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Abstract The use of biomass as a renewable energy source for electricity generation has gained attention due to its sustainability and environmental benefits. However, the intermittent electricity demand poses challenges for optimizing electricity generation in thermal systems. Time series forecasting techniques are crucial in addressing these challenges by providing accurate predictions of biomass availability and electricity generation. Here, wavelet transform is applied for denoising, convolutional neural networks (CNN) are used to extract features of the time series, and long short‐term memory (LSTM) is applied to perform the predictions. The result of the mean absolute percentage error equal to 0.0148 shows that the wavelet CNN‐LSTM is a promising machine‐learning methodology for electricity generation forecasting. Additionally, this paper discusses the importance of model evaluation techniques and validation strategies to assess the performance of forecasting models in real‐world applications. The major contribution of this paper is related to improving forecasting using a hybrid method that outperforms other models based on deep learning. Finally, future research directions and potential advancements in time series forecasting for biomass thermal systems are outlined to foster continued innovation in sustainable energy generation.

Abstract The study introduces a charge‐based fractionation method for fractionating plasma‐derived extracellular vesicles (EVs) into sub‐populations aimed at the improved purification from free plasma proteins to enhance the diagnostic potential of EV sub‐populations for specific pathophysiological states. Here, we present a novel approach for EV fractionation that leverages EVs’ inherent surface charges, differentiating them from other plasma components and, thus, reducing the sample complexity and increasing the purity of EVs. The developed method was optimized and thoroughly evaluated using proteomic analysis, transmission electron microscopy, nanoparticle tracking, and western blotting of isolated EVs from healthy donors. Subsequently, we pilot‐tested the developed technique for its applicability to real‐world specimens using a small set of clinical prostate cancer samples and matched controls. The presented technique demonstrates the effective isolation and fractionation of EV sub‐populations based on their surface charge, which may potentially help enhance EV‐based diagnostics, biomarker discovery, and basic biology research. The method is designed to be straightforward, scalable, easy‐to‐use, and it does not require specialized skills or equipment.

Abstract Introduction Hip dips, often referred to as the pronounced trochanteric depression, can be caused by athletic muscular definition or the ageing process. This depression might impact the desirable contour of the buttocks in some female patients. Patients and Methods A technique is described for female patients exhibiting moderate to severe degrees of lateral trochanteric depression. This technique utilizes a specific marking, a well‐thought‐out plan and a designated product. Eleven patients were selected to use this technique to improve their trochanteric depression and enhance their buttocks contour without undergoing surgery. The product used was Sofiderm Subskin, which was applied at the intermediate subcutaneous layer. Results The authors report favourable aesthetic results with the proposed technique, and the patients expressed high satisfaction levels. Discussion Though safe for injection, the lateral gluteal depression can still be challenging to expand. The product chosen has both a high G prime and a large molecular size, contributing to its resistance to deformation. Conclusion The hip dips technique using hyaluronic acid for the augmentation of lateral depression has shown to be minimally invasive; it provides quick results without significant risks or downtime.

Abstract This research explores green‐technology alternatives to extract vegetable oils as alternatives to hexane, a non‐renewable solvent, focussing on sunflower oil. It compares pressurized liquid extraction (PLE) with ethanol and supercritical fluid extraction (SFE) with CO2. Both processes aim to maximize oil yield, tocopherol content (α, β, γ, and δ), fatty acid profile (FA), and triacylglycerol (TAG) composition. Results show that SFE at 32 MPa achieves an 87.58% oil recovery, while PLE at 84 °C achieves 93.93%. PLE with ethanol extracts polar minority compounds along with the oil due to its higher temperature, favoring extraction. The total tocopherol content is 91.17 mg/100 g of oil in optimized SFE conditions, with α‐tocopherol extraction influenced by temperature, γ and δ‐tocopherol by pressure. PLE yields 83.16 mg/100 g of oil in tocopherols influenced less by process variables. The fatty acid (FA) profile do not vary in the oils obtained from different processes or based on the variables within each process, with linoleic and oleic acids being the most abundant. Similarly, triacylglycerols (TAGs) C54:5 and C54:6 are predominant. The optimization of SFE and PLE processes indicates a strong potential for using green solvents in the extraction of tocopherol‐rich sunflower oil.

Abstract Circulating RNAs have been investigated systematically for over 20 years, both as constituents of circulating extracellular vesicles (EVs) or, more recently, non‐EV RNA carriers, such as exomeres and supermeres. The high level of variability and low reproducibility rate of EV/extracellular RNA (exRNA) results generated even on the same biofluids promoted several efforts to limit pre‐analytical variability by standardizing sample collection and sample preparation, along with instrument validation, setup and calibration. Anticoagulants (ACs) are often chosen based on the initial goal of the study and not necessarily for the later EV and/or exRNA analyses. We show the effects of blood collection on EV size, abundance, and antigenic composition, as well on the miRNAs. Our focus of this work was on the effect of ACs on the number and antigenic composition of circulating EVs and on a set of circulating miRNA species, which were shown to be relevant as disease markers in several cancers and Alzheimer's disease. Results show that while the number of plasma EVs, their relative size, and post‐fluorescence labeling profile varied with each AC, their overall antigenic composition, with few exceptions, did not change significantly. However, the number of EVs expressing platelet and platelet‐activation markers increased in serum samples. For overall miRNA expression levels, EDTA was a better AC, although this may have been associated with stimulation of cells in the blood collection tube. Citrate and serum rendered better results for a set of miRNAs that were described as circulating markers for Alzheimer's disease, colon, and papillary thyroid cancers.

