The Essentials of Multiomics.

Within the last decade, the science of molecular testing has evolved from single gene and single protein analysis to broad molecular profiling as a standard of care, quickly transitioning from research to practice. Terms such as genomics, transcriptomics, proteomics, circulating omics, and artificial intelligence are now commonplace, and this rapid evolution has left us with a significant knowledge gap within the medical community. In this paper, we attempt to bridge that gap and prepare the physician in oncology for multiomics, a group of technologies that have gone from looming on the horizon to become a clinical reality. The era of multiomics is here, and we must prepare ourselves for this exciting new age of cancer medicine.

Lecithin:cholesterol acyltransferase: symposium on 50 years of biomedical research from its discovery to latest findings.

LCAT converts free cholesterol to cholesteryl esters in the process of reverse cholesterol transport. Familial LCAT deficiency (FLD) is a genetic disease that was first described by Kaare R. Norum and Egil Gjone in 1967. This report is a summary from a 2017 symposium where Dr. Norum recounted the history of FLD and leading experts on LCAT shared their results. The Tesmer laboratory shared structural findings on LCAT and the close homolog, lysosomal phospholipase A2. Results from studies of FLD patients in Finland, Brazil, Norway, and Italy were presented, as well as the status of a patient registry. Drs. Kuivenhoven and Calabresi presented data from carriers of genetic mutations suggesting that FLD does not necessarily accelerate atherosclerosis. Dr. Ng shared that LCAT-null mice were protected from diet-induced obesity, insulin resistance, and nonalcoholic fatty liver disease. Dr. Zhou presented multiple innovations for increasing LCAT activity for therapeutic purposes, whereas Dr. Remaley showed results from treatment of an FLD patient with recombinant human LCAT (rhLCAT). Dr. Karathanasis showed that rhLCAT infusion in mice stimulates cholesterol efflux and suggested that it could also enhance cholesterol efflux from macrophages. While the role of LCAT in atherosclerosis remains elusive, the consensus is that a continued study of both the enzyme and disease will lead toward better treatments for patients with heart disease and FLD.

Optimization and dust emissions analysis of the air jigging technology applied to the recycling of construction and demolition waste.

This work aims to evaluate the use of the air jigging technique, a density-based separation technology commonly applied in mineral processing, to upgrade the quality of mixtures (density and geometric properties) that represents the typical composition of construction and demolition waste (CDW) produced in Brazil. In this sense, tests involving the variation of the main operational parameters of jigging (bed expansion rate, pulsation frequency and jigging time) were carried out aiming to find those which provided the best recycled aggregates quality after processing. Also, fines and dust emissions generation during jigging were measured in order to estimate their potential impacts on human health and environment. The results showed that the air jigging process is adequate to improve the quality of CDW by increasing the concrete concentration in the dense product. The use of high bed expansion rates showed to be of major importance to decrease the content of ceramic aggregates in the dense product, allowing obtaining products richer in concrete. Also, the measured properties of the obtained aggregates (size distribution, shape, etc) met the usual standards required for natural aggregates. Finally, material losses and dust emissions generated were negligible in comparison to the total mass processed, although special attention must be given to safety measures due the presence of inhalable particles (<10 µm).

Demolished concretes recycling by the use of pneumatic jigs.

Large quantities of construction and demolition waste is generated annually around the world. Part of this material is processed in recycling plants. After removing metals, fines and lights, the construction and demolition waste is crushed and sized and can be used as aggregates for low resistance concrete, for road sub-base, city landfill and other low value-added applications. For their use as coarse aggregate in structural concretes, construction and demolition waste must exhibit high densities and regularity of the material. This material usually is presented in demolished concretes. About 20% of the particles from demolished concretes can be used as coarse aggregates substituting part of natural aggregates in structural concretes. This article presents studies of demolished concretes recycling by the use of a pneumatic jig. All jigging tests were carried out with three different concretes produced in three strength classes: C16/20, ordinary concrete; C50/60, high strength concrete; and C70/85, very high strength concrete. Based on density distribution of the three concretes, there are reasonable masses with densities over 2.7 g cm-3, particle density considered appropriate to the used as coarse aggregate for structural concretes. The concretes present different mass recoveries of the denser particles (different liberation). Coarse aggregates can be recovered with reasonable masses by the use of air jigs: About 65% for high strength concretes and about 75% for the low strength concrete. The jigging concentration efficiency depends on the concrete liberation, density and size distribution.

