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Maize (Zea mays) is the most commonly produced grain worldwide. One of the factors that can lead to a decrease in productivity is the Southern Leaf Blight caused by Bipolaris maydis. This is common in the main producing regions and can promote losses of up to 70% under suitable conditions. A few genotypes are resistant to this fungus, and there is no record of fungicides for the disease in Brazil. In order to search for alternative control measures with lower environmental impacts, the objective of this study was to investigate the use of polysaccharide fractions extracted from shiitake or aloe, as well as acibenzolar-S-methyl (ASM), as potential inductors of resistance in maize against B. maydis. Tests were conducted with maize plants (hybrids P1630H and BM3063) to evaluate the effects of the products on reducing disease severity, inhibiting pathogen germination and activating guaiacol peroxidase and phenylalanine ammonia-lyase (PAL) activities. Aloe and ASM were not efficient to control the disease. Fraction PS1 from shiitake reduced the disease severity in both hybrids by approximately 60%. Meanwhile, fraction PS2 was efficient only in hybrid BM3063, where it promoted an increase in PAL activity. However, these fractions did not affect the spore germination of B. maydis. Therefore, the polysaccharide fractions from shiitake have the potential to control Southern Leaf Blight (B. maydis) in maize probably through the activation of plant defense mechanisms. [ABSTRACT FROM AUTHOR]

Chronic postoperative pain (CPOP) is a potentially devastating consequence of a surgical procedure. It leads to increased medical costs, painful, and stress experience to the patients. After a surgical decompression performed in a patient with a non-traumatic compartment syndrome, a muscle biopsy confirmed McArdle disease, and after surgery, severe pain of neuropathic characteristics developed in the arm decompressed. Advanced techniques up to neuromedullary stimulation failed to improve the clinical status, after which repeated treatment with capsaicin patch ameliorated the patient's condition. This case report illustrates the need for a high index of suspicion for metabolic diseases in patients who present compartment syndrome without prior history of trauma and also the challenges in treating neuropathic pain after surgery. [ABSTRACT FROM AUTHOR]

The integration of metal and injection-molded composite materials has the potential to achieve numerous benefits in the design of structural components. However, due to the nature of plastics and the plastic injection molding (PIM), it becomes difficult to conciliate structural performance and part quality criteria. To obtain an optimal balance between the criteria, it is necessary an efficient design approach that can handle even complex models present in the real-world. In this study, the design enhancement of a recycled carbon fiber-reinforced plastic/metal hybrid automotive structure is realized via a novel manufacturability-constrained optimization with focus on part quality and PIM suitability. Multilayer size optimization is carried out by referring thickness design guidelines (TDGs) in order to optimize material distribution with composite material properties considered. Thickness-dependent properties are correlated with design variables and updated at each iteration. Part quality indicators and functional criteria are adopted to evaluate the optimized structures. The design procedure is shown to be superior to standard optimization methods and efficiently enable a satisfactory balance between performance and part quality by considering major injection-molded part design constraints. Reduction in cycle time, injection pressure, and warpage by 27, 63, and 7% were achieved along with 4% mass reduction. Moreover, statistical analyses showed that TDGs have a strong correlation with mass and stiffness while wall thickness has major effects in part quality and suitability with a confidence level of 95%. The results contribute to the advancement of lightweight and high-quality structural components produced by fast-manufacturing processes in the auto industry. [ABSTRACT FROM AUTHOR]

Designing a public transport timetable that maximizes passenger service, measured in weighted travel time, is an intricate problem. The weighted travel time depends on the free route choice of passengers. Passenger route choice depends on the timetable. In turn, the timetable that minimizes weighted travel time depends on the route choice of passengers—and therefore requires passenger route choice information. Consequently, a sequential approach where timetables are designed provided pre-fixed passenger assignment to routes may not find the optimal timetable. This paper aims to integrate passenger route choice and timetabling. It addresses the problem of designing maximal passenger service public transport timetables in systems with free route choice within a budget for operating costs. Operating costs are defined by the minimal cost vehicle schedule required to operate the timetable. The proposed methodology integrates a matheuristic for timetabling and vehicle scheduling with a passenger assignment model in an iterative framework, where different forms of integration are evaluated. Focus is on long- to medium-term timetabling, provided an initial timetable. The results for a realistic case study in the Greater Copenhagen area indicate that our approach consistently leads, at no additional cost, to timetables that represent a reduction in passenger weighted travel time in comparison with both an initial timetable and a non-integrated timetabling method that receives a single-passenger assignment as input. [ABSTRACT FROM AUTHOR]

Focused cardiac ultrasound (FoCUS) is a valuable point-of-care method for evaluating cardiovascular structures and function, but its scope is limited by equipment and operator's experience, resulting in primarily qualitative 2D exams. This study presents a novel framework to automatically estimate the 3D spatial relationship between standard FoCUS views. The proposed framework uses a multi-view U-Net-like fully convolutional neural network to regress line-based heatmaps representing the most likely areas of intersection between input images. The lines that best fit the regressed heatmaps are then extracted, and a system of nonlinear equations based on the intersection between view triplets is created and solved to determine the relative 3D pose between all input images. The feasibility and accuracy of the proposed pipeline were validated using a novel realistic in silico FoCUS dataset, demonstrating promising results. Interestingly, as shown in preliminary experiments, the estimation of the 2D images' relative poses enables the application of 3D image analysis methods and paves the way for 3D quantitative assessments in FoCUS examinations. • Focused cardiac ultrasound is primarily qualitative and bidimensional. • Novel framework for multi-view pose estimation in focused cardiac ultrasound. • Validated using a multi-view realistic in-silico cardiac ultrasound dataset. • Results demonstrate the framework's feasibility and accuracy. • Preliminary experiment corroborates its potential for 3D quantitative analysis. [ABSTRACT FROM AUTHOR]

Transverse myelitis can be a complication of SARS‐CoV‐2 infection. We report the case of a transverse myelitis related to SARS‐CoV‐2 infection. Beyond the disease itself, neurological involvement affects functionality. In this situation, physical and rehabilitation medicine plays a crucial role in managing patient rehabilitation. [ABSTRACT FROM AUTHOR]

