Ohio Presents Opportunities For Understanding Hospital Alignment With Public Health Agencies On Community Health Assessments.

Multisector collaboration is critical for improving population health. Improving alignment between nonprofit hospitals and local health departments is one promising approach to achieving health improvement, and a number of states are exploring policies to facilitate such collaboration. Using public documents, we evaluated the alignment between Ohio nonprofit hospitals and local health departments in the community health needs they identify and those they prioritize. The top three needs identified by hospitals and health departments were mental health, substance use, and obesity. Alignment across organizations was high among the top needs, but it varied more among less commonly identified needs. Alignment related to social determinants of health was low, with health departments being more responsive to social determinants than hospitals. Given the different strengths and capacities of hospitals and health departments, this divergence may be in the best interests of the communities they serve. Community benefit policies should consider how to promote collaboration between hospitals and health departments while also encouraging organizations to use their own expertise to meet community needs.

Reduced sympathetic activity is associated with the development of pain and muscle atrophy in a female rat model of fibromyalgia.

Fibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain accompanied by fatigue and muscle atrophy. Although its etiology is not known, studies have shown that FM patients exhibit altered function of the sympathetic nervous system (SNS), which regulates nociception and muscle plasticity. Nevertheless, the precise SNS-mediated mechanisms governing hyperalgesia and skeletal muscle atrophy in FM remain unclear. Thus, we employed two distinct FM-like pain models, involving intramuscular injections of acidic saline (pH 4.0) or carrageenan in prepubertal female rats, and evaluated the catecholamine content, adrenergic signaling and overall muscle proteolysis. Subsequently, we assessed the contribution of the SNS to the development of hyperalgesia and muscle atrophy in acidic saline-injected rats treated with clenbuterol (a selective ß2-adrenergic receptor agonist) and in animals maintained under baseline conditions and subjected to epinephrine depletion through adrenodemedullation (ADM). Seven days after inducing an FM-like model with acidic saline or carrageenan, we observed widespread mechanical hyperalgesia along with loss of strength and/or muscle mass. These changes were associated with reduced catecholamine content, suggesting a common underlying mechanism. Notably, treatment with a ß2-agonist alleviated hyperalgesia and prevented muscle atrophy in acidic saline-induced FM-like pain, while epinephrine depletion induced mechanical hyperalgesia and increased muscle proteolysis in animals under baseline conditions. Together, the results suggest that reduced sympathetic activity is involved in the development of pain and muscle atrophy in the murine model of FM analyzed.

A cross exploratory analysis between nursing working conditions and the occurrence of errors in the northeast region of Brazil.

OBJECTIVES: Analyze and verify the association between working conditions and the occurrence of errors in nursing work. BACKGROUND: Many of the known errors in nursing are based on the structural failure of the complex health service system. Our study addresses the question "Is there an association between errors made by nursing workers and working conditions?" METHODS: The study was carried out through a cross-sectional exploratory analysis of 19 ethical-disciplinary processes focused on errors made by nursing workers. The articles were processed, judged, and archived at the Regional Nursing Councils of the Northeast Region of Brazil from 2000 to 2018. The chi-square test or Fisher's exact test was used to verify the relationship between the variables through multivariate analysis. RESULTS: The analyzes show that working conditions can interfere at occurrence in error. This increases the chance of an "inconsequential" error occurring for the patient in poor/very poor working conditions. The most serious errors, "with consequences irreversible" for the patient, only occur from more severe working conditions. Adversely, it was found that there is no statistically significant difference in the frequency of errors in hospitals (33.33 %) compared to "other places" (28.58 %) when these occurred in poor working conditions. When conducting the incident in poor working conditions, there was a minimum of 52 % protection OR = 0.48 % [0.16; 11.80]; (1-0.48)) against these errors in general in the nursing area. CONCLUSION: The strong association was exposed in working conditions classified as bad/very bad/very bad, resulting in the most serious errors and with irreversible consequences for patients. However, a level of protection for different types of workers was noticed in the field, which shows that there is hope that if the work environment changes with more organization, management, and standards of care, we can prevent future errors.

Access to Mental Health and Substance Use Treatment in Comprehensive Primary Care Plus.

