Effects of climate and land-use change scenarios on fire probability during the 21st century in the Brazilian Amazon.

The joint and relative effects of future land-use and climate change on fire occurrence in the Amazon, as well its seasonal variation, are still poorly understood, despite its recognized importance. Using the maximum entropy method (MaxEnt), we combined regional land-use projections and climatic data from the CMIP5 multimodel ensemble to investigate the monthly probability of fire occurrence in the mid (2041-2070) and late (2071-2100) 21st century in the Brazilian Amazon. We found striking spatial variation in the fire relative probability (FRP) change along the months, with October showing the highest overall change. Considering climate only, the area with FRP ≥ 0.3 (a threshold chosen based on the literature) in October increases 6.9% by 2071-2100 compared to the baseline period under the representative concentration pathway (RCP) 4.5 and 27.7% under the RCP 8.5. The best-case land-use scenario ("Sustainability") alone causes a 10.6% increase in the area with FRP ≥ 0.3, while the worse-case land-use scenario ("Fragmentation") causes a 73.2% increase. The optimistic climate-land-use projection (Sustainability and RCP 4.5) causes a 21.3% increase in the area with FRP ≥ 0.3 in October by 2071-2100 compared to the baseline period. In contrast, the most pessimistic climate-land-use projection (Fragmentation and RCP 8.5) causes a widespread increase in FRP (113.5% increase in the area with FRP ≥ 0.3), and prolongs the fire season, displacing its peak. Combining the Sustainability land-use and RCP 8.5 scenarios causes a 39.1% increase in the area with FRP ≥ 0.3. We conclude that avoiding the regress on land-use governance in the Brazilian Amazon (i.e., decrease in the extension and level of conservation of the protected areas, reduced environmental laws enforcement, extensive road paving, and increased deforestation) would substantially mitigate the effects of climate change on fire probability, even under the most pessimistic RCP 8.5 scenario.

High Serum Thyrotropin Concentrations within the Reference Range: A Predictor of Malignancy in Nodular Thyroid Disease.

OBJECTIVE: This study assessed whether or not a simple biochemical parameter, serum thyrotropin (TSH), within the reference range can predict the likelihood of thyroid malignancy in subjects undergoing fine-needle aspiration biopsy (FNAB) for thyroid nodules. SUBJECTS AND METHODS: This cross-sectional study evaluated 236 patients without overt thyroid dysfunction who were not on levothyroxine therapy. They underwent FNAB of the thyroid nodules at the Clementino Fraga Filho University Hospital between 2011 and 2012. The reference range and serum TSH quartiles were determined according to age-specific values for serum TSH and then compared between the cases with benign thyroid nodular disease and differentiated thyroid carcinoma (DTC) based on surgical pathology reports. RESULTS: Of the 236 patients, 201 (85.1%) underwent a surgical procedure (thyroidectomy) and 89/236 (44.3%) had DTC. The mean TSH concentrations were 2.09 ± 1.15 mU/L in benign patients versus 2.73 ± 1.33 mU/L in cases of DTC (p < 0.01). As TSH increased from quartiles 1 to 4, the frequency of a malignant diagnosis also increased progressively from 22% in quartile 1 to 65% in the last quartile (p ≤ 0.001). CONCLUSION: Thyrotropin levels were positively associated with the diagnosis of DTC in thyroid nodules.

Land use change emission scenarios: anticipating a forest transition process in the Brazilian Amazon.

Following an intense occupation process that was initiated in the 1960s, deforestation rates in the Brazilian Amazon have decreased significantly since 2004, stabilizing around 6000 km(2) yr(-1) in the last 5 years. A convergence of conditions contributed to this, including the creation of protected areas, the use of effective monitoring systems, and credit restriction mechanisms. Nevertheless, other threats remain, including the rapidly expanding global markets for agricultural commodities, large-scale transportation and energy infrastructure projects, and weak institutions. We propose three updated qualitative and quantitative land-use scenarios for the Brazilian Amazon, including a normative 'Sustainability' scenario in which we envision major socio-economic, institutional, and environmental achievements in the region. We developed an innovative spatially explicit modelling approach capable of representing alternative pathways of the clear-cut deforestation, secondary vegetation dynamics, and the old-growth forest degradation. We use the computational models to estimate net deforestation-driven carbon emissions for the different scenarios. The region would become a sink of carbon after 2020 in a scenario of residual deforestation (~1000 km(2) yr(-1)) and a change in the current dynamics of the secondary vegetation - in a forest transition scenario. However, our results also show that the continuation of the current situation of relatively low deforestation rates and short life cycle of the secondary vegetation would maintain the region as a source of CO2 - even if a large portion of the deforested area is covered by secondary vegetation. In relation to the old-growth forest degradation process, we estimated average gross emission corresponding to 47% of the clear-cut deforestation from 2007 to 2013 (using the DEGRAD system data), although the aggregate effects of the postdisturbance regeneration can partially offset these emissions. Both processes (secondary vegetation and forest degradation) need to be better understood as they potentially will play a decisive role in the future regional carbon balance.

