Softmax parameterization of the occupation numbers for natural orbital functionals based on electron pairing approaches.

Within the framework of natural orbital functional theory, having a convenient representation of the occupation numbers and orbitals becomes critical for the computational performance of the calculations. Recognizing this, we propose an innovative parametrization of the occupation numbers that takes advantage of the electron-pairing approach used in Piris natural orbital functionals through the adoption of the softmax function, a pivotal component in modern deep-learning models. Our approach not only ensures adherence to the N-representability of the first-order reduced density matrix (1RDM) but also significantly enhances the computational efficiency of 1RDM functional theory calculations. The effectiveness of this alternative parameterization approach was assessed using the W4-17-MR molecular set, which demonstrated faster and more robust convergence compared to previous implementations.

Brazilian Guideline on Menopausal Cardiovascular Health ­ 2024 / Guía Brasileña de Salud Cardiovascular en el Climaterio y la Menopausia ­ 2024 / Diretriz Brasileira sobre a Saúde Cardiovascular no Climatério e na Menopausa ­ 2024

Women, who represent approximately half of the global population according to estimates as of January 2024, may experience signs and symptoms of menopause for at least one-third of their lives, during which they have a higher risk of cardiovascular morbidity and mortality. The effects of menopausal hormone therapy (MHT) on the progression of atherosclerosis and cardiovascular disease (CVD) events vary depending on the age at which MHT is initiated and the time since menopause until its initiation. Beneficial effects on CVD outcomes and all-cause mortality have been observed when MHT was initiated before the age of 60 or within 10 years after menopause. The decision regarding the initiation, dose, regimen, and duration of MHT should be made individually after discussing the benefits and risks with each patient. For primary prevention of postmenopausal chronic conditions, the combined use of estrogen and progestogen is not recommended in asymptomatic women, nor is the use of estrogen alone in hysterectomized women. Hormone-dependent neoplasms contraindicate MHT. For the treatment of genitourinary syndrome of menopause, vaginal estrogen therapy may be used in patients with known cardiovascular risk factors or established CVD. For women with contraindications to MHT or who refuse it, non-hormonal therapies with proven efficacy (antidepressants, gabapentin, and fezolinetant) may improve vasomotor symptoms. Compounded hormonal implants, or "bioidentical" and "compounded" hormones, and "hormone modulation" are not recommended due to lack of scientific evidence of their effectiveness and safety.

Mujeres, que representan aproximadamente la mitad de la población mundial según estimaciones de enero de 2024, pueden experimentar signos y síntomas de la menopausia durante al menos un tercio de sus vidas, durante los cuales tienen un mayor riesgo de morbilidad y mortalidad cardiovascular. Los efectos de la terapia hormonal de la menopausia (THM) en la progresión de la aterosclerosis y los eventos de enfermedad cardiovascular (ECV) varían según la edad en que se inicia la THM y el tiempo transcurrido desde la menopausia hasta su inicio. Se han observado efectos beneficiosos en los resultados de ECV y la mortalidad por todas las causas cuando la THM se inició antes de los 60 años o dentro de los 10 años posteriores a la menopausia. La decisión sobre la iniciación, dosis, régimen y duración de la THM debe tomarse individualmente después de discutir los beneficios y riesgos con cada paciente. Para la prevención primaria de condiciones crónicas en la posmenopausia, no se recomienda el uso combinado de estrógeno y progestágeno en mujeres asintomáticas, ni el uso de estrógeno solo en mujeres histerectomizadas. Las neoplasias dependientes de hormonas contraindican la THM. Para el tratamiento del síndrome genitourinario de la menopausia, se puede usar terapia estrogénica vaginal en pacientes con factores de riesgo cardiovascular conocidos o ECV establecida. Para mujeres con contraindicaciones a la THM o que la rechazan, las terapias no hormonales con eficacia demostrada (antidepresivos, gabapentina y fezolinetant) pueden mejorar los síntomas vasomotores. Los implantes hormonales compuestos, o hormonas "bioidénticas" y "compuestas", y la "modulación hormonal" no se recomiendan debido a la falta de evidencia científica sobre su efectividad y seguridad.

