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The employment of a suitable radioactive decay spectroscopy setup is essential for the operation of radioactive ion beam (RIB) facilities. CERN-ISOLDE recently developed a new fast tape station (FTS) setup to replace its more than 40 years old predecessor. The new FTS is equipped with several β-detectors, a HPGe-detector, provisions for an α-detector, and constitutes a significant improvement in terms of transport times and detector noise characteristics. Since 2021 it is routinely used as the primary asset for yield determination and quality control of produced RIBs at ISOLDE. We address in this work its technical features and introduce the utilized control system.

The Mustard procedure was an early cardiac surgery for transposition of the great arteries (TGA). Although successful, it has been associated with long-term arrhythmias and heart failure. A key factor complicating management in adults with congenital heart disease (CHD) is the deficiency of biomarkers predicting outcome. Soluble suppression of tumorogenicity-2 (sST2) is secreted by cardiomyocytes in response to mechanical strain and fibrosis. We hypothesized that adults with a Mustard procedure would have higher levels of sST2 than healthy individuals, and this would correlate with clinical outcome. We performed a single-center study in patients managed during childhood with a Mustard procedure versus age-matched controls. Clinical and demographic data were collected and biomarkers (sST2, cTnI, BNP, lipid panel, insulin, and glucose) were obtained. There were 18 patients (12 male) in the Mustard cohort and 18 patients (6 male) in the control group (22-49 years, mean of 35.8 vs. mean 32.6 years, respectively, p= ns). Nine Mustard subjects were NYHA class-II, and 9 subjects were class-III. The control group was asymptomatic. sST2 in the Mustard group was elevated in 56% vs. 17% in controls (p = 0.035). Of the Mustard subjects with elevated sST2, 60% had elevated cTnI and BNP, and 90% had low HDL. Over five years, the Mustard patients with elevated sST2 values had greater medication use, arrhythmias, hospitalizations, and ablation/pacer implantations than Mustard subjects with normal sST2. Mustard subjects with elevated sST2 had other biomarker abnormalities and clinically worse outcomes. Thus, sST2 may add a predictive value to cardiac-related morbidity and mortality.

Background Acute kidney injury (AKI) after noncardiac surgery is common and has substantial health impact. Preclinical and clinical studies examining the influence of sex on AKI have yielded conflicting results, although they typically do not account for age-related changes. The objective of the study was to determine the association of age and sex groups on postoperative AKI. The authors hypothesized that younger females would display lower risk of postoperative AKI than males of similar age, and the protection would be lost in older females. Methods This was a multicenter retrospective cohort study across 46 institutions between 2013 and 2019. Participants included adult inpatients without pre-existing end-stage kidney disease undergoing index major noncardiac, nonkidney/urologic surgeries. The authors’ primary exposure was age and sex groups defined as females 50 yr or younger, females older than 50 yr, males 50 yr or younger, and males older than 50 yr. The authors’ primary outcome was development of AKI by Kidney Disease-Improving Global Outcomes serum creatinine criteria. Exploratory analyses included associations of ascending age groups and hormone replacement therapy home medications with postoperative AKI. Results Among 390,382 patients, 25,809 (6.6%) developed postoperative AKI (females 50 yr or younger: 2,190 of 58,585 [3.7%]; females older than 50 yr: 9,320 of 14,4047 [6.5%]; males 50 yr or younger: 3,289 of 55,503 [5.9%]; males older than 50 yr: 11,010 of 132,447 [8.3%]). When adjusted for AKI risk factors, compared to females younger than 50 yr (odds ratio, 1), the odds of AKI were higher in females older than 50 yr (odds ratio, 1.51; 95% CI, 1.43 to 1.59), males younger than 50 yr (odds ratio, 1.90; 95% CI, 1.79 to 2.01), and males older than 50 yr (odds ratio, 2.06; 95% CI, 1.96 to 2.17). Conclusions Younger females display a lower odds of postoperative AKI that gradually increases with age. These results suggest that age-related changes in women should be further studied as modifiers of postoperative AKI risk after noncardiac surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

