Acute bronchiolitis: The economic impact of non-compliance with national guidelines.

INTRODUCTION: Acute bronchiolitis is a common reason for admission to the pediatric emergency department. Evidence has shown that most interventions do not change the natural course of the disease. MATERIAL AND METHODS: This study aimed to evaluate the economic impact of the non-compliance with the acute bronchiolitis Portuguese national guideline. A retrospective study of pediatric emergency episodes of a Portuguese hospital that had a diagnosis of acute bronchiolitis during 2019, was conducted. RESULTS: The sample included 344 emergency episodes. Non-compliance with the guideline occurred in 71.8% of the episodes, mostly due to unjustified treatment. Following guideline in the studied hospital for one year would have resulted in an estimated overall 76.6% cost reduction, with a reduction in mean direct costs per patient of 14.93 €, corresponding to a medium saving of 3.89 € for each patient and a reduction of 11.03 € for the Portuguese National Health Service. Analyzing the unjustified mean direct costs, of these 2.97 € were related to inpatient diagnostic tests and therapeutic and the remaining 11.96 € were related to outpatient therapy. Mean direct costs imputed to the patient for outpatient treatment represented only 3.31 €, therefore most of mean direct costs is paid by the National Health Service. CONCLUSIONS: Compliance with guideline would allow the reduction of total estimated costs by about 76.6%, representing a waste of resources, without compromising the quality of care provided. Most of the cost associated with non-compliance with the guideline is justified by outpatient therapy, 67% of which was paid by the National Health Service.

Sugarcane productivity and economic viability in response to planting density.

Planting with higher density in sugarcane is one of the practices used to overcome low productivity. However, this planting material is equivalent to 25% of the total cost of production, being one of the main expenses for cultivation. In this sense, the present work aims to evaluate the productivity and economic viability of sugarcane as a function of planting density. The experiment was carried out at Usina Monte Alegre in the municipality of Mamanguape, Paraíba, Brazil, from March 2021 to January 2022 with the variety RB92579. Seven planting density were studied: T1: 7 gems m-1, T2: 10 gems m-1, T3: 12 gems m-1, T4: 11 gems m-1, T5: 15 gems m-1, T6: 17 gems m-1, T7: 24 gems m-1, in randomized blocks with four replications. Growth, productivity and economic viability were evaluated. The highest productivity of cane and sugar, 77.69 ton ha-1 and 10.390 ton ha-1, respectively, was with planting density of 17 and 24 gems-1. While the minimum productivity of cane (61.313 ton ha-1) and sugar (7.924 ton ha-1) was recorded at sowing density of 7 and 11 gems-1. However, cultivation density with 7 and 10 gems m-1 were the ones that provided the highest profitability around 50%, followed by density of 12, 15 and 17 gems m-1 with an average of 45% profit and 11 and 24 gems m-1 with the lowest proportion of profit on average 38%. The cultivation with 17 gems m-1 of cane provides in cane-plant, variety RB92579, greater productivity with a profit rate of 45%, being the most suitable.

Swine manure treatment technologies as drivers for circular economy in agribusiness: A techno-economic and life cycle assessment approach.

Anaerobic digestion has been employed as a technology capable of adding value to waste coupled with environmental impact mitigation. However, many issues need to be elucidated to ensure the systems viability based on this technology. In this sense, the present study evaluated technically, environmentally, and economically, four configurations of swine waste treatment systems focused on the promotion of decarbonization and circularity of the swine chain. For this, a reference plant, based on a compact treatment process named SISTRATES® (Portuguese acronym for swine effluent treatment system) was adopted to serve as a model for comparison and validation. The results showed the importance of prioritization of the energy recuperation routes through anaerobic digestion, providing increased economic benefits and minimizing environmental damage. Thus, the SISTRATES® configuration was the one that presented the best designs in a circular context, maximizing the recovery of energy and nutrients, along with the reduction of greenhouse gas emissions, ensuring the sustainability of the pig production chain.

Homogenization method for microscopic characterization of the composite magnetoelectric multiferroics.

