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With the increasing worldwide rate of chronic diseases, such as cancer, the development of novel techniques to improve the efficacy of therapeutic agents is highly demanded. Nanoparticles are especially well suited to encapsulate drugs and other therapeutic agents, bringing additional advantages, such as less frequent dosage requirements, reduced side effects due to specific targeting, and therefore increased patient compliance. However, with the increasing use of nanoparticles and their recent launch on the pharmaceutical market, it is important to achieve high-quality control of these advanced systems. In this review, we discuss the properties of different nanoparticles, the pharmacokinetics, the biosafety issues of concern, and conclude with novel nanotherapeutics and nanotheragnostics for cancer drug delivery.

Objective: To analyze the effects of neuromuscular electrical stimulation of the femoral quadriceps associated or not with whey protein supplementation on the electromyographic activity and body mass distribution in volunteers undergoing anterior cruciate ligament reconstruction. Methods: 24 volunteers were randomly divided into three groups: basal control, whey protein in association with neuromuscular electrical stimulation, and neuromuscular electrical stimulation alone. Results: In the postoperative evaluation, during the mini squat, the basal group showed a decrease in the electromyographic activity of the vastus medialis (p = 0.005, eyes open; p = 0.003, eyes closed), vastus lateralis (p = 0.005, eyes open; p = 0.020; eyes closed) and rectus femoris (p = 0.075, eyes open; p = 0.074, eyes closed) and of body mass distribution in the injured limb (p < 0.001, eyes open; p < 0.001, eyes closed), and in the healthy limb (p < 0.001, eyes open; p < 0.001, eyes closed). Conclusion: The early use of neuromuscular electrical stimulation of the quadriceps femoris maintained the electromyographic activity of the vastus medialis and vastus lateralis muscles and prevented asymmetries in body mass distribution 15 days after anterior cruciate ligament reconstruction. Level of Evidence I, High quality randomized trial. RESUMO Objetivo: Analisar os efeitos da estimulação elétrica neuromuscular do quadríceps femoral associado ou não à suplementação com whey protein na atividade eletromiográfica e distribuição de massa corporal em voluntários submetidos à reconstrução do ligamento cruzado anterior. Métodos: 24 voluntários foram divididos em três grupos: controle basal, whey protein associado com estimulação elétrica neuromuscular e estimulação elétrica neuromuscular isolada. Resultados: Na avaliação pós-operatória, durante o miniagachamento, o grupo controle basal demonstrou diminuição da atividade eletromiográfica do vasto medial (p = 0,005, olhos abertos; p = 0,003, olhos fechados), vasto lateral (p = 0,005, olhos abertos; p = 0,020, olhos fechados) e reto femoral (p = 0,075, olhos abertos; p = 0,074, olhos fechados) e da distribuição de massa corporal no membro operado (p < 0,001, olhos abertos; p < 0,001, olhos fechados) e membro lesionado (p < 0,001, olhos abertos; p < 0,001, olhos fechados). Conclusão: O uso precoce de estimulação elétrica neuromuscular do quadríceps femoral, independentemente do uso de whey protein, foi eficaz para manter a atividade eletromiográfica dos músculos vasto medial e vasto lateral, e prevenir assimetrias na distribuição de massa corporal 15 dias após a reconstrução do ligamento cruzado anterior. Nível de Evidência I, Ensaio randomizado de alta qualidade.

SUMMARY: Adenosine deaminase 2 deficiency (OMIM #615688) is an autosomal recessive disorder characterized by a wide clinical spectrum, including small- and medium-sized vessel vasculopathies, but data focusing on the associated neuroimaging features are still scarce in the literature. Here, we describe the clinical neuroimaging features of 12 patients with genetically proven adenosine deaminase 2 deficiency (6 males; median age at disease onset, 1.3 years; median age at genetic diagnosis, 15.5 years). Our findings expand the neuroimaging phenotype of this condition demonstrating, in addition to multiple, recurrent brain lacunar ischemic and/or hemorrhagic strokes, spinal infarcts, and intracranial aneurysms, also cerebral microbleeds and a peculiar, likely inflammatory, perivascular tissue in the basal and peripontine cisterns. Together with early clinical onset, positive family history, inflammatory flares and systemic abnormalities, these findings should raise the suspicion of adenosine deaminase 2 deficiency, thus prompting genetic evaluation and institution of tumor necrosis factor inhibitors, with a potential great impact on neurologic outcome.

Obstructive sleep apnea syndrome (OSAS) and obesity are frequently associated with hypertension (HTN), dyslipidemia (DLP), and insulin resistance (IR). In patients with obesity and OSAS scheduled for bariatric surgery (BS), guidelines recommend at least 4 weeks of preoperative continuous positive airway pressure (CPAP). Low-calorie ketogenic diets (LCKDs) promote pre-BS weight loss (WL) and improve HTN, DLP, and IR. However, it is unclear whether pre-BS LCKD with CPAP improves OSAS more than CPAP alone. We assessed the clinical advantage of pre-BS CPAP and LCKD in patients with obesity and OSAS. Seventy patients with obesity and OSAS were randomly assigned to CPAP or CPAP+LCKD groups for 4 weeks. The effect of each intervention on the apnea–hypopnea index (AHI) was the primary endpoint. WL, C-reactive protein (CRP) levels, HTN, DLP, and IR were secondary endpoints. AHI scores improved significantly in both groups (CPAP, p=0.0231; CPAP+LCKD, p=0.0272). However, combining CPAP and LCKD registered no advantage on the AHI score (p=0.863). Furthermore, body weight, CRP levels, and systolic/diastolic blood pressure were significantly reduced in the CPAP+LCKD group after 4 weeks (p=0.0052, p=0.0161, p=0.0008, and p=0.0007 vs baseline, respectively), and CPAP+LCKD had a greater impact on CRP levels than CPAP alone (p=0.0329). The CPAP+LCKD group also registered a significant reduction in serum cholesterol, LDL, and triglyceride levels (p=0.0183, p=0.0198, and p

BACKGROUND Hemorrhage is a leading cause of early mortality following trauma. A massive transfusion protocol (MTP) to guide resuscitation while bleeding is definitively controlled may improve outcomes. Prompts to initiate massive transfusion (MT) include shock index (SI) and the Assessment of Blood Consumption (ABC) score. OBJECTIVE To compare SI with the ABC score for association with transfusion requirement, need for emergency hemorrhage interventions, and early mortality. METHODS A retrospective cohort analysis of trauma MTP activations at our Level I trauma center was conducted from January 1, 2012, to December 31, 2016. The study data were obtained from the Trauma Registry and the blood bank. An SI cutoff of 1.0 was chosen for comparison with the positive ABC score. RESULTS The study cohort included 146 patients. Shock index ≥ 1 had significant association with MT requirement (p = .002) whereas a positive ABC score did not (p = .65). More patients with SI ≥ 1 required bleeding control interventions (67% surgery, 47% interventional radiology) than patients having a positive ABC score (49% surgery, 29% interventional radiology). For geriatric patients who received MT, 65% had SI ≥ 1 but only 30% had a positive ABC score. Three-hour mortality following emergency department arrival was similar (60% SI ≥ 1, 62% positive ABC score). CONCLUSION Shock index ≥ 1 outperformed a positive ABC score for association with MT requirement. Shock index is a simple tool registered nurses can independently utilize to anticipate MT.

