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The exploitation of fruit residues is a tendency that has been raising considerable interest, since it reduces the amount of residues generated during agro-industrial processing, increases the profit generated in the operation and makes use of nutritional principals normally disposed of. Melon seeds are good sources of macronutrients such as proteins, lipids and carbohydrates, as well as micronutrients such as vitamins, minerals and bioactive compounds. The germination process leads to a modification in composition, possibly increasing the nutritional quality and altering the physicochemical characteristics of the original raw material positively. Thus, the aim of the present study was to make a comparative evaluation of the physical and physicochemical characteristics, the bioactive compound content and the technological properties of flours produced from the germinated seeds of Pele-de-Sapo, Gália, Cantaloupe and Orange melons, obtained after drying at 50, 60 and 70 ºC. The germinated seed flours of the four melon varieties presented good protein, lipid, ascorbic acid, flavonoid and carotenoid contents, especially Cantaloupe, with the best values for proteins, lipids and carotenoids and the highest phenolic compound contents. All the flours were highly cohesive with low fluidity and good solubility. The variety Cantaloupe provided flours with good water and oil absorption capacities and greater emulsion activities and stability. The highest drying temperatures led to increases in the phenolic compound, flavonoid and carotenoid compounds and increased the Hausner Factor and Carr Index, but reduced the solubility, the water and oil absorption capacities and the emulsion activity. The flours produced showed good nutritional quality and stability, with emphasis on those produced from Cantaloupe melons, which showed the best nutritional characteristics and technological properties.

Bleeding is common in patients with haematological malignancies undergoing intensive therapy. We aimed to assess the effect of tranexamic acid on preventing bleeding and the need for platelet transfusions.

The article describes the health benefits of curcumin, a polyphenol compounds found in turmeric root, and its role in helping cells clean up their metabolic waste. Topics discussed include the importance of autophagy, ways to stimulate autophagy, role of curcumin in promoting autophagy, and potential of curcumin to lower risk for age-related and chronic diseases by promoting autophagy and combating oxidative stress and chronic inflammation.

•The risk of VTE was increased among individuals with SCT, independent of genetic ancestry, and this risk was lower than heterozygous FVL.•The risk of PE in SCT is significantly higher than the risk of isolated DVT; this pattern suggests a unique mechanism of thrombosis in SCT.

A virtual high-dose-rate brachytherapy boost to the prostate resulted in near-ablative prostate-specific antigen responses and a 5-yr biochemical/clinical relapse–free rate of 94.1% in the PROMETHEUS trial, even though half of the patients did not receive androgen deprivation therapy and a quarter of patients had high-risk disease. The rate of proctopathy was very low. We present detailed data on physician-graded toxicity and patient-reported quality of life that demonstrate a small absolute risk of longer-term genitourinary sequelae.

Generative Artificial Intelligence technologies can potentially transform education, benefiting teachers and students. This study evaluated various GAIs, including ChatGPT 3.5, ChatGPT 4.0, Google Bard, Bing Chat, Adobe Firefly, Leonardo.AI, and DALL-E, focusing on textual and imagery content. Utilizing initial, intermediate, and advanced prompts, we aim to simulate GAI responses tailored to users with varying levels of knowledge. We aim to investigate the possibilities of integrating content from Chemistry Teaching. The systems presented responses appropriate to the scientific consensus for textual generation, but they revealed alternative chemical content conceptions. In terms of the interpretation of chemical system representations, only ChatGPT 4.0 accurately identified the content in all of the images. In terms of image production, even with more advanced prompts and subprompts, Generative Artificial Intelligence still presents difficulties in content production. The use of prompts involving the Python language promoted an improvement in the images produced. In general, we can consider content production as support for chemistry teaching, but only with more advanced prompts do the answers tend to present fewer errors. The importance of previously understanding chemistry concepts and systems’ functioning is noted.

U.S. policies increasingly limit lesbian, gay, bisexual, transgender, queer, or another marginalized gender identity or sexual orientation (LGBTQ +) education topics for children under the guise of age-appropriate curriculum, placing the responsibility of educating children about LGBTQ + identities and experiences on parents. We examined parents’ beliefs about the age-appropriateness of LGBTQ + topics for children, with implications for parent–child conversations and support for restricted LGBTQ + curriculum. In two studies, LGBTQ + and cisgender-heterosexual parents’ (N= 837) belief that LGBTQ + topics are age-appropriate for children at an older age was related to fewer parent–child conversations about LGBTQ + topics and greater anticipated discomfort having such conversations (Studies 1 and 2). Counter to hypotheses, exposure to restrictive LGBTQ + education policies did not affect age-appropriateness beliefs (Studies 1 and 2). In line with hypotheses, parents’ belief that sexual orientation discussion should be minimized was associated with later age-appropriateness beliefs and greater support for restricting LGBTQ + curriculum (cisgender-heterosexual parents; Study 2). These studies highlight age-appropriateness beliefs as a key mechanism hindering critical parent–child LGBTQ + conversations.

The present systematic review (SR) aimed to evaluate the scientific literature regarding the genotoxicity induced by mineral trioxide aggregate (MTA). A search of the scientific literature was conducted on Web of Science, PubMed and Scopus for all kinds of manuscripts for all data published until March, 2023. All types of experimental studies was considered in the present study according to the PRISMA-P guidelines. GRADE tool was used to detect the quality of evidence of the SR. A total of 16 studies were included in the review being 15 in vitro and one in vivo. After proper judgment, four studies were considered moderate and 12 were considered strong. The meta-analysis data did not reveal a statistically significant difference between the MTA and the negative control. This review was not able to demonstrate that MTA induced genotoxicity.

