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O presente estudo possui como objetivo apresentar a percepção dos profissionais contábeis acerca do futuro da profissão contábil no Estado de Rondônia. O estudo é classificado quanto à abordagem como qualitativo, com objetivo descritivo e no que se refere aos procedimentos, é caracterizado como uma pesquisa survey. Os dados foram coletados através de um questionário composto por 16 questões fechadas que foi aplicado entre os dias 25 de novembro e 06 de dezembro de 2022, tais questões foram baseadas no estudo de Martendal, Hoffmann e Martins (2020). Na visão dos respondentes, a profissão contábil teve uma evolução ao longo dos anos, assim como a contabilidade, fato esse que, é resultado principalmente das exigências de mercado, ressaltando a importância da adaptação dos profissionais. A classe contábil também se mostrou otimista quanto ao futuro da profissão, visto que a maioria dos profissionais concordam que a profissão será mais valorizada no futuro, e que necessitará de mais profissionais para suprir a demanda, profissionais que, conforme as percepções dos respondentes precisaram atuar de formas inovadoras e criativas e principalmente, em áreas fiscais e tributárias.

A importância da mensuração dos custos ocultos se torna uma ferramenta estratégica para o aumento da competitividade de uma organização, onde estes custos, quando mensurados, podem impactar diretamente nos resultados da empresa. Desta forma, esta pesquisa teve como objetivo destacar as vantagens de um estudo eficiente dos custos ocultos associados à lucratividade das pequenas e médias empresas no mercado atual, em uma empresa prestadora de serviços imobiliários, na região do Cone Sul do Estado de Rondônia, utilizando-se do Método IMPM (Integrated Manufacturing Performance Measure), Modelo de Desempenho Global de Produção, desenvolvido por Son e Park (1987), na qual podemos verificar quais os efeitos que os custos ocultos causam na produtividade econômica da empresa. Através de dados fornecidos pela empresa, foram identificados e mensurados os resultados de custos ocultos, dentre estes: a ociosidade, o estoque de produtos acabados, o absenteísmo e atestado médico. O valor dos custos ocultos identificados foi de R$ R$116.599,41. Deste modo, os resultados apontam para a existência de custos ocultos significativos quando comparado ao valor total de custos tangíveis apurados. Foram analisados os índices de produtividade nos itens de custos contidos no setor estudado, considerando a análise de cinco fatores de produção: mão-de-obra direta, material direto, energia elétrica, depreciação e instalações, no período estabelecido para a pesquisa, no ano de 2022, onde comparamos seus resultados com e sem a presença dos custos ocultos, podendo identificar a variação deste índice presente e o seu impacto. Estes dados demonstram a importância da identificação dos Custos Ocultos, visando melhorar a eficiência e os resultados operacionais da empresa, podendo assim achar formas de minimizar o seu impacto.

People experience instances of social feedback as interdependent with potential implications for their entire self-concept. How do people maintain positivity and coherence across the self-concept while updating self-views from feedback? We present a network model describing how the brain represents the semantic dependency relations among traits and uses this information to avoid an overall loss of positivity and coherence. Both male and female human participants received social feedback during a self-evaluation task while undergoing functional magnetic resonance imaging. We modeled self-belief updating by incorporating a reinforcement learning model within the network structure. Participants learned more rapidly from positive than negative feedback and were less likely to change self-views for traits with more dependencies in the network. Further, participants back propagated feedback across network relations while retrieving prior feedback on the basis of network similarity to inform ongoing self-views. Activation in ventromedial prefrontal cortex (vmPFC) reflected the constrained updating process such that positive feedback led to higher activation and negative feedback to less activation for traits with more dependencies. Additionally, vmPFC was associated with the novelty of a trait relative to previously self-evaluated traits in the network, and angular gyrus was associated with greater certainty for self-beliefs given the relevance of prior feedback. We propose that neural computations that selectively enhance or attenuate social feedback and retrieve past relevant experiences to guide ongoing self-evaluations may support an overall positive and coherent self-concept.SIGNIFICANCE STATEMENTWe humans experience social feedback throughout our lives, but we do not dispassionately incorporate feedback into our self-concept. The implications of feedback for our entire self-concept plays a role in how we either change or retain our prior self-beliefs. In a neuroimaging study, we find that people are less likely to change their beliefs from feedback when the feedback has broader implications for the self-concept. This resistance to change is reflected in processing in the ventromedial prefrontal cortex, a region that is central to self-referential and social cognition. These results are broadly applicable given the role that maintaining a positive and coherent self-concept plays in promoting mental health and development throughout the lifespan.