Emerging mobility technologies are changing the transportation system landscape. This is especially evident at airports, such as the Dallas-Fort Worth International Airport (DFW). Without careful analysis, these changes could lead to inefficient and costly airport operations. This paper presents a modeling framework that integrates travel mode encoding, demand projection, and microsimulation to enable airports to develop, simulate, and evaluate curbside traffic managements policies and measure their impact. The framework is utilized to analyze several traffic scenarios and policies for DFW: a baseline scenario which represents DFW traffic pattern as observed in 2018 and projected to 2045, a transit network company (TNC) electrification policy, a TNC queuing policy, a policy that increased transit ridership, a bus-only policy which considers the use of only buses inside DFW, an autonomous vehicle (AV) policy which investigates the impact of autonomous vehicle (AV) adoption on airport operations, and an example COVID-19 scenario which models the impact of the COVID19 pandemic. The simulations’ results demonstrate that: increasing the DFW transit ridership postpones the need for airport curbside expansion the most; encouraging shared-mobility with the bus-only policy produces the most savings in curbside congestion delays; automation and electrification for all passenger vehicle trips to/from DFW generates the most saving in fuel consumption and emissions; and uncontrolled AV adoption incurs the highest increase in fuel consumption, delay, and emissions and could require immediate airport capacity extension. Without policy intervention or investment in additional infrastructure capacity, these results predict the current operations would face significant congestion on high demand days starting as early as 2028. While derived in close partnership with DFW, the methodology presented here can be generalized to any airport.

OBJECTIVE The objective of this study was to describe the clinical and neuroradiological characteristics of a cohort of preterm infants who had undergone external ventricular drain insertion as a temporary measure to treat posthemorrhagic ventricular dilatation. In addition, the authors investigated the factors predicting permanent shunt dependency. METHODS The authors retrospectively reviewed the medical records of a cohort of preterm infants who had undergone external ventricular drain insertion at Gaslini Children’s Hospital (Genoa, Italy) between March 2012 and February 2018. They also analyzed clinical characteristics and magnetic resonance imaging data, including diffusion- and susceptibility-weighted imaging studies, which were obtained before both catheter insertion and removal. RESULTS Twenty-eight infants were included in the study. The mean gestational age was 28.2 ± 2.7 weeks, and the mean birth weight was 1209 ± 476 g. A permanent ventriculoperitoneal shunt was inserted in 15/28 (53.6%) infants because of the failure of external ventricular drainage as a temporary treatment option. Compared with the shunt-free group, the shunt-dependent group had a significantly lower gestational age (29.3 ± 2.3 vs 27.2 ± 2.7 weeks, p = 0.035) and tended toward a lower birth weight (p = 0.056). None of the clinical and neuroradiological characteristics significantly differed between the shunt-free and shunt-dependent groups at the time of catheter insertion. As expected, ventricular parameters as well as the intraventricular extension of intracerebral hemorrhage, as assessed using the intraventricular hemorrhage score, were reportedly higher in the shunt-dependent group than in the shunt-free group before catheter removal. CONCLUSIONS External ventricular drainage is a reliable first-line treatment for posthemorrhagic hydrocephalus. However, predicting its efficacy as a unique treatment remains challenging. A lower gestational age is associated with a higher risk of posthemorrhagic hydrocephalus progression, suggesting that the more undeveloped the mechanisms for the clearance of blood degradation products, the greater the risk of requiring permanent cerebrospinal fluid diversion, although sophisticated MRI investigations are currently unable to corroborate this hypothesis.

Background: The city of Manaus, Brazil, has seen two collapses of the health system due to the COVID-19 pandemic. We report anti-SARS-CoV-2 nucleocapsid IgG antibody seroconversion rates and associated risk factors in Manaus residents before the second wave of the epidemic in Brazil. Methods: A convenience sample of adult (aged ≥18 years) residents of Manaus was recruited through online and university website advertising into the DETECTCoV-19 study cohort. The current analysis of seroconversion included a subgroup of DETECTCoV-19 participants who had at least two serum sample collections separated by at least 4 weeks between Aug 19 and Oct 2, 2020 (visit 1), and Oct 19 and Nov 27, 2020 (visit 2). Those who reported (or had no data on) having a COVID-19 diagnosis before visit 1, and who were positive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at visit 1 were excluded. Using an in-house ELISA, the reactivity index (RI; calculated as the optical density ratio of the sample to the negative control) for serum anti-SARS-CoV-2 nucleocapsid IgG antibodies was measured at both visits. We calculated the incidence of seroconversion (defined as RI values ≤1·5 at visit 1 and ≥1·5 at visit 2, and a ratio >2 between the visit 2 and visit 1 RI values) during the study period, as well as incidence rate ratios (IRRs) through cluster-corrected and adjusted Poisson regression models to analyse associations between seroconversion and variables related to sociodemographic characteristics, health access, comorbidities, COVID-19 exposure, protective behaviours, and symptoms. Findings: 2496 DETECTCoV-19 cohort participants returned for a follow-up visit between Oct 19 and Nov 27, 2020, of whom 204 reported having COVID-19 before the first visit and 24 had no data regarding previous disease status. 559 participants were seropositive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at baseline. Of the remaining 1709 participants who were seronegative at baseline, 71 did not meet the criteria for seroconversion and were excluded from the analyses. Among the remaining 1638 participants who were seronegative at baseline, 214 showed seroconversion at visit 2. The seroconversion incidence was 13·06% (95% CI 11·52–14·79) overall and 6·78% (5·61–8·10) for symptomatic seroconversion, over a median follow-up period of 57 days (IQR 54–61). 48·1% of seroconversion events were estimated to be asymptomatic. The sample had higher proportions of affluent and higher-educated people than those reported for the Manaus city population. In the fully adjusted and corrected model, risk factors for seroconversion before visit 2 were having a COVID-19 case in the household (IRR 1·49 [95% CI 1·21–1·83]), not wearing a mask during contact with a person with COVID-19 (1·25 [1·09–1·45]), relaxation of physical distancing (1·31 [1·05–1·64]), and having flu-like symptoms (1·79 [1·23–2·59]) or a COVID-19 diagnosis (3·57 [2·27–5·63]) between the first and second visits, whereas working remotely was associated with lower incidence (0·74 [0·56–0·97]). Interpretation: An intense infection transmission period preceded the second wave of COVID-19 in Manaus. Several modifiable behaviours increased the risk of seroconversion, including non-compliance with non-pharmaceutical interventions measures such as not wearing a mask during contact, relaxation of protective measures, and non-remote working. Increased testing in high-transmission areas is needed to provide timely information about ongoing transmission and aid appropriate implementation of transmission mitigation measures. Funding: Ministry of Education, Brazil; Fundação de Amparo à Pesquisa do Estado do Amazonas; Pan American Health Organization (PAHO)/WHO. World Health Organization Revisión por pares

Sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially born as anti-diabetic drugs, have shown many beneficial effects on the cardiovascular system, in particular against heart failure (HF). HF is a complex and multifaceted disease that requires a comprehensive approach. It should not be considered as a simplistic cardiac disease, but a systemic disease that leads to multisystemic organ failure and death. Exploiting their pleiotropic effects, SGLT2i are a very valid tool for HF treatment. Beyond the indication to reduce HF hospitalization and death risk, in patients with diabetes mellitus at high cardiovascular risk or with established cardiovascular event, SGLT2i administration reported beneficial effects regarding the wide spectrum of HF manifestations and stages, independently by diabetes mellitus presence. Recent evidence focuses on HF rehospitalization, cardiac and all-cause death reduction, as well as symptoms and quality of life improvement, in patients with chronic HF or with a recent HF decompensation episode. Given the recent finding about the SGLT2i usefulness in HF patients, further studies are needed to define the best administration timing to maximize the SGLT2i-derived beneficial effects.

