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Measurement of muscle strength is fundamental for the management of patients with myotonic dystrophy type 1 (DM1). Nevertheless, guidance on this topic is somewhat limited due to heterogeneous outcome measures used. This systematic literature review aimed to summarise the most frequent outcome measures to assess muscle strength in patients with DM1. We searched on Pubmed, Web of Science and Embase databases. Observational studies using measures of muscle strength assessment in adult patients with DM1 were included. From a total of 80 included studies, 24 measured cardiac, 45 skeletal and 23 respiratory muscle strength. The most common method and outcome measures used to assess cardiac muscle strength were echocardiography and ejection fraction, for skeletal muscle strength were quantitative muscle test, manual muscle test and maximum isometric torque and medical research council and for respiratory muscle strength were manometry and maximal inspiratory and expiratory pressure. We successfully gathered the more consensual methods and measures to evaluate muscle strength in future clinical studies, particularly to test muscle strength response to treatments in patients with DM1. Future consensus on a set of measures to evaluate muscle strength (core outcome set), is important for these patients.

Chronic neuropathic pain affects 7%-10% of the population. Deep brain stimulation (DBS) has shown variable but promising results in its treatment. This study prospectively assessed the long-term effectiveness of DBS in a series of patients with chronic neuropathic pain, correlating clinical results with neuroimaging. Sixteen patients received 5 years' post-surgical follow-up in a single center. Six had phantom limb pain after amputation and 10 had deafferentation pain after traumatic brachial plexus injury. Patient-reported outcome measures were completed before and after surgery, using VAS, UWNPS, BPI and SF-36 scores. Neuroimaging evaluated electrode location and effective volumes of activated tissue (VAT). Two subgroups were created based on the percentage of VAT superimposed upon the ventroposterolateral thalamic nucleus (eVAT), and clinical outcomes were compared. Analgesic effect was assessed at 5 years and compared to preoperative pain, with an improvement on VAS of 76.4% (p=0.0001), on UW-NPS of 35.2% (p=0.3582), on BPI of 65.1% (p=0.0505) and on SF-36 of 5% (p=0.7406). Eight patients with higher eVAT showed improvement on VAS of 67.5% (p=0.0017) while the remaining patients, with lower eVAT, improved by 50.6% (p=0.03607). DBS remained effective in improving chronic neuropathic pain after 5 years. While VPL-targeting contributes to success, analgesia is also obtained by stimulating surrounding posterior ventrobasal thalamic structures and related spinothalamocortical tracts.

Costa, JA, Brito, J, Nakamura, FY, Figueiredo, P, and Rebelo, A. Using the rating of perceived exertion and heart rate to quantify training intensity in female soccer players: validity and utility. J Strength Cond Res 36(1): 201-206, 2022-The aims of this study were as follows: (a) to analyze associations between session rating of perceived exertion (sRPE) and training impulse (TRIMP); (b) to verify whether significantly different ranges of percentage of heart rate peak (%HRpeak) would be reached in each discrete RPE category; and (c) to investigate the amount of time spent90% of HRpeak and associated intraplayer and interplayer variability during soccer technical training sessions with similar contents and duration. This was a single-group observational study that measured the internal training load during 6 weeks of the competitive period in 17 high-level female soccer players. All training sessions started around 9 pm. and lasted on average 94 ± 5 minutes. During each training session, RPE, sRPE, TRIMP, HRex (%HRpeak), and time spent at90% of HRpeak were assessed. A very large correlation was found between sRPE and TRIMP (r = 0.78; 95% confidence interval: [0.74-0.82]). Significant differences were observed between %HRpeak associated with each RPE value (i.e., RPE = 2 arbitrary unit [68%; 65-69% of %HRpeak]; RPE 3 [72%; 69-75%]; RPE 4 [79%; 76-82%]; RPE 5 [84; 81-87%]; χ2 = 73.34; df = 3; P0.001). Intraplayer and interplayer coefficients of variation for the time spent90% of HRpeak (∼8% of training time, ∼7 minutes per session) during training sessions were 73 and 92%, respectively. In conclusion, it was confirmed that sRPE and TRIMP displayed good convergent validity, and different %HRpeak were observed for each discrete RPE. However, because of the high variability in the time90% of HRpeak, careful monitoring of individual exercises should be performed to ensure the desired training stimulus for each player.

Implantable biosensors are not yet at the developmental phase where they can be vital for personalized medicine, deconstructing healthcare as we see it today. However, the obstacles have been identified and multidisciplinary teams of researchers worldwide have been working to overcome the main technical problems that hamper their clinical application. TE strategies for implantable biosensors seem to be the way to tackle body’s immune rejection, since they can minimize the bodýs response by increasing their biocompatibility and reducing tissue mismatch, maintaining biosensor functionality for longer.

Background: Metabolic Syndrome (MetS) is defined by the presence of three or more of the following components: inadequate fasting serum glucose levels and elevated waist circumference, hypertension and dyslipidemia, which represent a potential risk for the development and/or worsening of Chronic Kidney Disease. Objective: Based on this, this research aimed to investigate the presence of MetS and its influence on associated factors in patients with Chronic Kidney Disease undergoing hemodialysis. Methods: This is an evaluation of a cross-sectional multicenter research project, carried out with 95 patients with Chronic Kidney Disease, seen at outpatient clinics in the state capital Piaui. Anthropometric, biochemical and hemodynamic parameters were determined. The data were analyzed using the Stata® v.12 software (Statacorp, College Station, Texas, USA), adopting a significance level of p < 0,05. The survey received ethical approval (no. 2.527.329). Results: It was observed that individuals with elevated BMI, WC, NC, SBP, DBP were more likely to develop MetS, with significant differences (p Conclusion: It was concluded that changes in the parameters analyzed in patients with CKD reinforce MetS as a predictive condition for worsening nutritional status and a factor for the progression of kidney disease.

