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Abstract Background Gestational diabetes is one of the most prevalent diseases in pregnancy, with an incidence of 5 to 18% in Brazil, and is associated with high morbidity rates. The first-line treatment is insulin, although some recent studies have indicated that metformin might also be effective. Metformin is safe in pregnancy and appears to produce better results than insulin, including reduced gestational weight gain (GWG) and smaller gestational-age newborns. Few studies have been conducted on this topic in low- and middle-income countries. Methods We designed an open randomized controlled trial comparing two treatments for pregnant women with type II diabetes mellitus (DM) and gestational diabetes (DMG): the metformin group (intervention) and the insulin group (as a routine service). The primary outcome is glycemic control. The secondary outcomes are GWG, the occurrence of hypertensive syndromes, macrosomia, and neonatal hypoglycemia. The sample will comprise 92 pregnant women, 46 per group. The inclusion criteria will be GDM or type II DM requiring medication for glycemic control, singleton pregnancy, and gestational age under 34 weeks. The exclusion criteria will be current treatment with any medication for glycemic control, type I DM, and intolerance to the study medications (metformin or insulin). Women will be routinely followed during antenatal care, childbirth, and the postpartum period. Statistical analyses will include the intention-to-treat approach and a comparison between the two groups. Discussion Considering the Brazilian socioeconomic reality and the safety of metformin demonstrated in previous trials, we expect that the MevIP study will demonstrate that metformin is an adequate and appropriate medication for GDM treatment in the Brazilian population, representing an alternative to insulin for GDM. Trial registration This protocol has been registered prospectively in ReBEC under the ID RBR-3j3cktx in August 11, 2023.

Abstract A suspected 443-486 kt of methane escaped from the Nord Stream pipelines in September 2022 at four explosion sites across three pipelines. Much of this methane rapidly escaped to the atmosphere, while an unknown amount was dissolved. We use sustained high-resolution observations of methane concentrations from autonomous gliders and an instrumented ship of opportunity to reveal the timing and spread of dissolved methane across different Baltic regions and marine protected areas. Estimates of methane spread and concentrations are essential to understand the ecosystem response, and for establishing accurate priors for atmospheric outgassing and transport models. A numerical model, initialized by engineering estimates and our observations, enables us to constrain the mass of locally dissolved Nord Stream methane (9.5-14.7 kt). We show that dissolved methane decreased rapidly through outgassing, however initial concentrations were so high that 14% of the Baltic Sea still experienced concentrations 5 times greater than average natural levels.

Abstract The Nord Stream pipeline leaks on 26 September 2022 released 465 ± 20 kt of methane into the atmosphere, which is the largest recorded transient anthropogenic methane emission event. While most of the gas escaped directly to the atmosphere, a fraction dissolved in the water. So far, studies on the fate of this dissolved methane rely on pipeline volumetric estimates or spatially sparse concentration measurements and ocean models. Here, we use atmospheric measurements with broad spatial coverage obtained from an airborne platform to estimate outgassing of 19-48 t h−1 on 5 October 2022. Our results broadly agree with ocean models but reveal uncertainties such as inaccuracies in their spatial emission distribution. Thus, we provide a data-driven constraint on the fate of the methane from the Nord Stream pipelines in the Baltic Sea. These results demonstrate the benefit of a fast-response airborne mission to track a dynamic methane emission event.

