Restrictive Approach Research Articles

Protective Effects of Chlorogenic Acid Against Amyloid-Beta-Induced Oxidative Stress and Ion Transport Dysfunction in SH-SY5Y Cells.

Caloric restriction mimetics mimic the beneficial effects of dietary restriction approaches, such as caloric restriction approaches, without limiting the dietary intake. Chlorogenic acid (CGA) acts as a caloric restriction mimetic; however, its neuroprotective mechanisms remain ambiguous. Therefore, in this study, we aimed to elucidate the neuroprotective effects of CGA on SH-SY5Y cells treated with amyloid-beta (Aβ)1-42. Aβ1-42 (1.25 μM) induced oxidative stress by significantly increasing the pro-oxidant levels and decreasing the antioxidant levels in the cells. Additionally, it decreased the Na+/K+-ATPase and Ca2+-ATPase ion transporter activities and enhanced the acetylcholinesterase activity. However, CGA (100 μM) reversed these Aβ1-42-induced changes in SH-SY5Y cells. Overall, CGA exerted neuroprotective effects against Aβ1-42-induced oxidative stress and impaired ion transporter and acetylcholinesterase activities, serving as a promising therapeutic candidate for neurodegenerative diseases, such as Alzheimer's disease.

Timing of veno-arterial extracorporeal membrane oxygenation support in patients with cardiogenic shock.

The optimal timing for implementing mechanical circulatory support (MCS) in cardiogenic shock (CS) remains indeterminate. This study aims to evaluate patient characteristics and outcome associated with the time interval between CS onset and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implementation. In this study, patients with CS treated with MCS at 15 tertiary care centres in three countries were enrolled. Patients treated with MCS were stratified into early (<2 h), intermediate (2-12 h) and delayed (≥12-24 h) MCS implantation by using the time interval between CS onset and MCS device implementation. Adjusted logistic and Cox regression models were fitted to assess the association between timing of MCS implementation, patient characteristics and 30-day mortality. A total of 330 patients with CS treated with VA-ECMO and/or microaxial flow pump were included in this study; 20.9% received early, 55.8% intermediate, and 23.3% delayed MCS. Although crude 30-day mortality was slightly lower in patients with early MCS (58.1% vs. 64.7% vs. 64.3%), adjusted analyses showed no significant association between timing of MCS implantation and 30-day all-cause mortality (hazard ratio [HR] for early vs. intermediate MCS: 0.93, 95% confidence interval [CI] 0.59-1.46, p = 0.74; HR for early vs. delayed MCS: 1.29, 95% CI 0.78-2.13, p = 0.33). Moreover, the incidence of complications, related and unrelated to MCS, did not differ significantly among groups. In this exploratory study of patients with CS treated with MCS, the timing of device implantation within 24 h after CS onset was not associated with mortality. This supports a restrictive MCS approach, reserving its application for patients experiencing CS deterioration despite conventional therapy.

Health optimisation for patients with obesity before elective orthopaedic surgery: a qualitative study of professionals’ views on restrictive approaches and future practice

