Van der Waals contacts between three-dimensional metals and two-dimensional semiconductors.

As the dimensions of the semiconducting channels in field-effect transistors decrease, the contact resistance of the metal-semiconductor interface at the source and drain electrodes increases, dominating the performance of devices1-3. Two-dimensional (2D) transition-metal dichalcogenides such as molybdenum disulfide (MoS2) have been demonstrated to be excellent semiconductors for ultrathin field-effect transistors4,5. However, unusually high contact resistance has been observed across the interface between the metal and the 2D transition-metal dichalcogenide3,5-9. Recent studies have shown that van der Waals contacts formed by transferred graphene10,11 and metals12 on few-layered transition-metal dichalcogenides produce good contact properties. However, van der Waals contacts between a three-dimensional metal and a monolayer 2D transition-metal dichalcogenide have yet to be demonstrated. Here we report the realization of ultraclean van der Waals contacts between 10-nanometre-thick indium metal capped with 100-nanometre-thick gold electrodes and monolayer MoS2. Using scanning transmission electron microscopy imaging, we show that the indium and gold layers form a solid solution after annealing at 200 degrees Celsius and that the interface between the gold-capped indium and the MoS2 is atomically sharp with no detectable chemical interaction between the metal and the 2D transition-metal dichalcogenide, suggesting van-der-Waals-type bonding between the gold-capped indium and monolayer MoS2. The contact resistance of the indium/gold electrodes is 3,000 ± 300 ohm micrometres for monolayer MoS2 and 800 ± 200 ohm micrometres for few-layered MoS2. These values are among the lowest observed for three-dimensional metal electrodes evaporated onto MoS2, enabling high-performance field-effect transistors with a mobility of 167 ± 20 square centimetres per volt per second. We also demonstrate a low contact resistance of 220 ± 50 ohm micrometres on ultrathin niobium disulfide (NbS2) and near-ideal band offsets, indicative of defect-free interfaces, in tungsten disulfide (WS2) and tungsten diselenide (WSe2) contacted with indium alloy. Our work provides a simple method of making ultraclean van der Waals contacts using standard laboratory technology on monolayer 2D semiconductors.

Challenges in assessing the effects of environmental governance systems on conservation outcomes.

Effective governance is crucial for the success of conservation projects aimed at protecting wildlife populations and supporting human well-being. However, few large-scale, comprehensive syntheses have been conducted on the effects of different environmental governance types on conservation outcomes (i.e., biological and ecological effectiveness or effects of conservation on human well-being), and clarity on the quantity and quality of evidence remains dispersed and ambiguous. We attempted a systematic map of the evidence on the effectiveness of different governance types to meet desired conservation outcomes in Africa, Asia, and Latin America. However, early in this effort, we observed a general lack of empirical research on the links between governance and conservation outcomes. To fill observed data gaps in the evidence base, we tried triangulating governance data from alternative sources (Protected Planet database) and pooling evidence from research conducted within the same conservation areas. Limited data were contained in the Protected Planet database, and governance types in conservation areas and landscapes were complex, making it difficult to use these approaches to assign governance types to conservation areas. To illustrate our observations from the failed systematic map attempt, we prepared a rapid evidence map that outlines a subset of the evidence base of articles linking governance types and governance principles with conservation outcomes. Only 3.2% (34 of 1067) of the articles we screened directly related conservation outcomes to governance type, and even fewer related governance principles to conservation outcomes. Based on our findings, we recommend improving the evidence base by supporting empirical research and increasing the availability and quality of governance data in freely accessible databases. These recommendations are critical for enhancing understanding of the role of governance in conservation projects and improving conservation outcomes.