Significant research has been carried out in the last decade to describe the CO2 system dynamics in the Baltic Sea. However, there is a lack of knowledge in this field in the NE Baltic Sea, which is the main focus of the present study. We analysed the physical forcing and hydrographic background in the study year (2018) and tried to elucidate the observed patterns of surface water CO2 partial pressure (pCO2) and methane concentrations (cCH4). Surface water pCO2 and cCH4 were continuously measured during six monitoring cruises onboard R/V Salme, covering the Northern Baltic Proper (NBP), the Gulf of Finland (GoF), and the Gulf of Riga (GoR) and all seasons in 2018. The general seasonal pCO2 pattern showed oversaturation in autumn–winter (average relative CO2 saturation 1.2) and undersaturation in spring–summer (average relative CO2 saturation 0.5), but it locally reached the saturation level during the cruises in April, May, and August in the GoR and in August in the GoF. The cCH4 was oversaturated during the entire study period, and the seasonal course was not well exposed on the background of high variability. Surface water pCO2 and cCH4 distributions showed larger spatial variability in the GoR and GoF than in the NBP for all six cruises. We linked the observed local maxima to river bulges, coastal upwelling events, fronts, and occasions when vertical mixing reached the seabed in shallow areas. Seasonal averaging over the CO2 flux suggests a weak sink for atmospheric CO2 for all basins, but high variability and the long periods between cruises (temporal gaps in observation) preclude a clear statement.

Infertility due to non-obstructive azoospermia is a common diagnosis in infertile male dogs. Chronic asymptomatic orchitis (CAO) has been postulated as a significant cause of non-obstructive azoospermia in acquired male canine infertility. Despite severe microenvironmental changes, some resilient spermatogonial stem cells persist in CAO-affected testes. As Sertoli cells play an essential role in spermatogenesis and the testicular micromilieu, they represent a new target for CAO potential treatment and consequently deserve further investigation. To investigate Sertoli cell number and maturational status, different markers [Vimentin, anti-Müllerian hormone (AMH), and cytokeratin-18 (CK18)] were evaluated in healthy and CAO-affected testes at mRNA and protein levels. Sertoli cell number was reduced in CAO-affected dogs. Sertoli cells also partly returned to an immature status, as indicated by the expression of AMH and CK18 at mRNA and protein levels. The degree of spermatogenesis disruption matched with the degree of Sertoli cell alterations. The investigation of CAO in this study is limited by the number of samples and the lack of testicular volume measurements, but this does not diminish its importance in new findings. In conclusion, this study identifies alterations in Sertoli cell number and maturation status as a cause or consequence of CAO. The results indicate the need to restore Sertoli cell function as a potential therapeutic target for a successful restart of spermatogenesis.

IntroductionThe potential consequences of back pain (BP) are poorly described in adolescents. This study evaluated the association between BP sites (neck, thoracic and low back) and number of painful sites with missed school classes, interference in physical activities, seeking healthcare, and medication use among school adolescents.MethodsThis cross-sectional study included 350 students (5th to 9th grade) of a public school in Brazil. Information on BP site and outcomes were self-reported. Logistic regression analyses were performed.ResultsParticipants reporting at least one painful site in spine were 74.9% (n = 262), with mean age of 12.73 ± 1.67 (55.7% were girls). Most of them reported pain in two sites (n = 100; 28.6%) and the most frequent pain site was neck (n = 223; 63.7%). Thoracic and low BP were associated with missing school classes, interference in physical activities, seeking healthcare, and medication use, while neck pain showed no association. The number of painful sites was associated with daily activities and healthcare with those gradients increasing with the number of painful sites.ConclusionThoracic and low BP were associated with daily activities, seeking healthcare, and medication use in early adolescence.

This paper explores the use of unplugged activities as a pedagogical approach for teaching computational thinking (CT) to student teachers at a Danish university college in the subject technology comprehension. Through an analysis of three cases—a toothbrushing routine, a political profiling quiz, and an interactive story creation—the study examines students’ learning experiences and engagement with CT concepts and practices. The paper employs a methodological approach rooted in participatory observation and visual ethnography. Data collection includes video recordings, audio recordings, post-class interviews, and artefacts created by the students. The analysis reveals possibilities as well as challenges experienced by students in their involvement in computational thinking activities, including algorithms, decomposition, and abstraction. These findings contest the oversimplified classification of activities as either 'plugged' or 'unplugged', suggesting that alternative factors hold more substantial importance. Subsequently, the paper explores the roles of self-efficacy and ‘be-greifbarkeit’ in students' learning processes, thereby elucidating how students' motivation and learning expectations, in conjunction with their tangible experiences and conceptual understandings, influence the development of their computational thinking competencies. In conclusion, the study provides valuable insights for teacher educators, emphasising the need to consider the perceived complexity of the activity, including the students’ prerequisites for engaging with plugged and unplugged elements. It highlights the multifaceted nature of plugged and unplugged approaches, offering a nuanced perspective on their impact on students' learning experiences in the field of computational thinking.

