Are Chiari Malformation and Basilar Invagination Associated with Jugular Foramen Stenosis?

OBJECTIVE: We compared the diameter of the jugular foramen (JF) between normal individuals and those with a diagnosis of craniovertebral junction abnormalities, such as Chiari malformation type I (CMI) and/or basilar invagination (BI). METHODS: This cross-sectional analytical study measured the diameter of the right and left JF on magnetic resonance imaging scans of patients divided into 4 groups: 68 with combined CMI and BI (CMI+BI), 42 with isolated BI, 45 with isolated CMI, and 102 control cases. The t test determined sex differences, and univariate analysis of variance with Tukey's post hoc test assessed JF differences between groups. RESULTS: Considering all combinations of laterality and sex, the CMI+BI group had a JF narrower than their respective control groups. The JF was bilaterally narrower in the BI group than in the control group only in the women. Regardless of laterality, the CMI group had a wider JF than did the CMI+BI group in men and did not differ from that of the control group. In the female patients with CMI, the right JF did not differ from that of the controls and was wider than that in the CMI+BI group. Also, the left JF was narrower than that in the control group and did not differ from that in the CMI+BI group. CONCLUSIONS: JF narrowing is associated with CMI and BI when combined in the same patient. When CMI or BI are detected separately, they do not imply evident changes in JF morphometry. It is expected that these findings could bring empiric substrate to support theories that claim a possible role of intracranial pressure disturbances as a triggering factor for CMI.

Sjögren: unique surname, two men, four syndromes and one disease.

Henrik and Torsten Sjögren (/'ʃoʊɡrən/ or SHOH-grən) were two Swedish physicians living in the same period, but completely unrelated, except for their notable contributions to Medicine. The first one described keratoconjunctivitis sicca, afterward called Sjögren's syndrome, and a fishing net aspect retinal pigmentation affecting visual acuity, nowadays known as Sjögren reticular dystrophy. The last one contributed to the understanding of Spielmeyer-Sjögren disease, Marinesco-Sjögren, and Sjögren-Larsson syndromes, all related to genetic disorders and neurological symptoms. In this paper, we aim to describe each disorder, in order to avoid any misunderstanding in diagnosis and for historical record.

Henrik e Torsten Sjögren (/ˈʃoʊɡrən/ ou SHOH-grən) foram dois médicos suecos que viveram na mesma época, mas não tinham nenhuma relação entre si, exceto por suas notáveis contribuições à medicina. O primeiro descreveu a ceratoconjuntivite sicca, posteriormente chamada de síndrome de Sjögren, e uma pigmentação da retina com aspecto de rede de pesca que afeta a acuidade visual, hoje conhecida como distrofia reticular de Sjögren. O último contribuiu para a compreensão da doença de Spielmeyer-Sjögren, das síndromes de Marinesco-Sjögren e Sjögren-Larsson, todas relacionadas a distúrbios genéticos e sintomas neurológicos. Neste artigo, pretendemos descrever cada desordem, a fim de evitar qualquer mal-entendido no diagnóstico e para registro histórico.

Small intestinal CaSR-dependent and CaSR-independent protein sensing regulates feeding and glucose tolerance in rats.

Proteins activate small intestinal calcium sensing receptor (CaSR) and/or peptide transporter 1 (PepT1) to increase hormone secretion1-8, but the effect of small intestinal protein sensing and the mechanistic potential of CaSR and/or PepT1 in feeding and glucose regulation remain inconclusive. Here we show that, in male rats, CaSR in the upper small intestine is required for casein infusion to increase glucose tolerance and GLP1 and GIP secretion, which was also dependent on PepT1 (ref. 9). PepT1, but not CaSR, is required for casein infusion to lower feeding. Upper small intestine casein sensing fails to regulate feeding, but not glucose tolerance, in high-fat-fed rats with decreased PepT1 but increased CaSR expression. In the ileum, a CaSR-dependent but PepT1-independent pathway is required for casein infusion to lower feeding and increase glucose tolerance in chow-fed rats, in parallel with increased PYY and GLP1 release, respectively. High fat decreases ileal CaSR expression and disrupts casein sensing on feeding but not on glucose control, suggesting an ileal CaSR-independent, glucose-regulatory pathway. In summary, we discover small intestinal CaSR- and PepT1-dependent and -independent protein sensing mechanisms that regulate gut hormone release, feeding and glucose tolerance. Our findings highlight the potential of targeting small intestinal CaSR and/or PepT1 to regulate feeding and glucose tolerance.

