Introduction: Pulse field ablation (PFA) is a new technology that has been approved for the isolation of pulmonary veins in paroxysmal and persistent atrial fibrillation. Using PFA for targetting extra pulmonary sites combined with ultrahigh density 3D electroanatomic mapping (EAM) is an innovative approach that has been reported as single center

The Agri-food Supply Chain (AFSC) encounters numerous challenges that impact its efficiency, sustainability, and overall performance. In addition, the growing recognition of risks to human life, agri-food loss and wastage resulting from the mishandling of agricultural products serves as a driving force for achieving sustainability across the entire supply chain. However, the nascent Blockchain Technology (BT) is believed to establish a more robust, transparent, sustainable and streamlined AFSC, offering advantages to all participants, ranging from farmers to consumers. This research aims to identify and categorize factors that contribute to the adoption of Blockchain Technology (BT), offering a comprehensive methodology for modelling and evaluating the recognized blockchain enablers. Fuzzy Total Interpretive Structural Modeling (F-TISM) is employed to gain an intricate understanding of the interrelationships among the blockchain enablers. Furthermore, Fuzzy Matriced’s Impacts Croisés Multiplication Appliquée à un Classement (F-MICMAC) is employed to assess the mutual influences and interactions among the enablers. The application of Fuzzy TISM-MICMAC contributes not only in theoretical advancements in blockchain adoption but also provides valuable practical insights for stakeholders in the agri-food industry, policymakers, and technology developers.

The research paper deals with the numerical solutions of the Rosenau- Hymann (R-H) equation, known as the generalized Korteweg-de Vries equation, which represents the dynamics of shallow water waves and models of pattern formation in liquid drops. To reach this aim based on septic B-spline approximation, a collocation finite element method has been offered and applied for numerical solutions of R-H equation conceiving different parameter values of test problem. Also, Von-Neumann stability analysis has been performed which guarantees that the scheme is unconditionally stable. A test problem has been successfully solved by calculating L 2 and L ∞ error norms for illustrate the proficiency and reliability of the method and highlighted the significance of this work. It is made an inference that the numerical results match well with the analytical solutions, which indicates that the current B-spline collocation algorithm is an attractive and powerful algorithm. Also to reflect the efficiency of this method for solving the nonlinear equation, the results are depicted both graphically and in tabular form. The results obtained from both analytical and numerical methods show us that this study will be very useful for scientists concern with searching characteristics features of nonlinear phenomena in several fields of science.

Introduction: Poor intra-operative blood pressure is a risk factor for kidney, heart, and cognitive post-operative complications. Literature suggests that use of low-dose peripheral norepinephrine (NOR) reduces organ dysfunction, yet its administration remains unstandardized. In this work we develop a pharmacokinetic/pharmacodynamics (PK/PD) model of NOR effect on mean arterial pressure (mAP). Methods: From June 2018 to December 2021, we included patients scheduled for elective neurosurgery and requiring vasopressors for intra-operative hypotension management at Lariboisière Hospital, Paris. Low doses of NOR were administered peripherally, and successive arterial blood samples were collected to track its plasmatic concentration. We used a compartmental modelling approach for NOR PK. We developed and compared two models for NOR PD on mAP. Model comparison was done using Bayes information criteria. The resulting PK/PD model parameters were fitted over the entire population and linked to age, weight, height and sex. Results: We included 29 patients (age 52[46-64] years, 69% female). NOR median time to peak effect on mAP was 74[53-94] seconds. After bolus administration, mAP increased by 24% [15 - 31]. A 3-comparments model best captured NOR PK. NOR PD effect on mAP was well represented by both Emax and Windkessel models, with better results for the former. We found that age, height and weight as well as history of smoking and hypertension were correlated with model parameters. Conclusions: We developed a PK/PD model to accurately track norepinephrine plasma concentration and its effect on mAP over time, which could serve for target-controlled infusion. Study registration: ClinicalTrials.gov (NCT03454204)

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Capture and manipulation are an integral part of wildlife research and management. These practices, however, can affect animals either directly or indirectly, and studies should generally evaluate the consequences of captures to ensure animal welfare and reduce sampling bias. Here, we investigated the indirect, behavioural effects of live-capture on escape response to humans in Alpine marmot Marmota marmota within the Stelvio National Park (central Italian Alps) over three seasons (2021- 2023). We used flight initiation distance (FID) as a measure of escape response and tested it in relation to capture status using linear mixed modelling. Captures did not have any detectable effect on escape response, and FID was best explained by covariates such as starting distance, distance to nearest burrow, current behaviour during the observation and year of observation. It might be that, in marmots, escape response to humans is a rather inert behaviour, and as such, although we cannot rule out unmeasured effects, capture may not represent an excessively traumatic experience which could trigger immediate behavioural modification. In turn, capture is unlikely to compromise animal welfare or cause scientific bias in studies investigating escape response in this species, at least over the short term.

