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Using microsatellite loci, we assessed the mating system and genetic diversity of the dioecious tropical tree Genipa americana in a natural population (NP) and a progeny test (PT). For NP, we also estimated the paternity correlation within and among fruits and mean pollen dispersal distance. As expected for dioecious species, all offspring originated from outcrossing (t = 1). Mating among relatives (1 − ts) and paternity correlation (rp) were variable among progenies (1 − ts = 0.03–0.19; rp = 0.04–0.40), but greater in NP than in PT. Fixation index (F) was generally significant and lower in adults than in offspring, indicating selection against inbred individuals. Paternity correlation was higher within (0.40) than among (0.26) fruits, indicating a lower effective number of pollen donors (Nep) within (2.5) than among (3.8) fruits. Due to the higher rp in NP, the effective size within progenies (Ne) was lower (2.69) than PT (3.27). The pollen dispersal pattern was strongly leptokurtic, suggesting long-distance pollen dispersal (mean of 179 m). The results show that both populations can be used for seed collection in environmental reforestation programmes; however, considering that PT is structured in maternal progenies, NP is more suitable for seed collection due to the lower probability of mating among related trees.
Lack of knowledge about iodine has been suggested as a risk factor for iodine deficiency in pregnant women, but no studies have addressed this issue in Portugal. So, the aim of this study was to investigate iodine knowledge among Portuguese pregnant women and its association with iodine status. IoMum, a prospective observational study, included 485 pregnant women recruited at Centro Hospitalar e Universitário de S. João, Porto, between the 10th and 13th gestational weeks. Partial scores for knowledge on iodine importance, on iodine food sources or on iodised salt were obtained through the application of a structured questionnaire. Then, a total iodine knowledge score was calculated and grouped into low, medium and high knowledge categories. Urinary iodine concentration (UIC) was measured in spot urine samples by inductively coupled plasma MS. Of the pregnant women, 54 % correctly recognised iodine as important to neurocognitive development, 32 % were unable to identify any iodine-rich food and 71 % presented lack of knowledge regarding iodised salt. Of the women, 61 % had a medium total score of iodine knowledge. Knowledge on iodine importance during pregnancy was positively associated with iodine supplementation and also with UIC. Nevertheless, median UIC in women who correctly recognised the importance of iodine was below the cut-off for adequacy in pregnancy (150 µg/l). In conclusion, knowledge on iodine importance is positively associated with iodine status. Despite this, recognising iodine importance during pregnancy may not be sufficient to ensure iodine adequacy. Literacy-promoting actions are urgently needed to improve iodine status in pregnancy.
The role of milk and dairy products in supplying iodine to pregnant women is unknown in Portugal. The aim of this study was to evaluate the association between milk and dairy product consumption and the iodine status of pregnant women in the IoMum cohort of the Oporto region. Pregnant women were recruited between 10 and 13 weeks of gestation, when they provided a spot urine sample and information on lifestyle and intake of iodine-rich foods. Urinary iodine concentration (UIC) was determined by inductively coupled plasma MS. A total of 468 pregnant women (269 iodine supplement users and 199 non-supplement users) were considered eligible for analysis. Milk (but not yogurt or cheese) intake was positively associated with UIC, in the whole population (P = 0·02) and in the non-supplement users (P = 0·002), but not in the supplement users (P = 0·29). In non-supplement users, adjusted multinomial logistic regression analysis showed that milk consumption <3 times/month was associated with a five times increased risk of having UIC < 50 µg/l when compared with milk consumption ≥2 times/d (OR 5·4; 95 % CI 1·55, 18·78; P = 0·008). The highest UIC was observed in supplement users who reported consuming milk once per d (160 µg/l). Milk, but not yogurt or cheese, was positively associated with iodine status of pregnant women. Despite the observed positive association, daily milk consumption may not be sufficient to ensure adequate iodine intake in this population.
