In the shift from the balance of nature to the flux of nature paradigm, the concept of resilience has gained great traction in ecology. While it has been suggested that the concept of resilience does ...not imply a genuine departure from the balance of nature paradigm, I shall argue against this stance. To do so, I first show that the balance of nature paradigm and the related conception of a single-state equilibrium relies on what Eliot Sober has named the “Natural State Model (NSM)”, suggesting that the NSM has instead been dismissed in the flux of nature paradigm. I then focus on resilience as the main explanatory concept of the flux paradigm. After distinguishing between two main different understandings of “resilience”, namely engineering resilience and ecological resilience, I argue that the former is close to the concept of balance or stability and still part of the NSM, while the latter is not. Finally, I claim that ecological resilience is inconsistent with the NSM, concluding that this concept–being incompatible with the NSM–is not part of the balance of nature paradigm but rather a genuinely new explanatory tool.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Acute circulatory dysfunction in patients with sepsis can evolve rapidly into a progressive stage associated with high mortality. Early recognition and adequate resuscitation could improve outcome. ...However, since the spectrum of clinical presentation is quite variable, signs of hypoperfusion are frequently unrecognized in patients just admitted to the emergency department (ED). Hyperlactatemia is considered a key parameter to disclose tissue hypoxia but it is not universally available and getting timely results can be challenging in low resource settings. In addition, non-hypoxic sources can be involved in hyperlactatemia, and a misinterpretation could lead to over-resuscitation in an unknown number of cases. Capillary refill time (CRT) is a marker of peripheral perfusion that worsens during circulatory failure. An abnormal CRT in septic shock patients after ICU-based resuscitation has been associated with poor outcome. The aim of this study was to determine the prevalence of abnormal CRT in patients with sepsis-related hyperlactatemia in the early phase after ED admission, and its relationship with outcome.
We performed a prospective observational study. Septic patients with hyperlactemia at ED admission subjected to an initial fluid resuscitation (FR) were included. CRT and other parameters were assessed before and after FR. CRT-normal or CRT-abnormal subgroups were defined according to the status of CRT following initial FR, and major outcomes were registered.
Ninety-five hyperlactatemic septic patients were included. Thirty-one percent had abnormal CRT at ED arrival. After FR, 87 patients exhibited normal CRT, and 8 an abnormal one. Patients with abnormal CRT had an increased risk of adverse outcomes (88% vs. 20% p<0.001; RR 4.4 2.7-7.4), and hospital mortality (63% vs. 9% p<0.001; RR 6.7 2.9-16) as compared to those with normal CRT after FR. Specifically, CRT-normal patients required less frequently mechanical ventilation, renal replacement therapy, and ICU admission, and exhibited a lower hospital mortality.
Hyperlactatemic sepsis patients with abnormal CRT after initial fluid resuscitation exhibit higher mortality and worse clinical outcomes than patients with normal CRT.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
There have been reports of procoagulant activity in patients with COVID‐19. Whether there is an association between pulmonary embolism (PE) and COVID‐19 in the emergency department (ED) is ...unknown. The aim of this study was to assess whether COVID‐19 is associated with PE in ED patients who underwent a computed tomographic pulmonary angiogram (CTPA).
Methods
A retrospective study in 26 EDs from six countries. ED patients in whom a CTPA was performed for suspected PE during a 2‐month period covering the pandemic peak. The primary endpoint was the occurrence of a PE on CTPA. COVID‐19 was diagnosed in the ED either on CT or reverse transcriptase–polymerase chain reaction. A multivariable binary logistic regression was built to adjust with other variables known to be associated with PE. A sensitivity analysis was performed in patients included during the pandemic period.
Results
A total of 3,358 patients were included, of whom 105 were excluded because COVID‐19 status was unknown, leaving 3,253 for analysis. Among them, 974 (30%) were diagnosed with COVID‐19. Mean (±SD) age was 61 (±19) years and 52% were women. A PE was diagnosed on CTPA in 500 patients (15%). The risk of PE was similar between COVID‐19 patients and others (15% in both groups). In the multivariable binary logistic regression model, COVID‐19 was not associated with higher risk of PE (adjusted odds ratio = 0.98, 95% confidence interval = 0.76 to 1.26). There was no association when limited to patients in the pandemic period.