As mulheres, que representam cerca de metade da população mundial segundo estimativas de janeiro de 2024, podem sofrer com sinais e sintomas da menopausa durante pelo menos um terço de suas vidas, quando apresentam maiores risco e morbimortalidade cardiovasculares. Os efeitos da terapia hormonal da menopausa (THM) na progressão de eventos de aterosclerose e doença cardiovascular (DCV) variam de acordo com a idade em que a THM é iniciada e o tempo desde a menopausa até esse início. Efeitos benéficos nos resultados de DCV e na mortalidade por todas as causas ocorreram quando a THM foi iniciada antes dos 60 anos de idade ou nos 10 anos que se seguiram à menopausa. A decisão sobre o início, a dose, o regime e a duração da THM deve ser tomada individualmente após discussão sobre benefícios e riscos com cada paciente. Para a prevenção primária de condições crônicas na pós-menopausa, não se recomendam o uso combinado de estrogênio e progestagênio em mulheres assintomáticas nem o uso de estrogênio sozinho em mulheres histerectomizadas. Neoplasias hormônio-dependentes contraindicam a THM. Para tratamento da síndrome geniturinária da menopausa, pode-se utilizar terapia estrogênica por via vaginal em pacientes com fatores de risco cardiovascular conhecidos ou DCV estabelecida. Para mulheres com contraindicação à THM ou que a recusam, terapias não hormonais com eficácia comprovada (antidepressivos, gabapentina e fezolinetante) podem melhorar os sintomas vasomotores. Os implantes hormonais manipulados, ou hormônios "bioidênticos" "manipulados", e a 'modulação hormonal' não são recomendados pela falta de evidência científica de sua eficácia e segurança.

Excited States by Coupling Piris Natural Orbital Functionals with the Extended Random-Phase Approximation.

In this work, we explore the use of Piris natural orbital functionals (PNOFs) to calculate excited-state energies by coupling their reconstructed second-order reduced density matrix with the extended random-phase approximation (ERPA). We have named the general method PNOF-ERPA, and specific approaches are referred to as PNOF-ERPA0, PNOF-ERPA1, and PNOF-ERPA2, according to the way the excitation operator is built. The implementation has been tested in the first excited states of H2, HeH+, LiH, Li2, and N2 showing good results compared to the configuration interaction (CI) method. As expected, an increase in accuracy is observed on going from ERPA0 to ERPA1 and ERPA2. We also studied the effect of electron correlation included by PNOF5, PNOF7, and the recently proposed global NOF (GNOF) on the predicted excited states. PNOF5 appears to be good and may even provide better results in very small systems, but including more electron correlation becomes important as the system size increases, where GNOF achieves better results. Overall, the extension of PNOF to excited states has been successful, making it a promising method for further applications.

Lateral Extensional Mode Piezoelectric ZnO-on-Nickel RF MEMS Resonators for Back-End-of-Line Integration.

High motional resistance and incompatibility with post-CMOS fabrication due to thermal budget constraints are imperative issues associated with the back-end-of-line integration of lateral extensional vibrating micromechanical resonators. This paper presents piezoelectric ZnO-on-nickel resonators as a viable means for mitigating both of the issues. Lateral extensional mode resonators equipped with thin-film piezoelectric transducers can exhibit much lower motional impedances than their capacitive counterparts due to piezo-transducers' higher electromechanical coupling coefficients. Meanwhile, the employment of electroplated nickel as the structural material allows the process temperature to be kept lower than 300 °C, which is low enough for the post-CMOS resonator fabrication. In this work, various geometrical rectangular and square plates resonators are investigated. Moreover, parallel combination of several resonators into a mechanically coupled array was explored as a systematic approach to lower motional resistance from ~1 kΩs to 0.562 kΩs. Higher order modes were investigated for achieving higher resonance frequencies up to 1.57 GHz. Local annealing by Joule heating was also exploited for quality factor improvement after device fabrication by ~2× enhancement and breaking the record of MEMS electroplated nickel resonators in lowering insertion loss to ~10 dB.

Depression and Cardiovascular Disease in Women

Abstract The prevalence of depression varies from 1 to 17% in different geographic regions, and its incidence is 70% higher in women than men. Today, depression affects more than 300 million people worldwide, affecting twice as many women from adolescence to adulthood. In addition to this earlier onset, depression in women tends to be more severe. Cardiovascular disease and depression are chronic diseases that have a major impact on cardiovascular and all-cause morbidity and mortality, with evidence of a two-way relationship between them, in which depression is a predictor of cardiovascular disease and vice versa. In females, the degree of illness and prognosis are more severe when both diseases are present, than when diagnosed alone. In patients with acute or chronic cardiovascular disease, especially women, a systematic screening for depression should be considered as a preventive strategy of cardiovascular events, aiming to reduce the risk of future events. There are still no clinical studies designed to assess the impact of antidepressant treatment on cardiovascular outcomes in women.

