Search Results (1,949)

Background/Objectives: The SARS-CoV-2 and influenza A (H1N1)pdm09 pandemics have resulted in high numbers of ICU admissions, with high mortality. Identifying risk factors for ICU mortality at the time of admission can help optimize clinical decision making. However, the risk factors identified may differ, depending on the type of analysis used. Our aim is to compare the risk factors and performance of a linear model (multivariable logistic regression, GLM) with a non-linear model (random forest, RF) in a large national cohort. Methods: A retrospective analysis was performed on a multicenter database including 8902 critically ill patients with influenza A (H1N1)pdm09 or COVID-19 admitted to 184 Spanish ICUs. Demographic, clinical, laboratory, and microbiological data from the first 24 h were used. Prediction models were built using GLM and RF. The performance of the GLM was evaluated by area under the ROC curve (AUC), precision, sensitivity, and specificity, while the RF by out-of-bag (OOB) error and accuracy. In addition, in the RF, the im-portance of the variables in terms of accuracy reduction (AR) and Gini index reduction (GI) was determined. Results: Overall mortality in the ICU was 25.8%. Model performance was similar, with AUC = 76% for GLM, and AUC = 75.6% for RF. GLM identified 17 independent risk factors, while RF identified 19 for AR and 23 for GI. Thirteen variables were found to be important in both models. Laboratory variables such as procalcitonin, white blood cells, lactate, or D-dimer levels were not significant in GLM but were significant in RF. On the contrary, acute kidney injury and the presence of Acinetobacter spp. were important variables in the GLM but not in the RF. Conclusions: Although the performance of linear and non-linear models was similar, different risk factors were determined, depending on the model used. This alerts clinicians to the limitations and usefulness of studies limited to a single type of model. Full article

Listeria monocytogenes poses health threats due to its resilience and potential to cause severe infections, especially in vulnerable populations. Plant extracts and/or phytocomplexes have demonstrated the capability of natural compounds in mitigating L. monocytogenes virulence. Here we explored the suitability of a computational pipeline envisioned to identify the molecular determinants for the recognition between the bacterial protein internalin A (InlA) and the human E-cadherin (Ecad), which is the first step leading to internalization. This pipeline consists of molecular docking and extended atomistic molecular dynamics simulations to identify key interaction clusters between InlA and Ecad. It exploits this information in the screening of chemical libraries of natural compounds that might competitively interact with InIA and hence impede the formation of the InIA–Ecad complex. This strategy was effective in providing a molecular model for the anti-adhesive activity of punicalagin and disclosed two natural phenolic compounds with a similar interaction pattern. Besides elucidating key aspects of the mutual recognition between InIA and Ecad, this study provides a molecular basis about the mechanistic underpinnings of the anti-adhesive action of punicalagin that enable application against L. monocytogenes. Full article

Parturition is accepted as a painful situation. Few studies explore pain-specific behaviours during farrowing in sows. The objectives of this study were, first, to assess if behavioural pain indicators (BPIs) are affected by the farrowing moment, parity, and suckling events, and second, to determine the relationship between the Facial Action Units (FAUs) and BPIs during farrowing. Ten Danbred sows were recorded throughout farrowing and on day 19 post-farrowing. Continuous observations of five BPIs and five FAUs were obtained across the three moments studied: (i) at the expulsion of the piglets, (ii) the time interval between the delivery of each piglet, and (iii) 19 days after farrowing, used as a control. Primiparous sows had more BPIs but fewer postural changes than multiparous sows. The BPIs were more frequent during suckling events in the pre-weaning moment. All the FAUs and BPIs were rare or absent post-farrowing (p < 0.05), and almost all of them were more frequent during farrowing (especially at the moment of delivery). Back arching showed the highest correlation with all the FAUs, and tension above the eyes showed the highest correlation with four of the BPIs. The BPIs and FAUs indicate that sows experience more pain during farrowing than during the third week post-farrowing, and piglet expulsion is the most painful moment in farrowing. Full article

