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Artificial Intelligence (AI) is increasingly influential across various sectors, including healthcare, with the potential to revolutionize clinical practice. However, risks associated with AI adoption in medicine have also been identified. Despite the general understanding that AI will impact healthcare, studies that assess the perceptions of medical doctors about AI use in medicine are still scarce. We set out to survey the medical doctors licensed to practice medicine in Portugal about the impact, advantages, and disadvantages of AI adoption in clinical practice. We designed an observational, descriptive, cross-sectional study with a quantitative approach and developed an online survey which addressed the following aspects: impact on healthcare quality of the extraction and processing of health data via AI; delegation of clinical procedures on AI tools; perception of the impact of AI in clinical practice; perceived advantages of using AI in clinical practice; perceived disadvantages of using AI in clinical practice and predisposition to adopt AI in professional activity. Our sample was also subject to demographic, professional and digital use and proficiency characterization. We obtained 1013 valid, fully answered questionnaires (sample representativeness of 99%, confidence level ( p < 0.01), for the total universe of medical doctors licensed to practice in Portugal). Our results reveal that, in general terms, the medical community surveyed is optimistic about AI use in medicine and are predisposed to adopt it while still aware of some disadvantages and challenges to AI use in healthcare. Most medical doctors surveyed are also convinced that AI should be part of medical formation. These findings contribute to facilitating the professional integration of AI in medical practice in Portugal, aiding the seamless integration of AI into clinical workflows by leveraging its perceived strengths according to healthcare professionals. This study identifies challenges such as gaps in medical curricula, which hinder the adoption of AI applications due to inadequate digital health training. Due to high professional integration in the healthcare sector, particularly within the European Union, our results are also relevant for other jurisdictions and across diverse healthcare systems.

Drought indices are a numerical representation of drought conditions aimed to provide quantitative assessments of the magnitude, spatial extent, timing, and duration of drought events. Since the adverse effects of droughts vary according to the characteristics of the event, the socioeconomic vulnerabilities, exposed communities or environments, there is a profusion of drought indicators to assess drought impacts in different sectors. In this study, we evaluated the performance of two drought indices, the Standardized Precipitation Index—SPI and Standardized Precipitation Evapotranspiration Index—SPEI over Brazil derived from gridded meteorological information over the period 1980–2019. Firstly, we compared the gridded derived indices against the same indices derived from weather station data and available from a global dataset for time scales of 3, 6, 12, 24 months. Then we analyzed the spatio-temporal trends in SPI and SPEI time-series, which revealed statistically significant trends toward drier conditions across central Brazil for all time scales, though with more intensity for time scales of 12 months and larger. Trends were more significant in magnitude for SPEI than SPI, indicating an important role in the increase in evaporation, driven by increasingly higher temperatures. Finally, we demonstrated that climate signals are already having a disruptive effect on the country's energy security.

Drought-related disasters are among the natural disasters that are able to cause large economic and social losses. In recent years, droughts have affected different regions of Brazil, impacting water, food, and energy security. In this study, we used the Integrated Drought Index (IDI), which combines a meteorological-based drought index and remote sensing-based index, to assess the drought events from 2011 to 2019 over Brazil. During this period, drought events were observed throughout the country, being most severe and widespread between the years 2011 and 2017. In most of the country, the 2014/15 hydrological year stands out due to the higher occurrence of severe and moderate droughts. However, drought intensity and observed impacts were different for each region, which is shown by the different case studies, assessing different types of impacts caused by drought in Brazil. Thus, it is fundamental to evaluate the impacts of droughts in a continental country such as Brazil, where a variety of vegetation, soil, land use, and especially different climate regimes predominate.

Brazil’s Pantanal wetland is one of the most threatened Brazilian ecosystems from direct anthropogenic pressures and climate change. In this study, the overarching research question is to explore whether compound drought-heat events (CDHEs) have become more recurrent, intense, and widespread over Brazil’s Pantanal wetland in recent decades. For this, we purpose and tested two different approaches using validated long-term time series of monthly precipitation, temperature, and the satellite-based Vegetation Health Index (VHI) to characterize the spatiotemporal pattern of CDHEs over Pantanal. Firstly, we assessed global gridded precipitation and temperature data sets against ground measurements to choose an appropriate dataset for this study. Then, we calculated the Standardized Precipitation Index (SPI), Standardized Temperature Index (STI), and Standardized Precipitation Evapotranspiration Index (SPEI) from 1981 to 2021. The results showed that using both approaches (CDHE-M1 and CDHE-M2), the frequency of events is higher considering the moderate category, which is expected since the criteria are less restrictive. In addition, the highest frequency of CDHE events occurs between September and November (the end of the dry season). The results also indicated that CDHE events have been more recurrent and widespread since 2000 in Pantanal. Besides, considering all methods for identifying the CDHEs, the probability density function indicates a shift pattern to warmer and drier conditions in the last 40 years. The Mann–Kendall tests also confirmed the assumption that there is a significantly increasing trend in the compound drought-heat events in the Pantanal. Developing methodologies for monitoring compound climate events is crucial for assessing climate risks in a warming climate. Besides, it is expected that our results contribute to the convincing of the urgent need for environmental protection strategies and disaster risk reduction plans for the Pantanal.