Abstract Introduction Chagas disease is caused by the protozoan Trypanosoma cruzi and is clinically divided into acute and chronic phases. Chronic Chagas cardiomyopathy is the most studied manifestation of the disease. Vitamin D deficiency has been suggested as a risk factor for cardiovascular disease. No studies demonstrate the action of this hormone in the cells of patients with chronic Chagas heart disease. Objective To evaluate the in vitro immunomodulatory effect of vitamin D on peripheral blood mononuclear cells of patients with the different chronic clinical forms of Chagas disease. Evaluating vitamin D's in vitro effect on blood cells by producing cytokines. Methods Thirteen patients of the undetermined form (IND), 13 of the mild cardiac form (CARD1) and 14 of the severe cardiac form (CARD2) of Chagas disease, and 12 with idiopathic heart disease (CARDid) were included. The cells obtained from peripheral blood were treated in vitro with vitamin D (1 × 10−7 M) for 24 h and cytokines were dosed in the culture supernatant. Results Although it was not possible to demonstrate statistically significant differences between the groups studied, our data showed that the cells treated with vitamin D modify (p

Abstract Background and Aims Vitamin D deficiency impacts a significant proportion of the world's population, and this deficiency has been linked to various conditions characterized by imbalanced serotonin regulation. The objective of this systematic review and meta‐analysis was to evaluate the effect of vitamin D supplementation on serum serotonin levels. Methods We conducted a comprehensive search of PubMed, Scopus, Cochrane Central for Randomized Clinical Trials, and Web of Science up to September 2022, without any language restrictions. The effect sizes were calculated using the standard mean difference (SMD) and 95% confidence interval (CI). Results Six randomized clinical trials involving 356 participants were included in the analysis. Our findings indicated no significant changes in serotonin levels between the intervention and control groups (SMD: 0.24 ng/mL, 95% CI: −0.28, 0.75, p > 0.10). Subgroup analysis also did not reveal any significant changes in serotonin levels among children, participants with autism spectrum disorders, interventions lasting 10 weeks or longer, or those receiving vitamin D doses below 4000 IU/day. Conclusion Although the results obtained in this systematic review are inconclusive, they support the need for further well‐designed randomized trials to assess the potential role of vitamin D supplementation in regulating serotonin levels and potentially ameliorating depression and related disorders.

Abstract The decarbonization of the power generation and transport sector encourage the analysis of connection of distributed energy resources (DER), such as electric vehicles (EVs), to the electrical system, as well as the evaluation of their impact on smart cities. A better understanding of the negative impacts on the power systems will lead to propose mitigation measures and eventually revolutionize the way distributed generation works. This paper aims at modelling and evaluating the impact of EVs on a real distribution network. The energy system chosen operates at 60 Hz, 34.5 kV (medium voltage) and 0.208 kV (low voltage) and it is simulated using PSCAD/EMTDC. To reproduce realistic user consumption profiles, dynamic load profiles based on EV owners behaviour have been simulated. The vehicle‐to‐grid (V2G) technology is modelled to mitigate the impacts of high penetration of EVs by supporting the network from undervoltage. The results show the importance of active management in modern power systems, especially considering the increase in DER penetration expected for the coming years. This work shows the benefits of implementing V2G technology while highlighting the challenges involved in a real case.

Abstract A proposal for taxonomic species description notation is presented to replace the traditional descriptive texts for a coded matrix, avoiding redundant adjectives and subjective descriptions. This is an attempt to enhance the species description rate and to make the descriptions output available to other scientific disciplines, machine learning, interactive and computer‐assisted identification keys, metadata analysis and its applications. The method consists of presenting the description of the overall morphology in a coded matrix, following a character list with detailed observed conditions for each character. The method is dynamic and open to amendments and new data addition as they become available. We test the new method describing five new species of Collembola Symphypleona of the genus Pararrhopalites as a generalized model and made the coded output available. We conclude that a coded taxonomic description is an advance to the traditional taxonomic text, with potential to enhance the global descriptions rate. The generated descriptions are dynamic, expandable and can be easily used in other fields of science, allowing non‐experts to access the data for phylogenetic, biogeographic, ecological studies and metadata analysis. Even though an experienced taxonomist will always be necessary to make a detailed taxonomic description, it is a step forward to a general template to semi‐automated taxon recognition and to future development of auxiliary tools for species description using machine learning and templates to speed up the time‐consuming phase of schematic figures preparation, after the expert interpretations are done.

Abstract Microorganisms are important associates of insect and arthropod species. Insect‐associated microbes, including bacteria, fungi, and viruses, can drastically impact host physiology, ecology, and fitness, while many microbes still have no known role. Over the past decade, we have increased our knowledge of the taxonomic composition and functional roles of insect‐associated microbiomes and viromes. There has been a more recent shift toward examining the complexity of microbial communities, including how they vary in response to different factors (e.g., host genome, microbial strain, environment, and time), and the consequences of this variation for the host and the wider ecological community. We provide an overview of insect–microbe interactions, the variety of associated microbial functions, and the evolutionary ecology of these relationships. We explore the influence of the environment and the interactive effects of insects and their microbiomes across trophic levels. Additionally, we discuss the potential for subsequent synergistic and reciprocal impacts on the associated microbiomes, ecological interactions, and communities. Lastly, we discuss some potential avenues for the future of insect‐microbe interactions that include the modification of existing microbial symbionts as well as the construction of synthetic microbial communities.

