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Amid the ongoing controversy surrounding the drafting process of the Indonesian Criminal Code, particularly with respect to the provisions on the death penalty, this study seeks to explore the ethos or spirit of prophetic law through a philosophical examination of these regulations. This research employs a normative legal methodology, utilizing both statutory and conceptual approaches. The concepts of humanization, liberation, and transcendence serve as foundational elements of the philosophical framework of prophetic law, which coherently and sequentially aligns with the structures of ontology, epistemology, and axiology. These concepts are employed as benchmarks to identify the prophetic legal ethos embedded within the death penalty provisions of the Indonesian Criminal Code. Essentially, the arrangements pertaining to the death penalty are positioned as instruments for societal education. If a convict sentenced to death demonstrates genuine remorse and makes efforts toward rehabilitation, the imposition of the death penalty may be reconsidered in favor of life imprisonment. This perspective aligns with the principles articulated in QS. Al Maidah (5:38–39), which emphasize that punishment is intended for self-improvement. Should the convict exhibit remorse prior to execution, it reflects the understanding that Allah is the Most Forgiving. This approach underscores a legal philosophy that prioritizes the substantive and soulful dimensions of law, rooted in the prophetic legal ethos of humanization, liberation, and transcendence.

Abstract Background Mucormycosis is a highly lethal opportunistic fungal disease caused by ubiquitous molds of the order Mucorales, with Rhizopus, Lichtheimia and Mucor being the most common genera. This rare disease primarily affects immunocompromised patients, with presentations ranging from rhino-orbito-cerebral infections to disseminated mucormycosis with angioinvasion, leading to thrombosis and tissue infarction. Gastrointestinal mucormycosis is the least common clinical presentation and is believed to be secondary to spore ingestion. It can involve multiple components of the gastrointestinal tract, such as the stomach, liver, ileum, and colon, with nonspecific manifestations, including pain, nausea, vomiting, and abdominal distension. The initial clinical presentation may even manifest as gastrointestinal bleeding due to gastric ulceration or intestinal perforation. Case presentation Here we present the case of a 48-year-old male patient with a 9-year history of human immunodeficiency virus (HIV) infection who was hospitalized in the context of febrile neutropenia and whose acute respiratory infection was documented; therefore, antibiotic treatment was initiated. However, due to persistent febrile peaks and peripheral blood showing documentation of multilineage cytopenias, a bone marrow biopsy was performed, compatible with presenting features of marrow myelodysplasia. During hospitalization, the patient presented left flank abdominal pain, and an abdominal computed tomography (CT) scan revealed signs of intussusception of a small bowel loop at the distal jejunum level, leading to intestinal obstruction with ischemic progression, requiring ileectomy (60 cm). Histopathological analysis of the resected intestine revealed severe transmural ischemic changes associated with venous thrombosis due to fungal structures, with histochemical studies demonstrating the presence of zygomycete (Mucor) fungal structures, leading to the initiation of treatment with amphotericin B. However, despite treatment, the patient experienced progressive clinical deterioration with persistent fever and ventilatory failure, with follow-up tests showing absolute neutropenia and blood cultures positive for yeast, leading to death 52 days after admission. Conclusions The diagnosis of intestinal mucormycosis may be delayed due to the lack of specificity of the signs and symptoms. Pathologists as well as histopathological studies are essential for timely treatment.

ABSTRACT BACKGROUND: Intrahepatic cholangiocarcinoma (iCCA) was considered a contraindication for liver transplantation. However, recent studies have shown that highly selected cases of patients with a good response to neoadjuvant therapy may achieve acceptable survival rates when following liver transplantation. AIMS: To present two cases of patients with iCCA, without extrahepatic disease, who underwent living donor liver transplantation after receiving neoadjuvant chemotherapy. METHODS: Two cases of patients with histopathological diagnosis of locally advanced iCCA, ineligible for resection and without evidence of extrahepatic disease, are presented. RESULTS: These patients underwent at least nine sessions of neoadjuvant chemotherapy, including Gemcitabine and Cisplatin, with or without the addition of immunobiological agents, resulting in a radiological tumor response. They subsequently underwent living donor liver transplantation. The average follow-up time was 15 months, with no clinical or radiological signs of disease. CONCLUSIONS: In well-selected patients without extrahepatic disease, living donor liver transplantation represents a potential therapeutic option for iCCA.

Abstract: This study assessed the influence of sociodemographic conditions, oral hygiene habits, and the socio-psychological need for orthodontic treatment on the emotions of caregivers of children with and without autism spectrum disorder (ASD). We conducted a comparative cross-sectional study with families of individuals aged 6 to 14 years at a reference center for neurodevelopmental disorders and two dental school clinics in northeastern Brazil. Caregiver emotions were assessed using the ‘Parental Emotions’ domain of the Family Impact Scale (FIS). We analyzed sociodemographic variables, oral hygiene habits, and sociopsychological need for orthodontic treatment using the esthetic component of the Index of Orthodontic Treatment Need (IOTN). We used descriptive and hierarchical Poisson regression analyses with robust variance (α = 5%). The study included 144 families evenly distributed across the groups. The caregiver group with ASD demonstrated a higher total score for parental emotions (p < 0.001). Factors associated with this factor included caregiver responsible for brushing (PR = 1.34; 95%CI: 1.12–1.59), mandatory need for orthodontic treatment (PR = 1.25; 95%CI: 1.07–1.46), and caregivers’ education up to 8 years (PR = 1.45; 95%CI: 1.02–2.07). Caregivers with lower income showed a lower prevalence of parental emotions (PR = 0.57; 95%CI: 0.35–0.93). Caregivers of children with ASD exhibited a higher emotional burden. Factors associated with parental emotions included responsibility for tooth brushing attributed to caregivers, sociopsychological need for orthodontic treatment, and family income.