The soaring brain drain in the healthcare sector constitutes a pressing and formidable threat to public health in third-world countries. The increasing interconnectedness of the world has facilitated sharing of ideas and collaborations across borders, benefiting the global population. However, this has also led to the migration of skilled healthcare professionals from low-income countries to more developed nations. This is due to push factors such as the lack of proper healthcare infrastructure, low income, poor working conditions, and limited career opportunities which push healthcare workers to seek better prospects in more developed countries. Pull factors such as better remuneration, working conditions, and career advancement entice them to migrate to these countries. Consequently, the delivery of adequate healthcare services becomes severely compromised, exacerbating existing challenges in achieving public health goals. The impact of this phenomenon extends beyond mere workforce loss. It stifles local education, hinders advancements in medical research, and undermines the overall capacity to combat prevalent health issues. Urgent action is imperative to address this silent crisis. By prioritizing the improvement of domestic healthcare systems, offering competitive incentives for healthcare professionals, and fostering international collaboration, we can effectively mitigate brain drain and strengthen the foundation of public health in third-world countries. This Paper aims to identify the drivers behind brain drain, highlight implications for public health and proffer potential solutions and actionable plans to address this growing concern.

Due to the innate unique highly reactive properties and short life-time, organic free radicals can often serve as promoters or inter-mediates to engage in various radical transformations, which are otherwise difficult to access by ionic pathway-based mechanisms. With the evolvement of radical chemistry, chiral radical catalyzed-transformations have recently emerged as an attractive and ro-bust platform for synthesis of chiral molecules of interest. Herein, we highlight several creative and strategic advances in chiral rad-ical catalyst design, cyclization reaction achievements, and future challenges.

The poor prognosis of triple-negative breast cancer (TNBC) resulting from its high metastasis, whereas inflammation accompanied by excessive reactive oxygen species (ROS) is prone to aggravate tumor metastasis. Although photothermal therapy (PTT) has extremely high therapeutic efficiency, the crafty tumor cells allow increase the expression of heat shock proteins to limit its effect, and PTT induced inflammation is also thought to be a potential trigger for tumor metastasis. Herein, myricetin, iron ions and polyvinylpyrrolidone were utilized to develop nanomedicines by self-assembly strategy for the treatment of metastatic TNBC. The nanomedicines with marvellous water solubility and dispersion can inhibit glucose transporter 1 and interfer with mitochondrial function to block the energy supply of tumor cells, achieving starvation therapy on TNBC cells. Nanomedicines with excellent photothermal conversion properties allow down-regulate the expression of HSPs to enhance the effect of PTT. Interestingly, the broad spectrum of ROS scavenging ability of nanomedicines successfully attenuat PTT induced inflammation as well as regulate metastasis-related proteins through glycometabolism inhibition to reduce tumor cell metastasis. Moreover, the nanomedicines have negligible side effects and good clinical application prospect, which provides a valuable paradigm for the treatment of metastatic TNBC through glycometabolism interference, anti-inflammation, starvation and photothermal synergistic therapy.

Many-body interactions in condensed matter could lead to emergent phenomena spanning superconductivity, ferromagnetism, and exciton condensation, etc. The emergence of these phenomena often requires highly ordered spatial arrangements of the inter-acting species to enforce specific space symmetries and interacting strengths. Metal−organic frameworks (MOFs), crystalline materi-als formed by self-assembly of metal ions and organic ligands, allow precise design of their crystal structures and sophisticated tun-ing of Coulombic interaction or magnetic coupling among lattice sites. Such atomic-level designability combined with high crystallin-ity and versatile types of lattices (e.g. kagome and honeycomb lattices) render MOFs as a great platform to investigate emergent physics. In this Emerging Topic, we summarize recent studies evidencing emergent phenomena in MOFs including strong correla-tions, superconductivity, charge density wave, long-range magnetic order, and quantum spin liquid. We highlight the great potential of MOFs as quantum materials and discuss challenges including growth of high-quality single crystals and in-depth physical charac-terizations to reveal insights into the nature of physical properties of MOFs.

Defects are unavoidable during the synthesis of materials due to thermodynamic equilibrium. In the synthesis of two-dimensional transition metal dichalcogenide (2D TMDC), point defects emerge as a dominant defect due to the absence of chalcogen atoms in the lattice structure. In one or a few layers of TMDC materials, the presence of defect states on the film surface changes their carrier concentration. The changing of carrier concentration in monolayer TMDC film shifts the position of the fermi level towards either conduction band edge or valence band edge depending on the type of majority carriers. The shifting of the fermi level changes the work function of the TMDC monolayer film. The conventional hall measurement is not feasible to measure the surface carrier concentration of 2D materials films. Instead, kelvin probe force microscopy (KPFM) is used to measure surface carrier density. The carrier density is calculated by measuring the work function of the monolayer film using KPFM. Each point defect in 2D TMDC materials increases the certain amount of carrier concentration that facilitates the defect quantification. In this work, we tried to quantify point defect in metal-organic chemical vapor deposition (MOCVD) monolayer MoS 2 using kelvin probe force microscopy (KPFM) by measuring the position of the fermi level that is shifted due to the unbounded electrons of MoS 2.

