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Objetivos: Descrever o desfecho do transplante de células tronco hematopoiéticas (TCTH) em pacientes (pts) com anemia de fanconi (AF) que desenvolveram síndrome mielodisplásica (SMD) ou leucemia mieloide aguda (LMA). Material e métodos: Análise retrospectiva dos prontuários médicos dos pts com AF em fase de SMD/LMA que foram submetidos ao TCTH entre janeiro de 2012 e dezembro de 2023. Resultados: Foram analisados 35 pts, a maioria do sexo masculino (n = 20). A mediana de idade foi 17 anos (2‒44 anos), sendo 51% menores de 18 anos (n = 17). Doze pts fizeram uso de andrógeno na fase de aplasia. Quinze pts foram transplantados com citopenia refratária (n = 15), seis pts com SMD com Excesso de Blastos tipo 1 (EB1); quatro com SMD tipo 2 (EB2) e dez com LMA. A maioria dos pts transplantados em fase avançada (SMD-EB2/LMA) recebeu esquema FLAG pré TMO (n = 12). Os doadores foram haploidênticos (n = 17), não aparentados (n = 11) e aparentados compatíveis (n = 7). Todos receberam medula óssea. Os regimes de condicionamento foram feitos com CY + FLU + TBI (NAP), FLU + TBI (Haplo). Quinze pts utilizaram seroterapia (ATG n = 10/Campath n = 5). Nenhum rejeitou. Nove pts tiveram recaída da doença após TCTH, com mediana de 240 dias (80‒1691 dias). Seis pts foram retransplantados, 1 fez uso de azacitidina como manutenção pós transplante e 1 usou venetoclax, mas todos evoluíram para óbito. A mediana de follow-up foi 3,6 anos (14 dias‒11,8 anos). A sobrevida global em 5 anos foi 51,4%. Dez pts morreram numa mediana de 138 dias após o TCTH (85‒1102 dias) e 3 pts morreram durante o condicionamento. A sobrevida livre de recaída foi 67,3% e a SG em 5 anos para pts em fase avançada foi 32,4%, com taxa de recidiva em 5 anos de 25%. As causas de óbito foram infecção fúngica invasiva (n = 5), progressão da doença (n = 4), infecções (bacteriana/viral n = 3), DECHa (n = 2), neoplasia (n = 1) e toxicidade medicamentosa (n = 1). Discussão: A AF é a causa hereditária mais frequente de falência de medula óssea. A incidência de SMD é 11% a 34% e a de LMA é de 10% a 37%, com taxas de sobrevida após o TCTH de 57% e 36% respectivamente, inferiores se comparados aos pts com LMA não portadores de AF. A adolescência ou a idade adulta jovem são os períodos mais comuns de evolução clonal. O uso de andrógenos tem resposta hematológica em cerca de 80% dos pts e não tem associação com evolução clonal, conforme a literatura. Neste estudo, quase a metade dos pacientes tinham mais de 18 anos e a SG foi semelhante às publicações anteriores (SG em 5 anos: 42%). O tratamento de pts com SMD e LMA tem altas taxas de recaída, pois os pts não toleram quimioterapia intensiva além da quimio resistência intrínseca. O esquema FLAG pré TCTH usa quimioterapia de baixa intensidade e a taxa de recidiva nesta população foi inferior à descrita na literatura (taxa de recidiva em 5 anos: 40%). As infecções fúngicas invasivas são uma preocupação devido à grande mortalidade associada. Conclusão: A AF continua sendo um desafio, devido ao alto risco de neoplasias secundárias. Mas estes resultados indicam que apesar do TCTH ser a única opção com possibilidade curativa para falência de medula óssea, a morte por infecção e recaída permanecem um grande problema. Mais estudos são necessários para determinar o melhor regime de condicionamento ou terapêutica de manutenção e profilática pós TCTH.

