ABSTRACT Background: There is limited research on the long-term effectiveness of epidural steroid injections (ESI) in older adults despite the high prevalence of back and leg pain in this age group. We tested the hypotheses that older adults undergoing ESI, compared to patients not receiving ESI: (1) have worse pain, disability and quality of life ('outcomes') pre-ESI, (2) have improved outcomes after ESI and (3) have improved outcomes due to a specific ESI effect. Methods: We prospectively studied patients ≥ 65 years old presenting to primary care with new episodes of back pain in three US healthcare systems (BOLD reg- istry). Outcomes were leg and back pain intensity, disability and quality of life, assessed at baseline and 3-, 6-, 12- and 24-month follow-ups. We categorized participants as: (1) ESI within 6 months from the index visit (n = 295); (2) no ESI within 6 months (n = 4809); (3) no ESI within 6 months, propensity-score matched to group 1 (n = 483). We analysed the data using linear regression and Generalized Estimating Equations. Results: Pain intensity, disability and quality of life at baseline were significantly worse at baseline in ESI patients (group 1) than in group 2. The improvement from baseline to 24 months in all outcomes was statistically significant for group 1. However, no statistically significant differences were observed between out- come trajectories for the propensity-score matched groups 1 and 3. Conclusions: Older adults treated with ESI have long-term improvement. However, the improvement is unlikely the result of a specific ESI effect. Significance: In this large, two-year, prospective study in older adults with a new episode of low back pain, back pain, leg pain, disability and quality of life improved after epidural steroid injections; however, propensity-score matching revealed that the improvement was unlikely the result of a specific effect of the injections, indicating that epidural steroids are unlikely to provide long-term benefits in older adults with new episodes of back and leg pain.

RESUMEN Antecedentes: Hay pocos estudios sobre la eficacia a largo plazo de las inyecciones epidurales de esteroides (IEE) en las personas mayores a pesar de la elevada prevalencia del dolor de espalda y de miembros inferiores en este grupo de edad. Probamos las hipótesis de que los adultos mayores que reciben IEE, frente a los que no: (1) tienen más dolor y discapacidad y peor calidad de vida ('resultados') antes de las IEE, (2) presentan mejores resultados después de las IEE y (3) tienen resultados mejores debido a un efecto específico de las IEE. Métodos: Estudiamos prospectivamente a pacientes de ≥ 65 años de edad que acudieron a la atención primaria con nuevos episodios de dolor de espalda en tres sistemas sanitarios estadounidenses (registro BOLD). Los resultados a evaluar fueron la intensidad del dolor de miembros inferiores y de espalda, la discapacidad y la calidad de vida, valorados en el momento basal y a los 3, 6, 12 y 24 meses de seguimiento. Clasificamos a los participantes en: (1) IEE en los 6 meses siguientes a la visita inicial (n = 295); (2) sin IEE en el plazo de 6 meses (n = 4809); (3) sin IEE en el plazo de 6 meses, puntuación de propensión equiparada a la del grupo 1 (n = 483). Analizamos los datos mediante regresión lineal y ecuaciones de estimación generalizadas. Resultados: La intensidad del dolor, la discapacidad y la calidad de vida basales fueron significativamente peores en los pacientes con IEE (grupo 1) que en los del grupo 2. La mejoría de todos los resultados evaluables desde el momento basal hasta los 24 meses fue estadísticamente significativa para el grupo 1. Sin embargo, no se observaron diferencias estadísticamente significativas entre las evoluciones de los resultados en los grupos con puntuaciones de propensión equiparadas, 1 y 3. Conclusiones: Los adultos mayores tratados con IEE presentan mejorías a largo plazo. Sin embargo, es improbable que dicha mejoría se deba a un efecto específico de la IEE. Significancia: En este gran estudio prospectivo de dos años de adultos mayores con un nuevo episodio de dolor lumbar, el dolor de espalda, el dolor de miembros inferiores, la discapacidad y la calidad de vida mejoraron después de las inyecciones epidurales de esteroides; sin embargo, la equiparación de las puntuaciones de propensión mostró que la mejoría era improbable que se debiera a un efecto específico de las inyecciones, indicando que es poco probable que los esteroides epidurales aporten beneficios a largo plazo a los adultos mayores con nuevos episodios de dolor de espalda y miembros inferiores.

