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Relationships between leaf anatomy and nutritive values have been intensively studied in forage plants to optimize crop breeding efforts and to reduce the time and costs involved in genotype selections. We evaluated the associations between the leaf anatomical characteristics and nutritive values of 34 genotypes ofBrachiaria ruziziensisduring both the rainy (October to March) and dry seasons (April to September). Anatomical characteristics of the median sections of completely expanded leaves were analysed using traditional techniques. High positive correlations (P< 0.05) were observed between in vitro digestibility of the dry material, crude protein and cellulose during both the dry and rainy seasons. The correlations between in vitro digestibility and acid detergent fibre, neutral detergent fibre and lignin fibre were also high and negative in both seasons. There were no apparent correlations between digestibility and the anatomical characteristics of the leaves in either the dry or rainy seasons. [ABSTRACT FROM PUBLISHER]

Introduction: Excess weight during pregnancy is a condition that can affect both mother and fetus, through the maternal-fetal interface, which is constituted by the placenta and umbilical cord. The umbilical vein is responsible for transporting oxygen and nutrients to the fetus, and its proper functioning depends on the integrity of its structure. The remodeling of the umbilical vein represents one of the causes of inadequate transport of nutrients to the fetus, being potentially harmful. This study aims to evaluate whether maternal overweight alters the structural characteristics of the umbilical vein., Methods: Umbilical cords were collected from eutrophic and overweight pregnant women and were processed according to histological routine. We analyzed morphometry parameters, collagen and elastin fibers deposition, glycosaminoglycan level, and cell proliferation., Results: Veins from overweight pregnant women were found to have greater total area, wall area, wall thickness, and diameter. There was higher collagen labeling in the perivascular region of the overweight group and a higher amount of type III collagen in the vascular smooth muscle. The proliferation of muscle and perivascular cells was higher in overweight pregnant women. A positive, although weak, correlation was observed between BMI and vessel thickness and with type III collagen deposition in vascular smooth muscle., Discussion: With this study, we show that being overweight can structurally alter the umbilical vein, causing vascular remodeling of the vessel, through hypertrophy and hyperplasia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor AED declared a past collaboration with the author FRG., (Copyright © 2024 Souza, Hochberger, Castrignano Camargo, Silva, Camargo, Mello, Alcantara Dos Santos, Giachini, Lobato and Souto.)

Worldwide cooperation is necessary to mitigate the effects of climate change. Many previous investigations employed the so-called collective risk dilemma, where the risk of losing everything whenever a target is not met was fixed from the outset, rendering predictions dependent on snapshot values assumed for this parameter, whose importance was found to be paramount. Here, we couple risk with the overall success of mitigation, investigating the co-evolution of risk and cooperation in a world where countries are partitioned in two different wealth classes, allowing us to further assess the impact of wealth inequality and homophily on the co-evolutionary dynamics. We show that the stochastic dynamics is dominated by a global attractor, typically located in a region of low risk, where most developed countries cooperate most of the time while developing countries cooperate to a lesser extent. This scenario assumes no homophily which, when moderate, can contribute to increase overall cooperation, more so when combined with the presence of a small fraction of developing countries that opt for an unconditional cooperative behavior., (© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences.)

Sarcopenia is a progressive age-related muscle disease characterized by low muscle strength, quantity and quality, and low physical performance. The clinical overlap between these subphenotypes (reduction in muscle strength, quantity and quality, and physical performance) was evidenced, but the genetic overlap is still poorly investigated. Herein, we investigated whether there is a genetic overlap amongst sarcopenia subphenotypes in the search for more effective molecular markers for this disease. For that, a Bioinformatics approach was used to identify and characterize pleiotropic effects at the genome, loci and gene levels using Genome-wide association study results. As a result, a high genetic correlation was identified between gait speed and muscle strength (rG=0.5358, p=3.39 × 10 -8 ). Using a Pleiotropy-informed conditional and conjunctional false discovery rate method we identified two pleiotropic loci for muscle strength and gait speed, one of them was nearby the gene PHACTR1. Moreover, 11 pleiotropic loci and 25 genes were identified for muscle mass and muscle strength. Lastly, using a gene-based GWAS approach three candidate genes were identified in the overlap of the three Sarcopenia subphenotypes: FTO, RPS10 and CALCR. The current study provides evidence of genetic overlap and pleiotropy among sarcopenia subphenotypes and highlights novel candidate genes and molecular markers associated with the risk of sarcopenia., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Background: In the United States, young men who have sex with men (YMSM) and young transgender women (YTGW) are disproportionately affected by HIV infection. Adequate HIV knowledge is critical for protecting adolescents and young adults at risk for HIV. This study aimed to evaluate the effectiveness of the mLab App intervention in enhancing HIV knowledge among YMSM and YTGW., Methods: This study was a secondary analysis of data collected from a randomized controlled trial (RCT) evaluating the effect of the mLab App on HIV knowledge. We calculated interactions between groups (mLab App intervention, standard of care, at-home testing) over time (6 and 12 months) following the baseline observation, indicating a difference in the outcome scores from baseline to each time across groups., Results: While the mLab App group initially had lower HIV knowledge compared to those in other groups, access to the App demonstrated a progressive impact on HIV knowledge over time. Despite the absence of a statistically significant effect at the 6-month, the long-term evaluation suggests improvements in HIV knowledge during the 12-month intervention follow-up., Conclusion: Our study suggests the potential of the mLab App as a valuable tool for long-term HIV education and awareness for YMSM and YTGW. Further research is needed to understand the factors influencing the short-term effect on HIV knowledge. The mLab App may be a useful intervention for improving HIV knowledge., Competing Interests: Conflict of Interests: No competing financial interests exist., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Extensive time spent on documentation in electronic health records (EHRs) impedes patient care and contributes to nurse burnout. Artificial intelligence-based clinical decision support tools within the EHR, such as ChatGPT, can provide care plan recommendations to the perinatal nurse. The lack of explicit methodologies for effectively integrating ChatGPT led to our initiative to build and demonstrate our ChatGPT-4 prompt to support nurse care planning., Methods: We employed our process model, previously tested with 22 diverse medical-surgical patient scenarios, to generate a tailored prompt for ChatGPT-4 to produce care plan suggestions for an exemplar patient presenting with preterm labor and gestational diabetes. A comparative analysis was conducted by evaluating the output against a "nurse-generated care plan" developed by our team of nurses on content alignment, accuracy of standardized nursing terminology, and prioritization of care., Results: ChatGPT-4 delivered suggestions for nursing diagnoses, interventions, and outcomes comparable to the "nurse-generated care plan." It accurately identified major care areas, avoided irrelevant or unnecessary recommendations, and identified top priority care. Of the 24 labels generated by ChatGPT-4, 16 correctly utilized standardized nursing terminology., Conclusion: This demonstration of the use of our ChatGPT-4 prompt illustrates the potential of leveraging a large language model to assist perinatal nurses in creating care plans. The next steps are improving the accuracy of ChatGPT-4-generated standardized nursing terminology and integrating our prompt into EHRs. This work supports our broader goal of enhancing patient outcomes while mitigating the burden of documentation that contributes to nurse burnout., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Cognitive decline is a public health concern affecting about 50 million individuals worldwide. Neuroticism, defined as the trait disposition to experience intense and frequent negative emotions, has been associated with an increased risk of late-life cognitive decline. However, the underlying biological mechanisms of this association remain unknown. This study investigated the relationship between genetic predisposition to neuroticism, computed by polygenic risk score (PRS), and performance in cognitive domains of reasoning, processing speed, visual attention, and memory in individuals over age 60. The sample consisted of UK Biobank participants with genetic and cognitive data available (N = 10,737, 4686 females; mean age = 63.4 ± 2.71). The cognitive domains were assessed at baseline for all participants and seven years later for a subset (N = 645, 262 females; mean age = 62.9 ± 2.44). Neuroticism PRS was not associated cross-sectionally with cognitive measures ( p > 0.05). However, the trajectory of change for processing speed (β = 0.020; 95% CI = [0.006, 0.035], adjusted p = 0.0148), visual attention (β = -0.077; 95% CI = [-0.0985, -0.0553], adjusted p = 1.412 × 10 -11 ), and memory (β = -0.033; 95% CI = [-0.0535, -0.0131], adjusted p = 0.005) was significantly associated with neuroticism PRS. Specifically, a higher genetic predisposition to neuroticism was associated with less decline in these cognitive domains. This trend persisted after sensitivity analysis using complete cases, although it only remained nominally significant for visual attention.