The aim of this systematic review was designed to help further elucidate the following question: Are dental implants able to induce DNA damage in vitro or in vivo? The systematic review was conducted according to the PRISMA-P guidelines. After searching the literature, full manuscripts from 19 studies were carefully selected by the authors. Regarding the general characteristics, endosseous implant was studied in ten manuscripts, and titanium disks were researched by 4 authors; two studies evaluated more than one type of material: titanium miniplates and endosseous implants, cylinders; endosseous implants and rectangular-shaped titanium miniplates, ceramic composites and titanium particles were research objects only once. Following the parameters for evaluating the risk assessment, 7 manuscripts had strong scores, another 8 papers reached the moderate score, and another 4 scored poorly. The meta-analysis data did not reveal a statistically significant difference in the micronucleated cells of the dental implants patients compared to the control (SMD = 0.22, 95% CI − 0.12 to 0.56, p= 0.20), with a Tau2= 0.00; Chi2= 0.01, and p= 0.92, so that the selected manuscripts were considered homogeneous and the I2of 0% indicated low heterogeneity. In our findings, after evaluating the works, it was observed that the results of the characteristics of the dental implants did not induce genotoxicity.

Objective:The objective of the scoping review will be to understand and describe risk factors associated with surgical site infection (SSI) in an orthopaedic surgery population in Sub-Saharan Africa and South Africa. This paper describes the protocol that will be used for the scoping review.Method:A comprehensive literature search will be conducted using MEDLINE (PubMed), CINAHL (EBSCO), Embase and Cochrane Libraries to identify articles meeting the inclusion criteria, including both published and grey literature, in order to provide a broad overview of the reported risk factors associated with patients who have undergone an orthopaedic surgery with an outcome of SSI within 90 days of a procedure. Additional studies will be sourced by exploring the reference list of included eligible studies. By using a combination of the Population, Exposure, Outcome framework, terms and synonyms related to each category, in different variations, along with Boolean operators (AND, OR, NOT) in the search strategy, identified comprehensive and relevant literature for the scoping review.Results:It is anticipated the results will provide a baseline of risk factors that will inform the development of a risk assessment tool for clinical use.Conclusion:This protocol will inform the development of a scoping review to describe factors associated with SSIs following orthopaedic surgery in Sub-Saharan Africa and South Africa.

Motivated by applications in distributed storage, distributed computing, and homomorphic secret sharing, we study communication-efficient schemes for computing linear combinations of coded symbols. Specifically, we design low-bandwidth schemes that evaluate the weighted sum of $\ell $ coded symbols in a codeword $\pmb {c}\in \mathbb {F}^{n}$ , when we are given access to d of the remaining components in $\pmb {c}$ . Formally, suppose that $\mathbb {F}$ is a field extension of $\mathbb {B}$ of degree t. Let $\pmb {c}$ be a codeword in a Reed-Solomon code of dimension k and our task is to compute the weighted sum of $\ell $ coded symbols. In this paper, for some $s\lt t$ , we provide an explicit scheme that performs this task by downloading $d(t-s)$ sub-symbols in $\mathbb {B}$ from d available nodes, whenever $d\ge \ell |\mathbb {B}|^{s}-\ell +k$ . In many cases, our scheme outperforms previous schemes in the literature. Furthermore, we provide a characterization of evaluation schemes for general linear codes. Then in the special case of Reed-Solomon codes, we use this characterization to derive a lower bound for the evaluation bandwidth.

Cyclooxygenase-2 (COX-2) is an enzyme that plays a pivotal role in peripheral inflammation and pain via the prostaglandin pathway. In the central nervous system (CNS), COX-2 is implicated in neurodegenerative and psychiatric disorders as a potential therapeutic target and biomarker. However, clinical studies with COX-2 have yielded inconsistent results, partly due to limited mechanistic understanding of how COX-2 activity relates to CNS pathology. Therefore, developing COX-2 positron emission tomography (PET) radiotracers for human neuroimaging is of interest. This study introduces [11C]BRD1158, which is a potent and uniquely fast-binding, selective COX-2 PET radiotracer. [11C]BRD1158 was developed by prioritizing potency at COX-2, isoform selectivity over COX-1, fast binding kinetics, and free fraction in the brain. Evaluated through in vivo PET neuroimaging in rodent models with human COX-2 overexpression, [11C]BRD1158 demonstrated high brain uptake, fast target-engagement, functional reversibility, and excellent specific binding, which is advantageous for human imaging applications. Lastly, post-mortem samples from Huntington’s disease (HD) patients and preclinical HD mouse models showed that COX-2 levels were elevated specifically in disease-affected brain regions, primarily from increased expression in microglia. These findings indicate that COX-2 holds promise as a novel clinical marker of HD onset and progression, one of many potential applications of [11C]BRD1158 human PET.

ABSTRACTMuch existing housing stock is inaccessible and does not adequately meet the needs of households with disabled members. As a result, households must often seek dwelling adaptations to improve the accessibility of their existing housing. However, adaptations can be costly, particularly in the context of limited state subsidies. This study examines the extent to which households with disabled members in Ontario, Canada’s most populous province, have access to needed dwelling adaptations and the impact of these adaptations on dwelling satisfaction. Using data from the Canadian Housing Survey, we find that close to ten percent of Ontario households need one or more disability-related dwelling adaptations, but close to half of these households do not have all the adaptations they need. Households led by older adults are more likely to have needed dwelling adaptations, as are renter households in the social housing sector. With respect to dwelling satisfaction, households with needed adaptations reported similar levels of satisfaction to households without disabled members, while households who did not have needed adaptations reported significantly lower satisfaction with their dwellings. These findings signal the importance of improving state supports for dwelling adaptations as one part of a broader commitment to inclusive housing policy.

