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Background: Airway clearance impairment has a significant impact on self-care and quality of life. Identifying clinical data, nursing diagnoses, and nursing interventions is essential to clinical reasoning and enhancing nursing care. This study aims to map the existing evidence on clinical data, nursing diagnoses, and nursing interventions addressing the nursing focus on “airway clearance”. Methods: Research was conducted based on Joanna Briggs’s Scoping Review Methodology. We searched four databases for published studies until December 2023. Results: From the initial 1854 studies identified, 123 were included in the review. The findings highlighted two areas of nursing attention: one related to signs and symptom management, and the other related to education and coping strategies. The data that led to nursing diagnoses were divided into cognitive and clinical data. The nursing diagnoses were mostly related to secretion retention, excessive mucus production, and airway obstruction. The most commonly identified nursing interventions were educational interventions assembled into predesigned education programs rather than patient-tailored programs. Conclusions: Findings can add substantial value for systematizing the nursing process related to “airway clearance”, improving nursing decision-making and care quality. This study was prospectively registered with the Open Science Framework (OSF) on 02 December 2022, with the registration number wx5ze.

Background: Healthcare-associated infections (HAIs) pose a significant global threat, particularly in developing regions such as Southeast Asia. International bodies emphasize the role of formal undergraduate training in the prevention and control of HAIs. To address this, we aimed to explore the perceptions of Southeast Asian nursing students regarding a novel educational approach developed by a European–Southeast Asian project consortium. Methods: A pilot study was conducted in four nursing higher education institutions from Cambodia and Vietnam. First, local nursing educators conducted a 2 h classroom-based training session. Then, students were invited to participate for the first time in one of twelve evidence-based simulation scenarios developed by the research team, covering a range of nursing care situations related to the prevention and control of HAIs. After attending both components, students were asked to complete a paper-based questionnaire and rate their agreement with a set of statements on the appropriateness and meaningfulness of both components. Results: A total of 430 nursing students enrolled in the pilot study; 77.4% were female, with an average age of 19.8 years. The PrevInf educational intervention received positive feedback from participating students across settings, with strong agreement on the importance of proactiveness in competency development (M = 5.9, SD = 1.4). Notable differences between Cambodian and Vietnamese students were observed in terms of their receptiveness to the pre-selected teaching materials (p = 0.001) and strategies (p = 0.01) used by the nursing educators during their experience with the simulation scenarios. Conclusions: The PrevInf educational intervention shows promise in engaging Southeast Asian nursing students and fostering a deeper understanding of the prevention and control of HAIs. Further studies are warranted to refine the learning content and standardize the pedagogical strategies used by nursing educators across settings. This study was not registered.

Introdução: A paracoccidioidomicose (PCM) é uma micose sistêmica causada pelo fungo Paracoccidioides brasiliensis e Paracoccidioides lutzii. Está relacionada às atividades agrícolas, nas quais o manejo de solos contaminados favorece a inalação dos conídios que, posteriormente, darão origem as fases leveduriformes ou por contiguidade. Apresenta incidência e prevalência subestimadas, por não ser de notificação compulsória no Brasil com cerca de 80% nas regiões sul e sudeste do país. O quadro clínico insidioso pode evoluir com sequelas graves se não tratados precocemente, como DPOC exarcebada, cor pulmonale, doença de Addison, estenose de laringe e traqueia. Objetivo: Explanar sobre as variadas manifestações clínicas secundária ao diagnóstico de paracoccidioidomicose em um Hospital Universitário. Método: Trata-se de um estudo unicêntrico, transversal, retrospectivo com pacientes avaliados e atendidos entre os anos 2016 a 2022, avaliados pelo mesmo infectologista no Ambulatório de Micologia do Hospital Universitário Oswaldo Cruz da Universidade de Pernambuco. Raspagens e culturas das lesões foram coletadas pela equipe especializada de Micologia da instituição e as biópsias encaminhadas ao Serviço de Patologia da Universidade (CIAP). Resultados: Durante o período de acompanhamento sete pacientes foram diagnosticados baseado em biópsia e histopatológico, sendo todos os sete homens e com idade média de 51 anos. Três pacientes (42,85%) tiveram acometimento de vias áreas (pulmão, laringe e/ou cavidade nasal); três apresentaram acomentimento de mucosas (42,85%) (oral e anal); e um paciente com acometimento linfonodal (14,3%). Seis pacientes (85,7%) foram tratados com sulfametoxazol/trimetoprim, tendo um dentre eles iniciado o tratamento com anfotericina B, e um paciente tratado com Itraconazol (14,3%). Conclusão: Na literatura, o grande fator de risco descrito para aquisição da infecção são as profissões ou atividades relacionadas ao manejo do solo contaminado com o fungo, como atividades agrícolas, grupo do qual a maioria (57,1%) dos pacientes do nosso serviço faz parte. Sendo assim, a PCM pode se manifestar com clínicas variadas e algumas mais raras, como acometimento anal, tendo como diagnóstico diferencial neoplasia.