ObjectivesTo conduct a systematic review to determine the acute and chronic effects of inspiratory muscle training (IMT) in type 2 diabetes mellitus (T2DM) patients on cardiac autonomic function, glucose variability, inspiratory muscle strength and endurance, hemodynamic variables, and exercise capacity.MethodsA search was carried out according to a specific search strategy, following the PRISMA statement, and three independent reviewers have undertaken the article selection process. Searches were carried out in June 2023, on the following electronic databases: EMBASE, MEDLINE (PubMed), SCOPUS (Elsevier), and Web of Science. The methodological quality of the studies was assessed using the PEDro scale. The search was limited to English-language, randomized controlled trials (RCTs), involving T2DM patients (>18 years old, with or without autonomic neuropathy, and/or inspiratory muscle weakness) following an acute or chronic intervention protocol based on IMT. Exclusion criteria were reviews, clinical trials, case studies, theses, dissertations, scientific conference abstracts, subjects with other chronic respiratory/neurological/cardiovascular diseases, and studies addressing other breathing exercises.ResultsThe search strategy identified 1,352 studies, of which eight (two involving acute and six involving chronic IMT effects) were included. A total of 214 adults aged 52–63 years (51/49 male/female ratio), with BMI ranging from 27 to 36.8 kg/m², were included. The results demonstrated that after IMT, acute effects were reported, such as reduced glucose levels and an increase in the parasympathetic pathway, but also chronic effects including improved inspiratory muscle strength, endurance, and exercise capacity.ConclusionAlthough some methodological differences among the studies were found, IMT may have beneficial effects on cardiac autonomic function, glucose level control, inspiratory muscle strength/endurance as well as exercise capacity. However, further studies are necessary to confirm these benefits.

This paper discusses the significance of school curricula in reflecting societal priorities and needs, focusing on the incorporation of computational thinking (CT) in Nordic national curricula. Our point of departure is that the preparedness of future generations for a digitally driven society can be determined by analysing how CT is either explicitly or implicitly framed in school curricula. Accordingly, this study examined the school curricula of Denmark, Finland, and Norway in terms of their similarities and differences in how they framed CT, as these countries have different approaches to the inclusion of CT. A framework for analysis that was grounded in influential works on CT in education was developed, focusing on problem-solving, algorithmic and transversal practices. National-level curricula were examined using a content analysis. Despite the differences in the approaches used in these countries, our findings indicate similarities across all three curricula, with an emphasis on how CT was framed.

IntroductionThe design of Pediatric Intensive Care Unit (PICU) rooms significantly impacts patient care and satisfaction. The aims were first, to describe the current physical space across PICUs in the USA, and second, to identify what proportion of PICUs are compliant with current guidelines.MethodsA descriptive cross-sectional survey was conducted, targeting division chiefs and medical directors of PICUs nationwide. The survey collected data on unit type, construction and renovation dates, room sizes, and available amenities. According to the Guidelines for Design and Construction of Hospitals, PICU rooms are recommended to be single rooms, at least 200 sq ft, have a window and a private bathroom. Data were anonymized and reported as median and interquartile ranges or frequencies and percentages.ResultsThirty units responded. Among the respondents, 26 had general PICUs, 9 had cardiac ICUs, and 3 had intermediate care units, with some units containing multiple types of ICUs. The median annual admissions were 1,125, with a median occupancy rate of 78%. Twenty-three percent of units had at least one double room, and 3% had triple or quadruple rooms. The median room size was 265 sq ft (IQR 230; 304), the smallest room size was 220 sq ft (IQR 179; 275), and the largest single room size was 312 sq ft (IQR 273; 330). Thirty-seven percent of units had bathrooms in every room, while 80% had windows in every room. Additionally, 46% of units had dialysis capabilities in every room, and 7% had negative pressure capabilities in every room. The median building year was 2008 (IQR 2001;2014), with 36% of units having undergone at least one renovation. Larger rooms were associated with more recent build dates (p = 0.01). Only 30% of the PICUs met the guidelines for physical space. These compliant units were built at a median of 4 years ago (IQR 1; 8).ConclusionThis study highlights the variability in PICU room design and amenities across healthcare facilities. Many units still fall short of meeting the guidelines for room size, windows, and private bathrooms. Future research should investigate the relationship between room characteristics and patient outcomes to inform better design practices, with a goal of improving patient experiences and clinical outcomes.