Background:Public funding of cataract surgery provided in private, for-profit surgical centres increased to help mitigate surgical backlogs during the COVID-19 pandemic in Ontario, Canada. We sought to compare the socioeconomic status of patients who underwent cataract surgery in not-for-profit public hospitals with those who underwent this surgery in private for-profit surgical centres and to evaluate whether differences in access by socioeconomic status decreased after the infusion of public funding for private, for-profit centres.Methods:We conducted a population-based study of all cataract operations in Ontario, Canada, between January 2017 and March 2022. We analyzed differences in socioeconomic status among patients who accessed surgery at not-for-profit public hospitals versus those who accessed it at private for-profit surgical centres before and during the period of expanded public funding for private for-profit centres.Results:Overall, 935 729 cataract surgeries occurred during the study period. Within private for-profit surgical centres, the rate of cataract surgeries rose 22.0% during the funding change period for patients in the highest socioeconomic status quintile, whereas, for patients in the lowest socioeconomic status quintile, the rate fell 8.5%. In contrast, within public hospitals, the rate of surgery decreased similarly among patients of all quintiles of socioeconomic status. During the funding change period, 92 809 fewer cataract operations were performed than expected. This trend was associated with socioeconomic status, particularly within private for-profit surgical centres, where patients with the highest socioeconomic status were the only group to have an increase in cataract operations.Interpretation:After increased public funding for private, for-profit surgical centres, patient socioeconomic status was associated with access to cataract surgery in these centres, but not in public hospitals. Addressing the factors underlying this incongruity is vital to ensure access to surgery and maintain public confidence in the cataract surgery system.

Hypoxia can reduce cellular respiration, ATP synthesis and crop yield and increase production of reactive oxygen species. The use of biostimulants in agriculture has been growing considerably and its use is associated as a strategy to increase crop productivity and plant resistance against abiotic stress. This study aimed to verify the influence of the application of biostimulants on the development and yield of soybean crop grown under hypoxia under field conditions. The treatments were composed of different biostimulants, being the control (no application), Lysine, Tryptophan, Methionine, Betaine-glycine, Histidine, Arginine, Leucine, Aparagine, Alanine, Glutamic acid, Proline, Phenylamine, Serine, Valine, Amino acid extract and algae extract, applied via foliar in soybean cultivated under hypoxia totaling 17 treatments. Hypoxia significantly reduced chlorophyll concentration, number of branches, shoot fresh weight and yield of soybean plants. The use of serine, proline, valine, algae and, amino acid extracts, methionine, arginine and betaine-glycine is promising to increase soybean tolerance to hypoxia by improving physiological parameters, development and yield of plants. Our results contribute to increase knowledge about the influence of biostimulants in combating the stress caused by hypoxia in the soybean crop and can be used as a strategy in agriculture to increase food production in the face of climate change and population growth in order to guarantee food security.

Factor V Leiden is the commonest hereditary prothrombotic allele, affecting 1% to 5% of the world’s population. The objective of this study was to characterize the perioperative and postoperative outcomes of patients with Factor V Leiden compared to patients without a diagnosis of hereditary thrombophilia. This was a focused systematic review of studies including adult (>18 years) patients with Factor V Leiden (heterozygous or homozygous) undergoing noncardiac surgery. Included studies were either randomized controlled trials or observational. The primary clinical outcomes of interest were thromboembolic events occurring from the perioperative period up to 1 year postoperatively, defined as deep venous thrombosis, pulmonary embolism, or other clinically significant thrombosis occurring during or after a surgical procedure. Secondary outcomes included cerebrovascular events, cardiac events, death, transplant-related outcomes, and surgery-specific morbidity. Pediatric and obstetrical patients were excluded, as were case reports and case series. Databases searched included MEDLINE and EMBASE from inception until August 2021. Study bias was assessed through the CLARITY (Collaboration of McMaster University researchers) Risk of Bias tools, and heterogeneity through analysis of study design and end points, as well as the I2statistic with its confidence interval and the Q statistic. A total of 5275 potentially relevant studies were identified, with 115 having full text assessed for eligibility and 32 included in the systematic review. On the whole, the literature suggests that patients with Factor V Leiden have an increased risk of perioperative and postoperative thromboembolic events compared to patients without the diagnosis. Increased risk was also seen in relation to surgery-specific morbidity and transplant-related outcomes, particularly arterial thrombotic events. The literature did not support an increased risk for mortality, cerebrovascular, or cardiac complications. Limitations of the data include predisposition toward bias due in many study designs and small sample sizes across the majority of published studies. Variable outcome definitions and durations of patient follow-up across different surgical procedures resulted in high study heterogeneity precluding the effective use of meta-analysis. Factor V Leiden status may confer additional risk for surgery-related adverse outcomes. Large, adequately powered studies are required to accurately estimate the degree of this risk by zygosity.

Etripamil is a fast-acting, intranasally administered calcium-channel blocker in development for on-demand therapy outside a health-care setting for paroxysmal supraventricular tachycardia. We aimed to evaluate the efficacy and safety of etripamil 70 mg nasal spray using a symptom-prompted, repeat-dose regimen for acute conversion of atrioventricular-nodal-dependent paroxysmal supraventricular tachycardia to sinus rhythm within 30 min.

