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Introducción: La hipertensión arterial es un problema de salud pública global, agudizado por el impacto de la pandemia por COVID-19, el cual ha generado importantes esfuerzos a escala mundial y nacional para fortalecer la prevención, la detección temprana y la terapia oportuna y así mitigar sus repercusiones multidimensionales. Objetivo: Unificar criterios y generar recomendaciones clínicas basadas en la evidencia para el diagnóstico y tratamiento de pacientes con hipertensión arterial. Método: Se realizó un consenso intersocietario con la participación de varias asociaciones colombianas para la adaptación y/o adopción de recomendaciones clínicas informadas en evidencia que orientan el diagnóstico y tratamiento del paciente adulto (mayor o igual a 18 años) con hipertensión arterial. Resultados: Se obtuvo respuesta de diecinueve expertos. El rango de acuerdo para las recomendaciones incluidas en el consenso osciló entre 84.2 y 100%. Se generaron veintidós recomendaciones clínicas para las dimensiones de diagnóstico (n = 6), tratamiento no farmacológico (n = 6) y tratamiento farmacológico (n = 10). Conclusiones: Las recomendaciones clínicas de este consenso orientan la toma de decisiones clínicas interdisciplinarias respecto al diagnóstico y tratamiento de personas con hipertensión arterial.

Abstract Polypharmacy in people living with HIV/AIDS (PLWHA) is a rising morbidity that exacts hefty economic burden on health budgets in addition to other adverse clinical outcomes. Despite recent advances, uncertainty remains around its exact definition in PLWHA. In this systematic review and Meta-analysis, we explored relevant databases (PUBMED, EMBASE, CROI) for studies evaluating polypharmacy in PLWHA from January 2000 to August 2021 to ascertain the exact numerical threshold that defines this morbidity. Two independent reviewers extracted and reviewed relevant variables for analyses. The review included a total of 31 studies involving n = 53,347 participants with a mean age of 49.5 (SD ± 17.0) years. There was a total of 36 definitions, with 93.5% defining polypharmacy as the concomitant use of 5 or more medications. We found significant variation in the numerical definition of polypharmacy, with studies reporting it as “minor” (N = 3); “major” (N = 29); “severe” (N = 2); “excessive” (N = 1); and “higher” (N = 1). Most studies did not incorporate a duration (84%) in their definition and excluded ART medications (67.7%). A plurality of studies in PLWHA have established that polypharmacy in this cohort of patients is the intake of ≥ 5 medications (including both ART and non-ART). To standardize the approach to addressing this rising morbidity, we recommend incorporation of this definition into national and international PLWHA treatment guidelines.

Abstract Due to the COVID-19 pandemic, the study modality changed from face-to-face to virtual, and the teaching-learning process changed drastically. Therefore, it was necessary to determine the effect of this pandemic on the academic performance of essential subjects that are part of the curriculum in most higher education careers. This research used the observational and analytical method on 101 students enrolled in the Mining career and a balanced factorial mathematical model and separation of means according to a significance value of 0.05 (p < 0.05). It was possible to determine that the academic performance of the students of the Mining career of the Escuela Superior Politécnica de Chimborazo in the basic subjects is different from the virtual average at least in a partial or in the final exam. In this case, it was significantly different in the second and third midterm, with the virtual performance being higher than the classroom performance.

Introduction Breast cancer (BC) is a most common and frequently occurring malignancy of women worldwide. Breast self-examination (BSE) is important for the early detection and prevention of BC and to limit the morbidity and mortality. Young students are ideal people to understand and motivate other women to perform BSE. Objective BSE behavior of undergraduate students was predicted using Champion's Health Belief Model Scale (CHBMS). Methods A descriptive cross-sectional design was adopted. This study was conducted in all nine colleges of Sultan Qaboos University, , Oman. Three-hundred eighty-one female undergraduate students were selected through convenient sampling technique. The health belief towards BSE was predicted using CHBMS. Results The mean and SD of beliefs about the benefits of performing BSE showed 10.84 and 3.2, respectively. Mean and SD of confidence in performing BSE indicated 56.24 and 10.8. Likewise, the mean and SD of barriers in performing BSE are 13.58 and 4.2. Source of information is found to be a statistically significant predictor of barrier in performing BSE at p

We encapsulated mesalazine (MSZ) in nanoparticles (NP) of acetylated cashew gum (ACG) in order to improve its absorption in the colon. NPs were synthesized by the dialysis method and different polymer:drug ratios (10:1, 10:2 and 10:5) were investigated. The NP-ACG-MSZ had a size of 273 ± 6.76 nm, PDI 0.10 ± 0.02 and zeta potential -43.2 ± 8.15 mV. SEM demonstrated spherical morphology. XRD analysis showed that the incorporation of the drug in crystalline state into polymeric nanoparticles made it more stable. In vitro release studies showed that switching to pH 6.8 increased release to 62.08 ± 6.03%, which remained at pH 7.4 and sustained release of 95.61 ± 3.25% was observed. In vitro cytotoxicity test demonstrated that NP-ACG (with or without MSZ) showed no basal cytotoxicity in CT26 cells up to a concentration of 131 μg/mL. NP-ACG has shown to be a promising vector for the sustained release of MSZ in the colon when administered orally .

Realizing the reversible transformation of the supramolecular hydrogels is essential for their application as smart materials. The reversible sol-gel transition of the polypseudorotaxane (PPR) hydrogels is achieved through adding a CO2-switchable guest molecule into the PPR hydrogel of poly(ethylene glycol) (PEG) and α-cyclodextrins (α-CDs). Alternating treatments with CO2 and heating drive such reversible transition due to the competitive complexation as evidenced by 2D NOESY 1H NMR and isothermal titration calorimetry as well as X-ray diffraction. The present work describes a straightforward way to obtain switchable PPR hydrogels triggered by a compatible stimulus of CO2. These stimuli-responsive PPR hydrogels have potential applications as biomaterials. [ABSTRACT FROM AUTHOR]

