Literatura académica sobre el tema "616.241 44"

AimsType IIIB open tibial fractures are devastating high-energy injuries. At initial debridement, the surgeon will often be faced with large bone fragments with tenuous, if any, soft-tissue attachments. Conventionally these are discarded to avoid infection. We aimed to determine if orthoplastic reconstruction using mechanically relevant devitalized bone (ORDB) was associated with an increased infection rate in type IIIB open tibial shaft fractures.Patient and MethodsThis was a consecutive cohort study of 113 patients, who had sustained type IIIB fractures of the tibia following blunt trauma, over a four-year period in a level 1 trauma centre. The median age was 44.3 years (interquartile range (IQR) 28.1 to 65.9) with a median follow-up of 1.7 years (IQR 1.2 to 2.1). There were 73 male patients and 40 female patients. The primary outcome measures were deep infection rate and number of operations. The secondary outcomes were nonunion and flap failure.ResultsIn all, 44 patients had ORDB as part of their reconstruction, with the remaining 69 not requiring it. Eight out of 113 patients (7.1%) developed a deep infection (ORDB 1/44, non-ORDB 7/69). The median number of operations was two. A total of 16/242 complication-related reoperations were undertaken (6.6%), with 2/16 (12.5%) occurring in the ORDB group.ConclusionIn the setting of an effective orthoplastic approach to type IIIB open diaphyseal tibial fractures, using mechanically relevant debrided devitalized bone fragments in the definitive reconstruction appears to be safe. Cite this article: Bone Joint J 2019;101-B:1002–1008.

In the given article, the flora of Ganja city and its surrounding areas was studied, the plants were systematically, biomorphologically, geographically, ecologically, and endemically analyzed. The article also analyzed rare and endangered plants on scientific basis. In the researched region, 68 families, 244 genera, and 441 species of plants were identified. It is reported that the basis of the flora composition of the territories is angiosperms, the leading families of which are Poaceae with 38 genera (15.6%), 63 species (14.3%), Fabaceae 23 genera (9.4%), 48 species (10.9%); Asteraceae is represented by 15 genera (6.6%), 35 species (7.9%). It was determined that the composition of the flora of the study area is dominated by perennial grasses with 194 species (44%).

Background: While sepsis may have especially marked impacts in young adults, there is limited population-based information on its epidemiology and trends. Methods: Population-based longitudinal study on sepsis in adults aged 20–44 years using the 2006–2015 Spanish national hospital discharge database. Cases are identified by an ICD-9-CM coding strategy. Primary endpoints are incidence and in-hospital mortality. Trends are assessed for annual percentage change (AAPC) in rates using Joinpoint regression models. Results: 28,351 cases are identified, representing 3.06‰ of all-cause hospitalisations and a crude incidence of 16.4 cases/100,000 population aged 20–44. The mean age is 36 years, 58% of cases are men, and around 60% have associated comorbidities. Seen in one third of cases, the source of infection is respiratory. Single organ dysfunction is recorded in 45% of cases. In-hospital mortality is 24% and associated with age, comorbidity and extent of organ dysfunction. Incidence rates increase over time in women (AAPC: 3.8% (95% CI: 2.1, 5.5)), whereas case-fatality decline with an overall AAPC of −5.9% (95% CI −6.6, −5.2). Our results indicate that sepsis is common in young adults and associated with high in-hospital mortality, though it shows a decreasing trend. The substantial increase in incidence rates in women needs further research.

Catatonia is a psychomotor abnormality caused by neurological, medical or severe psychiatric disorders and substances. Its prevalence ranges from less than 10% to just above 60%. Diagnosis may be influenced by the screening tools used. Screening of new admissions to a mental health unit for catatonia was undertaken using three instruments to determine prevalence of catatonia. Participants ranged from age 16 years and over. Recruitment took place from September 2020 to August 2021. The setting was a mental health unit within a general hospital in Nelson Mandela Metro, South Africa. Five assessors were trained by the principal investigator to apply the Bush Francis Screening Instrument (BFCSI), the Bush Francis Catatonia Rating Scale (BFCRS), and the Diagnostic and Statistical Manual 5 (DSM-5), to assess participants. Clinical and demographic data were collected using a specially designed datasheet. Data analysis was performed to identify significant associations between presence or absence of catatonia and clinical and demographic data. Up to 241 participants were screened and 44 (18.3%) had catatonia. All 44 cases were identified through the BFCSI while the DSM-5 identified only 16 (6.6%%) of the 44 cases even though the remaining 28 (63.6%) participants still required treatment for catatonic symptoms. The DSM-5 diagnostic criteria excluded staring, which was the commonest sign of catatonia identified through the BFCSI [n = 33 (75%)]. Close to half (21; 47.7%) of those with catatonia on the BFCSI had schizophrenia. The rest had bipolar disorder (12; 27.3%), substance-induced psychotic disorder (7; 15.9%) and no specified diagnosis in one (1; 2.6%). The BFCSI was very effective at identifying catatonia while the DSM-5 was inadequate, missing close to 64% (28 of 44) of cases. Predictors of catatonia in this sample were a younger age and being male. A prevalence of 18.3%, indicates that assessment for catatonia should be routinely conducted in this and similar settings.

The aim of the study was to evaluate the immediate results of treatment of high-risk PE developed against the background of COVID-19, and to analyze the features of the clinical course. Material and methods. The study is based on the experience of treatment applied to three patients with pulmonary embolism (PE) that developed against the background of COVID-19. The group under consideration is represented by males. The average age was 41 ± 3.1 years old. Verification of the primary diagnosis of COVID-19 was based on positive results of polymerase chain reaction, supplemented by the results of computed tomography. The formation of high-risk PE was noted on the 5th–7th day from the moment of hospitalization. There was also a decrease in SO2 below 85%, РаО2 — below 76 mm Hg, Borg index > 8, which required non-invasive high-flow ventilation. Catheterization of the right chambers of the heart with a Swan–Ganz catheter revealed an increase in systolic pressure in the right ventricle to 57 ± 1.2 mm Hg, and diastolic pressure to 13 ± 0.34 mm Hg. Pulmonary hypertension increased up to 70 mm Hg. Changes in the biochemical analysis of blood consisted in increasing the level of troponin I to 0.65 ± 0.14 ng/ml, С reactive protein — to 5.42 ± 2.1 mg/l, and creatine phosphokinase — to 324 ± 23.1 units. An increase in the D-dimer level was observed (0.68 ± 0.11 mg/l). Systemic thrombolysis actilyse was performed in all the cases. Results. Positive clinical dynamics was observed up to 15 hours after thrombolytic therapy. The level of SO2 came back to the initial values and was in the range 93–96% and RaO2 — from 86–92 mm Hg by the end of the first day after the intervention. The average pressure gradient in the pulmonary artery was 32 ± 4.12 mm Hg at the time of discharge, and at the peak — 44 ± 5.3 mm Hg.

