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In delay­-tolerant networks (DTN), energy-­efficient node operation is vital due to battery life constraints. Energy consumption significantly impacts data forwarding, necessitating novel energy­-efficient routing protocols. We begin by comparing the performance of several protocols, including CASPaR, Direct Delivery, Epidemic, Spray­and­Wait, and PRoPHETv2, using the Opportunistic Network Environment (ONE) simulator. Our findings demonstrate the superiority of CASPaR in terms of message delivery and latency. To further optimize energy usage, we propose EECASPaR, a combination of a threshold algorithm with CASPaR. EECASPaR is a single­-copy, congestion­avoidance, energy­-efficient protocol suitable for energy­-constrained applications, promoting sustainable communication. This protocol considers the remaining node energy to make informed decisions regarding message acceptance or forwarding to neighbor nodes. Through extensive simulations with varying energy thresholds, our results confirm that EECASPaR enhances remaining node energy and reduces the occurrence of dead nodes.

Background: Early thromboprophylaxis does not prevent hospital admissions and death among outpatients with symptomatic COVID-19. Its impact on long-term outcomes, including long COVID symptoms and performance status, is unknown. Objectives: To assess the long-term effects of thromboprophylaxis given at the time of acute COVID-19 in outpatients. Methods: The OVID (enoxaparin for outpatients with COVID-19) trial randomized outpatients older than 50 years with acute COVID-19 to receive either subcutaneous enoxaparin 40 mg once daily for 14 days or standard of care (no thromboprophylaxis). In this follow-up study, we assessed the 2-year outcomes, including all-cause hospitalization and death, cardiovascular events, long COVID symptoms, and functional limitations based on the Post–COVID-19 Functional Status (PCFS) scale and EuroQol-5 Dimensions-5 Levels scale. Results: Of 469 potentially eligible patients, 468 survived, of whom 439 (mean age 59 years; 54% men) participated in the Post-OVID study. There was no difference in terms of hospitalization and death (8.3% in the treatment group vs 10% in controls; relative risk, 0.83; 95% CI, 0.5-1.5) and of cardiovascular events between groups. The risk of presenting with long COVID symptoms was similar in the 2 groups (44% in the treatment group vs 47% in the standard of care group), with no difference between groups also concerning individual symptoms. A PCFS grade of 1 to 3, indicating light-to-moderate functional limitation, was recorded in 15% of patients in each group (odds ratio, 0.98; 95% CI, 0.6-1.7). No patients reported severe limitations (PCFS grade 4). Median EuroQol visual analog scale score was 85 on 100 points (IQR, 80-90 for the standard of care group and 75-90 for the enoxaparin group). Conclusion: Early thromboprophylaxis does not improve long-term, 2-year clinical and functional outcomes among symptomatic ambulatory patients with acute COVID-19.

Background: Gliadins have aroused significant interest in the last decade as suitable biomaterials for food and pharmaceutical applications. In particular, the oral route is the preferred method of administration for gliadin-based formulations, due to the affinity of this biomaterial for the gut mucosa. However, up to now, this has been demonstrated only by means of in vivo or ex vivo studies. Methods: This is why, in this study, various in vitro techniques were employed in order to evaluate the ability of polymeric nanoparticles, made up of a commercial grade of the protein and an etheric surfactant, to interact with porcine gastric mucin. The nanosystems were also used for the encapsulation of thiamine hydrochloride, used as a model of a micronutrient. Results: The resulting systems were characterized by a mean diameter of ~160–170 nm, a narrow size distribution when 0.2–0.6 mg/mL of thiamine was used, and an encapsulation efficiency between 30 and 45% of the drug initially employed. The incubation of the gliadin nanosystems with various concentrations of porcine gastric mucin evidenced the ability of the carriers to interact with the mucus glycoprotein, showing a decreased Zeta potential after a 4 h incubation (from ~−30 to −40 mV), while demonstrating that the encapsulation of the drug did not affect its bioadhesive features. Conclusions: Altogether, these data support the conceivable application of gliadin nanoparticles as formulations for the oral administration of bioactive compounds.

Abstract Background Women experience greater difficulty achieving smoking abstinence compared to men. Recent evidence suggests that hormonal fluctuations during different phases of the menstrual cycle can contribute to lower smoking abstinence rates following a quit attempt among women. However, these findings are limited by small sample sizes and variability among targeted smoking quit dates. This clinical trial aims to clarify whether targeting the quit date to the follicular or luteal phase of the menstrual cycle can improve smoking abstinence. Methods Participants will enroll in an online smoking cessation program providing nicotine replacement therapy (NRT) and behavioral support. We will randomize 1200 eligible individuals to set a target quit date: (1) during the mid-luteal phase, (2) during the mid-follicular phase, or (3) 15–30 days after enrollment with no regard to the menstrual cycle phase (usual practice). Participants will receive a 6-week supply of combination NRT consisting of a nicotine patch plus their choice of nicotine gum or lozenge. Participants will be instructed to start using NRT on their target quit date. Optional behavioral support will consist of a free downloadable app and brief videos focusing on building a quit plan, coping with cravings, and relapse prevention, delivered via e-mail. Smoking status will be assessed via dried blood spot analysis of cotinine concentration at 7 days, 6 weeks, and 6 months post-target quit date. Discussion We aim to overcome the limitations of previous studies by recruiting a large sample of participants and assigning target quit dates to the middle of both the follicular and luteal phases. The results of the trial can further elucidate the effects of the menstrual cycle on smoking cessation outcomes and whether it is beneficial to combine menstrual cycle phase timing strategies with accessible and low-cost NRT. Trial registration ClinicalTrials.gov NCT05515354. Registered on August 23, 2022.

