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Simonetta Baldi,1 Paul E Jose,2 Claudio Bruschi,1 Gian Domenico Pinna,3 Roberto Maestri,3 Antonella Rezzani,1 Ezio Bellinzona,1 Claudio Fracchia,1 Elena Dacosto,1 Paola Crotti,1 Silvia Montemartini1 1Department of Pneumology, Scientific Institute of Montescano, Salvatore Maugeri Foundation IRCCS, Montescano, Pavia, Italy; 2School of Psychology, Victoria University, Wellington, New Zealand; 3Department of Biomedical Engineering, Scientific Institute of Montescano, Salvatore Maugeri Foundation IRCCS, Montescano, Pavia, ItalyObjectives: To explore the mediating role of protein interleukin-6 (IL-6) on the relationship between forced expiratory volume in 1 second (FEV1) and 6-minute walk distance (6MWD) and, further, to determine whether status variables (such as age, sex, and body mass index [BMI]) operate as moderators of this mediation relationship.Design: Moderated mediation model.Setting: An inpatient pulmonary rehabilitation center in Italy.Participants: All 153 patients involved in the screening of a randomized controlled clinical trial (ClinicalTrials.gov identifier: NCT01253941) were included in this study. All patients were Global initiative for chronic Obstructive Lung Disease (GOLD) stages I–IV and were aged 70.1±9.1 years.Measurements: At run-in phase of the protocol, clinical and functional screening included BMI, fasting plasma levels of protein (IL-6), spirometry, and standardized 6-minute walking test, measured at the start of the respiratory rehabilitation program.Methods: The size of the indirect effect of the initial variable (FEV1) upon the outcome variable (6MWD) through the intervening variable (IL-6) was computed and tested for statistical significance. Moderated mediation analyses were subsequently conducted with age, sex, and BMI.Results: FEV1 averaged 53.4%±21.2%, and 6MWD 66.4%±41.3% of predicted. Median protein IL-6 was 6.68 pg/mL (interquartile range: 5.96). A bootstrapped mediation test supported the predicted indirect pathway (P=0.003). The indirect effect through IL-6 log units accounted for 17% of the total effect between FEV1 and 6MWD. Age functioned as a significant moderator of the mediational pattern. For individuals aged 70 years it was not significant (0.04, 95% CI: –0.010 to 0.142, P=0.10).Conclusion: This moderated mediation result based on concurrent data suggests, but does not prove, a causal role of systemic inflammatory syndrome on progression from functional impairment to “frailty” status and substantial disability in aging chronic obstructive pulmonary disease. Keywords: COPD, chronic airflow obstruction, aging, mediation analysis

A network digital twin can enable the ability to safely and rapidly recreate what-if scenarios of mobile networks for more cost effective and intelligent network optimization. Towards enabling a network digital twin of mobile networks, accurate and efficient radio access network models are needed. In this work, we present WirelessNet, a novel radio access network model based on Heterogeneous Message Passing Graph Neural Networks (HMPGNNs). WirelessNet represents network nodes and the underlying wireless phenomena between them as nodes and edges of different type in a heterogeneous graph. Heterogeneous graphs are fed as samples into the HMPGNN model to simulate the wireless phenomena within WirelessNet’s model architecture. Model parameters associated to the same underlying wireless phenomena are shared across network nodes. Results using system-level simulations to train and evaluate our proposal, show that WirelessNet efficiently outputs accurate downlink rates and vector representations of users, even for network deployments unseen during training, with significantly less computational runtime than a cellular network simulator and more accuracy than typical neural network architectures. With ablation experiments, we validate the downlink signal-to-interference-and-noise ratio (SINR) user equipment (UE) node feature as the most significant contributor to reconstruct downlink rates. In a more practical setting without SINR and with reference signal received power (RSRP) from serving base station (BS), WirelessNet generalizes to unseen network deployments and significantly outperforms homogeneous graph neural networks (GNNs). We further show the benefits of our proposal by implementing two network applications served by WirelessNet, namely: radio access network deployment planning and artificial intelligence/machine learning (AI/ML) model training for quality of service (QoS) prediction.

Introduction: Patients with familial adenomatous polyposis (FAP) are characterised by the appearance of colorectal cancer if the disease is left to follow its natural course, which means they frequently undergo prophylactic colectomy at a young age. In these patients, duodenal cancer becomes the leading cause of death, which deems surveillance necessary. Gastric cancer, although rare, can also occur in these patients, and total gastrectomy is the usual treatment option. Patients and Methods: We used a pedicled isoperistaltic jejunal flap interposition technique to reconstruct the digestive tract after a total gastrectomy so that duodenal surveillance could be maintained in patients followed in outpatient consultation for genetic diseases. We also describe how this technique was performed fully through laparoscopy in two of these cases. Results: We identified four patients with FAP who developed malignant or extensive pre-malignant gastric lesions which were not endoscopically resectable. Two patients were submitted to open surgery and the remaining two underwent laparoscopic surgery. There was no perioperative or post-operative morbidity, and all four patients are alive at the time of writing, with a minimum follow-up of 12 months. They were not diagnosed with major nutritional imbalances and were routinely submitted to endoscopic duodenal surveillance, sometimes including polypectomy, with ease. Conclusion: In our experience, this surgical technique has good results, and all surgical steps can be done entirely through laparoscopy, with every advantage this approach entails.

Abstract This study assessed the connectedness between oil shocks and industry stock indexes in the United States (US). We consider the normal and extreme conditions across different frequency horizons, and the quantile time–frequency connectedness method is used to determine the tail risk contagion under different frequency horizons. Our results reveal that the short-term frequency connectedness significantly exceeds the long-term frequency connectedness. We also indicate that the connectedness in the lower and upper quantiles is greater than at the conditional mean. Importantly, oil risk shock is the biggest net transmitter of shocks to the US sectors in normal and extreme conditions, highlighting that oil risk shocks cause substantial variations in US sector stock returns in the short, medium, and long term. Finally, QAR(3) model demonstrates the significant impact of oil risk shocks on US sector stock returns during extreme and normal conditions. Therefore, our study underscores the role of asymmetry in the reaction of US sector stock returns to oil-related shocks, and we suggest that policies aimed at overcoming the adverse effects of oil shocks on stock markets and promoting financial stability should incorporate asymmetric features.

Geophysical investigation in the coastal region of the emerged portion of Barra Falsa, Bojuru, RS, Brazil, provided valuable information about the depositional evolution and paleoenvironmental changes that occurred during the Quaternary period. The combination of electromagnetic surveys, analysis of stratigraphic wells, 3.5 kHz reflection seismic and previous geological data allowed for a comprehensive characterization of sedimentary environments associated with sea-level fluctuations. Electromagnetic surveys using the LIN- EM method with the Geonics EM34TM system revealed different conductivity responses in the subsurface, which could be interpreted in relation to depositional events. Five depth intervals were identified and related to specific events, such as the closure of the Barra Falsa channel, estuarine infilling, and channel drowning during marine transgressions. Furthermore, the comparison of the results of electromagnetic surveys with data from stratigraphic wells allowed calibration of indirect data. This multidisciplinary approach highlights the importance of integrating geophysical and geological techniques to reconstruct coastal environment evolution over time. This study provides a detailed insight into paleoenvironmental and depositional changes on the coast of Bojuru, demonstrating how these techniques can significantly contribute to future research and the sustainable management of coastal areas. The knowledge gained here is essential for understanding the dynamics of coastal zones and the influences of sea-level variations in the Southern region of Brazil.