Sjögren: unique surname, two men, four syndromes and one disease / Sjögren: sobrenome único, dois homens, quatro síndromes e uma doença

Abstract Henrik and Torsten Sjögren (/'ogrƏn/ or SHOH-grƏn) were two Swedish physicians living in the same period, but completely unrelated, except for their notable contributions to Medicine. The first one described keratoconjunctivitis sicca, afterward called Sjögren's syndrome, and a fishing net aspect retinal pigmentation affecting visual acuity, nowadays known as Sjögren reticular dystrophy. The last one contributed to the understanding of Spielmeyer-Sjögren disease, Marinesco-Sjögren, and Sjögren-Larsson syndromes, all related to genetic disorders and neurological symptoms. In this paper, we aim to describe each disorder, in order to avoid any misunderstanding in diagnosis and for historical record.

Resumo Henrik e Torsten Sjögren (/'ogrƏn/ or SHOH-grƏn) foram dois médicos suecos que viveram na mesma época, mas não tinham nenhuma relação entre si, exceto por suas notáveis contribuições à medicina. O primeiro descreveu a ceratoconjuntivite sicca, posteriormente chamada de síndrome de Sjögren, e uma pigmentação da retina com aspecto de rede de pesca que afeta a acuidade visual, hoje conhecida como distrofia reticular de Sjögren. O último contribuiu para a compreensão da doença de Spielmeyer-Sjögren, das síndromes de Marinesco-Sjögren e Sjögren-Larsson, todas relacionadas a distúrbios genéticos e sintomas neurológicos. Neste artigo, pretendemos descrever cada desordem, a fim de evitar qualquer mal-entendido no diagnóstico e para registro histórico.

Anatomical Implications of Chiari I and Basilar Invagination (Type B) in the IV Ventricle and Cisterna Magna.

OBJECTIVE: To analyze the anatomical changes of the IV ventricle and cisterna magna in the Chiari malformation I (CMI) and basilar invagination (type B). METHODS: This is a controlled study with 161 exams of magnetic resonance imaging (MRI) of adults grouped into control (n = 37), basilar invagination (BI; n = 31), Chiari malformation I (CMI; n = 37), and CMI+BI (n = 56). The MRIs were analyzed using the visualization software Osirix (Pixmeo, Bernex, Geneva, version 3.8.2). The morphometric variables were: distance from the obex to the McRae line; length of the IV ventricle floor; and the area and volume of the cisterna magna. The univariate ANOVA followed by Tukey's post-hoc test was applied to evaluate the difference between the groups. The difference between sexes was evaluated by the t test for each group. RESULTS: Alterations in the cisterna magna and IV ventricle were more evident only in the CMI and CMI+BI groups. For both sexes, the CMI and CMI+BI groups showed: a reduction in the CSF space (P < 0.001), cisterna magna with volume reduction (P < 0.001), low position of the obex (P < 0.001), and IV ventricle more elongated (male P = 0.007 and female P < 0.001). The BI group had no significant change in the analysis by sex. CONCLUSIONS: The CMI (isolated and associated with BI) showed a low obex position and elongation of the IV ventricle due to traction towards the spinal canal. The reduction of cisterna magna volume added to the occupation of the cerebellar tonsils can impact in the cerebrospinal fluid dynamics. The BI when isolated was not related to alterations in the parameters of cerebrospinal fluid spaces studied.

Metformin triggers a kidney GDF15-dependent area postrema axis to regulate food intake and body weight.

Metformin, the most widely prescribed medication for obesity-associated type 2 diabetes (T2D), lowers plasma glucose levels, food intake, and body weight in rodents and humans, but the mechanistic site(s) of action remain elusive. Metformin increases plasma growth/differentiation factor 15 (GDF15) levels to regulate energy balance, while GDF15 administration activates GDNF family receptor α-like (GFRAL) that is highly expressed in the area postrema (AP) and the nucleus of the solitary tract (NTS) of the hindbrain to lower food intake and body weight. However, the tissue-specific contribution of plasma GDF15 levels after metformin treatment is still under debate. Here, we found that metformin increased plasma GDF15 levels in high-fat (HF) fed male rats through the upregulation of GDF15 synthesis in the kidney. Importantly, the kidney-specific knockdown of GDF15 expression as well as the AP-specific knockdown of GFRAL expression negated the ability of metformin to lower food intake and body weight gain. Taken together, we unveil the kidney as a target of metformin to regulate energy homeostasis through a kidney GDF15-dependent AP axis.

