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Antimicrobial resistance poses a growing threat to human health, yet its implications for wildlife remain a subject of ongoing research. River otters inhabiting the Peñas Blancas River face exposure to various anthropogenic activities in their habitat, potentially leading to the accumulation of antibiotic-resistant genes (ARGs) with unknown consequences for their health. This study aimed to identify specific ARGs in otter feces from this river basin, employing quantitative polymerase chain reaction (qPCR), DNA sequencing of ARGs, and phylogenetic analysis techniques. Over the period from 2019 to 2022, we collected 102 fecal samples from otters through the Peñas Blancas River watershed, spanning its upper and middle basins. We assessed the bacterial presence via the 16S rRNA gene through qPCR analysis and screened for 12 ARGs. Sequences of 16 ARG-positive samples were subsequently analyzed using Maximum-likelihood-base taxonomic placement. In total, 56 samples tested positive for the 16S rRNA gene, with 24 exhibiting at least one ARG. Notably, three samples showcased a “multi-resistance microbiome”. qPCR analyses identified seven distinct ARGs: tetB (in 26.8 % of the samples), sulI (21.4 %), sulII (21.4 %), qnrS (10.7 %), tetQ (8.9 %), tetW (7.1 %), and tetA (3.6 %). Phylogenetic analysis confirmed the taxonomic association of all detected ARGs, which were compared with The Comprehensive Antibiotic Resistance Database. Our findings underscore the importance of comprehending the spread of ARGs in wildlife populations, with river otters serving as potential sentinels for ARG dissemination. Moreover, they highlight the potential impact of anthropogenic activities on the health of aquatic ecosystems, emphasizing the need for proactive measures to mitigate antimicrobial resistance in natural environments.

The rise of angiosperms to ecological dominance and the breakup of Gondwana during the Mesozoic marked major transitions in the evolutionary history of insect-plant interactions. To elucidate how contemporary trophic interactions were influenced by host plant shifts and palaeogeographical events, we integrated molecular data with information from the fossil record to construct a time tree for ancient phytophagous weevils of the beetle family Belidae. Our analyses indicate that crown-group Belidae originated approximately 138 Ma ago in Gondwana, associated with Pinopsida (conifer) host plants, with larvae likely developing in dead/decaying branches. Belids tracked their host plants as major plate movements occurred during Gondwana’s breakup, surviving on distant, disjunct landmasses. Some belids shifted to Angiospermae and Cycadopsida when and where conifers declined, evolving new trophic interactions, including brood-pollination mutualisms with cycads and associations with achlorophyllous parasitic angiosperms. Extant radiations of belids in the genera Rhinotia (Australian region) and Proterhinus (Hawaiian Islands) have relatively recent origins.

Chromosomal fragile sites (CFSs) are loci or regions susceptible to spontaneous or induced occurrence of breaks and rearrangements. They are classified in two main categories, rare and common, depending on their frequency in the population. In order to identify which CFSs are influential or significant in the occurrence of deletions and duplications (chromosomal constitutional imbalances), we propose a logistic regression analysis for the CFS data set, since the underlying response variable is categorical, specifically binary (deletion or duplication). Some results are presented here as an informative preliminary contribution to understand the frailty of these CFS in increasing/decreasing of the deletion odds. This study has implications for our comprehension of human pathogenesis.

Background Rights-based Respectful Maternity Care (RMC) is crucial for quality of care and improved birth outcomes, yet RMC measurements are rarely included in facility improvement initiatives. We aimed to (i) co-create a routine RMC measurement tool (RMC-T) for congested maternity units in Dar es Salaam, Tanzania, and (ii) assess the RMC-T’s acceptability among women and healthcare stakeholders. Method We employed a participatory approach utilizing multiple mixed methods. This included a scoping review, stakeholder engagement involving postnatal women, healthcare providers, health leadership, and global researchers through interviews, focus groups, and two surveys involving 201 and 838 postnatal women. Cronbach’s alpha and factor analysis were conducted for validation using Stata 15. Theories of social practice and Thematic Framework of Acceptability guided the assessment of stakeholder priorities and tool acceptability. Results The multi-phased iterative co-creation process produced the 25-question RMC-T that measures satisfaction, communication, mistreatment (including physical, verbal, and sexual abuse; neglect; discrimination; lack of privacy; unconsented care; post-birth clean-up; informal payments; and denial of care), supportive care (such as food intake and mobility), birth companionship, post-procedure pain relief, bed-sharing, and newborn respect. The pragmatic validation process prioritized stakeholder feedback over strict statistics, lowering Cronbach’s alpha from 0.70 in version 1 to 0.57 for the RMC-T. Women valued the opportunity to share their experiences. Conclusions The RMC-T is contextualized, validated, and acceptable for measuring women’s experiences of RMC. Routine use in facility-based quality improvement initiatives, along with targeted actions to address gaps, will advance rights-based RMC. Further validation and community-based studies are needed.