The Respect That Other Deserves: A Game Between Forces and Weaknesses in the Field of Health Care.

Caring for people with diminished faculties and forms of disease and handicap that break down their personality places high demands on care staff. Anchored in a caring science with a holistic and humanistic approach, this article analyzes the trajectories of control that emerge in nurse care interactions. A suggested answer is the responsibility of the nurse to be aware of the power inequality, to recognize the potential for patients to feel intimidated, and to create a therapeutic alliance. The right use of power in the nurse-patient interaction guarantees that the patient's needs are foremost and the patient's vulnerability is sheltered.

Current Applications of Recycled Aggregates from Construction and Demolition: A Review.

A literature review comprising 163 publications published over a period of 26 years from 1992 to 2018 is presented in this paper. This review discusses the generation and recycling of construction and demolition waste (CDW) as well as its main uses as raw materials for the construction engineering sector. This review pays attention to the use of CDW aggregates for sand, pavements/roads, bricks, ceramics, cementitious materials, and concrete productions, as well its uses as eco-friendly materials for water decontamination. The physical-chemical and mechanical characteristics of recycled aggregates play an important role in their correctly chosen applications. The results found in this literature survey allow us to conclude that recycled aggregates from CDW can be successfully used to produce construction materials with quality comparable to those produced with natural aggregates. We concluded that the use of CDWs as raw materials for manufacturing new construction materials is technically feasible, economical, and constitutes an environmentally friendly approach for a future construction and demolition waste management strategy.

Facile fabrication of hybrid titanium(IV) isopropoxide/pozzolan nanosheets (TnS-Pz) of high photocatalytic activity: characterization and application for Cr(VI) reduction in an aqueous solution.

This paper presents the synthesis of a hybrid material through the use of natural pozzolan and titanium(IV) isopropoxide using the sol-gel method and its application in the photocatalytic hexavalent chromium reduction. The characterization data indicated a mesoporous material possessing a surface area of 271.7 m2 g-1. The morphology studies (SEM and TEM) showed nanosheet hybrid structures. The analysis of DRUV, FTIR, XRD, and Mössbauer spectroscopy provides a different electronic structure of the synthetized material when compared with the originals, proving the hybridization process between pozzolan and titanium(IV) isopropoxide. The photocatalytic reduction of Cr(VI) to Cr(III) using the hybrid material showed a better performance than conventional photocatalysts (precursor and TiO2-P25). Operational conditions such as chromium initial concentration (0.02-0.20 mM), solution pH (3-6), and type of scavenger (citric or tartaric acid) were evaluated in order to determine the best experimental conditions for the Cr(VI) photoreduction. At their optimum (catalyst load of 15 mg L-1, tartaric acid as scavenger, [scavenger]0/[Cr(VI)]0 M ratio = 3:1, pH 3, and 25 °C), the total photoreduction of 0.20 mM Cr(VI) was achieved in 180 min. The novel hybrid materials synthesized from pozzolan and titanium(IV) isopropoxide showed to be a potential catalyst for the Cr(VI) reduction in aqueous solution. Graphical abstract.

Spotlight on International Quality: COVID-19 and Its Impact on Quality Improvement in Cancer Care.

