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SARS-CoV-2, the newest coronavirus, causes COVID-19, a disease that runs the gamut of symptoms from none too mild to severe to death. The severe cases are most often due to acute respiratory distress. In addition to pulmonary symptoms, the virus causes a wide variety of pathological manifestations involving multiple other systems, including eliciting an exaggerated immune response that contributes to fatalities. The elderly are at the highest risk of severe disease. Higher mortality is seen among males, along with individuals with pre-existing comorbidities such as cardiovascular disease and diabetes, among others. Although pregnancy has not been identified as a risk factor yet, more research is needed to assess vertical transmission and strict perinatal precautions are recommended to minimize infecting newborns. Although COVID-19 in children is less likely to be severe, recent cases, albeit rare, have emerged of a multiorgan inflammatory syndrome, similar to Kawasaki disease. Early diagnosis can be done using molecular tests that detect viral genome, while cases manifesting late symptoms can be detected using serological tests looking for antibodies. Although there are no FDA-approved vaccines or therapeutics for prophylaxis, there are many viable vaccine candidates either in clinical trials or awaiting study in humans. Of the several drugs being considered for treatment, some target the virus, while others address the host factors that facilitate virus infection, from proteases that enable virus entry, to cytokines that elicit a harmful and out-of-control immune response. While we await a standardized prophylactic regimen, it is our collective responsibility to continue engaging in prevention measures.

Orientador: Pedro Ramos Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Economia Resumo: A Política Ambiental do Brasil é implantada através de leis, sendo que a política de preservação das matas ciliares não é diferente. Mas para que os instrumentos preventivos e repressivos previstos nas leis surtam efeitos nos municípios, é necessária uma estrutura administrativa municipal e judiciária que cumpra os ditames legais. Deste modo, a presente pesquisa fez uma análise dos principais instrumentos legais de reservarão e de repressão adotados pela Administração Pública Municipal de Camanducaia, pelo Judiciário da Comarca e seus órgãos auxiliares nos casos de agressões praticadas contra as matas ciliares do rio Camanducaia e verificou a não efetividade do cumprimento de tais instrumentos Abstract: The Environmental Politics of Brazil is implemented though laws, and the politics of preservation of the ciliary forests is not differente. But, so that the preventive and repressive instruments foreseen in the lws supply effects in the municipal districts, it is necessary a municipal and judiciary administrative structure so that the legal dictates are accomplished. This research makes an analysis of the main legal instruments of preservation and repression adopted by the Municipal Public Administration of the city of Camanducaia, for the Judiciary of the District and their auxiliary organs, in the cases of agressions practiced against the ciliary forests of the river Camanducaia. It was verified that the executions of such instruments was not executed. Mestrado Desenvolvimento Economico, Espaço e Meio Ambiente Mestre em Desenvolvimento Econômico

Objective Health care providers and health systems confronted new challenges to deliver timely, high-quality prenatal care during the coronavirus disease 2019 (COVID-19) pandemic as the pandemic raised concerns that care would be delayed or substantively changed. This study describes trends in prenatal care delivery in 2020 compared with 2018 to 2019 in a large, commercially insured population and investigates changes in obstetric care processes and outcomes. Study Design This retrospective cohort study uses de-identified administrative claims for commercially insured patients. Patients whose entire pregnancy took place from March 1 to December 31 in years 2018, 2019, and 2020 were included. Trends in prenatal care, including in-person, virtual, and emergency department visits, were evaluated, as were prenatal ultrasounds. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included preterm birth and stillbirth. To determine whether COVID-19 pandemic-related changes in prenatal care had an impact on maternal outcomes, we compared the outcome rates during the pandemic period in 2020 to equivalent periods in 2018 and 2019. Results In total, 35,112 patients were included in the study. There was a significant increase in the prevalence of telehealth visits, from 1.1 to 1.2% prior to the pandemic to 17.2% in 2020, as well as a significant decrease in patients who had at least one emergency department visit during 2020. Overall prenatal care and ultrasound utilization were unchanged. The rate of SMM across this period was stable (2.3–2.8%) with a statistically significant decrease in the preterm birth rate in 2020 (7.4%) compared with previous years (8.2–8.6%; p Conclusion At a time when many fields of health care were reshaped during the pandemic, these observations reveal considerable resiliency in both the processes and outcomes of obstetric care. Key Points

