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Aotearoa New Zealand's aquatic ecosystems are declining despite widespread awareness of mitigation needs. This study employs storytelling to address this issue, testing the role of the messenger in encouraging freshwater restoration in rural catchment communities. We quantified peer-to-peer knowledge exchange on three cognitive processes (retention and extraction of information, motivation to reproduce modelled restoration behaviour, and recall of acquired information), using ArcGIS® ‘StoryMaps’. We created two restoration stories; one told through the voice of a respected catchment group member known for leadership, and one through a collective catchment group voice. We surveyed freshwater community members (N = 82) before and after reading the stories, and one month later, and found that participants reading either catchment restoration story (1) accepted both the catchment collective and the respected individual member as a trusted source, and could therefore relate to either, and (2) thought the story was informative and contained new details, independent of the time span land holders have been actively restoring. While our study found no significant differences between individual or collective storytellers, it confirms the value of trusted messengers as restoration knowledge brokers in rural catchment communities, a critical step in value-led freshwater restoration at large scales.

Abstract Neoadjuvant endocrine therapy (NET) for hormone receptor-positive (HR+) breast cancer might be as effective as chemotherapy, with a better toxicity profile. Blocking a crucial process such as angiogenesis with sunitinib may have a synergistic effect with NET. We aimed to assess the efficacy and safety of neoadjuvant sunitinib plus exemestane in early-stage HR+/HER2-negative breast cancer. In this phase I/II study, postmenopausal women with HR+/HER2− stage II-III breast cancer received neoadjuvant exemestane at conventional dose of 25mg plus sunitinib in a 3 + 3 design at 25mg (3/1weeks scheme) or 37.5mg continuous dose, for 6 months. Coprimary endpoints were the recommended dose of sunitinib combined with exemestane and objective response. Secondary endpoints included safety and biomarkers of early response. For 15 months, 18 patients were enrolled, 15 at sunitinib 25mg and 3 at 37.5mg. Median age was 73, 77% of patients had T2 tumors and 67% node-positive disease. The most common grade 2 toxicity was asthenia (44%), as was hypertension (22%) for grade 3. No grade 4–5 were reported. Twelve patients (66%) achieved an objective response. VEGFR-2 levels significantly decreased after one month of treatment. Differential gene expression analysis showed downregulation of ESR1, PGR and NAT1 in post-treatment samples and upregulation of EGFR, MYC, SFRP1, and FOXC1. PAM50 analysis on 83% of patients showed a prevalence of luminal A subtype, both in pre-treatment (63.6%) and post-treatment tumors (54.5%). Sunitinib plus exemestane was associated with substantial yet reversible toxicities, providing safety, efficacy and biological impact insights of combining an antiangiogenic drug with hormone therapy in early-stage breast cancer. Trial registration: Registered with ClinicalTrials.gov, NCT00931450. 02/07/2009

Abstract Genes of the Sprouty family (Spry1-4) are feedback inhibitors of receptor tyrosine kinases, especially of Ret and the FGF receptors. As such, they play distinct and overlapping roles in embryo morphogenesis and are considered to be tumor suppressors in adult life. Genetic experiments in mice have defined in great detail the role of these genes during embryonic development, however their function in adult mice is less clearly established. Here we generate adult-onset, whole body Spry1/2/4 triple knockout mice. Tumor incidence in triple mutant mice is comparable to that of wild type littermates of up to one year of age, indicating that Sprouty loss per se is not sufficient to initiate tumorigenesis. On the other hand, triple knockout mice do not gain weight as they age, show less visceral fat, and have lower plasma glucose levels than wild type littermates, despite showing similar food intake and slightly reduced motor function. They also show alopecia, eyelid inflammation, and mild hyperthyroidism. Finally, triple knockout mice present phosphaturia and hypophosphatemia, suggesting exacerbated signaling downstream of FGF23. In conclusion, triple knockout mice develop a series of endocrine abnormalities but do not show increased tumor incidence.