Num contexto em que taxa de transferência de tecnologia das universidades brasileiras não tem acompanhado o crescimento do número de pedidos de patentes e cartas-patente, o presente trabalho sugere a inclusão de uma avaliação do potencial comercial de uma invenção pelos Núcleos de Inovação Tecnológica (NITs) em adição à avaliação dos três critérios de patenteabilidade, ou seja, antes que o pedido seja protocolado no Instituto Nacional de Propriedade Industrial (INPI). Considerando a carência de métodos de avaliação compatíveis com a realidade de um NIT acadêmico, este trabalho desenvolve um novo método de avaliação de tecnologias projetado para ser integrado às rotinas operacionais desta instituição. O desenvolvimento parte de um grande conjunto de 201 critérios de avaliação obtidos na literatura, faz um pré-tratamento para 151 critérios, realiza a priorização com o auxílio de uma comissão, e utilizando-se de métodos de decisão multicritério identifica pesos para os critérios. O trabalho desenvolve quatro conjuntos de critérios (versões de 26 a 59 critérios), para que seja utilizado um deles conforme o estágio do projeto de pesquisa, desenvolvimento e inovação. Para ilustrar a utilização do método, ele é aplicado a uma invenção real. O estudo de caso demonstrou que o método pode ser aplicado em aproximadamente 73 minutos sendo, portanto, de fácil utilização.

OBJECTIVE The purpose of this study was to analyze risk factors for sacral fracture following noninstrumented partial sacral amputation for en bloc chordoma resection. METHODS A multicenter retrospective chart review identified patients who underwent noninstrumented partial sacral amputation for en bloc chordoma resection with pre- and postoperative imaging. Hounsfield units (HU) were measured in the S1 level. Sacral amputation level nomenclature was based on the highest sacral level with bone removed (e.g., S1 foramen amputation at the S1–2 vestigial disc is an S2 sacral amputation). Variables collected included basic demographics, patient comorbidities, surgical approach, preoperative radiographic details, neoadjuvant and adjuvant radiation therapy, and postoperative sacral fracture data. RESULTS A total of 101 patients (60 men, 41 women) were included; they had an average age of 69 years, BMI of 29 kg/m2, and follow-up of 60 months. The sacral amputation level was S1 (2%), S2 (37%), S3 (44%), S4 (9%), and S5 (9%). Patients had a posterior-only approach (77%) or a combined anterior–posterior approach (23%), with 10 patients (10%) having partial sacroiliac (SI) joint resection. Twenty-seven patients (27%) suffered a postoperative sacral fracture, all occurring between 1 and 7 months after the index surgery. Multivariable logistic regression analysis demonstrated S1 or S2 sacral amputation level (p = 0.001), combined anterior–posterior approach (p = 0.0064), and low superior S1 HU (p = 0.027) to be independent predictors of sacral fracture. The fracture rate for patients with superior S1 HU < 225, 225–300, and > 300 was 38%, 15%, and 9%, respectively. An optimal superior S1 HU cutoff of 300 was found to maximize sensitivity (89%) and specificity (42%) in predicting postamputation sacral fracture. In addition, the fracture rate for patients who underwent partial SI joint resection was 100%. CONCLUSIONS Patients with S1 or S2 partial sacral amputations, a combined anterior–posterior surgical approach, low superior S1 HU, and partial SI joint resection are at higher risk for postoperative sacral fracture following en bloc chordoma resection and should be considered for spinopelvic instrumentation at the index procedure.

