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The Brazilian public health system does not cover pharmacotherapy for urge urinary incontinence (UUI). The aim of this study was to estimate the cost-effectiveness and budget impact of providing tolterodine, solifenacin, oxybutynin (OXY), darifenacin, and mirabegron for the treatment of UUI in Brazilian public health system. A cost-effectiveness analysis with budget impact was performed. Six scenarios were assessed: in one scenario, all 5 therapeutic alternatives approved for coverage, and in the remaining 5 scenarios, only 1 alternative is approved for adoption for all patients. Clinical data were derived from a rapid systematic review conducted in several databases. One-way sensitivity analysis was also performed. The time horizon was 12 months. The cost-effectiveness analysis showed that patients treated with OXY had the lowest incremental cost-effectiveness ratio (ICER) per outcomes assessed (change in urinary incontinence episodes (UIE): R$1180.08; change in urge incontinence episodes: R$757.85 and change in micturition frequency: R$907.75), corresponding to a budget impact of R$17.9 billion over 5 years. The change in effectiveness measures was the parameter that most influenced the results of the ICER per patient-year. The results of the study have shown that OXY and solifenacin had the lowest ICER per patient-year and the lowest budget impact when compared with other drugs. [ABSTRACT FROM AUTHOR]

Abstract Objectives To estimate the average price of oral hypoglycemic agents provided by the Brazilian health system (SUS) and to compare them to other public health systems. Methods Cross-sectional study about drug prices purchased by Belo Horizonte (municipal level), Minas Gerais (state level) and federal institutions in January and February of 2014. Average prices were calculated by defined daily dosage (DDD) and were compared to the management levels and the program "Aqui Tem Farmácia Popular" (ATFP). For international comparison, reimbursement values from Spain, Portugal, the United Kingdom and Canada (Province of Quebec) were used. Results Belo Horizonte had higher average prices than Minas Gerais. In general, essential oral hypoglycemic agents purchased by the SUS had lower prices than ATFP. For example, glibenclamide 5 mg was 1.023% more expensive. Metformin purchased by ATFP was more expensive than by SUS. Eight drugs purchased by SUS had average values above the respective Brazilian price ceiling. As an international comparison, SUS had lower average prices for glibenclamide and metformin. In ATFP, metformin was more expensive than in other countries, while glibenclamide was cheaper than Portugal only. Conclusion The municipal management level had higher average prices than state level. Oral hypoglycemic agents purchased by SUS are predominantly cheaper than ATFP. Average prices paid by SUS are lower, while the prices paid by ATFP are higher than the reimbursed amounts from other countries. [ABSTRACT FROM AUTHOR]

Fish protein hydrolysates (FPH) have demonstrated in vitro anti-hypertensive and antioxidant properties. Since hypertension and oxidative stress are key factors for endothelial dysfunction, the main purpose of the present study was to investigate the effect of FPH on vascular function. Participants consumed 5 g of FPH or a placebo (PLA) supplement. Flow-mediated dilation (FMD) and tissue O 2 saturation (StO 2 ) were taken at different time points over 130 min after nutritional intervention. The FPH had 80.6 ± 1.0% of protein and the major amino acid present in the FPH was glutamic acid, followed by aspartic acid and histidine. There was no significant change in FMD as well as no significant change in the StO 2 parameters between FPH and PLA supplementation. Although FPH has been shown to be a valuable source of protein, essential amino acids and antioxidants, a single dose did not promote significant changes on vascular function in healthy individuals. [ABSTRACT FROM AUTHOR]

