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Wilson’s disease (WD) is a biallelic disease-causing variant in the ATP7B gene on chromosome 13q14.3 that results in copper accumulation in many organs, particularly the liver and brain. The phenotypic spectrum is wide and symptoms at onset can be heterogeneous. We describe two Sicilian siblings, a young man and his elder sister, both compound heterozygous for the variants c.1286-2A>G and c.2668G>A (p.Val890Met) in the ATB7B gene. The male patient presented with liver cirrhosis, which quickly progressed to end-stage liver disease (Child–Pugh score = C10), while his sister had moderate steatotic liver disease (SLD). Our findings highlight that SLD may not always be related to obesity in overweight patients, especially when there are other potential risk factors such as a family history of chronic liver disease, or the persistence of high transaminase despite the adoption of adequate dietary and pharmacological intervention. Screening for conditions such as WD could identify patients at risk of developing SLD and avoid delays in diagnosis. Phenotypic variability in WD is considerable; therefore, further studies are needed to identify which WD patients have a greater risk of developing SLD and determine factors that can predict the severity of the disease.

Assessing toxicity of complex mixtures of contaminants from industrial sites with historic and ongoing contamination remains a challenge for risk assessors. Groundwater from a pesticide packaging site in Canada containing a complex mixture of known and unknown contaminants was examined in male rats to determine the target organ toxicity. This study determined the time-course of toxicity (7, 14, 28, and 60 days) following ad libitum oral exposure to 0.05% v/v contaminated groundwater compared to tap water (control) in male Sprague Dawley rats (n=5 /group/time). Exposure to groundwater resulted in inflammation, indicated by a statistically significant increase in plasma lymphocyte and neutrophil counts on days 7 and 60, respectively, but a reduction in the plasma alpha 2 macroglobulin levels by day 60. Gonadotoxicity was indicated by a reduced Johnsen score (grading spermatogenesis) in all exposed groups at all time points, while seminiferous epithelial height was reduced on days 7, 14, and 28 compared to controls. Plasma testosterone was reduced in exposed groups on days 7 and 28, accompanied by elevated testicular lipid peroxidation at all time points compared to control. In contrast, lipid peroxidation in the lungs from exposed rats was elevated on days 7, 14, and 28. Plasma symmetric dimethylarginine was elevated on day 14 in the exposed group indicating renal impairment. Taken together, these results indicate that testes, kidney, immune and lung are target organs for the contaminated groundwater from this industrial site. The current study highlights the challenge in hazard assessment for complex mixtures and highlights the need for effects-directed analysis and the continued, albeit limited, use of animal models in toxicity testing.

It is known that dynamic transformation can occur in the austenite field above the Ae3 temperature in a rapidly displacive way and after diffusionally under stress. This phenomenon influences industrial thermomechanical processes by changing the expected applied loads during forging or rolling. In this investigation, laboratory-scale physical simulation of tensile test in a customized Gleeble thermomechanical simulator system equipped with a synchrotron light X-ray beam (12 keV) was carried out on a linepipe steel at 50 °C above the Ae3. The obtained stress-strain curves indicate that dynamic transformation took place during deformation. The X-ray diffraction patterns confirmed the formation of ferrite inside the austenite field during strain. The results confirm the direct evidence of the onset of ferrite formation due to the applied strain and its increase in volume fraction as the deformation continues. The main ferrite-phase peaks detected by the in-situ X-ray diffraction were the ones related to the (110) and (221) planes. Both peaks increased their intensity with the increasing strain, leading to a decrease in the gamma-phase peak intensities of the (111) and (220) planes. The total volume fraction of all ferrite peaks increased to approximately 50% when the strain reached a maximum value, while the fraction of all austenite peaks decreased proportionally. Microscopic measurements of the presented phases have shown excellent agreement with the results obtained from direct X-ray diffraction results. A comprehensive understanding of the dynamic transformation phenomenon mechanism is important to the industry sector in designing improved manufacturing parameters for products with good quality.

