Search

Abstract Background Studies have shown that more than 50% of the antibiotics used in hospitals are unnecessary or inappropriate and, that antimicrobial resistance may cost up to 20 billion USD in excess medical costs each year. On the other hand, Antimicrobial Stewardship Programs (ASP) significantly reduce inappropriate antimicrobial use, emergence of antimicrobial resistance, healthcare associated infections, and costs in hospital settings. Objective To evaluate the development of ASP and antibiotic savings in 7 Latin American hospitals using standardized quantitative indicators in all the participating health care institutions. Methods An interventional study was conducted, where pre- and post- evaluations were performed using a standardized score tool adapted from the Joint Commission International accreditation standards and, the Colombian Institute of Technical Standards and Certification. We evaluated ASP from 7 Latin American hospitals between 2019 and 2020. A pre-intervention evaluation was done in each hospital to quantify the degree of development of the ASP (ASP Development score). Based on these results, tailored on-site training was implemented in each hospital, followed by a post-intervention evaluation to quantify improvement of ASP-development indicators. In addition, monetary savings in antimicrobials derived from the ASP intervention were estimated. Results In the pre-intervention evaluation, the average ASP development score for the 7 institutions was 65.8% (40-94.3%). The items with the lowest development score were those related to monitoring and communicating the ASP progress and success. For the post-intervention evaluation, 2 institutions couldn’t participate due to the pressure imposed by the COVID-19 pandemic. For the remaining 5/7 hospitals, the average ASP development score was 82.3% with an increase of 12.0% when compared to the pre-intervention measurement of the same institutions (average pre-intervention score 70.3% (48.2%-94.3%) The items with a significant increase were key performance indicators, AMS education and training of the prescribers. Three of the seven (3/7) hospitals reported antibiotic monetary savings associated to the ASP intervention. Conclusions The use of the tool described shown to be useful to evaluate specific areas of ASP-development that were lacking and tailor interventions for the participating hospitals, consequently, it helped improve ASP-development in the institutions that underwent pre- intervention and post-intervention analysis. In addition, the strategies showed monetary savings on antimicrobial costs when measured.

Polymeric hydrogels are soft materials with a three-dimensional (3D) hydrophilic network capable of retaining and absorbing large amounts of water or biological fluids. Due to their customizable properties, these materials are extensively studied for developing matrices for 3D cell culture scaffolds, drug delivery systems, and tissue engineering. However, conventional hydrogels still exhibit many drawbacks; thus, significant efforts have been directed towards developing dynamic hydrogels that draw inspiration from organisms’ natural self-repair abilities after injury. The self-healing properties of these hydrogels are closely associated with their ability to form, break, and heal dynamic bonds in response to various stimuli. The primary objective of this review is to provide a comprehensive overview of dynamic hydrogels by examining the types of chemical bonds associated with them and the biopolymers utilized, and to elucidate the chemical nature of dynamic bonds that enable the modulation of hydrogels’ properties. While dynamic bonds ensure the self-healing behavior of hydrogels, they do not inherently confer adhesive properties. Therefore, we also highlight emerging approaches that enable dynamic hydrogels to acquire adhesive properties.

BackgroundAmbulance response times are considered important. Busy ambulances are common, but little is known about their effect on response times.ObjectiveTo assess the extent of busy ambulances in Central Norway and their impact on ambulance response times.DesignThis was a retrospective observational study. We used machine learning on data from nearby incidents to assess the probability of up to five different ambulances being candidates to respond to a medical emergency incident. For each incident, the probability of a busy ambulance was estimated by summing the probabilities of candidate ambulances being busy at the time of the incident. The difference in response time that may be attributable to busy ambulances was estimated by comparing groups of nearby incidents with different estimated busy probabilities.SettingMedical emergency incidents with ambulance response in Central Norway from 2013 to 2022.Main outcome measuresPrevalence of busy ambulances and differences in response times associated with busy ambulances.ResultsThe estimated probability of busy ambulances for all 216,787 acute incidents with ambulance response was 26.7% (95% confidence interval (CI) 26.6 to 26.9). Comparing nearby incidents, each 10-percentage point increase in the probability of a busy ambulance was associated with a delay of 0.60 minutes (95% CI 0.58 to 0.62). For incidents in rural and urban areas, the probability of a busy ambulance was 21.6% (95% CI 21.5 to 21.8) and 35.0% (95% CI 34.8 to 35.2), respectively. The delay associated with a 10-percentage point increase in busy probability was 0.81 minutes (95% CI 0.78 to 0.84) and 0.30 minutes (95% CI 0.28 to 0.32), respectively.ConclusionAmbulances were often busy, which was associated with delayed ambulance response times. In rural areas, the probability of busy ambulances was lower, although the potentially longer delays when ambulances were busy made these areas more vulnerable.

ABSTRACT Objective: to analyze care transition in hospital discharge planning for patients with chronic noncommunicable diseases. Method: a qualitative study, based on the Care Transitions Intervention theoretical model, with four pillars of intervention, to ensure a safe transition. Twelve professionals participated in a public hospital in the countryside of São Paulo. Data were collected through observation, document analysis and semi-structured interviews. Results: there was a commitment of a multidisciplinary team to comprehensive care and involvement of family members in patient care. The documents facilitated communication between professionals and/or levels of care. However, the lack of time to prepare for discharge can lead to fragmented care, impairing communication and jeopardizing a safe transition. Final considerations: they were shown to be important elements in discharge planning composition, aiming to ensure a safe care transition, team participation with nurses as main actors, early discharge planning and family involvement.

AbstractDue to the multiple barriers that prevent women from pursuing Science, Technology, Engineering, and Mathematics (STEM) careers, there is a persistent gender gap in these fields in many countries around the globe. Considering this, the purpose of this study was to compare the self-perceived employability among men and women, as well as to understand how it changes depending on age and employment status. For such purpose, an online questionnaire was administered to 505 senior students and recent graduates from five engineering programs offered by a higher education institution in Colombia. The relationships between the variables were examined using Pearson’s correlation test, data on women and men were compared using the t- Student test, and the interaction between gender and age was analyzed via factorial analysis of variance. According to the results, men had different and higher means than women, but these differences were not statistically significant. In terms of gender, the largest effect size was reported for the career resilience and optimism at work skills. Regarding employment status, employed respondents had different and higher means than unemployed respondents, and these differences were found to be statistically significant. These ground-breaking findings may help universities, organizations, and governments in the development of policies and strategies to draw and keep women in STEM careers. Importantly, it is imperative to focus on women’s career transition and advancement because their employability skills are just as strong as men’s, but they are less confident and less likely to achieve their career goals.