Deforestation scenarios for the Bolivian lowlands.

Tropical forests in South America play a key role in the provision of ecosystem services such as carbon sinks, biodiversity conservation, and global climate regulation. In previous decades, Bolivian forests have mainly been deforested by the expansion of agricultural frontier development, driven by the growing demands for beef and other productions. In the mid-2000s the Movimiento al Socialismo (MAS) party rose to power in Bolivia with the promise of promoting an alternative development model that would respect the environment. The party passed the world's first laws granting rights to the environment, which they termed Mother Earth (Law No. 300 of 2012), and proposed an innovative framework that was expected to develop radical new conservation policies. The MAS conservationist discourse, policies, and productive practices, however, have since been in permanent tension. The government continues to guarantee food production through neo-extractivist methods by promoting the notion to expand agriculture from 3 to 13 million ha, risking the tropical forests and their ecosystem services. These actions raise major environmental and social concerns, as the potential impacts of such interventions are still unknown. The objective of this study is to explore an innovative land use modeling approach to simulate how the growing demand for land could affect future deforestation trends in Bolivia. We use the LuccME framework to create a spatially-explicit land cover change model and run it under three different deforestation scenarios, spanning from the present-2050. In the Sustainability scenario, deforestation reaches 17,703,786 ha, notably in previously deforested or degraded areas, while leaving forest extensions intact. In the Middle of the road scenario, deforestation and degradation move toward new or paved roads spreading across 25,698,327 ha in 2050, while intact forests are located in Protected Areas (PAs). In the Fragmentation scenario, deforestation expands to almost all Bolivian lowlands reaching 37,944,434 ha and leaves small forest patches in a few PAs. These deforestation scenarios are not meant to predict the future but to show how current and future decisions carried out by the neo-extractivist practices of MAS government could affect deforestation and carbon emission trends. In this perspective, recognizing land use systems as open and dynamic systems is a central challenge in designing efficient land use policies and managing a transition towards sustainable land use.

Celiac Disease and Cystic Fibrosis: Challenges to Differential Diagnosis.

Cystic fibrosis and celiac disease were considered a single clinical entity for many years. Differentiation between the diseases occurred some time in the 1930s of the 20th Century. Both diseases may present the intestinal malabsorption syndrome and similar clinical manifestations that contribute to difficulties with clinical distinction. We describe a report of two patients with initial diagnosis of cystic fibrosis, who were subsequently diagnosed with celiac disease. These case reports emphasize the possibility of false positivity being shown in the sweat test in CD, which may result in delayed diagnosis and inadequate management of this disease.

Searching for the best approach to assess teachers' perception of inattention and hyperactivity problems at school.

Although major guidelines in the field and current diagnostic criteria clearly demand an assessment of children's attention deficit/hyperactivity disorder (ADHD) symptoms at school, few studies address the fundamental question of which is the best approach for clinicians to get this information from teachers. Three screening strategies for ADHD were applied to teachers of 247 third grade students. They were asked (1) an overt question about potential cases of ADHD in their classroom; (2) to complete a broad-band questionnaire assessing common child mental health problems; (3) to rate ADHD-specific symptoms in a narrow-band questionnaire. Based on the overt question, teachers identified one in five students (21.1 %) as having ADHD; 28 cases (11.3 %) were identified using standard cut-offs for the narrow-band, and 13 (5.3 %) using a standard threshold for the sub-scale of hyperactivity from the broad-band questionnaire. Agreement among strategies was low (k = 0.28). A subsample of students, clinically assessed to confirm screenings, showed modest agreement with final diagnosis. The narrow-band questionnaire had the best diagnostic performance. Multivariate analysis indicated that the presence of a comorbid externalizing disorder was the only variable associated with teachers' ascertainment of ADHD caseness or non-caseness. Choice of screening strategy significantly affects how teachers report on ADHD symptoms at school. The halo effect of externalizing behaviors impacts the correct identification of true cases of ADHD in the school setting. Clinicians can rely on narrow-band instruments like the SNAP-IV to get information on ADHD symptoms at school from teachers.

