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This study addresses the challenge of estimating above-ground biomass (AGB) in the Amazon rainforest by developing a reference geographical database, which provides the ground truth, and comparing the relative importance of using Synthetic Aperture Radar (SAR) and optical remote sensing data to automatically infer AGB. In the experiments reported in this article, we assessed how those two remote sensing data sources impact the accuracy of AGB estimates produced by regression models built with Random Forest (RF) and Extreme Gradient Boosting (XGBoost). The research involved compiling a comprehensive database from many available forest inventories, integrating parcel- and tree-level data to enable precise biomass estimation. The methodology included setting up a spatial data analysis environment, standardizing data, and implementing an experimental protocol with feature selection and leave-one-out cross-validation. The results demonstrate that both kinds of data, i.e., SAR and optical, and their combination can be used for estimating AGB, providing valuable insights for forest management and climate change mitigation efforts. The reference database is available upon request to the corresponding authors.

Since 2022, we have mapped native vegetation removal for all Brazilian biomes within the scope of the PRODES Project. In this study, our main objective was to present interpretation criteria for feature detection used to identify natural vegetation removal throughout the Caatinga. To this end, we created a catalog of typical patterns that can be used for supervised and unsupervised deforestation mapping. We used PRODES data from 2023 year's PRODES Caatinga based on the composition of top of atmosphere (TOA) reflectance images from MSI/Sentinel-2 satellite. The original reflectance data was used to generate false color images in the following combination: band 8 (Red), band 11 (Green) and band 4 (Blue). This image was then visually classified into different natural vegetation removal classes. These are good examples of what PRODES interpreters have encountered throughout this diverse region and can help any future mapping efforts of the Caatinga.

The native vegetation removal (NVR) of Caatinga Brazilian biome has been mapped by Prodes Project coordinated by National Institute for Spatial Research (INPE) between 2000 to 2023 year. Prodes is considered an official government product for achieving Brazilian and international targets for the conservation of natural vegetation. Therefore, Prodes is committed to achieving the highest possible accuracy associated with the history of mapping already carried out, by visual interpretation of satellite images and the use of past mapping masks techniques. Mapping NVR in Caatinga biome is a major challenge compared to biomes where the tree canopy with native vegetation prevails. Caatinga is one of the least protected of Brazilian biomes and is in one of the most pressured semi-arid regions on the planet. This work aims to present the NVR in Caatinga biome from Prodes data, in terms of its trajectory and main geographical patterns, concerning the municipalities, and areas that are the focus of monitoring, conservation or restoration. According to Prodes results, by 2023, the cumulative NVR in the entire Caatinga reached 43,05%; in 2000, this figure was 29,54%. The major NVR occurred in the easternmost areas of Caatinga and regions of Serrinha and Feira de Santana in Bahia State. Also, there are areas with considerable NVR further inside the biome, such as, Irecê and Guanambi region in Bahia, west of Pernambuco and Paraíba States and South and North of Ceará State. Areas prioritized for conservation actions showed high NVR values, indicating the urgent need for implementation of such actions. The fact that Desertification Cores showed low NVR values is important, and these regions should be closely monitored to prevent uncontrolled NVR rates. The two regions with high anthropic pressure or speculation showed contrasting behaviors; while the Araripe Gypsum Pole exhibited higher NVR levels compared to the control area, the São Francisco River integration project (PISF) so far does not appear significantly different from the rest of the biome. Overall, this study clearly demonstrates the potential of monitoring the Caatinga through Prodes in understanding and integrating the various factors influencing changes in the biome's native vegetation cover. Future approaches should move beyond descriptive studies to increasingly contribute to the territorial management of this important Brazilian region.

