Testing intra-species variation in allocation to growth and defense in rubber tree (Hevea brasiliensis).

Background: Plants allocate resources to growth, defense, and stress resistance, and resource availability can affect the balance between these allocations. Allocation patterns are well-known to differ among species, but what controls possible intra-specific trade-offs and if variation in growth vs. defense potentially evolves in adaptation to resource availability. Methods: We measured growth and defense in a provenance trial of rubber trees (Hevea brasiliensis) with clones originating from the Amazon basin. To test hypotheses on the allocation to growth vs. defense, we relate biomass growth and latex production to wood and leaf traits, to climate and soil variables from the location of origin, and to the genetic relatedness of the Hevea clones. Results: Contrary to expectations, there was no trade-off between growth and defense, but latex yield and biomass growth were positively correlated, and both increased with tree size. The absence of a trade-off may be attributed to the high resource availability in a plantation, allowing trees to allocate resources to both growth and defense. Growth was weakly correlated with leaf traits, such as leaf mass per area, intrinsic water use efficiency, and leaf nitrogen content, but the relative investment in growth vs. defense was not associated with specific traits or environmental variables. Wood and leaf traits showed clinal correlations to the rainfall and soil variables of the places of origin. These traits exhibited strong phylogenetic signals, highlighting the role of genetic factors in trait variation and adaptation. The study provides insights into the interplay between resource allocation, environmental adaptations, and genetic factors in trees. However, the underlying drivers for the high variation of latex production in one of the commercially most important tree species remains unexplained.

Atenção primária e informação em saúde: desempenho e financiamento no município de Natal/rn / Primary Care and Health Information: Performace and finance in the municipality Natal/RN / Atención Primaria e Información en Salud: Desempenõ y financiamiento en elmunicipio de Natal/RN

Introdução: O país adotou, com a criação do Programa Previne Brasil, uma nova forma de financiamento da Atenção Primária à Saúde, com a portaria ministerial 2.979/2019, a qual estabeleceu critérios para alocação de recursos, com foco para o desempenho e produtividade da Atenção Primária. Talmodelo vem sendo alvo de críticas pelo campo acadêmico da Saúde Coletiva e por gestões municipais, que em diferentes situações demonstram perdas financeiras, sobretudo, devido ao componente de capitação ponderada. Objetivo: Sistematizar o desempenho da Atenção Primária à Saúde do município de Natal, Rio Grande do Norte, com base em indicadores de desempenho do Sistema de Informação em Saúde para a Atenção Básica, e o financiamento da Atenção Primária, com base no Sistema de Informações sobre Orçamentos Públicos em Saúde, entre os anos 2019 a 2022. Metodologia: Trata-se de uma pesquisa descritiva-exploratória, com utilização de dados secundários e sistematização dos sete indicadores de desempenho da Atenção Primária e análise das despesas com saúdedo município de Natal. Resultados:Dos sete indicadores analisados, o município de Natal alcançou a meta em dois indicadores, referente à proporção de gestantes com pelo menos seis consultas pré-natal realizadas (46% em 2022) e com realização de exames para sífilis e HIV (67% em 2022). O município destinou à Atenção Primária, em 2022, apenas 6,33% de todas suas despesas com saúde. Destaca-se, também, que a cobertura da Atenção Primária no município é de 60%, havendo ainda um vazio assistencial para grande parte da população natalense. Conclusões:A análise de indicadores de saúde, torna-se importante ferramenta para a ação avaliativa do Sistema Único de Saúde, bem como dá suporte para a tomada de decisão por parte de gestores e equipes de saúde, além de produzir conhecimento crítico para a qualificação da Atenção Primária à Saúde (AU).

Introduction:The country adopted, with the creation of the Previne Brasil Program, a new form of financing Primary Health Care, with ministerial decree 2.979/2019, which established criteria for resource allocation, focusing on the performance and productivity of Primary Care. This model has been criticized by the academic field of Public Health and by municipal administrations, which in different situations demonstrate financial losses, mainly due to the weighted capitation component. Objective:Systematize the performance of Primary Health Care in the city of Natal, Rio Grande do Norte, based on performance indicators from the Health Information System for Primary Care, and the financing of Primary Care, based on the Information System of Public Health Budgets, between the years 2019 and 2022. Methodology:This is descriptive-exploratory research, using secondary data and systematization of the seven Primary Care performance indicators and analysis of health expenses in the city of Natal. Results: Of the seven indicators analyzed, the municipality of Natal reached the target in two indicators, referring to the proportion of pregnant women with at least six prenatal consultations carried out (46% in 2022) and with tests for syphilis and HIV (67% in 2022). In 2022, the municipality allocated only 6.33% of all its health expenses to PrimaryCare. It is also noteworthy that Primary Care coverage in the municipality is 60%, with there still being a care gap for a large part of the population of Natal. Conclusions:The analysis of health indicators becomes an important tool for the evaluative action of the Unified Health System, as well as providing support for decision-making by managers and health teams, in addition to producing critical knowledge for the qualification of Primary Health Care (AU).

