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In the framework of the wind energy network for distributed generation in urban environments for most South American countries, wind resource assessment studies have been carried out in activities to establish a suitable methodology to assess the wind potential in urban environments. Some methodologies are already published in research studies, and the wind tunnel is the most accurate solution to obtain insight into the wind resource when measurements are unavailable, which is the most frequent case. Nevertheless, besides its validity, one cannot disregard the high cost of producing a scaled urban model and access to a wind tunnel. In this sense, this paper compares results from a wind tunnel experiment and different numerical modeling approaches. Two commercial models (WindSim and Wasp Engineering) and one open-source CFD code (OpenFOAM) are used. The results from the modeling simulation concluded that CFD models could achieve lower deviations for the mean wind speed and turbulence intensity when compared with non-CFD models. With such results, CFD modeling is a promising tool for reliably evaluating wind potential in urban environments.

This work evaluated the process for heptaldehyde, undecylenic acid, and methyl undecenoate production from castor oil, methyl ester of castor oil, and ricinoleic acid. Experiments were performed in a continuous pilot-plant scale pyrolysis reactor. Those are very important green chemical products that the thermal cracking of castor oil might produce. Transesterification of castor oil produces methyl ricinoleate, and its thermal cracking generates methyl undecenoate and heptaldehyde. The pyrolysis temperatures tested were 530°C, 545°C, 560°C, and 575°C, with residence time from 17 s to 32 s and mass flow at 400 g/h of the mixture of materials with 25% distilled water. It was observed that the temperature influenced the bio-oil yield in different degree for each material. The bio-oil was characterized by iodine index, acid number, and mass, and the contents of its compounds were obtained by GC-FID chromatography. The best result for the undecylenic acid mass yield of the desired compounds occurred at 530°C, achieving 17.8% from ricinoleic acid and 16.5% from castor oil. For the heptaldehyde, the highest production was also obtained at 530°C, with a value of 20.7% from methyl ester and 15.2% from ricinoleic acid.

Abstract The most frequent volcanic eruptions are of low-intensity and small magnitude. They produce abundant ash-sized (

Justin K Scheer,1 Fabíola Costa,2 Dora Janela,2 Maria Molinos,2 Anabela C Areias,2 Robert G Moulder,3 Jorge Lains,4,5 Virgílio Bento,2 Vijay Yanamadala,2,6,7 Fernando Dias Correia2,8 1Department of Neurological Surgery, University of California, San Francisco, CA, USA; 2Sword Health, Inc, Draper, UT, USA; 3Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA; 4Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal; 5Faculty of Medicine, Coimbra University, Coimbra, Portugal; 6Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA; 7Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA; 8Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, PortugalCorrespondence: Fernando Dias Correia, Sword Health Inc, 13937 Sprague Lane Ste 100, Draper, UT, 84020, USA, Tel +1 385-308-8034, Fax +1 801-206-3433, Email fcorreia@swordhealth.comBackground: Musculoskeletal (MSK) pain is highly prevalent worldwide, resulting in significant disability, and comorbid sleep disturbances. Digital therapy for MSK pain can provide significant improvements in care access, alongside pain and disability reductions. However, studies on the effect of such programs on sleep are lacking.Purpose: To evaluate the impact on pain-related sleep impairment after a 12-week remote multimodal digital care program (DCP) for MSK conditions.Patients and Methods: This is an ad-hoc analysis of a decentralized single-arm study into engagement and clinical outcomes after a DCP for MSK rehabilitation. Patients were stratified by baseline sleep disturbance, based on sleep questions in the questionnaires: Oswestry Disability Index, Neck Disability Index, and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire. Additional outcomes were pain, Generalized Anxiety Disorder 7-item scale, Patient Health 9-item questionnaire, Work Productivity, and Activity Impairment, and program engagement.&#x00A0Results: At baseline, 5749 patients reported sleep disturbance (78.0% of eligible patients). These reported significantly worse clinical outcomes at baseline than patients without sleep disturbance (all p< 0.001). Patients with comorbid sleep disturbance showed improvements in sleep, with a significant proportion reporting full recovery at program completion: 56% of patients with upper limb conditions (including 10% of patients with severe sleep disturbance at baseline), and 24% with spine conditions. These patients also reported significant improvements in all clinical outcomes at program completion. Engagement and satisfaction were high, and also higher than in patients without sleep impairment.Conclusion: This is the first study of its kind investigating the effect of a completely remote DCP for MSK pain on sleep. Patients reporting comorbid sleep disturbance had significant improvement in sleep, alongside pain, mental health and work productivity at program completion. The results suggest that a DCP for MSK pain can improve sleep disturbances in patients with upper limb and spine conditions.Keywords: pain, physical therapy, eHealth, telerehabilitation, remote care