BackgroundA better understanding of the consequences of the Coronavirus Disease 2019 (COVID-19) pandemic on lifestyle of patients with Chagas disease (ChD) is of paramount importance to facilitate the implementation of intervention strategies tailored to this specific population.ObjectiveThe present study aimed to evaluate the level of physical activity (PA) in Chagas disease (ChD) patients during the Coronavirus Disease 2019 (COVID-19) pandemic and its main associated factors.MethodsThis is a cross-sectional study with 187 patients of both sexes, aged ≥18 years, followed in a national infectious disease center (Rio de Janeiro, Brazil). The level of PA was determined by the International Physical Activity Questionnaire short version and expressed in terms of total volume of physical activity (PA) (MET-minutes per week). Individuals were classified as physically active following the 2020 World Health Organization PA guideline. The exposure variables were age, sex, race, marital status, schooling, income per capita, number of rooms per domicile, number of residents per domicile, body mass index, clinical form of ChD, COVID-19 antibodies, comorbidities, self-reported anxiety, self-reported depression, self-reported fear, and self-reported sadness. The association between the exposure variables with total PA (as a continuous variable) was determined using univariate and multivariate linear regression models.ResultsMean age was 61.1 ± 11.6 years. Most (62%) were women and self-declared their race as mixed (50.8%). The percentage of physically active individuals according to was 52%. The variables independently associated with total PA levels were non-white race (Exp β = 1.39; 95% CI 1.02 to 1.90), dyslipidemia (Exp β = 0.73; 95% CI 0.56 to 0.95) and self-reported depression during quarantine (Exp β = 0.71; 95% CI 0.52 to 0.96).ConclusionNon-white race was positively associated with total levels of PA, while dyslipidemia, and self-reported depression during quarantine were negatively associated with total levels of PA. The identification of associated factors can facilitate the development of tailored strategies to increase PA levels ChD patients.

Kidney cancer is a common malignancy that constitutes around 5% of all cancer cases. Males are twice as likely to acquire renal cell carcinoma (RCC) compared to females and experience a higher rate of mortality. These disparities indicate that sex hormone (SH)-dependent pathways may have an impact on the aetiology and pathophysiology of RCC. Examination of SH involvement in conventional signalling pathways, as well as genetics and genomics, especially the involvement of ribonucleic acid, reveal further insights into sex-related differences. An understanding of SHs and their influence on kidney cancer is essential to offer patients individualized medicine that would better meet their needs in terms of prevention, diagnosis and treatment. This review presents the understanding of sex-related differences in the clinical manifestation of kidney cancer patients and the underlying biological processes.