Introducción: El país adoptó, con la creación del Previne Brasil, una nueva forma de financiamiento de la Atención Primaria de Salud, con el decreto ministerial 2.979/2019, que estableció criterios para la asignación de recursos, con foco en el desempeño y productividad de la Atención Primaria. Este modelo ha sido criticado por el ámbito académico de la Salud Pública y por las administraciones municipales, que en diferentes situaciones demuestran pérdidas financieras, principalmente por el componente de capitación ponderada. Objetivo: Sistematizar el desempeño de la Atención Primaria de Salud en la ciudad de Natal, Rio Grande do Norte, con base en indicadores de desempeño del Sistema de Información en Salud para la Atención Primaria, y el su financiamiento, con base en el Sistema de Información Presupuestaria Pública en Salud, entre los años 2019 y 2022. Metodología: Se trata de una investigación descriptiva-exploratoria, utilizando datos secundarios y sistematización de siete indicadores de desempeño de la Atención Básica y análisis del gasto en salud. Resultados: De los siete indicadores analizados, el municipio de Natal alcanzó la meta en dos indicadores, referidos a la proporción de gestantes con al menos seis consultas prenatales realizadas (46% en 2022) y con pruebas de sífilis y HIV (67% en 2022). En 2022, el municipio destinó sólo el 6,33% de todos sus gastos sanitarios a la Atención Primaria. También se destaca que la cobertura de Atención Primaria en el municipio es del 60%, existiendo aún brecha de atención para gran parte de la población. Conclusiones: El análisis de indicadores de salud se convierte en herramienta importante para la acción de evaluación del Sistema Único de Salud, además de brindar apoyo para la toma de decisiones de gestores y equipos de salud, además de producir conocimiento crítico para la calificación de la Atención Primaria de Salud (AU).

Efficient PAHs removal and CO2 fixation by marine microalgae in wastewater using an airlift photobioreactor for biofuel production.

Microalgae cultures have emerged as a promising strategy in diverse areas, ranging from wastewater treatment to biofuel production, thus contributing to the search for carbon neutrality. These photosynthetic organisms can utilize the resources present in wastewater and fix atmospheric CO2 to produce biomass with high energy potential. In this study, the removal efficiency of Polycyclic Aromatic Hydrocarbons (PAHs), CO2 fixation and lipid content in the biomass produced from microalgae grown in airlift photobioreactor were evaluated. Four mesoscale cultures were carried out: Control (Seawater + Conway medium), Treatment A (Oil Produced Water + Poultry Effluent Water), Treatment B (Poultry Effluent Water + Seawater) and Treatment C (Oil Produced Water, Seawater and nutrients). The impact of biostimulation, through the addition of nutrients, on PAHs removal efficiency (up to 90%), CO2 fixation rate (up to 0.20 g L-1 d-1) and the composition of the generated biomass was observed. Primarily, the addition of nitrates to the culture medium impacted CO2 fixation rate of the microalgae. In addition, a direct correlation was observed between PAHs removal and lipid accumulation in the biomass, up to 36% in dry weight, demonstrating microalgae's ability to take advantage of the organic carbon (PAHs) present in the culture medium to generate lipid-rich biomass. The concentration of polysaccharides in the biomass obtained did not exceed 12% on a dry weight basis, and the Higher Heating Value (HHV) ranged between 17 and 21 MJ kg-1. Finally, the potential of generating hydrogen through pyrolysis was highlighted, taking advantage of the characteristics of biomass as a conversion route to produce biofuels. These results show that microalgae are effective in wastewater treatment and have great potential in producing biofuels, thus contributing to the transition towards more sustainable energy sources and climate change mitigation.

Feasibility and success of a non-sedated brain MRI training protocol in 7-year-old children from rural and semi-rural Colombia.

BACKGROUND: Brain magnetic resonance imaging (MRI) is a crucial tool for clinical evaluation of the brain and neuroscience research. Obtaining successful non-sedated MRI in children who live in resource-limited settings may be an additional challenge. OBJECTIVE: To present a feasibility study of a novel, low-cost MRI training protocol used in a clinical research study in a rural/semi-rural region of Colombia and to examine neurodevelopmental factors associated with successful scans. MATERIALS AND METHODS: Fifty-seven typically developing Colombian children underwent a training protocol and non-sedated brain MRI at age 7. Group training utilized a customized booklet, an MRI toy set, and a simple mock scanner. Children attended MRI visits in small groups of two to three. Resting-state functional and structural images were acquired on a 1.5-Tesla scanner with a protocol duration of 30-40 minutes. MRI success was defined as the completion of all sequences and no more than mild motion artifact. Associations between the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Movement Assessment Battery for Children (MABC), Behavioral Rating Inventory of Executive Function (BRIEF), Child Behavior Checklist (CBCL), and Adaptive Behavior Assessment System (ABAS) scores and MRI success were analyzed. RESULTS: Mean (SD) age at first MRI attempt was 7.2 (0.2) years (median 7.2 years, interquartile range 7.1-7.3 years). Twenty-six (45.6%) participants were male. Fifty-one (89.5%) children were successful across two attempts; 44 (77.2%) were successful on their first attempt. Six (10.5%) were unsuccessful due to refusal or excessive motion. Age, sex, and scores across all neurodevelopmental assessments (MABC, TVIP, ABAS, BRIEF, CBCL, NIH Toolbox Flanker, NIH Toolbox Pattern Comparison, WPPSI) were not associated with likelihood of MRI success (P=0.18, 0.19, 0.38, 0.92, 0.84, 0.80, 1.00, 0.16, 0.75, 0.86, respectively). CONCLUSION: This cohort of children from a rural/semi-rural region of Colombia demonstrated comparable MRI success rates to other published cohorts after completing a low-cost MRI familiarization training protocol suitable for low-resource settings. Achieving non-sedated MRI success in children in low-resource and international settings is important for the continuing diversification of pediatric research studies.

