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Welcome to the 25th anniversary edition of PLEXUS, UC Irvine School of Medicine’s annual student-organized Journal of Medical Humanities & Arts. To mark this celebratory milestone, it is with great pleasure that I present to you NAVIGATE. In the ever-evolving landscape of medicine, the ability to navigate through challenges and unforeseen obstacles is paramount. NAVIGATE serves as a timely invitation for our colleagues to reflect on the distances traversed and to envision the new horizons that lie ahead. We sought to highlight the constellation of tools utilized when we feel lost and to acknowledge the beacons that steer our actions. The subsequent pages offer its readers profoundinsights into the extraordinary journeys undertaken by the greater UCI Health community. We hope it delivers a sense of direction, solace, and clarity to all readers.As we celebrate our 25th anniversary, wehonor the visionaries, contributors, and readers that have propelled us forward on this remarkable voyage. Their collective support fuels our efforts to serve as a creative outlet for the community, catalyze meaningful discussions, and apply the tenets of medical humanities to foster a cohort of compassionate healers.We extend our deepest gratitude to our faculty advisors Dr. Juliet McMullin and Dr. TanNguyen for their invaluable guidance and for sharing their expertise within the field. We thank the UCISOM Medical Humanities & Arts Program and the UCI Department of Family Medicine for their unwavering support. I invite you to embark on this exploration with us, and witness the intricate tapestry of our contributors’ lived experiences that defines our shared journey in healthcare.Bon voyage,Christopher SahagianEditor-in-ChiefCreative Review — Caroline GeeCreative Review — Huan NguyenCreative Review — Sana ShahDesign — Nicole ParkerDesign — Britney WengFaculty Advisor — Dr. Juliet McMullinFaculty Advisor — Dr. Tan NguyenStaff Advisor — Leonora Naser-Saravia{Front Cover): NEW HEIGHTS Britney Weng, MS1San Pedro de Atacama, Chile(Inner Cover): TRAVERSING  Britney Weng, MS1Chile Route 23

Technology has been viewed as a means to improve the quality of education for children globally, particularly in remote and marginal communities. This study examines the comparative advantages of the use of appropriate technology (off-line servers with digital libraries connected to a classroom set of laptops) in ten intervention schools in Indigenous communities in Guatemala for one school year. The study was too short (due to pandemic restrictions) to demonstrate statistically significant differences for learning outcomes. However, using an instructional core model as a framework, qualitative findings supported four previously identified comparative advantages, and identified four additional ones relevant to remote Indigenous communities. The intervention validated the ability of technology to improve standardised instruction, differentiated instruction, opportunities for practice, and learner engagement. Newly identified advantages are: access to high-quality educational resources (substitution for print materials), teacher capacity-building, student technical skills and digital literacy, and sharing cultural knowledge.

ABSTRACT Post-market surveillance of test performance is a critical function of public health agencies and clinical researchers that ensures tests maintaining diagnostic characteristics following their regulatory approval. Changes in product quality, manufacturing processes over time, or the evolution of new variants may impact product performance. During the COVID-19 pandemic, a plethora of point-of-care tests (POCTs) was released onto the Canadian market. This study evaluated the performance characteristics of several of the most widely distributed POCTs in Canada, including four rapid antigen tests (Abbott Panbio, BTNX Rapid Response, SD Biosensor, and Quidel QuickVue) and two molecular tests (Abbott ID NOW and Lucira Check IT). All tests were challenged with 149 SARS-CoV-2 clinical positives, including multiple variants up to and including Omicron XBB.1.5, as well as 29 clinical negatives. Results were stratified based on whether the isolate was Omicron or pre-Omicron as well as by reverse transcriptase quantitative PCR Ct value. The test performance of each POCT was consistent with the manufacturers' claims and showed no significant decline in clinical performance against any of the variants tested. These findings provide continued confidence in the results of these POCTs as they continue to be used to support decentralized COVID-19 testing. This work demonstrates the essential role of post-market surveillance in ensuring reliability in diagnostic tools.IMPORTANCEPost-market surveillance of diagnostic test performance is critical to ensure their reliability after regulatory approval. This is especially critical in the context of the COVID-19 pandemic as the use of point-of-care tests (POCTs) became widespread. Our study focused on four rapid antigen tests (Abbott Panbio, BTNX Rapid Response, SD Biosensor, and Quidel QuickVue) and two molecular tests (Abbott ID NOW and Lucira Check IT) that were widely distributed across Canada, assessing their performance using many SARS-CoV-2 variants, including up to Omicron subvariant XBB.1.5. Overall, we found no significant difference in performance against any variant, reinforcing confidence in their use. As concerns in test efficacy have been raised by news outlets, particularly regarding the BTNX Rapid Response, this work is even more timely and crucial. Our research offers insights into the performance of widely used COVID-19 POCTs but also highlights the necessity for post-market surveillance.

Transcarotid artery revascularization (TCAR) has risen as a promising minimally invasive intervention for high-risk patients with favorable anatomy. TCAR's noninferiority to carotid endarterectomy regarding stroke is reliant on its flow reversal technology and lack of aortic arch manipulation. We present the case of a 79-year-old man with a chronically occluded inferior vena cava who safely underwent staged bilateral TCAR for bilateral high-grade carotid artery stenosis. Although chronic inferior vena cava occlusion alters flow mechanics, we suspect that any pressure gradient facilitating retrograde flow from the carotid artery to the femoral vein provides neuroprotective benefits.