BackgroundHealthcare-associated infection (HAI) remains a significant risk for hospitalized patients and a challenging burden for the healthcare system. This study presents a clinical decision support tool that can be used in clinical workflows to proactively engage secondary assessments of pre-symptomatic and at-risk infection patients, thereby enabling earlier diagnosis and treatment.MethodsThis study applies machine learning, specifically ensemble-based boosted decision trees, on large retrospective hospital datasets to develop an infection risk score that predicts infection before obvious symptoms present. We extracted a stratified machine learning dataset of 36,782 healthcare-associated infection patients. The model leveraged vital signs, laboratory measurements and demographics to predict HAI before clinical suspicion, defined as the order of a microbiology test or administration of antibiotics.ResultsOur best performing infection risk model achieves a cross-validated AUC of 0.88 at 1 h before clinical suspicion and maintains an AUC >0.85 for 48 h before suspicion by aggregating information across demographics and a set of 163 vital signs and laboratory measurements. A second model trained on a reduced feature space comprising demographics and the 36 most frequently measured vital signs and laboratory measurements can still achieve an AUC of 0.86 at 1 h before clinical suspicion. These results compare favorably against using temperature alone and clinical rules such as the quick sequential organ failure assessment (qSOFA) score. Along with the performance results, we also provide an analysis of model interpretability via feature importance rankings.ConclusionThe predictive model aggregates information from multiple physiological parameters such as vital signs and laboratory measurements to provide a continuous risk score of infection that can be deployed in hospitals to provide advance warning of patient deterioration.

Peripheral neuropathy with antibodies to myelin-associated glycoprotein (MAG) is an autoimmune demyelinating disorder of the peripheral nervous system caused by pathogenic IgM recognizing the human natural killer-1 glycoepitope expressed on MAG. This study aimed to analyze the performance of a new indirect immunofluorescence cell-based assay (CBA, EUROIMMUN) for the detection of anti-MAG IgM. Antibody reactivity was determined in sera from 95 patients with clinical and neurophysiological evidence of anti-MAG-associated neuropathy and in control samples from 55 patients with other forms of peripheral neuropathy. Compared to the results of the gold standard method (ELISA, Bühlmann) and using samples at a dilution of 1:100, the CBA had a sensitivity of 98.9% and a specificity of 100% (PPV 100%, NPV 98.2%). In conclusion, the CBA allows the detection of antibodies to MAG using an easy and standardized technique, and it presents a sensitive and specific alternative to the more time-consuming ELISA. Larger studies are needed to address anti-MAG titer monitoring in parallel with clinical activity.

There is limited knowledge on how excess demand for elderly care influences patient outcomes. We used a natural experiment to estimate the causal effect of discharging elderly patients from hospital to municipalities with excess demand. In Norway, hospital in-patients are defined as ready-for-discharge when hospital treatment is completed, but the patient needs further care from municipal services. After this, the municipality of residence is obliged to either provide care for the patient or to pay the hospital a fixed fee per day that the patient spends in hospital. Municipal fee-days may thus indicate excess municipal demand. In the current paper, we studied how excess municipal demand, indicated by the number of fee-days accumulated in the municipality 30 days before an acute admission, influenced patient outcomes. To minimize confounding, we compared patients living within the same municipality, admitted during the same type of day, in the same year, but with varying excess demand. Our outcomes were mortality, resource use and healthcare costs at the primary and secondary care level, within 30 days. Between 2012 and 2016, 354,834 individuals (age≥70 years) had a total of 895,892 acute admissions. There was a 2% increased 30-day mortality per standard deviation change in accumulate fee-days (Hazard ratio (HR) of 1.02, 95% confidence interval (CI) 1.01-1.03). Individuals living in small municipalities (population10,000) had HR of 1.01 (95% CI 1.00-1.03). We found no substantial effect on subsequent healthcare use or costs. Relevance tests supported that fee-days was a good indication of excess demand, and balance tests supported that patients were comparable between periods with different excess demand. In conclusion, our results imply that older patients who are discharged to a municipality with excess demand have slightly elevated mortality, particularly in small municipalities.

ABSTRACT Objective: To conduct the cross-cultural adaptation and evaluate the evidence of content validity of the Adverse Events Associated with Nursing Practices instrument in the Brazilian context. Method: Psychometric study, conducted between June 2021 and February 2023, following the stages of the Patient-Reported Outcomes Measurement Information System protocol. Semantic, idiomatic, experimental and conceptual equivalences were evaluated, along with content validity evidence, considering Content Validity Ratio (CVR) parameters, with the participation of 25 experts. Results: A Brazilian version with 55 items was obtained, demonstrating good linguistic equivalence to the original version (agreement rate=99.2%), and adjustments in the items writing. CVR values remained above 0.60. Cognitive testing indicated good understanding, confirmed by the 31 participants in this stage, with a short application time (average = 17 minutes). Conclusion: The final version of the instrument showed good linguistic equivalence, strong evidence of content validity and a good response process in the Brazilian context.

The present paper introduces soil as a complex system, so a multidisciplinary approach is needed to study not only the composition, abundance, and transport of microplastics (MPs) in terrestrial ecosystems but also soil properties and processes involved in their degradation and/or interaction with soil polyphasic matrix. Despite many researchers focusing their studies on the impact of MPs on the terrestrial ecosystem over the past years, little has been done about the use of biochemical indicators to study their effect on soil functionality.

Introduction There is a need for simple and cheap diagnostic tools for diabetic polyneuropathy (DPN). We aimed to assess the diagnostic accuracy of the 5.07/10 g monofilament test in patients referred to polyneuropathy assessments, as well as to examine how disease severity, age, sex and neuropathic pain (NP) impact diagnostic accuracy.Research design and methods Five Norwegian university hospitals recruited patients with diabetes aged 18–70 referred to neurological outpatient clinics for polyneuropathy assessments. The 5.07/10 g Semmes-Weinstein monofilament examination (SWME) was validated against the Toronto consensus for diagnosing diabetic neuropathies; the results were stratified by age, sex and NP. Disease severity was graded by a combined nerve conduction study (NCS) Z-score, and logistic regression was applied to assess whether disease severity was a predictor of diagnostic accuracy.Results In total, 506 patients were included in the study. Global sensitivity was 0.60 (95% CI 0.55, 0.66), specificity 0.82 (95% CI 0.75, 0.87), positive and negative predictive values were 0.86 (95% CI 0.81, 0.90) and 0.52 (95% CI 0.46, 0.58), respectively, positive and negative likelihood ratios were 3.28 (95% CI 2.37, 4.53) and 0.49 (95% CI 0.42, 0.57), respectively. The SWME was less sensitive in females (0.43), had lower specificity in patients with NP (0.56), and performed worse in patients ≥50 years. NCS-based disease severity did not affect diagnostic accuracy (OR 1.15, 95% CI 0.95, 1.40).Conclusions This multicenter study demonstrates poor diagnostic performance for the 5.07/10 g SWME in patients with diabetes referred to polyneuropathy assessments; it is particularly unsuited for female patients and those with NP. The diagnostic accuracy of the SWME was not influenced by NCS-based disease severity, demonstrating that it does not perform better in patients with later stages of DPN. We do not recommend the use of the 5.07/10 g monofilament in the evaluation of patients with diabetes referred to polyneuropathy assessments.