(1) Background: Quality of life (QOL) is used as a health indicator to assess the effectiveness and impact of therapies in certain groups of patients. This study aimed to analyze the QOL of patients with acute coronary syndrome (ACS) who received medical treatment by a public or private health care system. (2) Methods: This observational, prospective, longitudinal study was carried out in four referral hospitals providing cardiology services in Sergipe, Brazil. QoL was evaluated using the Medical Outcomes Study 36-Item Short-Form Health Survey. The volunteers were divided into two groups (public or private health care group) according to the type of health care provided. Multiple linear regression models were used to evaluate QoL at 180 days after ACS. (3) Results: A total of 581 patients were eligible, including 44.1% and 55.9% for public and private health care, respectively. At 180 days after ACS, the public health care group had lower QoL scores for all domains (functional capacity, physical aspects, pain, general health status, vitality, social condition, emotional profile, and health) (p < 0.05) than the private group. The highest QoL level was associated with male sex (p < 0.05) and adherence to physical activity (p ≤ 0.003) for all assessed domains. (4) Conclusions: This shows that social factors and health status disparities influence QoL after ACS in Sergipe.

Purpose: This research aims to analyze to what extent sustainability and its related core aspects are integrated in media and communication's curricula of higher education institutions in Europe. Design/methodology/approach: A total of n = 1068 bachelor and master's degree programs, as well as their related curricula/program specifications, from 28 European countries were analyzed by means of content analysis. Findings: Results show that the level of curricular integration of sustainability aspects in the field of media and communication is low (14%) to very low (6%) on module level. In most cases, sustainability remains an abstract guiding principle that is not translated into a dedicated course offer. This can indicate the difficulty of operationalizing such a concept as sustainability, which is experienced by not only higher education institutions but also policy and society as a whole. In addition, the results leave space for a reflection on the social and educational responsibility of higher education institutions. Research limitations/implications: The authors are aware that not all teaching (content) is depicted in curricula. Especially where teaching is research-based, The authors assume that sustainability (communication) is more present as the curricula' analysis can represent it. In addition, the fact of solely investigating English language curricula can be seen as a further limitation. Originality/value: This research is one of the few attempts to verify the actual integration level of sustainability aspects in the curricula of a specific sustainability-relevant discipline, which is neither conducted as a case study nor as a single-country analysis.

Abstract Background Peripheral arterial disease is a progressive atherosclerotic disease with symptoms ranging from an intermittent claudication to acute critical limb ischemia and amputations. Drug-coated balloons and stents were developed to prevent neo-intimal proliferation and restenosis after percutaneous transluminal angioplasty. Randomized controlled trials showed that drug-coated, notably paclitaxel-coated, devices reduce restenosis, late lumen loss, and the need for target lesion re-vascularization compared with uncoated ones. However, the size of these trials was too small to prove superiority for “hard” clinical outcomes. Moreover, available studies were characterized by too restrictive eligibility criteria. Finally, it remains unclear whether paclitaxel-coated balloons may impair long-term survival. Alternative drug-coated balloons, the so-called limus-based analogs, have been approved for clinical use in patients with peripheral arterial disease. By encapsulating sirolimus in phospholipid drug nanocarriers, they optimize adhesion properties of sirolimus and provide better bioavailability. Methods In this investigator-initiated all-comer open-label phase III randomized controlled trial, we will evaluate whether sirolimus-coated balloon angioplasty is non-inferior and eventually superior, according to a predefined hierarchical analysis, to uncoated balloon angioplasty in adults with infra-inguinal peripheral arterial disease requiring endovascular angioplasty. Key exclusion criteria are pregnancy or breastfeeding, known intolerance or allergy to sirolimus, and participation in a clinical trial during the previous 3 months. The primary efficacy outcome is the composite of two clinically relevant non-subjective “hard” outcomes: unplanned major amputation of the target limb and endovascular or surgical target lesion re-vascularization for critical limb ischemia occurring within 1 year of randomization. The primary safety outcome includes death from all causes. Discussion By focusing on clinically relevant outcomes, this study will provide useful information on the efficacy and safety of sirolimus-coated balloon catheters for infra-inguinal peripheral arterial disease in a representative (“all-comer”) population of unselected patients. As regulatory agencies had raised safety concerns in patients exposed to paclitaxel-coated devices (versus uncoated ones), collect mortality data up to 5 years after randomization will be collected. Trial registration ClinicalTrials.gov NCT04238546

