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The grading of urinary tract dilatation (UTD) on postnatal sonography is a fundamental step to establish rational management for infants with antenatal hydronephrosis (ANH). The aim of this study was to compare the prediction accuracy of UTD grading systems for relevant clinical outcomes. In addition, we propose a refinement of the UTD classification by adding quantitative measurements and evaluate its impact on accuracy. Between 1989 and 2019, 447 infants diagnosed with isolated AHN were prospectively followed. The events of interest were surgical interventions and kidney injury. Comparison of performance of the grading systems and the impact on the accuracy of a modified UTD classification (including the size of the kidney parenchyma) was assessed by the area under the receiver-operating characteristic curve (AUC). Of 447 infants, 131 (29%) underwent surgical intervention and 26 (5.8%) had developed kidney injury. The median follow-up time was 9 years (IQ range, 7–12 years). The performance for detecting the need for surgical intervention was excellent for all grading systems (AUC > 0.90). However, for predicting kidney injury, the modified UTD classification exhibited significant improvement in accuracy (AUC = 0.913, 95%CI, 0.883–0.937) as compared with UTD classification (AUC = 0.887, 95%CI, 0.854–0.915) (P = 0.027). Our study confirms that the hydronephrosis grading systems provide excellent accuracy in discriminating patients who need surgical intervention among infants with AHN. Our findings suggest that the inclusion of kidney parenchymal thickness to UTD classification might increase the accuracy for predicting infants who may develop kidney injury. A higher resolution version of the Graphical abstract is available as Supplementary information.

Made available in DSpace on 2022-04-28T19:42:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-10-01 The Tocantins-Araguaia Basin is one of the largest river systems in South America, located entirely within Brazilian territory. In the last decades, capital-concentrating activities such as agribusiness, mining, and hydropower promoted extensive changes in land cover, hydrology, and environmental conditions. These changes are jeopardizing the basin’s biodiversity and ecosystem services. Threats are escalating as poor environmental policies continue to be formulated, such as environmentally unsustainable hydropower plants, large-scale agriculture for commodity production, and aquaculture with non-native fish. If the current model persists, it will deepen the environmental crisis in the basin, compromising broad conservation goals and social development in the long term. Better policies will require thought and planning to minimize growing threats and ensure the basin’s sustainability for future generations. Núcleo de Estudos Ambientais Universidade Federal do Tocantins (UFT) Programa de Pós Graduação em Ecologia de Ambientes Aquaticos Continentais (PEA) Universidade Estadual de Maringá (UEM) Museu Paraense Emílio Goeldi Grupo de Estudos em Leishmanioses Instituto René Rachou Fundação Oswaldo Cruz (FIOCRUZ) Universidade Estadual Paulista “Júlio de Mesquita Filho” Museu de Zoologia e Taxidermia José Hidasi Universidade Estadual do Tocantins (Unitins) Departamento de Ecologia Universidade Federal de Goiás (UFG) Laboratório de Ictiologia Departamento de Biologia Universidade Federal de Sergipe (UFS) Laboratório de Paleontologia e Evolução Curso de Geologia Universidade Federal de Goiás (UFG) Departamento de Ecologia Universidade Federal do Rio de Janeiro (UFRJ) Universidade Federal de Goiás (UFG) Laboratório de Biogeografia e Ecologia Aquática Universidade Estadual de Goiás Department of Fish and Wildlife Conservation Virginia Polytechnic Institute and State University Herbário do Tocantins Núcleo de Estudos Ambientais Universidade Federal do Tocantins (UFT) Laboratório de Ictiologia Sistemática Núcleo de Estudos Ambientais Universidade Federal do Tocantins (UFT) Departamento de Zoologia Universidade de Brasília Researcher Departamento de Ecologia Universidade de Brasília (UnB) Instituto Nacional de Pesquisas da Amazônia (INPA) Laboratório de Ecologia de Peixes e Invasões Biológicas Universidade Estadual de Londrina (UEL) Laboratório de Entomologia Universidade Federal do Tocantins (UFT) Universidade Federal de Pelotas (UFPel) Environmental Sciences Program-CIAMB Universidade Federal de Goiás (UFG) Universidade Federal de Mato Grosso (UFMT) Campus Universitário do Araguaia Laboratório de Microbiologia Universidade Federal do Tocantins (UFT) Fundação Brasileira para o Desenvolvimento Sustentável (FBDS) & Universidade Federal de Goiás (UFG) Laboratório de Ecologia e Zoologia (LABECZ) Universidade Federal do Tocantins (UFT) Laboratório de Ecologia de Peixes Departamento de Ecologia Universidade do Estado do Rio de Janeiro (UERJ) Laboratório de Análise e Síntese em Biodiversidade Departamento de Botânica Universidade Federal do Paraná (UFPR) Secretaria de Estado da Educação de Goiás-(Seduc-GO) UNISANTA PPGECOMAR Universidade Federal do Tocantins (UFT) Laboratório de Paleobiologia Universidade Federal do Tocantins (UFT) Departamento de Ecologia e Conservação Universidade Federal de Lavras (UFLA) Laboratório de Caracterização de Impactos Ambientais (LCIA) Universidade Federal do Tocantins (UFT) Embrapa Cerrado Instituto de Biodiversidade e Sustentabilidade Universidade Federal do Rio de Janeiro Programa de Pós-Graduação em Ecologia Universidade Federal do Pará (UFPA) Laboratório de Análises Geoambientais (LGA) Universidade Federal do Tocantins (UFT) Centro de Biologia Aquática Pontifícia Universidade Católica de Goiás Laboratório de Biodiversidade Universidade Evangélica de Goiás Escola de Ciências Agrárias e Biológicas Pontifícia Universidade Católica (PUC) Laboratório de Genética & Biodiversidade - ICB/UFG Núcleo de Pesquisas em Limnologia Ictiologia e Aquicultura (Nupelia) Universidade Estadual de Maringá (UEM) Departamento de Direito Universidade Federal do Tocantins (UFT) Núcleo de Estudos e Pesquisas Ambientais e Limnológicas (Nepal) Universidade de Brasília (UnB) Laboratório de Ecologia e Conservação (LEC) Universidade Federal do Paraná (UFPR) Coordenação de Biodiversidade Instituto Nacional de Pesquisas da Amazônia (INPA) Universidade Estadual Paulista “Júlio de Mesquita Filho”

BACKGROUND: Neuromuscular diseases are characterized by the compromise of respiratory muscles, thoracic ventilation, muscle strength and coughing capacity. Patients have low quality of life and increased morbidity and mortality mostly due to respiratory impairment. OBJECTIVE: To assess the benefits of adding inspiratory muscle training to neuromuscular patients’ treatment and their compliance to the approach. METHODS: We conducted a single-center prospective study with neuromuscular patients with decreased maximal inspiratory pressure. We developed an inspiratory muscle training protocol with three-month duration and once-daily training. The protocol had a progressive intensity that was individually tailored based on patients’ baseline characteristics and tolerance. We used Powerbreathe Medic Classic devices to perform the training. RESULTS: There were 21 patients who met the inclusion criteria and were enrolled in the study. Muscular dystrophy (n= 12, 57.3%) and amyotrophic lateral sclerosis (n= 4, 19%) were the most common diseases. After three months of training, patients increased their maximal inspiratory muscle pressure (p= 0.002) and peak cough flow (p= 0.011). Compliance to the protocol was 99 ± 5.5%. CONCLUSIONS: This protocol showed significant improvements on pulmonary muscles function and might be considered as an adjunct treatment to neuromuscular treatment. However, these positive results require larger further studies to validate the clinical benefits long-term.