Writing skills play a major part in communication, whether in a typing or in a handwriting scenario. Thus, a decrease or even loss of these skills can be a major setback. The system described herein aims to promote handwriting rehabilitation through haptic guidance and analysis of characters written using a haptic joystick. The first goal of this work is the creation of a system that encourages a user to write better through repetition, and thus have an impact on the proprioceptive system. In the second part of this work, there is a character analysis model evolution. Character analysis is performed by digit or letter classification and quantification of written characters quality. As such, different methods are studied and evaluated to achieve the best classification accuracy. Regarding handwritten characters classification, the pre-eminent procedure for digits consists in the use of Histogram of Oriented Gradients coupled with a multiclass Support Vector Machine (HOG-SVM) whereas for letters the strategy involves using a Convolutional Neural Network (CNN). For handwriting quality quantification, Dynamic Time Warping (DTW) was performed between the written character and a reference image of the same character. Finally, haptic guidance impact in a handwriting retraining in rehabilitation scenario is evaluated.

Abstract Introduction Preventing falls is a priority for aged care providers. Research to date has focused on fall prevention strategies in single settings (e.g., residential aged care (RAC) or community settings). However, some aged care providers deliver care, including fall prevention interventions, across RAC and community settings. We conducted an umbrella review to identify what type of fall prevention interventions had the greatest impact on falls outcomes in RAC and community settings. Methods Five databases were searched for systematic reviews of falls prevention randomised control trials in older adults living in the community or RAC. Data extracted included systematic review methods, population characteristics, intervention characteristics, setting details (RAC or community), and fall-related outcomes (falls, people who have had a fall, fall-related hospitalisations, and fall-related fractures). Review quality was appraised using the Assessment of Multiple Systematic Reviews-2 tool. Results One-hundred and six systematic reviews were included; 63 and 19 of these stratified results by community and RAC settings respectively, the remainder looked at both settings. The most common intervention types discussed in reviews included ‘exercise’ (61%, n = 65), ‘multifactorial’ (two or more intervention types delivered together) (26%, n = 28), and ‘vitamin D’ (18%, n = 19). In RAC and community settings, ‘exercise’ interventions demonstrated the most consistent reduction in falls and people who have had a fall compared to other intervention types. ‘Multifactorial’ interventions were also beneficial in both settings however demonstrated more consistent reduction in falls and people who fall in RAC settings compared to community settings. ‘Vitamin D’ interventions may be beneficial in community-dwelling populations but not in RAC settings. It was not possible to stratify fall-related hospitalisation and fall-related fracture outcomes by setting due to limited number of RAC-specific reviews (n = 3 and 0 respectively). Conclusion ‘Exercise’ interventions may be the most appropriate falls prevention intervention for older adults in RAC and community settings as it is beneficial for multiple fall-related outcomes (falls, fall-related fractures, and people who have had a fall). Augmenting ‘exercise’ interventions to become ‘multifactorial’ interventions may also improve the incidence of falls in both settings.

Introduction: Clear cell sarcoma (CCS) is a rare and aggressive soft tissue sarcoma. CCS is characterized by the translocation t(12;22) (q13;q12), involving the fusion of EWSR1 and ATF1 genes, and less frequently the fusion gene EWSR1-CREB1. Usually, CCSs are considered poorly responsive to conventional chemotherapy. However, trabectedin has shown activity against translocation-related sarcomas. Furthermore, preclinical results suggest that trabectedin is a promising antitumor agent for CCS, potentially inducing melanocytic differentiation. Case Presentation: We report the case of a challenging anatomopathological diagnosis in a patient with an aggressive metastatic CCS. Following the diagnosis of CCS, the patient experienced a clinical and radiological tumor response to trabectedin after four lines of treatment. Conclusion: This is a novel report of CCS treated with trabectedin that resulted in a partial response and suggests the need for further research on trabectedin as a therapeutic option for CCS.

Introduction: Teaching is an emotionally challenging profession, sometimes resulting in high levels of stress, burnout, and teacher burnout. It has often been claimed that certain emotional competencies such as emotional intelligence can reduce feelings of burnout in teachers. Method: Method. A descriptive and correlational analysis was made of the dimensions of emotional intelligence (evaluation of own emotions, evaluation of others' emotions, emotion regulation, use of emotions) and burnout factors (emotional exhaustion, depersonalization and low personal fulfillment). Network analysis was applied as a statistical technique, which jointly represents the partial correlations of all variables. A sample of 244 elementary school teachers (51.6% female) and (48.4% male) aged 25 to 65 years (M = 45.68, SD = 8.43) working in thirteen educational institutions located in urban and semi-urban areas of the metropolitan city of Lima, Peru, was taken into account. Results: The largest positive network connections were found between emotional exhaustion, depersonalization, and low self-actualization, as well as between understanding others' emotions and using emotions, both measures were more influential on the other associative network patterns. While the strongest negative association was recorded between low self-actualization and understanding one's own emotions. Likewise, the stability of the measures of strength centrality and the accuracy of the network nodes or variables was demonstrated. Discussion or Conclusion: It is possible to conclude in the present research a greater importance of the components of evaluation of the emotions of others and use of emotions, which directly and indirectly reinforce the connections of the dynamics of emotional intelligence and reduce the levels of burnout, especially strengthen a lower degree of emotional exhaustion, which was the factor with the highest score. The consideration of such emotional competencies is determinant for a better efficacy in the intervention and prevention of burnout in teachers. Likewise, the depersonalization measure is the nexus variable that influences the manifestation of higher levels of feelings of emotional exhaustion and low personal fulfillment. [The publication year (2022) shown on the PDF is incorrect. The correct year of publication is 2023.]

