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Abstract A visible light mediated photocatalyst-free synthesis of N-substituted 2-aminobenzimidazoles directly from o-phenylenediamines and isothiocyanates is developed in a one-pot fashion. This one-pot reaction proceeds through three steps: N-substitution of o-phenylenediamines, thiourea formation and visible light mediated cyclodesulfurization. This method enables the rapid and efficient synthesis of structurally diverse N-substituted 2-aminobenzimidazoles, achieving yields up to 92% across 69 examples. The practicality of the reaction is demonstrated by gram-scale synthesis. The key advantages of this method include the use of less toxic solvent in aqueous media, the elimination of photocatalyst, and a simple, practical setup (one-pot, open-flask, and ambient temperature). Mechanistic insights are gathered through control experiments, including light on/off cycles and radical inhibition studies. The results indicate that the reaction involves with radical pathway mediated by visible light.

Abstract Background Inequity in asthma and COVID-19 outcomes and research among Hispanic or Latino individuals is well established. Patient centered outcomes research (PCOR) may help address these inequalities. This report describes the development, implementation, and evaluation of a virtual conference series program titled “Unidos Hablemos de/United, Let’s Talk About” intended to address the health literacy of the Hispanic/Latino community regarding asthma and COVID-19 and to encourage involvement in PCOR. Methods A Project Advisory Group consisting of Hispanic/Latino patient advisors who had been diagnosed with asthma and/or COVID-19, healthcare providers, researchers, a Hispanic faith-based leader, and a program evaluator designed and implemented a six-month series of monthly one-hour virtual sessions. Speakers and topics were selected that fit the Hispanic/Latino community and culture regarding asthma, COVID-19, and PCOR. Recruitment was through a multichannel digital promotion strategy, including social media. The virtual sessions were free on the ZOOM webinar platform and included interactive polling questions, live chat box, and Q&A. All audio and written materials from the sessions were translated into Spanish and English. Evaluations were used to rate the overall satisfaction with the program. Results An average of 382 participants attended each of the six sessions, and participation generally increased with each session. The proportion of participants who considered themselves a Hispanic/Latino patient with asthma, caregiver, or clergy who served Hispanic/Latino communities increased by 100% from session one to session two. Preference for materials in Spanish ranged from 12 to 20% of participants over the six sessions. Among the sessions, 74–84% of polling question respondents indicated they would be willing to participate in research or a study, and 88% said they would be willing to serve as a patient partner/advocate. Program evaluations consistently indicated high satisfaction with the session content, session format, and feeling of inclusion. Conclusions Unidos Hablemos provided a voice to the Hispanic/Latino community that will inform future strategies to improve equity in asthma management, COVID-19, and PCOR. Patient speakers generated trust from the participants and “bridged the gap” between physicians, researchers, and the Hispanic/Latino community. Providing evidence-based, current information will empower patients and caregivers to make informed healthcare decisions.

Background The provision of clinical pharmacy services (CPS) in low- and middle-income countries is still low. The reported challenges in providing CPS include healthcare structures, public policies, resources, workforce, culture and education inequalities. This study aimed to explore the strategies to improve the provision of CPS in tertiary health facilities in Tanzania.Methods This study was conducted between August and September 2021. We adopted an exploratory qualitative study to conduct 14 in-depth interviews with hospital administrators and 10 focus group discussions (FGDs) with healthcare providers. A purposeful sampling technique was used to recruit 97 participants, including 45 pharmacists, 31 medical doctors and 21 nurses across five tertiary healthcare institutions. Of those, 14 hospital administrators participated in 14 IDIs and 83 healthcare workers divided into 10 FGDs. Analysis was done using a qualitative thematic approach.Results The study identified several strategies that fall under four major themes: (i) strengthen preservice training by reviewing the Bachelor of Pharmacy training curriculum to include clinical pharmacy components; (ii) improve continuing professional training through regular provision of on-job training to pharmacists; (iii) revise the scope of work for pharmacists to include CPS provision in the job description; and (iv) improve operational environment by ensuring availability of guidelines, policies, and adequate number of pharmacists and good inter-professional communication skills.Conclusions This study’s findings highlight that improving CPS provision requires strengthening pharmacists’ training, scope of work and operational environment. The latter calls for multifaceted engagement from pharmacists, training institutions, policymakers, regulatory bodies and health systems for sustainable progress.

This study investigated the study motivation and psychological responses of pre-second-year Ph.D. students from a comprehensive university in Malaysia. To gain an understanding of the challenges faced by students, we conducted group interviews with 15 pre-second-year students: Malay, Chinese, and Malaysian Chinese. The interview transcripts were analyzed thematically using Atlas. The results revealed three significant challenges: The passion for pursuing a Ph.D. diminishes over time.; The stark contrast between self-expectations and the harshness of reality; The challenges of reality give birth to the hope for pursuing a Ph.D. The finding suggests some implications for educators and students regarding active learning.

The purpose of this study was to explore the readiness of the Internal School Quality Assurance Teams (ISQATs) to supervise instruction in Tanzanian public secondary schools. The study employed a qualitative approach, and data were collected through semi-structured interviews and documentary reviews. A purposeful sampling technique was used to select 18 participants from the Kilimanjaro Region of Tanzania. The findings indicate that many Internal School Quality Assurance Officers (ISQAOs) had limited professional profiles despite having adequate teaching qualifications. Their supervisory practices included regular checking of academic records, reminding teachers of their responsibilities, and recommendations on academic matters. It was also found that ISQATs faced challenges such as heavy workloads, poor cooperation from teachers, a lack of supervision guidelines, and different perspectives regarding lesson planning. This study concludes that ISQATs were not fully ready to supervise instructions as professionals, implying that the existing ISQAOs need to receive professional training and that a supervision policy that requires possession of instructional supervision skills as a pre-requisite for teachers’ promotion to an instructional supervision role be implemented.

Abstract Powerful associations that link drugs of abuse with cues in the drug-paired environment often serve as prepotent relapse triggers. Drug-associated contexts and cues activate ensembles of nucleus accumbens (NAc) neurons, including D1-class medium spiny neurons (MSNs) that typically promote, and D2-class MSNs that typically oppose, drug seeking. We found that in mice, cocaine conditioning upregulated transiently the activity-regulated transcription factor, Neuronal PAS Domain Protein 4 (NPAS4), in a small subset of NAc neurons. The NPAS4+ NAc ensemble was required for cocaine conditioned place preference. We also observed that NPAS4 functions within NAc D2-, but not D1-, MSNs to support cocaine-context associations and cue-induced cocaine, but not sucrose, seeking. Together, our data show that the NPAS4+ ensemble of NAc neurons is essential for cocaine-context associations in mice, and that NPAS4 itself functions in NAc D2-MSNs to support cocaine-context associations by suppressing drug-induced counteradaptations that oppose relapse-related behaviour.