Retos para la evaluación de los efectos de los sistemas de gestión ambiental sobre los resultados de conservación Resumen Una gestión eficaz es crucial para el éxito de los proyectos de conservación destinados a proteger las poblaciones de fauna y flora y apoyar el bienestar humano. Sin embargo, hay pocas síntesis exhaustivas a gran escala sobre los efectos de los distintos tipos de gestión ambiental en los resultados de conservación (es decir, la eficacia biológica y ecológica o los efectos de la conservación sobre el bienestar humano), y la claridad sobre la cantidad y calidad de las pruebas todavía está dispersa y ambigua. Intentamos elaborar un mapa sistemático con evidencias de la eficacia de los distintos tipos de gestión para logar los resultados de conservación deseados en África, Asia y América Latina. Sin embargo, al principio de este esfuerzo observamos una falta general de investigación empírica sobre los vínculos entre la gestión y los resultados de la conservación. Para cerrar las brechas observadas en la base de pruebas, intentamos triangular los datos sobre gobernanza procedentes de fuentes alternativas (base de datos Protected Planet) y agrupar las pruebas de las investigaciones realizadas en las mismas áreas de conservación. La base de datos Protected Planet tenía datos limitados y los tipos de gestión en las áreas de conservación y los paisajes eran complejos, lo que complicaba el uso de estos enfoques para asignar tipos de gestión a las áreas de conservación. Para ilustrar nuestras observaciones a partir del mapa sistemático fallido, preparamos un mapa rápido con evidencias que resumía un subconjunto de la base de pruebas de artículos que vinculan los tipos y los principios de gestión con los resultados de conservación. Sólo el 3.2% (34 de 1067) de los artículos analizados relacionaban directamente los resultados de conservación con el tipo de gestión; fueron menos los que relacionaban los principios de gestión con los resultados de conservación. Con base en nuestros hallazgos, recomendamos mejorar la base de pruebas con apoyo a la investigación empírica y aumentando la disponibilidad y la calidad de los datos sobre gestiones en bases de datos de libre acceso. Estas recomendaciones son fundamentales para comprender mejor el papel de la gestión en los proyectos de conservación y mejorar los resultados de la conservación.

Cost-effectiveness of robotic vs laparoscopic distal pancreatectomy. Results from the national prospective trial ROBOCOSTES.

INTRODUCTION: Although several studies report that the robotic approach is more costly than laparoscopy, the cost-effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) is still an issue. This study evaluates the cost-effectiveness of the RDP and LDP approaches across several Spanish centres. METHODS: This study is an observational, multicenter, national prospective study (ROBOCOSTES). For one year from 2022, all consecutive patients undergoing minimally invasive distal pancreatectomy were included, and clinical, QALY, and cost data were prospectively collected. The primary aim was to analyze the cost-effectiveness between RDP and LDP. RESULTS: During the study period, 80 procedures from 14 Spanish centres were analyzed. LDP had a shorter operative time than the RDP approach (192.2 min vs 241.3 min, p = 0.004). RDP showed a lower conversion rate (19.5% vs 2.5%, p = 0.006) and a lower splenectomy rate (60% vs 26.5%, p = 0.004). A statistically significant difference was reported for the Comprehensive Complication Index between the two study groups, favouring the robotic approach (12.7 vs 6.1, p = 0.022). RDP was associated with increased operative costs of 1600 euros (p < 0.031), while overall cost expenses resulted in being 1070.92 Euros higher than the LDP but without a statistically significant difference (p = 0.064). The mean QALYs at 90 days after surgery for RDP (0.9534) were higher than those of LDP (0.8882) (p = 0.030). At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was a 62.64% and 71.30% probability that RDP was more cost-effective than LDP, respectively. CONCLUSIONS: The RDP procedure in the Spanish healthcare system appears more cost-effective than the LDP.

Anticoagulation strategies in COVID-19 infected patients receiving ECMO support.

