Mapping skills between symbols and quantities in preschoolers: The role of finger patterns.

Mapping skills between different codes to represent numerical information, such as number symbols (i.e., verbal number words and written digits) and non-symbolic quantities, are important in the development of the concept of number. The aim of the current study is to investigate children's mapping skills by incorporating another numerical code that emerges at early stages in development, finger patterns. Specifically, the study investigates (i) the order in which mapping skills develop and the association with young children's understanding of cardinality; and (ii) whether finger patterns are processed similarly to symbolic codes or rather as non-symbolic quantities. Preschool children (3-year-olds, N = 113, Mage = 40.8 months, SDage = 3.6 months; 4-year-olds, N = 103, Mage = 52.9 months, SDage = 3.4 months) both cardinality knowers and subset-knowers, were presented with twelve tasks that assessed the mappings between number words, Arabic digits, finger patterns, and quantities. The results showed that children's ability to map symbolic numbers precedes the understanding that such symbols reflect quantities, and that children recognize finger patterns above their cardinality knowledge, suggesting that finger patterns are symbolic in essence. RESEARCH HIGHLIGHTS: Children are more accurate in mapping between finger patterns and symbols (number words and Arabic digits) than in mapping finger patterns and quantities, indicating that fingers are processed holistically as symbolic codes. Children can map finger patterns to symbols above their corresponding cardinality level even in subset-knowers. Finger patterns may play a role in the process by which children learn to map symbols to quantities. Fingers patterns' use in the classroom context may be an adequate instructional and diagnostic tool.

Olive Polyphenol Oxidase Gene Family.

The phenolic compounds containing hydroxytyrosol are the minor components of virgin olive oil (VOO) with the greatest impact on its functional properties and health benefits. Olive breeding for improving the phenolic composition of VOO is strongly dependent on the identification of the key genes determining the biosynthesis of these compounds in the olive fruit and also their transformation during the oil extraction process. In this work, olive polyphenol oxidase (PPO) genes have been identified and fully characterized in order to evaluate their specific role in the metabolism of hydroxytyrosol-derived compounds by combining gene expression analysis and metabolomics data. Four PPO genes have been identified, synthesized, cloned and expressed in Escherichia coli, and the functional identity of the recombinant proteins has been verified using olive phenolic substrates. Among the characterized genes, two stand out: (i) OePPO2 with its diphenolase activity, which is very active in the oxidative degradation of phenols during oil extraction and also seems to be highly involved in the natural defense mechanism in response to biotic stress, and (ii) OePPO3, which codes for a tyrosinase protein, having diphenolase but also monophenolase activity, which catalyzes the hydroxylation of tyrosol to form hydroxytyrosol.

N,N-Dimethyldithiocarbamate Elicits Pneumococcal Hypersensitivity to Copper and Macrophage-Mediated Clearance.

Streptococcus pneumoniae is a Gram-positive, encapsulated bacterium that is a significant cause of disease burden in pediatric and elderly populations. The rise in unencapsulated disease-causing strains and antimicrobial resistance in S. pneumoniae has increased the need for developing new antimicrobial strategies. Recent work by our laboratory has identified N,N-dimethyldithiocarbamate (DMDC) as a copper-dependent antimicrobial against bacterial, fungal, and parasitic pathogens. As a bactericidal antibiotic against S. pneumoniae, DMDC's ability to work as a copper-dependent antibiotic and its ability to work in vivo warranted further investigation. Here, our group studied the mechanisms of action of DMDC under various medium and excess-metal conditions and investigated DMDC's interactions with the innate immune system in vitro and in vivo. Of note, we found that DMDC plus copper significantly increased the internal copper concentration, hydrogen peroxide stress, nitric oxide stress, and the in vitro macrophage killing efficiency and decreased capsule. Furthermore, we found that in vivo DMDC treatment increased the quantity of innate immune cells in the lung during infection. Taken together, this study provides mechanistic insights regarding DMDC's activity as an antibiotic at the host-pathogen interface.

