Irrational Use of Medications among Adults with Insomnia: An Observational Study at a Sleep Clinic in Mexico.

BACKGROUND: To determine the patterns of irrational use of medications among a sample of adult patients with insomnia. METHODS: We included 89 adult patients diagnosed with chronic insomnia who had consumed medications for this disorder during the 12 months prior to admission to a specialized Sleep Disorders Clinic (SDC) in Mexico City. With a 13-item survey, information was gathered on patterns of medication use and irrational use, considering therapeutic indications, dose, route of administration, and duration of treatment. RESULTS: The participants had taken hypnotics (65%), antidepressants (21%), anticonvulsants (8%), and antipsychotics (6%), and 92% had irrational use of their medication. Irrational use was greatest with benzodiazepines and antipsychotics. There were two main types of irrational use: (1) 47% of participants had consumed a drug unsuitable for their condition, although it was almost always prescribed by a doctor, and (2) 43% had consumed a drug for longer than the maximum time recommended. CONCLUSION: It is worrisome to find that the irrational use of medications to treat insomnia, especially benzodiazepines and antipsychotics is widespread. Although most participants had acquired their medication by prescription, for many the drug was inappropriate to treat their condition. It should be mandatory that patients with insomnia receive specialized medical attention in primary clinical care.

Unlocking Continuous Improvement in Heart Failure Remote Monitoring: A Participatory Approach to Unveil Value Dimensions and Performance Indicators.

Introduction: Heart failure (HF) constitutes a public health concern affecting quality of life, survival, and costs. Remote patient monitoring (RPM) can enhance HF management, involving patients actively and improving follow-up. While current HF RPM assessments emphasise cost-effectiveness analysis, there is a need to consider wider RPM impacts and integrate stakeholders' perspectives into assessments for better comprehensiveness. Methods: We developed a four-stage participatory approach to select value dimensions and indicators for continuous HF RPM assessment: Stage 1 involved building a literature-informed initial list; Stage 2 utilized expert interviews for validation and list expansion; Stage 3 involved a web-Delphi process with Portuguese stakeholders and experts for agreement assessment; and Stage 4 included a conclusive expert interview. Results: A literature review identified fourteen studies on telehealth, RPM, and HF, informing an initial list of four value dimensions (Access, Clinical aspects, Acceptability, and Costs) and 22 indicators. Seven semistructured interviews validated and further adjusted the list to 38 indicators. Subsequently, the web-Delphi process engaged 29 stakeholders, giving their opinions regarding assessment aspects' relevance and proposing additional elements - 1 dimension and 12 indicators. Five value dimensions and 38 indicators (76.0%) reached group agreement for selection, while 12 did not reach an agreement. Upon expert appreciation, 5 dimensions, 43 indicators, and 6 case-mix parameters were considered relevant. Discussion: This comprehensive social approach captured diverse stakeholder perspectives, achieving agreement on pertinent HF RPM monitoring and evaluation indicators. Findings can inform visualization and management tool development, aiding day-to-day RPM evaluation and identification of improvement opportunities.

Transcatheter Aortic Valve Implantation Wait-Time Management: Derivation and Validation of the Canadian TAVI Triage Tool (CAN3T).

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has seen indication expansion and thus exponential growth in demand over the past decade. In many jurisdictions, the growing demand has outpaced capacity, increasing wait times and preprocedural adverse events. In this study, we derived prediction models that estimate the risk of adverse events on the waitlist and developed a triage tool to identify patients who should be prioritized for TAVI. METHODS AND RESULTS: We included adult patients in Ontario, Canada referred for TAVI and followed up until one of the following events first occurred: death, TAVI procedure, removal from waitlist, or end of the observation period. We used subdistribution hazards models to find significant predictors for each of the following outcomes: (1) all-cause death while on the waitlist; (2) all-cause hospitalization while on the waitlist; (3) receipt of urgent TAVI; and (4) a composite outcome. The median predicted risk at 12 weeks was chosen as a threshold for a maximum acceptable risk while on the waitlist and incorporated in the triage tool to recommend individualized wait times. Of 13 128 patients, 586 died while on the waitlist, and 4343 had at least 1 hospitalization. A total of 6854 TAVIs were completed, of which 1135 were urgent procedures. We were able to create parsimonious models for each outcome that included clinically relevant predictors. CONCLUSIONS: The Canadian TAVI Triage Tool (CAN3T) is a triage tool to assist clinicians in the prioritization of patients who should have timely access to TAVI. We anticipate that the CAN3T will be a valuable tool as it may improve equity in access to care, reduce preventable adverse events, and improve system efficiency.

