three groups of medications evaluated (ACEI/ARB/ARNI, BB and ARM) and that are recommended in current guidelines is low and more worrisome is that after time (6-month follow-up), this percentage is lower, as mentioned in other trials. There is minor increases in the number of patients reaching maximal doses of those therapies during follow-up. We need to continue working to be able to identify factors associated with low adherence, access to medication, and using maximal recommended/tolerated doses. [ABSTRACT FROM AUTHOR]

Recent studies based on numerical models of the Local Group predict the existence of field haloes and galaxies that have visited both the Milky Way and M31 in the past, called Hermeian haloes. We extend this analysis beyond the Local Group using two high-resolution dark matter-only N-body simulations from the MultiDark suite. We define Hermeian haloes as field haloes which had close interactions with two other more massive field haloes in the past, called targets. We find that Hermeian haloes are a more extreme example of field haloes with interactions in the past than the well-known backsplash haloes that experienced only one interaction. Compared to backsplashers, Hermeians have more concentrated density profiles and tend to occupy more overdense regions. They also have higher velocities relative to their target haloes and relative to their neighbours within 1 h − 1 Mpc. Hermeian haloes can be found around every halo in the simulation (if the resolution is sufficient) and make up 0.4 to 2.3 per cent of the total number of field haloes (for haloes more massive than 1 0 10 h − 1 M ⊙ and 3. 3 × 1 0 7 h − 1 M ⊙ , respectively), increasing to 10 per cent in overdense regions. They tend to be distributed close to the line connecting their targets, which may help to identify Hermeian haloes in observations. We also identify Local Group analogues in the simulation and find that about one-third (15 out of 49) of them contain Hermeian haloes if the distance between the two main haloes is below 1 h − 1 Mpc. [ABSTRACT FROM AUTHOR]

Abstract Sustainability is of paramount importance when facing the design of long lasting, maintenance demanding structures. In particular, a sustainable life cycle design for concrete structure exposed to aggressive environments may lead to significant economic savings, and to reduced environmental consequences. The present study evaluates 18 different design alternatives for an existing concrete bridge deck exposed to chlorides, analyzing the economic and environmental impacts associated with each design as a function of the maintenance interval chosen. Results are illustrated in the context of a reliability-based maintenance optimization on both life cycle costs and life cycle environmental impacts. Maintenance optimization results in significant reductions of life cycle impacts if compared to the damage resulting from performing the maintenance actions when the end of the service life of the structure is reached. The use of concrete with 10% silica fume has been shown to be the most effective prevention strategy against corrosion of reinforcement steel in economic terms, reducing the life cycle costs of the original deck design by 76%. From an environmental perspective, maintenance based on the hydrophobic treatment of the concrete deck surface results in the best performance, allowing for a reduction of the impacts associated with the original design by 82.8%. Highlights • Environmental and Economic Life Cycle Assessment of different design strategies for bridge decks in coastal environments. • 18 design alternatives were studied and compared. • Maintenance strategies is optimized for each design following a reliability-based approach. • Maintenance optimization results in significant reductions of life cycle impacts. • Concrete with silica fume and hydrophobic surface treatments perform best in economical and environmental terms. [ABSTRACT FROM AUTHOR]

Highlights • The giant reed and the cork are good natural insulation materials and their use is an excellent solution to reduce agricultural waste. • The saved energy by the use of agglomerated cork walls for the envelope of buildings is more than 75% of the energy spent than building with brick walls. • The environmental effects of the disposed wastes of building components in giant reed or cork are lower than other building materials. • CO 2 production for heating and cooling the building was: 2517 kg for brick walls, 623 kg for cork walls and 1905 kg for giant reed walls. Abstract The environmental impact of buildings has to be assessed not only in reference to the energy consumed by their use but also with reference to the energy inside materials with which they are made of. The "Sick Building Syndrome" (SBS) is increasing. It was discovered that the major causes are linked to chemical contaminants from indoor sources such as building materials, inadequate ventilation, excessive use of Heating, Ventilation and Air Conditioning (HVAC) and volatile organic compounds (VOCs). The insulation building materials have a relevant role in the SBS for the capacity, not only to limit the use of HVAC but also to limit the emission of pollutants inside a building environment. The present paper reports an up- to- date review of some innovative uses of wastes deriving from agricultural production in order to build walls and partitions for Mediterranean houses. Some test methods of building elements, made with giant reed and agglomerate cork which are two typical natural materials of the Mediterranean area, are illustrated. These vegetal materials are often residues deriving from agricultural production, the agricultural residues are often a problem for farmers or firms because the organic wastes are considered dangerous and the disposal of such material is very expensive, therefore the reuse of the wastes is the best way to recycle these materials. This paper analyzes a cavity wall panel made with a wood skeleton on which two double crossed layers of giant reed stems were fixed and a multilayer agglomerated cork wall with a double cavity multilayer BOTH 20CM THICK. The dynamic thermal analysis carried out for the houses with the proposed walls highlights a better environmental performance of buildings with agglomerated cork and with giant reed walls rather than brick walls. The production of CO 2 for the indoor environmental thermal control of the house with giant reed walls is less than 1/2 and the house with agglomerated cork walls is less than 1/4 compared to the brick wall house. [ABSTRACT FROM AUTHOR]