Background: Implantation of modularly built-up stems with a tapered and fluted design is currently state of the art in revision total hip arthroplasty (RTHA). Nevertheless, implant-specific major complications like breakage of taper junctions as well as periprosthetic fractures (PPFs) may lead to failure of reconstruction during follow-up. Methods: A cohort of 117 cases receiving femoral RTHA by a modular stem was investigated retrospectively with a mean follow-up of 5.7 (0.5–13.7) years. Cumulative risk and potential factors affecting the occurrence of PPFs were calculated with the Kaplan–Meier method. In addition, cases were presented to discuss operative treatment options. Results: A cumulative risk of PPF of 12.1% (95% CI: 0–24.6%) was calculated at 13.7 years. Female patients had significantly higher risk compared to male patients (0% after 13.5 years for male patients vs. 20.8% (95% CI: 0.5–41.2%) after 13.7 years for female patients; log-rank p = 0.0438) as all five patients sustaining a PPF during follow-up were women. Four fractures were treated by open reduction and internal fixation. Non-union and collapse of the fracture occurred in one patient after closed reduction and internal fixation. Conclusions: Postoperative PPF after femoral revision with a modular stem has shown to be a frequent complication within this mid-term follow-up. Female patients were at a significantly higher risk in this aged cohort, indicating osteoporosis as a risk factor. The surgical treatment of PPF with an integrated long-stemmed prosthesis is challenging and thorough considerations of adequate operative treatment of PPFs are strongly advised in order to limit complication rates. Full article

Background/Objectives: This study explores the perspectives of mental health professionals on tailoring the Mentis Plus intervention to enhance positive mental health (PMH) in individuals experiencing First-Episode Psychosis (FEP). Although the Mentis Plus Program has been previously implemented in other contexts, it has not yet been applied to FEP care. Therefore, this study aimed to adapt the intervention for future implementation through expert consultation. Methods: A qualitative exploratory-descriptive design was employed. Data were collected via three focus groups comprising multidisciplinary professionals experienced in FEP care. Qualitative content analysis was used to examine the data. Results: Participants viewed the tailored Mentis Plus intervention as a valuable, recovery-oriented tool. Key recommendations included a flexible, group-based format with eight weekly sessions. Suggested intervention components encompassed gratitude journaling, emotional regulation techniques, and collaborative problem-solving exercises. Group delivery was highlighted as essential for mitigating isolation and promoting peer support. Practical implementation strategies included phased session structures and routine emotional check-ins. Identified barriers to implementation included the need for specialized training, limited therapeutic spaces, and the heterogeneity of participant needs. Facilitators included a person-centered approach, institutional backing, and sufficient resources. Conclusions: The findings support the feasibility and clinical relevance of a tailored Mentis Plus FEP Program—Brief Version. Expert-informed insights provide a foundation for adapting mental health interventions to early-psychosis care and inform future research and implementation strategies. Full article

Since its publication in the 1960s, the Kalman Filter (KF) has been a powerful tool in optimal state estimation. However, the KF and most of its variants have mainly focused on the state estimation of smooth systems. In this work, we propose a new algorithm called the Discrete Unilateral Constrained Extended Kalman Filter (DUCEKF) that expands the capabilities of the Extended Kalman Filter (EKF) to a class of hybrid mechanical systems known as systems with unilateral constraints. Such systems are non-smooth in position and discontinuous in velocity. Lyapunov stability theory is invoked to establish sufficient conditions for the estimation error stability of the proposed algorithm. A comparison of the proposed algorithm with the EKF is conducted in simulation through a case study to demonstrate the superiority of the DUCEKF for the state estimation tasks in this class of systems. Simulations and an experiment were developed in this case study to validate the performance of the proposed algorithm. The experiment was conducted using electronic hardware that consists of an Embedded System (ES) called “Mikromedia for dsPIC33EP” and an external DAC-12 Click board, which includes a Digital-to-Analog Converter (DAC) from Texas Instruments. Full article

Background/Objectives: Neonatal pain must be treated due to its potential short- and long-term adverse effects. A frenotomy is a painful procedure where common strategies to relieve pain (oral sucrose solutions and sucking) cannot be used because the technique is performed on the tongue. Lavender essential oil (LEO) is useful in treating pain during blood sampling, heel punctures, vaccination, and frenotomies. We aimed to determine whether smelling colostrum had similar effects as inhaled LEO during frenotomies. Methods: A prospective, randomized clinical trial was carried out with neonates who underwent a frenotomy for ankyloglossia between September 2023 and June 2024. We assessed pain using the NIPS score, heart rate, oxygen saturation, and crying time. After obtaining parental informed consent, we randomized patients into experimental and control groups. In both groups, we performed swaddling, administered 1 mL of oral sucrose, and let the newborn suck for 2 min. In the experimental group, we placed a gauze pad with two drops of colostrum, whereas in the control group, we used one drop of LEO 2 cm under the neonate’s nose prior to and during the frenotomy. Results: We enrolled 142 patients (71 experimental cases and 71 controls). The experimental group showed lower crying times (28.0 vs. 40.2 s, p = 0.03). Both groups showed similar NIPS scores (1.4 vs. 1.5, p = 0.28). We observed no side effects in either of the groups. Conclusions: Inhaled colostrum and LEO help relieve pain in neonates who undergo a frenotomy for ankyloglossia and have no side effects. Aromatherapy with colostrum may decrease crying time during the frenotomy. Full article