Background/Objectives: Transverse myelitis (TM) is a rare, acute inflammatory disorder affecting the spinal cord, with severe potential consequences, particularly in pediatric patients. Therapeutic plasma exchange (TPE) has emerged as a possible intervention for children unresponsive to high-dose corticosteroids. This study explores the efficacy of early TPE in pediatric TM through a case report and scoping review aiming to clarify the therapeutic benefits of TPE when used in conjunction with corticosteroids in children. Methods: We present a scoping review of existing literature on the early administration of TPE in pediatric patients with TM, supplemented by a case report of a 5-year-old boy with Longitudinally Extensive Transverse Myelitis (LETM), who received early TPE and corticosteroid therapy. Clinical progression, response to TPE, and functional outcomes were documented over a 9-month follow-up period. Results: Among the reviewed cases, early TPE demonstrated potential to expedite neurological recovery and improve functional outcomes. In our case report, the patient showed rapid recovery, achieving unassisted ambulation by day four of TPE. No adverse effects were observed. MRI findings revealed substantial resolution of spinal cord lesions by three months, with near-complete symptom resolution at nine months. Conclusions: Early initiation of TPE, in conjunction with corticosteroids, may offer significant therapeutic benefit in pediatric TM, potentially accelerating recovery and improving outcomes. This case highlights the need for further controlled studies to establish evidence-based guidelines for TPE use in pediatric TM.

Abstract While numerous studies have established correlations between parasite load and negative effects on their hosts, establishing causality is more challenging because parasites can directly compromise host condition and survival or simply opportunistically thrive on an already weakened host. Here, we evaluated whether Ixodes uriae, a widespread seabird tick, can cause a decrease in growth parameters (body mass, bill length and growth rates) and survival of chicks of a colonially seabird, the black-browed albatross (Thalassarche melanophris) breeding on New Island (West Falkland). To investigate this, we daily removed the ticks from 28 randomly selected chicks during their first 14 days of life (treated chicks) and compared their growth and survival with 49 chicks of a control group. The tick load on control chicks correlated negatively with their body mass, growth rates and survival. Comparisons between treated and control chicks demonstrated that tick infestation depleted body mass and hampered the growth of control chicks. Treated chicks had a higher survival rate than control ones to fledgling age, but not to 14 days old, suggesting that the delayed higher mortality on control chicks was caused by the accumulation of sub-lethal effects of ticks. This study experimentally demonstrates that high tick infestation can cause reduced host growth and survival.

The study of the historical intersections that shaped the history of international organizations and the history of decolonization has been the subject of increasing historiographical attention in the last couple of decades. The main aim of this introduction to the special theme section on International Organizations in the Era of Decolonization is to identify some of the most promising scientific developments that took place in this field, connecting them to specific historical phenomena and processes. The text concludes by showing how the different articles that are part of this theme section dialogue with, and try to respond to, some of these intellectual questions and problems.

Abstract Background Megaoesophagus (ME), a disorder of the oesophagus characterized by diffuse oesophageal dilation and decreased peristalsis that may be congenital or acquired. Knowledge regarding the aetiology and prognosis for canine acquired ME is currently limited with most cases being idiopathic, which is a considerable problem to implement an appropriate treatment and a potential better prognosis. Case presentation A 7-year-old, neutered, female Spanish Water Dog was evaluated for progressive weight loss, chronic vomiting and regurgitation. The patient did not present other clinical signs. The contrast radiography in the cervical zone revealed oesophageal dilation. Eventually, the endoscopy revealed a marked dilation of the oesophagus. A surgery was conducted to insert a gastrotomy feeding tube. Initially, the patient response to this treatment was positive. However, the vomiting and regurgitation reappeared after 8 days. Due to the grim prognosis the owners elected to euthanize the patient. Necropsy revealed severe oesophageal dilation. The histopathological evaluation revealed moderate erosive catarrhal oesophagitis and gastritis. The skeletal muscular layer of the oesophagus showed moderate angular atrophy of some muscular fibres and a severe infiltrate of lymphocytes with marked tropism to autonomous neuronal bodies, some of which showed severe degenerative changes with absence of Nissl corpuscles, pyknotic nuclei and eosinophilic cytoplasm. The immunohistochemical study revealed that the majority of the infiltrate surrounding neuronal bodies were CD3 + T cells. These findings are consistent with an immune-mediated megaoesophagus. Conclusions To the best of our knowledge, this is the first report describing a lymphoplasmacytic infiltrate surrounding the oesophageal myenteric plexus in an adult dog with no other clinical signs or other myopathies. With these results, the authors hope to raise awareness in the diagnostic of canine ME and include an immune-mediated cause that lean to the establishment of appropriate treatment and improve prognosis of this condition.

Abstract Ferroptosis is a regulated and non-apoptotic form of cell death mediated by iron-dependent peroxidation of polyunsaturated fatty acyl tails in phospholipids. Research of the past years has shed light on the occurrence of ferroptosis in organ injury and degenerative diseases of the brain, kidney, heart, and other tissues. Hence, ferroptosis inhibition may prove therapeutically beneficial to treat distinct diseases. In this study, we explored the ferroptosis-modulating activity of seratrodast, an inhibitor of thromboxane A2 (TXA2) receptor, which is approved in some countries for the treatment of asthma. Interestingly, seratrodast suppressed ferroptosis, but not apoptosis and necroptosis; thus, demonstrating selective anti-ferroptotic activity. While seratrodast itself does not inhibit lipid peroxidation, it exhibits potent radical-trapping antioxidant activity upon reduction to its corresponding hydroquinone form—analogously to ubiquinone and vitamin K. Importantly, seratrodast ameliorated the severity of renal ischemia-reperfusion injury in mice. Together, this study provides a drug repurposing case, where seratrodast—a marketed drug—can undergo fast-forward preclinical/clinical development for the inhibition of ferroptosis in distinct degenerative diseases.

The high-risk Human Papillomavirus (HR-HPV) is the causal agent of different human cancers such as cervical, vulvar, and oropharynx cancer. This is because persistent HR-HPV infection alters several cellular processes involved in cell proliferation, apoptosis, immune evasion, genomic instability, and cellular transformation. The above is mainly due to the expression of early expression proteins of HR-HPV, which interact and alter these processes. HR-HPV proteins have even been shown to regulate redox state and mitochondrial metabolism, which has been suggested as a risk factor for cancer development. Redox state refers to a balance between reactive oxygen species (ROS) and antioxidants. Although ROS regulates cell signaling, high levels of ROS generate oxidative stress (OS). OS promotes damage to DNA, proteins, carbohydrates, and lipids, which causes mutation accumulation and genome instability associated with cancer development. Thus, OS has been associated with the establishment and development of different types of cancer and has recently been proposed as a cofactor in HR-HPV-associated cancers. However, OS also induces cell death, which can be used as a target for different molecules, such as phytochemicals. Furthermore, phytochemicals target HPV oncoproteins E6 and E7, causing their degradation. Because phytochemicals could induce OS and target HPV oncoproteins, we hypothesize that these compounds induce cell death in HPV-associated cancers. Since the redox state is crucial in developing, establishing, and clearing HR-HPV-associated cancer, this review focuses on evidence for using phytochemicals as therapeutic agents that target HPV proteins and the redox state to induce the elimination of HPV-related cancers.

