Search

Policy and research literature worldwide support the need to build research capacity and capability among non-medical practitioners within healthcare systems. However, there exists a paucity of evidence on whether practitioners in cardiothoracic surgery are attuned to this and on what barriers or enablers exist. A survey was carried out with non-medical practitioners working in cardiothoracic surgery in the United Kingdom to explore attitudes towards health research and audit, and to identify current challenges and barriers to surgical research and audit as perceived by cardiothoracic nurses and allied health professionals. A total of 160 completed questionnaires were returned. 99% of respondents supported the need for research and believed that evidence-based surgical care improves outcomes for patients. Seventy-two percent reported that their employer motivates them to take part in national research or audit but, only 22% were allocated time to do so within their role; 96% reported their interest in being involved in research and audit, yet only 30% believed they had the skills to undertake research, and 96% reported needing additional training. More work is needed to increase awareness, capacity and capability among cardiothoracic surgery care practitioners, and indeed other specialities to achieve research progress.

Concerns about air pollution have increased recently. Currently, 94% of the world population face air pollution levels considered unsafe by the World Health Organization, which tells us that efforts are needed to raise people’s awareness about air pollution. The use of serious games and gamification of interactive applications have raised people’s perception. This work presents Problems in the Air, a game developed in Unity about air pollution, in which the player’s goal is to control a character that inhabits an imaginary city tasked to monitor indoor and outdoor air pollution with sensors deployed across several city zones. While playing, children are expected to learn the possible causes of pollution in each zone and, this way, the game attempts to promote pro-environmental behaviors. This game allows educators to configure the problems that the player has to solve. Customisation is a desired feature in existing serious games as teachers often need to tailor this type of tools to their students. Pre- and post-surveys about air pollution were elaborated to evaluate air pollution perception of twenty students of an elementary school before and after playing the game, with results showing some significant positive effects. A System Usability Scale questionnaire was also performed and we obtained an acceptable mean value of 75, out of 100.

Amid the COVID-19 pandemic, emerging adults are especially vulnerable as they experience its financial impact as a source of stress. We tested a model of psychological resilience among emerging adults (18–25 years) during the pandemic from six Western countries (Finland, Italy, Lithuania, Portugal, Slovenia, and United States) using online survey data collected between May and September 2020. Framed in the conservation of resources theory, we examined the association between financial loss and financial well-being and the moderating role of psychological resilience in the association. Using path analysis, we found a direct negative association between financial loss and financial well-being, a direct positive association between psychological resilience and financial well-being, but no evidence of moderation. We discuss the findings in the context of continuing global economic uncertainty and the support needed to foster adult independence and financial well-being of emerging adults.

Distribution and inventory planning in a multi-echelon system are studied under an uncertain demand context. To deal with this problem a mixed integer linear programming (MILP) model is proposed. This considers a multi-echelon system formed by N-warehouses and M-retailers. The problem consists on determining the optimal reordering plan for the operating network, which minimises the overall system's operation cost. The uncertain demand faced by retailers is addressed by defining the optimal safety stock that guarantees a given service level at each regional warehouse and each retailer. Also, the risk pooling effect is taken into account when determining inventory levels in each entity. A case study based on a real retailer distribution chain is presented and solved.

The reduction of junior doctors’ working hours over the last two decades paved the way to non-medical practitioners providing care traditionally discharged by surgeons and other medics. These registered practitioners play a vital role in the care of patients in surgery and work within multi-disciplinary teams comprising surgical care practitioners, advanced clinical practitioners in surgery, and physician associates, with significant experience in nursing or allied health care professional practice. Health Education England and the Royal Colleges of Surgeons have invested considerably in developing the relevant educational frameworks to support and quality assure the training of non-medical practitioners. Notwithstanding, to ascertain whether advanced and extended practice have been developed appropriately, a wide critical stance is needed. This article aims to begin to analyse the status quoof the extended surgical team and of the associated pitfalls and challenges, making conservative comparisons between the roles with the international scene. The objective is to help students, trainees and all involved in surgical care to adopt an informed and critical viewpoint about the extended surgical team in the United Kingdom, in the hope that this can lead to improvement and forward planning in workforce design for the benefit of patients and their communities.