The Peruvian Amazonian native cacao faces ongoing challenges that significantly undermine its productivity. Among them, frosty pod rot disease and cadmium accumulation result in losses that need for effective and environmentally safe strategies, such as those based on bacteria. To explore the biological resources in the cacao soil, a descriptive study was conducted to assess the diversity of culturable bacteria across three production districts in the Amazonas region: La Peca, Imaza, and Cajaruro. The study also focused on the functional properties of these bacteria, particularly those related to the major issues limiting cacao cultivation. For this purpose, 90 native bacterial isolates were obtained from the cacao rhizosphere. According to diversity analysis, the community was composed of 19 bacterial genera, with a dominance of the Bacillaceae family and variable distribution among the districts. This variability was statistically supported by the PCoA plots and is related to the pH of the soil environment. The functional assessment revealed that 56.8% of the isolates showed an antagonism index greater than 75% after 7 days of confrontation. After 15 days of confrontation with Moniliophthora roreri, 68.2% of the bacterial population demonstrated this attribute. This capability was primarily exhibited by Bacillus strains. On the other hand, only 4.5% were capable of removing cadmium, highlighting the biocontrol potential of the bacterial community. In addition, some isolates produced siderophores (13.63%), solubilized phosphate (20.45%), and solubilized zinc (4.5%). Interestingly, these traits showed an uneven distribution, which correlated with the divergence found by the beta diversity.Our results revealed a diverse bacterial community inhabiting the Amazonian cacao rhizosphere, showcasing crucial functional properties related to the biocontrol of M. roreri. The information generated serves as a significant resource for the development of further biotechnological tools that can be applied to native Amazonian cacao.

Arterial-enteric fistulas occur from a multitude of causes, especially following surgical manipulation of vasculature. The development of an iliac artery-enteric fistula (IEF) occurs rarely in patients with failed pancreatic transplants. IEFs warrant urgent intervention due to the high mortality from hemorrhagic and septic shock. The diagnosis can be delayed by a lack of suspicion, the low sensitivity of diagnostic tests, and the nonspecific signs of fistulas on computed tomography. The management of IEFs is adapted from guidelines for arterial-enteric fistulas of other causes, with little consensus on ideal vascular reconstruction and postoperative antimicrobial management. The outcomes are limited to the short-term results from case reports and case series. We report two cases of IEFs in patients with a history of simultaneous pancreatic kidney transplant. Our patients underwent successful resolution of gastrointestinal bleeding and sepsis, with definitive management of fistula resection and interposition iliac artery bypass. The index of suspicion for IEFs should be high, and they should be considered as a source of anemia or gastrointestinal bleeding of an unknown source in patients with failed pancreatic transplant. Definitive management should be pursued in patients who can tolerate fistula resection, allograft explant, and arterial reconstruction.

IntroductionEmotion recognition is a core feature of social perception. In particular, perception of dynamic facial emotional expressions is a major feature of the third visual pathway. However, the classical N170 visual evoked signal does not provide a pure correlate of such processing. Indeed, independent component analysis has demonstrated that the N170 component is already active at the time of the P100, and is therefore distorted by early components. Here we implemented, a dynamic face emotional paradigm to isolate a more pure face expression selective N170. We searched for a neural correlate of perception of dynamic facial emotional expressions, by starting with a face baseline from which a facial expression evolved. This allowed for a specific facial expression contrast signal which we aimed to relate with social communication abilities and cortical gamma-aminobutyric acid (GABA) levels.MethodsWe recorded event-related potentials (ERPs) and Magnetic Resonance (MRS) measures in 35 typically developing (TD) children, (10–16 years) sex-matched, during emotion recognition of an avatar morphing/unmorphing from neutral to happy/sad expressions. This task allowed for the elimination of the contribution low-level visual components, in particular the P100, by morphing baseline isoluminant neutral faces into specific expressions, isolating dynamic emotion recognition. Therefore, it was possible to isolate a dynamic face sensitive N170 devoid of interactions with earlier components.ResultsWe found delayed N170 and P300, with a hysteresis type of dependence on stimulus trajectory (morphing/unmorphing), with hemispheric lateralization. The delayed N170 is generated by an extrastriate source, which can be related to the third visual pathway specialized in biological motion processing. GABA levels in visual cortex were related with N170 amplitude and latency and predictive of worse social communication performance (SCQ scores). N170 latencies reflected delayed processing speed of emotional expressions and related to worse social communication scores.DiscussionIn sum, we found a specific N170 electrophysiological signature of dynamic face processing related to social communication abilities and cortical GABA levels. These findings have potential clinical significance supporting the hypothesis of a spectrum of social communication abilities and the identification of a specific face-expression sensitive N170 which can potentially be used in the development of diagnostic and intervention tools.