A nonpathogenic isolate of Fusarium oxysporum, 618-12, added to soil prior to the pathogen, suppressed fusarium wilt (F. o. f.sp. dianthi race 2) in a susceptible cultivar of carnation by 80% compared with the treatment with the pathogen only. The possibility of systemically induced resistance by the nonpathogenic isolate was assessed by inoculating antagonist and pathogen at different locations (stem versus soil, soil versus stem, and in a split-root system). No significant disease suppression was found with any of these spatially separated inoculations. However, inoculation of antagonist and pathogen at the same location within the stem (i.e., mixed stem inoculation) resulted in significant and reproducible disease reductions compared with stem inoculation with the pathogen alone. This reduction was found for different inoculum densities and different cultivars. Several other nonpathogenic Fusarium isolates could also reduce wilt symptoms in the susceptible carnation cultivar after mixed stem inoculation with the pathogen. This disease-suppressive effect after mixed stem inoculations may be caused by locally induced resistance or competition between isolates within the stem. Plants showed vascular browning around the inoculation point following inoculation with nonpathogenic isolates. Disease suppression, as well as vascular browning, were absent when dead conidia of the isolate 618-12 were used. After its addition to soil, the isolate was recovered from 44–78% of carnation stems. Spread of the nonpathogenic isolate within the stem occurred only in the first 4 days after stem inoculation, and it remained confined to limited distances from the inoculation point between 4 and 59 days after inoculation. The pathogenic isolate could be isolated at increasingly greater distances from the inoculation point during this period. These data suggest that the nonpathogenic isolate is not actively spread through the plant by growth of the fungus. Keywords: biological control, competition, induced resistance, wilt.

5046 Background: In VISION, lutetium (177Lu) vipivotide tetraxetan ([177Lu]Lu-PSMA-617; 177Lu-PSMA-617) plus protocol-permitted standard of care (SoC) significantly improved overall survival and radiographic progression-free survival compared with SoC alone, in patients with prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer. In a VISION dosimetry sub-study, 177Lu-PSMA-617 had a good safety profile with low radiotoxicity in at-risk organs. Here, we estimated the dosimetry of tumors after administration of 177Lu-PSMA-617. Methods: The VISION sub-study was performed in a separate cohort of 29 non-randomized participants at four sites in Germany. Eligible patients received 177Lu-PSMA-617 (7.4 GBq every 6 weeks, ≤ 6 cycles) plus SoC. Patients underwent single-photon emission computed tomography/computed tomography (SPECT/CT) scans at approximately 2, 24, 48 and 168 hours after the first administration of 177Lu-PSMA-617 (Cycle 1). Up to five tumors in each patient were selected according to tumor size and relative activity uptake. Tumor delineation, volume and morphology were determined using positron emission tomography (PET)/CT images. Kinetic (time-activity) data was determined using SPECT images and the application of phantom derived recovery coefficients. Tumor dosimetry was estimated using the standard Medical Internal Radiation Dose/Radiation Dose Assessment Resource (MIRD/RADAR) method for internal dosimetry. S-values were determined using CT-derived tumor volumes and tissue type as input to the Internal Dose Assessed by Computer (IDAC-Dose) 2.1 program. Tumor dosimetry estimates were reported as absorbed dose per unit activity (Gy/GBq) and cumulative estimated absorbed dose (Gy) over all 6 cycles (44.4 GBq cumulative activity). Results: In total, 104 tumors were analyzed after administration of 177Lu-PSMA-617 in Cycle 1. Tumor sites included bone (n = 84), lymphatic tissue (n = 18), lung tissue (n = 1) and soft tissue (n = 1). Mean tumor mass by site was 14.6 (standard deviation [SD], 29.8; range, 0.49–224) g for bone and 12.5 (15.9; 0.68–60.7) g for lymphatic tissue. The mean radiation-absorbed dose for all tumors was 6.5 (SD, 8.4; range, 0.13–55) Gy/GBq, and the median absorbed dose was 4.4 Gy/GBq. The mean radiation-absorbed dose by tumor site was 5.4 (SD, 6.0; range, 0.13–45) Gy/GBq for bone and 9.7 (12; 0.99–55) Gy/GBq for lymphatic tissue. The 6-cycle cumulative estimated absorbed dose for all tumors was 287 (SD, 373; range, 5.7–2432) Gy. The 6-cycle cumulative estimated absorbed dose by tumor site was 240 (SD, 268; range, 5.7–2010) Gy for bone and 429 (549; 44–2432) Gy for lymphatic tissue. Conclusions: Tumor dosimetry estimates after administration of 177Lu-PSMA-617 in the VISION sub-study patient population were consistent with previously published estimates. Clinical trial information: NCT03511664 .