This paper proposes a multi-platform algorithm methodology in order to define firing angles of torque sharing functions (TSFs) for the indirect torque control of switched reluctance motors (SRM) through a hardware-in-the-loop (HIL) system. This proposal is used to achieve optimal levels of torque ripple and losses with accuracy and reliability, while taking advantage of real-time simulation. The analysis is performed assuming steady-state conditions of speed and torque reference for levels below the base speed, aiming to obtain firing angles ensuring optimal tracking performance. A novel methodology is proposed by using a grid search algorithm that handles the communication between Python, Code Composer, and the Typhoon HIL device. For that, an experimental data FPGA-based model with 500~ns of simulation time step is used to ensure highly accurate dynamic responses of current and electromagnetic torque. Moreover, controller-HIL (C-HIL) is used to have a safe and high fidelity testing environment, allowing rapid testing before transitioning to an experimental test bench. The simulation results are experimentally validated, demonstrating that the proposed strategy is effective and ensures optimal performance, taking into account peripheral systems of A/D, signal conditioning, PWM, and sensor emulation.

Abstract Circadian rhythms have been shown in the subthalamic nucleus (STN) in Parkinson’s disease (PD), but only a few studies have focused on the globus pallidus internus (GPi). This retrospective study investigates GPi circadian rhythms in a large cohort of subjects with PD (130 recordings from 93 subjects) with GPi activity chronically recorded in their home environment. We found a significant change in GPi activity between daytime and nighttime in most subjects (82.4%), with a reduction in GPi activity at nighttime in 56.2% of recordings and an increase in activity in 26.2%. GPi activity in higher frequency bands ( > 20 Hz) was more likely to decrease at night and in patients taking extended-release levodopa medication. Our results suggest that circadian fluctuations in the GPi vary across individuals and that increased power at night might be due to the reemergence of pathological neural activity. These findings should be considered to ensure successful implementation of adaptive neurostimulation paradigms in the real-world.

The treatment of wastewater worldwide generates substantial quantities of sewage sludge (SS), prompting concerns about its environmental impact. Various approaches have been explored for SS reuse, with energy production emerging as a viable solution. This study focuses on harnessing energy from domestic wastewater treatment (WWT) sewage sludge through plasma gasification. Effective syngas production hinges on precise equipment design which, in turn, depends on the detailed feedstock used for characterization. Key components of plasma gasification include the plasma torch, reactor, heat exchanger, scrubber, and cyclone, enabling the generation of inert slag for landfill disposal and to ensure clean syngas. Designing these components entails considerations of sludge composition, calorific power, thermal conductivity, ash diameter, and fusibility properties, among other parameters. Accordingly, this work entails the development of an experimental setup for the plasma gasification of sewage sludge, taking into account a comprehensive sludge characterization. The experimental findings reveal that domestic WWT sewage sludge with 40% humidity exhibits a low thermal conductivity of approximately 0.392 W/mK and a calorific value of LHV = 20.78 MJ/kg. Also, the relatively low ash content (17%) renders this raw material advantageous for plasma gasification processes. The integration of a detailed sludge characterization into the equipment design lays the foundation for efficient syngas production. This study aims to contribute to advancing sustainable waste-to-energy technologies, namely plasma gasification, by leveraging sewage sludge as a valuable resource for syngas production.

A espécie vegetal Vasconcellea quercifolia A. St.-Hil. é nativa do Brasil, promissora para a agricultura, com grande importância ecológica e grande consumo em algumas regiões. Neste estudo, objetivou-se analisar a fenologia reprodutiva e a fenologia vegetativa em uma população natural da espécie. Foram realizados levantamentos durante 25 meses, observando-se, aleatoriamente, 12 indivíduos da espécie, na Fazenda Lageado da Faculdade de Ciências Agronômicas, na cidade de Botucatu, estado de São Paulo, Brasil. Os métodos de observação foram: índice de atividade fenológica (sincronia) e índice de Fournier (presença da fenofase). Os resultados foram submetidos à correlação de Spearman. Os eventos fenológicos da espécie apresentaram alta sincronia. Frutificação e temperatura média apresentaram forte correlação positiva; repouso vegetativo e temperatura apresentaram forte correlação negativa. Quanto às fenofases, a brotação começou em agosto e terminou em novembro. A queda de folhas iniciou em dezembro – a planta vai gradativamente perdendo as folhas até estar 100% desfolhada no mês de junho. Os meses de novembro e dezembro apresentaram as maiores taxas de floração. Os primeiros frutos apareceram em outubro e os últimos frutos maduros foram vistos em maio; o pico da frutificação ocorreu em janeiro e fevereiro. Essa é uma espécie sincrônica que precisa do frio do inverno para quebrar a dormência das gemas para que a brotação ocorra. Estudos agronômicos, ecológicos, químicos e nutricionais são necessários para fortalecer o uso de espécies nativas com potencial econômico, os quais também podem contribuir para a preservação de seus hábitats.