IMPORTANCE: Current fasting guidelines for procedures under anesthesia are poorly implemented, leading to negative metabolic sequelae. Recent studies in children showed support of liberal clear fluid intake; adult physiology can support clear fluid intake, but implementation studies are lacking. OBJECTIVE: To evaluate the successfulness of implementation of a liberal clear fluid policy with regard to fasting duration, well-being, and safety in adults scheduled for anesthesia. DESIGN, SETTING, AND PARTICIPANTS: This was a quality improvement study conducted from January 2016 to July 2021 at a tertiary referral hospital in the Netherlands. Adults scheduled for nonemergency procedures under anesthesia were included in the study. Patients undergoing obstetrics procedures or those who were intubated preoperatively were excluded. INTERVENTIONS: Stepwise introduction of a liberal fluid fasting policy, allowing for ingestion of clear fluids until arrival at the operating room. MAIN OUTCOMES AND MEASURES: The primary outcome was change in fasting duration. Secondary outcomes were patient well-being, measured as preoperative thirst, amount of fluid ingested, postoperative nausea and vomiting (PONV), and administration of antiemetics. Safety was measured as incidence of regurgitation and aspiration (pneumonia). RESULTS: Of the 76 451 patients (mean [SD] age, 56 [17] years; 39 530 male individuals [52%] 36 921) included in the study, 59 036 (78%) followed the standard policy, and 16 815 (22%) followed the liberal policy. Time series analysis showed an estimated fasting duration decrease of 3:07 hours (IQR, 1:36-7:22; P < .001) after implementation of the liberal policy. Postimplementation median (IQR) fasting duration was 1:20 (0:48-2:24) hours. The incidence of regurgitation changed from 18 (95% CI, 14-21) to 24 (95% CI, 17-32) in 10 000 patients, and the incidence of aspiration changed from 1.7 (95% CI, 0.6-2.7) to 2.4 (95% CI, 0.5-4.7) in 10 000 patients. In the liberal policy, thirst feelings decreased (37% [4982 of 8615] vs 46% [3373 of 7362]; P < .001). PONV incidence decreased from 10.6% (6339 of 59 636) to 9.4% (1587 of 16 815; P < .001) and antiemetic administration decreased from 11.0% (6538 of 59 636) to 9.5% (1592 of 16 815; P < .001). CONCLUSIONS AND RELEVANCE: Results of this quality improvement study suggest that a liberal fasting policy was associated with a clinically relevant reduction in fasting duration and improved patient well-being with regard to preoperative thirst and PONV. Although a slightly higher incidence of regurgitation could not be ruled out, wider implementation of such a policy may be advocated as results are still within the clinically accepted risks margins. Results suggest that surgical procedures in patients who drink clear fluids within 2 hours before anticipated anesthesia should not be postponed or canceled.

One of the ways in which students can be taught science is by doing science, the intention being to help students understand the nature, processes, and methods of science. Investigative research projects may be used in an attempt to reflect some aspects of science more authentically than other teaching and learning approaches, such as confirmatory practical activities and teacher demonstrations. In this article, we are interested in the affordances of investigative research projects where students, either individually or collaboratively, undertake original research. We provide a critical rather than a systematic review of the field. We begin by examining the literature on the aims of science education, and how science is taught in schools, before specifically turning to investigative research projects. We examine how such projects are typically undertaken before reviewing their aims and, in more detail, the consequences for students of undertaking such projects. We conclude that we need social science research studies that make explicit the possible benefits of investigative research projects in science. Such studies should have adequate control groups that look at the long-term consequences of such projects not only by collecting delayed data from participants, but by following them longitudinally to see whether such projects make any difference to participants’ subsequent education and career destinations. We also conclude that there is too often a tendency for investigative research projects for students in science to ignore the reasons why scientists work in particular areas and to assume that once a written report of the research has been authored, the work is done. We therefore, while being positive about the potential for investigative research projects, make specific recommendations as to how greater authenticity might result from students undertaking such projects.

IMPORTANCE: Patients with cancer are known to have increased risk of COVID-19 complications, including death. OBJECTIVE: To determine the association of COVID-19 vaccination with breakthrough infections and complications in patients with cancer compared to noncancer controls. DESIGN, SETTING, AND PARTICIPANTS: Retrospective population-based cohort study using linked administrative databases in Ontario, Canada, in residents 18 years and older who received COVID-19 vaccination. Three matched groups were identified (based on age, sex, type of vaccine, date of vaccine): 1:4 match for patients with hematologic and solid cancer to noncancer controls (hematologic and solid cancers separately analyzed), 1:1 match between patients with hematologic and patients with solid cancer. EXPOSURES: Cancer diagnosis. MAIN OUTCOMES AND MEASURES: Outcomes occurring 14 days after receipt of second COVID-19 vaccination dose: primary outcome was SARS-CoV-2 breakthrough infection; secondary outcomes were emergency department visit, hospitalization, and death within 4 weeks of SARS-CoV-2 infection (end of follow-up March 31, 2022). Multivariable cumulative incidence function models were used to obtain adjusted hazard ratio (aHR) and 95% CIs. RESULTS: A total of 289 400 vaccinated patients with cancer (39 880 hematologic; 249 520 solid) with 1 157 600 matched noncancer controls were identified; the cohort was 65.4% female, and mean (SD) age was 66 (14.0) years. SARS-CoV-2 breakthrough infection was higher in patients with hematologic cancer (aHR, 1.33; 95% CI, 1.20-1.46; P < .001) but not in patients with solid cancer (aHR, 1.00; 95% CI, 0.96-1.05; P = .87). COVID-19 severe outcomes (composite of hospitalization and death) were significantly higher in patients with cancer compared to patients without cancer (aHR, 1.52; 95% CI, 1.42-1.63; P < .001). Risk of severe outcomes was higher among patients with hematologic cancer (aHR, 2.51; 95% CI, 2.21-2.85; P < .001) than patients with solid cancer (aHR, 1.43; 95% CI, 1.24-1.64; P < .001). Patients receiving active treatment had a further heightened risk for COVID-19 severe outcomes, particularly those who received anti-CD20 therapy. Third vaccination dose was associated with lower infection and COVID-19 complications, except for patients receiving anti-CD20 therapy. CONCLUSIONS AND RELEVANCE: In this large population-based cohort study, patients with cancer had greater risk of SARS-CoV-2 infection and worse outcomes than patients without cancer, and the risk was highest for patients with hematologic cancer and any patients with cancer receiving active treatment. Triple vaccination was associated with lower risk of poor outcomes.

