Search

In this work the synthesis by thermal evaporation and optical characterization of the semiconductor thin film lead bromide (PbBr2) is reported, discussing its possible applicability in attenuation of UV radiation and ionizing radiation. In order to show the quality of the samples and their possible application, a series of experimental studies was carried out by means of X-ray diffraction that allowed establishing the crystallinity of the samples and scanning electron microscopy for the study of surface morphology, evidencing a high degree of film coating. Diffuse reflectance and transmittance spectroscopy experiments were used to study the optical properties of the material, finding a weakly semiconductor optical gap of 3.5 eV, which absorbs much of the radiation from a broad spectrum of ultraviolet, from 200 to 350 nm. The high value of the Pb atomic number favors the absorption of high-energy photons, and the mass absorption coefficient as well as the appearance of a doublet of transitions in the PL spectrum in the UV radiation regime, suggest the applicability of PbBr2 in the design of medical diagnostic and treatment equipment that involves ionizing radiation. Additionally, high transparency of the thin film was found as corroborated by the extinction coefficient, which could be useful for applications in microelectronic devices.

Objective:To quantify the energy, nutrients-to-limit and total gram amount consumed and identify their top food sources consumed by Latin Americans.Design:Data from the Latin American Study of Nutrition and Health (ELANS).Setting:ELANS is a cross-sectional study representative of eight Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela.Participants:Two 24-h dietary recalls on non-consecutive days were used to estimate usual dietary intake of 9218 participants with ages between 15–65 years. ‘What We Eat in America’ food classification system developed by United States Department of Agriculture was adapted and used to classify all food items consumed by the ELANS population. Food sources of energy, added sugars, SFA, Na and total gram amount consumed were identified and ranked based on percentage of contribution to intake of total amount.Results:Three-highest ranked food categories of total energy consumed were: rice (10·3%), yeast breads (6·9%), and turnovers and other grain-based items (6·8 %). Highest ranked food sources of total gram amount consumed were fruit drinks (9·6%), other 100% juice (9·3%) and rice (8·3%). Three highest ranked sources for added sugars were other 100% juice (24·1 %), fruit drinks (16·5%), and sugar and honey (12·4%). SFA ranked foods were turnovers and other grain-based (12·6 %), cheese (11·9%), and pizza (10·3%). Three top sources of Na were rice (13·9%), soups (9·1 %) and rice mixed dishes (7·3 %).Conclusion:Identification of top sources of energy and nutrients-to-limit among Latin Americans is critical for designing strategies to help them meet nutrient recommendations within energy needs.

As the features of microprocessors are miniaturized, low-dielectric-constant (low-k) materials are necessary to limit electronic crosstalk, charge build-up, and signal propagation delay. However, all known low-k dielectrics exhibit low thermal conductivities, which complicate heat dissipation in high-power-density chips. Two-dimensional (2D) covalent organic frameworks (COFs) combine immense permanent porosities, which lead to low dielectric permittivities, and periodic layered structures, which grant relatively high thermal conductivities. However, conventional synthetic routes produce 2D COFs that are unsuitable for the evaluation of these properties and integration into devices. Here, we report the fabrication of high-quality COF thin films, which enable thermoreflectance and impedance spectroscopy measurements. These measurements reveal that 2D COFs have high thermal conductivities (1 W m−1 K−1) with ultra-low dielectric permittivities (k = 1.6). These results show that oriented, layered 2D polymers are promising next-generation dielectric layers and that these molecularly precise materials offer tunable combinations of useful properties. Low-k dielectric materials are essential to allow continued electronics miniaturization, but their low thermal conductivity limits performance. Here, two-dimensional covalent organic frameworks are shown to combine high thermal conductivity with a low dielectric constant.

Despite enormous research efforts, the genetic component of longevity has remained largely elusive. The investigation of common variants, mainly located in intronic or regulatory regions, has yielded only little new information on the heritability of the phenotype. Here, we performed a chip-based exome-wide association study investigating 62 488 common and rare coding variants in 1248 German long-lived individuals, including 599 centenarians and 6941 younger controls (age < 60 years). In a single-variant analysis, we observed an exome-wide significant association between rs1046896 in the gene fructosamine-3-kinase-related-protein (FN3KRP) and longevity. Noteworthy, we found the longevity allele C of rs1046896 to be associated with an increased FN3KRP expression in whole blood; a database look-up confirmed this effect for various other human tissues. A gene-based analysis, in which potential cumulative effects of common and rare variants were considered, yielded the gene phosphoglycolate phosphatase (PGP) as another potential longevity gene, though no single variant in PGP reached the discovery p-value (1 × 10E−04). Furthermore, we validated the previously reported longevity locus cyclin-dependent kinase inhibitor 2B antisense RNA 1 (CDKN2B-AS1). Replication of our results in a French longevity cohort was only successful for rs1063192 in CDKN2B-AS1. In conclusion, we identified 2 new potential candidate longevity genes, FN3KRP and PGP which may influence the phenotype through their role in metabolic processes, that is, the reverse glycation of proteins (FN3KRP) and the control of glycerol-3-phosphate levels (PGP).

To produce functional active layers for photodetector devices, thin films of organic–inorganic CH3NH3PbI3 perovskite semiconductor have been grown by a close-space sublimation procedure and a hybrid dipping technique. x-Ray diffraction analysis was used to evaluate the crystalline quality of the thin films, confirming the achievement of a tetragonal structure of perovskite type in space group I4/mcm. Morphological analysis by scanning electron microscopy revealed a homogeneous and compact granular surface distribution. Kubelka–Munk analysis of the optical response measured by ultraviolet–visible (UV–Vis) spectrophotometry yielded an energy bandgap of 1.57 eV for the thin films produced by the close-space sublimation technique and 1.59 eV for those obtained by dipping. Photoluminescence experiments corroborated these bandgap values. The I–V characteristics of both thin films obtained at different incident laser powers and a wavelength of 650 nm demonstrated their potential for use as active layers in photodetector devices.