Beyond natural stimuli such as growth factors and stresses, the ability to experimentally modulate at will the levels or activity of specific intracellular signaling molecule(s) in specified cells within a tissue can be a powerful tool for uncovering new regulation and tissue behaviors. Here we perturb the levels of cAMP within specific cells of an epithelial monolayer to probe the time-dynamic behavior of cell-cell communication protocols implemented by the cAMP/PKA pathway and its coupling to the ERK pathway. The time-dependent ERK responses we observe in the perturbed cells for spatially uniform cAMP perturbations (all cells) can be very different from those due to spatially localized perturbations (a few cells). Through a combination of pharmacological and genetic perturbations, signal analysis, and computational modeling, we infer how intracellular regulation and regulated cell-cell coupling each impact the intracellular ERK response in single cells. Our approach reveals how a dynamic gap junction state helps sculpt the intracellular ERK response over time in locally perturbed cells. Author summary: To effectively respond to various perturbations, cells within in-vivo tissues must coordinate through intimate collaboration and sharing of information. Acquiring a quantitative understanding of the underlying biochemical signaling and cell-cell communication involved may require one to test the tissue response under various types of controlled spatiotemporal perturbations. While this may be hard, if not impossible, to do for an in-vivo tissue, in-vitro models can often serve as an approximate substitute. In this work we demonstrate how applying different types of spatiotemporal perturbations of specific intracellular signaling molecule(s) to an in-vitro tissue can uncover both intracellular and intercellular regulation as well as emergent phenotypes. Specifically, by controlling the levels of cAMP in chosen cells across an epithelial monolayer, either all cells or a small, localized group, we tease apart how the intracellular and intercellular regulation of cAMP impacts ERK signaling across cells in the tissue. Our approach could be used to contrast differences in signaling behavior between healthy and disease models of a given tissue type. [ABSTRACT FROM AUTHOR]

Introduction: Knowledge on the profile, nutritional status, eating habits, and degree of customer satisfaction are essential for the collective food sector. Objective: To evaluate the production, waste, and satisfaction regarding vegetarian preparations at a university. Methods: This cross-sectional study was carried out in a university restaurant in Espírito Santo state; the one on campus A served lunch to health workers and students and the one on campus B, lunch and dinner for students from other areas. Data collection took place in eight days at the restaurant on campus A and in 20 days on campus B, comprising the measurement of food production, waste, and acceptability. Results: We found that the average leftover portions were 43 ± 34 on campus A and 546 ± 114 and 36 ± 42 at lunch and dinner on campus B, respectively. The average quantity of food waste per customer was equal to 29.0 ± 9.9 g on campus A and 29.1 ± 5.5 g and 18.7 ± 3.8 g at lunch and dinner on campus B, respectively. In 64.7% of the days evaluated, the quantity of food waste per capita was above the recommended. As to the acceptability of vegetarian dishes on campus A, Eggplant Parmigiana had the highest overall acceptance (84.4%) and Textured Soybean Protein with Vegetables (68.89%) the lowest. On campus B, the most accepted preparation was Kibbeh with Pumpkin (87.6%) and the least accepted, Polenta with Textured Soybean Protein (71.4%). Conclusions: Despite the waste, the acceptability of the preparations was satisfactory, and these indicators should be continuously monitored. [ABSTRACT FROM AUTHOR]

The design of a recycled-carbon fiber–reinforced plastic/metal hybrid (PMH) engine cradle is realized via combined optimization techniques. Topology optimization (TO) and free-size optimization (FSO) techniques are exploited in the design process to find the optimal rib configuration and location of metal inserts. To analyze the obtained design in terms of functionality, a material exchange technique that accounts for fiber orientation elementwise is employed. The robust design procedure is shown to be effective in developing PMH parts while considering injection molding (IM) restrictions from the early design stages. The PMH model provides a good balance between functionality and IM suitability, with a 36% weight reduction from the steel baseline model. The results contribute to the efficient multimaterial design of PMH components in the auto industry, creating light and strong structures produced by fast manufacturing processes and low-cost carbon fibers. [ABSTRACT FROM AUTHOR]

The effect of different composts and their chemical composition on soil C and N mineralisation and greenhouse gas (GHG) emissions was explored by determining NH4+ and NO3− dynamics and monitoring CO2, N2O and CH4 fluxes from amended soils under laboratory conditions. Eight different composted agro-industrial wastes were incubated with a clay soil for 55 days at 20 °C and 60% water-holding capacity (WHC). Mineralisation of the C added to the soils was directly correlated to C/N, total phenolic/N, gallic acid/N and NH4+ and negatively correlated with total organic N (TON) and lignin content of the composts. Soils amended with straw compost presented the highest C mineralised with significantly higher CO2 emissions throughout the incubation period. N mineralisation was only negatively correlated with C/N ratio and straw compost exhibited a significant and strong immobilisation when compared with the rest of treatments. The study demonstrates that the C/N ratio by itself is not suitable for predicting N mineralisation. The results revealed that composts with high initial soluble N contents and narrow C/N ratio, as in the case of coffee grounds, produce higher N2O emissions. With the exception of mimosa (Acacia dealbata) and coffee grounds that behave as sources of methane, soils amended with composts displayed an overall sink effect for methane. These findings reveal that the effect of compost incorporation on GHG emissions depends essentially on their chemical composition. [ABSTRACT FROM AUTHOR]

Background: Microdiscectomy is the most commonly performed spine surgery and the first transitioning for outpatient settings. However, this transition was never studied, in what comes to cost-utility assessment. Accordingly, this economic study aims to access the cost-effectiveness of outpatient lumbar microdiscectomy when compared with the inpatient procedure. Methods: This is a cost utility study, adopting the hospital perspective. Direct medical costs were retrieved from the assessment of 20 patients undergoing outpatient lumbar microdiscectomy and 20 undergoing inpatient lumbar microdiscectomy Quality-adjusted life-years were calculated from Oswestry Disability Index values (ODI). ODI was prospectively assessed in outpatients in pre and 3- and 6-month post-operative evaluations. Inpatient ODI data were estimated from a meta-analysis. A probabilistic sensitivity analysis was performed and incremental cost-effectiveness ratio (ICER) calculated. Results: Outpatient procedure was cost-saving in all models tested. At 3-month assessment ICER ranged from €135,753 to €345,755/QALY, higher than the predefined threshold of €60,000/QALY gained. At 6-month costs were lower and utilities were higher in outpatient, overpowering the inpatient procedure. Probabilistic sensitivity analysis showed that in 65% to 73% of simulations outpatient was the better option. The savings with outpatient were about 55% of inpatient values, with similar utility scores. No 30-day readmissions were recorded in either group. Conclusion: This is the first economic study on cost-effectiveness of outpatient lumbar microdiscectomy, showing a significant reduction in costs, with a similar clinical outcome, proving it cost-effective. [ABSTRACT FROM AUTHOR]