This study characterized the impact of multimorbidity and cardiorespiratory fitness (CRF) on mortality in patients completing a 12-wk cardiac rehabilitation program. Peak METs at 12 wk and the presence of coexisting conditions were predictors of mortality. Increasing CRF by ≥0.5 METs improved survival regardless of multimorbidity status.

Children with medical complexity utilize health care at increased rates, and their caregivers feel unprepared to care for their child at home. Through a pretest/posttest design, this quality improvement project explored using telemedicine following hospital discharge. Twelve caregivers reported satisfaction with the telemedicine intervention and rated their confidence providing medical care to their child above the projected goal. There was a statistically significant decrease in unplanned hospital readmissions following the implementation. Overall, telemedicine in children with medical complexity serves to bridge the care they receive in the hospital as their caregivers establish a routine at home.

Introducción: El Lupus Eritematoso Sistémico de Inicio Juvenil (LESJ) es una enfermedad inflamatoria multisistémica, con un compromiso de manifestaciones neuropsiquiátricas (NPSLE) que oscila entre el 37 al 95%.

The history of hemophilia is well documented, yet reports focus heavily on the male perspective and severe forms of the disease. Although hemophilia was initially believed to only affect men with women seen as silent carriers, it is now universally acknowledged that women and girls can also be affected. In this narrative review, we tracked the progression of beliefs about women and hemophilia as documented in the literature from pre-1800s to the present time. We present a timeline of evolving beliefs and testing practices and identified 9 distinct time periods when key shifts occurred related to various scientific discoveries. Our review highlights how women affected by hemophilia experienced complete dismissal of their health issues despite evidence of bleeding symptoms as early as the 1900s. We identified 1990 as a major timepoint for shifting beliefs when large scale acknowledgment that hemophilia also affects women is documented and systematic testing for bleeding risk is first suggested. Women evolve from being seen as unaffected genetic transmitters only, to being recognized as a population affected by hemophilia in unique ways requiring timely testing and effective treatment. Yet, despite this clear progress, recent publications continue to document many persistent issues such as delayed diagnosis, untreated symptoms, and barriers to care. Ongoing research and advocacy efforts are required to improve knowledge translation until real-world outcomes are seen in screening, diagnosis, treatment, and prevention of bleeding.

•The powders made with tropical fruits are sources of magnesium and potassium.•Different drying processes influenced the characteristics of the powder particles.•Spray drying resulted in powders with higher crystallinity structure.•The powders exhibit good thermal stability.

•Deterministic and stochastic economic analysis of the demobilization process.•Even in the face of uncertainty, shareholders can expect a financial profit.•Policies must be aligned with the transition to renewable energy sources in Brazil.

Millions of cardiac procedures are performed worldwide each year, making the potential complication of periprocedural iatrogenic stroke an important concern. These strokes can occur intraoperatively or within 30 days of a procedure and can be categorised as either overt or covert, occurring without obvious acute neurologic symptoms. Understanding the prevalence, risk factors, and strategies for preventing overt and covert strokes associated with cardiac procedures is imperative for reducing periprocedural morbidity and mortality. In this narrative review, we focus on the impacts of perioperative ischemic strokes for several of the most common interventional cardiac procedures, their relevance from a neurologic standpoint, and future directions for the care and research on perioperative strokes. Depending on the percutaneous procedure, the rates of periprocedural overt strokes can range from as little as 0.01% to as high as 2.9%. Meanwhile, covert brain infarctions (CBIs) occur much more frequently, with rates for different procedures ranging from 10%-84%. Risk factors include previous stroke, atherosclerotic disease, carotid stenosis, female sex, and African race, as well as other patient- and procedure-level factors. While the impact of covert brain infarctions is still a developing field, overt strokes for cardiac procedures lead to longer stays in hospital and increased costs. Potential preventative measures include screening and vascular risk factor control, premedicating, and procedural considerations such as the use of cerebral embolic protection devices. In addition, emerging treatments from the neurologic field, including neuroprotective drugs and remote ischemic conditioning, present promising avenues for preventing these strokes and merit investigation in cardiac procedures.

The red palm mite Raoiella indicaHirst attacks coconut, banana and açai trees. In 2007, the mite was recorded for the first time in South America. In the State of Pará, R. indicawas recorded in the municipalities of the northwest, a region that is closer to the State of Amazonas, called ‘Low Amazons’. Between October and November 2019, it was observed, by chance, that coconut and banana plants infested by R. indica, in residential backyards in municipalities from Marabá and Parauapebas, Southest of Pará, Brazilian Amazon. Three species from the Araceae family, two from Arecaceae, one Heliconiaceae and one Zingiberaceae, in addition to the banana Musaceae and açaí plantations, were examined. All stages of development of R. indicawere found on coconut, banana trees and imperial palms, and few individuals were found on areca palm and red ginger leaves. This is the first record of the occurrence of the pest mite in the Southeast Pará sub-region.

Background: Black men who have sex with men (MSM) experience disproportionate rates of HIV infection in the USA, despite being no more likely to engage in sexual risk behaviors than other MSM racial/ethnic groups. HIV pre-exposure prophylaxis (PrEP) has been shown to reduce risk of HIV acquisition; however, rates of PrEP use among Black MSM remain low. Clinical, psychosocial, and structural factors have been shown to impact PrEP use and adherence among Black MSM. Care coordination of HIV prevention services has the potential to improve PrEP use and adherence for Black MSM, as it has been shown to improve HIV-related care outcomes among people living with HIV. Methods: Client-centered care coordination (C4) is a multi-level intervention designed to address clinical, psychosocial, and structural barriers to HIV prevention services for Black MSM within HPTN 073, a PrEP demonstration project among Black MSM in three cities in the USA. The current study examined the implementation process of C4, specifically investigating the activities, cost, time, and outcomes associated with the C4 intervention. Results: On average, participants engaged in five care coordination encounters. The vast majority of care coordination activities were conducted by counselors, averaging 30 min per encounter. The cost of care coordination was relatively low with a mean cost of $8.70 per client encounter. Conclusion: Although client-centered care coordination was initially implemented in well-resourced communities with robust HIV research and service infrastructure, our findings suggest that C4 can be successfully implemented in resource constrained communities.