Introduction Several studies have reported increased cardiometabolic risk among workers assisted by food assistance public policies. The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) and its individual components among manufacturing workers and their relationship to the Brazilian Workers' Food Program (WFP). Methods It was a prospective, cross-sectional, two-stage survey comparative of manufacturing workers from companies adherent and non-adherent to the WFP stratified by sector of activity and company size. The workers were interviewed in the workplace, and data on waist circumference (WC), blood pressure, and 12-hours fasting blood glucose (FBG), serum triglycerides (TG), and total and HDL-cholesterol were obtained. Mixed effects multilevel regression was used to compare WFP and non-WFP groups separately in each sex. All subjects gave written informed consent. Results The survey included 332 workers from 16 WFP companies and 344 workers from 17 non-WFP companies. The general prevalence of MetS, according to IDF/AHA/NHLBI criteria, was high but not statistically different between sexes (39.8% in females versus 28.5% for males, p=0.16). Statistically significant differences were found between sexes in the prevalence of individual components: WC (77.8% in females versus 38.3% in males, p=0.002), TG (27.3% in females versus 40.8% in males, p=0.07), and HDL-C (52.2% in females versus 43.1% in males, p=0.05). Among males, MetS prevalence was significantly higher in the WFP group (33.0% versus 23.9%, p=0.008), and, in the individual components, the WFP group had higher prevalence of increased WC (47.0% versus 29.4%, p

Objectives Mindfulness-Based Cognitive Therapy (MBCT) is a novel treatment for depression. Our published randomized controlled trial shows that MBCT improves symptoms of late-life depression (LLD) and anxiety (LLA). We now examine whether continuation sessions of MBCT (MBCT-C) can prevent LLD/LLA symptom recurrence. Methods/design Following an 8-week MBCT intervention, we compared patients who attended open-label weekly 1-hour MBCT-C for another 26 weeks (n = 10) vs those who did not (n = 17) for change in depressive and anxiety symptoms. Results While there were no significant differences between groups on depressive or anxiety symptom severities between 8- and 34- weeks (Cohen's d = 0.045), we observed a small clinical effect of MBCT-C on symptoms of anxiety (d = 0.29). Conclusions These preliminary results suggest that MBCT-C may be somewhat beneficial for symptoms of LLA, but not for LLD. Healthcare providers should consider what is clinically feasible before investing time and resources into MBCT-C in older adults with depression and/or anxiety. This article is protected by copyright. All rights reserved.

Outcomes for patients with metastatic colorectal cancer (mCRC) have been improved by the identification of biomarkers predictive and prognostic of clinical outcome. The present retrospective analysis was undertaken to assess the utility of key biomarkers and clinical parameters in predicting outcomes in Spanish patients with mCRC. We retrospectively analyzed tumor samples from a series of patients aged > 18 years with mCRC who were treated at the Hospital General Universitario Gregorio Maranon Spain. Real-time polymerase chain reaction was used to detect KRAS, NRAS, BRAF, and PIK3CA mutations. The key outcome of interest was overall survival (OS). Survival curves were estimated using the Kaplan–Meier method and stratified by the variables of greatest clinical interest. Differences were tested using the log-rank test. Median OS in the overall population was 24.4 months. Triple WT patients (WT KRAS, NRAS, and BRAF) and quadruple WT patients (WT KRAS, NRAS, BRAF, and PIK3CA) had significantly better OS than those who did not have triple or quadruple WT tumors. OS was significantly better in patients with left- vs. right-sided tumors, patients with resected primary tumors and metastases vs. those without resection, and patients with isolated hepatic and isolated pulmonary metastases. This retrospective, observational study has confirmed the prognostic value of the location and resection status of the primary tumor and metastases in Spanish patients with mCRC. Triple WT status, in particular, was prognostic in this patient population, with PIK3CA adding to the prognostic value in the quadruple WT population.

The response of marine predators to global climate change and shifting ocean conditions is tightly linked with their environment and prey. Environmental data are frequently used as proxies for prey availability in marine predator distribution models, as the ephemeral nature of prey makes sampling difficult. For this reason, the functional, ecological links between environment, prey, and predator are rarely described or explicitly tested. We used 3 years of vessel-based whale survey data paired with oceanographic sampling and hydroacoustic backscatter to model trophic relationships between water column structure, krill availability, and blue whaleBalaenoptera musculus brevicaudadistribution in New Zealand’s South Taranaki Bight region under typical (2014 and 2017) and warm (2016) austral summer oceanographic regimes. The warm regime was characterized by a shallower mixed layer, and a stronger, thicker, and warmer thermocline. Boosted regression tree models showed that krill metrics predicted blue whale distribution (typical regime = 36% versus warm regime = 64% cross-validated deviance explained) better than oceanography (typical regime = 19% versus warm regime = 31% cross-validated deviance explained). However, oceanographic features that predicted more krill aggregations (typical regime) and higher krill density (warm regime) aligned closely with the features that predicted higher probability of blue whale presence in each regime. Therefore, this study confirms that environmental drivers of prey availability can serve as suitable proxies for blue whale distribution. Considering changing ocean conditions that may influence the distribution of marine predators, these findings emphasize the need for models based on functional relationships, and calibrated across a broad range of conditions, to inform effective conservation management.

Endotracheal intubation in rats is challenging due to the difficult anatomical characteristics of the airway. The success rate at first attempt is low and airway damage is a common complication. We aimed to compare and evaluate the conventional intubation method with a modified procedure using an inclined plate, headlamp (700-Lumen), and 3D mouth-piece designed with a 20° curvature. Both techniques were conducted by laboratory personnel with and without previous experience in airway management of laboratory rats.In this study, we used 36 Wistar rats of both genders. Three groups of laboratory personnel (anesthesiologists, medical students, and laboratory technicians) performed both endotracheal intubation techniques, i.e., blind intubation at supine position and endotracheal intubation at 70° supine position with a 3D mouth-piece and direct illumination of the glottis.The modified technique had a significantly higher success rate and shorter procedure duration. Moreover, there was no significant difference in the procedure duration between personnel with and without previous training in airway management.Previous knowledge and experience in airway management are required when performing conventional endotracheal intubation; moreover, its success rate is low. Contrastingly, using proper instruments and the 3D mouth-piece facilitated easier and quicker airway management regardless of previous experience.