Conclusion
In ED patients who underwent CTPA for suspected PE, COVID‐19 was not associated with an increased probability of PE diagnosis. These results were also valid when limited to the pandemic period. However, these results may not apply to patients with suspected COVID‐19 in general.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Introduction: The clinical presentation of coronavirus disease 2019 (COVID-19) overlaps with many other common cold and influenza viruses. Identifying patients with a higher probability of infection ...becomes crucial in settings with limited access to testing. We developed a prediction instrument to assess the likelihood of a positive polymerase chain reaction (PCR) test, based solely on clinical variables that can be determined within the time frame of an emergency department (ED) patient encounter. Methods: We derived and prospectively validated a model to predict SARS-CoV-2 PCR positivity in patients visiting the ED with symptoms consistent with the disease. Results: Our model was based on 617 ED visits. In the derivation cohort, the median age was 36 years, 43% were men, and 9% had a positive result. The median time to testing from the onset of initial symptoms was four days (interquartile range IQR: 2-5 days, range 0-23 days), and 91% of all patients were discharged home. The final model based on a multivariable logistic regression included a history of close contact (adjusted odds ratio AOR 2.47, 95% confidence interval CI, 1.29-4.7); fever (AOR 3.63, 95% CI, 1.931-6.85); anosmia or dysgeusia (AOR 9.7, 95% CI, 2.72-34.5); headache (AOR 1.95, 95% CI, 1.06-3.58), myalgia (AOR 2.6, 95% CI, 1.39-4.89); and dry cough (AOR 1.93, 95% CI, 1.02-3.64). The area under the curve (AUC) from the derivation cohort was 0.79 (95% CI, 0.73-0.85) and AUC 0.7 (95% CI, 0.61-0.75) in the validation cohort (N = 379). Conclusion: We developed and validated a clinical tool to predict SARS-CoV-2 PCR positivity in patients presenting to the ED to assist with patient disposition in environments where COVID-19 tests or timely results are not readily available.
The development and formulation of core–shell latex‐based adhesives to improve the adhesion of aluminium to poly(ethylene terephthalate) (PET) films and enhance the permeability of the final laminate ...to oxygen and water is described. All particles have a soft acrylic component (the shell in core–shell particles) to improve adhesion, and occasionally a hydrophobic core to enhance the permeability. The performance of the different latexes is compared to that of a commercially available reference material. The coatings formed by core–shell nanoparticles present a lower permeability to water than the particles synthesized in the absence of the seed, while the permeability to oxygen is found to be mainly related to the correct deposition of the metallic layer. In terms of the industrial formulation, it is found that a limited amount of a wetting agent (WA) is needed to ensure the correct spreading of the latex onto the PET substrate because of the low levels of surfactant used for the latex production. This compound has a positive effect on the adhesive strength of the coating. A curing agent also improves barrier properties, but the optimal level of this compound is dependent on the degree of crosslinker used in the base latex.
A latex made from a hydrophobic inner seed and a film‐forming outer shell is formulated to improve the barrier properties against water and oxygen of a poly(ethylene terephthalate)‐aluminum laminate. Not only does the latex composition affect the barrier properties, but is also essential to control the degree of crosslinking of the seed and to incorporate a wetting agent.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
This article reports the fabrication of poly(N-vinylcaprolactam-co-itaconic acid)- (poly(NVCL-co-IA))-based microgels containing magnetic nanoparticles. Preformed iron oxide nanoparticles that were ...functionalized with oleic acid and the reactive surfactant dodecan-1-ene-1-sodium sulfonate were used for such a purpose. NVCL and IA were polymerized in situ from the functionalized iron oxide nanoparticle surfaces. The process resulted in hybrid microgels with size between 166.9 and 193.3nm. The polydispersity index was low, which indicated that the microgels' magnetic dispersion is stable and homogeneous. The hydrid poly(NVCL-co-IA)-based microgels showed both temperature- and pH-sensitive behavior. The addition of iron oxide to the microgels was confirmed qualitatively by FTIR, X-ray diffraction and magnetization. The transmission electron microscopy (TEM) images confirmed the spherical morphology of the hybrid microgel which had a core that consisted of magnetic nanoparticles surrounded by a polymeric shell. Finally, the biocompatibility of (poly(NVCL-co-IA)) microgel containing magnetic nanoparticles was confirmed in vitro. All together, these results indicate the feasibility of the hybrid microgel to be used as a new drug delivery system.
•Poly(NVCL-co-IA) microgels containing iron oxide were prepared.•NVCL and IA were polymerized from functionalized iron oxide nanoparticles surfaces.•Hybrid microgels with between 166.9 and 193.3nm in size were obtained.•The hydrid microgels showed temperature-, pH- and magnetic responsive behavior.•TEM revealed a core of magnetic nanoparticles surrounded by the polymeric shell.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Life expectancy of people living with human immunodeficiency (PLHIV) has increased mainly due to the accessibility and effectiveness of antiretroviral therapy (ART). However, adverse effects from ...long-term use of antiretrovirals, and the physiological changes associated with aging, may compromise the quality of life of PLHIV, in addition to causing new demands on the healthcare system.
Estimate the frequency of osteoporosis and osteopenia in patients on prolonged ART and to verify their associated factors.