BACKGROUND The possible link between dental status and school performance has been investigated. The influence of the clinical consequences of untreated dental caries in this association, however, has been minimally explored. AIM To assess the relationship between clinical consequences of untreated dental caries and school performance in adolescents, and to examine the demographics and socioeconomic status pathways by which clinical consequences of untreated dental caries is associated with school performance. DESIGN A cross-sectional study involving 363 low-income school adolescents was conducted in the city of Manaus, Brazil. Dental clinical measures were registered by five calibrated examiners to evaluate dental caries experience (decayed, missing, and filled teeth index [DMFT]) and clinical sequelae of dental caries (PUFA/pufa index). School performance was assessed using school grade history obtained from official records. Statistical analysis was conducted using pathway analysis to estimate beta coefficients (β) of the direct and indirect effects between variables. RESULTS DMFT and PUFA/pufa mean were 1.93 and 0.30, respectively. PUFA/pufa scores (β = -0.19) and male sex (β = 0.35) directly predicted poor school performance. DMFT was indirectly linked to poor school performance via PUFA/pufa scores (β = -0.03). CONCLUSIONS Dental caries and clinical consequences of dental caries were important predictors of poor school performance in low-income adolescents via direct and indirect effects.

The severe acute respiratory coronavirus virus 2 (SARS-CoV-2) delta variant is highly transmissible, and current vaccines may have reduced effectiveness in preventing symptomatic infection. Using epidemiological and genomic analyses, we investigated an outbreak of the variant in an acute-care setting among partially and fully vaccinated individuals. Effective outbreak control was achieved using standard measures.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents rapid transmission and significant mortality worldwide. It is responsible for coronavirus disease 2019 (COVID-19). The disease presents diverse clinical symptoms, including fever, cough, dyspnea, and pneumonia. However, other manifestations associated with COVID-19 need to be clarified, leading specialists to an early diagnosis and better prognosis. We describe the spectrum of clinicopathologic COVID-19-related oral lesions that can be the first and/or the unique manifestation of the disease. Fourteen patients with a mean age of 58 years (range: 23 to 88 y) with oral lesions were included. All patients were confirmed to be infected with SARS-CoV-2 by reverse transcription polymerase chain reaction testing. Patients demonstrated mild symptoms, including dysgeusia, anosmia, fever, and headache. The lesions were recognized and classified into 2 groups: (1) lesions caused by ischemia and/or hemorrhage and (2) lesions secondary to inflammatory events associated with viral load. The palate was most affected (n=8), followed by the tongue (n=4), and both the lip and palate (n=2). Histologic analysis demonstrated thrombosis of small arteries and capillaries, associated with areas of hemorrhage and chronic inflammatory infiltrate. Immunohistochemistry showed positive staining for spike protein (SARS-CoV and SARS-CoV-2) and angiotensin-converting enzyme 2 in the surface epithelium, salivary glands, inflammatory cells, and endothelial cells. Although the incidence of oral lesions among patients infected with SARS-CoV-2 appears to be uncommon, these findings suggest that the oral mucosa can also be a target organ for SARS-CoV-2.

Posterior reversible leukoencephalopathy syndrome (PRES) is a rare entity among children, characterised by acute neurological symptoms and radiological findings. The role of clinical symptoms and neuroimaging in predicting the prognosis of PRES have not been well-characterised. A retrospective descriptive study of children with PRES, admitted to a Paediatric Intensive Care Unit during a 10-year period, was performed to describe its characteristics, compare the accuracy of computed tomography (CT) scan and MRI on diagnosis and identify prognostic factors on paediatric population. Sixteen cases were identified. Most patients (13; 81%) presented underlying disorders, including malignancies (5; 31%), chronic kidney disease (3; 19%) and post-transplant status (3; 19%). Hypertension (15; 94%) was the most common trigger. All patients had seizures, 9 patients (56%) altered state of consciousness, 8 (50%) headache. CT scan was performed in 15 patients (94%) and MRI in 13 (81%); 1 patient underwent only MRI. MRI allows the identification of new areas of vasogenic oedema and a correct diagnosis of PRES when CT scan was inconclusive. Two patients (13%) remained with neurological sequelae and one died. In two patients (13%) cognitive disorders (specific learning disorder, intellectual disability, motor tic disorder) were diagnosed during follow-up period. Clinical presentation was not statistically associated with outcome. Also, atypical neuroimaging (haemorrhagic and unilateral lesions) were not statistically related with poor neurological or cognitive outcome. However, prospective studies with a larger cohort are needed to establish prognostic factors of PRES in the paediatric population.

Na cidade de Manaus, metrópole da Amazônia, graves problemas de saneamento básico, retratam a ineficiência política de gestão sobre a qualidade ambiental das águas urbanas. Neste sentido, a bacia hidrográfica do Gigante, selecionada para este estudo, constituiu a base de uma análise cartográfica e amostragem dessa problemática. Os resultados comprovam que entre 75,1% a 95% dos domicílios situados em locais próximos às nascentes dos rios, utiliza a fossa do tipo rudimentar para o esgotamento sanitário. O uso de poços para o abastecimento de água, em regiões adjacentes a cemitérios e aeroportos, atingiu 100%, gerando insegurança neste tipo de consumo. Sobre a coleta do lixo, enquanto nos domicílios situados à montante 100% do rejeito é recolhido, nos setores próximos à foz, a coleta é inexistente. O rendimento per capita de ½ até 1 salário, distribui-se espacialmente por toda a área da bacia, denotando sérias desigualdades socioeconômicas. Os problemas ambientais relacionados às questões de saneamento básico transformam-se em riscos à saúde da população que reside nos setores delimitados pela bacia. Palavras-chave: Hidrografia, Manaus, Saneamento Básico.

