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Multimetric indices play a pivotal role in assessing river ecological quality, aligning with the European Water Framework Directive (EU WFD) requirements. However, indices developed specifically for large rivers are uncommon. Our objective was to develop a fish-based tool specifically tailored to assess the ecological quality in Portuguese large rivers. Data were collected from seven sites in each of three Portuguese large rivers (Minho, Guadiana, and Tagus). Each site was classified using an environmental disturbance score, combining different pressure types, such as water chemistry, land use, and hydromorphological alterations. The Fish-based Multimetric Index for Portuguese Large Rivers (F-MMIP-LR) comprises four metrics: % native lithophilic individuals; % alien individuals; % migrant individuals; and % freshwater native individuals, representing compositional, reproductive, and migratory guilds. The index showed good performance in separating least- and most-disturbed sites. Least-disturbed sites were rated ‘high’ or ‘good’ by F-MMIP-LR, contrasting with no such classification for most-disturbed sites, highlighting index robustness. The three rivers presented a wide range of F-MMIP-LR values across the gradient of ‘bad’ to ‘high’, indicating that, on a large spatial extent, the biological condition was substantially altered. The F-MMIP-LR provides vital information for managers and decision-makers, guiding restoration efforts and strengthening conservation initiatives in line with the WFD.

The metaverse, powered by XR technologies, enables human augmentation by enhancing physical, cognitive, and sensory capabilities. Cultural heritage sees the metaverse as a vehicle for expression and exploration, providing new methods for heritage fruition and preservation. This article proposes a metaverse application, inspired by the events of the Italian Resistance, promoting interactions between multiple users in an immersive VR experience while safeguarding intangible cultural assets according to an edutainment approach. The virtual environment, based on Ivrea’s town hall square, provides in-depth information about the partisan’s life and the historical value of its actions for the city. Furthermore, the application allows users to meet in the same virtual place and engage with one another in real time through the Spatial SDK. Before the public presentation, a heterogeneous group of thirty users underwent usability and engagement tests to assess the experience on both VR headsets and smartphones. Tests revealed statistically significant evidence that there is a genuine difference in users’ perceptions of usability and engagement with different devices and types of interaction. This study highlights the effectiveness of adopting XR as a supporting technology to complement the real experience of cultural heritage valorization.

The topical use of sunscreens is recommended for avoiding the damaging effects of UV radiation. However, improvements are still needed in the existing products to enhance their photoprotection effectiveness and safety. This involves minimizing the use of chemical UV filters while providing enhanced and prolonged photoprotection. This work investigated novel sunscreen formulations and their UV protection effects by encapsulating Uvinul® A, Tinosorb® S, and Uvinul® T150 into nanostructured lipid carriers (NLCs) based on bacuri butter and raspberry seed oil. First, the impact of critical formulation and process parameters on NLCs’ particle size was evaluated using a 22 Face Centered Central Composite Design. Then, formulations were evaluated in terms of critical quality factors, in vitro skin permeation, and in vitro and in vivo photoprotection activities. The developed NLCs-containing formulations exhibited appropriate size (122–135 nm), PdI (90%), and drug content (>80%), which were preserved for at least 90 days under different stability conditions. Moreover, these NLCs-based formulations had equivalent skin permeation to emulsion-based controls, and the addition of NLCs into sunscreen cream bases in the optimum proportion of 20% (w/w) resulted in enhanced UVA and UVB photoprotection levels, despite a 10% reduction in the total filters content. Altogether, these results describe the application of nanoencapsulated organic UV filters in innovative sunscreen formulations to achieve superior photoprotection and cosmeceutical properties.