The UNEXMIN (Horizon 2020) and UNEXUP (EIT RawMaterials) projects developed a novel technology to send robots and even autonomously deliver optical images, 3D maps and other georeferenced scientific data from flooded underground environments, like abandoned mines, caves or wells. The concept turned into a market ready solution in seven years, where the last few years of field trials of the development beautifully demonstrating the technology's premier capabilities. Here in this paper, we focus on the wide variety of environments, circumstances and measurements where the UNEXMIN technology can be the best solution or the only solution to deliver certain research or engineering data. These are obtained from both simple and complex environments like different mines and caves, small and large cavities, long and tight tunnels and shafts, different visibility conditions, even different densities of the liquid medium where UX robots operated.

The increasing pressure from agriculture and pasture activities over non-forest vegetation areas revealed the need of INPE to extend forest regular monitoring to non-forested areas. Non-forest vegetation consists of savannahs, shrub lands, grasslands or seasonal floodplains that occupy 279 thousand km2 (6,63 %) of Brazilian Amazon biome extension. Addressed ecosystem services of non-forest vegetation vary from climate, soil, carbon storage, biodiversity, water and fire regulation to cultural benefits and living of the population. The challenge in monitoring non-forest removal lies in climatic seasonality, high variability of phytophysiognomies and cloud coverage. In this work we developed a method to map non-forest vegetation from 2000 to 2021 in a pilot area enclosing five municipalities in Roraima and Amapá states. Considering the total area of 47 thousand km2, 58 % was originally forest and 37 % was non-forest vegetation. In 2020, soybean planted areas occupied 60 thousands hectares in these municipalities. We adapted PRODES protocol to non-forest features using visual interpretation of Landsat and SENTINEL-2 satellite images. Regional expertise supported the interpretation keys to distinguish non-forest removal from seasonal changes or other land use changes. A baseline map for 2000 is provided together with biannual and annual increments for 2002–2018 and 2019–2021, respectively. Results show removal of non-forested areas even overpassing deforestation in some municipalities. Accumulated non-forest removal was 3.133,06 km2 or 17,44 % of the non-forest area enclosed. This work consolidated the method to be applied in the Brazilian Amazon biome allowing a uniform historical mapping series of deforestation and non-forest removal.

Introduction Lithium, a mood stabilizer, is a commonly prescribed and effective treatment for bipolar affective disorder. It´s excreted almost exclusively by the kidneys with a half-life primarily determined by renal function. Chronic intoxication results from an insidious accumulation of lithium in a chronically medicated patient (due to a reduction in renal function secondary to volume depletion, a new medication, et cetera). Patients often present with neurologic findings, including tremor, ataxia, dysarthria, confusion and neuromuscular excitability. Objectives The objective of this report is to describe a clinical case of lithium neurotoxicity (myoclonus and encephalopathy), along with a review of the literature on the topic. Methods We describe a case of lithium neurotoxicity, along with a brief non-systematic review of the literature on lithium toxicity. We conducted a PubMed bibliographic search using keywords such as “lithium intoxication”, “lithium neurotoxicity”, “lithium encephalopathy” and “lithium intoxication treatment”. Results A women aged 81 was brought to the emergency department by her daughter following 1 week of asthenia, diarrhoea, periods of confused speech and involuntary movements. In the previous week, the patient had been diagnosed with COVID-19. Her past medical history is significant for bipolar affective disorder, hypertension, diabetes mellitus, dyslipidemia and asthma. The patient has been treated with following drugs: lithium carbonate (no recent change of dose and previous serum levels around 1mmol/L), quetiapine, lisinopril, metformin, simvastatin, formoterol and budesonide. On the first examination, she had an exuberant multifocal myoclonus. Posteriorly, she became somnolent, with language impairment (verbal perseveration, echolalia) and dysarthria. Investigations revealed renal impairment (creatinine 1,5 mg/dL, blood urea nitrogen 42 mg/dL) and supratherapeutic lithium levels (lithium serum level 1,7 mmol/L). Computed tomography scan of the brain was negative for acute injuries. The electroencephalogram showed triphasic waves (1-1,5 Hz). Encephalopathy secondary to lithium intoxication was diagnosed (probably in the context of acute kidney injury precipitated by hypovolaemia – diarrhoea). Lithium was stopped and intravenous isotonic fluids were given. After 1 week, her myoclonus resolved and over the following week the other signs resolved as well. The patient was later discharged to her daughter’s home, with follow-up neurology and psychiatry visits. Conclusions Both reversible and irreversible neurotoxicity related to lithium have been reported, specially occurring alongside chronic intoxication. If not addressed, impaired consciousness can lead to coma and death. A high clinical suspicion is needed for prompt diagnosis and treatment (intravenous fluids and sometimes haemodialysis are warranted). Disclosure of Interest None Declared

