Objectives To achieve consensus among Brazilian experts on the concepts of equity and acceptability within the context of health technology assessment (HTA) in Brazil and to identify guidance for their practical application across assessment stages, operationalization methods, and strategies for evidence generation and use. Methods A 2-round online Delphi panel with Brazilian HTA experts assessed agreement on predefined literature-based concepts of equity and acceptability and explored perspectives on HTA stages, methods, and evidence generation and retrieval strategies. Reasons for disagreement and recommendations for further incorporating these dimensions were also qualitatively analyzed. Results Participants were experienced HTA professionals, and consensus on the concepts of equity and acceptability was reached in the first round, exceeding the predefined threshold of 80% agreement. These dimensions were considered cross-cutting throughout the HTA process, with priority given to technology assessment, clinical guideline development, and implementation stages. Evidence search methods and cost-effectiveness analyses were prioritized for equity, whereas qualitative evidence and mixed methods were prioritized for acceptability. Strategies including secondary data analysis, primary data collection, and standardized filter use were prioritized for both dimensions. Conclusions This study advances the conceptual understanding of equity and acceptability in HTA and provides methodological guidance across process stages, supporting the development of more comprehensive HTA that is sensitive to inequities and responsive to population needs.
Hydrothermal humic acids (HHA) have attracted attention due to their redox-active properties and potential for lignocellulosic waste valorization. However, the effects of alkaline hydrothermal extraction temperature on their molecular organization and antioxidant activity remain poorly understood. This study investigated the influence of extraction temperature (120–200 °C) on the structural characteristics and antioxidant properties of HHA produced from sugarcane straw hydrochar, with humic acid obtained by conventional alkaline extraction at 90 °C (HA90) included for comparison. HHA were characterized by SEM/EDS, elemental analysis, TGA, FTIR, and one- and two-dimensional NMR spectroscopy, together with measurements of total acidity and carboxylic and phenolic hydroxyl groups. Total phenolic content was determined, and antioxidant activity was evaluated by DPPH radical scavenging. Extraction yields remained similar among treatments, whereas increasing temperature promoted changes in chemical composition, thermal stability, and the distribution of oxygen-containing functional groups. 1H NMR showed an increase in the relative contribution of the δ 1.6–3.0 region, from 13.35% in HA90 to 21.13% in HHA200. HSQC and HMBC analyses indicated the presence of methoxyl groups associated with lignin-derived oxygenated aromatic structures. Increasing extraction temperature enhanced total phenolic content from 85.32 to 146.56 mg GAE g−1 and improved antioxidant activity, with IC50 decreasing from 1.34 to 0.72 g L−1. Exploratory correlation analysis indicated significant associations between antioxidant activity, phenolic content, phenolic hydroxyl groups, and other chemical constituents. The alkaline hydrothermal extraction modified the molecular organization and antioxidant properties of HHA, supporting the valorization of sugarcane residues into redox-active humic materials.
Objectives We conducted a randomized, double-masked, multicenter clinical trial to evaluate the incremental effect of leucine (LEU)-enriched chocolate supplementation (7.5 g of LEU/d for 12 wk) in addition to an active nutrition intervention on muscle strength in patients undergoing liver transplant (LTx) assessment. Methods Adult patients of both sexes with a diagnosis of cirrhosis and with a pre-LTx protocol completed or in progress at three LTx outpatient clinics were included. Clinical, nutritional, and functional data were collected at baseline (T0), after 6 wk (T6), and after 12 wk (T12). Data were analyzed according to the intention-to-treat approach. The effects of time and treatment on the primary and secondary outcomes were assessed using adjusted Generalized Estimating Equations models. Results The sample comprised 49 patients, 77.6% male, with a median age of 53.0 (47.0–60.0) years. No significant treatment effects were observed on muscle strength or on the secondary outcomes. However, dry body mass index (Δ 0.2 [−0.5 to 1.1] kg/m²), mid-arm circumference (Δ 0.5 [0.0–1.5] cm), triceps skinfold thickness (Δ 1.6 [0.0–2.7] mm), and adductor pollicis muscle thickness (Δ 0.7 [−0.8 to 2.8] mm) significantly increased over time, regardless of group allocation. Conclusions LEU supplementation had no significant effect on muscle strength in patients with cirrhosis. However, the nutritional intervention and chocolate consumption over 12 wk increased anthropometric markers of muscle mass and adiposity. The study was registered in the Brazilian Registry of Clinical Trials (REBEC—RBR-9snttn).
We obtain several sharp spectral bounds, approximations, and exact values for the isoperimetric number and related edge-expansion parameters of graphs. Our results focus on graph powers and on families of graphs with rich algebraic or geometric structure, including distance-regular graphs and graphs arising from finite geometries, among others. Our proofs use techniques from spectral graph theory, linear optimization, finite geometry, and probability, yielding new machinery for analysing edge-expansion phenomena in highly structured graphs.
The genus Helicteres, Malvaceae, includes several species used in traditional medicine for the treatment of dysentery, ulcers, skin wounds, and diabetes. Despite growing interest in its therapeutic potential, scientific data on its phytochemical composition and pharmacological activities remain fragmented. Thus, the objective was to conduct an integrative and scientometric review of the phytochemical and pharmacological evidence related to Helicteres, highlighting bioactive compounds, therapeutic indications, and research findings. Thus, a comprehensive search was performed across seven scientific databases. Studies that explicitly addressed Helicteres species were selected using PRISMA guidelines. Rayyan software was used for screening and data extraction. Bibliometric and thematic analyses were conducted using the Bibliometrix package (R environment). Out of 1381 articles retrieved, 296 met the inclusion criteria. Traditional use was mostly reported for Helicteres isora L. Phytochemical analysis revealed 332 unique metabolites, primarily phenolic compounds, alkaloids, saponins, and steroids. A total of 171 preclinical pharmacological evaluations were identified, with emphasis on cytoprotective, antioxidant, antihyperglycemic, antibacterial, and anti-inflammatory effects. Scientometric analysis showed a marked increase in publications from 2007 onward, with research concentrated in a small number of specialized journals. Thematic mapping identified both consolidated and emerging research areas. Helicteres, especially H. isora, shows considerable potential as a source of pharmacologically active natural products. Expanding studies to underexplored species and applying integrative research strategies may reveal new therapeutic applications. This review provides a basis for guiding future investigations and supports the ethnopharmacological relevance of the genus.