Purpose To study the immunization status and IgM and IgG antibody behavior against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in an unvaccinated population of Northeast Portugal (including RT-PCR diagnosed and undiagnosed individuals). Methods Application of a clinical-epidemiological survey, and analysis of IgM and IgG SARS-COV-2 antibodies (against N core protein) in 362 participants that voluntarily sought the laboratory for testing. Results At the time of the analysis, 31.7% (n = 114) of the study population had a previous SARS-CoV-2 diagnosis, 48.3% of which were asymptomatic, and 71.9% IgG seropositive. Of these, 83.3% and 60% were, respectively, IgM and IgG seropositive within 2 weeks after the initial diagnosis. Both antibodies peaked in the 3rd week post diagnosis, with titers decreasing over the following weeks, until a state of seronegativity was achieved after the 6th week for IgM, and the 21st for IgG. Symptomatic patients showed higher IgM and IgG values, when compared to asymptomatic ones. Fever, the most reported symptom, was found to be positively associated with IgM values. Ages of ≤ 18-year-old and ≥ 65-year-old exhibited the highest median values for both IgM and IgG, with the former being statistically significant. In the undiagnosed group, 13.9% and 11.1% were seropositive for IgM and IgG, respectively. Conclusion IgM and IgG displayed a similar initial increase (within 1/2 weeks), with IgG having a significant decrease after the 21st week post-diagnosis, translating a loss of immunity at this point. The youngest and oldest symptomatic age groups were found to be the highest responders. Antibody assays enabled the identification of previously undiagnosed participants.

Insulinomas, although rare, are the most common pancreatic functioning neuroendocrine tumors. The diagnostic workup is commonly made late in time and surgical treatment is the only curative method. Our aim was to analyze the surgical approach to pancreatic insulinomas, through a 15-year series of patients who underwent surgery for this matter. From January 2006 to December 2020, we performed a retrospective review of the medical records of all the patients who underwent surgical treatment for insulinoma. Fourteen patients with insulinoma performed surgical intervention, 78,6% were of the female gender and the mean age was 48 years (19-86 years). Four (28,6%) of the tumors were located in the head of the pancreas, 5 (35,7%) in the body and 5 (35,7%) in the tail. Complications occurred in 4 patients (28,6%) following surgery. On follow-up, there was one (7,1%) case of local recurrence, thus necessitating a new surgical intervention [1-8].

Purpose: this study aims to provide a better understanding of the behaviour of wine consumers in a completely new and unexpected setting, that is, a forced lockdown due to the COVID-19 pandemic. It seeks to explain consumer decisions and the probability of changes occurring in wine expenditure compared to a normal situation. Design/methodology/approach: the empirical analysis, conducted on a representative sample of Iberian consumers and based on the random utility theory, consists in the application of a multinomial logit model, setting the 'usual' pattern of expenditure as a baseline category. Findings: the results show that the coronavirus pandemic could have changed alcohol drinking habits. Consumers generally spent less on wine during the lockdown, maybe due to the uncertainty regarding their future income and professional situation. Those people more likely to spend more on wine were those who increased their wine consumption during the lockdown, those who drank for romantic purposes, those who purchased less wine in supermarkets but more online, those who used a wine app and those living in urban areas. The increased consumption of other alcoholic beverages also increases the probability of spending less than usual on wine. Additionally, the absence of certain reasons for drinking wine other than social purposes, such as wine and food pairing, its taste and relaxing effects, together with the previous consumption pattern leads to a decrease in the probability of spending less per bottle. Originality/value: This paper makes a significant contribution to the understanding of the determinants of wine consumption in a very abnormal setting, an imposed lockdown and provides important policy implications. The findings show that managers and policymakers should pay attention to the different influence of variables related to behaviour and consumption patterns that may contribute to an increase in the demand for less expensive wines. Specifically, they should focus on new consumption patterns that may arise, adapting the supply chain and defining appropriate marketing strategies to fill new market segments. Financial support from Ministerio de Economia y Competitividad ECO2017-86054-C3-2-R; CT – Portuguese Foundation for Science and Technology - UIDB/SOC/04011/2020 and FEDER – Interreg SUDOE, VINCI – Wine, Innovation and International Competitiveness - SA069G18; and partially funded by the ERDF-Interreg SUDOE Project SOE3/P2/F0917, VINCI (Wine, Innovation and International Competitiveness), the Ministry of Science and Innovation of the Spanish Government (project PGC2018-095529-B-I00) and by the Department of Science, Innovation and Universities of the Government of Aragon (Research Group S55_20R).