Objective This study aimed to evaluate the efficacy of Corymbia citriodora , Melaleuca alternifolia (Myrtaceae), Mentha × piperita (Lamiaceae), and Schinus terebinthifolius (Anacardiaceae) essential oils as an alternative to manage Sitophilus zeamais (Coleoptera: Curculionidae) adults. Methods Acute contact toxicity, acute toxicity on treated maize grain, fumigation toxicity, repellency bioassays, and GC-MS analysis of the essential oils were carried out. Results Corymbia citriodora , M. alternifolia , M. × piperita , and S. terebinthifolius oils were toxic at different levels to S. zeamais through residual contact, ingestion and via fumigation, and were also repellent to adults of this pest. Melaleuca alternifolia oil was the most active in contact (LC 50 = 18.98 μL.mL −1 ), ingestion (LC 50 = 1.03 μL.g −1 ), and fumigant (LC 50 = 20.05 μL.L −1 air) bioassays. Citronelal (53.6% in C. citriodora ), terpinen-4-ol (46.9% in M. alternifolia ), menthol (44.8% in M. × piperita ), and β -caryophyllene (16.2% in S terebinthifolius ) are the major constituents of these oils. Conclusions Melaleuca alternifolia and M. × piperita essential oils can be used by residual contact, while those of C. citriodora , M. alternifolia , and M. × piperita by mixing with maize grains. Melaleuca alternifolia essential oil can be used as a fumigant, while those of C. citriodora and S. terebinthifolius as repellents for S. zeamais adults.

The early identification of performance in the five-repetition sit-to-stand test (5-STS) at discharge in stroke patients could be of interest because it can determine independence for community-based activities. This study aimed to determine whether the initial measurement of the 5-STS test can be a determinant of the performance level prediction and amount of change in the 5-STS test at discharge in stroke patients. A prospective cohort study was conducted with a sample of 56 patients aged ≤60 d post-stroke. The 5-STS test results, as well as changes in patient condition, were measured at admission (T0) to an outpatient rehabilitation program, after the first month (T1), and at discharge (T2). The mean age was 62.7 (SD = 13.0), 58.9% of the subjects were male, and 75% had suffered an ischemic stroke. A multivariate linear regression model using the 5-STS test at T0 explained 57.7% of the variance in the performance at discharge. Using the 5-STS at T1 increased the variance to 75.5% (p < 0.001). Only the time from stroke onset at T0 significantly contributed to the two models. The measurement of the 5-STS at T0 and the amount of change in its performance at T2 explained 60.2% (p < 0.001) of the variance, while reassessment at T1 explained only 19.3% (p < 0.001). The level of patient performance on the 5-STS test at discharge, as well as any potential change, can be predicted by the admission measure of 5-STS in stroke patients.

Kappaphycus malesianus is a red seaweed farmed primarily for its carrageenan, a polysaccharide important in the food and pharmaceutical industries. Among the commercially cultivated Kappaphycus species, only K. malesianus has no mitogenome data available. Here, we assembled the mitochondrial genome of K. malesianus from next-generation sequencing data. The circular mitogenome consisted of 25,250 base pairs (bp) with a GC content of 30.25%. These values were comparable to previously sequenced solieriacean mitogenomes. Structural features, such as the stem-loop and hairpin, which were previously reported in other rhodophytes mitochondrial DNA, were also identified. The annotated genes (24 protein-coding genes, 24 tRNA genes, and 2 rRNA genes) were arranged in an order similar to the other available solieriacean mitogenomes. Lastly, phylogenetic analysis using 23 predicted protein domains showed the sister relationship of K. malesianus with other Kappaphycus species.

Background: There is a high frequency of monkeypox (MPOX) and sexually transmitted infections (STIs) in men who have sex with men (MSM). Aim: To identify the sexual behavior of MSM during the MPOX infection period. Methods: We conducted an observational study of cases and controls were carried out. Results: A total of 171 participants were considered, two heterosexual male controls (MSW) were included for each case of MSM with a consecutive selection of people who attended the STI prevention and control center from January to July 2022. The results revealed that the mean number of sexual partners reported in the last year was higher in cases (4.2) compared to controls 1.9 (p < 0.05). The related conditions for MSM to acquire some type of STI were sexual intercourse under the influence of alcohol (OR 2.42; 95% CI: 1.11–3.96), forgetting to use a protection method (condom) (OR 3.16; 95%: 1.73–7.48) and sexual intercourse with casual couples (OR 1.4; 95% CI: 1.01–2.16). Conclusion: Our findings demonstrated a link between the sexual behavior of men who have sex with men and the high prevalence of sexually transmitted infections during the human monkeypox virus outbreak.

Professional development like finishing graduate or post-graduate degrees is one of the key indicators of advancement in the practice of one’s profession. This research traced the lived experiences of Master Language Educators through their faces (characteristics), changes (transformation or improvement), and places (personal and professional promotions) using qualitative-narrative research design. All 14 alumni of the Master of Arts in Education major in English in 2019-2021 were taken as participants of the study using a homogenous sampling technique. Based on the results, the participants characterized themselves as more linguistically capable and highly strategic after completing their graduate program. They have developed confidence and practice time management and nurtured a critical eye for literature. As to their personal and professional promotions, they experienced more leadership opportunities, promotion and salary increases, and a variety of exposures in the field. Assigning of advisers while taking thesis writing and providing more writing sessions for thesis writing and offering more literature subjects as electives were their suggestions to improve the program. It is recommended that the significant findings of the study be used in revisiting the program, its course offerings, and the enhancement of the curriculum.