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p

Sustainability is not only a moral compass for organizations of all kinds and shapes; increasingly it can be identified as social representation influencing social practices and behavior. Conceptually inspired by the idea of preferences, conventions, and moral convictions influencing individual behavior and an innovative concept of moral harmonization strategies, this paper introduces a theoretical framework for the conceptualization of moralization effects in sustainability communication in general and food choices in particular. The framework is linked to empirical data from an exploratory qualitative pilot study, in which we conducted guideline-based interviews with 25 international students to gather information on individual perceptions of food choices and eating behaviors. Interview data were analyzed using inductive category formation to explore what role sustainability plays on an individual level in terms of coming in as a value or norm and how much sustainability as a normative principle influences individual decision-making processes and behavior. Based on the results of the pilot study, we hypothesize that food is less “morally overloaded” than expected and sustainability is not a moral imperative related to specific eating behavior. In line with previous findings, our results confirmed that food choices and changes in meat consumption involve a multi-faceted and complex decision-making process, which among others may be heavily influenced by inherent social norms within a person's social network, including family, friends as well as important other peers. Thus, with this preliminary study, we critically challenge existing literature on the influence of sustainability as moral imperative guiding and influencing individual behavior, at least in the domain of food and eating behavior. To elaborate on our proposed framework, additional empirical research is needed from a cultural, sustainability, language, and communication perspective.

Abstract Background Administrative healthcare databases are widespread and are often standardized with regard to their content and data coding, thus they can be used also as data sources for surveillance and epidemiological research. Chronic dialysis requires patients to frequently access hospital and clinic services, causing a heavy burden to healthcare providers. This also means that these patients are routinely tracked on administrative databases, yet very few case definitions for their identification are currently available. The aim of this study was to develop two algorithms derived from administrative data for identifying incident chronic dialysis patients and test their validity compared to the reference standard of the regional dialysis registry. Methods The algorithms are based on data retrieved from hospital discharge records (HDR) and ambulatory specialty visits (ASV) to identify incident chronic dialysis patients in an Italian region. Subjects are included if they have at least one event in the HDR or ASV databases based on the ICD9-CM dialysis-related diagnosis or procedure codes in the study period. Exclusion criteria comprise non-residents, prevalent cases, or patients undergoing temporary dialysis, and are evaluated only on ASV data by the first algorithm, on both ASV and HDR data by the second algorithm. We validated the algorithms against the Emilia-Romagna regional dialysis registry by searching for incident patients in 2014 and performed sensitivity analyses by modifying the criteria to define temporary dialysis. Results Algorithm 1 identified 680 patients and algorithm 2 identified 676 initiating dialysis in 2014, compared to 625 patients included in the regional dialysis registry. Sensitivity for the two algorithms was respectively 90.8 and 88.4%, positive predictive value 84.0 and 82.0%, and percentage agreement was 77.4 and 74.1%. Conclusions Algorithms relying on retrieval of administrative records have high sensitivity and positive predictive value for the identification of incident chronic dialysis patients. Algorithm 1, which showed the higher accuracy and has a simpler case definition, can be used in place of regional dialysis registries when they are not present or sufficiently developed in a region, or to improve the accuracy and timeliness of existing registries.

A biodegradable and biocompatible polymeric matrix made up of poly(d,l-lactide-co-glycolide) (PLGA) was used for the simultaneous delivery of rutin and the (S)-N-(2-oxo-3-oxetanyl)biphenyl-4-carboxamide derivative (URB894). The goal was to exploit the well-known radical scavenging properties of rutin and the antioxidant features recently reported for the molecules belonging to the class of N-acylethanolamine-hydrolyzing acid amidase (NAAA) inhibitors, such as URB894. The use of the compounds, both as single agents or in association promoted the development of negatively-charged nanosystems characterized by a narrow size distribution and an average diameter of ~200 nm when 0.2–0.6 mg/mL of rutin or URB894 were used. The obtained multidrug carriers evidenced an entrapment efficiency of ~50% and 40% when 0.4 and 0.6 mg/mL of rutin and URB894 were associated during the sample preparation, respectively. The multidrug formulation evidenced an improved in vitro dose-dependent protective effect against H2O2-related oxidative stress with respect to that of the nanosystems containing the active compounds as a single agent, confirming the rationale of using the co-encapsulation approach to obtain a novel antioxidant nanomedicine.

Doxorubicin hydrochloride (DOX) is a well-known antitumor drug used as first line treatment for many types of malignancies. Despite its clinical relevance, the administration of the compound is negatively affected by dose-dependent off-target toxicity phenomena. Nanotechnology has helped to overcome these important limitations by improving the therapeutic index of the bioactive and promoting the translation of novel nanomedicines into clinical practice. Herein, nanoparticles made up of wheat gliadin and stabilized by polyoxyethylene (2) oleyl ether were investigated for the first time as carriers of DOX. The encapsulation of the compound did not significantly affect the physico-chemical features of the gliadin nanoparticles (GNPs), which evidenced a mean diameter of ~180 nm, a polydispersity index < 0.2 and a negative surface charge. The nanosystems demonstrated great stability regarding temperature (25–50 °C) and were able to retain high amounts of drug, allowing its prolonged and sustained release for up to a week. In vitro viability assay performed against breast cancer cells demonstrated that the nanoencapsulation of DOX modulated the cytotoxicity of the bioactive as a function of the incubation time with respect to the free form of the drug. The results demonstrate the potential use of GNPs as carriers of hydrophilic antitumor compounds.