Conversations about research priorities with members of the public are rarely designed specifically to include people who identify as Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) and are not researchers. Generally, to address this gap, and specifically, to inform future research for CLS, we carried out a rapid review of published research priority sets covering LGBTQ+ topics, and an online workshop to prioritise identified themes. Rapid review: results. The rapid review identified 18 LGBTQ+ research priority sets. Some focussed on specific populations such as women or men, younger or older people or people living within families. Five addressed transgender and gender non- conforming populations. All of the research priority sets originated from English-speaking, high and middle-income countries (UK, US, Canada, and Australia), and date from 2016 onwards. Prioritization approaches were wide-ranging from personal commentary to expert workshops and surveys. Participants involved in setting priorities mostly included research academics, health practitioners and advocacy organisations, two studies involved LGBTQ+ public in their process. Research priorities identified in this review were then grouped into themes which were prioritised during the workshop. Workshop: results. For the workshop, participants were recruited using local (Cambridge, UK) LGBTQ+ networks and a national advert to a public involvement in research matching website to take part in an online discussion workshop. Those that took part were offered payment for their time in preparing for the workshop and taking part. Participants personal priorities and experiences contributed to a consensus development process and a final ranked list of seven research themes and participants’ experiences of healthcare, mental health advocacy, care homes, caring responsibilities, schools and family units added additional context. From the workshop the three research themes prioritised were: healthcare services delivery, prevention, and particular challenges / intersectionality of multiple challenges for people identifying as LGBTQ+. Research themes interconnected in many ways and this was demonstrated by the comments from workshop participants. This paper offers insights into why these priorities were important from participants’ perspectives and detail about how to run an inclusive and respectful public involvement research exercise. On a practical level these themes will directly inform future research direction for CLS. Conversations about research priorities with members of the public who identify as Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) and are not researchers are not common. We reviewed published research priorities covering LGBTQ+ topics and held an online workshop. The review identified 18 LGBTQ+ research published priority sets. Some focussed on specific populations such as women or men, younger or older people or people living within families. Five were on transgender and gender non- conforming populations. Priorities were achieved by different methods such as workshops and surveys. People involved in setting priorities mostly included researchers, health practitioners and advocacy organisations, two studies involved LGBTQ+ public in their process. Research priorities identified in the review were grouped into themes which were prioritised during the workshop. For the online workshop, participants were recruited using local (Cambridge, UK) LGBTQ+ networks and a national advert and offered payment for their time. Participants personal priorities and experiences contributed to agreeing a final list of seven research themes in priority order. Participants’ experiences of healthcare, mental health advocacy, care homes, caring responsibilities, schools and family units were helpful. From the workshop the three top research themes were: healthcare services delivery, prevention, and particular and multiple challenges of people identifying as lesbian, gay, bisexual, transgender or queer. Research themes interconnected in many ways as shown by the comments from workshop participants. This paper describes why these priorities were important from participants’ perspective and offers information about how to run an inclusive and respectful public involvement research exercise.

As a key technology to help bridging the gap between deaf and hearing people, sign language recognition (SLR) has become one of the most active research topics in the human–computer interaction field. Although several SLR methodologies have been proposed, the development of a real-world SLR system is still a very challenging task. One of the main challenges is related to the large intersigner variability that exists in the manual signing process of sign languages. To address this problem, we propose a novel end-to-end deep neural network that explicitly models highly discriminative signer-independent latent representations from the input data. The key idea of our model is to learn a distribution over latent representations, conditionally independent of signer identity. Accordingly, the learned latent representations will preserve as much information as possible about the signs, and discard signer-specific traits that are irrelevant for recognition. By imposing such regularization in the representation space, the result is a truly signer-independent model which is robust to different and new test signers. The experimental results demonstrate the effectiveness of the proposed model in several SLR databases.

Deficiency of adenosine deaminase 2 (DADA2) is an autosomal recessive inflammatory vasculopathy characterized by systemic vasculitis, early-onset stroke and livedo racemosa. We report a family cohort of 3 patients with ADA2 compound heterozygous mutation p.[Thr360Ala] and [Gly383Ser]. Two of them had progressive involvement of the peripheral nervous system in the fourth decade, both after stroke. In one patient, clinical and neurophysiological studies showed progression of mononeuritis multiplex to chronic axonal sensorimotor polyneuropathy, nerve biopsy had features of small vessel vasculitic neuropathy, and muscle biopsy disclosed neurogenic atrophy with reinnervation. The second patient presented with progressive sensory symptoms of the lower limbs and chronic axonal sensorimotor polyneuropathy in nerve conduction studies. These two patients had absent plasma ADA2 activity. The third patient had no neurological affection despite low, but not absent, plasma ADA2 activity. Patients were started on a tumor necrosis factor (TNF) inhibitor, which has presumed benefits for the vasculitic phenotype of DADA2.

We argue that the COVID epidemic disproportionately affected the economic well-being and health of poor people. To disentangle the forces that generated this outcome, we construct a model that is consistent with the heterogeneous impact of the COVID recession on low- and high-income people. According to our model, two-thirds of the inequality in COVID deaths reflect preexisting inequality in comorbidity rates and access to quality health care. The remaining third stems from the fact that low-income people work in occupations where the risk of infection is high. Our model also implies that the rise in income inequality generated by the COVID epidemic reflects the nature of the goods that low-income people produce. Finally, we assess the health–income trade-offs associated with fiscal transfers to the poor and mandatory containment policies.