Introduction Smoking elevates catecholamines that increase the risk for cardiovascular disease. Sparse evidence exists about the effects of e-cigarettes and catecholamines. Higher levels of catecholamines could trigger the increased heart rate, blood pressure, and decreased vascular function reported with the use of e-cigarettes. We investigated the difference in urinary catecholamines and their metabolites before and after the use of an e-cigarette containing nicotine or cigarettes compared to no tobacco use. Methods In our observational cohort exposure study, healthy adults aged 21– 45 years who were currently using e-cigarettes, cigarettes, or had never used tobacco, participated in an acute exposure visit using their most common tobacco product. Urine was collected before, 1, and 2 hours after a 3-second puff every 30 seconds for 10 minutes on an e-cigarette or straw or use of 1 cigarette. Urinary catecholamines and their metabolites were measured by ultra-high-performance liquid chromatography. Participants (n=323) were grouped by the product used at the visit. We compared levels of creatinine normalized log-transformed urinary catecholamines and their metabolites across groups using Dunn’s test following a Kruskal-Wallis test in unadjusted and demographically adjusted models. Results Prior to use, individuals who used cigarettes (n=70) had lower urinary metabolites from epinephrine, serotonin, and norepinephrine. No differences were seen in those who used e-cigarettes (n=171) and those who did not use tobacco (n=82). In fully adjusted models, 1 h after the use of a combustible or e-cigarette, log-transformed urinary metabolites from norepinephrine (β=1.22; 95% CI: 0.39– 2.05, p=0.004 and β=1.06; 95% CI: 0.39–1.74, p=0.002), dopamine (β=0.37; 95% CI: 0.24–0.5, p

It is crucial to investigate factors influencing the relation between social anxiety and alcohol use problems. In separate moderated mediation analyses, we explored whether social anxiety indirectly explained alcohol use problems via depression, and if 1) emotional distress tolerance (self-report) and 2) physical distress tolerance (breath-holding duration) moderated the relation between depression and alcohol use problems. Undergraduates (N=208, 76.9% women-identified) completed questionnaires and tasks. At low physical distress tolerance, there was a conditional indirect effect of social anxiety on alcohol use problems through depression (effect=.12, 95% CI=.03, .22). At high physical distress tolerance, there was no conditional indirect effect of social anxiety on alcohol use and problems through depression (effect).

Objetivo: Este ensaio teórico explica como as crises ocorrem e são enfrentadas por empreendedores, inclusive com o uso da efetuação (effectuation). Problema: As crises são variadas em natureza, intensidade e duração, exercem pressão sobre as organizações e os empreendedores. Exigem respostas rápidas, engenhosas e adaptadas ao contexto de incertezas e de falta de recursos. Contudo, falta o esclarecimento de como ocorrem para os empreendedores e como estes enfrentam-nas. Originalidade: A partir de uma caracterização das crises e de sua diversidade, o estudo aprofunda a explicação do enfrentamento das crises no empreendedorismo e de como a efetuação é (ou não consegue ser) útil em tal enfrentamento, destacando-se os níveis micro e macro das crises e variações de respostas a elas. Contribuições sociais/para gestão: Além de novos resultados de pesquisa, o ensaio oferece uma agenda para futuras publicações promissoras em busca de soluções para grandes desafios da humanidade.

Objective: This theoretical essay examines the processes by which crises are experienced and managed by entrepreneurs, with a particular focus on the role of effectuation. Problem: The nature, intensity, and duration of crises vary, exerting pressure on organizations and entrepreneurs. In order to respond effectively, it is necessary to develop quick, ingenious solutions that are adapted to the context of uncertainty and lack of resources. However, there is a lack of clarity regarding the occurrence of crises for entrepreneurs and the strategies they employ to cope with them. Originality: The study, based on a characterization of crises and their diversity, delves more profoundly into the ways in which entrepreneurs cope with crises and the extent to which effectuation is (or fails to be) useful in such coping. It illuminates the micro and macro levels of crises and the nuances in responses to them. Social/management contributions: In addition to presenting new research conclusions, the essay proposes a research agenda for prospective publications that seek to address humanity's significant challenges.

Postural Orthostatic Tachycardia Syndrome (POTS) is a rare heterogeneous syndrome secondary to a disorder of the autonomic nervous system, characterized by sustained symptomatic sinus tachycardia in the upright position without arterial hypotension. Chronic symptoms are nonspecific and involve multiple organ systems, often leading to debilitating effects on the individuals quality of life. Although relatively unfamiliar to cardiologists, it is an essential entity in the differential diagnosis of pre-syncope. We present a case report of an adolescent referred to pediatric cardiology to investigate intermittent and recurrent episodes of sweating, chest pain, muscle weakness without loss of consciousness, palpitations, pallor, and tachycardia. During the medical history, she also reported other symptoms impacting her daily activities and school performance. Following a comprehensive physical examination (including heart rate and blood pressure assessment) and additional tests (electrocardiogram, transthoracic echocardiogram, and Tilt Test), she was diagnosed with POTS. Subsequently, a treatment plan, both pharmacological and non-pharmacological, was initiated, resulting in an improvement in her quality of life and symptom control. Recognition of this recently described medical condition depends on clinical suspicion during the medical history and physical examination, allowing for the implementation of treatment with the aim of enhancing the patients quality of life.

Introduction Paediatric tuberculosis (TB) underdiagnosis is a critical concern. The INPUT stepped-wedge cluster-randomised trial assessed the impact of integrating child TB services into child healthcare on TB case detection among children under age 5 years.Methods We compared the standard of care, providing TB care in specific TB clinics (control phase), with the Catalysing Paediatric TB Innovations (CaP-TB) intervention, integrating TB services across all child health services (intervention phase). 12 clusters in Cameroon and Kenya transitioned from the standard of care to the intervention at randomly assigned times. Children with presumptive TB were enrolled after obtaining their parents’ consent and were followed throughout TB diagnostic procedures and treatment. Study outcomes included the rate of children with presumptive TB receiving TB investigations and that of children diagnosed with TB (the primary outcome was case detection), per thousand children under 5 years attending facilities. Generalised linear mixed Poisson models estimated the intervention’s effect as adjusted rate ratios (aRR) and associated 95% CIs. Ad hoc country-stratified analyses were conducted.Results During control and intervention phases, respectively, 121 909 and 109 614 children under 5 years attended paediatric entry points, 133 (1.1 per thousand) and 610 (5.6 per thousand) children with presumptive TB received TB investigations, and 79 and 74 were diagnosed with TB, corresponding to a case detection rate of 0.64 and 0.68 per thousand, respectively. CaP-TB significantly increased TB investigations in both countries overall (aRR=3.9, 95% CI 2.4 to 5.4), and in each. Overall, TB case detection was not statistically different between intervention and control (aRR 1.32, 95% CI 0.66 to 2.61, p=0.43). Country-stratified analysis revealed a 10-fold increase (aRR 9.75, 95% CI 1.04 to 91.84, p=0.046) in case detection with CaP-TB in Cameroon and no significant effect in Kenya (aRR 0.94, 95% CI 0.44 to 2.01, p=0.88).Conclusion CaP-TB increased TB investigations in both study countries and markedly enhanced TB case detection in one, underlining integrated TB services' potential to address paediatric TB underdiagnosis.

RESUMO Os defeitos de desenvolvimento de esmalte são alterações resultantes de distúrbios no processo da amelogênese, podendo envolver fatores genéticos, sistêmicos, locais ou ambientais. Os fatores que desencadeiam os defeitos de desenvolvimento de esmalte estão relacionados principalmente a injúrias durante o desenvolvimento da estrutura dental. Na dentição decídua, traumas e/ou consumo de medicamentos durante a gestação podem estar envolvidos. Na dentição permanente eventos traumáticos ou lesões de cárie nos correspondentes decíduos estão fortemente associados. O objetivo do presente estudo foi apresentar um caso clínico e discutir os possíveis fatores etiológicos relacionados ao diagnóstico dos defeitos de desenvolvimento do esmalte. Paciente do sexo feminino, sete anos de idade, procurou atendimento com queixa de dente não erupcionado. A história familiar não revelou alterações da mesma natureza em parentes próximos. A história médica revelou dificuldade respiratória, quadro de infecção e desenvolvimento deficiente da glândula timo ao nascimento, resultando em entubação orotraqueal logo nos primeiros dias de vida. Os exames imaginológicos revelaram alterações morfológicas nas coroas dos germes dentários 11 e 21, além de agenesia do 35. O exame extraoral revelou retrognatismo mandibular e o exame intraoral revelou alteração na coroa do 11, presença de manchas brancas opacas nos molares decíduos e mordida profunda. Inicialmente a hipótese diagnóstica foi de amelogênese imperfeita hipomaturada. Entretanto, devido às características clínicas e imaginológicas a hipótese foi revista, principalmente em relação aos fatores etiológicos e o diagnóstico foi fechado em defeito de desenvolvimento do esmalte por trauma durante a entubação orotraqueal.