Background: Autoimmune hemolytic anemia (AIHA) is a rare, life-threatening disease in pediatrics. This article describes the clinical features, diagnostic workup, treatment and outcome in patients with AIHA. Method: Medical charts of under 18-year-old patients with AIHA treated at a tertiary Brazilian institution from 2006 to 2021 were retrospectively reviewed. Data analysis was primarily descriptive, using medians, interquartile ranges, and categorical variables presented as absolute frequencies. Main results: Twenty-four patients (14 female, 10 male) were evaluated in this study. The median age at diagnosis was 5.99 years (range: 0.25–17.1 years) and the median hemoglobin level was 4.85 g/dL (range: 4.17–5.57 g/dL). Most had warm antibodies (83.3 %). Twelve patients (50 %) had known underlining diseases, four (16.6 %) presented with AIHA concomitant with acute infectious diseases and three (12.5 %) had an undetermined post-vaccine association. Steroids and intravenous immunoglobulin were first-line therapy in 23 cases. Seven patients (29.1 %) required second and third-line treatments (rituximab, cyclophosphamide and splenectomy). The median follow-up period was 4.4 years (range: 1.0–6.7 years). Thirteen patients (54.1 %) were discharged, five cases (20.8 %) were lost to follow-up and no patient died. The median age for the six remaining patients was 11.53 years (8.5–14.7) with all of them having complete responses with no further therapies. Conclusion: Most cases of AIHA are secondary to an underlying systemic disease or have a possible correlation with infections/vaccines and respond to steroids. The second and third-line therapies for refractory and relapse cases remain a dilemma. A prospective, multicenter study is essential to address the best therapeutic combinations.

Neste artigo, pretendo analisar a forma como os discursos dominantes sobre acontecimentos recentes da história portuguesa, concretamente o 25 de Abril de 1974 e o 11 de Março de 1975, são questionados em dois filmes de Pedro Costa: Juventude em marcha (2006) e Cavalo dinheiro (2014), respetivamente. Para além dos elementos discursivos, o ensaio propõe também uma análise dos procedimentos formais nos dois filmes de Costa através dos quais a narrativa consensual do 25 de Abril e do Processo Revolucionário em Curso (PREC), assim como os seus discursos emancipatórios, são questionados. Conclui-se que ambos os filmes sugerem que outras histórias estão ainda por atualizar, pondo em causa o consenso da narrativa histórica e, desta forma, gerando dissenso; impedindo, assim, a cristalização da narrativa emancipatória do acontecimento histórico e do subsequente período revolucionário.

Resumen: La salud mental (SM) y la mutilación genital femenina (MGF) son 2 aspectos de la salud del migrante poco cribados en general, son material sensible en la entrevista clínica y se requieren conocimientos para afrontarlas con profesionalidad.La migración es un acontecimiento vital que per se no conlleva un trastorno mental, pero los hechos vivenciados durante la migración pueden generar problemas de SM de diferente intensidad. Los migrantes tienen los mismos problemas que el resto de la población, difieren en su forma de expresión. Es necesario conocer el contexto cultural y establecer un buen vínculo para abordar tanto la SM como la MGF.La MGF es un problema de salud grave para las niñas y mujeres que cabe afrontar en la consulta de atención primaria para prevenir esta pràctica en las niñas y ofrecer apoyo a las mujeres afectadas. Tratar estos aspectos con los varones y las mujeres de los países de riesgo es imprescindible para facilitar el cambio y ayudar a eliminar esta pràctica. Abstract: Mental Health (MH) and Female Genital Mutilation (FGM) are two aspects of migrant health that should be addressed and screened in primary care. These topics are inherently sensitive, often challenging and difficult to approach in routine consultations. Providing comprehensive care and management needs both knowledge and a careful approach, yet these factors may sometimes result in low screening of both health issues.Migration itself does not inherently lead to MH disorders. However, the various experiences encountered throughout the migration process can contribute to MH challenges. Migrants face the same issues as the rest of the population, but their expressions may differ. Therefore, it is important to understand the cultural contexts and create a supportive environment within healthcare to effectively address both MH and FGM.FGM is a serious health issue for girls and women that should be assessed in primary care. This includes prevention for at-risk girls, support and care for affected women and community initiatives. To engage with individuals from high-risk countries, both men and women is essential to facilitate change and help to end this harmful practice.