Extensive literature on the subject of International Joint Ventures (IJVs) has developed during the last few decades. This work aims at identifying the main trends in this literature using a bibliometric analysis. The analysis of 507 studies published between 1975 and 2019 has allowed for the identification of key authors and journals and has revealed that the literature is focused on topics related to performance and success factors, knowledge acquisition and management, control and developing economies such as China. Thus, future research can focus on topics that have been neglected such as corporate social responsibility, legitimacy and absorptive capacity, and the study of countries and regions relatively neglected.

Cristiane Giacomelli da Costa,1,&ast; Mehrsa Jalalizadeh,1,&ast; Reza Yadollahvandmiandoab,1 Keini Buosi,1 Leonardo O Reis1,2 1Department of UroScience, School of Medical Sciences, University of Campinas – UNICAMP, Campinas, São Paulo, Brazil; 2Pontifical Catholic University of Campinas, PUC, Campinas, São Paulo, Brazil&ast;These authors contributed equally to this workCorrespondence: Leonardo O Reis, Department of UroScience, School of Medical Sciences, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil, Tel +55 19 35217481, Email Reisleo@unicamp.brIntroduction: Bacillus Calmette–Guérin (BCG) has been shown to have protective effects against respiratory viruses. We conducted a scoping review of the literature to clarify the available evidence regarding the effect of BCG therapy in preventing respiratory complications of coronavirus disease 2019 (COVID-19).Methods: We searched PubMed, Embase, CENTRAL, Scopus, and Web of Science for related studies up to October 2022.Results: In total, 35 publications and trials were included. One animal study, two observational studies, and six finalized trials measured the effect of BCG administration on respiratory complications of COVID-19. The remaining publications included eight unfinished trials, 12 ecological studies, and six observational studies that did not directly measure respiratory complications but assessed overall mortality of the disease and were included as an adjunct to our study. All trials involved vaccinating adults to protect them against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, and measured respiratory symptoms or the need for intensive respiratory support as the primary or secondary aim of the study. One trial that exclusively included at-risk adults between 18 and 60 years old showed a decreased chance of respiratory complications as the secondary outcome of the study. Another trial that exclusively evaluated this effect on the elderly (60 years and older) as the primary aim of the study reported no protective effect against respiratory complications. The remaining literature provided mostly inconclusive evidence.Conclusion: The majority of the literature on the protective effect of BCG against respiratory complications of COVID-19 is inconclusive.Keywords: COVID-19, SARS-CoV-2, pulmonary complication, respiratory system, immunotherapy, BCG, scoping review

