Photobiomodulation efficacy in age-related macular degeneration: a systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of vision loss. Photobiomodulation (PBM) offers a controversial approach for managing dry AMD, aiming to halt or reverse progression through mitochondrial activity modulation. However, the efficacy and clinical relevance of PBM as a potential approach for managing dry AMD remain debated. METHODS: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing PBM versus a sham in patients with dry AMD. We performed trial sequential analysis (TSA) and minimal clinically important difference (MCID) calculations to assess statistical and clinical significance applying a random-effects model with 95% confidence intervals (CI). RESULTS: We included three RCTs comprising 247 eyes. The pooled analysis showed that PBM significant improved BCVA (MD 1.76 letters; 95% CI: 0.04 to 3.48) and drusen volume (MD -0.12 mm³; 95% CI: -0.22 to -0.02) as compared with a sham control. However, the TSA indicated that the current sample sizes were insufficient for reliable conclusions. No significant differences were observed in GA area. The MCID analysis suggested that the statistically significant results did not translate into clinically significant benefits. In the quality assessment, all studies were deemed to have a high risk of bias. CONCLUSION: This meta-analysis points limitations in the current evidence base for PBM in dry AMD treatment, with issues around small sample sizes. Statistically significant improvements do not translate into clinical benefits. The research underscores need for larger RCTs to validate PBM's therapeutic potential for dry AMD.

What attributes of digital devices are important to clinicians in rehabilitation? A cross-cultural best-worst scaling study.

BACKGROUND: Digital interventions are becoming increasingly popular in rehabilitation. Understanding of device features which impact clinician adoption and satisfaction is limited. Research in the field should be conducted across diverse settings to ensure digital interventions do not exacerbate healthcare inequities. OBJECTIVE: This study aimed to understand rehabilitation clinicians' preferences regarding device attributes and included a cross-cultural comparison. MATERIALS AND METHODS: Choice experiment methodology (best-worst scaling) was used to survey rehabilitation clinicians across Australia and Brazil. Participants completed 10 best-worst questions, choosing the most and least important device attributes from subsets of 31 attributes in a partially balanced block design. Results were analysed using multinomial models by country and latent class. Attribute preference scores (PS) were scaled to 0-100 (least to most important). RESULTS: A total of 122 clinicians from Brazil and 104 clinicians from Australia completed the survey. Most respondents were physiotherapists (83%) working with neurological populations (51%) in the private/self-employed sector (51%) who had experience using rehabilitation devices (87%). Despite preference heterogeneity across country and work sector (public/not-for-profit versus private/self-employed/other), clinicians consistently prioritised patient outcomes (PS 100.0, 95%CI: 86.2-100.0), patient engagement (PS 93.9, 95%CI: 80.6-94.2), usability (PS 81.3, 95%CI: 68.8-82.5), research evidence (PS 80.4, 95%CI: 68.1-81.7) and risk (PS 75.7, 95%CI: 63.8-77.3). In Australia, clinicians favoured device attributes which facilitate increased therapy dosage (PS 79.2, 95%CI: 62.6-81.1) and encourage patient independent practice (PS 66.8, 95%CI: 52.0-69.2). In Brazil, clinicians preferred attributes enabling device use for providing clinical data (PS 67.6, 95%CI: 51.8-70.9) and conducting clinical assessments (PS 65.6, 95%CI: 50.2-68.8). CONCLUSION: Clinicians prioritise patients' needs and practical application over technical aspects of digital rehabilitation devices. Contextual factors shape clinician preferences rather than individual clinician characteristics. Future device design and research should consider preferences and influences, involving diverse stakeholders to account for context-driven variations across cultures and healthcare settings.

An extension of the best-worst method based on the spherical fuzzy sets for multi-criteria decision-making.

