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This paper presents a systematic framework of the most needed Vocational Education and Training (VET) reforms in The Azores, a Portuguese outermost region. Our report is based on a participatory research approach involving the perspectives of five different groups of stakeholders. Our data was collected in 18 virtual world-café sessions (n = 164 participants--58 trainees; 21 trainers; 42 institutional representatives; 21 unemployed people registered at local public employment agencies; and 22 businesspersons; M age = 45.20; 60.37 women). Based on content analysis, we identified three main priorities to restructure vocational training policies: (a) VET perception and valorization, comprising strategies to disseminate a more positive social representation of VET in the region; (b) horizontal coordination between stakeholders, including effective ways of coordinating and sharing information; and (c) vertical coordination in terms of VET improvements of "curricula," funding models, and investments in the sector's human capital. Our correspondence analysis did not show significant differences regarding the prevalence of the three priorities across the five groups of stakeholders. We interpret and contextualize our results according to relevant publicly available data about the region, and an integrated governance lens to inform policy design in outermost territories.

The 'virtual school' is an approach to supporting care-experienced children and young people in education. The Virtual School Head (VSH) has been a statutory role within the education landscape in England since 2014. In Scotland, where the education, social care and legal systems are distinct from those in England, there has been a recent increase in the number of local authorities utilising this concept. This research aimed to explore the role and remit of Virtual School Head Teachers (VSHTs) in Scotland, and to identify similarities and differences with those of VSHs in England, to uncover learning about the emergence of this concept and role in a new context. We conducted semi-structured interviews with relevant post-holders in Scotland, using key concepts from the published literature on virtual schools in England, and analysed these qualitatively to identify themes. We discuss some of the similarities and differences we identified, noting that while the purpose of the role, and the means by which it functions, were largely common to both countries, there were also nuanced differences. Key similarities included the importance of positioning within the local authority, and the development of relationships with social work. Differences were largely underpinned by the educational and legal contexts in which the post-holders operated, and included control of budgets and specificity of remit. This research contributes to our understanding of the role of the VSHT in Scotland, and identifies some emerging features as the virtual school concept is translated to a new context.

OBJECTIVES: Coronary computed tomography angiography (CCTA) has higher diagnostic accuracy than coronary artery calcium (CAC) score for detecting obstructive coronary artery disease (CAD) in patients with stable chest pain, while the added diagnostic value of combining CCTA with CAC is unknown. We investigated whether combining coronary CCTA with CAC score can improve the diagnosis of obstructive CAD compared with CCTA alone. METHODS: A total of 2315 patients (858 women, 37%) aged 61.1 ± 10.2 from 29 original studies were included to build two CAD prediction models based on either CCTA alone or CCTA combined with the CAC score. CAD was defined as at least 50% coronary diameter stenosis on invasive coronary angiography. Models were built by using generalized linear mixed-effects models with a random intercept set for the original study. The two CAD prediction models were compared by the likelihood ratio test, while their diagnostic performance was compared using the area under the receiver-operating-characteristic curve (AUC). Net benefit (benefit of true positive versus harm of false positive) was assessed by decision curve analysis. RESULTS: CAD prevalence was 43.5% (1007/2315). Combining CCTA with CAC improved CAD diagnosis compared with CCTA alone (AUC: 87% [95% CI: 86 to 89%] vs. 80% [95% CI: 78 to 82%]; p

The term at-promise gained prominence as a strength-based way to refer to students from minoritized backgrounds that contrasted from deficit-laden terms like "at-risk." In this scholarly paper, we argue that beyond avoiding an obvious deficit categorization, adoption of the term "at-promise" has potential to influence scholarship in higher education research by centering the need for systemic change. Building on prior literature on "at-promise" student terminology and conceptual frameworks of funds of knowledge, community cultural wealth, and validation theory, we suggest that the "at-promise" phrase offers two important contributions to higher education. First, by emphasizing interconnectivity and shared experiences across systems of power, the "at-promise" designation can be used to build coalitions amongst minoritized groups and advocate for broader systemic change. Second, the term promise reflects a societal commitment to improving educational access and retention that is integral to the social contract of higher education as a public good. Thus, use of "at-promise" can center the need for systemic change, but only when done with intentionality to avoid conflation of minoritized groups.

