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Objectives To assess people's level of recognition of rheumatic disease symptoms and their awareness that the rheumatologist is the main effector when it comes to these disorders. Materials and methods Survey performed in 8 towns in the Buenos Aires Province. Every town had at least one rheumatologist. Three clinical cases were presented: (1) inflammatory low back pain, (2) systemic disease, and (3) chronic polyarthritis. The population was asked whether (a) a physician should be immediately consulted, or (b) they could wait. They were asked whether they would advocate any initial treatment. They were also asked which physician should be consulted. Results Out of 150 surveys, 68% were female, the average age was 51.7 years old. Most people asserted that treatment with anti-inflammatory drugs should come first: 83% in inflammatory low back pain, 70% in systemic disease, and 70% in chronic polyarthritis (p = 0.02). The number of men that suggested waiting was higher (47% vs. 28% of women; p = 0.04). A rheumatologist was recommended by 51% for chronic polyarthritis, 15% for systemic disease, and 8% for inflammatory low back pain (p Conclusions Chronic polyarthritis was the disease people identified best as within the rheumatologist's field of expertise. Men tended to delay consultation more than women. Consultation is less likely when the level of education is lower.

Background Percutaneous transluminal angioplasty and stenting in acute stroke due to severe basilar artery stenosis or basilar artery occlusion remain a matter of debate. The higher risk of stroke recurrence in patients with vertebrobasilar stenosis compared to anterior circulation atherosclerotic disease creates high expectations concerning endovascular approaches. This study aims to review our experience with percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease. Methods Our prospective database from June 2014 until December 2020 was screened and patients with acutely symptomatic severe (>80%) basilar artery stenosis or acute basilar artery occlusion who underwent percutaneous transluminal angioplasty and stenting were analysed. Results Twenty-five patients included: 72% men (mean age 68.6 years), all with prior modified Rankin Scale Conclusions Percutaneous transluminal angioplasty and stenting showed to be a technically feasible and reasonably safe procedure in selected patients. However, good clinical outcomes may be difficult to achieve as only 43.5% of the patients remained independent at 3 months. Randomized studies are needed to confirm the efficacy and safety outcomes of percutaneous transluminal angioplasty and stenting in acute stroke caused by basilar artery steno-occlusive disease.

The field of protein data mining has been growing rapidly in the last years. To characterize proteins and determine their function from their amino acid sequences are challenging and long-standing problems, where Bioinformatics and Machine Learning have an emergent role. A myriad of machine and deep learning algorithms have been applied in these tasks with exciting results. However, tools and platforms to calculate protein features and perform both Machine Learning (ML) and Deep Learning (DL) pipelines, taking as inputs protein sequences, are still lacking and have their limitations in terms of performance, user-friendliness and restricted domains of application. Here, to address these limitations, we propose ProPythia, a generic and modular Python package that allows to easily deploy ML and DL approaches for a plethora of problems in protein sequence analysis and classification. It facilitates the implementation, comparison and validation of the major tasks in ML or DL pipelines including modules to read and alter sequences, calculate protein features, preprocess datasets, execute feature selection and dimensionality reduction, perform clustering and manifold analysis, as well as to train and optimize ML/DL models and use them to make predictions. ProPythia has an adaptable modular architecture being a versatile and easyto use tool, which will be useful to transform protein data in valuable knowledge even for people not familiarized with ML code. This platform was tested in several applications comparing with results from literature. Here, we illustrate its applicability in two cases studies: the prediction of antimicrobial peptides and the prediction of enzymes Enzyme commission (EC) numbers. Furthermore, we assess the performance of the different descriptors on four different protein classification challenges. Its source code and documentation, including an user guide and case studies are freely available at https://github.com/BioSystemsUM/propythia., This study was supported by FCT through project PTDC/CCI-BIO/28200/2017 and the strategic funding of UID/BIO/04469/2020, and also by the European Regional Development Fund under the scope of Norte2020, through the projects DeepBio (Ref. NORTE-01–0247-FEDER-039831). This work was also financially supported by Project LISBOA-01–0145-FEDER-007660 (Microbiologia Molecular, Estrutural e Celular) funded by FEDER funds through COMPETE2020 - Programa Operacional Competitividade e Internacionalização (POCI) and by national funds through FCT - Fundacao para a Ciencia e a Tecnologia., info:eu-repo/semantics/publishedVersion

Background Off-label (OL) drug use is the prescription of a drug for indications other than those authorised in its technical datasheet. The objective of this study was to identify drugs recommended in rheumatology but considered for off-label use in Argentina. Methods A list of medications for certain selected rheumatic conditions was compiled. A drug was considered recommended if it was endorsed by a) at least one Argentine or Pan-American treatment guideline or consensus, or b) two international treatment guidelines, or c) one international treatment guideline and one selected textbook. Approval of these drugs for any condition in Argentina until December 31st, 2018 was explored, and medicines were divided into those with on-label indications and those considered for OL use. Results One hundred and thirty-six medications were analysed in 13 clinical conditions. Sixty-seven OL recommendations (49%) were found, and several drugs had more than one. All the conditions included the recommendation of at least 1 OL drug except osteoporosis and rheumatoid arthritis. The frequency of OL recommendations for the following conditions was 100%: calcium pyrophosphate dihydrate crystal deposition disease, polymyalgia rheumatica, Sjogren syndrome, and systemic sclerosis. The drugs with the highest number of OL recommendations were methotrexate (in 7 conditions), and glucocorticoids and mycophenolate (in 4). There were 2 OL recommendations for rituximab and 1 for abatacept. Conclusions Almost all the rheumatic disorders analysed involved the recommendation of at least 1 OL medication, and in 4 conditions all the recommendations were OL. Most OL drugs recommended in rheumatology are neither biological nor small-molecule therapies.

Objectives Type 2 diabetes impacts greatly on quality of life. Health-care providers must focus on efforts to detect, treat, and manage clients through supportive educative approach. This study aims to measure effectiveness of nurse-led home care interventions. Materials and Methods This study among 103 diabetic subjects measured baseline blood pressure (BP), weight, and blood glucose levels. Information on compliance was obtained using a rating scale consisting of domains: dietary habits, exercise, rest, sleep, symptom management, prevention of complications, medication, and follow-up. Individualized comprehensive nursing interventions (education, testing, counselling) were provided, that were reinforced two times a week for 4 weeks, with minimum 7 home visits carried out by the researchers who are registered nurses and teaching faculty along with six interns of BSc nursing program. Post-tests were obtained at second and fourth weeks after start of intervention. Results Significant improvement in blood sugar (p 0.05). Post-hoc analysis found significant difference between pre-, post1- and post2-measures. Significant association was found between dietary habits and BMI (p Conclusion Individualized comprehensive interventions delivered at the natural environment of families by registered nurses effectively improve compliance to diabetes management.