This article argues that a ‘Right to Need-Satisfaction’ should be the basis of the Scottish Government’s proposed National Care Service. This service will take a ‘human rights-based approach’. The premise of this right is: if people are to participate in society, then they must be given sufficient resources to do so. However, this stance is insufficient unless such resources are accompanied by an awareness of people’s own oppressed situation within society and the support people need from their peer group.

Abortion is a stressful life event associated with wide variability in women's perceptions and adjustment. There is scarce evidence on interventions to help women cope with abortion and achieve positive psychological health outcomes. This study tested the effect of a stress and coping theory-formed intervention (START) on depression and coping of Chinese women undergoing a first-trimester abortion.A randomized controlled trial was conducted at a Chinese metropolitan hospital. 110 participants were recruited and randomized to intervention group (START + standard care) or control group (standard care) with a 1:1 allocation ratio. The primary outcome was depression at two-week post-abortion. Surveys were completed by participants when they sought abortion services (baseline), two and six-week post-abortion.At two-week post-abortion, women allocated to the intervention group compared to the control group, had significantly lower depression scores (aOR -2.81 [-4.12 to -1.50]), higher problem-focused coping (aOR 1.64 [0.36-2.93]), lower dysfunctional coping (aOR -2.29 [-3.69 to -0.89]), higher self-efficacy (aOR 3.17 [-0.42-5.94]), and higher personal growth scores (aOR 4.41 [0.30-8.53]). Lower depression scores at two-weeks were mediated by lower dysfunctional coping (mediated effect 0.96 [0.25, 1.74]; proportion of overall effect 36 % [9 %, 65 %]).Chinese women allocated to receive START had lower depression and better coping at two-week post-abortion. This brief, online intervention contributed to women's self-efficacy and positive perceptions of social support, abortion experience, and personal growth. Maintenance of the effects need further research.