• A plastic injection molding process is finely optimized. • Manufacturing and structural requirements are concurrently addressed. • Accurate predictions are obtained from the optimized artificial neural network. • Considerable enhancement of structural and quality aspects is achieved. This study addresses the enhancement of an injection-molded fiber-reinforced plastic / metal hybrid automotive structure and its plastic injection molding process through the integration of the finite element method, artificial intelligence and evolutionary search methods. Experiments are conducted to validate the finite element models. The orthogonal array and Latin hypercube methods are employed to generate a database via finite element analysis. The database is then used to train artificial neural networks that accurately evaluate component distortion, manufacturing time, and structural strength. A genetic optimization algorithm is applied to identify optimal process parameters. The procedure was demonstrated to simultaneously reduce product warpage and manufacturing time by 10 and 62 %, respectively, when compared with the reference manufacturing process while strength is kept above the required levels with a reduced number of required data points. A more in-depth investigation into the causes of strength variation and deformation is also provided. The results contribute to the advance of robust composite automotive structures with superior quality, manufactured through efficient processes. [ABSTRACT FROM AUTHOR]

Traumatic Brain Injury (TBI) is one of the leading causes of injury-related mortality in the world, with severe cases reaching mortality rates of 30-40%. It is highly heterogeneous both in causes and consequences making more complex the medical interpretation and prognosis. Gathering clinical, demographic, and laboratory data to perform a prognosis requires time and skill in several clinical specialties. Artificial intelligence (AI) methods can take advantage of existing data by performing helpful predictions and guiding physicians toward a better prognosis and, consequently, better healthcare. The objective of this work was to develop learning models and evaluate their capability of predicting the mortality of TBI. The predictive model would allow the early assessment of the more serious cases and scarce medical resources can be pointed toward the patients who need them most. Long Short Term Memory (LSTM) and Transformer architectures were tested and compared in performance, coupled with data imbalance, missing data, and feature selection strategies. From the Medical Information Mart for Intensive Care III (MIMIC-III) dataset, a cohort of TBI patients was selected and an analysis of the first 48 hours of multiple time series sequential variables was done to predict hospital mortality. The best performance was obtained with the Transformer architecture, achieving an AUC of 0.907 with the larger group of features and trained with class proportion class weights and binary cross entropy loss. Using the time series sequential data, LSTM and Transformers proved to be both viable options for predicting TBI hospital mortality in 48 hours after admission. Overall, using sequential deep learning models with time series data to predict TBI mortality is viable and can be used as a helpful indicator of the well-being of patients. • The learning models developed for the mortality prediction achieved promising performance results. • The study of the features with high predictive value improves the interpretability of the models. • The developed models can be quite helpful for prognosis indicators in a timely manner. [ABSTRACT FROM AUTHOR]

The paint coatings of three energy generators from the 20th‐century powerplant at Levada de Tomar, Portugal, were investigated using micro‐Raman and micro‐X‐ray fluorescence spectroscopies and scanning electron microscopy with energy dispersive spectroscopy. This multi‐analytical approach was used to identify the colouring agents, thus providing a chronological chromatic pallet and allowing to infer on the use of the three energy generators. Together with traditional pigments like Prussian blue, red iron oxide, and carbon black, pigments used in industrial areas like copper phthalocyanine and toluidine red were identified as colouring agents. Complex paint systems of the oldest equipment (1924) were revealed as well as maintenance procedures of the equipment that worked during a longer time (1944–1990). Powdery carbon black layers, resulting from incomplete hydrocarbon combustion and present between metallic substrates and coating layers, suggested the inexistence of paint coatings replacement after the powerplant shutdown. The identification of magnetite as a corrosion product of iron alloy substrate revealed that corrosion developed after the engine shutdown and not during the operation period. The results obtained highlight the potentialities of scientific‐based approach and Raman spectroscopy to the industrial heritage study, an emergent cultural area. [ABSTRACT FROM AUTHOR]

The free-living amoebae are currently considered an emerging parasitic infection. The infection by this protozoan can generate serious infection and even cause death. Due to their amphizoic and opportunistic characters of these microorganisms, one should give more attention, not only in swimming pools but also where there are immunologically susceptible patients such as those found in intensive care units and surgical centers. Due to their difficult diagnosis often postmortem, because they are considered to be an emerging parasitic infection and their diagnosis is difficult, often performed post mortem. This study aimed to evaluate the safety of these protozoa in air conditioners by taking samples of dust from both the surgical center and the intensive therapy unit. We analyzed 48 dust samples that were collected from six air conditioners equipment located in the Intensive Care Unit (ICU) and Surgical Center (SC) of a public hospital. We found 10.4% of the samples collected in the SC, and 75% of the samples collected in the ICU presented free-living amoeba cysts by light microscopy analysis. In total, 35.4% (17/48) of the air conditioning samples of the hospital were positive and, by PCR, were identified to belong to the genus Acanthamoeba spp and Balamuthia mandrillaris species. By DNA sequencing analysis, it was possible to classify the Acanthamoeba samples as belonging to the T3 and T4 genotypes. These genotypes are the main cause of keratitis in humans, and Balamuthia may cause amoebic encephalitis, and together are emerging parasitic infections. Our results show the presence of the two most important amoebas Acanthamoeba (T3 and T4 genotypes) and Balamuthia in the SC and the ICU, and these necessary precautions these sites could be propagating cysts of these amoebas and patients during their stay or discharge could present ocular and NSC alterations without perhaps arriving to the diagnosis of free-living amoeba infection. [ABSTRACT FROM AUTHOR]

Purpose: Electromagnetic tracking systems (EMTSs) have been proposed to assist the percutaneous renal access (PRA) during minimally invasive interventions to the renal system. However, the influence of other surgical instruments widely used during PRA (like ureteroscopy and ultrasound equipment) in the EMTS performance is not completely known. This work performs this assessment for two EMTSs [Aurora®Planar Field Generator (PFG); Aurora®Tabletop Field Generator (TTFG)]. Methods: An assessment platform, composed by a scaffold with specific supports to attach the surgical instruments and a plate phantom with multiple levels to precisely translate or rotate the surgical instruments, was developed. The median accuracy and precision in terms of position and orientation were estimated for the PFG and TTFG in a surgical environment using this platform. Then, the influence of different surgical instruments (alone or together), namely analogic flexible ureterorenoscope (AUR), digital flexible ureterorenoscope (DUR), two‐dimensional (2D) ultrasound (US) probe, and four‐dimensional (4D) mechanical US probe, was assessed for both EMTSs by coupling the instruments to 5‐DOF and 6‐DOF sensors. Results: Overall, the median positional and orientation accuracies in the surgical environment were 0.85 mm and 0.42° for PFG, and 0.72 mm and 0.39° for TTFG, while precisions were 0.10 mm and 0.03° for PFG, and 0.20 mm and 0.12° for TTFG, respectively. No significant differences were found for accuracy between EMTSs. However, PFG showed a tendency for higher precision than TTFG. AUR, DUR, and 2D US probe did not influence the accuracy and precision of both EMTSs. In opposition, the 4D probe distorted the signal near the attached sensor, making readings unreliable. Conclusions: Ureteroscopy‐ and ultrasonography‐assisted PRA based on EMTS guidance are feasible with the tested AUR or DUR together with the 2D probe. More studies must be performed to evaluate the probes and ureterorenoscopes' influence before their use in PRA based on EMTS guidance. [ABSTRACT FROM AUTHOR]