Objective This study sought to explore the perceptions of experts about the performance of nursing homes during the COVID-19 outbreak. Method A qualitative study was developed in two stages: (1) a focus group, conducted in May 2020, with 5 experts; (2) a modified e-Delphi, implemented in September 2020 with 22 experts, both in the area of assistance in nursing homes from Northern and Center of Portugal. Results The results allowed identifying three main areas that influenced the performance of nursing homes during the COVID-19 outbreak: organization models and resources; physical and mental health of residents and; family as a support. Conclusions Older adults residing in nursing homes are particularly vulnerable to severe disease or death from COVID-19. It is emergent that nursing homes prevent physical and mental frailty in older residents and the loneliness aggravated by the pandemic circumstances. Decision-makers need to recognize that older people living in nursing homes have several health needs, which should determine the implementation of new strategies namely the increase in the number of professionals with appropriate skills.

Introduction Compensatory sweating (CS) is a common complication after thoracoscopic sympathectomy (TS) and is mainly associated with surgical technique. Our aim was to identify potential risk-factors for CS following TS for primary focal hyperhidrosis in children. Methods A retrospective, single-center review of all bilateral TS was performed between 2017 and 2019. Hyperhidrosis disease severity scale was used for pre-operative severity assessment. Post-operative evaluations were performed after three and six months. Results More than the 36-month period, 41 patients were submitted to T2–T4 TS, and 25 were females (60.9%). Median age at surgery was 15.5 years. CS was identified at the 3rd month in 17 (41%) children with most in the dorsolumbar region (56%). By the 6th month, there was a significant reduction in CS (41 to 32%, p = 0.02). The probability of resolution of CS by 6 months is about 50% in both the dorsolumbar and abdominal regions. Neither age, gender, body mass index, family history, or concomitant illnesses seemed to influence CS (p > 0.05). Axillary hyperhidrosis appears to be associated with the development of dorsolumbar CS (p = 0.037). Conclusion Thoracoscopic sympathectomy for PFH is a safe and effective procedure, but compensatory sweating can be a common and debilitating side effect. Age, gender, and body mass index do not appear to influence CS. Axillary hyperhidrosis may be related to the development of dorsolumbar CS. Level of evidence III.

A 71-year-old woman was referred to the endocrinology clinic to investigate postmenopausal hirsutism with 10 years of evolution. She had history of regular menses and menopause with 50 years old. Physical examination showed a male pattern facies, deepening of the voice, androgenic alopecia and hirsutism with a score of 23 according to the modified Ferriman-Gallwey scale. Testosterone and androstenedione were increased. Transvaginal ultrasound, abdominal and pelvic CT showed uterine fibroids with no pathological findings in the adrenals or ovaries. Since she had postmenopausal vaginal bleeding, uterine fibroids and suspicion of an ovarian source for her hyperandrogenism, total hysterectomy and bilateral oophorectomy were performed. Histopathological diagnosis was a Leydig cell tumour located in left ovary and endometrial carcinoma. Improvement of hirsutism was started to notice 1 month after the surgery and she was referred to the oncology clinic for adjuvant treatment.

Chagas disease is the neglected tropical disease of greatest public health impact in the United States, where it affects over 300,000 people. Diverse barriers limit healthcare access for affected people; fewer than 1% have obtained testing or treatment. We interviewed 50 people with Chagas disease in Los Angeles, California, and administered a cultural consensus analysis questionnaire. Participants were asked about their experiences and perceptions of Chagas disease, access to healthcare, and strategies for coping with the disease. In participants' narratives, the physical and emotional impacts of the disease were closely interwoven. Participant explanatory models highlight difficulties in accessing care, despite a desire for biomedical treatment. Obtaining testing and treatment for Chagas disease poses substantial challenges for US patients.

We explored gender diverse youth’s experiences seeking and receiving gender-affirming care in various health system locations. Results provide evidence for system-, clinic-, and provider-level improvements to promote the development of affirming environments and to improve health outcomes for gender diverse youth.

Islands have the potential to be precursors in the transition to clean energy, by adopting new technologies and applying innovative solutions that can serve as showcases at an international level. This paper is a contribution towards understating the importance of community engagement on energy transition processes. It covers multiple aspects of a green transition process, including technical, environmental, social, and economic issues. Starting by a participatory diagnosis process, the community of a small island located in Portugal (Culatra Island, Algarve), was challenged to lead the transition process and define different pillars of energy transition. The process brought together local authorities, academia, citizens and companies. Using practical examples, it is shown how the community is succeeding in tailoring new technological solutions for a green transition, according with the specific needs of the island, as expressed by the islanders themselves, including batteries, electric vehicles, retrofitting of homes, or heat pumps, which, when combined, could lay the foundations for the creation of a Renewable Energy Community and leverage socioeconomic benefits. info:eu-repo/semantics/acceptedVersion

Hypertrophic cardiomyopathy (HCM) is a complex myocardial disorder with no well-established disease-modifying therapy so far. Our study aimed to investigate how autophagy, oxidative stress, inflammation, stress signalling pathways, and apoptosis are hallmark of HCM and their contribution to the cardiac dysfunction. Demembranated cardiomyocytes from patients with HCM display increased titin-based stiffness (Fpassive), which was corrected upon antioxidant treatment. Titin as a main determinant of Fpassive was S-glutathionylated and highly ubiquitinated in HCM patients. This was associated with a shift in the balance of reduced and oxidized forms of glutathione (GSH and GSSG, respectively). Both heat shock proteins (HSP27 and α-s crystalline) were upregulated and S-glutathionylated in HCM. Administration of HSPs in vitro significantly reduced HCM cardiomyocyte stiffness. High levels of the phosphorylated monomeric superoxide anion-generating endothelial nitric oxide synthase (eNOS), decreased nitric oxide (NO) bioavailability, decreased soluble guanylyl cyclase (sGC) activity, and high levels of 3-nitrotyrosine were observed in HCM. Many regulators of signal transduction pathways that are involved in autophagy, apoptosis, cardiac contractility, and growth including the mitogen-activated protein kinase (MAPK), protein kinase B (AKT), glycogen synthase kinase 3s (GSK-3s), mammalian target of rapamycin (mTOR), forkhead box O transcription factor (FOXO), c-Jun N-terminal protein kinase (JNK), and extracellular-signal-regulated kinase (ERK1/2) were modified in HCM. The apoptotic factors cathepsin, procaspase 3, procaspase 9 and caspase 12, but not caspase 9, were elevated in HCM hearts and associated with increased proinflammatory cytokines (Interleukin 6 (IL-6), interleukin 18 (IL-18), intercellular cell adhesion molecule-1 (ICAM1), vascular cell adhesion molecule-1 (VCAM1), the Toll-like receptors 2 (TLR2) and the Toll-like receptors 4 (TLR4)) and oxidative stress (3-nitrotyrosine and hydrogen peroxide (H2O2)). Here we reveal stress signalling and impaired PQS as potential mechanisms underlying the HCM phenotype. Our data suggest that reducing oxidative stress can be a viable therapeutic approach to attenuating the severity of cardiac dysfunction in heart failure and potentially in HCM and prevent its progression.