Cushing's disease (CD) is characterized by distinct syndromic features, often accompanied by obesity and depression. However, considering its gradual onset of symptoms, it is usually associated with diagnostic delays. In rare instances, CD may lead to severe infections due to the observed immunosuppression in affected individuals. We present a rare case of an undiagnosed CD in a 20-year-old male with a medical history of depression and obesity, complicated by severe COVID-19 infection. He presented to the Emergency Room with respiratory distress, hypertensive crisis, and fever, ultimately receiving the diagnosis of SARS-CoV-2 pneumonia. The patient required mechanical ventilation and intensive care unit (ICU) admission due to severe acute respiratory distress syndrome (ARDS). During ICU care, he received remdesivir and dexamethasone, subsequently developing severe hyperglycemia and worsened hypertension, requiring insulin and multiple antihypertensive agents to manage metabolic disruption. Upon physical examination, classic signs of hypercortisolism were noted. Subsequent laboratory tests and pituitary magnetic resonance imaging confirmed the diagnosis of CD. The patient underwent surgical resection with significant improvements in body composition and metabolic parameters postoperatively. After surgery, remission of hypercortisolism was evident, accompanied by notable improvements in mood and overall health. This case underscores the importance of recognizing hypercortisolism in the context of metabolic, physical, and mood changes. Timely diagnosis of CD is crucial to mitigate complications such as severe opportunistic infections and their outcomes.

Rearing entire male pigs presents several benefits, including enhanced feed efficiency, reduced environmental impact, and improved animal welfare. However, the risk of boar taint poses a significant challenge to pork quality. The objective of this pilot study is to evaluate growth performance, meat quality and the incidence of boar taint in intact male pigs of the Bísara breed (BI) and a terminal cross (TC). Five pigs from each breed were monitored during growth and blood samples were taken to measure tainting compounds (skatole and androstenone). The meat quality was compared concerning its colour, pH, and water-holding capacity (WHC). Bísaro pigs have more intensive muscle colour, higher WHC, and higher intramuscular fat content (p0.05). TC pigs demonstrated more consistent growth patterns and faster growth during later stages. Meat quality analysis revealed statistically significant differences (p < 0.05) between the two groups in parameters such as thawing loss, moisture content, meat colour, and intramuscular fat, which favoured BI pigs. Conversely, TC pigs exhibited significantly lower levels of boar taint (p

Large Language Models (LLMs) have revolutionized Artificial Intelligence (AI), with OpenAI's reasoning models and, more recently, DeepSeek reshaping the landscape. Despite AI being a strategic priority in Europe, the region lags behind global leaders. Spain's ALIA initiative, trained in Spanish and Catalan, seeks to bridge this gap. We assess ALIA and DeepSeek's performance against top LLMs using a dataset of high-school-level mathematical problems in Catalan from the Kangaroo Mathematics Competition. These exams are multiple-choice, with five options. We compiled each LLM's solution and the reasoning behind their answers. The results indicate that ALIA underperforms compared to all other evaluated LLMs, scoring worse than random guessing. Furthermore, it frequently failed to provide complete reasoning, while models like DeepSeek achieved up to 96% accuracy. Open-source LLMs are as powerful as closed ones for this task. These findings underscore challenges in European AI competitiveness and highlight the need to distill knowledge from large models into smaller, more efficient ones for specialized applications.

Introduction The EULAR points to consider (PtC) for reducing non-adherence need implementation.Objectives To design, implement and evaluate a strategy based on the PtC to improve treatment adherence in rheumatoid arthritis (RA).Methods A multidisciplinary panel cocreated an intervention that was subsequently tested in a cluster trial, where centres were randomised to access the developed intervention or follow the standard of care (SOC). 6-month initiation and implementation adherence were measured in consecutive patients with

The TCR-mediated activation of T cells expressing the TCR Vγ9Vδ2 relies on an innate-like mechanism involving the butyrophilin 3A1, 3A2 and 2A1 molecules and phospho-antigens, without the participation of classical antigen-presenting molecules. Whether TCR Vγ9Vδ2 cells also recognize complexes composed of antigens and antigen-presenting molecules in an adaptive-like manner is unknown. Here, we identify MR1-autoreactive cells expressing the TCR Vγ9Vδ2. This MR1-restricted response is antigen- and CDR3δ-dependent and butyrophilin-independent. TCR gene transfer reconstitutes MR1-antigen recognition, and engineered TCR Vγ9Vδ2 tetramers interact with soluble MR1-antigen complexes in an antigen-dependent manner. These cells are present in healthy individuals with low frequency and are mostly CD8+ or CD4-CD8 double negative. We also describe a patient with autoimmune symptoms and TCR γδ lymphocytosis in which ~10% of circulating T cells are MR1-self-reactive and express a TCR Vγ9Vδ2. These cells release pro-inflammatory cytokines, suggesting a possible participation in disease pathogenesis. Thus, MR1-self-antigen complexes can interact with some TCRs Vγ9Vδ2, promoting full cell activation and potentially contributing to diseases.

As investigações sobre os cristianismos antigos, ainda que desde o séc. XIX tenham desfrutado de ampla diversificação de aportes teórico-metodológicos e vertentes interpretativas, têm se voltado, em grande medida, à constituição e consolidação de fórmulas de fé cristãs em diálogo com a cultura envolvente na Antiguidade. Muito se discute acerca dos componentes simbólicos que passaram a constituir as experiências religiosas cristãs e a gradativa adesão das elites romanas ao movimento cristão. Na contramão desta historiografia, procuramos compreender, a partir do posicionamento do filósofo neoplatônico Celso, o impacto que as narrativas cristãs produziram em grupos sociais não-cristãos letrados. Em outras palavras, ocupamo-nos da recepção dos discursos cristãos por leitores não-cristãos, como Celso. Nosso estudo, nesse sentido, está centrado na obra do cristão alexandrino Orígenes, Contra Celso (248/9), graças a qual temos acesso aos argumentos anticristãos de Celso. Assim, indagamos as possíveis intencionalidades e objetivos de Celso ao questionar os discursos cristãos sobre o nascimento divino e a ressurreição de Jesus.

Introdução: A validação transcultural é um processo que se relaciona com a compreensão do outro. Objetivo: analisar as propriedades psicométricas e a estrutura fatorial da versão moçambicana da Self-Efficacy Scale for Physical Education Teacher Education Majors toward Children with Disabilities (SE-PETE-D) (Block et al., 2013), denominada de Escala de Autoeficácia na Educação Física Inclusiva (EAE-EFI). Como objetivos secundários, analisar o impacto do género e das experiências individuais em lecionar a disciplina de Educação Física (EF) numa perspetiva inclusiva. Metodológia: Foi realizada uma adaptação e uma validação para o contexto linguístico e cultural Moçambicano a partir da versão validada para a população portuguesa por Campos et al. (2022). Participaram 149 estudantes estagiários de EF, sendo 109 de género masculino (M=24,46 ± DP=3,16) e 40 do género feminino (M=21,38±DP=5,18) recrutados em cursos de EF nas universidades das zonas Sul, Centro e Norte de Moçambique. Foi utilizada a Análise Fatorial Confirmatória (AFC) para testar a robustez da estrutura fatorial do instrumento. Resultados: Os valores dos índices de bondade e de ajustamento do modelo atestam a fidignidade da versão Moçambicana (NFI=0,83; TLI=0,91; CFI=0,92; IFI=0,92; RMSEA =0,074). Os valores de Alpha de Cronbach de cada uma das variáveis observadas variaram entre 0,786 e 0,823 para Deficiência Intelectual (DI), entre 0,732 e 0,826 para Deficiência Física (DF) e entre 0,729 e 0,847 para Deficiência Visual (DV), demonstrando valores bons de consistência interna. Relativamente ao género, não se observaram diferenças significativas nas dimensões da autoeficácia. Quanto à experiência no ensino de aluno com deficiência, foram observadas diferenças significativas (p˂0.01), Conclusões: Propor programas de intervenções mais específicas e realistas.