Background: Bloodstream infection (BSI) is the most challenging conditions in patients who undergo hematopoietic stem cell transplantation (HSCT). These infections may be related to health care in cases of central-line–associated bloodstream infection (CLABSI) or to translocation secondary to mucosal barrier injury (MBI). In 2013, MBI surveillance was incorporated into the CDC NHSN. The aim was to increase the CLABSI diagnostic accuracy by proposing more effective preventive care measures. The objective of this study was to evaluate impact of the MBI surveillance on CLABSI incidence density in a Brazilian university hospital. Methods: The CLABSI incidence densities from the period before BMI surveillance (2007–2012) and the period after BMI surveillance was implemented (2013–2018) were analyzed and compared. Infections during the preintervention period were reclassified according to the MBI criterion to obtain an accurate CLABSI rate for the first period. The average incidence densities for the 2 periods were compared using the Student t test after testing for no autocorrelation (P > .05). Results: After reclassification, the preintervention period incidence density (10 infections per 1,000 patient days) was significantly higher than the postintervention period incidence density (6 infections per 1,000 patients day; P = .011) (Table 1). Therefore, the reclassification of nonpreventable infections (MBI) in the surveillance system made the diagnosis of CLABSI more specific. The hospital infection control service was able to introduce specific preventive measures related to the insertion and management of central lines in HSCT patient care. Conclusions: The MBI classification improved the CLABSI diagnosis, which upgraded central-line prevention measures, then contributed to the decrease of CLABSI rates in this high-risk population.
We evaluated the effects of fermentation time and acid casein content on the microbial rennet obtained by solid-state fermentation using wheat bran as the carbon source. The experiments used two fermentation times (72 and 96 h), while acid casein content was 1.5, 2.0, 2.5, and 3.0 g. Rennet strength from eight enzymatic extracts was measured using pasteurized whole milk. Rennet strength of samples from 72 h of fermentation showed an increase when acid casein content increased. The rennet strength increased at 96 h of fermentation with increasing amount of casein (up to 2.5 g), and then decreased with the largest addition (3.0 g) of casein. Coagulation time for the sample with highest rennet strength was 420 s.
Trichomonas vaginalis induces cellular damage to the host cells (cytotoxicity) through the proteolytic activity of multiple proteinases of the cysteine type (CPs). Some CPs are modulated by environmental factors such as iron, zinc, polyamines, etc. Thus, the goal of this study was to assess the effect of glucose on T. vaginalis cytotoxicity, proteolytic activity and the particular role of TvCP2 (TVAG_057000) during cellular damage. Cytotoxicity assays showed that glucose-restriction (GR) promotes the highest HeLa cell monolayers destruction (~95%) by trichomonads compared to those grown under high glucose (~44%) condition. Zymography and Western blot using different primary antibodies showed that GR increased the proteolytic activity, amount and secretion of certain CPs, including TvCP2. We further characterized the effect of glucose on TvCP2. TvCP2 increases in GR, localized in vesicles close to the plasma membrane and on the surface of T. vaginalis. Furthermore, pretreatment of GR-trichomonads with an anti-TvCP2r polyclonal antibody specifically reduced the levels of cytotoxicity and apoptosis induction to HeLa cells in a concentration-dependent manner. In conclusion, our data show that GR, as a nutritional stress condition, promotes trichomonal cytotoxicity to the host cells, increases trichomonad proteolytic activity and amount of CPs, such as TvCP2 involved in cellular damage.
Temporal and spatial scarcity of water in semi-arid and seasonal ecosystems often leads to changes in movements and behaviour of large vertebrates, and in the neotropics this dynamic is poorly understood due to logistical and methodological limitations. Here we used camera trapping to elucidate variation in patterns of seasonal use of waterholes and pathways by 10 large-mammal and four large-bird species in the dry forest of north-western Costa Rica. From 2011 to 2015, we deployed trail cameras at 50 locations, including waterholes and three types of pathway (roads, human trails and animal paths). We used Generalized Linear Models to evaluate the effect of location and seasonality on the rates at which independent photographs were taken. We found interacting effects of location and seasonality for the capuchin monkey (Cebus capucinus), the tiger heron (Trigrisoma mexicanum), the white-tailed deer (Odocoileus virginianus) and the tapir (Tapirus bairdii) suggesting that these species were the most influenced by waterholes during the dry season. Comparison of waterhole sites and specific types of pathways (roads, animal paths and human trails) showed that location influenced photo-capture rates of almost all species, suggesting a useful insight to avoid and account for bias in camera trap studies. Furthering our ecological understanding of seasonal water regimes and large vertebrates’ behaviours allow for better understanding of the consequences of climate change on them.