This study assessed the direct impacts of Cachoeira Caldeirão Hydropower Plant (before and during its construction) on the eating habits (fish and wild meat consumption) of the residents in Porto Grande City, Amapá State, Brazil. The study was conducted in 2015, based on a questionnaire for data collection (Sample size = 53) and on comparative analysis for significance (Wilcoxon test, p < 0.05) and correlation (Pearson’s test) assessment. Results suggested significant changes in families’ eating habits. The Wilcoxon test detected three significant variables (p < 0.05): family income, number of species (fish and wild meat consumption) and rate of wild meat consumption per family. Both the Wilcoxon and the Pearson’s correlation tests confirmed two variables (p < 0.05 and r > 0.7): family income versus wild meat consumption before (p value = 0.045; r = - 0.75) and family income versus fish consumption during (p value = 0.0029; r = - 0.83) hydropower plant construction. It can be inferred that the decrease in family fish consumption may be related to changes in the families' eating habits. Changes in diet may have led families to a growing consumption of industrialized and/or ultra-processed foods, very common in geographically isolated Amazon riverside regions with limited access to electricity. Furthermore, families were forced to adapt to a new reality due to environmental changes in their territories. Resumo O presente estudo avaliou os impactos diretos da Usina Hidrelétrica Cachoeira Caldeirão (antes e durante sua construção) sobre os hábitos alimentares (consumo de peixes e carnes silvestres) de residentes na cidade de Porto Grande, Estado do Amapá, Brasil. O estudo foi realizado em 2015, com base na aplicação de questionário para coleta de dados (tamanho da amostra = 53) e na análise comparativa para significância (teste de Wilcoxon, p 0,7): renda familiar versus consumo de carne selvagem antes (valor p = 0,045; r = - 0,75) e renda familiar versus consumo de peixe durante (valor p = 0,0029; r = - 0,83) construção de usina hidrelétrica. Pode-se inferir que a queda no consumo familiar de peixe pode estar relacionada à mudança de hábito alimentar das famílias. As mudanças na dieta alimentar podem ter levado as famílias ao consumo crescente de alimentos industrializados e/ou ultraprocessados, muito comuns em regiões ribeirinhas amazônicas isoladas geograficamente e com dificuldades de acesso a energia elétrica. Além disso, as famílias foram obrigadas a se adaptar a uma nova realidade devido às mudanças ambientais em seus territórios.

PurposeThe purpose of this article is to investigate the interrelationships between innovation climate and human capital in the development of dynamic capabilities related to innovation. The study presents a set of concepts about variables involved in the innovation process and their interrelationship, addressing the analysis of international scientific production related to the antecedents of the innovation climate, human capital and dynamic capabilities.Design/methodology/approachA review of the literature from 1998 to 2018 was carried out, using descriptive statistical methods, at first, and qualitative analysis of the results in order to visualize the current configuration of the field of study of innovation background.FindingsThe results demonstrate a significant number of studies relating human capital and dynamic capabilities and little quantitative significance in studies relating to a climate of innovation and dynamic capabilities. The research describes how the dynamic capabilities of innovation have been approached in a conceptual model based on the perspective of human capital and innovation climate.Research limitations/implicationsThe study did not contemplate the analysis of the interrelationship between the resource configuration construct and the dynamic innovation capacities (part of the gap pointed out by Tuzovic, Wirtz and Heracleous (2018), constituting a perceptible limitation of the analyzes carried out in this article.Practical implicationsThe influence of the innovation climate construct and its relationship with dynamic innovation capabilities deserves greater attention in research with an empirical approach, constituting a field to be explored by scientific research in organizations.Originality/valueThe research sought to investigate the gap involving the interrelations between innovation climate and human capital in the development of dynamic capabilities related to innovation, indicating the need for further empirical studies on the subject.

Since the start of the Precision Medicine Initiative by the United States of America in 2015, interest in personalized medicine has grown extensively. In short, personalized medicine is a term that describes medical treatment that is tuned to the individual. One possible way to realize personalized medicine is 3D printing. When using materials that can be tuned upon stimulation, 4D printing is established. In recent years, many studies have been exploring a new field that combines 3D and 4D printing with therapeutics. This has resulted in many concepts of pharmaceutical devices and formulations that can be printed and, possibly, tailored to an individual. Moreover, the first 3D printed drug, Spritam®, has already found its way to the clinic. This review gives an overview of various 3D and 4D printing techniques and their applications in the pharmaceutical field as drug delivery systems and personalized medicine., info:eu-repo/semantics/publishedVersion

Clinical Practice Points • MDS can occur in patients who have a history of prior exposure to chemotherapy and/or radiotherapy for a previous lymphoma. • MDS can occur with autoimmune disorders not responsive to immunosuppressive treatments. • Cytopenias and immunosuppressive treatments can lead to infections from opportunistic agents. • Mobilizing more cells than the amount needed to be infused could save patients with haematological disease from later cytopenic conditions.

Made available in DSpace on 2022-04-29T08:31:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-09-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Objectives: The majority of available scores to assess mortality risk of coronavirus disease 2019 (COVID-19) patients in the emergency department have high risk of bias. Therefore, this cohort aimed to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients and to compare this score with other existing ones. Methods: Consecutive patients (≥ 18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March–July, 2020. The model was validated in the 1054 patients admitted during August–September, as well as in an external cohort of 474 Spanish patients. Results: Median (25–75th percentile) age of the model-derivation cohort was 60 (48–72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count, and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829–0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833–0.885]) and Spanish (0.894 [95% CI 0.870–0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). Conclusions: An easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation was designed and validated for early stratification of in-hospital mortality risk of patients with COVID-19. Department of Internal Medicine Medical School Universidade Federal de Minas Gerais Telehealth Center University Hospital Universidade Federal de Minas Gerais Institute for Health Technology Assessment IATS/ CNPq)., Rua Ramiro Barcelos, 2359. Prédio 21 | Sala 507 Department of Statistics Universidade Federal de Minas Gerais Center for Research and Graduate Studies in Business Administration Universidade Federal de Minas Gerais Universidade Federal de São João del-Rei Infectious Diseases Department Vall d'Hebron University Hospita Universitat Autònoma de Barcelona Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor Grupo Hospitalar Conceição Pontifícia Universidade Católica do Rio Grande do Sul RGS) Hospital São Lucas PUCRS Rede Mater Dei de Saúde Hospital Márcio Cunha Universidade do Sul de Santa Catarina UNISUL Dissertare Scientific Advice SOS Cardio Hospital Internal Medicine Department University Hospital Universidade Federal de Minas Gerais Faculdade de Medicina de Botucatu Universidade Estadual Paulista Júlio de Mesquita Filho Hospital das Clínicas da Faculdade de Medicina de Botucatu Universidade Federal do Rio Grande do Sul Hospital Bruno Born Research Center of Vale do Taquari. Hospital Mãe de Deus Hospital Universitário de Canoas Mucuri Medical School FAMMUC Universidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM Hospital Santa Rosalia Hospital Metropolitano Doutor Célio de Castro Hospital Moinhos de Vento Hospital Unimed BH Hospital Risoleta Tolentino Neves Post-graduation Center Medical School Universidade Federal de Minas Gerais Hospital Metropolitano Odilon Behrens Hospital Eduardo de Menezes Universidade FUMEC Hospital Julia Kubitschek Hospital Universitário de Santa Maria Departamento de Medicina Interna Universidade Federal de Santa Maria Hospital São João de Deus Hospital Regional Antônio Dias Faculdade Ciências Médicas de Minas Gerais Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Faculdade de Ciências Humanas de Curvelo Hospital João XXIII Av. Professor Alfredo Balena Hospital Santo Antônio Hospital Universitário Ciências Médicas Vall d'Hebron University Hospital PROSICS Barcelona Instituto René Rachou-FIOCRUZ Minas. Universidade Federal da Fronteira Sul Hospital Regional do Oeste Pontifícia Universidade Católica de Minas Gerais Hospital Tacchini Centro Universitário de Patos de Minas. RPatos de Minas Hospital Semper Hospital Santa Cruz Universidade de Santa Cruz Fundação Hospitalar do Estado de Minas Gerais – FHEMIG. Universidade Federal de Ouro Preto Hospital das Clínicas da Universidade Federal de Pernambuco Universidade Federal de Pernambuco Centro de Ciências Médicas Centro Universitário de Belo Horizonte UniBH) Erasmus MC University Medical Center Rotterdam Department of Cardiology Faculdade de Medicina de Botucatu Universidade Estadual Paulista Júlio de Mesquita Filho Hospital das Clínicas da Faculdade de Medicina de Botucatu

