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Abstract Natural compounds are possible alternatives for wound treatment, including Ilex paraguariensis, a plant with several pharmacological actions already reported, including anti-inflammatory, antibacterial, antioxidant, and healing activities. Therefore, this study aimed to perform a technological and scientific mapping of Ilex paraguariensis used for healing and/or analgesic purposes. Technological prospection was carried out in the Questel-Orbit system, while the scientific research was carried out in PubMed, Web of Science, and SCOPUS databases. The terms “Ilex paraguariensis”, “Yerba-mate”, “Painkiller”, “Analgesic”, “Wound”, “Healing”, and “Scar” were combined using Boolean operators “OR” and “AND”. The technological prospection resulted in 164 patents found initially. After sorting the abstracts, five patents were read entirely, of which three were selected. Such selected patents report using Ilex paraguariensis for analgesics, wound healing, personal care, and pharmaceutical applications. In addition, the scientific research showed a small number of studies aimed at using Ilex paraguariensis for healing and/or analgesic purposes. Among the 26 articles initially found, only 5 met the inclusion requirements. Scientific studies demonstrate that Ilex paraguariensis is used as an extract or drink, presenting promising results regarding analgesia, inflammation, and wound healing, using in vitro or in vivo models. Despite the potential of Ilex paraguariensis in skin wound therapy, our study demonstrates that few patents and scientific studies explore Ilex paraguariensis for this purpose. This fact may be an incentive for the development of further studies employing Ilex paraguariensis in cutaneous wound management and the pain associated with them.

ABSTRACT Background Major depressive disorder is a difficult-to-treat psychological disorder. Approximately 30% of patients with major depressive disorder do not respond to conventional therapies; thus, the efficacy of alternative therapies for treating major depressive disorder, such as neurofeedback, a non-invasive neuromodulation method used in the treatment of psychiatric diseases, must be investigated. Objective We aimed to evaluate the efficacy of neurofeedback in minimizing and treating major depressive disorder and its application as a substitute to or an adjuvant with conventional therapies. Methods We searched for experimental studies published between 1962–2021 in Scopus, PubMed, Web of Science, and Embase databases and identified 1,487 studies, among which 13 met the inclusion exclusion criteria. Results We noted that not all patients responded to neurofeedback. Based on depression scales, major depressive disorder significantly improved in response to neurofeedback only in a few individuals. Additionally, the number of training sessions did not influence the results. Conclusion Neurofeedback can reduce depression symptoms in patients; however, not all patients respond to the treatment. Therefore, further studies must be conducted to validate the effectiveness of neurofeedback in treating major depressive disorder.

Abstract Background The preventive role of muscular strength on diminishing neuroinflammation is yet unknown. In this study, the role of the prophylactic muscular strength exercise was investigated in order to verify whether it would diminish cognitive alterations and modify the antioxidant intracellular scenery in an animal neuroinflammatory model in of the CA1 region of the hippocampus. Methods The animals received muscular strength training (SE) three times a week for eight weeks. Subsequently, the stereotaxic surgery was performed with an intra-hippocampal infusion of either saline solution (SAL) or lipopolysaccharide (LPS). Next, we performed the behavioral tests: object recognition and social recognition. Then, the animals were euthanized, and their hippocampus and prefrontal cortex were collected. In another moment, we performed the dosage of the antioxidant activity and histological analysis. Results The results showed that the muscular strength exercises could show a beneficial prophylactic effect in the cognitive deficiencies caused by acute neuroinflammation. Regarding oxidative stress, there was an increase in catalase enzyme activity (CAT) in the group (SE + LPS) compared to the control groups (p

ABSTRACT. Sarcopenic obesity (SO), the co-occurrence of sarcopenia and obesity, is associated with functional loss, frailty, and incapacity in older adults. Recently, SO was associated with reduced cognitive performance in adults. However, no SO studies have been done with older adults with Alzheimer’s disease (AD). Objective: The objective of this study was to verify the occurrence of SO and associated factors in 43 older adults with AD. Methods: We applied the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR). SO was verified by using dual-emission X-ray absorptiometry. Results: We found five women with SO. Women had higher body fat and lower muscle mass compared with men. There was a significant relationship between body fat and cognitive performance only in men (r=0.65; p75 years had better cognitive performance compared with non-obese men aged 75 years (p=0.033). Conclusions: Women with AD had higher body fat and lower muscle mass than men. SO occurs in older women with AD. Men with higher body fat showed better cognitive performance, independent of age and education.

A few epidemiological studies are evaluating the prevalence and mortality rates of Alzheimer's disease, with no one using a nationwide sample of Brazilian elderlies. This study aims to calculate the prevalence of Alzheimer's disease and investigate possible associations with sociodemographic and lifestyle factors and the presence of diseases non-communicable, and the prevalence and mortality for all Brazilian state capitals. This is an ecological design study made with secondary public data provided by the Ministry of Health. Prevalence rates were calculated based on the analysis of the dispensing of Alzheimer's disease-specific drugs. Correlation analyzes were performed between rates and factors, and a multiple linear regression analysis was used to analyze possible associations between variables, controlled for each other. AD prevalence was 313/100,000. Prevalence rates were positively associated with primary health care coverage factors and negatively associated with ultra-processed food consumption and physical activity levels. AD mortality was 98/100,000. Mortality rates were positively associated with the proportion of obese elderly and elderly living on up to half the minimum wage and were inversely associated with the proportion of elderly with diabetes factors. We found positive and negative associations of sociodemographic, behavioral and diabetes indicators with Alzheimer's disease prevalence and mortality, which provide data that can be investigated by studies with different designs.