This project studies the early Roman non-wheel-thrown Aquitania-Tarraconensis-type (AQTA) pottery from the Bay of Biscay region. The ‘ollae’-type AQTA ceramics display clear evidence of specialised production, consumption and interregional exchange by both terrestrial and maritime routes throughout the region.
The aim of this study was to develop and to assess a specific Multi-Criteria Decision Analysis (MCDA) framework to evaluate new drugs in an hospital pharmacy and therapeutics committee (P&TC) setting.
A pilot criteria framework was developed based on the EVIDEM (Evidence and Value: Impact on DEcisionMaking) framework, together with other relevant criteria, and assessed by a group of P&TC's members. The weighting of included criteria was done using a 5-point weighting technique. Two drugs were chosen by evaluation: an orphan-drug for Gaucher disease, and a nonorphan drug for the treatment of inflammatory bowel disease. Evidence matrices were developed, and value contribution of each drug was evaluated by P&TC's members. An agreed final framework was obtained through a discussion between the P&TC's members.
After criteria assessment, the pilot framework included eight quantitative criteria: “disease severity,” “unmet needs,” “comparative efficacy/effectiveness,” “comparative safety/tolerability,” “comparative patient-reported outcomes,” “comparative cost consequences-cost of treatment,” “comparative cost consequences-other medical costs,” and “quality of evidence”; and one contextual criterion: “opportunity costs and affordability.” The most valued criteria were: “comparative safety/tolerability,” “disease severity,” and “comparative efficacy/effectiveness.” When assessing the drugs most valued characteristics of the MCDA were the possibility that all team may contribute to drug assessment by means of scoring the matrices and the discussion to reach a consensus in drug positioning and value decision making.
The reflective MCDA would integrate quantitative and qualitative criteria relevant for a P&TC setting, allowing reflective discussions based on the criteria weighting score.
Extracorporeal circulatory membrane oxygenation (ECMO) is a technology that allows recovery of adults in cardiorespiratory failure with encouraging results, but is not available in the Brazilian universal public health system (SUS) due to high implementation costs. Time-driven activity based costing (TDABC) is applied to measure processes in an economic perspective by identifying opportunities to make processes more efficient through the reduction of resources used in each activity. The literature has explored the use of TDABC to measure costs related with clinical procedures and technologies in microcosting studies, identifying opportunities to improve the process by making it more efficient. This research measures the real costs to implement ECMO in Brazil to compare with the current public reimbursement system.
This study applied TDABC using data from 6 patients to measure costs of ECMO intervention considering the public perspective in Brazil. In sequence, standard price payed by SUS was used to estimate the current reimbursement amount received by the hospital for ECMO procedure. Cost variable analysis was conducted to understand when and how patients receiving ECMO are using hospital resources. Cost data were collected from an academic public hospital using an average of 18 months (2016–2017) for the department costs.
The real average cost was USD 128,923. Most significant resource costs was medical staff, particularly for the three survivor patients, and the ECMO equipment presented the second highest cost. ECMO activities were separated into: before implantation of ECMO, period using ECMO, intensive care post-ECMO and rehabilitation, being the period where ECMO is the most expensive, particularly in nurse and physician costs. The SUS average was USD 31,437, which shows a difference of USD 97,485 between the real ECMO cost and the public reimbursement in Brazil.
A critical element of the propagation of ECMO in Brazil and its reimbursement by public health system is the high cost and out-of-date standard payments by the Ministry of Health. Effort to implement a trustworthy method to guide decisions of SUS for the adoption and financing new technologies is essential to contribute to the optimization of public health policies in a country with a universal health system and limited resources dedicated to health sectors.
Venoarterial extracorporeal life support (ECLS) is increasingly used in patients during cardiogenic shock, due to favorable results in this very high-risk scenario. However, it is a costly intervention that requires heavy financial investment and specialized human resources.
Cost-effectiveness analysis to evaluate ECLS in the perspective of the Brazilian public health system (SUS) in the population of adult patients with cardiogenic shock. A decision tree comparing ECLS and usual care was built, using efficacy data from a systematic review of literature, and cost data from SUS reimbursement values. Impact of parameter variability and uncertainty were ascertained with deterministic and probabilistic sensitivity analysis.