Computational fluid dynamics is applied to reproduce the characteristics of the liquid methanol burner presented by the National Institute of Standards and Technology (NIST). Reynolds avera...

Asparaginase (ASNase) is a widely applied chemotherapeutic drug that is used to treat Acute Lymphoblastic Leukemia (ALL); however, immune responses and silent inactivation of the drug often limit its bioavailability. Many strategies have been proposed to overcome these drawbacks, including the development of improved formulations (biobetters), but only two of them are currently on the market. Nano- and micro-encapsulation are some of the most promising and novel approaches to enhance in vivo performance of ASNase, preventing the direct contact of the enzyme with the environment, protecting it from protease degradation, increasing the enzymes catalytic half-life, and in some cases, reducing immunogenicity. This review summarizes the strategies, particularly for ASNase nano- and micro-encapsulation, and their main findings, constraints, and current gaps in the state-of-the-art knowledge. The pros and cons of the use of different nanocarriers are discussed with the idea to ultimately provide safer and more effective treatments for patients with ALL.

(1) Objective: to determine if a brief mindfulness intervention (BMI) and a health education program (HEP) could improve measures of insomnia in patients undergoing hemodialysis. (2) Methods: this was a planned secondary analysis of a randomized controlled trial of BMI vs. HEP for hemodialysis patients with depression and/or anxiety symptoms. The primary outcome for the analysis was the Athens Insomnia Scale (AIS). The secondary outcome was consolidation of daily inactivity (ConDI), an actigraphy measure that describes sleep continuity and is based on a sleep detection algorithm validated by polysomnography. We also explored whether changes in AIS and ConDI were associated with changes in depression, anxiety, and quality of life scores over 8-week follow-up. (3) Results: BMI and HEP groups did not differ significantly from one another. Exposure to BMI or HEP improved sleep quality (baseline AIS 9.9 (±5.0) vs. 8-week follow-up 6.4 (±3.9), (V = 155.5, p = 0.015)), but not ConDI. Improvements in AIS were associated with lower depression scores (Rho = 0.57, p = 0.01) and higher quality-of-life scores (Rho = 0.46, p = 0.04). (4) Conclusions: mindfulness and HEP may be helpful interventions to improve self-reported sleep quality in patients undergoing hemodialysis. Decreases in insomnia scores were associated with decreased depression symptoms and increased quality of life scores.

The way that diversity, equity, and inclusion impact scientific careers varies for everyone, but it is evident that institutions providing an environment where being different or having differences creates a sense of being welcomed, supported, and valued are beneficial to the scientific community at large. In this commentary, three short stories from Texas-based microbiologists are used to depict (i) the importance of bringing the guiding principles of diversity, equity, and inclusion within their professional roles, (ii) the need to apply and translate those principles to support and enable successful scientific careers among peers and trainees, and (iii) the impact of effective science communication to increase the understanding of microbial environments among the community at large.

Background Approximately 25% of patients with untreated Kawasaki disease (KD) in childhood develop coronary aneurysms, which represent a higher likelihood for the occurrence of acute myocardial infarction (AMI) in young adults. Although the clinical characteristics of young adults with KD and suspected ischemia have been studied, the available data about suggestive lesions of KD in AMI is scarce. Purpose To describe the prevalence, clinical characteristics and in-hospital mortality of young adults with AMI and coronary artery lesions suggestive of KD. Methods We conducted a retrospective study of consecutive ≤40-year old patients hospitalized with AMI and coronary angiography in a coronary care unit of a Mexican teaching hospital between 2006–2020. Patients were classified according to the presence or absence of suggestive lesions of KD sequelae such as proximal aneurysms, larger size and normal distal segments Results There were included 488 patients of 40 years of age and younger, diagnosed with AMI, in whom a coronary angiography was performed. Among them, 44 patients (9%) showed coronary aneurysm or ectasia, within this group, 16 patients (36.3%) had angiographic lesions compatible with KD. The patients were classified according to the type of coronary lesions: Angiographic lesions compatible with KD, 3.3% (n=16); Diffuse coronary artery ectasia (CAE), 5.7% (n=28); and Obstructive coronary disease (OCD), 91% (n=444). The prevalence of smoking, dyslipidemia, and hypertension were similar between the groups, whereas a history of diabetes was absent in KD patients (0%, 10.7%, and 22.1% for KD, CAE and OCD, respectively; P=0.04). At admission, ST-elevation myocardial infarction was more frequent in patients with KD (81.3%, 75%, and 67.1% for KD, CAE and OCD, respectively; P=0.35). More than half of patients with KD had coronary aneurysms in two or more vessels. The right coronary artery was the most commonly affected artery followed by the left anterior descending artery and left circumflex coronary artery (87.5%, 56.3% and 56.3%, respectively). The presence of intracoronary thrombus identified at the time of angiography was more frequent in patients with KD (62.5%, 60.7% and 44.1% for KD, CAE and OCD, respectively; P=0.09). Overall, unadjusted in-hospital mortality was 3.9% and there were no deaths in the KD group (0%, 0% and 4.3% for KD, CAE, and OCD, respectively; P=0.37). Conclusion In young patients with AMI, the sequelae of KD should be considered as a possible etiology, based on their angiographic characteristics. To bear in mind the nature of the pathogenesis is crucial to assess medical and interventional management strategies, which are not well defined yet, in order to evaluate cardiovascular risk and optimize a patient-tailored treatment, which could differ from the treatment of atherosclerotic coronary artery disease Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

African pygmy hedgehogs ( Atelerix albiventris) frequently develop oral neoplasms, and most of these neoplasms are malignant. We characterized oral masses detected in hedgehogs at clinical examination. During a 1-y period, we diagnosed oral cavity masses in 27 privately owned hedgehogs; 16 were female and 11 were male, with ages of 2–7 y (mean: 4.3 y). Eight masses were non-neoplastic and were diagnosed as gingival hyperplasia (GH). Nineteen masses were neoplastic, of which 17 were squamous cell carcinomas (SCCs) and 2 were mesenchymal tumors (1 spindle cell tumor of probable neural origin, and 1 hemangiosarcoma). The GHs were noninvasive, exophytic, and did not recur after surgical excision. The SCCs were highly invasive tumors that induced facial deformation and were located in the caudal portion of the oral cavity, with 12 of them arising from the right-caudal maxilla. Thus, clinical signs, growth pattern, and anatomic location can be used to suspect a diagnosis of SCC among the other possible diagnoses, such as GH, in this location. However, histopathology is necessary for confirmation. Also, hemangiosarcoma should be considered among the differential diagnoses.