RESUMEN Introducción: La identificación temprana de factores de riesgo asociados a la presencia de periodontitis en embarazadas, permite encaminar las acciones de salud destinadas a evitar la aparición y avance de la enfermedad. Objetivo: Asociar factores de riesgo a la presencia de periodontitis en mujeres embarazadas del municipio Holguín. Método: Se realizó un estudio transversal en 403 embarazadas. Se estudiaron la presencia de periodontitis, factores socio-demográficos, hábitos y estrés psicológico. Se utilizó el Índice Periodontal de Russell forma OMS modificado. Para el análisis de la asociación entre la presencia de periodontitis y las variables descriptoras, en el caso de la edad, este análisis se desarrolló a través del coeficiente Eta cuadrado, mientras que para el resto de las variables se determinó esta posible asociación, a través de la prueba X2 de Independencia. Se analizaron además las razones de prevalencia de la exposición, para determinar la fuerza de la posible asociación entre las variables. Resultados: De las 403 embarazadas estudiadas, 80 presentaron periodontitis (12,41%), que predominó en las mayores de 29 años. La higiene bucal deficiente se detectó en 58 (72,5%) y 45 fueron fumadoras activas (56,3%). La vulnerabilidad elevada al estrés psicológico se presentó en 59 casos (73,8%). Conclusiones: La periodontitis estuvo asociada de forma significativa a la edad mayor de 29 años en el embarazo, la multiparidad, la higiene bucal deficiente, el hábito de fumar y a la vulnerabilidad al estrés psicológico. Palabras clave: enfermedad periodontal, embarazo, periodontitis

Objetivo:pesquisar, na literatura, o perfil laboratorial dos pacientes acometidos gravemente pela COVID-19,bem como organizar um plano de cuidados de enfermagem de acordo com as alterações de biomarcadores elencados nessa revisão. Método:revisão integrativa realizada nas bases de dados MEDLINE e PubMed. Incluíram-se artigos envolvendo pacientes adultos e hospitalizados.Excluíram-se aqueles que não responderam à questão norteadora, estudos genéticos ou imunológicos, estudos repetidos e artigos de opinião. Posteriormente, foram elencados diagnósticos e intervenções de enfermagem para alterações laboratoriais encontradas. Resultados:revisados 25 artigos, que mostraram alterações laboratoriais em biomarcadores inflamatórios,de coagulação, bioquímicos e hematológicos capazes de interferir na funcionalidade do organismo, podendo acarretar complicações clínicas, como sangramentos, edemas e tromboembolismos, tornando fundamental a elaboração de plano de cuidados pelo Enfermeiro.Considerações finais:biomarcadores laboratoriais são importantes para identificação de pacientes com risco de gravidade e mortalidade, contribuindo para definição de diagnósticos e condutas de enfermagem em terapia intensiva. Descritores:COVID-19.Biomarcadores.Unidade de Terapia Intensiva.Cuidados de Enfermagem.Diagnóstico de Enfermagem.

Abstract Background Damaging alterations in the BRCA1 gene have been extensively described as one of the main causes of hereditary breast and ovarian cancer (HBOC). BRCA1 alterations can lead to impaired homologous recombination repair (HRR) of double-stranded DNA breaks, a process which involves the RING, BRCT and coiled-coil domains of the BRCA1 protein. In addition, the BRCA1 protein is involved in transcriptional activation (TA) of several genes through its C-terminal BRCT domain. Methods In this study, we have investigated the effect on HRR and TA of 11 rare BRCA1 missense variants classified as variants of uncertain clinical significance (VUS), located within or in close proximity to the BRCT domain, with the aim of generating additional knowledge to guide the correct classification of these variants. The variants were selected from our previous study “BRCA1 Norway”, which is a collection of all BRCA1 variants detected at the four medical genetic departments in Norway. Results All variants, except one, showed a significantly reduced HRR activity compared to the wild type (WT) protein. Two of the variants (p.Ala1708Val and p.Trp1718Ser) also exhibited low TA activity similar to the pathogenic controls. The variant p.Trp1718Ser could be reclassified to likely pathogenic. However, for ten of the variants, the total strength of pathogenic evidence was not sufficient for reclassification according to the CanVIG-UK BRCA1/BRCA2 gene-specific guidelines for variant interpretation. Conclusions When including the newly achieved functional evidence with other available information, one VUS was reclassified to likely pathogenic. Eight of the investigated variants affected only one of the assessed activities of BRCA1, highlighting the importance of comparing results obtained from several functional assays to better understand the consequences of BRCA1 variants on protein function. This is especially important for multifunctional proteins such as BRCA1.

Abstract Thermal neutron detection is a key subject for nuclear physics research and also in a wide variety of applications from homeland security to nuclear medicine. In this work, it is proposed a novel flexible and conformable composite thermal neutron scintillator based on a fully enriched Lithium Tetraborate preparation ( $$^{6}$$ 6 Li $$_2^{10}$$ 2 10 B $$_4$$ 4 O $$_7$$ 7 ) combined with a phosphorescent inorganic scintillator powder (ZnS:Ag), and is then distributed into a polydimethylsiloxane matrix. The proposed scintillator shows a good neutron detection efficiency (max. $$\sim$$ ∼ 57% with respect to the commercial EJ-420), an average light output of $$\sim$$ ∼ 9000 ph/neutron-capture, a remarkable insensitivity to $$\gamma$$ γ -rays (Gamma Rejection Ratio

Abstract Background Abdominal examination is a routine procedure performed by midwives several times during pregnancy to monitor the growth and well-being of the baby. Literature and instructions regarding abdominal examination focus on the technical performance, with limited attention paid to the women’s experience of the examination or the bonding-related aspects between the mother and baby. The aim of the study was to explore how pregnant women experience the abdominal examination and how the examination affects maternal–fetal attachment. Methods Participant observation and semi-structured interviews with 10 pregnant women. We used thematic analysis to identify themes across the empirical material. Results We identified the following four central themes: an essential examination, the baby becomes real, the importance of being involved and different senses provide different experiences. These themes describe how the women regarded the abdominal examination as an essential part of the midwifery consultation and considered it the occasion when the baby became real and tangible. Being prepared and involved before and during the examination were pivotal for how the examination was experienced by the women. The abdominal examination was crucial to the pregnant women because it provided them with important sensory aspects that were not obtained from ultrasound examination. Conclusion The abdominal examination is regarded as essential in midwifery consultations and has the potential for supporting a woman’s bodily sensation of her baby, which is reinforced by the midwife’s manual palpation. Touch can be a way for a pregnant woman to become acquainted with her unborn child, which provides midwives a profound potential to facilitate the process of maternal–fetal attachment.

