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Abstract Background Intersectional stigma of drug-use and HIV hinders provision and utilization of HIV prevention services for people who inject drugs (PWID), particularly within rural US communities. Resilience and coping may be critical for PWID to counter pervasive stigma. Methods Between October 2021 and July 2022, 35 in-depth interviews were conducted in Appalachian Ohio to understand the intersection of drug-use and HIV prevention stigma and how resilience and coping processes are displayed, shared, and enacted. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted, guided by Harper et al.’s four key resilience processes: (a) engaging in health-promoting cognitive processes, (b) enacting in health behavioral practices, (c) exchanging social support, and (d) empowering other PWID to engage in health behavior practices. Results Resilience processes aligned with the Harper framework with additional coping processes identified, including anticipation strategies and maladaptive coping. Empowering other PWID emerged as a prominent resiliency process, often supported by systems of support like syringe service programs (SSPs), which provided resources and helped reduce stigma. However, bidirectional social support was constrained, as PWID frequently acted as providers of resources and referrals for peers despite limited knowledge of HIV prevention strategies and feeling unsupported themselves. Anticipation strategies were employed to manage anticipated stigma, including accessing support or, conversely, avoiding healthcare and refraining from disclosing drug use. Maladaptive coping included behaviors such as social isolation and self-administered medical care, highlighting critical gaps in opportunities to foster resilience. Conclusions Findings highlight that empowering peers and anticipation strategies can be key resilience processes, while maladaptive coping and limited bidirectional social support underscore the need for resilience-building and stigma-reduction interventions. Tailored systems of support for PWID in rural communities are critical to fostering adaptive coping and enhancing engagement with HIV prevention services.

Background Medications for opioid use disorder (MOUD) are the gold standard. However, significant barriers limit their use in the primary care setting, including limited knowledge of the medications and stigmatizing attitudes. In this study, we assess knowledge levels among primary care-aligned professionals (PCPs) currently in practice, and whether knowledge of MOUD is associated with stigma and treatment attitudes.Participants and methods Using rosters from the state of Ohio licensing boards, we surveyed 403 physicians, nurse practitioners, and physician associates in 2022, on the mechanism of different MOUD, as well as stigma and treatment attitudes. To assess MOUD knowledge, we employed descriptive and bivariate statistics. We fit four linear regression models, which controlled for empathy towards patients with OUD and provider demographics to assess the relationship between MOUD knowledge and four endpoints: stigma, perceived controllability of opioid use, perceived vulnerability to opioid use disorder, and support for abstinence-only treatment.Results 43% of participants correctly identified the mechanism of all 3 medications whereas 13% of participants did not identify the mechanism of any MOUD correctly. MOUD knowledge was higher among physicians as compared to nurse practitioners and physician associates. Lower MOUD knowledge was associated with more negative attitudes towards patients with OUD and MOUD treatment.Conclusion Expanding access to MOUD treatment requires a trained and willing health-care professional (HCP) workforce. Our findings highlight considerable variation in clinician knowledge of MOUD and suggest that knowledge levels are also related to negative attitudes towards patients with OUD and MOUD. Training interventions that increase knowledge, as well as focus on stigma reduction, are critical for reducing the longstanding treatment gap for opioid use disorder.

Abstract Background Option B + offers lifelong ART to pregnant or breastfeeding mothers, but postpartum loss to HIV care, partially driven by perinatal depression (PND), threatens the impact of this policy. This study aims to understand women’s and providers’ preferences for developing a feasible intervention to address PND and support engagement in HIV care among women living with PND and HIV. Methods We conducted a total of 6 focus group discussions (FGDs) involving 4 clinics in Lilongwe District from December 2018 through February 2019. We conducted 2 FGDs each among 3 stakeholder groups: clinical staff, prenatal women, and postnatal women. Perinatal participants were living with HIV and screened positively for PND using the validated Edinburgh Postnatal Depression Scale (EPDS). Clinical staff were nurses who were trained antiretroviral therapy (ART) providers. Interviewers led FGDs in Chichewa using a semi-structured guide. Data were analyzed using deductive and inductive coding in NVivo 12 software. Results Women favored ART linkage services, but providers said they already offered such services, with mixed results. Individual counselling was universally supported. A perceived benefit of group counselling was peer support, but there were concerns among women regarding confidentiality and stigma. Women liked mobile appointment reminders but identified low phone ownership as a barrier. Participants recommended home visits as an additional care engagement strategy. Women consistently discussed the need for social support from family members and friends to address PND and support engagement in HIV care. Conclusion This study highlights the importance of peer encouragement to support perinatal HIV care engagement among women with HIV and PND. The results from this study can be used to support intervention development to increase HIV care engagement and improve long-term HIV outcomes in women with PND.

Abstract Introduction HPTN 083 demonstrated the superiority of long‐acting cabotegravir (CAB‐LA) versus daily oral emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) as pre‐exposure prophylaxis (PrEP) among cisgender men and transgender women who have sex with men (MSM/TGW). HPTN 083 provided the first opportunity to understand experiences with injectable PrEP in a clinical trial. Methods Participants from two US sites (Chicago, IL and Atlanta, GA) and one international site (Rio de Janeiro, Brazil) were purposively sampled for individual qualitative interviews (N = 40), between November 2019 and March 2020, to explore trial experiences, barriers to adherence and other factors that may have impacted study implementation or outcomes. The blinded phase ended early due to efficacy; this analysis includes interviews conducted prior to unblinding with three groups defined by adherence (i.e. injection visit attendance): adherent (n = 27), non‐adherent (n = 12) and early discontinuers (n = 1). Data were organized using NVivo software and analysed using content analysis. Results Participants (mean age: 27) were primarily cisgender MSM (90%) and Black/African American (60%). Reasons for trial enrolment and PrEP use included a preference for using HIV prevention medication versus treatment in the event of HIV acquisition; the ability to enhance health via study‐related education and services; access to a novel, convenient HIV prevention product at no cost; and contributing to MSM/TGW communities through research. Participants contrasted positive experiences with study staff with their routine clinical care, and emphasized increased scheduling flexibility, thorough communication, non‐judgemental counselling and open, affirming environments (e.g. compassion, less stigma) as adherence facilitators. Injection experiences were positive overall; some described early injection‐related anxiety, which abated with time and when given some measure of control (e.g. pre‐injection countdown), and minimal injection site discomfort. Some concerns and misperceptions about injectable PrEP were reported. Barriers to adherence, across all adherence categories, included structural factors (e.g. financial constraints, travel) and competing demands (e.g. work schedules). Conclusions Respondents viewed injectable PrEP trial participation as a positive experience and a means of enhancing wellbeing. Study site flexibility and affirming clinic environments, inclusive of non‐judgemental counselling, were key facilitators of adherence. To support injection persistence, interventions that address structural barriers and promote flexible means of injection delivery may be most effective.

Introduction Index case testing (ICT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention services. In Malawi, delivery of ICT has faced challenges due to limited technical capacity of healthcare workers (HCWs) and clinical coordination. Digitisation of training and quality improvement processes presents an opportunity to address these challenges. We developed an implementation package that combines digital and face-to-face modalities (blended learning) to strengthen HCWs ICT skills and enhance quality improvement mechanisms. This cluster randomised controlled trial will assess the impact of the blended learning implementation package compared with the standard of care (SOC) on implementation, effectiveness and cost-effectiveness outcomes.Methods and analysis The study was conducted in 33 clusters in Machinga and Balaka districts, in Southern Malawi from November 2021 to November 2023. Clusters are randomised in a 2:1 ratio to the SOC versus blended learning implementation package. The SOC is composed of: brief face-to-face HCW ICT training and routine face-to-face facility mentorship for HCWs. The blended learning implementation package consists of blended teaching, role-modelling, practising, and providing feedback, and blended quality improvement processes. The primary implementation outcome is HCW fidelity to ICT over 1 year of follow-up. Primary service uptake outcomes include (a) index clients who participate in ICT, (b) contacts elicited, (c) HIV self-test kits provided for secondary distribution, (d) contacts tested and (e) contacts identified as HIV-positive. Service uptake analyses will use a negative binomial mixed-effects model to account for repeated measures within each cluster. Cost-effectiveness will be assessed through incremental cost-effectiveness ratios examining the incremental cost of each person tested.Ethics and dissemination The Malawi National Health Science Research Committee, the University of North Carolina and the Baylor College of Medicine Institutional Review Boards approved the trial. Study findings will be disseminated through peer-reviewed journals and conference presentations.Trial registration number NCT05343390.