The ambiguous information in multi-criteria decision-making (MCDM) and the vagueness of decision-makers for qualitative judgments necessitate accurate tools to overcome uncertainties and generate reliable solutions. As one of the latest and most powerful MCDM methods for obtaining criteria weight, the best-worst method (BWM) has been developed. Compared to other MCDM methods, such as the analytic hierarchy process, the BWM requires fewer pairwise comparisons and produces more consistent results. Consequently, the main objective of this study is to develop an extension of BWM using spherical fuzzy sets (SFS) to address MCDM problems under uncertain conditions. Hesitancy, non-membership, and membership degrees are three-dimensional functions included in the SFS. The presence of three defined degrees allows decision-makers to express their judgments more accurately. An optimization model based on nonlinear constraints is used to determine optimal spherical fuzzy weight coefficients (SF-BWM). Additionally, a consistency ratio is proposed for the SF-BWM to assess the reliability of the proposed method in comparison to other versions of BWM. SF-BWM is examined using two numerical decision-making problems. The results show that the proposed method based on the SF-BWM provided the criteria weights with the same priority as the BWM and fuzzy BWM. However, there are differences in the criteria weight values based on the SF-BWM that indicate the accuracy and reliability of the obtained results. The main advantage of using SF-BWM is providing a better consistency ratio. Based on the comparative analysis, the consistency ratio obtained for SF-BWM is threefold better than the BWM and fuzzy BWM methods, which leads to more accurate results than BWM and fuzzy BWM.

Comparison of Clinical Decision Support Tools to Improve Pediatric Lipid Screening.

OBJECTIVE: To test whether different clinical decision support tools increase clinician orders and patient completions relative to standard practice and each other. STUDY DESIGN: A pragmatic, patient-randomized clinical trial in the electronic health record was conducted between October 2019 and April 2020 at Geisinger Health System in Pennsylvania, with 4 arms: care gap-a passive listing recommending screening; alert-a panel promoting and enabling lipid screen orders; both; and a standard practice-no guideline-based notification-control arm. Data were analyzed for 13 346 9- to 11-year-old patients seen within Geisinger primary care, cardiology, urgent care, or nutrition clinics, or who had an endocrinology visit. Principal outcomes were lipid screening orders by clinicians and completions by patients within 1 week of orders. RESULTS: Active (care gap and/or alert) vs control arm patients were significantly more likely (P < .05) to have lipid screening tests ordered and completed, with ORs ranging from 1.67 (95% CI 1.28-2.19) to 5.73 (95% CI 4.46-7.36) for orders and 1.54 (95% CI 1.04-2.27) to 2.90 (95% CI 2.02-4.15) for completions. Alerts, with or without care gaps listed, outperformed care gaps alone on orders, with odds ratios ranging from 2.92 (95% CI 2.32-3.66) to 3.43 (95% CI 2.73-4.29). CONCLUSIONS: Electronic alerts can increase lipid screening orders and completions, suggesting clinical decision support can improve guideline-concordant screening. The study also highlights electronic record-based patient randomization as a way to determine relative effectiveness of support tools. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04118348.

Selective Internal Radiation Therapy Using Y-90 Resin Microspheres for Metastatic Colorectal Cancer: An Updated Systematic Review and Network Meta-Analysis.

INTRODUCTION: This literature review and exploratory network meta-analysis (NMA) aimed to compare the clinical effectiveness and tolerability of selective internal radiation therapy (SIRT) using yttrium-90 (Y-90) resin microspheres, regorafenib (REG), trifluridine-tipiracil (TFD/TPI), and best supportive care (BSC) in adult patients with chemotherapy-refractory or chemotherapy-intolerant metastatic colorectal cancer (mCRC). METHODS: In light of recently published data, the literature was searched to complement and update a review published in 2018. Studies up to December 2022 comparing two or more of the treatments and reporting overall survival (OS), progression-free survival (PFS), or incidence of adverse events (AE) were included. The NMA compared hazard ratios (HRs) for OS and PFS using Markov chain Monte Carlo techniques. RESULTS: Fifteen studies were included, with eight studies added (none addressing SIRT). All active treatments improved OS in relation to BSC. SIRT had the longest OS among all treatments, although without statistically significant differences (HR [95% credible interval] for SIRT, 0.48 [0.27, 0.87]; TFD/TPI, 0.62 [0.46, 0.83]; REG, 0.78 [0.57, 1.05]) in a fixed effects model. Information regarding SIRT was insufficient for PFS analysis, and TFD/TPI was the best intervention (HR 2.26 [1.6, 3.18]). One SIRT study reported radioembolization-induced liver disease in > 10% of the sample; this was symptomatically managed. Non-haematological AEs (hand-foot skin reaction, fatigue, diarrhoea, hypertension, rash or desquamation) were more common with REG, while haematological events (neutropoenia, leukopenia, and anaemia) were more common with TFD/TPI. CONCLUSION: Current evidence supports SIRT treatment in patients with chemotherapy-refractory or chemotherapy-intolerant mCRC compared to newer oral agents, with comparable OS and low incidence of AEs.