ABSTRACT BACKGROUND: Brazilian medical schools equitably divide their medical education assessments into five content areas: internal medicine, surgery, pediatrics, obstetrics and gynecology, and public health. However, this division does not follow international patterns and may threaten the examinations’ reliability and validity. OBJECTIVE: To assess the reliability indices of the content areas of serial, cross-institutional progress test examinations. DESIGN AND SETTINGS: This was an analytical, observational, and cross-sectional study conducted at nine public medical schools (mainly from the state of São Paulo) with progress test examinations conducted between 2017 and 2023. METHODS: The examinations covered the areas of basic sciences, internal medicine, surgery, pediatrics, obstetrics and gynecology, and public health. We calculated reliability indices using Cronbach’s α, which indicates the internal consistency of a test. We used simple linear regressions to analyze temporal trends. RESULTS: The results showed that the Cronbach’s α for basic sciences and internal medicine presented lower values, whereas gynecology, obstetrics, and public health presented higher values. After changes in the number of items and the exclusion of basic sciences as a separate content area, internal medicine ranked highest in 2023. Individually, all content areas except pediatrics remained stable over time. CONCLUSIONS: Maintaining an equitable division in assessment content may lead to suboptimal results in terms of assessment reliability, especially for internal medicine. Therefore, content sampling of medical knowledge for general assessments should be reappraised.

Background: Studies evaluating physical activity (PA) levels in individuals with Chagas disease (CD) are still scarce. The present study aimed to evaluate PA levels in CD individuals and examine their association with Chagas heart disease (ChHD). Methods: We included patients with CD regularly followed in a reference center for treatment of infectious diseases. PA levels were assessed using the short version of the International Physical Activity Questionnaire (IPAQ). ChHD was determined following the Brazilian Consensus on Chagas Disease. The association between ChHD and levels of PA (total, walking, moderate, and vigorous) as a continuous variable was fitted using generalized linear models. Logistic regression models were fitted to evaluate the association between ChHD and meeting WHO’s PA recommendations. Results: Among the 361 participants included in the analysis (60.7 ± 10.7 years; 56.2 % women), 58.1 % (n = 210) complied with the WHO’s PA recommendations. After adjustments for potential confounders, regression analyses revealed that ChHD without heart failure was significantly associated with reduced vigorous PA (Exp β 0.32 95 % CI 0.10 to 0.98). ChHD with heart failure had significantly lower levels of total (Exp β 0.61 95 % CI 0.44 to 0.84) and moderate (Exp β 0.59 95 % CI 0.39 to 0.89) PA. ChHD with heart failure had a lower odd of meeting the PA recommendation in comparison to those with no cardiac involvement (OR 0.48 95 % CI 0.24 to 0.97). Conclusions: We found low levels of PA among individuals with CD. Presence of ChHD (mainly with HF) was associated with decreased levels of PA.

Ocean surface pCO2 estimates are of great interest for the calculation of air–sea CO2 fluxes, oceanic uptake of anthropogenic CO2, and eventually the Global Carbon Budget. They are accessible from direct observations, which are discrete in space and time and thus always sparse, or from biogeochemical models, which only approximate reality. Here, a combined method for the extrapolation of pCO2 observations is presented that uses (1) model-based patterns of variability from an empirical orthogonal function (EOF) analysis of variability with (2) observational data to constrain EOF pattern amplitudes in (3) an ensemble approach, which locally adjusts the spatial scale of the mapping to the density of the observations. Thus, data-constrained, gap- and discontinuity-free mapped fields including local error estimates are obtained without the need for or dependence on ancillary data (e.g. satellite sea surface temperature maps). This extrapolation approach is generic in that it can be applied to any oceanic or coastal region covered by a suitable model and observations. It is used here to establish a regional pCO2 climatology of the Baltic Sea (Bittig et al., 2023: https://doi.org/10.1594/PANGAEA.961119), largely based on ICOS-DE ship of opportunity (SOOP) Finnmaid surface pCO2 observations between Lübeck-Travemünde (Germany) and Helsinki (Finland). The climatology can serve as improved input for atmosphere–ocean CO2 flux estimation in this coastal environment.

Wireless communications with greater transmission capacities are possible in the millimeter wave (mmWave) region. However, to overcome the significant propagation losses in this frequency band, it is necessary to employ more efficient and intelligent antennas based on MIMO and beam-steering phased array technologies. This paper demonstrates the fabrication of a beam steerable array antenna using a $4\times 4$ Butler matrix at 60 GHz employing the metallic nanowire membrane (MnM) substrate. This substrate has the advantage of interconnecting two metallization layers by vias fabricated through its nanopores. Experimental characterization of the fabricated samples shows that the MnM platform represents a high-potential candidate for millimeter-wave front-ends supporting the beam-steering technique.