With the advent of smart grid theory, distribution networks can include different microgrids (MGs). Therefore, to achieve the desired technical and economic objectives in these networks, there is a need for bilateral coordination between their operators. In the following, by defining an energy management problem for them, it is predicted that the mentioned goals can be achieved. Therefore, this paper presents the hybrid flexible-securable operation (HFSO) of a smart distribution network (SDN) with grid-connected multi-microgrids using a two-layer coordinated energy management strategy. In the first layer, the microgrid (MG) operator is coordinated with sources, storages, and demand response operators. This layer models the HFSO method in the grid-connected MGs, which is based on minimizing the difference between the sum of operating cost of nonrenewable distributed generations and cost of energy received from the SDN, and the sum of flexibility and security benefits. It is constrained to AC optimal power flow, flexibility and voltage security constraints, operation model of sources and storages, and demand response. The second layer concerns coordination between the MG operators and the SDN operator. Its formulation is the same as that of the first layer, except that the HFSO model is used in the SDN according to MGs power daily data obtained from the first layer problem. The strategy converts the mixed-integer nonlinear programming to linear one to obtain the optimal solution with low calculation time and error. Moreover, stochastic programming models the uncertainties of load, energy price, and renewable power. Eventually, numerical results confirm the capability of the scheme to improve technical and economic indices simultaneously. As a result, by expecting the optimal operation for sources, storage, and responsive loads, it succeeded to enhance energy loss, voltage profile, and voltage security of the mentioned networks by up to 30%, 22%, and 5%, respectively, compared to power flow studies. In addition, there was enhancement in economic and flexibility status of the SDN and MGs.

Leishmania is a complex disease caused by the protozoan parasites and transmitted by female phlebotomine sandfly. The disease affects some of the poorest people on earth with an estimated 700,000 to 1 million new cases annually. The current treatment for leishmaniasis is toxic, long, and limited, in view of the high resistance rate presented by the parasite, necessitating new perspectives for treatment. The discovery of new compounds with different targets can be a hope to make the treatment more efficient. Microbial metabolites and their structural analogues with enormous scaffold diversity and structural complexity have historically played a key role in drug discovery. We found thirty-nine research articles published between 1999 and 2021 in the scientific database (PubMed, Science Direct) describing microbes and their metabolites with activity against leishmanial parasites which is the focus of this review.Key points• Leishmania affects the poorest regions of the globe• Current treatments for leishmaniasis are toxic and of limited efficacy• Microbial metabolites are potential sources of antileishmania drugs

Background Rapid fluid administration may decrease hemoglobin concentration (Hb) by a diluting effect, which could limit the increase in oxygen delivery (DO 2 ) expected with a positive response to fluid challenge in critically ill patients. Our aim was to quantify the decrease in Hb after rapid fluid administration. Methods Our protocol was registered in PROSPERO (CRD42020165146). We searched PubMed, the Cochrane Database, and Embase from inception until February 15, 2022. We selected studies that reported Hb before and after rapid fluid administration (bolus fluid given over less than 120 min) with crystalloids and/or colloids in adults. Exclusion criteria were studies that included bleeding patients, or used transfusions or extracorporeal circulation procedures. Studies were divided according to whether they involved non-acutely ill or acutely ill (surgical/trauma, sepsis, circulatory shock or severe hypovolemia, and mixed conditions) subjects. The mean Hb difference and, where reported, the DO 2 difference before and after fluid administration were extracted. Meta-analyses were conducted to assess differences in Hb before and after rapid fluid administration in all subjects and across subgroups. Random-effect models, meta-regressions and subgroup analyses were performed for meta-analyses. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was assessed using the I 2 statistic. Results Sixty-five studies met our inclusion criteria (40 in non-acutely ill and 25 in acutely ill subjects), with a total of 2794 participants. Risk of bias was assessed as “low” for randomized controlled trials (RCTs) and ‘low to moderate’ for non-RCTs. Across 63 studies suitable for meta-analysis, the Hb decreased significantly by a mean of 1.33 g/dL [95% CI − 1.45 to − 1.12; p  < 0.001; I 2  = 96.88] after fluid administration: in non-acutely ill subjects, the mean decrease was 1.56 g/dL [95% CI − 1.69 to − 1.42; p  < 0.001; I 2  = 96.71] and in acutely ill patients 0.84 g/dL [95% CI − 1.03 to − 0.64; p  = 0.033; I 2  = 92.91]. The decrease in Hb was less marked in patients with sepsis than in other acutely ill patients. The DO 2 decreased significantly in fluid non-responders with a significant decrease in Hb. Conclusions Hb decreased consistently after rapid fluid administration with moderate certainty of evidence. This effect may limit the positive effects of fluid challenges on DO 2 and thus on tissue oxygenation.