Tuning of magnetization or electrical polarization using external fields other than their corresponding conjugate fields (i.e., magnetic field for the former or electric field for the latter response) attracts renewed interest due to its potential for applications. The magnetoelectric effect in multiferroic 1-3 composite composed of alternating magnetic and ferroelectric layers operating in linear regime consequent to external biasing fields is simulated and analysed theoretically. Two-scale homogenization procedure to arrive at the equilibrium overall physical properties of magnetoelectric multiferroic composite is formulated using variational analysis. This procedure is extended to quantify the underlying local (microscopic) electric, magnetic and elastic fields and thereby compute local distribution of stresses and strains, electrical and magnetic potentials, the electric and magnetic fields as well as the equivalent von Mises stresses. The computational model is implemented by modifying the software POSTMAT (material postprocessing). Computed local stress/strain profiles and the von Mises stresses consequent to biasing electrical and magnetic fields provide insightful information related to the magnetostriction and the ensuing electrical and magnetic polarization. Average polarization and magnetization against magnetic and electric fields respectively are computed and found to be in reasonable limits of the experimental results on similar composite systems. The homogenization model covers multiferroics and its composites regardless of crystallographic symmetry (with the caveat of assuming an ideal and semi-coherent interface connecting the constituent phases) and offer computational efficiency besides unveiling the nature of the underlying microscopic field characteristics.

Maternal high fat diet consumption reduces liver alpha7 nicotinic cholinergic receptor expression and impairs insulin signalling in the offspring.

The activation of nicotinic acetylcholine receptor α7 subunit (α7nAChR) has been associated to anti-inflammatory response in macrophages. High-fat diet (HFD) consumption during pregnancy and lactation impairs the cholinergic anti-inflammatory pathway in liver and white adipose tissue of offspring. In order to evaluate the relationship between damage in the cholinergic anti-inflammatory pathway and insulin resistance (IR) development, the liver of offspring of obese dams was investigated. Additionally, the capacity of α7nAChR activation to reduce IR induced by saturated fatty acid was investigated in hepatoma cell line. Initially, female mice were subjected to either standard chow (SC) or HFD during pregnancy and lactation period. After weaning, only male offspring from HFD dams (HFD-O) and SC dams (SC-O) were fed with the SC diet. Hepatic α7nAChR expression was downregulated, and hepatic TNF-α, IL-1ß, and pIKK level, but not pJNK, were elevated in the HFD-O compared to SC-O mice. Besides, hepatic expression of TNF-α in response to lipopolysaccharide (LPS) was higher in HFD-O than SC-O mice. Insulin-stimulated phosphorylation of the AKT was lower in HFD-O compared to SC-O. Additionally, insulin-stimulated phosphorylation of the AKT in KOα7Alb-Cre mice fed HFD was lower than WT mice fed HFD. In hepatoma cell line, palmitate increased IL-6 and TNF-α expressions and pJNK level. These effects were accompanied by reduced capacity of insulin to stimulate AKT phosphorylation. PNU or nicotine reduced cytokine expression and JNK activation, but improved insulin resistance induced by palmitate. Our results suggest that maternal obesity impairs hepatic α7nAChR expression and AKT phosphorylation in the offspring. In vitro studies suggest that α7nAChR activation has potential to reduce deleterious effect of saturated fatty acids on insulin signalling.

The Fitness and Economic Benefits of Rearing the Parasitoid Telenomus podisi Under Fluctuating Temperature Regime.