Enterococcus faecalis is an opportunistic pathogen frequently causing nosocomial infections. The virulence of this organism is underpinned by its capacity to evade phagocytosis, allowing dissemination in the host. Immune evasion requires a surface polysaccharide produced by all enterococci, known as the Enterococcal Polysaccharide Antigen (EPA). EPA consists of a cell wall-anchored rhamnose backbone substituted by strain-specific polysaccharides called “decorations”, essential for the biological activity of this polymer. However, the structural determinants required for innate immune evasion remain unknown, partly due to a lack of suitable validated assays. Here, we describe a quantitative, in vitro assay to investigate how EPA decorations alter phagocytosis. Using the E. faecalis model strain OG1RF, we demonstrate that a mutant with a deletion of the locus encoding EPA decorations can be used as a platform strain to express heterologous decorations, thereby providing an experimental system to investigate the inhibition of phagocytosis by strain-specific decorations. We show that the aggregation of cells lacking decorations is increasing phagocytosis and that this process does not involve the recognition of lipoproteins by macrophages. Collectively, our work provides novel insights into innate immune evasion by enterococci and paves the way for further studies to explore the structure/function relationship of EPA decorations.

The most typical pathological change in Alzheimer’s disease (AD) is the aggregated deposition of amyloid-β (Aβ). APOE ε3/ε3 is the most prevalent genotype in the AD population. Individuals with amyloid-PET (Aβ-PET) positivity (+) and disease progression may not be a minority in the APOE ε3/ε3 non-demented population. This study searched for accessible and available clinical models that can predict Aβ-PET (+), and assess factors that can predict clinical conversion in APOE ε3/ε3 non-demented individuals. We selected 293 non-demented individuals with APOE ε3/ε3 from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. They were divided into Aβ-PET (+) and Aβ-PET (-) groups based on the 18F-florbetapir PET SUVR cut-off value of >1.11. Stepwise regression and the receiver operating characteristic curve (ROC) were used to search for a single or a combination of clinical variables, and to assess the accuracy of clinical markers, respectively. The Cox regression model was used to explore the risk factors associated with clinical transition. Our study found that the combination of clinical markers (Model A4: sex, education, ventricle and WMH volume; Model D5: everyday cognition study-partner total (EcogSPTotal) score, age, plasma p-tau 181 and WMH) respectively predicted Aβ-PET status in cognitively normal (CN) individuals and mild cognitive impairment (MCI) individuals. Aβ-PET (+) and EcogSPTotal score were independent predictors of clinical transition in APOE ε3/ε3 non-demented individuals. These specific factors offered an attractive and cost-effective assessment for Aβ status and clinical conversion.

This study utilizes plant-derived fibers including Mikania, wool, kapok, sugarcane and pineapple as strengthening additions to fabricated and tested reinforced polyester mixtures. This study aimed to examine the mechanical qualities and potential applications of these natural materials in boosting the effectiveness of polyester composites. The composites were formed by including natural fibers into a polyester base using a hands-on preparation method. The finished samples received a complete assessment, covering tensile and impact testing as well as SEM analysis. The findings showed that incorporating natural materials like Mikania vines, wool, Kapok fuzz, sugarcane fibers, and pineapple leaves had a notably positive effect on the mechanical features of the plastic composites. The tensile strength of the material combined pineapple was particularly high, achieving a maximum stress of 42.4822 N/mm 2 and a maximum stretch of 4.27950%. Similarly, that same composite exhibited the greatest maximum stretch of 3.75753% and the highest maximum stress of 77.4922 N/mm 2 during the bending experiment. The substances exhibiting the strongest impact endurance, as determined by the impact assessment, were the ones including Kapok, Mikania, wool, pineapple, and sugarcane. The kapok provided an impact toughness of 1.2 Newton meters, which was somewhat elevated. This research offers a precious understanding of using natural fibers as strengthening additives in polyester composites, demonstrating their flexible perspective for many uses. The discoveries present hopeful possibilities for additional examination and progression in the area of composite materials, consequently advancing the development of sustainable materials.

Heptamethine based cyanines, namely 1,3,-trimethyl-2-(2-2[2-phenylsulfanyl-3-[2-(1,3,3-trimethyl-1,3,3-trithyl-1,3-dihydro-indol-2-ylidene)-ethylidene]cyclohex-1-enyl]vinyl)-3H-indolium chloride ( S1) and 2-[2-(2-chloro-[2-[1,1-dimethyl-7-sulfo-3-(4-sulfobutyl)-1,3-dihydro-benzo[e]indol-2-ylidene]-ethylidene]cyclopent-1-enyl]vinyl]-1,1-dimethyl-7-sulfo-3-(4-sulfobutyl)-1Hbenzo[e]indolium hydroxide, inner salt, triethylammonium salt ( S2), efficiently result in physical drying of an aqueous dispersion comprising a polyurethane binder. S2 possesses a water solubility of 40 g/L. A high-intensity NIR-LED emitting at 820 nm with an intensity of 1 W/cm 2 served as light source. The cyanine converted the light absorbed into heat by internal conversion needing less drying time compared to conventional drying. Water content after film formation showed less then 1%. In the second step, UV exposure with a LED emitting at 395 nm resulted in formation of semi-interpenetrating polymer networks by crosslinking of the multifunctional (meth)acrylate operating as reactive diluent. TPO-L served as effective UV-photoinitiator. Furthermore, the UV-exposure together with Norrish Type I and Type II photoinitator systems results in a very efficient bleaching of the green physical dried film. This contribution shows for the first time a new photonic hybrid technique describing successful replacement of an oven-based process by a photonic based step that generates heat needed for drying.

