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Objective The present review aims to clarify the relationship of thiamine, riboflavin, and niacin to exercise performance. News The B vitamins thiamine (vitamin B1), riboflavin (vitamin B2), and niacin (vitamin B3) are hydrophilic vitamins that play a fundamental role as coenzymes in enzymatic reactions of energy metabolism. The increase in energy demand during physical exercise can alter the requirements for these vitamins. Prospects and projects This study is a narrative review which selected and analyzed studies that investigated how the vitamins thiamine, riboflavin, and niacin can affect sports performance in both humans and experimental animal models. Conclusion The research shows that supplementation with these vitamins does not necessarily produce ergogenic effects. Despite their fundamental roles in anabolic pathways, only the intake of thiamine-derivative substances showed some positive effects on exercise performance and fatigue. Isolated riboflavin supplementation did not show positive effects, while there is evidence that high niacin intake can harm exercise performance. Some studies found an increase in excretion and a decrease in the blood levels of these vitamins after exercise, but the results are inconsistent. However, different pharmacokinetics, doses or dosing frequency, and administration route of the supplemented substances can influence the results. There are few studies of B-vitamins and exercise, and most of them are not recent. New studies, with systematically controlled protocols, are necessary to elucidate the real effects of thiamine, riboflavin, and niacin in exercise performance.

Critical illness encompasses a wide spectrum of life-threatening clinical conditions requiring intensive care. Our objective was to evaluate cognitive, inflammatory and cellular metabolism alterations in the central nervous system in an animal model of critical illness induced by zymosan. For this Wistar rats that were divided into Sham and zymosan. Zymozan was administered once intraperitoneally (30 g/100 g body weight) diluted in mineral oil. The animals were submitted to behavioral tests of octagonal maze, inhibitory avoidance and elevated plus maze. Brain structures (cortex, prefrontal and hippocampus) were removed at 24 h, 4, 7 and 15 days after zymosan administration for analysis of cytokine levels (TNF-α, IL-1b, IL-6 and IL-10), oxidative damage and oxygen consumption. Zymosan-treated animals presented mild cognitive impairment both in aversive (inhibitory avoidance) and non-aversive (octagonal maze) tasks by day 15. However, they did not show increase in anxiety (elevated-plus maze). The first neurochemical alteration found was an increase in brain pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α) at day 4th in the hippocampus. In cortex, a late (7 and 15 days) increase in TNF-α was also noted, while the anti-inflammatory cytokine IL-10 decrease from 4 to 15 days. Oxygen consumption was decreased in the hippocampus and pre-frontal, but not cortex, only at 7 days. Additionally, it was observed a late (15 days) increase in oxidative damage parameters. This characterization of brain dysfunction in rodent model of critical illness reproduces some of the alterations reported in humans such neuropsychiatric disorders, especially depression, memory loss and cognitive changes and can add to the nowadays used models.

Introduction: The definition of body posture involves a relative arrangement of body parts. Football is the most popular sport in the world with an injury rate of 4.47 injuries per 1000 hours of play/training per athlete. Photogrammetry is a valid and reproductive method for evaluating postural differences with quantitative and accurate results. The aim of this study is to present a postural analysis of children and young football players, using photogrammetry. Method: The sample consisted of 263 athletes (ages between 4 and 18 years) where, through the photographic register and use of SAPO® software the main postural deviations of the children were calculated and subsequently analyzed descriptively in the IBM SPSS software. Results: The results obtained show deviations in point A1 - alignment of the acromion (21.4% to 50% of athletes on the right (R) and 16.7% to 40.5% of athletes on the left (L); A2 - alignment of the anterosuperior iliac spine (42.9% of athletes to (R) and 14.3% to 64.9% to the left (L); A3 alignment of tibia tuberosities (27.9% to 55% of athletes (R), 27% to 48.5% of athletes (L); A4 and A5 – angle Q (R and L) (50% to 91% of athletes with tendency to knee varus); A6 – horizontal alignment of the pelvis (tendency to hyperlordosis of 28% for juveniles with an average deviation of -15.4° ± 7.7). Conclusion: The postural analysis of the athletes allows a better knowledge about the most frequent deviations that, over time, can become painful, being important an intervention and specific planning at this level, trying to prevent future injuries.

Over the last few years, an increasing interest in the scientific research of natural antioxidant molecules from plants capable to attenuate, or even prevent, stress oxidative-related disorders, such as diabetes, inflammatory, and neurological pathologies has been observed. Serotonin and melatonin are two of these molecules, being widely found in Mediterranean foodstuffs, fruits, vegetables, and medicinal herbs. The consumption of foods containing both antioxidants can raise their physiologic concentrations in blood and, consequently, enhance antioxidant defenses, improve mood, and treat sleep disorders, depression, and anxiety. Currently, there exist several analytical methods suitable for the determination of melatonin and serotonin in fruits and edible plants. Among them, the most used include chromatographic techniques and immunological assays. This work aims to present a comprehensive overview of the biosynthesis of these indolamines in nature, the most common techniques used to detect and quantify both compounds in fruits, vegetables, medicinal herbs, and other food sources, as well as to address their health benefits, particularly their antioxidant, neuroprotective, and sleep-promoting effects.

It has been more than 200 years since James Parkinson made the first descriptions of the disease that bears his name. Since then, knowledge about Parkinson’s disease has been improved, and its pathophysiology, diagnosis, and treatments are well described in the scientific and medical literature. However, there is no way to prevent the disease from its progressive nature yet and only its symptoms can be minimized. It is known that the process of neurodegeneration begins before the onset of motor signs and symptoms of the disease, when diagnosis is usually made. Therefore, recognizing manifested non-motor symptoms can make an early diagnosis possible and lead to a better understanding of the disease. Autonomic dysfunctions are important non-motor manifestations of Parkinson’s disease and affect the majority of patients. Importantly, heart failure is the third leading cause of death in people suffering from Parkinson’s disease. Several evidences have shown the correlation between Parkinson’s disease and the preexistence of cardiovascular diseases. Therefore, cardiovascular monitoring and identification of its dysfunctions can have a prodromal role for Parkinson’s disease. This review presents studies of the literature that can lead to a better understanding of Parkinson’s disease with special attention to its relation to heart and cardiovascular parameters.

Background: Neurogranin (Ng) concentrates at dendritic spines. In patients with Alzheimer disease Ng levels are elevated. The role of Ng in delirium development has not been assessed, therefore we hypothesized that Ng levels are associated with delirium in critically ill patients. Materials & methods: From 94 critically ill patients, 47 developed delirium and 47 controls were included. Blood was collected during the first 24 h of intensive care unit (ICU) admission, and on the day of delirium diagnoses. Ng and IL-1β were determined. Results: Ng and IL-1β levels were higher in the delirium group at ICU admission and on the day of delirium diagnoses. IL-1β and Ng were independently associated with delirium occurrence. Conclusion: Ng levels are associated with delirium development in ICU patients.

An important problem in project management is determining ways to distribute amongst activities the costs that are incurred when a project is delayed because some activities end later than expected. In this study, we address this problem in stochastic projects, where the durations of activities are unknown but their corresponding probability distributions are known. We propose and characterise an allocation rule based on the Shapley value, illustrate its behaviour by using examples, and analyse features of its calculation for large problems.

Background Discharge planning is a routine feature of health systems in many countries. The aim of discharge planning is to reduce hospital length of stay and unplanned readmission to hospital, and to improve the co-ordination of services following discharge from hospital.This is the third update of the original review. Objectives To assess the effectiveness of planning the discharge of individual patients moving from hospital. Search methods We updated the review using the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 9), MEDLINE, EMBASE, CINAHL, the Social Science Citation Index (last searched in October 2015), and the US National Institutes of Health trial register (ClinicalTrials.gov). Selection criteria Randomised controlled trials (RCTs) that compared an individualised discharge plan with routine discharge care that was not tailored to individual participants. Participants were hospital inpatients. Data collection and analysis Two authors independently undertook data analysis and quality assessment using a pre-designed data extraction sheet. We grouped studies according to patient groups (elderly medical patients, patients recovering from surgery, and those with a mix of conditions) and by outcome. We performed our statistical analysis according to the intention-to-treat principle, calculating risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous data using fixed-effect meta-analysis. When combining outcome data was not possible because of differences in the reporting of outcomes, we summarised the reported data in the text. Main results We included 30 trials (11,964 participants), including six identified in this update. Twenty-one trials recruited older participants with a medical condition, five recruited participants with a mix of medical and surgical conditions, one recruited participants from a psychiatric hospital, one from both a psychiatric hospital and from a general hospital, and two trials recruited participants admitted to hospital following a fall. Hospital length of stay and readmissions to hospital were reduced for participants admitted to hospital with a medical diagnosis and who were allocated to discharge planning (length of stay MD − 0.73, 95% CI − 1.33 to − 0.12, 12 trials, moderate certainty evidence; readmission rates RR 0.87, 95% CI 0.79 to 0.97, 15 trials, moderate certainty evidence). It is uncertain whether discharge planning reduces readmission rates for patients admitted to hospital following a fall (RR 1.36, 95% CI 0.46 to 4.01, 2 trials, very low certainty evidence). For elderly patients with a medical condition, there was little or no difference between groups for mortality (RR 0.99, 95% CI 0.79 to 1.24, moderate certainty). There was also little evidence regarding mortality for participants recovering from surgery or who had a mix of medical and surgical conditions. Discharge planning may lead to increased satisfaction for patients and healthcare professionals (low certainty evidence, six trials). It is uncertain whether there is any difference in the cost of care when discharge planning is implemented with patients who have a medical condition (very low certainty evidence, five trials). Authors' conclusions A discharge plan tailored to the individual patient probably brings about a small reduction in hospital length of stay and reduces the risk of readmission to hospital at three months follow-up for older people with a medical condition. Discharge planning may lead to increased satisfaction with healthcare for patients and professionals. There is little evidence that discharge planning reduces costs to the health service.

