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Resumo Objetivo Avaliar o desempenho do Escore Pediátrico de Alerta (EPA) no rastreio de casos de sepse em um contexto hospitalar. Métodos Estudo de teste diagnóstico guiado pelas recomendações do Standards for the Reporting of Diagnostic Accuracy Studies (STARD). A amostra foi de 190 crianças e adolescentes internados em um hospital do interior da Bahia, Brasil. A coleta foi realizada em banco de dados de um projeto guarda-chuva, em prontuários e sistema de registros do hospital. O processamento e análise foram realizados no SPSS® version 25.0 for Windows e MedCalc® version 20.00. O desempenho do EPA no rastreio da sepse quando comparado aos critérios do padrão de referência foi mensurado através da Sensibilidade, Especificidade, Valores Preditivos e curva ROC. Resultados Dentre os participantes, 53,2% eram do sexo masculino, com média da idade de 4,39 anos (DP: 4,28) e mediana 3 anos (IIQ: 1 – 8). A prevalência da sepse identificada pelo padrão de referência foi de 10% e pelo EPA 23.1%. A sensibilidade, especificidade e valores preditivos positivo e negativo do EPA no rastreio de sepse foram de 73,7%, 82,5%, 31,8% e 96,6%, respectivamente. A área sob a curva ROC foi de 0,794. Conclusão O estudo apresenta evidências sobre o desempenho do EPA no rastreio da sepse, demonstrando boa acurácia na discriminação de pacientes pediátricos com e sem sepse na amostra estudada.

ABSTRACT Objective: To construct and validate an instrument to assess events related to maintaining the sterility of processed healthcare products. Methods: This methodological study developed the instrument through analysis by a panel of experts, focusing on the integrity of commonly used packaging: spunbond-meltblown-spunbond and medical-grade paper. The instrument was analyzed using the Content Validity Index and Content Validity Ratio (≥ 0.80) and modified Kappa (≥ 0.74). The instrument underwent pre-testing. Results: Six experienced professionals participated in the expert panel. After two rounds, the final version of the instrument contained five dimensions. In the pre-test, 30 nursing professionals participated, of whom 86.67% considered the instrument good, and 90% found it understandable. Conclusion: The construction and validation followed literature recommendations. The instrument is available, aiding in the safe use of processed healthcare products.

ABSTRACT Objectives: to develop and validate an instrument for the classification of pregnant and postpartum women according to the demand for nursing care. Methods: a methodological study conducted in three stages: 1) construction of the instrument based on literature review; 2) content validation using the Delphi technique with 12 experts; and 3) Evaluation of the convergent construct validity through the correlation between the scores of the constructed instrument and the Fugulin instrument. Results: an instrument with ten indicators of specific care for pregnant and postpartum women was developed. A content validity index higher than 0.9 was obtained, requiring only one round of the Delphi technique. The Spearman coefficient was 0.64 between the instruments, indicating a strong correlation. Conclusions: the classification instrument specifically constructed for pregnant and postpartum women showed evidence of content validity and convergent construct validity with a widely used instrument in the national territory.

As the United Nations develops a post-2020 global biodiversity framework for the Convention on Biological Diversity, attention is focusing on how new goals and targets for ecosystem conservation might serve its vision of 'living in harmony with nature'1,2. Advancing dual imperatives to conserve biodiversity and sustain ecosystem services requires reliable and resilient generalizations and predictions about ecosystem responses to environmental change and management3. Ecosystems vary in their biota4, service provision5 and relative exposure to risks6, yet there is no globally consistent classification of ecosystems that reflects functional responses to change and management. This hampers progress on developing conservation targets and sustainability goals. Here we present the International Union for Conservation of Nature (IUCN) Global Ecosystem Typology, a conceptually robust, scalable, spatially explicit approach for generalizations and predictions about functions, biota, risks and management remedies across the entire biosphere. The outcome of a major cross-disciplinary collaboration, this novel framework places all of Earth's ecosystems into a unifying theoretical context to guide the transformation of ecosystem policy and management from global to local scales. This new information infrastructure will support knowledge transfer for ecosystem-specific management and restoration, globally standardized ecosystem risk assessments, natural capital accounting and progress on the post-2020 global biodiversity framework.

Research licensing administered by the Nunavut Research Institute (NRI) affords Nunavummiut (people of Nunavut) an opportunity to engage in research. The NRI partnered with researchers at McMaster and Carleton Universities to investigate social sciences research licensed between 2004 and 2019. This partnership aimed to understand the scope of research trends in Nunavut. Thematic content analysis was used to (i) identify research topics in social sciences and Inuit knowledge projects; (ii) determine frequency and diversity of topics according to leadership, location, and timeframe; (iii) develop metrics to improve tracking of research; and (iv) contribute to the development of a Nunavut research portal making NRI research applications and reports public. Social sciences research increased during the 16-year study period. Projects were predominantly led by Canadian academics. The highest intensity of research occurred in Iqaluit, and the lowest intensity in Grise Fiord. Social sciences research was mainly focused on topics related to Inuit culture and knowledge. Social scientists most often conducted research using interviews and shared their work via peer-reviewed journal articles. This project is a starting point in raising awareness about research trends for Nunavummiut. This work aims to contribute to broader efforts in developing Nunavut-specific approaches to achieving Inuit self-determination in research.

