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PURPOSE To determine the effects of stratified primary care for low back pain (SPLIT program) in decreasing back-related disability for patients with low back pain (LBP) in primary care. METHODS We conducted a before-and-after study. We compared health-related outcomes for 2 sequential, independent cohorts of patients with LBP recruited at 7 primary care units in Portugal. The first prospective cohort study characterized usual care (UC) and collected data from February to September 2018. The second was performed when the SPLIT program was implemented and collected data from November 2018 to October 2021. Between cohorts, physical therapists were trained in the implementation of the SPLIT program, which used the STarT Back Screening Tool to categorize patients for matched treatment. We compared back-related disability (Roland-Morris Disability Questionnaire, 0-24 points), pain (Numeric Pain Rating Scale, 0-10 points), perceived effect of treatment (Global Perceived Effect Scale, -5 to +5 points), and health-related quality of life (EuroQoL 5 dimensions 3 levels index, 0-1 points). RESULTS We enrolled a total of 447 patients: 115 in the UC cohort (mostly treated with pharmacologic treatment) and 332 in the SPLIT cohort (all referred for a physical therapy intervention program). Over the study period of 6 months, patients in the SPLIT program showed significantly greater improvements in back-related disability ([beta], -2.94; 95% CI, -3.63 to -2.24; P[less than or equal to].001), pain ([beta], -0.88; 95% CI, -1.18 to -0.57; P[less than or equal to].001), perceived effect of treatment ([beta], 1.40; 95% CI, 0.97 to 1.82; P[less than or equal to].001), and health-related quality of life ([beta], 0.11; 95% CI, 0.08 to 0.14; P[less than or equal to].001) compared with UC. CONCLUSIONS Patients in the SPLIT program for LBP showed greater benefits regarding health-related outcomes than those receiving UC. https://doi.org/10.1370/afm.3104, INTRODUCTION Low back pain (LBP) is a high-burden health problem worldwide, and its management represents a serious challenge for health systems. (1-4) The burden caused by LBP is mainly explained [...]