The research and application of biochars enriched with minerals have increased in recent years; however, the mineral fraction used consists of specific minerals, such as clay minerals and synthesized compounds. In this work, the effects of adding two specific soil types (sandy and clayey) to rice and coffee husks in order to generate biochars via pyrolysis was investigated. Chemical, physical?chemical, thermal, spectroscopic and crystallographic analyses were conducted on the produced biochars. The study confirmed that the presence of mineral soils during the pyrolysis process increases the yield, C retention ratio, and specific surface area. It also decreases the pH, cation exchange capacity (CEC), nutrient content, and carbon-to-nitrogen ratio of biochars. However, the biochars produced by mixing coffee husks and mineral soils still demonstrate a capacity to increase the pH and the CEC of tropical soils. In addition, increased C retention demonstrates an environmental benefit of this biochar production method. Biomass pyrolysis combined with clayey soil results in a biochar with a higher degree of aromaticity and higher thermal stability when compared to biomass pyrolysis alone. These characteristics give the biochar a recalcitrant character, without the necessity for steps related to the synthesis of specific mineral compounds, which reduces the economic and energy cost of the process. Made available in DSpace on 2020-12-18T09:05:33Z (GMT). No. of bitstreams: 1 cpafro-18490.pdf: 1522278 bytes, checksum: a37984477f7171629a3848c14c059f7a (MD5) Previous issue date: 2020

Pathogenic variants in KAT6A, encoding a histone acetyltransferase, have been identified as a cause of a developmental disorder with a definite clinical spectrum including intellectual disability, speech delay, dysmorphic facial features, microcephaly, cardiac and gastrointestinal defects. Seizures have been described in a minority of patients without a detailed characterization. In this work we focus on epilepsy in KAT6A syndrome, reporting two affected girls with history of seizures, bearing a KAT6A de novo heterozygous variant, of which one is novel. We describe the different epilepsy phenotypes of these two patients and compare them to the other individuals in literature presenting with epilepsy.

[Abstract] Aims. This study aimed to assess age‐ and sex‐related differences in management and 1‐year risk for all‐cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results. Of 16 354 patients included in the European Society of Cardiology Heart Failure Long‐Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline‐directed medical therapy (GDMT) were high (angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, beta‐blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P ≤ 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1‐year follow‐up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all‐cause mortality were lower in women than in men (7.1% vs. 8.7%; P = 0.015), as were rates of all‐cause hospitalization (21.9% vs. 27.3%; P < 0.001) and there were no differences in causes of death. All‐cause mortality and all‐cause hospitalization increased with greater age in both sexes. Sex was not an independent predictor of 1‐year all‐cause mortality (restricted to patients with LVEF ≤45%). Mortality risk was significantly lower in patients of younger age, compared to patients aged >75 years. Conclusions. There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all‐cause mortality in patients with LVEF ≤45%.

To explore the relationship between calcium and lactate in arterial cord blood of healthy term neonates in response to the stress of labor.This was a prospective cohort study of consecutive, vaginal, term births in a community medical center (April 2029 to February 2020). Calcium and lactate were measured in cord blood gas analysis immediately after delivery.In the arterial cord blood of 480 neonates, calcium levels were 1.5 (1.4; 1.5) mmol/L and lactate levels were 3.8 (2.9; 4.9) mmol/L. Calcium and lactate showed a statistically significant positive correlation (Pearson's correlation,In healthy term vaginally delivered neonates, it was found that calcium and lactate were strongly correlated, together pointing to a neonatal response to the stress of labor and delivery. Cord blood calcium regulation may have an ancillary role in defining neonatal adaptation to extrauterine life.

A pretensão desse trabalho é analisar as relações de integração de agricultores familiares agroecológicos com a empresa de comercialização Hortaliças Sempre Verde, localizada no município de Alagoa Nova-PB, especializada na comercialização de produtos hortifrutigranjeiros para redes de supermercados nos estados da Paraíba, Rio Grande do Norte e Pernambuco, mantendo parcerias com agricultores agroecológicos para o fornecimento de produtos orgânicos. Os agricultores familiares que fornecem os produtos orgânicos para a empresa, na sua grande maioria, residem no município de Alagoa Nova, situado no agreste paraibano. Contudo, um dos circuitos que tem se mostrado viável para esses agricultores é a produção agroecológica integrada à empresa, que consiste em um acordo de exclusividade produtiva, celebrado entre agricultores agroecológicos e a empresa Hortaliças Sempre Verde. Como estratégia metodológica optamos pela revisão da literatura, realização de entrevistas semiestruturadas e abertas, pela observação direta e pela análise de dados secundários acessados na base do IBGE. Verificou-se que os agricultores agroecológicos têm uma integração direta com a empresa e um retorno financeiro rápido, submetendo sua produção agroecológica a racionalidade da empresa, gerando dependência e sujeição da renda.

In animal and human neonates, expansion of the extracellular fluid volume is associated with "wet" lung and poor respiratory outcomes. To define fluid status changes during the transition from fetal to neonatal life in infants of diabetic mothers (IDM), we conducted a single-centre (Policlinico Abano Terme, Abano Terme, Italy) study of 66 IDM and a 1:2 matched control group from January 1 to September 30, 2020. Fluid status changes were assessed by computing Δ Hct from umbilical cord blood at birth and capillary heel Hct at 48 h, accounting for body weight decrease. IDM presented with significantly lower cord blood Hct levels in comparison to controls (47.33 ± 4.52 vs 50.03 ± 3.51%, p < 0.001), mainly if delivered by elective cesarean Sect. (45.01 ± 3.77 vs 48.43 ± 3.50%, p = 0.001). Hct levels at 48 h were comparable (55.18 ± 5.42 vs 54.62 ± 7.41%, p = 0.703), concurrently with similar body weight decrease (- 217.21 ± 113.34 vs - 217.51 ± 67.28 g, p = 0.614). This supports significantly higher ∆ Hct in IDM (5.13 ± 5.24 vs 7.29 ± 6.48, p < 0.01) and extra circulating fluid loss of 2-3%.Conclusion: Gestational diabetes is associated with an excess of circulating fluids during the transition from fetal to neonatal life, challenging the current assumption that is per se at risk of wet lung. What is Known: • In neonates, evidence suggests that expansion of the extracellular fluid volume prior to the postnatal diuresis is associated with poor respiratory outcomes. What is New: • Gestational diabetes is associated with an excess of circulating fluids during the transition from fetal to neonatal life, challenging the current assumption that is per se at risk of wet lung.

The microbiota of fish skin, the primary barrier against disease, is highly dynamic and modulated by several factors. In fish aquaculture, disease outbreaks occur mainly during early-life stages, with associated high economic losses. Antibiotic treatments sometimes remain the best option to control bacterial diseases, despite many reported negative impacts of its use on fish and associated microbiota. Notwithstanding, studies monitoring the effects of disease and antibiotic treatment on the microbiota of fingerlings are scarce. We sequenced the bacterial 16S rRNA V4 gene region using a metabarcoding approach to assess the impact of a mixed infection with Photobacterium damselae ssp. piscicida and Vibrio harveyi and subsequent antibiotic treatment with flumequine, on the skin microbiota of farmed seabass (Dicentrarchus labrax) fingerlings. Both infection and antibiotic treatment led to a significant increase in bacterial diversity and core microbial communities and impacted microbiome structure. Dysbiosis was confirmed by changes in the abundance of potential pathogenic and opportunistic bacterial taxa. Skin bacterial metabolic function was also significantly affected by flumequine administration, suggesting a detriment to fish skin health. Our results add to an increasing body of literature, showing how fish microbiome response to infection and antibiotics cannot be easily predicted.