The FAIR principles have become a data management instrument for the academic and scientific community, since they provide a set of guiding principles to bring findability, accessibility, interoperability and reusability to data and metadata stewardship. Since their official publication in 2016 by Scientific Data – Nature, these principles have received worldwide recognition and have been quickly endorsed and adopted as a cornerstone of data stewardship and research policy. However, when put into practice, they occasionally result in organisational, legal and technological challenges that can lead to doubts and uncertainty as to whether the effort of implementing them is worthwhile. Soon after their publication, the European Commission and other funding agencies started to require that project proposals include a Data Management Plan (DMP) based on the FAIR principles. This paper reports on the adherence of DMPs to the FAIR principles, critically evaluating ten European DMP templates. We observed that the current FAIRness of most of these DMPs is only partly satisfactory, in that they address data best practices, findability, accessibility and sometimes preservation, but pay much less attention to metadata and interoperability. Los principios FAIR se han convertido en una herramienta de gestión de datos para la comunidad académica y científica, ya que proporcionan un conjunto de principios rectores que facilitan la localización, accesibilidad, interoperabilidad y reutilización de la gestión de datos y metadatos. Desde su publicación oficial en 2016 por Scientific Data - Nature, estos principios han recibido reconocimiento mundial y fueron rápidamente respaldados y adoptados como pilares de la política de investigación y gestión de datos. Sin embargo, cuando se ponen en práctica, ocasionalmente presentan desafíos organizativos, legales y tecnológicos que pueden generar dudas e incertidumbres sobre el esfuerzo para implementarlos. Poco después de su publicación, la Comisión Europea y otras agencias de financiación comenzaron a exigir en sus propuestas de proyectos un Plan de Gestión de Datos (PGD) basado en los principios de FAIR. Este artículo informa sobre la adherencia de los PGD a los principios FAIR, evaluando críticamente diez modelos europeos de PGD. Observamos que el nivel de FAIRness de la mayoría de los PGD analizados sigue siendo parcialmente insatisfactorio, ya que abordan las mejores prácticas de datos, ubicación, accesibilidad y, a veces, preservación, pero prestan poca atención a los metadatos y la interoperabilidad. The FAIR principles have become a data management instrument for the academic and scientific community, since they provide a set of guiding principles to bring findability, accessibility, interoperability and reusability to data and metadata stewardship. Since their official publication in 2016 by Scientific Data – Nature, these principles have received worldwide recognition and have been quickly endorsed and adopted as a cornerstone of data stewardship and research policy. However, when put into practice, they occasionally result in organisational, legal and technological challenges that can lead to doubts and uncertainty as to whether the effort of implementing them is worthwhile. Soon after their publication, the European Commission and other funding agencies started to require that project proposals include a Data Management Plan (DMP) based on the FAIR principles. This paper reports on the adherence of DMPs to the FAIR principles, critically evaluating ten European DMP templates. We observed that the current FAIRness of most of these DMPs is only partly satisfactory, in that they address data best practices, findability, accessibility and sometimes preservation, but pay much less attention to metadata and interoperability.

PurposeThe insurance industry has not been able to effectively retain its customers and struggles to establish and maintain long-lasting relationships with them. The purpose of this paper is thus to identify the main factors that explain the cancellation of motor insurance policies by individual customers, considering the influence of intermediaries on their decisions.Design/methodology/approachThe data used in this research is based on a sample of 3,500 insurance policies that lapsed during the period of analysis between January and July 2017, against another sample of 3,500 policies that did not lapse, from a major insurance company in Portugal. Binary logistic regression was used for data analysis, using IBM SPSS software.FindingsAggressive tactics by insurance companies for customer acquisition may induce the cancellation of insurance policies. More valuable customers, the policies with higher premiums and recent claims, as well as the ancillary intermediaries and agents, are determinants of insurance cancellation. Conversely, the payment of policies by direct debit and without instalments reduces the probability of cancellations.Research limitations/implicationsThe main limitation of this study is the restriction on data access. Insurance companies are significantly resistant to sharing their customer data – including with academic researchers – even in an anonymised form.Practical implicationsThe paper highlights internal and external practices of insurance companies that should be reformulated to significantly improve their performance regarding product cancellation, related to customer information management, mistrust behaviours related to stakeholders and new value propositions that deepen the relationships with intermediaries.Originality/valueThis research developed a framework with which to identify the factors that are mainly associated with motor insurance cancellation and to predict its likelihood.

Evidence indicates that the physiological role of vitamin D goes beyond regulating classical domains of minerals and hormones. It is reported that the low status of Vitamin D may contribute to the occurrence of metabolic disorders, with emphasis on insulin resistance, atherosclerotic events and metabolic syndrome. In this sense, this study aimed to verify the association between metabolic and anthropometric parameters and vitamin D status in patients with chronic kidney disease undergoing hemodialysis. This was a cross-sectional study conducted with 95 patients with chronic kidney disease treated at clinics in Teresina, Piaui, Brazil. Lipid and inflammatory profile, glycemia, insulin and vitamin D status were determined. Data were analyzed using STATA software, adopting significance level of p

A relação entre a diabetes e o tabagismo é há muito conhecida. Estima-se que um em cada cinco diabético seja fumador, acrescentando ao risco cardiovascular base da sua doença também este por definição evitável. Por outro lado, os fumadores têm também maior risco de vir a apresentar diabetes. É fundamental levar as pessoas com diabetes a não fumar ou se o fizerem a abandonar o hábito. Este grupo deve ser prioritário nos programas de cessação tabágica.

This article presents the results of a research project on the design of a particular value capture instrument in the form of a development obligation. This has been modelled to capture part of the betterment engendered by tourism-oriented plans. The article subsequently explores the potential of applying this levy in the interest of social goals, thus complementing traditional municipal funding sources. The concept is applied to the Urban Zoning Plan of the Planning Unit 11 of the municipality of Lagoa, located in the Algarve, Portugal. It tries to overcome several gaps and contradictions identified in the literature and in the planning practices of different value capture instruments in diversified urban contexts. These shortcomings refer to: (i) uncertainties as to why the land value rises; (ii) undefined thresholds between betterment and profit; (iii) the classification of value capture whether as a tax or as an instrument of wealth redistribution; (iv) the application of the captured value; (v) dilemmas between private property rights and citizens’ rights over betterments due to public decisions; (vi) public regulation versus free market operation; (vii) responsibilities, benefits and obligations of private individuals in urban development; and (viii) the design, execution as well as the risks of capture instruments. This adds to the specific requirements enforced by the Portuguese Land Act regarding the economic and financial sustainability of urban development. This instrument is based on objective, reliable, and comparable data. This data is organised into a management information system which supports a flexible and continually updatable model to assess betterments engendered by public decisions. This model is easily generalizable to other urban contexts. Finally, the potential of the proposed instrument to achieve social goals is assessed against the background of factors such as the fiscal challenges currently faced by municipalities, the rising importance of increasingly diversified stakeholders and their awareness of issues of sustainability in urban development.

