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The framework of stakeholder pressures in sports industries, and in the specific case of football, has been used to identify the reasons why management bodies incorporate interested parties into their business strategy. This is primarily contingent on the pressures that interested parties generate. One of the most influential stakeholders is the fan base, given the emotional attachment that this type of sport evokes in them, commonly referred to as "the fan's affective connection." Despite the existence of studies on diverse typologies of fans, no investigation has been conducted into the impact these have on the sustainability outcomes of football clubs. Moreover, most existing studies have focused on European leagues, with a pronounced emphasis on the environmental dimension of sustainability. Therefore, the aim of this research is to evaluate the impact of diverse fan types on the sustainability performance of Colombian football clubs, with a specific focus on the triple bottom line approach. To this end, two major fan typologies-active and non-active-were defined based on the findings of the literature review, as well as the pressures associated with solidarity-based factors. A conceptual model and an estimation based on the structural equation model related the different fan typologies and their associated pressures to sustainability outcomes. The results indicate that among the solidarity-based pressures, fans valued social commitment the most, followed by the promotion of women's football and the fight against racism. Environmental engagement was the least relevant, but still positively rated, suggesting the need for awareness-raising efforts to extend fans' sustainability practices beyond the stadium. The findings of this research can inform strategies for football clubs to engage fans and improve their sustainability performance across economic, social and environmental dimensions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Hernández-Hernández, Londoño-Pineda and Cano.)

Orchids constitute one of the most spectacular radiations of flowering plants. However, their origin, spread across the globe, and hotspots of speciation remain uncertain due to the lack of an up-to-date phylogeographic analysis. We present a new Orchidaceae phylogeny based on combined high-throughput and Sanger sequencing data, covering all five subfamilies, 17/22 tribes, 40/49 subtribes, 285/736 genera, and c. 7% (1921) of the 29 524 accepted species, and use it to infer geographic range evolution, diversity, and speciation patterns by adding curated geographical distributions from the World Checklist of Vascular Plants. The orchids' most recent common ancestor is inferred to have lived in Late Cretaceous Laurasia. The modern range of Apostasioideae, which comprises two genera with 16 species from India to northern Australia, is interpreted as relictual, similar to that of numerous other groups that went extinct at higher latitudes following the global climate cooling during the Oligocene. Despite their ancient origin, modern orchid species diversity mainly originated over the last 5 Ma, with the highest speciation rates in Panama and Costa Rica. These results alter our understanding of the geographic origin of orchids, previously proposed as Australian, and pinpoint Central America as a region of recent, explosive speciation., (© 2024 The Authors New Phytologist © 2024 New Phytologist Foundation.)

This study presents a bibliometric analysis of stakeholder governance and sustainability in football. The PRISMA statement and the main techniques from the existing bibliometric analysis toolbox are applied to guide the research. The analysis includes 127 documents from Scopus and WoS, covering the period from 2007 to mid-2023, to examine the performance analysis and science mapping of the subject over time. The study's key findings highlight publication-related metrics, citation-and-publication-related metrics, co-authorship analysis, and co-word analysis. The analysis also identifies research gaps, including the need to explore barriers to stakeholder governance in football, the application of stakeholder pressure frameworks in football clubs, the examination of mimetic and normative pressures in the context of sustainability and governance in football, and the involvement of stakeholders and football institutions in collaborative efforts to enhance the effectiveness and impact of sustainability initiatives., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Chicken is one of the most consumed meats in the world because it is an economical protein source with a low fat content. Its conservation is important to maintain safety along the cold chain. In the present study, the effect of Neutral Electrolyzed Water (NEW) at 55.73 ppm was evaluated on contaminated chicken meat with Salmonella Typhimurium and Escherichia coli O157:H7, which was stored in refrigerated conditions. The present study was carried out to check whether the application of NEW can help to preserve chicken breasts without affecting its sensory characteristics. Chicken quality was measured by analyzing physicochemical properties (pH, color, lactic acid, total volatile basic nitrogen, and thiobarbituric acid reactive substances content) after bactericidal intervention. This work includes a sensory study to determine if its use affects the organoleptic properties of the meat. The results showed that in the in vitro assay, NEW and NaClO, achieved bacterial count reductions of >6.27 and 5.14 Log10 CFU for E. coli and Salmonella Typhimurium, respectively, even though, in the in situ challenge, they showed a bacterial decrease of 1.2 and 0.33 Log10 CFU/chicken breast in contaminated chicken breasts with E. coli and Salmonella Typhimurium, respectively, after 8 days of storage, and NaClO treatment did not cause bacterial reduction. Nonetheless, NEW and NaClO did not cause lipid oxidation and nor did they affect lactic acid production, and they also slowed meat decomposition caused by biogenic amines. Sensory results showed that chicken breast characteristics like appearance, smell, and texture were not affected after NEW treatment, and obtained results showed that NEW could be used during chicken meat processing due to the chicken physicochemical stability. However, more studies are still needed.

This study aims to mine a previously developed continuous-flow competitive exclusion culture (CFCEC) originating from the Tilapia gut microbiome as a rational and efficient autochthonous probiotic strain recovery source. Three isolated strains were tested on their adaptability to host gastrointestinal conditions, their antibacterial activities against aquaculture bacterial pathogens, and their antibiotic susceptibility patterns. Their genomes were fully sequenced, assembled, annotated, and relevant functions inferred, such as those related to pinpointed probiotic activities and phylogenomic comparative analyses to the closer reported strains/species relatives. The strains are possible candidates of novel genus/species taxa inside Lactococcus spp. and Priestia spp. (previously known as Bacillus spp.) These results were consistent with reports on strains inside these phyla exhibiting probiotic features, and the strains we found are expanding their known diversity. Furthermore, their pangenomes showed that these bacteria have indeed a set of so far uncharacterized genes that may play a role in the antagonism to competing strains or specific symbiotic adaptations to the fish host. In conclusion, CFCEC proved to effectively allow the enrichment and further pure culture isolation of strains with probiotic potential.