Successful biological control requires detailed knowledge about the mass rearing conditions of the control agents in order to ensure higher quality of field-released insects. Thus, we investigated whether rearing fluctuating thermal condition would affect the fitness and costs of the parasitoid wasp Telenomus podisi Ashmead (a biocontrol agent used for controlling the Neotropical brown stink bug Euschistus heros (Fabricius)) when compared with parasitoid reared at constant temperature condition, which is commonly used in insect facilities. Parasitoids were reared under either constant (continuous exposure at 25 ± 2°C) or fluctuating temperature conditions (i.e., 30 ± 2°C during day and 20 ± 2°C at night) during four consecutive generations. Our results indicated that tested fluctuating temperature is more suitable for rearing of T. podisi as such temperature condition not only resulted in fitness benefits (e.g., shorter developmental time, longer female longevity, higher fecundity/fertility) but also reduced (approximately 23.5%) the estimated costs for producing the parasitoids. Furthermore, rearing T. podisi under fluctuating temperatures improved tolerance to low constant temperatures (i.e., 20°C) without changing the tolerance to constant high temperatures (30°C) in the fourth generation. Surprisingly, even parasitoids that developed under fluctuating thermal conditions performed better than those reared at constant temperature of 25°C. Collectively, our findings suggest that T. podisi reared under fluctuating thermal condition can tolerate better fluctuating temperatures that normally occur both during long periods of transport and in agricultural ecosystems, which will increase the quality and productivity of mass-reared T. podisi for inundative releases.

Solutions for maximum coupling in multiferroic magnetoelectric composites by material design.

Electrical control of magnetization offers an extra degree of freedom in materials possessing both electric and magnetic dipole moments. A stochastic optimization combined with homogenization is applied for the solution for maximum magnetoelectric (ME) coupling coefficient α of a laminar ME composite with the thickness and orientation of ferroelectric phase as design variables. Simulated annealing with a generalized Monte Carlo scheme is used for optimization problem. Optimal microstructure with single and poly-crystalline configurations that enhances the overall α is identified. It is found that juxtaposing a preferentially oriented ferroelectric material with a ferromagnetic ferrite into a composite would result in manifold increase in magnetoelectric coupling. The interface shear strains are found to be richly contributing to the ME coupling. The preferential orientation of the ferroelectric phase in the optimal ME composite laminate is demonstrated using the optimal pole figure analyses.

Epaphroditidae sensu novo, an Endemic Caribbean Family of Morphologically Divergent Praying Mantises (Insecta, Mantodea).

Three endemic Caribbean praying mantis genera with a complex taxonomic history were recently discovered to be part of a lineage that colonized the Caribbean region during the Cretaceous period (Svenson & Rodrigues, Proc R Soc B Biol Sci 284, 2017). In all classification systems proposed up to now, the three genera, Callimantis, Epaphrodita, and Gonatista, were never considered as close relatives, a reflection of their divergent morphology. More recently, the genus Brancsikia was placed with Epaphrodita in a family based on the similarity of camouflage-related morphology. To address recent phylogenetic results that do not track current classification, we compared the morphology of the three Caribbean genera with each other and representative members of traditional or current family groups. Our morphological analysis of external and male genital characters provides strong support for the Caribbean lineage despite the divergent morphological evolution present in the three genera. We raise this Caribbean lineage to family status by employing a precedent family-group name, Epaphroditidae Brunner de Wattenwyl, 1893 sensu novo. We remove Brancsikia from our new concept of Epaphroditidae, rendering the genus incertae sedis.

Thermal Requirements and Performance of the Parasitoid Trichogramma pretiosum (Hymenoptera: Trichogrammatidae) on Helicoverpa armigera (Lepidoptera: Noctuidae) Eggs Under Variable Temperatures.

Temperature causes physiological and behavioral changes in egg parasitism. Egg parasitoids are a possible alternative for the control of Lepidoptera pests. The cotton bollworm Helicoverpa armigera (Hübner) is a generalist pest that has recently been introduced into Brazil. We evaluated the suitability of H. armigera eggs as hosts for Trichogramma pretiosum Riley and the effects of temperature (18-33°C) on its survival and development. We assessed the developmental time (egg adult), thermal requirements, age-specific fertility, and parasitism rate upon eggs of H. armigera at six different temperatures. Linear and nonlinear (Brière2) models were fitted to our data in order to describe the relationship between developmental rate and temperature for the immature stages of T. pretiosum and estimate the thermal constant (K), lower developmental temperature threshold (LT), optimum temperature for development (Topt), and upper developmental temperature threshold (Tmax). The estimated K and LT estimated by linear model were 130.38 degree days and 10.3°C, respectively. The T0, Topt, and Tmax by Brière model were 11.52, 32.89, and 41.1°C, respectively. Females of T. pretiosum developed at each temperature were assessed, and parasitism rate was above 75% on the first day, except at 30°C where it took 2 d to reach 75%. At 33°C, the highest rate of parasitism was 38%. The life table parameters predict population increases across the temperature range evaluated. The results demonstrated that T. pretiosum are suitable for the control of H. armigera, and the best performance will be achieved when used in regions with temperatures up to 30°C.