This report from ASCO's International Quality Steering Group summarizes early learnings on how the COVID-19 pandemic and its stresses have disproportionately affected cancer care delivery and its delivery systems across the world. This article shares perspectives from eight different countries, including Austria, Brazil, Ghana, Honduras, Ireland, the Philippines, South Africa, and the United Arab Emirates, which provide insight to their unique issues, challenges, and barriers to quality improvement in cancer care during the pandemic. These perspectives shed light on some key recommendations applicable on a global scale and focus on access to care, importance of expanding and developing new treatments for both COVID-19 and cancer, access to telemedicine, collecting and using COVID-19 and cancer registry data, establishing measures and guidelines to further enhance quality of care, and expanding communication among governments, health care systems, and health care providers. The impact of the COVID-19 pandemic on cancer care and quality improvement has been and will continue to be felt across the globe, but this report aims to share these experiences and learnings and to assist ASCO's international members and our global fight against the pandemic and cancer.

A three-dimensional nanoscale study in selected coal mine drainage.

Sediments from coal mine drainages (CMDs) contain large quantities of suspended pollutants (possibly numerous chemical substances) along with sulfates and hazardous elements (e.g., chromium, zinc, copper, lead) that irreversibly accumulate in the water. As this accumulation can continue for decades after discontinuation of coal extraction, it is necessary to employ multidisciplinary approaches to control the threat in such zones. The quantity of amorphous material in some CMDs was evaluated by X-ray powder diffraction (XRD) using the Rietveld-based SIROQUANT software package. Modern Dual Beam Focused Ion Beam (FIB), field emission scanning electron microscopy (FE-SEM), high-resolution transmission electron microscope (H-TEM), and energy-dispersive X-ray spectrometer (EDS) were used to evaluate the occurrence and transformation of nanophases (NPs). FIB is used to determine the 3D distribution of different species (internal structure) within individual NPs, whereas EDS is used to observe NP features (e.g., shape, constituent, range, assembly, and form of polymerization). The mineralogy of the sediment from the Brazilian CMDs, including the proportions of quartz, clays, Al-Fe-oxides, and amorphous NPs, appears to be related to the nature of the mineral matter in the relevant coal cleaning rejects (CCRs). The sediments of CMDs from the Brazilian coal area derived at a lower-pH range have different amorphous compositions as compared to those derived at a higher pH range. These special amorphous compositions are shown to be related to several other sediment properties such as particle surface area. The information gleaned in this study will be useful for further geochemical evaluation of CMDs in other parts of the world.

Atmospheric nanocompounds on Lanzarote Island: Vehicular exhaust and igneous geologic formation interactions.

Atmosphere contamination management is one of the most important features in pollution risk management. The worldwide rise in tourism increases apprehension about its probable destructive conservation influence on various aspects of global conservation. One of the principal dangers increased by tourism-based modes of travel are nanoparticles (NPs) containing potentially hazardous elements (PHEs) contamination. One example of this is island destination of Lanzarote, in Spain's Canary Islands in which we examined contamination of the local atmosphere, water and soil. Important NPs containing PHEs, (e.g. arsenic, chromium, lead, and mercury), were found in this locale. It is reasonable to assume that this pollution poses an increased environmental danger to the local biome(s). Modes of transport (i.e. by car, airplane, bus) were shown to be an important contributor to this localized contamination as demonstrated by particulate matter (PM) readings collected near the island's airport. If no measures are taken to reduce vehicle and aircraft traffic, the tendency is to increase environmental degradation will continue unabated. As this particular area of Lanzarote is also one of wine production, increased pollution has the potential for negative impacts on the region's economy.

Can Creatine Supplementation Interfere with Muscle Strength and Fatigue in Brazilian National Level Paralympic Powerlifting?