ABSTRACT: Vegetable soybean has high nutritional value and offers functional benefits to human body. However, its use in cooking is still limited, mainly due to the lack of knowledge about its properties. In addition, the availability of cultivars for human consumption is reduced. Therefore, this study was conducted in Botucatu, Brazil, to assess the potential of grain soybean (GS) and dual-purpose soybean (DPS) cultivars for consumption as vegetable soybean (VS). Pods were harvested at R6 stage, and the contents of bioactive compounds (total phenolic compounds, flavonoids, antioxidant activity and proteins) and antinutritional components (nitrates, oxalate, alkaloids and tannins) were evaluated. The cultivars showed the same protein content, not differing statistically from each other, as well as for nitrate and oxalate. The content of phenolic compounds and total antioxidant activity of the SG cultivar differed statistically from the content of the DPS and VS cultivars, respectively. According to the results, the GS cultivar, with pods harvested at R6 stage, showed nutraceutical quality and contents of antinutritional compounds similar to those of the two cultivars proposed for the vegetable soybean.

Nowadays, it is urgent to develop new energy production and utilisation routes to achieve sustainable development with low environmental impact. Gasification of biomass wastes followed by biomethane production may contribute to achieve these goals. The objective of this paper is to study hot cleaning and upgrading processes of gasification gas to allow it to be suitable for biomethane production. Gas produced by gasification of eucalyptus wastes at 750 ºC and 850 ºC was used to study the hot gas conditioning process. For this, two sequential fixed bed steps with different catalysts or sorbents and at different temperatures were tested. In Pathway A, a low cost natural mineral, limestone, was used in both steps at temperatures from 500 º to 700 ºC. In Pathway B, limestone was used in the first step and in the second one, a nickel-based catalyst was tested. The effect of temperature was also studied by using temperatures between 500 ºC and 700 ºC. Pathway B showed to be the best option, especially at the highest temperature tested, producing a syngas richer in H2 and CO2, with very low contents of tar and heavier gaseous hydrocarbons. Pathway B was also effective for great NH3 and H2S reductions, around 90 %, leading to final NH3 and H2S concentrations of around 158 and 21 mg/m3, respectively. Further reductions will be studied by testing new multi-functional and more specific catalysts in the next studies, accordingly with new biomethanation catalysts requirements.

A focus on water quality has intensified globally, considering its critical role in sustaining life and ecosystems. Wastewater, reflecting societal development, profoundly impacts public health. Wastewater-based epidemiology (WBE) has emerged as a surveillance tool for detecting outbreaks early, monitoring infectious disease trends, and providing real-time insights, particularly in vulnerable communities. WBE aids in tracking pathogens, including viruses, in sewage, offering a comprehensive understanding of community health and lifestyle habits. With the rise in global COVID-19 cases, WBE has gained prominence, aiding in monitoring SARS-CoV-2 levels worldwide. Despite advancements in water treatment, poorly treated wastewater discharge remains a threat, amplifying the spread of water-, sanitation-, and hygiene (WaSH)-related diseases. WBE, serving as complementary surveillance, is pivotal for monitoring community-level viral infections. However, there is untapped potential for WBE to expand its role in public health surveillance. This review emphasizes the importance of WBE in understanding the link between viral surveillance in wastewater and public health, highlighting the need for its further integration into public health management.

This paper introduces an online dataset focused on detecting hairiness in yarn, including loop and protruding fibers. The dataset is designed for use in assessing artificial intelligence algorithms. The dataset consists of 684 original images. Through augmentation, this number increases to 1644, with 11,037 annotations derived from videos featuring 56.4tex purple cotton yarn. The videos were captured during the winding and unwinding processes of the purple yarn coil. An image acquisition system capable of capturing high-resolution images while the yarn is in motion was used, reaching speeds of up to 4.2 m/s and producing images with a resolution of 1.6M pixels. This dataset containing 100m of purple cotton yarn images was recorded and is available for download in various formats, including, among others, YOLOv8, YOLOv5, YOLOv7, MT-YOLOv6, COCO JSON, YOLO Darknet, Pascal VOC XML, TFRecord, CreateML JSON. Within an interface developed for a designed mechatronic prototype, users can choose to gather images or videos of yarn. Various characteristics of the yarn, such us: diameter, linear mass, volume, twist orientation, twist step, number of cables, hairiness index, number of loose fibers, thin places, thick places, neps (mass parameters) and U, CV and sH (statistical parameters) can be obtained. Recently, this online yarn spinning dataset was employed to validate artificial neural network models for real-time detection of hairiness in yarns, including loop fibers and protruding fibers. The dataset presented, with its clear annotations and wide array of augmentation techniques, serves as a foundational resource for prospective studies in textile engineering, enabling progress in the analysis and comprehension of yarn analysis.

Coxiella burnetii is the agent of Q fever, a disease that poses risks to public health and damages livestock. We discovered the circulation of C. burnetii for the first time in Paraguay, based on the seropositivity of a flock of >300 sheep. The animals were tested by IFA for anti-C. burnetii antibodies and by SAM for anti-Leptospira spp. antibodies, an important differential diagnosis for reproductive disorders in sheep in Paraguay. C. burnetii seropositivity was determined in 45%, in contrast to Leptospira spp. which had no reactive samples. Cases of miscarriage and fetal resorption were associated with high seropositivity titers. This study suggests the circulation of a unique genotype in the country and an imminent risk to public health, since in addition to being highly transmissible and infectious to humans, Q fever is still not a cause for concern on the part of government and health agencies in the country.