Case Presentation: We present the case of a young male with high clinical suspicion of a penile fracture found to have dorsal vein rupture by emergency department point-of-care ultrasound. This false form of penile fracture was subsequently confirmed intraoperatively.Discussion: Penile fracture is a rare clinical entity that may be separated into true vs false penile fracture, with only true fracture requiring surgery. The images submitted here add to the sparse literature evidence that point-of-care ultrasound can be used to differentiate between these two clinical entities. Additionally, this case report highlights an opportunity for further research into and application of point-of-care ultrasound to the evaluation of suspected penile fractures.

Lanthanide elements have been recently recognized as "new life metals" yet much remains unknown regarding lanthanide acquisition and homeostasis. In Methylorubrum extorquens AM1, the periplasmic lanthanide-dependent methanol dehydrogenase XoxF1 produces formaldehyde, which is lethal if allowed to accumulate. This property enabled a transposon mutagenesis study and growth studies to confirm novel gene products required for XoxF1 function. The identified genes encode an MxaD homolog, an ABC-type transporter, an aminopeptidase, a putative homospermidine synthase, and two genes of unknown function annotated as orf6 and orf7. Lanthanide transport and trafficking genes were also identified. Growth and lanthanide uptake were measured using strains lacking individual lanthanide transport cluster genes, and transmission electron microscopy was used to visualize lanthanide localization. We corroborated previous reports that a TonB-ABC transport system is required for lanthanide incorporation to the cytoplasm. However, cells were able to acclimate over time and bypass the requirement for the TonB outer membrane transporter to allow expression of xoxF1 and growth. Transcriptional reporter fusions show that excess lanthanides repress the gene encoding the TonB-receptor. Using growth studies along with energy dispersive X-ray spectroscopy and transmission electron microscopy, we demonstrate that lanthanides are stored as cytoplasmic inclusions that resemble polyphosphate granules.

Monogenic disorders of the blood system have the potential to be treated by autologous stem cell transplantation of ex vivo genetically modified hematopoietic stem and progenitor cells (HSPCs). The sgRNA/Cas9 system allows for precise modification of the genome at single nucleotide resolution. However, the system is reliant on endogenous cellular DNA repair mechanisms to mend a Cas9-induced double stranded break (DSB), either by the non-homologous end joining (NHEJ) pathway or by the cell-cycle regulated homology-directed repair (HDR) pathway. Here, we describe a panel of ectopically expressed DNA repair factors and Cas9 variants assessed for their ability to promote gene correction by HDR or inhibit gene disruption by NHEJ at the HBB locus. Although transient global overexpression of DNA repair factors did not improve the frequency of gene correction in primary HSPCs, localization of factors to the DSB by fusion to the Cas9 protein did alter repair outcomes toward microhomology-mediated end joining (MMEJ) repair, an HDR event. This strategy may be useful when predictable gene editing outcomes are imperative for therapeutic success.

Increased homocysteine (Hcy) levels have been associated with a higher risk of cardiovascular and neurodegenerative diseases. Passive DNA demethylation has been suggested as one of the mechanisms implicated in the development of these conditions, and most studies have investigated this relationship in older adult populations. Therefore, this study aimed to evaluate the relationship between corporal composition and biochemical and haematological indicators with plasma homocysteine levels and genome-wide methylation (Alu, LINE-1, and SAT2) in a population of healthy young adults (median age, 18 years). We showed that the prevalence of hyperhomocysteinemia was significantly higher in men (18.5%) than in women (6.6%) (P = 0.034). Increased Hcy level was substantially associated with higher levels of body mass index and visceral fat in females, whereas in males, it was significantly associated with reduced red cell distribution width and high-density lipoprotein (HDL) cholesterol (HDL-C) levels and increased low-density lipoprotein/HDL ratio. Hypomethylation of Alu was significantly associated with reduced levels of HDL-C (

Abstract Background Aggression is observed across the animal kingdom, and benefits animals in a number of ways to increase fitness and promote survival. While aggressive behaviors vary widely across populations and can evolve as an adaptation to a particular environment, the complexity of aggressive behaviors presents a challenge to studying the evolution of aggression. The Mexican tetra, Astyanax mexicanus exists as an aggressive river-dwelling surface form and multiple populations of a blind cave form, some of which exhibit reduced aggression, providing the opportunity to investigate how evolution shapes aggressive behaviors. Results To define how aggressive behaviors evolve, we performed a high-resolution analysis of multiple social behaviors that occur during aggressive interactions in A. mexicanus. We found that many of the aggression-associated behaviors observed in surface-surface aggressive encounters were reduced or lost in Pachón cavefish. Interestingly, one behavior, circling, was observed more often in cavefish, suggesting evolution of a shift in the types of social behaviors exhibited by cavefish. Further, detailed analysis revealed substantive differences in aggression-related sub-behaviors in independently evolved cavefish populations, suggesting independent evolution of reduced aggression between cave populations. We found that many aggressive behaviors are still present when surface fish fight in the dark, suggesting that these reductions in aggression-associated and escape-associated behaviors in cavefish are likely independent of loss of vision in this species. Further, levels of aggression within populations were largely independent of type of opponent (cave vs. surface) or individual stress levels, measured through quantifying stress-like behaviors, suggesting these behaviors are hardwired and not reflective of population-specific changes in other cave-evolved traits. Conclusion These results reveal that loss of aggression in cavefish evolved through the loss of multiple aggression-associated behaviors and raise the possibility that independent genetic mechanisms underlie changes in each behavior within populations and across populations. Taken together, these findings reveal the complexity of evolution of social behaviors and establish A. mexicanus as a model for investigating the evolutionary and genetic basis of aggressive behavior.