The aim of the present study was to analyze the effect of creatine (Cr) supplementation on peak torque (PT) and fatigue rate in Paralympic weightlifting athletes. Eight Paralympic powerlifting athletes participated in the study, with 25.40 ± 3.30 years and 70.30 ± 12.15 kg. The measurements of muscle strength, fatigue index (FI), peak torque (PT), force (kgf), force (N), rate of force development (RFD), and time to maximum isometric force (time) were determined by a Musclelab load cell. The study was performed in a single-blind manner, with subjects conducting the experiments first with placebo supplementation and then, following a 7-day washout period, beginning the same protocol with creatine supplementation for 7 days. This sequence was chosen because of the lengthy washout of creatine. Regarding the comparison between conditions, Cr supplementation did not show effects on the variables of muscle force, peak torque, RFD, and time to maximum isometric force (p > 0.05). However, when comparing the results of the moments with the use of Cr and placebo, a difference was observed for the FI after seven days (U3: 1.12; 95% CI: (0.03, 2.27); p = 0.02); therefore, the FI was higher for placebo. Creatine supplementation has a positive effect on the performance of Paralympic powerlifting athletes, reducing fatigue index, and keeping the force levels as well as PT.

Phase III Trial of Adjuvant Capecitabine After Standard Neo-/Adjuvant Chemotherapy in Patients With Early Triple-Negative Breast Cancer (GEICAM/2003-11_CIBOMA/2004-01).

PURPOSE: Operable triple-negative breast cancers (TNBCs) have a higher risk of relapse than non-TNBCs with standard therapy. The GEICAM/2003-11_CIBOMA/2004-01 trial explored extended adjuvant capecitabine after completion of standard chemotherapy in patients with early TNBC. PATIENTS AND METHODS: Eligible patients were those with operable, node-positive-or node negative with tumor 1 cm or greater-TNBC, with prior anthracycline- and/or taxane-containing chemotherapy. After central confirmation of TNBC status by immunohistochemistry, patients were randomly assigned to either capecitabine or observation. Stratification factors included institution, prior taxane-based therapy, involved axillary lymph nodes, and centrally determined phenotype (basal v nonbasal, according to cytokeratins 5/6 and/or epidermal growth factor receptor positivity by immunohistochemistry). The primary objective was to compare disease-free survival (DFS) between both arms. RESULTS: Eight hundred seventy-six patients were randomly assigned to capecitabine (n = 448) or observation (n = 428). Median age was 49 years, 55.9% were lymph node negative, 73.9% had a basal phenotype, and 67.5% received previous anthracyclines plus taxanes. Median length of follow-up was 7.3 years. DFS was not significantly prolonged with capecitabine versus observation [hazard ratio (HR), 0.82; 95% CI, 0.63 to 1.06; P = .136]. In a preplanned subgroup analysis, nonbasal patients seemed to derive benefit from the addition of capecitabine with a DFS HR of 0.53 versus 0.94 in those with basal phenotype (interaction test P = .0694) and an HR for overall survival of 0.42 versus 1.23 in basal phenotype (interaction test P = .0052). Tolerance of capecitabine was as expected, with 75.2% of patients completing the planned 8 cycles. CONCLUSION: This study failed to show a statistically significant increase in DFS by adding extended capecitabine to standard chemotherapy in patients with early TNBC. In a preplanned subset analysis, patients with nonbasal phenotype seemed to obtain benefit with capecitabine, although this will require additional validation.

Illness trajectory in heart failure: narratives of family caregivers.

OBJECTIVE: To explore the meaning of being a family caregiver for a relative with advanced heart failure (HF) in their own home, and to gain an understanding of how dignity is upheld in family caregiving contexts. METHOD: We used a phenomenological-hermeneutical method inspired by the Ricoeurian philosophy. Portuguese caregivers for relatives with advanced HF participated in two reflective interviews over a four-month period. RESULTS: The ten family caregivers enrolled in this study included two daughters and eight spouses with a mean age of 70 years. We identified two main themes: (1) Struggle between inner force and sense of duty; (2) Struggle between feelings of burden and security. FINAL CONSIDERATIONS: People with HF have debilitating symptoms associated with psychological stress, which can burden both them and their family caregivers. Findings support that family caregivers require participation in the planning and execution of their relative's health care.

"When illness dictates who I am": A hermeneutic approach to older adults with heart disease.