BACKGROUND: Hospitalized COVID-19 patients with hypoxemic respiratory failure may deteriorate despite invasive mechanical ventilation and thus require extracorporeal membrane oxygenation (ECMO) support. Unfractionated heparin (UFH) is the antithrombotic of choice, however, bivalirudin may offer more predictable pharmacokinetics resulting in consistent anticoagulant effects with lower bleeding and thrombotic occurrences. The aim of this study was to evaluate efficacy and safety outcomes in patients undergoing venovenous (VV) ECMO receiving bivalirudin or UFH-based anticoagulation. METHODS: This retrospective, single-center, observational cohort study included patients with confirmed COVID-19 infection requiring VV ECMO support receiving anticoagulation with UFH or bivalirudin. Primary endpoints were time to reach therapeutic aPTT, percent time spent in aPTT range, and the occurrence of thrombotic events over the entire course of ECMO support. Secondary endpoints included the incidence of major/minor bleeding, the ability to wean off ECMO support, in-hospital mortality, and length of stay. RESULTS: Twenty-two patients were included in the study (n = 10 UFH, n = 12 bivalirudin). Time to therapeutic aPTT was achieved faster with UFH (10 h vs. 20 h). The percentage time spent within the goal aPTT range was similar between UFH and bivalirudin (50% vs. 52%). Thrombotic events were significantly higher in the UFH group (40% DVT, 40% PE, 80% oxygenator thrombus in ECMO machine, 10% ischemic stroke) versus bivalirudin (8% DVT, 17% PE, 33% oxygenator thrombus, no ischemic strokes) (CI 95%, p = 0.04). The overall bleeding incidence was higher in the UFH arm (90% vs. 75%). The mortality rate was 90% in the UFH group and 58% in the bivalirudin group. The length of stay was similar between the two study arms. CONCLUSION: In hospitalized patients with COVID-19-associated acute respiratory distress syndrome (ARDS) on VV ECMO support, the use of bivalirudin showed to be a viable anticoagulation alternative in terms of efficacy compared to UFH and resulted in a favorable safety profile with lower rates of bleeding and thrombotic events.

Operationalizing Stakeholder Engagement Through the Stakeholder-Centric Engagement Charter (SCEC).

There is a need for clear strategies and procedures to operationalize stakeholder engagement in research studies. Clear guidelines that promote shared leadership among study investigators and research stakeholders are important for inclusive and sustainable partnerships. Such guidelines may take the form of a governance charter and can be a means for encouraging the participation and inclusion of stakeholders who may have little to no experience with research or are otherwise underrepresented in research. This perspective article presents the Stakeholder-Centric Engagement Charter (SCEC), one effort to operationalize a stakeholder engagement approach between researchers and an advisory committee as guided by the Patient-Centered Outcomes Research Institute's (PCORI) Research Engagement Principles (i.e., reciprocal relationships, partnerships, co-learning, transparency-honesty-trust). Building on the SCEC can help future investigators develop a study-specific, dynamic, governance document outlining advisory committee and research team preferences in areas such as role expectations, study governance, and decision-making procedures.

Surgical Wound Complications after Colorectal Surgery with Single-Use Negative-Pressure Wound Therapy Versus Surgical Dressing over Closed Incisions: A Randomized Controlled Trial.

BACKGROUND: Global studies indicate that surgical site infections (SSIs) are a major healthcare challenge within hospitals and can have a profound impact on patient quality of life and healthcare costs. Closed-incision negative-pressure therapy (ciNPT) has been reported to provide positive clinical benefits for patients with various incisions, including those following colorectal surgeries. METHODS: Investigators performed a prospective, randomized, multicenter trial to evaluate complications of surgical incisions in patients who received a ciNPT dressing versus a conventional surgical dressing (control) over their closed incision following colorectal surgery. The incidence of SSI was determined at 7, 15, and 30 days postsurgery. RESULTS: A total of 148 patients participated in the study. Results showed that the SSI rate on day 7 was lower in the ciNPT group versus the control group (10/75 [13.3%] vs 17/73 [23.3%]), but this difference was not statistically significant. On day 15, the SSI rate was 12/75 (16.0%) in the ciNPT group versus 21/73 (28.8%) in the control group; however, this difference was only marginally statistically significant (P = .0621). At 1 month, the SSI rate remained lower in the ciNPT group (13/75 [17.3%] vs 21/73 [28.8%], P = .0983) compared with the control group. CONCLUSIONS: Future studies with larger population sizes are necessary to determine the impact of ciNPT on patients' incisions after colorectal surgery.