Typical avian eyes are phenotypically engineered for photopic vision (daylight). In contrast, the highly derived eyes of the barn owl (Tyto alba) are adapted for scotopic vision (dim light). The dramatic modifications distinguishing barn owl eyes from other birds include: 1) shifts in frontal orientation to improve binocularity, 2) rod-dominated retina, and 3) enlarged corneas and lenses. Some of thesefeaturesparallelmammalianeyepatterns,whicharehypothesizedtohaveinitiallyevolvedinnocturnalenvironments.Here,we used an integrative approach combining phylogenomics and functional phenotypes of 211 eye-development genes across 48 avian genomesrepresentingmostavianorders,includingthestemlineageofthescotopic-adaptedbarnowl.Overall,weidentified25eyedevelopment genes that coevolved under intensified or relaxed selection in the retina, lens, cornea, and optic nerves of the barn owl. The agtpbp1 gene, which is associated with the survival of photoreceptor populations, was pseudogenized in the barn owl genome. Our results further revealed that barn owl retinal genes responsible for the maintenance, proliferation, and differentiation of photoreceptors experienced an evolutionary relaxation. Signatures of relaxed selection were also observed in the lens and cornea morphology-associated genes, suggesting that adaptive evolution in these structures was essentially structural. Four eyedevelopment genes (ephb1, phactr4, prph2, and rs1) evolved in positive association with the orbit convergence in birds and under relaxedselectioninthebarnowllineage,likelycontributingtoanincreasedrelianceonbinocularvisioninthebarnowl.Moreover,we found evidence of coevolutionary interactions among genes that are expressed in the retina, lens, and optic nerve, suggesting synergetic adaptive events. Our study disentangles the genomic changes governing the binocularity and low-light perception adaptations of barn owls to nocturnal environments while revealing the molecular mechanisms contributing to the shift from the typical avian photopic vision to the more-novel scotopic-adapted eye. [ABSTRACT FROM AUTHOR]

Background: Understanding the barriers to and facilitators of participation in research could enhance recruitment rates for biomedical research on Neglected Tropical Diseases (NTDs) and help to avoid the problems associated with poor recruitment. Methodology/principal findings: We conducted a systematic review to identify factors related to willingness to participate in biomedical research on Neglected Tropical Diseases (NTDs). Our search included the following databases: Medline/PubMed, Embase (Embase.com), Global Index Medicus (WHO), Web of Science (Core collection), and gray literature. We included studies that analyzed or reported factors associated with willingness to participate in NTD research, using either quantitative methods (such as clinical trials, cohorts, and cross-sectional studies) or qualitative methods (such as focus group discussions, semi-structured interviews, and in-depth interviews). There were no language restrictions, but we excluded review articles, notes, case reports, letters to the editor, editor's notes, extended abstracts, proceedings, patents, editorials, and other editorial materials. Screening of citations, data extraction, and risk of bias assessment was conducted by independent reviewers, according to the study protocol registered on PROSPERO. For analyses, we assessed the frequency of barriers, enablers, and the frequency of recruitment interventions mentioned in the included studies. The protocol for this systematic review was registered under registration number CRD42020212536. (S1 Appendix) We identified 2070 citations, 1470 from the databases, and 600 from other sources. From these, eleven studies were selected for data extraction and analysis. The studies were conducted in Africa, Asia, and North America. Personal health benefits, monetary benefits, and community engagement and sensitization strategies were identified as the main reasons for participating in biomedical research on Neglected Tropical Diseases (NTDs). However, distrust in researchers, lack of knowledge about research methods among potential participants, and previous negative experiences were identified as the main barriers to participating in biomedical research on NTDs. Conclusions/significance: This systematic review provides recommendations for improving adherence to biomedical research on Neglected Tropical Diseases, which can be applied in practice. Author summary: Neglected Tropical Diseases (NTDs) are a group of around 25 health issues caused by different germs, and they bring about serious health, social, and economic problems. These diseases mainly affect poor communities in tropical areas, and some are found in other regions too. Despite their big impact, NTDs don't get much attention or funding from global agencies. Studying NTDs is crucial to gather information that can help control and eliminate these diseases. However, there are challenges in doing this research, like having a hard time convincing enough people to participate. This is important to fix because if not enough people take part, the research results may not be reliable, and it can make the study take longer and cost more. We did a careful review to understand what helps and what makes it challenging to convince people to participate in biomedical research on NTDs. Our findings can be useful for researchers to plan better, improve how many people take part in NTD studies, and avoid problems that come with not having enough participants. [ABSTRACT FROM AUTHOR]

This paper discusses the preliminary results of a research on the work of cable excavators in the extraction of iron ore. The research responds to the demand of the company, which seeks to develop a program of "high-performance" operators. Based on assumptions of the Clinic of Activity, using interviews, field observation, instructions to the look-alike and self-confrontation, we focus on the collective nature of the work, articulated with the notion of cooperation. That practical-theoretical alternative is opposed to the demand for individualized training, limited to the "operator-athlete". It is understood that the collective dimension of the activity bases the cooperation, structuring the productive process and the solidarity of the work teams. Preliminary results show that, although the organization does not privilege the logic of cooperation in the demands of productivity and in the preservation of workers' health and safety, it opens for the debate on this new perspective of collective work. [ABSTRACT FROM AUTHOR]