ABSTRACTNowadays, manufacturing companies present complex and robust in-house logistics operations that support production lines, where high system efficiency is the primary goal. However, to achieve the desired degree of efficiency, the use of tools that can help decision-makers to identify the improved set of operations is required. This need is explored in this work through the development of a simulation model. The model is inspired by a real automotive plant, where a segment of a mixed-model assembly line composed by a supermarket, diverse kits, human pickers and automated guided vehicles (AGV) is explored. Different scenarios are studied to analyse the potential for production support operation improvement, where the introduction of automated technologies, like robots, is explored. Results show that the system, through the addition of intelligent dynamic carrier robots, can significantly improve efficiency while reducing resources deployed. Furthermore, sizing the human workforce at the supermarket is the key to having a well-balanced production system.

Introduction: Robot-assisted surgery has grown exponentially since its inception and first approval in the United States in the year 2000. The surgeon operating with the assistance of the robot sits remotely to the patient and another practitioner assists at the bedside. The role of the bedside assistant and the training that is required to undertake this role are understudied topics.Aim: To explore the functions, training and professional development of the bedside assistant in robot-assisted surgery and propose the necessary foundations for the safe enactment of the role in the United Kingdom.Methods: Through critical interpretative synthesis, relevant literature was systematically searched and analysed to inform integration of evidence.Results: Seventy-three studies were retrieved from the literature, across several health care disciplines and surgical specialities. These were critically analysed to inform a theoretically sound account grounded on evidence.Conclusion: The role, functions and skills of the bedside assistant in robot-assisted surgery vary across contexts. These were analysed and critically synthetised to produce several keys to the success of bedside assistants in robot-assisted surgery in the context of the United Kingdom and of its national regulations.

Proximal humerus fractures (PHFs) are frequent and associated with significant health care burden. National epidemiological data are limited. Our objective is to characterize the Portuguese population admitted with PHFs and analyze therapeutic management, the impact of associated lesions, and mortality rate.

Methamphetamine (Meth) is a powerful illicit psychostimulant, widely used for recreational purposes. Besides disrupting the monoaminergic system and promoting oxidative brain damage, Meth also causes neuroinflammation, contributing to synaptic dysfunction and behavioral deficits. Aberrant activation of microglia, the largest myeloid cell population in the brain, is a common feature in neurological disorders triggered by neuroinflammation. In this study, we investigated the mechanisms underlying the aberrant activation of microglia elicited by Meth in the adult mouse brain. We found that binge Meth exposure caused microgliosis and disrupted risk assessment behavior (a feature that usually occurs in individuals who abuse Meth), both of which required astrocyte-to-microglia crosstalk. Mechanistically, Meth triggered a detrimental increase of glutamate exocytosis from astrocytes (in a process dependent on TNF production and calcium mobilization), promoting microglial expansion and reactivity. Ablating TNF production, or suppressing astrocytic calcium mobilization, prevented Meth-elicited microglia reactivity and re-established risk assessment behavior as tested by elevated plus maze (EPM). Overall, our data indicate that glial crosstalk is critical to relay alterations caused by acute Meth exposure.

Baricitinib is an oral selective Janus kinase 1/2 inhibitor with known anti-inflammatory properties. This study evaluates the efficacy and safety of baricitinib in combination with standard of care for the treatment of hospitalised adults with COVID-19.

Knowledge of anatomical variations of the superficial peroneal nerve (SPN) may minimize iatrogenic insults. The aim of the investigation was to perform an anatomical description of the SPN.