The objective of this study was to examine nutrient claims signage on the purchasing of snacks in corporate foodservice operations. The effectiveness of claims among foodservice operations serving primarily administrative roles (white-collar) were compared with those serving primarily manufacturing roles (blue-collar). An experimental study was conducted through the implementation of six nutrient claims evaluated by a group of registered dietitians. The snack items were conveniently placed near the cash register to “nudge” purchases, and sales of snacks before and after the implementation of claims were examined. Paired-samples t-tests indicated that after nutrient claims were implemented, sales of snacks increased in both groups. Blue-collar snack purchases increased by 79.8% after the six claims were implemented, and white-collar snack purchases increased by 33.2%. Results indicate that nutrient claims that had a significant impact on sales differed between the two groups.

We present avidity sequencing, a sequencing chemistry that separately optimizes the processes of stepping along a DNA template and that of identifying each nucleotide within the template. Nucleotide identification uses multivalent nucleotide ligands on dye-labeled cores to form polymerase–polymer–nucleotide complexes bound to clonal copies of DNA targets. These polymer–nucleotide substrates, termed avidites, decrease the required concentration of reporting nucleotides from micromolar to nanomolar and yield negligible dissociation rates. Avidity sequencing achieves high accuracy, with 96.2% and 85.4% of base calls having an average of one error per 1,000 and 10,000 base pairs, respectively. We show that the average error rate of avidity sequencing remained stable following a long homopolymer.

Funding Acknowledgements Type of funding sources: None. The Triglyceride-glucose (TyG) index is emerging as a novel marker of insulin resistance, metabolic syndrome and cardiovascular risk. The TyG index is calculated as Ln[(triglyceride [mg/dl]*fasting plasma glucose[mg/dl])/2]. It is being assessed in both primary and secondary prevention. The aim of this study was to measure the TyG index in a group of patients in cardiac rehabilitation (CH) and relate it to cardiovascular events, the severity of coronary arterial disease (CAD) and compare it with other indexes for cardiovascular disease. This unicenter, retrospective and observational study recruited patients who attended to CH program of a tertiary-level hospital between 1st January and 31st December, 2020. New cardiovascular events were registered until 15th October 2022. The TyG index was estimated according to the first blood sample at admission, we considered it abnormal above 8.8. The severity of CAD was measured using coronariography and stratified as single or multi-vessel (50% of stenosis in ≥2 main coronary arteries). MACCE was defined as myocardial infarction, stroke or cardiovascular death. We also calculated TG/HDL ratio (Triglycerides [mg/dl]/HDL cholesterol [mg/dl]), TC/HDL ratio (Total Cholesterol [mg/dl]/HDL [mg/dl]) and Remnant Cholesterol (non-HDL cholesterol [mg/dl] – LDL [mg/dl]). Statistical analyses were performed using R project. A total of 238 patients were enrolled, 190 (79.8%) were men, mean age 60.5 ± 11.3 years. The main indication for CH was CAD. Percutaneous coronary intervention was done in 175 patients (73.5%), coronary artery bypass grafting was performed in 9 (3.8%); 36 (15.1%) individuals had suffered MACCE previously. During the follow up, 12 underwent another MACCE. The TyG index was statistically higher between patients who suffered MACCE (8.9±0.6, p TyG index is an easy and early sign of diabetic dyslipemia. In association with others indicators, it can help us to focus on those patients at high cardiovascular risk or with higher residual risk, specially nowadays that new non-statin therapies are about to come.