A edição especial n.º 50 da Revista Dialogia tem como foco temático EDUCAÇÃO STEAM: FORMAÇÃO, PERCEPÇÕES E PRÁTICAS SOB OLHARES DE BRASIL E PORTUGAL, e reúne artigos resultantes de pesquisas e experiências realizadas sob a abordagem STEAM, que integra as áreas de Ciências, Tecnologia, Engenharia, Artes e Matemática. Essa abordagem tem se tornado cada vez mais relevante no contexto educacional contemporâneo, especialmente na Educação Básica, estendendo-se também ao Ensino Superior, uma vez que busca desenvolver nos estudantes não apenas habilidades, mas também competências criativas e críticas, essenciais para enfrentar os desafios do século XXI. Ao integrar essas áreas do conhecimento, a educação STEAM promove uma aprendizagem mais holística, conectando o conhecimento teórico e prático de forma interdisciplinar. Nesse sentido, cada uma das áreas que compõem o STEAM oferece contribuições valiosas para a formação dos estudantes. A Ciência estimula o pensamento lógico e a curiosidade ao buscar explicações e compreender o mundo natural. A Tecnologia prepara os estudantes para lidar com as ferramentas e inovações que dominam a sociedade atual, além de promover o desenvolvimento de habilidades de resolução de problemas e inovação. A Engenharia oferece uma abordagem prática para solucionar questões complexas, incentivando os estudantes a aplicar o conhecimento científico na criação de soluções viáveis. A Matemática, por sua vez, proporciona uma base sólida para a análise e interpretação de dados, sendo fundamental para a tomada de decisões informadas em diversas áreas. Por fim, as Artes desempenham um papel crucial ao incentivar a criatividade, a expressão pessoal e a capacidade de pensar fora da caixa. Além disso, ao incluir as Artes no currículo, a educação STEAM contribui para a formação de cidadãos mais empáticos, éticos e conscientes, capazes de usar sua criatividade para melhorar o mundo ao seu redor. Ao integrar essas áreas, a educação STEAM promove uma aprendizagem mais global, estimulando os estudantes a desenvolver habilidades cognitivas, socioemocionais e atitudes essenciais para o sucesso acadêmico e profissional, equipando-os para lidar com as rápidas mudanças tecnológicas e sociais. Em um mundo onde a inovação é constante e as profissões estão em transformação, os estudantes precisam estar preparados para se adaptar e colaborar de forma multidisciplinar. O modelo STEAM fomenta a interdisciplinaridade, incentivando a resolução de problemas complexos por meio de abordagens criativas e colaborativas. Vale ainda destacar que a educação STEAM é fundamental para promover a inclusão e a equidade no ensino, permitindo que todos os estudantes, independentemente de sua origem ou condições sociais, tenham acesso a um currículo que favoreça o desenvolvimento de habilidades essenciais para a vida moderna, como o pensamento crítico. Quando desafiados a trabalhar em projetos que envolvem múltiplas disciplinas, os estudantes precisam analisar problemas sob diversas perspectivas, pensar de forma independente e tomar decisões baseadas em evidências e dados, fortalecendo, assim, sua capacidade de resolução de problemas — uma habilidade crucial não apenas para a vida acadêmica, mas também para a carreira profissional e o cotidiano. A transição de um modelo tradicional para uma abordagem STEAM, no entanto, enfrenta desafios significativos. Muitos professores ainda estão inseridos em sistemas educacionais que priorizam a especialização disciplinar e os métodos de ensino convencionais. Essa mudança exige um esforço coletivo para a reformulação do currículo, das práticas pedagógicas e da formação docente. É necessário que as políticas educacionais incentivem a integração entre as áreas do conhecimento e ofereçam apoio concreto para que os professores desenvolvam as competências necessárias à abordagem STEAM. Isso pode ser realizado por meio de programas de capacitação, oficinas, workshops e espaços de troca de experiências entre educadores de diferentes áreas. Diante desse cenário, o número especial da Dialogia foi idealizado a partir do evento TRILHAS FORMATIVAS: A FORMAÇÃO DE PROFESSORES EM TEMPOS DE EDUCAÇÃO STEAM[1], realizado em 10 de abril de 2024, fruto da parceria entre o GRUPETEC (Grupo de Pesquisa em Educação, Tecnologias e Cultura Digital), vinculado ao CNPq e à Universidade Nove de Julho (São Paulo/Brasil), e a Universidade Aberta de Portugal (UAb-PT) — Unidade de Missão dos Centros Locais de Aprendizagem de Coruche e de Montijo. Esse evento contou com participantes de Portugal, Angola, Moçambique e Brasil. Como palestrantes, houve a colaboração de três pesquisadoras da UAb-PT e de cinco pesquisadores brasileiros, cujas apresentações abordaram temáticas relacionadas à Educação STEAM e alguns de seus desdobramentos, como: Universidade, Escola e Pesquisa; Internacionalização Pedagógica; Educação STEAM: Princípios e Práticas; Panorama sobre a Formação de Professores em Tempos de Educação STEAM no Brasil; Formação de Professores e os Projetos STEAM com uso de Tecnologias em Portugal; Robótica Educacional; Pensamento Computacional e Inovação; Criatividade e Empreendedorismo na Formação Acadêmica com ABP e STEAM. Essas temáticas permitiram uma discussão sobre as potencialidades da educação STEAM e sobre como trilhas formativas podem ser estruturadas para preparar os professores para esse contexto, promovendo uma prática educativa mais conectada e inovadora. Após o evento, os palestrantes foram convidados a contribuir para a construção desta edição especial n.º 50 da Dialogia. Como resultado desse convite, obtivemos os seguintes artigos: Trilhas formativas: mobilizando conhecimentos e interações docentes além Brasil/Portugal, de Adriana Aparecida de Lima Terçariol, Fernanda Pereira da Silva, João Barnabé e Lara Caeiro; Educação STEAM: conceito, breve histórico, diretrizes e prática, de Stephani Vilela Ferreira Custodio e Thais de Almeida Rosa; ePortfólios como recursos de carreira – programa online com estudantes do ensino superior, de Susana Henriques, Maria de Fátima Goulão e Daniela Barros; · Robótica educacional, avanços e desafios para o ensino médio integrado ao técnico, de Romeu Afecto, Andressa Algayer da Silva Moretti e Lucimara de Sousa Teixeira; · Educação STEAM e a formação inicial de Professores: perspectivas e desafios para escolas brasileiras, de Ronaldo Lasakoswitsck; · Criatividade, inovação e empreendedorismo na formação acadêmica com aprendizagem baseada em projetos integrada ao STEAM, de Lilian Amatucci Gazoti e Dalva Célia Henriques Rocha Guazzelli. Os demais textos, relacionados abaixo, foram elaborados por convidados externos, devido aos seus temas de estudo estarem alinhados à temática geral proposta para o evento e para esta edição especial. O radioamadorismo como ferramenta inovadora na Educação STEM: uma revisão bibliográfica, de Moisés Figueiredo da Silva, Luciano Henrique Trindade e Antonio Pires Barbosa; Uma nova abordagem usando simulação de modelos físicos com realidade aumentada para o ensino em engenharia elétrica: um estudo de caso usando eletromagnetismo, de Natan Menegasse e Cleber Dias; Contribuição de oficinas sobre metodologias ativas para o desenvolvimento profissional de professores em uma rede municipal catarinense, de Valdir Lamim-Guedes; Os impactos do CO2 em plantas: cultivando a consciência ambiental em estudantes por meio de uma atividade investigativa, de Daniel Bastos Souza Filho e Fabrício Bonfim Sudério; A cultura e metodologia maker na formação de professores: uma proposta criativa, interdisciplinar, inovadora, sustentável e inclusiva, de Katia Valeria Pereira Gonzaga, Vania Gabriela Dias Graça e Paula Quadros-Flores. É com imensa alegria que apresentamos a vocês, queridos leitores, a edição mais recente da Revista Dialogia. Nosso desejo é que esta publicação contribua para o avanço da inovação e do conhecimento em Educação, fortalecendo as redes de formação e expandindo as oportunidades de internacionalização entre pesquisadores, educadores e todos os interessados nos temas aqui tratados. Por fim, agradecemos ao interesse e à contribuição de cada autor (a)! Acreditamos que os artigos compartilhados poderão inspirar novas pesquisas e experiências articuladas à Educação STEAM em territórios luso-brasileiros. Excelente leitura! [1] Esse evento constitui-se como uma das ações previstas para oportunizar a formação continuada de professores nos seguintes projetos de pesquisa: (1) “A Robótica Criativa e Sustentável no Desenvolvimento de uma Educação Profissional e Tecnológica Integrada ao Ensino Médio: Potencializando Projetos em uma Abordagem STEAM”, em desenvolvimento desde fevereiro de 2023, com o apoio da Chamada do Programa de Pesquisa em Educação Básica – PROEDUCA – FAPESP/SEDUC e Universidade Nove de Julho (UNINOVE/SP/BRASIL); (2) "Educação STEAM: Uma Construção Colaborativa com a Robótica Educacional Sustentável", em curso desde março de 2023, com apoio do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), conforme a Chamada CNPq Nº 09/2022 - Produtividade em Pesquisa, em parceria com a Universidade Nove de Julho (Uninove/SP/BRASIL).