Sustainable design of structures includes environmental and economic aspects; social aspects throughout the life cycle of the structure, however, are not always adequately assessed. This study evaluates the social contribution of a concrete bridge deck. The social performance of the different design alternatives is estimated taking into account the impacts derived from both the construction and the maintenance phases of the infrastructure under conditions of uncertainty. Uncertain inputs related to social context are treated through Beta-PERT distributions. Maintenance needs for the different materials are estimated by means of a reliability based durability evaluation. Results show that social impacts resulting from the service life of bridges are not to be neglected in sustainability assessments of such structures. Designs that minimize maintenance operations throughout the service life, such as using stainless steel rebars or silica fume containing concretes, are socially preferable to conventional designs. The results can complement economic and environmental sustainability assessments of bridge structures. [ABSTRACT FROM AUTHOR]

Background In Colombia, taeniasis and cysticercosis have been significantly reduced over the past decades, however still reported with implications for public health and travel medicine. Methods An observational, retrospective study, in which the incidence of taeniasis and cysticercosis (ICD-10 codes B68s/B69s) in Colombia, 2009–2013, was estimated based on data extracted from the Individual Health Records System ( Registro Individual de Prestación de Servicios , RIPS) was performed. The Geographic Information System (GIS) generated national maps showing the distribution of taeniasis and cysticercosis by department by year. Results During the period, 3626 cases were reported (median 796/year), for a cumulative crude national rate of 7.7 cases/100,000pop; 58.2% corresponded to male; 57% were <40 year-old (10.2% < 9.9 year-old). Cases were 57.6% neurocysticercosis, the rest were taeniasis due to T. solium , T. saginata , ocular cysticercosis and cysticerci in other organs. Bolivar, a touristic department, had the highest cumulated incidence rate (16.17 cases/100,000pop), as also evident across the map series developed in this study. Conclusion Despite the limitations of this study, data presented provide recent estimates of national taeniasis and cysticercosis incidence in the country useful in public health and for travel medicine practitioners, as some highly touristic areas presented higher disease incidence. Improved control, particularly of taeniasis, should be an attainable goal, which among other strategies would require improved sanitation and health education to prevent transmission, but also enhanced surveillance. [ABSTRACT FROM AUTHOR]

Assessing the viability of a public infrastructure includes economic, technical and environmental aspects; however, on many occasions, the social aspects are not always adequately considered. This article proposes a procedure to estimate the social sustainability of infrastructure projects under conditions of uncertainty, based on a multicriteria deterministic method. The variability of the method inputs is contributed by the decision-makers. Uncertain inputs are treated through uniform and beta PERT distributions. The Monte Carlo method is used to propagate uncertainty in the method. A case study of a road infrastructure improvement in El Salvador is used to illustrate this treatment. The main results determine the variability of the short and long-term social improvement indices by infrastructure and the probability of the position in the prioritization of the alternatives. The proposed mechanism improves the reliability of the decision making early in infrastructure projects, taking their social contribution into account. The results can complement environmental and economic sustainability assessments. [ABSTRACT FROM AUTHOR]

Objective Geographical information systems (GIS) have been demonstrated earlier to be of great use to inform public health action against vector-borne infectious diseases. Methods Using surveillance data on the ongoing ZIKV outbreak from Pereira, Colombia (2015–2016), we estimated incidence rates (cases/100,000 population), and developed maps correlating with the ecoepidemiology of the area. Results Up to October 8, 2016, 439 cases of ZIKV were reported in Pereira (93 cases/100,000 pop.), with highest rates in the South-West area. At the corregiments (sub-municipalities) of Pereira, Caimalito presented the highest rate. An urban area, Cuba, has 169 cases/100,000 pop., with a low economical level and the highest Aedic index (9.1%). Entomological indexes were associated with ZIKV incidence at simple and multiple non-linear regressions (r 2 > 0.25; p < 0.05). Conclusions Combining entomological, environmental, human population density, travel patterns and case data of vector-borne infections, such as ZIKV, leads to a valuable tool that can be used to pinpoint hotspots also for infections such as dengue, chikungunya and malaria. Such a tool is key to planning mosquito control and the prevention of mosquito-borne diseases in local populations. Such data also enable microepidemiology and the prediction of risk for travelers who visit specific areas in a destination country. [ABSTRACT FROM AUTHOR]

