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Abstract Background There is a lack of self-report measures specifically designed for Adjustment disorder. One of the most widely used instruments is the Adjustment Disorder New Module (ADNM), which has already been validated in different countries. The aim of this study was to validate the Spanish version of the ADNM-20 with a non-clinical sample, including a comparison with a high-risk sample. Method 203 participants of the general population (mean age = 33.84) completed an online survey which included the Spanish version of the ADNM, the anxiety and depression measures GAD-7 and PHQ-9, and an assesment of coping strategies using the Brief-COPE. Results The analysis of the scale’s internal structure revealed that a hierarchical model could best fit the data, as well as a bifactorial structure. The scale showed high internal consistency and an adequate differential validity, as differences were observed when comparing the high-risk and non-clinical groups. Positive correlations were also identified between ADNM and depression and anxiety, as well as different correlations with coping strategies. Conclusion This study presents the first validation of the ADNM-20 in Spanish showing good reliability and validity results. In addition, a comparison with a high-risk sample and norms are offered to help future evaluators.

The aim of the research is to examine the biophysical, spatial, functional, and structural components of the pre-Hispanic terracing systems located in the ancient city of Pisaq, considering the impacts of tourism, geological instability, and cultural loss on the ecological and economic value of the terracing system. The methodology includes site analysis, climatology, and an examination of local flora and fauna, supported by digital tools such as QGIS 3.34, Google Earth Pro 2024, and Sun-Path. The results were primarily supported by the use of software tools such as QGIS, AutoCAD 2023, SketchUp 2022, 3D Sun-Path, D5 Render 2024, and Photoshop 2021. The findings include a biophysical analysis related to ecological and economic zoning (EEZ), which determines variables for preservation and reforestation; a spatial analysis measuring the cultivation terraces, with areas ranging from 4.89 ha to 110.20 ha; a functional analysis examining geophysical aspects such as seismic resistance and microclimate effects due to the greenhouse effect; and a constructive analysis that characterizes terrace typologies from an architectural perspective. In conclusion, this analysis evaluates the terracing system of the archaeological park to ensure its preservation and effective management. It also highlights that Inca culture has left a legacy of sustainable architecture, which aligns with the current Sustainable Development Goals (SDGs) (6, 11, 13, 15).

Background: Nursing, as an essential component of contemporary healthcare systems, has undergone significant changes in recent decades, resulting in an increase in research across various fields, such as mental health, well-being, and the development of the discipline itself. Currently, gender stereotypes persist, impacting the social image of the profession and influencing the professional identity of nurses and consequently, their work performance and the quality of care provided. Both public and internal perceptions of the profession are critical factors in these dynamics. Objective: to adapt and validate the Nursing Attitude Questionnaire in a Spanish sample, as it has only been validated in two languages to date. Methods: This study presents descriptive and validity analyses of several measures utilized, such as Nursing Image (NIS), Medical Empathy (JSE-HP), Professional Values (NPVS) and Communication Skills (HP-CSS). Results: Confirmatory factor model analyses indicated that a 21-item hierarchical model provided a superior fit (χ2(df = 1.65, NFI = 0.954, SRMR = 0.065), suggesting the presence of a general factor accounting for five first-order factors. Internal consistency was deemed adequate for the total measures (α = 0.789), though variable for the subscales. Correlations among measures provided evidence of convergent and discriminant validity, highlighting consistent correlation patterns between Attitude toward Nursing and other variables. In addition, significant differences were observed in the Professionalism subscale according to sex, albeit with a medium-low effect size. Scales are presented to facilitate future interpretation of the results in similar samples. Conclusions: The scale validated in this study exhibited overall good psychometric performance, although certain limitations were identified within the subscales. The established scales represent a novel contribution, providing a valuable tool for the comparison of similar samples.