The Infestation of Olive Fruits by Bactrocera oleae (Rossi) Modifies the Expression of Key Genes in the Biosynthesis of Volatile and Phenolic Compounds and Alters the Composition of Virgin Olive Oil.

Bactrocera oleae, the olive fruit fly, is one of the most important pests affecting the olive fruit, causing serious quantitative and qualitative damage to olive oil production. In this study, the changes induced by B. oleae infestation in the biosynthesis of volatile and phenolic compounds in olive (cvs. Picual, Manzanilla, and Hojiblanca) have been analyzed. Despite cultivar differences, the oils obtained from infested fruits showed a significant increase in the content of certain volatile compounds such as (E)-hex-2-enal, ethanol, ethyl acetate, and ß-ocimene and a drastic decrease of the phenolic contents. The impact of those changes on the inferred quality of the oils has been studied. In parallel, the changes induced by the attack of the olive fly on the expression of some key genes in the biosynthesis of volatile and phenolic compounds, such as lipoxygenase, ß-glucosidase, and polyphenol oxidase, have been analyzed. The strong induction of a new olive polyphenol oxidase gene (OePPO2) explains the reduction of phenolic content in the oils obtained from infested fruits and suggest the existence of a PPO-mediated oxidative defense system in olives.

Multivariate analysis to select chemical compounds and rheological parameters as predictors of bread quality: interaction of wheat genotype and particle size of fine bran.

This assay was performed to select chemical compounds and rheological parameters for the prediction of the bread volume and crumb firmness of breads made with a blend of wheat flour-fine bran, using multivariate analysis. Two main factors were used, the source of fine bran and the particle size of fine bran. The experiment consisted in a completely random design, in a 2 × 3 factorial arrangement, the statistical analysis shown that the particle size of fine bran influence almost all the analytical variables. In addition, discriminant analysis was performed to analyse which rheological parameters and chemical components show the greater influence on dough behaviour and bread quality. Biaxial extensional viscosity, farinograph consistency, dough development time and stability were the main rheological parameters that govern the specific volume and crumb firmness and, were both closely related to the fibre, protein and starch content in the flour-fine bran blends. Particle size-genotype interaction has a significant influence on gelatinisation enthalpy and biaxial extensional viscosity that change the bread volume and the crumb firmness. The simplicity of linear equation of five independent variables to predict bread quality with high levels of accuracy could be advantageous in both basic research and the routine quality control of wheat mills. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-021-05290-3.

Liver Transplantation for Acute Intermittent Porphyria.

Recurrent attacks of acute intermittent porphyria (AIP) result in poor quality of life and significant risks of morbidity and mortality. Liver transplantation (LT) offers a cure, but published data on outcomes after LT are limited. We assessed the pretransplant characteristics, complications, and outcomes for patients with AIP who received a transplant. Data were collected retrospectively from the European Liver Transplant Registry and from questionnaires sent to identified transplant and porphyria centers. We studied 38 patients who received transplants in 12 countries from 2002 to 2019. Median age at LT was 37 years (range, 18-58), and 34 (89%) of the patients were women. A total of 9 patients died during follow-up, and 2 patients were retransplanted. The 1-year and 5-year overall survival rates were 92% and 82%, which are comparable with other metabolic diseases transplanted during the same period. Advanced pretransplant neurological impairment was associated with increased mortality. The 5-year survival rate was 94% among 19 patients with moderate or no neuropathy at LT and 83% among 10 patients with severe neuropathy (P = 0.04). Pretransplant renal impairment was common. A total of 19 (51%) patients had a GFR < 60 mL/minute. Although few patients improved their renal function after LT, neurological impairments improved, and no worsening of neurological symptoms was recorded. No patient had AIP attacks after LT, except for a patient who received an auxiliary graft. LT is a curative treatment option for patients with recurrent attacks of AIP. Severe neuropathy and impaired renal function are common and increase the risk for poor outcomes. If other treatment options fail, an evaluation for LT should be performed early.