It is not uncommon to see prices that end with a 9 or 99, be it in a restaurant, grocery store, or clothes store. Yet, this convention in pricing is typically found in the US, and evidence of it in...

Background: Twice city of Manaus located in the Brazilian rainforest, has experienced a health system collapse due to the SARS-CoV-2 pandemic. However, little is known about which groups among the general population have been more affected. In this report, we present the overall prevalence of SARS-CoV-2 infection and associated factors from the DETECTCoV-19 cohort. Methods: A convenience sampling strategy via online advertising recruited 3046 adults. Sociodemographic characteristics, COVID-19-related symptoms, COVID-19 testing, self-medication and prescribed medications were recorded. Serum anti-SARS-CoV-2 nucleocapsid IgG antibodies were measured with an in-house ELISA. Prevalence ratios (PR) were obtained using cluster-corrected and adjusted Poisson’s regression models. Findings: A crude positivity rate among asymptomatic and symptomatic individuals, was estimated at 29·10%, with a maximum seroprevalence of 41·53% corrected by test characteristics and an antibody decay rate of 27%. Regression models demonstrated a strong association towards marginalized low-income and vulnerable residents with limited health access. Presence of a COVID-19 case (PR 1·39, 1·24-1·57) or death (PR 2·14, 1·74-2·62) in a household increased greatly the risk of other household members acquiring infection. SARS-CoV-2 seroprevalence was higher among those who self-medicated to prevent infection (PR 1·36, 1·27-1·46). Interpretation: High SARS-CoV-2 seropositivity reveals a much burdensome scenario than estimations based on confirmed COVID-19 cases in Manaus. Overall, prevalence of SARS-CoV-2 antibody response demonstrated a disproportionate social and economic disparity among the study participants. The syndemic nature of COVID-19 in the Amazon region needs differential policies and urgent solutions to control the pandemic. Funding: Research was funded by Ministry of Education (MEC), Brazil. BBS, IVPF, ROS, ARCB and WBSS received scholarship from CAPES. DSSS, TBNM, MFF and NOC received scholarship from FAPEAM Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The research ethics committee of Federal University of Amazonas (UFAM) approved this study (CAAE:34906920·4·0000·5020) in accordance with Brazilian law

Schizophrenia (SZ) is a chronic debilitating disease. Subjects with SZ have significant shorter life expectancy. Growing evidence suggests that a process of pathological accelerated aging occurs in SZ, leading to early development of severe clinical diseases and worse morbimortality. Furthermore, unaffected relatives can share certain endophenotypes with subjects with SZ. We aim to characterize accelerated aging as a possible endophenotype of schizophrenia by using a machine learning (ML) model of peripheral biomarkers to accurately differentiate subjects with SZ (n = 35), their unaffected siblings (SB, n = 36) and healthy controls (HC, n = 47). We used a random forest algorithm that included biomarkers related to aging: eotaxins CCL-11 and CCL-24; the oxidative stress markers thiobarbituric acid-reactive substances (TBARS), protein carbonyl content (PCC), glutathione peroxidase (GPx); and telomere length (TL). The ML algorithm of biomarkers was able to distinguish individuals with SZ from HC with prediction accuracy of 79.7%, SZ from SB with 62.5% accuracy and SB from HC with 75.5% accuracy. These results support the hypothesis that a pathological accelerated aging might occur in SZ, and this pathological aging could be an endophenotype of the disease, once this profile was also observed in SB, suggesting that SB might suffer from an accelerated aging in some level.

Acute phosphate nephropathy (APN) is an acute renal failure secondary to the use of oral sodium phosphate (OSP) laxatives, with a high risk of progression to chronicity. We report a 60-year-old woman with mixed connective tissue disease whose serum creatinine increased up to 2.0 mg/dL in her regular control tests, without an evident causative factor. Kidney biopsy showed numerous intratubular calcium phosphate deposits, consistent with APN. She had a history of OSP laxative intake, and a sodium phosphate enema was used before a colonoscopy performed six months earlier. The temporal association between the use of OSP laxatives and acute kidney injury, should lead to the suspicion of APN. The urine sediment is generally normal or with mild to moderate proteinuria. The diagnosis is confirmed with a kidney biopsy. Until now, there is no specific treatment for APN, thus prevention is essential. In high-risk patients for developing APN, the administration of these laxatives should be avoided.

Highlights • In-hospital mortality in COVID-19 Brazilian patients from 25 hospitals in 11 cities was 22·0%. • Among those who required invasive mechanical ventilation, mortality was 59.5%. • Easily assessed parameters at admission were associated with a higher risk of death. • Treatment included antibiotics in 87·1%. • Propagation of antimicrobial resistance may be a consequence of the pandemic., Objectives To describe clinical characteristics, laboratory and imaging findings, as well as in-hospital outcomes of COVID-19 patients admitted to Brazilian hospitals. Methods Cohort study of laboratory-confirmed COVID-19 patients hospitalized from March to September 2020 at 25 hospitals. Study data were collected from medical records using Research Electronic Data Capture (REDCap) tools. Multivariate Poisson regression model was used to assess risk factors for in-hospital mortality. Results Of 2054 patients (52.6% male, median age 58 years old), in-hospital mortality was 22.0%, and 47.6% among those treated in the ICU. Hypertension (52.9%), diabetes (29.2%) and obesity (17.2%) were the most prevalent comorbidities. Overall, 32.5% required invasive mechanical ventilation and 12.1% kidney replacement therapy. Septic shock was observed in 15.0%, nosocomial infection in 13.1%, thromboembolism in 4.1% and acute heart failure in 3.6%. Age ≥65 years-old, chronic kidney disease, hypertension, C-reactive protein ≥100 mg/dL, platelet count

We report a unique case of a Starr-Edwards prosthesis (model 6310, cloth covered) implanted in the mitral position by Christian Barnard that was successfully explanted and replaced after 50 years, the longest period free from valve dysfunction ever reported. Reoperation also included replacement of the native aortic valve combined with tricuspid valve annuloplasty. (Level of Difficulty: Beginner.), Central Illustration

OBJECTIVES Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals had to implement strategies to profoundly reshape both non-COVID-19 medical care and surgical activities. Knowledge about the impact of the COVID-19 pandemic on cardiac surgery practice is pivotal. The goal of the present study was to describe the changes in cardiac surgery practices during the health emergency at the national level. METHODS A 26-question web-enabled survey including all adult cardiac surgery units in Italy was conducted to assess how their clinical practice changed during the national lockdown. Data were compared to data from the corresponding period in 2019. RESULTS All but 2 centres (94.9%) adopted specific protocols to screen patients and personnel. A significant reduction in the number of dedicated cardiac intensive care unit beds (−35.4%) and operating rooms (−29.2%), along with healthcare personnel reallocation to COVID departments (nurses −15.4%, anaesthesiologists −7.7%), was noted. Overall adult cardiac surgery volumes were dramatically reduced (1734 procedures vs 3447; P, The coronavirus disease 2019 (COVID-19) pandemic is the world’s largest infectious disease crisis in the last 100 years.