Objective: To investigating the relationship between α-Klotho and FGF-23 with bone biochemical markers and bone density findings in extremely aged individuals., Methods: A total of 55 individuals with a mean age of 85.6 years were subjected to clinical, biochemical, and bone mineral density analyses and the enzyme-linked immunosorbent assay-based detection of α-Klotho and FGF-23. The mean, standard deviation, median, and interquartile ranges of the sample values were determined, and Spearman's test for association assessments was used for statistical analysis., Results: The study participants expressed median FGF-23 and α-Klotho levels of 69.81 RU/mL (51.43 RU/mL) and 733.43 pg/mL (360.83 pg/mL), respectively. The majority of the participants possessed osteopenia (54.5%) and a vitamin D deficiency (57%). The 25-hydroxyvitamin D concentrations ranged between 7.1 and 47.5ng/mL, with a median of 18.1ng/mL., Conclusion: No substantial associations were discovered between α-Klotho and FGF-23 levels and bone density in the study participants.

The aim of this study was to investigate the vertical transfer of microbiota from dams to the offspring. We studied a pair of 20 dams and its offspring. Maternal sources (colostrum, feces and vaginal secretion) and newborn fecal samples were analyzed using 16S rDNA amplicon sequencing on days 1, 3, 7, 14 and 28. Overall, newborns were maintained healthy and did not receive antimicrobial therapy. The Source Tracker analysis indicated that the newborn fecal microbiota was similar to colostrum and vaginal secretion from day 1 up to 7. However, an unknown source (probably from the environment) showed a gradual increase in its similarity with fecal samples from calves measured from day 3 to 28. The most abundant bacteria groups on meconium (day 1) and calf fecal samples on day 3 were Escherichia-Shigella and Clostridium, respectively. On day 7, the predominant genus were Bifidobacterium and Lactobacillus, while Fusobacterium was the most abundant genus on day 14, coinciding with the diarrhea peak. Faecalibacterium showed a gradual increase throughout the neonatal period. Maternal sources contribute to the neonatal microbiota, however other unknown sources (probably environment) had a strong influence on development of the gut microbiota later in the neonate period., (© 2024. The Author(s).)

