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To describe the development and implementation of a comprehensive in situ simulation-based curriculum for anesthesia residents. This is a prospective study. This study was conducted at a university hospital. This single-center prospective study included all 53 anesthesia residents enrolled in the anesthesia residency program. Introduction of a routine, high-fidelity, in situ simulation program that incorporates short sessions to train residents in the necessary skill sets and decision-making processes required in the operating room. Our team conducted 182 individual 15-minute simulation sessions over 3 months during regular working hours. All 53 residents in our program actively participated in the simulations. Most residents engaged in at least 3 sessions, with an average participation rate of 3.4 per resident (range, 1–6 sessions). Residents completed an online anonymous survey, with a response rate of 71.7% (38 of 53 residents) over the 3-month period. The survey aimed to assess their overall impression and perceived contribution of this project to their training. Our proposed teaching method can bridge the gap in resident training and enhance their critical reasoning to manage diverse clinical situations they may not experience during their residency. [ABSTRACT FROM AUTHOR]

Currently, graft options for pediatric liver transplantation (PLT) include whole (WL) and partial (P) grafts, in the form of either deceased donor transplantation (DD) or living donor liver transplantation (LD). WL transplants from LD are commonly referred to as domino LT. The objective of this manuscript is to compare the outcomes of PLT performed with each of the available graft options. Retrospective cohort study from Jan. 2010 to Dec. 2022. The variables included data on the recipients' preoperative clinical status, intraoperative technical aspects, post-operative complications, and survival studies. There were 4 groups: SPLIT (17), DD-WL (55), LD-WL (824), and LD-P (22). The median age and BW of the recipients was smaller in SPLIT, LD-P, and LD-WL compared to DDT-WL groups. HVOO (HR 15.87, 95% CI 1.89–133.06, P = 0.01), retransplantation (HR 7.94, 95% CI 2.63–24.02, P < 0.01), and malignancies (HR 3.08, 95% CI 1.29–7.37, P = 0.01) were independently associated with decreased patient survival. HAT (HR 27.54, 95% CI 10.44–72.68, P < 0.01) and malignancies (HR 2.42, 95% CI 1.10–5.34, P = 0.03) increased the risk of graft loss. The overall survival in this series was 91.4% (mean follow-up of 74.3 months). Patient and graft survival were not different among groups. HAT and malignancies were associated with reduced graft survival. Whole liver from living donors with MSUD presented 100% patient survival at 120 months. Even without statistical differences in survival among the studied groups, LD-P and LD-WL recipients presented a trend towards better outcomes. LEVEL III. • Liver transplantation (LT) in infants and small children presents significant challenges and necessitates specific technical refinements. • This paper delves into the outcomes of pediatric LT within a single center, covering more than 900 recipients over the past 12 years. • Notably, this report marks the first instance of comparing the outcomes of all available graft types used in pediatric LT. • The noteworthy addition in this study is the inclusion of whole livers from living donors (LD-WL), often referred to as domino LT. • Unexpectedly, the 10-year survival rate for LD-WL in this series reached 100%, whereas split LT showed lower survival rates during the same follow-up period. [ABSTRACT FROM AUTHOR]

During public health emergencies, demand for N95 filtering facepiece respirators (N95 FFRs) can outpace supply. Elastomeric half-mask respirators (EHMRs) are a potential alternative that are reusable and provide the same or higher levels of protection. This study sought to examine the practical aspects of EHMR use among health care personnel (HCP). Between September and December 2021, 183 HCPs at 2 tertiary referral centers participated in this 3-month EHMR deployment, wearing the EHMR whenever respiratory protection was required according to hospital protocols (ie, when an N95 FFR would typically be worn) and responding to surveys about their experience. Participants wore EHMRs typically 1 to 3 hours per shift, reported disinfecting the respirator after 85% of the removals, and reported high confidence in using the EHMR following the study. EHMRs caused minimal interference with patient care tasks, though they did inhibit communication. HCP who had not previously worn an EHMR were able to wear it as an alternative to an N95 FFR without much-reported interference with their job tasks and with high disinfection compliance. This study highlights the feasibility of the deployment of EHMRs during a public health emergency when an alternative respirator option is necessary. • Elastomeric half-mask respirators (EHMR) were typically worn 1 to 3 hours per shift. • Health care personnel disinfected the EHMR after 85% of the removals. • Health care personnel felt confident using the EHMR for patient care. • EHMRs did not interfere with most job tasks, though communication was sometimes challenging. [ABSTRACT FROM AUTHOR]

This study aimed to quantify the outcomes of adolescent patients with Class II malocclusion treated with the Carriere Motion 3D Appliance (CMA) combined with full fixed appliances. Cone-beam computed tomography scans of 22 patients were available before orthodontic treatment (T1), at removal of the CMA (T2), and posttreatment (T3). The average age of the patients was 13.5 ± 1.6 years at T1, 14.1 ± 0.2 years at T2, and 15.6 ± 0.5 years at T3. The 3-dimensional image analysis procedures were performed using ITK-SNAP (version 3.6.0; www.itksnap.org , Hatfield, Pa) and SlicerCMF (version 4.11.0; http://www.slicer.org , Cambridge, Mass); skeletal and dentoalveolar changes relative to cranial base, maxillary, and mandibular regional superimpositions were evaluated. Changes were analyzed with 1 sample t tests using the mean differences during the CMA phase (T1 to T2) and total treatment time (T1 to T3). Significant skeletal changes included a slight reduction of ANB from T1 to T3, mandibular growth (Co-Gn increment of 1.2 mm and 3.3 mm from T1 to T2 and T1 to T3, respectively), inferior displacement of point A, and anterior and inferior displacement of point B. The mandibular plane did not change significantly during treatment. During the CMA treatment, posterior tipping and distal rotation of the maxillary molars, tip back and inferior displacement of the maxillary canines, significant mesial rotation, and superior displacement of the mandibular molars were observed. These movements rebounded during the full fixed appliance phase except for the molar and canine vertical displacements. Clinically significant dental changes during treatment included a reduction in overjet and overbite, Class II correction of the molar and canine relationship, and proclination of the mandibular incisors. The CMA is an effective treatment modality for Class II correction in growing patients because of a combination of mesial movement of the mandibular molar, distal rotation of the maxillary molar, and anterior displacement of the mandible. • Carriere and full fixed appliances is an effective treatment modality for Class II correction. • During CMA phase, U6 showed distal rotation and tip back; U3, tip back and vertical displacement. • The changes due to CMA rebounded during FFA phase, except for the U6 and U3 vertical displacement. • Class II correction was due to mesialization of L6, distal rotation of U6, mandibular displacement. [ABSTRACT FROM AUTHOR]

In 2021, the Spanish Ministry of Health launched the CIBERPOSTCOVID project to establish what post COVID was. The present study reports the level of agreement among stakeholders on post COVID and its clinical and diagnostic characteristics in the Spanish health system. The agreement on post COVID among clinicians, public health managers, researchers and patients' representatives was explored in a real-time, asynchronous online Delphi. In a two-wave consensus, respondents rated from 1 (total disagreement) to 6 (total agreement) 67 statements related to terminology, duration, etiology, symptoms, impact on quality of life, severity, elements to facilitate diagnosis, applicability in the pediatric population, and risk factors. Consensus was reached when 70 % of ratings for a statement were 5 or 6, with an interquartile range equal or less than 1. A total of 333 professionals and patients participated in this eDelphi study. There was agreement that post COVID was "a set of multi-organic symptoms that persist or fluctuate after acute COVID-19 infection and are not attributable to other causes" with a minimum duration of 3 months. The highest levels of agreement were found in the most frequent symptoms and its impacts on everyday activities. Aspects related to the diagnostic process and the measurement of its severity reached a lower level of consensus. There was agreement on the need to rule out previous health problems and assess severity using validated functional scales. However, no agreement was reached on the risk factors or specific features in the pediatric population. This policy-based consensus study has allowed the characterization of post COVID generating collective intelligence and has contributed to an operational definition applicable in clinical practice, health services management and useful for research purposes in Spain and abroad. Agreements are consistent with existing evidence and reference institutions at European and international level. [ABSTRACT FROM AUTHOR]