RESUMO O catálogo de fotoidentificação da população de boto-cinza, Sotalia fluviatilis, da Baía de Sepetiba vem sendo formado desde 1994. São apresentados os dados preliminares do período entre abril de 1994 a junho de 1998, os quais indicam haver fidelidade ao habitat e algum grau de associação entre indivíduos. São também apresentados os diversos problemas de campo que levam a baixos índices de aproveitamento de fotos. O catálogo de fotoidentificação vem gerando informações que subsidiarão futuros estudos ecológicos, necessários à proposição de medidas que permitirão a conservação da espécie nesta baía.

Background: Infective endocarditis continues to be a significant concern and may be undergoing an epidemiological transition. Methods: Were studied 1804 consecutive episodes of infective endocarditis between 1978 and 2022. The mean age was 48 ( ± 19), and 1162 (64%) patients were male. Temporal trends in demographic data, comorbidities, predisposing conditions, microorganisms, complications and in-hospital death have been studied over the decades (1978–1988, 1989–1999, 2000–2010 and 2011–2022). The outcomes and clinical characteristics were modeled using nonlinear cubic spline functions. Findings: Valve surgery was performed in 50% of the patients and overall in-hospital mortality was 30%. From the first to the fourth decade studied, the average age of patients increased from 29 to 57 years (p

Por meio da análise de objetos e aparatos tecnológicos publicizados em propagandas da Kósmos, revista ilustrada e importante suporte documental dos primeiros anos do século XX, este artigo buscou alcançar entendimento sobre como a sociedade carioca assimilou a modernização da Capital Federal, que efeitos produziu a interação com carros, com bondes elétricos, máquinas pe-sadas e outros modernismos que iam além das de ordem urbana, representados na imprensa da época. Para o estudo, foram analisadas todas as edições dos seis anos de publicação do impressoperiódico. Como demonstrado no estudo, a hipótese é que, como “janelas” para o entendimentoda cultura moderna, os aparatos tecnológicos e outros objetos publicizados nas páginas da imprensa trouxeram mais que revelações de como se deu a reconfiguração do espaço público, das novas formas de ver e ser na relação com a modernidade. Com simbologias próprias, auxiliaram na aspiração e na construção de um novo valor moral, seu caráter e um novo estilo de vida paraos cariocas.

OBJECTIVES:. Anemia has been associated with an increased risk of both cardiac arrest and stroke, frequent complications of COVID-19. The effect of hemoglobin level at ICU admission on a composite outcome of cardiac arrest or stroke in an international cohort of COVID-19 patients was investigated. DESIGN:. Retrospective analysis of prospectively collected database. SETTING:. A registry of COVID-19 patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with cardiac arrest or stroke up to 30 days after ICU admission. Anemia was defined as: normal (hemoglobin ≥ 12.0 g/dL for women, ≥ 13.5 g/dL for men), mild (hemoglobin 10.0–11.9 g/dL for women, 10.0–13.4 g/dL for men), moderate (hemoglobin ≥ 8.0 and < 10.0 g/dL for women and men), and severe (hemoglobin < 8.0 g/dL for women and men). PATIENTS:. Patients older than 18 years with acute COVID-19 infection in the ICU. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Of 6926 patients (median age = 59 yr, male = 65%), 760 patients (11.0%) experienced stroke (2.0%) and/or cardiac arrest (9.4%). Cardiac arrest or stroke was more common in patients with low hemoglobin, occurring in 12.8% of patients with normal hemoglobin, 13.3% of patients with mild anemia, and 16.7% of patients with moderate/severe anemia. Time to stroke or cardiac arrest by anemia status was analyzed using Cox proportional hazards regression with death as a competing risk. Covariates selected through clinical knowledge were age, sex, comorbidities (diabetes, hypertension, obesity, and cardiac or neurologic conditions), pandemic era, country income, mechanical ventilation, and extracorporeal membrane oxygenation. Moderate/severe anemia was associated with a higher risk of cardiac arrest or stroke (hazard ratio, 1.32; 95% CI, 1.05–1.67). CONCLUSIONS:. In an international registry of ICU patients with COVID-19, moderate/severe anemia was associated with increased hazard of cardiac arrest or stroke.