Abstract A multidisciplinary approach appears to be fundamental for the treatment of critically ill patients with COVID‐19, improving clinical outcomes, even in the most severe cases. Such severe cases are advisable to be collegially discussed between intensivists, surgeons, infectious disease, and other physicians potentially involved.

Introduction: Boardwalk Cisterns is a government program that aims to attend a population with precarious access to water in Brazil. Developed as part of the Zero Hunger strategy, it intends to increase food security and contribute to the realization of the human right to food. The objective of this study was to assess farmers' perceptions of the Boardwalk Cisterns program and its impact on the food security situation of beneficiary households. Methods: Data were collected through a descriptive cross-sectional quali-quantitative survey. Questionnaires were applied to farming families selected from two municipalities in the state of Alagoas (Northeast Brazil), containing questions on sociodemographic characteristics, production methods, and food security status. The Free Evocation Technique for social representation, analyzed through the software Ensemble of Programs Permettant L'analyze des Évocations, was used to ascertain farmers' perceptions of the program. Results: The study showed a positive perception of the interviewees in relation to the boardwalk cisterns. The program brought some improvement in the agricultural production conditions and, consequently, in the food security situation of the households. Corn, beans and cassava were the most common crops, with almost half of this production (48.3%) destined for consumption by the families themselves. Farmers also reported having more water, allowing them to plant more fruit trees, as well as medicinal and ornamental plants. Nevertheless, 79.1% of the households interviewed were still in a situation of food insecurity, of which 28.1% were classified as mild food insecurity, 26% as moderate food insecurity, and 25% as severe food insecurity. Conclusion: Farmers were correct in their perception that the Boardwalk Cisterns program improved their food security situation. The program resulted in greater access to water, and greater production and consumption of food. However, by itself, the Boardwalk Cisterns program was not enough to raise beneficiary families above their food-insecure status. The program alleviated the problem of food insecurity, but other complementary government interventions are needed to guarantee the food security of families living in extreme poverty.

Every day, media managers face different challenges in a constantly changing global economic, cultural and technological setting (Hollifield, Leblanc Wicks, Sylvie, & Lowrey, 2016, p. 110, 177; Albarran, 2013; Shaver & Shaver, 2008; Hollifield, 2001). Between all these challenges, questions on what a media company is today, how it might be defined and the kinds of features characterizing it often remain unanswered. These questions are rarely addressed by authors and scholars working in both business economics, journalism, media, and communication science, maybe because there is the existing assumption of a self-evident and generally accepted definition of the term “media company” (as argued by Sjurts, 2004, p. 390) which actually does not exist. The aim of this paper is therefore to offer an overview of the existing theoretical approaches used to define “media companies,” to identify possible shortcomings of each definitional approach and, deduced from there, to suggest a theoretically sound and empirically applicable approach, which takes into account the challenges and needs of the actual media landscape.

Background: Cancer is a common disease in dogs, with a growing incidence related to the age of the animal. Nanotechnology is being employed in the veterinary field in the same manner as in human therapy. Aim: This review focuses on the application of biocompatible nanocarriers for the treatment of canine cancer, paying attention to the experimental studies performed on dogs with spontaneously occurring cancer. Methods: The most important experimental investigations based on the use of lipid and non-lipid nanosystems proposed for the treatment of canine cancer, such as liposomes and polymeric nanoparticles containing doxorubicin, paclitaxel and cisplatin, are described and their in vivo fate and antitumor features discussed. Conclusions: Dogs affected by spontaneous cancers are useful models for evaluating the efficacy of drug delivery systems containing antitumor compounds.

Background. Fixed-dose ultrasound-assisted catheter-directed thrombolysis (USAT) rapidly improves hemodynamic parameters and reverses right ventricular dysfunction caused by acute pulmonary embolism (PE). The effectiveness of USAT for acute PE associated with coronavirus disease 2019 (COVID-19) is unknown. Methods and results. The study population of this cohort study consisted of 36 patients with an intermediate-high- or high-risk acute PE treated with a fixed low-dose USAT protocol (r-tPA 10–20 mg/15 h). Of these, 9 patients tested positive for COVID-19 and were age–sex-matched to 27 patients without COVID-19. The USAT protocol included, beyond the infusion of recombinant tissue plasminogen activator, anti-Xa-activity-adjusted unfractionated heparin therapy (target 0.3–0.7 U/mL). The study outcomes were the invasively measured mean pulmonary arterial pressure (mPAP) before and at completion of USAT, and the National Early Warning Score (NEWS), according to which more points indicate more severe hemodynamic impairment. Twenty-four (66.7%) patients were men; the mean age was 67 ± 14 years. Mean ± standard deviation mPAP decreased from 32.3 ± 8.3 to 22.4 ± 7.0 mmHg among COVID-19 patients and from 35.4 ± 9.7 to 24.6 ± 7.0 mmHg among unexposed, with no difference in the relative improvement between groups (p = 0.84). Within 12 h of USAT start, the median NEWS decreased from six (Q1–Q3: 4–8) to three (Q1–Q3: 2–4) points among COVID-19 patients and from four (Q1–Q3: 2–6) to two (Q1–Q3: 2–3) points among unexposed (p = 0.29). One COVID-19 patient died due to COVID-19-related complications 14 days after acute PE. No major bleeding events occurred. Conclusions. Among patients with COVID-19-associated acute PE, mPAP rapidly decreased during USAT with a concomitant progressive improvement of the NEWS. The magnitude of mPAP reduction was similar in patients with and without COVID-19.

