Beginning in 2018, a quality improvement collaborative initiative in Brazil successfully reduced the baseline incidence density of healthcare-associated infections in intensive care settings after 2 years. We describe the adaptations of the quality improvement interventions as the COVID-19 pandemic emerged and how the pandemic affected the project outcomes.

The problem of traffic congestion incurs numerous social and economical repercussions and has thus become a central issue in every major city in the world. For this work we look at the transportation domain from a multiagent system perspective, where every driver can be seen as an autonomous decision-making agent. We explore how learning approaches can help achieve an efficient outcome, even when agents interact in a competitive environment for sharing common resources. To this end, we consider the route choice problem, where self-interested drivers need to independently learn which routes minimise their expected travel costs. Such a selfish behaviour results in the so-called user equilibrium, which is inefficient from the system’s perspective. In order to mitigate the impact of selfishness, we present Toll-based Q-learning (TQ-learning, for short). TQ-learning employs the idea of marginal-cost tolling (MCT), where each driver is charged according to the cost it imposes on others. The use of MCT leads agents to behave in a socially desirable way such that the is attainable. In contrast to previous works, however, our tolling scheme is distributed (i.e., each agent can compute its own toll), is charged a posteriori (i.e., at the end of each trip), and is fairer (i.e., agents pay exactly their marginal costs). Additionally, we provide a general formulation of the toll values for univariate, homogeneous polynomial cost functions. We present a theoretical analysis of TQ-learning, proving that it converges to a system-efficient equilibrium (i.e., an equilibrium aligned to the system optimum) in the limit. Furthermore, we perform an extensive empirical evaluation on realistic road networks to support our theoretical findings, showing that TQ-learning indeed converges to the optimum, which translates into a reduction of the congestion levels by 9.1%, on average.

There is no agreement regarding which solvent is more suitable to obtain sol–gel–derived titania (TiO2) samples with an enhanced photocatalytic behavior. Furthermore, the solvent effect on the preparation of TiO2-RGO (reduced graphene oxide) nanocomposites has not been published yet and could be an attractive experimental strategy to modulate structure and properties. On the basis of these observations, TiO2-RGO nanocomposites were fabricated in this study. It was evaluated for the influence of using either isopropyl (IsoprOH) or ethyl (EtOH) alcohol on the textural and photocatalytic properties of the prepared materials. The use of IsoprOH led to samples with smaller crystallite size, narrower apparent band gap, smaller isoelectric point, larger adsorption capacity, and higher photocatalytic activity. In addition, the incorporation of RGO into TiO2 greatly improved the adsorption capacity and photocatalytic activity of the latter. However, the optimal loading of RGO to prepare composites with enhanced photocatalytic activities was 1 wt%. This finding can be related to the stacking of RGO sheets when concentrations above 1 wt% are used, which could prevent UV light to reach the TiO2 particles and also decrease the photocatalytic capacity of the composites. Moreover, materials with RGO concentration above 1 wt% could exhibit a highly negatively charged surface, which may decrease the separation of the generated electron–hole pairs and lead to faster recombination rates of charge carriers.

In the current study, phage-exposed mimotopes as targets against tegumentary leishmaniasis (TL) were selected by means of bio-panning cycles employing sera of TL patients and healthy subjects, besides the immune stimulation of peripheral blood mononuclear cells (PBMCs) collected from untreated and treated TL patients and healthy subjects. The clones were evaluated regarding their specific interferon-γ (IFN-γ) and interleukin-4 (IL-4) production in the in vitro cultures, and selectivity and specificity values were calculated, and those presenting the best results were selected for the in vivo experiments. Two clones, namely A4 and A8, were identified and used in immunization protocols from BALB/c mice to protect against Leishmania amazonensis infection. Results showed a polarized Th1 response generated after vaccination, being based on significantly higher levels of IFN-γ, IL-2, IL-12, tumour necrosis factor-α (TNF-α) and granulocyte-macrophage colony-stimulating factor (GM-CSF); which were associated with lower production of specific IL-4, IL-10 and immunoglobulin G1 (IgG1) antibodies. Vaccinated mice presented significant reductions in the parasite load in the infected tissue and distinct organs, when compared with controls. In conclusion, we presented a strategy to identify new mimotopes able to induce Th1 response in PBMCs from TL patients and healthy subjects, and that were successfully used to protect against L. amazonensis infection.