In this manuscript the multifunctional multiferroic 0.6BiFeO3-0.4PbTiO3 (BFPT) thin films are presented as an interesting alternative for multifunctional photovoltaic applications. The compound is chemically and structurally stable at high temperatures and consequently reliable to work under difficult operating conditions, such as sunlight radiation. Nanostructured single-phased BFPT thin films were processed and their electric, dielectric, structural, and optics properties were characterized in this work. The films were used as active layers in a heterostructured photovoltaic arrangement, which proves their photovoltaic behavior. Interesting physical properties, as intrinsic photovoltage production (~ 1 mV/cm2) with excitation power (300 W) were associated to the high dielectric constant (> 220 at 1 kHz and room temperature), the existence of long-range electrical conductivity processes, and the presence of two band gap energies (at 3.95 eV and 2.51 eV) in the BFPT compound that enhance the light absorption with consequent photovoltaic generation in the visible light region.

Objectives Tuberculosis (TB) is the most common opportunistic infection and cause of mortality among people living with HIV, and it is possible that it may also influence the evolution of the HIV infection. We assessed the differences between HIV-positive and -negative people infected with TB. Methods The present study is a cross-sectional retrospective study by electronic record revision. We included patients admitted to a tertiary hospital with a diagnosis of TB between 2011 and 2016, comparing those with HIV coinfection with non-HIV patients, according to demographic and clinical characteristics. Results This study included 591 patients, of whom 32% were HIV-coinfected. HIV-TB patients were younger, with a predominance of male gender. Considering TB risk factors, there was a higher prevalence of homelessness and intravenous drug use in the HIV group. In the non-HIV group, direct contact with other patients with TB and immunosuppression were more prevalent. Relative to TB characteristics, the HIV-coinfected group presents with a higher prevalence of disseminated disease and a higher occurrence of previous TB infection. Cancer was the most frequent cause of immunosuppression in the HIV group and the number testing positive for TB via microbiological culture was lower. Assessment of microbiological resistance and in-hospital mortality showed similar numbers in both groups. Conclusions There are few papers comparing clinical course of TB between HIV-infected and non-infected patients. Our study differs from others in the literature as we focused on a country with middling incidence of TB and further characterized the differences between HIV-infected and non-infected patients which can contribute to the management of these patients.

Determining the timing of intracranial injuries in general, and abusive head trauma (AHT) in particular, is important to the care of children with traumatic brain injury. Additionally, identifying the time of the injury provides important information as to who might have, and who did not, inflict the trauma. Understanding the appearance and evolution of intracranial findings on neuroimaging has been an important factor in assessing the time of the injury. However, a number of studies in the last two decades have both suggested greater uncertainty about the reliability of this process and advanced our knowledge in this area. In this review, the authors consider the biophysical factors that contribute to the appearance and evolution of intracranial hemorrhage and, in particular, subdural hemorrhage (SDH). The traditional view of SDH is predicated largely on prior studies of intracerebral hemorrhage, although a number of variables make this comparison untenable. Moreover, more recent studies have suggested a number of factors that could alter the density (CT) or signal intensity (MRI) and produce mixed density/intensity SDH. These factors need to be considered in interpreting neuroimaging studies. A number of these recent studies evaluating serial neuroimaging in children with AHT have modified our understanding of intracranial hemorrhage and its evolution in this context. Taken together, the studies to date, having important limitations, provide only broad ranges over which to time injuries. The authors conclude that neuroimaging studies at this time are not likely, in isolation, to be able to accurately pinpoint a specific time of injury; rather, neuroimaging can only provide a range of possible times and should instead be used as a means to supplement or corroborate timing based on clinical presentation and other imaging findings.

OBJECTIVE The aims of this study were to review the National Spina Bifida Patient Registry (NSBPR) data set to study the rates of tethered spinal cord release (TCR) among patients with myelomeningocele and variability between centers, to compare TCR rates between males and females, and to study the relationships between TCR rates and other condition-specific characteristics. METHODS The NSBPR registry was queried to identify all patients with myelomeningocele. TCR rates were calculated over time using survival analyses; rates between centers and between males and females were compared. Cox proportional hazards models were constructed to identify relationships between TCR rates and sex, functional lesion level, ambulation status, treated hydrocephalus, and prior Chiari decompression. RESULTS Of 6339 patients with information about their operations, 1366 (21.5%) underwent TCR, with significant variability between centers. The majority (75.8%) underwent a single TCR. The annual TCR rate was linear between birth and 13 years (1.8%/year) but declined sharply from 14 to 21 years (0.7%/year). There was no period of time at which the TCR rate accelerated. There were no significant differences in TCR rates between males and females. TCR rate was not related to functional lesion level but was lower among nonambulators compared with community ambulators (p = 0.005) and among those with treated hydrocephalus (HR 0.30, p < 0.001), and higher among those having prior Chiari decompression (HR 1.71, p < 0.001). CONCLUSIONS These results extend the results of prior single-institution studies, demonstrate significant treatment variability between institutions, and challenge the traditional concept that tethering is related to spinal cord stretching due to spinal growth.

Abusive head trauma (AHT) is the most lethal form of child abuse; preventing AHT should be a national priority, but research into this area is woefully underfunded. Prevention programs have primarily focused on universal parent education during the neonatal period, a time when parents are a captive audience of the health care establishment whose focus is on the needs of their newborn infant, and who will soon be exposed to the frustration and anger of infant crying. Research has suggested a strong causal link between infant crying and AHT, and parents - particularly fathers and father figures - have been identified as the most common perpetrators of AHT. A number of studies have suggested that educating parents during the postnatal period about the normalcy of inconsolable infant crying and its evolution over the first several months of postnatal life improves parental knowledge about infant crying and a number of positive parenting behaviors, and decreases emergency room visits for crying. In 1998, we began a pilot program in Upstate New York near Buffalo that led to a 47% reduction in AHT incidence. Similar studies have demonstrated 35-75% reductions in incidence, which has led to enthusiasm for this approach to preventing AHT. We, as well as another group, have enacted statewide programs in Pennsylvania and North Carolina; unfortunately, these two large statewide replication trials failed to demonstrate any impact of such an intervention on AHT rates. Serial messages for parents, provided repeatedly over the period of greatest risk for AHT, might be another avenue of research.