A glucose-sensing mechanism with glucose transporter 1 and pyruvate kinase in the area postrema regulates hepatic glucose production in rats.

The area postrema (AP) of the brain is exposed to circulating metabolites and hormones. However, whether AP detects glucose changes to exert biological responses remains unknown. Its neighboring nuclei, the nucleus tractus solitarius (NTS), responds to acute glucose infusion by inhibiting hepatic glucose production, but the mechanism also remains elusive. Herein, we characterized AP and NTS glucose-sensing mechanisms. Infusion of glucose into the AP, like the NTS, of chow rats suppressed glucose production during the pancreatic (basal insulin)-euglycemic clamps. Glucose transporter 1 or pyruvate kinase lentiviral-mediated knockdown in the AP negated AP glucose infusion to lower glucose production, while the glucoregulatory effect of NTS glucose infusion was also negated by knocking down glucose transporter 1 or pyruvate kinase in the NTS. Furthermore, we determined that high-fat (HF) feeding disrupts glucose infusion to lower glucose production in association with a modest reduction in the expression of glucose transporter 1, but not pyruvate kinase, in the AP and NTS. However, pyruvate dehydrogenase activator dichloroacetate infusion into the AP or NTS that enhanced downstream pyruvate metabolism and recapitulated the glucoregulatory effect of glucose in chow rats still failed to lower glucose production in HF rats. We discovered that a glucose transporter 1- and pyruvate kinase-dependent glucose-sensing mechanism in the AP (as well as the NTS) lowers glucose production in chow rats and that HF disrupts the glucose-sensing mechanism that is downstream of pyruvate metabolism in the AP and NTS. These findings highlight the role of AP and NTS in mediating glucose to regulate hepatic glucose production.

Key points for the thermal comfort of water buffaloes in Eastern Amazon / Pontos-chave do conforto térmico de bubalinos na Amazônia Oriental

This study presented relevant aspects about the Amazonian environment and how it impacts the thermal comfort of domestic buffaloes (Bubalus bubalis) raised in the Eastern Amazon. Furthermore, strategies for monitoring and mitigating animal heat stress are presented, based on research results with the species. Although domestic buffaloes are considered adaptable animals, exposure to intense solar radiation causes thermal discomfort. This condition is expressed in biophysical indicators, in metabolic, endocrine, behavioral responses, and in body thermographic patterns. Therefore, the biometeorological monitoring of production is crucial to support decision-making regarding environmental management strategies, genetic selection of thermotolerant individuals, and increase in animal welfare. Lastly, the use of silvopastoral systems can help to provide higher thermal comfort, which is a condition that directly impacts the productivity of milk and meat buffaloes when they are raised in tropical regions, such as in the Eastern Amazon.

Objetivou-se apresentar aspectos relevantes sobre o ambiente amazônico e como este impacta no conforto térmico de búfalos domésticos (Bubalus bubalis) criados na Amazônia Oriental. Adicionalmente, são apresentadas estratégias para monitoramento e mitigação do estresse térmico animal, a partir de resultados de pesquisa com a espécie. Apesar dos búfalos domésticos serem considerados animais adaptáveis, a exposição à intensa radiação solar provoca desconforto térmico. Essa condição é expressa em indicadores biofísicos, nas respostas metabólicas, endócrinas, comportamentais e nos padrões termográficos corporais. Assim, o monitoramento biometeorológico da produção é crucial para subsidiar tomadas de decisão em relação a estratégias de manejo ambiental, seleção genética de indivíduos termotolerantes e incremento do bem-estar animal. Por fim, o uso de sistemas silvipastoris pode auxiliar na oferta de maior conforto térmico, que é uma condição que impacta diretamente na produtividade de bubalinos de leite e carne, quando estes são criados em regiões tropicais, como na Amazônia Oriental.

Risk of perioperative stroke and cerebral autoregulation monitoring: a systematic review.