BackgroundPreoperative health optimisation for elective surgery entails supporting patients to improve their health in preparation for their treatment and recovery. While there is consensus that this process should address obesity, approaches vary across England. Despite guidance from the National Institute for Health and Care Excellence to the contrary, restrictive approaches with body mass index thresholds for referral to arthroplasty are in use. This qualitative study aimed to investigate the views of professionals on the current use and future implications of these policies.MethodsSemi-structured interviews were conducted with 20 professionals including clinicians, commissioners, policymakers, and health service managers, with experience of developing and/or implementing health optimisation policies for elective arthroplasty. Participants were sampled from areas in England with and without restrictive policies. We undertook thematic analysis of the interview data.ResultsParticipants described pre-surgical health optimisation as an important trigger for health improvement but identified current resourcing and inadequacies in provision of weight management support as significant barriers to success. Participants expressed concerns about the appropriateness and fairness of including obesity as a determinant to restrict access to surgery. They described short-term financial pressures underlying the use of restrictive body mass index thresholds and a lack of an evidence base, such that policies amounted to rationing and risked exacerbations of health inequalities. The study identified four priorities for improvements to future health optimisation practices: developing and implementing national guidance with flexibility for local variation, initiating patient engagement in primary care with onward integration across all services, improving resourcing to support effective equitable impact, and addressing wider determinants of obesity through societal change.ConclusionsOverall, participants had limited expectations of the impact of health optimisation policies on obesity without additional support, investment, and national guideline implementation. They raised strong concerns over current restrictive approaches. We conclude that addressing concerns around weight management support service availability and impacts on health inequalities is essential for shaping effective health optimisation policies. Future policy direction should support health optimisation to be offered early (ideally in primary care). Health optimisation interventions should be non-restrictive, inclusive, and well-monitored, particularly around equality impact.

Real-time, dense UAV mapping by leveraging monocular depth prediction with monocular-inertial SLAM

We present a dense and metric 3D mapping pipeline designed for embedded operation on-board UAVs, by loosely coupling deep neural networks trained to infer dense depth single images with a SLAM system that restores metric scale from sparse depth. In contrast to computationally restrictive approaches that leverage multiple views, we propose a highly efficient, single-view approach without sacrificing 3D mapping performance. This enables real-time construction of a global 3D voxel map by iterative fusion of the rescaled dense depth maps obtained via raycasting from the estimated camera poses. Quantitative and qualitative experimentations of our framework in challenging environmental conditions show comparable or superior performance with respect to state-of-the-art approaches via a better effectiveness-efficiency trade-off.

Escalation of Human Resource Quality in National Health Resilience Through Estimating Multilevel Model Parameters with the Restricted Maximum Likelihood Approach to The 2019 UTBK Average

Multilevel modeling or Hierarchical Linear Modeling (HLM) is a statistical approach specifically used to analyze data with a two-level structure. This approach allows an understanding of the contribution of factors at both the individual and group levels to the response variable. One method commonly used in HLM is Restricted Maximum Likelihood (REML). REML is a parameter estimation method that is often applied in statistical models, especially linear models that incorporate random components. This allows more efficient parameter assessment compared to conventional estimation methods. In this research, multilevel model parameter estimation analysis was carried out using the limited maximum likelihood approach. The aim is to determine the multilevel linear regression model on the average UTBK score for health cluster study programs in 2019. This involves selecting the optimal node point based on the minimum Generalized Cross Validation (GCV) and identifying the factors that influence it. Predictor variables considered include interest and capacity of study programs at university level (Level-1), as well as the average UNBK and HDI scores at provincial level (Level-2). The findings of this research indicate that the most appropriate multilevel regression model is formed with three nodes with a minimum GCV value at Level-1 of 864.6593 and at Level-2 of 3.1816. At Level-1, the influencing factor is the interest variable and at Level-2 is the average provincial UNBK score in 2019 and the Human Development Index (HDI).

The Healthy User Effect in Pharmacoepidemiology.

The healthy user effect is a well-recognized bias in the field of pharmacoepidemiology and can be expected to overstate the effect of a preventive intervention when comparing long term users or "adherers" to non-users. Similar to the healthy worker effect observed in occupational epidemiology, the healthy user effect can be separated into a healthy initiator effect (baseline confounding) and a healthy adherer effect (selection bias). Restriction approaches and new user designs that implicitly condition on the indication and, similar healthy behaviors or health status can often mitigate the healthy initiator effect (confounding) or healthy adherer effect (selection bias) at the start of a study. Addressing the healthy adherer effect due to continued conditioning on adherence over the duration of a study is more challenging as methods to mitigate it require the ability to predict adherence, which is often difficult using databases common in pharmacoepidemiologic research. Here, we describe the healthy user effect, with supporting examples, and describe study design approaches available to pharmacoepidemiologists to mitigate the potential for bias.