Pediatric radiologists are frequently summoned to testify in court regarding the imaging of child abuse. This essay provides guidance on how to prepare for trial and what to expect in court. Preparation is paramount and includes meeting with the attorney and reviewing imaging studies, medical records and pertinent reports in anticipation of questioning in court. We also provide guidance to aid in testimony in court. Legal standards for testimony are discussed herein.

BACKGROUND: Cigarette smoking has a considerable health and economic burden in modern society, with increased risk of morbidity and mortality. Therefore, smoking cessation policies and medical treatments are essential. However, cessation rates are low and the abandonment of the consultation is common. The identification of characteristics that may predict adherence will help defining the best treatment strategy. This study aimed to identify predictors of follow-up loss in smoking cessation consultation. METHODS: We made a retrospective observational study, including a cohort of patients who started smoking cessation consultation (April-December 2018). Clinical data from consultations was collected and analyzed with IBM SPSS Statistics (SPSS, RRID:SCR_002865). RESULTS: A total of 175 patients was selected (41.1% female), with a mean age of 53±12 years. Eighty-five patients (48.6%) were discharged for abandonment. They had a median pack-year unit 38±36 (P=0.011), Fagerström and Richmond scores of 5±2 and 7±2, respectively. There was an association between women (P

The paper presents the development of a downscaled hardware-in-the-loop (HiL) setup for a wave energy converter heaving point absorber. HiL simulation involves the buoy motion coupled to a gearbox system that converts the buoy’s vertical movement into rotational. The dynamic movement of the heaving buoy is simulated and converted into rotation. A process is employed to determine the resultant torque based on the generator’s rotational speed. The use of an online derivative technique allows the system to implement an inertia emulation. Consequently, without modifying physical components, it is possible to change the system dimension. The demanded torque is then applied using an electric machine torque control loop. The technique is developed for real-time implementation and allows the reproduction of different wave conditions. Froude’s law is used to determine the scale down factor considering the machine limitations and the wave conditions. Experimental results validate the methodology.

The need to sense and track in real time through sustainable and multifunctional labels is exacerbated by the COVID-19 pandemic, where the simultaneous measurement of body temperature and the fast tracking of people is required. One of the big challenges is to develop effective low-cost systems that can promote healthcare provision everywhere and for that, smarter and personalized Internet of things (IoT) devices are a pathway in large exploration, toward cost reduction and sustainability. Using the concept of color-multiplexed quick response (QR) codes, customized smart labels formed by two independent layers and smart location patterns provide simultaneous tracking and multiple synchronous temperature reading with maximum sensitivity values of 8.5% K−1 in the physiological temperature range, overwhelming the state-of-the-art optical sensor for healthcare services provided electronically via the internet (eHealth) and mobile sensors (mHealth). published

Previous studies in the largest coal mining region of Brazil showed the strong influence of the coal-fired power plant in spatial distribution of As, especially in prevailing wind direction. However, it was not evaluated the risk of As on the local population. Thus, this study aims to assess the human health risk of As in a region under influence of atmospheric deposition of As from the coal-fired power plant. The human health risk assessment model was based on established by the U.S. Environmental Protection Agency (USEPA). It estimate the average daily dose (ADD), non-carcinogenic (HQ) and carcinogenic risk by in oral, dermal and inhalation exposure routes, as well as, the contribution of each via to ADD, HQ and carcinogenic risk to soil and air. Separately, both air and soil exposure pathways show HQ and HI below the risk threshold (

O sistema digestório tem como função fazer a digestão e absorção de nutrientes de modo a fornecer energia para o crescimento e renovação celular. Esse sistema é constituído pelos seguintes segmentos: boca, faringe, esôfago, estômago, intestino delgado, intestino grosso e canal anal. Os cães estão expostos a vários agentes (bactérias, vírus, parasitos e corpos estranhos) que podem acarretar diversos distúrbios gastrointestinais e provocar alterações patológicas no trato gastrointestinal. Diante disso, o objetivo deste trabalho foi identificar as principais patologias encontradas no estômago e intestino de cães por meio do exame de necropsia. Para tanto, foram avaliadas 83 fichas de necropsias preenchidas entre fevereiro de 2014 e abril de 2016, provenientes das aulas práticas de Patologia Animal da Universidade Presidente Antônio Carlos (UNIPAC), de Uberlândia-MG. Durante o estudo, apuraram-se alterações gastrointestinais em 70 casos do total analisado. Ao final do levantamento, constataram-se como alterações mais frequentes: mucosa espessada e hiperêmica, presença de hemorragia, presença de muco e erosões na mucosa.

Cardiovascular diseases represent the frst cause of death globally. Infammatory rheumatic disease (IRMD) patients, due to their lifelong infammatory status, are at increased risk of developing premature cardiovascular disease. We aimed to assess the risk for cardiovascular events (CVE) in a population-based study. We followed 10,153 adults from the EpiDoC Cohort, a large Portuguese population-based prospective study (2011–2016). IRMD patients were identifed at baseline and followed during 5 years. CVE were defned as a composite of self-reported myocardial infarction or angina pectoris, arrhythmias, valvular disease, stroke or transient ischemic attack and peripheral artery disease. Statistical analysis was performed by utilizing multivariate logistic regression and goodness-of-ft and area under ROC curve. At baseline, IRMD patients had similar age as the non-IRMD participants (mean age 55 vs 53 years-old; 72.1% female); dyslipidaemia and sedentary lifestyle were more common (40.7% vs 31.4%, p=0.033; 87.3% vs 67%, p=0.016, respectively). During an average follow-up of 2.6 years, 26 CVE were reported among IRMD patients. IRMD patients had higher odd of CVE (OR 1.64, 95% CI 1.04–2.58; p=0.03), despite comparable mortality rates (1.7% vs 0.7%, p=0.806). A stepwise approach attained that gender, age, history of hypertension, body mass index, IRMD and follow-up time are the most important predictive variables of CVE (AUC 0.80). IRMD patients, at community level, have an increased short-term risk of major CVE when compared to non-IRMD, and that highlights the potential beneft of a systematic screening and more aggressive cardiovascular risk assessment and management of these patients. info:eu-repo/semantics/publishedVersion