Abstract INTRODUCTION Whether circulating levels of sphingolipids are prospectively associated with cognitive decline and dementia risk is uncertain. METHODS We measured 14 sphingolipid species in plasma samples from 4488 participants (mean age 76.2 years; 40% male; and 25% apolipoprotein E (APOE) ε4 allele carriers). Cognitive decline was assessed annually across 6 years using modified Mini–Mental State Examination (3MSE) and Digital Symbol Substitution Test (DSST). Additionally, a subset of 3050 participants were followed for clinically adjudicated dementia. RESULTS Higher plasma levels of sphingomyelin‐d18:1/16:0 (SM‐16) were associated with a faster cognitive decline measured with 3MSE, in contrast, higher levels of sphingomyelin‐d18:1/22:0 (SM‐22) were associated with slower decline in cognition measured with DSST. In Cox regression, higher levels of SM‐16 (hazard ration [HR] = 1.24 [95% confidence interval [CI]: 1.08–1.44]) and ceramide‐d18:1/16:0 (Cer‐16) (HR = 1.26 [95% CI: 1.10–1.45]) were associated with higher risk of incident dementia. DISCUSSION Several sphingolipid species appear to be involved in cognitive decline and dementia risk. Highlights Plasma levels of sphingolipids were associated with cognitive decline and dementia risk. Ceramides and sphingomyelins with palmitic acid were associated with faster annual cognitive decline and increased risk of dementia. The direction of association depended on the covalently bound saturated fatty acid chain length in analysis of cognitive decline.

Abstract Background Most health systems are insufficiently prepared to promote the participation of chronically ill patients in their care. Strong primary health care (PHC) strengthens patients' resources and thus promotes their participation. The tasks of providing continuous care to people with chronic diseases and promoting self‐management are the responsibility of PHC nurses. Recent research assessing enablers of or barriers to nurses' efforts to support patients' participation has mostly not considered the special situation of patients with chronic diseases or focused on the PHC setting. Objective To investigate enablers of and barriers to PHC nurses' efforts to promote the participation of chronically ill patients in their care. Methods We interviewed 34 practicing PHC nurses and 23 key informants with advanced knowledge of PHC nursing practice in Brazil, Germany and Spain. The data was analyzed using thematic coding. Results We identified four categories of barriers and enablers. (1) Establishing bonds with patients: Interviewees emphasized that understanding patients' views and behaviours is important for PHC nurses. (2) Cooperation with relatives and families: Good relationships with families are fundamental, however conflicts within families could challenge PHC nurses efforts to strengthen participation. (3) Communication and cooperation within PHC teams: PHC nurses see Cooperative team structures as a potential enabler, while the dominance of a ‘biomedical’ approach to patient care is seen as a barrier. (4) Work environment: Interviewees agreed that increased workload is a barrier to patient participation. Discussion and Conclusions Supporting patient participation should be acknowledged as an important responsibility for nurses by general practitioners and PHC planners. PHC nurses should be trained in communicative competence when discussing participation with chronically ill patients. Interprofessional education could strengthen other professionals' understanding of patient participation as a nursing task. Patient or Public Contribution This study is part of a research project associated with the research network ‘forges: User‐oriented care: Promotion of health in the context of chronic diseases and care dependency’. The study's focus and provisional results were discussed continuously with partners in health and social care practice and presented to and discussed with the public at two conferences in which patient representatives, professionals and researchers participated.

Abstract Enpatoran is a selective inhibitor of toll‐like receptors 7 and 8 (TLR7/8) that potentially targets pro‐inflammatory pathways induced by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). A phase II study conducted in Brazil, the Philippines, and the USA during the early pandemic phase assessed the safety and efficacy of enpatoran in patients hospitalized with COVID‐19 pneumonia (NCT04448756). A total of 149 patients, who scored 4 on the World Health Organization's (WHO) 9‐point ordinal severity scale, were randomized 1:1:1 and received enpatoran 50 mg (n = 54) or 100 mg (n = 46), or placebo (n = 49) twice daily (b.i.d.) for 14 days plus standard of care. The primary objectives were safety and time to recovery (WHO 9‐point scale ≤3). Clinical deterioration (WHO 9‐point scale ≥ 5) was a key secondary objective. Treatment‐emergent adverse events (TEAEs) were comparable across groups (56.5%–63.0%). Treatment‐related TEAEs were numerically higher with enpatoran 50 mg (14.8%) than 100 mg (10.9%) or placebo (8.2%). Serious TEAEs were numerically lower with enpatoran (50 mg 9.3%, 100 mg 2.2%) than placebo (18.4%). The primary efficacy objective was not met; median time to recovery was 3.4–3.9 days across groups, with placebo‐treated patients recovering on average faster than anticipated. Clinical deterioration event‐free rates up to Day 7 were 90.6%, 95.6%, and 81.6% with enpatoran 50 mg, 100 mg, and placebo, respectively. Enpatoran was well tolerated by patients acutely ill and hospitalized with COVID‐19 pneumonia. Positive signals in some secondary end points suggested potential beneficial effects, supporting further evaluation of enpatoran in patients with hyperinflammation due to infection or autoimmunity.

Abstract Vaginoscopy allows an intravaginal endoscopic evaluation and can help in the diagnosis of female bovine genital tract disorders. The aim of this study is to validate a new method of gynaecological examination using a Scope VOR&GDI videovaginoscope. Twenty‐six heifers were used, divided into 2 groups with 13 animals, control group (GC) and videovaginoscopic group (GV). In the CG, vaginoscopy was performed with a vaginal speculum and in the GV with a Scope VOR&GDI videovaginoscope. All heifers underwent vaginoscopy on day 0 (D0), and 9 days later, on day 9 (D9). Vaginoscopy provided adequate intravaginal inspection. In the CG, 23% (3/13) of the heifers showed discomfort during the test. In GV, vaginal inspection was better due to better image quality. The videovaginoscope is the most effective equipment for carrying out the vaginoscopy procedure in Nellore heifers, as it produces sharper and clearer images and can help in the diagnostic and therapeutic routine of veterinarians.

