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The sustainability and efficiency of ecotourism regarding biodiversity conservation are under constant scrutiny and often dismissed based on negative effects arising from other types of nature-based tourism. Our study assess the impacts of infrastructure, human activity, and environmental factors on medium-large ground terrestrial species within the Lapa Rios Ecolodge Nature Reserve; results indicate that restoration, preservation, and conservation efforts are responsible for the wide range of species found within their reserve, including increased abundance of highly threatened rodents and ground birds. There is no indication that visitation or tour activities have negative impacts on wildlife; instead, the Ecolodge effectively created a 'human shield' that weakens threats to wildlife arising from hunting, logging, and gold mining. This shield effect ripples across the Osa Peninsula through the socio-economic benefits provided by ecotourism. Our results support a conservation model incorporating private reserves and parks to sustain biodiversity. [ABSTRACT FROM AUTHOR]

The article offers information about Non-meningothelial meningeal tumors with meningioangiomatosis. Topics discussed include perivascular spread of meningothelial and fibroblastic cells results Meningioangiomatosis; talks about biopsy of parieto-occipital mass reveals cellular neoplasm involving the leptomeninges; and mentions morphological and immunohistochemical sarcoma, shows features of rhabdomyosarcoma.

Detecting determinism in univariate and multivariate time series is difficult if the underlying process is nonlinear, and the noise level is high. In a previous paper, the authors proposed a method based on observable ordinal patterns. This method exploits the robustness of admissible ordinal patterns against observational noise, and the super-exponential growth of forbidden ordinal patterns with the length of the patterns. The new method compared favorably to the Brock-Dechert-Scheinkman independence test when applied to time series projected from the Hénon attractor and contaminated with Gaussian noise of different variances. In this paper, we extend this comparison to higher fractal dimensions by using noisy orbits on the attractors of the Lorenz map, and the time-delayed Hénon map. Finally, we make an analysis that enlightens the robustness of admissible ordinal patterns in the presence of observational noise. [ABSTRACT FROM AUTHOR]

• Soft tissue sarcoma (STS) and gastrointestinal tumors (GIST) encompass > 80 different histologic subtypes. • Clinical practice guidelines for STS and GIST still lack in Latin-American countries. • Tailored clinical guidelines are instrumental to improve outcome in sarcoma patients in LatinAmerican countries. • This is the first review establishing STS and GIST guidelines for the purpose of LatinAmerican clinical practices to our knowledge. [ABSTRACT FROM AUTHOR]

Tropical dry forests may be among the world's most threatened ecosystems, but few studies have objectively quantified their status and threats. This study analysed Venezuelan dry forests at multiple scales, assessing status, present threats and the policy context shaping their future. Historical and current dry forest cover at both national and local scales were contrasted, and a set of quantitative risk assessment criteria applied. While dry forests were vulnerable nationally, in northern-central locations they were endangered. Clearing for cattle ranching and for intensive and subsistence agriculture were the principal factors driving dry forest loss at the national scale, while at a local level, urbanization and fire seemed to be the primary threats. The analysis emphasized the separation of risk assessment from the very different task of establishing conservation priorities; high risk areas may not necessarily be the highest priority for investment, and policy makers may become explicitly aware of the spatial scale at which their policies are implemented, as well as how these policies may affect or be affected by the status of ecosystems beyond their area of influence. The main challenge to future dry forest conservation is a paucity of explicit policies for management and use. However, scientifically-based management can support positive dry forest policies in many ways, including identifying locations and protocols for ecological restoration, maintaining seed banks, quantifying baseline conditions, and monitoring genetic diversity and other indicators. [ABSTRACT FROM PUBLISHER]

Introduction: Palliative sedation (PS) is the subject of ethical and legal debates worldwide. Statistics of its utilization are available in developed countries; however, in Latin America, these data are scarcely known. The purpose of this research was to determine the practices and attitudes of palliativists in Latin America towards PS.Materials and Methods: Data was collected during the Latin American Congress on Palliative Care in Isla Margarita, Venezuela. A total of 89 professionals participated in this survey.Results: It was found that the use of PS was positively associated with being a physician and being members of a palliative care (PC) group. On the other hand, it was found that being a psychologist and identifying barriers toward PS limited its utilization.Discussion: The findings of this study support the need to establish clinical guidelines for its utilization and to educate other specialists on end-of-life care approaches, and the need to develop PC programs in acute care hospitals in Latin America. [ABSTRACT FROM AUTHOR]

We have proposed an adaptive procedure in order to estimate unknown parameters of a numerical model of a chaotic CO2 laser, which is observed through a time series that represents the output intensity of the laser. To do that, we consider a coupled system with the same functional form and adjustable parameters. The salient feature of the proposed technique is that accurate parameter estimation and identical synchronization can be jointly achieved by adaptively adjusting the desired parameters of the coupled system. [ABSTRACT FROM AUTHOR]