Funding Acknowledgements Type of funding sources: None. Current cardiovascular risk guidelines recommend target values of low-density lipoprotein cholesterol (LDLc) < 55 mg/dL and apolipoprotein B (apoB) < 65 mg/dL. However, they don’t clarify what the attitude should be when one of the two targets is not achieved. Our objective was to establish the prevalence of LDLc and ApoB discordance in a secondary prevention population in our cardiac rehabilitation unit and describe the size of LDLc particles in this cohort of patients. We conducted a retrospective observational study including patients with previous ischemic heart disease with lipid-lowering treatment in secondary prevention followed up in our cardiac rehabilitation unit between February 2022 and September 2022. We present a series of 100 patients with a mean age of 60.5 years (S.D. 9.7), 79% male, with high prevalence of cardiovascular risk factors (59% hypertension, 26% diabetes mellitus, 52% smokers). All patients received lipid-lowering therapies, with statins alone or in combination with Ezetimibe. 30 patients (30%) had LDLc > 55 mg/dL and ApoB < 65 mg/dL, 37 (37%) reached target LDL and ApoB levels (LDLc < 55 mg/dL and ApoB < 65 mg/dL), and 33 (33%) did not reach any of the target levels (LDLc > 55mg/dL and ApoB > 65 mg/dL). No patient had LDLc < 55mg/dL and ApoB > 65mg/dL. Among patients with ApoB target level achieved and LDLc > 55mg/dL, the mean LDLc/ApoB ratio was 1.1 (S.D. 0.1). The mean ratios stratified by LDLc level are represented in Figure 1 and specified in Table 1. The conclusion of our study is that in clinical practice we find a group of patients with discrepancy between LDLc and ApoB levels that is not represented in the main studies of cardiovascular outcomes. Therefore, we do not know what therapeutic approach we should take. It is known that these relatively high LDLc values when apoB is in range correspond to larger and less dense particles, and therefore less atherogenic, and it has been suggested that ApoB levels better reflect residual risk than LDLc in statin-treated patients. At this point, the question that arises is: should we take these patients to an LDL < 55mg/dL or is their lipid risk controlled?

SUMMARYThe emergence of three distinct highly pathogenic human coronaviruses – SARS-CoV in 2003, MERS-CoV in 2012, and SARS-CoV-2 in 2019 – underlines the need to develop broadly active vaccines against theMerbecovirusandSarbecovirusbetacoronavirus subgenera. While SARS-CoV-2 vaccines are highly protective against severe COVID-19 disease, they do not protect against other sarbecoviruses or merbecoviruses. Here, we vaccinate mice with a trivalent sortase-conjugate nanoparticle (scNP) vaccine containing the SARS-CoV-2, RsSHC014, and MERS-CoV receptor binding domains (RBDs), which elicited live-virus neutralizing antibody responses and broad protection. Specifically, a monovalent SARS-CoV-2 RBD scNP vaccine only protected against sarbecovirus challenge, whereas the trivalent RBD scNP vaccine protected against both merbecovirus and sarbecovirus challenge in highly pathogenic and lethal mouse models. Moreover, the trivalent RBD scNP elicited serum neutralizing antibodies against SARS-CoV, MERS-CoV and SARS-CoV-2 BA.1 live viruses. Our findings show that a trivalent RBD nanoparticle vaccine displaying merbecovirus and sarbecovirus immunogens elicits immunity that broadly protects mice against disease. This study demonstrates proof-of-concept for a single pan-betacoronavirus vaccine to protect against three highly pathogenic human coronaviruses spanning two betacoronavirus subgenera.