Background: Mammographic screening programmes reduce breast cancer mortality, but detect many small tumours with favourable biological features which may not progress during a woman’s lifetime. Screen-detected cancers are treated with standard surgery and adjuvant therapies, with associated morbidities. There is a need to reduce overtreatment of good prognosis tumours and numerous studies have evaluated the omission of radiotherapy in this context. However, there is little evidence to support surgical de-escalation, although percutaneous minimally invasive treatment approaches have been described. Vacuum-assisted excision (VAE) is in widespread use for management of benign lesions and lesions of uncertain malignant potential. SMALL (ISRCTN 12240119) is designed to determine the feasibility of using this approach for treatment of small invasive tumours detected within the UK NHS Breast Screening Programme (BSP). Methods: SMALL is a phase III multicentre randomised trial comparing standard surgery with VAE for screen-detected good prognosis cancers. The main eligibility criteria are age ≥47 years, unifocal grade 1 tumours with maximum diameter 15mm, which are strongly ER/PR+ve and HER2-ve, with negative clinical/radiological axillary staging. Patients are randomised 2:1 in favour of VAE or surgery; with no axillary surgery in the VAE arm. Completeness of excision is assessed radiologically, and if excision is incomplete, patients undergo open surgery. Adjuvant radiotherapy and endocrine therapy are mandated in the VAE arm but may be omitted following surgery. Co-primary end-points are: 1. Non-inferiority comparison of the requirement for a second procedure following excision 2. Single arm analysis of local recurrence (LR) at 5 years following VAE Recruitment of 800 patients will permit demonstration of 10% non-inferiority of VAE for requirement of a second procedure. This ensures sufficient patients for single arm analysis of LR rates, where expected LR free survival is 99% at 5 years, with an undesirable survival probability after VAE of 97%. To ensure that the trial as a whole only has 5% alpha, the significance level for each co-primary outcome is set at 2.5% with 90% power. The Data Monitoring Committee will monitor LR events to ensure these do not exceed 3% per year. Secondary outcome measures include time to ipsilateral recurrence, overall survival, complications, quality of life and health economic analysis. A novel feature of SMALL is the integration of a QuinteT Recruitment Intervention (QRI), which aims to optimise recruitment to the study. Recruitment challenges are identified by analysing recruiter/patient interviews and audio-recordings of trial discussions, and by review of trial screening logs, eligibility and recruitment data and study documentation. Solutions to address these are developed collaboratively, including individual/group recruiter feedback and recruitment tips documents. Results: SMALL opened in December 2019, but recruitment halted in 2020 for 5 months due to COVID-19. At 7st July 2022, 142 patients had been randomised from 26 centres, with a randomisation rate of approximately 45%, and a per site recruitment rate of 0.4-0.5 patients/month, approaching the feasibility recruitment target of 144 patients. Drawing from preliminary QRI findings and insights from patient representatives, a recruitment tips document has been circulated (on providing balanced information about treatments, encouraging recruiters to engage with patient preferences, and explaining randomisation). Individual recruiter feedback has commenced, with wider feedback delivered across sites via recruitment training workshops. Conclusion: Despite pandemic-related challenges, SMALL has an excellent recruitment rate to date and is expected to have a global impact on treatment of breast cancer within mammographic screening programmes. SMALL is funded by the UK NIHR HTA programme, award 17/42/32 Citation Format: Stuart A. McIntosh, Charlotte E. Coles, David Dodwell, Kenneth Elder, Jessica Foster, Claire Gaunt, Amanda Kirkham, Iain Lyburn, Jenna Morgan, Sangeetha Paramasivan, Sarah E. Pinder, Sarah Pirrie, Shelley Potter, Tracy Roberts, Nisha Sharma, Hilary Stobart, Elizabeth Southgate, Sian Taylor-Phillips, Matthew Wallis, Daniel Rea. SMALL: Open Surgery versus Minimally invasive vacuum-Assisted excision for smaLL screen-detected breast cancer – a UK phase III randomised multi-centre trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-20-02.

This work approaches the problem of estimating the Kautz optimal poles in kernel expansion in Wiener-Volterra models. The analytical solution for the suboptimal case is already established in the literature. However, the solution for the two parameters that compose the poles is still open. In this paper, an optimization strategy using the Levenberg-Marquardt is presented. This algorithm is used to find kernel expansion parameters, with the same base for all dimensions. The construction of bases using digital filter is considered. To validate the implemented algorithm, data collected from the excitation of an electrically coupled drive system was used to analyze the impact of the search space thresholds and the behavior of Levenberg-Marquardt’s parameters. It was also analyzed the impact on the model accuracy, as the number of functions in the base is increased. As a result, the models determined have achieved better results than the works found in the literature.

Current bone cement systems often demand free radical or metal-related initiators and/or catalysts for the crosslinking process, which may cause serious toxicity to the human body. In addition, the resultant dense scaffolds may have a prolonged degradation time and are difficult for cells to infiltrate and form new tissue. In this study, we developed a porous “click” organic—inorganic nanohybrid (PO-click-ON) cement that crosslinks via metal-free biorthogonal click chemistry and forms porous structures mimicking the native bone tissue via particulate leaching. Strain-promoted click reaction enables fast and efficient crosslinking of polymer chains with the exclusion of any toxic initiator or catalyst. The resulting PO-click-ON implants supported exceptional in vitro stem cell adhesion and osteogenic differentiation with a large portion of stem cells infiltrated deep into the scaffolds. In vivo study using a rat cranial defect model demonstrated that the PO-click-ON system achieved outstanding cell adsorption, neovascularization, and bone formation. The porous click cement developed in this study serves as a promising platform with multifunctionality for bone and other tissue engineering applications.