Introdução/objetivo: A hanseníase é uma doença infecciosa de caráter crônico causada pelo bacilo Mycobacterium leprae que pode causar graves deficiências físicas, psicológicas e sociais. É problema sanitário mundial e, no Brasil e em Sergipe, é endêmica. O objetivo do trabalho foi analisar os dados de laudos anatomopatológicos com a classificação clínica e operacional dos casos de hanseníase no estado de Sergipe em laboratórios de referência no período de 2007 a 2016. Métodos: Trata-se de um estudo observacional descritivo e retrospectivo realizado a partir de laudos anatomopatológicos de pacientes com diagnóstico de hanseníase. Esses laudos foram coletados no Hospital Universitário da Universidade Federal de Sergipe (laboratório público) e em três laboratórios particulares. Foram tabuladas as variáveis idade, sexo, baciloscopia e forma clínica. Utilizou-se o Teste de Mann Whitney e o Teste de Qui-Quadrado de Igualdade para comparação das variáveis entre os diferentes laboratórios. Os resultados foram considerados estatisticamente significativos quando p

Introdução/objetivo: A hanseníase é uma doença infectocontagiosa, crônica e granulomatosa, cujo agente etiológico é o bacilo Mycobacterium leprae. Os idosos estão suscetíveis à infecção devido a senescência e o longo período de incubação do bacilo. O objetivo do trabalho foi analisar o perfil clínico e epidemiológico dos casos de hanseníase na população idosa no Estado de Sergipe, no período de 2007 a 2016. Métodos: Estudo observacional descritivo e retrospectivo dos casos de hanseníase com laudos anatomopatológicos positivos na população idosa do Estado de Sergipe. Os laudos foram coletados na Unidade de anatomia patológica do Hospital Universitário da Universidade Federal de Sergipe, centro de referência para o diagnóstico anatomopatológico da hanseníase, e em três laboratórios privados, que possuem convênios com a rede municipal e estadual de saúde e recebem uma grande demanda de exames. Os dados coletados foram sexo, idade, forma clínica e baciloscopia. Para avaliação da associação entre as formas clínicas e sexo, foi utilizado o teste do qui-quadrado. O estudo foi aprovado pelo comitê de ética em Pesquisa do Hospital Universitário da Universidade Federal de Sergipe (CAAE 87953018.3.0000.5546). Resultados: Foram observados 261 laudos positivos em Sergipe na população idosa, sendo 50,57% do sexo feminino e predominância de casos na faixa etária de 60 a 69 anos (51,34%). Em relação a classificação operacional a forma paucibacilar predominou com 81,60%. As formas clínicas mais prevalentes foram a hanseníase tuberculóide e indeterminada com 49,81% e 25,29%, respectivamente, e a baciloscopia apresentou resultado positivo em 17,05% dos casos. Na comparação das formas polares da hanseníase entre os sexos, a forma clínica tuberculoide foi significativamente mais prevalente no sexo feminino, enquanto a virchowiana, forma mais grave da doença, predominou no masculino (0,0031). Por fim, na análise da razão de chance entre os sexos, observou-se que homens idosos apresentaram uma chance 3,96 vezes maior de desenvolver a forma grave da hanseníase. Conclusão: As ações de políticas públicas direcionadas para o controle e tratamento da hanseníase em áreas endêmicas precisam ser realizadas, principalmente para homens idosos, já que estes possuem um risco mais elevado de desenvolver a forma grave e contagiosa da doença.

ObjectivesCoordinated measurement strategies are needed to inform collaborative approaches to improve access to and quality of care for persons with sickle cell disease (SCD). The objective of our study was to develop a multilevel measurement strategy to assess improvements in access to and quality of care for persons with SCD in 4 US regions.MethodsFrom 2014 through 2017, regional grantees in the Sickle Cell Disease Treatment Demonstration Program collected administrative and patient-level electronic health record (EHR) data to assess quality improvement initiatives. Four grantees-covering 29 US states and territories and an SCD population of 56 720-used a collective impact model to organize their work. The grantees collected administrative data from state Medicaid and Medicaid managed care organizations (MCOs) at multiple points during 2014-2017 to assess improvements at the population level, and local patient-level data were abstracted from site-level EHRs at regular intervals to track improvements over time.ResultsAdministrative data were an important source of understanding population-level improvements but were delayed, whereas patient-level data were more sensitive to small-scale quality improvements.ConclusionsWe established a shared measurement approach in partnership with Medicaid and Medicaid MCO stakeholders that can be leveraged to effectively support quality improvement initiatives for persons with SCD in the United States.

