Impact of COVID-19 pandemic in the Brazilian maternal mortality ratio: A comparative analysis of Neural Networks Autoregression, Holt-Winters exponential smoothing, and Autoregressive Integrated Moving Average models.

BACKGROUND AND OBJECTIVES: The acute respiratory infection caused by severe acute respiratory syndrome coronavirus disease (COVID-19) has resulted in increased mortality among pregnant, puerperal, and neonates. Brazil has the highest number of maternal deaths and a distressing fatality rate of 7.2%, more than double the country's current mortality rate of 2.8%. This study investigates the impact of the COVID-19 pandemic on the Brazilian Maternal Mortality Ratio (BMMR) and forecasts the BMMR up to 2025. METHODS: To assess the impact of the COVID-19 pandemic on the BMMR, we employed Holt-Winters, Autoregressive Integrated Moving Average (ARIMA), and Neural Networks Autoregression (NNA). We utilized a retrospective time series spanning twenty-five years (1996-2021) to forecast the BMMR under both a COVID-19 pandemic scenario and a controlled COVID-19 scenario. RESULTS: Brazil consistently exhibited high maternal mortality values (mean BMMR [1996-2019] = 57.99 ±6.34/100,000 live births) according to World Health Organization criteria. The country experienced its highest mortality peak in the historical BMMR series in the second quarter of 2021 (197.75/100,000 live births), representing a more than 200% increase compared to the previous period. Holt-Winter and ARIMA models demonstrated better agreement with prediction results beyond the sample data, although NNA provided a better fit to previous data. CONCLUSIONS: Our study revealed an increase in BMMR and its temporal correlation with COVID-19 incidence. Additionally, it showed that Holt-Winter and ARIMA models can be employed for BMMR forecasting with lower errors. This information can assist governments and public health agencies in making timely and informed decisions.

How Did COVID-19 Impact the Antimicrobial Consumption and Bacterial Resistance Profiles in Brazil?

The indiscriminate use of antibiotics has favored the selective pressure of multidrug resistance among microorganisms. This research evaluated the pattern of antibiotic prescriptions among the Brazilian population between January 2018 and December 2021. Additionally, the study sought to analyze the incidence rates of central line-associated bloodstream infection (CLABSI) and examine the profiles of antibiotic resistance. We assessed the hospital and community antimicrobial consumption from the National Health Surveillance Agency Database and correlated it to microorganisms. The consumption of antimicrobials in the hospital environment increased by 26% in 2021, highlighting polymyxin B, which increased by 204%. In 2021, 244,266 cases of CLABSI were reported, indicating a nosocomial infection rate of 7.9%. The rate of resistance to polymyxin B was higher in Pseudomonas aeruginosa (1400%) and Klebsiella pneumoniae (514%). Azithromycin emerged as the predominant antibiotic utilized within the community setting, accounting for 24% of the overall consumption. Pearson's correlation analysis revealed a significant and positive correlation (r = 0.71) between the elevated usage of azithromycin and the incidence of COVID-19. Our results indicate an increase in antimicrobial consumption during the COVID-19 pandemic and reinforce the fact that the misuse of antimicrobials may lead to an expansion in antimicrobial resistance.

Social variables for replication of studies using mean scores of social support, self-care, and fibromyalgia knowledge: a cross-sectional study.