Plant phenology is the study of cyclical events in a plant life cycle such as leaf bud burst, flowering, and fruiting. In this article the problem of olive phenology prediction is addressed through the use of Deep Learning. Although Neural Networks have already been used in this area, to the best of our knowledge, this is the first implementation of Probabilistic Bayesian Neural Networks for olive phenology prediction. This architecture gives particular emphasis to estimating the model uncertainty, both aleatoric and epistemic. The Bayesian Inference method, more precisely the Variational Inference one, is compared with the Monte Carlo Dropout technique, which is known to be a less computationally intensive approximation of Variational Inference. For validation purposes, models performance is compared to the state-of-the-art results.

Epilepsy is a severe and common neurological disease that causes sudden and irregular seizures, necessitating patient-specific detection models for effective management. The proposed methodology, Epilepsy Tracking META-Set Analysis, establishes portability rules that identify similar patients, enabling the transfer of these detection models from one patient to another. Main issue is to identify clusters of patients analyzing a set of meta-features of each patient in terms of clinical descriptors, performance metrics of a machine learning model for seizure detection, and data complexity measures. The investigation of complexity measures represents a novelty in such a medical field, allowing to compare patients and to support automated seizure detection methods. The proposed methodology is validated using the well-known Epileptic Seizure EEG Database from the Epilepsy Center of the University Hospital of Freiburg and demonstrates promising results in transferring detection models to new cases.

IntroductionAccurately measuring the forces applied during spinal manipulation and its biomechanical effects on the spine are critically important in current research. This single case report discusses the potential benefit of accurately monitoring manipulative forces in treating low back pain with sciatica. The type of force-based spinal manipulation used to manage this case was Cox Technic flexion distraction decompression (CTFDD) spinal manipulation care, along with other ancillary modalities.MethodsThe treatment plan, in this case, was primarily force-based CTFDD, equal-force bi-directional traction (EqFT), pre-modulated electrical muscle stimulation (EMS), infrared light therapy (ILT), and a home stretching and strengthening program.Clinical findingsInitially, the case study patient presented with complaints of left lumbar spine pain, which radiated into the left buttock, down the left leg, accompanied by an inability to dorsiflex the left foot. The patient was concerned with this condition as the left leg pain and left lower extremity motor deficit were having a profound effect on the patient’s ability to perform activities of daily living and work. The patient was recommended to undergo spinal decompression surgery, which the patient did not want, and elected to exhaust all alternative, non-surgical treatments first.Diagnosis, intervention, and outcomesA diagnosis of sciatica with a sequestered disk fragment and left lower extremity motor deficit was rendered through objective physical examination results and a review of a lumbar MRI study. Past interventions included prescription medications, physical rehabilitation, chiropractic, pain management, and neurosurgical consultation. All past interventions prior to initiating CTFDD care provided minimal subjective and/or objective clinical improvement. This patient had a positive clinical outcome from a force-based CTFDD treatment plan along with other modalities consisting of pre-modulated EMS, ILT, and a home stretching and strengthening program.ConclusionForce-based CTFDD spinal manipulation, along with other modalities consisting of pre-modulated EMS, ILT, and a home stretching and strengthening program, has been found to be an alternative, non-surgical treatment for discogenic sciatica. Continued research is needed on force-based CTFDD spinal manipulation to further evaluate the neurological and biomechanical effects of the forces and motion applied to the spine and determine health benefits for the treatment of low back pain.

