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Abstract This study aims to obtain a composite index characterizing Bulgarian districts about their creativity by presenting results for the pre-pandemic. The composite index developed by Rodrigues and Franco (2019), use of quantitative method and multivariate statistical techniques have been used to answer this objective. From the data gathered primarily from NSI- The National Statistical Institute of Bulgaria, the results show that creativity is one of the pillars of economic growth, and financial resources and local and foreign investment for its development are still very limited. The government and cultural organisations supported initiatives to showcase the country's cultural diversity and historical significance. The creative sector, including design, arts, media, and technology started to be seen as a driving force for the country's economic growth. Startups and creative entrepreneurs are increasingly gaining weight, which has led to the creation of creative centers, and co-working spaces. Therefore, this study contributes to the intelligent application of creative cities’ ideas in the creative industries and contemporary cities’ management.

This review provides a comprehensive summary of evidence to explore the role and value of differential diagnosis in the management of Acute Respiratory Infections (ARIs) through point-of-care (POC) rapid testing in a post-pandemic scenario, paying particular attention to coronavirus disease 2019 (COVID-19), influenza, and respiratory syncytial virus (RSV). The document builds on a review of literature and policies and a process of validation and feedback by a group of seven experts from Latin America (LATAM). Evidence was collected to understand scientific and policy perspectives on the differential diagnosis of ARIs and POC rapid testing, with a focus on seven countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. The evidence indicates that POC rapid testing can serve to improve ARI case management, epidemiological surveillance, research and innovation, and evidence-based decision-making. With multiple types of rapid tests available for POC, decisions regarding which tests to use require the consideration of the testing purpose, available resources, and test characteristics regarding accuracy, accessibility, affordability, and results turnaround time. Based on the understanding of the current situation, this document provides a set of recommendations for the implementation of POC rapid testing in LATAM, supporting decision-making and guiding efforts by a broad range of stakeholders.

Abstract The consumption of bovine milk and its derivatives is associated with inflammation, gastrointestinal disorders and the development of diseases in humans. Most studies related to milk effects are based on either clinal trials or experimental models such as mice and cell cultures. In this study we present the nematode Caenorhabditis elegans as an alternative model to evaluate the effects of milk on oxidative stress in other animal models. The toxicological effect of 20% milk exposure for 8 h on C. elegans was evaluated by progeny quantification, body size and pharyngeal pumping rate. Treating the worms with milk did not affect the worms brood size but interfered with their fecundity by delaying the average number of eggs in the first day of oviposition when compared to the control group. The size of worms treated with milk were significantly smaller compared to control. The pharyngeal pumping rate of milk-treated animals was not significantly different compared to untreated animals. Taking together, the results suggest that 20% milk treatment is not toxic for the worms but induces a minor delay achieving its adulthood and therefore its reproduction period. Milk exposure did not reduce the worms’ survival under stress conditions and increase endogenous ROS levels. This study contributes to characterize the effects of milk exposure on the C. elegans nematode.

Nowadays ultrasound-based non-invasive techniques for the evaluation of tissue elasticity are becoming increasingly popular. A key determinant for the adequate treatment of focal liver lesions is on establishment of accurate diagnosis. Contemporary imaging modalities, particularly ultrasonographic, are widely accepted for assessing the elasticity of focal liver lesions but the investigation of their accuracy and differentiation potential is still ongoing. Aim: To compare the values of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for liver metastases from colorectal cancer. Materials and Methods: A total of 31 adult patients with liver metastases from colorectal cancer (CRC) were included from the Department of Gastroenterology of University Hospital Kaspela, Plovdiv, Bulgaria, in the period June 2022 to November 2022. The men/women ratio of the participants was respectively 11 women and 20 men. For all of them point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) were performed to evaluate the stiffness of liver metastases, by measuring the shear wave velocity (SWV) in a region of interest (ROI). Prior histological confirmation of colorectal cancer through diagnostic lower endoscopy was a prerequisite for inclusion in the study. Contrast-enhanced computer tomography (CECT) was used as a reference imaging modality to confirm the presence of lesions in the liver. All the images were evaluated by a radiologist with long-standing experience in liver imaging. Results: For point shear wave elastography (pSWE), the lower limit was found to be 1.80 m/s (90% CI: 1.39 to 2.32) and the upper limit was 4.21 m/s (90% CI: 3.69 to 4.60). For two-dimensional shear wave elastography (2D-SWE), the lower limit was determined to be 1.87 m/s (90% CI: 1.54 to 2.25) and the upper limit was 3.65 m/s (90% CI: 3.26 to 3.97). Conclusions: Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) could bring additional information about the stiffness of liver metastases from colorectal cancer but they are not to be considered a method to substitute biopsy of colorectal cancer during lower endoscopy.