Abstract Alzheimer’s disease is a neurodegenerative condition that causes changes in memory and cognition, in addition to behavioral disorders, and most commonly affects the elderly. Several studies in the literature have presented therapeutic measures in an attempt to interfere with the pathogenic mechanisms of the disease and to mitigate its clinical manifestations. Some factors, such as excitotoxicity, cholinergic dysfunctions, oxidative stress, tau protein hyperphosphorylation, changes in amyloid-beta peptide metabolism, herpes viruses, apolipoprotein E, glycogen synthase kinase 3, insulin resistance, and the endocannabinoid system seem to be related to pathophysiology of Alzheimer’s disease. Given this, a literature review was carried out to address the molecular mechanisms associated with the pathophysiological hypotheses previously mentioned, aiming to better understanding their underlying causes and contributing to possible pharmacological strategies about treatment of the disease.

Although malnutrition and risk of falls in the elderly have increased in recent years, uncertainties exist as to whether these conditions are associated after controlling for sociodemographic variables, body composition, metabolic condition, and Alzheimer’s disease (AD). This study aimed to analyze the association between nutritional status and risk of fall in the elderly population. Participants were matched by gender and age, after they had been grouped on the basis of diagnosis of AD. The risk of falls, nutritional status, and mental status were assessed using the Downton Fall Risk Score (FRS), Mini Nutritional Assessment (MNA), and Mini Mental State Evaluation (MMSE), respectively. Logistic regression models adjusted for the main confounders were used in the analyses. Among the 68 elderly individuals studied, participants who were malnourished or at risk of malnutrition were more likely to fall (odds ratio = 8.29; 95% confidence interval = 1.49-46.04) than those with normal nutritional status, regardless of gender, age, education, body composition, and metabolic condition. This association did not remain significant after adjustment for AD, a potential confounder in this association. Malnutrition or its risk was independently associated with high risk of fall; thus, malnutrition should be considered in the prevention of falls among the elderly population.

Assess the nutritional and biochemical state of patients with Alzheimer Disease (AD) compared to a control group. This is an observational, case-control and descriptive type study, based on the recruiting of 22 elderly individuals with a clinical diagnosis of AD considered as the case group, and 22 other elderly individuals considered as the control group. Evaluations were made using the results from the following scales Mini Nutritional Assessment (MNA), Mini Mental State Examination (MMSE), anthropometric measurements for obtaining the body mass index (BMI) and biochemical analyses. The analyses were performed on the program SPSS version 20.0, using absolute and relative measures, T test for independent samples for measurement comparisons and the Spearman correlation test. In the cognitive evaluation MMSE, those participants with AD present higher risk of cognitive decline (81.8%), greater risk of malnutrition according to MNA (45.5%) and altered levels of leptin (90.9%). Upon performing the comparison analysis between the group with AD and the control group, there existed noteworthy differences between the means for the variables MNA (4.40; BMI95% 2.75 – 6.06), MMSE (10.54; BMI95% 7.09 – 13.99) and doses of HDL (High Density Lipoproteins) (14.53; BMI95% 6.18 – 22.88). As well as differences in the p-value < 0.09 in the leptin doses (11.54; BMI95% (-24.98 – 1.89) and transferrin dose (-72.31; BMI95% -159.48 – 14.84). The Spearman correlation demonstrated that the cognitive decline in the group of senior citizens with AD was strongly associated with nutritional conditions MNA (R 0.484) and the leptin dose (R 0.590). Senior citizens with AD present worse nutritional conditions, cognitive decline and biochemical alterations when compared to senior citizens in the control group. As such, the study demonstrated the need for an integrated healthcare assistance concerning senior citizens with AD.

PURPOSE: Physiological variables must be scaled for body size differences to permit meaningful comparisons between groups. Using allometric scaling, this study compared the anaerobic performance, using both arms and legs, of men and women. Ten active male and 10 active female subjects performed the leg cycling and arm cranking in a 30-s all-out Wingate test (WAnT). Regional measurements of the legs, gluteal area, arms, and torso taken using dual-energy x-ray absorptiometry (DXA) served as indicators of lower body active musculature (LBAMM) and upper body (UBAMM) active musculature. RESULTS: Body mass (BM) was the best predictor (i.e., r = 0.93-0.96) for peak power (PP) and mean power (MP) generated from sprint cycling and arm cranking. Sex differences for leg and arm power (i.e., PP and MP) were identified in absolute terms and then expressed in ratio to BM(1.0). When the same data were allometrically scaled to BM and expressed as power function ratios (Power;BM(b)), the sex differences in PP and MP for sprint cycling were nullified (female:male ratio x 100: 100-103%), but remained for arm cranking (female:male power ratio x 100: 69-84%). CONCLUSIONS: These results confirmed that anaerobic power of the upper body and lower body were best normalized to BM and, when statistically appropriate methods were used to take into account differences in BM, PP, and MP generated from sprint cycling were similar for both men and women. In contrast, after allometric scaling for BM, men remained more powerful than women for the supramaximal arm cranking task. Qualitative differences in the upper body musculature between men and women are speculated to account for the more powerful performance of men, but confirmatory evidence using noninvasive techniques is warranted. [ABSTRACT FROM AUTHOR]