Background: Barth syndrome (BTHS) is caused by mutations of the gene encoding tafazzin, which catalyzes maturation of mitochondrial cardiolipin and often manifests with systolic dysfunction during early infancy. Beyond the first months of life, BTHS cardiomyopathy typically transitions to a phenotype of diastolic dysfunction with preserved ejection fraction, blunted contractile reserve during exercise, and arrhythmic vulnerability. Previous studies traced BTHS cardiomyopathy to mitochondrial formation of reactive oxygen species (ROS). Because mitochondrial function and ROS formation are regulated by excitation-contraction coupling, integrated analysis of mechano-energetic coupling is required to delineate the pathomechanisms of BTHS cardiomyopathy. Methods: We analyzed cardiac function and structure in a mouse model with global knockdown of tafazzin ( Taz -KD) compared with wild-type littermates. Respiratory chain assembly and function, ROS emission, and Ca 2+ uptake were determined in isolated mitochondria. Excitation-contraction coupling was integrated with mitochondrial redox state, ROS, and Ca 2+ uptake in isolated, unloaded or preloaded cardiac myocytes, and cardiac hemodynamics analyzed in vivo. Results: Taz -KD mice develop heart failure with preserved ejection fraction (>50%) and age-dependent progression of diastolic dysfunction in the absence of fibrosis. Increased myofilament Ca 2+ affinity and slowed cross-bridge cycling caused diastolic dysfunction, in part, compensated by accelerated diastolic Ca 2+ decay through preactivated sarcoplasmic reticulum Ca 2 + -ATPase. Taz deficiency provoked heart-specific loss of mitochondrial Ca 2+ uniporter protein that prevented Ca 2+ -induced activation of the Krebs cycle during β-adrenergic stimulation, oxidizing pyridine nucleotides and triggering arrhythmias in cardiac myocytes. In vivo, Taz -KD mice displayed prolonged QRS duration as a substrate for arrhythmias, and a lack of inotropic response to β-adrenergic stimulation. Cellular arrhythmias and QRS prolongation, but not the defective inotropic reserve, were restored by inhibiting Ca 2+ export through the mitochondrial Na + /Ca 2+ exchanger. All alterations occurred in the absence of excess mitochondrial ROS in vitro or in vivo. Conclusions: Downregulation of mitochondrial Ca 2+ uniporter, increased myofilament Ca 2+ affinity, and preactivated sarcoplasmic reticulum Ca 2+ -ATPase provoke mechano-energetic uncoupling that explains diastolic dysfunction and the lack of inotropic reserve in BTHS cardiomyopathy. Furthermore, defective mitochondrial Ca 2+ uptake provides a trigger and a substrate for ventricular arrhythmias. These insights can guide the ongoing search for a cure of this orphaned disease.

Background The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P Interpretation This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men.

The severity of the substance addiction consequences (SAC) is often the reason for seeking help and joining medication-based programs. However, little has been explored about the nature and extent of the consequences, the outcomes of these programs and of nursing consultations. This cross-sectional study with a nursing-assisted sample, enrolled on a methadone or an alcohol aversion therapy program, aims to find out the most severe indicators of SAC and identify factors to effective self-management of this consequences. The most severe indicators were “anxiety,” “maintaining employment,” “sadness,” “problems with self- supporting,” and “problems with family relationships.” Patients most likely to have severe SAC are those with Hepatitis B (HBs), with mood disorders, and those who consume cannabis. The factors that can contribute to a more effective SAC self-management are to stop consumption, enrolling in and complying with the therapeutic project related to addiction and comorbidities.

The significance of plasma ascorbic acid (AA) is underscored by its enzymatic and antioxidant properties as well as involvement in many aspects of health including the synthesis of biomolecules during acute illness, trauma and chronic health conditions. Dietary intake supports maintenance of optimal levels with supplementation at higher doses more likely pursued. Transient increased intestinal paracellular permeability following high dose AA may be utilised to enhance delivery of other micronutrients across the intestinal lumen. The potential mechanism following dietary intake however needs further study but may provide an avenue to increase small intestinal nutrient co transport and absorption, including in acute and chronic illness.

Chemical sensors are measurement devices that convert a chemical or physical property of a specific analyte into a measurable signal, whose magnitude is normally proportional to the concentration of the analyte [...]