Introdução: A frequência descrita de infecções fúngicas invasivas (IFI) em receptores de transplante hepático (TH) varia de 0 a 15%. Fatores que modulam o risco de IFI após TH incluem a ocorrência de complicações técnicas, necessidade de diálise, gravidade clínica dos receptores no momento do transplante, intensidade da imunossupressão, distribuição geográfica dos fungos e exposição aos mesmos. O uso de profilaxia antifúngica e os avanços nas técnicas cirúrgicas e no manejo do paciente submetido a TH levaram a redução expressiva do risco de IFI após TH: na era pré-MELD, a incidência chegava a 43%. Nas séries disponíveis, as causas mais frequentes das IFI após TH são candidíase invasiva, aspergilose invasiva e criptococose, representando, respectivamente, 68%, 11% e 6% das IFI ocorridas após TH. Dados brasileiros são escassos. Materiais e métodos: Avaliação retrospectiva de coorte de pacientes submetidos a TH entre 2015 e 2020 quanto ao diagnóstico de IFI. Os métodos diagnósticos incluíram cultura, pesquisa de antígenos, sorologia e histopatologia. O diagnóstico de IFI foi definido conforme critérios previamente descritos pelo EORTC/MSG e atualizados em 2020. Resultados Durante o período de estudo, foram realizados 565 transplantes em 531 pacientes. A incidência de IFI foi de 4%. Entre os 21 episódios de IFI diagnosticados, houve 17 episódios comprovados (81%) e 4 prováveis (19%). As etiologias mais frequentes foram candidíase invasiva (14 casos, 67%) e criptococose (3 casos, 14%). 86% dos casos de candidíase foram causados por espécies não-albicans. Houve um caso diagnosticado de aspergilose, histoplasmose, pneumocistose e tricosporonose. O tempo transcorrido desde o transplante até o diagnóstico foi, em mediana, de 20 dias para candidíase invasiva e de 535 dias, para criptococose. A mortalidade em 30 dias foi de 29% para candidíase invasiva e 67% para criptococose. Conclusões: A incidência de IFI nessa coorte de receptores de TH foi de 4%, com elevada mortalidade. A etiologia mais frequente foi Candida spp., com predomínio de espécies não-albicans. Após o período pós transplante precoce, criptococose representou a principal etiologia. Palavras-chave: Transplante hepático, Infecções fúngicas invasivas, Candidíase invasiva, Criptococose, Epidemiologia. Conflitos de interesse: Não houve conflitos de interesse relacionados a esse trabalho. Ética e financiamentos: Não houve conflitos de interesse relacionados a esse trabalho.

Objective: To assess the influence of the COVID-19 pandemic and sociodemographic factors on stress, anxiety, and depression levels among dental students. Material and Methods: This observational study employed a census approach featuring a quantitative, descriptive, and analytical cross-sectional analysis. The research was conducted within a university center in northeastern Brazil from March to May 2021. Two questionnaires were administered: the Depression, Anxiety, and Stress Scale (DASS-21) and another survey focusing on sociodemographic factors. Pearson's chi-square test was employed to examine potential associations between the variables, and multiple logistic regression models were fitted, with a significance level set at 5%. Results: The study included 128 dentistry students, predominantly female, with a high monthly family income. The data revealed normal levels across the three DASS subscales. A significant association was observed between anxiety and sex (X2=10.37; p=0.03). The depression subscale exhibited associations with ethnic group (X2=47.46; p

Abstract In recent years, the number of works seeking to advance the geological and geotectonic knowledge of the Borborema Province has been increasing. However, in the context of the Southern Borborema Province there are few studies aimed at understanding its tectonic evolution in an integrated way. This work presents a review of the lithostratigraphic and geochronological data available for the Pernambuco-Alagoas, Riacho do Pontal and Faixa Sergipana Domains, located in the southern portion of the Borborema Province (Northeast Brazil), in addition to a discussion on the tectonic evolution model. The Southern Borborema Province fully encompasses the state of Alagoas and partially the states of Pernambuco, Sergipe, Bahia and Piauí, and is delimited to the north by the Pernambuco Lineament and to the south by the São Francisco Craton. The methodology involved bibliographical survey, geological cartography, geochronological compilation, creation of detrital zircon histograms for metasedimentary rocks (with unconformity below 10%) and magmatic “barcodes” for ortho-derived rocks and preparation of regional geological profiles. The tectonic evolution of the Southern Borborema Province began with the breakup of the Rodínia Supercontinent (1000 Ma) during the Cariris Velhos Cycle. The processes involved in the interaction of fragments descending from Rodinia are diachronic, in a broad scenario of accretions and collisions that resulted in the merger of Gondwana. The Pernambuco-Alagoas Block is considered a complex tectonic domain, which was affected by the Cariris Velhos (1000 – 950 Ma) and Brasiliana (740 - 570 Ma) orogenies (Caxito & Alkmim 2023), preserving remnants of Archean rocks (Riacho Seco Fragment) and proterozoic. The Riacho do Pontal Domain and the Faixa Sergipana Domain are part of a large folding system formed from the collision of the Pernambuco-Alagoas Domain with the São Francisco Craton, in a tangential deformation, vergent towards the craton, during the Brasiliana Orogeny. From the ages of the syncollisional granites we can infer that the orogenic event that gave rise to the aforementioned folded bands occurred at very close time intervals, presenting a slight diachronism. The article presents an integrated approach to tectonic evolution, however, the need for new studies is quite evident, with an emphasis on isotopic geology, geochronology, geochemistry and geological mapping that can contribute to the understanding of the processes involved in the formation of tectonic domains, their space-time relationships and their implications for the evolution of the Gondwana Continent.