Phase-control techniques of chaos aim to extract periodic behaviors from chaotic systems by applying weak harmonic perturbations with a suitably chosen phase. However, little is known about the best strategy for selecting adequate perturbations to reach desired states. Here we use experimental measures and numerical simulations to assess the benefits of controlling individually the three terms of a Duffing oscillator. Using a real-time analog indicator able to discriminate on-the-fly periodic behaviors from chaos, we reconstruct experimentally the phase versus perturbation strength stability areas when periodic perturbations are applied to different terms governing the oscillator. We verify the system to be more sensitive to perturbations applied to the quadratic term of the double-well Duffing oscillator and to the quartic term of the single-well Duffing oscillator. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is linked to chronic NF-κB activity in myeloma cells, but this activity is generally considered a cell-autonomous property of the cancer cells. The precise extent of NF-κB activation and the contributions of the physical microenvironment and of cell-to-cell communications remain largely unknown. By quantitative immunofluorescence, we found that NF-κB is mildly and heterogeneously activated in a fraction of MM cells in human BMs, while only a minority of MM cells shows a strong activation. To gain quantitative insights on NF-κB activation in living MM cells, we combined advanced live imaging of endogenous p65 Venus-knocked-in in MM.1S and HS-5 cell lines to model MM and mesenchymal stromal cells (MSCs), cell co-cultures, microfluidics and custom microbioreactors to mimic the 3D-interactions within the bone marrow (BM) microenvironment. We found that i) reciprocal MM-MSC paracrine crosstalk and cell-to-scaffold interactions shape the inflammatory response in the BM; ii) the pro-inflammatory cytokine IL-1β, abundant in MM patients' plasma, activates MSCs, whose paracrine signals are responsible for strong NF-κB activation in a minority of MM cells; iii) IL-1β, but not TNF-α, activates NF-κB in vivo in BM-engrafted MM cells, while its receptor inhibitor Anakinra reduces the global NF-κB activation. We propose that NF-κB activation in the BM of MM patients is mild, restricted to a minority of cells and modulated by the interplay of restraining physical microenvironmental cues and activating IL-1β-dependent stroma-to-MM crosstalk., (© 2024. The Author(s).)

Purpose: To compare the clinical outcomes of children with unilateral retinoblastoma (Rb) and high-risk histopathology features (HRHF) following upfront enucleation with/without adjuvant chemotherapy, and investigate cases locally considered non-HRHF but converted to a standardized HRHF definition., Design: Retrospective multinational clinical cohort study., Methods: Children with Rb who presented to 21 centers from 12 countries between 2011-2020, and underwent primary enucleation were recruited. Centers retrieved clinical data and were asked to report detailed histopathology findings, as well as indicate cases defined locally as high-risk. For analysis, only unilateral cases with standardized HRHF, defined as retrolaminar optic nerve invasion, massive choroidal invasion, scleral invasion, anterior-segment involvement, and/or combined non-massive choroidal and prelaminar/laminar optic nerve invasion, were included. Main Outcome Measures included orbital tumor recurrence, systemic metastasis, survival and number and outcome of cases converted to standardized HRHF., Results: A total of 600 children presenting to 14 centers in 9 countries were included. Of these, 505 (84.2%) were considered locally as HRHF and received adjuvant chemotherapy. After a median follow-up period of 39.2±1.6 months (range: 0.8-60.0 months), 36 (6.0%) had orbital tumor recurrence, 49 (8.2%) metastasis, and 72 (12.0%) children died. Children not receiving adjuvant chemotherapy were at significantly increased risk of orbital tumor recurrence, metastasis, and death (p ≤0.002). Of the study children, 63/600 (10.5%) were considered locally non-HRHF, but converted to standardized HRHF and included in the analysis. Of these, 6/63 (9.5%) had orbital tumor recurrence, 5/63 (7.9%) metastasis, and 6/63 (9.5%) children died. Isolated minor choroidal invasion with prelaminar/laminar optic nerve invasion was reported in 114 (19.0%) children, but considered locally as HRHF only in 68/114 (59.6%). Of these, 6/114 (5.3%) children developed metastasis and subsequently died, yielding a number needed to treat of 15., Conclusion: Based on this multinational cohort of children with Rb, we recommend the use of adjuvant chemotherapy following upfront enucleation and diagnosis of HRHF. Variation exists worldwide among centers when defining HRHF, resulting in adverse patient outcomes, warranting standardization., Competing Interests: Declaration of competing interest None of the authors has any conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: Accurate healthcare data is indispensable for monitoring the epidemiology of autism spectrum disorders (ASD) and improving the quality of care for individuals on the spectrum. In Colombia, the Ministry of Health has developed the social protection information system (SISPRO) as a comprehensive registry, drawing data from the healthcare system with close to universal coverage (approximately 95%). This study utilizes data gathered by SISPRO to estimate the prevalence and specific characteristics of autistic children registered between January 2020 and December 2022., Method: A descriptive epidemiological approach was employed, using the International Statistical Classification of Diseases as search terms for ASD within the SISPRO dataset., Results: The study revealed a prevalence of 13.788 cases per 10,000 children in 2022 among aged 4 to 14. Regarding healthcare coverage types in 2022, the majority of autistic children served were under the contributory regime (68.28%), followed by the subsidized regime (25.36%). Geographic analysis indicated a non-uniform distribution of ASD prevalence in Colombia. The regions with the highest GDP, such as Antioquia, Atlántico, Bogotá, Cundinamarca, and Valle del Cauca, exhibited the highest prevalence (M = 17.90; SD = 14.3). In contrast, areas with the lowest GDP, including Amazonas, Guainía, Vaupés, Vichada, and Guaviare, showed the lowest prevalence among children (M = 2.6; SD = 2.5)., Conclusion: The estimation of ASD prevalence in Colombia represents an ongoing initiative to inform public policy actions. During the COVID-19 pandemic, there was a decrease in the number of autistic children served by the healthcare sector; however, the prevalence of ASD changed to higher levels in 2022. These findings contribute to strategies aimed at improving the quality of life for autistic individuals and mitigating the economic burden on their families., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Valproic acid (VPA) is an effective and widely used anti-seizure medication but is teratogenic when used during pregnancy, affecting brain and spinal cord development for reasons that remain largely unclear. Here we designed a genetic recombinase-based SOX10 reporter system in human pluripotent stem cells that enables tracking and lineage tracing of Neural Crest cells (NCCs) in a human organoid model of the developing neural tube. We found that VPA induces extensive cellular senescence and promotes mesenchymal differentiation of human NCCs. We next show that the clinically approved drug Rapamycin inhibits senescence and restores aberrant NCC differentiation trajectory after VPA exposure in human organoids and in developing zebrafish, highlighting the therapeutic promise of this approach. Finally, we identify the pioneer factor AP1 as a key element of this process. Collectively our data reveal cellular senescence as a central driver of VPA-associated neurodevelopmental teratogenicity and identifies a new pharmacological strategy for prevention. These results exemplify the power of genetically modified human stem cell-derived organoid models for drug discovery., (© 2024. The Author(s).)

