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Studies suggest that around 25% of the European population receive treatment for a chronic condition. As the population ages, the prevalence of chronic diseases increases, with an average of two per person in their mid-60s and three for those surviving to their mid-70s (Barnett et al., 2012). People with chronic diseases now form a sizeable proportion of all hospital admissions both elective and emergency. Once admitted to hospital, people with multiple complex conditions may require a long length of stay and place a significant demand on acute hospital services.
The goal of this study was to evaluate the effects of thinning eucalyptus trees on yield and nutritive value of corn for silage and palisadegrass in a crop–livestock–forest integrated system and to evaluate the total aboveground biomass yield in systems with and without trees. Plant variables, as well as the incidence of photosynthetically active radiation (PAR) and soil moisture, were evaluated between October 2016 and March 2018 in São Carlos, Brazil, in a crop–livestock–forest and a crop–livestock system. In the crop–livestock–forest system, eucalyptus trees (Eucalyptus urograndis clone GG100) were planted in April 2011, in single rows, with 15 × 2 m spacing. In 2016, the trees were thinned, and the spacing was changed to 15 × 4 m. The treatments comprised measurements at 0.00, 3.75, 7.50, and 11.25 m from the trees of the North row in the integrated crop–livestock–forest (iCLF) system and integrated crop–livestock (iCL) system. Palisadegrass (Urochloa brizantha) was sown after harvesting the corn. Corn yields were similar between treatments, with an average of 13.6 Mg ha−1. Corn for silage presented a higher percentage of grain in total biomass in the crop–livestock–forest positions (41.4 and 42.1%) than in the crop–livestock system (35.6%). No differences in forage accumulation were observed. Crude protein content in corn for silage and palisadegrass was higher in the crop–livestock–forest treatments than in the crop–livestock system. Such results indicate that thinning was favorable to production in the crop–livestock–forest system. Total aboveground biomass yield was higher in the iCLF system, indicating better land use for this type of integrated system.
Tuberculosis (TB) transmission in healthcare facilities is still a concern in low-income countries, where airborne isolation rooms are scarce due to high costs. We evaluated the use of single GeneXpert MTB/RIF, the molecular Mycobacterium tuberculosis (MTB) DNA and resistance to rifampicin (RIF) test, as an accurate and faster alternative to the current criteria of 3 negative acid-fast bacilli (AFB) smears to remove patients from airborne isolation.
In this real-world investigation, we evaluated the impact of a single GeneXpert MTB/RIF on the decision making for discharging patients from respiratory isolation. We enrolled patients with suspected pulmonary TB in a public hospital that provides care for high-complexity patients in Brazil. We studied the performance, costs, and time saved comparing the GeneXpert MTB/RIF with AFB smears.
We enrolled 644 patients in 3 groups based on the number of AFB smears performed (1, 2, and 3, respectively) on respiratory specimens. GeneXpert MTB/RIF demonstrated good performance compared to AFB smear to rule out TB in all groups. The negative predictive value for AFB smear was 94% (95% confidence interval [CI], 0.90–0.97) and 98% (95% CIs, 0.94–0.99) for GeneXpert MTB/RIF in G3. The isolation discharge based on 3 AFB smears took 84 hours compared to 24 hours with GeneXpert MTB/RIF, which represents 560 patient-days saved in the isolation rooms.
A single GeneXpert MTB/RIF is a fast and strong predictor for TB absence in a high-complexity hospital, which is quite similar to results obtained in recent studies in low-burden settings. This molecular test may also increase patient rotation through isolation rooms, with a positive impact in the emergency room and infectious diseases wards.
Basidiolichens are generally poorly researched because of the very small number of species and their restriction to special niches. Lichenomphalia basidiolichens grow in considerable quantities in arctic and alpine habitats but they are inadequately studied in these habitats in Mediterranean areas. Based on morphological and phylogenetic analyses, we identified the different symbionts of L. meridionalis, collected in localities in Spain at altitudes ranging from 533 to 2200 m above sea level. The present study provides the first molecular data available for L. meridionalis. We found that a microindel of six bp within the nrITS2 could help to discriminate L. meridionalis from other species of the genus. Molecular analyses revealed the existence of two different green algal strains, both belonging to Coccomyxa subellipsoidea, a species shared with other Lichenomphalia lichens. Notably, the two chlorobiont strains associated with L. meridionalis were differentially distributed according to altitude, and samples having one of the two strains consistently also included cyanobacteria.