Correlations between clinical parameters, blastocyst morphological classification and embryo euploidy.

OBJECTIVE: The aim of the present study was to evaluate clinical and embryo parameters to predict embryo ploidy. METHODS: In this retrospective analysis, we studied 838 biopsied day-5 blastocysts from 219 patients in the period from May 2021 to July 2022. All embryos were morphologically classified before biopsy and were divided into two groups according to genetic test results. Euploid embryos (299) were compared with aneuploid embryos (539) based on maternal age, anti-Mullerian hormone, antral follicle count, and embryo morphology. RESULTS: Maternal age (36.2±3.0) of euploid embryos was lower than maternal age (37.1±2.5) of aneuploid embryos (p<0.0001). AMH levels were higher (3.9±1.2) in the group of euploid embryos than in the group of aneuploid embryos (3.6±1.3, p<0.0001). However, the AFC was not different in the group of euploid embryos (15.3±6.0) compared to the group of aneuploid embryos (14.5±5.9, p=0.07). The presence of aneuploidy was negatively correlated with top embryo quality (embryos 4AA and 4AB). All euploid embryos (299) were top quality versus 331 of 539 (61.49%) aneuploid embryos (p<0.0001). CONCLUSIONS: We found that euploid embryos were associated with lower maternal age, higher AMH levels, and higher quality embryos.

Translation and cross-cultural adaptation to Brazilian Portuguese of two brief screening tools for at-risk psychosis youth: the Prodromal Questionnaire (PQ-16) and the PRIME-Screen.

INTRODUCTION: Prodromal characteristics of psychosis have been described for more than a century. Over the last three decades, a variety of studies have proposed methods to prospectively identify individuals (and youth in particular) who are at high risk of developing a psychotic disorder. These studies have validated various screening instruments and made them available in several languages. Here, we describe the translation into Brazilian Portuguese and cross-cultural adaptation of two such screening tools - the Prodromal Questionnaire-16 (PQ-16) and the Prevention through Risk Identification, Management, and Education (PRIME)-Screen. METHOD: Two bilingual native speakers of Brazilian Portuguese translated the questionnaires from English. A native English speaker then performed back-translations into English. These back-translated versions were submitted to the original authors. They provided feedback and later approved the final versions. RESULTS: After translation and cross-cultural adaptation, no items needed to be changed in the adapted PQ-16 and four items were revised in the PRIME-Screen. After the peer-review process, we included two suggestions in the PQ-16 to facilitate use of the tool in our cultural and social contexts. The PRIME-Screen did not need further changes. CONCLUSION: These new instruments can help screen Brazilian Portuguese-speaking patients who are at risk of psychosis in primary care.

Serum progesterone level in luteal phase improves pregnancy rate in fresh cycles with blastocyst embryo transfer.

OBJECTIVE: To assess the association between serum level of progesterone during stimulation and in the luteal phase with pregnancy rate in a cohort of patients undergoing in vitro fertilization and embryo transfer (IVF-ET) on day 5. METHODS: Retrospective Cohort Study. Patients: 62 infertile women, aged 24-42 years, undergoing ART at our center from May 2019 to May 2021. Progesterone was evaluated during ovarian stimulation on Day 2, Day 6, and Day 8 of stimulation, day of trigger (P4dhCG), and on the day of blastocyst transfer with 5 days of progesterone supplementation (P4d5+). We also calculated the difference of P4d5+ with P4dhCG. (∆P4). Then we divided the patients into two groups based on progesterone serum levels at P4d5+; <10ng/ml (Group A), ≥10ng/ml (Group B). The Student's t-test was performed for continuous variables; Mann-Whitney's Test and Spearman's Test were used where appropriate for categorical variables. p<0.05 was considered statistically significant. RESULTS: There were positive correlations between ßhCG positive with P4d5+ (p<0.001; Rho 0.770) and ∆P4 (p<0.001; Rho 0.703). The pregnancy rate doubled when the serum progesterone level was ≥10ng/ml on the fifth day of progesterone supplementation compared with P4<10ng/ml (44% vs. 21%, respectively). CONCLUSIONS: The pregnancy rate was positively correlated with the serum P4 level on the fifth day of progesterone supplementation and with the difference between the serum progesterone level in the Dd5+ / dhCG. A higher pregnancy rate was observed when serum progesterone level on the fifth day of progesterone supplementation was ≥10ng/ml.