This study aimed to develop a 3-dimensional (3D) characterization of the severity of maxillary impacted canines and to test the clinical performance of this characterization as a treatment decision support tool. Cone-beam computed tomography images obtained from 83 patients with 120 impacted maxillary canines were included. Quantitative information on the canine 3D position and qualitative assessment of root damage of adjacent teeth were evaluated. A severity index was constructed on the basis of the quantitative findings. Clinical applicability was tested by comparing clinical diagnosis and treatment planning for conventional records vs the 3D characterization via a 2-part survey. The average quantitative assessments of impacted maxillary canine position were 6.4 ± 3.6 mm from the midsagittal plane, 11.6 ± 3.1 mm in height relative to the occlusal plane, 31.5° ± 18° of roll, and 48.8° ± 14.3° of pitch. The severity index ranged from 0-13 with a mean score of 4.5 ± 2.2. Overlap with adjacent teeth was the greatest contributor (33%) to the index. Bicortically impacted canines caused the most severe root damage. Cone-beam computed tomography was preferred for assessing root damage and overall severity, whereas conventional imaging was sufficient for height and angulation assessment. The 3D report was very important or important for evaluating root damage, canine position, overall severity, and overlap. The 3D report changed most of the decisions relating to biomechanics, patient education, and treatment time estimate. The decision of exposure and traction vs extraction was changed 22% of the time after the presentation of the 3D report. The overlap with adjacent teeth frequently contributes the most to the severity index. The 3D report provided relevant clinical information regarding the canine position, damage to adjacent teeth, and the severity index, with a profound impact on the decisions of the clinicians regarding biomechanics, patient education, and treatment time estimate. • Canine impaction benefits from 3D imaging reports. • Bicortical canine impaction leads to root resorption of adjacent teeth. • Three-dimensional reports change the clinical decisions of orthodontists. [ABSTRACT FROM AUTHOR]

The lysosome is responsible for protein and organelle degradation and homeostasis and the cathepsins play a key role in maintaining protein quality control. Cathepsin D (CTSD), is one such lysosomal protease, which when deficient in humans lead to neurolipofuscinosis (NCL) and is important in removing toxic protein aggregates. Prior studies demonstrated that CTSD germ-line knockout- Ctsd KO (CDKO) resulted in accumulation of protein aggregates, decreased proteasomal activities, and postnatal lethality on Day 26 ± 1. Overexpression of wildtype CTSD, but not cathepsin B, L or mutant CTSD, decreased α -synuclein toxicity in worms and mammalian cells. In this study we generated a mouse line expressing human CTSD with a floxed STOP cassette between the ubiquitous CAG promoter and the cDNA. After crossing with Nestin - cre , the STOP cassette is deleted in NESTIN + cells to allow CTSD overexpression- CTSD tg (CDtg). The CDtg mice exhibited normal behavior and similar sensitivity to sub-chronic 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) induced neurodegeneration. By breeding CDtg mice with CDKO mice, we found that over-expression of CTSD extended the lifespan of the CDKO mice, partially rescued proteasomal deficits and the accumulation of A β 42 in the CDKO. This new transgenic mouse provides supports for the key role of CTSD in protecting against proteotoxicity and offers a new model to study the role of CTSD enhancement in vivo. Over-expression of human Cathepsin D in central nervous system partially rescued postnatal lethality of Ctsd germline knockout (CDKO) mice, and the accumulation of A β 42 and α -synuclein in the CDKO. [Display omitted] [ABSTRACT FROM AUTHOR]

This study aimed to review and appraise the evidence regarding airway ultrasound assessment in predicting difficult laryngoscopy in adult patients. A systematic review of the literature was conducted according to the Cochrane collaboration guidelines and the recommendations for the systematic review and meta-analysis of diagnostic studies. Observational studies that evaluated the diagnostic performance of airway ultrasound for the prediction of difficult laryngoscopy were included for consideration. Literature searches were performed in 4 databases (PubMed [Medline], Embase, Clinical Trials, and Google Scholar) to identify all observational studies using any ultrasound technique to assess difficult laryngoscopy. The search terms included "sonography," "ultrasound," "airway," "difficult airway," "difficult laryngoscopy," "Cormack," "risk factors," "ultrasound at the point of care," "difficult ventilation," "difficult intubation" and others, combined with sensitive filters. The search was done for studies performed in the last 20 years in English or Spanish. Adult patients older than 18 years old under general anesthesia for an elective procedure. Evident anatomic airway abnormalities, obstetric populations, those using an alternative imaging method besides ultrasound, and animal studies were excluded. Preoperative bedside ultrasound measuring distances and ratios from the skin to different reference points, such as the ratio of the hyomental distance in a neutral position (HMDN) and hyomental distance in extension (HMDR), HMDN, and the skin-to-epiglottis distance (SED), the preepiglottic area, and tongue thickness, among others. A total of 24 studies evaluated the prediction of a difficult laryngoscopy using airway ultrasound. The diagnostic performance and the number of ultrasound parameters reported in the studies were variable. Meta-analysis was performed for 3 measurements consistently included in most studies. The SED and the HMDR ratio presented a sensitivity of 75% and 61%, respectively, and a specificity of 86% and 88%, respectively. The ratio of the preepiglottic distance to the epiglottic distance at the midpoint of the vocal cords (pre-E/E-VC) presented the best performance for predicting a difficult laryngoscopy (sensitivity: 82%, specificity: 83%, diagnostic odds ratio: 22.2). With the currently available evidence, the 3 commonly used point-of-care ultrasound measures used to identify difficult laryngoscopy, (SED, HMDR, and pre-E/E-VC), showed better sensitivity and similar specificity to clinical measures. Future studies and more data may change the authors' confidence in these conclusions, given the wide variability of measurements noted in studies. [ABSTRACT FROM AUTHOR]

Closed-loop fluid circulation in wellbores has gained considerable attention for harnessing the earth's thermal energy. Recent studies with analytical and numerical models show that geothermal gradient and well depth constitute the two most consequential variables in fluid output temperature at the surface. This study presents a new strategy for managing geothermal-gradient cooling to ensure more prolonged operation by adopting another energy source, such as solar or wind, with a day/night cycle over the years. In other words, the fluid circulation will occur at night, while the solar or wind source will operate in the daytime. Well-depth and geothermal gradients dictate which geographic area provides the best opportunity for power generation or hot water production to meet various industrial needs. Economic tools, such as Net Present Value and Levelized Cost of Electricity, helped gauge their strengths and limitations, thereby offering business decisions objectively. Considering a 20-year power generation period, this study provides some pragmatic lessons. For example, retaining the near-wellbore geothermal gradient is essential for assuring about 130 °C for the binary cycle. We can attain this objective with a 12-h fluid-circulation cycle by juxtaposing a second well or a solar/wind source for a day/night cycle. Also, besides being a safety net, a power grid can aid the economic value proposition in this energy-transition phase. The generation of hot water for direct industrial usage for low-geothermal prospects also becomes economically viable, particularly in repurposing abandoned wells. These industries include food and agriculture, requiring 60 to 85 °C. • Harnessing thermal energy by wellbore fluid circulation • Combining thermal/solar/wind energy strategy with the grid power as a backup • Meaningful thermal energy occurs for power generation in favorable geothermal gradient and well depth • Hot water can meet various industrial needs even in unfavorable geothermal gradient situation • Economic analysis with NPV and LCOE suggests very lucrative value propositions [ABSTRACT FROM AUTHOR]

Competency-based management models are models through which the specific competencies for each job position are evaluated. This contemplates the development of additional competencies necessary for the personal and professional growth of employees. Therefore, in this research, a model is analyzed from theoretical and methodological bases, with the aim of knowing the skills of retail store managers so that they can keep their businesses at the forefront of this sector. The inductive scientific method was used with a methodology of two steps. The first stage consisted of carrying out a systematic study of the literature from the critical point of view of hermeneutics. In the second step, the core competency analysis approach is applied to generate a list of ten core competencies. It is concluded at the end of the study that in the retail economic sector, which consists mainly of various products such as food and groceries in general, many of the managers of this type of business currently focus their attention on customer orientation and decision-making through assertive communication. However, it was revealed that this technique can be enhanced by expanding the digital and computer skills of these managers, which will allow them to position their micro-businesses in the first place soon since in this sector they do not use the latest technologies because they do not master digital and computer skills. [ABSTRACT FROM AUTHOR]

Chondrogenic tumors are typically well recognized on radiographs, but differentiation between benign and malignant cartilaginous lesions can be difficult both for the radiologist and for the pathologist. Diagnosis is based on a combination of clinical, radiological and histological findings. While treatment of benign lesions does not require surgery, the only curative treatment for chondrosarcoma is resection. This article (1) emphasizes the update of the WHO classification and its diagnostic and clinical effects; (2) describes the imaging features of the various types of cartilaginous tumors, highlighting findings that can help differentiate benign from malignant lesions; (3) presents differential diagnoses; and (4) provides pathologic correlation. We attempt to offer valuable clues in the approach to this vast entity. [ABSTRACT FROM AUTHOR]