Objectives The aim was to outline the challenges of implementing outcomes-based contracts (OBCs) in Europe. Methods A scoping review was conducted, building on the searches of a previous systematic review and updating them for December 2017 until May 2021. The combined results were screened, based on inclusion and exclusion criteria. All identified studies published in the English language that described specific OBC schemes for medicines in European countries were included. Insights into the challenges of OBCs were extracted and analysed to develop a conceptual framework. Results Ten articles from the previous systematic review matched our inclusion criteria, along with 14 articles from electronic searches. Analysis of these 24 articles and classification of the challenges revealed that there are multiple barriers that must be overcome if OBCs that benefit all stakeholders are going to be adopted widely across Europe. These challenges were grouped according to five key themes: negotiation framework; outcomes; data; administration and implementation; and laws and regulation. Conclusions If the promise of OBCs is to be fully realised in Europe, there remain major challenges that need to be overcome by all stakeholders working in partnership. The overlapping and interconnected nature of these challenges highlights the complexity of OBC arrangements. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-021-01070-1.

Item does not contain fulltext BACKGROUND: Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. OBJECTIVES: To assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient-reported health outcomes and processes of care. SEARCH METHODS: We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. SELECTION CRITERIA: Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. DATA COLLECTION AND ANALYSIS: Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta-analyses of the results where possible. MAIN RESULTS: We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient-physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI -0.17 to 0.24; 2 studies, 552 participants; low-certainty evidence), social functioning (SMD 0.02, 95% CI -0.06 to 0.09; 15 studies; 2632 participants; moderate-certainty evidence), and pain (SMD 0.00, 95% CI -0.09 to 0.08; 9 studies; 2386 participants; moderate-certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. AUTHORS' CONCLUSIONS: PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high-quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.

Objectives: This is a protocol for a Cochrane Review (qualitative). The objectives are as follows:. To explore the views, experiences, and behaviours of health workers in order to understand the factors that influence their provision of postnatal care.

Cannabis use has become a hot topic in several countries due to the debate about its legalization for medical purposes. However, data are limited regarding adverse events, safety and potential impact on reproductive health. Cannabis consumption during pregnancy has been associated with gestational disorders such as preterm birth, intrauterine growth restriction, low birth weight and increased risk of miscarriage, though the underlying biochemical mechanisms are still unknown. Given that the endocannabinoid system (ECS) is involved in several reproductive processes, we tested the hypothesis that the negative outcomes may result from the impact on the ECS homeostasis caused by the main psychoactive compound of cannabis, Δ9-tetrahydrocannabinol (THC). We demonstrate that THC (10–40 µM) impairs placental endocannabinoid system by disrupting the endocannabinoid anandamide (AEA) levels and the expression of AEA synthetic and degrading enzymes N-arachidonoylphosphatidylethanolamine-specific phospholipase D (NAPE-PLD) and fatty acid amide hydrolase (FAAH), respectively. Although, no alterations in cannabinoid receptors CB1 and CB2 expression were observed. Thus, long-term local AEA levels are associated with a shift in the enzymatic profile to re-establish ECS homeostasis. In chronic cannabis users, high AEA levels in placenta may disturb the delicate balance of trophoblast cells turnover leading to alterations in normal placental development and foetal growth.

In this work, we report a comparison between the performance of two samples of commercial PIN photodiodes (SFH206K from Osram and S2506-04 from Hamamatsu) mainly addressing the variation of their current sensitivities with accumulated dose ranging from 0-15 kGy. All the results so far obtained have revealed that the radiation induced currents are linearly dependent on dose rates from 3.65 to 55.64 Gy/h. The current sensitivity of both unirradiated diodes (0.178 nA.h/Gy.mm3) slightly decreases with accumulated dose, namely 0.32%/kGy (SFH206K) and 1.4%/kGy (S2506-04). Although the SFH206K device compares favorably with the S2506-04, both diodes can be considered as a low budge alternative, good enough for on-line dosimetry applications in the field of radiation processing.

AIMS OF THE STUDY: Although many studies have investigated the influence of personal characteristics on recidivism, knowledge about the impact of correctional policies remains limited. The present study adds to this debate by investigating the effect of the dualistic system of custodial sanctions in Switzerland over time. Specifically, we: (1) tested the influence that different types of custodial sanctions – sentences (offering regular prison treatment) and measures (offering crime-related rehabilitation programmes) – have on reconviction rates; and (2) forecasted future reconviction rates to estimate their value in the year 2020.METHODS: National level data from the Swiss Federal Statistical Office were collected, including 3-year reconviction rates after release from custody and the number of persons serving custodial sentences and measures. A time series framework was used for the analyses, which included data available from 1988 to 2013 (n = 26 years).RESULTS: The number of persons serving custodial sentences had no effect on recidivism (p = 0.582); however, a higher number of persons serving custodial measures was significantly associated with a decrease in recidivism (p = 0.003). For the year 2020, a reconviction rate of 28% (range 23–33%) was predicted.CONCLUSIONS: Custodial measures seem to be associated with a reduction in recidivism. However, owing to the indeterminate time associated with some custodial measures, often at the cost of the prisoners’ rights and the criminal justice system, future studies are needed to determine the optimal serving time for custodial measures. published

Background The policy in a number of countries is to provide people with a terminal illness the choice of dying at home. This policy is supported by surveys indicating that the general public and people with a terminal illness would prefer to receive end-of-life care at home. This is the fourth update of the original review. Objectives To determine if providing home-based end-of-life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs, and caregivers, compared with inpatient hospital or hospice care. Search methods We searched the following databases until April 2015: Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), Ovid MEDLINE(R) (from 1950), EMBASE (from 1980), CINAHL (from 1982), and EconLit (from 1969). We checked the reference lists of potentially relevant articles identified and handsearched palliative care publications, clinical trials registries, and a database of systematic reviews for related trials (PDQ-Evidence 2015). Selection criteria Randomised controlled trials, interrupted time series, or controlled before and after studies evaluating the effectiveness of home-based end-of-life care with inpatient hospital or hospice care for people aged 18 years and older. Data collection and analysis Two review authors independently extracted data and assessed study quality. We combined the published data for dichotomous outcomes using fixed-effect Mantel-Haenszel meta-analysis. When combining outcome data was not possible, we reported the results from individual studies. Main results We included four trials in this review and did not identify new studies from the search in April 2015. Home-based end-of-life care increased the likelihood of dying at home compared with usual care (risk ratio (RR) 1.33, 95% confidence interval (CI) 1.14 to 1.55, P = 0.0002; Chi2 = 1.72, df = 2, P = 0.42, I2 = 0%; 3 trials; N = 652; high quality evidence). Admission to hospital while receiving home-based end-of-life care varied between trials, and this was reflected by a high level of statistical heterogeneity in this analysis (range RR 0.62 to RR 2.61; 4 trials; N = 823; moderate quality evidence). Home-based end-of-life care may slightly improve patient satisfaction at one-month follow-up and reduce it at six-month follow-up (2 trials; low quality evidence). The effect on caregivers is uncertain (2 trials; low quality evidence). The intervention may slightly reduce healthcare costs (2 trials, low quality evidence). No trial reported costs to patients and caregivers. Authors' conclusions The evidence included in this review supports the use of home-based end-of-life care programmes for increasing the number of people who will die at home, although the numbers of people admitted to hospital while receiving end-of-life care should be monitored. Future research should systematically assess the impact of home-based end-of-life care on caregivers.