The major depressive episode has become a common global public health issue all over the world. The arsenal for the treatment of this disorder is wide, however, a substantial part of the population is considered resistant to pharmacological treatment. The objective of the present study is to investigate the effects of physical exercise as a supporting factor in the treatment of depression. This literature review was carried out in January 2023, through a search in the Pubmed electronic database. The descriptors used were “Depression, Exercise and Physical activity”, combined using the Boolean operators “and” and “or”. The results of this review confirm important evidence of the use of physical exercise in the treatment of major depressive episodes, especially aerobic exercise. In addition, this study demonstrates physical exercise as one of the pillars in reducing depressive symptoms, especially in patients' cognition and memory.

Accurate chromosome segregation during meiosis is crucial for reproduction. Human and porcine oocytes transiently cluster their chromosomes before the onset of spindle assembly and subsequent chromosome segregation. The mechanism and function of chromosome clustering are unknown. Here we show that chromosome clustering is required to prevent chromosome losses in the long gap phase between nuclear envelope breakdown and the onset of spindle assembly, and to promote the rapid capture of all chromosomes by the acentrosomal spindle. The initial phase of chromosome clustering is driven by a dynamic network of Formin-2- and Spire-nucleated actin cables. The actin cables form in the disassembling nucleus and migrate towards the nuclear centre, moving the chromosomes centripetally by interacting with their arms and kinetochores as they migrate. A cage of stable microtubule loops drives the late stages of chromosome clustering. Together, our data establish a crucial role for chromosome clustering in accurate progression through meiosis.

SummaryThe IUCN Red List criteria are widely used to determine extinction risks of plant and animal life. Here, we use The Red List’s criterion B, Geographic Range Size, to provide preliminary conservation assessments of the members of a large tribe of grasses, the Andropogoneae, with ∼1100 species, including maize, sorghum, and sugarcane and their wild relatives.We use georeferenced occurrence data from the Botanical Information and Ecology Network (BIEN) and automated individual species assessments using ConR to demonstrate efficacy and accuracy in using time-saving tools for conservation research. We validate our results with those from the IUCN-authorized assessment tool, GeoCAT.We discovered a remarkably large gap in digitized information, with slightly more than 50% of the Andropogoneae lacking sufficient information for assessment. ConR and GeoCAT largely agree on which taxa are of least concern (>90%) or possibly threatened (Increasing digitization and collection needs to be a high priority. Available rapid assessment tools can then be used to identify species that warrant more comprehensive investigation.Societal Impact StatementThe current rate of global biodiversity loss creates a pressing need to increase efficiency and throughput of extinction risk assessments in plants. We must assess as many plant species as possible, working with imperfect knowledge, to address the habitat loss and seemingly countless extinction threats of the Anthropocene. Large-scale, preliminary conservation assessments can play a fundamental role in setting priorities for more in-depth investigation.

O presente estudo buscou encontrar evidências de validade do Inventário de Sexismo Ambivalente (ISA) para aplicação em adolescentes. Para tanto, foi realizado um estudo psicométrico, conduzido através de um survey online, do qual participaram 486 adolescentes de diferentes perfis sociodemográficos, com idade de 14 a 23 anos. Foi realizada uma Análise Fatorial Confirmatória para produzir evidências de validade de constructo e testes bivariados para indicar evidências de validade de critério e convergente. Os resultados foram satisfatórios, uma vez que a escala apresentou propriedades psicométricas adequadas para o uso com adolescentes.