Purpose: Tourism may have important positive and negative economic, socio-cultural and environmental impacts. However, cultural and natural resources are also the base to the development of competitive destinations and changes in these resources can have an important impact on tourism development. Despite the considerable literature regarding the impacts of tourism, a limited number of studies examine the impact of the environment on tourism, specifically the impact of air quality (AQ). Therefore, this paper aims to review what is known about the impact of AQ on tourism demand, analysing the different methods and approaches used, as well as the results obtained. Design/methodology/approach: A systematic literature review method was used to examine the state of the art in this topic and identify research gaps and new research directions. Only 26 papers were identified that examine the impact of AQ on tourism demand. Findings: The majority of the studies were carried out in China and investigate the impact of AQ on tourism from the perspective of tourism demand. Both global (tourism demand) and individual (tourist perceptions) approaches have been used to investigate the impact of AQ on tourism. Originality/value: This is the first systematic literature review on the impact of outdoor AQ on tourism demand. Moreover, this paper analyses the methods and approaches that have been used in the literature to examine the impact of outdoor AQ on tourism demand. The paper ends with a discussion on the identified research gaps concerning the influence of AQ on tourism development.

Molecular-assisted precision oncology gained tremendous ground with high-throughput next-generation sequencing (NGS), supported by robust bioinformatics. The quest for genomics-based cancer medicine set the foundations for improved patient stratification, while unveiling a wide array of neoantigens for immunotherapy. Upfront pre-clinical and clinical studies have successfully used tumor-specific peptides in vaccines with minimal off-target effects. However, the low mutational burden presented by many lesions challenges the generalization of these solutions, requiring the diversification of neoantigen sources. Oncoproteogenomicsutilizing customized databases for protein annotation by mass spectrometry (MS) is a powerful tool toward this end. Expanding the concept toward exploring proteoforms originated from post-translational modifications (PTMs) will be decisive to improve molecular subtyping and provide potentially targetable functional nodes with increased cancer specificity. Walking through the path of systems biology, we highlight that alterations in protein glycosylationat the cell surface not only have functional impact on cancer progression and dissemination but also originate unique molecular fingerprints for targeted therapeutics. Moreover, we discuss the outstanding challenges required to accommodate glycoproteomics in oncoproteogenomics platforms. We envisage that such rationale may flag a rather neglected research field, generating novel paradigms for precision oncology and immunotherapy.

The product development is a multidisciplinary process but also involves different areas of knowledge ranging from creativity in concept generation to refinement of design and finally the validation of the product. There are different approaches that attempt to define the best product development process, and thereby establishes a reliable method for efficiently transforming ideas into products. The use of a method that systematically establishes a work process seems to be highly advantageous, not only because it defines a critical and guiding path of work, organizing the tasks and their results, but also facilitates the communication of the development team. The methodology can provide records and other graphic documents that allow the development team to access these for future developments. The work presented here is the development of a systematic method supported by the use of structured tools to support the decisions, data processing and transposition of the same to the project in the approach to the new Product Development process. This research methodology was introduced and already implemented in projects at Department of Mechanical Engineering, University of Aveiro. The work developed on it, both at the level of the students’ project and in the work of Development cooperation with companies presented good results. This method result in a structured way to transforming ideas into products.

One of the priorities at our large Operating Theatres Department is to support awareness and basic education of the multi-disciplinary teams in clinical Human Factors, to help build competence and capacity in healthcare towards a resilient system. From May 2019 until February 2020, our Human Factors Champions embarked on a project called Observation of Non-technical Skills and Teamwork in the operating theatres (ONSeT), to monitor and evaluate the benefits of local Human Factors education. In September 2020, six months after the COVID-19 pandemic hit the UK and caused a major disruption of surgical services, we decided to investigate the usefulness of the project and the impact of COVID-19 in the operating theatres, looking through the eyes of the Human Factors Champions. Results pointed to a consensus about ONSeT having helped during the pandemic, with regards to how teams worked and in enabling team leaders to be more responsive. Human Factors Champions found that feedback on performance was received in a non-threatening way and observation of performance became ‘second nature’. As organisations need to develop critical thinking, we think that the ONSeT project has helped us build some capacity for this, from the front-line onwards.