The prospect of death influences people's thoughts about and how they deal with their remaining time. We aimed to understand whether patients with progressive, life-limiting diseases are oriented in the past, present, or future and how they deal with temporality. We conducted 57 in-depth interviews with end-of-life patients in 10 countries using thematic analysis at three levels (i.e., locally in three countries, with codes shared in the three-country subgroup, and in all 10 countries with a codebook that we developed). We found that the patients' thoughts were oriented toward all three time levels (i.e., past, present, and future). Complementing these levels, we identified another, namely, the future after death. Each time level included patients actively and passively dealing with their thoughts. Past themes were remorse and regret , nostalgia , and coming to terms with past choices ; present themes were feeling grateful for being alive , a time for farewells , and living for the day ; future themes were worries about the future , to miss out , hope , ideas about death and dying , and planning the near future ; and future after death themes were not being there , worries about loved ones , and preparations for a future after death . A changed view on lifetime and avoidance of thinking about a certain time level related to several time levels, while desire to die fluctuated between levels and between acting on and feeling about it. Living for the day, worries about the future , and worries about the well-being of loved ones were common themes in all countries., Competing Interests: Declaration of Conflicting InterestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract: Acral lentiginous melanoma (ALM) is an aggressive type of cutaneous melanoma (CM) that arises on palms, soles, and nail units. ALM is rare in White population, but it is relatively more frequent in dark-skinned populations. There is an unmet need to develop new personalized and more effective treatments strategies for ALM. Increased expression of antiapoptotic proteins (ie, BCL2, MCL1) has been shown to contribute to tumorigenesis and therapeutic resistance in multiple tumor types and has been observed in a subset of ALM and mucosal melanoma cell lines in vivo and in vitro. However, little is known about their expression and clinical significance in patients with ALM. Thus, we assessed protein expression of BCL2, MCL1, BIM, and BRAF V600E by immunohistochemistry in 32 melanoma samples from White and Hispanic populations, including ALM and non-ALM (NALM). BCL2, MCL1, and BIM were expressed in both ALM and NALM tumors, and no significant differences in expression of any of these proteins were detected between the groups, in our relatively small cohort. There were no significant associations between protein expression and BRAF V600E status, overall survival, or ethnicity. In summary, ALM and NALM demonstrate frequent expressions of apoptosis-related proteins BCL2, MCL1, and BIM. Our findings suggest that patients with melanoma, including ALM, may be potential candidates for apoptosis-directed therapies., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: The changes in health dynamics, caused by the SARS-COVD-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death., Objective: Identify interprofessional interventions and factors that improve the care of patients at the end of life., Methodology: Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in COCHRANE, CINAHL, CUIDEN, LILACS, SCIELO, Dialnet, PsychInfo, PubMed, PROQUES, PSYCHOLOGY, JOURNALS, SCIENCEDIRECT, with MeSH/DECS terms: "Critical Care", "IntensiveCare" "Life support care", "Palliative care", "Life Quality", "Right to die". 36,271 were identified, after excluding duplicate title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found., Results: It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, 38%, and 19% in Brazil. The pooled sample was 24,779 participants. 32.2% of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesises evidence to promote Interprofessional Collaborative Practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programmes for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel., Conclusion: There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care., (Copyright © 2023 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Published by Elsevier España S.L.U. All rights reserved.)