Alexandra Ferreira-Valente,1– 3 Benjamin P Van Dyke,4 Melissa A Day,2,5 Catarina Teotónio do Carmo,1 José Pais-Ribeiro,1 Filipa Pimenta,1 Rui M Costa,1 Mark P Jensen2 1William James Center for Research, Ispa – University Institute, Lisbon, Portugal; 2Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; 3Research Center for Human Development, Faculty of Education and Psychology, Universidade Católica Portuguesa, Porto, Portugal; 4Department of Psychology, Young Harris College, Young Harris, GA, USA; 5School of Psychology, Faculty of Health & Behavioral Sciences, University of Queensland, Brisbane, AustraliaCorrespondence: Alexandra Ferreira-Valente, Research Center for Human Development, Faculty of Education and Psychology, Universidade Católica Portuguesa, Rua de Diogo Botelho, Porto, 1327 4169-005, Portugal, Tel +351 226196200, Email mafvalente@gmail.comPurpose: Previous research supports the usefulness of hypnosis (HYP), mindfulness meditation (MM), and prayer as pain self-management strategies in adults with chronic pain. However, their effects on acute pain have been less researched, and no previous head-to-head study compared the immediate effects of these three approaches on pain-related outcomes. This study compared the immediate effects of HYP, MM, and Christian prayer (CP) on pain intensity, pain tolerance, and stress as assessed by heart rate variability (HRV).Participants and Methods: A total of 232 healthy adults were randomly assigned to, and completed, a single 20-minute session of MM, SH, CP, or an attention control (CN), and underwent two cycles (one pre- and one post-intervention) of Cold Pressor Arm Wrap (CPAW). Sessions were audio-delivered. Participants responded to pre- and post-intervention pain intensity measurements. Pain tolerance (sec) was assessed during the CPAW cycles. HRV was assessed at baseline, and at pre- and post-intervention CPAW cycles. The study protocol was pre-registered at the ClinicalTrials.gov registry (NCT04491630).Results: Small within-group decreases in pain intensity and small increases in pain tolerance were found for HYP and MM from the pre- to the post-intervention. Small within-group improvements in the LH/HF ratio were also found for HYP. The exploratory between-group pairwise comparisons revealed a medium effect size effects of HYP on pain tolerance relative to the control condition. The effects of CP were positive, but small and not statistically significant. Only small to medium, though non-significant, Time × Group interaction effects were found.Conclusion: Study results suggest that single short-term HYP and MM sessions, but not biblical-based CP, may be useful for acute pain self-management, with HYP being the slightly superior option. Future research should compare the effects of different types of prayer and examine the predictors and moderators of these pain approaches’ effects on pain-related outcomes.Keywords: hypnosis, mindfulness meditation, prayer, experimental pain, cold pressor arm wrap

Deforestation of Caatinga and inadequate land use of these dry environments have impacted soil quality in Northeastern Brazil. The objectives of this study were: (a) to evaluate the effect of deforestation and different agricultural uses on the physical and chemical properties of soil, and humic fractions of soil organic matter in dry environments; and (b) to detect the soil properties that were most affected by anthropic actions. We evaluated four dry areas in Chapada do Araripe, NE Brazil: preserved native vegetation; degraded native vegetation; cassava conventional cultivation; and eucalyptus agro-energy cultivation. Soil fertility, total organic carbon and humic fractions of soil organic matter were lower in the degraded native vegetation area. The best indicators for soil quality evaluation were: macroporosity; bulk density; soil resistance penetration; sum of bases (mainly Ca2+); available P; and saturation by Al3+. Total organic carbon and humic acid fractions of soil organic matter were important in improving soil quality. These properties were influenced by deforestation and agricultural uses, suggesting that the deforestation of native vegetation in dry environments has high capacity to degrade the soil, preventing its regeneration.

The use of open-pollinated seeds from seed orchards is a common strategy for the deployment of genetically improved eucalypts, including Eucalyptus globulus, an important pulpwood tree in many temperate climate areas. However, seed quality can be affected by the rate of selfing and to a lesser extent by contamination from pollen outside the orchard. Inbreeding between related parents and especially from self-crosses is known to cause diminished growth and developmental abnormalities in the resulting progeny. This study looks at the magnitude and variation in selfing and the impact in inbreeding depression across several E. globulus families collected over the years in a seed orchard. The effects on growth and development of outcrossed and selfed progeny were studied across five progeny trials, after pedigree reconstruction of the open pollinated progeny based on SSR genotyping. An additive genetic mixed linear model was fitted to the data to evaluate the impact of inbreeding on height growth. The results showed a significant inbreeding depression, with a height growth reduction of 15% in selfed progeny, when compared with crosses from unrelated parents. These inbreeding depression values varied among families, ranging between 7% and 24%, evidencing the importance of genetic background. Contamination rates were on average 10% suggesting long distance pollen dispersal was present. A small number of abnormal phenotypes (less than 10%) was observed in the field. This was associated with specific, unrelated, crosses and not to high inbreeding rates such as found among selfed progeny. The relevance of these results for orchard management and parent selection is discussed.