PRODES and DETER project together turned 33 years-old with an undeniably contribution to the state-of-art in mapping and monitoring tropical deforestation in Brazil. Monitoring systems all over the world have taken advantage of big data repositories of remote sensing data as they are becoming freely available together with artificial intelligence. Thus, considering the advent of new generation remote sensing data hubs, online platforms of big data that can fill in spatial and temporal resolutions gaps in current deforestation mapping, this work aims to present recent innovations at INPE´s deforestation monitoring systems in Brazil and how they are gauging new realms of technological levels. Recent innovations at INPE´s monitoring systems are: 1) the development of TerraBrasilis platform of data access and analysis; 2) the adoption of new sensors and cloud detection strategies; 3) the complementary use of multi-sensor images; 4) the complementary adoption of SAR C-band images using cloud data to sample and process Sentinel-1. Future innovations are: 1) development of a Brazilian data cube to be used in deep learning techniques of image classification; 2) Routine uncertainty analysis of PRODES data. Automatization might fasten mapping process, but the real challenge is to succeed in automatization maintaining data quality and historical series. The hyper-availability of remote sensing data, the initiative of a Brazilian Data Cube and promising machine learning techniques applied to land cover change detection, allowed INPE to reinforce its central role in tropical forest monitoring.

Introduction Shame is a profound negative emotion that can sometimes be cover up by guilt and remain undiagnosed. Shame and guilt have been described as self-conscious and moral emotions as they both involve self-evaluation and lay a role in facilitating moral conduct. They derive from the notion of responsibility, but some authors suggest that while guilt focuses only on the act at hand shame focuses on the one executing it. The self is the object. Objectives To review the literature on shame and its role in different disorders both as a causing agent and as a perpetuating agent Methods Non-systematic review of the literature with selection of scientific articles published in the past 20 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “shame”, “psychopathology. Results Since shame globally decreases self-esteem and is an awareness of personal flaws it can lead to the feelings of helplessness and the development or worsening of mental disorders. As such it is no wonder to find shame being studied in many different forms, more and less structured with important connections being made with social anxiety, eating disorders, dysmorphic disorders, personality disorders and bereavement. Conclusions Shame’s role, independently from guilt can have an impact on both the genesis and perpetuation of mental disorders. Its study can uncover missing links between different types of experiences and the pathological reactions that may subsequently follow. Disclosure No significant relationships.

Introduction Cognitive behavioural therapy for psychosis as an adjuvant to pharmacological treatment has been been shown to be one of the most effective interventions for schizophrenia with benefits noted in even treatment resistant schizophrenia. Benefits have been mostly registered in the positive symptoms domain of schizophrenia. Acceptance and commitment therapy is a third generation Cognitive-Behavioural Therapy, empirically supported for a range of symptoms and conditions, including psychosis, with quickly increasing data. It targets experiential avoidance, which seems to be closely related with psychopathology. Its ability to also target affective symptoms can be an important advantage in the adjuvant treatment of psychosis. Objectives To critically review the evidence of acceptance and commitment therapy in psychosis. Methods Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “schizophrenia”, “acceptance and commitment therapy”. Results Very few studies have been published on ACT and psychosis, with even less controlled trials and systematic reviews. So far there is convincing evidence for ACT reducing the frequency of hallucinations, increasing the outcomes of traumatic events associated with psychosis and having measurable effects on anxiety and help seeking behaviour. Conclusions As Acceptance and Commitment therapy evolves and more evidence arises a new kind of therapy with possible effects on both affective and positive symptoms in schizophrenia can emerge, allowing us to know what works for patients with psychosis and through what mechanisms and permitting the improvement of treatment strategies. Disclosure No significant relationships.