Clinicians’ attitudes towards supplemental oxygen for trauma patients – A survey

IntroductionThe Advanced Trauma Life Support guidelines (ATLS; 2018, 10th ed.) recommend an early and liberal supplemental oxygen for all severely injured trauma patients to prevent hypoxaemia. As of 2024, these guidelines remain the most current. This may lead to hyperoxaemia, which has been associated with increased mortality and respiratory complications. We aimed to investigate the attitudes among clinicians, defined as physicians and prehospital personnel, towards the use of supplemental oxygen in trauma cases. Materials and methodsA European, web-based, cross-sectional survey was conducted consisting of 23 questions. The primary outcome was the question: “In your opinion, should all severely injured trauma patients always be given supplemental oxygen, regardless of arterial oxygen saturation measured by pulse oximetry?”. ResultsThe survey was answered by 707 respondents, which corresponded to a response rate of 52 %. The respondents were predominantly male (76 %), with the largest representation from Denmark (82 %), and primarily educated as physicians (62 %). A majority of respondents (73 % [95 % CI: 70 to 76 %]) did not support that supplemental oxygen should always be provided to all severely injured trauma patients without consideration of their arterial oxygen saturation as measured by pulse oximetry (SpO2), with no significant difference between physicians and non-physicians (p = 0.08). Based on the respondents’ preferred dosages, the median initial administered dosage of supplemental oxygen for spontaneously breathing trauma patients with a normal SpO2 in the first few hours after trauma was 0 (interquartile range [IQR] 0–3) litres per minute, with 58 % of respondents opting not to provide any supplemental oxygen. The lowest acceptable SpO2 goal in the first few hours after trauma was 94 % (IQR 92–95). In clinical scenarios with TBI, higher dosage of supplemental oxygen and fraction of inspired oxygen (FiO2) were preferred, as well as targeting partial pressure of oxygen in arterial blood as opposed to adjusting the FiO2 directly, compared to no TBI. ConclusionAlmost three out of four clinicians did not support the administration of supplemental oxygen to all severely injured trauma patients, regardless of SpO2. This corresponds to a more restrictive approach than recommended in the current ATLS (2018, 10th ed.) guidelines.

Mental Health Education: Challenges And Future Perspectives

Basic education is a fundamental right and essential for the development of nations, as evidenced by the need for quality educational training. The relationship between socio-emotional behavior and learning is crucial, as cognitive and emotional characteristics directly affect learning. Mental health, often misunderstood and reduced to a restrictive treatment approach, is a determining factor in children's development, influencing emotional issues and how they develop throughout life. The school environment, where children spend most of their time, becomes central to promoting mental health and early intervention. Schools not only provide literacy but should also act as a space for socialization and prevention, integrating practices that address emotional and behavioral issues. The National Common Curricular Base (BNCC) emphasizes the importance of emotional and social competencies, such as empathy and conflict resolution, which are essential for the holistic development of students. Teacher training programs are vital, as they enable teachers to identify signs of emotional problems and intervene appropriately. Educator training should include knowledge about mental disorders and strategies to promote mental health, which can improve academic performance and student wellbeing. The approach should be holistic and student-centered, considering both individual needs and the social context. Ultimately, the school plays a transformative role in society, needing to adapt its curricula and practices to include topics of mental health and well-being, following Paulo Freire’s critical and emancipatory perspective. By integrating health actions into the daily school routine, schools contribute to the development of conscious citizens prepared to face life’s challenges.