Cultural adaptation and psychometric properties of the online learning climate scale for Chilean university students.

Introduction: The COVID-19 pandemic has profoundly changed university teaching and learning formats, leading to a significant increase in online learning. Consequently, the crisis has facilitated the potential development of this educational modality. However, researchers need adapted and validated instruments to assess the online learning climate in universities. Aim: This study aimed to adapt and psychometrically validate the Online Learning Climate Scale (OLCS) for Chilean university students. Method: Quantitative research was conducted with a non-experimental and cross-sectional, design executed in two phases: the first was oriented to the cultural adaptation of the instrument, and the second was focused on analyzing its psychometric properties in a sample of 491 university students. Results: A translated and culturally adapted version was obtained, composed of 15 items distributed in a factorial structure composed of four dimensions that showed excellent adjustment to the data [χ2 (84) = 189.628; p < 0.001; CFI = 0.979; TLI = 0.973; RMSEA = 0.051 (IC90% 0.044-0.059); SRMR = 0.028]; internal consistency was estimated through Cronbach's alpha and ranged between 0.892 and 0.955, and strict invariance between men and women was achieved. Discussion: The Online Learning Climate Scale (OLCS) is a valid and reliable measure for measuring the online learning climate within the Chilean higher education context so that it can be used both in research and in monitoring management programs in educational environments.

N-tert-Butoxycarbonyl-N-(2-(tritylthio)ethoxy)glycine as a Building Block for Peptide Ubiquitination.

N-Boc-N-(2-(tritylthio)ethoxy)glycine has been developed as a building block for peptide ubiquitination, which is fully compatible with solid-phase Fmoc chemistry and common peptide modifications including phosphorylation, methylation, acetylation, biotinylation, and fluorescence labeling. The optimal conditions for peptide cleavage and auxiliary removal were obtained. The utility of this building block in peptide ubiquitination was demonstrated by the synthesis of seven ubiquitinated histone and Tau peptides bearing various modifications. Cys residues were well tolerated and did not require orthogonal protection. The structural integrity and folding of the synthesized ubiquitinated peptides were confirmed by enzymatic deubiquitination of a fluorescently labeled ubiquitin conjugate. The synthetic strategy using this building block provides a practical approach for the preparation of ubiquitinated peptides with diverse modifications.

Radiotherapy in the head and neck region influences the chemical and mechanical properties of intraradicular dentin.

OBJECTIVES: To investigate the chemical and mechanical properties of intraradicular dentin submitted to radiotherapy. MATERIALS AND METHODS: Sixteen mandibular incisors were divided into two groups (n = 8): non-irradiated and irradiated. The irradiated teeth were obtained from head and neck radiotherapy patients, with a total dose ranging from 70.2 to 72 Gy divided into 1.8 Gy daily. After sample preparation, intraradicular dentin slices of each root third were evaluated by Raman spectroscopy, energy dispersive spectroscopy and Knoop microhardness test. Data were analyzed by Two-way ANOVA and Tukey's test (α = 0.05). RESULTS: In Raman spectroscopy, carbonate and amide III showed a significant difference for irradiation and third (carbonate p = 0.021 and p < 0.001; amide III p < 0.001 and p = 0.001, respectively). For amide I, there was a significant difference for third (p < 0.001). For carbonate/mineral ratio, there was a significant difference for irradiation (p = 0.0016) and third (p < 0.001), with the irradiated middle third showing the lowest values. For amide I/amide III ratio, there was a significant difference for irradiation (p = 0.005) in the cervical third. In energy dispersive spectroscopy, carbon (p = 0.004; p = 0.020), phosphorus (p < 0.001; p = 0.009) and calcium (p = 0.008; p = 0.007) showed differences for irradiation and third, with the irradiated groups presenting lower values in cervical and middle thirds. For calcium/phosphorus ratio, there was a significant difference for irradiation (p < 0.001) in cervical and middle thirds. Regarding microhardness, there was a significant difference for irradiation (p < 0.001), with all irradiated groups showing lower microhardness values. CONCLUSIONS: The radiotherapy altered the chemical and mechanical properties of intraradicular dentin, mainly in the cervical and middle root thirds.