Introduction Anorexia nervosa has an important burden on both patients and families, with important comorbidities such as depression and obsessive symptoms. These are more resistant to pharmacological treatment than in non-anorexia patients, due to both biological and psychological mechanisms. Electroconvulsive therapy is the best available therapy for treatment resistant depression making it a treatment to consider in treatment resistant depression in anorexia though only case reports exist. Objectives To review the current evidence for electroconvulsive therapy of depression in patients with anorexia nervosa as well as it’s ethical challenges Methods Non-systematic review of the literature with selection of scientific articles published in the past 10 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “electroconvulsive therapy”, “anorexia nervosa”. Results Electroconvulsive therapy in anorexia has no controlled trials with mostly case reports available on scientific databases. It presents important challenges due to patient age, medical status and ethical challenges. Even less evidence exist for electroconvulsive therapy in children and adolescents than for adults, anorexia can complicate medical status presenting an anesthetic and life-support challenge and it’s egosyntonicity can place a legal and ethical challenge when patient refuses treatment. Conclusions Anorexia has a dramatic burden on patients and families affected, with integrated evidence-based treatment being necessary both for treating the current episode and for remission prevention. Case-reports show that electroconvulsive therapy can play a role on treatment resistant depression in anorexia. Disclosure No significant relationships.

Introduction Electroconvulsive therapy (ECT) is one of the oldest psychiatric treatments used to this day. It is particularly useful in cases of schizophrenia resistant to treatment with antipsychotics. 49% of patients with schizophrenia experience little or no response with one trial of antipsychotics, 71% do not achieve remission and up to 20% of patients are also resistant to clozapine. Objectives Description of a clinical case where ECT is used in the treatment of resistant schizophrenia and review of the literature. Methods Description of a clinical case. Non systematic review of the literature, searching the terms “treatment resistant”; “schizophrenia”; “ect” in the databases Pubmed, Medline, Cochrane and Uptodate. Results Male, 38-year-old patient, diagnosed with schizophrenia for 20 years, with history of multiple hospitalizations, institutionalized for 9 years. Treated with risperidone 50 mg intramuscular fortnightly, clozapine 750 mg daily, aripiprazol 30 mg daily and diazepam 10 mg daily. He presented with increased delusional intensity for a year. Hospitalized for treatment with ECT, submitted to 12 sessions with bitemporal stimuli, with effective convulsions. MoCA, PANSS and BPRS were applied before and after treatment, with an increase of 25% in MoCA and a decrease of 47.3% and 57.9% respectively, in the psychotic symptoms scales. Conclusions We present a case of schizophrenia resistant to treatment with multiple antipsychotics, including clozapine. ECT was used, with clinically demonstrated efficacy. In the future, it might be interesting to study in detail the mechanism of action of this treatment with the goal of deepening the knowledge of the neurobiology of schizophrenia. Disclosure No significant relationships.

Introduction Intelectual disability is an illness with an important burden on patients and caregivers, especially when severe and when comorbidities such as other psychiatric disorders are present. There are case reports of treatment resistant self-aggression, agitation, epilepsy, catatonia and psychosis successfully treated with electroconvulsive therapy although controlled studies were not found. Objectives This work reviewed the current evidence for the use of electroconvulsive therapy in the management of patients with intellectual disability as well as its ethical and methodological implications. Methods Non-systematic review of the literature with selection of scientific articles published in the past 20 years; by searching Pubmed and Medscape databases using the combination of MeSH descriptors. The following MeSH terms were used: “electroconvulsive therapy”, “intellectual disability”. Results Patients with intellectual disability can have incapacitating comorbilities that greatly impair quality of life, and may require withdrawl from the community Treatment often differs from the general population as psychotropic medication can worsen other comorbilities. Electroconvulsive therapy can be a relevant treatment option for comorbidities in this population due to its safety profile. Ethical considerations should be taken into account, especially with non-verbal patients or when adequate representatives have not been chosen or cannot be reached. Different legal challenges may be present on different countries. Conclusions Electroconvulsive therapy and intellectual disability share the burdens of heavy stigma and low investment. Intellectual disability and it’s commorbidites present both a diagnostic and treatment challenge. Electroconvulsive therapy is an important weapon capable of restoring patients to their families and diminishing the burdens of caregivers and healthcare systems Disclosure No significant relationships.