Tilapia is one of the most extensively farmed fish on a global scale. Lately, many studies have been carried out to select and produce probiotics for cultured fish. Bacteria from the genera Bacillus, Lactiplantibacillus (synonym: Lactobacillus), and Lactococcus are the most widely studied with respect to their probiotic potential. Among these microorganisms, Lactococcus lactis has outstanding prospects as a probiotic because it is generally recognized as safe (GRAS) and has previously been shown to exert its probiotic potential in aquaculture through different mechanisms, such as competitively excluding pathogenic bacteria, increasing food nutritional value, and enhancing the host immune response against pathogenic microorganisms. However, it is not sufficient to simply select a microorganism with significant probiotic potential for commercial probiotic development. There are additional challenges related to strategies involving the mass production of bacterial cultures, including the selection of production variables that positively influence microorganism metabolism. Over the last ten years, L. lactis production in batch and fed-batch processes has been studied to evaluate the effects of culture temperature and pH on bacterial growth. However, to gain a deeper understanding of the production processes, the effect of hydrodynamic stress on cells in bioreactor production and its influence on the probiotic potential post-manufacturing also need to be determined. This review explores the trends in tilapia culture, the probiotic mechanisms employed by L. lactis in aquaculture, and the essential parameters for the optimal scale-up of this probiotic., (Copyright © 2021 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.)

Objective: To evaluate the clinical and electrophysiological results in the medium term of the arthroscopic release of the proximal entrapment of the suprascapular nerve., Material and Method: It is a retrospective study that includes 75 patients with idiopathic entrapment of the suprascapular nerve in the suprascapular notch in whom conservative treatment has failed. All patients underwent electrophysiological tests (EMG) as well as clinical test (Constant and DASH test) preoperatively and during follow-up., Results: 75 patients (53 women and 22 men) with a mean age of 44.1 ± 10.7 years met study criteria with a mean follow-up of 63.7 ± 29.1 months. Preoperatively the DASH value was 78,6 ± 10,2, the Constant test value was 37.1 ±8.8 and the EVA value was 8.8 ± 1.1 while the values in the last revision were 19.4 ± 15.8 for DASH, 80.2 ± 9.6 (for the CS and 2 ±1.3 for the EVA scale; the differences were significant in all cases (P<.001). Regarding the results of the electrophysiological test, preoperatively there were 21 very severe grades (28%), 32 severe (42.6%), 17 moderate (22.6%) and 5 mild (6.6%). While in the last review there were 3 severe degrees (4%), 6 moderate (8%), 40 mild (53.3%) and 26 normal (34.6%). There was no very severe grade (0%); 3 patients (4%) had to be reoperated due to persistent symptons., Conclusions: The arthroscopic release of idiopathic entrapment of the suprascapular nerve in the superior scapular notch achieved good clinical and electrophysiological results in the medium term., Level of Evidence: iv; case series; treatment study., (Copyright © 2020 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Physicochemical and microbiological properties of pork chops sprayed with Neutral Electrolyzed Water (NEW) were evaluated during storage at refrigeration temperature. Pork chops were randomly allocated into three groups and were artificially contaminated with an inoculum of 10 6  CFU/mL of Listeria monocytogenes. Each group was treated with either NEW (58 ppm), NaClO (35 ppm), or saline solution (SS). Subsequently, recovered bacteria were plated on TSA petri dishes and the reduction percentage of Listeria monocytogenes was calculated 24 h and 8 days after treatment. Physicochemical analysis [pH, content of lactic acid, thiobarbituric acid reactive substances (TBARS) and total volatile base nitrogen (TVBN)] were performed to evaluate the effect of all solutions used on pork meat kept at 4 °C for 19 days. In vitro NEW reduced L. monocytogenes titers by > 99.98% and 80.19% and 90.35% in artificially contaminated pork 24 h and 8 days after NEW treatment, respectively. Compared to the SS treatment, NEW and NaClO solutions caused a 0.67 Log UFC/g and 0.65 Log UFC/g reduction respectively. After eight days post-treatment, NEW and NaClO bacterial titers were below the SS treatment. NEW caused little color change in treated meat. It helped to reduce the formation of lactic acid and TVB-N when pork chops are kept at 4 °C for 19 days. Therefore, NEW could be considered as a new alternative to sanitize and preserve pork meat.

Infection control and antimicrobial stewardship programs (ICASPs) are essential to reduce the emergence and spread of antimicrobial resistance. The primary objective of this study was to assess the feasibility of extending a commercial off-the-shelf (COTS) software for ICASPs in low- and middle-income countries (LMICs). This project involved three hospitals in Colombia, including Centro Médico Imbanaco, Clínica San Francisco, and DIME Clínica Neurocardiovascular. A COTS platform (ILÚM Health Solutions ™ Kenilworth, NJ) was extended to function in a range of technology settings, and translatable to almost any language. ICASP features were added, including clinical practice guidelines, hand hygiene (HH) documentation, and isolation precaution (IP) documentation. The platform was delivered as a smartphone mobile application ("app") for both iOS and Android. The app was successfully implemented at all sites, however, full back-end data integration was not feasible at any site. In contrast to the United States, a suite of surveillance tools and physician-focused decision support without patient data proved to be valuable. Language translation processing occurred quickly and incurred minimal costs. HH and IP compliance tracking were the most used features among ICASP staff; treatment guidelines were most often used by physicians. Use of the app streamlined activities and reduced the time spent on ICASP tasks. Users consistently reported positive impressions including simplicity of design, ease of navigation, and improved efficiency. This ICASP app was feasible in limited-resource settings, highly acceptable to users, and represents an innovative approach to antimicrobial resistance prevention., Competing Interests: Conflicts of Interest WJS, JBFO, LNH and JMM are all employed by ILÚM Health Solutions, LLC, the developer of the mobile application. No conflicts of interest are reported by other authors.