Introduction: Patients with opioid use disorder (OUD) have a heightened need for quality health care, including access to evidence-based medications to reduce cravings and prevent overdose. However, primary care providers (PCPs) are reluctant to work with patients with OUD and implement medication prescribing into primary care practice. Previous studies have sought to identify potential ways to overcome these barriers, but often utilize interventions that facilitate both positive contact with as well as empathy for patients with OUD. In this study, we jointly assess positive contact and empathy to determine their unique impact on treatment attitudes and behaviors among PCPs, after controlling for other known predictors. Methods: We surveyed 409 PCPs currently practicing in Ohio in 2022. Our primary dependent variables were willingness to work with patients with OUD, receipt of an X-waiver to prescribe buprenorphine, and interest in receiving an X-waiver. Our primary independent variables were positive contact and empathy toward patients with OUD. We computed bivariate correlations and multivariable linear regression (for continuous dependent variables) and logistic regression (for binary dependent variables) to understand the relationship between positive contact, empathy, and our outcome variables while accounting for other known predictors and relevant participant demographics. Results: Positive contact was positively correlated with willingness to work with patients with OUD, receipt of the X-waiver, an interest in receiving the X-waiver, more frequent checking with patients about the need for naloxone, and higher odds of naloxone prescribing. These relationships held after accounting for PCP demographics, explicit bias toward patients with OUD, and overall levels of contact with patients with OUD. Empathy, conversely, was not a significant predictor of any treatment outcomes in the fully adjusted models. Conclusion: Interventions and medical education programs aimed at improving treatment outcomes for patients with OUD should facilitate positive contact between PCPs and patients with OUD.

Abstract Background Fidelity measurement of implementation strategies is underdeveloped and underreported, and the level of reporting is decreasing over time. Failing to properly measure the factors that affect the delivery of an implementation strategy may obscure the link between a strategy and its outcomes. Barriers to assessing and reporting implementation strategy fidelity among researchers are not well understood. The aims of this qualitative study were to identify barriers to fidelity measurement and pragmatic pathways towards improvement. Methods We conducted in-depth interviews among researchers conducting implementation trials. We utilized a theory-informed interview approach to elicit the barriers and possible solutions to implementation strategy fidelity assessment and reporting. Reflexive-thematic analysis guided coding and memo-writing to determine key themes regarding barriers and solutions. Results Twenty-two implementation researchers were interviewed. Participants agreed that implementation strategy fidelity was an essential element of implementation trials and that its assessment and reporting should improve. Key thematic barriers focused on (1) a current lack of validated fidelity tools with the need to assess fidelity in the short term, (2) the complex nature of some implementation strategies, (3) conceptual complications when assessing fidelity within mechanisms-focused implementation research, and (4) structural issues related to funding and publishing. Researchers also suggested pragmatic solutions to overcome each barrier. Respondents reported using specification and tracking data in the short term until validated tools become available. Participants suggested that researchers with strategy-specific content expertise lead the way in identifying core components and setting fidelity requirements for them. Addressing the third barrier, participants provided examples of what pragmatic prospective and retrospective fidelity assessments might look like along a mechanistic pathway. Finally, researchers described approaches to minimize costs of data collection, as well as more structural accountability like adopting and enforcing reporting guidelines or changing the structure of funding opportunities. Discussion We propose short- and long-term priorities for improving the assessment and reporting of implementation strategy fidelity and the quality of implementation research. Conclusions A better understanding of the barriers to implementation strategy fidelity assessment may pave the way towards pragmatic solutions.

Abstract Background Common mental health disorders (CMDs), including depression, anxiety and post-traumatic stress disorder (PTSD) may worsen both HIV and drug use outcomes, yet feasible tools to accurately identify CMDs have received limited study in this population. We aimed to validate the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder screen (GAD-7) and Primary Care PTSD screen for DSM-5 (PC-PTSD-5) in a methadone maintenance therapy (MMT) patient population in Hanoi, Vietnam. Methods We conducted a cross-sectional survey. The PHQ-9, GAD-7, and PC-PTSD-5 were administered to MMT patients. A blinded interviewer administered the Mini-International Neuropsychiatric Interview (MINI) as the reference gold standard. Total scores of each tool were compared with the MINI diagnoses using a receiver operating characteristic curves, and we identified the optimal respective cut-off scores using the Youden’s Index. Results We enrolled 400 MMT patients. Approximately 99.3% were male (n = 397) and 21.8% (n = 87) were HIV positive. The prevalence of major depressive disorder, generalized anxiety disorder and PTSD, respectively, was 10.5, 4 and 2%. Optimal cut-off scores for the PHQ-9, GAD-7 and PC-PTSD were ≥ 5, ≥3, and ≥ 4 with a sensitivity/specificity of 95.2%/91.9, 93.8%/87.5, and 62.5%/95.2%. Conclusions The prevalence of CMDs in the MMT population was lower than expected. A lower cut-off score may be considered when screening for CMDs in this population. Further research should investigate the validity of somatic symptom-based screening tools among other drug-using or MMT populations.

Abstract Background Injection drug use drives HIV transmission in Southeast Asia, where around a quarter of users are living with HIV. Vietnam developed Methadone Maintenance Therapy (MMT) programs to reduce unsafe drug abuse. Common mental health disorders (CMD), including depression, anxiety and post-traumatic stress disorder (PTSD), can worsen MMT outcomes and are highly prevalent among people living with HIV (PLH). We aimed to characterize HIV and CMD among MMT patients and assess the impact of HIV and CMD on MMT engagement outcomes in Hanoi, Vietnam. Methods This cross-sectional study was conducted at an urban MMT clinic in Hanoi. Participants were screened for CMD with the relevant sections of the Mini International Neuropsychiatric Interview (MINI). Tabular comparisons and regression models were used to understand the association of HIV and CMD with substance use and methadone compliance. Results Of the 400 MMT participants, 22% were living with HIV, 11% a CMD, 27% reported injection drug use, and 27% reported methadone noncompliance. Around 17% of those with HIV also had a CMD. Reporting non injection and injection drug use were each higher among those with CMD regardless of HIV status. In addition, reporting any drug use was much higher among those with both HIV and CMD than among those with neither (73% vs 31%, p value 0.001). While methadone noncompliance was lower among PLH than among those without HIV (16.3% vs 30.1%, p value 0.010), noncompliance was higher among those with CMD than among those without (40.5% vs 25.6%, p value 0.045). Among those without HIV, noncompliance was higher among those with CMD than among those without, but among those with HIV, the opposite relationship was observed. Conclusion There is complex overlap between substance use and methadone noncompliance among MMT patients living with HIV, CMD or both. In this population, we found a high prevalence of CMD and substance use among PLH, and a high prevalence of substance use and methadone noncompliance among those with CMD. Prioritizing provision of mental health care services to MMT patients living with HIV can help improve engagement with substance use disorder treatment and reduce the risk of HIV transmission.

Abstract Background With high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children’s lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the “What Matters Most” stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the “Mothers Moving towards Empowerment” (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period. Methods This study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at

Abstract Background Globally, depression is a leading cause of morbidity and mortality particularly in Low and Middle-Income Countries (LMICs). The burden of non-communicable diseases (NCDs) are also increasing in LMICs, the conditions frequently co-occur and exacerbate NCD outcomes. Depression interventions alone are not effective at improving NCD outcomes, resulting in wide-reaching calls for integrated services. Integrated services are in a nascent phase in LMICs in general and in Malawi in particular. This manuscript serves to clarify Malawian patients’ attitudes and perceptions towards depression integration into routine NCD services. Methods Ten District Hospitals were selected for data collection and 2 participants were interviewed from each site (N = 20). An iterative approach to concept-driven coding was applied to facilitate the formation of similarities, differences, and connections between codes. Results While patients infrequently described moderate depression as a medical condition, and held various attitudes regarding treatments, they agreed on the appropriateness of integrated services. Patients’ respect for their providers led them to support integration. Patients discussed how medical knowledge is highly regarded, revealing a power dynamic with their providers. Patients further acknowledged the importance of a provider’s communication in shaping a patient’s feelings about depression. Conclusions Training and interventions that facilitate providers’ abilities to transfer their medical knowledge, use strategies to channel their power, and engage patients in a meaningful and collaborative relationship will be key to successfully integrating depression treatment into Malawian NCD clinics. Trial registration This work served as part of formative data collection for National Institute of Mental Health (NIMH) Trail NCT03711786 registered on 10th October, 2018.