Background: Acute coronary syndrome (ACS) and acute heart failure (AHF) are severe medical conditions that are closely associated with higher rates of readmissions and mortality in hospitals. These conditions pose an exponential challenge to the healthcare system and increase patient burden. Objectives: This study aims to identify the effect of telephonic follow-up on readmission and mortality rates in Rashid Hospital due to ACS and AHF. Methods: In 2022, we conducted a prospective study. We divided 805 patients admitted with ACS and AHF in Rashid Hospital into two groups and compared the readmission and mortality rates of patients who were followed up with those who were not. The data collection tool included a demographic questionnaire, which was then analyzed by statistical tests and SPSS software. Results: There were patients in the follow-up call group versus patients in the nonfollow- up call group. The patients with follow-up calls had a higher survival rate (98.3%) compared with the ones who had not been called (93.4%) (p = 0.003). Readmission rates for follow-up patients were (7.7%) versus (5.9%) for those without follow-up calls (p = 0.429). The study analyzed and investigated the individuals on various other factors; however, no statistically significant difference was observed between the two groups. Conclusion: The study provides insight into the various factors associated with patients’ outcomes. Even though the association of readmission rate to follow-up was unremarkable, the mortality rate of patients with follow-up was significantly lower.

Abstract The present study brings the first report of species of Chaetomium and Humicola from Bahia state. Chaetomium globosum was isolated from different substrates of cacao, jackfruit, papaya and soursop and C. pseudoglobosum from cow dung. Humicola cuyabenoensis was isolated from soil samples of cacao plantations in the southeast Bahia.

Introdução A busca de referências sobre divulgação/disseminação de ATS para profissionais de saúde e para docentes de faculdades da área de saúde, revela uma lacuna na produção do conhecimento sobre o acesso desse público a essa temática. Destacamos que esses profissionais e docentes são responsáveis pelo diagnóstico, solicitação de exames, prescrições; ensino e preceptoria para adoção de tecnologias eficazes, efetivas e eficientes e contribuem para a evolução do conhecimento científico. Objetivo Identificar a usabilidade e o interesse de profissionais e docentes, em relação a um informe com a divulgação da incorporação e desincorporação de tecnologias no SUS em um hospital universitário na cidade do Rio de Janeiro em 2022. Métodos Estudo transversal quantitativo, com amostra não probabilística de profissionais e docentes de um hospital universitário, utilizando um questionário autoaplicável no forms para identificar a usabilidade dos dados de um informe que divulga internamente desde 2015, resultados de ATS pela CONITEC e o interesse no recebimento desse tipo de material. Resultados Responderam ao forms 153 (n para 90% de confiança =113) representantes da comunidade hospitalar, sendo 50,3% profissionais de saúde, 30,5% docentes e 19% técnicos administrativos. Em relação ao recebimento do informe do Núcleo de Avaliação de tecnologias em Saúde (NATS) do hospital no período 2015 a 2021, 52,3% responderam sim, 31,4% não lembravam e 16,3% declararam nunca ter recebido. Declararam abrir e ler o informe 72 respondentes (90%) dos que receberam e destes 95% consideram as informações relevantes ou muito relevantes. Dentre os respondentes que receberam os informes, abriram e leram, 31,2% declararam já ter utilizado as informações na docência, 45% na pratica clínica, 57,5% no processo de trabalho e 37,5% em outras situações. Dentre os 153 respondentes, 74,5% declararam ter interesse em participar de conversa remota sobre ATS, 13,1% não ter interesse e 12,4% não souberam responder. Em relação a continuar recebendo o informe NATS 83,7% disseram que sim, 7,8% não e 8,5% disseram não saber. Discussão e conclusões Com vistas a equidade na disseminação/divulgação de informações sobre ATS, o acesso por profissionais de saúde e docentes é importante já que esse público é estratégico para a institucionalização das decisões da CONITEC em prol de um SUS de qualidade.

BackgroundCo-use of alcohol and e-cigarettes (often called vaping) has been linked with long-term health outcomes, including increased risk for substance use disorder. Co-use may have been exacerbated by the COVID-19 pandemic. Social networking sites may offer insights into current perspectives on polysubstance use. ObjectiveThe aims of this study were to investigate concurrent mentions of vaping and alcohol on Twitter (subsequently rebranded X) during a time of changing vaping regulations in the United States and the emergence of the COVID-19 pandemic. MethodsTweets including both vape- and alcohol-related terms posted between October 2019 and September 2020 were analyzed using latent Dirichlet allocation modeling. Distinct topics were identified and described. ResultsThree topics were identified across 6437 tweets: (1) flavors and flavor ban (n=3334, 51.8% of tweets), (2) co-use discourse (n=1119, 17.4%), and (3) availability and access regulation (n=1984, 30.8%). Co-use discussions often portrayed co-use as positive and prosocial. Tweets focused on regulation often used alcohol regulations for comparison. Some focused on the perceived overregulation of vaping (compared to alcohol), while others supported limiting youth access but not at the expense of adult access (eg, stronger age verification over product bans). Across topics, vaping was typically portrayed as less harmful than alcohol use. The benefits of flavors for adult smoking cessation were also discussed. The distribution of topics across time varied across both pre– and post–regulatory change and pre– and post–COVID-19 pandemic declaration periods, suggesting shifts in topic focus salience across time. ConclusionsCo-use discussions on social media during this time of regulatory change and social upheaval typically portrayed both vaping and alcohol use in a positive light. It also included debates surrounding the differences in regulation of the 2 substances—particularly as it related to limiting youth access. Emergent themes from the analysis suggest that alcohol was perceived as more harmful but less regulated and more accessible to underage youth than vaping products. Frequent discussions and comparisons of the 2 substances as it relates to their regulation emphasize the still-evolving vaping policy landscape. Social media content analyses during times of change may help regulators and policy makers to better understand and respond to common concerns and potential misconceptions surrounding drug-related policies and accessibility.

Purpose. The purpose of the study was to identify specific components of a lesson plan that teachers struggle to design. Methodology. The study used a qualitative research approach and an exploratory case study design. The criterion-purposeful sampling technique was employed to select eighteen (18) participants from six public secondary schools in the Kilimanjaro region of Tanzania. The study participants comprised six heads of secondary schools, six internal school quality assurance officers, and six teachers. Through semi-structured interviews and document reviews, data on specific components of the lesson plan that teachers find challenging to design was collected. The reviewed documents included school performance evaluation reports (SPERs) and lesson plans. The researchers employed thematic analysis methods. The study also followed all necessary principles of research ethics, including obtaining participants’ consent and employing pseudonyms. Results. The study found that teachers were struggling in formulating a coherent statement of specific lesson objectives, teaching and learning materials, and teaching and learning activities. The study also demonstrated that teachers faced difficulties in selecting effective teaching and learning approach, establishing assessment criteria, and conducting proper lesson evaluation. Conclusion. We conclude that inadequate design of one component of the lesson plan negatively affects the overall quality of the lesson plan, the delivery of lessons in the classroom, and the quality of education. Therefore, instructional supervisors and teacher trainers must take immediate action to assist teachers in developing lesson planning skills. This endeavour will not only result in improved lesson planning and delivery by teachers, but it will also contribute to an overall improvement in student learning and educational quality.