Objective: Clinical and radiological evaluation of the surgical treatment of chronic acromioclavicular (AC) dislocations with triple button device and AC joint augmentation., Materials and Methods: This retrospective study included 21 patients with chronic AC dislocations. All patients underwent bilateral-weighted Zanca and Alexander views as well as the Constant score (CS) and Acromioclavicular Joint Instability Scoring System (ACJI)., Results: A total of 21 patients (19 men and 2 women) with the mean age of 30.7 ± 11.7 years (range, 19-62 years) were able to participate in clinical and radiographic follow-up. After a mean follow-up of 49.7 ± 17.1 months (range, 13-60 months), the results of the CS were 95.2 ± 5.5 (range, 85-100) and ACJI test 89.7 ± 7.9 (range, 75-100), showing no significant differences with the uninjured shoulder (CS, 96.2 ± 3.9; range, 85-100; ACJI, 95.7 ± 4.1; range, 85-100). At the final review, we observed that the preoperative coracoclavicular distance (Zanca view) improved from 12.8 ± 1.5 mm to 8.5 ± 1.3 mm and the AC distance (Alexander view) from 7.8 ± 2.3 mm to 0.99 ± 0.91 mm. Compared with healthy shoulder, these differences were not significant. Osteoarthritis or radiological calcifications were not associated with worse clinical outcomes., Conclusion: The triple button device is an acceptable alternative surgical method for chronic AC joint dislocations. The surgical technique is simple; it does not need a graft, nor does it present major complications, and material extraction is unnecessary., (© 2020 The Author(s).)

Neutral Electrolyzed Water (NEW) was tested in vitro and on artificially contaminated eggs against Salmonella enterica subsp. enterica or Escherichia coli. The antibacterial effect was measured 30 s after treatment. NEW microbicide activity results were compared against 2% citric acid and 0.9% saline solutions. NEW caused an in vitro decrease in Salmonella titers by ˃5.56 Log 10 CFU mL -1 and in artificially contaminated eggs by ˃1.45 Log 10 CFU/egg. When it was tested against E. coli, it decreased in vitro bacterial titers by ˃3.28 Log 10 CFU mL -1 and on artificially contaminated eggs by ˃6.39 Log 10 CFU/egg. The 2% citric acid solution caused an in vitro decrease of 0.4 Log 10 CFU mL -1 of Salmonella and E. coli and on eggs artificially contaminated with E. coli or Salmonella there was a decrease of 0.06 and 0.62 Log 10 CFU/egg respectively. We evaluated egg cuticle integrity by scanning electron microscopy after treatments with evaluated solutions; the 2% citric acid solution caused damage to the cuticle and exposed eggshell pores and no interaction of NEW or NaCl with the cuticle was observed. NEW treatment showed a fast-bactericidal effect in vitro and table eggs., Competing Interests: Declaration of competing interest Sandra Martinez-Vidal works at Esteripharma S.A. de C.V., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: The level of asthma control in Latin American countries is still poor and it does not reach the objectives that have been established by international guidelines. The reasons why this occurs are still unknown., Objective: To explore the frequency of anxiety and depression in patients with asthma and its possible associations with the control of this disease., Methods: A cross-sectional study in asthmatic patients from Guayaquil-Ecuador. A chi-squared test was applied in order to assess the associations between the presence of anxiety and depression and the demographic variables. The correlation between the Asthma Control Test (ACT) and the Hospital Anxiety and Depression Scale (HADS) was assessed by applying Kendall´s Tau-b test., Results: Of all 73 patients, 55 (80.9%) were women and 50 (69.4%) had a low educational level; 49 (67.1%) patients had uncontrolled asthma (p=.005). Few patients presented anxiety (2.7%) and depression (1.4%) symptoms (p=.000). The factors that were associated with the highest rate of anxiety and depression were: the age of 60 and younger, female sex, and uncontrolled asthma. There wasn't any significant correlation between asthma control and anxiety or depression scores., Conclusion: Numerous asthmatic patients don't have proper control of their disease, and anxiety or depression disorders seem to have only minor effects on the control of the illness.

Neutral electrolyzed water (NEW) was tested as a disinfectant against Listeria monocytogenes on the surface of table eggs. Eggs were collected from a single Bovans White flock and were exposed to L. monocytogenes . Artificially contaminated eggs were divided into three different treatment groups: NEW, 2% citric acid solution (CAS), and saline solution (SS). To evaluate the bactericidal effect, the Mexican norm for antimicrobial activity determination protocol was performed. The observed bactericidal effect was compared against those obtained from CAS and SS. Bacterial cells present on the eggshells were quantified. NEW exhibited a significantly higher bactericidal effect than CAS when evaluated on the surfaces of chicken eggshells (6.11 log 10 CFU/ml reduction in vitro and a 2.18 log 10 CFU/egg reduction on eggs vs. 1.06 log 10 CFU/ml in vitro reduction and 1.74 log 10 CFU/egg). Additionally, CAS was found to react with the carbonate egg shield, resulting in a loss of cuticle integrity. Mineral content of NEW-treated eggshells was similar to SS-treated eggshells; however, CAS-treated eggshells showed a significant decrease in phosphorous concentration compared to NEW treatment. In this study, we demonstrated the effect of NEW and CAS on the integrity of the L. monocytogenes wall using transmission electron microscopy. To the best of our knowledge, this is the first report of the effect of NEW against L. monocytogenes on eggshells. Our results show that NEW is a viable alternative solution for the disinfection of table eggs that does not affect the cuticle or shell., Competing Interests: The authors declare no conflict of interest.

The cause of progressive degeneration in Parkinson's disease is not clear, although, in the last years, different studies have suggested that both brain and peripheral inflammation could play a key role in the progression of this disorder. In our study, we aimed to analyze the effect of an acute inflammation confined to the colon on dopaminergic neuronal death and glial response in mice intoxicated with MPTP. The results obtained show a very significant decrease of dopaminergic neurons in the SNpc as well as a significant decrease of dopaminergic fibers in the striatum of the MPTP+DSS-treated group compared with the control animals. In addition, there was a significant exacerbation of microglial and astrocytes activation in MPTP+DSS animals compared with the control group. This data suggests that a specific gastrointestinal injury, which induces a systemic inflammatory response, is able to exacerbate cell death mechanisms of the remaining dopaminergic neurons and then contributes to the persistent progression of the disease. These results leave open new lines of research on the role of exclusive colonic inflammation and the progression of nigrostriatal dopaminergic degeneration.

Ellis-van Creveld syndrome (EVC) or chondroectodermal dysplasia is an autosomal recessive disorder, characterized by dwarfism, polydactyly, hypoplastic fingernails and congenital heart defects, finding in most of the cases orofacial anomalies. We describe a clinical case of a 9 year old male patient diagnosed with EVC who visited our Maxillofacial private consultation at Alcorcon Southern Hospital, presenting typical oral manifestations such as dental agenesis, delayed eruption, hypoplasia of the enamel, dental dysmorphism, taurodontism and supernumerary teeth. EVC syndrome is a rare disease and requires a multidisciplinary approach. Oral features are constant and requires the jointly performance of Odontologist and Maxillofacial surgeon aiming to get an appropriate treatment sequence surgery-orthodontics in order to achieve a suitable functional result to improve the quality of life of these patients. Key words: Ellis-Van creveld syndrome, chondroectodermal dysplasia, oral manifestations, craniofacial manifestations., Competing Interests: Conflict of interest statement:The authors have declared that no conflict of interest exist.