Disentangling the molecular underpinnings of major depressive disorder (MDD) is necessary for identifying new treatment and prevention targets. The functional impact of depression-related transcriptomic changes on the brain remains relatively unexplored. We recently developed a novel transcriptome-based polygenic risk score (tPRS) composed of genes transcriptionally altered in MDD. Here, we sought to investigate effects of tPRS on brain structure in a developmental cohort (Adolescent Brain Cognitive Development study; n = 5124; 2387 female) at baseline (9-10 years) and 2-year follow-up (11-12 years). We tested associations between tPRS and Freesurfer-derived measures of cortical thickness, cortical surface area, and subcortical volume. Across the whole sample, higher tPRS was significantly associated with thicker left posterior cingulate cortex at both baseline and 2-year follow-up. In females only, tPRS was associated with lower right hippocampal volume at baseline and 2-year follow-up, and lower right pallidal volume at baseline. Furthermore, regional subcortical volume significantly mediated an indirect effect of tPRS on depressive symptoms in females at both timepoints. Conversely, tPRS did not have significant effects on cortical surface area. These findings suggest the existence of a sex-specific neurodevelopmental signature associated with shifts towards a more depression-like brain transcriptome, and highlight novel pathways of developmentally mediated MDD risk., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Objective: Our article demonstrates the effectiveness of using a validated framework to create a ChatGPT prompt that generates valid nursing care plan suggestions for one hypothetical older patient with lung cancer., Method: This study describes the methodology for creating ChatGPT prompts that generate consistent care plan suggestions and its application for a lung cancer case scenario. After entering a nursing assessment of the patient's condition into ChatGPT, we asked it to generate care plan suggestions. Subsequently, we assessed the quality of the care plans produced by ChatGPT., Results: While not all the suggested care plan terms (11 out of 16) utilized standardized nursing terminology, the ChatGPT-generated care plan closely matched the gold standard in scope and nature, correctly prioritizing oxygenation and ventilation needs., Conclusion: Using a validated framework prompt to generate nursing care plan suggestions with ChatGPT demonstrates its potential value as a decision support tool for optimizing cancer care documentation., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Phosphorus (P) is a critical nutrient for plant growth, yet its uptake is often hindered by soil factors like clay minerals and metal oxides such as aluminum (Al), iron (Fe), and calcium (Ca), which bind P and limit its availability. Phosphate-solubilizing bacteria (PSB) have the unique ability to convert insoluble P into a soluble form, thereby fostering plant growth. This study aimed to assess the efficacy of inoculation of Bacillus megaterium B119 (rhizospheric) and B. subtilis B2084 (endophytic) via seed treatment in enhancing maize yield, grain P content, and enzyme activities across two distinct soil types in field conditions. Additionally, we investigated various mechanisms contributing to plant growth promotion, compatibility with commercial inoculants, and the maize root adhesion profile of these strains. During five crop seasons in two experimental areas in Brazil, Sete Lagoas-MG and Santo Antônio de Goiás-GO, single inoculations with either B119 or B2084 were implemented in three seasons, while a co-inoculation with both strains was applied in two seasons. All treatments received P fertilizer according to plot recommendations, except for control. Both the Bacillus strains exhibited plant growth-promoting properties relevant to P dynamics, including phosphate solubilization and mineralization, production of indole-3-acetic acid (IAA)-like molecules, siderophores, exopolysaccharides (EPS), biofilms, and phosphatases, with no antagonism observed with Azospirillum and Bradyrizhobium . Strain B2084 displayed superior maize root adhesion compared to B119. In field trials, single inoculations with either B119 or B2084 resulted in increased maize grain yield, with relative average productivities of 22 and 16% in Sete Lagoas and 6 and 3% in Santo Antônio de Goiás, respectively. Co-inoculation proved more effective, with an average yield increase of 24% in Sete Lagoas and 11% in Santo Antônio de Goiás compared to the non-inoculated control. Across all seasons, accumulated grain P content correlated with yield, and soil P availability in the rhizosphere increased after co-inoculation in Santo Antônio de Goiás. These findings complement previous research efforts and have led to the validation and registration of the first Brazilian inoculant formulated with Bacillus strains for maize, effectively enhancing and P grain content., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 de Oliveira-Paiva, Bini, de Sousa, Ribeiro, dos Santos, de Paula Lana, de Souza, Gomes and Marriel.)

Objectives: To evaluate whether the glycosylation of chrysin (CHR) enhances its protective effects against aluminum-induced neurotoxicity., Methods: To compare the antioxidant, anticholinesterase, and behavioral effects of CHR with its glycosylated form (CHR bonded to β-d-glucose tetraacetate, denoted as LQFM280), we employed an integrated approach using both in vitro (SH-SY5Y cells) and in vivo (aluminum-induced neurotoxicity in Swiss mice) models., Key Findings: LQFM280 demonstrated higher antioxidant activity than CHR in both models. Specifically, LQFM280 exhibited the ability to exert antioxidant effects in the cytoplasm of SH-SY5Y cells, indicating its competence in traversing neuronal membranes. Remarkably, LQFM280 proved more effective than CHR in recovering memory loss and counteracting neuronal death in the aluminum chloride mice model, suggesting its increased bioavailability at the brain level., Conclusions: The glycosylation of CHR with β-d-glucose tetraacetate amplifies its neuroprotective effects, positioning LQFM280 as a promising lead compound for safeguarding against neurodegenerative processes involving oxidative stress., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Spiritual care has been associated with better health outcomes. Despite increasing evidence of the benefits of spiritual care for older patients coping with illness and aggressive treatment, the role of spirituality is not well understood and implemented. Nurses, as frontline holistic healthcare providers, are in a position to address patients' spiritual needs and support them in finding meaning in life. This study aimed to identify spiritual care by analyzing nursing data and to compare the psychological and physical comfort between older chronically ill patients who received spiritual care versus those who did not receive spiritual care., Material and Methods: A propensity score matched cohort utilizing nursing care plan data was used to construct balanced groups based on patient characteristics at admission. 45 older patients (≥65 years) with chronic illnesses received spiritual care with measured psychological or physical comfort and 90 matched controls. To ensure the robustness of our results, two sensitivity analyses were performed. Group comparisons were performed to assess the average treatment effect of spiritual care on psychological and physical comfort outcomes., Results: The mean psychological comfort was 4.3 (SD = 0.5) for spiritual care receivers and 3.9 (SD = 0.9) for non-receivers. Regression analysis showed that spiritual care was associated with better psychological comfort (estimate = 0.479, std. error = 0.225, p = 0.041). While its effect on physical comfort was not statistically significant (estimate = -0.265, std. error = 0.234, p = 0.261). This study provides suggestive evidence of the positive impact of nurses' spiritual care in improving psychological comfort for older patients with chronic illnesses., Conclusion: Using interoperable nursing data, our findings suggest that spiritual care improves psychological comfort in older patients facing illness. This finding suggests that nurses may integrate spiritual care into their usual care to support patients experiencing distress., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Bacterial inoculants have been used in agriculture to improve plant performance. However, laboratory and field requirements must be completed before a candidate can be employed as an inoculant. Therefore, this study aimed to evaluate the parameters for inoculant formulation and the potential of Bacillus subtilis (B70) and B. pumilus (B32) to improve phosphorus availability in maize (Zea mays L.) crops. In vitro experiments assessed the bacterial ability to solubilize and mineralize phosphate, their adherence to roots, and shelf life in cassava starch (CS), carboxymethyl cellulose (CMC), peat, and activated charcoal (AC) stored at 4 °C and room temperature for 6 months. A field experiment evaluated the effectiveness of strains to increase the P availability to plants growing with rock phosphate (RP) and a mixture of RP and triple superphosphate (TS) and their contribution to improving maize yield and P accumulation in grains. The B70 was outstanding in solubilizing RP and phytate mineralization and more stable in carriers and storage conditions than B32. However, root adherence was more noticeable in B32. Among carriers, AC was the most effective for preserving viable cell counts, closely similar to those of the initial inoculum of both strains. Maize productivity using the mixture RPTS was similar for B70 and B32. The best combination was B70 with RP, which improved the maize yield (6532 kg ha -1 ) and P accumulation in grains (15.95 kg ha -1 ). Our results indicated that the inoculant formulation with AC carrier and B70 is a feasible strategy for improving phosphorus mobilization in the soil and maize productivity., (© 2023. The Author(s) under exclusive licence to Sociedade Brasileira de Microbiologia.)