Identifying and mapping strategic areas for conservation and restoration actions are essential initiatives to reduce human impact on biodiversity. However, most spatial prioritization does not involve decision-makers and stakeholders, generating a science-application gap. Here, we describe a participatory framework to map strategic areas for conservation of 27 species and their ecosystems (SASC), and strategic areas for ecosystem restoration (SAER) in a highly diverse region of Bahia, Brazil. We had eleven participatory meetings where scientists, decision-makers and stakeholders discussed and agreed with the project and methodology. The participants chose five prioritization criteria: habitat amount, environmental suitability, fire frequency, permanently protected area amount and diversity of phytophysiognomies, in this order of relevance. We generated technical maps based on these criteria, which were adjusted to 11 SASC and 12 SAER, according to participants’ perspectives. Many decisions taken during this process would hardly be taken in a conventional academic prioritization process, as some demands arose from participants. These maps are the first step for many posterior conservation actions (e.g. reducing agricultural impacts and species trade), therefore, the results were made accessible to the general public. This process provided participants a sense of ownership of the knowledge, as they became active agents in the process.

Abstract Dissemination of high-grade serous ovarian cancer (HG-SOC) in the omentum and intercalation into a mesothelial cell (MC) monolayer depends on functional α5β1 integrin (Intα5β1) activity. Although the binding of Intα5β1 to fibronectin drives these processes, other molecular mechanisms linked to integrin inside-out signaling might support metastatic dissemination. Here, we report a novel interactive signaling that contributes to Intα5β1 activation and accelerates tumor cells toward invasive disease, involving the protein β-arrestin1 (β-arr1) and the activation of the endothelin A receptor (ETAR) by endothelin-1 (ET-1). As demonstrated in primary HG-SOC cells and SOC cell lines, ET-1 increased Intβ1 and downstream FAK/paxillin activation. Mechanistically, β-arr1 directly interacts with talin1 and Intβ1, promoting talin1 phosphorylation and its recruitment to Intβ1, thus fueling integrin inside-out activation. In 3D spheroids and organotypic models mimicking the omentum, ETAR/β-arr1-driven Intα5β1 signaling promotes the survival of cell clusters, with mesothelium-intercalation capacity and invasive behavior. The treatment with the antagonist of ETAR, Ambrisentan (AMB), and of Intα5β1, ATN161, inhibits ET-1-driven Intα5β1 activity in vitro, and tumor cell adhesion and spreading to intraperitoneal organs and Intβ1 activity in vivo. As a prognostic factor, high EDNRA/ITGB1 expression correlates with poor HG-SOC clinical outcomes. These findings highlight a new role of ETAR/β-arr1 operating an inside-out integrin activation to modulate the metastatic process and suggest that in the new integrin-targeting programs might be considered that ETAR/β-arr1 regulates Intα5β1 functional pathway.

Presentamos un estudio comparativo, a lo largo de una trayectoria extensa (siglos VI-XIX), de un conjunto de hilados en fibra animal y vegetal que fueron recuperados a partir de excavaciones arqueológicas en Antofagasta de la Sierra, Puna meridional argentina. Nos enfocamos en tres temas, a modo de “hilos conductores”: la materia prima, los modos de hilar y el manejo del color. Discutimos continuidades y cambios en el tiempo y nos preguntamos acerca de sus implicancias en diversos aspectos técnicos y de la cosmovisión, especialmente a partir del impacto de la invasión hispana. Es por ello que, desde un punto de vista heurístico, tenemos en cuenta a las ontologías nativas, como miradas más próximamente situadas en relación a los contextos arqueológicos locales.

Objetivo: mapear los instrumentos para la evaluación del riesgo de lesiones por presión en adultos en situación crítica en una unidad de terapia intensiva; identificar los indicadores de desempeño de los instrumentos y la apreciación de los usuarios con respecto al uso/limitaciones de los instrumentos. Método: scoping review. Para redactar el estudio se utilizó la extensión Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. La investigación se realizó mediante la herramienta de búsqueda EBSCOhost en 8 bases de datos, resultando 1846 estudios, de los cuales 22 conforman la muestra. Resultados: se identificaron dos grandes grupos de instrumentos: los generalistas [Braden, Braden (ALB), Emina, Norton-MI, RAPS y Waterlow]; y los específicos (CALCULATE, Cubbin & Jackson, EVARUCI, RAPS-ICU, Song & Choi, Suriaidi y Sanada y el índice COMHON). En cuanto al valor predictivo, EVARUCI y CALCULATE mostraron los mejores resultados de indicadores de desempeño. En cuanto a las apreciaciones/limitaciones señaladas por los usuarios, destaca la escala CALCULATE, seguida de la EVARUCI y la RAPS-ICU, aunque aún necesitan ajustes futuros. Conclusión: el mapeo mostró que las evidencias son suficientes para indicar uno o más instrumentos para la evaluación del riesgo de lesiones por presión en adultos críticos en una unidad de cuidados intensivos.

Summary: Epidemiological data and research highlight increased neuropathy and chronic pain prevalence among females, spanning metabolic and normometabolic contexts, including murine models. Prior findings demonstrated diverse immune and neuroimmune responses between genders in neuropathic pain (NeP), alongside distinct protein expression in sciatic nerves. This study unveils adipose tissue’s (AT) role in sex-specific NeP responses after peripheral nerve injury. Metabolic assessments, metabolomics, energy expenditure evaluations, AT proteomic analyses, and adipokine mobilization depict distinct AT reactions to nerve damage. Females exhibit altered lipolysis, fatty acid oxidation, heightened energy expenditure, and augmented steroids secretion affecting glucose and insulin metabolism. Conversely, male neuropathy prompts glycolysis, reduced energy expenditure, and lowered unsaturated fatty acid levels. Males’ AT promotes regenerative molecules, oxidative stress defense, and stimulates peroxisome proliferator-activated receptors (PPAR-γ) and adiponectin. This study underscores AT’s pivotal role in regulating gender-specific inflammatory and metabolic responses to nerve injuries, shedding light on female NeP susceptibility determinants.