Maintaining connectivity in landscapes where natural ecosystems are quickly replaced by human land-uses is a challenge. To reduce the effects of habitat loss, ecological corridors have been proposed as a relevant tool for landscape planning. We aimed to develop a spatial model to identify and prioritize riparian corridors to improve landscape connectivity. The model considers the effect of the land-use/cover types and remaining forests on the movement capacity of a focal species sensitive to fragmentation. Since landscape elements act as barriers or promoters to ecological fluxes, suitability values were set according to the element’s ability in providing habitat. The model recognizes the effect of the contact between associated elements along the riparian corridor’s width and length and corrects their suitability. These procedures enabled the calculation of the Utility Factor, resulting in a measure of the quality of the corridor. The results show that the model assists the identification of the riparian corridor’s sections where connectivity is hampered and management efforts are required to maintain landscape connectivity. In addition, it can be applied to select the corridors dominated by large forests, which could be designed for conservation purposes. The two study cases evidence that the model is flexible, adjustable to distinct landscapes, and the decision-maker’s objectives. We concluded that the proposed strategy helps decision-makers to prioritize the territories for managing or preserving connectivity. Finally, the method provides quantitative information that would not be perceived by just interpreting land-use/cover maps.

This study aims to expand the knowledge on consumer experiences and values from an innovative marketing perspective in the context of shopping centers of inland towns in the Brazilian Northeast region. A qualitative approach was adopted using 50 in-depth interviews of shopping center visitors to collect data. Interpretative Phenomenological Analysis was used to evaluate the data. The results revealed two main categories: unpleasant and pleasant experiences. In terms of main results, 23 participants have a mix of pleasant and unpleasant experiences, while 24 report only pleasant, and 3 – unpleasant experiences. The unpleasant experiences are mostly related to the excess of people (n = 19). In what refers to pleasant experiences, functionality (n = 43), and sensory (n = 33) are the two most mentioned values, being functionality the top value to consumers regardless the purpose they have in going to the Shopping Centre. The results can be relevant inputs to design and manage Shopping Centers regarding cultural adjustment by considering consumers’ experiences and values and the importance of joining competing values behind pleasant and unpleasant experiences. The study contributes to the experiential marketing literature by highlighting the importance of cultural contexts in consumer experiences and behavior research. AcknowledgmentMaria Raquel Lucas and Andreia Dionísio are pleased to acknowledge financial support from Fundação para a Ciência e a Tecnologia (grant UIDB/04007/2020).

Background Lymphomas in the oral and oropharyngeal regions are relatively uncommon, and their diagnosis is challenging and complex due to the myriad histopathological subtypes. Herein, we report a large series of oral and oropharyngeal lymphomas and compare our data with the currently available literature. Methods All cases diagnosed as lymphomas affecting the oral and oropharyngeal regions were retrospectively retrieved from seven Brazilian institutions. Clinicodemographic data and histopathological features were evaluated and described, while a comprehensive literature review was undertaken in order to compare our findings. Results A total of 304 cases of oral and oropharyngeal lymphomas were obtained, mostly affecting individuals aged 60-69 years (n = 68) with a mean age at diagnosis of 54.2 ± 20.1 years. Males and females were equally affected. Mature B-cell neoplasms (87.2%) were the most common group, followed by mature T- and NK-cell neoplasms (11.2%) and precursor lymphoid neoplasms (1.6%). The most frequent subtypes in each group were diffuse large B-cell lymphomas, not otherwise specified (n = 99), extranodal NK/T-cell lymphomas, nasal type (n = 12), and B-lymphoblastic leukaemia/lymphomas, not otherwise specified (n = 4). The most commonly involved sites were the palate (26.3%), mandible (13%), and maxilla (10.5%). Conclusion Diffuse large B-cell lymphoma, not otherwise specified, remains the most common subtype of lymphomas in the oral and oropharyngeal region. Older patients are the most affected, with no gender predilection and the palate and jaw are usually affected.

Background Burkitt lymphoma (BL) is an aggressive B-cell lymphoma with three variants (endemic, sporadic, and immunodeficiency-associated), presenting with specific epidemiological and clinical features. Burkitt lymphoma affects the head and neck region (BLHN) in approximately 10% of cases. The aim of this study was to undertake a comparative analysis of the clinicopathologic and immunohistochemical (IHC) features of BLHN diagnosed in patients from Africa, Guatemala, and Brazil. Methods Cases diagnosed as BLHN were collected from the files of six oral pathology laboratory services (Brazil, South Africa, and Guatemala), and one Brazilian pediatric oncology hospital from 1986 to 2020. Clinicopathological and IHC data, and Epstein-Barr virus (EBV) status by in situ hybridization data for each case were reviewed and described. Results Of the 52 cases, BLHN was predominant in pediatric patients [43 (82.69%)] and males [43 (82.69%)], with a mean age of 11.26 ± 9.68 years (range, 1-39 years). Neck and cervical lymph nodes [14 (26.92%)], and involvement of both maxilla and mandible [8 (15.38%)], were the most common anatomical sites. Clinically, tumor/swelling [40 (31.25%)], cervical lymphadenopathy [14 (10.94%)], pain [12 (9.38%)], and bone destruction [12 (9.38%)] were frequent findings. All cases showed typical morphological characteristics of BL. IHC profiles included positivity for CD20 [52 (100%)], CD10 [38 (79.17%)], Bcl6 [29 (87.88%)], and c-Myc protein [18 (81.82%)]. EBV was positive in 18 cases (62.07%). The Ki-67 index ranged from 90-100%. Conclusion The clinicopathological and EBV profile of BLHN in South African, Guatemalan and Brazilian patients is similar.