Objetivo: A má função do enxerto (PGF) após o Transplante de Células Tronco Hematopoiéticas (TCTH) é definida por citopenias dependentes de transfusões de sangue e/ou suporte de G-CSF, apesar do quimerismo completo do doador. O objetivo deste trabalho é descrever o uso do Eltrombopag (EPAG) para PGF em pacientes (pts) pediátricos submetidos a TCTH entre 2009 e 2023. Métodos: Análise retrospectiva de prontuários médicos. Resultados: 30 pts desenvolveram PGF após o TCTH e foram tratados com EPAG. A maioria eram do sexo masculino (n = 20) e a medina de idade no TCTH foi 8,1 anos (6m‒17,4a). Os diagnósticos foram: erros inatos de imunidade (n = 12), falência medular (n = 11) e leucemias agudas (n = 7). Os doadores foram haploidênticos (n = 16), não aparentados (n = 12) ou aparentados compatíveis (n = 2). Medula óssea foi a fonte de células predominante (n = 27) e a maioria dos pts recebeu condicionamento de intensidade reduzida (n = 20). A mediana de células CD34 infundidas foi de 4,94×106/kg (1,56–12,6×106/kg). O EPAG foi iniciado em uma mediana de 116 dias após o TCTH (42d‒9,3a), devido à trombocitopenia persistente, com anemia e neutropenia concomitantes em 7 e 8 pts, respectivamente. A dose inicial foi de 25 mg/dia, e eventualmente aumentada para 150 mg/dia em caso de falta de resposta, nas crianças mais velhas. Dois pts morreram no primeiro mês após o início do EPAG e não foram avaliáveis para resposta. 28 pcts sobreviveram mais de 3 meses após o início do EPAG, com 22 exibindo uma resposta hematológica. A mediana de tempo para resposta foi de 110 dias. Entre os respondedores, o EPAG foi descontinuado sem recaídas, e todos os pacientes permaneceram vivos e bem em um acompanhamento médio de 37 meses após o EPAG. Seis pts não responderam ao EPAG. Entre eles, 3 foram submetidos a um 2º TCTH, enquanto 3 pacientes morreram (2 por complicações infecciosas e 1 por recidiva da doença), ocorrendo pelo menos 4 meses após a descontinuação do EPAG. A sobrevida global (SG) de 2 anos foi de 82% (95% IC: 0,55‒0,95). Todos os efeitos colaterais foram leves e não levaram à descontinuação do EPAG. Discussão: A má função do enxerto tem incidência variável de 5% a 26% e aumenta as taxas de morbimortalidade pós TCTH, principalmente associada à infecções. As causas da PGF são incertas e os pts apresentam hipocelularidade medular intensa relacionada a um déficit na capacidade de produção plaquetária. No presente estudo, todos os pacientes tinham plaquetopenia. O EPAG se mostrou eficaz no tratamento da citopenia tardia em pacientes submetidos ao TCTH, corroborando os dados publicados. A mediana de tempo para resposta ao EPAG é 3 meses de tratamento e os resultados dos não respondedores refletiram impacto na SG. Além disso, podemos destacar, uma maior prevalência da PGF em pts que realizaram transplante com doador alternativo (haploidêntico), o que é descrito na literatura, possivelmente associado ao uso da CFA pós. Conclusão: O EPAG demonstrou ser uma opção terapêutica viável para pts com citopenias persistentes após o TCTH. No entanto, é importante notar que o tempo médio para a resposta foi cerca de 3 meses, portanto, é crucial que os pts recebam suporte adequado durante esse período. Mais estudos são necessários para confirmar esses achados e determinar a melhor abordagem de tratamento para essa população específica.

Abstract Gravimetry is a versatile metrological approach in geophysics to accurately map subterranean mass and density anomalies. There is a broad diversification regarding the working principle of gravimeters, wherein atomic gravimeters are one of the most technologically progressive class of gravimeters which can monitor gravity at an absolute scale with a high-repetition without exhibiting drift. Despite the apparent utility for geophysical surveys, atomic gravimeters are (currently) laboratory-bound devices due to the vexatious task of transportation. Here, we demonstrated the utility of an atomic gravimeter on-site during a gravity survey, where the issue of immobility was circumvented with a relative spring gravimeter. The atomic gravimeter served as a means to map the relative data from the spring gravimeter to an absolute measurement with an effective precision of 7.7 $${\upmu }$$ μ Gal. Absolute measurements provide a robust and feasible method to define and control gravity data taken at different sites, or a later date, which is critical to analyze underground geological units, in particular when it is combined with other geophysical approaches.

Service quality is crucial to consumer loyalty. However, it is challenging to understand and meet customer expectations effectively. Translating customer feedback into actionable insights in the service industry poses difficulties, particularly without a systematic approach that balances customer requirements with business constraints and strategic objectives. This study proposes an approach that integrates customer perspectives into multi-criteria decision models by utilizing the fuzzy Kano model to capture service perceptions and minimize response uncertainty. It also uses 5W2H and PROMETHEE II to formulate service improvement actions and establish prioritizations, providing a structured framework for managerial implementation. When implemented in the food truck sector, this framework proves effective in addressing unique challenges, enhancing service quality, boosting customer satisfaction, and fostering loyalty. This study offers a valuable contribution to management by presenting a replicable model that aids managers in making strategic decisions, aligning customer perspectives with management efforts, and providing insights for continuously improving initiatives within the food service industry.