Introduction ISMiHealth is a clinical decision support system, integrated as a software tool in the electronic health record system of primary care, that aims to improve the screening performance on infectious diseases and female genital mutilation (FGM) in migrants. The aim of this study is to assess the health impact of the tool and to perform a process evaluation of its feasibility and acceptability when implemented in primary care in Catalonia (Spain).Methods and analysis This study is a cluster randomised control trial where 35 primary care centres in Catalonia, Spain will be allocated into one of the two groups: intervention and control. The health professionals in the intervention centres will receive prompts, through the ISMiHealth software, with screening recommendations for infectious diseases and FGM targeting the migrant population based on an individualised risk assessment. Health professionals of the control centres will follow the current routine practice.A difference in differences analysis of the diagnostic rates for all aggregated infections and each individual condition between the intervention and control centres will be performed. Mixed-effects logistic regression models will be carried out to identify associations between the screening coverage and predictor factors. In addition, a process evaluation will be carried out using mixed methodology.Ethics and dissemination The study protocol has been approved by the institutional review boards at Hospital Clínic (16 June 2022, HCB/2022/0363), Clinical Research Ethics Committee of the Primary Care Research Institute IDIAPJGol (22 June 2022, 22/113-P) and the Almería Research Ethics Committee (27 July 2022, EMC/apg). The study will follow the tenets of the Declaration of Helsinki and Good Clinical Practice. All researchers and associates signed a collaboration agreement in which they undertake to abide by good clinical practice standards.Findings will be disseminated in peer-reviewed journals and communications to congresses.Trial registration number NCT05868005.

BackgroundType 1 diabetes is a demanding chronic condition that requires diligent blood glucose monitoring and timely insulin administration by patients who must integrate self-management into their daily lives. ObjectiveThis study aimed to better understand what outcome measures are important to individuals living with type 1 diabetes (T1D) in Ontario, Canada, to help inform the development of type 1 diabetes virtual self-management Education and support (T1ME) trial. MethodsA qualitative approach was used, in which we conducted 6 focus groups with a total of 24 adult participants living with T1D (from age 18 to >65 years) in Ontario. Each focus group was semistructured in nature; participants were encouraged to talk openly about their experiences with T1D self-management and provide their perspectives on more focused topics such as technology and relationships with health care providers. ResultsAn interpretive analysis helped us devise a framework for our results that centered around 6 main discussion themes: (1) adapting self-management to meet evolving needs, (2) looking “beyond A1c” toward more personalized indicators of glycemic management, (3) the benefits and challenges of adopting new T1D technology, (4) establishing trusting relationships with diabetes care providers, (5) perceived benefits of peer support, and (6) pre– and post–COVID-19 perspectives on virtual care. ConclusionsOur goal is for these findings to help facilitate the development of patient-oriented outcome measures that are in line with the unique needs and preferences of T1D patients in this new, more virtual landscape of clinical care, education, and self-management support.

BACKGROUND: Similar to many resource-constrained urban settings, cesarean deliveries in Dar es Salaam, Tanzania, have increased rapidly, from 17% in 2015 to 26% in 2022. Alarmingly, at the population level, the increase was not followed by improvements in perinatal outcomes, suggesting the overuse of cesarean delivery. Prolonged labor is the leading cause of women's first cesarean delivery. Therefore, understanding the management of prolonged labor preceding cesarean delivery is crucial for preventing nonmedically indicated cesarean deliveries across Tanzania and globally. OBJECTIVE: This study aimed to estimate the proportion of cesarean deliveries with a written indication of prolonged labor that was performed in labors with uncomplicated progression. STUDY DESIGN: This study was conducted at 5 urban maternity units in Dar es Salaam, Tanzania, from October 1, 2021, to August 31, 2022. Data were extracted from case files of women who gave birth via cesarean delivery with a written indication of prolonged labor. The timing of cesarean delivery decision was assessed against predefined definitions of prolonged labor at each stage/phase of labor. The proportion of cesarean deliveries performed in cases of uncomplicated progression was calculated. The exclusion criteria included referral to study sites because of prolonged labor or cervical dilatation of >6 cm upon admission, noncephalic presentation, multiple pregnancy, intrauterine fetal death, failed induction of labor, previous cesarean delivery, or other written indications for cesarean delivery. RESULTS: The overall cesarean delivery rate was 32% (2949/9364). Of first-time cesarean delivery cases, 746 of 1517 patients (47.9%) had a written indication of prolonged labor. Finally, 456 of 746 patients (61.1%) met the inclusion criteria, of which 307 of 456 patients (67.3%) were admitted in the latent phase of labor. In 243 of 456 cesarean deliveries (53.3%) with an indication of prolonged labor, labor was not prolonged. This group included (1) women not being given a trial of labor (78/243 [32.1%]), (2) women in the first stage of active labor not crossing the partograph action line (145/243 [59.7%]), and (3) women in the second stage of labor lasting