Relative rank models of risky decision-making suggest that human preferences are informed by sampled (and not absolute) values and their relative ranks. According to this proposal, an attribute's absolute value (e.g., money or probability), retrieved from memory or/and available in the context, has a relative rank within the sampled attribute values. Moreover, decision-makers use the relative ranks of sampled absolute values when they choose or evaluate an option. In contrast, we present evidence from studies with more than 1100 UK adults, that human preferences are indeed informed by an attribute's absolute value. In particular, when making a choice between two economic gambles (a safe gamble or a risky gamble), we found that the likelihood of choosing the risky gamble increased when it was with a desirable monetary prize (a larger amount of money – £150), regardless of the distribution and relative ranks of sampled monetary values. However, when both the safe and risky gambles were with non-desirable monetary prizes (£0.50 or £1.50), participants' preferences were influenced by the distribution and relative ranks of sampled monetary values. Accordingly, we propose that decision-making desirability triggers participants' willingness to use absolute values in their choice; the switch between participants making relative and absolute judgment is predicted by Edwards et al. (2012).

Abstract Introduction This research explores the impact of the COVID-19 pandemic on psychotherapists' practices and their ability to maintain a framework despite a shared reality with their patients. The specific focus in this article is on the Lebanese context, which is characterized by a series of crises including economic collapse, the COVID-19 pandemic, and the Beirut blast. The objective of this study was to examine how the destabilization of the meta-frame due to crises necessitates adaptations in theoretical knowledge, practice, and setting. Methods We conducted a qualitative study among a population consisting of mental health professionals, which were recruited in Lebanon through associations and societies of psychologists, psychotherapists, and psychoanalysts. Data was collected using semi-structured individual interviews. The interviews were analyzed using interpretative phenomenological analysis (IPA), which allowed for a dynamic exploration of the participants' experiences. Results Our study revealed four superordinate themes: (1) The strained frontiers; (2) The cumulative traumatic reality and its impact; (3) A challenged professional identity; (4) The creativity stemming from collective trauma. Conclusions Our results highlight the insecurity caused by external reality infiltrating the therapeutic setting. Online therapy allowed for continued work, but uncertainty about the online environment's impact on therapeutic relationships was observed. The study underscores the importance of adaptability, containment, and support for therapists navigating crises, particularly in the online setting.

Resumo Fundamento A fibrilação atrial (FA) é a arritmia cardíaca mais prevalente e sua apresentação difere de acordo com a idade e o sexo. Estudos recentes revelaram diferenças na FA entre vários grupos demográficos, incluindo a população latino-americana. Objetivos Melhor compreender as possíveis disparidades na prevalência da FA e nas estratégias de tratamento na população brasileira por meio de dados de um registro prospectivo multicêntrico de grande escala. Métodos O registro de FA da Rede D’Or é um estudo observacional prospectivo multicêntrico que incluiu pacientes com idade ≥ 18 anos com FA atendidos no pronto-socorro de 32 hospitais terciários no Brasil. Os pacientes foram caracterizados de acordo com o sexo e outras características basais e classificados de acordo com o uso prévio de anticoagulantes. Foi analisada a falta de uso de anticoagulantes em pacientes com indicações prévias. A significância estatística foi estabelecida em 5%. Resultados Os dados do estudo foram provenientes de um total de 1.955 pacientes inscritos. O sexo masculino foi mais prevalente e os homens eram mais jovens que as mulheres. Devido ao aumento da prevalência de episódios anteriores de FA e a um escore CHA2DS2-VASc mais elevado, mais mulheres tiveram indicação de terapia anticoagulante; no entanto, uma proporção significativa não estava recebendo esse tratamento. Dos 29 óbitos intra-hospitalares, 15 pacientes tinham indicação prévia para anticoagulação, mas apenas 3 estavam em uso de anticoagulantes. Conclusão O presente estudo revelou diferenças relacionadas ao sexo na população brasileira de pacientes com FA que são consistentes com tendências em países de alta renda. A promoção de uma melhor implementação de terapias anticoagulantes e antitrombóticas para reduzir o risco de óbito e eventos tromboembólicos entre mulheres com FA no Brasil é crucial.

La fuerza de trabajo en los países iberoamericanos, evoluciona hacia una mayor presencia de trabajadores con educación superior, así el objetivo de esta investigación es determinar la influencia de algunos factores del capital psicológico en los trabajadores activos con título universitario en Lima Metropolitana. Además de analizar la relación entre el capital psicológico y el stress ocupacional en los mismos trabajadores. A través de un estudio de enfoque cuantitativo, de diseño transversal y no experimental, se aplica una encuesta a 395 trabajadores profesionales activos, los datos obtenidos son analizados empleando un modelo de ecuaciones estructurales basadas en covarianzas. El estudio demuestran la existencia de una relación causal significativa entre el balance trabajo-vida y el capital psicológico, asimismo, se comprueba una relación significativa entre los premios e incentivos y el capital psicológico. Finalmente, la investigación concluye que el apoyo social y la autoconfianza son los determinantes clave en el efecto positivo que el balance trabajo-vida y los premios e incentivos tienen sobre el capital psicológico.

In the ever-evolving landscape of educational technology, it is vital to understand the empirical relationships of teachers' Technological Pedagogical and Content Knowledge (TPACK) and its interplay with explanatory factors such as cyber wellness, school climate, and digital nativity. This study employs Covariance-Based Structural Equation Modeling (CB-SEM) to analyze self-reported data from 311 basic education teachers in Central Visayas, Philippines. The model demonstrates robust validity and reliability, showing diverse direct impacts on the antecedent variables to the seven constructs of TPACK. The findings reveal 16 significant hypothesized paths, with digital nativity has a significant effect on all three core knowledge domains of TPACK while school climate and cyber wellness have a significant effect on two knowledge domains. Another significant finding shows that content knowledge emerged with the highest significant effect on technological content knowledge (β = 0.621). This connection highlights the fundamental role of content knowledge in successfully integrating technological competencies among teachers, especially from a developing economy. The study provides policy insights tailored to post-pandemic educational management.