Abstract Environmental DNA (eDNA) refers to genetic material released by organisms into their surrounding environment. Collecting and identifying eDNA has gained popularity for monitoring and surveillance of aquatic invasive species. Invasive species management is most successful when an invasion is identified early while population size is likely to be low, highlighting the importance of eDNA detection sensitivity. Various factors influence DNA yield recovered from environmental samples. Environmental DNA storage and extraction methods, for example, can be adjusted to maximize DNA yield, thereby improving detectability. In this study, we compared the performance of two eDNA storage and extraction methods in detecting three common aquatic invasive species (Bythotrephes longimanus, Dreissena polymorpha, and Faxonius rusticus) across five natural ecosystems of Minnesota, United States. One method involved storing filters in 95% ethanol (EtOH) and extracting DNA using a DNeasy PowerSoil Pro Kit (Qiagen, Hilden, Germany), whereas the other method used cetyl trimethylammonium bromide (CTAB) for storage and a phenol–chloroform–isoamyl (PCI) procedure for DNA extraction. We also investigated the effect of DNA extract volume (1 μL relative to 3 μL) in qPCR reactions on eDNA detections for the commercial kit method. The CTAB‐PCI method yielded significantly more positive detections, across all three species, compared to the EtOH‐Qiagen method. Moreover, we found that using 1 μL of DNA extract in qPCR reactions was equally effective as using 3 μL. To improve detections of aquatic invasive species, we recommend that researchers store eDNA sample filters in CTAB or a similar lysis buffer such as Longmire's solution and extract with PCI when feasible, but note that lower extract volumes might be used without negative effect when either increasing technical replicates or repurposing samples for the detection of multiple species.

Goal: This paper aims to identify the dimensions that impact the perception of the quality of Brazilian air services in the eyes of customers, using a questionnaire based on the SERVPERF model adapted for the service studied as a data collection instrument. Design/Methodology/Approach: The research used a quantitative approach, in which 810 questionnaires were analyzed using Structural Equation Modeling methodology. Results: The results showed that the relationship between quality perceived by clients and the dimensions of quality Tangibles and Empathy were those confirmed by Structural Equation Modeling in this research. The fact that the study is exploratory, and temporal indicates that in this period, Brazilian consumers attach more importance to the environment and appearance of aircraft, equipment, and employees of the companies and that their needs are met in a personalized way. Limitations of the investigation: Only Tangibles and Empathy dimensions were confirmed. Practical implications: With the feedback of the customer, including the constant need for an accuracy of the assumptions and hypotheses studied in this paper, an airline can identify what the real needs of its customer must be met and, in its strategic planning, identify the possible actions to be implemented, such as the priority of the investments, and, thus, to be able to increase the competitive advantage, offering the clients what they prioritize. Originality/Value: The information brought by this research can support the development of business strategies oriented in aspects related to tangible elements and empathy in the service to add value to the service perceived by the clients, contributing to the development of the activity and the sector.

ABSTRACT The objective of this study was to fit the Logistic growth model for plant height and number of nodes of two buckwheat cultivars at sowing times, as well as comparing the cultivars and sowing times. Twenty uniformity trials were carried out, formed by the combination of two buckwheat cultivars (IPR91-Baili and IPR92-Altar), sown at five times, for two consecutive years. Evaluations were carried out twice a week throughout the vegetative stage until the end of flowering. In each evaluation, five plants were randomly collected from each trial to measure plant height and count the number of nodes on the main stem. The logistic model was fitted with the values of the five plants of each evaluation. Model parameters were estimated, as well as their respective confidence intervals. The goodness of fit of the model was assessed through the coefficient of determination, Akaike information criterion, and residual standard deviation. The plant height and number of nodes of buckwheat, cultivars IPR91-Baili and IPR92-Altar, were described by the Logistic model. The Logistic model satisfactorily describes the growth of buckwheat plants, and a specific fit considering each cultivar and sowing time is needed.

Introduction: The immune reconstitution (IR) after the allogenic hematopoietic stem cell transplantation (allo-HSCT) is a progressive process intrinsically correlated to the therapeutic success. It is essential to understand the interfering factors in IR to prevent the HSCT-related mortality. Methods: We retrospectively evaluated the clinical outcomes, absolute lymphocyte counts (ALCs) and lymphocyte subtypes at different time-points of 111 pediatric patients with allogeneic HSCT for malignant and non-malignant diseases from 2013 to 2018. Results: The ALCs gradually increased on D+30, D+100, and D+180 (medians 634/μL, 1022/μL and 1541/μL, respectively). On D+100, the CD3+CD8+ achieved the highest recovery rate (68%), followed by the CD16+CD56+ (47%), CD3+CD4+ (39%) and CD19+ (8%). The adequate ALC recovery was associated with age < 8 years, bone marrow grafts, myeloablative conditioning, non-use of serotherapy and non-haploidentical donors. The ALC and CD3+CD8+ on D+100 counts were higher in patients with the cytomegalovirus infection. The CD3+CD4+ recovery was associated with an age < 8 years, a non-malignant disease and a lower incidence of acute graft-versus-host disease ≥ grade 2. Furthermore, the ALC recovery on D+100 resulted in a higher overall survival, regardless of the disease type (HR 3.65, 1.05 - 12.71, p = 0.04). Conclusion: Several factors influenced the IR after the allo-HSCT. The ALC ≥ 500/μL on D+100 was a simple IR predictor of survival, easily available to resource-limited centers.