Multisystem inflammatory syndrome in children: a cross-sectional study of cases and factors associated with deaths during the COVID-19 pandemic in Brazil, 2020. / Síndrome inflamatória multissistêmica pediátrica: estudo seccional dos casos e fatores associados aos óbitos durante a pandemia de COVID-19 no Brasil, 2020.

OBJECTIVE: To characterize the clinical-epidemiological profile of multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C), and to identify factors associated with MIS-C deaths in Brazil, 2020. METHODS: This was a cross-sectional study, using national MIS-C monitoring data. Logistical regression was performed to estimate crude and adjusted odds ratios (OR). RESULTS: Median case (n=652) age was 5 years, 57.1% were male, 52.0% were of brown race/skin color and 6.4% died. Likelihood of death was greater among those who presented O2 saturation <95% (ORa=4.35 - 95%CI 1.69;11.20) and altered urea results (ORa=5.18 - 95%CI 1.91;14.04); likelihood of death was lower when red skin blotches were not present (ORa=0.23 - 95%CI 0.09;0.62), when anticoagulants were used (ORa=0.32 - 95%CI 0.12;0.89) and when immunoglobulins were used (ORa=0.38 - 95%CI 0.15;1.01). CONCLUSION: Fatality ratios were higher among cases that presented O2 saturation <95% and altered urea results. Fatality ratios were lower among those with red skin blotches, and those who used immunoglobulins and anticoagulants.

Multisystem Inflammatory Syndrome in Children: sectional study of cases and factors associated with deaths during COVID-19 pandemic in Brazil, 2020 / Síndrome inflamatorio multisistémico pediátrico: estudio seccional de casos y factores asociados a las muertes durante la pandemia COVID-19 en Brasil, 2020 / Síndrome inflamatória multissistêmica pediátrica: estudo seccional dos casos e fatores associados aos óbitos durante a pandemia de COVID-19 no Brasil, 2020

Objective: To describe the clinical-epidemiological profile of Multisystem Inflammatory Syndrome in Children (MIS-C) cases and to identify factors associated with MIS-C deaths in Brazil, 2020. Methods: Cross-sectional study, based on MIS-C national monitoring database in Brazil, 2020. Simple and multiple logistic regression was performed to estimate crude and adjusted odds ratios (OR). Results: The median age of cases (n=652) was 5 years, 57.1% were male, 52.0% were brown race/color and 6.4% died. The odds of death was greater among those who presented O2 saturation <95% (ORa=4.35 ­ 95%CI 1.69;11.20) and altered result of urea (ORa=5.18 ­ 95%CI 1.91;14.04); lower in the absence of cutaneous lesion such as rash (ORa=0.23 ­ 95%CI 0.09;0.62), with the use of anticoagulants (ORa=0.32 ­ 95%CI 0.12;0.89) and of immunoglobulins (ORa=0.38 ­ 95%CI 0.15;1.01). Conclusion: Fatality rates was higher among cases that presented O2 saturation<95% and altered urea, and lower among those with cutaneous lesion, who used immunoglobulins and anticoagulants.

Objetivo: Caracterizar o perfil clínico-epidemiológico da síndrome inflamatória multissistêmica pediátrica temporalmente associada à COVID-19 (SIM-P) e identificar fatores associados aos óbitos de SIM-P no Brasil, 2020. Métodos: Estudo seccional, utilizando dados do monitoramento nacional da SIM-P. Empregou-se regressão logística para estimar razões de chances (ORs, odds ratios) brutas e ajustadas. Resultados: Os casos (n=652) apresentaram idade mediana de 5 anos; 57,1% eram do sexo masculino e 52,0% de raça/cor da pele parda; 6,4% evoluíram a óbito. A chance de óbito foi significativamente maior nos que apresentaram saturação de O2<95% (ORa=4,35 ­ IC95% 1,69;11,20) e resultado alterado de ureia (ORa=5,18 ­ IC95% 1,91;14,04); e menor na ausência de manchas vermelhas pelo corpo (ORa=0,23 ­ IC95% 0,09;0,62), com uso de anticoagulantes (ORa=0,32 ­ IC95% 0,12;0,89) e imunoglobulinas (ORa=0,38 ­ IC95% 0,15;1,01). Conclusão: A letalidade foi maior entre casos que apresentaram saturação de O2<95% e ureia alterada; e menor nos que apresentaram manchas vermelhas, usaram imunoglobulinas e anticoagulantes.