Context: COVID-19 is a pandemic that has affected the entire population, characterized by multisystemic involvement. With around 130 million cases of infection and more than 2.5 million deaths globally. However, the development of a low-efficacy treatment has led to the study of natural products as possible therapeutic alternatives against SARS-CoV-2. Aims: To identify volatile compounds present in two plants in the Colombian Pacific and carry out in-silico studies to search for promising inhibitory molecules against SARS-CoV-2 proteases. Methods: This research carried out the identification of metabolites of two plants identified in the Colombian Pacific, called P. scaberrima (Juss. ex Pers.) Moldenke y D. ambrosioides (L.) Mosyakin & Clemants. Ethanolic extracts were obtained by rotary-evaporation and determinated by GC-MS. Subsequently, in-silico studies were carried out by molecular docking against Mpro and PLpro using Autodock-vina 1.1. Also, a prediction of ADMET properties using SwissADME and GUSAR-Online server was performed. Results: Thus, 15 volatile compounds with similarities greater than 85% were identified from both extracts, mostly sesquiterpenic and monoterpenic compounds. The compounds that showed the highest affinity against Mpro were α-amorphene and phytol for PLpro. Likewise, these were contrasted with co-crystallized molecules such as boceprevir and VIR2-251 as control structures. Finally, the predictions of ADMET properties showed values consistent with the literature. Conclusions: Therefore, the follow-up of in-silico studies with these plants from Colombian pacific are considered as possible tools in the search for active molecules against proteases linked to virus.

Abstract Background The novel coronavirus pandemic (COVID-19) has had severe impacts on morbidity and mortality globally. Methods This study was set in rural central Kentucky and included participants recruited from public spaces. Fifteen qualitative interviews about personal experiences during the COVID-19 pandemic were conducted by phone from July 3 to July 24, 2020. Interviews were recorded, transcribed, and coded using a grounded theory approach. Results Participants who perceived COVID-19 to be a severe risk tended to have personal health concerns and therefore reported taking protective measures for themselves. A slightly smaller proportion of participants reported taking measures to protect others (particularly family). A minority of participants had an ambivalent attitude towards the risk and only took measures if required. COVID-19 vaccine acceptability was low with most participants expressing concerns regarding their need for a vaccine, safety of this vaccine, the value of personal rights, or future vaccine supply. Conclusions Most participants perceived some risk of COVID-19 and took steps to prevent infections in themselves and others. Mandates for mask use in certain locations were additionally useful for those who had an ambivalent attitude towards the risk of illness. There was surprisingly little connection between perceiving COVID-19 risk and a desire for the COVID-19 vaccine. In this setting, vaccine acceptability was low, with vaccine concerns outweighing perceived potential benefits. In conclusion, because the risk was often constructed in terms of worries for themselves and others, the framing of health education materials for protective behaviors in these terms may be effective. Furthermore, future COVID-19 vaccine education should address vaccine knowledge and concerns, such as the need for a vaccine and its safety, and emphasize how a vaccination would reduce their chances of severe disease if they were to get sick.

Introdução e objetivo: A cirurgia bariátrica é um dos tratamentos para a obesidade e tem apresentado bom desempenho na redução da obesidade mórbida, porém, pode levar ao desenvolvimento de deficiências de nutrientes. O objetivo deste trabalho foi avaliar o perfil antropométrico e a deficiência de vitamina B12 em pacientes submetidos a bypass gástrico em Y-de-Roux. Materiais e Métodos: estudo do tipo coorte retrospectiva, com pacientes submetidos à cirurgia bariátrica entre 2010 e 2015. Foi realizado o teste de Shapiro-Wilk, teste de Mann-Whitney, teste exato de Fischer e qui-quadrado de Pearson a um nível de significância de 5%. Resultados: Foram avaliados 123 pacientes. O perfil antropométrico foi caracterizado por redução significativa do IMC médio no período pré em comparação com o período pós-operatório (p

We report a transfusion-transmitted hepatitis A virus infection in an immunocompromised patient in France, detected shortly after a transfusion of pathogen-reduced pooled platelets. This case raises questions about the efficacy of donor screening methods. Additional safety measures, such as routine donation screening, should be considered.

Abstract Environmental exposures and avoidable risk factors account for a large proportion of cancer burden. Exposures and lifestyle vary over time and between populations, which calls for updated and population-specific quantification of how various avoidable risk factors influence cancer risk to plan and design rational and targeted prevention initiatives. The study considered 12 risk-factor groups categorized as class I carcinogens by IARC/WCRF. Exposure data was derived from national studies and surveys and were linked to cancer incidence in 2018 based on the nationwide Danish Cancer Registry. In 2018, 23,078 men and 21,196 women were diagnosed with cancer excluding non-melanoma skin cancer, in Denmark. Of these, 14,235 (32.2%) were estimated to be attributable to avoidable class I carcinogens. Tobacco smoking accounted for 14.6% of total cancers, followed by UV-radiation that accounted for 5.8%. Based on exposure data from 2008, one-third of the cancers in Denmark in 2018 are estimated to be caused by class I carcinogens with tobacco use being the main contributor followed by UV-radiation. Our results should be integrated with public health policies to effectively increase awareness and promote strategies to decrease risk factor exposures at population level.

BackgroundLassa virus (LASV), the cause of the acute viral hemorrhagic illness Lassa fever (LF), is endemic in West Africa. Infections in humans occur mainly after exposure to infected excrement or urine of the rodent-host, Mastomys natalensis. The prevalence of exposure to LASV in Sierra Leone is crudely estimated and largely unknown. This cross-sectional study aimed to establish a baseline point seroprevalence of IgG antibodies to LASV in three administrative districts of Sierra Leone and identify potential risk factors for seropositivity and LASV exposure.Methodology and principal findingsBetween 2015 and 2018, over 10,642 participants from Kenema, Tonkolili, and Port Loko Districts were enrolled in this cross-sectional study. Previous LASV and LF epidemiological studies support classification of these districts as "endemic," "emerging," and "non-endemic", respectively. Dried blood spot samples were tested for LASV antibodies by ELISA to determine the seropositivity of participants, indicating previous exposure to LASV. Surveys were administered to each participant to assess demographic and environmental factors associated with a higher risk of exposure to LASV. Overall seroprevalence for antibodies to LASV was 16.0%. In Kenema, Port Loko, and Tonkolili Districts, seroprevalences were 20.1%, 14.1%, and 10.6%, respectively. In a multivariate analysis, individuals were more likely to be LASV seropositive if they were living in Kenema District, regardless of sex, age, or occupation. Environmental factors contributed to an increased risk of LASV exposure, including poor housing construction and proximity to bushland, forested areas, and refuse.Conclusions and significanceIn this study we determine a baseline LASV seroprevalence in three districts which will inform future epidemiological, ecological, and clinical studies on LF and the LASV in Sierra Leone. The heterogeneity of the distribution of LASV and LF over both space, and time, can make the design of efficacy trials and intervention programs difficult. Having more studies on the prevalence of LASV and identifying potential hyper-endemic areas will greatly increase the awareness of LF and improve targeted control programs related to LASV.