Introduction: Black ginseng (BG) was processed by “steaming and drying” (generally nine times) repeatedly to produce “rare saponins” and secondary ginsenosides. Both ginseng (GS) and red ginseng (RG) were commonly used in treating heart failure (HF), and the latter was confirmed to be more potent, implying the presence of rare ginsenosides that contribute positively to the treatment of heart failure. Previous research indicated that rare ginsenosides are more abundant in BG than in RG. Consequently, this study aims to investigate the effects of BG and its components on HF to elucidate the active substances and their underlying mechanisms in the treatment of HF.Methods: The effects of BG and its fractions (water-eluted fraction (WEF), total saponin fraction (TSF), and alcohol-eluted fraction (AEF)) on rats with isoproterenol (ISO)-induced HF were explored, and steroids belonging to the hypothalamic–pituitary–adrenal (HPA) and hypothalamic–pituitary–gonadal (HPG) axes were determined quantitatively using the ultra-performance liquid chromatography–triple quadrupole tandem mass spectrometry (UPLC-QqQ-MS/MS) method. In addition, 16S rDNA sequencing was performed on the gut microbiota, followed by GC–MS analysis of short-chain fatty acids (SCFAs), and the biochemical indexes related to energy metabolism and the serum cyclic nucleotide system were also analyzed by ELISA.Results: Based on a thorough evaluation of energy metabolism and the endocrine system, it was observed that the effects of BG components on the hypothalamic–pituitary–thyroid (HPT) and HPA axes were more pronounced. Notably, the treatment efficacy of the low dose of the total saponin fraction (TSFL), water decoction (WD), and high dose of the polysaccharide fraction (PSFH) was superior based on pharmacodynamic indicators such as brain natriuretic peptide (BNP), creatine kinase (CK), and estradiol (E2)/T). Furthermore, the WD and BG components exhibited significant effects on androgens (T and androstenedione (A4)). The TSFL group exerts an anti-inflammatory effect by regulating Lactobacillus/Erysipelotrichales. The WD, PSFH, and TSFL may impact inflammatory cytokines through the gut microbiota (Lactobacillus/Erysipelotrichales) and their metabolites (acetate and butyrate), exerting an anti-inflammatory effect.Discussion: The BG and all its split components demonstrated varying levels of efficacy in alleviating HF, and TSF and PSF exhibited a significant protective effect on HF. The main active components in TSF were revealed to be ginsenosides Rk1, Rk3, 20-(S)-Rg3, and 20-(S)-Rh2 by the H9C2 cell experiment. The decoction of BG and its components exhibited a potent impact on androgen hormones, with an elevation trend. This phenomenon may be attributed to the activation of the eNOS-NO pathway through androgen regulation, thereby contributing to its anti-HF activities. The WD, PSFH, and TSFL may exert anti-inflammatory effects through the intestinal flora (Lactobacillaceae/Erysipelotrichaceae) and its metabolites (acetic acid and butyric acid), which affect the inflammatory factors. The different mechanisms of action of each component of HF also reflect the significance and necessity of the overall role of traditional Chinese medicine (TCM). Our research was the first to report that the E2/T is related to HF and can be used as an indicator to evaluate HF.

Preeklampsia adalah onset hipertensi yang baru terdeteksi pada usia kehamilan ≥20 minggu pada minimal 2 pemeriksaan dengan jarak 4 jam, disertai dengan proteinuria atau kondisi penyulit lainnya (trombositopenia, gangguan fungsi hati, edema paru, gangguan ginjal, sakit kepala). Eklampsia adalah manifestasi kejang dari hipertensi dalam kehamilan. Preeklamsia dan eklampsia mempersulit 6–8% dari semua kehamilan dan menyebabkan berbagai komplikasi ibu dan janin. Lactate dehydrogenase (LDH) adalah enzim sitoplasma intraseluler yang dominan dari glikolisis anaerobik, dilepaskan ke sirkulasi umum selama apoptosis sel. Gen LDH A adalah gen yang diinduksi hipoksia yang ditandai dengan peningkatan/penurunan regulasi HIF-1 alfa yang tidak efektif. Dengan demikian, LDH dapat menjadi penanda utama iskemia, kerusakan jaringan yang berhubungan dengan disfungsi endotel dan keparahan preeklamsia. Preeklamsia menyebabkan gangguan multisistem dan kematian sel, semakin tinggi kematian seluler maka LDH akan semakin meningkat, maka terjadi peningkatan kadar laktat dalam darah. Peningkatan LDH mengindikasikan adanya kerusakan dan disfungsi sel, sehingga LDH dapat digunakan sebagai biomarker yang dapat mendiagnosis keparahan suatu penyakit, komplikasi, dan kondisi janin. Kadar LDH serum paska persalinan merupakan pemeriksaan yang relatif mudah dilakukan, sehingga dapat dijadikan salah satu dasar penentuan prognosis pasien preeklampsia/eklampsia.

Background The outbreak of COVID-19 has caused a setback to the gains achieved in tuberculosis (TB) control by impairing TB diagnosis, delaying treatment initiation and aggravating TB deaths. This study explored the effect of COVID-19 on paediatric TB services provided through the Catalysing Paediatric TB Innovations (CaP-TB) project among caregivers of children receiving TB services and healthcare workers (HCWs) providing TB services in Cameroon and Kenya.Methods From March to September 2021, in-depth interviews (44) were conducted with caregivers whose children under 5 years had gone through TB services and programme managers (10) overseeing the CaP-TB project. Focus group discussions were conducted with HCWs (07) and community health workers (04) supporting TB care services. Transcripts were coded and analysed by using MAXQDA V.12.Results The COVID-19 pandemic has caused fear and anxiety among HCWs and caregivers. This fear was motivated by stigma related to COVID-19 and affected the ability to screen patients for TB due to the similarity of symptoms with COVID-19. The health-seeking behaviour of patients was affected, as many caregivers avoided hospitals and those accessing the facilities concealed their sickness due to fear of testing positive or being vaccinated. In addition, COVID-19 mitigation strategies implemented by both government and health facilities to curb the spread of the virus limited patient access to paediatric healthcare services. These included temporary closure of health facilities due to COVID-19 infections among staff, transfer of services to other spaces, spacing out patient appointments and reduced time spent with patients.Conclusions The outbreak of COVID-19 has induced fear and stigma that affected patients’ health-seeking behaviour and provider attitudes towards paediatric TB service delivery. In addition, facility and governmental measures put in place to mitigate COVID-19 impact negatively affected paediatric service delivery. Training for health personnel, timely provision of personal protective equipments and appropriate communication strategies could help mitigate COVID-19 impact on paediatric TB service delivery.

Introdução: O futsal é uma modalidade esportiva coletiva, citada como uma das mais praticadas do mundo, considerando nível escolar, recreacional ou profissional. Com a evolução da competitividade, aliada à ciência de dados, cada vez tornou-se mais importante o monitoramento de aspectos técnicos. Objetivo: O presente estudo objetivou comparar a ocorrência de ações técnicas de uma equipe de futsal adulta considerando os diferentes resultados do jogo (vitória, empate ou derrota). Materiais e métodos: Através da gravação das partidas, foram coletados dados de 13 partidas por meio do método “scout”. Foram quantificadas as ações de passes errados, desarmes, interceptações, finalizações no alvo e finalizações fora do alvo. Para a análise estatística, foi empregada ANOVA one-way com post-hoc de Bonferroni. Resultados: Tanto as ações de passes errados, desarmes, interceptações, finalizações no alvo e finalizações fora do alvo não apresentaram diferenças estatísticas em relação aos diferentes desfechos. Conclusão: Conclui-se que, para as partidas analisadas, os valores médios das ações técnicas não apresentaram diferenças quando considerados os diferentes desfechos dos jogos.

Abstract Intimate partner violence (IPV) perpetration’s relationship with alcohol salience to college experience and eating disorder (ED) symptomatology is not well understood. Midwestern university students (n = 1580) participated in an online survey. Structural equation models examined the relationship between these variables. All models fit the data well, however, the risk factors of IPV perpetration or alcohol use were not significantly associated with ED symptomatology. However, IPV perpetration was significantly associated with both alcohol use (β = .13, p

Abstract High morbidity and mortality related to the use of drugs resulted in demand for clinical pharmacy services (CPS) globally. In developed countries, the evolution of pharmacists’ role in direct patient care started in the 1960s. The participation of pharmacists in CPS has resulted in positive clinical, economic, and humanistic outcomes. In developing countries, efforts have started to ensure pharmacists are engaged in the provision of CPS. However, the efforts are hampered by poorly defined pharmacist career paths, financial constraints, and a lack of political willingness. In Tanzania, efforts started in 2008, in which CPS was introduced into the Bachelor of Pharmacy curriculum, followed by the initiation of a postgraduate program on hospital and clinical pharmacy in 2013. A regulation was released by the Tanzania Ministry of Health in 2020 to enforce pharmacists' engagement in providing CPS. In 2021, a project was launched in the country, aiming to strengthen the provision of CPS in public and faith-based hospitals by training on-job pharmacists. The project was implemented in phases, including stakeholders’ engagement, baseline survey, training, and supportive supervision of the trained pharmacists. Therefore, this commentary aims to share what we experienced during project implementation, the achievements, challenges, and key lessons learned.