Purpose: As a crucial step in accessing the kidney in several minimally invasive interventions, percutaneous renal access (PRA) practicality and safety may be improved through the fusion of computed tomography (CT) and ultrasound (US) data. This work aims to assess the potential of a surface‐based registration technique and establish an optimal US acquisition protocol to fuse two‐dimensional (2D) US and CT data for image‐guided PRA. Methods: Ten porcine kidney phantoms with fiducial markers were imaged using CT and three‐dimensional (3D) US. Both images were manually segmented and aligned. In a virtual environment, 2D contours were extracted by slicing the 3D US kidney surfaces and using usual PRA US‐guided views, while the 3D CT kidney surfaces were transformed to simulate positional variability. Surface‐based registration was performed using two methods of the iterative closest point algorithm (point‐to‐point, ICP1; and point‐to‐plane, ICP2), while four acquisition variants were studied: (a) use of single‐plane (transverse, SPT; or longitudinal, SPL) vs bi‐plane views (BP); (b) use of different kidney's coverage ranges acquired by a probe's sweep; (c) influence of sweep movements; and (d) influence of the spacing between consecutive slices acquired for a specific coverage range. Results: BP view showed the best performance (TRE = 2.26 mm) when ICP2 method, a wide kidney coverage range (20°, with slices spaced by 5°), and a large sweep along the central longitudinal view were used, showing a statistically similar performance (P = 0.097) to a full 3D US surface registration (TRE = 2.28 mm). Conclusions: An optimal 2D US acquisition protocol was evaluated. Surface‐based registration, using multiple slices and specific sweep movements and views, is here suggested as a valid strategy for intraoperative image fusion using CT and US data, having the potential to be applied to other image modalities and/or interventions. [ABSTRACT FROM AUTHOR]

The Portuguese Severe Asthma Registry (Registo de Asma Grave Portugal, RAG) was developed by an open collaborative network of asthma specialists. RAG collects data from adults and pediatric severe asthma patients that despite treatment optimization and adequate management of comorbidities require step 4/5 treatment according to GINA recommendations. In this paper, we describe the development and implementation of RAG, its features, and data sharing policies. The contents and structure of RAG were defined in a multistep consensus process. A pilot version was pretested and iteratively improved. The selection of data elements for RAG considered other severe asthma registries, aiming at characterizing the patient’s clinical status whilst avoiding overloading the standard workflow of the clinical appointment. Features of RAG include automatic assessment of eligibility, easy data input, and exportable data in natural language that can be pasted directly in patients’ electronic health record and security features to enable data sharing (among researchers and with other international databases) without compromising patients’ confidentiality. RAG is a national web-based disease registry of severe asthma patients, available at asmagrave.pt. It allows prospective clinical data collection, promotes standardized care and collaborative clinical research, and may contribute to inform evidence-based healthcare policies for severe asthma. [ABSTRACT FROM AUTHOR]

Long transfer times often add unnecessary inconvenience to journeys in public transport systems. Synchronizing relevant arrival and departure times through small timetable modifications could reduce excess transfer times, but may also directly affect the operational costs, as the timetable defines the set of feasible vehicle schedules. Therefore better results in terms of passenger service, operational costs, or both, could be obtained by solving these problems simultaneously. This paper addresses the tactical level of the integrated timetabling and vehicle scheduling problem as a bi-objective mixed integer programming problem that minimizes transfer costs and operational costs. Given an initial non-cyclical timetable, and time-dependent service times and passenger demand, the weighted sum of transfer time cost and operational costs is minimized by allowing modifications to the timetable that respect a set of headway constraints. Timetable modifications consist of shifts in departure time and addition of dwell time at intermediate stops with transfer opportunities. A matheuristic is proposed that iteratively solves the mathematical formulation of the integrated timetabling and vehicle scheduling problem allowing timetable modifications for a subset of timetabled trips only, while solving the full vehicle scheduling problem. We compare different selection strategies for defining the sub-problems. Results for a realistic case study of the Greater Copenhagen area indicate that the matheuristic is able to find better feasible solutions faster than a commercial solver and that allowing the addition of dwell time creates a larger potential for reducing transfer costs. [ABSTRACT FROM AUTHOR]

The use of spent coffee grounds (SCG) in composting for organic farming is a viable way of valorising these agro-industrial residues. In the present study, four treatments with different amounts of spent coffee grounds (SCG) were established, namely, C0 (Control), C10, C20 and C40, containing 0, 10, 20 and 40% of SCG (DM), respectively; and their effects on the composting process and the end-product quality characteristics were evaluated. The mixtures were completed with Acacia dealbata L. shoots and wheat straw. At different time intervals during composting, carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O) emissions were measured and selected physicochemical characteristics of the composts were evaluated. During the composting process, all treatments showed a substantial decrease in total phenolics and total tannins, and an important increase in gallic acid. Emissions of greenhouse gases were very low and no significant difference between the treatments was registered. The results indicated that SCG may be successfully composted in all proportions. However C40, was the treatment which combined better conditions of composting, lower GHG emissions and better quality of end product. [ABSTRACT FROM AUTHOR]

The authors present a study focusing on T follicular regulatory cells (Tfr) in patients with rheumatoid arthritis (RA). Topics discussed include the phenotype and human circulating Tfr cells (2); the treatment of the patients with methotrexate; and the anti–citrullinated protein antibody levels in the body.

The February 22nd 2006 M w = 7 Machaze earthquake is one of the largest, if not the largest, earthquakes reported since 1900 within Continental Africa. This large continental intraplate event has important implications to our understanding of tectonics and strong ground motion prediction locally and in the global context. Thus, accurate estimates of source parameters of this earthquake are important. In this study, we inverted the complete azimuthally distributed high frequency (0.05–2 Hz) P waveform dataset available for a best-fitting point source model and obtained stress drop estimates assuming different theoretical rupture models from spectral fitting. Our best-fitting point source model confirms steep normal faulting, has strike = 173° (309°), dip = 73° (23°), rake = −72° (−132°), and shows a 12%–4% improvement in waveform fit compared to previous models, which translates into an error minimization. We attribute this improvement to higher order reverberations near the source region that we took in to account and the excellent azimuthal coverage of the dataset. Preferred stress drop estimates assuming a rupture velocity = 0.9 x shear wave velocity ( V s ) are between 11 and 15 MPa though, even higher stress drop estimates are possible for rupture velocities lower than 0.9 V s . The estimated stress drop is significantly higher than the global stress drop average of intraplate earthquakes, but is consistent with stress drop estimated for some intra-continental earthquakes elsewhere. The detection of a new active structure that appears to terminate in Machaze, its step-like geometry, and lithospheric strength all favors a hypothesis of stress concentration in the source region, which is likely the cause of this event and the higher than average stress drop. [ABSTRACT FROM AUTHOR]