Summary: Background: Supratentorial function-eloquent brain tumour surgeries challenge the balance between maximal tumour resection and preservation of neurological function. This study aims to evaluate the efficacy of preoperative and intraoperative mapping techniques on resection outcomes and post-operative deficits. Methods: This systematic review and meta-analysis examined literature up to March 2023, sourced from PubMed, Embase, and Medline. Criteria for inclusion were studies on patients undergoing surgery for supratentorial brain tumours, comparing preoperative mapping only (POM), intraoperative neuromonitoring and mapping (IONM), and combined techniques (POM&IONM), excluding non-randomized controlled trials. Data extraction focused on rates of gross total resection (GTR) and focal neurological deficits (FNDs). The main outcomes, assessed through a random-effects model and Cochran's Q-test for subgroup analysis. The study protocol is published on PROSPERO CRD42024512306. Findings: 19 studies involving 992 patients were included. Systematic review with meta-analysis revealed a non-significantly higher average GTR rates for POM&IONM (49.13%) and POM (50.79%) compared to IONM alone (41.23%). Highest rates of GTR were achieved with tractography-guided resection in POM group (66.59% versus fMRI–20.00%, p = 0.0004), multimodal stimulation in IONM group (54.16% versus low frequency stimulation (LFS)–13.29%, p 0.05). In language-eloquent tumours and in awake craniotomy techniques regardless of tumour functional eloquence, POM&IONM group had higher GTR when compared to IONM groups (language eloquent tumours–POM&IONM 43.31% versus IONM–15.09%, p = 0.022; awake craniotomy technique–POM&IONM–41.22% versus IONM–12.08%, p = 0.0006). Permanent FNDs were higher in the IONM group (IONM-73.0%; POM-29.6%; POM&IONM-33.7% of immediate postoperative deficits, p = 0.0010). Interpretation: A combined POM&IONM approach is responsible for higher rates of GTR in patients with language eloquent tumours and in both awake and asleep craniotomy techniques regardless of the tumour functional eloquence. The tumour histology is not relevant for differences in GTR rates among different mapping and monitoring strategies. Permanent postoperative FNDs are more likely with standalone utilization of IONM. Funding: Not applicable.

Pharmacological treatments for smoking associated with psychological counseling triple the chances of quitting. However, the accessibility of these drugs is limited by their financial cost. With this review we aim to demonstrate the effect of partial or full funding in terms of efficacy, effectiveness, cost-effectiveness and quality of life. We conducted a literature search for articles related to the issues mentioned above: analysis of the efficacy, effectiveness and cost-effectiveness of pharmacological treatments for nicotine dependence and the effect of their funding. It is shown that the funding of pharmacological treatment can increase the efficacy and effectiveness of smoking cessation interventions. Such funding increases motivation to make a quit attempt. In addition, these strategies can increase self-efficacy, generate social influence and change attitudes toward quitting. Although the funding of pharmacological treatment benefits all smokers, there are certain populations of smokers who are more sensitive to funding strategies such as social groups with lower incomes and lower educational attainment. These funding strategies for smoking cessation interventions have been shown to improve the health and quality of life of the population, as well as the economy, while reducing tobacco use. Resumen: Los tratamientos farmacológicos para el tabaquismo asociados al asesoramiento psicológico triplican las posibilidades de abandono del tabaco. Sin embargo, la accesibilidad a estos fármacos está limitada por su coste económico. Con esta revisión pretendemos demostrar el efecto de la financiación parcial o total en términos de eficacia, efectividad, coste/efectividad y calidad de vida. Así se realizó una búsqueda bibliográfica de artículos relacionados con las cuestiones mencionadas anteriormente: análisis de la eficacia, efectividad y coste/efectividad de los tratamientos farmacológicos de la dependencia nicotínica y el efecto de su financiación. Se demuestra que la financiación del tratamiento farmacológico puede aumentar la eficacia y la efectividad de las intervenciones para dejar de fumar. Dicha financiación aumenta la motivación para realizar un intento de abandono. Además, estas estrategias pueden incrementar la autoeficacia, generar influencia social y modificar las actitudes hacia el abandono. Aunque la financiación del tratamiento farmacológico beneficia a todos los fumadores, hay ciertas poblaciones de fumadores que son más sensibles a las estrategias de financiación como grupos sociales con menos ingresos y menor nivel educativo. Se ha demostrado que estas estrategias de financiación de las intervenciones para dejar de fumar mejoran la salud y la calidad de vida de la población, así como la economía, a la vez que reducen el consumo de tabaco.

Cancer cells exhibit a remarkable ability to orchestrate metabolic adaptations to survive and proliferate. Such metabolic adaptations, including carbohydrates, amino acids and lipid metabolism, have been shown to also contribute to the pathological cascade during cancer progression and therapy resistance. Importantly, these adaptations provide a rational for targeted therapies inducing selective cell death. Recently, two studies by Lorito et al (Lorito et al, 2024) and Ackermann et al (Ackermann et al, 2024) published in EMBO Molecular Medicine reported examples of alterations in lipid metabolism that can promote targetable vulnerabilities for tumors with poor prognosis.

Introduction Paraneoplastic syndromes are frequent in patients with renal cell carcinoma. Dermatomyositis is an idiopathic inflammatory myopathy that may be associated with neoplasms. This case aims to describe the rare association of dermatomyositis with renal cell carcinoma and to increase clinical suspicion of this neoplasm when systemic rheumatologic symptoms are present. Case presentation A 35‐year‐old female developed severe rheumatologic symptoms (progressive muscle weakness, heliotrope rash, and Gottron's papules). Clinical and laboratory findings indicated dermatomyositis. During the investigation, computed tomography revealed a left kidney solid mass. She underwent a left radical nephrectomy, and histology confirmed renal cell carcinoma. After 3 months, dermatomyositis manifestations disappeared and the patient withdrawn steroid therapy. Conclusion Most paraneoplastic syndromes associated with renal cell carcinoma are only cured with nephrectomy. We highlight the potential role of surgery in dermatomyositis caused by renal cell carcinoma. The recurrence of symptoms related to the syndrome should alert for disease progression.

Abstract The Polynomial Affine Gravity is an alternative gravitational model, where the interactions are mediated solely by the affine connection, instead of the metric tensor. In this paper, we explore the space of solutions to the field equations when the torsion fields are turned on, in a homogeneous and isotropic (cosmological) scenario. We explore various metric structures that emerge in the space of solutions.