Abstract DNA can be folded into rationally designed, unique, and functional materials. To fully realise the potential of these DNA materials, a fundamental understanding of their structure and dynamics is necessary, both in simple solvents as well as more complex and diverse anisotropic environments. Here we analyse an archetypal six-duplex DNA nanoarchitecture with single-particle cryo-electron microscopy and molecular dynamics simulations in solvents of tunable ionic strength and within the anisotropic environment of biological membranes. Outside lipid bilayers, the six-duplex bundle lacks the designed symmetrical barrel-type architecture. Rather, duplexes are arranged in non-hexagonal fashion and are disorted to form a wider, less elongated structure. Insertion into lipid membranes, however, restores the anticipated barrel shape due to lateral duplex compression by the bilayer. The salt concentration has a drastic impact on the stability of the inserted barrel-shaped DNA nanopore given the tunable electrostatic repulsion between the negatively charged duplexes. By synergistically combining experiments and simulations, we increase fundamental understanding into the environment-dependent structural dynamics of a widely used nanoarchitecture. This insight will pave the way for future engineering and biosensing applications.

Objective: To analyze the spatial pattern of the incidence of COVID-19 in association with social determinants of health (SDH) in the Northeast Region of Brazil during the first year of the pandemic. Methods: We conducted an ecological analytical study that included notifications made between 27 March 2020 and 27 March 2021. The data analysis used two global regression models: the ordinary least squares (OLS) and spatial lag model and the geographically weighted multiscale regression model (GWMSR). Results: We observed that the Gini index, illiteracy rate, percentages of people living below the poverty line, people in households who were vulnerable to poverty, and dependent elderly people are predictors of a higher incidence of COVID-19 in Northeast Brazil. Conclusions: Results of this study may contribute to generating new hypotheses for studies focusing on the syndemic process and for the formulation of intersectoral public policies targeting the population at greatest vulnerability to minimize the impact of the disease.

This review aims to explore the role of professional diagnostic rapid testing of acute respiratory infections (ARIs), especially COVID-19 and influenza, ensuring proper disease management and treatment in Europe, and particularly in Czech Republic, Poland, and Romania. The paper was constructed based on a review of scientific evidence and national and international policies and recommendations, as well as a process of validation by four experts. The development of new testing technologies, treatment options, and increased awareness of the negative multidimensional impact of ARI profiles transformed differential diagnosis into a tangible and desirable reality. This review covers the following topics: (1) the multidimensional impact of ARIs, (2) ARI rapid diagnostic testing platforms and their value, (3) the policy landscape, (4) challenges and barriers to implementation, and (5) a set of recommendations illustrating a path forward. The findings indicate that rapid diagnostic testing, including at the point of care (POC), can have a positive impact on case management, antimicrobial and antibiotic stewardship, epidemiological surveillance, and decision making. Integrating this strategy will require the commitment of governments and the international and academic communities, especially as we identified room for improvement in the access and expansion of POC rapid testing in the focus countries and the inclusion of rapid testing in relevant policies.

Objetivo: Construir y validar un escenario de simulación clínica destinado a enseñar la gestión de conflictos a estudiantes universitarios de enfermería. Método: Estudio metodológico en el que se construyó un escenario de gestión de conflictos en la ciudad de São Paulo, SP, Brasil, en 2022, a partir de la revisión bibliográfica y de la experiencia pedagógica de los investigadores. La validación del contenido se llevó a cabo con jueces sobre el terreno mediante la técnica Delphi. Los datos se analizaron con un Índice de Validez del Contenido (IVC>80%). Resultados: el escenario describe la escena de un practicante de enfermería que pide al técnico de enfermería que bañe a un paciente en la cama. Esto está impregnado de conflictos interpersonales. En la validación del contenido participaron ocho expertos en simulación clínica y dos estudiantes de enfermería. Hubo tres rondas, alcanzando el IVC al 100%. Conclusión: el escenario fue validado y contribuirá a la enseñanza práctica de esta habilidad en los cursos de licenciatura.