Abstract Background Myths of sexual aggression have a negative influence in aggressive behavior against women, in the institutional approaches to sexual violence and in how women cope with it. The objective of this study is to describe acceptance of myths of sexual aggression in young women and men residing in Spain. Method Cross-sectional study carried out online with 2,515 women (50.2%) and men (49.8%) ages 18–35 in Spain in 2020. Information on myths was collected using the Acceptance of Modern Myths About Sexual Aggression Scale (AMMSA). We described the myths most prevalent among women and men. The variables associated with myths were identified using multiple regression. The regression models were adjusted by sociodemographic and sexual orientation variables. Results The average AMMSA values were higher among men [mean: 3.11; standard deviation (sd):1.23] than among women (mean 2.49 sd:1.11). In both sexes, the myths with greater acceptance showed the presence of patriarchal gender roles in sexual contacts. Men were more likely than women to accept myths that question allegations and severity of violence. Having a higher level of educational studies (β -0.350 sd: 0.046) was associated with lower average AMMSA values. Being born in Latin America (β 0.047 sd: 0.063) was associated with higher average AMMSA values. Among heterosexual men, AMMSA values were greater than among gay and bisexual men. Among women, there was no difference in average AMMSA values based on sexual orientation. Conclusions Myths persist during youth that question and trivialize sexual violence against women. It is necessary to implement strategies that reduce these myths, particularly in heterosexual men, in those of foreign-born origin and among those with low levels of education.

Abstract Objective To evaluate the safety of a minimum continuous positive airway pressure of 4 cmH2O (CPAP + 4) during computed tomography (CT)-guided radiofrequency ablation (RFA) for lung malignancies under procedural sedation and analgesia (PSA). Methods This was a prospective, randomised, single-blind, parallel-group, placebo-controlled trial with an open-label medical device conducted at a single tertiary university hospital in Barcelona, Spain. Forty-six patients over 18 years of age scheduled for CT-guided RFA of a malignant pulmonary tumour under PSA were randomised to receive either CPAP + 4 or a modified mask for placebo CPAP (Sham-CPAP). Exclusion criteria included contraindications for RFA, refusal to participate, inability to understand the procedure or tolerate the CPAP test, lung biopsy just prior to RFA, intercurrent diseases, or previous randomisation for additional pulmonary RFA. Primary outcomes were the percentage of patients reporting at least one serious adverse event (SAE), classification for complications from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and Clavien-Dindo classifications for complications, hospital stay, and readmissions. Secondary outcomes included adverse events (AEs), respiratory parameters, airway management, and the local radiological efficacy of pulmonary ablation. Results CPAP + 4 prolonged hospital stay (1.5 ± 1.1 vs. 1.0 ± 0 inpatient nights, p = 0.022) and increased the risk of AE post-RFA (odds ratio (95% CI): 4.250 (1.234 to 14.637), p = 0.021 with more pneumothorax cases (n = 5/22, 22.7% vs. n = 0/24, 0%, p = 0.019). Per-protocol analysis revealed more SAEs and CIRSE grade 3 complications in the CPAP + 4 group (23.5% vs. 0%, p = 0.036). No significant differences were found in the effectiveness of oxygenation, ventilation, or pulmonary ablation. Conclusion CPAP is unsafe during CT-guided RFA for lung cancer under PSA even at the lowest pressure setting. Trial registration ClinicalTrials.Gov, ClinicalTrials.gov ID NCT02117908, Registered 11 April 2014, https://www.clinicaltrials.gov/study/NCT02117908 Critical relevance statement This study highlights the hazards of continuous positive airway pressure during radiofrequency ablation of lung cancer, even at minimal pressures, deeming it unsafe under procedural sedation and analgesia in pulmonary interventional procedures. Findings provide crucial insights to prioritise patient safety. Key Points No prior randomised controlled trials on CPAP safety in percutaneous lung thermo-ablation. Standardised outcome measures are crucial for radiology research. CPAP during lung RFA raises hospital stay and the risk of complications. CPAP is unsafe during CT-guided RFA of lung cancer under procedural sedoanalgesia. Graphical Abstract