Does body size influence mating success? A morphometric study of two Anastrepha (Diptera: Tephritidae) fruit fly species.

Male mating success depends on various traits and factors, and correctly identifying these traits can be key in the context of pest management. For tephritid pests, controlled through the sterile insect technique (SIT) traits, such as male size, can be manipulated through mass-rearing procedures. Thus, it is particularly important to understand whether male size can favor mating success. Here, we evaluated mating success of males of different sizes in Anastrepha ludens and Anastrepha obliqua, two species controlled through SIT. For both species, a morphometric analysis was performed of mated and unmated mass-reared and wild males in field cages. In both A. ludens and A. obliqua, wild females did not discriminate their mates based on male size and mated more frequently with wild males regardless of size. For mass-reared males, we found no evidence of an advantage of the large males compared to small males in mating success. However, we did find differences between the morphometric traits of mass-reared and wild males. In A. ludens, traits associated to mating success were Face Width (FW), Head Width (HW), Thorax Length (TL) and Wing Length (WL), and for A. obliqua were FW, HW, WL and WW (Wing Width). Overall, FW and TL were more consistent predictors of mating success. In conclusion, female choice seems to suggest multivariate selection, confirming that overall body size (expressed as pupal diameter, which is highly correlated with weight) is not a decisive factor in male mating success in these two species. However, morphological traits such as FW, HW, TL, WL and WW may be relevant in mating preference of wild female.

Study of the olive ß-glucosidase gene family putatively involved in the synthesis of phenolic compounds of virgin olive oil.

BACKGROUND: Hydrolysis of the fruit phenolic glucosides occurring during the oil extraction process is the main biochemical reaction affecting the biosynthesis and accumulation of secoiridoid compounds in virgin olive oil. An integrated approach at the molecular, biochemical, and metabolic level was used to study the olive ß-glucosidase gene family in seven olive cultivars selected by their different phenolic profiles. RESULTS: Eight ß-glucosidase genes have been identified by in silico analysis of an olive transcriptome. Their expression levels were analyzed by reverse transcription quantitative polymerase chain reaction in olive fruits at different ripening stages: I, green fruits, 16-19 weeks after flowering (WAF); II, yellow-green fruits, 22-25 WAF; III, turning fruits, 28-31 WAF; and IV, fully ripe fruits, 35-40 WAF. Gene expression was compared with the level of ß-glucosidase activity in the fruit and with the phenolic composition of fruits and oils from different olive cultivars. Phylogenetic analysis of the encoded proteins and differences found among the ß-glucosidase genes based on Gene Ontology enrichment analysis data suggests maximum involvement of two genes, OeBGLU1A and OeBGLU1B, in the phenolic composition of virgin olive oil. Positive correlation coefficients were found within each olive cultivar between OeBGLU1A and OeBGLU1B gene expression data and the phenolic content of the oil. CONCLUSION: The results obtained suggest that the expression pattern of specific ß-glucosidase genes may be an accurate predictor for the phenolic content of virgin olive oil that could be used in olive breeding programs. © 2021 Society of Chemical Industry.

Experience with tocilizumab in severe COVID-19 pneumonia after 80 days of follow-up: A retrospective cohort study.