BACKGROUND AND PURPOSE: Heart failure (HF) is increasing in prevalence and will continue to do so with an aging population. Few studies describe, from a lifeworld perspective, the experiences of elderly people who are very ill and living with advanced HF, and how meaning about personal dignity in daily life is created. METHODS: Data were collected by in-depth interviews with 12 Portuguese older people with advanced HF. The transcribed texts from the interviews were analyzed using the phenomenological hermeneutical method. FINDINGS: The results demonstrate two main themes: the perspective of oneself as vulnerable and as a significant person. CONCLUSION: Findings demonstrate the need for health care professionals to find an approach that ensures both quality medical care and, at the same time, acknowledges the uniqueness of each subject. From the elderly people's stories, it is clear that in order to retain a sense of dignity people need to be seen and respected for who they are. The information about life stories is often used to make possible biographical oriented care.

Giant Renal Angiomyolipoma Following Ovarian Stimulation Therapy.

Renal angiomyolipomas (AMLs) are benign tumors with higher prevalence in women. Female hormones have been shown to induce AML enlargement. This case refers to a 40-year-old woman with 4 left kidney AMLs, the larger ones with 1.0 and 1.3 cm. Ten months after ovarian stimulation for egg harvesting, a computed tomography revealed an 18-cm AML with large-caliber vessels. Given her high risk of AML bleeding, the patient was submitted to selective arterial embolization, which turned out unsuccessful, supporting a plan of nephron-sparing surgery. Our case highlights the pro-growth effects of female hormones on AML, with particular emphasis to ovarian stimulation.

Activated carbons from avocado seed: optimisation and application for removal of several emerging organic compounds.

In this study, avocado seed was successfully used as raw material for producing activated carbons by conventional pyrolysis. In order to determine the best condition to produce the activated carbons, a 22 full-factorial design of experiment (DOE) with three central points was employed by varying the temperature and time of pyrolysis. The two evaluated factors (temperature and time of pyrolysis) strongly influenced the SBET, pore volumes, hydrophobicity-hydrophilicity ratio (HI) and functional groups values; both factors had a negative effect over SBET, pore volumes and functional groups which means that increasing the values of factors leads to decrease of these responses; on the other hand, with regards to HI, both factors caused a positive effect which means that increasing their values, the HI has an enhancement over its values. The produced activated carbon exhibited high specific surface areas in the range of 1122-1584 m2 g-1. Surface characterisation revealed that avocado seed activated carbons (ASACs) have hydrophilic surfaces and have predominantly acidic groups on their surfaces. The prepared ASACs were employed in the adsorption of 25 emerging organic compounds such as 10 pharmaceuticals and 15 phenolic compounds which presented high uptake values for all emerging pollutants. It was observed that the activated carbon prepared at higher temperature of pyrolysis (700 °C), which generated less total functional groups and presented higher HI, was the activated carbon with higher sorption capacity for uptaking emerging organic contaminants. Based on results of this work, it is possible to conclude that avocado seed can be employed as a raw material to produce high surface area and very efficient activated carbons in relation to treatment of polluted waters with emerging organic pollutants.

Usage of air jigging for multi-component separation of construction and demolition waste.

The use of air jigging for performing multi-component separation in the treatment of mixed construction and demolition waste was studied. Sorting tests were carried out with mixtures of equal bulk volume of concrete and brick in which fixed quantities of unwanted materials - gypsum, wood and paper - were added. Experimental results have demonstrated the possibility to use air jigging to carry out both the removal of low-density contaminants and the concrete concentration in only one process step. In relation to the removal of contaminants only, the overall performance of jigging process can be comparable with that of commercial air classifiers and automatic sorting systems. Also, the initial content of contaminants seems does not have a significant effect on the separation extent. These results are of particular importance for recycling plants processing as they represent an alternative to optimize the use of air jigs. Further investigation is needed in order to evaluate the practical feasibility of such method.

Estimation of Premature Deaths From Lack of Access to Anti-HER2 Therapy for Advanced Breast Cancer in the Brazilian Public Health System.