Eating flowers? Exploring attitudes and consumers' representation of edible flowers.

Edible flowers have gained more attention in recent years thanks to their perceived health benefits. Despite this attention, it seems that edible flowers are not popularized for consumption in South America, being considered unfamiliar for some cultures from this continent. In this context, the general goal of the present study was to investigate the three dimensions of social representation theory, the representational field, the information and the attitude of the two conditions of edible flowers: a more general "food made with flowers" and more directional product "yoghurt made with flowers", using Brazilian consumers. To achieve this goal, a free word association task was applied. A total of 549 consumers participated in this study. Participants were divided into two conditions, in which the inductor expressions for the free word association task changed: (a) food products made with flowers and (b) yoghurt made with flowers. Results showed a very positive attitude to both situations, and consumers associated Food products made with flowers to "health care" while the central core of yoghurt made with flowers reflected the innovative condition of this product, supported here by their unpredictable character (information generated).

Pneumococcal nasopharyngeal carriage among children in Brazil prior to the introduction of the 10-valent conjugate vaccine: a culture- and PCR-based survey.

We performed two different approaches (broth enrichment step prior to culture (BEC) and PCR (BEPCR)) for detecting Streptococcus pneumoniae from nasopharyngeal specimens collected from 242 children aged <6 years attending one hospital (n = 140) and one childcare centre (n = 102) in a major urban area in Brazil. These specimens were collected immediately before the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) and the 13-valent vaccine (PCV13) for routine use in Brazil. Results were compared with previous findings obtained with direct culture (DC) on a selective medium. Colonisation prevalence was 58·3% (n = 141), being higher among children attending the childcare centre (62·7% vs. 55%). The culture-based methods (DC and BEC) enabled the detection of S. pneumoniae in 119 (49·2%) and 115 (47·5%) children, respectively. The PCR-based method (BEPCR) was more sensitive and 137 (56·6%) carriers were identified. Twenty-six serogroups/serotypes were identified, predominantly 6B, 19F, 14, 6A, 15C and 23F. Multiple colonisation was observed in 13 (5·4%) children. The estimated serotypes coverage of available PCVs was 40·4% for the 10-valent (included in the Brazilian immunisation programme) and 55·8% for the 13-valent (only available in private clinics). The use of robust approaches to obtain a more realistic insight about the asymptomatic carrier status is of paramount importance to estimate and assess the impact of vaccine implementation. The combination between culture-based and molecular methods constitutes a suitable strategy.

Bacterial short-chain fatty acid metabolites modulate the inflammatory response against infectious bacteria.

Short-chain fatty acids (SCFAs), predominantly acetic, propionic, and butyric acids, are bacterial metabolites with an important role in the maintenance of homeostasis due to their metabolic and immunomodulatory actions. Some evidence suggests that they may also be relevant during infections. Therefore, we aimed to investigate the effects of SCFAs in the effector functions of neutrophils to an opportunistic pathogenic bacterium, Aggregatibacter actinomycetemcomitans. Using a subcutaneous model to generate a mono, isolated infection of A. actinomycetemcomitans, we demonstrated that the presence of the SCFAs in situ did not affect leukocyte accumulation but altered the effector mechanisms of migrating neutrophils by downregulating the production of cytokines, their phagocytic capacity, and killing the bacteria, thus impairing the containment of A. actinomycetemcomitans. Similar effects were observed with bacteria-stimulated neutrophils incubated with SCFAs in vitro. These effects were independent of free-fatty acid receptor 2 (FFAR2) activation, the main SCFA receptor expressed on neutrophils, occurring possibly through inhibition of histone deacetylases because similar effects were obtained by using histone deacetylase inhibitors, such as SAHA, MS-275, and RGFP 966. Considering the findings of this study, we hypothesized that in an infectious condition, SCFAs may exert a detrimental effect on the host by inhibiting neutrophil's effector functions.