BackgroundDespite progress toward the Joint United Nations Programme on HIV/AIDS “95-95-95” targets (95% of HIV-positive persons tested, 95% of tested persons on treatment, and 95% of treated persons virally suppressed), a gap remains in achieving the first 95% target. Assisted contact tracing (ACT), in which health workers support HIV-positive index clients to recruit their contacts (sexual partners and children) for HIV testing, efficiently identifies HIV-positive persons in need of treatment. Although many countries, including Malawi, began implementing ACT, testing outcomes in routine settings have been worse than those in trial settings. ObjectiveThe aim of this paper is to use formative research and frameworks to develop and digitize an implementation package to bridge the gap between ACT research and practice. MethodsSemistructured qualitative research was conducted in 2019 in Malawi with key informants. Barriers and facilitators to intervention delivery were identified using the Consolidated Framework for Implementation Research. Approaches to digitization were examined using human-centered design principles. ResultsLimited clinic coordination and health worker capacity to address the complexities of ACT were identified as barriers. Ongoing individual training consisting of learning, observing, practicing, and receiving feedback, as well as group problem-solving were identified as facilitators. Important features of digitization included (1) culturally relevant visual content, (2) capability of offline use, and (3) simple designs and basic editing to keep costs low. ConclusionsFormative research and frameworks played a key role in designing and digitizing an implementation package for ACT delivery in a low-income setting such as Malawi.

Abstract Background Mental health (MH) disorders in low and middle-income countries (LMICs) account for a large proportion of disease burden. While efficacious treatments exist, only 10% of those in need are able to access care. This treatment gap is fueled by structural determinants including inadequate resource allocation and prioritization, both rooted in a lack of research and policy capacity. The goal of the Sub-Saharan Africa Regional Partnership for Mental Health Capacity Building (SHARP), based in Malawi and Tanzania, is to address those research and policy-based determinants. Methods SHARP aims to (1) build implementation science skills and expertise among Malawian and Tanzanian researchers in the area of mental health; (2) ensure that Malawian and Tanzanian policymakers and providers have the knowledge and skills to effectively apply research findings on evidence-based mental health programs to routine practice; and (3) strengthen dialogue between researchers, policymakers, and providers leading to efficient and sustainable scale-up of mental health services in Malawi and Tanzania. SHARP comprises five capacity building components: introductory and advanced short courses, a multifaceted dialogue, on-the-job training, pilot grants, and “mentor the mentors” courses. Discussion Program evaluation includes measuring dose delivered and received, participant knowledge and satisfaction, as well as academic output (e.g., conference posters or presentations, manuscript submissions, grant applications). The SHARP Capacity Building Program aims to make a meaningful contribution in pursuit of a model of capacity building that could be replicated in other LMICs. If impactful, the SHARP Capacity Building Program could increase the knowledge, skills, and mentorship capabilities of researchers, policymakers, and providers regarding effective scale up of evidence-based MH treatment.

Abstract Behavioral interventions to increase disclosure and proper management of concussion in youth sports have unrealized potential when it comes to preventing concussion. Interventions have focused on changing individual athlete behavior and have fallen short of the potential for sustained systemic behavioral change. One potentially critical reason for this shortfall is that other key determinants of risk behaviors at all levels of the socio-ecological model (e.g. interpersonal, community, policy) are not addressed in extant programming. There is a critical need for theory-driven interventions that address concussion prevention and education at the community level and target sustainable culture change. The Popular Opinion Leader (POL) intervention, a multi-level intervention model previously successfully employed in multiple public health contexts, is theoretically well positioned to affect such change. POL is based on the Diffusion of Innovations framework and involves identifying, recruiting, and training well-respected and trusted individuals to personally endorse prevention and risk-reduction within their social networks. Critical behavioral changes related to concussion disclosure and management have been shown to diffuse to others if enough opinion leaders endorse and support the behaviors. This article summarizes the concepts and principles of POL and describes how it could be adapted for and implemented in youth sport settings. For optimal impact, POL needs to adapt to several factors unique to youth sports settings and culture. First, adult involvement may be important, given their direct involvement in the athlete’s medical care. However, parents and coaches’ opinions on injury care-seeking, competition, and safety may affect their perceptions of POL. Second, youth sports are structured settings both physically and socioculturally. Games and practices may provide opportunities for the informal interactions that are critical to the success of POL. However, youth sport setting membership is transient as players get older and move to other sport settings; POL approaches need to be self-sustaining despite this turnover. Moreover, stakeholder value placed on athlete development and competition, alongside safety, must be considered. Formative research is needed to ensure that POL principles are translated into the youth sport setting while maintaining fidelity to the concepts and principles that have made POL successful for other health outcomes.

BackgroundPerinatal depression (PND) can interfere with HIV care engagement and outcomes. We examined experiences of PND among women living with HIV (WLWH) in Malawi.MethodsWe screened 73 WLWH presenting for perinatal care in Lilongwe, Malawi using the Edinburgh Postnatal Depression Scale (EPDS). We conducted qualitative interviews with 24 women experiencing PND and analyzed data using inductive and deductive coding and narrative analysis.ResultsWomen experienced a double burden of physical and mental illness, expressed as pain in one's heart. Receiving an HIV diagnosis unexpectedly during antenatal care was a key contributor to developing PND. This development was influenced by stigmatization and social support.ConclusionsThese findings highlight the need to recognize the mental health implications of routine screening for HIV and to routinely screen and treat PND among WLWH. Culturally appropriate mental health interventions are needed in settings with a high HIV burden.

La Educación Preuniversitaria en Cuba ha sido testigo de una constante evolución del trabajo científico metodológico que se aplica en las instituciones educativas. En la actualidad, como parte del Tercer Perfeccionamiento del Sistema Nacional de Educación que se llevaa cabo en nuestro país, su implementación es esencial para alcanzar el éxito en la laboreducativa. El objetivo de este artículo es sistematizar los antecedentes de esta direccióndel trabajo metodológico, examinando cómo ha evolucionado destacando las principales tendencias, enfoques y prácticas que han influido en su desarrollo a través del I, II y III Perfeccionamientos del Sistema Educativo cubano. Se consultaron reglamentos que explicitan algunas características del objeto de investigación, se utilizaron métodos del nivel teórico como el histórico-lógico, analítico-sintético y el método de la sistematización que permitieron considerar los rasgos que lo han caracterizado, para arribar a conclusiones acerca de su comportamiento en diferentes momentos de su desarrollo.

We are interested in how metaverse technologies can provide an environment for future virtual education beyond traditional videoconferencing technologies. This study investigates learning and the quality of the classroom experience by conducting classes in four metaverse environments: Meta Horizon Workrooms, Spatial, Mozilla Hubs, and Arthur. Through the analysis of questionnaires, we assess the influence of factors such as avatars, spatial arrangement, mobility, and extra functionalities on concentration, usability, presence, and learning. While we did not observe significant differences in learning outcomes, our analysis reveals substantial variations in the quality of the classroom experience. Specifically, higher immersion, concentration, and presence levels were observed in metaverses with limited movement and functionalities. Also, our findings emphasize the positive impact of avatars with realistic facial expressions on enhancing the overall experience. Finally, we present lessons learned and offer recommendations for class configurations in the metaverse based on our questionnaire analysis.

Introducción: El acoso sexual es un tipo frecuente de violencia de género que atenta profundamente contra la integridad personal y los derechos humanos. Este se puede presentar en diferentes contextos, y aún hoy en día los centros de salud no están libres de esta práctica. Actualmente existen instructivos presidenciales que establecen que todos los Servicios de Salud deben contar con protocolos de acoso sexual. El objetivo de esta revisión es evaluar los protocolos de acoso sexual de los Servicios de Salud de Chile dirigidos a personal de salud. Materiales y Métodos: Se desarrolló un análisis de contenido de los 29 protocolos de acoso sexual de los Servicios de Salud con respecto a los instructivos presidenciales 2015 y 2018. Se generaron 14 ítems de evaluación. Se extrajo el contenido de cada protocolo por ítem, y luego se categorizó de forma cuantitativa (muy adecuado, adecuado, insuficiente, ausente) y se realizó una síntesis de su contenido de forma cualitativa. Se describió el grado de cumplimiento de cada uno de los ítems, y se desarrolló análisis de contenido. Resultados: Se analizó el 100% de protocolos de los Servicios de Salud. Se evidenció heterogeneidad en la calidad de los mismos, con falencias importantes en el enfoque preventivo, claridad del proceso y medidas reparatorias. Discusión: Los hallazgos sugieren una revisión de los protocolos de acoso sexual para optimizar y homogeneizar su calidad y pertinencia.