Methodological quality of evidence-based clinical practice guidelines in cariology.

OBJECTIVE: The present study aimed to appraise the methodological quality of evidence-based Clinical Practice Guidelines (CPGs) in the cariology field. MATERIALS AND METHODS: A systematic search on electronic databases (MEDLINE/Pubmed, EMBASE, DARE and Epistemonikos), websites, and guideline organizations were undertaken. Evidence-based CPGs including at least one recommendation for clinical prevention and/or management of dental caries, developed for any clinical setting, were included. The quality of each guideline was evaluated using the AGREE II tool. Descriptive analysis was performed and the average overall score for each domain was calculated. RESULTS: Thirty-two guidelines were included. Most of the CPGs achieved higher scores for the domains of clarity of presentation (66.7%, 95% IC 37.3-52.2) and scope and purpose (59.6%, 95% IC 53.7-65.5) domains; and lower scores for editorial independence (46.1%, 95% IC 37.8-55.7) and applicability domain (44.7%, 95% IC 37-55.3). The reviewers assessed 12 CPGs (37.5%) as recommended for use, 15 (46.9%) recommended with modifications, and 5 (15.6%) as not recommended. CONCLUSION: The overall methodological quality of evidence-based CPGs in the cariology field is moderate, and there is a need for improvements in reporting related to most domains. The poorest reporting was found in the description of the domains' applicability of its recommendations and editorial independence. CLINICAL RELEVANCE: Clinical Practice Guidelines provide guidance to patients, healthcare professionals, and stakeholders. The quality of these documents is essential for establishing trust in their recommendations.

Critical Thinking: The ARDESOS-DIAPROVE Program in Dialogue with the Inference to the Best and Only Explanation.

In our daily lives, we are often faced with the need to explain various phenomena, but we do not always select the most accurate explanation. For example, let us consider a "toxic" relationship with physical and psychological abuse, where one of the partners is reluctant to end it. Explanations for this situation can range from emotional or economic dependency to irrational hypotheses such as witchcraft. Surprisingly, some people may turn to the latter explanation and consequently seek ineffective solutions, such as visiting a witch doctor instead of a psychologist. This choice of an inappropriate explanation can lead to actions that are not only ineffective but potentially harmful. This example underscores the importance of inference to the best explanation (IBE) in everyday decision making. IBE involves selecting the hypothesis that would best explain the available body of data or evidence, a process that is crucial to making sound decisions but is also vulnerable to bias and errors of judgment. Within this context, the purpose of our article is to explore how the IBE process and the selection of appropriate explanations impact decision making and problem solving in real life. To this end, we systematically analyze the role of IBE in the ARDESOS-DIAPROVE program, evaluating how this approach can enhance the teaching and practice of critical thinking.

Computational single cell oncology: state of the art.

Single cell computational analysis has emerged as a powerful tool in the field of oncology, enabling researchers to decipher the complex cellular heterogeneity that characterizes cancer. By leveraging computational algorithms and bioinformatics approaches, this methodology provides insights into the underlying genetic, epigenetic and transcriptomic variations among individual cancer cells. In this paper, we present a comprehensive overview of single cell computational analysis in oncology, discussing the key computational techniques employed for data processing, analysis, and interpretation. We explore the challenges associated with single cell data, including data quality control, normalization, dimensionality reduction, clustering, and trajectory inference. Furthermore, we highlight the applications of single cell computational analysis, including the identification of novel cell states, the characterization of tumor subtypes, the discovery of biomarkers, and the prediction of therapy response. Finally, we address the future directions and potential advancements in the field, including the development of machine learning and deep learning approaches for single cell analysis. Overall, this paper aims to provide a roadmap for researchers interested in leveraging computational methods to unlock the full potential of single cell analysis in understanding cancer biology with the goal of advancing precision oncology. For this purpose, we also include a notebook that instructs on how to apply the recommended tools in the Preprocessing and Quality Control section.