Funding Acknowledgements Type of funding sources: None. Introduction Inotropic support is frequently needed after acute coronary syndromes(ACS) at coronary care units(CCU). Despite it has being long time since approval of levosimendan(LV) as inotropic support to cardiogenic shock, dobutamine(DB) still being the basis of this treatment. We think levosimendan is a secure and effective alternative. Purpose To analyse the use of levosimendan and dobutamine done in our ACS patients to determine if we have followed some clear criteria of selection, and try to draw a defined pattern for future use. Method Retrospective, analytic, observational study of all ACS admitted to our CCU between 08/2011- 02/2022. We confront patients treated with dobutamine versus levosimendan. X2, U-Mann Whitney and T-Student were used when necessary. Statistical significance: p-value Result 2881patients were admitted with ACS, 6.49%of them(n: 187) needed ionotropic support. Out of these, 60.96%(n: 114) were supported with dobutamine, 28.88%(n: 54) with levosimedan and 10.16%(n: 19)received in some time both drugs, so were excluded from the analysis. Mean age: 68.43±11.48years old. 66.66%(n: 112) men. 54.76%(n: 92)with persistent ST-segment elevation. No difference was found between groups, neither in past medical history, including cardiovascular risk factors, history of arrhythmias(11.3% of patients), previous use of betablockers(30.4%), antiarrhythmic drugs(0.6%) or having pacemaker(1.2%). 114 patients(67.86%)needed norepinephrine(70.17%with DB and 62.96% LV, p:0.35); 29(17.26%) were supported with intra-aortic balloon pump(20.18% in DB group and 11.11% in LV group, p:0.134), without differences by drug. 62 patients(36.9%) presented atrial fibrillation(33.33% in DB and 44.44% in LV, p:0.166), 58(34.52%)ventricular arrhythmias[sustained ventricular tachycardia/ventricular fibrillation](33.33% in DB and 37.04% in LV, p:0.638). In-hospital mortality of these patients was 29.17%(n:49), 29.82% in DB and 27.77% in LV, p:0.785. In multivariate analysis adjusted by clinic and epidemiologic factors, only cardiogenic shock resulted an independent predictor of in-hospital death. Pattern of use we use DB in those patients with worst Killip-kimball(KK) state(73.54%in DB group with KK-IV vs53.70%in LV´s) and LV in those in intermediate states of instability(38.88%LV in KK-II/III vs 8.84%DB in KK-II/III),p Conclusion In our experience, dobutamine has been the most frequent ionotropic drug used in last 11 years after an acute coronary syndrome. Nevertheless, a substitution by levosimendan trend is evolving. We did not detect differences in complications or prognosis dependent on the inotropic drug used, but the use of dobutamine were predominant in those patients with more severe situation.

Funding Acknowledgements Type of funding sources: None. Introduction Acute coronary syndrome (ACS) is one of the most common health problems in the world, and the leading cause of death. The goals of this study are to determine ACS incidence and the seasonal distribution of ocurrence (Spring/Summer/Autumn/Winter) as well as clinical outcomes per season. Methods Retrospective and observational analysis of consecutive patients hospitalized for ST-elevation myocardial infarction (STEMI) in the Critical Coronary Care Unit (CCCU) of a tertiary center with Mediterranean climate from July 2011 to September 2022. We analyzed the influence of the seasons on the incidence and characteristics of ACS. Results We enrolled a total of 1668 patients: 431 in Winter, 382 in Spring, 405 in Summer and 450 in Autumn, with the baseline characteristics summarized in Table 1. There were no differences in baseline characteristics among the 4 seasons, except for the higher prevalence of obesity in Autumn. There was no statistically significant difference in the incidence of STEMI among seasons, although numerically the highest incidence was recorded in Autumn. The occurrence of ACS was not different according to age or sex. ACS complications were not statistically different among seasons with similar incidence of ventricular arrythmias (VT, VF), invasive mechanical ventilation support, need for inotrope/vasopressor support or development of de-novo atrial fibrillation. In-hospital mortality is less frequent in Autumn, but the differences did not reach statistical significance. Conclusions In this Mediterranean climate cohort, STEMI incidence was higher in Autumn, although no differences in clinical profile or outcomes were found among seasons.

In the present work the synthesis of ZnO semiconductor thin films was performed successively using spin coating and chemical bath deposition techniques. The deposition was made by varying the concentration of zinc acetate and hexamethylenetetramine (HMTA: ZnAc) in the precursor solution. This process led to two preferred growth directions (002) and (101), both with very similar texture coefficients, too; a noticeable change in morphology of structured surface, variation in unit cell parameters and crystalline grain size. All the films turned out homogeneously submicro and microstructured and with a wurtzite-type hexagonal crystalline structure. Using pre-loaded Mathematica 11.3 software functions and an algorithm developed in it, the micrographies were analyzed to calculate the percentage of substrate-covered area which was always greater than 80%. Likewise, it also found that resistivity decreases at a higher percentage of covered area and that the variation in the shape of the photo luminescent emission spectrum can be considered as a qualitative indication of the concentration of charge carriers.