BACKGROUND: In low-resource settings, antimicrobial resistance (AMR) is detected by traditional culture-based methods and ensuring the quality of such services is a challenge. The AMR Scorecard provides laboratories with a technical assessment tool for strengthening the quality of bacterial culture, identification, and antimicrobial testing procedures. OBJECTIVE: To evaluate the performance of the AMR Scorecard in 11 pilot laboratory evaluations in three countries also assessed with the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist METHODS: Pilot laboratory evaluations were conducted in Cameroon, Ethiopia and Kenya between February 2019 and March 2019. Assessors with previous SLIPTA and microbiology experience were trained. Assessors performed the laboratory assessments using the SLIPTA and AMR Scorecard tools. RESULTS: Weaknesses in technical procedures and the quality management systems were identified in all areas and all laboratories. Safety had the highest mean performance score (SLIPTA: 68%; AMR Scorecard: 73%) while management review had the lowest (SLIPTA: 32%; AMR Scorecard: 8%) across all laboratories. The AMR Scorecard scores were generally consistent with SLIPTA scores. The AMR Scorecard identified technical weaknesses in AMR testing, and SLIPTA identified weaknesses in the quality management systems in the laboratories CONCLUSION: Since the AMR Scorecard identified important gaps in AMR testing not detected by SLIPTA, it is recommended that microbiology laboratories use SLIPTA and the AMR Scorecard in parallel when preparing for accreditation. Expanding the use of the AMR Scorecard is a priority to address the need for quality clinical microbiology laboratory services in support of optimal patient care and AMR surveillance.

The savanna ecosystems in South Africa, which are predominantly characterised by woody vegetation (e.g. shrubs and trees) and grasslands with annual phenological cycles, are shaped by ecosystem processes such as droughts, fires and herbivory interacting with management actions. Therefore, monitoring of the intra- and inter-annual vegetation structure dynamics is one of the essential components for the management of complex savanna ecosystems such as the Kruger National Park (KNP). To map the woody cover in the KNP, data from European Space Agency's (ESA) Copernicus Sentinel-1 radar satellite (C-Band vertical-vertical [VV]/vertical-horizontal [VH]) for the years 2016 and 2017, at 10 m spatial resolution and repeated acquisitions every 12 days, were utilised. A high-resolution light detection and ranging (LiDAR) data set was reclassified to produce woody cover percentages and consequently used for calibration and validation. Woody cover estimation for different spatial resolutions was carried out by fitting a random forest (RF) model. Model accuracy was assessed via spatial cross-validation and revealed an overall root mean squared error (RMSE) of 22.8% for the product with a spatial resolution of 10 m and improved with spatial averaging to 15.8% for 30 m, 14.8% for 50 m and 13.4% for 100 m. In addition, the product was validated against a second LiDAR data set, confirming the results of the spatial cross-validation of the model. The methodology of this study is designed for savanna vegetation structure mapping based on height estimates by using open-source software and open-access data, to allow for a continuation of woody cover classification and change monitoring in these types of ecosystems. CONSERVATION IMPLICATIONS: Information about the state and changes in woody cover are important for park management and conservation efforts. Both increasing (e.g. because of atmospheric carbon fertilisation) and decreasing (e.g. because of elephant impact) woody cover patterns will have cascading effects on other ecosystem processes such as fire and herbivory.

We have successfully prepared a clay-based polymer nanocomposite having grown cholesterol bearing poly(norbornene) brushes end-tethered from a naturally-occurring montmorillonite clay template. The synthesis of this hybrid material involved the treatment of the clay with first generation Grubbs catalyst, a ruthenium alkylidene, which induced a ring-opening metathesis and subsequent surface initiated polymerization of the cholesterol bearing monomer. This results in an inorganic/organic hybrid functional nanomaterial where the inclusion of the clay particles in a liquid crystalline domain modifies the thermal transitions.