Introduction: The future wireless landscape is evolving rapidly to meet ever-increasing data requirements, which can be enabled using higher-frequency spectrums like millimetre waves (mmWaves) and terahertz (THz). However, mmWave and THztechnologies rely on line-of-sight (LOS) communication, making them sensitive to sudden environmental changes and higher mobility of users, especially in urban areas.Methods: Therefore, beam blockage prediction is a critical challenge for sixth-generation (6G) wireless networks. One possible solution is to anticipate the potential change in the wireless network surroundings using multi-sensor data (wireless, vision, lidar, and GPS) with advanced deep learning (DL) and computer vision (CV) techniques. Despite numerous advantages, the fusion of deep learning,computer vision, and multi-modal data in centralised training introduces many challenges, including higher communication costs for raw data transfer, inefficient bandwidth usage and unacceptable latency. This work proposes latency-aware vision-aided federated wireless networks (VFWN) for beam blockage prediction using bimodal vision and wireless sensing data. The proposed framework usesdistributed learning on the edge nodes (EN) for data processing and model training.Results and Discussion: This involves federated learning for global model aggregation that minimizes latency and data communication cost as compared to centralised learning while achieving comparable predictive accuracy. For instance, the VFWN achieves a predictive accuracy of 98.5%, which is comparable to centralised learning with overall predictive accuracy 99%, considering that no data sharing is done. Furthermore, the proposed framework significantly reduces the communication cost by 81.31% and latency by 6.77% using real-time on device processing and inference.

The diagnosis of human immunodeficiency virus 1 (HIV) infections is reliant on viral nucleic acid testing (NAT). HIV viral load (VL) is generally measured in plasma samples.We evaluated and compared plasma HIV VL results with those obtained using serum samples, the aim being to enable the use of serum in urgent contexts where plasma is not available. Our findings indicated a very high correlation between the HIV VL results obtained in plasma and in serum.

[This corrects the article DOI: 10.1371/journal.pone.0253588.].

Abstract Background To manage severe or potentially severe cases of CoronaVirus Disease 2019 (COVID-19), therapeutic monoclonal antibodies targeting Spike protein of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) have been designed. It has been noted in vitro that upon exposure to these treatments, mutations could be selected. Case presentation We here report the case of an immunosuppressed patient infected with a B.1.1.7 variant, who received a combination of monoclonal antibodies, and subsequently selected mutations K417N, E484K and Q493R on Spike protein of SARS-CoV-2. Conclusions Our case raises the importance of monitoring SARS-CoV-2 mutations in patients receiving monoclonal antibodies and having persistent excretion of the virus, in order to offer optimal management of their infection, and strengthen prevention measures to avoid subsequent transmission of these selected variants.

Abstract Patients with multiple myeloma are at high risk of severe forms of COVID-19. Despite data showing diminished response to vaccine, the era of highly efficient mRNA vaccine might be a gamechanger. We sought to examine response to mRNA vaccine between healthy controls (n = 28) and multiple myeloma (MM) patients (n = 27). Response was analyzed 1 month after the second dose of anti-SARS-CoV-2 BNT162b2 vaccine. Multiple myeloma patients showed diminished levels of Anti-Spike IgG levels compared to controls, but with a high proportion of patients achieving a humoral response (89% vs. 97% in controls). Neutralizing antibodies were present in 74% of patients versus 96% of controls. Patients under current daratumumab treatment had neutralizing activity of anti-SARS-CoV-2 antibodies. Multiple myeloma patients show diminished response to SARS-COV-2 vaccine but with still high response rate. The main potential risk factor of non-response to COVID-19 vaccine was uncontrolled disease under treatment.

Background Healthcaare delivery will change through the increasing use of artificial intelligence (AI). Physicians are likely to be among the professions most affected, though to what extent is not yet clear. Objective We analyzed physicians’ and AI experts’ stances towards AI-induced changes. This concerned (1) physicians’ tasks, (2) job replacement risk, and (3) implications for the ways of working, including human–AI interaction, changes in job profiles, and hierarchical and cross-professional collaboration patterns. Methods We adopted an exploratory, qualitative research approach, using semi-structured interviews with 24 experts in the fields of AI and medicine, medical informatics, digital medicine, and medical education and training. Thematic analysis of the interview transcripts was performed. Results Specialized tasks currently performed by physicians in all areas of medicine would likely be taken over by AI, including bureaucratic tasks, clinical decision support, and research. However, the concern that physicians will be replaced by an AI system is unfounded, according to experts; AI systems today would be designed only for a specific use case and could not replace the human factor in the patient–physician relationship. Nevertheless, the job profile and professional role of physicians would be transformed as a result of new forms of human–AI collaboration and shifts to higher-value activities. AI could spur novel, more interprofessional teams in medical practice and research and, eventually, democratization and de-hierarchization. Conclusions The study highlights changes in job profiles of physicians and outlines demands for new categories of medical professionals considering AI-induced changes of work. Physicians should redefine their self-image and assume more responsibility in the age of AI-supported medicine. There is a need for the development of scenarios and concepts for future job profiles in the health professions as well as their education and training.

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities.