The project Viable Alternative Mine Operating System (¡VAMOS!) develops a novel underwater mining technique for extracting inland mineral deposits in flooded open-cut mines. From a floating launch and recovery vessel a remotely-operated underwater mining vehicle with a roadheader cutting machine is deployed. The cut material is transported to the surface via a flexible riser hose. Since there is no direct intervisibility between the operator and the mining machine, the data of the sensor systems can only be perceived via a computer interface. Therefore, part of the efforts in the project focus on enhancing the situational awareness of the operator by providing a 3D model of the mine combined with representations of the mining equipment and sensor data. We present a method how a positioning and navigation system, perception system and mapping system can be used to create a replica of the physical system and mine environment in Virtual Reality (VR) in order to assist remote control. This approach is beneficial because it allows visualizing different sensor information and data in a consistent interface, and enables showing the complete context of the mining site even if only part of the mine is currently observed by surveying equipment. We demonstrate how the system is used during tele-operation and show results achieved during the field trials of the complete system in Silvermines, Ireland.

Introduction Nowadays we know that autism spectrum disorders (ASD) and Schizophrenic spectrum (SS) are different types of disorders in their etiology, symptoms and prognosis, but the clinical distinction is often difficult to make due to comorbidity and similar symptoms. Objectives With this project, the authors intend to explore the differential diagnosis between ASD and SS specially when we talk about critical ages of onset. Methods An analysis of articles searched on Pubmed (articles between 2010-2020) with the key words “adult autism”, “childhood onset schizophrenia”, “childhood psychosis”. Results Early-onset schizophrenia (EOS) is defined as occurring before age 18 years. The condition share key diagnostic symptoms with adult-onset schizophrenia (AOS) but his prognoses and comorbidities differ. Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by difficulties since early childhood across reciprocal social communication and restricted interests and behaviors. ASD is a lifelong neurodevelopmental disorder, however there is a lack of answers and research for adults with ASD. There are shared aspects of odd thinking, rigid behaviors and impaired socialization in schizophrenia and ASD and COS seems to have a strong relationship with ASD, being comorbid in up to 50% of cases. Conclusions Usually the evaluation of the developmental history of the person, prodrome and onset, its course and the presence of positive symptoms of schizophrenia is enough to help us find a diagnosis. Unfortunately, in some ages the conclusion is not so easy to find. However is essential to determine whether the clinical manifestations belong to the autistic spectrum, the schizophrenic or result from comorbidity.

RESUMO O objetivo deste trabalho é descrever o conhecimento popular relacionado à espinheira-santa (Maytenus ilicifolia) entre erveiros e feirantes que comercializam a planta no centro de Pelotas, Rio Grande do Sul, Brasil. Foi realizada uma pesquisa de abordagem qualitativa, exploratória e descritiva, de agosto a outubro de 2013. Entrevistas semi-estruturadas, com questões sobre os saberes e práticas relacionados à espinheira-santa, foram aplicadas a cinco erveiros e três feirantes do mercado informal de plantas medicinais. Para a análise dos dados foi utilizada a proposta operativa de Minayo, sendo Capra o referencial teórico para este estudo. Foi verificado que o saber relacionado ao uso da espinheira-santa é transmitido de geração a geração, embora existam outras fontes de conhecimento. As indicações do uso popular da espinheira-santa com finalidade terapêutica estão relacionadas a distúrbios gástricos, cicatrização e depuração do sangue. As diferentes formas dos sujeitos deste estudo interagirem com o ambiente, com sua família e em outras relações interpessoais resultam em diferentes saberes relacionados à espinheira-santa.