To investigate biopsychosocial variables that contribute to explaining social support, self-care, and fibromyalgia knowledge in patients with fibromyalgia. A cross-sectional study. We built ten models of predictive variables (schooling, ethnicity, associated diseases, body regions affected by pain, employment status, monthly income, marital status, health level, medication, sports activities, interpersonal relationships, nutrition level, widespread pain, symptom severity, cohabitation, dependent people, number of children, social support, self-care, and fibromyalgia knowledge) and individually tested their explanatory performance to predict mean scores on the Fibromyalgia Knowledge Questionnaire (FKQ), Medical Outcomes Study's Social Support Scale (MOS-SSS), and Appraisal of Self-Care Agency Scale-Revised (ASAS-R). We used analysis of variance to verify the association among all variables of mathematically adjusted models (F-value ≥ 2.20) and we reported only models corrected with p < 0.05 and R2 > 0.20. One hundred and ninety people with fibromyalgia (aged 42.3 ± 9.7 years) participated in the study. Our results show that the variables schooling, ethnicity, body regions affected by pain, frequency of sports activities, dependent people, number of children, widespread pain, social support, and self-care determine 27% of the mean FKQ scores. Marital status, self-care, and fibromyalgia knowledge determine 22% of mean MOS-SSS scores. Schooling, ethnicity, employment status, frequency of sports activities, nutrition level, cohabitation, number of children, social support, and fibromyalgia knowledge determine 30% of the mean ASAS-R scores. Studies using mean scores of social support, self-care, and fibromyalgia knowledge should collect and analyze the social variables described in the present study.

O processo "participar politicamente" de enfermeiros que atuam nas alas covid-19 de hospitais referência / The process of "participating politically" of nurses working in the covid-19 wards of reference hospitals / El proceso de "participación política" de enfermeros que trabajan en los hospitales de referencia para el covid-19

Objetivo: avaliar o processo de enfermagem agir politicamente de enfermeiros que atuam na ala SARS-CoV-2 dos Hospitais de Referência do Estado do Rio Grande do Norte. Métodos: estudo transversal, descritivo-exploratório, com abordagem quantitativa, realizado com 55 enfermeiros(as) de 11 hospitais de referência para SARS-CoV-2. Utilizou-se da técnica Snowball (bola de neve) e um formulário eletrônico online. Os dados foram analisados e interpretados por meio de estatística descritiva simples. Resultados: Dentre as questões respondidas pelos enfermeiros acerca de sua participação e atuação no referido processo, a "participação ativa nas tomadas de decisões referentes a pacientes com coronavírus no seu local de trabalho" foi a pergunta com mais respostas positivas, apresentando 61,1% de concordância. Quando questionados acerca da "satisfação da representação sindical da profissão durante a pandemia" a porcentagem de respostas negativas se sobressaiu, apresentando um valor de 62,5%. Em relação a valorização profissional, obteve-se 77,8% de respostas negativas, onde os participantes do estudo afirmam achar que com o fim da pandemia, a profissão não continuará sendo valorizada. Conclusão: mediante a escassez de estudos referentes a temática necessita-se de ações de pesquisas e publicações sobre o processo participar politicamente e a sua implementação na grade curricular de formação de novos profissionais. (AU)

Objective: to evaluate the nursing process acting politically of nurses working in the SARS-CoV-2 ward of the Reference Hospitals of the State of Rio Grande do Norte. Brazil. Methods: cross-sectional, descriptive exploratory study, with quantitative approach, with 55 nurses from 11 reference hospitals for SARS-CoV-2. Snowball technique and an online electronic form were used. Data were analyzed and interpreted using simple descriptive statistics. Results: among the questions answered by nurses about their participation and performance in this process, active 'participation in decision-making regarding patients with coronavirus in their workplace' was the question with the most positive answers, 61.1% agreement. When questioned about the satisfaction of the union representation of the profession during the pandemic, the percentage of negative answers stood out, with a value of 62.5%. In relation to the professional valorization, 77.8% of negative answers were obtained, where the participants of the study affirm that they think that with the end of the pandemic, the profession will not continue to be valued. Conclusion: due to the scarcity of studies on the theme, research and publications are needed on the process of political participation and its implementation in the curricula of training new professionals. (AU)