EVOLUCIÓN, BIOMIMÉTICA, DIVERSIDAD, SINERGIA Y COLABORACIÓN: Décadas a la espera de iniciar el control efectivo de la resistencia a los antimicrobianos (RAM) David Ortega-Paredes1,2.1 Facultad de Ciencias Médicas Enrique Ortega Moreira, Carrera de Medicina, Universidad Espíritu Santo, Samborondón, Ecuador.2 Theoretical Fundamentals Development Environment. Life Symphony Venture. Art Inspired by Science and Technology, ARTIST. Ohio, USA.Puntos Clave •           La estrategia antimicrobiana actual garantiza complicar la RAM. •           Es posible iniciar estrategias efectivas para combatir la RAM en cualquier momento, de hecho, se pudo iniciar decadas atrás.   •           Posición actual: El paciente sucumbió por una bacteria multirresistente, un “Superbug”. •           En rigor: El paciente sucumbió por una adaptación evolutiva bacteriana generada por el uso de antibióticos como única terapia, de forma irresponsable en industria y medicina. El aporte comunitario fue mínimo y sobre todo debido a ausencia o diseño inefectivo de estrategias sensibilizadoras por parte de academia y gobierno.Comentario En la literatura indexada, con excepción de menciones inconspicuas, el fundamento de la resistencia a los antimicrobianos (RAM) pasa desapercibido. Su valor radica en ser capaz de explicar y predecir, más allá de cualquier duda razonable, a esta importante causa del deterioro en la salud pública. Intriga que, a pesar de su descripción temprana, a la par del descubrimiento de la penicilina, este valioso y simple concepto, no sea identificado, incluso por inteligencias artificiales (IA) diseñadas con este fin. Tomando en consideración que dichas IA, destacan por su eficiencia en tareas retadoras para un ser humano, tales como búsquedas conceptuales, estructuración de revisiones y metaanálisis. Además de contar con credibilidad y ser cada vez más extendido su uso como fuente de consulta.Este principio evolutivo, evoca la famosa frase del biólogo Theodosius Dobzhansky, “Nada tiene sentido en biología si no es a la luz de la evolución” (1988). Enfocando este tan importante tema en términos de evolución, los antibióticos, en su presentación terapéutica, no evolucionan, no se adaptan a los cambios, no dejan descendencia. Simplemente, por tratarse de moléculas que carecen inherentemente de las cualidades de los seres vivos, y entidades virales.Si bien es cierto, in vitro, es posible modificarlos para generar variantes, son estructuras estáticas y lábiles. En contraste, las bacterias, los seres más resilientes, adaptables y diversos, cuentan con una fina modulación de los mecanismos mutacionales. Los cuales, estocásticamente, generan capacidades únicas en cada individuo que por su número y su rápida reproducción, les ha permitido adaptarse a todos los cambios ambientales, incluyendo cinco eventos de extinción a escala global.Su resiliencia se vincula a su capacidad colaborativa. Comparten comunitariamente las adaptaciones exitosas para cada presión selectiva, codificadas en cadenas de ADN, lo cual implica procesos de transferencia horizontal de información, mediados principalmente por elementos genéticos móviles. De esta manera, los integrantes del microbioma bajo cualquier presión selectiva adquieren las “respuestas biológicas” para cada reto. Adicionalmente, un hecho poco difundido; las bacterias, son los ancestros de todos los linajes eucariotas, incluido el ser humano. De hecho, cada una de las células eucariotas en plantas, animales, protozoos y hongos, es el resultado de la colaboración entre bacterias y el linaje de las archaeas (otro linaje procariota, caracterizado por las adaptaciones de sus integrantes a ambientes extremos, por ejemplo: altas temperaturas). Actualmente, los descendientes de las bacterias que protagonizaron este evento endosimbiótico, mitocondria y cloroplasto, son el motor energético de todos los seres vivos compuestos por células eucariotas.Para dimensionar su impacto en nuestra existencia, cada célula de nuestro cuerpo lleva descendientes bacterianos sin los cuales no podríamos sobrevivir. Cada superficie de nuestro cuerpo está cubierta por microbiomas, mayormente poblaciones bacterianas en symbiosis, las cuales, nos brindan protección y servicios metabólicos esenciales. En ausencia de esta colaboración, tampoco podríamos sobrevivir.En relación con los antimicrobianos, estas moléculas se seleccionaron durante el proceso evolutivo bacteriano. Asociadas a sus contrapartes en el sistema toxina-antitoxina, genes anti-suicidas, o su nombre en el contexto médico: mecanismos de resistencia a los antimicrobianos, estos dos elementos acoplados, presentan relevancia biológica en contextos más profundos que la RAM. Han sido esenciales en la misma endosimbiosis. Por tanto, sin RAM y antimicrobianos, la vida distaría de la forma que conocemos, y claramente nuestra especie no constaría en este esquema.En el formato actual para su uso médico, los antibióticos no tienen oportunidad frente a una población bacteriana y su diversidad. El resultado siempre será la selección de la población en favor de los individuos resistentes. Este resultado se repetirá las veces que se intente, y mientras incrementa el volumen y número de diferentes moléculas que se aplique, la respuesta evolutiva incrementará proporcionalmente hasta agotar la batería de moléculas antibióticas útiles disponibles. Dicho arsenal de moléculas antimicrobianas, efectivas contra bacterias y sin acción sobre eucariotas, es muy limitado, debido a sus características, por lo cual, se las ha denominado golden or magic bullets, balas mágicas, haciendo una analogía con una bala que daría en el blanco sin fallar y sin causar daños colaterales. El término fue acuñado en 1907 por Paul Ehrlich. Premio Nobel de Medicina por el desarrollo del salvarsán, considerado el primer quimioterapéutico moderno.El proceso previamente descrito, el cual, compromete la utilidad de los antimicrobianos, se ha llevado a cabo sistemáticamente por décadas, lo que ha conducido al resultado esperado, identificado con anterioridad. De hecho, Alexander Fleming lo expuso al recibir su premio Novel de Medicina, que compartió con Howard Florey y Ernst Boris Chain en 1945. Es decir, la selección de bacterias multirresistentes, extremadamente resistentes y finalmente panresistentes, con el consecuente desarme de la medicina frente a las infecciones bacterianas. Actualmente, con la comunidad pagando la factura en términos de mortalidad, morbilidad y económicos, y con las fracciones más vulnerables de la sociedad en mayor riesgo. Es cada vez más evidente, que no se trata de un problema con fundamentos en los dominios de la medicina. Es evidencia de un problema que implica, al menos, limitaciones para el pensamiento crítico, una moral a conveniencia, autocomplacencia, desinformación intencionada, y empatía por los bienes materiales, comportamientos que se han generalizado en nuestra especie. Durante, al menos 80 años, con escasas pero muy remarcables excepciones, la industria ha priorizado los beneficios económicos, la academia de ciencias ha ignorado la evidencia, y la academia de arte, junto a la comunidad, ha evadido el tema.Trae a la mente la frase del libro Sudden Death de Rita Mae Brown, en ocasiones erróneamente atribuida a Albert Einstein, que versa, “La locura es intentar lo mismo esperando resultados diferentes”. Para complicar el panorama, esta estrategia claramente insostenible, en nuestra comunidad, no ha sido la principal estrategia, sino la única opción disponible para salvaguardar la salud pública, frente a las infecciones bacterianas.Es importante, en este punto, incluir la reversión de la culpa. Actividades como la producción intensiva de animales de abasto, liberan toneladas de antibióticos diariamente, directo al ambiente, produciendo un disturbio ecológico de enormes proporciones, cuyos efectos inmediatos y a largo plazo permanecen desconocidos, mientras se hacen esfuerzos para ignorarlos. No obstante, las campañas de difusión, frecuentemente, se centran en la receta médica. Así como la demonización de las bacterias resistentes, peyorativamente llamadas “Superbugs”, con la consigna de ser peligrosas y culpables de la enfermedad y el fracaso medico, cuando estas bacterias únicamente se adaptaron a las estrategias de aplicación de antimicrobianos. A la vez que se ignora nuestro propio origen y nuestra íntima asociación estricta con este linaje.- Posición actual:El paciente sucumbió por una bacteria multirresistente, un “Superbug”.- Podría ser considerada la opción:El paciente sucumbió por una adaptación evolutiva bacteriana generada por el uso de antibióticos como única terapia, de forma irresponsable en industria y medicina. El aporte comunitario fue mínimo y sobre todo debido a ausencia o diseño inefectivo de estrategias sensibilizadoras por parte de academia y gobierno. Con frecuencia, las aproximaciones actuales siguen la misma línea. En busca de ilustrar este punto, sin intención de desmeritar sus beneficios transitorios, ni su valor en determinados casos.1. En un intento de prolongar la vida útil de los antimicrobianos, se han desarrollado variedad de planes y estrategias para rotar antibióticos en los entornos clínicos. No obstante, sabemos que el resultado será el mismo. Sabemos que los antimicrobianos siempre pierden frente a las bacterias. Sabemos que la diversidad es la estrategia definitiva de resiliencia común a todos los procesos y organismos vivos en la naturaleza. Puede ser conveniente escuchar este fundamento universal, el cual invita a diversificar nuestras opciones terapéuticas, las cuales idealmente deberían ser sinérgicas entre sí y con los antimicrobianos, para de esta manera, generar estrategias dinámicas para un problema adaptable.2. Los abundantes estudios de prevalencia de la resistencia a los antimicrobianos carecen de hipótesis, y por tanto, son observaciones. La “investigación observacional”, no es un concepto en la búsqueda de soluciones, los conceptos son: observación, o investigación. Dentro de la investigación, el primer paso es la observación, tras la cual, se ubican dos procesos intelectuales cruciales para el desarrollo del conocimiento: la generación de preguntas significativas, y el trazado de un mapa dicotómico de hipótesis hacia las respuestas. En este rigor académico, la investigación observacional aplicada a la RAM, en ocasiones denominada vigilancia epidemiológica, recuerda la obra, “Crónica de una muerte anunciada”, de autoría del premio Nobel de literatura Gabriel García Márquez.3. La introducción de ceftazidima/avibactam, una combinación cefalosporina de tercera generación e inhibidor de Beta-lactamasas, tiene la intención de actuar contra bacterias resistentes a carbapenémicos. Activa contra serín-carbapemenasas, pero no contra metalo-carbapemenasas, ambos mecanismos descritos y coexistiendo en los componentes de la triada One Health, Una Sola Salud, concepto que integra los componentes de nuestro bioma y resalta sus interrelaciones, que en definitiva nos indica que la afectación de cualquier componente del bioma afecta a todo el bioma.A primera vista, previa su introduccion en la práctica clínica, parecería responsable considerar la alta probabilidad de que las variantes de serín-carbapemenasas insensibles a este compuesto, se vuelvan más prevalentes, a la par que se incrementa la prevalencia de las metalo-carbapemenasas. Lo cual, desencadena la diversificación de elementos móviles, ahora con nuevas asociaciones de mecanismos de resistencia y mutantes seleccionados positivamente. Seguida de la liberación de estos elementos y las bacterias portadoras en el ambiente, su dispersión, anclaje de reservorios, y nuevamente su diversificación, Acto seguido, colonizan portadores sanos. Los cuales, tras diseminar estas cepas en la comunidad, inician las infecciones adquiridas en la comunidad, que posteriormente se asocian al cuidado de la salud, en cuadros clínicos con pronóstico reservado, que por su costo motivan una presión económica importante en los sistemas de salud, donde además este antibiótico ya no es una alternativa.Opcionalmente, se puede sugerir como estrategia a la biomimética, concepto que se acopla a este enfoque evolutivo, al basar las soluciones en la observación de la naturaleza y sus estrategias, las cuales, claramente son funcionales y sustentables. Para, tras su comprensión, mimetizarlas y proceder al diseño de aplicaciones. En el contexto de la RAM, la evolución resolvió un problema similar miles de millones de años atrás, disponible en la actualidad, gratuito, natural, seguro, adaptable, la más numerosa y diversa de las entidades biológicas. Por millones en cada superficie de nuestros cuerpos, e incontables en todo el ambiente, que ha regulado poblaciones bacterianas por miles de millones de años, y linaje sin el cual tampoco hubiese evolucionado el ser humano, ni sobreviviríamos actualmente.No obstante, salvo en una corta lista de países, donde por un siglo se han desempeñado como la principal estrategia antimicrobiana. Su desarrollo es muy limitado. Así, los bacteriófagos, virus que infectan exclusivamente bacterias, cumplen con los supuestos de una bala mágica. Sin embargo, solo son una de las opciones sinérgicas con antibióticos, que alcanzan varias decenas en la actualidad. En breve, se han desarrollado, a nivel de investigación, péptidos antimicrobianos, edición genética, enzimas líticas, RNA-antisentido, núcleos calientes, probióticos, mieles, subproductos metabólicos vegetales, defensinas, regulación de microbiomas, una extensa lista de estrategias de la medicina ancestral, vesículas lipídicas, bacteriocinas, terapia con anticuerpos, nanopartículas, entre las más conocidas. En este contexto, el desarrollo de terapias aliadas y su sinergia estratégica, se revela como una necesidad.Este comentario no busca promover sentimientos de intriga o desconfianza hacia ninguno de los actores vinculados a los antimicrobianos. En su lugar, está intencionado a llamar la atención sobre el desarrollo y la búsqueda de terapias aliadas. Por otra parte, la supervivencia y el bienestar de nuestra especie tienen mucha relación con la capacidad potenciada del ser humano, para reaccionar a problemas con soluciones creativas. Este es el momento para poner en funcionamiento esta herencia, y generar soluciones innovadoras, creativas y justas.Cabe destacar que la RAM afecta a todos. Por lo tanto, no es justo que la comunidad quede fuera de la participación, a la espera de que alguien lo solucione. La clave es la diversidad. Cada ser humano tiene una base de datos única en su memoria y, por tanto, puede iterar una solución única. Las bacterias, lo han solucionado todo a base de diversidad y colaboración, incluso orquestaron el desarme de la medicina moderna.Para ilustrar la relevancia de las soluciones generadas en la comunidad, consideremos nuestra historia. En breve, la humanidad ha enfrentado problemas globales en múltiples ocasiones, como la necesidad de cazar. Para lo cual, cada comunidad desarrolló herramientas, trampas y estrategias adaptadas a sus retos y oportunidades específicos. Por lo cual, no sorprende que las formas, materiales y esquemas en herramientas y estrategias, sean diversas. No obstante, la lógica subyacente a su aporte al bienestar comunitario es universal. Lo cual, permitió la resiliencia de nuestra especie, que se describe como una probabilidad directamente proporcional a la diversidad de soluciones, solo efectiva si alcanza la diversidad de la incertidumbre.El mismo principio se aplica al reto global que representa la resistencia a los antimicrobianos. Cada comunidad, al diseñar y aplicar soluciones adaptadas a su contexto, Incrementa su probabilidad de resiliencia y les capacita para integrarse a la colaboración efectiva. Por lo tanto, es esencial valorar la colaboración en la comunidad, que incluye a la academia y a todas las instituciones púbicas y privadas. Las cuales, en rigor de la lógica, son personas de la misma comunidad que comparten empatías y se rigen bajo fundamentos de igualdad, equidad y responsabilidad social.Para concluir:·       La diversidad de nuestra especie es la estrategia para desarmar la diversidad bacteriana. ·       La evolución, biomimética, diversidad, sinergia y colaboración son los fundamentos para cada solución.·       Igualdad, equidad y responsabilidad social. son los fundamentos para crear las soluciones.  “Nada tiene sentido si no es a la luz de la evolución”, modificación unificadora de la cita de Theodosius Dobzhansky. 1988.