Background Plasma cell neoplasms are characterized by the proliferation of a single clone of plasma cells with production of a monoclonal immunoglobulin. They can manifest as a single lesion (plasmacytoma) or as multiple lesions (multiple myeloma). Methods Paraffin-embedded tissue blocks of patients microscopically diagnosed with plasma cell neoplasms in the jaws were retrieved from five pathology files. Data including clinical, radiographic, microscopic and immunohistochemical findings, treatment employed, and follow-up status were retrieved from the pathology reports. Results Fifty-two cases were retrieved (mean age: 59.4 years) without sex predilection. The mandible was the most affected site (67.3%), usually associated with pain and/or paresthesia (53.8%). Lesions in other bones besides the jaws were reported for 24 patients (46.2%). Radiographically, tumors usually presented as poorly defined osteolytic lesions with unilocular or multilocular images, while microscopy revealed diffuse proliferation of neoplastic plasma cells with nuclear displacement and abundant eosinophilic cytoplasm. Two cases were classified as anaplastic, and amyloid deposits were found in two other cases. Immunohistochemistry was positive for plasma cell markers and negative for CD20 and CD3, and monoclonality for kappa light chain predominated. The overall survival rate after 5-years of follow-up was 26.6%. Conclusion Plasma cell neoplasms are aggressive tumors with a poor prognosis and involvement of the jaws may be the first complaint of the patient. Thus, oral pathologists, head and neck surgeons and dentists should be aware of their clinical, radiographic and microscopic manifestations.

O-Glycosylation changes in misfolded proteins are of particular interest in understanding neurodegenerative conditions such as Parkinson's disease (PD) and incidental Lewy body disease (ILBD). This work outlines optimizations of a microwave-assisted nonreductive release to limit glycan degradation and employs this methodology to analyze O-glycosylation on the human striatum and substantia nigra tissue in PD, ILBD, and healthy controls, working alongside well-established reductive release approaches. A total of 70 O-glycans were identified, with ILBD presenting significantly decreased levels of mannose-core (p = 0.017) and glucuronylated structures (p = 0.039) in the striatum and PD presenting an increase in sialylation (p < 0.001) and a decrease in sulfation (p = 0.001). Significant increases in sialylation (p = 0.038) in PD were also observed in the substantia nigra. This is the first study to profile the whole nigrostriatal O-glycome in healthy, PD, and ILBD tissues, outlining disease biomarkers alongside benefits of employing orthogonal techniques for O-glycan analysis.

Objective The aim of this study was to evaluate the influence of viral load and lymphocyte count on survival of patients who presented with human immunodeficiency virus (HIV)-associated oral Kaposi's sarcoma. Study Design Thirty-one cases (from January 2010 to December 2019) of oral Kaposi's sarcoma in patients with HIV from 2 oral pathology centers in Brazil were reviewed, considering clinical data and correlation of viral load and lymphocyte count with overall survival. Overall survival rates were estimated by a Kaplan-Meier analysis and compared using a log-rank test. The factors introduced stepwise into a Cox proportional hazard model to identify the independent predictors of survival. A P value Results Most of the patients were males (90.3%) with a mean age of 32.4 years (range, 19-58). Hard palate, soft palate, and tongue were the most affected sites. Treatment, viral load >999 copies/mL, CD4+ level ≤200 cells/mm3, CD4+/CD8+ level ≤0.39 cells/mm3, and CD4+ nadir level Conclusions Survival of patients affected by oral HIV-associated Kaposi's sarcoma is influenced by treatment, viral load, CD4+, CD4+/CD8+, and CD4+ nadir count.

BACKGROUND: In patients co-infected with HIV and tuberculosis, antiretroviral therapy options are limited due to drug—drug interactions with rifampicin. A previous phase 2 trial indicated that raltegravir 400 mg twice a day or efavirenz 600 mg once a day might have similar virological efficacy in patients given rifampicin. In this phase 3 trial, we assessed the non-inferiority of raltegravir to efavirenz. METHODS: We did a multicentre, open-label, non-inferiority, randomised, phase 3 trial at six sites in Côte d'Ivoire, Brazil, France, Mozambique, and Vietnam. We included antiretroviral therapy (ART)-naive adults (aged ≥18 years) with confirmed HIV-1 infection and bacteriologically confirmed or clinically diagnosed tuberculosis who had initiated rifampicin-containing tuberculosis treatment within the past 8 weeks. Using computerised random numbers, we randomly assigned participants (1:1; stratified by country) to receive raltegravir 400 mg twice daily or efavirenz 600 mg once daily, both in combination with tenofovir and lamivudine. The primary outcome was the proportion of patients with virological suppression at week 48 (defined as plasma HIV RNA concentration