Applications of artificial intelligence and bioinformatics methodologies in the analysis of ocular biofluid markers: a scoping review.

PURPOSE: This scoping review summarizes the applications of artificial intelligence (AI) and bioinformatics methodologies in analysis of ocular biofluid markers. The secondary objective was to explore supervised and unsupervised AI techniques and their predictive accuracies. We also evaluate the integration of bioinformatics with AI tools. METHODS: This scoping review was conducted across five electronic databases including EMBASE, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science from inception to July 14, 2021. Studies pertaining to biofluid marker analysis using AI or bioinformatics were included. RESULTS: A total of 10,262 articles were retrieved from all databases and 177 studies met the inclusion criteria. The most commonly studied ocular diseases were diabetic eye diseases, with 50 papers (28%), while glaucoma was explored in 25 studies (14%), age-related macular degeneration in 20 (11%), dry eye disease in 10 (6%), and uveitis in 9 (5%). Supervised learning was used in 91 papers (51%), unsupervised AI in 83 (46%), and bioinformatics in 85 (48%). Ninety-eight papers (55%) used more than one class of AI (e.g. > 1 of supervised, unsupervised, bioinformatics, or statistical techniques), while 79 (45%) used only one. Supervised learning techniques were often used to predict disease status or prognosis, and demonstrated strong accuracy. Unsupervised AI algorithms were used to bolster the accuracy of other algorithms, identify molecularly distinct subgroups, or cluster cases into distinct subgroups that are useful for prediction of the disease course. Finally, bioinformatic tools were used to translate complex biomarker profiles or findings into interpretable data. CONCLUSION: AI analysis of biofluid markers displayed diagnostic accuracy, provided insight into mechanisms of molecular etiologies, and had the ability to provide individualized targeted therapeutic treatment for patients. Given the progression of AI towards use in both research and the clinic, ophthalmologists should be broadly aware of the commonly used algorithms and their applications. Future research may be aimed at validating algorithms and integrating them in clinical practice.

Establishing the health and wellbeing needs of mining host community in Brazil, Chile and Peru: a mixed-method approach to identify priority areas for action to help communities meet their SDG3 targets.

BACKGROUND: The global mining industry is an important partner in advancing the 2030 Agenda for Sustainable Development. In 2018, Anglo American plc published their Sustainable Mining Plan, containing a goal for improving health and wellbeing aligned with the Sustainable Development Goal 3 (SDG3) targets. Having formed an independent multidisciplinary research consortium, we designed and implemented a mixed-methods approach to attain a deeper understanding of SDG3 priorities within the local context of communities hosting Anglo American mining operations located in Latin America. METHODS: In 2019, within the host communities of three mining operations in Chile, three in Brazil, and one in Peru, we conducted a qualitative study which included stakeholder workshops and key informant interviews. We also quantitatively appraised existing health data. Findings emerging from the qualitative and quantitative assessments were compared to identify health and wellbeing priority areas for action relevant to each community. RESULTS: Across the three countries, 120 people took part in workshops and 35 in interviews. In these workshops and interviews, non-communicable diseases (SDG3.4), harmful alcohol consumption (SDG3.5), and pollution, particularly air pollution (SDG3.9), were consistently identified as areas for priority action. There were similarities in the reporting of individual, interpersonal, community, societal, and structural factors underlying these priority areas across the different communities. The availability of quantitative data was generally good at the state level, becoming increasing sparse as we focused on smaller geographies. The priorities identified in the quantitative assessments generally aligned with those highlighted in the qualitative data. CONCLUSIONS: We highlight the importance of engaging with local populations to understand and address health needs. To address the priorities identified, intervention packages tailored to the specific needs of host communities, that tackle associated upstream societal level factors, are required. To facilitate this, appropriate monitoring systems and epidemiological investigations should be implemented to better understand the local context and quantify health issues. In the host communities, it is essential for the mining sector to be a key health partner in promoting integrated programmes that contribute to achieving the priority objectives and targets aligned with the SDG3 agenda.