Nowadays, sustainability assessments tend to focus on the biophysical and economic considerations of the built environment. Social facets are generally underestimated when investment in infrastructure projects is appraised. This paper proposes a method to estimate the contribution of infrastructure projects to social sustainability. This method takes into account the interactions of an infrastructure with its environment in terms of the potential for short and long-term social improvement. The method is structured in five stages: (1) social improvement criteria and goals to be taken into account are identified and weighed; (2) an exploratory study is conducted to determine transfer functions; (3) each criterion is homogenized through value functions; (4) the short and long-term social improvement indices are established; and finally, (5) social improvement indices are contrasted to identify the socially selected alternatives and to assign an order of priority. The method was implemented in six alternatives for road infrastructure improvement. The results of the analysis show that the method can distinguish the contribution to social sustainability of different infrastructure projects and location contexts, according to early benefits and potential long-term equitable improvement. This method can be applied prior to the implementation of a project and can complement environmental and economic sustainability assessments. [ABSTRACT FROM AUTHOR]

Emission factors are essential in order to accurately account and report land use and land use change emissions due to deforestation at a national level, in accordance with the United Nations Framework Convention on Climate Change reporting guidelines. Nonetheless, in many tropical countries its availability is still scarce, especially in Colombia where a National Forest Inventory is lacking. Here, we estimate the amount of carbon stored in the live aboveground biomass of the forests of Colombia, using data from 4981 sampling forest plots of various sizes established between 1990 and 2014. Our study included an analysis of the influence of the choice of allometric model and the carbon density estimation method employed in the estimation. We found that the most conservative total mean value for the entire country was 226.9 ± 4.5 Mg ha −1 , obtained by using a previous set of allometric equations developed for the natural forest of Colombia and an inverse-variance weighting that accounts for the variation in plot size, which represents a potential stock of 6.44 ± 0.13 Pg of carbon. Thus, our study provides a method to utilize existing sample data to assess forest carbon stocks at national level, make available conservative carbon stocks estimates for the natural forests of Colombia, and reports enhanced and adequate information subject to national capabilities and policies in the context of results-based payments for reducing emissions from deforestation and forest degradation and the conservation. [ABSTRACT FROM AUTHOR]

Abstract We propose a theoretical method for studying open quantum systems at the steady state within the framework of the perturbation theory. This approach allow us to compute the density operator of the system perturbatively and, in principle, to obtain an expression for its density matrix elements explicitly. To illustrate our methodology, we provide a case study of a nonlinear two-level system coupled to a thermal reservoir and special attention is given to the relationship between nonlinearity and nonclassicality. In particular, this relation is quantified by considering the quantum measures as the nonclassical depth, nonclassical distance and the quantum fidelity. We find that the nonclassicality is originated at least by second order contribution of nonlinear terms in quantum dynamics. [ABSTRACT FROM AUTHOR]

Objectives To assess the issue of hospital variations in Colombia and to contribute to the methodology on health care variations by using a model that clusters the variance between hospitals while accounting for individual-level reimbursement rates and objective health-status variables. Methods We used data on all births (N = 11,954) taking place in a contributory-regimen insurer network in Colombia during 2007. A multilevel logistic regression model was used to account for the share of unexplained variance between hospitals. In addition, an alternative variance decomposition specification was further carried out to measure the proportion of such unexplained variance due to the region effect. Results Hospitals account for 20% of the variation in performing cesarean sections, whereas region explains only one-third of such variance. Variables accounting for preferences on the demand side as well as reimbursement rates are found to predict the probability of performing cesarean sections. Conclusions Hospital variations explain large variances within a single-payer’s network. Because this insurer company is highly regarded in terms of performance and finance, these results might provide a lower bound for the scale of hospital variation in the Colombian health care market. Such lower bound provides guidance on the relevance of this issue for Colombia. Some factors such as demand-side preferences and physician reimbursement rates increase variations in health care even within a single-payer network. This is a source of inefficiencies, threatening the quality of health care and financial sustainability. The proposed methodology should be considered in further research on health care variations. [ABSTRACT FROM AUTHOR]