The aim of this study was to assess the effectiveness of minimally invasive antral membrane balloon elevation (MIAMBE). Twenty-seven patients with severe resorption of the posterior maxilla were treated by balloon catheter-assisted sinus lift procedure with deferred implant placement. Panoramic radiographs and computed tomography scans were obtained prior to surgery and at 6 months after surgery, before implantation. Data collected following surgery included inflammation, pain, bleeding, infection, and haematoma. Pain and inflammation were recorded using a six-point verbal rating scale (VRS). The patients were followed up for an average of 15 months. The initial sinus floor height was measured for each planned implant and compared with the height at 6 months post-surgery. The average bone height gain was 8.10±3.45mm (range 0.5-13.95mm). Inflammation on the VRS ranged from 0 to 3 (mean 0.97±0.85), while pain ranged from 0 to 4 (mean 0.87±1.19). There was a perforation of the Schneiderian membrane smaller than 2mm in one case. In another case, the balloon lift procedure had to be aborted and changed to the conventional Tatum technique due to breakage of the balloon inside the sinus. The results of this study show the balloon sinus lift technique to be an easy procedure to perform, with apparently low rates of inflammation and pain, and to provide sufficient quantity and quality of bone for the placement of osseointegrated implants., (Copyright © 2019. Published by Elsevier Ltd.)

The aim of the present study was to assess the frequency of uses and preferences of information and communication technologies (ICTs) among Latin American chronic obstructive pulmonary disease (COPD) patients. We conducted an anonymous cross-sectional survey study on Latin American COPD patients. The adapted version of the Michigan questionnaire was employed in eligible outpatients in different cities of Latin America. We categorized age and educational levels into three groups. The time passed since COPD diagnosis was categorized as ≤5 years and >5 years. χ 2 and crude and adjusted logistic regressions were performed. A total of 256 patients were enrolled with a mean age of 68.7 years old. The most recurrently used ICTs were short message service (SMS; 47.1%) and WhatsApp (30.7%) for receiving COPD information. Moreover, SMS (85.8%) and Facebook (36.1%) were rated as useful for asking physicians information about COPD. Regression analysis showed that the best predictor for patients using ICTs, for any purpose, was higher education (undergraduate or graduate school). Understanding the preferences of ICTs among COPD patients could help improve patient's outcomes through developing applications in response to specific requirements of each patient.

Background: Information on the burden of atrial fibrillation (AF) in rural areas of developing countries is limited. Here, we aimed to assess AF prevalence in community-dwelling older adults living in rural Ecuador., Methods: Atahualpa residents aged ≥60 years (mean age 70.5 ± 8.1 years) underwent 24-h Holter monitoring. Participants belong to the Amerindian ethnic group. The mean height in the study population was 147.9 ± 8.9 cm. Oily fish was a major source of food (mean intake: 8 ± 4 servings/week)., Results: Seven of 298 participants (2.3%) had AF. Persons with AF were older than those without (p = 0.051), but there were no differences in cardiovascular risk factors across groups. None of the seven AF cases had been detected in routine 12-lead ECGs taken at enrollment., Conclusions: Prevalence of AF in older Amerindians living in rural Ecuador is low. Both, racially-determined short stature and frequent dietary oily fish intake might explain the low prevalence of AF in this rural setting.

Purpose: The purpose of this study is to assess the frequency of use of information and communication technologies and patterns of preference among Ecuadorian patients with diabetes., Methods: We conducted an anonymous cross-sectional survey on type 2 diabetes mellitus. A chi-square test for association and adjusted regression analyses were performed., Results: 248 patients were enrolled, with a mean sample age of 57.7 years. SMS was the most used ICT (66.0%). The Internet was used by 45.2% of patients to obtain information about diabetes. SMS and email were rated as the most useful ICTs for receiving information (64.5% and 28.1%, resp.) and asking physicians about diabetes (63.8% and 26.1%, resp.). Patients were also interested in receiving disease information (82.4%) and asking physicians about diabetes (84.7%) through WhatsApp. Adjusted logistic regressions revealed that individuals aged 55 years or younger, those with superior degree level, and those with long diabetes history preferred email for receiving information and asking physicians about diabetes compared to those above 55 years, those with low education level, and those with short diabetes history, respectively., Conclusion: Understanding preferences of ICTs among patients with diabetes could facilitate application development targeted towards specific requirements from patients.

Background: Inadequate communication between asthmatic patients and their physicians may interfere directly with asthma control. In the last years, the use of information and communication technologies (ICTs) it has increased in Latin-America. This technology seems to be a good tool to improve communication and management of the asthmatic patient., Objective: We evaluated the frequency and preference patterns of communication and information technologies in Ecuadorian patients with bronchial asthma., Methods: We conducted a pilot cross-sectional study to identify the frequency and preferences of ICT in patients with asthma. The Spanish version of the Michigan questionnaire was used. Age and educational level were categorized into 3 groups. We used logistic regression between these groups regarding the frequency of use, interest in seeking and receiving information related to their asthma for the age and educational level of the patients., Results: A total of 222 patients participated in our study. The mean age was 45.6 years (SD 17.4), the most common sex was female with 89.25 %. Almost all patients had a cell phone (87.5 %) and internet access (62.7 %). The three ICTs most likely to be used to search for or receive information about their illness were WhatsApp, Facebook and email (p <0.05)., Conclusion: Information and communication technologies improve the care of asthmatic patients. In our pilot study email and text messages are the most preferred ICT among patients however WhatsApp and Facebook may be appropriate for certain ages especially young asthmatic. Knowledge of preferences can help the development of ICT in a personalized way and improve the outcomes in patients with asthma.