The large dc-link current is a known issue in switched reluctance motor (SRM) drives, which often demand the use of a bulky dc-link capacitor. However, control techniques can be designed and optimized to lessen this issue. In this context, this article proposes the optimization of analytical torque sharing functions (TSFs) for dc-link current reduction in SRMs. Initially, the analytical TSFs are described, and the importance of adequate parameter selection is highlighted. Next, an optimization procedure based on the nondominated sorting genetic algorithm II is proposed to determine the optimal turn-on and overlap angles by solving a multiobjective optimization problem considering torque rms error and dc-link rms current as objectives to be minimized, something not previously reported in the literature. The pareto fronts for different operating conditions are presented, including both soft and hard chopping operation, as well as different sampling frequencies. Then, an approach for selecting a solution from within the pareto front is described, enabling the result from the pareto front that yielded the desired tradeoff between torque RMSE and dc-link current to be identified. Experimental results are provided to support the effectiveness of the proposal. A comparison between three different cases is shown, highlighting the tradeoff between objectives.

Numerous plastic products are used in agriculture, including containers, packaging, tunnels, drip irrigation tubing, and mulches. Large amounts of plastics are used as mulches on the soil surface for vegetable and fruit production (tomato, cucumber, watermelon, strawberry, and vine) to reduce weed competition, increase water and fertilizer use efficiency, and enhance crop yield. Portugal uses around 4500 t/year of polyethylene to cover approximately 23,000 ha of agricultural land, and only a small amount is recovered for recycling or secondary uses because of issues of contamination with the soil, vegetation, pesticides, and fertilizers. Cleaning and decontaminating polyethylene mulch are costly, and commercial technology is often not accessible or economical. Most plastic mulch is composed of polyethylene that degrades slowly and produces a large quantity of residues in the soil, with a negative impact on the environment. In the present study, the effects of long-term cultivation of blueberry using green 100% high-density polyethylene mulch in the south Portugal were evaluated for soil chemical and biological changes. High-density green plastic mulch did not contaminate the topsoil with di(2-ethylhexyl) phthalate, and heavy metals, buttotal nitrogen, organic carbon concentrations, electric conductivity, and microbial activity were significantly reduced in the planting row compared with the bare soil without mulching. Furthermore, the presence of plastic mulch did not negatively affect the presence of nematodes, and the number of Rhabditida (bacterial feeders) increased in the planting and covered row.

The Free Word Association technique was used with the objective of knowing the perception of consumers about inspected and non-inspected cheeses and their main drivers. Participants residing in the State of Rio Grande do Sul, Brazil, were recruited online and invited to list the first four words and/or expressions that came to their minds when faced with images of uninspected homemade cheese and inspected cheeses, both artisanal and industrialized. All valid words were grouped by semantic meanings in dimensions/categories, and those cited by at least 5% of the participants were analyzed using the chi-square test of independence, considering 5% of the meaning. There was no statistical relationship (p0.05) of acceptance or rejection between the three types of cheese, most words related to feelings were positive for all products analyzed. For uninspected homemade cheeses, consumers’ perception is linked to traditional forms of production, mentioning words such as colonial, artisanal, homemade, and familiar; the correlation of these cheeses with cultural habits and forms of consumption is also strong. The artisanal inspected cheeses were associated with the words industrialized, standardized, label, packaging, and expensive, clearly linked to industrial manufacturing processes, greater consumer safety and greater added value. For inspected industrialized cheeses (mozzarella), the words pizza, snack, melted, and delicious indicate good acceptance and refer to gastronomy. The findings reveal that the perception of inspected cheeses is directly related to quality and control, which is not the case for non[1]inspected cheeses, related to traditional production and cultures.

This paper proposes a combined adaptive virtual Inertia and adaptive damping control of a virtual synchronous generator (AID-VSG) to improve the dynamic frequency response of microgrids. In the proposed control scheme, the VSG’s virtual inertia and damping coefficients adapt themselves during the transients to, respectively, reduce frequency deviations and increase the oscillations’ damping. In addition, as an important feature, the proposed AID-VSG is suitable for distributed control scheme applications and is designed to not rely on phase-locked loop (PLL) measurements, which avoids PLL stability issues on weak grids. The control parameters of the proposed AID-VSG are tuned by the particle swarm optimization (PSO) algorithm to minimize the overshoot and settling time of the microgrid’s frequency during an islanding event. The AID-VSG is validated by a comparative analysis with three existing VSG control schemes, also tuned by the stated optimization algorithm. The performance of each compared VSG strategy is evaluated through the simulation of a set of 10,000 initial conditions, using the islanded microgrid’s nonlinear model. The best response among the VSG strategies was achieved by the proposed AID-VSG control for both the optimization problem and the set of initial conditions’ simulations.