Previous studies of psychosocial work factors have indicated their importance for workers' health. However, to what extent health problems can be attributed to the nature of the work environment or other psychosocial factors is not clear. No previous systematic review has used inclusion criteria based on specific medical evaluation of work-related health outcomes and the use of validated instruments for the assessment of the psychosocial (work) environment. The aim of this systematic review is to summarize the evidence assessing the relationship between the psychosocial work environment and workers' health based on studies that used standardized and validated instruments to assess the psychosocial work environment and that focused on medically confirmed health outcomes. A systematic review of the literature was carried out by searching the databases PubMed, B-ON, Science Direct, Psycarticles, Psychology and Behavioral Sciences Collection and the search engine (Google Scholar) using appropriate words for studies published from 2004 to 2014. This review follows the recommendations of the Statement for Reporting Systematic Reviews (PRISMA). Studies were included in the review if data on psychosocial validated assessment method(s) for the study population and specific medical evaluation of health-related work outcome(s) were presented. In total, the search strategy yielded 10,623 references, of which 10 studies (seven prospective cohort and three cross-sectional) met the inclusion criteria. Most studies (7/10) observed an adverse effect of poor psychosocial work factors on workers' health: 3 on sickness absence, 4 on cardiovascular diseases. The other 3 studies reported detrimental effects on sleep and on disease-associated biomarkers. A more consistent effect was observed in studies of higher methodological quality that used a prospective design jointly with the use of validated instruments for the assessment of the psychosocial (work) environment and clinical evaluation. More prospective studies are needed to assess the evidence of work-related psychosocial factors on workers' health. [ABSTRACT FROM AUTHOR]

This paper presents a project whose main objective is to explore the ontological based development of Domain Specific Languages (DSL), more precisely, of their underlying Grammar. After reviewing the basic concepts characterizing Ontologies and DSLs, we introduce a tool, Onto2Gra, that takes profit of the knowledge described by the ontology and automatically generates a grammar for a DSL that allows to discourse about the domain described by that ontology. This approach represents a rigorous method to create, in a secure and effective way, a grammar for a new specialized language restricted to a concrete domain. The usual process of creating a grammar from the scratch is, as every creative action, difficult, slow and error prone; so this proposal is, from a grammar engineering point of view, of uttermost importance. After the grammar generation phase, the Grammar Engineer can manipulate it to add syntactic sugar to improve the final language quality or even to add specific semantic actions. The Onto2Gra project is composed of three engines. The main one is OWL2DSL, the component that converts an OWL ontology into a complete Attribute Grammar for the construction of an internal representation of all the input data. The two additional modules are Onto2OWL, converts ontologies written in OntoDL into standard OWL, and DDesc2OWL, converts domain instances written in the new DSL into the initial OWL ontology. [ABSTRACT FROM AUTHOR]

Using dynamical systems techniques, a new algorithm to direct the trajectory of gliders to a preassigned target point is proposed. The algorithm is applicable to any unpowered lift-enabled vehicle (glider) traveling in planetary atmospheres, locally determining the shortest path to the target point. The guidance commands are chosen taking into account the drag and lift coefficients of the glider, with a parameterization based on wind tunnel data. As a proof of concept, the new algorithm has been applied to the guidance of the Space Shuttle during its return flight to Earth. Numerical simulations over a wide range of parameter values have shown that the algorithm is resilient to changes in both the initial conditions and the atmospheric conditions. For a typical gliding flight in the Earth's atmosphere, from an altitude of 30 km down to 3 km, the margin of error for reaching the target ranges from 20 to 80 m. [ABSTRACT FROM AUTHOR]

The development and validation of crystal plasticity models requires the ability to map deformation at the microstructural scale. Here, a new method of high-resolution deformation mapping is used to measure strain, material rotation and lattice rotation in austenitic stainless steel at sub-micron resolution. Electron back-scatter diffraction maps are used to link the deformation to the microstructure. Deformation occurs in domains, in which most of the plastic strain originates from the activation of a single slip system with high resolved shear stress. Within domains, slip is localized in lamellar regions that increase in number with strain. The deformation incompatibility between grains that develops as a consequence of this single crystal like behaviour is accommodated by either a gradient in slip intensity and the consequent development of lattice curvature at the grain boundary or the activation of an additional high stressed slip system and the consequent formation of a complementary deformation domain within the grain. In many cases, however, lattice curvature across grain boundaries is small because the deformation domains in neighbouring grains are compatible. The implications of these observations for continuum crystal plasticity modelling are discussed. [ABSTRACT FROM AUTHOR]

Coprophagia and entomophagia are two phenomena not commonly reported in the medical literature and their occurrence is usually associated with mental disorders. We present the case of a 59-year-old man with a history of alcohol abuse who was evaluated due to cognitive deterioration and disturbed eating habits including feces and living insects. Organic causes were ruled out and an important cognitive impairment became evident on neuropsychological formal test. The behavior remitted after antipsychotic pharmacologic therapy and alcohol detoxification, leaving the diagnostic impression of alcohol related dementia. This report shows a rare association of these two conditions in a patient with dementia. [ABSTRACT FROM AUTHOR]

An artificial neural network (ANN) model is combined with finite element (FE) nanoindentation to evaluate free volume model (FVM) parameters for bulk metallic glass (BMG). FVM is numerically implemented with the user material subroutine (UMAT). A material database is generated based on FE analysis, in which indentation parameters are obtained from FVM parameters. An ANN is generated in order to correlate FVM and indentation parameters and trained/tested from the generated database after the application of removal of multicollinearity, sampling, and normalization for computational efficiency. The fully trained ANN inversely evaluates the FVM parameters from the indentation parameters. The ANN approach is experimentally validated by sphero-conical/Berkovich indentation load-depth curves of Zr 55 Cu 30 Ag 15 and Zr 65 Cu 15 Al 10 Ni 10. • ANN model for evaluating material properties of bulk metallic glass. • Practical application of free volume model. • Use of Latin hypercube sampling for high efficiency. • Cross-validation with sphero-conical and Berkovich indentations. [ABSTRACT FROM AUTHOR]

Juvenile idiopathic arthritis (JIA) refers to a heterogeneous group of illnesses that have in common the occurrence of chronic joint inflammation in children younger than 16 years of age. The diagnosis is made only on clinical assessment. The identification of antibody markers could improve the early diagnosis, optimizing the clinical management of patients. Type II collagen is one potential autoantigen that has been implicated in the process of arthritis development. The aims of our study were to investigate the occurrence of anti-type II collagen antibodies and also to determine the avidity of the antibody–antigen binding. Ninety-six patients with oligoarticular or polyarticular JIA, 13 patients with ankylosing spondylitis (AS) and 61 healthy controls (HC) were tested for anti-type II collagen antibodies by ELISA and avidity ELISA. Sensitivity and specificity were determined by the receiver operating characteristic (ROC) curve analysis. Forty-two JIA patients (44%) were positive for antibodies against type II collagen. Its detection was significantly higher in JIA patients than in AS patients ( p = 0.006) and HCs ( p < 0.0001). Furthermore, anti-type II collagen antibody detection was significantly more frequent in patients with JIA of ≤6 months duration ( p = 0.0007). Antibodies displaying high avidity to type II collagen were associated with disease activity ( p = 0.004). This study demonstrates that antibodies against type II collagen are present in the serum of patients with oligoarticular and polyarticular JIA, being its presence more prevalent in patients with early disease. It also demonstrates that JIA patients with active disease present antibodies with high avidity against type II collagen. [ABSTRACT FROM AUTHOR]