Summary: Background: Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. Methods: A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. Findings: 3807 patients were included with a median age of 48 (IQR 32–64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien–Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68–12.76) and any complication (31.6%, 30.09–33.07). POMR stood at 1.9% (1.48–2.37), with elective and emergency surgery mortalities at 0.7% (0.40–1.23) and 3% (2.3–3.89) respectively. Interpretation: The POMR was higher than the ratio reported in previous national studies, even when patients had a low–risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. Funding: This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

Abstract Background There are limited population-representative data that describe the potential burden of Post-COVID conditions (PCC) in Mexico. We estimated the prevalence of PCC overall and by sociodemographic characteristics among a representative sample of adults previously diagnosed with COVID-19 in Mexico. We additionally, characterized the PCC symptoms, and estimated the association between diagnosed type-2 diabetes and hypertension with PCC. Methods We used data from the 2021 National Health and Nutrition Survey in Mexico, a nationally and regionally representative survey, from August 1st to October 31st, 2021. Using the WHO definition, we estimated the prevalence of PCC by sociodemographics and prevalence of PCC symptoms. We fit multivariable log-binomial regression models to estimate the associations. Results The prevalence of PCC was 37.0%. The most common persistent symptoms were fatigue (56.8%), myalgia or arthralgia (47.5%), respiratory distress and dyspnea (42.7%), headache (34.0%), and cough (25.7%). The prevalence was higher in older people, women, and individuals with low socioeconomic status. There was no significant association between hypertension and PCC or diabetes and PCC prevalence. Conclusions About one-third of the adult Mexican population who had COVID-19 in 2021 had Post-COVID conditions. Our population-based estimates can help assess potential priorities for PCC-related health services, which is critical in light of our weak health system and limited funding.

Abstract Effective antibody responses are essential to generate protective humoral immunity. Different inflammatory signals polarize T cells towards appropriate effector phenotypes during an infection or immunization. Th1 and Th2 cells have been associated with the polarization of humoral responses. However, T follicular helper cells (Tfh) have a unique ability to access the B cell follicle and support the germinal center (GC) responses by providing B cell help. We investigated the specialization of Tfh cells induced under type-1 and type-2 conditions. We first studied homogenous Tfh cell populations generated by adoptively transferred TCR-transgenic T cells in mice immunized with type-1 and type-2 adjuvants. Using a machine learning approach, we established a gene expression signature that discriminates Tfh cells polarized towards type-1 and type-2 response, defined as Tfh1 and Tfh2 cells. The distinct signatures of Tfh1 and Tfh2 cells were validated against datasets of Tfh cells induced following lymphocytic choriomeningitis virus (LCMV) or helminth infection. We generated single-cell and spatial transcriptomics datasets to dissect the heterogeneity of Tfh cells and their localization under the two immunizing conditions. Besides a distinct specialization of GC Tfh cells under the two immunizations and in different regions of the lymph nodes, we found a population of Gzmk+ Tfh cells specific for type-1 conditions. In human individuals, we could equally identify CMV-specific Tfh cells that expressed Gzmk. Our results show that Tfh cells acquire a specialized function under distinct types of immune responses and with particular properties within the B cell follicle and the GC.