Obesity is a multifactorial disease, which in turn contributes to the onset of comorbidities, such as diabetes and atherosclerosis. Moreover, there are only few options available for treating obesity, and most current pharmacotherapy causes severe adverse effects, while offering minimal weight loss. Literature shows that metabotropic glutamate receptor 5 (mGluR5) modulates central reward pathways. Herein, we evaluated the effect of VU0409106, a negative allosteric modulator (NAM) of mGluR5 in regulating feeding and obesity parameters. Diet-induced obese C57BL/6 mice were treated for 14 days with VU0409106, and food intake, body weight, inflammatory/hormonal levels, and behavioral tests were performed. Our data suggest reduction of feeding, body weight, and adipose tissue inflammation in mice treated with high-fat diet (HFD) after chronic treatment with VU0409106. Furthermore, a negative modulation of mGluR5 also reduces binge-like eating, the most common type of eating disorder. Altogether, our results pointed out mGluR5 as a potential target for treating obesity, as well as related disorders., Graphical Abstract Diet-induced obese (DIO) C57BL/6 mice were treated for 14 days with VU0409106, a negative allosteric modulator of mGluR5. Food intake, body weight, inflammatory/hormonal levels, and behavioral tests were performed. Our data suggest reduction of feeding, body weight, and adipose tissue inflammation in DIO mice after chronic treatment with VU0409106.

Simulated moving bed technology is applied in the field of pharmaceutical, petrochemical and fine chemistry. It shows capability in separating multicomponent mixtures up to high purities. In this work, an attempt was made to optimize the production of 1,1-diethoxybutane (DEB), using the simulated moving bed technology. A fixed bed model is made with good agreement with experimental results. This fixed bed model was expanded to a simulated moving bed model. This model was used to determine the optimum conditions regarding the switching time and flowrates in each section. From this model, the optimum switching time was found to be 2.4 min, and the ratio of liquid flowrate over the solid flowrate in Section 1Section 2Section 3 and Section 4 of the SMBR was found to be 4.24, 1.77, 3.03 and 1.35, respectively. Under those conditions, the productivity was 19.8 kg DEB per liter of adsorbent per day, and the desorbent consumption was 6.1 L of ethanol per kg of DEB. The results were obtained with a minimum purity of the extract and raffinate of 97%.

Significance: The prevalence and incidence of age-related neurodegenerative diseases (NDDs) tend to increase along with the enhanced average of the world life expectancy. NDDs are a major cause of morbidity and disability, affecting the health care, social and economic systems with a significant impact. Critical Issues and Recent Advances: Despite the worldwide burden of NDDs and the ongoing research efforts to increase the underlying molecular mechanisms involved in NDD pathophysiologies, pharmacological therapies have been presenting merely narrow benefits. On the contrary, absent of detrimental side effects but growing merits, regular physical exercise (PE) has been considered a prone pleiotropic nonpharmacological alternative able to modulate brain structure and function, thereby stimulating a healthier and "fitness" neurological phenotype. Future Directions: This review summarizes the state of the art of some peripheral and central-related mechanisms that underlie the impact of PE on brain plasticity as well as its relevance for the prevention and/or treatment of NDDs. Nevertheless, further studies are needed to better clarify the molecular signaling pathways associated with muscle contractions-related myokines release and its plausible positive effects in the brain. In addition, particular focus of research should address the role of PE in the modulation of mitochondrial metabolism and oxidative stress in the context of NDDs.

International audience; Persistent Helicobacter pylori (H. pylori) infection is related to 90% of gastric cancers. With bacterial resistance rising and treatment inefficiency affecting 15% of the patients, alternative treatments urge. Chitosan microspheres (ChMics) have been proposed as an H. pylori-binding system. This work evaluates ChMics biocompatibility, mucopenetration and capacity to treat H. pylori infection in mice after oral administration. ChMics of different size (XL, ∼120 µm and XS, ∼40 µm) and degree of acetylation (6% and 16%) were developed and revealed to be able to adhere both human and mouse-adapted H. pylori strains without cytotoxicity towards human gastric cells. Ex vivo studies showed that smaller (XS) microspheres penetrate further within the gastric foveolae, suggesting their ability to reach deeply adherent bacteria. In vivo assays showed 88% reduction of infection when H. pylori-infected mice (C57BL/6) were treated with more mucoadhesive XL6 and XS6 ChMics. Overall, ChMics clearly demonstrate ability to reduce H. pylori gastric infection in mice, with chitosan degree of acetylation being a dominant factor over microspheres' size on H. pylori removal efficiency. These results evidence the strong potential of this strategy as an antibiotic-free approach to fight H. pylori infection, where microspheres are orally administered, bind H. pylori in the stomach, and remove them through the gastrointestinal tract. STATEMENT OF SIGNIFICANCE: Approximately 90% of gastric cancers are caused by the carcinogenic agent Helicobacter pylori, which infects >50% of the world population. Bacterial resistance, reduced antibiotic bioavailability, and the intricate distribution of bacteria in mucus and within gastric foveolae hamper the success of most strategies to fight H. pylori. We demonstrate that an antibiotic-free therapy based on bare chitosan microspheres that bind and remove H. pylori from stomach can achieve 88% reduction of infection from H. pylori-infected mice. Changing size and mucoadhesive properties, microspheres can reach different areas of gastric mucosa: smaller and less mucoadhesive can penetrate deeper into the foveolae. This promising, simple and inexpensive strategy paves the way for a faster bench-to-bedside transition, therefore holding great potential for clinical application.

Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 81 RCTs, with 69 meeting eligibility for the network meta-analysis (n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges’ g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges’ g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges’ g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges’ g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults, irrespective of severity. Registration: PROSPERO CRD42018115866 (23/11/2018).

Background The National Policy for Hearing Health Care in Brazil proposes that all newborns in the country undergo hearing screening in the first month of life.The Universal Neonatal Hearing Screening Program being extremely important for the early intervention of deafness. However, many parents/guardians do not return to the auditory retest, interrupting the neonatal protocol and making early auditory diagnosis impossible. Objective:To analyze the reasons for the non-attendance to retest of the Hearing Screening of a hospital in Curitiba. Methods This study was carried out in a Public Hospital, with live births from August 2017-May 2018. All the born were considered for the variables gender, risk for hearing loss, age at birth, results of Hearing Screening. Failed babies were analyzed, including the active search of those who did not attend the retest, through contact with parents/guardians to collect the reasons for faults. Results 2,531 infants were born, male had a prevalence of 1,275 (50.38%), term born 1,734(68.51%) and ICU stay as the most common risk indicator - 118(79.73%). 2,261(89.33%) infant passed on both ear; among those who failed only 94(40.0%) attended the retest. An active search was performed by phone, and 78(55.31%) could not establish contact, totaling 47(54.02%) mothers contacting. These motherś age was 19 to 24 years, 56.92% of whom had high school. The majority of those in charge are aware of the result of the test of the ear of their son (82.97%), was directed to test again (87.23%), were not able to answer the reason for not attending (27.65%) or had forgotten about this commitment (19.14%). Conclusions The data analyzed showed the lack of information that parents / guardians of the newborns give to the Hearing Screening, which compromises the integrality of health actions in newborns, making it necessary to seek other ways to ensure family adherence to the Program. Key messages Babies at risk of deafness need constant monitoring. Without parental participation, there is no success in health programs.

Background Worldwide, workers' health is still a Public Health concern, given the high number of hazardous occupational activities, as well as workers affected by work-related diseases. Among these diseases, occupational Noise-Induced Hearing Loss-NIHL is considered the second commonest occupational disease, and in Brazil, its reporting is compulsory. However, occupational diseases are usually underreported, hindering the knowledge of their actual magnitude, and the elaboration of prevention-oriented public policies. Objective To analyze the perception and knowledge of Primary Health Care professionals in Curitiba-Parana State, Brazil, on the compulsory NIHL reporting. Methods quantitative and qualitative approach conducted in three steps: analysis of a series of NIHL case histories reported in the official database between 2007 and 2018; application of a questionnaire to Primary Health Care Network professionals; collective interview with Primary Health Care Network nurses, speech therapists and doctors. Results NIHL reporting evidenced 82 cases, 67 (81.7%) among males, age ranging 50-64 years, 10 (12.2%) had complete high school level, 27 (32.9%) were formally employed, and 12 (14.6%) worked in the processing industry. Regarding the result of the applied questionnaire among the Primary Health Care professionals, 48 (68.7%) stated that they were prepared to identify workers' health problems, to 33 (68.7%) professionals, guidance to reassure users' comprehensive care is more important than the compulsory reporting, 21 (43.7%) claimed that they were qualified to identify NIHL cases, and 25 (52.1%) did not report the cases. Difficulties in reporting NIHL cases are: not understanding their flow, being afraid of the legal implications, which may generate difficulties in requesting audiometric testing, not having the management support, etc. Conclusions Most health care professionals are knowledgeable on NIHL, but they do not report the suspected cases due to lack of guidance. Key messages Primary care health professionals does not consider occupational health as part of the service to be provided. Primary care services are not prepared to establish the relationship between the injury and the job.