Introduction Erectile dysfunction is highly prevalent in patients with advanced age or cardiovascular disease risk factors ( CVDRFs). These conditions interfere on expression of vascular growth factors and respective receptors causing disturbance in endothelial function. Aim This study aims to assess the effect of aging and CVDRF on the expression of tyrosine kinase with immunoglobulin-like and EGF-like domains ( Tie) 1 in human corpus cavernosum ( CC). Methods CC fragments obtained from programmed surgeries or organ donors were divided into three groups: young, healthy aged, and aged with CVDRF. Angiopoietin ( Ang) 1, Ang2, Tie1, and Tie2 mRNA and protein levels were assessed by real-time polymerase chain reaction and Western blotting, respectively. Dual-immunolabeling of Tie1 with specific markers of endothelium and smooth muscle and Ang1 and Ang2 was performed. Main Outcome Measures To characterize the expression of Tie1 in human CC and elucidate its potential inhibitory effect in Ang- Tie2 system. Results Analysis of mRNAs demonstrated a decrease in Tie1 expression in CVDRF individuals compared with aged or young healthy individuals. No variation for Tie2, Ang1, or Ang2 expression was observed among the studied groups. In all analyzed CC fragments, a 125 kDa band, Tie1, was detected. This protein presented a significant age-related decrease, specially in individuals with CVDRF. Immunofluorescence study revealed Tie1 expression in the endothelium of samples of all experimental groups. Conclusions Employing different methodological approaches, we show for the first time that Tie1 is expressed in human CC endothelium, and its level of expression diminishes in aged individuals, particularly those with CVDRF. This finding reinforces the view that delivery of Ang1 to the CC of erectile dysfunction affected CVDRF patients is able to activate a beneficial Tie2 response. Fonseca J, Tomada N, Magalhães A, Rodrigues AR, Gouveia AM, and Neves D. Effect of aging and cardiovascular risk factors on receptor Tie1 expression in human erectile tissue. J Sex Med 2015;12:876-886. [ABSTRACT FROM AUTHOR]

This material attempts to formalize key issues about management control in international public sector, and, consequently, to illustrate a methodological approach to its implementation in social investment projects development in Angola. To reach such objective, the article firstly conducts a bibliographic overview of texts published in Europe, Latin-America, as well as the United States during the last decade; it secondly studies the limitations of projects Public Management in Angola with the use of observation, interviews, questionnaires together with the analysis of legal framework; finally, it is presented a conceptual approach, intended to improve performance of social investment projects. As a result there are exposed the main components of a model for management control of social investment projects, that aligns to the theoretical issues previously synthesized and practical context of Angolan public sector. [ABSTRACT FROM AUTHOR]

Background Control of Allergic Rhinitis and Asthma Test for Children ( CARATKids) is the first questionnaire that assesses simultaneously allergic rhinitis and asthma control in children. It was recently developed, but redundancy of questions and its psychometric properties were not assessed. This study aimed to (i) establish the final version of the CARATKids questionnaire and (ii) evaluate its reliability, responsiveness, cross-sectional validity, and longitudinal validity. Methods A prospective observational study was conducted in 11 Portuguese centers. During two visits separated by 6 wk, CARATKids, visual analog scale scales and childhood asthma control test were completed, and participant's asthma and rhinitis were evaluated by his/her physician without knowing the questionnaires' results. Data-driven item reduction was conducted, and internal consistency, responsiveness analysis, and associations with external measures of disease status were assessed. Results Of the 113 children included, 101 completed both visits. After item reduction, the final version of the questionnaire has 13 items, eight to be answered by the child and five by the caregiver. Its Cronbach's alpha was 0.80, the Guyatt's responsiveness index was −1.51, and a significant (p < 0.001) within-patient change of CARATKids score in clinical unstable patients was observed. Regarding cross-sectional validity, correlation coefficients of CARATKids with the external measures of control were between 0.45 and −0.69 and met the a priori predictions. In the longitudinal validity assessment, the correlation coefficients between the score changes of CARATKids and those of external measures of control ranged from 0.34 to 0.46. Conclusion CARATKids showed adequate psychometric properties and is ready to be used in clinical practice. [ABSTRACT FROM AUTHOR]

Over the past 10 years Northern aid agencies have made a concerted effort to participate in South–South cooperation. This article analyses the key modes and motivations behind this growing engagement, looking specifically at three areas: multilateral platforms, triangular cooperation and knowledge production about South–South cooperation. Across all these efforts we perceive a concerted attempt to gain legitimacy by emphasising horizontality in the co-construction of knowledge about development. We argue that, within a context of shrinking Northern aid, this engagement is a way to harness South–South cooperation in order to preserve and expand Northern influence, both within and outside the field of development cooperation. This interpretation suggests the need to further examine the ‘bridging’ initiatives and mutual impact of intersection points between Northern aid and South–South cooperation. [ABSTRACT FROM PUBLISHER]

Abstract: The present paper analyzes the internal destruction process of high strength granite under compression, focusing inconsistencies between some conventional theories and the observed reality. It is proposed that the crack progression is a result of the relative displacement of two fitted irregular faces, which implies an increase of the gap between them and tensile forces at the tips. This model explains some aspects of the mechanical behavior of granite: (a) Spalling of granite laminae without buckling processes; (b) Consequences of the destruction of crack face irregularities; (c) Effect of the grain size in the compressive strength. The paper also discusses some loading conditions effects in the compressive strength of granite: load distribution; constraints of transversal deformation on the loaded ends of specimens; long term loads; cyclic loads. [Copyright &y& Elsevier]

How fast? How strong? How many? So what? Why do numbers matter in biology? Chromatin binding proteins are forever in motion, exchanging rapidly between bound and free pools. How do regulatory systems whose components are in constant flux ensure stability and flexibility? This review explores the application of quantitative and mathematical approaches to mechanisms of epigenetic regulation. We discuss methods for measuring kinetic parameters and protein quantities in living cells, and explore the insights that have been gained by quantifying and modelling dynamics of chromatin binding proteins. [ABSTRACT FROM AUTHOR]