Graphical abstract: The hydrolysis process during the anaerobic co-digestion of residence waste and vegetable and fruit residues occurs in two kinetic stages, one slow and one fast, which were elucidated based on the kinetic models of zero, first, and second order.

Extended-spectrum β-lactamase (ESBL)-producing Gram negative bacteria are becoming increasingly important in veterinary and human medicine because they can hydrolyze the third generation β-lactams, penicillins, and monobactams. The aim of this study was to identify ESBL-producing Enterobacteriaceaein raw cow milk samples from northeast Brazil. Twenty-six bacterial isolates belonging to the Enterobacteriaceaefamily were obtained from milk samples from 257 cows with subclinical mastitis. Using microbiological tests, 53.85% (14/26) were identified as Escherichia coli, 15.38% (4/26) as Proteus mirabilis, 26.92% (7/26) as Klebsiellaspp., and 3.85% (1/26) as Citrobacterspp. Of all the isolates, 61.54% (16/26) were positive in the ESBL screening test, of which 12.5% (2/16) were positive in the double-disc synergy test using three types of cephalosporins and amoxicillin/clavulanic acid. The two isolates were identified as Klebsiellaspp. Among all the isolates, 53.85% (14/26) were positive for one or both ESBL-encoding genes, blaSHVand blaTEM; among these, 71.43% (10/14) were identified as E. coli. This study demonstrates that ESBL-producing bacteria can be found in raw cow milk from northeast Brazil. Cows with subclinical mastitis should be recognized as reservoirs of these strains, which can propagate to humans.

Background: We report the short-term outcomes of a retrospective cohort of Trabecular Metal total ankle arthroplasties (TAAs) via a transfibular approach from a single, nondesigner surgeon in Australia.Methods: This was a retrospective cohort study. Demographic, clinical, and patient-reported outcome measures (PROMs) were collected. The primary outcome was the Foot and Ankle Outcome Score (FAOS), and secondary outcomes included patient satisfaction, the EuroQol-5 Dimension (EQ5D), and complications including revision rates.Results: Between 2016 and 2019, 84 trabecular metal prostheses were implanted in 84 patients. Mean age (SD) at time of surgery was 68 (7.8) years, and 46 (55%) were male. Mean follow-up (SD) was 26.1 (13) months. There were significant (P< .001) improvements in the FAOS in the subscales of pain (47.9 to 79.1), activities of daily living (59.5 to 83.7), and quality of life (25.5 to 60.2) and EQ-5D (0.55 to 0.75) (P< .001), and overall satisfaction was 69.6%. The commonest complications were wound infection or breakdown (11.9%, n=10), fibular nonunion (3.5%), plate irritation (3.5%), and tibial nerve neuropathy (3.5%). There were no thromboembolic complications. Implant survivorship was 100%, with Trabecular Metal components retained in all patients. Two patients developed deep infection, with 1 requiring debridement and polyethylene exchange. No patients experienced implant loosening.Conclusion: Our results demonstrate that the trabecular metal survival rates are comparable with other total ankle implants in the Australian Orthopaedic Association National Joint Replacement Registry and as published in other international literature. Overall patient satisfaction was high, as were PROMs. However, the data highlight potential complications uniquely associated with this implant. The authors believe that these figures support TAA via a transfibular approach as a viable option in the treatment of ankle arthritis.Level of Evidence: Level IV, retrospective cohort study.

Huntington’s disease (HD) is a devastating monogenic neurodegenerative disease characterized by early, selective pathology in the basal ganglia despite the ubiquitous expression of mutant huntingtin. The molecular mechanisms underlying this region-specific neuronal degeneration and how these relate to the development of early cognitive phenotypes are poorly understood. Here we show that there is selective loss of synaptic connections between the cortex and striatum in postmortem tissue from patients with HD that is associated with the increased activation and localization of complement proteins, innate immune molecules, to these synaptic elements. We also found that levels of these secreted innate immune molecules are elevated in the cerebrospinal fluid of premanifest HD patients and correlate with established measures of disease burden.

Pisciculture represents one of the industries with the fastest growth rates worldwide. However, it presents obstacles to its development, such as bacteriosis, which is conventionally treated with antibiotics. The indiscriminate and inappropriate use of antibiotics can lead to bacterial resistance, thus alternatives to the use of antibiotics have been researched. The study aimed to analyze the potential of crude ethanol extract (CEE) from Hymenaea martianaleaf, gallic acid (GA), and polypyrrole (PPy) against Aeromonas hydrophila. Tests were performed to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the compounds individually and in synergy (checkerboard) against A. hydrophilaand in silico tests between the compounds evaluated. The CEE of H. martianaleaf and PPy were effective against A. hydrophilawith MBC results of 3125 μg/mL for the CEE of H. martianaand 125 μg/mL for PPy. Evaluating the GA, a MIC and MBC of 125 μg/mL was obtained. In the interaction tests (checkerboard, using PPy/CEE and PPy/GA), there was a significant reduction in individual introductions. Thus, for the PPy/CEE tests, we had a reduction of MIC/MBC to 1.95 and 781.25 μg/mL, and for the synergy tests between PPy/GA to 7.8125 and 31.125 μg/mL, respectively. The synergy tests are encouraging, and it is possible to verify a decrease of up to 98% in the introduction of PPy, 75% in CEE for H. martianaand 75.1% for GA, when compared to their individual tests. The tests with GA are encouraging due to GA's effectiveness as an antimicrobial agent and high synergy with polypyrrole, both in vitro results and molecular docking experiments showed the actions at the same activation site in A. hydrophila. In vivo tests evaluating isolated components of CEE from H. martianain synergy with PPy should be performed, to verify the quality of the interactions and the improvement of the immune responses of the animals. It was evidenced that gallic acid, a substance isolated from the extract, tends to have more promising results. This is relevant since the industry has been developing these compounds for different uses, thus providing easier access to the product. Thus, the present study indicates an efficient alternative in the use of bioactive compounds as substitutes for conventional antimicrobials.