Este artigo delineia as experiências formativas resultantes de projetos desenvolvidos pelo Grupo de Pesquisa em Educação, Tecnologias e Cultura Digital (GRUPETeC – CNPq/UNINOVE), incluindo projetos em andamento. É apresentado de forma concisa, as experiências com cada evento organizado pelo GRUPETeC, incluindo aqueles concebidos com a parceria da Universidade Aberta de Portugal (UAb-PT), com o objetivo de destacar contribuições desses processos para a formação continuada de professores, bem como para a ampliação e fortalecimento de parcerias internacionais para o desenvolvimento de projetos de investigação que visam a formação continuada de professores em temáticas que versam sobre tecnologias digitais, robótica, pensamento computacional e abordagem STEAM (Ciência, Tecnologia, Engenharia, Artes e Matemática) com foco em aprimorar práticas pedagógicas. O estudo evidencia a colaboração entre Brasil e Portugal, destacando o uso de recursos digitais e metodologias inovadoras. A discussão dos resultados demonstra participantes satisfeitos com as Trilhas Formativas, apontando, no entanto, desafios como a necessidade de mais apoio e estrutura para colocar o que foi abordado em prática em suas instituições de vínculo profissional.

“Despertando sensaciones” ofrece un conjunto de propuestas que, partiendo de la estimulación sensorial de diversos sentidos, activa procesos cognitivos de reconocimiento, memoria y percepción que trascienden el mero sentido de la vista como receptor y generador de información. El objetivo es que las futuras maestras y futuros maestros de infantil aprendan a trabajar con los diferentes sentidos, ampliando así su formación de manera integral para aprovechar las posibilidades perceptivas y expresivas que los niños y niñas les ofrecen según su edad. Este tipo de experiencias contribuye a romper estereotipos y perjuicios relacionados con la forma, el aspecto y el color de las cosas, así como con la percepción que los estudiantes tienen de su propio desempeño y habilidades artísticas.

In his lectures on the philosophy of nature, Maurice Merleau-Ponty interprets Jakob von Uexküll’s notion of Umwelt as akin to a melody. This essay outlines von Uexküll’s perspective on the feasibility of translating non-acoustic elements (optical: colours, shapes, and figures; haptic: tactile textures, flavours, tastes, and scents) into sounds or musical notes to compose a melody. It poses several inquiries: Does the link between melody and nature render natural entities as musical notes? Do the components of an entity constitute anatomical notes in the melody that defines the entity itself? Is it conceivable to distil every moment in life into a “note” symbol on a musical scale, characterised by specific duration, pitch, and volume? Melody, rhythm, and harmony are considered sophisticated “structures” that articulate and convey the essence of nature’s existence. Moreover, every human, every living creature, be it animal or plant, possesses a subjective “biological” interiority. The inner realm of each living subject, along with the objects in the external world, are enveloped within an atmosphere—a musical Umwelt. Humans exist within this musical milieu or atmosphere.

Background: Reduced abdominal perfusion pressure (APP) is an underdiagnosed potential pathophysiological mechanism for acute kidney injury (AKI) in the patient with liver cirrhosis and ascites. This study aimed to analyze the prevalence of abdominal hypoperfusion (AhP) (APP

Abstract Background Low back pain (LBP) is a common health condition and the leading cause of years lived with disability worldwide. Most LBP episodes have a favourable prognosis, but recurrences within a year are common. Despite the individual and societal impact related to LBP recurrences, there is limited evidence on effective strategies for secondary prevention of LBP and successful implementation of intervention programmes in a real-world context. The aim of this study is to analyse the effectiveness of a tailored exercise and behavioural change programme (MyBack programme) in the secondary prevention of LBP; and evaluate acceptability, feasibility and determinants of implementation by the different stakeholders, as well as the implementation strategy of the MyBack programme in real context. Methods This protocol describes a hybrid type I, randomized controlled trial to evaluate the effectiveness and implementation of MyBack programme in the context of primary health care. The Behaviour Change Wheel framework and FITT-VP principles will inform the development of the behaviour change and exercise component of MyBack programme, respectively. Patients who have recently recovered from an episode of non-specific LBP will be randomly assigned to MyBack and usual care group or usual care group. The primary outcome will be the risk of LBP recurrence. The secondary outcomes will include disability, pain intensity, musculoskeletal health, and health-related quality of life. Participants will be followed monthly for 1 year. Costs data related to health care use and the MyBack programme will be also collected. Implementation outcomes will be assessed in parallel with the effectiveness study using qualitative methods (focus groups with participants and health providers) and quantitative data (study enrolment and participation data; participants adherence). Discussion To our knowledge, this is the first study assessing the effectiveness and implementation of a tailored exercise and behaviour change programme for prevention of LBP recurrences. Despite challenges related to hybrid design, it is expected that data on the effectiveness, cost-effectiveness, and implementation of the MyBack programme may contribute to improve health care in patients at risk of LBP recurrences, contributing to direct and indirect costs reduction for patients and the health system. Trial registration number NCT05841732.

Our study was to characterize sarcopenia in C57BL/6J mice using a clinically relevant definition to investigate the underlying molecular mechanisms. Aged male (23-32 months old) and female (27-28 months old) C57BL/6J mice were classified as non-, probable-, or sarcopenic based on assessments of grip strength, muscle mass, and treadmill running time, using 2 SDs below the mean of their young counterparts as cutoff points. A 9%-22% prevalence of sarcopenia was identified in 23-26 month-old male mice, with more severe age-related declines in muscle function than mass. Females aged 27-28 months showed fewer sarcopenic but more probable cases compared with the males. As sarcopenia progressed, a decrease in muscle contractility and a trend toward lower type IIB fiber size were observed in males. Mitochondrial biogenesis, oxidative capacity, and AMPK-autophagy signaling decreased as sarcopenia progressed in males, with pathways linked to mitochondrial metabolism positively correlated with muscle mass. No age- or sarcopenia-related changes were observed in mitochondrial biogenesis, OXPHOS complexes, AMPK signaling, mitophagy, or atrogenes in females. Our results highlight the different trajectories of age-related declines in muscle mass and function, providing insights into sex-dependent molecular changes associated with sarcopenia progression, which may inform the future development of novel therapeutic interventions., Introduction Sarcopenia, the loss of muscle mass and function due to aging, affects 25%-45% of older adults in the United States (1) and is associated with increased incidence of falls [...]