Background Randomized controlled trials evaluating acute sciatica have not demonstrated prolonged improvements in terms of patient-reported pain and function. For chronic sciatica, however, microdiscectomy has been found to be superior at 1 year. Whether this effect persists during the second year is not known. The purpose of the present study was to report the 2-year outcomes following lumbar microdiscectomy as compared with standardized nonoperative care for the treatment of chronic sciatica resulting from a lumbar disc herniation. Methods The present study is a secondary analysis of a previously reported randomized controlled trial with extension to 2 years of follow-up. Patients with radiculopathy for 4 to 12 months resulting from an L4-L5 or L5-S1 disc herniation were randomized to microdiscectomy or 6 months of nonoperative care followed by surgery if needed. Intention-to-treat analysis was performed at 2 years for the primary outcome (the intensity of leg pain) (range of possible scores, 0 [no pain] to 10 [worst pain]) as well as for secondary outcomes (including the Oswestry Disability Index score, the intensity of back pain, and quality of life). Results One hundred and twenty-eight patients were randomized in the present study. Twenty-four (38%) of the 64 patients who had been randomized to nonoperative care crossed over to surgical treatment by 2 years following enrollment. At the 2-year time point, the follow-up rate was approximately 70%. At 2 years, the operative group had less leg pain than the nonoperative group (mean, 2.8 ± 0.4 compared with 4.2 ± 0.4; treatment effect, 1.3 [95% confidence interval, 0.3 to 2.4]). The treatment effect favored surgery for all secondary outcome measures at 6 months and 1 year and for back pain intensity and physical function at 2 years. Conclusions At 2 years, the present study showed that microdiscectomy was superior to nonoperative care for the treatment of chronic sciatica resulting from an L4-L5 or L5-S1 disc herniation. However, the difference between the groups did not surpass the minimal clinically important difference at 2 years as was reached at earlier follow-up points, likely as the result of patients crossing over from nonoperative to operative treatment. Level of evidence Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Background A recent randomized controlled trial (RCT), performed by the authors, comparing early surgical microdiscectomy with 6 months of nonoperative care for chronic lumbar radiculopathy showed that early surgery resulted in improved outcomes. However, estimates of the incremental cost-utility ratio (ICUR), which is often expressed as the cost of gaining one quality-adjusted life year (QALY), of microdiscectomy versus nonsurgical management have varied. Radiculopathy lasting more than 4 months is less likely to improve without surgical intervention and may have a more favorable ICUR than previously reported for acute radiculopathy. Question/purpose In the setting of chronic radiculopathy caused by lumbar disc herniation, defined as symptoms and/or signs of 4 to 12 months duration, is surgical management more cost-effective than 6 months of nonoperative care from the third-party payer perspective based on a willingness to pay of less than CAD 50,000/QALY? Methods A decision analysis model served as the vehicle for the cost-utility analysis. A decision tree was parameterized using data from our single-center RCT that was augmented with institutional microcost data from the Ontario Case Costing Initiative. Bottom-up case costing methodology generates more accurate cost estimates, although institutional costs are known to vary. There were no major surgical cost drivers such as implants or bone graft substitutes, and therefore, the jurisdictional variance would be minimal for tertiary care centers. QALYs derived from the EuroQoL-5D were the health outcome and were derived exclusively from the RCT data, given the paucity of studies evaluating the surgical treatment of lumbar radiculopathy lasting 4 to 12 months. Cost-effectiveness was assessed using the ICUR and a threshold of willingness to pay CAD 50,000 (USD 41,220) per QALY in the base case. Sensitivity analyses were performed to account for the uncertainties within the estimate of cost utility, using both a probabilistic sensitivity analysis and two one-way sensitivity analyses with varying crossover rates after the 6-month nonsurgical treatment had concluded. Results Early surgical treatment of patients with chronic lumbar radiculopathy (defined as symptoms of 4 to 12 months duration) was cost-effective, in that the cost of one QALY was lower than the CAD 50,000 threshold (note: the purchasing power parity conversion factor between the Canadian dollar (CAD) and the US dollar (USD) for 2019 was 1 USD = 1.213 CAD; therefore, our threshold was USD 41,220). Patients in the early surgical treatment group had higher expected costs (CAD 4118 [95% CI 3429 to 4867]) than those with nonsurgical treatment (CAD 2377 [95% CI 1622 to 3518]), but they had better expected health outcomes (1.48 QALYs [95% CI 1.39 to 1.57] versus 1.30 [95% CI 1.22 to 1.37]). The ICUR was CAD 5822 per QALY gained (95% CI 3029 to 30,461). The 2-year probabilistic sensitivity analysis demonstrated that the likelihood that early surgical treatment was cost-effective was 0.99 at the willingness-to-pay threshold, as did the one-way sensitivity analyses. Conclusion Early surgery is cost-effective compared with nonoperative care in patients who have had chronic sciatica for 4 to 12 months. Decision-makers should ensure adequate funding to allow timely access to surgical care given that it is highly likely that early surgical intervention is potentially cost-effective in single-payer systems. Future work should focus on both the clinical effectiveness of the treatment of chronic radiculopathy and the costs of these treatments from a societal perspective to account for occupational absences and lost patient productivity. Parallel cost-utility analyses are critical so that appropriate decisions about resource allocation can be made. Level of evidence Level III, economic and decision analysis.

This study aimed to assess whether the whole body metabolic active tumour volume (MTVWB), quantified on staging [18F]FDG PET/CT, could further stratify stage IV non-small cell lung cancer (NSCLC) patients. A group of 160 stage IV NSCLC patients, submitted to staging [18F]FDG PET/CT between July 2010 and May 2020, were retrospectively evaluated. MTVWB was quantified. Univariate and multivariate Cox regressions were carried out to assess correlation with overall survival (OS). C-statistic was used to test predictive power. Kaplan–Meier survival curves with Log-Rank tests were performed to compute statistical differences between strata from dichotomized variables and to calculate the estimated mean survival times (EMST). Survival rates at 1 and 5 years were calculated. MTVWB was a statistically significant predictor of OS on univariate (p

Cervical cancer remains a health concern. Effective screening programs are critical to reduce the incidence and mortality. High-risk HPV (hr-HPV) testing as primary screening tool discloses high sensitivity but suboptimal specificity. Adequate triage tests to reduce unnecessary colposcopy referrals and overdiagnosis/overtreatment are crucial. Hence, we aimed to validate a panel of DNA methylation-based markers as triage test for women hr-HPV+ in the population-based Regional Cervical Cancer Screening Program of Northern Portugal. Firstly, CADM1, MAL, FAM19A4 and hsa-miR124-2 promoter methylation levels were assessed by multiplex QMSP in a testing set of 402 FFPE tissue samples (159 normal samples and 243 cervical lesions, including 39 low-grade intraepithelial squamous lesions [LSIL], 59 high-grade intraepithelial squamous lesions [HSIL] and 145 cancerous lesions). Then, preliminary validation was performed in 125 hr-HPV+ cervical scrapes (including 59 normal samples, 30 LSIL, 34 HSIL and 2 cancerous lesions). Higher MALme , FAM19A4me and hsa-miR124-2me methylation levels were disclosed in histological HSIL or worse (HSIL+) in testing set. Individually, markers depicted over 86% specificity for HSIL+ detection. In validation set, all these genes significantly differed between histological HSIL+ and low-grade squamous intraepithelial lesions or less. In combination, these markers reached 74% specificity and 61% sensitivity for identification of histological HSIL+. We concluded that host gene methylation might constitute a useful referral triage tool of hr-HPV+ women enrolled in the Cervical Cancer Screening Program of Northern Portugal.

PURPOSE The purpose of this study was to evaluate the clinical outcome of patients with refractory neurotrophic keratopathy (NK) in stages 2 and 3 treated with topical insulin. METHODS Retrospective analysis of eyes with NK in stages 2 and 3 refractory to standard medical and/or surgical treatment which were treated with topical insulin (1 unit per mL). This treatment was applied 4 times per day and was continued until the persistent epithelial defect (PED) or ulcer resolved. The primary outcome of the study was the complete reepithelialization of the PED or persistent ulcer. "Best-corrected visual acuity" pretreatment and posttreatment, "days until complete reepithelialization" data, and anterior segment photographs were obtained. Outcome measures were compared before and after treatment in both groups using paired and independent samples t tests. RESULTS Twenty-one eyes were included in this study, and 90% achieved complete reepithelialization of the PED and/or persistent ulcer within 7 to 45 days of follow-up. The mean number of days until complete reepithelialization was significantly lower in NK stage 2 (18 ± 9 days) when compared with NK stage 3 (29 ± 11 days) (P = 0.025). The best-corrected visual acuity improved significantly in both NK stage 2 (P < 0.001) and NK stage 3 (P = 0.004). No side effects were reported during the follow-up. CONCLUSIONS Our results suggest that topical insulin drops may be an effective therapeutic in refractory NK. This therapy may prove extremely useful because of its low cost and high accessibility.