Abstract Objective Pregnancy after bariatric surgery is a reality of the 21st century and therefore is essential that all obstetricians know how to manage it. The most prevalent nutritional deficiency is iron deficiency and, consequently, anemia. Although bariatric surgery and pregnancy are already risk factors for anemia, we evaluated in our study if there were any other risk factors and actions to improve hemoglobin levels in this population. Methods We performed a retrospective cohort study, and performed frequency measurements and analyzes of odds ratio, X2 and Fisher exact test to evaluate the risk factors. Results We evaluated 44 pregnancies after bariatric surgery, with an incidence of anemia of 62%, and the only identifiable risk factor for anemia was being black. As for the treatment, the iron salt used for oral supplementation did not associate with anemia risk, and in 27% of the patients, the adjustment of the oral dosage was enough for improvement in hemoglobin levels, but in 36% supplementation with intravenous iron was necessary. Conclusion Being black is a risk factor for anemia. The type of iron salt does not correlate with the incidence of anemia, and for the treatment and improvement of iron dosages, it seems an effective increase in iron intake.

Abstract Objective Evaluate the different perspectives that involve the choice of long-acting reversible contraceptives (LARCs), the issues related to this process and the consequences of deciding one method in the women's in the primary health care (PHC) center in Sousas, a district in Campinas, SP (Brazil). Methods This is an analytical cross-sectional study, it was performed at the PHC in Sousas. Data were collected through the analysis of medical records and interviews with women who live in Sousas and had the insertion of the copper intrauterine device (IUD) (D) from April 2021 to April 2022 or the etonogestrel implant (I) from May to December 2022. The study was approved by the Research Ethics Committee of the Medical Science School at the State University of Campinas (UNICAMP). Results Reason for choosing this LARC: medical (D: 52%; I: 100%), easy adhesion (D: 71%; I: 67%), effectiveness (D: 55%; I: 100%). Indication by health professionals (D: 65%; I: 100%). And improvement of clinical characteristics: mood (D: 77%; I: 67%), body mass index (BMI; D: 52%; I: 33%), and libido (D: 84%; I: 67%). Conclusion It is suggested that women tend to decide between LARCs when guided by their doctor or PHC health professionals, and they select LARCs because of the ease of use and low failure rates. Therefore, this study highlights how LARCs can positively interfere in the aspects that pervade contraception, such as BMI, libido, and mood.

Abstract Increasing atmospheric CO2 drives ocean acidification globally. In coastal seas, acidification trends can however be either counteracted or enhanced by other processes. Ecosystem effects of acidification are so far small in the Baltic Sea, but changes should be anticipated unless CO2 emissions are curbed. Possible future acidification trends in the Baltic Sea, conditional on CO2 emissions, climate change, and changes in productivity, can be assessed by means of model simulations. There are uncertainties regarding potential consequences for marine organisms, partly because of difficulties to assign critical thresholds, but also because of knowledge gaps regarding species’ capacity to adapt. Increased temporal and spatial monitoring of inorganic carbon system parameters would allow a better understanding of current acidification trends and also improve the capacity to predict possible future changes. An additional benefit is that such measurements also provide quantitative estimates of productivity. The technology required for precise measurements of the inorganic carbon system is readily available today. Regularly updated status evaluations of acidification, and the inorganic carbon system in general, would support management when assessing climate change effects, eutrophication or characteristics of the pelagic habitats. This would, however, have to be based on a spatially and temporally sufficient monitoring program.