Objective: Develop and validate a clinical simulation scenario for undergrad nursing students to learn conflict management. Method: Methodological study in which a conflict management scenario was constructed in the city of São Paulo, SP, Brazil, in 2022, based on the literature review and the pedagogical experience of the researchers. Content validation was carried out with judges in the field using the Delphi technique. The data was analyzed with a Content Validity Index (CVI>80%). Results: The scenario describes the scene of a nursing trainee asking the nursing technician to bathe a patient in bed. This is permeated by interpersonal conflicts. The content validation involved eight experts in clinical simulation and two nursing students. There were three "rounds," reaching IVC 100%. Conclusion: The scenario was validated and will contribute to the practical teaching of this skill in undergraduate courses.

Objetivo: construir e validar um cenário de simulação clínica voltado para o ensino do gerenciamento de conflitos para estudantes de graduação em enfermagem. Método: estudo metodológico no qual construiu-se um cenário de gerenciamento de conflitos, na cidade de São Paulo, SP, Brasil, em 2022, a partir da revisão de literatura e da experiência pedagógica dos pesquisadores. Realizou-se validação de conteúdo com juízes da área por meio da técnica Delphi. Os dados foram analisados com Índice de Validade de Conteúdo (IVC>80%). Resultados: o cenário descreve a cena de um estagiário de enfermagem que solicita ao técnico de enfermagem realizar um banho no leito de um paciente. Tal fato é permeado por conflitos interpessoais. A validação de conteúdo contou com oito experts em simulação clínica e dois estudantes de enfermagem. Houve três “rounds”, chegando ao IVC 100%. Conclusão: o cenário construído foi validado e contribuirá para o ensino prático desta competência na graduação.

The ultrafiltration technique (UF) was used to achieve skim milk protein concentration and develop probiotic Greek-style yoghurt. Two yoghurts were prepared from ultrafiltered milk (with concentration factors 3 and 1.5, CF1 and CF2 samples, respectively) added with probiotic (Bifidobacterium animalis subsp. lactis) and compared to a control yoghurt. Proximal composition and physicochemical analyses were carried out after one day of processing. The microbiological viability of the starter and probiotic cultures, physicochemical composition, and technological properties of yoghurts during 28 days of storage were also evaluated. CF1 yoghurts showed the highest increase in protein content compared to the yoghurt CF2 and control. Consequently, this feature favoured lower post-acidification, better texture, higher water holding capacity, and absence of syneresis. Ultrafiltration was also satisfactory for enhancing the mineral content, especially calcium, phosphorus, and zinc. The probiotic bacteria remained viable throughout the refrigerated storage period, hence the use of ultrafiltered milk proved to be appropriate for producing high protein content probiotic yoghurts.

Non-invasive, ultrasound-based methods for visualizing and measuring tissue elasticity are becoming more and more common in routine daily practice. An accurate diagnosis of malignant and benign tumors is essential for determining the appropriate treatment. Despite the wide use of imaging techniques, the investigation for assessing the elasticity of focal liver lesions and their differentiating is still continuing. Aim: To investigate the value of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for the differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 125 adult patients were included from the Clinic of Gastroenterology of University Hospital Kaspela, Plovdiv city, Bulgaria, in the period from January 2021 to July 2022. Participants were divided into two groups—with benign (hemangiomas) and malignant focal liver lesions (hepatocellular carcinoma). The group with benign lesions included 63 patients and the group with malignant focal liver lesions (FLLs)—62 patients. Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) integrated in the same ultrasound machine (Esaote MyLab™ 9Exp) were performed for each lesion. Results: Malignant FLLs have significantly higher stiffness in both pSWE (2.52–4.32 m/s, 90% CI: 2.37 to 2.68, 90% CI: 4.19 to 4.55) and 2d-SWE (2.52–4.43 m/s, 90% CI: 2.31 to 2.65, 90% CI: 4.27 to 4.61). Conclusion: 2D-SWE and pSWE could provide complementary data about FLLs. They enable us to conveniently and easily obtain accurate stiffness information of FLLs.