On-farm Campylobacter and Escherichia coli in commercial broiler chickens: Re-used bedding does not influence Campylobacter emergence and levels across sequential farming cycles.

Limitations in quality bedding material have resulted in the growing need to re-use litter during broiler farming in some countries, which can be of concern from a food-safety perspective. The aim of this study was to compare the Campylobacter levels in ceca and litter across three litter treatments under commercial farming conditions. The litter treatments were (a) the use of new litter after each farming cycle; (b) an Australian partial litter re-use practice; and (c) a full litter re-use practice. The study was carried out on two farms over two years (Farm 1, from 2009-2010 and Farm 2, from 2010-2011), across three sheds (35,000 to 40,000 chickens/shed) on each farm, adopting three different litter treatments across six commercial cycles. A random sampling design was adopted to test litter and ceca for Campylobacter and Escherichia coli, prior to commercial first thin-out and final pick-up. Campylobacter levels varied little across litter practices and farming cycles on each farm and were in the range of log 8.0-9.0 CFU/g in ceca and log 4.0-6.0 MPN/g for litter. Similarly the E. coli in ceca were ∼log 7.0 CFU/g. At first thin-out and final pick-up, the statistical analysis for both litter and ceca showed that the three-way interaction (treatments by farms by times) was highly significant (P<0.01), indicating that the patterns of Campylobacter emergence/presence across time vary between the farms, cycles and pickups. The emergence and levels of both organisms were not influenced by litter treatments across the six farming cycles on both farms. Either C. jejuni or C. coli could be the dominant species across litter and ceca, and this phenomenon could not be attributed to specific litter treatments. Irrespective of the litter treatments in place, cycle 2 on Farm 2 remained Campylobacter-free. These outcomes suggest that litter treatments did not directly influence the time of emergence and levels of Campylobacter and E. coli during commercial farming.

The mGluR5 positive allosteric modulator, CDPPB, ameliorates pathology and phenotypic signs of a mouse model of Huntington's disease.

Huntington's disease (HD) is an autosomal-dominant neurodegenerative disorder caused by a polyglutamine expansion in the amino-terminal region of the huntingtin protein (htt), leading to motor dysfunction, cognitive decline, psychiatric alterations, and death. The metabotropic glutamate receptor 5 (mGluR5) has been implicated in HD and we have recently demonstrated that mGluR5 positive allosteric modulators (PAMs) are neuroprotective in vitro. In the present study we demonstrate that the mGluR5 PAM, CDPPB, is a potent neuroprotective drug, in vitro and in vivo, capable of delaying HD-related symptoms. The HD mouse model, BACHD, exhibits many HD features, including neuronal cell loss, htt aggregates, motor incoordination and memory impairment. However, chronic treatment of BACHD mice with CDPPB 1.5 mg/kg s.c. for 18 weeks increased the activation of cell signaling pathways important for neuronal survival, including increased AKT and ERK1/2 phosphorylation and augmented the BDNF mRNA expression. CDPPB chronic treatment was also able to prevent the neuronal cell loss that takes place in the striatum of BACHD mice and decrease htt aggregate formation. Moreover, CDPPB chronic treatment was efficient to partially ameliorate motor incoordination and to rescue the memory deficit exhibited by BACHD mice. Importantly, no toxic effects or stereotypical behavior were observed upon CDPPB chronic treatment. Thus, CDPPB is a potential drug to treat HD, preventing neuronal cell loss and htt aggregate formation and delaying HD symptoms.

Desferrioxamine treatment of porphyria cutanea tarda in a patient with HIV and chronic renal failure.

Porphyria cutanea tarda (PCT) can occur in HIV patients. Current evidence suggests that HIV infection may interfere with the hepatic cytochrome oxidase system, leading to porphyrin metabolism impairment. Moreover, chronic hemodialysis in renal failure may be a risk factor for PCT. In addition to the contributory factors for PCT associated to HIV infection, it is possible that porphyrin accumulation secondary to renal failure may play a role in the expression of this disease. We report a case of PCT in an HIV-1 infected patient under blood dialysis, refractory to antimalarials and controlled with desferrioxamine.