Introduction Fahr’s disease (FD) is a rare disorder consisting of bilateral and symmetrical calcium deposits in basal ganglia and cerebral cortex. These lesions are associated with neurological and psychiatric symptoms such as a rigid hypokinetic syndrome, mood disorders and memory and concentration abnormalities. It can be idiopathic or secondary to endocrine disorders, infectious diseases or mitochondrial myopathies. Objectives To highlight the importance of considering organic causes when evaluating patients presenting atypical psychiatric symptoms and claim the role of neuroimaging. Methods Case report and non-systematic review of literature: sources obtained from Pubmed database. Results A 69-year-old man, native of Syracuse (Italy), was admitted to the Psychiatry Unit in February 2022 presenting behavioural disturbances and irritability. In July 2021 he presented the same symptoms, being mistakenly diagnosed with Bipolar Disease type I. He has no previous psychiatric history. He started with changes in his personality, short-term memory loss, aggressiveness and disorganized behaviour at the age of 66. At admission he was talkative and hyperfamiliar, presenting delusions of grandiosity, exalted affectivity and insomnia. Neurological examination showed short-term memory problems, signs of frontal disinhibition and abnormal glabellar tap sign. Blood tests, CT brain and MRI were performed to rule out organic underlying causes. Neuro-imaging found bilateral and symmetric calcifications in globus pallidus, thalamus and corpus striatum, in favour of FD. Secondary causes (abnormalities in the PTH, vitamin disorders and infectious diseases such as HIV, brucellosis or neurosyphilis) where discarded, allowing us to conclude it was probably a primary case of FD. Valproate was started as a mood stabilizer and anticonvulsant. Genetic tests were indicated. Conclusions FD should be considered as a differential diagnosis in the evaluation of psychiatric symptoms, especially when atypical and/or presented with neurological symptoms. The role of neuro-imaging is essential. Disclosure of Interest None Declared

Introduction Currently, in addition to their frequent use in community medicine, the use of antidepressants is a fundamental pillar of pharmacological treatments used in psychiatry. Due to this frequent use, we must be aware of the possible side effects, in particular the SIADH produced in this clinical case by SSRIs. There are already described cases of this association including other antidepressants and many different types of drugs. Objectives To review the current literature on the management of this pathology when it is secondary to the use of frequently used drugs such as SSRIs. Methods We report the case of a 64-year-old woman hospitalised in the psychiatric department for malnutrition secondary to unspecified eating disorder (ED). During admission, treatment with sertraline was started with ascending doses up to 100mg, subsequently producing slight edema with the following analytical results: plasma Na: 123 mEq/L (135-145), plasma osmolarity: 250 mOsm/kg (275-300), urinary Na: 174 mEq/L (>40), fulfilling diagnostic criteria for SIADH. Afterwards, we reduced sertraline until discontinuation and started treatment with water restriction and urea (30 grams/24 hours) during admission and after discharge. During admission, we observed disappearance of the edema and partial improvement of the analytical values (Na:131 mEq/L), which were normalised with home treatment of daily urea. Results The precise prevalence of SIADH from the use of SSRIs is unknown, it is known that patients older than 65 are at higher risk of developing severe hyponatraemia in the first 5 weeks after initiation. Similarly, treatment with water and urea restriction, together with discontinuation of SSRIs, appears to be sufficient. Conclusions SSRIs can cause SIADH a reversible but potentially life-threatening pathology, and we need to be aware of this possibility especially in the older population and being able to handle it Disclosure of Interest None Declared

Introduction S100B is a calcium-binding astrocyte-specific cytokine, that is considered a biomarker of neurodegeneration; which may be involved in the imbalance of the inflammatory response observed in several brain disorders, including major depression and schizophrenia. Two meta-analyses have reported higher serum levels of S100B in patients with schizophrenia respect to healthy controls. Different studies have described circadian and seasonal variations of biological variables, such as melatonin or cortisol. It has been reported that there is not circadian rhythm of S100B blood levels in healthy subjects. However, it is not known whether there are circadian oscillations in S100B blood concentrations in patients with schizophrenia. Objectives The aim of this study is to describe S100B serum levels in patients with schizophrenia and to analyse whether they follow a circadian rhythm. Methods Our sample consists in 47 patients in acute phase and stabilized status. Blood samples were collected at 12:00 and 00:00 hours by venipuncture. Serum levels of Protein S100B were measured three times: at admission, discharge and three months after discharge. Protein S100B was measured by means of ELISA (Enzyme-linked immunosorbent assay) techniques. Results 12:00 24:00 P ADMISSION 132,95±199,27 85,85±121,44 0,004 DISCHARGE 73,65±71,744 75,80±123,628 0,070 CONTROL 43,49±34,60 40,14±23,08 0,47 P global P Admission Vs. Discharge P Admission Vs. Control P Discharge Vs. Control 0,97 There is a significance difference between 12:00 and 24:00 at admission for the Protein S100B.However, these difference did not occur at discharge and at three months after discharge.It can be interpreted as there is a circadian rhythm of Protein S100B when the patient has got a psychotic outbreak and disappears at discharge and when is psychopathologically stable. Conclusions With respect to our results we can hypothesize that schizophrenic patients in acute relapse present circadian S100B rhythm that is not present when the patients are clinically stable.Furthermore, the decrease of serum protein S100B levels at discharge is indicative of a reduction of the cerebral inflammation, thus it can be a biomarker of cerebral inflammation and this reduction can be the effect of the treatment. Finally, its circadianity could be a guide of this process and clinical improvement. Disclosure of Interest None Declared