BACKGROUND: Perioperative stroke, delirium, and cognitive impairment could be related to management and to variations in blood pressure control, cerebral hypoperfusion and raised blood volume. Cerebral autoregulation (CAR) is a mechanism to maintain cerebral perfusion through the control of the vascular tone and hemodynamic reactions in the circulation. OBJECTIVE: The present systematic review addresses the relationship between impaired CAR and perioperative stroke by evaluating the rate of neurological complications after surgery in studies in which perioperative CAR was tested or monitored. METHODS: We included randomized clinical trials and prospective observational studies. All studies had adjusted the relative risk, hazard ratio or 95% confidence interval (95%CI) values. These estimation effects were tested using random-effects models. Heterogeneity among the selected studies was assessed using the Higgins and Thompson I2 statistics. RESULTS: The Web of Science, PubMed and EMBASE electronic databases were searched to retrieve articles. A total of 4,476 studies published between 1983 and 2019 were analyzed, but only 5 qualified for the data extraction and were included in the final analysis. The combined study cohort comprised 941 patients who underwent CAR monitoring during surgical procedures. All studies provided information about perioperative stroke, which equated to 16% (158 of 941) of the overall patient population. CONCLUSION: The present meta-analysis showed evidence of the impact of CAR impairment in the risk of perioperative stroke. On the pooled analysis, blood fluctuations or other brain insults large enough to compromise CAR were associated with the outcome of stroke (odds ratio [OR]: 2.26; 95%CI: 1.54-2.98; p < 0.0001).

ANTECEDENTES: Acidente vascular cerebral (AVC) perioperatório, delírio e comprometimento cognitivo podem estar relacionados ao manejo e à variações no controle da pressão arterial, à hipoperfusão cerebral, e ao aumento do volume sanguíneo. A autorregulação cerebral (ARC) é um mecanismo para manter a perfusão cerebral por meio do controle do tônus vascular e das reações hemodinâmicas na circulação. OBJETIVO: Este trabalho aborda sistematicamente a determinação da relação entre a falha da ARC e o AVC perioperatório, com uma avaliação da taxa de complicações neurológicas pós-cirúrgicas em estudos em que a ARC perioperatória foi monitorada. MéTODOS: Esta revisão sistemática incluiu ensaios clínicos randomizados e estudos observacionais prospectivos. Todos os estudos ajustaram o risco relativo, a razão de risco ou os valores de intervalo de confiança de 95% (IC95%). Esses efeitos de estimativas foram testados usando modelos de efeitos aleatórios. A heterogeneidade entre os diferentes estudos foi avaliada por meio das estatísticas de Higgins e Thompson I2. RESULTADOS: As bases de dados eletrônicas Web of Science, PubMed e Embase foram pesquisadas para selecionar os artigos. Um total de 4.476 estudos publicados entre 1983 e 2019 foram analisados, mas apenas 5 se qualificavam para a extração de dados e foram incluídos na análise final. A coorte combinada do estudo foi composta por 941 pacientes. Todos os estudos forneceram informações sobre AVC perioperatório, o que equivaleu a 16% (158 de 941) da população geral de pacientes. CONCLUSãO: Esta meta-análise mostrou evidências do impacto do prejuízo da ARC no risco de AVC perioperatório. Na análise conjunta, as flutuações sanguíneas ou outros insultos cerebrais grandes o suficiente para comprometer a ARC foram associados ao resultado do AVC (razão de probabilidades [RP]: 2,26; IC95%: 1,54­2,98; p < 0,0001).

Risk of perioperative stroke and cerebral autoregulation monitoring: a systematic review / Risco de acidente vascular cerebral perioperatório e monitoramento de autorregulação cerebral: uma revisão sistemática

Abstract Background Perioperative stroke, delirium, and cognitive impairment could be related to management and to variations in blood pressure control, cerebral hypoperfusion and raised blood volume. Cerebral autoregulation (CAR) is a mechanism to maintain cerebral perfusion through the control of the vascular tone and hemodynamic reactions in the circulation. Objective The present systematic review addresses the relationship between impaired CAR and perioperative stroke by evaluating the rate of neurological complications after surgery in studies in which perioperative CAR was tested or monitored. Methods We included randomized clinical trials and prospective observational studies. All studies had adjusted the relative risk, hazard ratio or 95% confidence interval (95%CI) values. These estimation effects were tested using random-effects models. Heterogeneity among the selected studies was assessed using the Higgins and Thompson I2 statistics. Results The Web of Science, PubMed and EMBASE electronic databases were searched to retrieve articles. A total of 4,476 studies published between 1983 and 2019 were analyzed, but only 5 qualified for the data extraction and were included in the final analysis. The combined study cohort comprised 941 patients who underwent CAR monitoring during surgical procedures. All studies provided information about perioperative stroke, which equated to 16% (158 of 941) of the overall patient population. Conclusion The present meta-analysis showed evidence of the impact of CAR impairment in the risk of perioperative stroke. On the pooled analysis, blood fluctuations or other brain insults large enough to compromise CAR were associated with the outcome of stroke (odds ratio [OR]: 2.26; 95%CI: 1.54-2.98;p < 0.0001).