ABSTRACT Objective This study aimed to evaluate the prevalence of hypertensive disorders during pregnancy among Brazilian women with preterm births and to compare the epidemiological characteristics and perinatal outcomes among preterm births of women with and without hypertension. Methods This was a secondary cross-sectional analysis of the Brazilian Multicenter Study on Preterm Birth. During the study period, all women with preterm births were included and further split into two groups according to the occurrence of any hypertensive disorder during pregnancy. Prevalence ratios were calculated for each variable. Maternal characteristics, prenatal care, and gestational and perinatal outcomes were compared between the two groups using χ2 and t-tests. Results A total of 4,150 women with preterm births were included, and 1,169 (28.2%) were identified as having hypertensive disorders. Advanced maternal age (prevalence ratio (PR) 2.49) and obesity (PR= 2.64) were more common in the hypertensive group. The gestational outcomes were worse in women with hypertension. Early preterm births were also more frequent in women with hypertension. Conclusion Hypertensive disorders of pregnancy were frequent among women with preterm births, and provider-initiated preterm births were the leading causes of premature births in this group. The factors significantly associated with hypertensive disorders among women with preterm births were obesity, excessive weight gain, and higher maternal age.

The Arctic is warming at an above-average rate, and small, shallow waterbodies such as ponds are vulnerable to this warming due to their low thermal inertia compared to larger lakes. While ponds are a relevant landscape-scale source of methane under the current climate, the response of pond methane emissions to warming is uncertain. We employ a new, process-based model for methane emissions from ponds (MeEP) to investigate the methane emission response of polygonal-tundra ponds in northeastern Siberia to warming. MeEP is the first dedicated model of pond methane emissions which differentiates between the three main pond types of the polygonal-tundra, ice-wedge, polygonal-center, and merged polygonal ponds and resolves the three main pathways of methane emissions – diffusion, ebullition, and plant-mediated transport. We perform idealized warming experiments, with increases in the mean annual temperature of 2.5, 5, and 7.5 ∘C on top of a historical simulation. The simulations reveal an approximately linear increase in emissions from ponds of 1.33 g CH4 yr−1 ∘C−1 m−2 in this temperature range. Under annual temperatures 5 ∘C above present temperatures, pond methane emissions are more than 3 times higher than now. Most of this emission increase is due to the additional substrate provided by the increased net productivity of the vascular plants. Furthermore, plant-mediated transport is the dominating pathway of methane emissions in all simulations. We conclude that vascular plants as a substrate source and efficient methane pathway should be included in future pan-Arctic assessments of pond methane emissions.

Background: COVID-19 is usually milder in children and adolescents, leading to lower hospital admission rates than adults. This study evaluated clinical manifestations in children (< 10 years) and adolescents (10 to < 18 years) with COVID-19 admitted to a tertiary municipal hospital in Rio de Janeiro (Brazil) during the first (February to November 2020) and second pandemic waves (November 2020 to April 2021). Methods: this retrospective observational study considered patients in the pediatric age group (

ABSTRACT Objective The objective was to compare the maternal and perinatal characteristics and outcomes between women with and without diabetes in a Brazilian cohort of women with preterm births. Methods This was an ancillary analysis of the Brazilian Multicenter Study on Preterm Birth, which included 4,150 preterm births. This analysis divided preterm births into two groups according to the presence of diabetes; pregestational and gestational diabetes were clustered in the same Diabetes Group. Differences between both groups were assessed using χ 2 or Student’s t tests. Results Preterm births of 133 and 4,017 women with and without diabetes, respectively, were included. The prevalence of diabetes was 3.2%. Pregnant women aged ≥35 years were more common in the Diabetes Group (31.6% versus 14.0% non-diabetic women, respectively). The rate of cesarean section among patients with diabetes was 68.2% versus 52.3% in non-diabetic cases), with a gestational age at birth between 34 and 36 weeks in 78.9% of the cases and 62.1% of the controls. Large-for-gestational-age babies were 7 times more common in the Diabetes Group. Conclusion Preterm birth among Brazilian women with diabetes was more than twice as prevalent; these women were older and had regular late preterm deliveries, usually by cesarean section. They also had a greater frequency of fetal morbidities, such as malformations and polyhydramnios, and a higher proportion of large-for-gestational-age and macrosomic neonates.