Polarization is common in politics and public opinion. It is believed to be shaped by media as well as ideologies, and often incited by misinformation. However, little is known about the microscopic dynamics behind polarization and the resulting social tensions. By coupling opinion formation with the strategy selection in different social dilemmas, we reveal how success at an individual level transforms to global consensus or lack thereof. When defection carries with it the fear of punishment in the absence of greed, as in the stag-hunt game, opinion fragmentation is the smallest. Conversely, if defection promises a higher payoff and also evokes greed, like in the prisoner's dilemma and snowdrift game, consensus is more difficult to attain. Our research thus challenges the top-down narrative of social tensions, showing they might originate from fundamental principles at individual level, like the desire to prevail in pairwise evolutionary comparisons., Competing Interests: The authors declare no competing interests., (© 2024 The Authors.)

Even though the Theory of Mind in upper primates has been under investigation for decades, how it may evolve remains an open problem. We propose here an evolutionary game theoretical model where a finite population of individuals may use reasoning strategies to infer a response to the anticipated behavior of others within the context of a sequential dilemma, i.e., the Centipede Game. We show that strategies with bounded reasoning evolve and flourish under natural selection, provided they are allowed to make reasoning mistakes and a temptation for higher future gains is in place. We further show that non-deterministic reasoning co-evolves with an optimism bias that may lead to the selection of new equilibria, closely associated with average behavior observed in experimental data. This work reveals both a novel perspective on the evolution of bounded rationality and a co-evolutionary link between the evolution of Theory of Mind and the emergence of misbeliefs., Competing Interests: The authors declare no competing interests., (© 2024 The Author(s).)

The maize yield, nutritional status, and grain fumonisins concentration were evaluated in different genotypes, doses, and nitrogen sources (N) in two years and three locations. Two experiments were carried out in each area and year in an experimental design of a subdivided plot with four replications. One experiment involved a 4x2 factorial treatment: four nitrogen (N) doses (0, 80, 160, and 240 kg ha-1) in coverage and having urea as a source of N and two genotypes. Another experiment involved a 4x2 factorial treatment: four N sources: urea, urea covered with polymer, ammonium nitrate, and ammonium nitrate + urea (UAN), at a dose of 160 kg ha-1, in two genotypes. The genotype generally influenced maize yield more than N doses and sources, mainly due to the bushy stunt/corn stunt tolerance of AG7098 PRO2 and AG8677 PRO2. The N doses linearly increased the N leaf content. However, the N sources did not affect the N leaf content. The N doses and sources had no significant effect on the content of fumonisins, which was affected only by the genotypes in Sete Lagoas in 2016 (N doses experiment) and 2017 (N sources experiment). The hybrids, P3630H and AG8677PRO2 (Sete Lagoas, 2016, N doses experiment and 2017, N sources experiment, respectively) exceeded the Brazilian legislation for Maximum Tolerance Limit for fumonisins in corn grains, which is 5,000 µg kg-1. The best result was obtained with AG7098 PRO2, with yields (above 10,000 kg ha-1) and fumonisins consistently below 5,000 µg kg-1. Therefore, the selection of corn hybrids is a strategy to reduce the occurrence of fumonisins in the grains.

Current electronic health records (EHRs) are often ineffective in identifying patient priorities and care needs requiring nurses to search a large volume of text to find clinically meaningful information. Our study, part of a larger randomized controlled trial testing nursing care planning clinical decision support coded in standardized nursing languages, focuses on identifying format preferences after random assignment and interaction to 1 of 3 formats (text only, text+table, text+graph). Being assigned to the text+graph significantly increased the preference for graph (P = .02) relative to other groups. Being assigned to the text only (P = .06) and text+table (P = .35) was not significantly associated with preference for their assigned formats. Additionally, the preference for graphs was not significantly associated with understanding graph content (P = .19). Further studies are needed to enhance our understanding of how format preferences influence the use and processing of displayed information., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The difficulties associated with solving Humanity's major global challenges have increasingly led world leaders and everyday citizens to publicly adopt strong emotional responses, with either mixed or unknown impacts on others' actions. Here, we present two experiments showing that non-verbal emotional expressions in group interactions play a critical role in determining how individuals behave when contributing to public goods entailing future and uncertain returns. Participants' investments were not only shaped by emotional expressions but also enhanced by anger when compared with joy. Our results suggest that global coordination may benefit from interaction in which emotion expressions can be paramount., Competing Interests: The authors declare no competing interests., (© 2023 The Authors.)

Herding behavior has a social cost for individuals not following the herd, influencing human decision-making. This work proposes including a social cost derived from herding mentality into the payoffs of pairwise game interactions. We introduce a co-evolutionary asymmetric model with four individual strategies (cooperation vs. defection and herding vs. non-herding) to understand the co-emergence of herding behavior and cooperation. Computational experiments show how including herding costs promotes cooperation by increasing the parameter space under which cooperation persists. Results demonstrate a synergistic relationship between the emergence of cooperation and herding mentality: the highest cooperation is achieved when the herding mentality also achieves its highest level. Finally, we study different herding social costs and its relationship to cooperation and herding evolution. This study points to new social mechanisms, related to conformity-driven imitation behavior, that help to understand how and why cooperation prevails in human groups., Competing Interests: The authors declare no competing interests., (© 2023 The Authors.)