Resumo Os índios, em especial aqueles provindos do que então era entendido como “mestiçagem” ou “miscigenação” com brancos e negros, tornaram-se um fator-chave no plano teórico do médico e antropólogo Raimundo Nina Rodrigues. Habitualmente, sua herança intelectual é vinculada à população “áfrico-bahiana”, posto seus estudos detalhados sobre etnologia urbana. Este artigo busca explorar, dentre suas propostas, o papel do “brasílio-guarany” e seu fator nocivo para o desenvolvimento do país, na ótica cientificista. Nina Rodrigues abriu diálogo com dois autores de destaque no século XIX sobre os ameríndios do Norte do país (em especial Pará e Amazonas), José Veríssimo e Couto de Magalhães. Sustentamos que o resultado deste confronto de ideias é um exemplo contundente de como o médico maranhense realizou certo deslocamento de sua posição em face do racismo científico, do qual ele se afasta (mas não abandona), incorporando elementos do evolucionismo-social e criando uma leitura única das relações sociais e biológicas entre as chamadas três raças formadoras da nação.

ABSTRACT: Hops are grown mainly for the brewing market due to the rich chemical composition that gives beer aroma and bitterness. Brazil is one of the largest beer producers and consumers in the world and one of the largest hop importers. There is growing demand and interest in producing hops for domestic supply; however, as this crop originates from a temperate climate and the Northern Hemisphere, it is important to carry out research that describes the development of hops in a tropical climate to provide information on its cultivation in Brazil, as well as to determine its behavior in organic cultivation. A randomized block design was adopted, the treatments consisted of two cropping systems, conventional and organic, for Hallertau Mittelfrueh variety cultivation, with four blocks and three plants per plot. Gas exchange analyzes of plants under both cultivation systems were performed to obtain measurements of A, g s , Ci, E, WUE and A/Ci, morphometric and yield analyzes were also carried out. In comparison with the plants of the organic system, the plants of the conventional cultivation had greater photosynthetic efficiency; however, the practices adopted in the organic cultivation system provided the plants with greater productive capacity.

Introduction Non-adherence to antihypertensive medication significantly contributes to inadequate blood pressure control. Regarding non-pharmacological interventions to improve medication adherence, the question remains of which interventions yield the highest efficacy.Understanding the complementary perspectives of patients and healthcare professionals can be valuable for designing strategies to enhance medication adherence. Few studies explored the perspectives of patients and healthcare professionals regarding medication adherence. None of them focused specifically on adherence to pharmacological therapy for hypertension in Portugal.Considering the high prevalence of non-adherence and its location-specific aspects, the priority should be identifying its barriers and developing tactics to address them.This study aims to gather the perspectives of patients with hypertension and healthcare professionals such as family doctors, nurses and community pharmacists from Portugal, regarding the most effective strategies to enhance antihypertensive medication adherence and to understand the factors contributing to non-adherence.Methods and analyses We will conduct qualitative research through synchronous online focus groups of 6–10 participants. Some groups will involve patients with hypertension, while others will include family doctors, nurses and community pharmacists. The number of focus groups will depend on the achievement of theoretical saturation. A purposive sample will be used. Healthcare participants will be recruited via email, while patients will be recruited through their family doctors.The moderator will maintain neutrality while ensuring interactive contributions from every participant. Participants will be encouraged to express their opinions on the meeting summary. Meetings will be recorded and transcribed.Two researchers will perform content analyses using MAXQDA V.12 through comparative analyses and subsequent consensus. A third researcher will review the analyses. The results will be presented narratively.Ethics and dissemination The Ethics Committee of the University of Coimbra has approved this study with the number: CE-026/2021. The results will be disseminated via peer-reviewed publications and national and international conferences.

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Blood culture is crucial for accurate and timely bacteremia diagnosis and guide antibiotic therapy. However, during culture sampling, contamination can occur, resulting in misdiagnosis, unnecessary antibiotic exposure, and prolonged hospitalization. This before-and-after intervention study aimed to evaluate the effectiveness of a multimodal intervention in preventing blood culture contamination. The study was conducted in a 170-bed hospital in Portugal and included a total of 23,566 blood cultures. Contamination rates were assessed in two phases: Phase 1 (before intervention, month 0) included 10,928 cultures, and Phase 2 (after intervention, month 6) included 12,638 cultures. During the study period, a multimodal intervention targeting the nursing staff was implemented, consisting of training actions, guideline updates, regular data monitoring and feedback, and introduction of a blood culture pack. Following the intervention, blood culture contamination decreased from 6.8% (Phase 1) to 3.9% (Phase 2). A comparative analysis revealed that the risk of contamination before the intervention was nearly four times higher in first culture, OR = 3.97 (CI 2.86–5.49). Our findings suggest that the multimodal intervention enhanced nurses’ adherence to recommended practices, resulting in a reduced risk of blood culture contamination, earlier identification of infectious agents, and improved accuracy of antibiotic therapy.