The REBECGA brazilian registry of pregnancy and heart disease: rationale and design

BACKGROUND: Maternal mortality rates in Brazil remain above the goals established by the United Nations Sustainable Development Goals. Heart disease is estimated to affect 4% of all pregnancies and remains by itself the main indirect obstetric cause of maternal death. In the last decades, a significant improvement in the prognosis of heart diseases has made pregnancy possible in women with heart disease and provided better maternal and fetal outcomes. OBJECTIVES: To establish a multicenter Brazilian Registry of pregnant women with heart disease; to study the causes of immediate and late maternal mortality; and to assess the prevalence of heart disease in the country's macro-regions. METHODS: This is an observational study, with retrospective and prospective stages, of the clinical and obstetric progression of pregnant women with heart disease. These women consecutively received care during pregnancy and will be followed up for up to a year after delivery at public and private hospitals with infrastructure for the execution of this project, a principal investigator, and approval by Ethics and Research Committees. RESULTS: Our results will be presented after data collection and statistical analysis, aiming to demonstrate immediate and late maternal mortality rates, as well as the prevalence of heart disease in the country and its cardiovascular and obstetric complications during pregnancy. CONCLUSIONS: REBECGA will be the Brazilian Registry of heart disease and pregnancy and it will contribute to planning preventive measures, raising financial resources for the improvement of high-risk prenatal care, and reducing immediate and late maternal mortality due to heart disease.

Pediatric multisystem SARS COV2 with versus without cardiac involvement: a multicenter study from Latin America.

Latin America (LATAM) children offer special insight into Severe Acute Respiratory Syndrome Coronavirus 2 (SARS COV2) due to high-risk race/ethnicity, variability in medical resources, diverse socioeconomic background, and numerous involved organ systems. This multinational study of LATAM youth examined the distinguishing features of acute or late multisystem SARS COV2 with versus without cardiac involvement. A consecutive sample of youth 0-18 years old (N = 98;50% male) presenting with multisystem SARS COV2 to 32 centers in 10 Latin American countries participating in a pediatric cardiac multi-imaging society were grouped as with versus without cardiac involvement, defined as abnormal echocardiographic findings or arrhythmia. Collected clinical data were analyzed by Student's t-test or Fisher's exact test. Cardiac (N = 48, 50% male) versus no cardiac (N = 50, 50% male) were similar in age; weight; nonrespiratory symptoms; and medical history. The cardiac group had 1 death and symptoms including coronary artery dilation, ejection fraction <50%, pericardial effusion, peripheral edema, arrhythmia, and pulmonary artery thrombus. The cardiac group had higher risk of ICU admission (77% vs 54%, p = 0.02); invasive ventilation (23% vs 4%,p = 0.007); vasoactive infusions (27% vs 4%, p = 0.002); prominent respiratory symptoms (60% vs 36%, p < 0.03); abnormal chest imaging (69% vs 34%, p = 0.001); troponin (33% vs 12%, p = 0.01); alanine aminotransferase (33% vs 12%, p = 0.02); and thrombocytopenia (46% vs 22%, p = 0.02). Receiver operating curve analysis showed that abnormal laboratories had 94% sensitivity and 98% negative predictive value on the need for ICU interventions.Conclusion: In LATAM children with multisystem SARS COV2, cardiac involvement was prevalent. Cardiac involvement was more likely to require ICU interventions, certain abnormal labs, and respiratory involvement. What is Known: • SARS COV2 can be asymptomatic in children but in some cases can have serious multisystemic involvement. • Hispanic ethnicity is purportedly at high risk of SARS COV2 in nations where they are often disadvantaged minority populations. What is New: • Latin American children presenting with multisystem SARS COV2 frequently have cardiac involvement which was associated with ICU interventions; prominent respiratory symptoms; abnormal chest X-ray; elevated troponin, ALT, and thrombocytopenia. • Elevated troponin, ALT or thrombocytopenia had high sensitivity and negative predictive value on the need for intensive care interventions.