Introduction: Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. Aim: To present a consensus review based on evidence regarding the definition, epidemiology, pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. Methods: Three general coordinators carried out a literature review of all articles published in English and Spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: (i) definitions, epidemiology, and pathophysiology; (ii) diagnosis, and (iii) treatment. The statements underwent 3 rounds of voting, utilizing the Delphi system. The final statements were those that reached > 75% agreement, and they were rated utilizing the GRADE system. Results and conclusions: The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4 weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy. Resumen: Introducción: Dolor torácico no cardíaco (DTNC) se define como un síndrome clínico caracterizado por dolor retroesternal semejante a la angina de pecho, pero de origen no cardiaco y generado por enfermedades esofágicas, osteomusculares, pulmonares o psiquiátricas. Objetivo: Presentar una revisión consensuada basada en evidencias sobre definición, epidemiología, fisiopatología, diagnóstico y opciones terapéuticas para pacientes con DTNC. Métodos: Tres coordinadores generales realizaron una revisión bibliográfica de todas las publicaciones en inglés y español sobre el tema y elaboraron 38 enunciados iniciales divididos en tres categorías principales: 1) definiciones, epidemiología y fisiopatología; 2) diagnóstico, y 3) tratamiento. Los enunciados fueron votados (3 rondas) utilizando el sistema Delphi, y los que alcanzaron un acuerdo > 75% fueron considerados y calificados de acuerdo con el sistema GRADE. Resultados y conclusiones: El consenso final incluyó 29 enunciados Todo paciente que debuta con dolor torácico debe ser inicialmente evaluado por un cardiólogo. La causa más común de DTNC es la enfermedad por reflujo gastroesofágico (ERGE). Como abordaje inicial, si no existen síntomas de alarma, se puede dar una prueba terapéutica con inhibidor de bomba de protones (IBP) por 2-4 semanas. Si hay disfagia o síntomas de alarma, se recomienda hacer una endoscopia. La manometría de alta resolución es el mejor método para descartar trastornos motores espásticos y acalasia. La pHmetría ayuda a demostrar exposición esofágica anormal al ácido. El tratamiento debe ser dirigido al mecanismo fisiopatológico, y puede incluir IBP, neuromoduladores y/o relajantes de músculo liso, intervención psicológica y/o terapia cognitiva, y ocasionalmente cirugía o terapia endoscópica. Keywords: Pain, Chest, Non-cardiac, GERD, Esophageal motor disorders, Mexico, Palabras clave: Dolor, Torácico, No cardíaco, ERGE, Trastornos motores esofágicos, México

Introduction We expect that in the next 25 years, the population aged older than 65 will nearly double in the Unites States and Canada and other developing countries alike. This age group will require an increased amount of health care with increasing psychiatric, cognitive and medical complexity. However, there are few new incoming doctors wishing to care for older adults as part of their general medical practice, or to specialize in geriatric psychiatry or geriatric medicine. We hypothesize that early clinical exposure to elderly patients’ care could increase students’ interest in caring for older adults during their future career. Methods We conducted a pragmatic medical education randomized controlled trial at the Jewish General Hospital and the Douglas Mental Health Institute, McGill University in Montreal, Canada. 3rd year Medical students undergoing their mandatory 16-week half-time clerkship rotation in psychiatry were randomized to the equivalent of 2-4 weeks full-time exposure to clinical geriatric psychiatry (n=84). The main outcome measured was change in “interest in caring for older adults as part of your future practice” at the end of the mandatory psychiatry clerkship rotation. The secondary outcomes were change in “interest in becoming a geriatric psychiatrist” and change in “comfort in working with geriatric patients and their families”. We compared the intervention and control groups for demographic and other potentially confounding variables using the Chi-Squared Test and we examined bivariate associations between exposure to geriatric psychiatry and interest in caring for older adults using Chi-Square and the Mann-Whitey-U tests. Results Being randomized to geriatric psychiatry exposure (n=44/84) was associated with increased “comfort in working with geriatric patients and their families” at a 16-week follow-up (χ2 (1) =3.9, p=0.05) but there was no significant association found between geriatric psychiatry exposure and change “in interest in caring for older adults” (χ2 (1) =0.3, p=0.6), or change in “interest in becoming a geriatric psychiatrist” (χ2 (1) =0.2, p=0.7). Conclusions The results of this pragmatic geriatric psychiatry education RCT suggest that exposing 3rd year medical students to 2-4 weeks of geriatric psychiatry did not increase their interest to care for older adults in their future medical career or did not make them want to become a geriatric psychiatrist. However, it did increase their comfort level in working with older adults and their families, an important established predictor in the literature for choosing a medical career with patients 65 years and over. We believe these RCT results will help inform the design of medical school curricula in preparation for an increasingly again population in America and worldwide. However, more research is necessary to decorticate and identify potential co-synergic variables that would inspire and increase medical students’ interest in caring for older adults as part of their future careers. This research was funded by This project was supported by Charitable Donations to the Jewish General Hospital, as well as the Canadian Institutes of Health Research Fellowship Award. Dr. Rej is supported by a Fonds de Recherche Sante Quebec (FRQS) Clinician-Scientist Award and has investigator-initiated grant funding from Satellite Healthcare (dialysis company) for an unrelated project.