The interannual variation in arrival timing of Whitethroat in England is strongly correlated with temperature and wind speed at locations to the south, along the migration route through Europe, with higher temperatures and lower wind speed, in particular at more northerly sites in France, associated with earlier arrival. Analysis of en route weather conditions demonstrates significant warming and wind stilling during the migration period in recent years, suggesting a potential role for amelioration of weather conditions in the observed advancement trend of arrival. When linked to the meteorological trends, quantified reaction norms derived from the interannual variations indicate that perhaps close to half of the recently observed arrival advancement for this species might be explained by plasticity of this sort. According to this mechanism, less favourable weather conditions that were previously more prevalent will have retarded progress during migration to a greater extent prior to recent climate change-dependent amelioration of the weather which now reduces delays to onward migration. However, the wider literature indicates that there has been advancement of Mediterranean passage of long-distance passerine migrants of a similar magnitude as the advancement of Whitethroat arrival in England, suggesting a limited role for this proposed mechanism. Earlier arrival in these European passage areas may offset the potential for further advancement due to warmer temperatures and lower wind speeds. It may mean that birds will continue to encounter similar meteorological conditions as was previously the case but, having advanced passage of the Mediterranean, slightly earlier in the year and so providing for progress through Europe at a broadly similar, meteorologically moderated rate. Amelioration of en route weather conditions may still make an important contribution to arrival advancement since, without it, earlier arrival in Europe could result in increased delays to onward migration.