Randomized controlled trials of maternal-fetal surgery: a challenge to clinical equipoise.

This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as a criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable.

Body composition and survival in the early clinical trials setting.

PURPOSE: Delineate the relationships between body composition parameters, 90-day mortality and overall survival, and correlate them with known prognostic factors in an early clinical trials clinic. PATIENTS AND METHODS: We studied 306 consecutive patients with various tumours; body composition was analysed by computerised tomography images. Survival was measured from the first clinic visit, at 90-day period and until death/last follow-up visit. RESULTS: Median patient age was 56 years; 159 patients were men. Ninety-day mortality rate was 12%. Median overall survival was 9 months. In multivariate analyses, high MD Anderson Cancer Center (MDACC) score (p < 0.0001) [lactate dehydrogenase (LDH) > normal, albumin < normal, Eastern Cooperative Oncology Group (ECOG) performance status > 1, metastatic sites > 2, gastrointestinal (GI) tumours], low skeletal muscle index (SMI) (p = 0.0406) and male gender (p = 0.0077) were independent predictors of poor survival. If Royal Marsden Hospital (RMH) score (LDH > normal, albumin 2) was used in lieu of MDACC score, it was also significant (p = 0.0003). Including SMI and gender in the MDACC or RMH score improved the accuracy of the original model (p = 0.006 and p = 0.0037, respectively). CONCLUSION: Patients with low SMI have shorter survival. Gender and SMI strengthens the accuracy of MDACC or RMH scores as prognostic tools. Prospective validation of these findings is warranted.

Dotting the I's and crossing the T's: autonomy and/or beneficence? The 'fetus as a patient' in maternal-fetal surgery.

Chervenak and McCullough, authors of the most acknowledged ethical framework for maternal-fetal surgery, rely on the 'ethical-obstetrical' concept of the fetus as a patient in order to determine what is morally owed to fetuses by both physicians and the women who gestate them in the context of prenatal surgery. In this article, we reconstruct the argumentative structure of their framework and present an internal criticism. First, we analyse the justificatory arguments put forward by the authors regarding the moral status of the fetus qua patient. Second, we discuss the internal coherence and consistency of the moral obligations those authors derive from that concept. We claim that some of the dilemmas their approach is purported to avoid, such as the debate about the independent moral status of the fetus, and the foundation of the moral obligations of pregnant women (towards the fetuses they gestate) are not, all things considered, avoided. Chervenak and McCullough construct the obligations of physicians as obligations towards entities with equal moral status. But, at the same time, they assume that the woman has an independent moral status while the moral status of the fetus is dependent on the decision of the woman to present it to a physician for care. According to the logic of their own argumentation, Chervenak and McCullough implicitly admit a different moral status of the woman and the fetus, which will lead to different ascription of duties of the physician than those they ascribed.

Pre- and posttransplant monitoring of alloantibodies by complement-dependent cytotoxicity and luminex methodologies in liver transplantation.

BACKGROUND: This study evaluated the influence of circulating anti-HLA antibodies on outcomes of 97 liver allografts from deceased donors. METHODS: Human leukocyte antigen (HLA) antibody screening was performed by both complement-dependent cytotoxicity (CDC) and multiparameter Luminex microsphere-based assays (Luminex assay). RESULTS: The agreements between T- and B- cell CDC and Luminex assays were 67% and 77% for pre- and posttransplant specimens, respectively. Graft dysfunction was not associated with either positive pretransplant CDC or Luminex panel-reactive antibody (PRA) values. Likewise, positive posttransplant T- or B- cell CDC PRA values were not associated with graft dysfunction. In contrast, posttransplant Luminex PRA values were significantly higher among patients with graft dysfunction compared with subjects with good outcomes (P = .017). CONCLUSION: Posttransplant monitoring of HLA antibodies with Luminex methodology allowed identification of patients at high-risk for poor graft outcomes.