Objective. To determine the rate of the appropriateness of the requested CT and MRI procedures in the Outpatient Department of a tertiary hospital in the Philippines from January to June 2018 using the American College of Radiology Appropriateness Criteria (ACR-AC). Methods. This retrospective research reviewed outpatient CT and MR imaging requests and cross-referenced with the corresponding ACR-AC guideline available for the written clinical diagnosis. Results. Four hundred thirty-six (436) (56%) of the 774 retrieved requests were CT scan studies, while the remaining 338 (44%) are MR imaging procedures. Cross-referencing withACR-AC, the rate of appropriateness across all patients is high at 96.6%, with a 95% confidence interval of 95.0% and 97.6%. The rates were not significantly different between MRI and CT (p-value = 0.4502). Likewise, there was no significant difference in rates of appropriateness for the body parts abdomen, cranial, chest, and spine (p-value = 0.6502). Conclusion. Although the results were high, relative to the few available international studies, the importance and potential of the ACR-AC cannot be disregarded. The ACR-AC serves as a guide in selecting the appropriate imaging test given a clinical situation. This may equate to better patient management, considering all patient-related factors.

This review article explores the interface between art therapy and the growing field of self-compassion. The term ONEBird refers to a model that integrates mindfulness, compassion, and creative exp...

Ethiopia has made remarkable economic progress over the past decade, achieving high gross domestic product (GDP) growth and dramatically reducing poverty. Despite this success, current gender gaps show that challenges remain to realizing inclusive growth and the full potential of women’s economic empowerment. In Ethiopia, women still lag men on several important economic indicators, including employment rate, agricultural productivity, earnings from self-employment, and wage income. While the Government of Ethiopia has already made significant commitments and investments aiming to close the country’s gender gaps, new data offer an opportunity to generate critical evidence to strategically target these investments. For this reason, the Africa gender innovation lab’s (GIL) Ethiopia gender diagnostic report provides innovative analysis on the root causes and drivers of gender inequality in Ethiopia. Using data from the latest round of the Ethiopia socioeconomic survey (2015-2016) and an established statistical approach, the report examines the country’s gender gaps in employment, agricultural productivity, and income from self- and wage employment. It presents specific policy areas for the government to target in addressing the constraints faced by female workers, farmers, and business owners. The key findings and policy recommendations are discussed in the report.

Although changes in gene expression are necessary for arterial remodeling during hypertension, the genes altered and their mechanisms of regulation remain uncertain. The goal of this study was to identify cerebral artery genes altered by hypertension and define signaling pathways important in their regulation. Intact cerebral arteries from Dahl salt-sensitive normotensive and hypertensive high-salt (HS) rats were examined by immunostaining, revealing an increased phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2) and expression of the proliferative marker Ki-67 in arteries from hypertensive animals. Arterial RNA analyzed by microarray and validated with RT-quantitative PCR revealed that jun family member junB and matricellular genes plasminogen activator inhibitor-1 (PAI-1) and osteopontin (OPN) were significantly overexpressed in HS arteries. Fisher exact test and annotation-based gene subsets showed that genes upregulated by Jun and Ca2+/cAMP-response element-binding protein (CREB) were overrepresented. A model of cultured rat cerebrovascular smooth muscle cells was used to test the hypothesis that angiotensin II (ANG II), JunB, and CREB are important in the regulation of genes identified in the rat hypertension model. ANG II induced a transient induction of junB and a delayed induction of PAI-1 and OPN mRNA levels, which were reduced by ERK inhibition with U-0126. Silencing junB using small-interfering RNA reduced mRNA levels of OPN but not PAI-1. The silencing of CREB reduced PAI-1 induction by ANG II but enhanced the transcription of OPN. Together, these results suggest that salt-induced hypertensive disease promotes changes in matricellular genes that are stimulated by ANG II, regulated by ERK, and selectively regulated by JunB and CREB.

Objective: To evaluate the feasibility and efficacy of sequential neoadjuvant chemotherapy, chemoradiation, and surgery in patients with locally advanced esophageal cancer. Patients and Methods: There were 29 patients who received paclitaxel 150 mg/m 2 and gemcitabine 3000 mg/m 2 2 weeks apart. Two weeks later, patients received cisplatin 75 mg/m 2 and 5-fluorouracil (5-FU) 1000 mg/m 2 /d continuous infusion for 4 days with concurrent radiotherapy in 15 fractions to a total dose of 4000 cGy. After 6 weeks, cisplatin and 5-FU were repeated at the above doses. After 4 to 6 weeks, patients were restaged and underwent surgical resection. Results: All 29 patients completed the prescribed gemcitabine, paclitaxel, and radiation therapy. Febrile neutropenia occurred in 1 patient and 4 patients received growth factor support. After neoadjuvant treatment, 1 patient refused surgery, 23 underwent R0 resection (82%), while 5 developed progressive disease. Four patients developed anastomotic leaks (17%). Four patients had complete pathologic responses (14%) and 4 (14%) had only residual microscopic disease. Nine patients remain alive at a median follow-up of 48 months. Three-year survival for the entire cohort was 36%. Conclusion: This regimen was associated with a high rate of compliance and induction therapy had an acceptable toxicity profile. The R0 resection rate and 3-year survival data are similar to recently reported studies. While active, gemcitabine and paclitaxel induction therapy was associated with an increased rate of postoperative complications, but no increase in survival. Patterns of failure continue to demonstrate the need for regimens incorporating greater emphasis on systemic therapy for locally advanced esophageal cancer.