The maintenance of a healthy vascular system is essential to ensure the proper function of all organs of the human body. While macrovessels have the main role of blood transportation from the heart to all tissues, microvessels, in particular capillaries, are responsible for maintaining tissues' functionality by providing oxygen, nutrients and waste exchanges. Occlusion of blood vessels due to atherosclerotic plaque accumulation remains the leading cause of mortality across the world. Autologous vein and artery grafts bypassing are the current gold standard surgical procedures to substitute primarily obstructed vascular structures. Ischemic scenarios that condition blood supply in downstream tissues may arise from blockage phenomena, as well as from other disease or events leading to trauma. The (i) great demand for new vascular substitutes, arising from both the limited availability of healthy autologous vessels, as well as the shortcomings associated with small-diameter synthetic vascular grafts, and (ii) the challenging induction of the formation of adequate and stable microvasculature are current driving forces for the growing interest in the development of bioinspired strategies to ensure the proper function of vasculature in all its dimensional scales. Here, a critical review of well-established technologies and recent biotechnological advances to substitute or regenerate the vascular system is provided. published

Highlights • Healthcare workers are at high risk of mental health problems during viral epidemic outbreaks • This review of 117 studies offers pooled estimations of prevalence of acute stress disorder (40%), followed by anxiety (30%), burnout (28%), depression (24%), and post-traumatic stress disorder (13%). • It identifies a number of factors (sociodemographic, occupational and social) associated with mental health problems. • Interventional high-quality research is urgently needed to inform evidence-based policies for viral pandemics., Background: This study aimed at examining the impact of providing healthcare during health emergencies caused by viral epidemic outbreaks on healthcare workers'(HCWs) mental health; to identify factors associated with worse impact, and; to assess the available evidence base regarding interventions to reduce such impact. Method: Rapid systematic review. We searched MEDLINE, Embase, and PsycINFO (inception to August 2020). We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems, and used GRADE to ascertain the certainty of evidence. Results: We included 117 studies. The pooled prevalence was higher for acute stress disorder (40% (95%CI 39 to 41%)), followed by anxiety (30%, (30 to 31%)), burnout (28% (26 to 31%)), depression (24% (24 to 25%)), and post-traumatic stress disorder (13% (13 to 14%)). We identified factors associated with the likelihood of developing those problems, including sociodemographic (younger age and female gender), social (lack of social support, stigmatization), and occupational (working in a high-risk environment, specific occupational roles, and lower levels of specialised training and job experience) factors. Four studies reported interventions for frontline HCW: two educational interventions increased confidence in pandemic self-efficacy and in interpersonal problems solving (very low certainty), whereas one multifaceted intervention improved anxiety, depression, and sleep quality (very low certainty). Limitations: We only searched three databases, and the initial screening was undertaken by a single reviewer. Conclusion: Given the very limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified represent important targets for future interventions.

ObjectivesTo examine the impact of providing healthcare during or after health emergencies caused by viral epidemic outbreaks on healthcare workers′(HCWs) mental health, and to assess the available evidence base regarding interventions to reduce such impact.DesignSystematic rapid review and meta-analysis.Data sourcesMEDLINE, Embase, and PsycINFO, searched up to 23 March 2020.MethodWe selected observational and experimental studies examining the impact on mental health of epidemic outbreaks on HCWs. One reviewer screened titles and abstracts, and two reviewers independently reviewed full texts. We extracted study characteristics, symptoms, prevalence of mental health problems, risk factors, mental health interventions, and its impact. We assessed risk of bias for each individual study and used GRADE to ascertain the certainty of the evidence. We conducted a narrative and tabulated synthesis of the results. We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems.ResultsWe included 61 studies (56 examining impact on mental health and five about interventions to reduce such impact). Most were conducted in Asia (59%), in the hospital setting (79%), and examined the impact of the SARS epidemic (69%). The pooled prevalence was higher for anxiety (45%, 95% CI 21 to 69%; 6 studies, 3,373 participants), followed by depression (38%, 95% CI 15 to 60%; 7 studies, 3,636 participants), acute stress disorder (31%, 95% CI 0 to 82%, 3 studies, 2,587 participants), burnout (29%, 95% CI 25 to 32%; 3 studies; 1,168 participants), and post-traumatic stress disorder (19%, 95% CI 11 to 26%, 10 studies, 3,121 participants). Based on 37 studies, we identified factors associated with the likelihood of developing those problems, including sociodemographic (younger age and female gender), social (lack of social support, social rejection or isolation, stigmatization), and occupational (working in a high risk environment (frontline staff), specific occupational roles (e.g., nurse), and lower levels of specialised training, preparedness and job experience) factors. Five studies reported interventions for frontline HCW, two of which were educational and aimed to prevent mental health problems by increasing HCWs′ resilience. These interventions increased confidence in support and training, pandemic self-efficacy, and interpersonal problems solving (very low certainty). One multifaceted intervention implemented training and organisational changes) targeted at hospital nurses during the SARS epidemic, reporting improvements in anxiety, depression, and sleep quality (very low certainty). The two remaining interventions, which were multifaceted and based on psychotherapy provision, did not assess their impact.ConclusionThe prevalence of anxiety, depression, acute and post-traumatic stress disorder, and burnout, was high both during and after the outbreaks. These problems not only have a long-lasting effect on the mental health of HCWs, but also hinder the urgent response to the current COVID-19 pandemic, by jeopardising attention and decision-making. Governments and healthcare authorities should take urgent actions to protect the mental health of HCWs. In light of the limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified in this study, more so when they are modifiable, represent important targets for future interventions.SUMARY BOX1:What is already known on this topic?Previous studies showed that healthcare workers involved providing frontline care during viral epidemic outbreaks are at high risk of developing mental health problems.Given the current COVID-19 pandemic, there is an urgent need to synthesize the evidence regarding the impact of viral epidemic outbreaks on mental health of healthcare workers.2:What does this study add?This timely systematic rapid review offers for the first time pooled estimations of the prevalence of the most common mental health problems experienced by HCWs during and after viral epidemic outbreaks, namely anxiety (45%), depression (38%), and acute stress disorder (31%), among others.Our study also identifies a broad number of factors associated with these conditions, including sociodemographic factors such as younger age and female gender, social factors such as lack of social support, social rejection or isolation, stigmatization, and occupational factors such as working in a high risk environment, specific occupational roles, and having lower levels of specialised training, preparedness and job experience.Our study shows that, although educational and multifaceted interventions might mitigate the development of mental health problems, the certainty on the evidence is very low - therefore indicating that further high quality research is urgently needed to inform evidence-based policies for viral pandemics.

Emphysema, a pathological hallmark of Chronic Obstructive Pulmonary Disease, is characterized by the enlargement and destruction of alveoli in result of cell death and loss of elastic recoil. Typically, its onset before the fifth decade of life is attributed to alpha1-antitrypsin deficiency, a rare genetic condition. However, premature lung aging as an outcome of dysfunctional telomeres has been proven as another cause for family aggregation of young emphysema cases. Here, we report the findings of an agnostic study of 6 unrelated cases of early-onset emphysema (18-44 years). Whole exome sequencing was done using an Ion S5 XL system (>30x), where reads alignment and variant calling were executed through Ion Report software. Next, a manually curated procedure based in ANNOVAR output was employed to filter rare variants according to frequencies in Europeans (

Autism spectrum disorder (ASD) is characterized by deficits in communication and social interaction, restricted interests, and stereotyped behavior. Environmental factors, such as prenatal exposure to valproic acid (VPA), may contribute to the increased risk of ASD. Since disturbed functioning of the purinergic signaling system has been associated with the onset of ASD and used as a potential therapeutic target for ASD in both clinical and preclinical studies, we analyzed the effects of suramin, a non-selective purinergic antagonist, on behavioral, molecular and immunological in an animal model of autism induced by prenatal exposure to VPA. Treatment with suramin (20 mg/kg, intraperitoneal) restored sociability in the three-chamber apparatus and decreased anxiety measured by elevated plus maze apparatus, but had no impact on decreased reciprocal social interactions or higher nociceptive threshold in VPA rats. Suramin treatment did not affect VPA-induced upregulation of P2X4 and P2Y2 receptor expression in the hippocampus, and P2X4 receptor expression in the medial prefrontal cortex, but normalized an increased level of interleukin 6 (IL-6). Our results suggest an important role of purinergic signaling modulation in behavioral, molecular, and immunological aberrations described in VPA model, and indicate that the purinergic signaling system might be a potential target for pharmacotherapy in preclinical studies of ASD.