Resumo Antecedentes Acidente vascular cerebral (AVC) perioperatório, delírio e comprometimento cognitivo podem estar relacionados ao manejo e à variações no controle da pressão arterial, à hipoperfusão cerebral, e ao aumento do volume sanguíneo. A autorregulação cerebral (ARC) é um mecanismo para manter a perfusão cerebral por meio do controle do tônus vascular e das reações hemodinâmicas na circulação. Objetivo Este trabalho aborda sistematicamente a determinação da relação entre a falha da ARC e o AVC perioperatório, com uma avaliação da taxa de complicações neurológicas pós-cirúrgicas em estudos em que a ARC perioperatória foi monitorada. Métodos Esta revisão sistemática incluiu ensaios clínicos randomizados e estudos observacionais prospectivos. Todos os estudos ajustaram o risco relativo, a razão de risco ou os valores de intervalo de confiança de 95% (IC95%). Esses efeitos de estimativas foram testados usando modelos de efeitos aleatórios. A heterogeneidade entre os diferentes estudos foi avaliada por meio das estatísticas de Higgins e Thompson I2. Resultados As bases de dados eletrônicas Web of Science, PubMed e Embase foram pesquisadas para selecionar os artigos. Um total de 4.476 estudos publicados entre 1983 e 2019 foram analisados, mas apenas 5 se qualificavam para a extração de dados e foram incluídos na análise final. A coorte combinada do estudo foi composta por 941 pacientes. Todos os estudos forneceram informações sobre AVC perioperatório, o que equivaleu a 16% (158 de 941) da população geral de pacientes. Conclusão Esta meta-análise mostrou evidências do impacto do prejuízo da ARC no risco de AVC perioperatório. Na análise conjunta, as flutuações sanguíneas ou outros insultos cerebrais grandes o suficiente para comprometer a ARC foram associados ao resultado do AVC (razão de probabilidades [RP]: 2,26; IC95%: 1,54-2,98;p < 0,0001).

Mist and Edge Computing Cyber-Physical Human-Centered Systems for Industry 5.0: A Cost-Effective IoT Thermal Imaging Safety System.

While many companies worldwide are still striving to adjust to Industry 4.0 principles, the transition to Industry 5.0 is already underway. Under such a paradigm, Cyber-Physical Human-centered Systems (CPHSs) have emerged to leverage operator capabilities in order to meet the goals of complex manufacturing systems towards human-centricity, resilience and sustainability. This article first describes the essential concepts for the development of Industry 5.0 CPHSs and then analyzes the latest CPHSs, identifying their main design requirements and key implementation components. Moreover, the major challenges for the development of such CPHSs are outlined. Next, to illustrate the previously described concepts, a real-world Industry 5.0 CPHS is presented. Such a CPHS enables increased operator safety and operation tracking in manufacturing processes that rely on collaborative robots and heavy machinery. Specifically, the proposed use case consists of a workshop where a smarter use of resources is required, and human proximity detection determines when machinery should be working or not in order to avoid incidents or accidents involving such machinery. The proposed CPHS makes use of a hybrid edge computing architecture with smart mist computing nodes that processes thermal images and reacts to prevent industrial safety issues. The performed experiments show that, in the selected real-world scenario, the developed CPHS algorithms are able to detect human presence with low-power devices (with a Raspberry Pi 3B) in a fast and accurate way (in less than 10 ms with a 97.04% accuracy), thus being an effective solution (e.g., a good trade-off between cost, accuracy, resilience and computational efficiency) that can be integrated into many Industry 5.0 applications. Finally, this article provides specific guidelines that will help future developers and managers to overcome the challenges that will arise when deploying the next generation of CPHSs for smart and sustainable manufacturing.

Reliability and Agreement in the Cerebellar Tonsil Tip Localization: Two Methods Using the McRae Line Concept in MRI.