Graphical Abstract:

The aim of our study was to describe the anatomy of the anterior shoulder, specifically structures potentially involved in subscapularis tears pathophysiology and also to identify structures at risk during surgical approaches of this area.

Thinking about the future is paramount in emerging adulthood. The present study examines the role of economic strain during macroeconomic hard times and family functioning on emerging adults’ domain-specific future hopes and fears and their links with psychological well-being. Participating were 418 Portuguese emerging adults aged 18–30, mean (M) = 22.4; standard deviation (SD) = 2.8. Results from path analysis showed that greater economic strain was associated with a higher number of financial resources–related hopes and fears, positive levels of family functioning were associated with a higher number of work/career-related hopes and fears, and a higher number of property-related hopes were associated with a greater psychological well-being. Multigroup analyses indicated that these associations were moderated by living arrangements but not by participants’ sex, age, occupational status, and socioeconomic status. In sum, this study shed light on emerging adults’ lives during times of financial instability in Portugal.

The skin glands of amphibian species hold a major component of their innate immunity, namely a unique set of antimicrobial peptides (AMPs). Although most of them have common characteristics, differences in AMP sequences allow a huge repertoire of biological activity with varying degrees of efficacy. We present the first study of the AMPs from Pleurodema somuncurence(Anura: Leptodactylidae: Leiuperinae). Among the 11 identified mature peptides, three presented antimicrobial activity. Somuncurin-1 (FIIWPLRYRK), somuncurin-2 (FILKRSYPQYY), and thaulin-3 (NLVGSLLGGILKK) inhibited Escherichia coligrowth. Somuncurin-1 also showed antimicrobial activity against Staphylococcus aureus. Biophysical membrane model studies revealed that this peptide had a greater permeation effect in prokaryotic-like membranes and capacity to restructure liposomes, suggesting fusogenic activity, which could lead to cell aggregation and disruption of cell morphology. This study contributes to the characterization of peptides with new sequences to enrich the databases for the design of therapeutic agents. Furthermore, it highlights the importance of investing in nature conservation and the power of genetic description as a strategy to identify new compounds.

This paper considers a multi-echelon inventory/distribution system formed by N-warehouses and M-retailers that manages a set of diverse products within a dynamic environment. Retailers are replenished from regional warehouses and these are supplied by a central distribution entity. Transshipment at both regional warehouses and retailers levels is allowed. A mixed integer linear programming model is developed, where product demand at the retailers is assumed to be unknown. The problem consists of determining the optimal reorder policy by defining the new concept of robust retailer order, which minimises the overall system cost, including ordering, holding in stock and in transit, transportation, transshipping and lost sales costs while guaranteeing service level. The proposed model is extended to address simultaneously uncertainty in both products demands and replenishment lead times. A case study based on a real retailer distribution chain is solved.

Advanced-stage solid primary tumors and metastases often express mucin 16 (MUC16), carrying immature glycans such as the Tn antigen, resulting in specific glycoproteoforms not found in healthy human tissues. This presents a valuable approach for designing targeted therapeutics, including cancer glycovaccines, which could potentially promote antigen recognition and foster the immune response to control disease spread and prevent relapse. In this study, we describe an adjuvant-free poly(lactic-co-glycolic acid) (PLGA)-based nanoglycoantigen delivery approach that outperforms conventional methods by eliminating the need for protein carriers while exhibiting targeted and adjuvant properties. To achieve this, we synthesized a library of MUC16-Tn glycoepitopes through single-pot enzymatic glycosylation, which were then stably engrafted onto the surface of PLGA nanoparticles, generating multivalent constructs that better represent cancer molecular heterogeneity. These glycoconstructs demonstrated affinity for Macrophage Galactose-type Lectin (MGL) receptor, known to be highly expressed by immature antigen-presenting cells, enabling precise targeting of immune cells. Moreover, the glycopeptide-grafted nanovaccine candidate displayed minimal cytotoxicity and induced the activation of dendritic cells in vitro, even in the absence of an adjuvant. In vivo, the formulated nanovaccine candidate was also nontoxic and elicited the production of IgG specifically targeting MUC16 and MUC16-Tn glycoproteoforms in cancer cells and tumors, offering potential for precise cancer targeting, including targeted immunotherapies.