This review explores the state‐of‐the‐art of thermoelectric materials, covering different crystalline structures and material families (e.g., chalcogenides, Zintl phases, skutterudites, clathrates, oxides, half‐Heusler, organic–inorganic composites, metal–organic frameworks, and silicides). It examines their corresponding thermoelectric properties while considering the synthesis methods employed, paying significant attention to those that particularly follow sustainable routes. Additionally, the work addresses current challenges in the field, such as enhancing stability at high temperatures and reducing manufacturing costs. The understanding gained in this field opens avenues for designing more efficient and sustainable devices to convert waste heat into electrical energy, thereby advancing cleaner technologies.

Background and Objectives: Venous thromboembolism (VTE) can be the first manifestation of an underlying cancer. This study aimed to develop a predictive model to assess the risk of occult cancer between 30 days and 24 months after a venous thrombotic event using machine learning (ML). Materials and Methods: We designed a case–control study nested in a cohort of patients with VTE included in a prospective registry from two Spanish hospitals between 2005 and 2021. Both clinically and ML-driven feature selection were performed to identify predictors for occult cancer. XGBoost, LightGBM, and CatBoost algorithms were used to train different prediction models, which were subsequently validated in a hold-out dataset. Results: A total of 815 patients with VTE were included (51.5% male and median age of 59). During follow-up, 56 patients (6.9%) were diagnosed with cancer. One hundred and twenty-one variables were explored for the predictive analysis. CatBoost obtained better performance metrics among the ML models analyzed. The final CatBoost model included, among the top 15 variables to predict hidden malignancy, age, gender, systolic blood pressure, heart rate, weight, chronic lung disease, D-dimer, alanine aminotransferase, hemoglobin, serum creatinine, cholesterol, platelets, triglycerides, leukocyte count and previous VTE. The model had an ROC-AUC of 0.86 (95% CI, 0.83–0.87) in the test set. Sensitivity, specificity, and negative and positive predictive values were 62%, 94%, 93% and 75%, respectively. Conclusions: This is the first risk score developed for identifying patients with VTE who are at increased risk of occult cancer using ML tools, obtaining a remarkably high diagnostic accuracy. This study’s limitations include potential information bias from electronic health records and a small cancer sample size. In addition, variability in detection protocols and evolving clinical practices may affect model accuracy. Our score needs external validation.

Background: Amyotrophic lateral sclerosis (ALS) is characterized by progressive motor neuron degeneration, with oxidative stress playing a key role. Paraoxonase 1 (PON1) is an antioxidant enzyme that may influence ALS progression. This study aimed to establish a predictive model for the influence of PON1 activity on functionality in ALS patients and explore its relationship with nutrition. Methods: In this observational cross-sectional study, 70 ALS patients underwent assessments of PON1 activity, lipid profile, functional capacity, respiratory function, and heart rate variability. A structural equation model was developed to determine the relationships between variables. Nutritional intake was analyzed in 65 patients. Results: The predictive model showed that PON1 activity and LDL levels positively influenced functionality, both directly and indirectly through respiratory capacity. Heart rate variability moderately predicted functionality independently. HDL levels were not significantly associated with functionality. Weak to moderate correlations were found between PON1 activity and intake of certain nutrients, with positive associations for monounsaturated fats and vitamin D, and negative associations for carbohydrates, proteins, and some micronutrients. Conclusions: PON1 activity appears to play an important role in ALS patient functionality, both directly and through effects on respiratory capacity. However, its relationship with nutritional intake was not strongly evident in this sample population.