BACKGROUND: The cerebellar tonsil tip position (TP) is a common parameter used for the radiologic diagnosis of Chiari malformation type 1 (CM1). However, these paramedian structures are usually not properly visualized in the midsagittal section. Such mismatch may be a source of bias in TP measurements based on the McRae line (ML) traced between median craniometric points. This study aims to evaluate the intraoperator and interoperator reliability and agreement of 2 protocols to trace the ML in magnetic resonance imaging (MRI) for the cerebellar tonsil tip localization, adding a 3-dimensional multiplanar reconstruction (MPR) approach to the midsagittal plane. METHODS: Sixty-two T1-weighted head MRIs were obtained for 32 CM1 patients and 30 controls. Two operators independently applied 2 TP measurement protocols, one considering only the visualization of the sagittal plane and the other using MPR. The intraclass correlation coefficient was used to assess intraoperator and interoperator reliability, and the Bland-Altman graphical method was used to evaluate the agreement between the measurement protocols. RESULTS: The sagittal method significantly underestimated ML and tonsillar herniation when compared with the MPR method. The MPR method provided better reliability of the ML measurement when compared to the sagittal method, but this did not influence the reliability of the TP. Analysis of the Bland-Altman plot showed that the limits of agreement were close to acceptable for the ML, but not for measures of TP. CONCLUSIONS: The standardization of the LM tracing by the MPR method improves the acquisition of data regarding the position of the tonsils.

Peer Navigation to Support Transgender Women's Engagement in HIV Care: Findings from the Trans Amigas Pilot Trial in São Paulo, Brazil.

Trans women living with HIV (TWH) have suboptimal HIV care engagement. We pilot tested Trans Amigas, a theory-based, trans-specific peer navigation (PN) intervention to address barriers to care in São Paulo, Brazil. TWH were randomized to the PN intervention (n = 75) or control (n = 38) condition. Control participants were referred to trans-friendly HIV care. Intervention participants were assigned a navigator who conducted nine in-person one-on-one sessions and bi-weekly phone or text check-ins to help participants overcome barriers to care and work towards gender affirmation and healthcare goals. We followed participants for 9 months to determine intervention feasibility, acceptability, and preliminary efficacy in improving retention in care. Analyses were intention to treat (ITT). Intervention acceptability was high: at end line, 85.2% of PN participants said they would continue receiving services and 94.4% would recommend peer navigation to a friend. A priori feasibility criteria were met: 92% of eligible participants enrolled and 70% were retained at 9 months; however, only 47% achieved moderate or better adherence to both in-person and phone/text program components. Though the pilot was not powered for efficacy, ITT findings trended toward significance, with intervention participants 40% more likely to be retained in care at the end of the study. Population-specific peer programming to support care engagement is acceptable, feasible, and can improve HIV outcomes for Trans women living with HIV.

RESUMEN: Las mujeres transgénero que viven con VIH (MTV) tienen una participación subóptima en la atención del VIH. Nosotros evaluamos el programa piloto "Trans Amigas", una intervención de navegación (o acompañamiento) de pares (NP) basada en un marco teórico, diseñado específicamente para mujeres transgénero, para abordar las dificultades de acceso a la salud en São Paulo, Brasil. MTV fueron asignadas de manera aleatoria a la intervención (n = 75) o a la condición de control (n = 38). Las participantes del grupo control fueron referidas a una unidad con servicios especializados para MTV. Las participantes en la intervención fueron asignadas a una navegadora, quien realizó nueve sesiones individuales en persona, así como llamadas telefónicas o mensajes de texto cada dos semanas para ayudar a las participantes a superar las barreras de acceso a la atención médica y avanzar hacia sus metas de afirmación de género y de salud. Seguimos a las participantes durante nueve meses para determinar factibilidad, aceptabilidad y eficacia preliminar en la retención en los servicios médicos. Usamos análisis por intención de tratar (AIT). La aceptabilidad de la intervención fue alta: 85.2% de las participantes NP dijeron que les gustaría seguir recibiendo los servicios NP, y 94.4% recomendarían NP a una amiga. El criterio de factibilidad a priori fue alcanzado: 92% de las participantes eligibles se inscribió y el 70% continuó por nueve meses. Sin embargo, solo el 47% alcanzó una adherencia moderada o alta tanto a las visitas en persona como a los mensajes de texto/llamadas telefónicas. Aunque el estudio piloto no tuvo el poder necesario para evaluar eficacia, el AIT reveló una tendencia hacia la significancia de que las participantes de la intervención tuvieran uma retención en la atención médica un 40% mayor. Los programas NP que apoyan el la participación en la atención del VIH, diseñados especificamente para la población, son aceptables, factibles, y pueden mejorar la situación de salud de las mujeres transgénero que viven con VIH.