The objective of this study was to develop fresh and matured cheeses with different bovine colostrum levels, aiming to promote the consumption of dairy products with the addition of colostrum. Four different cheese formulations were produced with a mixture of 0:100, 15:85, 20:80, and 25:75, bovine colostrum:milk (v:v), and aged for 0, 10, 20, and 40 days. Milk, colostrum, and fresh and matured cheeses were submitted to physicochemical characterization. Moreover, microbiological quality, yield, texture profile, color, and sensory acceptance of cheese samples were evaluated. Colostrum supplementation favored low acidity, high moisture, a pH range of 5.0–6.2, and water activity of 0.94–99. Sensory attributes and overall evaluation of all cheese formulations achieved an Acceptability Index above 70, indicating good acceptability. Since cheese with colostrum presented the potential to be used as human food, assessing the presence of colostrum bioactive components in those dairy products is a promising goal for further research.

La propuesta titulada Curar una Colección entreteje formas sobre cómo una colección de arte –del Proyecto Bienal– genera varias posibilidades curatoriales. La administración 2019-2023 de la Bienal de Cuenca, comandada por Katya Cazar, propone –tras la recuperación de la colección– tres curadurías que públicamente han permitido exhibir obras de varias ediciones; tres muestras de pequeño formato que han mostrado parte del patrimonio ciudad, la memoria histórica y la trayectoria de un proyecto emblemático de carácter internacional, bajo un propio texto curatorial que despliega tres puestas en escena donde hila el interés de trabajar en una colección y cómo una misma colección puede tener varias lecturas y propuestas curatoriales; hablamos así de: Parábolas de Superficies (2019), conformada por siete premios-adquisición de la Colección; Máquinas Sensibles (2022), conformada por once obras entre premios-adquisición, menciones de honor y donaciones; y finalmente, Modulaciones en claroscuro (2023), conformada por cuatro obras, todas premios- adquisición.

The search for improvements in quality of life has increasingly involved changes in the diet, especially the consumption of foods which, in addition to having good nutritional value, are characterized by offering health benefits. Among the molecules that trigger several beneficial responses are peptides, which are specific fragments of proteins known to produce positive effects on the human body. This review aimed to discuss the bioactive potential of peptides from cheeses. Studies show that the protein composition of some cheese varieties exhibits a potential for the release of bioactive peptides. The production of these peptides can be promoted by some technological procedures that affect the milk structure and constituents. The cheese maturation process stands out for producing bioactive peptides due to the action of enzymes produced by lactic acid bacteria. Thus, in addition to being proteins with high biological value due to their excellent amino acid profile, peptides from some types of cheeses are endowed with functional properties such as anti-hypertensive, antimicrobial, antioxidant, anticarcinogenic, opioid, and zinc-binding activities.

ABSTRACT: Non-typhoidal Salmonella (NTS) poses a global threat to public health. Poultry, one of the main reservoirs of NTS, is usually not clinically affected by most NTS, yet the economic losses to the poultry industry due to control and mitigation efforts, and due to negative publicity can be tremendous.NTS strains are routinely characterized into serotypes in a time-consuming, labor-intensive multistep process that requires skilled personnel. Moreover, the discriminatory power of serotyping is limited compared to other subtyping methods. Whole-genome sequence data enable the identification of genetic variation within serotypes. However, sequencing is often limited by available resources, and analyzing and interpreting the genetic data may be time-consuming. Source tracing during epidemiological outbreak investigations requires rapid and efficient characterization of strains to control pathogen spread. Here we designed a multiplex polymerase chain reaction (PCR) assay for the detection of genetic variants of Salmonella Muenchen, a serotype that has emerged in Israel in the last 3 yr in both clinical human cases and different hosts. Test sensitivity of 99.21% and specificity of 94 to 100% were determined using in-silico PCR with a dataset of 18,282 NTS assemblies from 37 NTS serotypes. Similarly, test sensitivity of 100% and specificity of 96.2 to 100% were determined in-vitro with 120 NTS isolates of 52 serotypes. Moreover, the test enabled differentiation between the common sequence types of serotype Muenchen using both approaches. As opposed to traditional serotyping and other subtyping methods, the designed test allows for rapid and cost-efficient detection of the emerging S. Muenchen serotype and its variants in a single step. Future development of similar assays for other dominant serotypes may help reduce the time and cost required for detection and initial characterization of dominant NTS strains. Overall, these tests will be beneficial to both public health and for reducing of the economic losses to the poultry industry due to NTS infections.