Background: Premature children are at increased risk of executive functions (EF) deficits and these difficulties persist into adolescence and adulthood, potentially undermining their development and academic achievements. The aim of the present randomized controlled trial (RCT) is to evaluate the efficacy of the Intendu trainer, an adaptive virtual reality platform, at ameliorating EF in preterm children. Methods: A single-center, RCT was conducted. The intervention group was exposed to game session with the Intendu software in addition to the standard of care in use in our center. The main outcome was the proportion of children with a 10-point increase in the processing speed quotient as measured by WPPSI-III after 4 weeks from the baseline assessment. Results: Forty-seven children born before 36 + 5 weeks were randomized to the experimental ( n  = 24) or control arm ( n  = 23). Five children were lost to follow-up. Thirteen of 23 children (56%) reached the main outcome in the experimental group and 5 of 19 (26%) in the control group ( P  = 0.049, per-protocol analysis) with an absolute benefit increase (ABI) of 30% reconfirmed by the intention-to-treat analysis ( P  = 0.022, ABI of 32%). Conclusion: Intendu brain-trainer showed promising short-term results on EF in pre-term children, however, larger studies with longer periods of follow-up are warranted to better investigate the role of this or similar technology in promoting better EF in preterm children.

Background: Liver resection is the mainstay treatment option for patients with hepatocellular carcinoma in the non-cirrhotic liver (NCL-HCC), but almost half of these patients will experience a recurrence within five years of surgery. Therefore, we aimed to develop a rationale-based risk evaluation tool to assist surgeons in recurrence-related treatment planning for NCL-HCC., Methods: We analyzed single-center data from 263 patients who underwent liver resection for NCL-HCC. Using machine learning modeling, we first determined an optimal cut-off point to discriminate early versus late relapses based on time to recurrence. We then constructed a risk score based on preoperative variables to forecast outcomes according to recurrence-free survival., Results: We computed an optimal cut-off point for early recurrence at 12 months post-surgery. We identified macroscopic vascular invasion, multifocal tumor, and spontaneous tumor rupture as predictor variables of outcomes associated with early recurrence and integrated them into a scoring system. We thus stratified, with high concordance, three groups of patients on a graduated scale of recurrence-related survival., Conclusion: We constructed a preoperative risk score to estimate outcomes after liver resection in NCL-HCC patients. Hence, this score makes it possible to rationally stratify patients based on recurrence risk assessment for better treatment planning., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Dalbavancin has been used off-label to treat invasive bacterial infections in vulnerable populations like people who use drugs (PWUD) because of its broad gram-positive coverage and unique pharmacological properties. This retrospective, multisite study examined clinical outcomes at 90 days in PWUD versus non-PWUD after secondary treatment with dalbavancin for bacteremia, endocarditis, osteomyelitis, septic arthritis, and epidural abscesses., Methods: Patients at 3 teaching hospitals who received dalbavancin for an invasive infection between March 2016 and May 2022 were included. Characteristics of PWUD and non-PWUD, infection highlights, hospital stay and treatment, and outcomes were compared using χ 2 for categorical variables, t test for continuous variables, and nonparametric tests where appropriate., Results: There were a total of 176 patients; 78 were PWUD and 98 were non-PWUD. PWUD were more likely to have a patient-directed discharge (26.9% vs 3.1%; P < .001) and be lost to follow-up (20.5% vs 7.14%; P < .01). Assuming loss to follow-up did not achieve clinical cure, 73.1% of PWUD and 74.5% of non-PWUD achieved clinical cure at 90 days ( P = .08)., Conclusions: Dalbavancin was an effective treatment option for invasive gram-positive infections in our patient population. Despite higher rates of patient-directed discharge and loss to follow-up, PWUD had similar rates of clinical cure at 90 days compared to non-PWUD., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)