Brazilian Consensus on Photoprotection

Brazil is a country of continental dimensions with a large heterogeneity of climates and massive mixing of the population. Almost the entire national territory is located between the Equator and the Tropic of Capricorn, and the Earth axial tilt to the south certainly makes Brazil one of the countries of the world with greater extent of land in proximity to the sun. The Brazilian coastline, where most of its population lives, is more than 8,500 km long. Due to geographic characteristics and cultural trends, Brazilians are among the peoples with the highest annual exposure to the sun. Epidemiological data show a continuing increase in the incidence of nonmelanoma and melanoma skin cancers. Photoprotection can be understood as a set of measures aimed at reducing sun exposure and at preventing the development of acute and chronic actinic damage. Due to the peculiarities of Brazilian territory and culture, it would not be advisable to replicate the concepts of photoprotection from other developed countries, places with completely different climates and populations. Thus the Brazilian Society of Dermatology has developed the Brazilian Consensus on Photoprotection, the first official document on photoprotection developed in Brazil for Brazilians, with recommendations on matters involving photoprotection

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Stress-induced tailoring of energy storage properties in lead-free Ba0.85Ca0.15Zr0.1Ti0.9O3 ferroelectric bulk ceramics

In this study, the stress-modulated energy storage properties of lead-free polycrystalline Ba0.85Ca0.15Zr0.1Ti0.9O3 was investigated as a function of temperature from 25 °C to 55 °C. The externally applied uniaxial compressive stress of −160 MPa increased the recoverable energy storage density by 226% to a maximum value of 274 mJ/cm3, in addition to enhancing the energy storage efficiency by approximately 10% to a value of 88.2%. The macroscopic mechanical constitutive behavior is presented as well as the stress-dependent dielectric and ferroelectric properties and the Rayleigh behavior in order to elucidate the effect of stress on the energy storage properties. Importantly, the stress-induced tailoring of energy storage performance can be utilized for other nonlinear dielectric ceramics to tune their extrinsic polarization mechanisms to significantly enhance the recoverable energy density and reduce the hysteretic losses

The Impact of Grain Growth on the Functional Properties in Room-Temperature Powder Aerosol Deposited Free-Standing (Ba,Ca)(Zr,Ti)O₃ Thick Films

This study investigates the development of freestanding thick films (FSFs) of lead-free (Ba,Ca)(Zr,Ti)O3 and the role of grain growth on the electromechanical response. During deposition, room temperature powder aerosol deposition rapidly produces thick films with a nano-grain structure that limits the electromechanical properties. In this study, the films are removed from the substrate using a sacrificial buffering layer to avoid thermal treatment and allow for an initial as-processed state. Following this, FSFs were thermally treated at various annealing temperatures from 800 °C to 1400 °C to induce grain growth, which was characterized with scanning and transmission electron microscopy. X-ray diffraction revealed an increase in the crystallite size consistent with an increase in grain size and a decrease in internal residual stress. The temperature-dependent dielectric behavior and the large-field ferroelectric response were also characterized, revealing significant differences of the FSFs from the bulk properties

<i>In situ </i>electric field-dependent structural changes in (Ba,Ca)(Zr,Ti)O₃with varying grain size

The functional properties of piezoelectric ceramic materials, such as barium titanate, are highly dependent on grain size. Lead-free polycrystalline Ba0.85Ca0.15Zr0.1Ti0.9O3 (BCZT) samples were prepared with a combination of the hydrothermal method and spark plasma sintering to achieve grain sizes from 100 nm to 10 μm by varying the maximum sintering temperature. In this range, a transition from a nearly linear dielectric to a ferroelectric response can be seen in macroscopic electromechanical measurements, demonstrating the importance of grain size on functional properties in BCZT. Furthermore, in situ electric field-dependent synchrotron X-ray diffraction measurements were performed to quantify the intrinsic and extrinsic strain contributions and their variations with grain size. At lower grain sizes, the data revealed a significant loss of extrinsic contributions in the piezoelectric behavior, limiting the response to intrinsic contribution associated with lattice strain. For BCZT, a critical grain size between approximately 0.08 to 0.18 μm is proposed, below which no piezoelectric response was observed

Influence of Grain Size on Electromechanical Properties of (Ba,Ca)(Zr,Ti)O₃: A Multiscale Analysis Using Spark Plasma Sintering and Aerosol Deposition