Using data mining techniques to isolate chemical intrusion in water distribution systems.

The security of water distribution systems has become the subject of an increasing volume of research over the last decade. Data analysis and machine learning are linked to hydraulic and quality modeling for improving the capacity of water utilities to save lives when faced with the contamination of water networks. This research applies k-nearest neighbor and random forest algorithms to estimate the location of contamination sources at near-real time. Epanet and Epanet-MSX software are used to simulate intrusions of pesticide into water distribution system and the interaction with compounds already present in water bulk. Different pesticide concentrations are considered in the simulations, and chlorine monitoring occurs through placed quality sensors. The results show that random forest can localize [Formula: see text] of contamination scenarios, while the KNN algorithm found [Formula: see text]. Finally, an assessment of contamination spread is made for a better understanding of the impacts of non-localized contamination.

Ethical support to psychiatry residents: a report of a Brazilian ethics consultation group.

OBJECTIVE: It is not uncommon for medical residents to deal with critically ill patients who frequently show several ethical and human dilemmas, highlighting the need for a consultation with ethical specialists. The objective of this article is to present a description of a Brazilian Ethics Consultation group designed to attend psychiatry residents. METHODS: This article reports a case of a critically ill patient with Borderline Personality Disorder with multiple intervention failures and several ethical conflicts who was seen by a resident and supported by an ethics consultation group. RESULTS: When medical residents and medical staff face severe and unusual ethical dilemmas, they might feel unprepared and have ones' mental health impaired. Thus, this article reports a successful ethics consultation and discusses its development in other academic institutions. CONCLUSION: Medical educators and staff from academic hospitals should pay attention to the needs of the medical residents. The development and support of ethics consultation groups must be provided to fulfill the need of those residents who face serious ethical and human dilemmas.

A Review of Attacks, Vulnerabilities, and Defenses in Industry 4.0 with New Challenges on Data Sovereignty Ahead.

The concepts brought by Industry 4.0 have been explored and gradually applied.The cybersecurity impacts on the progress of Industry 4.0 implementations and their interactions with other technologies require constant surveillance, and it is important to forecast cybersecurity-related challenges and trends to prevent and mitigate these impacts. The contributions of this paper are as follows: (1) it presents the results of a systematic review of industry 4.0 regarding attacks, vulnerabilities and defense strategies, (2) it details and classifies the attacks, vulnerabilities and defenses mechanisms, and (3) it presents a discussion of recent challenges and trends regarding cybersecurity-related areas for Industry 4.0. From the systematic review, regarding the attacks, the results show that most attacks are carried out on the network layer, where dos-related and mitm attacks are the most prevalent ones. Regarding vulnerabilities, security flaws in services and source code, and incorrect validations in authentication procedures are highlighted. These are vulnerabilities that can be exploited by dos attacks and buffer overflows in industrial devices and networks. Regarding defense strategies, Blockchain is presented as one of the most relevant technologies under study in terms of defense mechanisms, thanks to its ability to be used in a variety of solutions, from Intrusion Detection Systems to the prevention of Distributed dos attacks, and most defense strategies are presented as an after-attack solution or prevention, in the sense that the defense mechanisms are only placed or thought, only after the harm has been done, and not as a mitigation strategy to prevent the cyberattack. Concerning challenges and trends, the review shows that digital sovereignty, cyber sovereignty, and data sovereignty are recent topics being explored by researchers within the Industry 4.0 scope, and GAIA-X and International Data Spaces are recent initiatives regarding data sovereignty. A discussion of trends is provided, and future challenges are pointed out.

COVID-19 in Amazonas, Brazil, was driven by the persistence of endemic lineages and P.1 emergence.

The northern state of Amazonas is among the regions in Brazil most heavily affected by the COVID-19 epidemic and has experienced two exponentially growing waves, in early and late 2020. Through a genomic epidemiology study based on 250 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes from different Amazonas municipalities sampled between March 2020 and January 2021, we reveal that the first exponential growth phase was driven mostly by the dissemination of lineage B.1.195, which was gradually replaced by lineage B.1.1.28 between May and June 2020. The second wave coincides with the emergence of the variant of concern (VOC) P.1, which evolved from a local B.1.1.28 clade in late November 2020 and replaced the parental lineage in <2 months. Our findings support the conclusion that successive lineage replacements in Amazonas were driven by a complex combination of variable levels of social distancing measures and the emergence of a more transmissible VOC P.1 virus. These data provide insights to understanding the mechanisms underlying the COVID-19 epidemic waves and the risk of dissemination of SARS-CoV-2 VOC P.1 in Brazil and, potentially, worldwide.