ABSTRACT: Brucellosis is a chronic contagious infectious zoonosis that affects the reproductive system of animals, causing economic and health losses. This study diagnosed Brucella spp. in commercial kennels, comparing PCR positivity in different biological samples (blood, semen, and vaginal secretion), as well as correlating these findings with reproductive indices. Hence, we analyzed dogs from kennels in the neighboring cities of Cuiabá and Várzea Grande/MT, Brazil. The reproductive histories of the animals were obtained and blood samples were collected from all animals (n=35); in addition, semen samples were collected from males (n=9) and vaginal swabs were collected from females (n=24) to perform polymerase chain reactions (PCR) for brucellosis. The findings indicated that vaginal swab PCR is an effective test to identify Brucella spp. For males, there were more positive results when testing blood samples, possibly because the male animals were at the beginning stage of infection.

Summary: Background: Preterm birth is associated with increased risk of childhood infections. Whether this risk persists into adulthood is unknown and limited information is available on risk patterns across the full range of gestational ages. Methods: In this longitudinal, register-based, cohort study, we linked individual-level data on all individuals born in Norway (January 01, 1967–December 31, 2016) to nationwide hospital data (January 01, 2008–December 31, 2017). Gestational age was categorised as 23–27, 28–31, 32–33, 34–36, 37–38, 39–41, and 42–44 completed weeks. The analyses were stratified by age at follow-up: 0–11 months and 1–5, 6–14, 15–29, and 30–50 years. The primary outcome was hospitalisation due to any infectious disease, with major infectious disease groups as secondary outcomes. Adjusted hospitalisation rate ratios (RRs) for any infection and infectious disease groups were estimated using negative binomial regression. Models were adjusted for year of birth, maternal age at birth, parity, and sex, and included an offset parameter adjusted for person-time at risk. Findings: Among 2,695,830 individuals with 313,940 hospitalisations for infections, we found a pattern of higher hospitalisation risk in lower gestational age groups, which was the strongest in childhood but still evident in adulthood. Comparing those born very preterm (28–31) and late preterm (34–36) to full-term (39–41 weeks), RRs (95% confidence interval) for hospitalisation for any infectious disease at ages 1–5 were 3.3 (3.0–3.7) and 1.7 (1.6–1.8), respectively. At 30–50 years, the corresponding estimates were 1.4 (1.2–1.7) and 1.2 (1.1–1.3). The patterns were similar for the infectious disease groups, including bacterial and viral infections, respiratory tract infections (RTIs), and infections not attributable to RTIs. Interpretation: Increasing risk of hospitalisations for infections in lower gestational age groups was most prominent in children but still evident in adolescents and adults. Possible mechanisms and groups that could benefit from vaccinations and other prevention strategies should be investigated. Funding: St. Olav's University Hospital and Norwegian University of Science and Technology, Norwegian Research Council, Liaison Committee for education, research and innovation in Central Norway, European Commission, Academy of Finland, Sigrid Jusélius Foundation, Foundation for Pediatric Research, and Signe and Ane Gyllenberg Foundation.

Acute Bacterial Skin and Skin Structure Infections (ABSSSI) are marked by substantial morbidity, frequent need for hospitalization, and long courses of intravenous antibiotic therapy. Herein, we report four cases of pediatric patients admitted for ABSSSI and managed with a combination antibiotic regimen incorporating dalbavancin: a second-generation lipoglycopeptide active against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus. In our experience, particularly in a setting with a high methicillin-resistance rate, dalbavancin demonstrated safety and efficacy, simplifying ABSSSI management in childhood. Its prolonged half-life enables a single-dose administration regimen, offering potential solutions to numerous challenges encountered in pediatric care, such as extended hospital stays, difficulties in securing and maintaining vascular access, lack of pediatric-specific drug indications, and limited availability of suitable oral formulations.

Pleurotus eryngii is an edible mushroom that suffers significant losses due to fungal contamination and bacteriosis. The Pseudomonadaceae family represents one of the most frequent etiologic agents. Grapefruit seed extract (GSE) is a plant extract that contains different bioactive components, such as naringin, and exhibits a strong antibacterial and antioxidant activity. Over the last decade, GSE use as an alternative to chemical treatments in the food sector has been tested. However, to our knowledge, its application on mushroom crops has never been investigated. This study focuses on evaluating GSE efficacy in preventing P. eryngii yellowing. GSE antibiotic activity, inhibitory and bactericidal concentrations, and antibiofilm activity against several microorganisms were tested with the Kirby–Bauer disk diffusion assay, the broth microdilution susceptibility test, and the Crystal violet assay, respectively. In vitro, the extract exhibited antimicrobial and antibiofilm activity against Staphylococcus aureus 6538 and MRSA (wild type), Escherichia coli ATCC 8739, and Pseudomonas spp. (Pseudomonas aeruginosa 9027, P. fluorescens (wild type)). GSE application in vivo, in pre- and post-sprouting stages, effectively prevented bacterial infections and subsequent degradation in the mushroom crops: none of the P. eryngii treated manifested bacteriosis. Our findings support the use of GSE as an eco-friendly and sustainable alternative to chemical treatments for protecting P. eryngii crops from bacterial contamination, consequently ensuring food safety and preventing financial losses due to spoilage. Furthermore, GSE’s potential health benefits due to its content in naringin and other bioactive components present new possibilities for its use as a nutraceutical in food fortification and supplementation.

Open resources are increasingly used in preventive archaeology, following a more general trend in society, with a useful and effective impact for this task. In fact, on the one hand, we are witnessing the definition of standards increasingly devoted to open source access by the direct decision of the Ministry of Culture, effective both at a central and peripheral level, in order to guarantee standardization and interoperability in data management. On the other hand, in the preliminary archaeological risk assessment phase, the use of contextual data—cartography, remote images, datasets, etc.—which increasingly populate the open source repositories of the web, is necessary, but not always obvious to recover. The use of open source resources in preventive archaeology must be improved, as sometimes they are employed at an insufficient definition. What are the opportunities ahead, but also the main limitations that have not yet been overcome?

This systematic review was conducted with the objective of understanding the efficacy and safety of proton pump inhibitors (PPIs) in the pediatric population. We used PubMed to identify randomized controlled trials (RCTs) published between 1 June 2010 and 30 June 2023, performed in patients from birth to 18 years old with gastroesophageal reflux disease (GERD) who received treatment with any PPI. This literature search yielded 76 articles and 13 of these met the inclusion criteria. For infants, PPIs were equal to placebos in reducing GERD symptoms in four articles. In one article, the numbers of GER episodes and esophageal acid exposures were lower in infants who received PPIs in the left lateral position, but there was generally no significant improvement in symptoms. In another publication, the combination of PPIs and feeding modifications (FMs) was not more effective than PPIs alone. For children and adolescents, PPIs were effective in improving symptoms and achieving endoscopic healing, which was subsequently maintained. To conclude, PPIs are not effective in reducing the symptoms related to GERD in infants but are effective in older children, where histological remission can be seen. Generally, PPIs are well tolerated, but it is important to remember the possible adverse events (AEs), especially if PPIs are used for an extended period.