Usual care resulted in thirty percent probability of survival, at an average cost of 3,000 international dollars (Int$/USD); the strategy that includes ECLS resulted in sixty-two percent survival rate, and average cost of Int$ 23,000, with incremental cost-effectiveness ratio (ICER) of Int$ 62.215 per averted in-hospital death. Results were sensitive to device cost, and survival difference between strategies. In probabilistic sensitivity analysis, ECLS was consistently more costly and more effective than usual care; based on a willingness-to-pay of three times Brazilian gross domestic product (GDP) per capita (Int$ 45,000), there was twenty-seven percent probability of ECLS being cost-effective.
ECLS has the potential to increase survival for cardiogenic shock, but would significantly increase costs. In the Brazilian public health system, the cost per averted in-hospital death is 4.1 times the domestic GDP per capita.
Using the Safe Islands for Seabirds LIFE project as a case study, we assessed the socio-economic impact of a nature conservation project on the local community, focusing on the wealth created and the jobs supported directly and indirectly by the project. The Safe Islands for Seabirds project took place during 2009–2012, mainly on Corvo Island, the smallest and least populated island of Portugal's Azores Archipelago. To assess the impact of the project we used a combination of methods to analyse the project expenditure, the jobs created directly as a result of it, and, by means of multipliers, the incomes and jobs it supported indirectly. We estimate that during 2009–2012 direct expenditure of EUR 344,212.50 from the project increased the gross domestic product of the Azorean region by EUR 206,527.50. Apart from the 4.5 jobs created directly by the project, it also supported indirectly the equivalent of 1.5–2.5 full-time jobs. The project also provided the opportunity to preserve and promote natural amenities important for the quality of life of the local community. Our findings show that a nature conservation project can have positive economic impacts, and we recommend the creation of a standardized tool to calculate in a straightforward but accurate manner the socio-economic impacts of conservation projects. We also highlight the need to design projects that support local economies.
The role of right ventricular longitudinal strain for assessing patients with repaired tetralogy of Fallot is not fully understood. In this study, we aimed to evaluate its relation with other structural and functional parameters in these patients.
Patients followed-up in a grown-up CHD unit, assessed by transthoracic echocardiography, cardiac MRI, and treadmill exercise testing, were retrospectively evaluated. Right ventricular size and function and pulmonary regurgitation severity were assessed by echocardiography and MRI. Right ventricular longitudinal strain was evaluated in the four-chamber view using the standard semiautomatic method.
In total, 42 patients were included (61% male, 32±8 years). The mean right ventricular longitudinal strain was −16.2±3.7%, and the right ventricular ejection fraction, measured by MRI, was 42.9±7.2%. Longitudinal strain showed linear correlation with tricuspid annular systolic excursion (r=−0.40) and right ventricular ejection fraction (r=−0.45) (all p<0.05), which in turn showed linear correlation with right ventricular fractional area change (r=0.50), pulmonary regurgitation colour length (r=0.35), right ventricular end-systolic volume (r=−0.60), and left ventricular ejection fraction (r=0.36) (all p<0.05). Longitudinal strain (β=−0.72, 95% confidence interval −1.41, −0.15) and left ventricular ejection fraction (β=0.39, 95% confidence interval 0.11, 0.67) were independently associated with right ventricular ejection fraction. The best threshold of longitudinal strain for predicting a right ventricular ejection fraction of <40% was −17.0%.
Right ventricular longitudinal strain is a powerful method for evaluating patients with tetralogy of Fallot. It correlated with echocardiographic right ventricular function parameters and was independently associated with right ventricular ejection fraction derived by MRI.
Two different crystalline structures corresponding to a zinc adipate and a zinc succinate were determined combining: X-ray powder and single-crystal diffraction, infrared spectroscopy, thermal analysis, and true densities experiments. The zinc succinate crystal structure was determined by single-crystal X-ray diffraction. This compound crystallizes in the orthorhombic space-group Cccm with unit-cell parameters a = 4.792(1) Å, b = 21.204(6) Å, c = 6.691(2) Å, V = 679.8(3) Å3, and Z = 8. Zinc adipate crystal structure was refined from the laboratory X-ray powder diffraction data by the Rietveld method. It crystallizes in the monoclinic space group P2/c with unit-cell parameters, a = 16.2037(17)Å, b = 4.7810(2)Å, c = 9.2692(6)Å, β = 90.329(3)°, V = 718.07(9) Å3, and Z = 4. The thermal expansion of it was estimated in 5.40 × 10−5 K−1. This contribution is a step on the way to systematize the regularities in the coordination diversity between linear dicarboxylates and transition metal–inorganic buildings units of metal–organic frameworks.