S-RNase-based gametophytic self-incompatibility (GSI) has evolved once before the split of the Asteridae and Rosidae. This conclusion is based on the phylogenetic history of the S-RNase that determines pistil specificity. In Rosaceae, molecular characterizations of Prunus species, and species from the tribe Pyreae (i.e., Malus, Pyrus, Sorbus) revealed different numbers of genes determining S-pollen specificity. In Prunus only one pistil and pollen gene determine GSI, while in Pyreae there is one pistil but multiple pollen genes, implying different specificity recognition mechanisms. It is thus conceivable that within Rosaceae the genes involved in GSI in the two lineages are not orthologous but possibly paralogous. To address this hypothesis we characterised the S-RNase lineage and S-pollen lineage genes present in the genomes of five Rosaceae species from three genera: M. × domestica (apple, self-incompatible (SI); tribe Pyreae), P. persica (peach, self-compatible (SC); Amygdaleae), P. mume (mei, SI; Amygdaleae), Fragaria vesca (strawberry, SC; Potentilleae), and F. nipponica (mori-ichigo, SI; Potentilleae). Phylogenetic analyses revealed that the Malus and Prunus S-RNase and S-pollen genes belong to distinct gene lineages, and that only Prunus S-RNase and SFB-lineage genes are present in Fragaria. Thus, S-RNase based GSI system of Malus evolved independently from the ancestral system of Rosaceae. Using expression patterns based on RNA-seq data, the ancestral S-RNase lineage gene is inferred to be expressed in pistils only, while the ancestral S-pollen lineage gene is inferred to be expressed in tissues other than pollen.

Historically, during periods of extreme drought, food security in the drylands of the semiarid region of Northeast Brazil (NEB) is under severe risk due to agricultural collapse. The drought that started in 2012 continues to highlight the vulnerability of this region, and arid conditions have been detected during the last years mainly in the central semiarid region, covering almost 2% of the NEB. Climate projections show an increase in the area under water stress condition, covering 49% and 54% of the NEB region by 2700 and 2100, respectively, with a higher likelihood with warming above 4 °C. The projections of vegetative stress conditions derived from the empirical model for Vegetation Health Index (VHI) are consistent with projections from vegetation models, where semi-desert types typical of arid conditions would replace the current semiarid bushland vegetation (“caatinga”) by 2100. Due to the impacts of the 2012–2017 drought, public policies have been implemented to reduce social and economic vulnerability for small farmers but are not enough as poor population continues to be affected. In the long term, to make the semiarid less vulnerable to drought, strengthened integrated water resources management and a proactive drought policy are needed to restructure the economy. Integrating drought monitoring and seasonal climate forecasting provides means of assessing impacts of climate variability and change, leading to disaster risk reduction through early warning. Lastly, there is an urgent need for integrated assessments because the possibility that under permanent drought conditions with warming above 4 °C, arid conditions would prevail in NEB since 2060.

Background Microfocused ultrasound with visualization (MFU‐V) is well established for noninvasive lifting of the face, neck, and décolleté. U.S. FDA clearance was recently granted for treatment of the abdomen and upper arms, supported by favorable safety data and emerging evidence of efficacy of its use to address skin and soft tissue laxity in body regions. Guidance on best practices for these additional indications is desirable. Aims This consensus aims to provide evidence‐based and practice‐informed recommendations supporting safe, effective, and reproducible MFU‐V treatments for the additional body indications. Methods An international, multidisciplinary panel of aesthetic experts developed consensus recommendations for MFU‐V treatment of additional body areas based on clinical evidence, expert experience, and structured virtual discussions. Results This global expert consensus affirms MFU‐V as a safe and effective noninvasive modality for treating mild to moderate skin and soft tissue laxity in the abdomen and upper arms. Three key domains were identified as critical to optimizing outcomes: patient selection, treatment planning, and expectation management. Ideal candidates are those with mild to moderate laxity and target tissues located at treatable depths. Real‐time ultrasound imaging was emphasized for accurate targeting, anatomical safety, and treatment precision. The panel developed practical treatment protocols for the abdomen and upper arms, including recommended treatment zones, line densities, and transducer depths tailored to tissue characteristics. Conclusion Safe and effective MFU‐V outcomes rely on real‐time ultrasound visualization, thoughtful patient selection, expectation management, and anatomically guided treatment. Continued research is needed to refine protocols and guide emerging body applications.