Posterior cerebral artery (PCA) territory infarction involving occipital cortical damage can give rise to contralateral homonymous hemianopia. Here, we report two rare cases of patients with lesions in the left hemisphere PCA territory who developed right visuo-spatial neglect. One patient suffered right hemianopia and right visuo-spatial neglect after a stroke that damaged the left primary visual cortex and the callosal splenial fibers. The other unique case is of a patient who had a brain tumor in the posterior cerebral region in the left hemisphere and initially exhibited only right hemianopia that developed into right visuo-spatial neglect after tumor resection that included the splenial fibers. These cases indicate that, as in cases with damage in the right PCA territory, lesions in the left PCA yield visuo-spatial neglect when the damage produces contralateral hemianopia and concomitant disconnection of the splenium of the corpus callosum, which interferes with the arrival of visual inputs from the intact right to the lesioned left hemisphere. These results also emphasize the necessity of sparing the splenial fibers in surgical interventions in patients who exhibit hemianopia.

In this paper, we analyze public discourses in 2018 about water-scarce Cape Town, SA. We investigated the discursive implications of apocalyptic rhetoric such as “Day Zero” by analyzing local and international news media talk (n = 111 newspaper articles) surrounding the Cape Town water crisis during pre-, height of, and post-crisis moments, complemented by 12 narrative problem-centered interviews in the height of the water crisis. The analysis led to a focus on the relationship between environmental and communicative developments with a high local impact, and mainly on examples of local engagement, social movements, or resistance as response to changing environmental scenarios and the evaluation of the role of (news) media in raising community concern and commitment. The findings show that the communication around the (twice-postponed) “Day Zero” in Cape Town is a very fruitful example of the digital disrupted, post-truth communication that happens with environmental issues today.

O presente estudo objetivou avaliar a participação das doações de alimentos realizadas pelo Programa Mesa Brasil SESC (Serviço Social do Comércio) no atendimento às recomendações nutricionais de crianças e adolescentes de instituições filantrópicas por ele assistidas, assim como sua importância em relação ao acesso à alimentação adequada e saudável. Todos os alimentos e as respectivas quantidades doadas para seis instituições no período de novembro de 2016 foram levantados e classificados de acordo com a extensão e grau de processamento. Estimaram-se as necessidades diárias de energia e nutrientes com base nas recomendações nutricionais de acordo com faixa etária e sexo do público atendido. Observou-se que para duas instituições, todos os alimentos doados eram do grupo in natura e para outras duas, grande parte era de alimentos deste grupo ou minimamente processados. O nutriente que obteve maior proporção de atendimento para todas as instituições foi a vitamina C, corroborando predominância nas doações de alimentos in natura. Conclui-se, portanto, que o Mesa Brasil contribuiu positivamente para o acesso à alimentação adequada e saudável na maioria das instituições pesquisadas, uma vez que a maioria dos alimentos doados era in natura, ressaltando o objetivo do programa de ser tão somente de caráter complementar.

Cerebral Palsy (CP) is commonly associated with low socioeconomic status. Use of spatial statistics and a Geographic Information Systems (GIS) are scarce and may contribute to the understanding of CP in a social context. To that end a spatial analysis of CP in children and adolescents was performed to analyze the association of CP with levels of vulnerability in a city (Aracaju, Sergipe) in north-eastern Brazil. In addition, an ecological study was conducted with data obtained from a populationbased survey and secondary data. Exploratory spatial data analysis and linear regression were used. A total of 288 CP cases were identified, with a prevalence of 1.65/1,000 and differences among city neighbourhoods ranging from 0-4/1,000. The mean age of cases studied was 9 years 1 month, with a standard deviation of 5 years 2 months. Most study subjects with cerebral palsy (163) were male (56.4%). The distribution of CP in the study population was not homogeneous throughout the territory. Some areas had clusters, with more cases associated with areas of high vulnerability. Spatial data analysis using GIS was useful to gain an epidemiological understanding of CP distribution that can guide decisionmaking with respect to production, distribution, and regulation of health goods as well as services at the local level.