Background: For the treatment of the bisphosphonates and other drugs related osteonecrosis of the jaws, currently medication-related osteonecrosis of the jaws (MRONJ), have been established different conservative therapeutic approaches, avoiding surgery except in cases of extreme need. Given the controversy and lack of current consensus regarding MRONJ therapy in patients, new techniques have been developed among which the use of fibrin membranes rich in platelets and leukocytes (L-PRF). The objective of this review is to evaluate whether L-PRF treatment is really effective, as well as the results that can be achieved by this therapeutic alternative., Material and Methods: A review of the literature in the PubMed/Medline database of all those studies using L-PRF in the treatment of osteonecrosis using the keywords "Osteonecrosis", "Jaws", "L-PRF" and " Leucocyte-rich platelet-rich fibrin "., Results: The use of L-PRF for the treatment of MRONJ is really effective, especially when it is performed with a simultaneous application of L-PRF and morphogenetic protein-2 (BMP-2), even in patients submitted for long periods of time to therapy with intravenous bisphosphonates. However, success will depend on several factors such as the previous existence of infection or the clinical stage in which the patient is., Conclusions: The current literature demonstrates the effectiveness of the use of L-PRF in osteonecrosis, and it can be considered as a real alternative in the treatment of this entity. However, more clinical studies are needed to really assess this new therapy. Key words: Osteonecrosis, Jaws, L-PRF, Leucocyte-rich platelet-rich fibrin., Competing Interests: Conflict of interest statement:The authors have declared that no conflict of interest exist.

Background: Since its appearance in the dental area, the laser has become a treatment of choice in the removal of lesions in the oral soft tissues, due to the numerous advantages they offer, being one of the most used currently the diode laser. The aim of this review was to determine the efficacy and predictability of diode laser as a treatment of soft tissue injuries compared to other surgical methods., Material and Methods: A literature review of articles published in PubMed/MEDLINE, Scopus and the Cochrane Library databases between 2007 and 2017 was performed. "Diode laser", "soft tissue", "oral cavity" and "oral surgery" were employed for the search strategy. Only articles published English or Spanish were selected., Results: The diode laser is a minimally invasive technology that offers great advantages, superior to those of the conventional scalpel, such as reduction of bleeding, inflammation and the lower probability of scars. Its effectiveness is comparable to that of other types of lasers, in addition to being an option of lower cost and greater ease of use. Its application in the soft tissues has been evaluated, being a safe and effective method for the excision of lesions like fibromas, epulis fissuratum and the accomplishment of frenectomies., Conclusions: The diode laser can be used with very good results for the removal of lesions in soft tissues, being used in small exophytic lesions due to their easy application, adequate coagulation, no need to suture and the slightest inflammation and pain. Key words: Diode laser, soft tissues, oral cavity, oral surgery., Competing Interests: Conflict of interest statement:The authors have declared that no conflict of interest exist.

Objective: Describe the clinical and radiological results of triple button device in the treatment of high-grade AC dislocations (Rockwood, type V) and assess whether improves vertical and horizontal stability compared to the techniques previously described., Material and Methods: This retrospective study included 39 patients with type V acromioclavicular dislocations treated with Twin Tail TightRope™ system (triple button device). Of the 39 patients, 33 (26 men and 7 women) were able to participate in clinical and radiographic follow up. At the time of surgery, the mean age was 25years±7(range, 17-49). All patients underwent bilateral-weighted Zanca (CC distance) and Alexander view (AC distance) as well as the Constant Score (CS) and Acromioclavicular Joint Instability Scoring System (ACJI). Radiological and clinical outcome was assessed during routine follow-up examinations preoperatively, postoperatively, 1, 3, 6 months and every year after the surgery. The presence of calcification, degenerative changes, mobilization of implants and bone resorption were also assessed., Results: After a mean follow up of 25±4months (range 14-38), the results of the Constant (CS) were 94.1±5,5 (range 76-100) and test ACJI 87.3±9,8 (range 65-100), showing no significant differences with the uninjured shoulder (CS 95.8±2.5, range 83-100; ACJI 94.1±3.7, range 80-100). At final review, we observed that preoperative coracoclavicular distance (Zanca View) improved from 21,75±1.97mm to 8,73mm±0.75 and the acromioclavicular distance (Alexander View) from 12,65mm±1.99 to 0,35±0.3mm. Compared with healthy shoulder, these differences were not significant. There was no loss of reduction with this system in the vertical plane. 4 patients (12.12%) revealed signs of posterior instability with worse clinical test results. The presence of degenerative joint changes (6,06%), calcifications (27,2%) or mobilization of the implant (18,18%) was not associated with worse clinical outcomes., Conclusion: Twin Tail device using minimally invasive technique improves stability in the vertical and, specially in the horizontal plane relative to the previously described techniques without increasing number of complications., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: The purpose of this study is to describe the outcomes of using a triple button device for the treatment of displaced distal-third clavicle fractures (Neer, type ii-b)., Material and Method: A retrospective review was conducted on a series of patients between November 2011 and December 2014. Fourteen patients initially met the inclusion criteria, but 2 were excluded, leaving 12 patients (83.3% male; mean age 32.2 years) for the final analysis at a mean follow-up of 26±11.24 months (range, 12-48). Post-operative follow-up was performed at 2 weeks (two first months), and monthly thereafter, until was achieving clinically and radiological healing. The functional outcome was evaluated using the Constant score, and DASH score in the last follow-up., Results: The mean Constant Score was 95.5±5.2 points (range, 85-100), with a mean DASH score of 3.3±4.4 points (range, 0-12.5). The mean time to clinical healing was10.3±3.1 weeks (range, 8-16), and the mean time to radiological healing was 13.6±2.6 weeks (range, 12-20). There were no major complications. There were 5 minor complications without clinical impact: 2 coracoclavicular calcifications, 1 hypertrophic scar, 1 patient with discomfort due to the device, and 1 superficial wound infection. All patients returned their previous activity., Conclusion: Good clinical results can be achieved with the triple button device in unstable distal fractures of the clavicle, without the need to remove the hardware., (Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Diagnosis of cerebral small vessel disease (SVD) is a challenge in remote areas where MRI is not available. Hypertensive retinopathy (HTRP) has shown to correlate with SVD in different ethnic groups, but there is no information from indigenous Latin American people. We assessed the usefulness of retinal photographs to detect cases with SVD among Amerindians living in rural Ecuador., Methods: Atahualpa residents aged ≥60years with arterial hypertension or prehypertension were identified during a door-to-door survey. A confocal line scanning laser ophthalmoscope was used to identify and grade HTRP (according to the Keith-Wagener-Barker classification). MRIs were read with attention to the presence of white matter hyperintensities (WMH) of presumed vascular origin and lacunar infarcts. Using logistic regression models, we evaluated whether HTRP was independently associated with neuroimaging signatures of SVD., Results: Of 323 eligible candidates, 241 (75%) were enrolled. MRI readings revealed moderate-to-severe WMH in 49 (20%) cases and lacunar infarcts in 29 (12%). HTRP Grade 1 was noticed in 90 (37%) individuals and Grade 2-3 in 42 (17%). After adjusting for demographics and cardiovascular risk factors, multivariate analyses showed a significant association between Grades 2-3 HTRP and moderate-to-severe WMH (OR: 3.87, 95% C.I.: 1.64-9.13) but not with lacunar infarcts (OR: 2.22, 95% C.I.: 0.83-5.92)., Conclusion: Amerindians with HTRP Grades 2-3 are almost four times more likely to have SVD-related subcortical damage than those with no- or only Grade 1-HTRP. Retinal photographs might allow recognition of people who need further investigation and therapy., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