Inês Santos Ferreira,1 Ana F Bettencourt,1 Lídia MD Gonçalves,1 Stefanie Kasper,2 Bertrand Bétrisey,3 Judith Kikhney,2 Annette Moter,2 Andrej Trampuz,4 António J Almeida1 1Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal; 2Biofilmcenter, German Heart Institute Berlin, Berlin, Germany; 3Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; 4Center for Musculoskeletal Surgery, Charité – University Medicine Berlin, Berlin, Germany Abstract: The aim of the present study was to develop novel daptomycin-loaded poly-epsilon-caprolactone (PCL) microparticles with enhanced antibiofilm activity against mature biofilms of clinically relevant bacteria, methicillin-resistant Staphylococcus aureus (MRSA) and polysaccharide intercellular adhesin-positive Staphylococcus epidermidis. Daptomycin was encapsulated into PCL microparticles by a double emulsion-solvent evaporation method. For comparison purposes, formulations containing vancomycin were also prepared. Particle morphology, size distribution, encapsulation efficiency, surface charge, thermal behavior, and in vitro release were assessed. All formulations exhibited a spherical morphology, micro­meter size, and negative surface charge. From a very early time stage, the released concentrations of daptomycin and vancomycin were higher than the minimal inhibitory concentration and continued so up to 72 hours. Daptomycin presented a sustained release profile with increasing concentrations of the drug being released up to 72 hours, whereas the release of vancomycin stabilized at 24 hours. The antibacterial activity of the microparticles was assessed by isothermal microcalorimetry against planktonic and sessile MRSA and S. epidermidis. Regarding planktonic bacteria, daptomycin-loaded PCL microparticles presented the highest antibacterial activity against both strains. Isothermal microcalorimetry also revealed that lower concentrations of daptomycin-loaded microparticles were required to completely inhibit the recovery of mature MRSA and S. epidermidis biofilms. Further characterization of the effect of daptomycin-loaded PCL microparticles on mature biofilms was performed by fluorescence in situ hybridization. Fluorescence in situ hybridization showed an important reduction in MRSA biofilm, whereas S. epidermidis biofilms, although inhibited, were not eradicated. In addition, an important attachment of the microparticles to MRSA and S. epidermidis biofilms was observed. Finally, all formulations proved to be biocompatible with both ISO compliant L929 fibroblasts and human MG63 osteoblast-like cells.Keywords: antibiotic release, Staphylococcus aureus, Staphylococcus epidermidis, fluorescence in situ hybridization, isothermal microcalorimetry

BackgroundProgression to cirrhosis in non-alcoholic steatohepatitis (NASH) is associated with a decrease in liver fat. However, the prognostic significance of liver fat content in NASH-related significant fibrosis and cirrhosis is unclear.AimTo investigate the risk of decompensation, hepatocellular carcinoma (HCC) and mortality stratified by liver fat content in NASH-related significant fibrosis and cirrhosis.MethodsIn this meta-analysis of individual participant data, 456 patients with both magnetic resonance elastography (MRE) and MRI-derived protein density fat fraction (MRI-PDFF) were enrolled, and 296 patients with longitudinal follow-up were analysed. MRE combined with fibrosis-4 (MEFIB-index), and MRI-PDFF were used to measure liver fibrosis and fat, respectively. MEFIB-negative, MEFIB-positive+ MRI-PDFF ≥5% and MEFIB-positive+ MRI-PDFF

BackgroundThere are limited data regarding the longitudinal association between MEFIB-Index (MRE combined with FIB-4) versus MAST-Score (MRI-aspartate aminotransferase) and hepatic decompensation.AimTo examine the longitudinal association between MEFIB-Index versus MAST-Score in predicting hepatic decompensation in patients with metabolic dysfunction-associated steatotic liver disease (MASLD).MethodsThis was a longitudinal, retrospective analysis of subjects from United States, Japan, and Turkey who underwent a baseline MRE and MRI-PDFF and were followed for hepatic decompensation. Cox-proportional hazard analyses were used to assess the association between MEFIB-Index versus MAST-Score with a composite primary outcome (hepatic decompensation) defined as ascites, hepatic encephalopathy, and varices needing treatment.ResultsThis meta-analysis of individual participants (IPDMA) included 454 patients (58% women) with a mean (±SD) age of 56.0 (±13.5) years. The MEFIB-Index (MRE ≥3.3 kPa + FIB 4 ≥1.6) and MAST-Score (>0.242) were positive for 34% and 9% of the sample, respectively. At baseline, 23 patients met criteria for hepatic decompensation. Among 297 patients with available longitudinal data with a median (IQR) of 4.2 (5.0) years of follow-up, 25 incident cases met criteria for hepatic decompensation. A positive MEFIB-Index [HR = 49.22 (95% CI: 6.23-388.64, p