Background: It is unclear whether persistent inhaled steroid exposure in chronic obstructive pulmonary disease (COPD) patients before coronavirus disease 2019 (COVID-19) is associated with hospitalization risk. Objective: Our objective was to examine the association between persistent steroid exposure and COVID-19–related hospitalization risk in COPD patients. Study Design and Methods: This retrospective cohort study used electronic health records from the Kaiser Permanente Northern California health care system (February 2, 2020, to September 30, 2020) for patients aged ≥40 years with COPD and a positive polymerase chain reaction test result for COVID-19. Primary exposure was persistent oral and/or inhaled steroid exposure defined as ≥6 months of prescriptions filled in the year before the COVID-19 diagnosis. Multivariable logistic regression was performed for the primary outcome of COVID-19–related hospitalization or death/hospice referral. Steroid exposure in the month before a COVID-19 diagnosis was a covariate. Results: Of >4.3 million adults, 697 had COVID-19 and COPD, of whom 270 (38.7%) had COVID-19–related hospitalizations. Overall, 538 (77.2%) were neither exposed to steroids in the month before COVID-19 diagnosis nor persistently exposed; 53 (7.6%) were exposed in the month before but not persistently; 23 (3.3%) were exposed persistently but not in the month before; and 83 (11.9%) were exposed both persistently and in the month before. Adjusting for all confounders including steroid use in the month before, the odds ratio for hospitalization was 0.77 (95% confidence interval 0.41–1.46) for patients persistently exposed to steroids before a COVID-19 diagnosis. Interpretation: No association was observed between persistent steroid exposure and the risk of COVID-19–related hospitalization in COPD patients.

Low concentration of antibiotics within the environment are known to select for antibiotic resistance (ABR), a global health and economic threat. This manuscript presents a framework to assess the ABR risk in soils where slurry or manure is applied.

OBJECTIVE There are few prior reports of acute pelvic instrumentation failure in spinal deformity surgery. The objective of this study was to determine if a previously identified mechanism and rate of pelvic fixation failure were present across multiple institutions, and to determine risk factors for these types of failures. METHODS Thirteen academic medical centers performed a retrospective review of 18 months of consecutive adult spinal fusions extending 3 or more levels, which included new pelvic screws at the time of surgery. Acute pelvic fixation failure was defined as occurring within 6 months of the index surgery and requiring surgical revision. RESULTS Failure occurred in 37 (5%) of 779 cases and consisted of either slippage of the rods or displacement of the set screws from the screw tulip head (17 cases), screw shaft fracture (9 cases), screw loosening (9 cases), and/or resultant kyphotic fracture of the sacrum (6 cases). Revision strategies involved new pelvic fixation and/or multiple rod constructs. Six patients (16%) who underwent revision with fewer than 4 rods to the pelvis sustained a second acute failure, but no secondary failures occurred when at least 4 rods were used. In the univariate analysis, the magnitude of surgical correction was higher in the failure cohort (higher preoperative T1-pelvic angle [T1PA], presence of a 3-column osteotomy; p < 0.05). Uncorrected postoperative deformity increased failure risk (pelvic incidence–lumbar lordosis mismatch > 10°, higher postoperative T1PA; p < 0.05). Use of pelvic screws less than 8.5 mm in diameter also increased the likelihood of failure (p < 0.05). In the multivariate analysis, a larger preoperative global deformity as measured by T1PA was associated with failure, male patients were more likely to experience failure than female patients, and there was a strong association with implant manufacturer (p < 0.05). Anterior column support with an L5–S1 interbody fusion was protective against failure (p < 0.05). CONCLUSIONS Acute catastrophic failures involved large-magnitude surgical corrections and likely resulted from high mechanical strain on the pelvic instrumentation. Patients with large corrections may benefit from anterior structural support placed at the most caudal motion segment and multiple rods connecting to more than 2 pelvic fixation points. If failure occurs, salvage with a minimum of 4 rods and 4 pelvic fixation points can be successful.

This study examined differences by ethnicity and socioeconomic status in attitudes to sleep and bedtime routine, as self-reported by children aged 7-9 years.Four groups of parent-child dyads were recruited: Māori participants from low- (nMost (77%) children reported liking to go to sleep (Māori, 88% vs New Zealand European, 65%;These findings suggest that more adverse differences in sleep habits and attitudes in children are most likely to be related to socioeconomic status than to ethnicity.Elder D, Miller J, Douglas B, Stanley J, McDowall P, Campbell A. Children talking about their sleep: a cross-sectional survey of differences by ethnicity and socioeconomic status in Aotearoa New Zealand primary schools.