Objective.Around one-third of patients with juvenile idiopathic arthritis (JIA) fail to respond to first-line methotrexate (MTX) or anti-tumor necrosis factor (TNF) therapy, with even fewer achieving ≥ American College of Rheumatology Pediatric 70% criteria for response (ACRpedi70), though individual responses cannot yet be accurately predicted. Because change in serum S100-protein myeloid-related protein complex 8/14 (MRP8/14) is associated with therapeutic response, we tested granulocyte-specific S100-protein S100A12 as a potential biomarker for treatment response.Methods.S100A12 serum concentration was determined by ELISA in patients treated with MTX (n = 75) and anti-TNF (n = 88) at baseline and followup. Treatment response (≥ ACRpedi50 score), achievement of inactive disease, and improvement in Juvenile Arthritis Disease Activity Score (JADAS)-10 score were recorded.Results.Baseline S100A12 concentration was measured in patients treated with anti-TNF [etanercept n = 81, adalimumab n = 7; median 200, interquartile range (IQR) 133–440 ng/ml] and MTX (median 220, IQR 100–440 ng/ml). Of the patients in the anti-TNF therapy group, 74 (84%) were also receiving MTX. Responders to MTX (n = 57/75) and anti-TNF (n = 66/88) therapy had higher baseline S100A12 concentration compared to nonresponders: median 240 (IQR 125–615) ng/ml versus 150 (IQR 87–233) ng/ml, p = 0.021 for MTX, and median 308 (IQR 150–624) ng/ml versus 151 (IQR 83–201) ng/ml, p = 0.002, for anti-TNF therapy. Followup S100A12 could be measured in 44/75 MTX-treated patients (34/44 responders) and 39/88 anti-TNF-treated patients (26/39 responders). Responders had significantly reduced S100A12 concentration (MTX: p = 0.031, anti-TNF: p < 0.001) at followup versus baseline. Baseline serum S100A12 in both univariate and multivariate regression models for anti-TNF therapy and univariate analysis alone for MTX therapy was significantly associated with change in JADAS-10.Conclusion.Responders to MTX or anti-TNF treatment can be identified by higher pretreatment S100A12 serum concentration levels.

Abstract Background Reported β-lactam allergy (BLA) is very common, yet less than 10% of these patients exhibit true hypersensitivity. When faced with reported BLAs, physicians often choose alternative antibiotics which can be associated with C. difficile infection, drug-resistance development, poorer outcomes, & increased costs. Effective identification of these patients is necessary for subsequent, appropriate BLA “de-labeling.” Here, we conducted a single-center analysis of alternative antibiotic utilization amongst patients reporting BLA and compare the frequency of drug-resistant infections and C. difficile infection in allergic & non-allergic patients. Methods This is a retrospective review of adult patients hospitalized at The University of Texas Medical Branch from 1/1/2015 to 12/31/2019. Pooled electronic medical records were filtered by antibiotic orders and reported allergies to penicillins or cephalosporins. Patients with drug-resistant and/or C. difficile infection (CDI) were identified by ICD-10 codes. Microsoft Excel & MedCalc were used for statistical calculations. Results Data were available for 118,326 patients and 9.3% (11,982) reported a BLA, with the highest rates seen in those receiving aztreonam (85.9%, 530/617) & clindamycin (33.7%, 3949/11718). Amongst patients reporting BLA, high ratios-of-consumption (relative to all patients receiving antibiotics) were seen with aztreonam (7.0), clindamycin (2.7), cephalosporin/β-lactamase inhibitors (2.4), & daptomycin (2.1). Compared to the non-BLA population, BLA patients more frequently experienced MRSA infection (3.0% vs 1.5%, OR 1.99, 95% CI 1.79–2.23, p&lt; 0.0001), β-lactam resistance (1.2% vs 0.6%, OR 2.07, 95% CI 1.72–2.49, p&lt; 0.0001), and CDI (1.2% vs 0.7%, OR 1.85, 95% CI 1.54–2.23, p&lt; 0.0001). Conclusion Our measured BLA rate matches approximate expectations near 10%. Moreover, these patients experienced significantly higher frequencies of drug-resistant bacterial infections and CDI. Targeted inpatient penicillin allergy testing stands to be particularly effective in those patients receiving disproportionately utilized alternative agents (e.g. aztreonam, clindamycin, daptomycin). β-lactam allergy “de-labeling” in these patients is likely a valuable antimicrobial stewardship target. Disclosures All Authors: No reported disclosures

Several fragments of 4th-century BC Athenian decree-inscriptions are discussed. Joins are made betweenIGii2. 13a and 68 andHesperia, 40, no. 3;IGii2. 257 and 300; 242 and 373; 407 andSEG32. 94;IGii2. 309 and 552; 530 and 590. Attributed to the same stele, but not joining, areIGii2. 139 and 289; 277 and 428; 540a andSEG24. 117;IGii2. 540b andHesperia, 21, no. 17;IGii2. 286 and 625; 414a and 403; 398a (+ 438) and 612; 484 and 558; 489 and 532; 495 and 709; 405 andHesperia, 4, no. 32. Other decrees discussed, mainly in light of the work of A.S. Henry on the formulae of Athenian decrees, areIGii2. 44; 81; 121; 129; 147; 154; 155; 156; 285+ 414d; 321; 335; 364; 406; 416; 1001; andSEG21. 362 and 25. 85.

Abstract This chapter provides a checklist for the family Eulophidae. It provides information on species diversity, host records, distribution records by province in Iran, as well as world distribution. Comparison of the eulophid fauna of Iran with adjacent countries indicates that the faunas of Russia (666 species) and Turkey (246 species) are more diverse than Iran (236 species), followed by Turkmenistan (70 species), Kazakhstan (57 species), Pakistan (44 species), Azerbaijan (34 species), United Arab Emirates (31 species), Armenia (23 species), Iraq (10 species), Afghanistan and Saudi Arabia (both with eight species) and Oman (six species); no species have so far been reported from Bahrain, Kuwait or Qatar. The much larger number of eulophid species reported from Russia likely correlates with not only its large land area but also its history of taxonomic research on Eulophidae in the country. Russia shares 147 known species with Iran, followed by Turkey (133 species), Azerbaijan (22 species), Turkmenistan (21 species), Armenia and Pakistan (both with 20 species), United Arab Emirates (13 species), Iraq (10 species), Afghanistan (seven species), Saudi Arabia (four species) and Oman (two species).

Abstract This chapter provides a checklist for the family Eulophidae. It provides information on species diversity, host records, distribution records by province in Iran, as well as world distribution. Comparison of the eulophid fauna of Iran with adjacent countries indicates that the faunas of Russia (666 species) and Turkey (246 species) are more diverse than Iran (236 species), followed by Turkmenistan (70 species), Kazakhstan (57 species), Pakistan (44 species), Azerbaijan (34 species), United Arab Emirates (31 species), Armenia (23 species), Iraq (10 species), Afghanistan and Saudi Arabia (both with eight species) and Oman (six species); no species have so far been reported from Bahrain, Kuwait or Qatar. The much larger number of eulophid species reported from Russia likely correlates with not only its large land area but also its history of taxonomic research on Eulophidae in the country. Russia shares 147 known species with Iran, followed by Turkey (133 species), Azerbaijan (22 species), Turkmenistan (21 species), Armenia and Pakistan (both with 20 species), United Arab Emirates (13 species), Iraq (10 species), Afghanistan (seven species), Saudi Arabia (four species) and Oman (two species).