Background: Lymphedema is a common complication following breast cancer treatment. The aim of this study is to evaluate the effectiveness of a self-adjusting compression garment (ReadyWrap®) in reducing (phase 1) and maintaining (phase 2) upper limb volume in women presenting breast cancer-related lymphedema., Methods: This study will comprise a randomized, controlled, single-blind clinical trial concerning women with breast cancer-related lymphedema undergoing treatment at a public cancer treatment reference hospital in the city of Rio de Janeiro, Brazil. The intervention will be carried out by adapting self-dressing versus the standard treatment of compressive bandaging (phase 1) and compressive mesh (phase 2). Both groups will be assessed at the beginning and end of intensive treatment and followed up for up to 12 months to evaluate immediate and late outcomes. Assessments will be carried out by physical upper limb examination (inspection, palpation, volume, dynamometry, and thermography) and questionnaires application to assess patient's quality of life pertaining to the health, functionality, and symptoms of the affected upper limb, as well adverse effects and adherence to treatment. Data will be analyzed descriptively and analytically through univariate and multiple linear regressions. P values < 0.05 will be considered statistically significant., Discussion: This study will evaluate the effectiveness of a self-adjustable garment (ReadyWrap®) in the treatment of lymphedema secondary to breast cancer in Brazilian women compared to the gold standard treatment for limb volume reduction (phase 1) and maintenance (phase 2) phases comprising, respectively, a compressive bandaging and a compressive mesh. The outcome results will provide data based on both quantitative responses and self-reported participant outcomes. The study will also assess the cost-effectiveness of the ReadyWrap® treatment versus standard care. Finally, we expect to reaffirm one more product/therapy as a treatment for this extremely complex and impactful condition following the data analysis., Trial Registration: NCT04934098 [Clinical trials phase 1]. Registered on June 22, 2021. NCT04881604 [Clinical trials phase 2]. Registered on May 11, 2021., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: The proliferation of health care data in electronic health records (EHRs) is fueling the need for clinical decision support (CDS) that ensures accuracy and reduces cognitive processing and documentation burden. The CDS format can play a key role in achieving the desired outcomes. Building on our laboratory-based pilot study with 60 registered nurses (RNs) from 1 Midwest US metropolitan area indicating the importance of graph literacy (GL), we conducted a fully powered, innovative, national, and web-based randomized controlled trial with 203 RNs., Objective: This study aimed to compare care planning time (CPT) and the adoption of evidence-based CDS recommendations by RNs randomly assigned to 1 of 4 CDS format groups: text only (TO), text+table (TT), text+graph (TG), and tailored (based on the RN's GL score). We hypothesized that the tailored CDS group will have faster CPT (primary) and higher adoption rates (secondary) than the 3 nontailored CDS groups., Methods: Eligible RNs employed in an adult hospital unit within the past 2 years were recruited randomly from 10 State Board of Nursing lists representing the 5 regions of the United States (Northeast, Southeast, Midwest, Southwest, and West) to participate in a randomized controlled trial. RNs were randomly assigned to 1 of 4 CDS format groups-TO, TT, TG, and tailored (based on the RN's GL score)-and interacted with the intervention on their PCs. Regression analysis was performed to estimate the effect of tailoring and the association between CPT and RN characteristics., Results: The differences between the tailored (n=46) and nontailored (TO, n=55; TT, n=54; and TG, n=48) CDS groups were not significant for either the CPT or the CDS adoption rate. RNs with low GL had longer CPT interacting with the TG CDS format than the TO CDS format (P=.01). The CPT in the TG CDS format was associated with age (P=.02), GL (P=.02), and comfort with EHRs (P=.047). Comfort with EHRs was also associated with CPT in the TT CDS format (P<.001)., Conclusions: Although tailoring based on GL did not improve CPT or adoption, the study reinforced previous pilot findings that low GL is associated with longer CPT when graphs were included in care planning CDS. Higher GL, younger age, and comfort with EHRs were associated with shorter CPT. These findings are robust based on our new innovative testing strategy in which a diverse national sample of RN participants (randomly derived from 10 State Board of Nursing lists) interacted on the web with the intervention on their PCs. Future studies applying our innovative methodology are recommended to cost-effectively enhance the understanding of how the RN's GL, combined with additional factors, can inform the development of efficient CDS for care planning and other EHR components before use in practice., (©Yingwei Yao, Karen Dunn Lopez, Ragnhildur I Bjarnadottir, Tamara G R Macieira, Fabiana Cristina Dos Santos, Olatunde O Madandola, Hwayoung Cho, Karen J B Priola, Jessica Wolf, Diana J Wilkie, Gail Keenan. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 11.08.2023.)

Background: Although there are several ways to assess pain in dementia, there is still a need for tools with better items to assess the presence of pain intensity in these individuals., Objective: To validate to Brazilian version of the "Pain Intensity Measure for Persons with Dementia - PIMD-p., Methods: Older adults, all demented with impaired verbal communication and exposed to potentially painful situations, were selected from an outpatient clinic and long-term care facility (LTCF). The PIMD-p was applied independently by 2 researchers (E1 and E2) on the same day. Within 14 days, the instrument was reapplied by one of the 2 researchers (E3). The pain intensity reported by participants' caregivers and LTCF nurses were recorded on a verbal numeric pain scale. For the statistical analysis, Cronbach's Alpha, Spearman's Coefficient and intraclass correlation Index were calculated., Results: A total of 50 older individuals were selected (mean age 86 years), majority with musculoskeletal pain. The PIMD-p demonstrated good internal consistency according to Cronbach's α (0.838), excellent intra and interobserver reproducibility (0.927 and 0.970, respectively; p  < 0.001), and convergent validity (strong significant correlations between reported pain intensities and pain indicators on the PIMD-p (except for expressive eyes; corr = 0.106 and p  = 0.462). A ROC curve was plotted to determine the best cut-off for the PIMD-P, and a score of 7.5 predicted moderate-to-severe pain, with 77.8% sensitivity and 95.7% specificity ( p  < 0.001)., Conclusion: The PIMD-p showed satisfactory psychometric properties for measuring intensity of pain in demented older adults with impaired verbal communication., Competing Interests: There is no conflict of interest to declare., (Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).)