The integration of distributed generation, microgrids, and renewable energy sources has significantly enhanced the resilience of modern electrical grids. However, this transition presents challenges in control, stability, safety, and protection due to low fault currents from renewables. This paper addresses these challenges by proposing novel methodologies to enhance fault detection, classification, and localization in microgrids. The literature review highlights a shift towards intelligent learning methods in microgrid protection systems, improving fault response times and identifying electrical faults, including high impedance faults. Nonetheless, existing methods often neglect high impedance fault detection and the integration of differential protection in clustered microgrids. To fill these gaps, this study presents a methodology combining support vector machines and convolutional neural networks for fault detection in microgrids, integrating differential protection for high impedance fault detection. The paper also proposes approaches to optimize protection in clustered microgrid systems. The effectiveness of the methodology is validated using Opal-RT through comparative analyses of signal decomposition techniques, performance and accuracy of support vector machines and convolutional neural networks, K-Fold validation, and sensitivity analysis. Results demonstrate robustness and high performance, achieving up to 100 % accuracy in fault detection and classification. • DG and RES integration in modern grids and MGs enhances resilience but challenges fault detection due to low fault currents. • Novel SVM-CNN methodology proposed for fault detection, addressing challenges like HIF detection. • Proposed SVM-CNN achieves up to 100 % accuracy in fault detection, including HIF and islanding events. • Results highlight methodology's effectiveness in improving fault response time and accuracy. [ABSTRACT FROM AUTHOR]

• What is currently known about this topic? Pediatric living donor liver transplantation (PLDLT) in infants and small children is a challenging procedure and requires particular technical refinements. Early vascular complications are still the main cause of patient and graft loss, especially in low body weight recipients, and centers responsible for the care of such patients utilize different strategies to mitigate the problem and achieve better outcomes.. • What new information is contained in this article? This paper analyzes the PLDLT outcomes in children with low body weight (<7 kg). It represents the largest population of PLDLT reported so far. With proper management and different technical strategies to avoid "large-for-size syndrome", that can increase the occurrence of early vascular complications, the long-term survival of small babies was similar to the group of patients with higher body weight. This series shows that, even challenging, PLDLT in small babies is feasible, with good outcomes. infants who require liver transplantation represent a treatment challenge because chronic liver disease at this early age affects the child's growth and development during a critical phase. The aim is to compare demographics, operative data, and long-term outcomes according to recipient weight at the time of LDLT. This retrospective study included primary LDLT analyzed in 2 groups: BW ≤ 7 kg (n = 322) and BW > 7 kg (n = 756). A historical comparison between periods was also investigated. BW ≤ 7 kg had significantly lower height/age and weight/age z-scores, with median PELD score of 19. Transfusion rates were higher in the BW ≤ 7 kg group (30.9 ml/kg versus 15.5 ml/kg, P < 0.001). Higher frequencies of PV complications were seen in the BW ≤ 7 kg cohort. HAT and retransplantation rates were similar. Those with BW ≤ 7 kg required longer ICU and hospital stays. Patient and graft survival were similar. Patient survival in BW≤ 7 kg was significantly better in the most recent period. Malnutrition and advanced liver disease were more frequent in BW ≤ 7 kg. Despite increased rates of PVT and longer hospital stay, patient and graft long-term survival were similar between groups. [ABSTRACT FROM AUTHOR]

• We unravel land subdivision spatial patterns in a global biodiversity hotspot. • Land subdivisions are mainly related to urban expansion predictors. • Observed subdivisions threaten biodiversity and soil with agricultural potential. • We mapped potential areas of land subdivision with implications for land planning. Land subdivisions, especially in rural areas, pose a significant threat to sustainable development in many regions of the world. This issue is particularly challenging to understand in complex landscapes, where many biophysical and anthropic drivers interact without the necessary land regulatory guidance. We combined kernel density analysis and machine learning modeling to unravel the spatial patterns of land subdivisions and the complex relationships between their drivers. We used the Los Lagos region in southern Chile as a study case because it is a global biodiversity hotspot where land subdivisions are constantly increasing. We identify a significant increasing trend of subdivisions. Our modeling approach showed robust performance with an R2 of 0.727, RMSE of 5.109, and a bias of −0.009. The proximity to urban areas, to the coast, distance to electric mains, demographic structure, and proximity to protected areas were significant predictors of land subdivision. Fertile lands, particularly those near urban centers, have become prime targets for subdivisions, exacerbating the conflict between urban development and agricultural sustainability. We highlight the increasing number of subdivisions on threatened ecosystems and highly productive soils. We discuss the interrelationship between the drivers and conclude that subdivision is primarily associated with conventional urban sprawl, although other urbanization phenomena could also be observed in some areas. These findings provide challenges and opportunities for global spatial planning and harmony with biodiversity conservation. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the "Value-Based Healthcare" concept of an integrated palliative care (PC) program in Bogotá, Colombia, through the measurement of health outcomes and care costs in the last 3 months of life. A multicenter, retrospective cohort study that included patients ≥18 years old who died in 2020 due to medical conditions amenable to PC. The measured health outcomes included pain, wellbeing, comfort, quality of life (QOL), and satisfaction. We analyzed the behavior of overall care costs during the last 3 months of the patients' lives and controlled for the effect of exposure to the program, considering the disease type and insurance coverage, using a linear regression model, nearest-neighbor matching, and sensitivity analysis. Among patients exposed to the program, the mean pain score was 2.1/10 (± 1.3) and wellbeing was rated at 3.5/10 (± 1.0), comfort at 1.6/24 (± 1.3), QOL at 3.6/5.0 (± 0.17), and satisfaction at 9.3/100 (± 0.15). The positive changes in these scores were greater for patients who remained in the program for over 3 months. Cost reduction was demonstrated in the last 90 days of life, with statistically significant and chronologically progressive savings during the last 30 days of life exceeding 5 million pesos per patient (P <.05). This study demonstrated the success of PC in reducing pain, improving wellbeing and QOL, providing comfort, and ensuring high levels of satisfaction. Moreover, PC is an effective value-based healthcare strategy and can significantly enhance the efficiency of healthcare services by reducing end-of-life healthcare costs. • Patients nearing their end of life due to advanced chronic and terminal illnesses experience pain and suffering, which is associated with increased costs in the last 3 months of life. Palliative care (PC) has been shown to be effective in relieving pain and suffering and improving the quality of life of people with these illnesses. The "Value-Based Healthcare" concept seeks to bring efficiency by achieving outcomes that truly matter to patients and reduce healthcare costs. • There exists a dearth of literature addressing the concept of value-based healthcare in PC. This study was designed to determine the applicability of this concept to an integrated PC program in Bogotá, D.C., Colombia, through the measurement of the health outcomes and impact on the healthcare costs in the last 3 months of life. The goal is to promote the development of PC as a strategy for improving healthcare quality and efficiency. • This study delved into the implementation of the value-based healthcare concept within a PC program, highlighting the impact of initiating PC early in the disease trajectory on health outcomes and costs. It concludes that PC can be a value-based healthcare strategy to reduce the suffering of millions of people who will be at the end-of-life worldwide and to improve health services. [ABSTRACT FROM AUTHOR]

Precocious puberty (PP) is an illness that appears when puberty, begins some years earlier than usual, provoking inferences in preadolescents and adolescents and their families. Therefore, the aim is to analyze if psychological consequences can be observed in groups of preadolescents or adolescents with PP. A bibliographic search of the scientific literature was made following the PRISMA guide in the following databases: ProQuest, Psychinfo, Web Of Science, and Scopus. 592 studies were found, were uploaded to Covidence to make a screening, of which finally 6 were included for the revision according to the inclusion and exclusion criteria. Two independent evaluators made the search, selection, data extraction and quality evaluation of studies independently. The agreement degree between both was excellent in all of the cases. 211 preadolescents participated in total in all studies, of which 99 were preadolescents with PP, with a mean age of 8,94 years old. Studies evaluated so heterogeneous variables, such as psychopathology, self-image, neuropsychological and cognitive variables, and reasons to delay or stop PP. The quality of studies was moderated especially due to the low quality of the studies design, which were mostly transversal, and the representativity of the sample, being selected by convenience. More research is needed to evaluate the psychological consequences of the PP diagnosis in pediatrics, and its protection factors, because none of the studies approached this question. We consider that it is necessary to increment the quality of these studies, and that these take a biopsychosocial perspective. • This is an updated systematic review on the impact of precocious puberty on pre-adolescence and adolescence. • The review is conducted according to scientific standards. • Some studies point to PP having a significant psychological impact on young girls, but this isn't consistent pattern. More studies are necessary. [ABSTRACT FROM AUTHOR]