Scaled up planning and implementation of nature-based solutions requires better understanding of broad characteristics (typologies) of the current governance and financing landscape, collaborative approaches amidst local complexities, and factors of scalability. An inventory was compiled of water-related ecological infrastructure intervention projects in two river systems in South Africa, incorporating actor, environmental, social, and financial dimensions and benefits. Qualitative participatory analysis revealed eight typologies. Post-hoc classification analysis determined similarities and/or unique characteristics of seven quantitative typologies. Key characterising factors included the complexity/size of financial flows, complexity of partnership/governance arrangements, mandates/goals of actors, type of ecological infrastructure, trade-offs in investment in ecological/built infrastructure, and the model used for social benefits. Identified scalable typologies offer structures suited to increased investment, with other typologies offering specialised local value. A range of ecological infrastructure intervention typologies with differing biophysical and socioeconomic outcomes provide choices for investors with specific goals, and benefits to landscape actors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13280-021-01531-z.

© 2021 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved., Preeclampsia (PE), a pregnancy disorder influenced by oxidative stress and hypoxia, affects the health of the mother and baby and is associated with an increased risk of future hypertension (HT). Aquaporins are a family of water channels, comprising members that also transport glycerol (aquaglyceroporins) and hydrogen peroxide (peroxiporins), key molecules for metabolic homeostasis and redox signaling. Here, we investigated the association of Aquaporin-3 (AQP3; rs2231231), Aquaporin-7 (AQP7; rs2989924), NOS3 (4B/A intron) and CYBA (rs4673) genetic polymorphisms with the development of hypertensive disorders by qPCR/PCR in a cohort of 150 normotensive (NT) women (N = 90) or with previous PE (N = 60) during pregnancy. Prospectively, women were reclassified 2-16 years after pregnancy as NT (N = 98) or hypertensive (N = 48) and the genetic associations were reevaluated. In addition, genetic associations were reevaluated and compared between normotensive and hypertensive (HT) subjects. We found that AQP3 rs2231231, an aquaglyceroporin/peroxiporin, is associated with the development of HT, whereas AQP7, NOS3 and CYBA polymorphism did not correlate with PE or future HT. Because AQP3 was associated with hypertension only after pregnancy, its role might be related to later risk factors of hypertension such as metabolic syndrome or oxidative stress., This research was funded by Fundação para a Ciência e Tecnologia (FCT), Portugal, through individual fellowship to IV da Silva (PD/BD/113634/2015), grant PTDC/BTM-SAL/28977/2017 and strategic projects UIDB/04138/2020 and UIDP/04138/2020 (iMed.ULisboa) and UIDB/04378/2020.

Introdução: O processo de envelhecimento configura ao idoso alterações importantes no controle postural. Essas alterações de equilíbrio predispõe o indivíduo que envelhece a um maior risco de queda, sendo, por isso, cada vez mais importante a implementação e o estudo de recursos que objetivem o ganho de equilíbrio, tanto em fins preventivos quanto terapêuticos. Objetivo: Avaliar o efeito da utilização do slackline como recurso auxiliar no treino de equilíbrio em idosos. Metodologia: Trata-se de um estudo quantitativo, quase-experimental, tendo como sujeitos da pesquisa dez idosas, participantes de um grupo de envelhecimento pela Universidade Aberta à Terceira Idade. Os sujeitos foram submetidos a uma avaliação prévia, com escalas e instrumentos validados de mensuração do equilíbrio e passaram por uma intervenção para treino de equilíbrio, utilizando como recurso o slackline. Após a intervenção, que durou seis semanas, com frequência de duas vezes por semana, as idosas foram reavaliadas com os mesmos testes. Resultados: Os resultados apontaram que o treino através do slackline proporcionou um ganho significativo para equilíbrio postural na Escala de Avaliação do Equilíbrio e da Marcha de Tinetti 26,20 (p

Chronic heel pain is a challenging diagnosis and although it is a common and disabling condition frequently mistreated. Baxter Nerve (BN) entrapment is responsible for 20% of heel pain and can be managed by an ultrasound guide nerve block, a simple, safe, and durable technique. A 67-year-old woman complained of paraesthesia on the left heel and a “stepping on glass” feeling. Various techniques were performed to manage her symptoms without any results. An ultrasound BN block was finally performed with an instant relief and satisfactory pain control for the follow-up period of six months. This clinical report highlights the success of the ultrasound BN block as an effective and lasting solution for chronic heel pain.

Introduction: The species Acinetobacter baumannii, within its genus, is the most important for epidemiological surveillance because it is associated, in humans, with different types of infections. Objectives: To evaluate the occurrence and resistance profile of Acinetobacter baumannii in biological samples of patients attended at an oncological hospital. Methods: Descriptive, retrospective and transversal study, carried out from the results of cultures of hospitalized patients and from the outpatient clinic of an oncological hospital, in the period from January 2017 to December 2018. Results: 1,258 positive cultures were recorded in 2017 and 1,729 in 2018. Within this, were obtained 5% of isolates of Acinetobacter baumannii in the first year of analysis and 8% in the second. The topographic site of highest isolation of A. baumannii, was the respiratory tract. The highest rates of occurrence were in older patients. The most frequent hospital sector of the bacteria were the Intensive Care Units. Acinetobacter baumannii showed lower resistance to colistin and tigecycline in both years of the study. The variation of the Minimum Inhibitory Concentration was more evident in the antibacterial drugs colistin. Conclusion: The results show that Acinetobacter baumannii is an important pathogen that causes nosocomial infections, commonly isolated from the respiratory tract of patients hospitalized at Intensive Care Units which presents a high resistance profile to most antibacterial classes.