Molecular Basis of Crops and Fruit Plants in Response to Stress.

This editorial summarizes the main scientific contributions from 11 papers comprising the Special Issue (SI) "Molecular Basis of Crops and Fruit Plants in Response to Stress". Here, we collected papers from different research groups encompassing molecular studies from monocots (ginger, rice, maize) and eudicots (common hazel, cowpea, pepper, soybean, tomato) species submitted to abiotic stresses as heat, cold, salt, drought, and heavy metals or biotic stresses induced by different viruses, such as BPEV, PepGMV, PMMoV, and TEV. These studies explored different aspects of molecular mechanisms involved in plant stress tolerance, establishing comparative analyses among genotypes/cultivars to identify potential molecular markers of stresses that are now available for future application in biotechnological studies. This SI presents a collection of advanced concepts and emerging strategies for readers and researchers aiming to accelerate plant breeding.

Magnesium supplementation alleviates drought damage during vegetative stage of soybean plants.

Our working hypothesis was that magnesium (Mg) supplementation modulates plant performance under low water availability and improves drought tolerance in soybean genotypes. Plants of Bônus 8579, M8808 and TMG1180 genotypes were grown under field conditions and subjected to three water stress treatments (control, moderate and severe stress) and three Mg levels [0.9 (low), 1.3 (adequate) and 1.7 cmolc dm-³ (supplementation)]. After 28 days of drought imposition, the growth parameters, osmotic potential, relative water content, leaf succulence, Mg content and photosynthetic pigments were assessed. In general, drought drastically decreased the growth in all genotypes, and the reductions were intensified from moderate to severe stress. Under adequate Mg supply, TMG1180 was the most drought-tolerant genotype among the soybean plants, but Mg supplementation did not improve its tolerance. Conversely, although the M8808 genotype displayed inexpressive responses to drought under adequate Mg, the Mg-supplemented plants were found to have surprisingly better growth performance under stress compared to Bônus 8579 and TMG1180, irrespective of drought regime. The improved growth of high Mg-treated M8808-stressed plants correlated with low osmotic potential and increased relative water content, as well as shoot Mg accumulation, resulting in increased photosynthetic pigments and culminating in the highest drought tolerance. The results clearly indicate that Mg supplementation is a potential tool for alleviating water stress in M8808 soybean plants. Our findings suggest that the enhanced Mg-induced plant acclimation resulted from increased water content in plant tissues and strategic regulation of Mg content and photosynthetic pigments.

Genome and Transcriptome Analyses of Genes Involved in Ascorbate Biosynthesis in Pepper Indicate Key Genes Related to Fruit Development, Stresses, and Phytohormone Exposures.

Pepper (Capsicum annuum L.) is a vegetable consumed worldwide, primarily used for vitamin C uptake and condiment purposes. Ascorbate (Asc) is a multifunctional metabolite, acting as an antioxidant and enzymatic cofactor involved in multiple cellular processes. Nevertheless, there is no evidence about the contribution of biosynthesis pathways and regulatory mechanisms responsible for Asc reserves in pepper plants. Here, we present a genome- and transcriptome-wide investigation of genes responsible for Asc biosynthesis in pepper during fruit development, stresses, and phytohormone exposures. A total of 21 genes, scattered in ten of twelve pepper chromosomes were annotated. Gene expression analyses of nine transcriptomic experiments supported the primary role of the L-galactose pathway in the Asc-biosynthesizing process, given its constitutive, ubiquitous, and high expression profile observed in all studied conditions. However, genes from alternative pathways generally exhibited low expression or were unexpressed and appeared to play some secondary role under specific stress conditions and phytohormone treatments. Taken together, our findings provide a deeper spatio-temporal understanding of expression levels of genes involved in Asc biosynthesis, and they highlight GGP2, GME1 and 2, and GalLDH members from L-galactose pathway as promising candidates for future wet experimentation, addressing the attainment of increase in ascorbate content of peppers and other crops.