To evaluate the perception of parents and children and the impact of molar and incisor hypomineralization (MIH) on the oral health-related quality of life (OHRQoL). A cross-sectional study was conducted with a group of 253 children aged 6–12 years presenting MIH and their parents or guardians who initially answered an interview containing socioeconomic and demographic questions as well as the Parental–Caregiver’s Perceptions Questionnaire (P-CPQ). The children answered the Child Perceptions Questionnaire (CPQ8-10) and Child Perceptions Questionnaire (CPQ11–14) and the clinical evaluation of MIH was performed. Poisson regression with robust variance was used in the data analysis. The parent’s perception showed that the impact felt by the children regarding caries leads to a higher oral symptom impact, functional limitation, emotional well-being and total PCPQ score domains, as well. For children with severe MIH, a higher prevalence of impact was felt regarding the functional limitation and emotional well-being. For CPQ8–10, the oral symptoms domain presented the highest mean score, while CPQ11–14 showed the functional limitations domain and P-CPQ the emotional well-being domain. Considering the perception of parents or guardians, it was concluded that MIH promotes a negative impact on the OHRQoL. MIH had no significant impact on OHRQoL according to children’s perceptions.

Aim: Quality of life (QoL) is one of the most important patient-reported outcomes in chronic diseases. Using a population-based cohort, our objective was to assess health-related QoL in individuals with a previous myocardial infarction (MI). Methods: This study was conducted on a large database representative of the adult Portuguese population aged 18 years or over, living in the community. Participants were assessed through telephone interview. A standardized questionnaire was applied to every individual about self-reported chronic diseases, including previous MI. QoL was assessed with the EQ-5D-3L version of EuroQol. The prevalence of previous MI was calculated and linear regression analysis was performed. Results: The estimated prevalence of previous MI in the adult Portuguese population was 1.1%. These patients were older and more often male, had lower income and lower education levels, and were more often from urban areas. Respondents with self-reported MI assigned a lower self-perception to their health status in all domains, particularly in mobility and anxiety/depression. The mean EQ-5D-3L score in patients with MI was 0.73±0.34, significantly lower than in patients without MI (0.78±0.29). Also, the number of chronic diseases was significantly higher in patients with MI (5.0±2.2 vs. 1.7±1.8). Previous MI was not independently associated with QoL, which was related to age, gender and number of comorbidities. Conclusions: Adults with previous MI have a worse self-perceived health status and QoL. Previous MI was not an independent predictor of health-related QoL after controlling for age, gender and associated chronic diseases. Resumo: Introdução: A qualidade de vida (QOL) é um dos mais importantes resultados reportados por doentes em doenças crónicas. Utilizando uma coorte baseada na população, foi nosso objetivo avaliar a qualidade de vida relacionada com a saúde em doentes com enfarte do miocárdio (EM) prévio. Métodos: Estudo realizado numa grande base de dados representativa da população portuguesa adulta com ≥ 18 anos, a viver na comunidade. Os participantes foram avaliados por entrevista telefónica e foi aplicado um questionário estandardizado a cada indivíduo sobre doenças crónicas autotreportadas, incluindo EM no passado. A QOL foi avaliada com a ferramenta EuroQol (EQ-5D-3L). Resultados: A prevalência estimada de EM prévio foi de 1,1%. Estes doentes são mais idosos e mais homens, com menor rendimento e nível de educação e mais frequentemente de áreas urbanas. Os indivíduos com EM prévio têm pior perceção do seu estado de saúde em todos os domínios, em particular na mobilidade e ansiedade/depressão. O índice EQ-5D-3L médio foi 0,73±0,34, significativamente inferior quando comparado com doentes sem EM (0,78±0,29). O número de doenças crónicas é significativamente superior em doentes com EM (5,6±2,2 versus 1,7±1,8). O EM prévio não se associa de forma independente à QOL, estando esta relacionada com idade, género e número de comorbilidades associadas. Conclusões: Adultos com EM prévio apresentam uma pior percepção da sua saúde e QOL. O EM prévio não é preditor independente de QOL após controlo para idade, género e doenças crónicas associadas.

The general use of smartphones assigns additional relevance to QR codes as a privileged tool to the Internet of Things (IoT). Crucial for QR codes is the evolution to IoT-connected smart tags with enhanced storage capacity and secure accesses. Using the concept of super-modules (s-modules) built from adjacent spatial multiplexed modules with regular geometrical shapes, assisted by colour multiplexing, we modelled and design a single QR code with, at least, the triple storage capacity of an analogous size black/white QR code, acting as a smart-tag ensuring restrict access and trackability. The s-modules are printed using luminescent low-cost and eco-friendly inks based on organic-inorganic hybrids modified by lanthanides with multiplexed colour emission in the orthogonal RGB space. The access to the restrict information is attained only under UV irradiation and encrypted for secure transmission. The concept of active QR codes for smart trackability and IoT was materialised through the development of a free friendly-user mobile app.

In utero hematopoietic cell transplantation (IUHCT) has the potential to cure congenital hematologic disorders including sickle cell disease. However, the window of opportunity for IUHCT closes with the acquisition of T-cell immunity, beginning at approximately 14 weeks gestation, posing significant technical challenges and excluding from treatment fetuses evaluated after the first trimester. Here we report that regulatory T cells can promote alloengraftment and preserve allograft tolerance after the acquisition of T-cell immunity in a mouse model of late-gestation IUHCT. We show that allografts enriched with regulatory T cells harvested from either IUHCT-tolerant or naive mice engraft at 20 days post coitum (DPC) with equal frequency to unenriched allografts transplanted at 14 DPC. Long-term, multilineage donor cell chimerism was achieved in the absence of graft-versus-host disease or mortality. Decreased alloreactivity among recipient T cells was observed consistent with donor-specific tolerance. These findings suggest that donor graft enrichment with regulatory T cells could be used to successfully perform IUHCT later in gestation.

This paper presents the updates implemented by the Vibration Laboratory of INMETRO on the electrical calibration of charge conditioning amplifiers. We can now carry out both standard classical calibrations with fixed in-series capacitors and including an adjustable parallel capacitance to match the total capacitance of a given pair of accelerometer plus cable. The calibration system and some analysis of measurement results are presented.

The elderly population has been significantly increasing all over the world, causing an emerging need to create products that facilitate the day-to-day life of this population and that prolong their independence in a domestic environment. This article focuses on the first phase of an investigation project which aims at creating a device that stores and dispenses pills automatically with the integration of a virtual assistant. In this first phase it was intended to define the user experience and business model for the product based on the state of the art, that addresses topics such as the problems resulting from aging, ambient assisted living, and current solutions available in the market for domestic environments, such as virtual assistants and pill dispensers. As a result, it was possible to determine that the product will have three type of user experiences, namely in the domestic environment, in hospitals and nursing homes/day centers/continuous care units and these experiences allowed it to define the business model much more clearly. In conclusion, this article will allow to proceed to the next phase of the project.