BackgroundThe consumption of sugar-sweetened beverages (SSBs) is associated with obesity, metabolic diseases, and incremental healthcare costs. Given their health consequences, the World Health Organization (WHO) recommended that countries implement taxes on SSB. Over the last 10 years, obesity prevalence has almost doubled in Brazil, yet, in 2016, the Brazilian government cut the existing federal SSB taxes to their current 4%. Since 2022, a bill to impose a 20% tax on SSB has been under discussion in the Brazilian Senate. To simulate the potential impact of increasing taxes on SSB in Brazil, we aimed to estimate the price-elasticity of SSB and the potential impact of a new 20% or 30% excise SSB tax on consumption, obesity prevalence, and cost savings.Methods and findingsUsing household purchases data from the Brazilian Household Budget Survey (POF) from 2017/2018, we estimated constant elasticity regressions. We used a log-log specification by income level for all beverage categories: (1) sugar-sweetened beverages; (2) alcoholic beverages; (3) unsweetened beverages; and (4) low-calorie or artificially sweetened beverages. We estimated the adult nationwide baseline intake for each beverage category using 24-h dietary recall data collected in 2017/2018. Taking group one as the taxed beverages, we applied the price and cross-price elasticities to the baseline intake data, we obtained changes in caloric intake. The caloric reduction was introduced into an individual dynamic model to estimate changes in weight and obesity prevalence. No benefits on cost savings were modeled during the first 3 years of intervention to account for the time lag in obesity cases to reduce costs. We multiplied the reduction in obesity cases during 7 years by the obesity costs per capita to predict the costs savings attributable to the sweetened beverage tax. SSB price elasticities were higher among the lowest tertile of income (-1.24) than in the highest income tertile (-1.13), and cross-price elasticities suggest SSB were weakly substituted by milk, water, and 100% fruit juices. We estimated a caloric change of -17.3 kcal/day/person under a 20% excise tax and -25.9 kcal/day/person under a 30% tax. Ten years after implementation, a 20% tax is expected to reduce obesity prevalence by 6.7%; 9.1% for a 30% tax. These reductions translate into a -2.8 million and -3.8 million obesity cases for a 20% and 30% tax, respectively, and a reduction of $US 13.3 billion and $US 17.9 billion in obesity costs over 10 years for a 20% and 30% tax, respectively. Study limitations include using a quantile distribution method to adjust self-reported baseline weight and height, which could be insufficient to correct for reporting bias; also, weight, height, and physical activity were assumed to be steady over time.ConclusionsAdding a 20% to 30% excise tax on top of Brazil's current federal tax could help to reduce the consumption of ultra-processed beverages, empty calories, and body weight while avoiding large health-related costs. Given the recent cuts to SSB taxes in Brazil, a program to revise and implement excise taxes could prove beneficial for the Brazilian population.

There is a lack of consensus on how many and which are the Brazilian gold provinces and districts, and what are their limits or configurations. As an effort of the Geological Survey of Brazil to standardize this subject, we present a compilation of the Brazilian gold-bearing metallogenic/mineral provinces and districts, including those containing polymetallic gold-bearing deposits, and a digital file (shape file) with the design of their respective limits. Because many areas have classic definitions, and even though some of them do not meet the appropriate requirement for a strict definition, their classic names are maintained. However, we strongly suggest that the use of the term metallogenic (province, district), in a broader geotectonic sense, should be preferable in relation to mineral (province, district), which is more generic.

This study investigated the effect of low-dose aspirin in primary adult liver transplantation (LT) on acute cellular rejection (ACR) as well as arterial patency rates. The use of low-dose aspirin after LT is practiced by many transplant centers to minimize the risk of hepatic artery thrombosis (HAT), although solid recommendations do not exist. However, aspirin also possesses potent anti-inflammatory properties and might mitigate inflammatory processes after LT, such as rejection. Therefore, we hypothesized that the use of aspirin after LT has a protective effect against ACR. This is an international, multicenter cohort study of primary adult deceased donor LT. The study included 17 high-volume LT centers and covered the 3-year period from 2013 to 2015 to allow a minimum 5-year follow-up. In this cohort of 2365 patients, prophylactic antiplatelet therapy with low-dose aspirin was administered in 1436 recipients (61%). The 1-year rejection-free survival rate was 89% in the aspirin group versus 82% in the no-aspirin group (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.63-0.94; p = 0.01). The 1-year primary arterial patency rates were 99% in the aspirin group and 96% in the no-aspirin group with an HR of 0.23 (95% CI, 0.13-0.40; p

RESUMO Esta pesquisa apresenta o contexto do lixo, que pode transformar-se de problema em fonte de R$ 100 bilhões anuais gerados pela reciclagem de resíduos, melhoria da limpeza pública e maior afluxo de turistas no Brasil, segundo o Ministério da Indústria, do Comércio e do Turismo, e pela redução da violência, segundo o Banco Interamericano de Desenvolvimento, através da criação de oportunidades para a mão-de-obra pouco qualificada. Para tanto será imprescindível a coleta seletiva, que requer engajamento popular - cujas componentes são conscientização, incentivo e punição. Discute a Loteria da Coleta Seletiva, acompanhada por um processo de educação não-formal e legislação punitiva aos responsáveis por poluição - conforme propõe o MICT - como solução para acelerar a obtenção de resultados. O Projeto Teresópolis, de desenvolvimento de metodologia para a gestão integrada municipal, agregou a proposta e forneceu a base de dados para um estudo de caso.

Neste trabalho procuramos sobretudo salientar, no processo de circulação internacional de ideias e projetos de proteção e normalização da infância à margem e sua escolarização, o papel das viagens de docentes e outros responsáveis entre Portugal e o Brasil nos meados do século XIX até à década de 1930.. Salientaremos as visitas de estudo de professores/as brasileiros/as a Portugal e à Europa e de portugueses a países europeus e ao Brasil, e sua importância para a formação do professorado. Partimos de fontes primárias e de legislação, assim como de algum material icónico no campo educativo.Concluimos que os casos apresentados são apenas alguns dos que se conhecem e têm sido estudados, mas acreditamos que outros “passadores” de ideias se tenham movimentado nos dois lados do Atlântico.