OBJECTIVES: To describe the clinical characteristics and predictors of major outcomes in patients treated with tocilizumab (TCZ) for severe COVID-19 pneumonia. PATIENTS AND METHODS: Case series of all sequential patients with severe COVID-19 pneumonia treated with TCZ at an Academic Spanish hospital (March 12 - May 2, 2020). Clinical outcomes: death, length of hospital stay. An early clinical response to TCZ (48-72 h after the administration) was assessed by variations in respiratory function markers, Brescia COVID Respiratory Severity Scale (BCRSS), inflammatory parameters, and patients' and physicians' opinion. Associations were tested by multiple logistic regression. RESULTS: From a cohort of 236 patients, 77 patients treated with TCZ were included (median age 62 years (IQR 53.0-72.0), 64.9% were males), 42.9% had Charlson index ≥3; hypertension (41.6%), obesity (34.7%), and diabetes (20.8%). Median follow-up was 83.0 days (78.0-86.5), no patient was readmitted. ICU admission was required for 42 (54.5%), invasive mechanical ventilation in 38 (49.4%) and 10 patients died (12.9% global, 23.8% at ICU admitted). After multivariate adjustment, TCZ response by BCRSS (OR 0.03 (0.01-0.68), p = 0.028), and Charlson index (OR 3.54 (1.20-10.44), p = 0.022) has been identified as independent factors associated with mortality. Median of hospital stay was 16.0 days (11.0-23.0); BCRSS, physician subjective and D-dimer response were associated with shorter hospitalization stay. CONCLUSIONS: In a Mediterranean cohort, use of tocilizumab for severe COVID-19 show 12.9% of mortality. Early TCZ-response by BCRSS and low comorbidity were associated with increased survival. Early TCZ-response was related to shorter median hospital stay.

MMP11 expression in intratumoral inflammatory cells in breast cancer.

AIMS: It is known that matrix metalloproteinase (MMP)-11 has a role in tumour development and progression, and also that immune cells can influence cancer cells to increase their proliferative and invasive properties. The aim of the present study was to propose the evaluation of MMP11 expression by intratumoral mononuclear inflammatory cells (MICs) as a useful biological marker for breast cancer prognosis. METHODS AND RESULTS: This study comprised 246 women with invasive breast carcinoma, and a long follow-up period. Patients were stratified with regard to nodal status and to the development of metastatic disease. The median follow-up period in patients without metastasis was 146 months and in patients with metastatic disease 31 months. MMP11 was determined by immunohistochemistry. For relapse-free survival (RFS) and overall survival (OS) analysis we used the Cox's univariate method. Cox's regression model was used to examine the interactions between different prognostic factors in a multivariate analysis. CONCLUSIONS: Our results showed that MMP11 expression by stromal cells was significantly associated with prognosis. MMP11 expression by cancer-associated fibroblasts (CAFs) was associated with both shortened RFS and OS, but MMP11 expression by MICs showed a stronger association with both shortened RFS and OS, therefore being the most potent and independent factor to predict RFS and OS.

A Concept Analysis of Trauma Coercive Bonding in the Commercial Sexual Exploitation of Children.

BACKGROUND: The sex trafficking of adolescents is known as commercial sexual exploitation of children (CSEC). CSEC is a complex phenomenon where identification requires understanding of developmental disruptions from toxic bonding experiences that increase in complexity over time. These toxic bonding experiences forced through coercive methods disrupt the holistic development of a self in the CSEC victim that interferes with daily functions, decision-making and social and emotional development. Lacking in the literature is a conceptual foundation for trauma coerced bonding. PURPOSE: The purpose of the analysis is to define and clarify the future concept of trauma coerced bonding from trauma bonding as it relates to CSEC victimization. METHODS: The concept analysis used Rodgers' evolutionary method to search four databases (PubMed, CINHAL, Scopus, and Google Scholar [for grey literature]), using terms associated with various descriptions of trauma bonding (for instance, Stockholm syndrome), resulting in twenty papers for review. RESULTS: Attributes, antecedents, and consequences of trauma bonding were delineated and explained. It became apparent through this analysis that the concept of trauma bonding of adolescents exposed to CSEC is very different from other forms of trauma bonding, leading this author to a more precise term, trauma-coercive bonding. Trauma coercive bonding is a long process that is a developmentally disruptive form of bonding that has ramifications throughout the life span. DISCUSSION: Trauma coercive bonding is influenced by more than just an emotional bond. The proposed definition of trauma coercive bonding brings an in-depth description of vulnerabilities and disruptions to childhood when CSEC, which persists long into adulthood. CONCLUSION: Future qualitative research should pursue a grounded theory of trauma coercive bonding to further explain and study this phenomenon.