Underutilised crops are important for diversifying food systems. The genomics of these crops should not be done in isolation but should align with their breeding and capacity building strategies while leveraging advances made in major crops.

Introduction: Abnormal Uterine Bleeding (AUB), occurring atleast one year after menopause, is one of the most concerning complaints among gynaecological patients. Endometrial atrophy is the most common endometrial finding in women with Postmenopausal Bleeding (PMB), approximately 10-15% of whom have endometrial carcinoma. Earlier studies suggested that obesity, Type 2 diabetes mellitus, and hypertension are risk factors for endometrial hyperplasia. Diabetes mellitus, obesity, and hypertension form the triad of endometrial cancer. Aim: To assess endometrial thickness by Transvaginal Sonography (TVS) and compare it with histopathological findings in women with PMB, evaluating whether an endometrial thickness of 11 mm, with mean and Standard Deviation (SD) values of 5.8±3. mm Statistical analysis data on the association between TVS findings and Histopathological Examination (HPE) findings was observed to be statistically significant (p25 kg/m2 together, DM+hypertension+BMI (Triad) and endometrial thickness, respectively. Conclusion: The TVS is easy, simple, non invasive, and involves no complications. Therefore, it can be used as the first diagnostic step in the investigations of women with PMB, combined with histopathological assessment.

Human papillomavirus (HPV) is the most common sexually transmitted infection and plays a significant role in cervical, penile, anal, vaginal, vulvar, and oropharyngeal cancers as well as non-cancerous genital warts and genital dysplasia. In the United States, there are approximately 46,000 new HPV-related cancers a year. There is an effective vaccine to prevent over 90% of these cancers and other HPV-related diseases; however, those that are aged 18–26 have the lowest vaccine rates among eligible age groups. The objective of this study was to examine student knowledge and perceptions about HPV vaccine hesitancy in university students and their notions of barriers and facilitators for HPV vaccine uptake. We aimed to identify components for an evidence-based community-oriented educational intervention to increase HPV vaccination uptake. The researchers recorded 10 focus groups featuring students from a Northeastern United States university, aged 18–26, which were analyzed using grounded theory and inductive thematic analysis to identify recurring themes. The participants mentioned many barriers and facilitators for attaining the HPV vaccine, with health literacy being prominent for both. They demonstrated some knowledge of what HPV is and ways to avoid it. They also expressed a desire for further information and felt that the way in which this information is presented to the public is vital for increasing vaccine uptake and designing future interventions. In order to increase HPV vaccination rates in the general population and overcome barriers such as family, religious, and cultural values, it is important to emphasize the link between HPV and cancer and its preventative benefits.

Abstract Background The design of clinical trials in rare diseases is often complicated by a lack of real-world translational knowledge. Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic disorder characterized by skeletal malformations and progressive heterotopic ossification (HO). Palovarotene is a selective retinoic acid receptor gamma agonist. Here, we describe the methodology of three studies in the palovarotene clinical development program in FOP and discuss insights that could inform future research, including endpoint suitability and the impact of trial design. Methods PVO-1A-001 (NCT02322255) was a prospective, protocol-specified, longitudinal FOP natural history study (NHS). PVO-1A-201 (NCT02190747) was a randomized, double-blind, placebo-controlled phase II trial; PVO-1A-202 (NCT02279095) was its open-label extension. Trial designs, including treatment regimens and imaging assessments, were refined between PVO-1A-201 and PVO-‍1A-202, and within PVO-1A-202, based on emerging data as the studies progressed. Palovarotene doses were administered using a flare-up treatment regimen (higher dose for 2/4 weeks, followed by lower dose for 4/≥8 weeks; from flare-up onset), with or without accompanying chronic (daily) treatment. Flare-up and disease progression outcomes were assessed, including incidence and volume of new HO during flare-ups and/or annually, as well as other clinical, patient-reported, and exploratory outcomes. Safety was monitored throughout all studies. Results Overall, 114 and 58 individuals with FOP were enrolled in the NHS and phase II trials, respectively. Results of the NHS and PVO-1A-201 were published in 2022; complete results of PVO-1A-202 will be publicly available in due course. Together the studies yielded important information on endpoint suitability, including that low-dose whole-body computed tomography was the optimum imaging modality for assessing HO progression annually and that long study durations are needed to detect substantial changes in functional and patient-reported outcomes. Conclusions A flexible clinical development program is necessary for underexplored rare diseases to overcome the many challenges faced. Here, the NHS provided a longitudinal evaluation of FOP progression and interventional trials were based on emerging data. The studies described informed the design and endpoints implemented in the phase III MOVE trial (NCT03312634) and provide a foundation for future clinical trial development. Trial registration NCT02322255 (registered 23/12/2014); NCT02190747 (registered 15/07/2014); NCT02279095 (registered 30/10/2014).

In this paper, we introduce a new modified inertial Mann-type method that combines the subgradient extragradient method with the projection contraction method for solving quasimonotone variational inequality problems and fixed point problems in real Hilbert spaces. We establish strong convergence of the proposed method under some mild conditions without knowledge of the operator norm. Finally, we give numerical experiments to illustrate the efficiency of the method over the existing one in the literature.

Introduction: Acute Kidney Injury (AKI) poses life-threatening risks in pregnancy, leading to adverse perinatal and maternal outcomes. Aim: To estimate the incidence of Pregnancy-Related Acute Kidney Injury (PRAKI) and describe maternal and foetal outcomes in cases of Acute Renal Failure (ARF) at a tertiary care institute. Materials and Methods: A prospective descriptive study was conducted on 104 antenatal women with ARF attending King George Hospital, Visakhapatnam, Andhra Pradesh, India, from January to December 2020. A total of 7,409 deliveries occurred during the study period, and antenatal women with evidence of pre-existing renal disease were excluded. A detailed history was obtained, and evaluation included renal function tests and a total abdominal scan. Mode of delivery, foetal deaths, stillbirths, maternal deaths, and APGAR scores were analysed. Laboratory findings were also reported. Data analysis was performed using coGuide statistical software, and results were expressed in terms of frequency and percentages. Results: The incidence of PRAKI was 14 per 1,000 deliveries (1.4%). The mean age of the participants was 24.05±4.11 years. The majority (78 out of 104, 75%) were in the third trimester. Out of the 104 cases of PRAKI, 77 (74%) were due to hypertension. There were 16 (15.4%) maternal deaths and 19 (21.8%) perinatal deaths. Conclusion: Pregnant women with ARF experienced increased morbidity and mortality. Urgent improvements in antenatal care, early detection of complications, effective management, and timely referrals to tertiary centres are crucial.

Authentic assessment has garnered significant interest among scholars in Higher Education Institutions (HEIs) globally. This study investigated the relationship between authentic assessment and the acquisition of teaching professional competencies among undergraduate science student-teachers in HEIs in Tanzania. Utilizing a quantitative research approach with a descriptive survey research design, we sampled 231 third-year students enrolled in the Bachelor of Science with Education (BSC. ED) Programme. Data were collected through questionnaires and documentary review, and analyzed by using inferential statistics, specifically through multiple linear regressions. The findings indicate a positive relationship between authentic assessment and teaching professional competencies. Furthermore, the results demonstrate a positive relationship between authentic assessment tools such as portfolios, projects, teaching practice, and practical work, and specific competencies including content, pedagogical, and generic knowledge, albeit with variations depending on the tools employed. This study argues that the implementation of authentic assessment positively correlates with the acquisition of teaching professional competencies among undergraduate science student-teachers in HEIs. To ensure students attain teaching professional competence essential for navigating the labor market economy, course instructors must prioritize the utilization of authentic assessment tools.