Importance: To meet increasing demand for mental health and substance use services, the Centers for Medicare & Medicaid Services launched the 5-year Comprehensive Primary Care Plus (CPC+) demonstration in 2017, requiring primary care practices to integrate behavioral health services. Objective: To examine the association of CPC+ with access to mental health and substance use treatment before and during the COVID-19 pandemic. Design, Setting, and Participants: Using difference-in-differences analyses, this retrospective cohort study compared adults attributed to CPC+ and non-CPC+ practices, from January 1, 2018, to June 30, 2022. The study included adults aged 19 to 64 years who had depression, anxiety, or opioid use disorder (OUD) and were enrolled with a private health insurer in Pennsylvania. Data were analyzed from January to June 2023. Exposure: Receipt of care at a practice participating in CPC+. Main Outcomes and Measures: Total cost of care and the number of primary care visits for evaluation and management, community mental health center visits, psychiatric hospitalizations, substance use treatment visits (residential and nonresidential), and prescriptions filled for antidepressants, anxiolytics, buprenorphine, naltrexone, or methadone. Results: The 188 770 individuals in the sample included 102 733 adults (mean [SD] age, 49.5 [5.6] years; 57 531 women [56.4%]) attributed to 152 CPC+ practices and 86 037 adults (mean [SD] age, 51.6 [6.6] years; 47 321 women [54.9%]) attributed to 317 non-CPC+ practices. Among patients diagnosed with OUD, compared with patients attributed to non-CPC+ practices, attribution to a CPC+ practice was associated with filling more prescriptions for buprenorphine (0.117 [95% CI, 0.037 to 0.196] prescriptions per patient per quarter) and anxiolytics (0.162 [95% CI, 0.005 to 0.319] prescriptions per patient per quarter). Among patients diagnosed with depression or anxiety, attribution to a CPC+ practice was associated with more prescriptions for buprenorphine (0.024 [95% CI, 0.006 to 0.041] prescriptions per patient per quarter). Conclusions and Relevance: Findings of this cohort study suggest that individuals with an OUD who received care at a CPC+ practice filled more buprenorphine and anxiolytics prescriptions compared with patients who received care at a non-CPC+ practice. As the Centers for Medicare & Medicaid Innovation invests in advanced primary care demonstrations, it is critical to understand whether these models are associated with indicators of high-quality primary care.

Dietary intake in individuals with phenylketonuria: an integrative review / Ingesta dietética en individuos con fenilcetonuria: una revisión integradora

Introduction: the dietary intake of individuals with phenylketonuria (PKU) may vary widely according to different cultural eating habits, lifestyle,access to multidisciplinary team, and metabolic formulas available. Thus, knowing the dietary intake of this population makes it possible to tailornutritional treatment strategies to impact their health.Objective: to analyze the evidence on the dietary intake of individuals with PKU.Methods: an integrative literature review was conducted on the dietary intake of individuals with PKU in the databases PUBMED, BIREME andScience Direct. Original articles that addressed the energy and macronutrient food intake of children, adolescents and/or adults with PKU wereincluded in the study, without time restriction, in any language. A total of 384 articles were found and 27 articles were selected and analyzed.Results: evidence about the nutritional composition of their diet showed that individuals with PKU consume between 1160-2721 kcal of energy—7.2-17.4 % (32.4-76.9 g) of energy as protein, 45.9-69.2 % of energy as carbohydrates, 16.6-39 % of energy as lipids— and between7.6 and 20 g of fiber.Conclusion: most individuals with PKU have low energy, protein and fiber intake, adequate lipid intake, and high carbohydrate intake. Metaboliccontrol of the disease is still a challenge in all countries. Nutritional strategies to improve dietary nutritional composition and phenylalanine bloodlevels in individuals with PKU remain an urgent issue.(AU)

Introducción: la ingesta dietética de los individuos con fenilcetonuria (PKU) puede variar ampliamente debido a los diferentes hábitos culturalesde alimentación, el estilo de vida, el acceso al equipo multidisciplinar y las fórmulas metabólicas disponibles. Por ello, conocer la ingesta dietéticade esta población permite adaptar las estrategias de tratamiento nutricional para incidir en su salud.Objetivo: analizar la evidencia sobre la ingesta dietética de individuos con PKU.Métodos: se realizó una revisión bibliográfica integradora sobre la ingesta dietética de las personas con PKU en las bases de datos PUBMED,BIREME y Science Direct. El estudio incluyó artículos originales que abordaran la ingesta alimentaria de energía y macronutrientes de niños,adolescentes y/o adultos con PKU, sin restricción de tiempo, en cualquier idioma. Se encontraron 384 artículos y se seleccionaron y analizaron 27.Resultados: la evidencia de la composición nutricional de la dieta mostró que los individuos con PKU consumen entre 1160 y 2721 kcal deenergía —7,2-17,4 % (32,4-76,9 g) de la energía en forma de proteínas, 45,9-69,2 % de la energía en carbohidratos, 16,6-39 % de la energíaen lípidos— y entre 7,6 y 20 g de fibra.Conclusiones: la mayoría de los individuos con PKU tienen una ingesta baja de energía, proteínas y fibra, una ingesta adecuada de lípidos y unaingesta alta de hidratos de carbono. El control metabólico de la enfermedad sigue siendo un reto en todos los países. Siguen siendo urgenteslas estrategias nutricionales para mejorar la composición nutricional de la dieta y los niveles de fenilalanina en sangre de los individuos con PKU.(AU)

Adrenalectomy attenuates hyperalgesia but does not regulate muscle wasting in a female rat model of fibromyalgia.