Abstract Nations have committed to reductions in the global rate of species extinctions through the Sustainable Development Goals 14 and 15, for ocean and terrestrial species, respectively. Biodiversity loss is worsening despite rapid growth in the number and extent of protected areas, both at sea and on land. Resolving this requires targeting the locations and actions that will deliver positive conservation outcomes for biodiversity. The Species Threat Abatement and Restoration (STAR) metric, developed by a consortium of experts, quantifies the contributions that abating threats and restoring habitats in specific places offer towards reducing extinction risk based on the IUCN Red List of Threatened SpeciesTM. STAR is now recommended as an appropriate metric by recent disclosure frameworks for companies to report their impacts on nature and STAR has seen widespread uptake within the private sector. However, it is currently only available for the terrestrial realm. We extend the coverage of the threat abatement component of the STAR metric (START), used to identify locations where positive interventions could make a large contribution to reducing global species extinction risk and where developments that increase threats to species should be mitigated, to the marine realm for 1646 marine species. Reducing unsustainable fishing provides the greatest opportunity to lower species extinction risk, comprising 43% of the marine START score. Three-quarters (75%) of the global marine START score falls entirely outside the boundaries of protected areas and only 2.7% falls within no-take protected areas. The STAR metric can be used both to guide protected area expansion and to target other actions, such as establishment and enforcement of fishing limits, to recover biodiversity.

Introduction: Overcoming misinformation is essential considering stigma and discrimination in the HIV/AIDS epidemic. This report presents the preliminary results of a health education strategy based on the massive open online course (MOOC) on Zero Discrimination in Brazil. Methods: Case study describing the development of the MOOC and its validation using the Delphi technique. Pre- and posttests were administered. People who enrolled from October 2021 to March 2022 were included in the study. Results and discussion: MOOC was made available free of charge for mobile phones, tablets, and desktops and included a 90-hr study certificate. Over 6 months, there were n = 665 people enrolled from different regions, mainly from the health field or working in the public health system. The completion rate of people included in the study (26.62%; n = 177) was above the average for other MOOCs. Conclusions: Initial results are promising but demand more extensive monitoring.

Objective: to evaluate the Nursing workload and its related factors in the assistance provided to hospitalized women with gynecological and breast cancers, according to the Nursing Activities Scores adapted for cancer patients. Method: a cross-sectional and epidemiological study. The participants were women with gynecological and/or breast cancer, over 18 years of age, and hospitalized for a minimum period of 24 hours. The following was collected from the medical records: sociodemographic and clinical data, Karnofsky Performance Status and workload, according to the adapted Nursing Activities Score. The factors related to workload were analyzed by means of multiple linear regression. Results: the mean Nursing Activities Scores was 29.3%, denoting seven hours of daily care per patient. The factors related to workload differed according to the breast or gynecological cancer diagnosis (β=-0.01; p

BackgroundBiological aging estimators derived from DNA methylation data are heritable and correlate with morbidity and mortality. Consequently, identification of genetic and environmental contributors to the variation in these measures in populations has become a major goal in the field.ResultsLeveraging DNA methylation and SNP data from more than 40,000 individuals, we identify 137 genome-wide significant loci, of which 113 are novel, from genome-wide association study (GWAS) meta-analyses of four epigenetic clocks and epigenetic surrogate markers for granulocyte proportions and plasminogen activator inhibitor 1 levels, respectively. We find evidence for shared genetic loci associated with the Horvath clock and expression of transcripts encoding genes linked to lipid metabolism and immune function. Notably, these loci are independent of those reported to regulate DNA methylation levels at constituent clock CpGs. A polygenic score for GrimAge acceleration showed strong associations with adiposity-related traits, educational attainment, parental longevity, and C-reactive protein levels.ConclusionThis study illuminates the genetic architecture underlying epigenetic aging and its shared genetic contributions with lifestyle factors and longevity.

The potentialities of mechanochemistry trough extrusion have been investigated for the design of nanosized catalysts and their use in C-C bond-forming reactions. The mechanochemical approach proved successful for the synthesis of supported palladium nanoparticles with mean diameter within 6–10 nm, achieved by the reduction of Pd(II) acetate with ethylene glycol, in the absence of any solvent. A mesoporous N-doped carbon derived from chitin as a renewable biopolymer, was used as a support. Thereafter, the resulting nanomaterials were tested as catalysts to implement a second extrusion based-protocol for the Suzuki-Miyaura cross-coupling reaction of iodobenzene and phenylboronic acid. The conversion and the selectivity of the reaction were 81% and >99%, respectively, with a productivity of the desired derivative, biphenyl, of 41 mmol gcat−1 h−1.

