54 (0.50-0.60) in the multivariate-adjusted analysis. Similar results were also observed in the sub-distribution hazard function model (SD model) with corresponding multivariate HRs (95%CI) of 0.57 (0.52-0.63). Our study suggested that PTR was associated with improved survival in female stage IV breast cancer patients. The role of PTR in these patients needs to be re-evaluated. The World Health Organization (WHO) Trauma Care Checklist (TCC) has been documented to improve care of the injured. Factors that promote TCC use have not been well evaluated. We sought to identify barriers and facilitators affecting TCC use. A qualitative study was conducted by interviewing regional leaders and health care providers at hospitals where the initial WHO TCC pilot study had been conducted in 2010-2012. Study participants included trauma system directors, surgeons, emergency medicine physicians, nurses, and house staff in nine countries. Interview transcripts were thematically analyzed in Dedoose software using deductive and inductive coding strategies incorporating elements of grounded theory. Eighteen participants representing nine of the 11 original pilot sites were interviewed, including 14 doctors and four nurses. Participants represented departments of trauma/trauma surgery (n=13) and emergency medicine (n=5). Three sites continued to use the TCC in a nearly original form; three sites rom individual providers hinder utilization. To improve TCC uptake, participants also recommended that TCC be more closely integrated with courses such as Advanced Trauma Life Support.Azoxystrobin (AZX) is a broad-spectrum systemic fungicide massively used worldwide. Its mode of action consists in the inhibition of mitochondrial respiration decreasing the synthesis of ATP and leading to oxidative stress in the target fungus. However, whether this effect occurs in non target organisms has been scarcely studied. The objectives of this work were (1) to evaluate biomarkers of oxidative stress, hematological, physiological and of genotoxicity in the native cichlid fish Australoheros facetus exposed to environmentally relevant concentrations of AZX and (2) to compare these biomarkers in different developmental stages using juvenile and adult fish (n = 6) exposed during 48 h. The exposure concentrations were 0 (negative control, C (-)), 0.05, 0.5, 5 and 50 μg/L AZX of the commercial formulation AMISTAR®. Blood was drawn to evaluate hematology, and DNA damage through the comet assay (CA) and micronucleus test (MN). Genotoxicity was observed by mean of both biomarkers in juvenile and adult fish at 50 μg/L AZX. Samples of liver and gills were used to determine antioxidant enzymes activity, hydrogen peroxide (H2O2) and malondialdehyde (MDA) contents. Aminocaproic mouse In juvenile fish inhibition of superoxide dismutase (SOD) was observed in liver at 0.05, 5 and 50 μg/L AZX and in gills at 5 and 50 μg/L AZX. Glutathione- S- transferases (GST) activity increased in gills at all AZX concentrations tested. In adult fish, increase of hepatic catalase (CAT) activity at 0.5 and 50 μg/L AZX and MDA content at 50 μg/L AZX were observed. In gills only H2O2 content showed changes at 50 μg/L AZX. The sensitivity showed by gills constitutes the first report about AZX toxicity in this organ. All these negative effects were observed in the range of realistic AZX concentrations, which warns of the possible consequences that it may have on the health of aquatic biota. Differences between juvenile and adult fish demonstrate the relevance of considering the developmental stage on the evaluation of biomarkers.Pogonatherum crinitum is a promising lead (Pb) hyperaccumulator; however, the effects of Pb contamination on P. crinitum rhizosphere soil enzymatic activities and microbial composition remain largely unexplored. Thus, an indoor experiment was conducted by cultivating P. crinitum seedlings and exposing them to four Pb concentrations (0, 1,000, 2000 and 3000 mg/kg Pb). Protease, urease, acid phosphatase and invertase activities were determined using standard methods while soil bacterial composition was determined by 16 S rDNA sequencing. The results showed that rhizosphere soil acid phosphatase activity significantly increased with increasing Pb concentration, while urease activity was significantly greater in rhizosphere soil contaminated with 1000 and 2000 mg/kg than in the control. There was a clear shift in bacterial composition during phytoremediation by P. crinitum. Compared to the control, Bacteroidetes was more abundant in all Pb-contaminated soils, Actinobacteria was more abundant in 1000 mg/kg Pb-treated soil, and Firmicutes was more abundant in 3000 mg/kg Pb-treated soil. Positive correlations were observed between dominant bacterial phyla and soil enzyme activities. Metabolic pathways, such as ABC transporter, quinine reductase, and ATP-binding protein were significantly increased in rhizosphere soil bacteria with Pb contamination. In conclusion, Pb contamination differentially influenced the activities of rhizosphere soil enzymes, specifically increasing acid phosphatase and urease activities, and alters the dominance of soil bacteria through up-regulation of genes related to some metabolic pathways. The strong correlations between dominant bacterial phyla and enzymatic activities suggest synergetic effects on the growth of P. crinitum during Pb contamination.Heavy metal contamination in soil has attracted great attention worldwide. In situ stabilization has been considered an effective way to remediate soils contaminated by heavy metals. In the present research, a multiple-modified biochar (BCM) was prepared to stabilize Cd and Cu contamination in two different soils a farmland soil (JYS) and a vegetable soil (ZZS). The results showed that BCM was a porous-like flake material and that modification increased its specific surface area and surface functional groups. The incubation experiment indicated that BCM decreased diethylenetriaminepentaacetic (DTPA)-extractable Cd and Cu by 92.02% and 100.00% for JYS and 90.27% and 100.00% for ZZS, respectively. The toxicity characteristic leaching procedure (TCLP)-extractable Cd and Cu decreased 66.46% and 100.00% for JYS and 46.33% and 100.00% for ZZS, respectively. BCM also reduced the mobility of Cd and Cu in soil and transformed them to more stable fractions. In addition, the application of BCM significantly increased the soil dehydrogenase, organic matter content and available K (p less then 0.