Outcomes and survival predictors of Latin American older adults with acute myeloid leukemia: Data from a single center

ABSTRACT Introduction: Acute myeloid leukemia (AML) is most commonly presented in older adults; however, it appears 10 years earlier in Latin American countries. Clinical evolution in older adults from this populations has not been characterized. We analyzed outcomes and survival predictors. Methods: Patients ≥ 55 years old diagnosed with AML at a hematology referral center from 2005 to 2020 receiving intensive chemotherapy (IC), low-dose cytarabine (LDAC) and best supportive care (BSC) were included. Survival analysis included the Kaplan-Meier and Cox models and the cumulative incidence of relapse (CIR). Results: Seventy-five adults were included and the overall survival (OS) was 4.87, 1.67 and 1.16 months, using IC, LDAC and BSC, respectively. The IC led to a higher OS (p < 0.001) and was a protective factor for early death, at a cost of more days spent hospitalized and more non-fatal treatment complications; non-significant differences were found between the LDAC and BSC. Eight (10.7%) patients underwent hematopoietic cell transplantation, with a higher OS (p = 0.013). Twenty (26.7%) patients achieved complete remission; 12 (60%) relapsed with a 6-month CIR of 57.9% in those < 70 years old vs. 86.5% in those ≥ 70 years old, p = 0.034. Multivariate analysis showed the white blood cell count (WBC) and IC had a significant impact on the patient survival, whereas chronological age and the Charlson comorbidity index (CCI) did not. Conclusion: AML in low-middle income countries demands a different approach; the IC improves survival, even with a high incidence of relapse, and should be offered as first-line treatment. Eligibility criteria should include WBC and a multidimensional evaluation. The age per se and the CCI should not be exclusion criteria to consider IC.

Inviabilidad de un régimen legal especial para la tenencia compartida de niños y niñas con discapacidad en el Perú / Unviability of a special legal regime for the shared custody of children with disabilities in Perú / Inviabilidade de um regime legal especial para a guarda compartilhada de meninos e meninas com incapacidade no Peru

En materia de Derecho de familia, la legislación peruana contempla la posibilidad de una tenencia compartida, regulada expresamente en el Código de los Niños y Adolescentes, sin establecer precisiones sobre las condiciones y formas de aplicación, lo que es similar en el Derecho comparado. Sustentado en principios bioéticos y jurídicos, en el presente artículo se analiza la posibilidad de generar una regulación especial para la tenencia compartida, enfocada en la necesidad de establecer criterios especiales que puedan tener en cuenta los jueces en los casos concretos que involucren a niños y niñas. Estos criterios deben partir de un modelo social dirigido a quebrar las barreras impuestas, dotando de las condiciones más adecuadas para un desarrollo integral y pleno. En esa línea de pensamiento, es fundamental el interés superior del niño, el compromiso de los progenitores y la implementación de ajustes razonables.

In terms of family law, Peruvian legislation contemplates the possibility of shared custody, expressly regulated in the Code of Children and Adolescents, without establishing details on the conditions and forms of application, which is similar in comparative law. Based on bioethical and legal principles, this article analyses the possibility of generating a special regulation for shared custody, focusing on the need to establish special criteria that judges can take into account in specific cases involving children. These criteria should be based on a social model aimed at breaking down the barriers imposed, providing the most appropriate conditions for an integral and full development. In this line of thought, the best interests of the child, the commitment of the parents and the implementation of reasonable accommodations are fundamental.

Em matéria de Direito de família, a legislação peruana contempla a possibilidade de uma guarda compartilhada, regulada expressamente no Código das Crianças e Adolescentes, sem estabelecer especificações sobre as condições e formas de aplicação, o que é similar no Direito comparado. Apoiado em princípios bioéticos e jurídicos, no presente artigo se analisa a possibilidade de gerar uma regulação especial para a guarda compartilhada, focada na necessidade de estabelecer critérios especiais que juízes possam ter em conta nos casos concretos que envolvem meninos e meninas. Esses critérios devem partir de um modelo social dirigido a quebrar as barreiras impostas, dotando as condições mais adequadas para um desenvolvimento integral e pleno. Nessa linha de pensamento, é fundamental o interesse superior da criança, o compromisso dos pais e a implementação de ajustes razoáveis.