Abstract Background Tumor-immune interactions shape a developing tumor and its tumor immune microenvironment (TIME) resulting in either well-infiltrated, immunologically inflamed tumor beds, or immune deserts with low levels of infiltration. The pre-treatment immune make-up of the TIME is associated with treatment outcome; immunologically inflamed tumors generally exhibit better responses to radio- and immunotherapy than non-inflamed tumors. However, radiotherapy is known to induce opposing immunological consequences, resulting in both immunostimulatory and inhibitory responses. In fact, it is thought that the radiation-induced tumoricidal immune response is curtailed by subsequent applications of radiation. It is thus conceivable that spatially fractionated radiotherapy (SFRT), administered through GRID blocks (SFRT-GRID) or lattice radiotherapy to create areas of low or high dose exposure, may create protective reservoirs of the tumor immune microenvironment, thereby preserving anti-tumor immune responses that are pivotal for radiation success. Methods We have developed an agent-based model (ABM) of tumor-immune interactions to investigate the immunological consequences and clinical outcomes after $$2\,\text{Gy} \times 35$$ 2 Gy × 35 whole tumor radiation therapy (WTRT) and SFRT-GRID. The ABM is conceptually calibrated such that untreated tumors escape immune surveillance and grow to clinical detection. Individual ABM simulations are initialized from four distinct multiplex immunohistochemistry (mIHC) slides, and immune related parameter rates are generated using Latin Hypercube Sampling. Results In silico simulations suggest that radiation-induced cancer cell death alone is insufficient to clear a tumor with WTRT. However, explicit consideration of radiation-induced anti-tumor immunity synergizes with radiation cytotoxicity to eradicate tumors. Similarly, SFRT-GRID is successful with radiation-induced anti-tumor immunity, and, for some pre-treatment TIME compositions and modeling parameters, SFRT-GRID might be superior to WTRT in providing tumor control. Conclusion This study demonstrates the pivotal role of the radiation-induced anti-tumor immunity. Prolonged fractionated treatment schedules may counteract early immune recruitment, which may be protected by SFRT-facilitated immune reservoirs. Different biological responses and treatment outcomes are observed based on pre-treatment TIME composition and model parameters. A rigorous analysis and model calibration for different tumor types and immune infiltration states is required before any conclusions can be drawn for clinical translation.

Abstract Background Rare-earth sulfide nanoparticles (NPs) could harness the optical and magnetic features of rare-earth ions for applications in nanotechnology. However, reports of their synthesis are scarce and typically require high temperatures and long synthesis times. Results Here we present a biosynthesis of terbium sulfide (TbS) NPs using microorganisms, identifying conditions that allow Escherichia coli to extracellularly produce TbS NPs in aqueous media at 37 °C by controlling cellular sulfur metabolism to produce a high concentration of sulfide ions. Electron microscopy revealed ultrasmall spherical NPs with a mean diameter of 4.1 ± 1.3 nm. Electron diffraction indicated a high degree of crystallinity, while elemental mapping confirmed colocalization of terbium and sulfur. The NPs exhibit characteristic absorbance and luminescence of terbium, with downshifting quantum yield (QY) reaching 28.3% and an emission lifetime of ~ 2 ms. Conclusions This high QY and long emission lifetime is unusual in a neat rare-earth compound; it is typically associated with rare-earth ions doped into another crystalline lattice to avoid non-radiative cross relaxation. This suggests a reduced role of nonradiative processes in these terbium-based NPs. This is, to our knowledge, the first report revealing the advantage of biosynthesis over chemical synthesis for Rare Earth Element (REE) based NPs, opening routes to new REE-based nanocrystals.

This review aims to enhance the understanding of the fundamentals, applications, and future directions in hydrogen production techniques. It highlights that the hydrogen economy depends on abundant non-dispatchable renewable energy from wind and solar to produce green hydrogen using excess electricity. The approach is not limited solely to existing methodologies but also explores the latest innovations in this dynamic field. It explores parameters that influence hydrogen production, highlighting the importance of adequately controlling the temperature and concentration of the electrolytic medium to optimize the chemical reactions involved and ensure more efficient production. Additionally, a synthesis of the means of transport and materials used for the efficient storage of hydrogen is conducted. These factors are essential for the practical feasibility and successful deployment of technologies utilizing this energy resource. Finally, the technological innovations that are shaping the future of sustainable use of this energy resource are emphasized, presenting a more efficient alternative compared to the fossil fuels currently used by society. In this context, concrete examples that illustrate the application of hydrogen in emerging technologies are highlighted, encompassing sectors such as transportation and the harnessing of renewable energy for green hydrogen production.

In 1961-1962, the Portuguese imperial administration undertook a number of political, administrative and social reforms, putting an end to the indigenato regime. This article demonstrates that, both in timing and content, the dynamics of legal and political change were closely related to actors, events, and processes located beyond imperial borders, in articulation with local dynamics, in national and colonial settings. Such reforms can only be rigorously understood if these dimensions are analytically integrated. With a longer history, not reducible to this two-year period, such dynamics of change were significantly marked by the participation of the Portuguese authorities in a disputed conversation – of global origin, scope and impact, involving different institutions and across distinct geographies – about the multiple configurations of ethnic-racial and socio-cultural difference and the contested postulates of sovereignty and self-determination politics. This article is part of the special theme section on International Organizations in the Era of Decolonization, guest-edited by José Pedro Monteiro.

Abstract Background Technological advances based on mobile health (mHealth), the field of digital health (eHealth) aimed at managing health services and care and their concomitant transformations, have become increasingly important in the 21st century. In this context, care for individuals diagnosed with Chronic Non-Communicable Diseases (CNCDs) deserves to be highlighted. The aim of this study is to present the creation, development and implementation of the Telehealth Center of the Federal University of Viçosa (NUTELES - UFV), for the monitoring and management of health care for individuals with Arterial Hypertension (AH) and/or Diabetes Mellitus (DM). Methods This study, carried out in 2022 and 2023, involved 374 patients diagnosed with AH and/or DM in the health micro-region of Viçosa/MG, Brazil, comprising nine municipalities. The research aims to describe the creation, development and implementation of a software (NutelesApp) for the collection, storage, management and analysis of epidemiological research in public health, focusing specifically, on the monitoring and management of health care for individuals with AH and/or DM monitored by Primary Health Care (PHC). The parameters collected and analyzed were obtained through a questionnaire applied to patients, consisting of 70 questions, subdivided into 12 classes of questions. The epidemiological survey data was collected using mobile devices and analyzed using computer techniques based on statistical analysis. Once the field teams had completed their work, the files were transferred to servers for general analysis processing, using estimates of means, prevalence and respective standard errors, calculated using the Statistical Package for Social Science (SPSS) program, which takes into account the planning variables and includes the basic weights resulting from the sampling process. This study was approved by the Human Research Ethics Committee and registered, prior to recruitment, by the Brazilian Registry of Clinical Trials (ReBEC), ID: RBR-45hqzmf (Last approval date: 11/30/2022). Results The information obtained through data collection with subsequent exploratory analysis of epidemiological data using the NutelesApp software suggests that mobile applications intended for the purpose of monitoring and managing healthcare for people with AH and/or DM should address the variables necessary to support a process of understanding the health conditions and/or disease of the individual as a whole and provide short- and long-term learning. Regarding the results of the survey using the software, the variables of 374 people were analyzed. Majority are female (73.2%) and white (43.5%). Most patients are elderly (average 64 years), with blood pressure levels within the normal range for this population, BMI indicates overweight, AC increased risk for cardiovascular events and CC within the recommendation value. All biochemical parameters analyzed were above normal limits. Conclusions The description of the creation and development of the software includes practical examples of its implementation, the results collected and its applicability in real scenarios, presenting determining criteria that can provide assertive and timely interventions for monitoring and managing the health and/or disease parameters of patients with HA and/or DM. In addition, the beneficial consequences of using this application will extend to health units and their respective management, improving the services provided by PHC and enhancing strategies and actions for health promotion and disease prevention.