Knowledge about the composition (volatile and non-volatile) and functionality of natural extracts from Mediterranean plants serves as a basis for their further application. In this study, five selected plants were used for the extraction of plant metabolites. Leaves and flowers of Critmum maritimum, Rosmarinus officinalis, Olea europea, Phylliera latifolia and Mellisa officinalis were collected, and a total of 12 extracts were prepared. Extractions were performed under microwave-assisted conditions, with two solvent types: water (W) and a hydroalcoholic (ethanolic) solution (HA). Detailed extract analysis was conducted. Phenolics were analyzed by detecting individual bioactive compounds using high-performance liquid chromatography and by calculating total phenolic and total flavonoid content through spectrophotometric analysis. Higher concentrations of total phenolics and total flavonoids were obtained in the hydroalcoholic extracts, with the significantly highest total phenolic and flavonoid values in the rosemary hydroalcoholic extract (3321.21 mg_GAE/L) and sea fennel flower extract (1794.63 mg_QE/L), respectively; and the lowest phenolics in the water extract of olive leaves (204.55 mg_GAE/L) and flavonoids in the water extracts of sea fennel leaves, rosemary, olive and mock privet (around 100 mg_QE/L). Volatile organic compounds (VOC) were detected using HS-SPME/GC–MS (Headspace Solid-Phase Microextraction coupled with Gas Chromatography-Mass Spectrometry), and antioxidant capacity was estimated using DPPH (2,2-diphenyl-1-picrylhydrazyl assay) and FRAP (Ferric Reducing Antioxidant Power) methods. HS-SPME/GC–MS analysis of samples revealed that sea fennel had more versatile profile, with the presence of 66 and 36 VOCs in W and HA sea fennel leaf extracts, 52 and 25 in W and HA sea fennel flower extracts, 57 in rosemary W and 40 in HA, 20 in olive leaf W and 9 in HA, 27 in W mock privet and 11 in HA, and 35 in lemon balm W and 10 in HA extract. The lowest values of chlorophyll a were observed in sea fennel leaves (2.52 mg/L) and rosemary (2.21 mg/L), and chlorophyll b was lowest in sea fennel leaf and flower (2.47 and 2.25 mg/L, respectively), while the highest was determined in olive (6.62 mg/L). Highest values for antioxidant activity, determined via the FRAP method, were obtained in the HA plant extracts (up to 11,216 mg_AAE/L for lemon balm), excluding the sea fennel leaf (2758 mg_AAE/L) and rosemary (2616 mg_AAE/L). Considering the application of these plants for fresh fish preservation, antimicrobial activity of water extracts was assessed against Vibrio fischeri JCM 18803, Vibrio alginolyticus 3050, Aeromonas hydrophila JCM 1027, Moraxella lacunata JCM 20914 and Yersinia ruckeri JCM 15110. No activity was observed against Y. ruckeri and P. aeruginosa, while the sea fennel leaf showed inhibition against V. fisheri (inhibition zone of 24 mm); sea fennel flower was active against M. lacunata (inhibition zone of 14.5 mm) and A. hydrophila (inhibition zone of 20 mm); and rosemary and lemon balm showed inhibition only against V. fisheri (inhibition zone from 18 to 30 mm). This study supports the preparation of natural extracts from Mediterranean plants using green technology, resulting in extracts rich in polyphenolics with strong antioxidant potential, but with no clear significant antimicrobial efficiency at the tested concentrations. Full article