Valoraciones emitidas por personas del gremio de profesionales en psicología de Costa Rica sobre sus habilidades terapéuticas y técnicas para ejercer psicoterapia clínica individual mediante las Tecnologías de la Información y Comunicación durante la pandemia por COVID-19 / Evaluations issued by Members of the Psychology Profession in Costa Rica on their Therapeutic Skills and Techniques for Practicing Individual Clinical Psychotherapy by means of Information and Communication Technologies During the COVID-19 Pandemic.v42i01.04

Resumen Durante la pandemia por COVID-19 se dio una acelerada virtualización de los procesos de atención psicológica en Costa Rica, en paralelo a la expansión en la regulación de esta modalidad por parte del Colegio de Profesionales en Psicología de Costa Rica. El presente artículo tiene el objetivo de identificar valoraciones de personas del gremio de profesionales en psicología de Costa Rica sobre sus habilidades terapéuticas y técnicas para ejercer psicoterapia clínica individual mediante las Tecnologías de la Información y Comunicación (TIC) durante la Pandemia por COVID-19. Mediante la aplicación de un cuestionario autoadministrado en línea, se realizó un acercamiento al gremio, donde se consultó sobre las estrategias, herramientas y habilidades que puso en práctica para comenzar a utilizar las TIC en su ejercicio psicoterapéutico. Se obtuvieron experiencias muy importantes, aprendizajes sobre la marcha y, sobre todo, la ausencia de un consenso y claridad entre las personas profesionales en psicología sobre las buenas prácticas para el uso de esta modalidad. Como principal reflexión del proceso, se invita al gremio a ejercitar al máximo las habilidades de terapeuta, especialmente aquellas que quizá no resulten empleadas regularmente durante una consulta a distancia, como la observación y el examen clínico integral.

Abstract During the COVID-19 Pandemic, the virtualization of psychological care grew rapidly in Costa Rica, parallel to the expansion of regulation for this modality in the Colegio de Profesionales en Psicología de Costa Rica. The objective of this article is to identify the appraisals of Costa Rican psychology professionals regarding their abilities to practice individual clinical psychotherapy by means of Information and Communication Technologies (ICT) during the COVID-19 Pandemic. Through the completion of a self-administered online questionnaire, professionals were consulted about the strategies, tools and skills that they put into play during the use of ICTs in their psychotherapeutic practice, narrating deeply important experiences, presenting key learnings and above all, making visible the absence of a consensus and clarity regarding the best practices for use in this modality. The main recommendation emanating from this process is to promote to the maximum continuing-education on the topic of therapist skills, especially those that may not be used regularly during a remote consultation, such as observation and comprehensive clinical examination.

Correlation between natural microbial load and formation of ropy slime affecting the superficial color of vacuum-packaged cooked sausage.

The present study outlines a comprehensive correlation between the natural microbial load, which is predominantly composed of heat-resistant sporous-forming Bacillus, and the changes in the original properties related to the superficial color of vacuum-packaged cooked sausages. For this purpose, microbial growth curves were plotted by stimulating the growth of the natural microbiota in sausage packages at different temperatures. The correlations were investigated during sample incubation by the instrumental evaluation of color and the ropy slime detection on the sausage surface. The entrance of the natural microbiota into the stationary phase (ca. 9.3 log cfu/g) resulted in changes in the superficial color, which was demonstrated by the discoloration of vacuum-packaged cooked sausages. Therefore, it seems to be a suitable borderline for predictive models applied in durability studies that aim to estimate the period in which vacuum-packaged cooked sausages keep their typical superficial color, anticipating product refusal in markets.

Food neophobia, risk perception and attitudes associations of Brazilian consumers towards non-conventional edible plants and research on sale promotional strategies.

Non-conventional edible plants (NCEP) are plants or parts of plants that are not usually consumed by the population and have limited geographic distribution. This study investigated the consumption of NCEP, the influence of Food Neophobia and risk perception on Brazilian consumers attitudes as well as purchase preferences to determinate the best sale promotional strategy. Participants (n = 271) answered the online questionnaire that consisted of socio-demographic questions, items about consumption (open questions), Food Neophobia Scale, risk perception (to assign the level risk) and attitudes towards NCEP (using 5-point Likert scale). Fisher's exact test was used to investigate possible associations. Task purchase choice was evaluated using the Best-Worst Scale. The most consumed conventional leafy vegetables were collard greens (Brassica oleracea L. var. acephala D.C) (95.6%) and lettuce (Lactuca sativa) (88.5%). As for NCEP, taioba (Xanthosoma taioba E.G) (26.7%), bertalha (Basela alba L.) (23.3%) and beldroega (Portulaca oleracea L.) (14.1%) were the most cited leafy vegetables. High food neophobia individuals demonstrated to try NCEP if its nutritional value and safety are proven, showing a demand for such strategy, this would increase the consumption of these vegetables. The perception of a high risk was also associated with the inclusion of NCEP in the diet. The inclusion of NCEP at the moment of purchase, even at a higher price, presented higher scores when compared to the purchase of only conventional vegetables, at lower prices. Despite this, the price can still be a limiting factor and the search for promotional strategies should be reinforced to increase the commercialization of NCEP at street markets.