Background: Sickle cell disease (SCD) affects approximately 100,000 people in the United States and millions worldwide, with the highest prevalence of 70% of SCD being found in individuals of African ethnicity. Delayed hemolytic, alloimmunization, and anamnestic transfusion reactions in multiple transfusion patients need to be investigated and managed to avoid a worsening of the patient’s clinical status. Objective: This paper aims to investigate delayed transfusion reactions in SCD patients who were polytransfused in the Brazilian Amazon. Material and Methods: The clinical and laboratory indicators of SCD patients with more than four transfusions were investigated. The patients were treated at the Fundação Hospitalar de Hematologia e Hemoterapia do Estado do Amazonas, Brazil. Results: A total of 44 polytransfused patients with SCD were followed. Regarding Rh phenotype, it was possible to observe a frequency of 26.6% (12) patients with the RZRZ (DCE/DCE) phenotype, in addition to 4.5% (two) patients with RH and RHCE variants. It was also possible to observe 20.5% (nine) patients with an alloimmunization reaction, who presented the following alloantibodies: anti-RhD, anti-E, anti-K, anti-Jkb, anti-N, anti-S, and anti-Dia, two of which are unidentified. Of these, four (44.4%) patients also presented autoantibodies, anti-e, and three unidentified antibodies, and four (44.4%) patients presented an anamnestic reaction, with anti-RhD, K, and Jkb antibodies. Of the 44 patients monitored, 54.4% (24) had clinical and laboratory indicators of a delayed hemolytic reaction. Conclusion: Delayed transfusion reactions, often neglected, occur frequently. Therefore, transfusions need to be monitored for at least 28 days, with medical investigation of clinical and laboratory indicators to make greater use of this therapeutic resource.

Summary Background The growing discussion on teacher development focuses on diversified educational skills that promote knowledge and innovation in the teaching, learning and assessment process. With the Covid-19 scenario, this picture of necessary changes has become more evident, demonstrating the need for professional preparation to work in teacher development. The aim of the study was to analyze the effectiveness of teacher development programs for the training of university teachers in the health area, through a systematic review and meta-analysis. Methods The systematic review and meta-analysis were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved searching five databases - PubMed-Medline, Education Resource Information Center (ERIC), SCOPUS, Embase and Web of Science. The review included randomized clinical trials and cohort studies that addressed the effectiveness of teaching professionalization in the health area for university professors. The quality of the selected studies was assessed based on the evaluation criteria of the Joanna Briggs Institute tool. The random effects meta-analysis method was used to explain the distribution of effects between the studies, using Stata® software (version 11.0) and publication bias was examined by visual inspection of the graphs and Egger's test. Results We included 12 studies in the systematic review and 8 in the meta-analysis. These studies were published between 1984 and 2022 in 14 countries. Significant changes were reported in teachers' behavior to stimulate and encourage students, improvement in the quality of teaching and teaching staff, as well as improvement in skills such as leadership and self-evaluation. Furthermore, the result of the meta-analysis showed that there is evidence of the effectiveness of the positive effects of teacher development programs after their implementation, with this effect being 1.70% and an increase of 4.75 in the effect of these teacher development programs. Conclusion Our study shows that development programs have been implemented in different countries and contexts, all of which have proven to be effective in the short, medium and long term. We recommend that future research focus specifically on the different competencies that have been acquired following the implementation of these programs.

Abstract Severe acute respiratory infections, such as community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia, constitute frequent and lethal pulmonary infections in the intensive care unit (ICU). Despite optimal management with early appropriate empiric antimicrobial therapy and adequate supportive care, mortality remains high, in part attributable to the aging, growing number of comorbidities, and rising rates of multidrug resistance pathogens. Biomarkers have the potential to offer additional information that may further improve the management and outcome of pulmonary infections. Available pathogen-specific biomarkers, for example, Streptococcus pneumoniae urinary antigen test and galactomannan, can be helpful in the microbiologic diagnosis of pulmonary infection in ICU patients, improving the timing and appropriateness of empiric antimicrobial therapy since these tests have a short turnaround time in comparison to classic microbiology. On the other hand, host-response biomarkers, for example, C-reactive protein and procalcitonin, used in conjunction with the clinical data, may be useful in the diagnosis and prediction of pulmonary infections, monitoring the response to treatment, and guiding duration of antimicrobial therapy. The assessment of serial measurements overtime, kinetics of biomarkers, is more informative than a single value. The appropriate utilization of accurate pathogen-specific and host-response biomarkers may benefit clinical decision-making at the bedside and optimize antimicrobial stewardship.

Riedel’s thyroiditis is the rarest form of thyroiditis, occasionally resulting in rapid thyroid enlargement and potential tracheal obstruction. Here, we detail the case of an 81-year-old woman with a medical history including Hodgkin lymphoma, Hashimoto’s thyroiditis, and multinodular goiter. She presented to the emergency room with stridor, cervical swelling, and breathing difficulties for over 2 days. CT scans revealed substantial thyroid enlargement causing significant glottal and tracheal compression, to a minimum tracheal diameter of 7 mm. Due to the severity of the compressive symptoms, orotracheal intubation and mechanical ventilation were deemed necessary. Surprisingly, despite the initial suspicion of malignancy given the rapid growth in the elderly, subsequent cytological and histological evaluations indicated a benign form of invasive fibrous thyroiditis – Riedel’s thyroiditis. Although surgical intervention was advised, the patient declined and opted for endobronchial treatment with a prosthetic stent and subsequent treatment with systemic glucocorticoids. Following successful treatment, she was discharged within a week and resumed normal activities without respiratory distress. This case is noteworthy for its rapid benign mass growth, rare emergent presentation, and the patient’s advanced age.

A multi-disciplinary symposium on early-age onset cancer (EAOC) was held in October 2023 to explore challenges experienced by this rapidly growing population. A major outcome of the symposium was recognition of the remarkable similarities of EAOC patients’ journeys across cancer sites. Prevention and early detection of cancer are hindered by a lack of awareness among patients and family doctors that cancer can and does occur in younger persons. Distinct characteristics of the disease—such as a later stage at diagnosis and more aggressive tumor biology—require more potent treatments, which result in profound physical and psychosocial consequences that are unique to this age group. EAOC patient empowerment emerged as another key theme of the symposium. The development of a greater number of specialized clinics was called for, and patient support groups were recognized for the vital role they play in empowering patients and their families. Leading-edge medical advancements hold tremendous hope across the spectrum of EAOC care. New technologies based on genomic profiling, immunotherapy and microbiome alteration contribute to the development of highly effective, personalized approaches to treatment. All symposium participants expressed their commitment to speak with one resounding voice to advocate for equitable access to leading care practices for EAOC patients; thus, a fourth symposium is planned for November 2024.