En el campo de la odontología y las ciencias médicas, las prácticas presenciales con el respectivo instrumento brindan una experiencia necesaria en la formación de profesionales. Sin embargo, el alto costo de los instrumentos y su respectivo mantenimiento son un obstáculo para estudiantes e instituciones con recursos limitados. El objetivo del presente trabajo de investigación es crear un repositorio gratuito de código abierto de modelos 3D perteneciente al instrumental de un kit odontológico, a partir de una metodología basada en procesos estandarizados en trabajos multimedia y recurrentemente, utilizados a su vez en producciones de índole tridimensional. Esta metodología se divide en tres amplias faces que son preproducción, producción y posproducción, cada una con sus diferentes etapas que favorecen al óptimo desarrollo del repositorio, de manera que los instrumentos modelados tengan un favorable acercamiento a la realidad. El estudio aspira a que el repositorio tenga diferentes usos que solventen las variadas necesidades presentes en la educación del campo odontológico y si es posible ser usados en trabajos con horizontes más extensos. Finalmente, el repositorio fue subido a una plataforma de libre acceso donde puede ser descargado para desarrollar proyectos que cumplan con la finalidad de los modelos almacenados.

Background: Major depressive disorder is identified as a mood disorder characterized by episodically recurring and potentially life-threatening negative symptoms. It is currently important for study, as it involves high morbidity, mortality and prevalence, as well as unsatisfactory treatment results. Aim: Establish an outpatient model from an integrative approach promoting the diversified development of traditional Chinese and Western medicine cooperation, leading to a holistic intervention for patients with depression. Experimental procedure: Fifteen participants with moderate to severe depression were followed up for eight weeks in the Acupuncture Department of the China Medical University Hospital in Taichung, Taiwan, under a collaborative outpatient model that combined Western psychiatry and traditional Chinese medicine (TCM). Interdisciplinary Intervention included manual acupuncture twice a week (16 sessions), tai chi, yoga meditation, and nutritional assessment. Symptomatology was measured with primary outcomes (self-reporting via questionnaires) and secondary outcomes (heart rate variability [HRV] and blood samples to measure inflammation via high-sensitivity C-reactive protein [hs-CRP]). Results: The response rate was 80% (12/15 participants), with a statistically and clinically significant decrease in depression severity according to the 21-question Hamilton depression rating scale (HDRS21) (p

Calcium phosphates are biomaterials widely used in bone tissue engineering. In recent years, the alternative of obtaining these materials with antimicrobial properties, has been explored due to the multiple advantages that this would imply in the design of devices or implants that prevent the failure of these associated with bacterial colonization. The goal of the present work was obtaining gold nanoparticles supported on biphasic calcium phosphates (BCPs) with high crystallinity by one-step solution combustion technique, and with antimicrobial response, a fact that can significantly reduce the production cost of these materials. X-ray diffractograms (XRD) showed that prepared powders have high crystallinity owing to high temperatures during the combustion reaction, also Rietveld refinement showed that the inclusion of gold nanoparticles (AuNPs) influenced the phases’ ratio obtained. Furthermore, scanning electron microscopy (SEM) showed agglomeration of particles with morphologies with shape tending to be equigranular, while the presence of AuNPs was corroborated by transmission electron microscopy (TEM). All samples that were obtained in a single step, by solution combustion, showed antimicrobial behavior validated through the inhibition halos, whereas particles subjected to thermal treatment lost their antimicrobial response. Resumen: Los fosfatos de calcio son biomateriales ampliamente usados en ingeniería de tejido óseo. En los últimos años, la alternativa de obtener estos materiales con propiedades antimicrobianas ha sido explorada debido a las múltiples ventajas que presentan en el diseño de dispositivos o implantes que incluyan la prevención de fallas asociadas a la colonización bacteriana. El principal objetivo de esta investigación fue obtener nanopartículas de oro soportadas en fosfatos de calcio bifásicos bien cristalizados en una sola etapa mediante la técnica de combustión de soluciones y con respuesta antimicrobiana, un hecho que puede significar la reducción del coste de producción de estos materiales. Los difractogramas de rayos X evidenciaron que los polvos preparados presentaron una alta cristalinidad debido a las altas temperaturas durante la reacción de combustión. El refinamiento Rietveld mostró que la inclusión de las nanopartículas de oro influenciaron la relación de las fases obtenidas. La microscopia electrónica de barrido mostró la aglomeración de partículas con morfologías tendentes a ser equigranulares. La presencia de nanopartículas de oro fue corroborada mediante microscopia electrónica de transmisión. Todas las muestras que fueron obtenidas en un solo paso mediante la combustión de soluciones mostraron un comportamiento antimicrobiano validado a través de halos de inhibición, mientras que, en las partículas sometidas a tratamiento térmico, este comportamiento estuvo ausente.

En el perfil profesional de los programas educativos de todas las disciplinas se señala que las competencias de los estudiantes universitarios tendrán que reflejar sus conocimientos, capacidades y habilidades para operar en un mundo más interconectado globalmente. Las competencias Sociales y Emocionales, como parte fundamental del ser y de la memoria social dan a los estudiantes de pregrado un punto de partida para su formación y al mismo tiempo influye en la constitución de la inteligencia Intercultural que le permitirá al futuro profesional desempeñarse en un contexto global, como parte fundamental del perfil integral.

Hybrid organic-inorganic (dendritic polymer-silica) xerogels containing silver nanoparticles (Ag Nps) were developed as antibacterial leather coatings. The preparation method is environmentally friendly and is based on two biomimetic reactions. Silica gelation and spontaneous Ag Nps formation were both mediated by hyperbranched poly (ethylene imine) (PEI) scaffolds of variable Mw (2000–750,000). The formation of precursor hydrogels was monitored by dynamic light scattering (DLS). The chemical composition of the xerogels was assessed by infrared spectroscopy (IR) and energy-dispersive X-ray spectroscopy (EDS), while the uniformity of the coatings was established by scanning electron microscopy (SEM). The release properties of coated leather samples and their overall behavior in water in comparison to untreated analogs were investigated by Ultraviolet-Visible (UV-Vis) spectroscopy. Antibacterial activity was tested against Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus, and antibiofilm properties against Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Acinetobacter baumannii, and Enterococcus faecalis, while the SARS-CoV-2 clinical isolate was employed for the first estimation of their antiviral potential. Toxicity was evaluated using the Jurkat E6.1 cell line. Finally, water-contact angle measurements were implemented to determine the enhancement of the leather surface hydrophilicity caused by these composite layers. The final advanced products are intended for use in medical applications.