Purpose: We aimed to evaluate the effect of the 2017 Canadian Cardiovascular Society (CCS) guidelines on troponin surveillance after noncardiac surgery. Methods: This was a single-centre, retrospective, observational study. Patients aged 40 yr or older undergoing intermediate- to high-risk elective noncardiac surgery between 2016 and 2021 were included. We compared the number and percentage of troponin tests ordered before and after the guidelines were published and compared patient characteristics, specifically cardiovascular comorbidity, using odds ratio’s (OR) with 95% confidence intervals (CIs). Outcomes were myocardial injury, myocardial infarction (MI), and in-hospital mortality. Results: The cohort included 36,386 patients and the median age was 63 yr. Between 2016 and 2018, troponin surveillance was done in 2,461 (13%) of the 19,046 patients, compared with 2,398 (14%) of the 17,340 patients who had surgery between 2019 and 2021 (OR, 1.08; 95% CI, 1.02 to 1.15). Patients who had surgery in the second period had less cardiovascular comorbidity; the adjusted OR for troponin surveillance was 1.14 (95% CI, 1.07 to 1.21). In the two periods, troponin was elevated in 561 (2.9%) and 470 (2.7%) patients, an MI was documented in 54 (0.3%) and 36 (0.2%) patients, and 95 (0.5%) and 73 (0.4%) patients died, respectively. After adjustment for baseline differences in the two periods, the ORs for MI and mortality were 0.83 (95% CI, 0.54 to 1.27) and 0.88 (95% CI, 0.64 to 1.19), respectively. Conclusion: Although the odds of troponin ordering were slightly but significantly higher after publication of the CCS guidelines, the odds for detecting an MI and for mortality did not change.

ABSTRACTIntroductionDuchenne muscular dystrophy is a lethal genetic disease which currently has no cure, and poor standard treatment options largely focused on symptom relief. The development of multiple biological and genetic therapies is underway across various stages of clinical progress which could markedly affect how DMD patients are treated in the future.Areas coveredThe purpose of this review is to provide an introduction to the different therapeutic modalities currently being studied, as well as a brief description of their progress to date and relative advantages and disadvantages for the treatment of DMD. This review discusses exon skipping therapy, microdystrophin therapy, stop codon readthrough therapy, CRISPR-based gene editing, cell-based therapy, and utrophin upregulation. Secondary therapies addressing nonspecific symptoms of DMD were excluded.Expert opinionDespite the vast potential held by gene replacement therapy options such as microdystrophin production and utrophin upregulation, safety risks inherent to the adeno-associated virus delivery vector might hamper the clinical viability of these approaches until further improvements can be made. Of the mutation-specific therapies, exon skipping therapy remains the most extensively validated and explored option, and the cell-based CAP-1002 therapy may prove to be a suitable adjunct therapy filling the urgent need for cardiac-specific therapies.

Glanders is an infectious disease that causes serious damage to the equine production chain in countries where it occurs endemically and poses a risk to public health. This study aimed to conduct an integrative review of the advances in the knowledge of glanders in Brazil over the last three decades since its re-emergence. Documentary research was conducted for the period between the years 2000 and 2022. SCOPUS and PUBMED databases were used to search for scientific articles, dissertations, and thesis, in addition to the Brazilian Digital Library of Thesis and Dissertations (BDTD). A total of 41 documents were retrieved, including 12 dissertations, five theses, and 24 scientific articles. The Federal Rural University of Pernambuco (UFRPE) group provided a noteworthy amount of material on this topic (25 documents, four theses, three dissertations, and 18 scientific articles). During this period, ten dissertations, one thesis, and six scientific articles published by other groups in other states of the Federation were also identified. It was concluded that there was a significant number of scientific publications with relevant data on the clinical, epidemiological, pathological, microbiological, serological, and molecular characteristics of glanders disease in Brazil. Additionally, training of human resources regarding this disease led to an increase in the nucleation of research groups, especially in the northeast region of Brazil. Despite significant advances, new research groups and specific funding are still needed for the development of more accurate diagnostic methods, immunizing production, training of veterinarians to recognize the disease, and more robust programs to control and eradicate the disease in Brazil.

Pregnant women are at higher risk of severe illness from coronavirus disease 2019 (COVID‐19) than non‐pregnant women of a similar age. Early in the COVID‐19 pandemic, it was clear that evidenced‐based guidance was needed, and that it would need to be updated rapidly. The National COVID‐19 Clinical Evidence Taskforce provided a resource to guide care for people with COVID‐19, including during pregnancy. Care for pregnant and breastfeeding women and their babies was included as a priority when the Taskforce was set up, with a Pregnancy and Perinatal Care Panel convened to guide clinical practice. As of May 2022, the Taskforce has made seven specific recommendations on care for pregnant women and those who have recently given birth. This includes supporting usual practices for the mode of birth, umbilical cord clamping, skin‐to‐skin contact, breastfeeding, rooming‐in, and using antenatal corticosteroids and magnesium sulfate as clinically indicated. There are 11 recommendations for COVID‐19‐specific treatments, including conditional recommendations for using remdesivir, tocilizumab and sotrovimab. Finally, there are recommendations not to use several disease‐modifying treatments for the treatment of COVID‐19, including hydroxychloroquine and ivermectin. The recommendations are continually updated to reflect new evidence, and the most up‐to‐date guidance is available online (https://covid19evidence.net.au). The National COVID‐19 Clinical Evidence Taskforce has been a critical component of the infrastructure to support Australian maternity care providers during the COVID‐19 pandemic. The Taskforce has shown that a rapid living guidelines approach is feasible and acceptable.