Pretest-post-test evaluation with lay midwives in remote Guatemala after educational activities about COVID-19.

INTRODUCTION: Guatemalan lay midwives are well-respected community leaders in a country that lacks the institutional capacity to meet healthcare needs related to pregnancy, newborns, and COVID-19. Thus, Guatemalan lay midwives, who attend the majority of births in their country and who attend most births at home, are in an optimal position to offer frontline support to pregnant women and newborns regarding the global pandemic. The primary objective of this program of study was to dispel myths about COVID-19 and to provide culturally relevant educational activities to low-literacy Guatemalan lay midwives about issues related to the virus, such as signs and symptoms, risks to the mother and fetus, which patients are most vulnerable, appropriate responses, benefits and side-effects of the vaccine, timing of the vaccine, how the virus interacts with breastfeeding, and breastfeeding recommendations. METHODS: In a partnership among the Guatemalan Ministry of Health, expert faculty at the University of Utah College of Nursing, and Madre y Niño, a non-profit organization from the US, evidence-based educational activities about COVID-19 were offered orally in the native language of participants. Two hundred and ten lay midwives attended educational sessions at 11 locations throughout the remote Peten department. Educational activities included repetition, storytelling, and role plays. A pretest-post-test evaluation of 10 questions with 24 correct answers was used to determine if the educational activities changed lay midwife knowledge about COVID-19. Participants were given essential birth supplies and laminated COVID Reminder Cards, which were designed to increase visual literacy, to encourage knowledge retention after the educational sessions. RESULTS: Participants showed a significant increase in knowledge scores (possible 0-24) from prescores 7.09 (standard deviation (SD)=3.06) to 15.20 (SD=4.61), Student's t-test p<0.001. In addition, a significantly higher proportion of participants mistakenly thought COVID-19 passed through breast milk on the pretest (70.1%) compared to post-test (8.4%) (McNemar test, p<0.001). Regarding breastfeeding, 12.6% of participants knew on the pretest that women with COVID-19 who breastfeed should wear a mask and wash their hands compared to 74.3% of participants who knew these recommendations on the post-test (Wilcoxon signed-rank test, p<0.001). Finally, 2% of participants knew on the pretest that pregnant women with COVID-19 should take a low-dose aspirin compared to 67% of participants on the post-test (χ² (1)=194.7, p<0.001). CONCLUSION: These essential primary care providers misunderstood many critical issues related to COVID-19, pregnancy, and newborns. Culturally relevant educational activities provided orally in the native language of participants dispelled myths about the virus and significantly improved lay midwife knowledge. Providing evidence-based educational activities in a culturally relevant format is critical to protecting remote, vulnerable populations, such as pregnant Guatemalan women and newborns, during a global pandemic.

Chromosome-Level Assembly and Annotation of the Genome of the Endangered Giant Patagonian Bumble Bee Bombus dahlbomii.

This article describes a genome assembly and annotation for Bombus dahlbomii, the giant Patagonian bumble bee. DNA from a single, haploid male collected in Argentina was used for PacBio (HiFi) sequencing, and Hi-C technology was then used to map chromatin contacts. Using Juicer and manual curation, the genome was scaffolded into 18 main pseudomolecules, representing a high-quality, near chromosome-level assembly. The sequenced genome size is estimated at 265 Mb. The genome was annotated based on RNA sequencing data of another male from Argentina, and BRAKER3 produced 15,767 annotated genes. The genome and annotation show high completeness, with >95% BUSCO scores for both the genome and annotated genes (based on conserved genes from Hymenoptera). This genome provides a valuable resource for studying the biology of this iconic and endangered species, as well as for understanding the impacts of its decline and designing strategies for its preservation.

Cost-consequence analysis of a combined COVID-19/influenza rapid diagnostic test in the Brazilian private healthcare setting.

Combination COVID-19/influenza rapid tests provide a way to quickly and accurately differentiate between the two infections. The goal of this economic evaluation was to assess the cost and health benefits of a combination COVID-19/influenza Rapid Diagnostic Test (RDT) vs. current standard-of-care in the Brazilian private healthcare setting. A dual decision tree model was developed to estimate the impact of rapid differentiation of COVID-19 and influenza in a hypothetical cohort of 1,000 adults with influenza-like illness in an ambulatory healthcare setting. The model compared the use of a combination COVID-19/influenza RDT to Brazil standard diagnostic practice of a COVID-19 RDT and presumptive influenza diagnosis. Different levels of influenza prevalence were modeled with co-infection estimated as a function of the COVID-19 prevalence. Outcomes included accuracy of diagnosis, antiviral prescriptions and healthcare resource use (hospital bed days and ICU occupancy). Depending on influenza prevalence, considering 1,000 patients with influenza-like illness, a combination RDT compared to standard practice was estimated to result in between 88 and 149 fewer missed diagnoses of influenza (including co-infection), 161 to 185 fewer cases of over-diagnosis of influenza; a 24 to 34% reduction in hospital bed days and a 16 to 26% reduction in ICU days. In the base case scenario (20% influenza, 5% COVID-19), the combination RDT was estimated to result in cohort cost savings of $99. Based upon a de novo economic model, this analysis indicates that use of a combination RDT could positively impact influenza antiviral prescriptions and lower healthcare resource use.