The amygdala facilitates memory encoding in the hippocampus. Here the authors show, using simultaneous intracranial recordings from these regions, that emotional memory encoding is mediated by the amygdala theta phase to which hippocampal gamma activity and neuronal firing is coupled.

Introduction: Significant progress has been made in terms of best practice in research data management for nanosafety. Some of the underlying approaches to date are, however, overly focussed on the needs of specific research projects or aligned to a single data repository, and this “silo” approach is hampering their general adoption by the broader research community and individual labs.Methods: State-of-the-art data/knowledge collection, curation management FAIrification, and sharing solutions applied in the nanosafety field are reviewed focusing on unique features, which should be generalised and integrated into a functional FAIRification ecosystem that addresses the needs of both data generators and data (re)users.Results: The development of data capture templates has focussed on standardised single-endpoint Test Guidelines, which does not reflect the complexity of real laboratory processes, where multiple assays are interlinked into an overall study, and where non-standardised assays are developed to address novel research questions and probe mechanistic processes to generate the basis for read-across from one nanomaterial to another. By focussing on the needs of data providers and data users, we identify how existing tools and approaches can be re-framed to enable “on-the-fly” (meta) data definition, data capture, curation and FAIRification, that are sufficiently flexible to address the complexity in nanosafety research, yet harmonised enough to facilitate integration of datasets from different sources generated for different research purposes. By mapping the available tools for nanomaterials safety research (including nanomaterials characterisation, nonstandard (mechanistic-focussed) methods, measurement principles and experimental setup, environmental fate and requirements from new research foci such as safe and sustainable by design), a strategy for integration and bridging between silos is presented. The NanoCommons KnowledgeBase has shown how data from different sources can be integrated into a one-stop shop for searching, browsing and accessing data (without copying), and thus how to break the boundaries between data silos.Discussion: The next steps are to generalise the approach by defining a process to build consensus (meta)data standards, develop solutions to make (meta)data more machine actionable (on the fly ontology development) and establish a distributed FAIR data ecosystem maintained by the community beyond specific projects. Since other multidisciplinary domains might also struggle with data silofication, the learnings presented here may be transferrable to facilitate data sharing within other communities and support harmonization of approaches across disciplines to prepare the ground for cross-domain interoperability.

This theoretical study presents a D-shaped photonic crystal fiber (PCF) surface plasmon resonance (SPR) based sensor designed for humidity detection in transformer oil. Humidity refers to the presence of water dissolved or suspended in the oil, which can affect its dielectric properties and, consequently, the efficiency and safety of the transformer’s operation, failures in the sealing system and the phenomenon of condensation can be the main sources of this humidity. This sensor leverages the unique properties of the coupling between surface plasmons and fiber guided mode at the Au-PCF interface to enhance the sensitivity to humidity changes in the external environment. The research demonstrated the sensor’s efficacy in monitoring humidity levels ranging from 0% to 100% with an average sensitivity of measured at 1106.1 nm/RIU. This high sensitivity indicates a substantial shift in the resonance wavelength corresponding to minor changes in the refractive index caused by varying humidity levels, which is critically important in the context of transformer maintenance and safety. Transformer oil serves as both an insulator and a coolant, and its humidity level is a key parameter influencing the performance and longevity of transformers. Excessive humidity can lead to insulation failure and reduced efficiency and, therefore, the ability to accurately detect and monitor humidity levels in transformer oil can significantly enhance preventive maintenance strategies, reduce downtime, and prevent potential failures, ensuring the reliable operation of electrical power systems.