Bovine colostrum is a rich source of nutrients and biologically active molecules known to be able to modulate the human immune system, such as lactoferrin, lysozyme, lactoperoxidase, immunoglobulins and growth factors. This comprehensive review aimed to gather evidence from animal experimentation and clinical trials that investigated the potential effects of bovine colostrum in preventing and treating diseases that affect the human gastrointestinal tract. Considered safe for human consumption, BC or its isolate components were used against a range of different gastrointestinal disorders. Beneficial effects were observed in several conditions: gastrointestinal infections, infectious diarrhoea, drug-induced lesions, gut-barrier malfunction, and inflammatory bowel disease. Under proper processing to maintain its components' integrity, BC products are valuable supplements with high nutraceutical value, capable of promoting and restoring gastrointestinal health.

The visual design of urban public spaces (hereinafter “cityscape”) has an important impact on city life – it can channel interpersonal communication into certain directions while excluding others; it can powerfully communicate notions of what is socially acceptable or important. Yet, while everyone may access urban public spaces, cityscapes are designed by a very limited social group. This paper focuses on the narratives embedded in the cityscapes. Analyzing legal conflicts arising around expressions that seek their way into the shared visual environment, as well as expressions whose presence in the cityscapes is disputed, we trace the dynamics of battles over urban narratives. The discussion of legal rules is complemented by photographs. Rather than illustrating the text, the photographs will relate to the discussed topics in their own way, enriching the discussion and broadening its perspective.

The dissociation rate (koff) associated with ligand unbinding events from proteins is a parameter of fundamental importance in drug design. Here we review recent major advancements in molecular simulation methodologies for the prediction of koff. Next, we discuss the impact of the potential energy function models on the accuracy of calculated koff values. Finally, we provide a perspective from high-performance computing and machine learning which might help improve such predictions.

This review aimed to gather information about the biological effects of bovine colostrum (BC) supplementation for improving the respiratory health in humans and the potential role of bioactive molecules from BC as adjunctive therapy for SARS-CoV-2 infection (Coronavirus Disease 2019 – COVID-19). Several studies have shown that BC supplementation is effective against infections and respiratory allergies, as well as in attenuating immunosuppression caused by intense exercise in high-performance athletes. The major immune system modulation proteins present in BC are immunoglobulins, lactoferrin and transforming growth factor-β (TGF-β). Studies have revealed that lactoferrin is effective in combating SARS-CoV-2. Hyperimmune colostrum may constitute an alternative way to produce specific antibodies against COVID-19. Based on the immune system boosting ability as well as anti-inflammatory, antioxidant and antiviral/antibacterial activities, we suggest that well designed, randomized, placebo-controlled, multicenter clinical trials should be done to verify the safety and effectiveness of BC supplements against SARS-CoV-2 infection.

The objective of this review was to search the literature for studies on the lactoperoxidase system (LPS) as milk natural preservation, action mechanisms, usage methods and perspectives for the dairy industry. A comprehensive literature review approach was conducted for collecting evidence in scientific publications. The biological properties of milk promote the development of microorganisms which compromise its quality, therefore demanding the use of techniques for preserving the milk matrix from its collection until processing. Within this context, LPS could represent an alternative to guarantee the safety of this food in are as where refrigeration is not possible; in addition, studies on applying this system in the dairy industry have been explored, as is the case in the test for verifying pasteurisation efficiency according to determining the lactoperoxidase enzyme activity. Natural antimicrobial properties of LPS make it a promising alternative for the industrial preservation and processing of milk, especially when considering the current quality standard demanded by the market. However, the potential of LPS as a biopreservative is still little technically and scientifically explored, which implies the need to develop new studies.