PURPOSE: This study examined cycling economy before and after 8 wk of maximal leg-strength training. METHODS: Seven previously untrained males (25 +/- 2 yr) performed leg-strength training 3 d x wk(-1) for 8 wk using four sets of five repetitions at 85% of one repetition maximum (1RM). Body mass, lean-leg muscle mass (LLM), percentage of body fat, and leg strength (1RM) were measured at 0, 4, and 8 wk of training. Cycling economy was calculated as the deltaVO2/deltaWR (change in the O2 cost of exercise divided by the change in the power between two different power outputs). RESULTS: There were significant increases in LLM and 1RM from 0 to 4 wk of training (LLM: 25.8 +/- 0.7 to 27.2 +/- 0.8 kg; 1RM: 138 +/- 9 to 215 +/- 9 kg). From 4 to 8 wk of training, 1RM continued to increase significantly (215 +/- 9 to 266 +/- 8 kg) with no further change observed in LLM. Peak power during incremental cycling increased significantly (305 +/- 14 to 315 +/- 16 W), whereas the power output achieved at the gas-exchange threshold (GET) remained unchanged. Peak O2 uptake and the O2 uptake achieved at the GET also remained unchanged following training. Cycling economy improved significantly when the power output was increased from below the GET to above the GET but not for power outputs below the GET. CONCLUSION: Maximal leg-strength training improves cycling economy in previously untrained subjects. Increases in leg strength during the final 4 wk of training with unchanged LLM suggest that neural adaptations were present. [ABSTRACT FROM AUTHOR]

Alzheimer’s disease (AD) is characterized by disorders that can impair the nutrition of the patient and lead to weight loss and nutritional deficits during the course of the disease. The aim of this study was to assess the nutritional status and food intake of Brazilian patients with Alzheimer’s disease at 3 different stages of the disease. The sample consisted of 30 subjects of both genders, mean age 77 years, with probable AD. Subjects were assessed by collecting anthropometric data, the Mini Nutritional Assessment (MNA), serum albumin content, Mini Mental State Examination and 24-hour records of food and drink. Although a steady decrease in average weight was observed as the disease progressed (CDR1: 70.8±15.9 kg; CDR2: 61.4±15.7 kg; CDR3: 56.1± 8.4 kg), the differences were not significant. MNA and serum albumin both fell during the progression of the disease (p = 0.042; p = 0.047, respectively) and, at the severe stage, half the patients were found to be undernourished and the other half at risk of undernutrition. According to their body mass index, 23.3% of patients were overweight. The nutritional value of the food consumed was similar across the stages of AD. In conclusion, the majority of Brazilian patients with AD in this study exhibited cognitive decline and malnutrition. However, food intake was similar among the stages of the disease, thus having no direct association with the progression of AD.

Encoding for several memory types requires neural changes and the activity of distinct regions across the brain. These areas receive broad projections originating in nuclei located in the brainstem which are capable of modulating the activity of a particular area. The histaminergic system is one of the major modulatory systems, and it regulates basic homeostatic and higher functions including arousal, circadian, and feeding rhythms, and cognition. There is now evidence that histamine can modulate learning in different types of behavioral tasks, but the exact course of modulation and its mechanisms are controversial. In the present paper we review the involvement of the histaminergic system and the effects histaminergic receptor agonists/antagonists have on the performance of tasks associated with the main memory types as well as evidence provided by studies with knockout models. Thus, we aim to summarize the possible effects histamine has on modulation of circuits involved in memory formation.