Although it is well established that fibromyalgia (FM) syndrome is characterized by chronic diffuse musculoskeletal hyperalgesia, very little is known about the effect of this pathology on muscle tissue plasticity. Therefore, the present study aimed to characterize the putative alterations in skeletal muscle mass in female rats subjected to a FM model by inducing chronic diffuse hyperalgesia (CDH) through double injections of acidic saline (pH 4.0) into the left gastrocnemius muscle at 5-day intervals. To determine protein turnover, the total proteolysis, proteolytic system activities and protein synthesis were evaluated in oxidative soleus muscles of pH 7.2 (control) and pH 4.0 groups at 7 days after CDH induction. All animals underwent behavioural analyses of mechanical hyperalgesia, strength and motor performance. Our results demonstrated that, in addition to hyperalgesia, rats injected with acidic saline exhibited skeletal muscle loss, as evidenced by a decrease in the soleus fibre cross-sectional area. This muscle loss was associated with increased proteasomal proteolysis and expression of the atrophy-related gene (muscle RING-finger protein-1), as well as reduced protein synthesis and decreased protein kinase B/S6 pathway activity. Although the plasma corticosterone concentration did not differ between the control and pH 4.0 groups, the removal of the adrenal glands attenuated hyperalgesia, but it did not prevent the increase in muscle protein loss in acidic saline-injected animals. The data suggests that the stress-related hypothalamic-pituitary-adrenal axis is involved in the development of hyperalgesia, but is not responsible for muscle atrophy observed in the FM model induced by intramuscular administration of acidic saline. Although the mechanisms involved in the attenuation of hyperalgesia in rats injected with acidic saline and subjected to adrenalectomy still need to be elucidated, the results found in this study suggest that glucocorticoids may not represent an effective therapeutic approach to alleviate FM symptoms.

Botanical Extracts and Compounds of Castanea Plants and Methods of Use: US20190125818A1 - The United States Patent Evaluation.

BACKGROUND: Bacterial infections are increasingly difficult to combat, which makes them a threat to public health on a global level. Staphylococcus aureus is considered one of the main causes of infections in hospitals, as it has a variety of virulence factors, as well as is able to produce bacterial biofilms, which, consequently, bring numerous damages to public health as a result of increased resistance to conventional antibiotics and a longer hospital stay. Therefore, the use of compounds extracted from medicinal plants is a potential pharmaceutically acceptable target, as they do not have toxicity and the potential to disrupt biofilms produced by Staphylococcus aureus already evidenced, thus revealing their relevance to our study. OBJECTIVE: The objective of this work was to perform a critical analysis of a patent with natural extracts against bacterial biofilms found in the United States Patent and Trademark Office (USPTO) database, to map the possible bioactive compounds that may serve as potential future antimicrobial drugs. METHODS: A technological survey was carried out to verify existing patents using natural extracts with anti-biofilm potential. For this, it was searched with the keywords: Botanical extracts AND biofilms; which were performed in the United States Patent and Trademark Office (USPTO) database. Thus, the selected patent used a non-aqueous extract partitioned and vacuum-contracted, subsequently lyophilized for assays with antimicrobial potential. Because of this, a patent was analyzed regarding its chemistry, and biological activity, followed by a critical analysis of the technology proposed in the invention. RESULTS: When using the keywords Botanical extracts AND biofilms in the USPTO, it was possible to find twenty-two inventions; however, only four patents in the USPTO were in agreement with the proposal of the natural extract having antimicrobial activity and an anti-biofilm potential, of which two belonged to the same applicant with similar proposals. The key point of this invention was to enable the compounds of the Castanea sativa plant and its methods of obtaining the extract to present a significant antimicrobial action associated or not with antibiotics, promoting the development of new therapies against bacterial infections capable of disrupting biofilms. The invention developed a methodology for extracting Castanea sativa, in which pentacyclic triterpene compounds were found mostly in its leaves. Whereas for the extraction, the crude methanol extracts called extracts 224 from the ground leaves were made by maceration, filtered, combined, concentrated under pressure in rotary evaporators, and lyophilized. After that, they were resuspended in water and partitioned in succession with hexane, ethyl acetate, and butanol. The most active refined partition was the 224C extract with the solvent ethyl acetate, which was subjected to further fractionation using silica column chromatography. Resulting in the most refined extract, which was 224C-F2, capable of acting directly on the quorum sensing of bacteria, mainly Staphylococcus aureus, blocking the translation of RNAIII, including a series of exotoxins. Regarding the antimicrobial capacity against Staphylococcus aureus, it presented Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of 1.56 µg/mL-1 and > 100 µg/mL -1, respectively. CONCLUSION: Given the analyzed patent, it was possible to verify the importance of alternatives to reduce the impact of bacterial biofilms, which causes damage to industries in general and to health. From this, the invention analyzed has a promising proposal with antimicrobial potential focusing on the great impact of bacterial biofilms. Therefore, natural extracts with antibiofilmic potential can help to minimize the economic losses caused to health due to these multidrug-resistant microorganisms with different virulence mechanisms.