Abstract Aim The objective was to identify if family social exclusion is associated with child motor and social development delay in Southeastern Brazil. Design A cross‐sectional study was conducted using data from a sample of 348 children under 3 years, proportional to the number of children registered in the primary care centres of the municipality. Methods Child development was measured using the “Developmental Surveillance Instrument” which was developed by the Ministry of Health in Brazil and is used for public health nurses and clinicians in their practice. An index was used to evaluate social exclusion. Results The prevalence of child motor and socioemotional developmental delay was 27.6% and 17.2%, respectively. Children in the most social excluded group were more likely to have delayed motor development (OR = 3.4; 95% CI = 1.14; 10.55) and socioemotional developmental delay (OR = 3.9; 95% CI = 1.05; 9.02) than children in the least social excluded group.

Abstract Background Cancer disparities exist between and within countries; we sought to compare cancer‐specific incidence and mortality according to area‐level socioeconomic status (SES) in the State of São Paulo, Brazil. Methods Cancer cases diagnosed 2003–2017 in the Barretos region and 2001–2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding cancer deaths were obtained from a Brazilian public government database. Age‐standardized rates for all cancer combined and the six most common cancers were calculated by SES quartiles. Results There were 14,628 cancer cases and 7513 cancer deaths in Barretos, and 472,712 corresponding cases and 194,705 deaths in São Paulo. A clear SES‐cancer gradient was seen in São Paulo, with rates varying from 188.4 to 333.1 in low to high SES areas, respectively. There was a lesser social gradient for mortality, with rates in low to high SES areas ranging from 86.4 to 98.0 in Barretos, and from 99.2 to 100.1 in São Paulo. The magnitude of the incidence rates rose markedly with increasing SES in São Paulo city for colorectal, lung, female breast, and prostate cancer. Conversely, both cervical cancer incidence and mortality rose with lower levels of SES in both regions. Conclusions A clear SES association was seen for cancers of the prostate, female breast, colorectum, and lung for São Paulo. This study offers a better understanding of the cancer incidence and mortality profile according to SES within a highly populated Brazilian state.

Abstract Aim This study aimed to identify and map the production of knowledge on non‐pharmacological strategies to reduce stress and anxiety in patients undergoing endovascular procedures. Design Scoping review. Methods The review was performed using the PRISMA‐ScR guidelines. The searches were conducted in Scopus, PubMed, Web of Science, Wiley Online Library, BVS/BIREME, Lilacs, Gale Academic OneFile, SciELO, Cochrane Library, CAPES Catalog of Dissertations and Theses, Oswaldo Cruz Foundation Portal of Theses and Dissertations, and Theses and Dissertations from Latin America. Results Twenty‐two articles were selected. The articles were published from 2001 to 2022, mostly in Iran, and there was a predominance of randomized clinical trials. The Spielberger State‐Trait Anxiety Inventory was the most used instrument. The findings indicated that music therapy, educational guidelines or videos on the procedure, massage, psychological preparation and aromatherapy were the main non‐pharmacological therapies used to reduce anxiety and stress in patients undergoing vascular procedures.

Liver cancer has been reported to be one of the most malignant diseases in the world. It is late diagnosis consequently leads to a difficult treatment, as the cancer reached an advanced stage. Hepatocellular carcinoma (HCC) is the primary type of cancer diagnosed in the liver, with deadly characteristics and a poor prognosis. The first-in-line treatment for advanced HCC is sorafenib. Sorafenib acts by inhibiting cell proliferation and by inducing apoptosis as well as blocks receptors associated with these mechanisms. Due to its constant use, sorafenib resistance has been described, especially to proteins of the Bcl-2 family, and their overexpression of Bcl-XL and Mcl-1. This review focuses on the role of the Bcl-2 proteins in relation to sorafenib resistance as a consequence of first-in-line treatment in HCC.

The genetic diversity of Breton horses in Brazil is a critical concern, mainly due to the small population size and low number of births per year. Given that the inbreeding was overlooked by breeders for multiple generations, we estimated the genetic diversity of this population utilizing pedigree-based measures of population diversity. A total of 1394 six-generation pedigrees representing the full population of registered Breton horses in Brazil defined a total population (TP, N = 2679), with horses born between 2000 and 2022, reproductively active and alive, as reported by the breed association, representing the reference population (RP, N = 731). Using the R package PurgeR, we estimated inbreeding coefficient (Fped), maternal inbreeding coefficient (Fda m), paternal inbreeding coefficient (Fsire), individual reproductive values, number of equivalents to complete generations (t), and unbiased ancestral inbreeding coefficient (Fa). We established the equivalent complete generations (ECG), effective population size (Ne), total number of founders (Nf), effective number of founders (Nfe), total number of ancestors (Na), effective number of ancestors (Nae), founder genomes (Ng), and the inbreeding coefficient estimated with effective population size (Ne) and generation numbers (t) (FNe:t), as well as Nfe/Nae and Nfe/Ng ratios for the RP. The RP inbreeding levels have stabilized, although they are still significantly rising by generation (t), and the Nfe/Ng ratio strongly suggests genetic drift. Pedigree-based analysis demonstrates that only five stallions have sired 52.83% of the RP individuals, which along with the Nae value of 36.73 implies that the observed inbreeding can be arising from patrilines. Our results suggest that observed inbreeding is due to Popular Sire Effect, highlighting the importance of monitoring breeding schemes and genetic diversity to maintain health.