Introduction: Alterations in the cholinergic metabolism may cause various clinical symptoms of schizophrenia. In addition to the 'monoamine hypothesis,' neuroinflammation is also discussed as a cause of schizophrenia. To date, there has been no evidence of alterations in the central cholinergic transmitter balance in patients with schizophrenia under clinical conditions. By contrast, studies in critically ill patients have established the measurement of acetylcholinesterase activity as a suitable surrogate parameter of central cholinergic transmitter balance/possible pathophysiological changes. Butyrylcholinesterase activity has been established as a parameter indicating possible (neuro)inflammatory processes. Both parameters can now be measured using a point-of-care approach. Therefore, the primary objective of this study is to investigate whether acetylcholinesterase and butyrylcholinesterase activity differs in patients with various forms of schizophrenia. Secondary objectives address the possible association between acetylcholinesterase and butyrylcholinesterase activity and (1) schizophrenic symptoms using the Positive and Negative Syndrome Scale, (2) the quantity of antipsychotics taken and (3) the duration of illness., Methods and Analysis: The study is designed as a prospective, observational cohort study with one independent control group. It is being carried out at the Department of Psychiatry and Psychotherapy III, Ulm University Hospital, Germany. Patient enrolment started in October 2020, and the anticipated end of the study is in January 2022. The enrolment period was set from October 2020 to December 2021 (extension required due to SARS-CoV-2 pandemic). The sample size is calculated at 50 patients in each group. Esterase activity is measured on hospital admission (acute symptomatology) and after referral to a postacute ward over a period of three consecutive days. The matched control group will be created after reaching 50 patients with schizophrenia. This will be followed by a comprehensive statistical analysis of the data set., Ethics and Dissemination: The study was registered prospectively in the German Clinical Trials Register (DRKS-ID: DRKS00023143,URL: https://www.drks.de/drks&#95;web/navigate.do?navigationId=trial.HTML&TRIAL&#95;ID=DRKS00023143) after approval by the ethics committee of the University of Ulm, Germany Trial Code No. 280/20., Trial Registration Number: DRKS00023143; Pre-results., Competing Interests: Competing interests: BS and EB have received lecture fees from Köhler Chemie in the past., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Bioelectrical impedance analysis (BIA) is a technology that provides a rapid, non-invasive measurement of volume in body compartments and may aid the physician in the assessment of volume status. We sought to investigate the effect of BIA-measured volume status on duration of mechanical ventilation, 28-day mortality, and acute kidney injury requiring renal replacement therapy in a population of medical/surgical patients admitted to the intensive care unit (ICU)., Methods: Prospective observational study of adult patients who required mechanical ventilation within 24 hr of admission to ICU. Bioelectrical impedance analysis measured extracellular water (ECW) and total body water (TBW) and these measurements were recorded on days 1, 3, 5, and 7., Results: A total of 36 patients were enrolled. Mean (standard deviation) age was 61.8 (21.3) years and 31% of patients were female. The majority were admitted from the emergency department or operating room. The most common diagnosis was sepsis. At 28 days, eight patients (22%) had died. There was no association between ECW/TBW ratio at day 1 and 28-day mortality (odds ratio, 1.2; 95% confidence interval [CI], 0.6 to 2.3) after adjusting for age, sex, and Acute Physiology and Chronic Health Evaluation II score. The median [interquartile range] number of ventilator days was 5 [2.5-7.5]. On day 1, for each 1% increase in the ECW/TBW ratio, there was a 1.2-fold increase in ventilator days (95% CI, 1.003 to 1.4; P = 0.05). It is notable that 20% of eligible patients could not be enrolled because medical equipment interfered with correct electrode placement., Conclusion: Bioimpedance-measured ECW/TBW on day 1 of admission to the ICU is associated with time on the ventilator. While this technology may be a useful adjunct to the clinical assessment of volume status, there are technical barriers to its routine use in a general ICU population.

Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht.

The purpose of this study is to communicate findings from a case study on a South African mother with three children diagnosed with full mutation fragile X syndrome (FXS). The participant is an unaffected carrier of FXS. Research has shown that mothers of children with FXS often experience high levels of parenting stress and low levels of psychological well-being. However, observations made have piqued curiosity about their positivity and determination to carry on each day raising children diagnosed with FXS. The aim is to develop a better understanding of the manner in which a mother of children with FXS make sense of her situation, to gain further insight into the specific resilience processes she acquired. A qualitative case study approach was followed, gathering data through semi-structured interviews based on open-ended questions. The findings offer new insights into a South African mother's life raising children with FXS. Even though there is very limited support and little awareness of FXS in South Africa, she still found ways to seek help, and find solutions to every day challenges. The study conclusions discourage blind stereotyping of mothers of children with FXS as vulnerable only. Future research should concentrate on promoting awareness, education, advocacy, and support for individuals with FXS in South Africa.

The recent increase in the production of natural gas from shale deposits has significantly changed energy outlooks in both the US and world. Shale gas may have important climate benefits if it displaces more carbon-intensive oil or coal, but recent attention has discussed the potential for upstream methane emissions to counteract this reduced combustion greenhouse gas emissions. We examine six recent studies to produce a Monte Carlo uncertainty analysis of the carbon footprint of both shale and conventional natural gas production. The results show that the most likely upstream carbon footprints of these types of natural gas production are largely similar, with overlapping 95% uncertainty ranges of 11.0-21.0 g CO(2)e/MJ(LHV) for shale gas and 12.4-19.5 g CO(2)e/MJ(LHV) for conventional gas. However, because this upstream footprint represents less than 25% of the total carbon footprint of gas, the efficiency of producing heat, electricity, transportation services, or other function is of equal or greater importance when identifying emission reduction opportunities. Better data are needed to reduce the uncertainty in natural gas's carbon footprint, but understanding system-level climate impacts of shale gas, through shifts in national and global energy markets, may be more important and requires more detailed energy and economic systems assessments.

China's annual CO(2) emissions grew by around 4 billion tonnes between 1992 and 2007. More than 70% of this increase occurred between 2002 and 2007. While growing export demand contributed more than 50% to the CO(2) emission growth between 2002 and 2005, capital investments have been responsible for 61% of emission growth in China between 2005 and 2007. We use structural decomposition analysis to identify the drivers for China's emission growth between 1992 and 2007, with special focus on the period 2002 to 2007 when growth was most rapid. In contrast to previous analysis, we find that efficiency improvements have largely offset additional CO(2) emissions from increased final consumption between 2002 and 2007. The strong increases in emissions growth between 2002 and 2007 are instead explained by structural change in China's economy, which has newly emerged as the third major emission driver. This structural change is mainly the result of capital investments, in particular, the growing prominence of construction services and their carbon intensive supply chain. By closing the model for capital investment, we can now show that the majority of emissions embodied in capital investment are utilized for domestic household and government consumption (35-49% and 19-36%, respectively) with smaller amounts for the production of exports (21-31%). Urbanization and the associated changes in lifestyle are shown to be more important than other socio-demographic drivers like the decreasing household size or growing population. We argue that mitigation efforts will depend on the future development of these key drivers, particularly capital investments which dictate future mitigation costs.