ABSTRACT The expansion of sugarcane, a tropical high‐yielding feedstock, will likely reshape the Southeastern United States (SE US) bioenergy landscape. However, the sustainability of sugarcane, particularly as it displaces grazed pastures, is highly uncertain. Here, we investigated how pasture conversion to sugarcane in subtropical Florida impacts net ecosystem CO2 exchange (NEE) and net ecosystem carbon (C) balance (NECB). Measurements were made over three full growth cycles (> 3 years) in sugarcane—plant cane, PC; first ratoon cane, FRC; second ratoon cane, SRC—and in improved (IM) and semi‐native (SN) pastures, which make up ca. 37% of agricultural land in the region. Immediately following conversion, PC was a stronger net source of CO2 than pastures, indicating the importance of CO2 losses related to land disturbance. Sugarcane, however, shifted to a strong net sink of CO2 after first regrowth, and overall sugarcane was a stronger net CO2 sink than pastures. Both stand age and low water availability during cane emergence and tillering substantially decreased its potential gross CO2 uptake. Accounting for all C gains and removals (i.e., NECB), greater frequency of burn events and repeated harvest increased removals and overall made sugarcane a stronger C source relative to pastures despite substantial C inputs from the previous land use and a stronger CO2 sink strength. Time since conversion substantially reduced C losses from sugarcane, and the NECB of SRC was similar to that of IM pasture but lower than that of SN pasture, indicating a rapid shift in the NECB of cane. We conclude that the C‐balance implications following conversion will depend on the proportion of IM versus SN pastures converted to sugarcane. Furthermore, our findings suggest that no‐burn harvest management strategies will be critical to the development of a sustainable bioenergy landscape in SE US.

Over the last few years, percutaneous procedures have undergone great advances, thanks to the ultrasound (US) guidance, due to the technical improvements in the US field, combined with the greater availability, good portability, and reduced cost of US devices. The direct target visualization and the real-time imaging performance enabled by US-guidance account for an improved accuracy in needle placement in several rheumatology interventions. So, ultrasound-guided procedures contribute to several diagnostic or therapeutic procedures such as fluid aspiration or treatment instillations of common joints, tendons, and bursas. In clinical practice, this fact is especially important in the case of depth areas like the hip, small anatomical structures as tendon sheaths or nerves in tenosynovitis or nervous blocks, or complex anatomical structures like the spine’s facet joints. The US-guide is an essential tool for performing diagnostic procedures as synovial biopsy. US can also be combined with other imaging techniques, like the establishment portal arthroscopy for instance. Compared to older blind procedures, US-guided injections are more accurate and safer, and they result in better clinical outcomes in terms of joints improvement in function and decreased risk of damages caused by needle misplacement. With the ultrasound guided treatment, we can avoid the instillation of therapeutic products outside the predetermined target, which may be sometimes potentially harmful. The aim of this article is to describe the main generalities of ultrasound-guided procedures in rheumatology, their main advantages and disadvantages, and their particularities in joints where they are most frequently used, such as the shoulder, hip, and knee.

The Pliocene faunas of the northeastern Iberian Peninsula are poorly known due to the scarcity of deposits from this interval. In this context, the site of Sant Nofre-Campredó (Baix Ebre, Catalonia, Spain), comprising two contemporaneous outcrops belonging to geologically correlated sections (Sant Nofre and Campredó-Via Fèrria), makes a significant contribution to the study of Pliocene faunas in this region. The first vertebrate remains were recovered in the late 1970s in clay deposits close to the Sant Nofre Hill. Later, intensive sampling in the 1980s at the Campredó-Via Fèrria outcrop led to the recovery of more than a hundred fossil specimens, including small vertebrates and large mammals. Here, we revise these collections to expand and update the vertebrate list, better constrain the age of the continental deposits, and characterize the environment and climate around the mouth of the Ebro River during the formation of the site. Up to 24 vertebrate species have been identified at Sant Nofre-Campredó, including amphibians, reptiles, and mammals. The presence of the rodents Paraethomys baeticus Piñero & Verzi, 2020, Apocricetus barrierei (Mein & Michaux 1970), and Occitanomys brailloni Michaux, 1969 implies an early Ruscinian age (MN14 unit) for the two outcrops. Biostratigraphic correlations with other well-dated sites in the Iberian Peninsula refine the estimated age of Sant Nofre-Campredó to approximately 4.6 Ma. The ecological affinities of the identified fauna reveal a landscape dominated by woodland habitats in the surroundings of the site during the Early Pliocene, with presence of open humid meadows and water bodies under warm and moist climatic conditions.