Human cytomegalovirus (CMV) infection is the most prevalent infection affecting organ transplant recipients, and it is a cause of morbidity and mortality in patients undergoing kidney transplantation. The introduction of ganciclovir (GCV) for both prophylaxis and treatment has vastly improved patient outcomes. GCV resistance can be caused by mutations in the UL97 phosphotransferase gene or the UL54 polymerase gene. It occurs in 1 to 2% of kidney transplant recipients with CMV infection or disease. Antiviral resistance should be considered when increased viral loads and disease progression are observed despite the administration of adequate antiviral therapy. The degree of resistance varies depending on the type of mutation present. We report a patient with resistance to GCV due to a UL97 del597-599 mutation who, despite typically requiring an 8-fold increase in GCV dose, showed a significant decrease in viral load with just a double dose increase. However, the patient’s overall clinical course remained complicated. Due to severe leukopenia, maribavir had to be started, with a good response. Nevertheless, he ultimately died due to indirect CMV-related complications. This case also highlights the complexity of transplant patients, who present multiple challenges ranging from infections to therapy management.

Resumen: Introducción y objetivos: En cirugía protésica de rodilla y cadera está claro que aún no se ha desarrollado una técnica de cierre estandarizada óptima. A nivel local no existen datos que describan la práctica quirúrgica habitual en cierre de herida. El objetivo de este trabajo es analizar el cierre de herida en cirugía protésica a través de una encuesta sobre una muestra representativa a nivel nacional y así obtener información sobre el contexto del cierre en España. Material y método: Se conforma un grupo ad hoc de especialistas en cirugía protésica. El grupo de expertos, posterior al análisis de la literatura, elabora un cuestionario de 32 preguntas cerradas de opción múltiple, divididas en los siguientes bloques: hemostasia, cierre quirúrgico de la herida y apósitos. Resultados: Un total de 471 cirujanos respondieron la encuesta de forma completa y con información suficiente para efectuar el análisis descriptivo; 79% cree que el ácido tranexámico (ATX) puede influir en la disminución de tasa de infección de sitio quirúrgico; 96% cree que el tipo de cierre profundo a nivel de la artrotomía podría influir en los resultados y complicaciones tras prótesis de cadera y/o rodilla; 85% cree que el tipo de cierre superficial a nivel subcutáneo puede influir en los resultados y complicaciones tras prótesis de cadera y/o rodilla; 64% de los cirujanos utiliza la terapia de presión negativa incisional de simple uso para el tratamiento de las complicaciones de la herida quirúrgica (seromas, drenaje prolongado, dehiscencias). Conclusiones: Existe en nuestro entorno una alta variabilidad en el cierre de la herida y una baja inversión en formación sobre este tema. Los autores recomiendan a las diferentes sociedades científicas la inversión de recursos para mejorar la formación en dicho campo y reducir el porcentaje de cirujanos que se consideran inadecuadamente formados, así como adaptar las técnicas de cierre a aquellas consideradas patrón oro según la evidencia. Abstract: Background and objective: In orthopedic surgery, it is clear that an optimal standardized closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyze the clinical practice of surgical wound closure in orthopedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. Method: an ad hoc group of specialists in orthopedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. Results: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). Conclusions: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.

Self-Regulated Learning addresses key students’ competences for performance in higher education, particularly in engineering disciplines. Assessing these competences helps identify students’ gaps and provide appropriate support towards their development. Currently, the main self-regulated learning assessment tools are questionnaires with a large number of items administered in one session, for example, the MSLQ has 81 questionnaire items. Rather than snapshotting the students’ self-regulated learning competences in a single session, this manuscript proposes a novel assessment approach, the SMSRLQ, which includes 150 questionnaire items (81 from the MSLQ and 69 from other questionnaires) but spacing the items weekly and providing feedback monthly. The spaced approach was experienced on several Egyptian universities using a social network service (Facebook) and distributing students into control (113) and experimental groups (107). Many variations in the students’ answers are observed, with statistically significant differences between 11% to 30% in MAE and MAPE indicators. Variations in standard deviation, reliability and clustering between the approaches also were identified, demonstrating that there are clear differences between the two administration approaches. Regarding monthly feedback, the results show that it enhances students’ participation and improves their self-regulated learning competences: 77% of the experimental group respondents found that their self-learning knowledge was developed after the study, compared to 50% of the control group respondents.

Abstract Background Recurrences of low back pain (LBP) are frequent and associated with high levels of disability and medical costs. Regular exercise practice may be an effective strategy to prevent recurrences of LBP, however, the promotion of this behaviour by physiotherapists seems to be challenging. This study aims to explore physiotherapists’ perceived barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice by patients at risk of recurrence of low back pain. Methods Two focus groups with primary healthcare physiotherapists were conducted, based on a semi-structured interview schedule informed by the Behaviour Change Wheel, including the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). All focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis, using a coding matrix based on the COM-B and TDF, was performed by two independent researchers. A third researcher was approached to settle disagreements. Results In total, 14 physiotherapists participated in the focus groups. The analysis revealed a total of 13 barriers (4 COM-B components and 7 TDF domains) and 23 facilitators (5 COM-B and 13 TDF) to physiotherapists’ implementation of a behaviour change-informed exercise intervention. The most common barriers were the lack of skills and confidence to implement the proposed intervention. These were explained by the fact that it differs from the usual practice of most participants and requires the learning of new skills applied to their contexts. However, for those who had already implemented other similar interventions or whose rationale is aligned with the new intervention, there seemed to exist more positive determinants, such as potential benefits for physiotherapists and the profession, improvement of quality of care and willingness to change clinical practice. For others who did not previously succeed in implementing these types of interventions, more context-related barriers were mentioned, such as lack of time to implement the intervention, schedule incompatibilities and lack of material and human resources. Conclusions This study identified modifiable barriers and facilitators to physiotherapists’ implementation of a behaviour change-informed exercise intervention for patients at risk of recurrence of LBP in primary healthcare. The findings of this study will allow the systematic and theory-based development of a behaviour change-informed training programme, aimed at physiotherapists and supporting the successful implementation of the exercise intervention.