Simple ionic liquids exhibit unique physical and chemical properties that make them very useful for deployment in electrochemical devices such as solvent-free electrolytes in capacitors and batteries. However, incorporating redox functionality into ionic liquid structures opens up in situ faradaic electrochemistry which allows access to a large array of new electrochemical applications reliant upon heterogeneous or homogenous electron-transfer processes. This paper presents and discusses the opportunities and challenges for these types of electro-materials across a myriad of applications by considering exemplar quinone-functionalised ionic liquids.

Los líquidos iónicos simples exhiben propiedades físicas y químicas únicas, lo que los hace de utilidad en dispositivos electroquímicos, funcionando como electrolitos libres de disolvente en capacitores y baterías. Sin embargo, la incorporación de funcionalidades redox en las estructuras de líquidos iónicos permite realizar electroquímica faradaica in situ, abriendo una nueva categoría de aplicaciones electroquímicas relevantes como procesos de transferencia electrónica heterogénea u homogénea. Este trabajo presenta y discute las oportunidades y retos en la generación de estos nuevos materiales sobre diversas aplicaciones, ejemplificadas mediante el uso de líquidos iónicos funcionalizados con grupos quinona.

Avanços recentes no conhecimento sobre a função do receptor de canabinoide renovaram o interesse na associação entre cannabis e psicose. Linhas convergentes de evidências sugerem que os canabinoides podem produzir uma ampla gama de sintomas transitórios positivos, negativos e cognitivos assemelhados aos de esquizofrenia. Os canabinoides também produzem alguns déficits psicofisiológicos sabidamente presentes na esquizofrenia. É igualmente claro que em indivíduos com um transtorno psicótico estabelecido, os canabinoides podem exacerbar sintomas, desencadear recaídas e ter consequências negativas no curso da doença. Evidências crescentes sugerem que a exposição precoce e pesada à cannabis pode aumentar o risco de se desenvolver um transtorno psicótico como a esquizofrenia. A relação entre exposição à cannabis e esquizofrenia preenche alguns, mas não todos os critérios usuais de causalidade. Porém, a maioria das pessoas que utilizam cannabis não desenvolve esquizofrenia e muitas pessoas diagnosticadas com esquizofrenia nunca utilizaram cannabis. Portanto, é provável que a exposição à cannabis seja uma "causa componente" que interage com outros fatores para "causar" esquizofrenia ou outro transtorno psicótico, mas não é nem necessária nem suficiente para fazê-lo sozinha. No entanto, na ausência de causas conhecidas da esquizofrenia e com as implicações de políticas de saúde pública, se tal vínculo for estabelecido, as causas componentes, tais como a exposição a canabinoide, devem continuar sendo um foco de estudos futuros. Finalmente, são necessárias mais pesquisas para identificar os fatores subjacentes à vulnerabilidade à psicose relacionada a canabinoide e para elucidar os mecanismos biológicos subjacentes a esse risco.

Recent advances in knowledge about cannabinoid receptor function have renewed interest in the association between cannabis and psychosis. Converging lines of evidence suggest that cannabinoids can produce a full range of transient schizophrenia-like positive, negative and cognitive symptoms. Cannabinoids also produce some psychophysiological deficits also known to be present in schizophrenia. Also clear is that in individuals with an established psychotic disorder, cannabinoids can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness. Increasing evidence suggests that early and heavy cannabis exposure may increase the risk of developing a psychotic disorder such as schizophrenia. The relationship between cannabis exposure and schizophrenia fulfills some, but not all, of the usual criteria for causality. However, most people who use cannabis do not develop schizophrenia, and many people diagnosed with schizophrenia have never used cannabis. Therefore, it is likely that cannabis exposure is a "component cause" that interacts with other factors to "cause" schizophrenia or other psychotic disorder, but is neither necessary nor sufficient to do so alone. In the absence of known causes of schizophrenia, however, and the implications for public health policy should such a link be established the role of component causes such as cannabinoid exposure should remain a focus of further study. Finally, further work is necessary to identify the factors that underlie individual vulnerability to cannabinoid-related psychosis and to elucidate the biological mechanisms underlying this risk.