Uric acid plays important roles in the body, acting as an antioxidant, contributing to the elimination of metabolic waste, and helping to combat some infections. Alterations in uric acid concentration can be important indicators of disease and their real-time and point-of-care monitoring is of extreme importance, for instance in primary care facilities. Optical fibre biosensors are a promising option, allowing real-time detection, quantification, and monitoring of uric acid concentrations in blood plasma or urine. In this work, enzymatic plasmonic sensors were developed for the detection of uric acid using multimode optical fibres composed of a 400 µm silica core and a polymer cladding. To prepare the sensors, the coating and cladding were removed from a section at the fibre tip, and nano film of gold was deposited on their surface, obtaining gold-coated sensors at the fibre tips (Au-tips). Initially, the sensor was characterized to bulk refractive index, exhibiting a sensitivity of 1420.7 ± 59.8 nm/RIU. The Au-tip was biofunctionalized with the enzyme uricase and detection tests were carried out. Uric acid detection tests revealed a response consistent with the Michaelis-Menten function, which was employed to assess the enzymatic kinetics of uricase immobilized on the Au-tips.

This study investigated the effectiveness of a coil-shaped optical fiber interferometric sensor, with a diameter of 13 mm, for measuring compression. The sensor’s design utilizes the principles of interferometry to create a pattern that changes with applied pressure. This configuration significantly amplifies the sensor’s sensitivity to compression due to the extended optical path length within the compact form factor. The experimental results demonstrated that even small compressive forces caused detectable alterations in the interference pattern, allowing for precise quantification of pressure changes. The 13 mm diameter proved to be particularly advantageous, providing a balance between sensitivity and practical integration into various systems, from structural health monitoring to biomedical devices. This study also highlights the sensor’s robustness against electromagnetic interference and environmental variations, attributing this to the intrinsic properties of optical fiber. Overall, the findings suggest that coil-shaped optical fiber interferometric sensors are highly effective for accurate and reliable compression sensing, with potential for broad application across multiple industries.

Photonic circuits are an enabling technology for the development of novel solutions in different fields such as healthcare, quantum computing, neural networks, communications, and manufacturing. Interconnections between devices and systems require low-loss light coupling strategies. Grating couplers are a promising solution to couple light between photonic circuits and optical fibres due to their off-plane coupling capabilities. Hydrogenated amorphous silicon (a-Si:H), which can be deposited by PECVD over a substrate of silica or glass, is a suitable low-cost solution for the production of such light coupling devices. In this work we developed, trained and tested a fully connected feedforward neural network for coupling efficiency prediction in a-Si:H grating couplers. The light coupling gratings were simulated by twodimensional finite-difference time-domain (FDTD) analysis and field distributions were analysed with the Finite Element Method (FEM). Simulated gratings include non-apodized, linear and quadratic refractive index variation designs featuring full or partial etching, operating at 1550 nm. Not featuring any type of bottom reflector, the couplers exhibit coupling efficiencies up to about 40 % (~ -4 dB). The neural network multiclass grating coupler efficiency classifier was trained with over 3000 simulation results, reaching an accuracy over 85%, for coupling efficiencies between 0 and 30%+.

ALICE (A Large Ion Collider Experiment) has undertaken a major upgrade during the LHC Long Shutdown 2. The increase in the detector data rates led to a hundredfold increase in the input raw data, up to 3.5 TB/s. To cope with it, a new common Online and Offline computing system, called O2, has been developed and put in production. The O2/FLP (First Level Processor) system, successor of the ALICE DAQ system, implements the critical functions of detector readout, data quality control and operational services running in the CR1 data centre at the experimental site. Data from the 15 ALICE subdetectors are read out via 8000 optical links by 500 custom PCIe cards hosted in 200 nodes. It addresses novel challenges such as the continuous readout of the TPC detector while keeping compatibility with legacy detector front-end electronics. This paper discusses the final architecture and design of the O2/FLP system and provides an overview of all its components, both hardware and software. It presents the selection process for the FLP nodes, the different commissioning steps and the main accomplishments so far. It will conclude with the challenges that lie ahead and how they will be addressed.