Post-varicella arterial ischemic stroke (AIS) is considered an uncommon cause of pediatric stroke that is considered a self-limiting, monophasic disease. However, in a subset of patients, disease recurs; the prevalence of vasculopathy or AIS recurrence, severity of clinical outcomes, and standardized therapies have not been well characterized. Herein, we determined the clinical-neuroradiological features, long-term evolution, and relationship between acute phase treatment and vasculopathy recurrence in a pediatric population with post-varicella AIS. Clinical, laboratory, and neuroradiological features of 22 children with post-varicella AIS between 2010 and 2019 (16 males, mean age at stroke 4 years, range 1.7–10) were reviewed. Statistical analyses were performed using χ2 and Fisher exact tests. Of the 22 cases, mean time from varicella to stroke was 4.5 months with 3 cases presenting more than 12 months after rash; 21 (95%) were not vaccinated for varicella; 3 (13.6%) had posterior circulation involvement; and 5 (22.7%) had AIS or vasculopathy recurrence, of which 4 recurred 6.1 months to 2.8 years after initial clinical onset. Recurrence was associated with lack of antiviral treatment during the first episode (p = 0.02). Post-varicella AIS can occur months after rash making diagnosis challenging. Because recurrent vasculopathy was seen predominantly in cases not treated with antiviral therapy during initial presentation, it is important to rapidly diagnose post-varicella AIS through clinical criteria and/or virological testing then treat with antivirals to prevent recurrence.

Introduction: Drug design and discovery of new antivirals will always be extremely important in medicinal chemistry, taking into account known and new viral diseases that are yet to come. Although machine learning (ML) have shown to improve predictions on the biological potential of chemicals and accelerate the discovery of drugs over the past decade, new methods and their combinations have improved their performance and established promising perspectives regarding ML in the search for new antivirals.Areas covered: The authors consider some interesting areas that deal with different ML techniques applied to antivirals. Recent innovative studies on ML and antivirals were selected and analyzed in detail. Also, the authors provide a brief look at the past to the present to detect advances and bottlenecks in the area.Expert opinion: From classical ML techniques, it was possible to boost the searches for antivirals. However, from the emergence of new algorithms and the improvement in old approaches, promising results will be achieved every day, as we have observed in the case of SARS-CoV-2. Recent experience has shown that it is possible to use ML to discover new antiviral candidates from virtual screening and drug repurposing.

Brain-derived neurotrophic factor (BDNF) is a neurotrophic factor highly expressed in coronary plaques, particularly in macrophages, and in activated platelets. Thus, a possible role in the pathogenesis of acute coronary syndrome (ACS) has been suggested. We evaluated systemic BDNF levels according to the different clinical presentations of ACS. Moreover, we assessed the relationship between BDNF levels and the presence of optical coherence tomography (OCT)-defined macrophage infiltrates (MØI) and healed plaques along the culprit vessel. We enrolled consecutive patients presenting with ST-elevation myocardial infarction (STEMI) or non-ST-elevation (NSTE)-ACS. Serum BDNF levels were assessed by enzyme-linked immunosorbent assay. Plaque characteristics of the culprit vessel were assessed by OCT. Among 126 ACS patients (median age 68.00, interquartile range [IQR] 59.75-75.25 years, male 74.6%, 71 (56.3%) were NSTE-ACS and 55 (43.7%) were STEMI. BDNF levels were higher in STEMI patients compared to NSTE-ACS. OCT assessment was performed in 53 (42.1%) patients. Patients with MØI (n = 27) had higher BDNF levels compared to patients without MØI. Furthermore, patients with healed plaques (n = 13) had lower BDNF levels than patients without healed plaques. At multivariate regression analysis BDNF levels independently predicted the presence of MØI (odds ratio [OR] = 2.856; 95% confidence interval [CI] [1.151-7.090], P = 0.024) and the absence of healed plaques (OR = 0.438, 95% CI [0.185-0.992], P= 0.050). Among ACS patients, BDNF levels were higher in patients with STEMI. Moreover, BDNF levels were independently associated with MØI and with the absence of healed plaques along the culprit vessel, suggesting a possible role of BDNF in promoting plaque inflammation, destabilization and occlusive thrombosis.

Background: Unfinished root formation has always offered challenges in endodontics due to technical difficulties and weakened teeth resistance during the lifetime of an individual. Pulp revascularization therapy appeared as a solution for apical closure and root maturation. The existence of oral stem cells involved in the process associated with traditional resident cells requires adequate blood supply given by induced controlled injury deliberately accomplished into the periapical zone. Objective: The aim of this work was to research, through literature review, the main mechanisms involved in the process of apical closure through the technique of pulp revascularization. Conclusion: Apice closure in pulpless teeth seems to happen as a result of professional intervention and biological activity. The success rate depends on the role of traditional local immune cells and stem cells associated with adequate blood supply to finish root formation.

The proposed role of interleukin (IL)-17 in vitiligo pathogenesis, as well as the possible action of anti-IL-17A drugs on vitiligo, are not fully understood. The appearance of vitiligo as a paradoxical effect of treatment with anti-tumor necrosis factor-α drugs is an event well known in the literature, but is rarely described with anti-IL-17A drugs. In this case report, we describe a 42-year-old woman who developed new-onset vitiligo with repigmentation during successful secukinumab therapy for psoriatic arthritis. After 1 year of secukinumab therapy, vitiligo affecting >85% of the skin was evident on clinical and dermatoscopic examination, together with small, repigmented lesions. In depigmented lesions, reflectance confocal microscopy (RCM) showed disappearance of the bright dermal papillary rings normally seen at the dermo-epidermal junction. In repigmented lesions, activated dendritic melanocytes were observed on RCM. The patient continued to receive secukinumab, and continued to experience a slow and progressive repigmentation. Our case shows that anti-IL-17A biological agents for chronic inflammatory diseases may be associated with the development of new-onset vitiligo that improves over time with ongoing therapy. Therefore, physicians should be aware of the possibility of this rare paradoxical skin reaction in patients receiving secukinumab, and that it may not be necessary to discontinue secukinumab to achieve repigmentation.

The COVID-19 pandemic abruptly shut down schools in an urban based school district in the Spring of 2020. As the closures persisted over months, an immediate educational need arose for online curricula that could help alleviate the learning gaps caused by the shutdown. The purpose of this study was to create a process and model for the development of a fully asynchronous online learning environment for prekindergarten through 2nd grade students that could help other districts implement similar projects. Since the turnaround time for development and implementation was a matter of weeks the project team used an iterative process to solve a “wicked problem” and identified solutions to create an improved user experience. A modified design thinking model approach was developed through the process of developing this six-week, theme based virtual curriculum that included interactivities in early literacy, writing, reading comprehension, science and math. This adjusted model includes 6 stages: Discover, interpretation, ideation, experimentation, implementation, and evolution. This research focuses on the processes involved during each of the stages and the resulting use by the intended audience. The curriculum was used by over 5,800 prekindergarten through second grade students during the 6-week period of the summer of 2020. The online platform continues to be used by students presently. © 2021, The International Academic Forum (IAFOR). All rights reserved.

This prospective cohort study took place at the Division of Perinatal Medicine of Policlinico Abano Terme, Italy, from January to November 2018. In the second day postpartum, 463 healthy at term puerperae, 122 (26.35%) with inadequate gestational weight gain (GWG), 210 (45.46%) with adequate GWG, and 131 (28.29%) with excessive GWG, were studied by EAT-26, through distinguishing three factors: 'Dieting', 'Bulimia and food preoccupation', and 'Oral control'. EAT-26 Global score increased from inadequate, to adequate, and excessive GWG puerperae, resulting significantly higher in excessive GWG group (

A nova Escala de Paradigma Ecológico revisada (NEP-R) traduzida para o espanhol é um instrumento amplamente utilizado em vários países, culturas e populações para medir as crenças ambientais das pessoas. Dada a discrepância em sua dimensionalidade relatada em estudos anteriores e como não há relatos de suas propriedades psicométricas da escala NEP-R na população universitária mexicana, eles foram analisados. A escala foi aplicada a 503 estudantes da Universidade Autônoma do Carmen, de diferentes entidades federais do sudeste do México. A consistência interna (α de Cronbach) da escala NEP-R foi analisada e uma análise fatorial exploratória (AFE) com rotação varimax foi realizada. A descoberta revelou um ótimo coeficiente de consistência interna (α = 0,702) e uma estrutura de dois fatores (ecocentrismo e antropocentrismo), que juntos representam 43,272% da variância total em uma versão da escala de 9 itens. Concluise que a escala NEP.R é uma ferramenta útil. No entanto, é imperativo avaliar sua confiabilidade e dimensionalidade para diferentes populações-alvo.