AbstractThis chapter explores what it means to study a bureaucracy at work. It outlines my methodological approach for analysing everyday practices in the SEM, the challenges I encountered during fieldwork as well as the methodological limits of this study. Building on Reckwitz’s (European Journal of Social Theory 5: 243–263, 2002) definition of practice, I argue that methodological triangulation and particularly participant observation—mostly in the form of following administrative caseworkers around in their daily work—are crucial for analysing both the discursive and non-discursive aspects of practices. Yet, at the same time, following Hitchings (Area 44: 61–67, 2012), I challenge the claim made by some authors that discursive methods are methodologically unfitting for researching practices from a practice theoretical perspective. Rather, I argue that people’s retrospective descriptions of past events, their explicit knowledge of rules and norms and particularly their capacity to reflect on why they do what they do provide us with valuable insights into everyday practice.

Abstract Russia is the fourth largest cigarette market in the world, and one of the fastest-growing. Russians consume about 300 billion cigarettes a year. According to official statistics in 1985 Russians consumed 240 billion cigarettes. The smoking rate in Russia was already quite high in mid-1980s, 46-48% among men and 3-12% among women (The principal investigators. The MONICA Project 1989). Since then smoking rates in men increased by about 10-15% and the rates in women have at least doubled. In the survey carried out in Karelia in 1992 (Puska et al. 1993), highest smoking rates were recorded among people aged 25-34 years, 77% and 20% in men and women, respectively. Proportion of smokers among men aged 35-44 and 45-54 was 61% and 68% respectively. In women, in these age groups smoking rates were lower, 13% and 3%, respectively. Lowest rates were observed in those aged 55-64 years, 57% in men and 3% in women (Table 12.1).

A Anemia Falciforme (AF) é uma doença genética autossômica recessiva, causada por uma mutação no gene que codifica o polipeptídeo β-globina. Com isso, indivíduos que possuem duas cópias desse alelo mutante apresentam hemácias em forma de foice, o que dificulta o transporte de oxigênio1 . A AF é a doença monogênica mais comum no Brasil e o seu tratamento é complexo. O transplante de células-tronco hematopoéticas é o único recurso terapêutico para a AF, mas apenas 25% dos casos apresentam doadores compatíveis. Além disso, a maioria dos métodos que tratam os sintomas da doença podem causar diversos efeitos colaterais aos indivíduos afetados2 . Diante disso, este trabalho buscou realizar um levantamento das tecnologias desenvolvidas para tratar a Anemia Falciforme. Uma prospecção tecnológica dos pedidos de patentes foi realizada na base de dados nacional do Instituto Nacional da Propriedade Intelectual (INPI), e nos bancos de dados do European Patent Office (EPO) e da World Intellectual Property Organization (WIPO). Os termos usados na busca foram “Anemia Falciforme” (Sickle Cell Anemia) e “Tratamento AND Anemia Falciforme” (Sickle Cell Anemia AND Treatment). Foram encontrados 696 pedidos de patentes com a palavra-chave Anemia Falciforme, dessas, apenas 45,11% (314) dos documentos foram encontradas com o termo Anemia Falciforme AND Tratamento. Tal resultado indica que a maioria das patentes registradas não estão relacionadas com essa temática. O WIPO foi a base de dados em que foi localizada a maior quantidade de documentos, e o INPI foi a base em que foi encontrada a menor quantidade. Os documentos encontrados com “Sickle Cell Anemia AND Treatment” no WIPO foram analisados quanto ao país depositante, ano de depósito e conforme a Classificação Internacional de Patentes (CIP). Foi observado que os Estados Unidos da América detém a maior quantidade de pedidos, com um total de 87 documentos, enquanto países como a Tailândia, Costa Rica e Israel possuem apenas 1 pedido de patente. Os EUA 33 investem muito em pesquisa científica, sendo o segundo país que mais investe em inovação3 . Tal fato pode explicar a maior quantidade de pedidos de patentes que o país possui. Dois mil e dezenove foi o ano que teve o maior número de pedidos de patente, com 24 documentos depositados, o que pode ser fruto dos avanços recentes nessa área e, também, por ser um campo de pesquisa ativo2 . Dos 302 documentos encontrados, 242 estão classificados na categoria A61K na CIP. Essa ocorrência pode ser explicada por tal categoria abranger medicamentos e substâncias capazes de prevenir, aliviar, tratar ou curar condições patológicas ou anormais do corpo vivo. Mediante isso, nota-se que pesquisas relacionadas ao tratamento de AF vem apresentando maior investimento em inovação nos últimos anos. No entanto, o governo brasileiro deveria aplicar mais recursos em pesquisas que possam contribuir com novas alternativas de tratamento para a AF.

We studied the fiber flax varieties bred in the Tomsk region in 2017–2019 in the subtaiga zone of the Omsk region on the experimental field of the Northern Agriculture Department of the Omsk Agricultural Scientific Center. We provide the material for 7 varieties. The soil of the experimental plot is gray wooded podzolic, medium, loamy with a humus content of 3–4 %. The predecessor is spring wheat after fallow. The research results showed that the weather conditions significantly affected the growth, development, and formation of the yield. In 2017, cold and wet weather generally affected the yield and quality of fiber flax in comparison to 2018-2019. As a result of the research, we established that for 3 years the best varieties were TOST 5 and Tomich. The variety TOST 5 gave a straw yield of 4.70 t/ha with number 1.9, an estimated fiber yield of 1.31 t/ha and a seed yield of 0.80 t/ha with the growth season of 61 days. The variety Tomich was characterized by the high quality of straw with number 2.1 with a short growth season (48 days), it had a straw yield of 4.0t/ha, a fiber yield of 1.18 t/ha and a seed yield of 0.70 t/ha. Therefore, the combination of varieties of different ripening duration will optimize the harvesting timing, raise the flax straw, and get a high yield of quality products.