Single-step genomic evaluation for growth traits in a Mexican Braunvieh cattle population.

OBJECTIVE: The objective was to compare (pedigree-based) best linear unbiased prediction (BLUP), genomic BLUP (GBLUP), and single-step GBLUP (ssGBLUP) methods for genomic evaluation of growth traits in a Mexican Braunvieh cattle population. METHODS: Birth (BW), weaning (WW), and yearling weight (YW) data of a Mexican Braunvieh cattle population were analyzed with BLUP, GBLUP, and ssGBLUP methods. These methods are differentiated by the additive genetic relationship matrix included in the model and the animals under evaluation. The predictive ability of the model was evaluated using random partitions of the data in training and testing sets, consistently predicting about 20% of genotyped animals on all occasions. For each partition, the Pearson correlation coefficient between adjusted phenotypes for fixed effects and non-genetic random effects and the estimated breeding values (EBV) were computed. RESULTS: The random contemporary group (CG) effect explained about 50%, 45%, and 35% of the phenotypic variance in BW, WW, and YW, respectively. For the three methods, the CG effect explained the highest proportion of the phenotypic variances (except for YW-GBLUP). The heritability estimate obtained with GBLUP was the lowest for BW, while the highest heritability was obtained with BLUP. For WW, the highest heritability estimate was obtained with BLUP, the estimates obtained with GBLUP and ssGBLUP were similar. For YW, the heritability estimates obtained with GBLUP and BLUP were similar, and the lowest heritability was obtained with ssGBLUP. Pearson correlation coefficients between adjusted phenotypes for non-genetic effects and EBVs were the highest for BLUP, followed by ssBLUP and GBLUP. CONCLUSION: The successful implementation of genetic evaluations that include genotyped and non-genotyped animals in our study indicate a promising method for use in genetic improvement programs of Braunvieh cattle. Our findings showed that simultaneous evaluation of genotyped and non-genotyped animals improved prediction accuracy for growth traits even with a limited number of genotyped animals.

Nitrate isotopes (δ15N, δ18O) in precipitation: best practices from an international coordinated research project.

Stable isotope ratios of nitrogen and oxygen (15N/14N and 18O/16O) of nitrate (NO3-) are excellent tracers for developing systematic understanding of sources, conversions, and deposition of reactive atmospheric nitrogen (Nr) in the environment. Despite recent analytical advances, standardized sampling of NO3-) isotopes in precipitation is still lacking. To advance atmospheric studies on Nr species, we propose best-practice guidelines for accurate and precise sampling and analysis of NO3- isotopes in precipitation based on the experience obtained from an international research project coordinated by the International Atomic Energy Agency (IAEA). The precipitation sampling and preservation strategies yielded a good agreement between the NO3- concentrations measured at the laboratories of 16 countries and at the IAEA. Compared to conventional methods (e.g., bacterial denitrification), we confirmed the accurate performance of the lower cost Ti(III) reduction method for isotope analyses (15N and 18O) of NO3- in precipitation samples. These isotopic data depict different origins and oxidation pathways of inorganic nitrogen. This work emphasized the capability of NO3- isotopes to assess the origin and atmospheric oxidation of Nr and outlined a pathway to improve laboratory capability and expertise at a global scale. The incorporation of other isotopes like 17O in Nr is recommended in future studies.

SNP- and haplotype-based single-step genomic predictions for body weight, wool, and reproductive traits in North American Rambouillet sheep.