BackgroundIt is unknown if early COVID-19 monoclonal antibody (mAb) therapy can reduce risk of Long COVID. The mAbs amubarvimab/romlusevimab were previously demonstrated to reduce risk of hospitalization/death by 79%. This study assessed the impact of amubarvimab/romlusevimab on late outcomes, including Long COVID.MethodsNon-hospitalized high-risk adults within 10 days of COVID-19 symptom onset enrolled in a randomized, double-blind, placebo-controlled phase 2/3 trial of amubarvimab/romlusevimab for COVID-19 treatment. Late symptoms, assessed using a participant-completed symptom diary, were a pre-specified exploratory endpoint. The primary outcome for this analysis was the composite of Long COVID by participant self-report (presence of COVID-19 symptoms as recorded in the diary at week 36) or hospitalization or death by week 36. Inverse probability weighting (IPW) was used to address incomplete outcome ascertainment, giving weighted risk ratios (wRR) comparing amubarvimab/romlusevimab to placebo.FindingsParticipants received amubarvimab/romlusevimab (n = 390) or placebo (n = 390) between January and July 2021. Median age was 49 years, 52% were female, 18% Black/African American, 49% Hispanic/Latino, and 9% COVID-19-vaccinated at entry. At week 36, 103 (13%) had incomplete outcome ascertainment, and 66 (17%) on amubarvimab/romlusevimab and 92 (24%) on placebo met the primary outcome (wRR = 0.70, 95% confidence interval (CI) 0.53-0.93). The difference was driven by fewer hospitalizations/deaths with amubarvimab/romlusevimab (4%) than placebo (13%). Among 652 participants with available diary responses, 53 (16%) on amubarvimab/romlusevimab and 44 (14%) on placebo reported presence of Long COVID.InterpretationAmubarvimab/romlusevimab treatment, while highly effective in preventing hospitalizations/deaths, did not reduce risk of Long COVID. Additional interventions are needed to prevent Long COVID.FundingNational Institute of Allergy and Infectious Diseases of the National Institutes of Health. Amubarvimab and romlusevimab supplied by Brii Biosciences.

The objective of this study was to investigate the nutritional quality of bovine colostrum and whey mixtures. Five whey with bovine colostrum formulations were prepared (90:10; 80:20; 70:30; 60:40 and 50:50 whey:colostrum v:v) to be subjected to low-temperature pasteurization (63°C to 65°C for 30 minutes) and freeze-drying. The samples underwent chemical composition characterization, fatty acid profile analysis, determination of contamination by Enterobacteriaceae, pH, and Dornic acidity measurements before and after vat pasteurization. The amount of protein, fat, total solids, defatted dry extract, Brix and density increased as the bovine colostrum concentration increased. The level of saturated fatty acids and the thrombogenicity and atherogenicity indices reduced, while unsaturated fatty acids increased as the level of added bovine colostrum increased. The low-temperature pasteurization of the formulations was possible and effective, eliminating contamination by Enterobacteriaceae in the samples. Mixing bovine colostrum and whey reduced the colostrum viscosity, allowing a successful pasteurization procedure. Due to colostrum composition, the formulations yielded a higher nutritional value when compared to whey alone. The parameters applied in the formulation of mixtures of bovine colostrum and whey resulted in valuable ingredients for preparing novel dairy products.

This report describes how image processing harnessed to multivariate analysis techniques can be used as a bio-analytical tool for mastitis screening in cows using milk samples collected from 48 animals (32 from Jersey, 7 from Gir, and 9 from Guzerat cow breeds), totalizing a dataset of 144 sequential images was collected and analyzed. In this context, this methodology was developed based on the lactoperoxidase activity to assess mastitis using recorded images of a cuvette during a simple experiment and subsequent image treatments with an R statistics platform. The color of the sample changed from white to brown upon its exposure to reagents, which is a consequence of lactoperoxidase enzymatic reaction. Data analysis was performed to extract the channels from the RGB (Red-Green-Blue) color system, where the resulting dataset was evaluated with Principal Component Analysis (PCA), Multiple Linear Regression (MLR), and Second-Order Regression (SO). Interesting results in terms of enzymatic activity correlation (R2 = 0.96 and R2 = 0.98 by MLR and SO, respectively) and of somatic cell count (R2 = 0.97 and R2 = 0.99 by MLR and SO, respectively), important mastitis indicators, were obtained using this simple method. Additionally, potential advantages can be accessed such as quality control of the dairy chain, easier bovine mastitis prognosis, lower cost, analytical frequency, and could serve as an evaluative parameter to verify the health of the mammary gland.