Enquadramento: o Grupo de Estudos de Gestão em Saúde (GEST) da Associação Portuguesa de Medicina Geral e Familiar (APMGF) elaborou o questionário “AVALIA-ULS: Análise das Vantagens e Limitações das Unidades Locais de Saúde (ULS) – Perspetivas da Medicina Geral e Familiar” para avaliar as perceções dos profissionais de Medicina Geral e Familiar (MGF) quanto à universalização deste modelo. O presente artigo constitui a segunda parte do estudo AVALIA-ULS, dedicando-se à análise das perspetivas acerca dos recursos e a organização da formação nas ULS. Objetivos: conhecer a perceção dos Médicos de Família sobre os recursos e a organização da formação nas ULS. Metodologia: aplicação de questionário online em 2023. Respostas analisadas através de Microsoft Excel® e SPSS®v. 27. Foi utilizado o teste qui-quadrado para análise entre subgrupos de profissionais com e sem experiência prévia em ULS (significância estatística para p

Este trabajo analiza la evolución de los catálogos de material educativo y su función en la preservación del patrimonio educativo. A través del estudio de diversos catálogos, se exploran las transformaciones en la clasificación y organización de los materiales en respuesta a las demandas del sistema educativo. La propuesta de sistematización presentada busca contribuir al estudio del contexto histórico de estos materiales, ofreciendo una perspectiva que abarca múltiples disciplinas. Este enfoque permite comprender la influencia del mercado y los cambios pedagógicos en la oferta educativa a lo largo del tiempo.

Worldwide 56·8 million people need palliative care (PC), and Africa shows the highest demand. This study updates the 2017 review of African PC development, using a scoping review methodology based on Arksey and O'Malley's framework and the PRISMA-ScR checklist. The review was conducted across PUBMED, CINAHL, Embase, government websites, and the African PC Association Atlas, from 2017 to 2023, charting its progress using the new WHO framework for PC Development, which, in addition to Services, Education, Medicines, and Policies, two new dimensions were incorporated: Research and Empowerment of people and Communities. Of the 4.420 records, 118 met the inclusion criteria. Findings showed increased adult specialised services (n = 675), and 15 of 54 countries have paediatric services. Nonetheless, the ratio of services per population mostly remains under 0,10 per 100.000 inhabitants. PC education was included in undergraduate curricula in 29 countries; despite the rise in morphine availability (28 countries), median consumption remains under 3 mg/per capita/year, and 14 countries presented stand-alone policies. Publications on PC development increased, and 26 countries have National PC Associations. Notwithstanding progress since 2017, significant hurdles remain, highlighting the need for ongoing research and policy development to ensure equitable access to palliative care in Africa.

Os videojogos têm-se revelado uma área em exponencial evolução nos últimos anos. Esta área tem uma estreita relação com a arquitetura quer sob o ponto de vista do seu processo de conceção quer sob o ponto de vista da necessidade de criar espaços habitáveis. Este trabalho começa por criar um enquadramento cronológico do desenvolvimento gráfico dos videojogos descrevendo, em seguida, o processo de conceção de um videojogo, principalmente, do ponto de vista da conceção do espaço e da arquitetura. São em seguida analisados alguns exemplos de videojogos, organizados segundo uma proposta de categorização representativa dos vários tipos de espaços. Por fim, de modo a validar a caracterização feita e analisar as características espaciais, estéticas e estruturais de cada tipo de videojogo, são realizados testes de usabilidade com vários jogadores. Estes testes permitem reconhecer o grau de perceção dos jogadores em relação ao espaço de cada videojogo, com o objetivo de identificar de que modo a arquitetura influencia a experiência de jogo de cada utilizador. As nossas conclusões apontam para a não existência de evidências suficientes que mostrem que os jogadores são sensíveis a questões arquitetónicas incoerentes presentes nos videojogos, mas que reagem a estímulos do espaço.

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Purpose: To evaluate olaparib in advanced triple negative breast cancer (TNBC) patients with homologous recombination deficiency (HRD) and no germline BRCA1/2 mutations (gBRCA1/2mut). Methods: NOBROLA (NCT03367689) is a single-arm, open-label, multicenter, phase IIa trial, enrolling adult patients with advanced TNBC without gBRCA1/2mut and with HRD, who were treated with olaparib. The primary endpoint was clinical benefit rate (CBR) per RECIST v.1.1. Results: Six of 114 patients were eligible and received olaparib. Median follow up was 8.5 months. CBR and overall response rate (ORR) were 50 % (95 % CI, 11.8–88.2). Conclusions: The observed results could prompt further investigation. Trial: ClinicalTrials.gov identifier NCT03367689.

Introduction Although psychoactive medicines (PMed) are needed in several psychiatric conditions, their use and misuse bear risks. We aimed at estimating the prevalence of PMed use and misuse.Methods Data on all PMed prescribed in 2017 and dispensed in community pharmacies of the Lisbon and Tagus Valley region of Portugal (ARSLVT) were extracted from ARSLVT medicines’ dispensing database. For 21 PMed among prescription opioids, benzodiazepines and z-drugs (BZDR), antidepressants (AD) and anticonvulsants (AC), we estimated the number of users of each PMed, and assessed PMed misuse by a set of proxy indicators for studying this practice: chronic use (use of ≥180 DDD during the study period) of PMed intended for short-term treatments, concomitant use of several PMed, in particular if involving long-term (≥ 30 days) opioid analgesic (OA) use, and doctor shopping (patients consulting several physicians in order to have access to a quantity higher than intended by each prescriber). Data were analysed using descriptive statistics and hypothesis testing, and multivariate logistic regression was used to explore potential factors affecting long-term concomitant treatment of chronic OA with other PMed.Results PMed use prevalence was 21.7%: 6.6% for OA, 12.7% for benzodiazepines (BZD), 5.3% for AD and 2.8% for AC. BZDR were mainly prescribed in primary care and OA in hospital outpatients. Chronic use of PMed was observed in 25%, especially with sertraline and buprenorphine for opioid use disorder (long-term treatment), and lorazepam (short-term treatment). About 56.6% of OA chronic users were long-term concurrent users with other PMed, mainly BZDR. Risk of abuse was low for BZDR, whilst four opioids had meaningful doctor shopping indicators – fentanyl, opioid use disorder buprenorphine, morphine and hydromorphone.Conclusions BZD are the main PMed used in ARSLVT, often chronically, especially lorazepam. Prevalence of OA use is low, although with higher risk of misuse than BZDR. Concomitant use of several PMed is frequent.

Objetivo: Proporcionar intervenciones de enfermería que contribuyan a mejorar el estado de salud de la persona usuaria. Caso clínico: Paciente de sexo masculino de 32 años de edad, con antecedentes de depresión hace 5 años (aumenta la ingesta de alimentos) y obesidad mórbida, peso de 354 kg. Ingresa al hospital el día 24/2/24; refiere a los familiares “dolor torácico hace dos días, sensaciones de falta de aire y desmayo en dos oportunidades”. Sale de alta el 15/4/24. Métodos: El método es un estudio temático único. Se utilizó la teoría de 11 modelos funcionales de Marjory Gordon como una herramienta para procesar datos que utilizaban nomenclaturas taxonómicas internacionales de diagnósticos de enfermería 2021-2023. NANDA, NOC y NIC. Resultados: La evolución del usuario fue óptima, ya que los cuidados brindados se basaron en planes individualizados. El paciente sale de alta el día 15/4/24. Conclusiones: El diagnóstico de prioridad de patrón respiratorio ineficaz tuvo como puntuación de cambio con base en los indicadores: frecuencia respiratoria puntuación cambio (+3), disnea puntuación cambio (+4) y para el indicador de saturación de oxígeno puntuación cambio (+4).