Introduction Wenicke-Korsakoff syndrome (WKS) is a neurological disorder caused by thiamine deficiency. Wernicke Encephalopathy (WE) is the acute phase and the chronic phase is called Korsakoff-syndrome (KS). Objectives To review the current literature on the management of WKS in a patient with anorexia nervosa. Methods We report the case of a 63-year-old woman admitted to the Psychiatry Unit after weight loss in the last 3 months (from 39 kg to 33,500 kg). She only made one meal a day. By exploration and analysis, neoplastic disease is ruled out (thoraco-abdomino-pelvic CT without pathological findings). She has maintained restrictive intakes for more than 30 years. A long-term anorexia nervosa (AN) is suspected, with a worsening of restrictive behavior in recent months. Upon admission, she has a weight of 33,500 kg and a BMI of 14,10. She has a left palpebral ptosis and an alteration of the anterograde memory as well as affectation of executive functions. Progressive oral diet is started, and due to the suspicion of a WKS, thiamine ev is started for a week and then continued with oral thiamine. Thiamine levels are extracted once the ev treatment has begun, so we do not have previous levels to know if they were decreased. Brain MRI shows bilateral hyperintensities in white matter and at supratentorial level in T2 and FLAIR. After a month and a half of admission, the patient has progressively regained weight, has managed to make adequate intakes and has improvement in memory. Results An adverse consequence of severe malnutrition in AN due to severe food restriction and purging behavior is thiamine deficiency, and also global cerebral atrophy and concomitant cognitive deficits can be found. Thiamine deficiency occurs in 38% of individuals with AN and is often unrecognized. WKS is caused by thiamine deficiency, and WE is the acute phase of this syndrome (presentation of triad can vary). The chronic phase is KS and consists in amnesia with confabulations. WKS typically develops after malnourishment in alcoholic patients but can be associated in nonalcoholic such as prolonged intravenous feeding, hyperemesis, anorexia nervosa, refeeding after starvation, thyrotoxicosis, malabsorption syndromes; hemodialysis; peritoneal dialysis; AIDS; malignancy. WKS is a clinical diagnosis, and no specific abnormalities have been found in cerebrospinal fluid, brain imaging or electroencephalograms. MRI has a sensitivity of 53%, but high specificity of 93%, and shows an increased signal in T2 and FLAIR sequences, bilaterally symmetrical in the paraventricular regions of the thalamus, the hypothalamus, mamillary bodies, the periaquedutal region, the floor of the fourth ventricle and midline cerebellum. Conclusions If the disorder is suspected, thiamine should be initiated immediately in order to prevent irreversible brain damage, with an estimated mortality rate of about 20%, or to the chronic form of the WE in up to 85% of survivors Disclosure of Interest None Declared

The present study aimed to evaluate the effect of citric acid on the properties of solid pine wood, which were submitted to thermomechanical treatment. A preliminary test was performed in a previous study to evaluate the influence of different temperatures of pressing and concentrations of citric acid on the physical properties of wood. After choosing the best treatments (170 °C and 5% and 10% of citric acid), the effect of these on the chemical properties (SEM, FTIR and pH); on the density profile using an X-ray microtomography and on the resistance to aging through an abrasion test were evaluated. The result of the chemical analysis showed an increase of the presence of ester functional groups, as well as better coverage and higher acidity of the surface. The density profile technique allowed us to observe the formation of peaks of density on the surface where the acid was applied. Lastly, it was also possible to verify an increase in the resistance to abrasions because of the application of citric acid.

Abstract The Lancet Commission on Global Surgery (LCoGS) launched Global Surgery 2030 to address the surgical services inequities with a bias toward low‐income and middle‐income countries like the Philippines. The same inequity is observed particularly when it comes to the urban‐rural divide. With more than half of the population living in rural areas, access to surgery becomes a major challenge that further impedes the much‐needed health of an economically productive workforce. The Universal Health Care [UHC] Act (RA 11332) of 2019 ensures that all Filipinos have access to quality, cost‐effective, promotive, preventive, curative, rehabilitative, and palliative health services without causing a financial burden. Recognizing the provision of essential surgery, in the context of primary healthcare is important. It should be accessible, continuous, comprehensive, and coordinated at the time of need – parallel to the principle of primary health care. Driven by this concept and experiences, the authors conceptualized and presented the Philippine Rural Surgery model for future development and implementation. This is envisioned to provide essential surgery among local rural primary health care settings that is universal, accessible, cost‐effective and safe. As this is still new in the Philippines, we proposed tenets and recommendations based on WHO Health System Strengthening building blocks to guide stakeholders in creating formal plans towards institutionalization under the principles of UHC. Such access to surgical service in the context of a unique socio‐demography of the Philippines would be essential in attaining the parameters and provisions set by the UHC Act.

Inspired by a posthuman philosophy, this paper explores sustainable natureculture kindergarten praxis as a pragmatic transcorporeal collective engagement with the present and sustainable future events to come. The point of departure is the economic argument for implementing science, technology, engineering and mathematics education within early childhood education and care as a preparation for the challenges a science- and technology-driven society brings at the forefront. By exploring and experimenting with dataphilosophy as our theory-method and the concept of non-position, we embrace and critique technology and technological solutions in connection with kindergarten praxis and steer them towards new forms of solidarity and socially just pedagogies. Through the article, we ask (in)directly what kind of subject position digitalization as part of a sustainable future requires, and the inevitable questions this subject position regarding professionalism within early childhood education and care brings.