Bringing the Nature Futures Framework to life: creating a set of illustrative narratives of nature futures.

To halt further destruction of the biosphere, most people and societies around the globe need to transform their relationships with nature. The internationally agreed vision under the Convention of Biological Diversity-Living in harmony with nature-is that "By 2050, biodiversity is valued, conserved, restored and wisely used, maintaining ecosystem services, sustaining a healthy planet and delivering benefits essential for all people". In this context, there are a variety of debates between alternative perspectives on how to achieve this vision. Yet, scenarios and models that are able to explore these debates in the context of "living in harmony with nature" have not been widely developed. To address this gap, the Nature Futures Framework has been developed to catalyse the development of new scenarios and models that embrace a plurality of perspectives on desirable futures for nature and people. In this paper, members of the IPBES task force on scenarios and models provide an example of how the Nature Futures Framework can be implemented for the development of illustrative narratives representing a diversity of desirable nature futures: information that can be used to assess and develop scenarios and models whilst acknowledging the underpinning value perspectives on nature. Here, the term illustrative reflects the multiple ways in which desired nature futures can be captured by these narratives. In addition, to explore the interdependence between narratives, and therefore their potential to be translated into scenarios and models, the six narratives developed here were assessed around three areas of the transformative change debate, specifically, (1) land sparing vs. land sharing, (2) Half Earth vs. Whole Earth conservation, and (3) green growth vs. post-growth economic development. The paper concludes with an assessment of how the Nature Futures Framework could be used to assist in developing and articulating transformative pathways towards desirable nature futures. Supplementary Information: The online version contains supplementary material available at 10.1007/s11625-023-01316-1.

Projections of future forest degradation and CO2 emissions for the Brazilian Amazon.

In recent years, the area affected by forest degradation in the Brazilian Amazon has frequently been higher than deforestation. From August 2006 to July 2019, the degraded area totaled 194,058 km2, representing almost two times the 99,630 km2 deforested in the same period. The impacts of degradation include biodiversity loss and changes in the carbon stocks, affecting the CO2 balance and future climate changes. This paper aims to explore socioeconomic and environmental factors that influence forest degradation, project future scenarios, and assess the impact on the regional carbon balance, combining forest degradation and deforestation-related processes (clear-cut deforestation and secondary vegetation dynamics). We show that, while net CO2 emissions from 2020 to 2050 are 0.74 Gt CO2 in the Sustainable scenario, this value reached 22.63 Gt CO2 in the Fragmentation scenario, an increasingly plausible scenario given the recent trends in the region.

New land-use change scenarios for Brazil: Refining global SSPs with a regional spatially-explicit allocation model.

The future of land use and cover change in Brazil, particularly due to deforestation and forest restoration processes, is critical for the future of global climate and biodiversity, given the richness of its five biomes. These changes in Brazil depend on the interlink between global factors due to its role as one of the main exporters of commodities globally and the national to local institutional, socioeconomic, and biophysical contexts. Aiming to develop scenarios that consider the balance between global (e.g., GDP growth, population growth, per capita consumption of agricultural products, international trade policies, and climatic conditions) and local factors (e.g., land use, agrarian structure, agricultural suitability, protected areas, distance to roads, and other infrastructure projects), a new set of land-use change scenarios for Brazil were developed that aligned with the global structure Shared Socioeconomic Pathways (SSPs) and Representative Concentration Pathway (RCPs) developed by the global change research community. The narratives of the new scenarios align with SSP1/RCP 1.9 (Sustainable development scenario), SSP2/RCP 4.5 (Middle of the road scenario), and SSP3/RCP 7.0 (Strong inequality scenario). The scenarios were developed by combining the LuccME spatially explicit land change allocation modeling framework and the INLAND surface model to incorporate the climatic variables in water deficit. Based on detailed biophysical, socioeconomic, and institutional factors for each biome in Brazil, we have created spatially explicit scenarios until 2050, considering the following classes: forest vegetation, grassland vegetation, planted pasture, agriculture, a mosaic of small land uses, and forestry. The results aim to detail global models regionally. They could be used regionally to support decision-making and enrich the global analysis.