Objetivos A anemia falciforme e uma doenca genetica inflamatoria cronica causada pela substituicao da hemoglobina A pela hemoglobina S. Esse quadro leva a producao de mediadores inflamatorios, como o sistema complemento, que podem estar relacionados a condicao clinica dos pacientes. Assim, fez-se necessario avaliar a concentracao das anafilotoxinas dentro dos aspectos clinicos nestes pacientes. Material e metodos Foram utilizadas amostras de plasma de pacientes com anemia falciforme: 27 em estado estacionario (EE) e 22 em crise vaso-oclusiva (CVO), alem de 53 amostras de doadores saudaveis (DS). O grupo CVO foi acompanhado no periodo de 90 dias apos a recuperacao da crise, descritos como convalescentes (CV). Realizou-se a tecnica de Cytometric Bead Array com o kit The BD™CBA Human Anaphylatoxin para a quantificacao das anafilotoxinas C3a, C4a e C5a, analisados pelo software FCAP Array v.3.0, e a concentracao dos analitos foi dada em pg/mL. A analise dos dados foi realizada no software GraphPadPrism v.5.0, com os testes Kruskal-Wallis e pos-teste de Multiplas Comparacoes de Dunn. Para analise pareada entre os individuos do grupo CVO e CV, foi empregado o teste de Wilcoxon. Para todas as analises foi considerado intervalo de confianca de 95% e valor de p significativo quando p Resultados Para os dados sociodemograficos nao foi identificada diferenca estatistica entre os grupos. Ja para as anafilotoxinas foi observada maior concentracao das C3a e C4a no grupo EE em comparacao ao grupo DS. Ja quanto ao grupo CVO, foi identificada menor concentracao dos niveis de C4a e C5a, em comparacao ao grupo EE. Na analise pareada entre os grupos CVO e CV, nao foi observada alteracao significativa. Discussao Os resultados encontrados descrevem a ativacao do sistema complemento nos pacientes falciformes, onde e possivel observar a ativacao da via classica do complemento de maneira cronica, que pode estar relacionado com o desenvolvimento de vaso-oclusoes e mudanca do estado clinico. A participacao de outros mediadores inflamatorios pode acabar contribuindo com a taxa de clivagem, e consequentemente, induzir a um perfil inflamatorio mais exacerbado. Conclusao Os dados deste estudo demostram maior grau de ativacao da via classica em pacientes sem sintomas graves, o que pode estar voltado ao agravamento da condicao clinica. Poucos estudos sao voltados para compreender a participacao do sistema complemento em doencas hemoliticas, e assim, mais pesquisas sao necessarios para avaliar outros parâmetros e descrever sua relacao com aspectos imunologicos e clinicos.

A renewable hybrid system combines energy sources for electricity generation and its use is motivated by the call for diversification and decentralization of non-polluting sources and complementarity between renewable resources. This system is more reliable and cost-effective than a system based on a single source and among different combinations of components the most commonly used is solar wind. The operation of these systems depends on factors such as design, optimization, reliability and economic performance. Thus, the main objective of this article is to present the state of the art of renewable hybrid systems worldwide, highlighting its main characteristics. Among the 14 analyzed articles, Homer software is the most used for Hybrid System scaling; for optimization the most commonly used metaheuristic is the PSO. In addition, 36.4% of the articles did not use any type of energy storage, and the remaining used batteries, fuel cells or both technologies. As application, 63.6% of the plants supplied reverse osmosis systems or residential loads; the others supplied the demand for remote rural areas or to charge electric cars.

RESUMO:O objetivo aqui proposto foi demostrar a experiência da produção e consumo de hortaliças no lar dos idosos localizado em Cruz das Almas, BA. Metodologicamente, foi desenvolvida uma pesquisa de campo, com entrevistas semiestruturadas. Anterior a este processo foi construída a horta. Os principais resultados apontaram que os alimentos produzidos além de representar acesso ao consumo de alimentos livres de agroquímicos, que proporcionou segurança alimentar e nutricional, retrataram ainda histórias de vidas dos internos, as lembranças familiares, à memória de um tempo que desenvolvia atividades no campo. E assim, com fortes referências da sua identidade, muitas das quais, pautadas em questões subjetivas e simbólicas, aproveitando sua bagagem cultural no território urbano.Palavras-chave: referências identitárias, terceira idade, produção agroecológica. ABSTRACT:The objective here was to demonstrate the experience of the production and consumption of vegetables in the home of the elderly located in Cruz das Almas, BA. Methodologically, a field research was developed, with semi-structured interviews. Prior to this process the vegetable garden was built. The main results pointed out that the food produced besides representing access to the consumption of food free of agrochemicals, which provided food and nutritional security, also portrayed histories of the inmates' lives, the familiar memories, the memory of a time that developed activities in the field. And so, with strong references of their identity, many of them, based on subjective and symbolic issues, taking advantage of their cultural baggage in the urban territory.Keywords: identity references, third age, agroecological production.

Process systems engineering (PSE) tools can be utilized to enable the optimal operation and control of intensified processes. In this work, the challenges in the control of intensified processes are summarized, including the difficulties in modelling and performing online optimization of these highly complex dynamic systems. Nevertheless, PSE progress in the areas of nonlinear programming, reduced-order modeling, development of software tools, parallel computing and artificial intelligence are enabling the implementation and optimization of large-scale intensified systems. Future opportunities for research are identified, including the simultaneous optimization of scheduling of operation and control, a promising strategy that has proven its value in regular operations, and can expand the operating windows of intensified processes.

Background Antenatal hydronephrosis (ANH) affects ∼1–5% of pregnancies. The aim of this study was to develop a clinical prediction model of renal injury in a large cohort of infants with isolated ANH. Methods This is a longitudinal cohort study of 447 infants with ANH admitted since birth between 1989 and 2015 at a tertiary care center. The primary endpoint was time until the occurrence of a composite event of renal injury, which includes proteinuria, hypertension and chronic kidney disease (CKD). A predictive model was developed using a Cox proportional hazards model and evaluated by C-statistics. Results Renal pelvic dilatation (RPD) was classified into two groups [Grades 1–2 (n = 255) versus Grades 3–4 (n = 192)]. The median follow-up time was 6.4 years (interquartile range 2.8–12.5). Thirteen patients (2.9%) developed proteinuria, 6 (1.3%) hypertension and 14 (3.1%) CKD Stage 2. All events occurred in patients with RPD Grades 3–4. After adjustment, three covariables remained as predictors of the composite event: creatinine {hazard ratio [HR] 1.27, [95% confidence interval (CI) 1.05–1.56]}, renal parenchyma thickness at birth [HR 0.78(95% CI 0.625–0.991)] and recurrent urinary tract infections [HR 4.52 (95% CI 1.49–13.6)]. The probability of renal injury at 15 years of age was estimated as 0, 15 and 24% for patients assigned to the low-risk, medium-risk and high-risk groups, respectively (P Conclusion Our findings indicate an uneventful clinical course for patients with Society for Fetal Urology (SFU) Grades 1–2 ANH. Conversely, for infants with SFU Grades 3–4 ANH, our prediction model enabled the identification of a subgroup of patients with increased risk of renal injury over time.