Although specific phobia is one of the most prevalent lifetime anxiety disorders, little is known about the particular risk factors related to its development. The underlying goal of this study was to analyse the risk factors associated with worrying about specific phobias (SP) in a representative sample of community dwelling adults. The sample was composed of 8461 participants (mean age 47.68 years, range 18-85, 54.60% female), from the Australian National Mental Health Survey. A total of 188 participants (2.22%) reported worrying about SPs. Multivariate logistic regression analysis indicated that female sex (odds ratio (OR) = 1.98, p

Medicinal plants are the richest bioresource of drugs on traditional systems of medicine and their use in treating diseases by ancestral societies has caught the attention of the scientific community. Application of these plants in daily diet, cosmetic and pharmaceutical industries is widely implemented for many years. However, with the increasing need for more sustainable and environmentally friendly techniques, substituting chemical processes by plants in the production and enrichment of nanomaterials is certainly a very appealing alternative.

Background The widespread use of mobile technologies can potentially expand the use of telemedicine approaches to facilitate communication between healthcare providers, this might increase access to specialist advice and improve patient health outcomes. Objectives To assess the effects of mobile technologies versus usual care for supporting communication and consultations between healthcare providers on healthcare providers' performance, acceptability and satisfaction, healthcare use, patient health outcomes, acceptability and satisfaction, costs, and technical difficulties. Search methods We searched CENTRAL, MEDLINE, Embase and three other databases from 1 January 2000 to 22 July 2019. We searched clinical trials registries, checked references of relevant systematic reviews and included studies, and contacted topic experts. Selection criteria Randomised trials comparing mobile technologies to support healthcare provider to healthcare provider communication and consultations compared with usual care. Data collection and analysis We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. Main results We included 19 trials (5766 participants when reported), most were conducted in high‐income countries. The most frequently used mobile technology was a mobile phone, often accompanied by training if it was used to transfer digital images. Trials recruited participants with different conditions, and interventions varied in delivery, components, and frequency of contact. We judged most trials to have high risk of performance bias, and approximately half had a high risk of detection, attrition, and reporting biases. Two studies reported data on technical problems, reporting few difficulties. Mobile technologies used by primary care providers to consult with hospital specialists We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: ‐ probably make little or no difference to primary care providers following guidelines for people with chronic kidney disease (CKD; 1 trial, 47 general practices, 3004 participants); ‐ probably reduce the time between presentation and management of individuals with skin conditions, people with symptoms requiring an ultrasound, or being referred for an appointment with a specialist after attending primary care (4 trials, 656 participants); ‐ may reduce referrals and clinic visits among people with some skin conditions, and increase the likelihood of receiving retinopathy screening among people with diabetes, or an ultrasound in those referred with symptoms (9 trials, 4810 participants when reported); ‐ probably make little or no difference to patient‐reported quality of life and health‐related quality of life (2 trials, 622 participants) or to clinician‐assessed clinical recovery (2 trials, 769 participants) among individuals with skin conditions; ‐ may make little or no difference to healthcare provider (2 trials, 378 participants) or participant acceptability and satisfaction (4 trials, 972 participants) when primary care providers consult with dermatologists; ‐ may make little or no difference for total or expected costs per participant for adults with some skin conditions or CKD (6 trials, 5423 participants). Mobile technologies used by emergency physicians to consult with hospital specialists about people attending the emergency department We assessed the certainty of evidence for this group of trials as moderate. Mobile technologies: ‐ probably slightly reduce the consultation time between emergency physicians and hospital specialists (median difference −12 minutes, 95% CI −19 to −7; 1 trial, 345 participants); ‐ probably reduce participants’ length of stay in the emergency department by a few minutes (median difference −30 minutes, 95% CI −37 to −25; 1 trial, 345 participants). We did not identify trials that reported on providers' adherence, participants’ health status and well‐being, healthcare provider and participant acceptability and satisfaction, or costs. Mobile technologies used by community health workers or home‐care workers to consult with clinic staff We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: ‐ probably make little or no difference in the number of outpatient clinic and community nurse consultations for participants with diabetes or older individuals treated with home enteral nutrition (2 trials, 370 participants) or hospitalisation of older individuals treated with home enteral nutrition (1 trial, 188 participants); ‐ may lead to little or no difference in mortality among people living with HIV (RR 0.82, 95% CI 0.55 to 1.22) or diabetes (RR 0.94, 95% CI 0.28 to 3.12) (2 trials, 1152 participants); ‐ may make little or no difference to participants' disease activity or health‐related quality of life in participants with rheumatoid arthritis (1 trial, 85 participants); ‐ probably make little or no difference for participant acceptability and satisfaction for participants with diabetes and participants with rheumatoid arthritis (2 trials, 178 participants). We did not identify any trials that reported on providers' adherence, time between presentation and management, healthcare provider acceptability and satisfaction, or costs. Authors' conclusions Our confidence in the effect estimates is limited. Interventions including a mobile technology component to support healthcare provider to healthcare provider communication and management of care may reduce the time between presentation and management of the health condition when primary care providers or emergency physicians use them to consult with specialists, and may increase the likelihood of receiving a clinical examination among participants with diabetes and those who required an ultrasound. They may decrease the number of people attending primary care who are referred to secondary or tertiary care in some conditions, such as some skin conditions and CKD. There was little evidence of effects on participants' health status and well‐being, satisfaction, or costs., Plain language summary Using mobile technologies to promote communication and management of care between healthcare professionals What is the aim of this review? We aimed to find out if healthcare workers using mHealth services through their mobile phones or other mobile devices to communicate with other healthcare workers provide quicker access to healthcare, and improve patient health outcomes. We collected and analysed all relevant research and found 19 studies. Key messages Mobile technologies probably slightly decrease the time to deliver health care, as well as the number of face‐to‐face appointments, when compared with usual care, and probably increase the number of people receiving clinical examinations for some conditions, including an eye exam for people with diabetes. Mobile technologies may have little or no impact on healthcare workers' and participants' satisfaction, health status or well‐being. What was studied in the review? Many healthcare workers work alone or have little access to colleagues and specialists. This is a common problem for healthcare workers in rural areas or low‐income countries. One possible solution to this problem is to offer healthcare workers advice and support through mobile technologies that allow healthcare workers to get help from colleagues who are not in the same place. For instance, healthcare workers can contact specialists or colleagues with more experience through a phone or the Internet. Healthcare workers can also use their mobile phones or other mobile devices such as tablets. As more healthcare workers use mobile phones and other devices as part of their work, this could make it particularly easy for them to use mHealth services. What are the main results of the review? We found 19 relevant studies, which included more than 5766 people who needed health care. Sixteen studies were from high‐income countries. Two studies reported on technical problems, reporting few difficulties. When primary healthcare workers use mobile technologies to consult with hospital specialists, they: ‐ probably make little or no difference to whether guidelines are followed for people with chronic kidney disease, or to health status or quality of life of people with psoriasis. ‐ may increase the likelihood of retinopathy screening for people with diabetes, or receiving an ultrasound if referred with symptoms, and may reduce referrals or a visit to the clinic for people with a skin condition or referred for clinic follow‐up for different health problems. ‐ may make little or no difference to healthcare worker or patient satisfaction, or to how much it costs to deliver health care. When emergency doctors use mobile technologies to consult with hospital specialists: ‐ patients are probably managed slightly more quickly. We did not find any studies that looked at the effect of mobile technologies on emergency doctors following guidelines, patients’ health and well‐being, healthcare worker or patient satisfaction, or costs. When community health workers or home‐care workers use mobile technologies to consult with clinic staff, they: ‐ probably make little or no difference to the number of times people with a new diabetes‐related foot ulcer have to see a nurse, or elderly people using tube feeding have to see a nurse or go into hospital. ‐ may make no difference to the number of people living with HIV or diabetes who die; and may make little or no difference to the health status or quality of life of people with rheumatoid arthritis. ‐ probably make little or no difference to the satisfaction of people with diabetes or rheumatoid arthritis. We did not find any studies that looked at the effect of mobile technologies on whether community health workers follow guidelines, how quickly people receive care, healthcare worker satisfaction, costs, or technical difficulties. How up‐to‐date is this review? We searched for studies up to 22 July 2019.

Keto analogues and amino acids (KAAA) supplementation can reduce blood ammonia concentrations in athletes undergoing high-intensity exercise under both ketogenic and thermoneutral conditions. This study evaluated the acute effects of KAAA supplementation on ammonia metabolism during extenuating endurance exercise in rats fed a ketogenic diet. In all, eighty male Fischer rats at 90 d of age were divided into eight groups, and some were trained using a swimming endurance protocol. A ketogenic diet supplemented with keto analogues was administered for 10 d. Administration of the ketogenic diet ended 3 d before the exhaustion test (extenuating endurance exercise). A ketogenic diet plus KAAA supplementation and extenuating endurance exercise (trained ketogenic diet supplemented with KAAA (TKKa)) increased blood ammonia concentrations by approximately 50 % compared with the control diet (trained control diet supplemented with KAAA (TCKa)) and similar training (effect size=1·33; statistical power=0·50). The KAAA supplementation reduced blood urea concentrations by 4 and 18 % in the control and ketogenic diet groups, respectively, compared with the groups fed the same diets without supplementation. The trained groups had 60 % lower blood urate concentrations after TCKa treatment than after TKKa treatment. Our results suggest that KAAA supplementation can reduce blood ammonia concentrations after extenuating endurance exercise in rats fed a balanced diet but not in rats fed a ketogenic diet.