Ichneumonidae é uma das maiores famílias de Hymenoptera, com estimativa de 60.000 espécies, dessas 17.000 ocorrem na Região Neotropical. Apesar de sua elevada diversidade, os estudos do grupo são escassos na região Amazônica. Assim, o objetivo desse trabalho foi realizar a análise faunística das subfamílias de Ichneumonidae em uma área de Floresta Amazônica e apresentar considerações sobre alguns gêneros. Foram instaladas duas armadilhas Malaise em uma área de floresta do Campus II da Universidade Federal do Amazonas - UFAM, em Itacoatiara, Amazonas. Foram feitas coletas semanais durante o período de novembro de 2017 a janeiro de 2018. Os Hymenoptera amostrados foram identificados ao nível de família e subfamília, e posteriormente encaminhados a especialista para identificação ao nível de gênero. Foi utilizado da Análise Faunística para determinar as principais subfamílias. Ao todo, foram coletados 541 exemplares de Ichneumonidae, distribuídos em 16 subfamílias. As subfamílias predominantes foram Cryptinae, Orthocentrinae, Ichneumoninae e Pimplinae. Vale ressaltar a presença de Cremastinae e Campopleginae, que são importantes para o equilíbrio das populações naturais, bem como são indicadores de áreas degradadas.

O presente estudo propõe analisar a viabilidade do uso da greve ecológica como ferramenta de pressão pelos trabalhadores para a oposição de políticas governamentais neoextrativistas no Brasil. Partindo da metodologia de estudo de caso, o texto traz, em um primeiro momento, uma análise do neoextrativismo enquanto política pública no país. Em um segundo momento, dedica-se ao estudo da greve e a sua variante ecológica. Por fim, são analisadas as potencialidades da greve ecológica no contexto brasileiro a partir de experiências predecessoras. Com base na metodologia disposta, foi possível concluir que a greve ecológica apresenta-se como alternativa viável de resistência a ser empreendida pelos trabalhadores frente ao ímpeto destrutivo capitalista, firmando uma abordagem ecológica enquanto um bem indispensável para o bem-estar coletivo.

Hymenoptera tem sido considerado por diversos autores como a mais útil de todas as ordens de insetos, principalmente os parasitoides, pois possuem uma grande importância biológica, ecológica e econômica. O objetivo deste trabalho foi realizar um levantamento das famílias de Hymenoptera, com ênfase em Vespidae, presentes em uma área de floresta tropical úmida, no município de Itacoatiara, Amazonas, Brasil. As coletas foram realizadas semanalmente com ajuda da armadilha Malaise, durante o período de novembro de 2017 a janeiro de 2018. Foram coletados 12.160 indivíduos desta ordem, distribuídos em 11 superfamílias e 32 famílias. Das 32 famílias identificadas, 26 são compostas de himenópteros que apresentam hábitos parasitoides. Os parâmetros faunísticos como frequência, constância, dominância e abundância foram calculados através do software livre de Análise Faunística – ANAFAU. Formicidae foi considerada superabundante (49,38%). Já Braconidae (10,4%), Platygastridae (9,79%), Ichneumonidae (5,95%), Diapriidae (5,53%), Vespidae (4,96%) e Figitidae (3,84%) foram muito abundantes. De Vespidae foram coletados 575 indivíduos, pertencentes a 12 espécies de cinco gêneros. A espécie mais abundante foi Polybia liliacea (260/45,3%), seguido de Agelaia fulvofasciata (142/24,74%) e Polybia velutina (92/16,03%). A análise faunística mostrou resultados semelhantes a outros estudos já conduzidos em relação à Hymenoptera, porém, reforçam a necessidade de mais pesquisas sobre a biodiversidade das famílias na região, levando em consideração maior período nas coletas e uso de outros métodos de amostragens.

Produzidas a partir de determinadas concepções e posicionamentos políticos e filosóficos, as tecnologias expressam intencionalidades que orientam as dinâmicas sociais e afetam os seus usos, design e desempenho. Neste artigo, partimos do pressuposto de que as tecnologias não são produzidas e disseminadas de modo neutro, sendo afetadas pelo modo como gênero e raça estruturam as relações sociais. A partir de informações obtidas na Plataforma Lattes, do CNPq, e em sites institucionais, realizamos um mapeamento das docentes universitárias afro-brasileiras e africanas dos países africanos de língua oficial portuguesa (PALOP) que pesquisam sobre tecnologias digitais e são vinculadas aos cursos de Ciências da Computação, Comunicação, Pedagogia e Ciências Sociais de universidades públicas, no período compreendido entre 1989 e 2019. Por meio de uma abordagem interseccional, analisamos como o fenômeno da brecha digital posiciona as mulheres negras no campo da pesquisa sobre tecnologias digitais e concluímos que, apesar de ser identificada a presença de docentes negras nas universidades desenvolvendo pesquisas sobre tecnologias digitais, sua participação nesta área ainda é incipiente. No que se refere aos PALOP, as informações disponíveis na internet foram insuficientes para que pudéssemos reunir elementos que garantam uma análise segura do fenômeno nas universidades públicas investigadas.