The buildings' energy consumption increasing requires solutions to improve their energy efficiency, thus reducing the electricity bill's associated costs. This paper aims to study the load profiles of a service building and its optimization to reduce the costs related to electricity consumption. The electrical load profiles are analyzed, and the electrical equipment and its consumption are characterized. Moreover, to increase energy efficiency and reduce energy costs, a renewable energy system based on photovoltaic panels is sized and integrated into the building. The analysis of the building's consumption profiles allowed the PV system's dimensioning to eliminate power peaks, enabling a reduction in the contracted power. The results demonstrate the effectiveness of the proposed solution, resulting in a reduction of the electricity bill.

A acupuntura auricular (AA) consiste em uma técnica de aplicação em acupontos específicos cujos efeitos são baseados no envio de sinais ao SNC através de estímulos em ramos nervosos do pavilhão auricular. Estudos atuais abordam a AA como alternativa não medicamentosa promissora no controle da obesidade e benéfica no tratamento de distúrbios neurológicos dolorosos e não dolorosos, tendo como base a regulação neurofisiológica simpática e parassimpática. O objetivo da atual pesquisa consiste em analisar a aplicabilidade e eficácia da AA no contexto da neurofisiologia. Realizou-se uma busca nas plataformas bibliográficas Scielo, PubMed, BVS e Science Direct entre os anos de 2016 a 2021. Foram encontrados 22 artigos e apenas 8 atenderam à necessidade da pesquisa. Quanto à obesidade, observou-se que a AA causou redução no peso corporal, inibiu a liberação de citocinas inflamatórias nos tecidos adiposos brancos, por meio da regulação da expressão dos níveis circulantes de Irisina através da estimulação do gene FNDC5. Ademais, atua na síntese de óxido nítrico e regula a expressão gênica da 5-hidroxitriptamina para o controle da dor e inflamação, juntamente com a liberação de dopamina, acetilcolina e noradrenalina. Além disso, atua nos nervos auriculotemporal; ramo auricular do nervo vago; nervo occipital menor; nervo auricular maior e nervo auriculotemporal, promovendo controle da dependência química, regulação dos sintomas da ansiedade, epilepsia e distúrbio do sono. Constatou-se que a acupuntura auricular foi efetiva no controle da obesidade, bem como na regulação da intensidade da dor e útil em uma variedade de distúrbios neurológicos. Ressalta-se a necessidade de mais estudos.

Introdução: A literacia em saúde mental é fundamental para o reconhecimento de problemas de saúde mental e intervenção precoce. A sua avaliação é importante para identificar deficits de conhecimento sobre a saúde/doença mental e ajudar na definição de programas de intervenção para a promover a literacia em saúde mental, bem como para a avaliação dessas intervenções. Objetivos: Identificar que variáveis sociodemográficas e contextuais à história de doença e comportamentos de saúde interferem na saúde mental positiva dos enfermeiros doscuidados de saúde primários;verificarseexisterelação entrealiteraciaem saúde mentaleasaúde mental positiva dos enfermeiros dos cuidados de saúde primários. Métodos: Estudo transversal, descritivo-correlacional e de natureza quantitativa numa amostra de 89 enfermeiros a exercerem funções num agrupamento de centros de saúde da região centro de portugal (ACES-Dão Lafões). O instrumento de colheita de dados incluiu um questionário com questões relativas á caracterização sociodemográfica, história de doença mental e comportamentos de saúde. A Escala de Literacia em Saúde Mental (O Conner et al., 2015) adaptada e validada para a população portuguesa por Loureiro e Carvalho (2018), Questionário de Saúde Mental Positiva traduzido e adaptado para a população portuguesa por Sequeira, Carvalho, Sampaio, Sá, Lluch-Canut e Roldán-Merino (2014) e a Escala O que é importante para uma boa saúde mental? (Chaves, Sequeira & Duarte, 2019). Resultados: Os resultados do estudo mostram um predomínio do género feminino (82,0%), com uma idade média de 45,60±8,43 anos. Pela ordenação dos valores da média os enfermeiros da amostra possuem níveis elevados de literacia em saúde mental (67,06±7.73). Os valores médios mais elevados foram encontrados nas dimensões: Reconhecimento e auto ajuda apropriada (M=71,34±10,58) e Conhecimento sobre apoio profissional disponível (M=68.41±16.74). A análise da relação entre a saúde mental positiva e a literacia em saúde mental revela que os enfermeiros com literacia crítica apresentam melhores níveis de saúde mental positiva. As variáveis Preditores da saúde mental positiva foram: O sexo masculino, idade, os anos de experiência profissional, as horas de sono e todas as dimensões da literacia em saúde mental que explicam 24,8% da variação. Conclusão: Os enfermeiros que participaram no estudo possuem níveis elevados de Literacia em Saúde Mental (Literacia Critica), com associações positivas e significativas com a saúde mental positiva. Esta investigação, mostra algumas das implicações que podem resultar de baixos níveis de literacia em saúde mental, podendo impedir o reconhecimento precoce dos sintomas e adiar a procura de ajuda. Os resultados encontrados trazem contributos importantes para a criação de programas de intervenção em literacia em saúde mental nos profissionais dos cuidados de saúde primários. Investir nesta área, junto dos enfermeiros que prestam cuidados de proximidade (CSP) aumenta a eficácia das suas intervenções de promoção da saúde mental.

Even though classical Hodgkin lymphoma is highly curable, the outcome of patients with a refractory or relapsed disease has been disappointing. Multiple lines of therapy are available for patients after their first failure, and most respond to subsequent therapies. However, there is a sizable proportion that remains relapsing/recurrent even after several lines of therapy. The overall prognosis of patients with relapsing and recurrent classical Hodgkin lymphoma (rrcHL) has been very disappointing until recently. Immune checkpoint inhibitors such as the anti-programmed death 1 (PD-1) receptor antibodies have recently been approved to treat relapsed and refractory cHL and have significantly improved the outcome of patients with rrcHL. The approved immune checkpoint inhibitors for relapsed and refractory cHL are nivolumab and pembrolizumab. In the Checkmate 205 study nivolumab demonstrated an objective response rate of 69% with an acceptable safety profile. Similarly, pembrolizumab demonstrated an overall response rate (ORR) of 69% with a complete remission rate (CRR) of 22.4% in the KEYNOTE-087 study in heavily pretreated patients with rrcHL.