A cross-sectional study was conducted in Belo Horizonte, Minas Gerais, Brazil, from August 2017 to June 2018, in a sample of PLHIV (age ≥ 18 years) who started ART between 2001 and 2005. Data were collected through face-to-face interviews, physical evaluation, laboratory tests, and Dual-Energy X-Ray Absorptiometry Screening (DEXA). The outcome of interest was presence of bone alteration, defined as presence of osteopenia or osteoporosis in DEXA. The association between the explanatory variables and the event was assessed through odds ratio (OR) estimate, with 95% confidence interval (CI). Multiple logistic regression was performed to evaluate factors independently associated with bone alteration.
Among 92 participants, 47.8% presented bone alteration (19.6% osteoporosis and 28.2% osteopenia). The variables that remained in the final logistic regression model were age ≥ 50 years (OR: 12.53; 95% CI: 4.37–35.90) and current alcohol use (OR: 2.63; 95% CI: 0.94–7.37).
This study showed a high frequency of bone changes, especially in PLHIV older than 50 years. This information is useful to stimulate the screening and timely intervention of this comorbidity of PLHIV on prolonged use of ART in order to prevent or minimize complications and new demands on the healthcare system.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The acceptance or rejection of classmates is one of the most widely recognized determinants of wellbeing in childhood. This study analyses psychosocial adjustment and sociometric status in primary ...education pupils, and possible differences by gender. A cross-sectional survey was undertaken in Huelva (Spain). The surveyed schools were selected using a stratified random sampling technique with both public and private elementary schools. Sample was composed of 247 4th grade students. Data revealed gender differences in psychosocial adjustment, particularly in terms of prosocial behavior in girls and behavioral problems in boys. Popular and rejected statuses presented opposing adjustment profiles, particularly in hyperactive symptoms and behavioral problems. When the sample was separated by gender, the differences between the types of status in emotional symptomatology and prosocial behavior disappeared. In addition, the differences between statuses were greater in boys, and were defined mainly by hyperactivity, whilst for girls these differences were more apparent in behavioral problems.
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•Sensitive hydrogels were synthesized by surfactant-free precipitation polymerization.•The type and concentration of comonomer played an important role on their properties.•The ...hydrogel nanoparticles were non toxic and spherical in shape with low polydispersity.•These materials may be used to develop new controlled drug delivery systems.
Stimuli-responsive microgels have great potential for biomedical applications owing to their well-defined structure and tunable swelling-collapse behavior in response to environmental conditions changes. Herein, thermo- and pH-responsive biocompatible microgels have been developed via surfactant-free precipitation polymerization of N-vinylcaprolactam (NVCL) in aqueous media using acrylic or itaconic acid (AA or IA) as acidic comonomers. A comparative study was performed regarding the incorporation of acidic comonomers and their effect on the stimuli-responsive behavior and nanoparticles stability in aqueous dispersion. The particles size, polydispersity as well as temperature- and pH-responsiveness were characterized by Dynamic Light Scattering experiments. The results indicated that the acidic segments in the microgel networks not only rendered pH-responsiveness behavior but were also capable to stabilize the nanoparticles due to the negative charges from carboxyl groups present in AA and IA. Smaller particles diameters were obtained when IA was used as the ionizable comonomer. Moreover, IA proved to be more efficient in the stability of the dispersions against time. The microgels morphology was accessed by Electron Transmission Microscopy, which revealed their spherical shape and low polydispersity, although a tendency for particles aggregation. All microgels were well tolerated by murine peritoneal macrophages, as revealed by cytotoxic tests. These results provide important information for further studies on the incorporation of active ingredients in such microgels for controlled drug release systems.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Approaches that are transdisciplinary and participatory can help to address complex socio-ecological issues by integrating multiple disciplinary perspectives while taking into account the different ...needs and experiences of community members and other stakeholders. Despite this promise, such approaches are rarely applied within the scientific community, as researchers and public actors often lack the training, practice and reference cases required to handle the working relationships and translations of terminology, ideas and values across multiple bodies of knowledge. A case study described in this manuscript depicts a group of researchers, artists and citizens consciously engaged in the construction of a transdisciplinary process as part of a 40-day ‘citizen science’ experiment focussed on assessing soil fertility in the urban area of Milan, Italy. The group drew from recognised scientific approaches, applied agronomic methodologies, artistic practices and technological tools, integrating them into a hybrid process of collective and participatory inquiry. As a quantitative outcome of the experiment, a dataset of bio-chemical parameters was generated, which was enriched by agronomic interpretations but also by artistic and reflective materials. Importantly, the process developed transdisciplinary and participatory skills, as it created a potentially replicable procedure of engagement, analysis and presentation for use in other citizen science settings. This article presents the context, the multiple objectives of the research and the applied approach and its timeline. Described in detail are the process of designing and conducting the experiment by involving an extended research community—including both junior and senior researchers—in progressive steps. Quantitative and qualitative results are provided. The findings are meant to contribute case material and methods to inform the advancement of transdisciplinary research approaches within the scientific community as well as examples of ways to transcend the boundaries of science to include artists and community stakeholders. The aspiration is to inform and inspire concrete application of transdisciplinary and participatory methods in concert to address complex socio-environmental challenges.
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