Abstract Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rising morbidity amongst hospitalized patients. Whilst clinical protocols for the management of individual DRESS cases have been well established, determination of potential prevention of these cases by utilizing novel “avoidability” tools has remained unexplored. This retrospective study reviewed records of patients who presented to the emergency department of Weill Cornell Medicine-affiliated Hamad General Hospital, Doha Qatar with suspected DRESS syndrome. These cases were independently adjudicated (utilizing the RegiSCAR, and JSCAR tools) as DRESS-drug pairs by a team of two clinical pharmacists and two General Physicians. They were then rated for potential avoidability with the Liverpool adverse drug reactions avoidability tool (LAAT) by the same team of raters. A total of 16 patients satisfied RegiSCAR criteria for DRESS syndrome. The mean age of the study population was 41.5 years (SD ± 13.3). The study population was predominantly male (n = 12; [75%]). The median latent period from drug ingestion to clinical presentation was 14 days (interquartile range [IQR] 6.5, 29). The median RegiSCAR and J-SCAR scores were 6 (IQR 5, 6.8), 5 (IQR 4, 5.8) respectively. Utilizing the LAAT, about 60% of the DRESS syndrome-drug pairs were rated as “avoidable” (“probable” or “definite”). The overall Krippendorf’s alpha with the LAAT was 0.81 (SE 0.10, CI 0.59–1.00); with an intraclass correlation coefficient (ICC) of 0.90 (CI 0.77, 0.96.). In a randomly selected cohort of DRESS syndrome-drug pairs, a significant proportion was potentially avoidable (“possibly” and “definitely”) utilizing the LAAT. This will need validation by larger sample-sized prospective studies utilizing the updated LAAT proposed by this study.

Abstract Background Coronavirus disease 2019 (COVID-19) has been shown to cause serious health problems among them is the Acute Respiratory Distress syndrome (ARDS). Vitamin D receptor (VDR) signaling possibly partakes in the pathophysiology of this devastating complication. Methods In the current project, we have appraised expression levels of VDR, CYP27B1 and a number of associated lncRNAs in the circulation of COVID-19 patients versus healthy subjects using real-time PCR method. Results Expression of SNHG6 was considerably lower in COVID-19 patients compared with control subjects (Ratio of mean expression (RME) = 0.22, P value = 7.04E-05) and in both female and male COVID-19 patients compared with sex-matched unaffected individuals (RME = 0.32, P value = 0.04 and RME = 0.16, P value = 0.000679683, respectively). However, its expression was similar among ICU-hospitalized and non-ICU patients. Similarly, expression of SNHG16 was lower in in COVID-19 patients compared with controls (RME = 0.20, P value = 5.94E-05) and in both female and male patients compared with sex-matched controls (RME = 0.32, P value = 0.04 and RME = 0.14, P value = 0.000496435, respectively) with no significant difference among ICU-hospitalized and non-ICU hospitalized patients. Expression of VDR was lower in COVID-19 patients compared with controls (RME = 0.42, P value = 0.04) and in male patients compared with male controls (RME = 0.27, P value = 0.02). Yet, expression of VDR was statistically similar between female subgroups and between ICU-hospitalized and non-ICU hospitalized patients. Expression levels CYP27B, Linc00511 and Linc00346 were similar among COVID-19 patients and healthy subjects or between their subgroups. Significant correlations have been detected between expression levels of VDR, CYP27B and SNHG6, SNHG16, Linc00511 and Linc00346 lncRNAs both among COVID-19 patients and among healthy controls with the most significant ones being SNHG6 and SNHG16 (r = 0.74, P value = 3.26e-17 and r = 0.81, P = 1.54e-22, respectively). Conclusion Combination of transcript levels of VDR, CYP27B and SNHG6, SNHG16, Linc00511 and Linc00346 could differentiate patients from controls with AUC = 0.76, sensitivity = 0.62 and specificity = 0.81. The current data potentiate SNHG6, SNHG16 and VDR as possible contributors in COVID-19 infection but not in the severity of ARDS.

Interior design is the art of designing and studying spaces according to the type of activity used, as it is a process of interaction between humans, time, place and culture (5), and with the increase in electronic commerce operations, the need for a new kind of untraditional banks that goes beyond the usual pattern of performance and is not restricted to a specific place or time, the interior designer plays an effective role in using the elements and foundations of interactive technology that were recently discovered and employed in these smart banks, with low costs, saving time and space, so that banking service is achieved without full dependence on the human resources and is provided all day time. Accordingly, the use of smart technology techniques in architecture and interior design within smart banks has become a fundamental matter that must be taken care of for both global banks and local ones in Egypt as in our study. Smart banks are unique in the field of electronic services that can be achieved other than traditional banks services and this advantage meets the needs, Hopes and aspirations of their customers, the following is an explanation of the areas that are characterized by smart banks: 1- Acquiring the largest possible number of clients due to the extended working hours 24/7 in addition to providing all banking services. 2- Providing banking services to customers in a safe manner during the spread of a new kind of diseases and epidemics such as COVID-19, which forced traditional banks to follow strict rules in order to limit the spread of COVID-19 among their clients as well as their employees, and that negatively affects the efficiency of these banks in the way they provide their services due to limitation of time, smart banks succeeded to overcome such circumstances, as they provide banking services all day time as mentioned before.

Abstract Background Morquio A syndrome is a rare, autosomal recessive, progressively debilitating disorder, with multi-system impairments and high medical burden. Quebec, Canada has a large Morquio A population, which is considered unique due to the presence of founder pathogenic variants. The objectives of this study were to document the genetic and clinical heterogeneity of patients with Morquio A in Quebec, to better characterize the phenotype of those with the French Canadian founder pathogenic variant (NM_000512.5: c.1171A>G, p.Met391Val), and to describe the natural history of the patients treated with elosulfase alfa enzyme replacement therapy. Patients with Morquio A were genotyped for pathogenic variants in the lysosomal enzyme N-acetylgalactosamine-6-sulfatase. Clinical data were retrospectively collected from medical charts of patients and included medical history, height, physical examination, respiratory function tests, electrocardiogram, echocardiogram, endurance in the 6-min walk test (6MWT), and activities of daily living (ADL) as assessed by the Mucopolysaccharidosis Health Assessment Questionnaire (MPS-HAQ). Longitudinal data were collected retrospectively and prospectively for patients treated with elosulfase alfa. Results A total of 33 patients, aged 5–63 years, were included in the analysis. Patients with the founder pathogenic variant (n = 17) generally exhibited a non-classical form of Morquio A. As compared with patients with a non-founder pathogenic variant (n = 16), these patients were generally taller, had greater endurance and were better able to perform ADL. However, they still had significant musculoskeletal disease. Most of the 26 patients treated with elosulfase alfa, regardless of pathogenic variant, showed improvements in endurance and ADL. After 5 to 12 months of treatment, the mean improvement from baseline in the 6MWT was 23% and 10 of 14 patients improved in at least one MPS-HAQ domain. Endurance and ADL generally continued to improve or maintained stable in the long term (up to 7 years). Four out of 19 treated patients with echocardiogram data at follow-up showed progression of cardiac disease. Conclusions In Quebec, Canada, Morquio A frequently manifests as a non-classical form of the syndrome due to a founder effect. Patients treated with elosulfase alfa generally show long-term improvement or stability in endurance and function, regardless of pathogenic variant.