Background: Asthma and wheezing are significant health concerns for children in Africa. There is a dearth of prior research examining the occurrence of asthma and wheezing in both preschool and school-aged children within the African environment. Therefore, this meta-analysis aimed to estimate the prevalence of asthma and wheezing in African infants from zero months to children eight years of age. Methods: An electronic search was conducted in July 2023 in Scopus, Web of Science, PubMed, MEDLINE, CINAHL, and Academic Search Complete for studies published from January 2012 to July 2023 using the following subject-specific terms: 1. “Risk factors” OR “Contributing factors” OR “Predisposing factors” OR “Predictor” OR “Cause” OR “Prevalence” OR “Trends” 2. “Asthma” OR “Wheeze” OR “Wheezing” OR “Asthma symptoms”, 3. “Preschool” OR “early childhood” OR “kindergarten” OR “0 to 8 years” OR “School children”, 4. Africa/ or, 5. limit to (English language and year=“2012 -Current” and children). STATA 17 software and a fixed effects model were utilized. Heterogeneity was assessed using I2. Results: The study revealed a prevalence of asthma in preschool and school-aged children of 4.41%, with no heterogeneity observed ( I2 <0). Wheezing in the past prevalence rate was 22.91%, also without heterogeneity ( I2 <0), with no significant differences observed among the studies. This indicates a lack of heterogeneity in studies for asthma and wheezing prevalence rates. Conclusions: Asthma and wheezing are prevalent among African preschool and school-aged children, highlighting the need for comprehensive and localized research to address this public health issue.