Introduction: Intestinal parasitic infections represent a public health problem, being responsible for high rates of morbidity and mortality. Ascaris lumbricoides is one of the main parasites prevalent in the community. The A. lumbricoides infection method is oral fecal cicle, in this sense, it is necessary to expand effective methods to prevent the ingestion of eggs, such as sanitation, cleansing habits or even effective methods for the sterilization of eggs. Objective: Evaluate different agents of antisepsis action, with the purpose of find which ones are more efficient in larval mortality inside eggs. Methodology: The parasites were provided by the Federal University of Minas Gerais, which were sectioned, in this way, the recovered eggs were kept in culture bottles. After 40 days the embryonated eggs were purified and separated in culture bottles, and in each bottle had one different disinfectant products were added, in different concentrations and action time. As control, egg aliquots were maintained by adding distilled water. Using a microscope, it was observed the viability of the larvae inside. To determine the viability of the larvae, distilled water at 40 °C was added, then allowing the visualization of mobility inside the eggs. Results: It was observed that, fifteen disinfectant agents tested, only four showed efficacy, at intervals of 24 and 48 hours after exposure to the disinfectant and when undiluted. Conclusion: The data obtained in this study will contribute to the understanding of the epidemiology of this disease, as well as contributing to the development of more effective hygiene programs for the control of this parasitosis.

Environmental concern has encouraged development related to polluted water treatment. Produced water originated from oil exploration has been submitted to different separation processes such as settling tanks, floaters, two-phase and three-phase separators, hydrocyclones, and membranes. On the use of membranes, the goal is to separate soluble components from solutions based on the size, charge, shape, and molecular interactions between the solute and membrane surface. In the present work, a numerical study was developed on the oil-water mixture separation process using a porous ceramic membrane module. The mathematical model used in this research is composed of mass and momentum conservation equations coupled to Darcy ́s law and SST k-ω turbulence model. Simulations were carried out employing the Ansys CFX commercial software. Results of the pressure, velocity, oil concentration distribution inside the device and membrane are presented and discussed. The results showed that the geometric aspects of the proposed microfiltration module and the membrane distribution within the separation module had a significant influence on the hydrodynamic flow leading to polarized layer dispersion.

Lithium is the gold standard therapy for Bipolar Disorder (BD) but its effectiveness differs widely between individuals. The molecular mechanisms underlying treatment response heterogeneity are not well understood, and personalized treatment in BD remains elusive. Genetic analyses of the lithium treatment response phenotype may generate novel molecular insights into lithium’s therapeutic mechanisms and lead to testable hypotheses to improve BD management and outcomes. We used fixed effect meta-analysis techniques to develop meta-analytic polygenic risk scores (MET-PRS) from combinations of highly correlated psychiatric traits, namely schizophrenia (SCZ), major depression (MD) and bipolar disorder (BD). We compared the effects of cross-disorder MET-PRS and single genetic trait PRS on lithium response. For the PRS analyses, we included clinical data on lithium treatment response and genetic information for n = 2283 BD cases from the International Consortium on Lithium Genetics (ConLi+Gen; www.ConLiGen.org). Higher SCZ and MD PRSs were associated with poorer lithium treatment response whereas BD-PRS had no association with treatment outcome. The combined MET2-PRS comprising of SCZ and MD variants (MET2-PRS) and a model using SCZ and MD-PRS sequentially improved response prediction, compared to single-disorder PRS or to a combined score using all three traits (MET3-PRS). Patients in the highest decile for MET2-PRS loading had 2.5 times higher odds of being classified as poor responders than patients with the lowest decile MET2-PRS scores. An exploratory functional pathway analysis of top MET2-PRS variants was conducted. Findings may inform the development of future testing strategies for personalized lithium prescribing in BD.

Nevus comedonicus (NC) is a rare type of organoid epidermal nevus with comedones and inflammatory cysts 1 . It may be associated with extracutaneous manifestations (cataract, neurological and skeletal anomalies), defining NC syndrome 2 . Acne nevus, a clinically similar mosaic skin condition, is related to FGFR2, whereas postzygotic NEK9 mutations have been identified in four NC patients so far, including only one with NC syndrome 3 4 . Here we report on novel clinical findings, fibrous dysplasia and premature puberty in a case of NC syndrome associated with a NEK9 mutation.

Background: Over the past decade, the use of electronic nicotine delivery system (ENDS) devices such as e-cigarettes has increased dramatically, particularly among students and other transitional- age youth. Societal norms and the variety of ENDS devices available have also evolved dramatically in recent years. Objective: This article provides a comprehensive review and synthesis of contemporary literature, as it relates to ENDS use among transitional-age youth. Methods: Over 125 peer-reviewed studies, literature syntheses, legal reports and contemporary media works focused on ENDS use and vaping were reviewed. Results: Marketing strategies for ENDS devices have primarily targeted teens and young adults. Though ENDS devices are advertised as a safer alternative to cigarettes, accumulating data demonstrate significant health risks and consequences associated with use. The long-term health effects remain largely unknown; however, detrimental acute effects are apparent. Furthermore, rather than aiding in tobacco cessation efforts, the use of ENDS by transitional-age youth is correlated with the increased use of conventional tobacco products and other substances of abuse. Students appear to be ill-informed regarding the dangers of using ENDS products. Conclusion: Given the rapid increase in ENDS users each year, and accumulating concerns about health risks associated with use, university student health services must be prepared to address this growing problem. As clinical practice guidelines do not yet exist to encourage ENDS-product cessation, the use of the evidence-based strategies developed for tobacco cessation is advised. More research is needed to determine the most effective methods to prevent the initiation of ENDS use within this population.

Background A 52-year-old woman presented with shortness of breath and cough. An endobronchial sialolipoma was found at the left entrance of the main bronchus. Sialolipoma is an exceedingly rare type of lipoma reported of the minor salivary glands, especially within the bronchus. Case presentation A 52-year-old woman presented with shortness of breath and cough with 6 months´ evolution. Endobronchial endoscopy revealed a tumour at the left entrance of the main bronchus. The entire removal of the tumour was removed using a cryoprobe device. Pathological examination showed a tumour consistent with the diagnosis of sialolipoma due to the presence of mature adipose cells blended with acinar, ductal, basal, and myoepithelial cells. The patient had a favourable outcome. Conclusion The infrequent tracheobronchial presentation of this tumour can be challenging for correct diagnosis.

This research focuses on performing multiphase solid/liquid/gas CFD simulations of a UASB reactor in order to obtain a validated model that provides a clearer understanding of the hydrodynamic behaviour of the three phases in UASB reactors. Eulerian–Eulerian, laminar, three-dimensional, multiphase simulations are carried out using Fluent 16.2. The liquid phase velocity and flow profile are validated through PIV experiments. A liquid mean velocity difference of 8.45% is found between the experimental and numerical results, thus validating the CFD model. Shadowgraphy is applied successfully to validate the biogas phase velocity and bubble size. Based on the hydrodynamic analysis results, the reactor can be divided into four regions, according to its mixing conditions. For the flow rates studied, minimal solids washout is observed. In the present research, only 0.02% of the volume are dead zones within the reactor, which indicates good mixing conditions. The reactor shows a recirculation stream at the centre that has an important role in relation to the mixing conditions. The validated model can be used for further studies on the optimisation of UASB reactors.