Sustainable natural resource management is a high priority in the 21st century as it plays a crucial role in mitigating climate change and preventing some of its consequences like loss of biodiversity, land degradation, desertification, and the exhaustion of natural resources. This concern is reflected in the United Nations Sustainable Development Goals (SDGs), which emphasize, among other factors, sustainable cities and communities, responsible production and consumption, and climate action. Achieving sustainable natural resource management begins with raising awareness and educating the next generation. Therefore, it is essential to develop educational initiatives that prepare young people to become responsible and proactive adults in promoting environmental sustainability across industries and communities. Additionally, these initiatives should develop critical and analytical thinking skills, nurture innovative mindsets for creating environmentally sound solutions, and enhance the ability to collaborate within multidisciplinary teams. The NATURE project addressed these needs by designing and developing a serious educational game that fosters this set of skills. The results of the pilot testing show that the game is an effective tool and contributes to the education and awareness of the younger generation.

En las Metodologías Artísticas de Enseñanza (MAE) o Métodos Artísticos Educadores (MAES) encontramos un contexto idóneo para involucrar al alumnado de magisterio en métodos que articulan la contemporaneidad del arte y la educación, como son las instalaciones. Estas metodologías, arraigadas en el ámbito artístico, promueven la enseñanza y el aprendizaje a través de la creación y desarrollo de diversos proyectos artístico-educadores. El presente estudio se inscribe dentro de un Proyecto de Innovación Docente implementado en los Grados de Magisterio de Infantil y Primaria. Su propósito es explorar el impacto de los MAES en los estudiantes de magisterio mediante la creación de instalaciones. Se realiza un análisis detallado que abarca el tipo de instalaciones, las experiencias generadas, los aprendizajes adquiridos y las dificultades enfrentadas. Los resultados nos permiten concluir que el alumnado comprende el valor y las posibilidades de trabajar con instalaciones artísticas en su futura labor docente. Al mismo tiempo son conscientes de los obstáculos que pueden encontrarse, tanto en la concepción como en la realización de este tipo de propuestas.

This paper explores the intricate relationship between our personal experiences of space and the autobiographical nature of our geography. Our geographical awareness is profoundly shaped by the places we have been, encompassing a rich tapestry of places such as childhood homes, educational institutions, vacation spots, and bustling city streets. These spaces become imbued with personal memories and significance, forming the backdrop of our individual narratives. While these experiences are inherently personal and unique, they are also shared in a broader sense. This duality of personal fand communal experience adds layers of complexity to our understanding of space. Furthermore, our experiences of space are deeply intertwined with the passage of time.

Chronic heart failure (HF) is the 21st-century cardiovascular epidemic, marked by recurrent hospitalizations and high mortality rates, and represents a considerable burden on Western societies. The complex care demands of HF patients require multidisciplinary approaches, aligning with contemporary guidelines. Accordingly, the Excellence in Heart Failure Program, implemented in Portuguese tertiary hospitals, aims to establish multidisciplinary HF outpatient clinics in Portugal, improving patients’ clinical outcomes. Herein, the results of its pilot project are presented, showing that the implementation of the multidisciplinary clinic resulted in a minimal number of hospitalizations and emergency visits, with only one rehospitalization reported. In addition, patients in the Program experienced significant improvements in ejection fraction (EF) and NT-proBNP levels. Despite the limited power of the sample, these findings underscore the effectiveness of the Program in the management of Portuguese HF patients, particularly in the early discharge period after heart failure, when patients are most vulnerable.

Although several lines of evidence from different studies highlight sex differences in cardiovascular diseases, to date, most studies have been focused on males, with the idea that males and females are similar, differing only in the magnitude of the response. However, the principles learned in male models cannot and should not be extrapolated to women and, therefore, it is important to study in greater detail not only the differences between the sexes but also the physiological intertwining of the underlying genetic and hormonal mechanisms of sexual dimorphism. This review explores the sex disparities in the autonomic nervous system regulation of blood pressure (particularly baroreceptor function), with special emphasis on sex hormones and sex chromosome complement factors involved in sexually dimorphic autonomic blood pressure regulation. A more detailed understanding of the sources of physiological disparities between the sexes may also help in understanding the differences between the sexes in rates of cardiovascular disease and may also aid in designing future improvements for sex-tailored therapeutic treatments.