Introduction. Despite all the improvements in surgical and anesthetic techniques, this procedure is still associated with pulmonary and cardiovascular complications in the postoperative period, and early rehabilitation, done through the use of cycloergometer, can minimize such complications, besides reducing the length of hospital stay. Objective. Therefore, the aim of the study was to assess the impact of cardiovascular exercise on lung function, respiratory muscle strength, and functional capacity in elderly patients after heart bypass surgery. Methods. To this purpose, a randomized and controlled clinical trial was conducted. Research participants were randomized to the cycle ergometer group (CEG) or to the control group (CG). The CG was managed based on the institution’s protocol. The CEG also carried out all the activities of the control group, but there was the inclusion of cycle ergometry through a device built by the researchers. Pulmonary function (vital capacity (VC) and peak expiratory flow (PEF)), ventilatory muscle strength (maximum inspiratory pressure (MIP) and maximal expiratory pressure (MEP)), and functional capacity (six-minute walk test) were evaluated before surgery, at ICU, and hospital discharge. Results. During the research period, 122 patients were evaluated, 61 in each group. The MIP of the cycle ergometry group was higher at discharge from the ICU 95% CI 8 (5.46 to 10.54) and at hospital discharge 95% CI 14 (16.89 to 11.11). MEP was higher in the cycle ergometry group at discharge from the ICU with 95% CI 6 (8.18 to 3.82) and at hospital discharge with 95% CI 9 (11.69 a 6.31). Vital capacity at ICU discharge with 95% CI 6 (7.98 to 4.02) and at hospital discharge with 95% CI 7 (8.98 to 5.02), as well as peak flow at ICU discharge with 95% CI 43 (75.27 to 10.73), showed relevance, being higher in the group that used the cycle ergometer. The CEG showed improvement in functional capacity at the time of hospital discharge with a 95% CI 56 (30.37 to 81.63). Conclusion. We conclude that application of cycloergometry after CABG decreases the loss of pulmonary function, muscle strength, and functional capacity. This trial is registered with RBR-39yrht6.

Introduction Patients with baseline disability account for one‐third of stroke presentations. However, there remains controversy in treatment selection for endovascular thrombectomy (EVT). We compared long‐term outcomes and likelihood of transitioning to comfort care for large vessel occlusion (LVO) patients with severe pre‐stroke disability treated with EVT versus medical management at a single center from 2017‐2020. Methods Individuals who presented with LVO were identified retrospectively from a prospectively maintained database. Severe baseline disability was defined as modified Rankin Scale (mRS) 3‐5. Delta mRS was defined as the difference between baseline and 90‐day mRS. Logistic and ordinal regressions were performed to evaluate the relationships between EVT and outcomes. A mixed‐methods analysis was performed to assess rates and reasons for transitions to comfort care. Results A total of 175/1008 (17%) were identified with severe baseline disability. The median age was 82 (IQR 70‐89), and 59% were female. Thirty‐two (18%) with severe baseline disability were treated with EVT. EVT was independently associated with improved delta mRS (B=‐1.048; 95%CI=‐1.777,‐0.318; p=0.005) accounting for age and NIHSS. However, EVT did not reduce the odds of transitioning to comfort care (aOR=0.794; 95%CI=0.347,1.818; p=0.585) accounting for age and NIHSS. Seventy‐six (43%) with severe baseline disability were transitioned to comfort care. Of the 99 not transitioned to comfort care, 18 were treated with EVT, and EVT was independently associated with improved delta mRS (B=‐2.794; 95%CI=‐4.002,‐1.586; p

Abstract Green spaces in urban areas—like remnant habitat, parks, constructed wetlands, and street trees—supply multiple benefits. Many studies show green spaces in and near urban areas play important roles harbouring biodiversity and promoting human well‐being. On the other hand, evidence suggests that greater human population density enables compact, low‐carbon cities that spare habitat conversion at the fringes of expanding urban areas, while also allowing more walkable and livable cities. How then can urban areas have abundant green spaces as well as density? In this paper, we review the empirical evidence for the relationships between urban density, nature, and sustainability. We also present a quantitative analysis of data on urban tree canopy cover and open space for United States large urbanized areas, as well as an analysis of non‐US Functional Urban Areas in OECD countries. We found that there is a negative correlation between population density and these green spaces. For Functional Urban Areas in the OECD, a 10% increase in density is associated with a 2.9% decline in tree cover. We argue that there are competing trade‐offs between the benefits of density for sustainability and the benefits of nature for human well‐being. Planners must decide an appropriate density by choosing where to be on this trade‐off curve, taking into account city‐specific urban planning goals and context. However, while the negative correlation between population density and tree cover is modest at the level of US urbanized areas (R2 = 0.22), it is weak at the US Census block level (R2 = 0.05), showing that there are significant brightspots, neighbourhoods that manage to have more tree canopy than would be expected based upon their level of density. We then describe techniques for how urban planners and designers can create more brightspots, identifying a typology of urban forms and listing green interventions appropriate for each form. We also analyse policies that enable these green interventions illustrating them with the case studies of Curitiba and Singapore. We conclude that while there are tensions between density and urban green spaces, an urban world that is both green and dense is possible, if society chooses to take advantage of the available green interventions and create it. Read the free Plain Language Summary for this article on the Journal blog.

Two significant issues in biosensors that can't be solved by conventional analytical methods are selectivity among likely biological interfering molecules and background noise in clinical samples. The application of embedded machine learning in the removal of background interference, which is extremely common in complex matrix solutions such as cerebrospinal fluid, is still unexplored. The implementation of machine learning into devices and sensors can enhance their reliability to discriminate responses. In addition, implementing these models into portable devices can further improve the usage of point‐of‐care devices, continuous monitoring, and viral mutation assessments. Herein, the requirements to implement an embedded AI model (TinyML) into low‐power portable systems and its use in the electrochemical field are presented. The application of TinyML to discriminate between interference of uric acid and ascorbic acid, both well‐known abundant electrochemically active species, in neurotransmitter detection, is explored, reaching overall accuracy of 98.1% for 32‐bit float point unit and 96.01% after 8‐bit quantization, with the usage of 4.55% of the custom‐made potentiostat memory. The model can be improved simply by having the trade‐off between memory and accuracy. The research suggests that TinyML can be a key component in future medical devices, allowing data processing in real time and with increasing reliability.