Xanthommatin is Behind the Antioxidant Activity of the Skin of Dosidicus gigas.

Marine bioactive compounds have been found in very different sources and exert a very vast array of activities. Squid skin, normally considered a discard, is a source of bioactive compounds such as pigments. Recovering these compounds is a potential means of valorizing seafood byproducts. Until now, the structure and molecular properties of the bioactive pigments in jumbo squid skin (JSS) have not been established. In this study, methanol-HCl (1%) pigment extracts from JSS were fractionated by open column chromatography and grouped by thin-layer chromatography in order to isolate antioxidant pigments. Antioxidant activity was determined by the 2,2-diphenyl-1-picrylhydrazyl (DPPH●) and 2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS●+) radical scavenging assays and ferric reducing power (FRAP) assay. Fractions 11-34 were separated and grouped according to flow rate values (F1-F8). Fractions F1, F3, and F7 had the lowest IC50 against ABTS●+ per milligram, and fractions F3 and F7 showed the lowest IC50 in the FRAP assay. Finally, fraction F7 had the highest DPPH● scavenging activity. The chemical structure of the F7 fraction was characterized by infrared spectroscopy, 1H nuclear magnetic resonance, and electrospray ionization-mass spectrometry. One of the compounds identified in the fraction was xanthommatin (11-(3-amino-3-carboxypropanoyl)-1-hydroxy-5-oxo-5H-pyrido[3,2-a]phenoxazine-3-carboxylic acid) and their derivatives (hydro- and dihydroxanthommatin). The results show that JSS pigments contain ommochrome molecules like xanthommatin, to which the antioxidant activity can be attributed.

Effect of Extrusion Conditions and the Optimization of Phenolic Compound Content and Antioxidant Activity of Wheat Bran Using Response Surface Methodology.

The extrusion process (EP) consists of heat and mechanical treatments under different conditions of moisture, shear, and pressure and rapidly causes structural alterations and changes in the functional properties of the extruded material. The aim of this study was to evaluate the effect of extrusion conditions and optimize the wheat bran extrusion conditions to achieve the greatest content of phenolic compounds and antioxidant activity using response surface methodology. The EP factors evaluated were feed moisture (FM) (25-33.54%) and final extrusion temperature (T) (140-180 °C). The properties evaluated in the extruded material were bound total phenol content (BTPC), total phenolic compounds and antioxidant activity (AOX). Analysis of variance (ANOVA) and response surface methodology were used in the evaluation. The determination coefficients, (FM)2 and (T)2, very significantly affected the BTPC and bound 2,2-diphenyl-1-picrylhydrazyl content (BDPPHC). The optimization was performed by overlaying two contour plots to predict the best combination regions. The optimized extrusion conditions were the following: FM = 30% and T = 140 °C, which provided BTPC = 3547.01 µgGAE/g (predicted: 3589.3 µgGAE/g) and BDPPHC = 9.5 µmolTE/g (predicted: 10.4 µmolTE/g); and FM = 30% and T = 180 °C, which provided BTPC = 3342.3 µgGAE/g (predicted: 3727.7 µgGAE/g) and BDPPHC = 9.5 µmolTE/g (predicted: 9.3 µmolTE/g). The EP increased the phenolic compounds and AOX, and enhancement of these properties in wheat bran products could make them functional foods.

Molecular and biochemical characterization of the OLE-1 high-oleic castor seed (Ricinus communis L.) mutant.

