Prognosticating the outcome of intensive care in older patients-a narrative review.

Prognosis determines major decisions regarding treatment for critically ill patients. Statistical models have been developed to predict the probability of survival and other outcomes of intensive care. Although they were trained on the characteristics of large patient cohorts, they often do not represent very old patients (age ≥ 80 years) appropriately. Moreover, the heterogeneity within this particular group impairs the utility of statistical predictions for informing decision-making in very old individuals. In addition to these methodological problems, the diversity of cultural attitudes, available resources as well as variations of legal and professional norms limit the generalisability of prediction models, especially in patients with complex multi-morbidity and pre-existing functional impairments. Thus, current approaches to prognosticating outcomes in very old patients are imperfect and can generate substantial uncertainty about optimal trajectories of critical care in the individual. This article presents the state of the art and new approaches to predicting outcomes of intensive care for these patients. Special emphasis has been given to the integration of predictions into the decision-making for individual patients. This requires quantification of prognostic uncertainty and a careful alignment of decisions with the preferences of patients, who might prioritise functional outcomes over survival. Since the performance of outcome predictions for the individual patient may improve over time, time-limited trials in intensive care may be an appropriate way to increase the confidence in decisions about life-sustaining treatment.

Proximalization of Arterial Inflow for the Treatment of Limb Ischemia in a Transposed Femoral Arteriovenous Fistula-A Case Report.

INTRODUCTION: Femoral vein transposition is one of the final resorts for vascular access in patients with exhaustion of upper limb venous patrimony and central venous occlusive disease. Its major pitfalls include hemodialysis access-induced distal ischemia and infection. Surgical procedures may be warranted to preserve vascular access if ischemia develops. Several techniques are reported in the literature for femoral vein transposition. CASE REPORT: We expose an endoscopic femoral vein harvesting as an alternative to the single thigh incision in order to avoid its associated complications. In the setting of ischemia, proximalization of arterial inflow was used to manage femoral vein transposition associated limb ischemia. CONCLUSION: This case report aims to expose the aforementioned unreported surgical techniques for lower limb arteriovenous fistula, its advantages, and pitfalls, as well as considerations on its future use.

Repair versus replacement of defective direct dental restorations: A multinational cross-sectional study with meta-analysis.

OBJECTIVES: When dental practitioners encounter a defective restoration, they are faced with a crucial decision whether to repair or replace it. This study aims to explore international preferences for repair procedures and the clinical steps taken during the repair process. METHOD: An 11-question survey was distributed to dentists across 21 countries via different platforms. The survey comprised two sections: the first included five questions aimed at gathering demographic information, while the second consisted of six questions focusing on participants' practices related to the repair of composite or amalgam restorations A meta-analysis was employed to ascertain the pooled odds ratio of repairing versus replacement. The statistical analysis was carried out using the RevMan 5.3 program and forest plots were generated using the same program to visualize the results. RESULTS: The survey was completed by 3680 dental practitioners. The results indicated a strong tendency to repair defective composite restorations (OR: 14.23; 95 % CI: 7.40, 27.35, p < 0.001). In terms of amalgam, there was a significant tendency to replace the restorations (OR: 0.19; 95 % CI: 0.12, 0.30, p < 0.001). When repairing restorations, the most common protocols were etching with orthophosphoric acid and creating an enamel bevel, regardless of the restorative material used. CONCLUSION: The findings of this study indicate that there exists a knowledge gap among dental practitioners regarding restoration repair. It is imperative that dental practitioners receive proper education and training on restoration repair, to ensure the usage of adequate protocols and restoration survival. CLINICAL SIGNIFICANCE: A significant portion of dental practitioners lack the necessary knowledge and education required for the repair of restorations. Therefore, it is imperative to establish guidelines aimed at enhancing the management of defective restorations, along with protocols for clinical interventions. This includes the incorporation of proper courses in undergraduate, graduate, and continuing education programs.

Sensor-based systems for the measurement of Functional Reach Test results: a systematic review.