Rambouillet sheep are commonly raised in extensive grazing systems in the US, mainly for wool and meat production. Genomic evaluations in US sheep breeds, including Rambouillet, are still incipient. Therefore, we aimed to evaluate the feasibility of performing genomic prediction of breeding values for various traits in Rambouillet sheep based on single nucleotide polymorphisms (SNP) or haplotypes (fitted as pseudo-SNP) under a single-step GBLUP approach. A total of 28,834 records for birth weight (BWT), 23,306 for postweaning weight (PWT), 5,832 for yearling weight (YWT), 9,880 for yearling fibre diameter (YFD), 11,872 for yearling greasy fleece weight (YGFW), and 15,984 for number of lambs born (NLB) were used in this study. Seven hundred forty-one individuals were genotyped using a moderate (50 K; n = 677) or high (600 K; n = 64) density SNP panel, in which 32 K SNP in common between the two SNP panels (after genotypic quality control) were used for further analyses. Single-step genomic predictions using SNP (H-BLUP) or haplotypes (HAP-BLUP) from blocks with different linkage disequilibrium (LD) thresholds (0.15, 0.35, 0.50, 0.65, and 0.80) were evaluated. We also considered different blending parameters when constructing the genomic relationship matrix used to predict the genomic-enhanced estimated breeding values (GEBV), with alpha equal to 0.95 or 0.50. The GEBV were compared to the estimated breeding values (EBV) obtained from traditional pedigree-based evaluations (A-BLUP). The mean theoretical accuracy ranged from 0.499 (A-BLUP for PWT) to 0.795 (HAP-BLUP using haplotypes from blocks with LD threshold of 0.35 and alpha equal to 0.95 for YFD). The prediction accuracies ranged from 0.143 (A-BLUP for PWT) to 0.330 (A-BLUP for YGFW) while the prediction bias ranged from -0.104 (H-BLUP for PWT) to 0.087 (HAP-BLUP using haplotypes from blocks with LD threshold of 0.15 and alpha equal to 0.95 for YGFW). The GEBV dispersion ranged from 0.428 (A-BLUP for PWT) to 1.035 (A-BLUP for YGFW). Similar results were observed for H-BLUP or HAP-BLUP, independently of the LD threshold to create the haplotypes, alpha value, or trait analysed. Using genomic information (fitting individual SNP or haplotypes) provided similar or higher prediction and theoretical accuracies and reduced the dispersion of the GEBV for body weight, wool, and reproductive traits in Rambouillet sheep. However, there were no clear improvements in the prediction bias when compared to pedigree-based predictions. The next step will be to enlarge the training populations for this breed to increase the benefits of genomic predictions.

How, When, & Where temporary hospitals fit in turbulent times: A hybrid MADM optimization in the middle east.

Governments have been challenged to provide temporary hospitals and other types of facilities to face the COVID-19 pandemic. This research proposes a novel multi-attribute decision-making (MADM) model to help determine how, when, and where these temporary facilities should be installed based on a set of critical success factors (CSFs) mapped in an uncertain environment. We portray the available facilities for temporary hospitals based on the CSFs that must be considered to make critical decisions regarding the optimal position based on the government's strategic decision-making process, thus indirectly providing better services and maximizing resources. In relation to earlier work, this research builds upon hybrid Pythagorean fuzzy numbers to find weights in Best-Worst Methods and rank temporary facilities based on evaluation by an area-based method for ranking. Policy implications and future directions are derived.

Outcomes and survival predictors of Latin American older adults with acute myeloid leukemia: Data from a single center.

INTRODUCTION: Acute myeloid leukemia (AML) is most commonly presented in older adults; however, it appears 10 years earlier in Latin American countries. Clinical evolution in older adults from this populations has not been characterized. We analyzed outcomes and survival predictors. METHODS: Patients ≥ 55 years old diagnosed with AML at a hematology referral center from 2005 to 2020 receiving intensive chemotherapy (IC), low-dose cytarabine (LDAC) and best supportive care (BSC) were included. Survival analysis included the Kaplan-Meier and Cox models and the cumulative incidence of relapse (CIR). RESULTS: Seventy-five adults were included and the overall survival (OS) was 4.87, 1.67 and 1.16 months, using IC, LDAC and BSC, respectively. The IC led to a higher OS (p < 0.001) and was a protective factor for early death, at a cost of more days spent hospitalized and more non-fatal treatment complications; non-significant differences were found between the LDAC and BSC. Eight (10.7%) patients underwent hematopoietic cell transplantation, with a higher OS (p = 0.013). Twenty (26.7%) patients achieved complete remission; 12 (60%) relapsed with a 6-month CIR of 57.9% in those < 70 years old vs. 86.5% in those ≥ 70 years old, p = 0.034. Multivariate analysis showed the white blood cell count (WBC) and IC had a significant impact on the patient survival, whereas chronological age and the Charlson comorbidity index (CCI) did not. CONCLUSION: AML in low-middle income countries demands a different approach; the IC improves survival, even with a high incidence of relapse, and should be offered as first-line treatment. Eligibility criteria should include WBC and a multidimensional evaluation. The age per se and the CCI should not be exclusion criteria to consider IC.