Background Allergic diseases are considered a health burden because of their high and constantly increasing prevalence, high direct and indirect costs, and undesirable effects on quality of life. Probiotics have been suggested as an intervention to prevent allergic diseases. Objective We sought to synthesize the evidence supporting use of probiotics for the prevention of allergies and inform World Allergy Organization guidelines on probiotic use. Methods We performed a systematic review of randomized trials assessing the effects of any probiotic administered to pregnant women, breast-feeding mothers, and/or infants. Results Of 2403 articles published until December 2014 identified in Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, 29 studies fulfilled a priori specified inclusion criteria for the analyses. Probiotics reduced the risk of eczema when used by women during the last trimester of pregnancy (relative risk [RR], 0.71; 95% CI, 0.60-0.84), when used by breast-feeding mothers (RR, 0.57; 95% CI, 0.47-0.69), or when given to infants (RR, 0.80; 95% CI, 0.68-0.94). Evidence did not support an effect on other allergies, nutrition status, or incidence of adverse effects. The certainty in the evidence according to the Grading of Recommendation Assessment Development and Evaluation approach is low or very low because of the risk of bias, inconsistency and imprecision of results, and indirectness of available research. Conclusion Probiotics used by pregnant women or breast-feeding mothers and/or given to infants reduced the risk of eczema in infants; however, the certainty in the evidence is low. No effect was observed for the prevention of other allergic conditions. [ABSTRACT FROM AUTHOR]

Most male breast problems are benign, and men with typical symptoms of gynecomastia or pseudogynecomastia do not usually need imaging. When a differentiation between benign disease and breast cancer cannot be made on the basis of clinical findings or when the clinical findings are suspicious for breast cancer, imaging is indicated. Mammography is useful in both identifying cancer and obviating the need for biopsy in patients for whom a benign mammographic impression confirms the clinical impression. However, because of the relationship of breast cancer to increasing age, age-based protocols that do not include mammography have been developed. For men with an indeterminate palpable mass, begin with ultrasound if the patient is <25 years of age, because breast cancer is highly unlikely. Mammography should be performed if ultrasound is suspicious. For men ≥25 years of age or having a highly concerning physical examination, usually begin with mammography; ultrasound is useful if mammography is inconclusive or suspicious. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

To reduce the pollution emissions of bridges to the environment, researchers need to conduct more in-depth research and design the structure. Today's architectural, structural, and mechanical engineers pay more attention to funders' requirements and pursue the maximization of economic benefits. The research begins with establishing a theoretical model of the bridge's robustness under dead and dynamic loads: applying a Three-Dimensional (3D) solid finite element model, swarm intelligence optimization algorithm, and mathematical model of quadratic interpolation approximation solves the problems of multiple loads, discrete data, and convergence. Based on the establishment and analysis data of the research model, the research and analysis of the optimal topology bridge model are completed, and the optimal structure size is obtained. The carbon emissions from the bridge optimization decreased by 2242.92 t, accounting for 25% of the total emissions. This data is shocking, and it also gives investors and governments a painful reminder that they must pay more attention to the sustainable construction and development of the construction industry and achieve the goal of zero carbon emissions in the construction industry as soon as possible. • This article applies interdisciplinary 3D research and design. • The article solves problem of topology optimization of hyperstatic structures. [ABSTRACT FROM AUTHOR]

We have investigated computationally a series of 18 Diels–Alder cycloadditions, involving four dienes (butadiene, 2-hydroxybutadiene, cyclopentadiene and cyclohexadiene) and variously-substituted ethylenes and acetylenes as dienophiles. It is demonstrated that the respective molecular electrostatic potentials can be used to provide insight into the initial modes of interaction of the dienes and dienophiles, focusing particularly upon the synchronicities and nonsynchronicities of the processes. This is shown to complement predictions based upon the profiles of the reaction force constants κ ( ξ ) in the transition regions along the intrinsic reaction coordinates ξ : one κ ( ξ ) minimum ∼ synchronicity, a minimum and a shoulder ∼ moderate nonsynchronicity, two minima ∼ strong nonsynchronicity. Temporal aspects of the reactions can also be examined through κ ( ξ ). [ABSTRACT FROM AUTHOR]