Objetivo: evaluar el proceso de acción política de los enfermeros que trabajan en los Hospitales de Referencia para el SARS-CoV-2 del Estado de Rio Grande do Norte (Brasil). Métodos: estudio transversal, descriptivo-exploratorio, de tipo cuantitativo, realizado con 55 enfermeros/as de 11 hospitales de referencia para el SARS-CoV-2. Se aplicó la técnica Snowball (bola de nieve) y un formulario electrónico en línea. Para el análisis de datos, se utilizó la estadística descriptiva simple. Resultados: entre las preguntas respondidas por los enfermeros sobre su 'participación y desempeño en ese proceso, la participación activa en la toma de decisiones sobre los pacientes con coronavirus en su lugar de trabajo' fue la pregunta con más respuestas positivas, con un 61,1% de consenso. Al ser preguntados por la satisfacción de la representación sindical de la profesión durante la pandemia, destaca el porcentaje de respuestas negativas, que presenta un valor del 62,5%. En relación a la valorización profesional, se obtuvo un 77,8% de respuestas negativas, donde los participantes del estudio afirmaron que creen que con el fin de la pandemia, la profesión no seguirá siendo valorada. Conclusión: mediante la escasez de estudios relacionados con el tema, es necesario realizar investigaciones y publicaciones sobre el proceso de participación política y su implementación en el grado de formación de nuevos profesionales. (AU)

Interaction of Ginseng with Ilyonectria Root Rot Pathogens.

The Ilyonectria radicicola species complex (A.A. Hildebr.) A. Cabral and Crous 2011 contains species of soilborne necrotrophic plant pathogens. The most aggressive to ginseng roots is I. mors-panacis, whereas I. robusta, I. crassa, I. panacis and I. radicicola are less aggressive. Infected ginseng roots show orange-red to black-brown lesions that can expand into a severe root rot, known as disappearing root rot, where only epidermal root tissue remains. Leaves become red-brown with wilting, and stems can have vascular discoloration with black-brown lesions at the base. Less aggressive Ilyonectria species trigger jasmonic acid (JA)-related defenses inducing host ginsenosides, pathogenesis-related (PR) proteins, wound periderm, and cell wall thickening. In contrast, I. mors-panacis triggers reactive oxygen species (ROS) and salicylic acid (SA) production but suppresses JA-related defenses and ginsenoside accumulation. It is also able to suppress SA-related PR protein production. Virulence factors include potential effectors that may suppress PAMP (Pathogen Associated Molecular Patterns) triggered immunity (PTI), polyphenoloxidases, Hsp90 inhibitors, siderophores and cell-wall-degrading enzymes, such as pectinases. Overall, I. mors-panacis appears to be more aggressive because it can suppress JA and SA-related PTI allowing for more extensive colonization of ginseng roots. While many possible mechanisms of host resistance and pathogen virulence mechanisms have been examined, there is a need for using genetic approaches, such as RNAi silencing of genes of Panax or Ilyonectria, to determine their importance in the interaction.

Broiler behavior differs from males to females when under different light wavelengths.

It is well established that different light wavelengths affect broiler behavior. The present study aims to evaluate the effect of four light wavelengths on broiler behavior from 1 to 42 days of age. Birds were housed at a stocking density of 13 birds/m2, in 32 boxes of 1.56 m2. The experimental design was a completely randomized factorial of 4 × 2 (four colors × two sexes), with four replicates. Behavioral variables were accessed through cameras and observed in person thrice a week for 30 min per day in three different periods. Data were organized according to age groups and analyzed by a data mining approach with the different light wavelengths as the classes. Natural behavior defined by stretch, dust bath of male broilers reared in environments with green and blue light was more relevant to the classification of male broilers' behavior (96.9 and 96.9% accuracy and 0.8 and 1.0 of class precision of behavior classification, respectively). Blue and green lights affected the behavior of male broilers starting at 7 days of age, increasing the presence at the bird feeder, and reducing the idle period.

Structural equation models for slaughtering weight prediction for broilers.