Introduction Continuous general practitioner (GP) and patient relations associate with positive health outcomes. Termination of GP practice is unavoidable, while consequences of final breaks in relations are less explored. We will study how an ended GP relation affects patient’s healthcare utilisation and mortality compared with patients with a continuous GP relation.Methods and analysis We link national registries data on individual GP affiliation, sociodemographic characteristics, healthcare use and mortality. From 2008 to 2021, we identify patients whose GP stopped practicing and will compare acute and elective, primary and specialist healthcare use and mortality, with patients whose GP did not stop practicing. We match GP–patient pairs on age and sex (both), immigrant status and education (patients), and number of patients and practice period (GPs). We analyse the outcomes before and after an ended GP–patient relation, using Poisson regression with high-dimensional fixed effects.Ethics and dissemination This study protocol is part of the approved project Improved Decisions with Causal Inference in Health Services Research, 2016/2159/REK Midt (the Regional Committees for Medical and Health Research Ethics) and does not require consent. HUNT Cloud provides secure data storage and computing. We will report using the STROBE guideline for observational case–control studies and publish in peer-reviewed journals, accessible in NTNU Open and present at scientific conferences. To reach a broader audience, we will summarise articles in the project’s web page, regular and social media, and disseminate to relevant stakeholders.

Este artigo teve como objetivo identificar as concepções e práticas de gestão relacionadas à política do envelhecimento ativo em um município C. É uma pesquisa qualitativa, estudo de caso, realizada por meio de entrevista semiestruturada com oito sujeitos. Para análise dos dados, foi utilizado como suporte teórico-metodológico o documento da Organização Mundial da Saúde, Envelhecimento Ativo e a Análise do Discurso sob a perspectiva da Teoria Semiolinguística de Patrick Charaudeau. Os gestores envolvidos apontam o envelhecimento como processo natural, multifatorial e contínuo, que requer políticas públicas voltadas às demandas geradas pelo fenômeno, além de uma vitória, que necessita de investimentos ao longo da vida para que o momento seja vivido com autonomia, independência, saúde e qualidade de vida. Outra associação do envelhecimento foi conferida à incapacidade, necessidade de provisão de cuidados, aumento dos gastos com saúde e previdência, e preconceito com a pessoa idosa. Quanto às práticas, os gestores reconhecem a importância da atuação do órgão ou instituição da qual eles fazem parte, oportunizando a construção de uma velhice ativa e saudável, porém parece apresentar um distanciamento de uma intervenção que se aproprie dos pilares do Envelhecimento Ativo, como estratégia de gestão.

Introduction: complicated skin injuries have become a global health problem, being difficult to treat due to the body’s limited healing process. Many studies aim to enhance traditional treatments for skin injuries, which have many disadvantages. Therefore, wound healing research is aiming towards tissue engineering options, such as decellularized matrix, which have shown great healing and biocompatibility competencies. Objectives: to obtain and characterize the properties of a decellularized biological matrix derived from the small intestine of animals. Methods: porcine small intestine was prepared and decellularized using four different methods: Triton X-100, sodium dodecyl sulfate (SDS) and sodium deoxycholate (SDC) for one or two cycles of 6 hours or 24 hours, and peracetic acid for one cycle of 2 hours. The remaining DNA was quantified with Nanodrop and electrophoresis characterization. Histology stains and Scanning Electron Microscopy (SEM) were performed to assess surface structure and integrity. Resistance assays were conducted to measure mechanical strength. Finally, degradability assays with different buffers were performed. Results: no differences between the decellularization protocols regarding remaining DNA were found, making protocols of one cycle of six hours more efficient. With the least remaining DNA content and better structure perseveration, TX-100 could be considered as the best protocol. No statistically difference between protocols and native tissue were found during the mechanical analysis. Biodegradability assays showed the expected degradability properties of the produced matrix. Conclusions: promising results were achieved to obtain decellularized biological matrices that could serve as a treatment for complicated skin wounds. More in vitro and molecular studies should be carried out in future studies to further characterize these scaffolds.

IntroductionThe association of myelin oligodendrocyte glycoprotein (MOG) antibody associated disease (MOGAD) and tumors has seldom been reported. We aim to investigate the occurrence of tumors in a cohort of patients with MOGAD and to describe their clinical features, in addition to previously reported cases.MethodsWe retrospectively identified patients with MOGAD (i.e., compatible clinical phenotype and positive MOG antibodies analysed with a live cell-based assay) from 1/1/2015 to 1/1/2023 who had a neoplasm diagnosed within 2 years from MOGAD onset. Furthermore, we performed systematic review of literature to identify previously reported cases. Clinical, paraclinical and oncological findings were collected and reported as median (range) or number (percentage).ResultsTwo of 150 MOGAD patients (1%) had a concomitant neoplasm in our cohort. Fifteen additional cases were retrieved from literature. Median age was 39 (16–73) years-old, 12 patients were female. ADEM (n = 4;23.5%), encephalomyelitis (n = 3;17.6%), and monolateral optic neuritis (n = 2;11.8%) were the most frequent phenotypes. Median number of treatments was 1 (range 1–4), improvement was reported in 14/17 cases (82.4%). Oncological accompaniments were teratoma (n = 4), CNS (n = 3), melanoma (n = 2), lung (n = 2), hematological (n = 2), ovary (n = 1), breast (n = 1), gastrointestinal (n = 1), and thymic (n = 1) neoplasms. Median time from tumor diagnosis to MOGAD onset was 0 (range − 60 to 20) months. MOG expression in neoplastic tissue was reported in 2/4 patients. Median PNS-CARE score was 3 (range 0–7): 11 patients were classified as “non-PNS,” 5 as “possible PNS,” and 1 as “probable PNS.”DiscussionOur study confirms that MOG is a low-risk antibody for paraneoplastic neurological syndromes and that the clinical presentation and oncological accompaniments are extremely variable. Most of these patients were classified as non-PNS, whereas only a minority was diagnosed with possible/probable PNS, frequently in association with ovarian teratoma. These findings support the notion that MOGAD is not a paraneoplastic disease.