Societal Impact Statement Transformative agricultural strategies like agrivoltaics (AV) are essential for addressing the pressing global issues of sustainable energy and food production in a changing climate. Conservation‐agrivoltaics (Conservation‐AV) provides the potential to meet these needs while reinforcing natural resources and protecting the environment. It could enhance the ecological benefits of AV by improving soil health and biodiversity. It could create economic opportunities for farmers and increase the resilience and diversity of food crops under changing climate conditions. Furthermore, it could inform stakeholders about the benefits and challenges of implementing conservation agriculture management practices (CAMP) in AV and encourage further exploration and adoption of this innovative approach. Summary Transformative strategies in agriculture are needed to address urgent global challenges related to energy and food production while reinforcing natural resources and the environment. Agrivoltaics (AV) has emerged in the past decade as one solution to this fundamental challenge of improving energy and food security. AV is defined as the co‐location of solar photovoltaic (PV) panels and crops on the same land to optimize food and energy production simultaneously and sustainably. Here, we propose that AV, together with conservation agriculture management practices (CAMP) strategies can help to intensify food security and energy production while reinforcing natural resources and the environment. Our main assertions in this opinion article are that: (1) AV systems need to overcome several agronomical, environmental, and ecological challenges to intensify food and energy production sustainably; (2) CAMP applied to AV systems can preserve the environment and ensure climate‐resilient food production; (3) implementation of CAMP in AV can lead to long‐term carbon sequestration, lower greenhouse gas emissions, and maintain or increase crop yields while preserving soil health and biodiversity; and (4) adoption of CAMP in AV can bring economic benefits, although challenges need to be overcome. This opinion article proposes a new ecosystem approach to integrate renewable energy and sustainable food production and encourages research on the effects of CAMP on AV systems.

Background: Recurrent urinary tract infection (rUTI) remains a major health burden for women. A randomized, double-blind, placebo-controlled trial (RCT; NCT02543827) reported that female patients with rUTI receiving a sublingual vaccine, MV140, had a reduction in rUTI and increase in UTI-free rate compared with placebo. Objective: To determine the impact of MV140 on the personal burden of disease in women with rUTI using secondary endpoint data from the pivotal RCT evaluating MV140. Design, setting, and participants: In the primary RCT, female patients with rUTI enrolled in Spain and UK (from October 2015 to April 2019) were randomized to placebo (6 mo) or MV140 (3 or 6 mo), and followed for 12 mo. Individuals analyzed in this secondary analysis included those in the placebo and 3-mo (recommended dose) groups. Intervention: A polybacterial sublingual vaccine, MV140 (four inactivated whole-cell bacteria—Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, and Enterococcus faecalis), or placebo. Outcome measurements and statistical analysis: Symptom severity scoring, antibiotic use, safety, and multiple aspects of quality of life (QoL; Short-Form Questionnaire [SF-36]) were assessed. Results and limitations: Compared with the placebo group (n = 76), the 3-mo vaccinated group (n = 74) experienced fewer overall UTI symptoms (mean symptom score 102.2 ± 222.9 vs 194.2 ± 178.8; p = 0.0002), fewer days on antibiotics (12.4 ± 17.7 vs 28.7 ± 25.2; p = 0.0001), and improved total, general, and physical SF-36 QoL improvement (differences in means for total SF-36 score 15.7; 95% confidence interval [CI] 8.80, 22.64; p

En el artículo se propone una estrategia para la capacitación de los tutores de la práctica pedagógica en el adiestramiento laboral en el Instituto Superior de Ciencias de la Educación (ISCED) en la provincia Huambo-Angola, que responde a las insuficiencias detectadas durante el adiestramiento laboral de los estudiantes de quinto año de la carrera Matemática. A través de la aplicación de métodos empíricos se logró identificar que una de los causales fundamentales que propician estas insuficiencias está dada por la falta de preparación de los profesores que asumen el rol de tutores durante esta etapa para orientar, acompañar y evaluar a los estudiantes en formación. La propuesta fue sometida al criterio de expertos y fue valorada de pertinente y factible, lo que permite a estos estudiantes apropiarse de los conocimientos y las habilidades necesarias para enfrentar esta labor en el nuevo contexto en que se desarrolla la Educación en Angola.