Key Clinical Message The findings in the literature, as well as those described in this study, emphasize the need for systematic and longitudinal care for patients with neglected diseases during and after treatment, mainly in low‐middle income countries. Abstract Leprosy is a chronic, granulomatous, mycobacterial infection caused by mycobacterium leprae, affecting the skin and peripheral nervous system. We present a case of a 13‐year‐old child with leprosy for more than a year, indicating decompression of the ulnar nerve. During surgery, an intraneural large caseous granule was evidenced.

Abstract Bread wheat (Triticum aestivum L.) is a major crop and its genome is one of the largest ever assembled at reference‐quality level. It is 15 Gb, hexaploid, with 85% of transposable elements (TEs). Wheat genetic diversity was mainly focused on genes and little is known about the extent of genomic variability affecting TEs, transposition rate, and the impact of polyploidy. Multiple chromosome‐scale assemblies are now available for bread wheat and for its tetraploid and diploid wild relatives. In this study, we computed base pair‐resolved, gene‐anchored, whole genome alignments of A, B, and D lineages at different ploidy levels in order to estimate the variability that affects the TE space. We used assembled genomes of 13 T. aestivum cultivars (6x = AABBDD) and a single genome for Triticum durum (4x = AABB), Triticum dicoccoides (4x = AABB), Triticum urartu (2x = AA), and Aegilops tauschii (2x = DD). We show that 5%–34% of the TE fraction is variable, depending on the species divergence. Between 400 and 13,000 novel TE insertions per subgenome were detected. We found lineage‐specific insertions for nearly all TE families in di‐, tetra‐, and hexaploids. No burst of transposition was observed and polyploidization did not trigger any boost of transposition. This study challenges the prevailing idea of wheat TE dynamics and is more in agreement with an equilibrium model of evolution.

Abstract Background Self‐injurious thoughts and behaviours (SITBs) have been associated with dysfunction of the Autonomic Nervous System (ANS) in children and young people, suggesting that objective ANS measures may aid assessment of suicide risk, but a systematic synthesis of this literature is currently lacking. Methods Following a pre‐registered protocol (PROSPERO CRD42022327605), we conducted a systematic search of PubMed, Medline, Embase, PsycINFO, and Web of Science, for empirical studies published until 10th May 2022 that compared indices of ANS functioning in individuals aged 0–25 years with versus without SITBs, or reported continuous associations between ANS measures and SITBs. Study quality was assessed with the Newcastle‐Ottawa Scales. Pooled effect sizes (Hedge's g) were estimated with random‐effects meta‐analytic models. Results Twenty studies (1979 participants) were included in our systematic review, with 16 included in meta‐analyses. Results suggested that SITBs were associated with altered cardiac indices of arousal (g = −0.328, p

Background The association of circulating trimethylamine‐N‐oxide (TMAO) with stroke has received limited attention. To address this gap, we examined the associations of serial measures of plasma TMAO with incident ischemic stroke. Methods and Results We used a prospective cohort design with data pooled from 2 cohorts. The settings were the CHS (Cardiovascular Health Study), a cohort of older adults, and the MESA (Multi‐Ethnic Study of Atherosclerosis), both in the United States. We measured plasma concentrations of TMAO at baseline and again during the follow‐up using high‐performance liquid chromatography and mass spectrometry. We assessed the association of plasma TMAO with incident ischemic stroke using proportional hazards regression adjusted for risk factors. The combined cohorts included 11 785 participants without a history of stroke, on average 73 (CHS) and 62 (MESA) years old at baseline, including 60% (CHS) and 53% (MESA) women. We identified 1031 total incident ischemic strokes during a median 15‐year follow‐up in the combined cohorts. In multivariable analyses, TMAO was significantly associated with incident ischemic stroke risk (hazard ratios comparing a doubling of TMAO: 1.11 [1.03–1.18], P=0.004). The association was linear over the range of TMAO concentrations and appeared restricted to those without diagnosed coronary heart disease. An association with hemorrhagic stroke was not found. Conclusions Plasma TMAO levels are associated with incident ischemic stroke in a diverse population. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00005133.

Abstract Land degradation resulting from increased continental surface erosion is a worldwide and systemic phenomenon due to unsustainable human activities. Already fragile, the intertropical zone is likely to be further affected by climate change like increased aridity, an aggravating factor of soil erosion and land degradation. A major challenge is thus to provide the necessary knowledge to not only deepen our understanding of the Earth's system and its critical thresholds but also to help achieving sustainability. Understanding the factors that control the properties and processes of the critical zone, and especially what will be its responses to ongoing climate and land use changes, requires multidisciplinary efforts to tackle time scales that are compatible with morphogenesis and soil development as well as environmental disturbances of anthropogenic origin. Due to its prominent ecological importance, the Brazilian Cerrado biome is an ideal natural laboratory were to gauge the consequences of recent and intense agricultural activities on continental surface erosion. We focused on the region of Brasília where our approach allows confronting the temporal scales of long‐lived and stable cosmogenic nuclides with that of short‐lived radioactive isotopes, through a comparison of natural and anthropogenically disturbed land surfaces. Our results indicate that long‐term, background denudation rates are lower than 10 mm Kyr−1 whereas recent erosion rates due to human activities may reach rates at least 160 times higher, exceeding by far the sustainability of the soil resource.