Background: We describe urinary neutrophil gelatinase-associated lipocalin (uNGAL) values in association with clinical characteristics and urinary parameters in adults undergoing coronary angiography., Methods: This is an observational study of consecutive patients who underwent elective coronary angiography during a 4-month period in a large urban tertiary care hospital., Results: One hundred and thirteen patients were enrolled, and 100 had sufficient data to be included in the analyses. A large range of preprocedural uNGAL levels were observed (range 1-269 ng/mg Cr). Median preprocedural uNGAL was 8 ng/mg Cr. Age (P = 0.009), serum creatinine (P = 0.077) and albumin excretion (P = 0.009) were significant predictors of baseline uNGAL. Half the cohort demonstrated an increase and half a decrease in the absolute values of uNGAL after angiography, irrespective of preprocedural levels., Conclusions: We observed variable, but relatively low absolute levels of uNGAL prior to angiography in this 'cardiac' cohort. Only age, serum creatinine and albumin excretion could explain some of this variability. When designing studies of at-risk individuals where uNGAL may be used as a marker for acute kidney injury, this variability should be taken into account.

As populations and demands for land-intensive products, e.g., cattle and biofuels, increase the need to understand the relationship between land use and consumption grows. This paper develops a production-based inventory of land use (i.e., the land used to produce goods) in the U.S. With this inventory an input-output analysis is used to create a consumption-based inventory of land use. This allows for exploration of links between land used in production to the consumption of particular goods. For example, it is possible to estimate the amount of cropland embodied in processed foods or healthcare services. As would be expected, agricultural and forestry industries are the largest users of land in the production-based inventory. Similarly, we find that processed foods and forest products are the largest users of land in the consumption-based inventory. Somewhat less expectedly this work finds that the majority of manufacturing and service industries, not typically associated with land use, require substantial amounts of land to produce output due to the purchase of food and other agricultural and wood-based products in the supply chain. The quantitative land use results of this analysis could be integrated with qualitative metrics such as weighting schemes designed to reflect environmental impact or life cycle impact assessment methods.

Despite the emergence of regional climate policies, growth in global CO(2) emissions has remained strong. From 1990 to 2008 CO(2) emissions in developed countries (defined as countries with emission-reduction commitments in the Kyoto Protocol, Annex B) have stabilized, but emissions in developing countries (non-Annex B) have doubled. Some studies suggest that the stabilization of emissions in developed countries was partially because of growing imports from developing countries. To quantify the growth in emission transfers via international trade, we developed a trade-linked global database for CO(2) emissions covering 113 countries and 57 economic sectors from 1990 to 2008. We find that the emissions from the production of traded goods and services have increased from 4.3 Gt CO(2) in 1990 (20% of global emissions) to 7.8 Gt CO(2) in 2008 (26%). Most developed countries have increased their consumption-based emissions faster than their territorial emissions, and non-energy-intensive manufacturing had a key role in the emission transfers. The net emission transfers via international trade from developing to developed countries increased from 0.4 Gt CO(2) in 1990 to 1.6 Gt CO(2) in 2008, which exceeds the Kyoto Protocol emission reductions. Our results indicate that international trade is a significant factor in explaining the change in emissions in many countries, from both a production and consumption perspective. We suggest that countries monitor emission transfers via international trade, in addition to territorial emissions, to ensure progress toward stabilization of global greenhouse gas emissions.

Carbon Border Tax Adjustments (BTAs) are a politically popular strategy for avoiding competitive disadvantage problems when a country implements a unilateral climate change policy. A BTA taxes carbon embodied in imported goods in order to protect domestic industry and motivate other countries to implement climate change policy. To estimate the effectiveness of a BTA, is it is necessary to know which products are covered, where they were originally produced and ultimately exported from, and how the covered amount compares to total production in foreign countries. Using a scrap-adjusted, mixed-unit input-output model in conjunction with a multiregional input-output model, this analysis evaluates the effectiveness of BTAs for the case study of U.S. steel imports. Most imported steel by mass is embedded in finished products (60%), and 30% of that steel is produced in a different country than the one from which the final good is exported. Given the magnitudes involved and complexities of global supply chains, a BTA that protects domestic industry will be a challenge to implement. We propose a logistically feasible BTA structure that minimizes the information burden while still accounting for these complexities. However, the amount of steel imported to the U.S. is negligible (5%) compared to foreign production in BTA-eligible countries and is unlikely to motivate affected countries to impose an emissions reduction policy.

The generation and distribution of electricity comprises nearly 40% of U.S. CO(2), emissions, as well as large shares of SO(2), NO(x), small particulates, and other toxins. Thus, correctly accounting for these electricity-related environmental releases is of great importance in life cycle assessment of products and processes. Unfortunately, there is no agreed-upon protocol for accounting for the environmental emissions associated with electricity, as well as significant uncertainty in the estimates. Here, we explore the limits of current knowledge about grid electricity in LCA and carbon footprinting for the U.S. electrical grid, and show that differences in standards, protocols, and reporting organizations can lead to important differences in estimates of CO(2) SO(2), and NO(x) emissions factors. We find a considerable divergence in published values for grid emissions factor in the U.S. We discuss the implications of this divergence and list recommendations for a standardized approach to accounting for air pollution emissions in life cycle assessment and policy analyses in a world with incomplete and uncertain information.