El estudio revisa los antecedentes publicados por fabricantes de viviendas prefabricadas en madera en Chile central. La metodología indaga en medios digitales de venta y servicio de impuestos internos. Utiliza los atributos de cumplimiento normativo-técnico, complejidad y sustentabilidad para calificar las viviendas prefabricadas en las regiones de Valparaíso, O’Higgins y Metropolitana. Un 83% de empresas son “constructoras-fabricantes”, 83% están legalmente constituidas. La complejidad revela que, para proyectos de mayor envergadura, 54% tienen nivel bajo, 35% nivel medio y 11% nivel alto. Hay debilidades en cumplimientos normativos y en información técnica para los potenciales clientes, siendo la sustentabilidad el atributo menos destacado, ya que pocas explicitan datos como huella de carbono, reciclaje de materiales o certificaciones voluntarias para diferenciarse en el mercado. Por tanto, se concluye que faltan acciones para potenciar a este sector productivo, con potencial de industrialización, incorporando gestión y reglamentación, con lo que disminuiría la inseguridad territorial por autoconstrucción

O agronegócio, um dos principais setores econômicos do Brasil, compõe uma das mais poderosas forças políticas no congresso do país, a Frente Parlamentar da Agropecuária (FPA), e aparece como o principal impulsionador do lobby anti-ambiental. A FPA busca incidir sobre a legislação trabalhista, fundiária e tributária e foi uma importante aliada do Governo de Jair Bolsonaro, uma vez que a agenda de desmonte ambiental do ex-presidente ia ao encontro dos interesses econômicos do agronegócio. No entanto, a necessidade de garantir uma imagem positiva do setor se reflete em diversas estratégias de comunicação, inclusive na veiculação de anúncios pagos nas plataformas online. Nesse sentido, a presente pesquisa pretende analisar a possível presença de greenwashing e/ou desinformação nos 158 anúncios publicados pela FPA no Facebook e Instagram durante o ano de 2023. Após coletarmos os anúncios na interface da Biblioteca de Anúncios da Meta, adotamos três abordagens complementares de análise que nos permitiram identificar e interpretar as estratégias discursivas empregadas pela FPA para “melhorar a imagem do agro”: contagem automática de palavras e análise de coocorrência entre elas, análise de conteúdo e análise de discurso. Nos anúncios analisados, a sustentabilidade é instrumentalizada pelo agronegócio brasileiro como greenwashing e desinformação em sua comunicação publicitária online. Essas estratégias discursivas são utilizadas na publicidade digital da FPA para criminalizar os movimentos sociais que lutam por uma reforma agrária e para disseminar pânico sobre inseguranças jurídicas relacionadas ao direito à propriedade. De uma forma geral, nossos resultados mostram que os anúncios defendem a necessidade de manutenção do status quo das relações socioeconômicas no campo brasileiro e promovem negacionismo em relação aos impactos ambientais do agronegócio.

Enquadramento: O quotidiano do motorista de autocarros é dinâmico. Muitas variáveis o cercam: a habilidade na condução e de controlar os seus medos e o cumprimento correto do seu itinerário. As limitações e desafios vivenciados podem desencadear um processo de sofrimento psíquico. Objetivo: Descrever as perceções dos motoristas de autocarros acerca da vivência no trânsito e os possíveis efeitos do quotidiano da mobilidade urbana nos motoristas. Metodologia: Estudo descritivo fenomenológico, pautado no pensamento de Maurice Merleau-Ponty, realizado num terminal rodoviário de autocarros, no período de julho a dezembro de 2017. Entrevistaram-se 24 motoristas de autocarros através de perguntas abertas. Resultados: Emergiram duas categorias: O trânsito é uma caixa de surpresas e O equilíbrio psicológico é necessário. Conclusão: Dar voz a estes profissionais, trazendo à luz o que acarreta o seu sofrimento, e reconhecer as suas necessidades, contribuirá para a prevenção de doenças físicas e psicológicas, bem como de acidentes de trânsito. Os motoristas rodoviários carecem de melhores condições para poderem colocar a cidade em movimento diariamente.

Resumo Fundamento: Distrofia Muscular de Duchenne (DMD) é uma doença neuromuscular hereditária rara. O acometimento cardíaco inicial pode ser assintomático. Portanto, a avaliação por métodos não invasivos pode auxiliar sua abordagem. Objetivos: Analisar o eletrocardiograma (ECG) e a variabilidade da frequência cardíaca (VFC) do grupo com DMD, e comparar com a do grupo controle pareado por idade. Métodos: Estudo prospectivo com 27 pacientes masculinos com DMD (idade de 11,9 anos) que foram submetidos à avaliação clínica, ECG, ecocardiograma e Holter. ECG (aumento de 200%) foi avaliado por dois observadores independentes. VFC foi feita no domínio do tempo (24 h) e da frequência na posição supina e sentada. O grupo saudável foi de nove pacientes (11,0 anos). Um valor de p < 0,05 foi considerado estatisticamente significante. Resultados: A média da fração de ejeção (FE) foi de 60% (34 a 71%). O coeficiente de Kappa para as medidas do ECG variou de 0,64 a 1,00. Foram verificados aumento da relação R/S em V1 em 25,9%, onda Q patológica em 29,6% e QRS fragmentado em 22,2% em regiões inferior/lateral alta, este com correlação negativa com FE (p = 0,006). Houve baixa VFC, sem influência de nenhuma variável, inclusive tratamento. Com a mudança da posição, houve aumento da FC (p = 0,004), porém não houve alteração da VFC. A relação LF/HF foi de 2,7 na DMD e de 0,7 no controle (p = 0,002). Conclusões: Nos participantes com DMD, as ondas R proeminentes em V1 e alterações nas regiões inferior/lateral alta ocorreram em quase 30% dos casos. Houve menor tônus vagal sem influência das variáveis idade, fração de ejeção, dispersão do QT e tratamento. Apesar do aumento da FC, não houve resposta adequada da VFC com a mudança de posição.

La fusariosis es una micosis oportunista producida por Fusarium spp. Su presentación clínica depende del estado inmunológico del huésped, especialmente, el de aquellos con enfermedades hematooncológicas, cuyas manifestaciones varían desde formas localizadas hasta infección fúngica invasora. El cultivo de piel o de sangre permite orientar el tratamiento antifúngico combinado con anfotericina B y voriconazol. Se presentan 13 casos de pacientes con cáncer en un periodo de once años que desarrollaron fusariosis diseminada; asimismo, se hizo con una revisión extensa de la literatura. En esta serie de casos, la mortalidad fue del 61,5 % (8/13), a pesar del uso del antifúngico. De los 13 pacientes, 11 tenían neoplasia hematológica y 2 neoplasia sólida. El factor de riesgo más importante fue la neutropenia profunda. El compromiso de la piel y los hemocultivos positivos facilitaron la prescripción del tratamiento combinado en la mayoría de los casos. La neutropenia febril persistente asociada a lesiones cutáneas, la onicomicosis, los nódulos o las masas pulmonares permitieron sospechar una infección fúngica invasora por Fusarium spp. El objetivo de la presentación de esta serie de casos es recordar el diagnóstico de fusariosis a la comunidad médica en contacto con pacientes oncológicos, con neutropenia febril profunda y persistentes.