Women newly diagnosed with stage 1 breast cancer have an early-stage disease that can be effectively treated. Evidence provides little justification for performing imaging to exclude metastasis in asymptomatic women with stage I breast cancer. No differences have been found in survival or quality of life in women regardless of whether they underwent initial workup for metastatic disease. These women generally prefer intensive follow-up to detect an early recurrence. However, survival rates do not differ between women who obtain intensive screening and surveillance, with imaging and laboratory studies, and women who undergo testing only as a result of development of symptoms or findings on clinical examinations. In addition, quality of life is similar for women who undergo intensive surveillance compared with those who do not. American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines state that annual mammography is the only imaging examination that should be performed to detect a localized breast recurrence in asymptomatic patients. Additional imaging may be needed if the patient has locoregional symptoms. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review by the panel include extensive analysis of current medical literature from peer-reviewed journals and application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. When evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

In a series of experiments at the Texas Petawatt Laser (TPW) in Austin, TX, we have used attenuation spectrometers, dosimeters, and a new Forward Compton Electron Spectrometer (FCES) to measure and characterize the angular distribution, flux, and energy spectrum of the X-rays and gamma rays produced by the TPW striking multi-millimeter thick gold targets. Our results represent the first such measurements at laser intensities ≥1021 W x cm-2 and pulse durations ≤150 fs. We obtain a maximum yield of X-ray and gamma ray energy with respect to laser energy of 4% and a mean yield of 2%. We further obtain a Full Width Half Maximum (FWHM) of the gamma angular distribution of 33°. We were able to characterize the gamma-ray spectrum from 3 MeV to 50 MeV using a Forward Compton Electron Spectrometer, with an energy resolution of 10-15% and mean bremsstrahlung effective kT of ~6 MeV. We were able to characterize the spectrum from 1 to 5 MeV using a Filter Stack (attenuation) Spectrometer, measuring a mean X-ray temperature for the spectrum from 3 to 5 MeV of 2.1 MeV, suggesting that the low-energy gammas are bremsstrahlung from secondary electrons. [ABSTRACT FROM AUTHOR]

Confined electronic states and optical transitions in 3D topological insulator nanoparticles have been studied in the literature, assuming idealized geometries such as spheres or infinitely long cylinders, that allow to obtain analytical solutions to the corresponding eigenvalue equation within such geometries. In contrast, in this article we consider triangular-shaped nanoplates as a more realistic approximation to the experimentally observed morphologies of topological insulator nanoparticles. In this particular geometry, we obtain analytical expressions for the confined eigenstates and the corresponding energy spectrum. Moreover, by a spatial representation of the probability density distribution, we further identify the conditions leading to the emergence of topologically trivial surface states , i.e. those arising as a result of morphological-dependent quantum confinement of the bulk that nonetheless project onto the surface, in contrast with topologically protected surface states. Finally, we also study the optical transitions and the corresponding selection rules imposed by the nanoparticle size and morphology. • Quantum confinement of bulk states in TI nanoparticles strongly depends on size and morphology. • Topologically trivial surfaces states, i.e. quantum-confined bulk states that project onto the surface, may emerge due to the nanoparticle morphology. • General boundary condition for quantum confinement is the vanishing of the surface normal current [ABSTRACT FROM AUTHOR]

Objectives: Factors influencing xerostomia during intensity-modulated radiation therapy (IMRT) were assessed. Methods: A 6-week study of 32 head and neck cancer (HNC) patients was performed. Subjects completed the Xerostomia Inventory (XI) and provided stimulated saliva (SS) at baseline, week 2 and at end of IMRT. Influence of SS flow rate (SSFR), calcium and mucin 5b (MUC5b) concentrations and radiation dose on xerostomia was determined. Results: HNC subjects experienced mean SSFR decline of 36% by visit 2 (N = 27; P = .012) and 57% by visit 3 (N = 20; P = .0004). Concentrations of calcium and MUC5b increased, but not significantly during IMRT (P > .05). Xerostomia correlated most with decreasing salivary flow rate as determined by Spearman correlations (P < .04) and linear mixed models (P < .0001). Conclusions: Although IMRT is sparing to the parotid glands, it has an early effect on SSFR and the constituents in saliva in a manner that is associated with the perception of xerostomia. [ABSTRACT FROM AUTHOR]