Resources for the practice of pediatric neuro-oncology in Mexico: a cross-sectional evaluation.

Background: The evaluation of existing resources and services is key to identify gaps and prioritize interventions to expand care capacity for children with central nervous system (CNS) tumors. We sought to evaluate the resources for pediatric neuro-oncology (PNO) in Mexico. Methods: A cross-sectional online survey with 35 questions was designed to assess PNO resources and services, covering aspects including number of patients, infrastructure, human resources, and diagnostic and treatment time intervals. The survey was distributed to the members of the Mexican Association of Pediatric Oncology and Hematology (AMOHP) who belong to the nation's many different health systems. Results: Responses were obtained from 33 institutions, distributed throughout the country and part of the many health systems that exist in Mexico. Twenty-one (64%) institutions had less than 10 new cases of pediatric CNS tumors per year. Although 30 (91%) institutions saw pediatric patients up to the age of 18 years, 2 (6%) had a cutoff of 15 years. Twenty-four (73%) institutions had between 1 and 3 pediatric oncologists providing care for children with CNS tumors. Six (18%) institutions did not have a neurosurgeon, while 19 (57%) institutions had a pediatric neurosurgeon. All centers had a pathology department, but 13 (39%) institutions only had access to basic histopathology. Eleven (33%) institutions reported histopathological diagnoses within one week, but 3 (9%) took more than 4 weeks. Radiotherapy for pediatric CNS tumors was referred to outside centers at 18 (55%) institutions. All centers had access to conventional cytotoxic chemotherapy, but only 6 (18%) had access to targeted therapy. Eighteen (55%) respondents estimated a survival rate of less than 60%. Fifteen (45%) centers attributed the main cause of mortality to non-tumor related factors, including infection and post-surgical complications. Conclusions: This is the first national assessment of the resources available in Mexico for the treatment of CNS tumors. It shows disparities in resource capacity and a lack of the specific and efficient diagnoses that allow timely initiation of treatment. These data will enable the prioritization of collaborative interventions in the future.

Behavioral report of Chrysomya rufifacies in response to substrate infestation by Lucilia sericata and Lucilia cuprina using a tetrahedron olfactometer device.

Calliphoridae are widespread globally and can inhabit a variety of habitats. In this brief report, we assessed the appeal of Chrysomya rufifacies to resources that were previously inhabited by Lucilia sericata and L. cuprina, both common carrion colonizers. Two hundred adult male and female (1:1) C. rufifacies were released under controlled conditions into clear plastic cages (45 x 45 x 45 cm) with four types of substrates: beef-liver; liver with 100 third-instar larvae of L. cuprina; (III) liver containing 100 third-instar larvae of L. sericata; and liver containing 100 third-instar larvae of C. rufifacies. Each substrate was left in place for 24 hours at the end of a tube connected to the cage, where sticky traps were positioned to capture flies that might have been attracted to a specific substrate. The results indicate variations in the attraction of flies to different types of livers colonized by larvae of various species. It is suggested that flies may have specific preferences depending on the species of larvae present in the substrate. The liver without larvae was the preferred choice, while beef liver with C. rufifacies larvae was the least attractive. Results of statistical tests indicated that there is independence between attractiveness preference and the presence of C. rufifacies flies. Although there is a trend among certain levels of the variables in the correspondence analysis, these relationships are not statistically significant. However, they indicate specific patterns of association between different groups of flies and species of larvae. This study demonstrated that C. rufifacies does not show reduced attraction to any of the resources. A tetrahedron olfactometer device has been used for the first time in a behavioral study of C. rufifacies flies. This may enable future studies to enhance the understanding of fly behavior.

Scavenging in two mountain ecosystems: Distinctive contribution of ants in grassland and non-ant invertebrates in forest.

Scavenging is a key process for the cycling of nutrients in ecosystems, yet it is still neglected in the ecological literature. Apart from the importance of specific groups of animals in scavenging, there have been few ecological studies that compare them. Furthermore, the ecological studies on scavenging have mainly focused on vertebrates despite the crucial importance of invertebrates in this process. Here, we performed a large-scale ant suppression and vertebrate exclusion experiment to quantify the relative contribution of ants, non-ant invertebrates and vertebrates in scavenging nitrogen-rich (insect carcasses) and carbon-rich (seeds) baits in two contrasting mountainous habitats in Brazil (grasslands and forests). Overall, bait removal was 23.2% higher in forests than in grasslands. Ants were the primary scavengers in grasslands, responsible for more than 57% of dead insect larvae and seed removal, while, in forests, non-ant invertebrates dominated, removing nearly 65% of all baits. Vertebrates had a minor role in scavenging dead insect larvae and seeds in both habitats, with <4% of removals. Furthermore, our results show that animal-based baits were more consumed in forests than seeds, and both resources were equally consumed in grasslands. Therefore, we demonstrate the superiority of invertebrates in this process, with a particular emphasis on the irreplaceable role of ants, especially in this grassland ecosystem. As such, we further advance our knowledge of a key ecosystem process, showing the relative importance of three major groups in scavenging and the differences in ecosystems functioning between two contrasting tropical habitats.