Urinary tract infections are among the most prevalent types of healthcare-associated infections (HAIs) in hospitals and nursing homes, and they are primarily a result of unnecessary catheter usage and inadequate care. In Portugal, epidemiological data indicate that catheter-associated urinary tract infections (CAUTIs) remain widespread in clinical settings, resulting in increased morbidity and mortality rates among vulnerable populations. This study aimed to assess urinary catheter use in an oncology ward in Portugal and to evaluate nurses’ adherence to the government-endorsed standards for preventing CAUTIs. An observational study was conducted over a four-month period with daily assessments of nurses’ practices during urinary catheter insertion and maintenance using a government-endorsed auditing tool. Data were collected through on-site observations and nurses’ feedback. The findings revealed a urinary catheter utilization rate of 17.99%. However, there was a lack of complete adherence to government-endorsed standards among oncology nurses (0%). These results indicate that current practices lack evidence-based standardization. Therefore, there is a need to develop and implement quality improvement initiatives to enhance patient safety and experiences.

The main aim of this study is to explore early childhood teachers’ social self-efficacy in Cyprus, Greece, and Portugal. In addition, this study examines the validity of the factorial structure of the Teachers’ Social Self-Efficacy Scale (TSSES). A sample of 349 early childhood teachers across the three countries participated in this study. An exploratory analysis and then a confirmatory factor analysis were employed to reveal the structure of the TSSES. Configural and metric invariance were established for the one-factor structure of the TSSES. The results showed that teachers in Portugal and Cyprus experience high levels of social self-efficacy, whereas Greek teachers experience moderate to high levels of social self-efficacy. The TSSES seems to be a reliable instrument for assessing social self-efficacy beliefs. Possible implications for practice are also discussed.

Agricultural wastes (AWs) generated from farming practices pose environmental threats if not properly disposed of or recycled through biological processes. Mushroom production presents a sustainable solution by converting AWs into highly nutritious food while mitigating environmental pollution. However, there is a lack of comprehensive frameworks to assist farmers and businesses in visually understanding the essential elements of a circular bioeconomy, such as mushroom production’s potential interconnections and impacts on value creation. This study theoretically elaborates on a framework using the Business Model Canvas to structure mushroom production across the following key business areas: customers, supply chains, infrastructure, and economic viability. We discuss these aspects within the context of recent studies. In addition to guiding farmers and businesses, we align mushroom production with Sustainable Development Goals (SDGs) within the supply chain, underscoring the importance of developing business models to foster the growth of circular economies and sustainability.

Background: The sanitary measures imposed by COVID-19 intensified challenges in the pain management of cancer patients. Methods: A descriptive study was conducted in a chronic pain unit of an oncological hospital aiming to explore the experiences of cancer patients with chronic pain and their caregivers during the pandemic period, as well as identify strategies to improve care in chronic pain management. An electronic questionnaire was developed containing sociodemographic variables, the Depression, Anxiety and Stress Scale-21, and open-ended questions exploring the experiences and circumstances of pain management. Results: A total of 30 patients and 13 caregivers filled in the questionnaire. Patients revealed a higher level of depression, anxiety, and stress than caregivers, without statistically significant differences. Both groups mentioned having experienced difficulties in self-care, particularly in relation to sleep, nutrition, and recreation. In total, 83.7% patients needed pain relief medication related to uncontrolled pain. Both mentioned that they would have benefited from a digital application to ease the communication with the healthcare professionals of the chronic pain unit, as well as non-pharmacological interventions, such as therapeutic massage. Conclusions: Recognizing that chronic pain leads to significant limitations, it is essential to implement and anticipate objective and effective responses in pain management.

Deep brain stimulation (DBS) is an effective surgical therapy for carefully selected patients with medication refractory essential tremor (ET). The most popular anatomical targets for ET DBS are the ventral intermedius nucleus (VIM) of the thalamus, the caudal zona incerta (cZI) and the posterior subthalamic area (PSA). Despite extensive knowledge in DBS programming for tremor suppression, it is not uncommon to experience stimulation induced side effects related to DBS therapy. Dysarthria, dysphagia, ataxia, and gait impairment are common stimulation induced side effects from modulation of brain tissue that surround the target of interest. In this review, we explore current evidence about the etiology of stimulation induced side effects in ET DBS and provide several evidence-based strategies to troubleshoot, reprogram and retain tremor suppression.

IntroductionMultiple sclerosis (MS), a chronic inflammatory immune-mediated disease of the central nervous system (CNS), is a common condition in young adults, but it can also affect children. The aim of this study was to construct radiomic models of lesions based on magnetic resonance imaging (MRI, T2-weighted-Fluid-Attenuated Inversion Recovery), to understand the correlation between extracted radiomic features, brain and lesion volumetry, demographic, clinical and laboratorial data.MethodsThe neuroimaging data extracted from eleven scans of pediatric MS patients were analyzed. A total of 60 radiomic features based on MR T2-FLAIR images were extracted and used to calculate gray level co-occurrence matrix (GLCM). The principal component analysis and ROC analysis were performed to select the radiomic features, respectively. The realized classification task by the logistic regression models was performed according to these radiomic features.ResultsTen most relevant features were selected from data extracted. The logistic regression applied to T2-FLAIR radiomic features revealed significant predictor for multiple sclerosis (MS) lesion detection. Only the variable “contrast” was statistically significant, indicating that only this variable played a significant role in the model. This approach enhances the classification of lesions from normal tissue.Discussion and conclusionOur exploratory results suggest that the radiomic models based on MR imaging (T2-FLAIR) may have a potential contribution to characterization of brain tissues and classification of lesions in pediatric MS.