IntroductionExcessive daytime sleepiness (EDS) is a common and debilitating symptom in both forms of myotonic dystrophy (DM), significantly impacting patients’ quality of life. The review focuses on the purpose of examining the current understanding of EDS in these conditions, the difficulty in correctly accessing it, the recent findings related to its etiology and prevalence, and a summary of potential therapeutic implications.MethodsWe conducted a comprehensive search through PubMed, selecting studies that provided significant insights into the mechanisms, prevalence, and management of EDS in DM1 and DM2.Results and discussionEDS is highly prevalent in both DM1 and DM2. Polysomnographic studies have revealed prominent dysregulation of REM sleep in DM1, suggesting a possible narcoleptic-like phenotype and alterations in NREM sleep that contributes to daytime sleepiness. Other factors have been proposed to explain EDS in DM1, including dysregulation of the sleep-wake circadian rhythm through nocturnal actigraphy analysis. The central origin of EDS is increasingly delineated supported by serotonin and orexin pathways dysfunction, and recent neuroradiological findings showing that in DM1 hippocampus volume was positively correlated with self-reported fatigue and somnolence. Sleep-disordered breathing and respiratory dysfunctions are prevalent in DM, their direct correlation with EDS remains complex and inconclusive, but respiratory evaluation should be recommended if obstructive sleep apneas or respiratory muscle dysfunctions are suspected. Drug interventions, such as modafinil and mexiletine, have shown promise in managing excessive daytime sleepiness and reducing myotonia without significant cardiac conduction effects. Enhancing EDS management in myotonic dystrophy is key to improving overall patient well-being.

Objectives: Whether pre-exposure prophylaxis (PrEP) with tixagevimab/cilgavimab 150 mg/150 mg (T/C) in individuals with hematologic disease (HD) may lead to a reduced risk of SARS-CoV-2 breakthrough infection (BTI)/hospitalization, or death in the Omicron era remains to be established. Methods: An observational study included participants with HD who received PrEP. BTIs were defined as SARS-CoV-2 positivity by reverse transcription-polymerase chain reaction. The incidence of BTIs (95% CI) and of BTIs/hospitalization/death was calculated using the Kaplan-Meier method and as the number of BTIs per 100 person-years of follow-up according to the circulating variant of concern (VoC). A Poisson regression model was used to evaluate the association between the rate of incidence and circulating VoCs after controlling for demographics and clinical factors. Results: We included 550 HD patients: 71% initiated T/C PrEP when BA.5 was the most prevalent, followed by XBB/EG, BA.2, and BA.1 (19%, 7%, and 3%, respectively). Overall, the 1-year incidence estimate of BTIs/hospitalization/death was 24% (18.7-29.4%). A greater risk of incident infections was observed when BA.5 and XBB/EG sub-lineages circulated (aRR 5.05 [2.17, 11.77]; P < .001 and 3.82 [1.50, 9.7]; P = 0.005, compared to BA.1, respectively). Conclusions: The 1-year incidence of SARS-CoV-2 BTIs/hospitalization/death was 24% which is in line with what was observed in other similar studies. The risk appeared to be higher when more recent Omicron sub-lineages were circulating suggesting a reduction of in vitro neutralization.

We have performed a detailed γ-ray spectroscopy study of the nucleus, 49Mn, using the GRETINA tracking array and FMA recoil separator. With this powerful new setup, low-spin excited states, which are most relevant for astrophysical processes, have been identified for the first time, including four proton-unbound levels, corresponding to key astrophysical resonances in the 48Cr(p,γ)49Mn reaction. Of these four levels, two were found to dominate the 48Cr(p,γ)49Mn reaction for temperatures, T = 0.2 − 1.4 GK, and uncertainties in the rate have been reduced by more than 3 orders of magnitude. Specifically, γ decays were observed from 1/2+ and 3/2− excited states at Ex = 2570.9(26) keV and 2595.8(21) keV, corresponding to an ℓ = 0 and ℓ = 1 resonance in the 48Cr + p system at Er = 482.9(84) keV and 507.9(83) keV, respectively. Present simulations of Type-I X-ray burst nucleosynthesis indicate that the newly defined 48Cr(p,γ) reaction rate is sufficiently fast to drive the flow of material towards higher masses in such environments. Consequently, despite the relatively long half life of 48Cr, we now do not expect a strong waiting point in the rp process at A = 48.