This study examines the impact of monetary policy surprises on the stock price behaviour of a small developed economy, whose monetary policy is based on the exchange rate. We find that monetary policy surprises associated with all contractionary policy levers and a neutral policy lever, have a consistently significant and negative impact on stock returns. In comparison, only monetary policy surprises associated with a downward re-centering policy lever, has a significantly positive effect on stock returns. Using a recalibrated classification system, we also find that monetary policy surprises differ across sectors of the economy. Our results show how monetary policy surprises can have a significant impact on the stock market by having a disproportionate effect on sectors that face financial and liquidity constraints.

Background There are several studies comparing techniques and different materials, yet the results are not unanimous. We compared three methods of skin closure in total knee arthroplasty (TKA), including suture with single stitches and unabsorbable MonoNylon®, as well as continuous subcuticular suture with Monocryl® or barbed Stratafix® absorbable suture. Methods A prospective, randomized study was conducted with 63 patients undergoing TKA between March 2016 and December 2016. Patients were divided into three groups: traditional suture MonoNylon® (n 22), subcuticular continuous suture with Monocryl® (n 20), and another barbed with Stratafix® (n 21). The closure time, length of wire used, pain intensity, possible complications, and cosmeses were evaluated. Results Subcuticular continuous suture using Monocryl® was superior to traditional suture using MonoNylon® as less thread was used (p 0.01) and a better cosmetic effect was achieved (p Stratafix® aspects analyzed (p > 0.05). Complications were observed mostly in patients who used Stratafix®. Conclusions This study concluded that the subcuticular suture with absorbable monofilament Monocryl® proved to be advantageous compared to the others because it presented results equal to the barbed Stratafix®, however with fewer complications. Furthermore, Monocryl® was shown to be equal or superior to traditional MonoNylon® suture regarding in relation pain intensity, aesthetic result, and effective cost. Trial registration WHO ICTRP identifier RBR78dh5d. Retrospectively registered: 07/29/2020.

Objective Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overall high risk of bias, according to PROBAST. In the IPD meta-analysis, the models had summary C-statistics ranging from 0.53 to 0.65 and summary calibration slopes ranging from 0.40 to 0.88, with risk predictions that were generally too extreme compared with the observed risks. The models had little to no clinical utility, as assessed by net benefit. However, there remained uncertainty in the performance of some models due to small available sample sizes. Conclusions The three validated stillbirth prediction models showed generally poor and uncertain predictive performance in new data, with limited evidence to support their clinical application. The findings suggest methodological shortcomings in their development, including overfitting. Further research is needed to further validate these and other models, identify stronger prognostic factors and develop more robust prediction models. (c) 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

An important area in the company is the operational field that ensures business operations to improve the company's operational performance over a certain period. The purpose of this study is to propose a conceptual model for further research on the effect of superior management support and coffee introduction technology to improve company operational performance. Operational performance refers to the company's capability, which is indicated by the aspects of cost, production volume, fulfilment of demand, customer handling, process control and quality. A number of data will be required and collected in this study to test the existing hypothesis models. The data were collected using a questionnaire that was distributed directly to individual workers in the company with positive questions on a 6-point measurement scale from strongly agree to strongly disagree. Data processing will be carried out using the SEM-AMOS method. One of the results of operational performance is customer focus, which is the orientation of a series of services provided to customers to improve customer satisfaction. The mechanism for eliminating waste and creating added value for the company is process control and improvement at every stage of the process in the company. The results of this study present a conceptual model for further research with the aim of knowing the effect of superior management support, consumer focus, and process control, and coffee introduction technology on the operational performance of CCT companies in Timor-Leste.

BACKGROUND: Prognostication tools that report personalized mortality risk and survival could improve discussions about end-of-life and advance care planning. We sought to develop and validate a mortality risk model for older adults with diverse care needs in home care using self-reportable information — the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT). METHODS: Using a derivation cohort that comprised adults living in Ontario, Canada, aged 50 years and older with at least 1 Resident Assessment Instrument for Home Care (RAI-HC) record between Jan. 1, 2007, and Dec. 31, 2012, we developed a mortality risk model. The primary outcome was mortality 6 months after a RAI-HC assessment. We used proportional hazards regression with robust standard errors to account for clustering by the individual. We validated this algorithm for a second cohort of users of home care who were assessed between Jan. 1 and Dec. 31, 2013. We used Kaplan–Meier survival curves to estimate the observed risk of death at 6 months for assessment of calibration and median survival. We constructed 61 risk groups based on incremental increases in the estimated median survival of about 3 weeks among adults at high risk and 3 months among adults at lower risk. RESULTS: The derivation and validation cohorts included 435 009 and 139 388 adults, respectively. We identified a total of 122 823 deaths within 6 months of a RAI-HC assessment in the derivation cohort. The mean predicted 6-month mortality risk was 10.8% (95% confidence interval [CI] 10.7%–10.8%) and ranged from 1.54% (95% CI 1.53%–1.54%) in the lowest to 98.1% (95% CI 98.1%–98.2%) in the highest risk group. Estimated median survival spanned from 28 days (11 to 84 d at the 25th and 75th percentiles) in the highest risk group to over 8 years (1925 to 3420 d) in the lowest risk group. The algorithm had a c-statistic of 0.753 (95% CI 0.750–0.756) in our validation cohort. INTERPRETATION: The RESPECT mortality risk prediction tool that makes use of readily available information can improve the identification of palliative and end-of-life care needs in a diverse older adult population receiving home care.

Anxiety and depressive disorders are global public health concerns, and research suggests that these disorders are common in parents and can adversely influence family functioning. However, little is known about normative levels of anxiety and depressive symptoms in parents of school-age children. The present study reports on generalized anxiety and depressive symptoms in 1570 parents and guardians of a nationally representative sample of children ages five to twelve years using two widely used and validated questionnaires: the eight-item variant of the Patient Health Questionnaire depression scale (PHQ-8) and the seven-item Generalized Anxiety Disorder scale (GAD-7). Moderate to severe levels of generalized anxiety symptoms were reported in 12.7% of the total sample and moderate to severe levels of depressive symptoms were reported in 14.1% of the sample; 17.7% of the sample reported moderate to severe levels of either generalized anxiety or depressive symptoms. This percentage was higher for females, younger parents and guardians, and parents and guardians reporting lower household incomes. These data, collected online in early 2018, may be useful for researchers and clinicians studying and treating anxiety and depression in parents. Further, these data provide a baseline for researchers currently studying the impact of changes related to the novel coronavirus (COVID-19) pandemic (e.g., school closures) on the mental health of parents of school-age children., Highlights Almost 18% of parents and guardians of school-age children in the United States report moderate to severe symptoms of generalized anxiety or depression. Symptoms of generalized anxiety and depression are higher in younger parents and guardians and those reporting the lowest household incomes. Normative levels of generalized anxiety and depressive symptoms are provided for researchers, clinicians, and other health professionals studying and treating parents of school-age children.