Beetroot consumption has been associated with increased NO bioconversion, which may promote beneficial effects on vascular health. The present study evaluated the effects of a beetroot-based nutritional gel (BG) on endothelial function, arterial stiffness and blood pressure in the elderly with cardiovascular risk factors. Twenty elderly individuals were submitted to BG and nitrate-depleted gel (PLA) interventions. Brachial flow-mediated dilation (FMD), reactive hyperaemia (RH), blood flow velocity (BFV), pulse wave velocity (PWV β ), augmentation index (AI), stiffness parameter ( β ), pressure-strain elasticity modulus (Ep) and arterial compliance (AC) were measured 120 min after interventions. Urinary nitrate, nitrite, systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured at baseline, 120 min and 180 min after interventions. BG intervention promoted increase (P < 0.05) in FMD (77%), BFV (31%), RH (18%) and urinary nitrite (214%) and nitrate (283%) compared with PLA. A single dose of a new food matrix rich in dietary nitrate improves NO bioconversion and endothelial function in the elderly. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy of ibuprofen (IBU) and etodolac (ETO) for controlling pain, edema, and trismus after extraction of lower third molars.Materials and Methods: Twenty adolescents and adults with 2 impacted mandibular-third molars (in similar positions) were selected for the study. Patients were randomly assigned either to the IBU group (600 mg of IBU 3 times a day for 3 days) or to the ETO group (300 mg of ETO 3 times a day for 3 days). Drugs were administered immediately after dental extraction.Results: During the first 2 days after extraction, swelling was more pronounced in the IBU group than in the ETO group (P = .033). Seven days after surgery, there was no difference in the degree of edema between the groups. At the 2- and 7-day evaluation points, mouth opening was significantly more reduced in the IBU group than in the ETO group (P < .05). After the first 6 hours, the ETO group had more effective pain relief (P < .05), but after this time point, both groups reported similar degrees of relief. Compared with the IBU group, the ETO group had a lower need for administration of additional rescue analgesics.Conclusions: After extraction of impacted lower third molars, we found that swelling, trismus, and pain were more effectively controlled with ETO than with IBU. [ABSTRACT FROM AUTHOR]

Basilar invagination (BI) is a prolapse of the odontoid process cranially and posteriorly towards the foramen magnum. Several surgical treatment options are available for this condition. Herein, we describe a stress maneuver technique for BI reduction using a single-stage posterior approach. We described the case of a 56-year-old male diagnosed with type A BI and brainstem compression, who was treated with posterior fossa decompression and occipitocervical fusion. The BI was reduced intraoperatively using a stress maneuver, and cranial traction or atlantoaxial joint distraction was not necessary. Postoperative imaging revealed a reduction of the odontoid process and adequate brainstem decompression. The patient showed progressive improvement of his symptoms. In selected cases, stress maneuvers for BI reduction can be a less morbid, easier, and replicable option within the already existing technical arsenal. [ABSTRACT FROM AUTHOR]

Dietary nitrate supplementation has been widely investigated by the scientific community due to its beneficial effects on the cardiovascular system. However, there is evidence suggesting a possible effect of nitrate in scavenger iodine from the thyroid gland, which may affect thyroid hormone synthesis. Therefore, this study evaluated the effect of seven days of a nitrate-rich beetroot juice supplementation on thyroid hormones and iodine concentrations in healthy adults. Thirteen healthy adults were enrolled in a randomized, double-blind, crossover and placebo-controlled study. Participants ingested 140 mL of nitrate-rich beetroot juice (8.12 ± 3.61 mmol/day) or placebo (nitrate-depleted BJ) during one week. Before and after the supplementation period, blood and urine were drawn for analysis of thyroid hormones, iodine, nitrate and nitrite. No significant changes were observed in plasma triiodothyronine, thyroxine, nitrate and nitrite, and urinary iodine concentrations. In conclusion, these results suggest that one-week supplementation with a nitrate-rich beetroot juice intake does not affect thyroid function. [ABSTRACT FROM AUTHOR]