Esta investigação teve como objetivo, analisar a perceção dos docentes de três faculdades públicas de Educação Física (EF) de Moçambique, para perceber as suas práticas pedagógicas numa perfectiva inclusiva. Neste âmbito, foi realizada uma entrevista semiestruturada envolvendo três professores universitários de EF que trabalham em áreas inclusivas. Após a análise de conteúdo, os depoimentos foram grupados em três categorias: a) Formação inicial docente; b) perceção sobre o currículo e disciplinas inclusivas na formação inicial; c) Apreciação em relação as barreiras. Os resultados da investigação apontam para uma visão positiva sobre a formação inicial em Educação Física Inclusiva (EFI), entretanto alguns desafios foram apontados tais como: Falta de programas de capacitação dos docentes e futuros professores; insuficiência de conteúdos específicos ligados a inclusão dentro dos currículos de formação e pouco trabalho na componente prática ao longo da formação. Estes resultados nos remete a uma recomendação sobre propostas de formação continuada a longo prazo e de uma restruturação curricular nos cursos de EF por meio de propostas e adendas nos programas de formação inicial. Palavras-chaves: Formação inicial, inclusão, docentes, perceção, Moçambique

ABSTRACT: This study obtained information about the external and internal morphology of the alimentary canal of the main pest of brassica, Plutella xylostella L. (Lepidoptera: Plutellidae), when it is exposed to a microencapsulated formulation of the seed extract of Annona muricata L. (Annonaceae). The toxicity of the microencapsulated formulation of the caterpillars fed for 12, 24, and 48 hours plus the control was evaluated to verify and evaluate external and internal morphological changes caused by the extract that may have killed the caterpillars. After the assays, the alimentary canal of the caterpillars was dissected, fixed, dehydrated, blocked, cut, and colored. Then, histological slides were produced and studied under light microscopy and scanning microscopy (SEM). The microencapsulated formulation of A. muricata caused irreversible damage to the alimentary canal of P. xylostella, with disorganization, cell stratification, and modifications in the morphology of the cells considered essential for survival. SEM verified that the peritrophic membrane and the muscular layer remained intact during all the assays. The effects were more severe with more hours of exposure. These results demonstrated that after contact by ingestion, the insect dies due to intoxication and cellular disorganization, inhibiting its ability to continue feeding.

The global impact of physical activity and physical exercise on body mass index (BMI) and waist circumference (WC) in people with Intellectual and Developmental Disabilities (IDD), is not known, nor is the most effective type of exercise training for promoting these variables. The aim of this study was to assess the magnitude of the effect of physical exercise on BMI and WC in individuals with IDD through a systematic review with meta-analysis. Nine manuscripts met the eligibility criteria for the study. For BMI, the Z-value was Z=-2.176 and p=0.03. The highest magnitude of the effect was from the intervention with combined training showed the highest magnitude of effect (difference in means: -0.399, with a value of Z=-1.815 and p=0.07). For WC, the Z-value is Z=-3.306 and p=0.001. The intervention with continuous cardiorespiratory training showed the highest magnitude of effect (difference in means: -0.786, with a value of Z=-2.793 and p=0.005). Regular physical exercise seems to prevent an increase in BMI and WC in individuals with IDD. Similarly, the prescription of aerobic exercise seems to be more effective in promoting WC and the prescription of combined exercise in promoting BMI.

The increase in overweight and obesity among individuals with Intellectual and Developmental Disabilities (IDD) also increases the deterioration of functionality and the risk of developing chronic diseases. Physical exercise has been identified as an effective strategy for reducing overweight and obesity and promoting health. The aim of this study was to investigate the effects of an indoor and outdoor exercise programme on individuals with IDD. Were split by convenience into three groups twenty-one adults with IDD (43.04 ± 11.18 years): i) an indoor training group (IG; N=7; 24-week machine-based gym intervention), ii) an outdoor training group (OG; N=7; 24-week outdoor intervention with low-content materials), and iii) a control group (CG; N=7). Various variables were assessed, including indicators of health and neuromuscular capacity. The Shapiro-Wilk (n

PURPOSETo better understand immigration disparities among a Spanish Early-Onset Colorectal Cancer (SECOC) subset, according to the country of origin.PATIENTS AND METHODSWe selected 250 consecutive participants from the SECOC consortium. Data on baseline patient and tumor characteristics, family history of colorectal cancer (CRC), and follow-up were collected. The presence of mismatch repair deficiency was also assessed. Special data regarding country of origin, time of stay in Spain in case of other different country, and a 10-year cutoff that specifies the obtaining of Spanish nationality defined the variables of interest for comparison.RESULTSSeventy-five percent of patients with early-onset CRC (EOCRC) (188) were born in Spain, whereas the other 25% were born outside of Spain. The mean time of living in Spain until the EOCRC diagnosis was 16.5 years. Comparatively, most of the analyzed features showed equivalent proportions between cohorts. Only Spanish patients appeared to have more familial cancer component in first degree in general (32.3%; P = .01), compared with non-Spaniards, which showed a predominant sporadic component (56.4%; P < .001). Among immigrants, those patients living in Spain before CRC diagnosis ≤10 years were younger at diagnosis (39.1 v 42.5), more frequently male (77.8 v 47.7), were in more advanced stages (88.8% diagnosed at stage III and IV [P = .01]), and had a worse prognosis regarding recurrence rates (29.4% v 6.3%).CONCLUSIONAlthough there were few differences between Spanish and non-Spanish EOCRC, the most remarkable difference was that linked with the situation of those immigrants who have recently arrived in Spain, in relation to their lower health coverage, which could be associated with the delay in the diagnosis and their subsequent worse prognosis.

Algunos subproductos, pueden ser utilizados en alimentación animal dependiendo de sus características nutricionales, con respecto a esto el subproducto de Chía presenta poca información sobre uso del mismo en raciones de vacas lecheras. Con el objetivo de evaluar la inclusión de torta de Chía (Salvia hispanica L.) en la ración de vacas lecheras y su efecto en la producción y composición química de la leche, se llevó a cabo el siguiente experimento. Fueron seleccionadas diez vacas de raza Holstein en primer tercio de lactación, PV 500 ± 50 kg, se utilizó un diseño cruzado con dos tratamientos, en 2 periodos. Un grupo fue alimentado con inclusión de torta de Chía en la ración (Dieta 1) y el otro sin inclusión de torta de Chía en la ración (Dieta 2). Los animales fueron mantenidos en las mismas condiciones de sanitación y manejo, con dos ordeños diarios, a la mañana y tarde. Tras 12 días (d) de adaptación a la dieta, y durante un periodo de mediciones de 5 d, se registraron diariamente la ingesta de alimentos, producción láctea individual y se tomaron muestras para determinar la composición química de la misma. Se presentaron diferencias estadísticas significativas en la producción de leche a favor de la Dieta 2 (P