The cryopreservation of epididymal sperm is an important technique that allows genetic material to be preserved, even post mortem. However, cryopreservation leads to increased oxidative stress and impaired sperm viability. Polyunsaturated fatty acid (PUFA) supplementation may improve certain sperm characteristics, but it also makes sperm more susceptible to oxidative stress, therefore adding antioxidants that counteract oxidative stress has become an option. In this context, this study aimed to evaluate the effect of the interaction between docosahexaenoic acid (DHA) and antioxidants on the quality after the cryopreservation of epididymal bull sperm. Twenty epididymides were collected after slaughter, and epididymal sperm was cryopreserved with bovine extender supplemented with docosahexaenoic acid (DHA), glutathione peroxidase (GPx) and superoxide dismutase (SOD). We verified an improvement in motility in the group that was treated only with DHA 5 µM and a concentration-dependent effect on susceptibility to lipid peroxidation that was associated with DHA concentration (1 µM, 5 µM or 10 µM). Moreover, treatment with DHA (5 µM) and SOD (20 IU/ml) resulted in higher sperm motility. Thus, the association between DHA (5 µM) and SOD (20 IU/ml) appears to be an option for increased epididymal sperm features in bulls.

Three assays were performed. In assay 1, oocytes harvested during the winter months were subjected to kinetic heat shock by stressing the oocytes at 39.5°C (HS1) or at 40.5°C (HS2) for either 6, 12, 18 or 24 h and then matured at control temperature (38.5°C). The nuclear maturation rates (NMR) of all oocytes were recorded after 24 h. In assay 2, oocytes collected year-round maturated, were implanted via in vitro fertilization (IVF) and developed for 9 days. Gene expression analysis was performed on target genes (Cx43, CDH1, DNMT1, HSPA14) with reference to the two housekeeping genes (GAPDH and SDHA) in embryos. Similarly, in assay 3, genetic analysis was performed on the embryos produced from heat-stressed oocytes (from HS1 and HS2). In assay 1, the duration of heat stress resulted in a significant decline in NMR (P < 0.05) with HS1 for maturated oocytes at 86.4 ± 4.3; 65.5 ± 0.7; 51.3 ± 0.9; 38.1 ± 1.9 and 36.3 ± 0.9, for control, 6 h, 12 h, 18 h and 24 h, respectively. For assays 2 and 3, results demonstrated that DNMT1, Cx43 and HSPA14 were down-regulated in the embryos produced in the warm with respect to the cold months (P < 0.05). A constant up- and down-regulation of DNMT1 and HSPA14 genes were observed in both HS-treated samples. Also, an inconsistent pattern of gene expression was observed in Cx43 and CDH1 genes (P < 0.05). Targeted gene expression was aberrant in embryo development, which can provide evidence on early embryo arrest and slowed embryo development.

This study was conducted to evaluate the development of the mammary gland in Holstein heifers subjected to different dietary metabolisable protein (MP): metabolisable energy (ME) ratios. Twenty-five Holstein heifers (initial body weight (BW) 213±13·5 kg and initial average age 7·8±0·5 months) were divided into five treatments. The treatments were designed to provide MP:ME ratios equal to 33, 38, 43, 48, and 53 g of MP per Mcal of ME. All diets were formulated to have the same energy content (2·6 Mcal ME/kg dry matter). Actual MP:ME ratios were 36·2, 40·2, 46·2, 47·1, and 50·8 g MP/Mcal ME. The experiment was conducted in a randomised block design, while considering initial BW as a blocking factor to evaluate pre- and post-pubertal periods. Block effect was not observed for all variables evaluated; hence it was considered that the diets had the same influence both on pre- and post-pubertal phases. Dry matter and nutrient intake did not change between treatments, excepting protein intake and digestibility. Serum concentrations of insulin-like growth factor 1 increased linearly across treatments. Changes in the pixel brightness of mammary gland ultrasound images, which are associated with lipid content, were significantly influenced by MP:ME ratios in the diet of heifers that were subjected to accelerated growth rates. It is not recommended to use diets of less than 38 g MP/Mcal ME in diets to heifers allowed to gain more than 1 kg/d.