Background: We aimed to develop and validate a practical instrument to assess older adults' satisfaction with their social participation (SP)., Design and Setting: This methodological validation study was conducted at a public higher education institution., Methods: A two-phase study was designed, developed, and validated to assess older adults' satisfaction with their SP. In the first phase, we conceptualized SP and developed an "instrument to assess older adults' satisfaction with their SP (IAPSI)," as approved by a committee of specialists, pre-tested, and partially validated. Second, we determined the IAPSI's reproducibility using Cronbach's alpha to measure internal consistency, Pearson's and Spearman's coefficients to measure correlations, the Bland-Altman plot and intraclass correlation coefficient (ICC) to measure reproducibility. We also generated a receiver operating characteristic (ROC) curve., Results: 102 older adults (mean age, 87.29) participated in the first phase. Moderate internal consistency (Cronbach's alpha 0.7) and significant moderate correlations with quality of life by World Health Organization Quality of Life (WHOQOL)-bref and by WHOQOL-old social domains (Pearson's coefficients 0.54 and 0.64, respectively; P < 0.001) were found. The ROC curve indicated an IAPSI score of 17 as the threshold for the impact of pain on satisfaction with SP (83.3% sensitivity and 88.9% specificity, P < 0.001). In the second phase, 56 older adults (between 81 and 90 years old) participated. We found adequate intra- and inter-observer reproducibility for the IAPSI (ICC 0.96 and 0.78, respectively)., Conclusion: We have developed a practical instrument with appropriate psychometric properties to assess older adults' satisfaction with their SP.

Objective: Takayasu arteritis (TAK) is a rare chronic granulomatous vasculitis that affects large vessels and usually begins in women of childbearing age, so it is not uncommon for pregnancies to occur in these patients. However, there is limited information about these pregnancies, with reports of adverse maternal and obstetric outcomes. The objective of this study is to evaluate adverse maternal, fetal and neonatal events in pregnant patients with TA., Methods: This is a cross-sectional study with retrospective data collection. We reviewed 22 pregnancies in 18 patients with TAK, according to the American College of Rheumatology criteria, that were followed up in a high-risk prenatal clinic specialized in systemic autoimmune diseases and thrombophilia (PrAT) at Hospital Universitário Pedro Ernesto, from 1998 to 2021., Results: In twenty-two pregnancies, the mean age of patients was 28.09 years and the mean duration disease was 10.9 years. Of the 18 patients with TAK studied, only one had the diagnosis during pregnancy and had active disease. All other patients had a previous diagnosis of TAK and only 3 had disease activity during pregnancy. Twelve patients (66.6%) had previous systemic arterial hypertension and eleven (61.1%) had renal involvement. Among maternal complications, eight patients (36.3%) developed preeclampsia and six (27.2%) had uncontrolled blood pressure without proteinuria, while 10 (45%) had puerperal complications. Four (18.1%) births were premature, all due to severe preeclampsia and eight newborns (34.7%) were small for gestational age. When all maternal and fetal/neonatal outcomes included in this study were considered, only 6 (27.2%) pregnancies were uneventful., Conclusion: Although there were no maternal deaths or pregnancy losses in this study, the number of adverse events was considerably high. Hypertensive disorders and small for gestational age newborns were more common than general population, while the number of patients with active disease was low. These findings suggest that pregnancies in patients with TAK still have several complications and a high-risk prenatal care and delivery are necessary for these patients., (© 2023. The Author(s).)

Ecosystem restoration conventionally focuses on ecological targets. However, while ecological targets are crucial to mobilizing political, social, and financial capital, they do not encapsulate the need to: integrate social, economic, and ecological dimensions and systems approaches; reconcile global targets and local objectives; and measure the rate of progress toward multiple and synergistic goals. Restoration is better conceived as an inclusive social-ecological process that integrates diverse values, practices, knowledge, and restoration objectives across temporal and spatial scales and stakeholder groups. Taking a more process-based approach will ultimately enable greater social-ecological transformation, greater restoration effectiveness, and more long-lasting benefits to people and nature across time and place., Competing Interests: Declaration of interests None declared by authors., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: To compare the 2-year retention rate between a second tumor necrosis factor alpha inhibitor (TNFi) and secukinumab (SEK) or ustekinumab (UST), in Psoriatic Arthritis (PsA) patients with previous inadequate response to their first TNFi., Methods: Prospective longitudinal cohort study with a follow-up period of 2 years using the Nationwide Portuguese Reuma.pt database. Patients with a clinical diagnosis of PsA who also fulfill the CASPAR classification criteria, with previous treatment failure to a first-line TNFi and having started a second biotechnological drug (TNFi, SEK or UST) were included. The Cycling group was defined as switching from a first TNFi to a second TNFi, and the Swapping group as switching from a first TNFi to SEK or UST. Sociodemographic data, disease characteristics, disease activity scores and physical function at baseline and after 6, 12 and 24 months were recorded. Cox-proportional hazards regression was used to compare retention rates between Cycling and Swapping groups. To obtain a predictor model of 2-year discontinuation, a multivariable Cox regression model was performed., Results: In total, 439 patients were included, 58% were female, with a mean age (standard deviation) of 49 (12) years. Globally, 75.6% initiated a second TNFi (Cycling group), and 24.4% started SEK/UST (Swapping group). The retention rates after 6, 12 and 24 months were 72%/66%/59% in the Cycling group; and 77%/66%/59% in the Swapping group. There were no significant differences in retention rates between both strategies (HR: 1.06, 95% CI 0.72-1.16). After 2 years of follow-up, 34.4% of patients discontinued their second biologic, mainly due to inefficacy (72.8%), with no differences found between groups. Baseline treatment with glucocorticoids was the only predictor of discontinuation after 2 years of follow-up (HR:1.668, 95% CI 1.154-2.409)., Conclusions: After failure of a first TNF inhibitor, Cycling and Swapping strategies result in similar retention rates suggesting that both are acceptable in the management of patients with psoriatic arthritis.