Technological and health properties and main challenges in the production of vegetable beverages and dairy analogs.

Lactose intolerance affects about 68-70% of the world population and bovine whey protein is associated with allergic reactions, especially in children. Furthermore, many people do not consume dairy-based foods due to the presence of cholesterol and ethical, philosophical and environmental factors, lifestyle choices, and social and religious beliefs. In this context, the market for beverages based on pulses, oilseeds, cereals, pseudocereals and seeds and products that mimic dairy foods showed a significant increase over the years. However, there are still many sensory, nutritional, and technological limitations regarding producing and consuming these products. Thus, to overcome these negative aspects, relatively simple technologies such as germination and fermentation, the addition of ingredients/nutrients and emerging technologies such as ultra-high pressure, pulsed electric field, microwave and ultrasound can be used to improve the product quality. Moreover, consuming plant-based beverages is linked to health benefits, including antioxidant properties and support in the prevention and treatment of disorders and common diseases like hypertension, diabetes, anxiety, and depression. Thus, vegetable-based beverages and their derivatives are viable alternatives and low-cost for replacing dairy foods in most cases.

Nursing care for the Warao people: an experience report based on transcultural theory.

OBJECTIVE: To report on the experience of nurses from the Street Clinic in caring for the Indigenous Venezuelan population of the Warao ethnic group in Maceió/AL based on Madeleine Leininger's Transcultural Theory. METODOLOGY: A descriptive study, of the experience report type, based on the care of the Warao Indigenous population in the light of Madeleine Leininger's Transcultural Theory, carried out during the year 2022. RESULTS: Light technologies were used to form bonds and understand the cultural universe of the Warao people. The concepts of preservation, accommodation and cultural restructuring of care from Leininger's transcultural theory helped to elucidate the practice. Comprehensive care was offered in accordance with the programs recommended by the Ministry of Health, with transcultural care, including respect for refusal of care. The language barrier and health beliefs represented challenges in the context of singular care. FINAL CONSIDERATIONS: The experience of nurses from the Street Clinic in caring for the Indigenous population favored significant social interaction and expanded the possibilities for achieving comprehensive health care. The application of Transcultural Theory proved to be an effective and congruent device for health care.

Dietary intake in individuals with phenylketonuria: an integrative review.

Introduction: Introduction: the dietary intake of individuals with phenylketonuria (PKU) may vary widely according to different cultural eating habits, lifestyle, access to multidisciplinary team, and metabolic formulas available. Thus, knowing the dietary intake of this population makes it possible to tailor nutritional treatment strategies to impact their health. Objective: to analyze the evidence on the dietary intake of individuals with PKU. Methods: an integrative literature review was conducted on the dietary intake of individuals with PKU in the databases PUBMED, BIREME and Science Direct. Original articles that addressed the energy and macronutrient food intake of children, adolescents and/or adults with PKU were included in the study, without time restriction, in any language. A total of 384 articles were found and 27 articles were selected and analyzed. Results: evidence about the nutritional composition of their diet showed that individuals with PKU consume between 1160-2721 kcal of energy -7.2-17.4 % (32.4-76.9 g) of energy as protein, 45.9-69.2 % of energy as carbohydrates, 16.6-39 % of energy as lipids- and between 7.6 and 20 g of fiber. Conclusion: most individuals with PKU have low energy, protein and fiber intake, adequate lipid intake, and high carbohydrate intake. Metabolic control of the disease is still a challenge in all countries. Nutritional strategies to improve dietary nutritional composition and phenylalanine blood levels in individuals with PKU remain an urgent issue.