Abstract Background The effects of COVID-19 on the organism are still being investigated, especially after the transformation of this virus from a respiratory disease in its first appearance to a multi-organ disease that can affect nearly all systems and organs including the endocrinological system. The objective of the study was to find an association between COVID-19 infection and new onset type 2 diabetes in Lebanese adults. Methods A retrospective case–control study (2019–2022) included 200 subjects, 100 cases with new onset diabetes and 100 controls recruited from endocrinology clinics in rural and suburban located regions of Lebanon. Univariate and multivariate logistic regression were performed. Results Older age (aOR = 1.07; 95% CI 1.03–1.12), higher BMI (aOR = 1.32; 95% CI 1.17–1.48), having been infected with COVID-19 (aOR = 2.38; 95% CI 1.001–5.68) and having a family history of diabetes (aOR = 11.80; 95% CI 4.23–32.87) were significantly associated with higher odds of having new onset type 2 diabetes after adjusting for multiple risk factors. Conclusion In addition to the traditional risk factors for developing type 2 diabetes, a recent COVID-19 infection was associated with the new onset DM in our study. Subsequently screening for diabetes should be strongly recommended for patients post COVID-19 infection.

Antimicrobial resistance has emerged as a significant danger to global health, and the need for more effective antimicrobial resistance (AMR) control has been highlighted. Cinnamic acid is abundant in plant products and is a potential starting material for further modification, focusing on the development of new antimicrobial compounds. In the following review, we describe the classification of critical antibacterial-guided reactions applied to the main skeleton structure of cinnamic acid derivatives over the last decade. Of all of the main parts of cinnamic acids, the phenyl ring and the carboxylic group significantly affect antibacterial activity. The results presented in the following review can provide valuable insights into considerable features in the organic modification of cinnamic acids related to antibacterial medication development and the food industry.

Chronic myelomonocytic leukemia (CMML) is a hematologic malignancy affecting the bone marrow and resulting in peripheral blood monocytosis. Kidney and urinary tract involvement is common and can present dramatically with life-threatening consequences. Kidney involvement can be the result of direct or indirect mechanisms, including prerenal azotemia, glomerular disease, tubulointerstitial involvement, and renovascular disorders. Urinary tract involvement, electrolyte and acid-base disorders, as well as nephrotoxicity from treatment of the disorder can also occur. Given this multifactorial pathogenesis involving several mechanisms concomitantly, nephrologists must exercise heightened awareness and maintain a low threshold for kidney biopsy. There is a pressing need for future research endeavors to elucidate and target the manifestations of CMML that involve the kidneys with the ultimate goal of augmenting overall prognosis and therapeutic outcomes.

Neste artigo, buscamos mapear os sites que compõem o ecossistema de mídia evangélica digital no Brasil e construir uma tipologia própria para analisá-lo. Apesar de suas diferenças internas, os evangélicos brasileiros formam uma importante força política, graças a esforços que já duram décadas. No entanto, pouco se estudou seu ecossistema na internet e seu papel na reprodução de posições políticas divisivas. Identificamos os sites evangélicos compartilhados por lideranças no Facebook entre abril e outubro de 2021, complementando a base de dados com outros sites previamente conhecidos e encontrados na plataforma. Avaliamos estes sites conforme a tipologia construída e apresentamos uma análise das narrativas políticas comumente sustentadas por eles. Demonstramos que estes sites frequentemente reforçam um imaginário permeado por uma guerra político-cultural travada contra os cristãos, cuja identidade é redesenhada pela ameaça de uma ampla perseguição e pela derrocada de seus valores.

BackgroundSickle cell disease (SCD) is one of the most frequent and traumatizing genetic disease in Uganda, with the prevalence of the sickle cell trait (SCT) estimated at 13.3% leading to serious psycho-social and economic impact on the patients and their families.AimThis study aimed to determine the burden of SCT and factors influencing the uptake of screening services among secondary school students in Uganda.MethodsWe used an analytical cross-sectional design with a multi-stage sampling approach. A total of 399 students from four secondary schools in Kampala City were enrolled in this study. Data were gathered using semi-structured questionnaires and blood screening. We used the sickling test to determine the presence of sickle cell alleles among the participants and hemoglobin electrophoresis as a confirmatory test. Data gathered using the questionnaire were analyzed using descriptive and inferential statistics.ResultsIn total, 5.8% of participants who were tested during this study had SCT. Most (80.2%) participants were not in an intimate relationship at the time of data collection. The majority (60.4%) had moderate knowledge about SCT screening and obtained information about screening from the school. Only 29 (7.3%) participants knew of a family member with sickle cell. Overall, participants had a negative attitude toward SCT screening (67%), although 41.6% believed that most people who were sickle cell carriers did not live long and were often sick. Statistically significant associations were found between testing for SCT and knowing a partner's sickle cell status (odds ratio [OR] 2.112, p = 0.043) and Anglican religion (OR 2.075, p = 0.047).ConclusionDespite the moderate level of knowledge and negative attitudes, a relatively large number of participants had SCT. This highlights the need for a comprehensive health education package targeting adolescents to promote SCD/SCT screening.

Adolescents and youth living with HIV (AYLHIV) experience worse health outcomes compared to adults. We aimed to understand the experiences of AYLHIV in care in the youth-focused Red-Carpet program in Kenya to assess the quality of service provision and identify programmatic areas for optimization. We conducted focus group discussions among 39 AYLHIV (15-24 years) and structured analysis into four thematic areas. Within the HIV testing theme, participants cited fear of positive results, confidentiality and stigma concerns, and suggested engaging the community and youth in HIV testing opportunities. Within the HIV treatment adherence theme, participants cited forgetfulness, stigma, adverse side effects, lack of family support, and treatment illiteracy as barriers to adherence. Most participants reported positive experiences with healthcare providers and peer support. In terms of the HIV status disclosure theme, AYLHIV cited concerns about their future capacity to conceive children and start families and discussed challenges with understanding HIV health implications and sharing their status with friends and partners. Youth voices informing service implementation are essential in strengthening our capacity to optimize the support for AYLHIV within the community, at schools and healthcare facilities.

Abstract Background This study explores the association between psychosocial stressors and current e-cigarette use among adolescents in the United States. Methods We used data from 12,767 participants in the 2019 National Youth Risk Behavioral Survey to examine the association between psychosocial stressors (bullying, sexual assault, safety-related absence from school, depressive symptoms, suicidal ideation, physical altercation, and weapon threats) and past-30-day e-cigarette use using multivariable-adjusted logistic regression models. We examined the association for each stressor and then as a burden score (0–7). To compare the strength of the association between stressors and current e-cigarette use to current combustible cigarette use, we additionally examined the association between each stressor and current combustible cigarette use. Results Approximately 32.7% reported current e-cigarette use. The weighted prevalence of current e-cigarette use was higher among individuals who experienced stressors than those who did not. For example, bullying (43.9% vs. 29.0%). Similar prevalence patterns were seen among other stressors. Individuals who experienced stressors had significantly higher adjusted odds of current e-cigarette use than those who did not (OR [Odds Ratio] range: 1.47–1.75). Similarly, individuals with higher burden scores had a higher prevalence (zero [20.5%], one [32.8%], two [41.4%], three [49.6%], four to seven [60.9%]) and higher odds of current e-cigarette use (OR range: 1.43–2.73) than those with a score of zero. The strength of the association between the stressors and e-cigarette use was similar to that between the stressors and combustible cigarette use. Conclusion The study demonstrates a significant association between psychosocial stressors and adolescent e-cigarette use, highlighting the potential importance of interventions, such as targeted school-based programs that address stressors and promote stress management, as possible means of reducing adolescent e-cigarette use. Future research directions include exploring underlying mechanisms linking stressors to e-cigarette use and evaluating the effectiveness of interventions addressing stressors in reducing adolescent e-cigarette use.