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IntroductionEarly identification of patients with a more unfavorable outcome in Multiple Sclerosis (MS) is crucial to optimize individualized treatment. Neutrophil-lymphocyte index (NLI) and monocyte-lymphocyte index (MLI) have been considered as potential biomarkers for disease prognosis. Our study aims to investigate the usefulness of NLI and MLI as predictors of relapse, disability progression, and lesion accumulation on magnetic resonance imaging (MRI) 1 year after diagnosis and treatment initiation, in pediatric-onset MS.MethodsA retrospective single-center study was conducted, including patients with diagnosis of MS established in pediatric age (1.89, 66.7%) and MLI (>0.21, 66.7%) values than those in the non-relapsing group (46.7%). Patients who presented new T2-hyperintense lesions on MRI after 1 year of follow-up also had higher mean, minimum, and maximum values of both biomarkers. Patients who did not achieve No Evidence of Disease Activity-3 (NEDA-3) state exhibited higher values for both ratios. However, in our sample, no statistically significant correlations were found between MLI and NLI values and the clinical and imaging variables considered.ConclusionThe ease of obtaining NLI and MLI from routine blood tests renders them useful biomarkers as a screening tool in longitudinal follow-up. Our study was based on a very small sample size, but it allowed us to verify the feasibility of the protocol used. It is intended to involve other centers in the next phase of this work, testing the possible usefulness of the indices under analysis on a larger sample.

IntroductionMultiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system which, when it begins before the age of 18, is defined as paediatric MS. Most common clinical presentations include long tract involvement, brainstem/cerebellum syndromes, optic neuritis and acute disseminated encephalomyelitis. Paediatric-onset MS typically has a more inflammatory-active course and a higher lesion burden in imaging studies, but an extensive post-relapse recovery, with a slower long-term disability progression. The first demyelinating clinical attack occurs before 10 years old in less than 1% of patients, and, in this special population, the condition has particularities in clinical presentation, differential diagnosis, diagnostic assessment, current treatment options and outcome.Clinical casesWe present the cases of four Caucasian children (2 girls) diagnosed with relapsing–remitting MS before the age of ten, with a mean age at the time of the first relapse of 7.4 ± 2.4 years. Clinical presentation included optic neuritis, myelitis, brainstem syndrome, and acute disseminated encephalomyelitis. Baseline MRI identified several lesions, frequently large and ill-defined. Two patients were included in clinical trials and two patients remain in clinical and imaging surveillance.ConclusionDiagnosis of MS before the age of 10 years is rare, but it has significant long-term physical and cognitive consequences, as well as a substantial impact on the current and future quality of life of the child and family. Early and correct diagnosis is essential. Prospective, randomized, large cohort studies are needed to assess the efficacy and safety of disease-modifying treatments in children under the age of ten.

Objectives Our systematic review aimed to summarise non-pharmacological interventions applicable in primary care that improve the quality of life of older patients with palliative care needs.Design Systematic review.Primary and secondary outcome measures The primary outcome was patients’ quality of life. Secondary outcomes were symptoms relief and patients’ well-being measures.Methods and analysis We searched MEDLINE, EMBASE, PsycINFO, Cochrane and CINAHL up to October 2022 for randomised controlled trials (RCTs). We also handsearched abstract books of relevant congresses and scientific meetings in the last 5 years. Screening, data extraction and quality evaluation (Cochrane risk-of-bias (RoB) V.2.0 tool and Grading of Recommendations, Assessment, Development and Evaluations (GRADE)) were done independently by two reviewers, with disagreements solved by a third reviewer. Findings were narratively synthesised.Results We identified 4 RCTs, including 268 patients. One study used a broad criteria of palliative care needs (‘progressive, life-threatening disease’), two studies focused on advanced cancer and one study on heart failure. The non-pharmacological interventions evaluated were advance care planning conducted by general practitioners (GPs); social worker-aided palliative care; online primary palliative care training for GPs and spiritual history taking by nurses and GPs. No intervention showed a statistically significant impact on quality of life and the evidence was low according to GRADE.Conclusion The results highlight a dearth of evidence on what non-pharmacological interventions can be effectively done in primary care to improve the quality of life of older persons with palliative care needs. The results should be interpreted with caution, as the search more comprehensively covers interventions delivered by GPs.PROSPERO registration number CRD42020154216.

Abstract Zika virus (ZIKV) infection is a global public health concern linked to adult neurological disorders and congenital diseases in newborns. Host lipid metabolism, including lipid droplet (LD) biogenesis, has been associated with viral replication and pathogenesis of different viruses. However, the mechanisms of LD formation and their roles in ZIKV infection in neural cells are still unclear. Here, we demonstrate that ZIKV regulates the expression of pathways associated with lipid metabolism, including the upregulation and activation of lipogenesis-associated transcription factors and decreased expression of lipolysis-associated proteins, leading to significant LD accumulation in human neuroblastoma SH-SY5Y cells and in neural stem cells (NSCs). Pharmacological inhibition of DGAT-1 decreased LD accumulation and ZIKV replication in vitro in human cells and in an in vivo mouse model of infection. In accordance with the role of LDs in the regulation of inflammation and innate immunity, we show that blocking LD formation has major roles in inflammatory cytokine production in the brain. Moreover, we observed that inhibition of DGAT-1 inhibited the weight loss and mortality induced by ZIKV infection in vivo. Our results reveal that LD biogenesis triggered by ZIKV infection is a crucial step for ZIKV replication and pathogenesis in neural cells. Therefore, targeting lipid metabolism and LD biogenesis may represent potential strategies for anti-ZIKV treatment development.