- The fracture of anterior teeth in children and adolescents is a common injury. When most tooth structure is compromised and the broken fragment is not recovered, its restoration can become rather complex to both dentist and dental technician. Restoration of single anterior elements is one of the most demanding challenges in fixed prosthodontics. This article describes a clinical case of a 13-year-old patient with an extensive fractured central incisor and contra lateral incisor. Endodontic treatment was performed on both teeth, and a temporary removable appliance was made for esthetics. One month later, an indirect esthetic post and core was made for each tooth, and provisionals were placed. After a 6-month period of soft tissue stabilization, two pressed all-ceramic crowns were fabricated and bonded to the preparations. The authors believe this to be a stable long-term option relative to the reminiscent tooth structure, esthetic demand, and occlusal features of the case. [ABSTRACT FROM AUTHOR]

This paper is based on a phenomenological investigation regarding the subjective experience of the awareness of finitude during old-age. Three elders who had already undergone the awareness of finitude were selected and Amadeo Giorgi's method was used in order to describe this lived experience and its respective acts of meaning. Results revealed the existence of nine key-constituents in its general structure of meaning. Two of them resulted from life events which originated the emergence of this particular awareness (unexpected loss of significant reference; body and temporal limits), while the other seven (memory of relational separation; anticipation; paradoxical situation; uncertainty; spiritual questioning; emotional vulnerability; change of perspective and relatedness with existence), were key constituents that were built without being directly related to life and/or ageing contingencies. Subsequently, these findings where contextualized within a phenomenological-existential background, allowing the acknowledgement of how this respective awareness and its subjective meaning seem very much undermined by the elder's temporality, corporality, historicity and relatedness, and play in the end a fundamental role that will significantly set the way in which elders deal with their remaining time. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents a simulation code for the thermal power plant AVV1, located in Copenhagen, Denmark, in response to the challenge launched at the ECOS 2003 congress. The simulation program was specially created for this contest, including the calculation of the thermodynamic properties of water, as based on IAPWS97. Every component of the plant is modeled through mass and energy balance equations, and the solution of the whole system is achieved by a successive substitution scheme. The plant is simulated in two operation modes: generating electricity only, and generating electricity and district heating simultaneously. In the first operation mode, four series of simulations are run for loads varying from 40% to 100%. Each series assumes different hypotheses with respect to the variation in the isentropic efficiencies and pressures of the groups that form the turbine. In the second mode, the plant is simulated with a 100% load. An exergetic analysis of the plant, in the two modes analyzed, is presented. The generated results are compared with those presented by several researchers who have tackled the problem. The comparison shows that the results presented here agree most satisfactorily with the results presented in the literature. [Copyright &y& Elsevier]

• A new optimal regression process for acquiring the weld material properties is proposed by using tensile and hardness test data. • The regression function for the hardness distribution with local softening of weld zone is proposed. • The change in material properties resulting from the change in hardness showed a similar tendency in the two materials used in this study. • The weld material properties of two different pipes were estimated, and showed great accuracy compared to the finite element results and tensile test in terms of load-displacement curve. A new method is proposed to obtain the coefficients of plastic constitutive laws of weld metal via tensile test and hardness test. In this method, a general expression between hardness ratio and flow stress model coefficients is established. The predicted flow stresses for the differential areas are integrated over the entire section of tensile specimen to predict the tensile load. The optimal regression coefficients that minimize the difference between the predicted and experimental loads are derived using the Nelder-Mead simplex direction search algorithm. The constraint for the diffuse necking strain is applied in the convergence procedure to avoid the ' mystical ' material property shown as non-unique solution. The material constants obtained from the proposed method are independent of the width of tensile specimen. The difference of tensile loads between finite element analysis results using the determined material constants and the experiment was less than 8 %. As the derived material constants were shown to be consistent and reliable, the methodology can be applied to general line welded parts. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Malignant hypertension is associated with high mortality and morbidity usually caused by cardiovascular events. The course and prognosis of malignant hypertension patients treated with renal replacement therapy has not been thoroughly investigated. In the present work, we compared the clinical evolution and survival of 24 end-stage renal failure malignant hypertension patients with that of a group of individually matched renal failure patients admitted to the same dialysis center during a period of 21 years. Survival rates at 1, 5 and 8 years were 87, 82 and 50% for malignant hypertension patients and 87, 75 and 65% for controls, respectively (p = 0.766, NS). Nonfatal cardiovascular complications occurred in 2 individuals of each group. The most important cause of death in both groups was cardiovascular. The frequency of fatal cardiovascular events was similar in the two groups: 64% of deaths for malignant hypertension and 71% for controls (NS). In conclusion, previous malignant hypertension did not increase the risk of patients in long-term hemodialysis in our series. [ABSTRACT FROM AUTHOR]

A 51-year-old man with a renal carcinoma with inferior vena cava ( IVC) invasion was referred to our hospital for the performance of a radical nephrectomy with IVC thrombus excision. To prevent embolism, an IVC filter was implanted the day before surgery below the suprahepatic veins. On nephrectomy completion, the clinical status of the patient started to deteriorate and an unsuccessful attempt was made to excise the IVC thrombus. The patient developed profound refractory hypotension without significant bleeding and worsening splanchnic stasis was noted. A transesophageal echocardiogram was immediately performed in the operating room, revealing a hemispheric mass protruding from the IVC ostium to the right atrium, completely blocking all venous return. Volume depletion was evident by low left and right atrial volumes and increased septum mobility. No other abnormalities were found that could explain the shock, namely ventricular dysfunction or valvular disease. Cardiac surgery consultation was immediately obtained, ultimately deciding to perform a median sternotomy with direct exploration of right atrium. Under cardiopulmonary bypass, a 6-cm long thrombotic mass was identified, involving the IVC filter, blocking all lower body venous return; the removal of the mass reversed the shock. The patient had an uneventful recovery. Adverse outcomes associated with IVC filters are common. Our case highlights the importance of a team approach to rapid changes in hemodynamic status in the operating room, including the surgeon, the anesthesiologist, and the cardiologist. It also emphasizes the pivotal role of transesophageal echocardiogram in the clinical evaluation of severely unstable patients. [ABSTRACT FROM AUTHOR]

The article describes how the rates of testing for COVID-19 affect hospitalizations. Topics covered include the recommendation of the World Health Organization (WHO) for governments to increase testing, data which suggest that increasing SARS-CoV-2 testing may prompt savings for healthcare services, and an online tool which enables users to project how many hospitalizations could be prevented if more SARS-CoV-2 tests were performed.