Excess all-cause mortality and COVID-19-related mortality: a temporal analysis in 22 countries, from January until August 2020.

BACKGROUND: This study aimed to investigate overall and sex-specific excess all-cause mortality since the inception of the COVID-19 pandemic until August 2020 among 22 countries. METHODS: Countries reported weekly or monthly all-cause mortality from January 2015 until the end of June or August 2020. Weekly or monthly COVID-19 deaths were reported for 2020. Excess mortality for 2020 was calculated by comparing weekly or monthly 2020 mortality (observed deaths) against a baseline mortality obtained from 2015-2019 data for the same week or month using two methods: (i) difference in observed mortality rates between 2020 and the 2015-2019 average and (ii) difference between observed and expected 2020 deaths. RESULTS: Brazil, France, Italy, Spain, Sweden, the UK (England, Wales, Northern Ireland and Scotland) and the USA demonstrated excess all-cause mortality, whereas Australia, Denmark and Georgia experienced a decrease in all-cause mortality. Israel, Ukraine and Ireland demonstrated sex-specific changes in all-cause mortality. CONCLUSIONS: All-cause mortality up to August 2020 was higher than in previous years in some, but not all, participating countries. Geographical location and seasonality of each country, as well as the prompt application of high-stringency control measures, may explain the observed variability in mortality changes.

A comparison of the effects of three different estrogen used for endometrium preparation on the outcome of day 5 frozen embryo transfer cycle.

OBJECTIVE: To evaluate the effects of three different estrogen used for endometrium preparation on pregnancy rate, as well as hormone profile on day 5 frozen embryo transfer (FET) cycles. METHODS: Retrospective, observational study. Setting: A tertiary teaching and research private reproductive medicine center. Patients: Ninety patients who were undergoing endometrium preparation for day five frozen embryo transfer cycle (FET). Intervention(s): The women were divided in three groups according to the administration route of estrogen (E2): oral (Primogyna), transdermal patches (Estradot), or transdermal gel (Oestrogel Pump). These administration routines of estrogen are equivalent to 6mg of estradiol daily. All women received 600mg of vaginal progesterone (P) per day (Utrogestan) for luteal phase support. We drew blood samples on starting P day, as well as on beta hCG day for E2 and P measurements. Main Outcome Measure(s): Clinical pregnancy rates (PR). RESULTS: Patient features in the three groups were comparable. There were no significant differences concerning implantation rate, clinical PR, miscarriage rate, multiple-pregnancy rate, or E2 and P levels on starting P day and on beta hCG day. CONCLUSIONS: In FET cycles with oral (Primogyna) or transdermal patches (Estradot), or transdermal gel (Oestrogel Pump), there was no significant difference on pregnancy rates.

Which ovarian reserve marker relates to embryo quality on day 3 and blastocyst; age, AFC, AMH?

OBJECTIVE: The aim of the present prospective study was to evaluate which ovarian reserve marker would be more reliable as the quality of the A + B embryos (day 3 and blastocyst). METHODS: We ran a prospective study with 124 infertile women, aged 24-48 years, from 2017 to 2018. The patients were divided into 3 groups according to age and the subgroups were compared for AMH, AFC, number of A+B embryos. New division of the 3 groups was performed based on the AMH, and the subgroups were compared for age, AFC and number of A+B embryos. Finally, we divided the patients into 3 groups, based on the AFC, and we compared the subgroups for age, AMH and number of A+B embryos. P<0.05 was considered statistically significant. RESULTS: When the 124 patients were divided according to age, we found a significant fall in an A+B embryo quality (day3; blastocyst) after 35 years (p<0.038; p<0.035), and more severely after 37 years (p<0.032; p<0.027). When the 124 patients were divided according to AMH, there was a significant fall in A+B embryo quality (day 3; blastocyst), with AMH<1ng/ml (p<0.023; p<0.021). When the 124 patients were divided according to AFC, there was a significant fall in A+B embryo quality (day 3; blastocyst) with AFC<7 (p<0.025; p<0.023). These markers had significant associations with embryo quality (p<0.005). CONCLUSION: Age, AFC and AMH have significant associations with A +B embryo quality on day 3 and blastocyst.