The objective of this study was to identify and describe the experience of family farmers and their respective families after using the Boardwalk Cistern rainwater collection system and consequent impacts on nutrition profile and food security. This is a qualitative-quantitative study conducted in two municipalities in the semi-arid region of the state of Alagoas, northeastern Brazil. A structured questionnaire was applied to collect information on demographic and socioeconomic status and household access to food, based on the Brazilian Food Insecurity Scale of 29 family farmers' households. Food intake was assessed by food intake markers of the Ministry of Health, while nutritional status was determined by measuring the weight and height of all family members and waist circumference of adults. Nutrition diagnosis was performed using the cutoff points of body mass index for age. Three focus groups were conducted, and the information collected was analyzed through Content Analysis with the aim of knowing the participants' perception of the effects of the received water equipment. The study showed a high prevalence of excess weight (52.7%) and high risk for cardiovascular diseases (35.9%) marked by a high salt and sugar in the food intake. Food Insecurity Scale showed that food insecurity is a problem occurring in 75% of these families. However, focus groups showed that families have a positive perception of Boardwalk Cisterns for their food security. They believe that agricultural production has improved, thereby offering a wider range of foods and, consequently, improving food security. In conclusion, this study highlights the importance of water access programs for food production within public policies to guarantee FNS.

[This corrects the article DOI: 10.1371/journal.pone.0235709.].

BackgroundSince 2005, the Smoking Treatment for Ontario Patients (STOP) program has provided smoking cessation treatment of varying form and intensity to smokers through 11 distinct treatment models, either in-person at partnering healthcare organizations or remotely via web or telephone. We aimed to characterize the patient populations reached by different treatment models.MethodsWe linked self-report data to health administrative databases to describe sociodemographics, physical and mental health comorbidity, healthcare utilization and costs. Our sample consisted of 107,302 patients who enrolled between 18Oct2005 and 31Mar2016, across 11 models operational during different time periods.ResultsPatient populations varied on sociodemographics, comorbidity burden, and healthcare usage. Enrollees in the Web-based model were youngest (median age: 39; IQR: 29-49), and enrollees in primary care-based Family Health Teams were oldest (median: 51; IQR: 40-60). Chronic Obstructive Pulmonary Disease and hypertension were the most common physical health comorbidities, twice as prevalent in Family Health Teams (32.3% and 30.8%) than in the direct-to-smoker (Web and Telephone) and Pharmacy models (13.5%-16.7% and 14.7%-17.7%). Depression, the most prevalent mental health diagnosis, was twice as prevalent in the Addiction Agency (52.1%) versus the Telephone model (25.3%). Median healthcare costs in the two years up to enrollment ranged from $1,787 in the Telephone model to $9,393 in the Addiction Agency model.DiscussionWhile practitioner-mediated models in specialized and primary care settings reached smokers with more complex healthcare needs, alternative settings appear better suited to reach younger smokers before such comorbidities develop. Although Web and Telephone models were expected to have fewer barriers to access, they reached a lower proportion of patients in rural areas and of lower socioeconomic status. Findings suggest that in addition to population-based strategies, embedding smoking cessation treatment into existing healthcare settings that reach patient populations with varying disparities may enhance equitable access to treatment.

Drowning is an acute respiratory failure as a result from immersion or submersion of the airways in a liquid medium (predominantly water). Inhalation of water causes severe lung damage due to the destruction of pulmonary surfactant, resulting in decreased lung elasticity, alveolar collapse, alteration of ventilation-perfusion ratio, intrapulmonary blood shunting, hypoxia, acute lung injury, and Acute Respiratory Distress Syndrome (ARDS). Poractant alfa (Curosurf®), a natural surfactant effective in the treatment of newborn respiratory distress, has been used in various forms of ARDS, but in drowning syndromes, experience is still poor. We describe a series of nine clinical cases of drowning, six adults and three children, treated in our Intensive Care Unit (ICU) with endobronchial administration of poractant alfa. After 24 and 48 hours of administration in all cases, there was an improvement in arterial blood gas analysis (ABG) parameters and imaging. All patients were discharged without clinical consequences.

This is the case of a 76-year-old man admitted to hospital in a delirium state, previously diagnosed with a major depressive disorder at an age of 50 years, treated for years for chronic tension headache. The computed tomography of the head resulted negative. Inpatient laboratory tests revealed a mild hypercalcemia. Due to the progression of the disease (delirium state, dementia, tension headache, and depression), he was again admitted to hospital. The patient showed dysarthria, postural tremors, mirror movements and palmar hyperhidrosis, mild ataxia when walking, and rigidity. Sleep disturbances were also observed. He underwent several clinical diagnostic tests, which resulted negative. After more than 2 years, the ultrasound of the neck identified enlarged parathyroid glands. The patient was surgically treated, and three parathyroid glands were removed. Parathyroidectomy and lithium treatment resulted in improvement of cognitive functions. In elderly patients, concomitant presence of cognitive dysfunction may mask the underlying primary hyperparathyroidism.