El conocimiento que el alumnado actual posee sobre las menciones de los grados de Maestro/a es un campo de interés para saber en qué punto se encuentran con respecto a sus elecciones en relación con sus salidas profesionales. Esta investigación pretende explorar las diferencias de la percepción sobre las menciones en función del sexo, el grado estudiado (Doble grado o Infantil/Primaria) y el curso (2º, 3º, 4º o 5º) y si el hecho de poseer estudios previos musicales influye en la percepción de las menciones. También analizar el papel que tiene en esta percepción el hecho de haber trabajado aspectos musicales en el instituto. Se aplicó un cuestionario a 337 alumnos de los cursos 2º, 3º, 4º y 5º del Grado de Maestro en Educación Infantil, Maestro en Educación Primaria y Doble grado en Maestro en Educación Infantil y Maestro en Educación Primaria de la Universidad Autónoma de Madrid, Universidad de Castilla-La Mancha, Universidad de Salamanca y Universidad de Murcia. Se analizaron los datos en primer lugar realizando los estadísticos previos de las principales medidas del cuestionario. En segundo lugar, se llevó a cabo un Análisis Factorial Exploratorio y por último se estudiaron las diferencias mediante pruebas t de Student. Finalmente, se estudiaron asociaciones entre las medidas de percepción de las menciones y el resto de las medidas categóricas usando pruebas χ2 de Pearson, además, del cálculo de la V de Kramer como índice de asociación. Se concluye insistiendo en la necesidad de más información con respecto a la definición de las menciones y a sus salidas profesionalizantes en el alumnado actual.

Background: The clinical burden of influenza is increasing worldwide. Aging, immunosuppression, and underlying respiratory illness are determinants of poor clinical outcomes, including greater mortality. Bacterial infections seem to be the main reason. Updated information on the role of bacterial infection as the cause of complications would be of value in improving the prognosis of patients with influenza. Methods: A systematic review and meta-analysis were performed by using the PubMed repository using keywords like: Influenza, H1N1, Streptococcus pneumoniae, bacterial coinfection, secondary coinfection, bacterial complications in pneumonia, and seasonal influenza. Only articles written in English were included in publications from 2010 to 2020. The analyses were conducted following the preferred reporting items for systematic review and meta-analyses guidelines. The results were independently validated using a TrinetX database cohort of roughly 4 million patients. Results: We included 135 studies that contained data from 48,259 patients hospitalized with influenza of any age. Bacterial infections were diagnosed in 5391 (11.2%). Streptococcus pneumoniae (30.7%) and Staphylococcus aureus (30.4%) were the most frequent microorganisms, followed by Haemophilus influenzae (7.1%) and Pseudomonas aeruginosa (5.9%). The random-effects model of the meta-analysis indicated that bacterial infections posed a 3.4-fold increased risk of death compared with influenza infection alone. Unexpectedly, asthma was protective (odds ratio 0.8). Conclusion: Bacterial infections diagnosed in 11.2% of patients with influenza increase 3.4-fold the mortality risk. S. pneumoniae, S. aureus, H. influenzae, and P. aeruginosa account for nearly 75% of the cases. Earlier diagnosis and use of antibiotics should improve outcomes in this population.

ABSTRACT Influenza A virus (IAV) infection triggers quantitative and qualitative modifications in lung and intestinal microbiota composition, which contain an important reservoir of antibiotic resistance genes. Analysis of genetic changes is a common practice in studies that analyze microbiota modifications. However, there is little evidence of functional changes linked to such microbiota modifications. This study evaluates some cecal microbiota’s functional changes, comparing sublethal IAV with mock-infected mice. Community-wide phenotypic metabolic profile (Biolog EcoPlatesTM) and relative antibiotic resistance changes to clinically relevant antibiotics (cenoantibiogram) have been performed in this context. Results reveal a temporal association between IAV infection and alterations in nutrient substrate profile usage as well as changes in antibiotic resistance of cecal microbiota. Alterations are transient and predominantly occur at early time points post-IAV infection. There is a functional rebalance in nutrient substrate usage and antibiotic resistance under the established culture conditions, accompanied by a decrease in microbial density of the cecal community on days 5 and 7 after the IAV infection. Our data underline that active IAV infections altering microbial populations are associated with changes in nutrient usage preferences and affect community behaviors toward specific antibiotics. These findings could have implications including activation of nutrient-related metabolic stress at the microbiota community level and additional antibiotic resistance selection mechanisms of clinically relevant infections. IMPORTANCE Influenza virus infection affects both lung and intestinal bacterial community composition. Most of the published analyses focus on the characterization of the microbiota composition changes. Here we assess functional alterations of gut microbiota such as nutrient and antibiotic resistance changes during an acute respiratory tract infection. Upon influenza A virus (IAV) infection, cecal microbiota drops accompanied by a decrease in the ability to metabolize some common nutrients under aerobic conditions. At the same time, the cecal community presents an increase in resistance against clinically relevant antibiotics, particularly cephalosporins. Functional characterization of complex communities presents an additional and necessary element of analysis that nowadays is mainly limited to taxonomic description. The consequences of these functional alterations could affect treatment strategies, especially in multimicrobial infections.