Summary Introduction Irisin myokine whose secretion is induced by exercise is associated with an increase in thermogenesis. However, the effect of acute and chronic exercise on the production and release of irisin in overweight individuals is controversial. Objective To evaluate whether acute and chronic exercise affects irisin concentrations in overweight individuals. Methods The Medline/PubMed and Science Direct databases were used. The data search included clinical trials with humans that assessed the effect of acute or chronic exercise on irisin concentrations in overweight or obese individuals. The search terms used were: “irisin” AND “exercise” OR “acute exercise” OR chronic exercise “OR” endurance exercise “OR” aerobic exercise “OR” strength exercise “OR” resistance exercise “OR” obesity”. Results Nine articles performed in healthy and diabetic subjects were found. The irisin concentrations in individuals with excess weight increased with acute exercise and remained the same with chronic exercise. The maximum concentration of irisin occurred between 1 and 2 hours after the exercise was completed. The protocols of resistance and high-intensity training were more effective. Conclusion The increase in irisin concentrations after exercise is transient. Further research is needed to assess whether this change has a cumulative effect and actually acts on thermogenesis.

A endometriose é uma doença benigna, crónica e estrogénio-dependente. Pensa-se que a gravidez tenha um efeito positivo na endometriose através da inibição da ovulação, contudo tem surgido evidência da associação da endometriose não só com infertilidade, mas também com complicações obstétricas. Descreve-se o caso de uma grávida de 34 semanas, com antecedentes clínicos e ecográficos sugestivos de endometriose, admitida por dor abdominal súbita e intensa. Durante a cesariana emergente, realizada por bradicardia fetal sustentada, constatou-se a presença de um volumoso hemoperitoneu e focos hemorrágicos na parede uterina posterior. Apesar de raro, o hemoperitoneu espontâneo é uma complicação possível na gravidez, sobretudo em mulheres com antecedentes de endometriose. Dadas as complicações materno-fetais associadas, uma rápida suspeição diagnóstica e intervenção são fundamentais.

The global p-xylene market has demonstrated positive growth thanks to increasing demand for polyester fibers in the textile industry. Additionally, the chemical process becomes a target for energy efficiency; thus, process improvement and intensification have increasingly gained the attention of the scientific community. This article summarizes the advances in the production and separation of xylene isomers. An overview of the aromatics complex is displayed followed by a detailed description of the p-xylene production and separation processes. It summarizes the improvement of the catalysts, adsorbents, advanced materials; processes that strengthen the performance of the existing units, membrane-based processes, and alternative sources in past years. Special attention is given to the Simulated Moving Bed technology for separation; the flushing strategies and model development studies are also addressed. Attention has also been given to the process intensification and the unit combination with other aromatic technologies. A brief review of the latest results of Simulated Moving Bed Reactor and heat integration is also included. In summary, process intensification and integration are promising to save energy and costs, and it also allows flexibility within the feeds and intermediate products, maximizing the advantages of each process.

Gallbladder cancer is the 5th most common gastrointestinal cancer, is 2-3 times more frequent in females, and gallstones represent the most important association with this type of cancer. It is generally diagnosed incidentally after cholecystectomy for cholelithiasis and complete surgical resection offers the only potential cure. We report a case of a 42-year-old female, previously healthy, with upper right quadrant pain for 2 weeks and an ultrasound suggestive of cholecystitis. Unfortunately, intraoperative findings were discouraging.

Fosaprepitant is administered intravenously to treat chemotherapy-induced nausea and vomiting. To verify the incidence of infusion site reactions and the relationship among risk factors, a quantitative retrospective cohort study was undertaken. The study included patients seen between October 2013 and February 2014. Fifty-seven patients were included in the study, and there were 105 infusions among them. Infusion site reactions were identified in 42 (40%) cases. Risk factors identified by the study included age (P < .001), insertion at the back of the hand and wrist (P < .001), and first fosaprepitant administration (P < .001). The study found evidence of a higher incidence of infusion site reactions than was reported in the package insert.

The activation technique allows much more precise measurements of neutron intensity, relative or absolute. This technique requires the knowledge of the Doppler Broadening Function to determine the resonance self-shielding factors in the epithermal range. In this technical note the influence of considering the enlarged Doppler Broadening Function proposed by Palma et al. in the calculation of the self-shielding factors in the epithermal range in round disks is evaluated. Although the enlarged Doppler Broadening Function version shows considerable deviations from the conventional Doppler Broadening Function when ξ ⩽ 0.06 it has been shown that the effect is not fully transmitted to the calculation of the self-shielding factors in the epithermal range of 232 Th, 240 Pu, and 238 U isotopes. Thus, it is possible to conclude that there is no measurable gain in using enlarged Doppler Broadening Function instead of conventional Doppler Broadening Function in the activation technique and the conventional version is recommended in this application. For applications involving higher temperatures and consequently lower values of parameter ξ , there may be a gain depending on the degree of precision required in the calculations.

The best route of delivery for the term breech fetus is still controversial. We aim to compare maternal and neonatal outcomes between vaginal and cesarean term breech deliveries.Multicentric retrospective cohort study of singleton term breech fetuses delivered vaginally or by elective cesarean section from January 2012 - October 2014. Primary outcomes were maternal and neonatal morbidity or mortality.Sixty five breech fetuses delivered vaginally were compared to 1262 delivered by elective cesarean. Nulliparous women were more common in the elective cesarean group (69.3% vs 24.6%; p0.0001). Gestational age at birth was significantly lower in the vaginal delivery group (38 ± 1 weeks vs 39 ± 0.8 weeks; p = 0.0029) as was birth weight (2928 ± 48.4 g vs 3168 ± 11.3 g; p0.0001). Apgar scores below seven on the first and fifth minutes were more likely in the vaginal delivery group (1st minute: 18.5% vs 5.9%; p = 0.0006; OR 3.6 [1.9 - 7.0]; 5th minute: 3.1% vs 0.2%; p = 0.0133; OR 20.0 [2.8 - 144.4]), as was fetal trauma (3.1% vs 0.3%: p = 0.031; OR 9.9 [1.8-55.6]). Neither group had cases of fetal acidemia. Admission to the Neonatal Intensive Care Unit, maternal postpartum hemorrhage and the incidence of other obstetric complications were similar between groups.Although vaginal breech delivery was associated with lower Apgar scores and higher incidence of fetal trauma, overall rates of such events were low. Admission to the neonatal intensive care unit and maternal outcomes were similar.Both delivery routes seem equally valid, neither posing high maternal or neonatal complications' incidence.Introdução: A melhor via de parto do feto pélvico de termo ainda é controversa. Pretendemos comparar desfechos maternos e neonatais entre partos vaginais e cesarianas de fetos pélvicos de termo. Material e Métodos: Estudo de coorte, multicêntrico e retrospetivo, incluindo gestações de feto único de termo, em apresentação pélvica, que terminaram em parto vaginal ou cesariana eletiva entre janeiro de 2012 e outubro de 2014. Os desfechos primários foram a morbilidade e mortalidade maternas e neonatais. Resultados: Sessenta e cinco partos vaginais foram comparados com 1262 cesarianas eletivas. As nulíparas foram mais frequentes no grupo das cesarianas (69,3% vs 24,6%; p0,0001). A idade gestacional foi inferior nos partos vaginais (38 ± 1 semanas vs 39 ± 0,8 semanas; p = 0,0029), verificando-se o mesmo para o peso ao nascer (2928 ± 48,4 g vs 3168 ± 11,3 g; p0,0001). Índices de Apgar7 foram mais frequentes nos partos vaginais (1º minuto: 18,5% vs 5,9%; p = 0,0006; OR 3,6 [1,9 - 7,0]; 5º minuto: 3,1% vs 0,2%; p = 0,0133; OR 20,0 [2,8 - 144,4]). Verificou-se também uma maior incidência de traumatismo fetal neste grupo (3,1% vs 0,3%; p = 0,031; OR 9,9 [1,8 - 55,6]). Nenhum grupo teve casos de acidemia fetal. As taxas de internamento na unidade de cuidados intensivos neonatais, de hemorragia materna pós-parto ou de outras complicações obstétricas foram idênticas. Discussão: O parto vaginal associou-se a índices de Apgar inferiores e a uma maior incidência de traumatismo fetal, com taxas globalmente baixas. Não se verificaram diferenças nas taxas de internamento neonatal nem nos desfechos maternos. Conclusão: Ambas as vias de parto parecem adequadas, nenhuma condicionando incidências elevadas de complicações maternas ou neonatais.