Este artigo tem por objetivo estudar a caracterização do migrante negro Moïse Kabagambe em um grupo de tuítes realizado em protesto ao seu assassinato. Os dados foram coletados e processados utilizando-se a linguagem de programação R de forma a gerar redes de palavras, suas colocações e concordâncias como forma de compreensão do espaço de significação representado pelo léxico. Os resultados mostram a presença de padrões discursivos que evidenciam o posicionamento político nos tuítes. Tais padrões revelam que o crime e suas repercussões serviram como um caminho de reflexão e mobilização em relação a causa dos migrantes, com especial repercussão sobre suas condições de sobrevivência no Brasil e na violência sofrida.

Background: This paper shows how current collaborative virtual environments (VEs) such as Mozilla Hubs and AltspaceVR can aid in the task of requirements gathering in VR for simulation and training. Methods: We performed a qualitative study on our use of these technologies in the requirements gathering of two projects. Results: Our results show that requirements gathering in virtual reality has an impact on the process of requirements identification. We report advantages and shortcomings that will be of interest to future practitioners. For example, we found that VR sessions for requirements gathering in current VEs could benefit from better pointers and better sound quality. Conclusion: Current VEs are useful for the requirements gathering task in the development of VR simulators and VR training environments.

Background: the COVID 19 pandemic causes the death of many people, mainly older adults. Knowing about it is one way to prevent it.Objective: to describe the results of an educational intervention on COVId 19, in older adults.Methods: educational intervention carried out in a universe of 230 older adults, from which a sample of 178 dispensed elderly people belonging to the Family Doctor´s Office No. 4 in Cumanayagua was selected. A diagnosis was made to identify the level of knowledge about COVID-19, in which aspects about the disease were investigated, such as: symptoms, prevention measures, transmission routes. They were also asked about compliance with prevention measures. On that basis, an educational intervention was developed. Results: The 50 % present risk factors; knowledge about symptoms increased from 10.1% before the intervention to 100% after; on transmission routes from 35.9 % to 83.7 % and that of preventive measures from 53.9 % to 91.7 %. They learned to use the mask correctly. The satisfaction of the elderly with the educational actions was high.Conclusions: after the application of educational actions, there was an increase in knowledge about the disease, which may be favorable for its prevention in this group of elderly.

Objective: To evaluate the best strategy for pacifier disinfection methods. Material and Methods: The literature search was conducted on MEDLINE/PubMed, Scielo, Lilacs, Web of Science, and Scopus databases to find all relevant articles published over the past 20 years, based on PRISMA guidelines. Two reviewers extracted data independently by using a standardized form. The following factors were recorded: country of study, type of study, pacifier material, sample number, microorganisms analyzed, decontamination methods used, method accessibility and results found. Results: A total of 121 articles were obtained from all databases. The selected documents underwent a final screening, resulting in 8 articles. The method of disinfection analyzed by the literature were: 3.5% neutral detergent, apple cider vinegar 70% spray, boiling water during 15 minutes, sodium hypochlorite 2.5, hydrogen peroxide 70% spray, chlorhexidine 0.12%, Brushtox®, sterile water and microwave. Conclusion: Because of the broad methods for pacifier disinfection and different levels of accessibility to disinfectant agents, the pacifier consensus for decontamination remains unclear. Although the disinfection methods are diverse, the methods suggested to its disinfection were identified and described in this article.

Objective: To evaluate the dentists' knowledge about biosafety considering the SARS-CoV-2 and the risks of increasing the COVID-19 outbreak by dental practices during the pandemic in Brazil. Material and Methods: A cross-sectional study was performed by internet-based snowball sampling technique. A questionnaire with questions about different content was applied, and then analyzed the following two parameters: participants’ Brazilian region and professional’s specialty. Results: A total of 413 e-questionnaires from all Brazilian regions were considered valid. There were no significant differences among biosafety measures adopted by participants from different Brazilian regions (p≥0.05), except for those from North region, which have applied less previous oral antisepsis, temperature screening, and specific anamnesis tracking COVID-19 symptoms (p

Introduction: Head and neck neoplasms represent 17.6% worldwide. Cancer of the oral cavity is one of the most common that appear in this region, being 95% epidermoid carcinoma with a poor prognosis of survival because they develop from premalignant lesions dangerously asymptomatic, the reason why the precocious detection is imperative. Objective: Characterize potentially malignant oral disorders through epidemiological, clinical and topographical aspects in adults served at the Montalvo health subcenter. Methods: A descriptive and cross-sectional study was conducted on 99 patients treated at the Montalvo health subcentre in Ambato, Ecuador, from November 2012 to January 2013. The data were collected in the stomatological medical history, which included: general data, interrogation and physical examination of the oral cavity. The potentially malignant oral disorders considered were leukoplakia, erythroleukoplakia, erythroplasia and the palate of the inverted smoker. The descriptive statistic and the Sperman chi square statisticwast were applied. It was worked with confidentiality in the handling of the data obtained and with the authorization corresponding to the consent.. Results: Patients over 60 years of age accounted for the most affected age group for 60.6%, with a female predominance (54.5%). The skin color did not make a significant difference. The most common disorder was leukoplakia (30%), followed by erythroleukoplakia (15%) erythroplasia (11%). 75.8% of patients had no symptoms, however 73% of injured cases had physical trauma. The most common location of leukoplakia was the mucosa of the cheek and the base of the tongue. Conclusion: Leukoplakia, erythroleukoplakia and erythroplasia were the most common potentially malignant oral disorders, most commonly located at the base of the tongue and mucosa of the carrillo, with predominance in patients over 60 years of age and in patients over 60 years of age and in Women.

Introduction: Bacteremia is a common but life-threatening infectious disease. However, a well-defined rule to assess patient risk of bacteremia and the urgency of blood culture is lacking. The aim of this study is to establish a predictive model for bacteremia in septic patients using available big data in the emergency department (ED) through logistic regression and other machine learning (ML) methods. Material and Methods: We conducted a retrospective cohort study at the ED of National Cheng Kung University Hospital in Taiwan from January 2015 to December 2019. ED adults (≥18 years old) with systemic inflammatory response syndrome and receiving blood cultures during the ED stay were included. Models I and II were established based on logistic regression, both of which were derived from support vector machine (SVM) and random forest (RF). Net reclassification index was used to determine which model was superior. Results: During the study period, 437,969 patients visited the study ED, and 40,395 patients were enrolled. Patients diagnosed with bacteremia accounted for 7.7% of the cohort. The area under the receiver operating curve (AUROC) in models I and II was 0.729 (95% CI, 0.718–0.740) and 0.731 (95% CI, 0.721–0.742), with Akaike information criterion (AIC) of 16,840 and 16,803, respectively. The performance of model II was superior to that of model I. The AUROC values of models III and IV in the validation dataset were 0.730 (95% CI, 0.713–0.747) and 0.705 (0.688–0.722), respectively. There is no statistical evidence to support that the performance of the model created with logistic regression is superior to those created by SVM and RF. Discussion: The advantage of the SVM or RF model is that the prediction model is more elastic and not limited to a linear relationship. The advantage of the LR model is that it is easy to explain the influence of the independent variable on the response variable. These models could help medical staff identify high-risk patients and prevent unnecessary antibiotic use. The performance of SVM and RF was not inferior to that of logistic regression. Conclusions: We established models that provide discrimination in predicting bacteremia among patients with sepsis. The reported results could inspire researchers to adopt ML in their development of prediction algorithms.