Background The global financial crisis and the economic and financial adjustment programme (EFAP) forced the Portuguese government to adopt austerity measures, which also included the health sector. The aim of this study was to analyse factors associated with HIV/AIDS patients’ length of stay (LOS) among Portuguese hospitals, and the potential impact of the EFAP measures on hospitalizations among HIV/AIDS patients. Methods Data used in this analysis were collected from the Portuguese database of Diagnosis Related Groups (DRG). We considered only discharges classified under MCD 24 created for patients with HIV infection. A total of 20,361 hospitalizations occurring between 2009 and 2014 in 41 public hospitals were included in the analysis. The outcome was the number of days between hospital admission and discharge dates (LOS). Hierarchical Poisson regression model with random effects was used to analyse the relation between LOS and patient, treatment and setting characteristics. To more effectively analyse the impact of the EFAP implementation on HIV/AIDS hospitalizations, yearly variables, as well as a variable measuring hospitals’ financial situation (current ratio) was included. Results For the 5% level, having HIV/AIDS as the principal diagnosis, the number of secondary diagnoses, the number of procedures, and having tuberculosis have a positive impact in HIV/AIDS LOS; while being female, urgent admission, in-hospital mortality, pneumocystis pneumonia, hepatitis C, and hospital’s current ratio contribute to the decrease of LOS. Additionally, LOS between 2010 and 2014 was significantly shorter in comparison to 2009. Differences in LOS across hospitals are significant after controlling for these variables. Conclusion Following the EFAP, a number of cost-containment measures in the health sector were implemented. Results from our analysis suggest that the implementation of these measures contributed to a significant decrease is LOS among HIV/AIDS patients in Portuguese hospitals.

Cost competitiveness is a determinantal factor in the future of nuclear power when it is compared to the trends in costs of alternative energy sources. The industry-planned burnup extension for PWRs is 75 MWd/kgU. The financial impacts of a very high burnup (VHB) core based on isotopic oxide 155GdO1.5 as burnable poison was evaluated and compared with the original core for Angra 2 NPP. A standard design methodology (SAV79 Standardauslegungsverfahren) was applied for the current Angra 2 design calculations. The results confirmed the incentives for operating fuel to high burnup: economic savings, capability for longer cycles, improved resource utilization, increased margin to storage capacity, and eventual decreased offsite shipping and storage costs. In fact, the levelized total costs for capital investments, operation and maintenance (O&M) costs, fuel fabrication, spent fuel storage and decommissioning fund indicate preliminary savings of US$ 45.2 million/year of the 155Gd isotopic fuel in comparison with the natural Gd fuel. In addition, the proposed VHB fuel for Angra 2 solved issues regarding to peaks of temperature and reactivity observed in the natural Gd fuel. Another relevant result in this study was the detections of the possibility of a very high burnup fuel (maximal burnup up to 73 MWd/kgU) without exceeding the usual 5 w/o 235U enrichment limit in the fuel fabrication process and obviously without the need to review its licensed limit. The same results are also valid for the design and licensed limits of the critical boron concentration, moderator temperature coefficient and power peaking factor.

Tympanostomy with ventilation tube insertion is the most common otologic surgery. Many surgeons recommend water precautions, although its utility is questioned. We aimed to investigate if water precautions reduce the rate of otorrhea after transtympanic tube insertion.Multicenter randomized controlled trial.A total of 244 children aged 2 to 10 years undergoing their first set of Shepard tubes for otitis media with effusion and concomitant adenoidectomy were randomized to 2 groups: 1 with ear protection during water exposure (ear plugs and headbands, n = 130) and 1 without (n = 114). Bathing or swimming with unprotected ears was considered the exposure event and incidence of otorrhea, the primary outcome. Outcomes were assessed during the 6-month follow-up period.In the water precaution group, 32% had at least 1 episode of otorrhea as compared with 22% in the unprotected group, which was not statistically significant (The incidence of otorrhea was not different with or without prescription of ear protection during water exposure among children with tympanostomy tubes, which supports current guideline recommendations that routine water precautions are unnecessary in this population.

IntroductionChildren and adolescents with Covid-19 have been shown lower mortality less intense symptoms when compared to adults, but studies in Brazil have been based on the compulsory notifying system only.ObjectiveTo analyse clinical, laboratory, radiological characteristics and outcomes of hospitalized patients under 20 years with Covid-19.MethodsCases series of hospitalized patients with confirmed Covid-19 under 20 years, obtained from a cohort study in 37 hospitals from five states of Brazil.ResultsFrom 36 patients, 20 (55.5%) were adolescentes, 20 (55.5%) were male, 18 (50.0%) had comorbidities, 2 were pregnant and in 7 (19.4%), initial symptoms occurred during hospitalization for other causes, of whom 3 were possibly infected in the hospital. Fever (61.1%), dyspnea (33.3%) and neurological symptoms (33.0%) were the most common complaints. C-reactive protein was higher than 50mg/L in 16.7% and D-dimer was above the reference limit in 22.2%. Chest X-rays were performed in 20 (55.5%) patients, 9 had abnormalities, and chest tomography in 5. Hospital length of stay ranged from 1-40 days (median 5 [interquartile range 3-10]), 16 (44.4%) needed intensive therapy, 6 (16.7%) required mechanical ventilation and one patient (2.8%) died.ConclusionIn case series patients under 20 years from hospitals from 5 states of Brazil, comorbidities were frequent, and most common symptoms were fever, dyspnea and neurological symptoms. Forty-four percent required intensive therapy, showing that the disease was not as mild as it was expected, and one patient died.

The implementation of digital assistants in healthcare is not a new concept and has been in development since the first appearance of digital assistant technologies. The need to use these intelligent systems, is increasing due to population growth and the consequent overload of health systems. Nowadays the use of digital assistants in healthcare is becoming common and advantageous and its implementation in the healthcare field can potentially improve the efficiency of health systems and work as it means to provide quality medical care to everyone. This paper does a scoping review about the current state of implementation and development of digital assistants for healthcare and assess which health fields are more in need of these intelligent systems. Some medical fields still lack the implementation of digital assistants, such as treatment and rehabilitation, also some applications still need improvement and could benefit from the integration of new technologies such as deep learning and voice recognition.

