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Dry eye has two basic subdivisions: aqueous deficient dry eye (ADDE), with SS a major cause; and evaporative dry eye (EDE), due to either intrinsic or extrinsic factors. SS is a chronic inflammatory disorder defined by dysfunction of the exocrine glands leading to dry eye and dry mouth. The objective of this article was to carry out a systematic and critical review of several scientific publications on dry eye disease, with the aim of providing general recommendations to distinguish dry eye and its different variants in patients with SS, during the period 1979 to 2020, using search engines for articles indexed in Scopus, Latindex, Scielo, Clinical Trials, Medline, Embase, and Cochrane, allowing the analysis of 132 articles published in indexed journals on the subject of dry eye disease and SS, evidencing its conceptualization, prevalence, risk factors, etiopathogenesis, clinical manifestations, diagnosis, and treatment.

Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. In this paper, we offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions. The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary healthcare in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior healthcare experience. We describe here the progression of the partnership between these institutions to carry out the project and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health.

FUNDAMENTO: Durante a descompensação da insuficiência cardíaca, ocorre uma intensa ativação do sistema renina-angiotensina-aldosterona, entretanto, o uso de inibidor da enzima de conversão de angiotensina (IECA) não pode bloqueá-lo completamente. De outro modo, a adição de bloqueador do receptor de angiotensina II (BRA) pode ser útil quando ocorre a dependência de inotrópico. Avaliamos a eficiência da associação BRA-IECA para retirada da dobutamina na insuficiência cardíaca avançada e descompensada. OBJETIVO: Avaliar a eficácia da associação de bloqueador do receptor AT1 de angiotensina II ao inibidor de enzima de conversão, para a retirada da dobutamina em pacientes com dependência de suporte inotrópico decorrente da descompensação aguda da insuficiência cardíaca crônica. MÉTODOS: Em um estudo caso-controle (N = 24), selecionamos pacientes internados por descompensação da insuficiência cardíaca e com uso por mais de 15 dias de dobutamina, ou uma ou mais tentativas sem sucesso de retirada; dose otimizada de IECA; e FEVE < 0,45. Os pacientes então receberam adicionalmente BRA (n = 12) ou não (controle, n = 12). O desfecho foi o sucesso na retirada da dobutamina, avaliado pela regressão logística, com p < 0,05. RESULTADOS: A fração de ejeção foi de 0,25, e a idade de 53 anos, com dose de dobutamina de 10,7 μg/kg.min. O sucesso na retirada de dobutamina ocorreu em oito pacientes do grupo BRA (67,7%), e em dois no grupo controle (16,7%). A "odds ratio" foi de 10,0 (intervalo de confiança de 95%:1,4 a 69,3; p = 0,02). A piora da função renal foi semelhante (grupo BRA: 42% vs. grupo controle: 67%, p = 0,129). CONCLUSÃO: Neste estudo piloto, a associação BRA-IECA foi relacionada ao sucesso na retirada da dobutamina, na insuficiência cardíaca avançada descompesada. A piora da função renal foi semelhante em ambos os grupos. Estudos adicionais são necessários para esclarecer o assunto.FUNDAMENTO: Durante la descompensación de la insuficiencia cardiaca, ocurre una intensa activación del sistema renina-angiotensina-aldosterona, sin embargo, el empleo de inhibidor de la enzima de conversión de angiotensina (IECA) no puede bloquearlo completamente. De otro modo, la adición de bloqueante del receptor de angiotensina II (BRA) puede ser útil cuando ocurre la dependencia de inotrópico. Evaluamos la eficiencia de la asociación BRA-IECA para retirada de la dobutamina en la insuficiencia cardiaca avanzada y descompensada. OBJETIVO: Evaluar la eficacia de la asociación de bloqueante del receptor AT1 de angiotensina II al inhibidor de enzima de conversión, para la retirada de la dobutamina en pacientes con dependencia de soporte inotrópico que trascurre de la descompensación aguda de la insuficiencia cardiaca crónica. MÉTODOS: En un estudio caso-control (N = 24), seleccionamos a pacientes internados por descompensación de la insuficiencia cardiaca y con empleo por más de 15 días de dobutamina, o una o más intentos sin éxito de retirada; dosis optimizada de IECA; y FEVI < 0,45. Así que los pacientes recibieron adicionalmente BRA (n = 12) o no (control, n = 12). El desenlace fue el éxito en la retirada de la dobutamina, evaluado por la regresión logística, con p < 0,05. RESULTADOS: La fracción de eyección fue de 0,25, y la edad de 53 años, con dosis de dobutamina de 10,7 μg/kg.min. El éxito en la retirada de dobutamina ocurrió en ocho pacientes del grupo BRA (67,7%), y en dos en el grupo control (16,7%). La "odds ratio" fue de 10,0 (intervalo de confianza de 95%:1,4 a 69,3; p = 0,02). El empeoramiento de la función renal se halló similar (grupo BRA: 42% vs grupo control: 67%, p = 0,129). CONCLUSIÓN: En este estudio piloto, la asociación BRA-IECA se relacionó al éxito en la retirada de la dobutamina, en la insuficiencia cardiaca avanzada descompensada. El empeoramiento de la función renal fue similar en ambos los grupos. Estudios adicionales son necesarios para clarificar el asunto.BACKGROUND: During heart failure (HF) decompensation, an intense activation of the renin-angiotensin-aldosterone system occurs; however, the use of angiotensin-converting enzyme inhibitor (ACEI) cannot block it completely. Otherwise, the addition of angiotensin II receptor blocker (ARB) can be useful when the inotropic dependence occurs. We evaluated the efficacy of the ARB-ACEI association on dobutamine withdrawal in advanced decompensated HF. OBJECTIVE: To assess the efficacy of association angiotensin receptor blocker - angiotensin converting enzyme inhibitor to withdraw the intravenous inotropic support in decompensated severe heart failure. METHODS: In a case-control study (N = 24), we selected patients admitted at the hospital due to HF that had been using dobutamine for more than 15 days, with one or more unsuccessful drug withdrawal attempts; optimized dose of ACEI and ejection fraction (EF) < 0.45. Then, the patients additionally received ARB (n=12) or not (control, n=12). The outcome was the successful dobutamine withdrawal, evaluated by logistic regression, with a p < 0.05. RESULTS: The EF was 0.25 and the age was 53 years, with a dobutamine dose of 10.7 μg/kg.min. The successful drug withdrawal was observed in 8 patients from the ARB group (67.7%) and in 2 patients from the control group (16.7%). The odds ratio (OR) was 10.0 (95%CI: 1.4 to 69.3; p = 0.02). The worsening in renal function was similar (ARB group: 42% vs. control group: 67%; p=0.129). CONCLUSION: In this pilot study, the ARB-ACEI association was associated with successful dobutamine withdrawal in advanced decompensated heart failure. The worsening in renal function was similar in both groups. Further studies are necessary to clarify the issue.