Structured intervention programs are an important resource for supporting people with substance addiction. Although evidence suggests that they improve health outcomes, such as specific symptoms, less is known about their impact on patients' ability to self-manage the consequences of substance addiction. The aim of this review is to scope outpatient intervention programs focused on the self-management of substance addiction consequences. Approach. This review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. MEDLINE and CINAHL (through Ebsco), Psychology & Behavioral Sciences Collection (including PsycINFO) and Web of Science were screened to identify articles published in the last 10 years. Only primary research was included. Out of 891 records, 19 were eligible for this review-12 randomized controlled trials (RCT), 6 quasi-experimental study and 1 observational study. Those studies reported group interventions (10), individual interventions (8) and 1 mixed approach. The most common interventions were based on motivational strategies, relapse prevention and definition of active plans for risky situations. 10 studies reported positive effects. The identification of structured programs may support the development of new approaches focused on empowerment and quality of life of people with substance addiction. Programs to empower patients for self-management of substance addiction consequences are often complex and rely on health professionals' commitment. Nevertheless, they are a feasible approach that seems to benefit patients managing chronic conditions associated with substance addiction., Author(s): Paulo Seabra [sup.1] [sup.2] [sup.3] , Gabriella Boska [sup.4] , Rui Sequeira [sup.5] , Ana Sequeira [sup.5] , Ana Simões [sup.5] , Inês Nunes [sup.1] , Carlos Sequeira [sup.6] [...]

A nine-year-old female patient reported to the Department of Paediatric and Preventive Dentistry with a chief complaint of pain in the lower left back tooth region for two months. The patient experienced dull achy pain, which aggravated over two weeks and gradually progressed. The patient reported a history of nocturnal pain and previous dental treatment in the area of concern. On extraoral examination, facial asymmetry was seen [Table/Fig-1]. Upon inspection, mild diffuse swelling 2×3 cm in size was noted on the left lower third of the face, extending across the lower border of the mandible. On palpation, an oval swelling, firm in consistency with a smooth surface and a diffuse edge, was noted in the lower border of the mandible. It was non compressible, non reducible, tender, and febrile.

The increase in floods as a consequence of climate change is causing considerable concern in vulnerable localities. The community of Pandora Oeste in Costa Rica has experienced increasingly frequent flooding. Therefore, the aim of this study was to describe the social vulnerability to flood risk, associated with people and housing characteristics, as well as current conditions, to generate information that contributes to integrated risk management. The action-research methodology utilized allowed the development of joint activities between local actors and academia to better understand several variables that influence social vulnerability. To achieve this, a survey was administered to community residents, and a social mapping workshop was conducted with the participation of members of the Valle la Estrella Community Emergency Committee. This gathered information serves as an input for community decision-making, directing efforts toward the implementation of flood risk mitigation actions. At the same time, the results have established an approach to the flood problem, providing the methodological scenarios implemented, which could potentially be replicated in other communities, including new perspectives from community management to the articulation of actors, strengthening shared responsibility for social resilience in the face of future extreme weather events.