This paper analyzes the inventory management system of spare parts for Locomotive Depot-Sofia. Considering the large inventory park of the depot, mainly the repair works related to the electric locomotives, series 44, 45, 61, as well as diesel-hydraulic locomotives, series 52 and 55 were considered. The periodicity of planned inspections and repairs is determined on the basis of traveled kilometers or working days. Exploitational inspections are provided for in the locomotive turnover schedule. In order to make an optimal delivery of spare parts in Locomotive Depot-Sofia, it is necessary to carry out analyzes and choose a system for managing the inventory. The decrease in the average availability of spare parts is related to an increase in the number of deliveries during the year, respectively a decrease in the quantity in one delivery. The higher the number of deliveries during the year, the higher the costs of deliveries. Inventory management is related to determining the optimal quantity in one delivery, as well as the optimal number of orders that will balance both types of costs and minimize them without affecting the continuous production.

Objetivos Describir la población observada en una consulta de salud mental en una organización no gubernamental (ONG) que apoya a personas con trastornos por uso de sustancias en Lisboa, Portugal, y analizar la patología dual existente. Material y métodos Se realizó un estudio observacional retrospectivo de todos los pacientes observados en un período de 18 meses desde la creación de la consulta de salud mental. Toda la información recopilada se extrajo de forma anónima y se destruyó después del procesamiento. Resultados y conclusiones En los 18 meses desde la creación de la consulta de salud mental se observaron 76 pacientes, 66% hombres. La mayoría tenía entre 35 y 44 años (el promedio era de 41 años) y el 74% tenía nacionalidad portuguesa. El 29% de los pacientes eran indigentes u ocupaban casas abandonadas. Una parte de la población presentaba únicamente enfermedad mental o trastorno por adicción, pero la mayoría (66%) presentaba patología dual. Las patologías más frecuentes como diagnóstico primario fueron los Trastornos mentales y del comportamiento derivados del consumo de sustancias psicoactivas (37 %), en su mayoría por plurisustancias, y los Trastornos afectivos (37 %), seguidos de la Esquizofrenia, el trastorno esquizotípico y delirante ( 13%). La tasa de trastorno por uso de sustancias fue la siguiente: alcohol 49%; benzodiazepinas 24%; cannabinoides 50%; cocaína 43%; heroína 37%. El 21% de los pacientes están en un Programa de Mantenimiento con Metadona. También se comprueba que el 59% de los pacientes tienen patología médica importante (principalmente infecciosa o neurológica). Cada vez más, se hace imperativo reconocer los trastornos de adicción como fuente y consecuencia de la enfermedad mental, en un ciclo que se perpetúa y requiere un abordaje conjunto, fundamental para brindar la mejor atención en salud mental a quienes padecen patología dual.

OBJETIVOS Analizar los reingresos durante un período de doce meses siguientes al alta hospitalaria (motivo y tiempo hasta el evento) de pacientes con trastorno psicótico, en tratamiento con palmitato de paliperidona mensual, valorando el rol de consumo de tóxicos. MATERIAL Y MÉTODOS Se estudian los motivos más frecuentes y tiempo hasta el reingreso, durante un período de doce meses, en un grupo de pacientes ingresado en una unidad de psiquiatría. RESULTADOS Y CONCLUSIONES Se reclutaron 301 pacientes, con una media de edad de 44.6 años. 176 pacientes (58.5%) eran hombres (con una media de edad de 39.6) y 125 (41.5%) eran mujeres (con una media de edad de 51.6 años). Todos diagnosticados dentro del espectro de la psicosis: esquizofrenia (166, 55.1%), psicosis no especificada (61, 20.3 %), trastorno de ideas delirantes (44, 14.6%) y trastorno esquizoafectivo (30, 10%). A todos los pacientes se les administró palmitato de paliperidona de liberación prolongada durante el ingreso. Un 27.6% de los pacientes presentaban criterios de dependencia a diversas sustancias (17.6% a cannabis, 8% a alcohol, 1.7% a cocaína y un 0.3% a opiáceos). Un total de 69 (23.2%) pacientes precisaron reingreso durante el año siguiente al alta hospitalaria. El consumo de tóxicos tras el alta fue el tercer motivo más frecuente de reingreso (3.7%). El tiempo hasta el reingreso, debido al consumo de tóxicos, fue de 24.1 días; comparado al abandono de tratamiento (142.9 días); y los pacientes que presentan recaída a pesar de realizar correctamente el tratamiento con palmitato de paliperidona mensual, que es de 73.9 días. En conclusión, el consumo de tóxicos es una de las principales causas de reingreso en pacientes con diagnóstico del espectro de la psicosis, que se asocia además con una recaída temprana de estas patologías.

Objetivo: O papilomavírus humano (HPV) é um vírus da família Papilomaridae, vírus de DNA de fita dupla com grande afinidade por pele e mucosas. A infecção pelo HPV é considerada uma infecção sexualmente transmissível (IST), podendo levar anos para seu aparecimento depois da infecção pelo vírus. Geralmente, ocorre o aparecimento de verrugas papilomatosas na região genital, sendo possível, também, o surgimento de câncer de colo do útero. Existem mais de 200 tipos de HPV identificados, e eles são classificados em alto e baixo risco. O objetivo deste estudo foi analisar a incidência de casos positivos de HPV obtidos por um laboratório particular em São Paulo, no ano de 2022. Método: Foram analisadas 2.680 amostras, de mulheres na faixa etária adulta, com idade entre 20 e 59 anos de idade. O método utilizado foi a PCR, seguida de hibridização reversa (Dot-Blot), com sondas específicas de DNA imobilizadas em chip composto por membrana de nylon – flow chip, que identifica 35 genótipos HPV específicos, de alto e baixo risco oncogênico, além de pesquisar, através de uma sonda universal, a presença de algum outro genótipo HPV não identificado especificadamente. Conclusão: Dentre os 2.680 exames, a maior incidência dos 35 genótipos de HPV pesquisados foi a presença de 1.330 casos positivos para sonda de HPV universal. HPVs de alto risco oncogênico: 165 casos para genótipo 52; 156 para genótipo 68; 149 para o genótipo 56; 143 para genótipo 16; e 104 para genótipo 31. Os de baixo risco oncogênico: 246 casos para genótipos 62 e 81; 192 para genótipo 44 e 55; 148 para genótipo 61; e 139 casos para genótipo 06. O painel molecular de genotipagem HPV demonstra a importância da identificação do genótipo específico do HPV, uma vez que isso auxilia o médico no acompanhamento da persistência específica em relação ao prognóstico da paciente. O exame permite a identificação de região consenso para o vírus do HPV, possibilitando a identificação de outro tipo presente na amostra, além do painel pesquisado.