The INFN Cloud project was launched at the beginning of 2020, aiming to build a distributed Cloud infrastructure and provide advanced services for the INFN scientific communities. A Platform as a Service (PaaS) was created inside INFN Cloud that allows the experiments to develop and access resources as a Software as a Service (SaaS), and CYGNO is the betatester of this system. The aim of the CYGNO experiment is to realize a large gaseous Time Projection Chamber based on the optical readout of the photons produced in the avalanche multiplication of ionization electrons in a GEM stack. To this extent, CYGNO exploits the progress in commercial scientific Active Pixel Sensors based on Scientific CMOS for Dark Matter search and Solar Neutrino studies. CYGNO, like many other astroparticle experiments, requires a computing model to acquire, store, simulate and analyze data typically far from High Energy Physics (HEP) experiments. Indeed, astroparticle experiments are typically characterized by being less demanding of computing resources with respect to HEP ones but have to deal with unique and unrepeatable data, sometimes collected in extreme conditions, with extensive use of templates and montecarlo, and are often re-calibrated and reconstructed many times for a given data set. Moreover, the varieties and the scale of computing models and requirements are extremely large. In this scenario, the Cloud infrastructure with standardized and optimized services offered to the scientific community could be a useful solution able to match the requirements of many small/medium size experiments. In this work, we will present the CYGNO computing model based on the INFN cloud infrastructure where the experiment software, easily extendible to similar experiments to similar applications on other similar experiments, provides tools as a service to store, archive, analyze, and simulate data.

CloudVeneto is a private cloud targeted to scientific communities based on OpenStack software. It was designed in 2013 and put in operation one year later, to support INFN projects, mainly HEP ones. Its resources are physically distributed among two sites: the Physics Department of University of Padova-INFN Padova Unit and the INFN Legnaro National Laboratories. During these 10 years CloudVeneto evolved to integrate also resources funded by ten Departments of the University of Padova, and to support several scientific disciplines of different domains. The use cases the communities have to face up often show a common pattern. This was an opportunity for us to develop and improve the services on our infrastructure to provide common solutions to different use cases. It happened for example with the Container as a Service (CaaS) that makes the management of Kubernetes clusters easier from a user point of view. Moreover, CloudVeneto joined the INFN national cloud infrastructure (INFN Cloud), making available some resources to this federated infrastructure. CloudVeneto is also involved in an R&D project to realize a distributed analysis facility for the CMS experiment based on the HTCondor batch system. In this paper we describe some use-cases of different projects pointing out the common patterns and the new implementations and configurations done in the infrastructure.

This paper presents a unified predictive modeling for Common-Mode (CM) and Differential-Mode (DM) impedance estimation of a Permanent Magnet Synchronous Motor (PMSM) with random wounds used in aeronautic applications. This methodology combines 2D Finite Element modeling and generated lumped parameter circuits in a Spice environment. It is then used to determine the consequences of design choices and evaluate the importance of controlling the winding process in PMSM manufacturing. By doing so and by changing parts of the PMSM design, the overall high-frequency response of the system with regard to input parameters can help in satisfying ElectroMagnetic Compatibility (EMC) high-frequency constraints (between 1 kHz and 10 MHz).This paper presents evidence demonstrating the importance of design parameters such as the number of wires in parallel used by turns and the overall placement of the conductor not only with regard to the slot but to other wires within the slot

Shahla Bari,1 David Boulware,2 Jiannong Li,2 Loretta Loftus,3 Aixa Soyano Muller,3 Zena Jameel,4 Hung Khong,3 Brian J Czerniecki,3 Ricardo LB Costa3 1Department of Hematology/Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; 2Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; 3Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; 4Department of Anatomic and Clinical Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USACorrespondence: Ricardo LB Costa, Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA, Tel +813 745 3806, Fax +813 745 7287, Email ricardo.costa@moffitt.orgPurpose: Estrogen receptor-positive (ER+) breast cancer (BC) is a heterogeneous disease, and there is an ongoing debate regarding the optimal cut point for clinically relevant ER expression. We used a real-world database to assess the prognostic and predictive values of lower ER expression levels on treatment outcomes with endocrine therapy.Methods: We used a nationwide electronic health record database. Descriptive statistics were used to evaluate the association between ER expression, tumor characteristics, and treatment patterns among patients with early-stage BC. We used Kaplan–Meier survival curves to estimate recurrence-free survival (RFS) and overall survival (OS). We assessed associations between an alternative ER expression-level cut point and clinical outcomes.Results: Among 4697 patients with early-stage HER2-negative BC, 83 (2.04%) had ER+-low BC (ER expression, 1– 9.99%) and 36 (0.88%) had ER+-intermediate BC (10– 19.9%). ER+-low tumors were associated with higher tumor grade, larger size, and higher axillary tumor burden than ER+-high tumors (≥ 20% ER expression). African Americans had a higher prevalence of both triple-negative BC (TNBC) and ER+-low BC than ER+-high BC. Patients with ER+-low and ER+-intermediate tumors had survival outcomes similar to patients with TNBC and worse survival outcomes than patients with ER+-high tumors (P < 0.001). Tumors with < 20% ER expression were associated with worse outcomes.Conclusion: In our cohort, patients with BCs with ER expression levels < 20% had poor clinical outcomes similar to those of patients with TNBC.Keywords: breast cancer, estrogen receptor, low-positive, recurrence-free survival