Objetive To evaluate Neosaxitoxin (NeoSTX) as a local anesthetic drug, for pain control during and after piglet castration. Study design Prospective, randomized and double-blind study. Animals 24 commercial hybrids, males, 23-day-old piglets. Methods The piglets were randomized into two groups: a Lidocaine group and a NeoSTX group. One minute before castration, they were injected intra-scrotally with a single dose of Lidocaine (20 mg, in 1 mL) and NeoSTX (0.1 μg, in 1 mL), respectively. Results NeoSTX does not generate vasoconstriction or scrotal contraction, unlike Lidocaine, where a decrease in temperature and scrotal size is observed within 5 min after the procedure. After 24 h, wound inflammation, as measured by scrotal size, was lower in the NeoSTX group. No significant difference could be shown between the vocalizations and facial expressions of pain of both groups during the castration procedure. Conclusions A single dose of NeoSTX is safe and effective for pain management during and after piglet castration. NeoSTX treated piglets were less affected by castration than those in the Lidocaine group, thus reducing piglet stress and enhancing the quality of piglet convalescence.

Physiological measures, such as blood variables, are commonly used to assess the welfare state of animals. The basal concentration of indicators such as plasma cortisol, white blood cells, cytokines, and indicators of oxidative stress could vary depending on the coping style of individuals. In the case of horses, coping styles could be associated to the activity they perform because owners seek different behavioral characteristics. The aim of this study was to compare blood variables frequently used to assess welfare, between urban working horses and Chilean rodeo horses, and secondly to determine if horses could be classified according to activity and blood variable characteristics associated to coping styles (proactive and reactive). A total of 204 horses were sampled and 13 blood variables were assessed. K-means clusters analysis was used to classify horses in two groups. Significant differences between working horses and Chilean rodeo horses were found for nine of the 13 variables studied. Two clusters were formed; cluster 1 grouped most working horses and is characterized by a higher concentration of cortisol, leukocytes (mainly lymphocytes), and carbonyl groups. On the other hand, cluster 2 groups most rodeo horses and is characterized by horses with lower cortisol concentrations, but a higher antioxidant capacity. Further studies are required to assess if owners are selecting horses by coping style according to the activity they perform (rodeo or draft work) and how these physiological characteristics should be considered when assessing their welfare state.

Many cetacean species are at risk from anthropogenic disturbances including climate change, pollution, and habitat degradation. Identifying cetacean hotspots for conservation management is therefore required. Aotearoa–New Zealand waters are used by 53% of the world’s cetacean species and are a global cetacean diversity hotspot. Using geographic predictions of cetacean taxa, we aimed to identify important areas within New Zealand waters using two methods: estimates of cetacean richness and a spatial prioritization analysis. For both methods, we investigated how varying levels of uncertainty in predictions of the taxa’ occurrence layers would affect our interpretation of cetacean hotspots. Despite some marked spatial differences in distribution of important areas for cetacean diversity, both methods, across all uncertainty scenarios, highlighted six distinct deep offshore regions as important habitat. Generally, inshore areas had lower richness estimates than offshore areas, but these remain important for conservation for species with limited ranges (e.g., the endemic Māui and Hector’s dolphins), and in some places had similar richness values to offshore hotspots. Furthermore, inshore hotspots had lower uncertainty in predicted taxa distribution and richness estimates. The use of two different uncertainty estimates allows the integration of distributional information from differing sources (different modeling methods with varying numbers of cetacean records) to be integrated in a robust and conservative way. Identification of cetacean hotspots with varying levels of uncertainty provides a robust and efficient step toward prioritizing areas for conservation management in a participatory process.

Background: Between 20–50% of patients undergoing maintenance dialysis for end-stage kidney disease experience symptoms of depression and/or anxiety, associated with increased mortality, greater health care utilization, and decreased quality of life. It is unknown whether mindfulness-based interventions can improve depression and anxiety symptoms in patients receiving this treatment. Methods: We conducted an 8-week multicenter randomized controlled trial comparing a brief mindfulness intervention (BMI) vs. an active control (Health Enhancement Program [HEP]) in 55 patients receiving dialysis with symptoms of depression and/or anxiety. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) depression scores, with a primary analysis in participants with baseline PHQ-9 ≥ 10, and a secondary analysis including all participants. The secondary outcome was change in Generalized Anxiety Disorder-7 (GAD-7) anxiety scores with corresponding primary and secondary analyses. Results: Both BMI and HEP reduced depressive symptoms, with no difference between trial arms (PHQ-9 change = −7.0 vs. −6.1, p = 0.62). BMI was more effective than HEP in reducing anxiety (GAD-7 change = −8.7 vs. −1.4, p = 0.01). Secondary analyses revealed no differences between arms. Conclusions: For patients undergoing dialysis, both BMI and HEP may be helpful interventions for depression symptoms, and BMI may be superior to HEP for anxiety symptoms. Mindfulness-based and other psychosocial interventions may be further evaluated in those undergoing dialysis as treatment options for symptoms of depression and anxiety.

Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 infection with clinical features of Kawasaki-like disease was reported in various pediatric centers in late April 2020. Currently, cases have increased throughout the world with a range of manifestations from less to greater severity. However, hemophagocytosis has not been described in patients with MIS-C. We describe two infants diagnosed with MIS-C who presented Macrophage Activation Syndrome (MAS) with hemophagocytosis documented in the bone marrow. MIS-C can be complicated with MAS, the key features for diagnosis are splenomegaly, hypofibrinogenemia, hypertriglyceridemia and bone marrow hemophagocytosis. Cytokine storm and MAS in MIS-C may represent part of the spectrum of the disease and HScore could be of value in order to give timely and aggressive treatment.