Parallel manipulators may present higher speed/acceleration ratios and energy efficiency when compared with serial manipulators. In addition, reducing their components' inertia can further improve performance. However, this design alternative might yield vibrations requiring novel joint and task space control strategies. While the former involves precise models, the latter might require adequate computation vision schemes. These requirements impose critical challenges. This manuscript proposes a hybrid control strategy and experimentally investigates using a 3 R RR prototype with flexible links. This hybrid strategy comprises two control loops: position-based visual servo and strain-based feedback control schemes. The strain-based loop uses a sliding mode control and the time derivative of the signals obtained by strain gauges installed in the flexible links. Compared with the position-based visual servo scheme, the hybrid strategy can considerably attenuate the vibrations since the approach reduced the overshoot response by 36% and the maximum value of the Euclidean error on position by 38%, on average. [Display omitted] • Lightweight component yield vibrations. • A hybrid vision/strain-based controller for PMs with flexible links is proposed. • The time derivative of the strain gauge signals are used in a sliding mode control scheme. • Experimental results show a significant reduction in the overshoot response. [ABSTRACT FROM AUTHOR]

The elephant grass has proved to be a great option for biomass production because it causes less damage to the environment, yet there is not a lot of information about its use as a renewable energy source. The objective of this study was to use multivariate analysis to check elephant grass genotypes for biomass production. Between 2016 and 2018, comprising four semiannual cutting, 12 entries were evaluated, and the Active Germplasm Bank of Elephant grass of North Fluminense State University Darcy Ribeiro presented better performances for dry matter yield. The experimental design was a randomized complete block design with three replications. ANOVA and biplot graphs were drawn for variables plant height, number of tillers, stem diameter, leaf blade length, leaf blade width, dry weight and percentage of dry matter. The variance analysis showed the existence of genetic variability between elephant grass genotypes and two first principal components, a biplot analysis of the genotype and the characteristics explained 70.07% of the total variation. The dry weight per linear meter and yield per hectare were the variables with greater discriminatory powers, thus being suitable for selecting elephant grass genotypes. The dry matter yield was positively correlated with dry weight and stem diameter. Genotypes 7, 11 and 12 presented the highest overall mean and were also the most stable. • The GT biplot analysis is an effective tool in the selection of high-yield elephant grass genotypes. • The analysis allowed selecting the best performing genotypes with good stability. • Productivity showed a positive correlation with dry weight and number of tillers. [ABSTRACT FROM AUTHOR]

Ice slurry ingestion during prolonged exercises may improve performance in hot environments; however, the ideal amount and timing of ingestion are still uncertain. We determined whether ad libitum ice slurry ingestion influences physiological and perceptual variables and half-marathon performance while comparing the effects of the amount and moment of ingestion between ice slurry and water at 37 °C. Ten trained participants (28 ± 2 years; mean and SD) were required to run two half marathons while consuming either ice slurry (-1 °C; Ad-1) or water (37 °C; 37 CE) ad libitum. They then performed two other half marathons where, during one, they were required to ingest an amount of water equivalent to the amount consumed during the Ad-1 trial (Pro37), and in the other, to ingest ice slurry in the amount consumed during the 37 CE trial (Pro-1). During the half marathons, dry-bulb temperature and relative humidity were controlled at 33.1 ± 0.3 °C and 60 ± 3%, respectively. Ad-1 ingestion (349.6 ± 58.5 g) was 45% less than 37 CE ingestion (635.5 ± 135.8 g). Physical performance, heart rate, perceived exertion, body temperatures, and thermal perception were not influenced by the temperature or amount of beverage ingestion. However, a secondary analysis suggested that lower beverage ingestion was associated with improved performance (Ad-1 + Pro37 vs. 37 CE + Pro-1: −4.0 min, Cohen's d = 0.39), with a significant relationship between lower beverage ingestion and faster running time (b = 0.02, t = 4.01, p < 0.001). In conclusion, ice slurry ingestion does not affect performance or physiological or perceptual variables during a half marathon in a hot environment. Preliminary evidence suggests that lower beverage ingestion (ice slurry or warm water) is associated with improved performance compared to higher ingestion. • The current study controlled the temperature of beverages and ingestion behavior. • Ad libitum ice slurry does not improve half-marathon performance in the heat. • Athletes ingested less ice slurry than 37 °C water during the ad libitum trials. • 80% of athletes reported gastric discomfort and headache when ingesting ice slurry. • Half-marathon performance was 3–4% better in trials with lower beverage ingestion. [ABSTRACT FROM AUTHOR]