Background/Objectives: Frenotomy is the procedure of choice for treating ankyloglossia. The literature reports that readhesion of the frenulum occurs in 2.6–13% of cases. There is no published evidence to support performing tongue exercises to prevent it. We aimed to determine the readhesion rate of ankyloglossia, the benefits of tongue exercises to prevent it, and the characteristics of patients who experienced readhesion. Methods: This is a prospective, observational study of neonates who underwent a frenotomy between January and August 2024. Following the frenotomy, we recommended that all parents perform a series of exercises 6–8 times daily over 15 days. Patients were re-evaluated 10–15 days post-procedure for signs of ankyloglossia using the Hazelbaker tool and clinical variables such as nipple pain or cracks. Results: We enrolled 212 patients; thirty patients underwent a refrenotomy (14.1%). The raw risk of readhesion in our study was 0.335 (95%CI 0.275–0.401), and for symptomatic readhesion, 0.156 (95%CI 0.113–0.211). Adjusted by sex, the risk of readhesion for female patients was 0.236 (95%CI 0.155–0.344), and for males, 0.390 (95%CI 0.312–0.474). The appearance and function Hazelbaker scores were significantly lower before the frenotomy than post-procedure in all cases. In females, not following the exercise protocol multiplied the risk of readhesion by 1.61 (95%CI 1.03–2.56), whereas in males the risk was multiplied by 1.47 (95%CI 1.03–2.08). Symptomatic readhesion was significantly correlated with age at frenotomy and Hazelbaker score. Conclusions: Readhesion of tongue-tie was higher than previously published (33.5%); however, symptomatic readhesion was less frequent (15.6%). Proper adherence to post-frenotomy exercises significantly reduces the risk of readhesion, although it has less impact on symptomatic readhesion. Full article

As climate change intensified water scarcity in Southern Europe, tourism-dependent regions such as Portugal’s Algarve faced growing pressure to adapt their water management systems. This study investigated how hotel groups in the Algarve have adopted and communicated water reuse technologies—specifically desalination and greywater recycling—under environmental, institutional, and reputational constraints. A comparative qualitative case study was conducted involving three hotel groups—Vila Vita Parc, Pestana Group, and Vila Galé—selected through purposive sampling based on organizational capacity and technology adoption stage. The analysis was supported by a supplementary mini-case from Mallorca, Spain. Publicly accessible documents, including sustainability reports, media coverage, and policy frameworks, were thematically coded using organizational environmental behavior theory and the OECD Principles on Water Governance. The results demonstrated that (1) higher organizational capacity was associated with greater maturity in water reuse implementation; (2) communication transparency increased alongside technological advancement; and (3) early-stage adopters encountered stronger financial, regulatory, and operational barriers. These findings culminated in the development of the Maturity–Communication–Governance (MCG) Framework, which elucidates how internal resources, stakeholder signaling, and institutional alignment influence sustainable infrastructure uptake. This research offered policy recommendations to scale water reuse in tourism through financial incentives, regulatory simplification, and public–private partnerships. The study contributed to the literature on sustainable tourism and decentralized climate adaptation, aligning with UN Sustainable Development Goals 6.4, 12.6, and 13. Full article

This study aims to explore the walkability of three small areas (basic healthcare areas) of Barcelona city (Catalonia, Spain) for frail older adults. A mixed methods study design was conducted with 132 frail older adults in three primary care centers of Barcelona: Larrard, Barceloneta, and Vila Olímpica. A literature review was conducted to identify urban design indicators related to walkability and the aging population. These were then reflected in the surveys administered to the program participants, capturing information on their preferred routes, usual destinations, and walkability perceptions. Findings reveal significant mobility challenges for older adults, particularly the ones related to safety issues, the adequacy of sidewalk widths, greenery and urban furniture maintenance, and the presence/absence of commercial activities. This research underscores the importance of age-sensitive urban design in healthcare environments and provides a framework for enhancing walkability and accessibility for populations at greater risk of mobility-related health problems, such as frail older adults. Full article

Herein, we report a one-pot palladium- and ligand-free tandem Sonogashira coupling/regioselective 6-endo-dig oxacyclization reaction of 2,4-diiodo-1-methyl-imidazole-5-carboxylic acid with terminal alkynes mediated by Copper(I). This impressive approach offers a straightforward, practical, and efficient tandem procedure for accessing 2-alkynylated pyrano[4,3-d]imidazol-4-one in moderate to good yields with an exclusive 6-endo-dig oxacyclization. Notably, this cost-effective methodology demonstrates broad substrate compatibility with various commercially available aliphatic and (hetero)aromatic terminal alkynes. Furthermore, DFT studies were performed to elucidate the origin of this regioselective 6-endo-dig oxacyclization reaction. Full article