Eva Dopico,1,2 Francisco Rodriguez-Frias,3– 5 Itziar Ubillos,6 Ariadna Rando-Segura,3 Damir Garcia-Cehic,4,7 Josep Gregori,4,7 Yolanda Rando-Matos,8,9 Luis Solsona,8,9 Jordi Niubó,1,2 Juan Ignacio Esteban,4,7 Josep Costa,4,10 Miguel J Martínez,10,11 Josep Quer4,5,7 1Microbiology Department, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain; 2Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain; 3Biochemistry Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain; 4Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; 5Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain; 6Laboratory Clínic Territorial Metropolitana Sud, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain; 7Liver Diseases-Viral Hepatitis, Liver Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain; 8Equip d’Atenció Primària Florida Nord, Gerència d’Àmbit d’Atenció Primària Metropolitana Sud, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain; 9Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; 10Microbiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain; 11ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, SpainCorrespondence: Josep Quer, Liver Diseases-Viral Hepatitis, Liver Unit, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain, Tel +34 934894034, Email josep.quer@vhir.org Miguel J Martínez, Microbiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain, Email MYOLDI@clinic.catBackground: Hepatitis C virus (HCV) is a major cause of chronic liver infection with 71 million people infected worldwide. Pakistan has the second highest prevalence of HCV infection and more than half (52%) of Pakistani living in Spain reside in Barcelona. The aim of this study was to analyse the seroprevalence and viraemic rate and determine the genotypes and subtypes of HCV among Pakistanis living in the southern metropolitan area of Barcelona.Methods: We included all Pakistani patients seeking primary healthcare in the southern metropolitan area of Barcelona from August 2011 to July 2014. Serum samples were screened for HCV antibodies. HCV viral load was determined by reverse transcription polymerase chain reaction and genotypes and subtypes were performed using Versant HCV Genotype and/or deep-sequencing. Screening for hepatitis B virus (HBV) was also carried out.Results: Among 5877 Pakistani patients, 565 (9.61%) were screened for anti-HCV antibodies, with 68 (12.04%) being positive. The viral load was determined in 65, with 31 presenting active infection and the viraemic rate was 47.69% (95% confidence interval 36.02– 59.62). HCV genotyping and subtyping were performed in 24 individuals. Most infections corresponded to HCV genotype 3 (91.67%), and high resolution HCV subtyping was performed in 18 samples, 16 of which presented subtype 3a. One subject presented HBV coinfection with undetectable HBV DNA. During the study period, we identified a possible case of HCV vertical transmission followed by spontaneous viraemia clearance in a chronically infected mother with a C/T IL28B genetic polymorphism.Conclusion: These results suggest that general HCV screening protocols in patients from high prevalence countries, such as Pakistan, would be helpful to identify and treat active HCV infections. This could avoid further transmission and contribute to building targeted health policies for micro-elimination of HCV infection in specific communities.Keywords: hepatitis C virus, migrants, HCV genotype, HCV subtype

This paper analyses the longest sediment flows measured in action on Earth. These seabed flows were caused by floods and spring tides, and flushed prodigious sediment and carbon volumes into the deep sea, as they accelerated for a thousand kilometres.