Purpose: To evaluate the diagnostic accuracy of machine learning (ML) techniques applied to radiomic features extracted from OCT and OCT angiography (OCTA) images for diabetes mellitus (DM), diabetic retinopathy (DR), and referable DR (R-DR) diagnosis. Design: Cross-sectional analysis of a retinal image dataset from a previous prospective OCTA study (ClinicalTrials.gov NCT03422965). Participants: Patients with type 1 DM and controls included in the progenitor study. Methods: Radiomic features were extracted from fundus retinographies, OCT, and OCTA images in each study eye. Logistic regression, linear discriminant analysis, support vector classifier (SVC)-linear, SVC-radial basis function, and random forest models were created to evaluate their diagnostic accuracy for DM, DR, and R-DR diagnosis in all image types. Main Outcome Measures: Area under the receiver operating characteristic curve (AUC) mean and standard deviation for each ML model and each individual and combined image types. Results: A dataset of 726 eyes (439 individuals) were included. For DM diagnosis, the greatest AUC was observed for OCT (0.82, 0.03). For DR detection, the greatest AUC was observed for OCTA (0.77, 0.03), especially in the 3 × 3 mm superficial capillary plexus OCTA scan (0.76, 0.04). For R-DR diagnosis, the greatest AUC was observed for OCTA (0.87, 0.12) and the deep capillary plexus OCTA scan (0.86, 0.08). The addition of clinical variables (age, sex, etc.) improved most models AUC for DM, DR and R-DR diagnosis. The performance of the models was similar in unilateral and bilateral eyes image datasets. Conclusions: Radiomics extracted from OCT and OCTA images allow identification of patients with DM, DR, and R-DR using standard ML classifiers. OCT was the best test for DM diagnosis, OCTA for DR and R-DR diagnosis and the addition of clinical variables improved most models. This pioneer study demonstrates that radiomics-based ML techniques applied to OCT and OCTA images may be an option for DR screening in patients with type 1 DM. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Abstract Aims To study the consequences of crowded wards among patients with cardiovascular disease. Methods and results This is a cohort study among 201 801 patients with 258 807 admissions who were acutely admitted for myocardial infarction (N = 107 895), stroke (N = 87 336), or heart failure (N = 63 576) to any Norwegian hospital between 2008 and 2016. The ward admitting most patients with the given clinical condition was considered a patient's home ward. We compared patients with the same condition admitted when home ward occupancy was different, at the same hospital and during comparable time periods. Occupancy was standardized such that a one‐unit difference corresponded to the interquartile range in occupancy in the given month. One interquartile increase in home ward occupancy was associated with 7% higher odds of admission to an alternate ward [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.09 to 1.11], and length of stay was shorter (−0.10 days, 95% CI −0.18 to −0.09). Patients with heart failure had 15% higher odds of admission to alternate wards (OR 1.15, 95% CI 1.08 to 1.23) and increased mortality [hazard ratio (HR) 1.08, 95% CI 1.03 to 1.15]. We found no apparent effect on mortality for patients with myocardial infarction (HR 0.99, 95% CI 0.94 to 1.05) or stroke (HR 1.00, 95% CI 0.96 to 1.05). Conclusions Patients with heart failure had higher risk of admission to alternate wards when home ward occupancy was high. These patients may be negatively affected by full wards.

The role of women’s care in the territorial transformation represents, in a natural manner in the community, an extension of the domestic space in the community development field. To understand this, a qualitative research was carried out in contexts of inequality based on the experience of eight professional women, thirty-eight and sixty-two years old, mothers and heads of household, with historical and leadership responsibilities in their neighborhoods and microterritories of the Popular Commune 1. Among the discourses recorded, intentions, fears, errors, and difficulties in exercising social participation in health are revealed by the complex institutional and community tensions. Even so, women assume social participation in health as a way of life, and health, particularly as an issue that transcends the health sector and creates opportunities for well-being.

A domain-specific perspective to cognitive functioning in stroke patients may predict their cognitive recovery over time and target stroke rehabilitation intervention. However, data about domain-specific cognitive impairment after stroke are still scarce. This study prospectively investigated the domain-specific pattern of cognitive impairments, using the classification proposed by the Montreal Cognitive Assessment (MoCA), in a cohort of 49 stroke patients at admission (T0), discharge (T1), and six-month follow-up (T2) from subacute intensive rehabilitation. The predictive value of T0 cognitive domains cognitive impairment at T1 and T2 was also investigated. Patients’ cognitive functioning at T0, T1, and T2 was assessed through the MoCA domains for executive functioning, attention, language, visuospatial, orientation, and memory. Different evolutionary trends of cognitive domain impairments emerged across time-points. Patients’ impairments in all domains decreased from T0 to T1. Attention and executive impairments decreased from T0 to T2 (42.9% and 26.5% to 10.2% and 18.4%, respectively). Conversely, altered visuospatial, language, and orientation increased between T1 and T2 (16.3%, 36.7%, and 40.8%, respectively). Additionally, patients’ global cognitive functioning at T1 was predicted by the language and executive domains in a subacute phase (p = 0.031 and p = 0.001, respectively), while in the long term, only attention (p = 0.043) and executive (p = 0.019) domains intervened. Overall, these results confirm the importance of a domain-specific approach to target cognitive recovery across time in stroke patients.

Abstract Optical coherence tomography angiography (OCTA) enables three-dimensional, high-resolution, depth-resolved flow to be distinguished from non-vessel tissue signals in the retina. Thus, it enables the quantification of the 3D surface area of the retinal vessel signal. Despite the widespread use of OCTA, no representative spatially rendered reference vessel surface area data are published. In this study, the OCTA vessel surface areas in 203 eyes of 107 healthy participants were measured in the 3D domain. A Generalized Linear Model (GLM) model analysis was performed to investigate the effects of sex, age, spherical equivalent, axial length, and visual acuity on the OCTA vessel surface area. The mean overall vessel surface area was 54.53 mm2 (range from 27.03 to 88.7 mm2). OCTA vessel surface area was slightly negatively correlated with age. However, the GLM model analysis identified axial length as having the strongest effect on OCTA vessel surface area. No significant correlations were found for sex or between left and right eyes. This is the first study to characterize three-dimensional vascular parameters in a population based on OCTA with respect to the vessel surface area.

En la actualidad el aprendizaje significativo debe enfocarse en lograr que los estudiantes comprendan y apliquen sus habilidades cognitivas y socioemocionales en situaciones reales, debido a que se encuentran en una sociedad en constante cambio tecnológico, por lo que deben resolver problemas, tomar decisiones y construir un futuro exitoso y resiliente. El objetivo de este estudio fue analizar y cuestionar el concepto del aprendizaje significativo en la educación actual. La metodología aplicada fue cualitativa etnográfica, la técnica utilizada fue una entrevista basada en un instrumento de cinco preguntas semiestructuradas validada por juicio de expertos, la muestra por conveniencia estuvo conformada por 16 docentes de diferentes áreas de conocimiento pertenecientes a la ciudad de Milagro. Los resultados obtenidos fueron la comprensión profunda y crítica del concepto del aprendizaje significativo en el contexto de la educación actual, así como de sus implicaciones y potencialidades para mejorar la calidad y relevancia de la educación. Se concluye que el aprendizaje significativo sigue siendo un enfoque pedagógico relevante y necesario después de la pandemia, pero su implementación requiere de un esfuerzo conjunto por parte de los docentes, las autoridades educativas y la sociedad en general para superar los desafíos y obstáculos que se presentan, por lo que se debe crear un entorno educativo que promueva la reflexión crítica sobre el éxito de la práctica docente y fomente la colaboración entre los docentes.