Introducción: La prevalencia de las alteraciones de la deglución varia ampliamente según la edad y comorbilidad. Objetivos: Determinar la prevalencia de disfagia y alteraciones de la alimentación en personas mayores que viven en residencias de la provincia de Sevilla, valorando la efectividad del consejo dietético. Métodos: Se realizó un estudio descriptivo transversal sobre una población de 3.921 residentes distribuidos en 86 residencias. En una primera fase del estudio se pretendía estimar la prevalencia de disfagia, para lo cual se seleccionaron 373 residentes en 23 residencias. En una segunda fase se seleccionó una muestra de residentes con disfagia, siendo reevaluados un mes después tras recibir consejo dietético y medidas básicas para control de disfagia. Resultados: La mediana de edad fue 80 (73-86) años, presentaron disfagia 60 (17,3%), y dificultades de alimentación 50 (13,4%). Ambas se asociaron de forma significativa (p < 0,05) con enfermedades neurológicas. Presentaron accidente cerebrovascular (AVC) 40 (11,3%), y demencia 123 (34,8%). En la segunda parte se estudiaron 12 pacientes con disfagia, de edad media 80,6 ± 11,9 años, MNA 19 ± 3, Barthel 24 ± 27, y grado de disfagia Karnell 3-4, en un 75% de los casos. Estos pacientes a los que se sometió a consejo dietético y medidas básicas para control de disfagia no mejoraron el nivel de ingesta, disfagia o dependencia. Conclusiones: La prevalencia de disfagia y dificultades de la alimentación es muy elevada en residencias. Las medidas estándar para el control de la disfagia son poco efectivas en pacientes con dependencia severa o demencia avanzada.Introduction: The prevalence of swallowing disorders widely varies depending on age and comorbidity. Objectives: To determine the prevalence of dysphagia and feeding disorders in elderly people living in nursing homes from the province of Seville and assess the effectiveness of dietary counselling. Methods: We carried out a cross-sectional descriptive study on a population of 3921 residents distributed among 86 nursing homes. At the first phase of the study, we pretended to estimate the prevalence of dysphagia so that we selected 373 residents in 23 nursing homes. At the second phase, a sample of residents with dysphagia was selected, being reassessed a month later after receiving dietary counselling and basic measures for managing dysphagia. Results: The median age was 80 (73.86) years, 60 (17.3%) had dysphagia and 50 (13.4%) had feeding difficulties. Both conditions were significantly (p < 0.05) associated with neurological diseases. Forty (11.3%) presented cerebrovascular accident and 123 (34.8%) dementia. Twelve patients with dysphagia were studied at the second phase, the mean age being 80.6±11.9 years, MNA 19 ± 3, Barthel 24 ± 27, and dysphagia Karnell level of 3-4 in 75% of the cases. These patients, receiving dietary counselling and basic measures for managing dysphagia, did not improve their intake level, dysphagia or dependency. Conclusions: The prevalence of dysphagia and feeding difficulties is high among nursing homes residents. The standard measures for controlling dysphagia are little effective in patients with severe dependence or advanced dementia.

Este artigo tem como objetivo apresentar o percurso da Saúde Escolar em Portugal. Abarca a análise de diversa literatura no âmbito da Educação e a construção de um pensamento reflexivo acerca da sua história. A primeira referência à Saúde Escolar data de 1901, evoluiu até aos nossos dias e passou por etapas diversas. Ao longo deste percurso, salientam-se, como momentos relevantes, nalgumas escolas, a existência de um médico e de uma visitadora, a preocupação com o exercício físico e o desporto, o acompanhamento do crescimento e desenvolvimento saudável dos alunos, o combate à droga, tendo como meta a promoção da saúde de todos os alunos inseridos na escolaridade obrigatória e, mais recentemente, a educação para a sexualidade, inserta na Educação Para a Saúde, tendo como primordial preocupação o bem-estar físico, intelectual, mental, psicológico e social das crianças e jovens.