En este artículo, los autores relatan el caso de un individuo que cometió el delito de homicidio y fue evaluado en peritaje psiquiátrico para el análisis de imputabilidad penal. Se le diagnosticó trastorno delirante con inimputabilidad penal, y se le aplicó una medida de seguridad, con internación en Hospital de Custodia y Tratamiento Psiquiátrico en Río de Janeiro, Brasil. Este caso ejemplifica la técnica para la aplicación del criterio biopsicológico según el Código de Proceso Penal brasileño.

Nicotinamide riboside (NR), a NAD+precursor, has received attention due to several health benefits it has induced in experimental models. Studies in cultured cells, animals, and humans consistently show increased NAD+availability after NR supplementation, which is considered the only mode of NR action that leads to health benefits. In the present study, we show that a persistently low NR concentration (1 μM) in the growth medium of BEAS-2B human cells, grown in a monolayer, induces energy stress, which precedes a cellular NAD+increase after 192 h. NR concentrations greater than 1 μM under the specified conditions were cytotoxic in the 2D cell culture model, while all concentrations tested in the 3D cell culture model (BEAS-2B cell spheroids exposed to 1, 5, 10, and 50 μM NR) induced apoptosis. Shotgun proteomics revealed that NR modulated the abundance of proteins, agreeing with the observed effects on cellular energy metabolism and cell growth or survival. Energy stress may activate pathways that lead to health benefits such as cancer prevention. Accordingly, the premalignant 1198 cell line was more sensitive to NR cytotoxicity than the phenotypically normal parent BEAS-2B cell line. The role of a mild energy stress induced by low concentrations of NR in its beneficial effects deserves further investigation. On the other hand, strategies to increase the bioavailability of NR require attention to toxic effects that may arise.

Objective: To test the hypothesis that a continuing educational strategy (ie, “the manual”) in primary health-care improves infant feeding practices among infants under 1 year of age.Methods: A before and after study was conducted at primary health-care units in Embu das Artes, Brazil. The intervention was the use of a manual created to support continuing educational activities on breastfeeding and complementary feeding to be performed by tutors of Estratégia Amamenta e Alimenta Brasilwith health-care teams, in a period of 8 months. Five hundred sixty-one mothers before and 598 mothers after intervention were interviewed about breastfeeding and complementary feeding practices. Multivariate analysis was performed using Poisson multilevel regression to test the hypothesis.Results: Lack of minimum food diversity (before 62.9%; after 50.3%) and lack of food adequacy (before 77.5%; after 63.3%) decreased significantly. Regression analysis confirmed that infants after the intervention had lower prevalence of inadequacy of complementary feeding. While the intervention did not show significant association with exclusive breastfeeding, it showed association with the improvement of complementary feeding practices.Conclusions: The manual is a continuing educational strategy that improved complementary feeding practices in primary health care.

Nowadays, emerging adults live in a context of macroeconomic uncertainty. As the major processes of one’s identity exploration currently occur in emerging adulthood, understanding how these individuals foresee their future is of special interest. The purpose of this study was 2-fold: (i) to investigate future orientation (FO) in a sample of Portuguese emerging adults and (ii) to validate the Portuguese version of the Hopes and Fears Questionnaire. Data from 332 individuals were analyzed. Results demonstrated that participants’ future hopes and fears were mainly pertaining to education, work/career, and family/marriage. Participants also reported concerns related to their financial resources. Thus, the results showed that participants’ FO reflected major tasks associated with their development stage, as well as contextual factors, such as macroeconomic trends. This study contributed to the knowledge of emerging adulthood in Portugal, simultaneously providing a useful and reliable measure to evaluate emerging adults’ FO in that country.