Objetivo: Determinar la relación entre síndrome de burnout, ansiedad y depresión en trabajadores del área de la salud de un hospital de alta complejidad de Cúcuta en el año 2022. Metodología: Estudio de corte, con 285 participantes, profesionales en medicina general, médicos especialistas, enfermeras, auxiliares de enfermería, fisioterapeutas y camilleros. Se aplicó un cuestionario sociodemográfico, el inventario de Maslach de Burnout y la escala hospitalaria de ansiedad y depresión. Resultados: El 72,2 % de los casos de ansiedad obtuvo puntaje alto en agotamiento emocional; el 33,3 %, en despersonalización, y el 27,8 % tuvo puntuación baja en realización personal. Para depresión, el 83,5 % de los participantes presentaron puntuaciones altas en agotamiento emocional y el 66,7 % en despersonalización y realización personal. Los factores que aumentaron el riesgo de ansiedad fueron el agotamiento emocional (or = 5,64 ic = 3,45-9,17) y la baja realización personal (or = 0,42, ic= 0,23-0,66), mientras que para la depresión fueron el agotamiento emocional (or = 4,14, ic = 2,54-6,74) y la baja realización personal (or = 0,53, ic = 0,30-0,94). Conclusión: El agotamiento emocional estuvo relacionado con el riesgo de ansiedad y de la depresión. La realización personal fue un factor protector contra los síntomas de los trastornos emocionales. Este estudio permitió identificar que los ambientes hospitalarios laborales exigentes pueden afectar la salud mental del trabajador, por lo que se hace necesario plantear estrategias para reducir el riesgo y prevenir la aparición de enfermedades mentales.

Initial conditions can have a substantial impact on the behavior of iterative root-finding techniques for nonlinear equations. By allowing complex starting points and complex roots, it is possible to examine the basins of attraction in the complex plane in order to compare the performance of various iterative techniques. In this paper, a one-parameter family of third-order root-finding methods is studied by varying its parameter A within −2.0 and 2.4 and applying it to a polynomial equation of high degree (degree 25). This family includes the Euler–Chebyshev’s (A = 0), Halley’s (A = 1) and BSC (A = 2) techniques. According to the results, the one-parameter family provides the best performance for values near A = 1, which equals to the Halley’s method.

Resumo Dada a insuficiente evidência científica, decisões relativas à utilização de nutrição e hidratação artificiais em pacientes terminais configuram um importante dilema ético. Identifica-se um conflito entre as perspetivas de “tratar” e “cuidar”, com variação quanto a sua utilização conforme o contexto legal e cultural de diferentes países. O intuito deste estudo é esclarecer se essa prática constitui uma medida de cuidado básico ou um tratamento fútil e desproporcionado. Procede-se a uma revisão das diretrizes e dos códigos deontológicos de diferentes países europeus. Em Portugal, na Itália e na Polônia, tal prática é vista como uma medida de cuidado básico; já em países como França, Inglaterra, Noruega, Irlanda, Alemanha, Finlândia, Holanda, Bélgica e Suíça, é considerada um tratamento fútil. Na Romênia, na Croácia e na Hungria, verifica-se um enquadramento ético e legal insuficiente. As diferenças de abordagem a doentes terminais podem ser reflexo das diferentes perspetivas culturais.

Plastic production has increased over the years and the packaging industry was responsible for 44% of the total plastic production. Polyethylene terephthalate (PET), due to its favorable properties, is one of the most used polymers in this sector.This study first aimed to compare the environmental performance related to the production of a novel recycled PET (rPET) form, namely, rPET flake, and then compare it with the production of virgin PET (vPET) and rPET pellet. Secondly, this study aimed to compare the environmental impacts of four water bottles with different compositions, namely, option A composed with only vPET, option B made with 50% vPET and 50% rPET pellet, option C made with 75% rPET pellet and 25% rPET flake, and option D made with 50% vPET, 25% rPET pellet and 25% rPET flake. Option A was designed as a single-use water bottle, while the remaining options (Options B, C and D) were thought to be reusable bottles, and for that reason were heavier and more robust compared to Option A. The environmental impact assessment followed the International Standard Rules of Life Cycle Assessment (LCA), and the impact assessment method used was the Environmental Product Declaration. Ecoibéria and Logoplaste provided the majority of the required data, and three functional units were considered. The first one was the production of 1 kg of PET, the second was the production of different water bottles, and finally, the third one was the consumption of 2 l of water with different water bottles. As a result, it was first observed that the production of rPET flake in comparison to vPET reduces, on average, 79% of the impacts, and rPET pellet reduces 10% of the impacts. Secondly, in the production of the different water bottles, Option A, the single-use bottle, presented the lowest environmental impacts in almost all categories. Finally, when taking into account the reusable factor, the use of single-use bottles presented the higher environmental impact in all categories, probably because of the dilution of the environmental impacts associated with the production of heavier and robust reusable bottles by the multiple times of uses of these bottles.

This paper presents the conceptual underpinnings organized by a group of designers and design researchers for the creation of the Ecotopias Socioenvironmental Design Laboratory at PUC-Rio University. It begins by discussing the anthropogenic crisis, which the planet is currently facing, and the consequent design crisis. It also presents the field of design for sustainability, its transversality and eco-logic possibilities. It situates the process of constructing scenarios in this field as a methodological option for opening the imaginative and anticipatory potential of art and design to confront the planetary environmental crises and regenerate ecologies of the mind, social relations, and the environment. It describes the methodological steps of the scenario-building process derived from the project Sustainable Everyday, and, finally, it distinguishes the concepts of utopia and ecotopia.