550. INTRAOPERATIVE VOLUME STATUS DOES NOT AFFECT ERAS OUTCOMES OR COMPLICATION RATES IN HYBRID ROBOTIC ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY

Abstract Background Intraoperative volume management in patients undergoing esophagectomy is nuanced. Data is conflicting in regards to the benefits of volume restrictive versus liberal approaches. Within a hybrid robotic assisted minimally invasive esophagectomy (hRAMIE) population undergoing oncologic resection there is a paucity of data regarding intraoperative volume status as it affects postoperative outcomes and no data regarding the impact on enhanced recovery after surgery (ERAS) outcomes. Methods Demographics, anthropometrics, cancer characteristics, and perioperative outcome data were gathered between January 2020 and December 2023 at a single, tertiary referral center in patients undergoing oncologic hRAMIE. Intraoperative volume status was defined, as in other reports, by identifying the median operative volume rate per hour and normalizing via the Du Bois body surface area; above or below 225 mL/hour/m2. ERAS outcomes were reported. Complications were stratified in accordance with the Esophagectomy Complications Consensus Group guidelines. Continuous variables were compared via Mann-Whitney U-Test; categorical via Fisher's Exact. Alpha set to 0.05. Results 96 patients (46 volume restrictive, 45 volume liberal) were identified. There were no differences in age, sex, body mass index, ASA class, Charlson Comorbidity Index, cancer histology, location, rate of neoadjuvant chemotherapy, or chemoradiotherapy. ERAS outcomes analysis reveals no statistical difference in ICU length of stay, mobilization times, return of bowel function, or length of stay (Table 1). Complications were reported in 45.8% of patients and did not differ between groups (p=0.8934). Pulmonary complications were most frequent (total 21.9%; restrictive 17.4%, liberal 28.9%, p=0.1422) followed by anastomotic leak (total 12.5%; restrictive 17.4%, liberal 8.9%, p=0.3681). Conclusion The current study demonstrates no impact of volume restriction on perioperative outcomes, ERAS benchmarks, or length of stay in patients undergoing hRAMIE for esophageal cancer. Data suggests that minimally invasive approaches may be associated with less total body and pleural inflammatory mediator generation, perhaps limiting susceptibility to variation in volume status. Highly powered, multicenter retrospective minimally invasive esophagectomy and volume status investigation is warranted prior to proceeding with controlled trial.

Lipid discovery enabled by sequence statistics and machine learning.

Bacterial membranes are complex and dynamic, arising from an array of evolutionary pressures. One enzyme that alters membrane compositions through covalent lipid modification is MprF. We recently identified that Streptococcus agalactiae MprF synthesizes lysyl-phosphatidylglycerol (Lys-PG) from anionic PG, and a novel cationic lipid, lysyl-glucosyl-diacylglycerol (Lys-Glc-DAG), from neutral glycolipid Glc-DAG. This unexpected result prompted us to investigate whether Lys-Glc-DAG occurs in other MprF-containing bacteria, and whether other novel MprF products exist. Here, we studied protein sequence features determining MprF substrate specificity. First, pairwise analyses identified several streptococ-cal MprFs synthesizing Lys-Glc-DAG. Second, a restricted Boltzmann machine-guided approach led us to discover an entirely new substrate for MprF in Enterococcus , diglucosyl-diacylglycerol (Glc 2 -DAG), and an expanded set of organisms that modify glycolipid substrates using MprF. Overall, we combined the wealth of available sequence data with machine learning to model evolutionary constraints on MprF sequences across the bacterial domain, thereby identifying a novel cationic lipid.

Restrictive Approach to Data Protection in the gcc: Is the EU gdpr a Potential Inspiration?

Abstract The implementation of data protection laws in Gulf Cooperation Countries (gcc) has been a phased and incremental development. Qatar took the lead by enacting such legislation in 2016, paving the way for subsequent adoption in Bahrain in 2018 and Kuwait in 2021. The economic growth and increased use of digital technology in major gcc states like Saudi Arabia and Qatar have played a role in necessitating the development of data protection laws. The awareness of cyberattack risks has further emphasized the importance of having a legal framework to protect data, especially as multinational companies and startups operate in these regions. The fact that the adoption of data protection laws is relatively recent in gcc countries highlights the evolving nature of data privacy regulations in the region. It’s noteworthy that the European Union’s General Data Protection Regulation (gdpr) is seen as a reference point and could potentially influence the development of data protection laws in the gcc. Understanding the gdpr is crucial for gcc countries, not only to align with global data protection standards but also to potentially contribute to the creation of a unified regional data protection framework.