This research presents the mineralogical and chemical characterization and beneficiation study of two kaolin deposits from the Borborema Pegmatite Province, Brazil. Seven samples were collected and treated in two different beneficiation routes involving magnetic separation and chemical bleaching. The fractions obtained were studied by X-ray diffraction, X-ray fluorescence spectrometry, scanning electron microscopy, particle-size analyses, electron paramagnetic resonance and determination of optical properties. The samples are composed mainly of subhedral kaolinite in the form of booklets, as well as muscovite, quartz, microcline and illite impurities. The kaolinite structural formulae indicated significant replacement of Si4+ by Al3+ in tetrahedral sites and low replacement of Fe3+ by Al3+ in the octahedral sites. The first 30 min of chemical bleaching improved significantly the optical properties of kaolin, indicating that the process is more efficient than magnetic separation.
The objective of this work is to set a corpus-driven methodology to quantify automatically diachronic language distance between chronological periods of several languages. We apply a perplexity-based measure to written text representing different historical periods of three languages: European English, European Portuguese, and European Spanish. For this purpose, we have built historical corpora for each period, which have been compiled from different open corpus sources containing texts as close as possible to its original spelling. The results of our experiments show that a diachronic language distance based on perplexity detects the linguistic evolution that had already been explained by the historians of the three languages. It is remarkable to underline that it is an unsupervised multilingual method which only needs a raw corpora organized by periods.
The Sun is our dynamic host star due to its magnetic fields causing plentiful of activity in its atmosphere. From high energetic flares and coronal mass ejections (CMEs) to lower energetic phenomena such as jets and fibrils. Thus, it is of crucial importance to learn about formation and evolution of solar magnetic fields. These fields cover a wide range of spatial and temporal scales, starting on the larger end with active regions harbouring complex sunspots, via isolated pores, down to the smallest yet resolved elements – so-called magnetic bright points (MBPs). Here, we revisit the various manifestations of solar magnetic fields by the largest European solar telescope in operation, the 1.5-meter GREGOR telescope. We show images from the High-resolution Fast Imager (HiFI) and spectropolarimetric data from the GREGOR Infrared Spectrograph (GRIS). Besides, we outline resolved convective features inside the larger structures – so-called light-bridges occurring on large to mid-sized scales.
Obtention of titanium (Ti)- and titanium dioxide (TiO2)–based nanocomposites is of great interest for biological nanomaterial applications, including for dental implants. Their mechanical properties can be improved by use of hydroxyapatite (HA) and chitosan through their biological anchorage with osseointegration and antibacterial activity. Electrochemical methods were chosen to obtain these composites in a quick and controllable way. In this work, electrochemical synthesis in one (alternated potential) or two steps (alternated or constant potential) was successfully applied. The single step (SS) obtained TiO2 + HA sample had different optical properties, as shown using ultraviolet–visible spectrometry, and the HA phase formation was proved using Raman spectroscopy. Thereby, SS_TiO2 + HA increased the corrosion resistance of titanium in artificial saliva medium, as shown by linear polarization and electrochemical impedance spectroscopy results. When using chitosan, the samples showed two corrosion interfaces, indicating its dissolution in human medium. These results indicate that the samples are excellent materials for dental implants.
Conclusions and recommendations of health technology assessment (HTA) reports have an impact on all relevant actors involved in the health system (health authorities, administrators, health professionals, patients, citizens and industry). The involvement of all those relevant stakeholders in the HTA process facilitates making valid and informed decisions and an efficient allocation of resources. Improving communication, participation and transparency among all agents will lead to more efficient evaluation and decision-making processes.
To review key aspects of the relations between HTA agencies and health industries, two process were carried out: a narrative review of literature searched in Medline, PubMed, Embase, CINAHL and WOS (2007-2017) and a review of websites of international HTA agencies. References and webs with information on the framework, objectives, methodologies, impact or results of the relationships were included.
A total of 1961 references were located and forty-five were selected. From the synthesis of the selected references the following key aspects of the relationships between HTA and industry were identified: (i) the importance of early dialogues with industry to align HTA objectives with the generation of evidence; (ii) challenges of the bias in the evidence produced by industry; (iii) difficulties in industry engagement in HTA processes; and (iv) industry interest in HTA. The review of six agency websites provided information on industry involvement in strategic activities, early dialogues, provision of documentation, management of industry clarifications, review of the report/allegations and other forms of relationship.