MAIN CONCLUSION: The natural OLE-1 high-oleic castor mutant has been characterized, demonstrating that point mutations in the FAH12 gene are responsible for the high-oleic phenotype. The contribution of each mutation was evaluated by heterologous expression in yeast, and lipid studies in developing OLE-1 seeds provided new evidence of unusual fatty acids channeling into TAGs. Ricinus communis L. is a plant of the Euphorbiaceae family well known for producing seeds whose oil has a very high ricinoleic (12-hydroxyoctadecenoic) acid content. Castor oil is considered the only commercially renewable source of hydroxylated fatty acids, which have many applications as chemical reactants. Accordingly, there has been great interest in the field of plant lipid biotechnology to define how ricinoleic acid is synthesized, which could also provide information that might serve to increase the content of other unusual fatty acids in oil crops. Accordingly, we set out to study the biochemistry of castor oil synthesis by characterizing a natural castor bean mutant deficient in ricinoleic acid synthesis (OLE-1). This mutant accumulates high levels of oleic acid and displays remarkable alterations in its seed lipid composition. To identify enzymes that are critical for this phenotype in castor oil, we cloned and sequenced the oleate desaturase (FAD2) and hydroxylase (FAH12) genes from wild-type and OLE-1 castor bean plants and analyzed their expression in different tissues. Heterologous expression in yeast confirmed that three modifications to the OLE-1 FAH12 protein were responsible for its weaker hydroxylase activity. In addition, we studied the expression of the genes involved in this biosynthetic pathway at different developmental stages, as well as that of other genes involved in lipid biosynthesis, both in wild-type and mutant seeds.

Sunflower (Helianthus annuus) fatty acid synthase complex: ß-hydroxyacyl-[acyl carrier protein] dehydratase genes.

MAIN CONCLUSION: Two sunflower hydroxyacyl-[acyl carrier protein] dehydratases evolved into two different isoenzymes showing distinctive expression levels and kinetics' efficiencies. ß-Hydroxyacyl-[acyl carrier protein (ACP)]-dehydratase (HAD) is a component of the type II fatty acid synthase complex involved in 'de novo' fatty acid biosynthesis in plants. This complex, formed by four intraplastidial proteins, is responsible for the sequential condensation of two-carbon units, leading to 16- and 18-C acyl-ACP. HAD dehydrates 3-hydroxyacyl-ACP generating trans-2-enoyl-ACP. With the aim of a further understanding of fatty acid biosynthesis in sunflower (Helianthus annuus) seeds, two ß-hydroxyacyl-[ACP] dehydratase genes have been cloned from developing seeds, HaHAD1 (GenBank HM044767) and HaHAD2 (GenBank GU595454). Genomic DNA gel blot analyses suggest that both are single copy genes. Differences in their expression patterns across plant tissues were detected. Higher levels of HaHAD2 in the initial stages of seed development inferred its key role in seed storage fatty acid synthesis. That HaHAD1 expression levels remained constant across most tissues suggest a housekeeping function. Heterologous expression of these genes in E. coli confirmed both proteins were functional and able to interact with the bacterial complex 'in vivo'. The large increase of saturated fatty acids in cells expressing HaHAD1 and HaHAD2 supports the idea that these HAD genes are closely related to the E. coli FabZ gene. The proposed three-dimensional models of HaHAD1 and HaHAD2 revealed differences at the entrance to the catalytic tunnel attributable to Phe166/Val1159, respectively. HaHAD1 F166V was generated to study the function of this residue. The 'in vitro' enzymatic characterization of the three HAD proteins demonstrated all were active, with the mutant having intermediate K m and V max values to the wild-type proteins.

Nasoalveolar Molding Therapy for the Treatment of Unilateral Cleft Lip and Palate Improves Nasal Symmetry and Maxillary Alveolar Dimensions.