The measurement of Functional Reach Test (FRT) is a widely used assessment tool in various fields, including physical therapy, rehabilitation, and geriatrics. This test evaluates a person's balance, mobility, and functional ability to reach forward while maintaining stability. Recently, there has been a growing interest in utilizing sensor-based systems to objectively and accurately measure FRT results. This systematic review was performed in various scientific databases or publishers, including PubMed Central, IEEE Explore, Elsevier, Springer, the Multidisciplinary Digital Publishing Institute (MDPI), and the Association for Computing Machinery (ACM), and considered studies published between January 2017 and October 2022, related to methods for the automation of the measurement of the Functional Reach Test variables and results with sensors. Camera-based devices and motion-based sensors are used for Functional Reach Tests, with statistical models extracting meaningful information. Sensor-based systems offer several advantages over traditional manual measurement techniques, as they can provide objective and precise measurements of the reach distance, quantify postural sway, and capture additional parameters related to the movement.

Carbon nanotube heterogenization improves cobalt pyridyldiimine complex CO2 reduction activity in aqueous carbonate buffer.

We present two novel cobalt pyridyldiimine complexes functionalized with pyrene. Initially modest in homogeneous acetonitrile solution, their electrocatalytic CO2 reduction performance significantly improves upon immobilization on MWCNTs in an aqueous carbonate buffer. The complexes exhibit outstanding stability, with CO selectivity exceeding 97%, and TON and TOF values reaching up to 104 and above 1.2 s-1, respectively.

Recent Advances in 4D Printing of Advanced Materials and Structures for Functional Applications.

4D printing has attracted tremendous worldwide attention during the past decade. This technology enables the shape, property, or functionality of printed structures to change with time in response to diverse external stimuli, making the original static structures alive. The revolutionary 4D-printing technology offers remarkable benefits in controlling geometric and functional reconfiguration, thereby showcasing immense potential across diverse fields, including biomedical engineering, electronics, robotics, and photonics. Here, a comprehensive review of the latest achievements in 4D printing using various types of materials and different additive manufacturing techniques is presented. The state-of-the-art strategies implemented in harnessing various 4D-printed structures are highlighted, which involve materials design, stimuli, functionalities, and applications. The machine learning approach explored for 4D printing is also discussed. Finally, the perspectives on the current challenges and future trends toward further development in 4D printing are summarized.

Monthly Analysis of Infant Mortality Rate in Portugal during the COVID-19 Pandemic: Insights from Continuous Monitoring.

INTRODUCTION: The COVID-19 pandemic significantly impacted global public health. Infant mortality rate (IMR), a vital statistic and key indicator of a population's overall health, is essential for developing effective health prevention programs. Existing evidence primarily indicates a decrease in IMR during the COVID-19 pandemic. We conducted a national-level analysis to calculate IMR and describe its course over the years (from 2016 until 2022), using a month-by-month analysis. METHODS: Data on the number of deaths under one year of age was collected from the Portuguese E-Death Certification System (SICO), and data on the number of monthly live births was obtained from Statistics Portugal. The IMR was calculated per month, considering the previous 12 months' cumulative number of deaths under one year of age and the number of live births. RESULTS: In Portugal, the IMR decreased before and during the COVID-19 pandemic. The lowest values were observed in September and October 2021 (2.15 and 2.14 per 1000 live births, respectively). The IMR remained below the threshold of three deaths per 1000 live births during the pandemic's critical period. CONCLUSION: Portugal has achieved remarkable progress in reducing its IMR over the last 60 years. The country recorded its lowest-ever IMR values during the COVID-19 pandemic. Further studies are needed to fully understand the observed trends.

Mobile Data Gathering and Preliminary Analysis for the Functional Reach Test.

The functional reach test (FRT) is a clinical tool used to evaluate dynamic balance and fall risk in older adults and those with certain neurological diseases. It provides crucial information for developing rehabilitation programs to improve balance and reduce fall risk. This paper aims to describe a new tool to gather and analyze the data from inertial sensors to allow automation and increased reliability in the future by removing practitioner bias and facilitating the FRT procedure. A new tool for gathering and analyzing data from inertial sensors has been developed to remove practitioner bias and streamline the FRT procedure. The study involved 54 senior citizens using smartphones with sensors to execute FRT. The methods included using a mobile app to gather data, using sensor-fusion algorithms like the Madgwick algorithm to estimate orientation, and attempting to estimate location by twice integrating accelerometer data. However, accurate position estimation was difficult, highlighting the need for more research and development. The study highlights the benefits and drawbacks of automated balance assessment testing with mobile device sensors, highlighting the potential of technology to enhance conventional health evaluations.