Based on historical data of abundance, we report evidence of changes in zooplankton abundance in the 0-200 m layer related to the moon cycle confirming that this phenomenon is produced in the marine environment, similarly to the one described for freshwater ecosystems. A clear decrease in the abundance of copepodites plus copepods was observed from the second to the fourth quarter of the moon when the seasonal variability was suppressed. During the full moon phase the large zooplankton and micronekton of the deep scattering layers (DSL) would not reach the upper mixed layer in order to avoid predation because of the relatively high level of illumination. Thus epipelagic zooplankton abundance increases as the effect of a lower predatory pressure. Conversely, during the new moon phase the diel migrants reach the surface waters and epiplankton abundance considerably decreases. Recent oceanic sediment trap data in subtropical waters indicate that the particle flux increases at about 30 days period. Thus, the effect of diel vertical migrants could promote not only the variability in their resources and the intensity of the active flux, but could also drive the variability in the gravitational flux.

ObjectiveExamine whether glycaemic control varies according to sex and whether the latter plays a role in modifying factors associated with inadequate glycaemic control in patients with type 2 diabetes (T2D) in Brazil and Venezuela.Design, setting and participantsThis was a cross-sectional, nationwide survey conducted in Brazil and Venezuela from February 2006 to June 2007 to obtain information about glycaemic control and its determinants in patients with diabetes mellitus attending outpatient clinics.Main outcome measuresHaemoglobin A1c (HbA1c) level was measured by liquid chromatography, and patients with HbA1c ≥7.0% (53 mmol/mol) were considered to have inadequate glycaemic control. The association of selected variables with glycaemic control was analysed by multivariate linear regression, using HbA1c as the dependent variable.ResultsA total of 9418 patients with T2D were enrolled in Brazil (n=5692) and in Venezuela (n=3726). They included 6214 (66%) women and 3204 (34%) men. On average, HbA1c levels in women were 0.13 (95% CI 0.03 to 0.24; p=0.015) higher than in men, after adjusting for age, marital status, education, race, country, body mass index, duration of disease, complications, type of healthcare, adherence to diet, adherence to treatment and previous measurement of HbA1c. Sex modified the effect of some factors associated with glycaemic control in patients with T2D in our study, but had no noteworthy effect in others.ConclusionsWomen with T2D had worse glycaemic control than men. Possible causes for poorer glycaemic control in women compared with men include differences in glucose homeostasis, treatment response and psychological factors. In addition, sex modified factors associated with glycaemic control, suggesting the need to develop specific treatment guidelines for men and women.

The ability to control the activity of kinases spatially and temporally is essential to elucidate the role of signalling pathways in development and physiology. Progress in this direction has been hampered by the lack of tools to manipulate kinase activity in a highly controlled manner in vivo. Here we report a strategy to modify BI2536, the well characterized inhibitor of the conserved and essential mitotic kinase Polo-like kinase 1 (Plk1). We introduce the same coumarin photolabile protecting group (PPG) at two positions of the inhibitor. At one position, the coumarin prevents the interaction with Plk1, at the second it masks an added carboxylic acid, important for cellular retention. Exposure to light results in removal of both PPGs, leading to the activation of the inhibitor and its trapping inside cells. We demonstrate the efficacy of the caged inhibitor in three-dimensional spheroid cultures: by uncaging it with a single light pulse, we can inhibit Plk1 and arrest cell division, a highly dynamic process, with spatio-temporal control. Our design can be applied to other small molecules, providing a solution to control their activity in living cells with unprecedented precision. Light is a powerful tool for controlling biological processes. Here, the authors demonstrate its use to modulate inhibitor activity and diffusion, enabling precise control of cell division in multicellular systems with a single light pulse delivered via a microscope. [ABSTRACT FROM AUTHOR]