Abstract Background Asymptomatic infection is the most common outcome of exposure to Leishmania parasites. In the Mediterranean region, where Leishmania infantum is endemic, studies on the prevalence of asymptomatic infection have often relied on serological testing in blood donors. In Spain, regional studies have shown seroprevalence in blood donors between 1 and 8%; in Portugal, values of 0 and 2% were suggested by two localized studies, in different populations. The purpose of this study was (i) to estimate the prevalence of asymptomatic Leishmania infection in blood donors in mainland Portugal, and (ii) to study the association between the detection of antibodies to Leishmania and sociodemographic factors, and also the knowledge, perceptions and practices (KPP) of the blood donors regarding leishmaniasis. Methods A cross-sectional study targeted the population of people who donated blood in mainland Portugal. Participants, distributed proportionally by municipality and aged between 18 and 65 years, were selected randomly in 347 blood collection points between February and June 2022, and completed a sociodemographic and a KPP questionnaire. Detection of anti-Leishmania antibodies in serum was performed using an ELISA commercial kit. Individual KPP scores were calculated by adding grades defined for each question. Results Globally, 201/3763 samples were positive. The estimated national true seroprevalence was 4.8% (95% CI 4.1–5.5%). The proportion of positive results was significantly different between NUTS (Nomenclature of Territorial Units for Statistics) regions. Models suggested that seropositivity was significantly higher in male sex, people older than 25 years, or residing in the Centro NUTS2 region, but not in dog owners nor people with lower KPP scores. Overall, 72.3% of participants had previously heard of leishmaniasis and, in multivariate analysis, a higher Knowledge score was associated with age 25–40 years, female sex, ownership of dogs, and higher education. Conclusions Global estimated true seroprevalence (4.8%) was similar to previous regional studies in blood donors in neighboring Spain. Higher seroprevalence values in the NUTS2 Centro region were consistent with incidence data from humans and seroprevalence studies in dogs. On the other hand, the low values in the Alentejo and the high values in the northern subregions may be the result of geographical shifts in parasite circulation due to climate change and should prompt localized and integrated, vector, canine, and human research, following a One Health approach. Graphical Abstract

The estimation of the extreme value index (EVI) is a crucial task in the field of statistics of extremes, as it provides valuable insights into the tail behavior of a distribution. For models with a Pareto-type tail, the Hill estimator is a popular choice. However, this estimator is susceptible to bias, which can lead to inaccurate estimations of the EVI, impacting the reliability of risk assessments and decision-making processes. This paper introduces a novel reduced-bias generalized Hill estimator, which aims to enhance the accuracy of EVI estimation by mitigating the bias.

Background: Human papillomavirus (HPV), a leading cause of cervical cancer, is present in most cases of the disease and ranks as the fourth most common cancer in women globally. Among the HPV types, fourteen (HPV 16/18/31/33/35/39/45/51/52/56/58/59/66/68) are recognized as high-risk (hrHPV), each with varying levels of oncogenic potential. Detecting and genotyping these hrHPV types in cervical lesions is crucial, requiring the development of new diagnostic methods. Methods: This study focuses on a retrospective analysis conducted on 44 women from the Cova da Beira Local Health Unit. We used the Anyplex™ II hrHPV Detection kit for hrHPV genotyping from paraffin-embedded cervical tissue samples. Results: hrHPV types were identified in 38 out of the 44 women. Genotyping revealed HPV-16 (55.3%), HPV-18/39/56/58/59 (5.3%), HPV-31 (21.1%), HPV-35 (7.9%), HPV-51/66 (2.6%), and HPV-52 (10.5%). Conclusions: This study demonstrates that the Anyplex™ II hrHPV Detection kit, originally designed for cervical cancer screening, is also effective for hrHPV genotyping in histological analyses. This methodology offers a simpler and more cost-effective approach for cervical cancer risk stratification. Its implementation in clinical practice could enhance the detection of hrHPV in cervical lesions, thereby contributing to more precise diagnoses and potentially more informed treatment strategies.

Non-negative distributions are important tools in various fields. Given the importance of achieving a good fit, the literature offers hundreds of different models, from the very simple to the highly flexible. In this paper, we consider the power–Pareto model, which is defined by its quantile function. This distribution has three parameters, allowing the model to take different shapes, including symmetrical and left- and right-skewed. We provide different distributional characteristics and discuss parameter estimation. In addition to the already-known Maximum Likelihood and Least Squares of the logarithm of the order statistics estimation methods, we propose several additional methods. A simulation study and an application to two datasets are conducted to illustrate the performance of the estimation methods.

Macrhybopsis tetranema and Oncorhynchus gilae are fish species endemic to the Southwestern United States. We present the complete mitochondrial genomes for these species. Each genome consisted of 13 protein-coding genes, two ribosomal (rRNA) genes, 22 transfer RNA (tRNA) genes, and the control region (D-loop). Mitogenome lengths were 16,916 base pairs (bp) for M. tetranema, and 16,976 bp for O. gilae. The GC content was 41% for M. tetranema and 46% for O. gilae. The relationships of M. tetranema and O. gilae were consistent with previous phylogenetic analyses.

Background and objective: In orthopaedic surgery, it is clear that an optimal standardised closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyse the clinical practice of surgical wound closure in orthopaedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain. Material and Method: An ad hoc group of specialists in orthopaedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings. Results: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence). Conclusions: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence. Resumen: Introducción y objetivos: En cirugía protésica de rodilla (PTR) y cadera (PTC) está claro que aún no se ha desarrollado una técnica de cierre estandarizada óptima. A nivel local no existen datos que describan la práctica quirúrgica habitual en cierre de herida. El objetivo de este trabajo es analizar el cierre de herida en cirugía protésica a través de una encuesta sobre una muestra representativa a nivel nacional y así obtener información sobre el contexto del cierre en España. Material y método: El estudio se conforma de un grupo ad hoc de especialistas en cirugía protésica. El grupo de expertos, posterior al análisis de la literatura, elabora un cuestionario de 32 preguntas cerradas de opción múltiple, divididas en los siguientes bloques: hemostasia, cierre quirúrgico de la herida y apósitos. Resultados: Un total de 471 cirujanos respondieron la encuesta de forma completa y con información suficiente para efectuar el análisis descriptivo; de estos, 79% cree que el ácido tranexámico (ATX) puede influir en la disminución de tasa de infección de sitio quirúrgico; por otro lado, 96% piensa que el tipo de cierre profundo a nivel de la artrotomía podría influir en los resultados y complicaciones tras prótesis de cadera y/o rodilla; mientras, 85% considera que el tipo de cierre superficial a nivel subcutáneo es el que puede influir en los resultados y las complicaciones después de prótesis de cadera y/o rodilla; de los cirujanos, 64% utiliza la terapia de presión negativa incisional de simple uso para el tratamiento de las complicaciones de la herida quirúrgica (seromas, drenaje prolongado, dehiscencias). Conclusiones: Existe en nuestro entorno una alta variabilidad en el cierre de la herida y una baja inversión en formación sobre este tema. Los autores recomiendan a las diferentes sociedades científicas la inversión de recursos para mejorar la formación en dicho campo y reducir el porcentaje de cirujanos que se consideran inadecuadamente formados, así como adaptar las técnicas de cierre a aquellas estimadas patrón oro según la evidencia.