The evaluation of the physico-chemical features of nanocarriers is fundamental because the modulation of these parameters can influence their biological and in vivo fate. This work investigated the feasibility of saline, 5% w/v glucose and phosphate-buffered saline solution, as polar media for the development of nanoparticles made up of two vegetal proteins, zein from corn and gliadin from wheat, respectively. The physico-chemical features of the various systems were evaluated using dynamic and multiple light scattering techniques, and the results demonstrate that the 5% w/v glucose solution is a feasible medium to be used for their development. Moreover, the best formulations were characterized by the aforementioned techniques following the freeze-drying procedure. The aggregation of the zein nanoparticles prepared in water or glucose solution was prevented by using various cryoprotectants. Mannose confirmed its crucial role in the cryopreservation of the gliadin nanosystems prepared in both water and glucose solution. Sucrose and glucose emerged as additional useful excipients when they were added to gliadin nanoparticles prepared in a 5% glucose solution. Specifically, their protective effect was in the following order: mannose > sucrose > glucose. The results obtained when using specific aqueous media and cryoprotectants permitted us to develop stable zein or gliadin nanoparticles as suspension or freeze-dried formulations.

Abstract Background Provision of evidence-based smoking cessation treatment may contribute to health disparities if barriers to treatment are greater for more disadvantaged groups. We describe and evaluate the public health impact of a novel outreach program to improve access to smoking cessation treatment in Ontario, Canada. Methods We partnered with Public Health Units (PHUs) located across the province to deliver single-session workshops providing standardized evidence-based content and 10 weeks (2007–2008) or 5 weeks (2008–2016) of nicotine replacement therapy (NRT). Participants completed a baseline assessment and were followed up by phone or e-mail at 6 months. We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to evaluate the public health impact of the program from 2007 to 2016. Given the iterative design and changes in implementation over time, data is presented annually or bi-annually. Results There were 26,122 enrollments from 2007 to 2016. Between 31 and 442 workshops were held annually. The annual reach was estimated to be 0.1–0.3% of eligible smokers in Ontario. Participants were older, smoked more heavily, had a lower household income, were more likely to be female and be diagnosed with a mood or anxiety disorder, and less likely to have a postsecondary degree compared to average Ontario smokers eligible for participation. The intervention was effective; at 6-month follow-up 22–33% of respondents reported abstinence from smoking. Adoption by PHUs was 81% by the second year of operation and remained high (72–97%) thereafter, with the exception of 2009–2010 (33–56%) when the program was temporarily unavailable to PHUs due to lack of funding. Implementation at the organizational level was not tracked; however, at the individual level, approximately half of participants used most or all of the NRT received. On average, maintenance of the program was high, with PHUs conducting workshops for 7 of the 10 years (2007–2016) and 4 of the 5 most recent years (2012–2016). Conclusions The smoking cessation program had a high rate of adoption and maintenance, reached smokers over a large geographic area, including individuals more likely to experience disparities, and helped them make successful quit attempts. This novel model can be adopted in other jurisdictions with limited resources.

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in industrialized countries and is associated with increased risk of cardiovascular, hepatic and metabolic diseases. Molecular mechanisms on the root of the disrupted lipid homeostasis in NAFLD and potential therapeutic strategies can benefit of in vivo and in vitro experimental models of fatty liver. Here, we describe the high fat diet (HFD)-fed rat in vivo model, and two in vitro models, the primary cultured rat fatty hepatocytes or the FaO rat hepatoma fatty cells, mimicking human NAFLD. Liver steatosis was invariably associated with increased number/size of lipid droplets (LDs) and modulation of expression of genes coding for key genes of lipid metabolism such as peroxisome proliferator-activated receptors (Ppars) and perilipins (Plins). In these models, we tested the anti-steatotic effects of 3,5-L-diiodothyronine (T2), a metabolite of thyroid hormones. T2 markedly reduced triglyceride content and LD size acting on mRNA expression of both Ppars and Plins. T2 also stimulated mitochondrial oxidative metabolism of fatty acids. We conclude that in vivo and especially in vitro models of NAFLD are valuable tools to screen a large number of compounds counteracting the deleterious effect of liver steatosis. Because of the high and negative impact of liver steatosis on human health, ongoing experimental studies from our group are unravelling the ultimate translational value of such cellular models of NAFLD.

The discovery of paclitaxel (PTX) has been a milestone in anti-cancer therapy and has promoted the development and marketing of various formulations that have revolutionized the therapeutic approach towards several malignancies. Despite its peculiar anti-cancer activity, the physico-chemical properties of PTX compromise the administration of the compound in polar media. Because of this, since the development of the first Food and Drug Administration (FDA)-approved formulation (Taxol®), consistent efforts have been made to obtain suitable delivery systems able to preserve/increase PTX efficacy and to overcome the side effects correlated to the presence of some excipients. The exploitation of natural polymers as potential materials for drug delivery purposes has favored the modulation of the bioavailability and the pharmacokinetic profiles of the drug, and in this regard, several formulations have been developed that allow the controlled release of the active compound. In this mini-review, the recent advances concerning the design and applications of natural polymer-based hydrogels containing PTX-loaded biocompatible nanocarriers are discussed. The technological features of these formulations as well as the therapeutic outcome achieved following their administration will be described, demonstrating their potential role as innovative systems to be used in anti-tumor therapy.