Background Technology reduces the nursing workload, improve the quality care processes, patient’s safety, and avoid staff burnout. Innovative technologies are disrupting healthcare systems by improving the efficiency of processes and management. There is a discussion on the benefits, challenges, and barriers of these technologies and considering human factors of nursing management. The aim was to analyze the influence of technologies on the distribution of workload for nursing care management. Methods An integrative literature review was performed. Four databases were searched: Scopus, Scielo, PUBMED, and CINALH following PRISMA guidelines. Articles published from January 2016 to December 2020, published in English, Spanish and Portuguese were included. Studies were excluded when they were not original research, did not met the quality criteria or they did not answer the research questions. Quality appraisal was performed using the Crowe Critical Appraisal Tool version 1.4 (CCAT). Two reviewers independently examined the title and abstract for eligibility according to the inclusion and exclusion criteria. Results 2818 potentially relevant articles were found, but once the inclusion and exclusion criteria in the abstracts were analyzed, 177 remained for evaluation. After following the PRISMA Guidelines, 35 studies were included in the review. Three categories were identified: Nursing workload; Information technologies and technological means for management; Technology acceptance. Conclusions Technology has the potential to improve care management by estimating nurse workload in ICUs and non-critical units, but scientific evidence is more detailed in the former type of services. The literature provides insights about the factors that factors and the barriers that promote the technology acceptance and usability. We did not find studies comparing technologies and no scientific evidence proving improvements in care.

Head and neck cancer (HNC) patients submitted to radical chemoradiotherapy (CRT) have to deal with various physical and psychosocial problems related to cancer and its treatment, which negatively affect functional capacity and health-related quality of life (HRQoL). Thus, the aim of this work was to analyse the impact of an exercise prehabilitation (EP) program on the functional capacity and HRQoL in HNC patients. In this randomised-controlled trial (NCT05418842), 30 HNC patients proposed for radical CRT were randomly allocated to EP or usual care (UC) group. The EP group participated in an exercise program composed of a combined aerobic and resistance training program (60 minutes), three sessions/week, from randomisation to the beginning of radiotherapy (RT). Aerobic capacity (6-minute walk test, 6MWT), isometric handgrip muscle strength (dynamometer), lower limb functional capacity (30 seconds chair sit-to-stand test, STS) and HRQoL (EORTC QLQ-C30 and EORTC QLQ-HN43) were assessed at diagnosis (baseline, M0), and 1-3 days before starting RT (M1). Twenty-six patients completed both pre-treatment assessments, 12 in the EP (61.8±8.4 years, 91.7% men) and 14 in the UC (66.1±9.9 years, 92.9% men) group. The median length of the pre-treatment phase was 28 days (IQR, 24-28 days) and 29 days (IQR, 22-32 days) in EP and UC groups (p=0.786), respectively. Patients adhered on average to 66.3±34.9% of exercise sessions. No differences between groups were observed in any variable at baseline (M0). The 30 seconds STS performance improved with the EP program and remained unchanged in the UC group (EP: Δ4.4±4.6 vs UC: Δ0.1±2.5 repetitions, p=0.007). No differences between groups were observed for the change in the 6MWT (p=0.162); handgrip muscle strength (dominant hand: p=0.819; non-dominant hand, p=0.964); or any domain of HRQoL, except for body image (p=0.020) and dry mouth and sticky saliva (p=0.020) favouring the EP group. In the per-protocol analysis (i.e., adherence ≥80% of planned exercise sessions), changes in 30 seconds STS test remained significant (EP: Δ7.2±2.9 vs UC: Δ0.1±2.5 repetitions, p=0.009) while the 6MWT improved as compared in EP as compared to the UC group (EP: Δ44.7±31.5 vs UC: Δ-5.9±36.0 meters, p

Abstract We developed an algorithm to explore unexpected growth in the usage and costs of health technologies. We exploit data from the expenditures on technologies funded by the Colombian government under the compulsory insurance system, where all prescriptions for technologies not included in an explicit list must be registered in a centralized information system, covering the period from 2017 to 2022. The algorithm consists of two steps: an outlier detection method based on the density of the expenditures for selecting a first set of technologies to consider (39 technologies out of 106,957), and two anomaly detection models for time series to determine which insurance companies, health providers, and regions have the most notorious increases. We have found that most medicines associated with atypical behavior and significant monetary growth could be linked to the use of recently introduced drugs in the market. These drugs have valid patents and very specific clinical indications, often involving high-cost pharmacological treatments. The most relevant case is the Burosumab, approved in 2018 to treat a rare genetic disorder affecting skeletal growth. Secondly, there is clear evidence of anomalous increasing trend evolutions in the identified enteral nutritional support supplements or Food for Special Medical Purposes. The health system did not purchase these products before July 2021, but in 2022 they represented more than 500,000 USD per month.