The Emerging Risks Unit has the responsibility for coordinating EFSA’s activities to establish a capacity for the identification of emerging risks. A process was trialled and further developed during a pilot period of 18 months from 2010-2012. This included the implementation of an operational procedure for emerging risks identification, the assessment of selected data sources, the testing of tools for collecting information, the consolidation of knowledge networks for sharing information and the development of a methodological framework. Specific issues were identified for follow-up activities using an expert judgment approach. These include a study on climate change and the emergence of aflatoxins in cereal crops in the European Union (EU), a European-wide survey on the consumption of energy drinks, a task force on human risk assessment of chemical mixtures, an internal task force on bee health, and a foresight study on the potential impact of omics technologies on food and feed safety risk assessment. These follow-up activities will contribute to the determination of whether the issues identified can indeed give rise to emerging risks. Overall, our experience shows that emerging risks identification requires a high level of expertise due to major data gaps and uncertainties in the evaluation process. Effective networking has proven to be essential for exchanging methods, data and evaluations of emerging risks. The system piloted has shown some potential for the identification of issues that may give rise to emerging risks. Useful knowledge has been gained in the area of gathering and filtering large amounts of information and building knowledge networks on emerging risks. Next steps include the establishment of a standing Working Group (WG) on Emerging Risks, the reinforcement of the engagement with Member States and Stakeholders, the fine tuning of the revised methodological framework, and the completion of the projects on the issues identified.

Background Vietnam's healthcare system offers limited services and facilities for older adults. This study explored the perceptions of health and social care workers regarding geriatric care issues, their impact on older adults and the potential of collaboration for enhancing older adults' health and well-being. Methods This qualitative case study employed 27 focus group discussions and two in-depth interviews with 174 participants in Thua Thien Hue Province, Vietnam. An inductive thematic analysis was conducted. Results According to the participants, the major challenges that hindered geriatric care consisted of caregiver and care recipient issues, which were identified to constrain care accessibility, resulting in decreased physical, mental and social health. Across different settings and professions, collaboration was considered a routine and natural aspect of daily work. It was perceived that establishing and strengthening collaboration could facilitate improvement in health and social welfare services through the prioritization of needs and enhancement of caregiver skills and training. Conclusions Collaboration was viewed as ad hoc but indispensable for addressing the identified geriatric care issues that could improve the general health and well-being of older adults. The findings indicate a need for better collaboration in Vietnam, achieved through defined guidelines, training and improved interprofessional education and practice. [ABSTRACT FROM AUTHOR]

Electromagnetic interference shielding composite materials can be designed with properties that are tailored for specific applications. We have explored the magnetic properties of Ni-coated carbon fibers embedded in a polymer matrix through an extrusion process. This method can produce large, pliable flat sheets, which can be easily bent and shaped. Microscopy imaging shows that the extrusion process preferentially orders most of the fibers with their long axis along the extrusion direction. The measured samples reached 90% of the saturation magnetization value at a field of approximately 800 Oe along the extrusion direction, much lower than needed for other directions (in-plane perpendicular to the extrusion or perpendicular to the foil surface). A field on the order of 6 kOe must be applied to obtain the full saturation of the magnetization in all three directions. The absorption characteristics were measured, with zero external applied field to determine the shielding effectiveness of the composite materials for multiple orientations with respect to the TE10 mode of an S-band waveguide. The nickel-coated carbon fiber composite materials exhibit dramatic orientation-dependent shielding effectiveness. The most effective orientation has shielding effectiveness of up to 45 dB at 4.5 GHz, which is comparable to multi-walled carbon nanotube composites with similar volumetric filling fractions. [ABSTRACT FROM AUTHOR]

Members of the Joint Working Group on Improving Underrepresented Minorities (URMs) Persistence in Science, Technology, Engineering, and Mathematics (STEM)-convened by the National Institute of General Medical Sciences and the Howard Hughes Medical Institute-review current data and propose deliberation about why the academic "pathways" leak more for URM than white or Asian STEM students. They suggest expanding to include a stronger focus on the institutional barriers that need to be removed and the types of interventions that "lift" students' interests, commitment, and ability to persist in STEM fields. Using Kurt Lewin's planned approach to change, the committee describes five recommendations to increase URM persistence in STEM at the undergraduate level. These recommendations capitalize on known successes, recognize the need for accountability, and are framed to facilitate greater progress in the future. The impact of these recommendations rests upon enacting the first recommendation: to track successes and failures at the institutional level and collect data that help explain the existing trends.