The Virginia opossum (Didelphis virginiana) is considered highly adaptable to anthropogenic disturbances; however, the genetic effects of disturbance on this marsupial have not been studied in wild populations in Mexico. Here we evaluated the genetic diversity of D. virginiana at sites with different levels of disturbance within the Highlands and Central Depression regions of Chiapas in southern Mexico. Twelve microsatellite loci were used and the results demonstrated moderate mean heterozygosity (He = 0.60; Ho = 0.50). No significant differences in heterozygosity were found among sites with different levels of disturbance in both regions (range Ho = 0.42–0.57). We observed low but significant levels of genetic differentiation according to disturbance level. The inbreeding coefficient did not differ significantly from zero, suggesting that low genetic differentiation in these environments may be associated with sufficient random mating and gene flow, a result associated with the high dispersal and tolerance characteristics of this marsupial. Our results for D. virginiana in this particular area of Mexico provide a foundation for exploring the impact of human disturbance on the genetic diversity of a common and generalist species.
In this work, the correlation between the number of nonbridging oxygen (NBO) atoms and the thermal and optical properties of TeO2–Li2O–MoO3 glasses was studied. Samples containing (100 − x)TeO2–x(Li2O–MoO3) with x = 10, 15, 20, and 25 mol% were investigated by Raman and Fourier transform infrared (FTIR) spectroscopies. From the optical absorption measurements, the band gap energies were determined. The Raman and FTIR results showed that with increasing x, the TeO4 units transform into TeO3+1 units and then into TeO3 units, while the Mo coordination changes from 4 → 6. This transformation corresponds to a decrease in the total number of NBO with increasing x in this glass matrix. The decrease in the NBO is also confirmed by the increase in band gap energies and the decrease in the optical basicity, indicating a more polymerized network with increasing x.
The inhibition of nuclear maturation allows time for the oocyte to accumulate molecules that are important for embryonic development. Thus, the objective of this work was to evaluate the effect of blocking oocyte meiosis with the addition of forskolin, an efficient inhibitor of nuclear maturation, in in vitro maturation (IVM) medium. Forskolin was added to the IVM medium for 6 h at concentrations of 0.1 mM, 0.05 mM or 0.025 mM, then the oocytes were allowed to mature in drug-free medium for 18 h. The oocytes were assessed for the stage of nuclear maturation, the activity and distribution of mitochondria, oocyte ultrastructure, the number of viable cells and the apoptosis rate. After forskolin treatment, the oocytes were fertilized in vitro and cultured for 7 days. On day 7, the blastocyst rate, the ultrastructure, the number of intact cells and the apoptosis rate of the blastocysts were measured. No differences were observed for the stage of nuclear maturation of the oocyte, the mitochondrial activity and distribution, the blastocyst rate or total number of intact cells. However, a higher rate of apoptosis was observed in the blastocysts produced from oocytes blocked for 6 h with the higher concentration of forskolin (P < 0.05). We conclude that all the experimental groups reached the MII stage after the addition of forskolin and that the highest concentration of forskolin caused cellular degeneration without harming embryo production on the 7th day.
This article analyses the organisation of the Army of the Andes, created in Mendoza between 1814 and 1817 with the aim of reconquering Chile from the royalists. The first section studies the role of José de San Martín as an informal arbiter in Bernardo O'Higgins’ dispute with José Miguel Carrera. The aim is to explain why San Martín decided to support O'Higgins, and the immediate consequences of this alliance. The second section addresses the main characteristics of the Army of the Andes and the process of militarisation experienced by the local inhabitants. Everyday life in Mendoza became inseparable from the needs of the revolutionary army. The paper then considers the so-called guerra de zapa and the participation of irregular agents. The involvement of spies and guerrilla officers in the revolution increased as warfare intensified. The final section analyses the crossing of the cordillera by the insurgents and the revolutionary triumph of 12 February 1817 at Chacabuco.