Summary: Background: The underlying health status of populations was a major determinant of the impact of the COVID-19 pandemic, particularly obesity prevalence. Mexico was one of the most severely affected countries during the COVID-19 pandemic and its obesity prevalence is among the highest in the world. It is unknown by how much the COVID-19 burden could have been reduced if systemic actions had been implemented to reduce excess weight in Mexico before the onset of the pandemic. Methods: Using a dynamic epidemic model based on nationwide data, we compare actual deaths with those under hypothetical scenarios assuming a lower body mass index in the Mexican population, as observed historically. We also model the number of deaths that would have been averted due to earlier implementation of front-of-pack warning labels or due to increases in taxes on sugar-sweetened beverages and non-essential high-energy foods in Mexico. Findings: We estimate that 52.5% (95% prediction interval (PI) 43.2, 61.6%) of COVID-19 deaths were attributable to obesity for adults aged 20–64 and 23.8% (95% PI 18.7, 29.1%) for those aged 65 and over. Had the population BMI distribution remained as it was in 2000, 2006, or 2012, COVID-19 deaths would have been reduced by an expected 20.6% (95% PI 16.9, 24.6%), 9.9% (95% PI 7.3, 12.9%), or 6.9% (95% PI 4.5, 9.5%), respectively. If the food-labelling intervention introduced in 2020 had been introduced in 2018, an expected 6.2% (95% PI 5.2, 7.3%) of COVID-19 deaths would have been averted. If taxes on sugar-sweetened beverages and high-energy foods had been doubled, trebled, or quadrupled in 2018, COVID-19 deaths would have been reduced by an expected 4.1% (95% PI 2.5, 5.7%), 7.9% (95% PI 4.9, 11.0%), or 11.6% (95% PI 7.3, 15.8%), respectively. Interpretation: Public health interventions targeting underlying population health, including non-communicable chronic diseases, is a promising line of action for pandemic preparedness that should be included in all pandemic plans. Funding: This study received funding from Bloomberg Philanthropies, awarded to Juan A. Rivera from the National Institute of Public Health; Community Jameel, the UK Medical Research Council (MRC), Kenneth C Griffin, and the World Health Organization.

This is a cross-sectional study, with secondary data from Brazilian hospitals in the state of Paraíba, between January 2021 and January 2022. The evolution of clinical cases configured the dependent variable (cure or death), while the predictive variables were sociodemographic data, risk factors, use of ventilatory support, and vaccination against COVID-19. With the help of R software, the following tests were used: chi-square, Pearson’s chi-square, and Fisher’s exact adherence. Simple logistic regression models were constructed, and odds ratios (95% CI) were estimated using the LR test and Wald test. 7373 cases were reported, with a mean age of 58.1. Of the reported cases, 63.8% died. The most frequent sociodemographic profile included male people, of mixed race, with less than eight years of schooling. Chronic cardiovascular disease (OR 1.28; 95% CI: 1.13–1.45), diabetes (OR 1.41; 95% CI: 1.24–1.61), lung disease (OR 1.52; 95% CI: 1.11–2.09), and the use of invasive ventilatory support (OR 14.1; 95% CI: 10.56–18.59) were all associated with increased mortality. Nonvaccination was associated with a decreased risk of death (OR 0.74; 95% CI: 0.65–0.84). Male patients, nonwhite, and those with low education were more likely to have a worse clinical outcome. The risk factors studied were related to deaths, and those who did not require ventilatory support were related to cure.

La amiloidosis cardiaca es una enfermedad que se caracteriza por el depósito de material amiloide en la matriz extracelular del miocardio. Las arritmias son parte del amplio espectro de la enfermedad, de las cuales la fibrilación auricular (FA) es la más frecuente de todas. Debido a la heterogeneidad de la amiloidosis cardiaca, su incidencia real es desconocida, con lo que se denota un subdiagnóstico y en muchos casos estando oculta bajo la presentación de una enfermedad cardiaca habitual, lo que conlleva a una progresión silente de la misma y peores desenlaces. Se describe el caso clínico de un paciente con FA refractaria a cardioversión eléctrica y terapia ablativa en el contexto de amiloidosis cardiaca por transtirretina (ATTR) inicialmente inadvertida y descubierta como hallazgo incidental. El propósito de este reporte es revisar la asociación entre FA y ATTR, su epidemiología, fisiopatología, manifestación clínica, diagnóstico y tratamiento con el fin de ofrecer al personal médico herramientas para un diagnóstico oportuno de una enfermedad poco reconocida.

In order to make an informed, evidence-based decision, it is vital to recognize numbers, statistics and concepts that are apparently transparent but are not always adequately accounted for. Health professionals, patients, and others frequently misinterpret numbers, statistics and concepts in healthcare. Among the many repercussions of health literacy, appropriate decision-making and the reduction in the number of interventions and treatments stand out, resulting in an improvement in people's health and a decrease in overtreatment and health expenses. This study intends to evaluate how properly health professionals and the public, in general, comprehend and interpret some health-related numbers. To accomplish this goal, the researchers shared a questionnaire made available online in Portugal from January 2, 2019, until April 12, 2019. The final sample comprised 485 respondents; 154 physicians, 142 nurses, and 189 people from other professions. The findings suggest that there is a problem with widespread numerical illiteracy, which should not be the case, highlighting the need to improve the numerical and statistical health literacy of both health professionals and the general population. So, medical professionals and patients must thus comprehend the statistics and health-related concepts to obtain the proper consent.