In cohort studies, binary outcomes are very often analyzed by logistic regression. However, it is well known that when the goal is to estimate a risk ratio, the logistic regression is inappropriate if the outcome is common. In these cases, a log-binomial regression model is preferable. On the other hand, the estimation of the regression coefficients of the log-binomial model is difficult owing to the constraints that must be imposed on these coefficients. Bayesian methods allow a straightforward approach for log-binomial regression models and produce smaller mean squared errors in the estimation of risk ratios than the frequentist methods, and the posterior inferences can be obtained using the software WinBUGS. However, Markov chain Monte Carlo methods implemented in WinBUGS can lead to large Monte Carlo errors in the approximations to the posterior inferences because they produce correlated simulations, and the accuracy of the approximations are inversely related to this correlation. To reduce correlation and to improve accuracy, we propose a reparameterization based on a Poisson model and a sampling algorithm coded in R., (Copyright © 2015 John Wiley & Sons, Ltd.)

The visual behaviour is a determining factor in sailing due to the influence of the environmental conditions. The aim of this research was to determine the visual behaviour pattern in sailors with different practice time in one star race, applying a probabilistic model based on Markov chains. The sample of this study consisted of 20 sailors, distributed in two groups, top ranking (n = 10) and bottom ranking (n = 10), all of them competed in the Optimist Class. An automated system of measurement, which integrates the VSail-Trainer sail simulator and the Eye Tracking System(TM) was used. The variables under consideration were the sequence of fixations and the fixation recurrence time performed on each location by the sailors. The event consisted of one of simulated regatta start, with stable conditions of wind, competitor and sea. Results show that top ranking sailors perform a low recurrence time on relevant locations and higher on irrelevant locations while bottom ranking sailors make a low recurrence time in most of the locations. The visual pattern performed by bottom ranking sailors is focused around two visual pivots, which does not happen in the top ranking sailor's pattern. In conclusion, the Markov chains analysis has allowed knowing the visual behaviour pattern of the top and bottom ranking sailors and its comparison.

Currently, cardiovascular diseases are the deadliest diseases with a total of 17 million deaths worldwide. Hence, they are the focus of many mobile applications for smartphones and tablets. This paper will assess the ex-ante economic impact as well as will determine the cost-effectiveness analysis that the use of one of this app, CardioManager, by patients with heart failure will have in a Spanish community, Castile and Leon. For this, a cost-effectiveness analysis using the hidden Markov model were performed in a hypothetical cohort of patients diagnosed with heart failure, based on the information of epidemiological parameters and the costs derived from the management and care of heart failure patients by the Public Health Care System of Castile and Leon. The costs of patient care were estimated from the perspective of the Ministry of Health of Spain using a discount rate of 3 %. Finally, an estimation of the ex-ante impact that would suppose the introduction of CardioManager in the Health Care System is performed. It is concluded that the introduction of CardioManager may generate a 33 % reduction in the cost of management and treatment of the disease. This means that CardioManager may be able to save more than 9,000 € per patient to the local Health Care System of Castile and Leon, which can be translated in a saving of 0.31 % of the total health expenditure of the region.

Islet transplantation to treat type 1 diabetes has been limited in part by toxicities of current immunosuppression and recipient humoral sensitization. Blockade of the CD28/CD80/86 and CD40/CD154 pathways has shown promise to remedy both these limitations, but translation has been hampered by difficulties in translating CD154-directed therapies. Prior CD40-directed regimens have led to prolonged islet survival, but fail to prevent humoral allosensitization. We therefore evaluated the addition of CTLA4Ig to a CD40 blockade-based regimen in nonhuman primate (NHP) alloislet transplantation. Diabetic rhesus macaques were transplanted allogeneic islets using the CD40-specific antibody 3A8, basiliximab induction, and sirolimus with or without CTLA4Ig maintenance therapy. Allograft survival was determined by fasting blood glucose levels and flow cytometric techniques were used to test for donor-specific antibody (DSA) formation. CTLA4Ig plus 3A8, basiliximab and sirolimus was well tolerated and induced long-term islet allograft survival. The addition of CTLA4Ig prevented DSA formation, but did not facilitate withdrawal of the 3A8-based regimen. Thus, CTLA4Ig combines with a CD40-specific regimen to prevent DSA formation in NHPs, and offers a potentially translatable calcineurin inhibitor-free protocol inclusive of a single investigational agent for use in clinical islet transplantation without relying upon CD154 blockade., (© Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Costimulation blockade of the CD40/CD154 pathway has been effective at preventing allograft rejection in numerous transplantation models. This strategy has largely depended on mAbs directed against CD154, limiting the potential for translation due to its association with thromboembolic events. Though targeting CD40 as an alternative to CD154 has been successful at preventing allograft rejection in preclinical models, there have been no reports on the effects of CD40-specific agents in human transplant recipients. This delay in clinical translation may in part be explained by the presence of cellular depletion with many CD40-specific mAbs. As such, the optimal biologic properties of CD40-directed immunotherapy remain to be determined. In this report, we have characterized 3A8, a human CD40-specific mAb and evaluated its efficacy in a rhesus macaque model of islet cell transplantation. Despite partially agonistic properties and the inability to block CD40 binding of soluble CD154 (sCD154) in vitro, 3A8-based therapy markedly prolonged islet allograft survival without depleting B cells. Our results indicate that the allograft-protective effects of CD40-directed costimulation blockade do not require sCD154 blockade, complete antagonism or cellular depletion, and serve to support and guide the continued development of CD40-specific agents for clinical translation., (©Copyright 2011 The American Society of Transplantation and the American Society of Transplant Surgeons.)