ROX Index Variation as a Predictor of Outcomes in COVID-19 Patients.

Background: During the COVID-19 pandemic, emergency departments were overcrowded with critically ill patients, and many providers were confronted with ethical dilemmas in assigning respiratory support to them due to scarce resources. Quick tools for evaluating patients upon admission were necessary, as many existing scores proved inaccurate in predicting outcomes. The ROX Index (RI), a rapid and straightforward scoring system reflecting respiratory status in acute respiratory failure patients, has shown promise in predicting outcomes for COVID-19 patients. The 24 h difference in the RI accurately gauges mortality and the need for invasive mechanical ventilation (IMV) among patients with COVID-19. Methods: Study design: Prospective cohort study. A total of 204 patients were admitted to the emergency department from May to August 2020. Data were collected from the clinical records. The RI was calculated at admission and 24 h later, and the difference was used to predict the association with mortality and the need for IMV, a logistic regression model was used to adjust for age, sex, presence of comorbidities, and disease severity. Finally, the data were analyzed using ROC. Results: The difference in respiratory RI between admission and 24 h is a good predictor for death (AUC 0.92) and for mechanic ventilation (AUC: 0.75). Each one-unit decrease in the RI difference at 24 h was associated with an odds ratio of 1.48 for the risk of death (95%CI: 1.31-1.67) and an odds ratio of 1.16 for IMV (95% IC: 1.1-1.23). Conclusions: The 24 h variation of RI is a good prediction tool to allow healthcare professionals to identify the patients who will benefit from invasive treatment, especially in low-resource settings.

Resource and Service Use after Discharge Among Infants 22-25 Weeks Estimated Gestational Age at the First High-Risk Infant Follow-Up Visit in California.

OBJECTIVE: To examine resource and service use after discharge among infants born extraordinarily preterm in California who attended high-risk infant follow-up (HRIF) clinic by 12 months corrected age. STUDY DESIGN: We included infants born 2010-2017 between 22 + 0/7 and 25 + 6/7 weeks' gestational age in the California Perinatal Quality Care Collaborative and California Perinatal Quality Care Collaborative-California Children's Services HRIF databases. We evaluated rates of hospitalization, surgeries, medications, equipment, medical service and special service use, and referrals. We examined factors associated with receiving ≥ 2 medical services, and ≥ 1 special service. RESULTS: A total of 3941 of 5284 infants received a HRIF visit by 12 months corrected age. Infants born at earlier gestational ages used more medications, equipment, medical services, and special services and had higher rates of referral to medical and special services at the first HRIF visit. Infants with major morbidity, surgery, caregiver concerns, and mothers with more years of education had higher odds of receiving ≥ 2 medical services. Infants with Black maternal race, younger maternal age, female sex, and discharge from lower level neonatal intensive care units (NICUs) had lower odds of receiving ≥ 2 medical services. Infants with more educated mothers, multiple gestation, major morbidity, surgery, caregiver concerns, and discharge from lower level NICUs had increased odds of receiving a special service. CONCLUSIONS: Infants born extraordinarily preterm have substantial resource use after discharge. High resource utilization was associated with maternal/sociodemographic factors and expected clinical factors. Early functional and service use information is valuable to parents and underscores the need for NICU providers to appropriately prepare and refer families.

Rice Husk-Based Insulators: Manufacturing Process and Thermal Potential Assessment.

The development of bio-insultation materials has attracted increasing attention in building energy-saving fields. In tropical and hot-humid climates, building envelope insulation is important for an energy efficient and comfortable indoor environment. In this study, several experiments were carried out on a bio-insulation material, which was prepared by using rice husk as a raw material. Square rice husk-based insultation panels were developed, considering the ASTM C-177 dimensions, to perform thermal conductivity coefficient tests. The thermal conductivity coefficient obtained was 0.073 W/(m K), which is in the range of conventional thermal insulators. In a second phase of this study, two experimental enclosures (chambers) were constructed, one with rice husk-based insulation panels and the second one without this insulation. The measures of the temperatures and thermal flows through the chambers were obtained with an electronic module based on the ARDUINO platform. This module consisted of three DS18B20 temperature sensors and four Peltier plates. Daily temperature and heat flux data were collected for the two chambers during the dry season in Panama, specifically between April and May. In the experimental chamber that did not have rice husk panel insulation on the roof, a flow of up to 28.18 W/m2 was observed, while in the chamber that did have rice husk panels, the presence of a flow toward the interior was rarely observed. The rice husk-based insulation panels showed comparable performance with conventional insulators, as a sustainable solution that takes advantage of a local resource to improve thermal comfort and the reduction of the environmental impact.