This article presents, in detail, the paths and mechanisms, main by-products, and a kinetic study of the oxidation of profenofos (PFF) by HO•radicals. Photo-assisted peroxidation was the precursor reaction for generation of radicals; the effect of UV-C (245 nm) radiation was evaluated. The results of the kinetics study indicated that the best fit for the experimental data was the pseudo-first-order model; further, that oxidation occurs in a fast initial stage and a slow final stage. In an acidic environment, the fast oxidation stage was favored over the slow stage; while in the basic medium the opposite behavior was observed. Eight oxidation by-products and 29 reaction intermediates were identified. The main mechanisms involved in the mineralization of PFF were reactions of electron ABSTRACTion, HO•ABSTRACTion, H•ABSTRACTion, substitution, displacement, and addition of electrons. The rapid oxidation step was related to the mining of the O–C2H5and S–C3H7chains of the intermediate O-ethyl S-propyl phosphonothioate. The slow oxidation step included the mineralization of 4-bromo-2-chlorophenyl and derivatives.

The international spread of poliovirus exposes all countries to the risk of outbreaks and is designated a Public Health Emergency of International Concern by WHO. This risk can be exacerbated in countries using inactivated polio vaccine, which offers excellent protection against paralysis but is less effective than oral vaccine against poliovirus shedding, potentially allowing circulation without detection of paralytic cases for long periods of time. Our study investigated the molecular properties of type 2 poliovirus isolates found in sewage with an aim to detect virus transmission in the community.

Patients with coronary artery disease (CAD) are at risk for developing atrial fibrillation (AF). Whether attending a cardiac rehabilitation (CR) program can attenuate this risk is unclear.

Bamboos are considered one of China’s four noble plants and have been used for medicinal purposes for centuries. Despite that, what is really known about the chemical composition and biological activities of bamboos? Which species have been studied? What trials have been done to test their medicinal properties? This paper compiled studies of the last 11 years about phytochemical and biological activities of bamboos aiming a critical analysis of the results to provide perspectives and directions for future research using bamboo species as a potential source of drug leads. This review gathers available information on major scientific databases from the period of 2007–2018. A total of 136 papers regarding 87 bamboo species and 24 genera were compiled. Studies regarding phytochemical and or bioactivity of species from the Olyreae tribe (herbaceous bamboo) were not found. Phenolic compounds were the major class of secondary metabolites reported for bamboos species, followed by coumarins and alkaloids. Antioxidant capacity was the most performed bioassay. Phyllostachyshas been the most studied genus. This review highlights a big lack of knowledge regarding American bamboos, mainly for the herbaceous species. Although bamboos are known to have a diversity of flavonoids, there are other classes of constituents that should be better studied. There are few bamboo species with their in vivo biological potential tested. Therefore, bamboos have economically important secondary metabolite classes with a possible medicinal application, but further studies on phytochemistry and in vivo assays are still needed to better evaluate their benefits to human health.

Pharmacoepidemiology has emerged as a crucial field in evaluating the use and effects of medications in large populations to ensure their safe and effective use. This study aimed to assess the agreement of cardiac medication use between a provincial medication database, the Pharmaceutical Information Network (PIN), and reconciled medication data from confirmation through patient interviews for patients referred to cardiac rehabilitation.

This work presents a novel optimization strategy for maximum coupling results in optical coupler design. It was performed by the association between Evolutionary Strategy based metaheuristic with Fuzzy Logic and Shannon’s Entropy estimation for fitness bias support and control population diversity, respectively. This solution provided convergence for better results with fewer iterations and, consequently, reduced processing time. The results of some of the performance tests are presented, in which the best configuration obtained using the ES+Fuzzy with Shannon’s Entropy leads to an optical coupling around 86% by a device operating at a wavelength of 1.55μmto support the telecommunication services.

Alkaline fermentation of two distinct types of waste activated sludge was assessed to evaluate the recovery of by-products, such as nutrients, organic matter as a source of bioenergy, volatile fatty acids, and water. Also, to reduce the amount of solids to be disposed of, and the total management costs. Sludge 1 was from conventional activated sludge, and Sludge 2 was from a sequential batch reactor set for biological phosphorus removal. In the laboratory three different fermentation processes were provided in parallel, treating Sludge 1, followed by Sludge 2. Treatment A was the control, wherein the fermentation process occurred without alkali addition. Treatment B was alkaline fermentation with a controlled pH 10 of pre-solubilized sludge, and treatment C was alkaline fermentation at a controlled pH 10. The results indicated that alkaline fermentation significantly reduced the volatile suspended solids (VSS) to 45% treating Sludge 1, and to 50% treating Sludge 2, which was significantly improved for both sludges when pre-solubilized achieving 59% and 60%, respectively. Also, comparing the biogas production test of treatment A to the other conditions set, both increased almost four, and three times, for B and C, respectively. Orthophosphate, chemical oxygen demand, carbohydrates, and proteins in soluble fractions significantly increased under alkaline fermentation compared with the control, and all of these parameters were boosted with pre-solubilization. Comparing both sludges, the one from biological phosphorus removal systems achieved higher VSS reduction, and a significantly higher rate of orthophosphate release.