Introduction and objectives: Three-dimensional (3D) model simulation provides the opportunity to manipulate real devices and learn intervention skills in a realistic, controlled, and safe environment. To ensure that simulators provide a realistic surrogate to real procedures they must undergo scientific validation. We aimed to evaluate the 3D-printed simulator SimulHeart® for face and content validity to demonstrate its value as a training tool in interventional cardiology (IC). Methods: Health professionals were recruited from sixteen Portuguese IC units. All participants received a 30-minute theoretical introduction, 10-minute demonstration of each task and then performed the intervention on a 3D-printed simulator (SimulHeart®). Finally, a post-training questionnaire focusing on the appearance of the simulation, simulation content, and satisfaction/self-efficacy was administered. Results: We included 56 participants: 16 “experts” (general and interventional cardiologists), 26 “novices” (cardiology residents), and 14 nurses and allied professionals. On a five-point Likert scale, the overall mean score of face validity was 4.38±0.35 and the overall mean score of content validity was 4.69±0.32. There was no statistically significant difference in the scores provided by “experts” and “novices”. Participants reported a high level of satisfaction/self-efficacy with 60.7% considering it strongly improved their skills. The majority (82.1%) “agreed” or “strongly agreed” that after the simulation they felt confident to perform the procedure on a patient. Conclusion: The 3D-printed simulator (SimulHeart®) showed excellent face and content validity. 3D simulation may play an important role in future IC training programs. Further research is required to correlate simulator performance with clinical performance in real patients. Resumo: Introdução e objetivos: A simulação de modelos tridimensionais (3D) proporciona a oportunidade de manipular dispositivos reais e aprender competências de intervenção num ambiente realista, controlado e seguro. Para garantir que os simuladores fornecem uma comparação realista, estes devem ser submetidos a validação científica. O nosso objetivo foi avaliar o simulador 3D SimulHeart® quanto à validade de aparência e conteúdo, para demonstrar o seu valor como ferramenta formativa em cardiologia de intervenção (CI). Métodos: Recrutamos profissionais de saúde de 16 unidades de CI portuguesas. Todos os participantes receberam uma introdução teórica de 30 minutos, 10 minutos de demonstração e de seguida tentaram realizar a intervenção num simulador 3D Simulheart. Por fim, foi aplicado um questionário pós-formação com foco na aparência da simulação, conteúdo da simulação e satisfação/autoeficácia. Resultados: Incluímos 56 participantes: 16 «especialistas» (cardiologistas gerais e de intervenção), 26 «novatos» (internos de cardiologia) e 14 enfermeiros e profissionais aliados. A pontuação média geral da validade de aparência foi de 4,38±0,35, e a pontuação média geral da validade de conteúdo foi de 4,69 ± 0,32, numa escala Likert de cinco pontos. Não houve diferenças estatisticamente significativas nas pontuações de «especialistas» e «novatos». Os participantes relataram um alto nível de satisfação/autoeficácia sendo que 60,7% consideraram que melhoraram fortemente as suas competências. A maioria (82,1%) «concordou» ou «concordou totalmente>» que após a simulação se sentiram confiantes para realizar o procedimento num paciente. Conclusão: O simulador 3D (SimulHeart®) apresentou excelente validade de aparência e de conteúdo. A simulação 3D pode desempenhar um papel importante nos programas formativos em cardiologia de intervenção. Mais estudos são necessários para correlacionar o desempenho no simulador com o desempenho clínico em pacientes reais.

Riedel’s thyroiditis is the rarest form of thyroiditis, occasionally resulting in rapid thyroid enlargement and potential tracheal obstruction. Here, we detail the case of an 81-year-old woman with a medical history including Hodgkin lymphoma, Hashimoto’s thyroiditis, and multinodular goiter. She presented to the emergency room with stridor, cervical swelling, and breathing difficulties for over 2 days. CT scans revealed substantial thyroid enlargement causing significant glottal and tracheal compression, to a minimum tracheal diameter of 7 mm. Due to the severity of the compressive symptoms, orotracheal intubation and mechanical ventilation were deemed necessary. Surprisingly, despite the initial suspicion of malignancy given the rapid growth in the elderly, subsequent cytological and histological evaluations indicated a benign form of invasive fibrous thyroiditis – Riedel’s thyroiditis. Although surgical intervention was advised, the patient declined and opted for endobronchial treatment with a prosthetic stent and subsequent treatment with systemic glucocorticoids. Following successful treatment, she was discharged within a week and resumed normal activities without respiratory distress. This case is noteworthy for its rapid benign mass growth, rare emergent presentation, and the patient’s advanced age.

Background: Cervical cancer screening remains an essential preventive tool worldwide. First line high-risk Human Papillomavirus (HrHPV) genotyping became gold standard for cervical cancer screening, and has been adopted by several countries, including Portugal. Herein, we aimed to assess the early outcomes of the regional Cervical Cancer Screening Program of Northern Portugal. Methods: The analysis of a representative set of cases evaluated during a one-month period (January 2020), with adequate follow-up was performed. Descriptive analysis was performed. Results: Overall, 7278 samples were received, of which 15.2% were HrHPV positive, most of these disclosing a negative result in subsequent liquid-based cytology. Nearly half of the HrHPV-positive women were referred to colposcopy. Within this group, HPV16/18+ cases depicted the higher frequency of high-grade squamous intraepithelial lesion (HSIL) or worse, compared with abnormal cytology or persistent HrHPV infection. Among women with non-HPV16/18 HrHPV infection and negative cytology, which are eligible for repeat sampling in one year, 65% were re-tested. Importantly, nearly half of these cleared HrHPV infection. Furthermore, referral to colposcopy due to HPV16/18 infection and/or abnormal cytology results were associated with > 40% risk for HSIL or worse lesion. Conclusions: Our study confirmed the reliability and effectiveness of first line HrHPV genotyping in the Cervical Cancer Screening Program of Northern Portugal. Nonetheless, it also raised concerns about excessive referral to colposcopy, with the inherent human and financial costs. Thus, further improvement and optimization are key to ensure the sustainability of the program.