New Biomarkers to Define a Biological Borderline Situation for Pancreatic Adenocarcinoma: Results of an Ancillary Study of the PANACHE01-PRODIGE48 Trial.

To investigate in patients treated for a resectable pancreatic ductal adenocarcinoma [pancreatic adenocarcinoma (PA)], the prognostic value of baseline carbohydrate antigen 19.9 (CA19-9) and circulating tumor DNA (ctDNA) for overall survival (OS), to improve death risk stratification, based on a planned ancillary study from PANACHE01-PRODIGE 48 trial. Biological borderline situation that was first used by the MD Anderson, became a standard practice following the international consensus conference in 2016 to manage PA. Regarding the risk of systemic disease, especially in the setting of "markedly elevated" CA19-9, neoadjuvant therapy is advised to avoid unnecessary surgery, with a risk of early recurrence. To best define biological borderline situations, new biomarkers are needed. Characteristics at diagnosis and OS were compared between patients with or without ctDNA status available. OS was estimated with the Kaplan-Meier method and compared with a log-rank test. The restricted cubic spline approach was used to identify the optimal threshold for biological parameters for death risk stratification. Univariate and multivariate Cox proportional hazard models were estimated to assess the association of ctDNA status and other parameters with OS. Among the 132 patients from the primary population for analysis in the PANACHE01 -PRODIGE 48 trial, 92(71%) were available for ctDNA status at diagnosis. No selection bias was identified between patients with or without ctDNA status. Fourteen patients (15%) were ctDNA+ and exhibited a higher risk for death [ P = 0.0188; hazard ratio (95% CI): 2.28 (1.12-4.63)]. In the 92 patients with ctDNA status available among the other parameters analyzed, only CA19-9 was statically associated with OS in univariate analysis. Patients with a log of CA19-9 equal or superior to 4.4 that corresponds to a CA19-9 of 80 UI/mL were identified at higher risk for death [ P = 0.0143; hazard ratio (95% CI): 2.2 (1.15-4.19)]. In multivariate analysis, CA19-19 remained independently associated with OS ( P = 0.0323). When combining the 2 biomarkers, the median OS was 19.4 [IC 95%: 3.8-not reached (NR)] months, 30.2 (IC 95%: 17.1-NR) months and NR (IC 95%: 39.3-NR) for "CA19-9 high and ctDNA+ group," "CA19-9 high or ctDNA+ group," and "CA19-9 low and ctDNA- group," respectively (log-rank P = 0.0069). Progress in the management of potentially operable PA remains limited, relying solely on strategies to optimize the sequence of complete treatment, based on modern multidrug chemotherapy (FOLFIRINOX, GemNabPaclitaxel) and surgical resection. The identification of risk criteria, such as the existence of systemic disease, is an important issue, currently referred to as "biological borderline disease." Few data, particularly from prospective studies, allow us to identify biomarkers other than CA19-9. Combining ctDNA with CA19-9 could be of interest to best define biological borderline situations in PA.

The Socio-Economic Contribution of Muʾlft qulub and Fi sabilillah Zakat: Contemporary Applications in Sri Lanka