Síndrome inflamatória multissistêmica pediátrica: estudo seccional dos casos e fatores associados aos óbitos durante a pandemia de COVID-19 no Brasil, 2020 / Multisystem inflammatory syndrome in children: a cross-sectional study of cases and factors associated with deaths during the COVID-19 pandemic in Brazil, 2020

Objetivo: Caracterizar o perfil clínico-epidemiológico da síndrome inflamatória multissistêmica pediátrica temporalmente associada à COVID-19 (SIM-P) e identificar fatores associados aos óbitos de SIM-P no Brasil, 2020. Métodos: Estudo seccional, utilizando dados do monitoramento nacional da SIM-P. Empregou-se regressão logística para estimar razões de chances (OR, odds ratios ) brutas e ajustadas. Resultados: Os casos (n=652) apresentaram mediana de idade de 5 anos; 57,1% eram do sexo masculino e 52,0% de raça/cor da pele parda; 6,4% evoluíram a óbito. A chance de óbito foi significativamente maior nos que apresentaram saturação de O2<95% (ORa=4,35 - IC95% 1,69;11,20) e resultado alterado de ureia (ORa=5,18 - IC95% 1,91;14,04); e menor na ausência de manchas vermelhas pelo corpo (ORa=0,23 - IC95% 0,09;0,62), com uso de anticoagulantes (ORa=0,32 - IC95% 0,12;0,89) e imunoglobulinas (ORa=0,38 - IC95% 0,15;1,01). Conclusão: A letalidade foi maior entre casos que apresentaram saturação de O2<95% e ureia alterada; e menor nos que apresentaram manchas vermelhas, usaram imunoglobulinas e anticoagulantes.

Objetivo: Caracterizar el perfil clínico-epidemiológico de los casos por síndrome inflamatorio multisistémico pediátrico asociado temporalmente a la COVID-19 (SIM-PedS) e identificar factores asociados a los óbitos por SIM-PedS en Brasil, 2020. Métodos: Estudio transversal basado en datos del monitoreo nacional de la SIM-PedS, Brasil, 2020. Se utilizó regresión logística para estimar razones de probabilidades brutas y ajustadas (OR, odds ratio). Resultados: Los casos (n=652) presentaron edad mediana de 5 años, 57,1% eran hombres, 52,0% de raza/color pardo y 6,4% falleció. La probabilidad de muerte fue significativamente mayor entre aquellos con saturación de O2<95% (ORa=4,35 - IC95%1,69;11,20) y resultado alterado de urea (ORa=5,18 - IC95% 1,91;14,04); menor en ausencia de manchas rojas como erupción (ORa=0,23 - IC95% 0,09;0,62), con uso de anticoagulantes (ORa=0,32 - IC95% 0,12;0,89) e inmunoglobulinas (ORa=0,38 - IC95%0,15;1,01). Conclusión: La letalidad fue mayor entre casos que presentaron saturación de O2<95% y urea alterada, y menor entre aquellos con manchas rojas, que usaron inmunoglobulinas y anticoagulantes.

Objective: To characterize the clinical-epidemiological profile of multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C), and to identify factors associated with MIS-C deaths in Brazil, 2020. Methods: This was a cross-sectional study, using national MIS-C monitoring data. Logistical regression was performed to estimate crude and adjusted odds ratios (OR). Results: Median case (n=652) age was 5 years, 57.1% were male, 52.0% were of brown race/skin color and 6.4% died. Likelihood of death was greater among those who presented O2 saturation <95% (ORa=4.35 - 95%CI 1.69;11.20) and altered urea results (ORa=5.18 - 95%CI 1.91;14.04); likelihood of death was lower when red skin blotches were not present (ORa=0.23 - 95%CI 0.09;0.62), when anticoagulants were used (ORa=0.32 - 95%CI 0.12;0.89) and when immunoglobulins were used (ORa=0.38 - 95%CI 0.15;1.01). Conclusion: Fatality ratios were higher among cases that presented O2 saturation <95% and altered urea results. Fatality ratios were lower among those with red skin blotches, and those who used immunoglobulins and anticoagulants.