OBJECTIVE: The aim of this study is to assess the esthetic and morphologic outcomes before surgery using nasoalveolar molding (NAM) therapy in children with unilateral cleft lip and palate. DESIGN: A prospective analysis was performed. SETTING: The study was carried out in the Congenital Malformations Craniofacial and Cleft Lip and Palate Unit, Hospital Virgen de las Nieves, Andalusian Health Service, Granada (Spain). PATIENTS: Twenty consecutively enrolled infants ranging in age from 7 to 30 days with nonsyndromic unilateral cleft lip and palate treated from 2008 to 2012. INTERVENTIONS: All patients were treated with NAM appliances to align the alveolar segments and reduce severity of the nasal deformity. MAIN OUTCOME MEASURE: The extraoral nasal measurements were performed on casts and nasal photographs. The measurements consisted of bialar width (BAW), columellar deviation (CD), cleft nostril height (CNH), cleft nostril width (CNW), non-CNH, non-CNW, and the deviation of the columella to the horizontal line represented by bilateral pupil line (BIA). The authors have made the measurements following Barilla method. Also 2 intraoral measurements were taken. RESULTS: Following NAM the extraoral records showed a statistically significant decrease in CD (P < 0.0001), CNW (P < 0.0001), and BAW (P < 0.001). Furthermore, statistically significant increases in CNH (P < 0.05) and BIA (P < 0.0001) were observed.Following Barilla measurements, the authors have found a high percentage of symmetry in all the nasal measurements after the NAM therapy.Intraoral results showed a statistically significant decrease in the gap between the greater and lesser alveolar segments and a statistically significant increase in maxillary arch width. CONCLUSIONS: Nasoalveolar molding improves nasal symmetry and achieves an improvement of all maxillary alveolar dimensions, increasing alveolar rim width, reducing the size of alveolar cleft gap, and improving shape of the maxillary dental arch. As a consequence of reducing the alveolar and nasal deformities before surgery, it is expected that the primary repair will be easier for the surgeon and more successful.

Analyzing the concept of disruptive behavior in healthcare work: an integrative review.

OBJECTIVE: To analyze the concept of disruptive behavior in healthcare work. METHOD: An integrative review carried out in the theoretical phase of a qualitative research substantiated by the theoretical framework of the Hybrid Model of Concept Development. The search for articles was conducted in the CINAHL, LILACS, PsycINFO, PubMed and SciVerse Scopus databases in 2013. RESULTS: 70 scientific articles answered the guiding question and lead to attributes of disruptive behavior, being: incivility, psychological violence and physical/sexual violence; with their main antecedents (intrapersonal, interpersonal and organizational) being: personality characteristics, stress and work overload; and consequences of: workers' moral/mental distress, compromised patient safety, labor loss, and disruption of communication, collaboration and teamwork. CONCLUSION: Analysis of the disruptive behavior concept in healthcare work showed a construct in its theoretical stage that encompasses different disrespectful conduct adopted by health workers in the hospital context, which deserve the attention of leadership for better recognition and proper handling of cases and their consequences. OBJETIVO: Analisar o conceito comportamento destrutivo no trabalho em saúde. MÉTODO: Revisão integrativa realizada na fase teórica de pesquisa qualitativa fundamentada pelo referencial teórico-metodológico do Modelo Híbrido de Análise de Conceitos. A busca dos artigos foi realizada nas bases de dados CINAHL, LILACS, PsycINFO, PubMed e SciVerse Scopus, em 2013. RESULTADOS: 70 artigos científicos responderam à questão norteadora e atenderam aos critérios de inclusão, permitindo evidenciar os atributos do comportamento destrutivo: incivilidade, violência psicológica e violência física/sexual; seus principais antecedentes (intrapessoais, interpessoais e organizacionais): características de personalidade, estresse e sobrecarga de trabalho; e consequentes: sofrimento moral/psíquico dos trabalhadores, comprometimento da segurança do paciente, prejuízos laborais, rompimento da comunicação, da colaboração e do trabalho em equipe. CONCLUSÃO: A análise do conceito comportamento destrutivo no trabalho em saúde evidenciou, em sua fase teórica, um constructo que abrange diferentes condutas desrespeitosas adotadas por trabalhadores de saúde no contexto hospitalar, merecendo atenção de lideranças da área para maior reconhecimento e manejo adequado dos casos e suas consequências.