Both the review of the literature and the contents of the web pages of international agencies with experience in relations with industry show that the interest is in the creation of collaborative frameworks between regulatory authorities that decide on authorization and price and reimbursement and HTA agencies, while both try to maintain an early, transparent and systematic interaction with the healthcare industry.
Highly porous alumina-based oxides, γ-Al2O3, SiO2–Al2O3, and TiO2–Al2O3 were synthesized by a modified sol–gel method. Polivinylpyrrolidone was used as the pore expanding agent, whereas cetyltrimethylammonium bromide was used as the template in the presence of alkoxide inorganic precursors. Both as-synthesized and calcined solids were used as catalysts for esterification of glycerol with acetic acid (EG). The XRD and SEM-EDS measurements demonstrated that the Si-containing solids are amorphous while those containing Ti are semicrystalline with the latter composed of TiO2 rutile, TiO2 anatase, and γ-Al2O3 phases. All solids possessed ordered porous structures comprising of micro- and mesoporosity, with interconnectivity between these pores of different length scales. The high acidity of γ-Al2O3 and TiO2–Al2O3 materials resulted in good catalytic performances in the EG. Porosity of the solids plays a secondary role in determining the catalytic activity. Under the same conditions, the as-synthesized solids exhibited slightly lower catalytic performances compared to that of the calcined ones.
The aim of this study was to establish a functional freezing–thawing protocol for epididymal sperm of collared peccaries (Pecari tajacu L., 1758) by comparing different extenders. The epididymal sperm from 12 sexually mature males was recovered by retrograde flushing using Tris-based or coconut water-based (ACP®-116c) extenders. After initial evaluation, samples were diluted and frozen with the same extenders to which 20% egg yolk and 6% glycerol were added. After 2 weeks, thawing was performed at 37°C/60 s and sperm motility, vigour, morphology, functional membrane integrity, sperm viability, sperm plasma membrane integrity, and a computer-assisted semen analysis (CASA) were assessed. In addition, to evaluate the survival of frozen–thawed sperm, a thermal resistance test (TRT) was executed. Samples preserved using Tris were in better condition compared with those preserved using ACP®, showing higher values for most assessments performed, including CASA and the TRT (P<0.05). After determining Tris to be the better of the two extenders, additional samples were thawed using different thawing rates (37°C/60 s, 55°C/7 s, 70°C/8 s). Sperm thawed at 37°C/60 s had the greatest preservation (P<0.05) of viability (54.1 ± 5.9%) and functional membrane integrity (43.2 ± 5.4%), and had higher values for various CASA parameters. In conclusion, we suggest the use of a Tris-based extender added to egg yolk and glycerol for the cryopreservation of epididymal sperm obtained from collared peccaries. In order to achieve better post-thawing sperm quality, we suggest that samples should be thawed at 37°C/60 s.
Selenium (Se) is an essential micronutrient for humans, yet its dietary intake is low, mostly due to the low bioavailability in soils and therefore in edible plant tissues. To overcome Se deficiency, the breeding approach (i.e., genetic biofortification), namely in rice, is largely dependent on available Se pools. To ensure the success of genetic biofortification with Se, agronomic biofortification can be accomplished through foliar Se application. Considering this background, the main hypothesis of this work was centered in the foliar application of Se to attain agronomic biofortification of rice crops. This study also aimed to assess the full potential for increasing grain Se concentrations during rice filling, as well as the types of nutrients deposition. An experimental design applying two foliar fertilizers (sodium selenite and sodium selenate) was developed. As test systems, four rice genotypes (Ariete, Albatros, OP1105 and OP1109) were used and the kinetics of micro- and macro-nutrients accumulation and deposition were assessed. Biofortification was performed in field trials for two years with foliar fertilization ranging between 0 and 300 g Se ha−1. At the end of the plant cycle, selenite applications triggered 427- to 884-fold increases in grain Se concentrations among rice genotypes (Albatros > OP1105 > OP1109 > Ariete). The application of selenate also prompted 128- to 347-fold increases in grain Se concentrations in rice crops (Albatros > OP1105 > Ariete > OP1109). Regardless of the foliar fertilizer applied, Se deposition among genotypes occurred throughout the grain without relevant inhibitory effects on yields. In each genotype, micro and macronutrients varied among crop tissues.