Long-Term Follow-Up of a Lifestyle Intervention for Late-Midlife, Rural-Dwelling Latinos in Primary Care.

IMPORTANCE: Rural-dwelling Latinos are an underresourced population in need of accessible and effective wellness programs. OBJECTIVE: To evaluate patients' long-term health-related outcomes after lifestyle intervention. DESIGN: An uncontrolled pilot trial assessing change in health from pretreatment to long-term follow-up (12 mo after intervention completion, no contact) and from posttreatment to long-term follow-up. SETTING: Rural, community-based primary care. PARTICIPANTS: Latino and Hispanic safety-net primary care patients, ages 50 to 64 yr. INTERVENTION: A culturally tailored, 4-mo lifestyle intervention co-led by occupational therapy practitioners and Latino community health workers that features telehealth and in-home sessions covering topics such as healthy eating and navigating health care. OUTCOMES AND MEASURES: Self-reported and physiological outcomes: symptom-well-being (primary), stress, sleep disturbance, social satisfaction, physical activity, patient activation, blood pressure, and weight. Exit interviews addressed health experiences and intervention impact on participants' lives. RESULTS: Participants (N = 27) demonstrated clinically significant pretreatment to long-term follow-up benefits in all symptom-well-being dimensions (Cohen's d ≥ 0.8, p ≤ .004), with additional gains from posttreatment to long-term follow-up (d ≥ 0.4, p ≤ .05). Significant improvements from pre- to posttreatment in systolic blood pressure, stress, and social role and activity satisfaction were maintained at long-term follow-up. No changes were observed in weight, physical activity, or diastolic blood pressure. Participants described the intervention's sustained positive effect on their wellness. CONCLUSIONS AND RELEVANCE: A lifestyle intervention led by occupational therapy practitioners and community health workers in a primary care context has potential to achieve long-term health benefits in rural-dwelling, late-midlife Latinos. WHAT THIS ARTICLE ADDS: This study reveals that rural, late-midlife Latinos showed long-lasting improvements in psychological and physical health after finishing a program that helped them make healthy lifestyle choices. This finding supports the unique contribution of occupational therapy in primary care settings.

Language Discordance and Patient- Centered Care in Occupational Therapy: A Case Study.

The accumulative burden of a growing non-English speaking minority population and health disparities in the United States demonstrate the urgency of examining occupational therapy practices and defining care that is timely, effective, safe, and patient-centered. In this context, we investigate an occupational therapy episode of care from the perspectives of patient, caregiver, and primary occupational therapy care provider. Treatment sessions were observed and one-on-one semistructured interviews were conducted with the participants. Several themes describing areas of concern in communication and care delivery emerged, including expectations for care, the therapy relationship, professional identity, and pragmatic constraints. The use of untrained interpreters compromised treatment effectiveness and safety. This case highlights potential areas of concern in therapy when working with a diverse patient population. Abundant opportunities exist for occupational therapy to situate itself as an equitable, responsive, valuable, and essential service.

Understanding the Experiences of Family Caregivers of Nursing Home Residents With Dementia: A Grounded Theory Study.