Non-adherence to the medication has been a serious health issue, leading to lower therapy results and possibly even death. One of the largest non-adherence causes is a complex drug regimen. To ease this issue, the researchers evaluated the use of a calendar blister pack, individually prepared for each patient. Pharmacies have been offering services of individually prepared medication with successful results and significant acceptability from the patients. Nowadays, numerous solutions on the market, namely pill organizers and dispensers, aim to remind patients about the medication and help them to manage medication stock. This document aims to be a steppingstone for those who want to improve and further develop medication organizing and dispensing devices.

The aim of this study was to evaluate the performance of the new classification of urinary tract dilatation (UTD) to predict long-term clinical outcomes in infants with isolated antenatal hydronephrosis (ANH).Between 1989 and 2019, 447 infants diagnosed with isolated severe ANH and were prospectively followed. The main predictive variable for the analysis was the new UTD classification system. The events of interest were surgical interventions, urinary tract infections, chronic kidney disease stage II or higher, hypertension and proteinuria. The primary end-point was time until the occurrence of a composite event of renal injury, including proteinuria, hypertension and chronic kidney disease.Among 447 infants with ANH included in the analysis, 255 (57%) had UTD P1, 93 (20.8%) UTD P2 and 99 (22.2%) UTD P3. Median followup time was 9 years (IQR 7-12 years). Of 447 patients included in the analysis, 11 (2.5%) had hypertension, 13 (2.9%) exhibited persistent mild proteinuria, 14 (3%) developed chronic kidney disease Stage 2 and 26 (5.8%) had the composite outcome of renal injury. By survival analysis, the UTD system predicted accurately all events of interest. According to the Kaplan-Meier survival analysis, the probability of renal injury at 20 years of age was estimated at about 0%, 14% and 56% for patients assigned to UTD P1, UTD P2 and UTD P3, respectively (p0.001).Our findings provide insights that the new UTD classification has a good performance for discriminating not only mid-term, but also long-term clinical outcomes, including renal injury.

In this work, we presented an experimental evaluation of the performance of Virtual Generalizing Random Access Memory Weightless Neural Networks (VG-RAM WNN Aleksander (1998)) on face recognition. We presented two VG-RAM WNN face recognition architectures, one holistic and the other feature-based, and examined its performance with two well known face database: the AR Face Database and the Extended Yale Face Database B. The AR Face Database is challenging for face recognition systems because it has images with different facial expressions, occlusions, and varying illumination conditions. The best performing architecture (feature-based) showed robustness in all image conditions and better performance than many other techniques from literature, even when trained with a single sample per person. In future works, we will examine the performance of VG-RAM WNN with other databases and use it to tackle other problems associated with face recognition systems, such as face detection, face alignment, face recognition in video, etc.

Façades, as the most external building envelope component, are subject to different ex-ternal environmental loads, such as: Temperature, precipitation, damp, and wind. Therefore, the contribution of environmental actions to the occurrence of defects in façades claddings is an important subject of study since these actions strongly affect the degradation process and natural ageing of these components during their service life. In this study, a methodology to support decision-makers in the process of selecting a façade cladding system and the maintenance strategy to implement is presented and discussed. This methodology covers the performance of four façade claddings (ceramic tiling systems (CTS), natural stone claddings (NSC), external thermal insulation composite systems (ETICS), and architectural concrete façades (ACF)) over time, according to three environmental exposure variables (exposure to damp, distance from the sea, and orientation). The databases were established based on the diagnosis of the degradation condition of these claddings in-service conditions, in Portugal. The results reveal that the environmental exposure variables have a significant impact on maintenance requirements and costs. For all the categories of the environmental exposure condition variables, under all scenarios, ETICS is the least favorable constructive solution while CTS is the most advantageous solution. Furthermore, the results show that properly implemented maintenance activities enhance the performance level of building components, which positively affects their degradation behavior over time.

Aims: Chronic heart failure (HF) is a major comorbidity accounting for an increased severity and mortality related to coronavirus disease 2019 (COVID-19). To reduce the risk of COVID-19 in HF patients, telemedicine has been encouraged. Methods and results: During the COVID-19 pandemic, telemedical management with mainly over-the-phone appointments became a major strategy of follow-up of our HF clinic patients. Previously, the large majority of patients have been seen in the hospital with direct patient-provider contact. We compared both strategies of follow-up, in pre-pandemic (PPP) and pandemic (PP) periods, regarding total mortality and hospitalizations/emergency department (ED) visits due to HF exacerbation. We prospectively studied a cohort of 196 patients. The mean follow-up time in PPP was 1.4 years. In this period, 20 patients died. In PP (follow-up of 71 days), there was one additional death. Total mortality in the first year of follow-up was 12.0%, matching the mortality predicted by the Meta-Analysis Global Group in Chronic Heart Failure score. Considering hospitalizations/ED visits due to decompensated HF, there was no statistically significant difference between PPP and PP. Only one patient was diagnosed with COVID-19. Conclusions: In the light of an increase in telemedical management of this cohort of HF patients, we were able to maintain a low rate of admissions due to HF decompensation, without an increment in mortality. Regarding these results, we encourage the incremental use of telemedicine in HF patients in the context of this or future pandemics and also in situations in which physical consultation might not be possible due to logistic issues. publishersversion published

To estimate the impact of the PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule (CDR) on abuse evaluations and missed abusive head trauma in pediatric intensive care settings.This was a cluster randomized trial. Participants included 8 pediatric intensive care units (PICUs) in US academic medical centers; PICU and child abuse physicians; and consecutive patients with acute head injures3 years (n = 183 and n = 237, intervention vs control). PICUs were stratified by patient volumes, pair-matched, and randomized equally to intervention or control conditions. Randomization was concealed from the biostatistician. Physician-directed, cluster-level interventions included initial and booster training, access to an abusive head trauma probability calculator, and information sessions. Outcomes included "higher risk" patients evaluated thoroughly for abuse (with skeletal survey and retinal examination), potential cases of missed abusive head trauma (patients lacking either evaluation), and estimates of missed abusive head trauma (among potential cases). Group comparisons were performed using generalized linear mixed-effects models.Intervention physicians evaluated a greater proportion of higher risk patients thoroughly (81% vs 73%, P = .11) and had fewer potential cases of missed abusive head trauma (21% vs 32%, P = .05), although estimated cases of missed abusive head trauma did not differ (7% vs 13%, P = .22). From baseline (in previous studies) to trial, the change in higher risk patients evaluated thoroughly (67%→81% vs 78%→73%, P = .01), and potential cases of missed abusive head trauma (40%→21% vs 29%→32%, P = .003), diverged significantly. We did not identify a significant divergence in the number of estimated cases of missed abusive head trauma (15%→7% vs 11%→13%, P = .22).PediBIRN-4 CDR application facilitated changes in abuse evaluations that reduced potential cases of missed abusive head trauma in PICU settings.ClinicalTrials.gov: NCT03162354.