Here we evaluated the effect of fermented milk supplemented with whey protein (approximately 80 % protein), probiotic (Bifidobacterium animalis subsp. lactis BB12) and pomegranate juice (Punica granatum L.) on the physical performance, intestinal motility and villi structure, inflammatory markers and intestinal microbiota of rats under high-intensity acute exercise. In all, twenty-four Wistar rats were separated into groups: control (Ctrl), supplemented (Supp), exercised (Exe) and exercised and supplemented (Exe+Supp). Rats in the Supp groups received fermented milk during 6 weeks by oral administration. At the end of the supplementation period, the Exe groups were submitted to high-intensity acute exercise on a treadmill. We found that intense acute exercise caused changes in the intestinal villi interspace, changes in the proportion of Lactobacillus species and an increase in Clostridium species, as well as a decrease in intestinal motility. Supplementation increased intestinal motility, and maintained the intestinal villi interspace and the natural microbiota proportions of the exercised rats. Physical performance was not improved by fermented milk supplementation. We conclude that the fermented milk containing whey protein, B. animalis (BB12) and pomegranate juice can re-establish intestinal microbiota and protect the animals from the undesirable effects of intense acute exercise.
The aim of this study was to evaluate the performance of cavy (Galea spixii) epididymal sperm following addition to TES or TRIS extenders and using a thermal resistance test (TRT), as well as fluorescence analysis as a complementary method to predict the viability of these gametes. Nine testicle–epididymis complexes were used for sperm collection using a flotation method. Epididymis tails were sliced and one was immersed in 3 ml of TRIS buffer, and the other in 3 ml of TES, for 5 min. After sperm recovery, the samples were subjected to a TRT which involved incubation in a water bath at 37°C for 3 h. During incubation, sample parameters were assessed at 0, 15, 30, 60, 90, 120, 150 or 180 min intervals. Results indicated that the TRIS diluent was more efficient than TES (P < 0.05) for the maintenance of sperm parameters in Spix's yellow-toothed cavies over the whole TRT, maintaining sperm longevity for an extended time. In conclusion, we indicate the use of TRIS diluent for recovery and maintenance of longevity of epididymal sperm from cavies (G. spixii).
The Spanish Network of Agencies for Health Technology Assessment (REDETS) is a group of eight agencies, units and services, depending on National and Regional Governments that coordinate their work within a common methodological framework, guided by the principles of mutual recognition and cooperation. In this work, guided by the necessity of implementing a Quality Management System, we present the process to achieve this objective.
As an initial step, a review was carried out based on a structured search strategy in the main electronic databases Medline and EMBASE, and a manual search in websites of national and international agencies (March 2016) in order to collate previous knowledge and experiences. Through the information included in this review, a proposal to create a quality, self-evaluating tool is necessary.
In total, 800 references were found and finally 6 studies were included in the review (1-3). All had a similar structure. Some lists of good practices, classified in dimensions related to different quality aspects in Health Technology Assessment (HTA) organizations, were found. Also some information about questions for evaluating quality standards was indicated. Taking all this information, a proposal of sixty-six standard titles was put forward. These standards were then grouped into twelve quality criteria structured in four dimensions: I Responsibility, II Clients and Stakeholders, III Production Process and IV Resources.
Based on the systematic review, we developed a proposal for a self-evaluating tool and this is the baseline for a common Quality Management System for the Spanish Network of HTA Agencies. The quality management process will require the development of a handbook by each member of REDETS that will be based on agreed quality standards.
The Spanish National Network (REDETS) is a group of eight agencies, units and services, depending on National and Regional Governments that coordinate their work within a common methodological framework, guided by the principles of mutual recognition and cooperation. The necessity of considering a Quality Management System has been detected and, consequently, a common tool for all the members needs to be developed. We describe in this study the process to achieve that goal.
Based on both a review of previous literature and the proposal for a self-evaluating tool, a group of experts from each agency through consensus have developed a tool for self-evaluation in Health Technology Assessment (HTA) agencies. Through the structure described in the handbook of the Andalusian Agency for Healthcare Quality (ACSA), each standard should have a statement or proposal that needs to also include evidence or good practices, and the corresponding evaluation questions. In separate workgroups, the definition of these proposals, evidence and evaluation questions were developed. One face-to-face meeting and two meetings via teleconference were necessary to achieve a final document with all the quality standards.