BACKGROUND AND OBJECTIVES: Alzheimer's disease and related dementias progress over time and result in cognitive decline, loss of independence, and behavioral and psychiatric symptoms of dementia that can lead to nursing home placement. Research has focused on examining the effects of nursing home placement on the family caregiver; however, their experiences are less understood. We sought to investigate the experiences and perceptions of family caregivers of nursing home residents with dementia. The objective was to create a conceptual model that explains the complex nature of the family caregiver experience. RESEARCH DESIGN AND METHODS: This study is part of a larger randomized controlled trial. Following a grounded theory approach, we completed 30 in-depth, one-on-one interviews with family caregivers of nursing home residents with dementia. Data analysis followed an iterative process that employed open, axial, and selective coding. RESULTS: Our conceptual model depicts the interrelationship between contributing factors that interrelate and impact family caregiver satisfaction with nursing home care. Six factors contribute to family caregiver satisfaction: family caregiver interactions with nursing home staff; staff management of resident behavioral symptoms; nursing home context; family caregiver knowledge of dementia; family caregiver strain; and the resident experience. DISCUSSION AND IMPLICATIONS: Our findings revealed family caregiver experiences that are unique to the institutional nursing home setting and not reflected in prior work focusing on experiences within community-based settings. Understanding family caregiver experiences and the contributors to how satisfaction in care is perceived, may foster collaboration and teamwork among families and staff.

First reported case of Trichomonas gallinae infection in red-breasted toucan (Ramphastos dicolorus).

This study reports the infection and diagnosis of the protozoan morphologic complex Trichomonas gallinae in a baby red-breasted toucan (Ramphastos dicolorus). Nodular lesions on the soft palate and edema in the oral cavity were observed macroscopically. Microscopically, a granuloma with multiple layers of necrosis interspersed with inflammatory polymorphonuclear infiltrates was observed. Parasitism was confirmed by parasitological diagnosis, isolation of the flagellates in culture medium, and Polymerase Chain Reaction (PCR) using 5.8S ribosomal RNA (rRNA). Flanking internal transcribed spacer (ITS) gene regions were amplified by polymerase chain reaction, and the sequences were analyzed phylogenetically using MEGA 11 software. Phylogenetic analysis based on ITS1/5.8S rRNA/ITS2 sequences demonstrated high nucleotide identity with two Trichomonas sequences available in GenBank, which were more closely related to T. vaginalis (99%) than to T. gallinae (98%). In addition to being potential transmitters of this protozoan, rigorous monitoring of infectious and parasitic diseases in wild bird populations is essential for their preservation. The forms of transmission of Trichomonas sp. favor the occurrence of the disease in many non-Columbiformes species, which is essential for the monitoring of this disease in wild birds.

Comparison of Pediatric Patients With and Without Multisystem Inflammatory Syndrome Associated With COVID-19: Retrospective Cohort From Ecuador.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) has been associated with severe acute respiratory syndrome coronavirus 2 infection in the pediatric population cared for in the pediatric intensive care unit. We aimed to compare patients with pediatric acute respiratory distress syndrome (PARDS) with those who also present a MIS-C diagnosis (PARDS vs. PARDS + MIS-C). METHODS: One hundred and sixty-seven children (0-15 years) admitted to the pediatric intensive care unit COVID-19 ward of a national reference children's hospital in Quito, Ecuador, from June 2020 to June 2021 who developed PARDS with or without MIS-C. To diagnose PARDS, the criteria of the Pediatric Acute Lung Injury Consensus Conference Group were used, and to diagnose MIS-C, the criteria of the Centers for Disease Control and Prevention were used. Additionally, the PRISM score was used to calculate the mortality risk of study patients on admission. RESULTS: Of the 167 patients with PARDS, ~59% also developed MIS-C. Patients with PARDS + MIS-C had higher risks than patients without MIS-C in the following: frequency of associated bacterial infections (81.6% vs. 55.1%), mortality risk (36.7% vs. 11.6%), use of respiratory support (invasive mechanical ventilation: 92% vs. 86%), use of vasopressors/inotropes (90.8% vs. 30.4%), renal complications (36.7% vs. 8.7%), septic shock (84.7% vs. 20.3%), multiorgan failure (39.8% vs. 1.4%) and mortality at discharge (39.8% vs. 4.3%). Logistic regression failed to find an association between MIS-C and age, race, sex, ≥3 signs/symptoms and ≥2 comorbidities. CONCLUSIONS: Patients with PARDS + MIS-C had a more severe clinical picture than patients without MIS-C. The findings provide useful information to improve the management of PARDS patients with and without MIS-C in Ecuador.