The current Ecuadorian regulation in the electricity area establishes that for the evaluation of the quality indices of the electricity service of the distribution companies, all those electric service interruptions with a time greater than three minutes must be considered. Failure to comply with these regulations gives way to a sanctioning regime in which financial fines are imposed for each non compliant index. Endogenous and exogenous agents produce failures in the distribution companies' infrastructure, causing disconnections in the electricity supply that require the execution of corrective actions, which affect the time of restoration of the service. In this research, a model is proposed for the evaluation of the electric service in the event of a failure, using fuzzy logic and based on the historical information registered by an Ecuadorian electric power distribution company. For the implementation of this model, a statistical analysis was carried out of the records of the time of affectation attributable to four input variables. The simulation was run with free software tools considering four scenarios to evaluate the management of the distribution company with respect to the service reconnection time. The results obtained show that the implemented model is capable of obtaining an output, which by means of adopted membership functions, allowed to express in percentage terms the efficient management of the electricity distribution company. For service reconnection times greater than 27,000 seconds, the electricity distribution company management adopted a very poor membership, while for service reconnection times less than 6,200 seconds, the model solution adopted a very efficient membership. The simulations for the validation of the fuzzy model determined that there is a correspondence between the statistical ranges established for the membership functions of the input variables and the output of the model used by the inference engine. [ABSTRACT FROM AUTHOR]

Retrospective studies and meta-analyses suggest that upfront primary tumour resection (UPTR) confers a survival benefit in patients with asymptomatic unresectable metastatic colorectal cancer (mCRC) undergoing chemotherapy, however a consensus of its role in routine clinical practice in the current era of targeted therapies is lacking. This retrospective study aimed to analyse the survival benefit of UPTR in terms of tumour location and mutational status, in patients with synchronous mCRC receiving chemotherapy and targeted therapy. Survival was analysed in a pooled cohort of synchronous mCRC patients treated with a first-line anti-VEGF or anti-EGFR inhibitor in seven trials of the Spanish TTD group, according to UPTR, tumour-sidedness and mutational profiling. Of 1334 eligible patients, 642 (48%) had undergone UPTR. UPTR was associated with significantly longer overall survival (OS; 25.0 vs 20.3 months; HR 1.30, 95%CI 1.15–1.48; p < 0.0001). UPTR was associated with significant OS benefit in both left-sided (HR 1.38, 95%CI 1.13–1.69; p = 0.002) and right-sided (HR 1.39, 95%CI 1.00–1.94; p = 0.049) tumours, RASwt (HR 1.29, 95%CI 1.05–1.60; p = 0.016) and BRAFwt (HR 1.49, 95%CI 1.21–1.84; p = 0.0002) tumours, and treatment with anti-EGFRs (HR 1.47, 95%CI 1.13–1.92; p = 0.004) and anti-VEGFs (HR 1.25, 95%CI 1.08–1.44; p = 0.003). Multivariate analysis identified number of metastatic sites, RAS status, primary tumour location and UPTR as independent prognostic factors for OS. Considering the selection bias inherent to this study, our results support UPTR before first-line anti-EGFR or anti-VEGF targeted therapy in right and left-sided asymptomatic unresectable synchronous mCRC patients. RAS/BRAF mutational status may also influence UPTR function. • Upfront primary tumor resection improves survival in right and left-sided mCRC •Upfront primary tumor resection before targeted agents may improve survival •Upfront primary tumor resection may benefit RAS/BRAF wild-type mCRC [ABSTRACT FROM AUTHOR]

This work presents the design and development of an educational video game, a product committed to the project "Model for the production of educational digital content for the inclusion of deaf people" attached to the national program financed by Colciencias - Colombia: "Educational and technological pedagogical architecture for teacher training in and for diversity". The video game was made under the logic of applied and design research. It recognizes the importance of this resource as a didactic tool, which enhances and strengthens the learning process in deaf and hearing children, in the area of ​​natural sciences. Instructional design includes: topic, purpose, target audience, learning objectives, and competencies. For its planning, elaboration and development, the environment, the rules, the challenge and the genre of the game were taken into account, deriving the prototype in the Unity engine. [ABSTRACT FROM AUTHOR]

The Neospora caninum Calcium-dependent protein kinase 1 (NcCDPK1) inhibitor BKI-1294 had demonstrated excellent efficacy in a pregnant mouse model of neosporosis, and was also highly efficacious in a pregnant sheep model of toxoplasmosis. In this work, we present the efficacy of BKI-1294 treatment (dosed 5 times orally every 48 h) starting 48 h after intravenous infection of sheep with 105 Nc-Spain7 tachyzoites at mid-pregnancy. In the dams, BKI-1294 plasma concentrations were above the IC 50 for N. caninum for 12–15 days. In treated sheep, when they were compared to untreated ones, we observed a minor increase in rectal temperature, higher IFNγ levels after blood stimulation in vitro , and a minor increase of IgG levels against N. caninum soluble antigens through day 28 post-infection. Additionally, the anti-NcSAG1 and anti-NcSAG4 IgGs were lower in treated dams on days 21 and 42 post-infection. However, BKI-1294 did not protect against abortion (87% foetal mortality in both infected groups, treated and untreated) and did not reduce transplacental transmission, parasite load or lesions in placentomes and foetal brain. The lack of foetal protection was likely caused by short systemic exposure in the dams and suboptimal foetal exposure to this parasitostatic drug, which was unable to reduce replication of the likely established N. caninum tachyzoites in the foetus at the moment of treatment. New BKIs with a very low plasma clearance and good ability to cross the blood-brain and placental barriers need to be developed. [Display omitted] • BKI-1294 triggers a transiently decrease in anti- N. caninum IgG levels in sheep. • BKI-1294 does not protect against abortion and vertical transmission of N. caninum. • The efficacy of BKI-1294 is different in pregnant mice and sheep models of neosporosis. [ABSTRACT FROM AUTHOR]

Introduction: The objectives of this study were to evaluate postsurgical condylar remodeling using a radiographical interpretation, quantify condylar volumetric asymmetry, and assess soft tissue symmetry after simultaneous unilateral high condylectomy and bimaxillary osteotomies.Methods: Sixteen patients diagnosed with unilateral condylar hyperplasia underwent unilateral high condylectomy and orthognathic surgery to correct skeletal and facial asymmetries. Cone-beam computed tomography scans were acquired before and 1-year after surgery. A radiographic consensus was evaluated for signs of reparative or degenerative changes. The condyles were mirrored and registered for assessment of volumetric and morphologic asymmetry. Soft tissue symmetry was evaluated by measurement of the distance of soft tissue pogonion from the skeletal midsagittal plane.Results: Patients who undergo unilateral high condylectomy and orthognathic surgery present radiographic signs suggestive of degenerative changes, including sclerosis, osteophytes, flattening, and erosion in both the surgical and nonsurgical condyles (P ≤0.01). There was an average volumetric improvement of 531.9 ± 662.3 mm3 1-year postsurgery (P = 0.006). Soft tissue symmetry improved in all patients, with an average improvement of 65.8% (4.0 mm ± 2.6 mm, P ≤ 0.01). There was no correlation between the change in condylar volumetric asymmetry and the stability of the soft tissue correction.Conclusions: High condylectomy for the correction of a skeletal asymmetry in patients with condylar hyperplasia successfully reduces the volumetric asymmetry between the condyles. Postsurgical dysmorphic remodeling and degenerative changes were noted in both the surgical and nonsurgical condyles. Despite remarkable changes and remaining joint asymmetry, the soft tissue correction is stable 1-year postsurgery. [ABSTRACT FROM AUTHOR]

[Display omitted] Biostimulation and toxicity constitute the continuous response spectrum of a biological organism against physicochemical or biological factors. Among the environmental agents capable of inducing biostimulation or toxicity are nanomaterials. On the < 100 nm scale, nanomaterials impose both physical effects resulting from the core's and corona's surface properties, and chemical effects related to the core's composition and the corona's functional groups. The purpose of this review is to describe the impact of nanomaterials on microorganisms and plants, considering two of the most studied physical and chemical properties: size and concentration. Using a graphical analysis, the presence of a continuous biostimulation-toxicity spectrum is shown considering different biological responses. In microorganisms, the results showed high susceptibility to nanomaterials. Simultaneously, in plants, a hormetic response was found related to nanomaterials concentration and, in a few cases, a positive response in the smaller nanomaterials when these were applied at a higher level. With the above, it is concluded that: (1) microorganisms are more susceptible to nanomaterials than plants, (2) practically all nanomaterials seem to induce responses from biostimulation to toxicity in plants, and (3) the kind of response observed will depend in a complex way on the nanomateriaĺs physical and chemical characteristics, of the biological species with which they interact, and of the form and route of application and on the nature of the medium -soil, soil pore water, and biological surfaces- where the interaction occurs. [ABSTRACT FROM AUTHOR]