Introducción: Introducción: la ingesta dietética de los individuos con fenilcetonuria (PKU) puede variar ampliamente debido a los diferentes hábitos culturales de alimentación, el estilo de vida, el acceso al equipo multidisciplinar y las fórmulas metabólicas disponibles. Por ello, conocer la ingesta dietética de esta población permite adaptar las estrategias de tratamiento nutricional para incidir en su salud. Objetivo: analizar la evidencia sobre la ingesta dietética de individuos con PKU. Métodos: se realizó una revisión bibliográfica integradora sobre la ingesta dietética de las personas con PKU en las bases de datos PUBMED, BIREME y Science Direct. El estudio incluyó artículos originales que abordaran la ingesta alimentaria de energía y macronutrientes de niños, adolescentes y/o adultos con PKU, sin restricción de tiempo, en cualquier idioma. Se encontraron 384 artículos y se seleccionaron y analizaron 27. Resultados: la evidencia de la composición nutricional de la dieta mostró que los individuos con PKU consumen entre 1160 y 2721 kcal de energía ­7,2-17,4 % (32,4-76,9 g) de la energía en forma de proteínas, 45,9-69,2 % de la energía en carbohidratos, 16,6-39 % de la energía en lípidos­ y entre 7,6 y 20 g de fibra. Conclusiones: la mayoría de los individuos con PKU tienen una ingesta baja de energía, proteínas y fibra, una ingesta adecuada de lípidos y una ingesta alta de hidratos de carbono. El control metabólico de la enfermedad sigue siendo un reto en todos los países. Siguen siendo urgentes las estrategias nutricionales para mejorar la composición nutricional de la dieta y los niveles de fenilalanina en sangre de los individuos con PKU.

Combinação de terapia por ondas de choque extracorpórea e agulhamento seco no tratamento de lombalgia crônica incapacitante: um relato de caso / Combination of extracorporeal shockwave therapy and dry needling as treatment of disabling chronic low back pain: a case report

Paciente do sexo masculino, 55 anos, apresentava antecedente clínico de radiculopatia lombar abordado cirurgicamente (discectomia e artrodese L5-S1) em dezembro de 2021, com resolução completa da dor associada. Iniciou com quadro de dor pós-operatória de características distintas. A primeira sessão de tratamento iniciou-se com terapia por ondas de choque extracorpóreas focal direcionada ao quadrado lombar, glúteo médio, glúteo mínimo e região peritrocantérica à direita. Posteriormente, associou-se agulhamento seco em pontos-gatilho presentes nesses mesmos 3 músculos e também no ligamento sacrotuberal direito, junto à inserção do glúteo máximo direito. Numa reavaliação uma semana depois, o paciente referiu uma redução de 70% da intensidade da dor inicial. O mesmo tratamento foi repetido, com resolução completa dos sintomas no final da sessão. Três meses depois, o doente manteve o controle álgico e recuperou totalmente a sua funcionalidade e qualidade de vida anteriores. Neste caso de limitação funcional a longo prazo devido a dor lombar crônica, a combinação da terapia por ondas de choque extracorporais e do agulhamento seco resultou num método eficaz e rápido para obter o alívio da dor e restaurar a funcionalidade anterior. No entanto, são necessários mais estudos para investigar o impacto desta combinação de terapias no controle da dor e na perda de funcionalidade devido à dor lombar crônica.

Male patient, 55 years old, had a clinical background of lumbar radiculopathy and a surgical approach (L5-S1 discectomy and arthrodesis) in December of 2021, with complete resolution of associated pain. One year later, the patient seeks medical treatment, referring a new, different pattern of low back pain, which initiated post-surgery. The first treatment session began with focused extracorporeal shockwave therapy directed at the right quadratus lumborum, gluteus medius, gluteus minimus and peritrochanteric region. Afterwards, dry needling was associated in trigger-points present in those same 3 muscles and also in the right sacrotuberal ligament, close to the insertion of the right gluteus maximus. In a reevaluation one week later, the patient reported a reduction of 70% of initial pain intensity. The same treatment was repeated, with complete resolution of symptoms at the end of the session. Three months later, the patient-maintained symptom control and fully recovered his previous functionality and quality of life. In this case of long-term functional limitation due to chronic low back pain, the combination of extracorporeal shock wave therapy and dry needling resulted in an effective and quick method to achieve pain relief and restore previous functionality. However, more studies are needed to investigate the impact of this combination of therapies in pain management and functionality loss due to chronic low back pain.

New Breakfast Cereal Developed with Sprouted Whole Ryegrass Flour: Evaluation of Technological and Nutritional Parameters.