Introdução: O hábito de sucção de chupeta é comum em crianças, sendo este objeto um veículo de contaminação e transmissão de microrganismos causadores de doenças, necessitando, dessa forma, de uma correta desinfecção. Objetivo: Avaliar as práticas de desinfecção de chupetas realizadas pelos responsáveis de crianças que tenham ou que já tiveram o hábito de usar chupeta. Material e Métodos: Após a aprovação ética, foi aplicado questionário semiestruturado (12 questões) a pais e avós de crianças que mantinham o hábito da chupeta ou que o interromperam há no máximo dois anos. As questões versaram sobre hábitos de desinfecção de chupetas, acesso a instrução sobre a desinfecção e a profissionais de saúde, incluindo dentistas. A associação entre variáveis categóricas foi estabelecida pelo teste Qui-quadrado e das variáveis contínuas pela correlação de Pearson. O nível de significância adotado foi de 5%. Resultados: Foram considerados para a amostra 104 questionários. A média de idade dos respondentes foi de 32 anos, sendo a maioria mulheres (91,3%). A idade média das crianças que usaram a chupeta foi de 26 meses. Apesar de água sob fervura ser o método de desinfecção das chupetas mais relatado (35,6%), 15,4% dos respondentes relataram usar apenas água corrente. Além disso, apenas 20,2% dos respondentes receberam alguma instrução de profissionais de saúde sobre a desinfecção, e somente 29,8% relataram já ter levado a criança ao dentista. A associação entre a frequência de desinfecção de chupetas e a frequência de ida ao cirurgião-dentista apresentou significância estatística. Conclusão: O conhecimento por pais e familiares sobre a desinfecção de chupetas não se mostrou adequado neste estudo. Tal fato pode estar relacionado à falta de acesso à informação, por meio de profissionais de saúde.

Introdução: A disfunção temporomandibular (DTM) representa uma das principais causas de dor na região orofacial. A dimensão vertical de oclusão (DVO) refere-se à posição vertical da mandíbula em relação à maxila e seu restabelecimento correto é essencial nas reabilitações protéticas, pois variações deste parâmetro podem influenciar negativamente os quadros de DTM. Objetivo: Avaliar a presença de disfunção temporomandibular em pacientes portadores de prótese total e sua possível associação com a redução de dimensão vertical de oclusão. Material e Métodos: A amostra foi composta de 31 pacientes voluntários, com idades entre 42 e 87 anos, de ambos os sexos, sendo portadores de prótese total, atendidos na Clínica de Prótese Total Removível da Faculdade de Odontologia da Universidade Federal de Juiz de Fora. A análise da redução de DVO foi realizada através dos testes métrico, estético e fonético e o diagnóstico de DTM foi estabelecido a partir do Eixo I do RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders). Os dados foram tabulados e submetidos à análise estatística descritiva no programa pelo SPSS (Statistical Package for the Social Science) versão 15.0 para Windows. Para comparação das variáveis categóricas entre os grupos de DTM ​ foi utilizado o teste Qui-quadrado com nível de significância admitido de 5% (p0,05).

Cancer is one of the most important health problems and the second leading cause of death worldwide. Despite the advances in oncology, cancer heterogeneity remains challenging to therapeutics. This is because the exosome-mediated crosstalk between cancer and non-cancer cells within the tumor microenvironment (TME) contributes to the acquisition of all hallmarks of cancer and leads to the formation of cancer stem cells (CSCs), which exhibit resistance to a range of anticancer drugs. Thus, this review aims to summarize the role of TME-derived exosomes in cancer biology and explore the clinical potential of mesenchymal stem-cell-derived exosomes as a cancer treatment, discussing future prospects of cell-free therapy for cancer treatment and challenges to be overcome.

Los repelentes son aquellos que nos defienden de insectos, principalmente de los mosquitos. Es necesario protegerse de sus picaduras, razón por la cual, la presente investigación tiene como objetivo general la elaboración de un repelente a base del zumo extraído de frutas cítricas y verificar, por medio de la observación directa en campo, sobre su efectividad para mantener alejado de la piel humana mosquitos, bajo diferentes condiciones. En los ensayos de laboratorio se pesaron 252g de cáscaras de naranja y se colocaron en maceración por 5 días en una solución de 325mL de alcohol comercial. Datos preliminares obtenidos, indican de que sí es factible la elaboración de repelentes a base del zumo extraído de la cáscara de frutas cítricas y que el mismo presenta una acción repulsiva hacia los mosquitos en las condiciones estudiadas, sin embargo se hace necesario profundizar en futuras investigaciones.

Aim: To determine parent´s perceptions and concerns about inhaled therapy and their relation to disease control. Methods: A questionnaire was applied by interviewing parents of 119 asthmatic children attending the Pediatric Allergy or Pneumology outpatient clinic. Results: Eighty-one (68%) parents expressed concerns and worries about the use of inhaled therapy in their children, either with controlled or partially/uncontrolled asthma (65% Vs 78% p=0.22). Regarding their beliefs about inhaled therapy, 11% (n=13) stated that they considered pMDI’s/DPI’s less effective than nebulizers. When questioned about the knowledge of their child's acute exacerbation therapy, 91.5% (n=109) reported knowing it, albeit only 40% (n=44) did answer it correctly. Nine parents said they were unaware of their children’s reliever treatment. Discussion: We expected to find parental concerns about inhaled therapy, but such a high percentage wasn´t expected. A substantial number of parents believe that their children can become addicted or dependent on the use of the inhaler. This finding reinforces the misconceptions parents do have regarding inhaled therapy. There is a higher proportion of parents with concerns in the group with partially/uncontrolled asthma, although it was not statistically significant. The majority of patients/parents reported knowing the reliever plan in an exacerbation, although most of them could not explain the plan correctly. These results are worrying, as they show parents have an inappropriate knowledge of reliever measures. Therefore, we suggest that improvements in education about inhaled therapy should be made, including the regular review of the inhalation technique and the reliever plan in every consultation.

Este estudo foi realizado com o objetivo de avaliar o desempenho produtivo da tilápia do Nilo (Oreochromis niloticus) alimentada com níveis de colina na dieta pelo período de 109 dias. Foram utilizados 192 alevinos com 4,0 ± 0,15 g de peso médio, distribuídos em 32 tanques-rede de 200 L, na densidade de seis peixes por tanque-rede, dispostos em aquários de 1.000 L. O delineamento experimental foi inteiramente casualizado com oito tratamentos e quatro repetições. As rações foram suplementadas com 0, 100, 200, 400, 600, 800, 1.000 e 1.200 mg de colina kg-1 de ração. Não foram observadas diferenças para ganho de peso, taxa de sobrevivência, conversão alimentar aparente, porcentagem de extrato etéreo do filé e do fígado, índice hepatossomático e concentração de lipídeos no plasma. Concluiuseque os diferentes níveis de colina não melhoraram o desempenho produtivo dos peixes nestas condições, pois a dieta basal supostamente supriu a exigência do peixe para colina.A 109-day feeding trial was undertaken aiming to evaluate the growth performance of Nile tilapia fed graded choline levels. One hundred and ninety-two (initial weight 4.0 ± 0.15 g) fingerlings were distributed into 32 net cages (200 L each), four cages per treatmentand six fish per cage, placed in eight 1000L aquaria in a closed recirculation system. The treatments were assigned to the tanks comprising eight treatments and four replications arranged in a completely randomized experimental design. Diets were supplemented with choline chloride to provide 100, 200, 400, 600, 800, 1000, 1200 mg of choline per kg of feed and an unsupplemented diet. No significant differences were observed in growth performance, survival, apparent feed conversion, liver and fillet ether extract, hepatosomatic index and plasma lipid concentration, among treatments. Choline levels did not improve growth performance, possibly because the amount of choline in the diet had already met fish requirement.