• Urinary and serum levels of Cathepsin D were significantly higher in the preeclampsia group compared to the normotensive group, indicating its potential role as a diagnostic biomarker for this disease. • Our study highlights the use of non-invasive biological samples such as urine to detect preeclampsia and develop new therapeutic strategies for early management of the condition. • This study presents a novel approach to detecting preeclampsia by comparing urinary and serum levels of Cathepsin D, which has previously been shown to be involved in the pathophysiology of the condition. The early and accurate diagnosis of preeclampsia is crucial to avoid serious complications for both the mother and baby. However, the current diagnostic methods are limited, and there is a need for new diagnostic biomarkers. Previous studies have shown that cathepsin D (CTD) participates in the pathophysiology of preeclampsia and is present in urine samples, making it a potential biomarker for the disease. This study aimed to compare urinary and serum levels of CTD in preeclamptic and normotensive women and analyze its potential role as a diagnostic biomarker in preeclampsia. The study included thirty-nine patients with preeclampsia and twelve normotensive pregnant women as controls. Biomarkers were determined using Multiplex Assay kit, and serum prolactin (Prl) and urinary TNF-α levels were also evaluated. Statistical analysis was conducted using the Mann-Whitney U test. We found that urinary and serum CTD levels were significantly higher in the preeclampsia group than in the normotensive group, suggesting that CTD could be a diagnostic biomarker for preeclampsia. No significant differences were found in the levels of serum prolactin or urinary TNF-α between the two groups. The study provides evidence that non-invasive biological samples such as urine can be used to improve new therapeutic strategies for the early management of preeclampsia. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) of the mesencephalic locomotor region (MLR) has been studied as a therapeutic target in rodent models of stroke, parkinsonism, and spinal cord injury. Clinical DBS trials have targeted the closely related pedunculopontine nucleus in patients with Parkinson's disease as a therapy for gait dysfunction, with mixed reported outcomes. Recent studies suggest that optimizing the MLR target could improve its effectiveness. We sought to determine if stereotaxic targeting and DBS in the midbrain of the pig, in a region anatomically similar to that previously identified as the MLR in other species, could initiate and modulate ongoing locomotion, as a step towards generating a large animal neuromodulation model of gait. We implanted Medtronic 3389 electrodes into putative MLR structures in Yucatan micropigs to characterize the locomotor effects of acute DBS in this region, using EMG recordings, joint kinematics, and speed measurements on a manual treadmill. MLR DBS initiated and augmented locomotion in freely moving micropigs. Effective locomotor sites centered around the cuneiform nucleus and stimulation frequency controlled locomotor speed and stepping frequency. Off-target stimulation evoked defensive and aversive behaviors that precluded locomotion in the animals. Pigs appear to have an MLR and can be used to model neuromodulation of this gait-promoting center. These results indicate that the pig is a useful model to guide future clinical studies for optimizing MLR DBS in cases of gait deficiencies associated with such conditions as Parkinson's disease, spinal cord injury, or stroke. • Cuneiform nucleus DBS initiates locomotion and augments ongoing locomotion in the pig. • Low frequencies (20–50Hz) had the best results for locomotion. • Stimulation frequency controlled locomotor speed. • Off-target effects included defensive behaviors that prevented locomotion. [ABSTRACT FROM AUTHOR]

Introduction: This study evaluated whether presurgical characteristics, the magnitude of mandibular advancement, and changes in mandibular plane angle are correlated with long-term stability and postsurgical condylar remodeling and adaptations using 3-dimensional imaging.Methods: Forty-two patients underwent bilateral sagittal split osteotomies for mandibular advancement using rigid fixation. Cone-beam computed tomography (CBCT) scans were acquired before surgery (T1), immediately after surgery (T2), and at long-term follow-up (T3). The average follow-up period was 5.3 ± 1.7 years after surgery. Anatomic landmark identification on the cone-beam computed tomographies and subsequent quantification of the changes from T1 to T2 and T2 to T3 were performed in ITK-SNAP (version 2.4; itksnap.org) and 3DSlicer (version 4.7; http://www.slicer.org) software. Surgical displacements, mandibular plane angle changes, and skeletal stability were measured relative to cranial base superimposition, whereas condylar remodeling was measured relative to regional condylar registration. Partial correlation coefficients were used to assess relationships between clinical and surgical variables, condylar remodeling, and long-term surgical relapse while controlling for variability in the length of follow-up.Results: B-point relapsed more than 2 mm posteriorly in 55% of the patients. The only variables strongly associated with the posterior movement of B-point long-term were mesial yaw of the condyle during surgery (P ≤0.01) and the length of follow-up from T2 to T3 (P ≤ 0.01). There was no relationship between the magnitude of advancement or presurgical mandibular plane angle and relapse or condylar resorption. Condylar resorption was strongly associated with relapse of B-point in the posterior direction (P ≤0.01) and clockwise rotation of the mandibular plane long-term (P ≤0.01). Twenty-nine percent of subjects showed resorption of more than 2 mm in the inferior direction at the lateral pole, and 17% of the subjects showed resorption of more than 2 mm in the inferior direction at condylion. Compared with male subjects, females exhibited significantly greater condylar remodeling (P ≤0.01) and slightly greater relapse at B-point (P ≤0.05).Conclusions: Surgical relapse at B-point may occur slowly over time and is primarily due to condylar resorption in mandibular advancement patients. Mesial yaw of the condyle during surgery may lead to condylar resorption postsurgically. In addition, females are at greater risk of condylar resorption postsurgically. [ABSTRACT FROM AUTHOR]

Introduction/Background : Few investigations have sought to explain discrepancies between dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) body composition estimates. The purpose of this analysis was to explore physiological and anthropometric predictors of discrepancies between DXA and BIA total and segmental body composition estimates. Methodology : Assessments via DXA (GE Lunar Prodigy) and single-frequency BIA (RJL Systems Quantum V) were performed in 179 adults (103 F, 76 M, age: 33.6 ± 15.3 yr; BMI: 24.9 ± 4.3 kg/m2). Potential predictor variables for differences between DXA and BIA total and segmental fat mass (FM) and lean soft tissue (LST) estimates were obtained from demographics and laboratory techniques, including DXA, BIA, bioimpedance spectroscopy, air displacement plethysmography, and 3-dimensional optical scanning. To determine meaningful predictors, Bayesian robust regression models were fit using a t -distribution and regularized hierarchical shrinkage "horseshoe" prior. Standardized model coefficients (β) were generated, and leave-one-out cross validation was used to assess model predictive performance. Results: LST hydration (i.e., total body water:LST) was a predictor of discrepancies in all FM and LST variables (|β|: 0.20–0.82). Additionally, extracellular fluid percentage was a predictor for nearly all outcomes (|β|: 0.19–0.40). Height influenced the agreement between whole-body estimates (|β|: 0.74–0.77), while the mass, length, and composition of body segments were predictors for segmental LST estimates (|β|: 0.23–3.04). Predictors of segmental FM errors were less consistent. Select sex-, race-, or age-based differences between methods were observed. The accuracy of whole-body models was superior to segmental models (leave-one-out cross-validation-adjusted R 2 of 0.83–0.85 for FM TOTAL and LST TOTAL vs. 0.20–0.76 for segmental estimates). For segmental models, predictive performance decreased in the order of: appendicular lean soft tissue, LST LEGS , LST TRUNK and FM LEGS , FM ARMS , FM TRUNK , and LST ARMS. Conclusions : These findings indicate the importance of LST hydration, extracellular fluid content, and height for explaining discrepancies between DXA and BIA body composition estimates. These general findings and quantitative interpretation based on the presented data allow for a better understanding of sources of error between 2 popular segmental body composition techniques and facilitate interpretation of estimates from these technologies. [ABSTRACT FROM AUTHOR]