Selection of Soybean and Cowpea Cultivars with Superior Performance under Drought Using Growth and Biochemical Aspects.

Identifying cultivars of leguminous crops exhibiting drought resistance has become crucial in addressing water scarcity issues. This investigative study aimed to select soybean and cowpea cultivars with enhanced potential to grow under water restriction during the vegetative stage. Two parallel trials were conducted using seven soybean (AS3810IPRO, M8644IPRO, TMG1180RR, NS 8338IPRO, BMX81I81IPRO, M8808IPRO, and BÔNUS8579IPRO) and cowpea cultivars (Aracê, Novaera, Pajeú, Pitiúba, Tumucumaque, TVU, and Xique-xique) under four water levels (75, 60, 45, and 30% field capacity-FC) over 21 days. Growth, water content, membrane damage, photosynthetic pigments, organic compounds, and proline levels were analyzed. Drought stress significantly impacted the growth of both crops, particularly at 45 and 30% FC for soybean and 60 and 45% FC for cowpea plants. The BÔNUS8579IPRO and TMG1180RR soybean cultivars demonstrated the highest performance under drought, a response attributed to increased amino acids and proline contents, which likely help to mitigate membrane damage. For cowpea, the superior performance of the drought-stressed Xique-xique cultivar was associated with the maintenance of water content and elevated photosynthetic pigments, which contributed to the preservation of the photosynthetic efficiency and carbohydrate levels. Our findings clearly indicate promising leguminous cultivars that grow under water restriction, serving as viable alternatives for cultivating in water-limited environments.

Soil and foliar Si fertilization alters elemental stoichiometry and increases yield of sugarcane cultivars.

Silicon (Si) fertilization is widely recognized to improve the development of crops, especially in tropical soils and cultivation under dryland management. Herein, our working hypothesis was that Si stoichiometry favors the efficient use of carbon (C), nitrogen (N), and phosphorus (P) in sugarcane plants. Therefore, a field experiment was carried out using a 3 × 3 factorial scheme consisting of three cultivars (RB92579, RB021754 and RB036066) and three forms of Si application (control without Si; sodium silicate spray at 40 mmol L-1 in soil during planting; sodium silicate spray at 40 mmol L-1 on leaves at 75 days after emergence). All Si fertilizations altered the elemental C and P stoichiometry and sugarcane yield, but silicon-induced responses varied depending on sugarcane cultivar and application method. The most prominent impacts were found in the leaf Si-sprayed RB92579 cultivar, with a significant increase of 7.0% (11 Mg ha-1) in stalk yield, 9.0% (12 Mg ha-1) in total recoverable sugar, and 20% (4 Mg ha-1) in sugar yield compared to the Si-without control. In conclusion, our findings clearly show that silicon soil and foliar fertilization alter C:N:P stoichiometry by enhancing the efficiency of carbon and phosphorus utilization, leading to improved sugarcane production and industrial quality.

Inclusion of non-medical interventions in model-based economic evaluations for tuberculosis: A scoping review.

BACKGROUND: The economic evaluation of health interventions is important in priority setting. Several guidance documents exist to support the conduct of economic evaluations, however, there is limited guidance for the evaluation of non-medical interventions. For tuberculosis (TB), where equity-deserving groups are disproportionately impacted, assessing interventions aimed at addressing social risk factors is necessary to effectively reduce TB burden. OBJECTIVE: This scoping review seeks to assess the existing literature on model-based economic evaluations of TB interventions to gauge the extent to which non-medical interventions have been evaluated in low-TB-incidence jurisdictions. As a secondary objective, this review aims to characterize key features of existing economic evaluations of medical and non-medical interventions. METHODS: A literature search was conducted in the grey literature and MEDLINE, Embase, EconLit, and PsychINFO databases to September 6, 2022 following the Arksey and O'Malley framework. Eligible articles were those that used decision-analytic modeling for economic evaluation of TB interventions in low-TB-incidence jurisdictions. RESULTS: This review identified 127 studies that met the inclusion criteria; 11 focused on prevention, 73 on detection, and 43 on treatment of TB. Only three studies (2%) evaluated non-medical interventions, including smoking reduction strategies, improving housing conditions, and providing food vouchers. All three non-medical intervention evaluations incorporated TB transmission and robust uncertainty analysis into the evaluation. The remainder of the studies evaluated direct medical interventions, eight of which were focused on specific implementation components (e.g., video observed therapy) which shared similar methodological challenges as the non-medical interventions. The majority of remaining evaluated medical interventions were focused on comparing various screening programs (e.g., immigrant screening program) and treatment regimens. CONCLUSIONS: This scoping review identified a gap in literature in the evaluation of non-medical TB interventions. However, the identified articles provided useful examples of how economic modeling can be used to explore non-traditional interventions using existing economic evaluation methods.