Abstract Interpreting chest X-rays is a complex task, and artificial intelligence algorithms for this purpose are currently being developed. It is important to perform external validations of these algorithms in order to implement them. This study therefore aims to externally validate an AI algorithm’s diagnoses in real clinical practice, comparing them to a radiologist’s diagnoses. The aim is also to identify diagnoses the algorithm may not have been trained for. A prospective observational study for the external validation of the AI algorithm in a region of Catalonia, comparing the AI algorithm’s diagnosis with that of the reference radiologist, considered the gold standard. The external validation was performed with a sample of 278 images and reports, 51.8% of which showed no radiological abnormalities according to the radiologist's report. Analysing the validity of the AI algorithm, the average accuracy was 0.95 (95% CI 0.92; 0.98), the sensitivity was 0.48 (95% CI 0.30; 0.66) and the specificity was 0.98 (95% CI 0.97; 0.99). The conditions where the algorithm was most sensitive were external, upper abdominal and cardiac and/or valvular implants. On the other hand, the conditions where the algorithm was less sensitive were in the mediastinum, vessels and bone. The algorithm has been validated in the primary care setting and has proven to be useful when identifying images with or without conditions. However, in order to be a valuable tool to help and support experts, it requires additional real-world training to enhance its diagnostic capabilities for some of the conditions analysed. Our study emphasizes the need for continuous improvement to ensure the algorithm’s effectiveness in primary care.

Abstract BackgroundOfficial conference hashtags are commonly used to promote tweeting and social media engagement. The reach and impact of introducing a new hashtag during an oncology conference have yet to be studied. The American Society of Clinical Oncology (ASCO) conducts an annual global meeting, which was entirely virtual due to the COVID-19 pandemic in 2020 and 2021. ObjectiveThis study aimed to assess the reach and impact (in the form of vertices and edges generated) and X (formerly Twitter) activity of the new hashtags #goASCO20 and #goASCO21 in the ASCO 2020 and 2021 virtual conferences. MethodsNew hashtags (#goASCO20 and #goASCO21) were created for the ASCO virtual conferences in 2020 and 2021 to help focus gynecologic oncology discussion at the ASCO meetings. Data were retrieved using these hashtags (#goASCO20 for 2020 and #goASCO21 for 2021). A social network analysis was performed using the NodeXL software application. ResultsThe hashtags #goASCO20 and #goASCO21 had similar impacts on the social network. Analysis of the reach and impact of the individual hashtags found #goASCO20 to have 150 vertices and 2519 total edges and #goASCO20 to have 174 vertices and 2062 total edges. Mentions and tweets between 2020 and 2021 were also similar. The circles representing different users were spatially arranged in a more balanced way in 2021. Tweets using the #goASCO21 hashtag received significantly more responses than tweets using #goASCO20 (75 times in 2020 vs 360 times in 2021; zP ConclusionsIntroducing a gynecologic oncology specialty–specific hashtag (#goASCO20 and #goASCO21) that is related but different from the official conference hashtag (#ASCO20 and #ASCO21) helped facilitate discussion on topics of interest to gynecologic oncologists during a virtual pan-oncology meeting. This impact was visible in the social network analysis.