Nature's masterfully synthesized biological materials take on greater relevance when viewed through the perspective of evolutionary abundance. The fact that beetles (order Coleoptera) account for a quarter of all extant lifeforms on Earth, makes them prime exponents of evolutionary success. In fact, their forewings are acknowledged as key traits to their radiative-adaptive success, which makes the beetle elytra a model structure for next-generation bioinspired synthetic materials. In this work, the multiscale morphological and mechanical characteristics of a variety of beetle species from the Cetoniinae subfamily are investigated with the aim of unraveling the underlying principles behind Nature's adaptation of the elytral bauplan to differences in body weight spanning three orders of magnitude. Commensurate with the integral implications of size variation in organisms, a combined material, morphological, and mechanical characterization framework, across spatial scales, was pursued. The investigation revealed the simultaneous presence of size-invariant strategies (chemical compositions, layered-fibrous architectures, graded motifs) as well as size-dependent features (scaling of elytral layers and characteristic dimensions of building blocks), synergistically combined to achieve similar levels of biomechanical functionality (stiffness, energy absorption, strength, deformation and toughening mechanisms) in response to developmental and selection constraints. The integral approach here presented seeks to shed light on Nature's solution to the problem of size variation, which underpins the diversity of beetles and the living world. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Bone degradation of the condylar surface is seen in temporomandibular joint osteoarthritis (TMJ OA); however, the initial changes occur in the subchondral bone. This cross-sectional study was performed to evaluate 23 subchondral bone imaging biomarkers for TMJ OA. The sample consisted of high-resolution cone beam computed tomography scans of 84 subjects, divided into two groups: TMJ OA (45 patients with TMJ OA) and control (39 asymptomatic subjects). Six regions of each mandibular condyle scan were extracted for computation of five bone morphometric and 18 grey-level texture-based variables. The groups were compared using the Mann–Whitney U -test, and the receiver operating characteristics (ROC) curve was determined for each variable that showed a statically significance difference. The results showed statistically significant differences in the subchondral bone microstructure in the lateral and central condylar regions between the control and TMJ OA groups (P < 0.05). The area under the ROC curve (AUC) for these variables was between 0.620 and 0.710. In conclusion, 13 imaging bone biomarkers presented an acceptable diagnostic performance for the diagnosis of TMJ OA, indicating that the texture and geometry of the subchondral bone microarchitecture may be useful for quantitative grading of the disease. [ABSTRACT FROM AUTHOR]

The American College of Surgeons/Association of Program Directors in Surgery operative skills curriculum standardizes training. However, simulation resources are variable with curriculum implementation institution dependent. Our aim was to use Kern's six steps of curricular development to demonstrate how to tailor the American College of Surgeons/Association of Program Directors in Surgery Phase 2 curriculum to program specific needs. Problem identification and general needs assessment was performed. Targeted needs assessment of general surgery residents and attendings was conducted to determine perceived importance of operative skills and residents' confidence with these skills and attendings perceptions of deficiencies in technical skills using the Objective Structured Assessment of Technical Skills criteria. Educational strategies were developed dependent on program resources. The program was piloted between 2018 to 2019 and implemented in the 2019 to 2020 academic year. Assessment of resident technical skills and resident or faculty teaching skills was performed for each session. Resident confidence with procedures was assessed using the Zwisch scale before and after modules. Curricular evaluations were completed by residents after each module. The previous curriculum did not comprehensively cover Phase 2 modules and was not tailored to the needs of residents. Targeted needs assessment revealed differences in prioritization of learning for techniques by seniority (most important operation for faculty: laparoscopic cholecystectomy, postgraduate year 4 and 5: laparoscopic partial colectomy, interns: open inguinal/femoral hernia repair). Faculty identified technical skills on which to focus (ie, interns' knowledge of a specific procedure, postgraduate year 4 and 5 flow of the operation and forward planning). Educational strategies employed included wet and dry lab simulations and online materials. Residents reported increased procedural confidence after curriculum completion. This comprehensive implementation of the American College of Surgeons/Association of Program Directors in Surgery Phase 2 skills curriculum effectively used resources and expertise of an institution and focused on the knowledge and technical deficiencies of the target learners. Improvement in learner confidence was demonstrated by this approach. [ABSTRACT FROM AUTHOR]

• High-grade dural arteriovenous fistulas have an increased risk of hemorrhage. • Consider alternative treatment when vascular abnormalities limit regular approaches. • Direct transcranial cannulation is an effective route for transvenous embolization. Intracranial high-grade dural arteriovenous fistulas (DAVFs) have higher bleeding rates compared to other intracranial vascular malformations. Endovascular treatment is usually recommended for high-grade lesions, aiming at a complete fistula obliteration. However, some patients have vascular abnormalities that limit endovascular access to the precise location of the shunt. Alternative techniques may be considered in this scenario. A middle-aged man presented with intracranial hypertension secondary to a high-grade DAVF. Because of vascular abnormalities precluding transvenous access to the intracranial venous circulation, the patient required treatment by a direct transcranial coil and Onyx embolization of the shunt. Direct transcranial cannulation of a dural sinus is an alternative and effective route for transvenous embolization of DAVFs, especially if abnormal venous anatomy precluding venous access to the required cranial venous system is identified. [ABSTRACT FROM AUTHOR]

Body composition assessment via 3-dimensional optical (3DO) scanning has emerged as a rapid and simple evaluation method. The aim of this study was to establish the precision of body composition estimates from four commercially available 3DO scanners and evaluate their validity as compared to a reference 4-component (4C) model. The body composition of 171 participants was assessed using four commercially-available 3DO scanners (FIT3D®, Naked Labs®, Size Stream®, and Styku®) and a 4C model utilizing data from dual-energy x-ray absorptiometry, air displacement plethysmography, and bioimpedance spectroscopy. Body composition estimates were compared via equivalence testing, Deming regression, Bland–Altman analysis, concordance correlation coefficients (CCC), root mean square error (RMSE), and related metrics. Precision metrics, including the root mean square coefficient of variation (RMS-%CV), precision error, and intraclass correlation coefficient, were generated for duplicate scans in 139 participants. All scanners produced reasonably reliable estimates, with RMS-%CV of 2.3–4.3% for body fat percentage (BF%), 2.5–4.3% for fat mass (FM), and 0.7–1.4% for fat-free mass (FFM). ICC values ranged from 0.975 to 0.996 for BF% and 0.990 to 0.999 for FM and FFM. All scanners except Styku® demonstrated equivalence with 4C, using 5% equivalence regions, and constant errors of <1% for BF% and ≤0.5 kg for FM and FFM. However, the slopes of regression lines differed from the line of identity for most scanners and variables. CCC values ranged from 0.74 to 0.90 for BF%, 0.85 to 0.95 for FM, and 0.93 to 0.97 for FFM. RMSE values ranged from 3.7 to 6.1% for BF% and 2.8–4.6 kg for FM and FFM. Bland–Altman analysis indicated proportional bias of varying magnitudes was present for all scanners. Commercially available 3DO scanners produce relatively reliable body composition estimates. Three out of four scanners demonstrated equivalence with a 4C model for assessments of BF%, FM, and FFM, although other metrics of validity varied among scanners, and proportional bias was present for all scanners. [ABSTRACT FROM AUTHOR]

O Bloqueio do Gânglio Esfenopalatino (BGEP) é opção de tratamento efetivo associado a baixo risco para Cefaleia Pós‐Punção Dural (CPPD) refratária às medidas conservadoras. Este relato apresenta quatro pacientes com alta complexidade que apresentaram cefaleia relacionada à baixa pressão do líquido cefaloraquidiano. Três pacientes foram tratados com sucesso pela instilação de gotas de anestésico local tópico na cavidade nasal. A nova abordagem descrita neste relato apresenta riscos mínimos de desconforto ou lesão à mucosa nasal. A aplicação é rápida e pode ser administrada pelo próprio paciente. The Sphenopalatine Ganglion Block (SGB) is an effective, low‐risk treatment option for Postdural Puncture Headache (PDPH) refractory to conservative management. This report presents four complex cases of patients with headache related to low cerebrospinal fluid pressure. Three of them were successfully treated with the application of local anesthetic topical drops through the nasal cavity. The novel approach described in this report has minimal risks of discomfort or injury to the nasal mucosa. It is quick to apply and can be administered by the patient himself. [ABSTRACT FROM AUTHOR]

Segmental estimates add specificity to body composition evaluation and could potentially have greater health and function implications than whole-body estimates alone. The aim of this study was to quantify the level of agreement between total and segmental fat mass (FM) and lean soft tissue (LST) estimates from dual-energy x-ray absorptiometry (DXA) and single-frequency bioelectrical impedance analysis (SFBIA). Assessments via DXA (GE® Lunar Prodigy) and SFBIA (RJL Systems® Quantum V) were performed in 179 adults (103 F, 76 M; 30% racial/ethnic minorities). Total and segmental FM and LST estimates were compared in the entire sample, females, and males using null hypothesis significance testing (NHST; via paired-samples t-tests), equivalence testing with 5% equivalence regions, Bland–Altman analysis with linear regression, and additional error metrics. In females and the entire sample, all LST variables except LST ARMS exhibited equivalence between methods, despite statistically significant differences via NHST for most variables. In males, only estimates of LST TOTAL and appendicular lean soft tissue (ALST) were equivalent between methods. LST variables exhibited minimal proportional bias. All FM variables failed to exhibit equivalence, and most FM variables were underestimated by SFBIA. The magnitude of relative errors for FM generally appeared larger in males than females. Proportional bias was observed for FM LEGS and FM ARMS , as well as FM TOTAL in females only. ALST estimates were equivalent between DXA and SFBIA in all analyses, did not differ between methods based on NHST, exhibited relatively low errors, and displayed no proportional bias. In the context of the present study, DXA and SFBIA LST estimates appear to exhibit better overall agreement than FM estimates. Additionally, overall agreement between SFBIA and DXA may be superior in females as compared to males. The relatively strong agreement between ALST estimates indicates potential utility of SFBIA for clinical applications, such as evaluation of sarcopenia. Further investigation into the explanatory physiological (e.g. hydration) and anthropometric (e.g. segment lengths, circumferences, and volumes) variables predicting individual discrepancies between DXA and BIA is warranted. [ABSTRACT FROM AUTHOR]