The fifth generation (5G) mobile networks are envisaged to enable a plethora of breakthrough advancements in wireless technologies, providing support of a diverse set of services over a single platform. While the deployment of 5G systems is scaling up globally, it is time to look ahead for beyond 5G systems. This is mainly driven by the emerging societal trends, calling for fully automated systems and intelligent services supported by extended reality and haptics communications. To accommodate the stringent requirements of their prospective applications, which are data-driven and defined by extremely low-latency, ultra-reliable, fast and seamless wireless connectivity, research initiatives are currently focusing on a progressive roadmap towards the sixth generation (6G) networks, which are expected to bring transformative changes to this premise. In this article, we shed light on some of the major enabling technologies for 6G, which are expected to revolutionize the fundamental architectures of cellular networks and provide multiple homogeneous artificial intelligence-empowered services, including distributed communications, control, computing, sensing, and energy, from its core to its end nodes. In particular, the present paper aims to answer several 6G framework related questions: What are the driving forces for the development of 6G? How will the enabling technologies of 6G differ from those in 5G? What kind of applications and interactions will they support which would not be supported by 5G? We address these questions by presenting a comprehensive study of the 6G vision and outlining seven of its disruptive technologies, i.e., mmWave communications, terahertz communications, optical wireless communications, programmable metasurfaces, drone-based communications, backscatter communications and tactile internet, as well as their potential applications. Then, by leveraging the state-of-the-art literature surveyed for each technology, we discuss the associated requirements, key challenges, and open research problems. These discussions are thereafter used to open up the horizon for future research directions.

These days, mesenchymal stem cells (MSCs), because of immunomodulatory and pro-angiogenic abilities, are known as inevitable factors in regenerative medicine and cell therapy in different diseases such as ocular disorder. Moreover, researchers have indicated that exosome possess an essential potential in the therapeutic application of ocular disease. MSC-derived exosome (MSC-DE) have been identified as efficient as MSCs for treatment of eye injuries due to their small size and rapid diffusion all over the eye. MSC-DEs easily transfer their ingredients such as miRNAs, proteins, and cytokines to the inner layer in the eye and increase the reconstruction of the injured area. Furthermore, MSC-DEs deliver their immunomodulatory cargos in inflamed sites and inhibit immune cell migration, resulting in improvement of autoimmune uveitis. Interestingly, therapeutic effects were shown only in animal models that received MSC-DE. In this review, we summarized the therapeutic potential of MSCs and MSC-DE in cell therapy and regenerative medicine of ocular diseases.

Growing literature has shown heterogenous effects of conditional cash incentives (CCIs) on HIV care retention. The field lacks insights into reasons why incentives impact various patients in different ways-differences that may be due to variations in psychological and social mechanisms of effect. A deeper understanding of patients' perceptions and experiences of CCIs for retention may help to clarify these mechanisms. We conducted a qualitative study embedded in the ADAPT-R trial (NCT#02338739), a sequential multiple assignment randomized trial (SMART) that evaluated economic incentives to support retention in HIV care among persons living with HIV (PLHIV) initiating antiretroviral therapy in Kenya. Participants who attended their scheduled clinic visits received an incentive of approximately $4 each visit. Interviews were conducted between July 2016 and June 2017 with 39 participants to explore attitudes and experiences with economic incentives conditional on care engagement. Analyses revealed that incentives helped PLHIV prioritize care-seeking by alleviating transport barriers and food insecurity: "I decided to forgo [work] and attend clinic […] the voucher relieved me". Patients who borrowed money for care-seeking reported feeling relieved from the burden of indebtedness to others: "I borrow with confidence that I will pay after my appointment." Incentives fostered their autonomy, and enabled them to support others: "I used the money to buy some clothes and Pampers for the children." Participants who were intrinsically motivated to engage in care ("my life depends on the drugs, not the incentive"), and those who mistrusted researchers, reported being less prompted by the incentive itself. For patients not already prioritizing care-seeking, incentives facilitated care engagement through alleviating transport costs, indebtedness and food insecurity, and also supported social role fulfillment. Conditional cash incentives may be an important cue to action to improve progression through the HIV treatment cascade, and contribute to better care retention.

Mammea americana L. is a plant with diverse medicinal uses in the municipality of Cértegui, Chocó, Colombia. This research characterized the ethnomedicinal, chemical, and antibacterial activities of the bark of Mammea americana. Through interviews and semistructured surveys with the community, its ethnomedicinal uses were determined. Compounds present in the bark extract were identified and quantified by gas chromatography-coupled to mass spectrometry (GC-MS), and a qualitative analysis was performed by preliminary phytochemistry. Antibacterial activity and minimum inhibitory concentration (MIC) were carried out by agar diffusion and dilution methods, respectively, using ethanolic and aqueous extracts. Ethnomedical data showed that the bark is used to treat 14 conditions, the most representative being gallstones, prostate inflammation, and malaria. Preliminary phytochemical analyses showed the existence of several secondary metabolites such as tannins, alkaloids, flavonoids, triterpenes and/or steroids, quinones, and saponins. A total of 29 compounds were identified; the most abundant were ethyl 5-oxo-4-(p-toluidine)-2,5-dihydro-3-furancarboxylate, phenol, 4,4′,4″-ethylidynetris, nerolidol, 19-hydroxy-13-epimanoyl oxide, α-elemene, and δ-cadinene. The results showed remarkable antibacterial activity of the ethanolic extract (20 mg/ml) against Staphylococcus aureus (22.6 mm) and Escherichia coli (19.6 mm) and of the crude water extract (20 mg/ml) against Staphylococcus aureus (18.5 mm) and Escherichia coli (12.4 mm). The strongest MIC was for the ethanolic extract with values of 0.357 and 0.897 mg/ml against S. aureus and E. coli strains, respectively, while in the aqueous extract, S. aureus (3.99 mg/ml) and E. coli (4.3 mg/ml) were recorded. It is assumed that the compounds identified in this study could be responsible for the antibacterial activity of the species, as well as the relationship of the identified compounds and metabolites with the ethnomedical uses given by the community, providing a scientific and traditional basis for its different traditional medical uses.