Multimorbidity and frailty are associated with poorer SARS-CoV-2-related outcomes: systematic review of population-based studies.

BACKGROUND: Estimating the risks and impacts of COVID-19 for different health groups at the population level is essential for orienting public health measures. Adopting a population-based approach, we conducted a systematic review to explore: (1) the etiological role of multimorbidity and frailty in developing SARS-CoV-2 infection and COVID-19-related short-term outcomes; and (2) the prognostic role of multimorbidity and frailty in developing short- and long-term outcomes. This review presents the state of the evidence in the early years of the pandemic. It was conducted within the European Union Horizon 2020 program (No: 101018317); Prospero registration: CRD42021249444. METHODS: PubMed, Embase, World Health Organisation COVID-19 Global literature on coronavirus disease, and PsycINFO were searched between January 2020 and 7 April 2021 for multimorbidity and 1 February 2022 for frailty. Quantitative peer-reviewed studies published in English with population-representative samples and validated multimorbidity and frailty tools were considered. RESULTS: Overall, 9,701 records were screened by title/abstract and 267 with full text. Finally, 14 studies were retained for multimorbidity (etiological role, n = 2; prognostic, n = 13) and 5 for frailty (etiological role, n = 2; prognostic, n = 4). Only short-term outcomes, mainly mortality, were identified. An elevated likelihood of poorer outcomes was associated with an increasing number of diseases, a higher Charlson Comorbidity Index, different disease combinations, and an increasing frailty level. DISCUSSION: Future studies, which include the effects of recent virus variants, repeated exposure and vaccination, will be useful for comparing the possible evolution of the associations observed in the earlier waves.

Exploring the potential of the carbon credit program for hedging energy prices in Brazil.

The transition to a low-carbon economy is imperative to reduce reliance on fossil fuels and mitigate pollution emissions. This preposition also aligns with the United Nations Sustainable Development Goals (SDGs-13), which highlight the climate change action. In this vein, Brazil has implemented the Decarbonization Credit (CBIOS) program to incentivize biofuel production and promote environmental sustainability through carbon credit emissions. To this end, the present study evaluates the effectiveness of the CBIO contract as a hedging tool for investors in the face of energy price fluctuations and decarbonization efforts. Specifically, we employ conditional dynamic correlation (DCC-GARCH) and optimal hedge ratio (HR) techniques to assess the relationship between CBIO and the futures and spot prices of sugar, oil, and ethanol. Our findings suggest that the current CBIO contract is not an effective hedge against energy spot and future prices. However, our analysis identifies a strengthening correlation between ethanol traded in Chicago and CBIO over time, highlighting the potential for an underlying contract to serve as an effective hedging tool in the future. Our study adds to the existing literature on carbon pricing mechanisms and their impact on financial markets, emphasizing the importance of sustainable energy policies and their potential to mitigate the risks associated with energy price volatility and decarbonization efforts.

Performance Evaluation of Computer Vision Algorithms in a Programmable Logic Controller: An Industrial Case Study.

This work evaluates the use of a programmable logic controller (PLC) from Phoenix Contact's PLCnext ecosystem as an image processing platform. PLCnext controllers provide the functions of "classical" industrial controllers, but they are based on the Linux operating system, also allowing for the use of software tools usually associated with computers. Visual processing applications in the Python programming language using the OpenCV library are implemented in the PLC using this feature. This research is focused on evaluating the use of this PLC as an image processing platform, particularly for industrial machine vision applications. The methodology is based on comparing the PLC's performance against a computer using standard image processing algorithms. In addition, a demonstration application based on a real-world scenario for quality control by visual inspection is presented. It is concluded that despite significant limitations in processing power, the simultaneous use of the PLC as an industrial controller and image processing platform is feasible for applications of low complexity and undemanding cycle times, providing valuable insights and benchmarks for the scientific community interested in the convergence of industrial automation and computer vision technologies.