Calcium (Ca2+) signals affect virtually every biological process, including both contraction and gene transcription in smooth muscle. Ca2+-regulated gene transcription is known to be important for both physiological and pathological responses in smooth muscle. The aim of this review is to discuss the current understanding of gene transcription regulated by excitation through Ca2+ signalling using a comparison of the two most characterized Ca2+-regulated transcription factors in smooth muscle, Ca2+–cyclic AMP response element binding protein (CREB) and nuclear factor of activated T-cells (NFAT). Recent studies have shown commonalities and differences in the regulation of CREB and NFAT through both voltage- and non-voltage-gated Ca2+ channels that lead to expression of smooth muscle cell specific differentiation markers as well as markers of proliferation. New insights into the regulation of specific genes through companion elements on the promoters of Ca2+-regulated genes have led to new models for transcriptional regulation by Ca2+ that are defined both by the source and duration of the Ca2+ signal and the composition of enhancer elements found within the regulatory regions of specific genes. Thus the combination of signalling pathways elicited by particular Ca2+ signals affect selective promoter elements that are key to the ultimate pattern of gene transcription.

A 10-year-old, spayed female, Irish water spaniel was presented with a 2-week history of anisocoria characterized by mydriasis of the right eye compared to the left eye in ambient light. Ophthalmic and neurological examinations, combined with pharmacological testing, identified a disease process affecting the right parasympathetic nucleus of cranial nerve 3 (CN III) and/or the parasympathetic component of CN III. Magnetic resonance imaging (MRI) identified a mass involving the right midbrain and extending caudally to the rostral border of the medulla oblongata. The dog became comatose within 12 h following MRI and was euthanized. Histopathology identified the intracranial mass as a meningioma.

Ca 2+ -regulated gene transcription is a critical component of arterial responses to injury, hypertension, and tumor-stimulated angiogenesis. The Ca 2+ /cAMP response element binding protein (CREB), a transcription factor that regulates expression of many genes, is activated by Ca 2+ -induced phosphorylation. Multiple Ca 2+ entry pathways may contribute to CREB activation in vascular smooth muscle including voltage-dependent Ca 2+ channels and store-operated Ca 2+ entry (SOCE). To investigate a role for SOCE in CREB activation, we measured CREB phosphorylation using immunofluorescence, intracellular Ca 2+ levels using a fluorescence resonance energy transfer (FRET)–based Cameleon indicator, and c-fos transcription using RT-PCR. In this study, we report that SOCE activates CREB in both cultured smooth muscle cells and intact arteries. Depletion of intracellular Ca 2+ stores with thapsigargin increased nuclear phospho-CREB levels, intracellular Ca 2+ concentration, and transcription of c-fos . These effects were abolished by inhibiting SOCE through lowering extracellular Ca 2+ concentration or by application of 2-aminoethoxydiphenylborate and Ni 2+ . Inhibition of Ca 2+ influx through voltage-dependent Ca 2+ channels using nimodipine partially blocked intact artery responses, but was without effect in cultured smooth muscle cells. Our findings indicate that Ca 2+ entry through store-operated Ca 2+ channels leads to CREB activation, suggesting that SOCE contributes to the regulation of gene expression in vascular smooth muscle.

The story of Acheflour and her son in Sir Perceval of Galles is a particularly poignant and empowering one for the female reader, but, strangely, this fourteenth-century romance has remained relatively untouched by feminist scholars. The majority of studies of Sir Perceval of Galles, to date, have concentrated on its sources, structure, analogues, and ancient mythic content.1 Another significant body of work has explored the meaning of the Grail its presence or absence in the text.2 In this essay I will argue that a reading which focuses on Acheflour and her values, both overt and covert, can highlight the significant challenge which Sir Perceval of Galles poses to the values and underpinning philosophy of androcentric society, be it medieval or contemporary. The portrayal of Acheflour in the tale of Sir Perceval of Galles differs markedly from both the German and the French versions of this story. Wolfram von Eschenbach' s Parzival and Chretien de Troyes' tale of Perceval each demonstrate the misogyny characteristic of their age, both in relation to the female protagonists and, specifically, to Perceval's mother and to issues of power and linguistic control. Sir Perceval of Galles, however, exhibits a curious ambivalence towards Acheflour and towards the value systems social and spiritual of the two opposing worlds in which the story is played out, the royal court and the primitive forest. While it might be argued that this ambivalence is simply a feature of any maledominant narrative, psychoanalytic theory clearly demonstrates that areas of ambivalence often provide significant clues to hidden textual meaning. Terry Eagleton proposes that the real meaning of a text lies in precisely these areas, in the