The aim of this research was to determine the effect of gut health parameters on the flock's final weight of broilers and to calculate an accurate equation to estimate this weight with information available at 7, 14, and 21 days, in field conditions. Gut health parameters (gizzard erosion, coccidiosis, feed passage, and redness, gut tone, consistency of content, and presence of mucus for each part of the small intestine [duodenum, jejunum, and ileum], and color, consistency, and presence of gas for caeca content) were evaluated at 7 and 14 days. Other parameters evaluated for impact on flock final weight were body weight and mortality, both at 7, 14, and 21 days; stocking density; litter reuse; and downtime period. Structural equation model evaluation of the data showed that stocking density and litter reuse did not affect (P > 0.05) flock final weight, while downtime period, body weight (14 and 21 days), and mortality (14 and 21 days) directly affected (P ≤ 0.05) the flock final weight. Gut health parameters did not directly affect the flock's final weight; however, they affected body weight and mortality at 14 days, thus showing an indirect effect on the flock's final weight. It was also possible to determine two accurate equations to estimate the flock's final weight using information available at both 14 (R2 = 0.56) and 21 (R2 = 0.77) days.

Avaliação do processo de enfermagem nos cuidados com pacientes com covid-19 em hospitais de referência / Evaluación del proceso de enfermería en la atención a pacientes con covid-19 en hospitales de referencia / Evaluation of the nursing process in care of patients with covid-19 in reference hospitals

Objetivo avaliar como tem sido desenvolvido o processo de enfermagem na atenção à saúde dos pacientes com COVID-19, nos Hospitais de Referência do estado do Rio Grande do Norte. Método estudo transversal, descritivo-exploratório, com abordagem quantitativa, realizado com 55 enfermeiros de 11 hospitais de referência para COVID-19. Utilizou-se a técnica Snowball e um formulário on-line. Na análise e interpretação dos dados utilizou-se a estatística descritiva simples. Resultados do total, 43,6% (n=24) dos enfermeiros conseguiram realizar o processo de enfermagem. A investigação foi a etapa realizada com mais frequência (45,4%; n=25). Dificuldades na realização das fases do processo de enfermagem foram relatadas por 83,6% (n=46). A etapa de implementação da assistência de enfermagem foi a mais desafiadora (36,3%; n=20). Conclusão o processo de enfermagem ainda é uma fragilidade da profissão, visto que suas fases são interrelacionadas e sucessivas e a quebra desse ciclo compromete a efetividade do cuidado prestado.

Objetivo evaluar cómo se ha desarrollado el proceso de enfermería en la atención a la salud de los pacientes con COVID-19, en los hospitales de referencia del estado de Rio Grande do Norte. Método estudio transversal, descriptivo-exploratorio, con enfoque cuantitativo, realizado con 55 enfermeras de 11 hospitales de referencia para el COVID-19. Se utilizó la técnica de bola de nieve y un formulario en línea. En el análisis e interpretación de los datos, se utilizó la estadística descriptiva simple. Resultados del total, el 43,6% (n=24) de los enfermeros fueron capaces de realizar el proceso de enfermería. La investigación fue la etapa más frecuentemente realizada (45,4%; n=25). Las dificultades para realizar las fases del proceso de enfermería fueron señaladas por el 83,6% (n=46). La etapa de implementación de los cuidados de enfermería fue la más desafiante (36,3%; n=20). Conclusión el proceso de enfermería sigue siendo una fragilidad de la profesión, ya que sus fases están interrelacionadas y son sucesivas y la ruptura de este ciclo compromete la eficacia de los cuidados prestados.

Objective to evaluate how the nursing process has been developed in the health care of patients with COVID-19, in the Reference Hospitals of the state of Rio Grande do Norte. Method cross-sectional, descriptive-exploratory study, with a quantitative approach, conducted with 55 nurses from 11 referrence hospitals for COVID-19. The Snowball technique and an online form have been used. In the analysis and interpretation of the data, simple descriptive statistics was used. Results of the total, 43.6% (n=24) of the nurses were able to perform the nursing process. The investigation was the most frequently performed stage (45.4%-n=25). Difficulties in performing the phases of the nursing process were reported by 83.6% (n=46). The nursing care implementation step was the most challenging (36.3%-n=20). Conclusion the nursing process is still a fragility of the profession, since its phases are interrelated and successive, and the break of this cycle compromises the effectiveness of the care provided.