Whether there is an influence of the ABO blood system on SARS-CoV-2 infection is unknown.To analyze if there is an association between the ABO system antigens and susceptibility to and severity of SARS-CoV-2 infection.The frequency of ABO system antigens was compared in 73 confirmed cases of SARS-CoV-2 infection and 52 clinically healthy donors. Infection severity was assessed by comparing the frequency of antigens by disease severity and mortality.The risk of suffering from SARS-CoV-2 infection increases in subjects with A vs. non-A antigen (OR = 1.45; 95 % CI: 1.061-1.921). Blood phenotype O reduces the risk of SARS-CoV-2 infection (OR = 0.686; 95 % CI: 0.522-0.903). No differences were found regarding disease severity. In critically ill patients, the risk of mortality increased in subjects with A vs. non-A antigen (OR = 3.34; 95 % CI: 1.417-8.159).Blood group A is a risk factor for SARS-CoV-2 infection, but not for disease severity, although in critically ill patients it is a risk factor for mortality.Se desconoce si existe una influencia del sistema sanguíneo ABO en susceptibilidad y gravedad de la enfermedad.Analizar si existe una asociación entre los antígenos del sistema ABO y la susceptibilidad y gravedad de la infección por SARS-CoV-2.Se compararon las frecuencias de los antígenos del sistema ABO en 73 casos confirmados de infección por SARS-CoV-2 y 52 donadores clínicamente sanos. La gravedad de la infección se evaluó comparando la frecuencia de los antígenos por gravedad de la enfermedad y la mortalidad.El riesgo de padecer infección por SARS-CoV-2 se incrementa en sujetos con antígeno A vs los no-A (OR=1.45; IC95 %:1.061-1.921). El fenotipo sanguíneo O disminuye el riesgo de padecer infección por SARS-CoV-2 (OR=0.686; IC95 %: 0.522-0.903). No se encontraron diferencias entre la gravedad de la enfermedad. En los pacientes graves, el riesgo de mortalidad se incrementó en sujetos con antígeno A vs los no-A (OR= 3.34; IC95 %: 1.417-8.159).El grupo sanguíneo A es un factor de riesgo para padecer infección por SARS-CoV-2, no así en la gravedad de la enfermedad, pero en los pacientes graves fue un factor de riesgo para la mortalidad.

Background Melioidosis is an infectious disease caused by Burkholderia pseudomallei. In Mexico, the disease is rarely diagnosed in humans and there is no evidence of simultaneous environmental isolation of the pathogen. Here, we describe clinical profiles of fatal cases of melioidosis in two children, in a region without history of that disease. Case presentation About 48 h before onset of symptoms, patients swam in a natural body of water, and thereafter they rapidly developed fatal septicemic illness. Upon necropsy, samples from liver, spleen, lung, cerebrospinal fluid, and bronchial aspirate tissues contained Burkholderia pseudomallei. Environmental samples collected from the locations where the children swam also contained B. pseudomallei. All the clinical and environmental strains showed the same BOX-PCR pattern, suggesting that infection originated from the area where the patients were swimming. Conclusions The identification of B. pseudomallei confirmed that melioidosis disease exists in Sonora, Mexico. The presence of B. pseudomallei in the environment may suggest endemicity of the pathogen in the region. This study highlights the importance of strengthening laboratory capacity to prevent and control future melioidosis cases.

Background: Published findings on breast cancer risk associated with different types of menopausal hormone therapy (MHT) are inconsistent, with limited information on long-term effects. We bring together the epidemiological evidence, published and unpublished, on these associations, and review the relevant randomised evidence. Methods: Principal analyses used individual participant data from all eligible prospective studies that had sought information on the type and timing of MHT use; the main analyses are of individuals with complete information on this. Studies were identified by searching many formal and informal sources regularly from Jan 1, 1992, to Jan 1, 2018. Current users were included up to 5 years (mean 1·4 years) after last-reported MHT use. Logistic regression yielded adjusted risk ratios (RRs) comparing particular groups of MHT users versus never users. Findings: During prospective follow-up, 108 647 postmenopausal women developed breast cancer at mean age 65 years (SD 7); 55 575 (51%) had used MHT. Among women with complete information, mean MHT duration was 10 years (SD 6) in current users and 7 years (SD 6) in past users, and mean age was 50 years (SD 5) at menopause and 50 years (SD 6) at starting MHT. Every MHT type, except vaginal oestrogens, was associated with excess breast cancer risks, which increased steadily with duration of use and were greater for oestrogen-progestagen than oestrogen-only preparations. Among current users, these excess risks were definite even during years 1–4 (oestrogen-progestagen RR 1·60, 95% CI 1·52–1·69; oestrogen-only RR 1·17, 1·10–1·26), and were twice as great during years 5–14 (oestrogen-progestagen RR 2·08, 2·02–2·15; oestrogen-only RR 1·33, 1·28–1·37). The oestrogen-progestagen risks during years 5–14 were greater with daily than with less frequent progestagen use (RR 2·30, 2·21–2·40 vs 1·93, 1·84–2·01; heterogeneity p Interpretation: If these associations are largely causal, then for women of average weight in developed countries, 5 years of MHT, starting at age 50 years, would increase breast cancer incidence at ages 50–69 years by about one in every 50 users of oestrogen plus daily progestagen preparations; one in every 70 users of oestrogen plus intermittent progestagen preparations; and one in every 200 users of oestrogen-only preparations. The corresponding excesses from 10 years of MHT would be about twice as great.

La hipoglucemia por hiperinsulinismo endógeno suele presentarse en dos situaciones patológicas: la más frecuente es el insulinoma y, en segundo lugar, la nesidioblastosis o síndrome hipoglucémico pancreático no insulinoma. La nesidioblastosis es una causa poco frecuente de hipoglucemia por hiperinsulinismo en adultos. Presentamos el caso de un paciente adulto con cuadros recurrentes de hipoglucemia secundarios a nesidioblastosis.

This chapter reviews the innovation endeavors of the second biggest dairy company in Mexico, from a resource-based point of view, to catch up with the market dynamics in the mature business of dairy products in an emerging economy. First, we address the strategic decisions of the top management team, headed by a new CEO with a transformational profile, to lay the foundations of a long-term competitive strategy that respond to the poundings of well-positioned and new aggressive competitors. Then we turn next to take a close look at the efforts to developing innovation capabilities and the reconfiguration of the capabilities structure for the implementation of the innovation strategy that guarantees a bright, innovative future for this iconic company in Mexico.