The zakat obligation mandates Muslims with surplus wealth to donate to specific beneficiaries. In Sri Lankan zakat jurisprudence, Muʾlft qulub is narrowly interpreted to include only recent converts to Islam, while Fi sabilillah is limited to warriors fighting for Islam. This interpretation follows the Shafiʿi school of thought, which advises against distributing zakat to non-Muslims or to righteous individuals broadly. This restrictive approach undermines the broader objectives of zakat, such as promoting social justice, reducing poverty, enhancing welfare, ensuring economic stability, and fostering inter- and intra-community relationships. The paper employs a qualitative content analysis methodology alongside a Muslim minority fiqh approach to connect Islamic principles with the socio-economic context of the Sri Lankan Muslim minority. It argues that the classical jurisprudential interpretation is inadequate for addressing the unique challenges of the modern Sri Lankan socio-economic environment. By applying a fiqh of the Muslim minority approach, the paper suggests a moderate expansion of the Muʾlft qulub and Fi sabilillah categories. This expansion would help achieve the broader socio-economic goals of zakat and empower the Muslim community in Sri Lanka.

Considerations of (Non)-Application of Immunity of State Officials from Foreign Jurisdiction in Cases of International and Transnational Crimes

Abstract This article examines the scope and limitations of jurisdictional immunities afforded to high-ranking state officials accused of international and transnational crimes in foreign courts, including international courts. It discusses how international law balances the immunities granted to facilitate international relations and uphold state sovereignty against the need to address serious crimes that threaten the international community as a whole. The analysis delves into key legal debates and landmark cases shaping the understanding of these immunities. A focal point of the analysis is the work of the International Law Commission (ilc) on the topic of Immunity of State Officials from Foreign Criminal Jurisdiction, particularly Draft Article 7. It is argued that ilc’s Draft Article 7, while explicitly clarifying the application of immunity in international crime cases, also provides valuable insights into the scope of immunity for transnational crimes. Transnational crimes, like corruption, are fundamentally private acts carried out for personal gain, regardless of whether they are committed by someone in an official capacity or utilizing the resources and instrumentalities of the state. Therefore, these acts cannot be considered official and do not trigger the application of immunity ratione materiae. By highlighting the implications of Draft Article 7, the article contributes to the broader understanding of how international law can reconcile the need for state officials to perform their duties without fear of foreign prosecution with the necessity of holding them accountable for serious crimes. It suggests a more restrictive approach to immunity, particularly concerning transnational crimes, thereby enhancing the potential for legal accountability for offending state officials.

Probe Specification and Agreement Variation: Evidence from the Algonquian Inverse

The distribution of a special agreement pattern known as the “inverse” varies across the Algonquian languages. This article shows that, under an interaction-and-satisfaction model of ϕ-agreement (Deal 2015, 2021), twelve distinct distributions of inverse agreement can be derived simply by varying the interaction and satisfaction conditions of the probe on Infl. This syntax-based approach to agreement variation has strong predictive power: it not only accounts for the twelve attested patterns but also rules out the unattested patterns, a result that a less restrictive postsyntactic approach cannot deliver. The Algonquian data thus provide support for a syntactic model of agreement patterns in general, and for the interaction-and-satisfaction model in particular.

ADAPTATION OF AN AGRICULTURAL PROJECT TO THE REGULATION OF GREENHOUSE GAS EMISSIONS

Using an original methodological approach, a model analysis of the adaptation of an agricultural project to the regulation of greenhouse gas emissions from agricultural land was carried out for the farms in the south of Russia. Emissions from both technological and ecosystem processes were taken into account. Methods of operations research and simulation modeling are applied to the study of two options for regulating greenhouse gas emissions, i.e. through market mechanisms focusing on the cost of carbon units in the EU and through the administrative control, which sets the emission limits. For each of the options, the optimal intensity of use was estimated for each land plot involved in the project.The proposed methodology supplements the scientific and methodological support for the analysis of the largescale agricultural projects under the state regulation of the impact of economic activities on the Earth’s climate. It is applicable to projects with a significant spatial dispersion of plots. As a result of the study, the scientific visions of the climate policy impact on the technological configuration of agricultural production were specified. A significant margin of sustainability of agriculture in the south of Russia to carbon market methods has been revealed; It is shown that as the restrictive administrative approaches are tightened, farmers prefer to stop the intensive use of areas with the highest productivity potential while maintaining the maximum production intensity within the rest. The totality of the results obtained is recommended for practical application for developing and analyzing investment agricultural projects, including the analysis of project risks, as well as for improving the state environmental and climate policy as a tool for analyzing its consequences.