Implementación de tres guías de buenas prácticas clínicas en la escuela de enfermería de la universidad de talca, chile

El presente artículo describe el proceso de implementación de tres guías elaboradas por la Registered Nurses' Association of Ontario (RNAO) de Canadá, en el módulo enfermería en el adulto en la Escuela de Enfermería de la Universidad de Talca, proceso que se enmarca en el convenio establecido entre la Universidad de Talca y esta asociación, a través del Departamento de Enfermería de la Universidad de Chile, host leader del Programa de Guías de Buenas Prácticas Clínicas de la RNAO. Esta implementación se llevó a cabo a través de diversas metodologías de enseñanza-aprendizaje que han permitido a los estudiantes integrar y aplicar la Enfermería Basada en Evidencia en la práctica clínica y también, establecer una alianza entre la institución académica y los centros de asistencia sanitaria.

This article describes the implementation process of three guidelines developed by the Registered Nurses' Association of Ontario (RNAO) in the adult nursing module at the School of Nursing of the University of Talca. This process is part of the agreement reached between the University of Talca and this association, through the Department of Nursing of the University of Chile, Host Leader of the RNAO's Best Clinical Practice Guidelines Program. This implementation has been carried out through various teaching-learning methodologies that have allowed students to integrate and apply Evidence-Based Nursing in clinical practice and also to establish an alliance between the academic institution and health care centers.

Este artigo descreve o processo de implementação de três diretrizes desenvolvidas pela Associação de Enfermeiros Registrados de Ontario (RNAO, sigla em inglês) do Canadá no módulo de enfermagem para adultos da Escola de Enfermagem da Universidade de Talca. Esse processo faz parte do acordo estabelecido entre a Universidade de Talca e esta associação, por meio do Departamento de Enfermagem da Universidade do Chile, host leader do Programa de Boas Práticas Clínicas da RNAO. Essa implementação foi realizada por meio de várias metodologias de ensino-apredizagem que permitiram aos estudantes integrarem a Enfermagem Baseada em Evidências à prática clínica, e também estabelecer uma aliança entre a instituição académica e os centros de saúde.

Experiencia formadora con cuatro guías de buenas prácticas clínicas de la registered nurses' association of ontario

El presente artículo trata sobre la implementación de cuatro guías elaboradas por la Registered Nurses' Association of Ontario (Canadá) en la enseñanza de pregrado de la Carrera de Enfermería de la Universidad de Chile, proceso que se enmarca en el primer convenio establecido entre la Universidad de Chile y esta asociación. El acuerdo instaurado entre ambas instituciones promovió la incorporación de las guías: Valoración y Selección de Accesos Vasculares, Atención a las Familias, Establecimiento de Relación Terapéutica, y Valoración y Manejo del Dolor, al plan de formación de la Carrera de Enfermería, proceso liderado por docentes asesores de cada una de las guías a través de diversas estrategias pedagógicas y didácticas, demostrando un aporte significativo de este material al aprendizaje de los estudiantes de enfermería de la institución académica.

This article describes the implementation of four guidelines developed by the Registered Nurses' Association of Ontario for undergraduate nursing education at the Universidad de Chile, a process that is part of the first agreement reached between the University of Chile and the Registered Nurses' Association of Ontario. The agreement established between both institutions helped incorporate the following guidelines: Assessment and Selection of Vascular Accesses, Family Care, Establishment of Therapeutic Relationship, and Assessment and Management of Pain, into the training plan of the nursing program, a process led by the faculty advisors of each of the guidelines through various pedagogical and didactic strategies, demonstrating a significant contribution of this material to the learning process of the nursing students.

Este artigo trata da implementação de quatro guias desenvolvidas pela Associação de Enfermeiros Registrados de Ontário (Canadá) para a educação de enfermagem de graduação na Universidade do Chile, um processo que faz parte do primeiro acordo estabelecido entre Universidade do Chile e a Associação de Enfermeiros Registrados de Ontário. O acordo assinado entre as duas instituições promoveu a incorporação das seguintes guias: Avaliação e Seleção de Acessos Vasculares, Cuidado Familiar, Estabelecimento de Relacionamento Terapêutico e Avaliação e Gerenciamento da Dor, ao plano de treinamento do programa de enfermagem, um processo conduzido pelos orientadores de cada uma das guias através de várias estratégias pedagógicas e didáticas, demonstrando uma contribuição significativa deste material para o aprendizado dos estudantes de enfermagem.