Introduction: Amyotrophic lateral sclerosis (ALS) produces alterations in the autonomic nervous system (ANS), which explains the cardiac manifestations observed in patients. The assessment of heart rate variability (HRV) is what best reflects the activity of the ANS on heart rate. The Polar H7 Bluetooth® device proves to be a non-invasive and much faster technology than existing alternatives for this purpose. Objective: The goal of this study is to determine HRV using Polar H7 Bluetooth technology in ALS patients, comparing the obtained measurements with values from healthy individuals. Method: The sample consisted of 124 participants: 68 diagnosed with ALS and 56 healthy individuals. Using Polar H7 Bluetooth technology and the ELITE HRV application, various HRV measurements were determined for all participants, specifically the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, LF, HF, LF/HF ratio, HR average, and HF peak frequency. Results: Statistically significant differences were observed between ALS patients and healthy individuals in the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, HF, and LF, where healthy individuals exhibited higher scores. For the HR average, the ALS group showed a higher value. Values were similar when comparing men and women with ALS, with only a higher HF peak frequency observed in women. Conclusion: The Polar H7 Bluetooth® device is effective in determining heart rate variability alterations in ALS, being a promising prognostic tool for the disease.

Determining the eruption frequency-Magnitude (f-M) relationship for data-limited volcanoes is challenging since it requires a comprehensive eruption record of the past eruptive activity. This is the case for Melimoyu, a long-dormant and data-limited volcano in the Southern Volcanic Zone (SVZ) in Chile with only two confirmed Holocene eruptions (VEI 5). To supplement the eruption records, we identified analogue volcanoes for Melimoyu (i.e., volcanoes that behave similarly and are identified through shared characteristics) using a quantitative and objective approach. Firstly, we compiled a global database containing 181 variables describing the eruptive history, tectonic setting, rock composition, and morphology of 1,428 volcanoes. This database was filtered primarily based on data availability into an input dataset comprising 37 numerical variables for 438 subduction zone volcanoes. Then, we applied Agglomerative Nesting, a bottom-up hierarchical clustering algorithm on three datasets derived from the input dataset: 1) raw data, 2) output from a Principal Component Analysis, and 3) weighted data tuned to minimise the dispersion in the absolute probability per VEI. Lastly, we identified the best set of analogues by analysing the dispersion in the absolute probability per VEI and applying a set of criteria deemed important by the local geological service, SERNAGEOMIN, and VB. Our analysis shows that the raw data generate a low dispersion and the highest number of analogues (n = 20). More than half of these analogues are in the SVZ, suggesting that the tectonic setting plays a key role in the clustering analysis. The eruption f-M relationship modelled from the analogue’s eruption data shows that if Melimoyu has an eruption, there is a 49% probability (50th percentile) of it being VEI≥4. Meanwhile, the annual absolute probability of a VEI≤1, VEI 2, VEI 3, VEI 4, and VEI≥5 eruption at Melimoyu is 4.82 × 10−4, 1.2 × 10−3, 1.45 × 10−4, 9.77 × 10−4, and 8.3 × 10−4 (50th percentile), respectively. Our work shows the importance of using numerical variables to capture the variability across volcanoes and combining quantitative approaches with expert knowledge to assess the suitability of potential analogues. Additionally, this approach allows identifying groups of analogues and can be easily applied to other cases using numerical variables from the global database. Future work will use the analogues to populate an event tree and define eruption source parameters for modelling volcanic hazards at Melimoyu.