Métodos de avaliação da apraxia de fala na infância: revisão sistemática / Methods of assessing of childhood apraxia of speech: systematic review

RESUMO Objetivos Revisar sistematicamente os protocolos e/ou avaliações que contribuem para o diagnóstico de apraxia de fala na infância (AFI) e classificá-los de acordo com a dimensão clínica avaliada. Estratégia de pesquisa Estudo de revisão sistemática da literatura nas bases de dados MEDLINE (acessado via PubMed), LILACS, Scopus e SciELO, com os descritores Apraxias, Childhood apraxia of speech, Evaluation, Assessment, Validation Studies, Evaluation Studies, Language Therapy, Rehabilitation of Speech and Language Disorders, Child e Child, Preschool. Critérios de seleção A busca nas bases de dados foi conduzida por três pesquisadores independentes. Foram incluídos estudos que avaliavam, de forma clara, sujeitos com suspeita ou diagnóstico de AFI. Os revisores realizaram a coleta de dados no que diz respeito às características metodológicas, intervenções e desfechos dos estudos, por meio de planilhas previamente elaboradas especificamente para o presente estudo. O dado principal coletado foi referente aos procedimentos de avaliação da AFI para crianças. Resultados A maior parte dos estudos (14 dos 21 incluídos) realizou a associação entre a avaliação de habilidades motoras e/ou articulatórias e segmentais. Cinco realizaram avaliação de todos os aspectos elencados: motor e/ou articulatória, segmental e suprassegmental e dois realizaram apenas avaliação motora e/ou articulatória. A idade dos sujeitos variou de 3 a 12 anos. Conclusão A maioria das pesquisas considerou a associação entre habilidades motoras e/ou articulatórias e segmentais para avaliação da apraxia de fala na infância. Sugere-se a realização de mais estudos, a fim de buscar evidências de validade.

ABSTRACT Purpose Systematically review the protocols and/or assessments that contribute to the diagnosis of CAS and classify them according to the clinical dimension evaluated Research strategy Study of systematic literature review in the databases MEDLINE (accessed via PubMed), LILACS, Scopus and SciELO with the descriptors Apraxias, Childhood apraxia of speech, Evaluation, Assessment, Validation Studies, Evaluation Studies, Language Therapy, Rehabilitation of Speech and Language Disorders, Child and Child, Preschool. Selection criteria The search for scientific articles in the databases was conducted by three independent researchers. Studies that clearly assessed subjects with suspected or diagnosed PIA were included. The reviewers performed data collection with regard to methodological characteristics, interventions and study outcomes using standardized forms. The main data collected was related to the assessment procedures of CAS. Results Most studies (14 of the 21 included) made an association between the assessment of motor and/or articulatory and segmental skills. Five performed an evaluation of all listed aspects: motor and/or articulatory, segmental and suprasegmental; and two underwent only motor and/or articulatory assessment. The age of the subjects in the present study ranged from 3 to 12 years. Conclusion The assessment of CAS generally involves the association between the assessment of motor and/or articulatory and segmental skills. It is suggested that further studies in order to evidence validity for the assessment of CAS.

Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19.

Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.

A PUERICULTURA NO PRIMEIRO ANO DE VIDA ­ UMA AVALIAÇÃO NA ATENÇÃO PRIMÁRIA EM SAÚDE / CHILDCARE IN THE FIRST YEAR OF LIFE-AN EVALUATION IN PRIMARY HEALTH CARE

Objetivo: avaliar a frequência de consultas no primeiro ano da criança e relacionar com as características maternas, de pré-natal e perinatais. Métodos: Coorte de crianças nascidas entre maio e outubro de 2015 que realizaram no mínimo uma consulta na Unidade Básica de Saúde até seus 13 meses incompletos. As informações maternas, de pré-natal e perinatais foram obtidas do SINASC e o número total e o tipo de consulta pelo prontuário da UBS. Foram realizadas análise descritiva das variáveis e testes de associação das características maternas, informações de pré-natal e perinatais com o número de consultas no primeiro ano. Resultados: das 237 crianças nascidas no período, 35 (14,7%) consultaram até os 13 meses incompletos (m=7,6 atendimentos). Destas, 22 (62,9%) realizaram no mínimo 7 atendimentos de puericultura. A menor escolaridade materna esteve associada a um maior número de consultas no primeiro ano de vida (p=0,050) e houve correlação do número de consultas de pré-natal com as de puericultura (p=0,044). Conclusão: o maior número de atendimentos durante o primeiro ano de vida da criança está associado à menor escolaridade materna ao mesmo tempo em que, o vínculo estabelecido durante o pré-natal, ocasionou um maior número de consultas de puericultura.