Abstract Periodontitis affects billions of people worldwide. To address relationships of periodontal niche cell types and microbes in periodontitis, we generated an integrated single-cell RNA sequencing (scRNAseq) atlas of human periodontium (34-sample, 105918-cell), including sulcular and junctional keratinocytes (SK/JKs). SK/JKs displayed altered differentiation states and were enriched for effector cytokines in periodontitis. Single-cell metagenomics revealed 37 bacterial species with cell-specific tropism. Fluorescence in situ hybridization detected intracellular 16 S and mRNA signals of multiple species and correlated with SK/JK proinflammatory phenotypes in situ. Cell-cell communication analysis predicted keratinocyte-specific innate and adaptive immune interactions. Highly multiplexed immunofluorescence (33-antibody) revealed peri-epithelial immune foci, with innate cells often spatially constrained around JKs. Spatial phenotyping revealed immunosuppressed JK-microniches and SK-localized tertiary lymphoid structures in periodontitis. Here, we demonstrate impacts on and predicted interactomics of SK and JK cells in health and periodontitis, which requires further investigation to support precision periodontal interventions in states of chronic inflammation.

Abstract Objective Social media (SM), with its addictive nature and the accompanying psychosocial challenges such as stress, anxiety, and depression, is the primary factor exacerbating mental health problems and adversely impacting individuals’ wellbeing. Our study’s goal was to determine how SM affects employees’ psychosocial behaviours and assess the various factors that contributed to the employee’s excessive use of SM. Methods A cross-sectional correlational analysis was conducted. Using a relevant questionnaire on employees, the study was assessed to establish the relationship or association between SM addiction and psychosocial disorders like depression, anxiety, and stress. 200 people with a minimum age of 24 were enrolled in the study. The questionnaire contained the social networking addiction scale (SNAS) and the depression, anxiety, and stress-21 (DASS-21) scales; the data were statistically assessed. Results The association between SM addiction and psychosocial behaviours has been examined using statistical tools including descriptive statistics and the Chi-square analysis. SM addiction has a strong, statistically significant correlation with depression (p = 0.001), stress (p = 0.001), and anxiety (p = 0.001). Conclusion This study discovered a connection between SM use and depression, stress, and anxiety among working employees, raising questions regarding worries about overuse and addiction to SM. Various factors influencing excessive usage included revealed that employees also majorly over used SM for entertainment, boredom avoidance, constant knowledge sharing, and relationship-building.

Introduction: Literacy of health professionals on patient safety aims to prevent and reduce risks and adverse events in healthcare. Objective: The objective of this study was to translate, adapt, and validate for Portugal of the World Health Organization Questionnaire to Assess the Implementation of the Multiprofessional Guide. Methodology: Following the cultural adaptation process, we carried out a psychometric analysis on a sample of 300 health professionals. The scale was tested for apparent and content validity. Psychometric properties were assessed using Cronbach’s alpha coefficient (α) through exploratory and confirmatory factor analysis, convergent validity, and discriminant validity. Results: Exploratory factor analysis led to a tetra factor structure that accounted for 43.0% of the variance and had an overall alpha of 0.759. The hypothesized structure was submitted to confirmatory factor analysis, and the following items were eliminated from factors 1, 2, and 3 and the respective items: 7; 5; and 3, 4, 5, and 6, due to multicollinearity problems. Overall good-of-fit indexes are reliable. Conclusions: The “KIT TOOL-S2 TEXT” scale presents a factor structure with satisfactory validity and reliability results, adequately representing the constructs in question.

Abstract Nonpharmaceutical interventions (NPIs) implemented during the COVID-19 pandemic have disrupted the dynamics of respiratory syncytial virus (RSV) on a global scale; however, the cycling of RSV subtypes in the pre- and post-pandemic period remains poorly understood. Here, we used a two subtype RSV model supplemented with epidemiological data to study the impact of NPIs on the two circulating subtypes, RSV-A and RSV-B. The model is calibrated to historic RSV subtype data from the United Kingdom and Finland and predicts a tendency for RSV-A dominance over RSV-B immediately following the implementation of NPIs. Using a global genetic dataset, we confirm that RSV-A has prevailed over RSV-B in the post-pandemic period, consistent with a higher R0 for RSV-A. With new RSV infant monoclonals and maternal and elderly vaccines becoming widely available, these results may have important implications for understanding intervention effectiveness in the context of disrupted subtype dynamics.