Ryegrass is one such cereal that has been underutilized in human nutrition despite its high nutritional and functional value due to the presence of phytochemicals and dietary fibers. Exploiting ryegrass for human consumption is an exciting option, especially for countries that do not produce wheat, as it is easily adaptable and overgrows, making it economically viable. This study evaluated the nutritional content of γ-aminobutyric acid and bioactive compounds (total soluble phenolic compounds) and the physicochemical and technological properties of partially substituting maize flour (MF) with sprouted whole ryegrass flour (SR) in developing extrusion-cooked breakfast cereals. A completely randomized design with substitutions ranging from 0 to 20% of MF with SR was employed as the experimental strategy (p < 0.05). Partial incorporation of SR increased the content of γ-aminobutyric acid and total soluble phenolic compounds. Using sprouted grains can adversely affect the technological quality of extruded foods, mainly due to the activation of the amylolytic enzymes. Still, ryegrass, with its high dietary fiber and low lipid content, mitigates these negative effects. Consequently, breakfast cereals containing 4 and 8% SR exhibited better physicochemical properties when compared to SR12, SR16, SR20, and USR10, presenting reduced hardness and increased crispness, and were similar to SR0. These results are promising for ryegrass and suggest that combining the age-old sprouting process with extrusion can enhance the nutritional quality and bioactive compound content of cereal-based breakfast products while maintaining some technological parameters, especially crispiness, expansion index, water solubility index, and firmness, which are considered satisfactory.

Non-canonical Ca2+- Akt signaling pathway mediates the antiproteolytic effects induced by oxytocin receptor stimulation in skeletal muscle.

Although it has been previously demonstrated that oxytocin (OXT) receptor stimulation can control skeletal muscle mass in vivo, the intracellular mechanisms that mediate this effect are still poorly understood. Thus, rat oxidative skeletal muscles were isolated and incubated with OXT or WAY-267,464, a non-peptide selective OXT receptor (OXTR) agonist, in the presence or absence of atosiban (ATB), an OXTR antagonist, and overall proteolysis was evaluated. The results indicated that both OXT and WAY-267,464 suppressed muscle proteolysis, and this effect was blocked by the addition of ATB. Furthermore, the WAY-induced anti-catabolic action on protein metabolism did not involve the coupling between OXTR and Gαi since it was insensitive to pertussis toxin (PTX). The decrease in overall proteolysis induced by WAY was probably due to the inhibition of the autophagic/lysosomal system, as estimated by the decrease in LC3 (an autophagic/lysosomal marker), and was accompanied by an increase in the content of Ca2+-dependent protein kinase (PKC)-phosphorylated substrates, pSer473-Akt, and pSer256-FoxO1. Most of these effects were blocked by the inhibition of inositol triphosphate receptors (IP3R), which mediate Ca2+ release from the sarcoplasmic reticulum to the cytoplasm, and triciribine, an Akt inhibitor. Taken together, these findings indicate that the stimulation of OXTR directly induces skeletal muscle protein-sparing effects through a Gαq/IP3R/Ca2+-dependent pathway and crosstalk with Akt/FoxO1 signaling, which consequently decreases the expression of genes related to atrophy, such as LC3, as well as muscle proteolysis.

Lightweight carbon foam obtained from post-use polyethylene terephthalate bottles, properties, and potential applications.

The excessive consumption of plastic packaging, especially those produced with polyethylene terephthalate (PET), and the fact that most of them are destined for garbage have made such packaging a worrying environmental liability. Their inadequate disposal promotes the pollution of soils, watercourses, and oceans, and even the presence of component materials of these packages in the human body, in the form of microplastics, has been observed. As research in the area advances, greater concerns arise, as more problems arising from the excessive use and disposal of plastics are identified. Looking for an alternative for the destination of this material, a technology was developed for the production of materials with characteristics similar to 3D graphene. This carbon material has qualities and versatility that allow its wide use in several applications and is produced using PET as a carbon precursor. This work presents this production technology with possible variables, the characterization of the produced materials, and their potential applications. For the electronics area, such as supercapacitors, improvement points needed for validation were observed. For application as an adsorbent and use in the treatment of industrial effluents when using sand covered by carbon material, the results demonstrated efficiency. The material proved to be a potential destination for PET, as an alternative to reduce this environmental liability.

Pequi Oil (Caryocar brasiliense Camb.) Attenuates the Adverse Effects of Cyclical Heat Stress and Modulates the Oxidative Stress-Related Genes in Broiler Chickens.