The Tuscan Region (Central Italy) spends about 12 million euros every year in the prevention and suppression of forest fires. In this context, this study aims to analyse the economic and environmental benefits derived from fire suppression activities. Starting from a case study of a real fire event in Tuscany, we simulated three hypothetical scenarios (with different fire durations) without fire extinction activities planned by using the open source software FARSITE. Benefits derived from fire extinction activities can be quantified as the avoided damage, which has been calculated through the estimation of the total economic value of forests not destroyed by fire thanks to the extinction action. The avoided damage is represented by the difference between values of forest areas burned by the real fire event and those burned by simulated fire. By providing an economic estimation of avoided damages, our results confirm that forest fire services and forest management have a high impact on both the economy and the environment.

Purpose This paper aims to share responses from current literature, a small case study about perceptions and practices of the school of education faculty toward multicultural and educational issues concerning the rapid rise in online environments during coronavirus (COVID-19) experiences and just-in-time strategies for addressing digital equity and educational inclusion in K-16 online educational settings. Design/methodology/approach This is a conceptual paper that emerged from an action research case study. The study included four faculty in an urban school of education. The faculty participants were asked to provide examples of educational inclusion strategies used during transitioning their courses and advising to online environments in a Research I university. Faculty included one educational leadership, one sports management, one special education and one teacher education professor. Central issues explored practices related to language, technology access, curriculum design and technological competencies and assessment. A driving question was: How do institutions, schools or educators provide learning opportunities to support digital equity and inclusive education practice to maintain and strengthen relationships and core practices of multicultural education during a time of physical distancing during COVID-19? And what are the experiences, barriers, successes? Findings Research-based transformative knowledge, real situations and practical resources for considering inclusive education curriculum concepts were found that are connecting educators, teachers, learners and communities during this time of crisis. Research limitations/implications Methodological limitations that influenced the research design include conducting research in a totally virtual environment, small sample size, lack of diversity in curriculum content and one research site. The data collection was limited to written responses from the faculty participants. This action research study took place in a time frame limited by COVID-19 conditions during a four-month period. Practical implications In theory and practice, this new online movement suggests learners, teachers, educators and leaders are gaining experience and knowledge about resources and strategies for using new technologies, assessments and flexible curriculum as powerful tools for building language, curriculum and social-cultural communication bonds across generations and including special needs populations. Such new and emerging strategies could be used to bridge gaps in a time of distancing to support inclusive and equitable learning environments in education to minimize the effects of an emergent COVID-19 digital divide. Social learning culture as constructed, performed and captured in patterns of cooperation among faculties shows the world becoming more open and less restricted by borders. In conclusion, an emerging new conceptual framework is presented in Figure 2 to support action planning to bridge the digital equity access and learning gaps created by COVID-19. Social implications It is in times of strife and difficulty that problems and issues become exacerbated. While some educators easily adapted and took on the challenges of online learning, others needed time for learning and mourning (literally and figuratively). The issues of equity and access have become even more apparent as this paper takes inventory of intersections between multicultural education, special education, sports education and K-16 education overall. This is an excellent time to reflect on how education can address the cultural, economic and social barriers that impact student learning globally for all learners. Originality/value The brief collective case study reports educational experiences during a time of crisis that stimulates creative and innovative approaches to creating inclusive and equitable online learning environments to address diverse learning needs. The various and often contrasting educator responses from faculty facing digital and educational challenges present ideas that might be applicable in the global learning environment beyond the COVID-19 pandemic.

Short-term mechanical circulatory support (MCS) devices are designed to provide hemodynamic support for a wide range of clinical conditions such as high-risk cardiac surgery or interventional procedures, post-cardiotomy cardiogenic shock, acute decompensated heart failure. Electrical storm (defined as three or more sustained episodes of ventricular fibrillation-VF- in a 24-h period) is a rare but critical complication following revascularization in patients with ischemic heart disease and it is associated with a very high mortality (80-90%) both during the incident alone and during further observation. Here we report the case of a 38-year-old patient affected by coronary artery disease with moderate to severe left ventricular systolic dysfunction (EF 30-35%) who underwent emergency coronary artery bypass grafting (CABG) complicated by electrical storm and severe haemodynamic instability, successfully managed with a novel approach of biventricular mechanical circulatory support with extracorporeal life support (ECLS) in first instance, subsequently switched to Impella CP and ProtekDuo.

Background: Health systems worldwide have been overburdened by the "COVID-19 surge". Consequently, strategies to remodulate non-COVID medical and surgical care had to be developed. Knowledge of the impact of COVID surge on cardiac surgery practice is mainstem. Present study aims to evaluate the regional practice pattern during lockdown in Campania. Methods: A multicenter regional observational 26-question survey was conducted, including all adult cardiac surgery units in Campania, Italy, to assess how surgical practice has changed during COVID-19 national lockdown. Results: All centers adopted specific protocols for screening patients and personnel. A significant reduction in the number of dedicated intensive care unit (ICU) beds (-30.0%±38.1%, range: 0-100%) and cardiac operating rooms (-22.2%±26.4%, range: 0-50%) along with personnel relocation to other departments was disclosed (anesthesiologists -5.8%±11.1%, range: 0-33.3%; perfusionists -5.6%±16.7%, range: 0-50%; nurses -4.8%±13.2%, range: 0-40%; cardiologists -3.2%±9.5%, range: 0-28.6%). Cardiac surgeons were never reallocated to other services. Globally, we witnessed dramatically lower adult cardiac surgery case volumes (335 vs. 667 procedures, P

No mundo, a doenca mais comum da prostata e uma hiperplasia prostatica benigna (HPB), que constringe e afila o canal uretral, gerando uma obstrucao parcial ou total da uretra. Ja o câncer prostatico (CaP) e o segundo tipo de câncer mais frequente em homens no mundo e esta relacionado a quinta principal causa de obitos. Veja que HPB e o CaP sao importantes na saude dos homens, que possuem alta incidencia e prevalencia e que a literatura sobre os dados epidemiologicos dessas na regiao do sudoeste goiano doencas e escassa, esse trabalho teve por objetivo fazer um levantamento de todos os laudos de biopsias prostaticas emitidos nos ultimos 20 anos em um municipio da regiao, para caracterizar a sua frequencia e relacionar com a idade dos homens acometidos. Com esse estudo, foi possivel detectar uma alta frequencia de tais doencas na cidade, pois mais da metade de todos os laudos emitidos durante os vinte anos eram de HPB e CaP, representando 54,5% (n = 756), dos quais mais de 50% foram de HPB. A idade media dos diagnosticados com câncer foi superior ao HPB, respectivamente 70,9 e 68,2 anos. Com um perfil demografico em mudanca e um crescente da populacao em quase todas as sociedades, e inevitavel que a HPB e o CaP se tornem ainda mais prevalentes e um grande desafio para todos os sistemas de saude, sendo importante ampliar os investimentos em acoes de saude com foco em medidas educativas e preventivas para populacao masculina. A idade media dos diagnosticados com câncer foi superior ao HPB, respectivamente 70,9 e 68,2 anos. Com um perfil demografico em mudanca e um crescente da populacao em quase todas as sociedades, e inevitavel que a HPB e o CaP se tornem ainda mais prevalentes e um grande desafio para todos os sistemas de saude, sendo importante ampliar os investimentos em acoes de saude com foco em medidas educativas e preventivas para populacao masculina. A idade media dos diagnosticados com câncer foi superior ao HPB, respectivamente 70,9 e 68,2 anos. Com um perfil demografico em mudanca e um crescente da populacao em quase todas as sociedades, e inevitavel que a HPB e o CaP se tornem ainda mais prevalentes e um grande desafio para todos os sistemas de saude, sendo importante ampliar os investimentos em acoes de saude com foco em medidas educativas e preventivas para populacao masculina.