Fabíola Costa,1 Dora Janela,1 Maria Molinos,1 Robert G Moulder,2 Jorge Lains,3,4 Virgílio Bento,1 Justin Scheer,5 Vijay Yanamadala,1,6,7 Fernando Dias Correia,1,8 Steven P Cohen9,10 1SWORD Health, Inc, Clinical Research, Draper, UT, USA; 2Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA; 3Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal; 4Faculty of Medicine, Coimbra University, Coimbra, Portugal; 5Department of Neurological Surgery, University of California, San Francisco, CA, USA; 6Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA; 7Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA; 8Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal; 9Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; 10Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USACorrespondence: Fernando Dias Correia, 65 E Wadsworth Park Dr Ste 230, Draper, UT, 84020, USA, Tel +1 385-308-8034, Fax +1 801-206-3433, Email fcorreia@swordhealth.comBackground: Low back pain (LBP) has a lifetime prevalence of 70– 80%. Access to timely and personalized, evidence-based care is key to prevent chronic progression. Digital solutions may ease accessibility to treatment while reducing healthcare-related costs.Purpose: We aim to report the results of a fully remote digital care program (DCP) for acute LBP.Patients and Methods: This was an interventional, single-arm, cohort study of patients with acute LBP who received a DCP. Primary outcome was the mean change in disability (Oswestry Disability Index – ODI) after 12 weeks. Secondary outcomes included change in pain (NPRS), analgesic consumption, surgery likelihood, depression (PHQ-9), anxiety (GAD-7), fear-avoidance beliefs (FABQ-PA), work productivity (WPAI) and engagement.Results: A total of 406 patients were enrolled in the program and of those, 332 (81.8%) completed the intervention. A significant disability reduction of 55.1% (14.93, 95% CI 13.95; 15.91) was observed, corresponding to a 76.1% responder rate (30% cut-off). Disability reduction was accompanied by significant improvements in pain (61.0%), depression (55.4%), anxiety (59.5%), productivity (65.6%), fear-avoidance beliefs (46.3%), intent to pursue surgery (59.1%), and analgesic consumption (from 35.7% at baseline to 10.8% at program end). DCP-related patient satisfaction score was 8.7/10.0 (SD 1.4).Conclusion: This study demonstrated the utility of a multimodal DCP for patients with acute LBP. Very high adherence rates and patient satisfaction were observed, alongside significant reductions in all assessed outcomes, consistent with the growing body of evidence supporting the management of acute LBP with DCPs.Keywords: physical therapy, telerehabilitation, digital therapy, eHealth, musculoskeletal conditions

Abstract Background Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspirational in its scope. This initiative aimed to produce guidelines for the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) using a novel methodology to maximise the likelihood of national adoption. Methods A voluntary steering committee oversaw 3 phases of development: 1) clarification of topic areas, data collection and assimilation, including systematic reviews and a National Audit of Practice; 2) a National Consensus Day, presenting data from the above to generate candidate consensus statements for indicative voting by attendees; and 3) a National Delphi Exercise seeking agreement on the candidate consensus statements, including representatives from all 58 UK Head and Neck Multidisciplinary Teams (MDT). Methodology was published online in advance of the Consensus Day and Delphi exercise. Results Four topic areas were identified to frame guideline development. The National Consensus Day was attended by 227 participants (54 in-person and 173 virtual). Results from 7 new systematic reviews were presented, alongside 7 expert stakeholder presentations and interim data from the National Audit and from relevant ongoing Clinical Trials. This resulted in the generation of 35 statements for indicative voting by attendees which, following steering committee ratification, led to 30 statements entering the National Delphi exercise. After 3 rounds (with a further statement added after round 1), 27 statements had reached ‘strong agreement’ (n = 25, 2, 0 for each round, respectively), a single statement achieved ‘agreement’ only (round 3), and ‘no agreement’ could be reached for 3 statements (response rate 98% for each round). Subsequently, 28 statements were adopted into the National MDT Guidelines for HNSCCUP. Conclusions The described methodology demonstrated an effective multi-phase strategy for the development of national practice recommendations. It may serve as a cost-effective model for future guideline development for controversial or rare conditions where there is a paucity of available evidence or where there is significant variability in management practices across a healthcare service.