Many organizations look to carbon footprint protocols for guidance on measuring their greenhouse gas emissions, or carbon footprint. Existing protocols generally require estimation of direct emissions (Scope 1) and emissions from direct purchases of energy (Scope 2), but focus less on indirect emissions upstream and downstream of the supply chain (optional Scope 3). Because on average more than 75% of an industry sector's carbon footprint is attributed to Scope 3 sources, better knowledge of Scope 3 footprints can help organizations pursue emissions mitigation projects not just within their own plants but also across their supply chain. In this work, Scope 3 footprints of U.S. economic sectors are categorized using an Economic Input-Output Life Cycle Assessment (EIO-LCA) model to identify upstream emission sources that are likely to contribute significantly to different sectors' footprints. The portions of the upstream footprint captured by the sector's top-10 upstream suppliers are estimated at 3 different levels of specificity: general economy-wide, industry specific, and sector specific. The results show that enterprises can capture a large portion of their total upstream carbon footprint by collecting full emissions information from only a handful of direct suppliers, and Scope 3 footprint capture rates can be improved considerably by sector-specific categorization. Employee commuting and air transportation may be more important (7%-30%) for the services industries, but should not be a focus of detailed Scope 3 footprint estimates for the manufacturing industries (<1% of the total analyzed footprint). Protocol organizations should actively make more specific Scope 3 guidelines available for their constituents by developing sector-specific categorizations for as many sectors as they feasibly can and create broader industry-specific protocols for others.

A 2-year single institution experience of the successes and complications of arteriovenous fistula (AVF) creation before dialysis initiation is reported. Study cohort: all patients who underwent AVF creation before need for dialysis (AVF group, n = 125). "Control" group: all patients with a sustained glomerular filtration rate (GFR) 12 months in both groups and mean eGFR at creation (AVF group) was 12 ml/min. In the AVF group, 72% underwent a successful first AVF creation, 11% suffered AVF thrombosis, and 17% had a nonmaturing AVF before need for dialysis. Sixty-six percent (n = 23) of these latter patients underwent a second AVF creation and 48% were mature at dialysis initiation. During the study period, 70% (n = 88, AVF group) and 61% (n = 121, no AVF group) commenced dialysis. Impressively, 72% (n = 66) of the AVF group used a mature fistula as their first dialysis access. A snapshot of "access in use" at the 6-month mark of dialysis revealed the AVF group had a higher number of patients using an AVF (81% vs. 44%) and a lower number with catheters (19% vs. 56%, respectively, p = 0.001). In conclusion, the success rate of early AVF creation is reasonable and complications when identified can be remedied without the need for a catheter, thus ultimately maximizing the use of AVF in dialysis patients.

This case report describes a patient with reportedly new onset of tics, beginning at 21 years of age, in the context of posttraumatic stress disorder (PTSD) and comorbid alcohol abuse, with no known head injury. The setting is an American Society of Addiction Medicine intensive outpatient substance abuse rehabilitation program in an United States Army Medical Center. The patient is a 22-year-old male diagnosed with alcohol abuse and delayed PTSD who presented to the program's medical officer due to insomnia. We discovered he had a reportedly new ocular tic of appoximately 9 months duration, which he claimed developed at 21 years of age soon after returning from 1 year of combat duty. The patient was thoroughly evaluated, and we surmised the tic was a symptom of PTSD. After achieving full remission from alcohol, the tic persisted. However, as his PTSD symptoms remitted, so did his tic symptoms. At 6-month follow-up, the patient reported he was essentially free from PTSD symptoms, and his tic was significantly reduced.

Background: The significance of focal segmental glomerulosclerosis (FSGS) in mild IgA nephropathy is uncertain., Methods: All consecutive renal biopsies performed between 1996 and 2005 in adults with a diagnosis of mild IgA nephropathy (Lee Grade 1 or 2) at St Paul's Hospital, Vancouver, Canada, were reviewed., Results: Seventy-five patients were included, 26 (35%) with IgA nephropathy and FSGS (FSGS+ group) and 49 (65%) with IgA nephropathy without FSGS (FSGS- group). The mean follow-up was 3 years. At the time of renal biopsy the FSGS+ group had a lower eGFR (60 versus 73 mL/min, P = 0.02), lower serum albumin (38 versus 41 g/L, P = 0.02), higher mean arterial pressure (103 versus 97 mmHg, P = 0.03) and greater protein excretion (3.0 versus 1.3 g/day, P < 0.01) than the FSGS- group. On histology, the FSGS+ group had a higher percentage of obsolete glomeruli (23.4% versus 12.7%, P < 0.01), and 31% of FSGS+ biopsies had >or=25% tubular atrophy/interstitial fibrosis while this was not observed in the FSGS- group (P < 0.01). The primary outcome measure, DeltaGFR, was -2.56 mL/ min/year in the FSGS+ group and +1.14 mL/min/year in the FSGS- group, difference: 3.70 mL/min/year (P = 0.03) (univariate). In the multivariate model, the FSGS+ group declined at 0.19 mL/min/year (-14.16, 13.78) and the FSGS- group improved at 2.85 mL/min/year (-11.64, 17.34), difference 3.04 mL/min/year, P = 0.18., Conclusions: Our study suggests that the focal segmental glomerulosclerosis lesion and associated clinical and pathologic findings in patients with mild IgA nephropathy are associated with a worse renal outcome.