IntroductionRetrospective studies report that angiotensin-converting enzyme inhibitors (ACEIs) may reduce the severity of COVID-19, but prospective data on de novo treatment with ACEIs are limited. The RAMIC trial was a randomized, multicenter, placebo-controlled, double-blind, allocation-concealed clinical trial to examine the efficacy of de novo ramipril versus placebo for the treatment of COVID-19.MethodsEligible participants were aged 18 years and older with a confirmed diagnosis of SARS-CoV-2 infection, recruited from urgent care clinics, emergency departments, and hospital inpatient wards at eight sites in the USA. Participants were randomly assigned to daily ramipril 2.5 mg or placebo orally in a 2:1 ratio, using permuted block randomization. Analyses were conducted on an intention-to-treat basis. The primary outcome was a composite of mortality, intensive care unit (ICU) admission, or invasive mechanical ventilation by day 14.ResultsBetween 27 May 2020 and 19 April 2021, a total of 114 participants (51% female) were randomized to ramipril (n = 79) or placebo (n = 35). The overall mean (± SD) age and BMI were 45 (± 15) years and 33 (± 8) kg/m2. Two participants in the ramipril group required ICU admission and one died, compared with none in the placebo group. There were no significant differences between ramipril and placebo in the primary endpoint (ICU admission, mechanical ventilation, or death) (3% versus 0%, p = 1.00) or adverse events (27% versus 29%, p = 0.82). The study was terminated early because of a low event rate and subsequent Emergency Use Authorization of therapies for COVID-19.ConclusionDe novo ramipril was not different compared with placebo in improving or worsening clinical outcomes from COVID-19 but appeared safe in non-critically ill patients with COVID-19.Trial registrationClinicaltrials.gov NCT04366050.

Legionella, the causative agent of Legionnaires' disease (LD), is a facultative intracellular gram-negative bacterium that is ubiquitous in freshwater environments. Legionella bacteria usually thrive in natural and artificial water sources, [...]

Doctoral advising serves a pivotal role in graduate education but is too often rooted in power inequities that have adverse impacts. In this narrative inquiry study, we examined how 28 doctoral students in STEM fields navigated power in their advising relationships through the context of their decision to switch advisors. We found that Ph.D. students encountered several forms of power in their advising relationships aligned with those proposed by Guerrero et al. (2020): resource-based power, enabling or disabling power, perceptual power, relational power, and power as prerogative. Our analysis illuminates how power is fueled by exo- and macro-level factors but is carried out on the meso- and micro-levels, often to the detriment of Ph.D. students. We also found that doctoral students exerted their own agency and power where possible, even in the face of severe power differentials and abuses. Our findings suggest that STEM departments engaged in doctoral education should create objective criteria for student feedback, offer more regular benchmarks and assessments for feedback, and decouple financial support from the advising relationship.

Advisors play an important role in the success of all doctoral students, but particularly so in science, technology, engineering, and mathematics (STEM) fields, where advising relationships determine funding structures and lab work possibilities. In cases where there is a mismatch between advisors and advisees, conflict can hinder students' academic progress, research expertise, and career prospects. However, relatively few institutions have clear processes to address power imbalances, creating an onerous burden for students who may risk damaging relationships and incurring unexpected consequences by raising concerns. In this critical constructivist narrative inquiry, we used self-authorship (Baxter Magolda, 1998, 1999) within a power-conscious framework of doctoral advising (Bettencourt et al., 2021; Linder, 2018) to examine how 28 STEM doctoral students made meaning of power in advising relationships. Our findings demonstrate that the STEM doctoral environment heavily emphasizes external messages, which students must often negotiate within rather than move away from to succeed.