Cryptococcus neoformans is an encapsulated yeast, etiological agent of cryptococcosis. The species is commonly associated with pigeon droppings and plant materials. The aim of the present work was to verify the presence of the yeast in pigeon droppings, and to identify the isolates obtained in serotypes and mating types (MAT). Ten samples of pigeon droppings were collected in the rural area of the city of Alfenas, Brazil. Samples were inoculated in agar Niger medium for fungal isolation and 22 isolates with characteristics of C. neoformans were obtained. The serotypes and MAT were determined by multiplex PCR using specific primers. Serotypes were also determined by using the Kit Crypto Check. Among the 22 samples evaluated, eight were identified as C. neoformans by classic identification tests. These samples were characterized as serotype A by the Kit Crypto check and as serotype A MAT alpha by the multiplex PCR. The present study reinforces the evidence that pigeon droppings are a reservoir for C. neoformans and confirms the prevalence of C. neoformans var. grubii (Aalpha) among environmental isolates. It also demonstrates that multiplex PCR is an acceptable alternative for serotype analysis because it reduces the costs for each reaction and analyses serotype and MAT simultaneously.Cryptococcus neoformans é levedura encapsulada, agente etiológico da criptococose. As espécies são comumente associadas com fezes de pombos e material vegetal. O objetivo do presente trabalho foi verificar a presença de leveduras em fezes de pombos e identificar os isolados em relação aos sorotipos e "mating types". Dez amostras de fezes de pombos foram coletadas na zona rural da cidade de Alfenas, Brasil. As amostras foram inoculadas em agar Niger e 22 isolados com características de C. neoformans foram obtidos. Os sorotipos e "mating types" foram determinados pela PCR multiplex e os sorotipos foram identificados também pelo Kit Crypto Check. Dentre as 22 amostras avaliadas, oito foram identificadas como C. neoformans através dos testes clássicos. Estas amostras foram caracterizadas como sorotipo A pelo Kit Crypto check e como sorotipo A MATalfa pela PCR multiplex. O presente estudo reforça a evidência de que as fezes de pombos constituem reservatório para C. neoformans e confirma a prevalência de C. neoformans var. grubii (Aalfa) nos isolados ambientais. PCR multiplex é uma alternativa aceitável para análise do sorotipo porque reduz os custos de cada reação e analisa simultaneamente os sorotipos e "mating type".

Avaliou-se o desempenho de tilápias-do-nilo (Oreochromis niloticus) criadas em tanques-rede e alimentadas com dietas contendo 27,0 (controle); 25,2; 24,3 e 22,7% de proteína digestível. Aminoácidos cristalinos (L-lisina, DL-metionina e L-treonina) foram adicionados à dieta considerando o conceito de proteína ideal e simulando o perfil de aminoácidos da dieta controle. Os peixes (34,63±19 g) foram alimentados manualmente com dietas isoenergéticas (3.075 kcal de energia digestível/kg de dieta) até saciedade aparente, três vezes ao dia, durante 91 dias. Utilizou-se um delineamento inteiramente casualizado, com quatro tratamentos, três repetições e 25 peixes/unidade experimental. Não foram observados efeitos dos níveis de proteína digestível sobre o ganho de peso, a conversão alimentar, a taxa de eficiência protéica, o peso da carcaça eviscerada, o rendimento de carcaça, o peso e o rendimento de filé, a sobrevivência e o hematócrito. Houve efeito quadrático dos níveis de proteína digestível sobre o consumo; o maior valor foi estimado para a dieta contendo 24,41% de proteína digestível e excreção de nitrogênio, na qual o melhor resultado estimado foi obtido com peixes que receberam a dieta contendo 24,92% de PD. Com a redução nos níveis de proteína digestível, observou-se aumento linear na retenção de nitrogênio. É possível reduzir o nível de proteína digestível, de 27 (29,1% de PB) para 24,3% (26,6% de PB), em dietas para tilápias-do-nilo criadas em tanques-rede. Essa redução deve ser feita por meio da suplementação de aminoácidos (com base no conceito de proteína ideal), considerando o desempenho e o custo da dieta/kg ganho em filé.This study was carried out to evaluate the performance of Nile tilapia, cultured in net pens, and fed diets containing 27.0 (control), 25.2, 24.3, and 22.7% of digestible protein. Crystalline amino acids (L-lysine, DL-methionine and L-threonine) were added to keep amino acid levels according to the ideal protein profile and to simulate amino acid levels of the control diet. Fish (34.63±1.19 g) were hand-fed one of the four isoenergetic (3,075 kcal of digestible energy/kg, as fed basis) experimental diets until apparent satiation, three times a day during 90 days. A completely randomized design with four treatments, three replicates and 25 fishes per experimental unit was utilized. No effects of dietary digestible protein levels on weight gain, feed conversion, protein efficiency ratio, empty carcass weight, carcass yield, fillet weight and yield, survival, and hematocrit were observed. It was observed quadratic effect on feed intake and nitrogen excretion, wich increased up to 24.41 and 24.92% of dietary digestible protein, respectively. The reduction of digestible protein levels resulted in a linear increase of nitrogen retention. It was concluded that it is possible to reduce the dietary digestible protein from 27.0 (29.1% of CP) to 24.3% (26.6% of CP) in amino acid supplemented diets (based on ideal protein concept), for juvenile Nile tilapia, cultured in net pens, without adverse effects on growth performance, carcass yield and composition, hematological parameters and cost of diet/kg of fillet gain.

Two mammalian genes, Kcnt1 and Kcnt2, encode pore-forming subunits of Na+-dependent K+ (KNa) channels. Progress in understanding KNa channels has been hampered by the absence of specific tools and methods for rigorous KNa identification in native cells. Here, we report the genetic disruption of both Kcnt1 and Kcnt2, confirm the loss of Slo2.2 and Slo2.1 protein, respectively, in KO animals, and define tissues enriched in Slo2 expression. Noting the prevalence of Slo2.2 in dorsal root ganglion, we find that KO of Slo2.2, but not Slo2.1, results in enhanced itch and pain responses. In dissociated small diameter DRG neurons, KO of Slo2.2, but not Slo2.1, abolishes KNa current. Utilizing isolectin B4+ neurons, the absence of KNa current results in an increase in action potential (AP) firing and a decrease in AP threshold. Activation of KNa acts as a brake to initiation of the first depolarization-elicited AP with no discernible effect on afterhyperpolarizations.

Este estudo foi realizado para determinar a exigência de treonina para tilápia-do-nilo. Os peixes (37,61 ± 1,16 g de peso inicial) foram distribuídos em um delineamento inteiramente casualizado, com quatro tratamentos, três repetições e 25 peixes por unidade experimental. Foi utilizada uma ração-referência (27% de PB e 3.000 kcal de ED/kg) suplementada com L-treonina, resultando em rações com 0,92; 1,06; 1,21 e 1,35% de treonina total. Os aminoácidos sintéticos foram adicionados para manutenção do perfil de aminoácidos, de acordo com o conceito de proteína ideal. Os peixes foram alimentados até saciedade aparente durante 110 dias. Não foram observados efeitos dos níveis de treonina nas rações sobre o consumo de ração, o peso do fígado, o índice hepato-somático, os rendimentos de carcaça e de filé e a composição do filé em água (PB e EE). Constatou-se aumento linear sobre o ganho de peso, a conversão alimentar, a taxa de eficiência protéica, a retenção de nitrogênio, os pesos da carcaça e do filé e o teor de cinzas no filé. Considerando os resultados de desempenho, de custo/kg de ganho de peso e de custo/kg de peso em filés, pode-se inferir que tilápias-do-nilo de 38 a 351 g criadas em tanques-rede necessitam de 1,35% de treonina na ração - 5,51% da proteína digestível ou 74% de lisina (com base no conceito de proteína ideal).This experiment was conducted to determine the dietary threonine requirements for Nile tilapia. The fishes (37.61 ± 1.16 of initial weight) were allotted to a completely randomized design with four treatments, three replicates and 25 fishes per experimental unit. It was used a reference diet with 27% of CP and 3,000 kcal of DE/kg, supplemented with L-threonine, resulting in diets with 0.92, 1.06, 1.21, and 1.35% of total threonine. Synthetic amino acids were added to mantain their profile according to the ideal protein concept. Fishes were fed ad libitum during 110 days. No effects of dietary threonine levels on feed intake, liver weight, hepatic somatic index, carcass yield, fillet yield and fillet water composition (CP and EE) were observed. It was observed linear increase on weight gain, feed:gain ratio, protein efficiency rate, nitrogen retention, carcass weight, fillet weight and ash content in fillet. Considering data of performance, cost/kg of weight gain and cost/kg of fillet weight, the dietary total threonine requirement is of 1.35% [5.51% of digestible protein or 74% of lysine (based on the ideal protein concept)] for Nile tilapia from 38 to 351 g, reared in net pens.