Given the scarcity of studies relating fire to deforestation in the Atlantic Forest and great economic and ecological importances of this biome, this work aimed to investigate this relationship in the Atlantic Forest of the State of São Paulo, trying to answer whether deforestation is related to fire events in up to three years, if there are regions most affected by this relationship and what land use and land cover predominates after fire and deforestation in these areas. The study was carried out in Evergreen Forest and Semideciduous Seasonal, along the time series from 2000 to 2019 using the MapBiomas Project database to survey deforested and burned sites with moderate to high severity fires. Burning positively influenced deforestation in EGF in eight of 19 years studied (2001, 2004, 2005, 2007, 2008 and 2009, 2013 and 2015), while only for three years in the SSF. Burning followed by deforestation corresponded to only 3.2% of the total deforestation, located mainly in the eastern region of the state with the highest density in the EGF. Most of these areas have been converted to agriculture. This study provides the first indication that, generally, fire is not a driver of deforestation in the southeast Atlantic Forest., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 de Praga Baião et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Osteoporosis compromises bone strength and increases the risk of fractures. Zoledronate prevents loss of bone mass and reduces the risk of fractures., Objectives: To determine the efficacy and safety of zoledronate in postmenopausal women with osteopenia and osteoporosis., Design and Settings: A systematic review and meta-analysis was conducted within the evidence-based health program at the Universidade Federal de São Paulo., Methods: An electronic search of the CENTRAL, MEDLINE, Embase, and LILACS databases was performed until February 2022. Randomized controlled trials comparing zoledronate with placebo or other bisphosphonates were included. Standard methodological procedures were performed according to the Cochrane Handbook and the certainty of evidence for the Grading of Recommendations Assessment, Development, and Evaluation Working Group. Two authors assessed the risk of bias and extracted data on fractures, adverse events, bone turnover markers (BTM), and bone mineral density (BMD)., Results: Twelve trials from 6,652 records were included: nine compared zoledronate with placebo, two trials compared zoledronate with alendronate, and one trial compared zoledronate with ibandronate. Zoledronate reduced the incidence of fractures in osteoporotic [three years: morphometric vertebral fractures (relative risk, RR = 0.30 (95% confidence interval, CI: 0.24-0.38))] and osteopenic women [six years: morphometric vertebral fractures (RR = 0.39 (95%CI: 0.25-0.61))], increased incidence of post-dose symptoms [RR = 2.56 (95%CI: 1.80-3.65)], but not serious adverse events [RR = 0.97 (95%CI: 0.91-1.04)]. Zoledronate reduced BTM and increased BMD in osteoporotic and osteopenic women., Conclusion: This review supports the efficacy and safety of zoledronate in postmenopausal women with osteopenia for six years and osteoporosis for three years., Prospero Registration Number: CRD42022309708, https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=309708.

Several pollutants can alter neonatal prostatic development predisposing this gland to diseases. The toxicity and endocrine disrupting potential of aluminum has been reported in many organs, but little is known about its effects on the prostate. This study aimed to evaluate the effects that aluminum neonatal exposure can cause in the male ventral prostate and in the female prostate of adult and senile gerbils. Male and female pups were treated orally with aluminum chloride (10 mg/kg) from the 1st to the 14th day life. After treatment, the animals were aged until they reached 90 days or 1 year of life. The prostate glands were dissected out and submitted to morphological, immunohistochemical and ultrastructural analyses. Ventral prostates of adult males showed moderate hyperplasia and increased epithelial proliferation not associated with androgen receptor (AR) deregulation. On the other hand, senile males showed intense prostatic hyperplasia, and increased cell proliferation and epithelial AR regulation. Additionally, at both ages, there was a reduction in the prostate secretory function. The morphological changes observed in the female prostate were like those found in males. However, in adult females, prostatic hyperplasia was accompanied by a lower regulation of AR and estrogen receptor alpha, while in senile females, intense hyperplastic growth was associated with an increase in estrogen receptor alpha and a reduction in stromal AR. These results demonstrate that aluminum chloride neonatal exposure alters the hormonal regulation of the male and female prostate, inducing tissue damage that occurs in adulthood and intensifies during aging., (© 2023 International Federation for Cell Biology.)