BackgroundDrug induced liver injury (DILI) is a rising morbidity amongst patients with COVID-19 clinical syndrome. The updated RUCAM causality assessment scale is validated for use in the general population, but its utility for causality determination in cohorts of patients with COVID-19 and DILI remains uncertain.MethodsThis retrospective study was comprised of COVID-19 patients presenting with suspected DILI to the emergency department of Weill Cornell medicine-affiliated Hamad General Hospital, Doha, Qatar. All cases that met the inclusion criteria were comparatively adjudicated by two independent rating pairs (2 clinical pharmacist and 2 physicians) utilizing the updated RUCAM scale to assess the likelihood of DILI.ResultsA total of 72 patients (mean age 48.96 (SD ± 10.21) years) were examined for the determination of DILI causality. The majority had probability likelihood of "possible" or "probable" by the updated RUCAM scale. Azithromycin was the most commonly reported drug as a cause of DILI. The median R-ratio was 4.74 which correspond to a mixed liver injury phenotype. The overall Krippendorf's kappa was 0.52; with an intraclass correlation coefficient (ICC) of 0.79 (IQR 0.72-0.85). The proportion of exact pairwise agreement and disagreement between the rating pairs were 64.4%, kappa 0.269 (ICC 0.28 [0.18, 0.40]) and kappa 0.45 (ICC 0.43 [0.29-0.57]), respectively.ConclusionIn a cohort of patients with COVID-19 clinical syndrome, we found the updated RUCAM scale to be useful in establishing "possible" or "probable" DILI likelihood as evident by the respective kappa values; this results if validated by larger sample sized studies will extend the clinical application of this universal tool for adjudication of DILI.

Vaccination against COVID-19 is the main public health approach to fight against the pandemic. The Spike (S) glycoprotein of SARS-CoV-2 is the principal target of the neutralizing humoral response. We evaluated the analytical and clinical performances of a surrogate virus neutralization test (sVNT) compared to conventional neutralization tests (cVNTs) and anti-S eCLIA assays in recovered and/or vaccinated healthcare workers. Our results indicate that sVNTs displayed high specificity and no cross-reactivity. Both eCLIA and sVNT immunoassays were good at identifying cVNT serum dilutions ≥1:16. The optimal thresholds when identifying cVNT titers ≥1:16, were 74.5 U/mL and 49.4 IU/mL for anti-S eCLIA and sVNT, respectively. Our data show that neutralizing antibody titers (Nab) differ from one individual to another and may diminish over time. Specific assays such as sVNTs could offer a reliable complementary tool to routine anti-S serological assays.

The SARS-CoV-2 Delta variant has become one of the greatest public health challenges worldwide since, after being first identified in India in December 2020, it has spread rapidly, affecting mainly countries with low vaccination rates and those that have relaxed the public health and social measures implemented to control the COVID-19 pandemic. The Delta variant has a higher replication capacity and is associated with viral loads up to 1 260 times higher than those of infections caused by the original strain, which may be associated with an increased likelihood of hospitalization, ICU admission, need for oxygen therapy, pneumonia, or even death. Fully vaccinated individuals have almost similar protection against both Delta and Alpha variants. Given the impact of Delta in countries where it is the dominant variant, it is necessary for all countries to develop systematic action plans focused on implementing strict public health and social measures in the context of the COVID-19 pandemic and on increasing vaccination coverage. Bearing this in mind, the objective of this reflection paper is to describe the main characteristics of the Delta variant, its impact on the dynamics of the pandemic in some of the countries where it has been detected, the effectiveness of vaccines against this variant, and its implications for public health in Colombia.

Book review

This report describes the result of the study using lean management approach in improving clinical team leader handover process in nursing services at Sultan Bin Abdulaziz Humanitarian City, the largest rehabilitation facility in the Middle East with 511-bed capacity and more than 20 nursing inpatient units. Clinical handover refers to the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another pehealthcare system is a crson or professional group on a temporary or permanent basis. It is in fact a valuable and essential part of the care processes in the hospitals. However, clinical team leaders face a challenging role during handover due to prolonged process, causing extra nursing working hour beyond their 12-hour scheduled shift, resulting in additional burden and exhaustion. The aim of this project was to test the effectivity of the lean management approach in improving the duration of clinical handover by reducing the handover time frame to 50% through eliminating unnecessary steps towards a more efficient, sustainable and effective communication between clinical nursing team leaders. The project results demonstrated the effectiveness and efficiency of the team leader clinical handover process by decreasing the duration by 50%. One hundred per cent of nursing units that were involved in the project were able to start and end their team leader handover process by the average of the selection target of 20–30 min of handover duration.

Este artigo tem como objetivo analisar a atual situação da produção científica internacional sobre competências digitais docentes. Para tanto foi realizada uma meta-análise dos artigos recuperados no Portal de Periódico da CAPES. Importa dizer que se optou pela busca no Portal de Periódico da CAPES porque, à época, este permitia o acesso da coleta de dados para este estudo, aos textos completos de artigos de mais de 38.000 publicações periódicas internacionais e 126 bases de dados (a exemplo do Proquest, EBSCO, Science Direct, Emerald, Web of Science e Web of Knowledge) com resumos de documentos em todas as áreas do conhecimento. Optou-se pela regra de exaustividade de Bardin (2011), não sendo definido corte temporal a priori para coleta de dados. Após a coleta de dados, foram recuperados 175 artigos, sendo 37 considerados válidos para compor o corpus deste estudo. As conclusões revelam que o interesse maior dos pesquisadores é sobre as competências digitais docentes de uma maneira mais ampla e que, por exemplo, pouco se estuda sobre a sua transposição pedagógica. Os achados corroboram também com estudos anteriores com relação às múltiplas interpretações da compreensão do que seja competência digital. Também há indícios na literatura analisada do uso de mais de uma terminologia, inclusive no mesmo texto, de maneira indistinta e sinonímica, para se referir às competências digitais.