This work presents the specification of a testing tool according to interaction design standards and heuristics of Digital TV reception platforms, such as terrestrial and / or satellite TV receivers, integrated or not with IP networks (such as, for example, the standard 10-foot-UI). The proposed solution has two main modules. The first is represented by a Web application used for the management of users and resources (devices, metrics, tests and reports), where it is possible to use 19 categories of evaluation metrics that can be managed (edited or expanded) associated for an evaluation (test) of a given product or family of products registered in this module. The second is a mobile application that uses a navigation strategy with wizards, allowing it to conduct the tester in each of the stages of the execution of a product evaluation, as well as the generation and analysis of reports.

We present a new method to obtain the first-order temporal correlation function, $g^{(1)} (\tau)$, of the light scattered by an assembly of point-like quantum scatterers, or equivalently its spectral power distribution. This new method is based on the mirror-assisted backscattering interferometric setup. The contrast of its angular fringes was already linked in the past to the convolution of $g^{(1)} (\tau)$ for different Rabi frequencies taking into account the incoming spatial intensity profile of the probe beam, but we show here that by simply adding a half waveplate to the interferometer in a specific configuration, the fringe contrast becomes $g^{(1)} (\tau)$ of the light scattered by atoms, which are now all subjected to the same laser intensity. This new method has direct application to obtain the saturated spectrum of quantum systems. We discuss some non-trivial aspects of this interferometric setup, and propose an analogy with a double Mach-Zehnder interferometer.

In this article, we measure the collimation of an atomic beam of strontium that emerges from an array of microtubes installed at the output of an atomic oven, through the characterization of the beam fluorescence caused by a monochromatic laser beam close to resonance with a strontium electronic transition, as a function of the transverse position at the atomic beam and the light detuning. We develop a theoretical model to obtain the total fluorescence rate as a function of the collimation of the atomic beam, the temperature of the atomic oven, and the laser frequency. Collision effects between the atoms, and the atoms with the recipient walls, are included to make the model realistic. The method and theory developed are useful to laboratories willing to implement such atomic sources, for experiments with atomic beams or cold atomic samples.

Pediatric care providers, pediatricians, pediatric subspecialty physicians, and other health care providers should be able to recognize children with abnormal head shapes that occur as a result of both synostotic and deformational processes. The purpose of this clinical report is to review the characteristic head shape changes, as well as secondary craniofacial characteristics, that occur in the setting of the various primary craniosynostoses and deformations. As an introduction, the physiology and genetics of skull growth as well as the pathophysiology underlying craniosynostosis are reviewed. This is followed by a description of each type of primary craniosynostosis (metopic, unicoronal, bicoronal, sagittal, lambdoid, and frontosphenoidal) and their resultant head shape changes, with an emphasis on differentiating conditions that require surgical correction from those (bathrocephaly, deformational plagiocephaly/brachycephaly, and neonatal intensive care unit-associated skill deformation, known as NICUcephaly) that do not. The report ends with a brief discussion of microcephaly as it relates to craniosynostosis as well as fontanelle closure. The intent is to improve pediatric care providers’ recognition and timely referral for craniosynostosis and their differentiation of synostotic from deformational and other nonoperative head shape changes.

Issue What has to be done to achieve health equity for migrants? International bodies have published many weighty declarations and recommendations to this end, but these need to be ordered and synthesised. A recurring theoretical problem is how to disentangle the health effects of socioeconomic position (SEP) and migrant status, in order to develop policies that effectively address both factors. Description of the problem As part of the Policy Framework for Analysis (PFA) for Work Package 7 of the Joint Action on Health Equity Europe (JAHEE), key policy documents between 2007 and 2018 were reviewed to form a ‘Road Map' from which a coherent synthesis was extracted. The PFA also developed a model for conceptualising the joint influence of SEP and migrant status. What is the relationship between these, and what policy approaches does it imply? Results The main recommendations of the ‘Road Map' were summarised in two categories: ‘upstream' measures (data collection and research, governance, and intersectoral action to tackle social determinants of health) and ‘downstream' ones (access to health services, responsiveness to migrants' needs, and attention for vulnerable groups). In the past, ‘upstream' measures have been unduly neglected. According to the proposed model, migrant status can have both direct effects on health and indirect ones that are mediated via SEP. Along the indirect pathways, migrants may suffer from increased exposure and/or increased vulnerability to health threats associated with low SEP. Lessons A high degree of consensus already exists about health inequities affecting migrants and the measures needed to tackle them. The urgent challenge at the moment is to put these conclusions into practice. To this end, there is little point in tackling socioeconomic inequities and those linked to migration and ethnicity as though they had nothing to do with each other. Key messages The recommendations of international bodies on migrant health from 2007-2018 can be summarized in three ‘upstream’ measures and three ‘downstream’ ones. Promoting health equity for migrants requires breaking down the silos in which work on migration and on SEP has hitherto been carried out.

Water reuse is an important practice in water resource management especially in arid and semi-arid areas. The objective was to evaluate the mineral composition and boll weight of upland cotton (cultivar BRS 335) plants under fertigation with domestic sewage effluent and phosphate fertilization. An experiment was carried out using randomized block design in a 3 × 2 factorial scheme with six repetitions. Cotton plants were fertigated with three fertigation solutions containing domestic sewage effluent (RW) and supply water (SW) in the proportions of 100% SW - T1, 50% SW + 50% RW - T2 and 100% RW - T3, and two phosphate fertilizer managements (with and without phosphate fertilization at pre-planting). Macronutrient and micronutrient concentrations in the shoots and boll weight were measured and evaluated. Fertigation utilizing reuse water is able to supply both water and part of the nutritional demand of cotton plants. Calcium, copper, iron and zinc concentrations in cotton leaves were below the optimum range for the crop. Reuse water did not meet the total requirements of Ca, Cu, Fe and Zn of cotton, so complementary mineral supplementation with these nutrients is recommended for the crop to obtain high yield.

Myelomeningoceles (MMCs) represent a localized failure of primary neurulation during the fourth week of embryonic development. There are a number of misconceptions concerning the proper identification, classification, and surgical repair of these lesions. To provide surgeons with a working knowledge of early neural embryology as it relates to MMC closure as a localized failure of primary neurulation. We review the embryology of early neural development as a means of providing neurosurgeons with a better understanding of MMC closure techniques. Early neural development predicts the anatomy of MMC and knowledge of embryology helps guide repair. Repair of MMC is enhanced by knowing early neural development.