Multiple Sclerosis (MS) is a neurodegenerative disease characterized by motor and non-motor symptoms, including emotional distress, anxiety, and depression. These emotional symptoms currently have a pharmacological treatment with limited effectiveness; therefore, it is necessary to delve into their relationship with other psychological, functional, or prefrontal alterations. Additionally, exploring non-pharmacological therapeutic alternatives that have shown benefits in addressing emotional distress in MS patients is essential. Aim: To establish a predictive model for the presence of anxiety and depression in MS patients, based on variables such as psychological well-being, functional activity, and prefrontal symptoms. Additionally, this study aimed to propose non-pharmacological therapeutic alternatives based on this model. Materials and Methods: A descriptive, observational, and cross-sectional study was conducted with a sample of 64 diagnosed MS patients who underwent functional and cognitive assessments using the following questionnaires and scales: Functional Activities Questionnaire (FAQ), Acceptance and Action Questionnaire (AAQ-II), Experiences Questionnaire (EQ), Self-Compassion Scale Short Form (SCS-SF), Beck Depression Inventory II (BDI-II), State-Trait Anxiety Inventory (STAI), and Prefrontal Symptoms Inventory (PSI). Results: The model showed an excellent fit to the data and indicated that psychological well-being was the most significant predictor of the criteria (β = −0.83), followed by functional activity (β = −0.18) and prefrontal symptoms (β = 0.15). The latter two are negatively related to psychological well-being (β = −0.16 and β = −0.75, respectively). Conclusions: Low psychological well-being is the variable that most significantly predicts the presence of anxiety and depression in MS patients, followed by functional activity and prefrontal alterations. Interventions based on mindfulness and acceptance are recommended, along with nutritional interventions such as antioxidant-enriched ketogenic diets and moderate group physical exercise.

The association between obstructive sleep apnea (OSA) and metabolic disorders is well-established; however, the underlying mechanisms that elucidate this relationship remain incompletely understood. Since the liver is a major organ in the maintenance of metabolic homeostasis, we hypothesize that liver dysfunction plays a crucial role in the pathogenesis of metabolic dysfunction associated with obstructive sleep apnea (OSA). Herein, we explored the underlying mechanisms of this association within the liver. Experiments were performed in male Wistar rats fed with a control or high fat (HF) diet (60% lipid-rich) for 12 weeks. Half of the groups were exposed to chronic intermittent hypoxia (CIH) (30 hypoxic (5% O2) cycles, 8 h/day) that mimics OSA, in the last 15 days. Insulin sensitivity and glucose tolerance were assessed. Liver samples were collected for evaluation of lipid deposition, insulin signaling, glucose homeostasis, hypoxia, oxidative stress, antioxidant defenses, mitochondrial biogenesis and inflammation. Both the CIH and HF diet induced dysmetabolism, a state not aggravated in animals submitted to HF plus CIH. CIH aggravates hepatic lipid deposition in obese animals. Hypoxia-inducible factors levels were altered by these stimuli. CIH decreased the levels of oxidative phosphorylation complexes in both groups and the levels of SOD-1. The HF diet reduced mitochondrial density and hepatic antioxidant capacity. The CIH and HF diet produced alterations in cysteine-related thiols and pro-inflammatory markers. The results obtained suggest that hepatic mitochondrial dysfunction and oxidative stress, leading to inflammation, may be significant factors contributing to the development of dysmetabolism associated with OSA.