OBJECTIVES: To introduce the combined South African cohorts of the International epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) collaboration as reflecting the South African national antiretroviral treatment (ART) programme; to characterise patients accessing these services; and to describe changes in services and patients from 2003 to 2007. DESIGN AND SETTING: Multi-cohort study of 11 ART programmes in Gauteng, Western Cape, Free State and KwaZulu-Natal. SUBJECTS: Adults and children (<16 years old) who initiated ART with ≥3 antiretroviral drugs before 2008. RESULTS: Most sites were offering free treatment to adults and children in the public sector, ranging from 264 to 17 835 patients per site. Among 45 383 adults and 6 198 children combined, median age (interquartile range) was 35.0 years (29.8 - 41.4) and 42.5 months (14.7 - 82.5), respectively. Of adults, 68% were female. The median CD4 cell count was 102 cells/µl (44 - 164) and was lower among males than females (86, 34 - 150 v. 110, 50 - 169, p<0.001). Median CD4% among children was 12% (7 - 17.7). Between 2003 and 2007, enrolment increased 11-fold in adults and 3-fold in children. Median CD4 count at enrolment increased for all adults (67 - 111 cells/µl, p<0.001) and for those in stage IV (39 - 89 cells/µl, p<0.001). Among children <5 years, baseline CD4% increased over time (11.5 - 16.0%, p <0.001). CONCLUSIONS: IeDEA-SA provides a unique opportunity to report on the national ART programme. The study describes dramatically increased enrolment over time. Late diagnosis and ART initiation, especially of men and children, need attention. Investment in sentinel sites will ensure good individual-level data while freeing most sites to continue with simplified reporting.

Foi realizado um estudo visando comparar os ambientes de várzea sistematizada e de posto meteorológico, no município de Mococa (SP), por meio de medições de temperatura e umidade relativa do ar, radiação solar global e velocidade do vento. No ambiente de várzea, foi medido também o saldo de radiação. A comparação de médias foi feita por análise de dados pareados, de outubro a março (representando as condições de primavera/verão) e de abril a julho (outono e inverno). A evapotranspiração na escala diária foi estimada pelo método de Penman-Monteith, adotado como padrão pela FAO. No período outono-inverno (O-I), observou-se que, para a temperatura máxima do ar, a diferença média entre os ambientes foi de 0,1 ºC; para a temperatura mínima do ar, a várzea apresentou média inferior de 3,4 ºC, enquanto no período de primavera-verão as temperaturas máximas, na várzea, foram, em média, 0,9 ºC mais elevadas que no posto meteorológico. Os valores de evapotranspiração, no período de primavera/verão, os dois ambientes analisados foram muito semelhantes. A evapotranspiração em ambos os ambientes variou entre 1,0 e 7,8 mm por dia com valores máximos ocorrendo no período outubro/novembro. Durante o outono/inverno as estimativas feitas para o posto meteorológico foram superiores em 1,6 mm por dia às da várzea. No período de outono-inverno foram mais acentuadas as diferenças entre várzea e posto meteorológico.

A study was conducted to compare the systematic flood plain environment and that of a Weather Station. The survey was conducted in the Mococa county, São Paulo State, Brazil. The measurements of the microclimatic parameters at the weather station and floodplain environment were made by means of the automated weather station (SCI) determining: temperature and relative humidity of the air, and global solar radiation. In the floodplain environment the net radiation was also measured. The average values were compared by paired comparison analysis, for the months from October to March (representing spring and summer conditions) and the months from April to July (representing autumn and winter conditions).The evapotranspiration in the daily scale was estimated by the Penman-Monteith method adopted by FAO. During the autumn-winter (O-I) period, in the floodplain, it was observed that the average maximum air temperature were 0.1ºC and the minimum air temperature was found to be 3.4ºC lower than the weather station environment. During autumn-winter period the maximum temperatures, at the floodplain, were 0,9 ºC higher than the standard weather conditions. Considering the evapotranspiration in the spring/summer period, the values in the two conditions analyzed (station vs. floodplain) were very similar. Evapotranspiration in both environments varied between 1.0 and 7.8 mm/day with maximum values occurring during the October/November period. On the other hand, the estimates made during the autumn/winter period for the weather station were higher, than those made for the floodplain. In the autumn/winter period the evapotranspiration estimated for the station were mostly superior( 1.6 mm/day) to those of the floodplain. During the autumn/winter period the differences between the environment of flood plains and weather station were higher showing that for the floodplains the microclimatic parameters are more extreme than for the weather station.