Introdução: Segundo a OMS temos cerca de 6 milhões de indivíduos infectados pelo parasito Trypanosoma cruzi no mundo. O mecanismo de transmissão vetorial continua sendo de grande importância na epidemiologia da doença, sendo, portanto, o alvo dos programas de controle. No Brasil observou-se uma notável diminuição de novos casos da infecção após a implementação das campanhas de controle vetorial. Objetivo: Avaliar a vigilância entomológica da DCh nos municípios da jurisdição da Superintendência Regional de Saúde de Governador Valadares (SRS/GV) nos anos de 2014 a 2019. Métodos: A área estudada corresponde a 51 municípios da mesorregião do Vale do Rio Doce, no Leste de Minas Gerais. Os dados foram disponibilizados pelo laboratório de referência em entomologia da SRS/GV. Os insetos capturados pelos moradores e enviados foram avaliados quanto ao hábito alimentar, estádio evolutivo, local de captura, espécie do triatomíneo e presença ou ausência de infecção pelo T. cruzi. Resultados: Foram encaminhados à SRS/GV 1.704 insetos, sendo 1.491 hematófagos, 107 fitófagos e 99 predadores. Avaliando os insetos hematófagos quanto ao estádio evolutivo constatou-se que 1.425 (95,6%) eram adultos e 66 (4,4%) eram ninfas, sendo a maioria capturados no intradomicílio (1.083/1.491). Foram examinados 1.225 insetos, sendo constatado a infecção pelo T. cruzi em 514 exemplares, revelando assim uma taxa de infecção natural de 42%. Dentre os insetos infectados, 407 (79,5%) exemplares foram capturados no intradomicílio, 96 (18,5%) no peridomicílio e 11 (2%) em locais não identificados. As seguintes espécies de triatomíneos foram identificadas na região: Triatoma vitticeps (936), Panstrongylus megistus (284), Panstrongylus diasi (244), Rhodnius neglectus (11) e Panstrongylus geniculatus (1). Foi constatado a presença de triatomíneos infectados em 46 municípios, com destaque para Conselheiro Pena (64), Tarumirim (48), Sobrália (46), Capitão Andrade (44), Itanhomi (36) e José Raydan (30). Conclusão: Os dados nos permitem afirmar que T. vitticeps é a espécie predominante na região, sendo capturados frequentemente insetos adultos no intradomicílio e com consideráveis taxas de infecção natural pelo T. cruzi. Vale ressaltar ainda o encontro de ninfas no intradomicílio que caracteriza um processo de colonização e reforça a necessidade de aprimoramento das ações de vigilância entomológica na região atendida pela SRS/GV.

Abstract. Introduction. The organization of medical care for employees of remote industrial enterprises (remote healthcare) is an extremely important task and an urgent problem in the healthcare system as a whole. The correct organization and evidence-based approaches in the remote healthcare system will save the labor force, which forms the basis of the economic development of any country. Purpose: to evaluate the system of organizing medical care for employees of remote industrial facilities based on the analysis of the results of periodic medical examinations and medical evacuations. Research methods. The analysis of the results of periodic medical examination of a large mining enterprise in the period 2018-2021 was carried out. , and also analyzed the results of medical evacuations from industrial facilities in the period 2018-2020. (154 objects from 14 regions of the country). Taking into account the fact that the bulk of workers in remote industrial facilities are men employed in the main profile of the enterprise, women were excluded from the analysis. Results. According to the results of medical examinations, 18.6% were recognized as completely healthy in 2018, 6.6% in 2019, and 12.6% of workers in remote industrial facilities in 2021. The rest had one or another pathology. The structure of workers' diseases revealed during medical examinations was analyzed in accordance with ICD-10. In the structure of the morbidity of workers at remote industrial facilities, the first three places in descending order of rank are occupied by diseases of the digestive system, diseases of the eyes and adnexa, diseases of the nervous system (in 2018 -38.2%, 35.3%, 22%; in 2019 - 53.1%, 45.3%, 19.5%; in 2021 - 44%, 34.1% 15.8%, respectively). In addition, in 2021, the prevalence of risk factors in men and women was analyzed, the contribution of each of the factors was revealed (physical - 26.5%, smoking - 26%, alcohol - 11.1%). The number of medical evacuations was: 2,390 planned (61.5%) and 1,493 emergency (38.4%). In the structure of all evacuations of personnel of remote industrial facilities, BSK was in the lead, followed by injuries and poisoning, diseases of the digestive system and diseases of the respiratory system. The main reason for emergency evacuations was injuries and poisoning, 2nd and 3rd places were taken by BSK and diseases of the digestive system, respectively. In the group of workers under 39 years of age, the first three positions were occupied by injuries and poisoning, diseases of the digestive system and BSC, and in the group of older age intervals, BSC significantly prevailed, the second place was taken by injuries and poisoning, and the third - diseases of the digestive system. Conclusion. The results of the study and data analysis made it possible to identify the key components (human, informational, financial, educational, material resources) of remote health care and confirmed the importance and necessity of developing a unified concept of maintaining the health of personnel at industrial facilities located in hard-to-reach areas.