In this study, hydrothermal co-liquefaction of restaurant waste for biocrude production was conducted. The feedstock was resembled using the organic fraction of restaurant waste and low-density polyethylene, polypropylene, polystyrene, and polyethylene terephthalate, four plastic types commonly present in municipal solid waste. Using design of experiment and a face-centered central composite design, three factors (feedstock plastic fraction, temperature, time) were varied at three levels each: feedstock plastic fraction (0, 0.25, 0.5), temperature (290 °C, 330 °C, 370 °C), and reaction time (0 min, 30 min, 60 min). The literature reports positive synergistic interactions in hydrothermal co-liquefaction of biomass and plastics; however, in this work, only negative synergistic interactions could be observed. A reason could be the high thermal stability of produced fatty acids that give little room for interactions with plastics. At the same time, mass might transfer to other product phases.

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The assets of electric power transmission systems are characterized by their high cost and complexity, leading utilities to seek ways to improve the efficiency and economic-financial performance of these assets. Thus, this article proposes a tool to support asset management for electricity transmission systems. This tool considers the useful life of the equipment, its importance to the system, financial aspects, and the forecast of electricity demand. An evaluation of the criteria that impact decision-making on the replacement of assets with specialists was carried out. Thus, the tool uses the Analytic Hierarchy Process method to classify the most critical equipment in the system. For analysis of future scenarios, the Monte Carlo Method was incorporated into the tool to simulate the behavior of equipment during a defined time horizon. As a result, the tool presents a ranking of the most critical equipment in the system under analysis within the simulated time horizon. The tool was applied in a case study with real data in the power transformer of a Brazilian utility. The tool helps in decision-making indicating changes that may be made in the period under review, their likely impact on equipment loading, and the list of critical transformers in the system.

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Introdução: A doença invasiva meningocócica (DIM) é uma infeção causada pela bactéria Neisseria meningitidis, manifestando-se habitualmente sob a forma de meningite (MM) e/ou septicémia (SM). O objetivo deste estudo é estimar os custos da DIM (MM e SM) para o Estado português. Métodos: Para estimar os custos associados à DIM foi desenvolvido um modelo, no qual os doentes podem ter um de três desfechos: sobreviver sem sequelas, sobreviver com sequelas ou morrer. A população foi modelizada separadamente em função da faixa etária (idade inferior a 18 anos e idade igual ou superior a 18 anos) e da forma de DIM (MM/SM). As taxas de incidência e de letalidade de casos de MM e SM no Serviço Nacional de Saúde foram estimadas a partir dos microdados das Bases de Dados de Morbilidade Hospitalar (anos 2016 e 2017) e a taxa de incidência de sequelas foi estimada a partir da literatura. O consumo de recursos baseou-se num painel de peritos nacionais e os custos unitários foram obtidos em fontes oficiais. A análise foi efetuada na perspetiva do Estado, assumindo um horizonte temporal lifetime e uma taxa de atualização de 5% para custos. Foi efetuada uma análise adicional na qual se incluíram os custos indiretos. Resultados: Considerando o número médio de doentes incidentes por ano, correspondente à média dos anos 2016 e 2017, estima-se que o custo total da DIM em Portugal seja de 507 094€ (297 101€ de custos diretos e 209 993€ de custos indiretos), sendo que os custos totais nos adultos e nas crianças são semelhantes (266 644€ e 251 116€, respetivamente). Comparando os tipos de DIM, os resultados indicam que os custos totais com MM, por caso, são superiores aos custos com SM (15 234€ vs 6744€ nas crianças e 11 085€ vs 7729€ nos adultos). Tanto na MM como na SM, a maior componente dos custos diretos deve-se ao internamento inicial. Relativamente aos custos indiretos, a maioria resulta da diminuição da produtividade ao longo do ciclo de vida remanescente. Conclusão: Poucos são os estudos que estimam o custo da doença meningocócica e os que existem compreendem diferentes horizontes temporais e utilizam metodologias muito díspares, dificultando a possibilidade de comparação. Dada a heterogeneidade nas estimativas de custos presentes na literatura, será necessário um melhor entendimento das sequelas da DIM no seu conjunto de forma a caracterizar com maior precisão e detalhe o custo da doença.

IntroductionMultiple sclerosis (MS) is an inflammatory and demyelinating disorder of central nervous system that can be diagnosed in pediatric age (

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The search for antivirals against SARS-CoV-2 continue due to the emergence of variants of concerns, able to escape the vaccinal humoral response. In this work, authors pre-clinically explore the potential of kinetin against SARS-CoV-2, which could be used alone or in combination with other antivirals.