The present study was conducted to determine the possible antioxidant protection of pequi oil (PO) against cyclic heat stress in broiler chickens and to highlight the application of PO as a promising additive in broiler feed. A total of 400 one-day-old male broiler chicks (Cobb 500) were randomly assigned to 2 × 5 factorially arranged treatments: two temperature-controlled rooms (thermoneutral-TN or heat stress-HS for 8 h/day) and five dietary PO levels (0, 1.5, 3.0, 4.5, or 6.0 g/kg diet) for 42 days. Each treatment consisted of eight replicates of five birds. The results showed that HS increased glucose (p = 0.006), triglycerides (p < 0.001), and HDL (p = 0.042) at 21 days and reduced (p = 0.005) serum total cholesterol at 42 days. The results also showed that HS increased the contents of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). In contrast, PO linearly decreased AST (p = 0.048) and ALT (p = 0.020) at 21 and 42 days, respectively. The heterophil-to-lymphocyte ratio in the birds under HS was higher than in those in the TN environment (p = 0.046). Heat stress decreased (p = 0.032) the relative weight of their livers at 21 days. The superoxide dismutase activity increased (p = 0.010) in the HS treatments in comparison to the TN treatments, while the glutathione peroxidase activity in the liver decreased (p < 0.001) at 42 days; however, the activity of catalase had no significant effects. Meanwhile, increasing the dietary PO levels linearly decreased plasma malondialdehyde (p < 0.001) in the birds in the HS environment. In addition, PO reduced (p = 0.027) the expression of Hsp 70 in the liver by 92% when compared to the TN treatment without PO, mainly at the 6.0 g/kg diet level. The expression of Nrf2 was upregulated by 37% (p = 0.049) in response to PO with the 6.0 g/kg diet compared to the HS treatment without PO. In conclusion, PO supplementation alleviated the adverse effects of HS on broilers due to its antioxidant action and modulation of the genes related to oxidative stress, providing insights into its application as a potential feed additive in broiler production.

Effects of dietary copper and zinc hydroxychloride supplementation on bone development, skin quality and hematological parameters of broilers chickens.

This study was carried out to evaluate the effects of supplementation with different levels of copper (Cu) and zinc (Zn), using two mineral sources (sulphate and hydroxy forms), on the bone characteristics, skin strength/elasticity, and haematological parameters of broilers. A total of 1792 1-day-old male Cobb-500 broiler chickens were randomly distributed among eight dietary treatments, using Cu sulphate (CSM) or hydroxychloride (CHC), and Zn sulphate (ZSM) or hydroxychloride (ZHC). The dietary treatments were as follows: (1) low-CSM/high-ZSM, (2) high-CSM/high-ZSM, (3) low-CHC/low-ZHC, (4) low-CHC/medium-ZHC, (5) low-CHC/high-ZHC, (6) high-CHC/low-ZHC, (7) high-CHC/medium-ZHC, and (8) high-CHC/high-ZHC. On Day 42, blood samples were collected from one bird/pen to analyze the haematological parameters. Finally, two birds/pen were slaughtered, and the tibia and femur were collected to analyze the quality of bone and skin. The means were subjected to ANOVA and, when significant, compared by Tukey's test (p < 0.05) or Dunnett's (p < 0.05) test. The haematological parameters were not influenced by mineral supplementation. However, the inclusion of low ZHC enhanced the skin strength compared to high ZHC (p = 0.046). Furthermore, the bone mineral density of the tibia proximal epiphysis, tibia ash and tibia mineral content were positively improved with supplementation of low-CHC/medium-ZHC compared to high-CHC/medium-ZHC. This study demonstrated that hydroxy compounds are potential alternatives for replacing sulphate supplements in broiler diets. Moreover, among the Cu and Zn levels, the low CHC (15 mg/kg) and medium ZHC (100 mg/kg) improved bone development and skin integrity, suggesting that the combination of Cu and Zn can be a nutritional strategy to prevent the incidence of leg disorders in broilers.

The Early Impact of the COVID-19 Pandemic on Hospital Finances.