Educational attainment is an important social determinant of maternal, newborn, and child health1-3. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting4-6. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness7,8; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health9-11. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but-to our knowledge-no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries12-14. By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations.

Abstract The recent SARS‐CoV‐2 pandemic has highlighted the urgent need for novel point‐of‐care devices to be promptly used for a rapid and reliable large screening analysis of several biomarkers like genetic sequences and antibodies. Currently, one of the main limitations of rapid tests is the high percentage of false negatives in the presence of variants and, in particular for the Omicron one. We demonstrate in this work the detection of SARS‐CoV‐2 and the Omicron variant with a cost‐effective silicon nanosensor enabling high sensitivity, selectivity, and fast response. We have shown that a silicon (Si) nanowires (NW) platform detects both Sars‐CoV‐2 and its Omicron variant with a limit of detection (LoD) of four effective copies (cps), without any amplification of the genome, and with high selectivity. This ultrasensitive detection of 4 cps allows to obtain an extremely early diagnosis paving the way for efficient and widespread tracking. The sensor is made with industrially compatible techniques, which in perspective may allow easy and cost‐effective industrialization.

Background: Climate change, increasing recognition of institutionalized discrimination, and the COVID-19 pandemic are large-scale, societal events (ie, forces of change) that affect the timing, settings, and modes of youth physical activity. Despite the impact that forces of change have on youth physical activity and physical activity environments, few studies consider how they affect physical activity promotion. Methods: The authors use 2 established frameworks, the ecological model of physical activity and the youth physical activity timing, how, and setting framework, to highlight changes in physical activity patterns of youth in North America that have resulted from contemporary forces of change. Results: North American countries—Canada, Mexico, and the United States—have faced similar but contextually different challenges for promoting physical activity in response to climate change, increasing recognition of institutionalized discrimination, and the COVID-19 pandemic. Innovative applications of implementation science, digital health technologies, and community-based participatory research methodologies may be practical for increasing and sustaining youth physical activity in response to these forces of change. Conclusions: Thoughtful synthesis of existing physical activity frameworks can help to guide the design and evaluation of new and existing physical activity initiatives. Researchers, practitioners, and policymakers are encouraged to carefully consider the intended and unintended consequences of actions designed to respond to forces of change. [ABSTRACT FROM AUTHOR]

Abstract Background Physician delivered weight management counseling (WMC) occurs infrequently and physicians report lack of training and poor self-efficacy. The purpose of this study was to develop and test the Video-based Communication Assessment (VCA) for weight management counseling (WMC) training in medical residents. Methods This study was a mixed methods pilot conducted in 3 phases. First, we created five vignettes based on our prior data and expert feedback, then administered the vignettes via the VCA to Internal Medicine categorical residents (n = 16) from a University Medical School. Analog patients rated responses and also provided comments. We created individualized feedback reports which residents were able to view on the VCA. Lastly, we conducted debriefing interviews with the residents (n = 11) to obtain their feedback on the vignettes and personalized feedback. Interviews were transcribed, and we used thematic analysis to generate and apply codes, followed by identifying themes. Results Descriptive statistics were calculated and learning points were created for the individualized feedback reports. In VCA debriefing interviews with residents, five themes emerged: 1) Overall the VCA was easy to use, helpful and more engaging than traditional learning and assessment modes, 2) Patient scenarios were similar to those encountered in the clinic, including diversity, health literacy and different stages of change, 3) The knowledge, skills, and reminders from the VCA can be transferred to practice, 4) Feedback reports were helpful, to the point and informative, including the exemplar response of how to best respond to the scenario, and 5) The VCA provide alternatives and practice scenarios to real-life patient situations when they aren’t always accessible. Conclusions We demonstrated the feasibility and acceptability of the VCA, a technology delivered platform, for delivering WMC to residents. The VCA exposed residents to diverse patient experiences and provided potential opportunities to tailor providers responses to sociological and cultural factors in WMC scenarios. Future work will examine the effect of the VCA on WMC in actual clinical practice.