Two New Mexico state agencies implemented a statewide contraceptive access initiative in a sizable rural border state through the provision of low- or no-cost contraception, provider training and technical assistance, public awareness campaigns, and policy changes. These interventions resulted in successful expansion of reproductive health services provision and contraceptive use among Medicaid-enrolled adolescents and young women of reproductive age between 2014 and 2020. These findings demonstrate how multilevel interventions can expand contraceptive access, even in rural limited-provider settings. (Am J Public Health. 2022;112(S5):S541–S544. https://doi.org/10.2105/AJPH.2022.306817 )

This paper presents a control method to balance, in average, the DC-link capacitor voltages while injecting power to the grid using an h-bridge neutral-point clamped five-level inverter grid-tied through an LCL filter. The method exploits the structure of a particular model representation of the system comprising a differential-mode part and a common-mode part, which turn out to be decoupled from one another. These decoupled representation enormously facilitates the control design as it can be performed as two independent processes as well. The first design process involves the differential-mode model part and focuses on the grid current injection, while the second design process focuses on the balance of the DC-link capacitors voltages, and is based on the common-mode model part. Out of this, two control components are derived, namely differential-mode and common-mode control components, which are later recombined to form the two control signals, one per inverter branch, required as references in a conventional modulation algorithm to generate the switching sequence. Numerical and experimental results are performed to evaluate the performance of the proposed controller for the h-bridge neutral-point clamped inverter subject to those interconnections.

Dihydroartemisinic acid (DHAA) is a plant natural product that undergoes a spontaneous endoperoxide-forming cascade reaction to yield artemisinin in the presence of air. The endoperoxide functional group gives artemisinin its biological activity that kills Plasmodium falciparum, the parasite that causes malaria. To enhance our understanding of the mechanism of this cascade reaction, 2,3-didehydrodihydroartemisinic acid (2,3-didehydro-DHAA), a DHAA derivative with a double bond at the C2-position, was synthesized. When 2,3-didehydro-DHAA was exposed to air over time, instead of forming an endoperoxide, this compound predominantly underwent aromatization. This olefinated DHAA analogue reveals the requirement of a monoalkene functional group to initiate the endoperoxide-forming cascade reaction to yield artemisinin from DHAA. In addition, this aromatization process was exploited to illustrate the autoxidation process of a different plant natural product, dihydroserrulatene, to form the aromatic ring in serrulatene. This spontaneous aromatization process has applications in other natural products such as leubethanol and erogorgiaene. Due to their similarity in structure to antimicrobial natural products, the synthesized compounds in this study were tested for biological activity. A group of the tested compounds had minimum inhibitory concentration (MIC) values ranging from 12.5 to 25 μg/mL against the bacterial pathogen Staphylococcus aureus and the fungal pathogen Cryptococcus neoformans.

Lack of safe and stable housing is a pernicious and growing social concern, and stereotypes about individuals experiencing houselessness are generally quite negative. Little scholarly work has examined housing insecurity and its associated stereotypes in employment contexts. The purpose of the current research was to examine, in the context of the hospitality industry, whether housing status influences hiring managers' perceptions of hireability (Study 1) and customers' evaluations of an organization and its employees (Study 2) using the stereotype content model. Across two experimental studies, we assessed participant attitudes toward individuals experiencing houselessness. In Study 1, we instructed 148 hotel managers to listen to a hypothetical job interview with either an unhoused or housed job applicant, and then complete measures of hireability. In Study 2, we instructed 139 hotel customers to observe a hypothetical interaction with either an unhoused or housed employee, and then evaluate the employee and the organization. Study 1's findings suggested an indirect effect of housing status on perceived hireability through warmth, and this indirect relationship was moderated by gender. Men who were houseless were rated lower in warmth, and thus lower in hireability, than non-houseless men or women regardless of their housing status. However, houseless men were perceived by customers as warmer than non-houseless men as employees, driving higher evaluations of the organization and the employee (Study 2). Hiring initiatives targeted at providing short-term housing for unhoused employees will benefit employees, employers, and the larger communities they encompass.

Cryptococcal meningoencephalitis (CME) is a serious disease caused by infection by the neurotropic fungal pathogen Cryptococcus neoformans . Due to the increasing number of cases in HIV-infected individuals, as well as the limited therapies available, investigation into potential targets for new therapeutics has become critical.