The dairy industry is a mature industry that tends to take a traditional approach toward innovation. In recent years, however, firms in this industry have pursued more constant innovation by recognizing the value of their innovation mistakes. This chapter presents the case study of Alpura, the second-largest dairy company in Mexico, a country with a complex, competitive mix of more than 26 large domestic and international dairy companies. This case study describes the events related to the unsuccessful innovations that eventually drove an urgent change in the innovation strategy in Alpura, which was a leader in its market for several decades. Alpura’s case portrays the importance of organizations recognizing the value of their unsuccessful innovations and other innovation missteps to focus on better future innovation efforts.

Melioidosis, caused by Burkholderia pseudomallei (Bpm), lacks a vaccine. We identify the immune correlates of protection induced by B. mallei ΔtonB Δhcp1 (CLH001) and Bpm ΔtonB Δhcp1 (PBK001) vaccines against inhalational melioidosis. Mucosal immunization with either vaccine generates Bpm-specific IgM and IgG (IgG2b/c > IgG1 > IgG3) antibodies in sera and lungs, and lung IgA antibodies. Sera confers complement-independent bactericidal activity and macrophages opsonophagocytic uptake but is insufficient in passive transfer experiments to provide significant protection. Both vaccines elicit memory Th1 and Th17 CD4+ T-cell responses in lung and spleen after Bpm antigen-specific recall. The PBK001 vaccine is superior in generating respiratory IgA post-boost, anamnestic IgG at challenge, T-cell recall to specific antigen, and development of diverse polyfunctional memory T-cell pools. Analysis of lung histology suggests that potent polyfunctional T-cell memory and/or IL-17 signatures generated with PBK001 vaccination may be associated with moderate lung inflammation post vaccination.

INTRODUCTION: Burkholderia pseudomallei is an environmental intracellular Gram-negative bacterium that causes melioidosis, a severe infectious disease affecting humans and animals. An increase in melioidosis cases worldwide and the high mortality rate of the disease makes it a public health concern. Melioidosis is known as the ‘great mimicker’ because it presents with a wide range of disease manifestations. B. pseudomallei is naturally resistant to antibiotics and delay in diagnosis leads to ineffective treatment. Furthermore, there is no approved vaccine to prevent melioidosis infection in humans. Therefore, it is a priority to license a vaccine that can be used for both high-risk endemic areas and for biodefense purposes. AREAS COVERED: In this review, we have focussed on recent progress in the USA for the development and advancement of lead B. pseudomallei vaccine candidate(s) ready for testing in pre-clinical trials. Those candidates include live-attenuated vaccines, glycoconjugate vaccines, outer-membrane vesicles, and gold nanoparticle vaccines. EXPERT OPINION: Side-by-side comparison of the leading B. pseudomallei vaccine candidates will provide important information to further advance studies into pre-clinical trials. The likelihood of any of these current vaccines becoming the selected candidate that will reduce the occurrence of melioidosis worldwide is closer than ever.

The association of patients with heart failure (HF) and preserved ejection fraction (HFpEF) and with type 2 diabetes mellitus (T2DM) is strong and related additionally to blood pressure (BP). To analyze distinctive clinical profiles among patients with HFpEF both with and without T2DM. The study was based on a Spanish National Registry (multicenter and prospective) of patients with HF (DICUMAP), that enrolled outpatients with HF who underwent an ambulatory BP monitoring (ABPM) and then were followed-up for 1 year. We categorized patients according to the presence/absence of T2DM then building different clusters based on K-medoids algorithm. 103 patients were included. T2DM was present in 44.7%. The patients with T2DM were grouped into two clusters and those without T2DM into three. All patients with T2DM had kidney disease and anemia. Among them, cluster 2 had higher systolic blood pressure and pulse pressure (PP) with a bad outcome (p = 0.03) regarding HF mortality and readmissions, influenced by eGFR (HR 0.93, 95% CI 0.97–0.87, p = 0.04), and hemoglobin (HR 0.65, 95% CI 0.71–0.63, p = 0.03). Among those without T2DM, cluster 3 had a pathological ABPM pattern with the highest PP, cluster 4 was slightly similar to cluster 2, and cluster 5 expressed a more benign pattern without differences on both, HF mortality and readmissions. Patients with HFpEF and T2DM expressed two different profiles depending on neurohormonal activation and arterial stiffness with prognostic implications. Patients without T2DM showed three profiles depending on ABPM pattern, kidney disease and PP without prognostic repercussion.

This chapter reviews the different starch based Drug Delivery Systems (DDS). Poor solubility can hinder the achievement of a convenient pharmaceutical format as hydrophobic drugs can precipitate in aqueous media, whereas unfavourable pharmacokinetics impliy that the drug is cleared too rapidly from the body, requiring high doses or continuous infusion. Polymers are used for clinical applications due to the fact that their wide architecture offers diversity in chemistry, dimensions and topology. Starch can be extracted from roots, seeds, stems and tubers of different plants, such as com, potato, wheat, rice and others. Modification treatments of starch in the food industry include gelatinization, monoester or cross-linked phosphorylation, and hydroxy- propylation. Starch graft copolymers have also been used as drug delivery systems. Polymer blending is a well-used technique whenever modification of properties is required, because it uses conventional technology at low cost. Starch blends have also been used in the production of DDS.

BACKGROUND Lipid modification results in several benefits for the food industry, biotechnology advances and human health. Customizing bioactive lipids is very appealing because it improves the product's nutritional quality. Lipases are sustainable biocatalysts that can be reused, show selectivity towards substrates and reactions occur in mild conditions. OBJECTIVES We aimed at systematically searching for patents deposited worldwide, that approached the production of structured lipids by using lipases as biocatalysts. METHOD A patent-search strategy was set up in Questel-Orbit and the search strategy adopted was based on the combination of specific keywords in the title/abstract of the documents, encompassing thoroughly the search scope. We revised all patents relating structured lipids produced by enzyme reactions and provided an overview of the main objectives of the patents describing it, as well as a view of the principal depositors, years of publication and principal countries of deposit, as a mean to access the technological landscape on the subject. RESULTS Forty-four documents, published over the last 34 years, were retrieved. Nine main patents' objectives were found, and the two major groups are: SL with bioactive properties and/or with fatty acids (FA) esterified at specific triacylglycerol positions and SL analogous of natural lipids. China, Japan and USA were the three main patent depositors. CONCLUSION Although the number of patents retrieved was relatively low, this review indicates that SL production aiming at improvements in nutritional/health and/or physical attributes for food enhancement is a new field, and technological interest and innovation have been increasing over the last ten years.