The research focuses on studying the effect of microwave energy as an alternative heating method on dyeing and printing pretreatments of cotton fabrics. In this research, a microwave oven was used to heat the solutions which used in de-sizing, scouring, bleaching and mercerizing processes at different energy levels. The results showed the importance of this heating method in improving desizing efficiency where the best result was obtained at 180 W and 24 min and this method was beneficial in saving energy and time. The best result in scouring was obtained at 720 watts and 24 minutes, whereas at 720 watts and 20 minutes was the best result in bleaching. We can save energy, time and chemicals compared with the conventional method. The mercerizing by microwave increased the absorption of dye solutions for the samples compared with the traditional method, where the color strength increased by increasing the treatment time and the level of energy in the microwave and the best result was obtained at 900 watts and 90 seconds.

In recent years, the Open Educational Resources (OER) and Open Access (OA) movements have been essential in creating opportunities in all scholarly activities, within the context of higher education. The main purpose of this research was to understand how perceptions and practices of faculty towards OER are related to their perceptions and practices towards OA. It is an exploratory and descriptive study, with a mixed methods approach, undertaken in Portugal. Results indicate that, although faculty already show some degree of knowledge and use of OER and OA in their teaching and research practices, there is still a general lack of knowledge in both fields. However, the convergence of perceptions regarding both fields provide evidence on the possibility of a common approach to both fields in faculty’s educational practices, with the purpose of opening up their educational and scientific resources, thus reinforcing the principles of transparency, collaboration and openness to knowledge.

(1) Background: What is the role of serum CMV PCR in the diagnosis of recent primary infection (PI) in pregnant women when IgG avidity is uninformative? (2) Methods: Retrospective cohort study to compare serum versus whole blood CMV PCR. (a) Qualitative assessment: CMV PCR was performed on 123 serum samples and 74 whole blood samples collected from 132 pregnant women with recent CMV PI. PCR positivity rate was used to calculate sensitivity in serum and whole blood. (b) Quantitative assessment: CMV PCR was performed on 72 paired samples of serum and whole blood collected on the same day from 57 patients. (3) Results: In pregnant women, PCR positivity rate was 89% for serum samples versus 100% in whole blood in the case of very recent PI (

Intelligent building management systems are proven to lead to energy savings and are an integral component of smart buildings. The procedures developed in the EN standards describe the methodology for calculating the energy savings achieved by improving the automation and control levels of separate services in building systems. However, although this method is used in practice, it is rarely applied or investigated by the research community. Typically, energy savings resulting from a single automation improvement intervention in a building heating system are observed, while the holistic view of combined automation upgrades is not considered. Therefore, the purpose of this study was to assess the energy savings resulting from several upgrades to control levels in the heating system components of the building. In addition, this research provides a rationale for the impact of multiple automation and control options for heating systems as well as examines the difference in energy savings. Finally, an analytical model is developed and demonstrated to assess the feasibility of building automation and control upgrades, by determining the allowed investment according to a set of predefined indicators.

Os média alternativos abordam assuntos que não são tratados pelos meios de comunicação tradicionais e dão enfoque a temáticas voltadas à defesa dos direitos humanos. Surgidos no ambiente digital, tiram partido dos baixos custos de distribuição e das potencialidades de participação do público. De forma crescente, os média alternativos utilizam plataformas de crowdfunding ou financiamento coletivo como modelo de manutenção das atividades. Estas plataformas que permitem o patronato não alojam nem publicam conteúdo, mas estão inseridas num ecossistema com outras plataformas que visam obter dados e transformá-los em valor económico. O presente artigo mapeia a forma como média alternativos de Portugal, Espanha e Brasil articulam as plataformas de crowdfunding com as suas estratégias de financiamento, por um lado, e com as plataformas de redes sociais, por outro. O estudo pretende debater as possibilidades e limitações das diferentes plataformas de financiamento coletivo para estes meios. O desenho metodológico inclui entrevistas pessoais, observação online sobre os média alternativos e uma análise de conteúdo sobre o seu financiamento e concretamente as plataformas digitais de financiamento. Os média alternativos articulam o seu uso de plataformas de crowdfunding com as de redes sociais, num trabalho constante de demonstração da relevância do tipo de jornalismo que praticam e do seu contributo social em busca do envolvimento do público enquanto financiador.

Background: Oral tranexamic acid is effective for heavy menstrual bleeding, but the thrombosis risk with this treatment is largely not studied. Methods: Using nationwide registries, we assessed associations between use of oral tranexamic acid and risk of deep-vein thrombosis or pulmonary embolism and arterial thrombosis in heart or brain in a nationwide historical prospective cohort of Danish women aged 15 to 49 years in the period 1996–2017. Exclusion criteria included potential confounding factors such as history of thromboembolism, anticoagulation therapy, thrombophilia, and cancer. Findings: Among 2·0 million women followed for 13·8 million person-years, 3,392 venous thromboembolisms and 4,198 arterial thromboses occurred. A total of 63,896 women (3·2%) filled 146,729 prescriptions of oral tranexamic acid during follow-up with median filled prescription per user being one of 15 g. The age-standardised incidence rate of venous thromboembolism was 11·8 (95% CI 4·6 to 30·2) per 10,000 person-years in oral tranexamic acid use compared to 2·5 (2·4 to 2·6) per 10,000 person-years in non-use. For arterial thrombosis, the age-standardised incidence rate per 10,000 person-years was 3·4 (1·1 to 10·7) among exposed compared to 3·0 (2·9 to 3·1) in non-exposed. Comparing oral tranexamic acid use with non-use, the adjusted incidence rate ratio was 4·0 (1·8 to 8·8) for venous thromboembolism and 1·3 (0·4 to 4·2) for arterial thrombosis.Number needed to harm per five days of treatment was 78,549 women for venous thromboembolism. Interpretation: We found use of oral tranexamic acid to be positively associated with venous thromboembolism. However, number needed to harm per five days of treatment was high.