Pregnancy increases metabolic demand for insulin and may lead to the exhaustion of intraportally transplanted islets and post-gestational hyperglycemia. To prevent these complications, we implemented preemptive insulin supplementation during two subsequent pregnancies in an insulin-independent islet transplant recipient. This strategy resulted in optimal blood glucose control during the pregnancies, the preservation of the optimal islet graft function and the postpartum maintenance of long-term insulin independence.

Renato Correia Barbosa, Rita Gonçalves, Ricardo Bastos, Sara Alves Pereira, Rita Basto, Ana Rita Viana, Paula Tenedório Ophthalmology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, PortugalCorrespondence: Renato Correia Barbosa, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Rua Dr. Eduardo Torres, Matosinhos, 4464-513, Portugal, Email renato-barbosa@sapo.ptIntroduction: Glaucoma is the second leading cause of vision loss worldwide. The reduction of intraocular pressure remains the backbone of its therapy. Among surgical techniques for its treatment, deep non-penetrating sclerotomy is the most widely practiced non-penetrating surgery. The purpose of this study was to evaluate the long-term efficacy and safety of deep non-penetrating sclerotomy compared to standard trabeculectomy in patients with open-angle glaucoma.Patients and methods: Retrospective study including 201 eyes with open-angle glaucoma. Closed-angle and neovascular cases were excluded. Absolute success was considered when intraocular pressure under 18 mmHg, or a reduction of at least 20% in patients with a baseline intraocular pressure below 22 mmHg, was obtained after 24 months, without the use of medication. Qualified success was considered when those targets were met with or without the use of hypotensive medication.Results: Deep non-penetrating sclerectomy showed a slightly lower long-term hypotensive effect compared to standard trabeculectomy, with significant differences at 12 months, but not at 24 months of follow-up. The absolute and qualified success rates were 51.85% and 65.43% for the trabeculectomy group and 50.83% and 60.83% for the deep non-penetrating sclerectomy, without significant differences. Regarding postoperative complications, mainly due to postoperative hypotonia, or related to the filtration bleb, they were significantly different between groups, with 10.8% and 24.7%, in deep-nonpenetrating sclerectomy and trabeculectomy groups, respectively.Conclusion: Deep non-penetrating sclerectomy seems to be an effective and safe surgical option for patients with open-angle glaucoma unable to be controlled by non-invasive strategies. Data suggests that the intraocular pressure-lowering effect of this technique may be marginally lower than that of trabeculectomy, but the achieved efficacy outcomes were similar, with a significantly lower risk of complications.Keywords: glaucoma, intraocular pressure, filtering surgery, trabeculectomy

This study aimed to explore the effect of FM substitution by defatted Tenebrio molitor larvae meal (dTM) on the response of European seabass to an acute stress challenge. An FM-based diet was used as a control and two other isoproteic/isoenergetic diets were formulated to replace 50 and 100% of FM by dTM. Each diet was tested in quadruplicate groups of 15 fish (69 ± 5 g) fed until visual satiety for 16 weeks. After the feeding trial, fish were subjected to 1 min air exposure followed by 1 h of recovery before sampling. The haematological profile, plasma metabolites, and humoral immunity biomarkers, as well as hepatic oxidative stress and antioxidant capacity, were analysed. A clear response to acute stress was observed by a significant increase in haemoglobin, haematocrit, red blood cells, and almost all evaluated plasma metabolites and humoral parameters, regardless of dietary treatment. The obtained results demonstrated that partial substitution of FM by IM did not affect the stress response of seabass. However, total FM replacement increased the hepatic activity of total peroxidase and superoxide dismutase in fish fed TM100.

Abstract Using a dataset of 591 capture events between 2001–2019 in California, USA, we examined the impact of capture methods and immobilization drugs on mountain lion (Puma concolor) welfare. The 3 methods used to capture mountain lions were cage traps, trained hounds, and cable restraints. The drugs used to immobilize mountain lions were either tiletamine/zolazepam (Telazol®), ketamine/medetomidine, or ketamine/xylazine. Mortality occurred in 1.4% of captures, with only one mortality out of 310 captures occurring since 2012. We used a logistic regression framework to compare morbidity and vital parameters of mountain lions among the different capture methods and immobilization drugs used. Vomiting (a risk factor for developing aspiration pneumonia) was the most common severe risk factor associated with cage trapping and was only seen with the use of ketamine/medetomidine or ketamine/xylazine. Morbidity scores were not well predicted by any of the variables we accounted for. Animals immobilized with Telazol® were more likely to experience abnormal heart and respiratory rates, as well as high body temperatures, than those immobilized with the other two combinations. Although there are risks associated with each of the capture methods and drug combinations commonly used in mountain lion captures in California, our analyses demonstrated they are all relatively safe when following appropriate animal welfare practices. Our analyses suggested that unaccounted for factors are equally or more important in explaining injury and physiological abnormality rates, and we urge that agencies train personnel in best practices and conservative decision‐making in order to assure that the welfare of the animal takes precedence over collaring. We suggest training on how to choose between several capture techniques, immobilization drugs and monitoring methods and how to reduce both detrimental effects to mountain lions and danger to humans.