Introduction Tuberculosis (TB) is the leading cause of death from a single infectious agent. Risk of TB disease is higher among people living with HIV. HIV prevalence among tuberculosis patients is in Africa is approximately 38%. Malawi registered a 44.6% TB/HIV coinfection in 2020. TPT prevents development of active TB disease. TPT uptake has been suboptimal Malawi. We conducted a study assessing the uptake of TPT and associated factors among PLWHIV in Kasungu district, Malawi. Methods A quantitative cross-sectional study among PLHIV from the 2021 cohort in Kasungu district. Target participants were from health facilities that provide TPT. An adapted questionnaire was used to collect socio-demographic factors including age, sex, education, residence, religion, marital status, economic status and assessed the knowledge of participants about TPT with their understanding of the use of TPT. The data was subjected to descriptive, bivariate and logistic regression analyses in SPSS version 25. Results Uptake of TPT was at 62%. Seventy five percent of the participants had good knowledge about TPT. Low uptake of TPT was associated with low education status, poor knowledge about TPT, being on ART for more than 24 months and receiving services at rural hospitals. Conclusion Low uptake of TPT needs to be addressed. There is for intensified health communication and promotion about TPT among the PLWHIV including diversifying the communication messages and channels to reach all literacy levels. Further studies are needed to ascertain other factors including the health care workers’ attitudes and perception about TPT.