Abstract The approval of anticancer therapeutic strategies is still slowed down by the lack of models able to faithfully reproduce in vivo cancer physiology. On one hand, the conventional in vitro models fail to recapitulate the organ and tissue structures, the fluid flows, and the mechanical stimuli characterizing the human body compartments. On the other hand, in vivo animal models cannot reproduce the typical human tumor microenvironment, essential to study cancer behavior and progression. This study reviews the cancer-on-chips as one of the most promising tools to model and investigate the tumor microenvironment and metastasis. We also described how cancer-on-chip devices have been developed and implemented to study the most common primary cancers and their metastatic sites. Pros and cons of this technology are then discussed highlighting the future challenges to close the gap between the pre-clinical and clinical studies and accelerate the approval of new anticancer therapies in humans.

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is an interventional procedure that requires deep sedation or general anaesthesia. The purpose of this prospective observational study was to assess the feasibility and safety of deep sedation in ERCP to maintain spontaneous breathing. Methods This is a single-centre observational prospective cohort study conducted in a tertiary referral university hospital. All consecutive patients who needed sedation or general anaesthesia for ERCP were included from January 2021 to June 2021. Deep sedation was achieved and maintained by continuous infusion of an association of propofol and remifentanil. The primary endpoint was to assess the prevalence of major anaesthesia-related complications, such as arrhythmias, hypotension, gas exchange dysfunction, and vomiting (safety endpoint). Secondary endpoints were: (a) to assess the prevalence of signs of an insufficient level of sedation, such as movement, cough, and hiccups (feasibility endpoint): (b) time needed to achieve the target level of sedation and for recovery from anaesthesia. In order to do so we collect the following parameters: peripheral oxygen saturation, fraction of inspired oxygen, noninvasive systemic blood pressure, heart rate, number of breaths per minute, neurological functions with the use of the bispectral index to determine depth of anaesthesia, and partially exhaustive CO2 end pressure to continuously assess the ventilatory status. The collected data were analysed by several tests: Shapiro-Wilk, Student’s t, Tuckey post-hoc, Wilcoxon rank-sum and Kruskall-Wallis ran. Statistical analysis was performed using Stata/BE 17.0 (StataCorp LLC). Results 114 patients were enroled. Eight patients were excluded because they did not meet the inclusion criteria. We found that all patients were hemodynamically stable: intraoperative mean systolic blood pressure was 139,23 mmHg, mean arterial pressure was on average 106,66 mmHg, mean heart rate was 74,471 bpm. The mean time to achieve the target level of sedation was 63 s, while the mean time for the awakening after having stopped drug infusion was 92 s. Conclusions During ERCP, deep sedation and analgesia using the association of propofol and remifentanil and maintaining spontaneous breathing are safe and feasible, allowing for a safe and quick recovery from anaesthesia.

Background & Aims: Cholangiocarcinoma (CCA) is a primary liver tumour characterised by a poor prognosis and limited therapeutic options. Available 3D human CCA models fail to faithfully recapitulate the tumour niche. We aimed to develop an innovative patient-specific CCA-on-chip platform. Methods: A CCA tumour microenvironment was recapitulated on a microfluidic three-channel chip using primary CCA cells, cancer-associated fibroblasts (CAFs), endothelial cells, and T cells isolated from CCA specimens (n = 6). CAF and CCA cells were co-cultured in the central channel, flanked by endothelial cells in one lateral channel, recreating a tubular structure. An extensive characterisation of this platform was carried out to investigate its diffusion ability, hydrogel properties, and changes in matrix composition. Cell phenotype and functional properties were assessed. Results: Primary cells seeded on the microfluidic device were shown to reproduce the architectural structure and maintain the original phenotype and functional properties. The tumour niche underwent a deep remodelling in the 3D device, with an increase in hydrogel stiffness and extracellular matrix deposition, mimicking in vivo CCA characteristics. T cells were incorporated into the device to assess its reliability for immune cell interaction studies. Higher T cell migration was observed using cells from patients with highly infiltrated tumours. Finally, the drug trial showed the ability of the device to recapitulate different drug responses based on patient characteristics. Conclusions: We presented a 3D CCA platform that integrates the major non-immune components of the tumour microenvironment and the T cell infiltrate, reflecting the CCA niche. This CCA-on-chip represents a reliable patient-specific 3D platform that will be of help to further elucidate the biological mechanisms involved in CCA and provide an efficient tool for personalised drug testing. Impact and implications: An innovative patient-specific cholangiocarcinoma (CCA)-on-chip platform was successfully developed, integrating the major components of the tumour microenvironment (tumour cells, cancer-associated fibroblasts, endothelial cells, and immune infiltrate) and faithfully mimicking the CCA niche. This CCA-on-chip represents a powerful tool for unravelling disease-associated cellular mechanisms in CCA and provides an efficient tool for personalised drug testing.