Abstract Identifying deforested areas with high potential for natural forest recovery can be used as an aid for ecological restoration projects at large‐scale. However, accurate predictions that infer the resilience (i.e. recovery rate after deforestation) and stability (i.e. the ability of the ecosystem to maintain its functions) of early second‐growth forests are scarce at a regional scale. Here, we investigated the effect of climate, soil and topography on the resilience and stability of 165 early second‐growth forests throughout the Brazilian Atlantic Forest. We also built prediction maps of potential resilience and stability to identify where reforestation could be optimized in the early stages of forest succession. We assessed the resilience and stability through an interannual plant primary productivity time series using a normalized difference vegetation index. Our analysis reveals that resilience was mainly associated with isothermality (i.e. diurnal temperature oscillation relative to the annual temperature oscillation) and precipitation of the warmest quarter. In turn, stability was mainly associated with the probability of bedrock occurrence, annual precipitation and precipitation seasonality. The prediction maps show a spatial pattern in which potential resilience and stability increase from north to south of the Atlantic Forest. Forest restoration can be optimized in regions with high potential resilience and stability, such as an isolated area on the north coast in the Bahia state and the southern region. However, restoration may require active practices and management in regions with low potential for both ecosystem properties, such as the north inland in the Bahia and Minas Gerais states. This ecosystemic approach can help achieve Atlantic Forest restoration commitments.

Background The burden of cardiovascular disease is increasing, with many people treated for multiple cardiovascular conditions. We examined persistence and adherence to medicines for cardiovascular disease treatment or prevention in Australia. Methods and Results Using national dispensing claims for a 10% random sample of people, we identified adults (≥18 years) initiating antihypertensives, statins, oral anticoagulants, or antiplatelets in 2018. We measured persistence to therapy using a 60‐day permissible gap, and adherence using the proportion of days covered up to 3 years from initiation, and from first to last dispensing. We reported outcomes by age, sex, and cardiovascular multimedicine use. We identified 83 687 people initiating antihypertensives (n=37 941), statins (n=34 582), oral anticoagulants (n=15 435), or antiplatelets (n=7726). Around one‐fifth of people discontinued therapy within 90 days, with 50% discontinuing within the first year. Although many people achieved high adherence (proportion of days covered ≥80%) within the first year, these rates were higher when measured from first to last dispensing (40.5% and 53.2% for statins; 55.6% and 80.5% for antiplatelets, respectively). Persistence was low at 3 years (17.5% antiplatelets to 37.3% anticoagulants). Persistence and adherence increased with age, with minor differences by sex. Over one‐third of people had cardiovascular multimedicine use (reaching 92% among antiplatelet users): they had higher persistence and adherence than people using medicines from only 1 cardiovascular group. Conclusions Persistence to cardiovascular medicines decreases substantially following initiation, but adherence remains high while people are using therapy. Cardiovascular multimedicine use is common, and people using multiple cardiovascular medicines have higher rates of persistence and adherence.

Abstract Uncontrolled hypertension has a high prevalence and is related to numerous negative health outcomes. This study aimed to investigate the factors associated with the lack of blood pressure control in hypertensive Brazilians treated in public and private services. This is an analytical, multicentric, and national cross‐sectional study, carried out with adult hypertensive patients, monitored in 45 outpatient clinics (September 2013 to October 2015) in a prospective record interview, clinical, and anthropometric assessment. Outcome variables included uncontrolled pressure (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg). Simple and multiple logistic regression analyses were performed. Two thousand six hundred forty‐three participants were assessed with a mean age of 61.6 ± 11.9 years, 55.7% of women, and 46.4% with uncontrolled blood pressure (BP). The following were associated with uncontrolled BP: age over 60 years (OR: 1.31 [1.11–1.55]); practice of irregular physical activity (OR: 1.28 [1.06–1.55]); attending the emergency room for hypertensive crises in the last six months (OR: 1.80 [1.46–2.22]); increased body mass index (OR: 1.02 [1.01–1.04]); low adherence to drug treatment (OR: 1.22 [1.04–1.44]) and menopause (OR: 1.36 [1.07–1.72]). The following were negatively associated: fruit consumption (OR: 0.90 [0.85–0.94]); presence of dyslipidemia (OR: 0.75 [0.64–0.89]), acute myocardial infarction (OR: 0.59 [0.46–0.76]), and peripheral arterial disease (OR: 0.52 [0.34‐0.78]). Factors associated with difficult‐to‐control blood pressure are the same that increase the risk for hypertension, while the presence of atherosclerotic disease and its outcomes were associated with better control.

Abstract Hypertension is the leading cause of overall mortality in low‐ and middle‐income countries. In Brazil, there is paucity of data on the determinants of incident hypertension and related risk factors. We aimed to determine the incidence of hypertension in a sample from the Brazilian population and investigate possible relationships with body adiposity indexes. We assessed risk factors associated with cardiovascular disease, including adiposity body indexes and biochemical analysis, in a sample from the Baependi Heart Study before and after a 10‐year follow‐up. Hypertension was defined by the presence of systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg or the use of antihypertensive drugs. From an initial sample of 1693 participants, 498 (56% women; mean age 38 ± 13 years) were eligible to be included. The overall hypertension incidence was 24.3% (22.3% in men and 25.6% in women). Persons who developed hypertension had higher prevalence of obesity, higher levels for blood pressure, higher frequency of dyslipidemia, and higher body adiposity indexes at baseline. The best prediction model for incident hypertension includes age, sex, HDL‐c, SBP, and Body Mass Index (BMI) [AUC = 0.823, OR = 1.58 (95% CI 1.23‐2.04)]. BMI was superior in its predictive capacity when compared to Body Adiposity Index (BAI), Body Roundness Index (BRI), and Visceral Adiposity Index (VAI). Incident hypertension in a sample from the Brazilian population was 24.3% after 10‐year follow‐up and BMI, albeit the simpler index to be calculated, is the best anthropometric index to predict incident hypertension.