The importance of Ca2+ in pulmonary smooth muscle physiological function, including events such as contraction, gene transcription, and cell proliferation, is well established. Yet, there is much to learn regarding the complex interplay between Ca2+ signaling, gene expression, and the development of lung diseases such as pulmonary arterial hypertension. Under normal physiological conditions, vascular smooth muscle cells in adult blood vessels show low rates of proliferation and synthetic activity. Mature smooth muscle cells, unlike cardiac muscle cells, are not terminally differentiated, and thus have the unique ability to dedifferentiate and alter their phenotype in response to changes in the extracellular environment. Phenotypical switching is an important survival mechanism in response to injury, and is necessary during vascular development. However, abnormal signal transduction results in the development of a proliferative synthetic phenotype rather than one that is quiescent and contractile, leading to pathologic vascular remodeling. Ca2+ is known to be a key transcriptional regulator of both the onset and the maintenance of many genes associated with vascular remodeling. This chapter focuses on events that underlie changes in gene expression and proliferation that are mediated by Ca2+ signaling in pulmonary smooth muscle. In addition, the role of Ca2+ in the development of lung disease as it relates to cell signaling is discussed in the chapter.

In Canada, there is a growing gap between the number of organs donated each year and the number of organs needed for transplant. This gap is forcing health care professionals to re-examine end-of-life care and donation practices. In 2005, a national forum created recommendations for the development and implementation of donation after cardio-circulatory death programs. In this article, the authors outline the multifaceted approach needed for change in interdisciplinary clinical practice. Clinical nurse specialist leadership, ethics consultation, partnerships with key physician colleagues and administrators, as well as comprehensive workshops are described as essential for success. Lessons learned throughout are shared.

http://dx.doi.org/10.5902/2179460X14634This paper presents a proposal for teaching Logic for the first year of high school. Considering the diversity of students, this study was developed through a sequence of activities to address the weaknesses of interpretation, reasoning and logical reasoning from a false idea that mathematics works only with numbers and accounts. The proposal is to make the activities more meaningful and comprehensive learning for students in which the teacher's role is that of a facilitator and the student constructor of knowledge. Students are invited to take action, seek and express their opinion by giving meaning to their learning, and teachers are suggested to reflect on their experience in the classroom, encouraging and stimulating the search for diversified activities. We conclude by presenting what skills and competencies that will be developed and how they can assist in the development of new mathematical content.

The inverses of the 19F(α,n)22Na and 22Ne(p,n)22Na reactions may be important destruction mechanisms for 22Na in neutron-rich, high-temperature or explosive nucleosynthesis. I have measured the cross sections for the 19F(α,n)22Na and 22Ne(p,n)22Na reactions from threshold to 3.1 and 5.4 MeV, respectively. The absolute efficiency of the 4π neutron detector was determined by Monte Carlo calculations and calibrated using two standard sources and two nuclear reactions. Cross sections for the inverse reactions have been calculated using the principle of detailed balance, and reaction rates for both the reactions and their inverses determined for temperatures between 0.01 and 10 GK for 19F(α,n)22Na and between 0.1 and 10 GK for 22Ne(p,n)22Na.

Lymphocytotoxic autoantibodies (LCAbs) of the IgM class have been identified in patients with borderline tuberculoid (BT) and borderline lepromatous (BL) leprosy with Type I reactions (I) as well as lepromatous leprosy (LL) patients with erythema nodosum leprosum reactions (ENL). The observation that lymphocytotoxic activity (LCA) was reduced in the presence of platelets led us to determine whether LCAbs had specificities for Class I Major Histocompatibility Complex (MHC) determinants. Absorption of LCA positive sera with platelets, classically used to deplete Class I specific lymphocytotoxic antibodies, reduced LCA towards autologous as well as allogeneic target cells. This was true for LCA positive sera from all patient classifications (group BT in the autologous system, p less than 0.01; in all other patient groups, p less than 0.001). Introducing B-2m to cytotoxicity assays only marginally reduced LCA when added at high concentrations (5 mg/ml). An anti-Class I MHC antiserum which blocked the lytic activity. The data indicate that LCAbs while absorbed by platelets, are not specific for the Class I MHC antigens. The autoantigen recognized by these autoantibodies therefore remains to be identified.