Background & Aims: Portal vein thrombosis (PVT) is a frequent event in patients with cirrhosis; it can be treated with anticoagulants, but there are limited data regarding safety and efficacy of this approach. We evaluated this therapy in a large series of patients with cirrhosis and non-neoplastic PVT. Methods: We analyzed data from 55 patients with cirrhosis and PVT, diagnosed from June 2003 to September 2010, who received anticoagulant therapy for acute or subacute thrombosis (n = 31) or progression of previously known PVT (n = 24). Patients with cavernomatous transformation were excluded. Thrombosis was diagnosed, and recanalization was evaluated by using Doppler ultrasound, angio–computed tomography, and/or angio–magnetic resonance imaging analyses. Results: Partial or complete recanalization was achieved in 33 patients (60%; complete in 25). Early initiation of anticoagulation was the only factor significantly associated with recanalization. Rethrombosis after complete recanalization occurred in 38.5% of patients after anticoagulation therapy was stopped. Despite similar baseline characteristics, patients who achieved recanalization developed less frequent liver-related events (portal hypertension–related bleeding, ascites, or hepatic encephalopathy) during the follow-up period, but this difference was not statistically significant (P = .1). Five patients developed bleeding complications that were probably related to anticoagulation. A platelet count <50 × 109/L was the only factor significantly associated with higher risk for experiencing a bleeding complication. There were no deaths related to anticoagulation therapy. Conclusions: Anticoagulation is a relatively safe treatment that leads to partial or complete recanalization of the portal venous axis in 60% of patients with cirrhosis and PVT; it should be maintained indefinitely to prevent rethrombosis. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Human herpesviruses, e.g., herpes simplex virus (HSV) type 1, Epstein-Barr virus, and cytomegalovirus, appear in saliva at greater frequency in persons infected with human immunodeficiency virus (HIV) than in healthy individuals. However, it is not known if varicella zoster virus (VZV) and HSV-2 appear simultaneously during HIV infection at greater frequency in saliva in this era of highly active antiretroviral therapy (HAART). The aim of this study was to investigate the prevalence and amounts of VZV and HSV-2 in the saliva of HIV-infected orally asymptomatic patients. STUDY DESIGN: Quantitative polymerase chain reaction was used to investigate the prevalence, quantity, risk, and correlations of salivary VZV and HSV-2 from 59 HIV-seropositive individuals and 53 healthy control subjects in a case-control cross-sectional study. Seventy-eight percent of the HIV-seropositive patients (46 out of 59) were taking HAART. RESULTS: VZV DNA was detected in the saliva of 5.1% (3 out of 59) of the HIV-positive group and in only 1 healthy control 1.9% (1 out of 53; P = .62). The amount of VZV DNA in the expressors was low, generally <1,100 copies/mL, with no observed difference between the HIV-positive group and the control subjects (P = 1.0). HSV-2 DNA was not detected in either group. In the HIV-infected group, VZV shedding occurred in those on HAART, but was not associated with oral lesions, specific CD4(+) or CD8(+) T-cell levels, or demographic factors. CONCLUSIONS: Varicella zoster virus was detected at low prevalence in the saliva of HIV-infected persons, whereas HSV-2 was not detected in the saliva of this cohort. HAART does not appear to diminish the risk for asymptomatic VZV shedding. [ABSTRACT FROM AUTHOR]

Purpose: Our purpose was to study the vascular anatomy of the subacromial space and to map the major sources of expected bleeding during subacromial arthroscopy surgery. Methods: Ten shoulders of five adult cadavers underwent whole-body arterial perfusion with a mixture of lead oxide, gelatin, and water. The tissue specimens were dissected, photographed, radiographed, scanned, and analyzed with a digital software analyzer. Dissection of the arteries of the subacromial space, with their respective anatomic landmarks, was documented. Correlations of bleeding areas during subacromial arthroscopic surgery and cadaveric dissection were carried out. A vascular map of the walls of the subacromial space was created. Results: The vascularity of the subacromial structures showed consistent patterns of distribution in 60% of the shoulders dissected, and specific sources of bleeding were analyzed. We divided this space into walls with their major arteries as follows: anterior wall, with the acromial branch of the thoracoacromial artery; posterior wall, with the posteromedial acromial branch of the suprascapular artery; and medial wall, with the anterior and posterior arteries of the acromioclavicular joint. The vascular map of the lateral wall, roof, and floor of the subacromial space was also described. Conclusions: Vascular maps of the arteries of the walls of the subacromial space were created. The subacromial space is highly vascular, and the pattern of blood supply was found to be constant in 60% of the shoulders dissected. This knowledge of the vascular anatomy may decrease bleeding during surgery. Clinical Relevance: Knowledge of the vascular anatomy may decrease vascular damage during subacromial arthroscopy surgery. [Copyright &y& Elsevier]