1. Activities of wood decomposer fungi alter abiotic and biotic properties of deadwood, which are important for tree seedling regeneration on nurse logs. However, the effects were seldom evaluated experimentally. 2. In this study, we examined germination, growth, and survival of six arbuscular mycorrhizal and six ectomycorrhizal tree species on three substrates (brown rot logs, white rot logs, and soil) by seed sowing experiments in a mixed forest dominated by Pinus densiflora and Quercus serrata. We also analyzed fungal communities in these substrates by rDNA ITS1 sequencing. 3. Some significant substrate effects were found on seedling performance when comparing wood decay types, but these were not clearly consistent across mycorrhizal status of the seedlings. Nevertheless, seedlings of arbuscular mycorrhizal trees tended to show better growth on brown rot logs than on white rot logs, whereas ectomycorrhizal tree seedlings tended to survive better on white rot logs and soil compared to brown rot logs. 4. The fungal community was significantly different across three substrates. Richness of Operational Taxonomic Units (OTUs) of arbuscular mycorrhizal fungi was largest in brown rot logs, whereas OTU richness of ectomycorrhizal fungi was largest in soil. 5. Synthesis: The effects of fungal wood decay type on nurse log regeneration of tree seedlings might be partly attributable to water content and fungal communities in the logs. Particularly, rich communities of arbuscular mycorrhizal fungi in brown rot logs could assist in the growth of arbuscular mycorrhizal tree seedlings.

Background: The Patient Voice Program and Citizen Voice and Action models use scorecard meetings for community-provider-government dialogue to improve health services. This study evaluates the responsiveness of leaders and providers to concerns voiced by citizens through these scorecard meetings at the health center and district office levels in Rwanda. Methods: We conducted a cross-sectional study from July to September 2022 in 325 Rwandan health centers across 20 districts. Responsiveness was measured by comparing resolved issues to raised issues. Logistic regression identified predictors of issue resolution, with a p-value less than 0.05 considered significant. Median responsiveness turnaround time was also analyzed. Results: In total, 59.4% (1,163) of the identified gaps were resolved. Facility-level issues experienced a higher resolution rate (65.9%) than district-level issues (35.4%). Gaps at the facility level were 3.24 times more likely to be resolved than those at the district level (OR: 3.24, p<0.001, 95% CI: [2.48,4.25]). Integrated gaps had 1.46 times higher odds of resolution compared to issues stemming from reproductive, maternal, newborn, and child health services (OR: 1.46, p<0.05, 95% CI: [1.13,1.88]). The median responsiveness turnaround time for resolving a gap was approximately 15.4 months (IQR: 6.7-25.8). Conclusions: The study shows that Patient Voice Program and Citizen Voice and Action models are effective in addressing healthcare service gaps. By promoting collaboration among communities, healthcare providers, and governments, these models facilitate targeted, locally-supported solutions that significantly improve the resolution of health service delivery issues.

A document by Ali Chamani. Click on the document to view its contents.

This qualitative phenomenological study aimed to explore middle school students' perceptions of using the school-based cooperative problem-based learning (SB-CPBL) approach in learning science. The study explored how SB-CPBL differs from the students' usual learning, how the new approach affects their learning process, and what are the main challenges of learning via SB-CPBL. The study elucidates the pattern of students' perceptions changes towards using SB-CPBL in learning science. The study sample consisted of two sections of eighth-graders; males (28 students) and females (32 students), with a total of 60 students, aged 14-15 years old from the King Abdullah II School for Excellence in Jordan. The study conducted semi-structured group interviews with each gender class using their native language (Arabic), and semi-structured individual interviews with the teacher and students. Findings suggested that the students' response at the final stage includes that SB-CPBL is enjoyable, attractive, and initiates the urge to think critically. However, some negative perceptions and a sense of anxiety were also shown during the initial stage.

Converging electrophysiological, molecular, and ultrastructural evidence supports the hypothesis that sleep promotes a net decrease in excitatory synaptic strength, counteracting the net synaptic potentiation caused by ongoing learning during waking. However, several outstanding questions about sleep-dependent synaptic weakening remain. Here, we address some of these questions by using two established molecular markers of synaptic strength, the levels of the calcium-permeable AMPA (Alpha-Amino-3-Hydroxy-5-Methyl-4-Isoxazole Propionic Acid) receptors containing the GluA1 subunit, and the phosphorylation of GluA1 at serine 845. We previously found that, in the rat cortex and hippocampus, these markers are lower after 6-8 hours of sleep than after the same time spent awake. Here, we measure GluA1 expression in mouse cortex after 5 hours of either sleep, sleep deprivation, recovery sleep after sleep deprivation, or selective REM sleep deprivation (32 C57BL/B6 adult mice, 16 females). We find that relative to after sleep deprivation, synaptic GluA1 expression is lower after sleep independent of whether the mice were allowed to enter REM sleep. Moreover, 5 hours of recovery sleep following acute sleep deprivation are enough to renormalize GluA1 expression. In a pilot study in old mice (12 C57BL/B6 male mice, 20-month-old) we also find that GluA1 expression is high after sleep deprivation and low after sleep and recovery sleep. Thus, the renormalization of GluA1 expression crucially relies on NREM sleep and can occur in a few hours of sleep after acute sleep deprivation. Moreover, as measured by GluA1 expression, it appears that sleep-dependent synaptic weakening is unaffected by aging.