Intraguild processes drive space-use patterns in a large-bodied marine predator community.

Interspecific interactions, including predator-prey, intraguild predation (IGP) and competition, may drive distribution and habitat use of predator communities. However, elucidating the relative importance of these interactions in shaping predator distributions is challenging, especially in marine communities comprising highly mobile species. We used individual-based models (IBMs) to predict the habitat distributions of apex predators, intraguild (IG) prey and prey. We then used passive acoustic telemetry to test these predictions in a subtropical marine predator community consisting of eight elasmobranch (i.e. shark and ray) species in Bimini, The Bahamas. IBMs predicted that prey and IG prey will preferentially select habitats based on safety over resources (food), with stronger selection for safe habitat by smaller prey. Elasmobranch space-use patterns matched these predictions. Species with predator-prey and asymmetrical IGP (between apex and small mesopredators) interactions showed the clearest spatial separation, followed by asymmetrical IGP among apex and large mesopredators. Competitors showed greater spatial overlap although with finer-scale differences in microhabitat use. Our study suggests space-use patterns in elasmobranchs are at least partially driven by interspecific interactions, with stronger spatial separation occurring where interactions include predator-prey relationships or IGP.

Aerobic granulation and resource production under continuous and intermittent saline stress.

Three sequential batch reactors (SBR) were operated to evaluate salt addition's impact on granulation, performance, and biopolymer production in aerobic granular sludge (AGS) systems. System R1 was fed without adding salt (control); system R2 operated with saline pulses, i.e., one cycle with salt (2.5 g NaCl/L) addition followed by another without salt; and R3 received continuous supplementation of 2.5 g NaCl/L. The results indicated that the reactors supplemented with salt presented higher concentrations of mixed liquor volatile suspended solids (MLVSS) and better settleability than R1, showing that osmotic pressure contributed to biomass growth, accelerated granulation, and improved physical characteristics. The faster granulation occurred in R2, thus proving the beneficial effects of intermittent salt addition through alternating pulses. Salt addition did not impair the simultaneous removal of carbon, nitrogen, and phosphorus. In fact, R2 showed better carbon removals. In conclusion, continuous or intermittent (pulsed) supplementation of 2.5 g NaCl/L did not lead to increased production of extracellular polymeric substances (EPS) and alginate-like exopolymers (ALE). This outcome could be attributed to the low saline concentration employed, a higher food-to-microorganism (F/M) ratio observed in R1, and possibly greater endogenous consumption of biopolymers in the famine period in R2 and R3 due to the greater solids retention time (SRT). Therefore, this study brings important results that contribute to a better understanding of the effect of salt in continuous dosing or in pulses as a selection pressure strategy to accelerate granulation, as well as the behavior of the AGS systems for saline effluents.

Management of disseminated histoplasmosis in a high-complexity clinic in Cali, Colombia.

Histoplasmosis presents a substantial clinical challenge globally, with a particular prevalence in South America, especially among patients with concurrent Human Immunodeficiency Virus (HIV) infection. Despite itraconazole's established efficacy, investigating alternative therapeutic approaches remains imperative. This is the largest study in our region to date, assessing the effectiveness of the less explored posaconazole treatment. This observational study, conducted at Fundación Valle del Lili (FVL) from 2016 to 2022, encompassed adults with disseminated histoplasmosis. Patients (n = 31) were treated with liposomal amphotericin B as an initial treatment, followed by consolidation treatment with posaconazole or itraconazole. Patients with single-organ cases, those lacking microbiological diagnosis, those who received initial treatment with antifungals other than liposomal Amphotericin B and those with < 6 months follow-up were excluded (Figure 1). Analyses considered population characteristics, treatments, and outcomes. Patients (average age: 45.6; 58.1% female) had common comorbidities (HIV 38.7%, solid organ transplantation 29% and oncologic disease 12.9%). Lungs (48.4%) and lymph nodes (16.1%) were commonly affected. Biopsy (64.5%) was the primary diagnostic method. Initial treatment with liposomal amphotericin B (100%) was given for 14 days on average. Follow-up indicated 71% completion with 19.4% requiring treatment modifications. Notably, 70.9% completed a posaconazole consolidation regimen over 350 days on average. Drug interactions during consolidation (80.6%) were common. No relapses occurred, and three deaths unrelated to histoplasmosis were reported. Traditionally, itraconazole has been the prevalent initial treatment; however, in our cohort, 55.9% of patients received posaconazole as the primary option. Encouragingly, posaconazole showed favorable tolerance and infection resolution, suggesting its potential as an effective and well-tolerated alternative for consolidation treatment. This finding prompts further exploration of posaconazole, potentially leading to more effective patient care and better outcomes.

Histoplasmosis is a critical concern in South America, notably among human immunodeficiency virus patients, leading to high mortality rates. This study, the largest in our region, investigates the effectiveness of posaconazole as an alternative treatment to itraconazole. The results offer the potential for enhanced patient care and improved outcomes.

Collider Bias Assessment in Colombian Indigenous Wiwa and Kogui Populations with Chronic Gastroenteric Disorder of Likely Infectious Etiology Suggests Complex Microbial Interactions Rather Than Clear Assignments of Etiological Relevance.