Este estudo foi realizado com o objetivo de determinar a exigência de lisina digestível para juvenis de tilápia-do-nilo. Noventa e seis peixes revertidos sexualmente e com peso vivo inicial de 5,72 ± 0,10 g foram alimentados por 42 dias com quatro rações (29.51% de PB e 3.235 kcal de energia digestível/kg) contendo diferentes níveis de L-lisina HCl (0,1; 0,3; 0,5 e 0,7%, correspondendo a rações com 1,04; 1,27; 1,51 e 1,741% de lisina digestível, respectivamente). Os peixes foram distribuídos em 16 tanques com capacidade de 1.000 L cada um, em um delineamento inteiramente casualizado, com quatro tratamentos, três repetições e seis peixes por unidade experimental. Não foi observado efeito dos níveis de lisina sobre o índice hepato-somático, a gordura visceral, a sobrevivência e os teores de água e extrato etéreo na carcaça. A análise de Linear Response Plateau do ganho de peso e da conversão alimentar versus níveis de lisina digestível demonstrou estimativa de exigência de 1,56 e 1,44% de lisina digestível, respectivamente. Foi observado efeito quadrático sobre o rendimento de carcaça, que aumentou até o nível de 1,61% de lisina digestível. Considerando o desempenho, recomenda-se que dietas para juvenis de tilápia-do-nilo devem conter 1,44% de lisina digestível (5,23% da proteína da dieta).This trial was carried out to determine the digestible lysine requirements of Nile tilapia juveniles. Ninety- six reverted fishes averaging initial weight of 5.72 ± 0.10 g were fed four diets (29.51% of crude protein and 3,235 kcal/kg of digestible energy) containing increasing levels of L-lysine HCl (0.1, 0.3, 0.5, and 0.7%), during 42 days. The following treatments were evaluated: dietary lysine levels of 1.04; 1.27; 1.51 and 1.741%. Fishes were allotted to 1000-L 16 tanks, as a completely randomized design with four treatments, three replicates and eight fishes per experimental unit. No treatment effects on hepatosomatic index, visceral fat, survival rate and water ether extract in the carcass were observed. The Linear Response Plateau analysis of weight gain and feed:gain ratio versus digestible lysine level yielded an estimated digestible lysine requirement of 1.56 and 1.44% for Nile tilapia juveniles, respectively. Quadratic effect of treatments on carcass yield that increased up to 1.61% of digestible lysine was observed. Considering the performance, it is recommended diets containing up to 1.44% of digestible lysine (5.23% of protein) for Nile tilapia juveniles.

Este estudo foi realizado para se avaliar a redução dos níveis de proteína em dietas para tilápia-do-nilo (5 a 125 g), adotando-se o conceito de proteína ideal. Cento e sessenta peixes (4,40 ± 0,9 g) foram distribuídos em um delineamento inteiramente casualizado, com quatro tratamentos [25,5; 27; 28,5 e 30% (controle) de proteína digestível], três repetições e dez animais por unidade experimental. Os aminoácidos sintéticos foram suplementados para se manter as proporções de aminoácidos de acordo com o conceito de proteína ideal. Os aminoácidos lisina, metionina e treonina foram suplementados para se obter os níveis de aminoácidos da dieta controle. As dietas foram fornecidas à vontade, durante 83 dias. Não foram observados efeitos dos níveis de proteína sobre o ganho de peso, a conversão alimentar, o índice hepatossomático, o peso da gordura visceral, a taxa de sobrevivência, os níveis de proteína na carcaça e o diâmetro da fibra intermediária. O aumento nos níveis de proteína resultou em redução linear na taxa de eficiência protéica e de retenção do nitrogênio e aumento linear na excreção de nitrogênio. Foi observado efeito quadrático sobre o rendimento de carcaça e o teor de extrato etéreo na carcaça; os melhores valores foram obtidos com 28,40 e 27,31% de proteína na dieta, respectivamente. Concluiu-se que é possível a redução do nível de proteína de 30 para 27,5% em dietas para juvenis de tilápia do Nilo, sem efeitos negativos sobre o crescimento, rendimento de carcaça e a composição química dos filés. No entanto, a redução do nível de proteína de 30 para 25,5% acarreta redução no diâmetro das fibras musculares vermelha e branca.This trial was carried out to evaluate the effects of ideal protein concept on reduction of dietary protein content for Nile tilapia (5 to 125 g). A hundred and sixty juvenile fishes (4.40 ± 0.9 g) were assigned to a randomized experimental design with four treatments [25.5, 27, 28.5 and 30% (control) of digestible protein], three replicates and ten fish by experimental unit. Crystalline amino acids were added to maintain amino acid levels according to the ideal protein concept. The amino acids (lysine, methionine and threonine) were supplemented at levels to simulate amino acid levels of the reference diet. Diets were fed ad libitum during 83 days. No significant effects of protein levels on weight gain, feed:gain ratio, hepatossomatic, visceral fat, survival rate, carcass protein and intermediate fiber diameter were observed. The protein efficiency rate and nitrogen retention decreased linearly and excreted nitrogen increased linearly as the dietary digestible protein levels increased. Quadratic effect for carcass yield and carcass ether extract content was observed, with the best values at 28.40 and 27.31% dietary protein, respectively. It was concluded that is possible to reduce the dietary protein from 30 to 27.5% for juvenile Nile tilapia, with no change on growth, carcass yield and fillet chemical composition. However, the reduction of white and red fibers diameter was observed when dietary protein decreased from 30 to 27.5%.

Este estudo foi realizado para determinar o coeficiente de digestibilidade aparente (CDA) da energia bruta e proteína bruta da silagem de sorgo de baixo tanino (SSBT) e da silagem de sorgo de alto tanino (SSAT) para a tilápia do Nilo (Oreochromis niloticus). A ração referência foi misturada aos ingredientes-teste na proporção de 60:40. Os peixes (53,26 ± 12,94g) foram alimentados até a saciedade aparente e as fezes foram coletadas após sedimentação. A fibra em detergente neutro foi utilizada como indicador endógeno. Os CDA da energia bruta e proteína bruta da SSBT e SSAT variaram entre 70,17 e 68,37% e 84,94 e 82,40%, respectivamente. Os valores de energia digestível foram de 3049,81 e 2954,74kcal kg-1 para SSBT e SSAT, respectivamente. A SSBT apresentou valores significa-tivamente (PThis study was carried out to determine the apparent digestibility coefficients (ADC) of gross energy and crude protein of low tannin silage sorghum (LTSS) and high tannin silage sorghum (HTSS) for Nile tilapia (Oreochromis niloticus). The reference diet was mixed with test ingredients in a 60:40 ratio. Fish (53.26 ± 12.94g) were fed to apparent satiation and faeces were collected other sedimentation The neutral detergent fiber was used as an endogenous indicator. ADC for gross energy and crude protein of LTSS and HTSS varied between 70.17 and 68.37% and 84.94 and 82.40%, respectively. Digestible energy values were 3,049.81 and 2,954.74kcal kg-1 for LTSS and HTSS, respectively. LTSS produced significantly (P

La axotomía de un nervio periférico conduce a la interrupción de la continuidad del axón, con degeneración walleriana en el segmento distal de la neurona. El proceso postraumático del nervio lesiona el axón y su vaina de mielina y el material dañado es invadido por fagocitos hematógenos, que remueven con el tiempo la gran mayoría de las fibras de mielina y otras células endoneurales. Este hecho permitió el seguimiento del trayecto nervioso intrapulmonar, después de la sección del tronco vago-simpático cervical en la rata, por la aparición en el proceso degenerativo de productos de desintegración de lípidos de la mielina, teñidos con Sudán III y IV. El objetivo del trabajo fue poner en evidencia y se demostró el trayecto de las fibras autónomas intrapulmonares y su relación con las divisiones más finas de los bronquios respiratorios, por la función que el sistema autónomo tiene en el asma bronquialThe axotomy of a peripheral nerve leads to the interruption of the continuity of the axon with wallerian degeneration in the distal segment of the neuron. The posttraumatic process of the nerve injures the axon and its sheath of myelin and the damaged material is invaded by haematogenous phagocytes that with the course of time remove most of the myelin fibers and other endoneural cells. This fact allowed to follow the nervous intrapulmonary pathway after the section of the vagosympathetic cervical trunk in the rat, due to the appearance in the degenerative process of products of the desintegration of lipids from myelin, stained with Sudan III and IV. The aim of this paper was to show the pathway of the autonomic intrapulmonary fibers and their relationship with the thinnest divisions of the respiratory bronchi, taking into account the function of the autonomic nervous system in bronchial asthma

Spondylodiscitis in childhood is rare and has non-specific clinical features, requiring a high index of suspicion.The authors describe a nine month-old female infant, who presented at the emergency room (ER) with a torticollis for four days, without fever or trauma. Cervical X-rays were normal, and she received symptomatic treatment. Six days after, she returned to the ER with the same torticollis and also irritability, anorexia, and cervical hyper-extension. The CT scan showed cervical spondylodiscitis (C6-C7) with pre-vertebral abscess. The laboratory results only revealed a slightly elevated Sedimentation Rate. Treatment was systemic vancomycin, gentamicin and metronidazol for six weeks, followed by two weeks of oral flucloxacillin. The causative organism was not identified. The symptoms and the abscess resolved during the first week of treatment. Five days after finishing the antibiotics the magnetic resonance showed partial C6-C7 fusion, without neurologic compression or functional disability.Cervical spondylodiscitis with abscess is rare, especially in this age group. This case also emphasizes the importance of investigating an acquired persistent torticollis.