Effect of an online Workplace Vocal Health and Low Stress Levels Promotion Program implemented in a Colombian university during COVID-19 pandemic.

PURPOSE: To determine the effect of an online Workplace Vocal Health and Low Stress Levels (WVHLS) Promotion Program implemented in a Colombian university during COVID-19 pandemic. METHODS: This research was a quasi-experimental study. Twenty-nine professors participated in this study within two groups: (1) intervention group (n=17) or (2) non-intervention group (n=12). Participants in the intervention group took part in four virtual sessions about how to improve vocal health and strategies to reduce stress levels during their homeworking and online classes. Teachers filled in a questionnaire including questions about working conditions, work-related stress, and the voice functioning (including the Vocal Fatigue Index-VFI). They also recorded a voice sample of a sustained vowel on two separate occasions (before and after the follow-up). RESULTS: At the end of the follow-up, there was a tendency to reduce Factor 1 of VFI in the intervention group. Although, all participants had a longer MPT at the end of the study compared with the baseline measures, males in the intervention group had longer MPT compared with other participants. CONCLUSION: Our results suggest a positive effect of a WVHLS promotion program on reducing vocal fatigue perception measured by means of the Vocal Fatigue Index and improving coordination and control of breathing speech measured MPT. These changes at the end of the follow-up may indicate that holistic programs that include voice care recommendations, breathing exercises, vocal warm-up, cold-down and laryngeal relaxation vocal exercises, and stress management may be beneficial for reducing work-related stress and voice symptoms among professors.

Evaluating non-pharmacological approaches to nursing home dementia care: A protocol.

Background: The COVID-19 pandemic has underscored the daily challenges nursing home (NH) staff face caring for the residents living with Alzheimer's Disease and Related Dementias (ADRD). Non-pharmacological approaches are prioritized over off-label medication to manage the behavioral and psychological symptoms of ADRD. Yet, it is not clear how to best equip NH staff and families with the knowledge and strategies needed to provide non-pharmacological approaches to these residents. Methods: This clustered randomized trial will compare team- and problem-based approaches to non-pharmacological ADRD care. The team-based approach includes core training for all NH staff using a common language and strategies to support continuity and sustainability. The problem-based approach capitalizes on the expertise of the professional healthcare providers to target issues that arise. A convergent mixed methods design will be used to examine (a) comparative effectiveness of the two approaches on long-term NH resident outcomes and (b) whether either approach is protective against the negative consequences of COVID-19. The primary outcome is the percentage of ADRD residents with off-label antipsychotic medication use, which will be evaluated with an intent-to-treat approach. Staff and family caregiver perspectives will be explored using a multiple case study approach. Conclusion: This trial will be the first-ever evaluation of team- and problem-based approaches to ADRD care across multiple NHs and geographic regions. Results can provide health system leaders and policymakers with evidence on how to optimize ADRD training for staff in an effort to enhance ADRD care delivery.

[Comparison between two diagnostic tests for preterm rupture of membrane]. / Comparación entre dos pruebas diagnósticas de rotura prematura de membranas.

BACKGROUND: Rupture premature of membranes occurs in 8% of all births constituting one of main causes of prematurity. OBJECTIVE: Determine qualitatively the presence of human chorionic gonadotropin hormone in vagina and used as diagnostic test to rupture of membranes. PATIENTS AND METHOD: We performed a study of diagnostic test observational, transverse, comparative, prospective, not blind type; in 175 healthy pregnant woman with 20 to 42 weeks of gestation, with suspicion of vaginal liquid outlet, at the Obstetrics Department Academic Hospital "Dr Jose Eleuterio Gonzalez" during the period of April 2009 to June 2011, crystallography and vaginal human chorionic gonadotropin hormone test were performed. RESULTS: We analyzed 175 patients, average age was 22.35 years old, was obtained sensibility and specificity of 98.90% y 77.38% to crystallography and 93.41% y 73.81% to vaginal human chorionic gonadotropin hormone test, with value positive predictive of 79.44% and value negative predictive of 91.18% for this last. CONCLUSIONS: Determine qualitatively the presence of human chorionic gonadotropin hormone in vagina is a diagnostic test useful for detecting premature rupture of membranes has been shown to be as effective as crystallography.