Aim: This study aims to compare the level of serum beta-2 microglobulin (β2-M) in normal healthy individuals and patient with squamous cell carcinoma (SCC). Methodology: This study has been conducted in patients attending the Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Deralakatte, Mangalore. Sample comprises of 25 cases of clinically and histologically diagnosed oral cancer and 25 normal healthy individuals as control group. The serum was analyzed for β2-M by enzyme-linked immunosorbent assay. Results: It was observed that there was a significant increase in serum β2-M levels in oral SCC patients as compared to controls. Circulating levels in serum β2-M were also elevated significantly among different clinical stages with progressive rise from stage I to stage IV of the disease. Conclusion: The evaluation of these markers would be useful in assessing malignant change, increasing accuracy of clinical diagnosis and also in assessing the spread and invasiveness of the cancer of the oral cavity.

Biometric recognition and presentation attack detection (PAD) methods strongly rely on deep learning algorithms. Though often more accurate, these models operate as complex black boxes. Interpretability tools are now being used to delve deeper into the operation of these methods, which is why this work advocates their integration in the PAD scenario. Building upon previous work, a face PAD model based on convolutional neural networks was implemented and evaluated both through traditional PAD metrics and with interpretability tools. An evaluation on the stability of the explanations obtained from testing models with attacks known and unknown in the learning step is made. To overcome the limitations of direct comparison, a suitable representation of the explanations is constructed to quantify how much two explanations differ from each other. From the point of view of interpretability, the results obtained in intra and inter class comparisons led to the conclusion that the presence of more attacks during training has a positive effect in the generalisation and robustness of the models. This is an exploratory study that confirms the urge to establish new approaches in biometrics that incorporate interpretability tools. Moreover, there is a need for methodologies to assess and compare the quality of explanations.

A Hipertensão Arterial Sistêmica (HAS) é um grave problema de saúde pública no Brasil e no mundo. A adesão ao tratamento medicamentoso entre pacientes com HAS é muito baixa, sendo ainda menor em países em desenvolvimento. Este estudo avaliou pacientes de uma Unidade de Saúde da família (USF), na cidade de Cascavel/PR, Brasil, já diagnosticados com HAS, avaliando a adesão ao tratamento em função das características demográficas dos mesmos. Para isso, foram entrevistados 200 pacientes através de questionários sociodemográfico e de adesão medicamentosa, os pacientes foram separados em grupos e suas respostas foram comparadas através do teste qui-quadrado de Pearson. Diversas questões não apresentaram diferença entre grupos separados por sexo, entretanto, verificou-se que houve diferença significativa quanto ao esquecimento em tomar a medicação, sendo que pacientes do sexo feminino alegaram esquecer mais frequentemente a medicação do que pacientes do sexo masculino. Quanto a faixa etária, verificou-se que pacientes mais jovens tem menor adesão ao tratamento medicamentoso, independente do sexo. Além disso pode-se constatar que o acesso gratuito ao medicamento e o relacionamento profissional-paciente são fatores importantes para a adesão ao tratamento medicamentoso de HAS.

BackgroundMost dementia algorithms are unsuitable for population-level assessment and planning as they are designed for use in the clinical setting. A predictive risk algorithm to estimate 5-year dementia risk in the community setting was developed.MethodsThe Dementia Population Risk Tool (DemPoRT) was derived using Ontario respondents to the Canadian Community Health Survey (survey years 2001 to 2012). Five-year incidence of physician-diagnosed dementia was ascertained by individual linkage to administrative healthcare databases and using a validated case ascertainment definition with follow-up to March 2017. Sex-specific proportional hazards regression models considering competing risk of death were developed using self-reported risk factors including information on socio-demographic characteristics, general and chronic health conditions, health behaviours and physical function.ResultsAmong 75 460 respondents included in the combined derivation and validation cohorts, there were 8448 cases of incident dementia in 348 677 person-years of follow-up (5-year cumulative incidence, men: 0.044, 95% CI: 0.042 to 0.047; women: 0.057, 95% CI: 0.055 to 0.060). The final full models each include 90 df (65 main effects and 25 interactions) and 28 predictors (8 continuous). The DemPoRT algorithm is discriminating (C-statistic in validation data: men 0.83 (95% CI: 0.81 to 0.85); women 0.83 (95% CI: 0.81 to 0.85)) and well-calibrated in a wide range of subgroups including behavioural risk exposure categories, socio-demographic groups and by diabetes and hypertension status.ConclusionsThis algorithm will support the development and evaluation of population-level dementia prevention strategies, support decision-making for population health and can be used by individuals or their clinicians for individual risk assessment.

Objective This review aims to continuously map the nursing knowledge on skin ulcer healing in any context of care. Introduction Chronic wounds are an increasing concern for society and health care providers. Pressure ulcers and venous ulcers, among others, have devastating effects on morbidity and quality of life and require a systematic approach. The nursing process is an important method that allows a better organization and overall care quality for a systematic and continuous professional approach to nursing management of skin ulcers. The integration of this nursing knowledge in informatics systems creates an opportunity to embed decision-support models in clinical activity, promoting evidence-based practice. Inclusion criteria This scoping review will consider articles that focus on nursing data, diagnosis, interventions, and outcomes focused on the person with skin ulcers in all contexts of care. This review will include quantitative, qualitative, and mixed methods study designs as well as systematic reviews and dissertations. Methods JBI's scoping review guidance, as well as the Cochrane Collaboration's guidance on living reviews, will be followed to meet the review's objective. Screening of new literature will be performed regularly, with the review being updated according to new findings. The search strategy will map published and unpublished studies. The databases to be searched include: MEDLINE (PubMed), CINAHL (EBSCO), Scopus (Elsevier), JBI Library of Systematic Reviews, and Cochrane Central Register of Controlled Trials. Searches for unpublished studies will include OpenGrey and Repositorios Cientificos de Acesso Aberto de Portugal. Studies published in English and Portuguese since 2010 will be considered for inclusion. Registration Open Science Framework: https://osf.io/f6s4e/.

Summary: To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation (eg, human resources) as well as gains and losses (eg, cost-efficiency). Such development of more realistic clinical practice guidelines at the global level will pave the way for simpler and achievable adaptation at local levels. We also urge the development and adaptation of high-quality clinical practice guidelines at national and subnational levels in low-income and middle-income countries through co-creation with end-users, and we encourage global sharing of these experiences.