The detection of psychological stress using the electrocardiogram (ECG) signal is most commonly based on the detection of the R peak—the most prominent part of the ECG waveform—and the heart rate variability (HRV) measurements derived from it. For stress detection algorithms focused on short-duration time windows, there is potential benefit in including HRV features derived from the detection of smaller peaks within the ECG waveform: the P, Q, S, and T waves. However, the potential drawback of using these small peaks is their smaller magnitude and subsequent susceptibility to noise, making them more difficult to reliably detect. In this work, we demonstrate the potential benefits of including smaller waves within binary stress classification using a pre-existing data set of ECG recordings from 57 participants (aged 18–40) with a self-reported fear of spiders during exposure to videos of spiders. We also present an analysis of the performance of an automated peak detection algorithm and the reliability of detection for each of the smaller parts of the ECG waveform. We compared two models, one with only R peak features and one with small peak features. They were similar in precision, recall, F1, area under ROC curve (AUC), and accuracy, with the greatest differences less than the standard deviations of each metric. There was a significant difference in the Akaike Information Criterion (AIC), which represented the information loss of the model. The inclusion of novel small peak features made the model 4.29×1028 times more probable to minimize the information loss, and the small peak features showed higher regression coefficients than the R peak features, indicating a stronger relationship with acute psychological stress. This difference and further analysis of the novel features suggest that small peak intervals could be indicative of independent processes within the heart, reflecting a psychophysiological response to stress that has not yet been leveraged in stress detection algorithms.

INTRODUCTION: Living kidney donor evaluation is a lengthy and complex process requiring in-person visits. Access to transplant centers, travel costs, lost wages, and dependent care arrangements are barriers to willing donors initiating evaluation. Telemedicine can help streamline and epedite the evaluation process. We aimed to deeply understand donor experiences and preferences using hybrid telemedicine video/in-person visits to ease access to donor evaluation or counseling. METHODS: We conducted in-depth, semistructured interviews with donors or donor candidates who completed their evaluation through telemedicine/in-person, or in-person only visits at a tertiary transplant center between November 27, 2019 and March 1, 2021. Enrollment continued until data saturation was reached (interviews with 20 participants) when no new information emerged from additional interviews. Transcripts were analyzed using inductive thematic analysis. RESULTS: Eight themes were identified as follows: (i) reducing financial and logistical burdens (minimizing travel time and travel-related expenses), (ii) enhancing flexibility with scheduling (less time off work and child or family caregiver arrangements), (iii) importance of a walkthrough and establishing shared understanding, (iv) supporting information with technology and visual aids, (v) key role of the coordinator, (vi) preferred visit by provider role (meeting donor surgeon in-person to create rapport and engaging primary care provider in donor evaluation/follow-up), (vii) comparing modality differences in human connection, and (viii) opportunity for family and support network engagement (allowing loved ones to be involved in telemedicine visits irrespective of geographic locations and pandemic restrictions). CONCLUSION: Telemedicine/in-person hybrid model can make donor evaluation more accessible and convenient. Our findings help inform about determinants that influence the adoption of telemedicine to initiate donor evaluation to motivate willing donors. In addition, our results call for policy and legislation that support telemedicine services for living donor kidney transplantation across states.

Present and future climatic trends are expected to markedly alter water fluxes and stores in the hydrologic cycle. In addition, water demand continues to grow due to increased human use and a growing population. Sustainably managing water resources requires a thorough understanding of water storage and flow in natural, agricultural, and urban ecosystems. Measurements of stable isotopes of water (hydrogen and oxygen) in the water cycle (atmosphere, soils, plants, surface water, and groundwater) can provide information on the transport pathways, sourcing, dynamics, ages, and storage pools of water that is difficult to obtain with other techniques. However, the potential of these techniques for practical questions has not been fully exploited yet. Here, we outline the benefits and limitations of potential applications of stable isotope methods useful to water managers, farmers, and other stakeholders. We also describe several case studies demonstrating how stable isotopes of water can support water management decision-making. Finally, we propose a workflow that guides users through a sequence of decisions required to apply stable isotope methods to examples of water management issues. We call for ongoing dialogue and a stronger connection between water management stakeholders and water stable isotope practitioners to identify the most pressing issues and develop best-practice guidelines to apply these techniques.