Multiple microbial detections in stool samples of indigenous individuals suffering from chronic gastroenteric disorder of a likely infectious origin, characterized by recurring diarrhea of variable intensity, in the rural north-east of Colombia are common findings, making the assignment of etiological relevance to individual pathogens challenging. In a population of 773 indigenous people from either the tribe Wiwa or Kogui, collider bias analysis was conducted comprising 32 assessed microorganisms including 10 bacteria (Aeromonas spp., Campylobacter spp., enteroaggregative Escherichia coli (EAEC), enteropathogenic Escherichia coli (EPEC), enterotoxigenic Escherichia coli (ETEC), Salmonella spp., Shiga toxin-producing Escherichia coli (STEC), Shigella spp./enteroinvasive Escherichia coli (EIEC), Tropheryma whipplei and Yersinia spp.), 11 protozoa (Blastocystis spp., Cryptosporidium spp., Cyclospora spp., Dientamoeba fragilis, Entamoeba coli, Entamoeba bangladeshi/dispar/histolytica/moshkovskii complex, Entamoeba histolytica, Endolimax nana, Giardia duodenalis, Iodamoeba buetschlii and Pentatrichomonas hominis), 8 helminths (Ascaris spp., Enterobius vermicularis, Hymenolepis spp., Necator americanus, Schistosoma spp., Strongyloides spp., Taenia spp. and Trichuris spp.), microsporidia (Encephalocytozoon spp.) and fungal elements (microscopically observed conidia and pseudoconidia). The main results indicated that negative associations potentially pointing towards collider bias were infrequent events (n = 14), while positive associations indicating increased likelihood of co-occurrence of microorganisms quantitatively dominated (n = 88). Microorganisms showing the most frequent negative associations were EPEC (n = 6) and Blastocystis spp. (n = 3), while positive associations were most common for Trichuris spp. (n = 16), Dientamoeba fragilis (n = 15), Shigella spp./EIEC (n = 12), Ascaris spp. (n = 11) and Blastocystis spp. (n = 10). Of note, positive associations quantitively dominated for Blastocystis spp. In conclusion, collider bias assessment did not allow clear-cut assignment of etiological relevance for detected enteric microorganisms within the assessed Colombian indigenous population. Instead, the results suggested complex microbial interactions with potential summative effects. Future studies applying alternative biostatistical approaches should be considered to further delineate respective interactions.

Oficina vivencial: intervenção educativa sobre tecnologia grupal para profissionais de saúde mental / Workshop: educational intervention on group technology for mental health professionals / Taller: intervención educativa en tecnología grupal para profesionales de salud mental

Objetivo: descrever a experiência de uma intervenção educativa sobre tecnologia grupal para profissionais de saúde mental. Métodos: relato de experiência relativo a última etapa de uma pesquisa-intervenção, em que foram realizadas duas oficinas norteadas pelo referencial do Ciclo de Aprendizagem Vivencial, com a participação de 19 profissionais de três Centros de Atenção Psicossocial Álcool e Drogas da região central do Brasil. Resultados: ao longo do processo vivencial foi possível perceber que os participantes puderam repensar sua prática profissional nos grupos terapêuticos que conduzem, sensibilizando-os para a necessidade de instrumentalização dos recursos da tecnologia grupal. Conclusão: o uso do Ciclo de Aprendizagem Vivencial como ferramenta de qualificação favoreceu a tomada de consciência dos participantes com reflexões contextualizadas de suas práticas com grupos no cotidiano dos serviços, sensibilizando-os para incrementar suas competências teórico-práticas nos seus atendimentos. (AU)

Objective: to describe the experience of an educational intervention on group technology for mental health professionals. Methods: experience report on the last stage of an intervention research, in which two workshops were held guided by the framework of the Experiential Learning Cycle, with the participation of 19 professionals from three Psychosocial Care Centers for Alcohol and Drugs in the central region of Brazil. Results: throughout the experiential process, it was possible to see that the participants were able to rethink their professional practice in the therapeutic groups they lead, sensitizing them to the need to implement group technology resources. Conclusion: the use of the Experiential Learning Cycle as a qualification tool favored the participants' awareness with contextualized reflections on their practices with groups in the daily service, sensitizing them to increase their theoreticalpractical skills in their care. (AU)

Objetivo: describir la experiencia de una intervención educativa en tecnología grupal para profesionales de la salud mental. Métodos: relato de experiencia de la última etapa de una investigación de intervención, en la que se realizaron dos talleres guiados por el marco del Ciclo de Aprendizaje Experiencial, con la participación de 19 profesionales de tres Centros de Atención Psicosocial por Alcohol y Drogas de la región central de Brasil. Resultados: a lo largo del proceso vivencial, se pudo constatar que los participantes fueron capaces de repensar su práctica profesional en los grupos terapéuticos que lideran, sensibilizándolos sobre la necesidad de implementar recursos tecnológicos grupales. Conclusion: el uso del CAV como herramienta de calificación favoreció la conciencia de los participantes con reflexiones contextualizadas sobre sus prácticas con grupos en el servicio diario, sensibilizándolos para incrementar sus habilidades teórico-prácticas en su cuidado. (AU)

Bigger pies, bigger slices: Increased hospitalization costs for lung transplantation recipients in the non-donation service area allocation era.