Motivation and psychological characteristics play important roles in college student success. Upon matriculation, pre-health students must strive for academic success to present competitive profiles for health professions schools. In this qualitative study, 17 high-achieving, upper level pre-health students at a large, mid-Atlantic university participated in focus groups and wrote letters of advice to incoming freshmen, which provided insight into their definitions of academic success and the psychological and contextual factors they perceive as promoters of success. They struggled to reconcile their mastery goals for academic success with perceived expectations to perform and compete for admissions to health professions schools. Students with grit maintained passion for long-term goals and actively sought resources to support individual needs.

Wastewater surveillance for SARS-CoV-2 has been demonstrated to be a valuable tool in monitoring community-level virus circulation and assessing new outbreaks. It may become a useful tool in the early detection and response to future pandemics, enabling public health authorities to implement timely interventions and mitigate the spread of infectious diseases with the fecal excretion of their agents. It also offers a chance for cost-effective surveillance. Reverse transcription-quantitative polymerase chain reaction (RTqPCR) is the most commonly used method for viral RNA detection in wastewater due to its sensitivity, reliability, and widespread availability. However, recent studies have indicated that reverse transcription droplet digital PCR (RTddPCR) has the potential to offer improved sensitivity and accuracy for quantifying SARS-CoV-2 RNA in wastewater samples. In this study, we compared the performance of RTqPCR and RTddPCR approaches for SARS-CoV-2 detection and quantification on wastewater samples collected during the third epidemic wave in Saxony, Germany, characterized by low-incidence infection periods. The determined limits of detection (LOD) and quantification (LOQ) were within the same order of magnitude, and no significant differences were observed between the PCR approaches with respect to the number of positive or quantifiable samples. Our results indicate that both RTqPCR and RTddPCR are highly sensitive methods for detecting SARS-CoV-2. Consequently, the actual gain in sensitivity associated with ddPCR lags behind theoretical expectations. Hence, the choice between the two PCR methods in further environmental surveillance programs is rather a matter of available resources and throughput requirements.

Only a small proportion of refugees requiring treatment actually receive psychotherapy. Alongside structural barriers, it has been hypothesized that causal attributions for mental health problems that deviate from Western explanatory models may reduce refugees' help-seeking behavior. Prevailing assumptions suggest that refugees predominantly hold causal beliefs that are incompatible with the rationales of psychotherapy. Testing these assumptions requires a reliable assessment tool to evaluate refugees' causal beliefs. Therefore, we developed the Causal Attributions for Mental Health Problems Scale (MH-CAUSE) and validated it in a sample of Middle Eastern refugees living in Germany (N = 429). The outcomes of the psychometric analysis, which included exploratory and confirmatory factor analysis, internal consistency, and convergent validity, indicate that the MH-CAUSE is a suitable instrument for assessing refugees' causal beliefs about mental health problems. Our findings suggest that refugees' causal attributions are in line with a biopsychosocial-spiritual model of mental illness. Contrary to common assumptions, the majority of participants predominantly explained mental illness via psychosocial and biomedical causes, whereas spiritual beliefs were relevant only for a minority of participants. We observed significant associations between causal beliefs and help-seeking attitudes and behavior. However, effect sizes were only small to moderate. While mental health beliefs might contribute to mental health inequities, alleged cultural differences of refugees should not be overemphasized.

Background: Compared to the general German population, refugees in Germany are a high-risk group for trauma spectrum disorders. Currently, many barriers exist for the implementation of a screen-and-treat approach for mental disorders as part of the routine health care provision during the early stage of the immigration process. Objective: The aim of the present study was to develop and test a systematic screening approach to identify individual refugees in need of mental health care during the initial immigration phase. Method: 167 newly arrived refugees underwent a screening interview with the Refugee Health Screener (RHS) carried out by Intercultural Therapy Assistants (ITAs). The ITAs were super­vised by psychologists at a reception centre in Bielefeld, Germany. A subsample of 48 persons partici­pated in clinical validation interviews. Results: Findings demonstrated the need for and feasibility of a systematic screening during the initial immigration phase. However, established cut-off values of the RHS had to be adapted and the screening procedure had to be adjusted due to the needs of a significant number of refugees in severe psychological crises. Conclusion: A systematic screening that is applied shortly after arrival facilitates the early identification of refugees at risk of developing mental disorders and may be helpful to prevent chronic symptom development and an aggravation of psychological crises.