Abstract Background Transcranial magnetic stimulation (TMS) (including the theta burst stimulation (TBS) form of TMS used in this study) is a non-invasive means to stimulate nerve cells in superficial areas of the brain. In recent years, there has been a growth in the application of TMS to investigate the modulation of neural networks involved in substance use disorders. This study examines the feasibility of novel TMS protocols for the treatment of methamphetamine (MA) use disorder in an ambulatory drug and alcohol treatment setting. Methods Thirty participants meeting the criteria for moderate to severe MA use disorder will be recruited in community drug and alcohol treatment settings and randomised to receive active TMS or sham (control) intervention. The treatment is intermittent TBS (iTBS) applied to the left dorsolateral prefrontal cortex (DLPFC), then continuous TBS (cTBS) to the left orbitofrontal cortex (OFC). Twelve sessions are administered over 4 weeks with opt-in weekly standardized cognitive behaviour therapy (CBT) counselling and a neuroimaging sub-study offered to participants. Primary outcomes are feasibility measures including recruitment, retention and acceptability of the intervention. Secondary outcomes include monitoring of safety and preliminary efficacy data including changes in substance use, cravings (cue reactivity) and cognition (response inhibition). Discussion This study examines shorter TBS protocols of TMS for MA use disorder in real-world drug and alcohol outpatient settings where withdrawal and abstinence from MA, or other substances, are not eligibility requirements. TMS is a relatively affordable treatment and staff of ambulatory health settings can be trained to administer TMS. It is a potentially scalable and translatable treatment for existing drug and alcohol clinical settings. TMS has the potential to provide a much-needed adjuvant treatment to existing psychosocial interventions for MA use disorder. A limitation of this protocol is that the feasibility of follow-up is only examined at the end of treatment (4 weeks). Trial registration Australia New Zealand Clinical Trial Registry ACTRN12622000762752. Registered on May 27, 2022, and retrospectively registered (first participant enrolled) on May 23, 2022, with protocol version 7 on February 24, 2023.

Abstract Extracellular vesicles (EVs) are lipid-membrane enclosed structures that are associated with several diseases, including those of genitourinary tract. Urine contains EVs derived from urinary tract cells. Owing to its non-invasive collection, urine represents a promising source of biomarkers for genitourinary disorders, including cancer. The most used method for urinary EVs separation is differential ultracentrifugation (UC), but current protocols lead to a significant loss of EVs hampering its efficiency. Moreover, UC protocols are labor-intensive, further limiting clinical application. Herein, we sought to optimize an UC protocol, reducing the time spent and improving small EVs (SEVs) yield. By testing different ultracentrifugation times at 200,000g to pellet SEVs, we found that 48 min and 60 min enabled increased SEVs recovery compared to 25 min. A step for pelleting large EVs (LEVs) was also evaluated and compared with filtering of the urine supernatant. We found that urine supernatant filtering resulted in a 1.7-fold increase on SEVs recovery, whereas washing steps resulted in a 0.5 fold-decrease on SEVs yield. Globally, the optimized UC protocol was shown to be more time efficient, recovering higher numbers of SEVs than Exoquick-TC (EXO). Furthermore, the optimized UC protocol preserved RNA quality and quantity, while reducing SEVs separation time.

Abstract Background Decentralization of a health system is a complex and multidimensional phenomenon that demands thorough investigation of its process logistics, predisposing factors and implementation mechanisms, within the broader socio-political environment of each nation. Despite its wide adoption across both high-income countries (HICs) and low-and-middle-income countries (LMICs), empirical evidence of whether decentralization actually translates into improved health system performance remains inconclusive and controversial. This paper aims to provide a comprehensive description of the decentralization processes in three countries at different stages of their decentralization strategies – Pakistan, Brazil and Portugal. Main body This study employed a systematic analysis of peer-reviewed academic journals, official government reports, policy documents and publications from international organizations related to health system decentralization. A comprehensive search was conducted using reputable databases such as PubMed, Google Scholar, the WHO repository and other relevant databases, covering the period up to the knowledge cutoff date in June 2023. Information was systematically extracted and organized into the determinants, process mechanics and challenges encountered during the planning, implementation and post-decentralization phases. Although decentralization reforms have achieved some success, challenges persist in their implementation. Comparing all three countries, it was evident that all three have prioritized health in their decentralization reforms and aimed to enhance local decision-making power. Brazil has made significant progress in implementing decentralization reforms, while Portugal and Pakistan are still in the process. Pakistan has faced significant implementation challenges, including capacity-building, resource allocation, resistance to change and inequity in access to care. Brazil and Portugal have also faced challenges, but to a lesser extent. The extent, progress and challenges in the decentralization processes vary among the three countries, each requiring ongoing evaluation and improvement to achieve the desired outcomes. Conclusion Notable differences exist in the extent of decentralization, the challenges faced during implementation and inequality in access to care between the three countries. It is important for Portugal, Brazil and Pakistan to address these through reinforcing implementation strategies, tackling inequalities in access to care and enhancing monitoring and evaluation mechanism. Additionally, fostering knowledge sharing among these different countries will be instrumental in facilitating mutual learning.