1. Tema dotado de forte complexidade e hibridez de tratamento pois nele se inserem vertentes filosóficas e pedagógicas díspares e se conjugam realidades oriundas de campos diferentes como a cultura, a língua, a nacionalidade – importa abordá-lo partindo da situação concreta de um aqui e agora, da verificação inicial de uma vivência comum, para, no seguimento, tentar estabelecer o horizonte teórico da questão. Será este, com efeito, o suposto que permitirá alcançar a convergência temática, senão a coerência interna, de diversos percursos, que veiculam um conjunto de teoremas, ou seja, de proposições que necessitam de ulterior demonstração, ou explicitação (ou, pelo menos, de viabilidade da sua mostração), com vista a sugerir os termos de uma reflexão possível.

Sempre nos pareceu pouco verossímil que a maior figura de pedagogo do iluminismo lusitano. Luis Antônio Verney. não tivesse alcançado repercussão notável no Brasil. No entanto, à medida que íamos conhecendo mais de perto esse quadro invulgar duma pujante florescência intelectual, o da cultura setecentista brasileira, verificamos a ausência generalizada, mesmo em estudos de mérito científico, duma pesquisa, ou até simples menção, de eventuais influências verneyanas.

A projeção em Portugal das diferentes fases da história do Lulismo espanhol vem, uma vez mais, confirmar essa lei da reciprocidade de influências e repercussão de sucessos entre culturas das duas nações.

Chagas’ is a neglected disease caused by the eukaryotic kinetoplastid parasite, Trypanosoma cruzi. Currently, approximately 8 million people are infected worldwide, most of whom are in the chronic phase of the disease, which involves cardiac, digestive, or neurologic manifestations. There is an urgent need for a vaccine because treatments are only effective in the initial phase of infection, which is generally underdiagnosed. The selection and combination of antigens, adjuvants, and delivery platforms for vaccine formulations should be designed to trigger mixed humoral and cellular immune responses, considering that T. cruzi has a complex life cycle with both intracellular and bloodstream circulating parasite stages in vertebrate hosts. Here, we report the effectiveness of vaccination with a T. cruzi-specific protein family (TcTASV), employing both recombinant proteins with aluminum hydroxide and a recombinant baculovirus displaying a TcTASV antigen at the capsid. Vaccination stimulated immunological responses by producing lytic antibodies and antigen-specific CD4+ and CD8+ IFNɣ secreting lymphocytes. More than 90% of vaccinated animals survived after lethal challenges with T. cruzi, whereas all control mice died before 30 days post-infection. Vaccination also induced a strong decrease in chronic tissue parasitism and generated immunological memory that allowed vaccinated and infected animals to control both the reactivation of the infection after immunosuppression and a second challenge with T. cruzi. Interestingly, inoculation with wild-type baculovirus partially protected the mice against T. cruzi. In brief, we demonstrated for the first time that the combination of the baculovirus platform and the TcTASV family provides effective protection against Trypanosoma cruzi, which is a promising vaccine for Chagas disease.

Introduction: The World Health Organization (WHO)'s Research and Development (R&D) Blueprint for Action to Prevent Epidemics, a plan of action, highlighted several infectious diseases as crucial targets for prevention. These infections were selected based on a thorough assessment of factors such as transmissibility, infectivity, severity, and evolutionary potential. In line with this blueprint, the VACCELERATE Site Network approached infectious disease experts to rank the diseases listed in the WHO R&D Blueprint according to their perceived risk of triggering a pandemic. VACCELERATE is an EU-funded collaborative European network of clinical trial sites, established to respond to emerging pandemics and enhance vaccine development capabilities. Methods: Between February and June 2023, a survey was conducted using an online form to collect data from members of the VACCELERATE Site Network and infectious disease experts worldwide. Participants were asked to rank various pathogens based on their perceived risk of causing a pandemic, including those listed in the WHO R&D Blueprint and additional pathogens. Results: A total of 187 responses were obtained from infectious disease experts representing 57 countries, with Germany, Spain, and Italy providing the highest number of replies. Influenza viruses received the highest rankings among the pathogens, with 79 % of participants including them in their top rankings. Disease X, SARS-CoV-2, SARS-CoV, and Ebola virus were also ranked highly. Hantavirus, Lassa virus, Nipah virus, and henipavirus were among the bottom-ranked pathogens in terms of pandemic potential. Conclusion: Influenza, SARS-CoV, SARS-CoV-2, and Ebola virus were found to be the most concerning pathogens with pandemic potential, characterised by transmissibility through respiratory droplets and a reported history of epidemic or pandemic outbreaks.