Este estudo foi realizado com o objetivo de avaliar o desempenho produtivo da tilápia do Nilo (Oreochromis niloticus) alimentada com níveis de colina na dieta pelo período de 109 dias. Foram utilizados 192 alevinos com 4,0 ± 0,15 g de peso médio, distribuídos em 32 tanques-rede de 200 L, na densidade de seis peixes por tanque-rede, dispostos em aquários de 1.000 L. O delineamento experimental foi inteiramente casualizado com oito tratamentos e quatro repetições. As rações foram suplementadas com 0, 100, 200, 400, 600, 800, 1.000 e 1.200 mg de colina kg-1 de ração. Não foram observadas diferenças para ganho de peso, taxa de sobrevivência, conversão alimentar aparente, porcentagem de extrato etéreo do filé e do fígado, índice hepatossomático e concentração de lipídeos no plasma. Concluiu-se que os diferentes níveis de colina não melhoraram o desempenho produtivo dos peixes nestas condições, pois a dieta basal supostamente supriu a exigência do peixe para colina.

This study was conduced at the FMVZ – Unesp - Botucatu, to determine the Chemical composition and apparent digestibility coefficient (ADC) of dry matter (DM), crude protein (CP), raw energy (RE), amino acids (AA) and phosphorus availability. The fish were fed with a purified feed (base diet) and a 60% base diet plus 40% of fodder radish meal feed. Radish meal presented 91.28% DM, 42,07% CP, 4256 kcal/kg RE, 3.47% Ether extract, 7.37% crude fiber, 1.25% calcium and 1.0% phosphorus. The ADC values were DM: 55.92%, CP: 82.10%, RE: 75.26% and phosphorus: 85.23%. The ADC value for AA was 81.12% for glycine and 95.11% for glutamic acid. The results presented a potential utility for radish meal as an alternative protein source in Nile tilapia feeds.Este estudo foi realizado na Unesp - FMVZ -Botucatu, para determinar a composição química e os coeficientes de digestibilidade aparente (CDA) da matéria seca (MS), proteína bruta (PB), energia bruta (EB), aminoácidos (AA) e a disponibilidade do fósforo do farelo de nabo forrageiro, pela tilápia do Nilo. Empregou-se uma ração purificada (referência) e uma ração composta de 60% da ração referência e 40% do farelo de nabo forrageiro. O farelo de nabo forrageiro apresentou 91,28% de MS; 42,07% de PB, 4256 kcal/kg de EB, 3,47% de extrato etéreo, 7,37% de fibra bruta, 1,25% de cálcio e 1,0% de fósforo. Os CDA foram de 55,92% para MS, 82,10% para PB, 75,26% para EB e 85,23% do fósforo. Os CDA dos AA estiveram entre 81,12% para a glicina e 95,11% para o ácido glutâmico. Os resultados demonstram que o farelo de nabo forrageiro apresenta potencial para ser usado como fonte proteica alternativa para compor a ração da tilápia do Nilo.

Este trabalho foi realizado para avaliar a substituição do milho pela silagem de sorgo como fonte de energia para juvenis de tilápia do Nilo, Oreochromis niloticus L. (Cichlidae). Foram formuladas 3 dietas práticas isocalóricas (3000kcal de energia digestível) e isoprotéica (28% de proteína bruta). O farelo de milho foi substituído pela silagem de sorgo de baixo (0,44%) (SSBT) e alto (1,14%) (SSAT) teor de tanino. Os peixes (55,09 ± 0,94g) foram distribuídos em tanques de fibro-cimento (1000L) e alimentados com dietas experimentais até à saciedade 3 vezes ao dia, durante 67 dias. Não foram observadas diferenças significativas sobre a conversão alimentar, eficiência protéica, índice hepato-somático, gordura visceral e taxa de sobrevivência. O ganho de peso dos peixes alimentados com SSBT foi significativamente maior que os alimentados com dietas contendo milho e SSAT. Os peixes alimentados com dietas contendo SSBT consumiram mais ração do que os peixes alimentados com a dieta com SSAT. Os resultados indicaram que a inclusão de 44% de silagem de sorgo nas dietas podem suportar normal crescimento nos juvenis de tilápia do Nilo, com potencial para substituir o milho.

Este trabalho foi realizado para determinar os coeficientes de digestibilidade aparente (CDa) do farelo de soja integral sem e com (1000 unidades de fitase/kg dieta) suplementação de fitase pela tilápia do Nilo (110,3 ± 20 g). Os peixes foram alimentados com dieta peletizada até saciedade aparente. Foi utilizada dieta referência com 26,76% de proteína bruta e 3400 kcal de energia digestível/kg de dieta. Para a elaboração das dietas-teste o farelo de soja integral substituiu 30% da dieta referência. O óxido de crômio foi utilizado como indicador inerte e as fezes foram coletadas pelo sistema de Guelph modificado. A suplementação de fitase resultou em aumento na disponibilidade do fósforo. Os CDa da matéria seca, energia bruta, proteína bruta, extrato etéreo e do fósforo total foram, respectivamente: 67,64%; 73,34%; 92,49%; 96,12% e 26,14% e 65,96%; 75,33%; 93,28%; 95,73% e 58,82%, para o farelo de soja integral sem e com suplementação de fitase. Concluiu-se que o farelo de soja integral é efetivamente utilizado pela tilápia do Nilo e que a utilização de fitase aumenta a disponibilidade do fósforo total

Bexiga neurogênica é o termo utilizado para designar a disfunção vesical decorrente de uma lesão do sistema nervoso, cuja causa pode ser congênita ou adquirida. Sua terapêutica consiste em diferentes técnicas, porém todas têm como principal objetivo preservar a função renal e prevenir o aparecimento de lesões na região perianal. O intuito deste trabalho é reconhecer o hábito urinário do portador de bexiga neurogênica através do diário miccional, na tentativa de estabelecer a melhor conduta de reeducação da função vesical. A metodologia empregada foi a revisão de literatura específica sobre disfunção miccional de origem neurogênica. Observa-se que o diário miccional é um método investigativo simples, barato e de extrema importância para caracterizar o hábito miccional do paciente, permitindo ao enfermeiro estabelecer a terapia mais adequada em relação ao tipo de bexiga e às necessidades de cada indivíduo. Desta forma, pode-se obter a adesão ao tratamento, impedir as possíveis complicações e promover o desenvolvimento da autonomia do paciente. É papel do profissional de saúde, em especial do enfermeiro, garantir qualidade de vida e a reintegração social dessaspessoas.

Los milípedos, artrópodos terrestres, pertenecientes a la clase Diplopoda, son un grupo de invertebrados muy antiguos que comprende unas 11 000 especies1,2 distribuidas en todas las zonas ecogeográficas del planeta. Las especies que habitan en la zona neotropical se caracterizan por su gran tamaño y poca conocida ecología química en comparación con el gran número de publicaciones en este campo para la clase Insecta y Arachnida.3 Estos invertebrados se caracterizan por una gran diversidad. Existen especies estratobiónticas, edafobiontes y epifitobiontes cuya participación resulta importante en la formación, biodegradación y evolución orgánica de los suelos. Las secreciones defensivas de los milípedos, secretadas en glándulas especializadas, que se localizan en los segmentos del cuerpo y cuya composición varía según la familia y la especie del milípedo, constituyen una extraordinaria fuente de metabolitos secundarios biológicamente activos, 4-6 cuyo estudio y valoración ecoquimiotaxonómica pueden facilitar la compleja tarea de identificación de las especies en sus hábitat y comprender el mecanismo de relaciones químico-conductuales interespecies en la fauna edáfica.7,8