Incidence of Venous Thromboembolism in Hospitalized COVID-19 Patients Receiving Thromboprophylaxis.

Background: The purpose of this study was to investigate the association between anticoagulant dosing intensity in coronavirus disease 2019 (COVID-19) infected patients and its outcomes on venous thromboembolism (VTE) and all-cause mortality. Methods: This is a retrospective observational study that examined different anticoagulation regimens among COVID-19 patients for prophylaxis of VTE. Primary outcomes of the study were VTE incidence and all-cause mortality for patients receiving prophylaxis-intensity (PPX) and therapeutic-intensity (TX) anticoagulation. Secondary outcomes were incidence of hemorrhagic events and hospital length of stay. Patients were matched (1:1) based on age and Charlson comorbidity score. Sub-group analyses evaluated outcomes within critically ill patients, between specific anticoagulant agents and comorbid conditions. Results: The primary outcome of VTE occurred in six patients within the prophylactic dose group and eight patients in the therapeutic-intensity dose group (risk ratio (RR): 2.02 (95% confidence interval (CI): 0.7 - 5.2); P = 0.2). Bleeding occurred in 15 (11%) patients in the prophylactic group and 27 (19%) patients in the therapeutic group (RR: 0.5 (95% CI: 0.3 - 1.0); P < 0.049). Hospital length of stay was shorter by 4 days in those treated with prophylactic-intensity anticoagulation (P = 0.003). Intensive care unit admission and ventilation were negatively correlated with mortality in a multivariate analysis. Conclusions: Among hospitalized COVID-19 patients, the use of therapeutic-intensity anticoagulation did not show any benefits in reducing the occurrence of VTE. An increase in mortality and in the incidence of hemorrhagic events was statistically significant in the therapeutic-intensity group. Future prospective studies are warranted to evaluate anticoagulation therapy in COVID-19 infected patients.

Functional, Antioxidant, and Anti-Inflammatory Properties of Cricket Protein Concentrate (Gryllus assimilis).

Edible insects can represent an alternative to obtain high-quality proteins with positive biological properties for human consumption. Cricket flour (Gryllus assimilis) was used to obtain cricket protein concentrate (CPC) using pHs (10.0 and 12.0) of extraction and pHs (3.0, 4.0, 5.0, and 6.0) of isoelectric precipitation (pI). Protein content, water and oil absorption capacity, protein solubility, antioxidant, and anti-inflammatory activities were determined. In addition, the protein profile was characterized by electrophoresis and the in vitro CPC digestibility was evaluated. Cricket flour presented 45.75% of protein content and CPC 12-5.0 presented a value of 71.16% protein content using the Dumas method. All samples were more soluble at pH 9.0 and 12.0. CPC 12-3.0 presented a percentage of water-binding capacity (WBC) of 41.25%. CPC 12-6.0 presented a percentage of oil-binding capacity (OBC) of 72.93%. All samples presented a high antioxidant and anti-inflammatory activity. CPC 12-4.0 presented a value FRAP of 70,034 umol trolox equivalents (TE)/g CPC, CPC 12-6.0 presented a value ABTS of 124,300 umol TE/g CPC and CPC 10-3.0 presented a DPPH value of 68,009 umol TE/g CPC. CPC 10-6.0 and CPC 12-6.0 presented high anti-inflammatory activity, with values of 93.55% and 93.15% of protection, respectively. CPCs can be used as functional ingredients in the food industry for their excellent functional and biological properties.