Abstract Background Ghrelin is a potential therapy for cachexia due to its orexigenic properties and anabolic effects on muscle and fat. However, its clinical use is limited by the short half‐life of active (acylated) ghrelin (~11 min in humans). EXT418 is a novel long‐acting, constitutively active ghrelin analog created by covalently linking it to a vitamin D derivative. Here, we evaluated the effects and mechanisms of action of EXT418 on Lewis lung carcinoma (LLC)‐induced cachexia in mice. Methods Male C57BL/6J mice (5‐ to 7‐month‐old) were implanted with 1 × 106 heat‐killed (HK) or live LLC cells. When the tumour was palpable, mice were injected with vehicle (T + V) or EXT418 daily (T + 418 Daily, 0.25 mg/kg/day) or every other day (T + 418 EOD, 0.5 mg/kg/EOD) for up to 14 days, whereas HK‐treated mice were given vehicle (HK + V). Subsets of T + 418 Daily or EOD‐treated mice were pair‐fed to the T + V group. Body composition and grip strength were evaluated before tumour implantation and at the end of the experiment. Molecular markers were probed in muscles upon termination. Results In tumour‐bearing mice, administration of EXT418 daily or EOD partially prevented weight loss (T + V vs. T + 418 Daily, P = 0.030; and vs. T + 418 EOD, P = 0.020). Similar effects were observed in whole body fat and lean body mass. Grip strength in tumour‐bearing mice was improved by EXT418 daily (P = 0.010) or EOD (P = 0.008) administration compared with vehicle‐treated mice. These effects of EXT418 on weight and grip strength were partially independent of food intake. EXT418 daily administration also improved type IIA (P = 0.015), IIB (P = 0.037) and IIX (P = 0.050) fibre cross‐sectional area (CSA) in tibialis anterior (TA) and EXT418 EOD improved CSA of IIB fibres in red gastrocnemius (GAS; P = 0.005). In skeletal muscles, tumour‐induced increases in atrogenes Fbxo32 and Trim63 were ameliorated by EXT418 treatments (TA and GAS/plantaris, PL), which were independent of food intake. EXT418 administration decreased expression of the mitophagy marker Bnip3 (GAS/PL; P ≤ 0.010). Similar effects of EXT418 EOD were observed in p62 (GAS/PL; P = 0.039). In addition, EXT418 treatments ameliorated the tumour‐induced elevation in muscle Il6 transcript levels (TA and GAS/PL), independently of food intake. Il‐6 transcript levels in adipose tissue and circulating IL‐10 were elevated in response to the tumour but these increases were not significant with EXT418 administration. Tumour mass was not altered by EXT418. Conclusions EXT418 mitigates LLC‐induced cachexia by attenuating skeletal muscle inflammation, proteolysis, and mitophagy, without affecting tumour mass and partially independent of food intake.

The sooty bark disease (SBD) is an emerging disease affecting sycamore maple trees (Acer pseudoplatanus) in Europe. Cryptostroma corticale, the causal agent, putatively native to eastern North America, can be also pathogenic for humans causing pneumonitis. It was first detected in 1945 in Europe, with markedly increasing reports since 2000. Pathogen development appears to be linked to heat waves and drought episodes. Here, we analyse the conditions of the SBD emergence in Europe based on a three-decadal time-series data set. We also assess the suitability of aerobiological samples using a species-specific quantitative PCR assay to inform the epidemiology of C. corticale, through a regional study in France comparing two-year aerobiological and epidemiological data, and a continental study including 12 air samplers from six countries (Czechia, France, Italy, Portugal, Sweden and Switzerland). We found that an accumulated water deficit in spring and summer lower than -132 mm correlates with SBD outbreaks. Our results suggest that C. corticale is an efficient airborne pathogen which can disperse its conidia as far as 310 km from the site of the closest disease outbreak. Aerobiology of C. corticale followed the SBD distribution in Europe. Pathogen detection was high in countries within the host native area and with longer disease presence, such as France, Switzerland and Czech Republic, and sporadic in Italy, where the pathogen was reported just once. The pathogen was absent in samples from Portugal and Sweden, where the disease has not been reported yet. We conclude that aerobiological surveillance can inform the spatial distribution of the SBD, and contribute to early detection in pathogen-free countries.

Recent empirical studies have demonstrated that speciation with gene flow is more common than previously thought. From a conservation perspective, the potential negative effects of hybridization raise concerns on the genetic integrity of endangered species. However, introgressive hybridization has also been growingly recognized as a source of diversity and new advantageous alleles. Carbonell's wall lizard (Podarcis carbonelli) is an endangered species whose distribution overlaps with four other congeneric species. Our goal here was to determine whether P. carbonelli is completely reproductively isolated from its congeners and to evaluate the relevance of hybridization and interspecific gene flow for developing a conservation plan. We used restriction site associated DNA (RAD) sequencing to discover SNPs in samples from four contact zones between P. carbonelli and four other species. Principal component analysis, multilocus genotype assignment and interspecific heterozygosity suggest incomplete reproductive isolation and ongoing gene flow between species. However, hybridization dynamics vary across all pairs, suggesting complex interactions between multiple intrinsic and extrinsic barriers. Despite seemingly ubiquitous interspecific gene flow, we found evidence of strong reproductive isolation across most contact zones. Instead, indirect effects of hybridization like waste of reproductive effort in small isolated populations may be more problematic. Our results highlight the need to further evaluate the consequences of introgression for P. carbonelli, both on a geographic and genomic level and included in a comprehensive and urgently needed conservation plan. Besides, those findings will add important insights on the potential effects of hybridization and introgression for endangered species.

This scientific study employs the Taylor dispersion technique for diffusion measurements to investigate the interaction between sulfamerazine (NaSMR) and macromolecular cyclodextrins (β-CD and HP-β-CD). The results reveal that the presence of β-CD influences the diffusion of the solution component, NaSMR, indicating a counterflow of this drug due to solute interaction. However, diffusion data indicate no inclusion of NaSMR within the sterically hindered HP-β-CD cavity. Additionally, toxicity tests were conducted, including pollen germination (Actinidia deliciosa) and growth curve assays in BY-2 cells. The pollen germination tests demonstrate a reduction in sulfamerazine toxicity, suggesting potential applications for this antimicrobial agent with diminished adverse effects. This comprehensive investigation contributes to a deeper understanding of sulfamerazine–cyclodextrin interactions and their implications for pharmaceutical and biological systems.