The piezoelectric and ferroelectric properties of aerosol deposited (AD) thick ceramic films are significantly reduced in comparison to bulk materials, which is assumed to be largely related to the nanometer-sized grains (∼ 0.01 μm) observed in the resulting microstructures. This work, therefore, focuses on understanding the role of grain size in electromechanical properties within the range of AD films based on Ba0.85Ca0.15Zr0.1O3 (BCZT). In a comprehensive compilation of the piezoelectric constant (d33) of samples from various studies the grain size dependency of the d33 was shown for the lead-free ferroelectrics BCZT, BaTiO3, and (K,Na)NbO3. In this, it can be seen that no BCZT sample with a grain size below 0.4 μm was analyzed regarding their d33 before, thereby leaving a gap to the grain size of AD films. In this study, the grain size of ceramic bulk samples was varied using spark plasma and conventional sintering (0.1 μm – 11 μm) and their properties compared to those of AD films. To enable the fabrication of bulk samples in the same range as AD films, a hydrothermal powder with an average particle size of 0.075 μm was synthesized. A continuous increase of the permittivity, the polarization, and the piezoelectric coefficient was observed through grain size increase. These results suggest that the grain size of AD films needs to be enhanced to improve their properties. Importantly, the insights of this multiscale analysis on the grain size can help to tailor also the properties of other BCZT films and bulk samples.<br/

Obesity and associated lifestyle in a large sample of multi-morbid German primary care attendees.

Obesity and the accompanying increased morbidity and mortality risk is highly prevalent among older adults. As obese elderly might benefit from intentional weight reduction, it is necessary to determine associated and potentially modifiable factors on senior obesity. This cross-sectional study focuses on multi-morbid patients which make up the majority in primary care. It reports on the prevalence of senior obesity and its associations with lifestyle behaviors.A total of 3,189 non-demented, multi-morbid participants aged 65-85 years were recruited in primary care within the German MultiCare-study. Physical activity, smoking, alcohol consumption and quantity and quality of nutritional intake were classified as relevant lifestyle factors. Body Mass Index (BMI, general obesity) and waist circumference (WC, abdominal obesity) were used as outcome measures and regression analyses were conducted.About one third of all patients were classified as obese according to BMI. The prevalence of abdominal obesity was 73.5%. Adjusted for socio-demographic variables and objective and subjective disease burden, participants with low physical activity had a 1.6 kg/m2 higher BMI as well as a higher WC (4.9 cm, p<0.001). Current smoking and high alcohol consumption were associated with a lower BMI and WC. In multivariate logistic regression, using elevated WC and BMI as categorical outcomes, the same pattern in lifestyle factors was observed. Only for WC, not current but former smoking was associated with a higher probability for elevated WC. Dietary intake in quantity and quality was not associated with BMI or WC in either model.Further research is needed to clarify if the huge prevalence discrepancy between BMI and WC also reflects a difference in obesity-related morbidity and mortality. Yet, age-specific thresholds for the BMI are needed likewise. Encouraging and promoting physical activity in older adults might a starting point for weight reduction efforts

Cross-Cultural Validation of the Four-Dimensional Symptom Questionnaire (4DSQ) in Multimorbid Elderly People

Purpose: Psychosomatic symptoms and mental health problems are highly prevalent in multimorbid elderly people challenging general practitioners to differentiate between normal stress and psychopathological conditions. The 4DSQ is a Dutch questionnaire developed to detect anxiety, depression, somatization, and distress in primary care. This study aims to analyze measurement equivalence between a German version and the original Dutch instrument. Methods: A Dutch and a German sample of multimorbid elderly people, matched by gender and age, were analyzed. Equivalence of scale structures was assessed by confirmatory factor analysis (CFA). To evaluate measurement equivalence across languages, differential item functioning (DIF) was analyzed using Mantel–Haenszel method and hybrid ordinal logistic regression analysis. Differential test functioning (DTF) was assessed using Rasch analysis. Results: A total of 185 German and 185 Dutch participants completed the questionnaire. The CFA confirmed one-factor models for all scales of both 4DSQ versions. Nine items in three scales were flagged with DIF. The anxiety scale showed to be free of DIF. DTF analysis revealed negligible scale impact of DIF. Conclusions: The German 4DSQ demonstrated measurement equivalence to the original Dutch instrument. Hence, it can be considered a valid questionnaire for the screening for mental health problems in primary care