Self-Healable and 4D Printable Hydrogel for Stretchable Electronics.

Materials with high stretchability and conductivity are used to fabricate stretchable electronics. Self-healing capability and four-dimensional (4D) printability are becoming increasingly important for these materials to facilitate their recovery from damage and endow them with stimuli-response properties. However, it remains challenging to design a single material that combines these four strengths. Here, a dually crosslinked hydrogel is developed by combining a covalently crosslinked acrylic acid (AAC) network and Fe3+ ions through dynamic and reversible ionically crosslinked coordination. The remarkable electrical sensitivity (a gauge factor of 3.93 under a strain of 1500%), superior stretchability (a fracture strain up to 1700%), self-healing ability (a healing efficiency of 88% and 97% for the mechanical and electrical properties, respectively), and 4D printability of the hydrogel are demonstrated by constructing a strain sensor, a two-dimensional touch panel, and shape-morphing structures with water-responsive behavior. The hydrogel demonstrates vast potential for applications in stretchable electronics.

Integrating factors associated with complex wound healing into a mobile application: Findings from a cohort study.

Complex, chronic or hard-to-heal wounds are a prevalent health problem worldwide, with significant physical, psychological and social consequences. This study aims to identify factors associated with the healing process of these wounds and develop a mobile application for wound care that incorporates these factors. A prospective multicentre cohort study was conducted in nine health units in Portugal, involving data collection through a mobile application by nurses from April to October 2022. The study followed 46 patients with 57 wounds for up to 5 weeks, conducting six evaluations. Healing time was the main outcome measure, analysed using the Mann-Whitney test and three Cox regression models to calculate risk ratios. The study sample comprised various wound types, with pressure ulcers being the most common (61.4%), followed by venous leg ulcers (17.5%) and diabetic foot ulcers (8.8%). Factors that were found to impair the wound healing process included chronic kidney disease (U = 13.50; p = 0.046), obesity (U = 18.0; p = 0.021), non-adherence to treatment (U = 1.0; p = 0.029) and interference of the wound with daily routines (U = 11.0; p = 0.028). Risk factors for delayed healing over time were identified as bone involvement (RR 3.91; p < 0.001), presence of odour (RR 3.36; p = 0.007), presence of neuropathy (RR 2.49; p = 0.002), use of anti-inflammatory drugs (RR 2.45; p = 0.011), stalled wound (RR 2.26; p = 0.022), greater width (RR 2.03; p = 0.002), greater depth (RR 1.72; p = 0.036) and a high score on the healing scale (RR 1.21; p = 0.001). Integrating the identified risk factors for delayed healing into the assessment of patients and incorporating them into a mobile application can enhance decision-making in wound care.

Ten meter walk test with mobile devices: A dataset with accelerometer, magnetometer, and gyroscope.

This paper presents a dataset related to the performance of the Ten Meter Walking Test, a test to allow locomotor capacity in different research and clinical settings. One of the most important parameters to measure is the gait speed during a path of ten meters. The data available in this dataset consists of accelerometer, magnetometer, and gyroscope data acquired with a mobile device in a waistband. The experiments were performed two times by 109 individuals (30 males and 79 females) in different senior residences in the Fundão municipality (Portugal). The dataset includes 208 samples because the sensors reported some failures. The acquisition of the sensors data allows the creation of a technological method for the automatic measurement of features related to the Ten Meter Walk Test, promoting patient independence in measuring their physical health status.

Mineralogical fingerprint and human health risk from potentially toxic elements of Fe mining tailings from the Fundão dam.