Zinc (Zn)-based nanoparticles (NPs) can be potentially used in medical and food preservation applications. As proof of principle, we investigated the bactericidal and antibiofilm activity of zinc oxide (ZnO) and zinc sulfide (ZnS) NPs against medically important bacteria.

Cryptococcus neoformans(Cn) is an encapsulated neurotropic fungal pathogen and the causative agent of cryptococcal meningoencephalitis (CME) in humans. Recommended treatment for CME is Amphotericin B (AmpB) and 5-fluorocytosine (5-FC). Though effective, AmpB has displayed numerous adverse side effects due to its potency and nephrotoxicity, prompting investigation into alternative treatments. Palmitoylethanolamide (PEA) is an immunomodulatory compound capable of promoting neuroprotection and reducing inflammation. To investigate the efficacy of PEA as a therapeutic alternative for CME, we intracerebrally infected mice withCnand treated them with PEA or AmpB alone or in combination. Our results demonstrate that PEA alone does not significantly prolong survival nor reduce fungal burden, but when combined with AmpB, PEA exerts an additive effect and promotes both survivability and fungal clearance. However, we compared this combination to traditional AmpB and 5-FC treatment in a survivability study and observed lower efficacy. Overall, our study revealed that PEA alone is not effective as an antifungal agent in the treatment of CME. Importantly, we describe the therapeutic capability of PEA in the context ofCninfection and show that its immunomodulatory properties may confer limited protection when combined with an effective fungicidal agent.

UNSTRUCTURED Background: Low medication adherence is a common cause of high blood pressure but is often unrecognized in clinical practice. Electronic data linkages between electronic health records (EHRs) and pharmacies offers the opportunity to identify low medication adherence which can be used for interventions at the point of care. This study describes the design of the Leveraging EHR Technology and Team care to Address Medication adherence (TEAMLET) trial, which aims to evaluate the effectiveness of a multicomponent intervention that uses linked EHR and pharmacy data to automatically identify patients with elevated blood pressure and low medication adherence. The intervention then combines team based-care with EHR-based workflows to address medication nonadherence. Methods/Design: TEAMLET is a pragmatic, cluster randomized control trial in which ten primary care practices will be randomized 1:1 to the multicomponent intervention or usual care. We will include all patients with hypertension and low medication adherence who are seen at enrolled practices. The primary outcome is medication adherence, as measured by proportion of days covered (PDC), and the secondary outcome is clinic systolic blood pressure. We will also assess intervention implementation, including adoption, acceptability, fidelity, cost and cost-effectiveness, and sustainability. Discussion: The trial will assess the effectiveness of a multicomponent intervention that leverages EHR-based data and team-based care on medication adherence. If successful, the intervention could offer a scalable approach to address inadequate blood pressure control among millions of patients with hypertension.

Spatial restrictions to human activities such as bottom trawling are increasingly used to improve the ecological condition of disturbed habitats. Such management interventions typically have socio-economic consequences, which creates a challenge for those making decisions about which activities should be restricted and where restrictions should apply. We present an approach for predicting the effects of fisheries management scenarios in spatially delimited marine areas and ranking them—using a loss function—according to how well they achieve desired outcomes across a set of ecological and socio-economic indicators. This approach is demonstrated by simulating alternative fishing gear restrictions and zoning options within a hypothetical marine protected area (MPA). Relative benthic status (RBS; an indicator of ecological condition) and relative catch value (RCV; an indicator of potential economic cost) were estimated for the baseline environment and 21 potential management scenarios. The rank order depended on which indicator was prioritized (i.e. whether RBS or RCV was given greater weighting in the loss function), with the top-ranked scenarios in each case involving considerably different management measures. The methods presented can be applied anywhere using locally or strategically relevant indicators to help identify spatial fisheries management measures that minimize ecological and socio-economic trade-offs.