Background The mortality of dialysis patients greatly exceeds that of the general population and identifying predictive factors for mortality may provide opportunities for earlier intervention. This study assessed the influence of sarcopenia on mortality in patients on haemodialysis. Methods This prospective, observational study enrolled 77 haemodialysis patients aged 60 years and over, of whom 33 (43%) were female, from two community dialysis centres. Baseline demographic and laboratory data were collected, and sarcopenia was diagnosed using grip strength, muscle mass by bioimpedance analysis (BIA) and muscle function by timed up-and-go according to European Working Group on Sarcopenia in Older People criteria. Nutritional status was assessed using a subjective nutritional assessment score, comprising functional changes in weight, appetite, gastrointestinal symptoms and energy.. A comorbidity score (maximum 7 points) was derived from the presence or absence of hypertension, ischaemic heart disease, vascular disease (cerebrovascular disease, peripheral vascular disease, and abdominal aortic aneurysm), diabetes mellitus, respiratory disease, a history of malignancy and psychiatric disease. Outcomes over six years were linked to the Australian and New Zealand Dialysis and Transplant Registry. Results The median participant age was 71 years (range 60–87). Probable and confirmed sarcopenia was present in 55.9% and severe sarcopenia with reduced functional testing in 11.7%. Over 6 years, overall mortality was 50 of the 77 patients (65%), principally from cardiovascular events, dialysis withdrawal and infection. There were no significant survival differences between patients with no, probable, confirmed, or severe sarcopenia, or between tertiles of the nutritional assessment score. After adjustment for age, dialysis vintage, mean arterial pressure (MAP) and the total comorbidity score, no sarcopenia category predicted mortality. However, the total comorbidity score [Hazard Ratio (HR) 1.27, Confidence Intervals (CI) 1.02, 1.58, p = 0.03] and MAP (HR 0.96, CI 0.94, 0.99, P = Conclusion Sarcopenia is highly prevalent in elderly haemodialysis patients but is not an independent predictor of mortality. Haemodialysis patients have multiple competing risks for mortality which, in this study, was predicted by a lower MAP and a higher total comorbidity score. Trial registration Recruitment commenced December 2011. The study was registered 10.01.2012 with the Australian New Zealand Clinical Trials Registry (ACTRN12612000048886).

In this comment piece, Danielle Poole and colleagues discuss clinical and research collaboration between nursing and midwifery professions to improve maternal cardiovascular outcomes.

Purpose The definition of chronic adult hydrocephalus encompasses different pathological entities with overlapping characteristics, including long-standing overt ventriculomegaly in adults (LOVA), late-onset idiopathic aqueductal stenosis (LIAS) and idiopathic normal pressure hydrocephalus (iNPH). The aim of our study was to identify preoperative clinical and radiological features peculiar of these diseases providing some pathophysiology inferences on these forms of hydrocephalus. Methods Clinical and radiological preoperative records, type of surgical treatment and clinical outcome of patients with chronic adult hydrocephalus who were surgically treated between 2013 and 2019 were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the contribution of each variable to the differential diagnosis. Results In total, 105 patients were included: 18 with LOVA, 23 with LIAS and 64 with iNPH. On multivariate analysis, an enlarged cisterna magna and a more severe ventriculomegaly were associated with the diagnosis of LOVA, while an older age and DESH with iNPH. LIAS patients tend to have an higher prevalence of raised ICP symptoms. Based on that, a clinical and radiological scoring system was developed to distinguish between iNPH and no iNPH cases. A precise cut-off value with a sensitivity of 95.1% and a specificity of 90.6% was identified. Conclusions LOVA, LIAS and iNPH are different forms of chronic adulthood hydrocephalus and present different and peculiar clinical and radiological features, with an impact on the treatment and outcome prediction. The implementation of a clinical-radiological score for differential diagnosis may help the differentiation. Further studies are warranted.