At present, there is a high demand for carbon (C) sequestration alternatives; thus, understanding tree growth and the efficacy of remote sensing techniques to capture forest plantation ecophysiology is crucial. This study evaluated the effect of contrasting stockings of Gmelina arborea on its initial growth and aboveground Carbon stock, and the efficacy of aerial images obtained using drones to capture the crown cover at different stockings. The results indicated that denser stockings showed greater tree heights and stem diameter increments, contrary to traditional measurements. The C storage capacity of Gmelina arborea was promising, with an aboveground estimated C stock of about 13 Mg ha−1 in 9 months, making it a valuable and promising species for CO2 sequestration under the context of climate change. The use of simple Red-Green-Blue (RGB) cameras and drones to detect and estimate crown areas in young plantations was mainly viable within the commercial range of stockings (500–2000 trees ha−1), and can be used as a powerful tool to better understand tree initial growth. The results showed effective discrimination without weeds independently of the stocking level; however, when weeds were present, the effectiveness decreased. This research provides valuable insights into forest management and improves the understanding of the silviculture behavior of a potential native species for reforestation in the tropics.

Inorganic materials can provide a set of tools to decontaminate solid, liquid or air containing viral particles. The use of disinfectants can be limited or not practical in scenarios where continuous cleaning is not feasible. Physicochemical differences between viruses raise the need for effective formulations for all kind of viruses. In the present work we describe two types of antimicrobial inorganic materials: i) a novel soda-lime glass (G3), and ii) kaolin containing metals nanoparticles (Ag or CuO), as materials to disable virus infectivity. Strong antiviral properties can be observed in G3 glass, and kaolin-containing nanoparticle materials showing a reduction of viral infectivity close to 99% in the first 10 ​min of contact of vesicular stomatitis virus (VSV). A potent virucidal activity is also present in G3 and kaolin containing Ag or CuO nanoparticles against all kinds of viruses tested, reducing more than 99% the amount of HSV-1, Adenovirus, VSV, Influenza virus and SARS-CoV-2 exposed to them. Virucidal properties could be explained by a direct interaction of materials with viruses as well as inactivation by the presence of virucidal elements in the material lixiviates. Kaolin-based materials guarantee a controlled release of active nanoparticles with antiviral activity. Current coronavirus crisis highlights the need for new strategies to remove viruses from contaminated areas. We propose these low-cost inorganic materials as useful disinfecting antivirals in the actual or future pandemic threats.

The goal of the current work was to identify an air-side-optimized contact material for La0.3Ca0.7Fe0.7Cr0.3O3−δ (LCFCr) electrodes and a Crofer22APU interconnect for use in reversible solid oxide fuel cells (RSOFCs). LaNi0.6Co0.4−xFexO3 (x = 0–0.3) perovskite-type oxides were investigated in this work. The partial substitution of Co by Fe decreased the thermal expansion coefficient values (TEC) closer to the values of the LCFCr and Crofer 22 APU interconnects. The oxides were synthesized using the glycine–nitrate method and were characterized using X-ray thermodiffraction and 4-probe DC electrical conductivity measurements. Based on the materials characterization results from the Fe-doped oxides investigated here, the LaNi0.6Co0.2Fe0.2O3−δ composition was selected as a good candidate for the contact material, as it exhibited an acceptable electrical conductivity value of 395 S·cm−1 at 800 °C in air and a TEC value of 14.98 × 10−6 K−1 (RT-900 °C).

This study aimed to examine the effect of visual pre-cueing presented at different time intervals in the response time of dyslexic and non-dyslexic children. Fifteen dyslexic and 15 non-dyslexic children performed a computerised four-choice reaction time task across four conditions: no pre-cue and a 43-ms time interval (or duration) of a centralised dot appearing in the stimulus circle at 43, 86 or 129 ms prior to the stimulus. Each condition was repeated eight times, totaling 32 trials, and presented in a random order. Response correctness and response times were recorded for each trial, and z-scores were obtained by standardising performance in the three pre-cued conditions relative to the no pre-cue condition. Dyslexic children took longer to respond in the task than non-dyslexic children. Both dyslexic and non-dyslexic children had faster response times in the pre-cued conditions than in the conditions without the pre-cue. These lower response times were inversely correlated with the length of the pre-cueing interval. These results suggest that dyslexic children use visual pre-cueing to improve decision-making. The ability of dyslexic children to use pre-cues may offer an interesting avenue for the exploration of interventions aimed at minimising behavioural and cognitive difficulties resulting from dyslexia., (© 2024 John Wiley & Sons Ltd.)