Resumen: Objetivo: El objetivo de este trabajo es describir cómo se han utilizado las tecnologías de la información y la comunicación en el control clínico, el seguimiento, el tratamiento y el alta de pacientes afectados de viruela símica. Diseño y lugar: Se ha realizado un estudio descriptivo, observacional y retrospectivo de todos los casos de viruela símica asistidos en el Área de Salud de Ibiza y Formentera (ASEF), en el ámbito de la atención primaria. Participantes y métodos: Se incluyeron todos los pacientes afectados por la viruela del mono que cumplían con los criterios de inclusión (en total 79 pacientes), cubriendo el período comprendido entre el 1 junio y el 30 de noviembre de 2022. Se diseñó un protocolo asistencial para la captación de los pacientes, la toma de muestras, el rastreo de contactos, la notificación a las autoridades sanitarias, la asistencia clínica telefónica y la tramitación telemática de bajas y altas laborales. Resultados y conclusiones: La adhesión de los pacientes con el sistema de control fue mayoritaria. La telemedicina ha sido una herramienta muy útil para el intercambio de información durante la prestación de una atención médica continua a los pacientes afectados por el brote de infección por viruela símica, garantizando su seguridad y su intimidad y permitiendo el manejo de una enfermedad infecciosa que requiere aislamiento, control y seguimiento médico. Abstract: Objective: The objective of this work is to describe how the use of the information and communication technologies has been used in the clinical control, follow-up and treatment of all the patients affected by monkeypox in our health area. Design and site: A descriptive, observational and retrospective work has been carried out to show the clinical management of the monkeypox cases assisted in the Health Area of Ibiza and Formentera (ASEF), in the field of the primary care. Participants and methods: All patients affected by monkeypox who met the inclusion criteria were included in the study (a total of 79 patients), covering the period from 01/06/22 to 30/11/22. A protocol was designed in order to recruit the patients, extract the samples, monitor the close contacts, notify the cases to the health authorities, clinical assistance and administrative processing of the sick leaves. Results and conclusions: The adherence of the patients with the control system was majoritarian. Telemedicine has been a useful tool for the exchange of information during the provision of continuous medical care to patients affected by the outbreak of monkeypox infection, guaranteeing their safety and privacy and allowing the management of an infectious disease that requires isolation, control, and medical monitoring.

Organizations face rising pressure to take action to reduce their climate-affecting emissions (i.e., decarbonize). While many responses are possible, an essential approach—strategically managing their energy consumption as an essential business practice via an ISO 50001-based energy management system—is not yet widely recognized as a framework for decarbonization. This study analyzes interim survey results from 24 organizations (a 48% response rate) implementing a rigorous energy management system, one deployed by the U.S. Department of Energy as “50001 Ready”, to test whether participating organizations perceive the energy management system under development as an essential aspect of their decarbonization efforts. The results are preliminary in nature, given the ongoing nature of the program and associated data collection; however, they are sufficient to refute our hypothesis that energy management systems are perceived by organizations participating in 50001 Ready cohorts to primarily affect energy performance with little-to-no connection regarding decarbonization efforts. Major findings include that participants’ decarbonization targets and commitments are driven by market imperatives (highlighting the importance of ISO 50001 as a management system tool) and that they see energy efficiency as vital to decarbonizing. We conclude by suggesting future research directions to further establish the premise that energy management systems are an effective, efficient, and long-lasting decarbonization strategy.

Abstract High-flow nasal cannula (HFNC) is a relatively recent therapy that has been used to treat respiratory failure. Until now, the criterion for failure requiring escalation to other forms of ventilatory support has remained unclear. This study evaluated how the ROX index predicts the success or failure of HFNC in infants with bronchiolitis. A prospective, observational, multicenter study was conducted in 2 pediatric ICUs. The data were collected at 7 moments. Patients were categorized into failure and success groups according to HFNC. A total of 102 infants were included, 18(17.6%) of whom failed HFNC therapy. For the ROX index, significant differences were observed between the failure 5.8(95%CI 4.7–7.1) and success 7.7(95%CI 7.2–8.2) groups (p = 0.005) at the 12 h evaluation. According to the analysis of the performance of the ROX index, the AUC at 12 h was 0.716(95%CI 0.591–0.842; p = 0.016). The best cutoff range for the ROX index at 12 h was 6.50–7.18, with a sensitivity of 42% and a specificity of 66% at the cutoff of 6.50, and a sensitivity of 92% and a specificity of 54% at the cutoff of 7.18. We concluded that the ROX index could be effective at predicting the failure of HFNC therapy in infants with bronchiolitis beginning at 12 h after installation.