Objective: To evaluate the frequency of consultations in the first year of the child and to relate to the maternal, prenatal and perinatal characteristics.Methods: Cohort of children born between May and October 2015 who performed at least one visit to the Basic Health Unit until their 13 months. Maternal, prenatal and perinatal information were obtained from the SINASC and the total number and type of consultation by the UBS medical record. Descriptive analysis of the variables and tests of association of maternal characteristics, prenatal and perinatal information with the number of visits in the first year were performed.Results: Of the 237 children born, 35 (14.7%) consulted until the incomplete 13 months (m = 7.6 visits). Of these, 22 (62.9%) performed at least 7 childcare services. Maternal schooling was associated with a higher number of visits in the first year (p=0.050) and there was a correlation between the number of prenatal consultations and those of childcare (p = 0.044). Conclusions: The higher number of visits during the first year of life of the child is associated with lower maternal schooling, while the link established during the prenatal period has resulted in a greater number of childcare consultations.

Behavioral responses of turkeys subjected to different climatic conditions.

I was evaluated the effect of seven different combinations of temperature, air velocity, and relative air humidity on the frequency and duration of eating, drinking, resting, cannibalism, dust bathing, scratching, ground pecking, shivering, and stretching behaviors of turkeys at three different ages. The combinations tested of temperature, relative air humidity, and air velocity were, respectively: 1 (22 °C, 50%, 1 m/s); 2 (26.2 °C, 73.2%, 0.45 m/s); 3 (26.6 °C, 71.2%, 1 m/s); 4 (28.9 °C, 72%, 1.4 m/s); 5 (31.1 °C, 85%, 0.45 m/s); 6 (34.1 °C, 82.1%, 1 m/s); and 7 (34.4 °C, 82.1%, 1.4 m/s) for three ages of birds (61, 96, and 131 days of age). Seven birds were housed per pen, at a density of 3 males/m2, totaling 147 birds in the entire experiment. Each combination was applied for 5 days. The data were analyzed considering the number of times the bird performed the behavior and the time it performed (in seconds). Each pen was considered a repetition. A comparison of the medians was used to compare the treatments by each age. The results showed that young birds were more likely to suffer from the combination of low temperature and high air velocity, reducing their frequency of normal behaviors. Increased humidity at a low temperature raised the frequency of scratching, shivering, and cannibalism behaviors leading to poorer bird welfare. It is recommended that the temperature, relative air humidity, and air velocity combination of 26.6 °C; 71.2%; and 1 m/s, respectively, for young birds, and 22 °C; 50%; and 1 m/s, respectively, for older birds should be used.

Evaluation of different heating systems for new-born swine.

The use of heating systems for new-born piglets can prevent major losses in the first 5 weeks of life. The present study had the objective of evaluating three heating systems in creeps for new-born piglets, being: floor-heated floor with circulating water (HF), incandescent lamp type SPOT 40 W (L) and incandescent lamp type SPOT 40 W plus black metal plate (LP). The variables evaluated were piglet performance (total weight gain and mortality), bioclimatic data (temperature and relative air humidity), animal behaviour and economic revenue. Bioclimatic data were recorded in the external environment, in the maternity and in the interior of each shelter/creep for 21 days, three times a day, as well as the capture of photographic images for analysis of the animals' disposal. The mean temperature of the retractors, the weight at weaning and the weight gain were higher in the HF treatment. Treatment HF improved the percentage of dispersed animals and provided the best thermal environment and the highest revenue at the time of the commercialization of the piglets.