Burkholderia are highly evolved Gram-negative bacteria that primarily infect solipeds but are transmitted to humans by ingestion and cutaneous or aerosol exposures. Heightened concern over human infections of Burkholderia mallei and the very closely related species B. pseudomallei is due to the pathogens' proven effectiveness as bioweapons, and to the increased potential for natural opportunistic infections in the growing diabetic and immuno-compromised populations. These Burkholderia species are nearly impervious to antibiotic treatments and no vaccine exists. In this study, the genome of the highly virulent B. mallei ATCC23344 strain was examined by expression library immunization for gene-encoded protective antigens. This protocol for genomic-scale functional screening was customized to accommodate the unusually large complexity of Burkholderia, and yielded 12 new putative vaccine candidates. Five of the candidates were individually tested as protein immunogens and three were found to confer significant partial protection against a lethal pulmonary infection in a murine model of disease. Determinations of peripheral blood cytokine and chemokine profiles following individual protein immunizations show that interleukin-2 (IL-2) and IL-4 are elicited by the three confirmed candidates, but unexpectedly interferon-γ and tumor necrosis factor-α are not. We suggest that these pathogen components, discovered using genetic immunization and confirmed in a conventional protein format, will be useful toward the development of a safe and effective glanders vaccine.

Outcomes in transplantation have been limited by suboptimal long-term graft survival and toxicities associated with current immunosuppressive approaches. T cell costimulation blockade has shown promise as an alternative strategy to avoid the side effects of conventional immunosuppressive therapies, but targeting CD28-mediated costimulation alone has proven insufficient to prevent graft rejection in primates. Donor-specific memory T (TM) cells have been implicated in costimulation blockade-resistant transplant rejection, due to their enhanced effector function and decreased reliance on costimulatory signaling. Thus, we have tested a potential strategy to overcome TM cell-driven rejection by targeting molecules preferentially expressed on these cells, such as the adhesion molecule lymphocyte function-associated antigen 1 (LFA-1). Here, we show that short-term treatment (i.e., induction therapy) with the LFA-1-specific antibody TS-1/22 in combination with either basiliximab (an IL-2Rα-specific mAb) and sirolimus (a mammalian target of rapamycin inhibitor) or belatacept (a high-affinity variant of the CD28 costimulation-blocker CTLA4Ig) prolonged islet allograft survival in nonhuman primates relative to control treatments. Moreover, TS-1/22 masked LFA-1 on TM cells in vivo and inhibited the generation of alloproliferative and cytokine-producing effector T cells that expressed high levels of LFA-1 in vitro. These results support the use of LFA-1-specific induction therapy to neutralize costimulation blockade-resistant populations of T cells and further evaluation of LFA-1-specific therapeutics for use in transplantation.

To meet the growing demand for synthetic genes more robust, scalable and inexpensive gene assembly technologies must be developed. Here, we present a protocol for high-quality gene assembly directly from low-cost marginal-quality microarray-synthesized oligonucleotides. Significantly, we eliminated the time- and money-consuming oligonucleotide purification steps through the use of hybridization-based selection embedded in the assembly process. The protocol was tested on mixtures of up to 2000 oligonucleotides eluted directly from microarrays obtained from three different chip manufacturers. These mixtures containing <5% perfect oligos, and were used directly for assembly of 27 test genes of different sizes. Gene quality was assessed by sequencing, and their activity was tested in coupled in vitro transcription/translation reactions. Genes assembled from the microarray-eluted material using the new protocol matched the quality of the genes assembled from >95% pure column-synthesized oligonucleotides by the standard protocol. Both averaged only 2.7 errors/kb, and genes assembled from microarray-eluted material without clonal selection produced only 30% less protein than sequence-confirmed clones. This report represents the first demonstration of cost-efficient gene assembly from microarray-synthesized oligonucleotides. The overall cost of assembly by this method approaches 5¢ per base, making gene synthesis more affordable than traditional cloning.

Islet transplantation is an experimental therapy for selected patients with type 1 diabetes (T1DM). It remains limited by immunosuppressive drug toxicity, progressive loss of insulin independence, allosensitization and the need for multiple islet donors. We describe our experience with an efalizumab-based immunosuppressive regimen as compared to the prevailing standard regimen, the Edmonton protocol. Twelve patients with T1DM received islet transplants: eight were treated with the Edmonton protocol; four were treated with daclizumab induction, a 6-month course of tacrolimus, and maintenance with efalizumab and mycophenolate mofetil. The primary endpoint was insulin independence after one islet infusion. Only two Edmonton protocol treated patients achieved the primary endpoint; six required islets from multiple donors, and all experienced leukopenia, mouth ulcers, anemia, diarrhea and hypertransaminasemia. Four became allosensitized. All patients treated with the efalizumab-based regimen achieved insulin independence with normal hemoglobin A1c after a single islet cell infusion and remained insulin independent while on efalizumab. These patients experienced significantly fewer side effects and none became allosensitized. Trial continuation was terminated by withdrawal of efalizumab from the market. These data suggest that this efalizumab-based regimen prevents islet rejection, is well tolerated, and allows for single donor islet transplantation., (© 2010 The Authors Journal compilation © 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.)

The licensed smallpox vaccine, comprised of infectious vaccinia, is no longer popular as it is associated with a variety of adverse events. Safer vaccines have been explored such as further attenuated viruses and component designs. However, these alternatives typically provide compromised breadth and strength of protection. We conducted a genome-level screening of cowpox, the ancestral poxvirus, in the broadly immune-presenting C57BL/6 mouse as an approach to discovering novel components with protective capacities. Cowpox coding sequences were synthetically built and directly assayed by genetic immunization for open-reading frames that protect against lethal pulmonary infection. Membrane and non-membrane antigens were identified that partially protect C57BL/6 mice against cowpox and vaccinia challenges without adjuvant or regimen optimization, whereas the 4-pox vaccine did not. New vaccines might be developed from productive combinations of these new and existing antigens to confer potent, broadly efficacious protection and be contraindicated for none.