Effects of chronic restraint stress and estradiol replacement on glutamate release and uptake in the spinal cord from ovariectomized female rats.

Glutamate is an excitatory neurotransmitter involved in neuronal plasticity and neurotoxicity. Chronic stress produces several physiological changes on the spinal cord, many of them presenting sex-specific differences, which probably involve glutamatergic system alterations. The aim of the present study was to verify possible effects of exposure to chronic restraint stress and 17beta-estradiol replacement on [3H]-glutamate release and uptake in spinal cord synaptosomes of ovariectomized (OVX) rats. Female rats were subjected to OVX, and half of the animals received estradiol replacement. Animals were subdivided in controls and chronically stressed. Restraint stress or estradiol had no effect on [3H]-glutamate release. The chronic restraint stress promoted a decrease and 17beta-estradiol induced an increase on [3H]-glutamate uptake, but the uptake observed in the restraint stress +17beta-estradiol group was similar to control. Furthermore, 17beta-estradiol treatment caused a significant increase in the immunocontent of the three glutamate transporters present in spinal cord. Restraint stress had no effect on the expression of these transporters, but prevented the 17beta-estradiol effect. We suggest that changes in the glutamatergic system are likely to take part in the mechanisms involved in spinal cord plasticity following repeated stress exposure, and that 17beta-estradiol levels may affect chronic stress effects in this structure.

Ligninases production by Basidiomycetes strains on lignocellulosic agricultural residues and their application in the decolorization of synthetic dyes.

Wood rotting Basidiomycetes collected in the "Estação Ecológica do Noroeste Paulista", São José do Rio Preto, São Paulo State, Brazil, concerning Aphyllophorales order and identified as Coriolopsis byrsina SXS16, Lentinus strigellus SXS355, Lentinus sp SXS48, Picnoporus sanguineus SXS 43 and Phellinus rimosus SXS47 were tested for ligninases production by solid state fermentation (SSF) using wheat bran or rice straw as culture media. C. byrsina produced the highest laccase (200 U mL(-1)) and Lentinus sp produced the highest activities of manganese peroxidase (MnP) and lignin peroxidase (LiP) (7 and 8 U mL(-1), respectively), when cultivated on wheat bran. The effect of N addition on enzyme production was studied in medium containing rice straw and the data showed an increase of 3 up to 4-fold in the laccase production compared to that obtained in SSF on wheat bran. The laccases presented optimum pH at 3.0-3.5 and were stable at neutral pH values. Optimum pH for MnP and LiP activities was at 3.5 and between 4.5 and 6.0, respectively. All the strains produced laccase with optimum activities between 55-60ºC while the peroxidases presented maximum activity at temperatures of 30 to 55ºC. The crude enzymes promoted decolorization of chemically different dyes with around 70% of decolorization of RBBR and cybacron blue 3GA in 6h of treatment. The data indicated that enzymes from these basidiomycetes strains are able to decolorize synthetic dyes.

A comparison of the effects of three luteal phase support protocols with estrogen on in vitro fertilization-embryo transfer outcomes in patients on a GnRH antagonist protocol.