Studies of outcomes among adults with congenital heart defects (CHDs) have focused on those receiving cardiac care, limiting generalizability. The Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) will assess comorbidities, health care utilization, quality of life, and social and educational outcomes from a US population-based sample of young adults living with CHD.Methods: Individuals with CHD born between 1980 and 1997 were identified using active, population-based birth defects surveillance systems from 3 US locations (Arkansas [AR]; Arizona [AZ]; and Atlanta, Georgia [GA]) linked to death records. Individuals with current contact information responded to mailed survey materials during 2016 to 2019. Respondents and nonrespondents were compared using χ2 tests.Results: Sites obtained contact information for 74.6% of the 9,312 eligible individuals alive at recruitment. Of those, 1,656 returned surveys, either online (18.1%) or via paper (81.9%), for a response rate of 23.9% (AR: 18.3%; AZ: 30.7%; Atlanta, GA: 28.0%; P value < .01). For 20.0% of respondents, a proxy completed the survey, with 63.9% reporting that the individual with CHD was mentally unable. Among respondents and nonrespondents, respectively, sex (female: 54.0% and 47.3%), maternal race/ethnicity (non-Hispanic white: 74.3% and 63.0%), CHD severity (severe: 33.8% and 27.9%), and noncardiac congenital anomalies (34.8% and 38.9%) differed significantly (P value < .01); birth year (1991-1997: 56.0% and 57.5%) and presence of Down syndrome (9.2% and 8.9%) did not differ.Conclusions: CH STRONG will provide the first multisite, population-based findings on long-term outcomes among the growing population of US adults with CHD. [ABSTRACT FROM AUTHOR]

The purpose of this study is to evaluate the relevancy and fit of a proposed group-based, peer-mentored intervention, based on the principles of Self-Determination Theory (SDT), to facilitate the development of health self-management skills needed to transition from pediatric to adult-based healthcare. Individual in-depth interviews with 28 transition-age youth (TAY) ages 17–22 and 24 caregivers (parents) from Gastroenterology, Renal and Rheumatology clinical services assessed interests in and preferred content, timing of and format for an intervention to help youth build self-management skills. Descriptive statistics were used for short answer questions and rating scales. Thematic analysis was used to analyze transcripts. >90% of TAY and all caregivers thought the proposed group-based transition skills-building intervention was a good idea. TAY expressed wanting someone with lived experience to lead it and a desire to meet other youth with chronic conditions. All caregivers would want their TAY to participate if given the opportunity. Both TAY and caregivers voiced the importance of mental health topics as many TAY experienced anxiety or depression over managing their illness. Nearly 50% of TAY and caregivers thought parents should attend some or all group sessions, though TAY and caregivers within the same family did not always agree. Findings establish the relevancy and fit of a peer-mentored intervention focused on skill development to successfully transition to adult healthcare. The group intervention designed using a SDT framework may be particularly relevant as autonomy, competence, and relatedness undergo major developmental changes during adolescence. • Youth and caregivers endorse a group-based, peer-mentored intervention to promote healthcare management skills. • Both practical skills and social support are important to TAY. • There are small but important differences in how TAY and caregivers define successful HCT transition. • Many TAY and caregivers do not agree on who should attend HCT intervention sessions. • Self-Determination Theory (SDT) is a promising framework for a HCT interventions targeting skills development. [ABSTRACT FROM AUTHOR]

The use of machine learning allows automating decision-making based on data, saving time and resources compared to traditional methods that require human intervention. This automation poses significant challenges in terms of ensuring that the model-building process incorporates ethical considerations and addresses potential biases that may arise. In the context of this research, proposed approaches were explored to ensure fairness through interventions during data preprocessing in the construction of a binary classification model. The use case employed aimed to develop a model capable of determining whether demobilized individuals from armed groups in Colombia, who are in the process of reintegration, were eligible to access the Economic Insertion Benefit. Fairness was evaluated by the difference in false negative rates between men and women. To achieve a balance between model performance and non-discrimination, techniques such as feature engineering, hyperparameter optimization, balancing or resampling, suppression or unawareness, and reweighing were included. These techniques were used both independently and in combination with each other. The results highlighted the need to complement balancing or resampling techniques that do not consider fairness. On the other hand, applying balancing or resampling techniques with a fairness focus reduced the difference in false negative rates but resulted in a higher number of errors. In addition, the application of hyperparameter optimization and reweighing improved fairness without compromising the overall model accuracy. • New database, which is innovative in the literature and has the potential to added value with social impact. • Fairness in unbalanced learning associating optimization techniques and sensitive groups with classes. • Fairness notions not common in the literature, such as reducing false negatives. • Combining preprocessing techniques, achieving compensation between performance and non-discrimination. [ABSTRACT FROM AUTHOR]

• Policy measures and technology cost reductions are key to low carbon steel deployment. • Techno-economics drive technology deployment in integrated assessment models. • Steelmaking with CO 2 capture and storage is cheaper than hydrogen-based steel now. • Hydrogen based steelmaking is competitive with reduced hydrogen production cost. We conduct a techno-economic assessment of two low-emissions steel production technologies and evaluate their deployment in emissions mitigation scenarios utilizing the MIT Economic Projection and Policy Analysis (EPPA) model. Specifically, we assess direct reduced iron-electric arc furnace with carbon capture and storage (DRI-EAF with CCS) and H 2 -based direct reduced iron-electric arc furnace (H 2 DRI-EAF) which utilizes low carbon hydrogen to reduce CO 2 emissions. Our techno-economic analysis based on the current state of technologies found that DRI-EAF with CCS increased costs ∼7% relative to the conventional steel technology. H 2 DRI-EAF increased costs by ∼18% when utilizing Blue hydrogen and ∼79% when using Green hydrogen. The exact pathways for hydrogen production in different world regions, including the extent of CCS and hydrogen deployment in steelmaking are highly speculative at this point. In illustrative scenarios using EPPA, we find that, using base cost assumptions, switching from BF-BOF to DRI-EAF or scrap EAF can provide significant emissions mitigation within steelmaking. With further reductions in the cost of advanced steelmaking, we find a greater role for DRI-EAF with CCS, whereas reductions in both the cost of advanced steelmaking and hydrogen production lead to a greater role for H 2 DRI-EAF. Our findings can be used to help decision-makers assess various decarbonization options and design economically efficient pathways to reduce emissions in the steel industry. Our cost evaluation can also be used to inform other energy-economic and integrated assessment models designed to provide insights about future decarbonization pathways. [ABSTRACT FROM AUTHOR]

Microalgae are vital sources of high-value compounds, like polyphenols. Boosting polyphenol production requires considering diverse factors and their impacts on synthesis. This study aims to optimise polyphenol yield in microalga Parachlorella kessleri using an artificial neural network coupled with a genetic algorithm (ANN-GA). P. kessleri was grown under mixotrophic conditions and subjected to 13 experimental treatments. Factors studied included glucose, NaNO3, KH2PO4, LED light wavelength, intensity, and photoperiod. Total polyphenol concentration was quantified with Folin-Ciocalteu reagent; the polyphenol profile was obtained via HPLC. A database was constructed for ANN training to predict polyphenol production. Developed models were compared using indicators: coefficient of determination (R2pred), Mean Absolute Error (MAE), and Mean Square Error (MSE). Optimal models were fine-tuned with a genetic algorithm and validated using randomised experiments. The optimal ANN architecture for P. kessleri polyphenol production is: 6 inputs, 4 hidden layers, 6 neurons per layer, one output. This design achieved high prediction accuracy (R2 = 0.93). The genetically algorithm-optimised ANN model has these conditions: 26.60 g/L glucose; 1.42 g/L NaNO3; 0.59 g/L KH2PO4; white light; 1000 lx light intensity; 12:12 photoperiod. In experimental validation, 28 mg gallic acid equivalents per gram dry weight (GAE/g DW) were obtained, surpassing all models. An ANN-GA optimisation procedure was used for the first time for polyphenol production in P. kessleri. The model under mixotrophic conditions showed higher polyphenol production than autotrophic conditions. Polyphenol composition in P. kessleri varied between autotrophic and mixotrophic cultures, indicating inducible polyphenol production. The ANN-GA approach for polyphenol production in P. kessleri proved effective, with potential for maximising other high-value microalgae metabolites. • High-mountain lake-isolated P. kessleri has industrial polyphenol potential. • An ANN-GA model that maximizes polyphenol production in P. kessleri was developed. • P. kessleri produces 4.5 times more polyphenols in mixotrophic than under autotrophic conditions. • Subtle changes in cultivation conditions result in significant polyphenol production shifts in P. kessleri. [ABSTRACT FROM AUTHOR]