Is All Psychiatry Forensic? Association between Mental Disorders and Legal Proceedings

ABSTRACT Background: Psychiatric disorders cause significant impact to the individual, leading to lack of productivity and involvement with the legal system. Objectives: The present study aims to determine the association of mental disorders and an individuals' odds of involvement with the legal system Methods: Through a descriptive cross-sectional study, 126 patients selected according to convenience sampling were interviewed for the study on their appointment days at University of São Paulo School of Medicine hospital. They were divided into a case group (n = 63) with patients from the outpatient clinic of the Department of Psychiatry and a control group (n = 63), with patients from the outpatient clinic of Department of Internal Medicine. These patients were asked to answer a questionnaire on sociodemographic information, age, medical diagnosis, and legal proceedings as related to their diagnoses. Results: We found high difference between the groups, in longer absences 57.10% of psychiatric patients, with only 33.3% in clinical group. This difference also appears in the requirement for forensic medical exams - 65.1% of psychiatric patients versus 44.4% of clinical patients. Discussion: This data clearly shows that involvement of psychiatric patients in legal matters is quite common, and therefore it is increasingly important for psychiatrists to be aware of legal implications when evaluating their patients.

Supplementation with an Inorganic Zinc Source in the Metalloproteomic Profile of Royal Jelly in Apis mellifera L.

This study aimed to evaluate the quality of royal jelly produced by honeybees Apis mellifera supplemented with different concentrations of inorganic zinc (zinc sulfate monohydrate-0, 25, 50, and 75 ppm). Two-dimensional electrophoresis for the fractionation of royal jelly proteins was performed, and the zinc level was quantified by the flame atomic absorption spectrometry (FAAS) technique. Proteins were identified by electrospray ionization mass spectrometry (ESI MS MS). Analysis of variance followed by the Tukey test (P < 0.05) was used. Supplementation with the mineral zinc positively affected the quantification of proteins for treatments 50 and 75 ppm. However, all treatments independent of zinc concentrations showed fewer protein spots when compared to the control. All zinc-containing proteins were classified as major royal jelly proteins (MRJPs). The exposure of nursing bees to the mineral zinc in its inorganic form reduced the expression of six different MRJPs involved in larval and glands development of nursing bees (MRJP1, MRJP2, MRJP3, MRJP5, and MRJP7), however promoted an increase in the expression of royal jelly proteins involved in defense systems (MRJP8 and MRJP9). The results demonstrate that vital proteins and metabolic processes are impaired in nursing bees exposed to the mineral zinc in its inorganic form in all doses used affecting nutrition and maintenance of colonies.

COVID-19 epidemic in the Brazilian state of Amazonas was driven by long-term persistence of endemic SARS-CoV-2 lineages and the recent emergence of the new variant of concern P.1.

Dentre as 27 Unidades Federativas brasileiras, o estado do Amazonas foi uma das mais afetadas pela presente pandemia do novo coronavírus, com a ocorrência de uma segunda onda ao final de 2020 na qual um grande número de casos graves levou a um colapso no sistema de saúde. Este pre-print, resultado da análise do genoma completo de 250 amostras do SARS-CoV-2 coletadas no Amazonas entre março de 2020 e janeiro de 2021, descreve a dinâmica de sucessões de linhagens dominantes no estado. Mais recentemente, ele foi publicado na revista Nature Medicine, após editoração e a revisão por pesquisadores independentes. A publicação apresenta dados que embasam as hipóteses de que a linhagem responsável pela maioria dos casos no primeiro momento da pandemia (entre março e maio de 2020) foi a B.1.195, de que esta foi suplantada pela B.1.1.28, que tornou-se a linhagem dominante no estado entre maio e dezembro de 2020, e de que em dezembro o surgimento de uma variante da B.1.1.28, denominada P.1 e dotada de maior transmissibilidade, foi responsável pela nova ascensão no número de casos e mortes. Desta forma, a dinâmica local de surgimento de novas genéticas virais foi uma importante força-motriz para a forma com a qual a pandemia avançou sobre o estado do Amazonas, influenciada diretamente pela circulação da população e sua relação com o espalhamento do vírus, que culminou com a substituição da B.1.1.28 pela variante de preocupação P.1 em um processo que acredita-se ter durado apenas dois meses.