Caesarean section on maternal request: a qualitative study of conflicts related to shared decision-making and person-centred care in Sweden

BackgroundToday, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals’ perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making.MethodsA qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription.ResultsIn the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman’s current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman’s sense of security (an uncomplicated decision-making process). ConclusionsThe complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals’ reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context.

Totalidade e pragmatismo teórico

This article is part of a growing problem within the current stage of global and especially national economic development. Given the socioeconomic, cultural and educational context in which social relations are increasingly guided by immediacy (instrumentalization) and their practicality given the accelerated need to accumulate wealth, restrictive approaches within research cause the order of the educational process as a whole to be lost. In other words, education is a social relationship and, as such, subject to the same logic as the determinations of society: society increasingly loses its capacity to understand more complex dynamics of its own processes; in education, the relevance of theory and training as the development of subjectivities and not of the self is lost. Instead of networks, walls are formed and “education for war” becomes the paradigm of the entire educational process.

Associations of Local Cannabis Control Policies With Harmful Cannabis Exposures Reported to the California Poison Control System.

Cannabis exposures reported to the California Poison Control System increased following the initiation of recreational cannabis sales on 1 January 2018 (i.e., "commercialization"). We evaluated whether local cannabis control policies adopted by 2021 were associated with shifts in harmful cannabis exposures. Using cannabis control policies collected for all 539 California cities and counties in 2020-2021, we applied a differences-in-differences design with negative binomial regression to test the association of policies with harmful cannabis exposures reported to California Poison Control System (2011-2020), before and after commercialization. We considered three policy categories: bans on storefront recreational retail cannabis businesses, overall restrictiveness, and specific recommended provisions (restricting product types or potency, packaging and labeling restrictions, and server training requirements). Localities that ultimately banned storefront recreational retail cannabis businesses had fewer harmful cannabis exposures for children aged <13 years (rate ratio = 0.82; 95% confidence interval = 0.65, 1.02), but not for people aged >13 years (rate ratio = 0.97; 95% confidence interval = 0.85, 1.11). Of 167 localities ultimately permitting recreational cannabis sales, overall restrictiveness was not associated with harmful cannabis exposures among children aged <13 years, but for people aged >13 years, a 1-standard deviation increase in ultimate restrictiveness was associated with fewer harmful cannabis exposures (rate ratio = 0.93; 95% confidence interval = 0.86, 1.01). For recommended provisions, estimates were generally too imprecise to detect associations with harmful cannabis exposures. Bans on storefront retail and other restrictive approaches to regulating recreational cannabis may be associated with fewer harmful cannabis exposures for some age groups following statewide commercialization.

Intermittent Fasting: Myths, Fakes and Truth on This Dietary Regimen Approach.

Intermittent fasting (IF) has been indicated as a valuable alternative to the classical caloric restriction dietary regimen for lowering body weight and preventing obesity-related complications, such as metabolic syndrome and type II diabetes. However, is it effective? In this review article, we analyzed over 50 clinical studies in which IF, conducted by alternate day fasting (ADF) or time-restricted feeding (TRF), was compared with the caloric restriction approach. We evaluated the different roles of IF in treating and preventing human disorders such as metabolic syndrome, type II diabetes, and some types of cancer, as well as the usefulness of IF in reducing body weight and cardiovascular risk factors such as hypertension. Furthermore, we explored the cellular pathways targeted by IF to exert their beneficial effects by activating effector proteins that modulate cell functions and resistance to oxidative stress. In contrast, we investigated concerns regarding human health related to the adoption of IF dietary regimens, highlighting the profound debate surrounding weight loss regimens. We examined and compared several clinical trials to formulate an updated concept regarding IF and its therapeutic potential.