The War in the Pacific National Historical Park (WAPA), a protected area managed by the National Park Service (NPS), was established "to commemorate the bravery and sacrifice of those participating in the campaigns of the Pacific Theater of World War II and to conserve and interpret outstanding natural, scenic, and historic values on the island of Guam." Coral reef systems present in the park represent a vital element of Guam?s cultural, traditional, and economical heritage, and as such, are precious and in need of conservation. To facilitate the management of these resources, NPS determined that a scleractinian (stony coral) species survey was necessary to establish a baseline for existing coral communities and other important factors for conservation. EnviroScience, Inc. performed a survey of stony coral species, coral habitat, and current evidence of stressors at WAPA?s H?gat and Asan Units in 2022. This report summarizes these findings from a management perspective and compares its findings to previous survey data from 1977 and 1999 (Eldridge et al. 1977; Amesbury et al. 1999). WAPA is located on the tropical island of Guam, located on the west-central coast of the island, and encompasses 2,037 acres. Underwater resources are a significant component of the park, as 1,002 acres consists of water acres. The park is comprised of seven units, of which two of these, the H?gat and Asan Beach Units, include all the oceanic water acres for the park. The H?gat Beach Unit (local spelling, formerly known as ?Agat?) is located at the south-west portion of the park and consists of 38 land acres and 557 water acres (NPS 2003). The Asan Beach Unit consists of 109 acres of land and 445 water acres (NPS 2003). A current baseline for existing coral communities and other important factors for conservation necessitates the need for up-to-date data on the location, presence, relative abundance, and present health of corals. Park managers need this updated data to determine where and how to best focus conservation priorities and identify restoration opportunities. Management actions in park reef areas informed by this inventory included identifying locations where there were: high rates of sedimentation; high coral biomass; rare or threatened species, with a priority given to species endemic to Guam and listed as ?threatened? under the U.S. Endangered Species Act (ESA; Acropora globiceps, A. retusa, A. speciosa, and Seriatopora aculeata); coral persistence and decline, disease and/or nuisance species, including the crown-of-thorns starfish (Acanthaster cf. solaris, ?COTS?) and the sponge Terpios hoshinota; and bleached areas. All work carried out was in accordance with the NPS statement of work (SOW) requirements, which involved a quantitative inventory using both new and pre-existing transects. The resulting transects totaled 61 (including the four from the 1999 study), each measuring 50 meters in length and distributed across depths of up to 50 feet. Divers took photo-quadrat samples covering an area of approximately 9 m?, encompassing 50 photo-quadrats of dimensions 0.50 m x 0.36 m (n=50). The collective area surveyed across all 61 transects amounted to ~549 m?. Additionally, a qualitative search was conducted to enhance documentation of coral species that have limited distribution and might not be captured by transects, along with identifying harmful species and stressors. Timed roving diver coral diversity surveys were carried out at a total of 20 sites occurring within the waters of WAPA, including eight sites at the H?gat unit and 12 sites at the Asan unit. The findings from this report reveal significant disparities in benthic cover compositions between H?gat and Asan units. The H?gat unit exhibits high abundances of turf algae and unconsolidated sediment while the Asan beach unit presents a different scenario, with hard coral as the dominant benthic cover, followed closely by crustose coralline algae (CCA). The Asan unit is also more difficult to access from shore or boat relative to H?gat which provides that unit some protection from human influences. The Asan beach unit's prevalence of hard coral, CCA, and colonizable substrate suggests a more favorable environment for reef growth and the potential benefits of maintaining robust coral cover in the area. These distinct differences in benthic communities highlight the contrasting ecological dynamics and habitats of the two study areas. Across both H?gat and Asan beach unit transects, a total of 56 hard coral species were recorded from 27 genera, with 44 species recorded from the H?gat unit and 48 species recorded from the Asan unit. Of the four historical transects surveyed in the Asan unit from 1999, three experienced declines in percent coral cover (17.38-78.72%), while the fourth had an increase (10.98%). During the timed roving diver coral diversity surveys, a total of 245 hard coral species, including 241 scleractinian coral species representing 49 genera and 4 non-scleractinian coral species representing 4 genera were recorded. Uncertainties related to coral identification, unresolved boundaries between morphospecies, differences in taxonomists' perspectives, and the rapidly evolving state of coral taxonomy have significant implications for species determinations during coral diversity surveys. While the recent surveys have provided valuable insights into coral diversity in WAPA waters, ongoing taxonomic research and collaboration among experts will be essential to obtain a more comprehensive and accurate understanding of coral biodiversity in the region. Of the several ESA coral species that were searched for among the H?gat and Asan beach units, Acropora retusa was the only coral species found among quantitative transects (n=2) and A. globiceps was observed during coral diversity surveys. Acropora speciosa, which was dominant in the upper seaward slopes in 1977, is now conspicuously absent from all the surveys conducted in 2022 (Eldredge et al., 1977). The disappearance and reduction of these once-dominant species underscores the urgency of implementing conservation measures to safeguard the delicate balance of Guam's coral reefs and preserve the diversity and ecological integrity of these invaluable marine ecosystems. Other formerly common or locally abundant species were infrequently encountered during the diversity surveys, including Acropora monticulosa, A. sp. ?obtusicaulis?, A. palmerae, Stylophora sp. ?mordax?, Montipora sp. ?pagoensis?, and Millepora dichotoma. Significant bleaching-associated mortality was recorded for these species, most of which are restricted to reef front/margin zones exposed to moderate-to-high levels of wave energy. Sedimentation was present in both H?gat and the Asan units, though it was more commonly encountered in H?gat transects. While significant portions of the reef area within the WAPA H?gat unit are in poor condition due to a variety of stressors, some areas still hosted notable coral communities, which should be a potential focus for park management to prevent further degradation. There is a need for more effective management of point source pollution concerns, particularly when subpar wastewater treatment or runoff from areas with potential pollution or sediment-laden water is flowing from nearby terrestrial environments. Future monitoring efforts should aim to establish a framework that facilitates a deeper understanding of potential point source pollution incidents. This would empower park managers to collaborate with adjacent communities, both within and outside of park boundaries, to mitigate the localized impacts of pollution (McCutcheon and McKenna, 2021). COTS were encountered during transect surveys as well as in coral diversity surveys. including along the upper reef front/reef margin at site Agat-CS-2. The frequency of these observations, particularly in the WAPA H?gat unit and where stress-susceptible corals are already uncommonly encountered, raise concern about the ability of the populations of these coral species to recover following acute disturbance events, and calls in to question the ability of some of these species to persist in WAPA waters, and in Guam?s waters more broadly. More frequent crown-of-thorns control efforts, even if only a handful of sea stars are removed during a single effort, may be required to prevent further loss to vulnerable species. There were several documented incidents of Terpios hoshinota covering large sections of branching coral in the reef flat along transects, but it is still unclear how detrimental this sponge is to the overall reef system. There is a concern that elevated levels of organic matter and nutrients in the water, such as those resulting from sewage discharge or stormwater runoff, could lead to increased Terpios populations (De Voogd et al. 2013). Consequently, it is important to track populations in known areas of sedimentation and poor water quality. The presence of unique species at single survey sites within the study areas underscores the ecological importance of certain locations. Some species are known to occur in other locations in Guam, while a few may be limited to specific sites within WAPA waters. These differences are likely influenced by environmental and biological factors such as poor water quality, severe heat stress events, chronic predation by crown-of-thorns sea stars, disease, and reduced herbivore populations. These factors collectively shape the condition of the benthic community, leading to variations in species distribution and abundance across the study sites. Documenting coral stress and identifying potentially harmful species allows for proactive management strategies to prevent the establishment of nuisance or detrimental species while populations are still manageable. Updated data on the location, presence, relative abundance, and health of corals is essential for park managers to prioritize conservation efforts and identify restoration opportunities effectively. Observations from this report raise concerns about the health and resilience of coral ecosystems in the H?gat unit and emphasize the need for knowledge of local factors that shape benthic community structure. Understanding the drivers responsible for these variations is crucial for effective conservation and management strategies to preserve the ecological balance and overall health of coral reefs in both units. Continued monitoring efforts will be critical in assessing long-term trends and changes in benthic cover and enabling adaptive management approaches to safeguard these valuable marine ecosystems in the face of ongoing environmental challenges.