Background: Changing population demographics have led to an increasing number of functionally dependent older people who require care and medical treatment. In many countries, government policy aims to shift resources into the community from institutional care settings with the expectation that this will reduce costs and improve the quality of care compared. Objectives: To assess the effects of long‐term home or foster home care versus institutional care for functionally dependent older people. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, MEDLINE, Embase, CINAHL, and two trials registers to November 2015. Selection criteria: We included randomised and non‐randomised trials, controlled before‐after studies and interrupted time series studies complying with the EPOC study design criteria and comparing the effects of long‐term home care versus institutional care for functionally dependent older people. Data collection and analysis: Two reviewers independently extracted data and assessed the risk of bias of each included study. We reported the results narratively, as the substantial heterogeneity across studies meant that meta‐analysis was not appropriate. Main results: We included 10 studies involving 16,377 participants, all of which were conducted in high income countries. Included studies compared community‐based care with institutional care (care homes). The sample size ranged from 98 to 11,803 (median N = 204). There was substantial heterogeneity in the healthcare context, interventions studied, and outcomes assessed. One study was a randomised trial (N = 112); other included studies used designs that had potential for bias, particularly due lack of randomisation, baseline imbalances, and non‐blinded outcome assessment. Most studies did not select (or exclude) participants for any specific disease state, with the exception of one study that only included patients if they had a stroke. All studies had methodological limitations, so readers should interpret results with caution. It is uncertain whether long‐term home care compared to nursing home care decreases mortality risk (2 studies, N = 314, very‐low certainty evidence). Estimates ranged from a nearly three‐fold increased risk of mortality in the homecare group (risk ratio (RR) 2.89, 95% confidence interval (CI) 1.57 to 5.32) to a 62% relative reduction (RR 0.38, 95% CI 0.17 to 0.61). We did not pool data due to the high degree of heterogeneity (I2 = 94%). It is uncertain whether the intervention has a beneficial effect on physical function, as the certainty of evidence is very low (5 studies, N = 1295). Two studies reported that participants who received long‐term home care had improved activities of daily living compared to those in a nursing home, whereas a third study reported that all participants performed equally on physical function. It is uncertain whether long‐term home care improves happiness compared to nursing home care (RR 1.97, 95% CI 1.27 to 3.04) or general satisfaction because the certainty of evidence was very low (2 studies, N = 114). The extent to which long‐term home care was associated to more or fewer adverse health outcomes than nursing home care was not reported. It is uncertain whether long‐term home care compared to nursing home care decreases the risk of hospital admission (very low‐certainty evidence, N = 14,853). RR estimates ranged from 2.75 (95% CI 2.59 to 2.92), showing an increased risk for those receiving care at home, to 0.82 (95% CI 0.72 to 0.93), showing a slightly reduced risk for the same group. We did not pool data due to the high degree of heterogeneity (I2 = 99%). Authors' conclusions: There are insufficient high‐quality published data to support any particular model of care for functionally dependent older people. Community‐based care was not consistently beneficial across all the included studies; there were some data suggesting that community‐based care may be associated with improved quality of life and physical function compared to institutional care. However, community alternatives to institutional care may be associated with increased risk of hospitalisation. Future studies should assess healthcare utilisation, perform economic analysis, and consider caregiver burden.

Background The prevalence of overweight and obesity is increasing globally, an increase which has major implications for both population health and costs to health services. This is an update of a Cochrane Review. Objectives: To assess the effects of strategies to change the behaviour of health professionals or the organisation of care compared to standard care, to promote weight reduction in children and adults with overweight or obesity. Search methods: We searched the following databases for primary studies up to September 2016: CENTRAL, MEDLINE, Embase, CINAHL, DARE and PsycINFO. We searched the reference lists of included studies and two trial registries. Selection criteria: We considered randomised trials that compared routine provision of care with interventions aimed either at changing the behaviour of healthcare professionals or the organisation of care to promote weight reduction in children and adults with overweight or obesity. Data collection and analysis: We used standard methodological procedures expected by Cochrane when conducting this review. We report the results for the professional interventions and the organisational interventions in seven 'Summary of findings' tables. Main results: We identified 12 studies for inclusion in this review, seven of which evaluated interventions targeting healthcare professional and five targeting the organisation of care. Eight studies recruited adults with overweight or obesity and four recruited children with obesity. Eight studies had an overall high risk of bias, and four had a low risk of bias. In total, 139 practices provided care to 89,754 people, with a median follow‐up of 12 months. Professional interventions: Educational interventions aimed at general practitioners (GPs), may slightly reduce the weight of participants (mean difference (MD) ‐1.24 kg, 95% confidence interval (CI) ‐2.84 to 0.37; 3 studies, N = 1017 adults; low‐certainty evidence). Tailoring interventions to improve GPs' compliance with obesity guidelines probably leads to little or no difference in weight loss (MD 0.05 (kg), 95% CI ‐0.32 to 0.41; 1 study, N = 49,807 adults; moderate‐certainty evidence). It is uncertain if providing doctors with reminders results in a greater weight reduction than standard care (men: MD ‐11.20 kg, 95% CI ‐20.66 kg to ‐1.74 kg, and women: MD ‐1.30 kg, 95% CI [‐7.34, 4.74] kg; 1 study, N = 90 adults; very low‐certainty evidence). Providing clinicians with a clinical decision support (CDS) tool to assist with obesity management at the point of care leads to little or no difference in the body mass index (BMI) z‐score of children (MD ‐0.08, 95% CI ‐0.15 to ‐0.01 in 378 children; moderate‐certainty evidence), CDS tools may lead to little or no difference in weight loss in adults: MD ‐0.095 kg (‐0.21 lbs), P = 0.47; 1 study, N = 35,665; low‐certainty evidence. Organisational interventions: Adults with overweight or obesity may lose more weight if the care was provided by a dietitian (by ‐5.60 kg, 95% CI ‐4.83 kg to ‐6.37 kg) or by a doctor‐dietitian team (by ‐6.70 kg, 95% CI ‐7.52 kg to ‐5.88 kg; 1 study, N = 270 adults; low‐certainty evidence). Shared care leads to little or no difference in the BMI z‐score of children with obesity (adjusted MD ‐0.05, 95% CI ‐0.14 to 0.03; 1 study, N = 105 children; low‐certainty evidence). Organisational restructuring of the delivery of primary care (i.e. introducing the chronic care model) may result in a slightly lower increase in the BMI of children who received care at intervention clinics (BMI change: adjusted MD ‐0.21, 95% CI ‐0.50 to 0.07; 1 study, unadjusted MD ‐0.18, 95% CI ‐0.20 to ‐0.16; N=473 participants; moderate‐certainty evidence). Mail and phone interventions probably lead to little or no difference in weight loss in adults (mean weight change (kg) using mail: ‐0.36, 95% CI ‐1.18 to 0.46; phone: ‐0.44, 95% CI ‐1.26 to 0.38; 1 study, N = 1801 adults; moderate‐certainty evidence). Care delivered by a nurse at a primary care clinic may lead to little or no difference in the BMI z‐score in children (MD ‐0.02, 95% CI ‐0.16 to 0.12; 1 study, N = 52 children; very low‐certainty evidence). Two studies reported data on cost effectiveness: one study favoured mail and standard care over telephone consultations, and the other study achieved weight loss at a modest cost in both intervention groups (doctor and doctor‐dietitian). One study of shared care reported similar adverse effects in both groups. Authors' conclusions: We found little convincing evidence for a clinically‐important effect on participants' weight or BMI of any of the evaluated interventions. While pooled results from three studies indicate that educational interventions targeting healthcare professionals may lead to a slight weight reduction in adults, the certainty of these results is low. Two trials evaluating CDS tools (unpooled results) for improved weight management suggest little or no effect on weight or BMI change in adults or children with overweight or obesity. Evidence for all the other interventions evaluated came mostly from single studies. The certainty of the included evidence varied from moderate to very low for the main outcomes (weight and BMI). All of the evaluated interventions would need further investigation to ascertain their strengths and limitations as effective strategies to change the behaviour of healthcare professionals or the organisation of care. As only two studies reported on cost, we know little about cost effectiveness across the evaluated interventions.