From a proposed structure of sixty-six standards, the titles, definitions, statements and evidence as well as good practices and evaluation questions were established in workgroups with consensus among all of the members (1 - 3). The final version of the self-assessment tool was composed of sixty-eight standards, grouped in twelve quality criteria structured in four dimensions: I Responsibility, II Clients and Stakeholders, III Production Process, and IV Resources.
Quality management requires an evaluation tool and this version, based on a systematic review and consensus, is a useful and practical instrument for developing a handbook by each member of REDETS. An online version of the tool is in process of development.
The effect of heavy metal in fish has been the focus of extensive research for many years. However, the combined effect of heavy metals and nanomaterials is still a new subject that needs to be studied. The aim of this study was to examine histopathologic alterations in the gills of Nile tilapia (Oreochromis niloticus) to determine possible effects of lead (Pb), carbon nanotubes, and Pb+carbon nanotubes on their histological integrity, and if this biological system can be used as a tool for evaluating water quality in monitoring programs. For this, tilapia were exposed to Pb, carbon nanotubes and Pb+carbon nanotubes for 4 days. The main alterations observed were epithelial structure, hyperplasia and displacement of epithelial cells, and alterations of the structure and occurrence of aneurysms in the secondary lamella. The most severe alterations were related to the Pb+carbon nanotubes. We conclude that the oxidized multi-walled carbon nanotubes enhanced the acute lead toxicity in Nile tilapias. This work draws attention to the implications of carbon nanomaterials released in the aquatic environment and their interaction with classical pollutants.
Entamoeba histolytica is the causative agent of amoebic liver abscess (ALA), which course with an uncontrolled inflammation and nitro-oxidative stresses, although it is well known that amoeba has an effective defence mechanisms against this toxic environment, the underlying molecular factors responsible for progression of tissue damage remain largely unknown. The purpose of the present study was to determine during the acute stage of ALA in hamsters, the involvement of nuclear factor (erythroid-derived 2)-like 2 (Nrf2) and nuclear factor-kappa B (NF-κB), which are activated in response to oxidative stress. From 12 h post-infection the ALA was visible, haematoxylin-eosin and Masson's trichrome stains were consistent with these observations, and alanine aminotransferase, alkaline phosphatase and γ-glutamyl transpeptidase serum activities were increased too. At 48 h after infection, liver glycogen content was significantly reduced. Western blot analyses showed that 4-Hydroxy-2-nonenal peaked at 12 h, while glycogen synthase kinase-3β, cleaved caspase-3, pNF-κB, interleukin-1β and tumour necrosis factor-α were overexpressed from 12 to 48 h post-infection. Otherwise, Nrf2 and superoxide dismutase-1, decreased at 48 h and catalase declined at 36 and 48 h. Furthermore, heme oxygenase-1 was increased at 12 and 24 h and decreased to normal levels at 36 and 48 h. These findings suggest for the first time that the host antioxidant system of Nrf2 is influenced during ALA.
Reproductive cycles were studied in seven natural populations of the intertidal bivalve Perumytilus purpuratus, distributed in a latitudinal gradient of ~2400 km along the Chilean Pacific coast (20–40°S). The results, both qualitative (gametogenic stages) and quantitative (GSI and GVF), over a period of 24 months, showed that these populations presented asynchrony in the reproductive cycle. Semi-annual cycles in Iquique (20°S), Antofagasta (23°S) and Montemar (32°S), and annual cycles in Caleta Bolfin (23°S), Taltal (25°S), Tumbes (36°S) and Pucatrihue (40°S) (2010–2012) were found. The results indicate that latitude does not have an effect on the development stage, but it does on the spawning date. However, there is a relationship between the reproductive cycles and temperature fluctuations. In addition, there was a significant negative linear correlation between gonadosomatic index and sea surface temperature in the populations studied. The decrease in temperature reduces the rate of development stages and, therefore, increases the reproductive cycles from semi-annual to annual, as evidenced in bivalve samples from Taltal, along a semi-decadal period (2007–2012). From these results, we discuss the likely biological and ecosystem consequences in connection to the effects of climate change in the South Pacific.