Towards A Framework for Implementing Remote Patient Monitoring From an Integrated Care Perspective: A Scoping Review.

BACKGROUND: Remote patient monitoring (RPM) has been increasingly adopted over the last decade, with the COVID-19 pandemic fostering its rapid development. As RPM implementation is recognised as complex and highly demanding in terms of resources and processes, there are multiple challenges in providing RPM in an integrated logic. METHODS: To examine the structural elements that are relevant for implementing RPM integrated care, a scoping review was conducted in PubMed, Scopus, and Web of Science, leveraging a search strategy that combines terms relative to (1) conceptual models and reallife initiatives; (2) RPM; and (3) care integration. RESULTS: 28 articles were included, covering nine conceptual models and 19 real-life initiatives. Eighteen structural elements of RPM integrated care implementation were identified among conceptual models, defining a structure for assessing real-life initiatives. 78.9% of those initiatives referred to at least ten structural elements, with patient education and self-monitoring promotion, multidisciplinary core workforce, ICTs (information and communications technologies) and telemonitoring devices, and health indicators measurement being present in all studies, and therefore being core elements to the design of RPM initiatives. CONCLUSION: RPM goes far beyond technology, with underlying processes and involved actors playing a central role in care provision. The structural elements identified can guide RPM implementation and promote maturity in adoption. Future research may focus on assessing design completeness, evaluating impacts, and analysing related financial arrangements.

Cost-Utility of Rhegmatogenous Retinal Detachment Repair With Pars Plana Vitrectomy, Scleral Buckle, and Pneumatic Retinopexy: A Microsimulation Model.

PURPOSE: To assess the cost-effectiveness of primary noncomplex rhegmatogenous retinal detachment (RRD) repair, comparing 3 different strategies, pars plana vitrectomy (PPV), scleral buckle (SB), and pneumatic retinopexy (PnR) from the health care payer perspective over a lifetime. DESIGN: Model-based cost-utility analysis. METHODS: A simulated cohort of 100,000 adult patients (≥18 years old) requiring primary noncomplex RRD repair in theoretical surgical centers in the United States. Quality-adjusted life years (QALYs), lifetime costs (2022 United States dollars), and the incremental cost-effectiveness ratio (ICER) of the 3 interventions were projected over a lifetime horizon, with a cost-effectiveness threshold of ≤$50,000 per gained QALY. RESULTS: Based on inputted parameters, the primary anatomical success was highest for PPV (95.00%) compared to SB (91.76%) and PnR (63.41%). The QALYs associated with PPV, SB, and PnR were (11.87, SD 1.62), (11.84, SD 1.63), and (11.59, SD 1.72), respectively. The incurred lifetime costs of RRD repair and associated postoperative surgeries for PPV, SB, and PnR were $4445.72 (SD 655.75), $4518.04 (662.92), and $3978.45 (728.50), respectively. Parameter-level simulations suggested that PPV was most likely to be the most cost-effective therapy compared to SB and PnR beyond a threshold of $3000/QALY. The incremental cost-effectiveness ratio for PPV compared to PnR was $1693.54. SB was dominant in all scenarios. Threshold analyses indicated that the success rate of PnR would have to be 100% and/or the cost would have to be $2000 or less over lifetime for it to be more cost-effective than PPV. CONCLUSIONS: This study found PPV to be the most cost-effective primary procedure for RRD repair at a threshold of $50,000/QALY gained over a lifetime horizon from the health care payer perspective.