Abstract Patients with amnestic mild cognitive impairment (aMCI) are at a higher risk of converting to Alzheimer's disease. The aim of this study was to examine the potential use of Verbal Fluency (VF) measures as markers for predicting the conversion to dementia. At baseline, 61 aMCI, aged 65 to 80 years, underwent a comprehensive neuropsychological assessment, including phonemic (PVF) and semantic verbal fluency (SVF) tasks. After 18 months, 14 individuals with aMCI had progressed to a diagnosis of dementia. The findings revealed that aMCI-converter group had lower Mini Mental State Examination and Rey Auditory Verbal Learning Task scores than aMCI-no converter and produced fewer clusters in both VF tasks and a lower number of switches in PVF at baseline (p

ChatGPT has played a prominent role in the media narrative on artificial intelligence over the past year. However, the potential applications of this popular chatbot have also been studied from a medical-health perspective. There are more than 600 papers published on this topic in 2023. The undisputed qualities of this form of AI, which is one of the deep-learning machines, are due to its ability to simulate conversation that is almost indistinguishable from that with another human being. We know how important communication is in medicine. That is why the many studies presented investigate ChatGPT's ability to answer public health questions or assist patients with certain diseases. We can say that communication is a therapeutic intervention, but can AI do it better than doctors?

Non-thermal plasma (NTP) is gaining increasing attention as a promising approach for advanced water treatment to degrade persistent organic pollutants. Aqueous solutions of sulfamethoxazole (4-amino-N-(5-methylisoxazol-3-yl)-benzensulfonamide, SMZ), an antibiotic largely employed for humans and animals and a widespread persistent pollutant of waters and wastewaters, were subjected to air NTP treatment in a dielectric barrier discharge (DBD) reactor. The effects of SMZ initial concentration and of the solution pH on SMZ decomposition kinetics and transformation products were investigated. Efficient degradation was achieved, resulting in the complete removal of SMZ (10 μM initial concentration) in less than 25 min treatments, in the exhaustive mineralization (a result never reported before in plasma treatments and seldom reached also with other advanced oxidation processes) of all organic carbon in 6 h and in an energy efficiency of 6.4 g/kWh at 50% conversion. By means of HPLC-UV/Vis and LC-ESI-MSn analyses, a number of organic transformation products was identified along the path to SMZ mineralization, all present always in very small amounts and in turn decomposed at short treatment times. The effect of the solution pH on the genesis and decay of transformation products was also investigated. Based on comparisons with literature data and on previous findings obtained with the DBD reactor used in this work, it is concluded that the major reactive species involved in the degradation of SMZ are the hydroxyl radical and ozone. Finally, toxicological analyses of water initially containing 0.5 mM SMZ and subjected to 4 h NTP treatment showed that the by-products are not toxic to Raphidocelis subcapitata and Daphnia magna, while residual toxicity was detected by Aliivibrio fischeri.

This study reports the predation on an adult common boa Boa constrictor specimen by the crab- eating fox Cerdocyon thous in the Caatinga Biome, a semi-arid Brazilian region. Such interactions represent cases of risk-sensitive predation, given the real possibility of crab-eating foxes being injured or killed when attacking adult common boa specimens. The likely role of extreme climatic events, such as the severe and prolonged drought that occurred in the region at the time of this record, in the occurrence of these trophic interactions between species is discussed. as entre especies.

As the demand for rare earth elements (REEs) continues to surge in diverse industrial and medical domains, the ecological consequences of their ubiquitous presence have garnered heightened attention. Among the REEs, gadolinium (Gd), commonly used in medical imaging contrast agents, has emerged as a pivotal concern due to its inadvertent introduction into marine ecosystems via wastewater release. This study delves into the complex ecotoxicological implications of Gd contamination, focusing on its impact on the embryonic development and sperm functionality of Mytilus galloprovincialis. The findings from this study underscore the potential hazards posed by this rare element, offering a critical perspective on the ecological risks associated with Gd. Notably, this exploratory work reveals that Gd exerts a significant embryotoxic effect at elevated concentrations, with an observed half maximal effective concentration (EC50) value of 0.026 mg/L. Additionally, Gd exposure leads to a considerable reduction in sperm motility and alters sperm morfo-kinetic parameters, especially at a concentration of 5.6 mg/L. The results highlight a dose-dependent relationship between Gd exposure and the prevalence of specific malformation types in Mytilus embryos, further providing crucial insights into the potential risks imposed by this rare earth element.