Objectives: To analyze the clinical characteristics and outcomes of admitted patients with the hospital- versus community-manifested COVID-19 and to evaluate the risk factors related to mortality in the first population., Methods: This retrospective cohort included consecutive adult patients with COVID-19, hospitalized between March and September 2020. The demographic data, clinical characteristics, and outcomes were extracted from medical records. Patients with hospital-manifested COVID-19 (study group) and those with community-manifested COVID-19 (control group) were matched by the propensity score model. Logistic regression models were used to verify the risk factors for mortality in the study group., Results: Among 7,710 hospitalized patients who had COVID-19, 7.2% developed symptoms while admitted for other reasons. Patients with hospital-manifested COVID-19 had a higher prevalence of cancer (19.2% vs 10.8%) and alcoholism (8.8% vs 2.8%) than patients with community-manifested COVID-19 and also had a higher rate of intensive care unit requirement (45.1% vs 35.2%), sepsis (23.8% vs 14.5%), and death (35.8% vs 22.5%) (P <0.05 for all). The factors independently associated with increased mortality in the study group were increasing age, male sex, number of comorbidities, and cancer., Conclusion: Hospital-manifested COVID-19 was associated with increased mortality. Increasing age, male sex, number of comorbidities, and cancer were independent predictors of mortality among those with hospital-manifested COVID-19 disease., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Multiple Sclerosis, known main cause of non-traumatic neurological disability in adults, leads to changes in muscle strength, especially in the lower limbs. Assessing muscle strength in these patients is thus essential and can be achieved by the Five Times Sit to Stand Test (FTSST), commonly performed in person. Due to the COVID-19 pandemic and social distancing measured adopted, Brazilian physiotherapists turned to remote monitoring and assessment, supported by Resolution n° 516/2020, which required proving the reliability of tests. Given this scenario, this study sought to evaluate the intra- and inter-rater reliability of the Five Times Sit to Stand Test performed remotely and synchronously by multiple sclerosis patients., Methods: A sample of 33 individuals with relapsing-remitting Multiple Sclerosis (18 women and 15 men, mean age 43.7 ± 13.4 years) were remotely and synchronously by video call. Inter-rater reliability was evaluated by analyzing FTSST execution time, in seconds, timed by two different raters on the same video call. In turn, intra-rater reliability was assessed by analyzing the execution time recorded in two different video calls made by the same rater, within a 24-28-h interval. Descriptive and inferential data analysis were performed using SPSS 20.0 software. Means and standard deviation were calculated for descriptive statistic. Intraclass correlation coefficient (ICC), with a 0.05 significance level, standard error of measurement (SEM) and minimal detectable change (MDC) were calculated for inferential analysis., Results: Data analysis showed excellent ICC values and low SEM and MDC values regarding inter-rater reliability (ICC: 0.993 (0.986-0.996); p-value: <0.001; SEM: 0.6 s; MDC: 1.6 s) and intra-rater reliability (ICC: 0.962 (0.925-0.981); p-value: <0.001; SEM: 1.4 s; MDC: 3.8 s)., Conclusion: Based on these values, FTSST performed remotely and synchronously by relapsing-remitting Multiple Sclerosis patients is reliable and can be used both by different raters, for assessment, or by the same rater, in pre- and post-test situations., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The aim of this study was to evaluate and correlate modifications of vaginal mucous impedance, vulvar temperature and ultrasonographic measurements (echobiometric parameters) to parturition in pregnant Saanen does. 30 does were selected for the study and submitted to an estrus synchronization protocol and natural mating. The females were evaluated daily from Day 143 of pregnancy to parturition. For the sonographic evaluations, the following structures were measured: biparietal diameter, thoracic diameter, abdominal diameter, ocular orbit, kidney length, kidney height, cardiac area, placentome length, cervical measurement and fetal heart rate; by means of two different approaches: transrectal and transabdominal, using a 7.5 MHz linear transducer. The vaginal mucous impedance was assessed using an electric estrous detector and vulvar temperature was measured using a non-contact infrared thermometer. Statistical analysis was performed using the R-project software and the significance level was set at 5% for all tests. 25 Saanen does became pregnant, resulting in 80.33% pregnancy rate. Fetal heart rate was negatively correlated to the hours to parturition (p<0,001; r-Pearson= -0,451), as well as vaginal temperature (p= 0,001; r-Pearson= -0,275), while cervical thickness was positively correlated to hours to parturition (p<0,001; r-Pearson= 0,490). The echobiometric parameters (biparietal diameter, thoracic diameter, abdominal diameter, ocular orbit, kidney length and height, cardiac area, placentome length), as well as vaginal mucous impedance did not vary throughout the timepoints of evaluation and did not correlate to the moment of parturition. It was concluded that the parameters of fetal heartbeat, vaginal temperature and cervical effacement in the last week of pregnancy provide valuable information regarding the proximity of parturition., Competing Interests: Conflict of interest: The authors have no conflict of interest to declare.

Humans have developed considerable machinery used at scale to create policies and to distribute incentives, yet we are forever seeking ways in which to improve upon these, our institutions. Especially when funding is limited, it is imperative to optimise spending without sacrificing positive outcomes, a challenge which has often been approached within several areas of social, life and engineering sciences. These studies often neglect the availability of information, cost restraints or the underlying complex network structures, which define real-world populations. Here, we have extended these models, including the aforementioned concerns, but also tested the robustness of their findings to stochastic social learning paradigms. Akin to real-world decisions on how best to distribute endowments, we study several incentive schemes, which consider information about the overall population, local neighbourhoods or the level of influence which a cooperative node has in the network, selectively rewarding cooperative behaviour if certain criteria are met. Following a transition towards a more realistic network setting and stochastic behavioural update rule, we found that carelessly promoting cooperators can often lead to their downfall in socially diverse settings. These emergent cyclic patterns not only damage cooperation, but also decimate the budgets of external investors. Our findings highlight the complexity of designing effective and cogent investment policies in socially diverse populations., (© The Author(s) 2023.)

Evolutionary Game Theory (EGT) provides an important framework to study collective behavior. It combines ideas from evolutionary biology and population dynamics with the game theoretical modeling of strategic interactions. Its importance is highlighted by the numerous high level publications that have enriched different fields, ranging from biology to social sciences, in many decades. Nevertheless, there has been no open source library that provided easy, and efficient, access to these methods and models. Here, we introduce EGTtools, an efficient hybrid C++/Python library which provides fast implementations of both analytical and numerical EGT methods. EGTtools is able to analytically evaluate a system based on the replicator dynamics. It is also able to evaluate any EGT problem resorting to finite populations and large-scale Markov processes. Finally, it resorts to C++ and MonteCarlo simulations to estimate many important indicators, such as stationary or strategy distributions. We illustrate all these methodologies with concrete examples and analysis., Competing Interests: The authors declare no competing interests., (© 2023 The Author(s).)

Introduction: The presence of another rheumatological condition in patients with systemic sclerosis (SSc) is not uncommon. To report a case of a patient with SSc-RA overlap and perform a review of the cases reported in the literature., Material and Methods: A chart review of the present case report was performed. After, we performed a literature search in MEDLINE, EMBASE and Cochrane databases., Results: We included 26 articles. Sixty-three patients were reviewed, 51 were female with a mean age of 45.03 years at the time of the first diagnosis. Sixty-three patients were diagnosed with limited cutaneous SSc. Regarding organ involvement, the most frequently reported were cutaneous, vascular, pulmonary and gastrointestinal involvement. Erosions were presenting 65.08% of patients. A panoply of treatments was used., Conclusions: The authors concluded that screening for an associated disease should be encouraged since the overlap with SSc may affect prognosis and treatment., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie.)

Coronavirus disease 2019 (COVID-19) is a systemic disease that impacts multiple organ systems with a complex clinical presentation and outcomes that can vary from person to person and between populations. To optimize COVID-19 treatment outcomes, and in light of the availability of antiviral drugs, there is a need for greater attention to the field of theranostics, the fusion of therapeutics and diagnostics. Theranostics tests would be invaluable, we suggest in this expert review, so as to optimize the efficacy and safety of current and future antiviral drugs against COVID-19. Theranostics would also assist in the design and implementation of clinical trials with antiviral drug candidates. We discuss here theranostics considering drugs such as remdesivir, Paxlovid™, and molnupiravir. All in all, we underscore that theranostics as a concept and practice is essential for efficient and safe health interventions against COVID-19 and other ecological crises in the 21st century.