BACKGROUND: We sought to review our institutions experience with dental implant placement in free flap jaw reconstruction to determine factors impacting restoration of dental occlusion. METHODS: Exactly 48 patients underwent free flap jaw reconstruction with or without dental restoration from 2017 to 2022. Primary outcome was achievement of restored dental occlusion after jaw free flap reconstruction. RESULTS: A total of 48 patients with a mean age of 59.8 ± 16.4 years underwent jaw reconstruction from 2017 to 2022. Ten patients (20.8%) received osteointegrated dental implants. Two patients received a temporary dental prosthesis, 12 ± 4 months after initial reconstruction. Three patients received a final prosthesis, with a mean time to final prosthesis of 17.7 ± 12.4 months. Five patients did not receive any prosthesis despite placement of implants. CONCLUSION: A minority of patients received dental implant placement with free flap jaw reconstruction and only a small subset of these received a definitive dental prosthesis.

Objetivo: reconocer y reflexionar sobre los impactos de la infección por coronavirus en ámbitos diversos en los que las mujeres viven y cómo afrontar los retos derivados de esta situación durante y después de la pandemia. Síntesis de contenido: este documento de reflexión expresa la experiencia y el sentir de mujeres, enfermeras y docentes frente a lo que está sucediendo en la vida de las personas, en particular de las mujeres, a partir de diciembre de 2019 con la aparición del SARS-CoV 2 y la COVID-19. Conclusión: se evidencian los cambios en diversas áreas de la vida de las personas, especialmente en las mujeres, haciendo evidente las inequidades, desigualdades y vulnerabilidades. A partir de ello, se propone la cuidadanía como una nueva forma de ciudadanía basada en el cuidado.

Rabbit anti-thymocyte globulin (rATG) is currently the treatment of choice for glucocorticoid-resistant, recurrent, or severe acute allograft rejection (AR). However, rATG is associated with severe infusion-related side effects. Alemtuzumab is incidentally given to kidney transplant recipients as treatment for AR. In the current study, the outcomes of patients treated with alemtuzumab for AR were compared with that of patients treated with rATG for AR. The patient-, allograft-, and infection-free survival and adverse events of 116 alemtuzumab-treated patients were compared with those of 108 patients treated with rATG for AR. Propensity scores were used to control for differences between the two groups. Patient- and allograft survival of patients treated with either alemtuzumab or rATG were not different [hazard ratio (HR) 1.14, 95%-confidence interval (CI) 0.48–2.69, p = 0.77, and HR 0.82, 95%-CI 0.45–1.5, p = 0.52, respectively). Infection-free survival after alemtuzumab treatment was superior compared with that of rATG-treated patients (HR 0.41, 95%-CI 0.25–0.68, p < 0.002). Infusion-related adverse events occurred less frequently after alemtuzumab treatment. Alemtuzumab therapy may therefore be an alternative therapy for glucocorticoid-resistant, recurrent, or severe acute kidney transplant rejection.

Objetivo: avaliar a satisfação do paciente e suas experiências vivenciadas com o cuidado de enfermagem no pós-operatório de prostatectomia radical aberta.Métodos: estudo transversal, realizado com 60 pacientes. Foram utilizados ficha de caracterização pessoal e clínica dos sujeitos e a versão brasileira do instrumento Newcastle Satisfaction with Nursing Scales. Realizada análise descritiva dos dados e de correlação das características dos pacientes com escores de satisfação e experiência do paciente.Resultados: a satisfação dos pacientes e a vivência de experiências positivas com os cuidados de enfermagem no período pós-operatório foram relacionados principalmente ao papel educacional da equipe de enfermagem, habilidade de comunicação e respeito a privacidade. Pacientes que com hospitalização prévia em outra instituição apresentaram nível de satisfação maior comparado aos que não tiveram hospitalização anterior.Conclusão: pacientes submetidos à prostatectomia radical aberta vivenciaram experiências positivas e demostraram alto nível de satisfação com o cuidado de enfermagem.

Abstract Background Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation. Methods A health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities. Results The general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of sufficient funding and resources (antigen) for training programs. Conclusions Our study suggested that health facilities suffered from lack of readiness in various aspects, most notably in diagnostic capacity. Conversely, with very few challenges, nearly all the health facilities designated to provide immunization services were ready to deliver routine childhood immunization services as well as newly introduced PCV and IPV.