The goal of this study was to examine the relation between real-world socio-emotional measures and neural activation to parental criticism, a salient form of social threat for adolescents. This work could help us understand why heightened neural reactivity to social threat consistently emerges as a risk factor for internalizing psychopathology in youth. We predicted that youth with higher reactivity to parental criticism (vs neutral comments) in the subgenual anterior cingulate cortex (sgACC), amygdala and anterior insula would experience (i) less happiness in daily positive interpersonal situations and (ii) more sadness and anger in daily negative interpersonal situations. Participants (44 youth aged 11-16 years with a history of anxiety) completed a 10-day ecological momentary assessment protocol and a neuroimaging task in which they listened to audio clips of their parents' criticism and neutral comments. Mixed-effects models tested associations between neural activation to critical (vs neutral) feedback and emotions in interpersonal situations. Youth who exhibited higher activation in the sgACC to parental criticism reported less happiness during daily positive interpersonal situations. No significant neural predictors of negative emotions (e.g. sadness and anger) emerged. These findings provide evidence of real-world correlates of neural reactivity to social threat that may have important clinical implications.

BACKGROUND: The COVID 19 pandemic adversely impacted delivery of preventive, routine, urgent, and essential care worldwide. Dialysis access care was particularly affected due to the lack of specific guidelines regarding procedures for its creation and maintenance. Early guidance by Centers for Medicare and Medicaid was inadvertently interpreted as guidance to stop dialysis access procedures. Prompt action by professional societies was needed to furnish detailed guidance to establish essential nature of these procedures. METHODS: The American Society of Diagnostic and Interventional Nephrology (ASDIN) issued a joint statement with Vascular Access Society of the Americas (VASA) - Maintaining Lifelines for ESKD Patients to clearly establish the role of vascular access as a lifeline for ESKD (End Stage Kidney Disease) patients and the importance and urgency of its timely management. ASDIN also conducted a survey in mid-2020, that was administered to the ASDIN database as well as shared with the general public via the organizations social media platforms. The respondents reported their experiences in the care of dialysis access, practice patterns and the utility of the ASDIN-VASA statement during the COVID 19 pandemic. RESULTS: Of the 2030 individual surveys sent, 581 were opened and 53 (9.1%) responses were received from different parts of the country and from different practice settings. ASDIN COVID 19 triage document was frequently utilized and 83% of respondents found the document valuable. The survey also revealed multiple obstacles, including logistical and financial issues that led to significant disruption of services. CONCLUSIONS: The care of dialysis access was significantly affected in the United States during the COVID 19 pandemic due to multiple reasons. ASDIN actions provided valuable specific guidance regarding and explored barriers to dialysis access care. We describe those results and discuss strategies to prevent COVID 19 transmission with innovative strategies of providing access care. Individualized decision making is of essence when considering dialysis access procedures.

ObjectiveThis study aimed to determine the post-matriculation perceptions of interns and faculty who participated in the 2020-2021 virtual interview process and how their expectations of the program and the applicants, respectively, aligned with reality.Design, setting, and participantsPublished surveys on virtual interviewing were reviewed and modified to design two surveys, for interns and for faculty who interviewed. Interns and faculty members from the Departments of Surgery and Medicine at one institution who participated in the 2020-2021 virtual interview process completed the surveys four to six months after the start of the academic year. Following survey completion, surgical interns from the same application cycle participated in one in-person focus group nine months after the start of the academic year to clarify points raised in the surveys.ResultsForty-six interns and faculty members responded to the survey (subgroup response rates ranging from 13-30%) and ten interns participated in the focus group (participation rate 100%). Most faculty and intern participants found that expectations formed during virtual interviews were accurate. However, our respondents noted limitations to virtual interviews that reduced their usefulness, including challenges with unnatural social interactions, understanding city fit, and getting a sense of resident and program culture. Participants provided possible solutions to address these challenges.ConclusionsOverall, this mixed-methods study at a single institution found that perceptions from virtual interviews were generally accurate but with some limitations. We describe several opportunities to improve the virtual interview process and optimize the application experience.