Because of increasing concern about global climate change and carbon emissions as a causal factor, many companies and organizations are pursuing "carbon footprint" projects to estimate their own contributions to global climate change. Protocol definitions from carbon registries help organizations analyze their footprints. The scope of these protocols varies but generally suggests estimating only direct emissions and emissions from purchased energy, with less focus on supply chain emissions. In contrast approaches based on comprehensive environmental life-cycle assessment methods are available to track total emissions across the entire supply chain, and experience suggests that following narrowly defined estimation protocols will generally lead to large underestimates of carbon emissions for providing products and services. Direct emissions from an industry are, on average, only 14% of the total supply chain carbon emissions (often called Tier 1 emissions), and direct emissions plus industry energy inputs are, on average, only 26% of the total supply chain emissions (often called Tier 1 and 2 emissions). Without a full knowledge of their footprints, firms will be unable to pursue the most cost-effective carbon mitigation strategies. We suggest that firms use the screening-level analysis described here to set the bounds of their footprinting strategy to ensure that they do not ignore large sources of environmental effects across their supply chains. Such information can help firms pursue carbon and environmental emission mitigation projects not only within their own plants but also across their supply chain.

Despite significant recent public concern and media attention to the environmental impacts of food, few studies in the United States have systematically compared the life-cycle greenhouse gas (GHG) emissions associated with food production against long-distance distribution, aka "food-miles." We find that although food is transported long distances in general (1640 km delivery and 6760 km life-cycle supply chain on average) the GHG emissions associated with food are dominated by the production phase, contributing 83% of the average U.S. household's 8.1 t CO2e/yr footprint for food consumption. Transportation as a whole represents only 11% of life-cycle GHG emissions, and final delivery from producer to retail contributes only 4%. Different food groups exhibit a large range in GHG-intensity; on average, red meat is around 150% more GHG-intensive than chicken or fish. Thus, we suggest that dietary shift can be a more effective means of lowering an average household's food-related climate footprint than "buying local." Shifting less than one day per week's worth of calories from red meat and dairy products to chicken, fish, eggs, or a vegetable-based diet achieves more GHG reduction than buying all locally sourced food.

China's rapidly growing economy and energy consumption are creating serious environmental problems on both local and global scales. Understanding the key drivers behind China's growing energy consumption and the associated CO2 emissions is critical for the development of global climate policies and provides insight into how other emerging economies may develop a low emissions future. Using recently released Chinese economic input-output data and structural decomposition analysis we analyze how changes in China's technology, economic structure, urbanization, and lifestyles affect CO2 emissions. We find that infrastructure construction and urban household consumption, both in turn driven by urbanization and lifestyle changes, have outpaced efficiency improvements in the growth of CO2 emissions. Net trade had a small effect on total emissions due to equal, but significant, growth in emissions from the production of exports and emissions avoided by imports. Technology and efficiency improvements have only partially offset consumption growth, but there remains considerable untapped potential to reduce emissions by improving both production and consumption systems. As China continues to rapidly develop there is an opportunity to further implement and extend policies, such as the Circular Economy, that will help China avoid the high emissions path taken by today's developed countries.

Significant recent attention has been given to quantifying the environmental impacts of international trade. However, the United States, despite being the world's largest emitter of greenhouse gases and having large recent growth in international trade, has seen little analysis. This work uses a multi-country input-output model of the U.S. and its seven largest trading partners (Canada, China, Mexico, Japan, Germany, the UK, and Korea) to analyze the environmental effects of changes to U.S. trade structure and volume from 1997 to 2004. It is shown that increased import volume and shifting trade patterns during this time period led to a large increase in the U.S.' embodied emissions in trade (EET) for CO2, SO2, and NO(x). Methodological uncertainties, especially related to uncertainties of international currency conversion, lead to large differences in estimation of the total EET, but we estimate that the overall embodied CO2 in U.S. imports has grown from between 0.5 and 0.8 Gt of CO2 in 1997 to between 0.8 and 1.8 Gt of CO2 in 2004, representing between 9-14% and 13-30% of U.S. (2-4% to 3-7% of global) CO2 emissions in 1997 and 2004, respectively.

Aboriginal populations experience a very high rate of end-stage renal disease (ESRD); however, little is known about the outcomes of transplantation in this population. We performed a retrospective database review to determine the short- and long-term outcomes of kidney transplantation in Aboriginals. Adult Aboriginal (AB) and Caucasian (C) individuals receiving primary kidney transplants between 1969 and 2003 in Manitoba, Canada were examined. A total of 705 recipients were included (126 AB and 579 C). AB recipients were younger, had different etiologies of ESRD, longer cold-ischemic times for deceased donor transplants, and higher peak panel reactive antibody levels. At 1 year post-transplant, there was no difference in serum creatinine, acute rejection or graft survival between AB and C recipients. However, AB recipients experienced greater weight gains early post-transplant and were more likely to develop post-transplant diabetes mellitus. AB recipients exhibited inferior 10-year graft (AB 26% vs. C 47%, p < 0.01) and patient survival (AB 50% vs. 75%, p < 0.01). When graft survival was censored for death with a functioning graft, there was no difference between the two groups. Multivariate analysis revealed AB race to be an independent predictor of premature graft failure and patient death. In conclusion, kidney transplant outcomes have historically been inferior in the Manitoba population of Canadian Aboriginals.