Background: Health literacy (HL) impacts people's health and well-being. In Latin America and the Caribbean (LAC), there are no general estimates of the prevalence of low HL. This study aimed to estimate the prevalence of low HL among citizens of LAC and identify the tools used to measure it., Methods: We included observational studies quantifying the prevalence of low HL in people living in LAC. We searched PubMed, CINAHL, EMBASE, ERIC, LILACS, PsycINFO, Redalyc, SciELO, Web of Science, PQDT, and the reference lists of the included studies in June 2023. Two reviewers independently conducted the selection, extraction, and risk of bias assessment using the JBI Critical Appraisal Tools. Meta-analysis of proportions using random effects models was used to summarize the prevalence of low HL estimated. This prevalence was measured in each study using different classification methods: word recognition items, reading and numeracy comprehension items, and self-reported comprehension items., Results: Eighty four studies involving 23,914 participants from 15 countries were included. We identified 23 tools to assess HL, and most of the studies were carried out in health services. The pooled prevalence of low HL were 44.02% (95%CI: 36.12-52.24) for reading and numeracy comprehension items, 50.62% (95%CI: 41.82-59.39) for word recognition items, and 41.73% (95%CI: 31.76-52.43) for self-reported comprehension items., Conclusion: Despite the variability in the prevalence of low HL and a diversity of tools, the average of low HL is of concern. Almost half of the participants in the included studies have low HL. Most of the studies targeted users of healthcare services. Further research investigating the prevalence of low HL in the general population and actions focused on health education, communication, and information are necessary., Trial Registration: PROSPERO (CRD42021250286)., (© 2024. The Author(s).)

Introduction: This systematic review aimed to compare the effect of alternative levothyroxine administration regimens on thyroid hormone levels and patient-reported outcomes (PROs) among adults with hypothyroidism., Methods: We searched PubMed, Embase, CENTRAL, CINAHL, LILACS, SciELO, Scopus, Web of Science, OpenGrey, ProQuest, ClinicalTrials.gov, and ICTRP from inception to May/2023 for randomized controlled trials (RCTs). We assessed the risk of bias with Cochrane Risk of Bias 2.0 tool. We analyzed TSH levels by pairwise and network meta-analyses (NMA). The FT4 levels and PROs were qualitatively assessed., Results: We included 14 RCTs (906 participants) comparing different regimens, as bedtime vs. before breakfast. A total of 12 RCTs were at high risk of bias. Seven RCTs were included in the TSH meta-analysis, where the mean difference (MD) and 95% confidence interval (CI) were as follows: bedtime vs before breakfast (4 RCTs) 0.69 (-1.67-3.04), I 2  = 92%, very low certainty evidence; weekly dose vs before breakfast (2 RCTs) 1.68 (0.94-2.41), I 2  = 0%, low certainty evidence; and at breakfast vs before breakfast (1 RCT) 0.65 (-1.11-2.41), very low certainty evidence. The NMA showed no evidence of differences in TSH level with different regimens., Conclusion: The evidence is insufficient to determine the most effective levothyroxine administration regimen for hypothyroidism., Systematic Review Registration: PROSPERO - CRD42021279375.