Orofacial clefts (OFCs) are among the most prevalent craniofacial birth defects worldwide and create a significant public health burden. The majority of OFCs are non-syndromic and vary in prevalence by ethnicity. Africans have the lowest prevalence of OFCs (~ 1/2,500), Asians have the highest prevalence (~1/500), Europeans and Latin Americans lie somewhere in the middle (~1/800 and 1/900, respectively). Thus, ethnicity appears to be a major determinant of the risk of developing OFC. The Pittsburgh Orofacial Clefts Multiethnic study was designed to explore this ethnic variance, comprising a large number of families and individuals (~12,000 individuals) from multiple populations worldwide: US and Europe, Asians, mixed Native American/Caucasians, and Africans. In this current study, we analyzed 2,915 OFC cases, 6,044 unaffected individuals related to the OFC cases, and 2,685 controls with no personal or family history of OFC. Participants were grouped by their ancestry into African, Asian, European, and Central and South American subsets, and genome-wide association run on the combined sample as well as the four ancestry-based groups. We observed 22 associations to cleft lip with or without cleft palate at 18 distinct loci with p-values < 1e-06, including 10 with genome-wide significance (

Background. Candida glabrata is a human opportunistic pathogen that can cause life-threatening systemic infections. Although there are multiple effective vaccines against fungal infections and some of these vaccines are engaged in different stages of clinical trials, none of them have yet been approved by the FDA. Aim. Using immunoinformatics approach to predict the most conserved and immunogenic B- and T-cell epitopes from the fructose bisphosphate aldolase (Fba1) protein of C. glabrata. Material and Method. 13 C. glabrata fructose bisphosphate aldolase protein sequences (361 amino acids) were retrieved from NCBI and presented in several tools on the IEDB server for prediction of the most promising epitopes. Homology modeling and molecular docking were performed. Result. The promising B-cell epitopes were AYFKEH, VDKESLYTK, and HVDKESLYTK, while the promising peptides which have high affinity to MHC I binding were AVHEALAPI, KYFKRMAAM, QTSNGGAAY, RMAAMNQWL, and YFKEHGEPL. Two peptides, LFSSHMLDL and YIRSIAPAY, were noted to have the highest affinity to MHC class II that interact with 9 alleles. The molecular docking revealed that the epitopes QTSNGGAAY and LFSSHMLDL have the lowest binding energy to MHC molecules. Conclusion. The epitope-based vaccines predicted by using immunoinformatics tools have remarkable advantages over the conventional vaccines in that they are more specific, less time consuming, safe, less allergic, and more antigenic. Further in vivo and in vitro experiments are needed to prove the effectiveness of the best candidate’s epitopes (QTSNGGAAY and LFSSHMLDL). To the best of our knowledge, this is the first study that has predicted B- and T-cell epitopes from the Fba1 protein by using in silico tools in order to design an effective epitope-based vaccine against C. glabrata.

IntroductionMedication errors are avoidable events that can occur at any stage of the medication use process. They are widespread in healthcare systems and are linked to an increased risk of morbidity and mortality. Several strategies have been studied to reduce their occurrence including different types of pharmacy-based interventions. One of the main pharmacist-led interventions is educational programs, which seem to have promising benefits.ObjectiveTo describe and compare various pharmacist-led educational interventions delivered to healthcare providers and to evaluate their impact qualitatively and quantitatively on medication error rates.MethodsA systematic review and meta-analysis was conducted through searching Cochrane Library, EBSCO, EMBASE, Medline and Google Scholar from inception to June 2020. Only interventional studies that reported medication error rate change after the intervention were included. Two independent authors worked through the data extraction and quality assessment using Crowe Critical Appraisal Tool (CCAT). Summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model for rates of medication errors. Research protocol is available in The International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42019116465.ResultsTwelve studies involving 115058 participants were included. The two main recipients of the educational interventions were nurses and resident physicians. Educational programs involved lectures, posters, practical teaching sessions, audit and feedback method and flash cards of high-risk abbreviations. All studies included educational sessions as part of their program, either alone or in combination with other approaches, and most studies used errors encountered before implementing the intervention to inform the content of these sessions. Educational programs led by a pharmacist were associated with significant reductions in the overall rate of medication errors occurrence (OR, 0.38; 95% CI, 0.22 to 0.65).ConclusionPharmacist-led educational interventions directed to healthcare providers are effective at reducing medication error rates. This review supports the implementation of pharmacist-led educational intervention aimed at reducing medication errors.

Este artigo analisa a problemática das emoções online em contextos de aprendizagem online, apresentando um novo modelo para a lábil identificação emocional. Trata-se duma investigação sobre a vinculação do docente-estudante, baseada no design de experiências de aprendizagem decorrentes das necessidades emergentes no contexto online, reforçadoras da interação afetiva e motivacional. Pretende-se melhorar o bem-estar e a qualidade na aprendizagem, envolvendo os estudantes integrados em ambientes digitais formais e não formais, no ensino superior. Recorre à metodologia Design-Based-Research, num estudo multi-casos: cenário “fechado”: LMS+Licenciatura e cenário “misto”: LMS +Twitter+Mestrado. A caracterização do bem-estar emocional e envolvimento cognitivo advém da análise daqueles cenários, produzindo princípios de design e soluções baseadas em estratégias de proximidade: Fóruns temáticos, Feedbacks, Acompanhamento Online e Fórum Café-Lounge. Os dados foram recolhidos com base em: Escala de Emoções (90 emoções positivas e negativas); questionário e entrevista semi-estruturada; análise das interações no discurso online. Os resultados obtidos no cenário 1 apontam para a importância do reforço da presença emocional do Professor e das micro-lideranças estudantis. Apesar de não corresponder a uma participação massiva, beneficiou a aprendizagem e bem-estar do grupo, criando-lhe o desejo da replicação desta experiência. Considera-se necessário que as estratégias de classificação e presença emocional sejam aperfeiçoadas noutras investigações.