The aim of the study is to clarify if a classification based on the time of occurrence of associated malignancies in GIST patients can help in the understanding of the clinical controversies observed in these patients. We retrospectively reviewed all the patients diagnosed with GIST tumors between January 1999 and October 2016. They were divided into GIST patients associated with other tumors (A-GIST) and those not associated (NA-GIST). A-GIST patients were also divided into four types according to the proposed classification. Of 104 GIST patients, 32 (30.7%) (A-GIST group) had at least one additional primary malignancy. The most frequent location of the associated malignancy was the GI tract (26%). Compared to NA-GIST, A-GIST were more often asymptomatic with a lower risk of recurrence. The main cause of death in NAGIST was GIST itself, being associated tumors the main cause of death in A-GIST group. No differences were found in DFS and OS between A-GIST and NA-GIST. The use of the proposed classification classifies GIST patients with associated malignancies in different subtypes that differ substantially in terms of incidence, type of neoplasms associated, cause of the association and prognosis.

Background We aimed to identify risk factors for early complications in systemic lupus erythematosus (SLE) patients undergoing major surgery. Methods We conducted a retrospective comparative cohort study including patients with SLE undergoing major surgery, and non-SLE patients matched 1:1. Main outcomes were development of infectious and noninfectious complications, and 30-day postoperative mortality. Results A total of 382 patients (191 SLE and 191 non-SLE) were included. Postoperative complications occurred in 82 (43%) SLE patients and 58 (30%) without SLE, ( p = 0.01). Variables associated with infectious complications in SLE patients: prednisone use (OR 1.81, 95% CI 1.13–2.90), anemia (OR 2.43, 95% CI 1.45–4.08), hypoalbuminemia (OR 2.58, 95% CI 1.55–4.30) and lymphopenia (OR 2.43, 95% CI 1.52–3.89), p Conclusions SLE patients present higher frequency of postoperative complications and mortality compared with non-SLE patients. Hypoalbuminemia, anemia, lymphopenia and aspirin use are independent risk factors.

International partners are united to reach the shared goal of zero dog-mediated human rabies deaths by 2030, worldwide. Under the Tripartite collaboration, the World Health Organization, the World Organisation for Animal Health and the Food and Agriculture Organization of the United Nations are prioritising rabies as a model for 'One Health' in action. In 2015, the Global Rabies Conference led to the development of the Global Framework for the Elimination of Dog-Mediated Human Rabies. This long-term strategy centres around five pillars of rabies elimination (STOP-R): i) Sociocultural; ii) Technical; iii) Organisational; iv) Political; and v) Resources. Together with their partners, the Tripartite are working to operationalise the Framework through: i) engaging communities to build rabies awareness; ii) strengthening human and animal health systems, surveillance, and providing proof of concept that rabies elimination is feasible; iii) promoting intersectoral and regional collaboration; iv) advocating for political engagement and support; and v) building the case for investment through public-private partnerships and a Global Strategic Plan to end human deaths from dog-mediated rabies. By creating an enabling environment for countries to prioritise rabies and implement existing tools, the Tripartite are committed to catalysing change, empowering nations and providing the necessary support to consign rabies to the history books.

Copyright © 2018 by the American Society of Plastic Surgeons. Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.

Because of competition and the resulting confidentiality, there is little information on induction-heating MOCVD reactor design available in print and on the internet. We thus appreciate the following people who have generously provided suggestions and advice: Dr. G. Tompa and the engineers at Structured Materials Industries, Dr. K. Balakrishnan at BRIDGE, Dr. J. Creighton at Sandia National Laboratories, Prof. Z. Sitar and Prof. R. Collazo at North Carolina State University, Dr. A. Paranjpe at Veeco Instruments, Mr. J. Schmitt at Nitride Solution, Dr. A. Boyd at AIXTRON, and Prof. S. Novikov at the University of Nottingham. This research was sponsored by the KAUST Baseline Fund BAS/1/1664-01-01 and Equipment Fund BAS/1/1664-01-07.

The ongoing COVID-19 pandemic has driven massive consumption of personal protective equipment (PPE) worldwide. Single-use face masks are one of the most used PPE to prevent the transmission of the virus. However, mismanagement of such materials threatens the environment with a new form of plastic pollution. Researchers argue that it is necessary to develop and implement innovative ways to manage and recycle PPE in order to reduce their impacts on the environment. In the present work, we have reviewed and discussed the recent development of sustainable face mask alternatives and recycling and repurposing routes under the COVID-19 pandemic context. Moreover, we have conducted estimations of the daily face mask waste generation in Peru, a developing country struggling with a poor solid waste management framework and infrastructure. Unlike previous studies, our equation incorporates the “economically active population” variable in order to provide more precise estimations, while evaluating single-use and reusable scenarios. The scenarios of incorporating reusable face masks significantly reduced the amount of solid waste generated in Peru. In situ evidence shows that face masks are polluting the streets and beaches of Peru, probably driven by mismanagement and poor environmental awareness., Graphical abstract Unlabelled Image

Background By 2030, more than 50% of patients with bipolar disorder may be aged ≥ 60, with few studies to guide their treatment. In the past few years, a renewed effort has been undertaken to increase the amount of pharmacotherapy research in older age bipolar disorder (OABD). Methods In this review, we used Ovid Medline to search for publications from January 2011 to July 2017 relevant to the pharmacotherapy of OABD. Results Four relevant publications were identified, as well as two conference abstracts. These studies found beneficial effects of lurasidone, lamotrigine, and asenapine on depressive symptoms in OABD, as well as treatment benefits of lithium, valproate, and asenapine on manic/hypomanic symptoms. The majority of studies were open-label and two of the studies had sample sizes < 20, although two larger reports of lithium, valproate, and lurasidone had randomized controlled data. Conclusions The evidence base in OABD is continuing to grow, with medications effective in younger adults also appearing to have beneficial effects in older adults, with reasonable tolerability.