Breast cancer is the second most common diagnosed type of cancer in women. Chronic neuropathic pain after mastectomy occurs frequently and is a serious health problem. In our previous single-center, prospective, randomized controlled clinical study, we demonstrated that the combination of serratus anterior plane block (SAM) and pectoral nerve block type I (PECS I) with general anesthesia reduced acute postoperative pain. The present report describes a prospective follow-up study of this published study to investigate the development of chronic neuropathic pain 12 months after mastectomy by comparing the use of general anesthesia alone and general anesthesia with SAM + PECS I. Additionally, the use of analgesic medication, quality of life, depressive symptoms, and possible correlations between plasma levels of interleukin (IL)-1 beta, IL-6, and IL-10 collected before and 24 h after surgery as predictors of pain and depression were evaluated. The results showed that the use of SAM + PECS I with general anesthesia reduced numbness, hypoesthesia to touch, the incidence of patients with chronic pain in other body regions and depressive symptoms, however, did not significantly reduce the incidence of chronic neuropathic pain after mastectomy. Additionally, there was no difference in the consumption of analgesic medication and quality of life. Furthermore, no correlation was observed between IL-1 beta, IL-6, and IL-10 levels and pain and depression. The combination of general anesthesia with SAM + PECS I reduced the occurrence of specific neuropathic pain descriptors and depressive symptoms. These results could promote the use of SAM + PECS I blocks for the prevention of specific neuropathic pain symptoms after mastectomy.Registration of clinical trial: The Research Ethics Board of the Hospital Sirio-Libanes/Brazil approved the study (CAAE 48721715.0.0000.5461). This study is registered at Registro Brasileiro de Ensaios Clinicos (ReBEC), and ClinicalTrials.gov, Identifier: NCT02647385.

Meaningful and contemporary data regarding the clinical use of mechanical circulatory support (MCS) is founded on the work conducted in the 1950s when a “heart-lung” machine was incorporated to provide support during surgical interventions. Following this milestone, the need to support artificial circulation in patients with heart failure initiated an investigational and legislative collaboration to implement the mission-oriented Artificial Heart Program in the United States during the 1960s. In the subsequent decades, technological discoveries have integrated a series of mechanical systems employed as therapeutic options for short- and long-term artificial circulation in children and adults with advanced heart failure. Since their clinical application, MCS devices have been employed as a bridge to transplantation in over 4000 patients globally. In recent years, the adverse effects and economic burden of MCS have been counterbalanced by the harmonization of therapeutic protocols, the inclusion of multidisciplinary insight, and the allowance of families and patients to participate in shared decision making to address candidacy. In this chapter, we provide a review of the historical aspects of MCS, a therapeutic option for overcoming complexities encountered in reestablishing adequate hemodynamic states and providing a reasonable quality of life.

PurposeThe aim of the present study was to contribute to the workplace diversity literature by experimentally manipulating gender expression through the use of makeup among women and men to determine makeup's impact on interpersonal discrimination in a real-world job selection context.Design/methodology/approachIn an experimental field study, we applied either real (i.e. tinted) or placebo (i.e. transparent) cosmetic products to women and men confederate applicants. The women and men engaged in job inquiry and pre-interview conversations with store personnel in 136 retail stores across 3 shopping malls that were randomly assigned to one of 4 conditions in a 2 (confederate gender: women versus men) by 2 (cosmetic usage: real versus placebo) experimental design. The confederate applicants were accompanied by confederate observers and recorded interactions were later analyzed by naïve coders. The applicants, observers, and naïve coders rated interpersonal discrimination from store personnel in each interaction.FindingsAs hypothesized, women who enhanced their femininity through the use of makeup experienced significantly less interpersonal discrimination than women who did not. In contrast, there was no significant difference in interpersonal discrimination for men as a function of visual gender expression.Originality/valueThese findings highlight the pervasive gender norm expectations for women at work by examining gender non-conformity of women and men.