OBJECTIVE: On November 24, 2017, lung transplant allocation switched from donation service area to a 250-nautical mile radius policy to improve equity in access to lung transplantation. Given the growing consideration of healthcare costs, we evaluated changes in hospitalization costs after this policy change. METHODS: Lung transplant hospitalizations were identified within the National Inpatient Sample from 2005 to 2020. Recipients were categorized as donation service area era (August 2015 to October 2017) or non-donation service area era (December 2017 to February 2020). Median total hospitalization costs (inflation adjusted) were compared by era nationally and regionally. Multivariable generalized linear regression was performed to determine if the removal of the donation service area was associated with total hospitalization costs. The model was adjusted for recipient demographics, Charlson Comorbidity Index, hospitalization region, transplant type (single, double), and use of extracorporeal membrane oxygenation, ex vivo lung perfusion, and mechanical ventilation. RESULTS: We analyzed 12,985 lung transplant recipients (median age of 61 years, 66% were male): 7070 in the donation service area era and 5915 in the non-donation service area era. Demographics were not different between recipients in both eras. Non-donation service area era recipients had greater extracorporeal membrane oxygenation use, mechanical ventilation (<24 hours), and longer length of stay than donation service area era recipients. Median total hospitalization costs for non-donation service area versus donation service area era recipients increased by $24,198 ($157,964 vs $182,162, percentage change = 15.32%, P < .001). Median costs increased in East North Central ($42,281) and Mountain ($35,521) regions (both P < .01). After adjustment, median costs for non-donation service area versus donation service area era recipients still increased ($19,168, 95% CI, 145-38,191, P = .048). CONCLUSIONS: Hospitalization costs for lung transplant hospitalizations have increased from 2015 to 2020. The transition from donation service area-based allocation to the non-donation service area system may have contributed to this increase after 2017 by increasing access to transplant for sicker recipients.

[The role of nursing professionals in the development and care of adolescent health in HondurasPapel dos profissionais de enfermagem no desenvolvimento e na atenção à saúde de adolescentes em Honduras]. / El papel de los profesionales de enfermería en el desarrollo y atención de la salud adolescente en Honduras.

Objective: Identify and analyze the role of nursing professionals in the development and care of adolescent health in Honduras, by analyzing the curricular content of the training provided to nursing students with respect to adolescent health, and by studying policies on adolescent health. Methods: Mixed methods study, with a sequential explanatory approach, carried out from May to July 2023 through surveys of nursing schools, analysis of policy documents, a survey with nursing professionals, and a focus group. Quantitative data were analyzed using descriptive statistics and qualitative data, applying the theoretical framework of Walt and Gilson. Results: During the research, 18 documents were analyzed and seven nursing schools, 141 nurses, and 10 key actors in leadership positions participated. The results point to the need to update and disseminate the regulatory framework, ensure the necessary resources and structure to implement sustainable intersectoral programs, and train professionals. Schools are an important space for the implementation of actions; in this context, the adoption of school nursing programs could be beneficial. Nurses were identified as key figures in program implementation and should be taken into consideration when developing policies aimed at adolescents. Conclusions: Nurses participate in various stages of the policy implementation process and can make important contributions to school health at the first level of care. To this end, it is necessary to increase the capacities of nurses and nursing educators in relation to current and relevant issues in adolescent care.

Objetivo: Identificar e analisar o papel dos profissionais de enfermagem no desenvolvimento e na atenção à saúde de adolescentes em Honduras por meio de análise do conteúdo da formação dos estudantes de enfermagem em saúde de adolescentes e das políticas relacionadas aos adolescentes. Métodos: Estudo de métodos mistos, com abordagem sequencial explanatória, realizado de maio a julho de 2023 por meio de um questionário aplicado a escolas de enfermagem, análise de documentos de política, um questionário aplicado a profissionais de enfermagem e um grupo focal. Os dados quantitativos foram analisados mediante estatísticas descritivas, e os qualitativos, usando o modelo teórico de Walt e Gilson. Resultados: Durante a pesquisa, foram analisados 18 documentos. Sete escolas de enfermagem, 141 profissionais de enfermagem e 10 atores-chave em cargos de liderança participaram do estudo. Os resultados apontam para a necessidade de atualizar e divulgar o marco normativo, garantir recursos e estrutura para a implementação de programas intersetoriais e sustentáveis e capacitar os profissionais. A escola representa um espaço importante para a implementação de ações, contexto no qual a adoção da enfermagem escolar pode ser proveitosa. Os profissionais de enfermagem foram identificados como atores-chave na implementação dos programas e devem ser levados em consideração no desenvolvimento de políticas voltadas para esse público. Conclusões: Os profissionais de enfermagem estão envolvidos em vários estágios do processo de implementação de políticas e podem fazer aportes importantes para a saúde escolar no nível da atenção primária. Para isso, é necessário aumentar a capacitação dos profissionais e docentes de enfermagem em tópicos atuais e relevantes da atenção a adolescentes.