The survey presented in this report reveals that Nordic citizens are concerned about climate change. Many people are willing to increase efforts to fight climate change, even if this entails a personal contribution in terms of higher taxes or behavioural change. The survey shows that different social groups perceive the impacts of climate change and climate mitigation policies in different ways. In general, attitudes towards climate policies and perceptions regarding their fairness are conditioned by socio-demographic factors such as gender, age, employment status, type of housing and transport behaviour. General attitudes towards climate change and climate policies The first part of this report explores general attitudes towards climate change and climate policies. This section shows that seven in ten (71%) respondents think that climate change is a serious or very serious problem, particularly among the youngest age group (18-29 years). Three in four (74%) interviewed persons in this group share this view. Those with a university degree are more concerned about climate change (83%) than those with primary or secondary education (57% and 62%, respectively). Approximately half (48-51%) of respondents in all age groups agree that more financial resources should be invested in preventing climate change, even if this would imply an increase in taxes. The survey results show that women in the Nordic Region are more concerned about climate change than men (79% compared to 64%). It also reveals that people living in urban areas are more worried about climate change (82%) than those who live in towns and suburbs (68%) or in rural areas (62%). Urban dwellers are also more positive about investing more resources in preventing climate change (59%) than those who live in rural areas (39%) and in towns and suburbs (46%). More than half of the respondents (52%) agree that taking further action on climate change would be beneficial for the economy. Students, unemployed and retired people are more likely to agree with this view (55%, 57% and 55%, respectively) than those currently in employment, including the self-employed (50%). Those employed in carbon-intensive sectors are less positive about the expected economic impact of climate policies than those who work in other economic sectors (41% compared to 55%). They are also more concerned about the risk of job losses during the transition to a low-carbon economy than those employed in sectors with lower carbon intensity (37% compared to 24%). Concerns about this issue are also higher among those who live in rural areas (31%) or towns and suburbs (30%) compared to those who live in cities (22%). Present and future effects of climate change mitigation policies on individuals and households The central part of the survey explores perceptions regarding the present and future impacts of climate policies. Such challenges are perceived differently depending on specific sociodemographic conditions. Nearly one fourth (23%) of respondents state that high energy costs mean they are struggling to keep their homes at a comfortable temperature. Those living in houses report being more impacted (27%) than those living in apartments (18%), and those using fossil fuels to heat their homes are most affected (44%). The risk of energy poverty is also higher among non-EU immigrants to the Nordic Region. Those who say they are struggling to keep their homes at a comfortable temperature range from 23% among Nordic-born citizens to 37% among non-EU immigrants. Nearly three in ten respondents (28%) have modified their transportation behaviour during the last year due to high fuel costs. This proportion is substantially greater among those living in towns and suburbs (32%) compared to those who live in rural areas (29%) or cities (23%). The majority of the Nordic population (52%) states that current climate policies have a neutral effect on their household economies. However, 28% of respondents say they are negatively impacted by climate policies in economic terms. Men report being negatively affected more frequently than women (33% vs 22%, respectively). People who live in houses are more likely to claim they are being negatively impacted than people who live in apartments (31% and 23%, respectively). Nearly half (45%) of the respondents in the Nordic Region agree that climate initiatives will improve health and well-being, and half of the respondents (50%) think that climate change initiatives will lead to more sustainable lifestyles in their area. However, half (51%) of the Nordic population expect to see increases in prices and the cost of living as a consequence of climate policies, and those who believe that climate policies will create jobs and improve working conditions in the areas where they live (31% and 24%, respectively) are outnumbered by those who believe the opposite (35% and 34%, respectively). Fairness of climate policies The last section of the report looks at how the Nordic people perceive the fairness of climate policies in distributional terms. In the survey, the respondents were asked to judge to what extent they agree or disagree that everyone in their country or territory is equally affected by initiatives to fight climate change regardless of personal earnings, gender, age, country of origin and where they live – cities or rural areas. The results show that the Nordic people believe climate change initiatives affect citizens in different ways depending on their demographic, socioeconomic and territorial backgrounds. More than half of the respondents (56%) disagree that everyone is equally affected by initiatives to fight climate change regardless of earnings. Only 22% agree with this statement. Younger age groups are more pessimistic than older age groups on this point (66% in the 18-29 age group compared to 41% in the 65+ group). Almost half of respondents (48%) agree that climate policies are fair from a gender perspective, while 25% disagree with this statement and 23% are neutral. Roughly one in three (30%) respondents in the Nordic Region agree that people are equally affected by climate change initiatives regardless of age, 41% disagree with this statement and 25% are neutral. More than one third (35%) of the Nordic population agree that everyone is equally affected by initiatives to fight climate change regardless of the country of origin, while 34% of them disagree. More than half of respondents (56%) think that the impact of climate initiatives differs between rural and urban areas, while only 22% think that all areas are equally affected. Respondents who live in cities are more likely to respond that climate policy impacts differ between rural and urban areas (60%) than respondents who live in rural areas (55%) and towns and suburbs (53%). One third (33%) of respondents in the survey think that the Sámi population is affected by climate change initiatives to the same extent as the rest of the population. In Greenland, a majority of the population (62%) agrees that the indigenous population in Greenland is equally affected by measures to combat climate change. The results from this survey conducted in the autumn of 2022, show that the population in the Nordic Region perceive the impacts of climate mitigation policies in different ways. These results can raise awareness and stimulate debate about the implementation of climate mitigation policies for a just green transition.