Optimizing Post-Acute Care Patient Safety: A Scoping Review of Multifactorial Fall Prevention Interventions for Older Adults.

Accidental falls are preventable adverse events for older post-acute care (PAC) patients. Yet, due to the functional and medical care needs of this population, there is little guidance to inform multidisciplinary prevention efforts. This scoping review aims to characterize the evidence for multifactorial PAC fall prevention interventions. Of the 33 included studies, common PAC intervention domains included implementing facility-based strategies (e.g., staff education), evaluating patient-specific fall risk factors (e.g., function), and developing an individualized risk profile and treatment plan that targets the patient's constellation of fall risk factors. However, there was variability across studies in how and to what extent the domains were addressed. While further research is warranted, health system efforts to prevent accidental falls in PAC should consider a patient-centered multifactorial approach that fosters a culture of safety, addresses individuals' fall risk, and champions a multidisciplinary team.

Temporal-Spatial Distribution of Vibrio cholerae in Cuba: July 1997-December 2019.

INTRODUCTION: Vibrio cholerae is a microorganism that causes acute diarrheal diseases and cholera, one of the leading causes of global morbidity and mortality, especially in children under five years old. It is present in many regions and has been isolated from diverse sources such as water, soil and food. Surveillance of this microorganism in Cuba from 1985 through June 1997 showed circulation of non-epidemic non-O1/non-O139 serogroups, but surveillance continued to identify distribution of V. cholerae serotypes and serogroups in the different geographic regions of the country during the following years, due to the risk of introducing cholera-causing serogroups that provoked cholera epidemics in other countries of the region. OBJECTIVE: Describe the temporal‒spatial distribution of serogroups and serotypes of V. cholerae in Cuba. METHODS: A cross-sectional study was conducted that included isolates from passive surveillance of V. cholerae in 16 hygiene and epidemiology centers throughout Cuba from July 1997 through December 2019, submitted to the National Reference Laboratory for Acute Diarrheal Diseases of the Pedro Kourí Tropical Medicine Institute in Havana, Cuba. The timeline was subdivided into three five-year periods and one eight-year period. The centers submitting isolates were grouped into three geographical regions: western, central and eastern Cuba. A total of 1060 V. cholerae isolates were studied, from the 1438 samples sent from 15 Provincial Hygiene, Epidemiology and Microbiology Centers and the Municipal Hygiene, Epidemiology and Microbiology Center of the Isle of Youth Special Municipality. Genus, species and serotype of all specimens were studied and reviewed in the context of the outbreaks of acute diarrheal diseases reported in the country. RESULTS: All 1060 isolates were confirmed as V. cholerae. In the distribution by time period and region, the highest percentage occurred in the 2012‒2019 period, and the eastern region contributed the most isolates in all periods. Approximately 63.9% (677/1060) were from outbreaks, and in the 2012‒2019 period, the most epidemic-causing isolates came from the western region. Approximately 52.8% (560/1060) were identified as non-O1/non-O139 V. cholerae, and 47.2% (500/1060) as O1 V. cholerae; of these, 96.4% (482/500) corresponded to Ogawa serotype and 3.6% (18/500) to Inaba. Circulation of non-O1/non-O139 V. cholerae occurred throughout the entire period. The O1 serogroup began to circulate in 2012 and continued through 2016; however, since 2017, it has not been identified again. In the western region, there were smaller percentages of isolates of non-O1/non-O139 V. cholerae in all periods, except 2012‒2019. In that period, V. cholerae O1 was identified to a lesser degree in the central region. CONCLUSIONS: Vibrio cholerae circulated in all three Cuban regions during the years studied, with a higher percentage of isolates of the non-O1/non-O139 serogroup, which caused outbreaks or sporadic cases of diarrhea in the eastern region, with the exception of the 2012‒2019 period, when epidemic outbreaks of the O1 serogroup (which causes cholera) occurred in all three regions, with higher percentages in the western region.