S-adenosylmethionine (SAMe) is an endogenous methyl donor derived from ATP and methionine that has pleiotropic functions. Most SAMe is synthetized and consumed in the liver, where it acts as the main methylating agent and in protection against the free radical toxicity. Previous studies have shown that the administration of SAMe as a supernutrient exerted many beneficial effects in various tissues, mainly in the liver. In the present study, we aimed to clarify the direct effects of SAMe on fatty acid-induced steatosis and oxidative stress in hepatic and endothelial cells. Hepatoma FaO cells and endothelial HECV cells exposed to a mixture of oleate/palmitate are reliable models for hepatic steatosis and endothelium dysfunction, respectively. Our findings indicate that SAMe was able to significantly ameliorate lipid accumulation and oxidative stress in hepatic cells, mainly through promoting mitochondrial fatty acid entry for β-oxidation and external triglyceride release. SAMe also reverted both lipid accumulation and oxidant production (i.e., ROS and NO) in endothelial cells. In conclusion, these outcomes suggest promising beneficial applications of SAMe as a nutraceutical for metabolic disorders occurring in fatty liver and endothelium dysfunction.

The controlled release of a compound entrapped in a biocompatible formulation is a sought-after goal in modern pharmaceutical technology. Zein is a hydrophobic protein which has several advantageous properties that make it suitable for use as a biocompatible and degradable material under physiological conditions. It is, therefore, proposed for different biomedical and pharmaceutical applications. In particular, due to its gelling properties, it can be used to form a polymeric network able to preserve biomolecules from harsh environments. The current study was designed to investigate the influence of different probes on the rheological properties of gels made up of zein, in order to characterize the systems as a function of the polymer concentration. Four model compounds characterized by different physico-chemical properties were entrapped in zein gels, and different behaviors (viscoelastic or pronounced solid-like characteristics) of the systems were observed. Zein-based gels showed various release profiles of the encapsulated compounds, suggesting that there are different interaction rates between the probes and the polymeric matrix.

Cancer cells are known to secrete many bioactive factors acting both with paracrine and autocrine mechanisms by which they condition the surrounding microenvironment. At the same time, the intracytoplasmic metabolic activities microenvironment influences the profile of this secretion. It is well known that cancer cells exhibit prevalent glycolytic metabolism and a more oxidative atmosphere compared to their healthy counterparts; this metabolic phenotype promotes glycate adducts formation and secretion. Considering the exacerbation of metabolic changes during the cancer progression, it is suggestive to explore the potential correlation between the increasing rate of glycan adducts and the specific pattern of secreted cytokines in different phases of cancer disease. We analyzed the secretomes of blood-derived cancer cell cultures from cancer patients and healthy subjects. The relative glycate adducts content in cancer secretomes was higher in comparison to that of healthy samples. Moreover, the stratification based on different phases of cancer disease correlated with a specific cytokines panel. The results obtained open a new perspective of observation of the intricate relationship between metabolome and inflammation in cancer. By using the analysis of secretome combined with a standardized protocol of liquid biopsy, it would be possible to identify specific profiles of molecular markers useful to arrange alternative and personalized medicine strategies.

Our work concerns the actual problem of spread of SARS- CoV-2 outbreak which requires fast and correct as possible answer. In current scenario, the need of rapid answer put away the imperative of proper methodology. We focus on the serogical immunoassay for diagnosis of Covid-19 as an important weapon not only for diagnostic purpose, but also for epidemiologic one. The right equilibrium between high speed, low cost and accuracy is obtained with easy-to-use decentralized point-of-care test as the colloidal gold-based immunochromatographic strip assay which detects IgM and IgG antibodies directed against SARS-CoV-2. As our aim is to evaluate the efficacy of Covid-19 rapid tests and of serological assays in real-life settings, we designed a research protocol aimed to establish how to use correctly these diagnostics, taking into account the different possible clinical and epidemiological scenarios.

The development of sensitive methods for in situ detection of biomarkers is a real challenge to bring medical diagnosis a step forward. The proof-of-concept of a remote multiplexed biomolecular interaction detection through a plasmonic optical fiber bundle is demonstrated here. The strategy relies on a fiber optic biosensor designed from a 300 µm diameter bundle composed of 6000 individual optical fibers. When appropriately etched and metallized, each optical fiber exhibits specific plasmonic properties. The surface plasmon resonance phenomenon occurring at the surface of each fiber enables to measure biomolecular interactions, through the changes of the retro-reflected light intensity due to light/plasmon coupling variations. The functionalization of the microstructured bundle by multiple protein probes was performed using new polymeric 3D-printed microcantilevers. Such soft cantilevers allow for immobilizing the probes in micro spots, without damaging the optical microstructures nor the gold layer. We show here the potential of this device to perform the multiplexed detection of two different antibodies with limits of detection down to a few tenths of nanomoles per liter. This tool, adapted for multiparametric, real-time, and label free monitoring is minimally invasive and could then provide a useful platform for in vivo targeted molecular analysis.