Electric power system applications are intricate optimization problems. Most literature reviews focus on studying an electrical paradigm through different optimization techniques. Since no review targets Metaheuristics (MHs) in electric power system applications, our work provides a general panorama of the paradigms that underlay such applications: Renewable Energies, Load Forecasting, Power Flow, Microgrids and Smart grids, and Power Quality. Our analysis revealed that the most employed MHs are Particle Swarm Optimization, Gray Wolf Optimizer, Genetic Algorithms, Cuckoo Search, and Differential Evolution. Historically, MHs have been classified into metaphor-based and non-metaphor-based. However, in some cases, this categorization does not correspond to pure MH procedures. Therefore, we also analyze MHs from a more formal perspective: their search operators. Moreover, we detected that the Renewable Energies paradigm presents a strong synergy with the remaining ones. Plus, there is a significant interest in topics related to Load-Forecasting optimization problems. Based on these data, we provide helpful recommendations for the current challenges and potential research paths. In doing so, our insights can support researchers and practitioners interested in furthering this field. • Systematic review of metaheuristics in electric power systems optimization. • Detailed taxonomy of optimization problems in electric power systems. • Identification of dominant metaheuristics for electric power system paradigms. • In-depth analysis of predominant metaheuristics from their search operators. • Discussion on challenges and opportunities in electric power systems optimization. [ABSTRACT FROM AUTHOR]

Students consider numerous variables before applying to a doctor of pharmacy program. Some key non-modifiable variables may include program length, institution type, graduating class size, and pharmacy school grading system. The purpose of this study was to determine if there exists a difference in North American Pharmacists Licensure Examination (NAPLEX) performance based upon these variables. This was a retrospective cohort study using observational data. NAPLEX pass rates from 2015 to 2017 were obtained from the National Association of Boards of Pharmacy (NABP) website. Data for pharmacy programs were extracted from the program, Pharmacy College Application Service, American Association of Colleges of Pharmacy, and NABP websites. Based on each pharmacy program's performance on NAPLEX, variables with significantly higher pass rates were public institutions and those with graduating class sizes of 100 or more students. The results of this study suggest that graduating class size of 100 or more students and public institutions were significant predictors of success on the NAPLEX. Lower pass rates in 2016 may be due to the examination changes implemented by NABP that year. It is possible that programs and students were not being adequately prepared for the changes made to the NAPLEX format. Although not statistically significant, there was a rise in pass rates between the years 2016 and 2017. Therefore, future studies such as this one should be performed to compare NAPLEX pass rates from 2017 forward. [ABSTRACT FROM AUTHOR]

ALS deficiency (ACLSD), caused by mutations in IGFALS, is characterized by a mild short stature, low concentrations of IGF-I and IGFBP-3, and a normal growth hormone (GH) stimulation test response. To our knowledge, no larger deletions have been reported. A 17-year-old adolescent male was evaluated due to delayed puberty and short stature. He had a height of 154.4 cm (SDS -2.84), a weight of 53.3 kg (SDS -1.41), a BMI of 22.4 kg/m2 (SDS +0.31), a Tanner 2 pubertal stage with a testicular volume of 10 mL, and a bone age of 16 years (SDS -1.33). After biochemical evaluation, low IGF-I levels, undetectable IGFBP-3 levels, and a normal response to the GH stimulation test were observed, suggesting GH insensitivity. ACLSD was confirmed by ALS measurement (116 ng/mL, SDS -3.19) and genetic analysis of IGFALS. An apparently homozygous missense variant, p. Pro624Leu, was found in exon 2 of the proband; this mutation was observed on one allele of the proband's father but was absent in the mother and siblings. Deletion/duplication analysis by multiplex ligation-dependent probe amplification (MLPA) was consistent with a deletion encompassing a significant part of exon 2 on one allele in the proband and in his mother and siblings. This is the first report of a large deletion in a patient with ACLSD. Deletion/duplication analysis should be considered in the genetic study of ACLSD, especially when homozygosity for a pathogenic variant cannot be confirmed by the study of the parents or when no variants are found but ALS concentrations are very low. • Description of ACLSD novel genetic cause in the first reported Chilean patient. • The first larger deletion involving exon 2 of IGFALS, demonstrated by MLPA. • On the other allele we find a missense variant not described in a clinical context. • In available relatives, some had one of the variants and reduced ALS concentration. [ABSTRACT FROM AUTHOR]

In previous studies we showed that prevalence of myocardial fibrosis as assessed by late enhancement on cardiac MRI in SSc patients is 45% and is associated to diffuse disease (dcSSc) and lower left ventricle ejection fraction; microvascular damage defined as decreased perfusion on cardiac MRI after adenosine infusion, was also very frequent (79%). Our aim was to identify baseline characteristics associated to the development of cardiovascular outcomes (heart failure, coronary artery disease, arrhythmias, vasculopathy, elevated systolic pulmonary artery pressure and death) in SSc patients with previously documented myocardial fibrosis and microvascular damage. We included 62 SSc patients who participated in the study of prevalence of myocardial fibrosis (2008–2010) and in our local SSc cohort. We performed baseline clinical evaluation, cardiac MRI, coronary CT angiography, transthoracic echocardiogram, and yearly clinical and cardiovascular evaluation that included Medsger's severity scale items, electrocardiogram, echocardiogram, chest X-ray or HRCT and spirometry; we registered presence and severity of internal organ involvement and cardiovascular outcomes. Ordinal variables were analyzed using Chi square test and Fisher test when appropriate, numeric variables were compared using Student's t -test or Mann Whitney U when appropriate, logistic regression and Cox proportional hazard ratio were used to perform multivariable analysis. We obtained follow-up information from 62 patients (29 dcSSc, 33 lcSSc), mean follow-up was 43.5 months. Multivariable analysis showed that elevated basal ultrasensitive CRP was associated to mortality (p = 0.004, OR: 11.9, 95% CI 2.1–65.7) and recurrent digital tip ischemic ulcers (p = 0.001, OR 26.8, 95% CI 3,9–181.3) on follow-up. Myocardial fibrosis, particularly in the middle segments (p = 0.01, OR: 11.49, 95% CI 1.6–83), and older age (p = 0.02, OR: 1.11, 95% CI 1.01–1.22) were associated to heart failure on follow-up. Higher maximum mRSS was associated to coronary artery disease (p = 0.02, OR: 1.2, 95% CI 1.02–1.38), while insertion point fibrosis (p = 0.001, OR: 12.5 95% CI 2.7–56.6) was associated to recurrent digital tip ischemic ulcers. This study shows that myocardial fibrosis, elevated ultrasensitive CRP, and higher maximum mRSS are independent predictors of cardiovascular outcomes in SSc patients. Future studies should focus on early preventive and therapeutic strategies for this group of patients. [ABSTRACT FROM AUTHOR]

The Beagle Channel is a remote subantarctic environment where mussel aquaculture initiatives have existed since the early 1990s. Here we analyze phytoplankton biomass and composition, and the occurrence of harmful microalgae species and their toxins at three sites during the period 2015–2016. The occurrence of potentially harmful algae was observed throughout the study period, including toxigenic dinoflagellates such as Alexandrium catenella (Group I of the A. tamarense complex), A. ostenfeldii , Dinophysis acuminata , Gonyaulax spinifera , Azadinium sp., and the diatoms Pseudo-nitzschia australis and P. fraudulenta. Toxic dinoflagellates were detected in low densities whereas a Pseudo-nitzschia bloom was observed in late February. Isolates of A. catenella and P. delicatissima sensu stricto were phylogenetically characterized. The toxin profile of A. catenella was dominated by GTX4, while P. delicatissima sensu stricto showed no production of the neurotoxin domoic acid in culture conditions. The results provide base-line information for the management of harmful algal blooms in this little explored subantarctic area. • Harmful phytoplankton at aquaculture sites in the Beagle Channel, South America • Identification of several toxigenic dinoflagellate and diatom species • High densities of potentially harmful Phaeocystis -like and Chaetoceros species • Toxin analyses of Alexandrium catenella and Pseudo-nitzschia delicatissima [ABSTRACT FROM AUTHOR]