Background Good quality shared decision-making (SDM) conversations involve people with, or at risk of osteoporosis and clinicians collaborating to decide, where appropriate, which evidence-based medicines best fit the person’s life, beliefs, and values. We developed the improving uptake of Fracture Prevention drug treatments (iFraP) intervention comprising a computerised Decision Support Tool (DST), clinician training package and information resources, for use in UK Fracture Liaison Service consultations. Two primary objectives to determine (1) the effect of the iFraP intervention on patient-reported ease in decision-making about osteoporosis medicines, and (2) cost-effectiveness of iFraP intervention compared to usual NHS care. Secondary objectives are to determine the iFraP intervention effect on patient reported outcome and experience measures, clinical effectiveness (osteoporosis medicine adherence), and to explore intervention acceptability, mechanisms, and processes underlying observed effects, and intervention implementation. Methods The iFraP trial is a pragmatic, parallel-group, individual randomised controlled trial in patients referred to a Fracture Liaison Service, with nested mixed methods process evaluation and health economic analysis. Participants aged ≥50 years (n=380) are randomised (1:1 ratio) to one of two arms: (1) iFraP intervention (iFraP-i) or (2) comparator usual NHS care (iFraP-u) and are followed up at 2-weeks and 3-months. The primary outcome is ease of decision-making assessed 2 weeks after the consultation using the Decisional Conflict Scale (DCS). The primary objectives will be addressed by comparing the mean DCS score in each trial arm (using analysis of covariance) for patients given an osteoporosis medicine recommendation, alongside a within-trial cost-effectiveness and value of information (VoI) analysis. Process evaluation data collection includes consultation recordings, semi-structured interviews, and DST analytics. Discussion The iFraP trial will answer important questions about the effectiveness of the new ‘iFraP’ osteoporosis DST, coupled with clinician training, on SDM and informed initiation of osteoporosis medicines. Trial registration: ISRCTN 10606407, 21/11/2022 https://doi.org/10.1186/ISRCTN10606407

Introducción: La pandemia impactó en la calidad de vida, salud integral y formación de los estudiantes de posgrados a nivel mundial. Objetivos: Describir la percepción del efecto de la pandemia en la salud integral y formación académica de estudiantes de posgrado de pediatría de Uruguay durante los años 2019- 2021. Metodología: Estudio descriptivo, transversal mediante encuesta a estudiantes de las generaciones 2019, 20 y 21. Se analizaron variables sociodemográficas y percepción del efecto de la pandemia en calidad de vida, salud, formación académica y rendimiento. Resultados: Participaron 93 estudiantes (65% de los habilitados). La mediana de edad fue 30,5 años, de género femenino: 88%. Cursaron la especialidad por residencia: 78,4%, en Montevideo 96%. El 41,3% expresó que cursar el posgrado durante la pandemia repercutió de forma negativa en su calidad de vida. Reportando reducción de actividades sociales: 83,3%, oferta laboral: 33,3%. Manifestaron sentirse agotados: 84%, fatigados: 64,4%. Se le diagnosticó una enfermedad nueva a 12,2% trastorno de ansiedad 5, depresión 4; reportaron consumo de psicofármacos durante la pandemia 13,3% versus 5,5% previo a esta. Consideraron que su formación se afectó negativamente: 57,3% y manifestaron afectación del rendimiento: 38,2%. Refirieron obstáculos en la participación de actividades virtuales: 94,3%, por superposición con otras actividades: 85,3%, o problemas de concentración: 22,4%. Conclusiones: Los encuestados reportaron efectos de la pandemia en su salud, sobre todo en el área psicoemocional, con repercusión en su calidad de vida. El efecto en la formación fue menor, identificándose puntos a mejorar, sobre todo evitar la superposición de actividades.