The Trier Social Stress Test (TSST) is a psychosocial stressor that effectively stimulates the stress response but is labor and time intensive. Although other psychological stressors are often used experimentally, none are known to comparably elevate stress. Two stressors that may potentially elevate stress are a singing task (ST) and unsolvable anagrams, but there are not enough data to support their effectiveness. In the current experiment, 53 undergraduate males and females (mean age = 21.9 years) were brought into the laboratory, and baseline blood pressure, heart rate, self-rated anxiety, and salivary cortisol were recorded. Then, participants were randomly assigned to one of three stress conditions: TSST (n = 24), ST (n = 14), or an unsolvable anagram task (n = 15). Stress measures were taken again after the stressor and during recovery. The TSST significantly elevated systolic blood pressure, diastolic blood pressure, heart rate, and self-rated anxiety from pre-stress levels, replicating its stress-inducing properties. However, the ST and unsolvable anagrams only elevated heart rate, indicating that these methods are not as able to stimulate physiological or psychological stress. Overall, results indicate that out of these three laboratory stressors, the TSST clearly engages the stress response over the ST or unsolvable anagrams.

Purpose The existing literature expresses a strong need to develop tools that support the manufacturing reshoring decision-making process. This paper aims to examine the suitability of analytical hierarchy process (AHP)-based tools for initial screening of manufacturing reshoring decisions. Design/methodology/approach Two AHP-based tools for the initial screening of manufacturing reshoring decisions are developed. The first tool is based on traditional AHP, while the second is based on fuzzy-AHP. Six high-level and holistic reshoring criteria based on competitive priorities were identified through a literature review. Next, a panel of experts from a Swedish manufacturing company was involved in the overall comparison of the criteria. Based on this comparison, priority weights of the criteria were obtained through a pairwise analysis. Subsequently, the priority weights were used in a weighted-sum manner to evaluate 20 reshoring scenarios. Afterwards, the outputs from the traditional AHP and fuzzy-AHP tools were compared to the opinions of the experts. Finally, a sensitivity analysis was performed to evaluate the stability of the developed decision support tools. Findings The research demonstrates that AHP-based support tools are suitable for the initial screening of manufacturing reshoring decisions. With regard to the presented set of criteria and reshoring scenarios, both traditional AHP and fuzzy-AHP are shown to be consistent with the experts' decisions. Moreover, fuzzy-AHP is shown to be marginally more reliable than traditional AHP. According to the sensitivity analysis, the order of importance of the six criteria is stable for high values of weights of cost and quality criteria. Research limitations/implications The limitation of the developed AHP-based tools is that they currently only include a limited number of high-level decision criteria. Therefore, future research should focus on adding low-level criteria to the tools using a multi-level architecture. The current research contributes to the body of literature on the manufacturing reshoring decision-making process by addressing decision-making issues in general and by demonstrating the suitability of two decision support tools applied to the manufacturing reshoring field in particular. Practical implications This research provides practitioners with two decision support tools for the initial screening of manufacturing reshoring decisions, which will help managers optimize their time and resources on the most promising reshoring alternatives. Given the complex nature of reshoring decisions, the results from the fuzzy-AHP are shown to be slightly closer to those of the experts than traditional AHP for initial screening of manufacturing relocation decisions. Originality/value This paper describes two decision support tools that can be applied for the initial screening of manufacturing reshoring decisions while considering six high-level and holistic criteria. Both support tools are applied to evaluate 20 identical manufacturing reshoring scenarios, allowing a comparison of their output. The sensitivity analysis demonstrates the relative importance of the reshoring criteria.

Los sistemas gubernamentales son, cada vez más, objeto de desconfianza por parte de los ciudadanos. Este panorama se puede explicar a través de múltiples y complejos factores: uno de ellos tiene que ver con la comunicación pública que los voceros institucionales emiten para dar a conocer los planes, las decisiones o las acciones de gobierno. Con base en esa premisa, este artículo realiza un análisis sobre la comunicación gubernamental pública bajo la perspectiva de comunicación responsable y se detiene, particularmente, en un caso de relevancia actual en México: el discurso público del presidente Andrés Manuel López Obrador y su gabinete en los primeros cien días de la gestión iniciada el 1 de diciembre de 2018. El objetivo de este trabajo es revisar, a partir de este caso, el discurso gubernamental de López Obrador y sus funcionarios, basándose en una metodología de desarrollo propio que permite fijar los rasgos básicos que establece la perspectiva de comunicación responsable y clasificar, en tal sentido, el discurso de una figura pública.

Encephalitis is characterized by inflammation of the brain. Literature describes autoimmune as one of the most common aetiology of non-infectious encephalitis. Given the similarities in clinical, imagological and laboratory findings with viral encephalitis and due to the wide variety of clinical features, the diagnosis is rather challenging and therefore physicians need an increased clinical suspicion to make the correct diagnosis. We report a case of a 35-year-old male with no past medical history that presented with two episodes of autoimmune encephalitis in a 6-month period. Despite having the typical clinical presentation and imagological findings consistent with autoimmune encephalitis, this case had negative results for antibodies, which delayed the diagnosis. It is essential to highlight the importance of considering the hypothesis of autoimmune aetiology on the differential diagnosis of all patients presenting with clinical and magnetic resonance imaging results suggestive of probable encephalitis, regardless of the negative antibodies results. This case clearly depicts the difficulties of diagnosing and treating an autoimmune encephalitis. The main goal of this case report is to increase awareness towards early diagnosis to promptly implement a specific treatment that has proven to improve the outcome and prognosis.A encefalite é caracterizada por inflamação cerebral. A literatura descreve a etiologia autoimune como uma das causas mais frequentes de encefalite não infeciosa. Dadas as semelhanças dos resultados laboratoriais e imagiológicos com a encefalite viral, e devido a uma extensa variedade de manifestações clínicas, o diagnóstico é desafiante, pelo que os médicos precisam de maior suspeita clínica realizarem um diagnóstico correto. Relatamos o caso de um indivíduo de 35 anos, do sexo masculino, sem antecedentes pessoais de relevo, que apresentou dois episódios de encefalite autoimune num período de seis meses. Não obstante uma apresentação clínica e imagiológica típica de encefalite autoimune, o doente apresentava resultados negativos para anticorpos, o que atrasou o diagnóstico. É importante considerar a hipótese de etiologia autoimune no diagnóstico diferencial de todos os pacientes que apresentem sintomas clínicos ou resultados de ressonância magnética nuclear sugestivos de provável encefalite, independentemente da presença ou ausência de anticorpos. Este caso retrata claramente as dificuldades de diagnóstico e tratamento de uma encefalite autoimune. O principal objetivo deste relato de caso é salientar a importância do diagnóstico precoce, que permite implementar rapidamente umaterapêutica específica, e demonstrou melhorar o prognóstico e suavizar as consequências da doença.