OBJECTIVE: This study aimed to evaluate the effects of three different luteal phase support protocols with estrogen on the pregnancy rates and luteal phase hormone profiles of patients undergoing in vitro fertilization-embryo transfer (IVF-ET) cycles. A secondary objective was to evaluate which ovarian reserve markers correlated with pregnancy rates. METHODS: This retrospective observational study was carried out at a private tertiary reproductive medicine teaching and research center. The study enrolled 104 patients undergoing intracytoplasmic sperm injection (ICSI) on an antagonist protocol for controlled ovarian hyperstimulation (COH). The women were divided into three groups based on the route of administration of estrogen (E2) for luteal phase support: oral (Primogyna); transdermal patches (Estradott); or transdermal gel (Oestrogel Pump). The administration of estrogen provided the equivalent to 4 mg of estradiol daily. All women received 600mg of vaginal progesterone (P) per day (Utrogestan) for luteal phase support. Blood samples were drawn on the day of hCG administration and on the day of beta hCG testing to measure E2 and P levels. Clinical pregnancy rate (PR) was the main endpoint. RESULTS: The patients included in the three groups were comparable. No significant differences were found in implantation rates, clinical PR, miscarriage rates, multiple-pregnancy rates, E2 or P levels on the day of beta hCG measurement. Concerning ovarian reserve markers, significant correlations between testing positive for clinical pregnancy and AMH (r = 0.66, p<0.0001) and E2 levels on beta hCG measurement day (r = 0.77; p<.0001) were observed. CONCLUSIONS: No significant differences were seen in the pregnancy rates of patients submitted to IVF-ET cycles with GnRH antagonists given oral, transdermal patches, or transdermal gel E2 during the luteal phase. A correlation was found between clinical pregnancy rate and AMH and E2 levels on beta hCG testing day.

Effect of Hydrofluoric Acid Concentration and Thermal Cycling on the Bond Strength of Brackets to Ceramic.

This study to evaluate the effects of different hydrofluoric acid (HF) concentrations and thermal cycling on the shear bond strength (SBS) of brackets to ceramic. Cylinders of ceramic were divided into 10 groups (n=15), according to HF concentrations: 1-1%;2-2.5%;3-5%;4-7.5%;5-10% (storage 24 h); 6-1%;7-2.5%;8-5%;9-7.5%; and, 10-10% (thermal cycling). All cylinders were etched for 60s and received one layer of silane. Metallic brackets were bonded to the cylinders using Transbond-XT, light activated for 40 s, using a LED (Radii Plus) and stored in deionized water at 37o C for 24h. The groups 6 to 10 were submitted to thermal cycling (7,000 cycles - 5o/55oC). SBS was performed in an Instron at crosshead speed of 1.0 mm/min. Data were submitted to two-way ANOVA and Tukey's post-hoc test (α=0.05). The Adhesive Remaining Index (ARI) was evaluated at 40x magnification. The different HF acid concentrations influenced on the SBS of the brackets to ceramic (p<0.05). The thermal cycling decreased the SBS of the brackets to ceramic for all acid concentrations (p<0.05). The ARI showed a predominance of scores 0 for all groups, with an increase in scores 1, 2 and 3 for the group storage for 24 h. In conclusion, the different HF acid concentrations 5.0%, 7.5% and 10% influenced on the SBS of brackets to ceramic. The thermal cycling decreased significantly the SBS of brackets to ceramic.

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts.

OBJECTIVE: We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. DESIGN: Baseline data from two prospective multicentre observational studies. SETTING: 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. PARTICIPANTS: 395 patients (≥13 years old) with persistent asthma. MEASURES: Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. RESULTS: High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p<0.001). Discordance occurred in 56% of cases: in 28% physicians overestimated adherence and in 27% underestimated. Low adherence as assessed by the physician (OR=27.35 (9.85 to 75.95)), FEV1 ≥80% (OR=2.59 (1.08 to 6.20)) and a first appointment (OR=5.63 (1.24 to 25.56)) were predictors of underestimation. An uncontrolled asthma (OR=2.33 (1.25 to 4.34)), uncontrolled upper airway disease (OR=2.86 (1.35 to 6.04)) and prescription of short-acting beta-agonists alone (OR=3.05 (1.15 to 8.08)) were associated with overestimation. Medium adherence as assessed by the physician was significantly associated with higher risk of discordance, both for overestimation and underestimation of adherence (OR=14.50 (6.04 to 34.81); OR=2.21 (1.07 to 4.58)), while having a written action plan decreased the likelihood of discordance (OR=0.25 (0.12 to 0.52); OR=0.41 (0.22 to 0.78)) (R2=44%). CONCLUSION: Although both patients and physicians report high inhaler adherence, discordance occurred in half of cases. Implementation of objective adherence measures and effective communication are needed to improve patient-physician agreement.