In 2015, >50 million cubic meters of Fe mining tailings were released into the Doce River basin from the Fundão dam, raising the question of its consequences on the affected ecosystems. This study aimed to establish a mineralogical-(geo)chemical association of potentially toxic elements (PTEs) from Fe mining tailings from the Fundão dam, collected seven days after the failure, through a multidisciplinary approach combining assessment of the risk to human health, environmental geochemistry, and mineralogy. Thus, eleven tailings samples were collected with the support of the Brazilian Military Police Fire Department. Granulometry, magnetic measurements, optical microscopy, X-ray diffraction, Fourier transform infrared spectroscopy, and sequential chemical extraction of PTEs analyses were performed. Contamination indexes, assessment of risk to human health, and Pearson correlation were calculated using the results of sequential chemical extraction of PTEs. The predominance of goethite in Fe oxyhydroxide concentrates from the mud indicates that the major source of hematite may not be from tailings, but from pre-existing soils and sediments, and/or preferential dissolution of hematite in deep flooded zones of the tailings column of the Fundão dam. Moreover, the high correlation of most carcinogenic PTEs with their crystallographic variables indicates that goethite is the primary source of contaminants. Goethites from Fe mining tailings showed high specific surface area and Al-substitution, and due to their greater stability and reactivity, the impacts on PTE sorption phenomena and bioavailability may be maintained for long periods. However, their lower dissolution rate, and the consequent release of heavy metals would promote greater resilience for affected ecosystems, preventing significant PTE inputs under periodic reduction conditions. More specific studies, involving the crystallographic characteristics of Fe oxyhydroxides should be developed since they may provide another critical component of this set of complex and dynamic variables that interfere with the bioavailability of metals in ecosystems.

Metabolic bone disorders and the promise of marine osteoactive compounds.

Metabolic bone disorders and associated fragility fractures are major causes of disability and mortality worldwide and place an important financial burden on the global health systems. These disorders result from an unbalance between bone anabolic and resorptive processes and are characterized by different pathophysiological mechanisms. Drugs are available to treat bone metabolic pathologies, but they are either poorly effective or associated with undesired side effects that limit their use. The molecular mechanism underlying the most common metabolic bone disorders, and the availability, efficacy, and limitations of therapeutic options currently available are discussed here. A source for the unmet need of novel drugs to treat metabolic bone disorders is marine organisms, which produce natural osteoactive compounds of high pharmaceutical potential. In this review, we have inventoried the marine osteoactive compounds (MOCs) currently identified and spotted the groups of marine organisms with potential for MOC production. Finally, we briefly examine the availability of in vivo screening and validation tools for the study of MOCs.

Beyond scores: A machine learning approach to comparing educational system effectiveness.

Studies comparing large-scale assessment data among educational systems have been an important tool for understanding the differences in how education is delivered worldwide. Many of these studies do not go beyond reporting average student scores in a particular educational system. A more unbiased analysis would avoid the simple use of gross performance and consider educational system contexts. A common approach is to estimate effectiveness by the residuals of parametric linear models. These models rely upon strong assumptions regarding the data-generating process, and are limited to handling extensive datasets. To address this issue, our paper provides a new approach based on machine learning models. The new approach is flexible, allows paired comparison, and is model-independent. An analysis conducted in Brazil verifies the suitability of the method to explore differences in effectiveness between Brazilian educational administrative units at the regional and state levels from 2009 to 2019. Our results are consistent with the existing literature, but the methodology produced a number of new findings that were not observed in studies using more traditional approaches.

A Novel Genetic Variant in MBD5 Associated with Severe Epilepsy and Intellectual Disability: Potential Implications on Neural Primary Cilia.

Disruptions in the MBD5 gene have been linked with an array of clinical features such as global developmental delay, intellectual disability, autistic-like symptoms, and seizures, through unclear mechanisms. MBD5 haploinsufficiency has been associated with the disruption of primary cilium-related processes during early cortical development, and this has been reported in many neurodevelopmental disorders. In this study, we describe the clinical history of a 12-year-old child harboring a novel MBD5 rare variant and presenting psychomotor delay and seizures. To investigate the impact of MBD5 haploinsufficiency on neural primary cilia, we established a novel patient-derived cell line and used CRISPR-Cas9 technology to create an isogenic control. The patient-derived neural progenitor cells revealed a decrease in the length of primary cilia and in the total number of ciliated cells. This study paves the way to understanding the impact of MBD5 haploinsufficiency in brain development through its potential impact on neural primary cilia.