In addition to mutations, epigenetic alterations are important contributors to malignant transformation and tumor progression. The aim of this work was to identify epigenetic events in which promoter or gene body DNA methylation induces gene expression changes that drive melanocyte malignant transformation and metastasis. We previously developed a linear mouse model of melanoma progression consisting of spontaneously immortalized melanocytes, premalignant melanocytes, a nonmetastatic tumorigenic, and a metastatic cell line. Here, through the integrative analysis of methylome and transcriptome data, we identified the relationship between promoter and/or gene body DNA methylation alterations and gene expression in early, intermediate, and late stages of melanoma progression. We identified adenylate cyclase type 3 (Adcy3) and inositol polyphosphate 4‐phosphatase type II (Inpp4b), which affect tumor growth and metastatic potential, respectively. Importantly, the gene expression and DNA methylation profiles found in this murine model of melanoma progression were correlated with available clinical data from large population‐based primary melanoma cohorts, revealing potential prognostic markers.

Abstract Aim To describe nursing students’ level of self‐directed learning abilities and identify possible factors related to it at graduation in six European countries. Design A cross‐sectional comparative design across the countries. Methods The study was conducted from February 2018 to September 2019. Nursing students (N = 4,135) from the Czech Republic, Finland, Italy, Portugal, Slovakia and Spain were invited to respond to the research instruments (the Self‐Rating Scale of Self‐Directed Learning and the Nurse Competence Scale) at graduation. The data were analysed using the chi‐square test, Pearson correlation coefficient and the linear model. Results The nursing students’ (N = 1,746) overall self‐directed learning abilities were at high level in all countries. Statistically significant differences occurred between countries. Spanish nursing students reported the highest level of self‐directed learning abilities while students from the Czech Republic reported the lowest. Higher level of self‐directed learning abilities was related to several factors, particularly with the self‐assessed level of competence and country.

Summary Oxalic acid‐producing fungi play an important role in biogeochemical transformations of rocks and minerals and possess biotechnological potential for extraction of valuable elements from primary or waste ores and other solid matrices. This research investigates the extraction of phosphate from rock phosphate (RP) by oxalic acid. Reaction parameters were derived using pure oxalic acid solutions to solubilize RP. It was found that the oxalic acid concentration was the main factor driving reaction kinetics. Excess oxalic acid could retard the reaction due to calcium oxalate encrustation on RP surfaces. However, complete P extraction was reached at stoichiometric proportions of apatite and oxalic acid. This reaction reached completion after 168 h, although most of the P (up to 75%) was released in less than 1 h. Most of the Ca released from the apatite formed sparingly soluble calcium oxalate minerals, with a predominance of whewellite over weddellite. Bioleaching of RP employing biomass‐free spent culture filtrates containing oxalic acid (100 mM) produced by Aspergillus niger extracted ~ 74% of the P contained in the RP. These findings contribute to a better understanding of the reaction between apatite and oxalic acid and provide insights for potential applications of this process for biotechnological production of phosphate fertilizer.

Abstract Tambaqui or cachama (Colossoma macropomum) is one of the most important neotropical freshwater fish used for aquaculture in South America, and its production is concentrated at low latitudes (close to the Equator, 0°), where the water temperature is warm. Therefore, understanding how selection shapes genetic variations and structure in farmed populations is of paramount importance in evolutionary biology. High‐throughput sequencing to generate genome‐wide data for fish species allows for elucidating the genomic basis of adaptation to local or farmed conditions and uncovering genes that control the phenotypes of interest. The present study aimed to detect genomic selection signatures and analyze the genetic variability in farmed populations of tambaqui in South America using single‐nucleotide polymorphism (SNP) markers obtained with double‐digest restriction site‐associated DNA sequencing. Initially, 199 samples of tambaqui farmed populations from different locations (located in Brazil, Colombia, and Peru), a wild population (Amazon River, Brazil), and the base population of a breeding program (Aquaculture Center, CAUNESP, Jaboticabal, SP, Brazil) were genotyped. Observed and expected heterozygosity was 0.231–0.350 and 0.288–0.360, respectively. Significant genetic differentiation was observed using global FST analyses of SNP loci (FST = 0.064, p

Abstract Background Cow's milk (CM) and hen's egg (HE) are leading triggers of anaphylaxis in early childhood. The aim of this study was to identify clinical phenotypes and therapeutic measures for CM anaphylaxis (CMA) compared to HE anaphylaxis (HEA) in children up to 12 years of age, based on a large pan‐European dataset from the European Anaphylaxis Registry. Methods Data from 2007 to 2020 on clinical phenotypes and treatment from 10 European countries, as well as Brazil, were analysed. The two‐step cluster analysis was used to identify the most frequent phenotypes. For each trigger, three clusters were extracted based on sex, age, and existence of symptoms in four vitally important systems. Results Altogether 284 children with CMA and 200 children with HEA were identified. They were characterised as male (69% vs. 64%), infants (65% vs. 61%), with a most frequent grade III of Ring&Messmer classification (62% vs. 64%), in CMA versus HEA, respectively. Respiratory symptoms occurred more often in CMA (91% vs. 83%, p = 0.010), especially in infants (89% vs. 79%, p = 0.008). Cardiovascular symptoms were less frequent in CMA (30% vs. 44%, p = 0.002), in both infants (33% vs. 46%, p = 0.027), and older children (25% vs. 42%, p = 0.021). The clusters extracted in the CMA group were characterised as: (1) mild dermal infants with severe GI (40%), 2. severe dermal (35%), 3. respiratory (25%). While in HEA group: 1. infants with severe GI and/or reduction of alertness (40%), (2) conjunctival (16%), (3) mild GI without conjunctivitis (44%). The severity of the reaction was independent from the amount of ingested allergen protein, regardless of trigger. The first‐line adrenaline application differed between the countries (0%–92%, as well as the reasons for not administering adrenaline, p