This study investigated mealworm frass as a sustainable substrate for Pleurotus ostreatus cultivation while valorizing mushroom stems as aquaculture feed. Mushrooms were grown on substrates containing 0–15% frass, and nutritional analyses were conducted on both fruiting bodies (for human consumption) and stems (for fish feed). Increasing frass levels significantly enhanced protein content, rising from 7.78% to 22.31% in stems and 24.74% to 30.99% in fruiting bodies. Lipid concentrations showed minor fluctuations while, in contrast, β-glucan content declined with high frass inclusion percentages. Essential amino acid levels peaked at 7.37% in stems (15% frass) and 8.08% in fruiting bodies (12.5% frass). Polyunsaturated fatty acids dominated the fatty acid profile, increasing with high frass levels. Mushroom bodies and stems were additionally investigated for their antimicrobial activity to determine whether they could offer protection against common fish and human pathogens. Antimicrobial assays revealed that dichloromethane extracts from stems grown on 12.5% and 15% frass exhibited inhibitory activity (inhibition zones of 10–11 mm) against Tenacibaculum maritimum, a microorganism that poses a significant threat to aquaculture. These findings highlight mealworm frass as a promising substrate for enhancing mushroom nutritional value while providing a sustainable, protein-rich feed ingredient for aquaculture. Full article

We investigated a novel natural dye-sensitized solar cell (DSSC) utilizing gadolinium ruthenate pyrochlore oxide Gd₂Ru₂O₇ (GRO) as a photoanode and compared its performance to the TiO₂-Gd₂Ru₂O₇ (TGRO) combined-layer configuration. The films were fabricated using the spin-coating technique, resulting in spherical grains with an estimated mean diameter of 0.2 µm, as observed via scanning electron microscopy (SEM). This innovative photoactive gadolinium ruthenate pyrochlore oxide demonstrated strong absorption in the visible range and excellent dye adhesion after just one hour of exposure to natural dye. X-ray diffraction confirmed the presence of the pyrochlore phase, where Raman spectroscopy identified various vibration modes characteristic of the pyrochlore structure. Incorporating Gd₂Ru₂O₇ as the photoanode significantly enhanced the overall efficiency of the DSSCs. The device configuration FTO/compact-layer/Gd₂Ru₂O₇/Hibiscus-sabdariffa/electrolyte(I⁻/I₃⁻)/Pt achieved a high efficiency of 9.65%, an open-circuit voltage (Voc) of approximately 3.82 V, and a current density of 4.35 mA/cm² for an active surface area of 0.38 cm². A mesoporous TiO₂-based DSSC was fabricated under the same conditions for comparison. Using impedance spectroscopy and cyclic voltammetry measurements, we provided evidence of the mechanism of conductivity and the charge carrier’s contribution or defect contributions in the DSSC cells to explain the obtained Voc value. Through cyclic voltammetry measurements, we highlight the redox activities of hibiscus dye and electrolyte (I⁻/I₃⁻), which confirmed electrochemical processes in addition to a photovoltaic response. The high and unusual obtained Voc value was also attributed to the presence in the photoanode of active dipoles, the layer thickness, dye concentration, and the nature of the electrolyte. Full article

Brucellosis remains endemic in Tunisia, causing abortions in small ruminants, and represents a public health threat through occupational exposure and the consumption of contaminated animal products. The aims of this study are to assess the antibiotic susceptibility of two Brucella melitensis isolates (TATA and SBZ) from aborted sheep, to analyze their genomes using hybrid whole-genome sequencing, and to investigate their antimicrobial resistance (AMR), potential virulence factors (VFs), and phylogenetic relationships. Both isolates were phenotypically confirmed to be susceptible to doxycycline, gentamicin, rifampicin, streptomycin, and trimethoprim–sulfamethoxazole, and no corresponding classical AMR genes were identified. However, several potential AMR-related genes (mprF, bepCDEFG, qacG, and adeF) and a mutation in the parC gene were detected. The analysis of the genotypes revealed 74 potential virulence genes, primarily involved in lipopolysaccharide synthesis and type IV secretion systems. Genomic comparison showed over 99% nucleotide identity between the Tunisian strains, B. melitensis bv. 1 16M and B. melitensis bv. 3 Ether. Five gene clusters, including three hypothetical proteins with 100% identity, were detected exclusively in the TATA and SBZ strains. Additionally, two unique gene clusters were identified in SBZ: a rhodocoxin reductase and another hypothetical protein. Both isolates were assigned to sequence types ST11 and ST89. Core-genome-based phylogenetic analysis clustered both strains with biovar 3 and ordered the Tunisian strains into two distinct groups: TATA within Tunisian Cluster 1 is closely related to strains from Egypt and Italy, while SBZ near MST Cluster 4 is more related to isolates from Austria and two outliers from Italy and Tunisia. This study provides the first genomic characterization of B. melitensis from aborted sheep in Tunisia and offers valuable insights into AMR, virulence, and phylogenetic distribution. Full article