GOAL: The COVID-19 pandemic has caused both short- and long-term impacts on every aspect of society. Hospitals are among the most critical frontliners and have had to continually navigate the challenges caused by the pandemic. In this study, we examined hospitals' financial performance following the onset of the pandemic. METHODS: We used data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System. The study sample included all general acute care and critical access hospitals that receive Medicare payments. The primary outcomes included operating margins, net patient revenues, operating expenses, and uncompensated care costs. We tested for average changes from 2019 to 2020 in hospitals' financial outcomes. We also tested for changes in financial outcomes across samples stratified by hospital characteristics: ownership type (investor-owned, nonprofit, and public), Medicaid disproportionate share hospital status, rural status, county uninsured rate quartile, and Medicaid expansion status. PRINCIPAL FINDINGS: Our sample consisted of a balanced panel of 4,059 hospitals (8,118 observations) with data spanning 2019 and 2020. Across the full sample of hospitals, operating margins declined by an average of 5.3 percentage points between 2019 and 2020, equating to a 130% reduction from 2019 levels. Underlying these margin declines, net patient revenues declined by 3.2% on average, while operating expenses increased by 1.5%. We observed no changes in uncompensated care costs despite the large number of job losses that accompanied the pandemic. When stratifying the analysis by hospital characteristics, differences were observed across ownership types. Notably, investor-owned facilities were less affected financially than nonprofit and public hospitals. Although safety-net and rural hospitals generally fared no worse than their non-safety-net and nonrural counterparts, hospitals located in Medicaid expansion states experienced steeper declines in operating margins relative to hospitals located in nonexpansion states, driven by larger relative declines in patient revenues. PRACTICAL APPLICATIONS: The operating margin declines we observed can be attributed to supply-chain issues, persistent labor shortages, and suspension of elective services. The Affordable Care Act reforms in health insurance markets likely helped to insulate hospitals from increases in uncompensated care costs. In the shifting context of the pandemic, it is important to understand hospitals' financial performance so that measures can be taken to address further financial distress that may eventually lead to increased consolidation, hospital closures, and lower quality of care. Our findings stress the need for targeted responses that are tailored to underlying hospital characteristics. Temporary and targeted increases in inpatient and outpatient service prices can help offset revenue losses from the deferment of nonurgent care. Other policies can address the ongoing workforce challenges and supply-chain issues.

Sources and levels of copper and manganese supplementation influence performance, carcass traits, meat quality, tissue mineral content, and ileal absorption of broiler chickens.

This study was conducted to evaluate the effects of different levels and sources of Cu and Mn (sulfate or hydroxychloride - H) on growth performance, carcass traits, meat and skin quality, footpad dermatitis severity, litter quality, liver and plasma mineral content, and ileal mineral absorption. A total of 1,920 one-day-old male Cobb 500 broiler chicks were assigned randomly to one of 2 × 3+2 factorially arranged treatments: CuH (15 and 150 ppm) × MnH (40, 80, 120 ppm) + 15 ppm Cu Sulfate with 80 ppm Mn Sulfate (control 1) or 150 ppm Cu Sulfate with 120 ppm Mn sulfate (control 2) for 42 d. Each treatment consisted of 8 replicates of 30 birds. At 42-day-old were slaughtered for carcass yield and meat quality analyses. At 43-day-old, it was determined the apparent ileal absorption of minerals and the concentration of Cu and Mn in the liver and plasma. The resistance and elasticity of the skin, and footpad dermatitis severity were also evaluated. The level 150 ppm CuH improved the FCR compared to the 15 ppm CuH and 15 ppm Cu Sulfate level. Broilers fed diets containing 150 ppm CuH showed higher breast yield compared to those fed diets containing 15 ppm. Breast yield was positively influenced by the inclusion of 40 ppm MnH. There was an interaction between the CuH and the MnH for skin elasticity, and the highest elasticity was found when the supplementation levels were 150 ppm CuH and 40 ppm MnH. High levels of copper decreased the incidence of footpad dermatitis. The hydroxychloride source determined a higher mineral concentration in the liver and plasma and greater apparent ileal absorption of Cu and Mn. In conclusion, dietary supplementation with 150 ppm CuH and 40 or 80 ppm MnH enhance breast yield and improves skin resistance. The inclusion of 150 ppm CuH has the possibility to improve the FCR and decrease leg injuries. Furthermore, the hydroxychloride source seems to be more bioavailable than the sulfate source.

Hospitals' uneven recovery from the COVID-19 pandemic.

Using hospital cost report data from the Centers for Medicare and Medicaid Services, we examined the changes in hospitals' operating margins and total margins between 2019 and 2021. We found that, as of 2021, hospitals' operating margins had not fully rebounded to 2019 levels, although they had recovered from the 2020 nadirs. Conversely, average total margins increased by 140% during this period across all US hospitals, with the most significant growth occurring among rural hospitals, publicly operated hospitals, and critical access hospitals. Rural hospitals exhibited the largest gains in total margins during this time, experiencing a 1600% increase from 2019 to 2021. Our findings indicate that government relief funding tied to the COVID-19 Public Health Emergency significantly bolstered the financial health of the average hospital and had an outsize effect on lifting total margins among smaller hospitals that entered the pandemic in the most financially vulnerable position.