Correction to "Assessment of the Trust Crisis between Upstream and Downstream States of the Helmand River Basin (1973-2022): A Half-Century of Optimism or Cynicism?"

[This corrects the article DOI: 10.1021/acsestwater.2c00428.].

Severe Gastrointestinal Cytomegalovirus Infection in a Patient Diagnosed with Late Onset Combined Immunodeficiency.

Late onset combined immunodeficiency (LOCID) is a rare variant of common variable immunodeficiency (CVID), typically affecting adult patients who present with opportunistic infections (OI) and/or low CD4+ T lymphocytes. Diagnostic delay is common due to the rareness of this entity, increasing morbidity and mortality. We report on a 66-year-old male who developed a severe gastrointestinal cytomegalovirus (CMV) infection, refractory to antiviral treatment and anti-cytomegalovirus specific human immunoglobulin administration, with a fatal outcome due to an undiagnosed LOCID. LEARNING POINTS: Infections in patients with primary immunodeficiencies (PIDs) could be more severe and life-threatening than in immunocompetent hosts.PIDs are not exclusive to paediatric patients; diagnostic delay is common, and they should also be suspected in adulthood.Diagnostic delay in PID patients is associated with more morbidity and mortality.

Adherence to quality indicators for emergency department treatment of acute poisoning according to patient sex. / Grado de cumplimiento de los indicadores de calidad según el sexo del paciente en las intoxicaciones agudas en urgencias.

OBJECTIVES: To study differences in the emergency department treatment of acute poisoning according to biological sex of patients and to assess adherence to care quality indicators. MATERIAL AND METHODS: Retrospective observational study including all cases of acute poisoning diagnosed in patients over the age of 14 years treated in a tertiary care hospital emergency department over a period of 4 years. We analyzed demographic variables, substance type and reason for acute poisoning, degree of adherence to quality indicators, and discharge destination. RESULTS: A total of 1144 cases were included; 710 patients (62.1%) were female and 434 (37.9%) were male. The proportion of deliberate self-poisoning was higher in females (52.3% vs 41.4% in males; P .001); unintentional poisoning was less frequent in females (in 24.9% vs in 30.3% of males; P = .047). Benzodiazepine poisoning was more frequent in females (in 49.6% vs 41.2%; P = .007). Street drug and alcohol poisoning was less common in females. Adherence to quality indicators was high (> 85%) for both sexes. CONCLUSION: The epidemiologic profile of poisoning is different in females and males. General emergency department adherence to quality indicators can be considered optimal. We detected no qualitative sex-related differences in the care of patients with acute poisoning.

OBJETIVO: Estudiar las diferencias dependiendo del sexo en la atención de pacientes con intoxicaciones agudas en urgencias y en el grado de cumplimiento de los indicadores de calidad (IC). METODO: Estudio observacional y retrospectivo, que incluyó todos los casos de intoxicación aguda de pacientes mayores de 14 años atendidos en el servicio de urgencias de un hospital terciario durante 4 años. Se analizaron variables demográficas, tipo de tóxicos y causa de la intoxicación, el grado de cumplimiento de los IC y destino al alta. RESULTADOS: Se registraron 1.144 casos, un 62,1% (n = 710) eran mujeres. Las mujeres tuvieron mayor número de intoxicaciones voluntarias (52,3% vs 41,4%; p 0,001) y menos de manera accidental (24,9% vs 30,3%; p = 0,047). Los fármacos más frecuentes en mujeres fueron las benzodiacepinas (49,6% vs 41,2%; p = 0,007), y las intoxicaciones por drogas de abuso y alcohol fueron menores que en hombres. Hubo un alto grado de cumplimiento en la mayoría de los IC (> 85%) en ambos sexos. CONCLUSIONES: El perfil epidemiológico de la intoxicación aguda en mujeres es diferente al de los hombres. En general se puede considerar como óptimo el cumplimiento de los IC en urgencias. No existen diferencias cualitativas en la asistencia del paciente intoxicado con respecto a su sexo.