The mitochondrial DNA (mtDNA) working group of the GEP-ISFG (Spanish and Portuguese Group of the International Society for Forensic Genetics) carried out an inter-laboratory exercise consisting of the analysis of mtDNA sequencing patterns in mixed stains (saliva/semen and blood/semen). Mixtures were prepared with saliva or blood from a female donor and three different semen dilutions (pure, 1:10 and 1:20) in order to simulate forensic casework. All labs extracted the DNA by preferential lysis and amplified and sequenced the first mtDNA hypervariable region (HVS-I). Autosomal and Y-STR markers were also analysed in order to compare nuclear and mitochondrial results from the same DNA extracts. A mixed stain prepared using semen from a vasectomized individual was also analysed. The results were reasonably consistent among labs for the first fractions but not for the second ones, for which some laboratories reported contamination problems. In the first fractions, both the female and male haplotypes were generally detected in those samples prepared with undiluted semen. In contrast, most of the mixtures prepared with diluted semen only yielded the female haplotype, suggesting that the mtDNA copy number per cell is smaller in semen than in saliva or blood. Although the detection level of the male component decreased in accordance with the degree of semen dilution, it was found that the loss of signal was not consistently uniform throughout each electropherogram. Moreover, differences between mixtures prepared from different donors and different body fluids were also observed. We conclude that the particular characteristics of each mixed stain can deeply influence the interpretation of the mtDNA evidence in forensic mixtures (leading in some cases to false exclusions). In this sense, the implementation of preliminary tests with the aim of identifying the fluids involved in the mixture is an essential tool. In addition, in order to prevent incorrect conclusions in the interpretation of electropherograms we strongly recommend: (i) the use of additional sequencing primers to confirm the sequencing results and (ii) interpreting the results to the light of the phylogenetic perspective.

Platelet-activating factor (PAF) is a potent signaling phospholipid that has been implicated in a number of biological activities. PAF concentration in primate spermatozoa has a positive correlation with fertility. While PAF is present in rhesus spermatozoa, there are no relational reports on its concentration and the cell's motility. The study objective was to determine if PAF concentration in rhesus spermatozoa was correlated with motility indices (percent motility and forward progression). Semen was collected from sexually mature males and cell counts, and percent motilities and forward progressions were recorded prior to PAF measurement by radioimmunoassay. Spermatozoa-derived PAF concentration ranged from a low of 0.9 picomoles/10(6) cells to a high of 13.0 picomoles/10(6) cells. The overall mean (+/-SEM) PAF concentration was 4.6 (+/-1.6) picomoles/10(6) spermatozoa. Regression analysis revealed a positive and significant relationship between PAF concentration in the spermatozoa and percent motility (R2 = 0.914; P < 0.01) as well as forward progression (R2 = 0.849; P < 0.05). A receiver-operator characteristic curve and the calculation of the probability that a positive forward progression will be predicted indicated a cutoff limit of 1.5 picomoles/10(6) cells for PAF concentration in rhesus sperm. Rhesus monkey spermatozoa motility was significantly greater (P < 0.01) in the high-PAF (> or =2 picomoles/10(6) cells) group (31.0 +/- 7.6) than in the low-PAF (<2 picomoles/10(6) cells) group (6.8 +/- 2.1). Rhesus monkey spermatozoa forward progression was significantly greater (P < 0.05) in the high-PAF (> or =2 picomoles/10(6) cells) group (3.0 +/- 1.0) than in the low-PAF (<2 picomoles/10(6) cells) group (0.7 +/- 0.3). The data demonstrate that PAF concentration in rhesus spermatozoa has a significant relationship with percent motility and the cell's forward progression. Determining PAF concentration in spermatozoa may be a significant predictor of fertility in the primate. Additional studies will elucidate the role of PAF in spermatozoa function and the significance PAF plays in primate fertility., (Copyright 2002 Wiley-Liss, Inc.)

GPIIb/IIIa, the human platelet glycoprotein complex, is the autoantigen most commonly recognized by autoantibodies in autoimmune thrombocytopenic purpura (AITP). Two murine monoclonal antibodies (mAbs), namely Y2/51 and 5B12, directed against gpIIIa and gpIIb/IIIa, respectively, and rabbit anti-human platelet polyclonal antibodies have been used to select AITP-related epitopes from a phage display peptide library expressing random dodecapeptides in the pIII coat protein of M13 phage. The selected phage clones were tested by ELISA for binding to rabbit anti-human platelet antibodies as well as to sera from AITP patients. Seven clones reacted strongly with rabbit anti-human platelet antibodies, and four clones reacted with sera from AITP patients. Some homology between peptide inserts sequences of selected clones and human platelet gpIIIa and gpIb were found., (Copyright 2000 Academic Press.)

The concentrations of contaminants in the supply air of mechanically ventilated buildings may be altered by pollutant emissions from and interactions with duct materials. We measured the emission rate of volatile organic compounds (VOCs) and aldehydes from materials typically found in ventilation ducts. The emission rate of VOCs per exposed surface area of materials was found to be low for some duct liners, but high for duct sealing caulk and a neoprene gasket. For a typical duct, the contribution to VOC concentrations is predicted to be only a few percent of common indoor levels. We exposed selected materials to approximately 100-ppb ozone and measured VOC emissions. Exposure to ozone increased the emission rates of aldehydes from a duct liner, duct sealing caulk, and neoprene gasket. The emission of aldehydes from these materials could increase indoor air concentrations by amounts that are as much as 20% of odor thresholds. We also measured the rate of ozone uptake on duct liners and galvanized sheet metal to predict how much ozone might be removed by a typical duct in ventilation systems. For exposure to a constant ozone mol fraction of 37 ppb, a lined duct would initially remove approximately 9% of the ozone, but over a period of 10 days of ozone removal efficiency would diminish to less than 4%. In an unlined duct, in which only galvanized sheet metal is exposed to the air-stream, the removal efficiency would be much lower, approximately 0.02%. Therefore, ducts in ventilation systems are unlikely to be a major sink for ozone.