PURPOSE: Patients with human epidermal growth factor receptor 2 (HER2) -positive metastatic tumors treated in the public health system in Brazil do not have access to trastuzumab. This study aimed to estimate the impact of the lack of access to anti-HER2 therapies on the mortality of these patients. METHODS: On the basis of published data, the number of patients with HER2-positive advanced breast cancer in 2016 who should receive anti-HER2 targeted therapy was estimated. Three different treatment groups were considered for this hypothetical cohort: chemotherapy alone, chemotherapy plus trastuzumab, and chemotherapy plus trastuzumab and pertuzumab. The number of patients alive after 2 years of follow-up was estimated on the basis of the efficacy results of the pivotal trials considering these interventions. RESULTS: It was calculated that 2,008 women will be diagnosed with advanced HER2-positive breast cancer in Brazil in 2016. It was estimated that only 808 women would be alive in 2018 if they receive only chemotherapy (which is the treatment offered by the public health system). On the other hand, the bar rises to 1,408 women alive in 2018 if they receive chemotherapy plus trastuzumab and 1,576 women alive in 2018 if they receive the gold standard of chemotherapy plus trastuzumab and pertuzumab. CONCLUSION: Trastuzumab is included in the WHO's list of essential medications, but the Brazilian public health system does not yet provide this treatment to its population with advanced disease. The introduction of trastuzumab and pertuzumab would have a positive effect, preventing premature deaths in women with metastatic HER2-positive breast cancer in Brazil.

Nanominerals and potentially hazardous elements from coal cleaning rejects of abandoned mines: Environmental impact and risk assessment.

Soils around coal mining are important reservoir of hazardous elements (HEs), nanominerals, and ultrafine compounds. This research reports and discusses the soil concentrations of HEs (As, Cd, Cr, Cu, Ni, Pb, and Zn) in coal residues of abandoned mines. To assess differences regarding environmental impact and risk assessment between coal abandoned mines from the Santa Catarina state, eighteen coal cleaning rejects with different mineralogical and chemical composition, from eight abandoned mines were collected. Nanominerals and ultra-fine minerals from mining-contaminated areas were analyzed by X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), and high-resolution transmission electron microscope (HR-TEM), providing new information on the mineralogy and nano-mineralogy of these coal residues. The total contents of 57 elements (HEs, alkali metals, and rare earth elements) were analyzed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The calculation of NWACs (Normalized Average Weighted Concentration), together with the chemometric analysis by Principal component analysis (PCA) confirmed the variability of the samples regarding their city and their mine of origin. Moreover, the results confirmed the existence of hotspots in mines near urban areas.

Nanomineralogy in the real world: A perspective on nanoparticles in the environmental impacts of coal fire.

Detailed geochemistry similarities between the burning coal cleaning rejects (BCCRs) and non-anthropogenic geological environments are outlined here. While no visible flames were detected, this research revealed that auto-combustion existed in the studied area for many years. The occurrence of several amorphous phases, mullite, hematite and many other Al/Fe-minerals formed by high temperature was found. Bad disposal of coal-dump wastes represents significant environmental concerns due to their potential influence on atmosphere, river sediments, soils and as well as on the surface and groundwater in the surroundings of these areas. The present work using multi-analytical techniques were performed to provide an improved understanding of the complex processes related with sulphide-rich coal waste oxidation, spontaneous combustion and newmineral creation. It recording huge numbers of rare minerals with alunite, montmorillonite, szmolnockite, halotrichite, coquimbite and copiapite at the BCCRs. The information presented the presence of abundant amorphous Si-Al-Fe-Ti as (oxy-)hydroxides and Fe-hydro/oxides with goethite and hematite with various degrees of crystallinity, containing potential hazardous elements (PHEs), such as Cu, Cr, Hf, Hg, Mo, Ni, Se, Pb, Th, U, Zr, and others. Most of the nano-particles and ultra-fine particles found in the burned coal-dump wastes are the same as those commonly associated with coal cleaning rejects, in which oxidation of sulphides plays an important impact to environment and subsequently animal and human health.