Background Few studies have directly compared the effects of different exercise therapies on clinical depression in older adults. Thus, we conducted a systematic review and network meta-analysis of current evidence from randomised controlled trials (RCTs) to compare the effectiveness of three major exercise types (aerobic, resistance, and mind-body exercise) in clinically depressed older adults. Methods We followed PRISMA-NMA guidelines and searched databases for eligible RCTs (inception – September 12th, 2019). RCTs were eligible if they included clinically depressed adults aged >65 years, implemented one or more exercise therapy arms using aerobic, resistance, or mind-body exercise, and assessed depressive symptoms at baseline and follow-up using a validated clinical questionnaire. Results A network meta-analysis was performed on 15 eligible RCTs comprising 596 participants (321 treatment and 275 controls), including aerobic (n = 6), resistance (n = 5), and mind-body (n = 4) exercise trials. Compared with controls, mind-body exercise showed the largest improvement on depressive symptoms (g = −0.87 to −1.38), followed by aerobic exercise (g = −0.51 to −1.02), and resistance exercise (g = −0.41 to −0.92). Notably, there were no statistically significant differences between exercise types: aerobic versus resistance (g = −0.10, PrI = −2.23, 2.03), mind-body versus aerobic (g = −0.36, PrI = −2.69, 1.97), or mind-body versus resistance (g = −0.46, PrI = −2.75, 1.83). Conclusions These findings should guide optimal exercise prescription for allied health professionals and stakeholders in clinical geriatrics. Notably, clinically depressed older adults may be encouraged to self-select their preferred exercise type in order to achieve therapeutic benefit on symptoms of depression. In coalition with high levels of compliance, these data provide encouraging evidence for the antidepressant effect of either aerobic, resistance, or mind-body exercise as effective treatment adjuncts for older adults presenting with clinical depression.

In this work, we report on the results obtained with rad-hard Standard Float Zone (STFZ) and Diffused Oxygenated Float Zone (DOFZ) silicon diodes in radiation processing dosimetry. The dosimetric probes were designed to operate in the direct current mode, as on-line radiation dosimeter. The irradiation of the samples was performed using a 60Co source with a dose rate of almost 2.4 kGy/h. The current response of each diode was measured as a function of the exposure time in steps from 5 kGy up to 50 kGy to achieve a total absorbed dose of 275 kGy. In this dose range it is observed a significant decrease in the photocurrent generated in both devices due to gamma radiation defects produced in their active volumes. To mitigate this effect, the samples were pre-irradiated with Co-60 gamma rays at 700 kGy. Despite of being less sensitive, these devices presented stable and reproducible current signals with a relative sensitivity decrease of about 19% within the whole range of dose studied. The dose-response curves of the pre-irradiated diodes showed quadratic behavior with correlation coefficient higher than 0.9999 for total absorbed dose up to 275 kGy. The comparison of the FZ and DOFZ responses evidenced that the latter was slightly superior to the first. However, it is important to note that all pre-irradiated diodes can be used as gamma dosimeters in radiation processing applications.

Common bean (Phaseolus vulgaris L.) has become, over the last 20 years, a competitive crop in national, regional, and international markets. This situation presents a dynamic environment for producers and researchers of this crop and requires a rethinking of current strategies against research and production needs, the opportunities and challenges of the future, and adaptation to changing agri-environmental conditions. Improvement of the common bean means possessing in-depth knowledge of its genetic diversity, the genome and gene functions, to enable the analysis of pathways and networks in response to fluctuating environmental conditions. An important long-term challenge is the discovery of the gene(s) that control important production traits such as pest and disease resistance, abiotic stress tolerance, and biological fixation of nitrogen. This will need to be a cooperative worldwide effort that involves breeders, geneticists, and genomic and bioinformatics experts. Currently, new technologies built around the recently released common bean genome sequence are now being developed, and various genomic resources for common bean are available and include physical maps, bacterial artificial chromosome libraries, anchored physical and genetic maps, and expressed sequence tags. However, these approaches require precise phenotypic data. Complex interactions between the common bean crop genotype, environmental factors in combination with plant population dynamics and crop management greatly affect plant phenotypes in field experiments and are the key for the expansion of the productivity of this crop in traditional and nontraditional growing areas.

The objective response detection (ORD) techniques such as Global Spectral F-Test (GSFT) are mathematical methods used to detect potentials evoked to rhythmic stimulation that are embedded in the ongoing electroencephalogram (EEG). The ORDs are based on the detector sampling distribution under the null hypothesis of no response to assess whether a given response is embedded in the electroencephalogram background (EEG). The performance of these detectors is strongly affected on both the signal-to-noise ratio (SNR) and the length of the electroencephalogram (EEG) signal. In this context, multivariate detectors are developed to increase the performance of the detection technique without increasing data recording time by using the information from more signals simultaneously. This work proposes three new bivariate detectors based on the normalization of the Global Spectral F-Test. The critical values ​​and detection probabilities for the new techniques were obtained theoretically and using a Monte Carlo simulation. The bivariate new detectors were next applied to the EEG from 10 subjects during intermittent, photic stimulation leading to an increase of up to 32.69% in mean detection rate in comparison with the univariate Global Spectral Beta-Test. The higher detection rate obtained with the proposed techniques without the need of increasing the number of data segments allows evoked responses to be detected faster, which might be useful in clinical practice.

This study had the financial support of Operational Programme MAR2020 through the project 16-02-01-FMP-0004: Ouriceira AQUA: Aquaculture and Enhancement of Gonad Production in the Sea Urchin (Paracentrotus lividus), and the support of Fundaçao ˜ para a Ciˆencia e Tecnologia (FCT), through the strategic project UIDB/ 04292/2020 granted to MARE-Marine and Environmental Sciences Centre. MN was supported by the Integrated Programme of SR&TD “Smart Valorization of Endogenous Marine Biological Resources Under a Changing Climate” (reference Centro-01-0145-FEDER-000018), co-funded by Centro 2020 program, Portugal 2020, European Union, through the European Regional Development Fund. Sea urchins’ gonads are a delicacy highly appreciated worldwide. In Europe, Paracentrotus lividus is one of the most valuable edible sea urchin species and a desired target for aquaculture. One of the challenges of echinoculture is to increase the sea urchins’ growth rate during the on-growing phase and reducing the production cycle required to obtain sea urchins of commercial size (test diameter ≈ 50 mm). The present study aimed to evaluate the growth and gonad development of P. lividus urchins fed with three dry diets for 15 weeks. The diets were formulated with ingredients of three different sources: an algae-based, a fishmeal-based and a cereals-based diet. The somatic growth was assessed by biometric indicators like the linear and specific growth rates. The gonadal development was assessed by the gonadal somatic index (GSI), gametogenesis level, proximate composition and fatty acids profile. The results obtained showed high growth rates in all the three diets tested (0.44% per day). The sea urchins fed with the cereals diet presented the highest GSI (8.22%) with higher proportion of gonads in growing and premature stages. The proximate composition of the sea urchins’ gonads was significantly affected by diet and sea urchins’ sex, particularly the lipid content. Concomitantly, fatty acids (FA) profile of the gonads was influenced by both diet and sea urchins’ sex with saturated and polyunsaturated FA playing an important role in this differentiation. info:eu-repo/semantics/publishedVersion

IntroductionKnee osteoarthritis (OA) is a prevalent condition with associated high disability and healthcare costs. Evidence of major gaps in the implementation of evidence-based interventions in people with knee OA led several healthcare systems to implement models of care (MoCs) in order to improve knowledge translation and guaranty their economic sustainability. Nevertheless, there are few studies that analyse the existing body of evidence of MoCs for patients with knee OA in primary healthcare settings. Therefore, we aim to identify MoCs developed for patients with knee OA implemented in primary healthcare and, analyse their core components and outcomes. This scoping review will create knowledge about the components and outcomes of these MoCs which, in the future, will facilitate their transferability to practice.Methods and analysisWe will include studies that developed and implemented an MoC for people with knee OA in primary healthcare. We will use the PCC mnemonic, being ‘Population’—people with Knee OA, ‘Concept’—the MoCs and ‘Context’—the primary healthcare setting. We will conduct the search on PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science Core Collection, as well as grey literature databases and relevant institutions and organisations websites, for articles published after 2000. Two independent reviewers will screen titles and abstracts followed by a full-text review to assess papers regarding their eligibility. We will evaluate the methodological quality of the included studies with the Mixed Methods Appraisal tool and apply a data abstraction form to describe and interpret the evidence.Ethics and disseminationAs a secondary analysis, this scoping review does not require ethical approval. Findings will be published in peer-review journal, presented in scientific conferences and as a summary through primary healthcare units.

The response of thin diodes (SFH206k) as dosimeters has been investigated employing the beam of an electron accelerator within the dose rate range of 2–8 kGy/s and accumulated doses up to 100 kGy. These devices, operating in the short-circuit mode and under industrial irradiation conditions, deliver current signals nonlinearly dependent on the dose rate, whichever the dose history of the diodes, due to the high density of the generated electron-hole pairs herein achieved. Despite this nonlinearity, the dose rate response is stable and characterized by current signals with repeatability better than 2.0%, regardless of the accumulated dose. It is also found that the dose responses are quite linear with sensitivities slightly dependent on the accumulated dose at a constant dose rate. The decrease in the charge sensitivity, taking as reference that obtained before any radiation damage, reaches only 9% (k = 2) at 100 kGy, which is much smaller than the values reported in the literature. From this low aging and the repeatability of both dose rate and dose responses, it seems that the photodiode under investigation is a low budget alternative, good enough for routine dosimetry, provided it has been previously calibrated in the same processing facility.