In the complex landscape of energy transition, Cultural Heritage emerges as a fundamental pillar of ‘innovability’, suggesting a lesson from the past. Historically, technical culture has been able to adapt building wisdom to available energy resources, demonstrating surprising resilience and an innate propensity for innovation. The energy adaptation associated with conserving this heritage must preserve the Mediterranean identity this essay aims to address; traditional technologies are still relevant today, while modern energy technologies require harmonious integration. This symbiosis between past and present is of crucial practical and symbolic importance: reconnecting with our cultural roots in moving towards a more sustainable future ensures a painless path to energy efficiency. Article info Received: 05/05/2024; Revised: 12/05/2024; Accepted: 20/05/2024

BackgroundPolymerized allergoids conjugated with mannan represent a novel approach of allergen immunotherapy targeting dendritic cells. In this study, we aimed to determine the optimal dose of mannan-allergoid conjugates derived from grass pollen (Phleum pratense and Dactylis glomerata) administered via either the subcutaneous or sublingual route.MethodsA randomized, double-blind, placebo-controlled trial with a double-dummy design was conducted, involving 162 participants across 12 centers in Spain. Subjects were randomly allocated to one of nine different treatment groups, each receiving either placebo or active treatment at doses of 500, 1,000, 3,000, or 5,000 mTU/mL over four months. Each participant received five subcutaneous (SC) doses of 0.5 mL each, every 30 days, and a daily sublingual (SL) dose of 0.2 mL. Participants who received active treatment through SC, received placebo through SL. Participants who received active treatment through SL, received placebo SC. One Group, as control, received bot SC and SL placebo. The primary efficacy outcome was the improvement in titrated nasal provocation tests (NPT) at the end of the study compared to baseline. Secondary outcomes included specific antibody (IgG4, IgE) and cellular (IL-10 producing and regulatory T cell) responses. All adverse events and side reactions were recorded and assessed.ResultsPost-treatment, the active groups showed improvements in NPT ranging from 33% to 53%, with the highest doses showing the greatest improvements regardless of the administration route. In comparison, the placebo group showed a 12% improvement. Significant differences over placebo were observed at doses of 3,000 mTU/mL (p=0.049 for SL, p=0.015 for SC) and 5,000 mTU/mL (p=0.011 for SL, p=0.015 for SC). A dose-dependent increase in IgG4 was observed following SC administration, and an increase in IL-10 producing cells for both routes of administration. No serious systemic or local adverse reactions were recorded, and no adrenaline was required.ConclusionGrass pollen immunotherapy with mannan-allergoid conjugates was found to be safe and efficacious in achieving the primary outcome, whether administered via the subcutaneous or sublingual routes, at doses of 3,000 and 5,000 mTU/mL.Clinical trial registrationhttps://www.clinicaltrialsregister.eu/ctr-search (EudraCT), identifier 2014–005471–88; https://www.clinicaltrials.gov, identifier NCT02654223.

La Legionella es la bacteria causante de la legionelosis y constituye un notable problema de salud pública. El objetivo de este estudio es establecer la distribución y frecuencia de las diferentes especies y serogrupos de Legionella obtenidos de las muestras analizadas en el Laboratorio de Salud Pública de L’Hospitalet durante el período 2002-2019. Se analizaron 3 935 muestras de agua procedentes de instalaciones con probabilidad de proliferación y dispersión de Legionella mediante el método ISO 11731:1998. Se determinaron número y porcentaje de Legionella spp., L. pneumophila serogrupo Sg 1 y L. pneumophila Sg 2-14 por tipo de instalación y por año. Los resultados indican que las instalaciones con mayor presencia de Legionella son las que incluyen sistemas de agua caliente sanitaria (ACS), (36,4 %). Los sistemas de agua fría sanitaria (AFS) también han de ser considerados lugares propicios para el crecimiento de Legionella (17 %), junto con los sistemas de riego por aspersión (13,5 %). De la totalidad de las muestras positivas halladas en las instalaciones (21,5 %), L. pneumophila es la más aislada en cultivos (70,5 %) y el serogrupo más frecuentemente encontrado es el 2-14 (34,2 %), seguido del Sg 1 (26,4 %). Esto es contrario a lo encontrado en la mayoría de estudios publicados, ya que citan al Sg 1 como el más frecuente en muestras ambientales. Estos aspectos avalarían la necesidad de ampliar el espectro de diagnóstico de la enfermedad en pacientes ya que la mayoría de hospitales utilizan antígeno en orina, cuya principal limitación es que solo detecta L. pneumophila Sg 1.