Sea turtles are vulnerable to climate change since their reproductive output is influenced by incubating temperatures, with warmer temperatures causing lower hatching success and increased feminization of embryos. Their ability to cope with projected increases in ambient temperatures will depend on their capacity to adapt to shifts in climatic regimes. Here, we assessed the extent to which phenological shifts could mitigate impacts from increases in ambient temperatures (from 1.5 to 3°C in air temperatures and from 1.4 to 2.3°C in sea surface temperatures by 2100 at our sites) on four species of sea turtles, under a "middle of the road" scenario (SSP2-4.5). Sand temperatures at sea turtle nesting sites are projected to increase from 0.58 to 4.17°C by 2100 and expected shifts in nesting of 26-43 days earlier will not be sufficient to maintain current incubation temperatures at 7 (29%) of our sites, hatching success rates at 10 (42%) of our sites, with current trends in hatchling sex ratio being able to be maintained at half of the sites. We also calculated the phenological shifts that would be required (both backward for an earlier shift in nesting and forward for a later shift) to keep up with present-day incubation temperatures, hatching success rates, and sex ratios. The required shifts backward in nesting for incubation temperatures ranged from -20 to -191 days, whereas the required shifts forward ranged from +54 to +180 days. However, for half of the sites, no matter the shift the median incubation temperature will always be warmer than the 75th percentile of current ranges. Given that phenological shifts will not be able to ameliorate predicted changes in temperature, hatching success and sex ratio at most sites, turtles may need to use other adaptive responses and/or there is the need to enhance sea turtle resilience to climate warming., (© 2023 The Authors. Global Change Biology published by John Wiley & Sons Ltd.)

Objective:  The aim of this study was to systematically review literature on the use of iron supplements (not including iron derived from diet), increased levels of hemoglobin and/or ferritin, and the risk of developing gestational diabetes mellitus (GDM)., Data Source:  The following databases were searched, from the study's inception to April 2021: PUBMED, Cochrane, Web of Science, Scopus, Embase, Cinahl and Lilacs., Selection of Studies:  A total of 6,956 titles and abstracts were reviewed, 9 of which met the final inclusion criteria, with 7,560 women in total., Data Collection:  Data extraction was performed by two independent reviewers and disagreements were resolved by a third researcher., Data Synthesis:  Methodological quality in controlled trials were assessed according to the Cochrane Collaboration tools (ROB-2 and ROBINS-1) and for the observational studies, the National Institutes of Health's (NIH) quality assessment tool was used. Among the 5 observational studies, women with a higher hemoglobin or ferritin level were more likely to develop GDM when compared with those with lower levels of these parameters. Among the 3 randomized clinical trials, none found a significant difference in the incidence of GDM among women in the intervention and control groups. However, we identified many risks of bias and great methodological differences among them., Conclusion:  Based on the studies included in this review, and due to the important methodological problems pointed out, more studies of good methodological quality are needed to better establish the association between iron supplementation and GDM., Competing Interests: None to declare, (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Introduction: Monitoring water quality in mobile dialysis (MD) services, assessing critical points and characterizing the risks inherent in the process, is essential to avoid risks to the patient's health. This study evaluated the microbiological quality of water in the MD of 36 hospitals with intensive treatment in the city of Rio de Janeiro., Methods: 204 water samples were collected from the points of entry to the network (NET), post-osmosis (PO) and dialysis solution (DS). The samples were evaluated for heterotrophic bacteria count, pathogen search, presence of endotoxins and aluminum content., Results: Bacterial contamination at 3 collection points in 36 hospitals was 30% (32/108); 42% from DS, 31% from PO and 17% from NET, with the presence of Pseudomonas aeruginosa, Stenotrophomonas maltophilia , Burkholderia cepacia and Ralstonia pickettii in the 3 points. Endotoxin concentrations above 0.25 EU/mL occurred in 77% of the samples (17/22) analyzed in the PO. In the aluminum content, values above 0.01 mg/L were presented in 47% (7/15) of PO samples and 27% (4/15) of NET samples. There is no specific legislation for water used in the MD; therefore, the limits of the RDC of the National Health Surveillance Agency (Anvisa) 11/2014 were used; which regulates conventional hemodialysis services., Conclusion: The results highlight the importance of evaluating water quality in MD services to ensure patient safety and support the sanitary monitoring of this process as a healthcare promoter.