Macro and Micro-Nutrient Accumulation and Partitioning in Soybean Affected by Water and Nitrogen Supply.

This study aimed to investigate the influence of water availability and nitrogen fertilization on plant growth, nutrient dynamics, and variables related to soybean crop yield. Trials were performed in Teresina, Piauí, Brazil, using randomized blocks in a split-split plot arrangement. The plots corresponded to water regimes (full and deficient), the split plots to N fertilization (0 and 1000 kg ha-1 N-urea), and the split-split plots to harvest times of soybean plants (16, 23, 30, 37, 44, 58, 65, 79 and 86 days after emergence), with three replicates. In general, the accumulation and partitioning of nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), magnesium (Mg), sulphur (S), copper (Cu), iron (Fe), manganese (Mn), zinc (Zn) and boron (B) were decreased in plants subjected to water deficit and without N fertilization. Although nitrogen fertilization promoted elevated N accumulation in tissues, it did not result in any significant yield gain, and the highest seed yields were found in plants under full irrigation, regardless of N supplementation. However, deficient irrigation decreased the seed oil content of N-fertilized plants. In conclusion, N fertilization is critical for nutrient homeostasis, and water availability impairs biomass and nutrient accumulation, thereby limiting soybean yield performance.

Streams in the Mediterranean Region are not for mussels: Predicting extinctions and range contractions under future climate change.

Climate change is becoming the leading driver of biodiversity loss. The Mediterranean region, particularly southwestern Europe, is already confronting the consequences of ongoing global warming. Unprecedented biodiversity declines have been recorded, particularly within freshwater ecosystems. Freshwater mussels contribute to essential ecosystem services but are among the most threatened faunal groups on Earth. Their poor conservation status is related to the dependence on fish hosts to complete the life cycle, which also makes them particularly vulnerable to climate change. Species Distribution Models (SDMs) are commonly used to predict species distributions, but often disregard the potential effect of biotic interactions. This study investigated the potential impact of future climate on the distribution of freshwater mussel species while considering their obligatory interaction with fish hosts. Specifically, ensemble models were used to forecast the current and future distribution of six mussel species in the Iberian Peninsula, including environmental conditions and the distribution of fish hosts as predictors. We found that climate change is expected to severely impact the future distribution of Iberian mussels. Species with narrow ranges, namely Margaritifera margaritifera and Unio tumidiformis, were predicted to have their suitable habitats nearly lost and could potentially be facing regional and global extinctions, respectively. Anodonta anatina, Potomida littoralis, and particularly Unio delphinus and Unio mancus, are expected to suffer distributional losses but may gain new suitable habitats. A shift in their distribution to new suitable areas is only possible if fish hosts are able to disperse while carrying larvae. We also found that including the distribution of fish hosts in the mussels' models avoided the underprediction of habitat loss under climate change. This study warns of the imminent loss of mussel species and populations and the urgent need of management actions to reverse current trends and mitigate irreversible damage to species and ecosystems in Mediterranean regions.

Telemonitoring in Portugal: where do we stand and which way forward?

Following the pandemic, there is growing pressure in Portugal to adopt new practices that promote more efficient, sustainable, and equitable healthcare. Telemonitoring (TM) has been identified as a valuable solution, particularly for chronically ill, long-term or socially isolated patients. Several initiatives have since emerged. Thus, Portuguese stakeholders recognise the need to reflect upon TM's current state and prospects. This study aims to provide a comprehensive analysis of the TM landscape in Portugal. We begin by analysing the underlying conditions for telehealth development. Then, we describe the governmental strategy and priorities towards TM - the National Strategic Plan for Telehealth development and NHS reimbursement opportunities for TM. To understand TM implementation, adoption, and dissemination in Portugal, we analyse 46 reported initiatives and adoption studies focusing on providers' perspectives. Finally, a structured reflection on current challenges and the way forward is provided, according to the seven domains of the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework. The adoption of TM by Portuguese institutions has been growing, leveraged by the telehealth governance model and public reimbursement mechanisms, proving particularly relevant during the pandemic. However, monitored patients are still few. Low digital literacy among patients and providers, lack of care integration and resource scarcity represent barriers hampering pilot TM initiatives' scale-up.