Chemical speciation modeling is a vital tool for assessing the bioavailability of inorganic species, yet significant uncertainties in thermodynamic parameters and model form limit its potential for decision-making. In this paper we present a novel method for the quantification of thermodynamic parameter uncertainty and ionic strength correction model uncertainty using Bayesian Markov Chain Monte Carlo (MCMC) estimation methods. These methods allow for the inclusion of correlation modeling, which has not been present in previous work. The MCMC simulations are used to model a natural river water to determine the uncertainty in the calculated environmental speciation of ethylenediamenetetraacetate, a chelating agent that has attracted considerable environmental interest. The results indicate that incorporating correlation among related thermodynamic parameters into the uncertainty model is necessary to correctly quantify the overall system uncertainty. This result indicates the superiority of MCMC estimation methods overtraditional Monte Carlo methods when available data are used to estimate parameter uncertainty in systems with closely related model parameters.

Hydrophobic bile acids such as deoxycholate (DOC) are known to damage liver cells during cholestasis and promote colon cancer. Cellular stresses induced by bile acids, which include mitochondrial and endoplasmic reticulum (ER) stresses, can result in apoptosis. We found that inhibition of mitochondrial complexes I-V with rotenone, thenoyltrifluoroacetone (TTFA), antimycin A, myxothiazol or oligomycin strongly protected against DOC-induced apoptosis of HCT-116 cells. To understand the mechanism of this protection, we explored the ability of these specific inhibitors to reduce DOC-induced mitochondrial and ER stresses. Different inhibitors markedly reduced DOC-induction of mitochondrial condensation, the DOC-induced decrease in mitochondrial membrane potential and the DOC-induced dilatation of the ER (evidence of ER stress). A dramatic induction of nucleolar segregation by antimycin A and myxothiazol, two distinct complex III inhibitors, was also observed. These findings strongly implicate mitochondrial crosstalk with apoptotic signaling pathways and mitochondrial-nucleolar crosstalk in the development of apoptosis resistance in the colon.

The aim of this study was to determine whether the net efficiency of mammalian muscles depends on muscle fibre type. Experiments were performed in vitro (35 degrees C) using bundles of muscle fibres from the slow-twitch soleus and fast-twitch extensor digitorum longus (EDL) muscles of the mouse. The contraction protocol consisted of 10 brief contractions, with a cyclic length change in each contraction cycle. Work output and heat production were measured and enthalpy output (work + heat) was used as the index of energy expenditure. Initial efficiency was defined as the ratio of work output to enthalpy output during the first 1 s of activity. Net efficiency was defined as the ratio of the total work produced in all the contractions to the total, suprabasal enthalpy produced in response to the contraction series, i.e. net efficiency incorporates both initial and recovery metabolism. Initial efficiency was greater in soleus (30 +/- 1%; n=6) than EDL (23 +/- 1%; n=6) but there was no difference in net efficiency between the two muscles (12.6 +/- 0.7% for soleus and 11.7 +/- 0.5% for EDL). Therefore, more recovery heat was produced per unit of initial energy expenditure in soleus than EDL. The calculated efficiency of oxidative phosphorylation was lower in soleus than EDL. The difference in recovery metabolism between soleus and EDL is unlikely to be due to effects of changes in intracellular pH on the enthalpy change associated with PCr hydrolysis. It is suggested that the functionally important specialization of slow-twitch muscle is its low rate of energy use rather than high efficiency.

The development of apoptosis resistance appears to be an important factor in colon carcinogenesis. To gain an understanding of the molecular pathways altered during the development of apoptosis resistance, we selected three cell lines for resistance to induction of apoptosis by deoxycholate, an important etiologic agent in colon cancer. We then evaluated gene expression levels for 825 proteins in these resistant lines, compared with a parallel control line not subject to selection. Eighty-two proteins were identified as either over-expressed or under-expressed in at least two of the resistant lines, compared with the control. Thirty-five of the 82 proteins (43%) proved to have a known role in apoptosis. Of these 35 proteins, 21 were over-expressed and 14 were under-expressed. Of those that were over-expressed 18 of 21 (86%) are anti-apoptotic in some circumstances, of those that were under-expressed 11 of 14 (79%) are pro-apoptotic in some circumstances. This finding suggests that apoptosis resistance during selection among cultured cells, and possibly in the colon during progression to cancer, may arise by constitutive over-expression of multiple anti-apoptotic proteins and under-expression of multiple pro-apoptotic proteins. The major functional groups in which altered expression levels were found are post-translational modification (19 proteins), cell structure (cytoskeleton, microtubule, actin, etc.) (17 proteins), regulatory processes (11 proteins) and DNA repair and cell cycle checkpoint mechanisms (10 proteins). Our findings, overall, bear on mechanisms by which apoptosis resistance arises during progression to colon cancer and suggest potential targets for cancer treatment. In addition, assays of normal-appearing mucosa of colon cancer patients, for over- or under-expression of genes found to be altered in our resistant cell lines, may allow identification of early biomarkers of colon cancer risk.