Background: The use of new technology has recently grown considerably as an increasing number of college students using Internet. In nursing education, the personal computer and the Internet facilitate teaching theoretical and practical knowledge.Objectives: Evaluate an educational technology known as "Anatomy and Vital Signs" with respect to content, appearance and usability.Method: This was a first stage evaluation-by specialists to verify content and functioning, prior to a second validation as to learning by students. A methodological study in which instructional technologists (11 participants) and nursing specialists (17 participants) used the technology in an unguided manner and completed three questionnaires. The evaluation was measured by the difference between disagreement and agreement for each statement in the questionnaires.Results: Most of the items were positively evaluated at a level higher than 70% by most of the evaluators except for the following usability criteria: grouping by shape, minimum actions and user control, which did not attain the 70% agreement level among instructional technologists.Conclusion: The evaluation was useful to improve the technology and guarantee suitable product for nursing education. It may be a reliable educational tool for nursing education that applies technological resources. [ABSTRACT FROM AUTHOR]

Abstract: Meloidogyne spp., plant-parasitic nematodes present worldwide, are intensively studied because of the damage caused to a large variety of agronomically important crops. Several reports indicate that proteins from the Meloidogyne spp. dorsal gland might play an important role to allow proper establishment of a functional nematode feeding site. The precise role of these proteins in the process of feeding cell development is unknown. To gain insights into the function of these secreted M. incognita proteins, we constitutively (ectopically) expressed the nematodes dorsal gland protein 7E12 in tobacco plants. It was found that the number of galls at 8 and 16 days after nematode infection was significantly higher in transgenic plants compared to control plants. Eggs from nematodes in transgenic plants hatched faster than those in control plants. Histological analysis of nematode induced galls in transgenic plants clearly shows a different morphology. Giant feeding cells harbor more vacuoles and an increased amount of cell wall invaginations, while neighboring cells surrounding feeding cells are more numerous. These results suggest that the presence of the 7E12 protein in tobacco accelerates gall formation. This assumption is supported by our data illustrating faster gall formation and egg eclosion in transgenic plants. [Copyright &y& Elsevier]

Abstract: Objective: To perform a cost-effectiveness evaluation from the perspective of the Brazilian National Health System of alternatives strategies (i.e., conventional interferon, pegylated interferon, and lamivudine) for the treatment of patients with chronic hepatitis B who present elevated aminotransferase levels and no evidence of cirrhosis at the beginning of treatment. Methods: A Markov model was developed for chronic hepatitis B (hepatitis B antigen e [HBeAg] positive and negative) with 40 years'' time horizon. Costs and benefits were discounted at 5%. Annual rates of disease progression, costs due to complications, and the efficacy of medicines were obtained from the literature. One-way and probabilistic sensitivity analysis evaluated uncertainties. Results: For HBeAg positive patients, peginterferon (48 weeks) resulted in an increase of 0.21 discounted life-years gained compared to interferon (24 weeks). The incremental cost-effectiveness ratio (ICER) converted to US dollars using the 2009 purchasing power parity conversion factor was US$100,752.24 per life-year gained. For HBeAg negative patients, it was observed that interferon (48 weeks) compared with long-term lamivudine presented an increase of 0.45 discounted life-years gained and ICER of US$15,766.90 per life-year gained. In the sensitivity analysis, the ICER was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate, and medicine prices. Cost-effectiveness acceptability curve for HBeAg positive (pegylated interferon vs. conventional interferon) and negative (conventional interferon vs. lamivudine) showed that conventional interferon was cost-effective until three times the gross domestic product per capita. Conclusions: For patients with chronic hepatitis B with elevated aminotransferase levels in the pretreatment and no cirrhosis who were HBeAg positive, pegylated interferon (48 weeks) provided more life-years gained when compared to conventional interferon (24 weeks), and the ICER surpasses the country''s buying power, which makes conventional interferon the chosen alternative. For HBeAg negative patients, conventional interferon (48 weeks) compared to lamivudine provided more life-years gained at a favorable ICER. [Copyright &y& Elsevier]