Cardiac disease has emerged as a leading cause of mortality in Duchenne muscular dystrophy in the current era. This survey sought to identify the diagnostic and therapeutic approach to DMD among pediatric cardiologists in Advanced Cardiac Therapies Improving Outcomes Network. Pediatric cardiology providers within ACTION (a multi-center pediatric heart failure learning network) were surveyed regarding their approaches to cardiac care in DMD. Thirty-one providers from 23 centers responded. Cardiac MRI and Holter monitoring are routinely obtained, but the frequency of use and indications for ordering these tests varied widely. Angiotensin converting enzyme inhibitor and aldosterone antagonist are generally initiated prior to onset of systolic dysfunction, while the indications for initiating beta-blocker therapy vary more widely. Seventeen (55%) providers report their center has placed an implantable cardioverter defibrillator in at least 1 DMD patient, while 11 providers (35%) would not place an ICD for primary prevention in a DMD patient. Twenty-three providers (74%) would consider placement of a ventricular assist device (VAD) as destination therapy (n = 23, 74%) and three providers (10%) would consider a VAD only as bridge to transplant. Five providers (16%) would not consider VAD at their institution. Cardiac diagnostic and therapeutic approaches vary among ACTION centers, with notable variation present regarding the use of advanced therapies (ICD and VAD). The network is currently working to harmonize medical practices and optimize clinical care in an era of rapidly evolving outcomes and cardiac/skeletal muscle therapies.

Transformerless inverters for photovoltaic systems are widely used as it features low cost, volume, and weight. Thus, in recent years, its study has been of great interest to the research community. In this paper a transformerless cascade multilevel inverter for photovoltaic applications with leakage ground current compensation capability is presented. The proposed solution involves a second-order LC output filter with a particular connection, which is referred to as the DC-link-tied LC output filter. This solution is aimed to deal with the leakage-ground current issue, regardless of the considered PWM strategy. The mathematical model of the system involving such a particular LC output passive filter configuration is presented, out of which, both the differential-mode and the common-mode models are obtained. These models are used to explain the leakage-ground current improvement of the proposed DC-link-tied LC output filter. This hardware solution is evaluated under different modulation schemes to contrast the converter output response and the leakage-ground current performance. Finally, simulation and experimental results are performed using a 1 kW academic prototype to assess the performance of the proposed DC-link-tied LC output filter used in a transformerless inverter application. Peer Reviewed Objectius de Desenvolupament Sostenible::7 - Energia Assequible i No Contaminant Objectius de Desenvolupament Sostenible::11 - Ciutats i Comunitats Sostenibles

The relationship between costs and health benefits of branded pharmaceuticals remains controversial. This paper examines the incremental costs incurred for incremental health benefits gained from the largest available sample of cost-effectiveness studies of branded drugs in the USA, the 1994–2015 Tufts Registry of Cost-Effectiveness Analyses. Earlier studies used small, specialized samples of drugs. We use linear regression analysis to estimate the association in those studies between additional quality-adjusted life years (QALYs) and incremental pharmaceutical costs. The preferred sample uses 476 studies involving branded pharmaceuticals with both higher costs and increased effectiveness compared to the previous standard of care. Regressions of costs on QALYs imply that an additional QALY is associated, on average, with a $28,561 increase in cost (95 % CI, $18,853–$38,270). This regression explains 20 % of the variation in sample costs. In this analytical sample, a share of the variation in the cost of pharmaceuticals is, therefore, not random but rather associated with variation in QALYs; prices are to some extent “value-based.” Our results are robust to varying sample inclusion criteria and to the funding source. In subgroup analyses, the highest cost per QALY was $44,367 (95 % CI, $35,373–$53,361). Costs of pharmaceuticals in this data set are, on average, lower than common estimates of the monetary value of a QALY to American consumers. As in other studies, we find that sellers of patent-protected beneficial new technology appear to capture only a fraction of the benefits provided.

Amyloidosis is caused by deposition of abnormal amyloid fibrils with the feared consequence of end stage organ failure. Cardiac amyloidosis (CA) is an increasingly recognized antecedent of cardiomyopathy. CA is classified into transthyretin variants (ATTRwt – wild type and ATTRv – genetic variant) and a light chain variant (AL); each of these variants can be associated with unique electrophysiologic abnormalities. Pacing indications in current societal guidelines do not specify treatment options in infiltrative cardiac diseases, such as CA, and new disease modifying treatments are altering the landscape for intervention. Given the paucity of data, national and international groups have differing treatment options and recommendations. In this review, we aim to update and highlight the differing electrophysiologic changes seen in CA, their respective treatment course and suggest areas for future intervention.