Many student affairs practitioners passionately support students, but the cost of caring may include compassion fatigue or secondary stress. This constructivist case study examined how a program that serves at-promise students contributes to and alleviates compassion fatigue among staff members. While the scope of work, position of the program at the institution, and high rates of staff transition challenged participants, their compassion fatigue was buffered by a culture of care and mentorship within the program.

School-based mental health programs (SBMHP) are vital to providing youth access to mental health services. This study aims to characterize changes in therapy encounters and psychotropic medication prescriptions in an urban SBMHP during the COVID-19 pandemic. We used electronic medical records to extract demographic, clinical, and utilization data from encounters through a SBMHP associated with an urban mid-Atlantic academic medical institution from September 2019 to September 2021. We compared encounter trends in the 3 months preceding the onset of the COVID-19 pandemic (December 2019-February 2020) and the first 3 months of the pandemic (March-May 2020). Using all data from the study period, we plotted encounter statistics and conducted an interrupted time series analysis to examine longitudinal trends in encounter type and attendance, psychotropic medication prescriptions by therapeutic indication, and medication dosage increase before and after schools closed due to COVID-19 pandemic-related restrictions. A total of 625 students with 25,641 encounters were included. Students had a median age of 11 years (range 5-18 years) and the majority identified as Black (57.9%), and non-Hispanic (74.4%). Average monthly encounter volume increased by 557% from March to May 2020 compared to the prior 3 months, 88.6% of which were video encounters, compared to 0% previously. In contrast, psychotropic medication prescriptions decreased by 7.4%. Medication dosage adjustments declined in the period after March 2020, when a state mandate to close schools was ordered due to COVID-19, with the most prominent decline being in ADHD medication prescriptions, which averaged 6 increases per month pre-pandemic versus 1 per month during the pandemic period. In this SBMHP, encounters increased during the pandemic period, primarily in video encounters, while psychotropic medication prescriptions, mostly ADHD medications, declined during the pandemic. Reasons for this decline warrant further study.

This sequential mixed methods study evaluated the impact of the Chicago Parent Program (CPP) in 12 Baltimore Title I PreK programs on parent engagement and student outcomes from kindergarten through 2nd grade. Phase 1 (quasi-experiment; N = 11,996) compared PreK students whose parents enrolled in CPP with those whose parents did not enroll in CPP on measures of kindergarten readiness, chronic absenteeism, suspensions/expulsions, and grade retention. Phase 2 (qualitative; n = 20) explored the perceptions of school-based staff, principals, and district and community leaders on CPP's impact on parents, students, and parent engagement, and why they sought to continue CPP in the schools. Research Findings: No effects on student outcomes were found using administrative data. However, all of those interviewed described observed improvements in parent and student behavior and parent engagement and all schools have continued implementing CPP. Practice or Policy: Qualitative results highlight the importance of stakeholder perspectives and the limitations of administrative data for evaluating brief interventions serving families with complex needs.

Background: Little is known about the cost-effectiveness of parent training programs when offered universally in U.S. elementary schools in disadvantaged urban communities. Objective: To estimate the cost-effectiveness of a universal school-based implementation study of the Chicago Parent Program (CPP). Methods: CPP was offered universally from 2014 to 2017 to parents of PreK students in 12 Baltimore City Title 1 schools (n = 380; 61.1% Black/African American, 24.1% Hispanic). CPP program implementation and operating costs were estimated using microcosting methods and data drawn from study records. A Complier Average Causal Effects (CACE) framework was used to estimate an Incremental Cost Effectiveness Ratio (ICER) for CPP's average cost per child per 1% decrease in conduct problem prevalence at follow-up. This ICER was then compared with comparable ICERs for four parenting interventions that have been implemented and evaluated in Europe: Connect, Incredible Years, COPE, and Comet. Results: CPP cost $937.51 per child (95% CI: $902.09 to $971.92). Adjusted CACE estimates indicated that CPP resulted in a 31.4% reduction (95% CI: -39.7% to -23.9%) in conduct problem prevalence at follow-up among children whose parents attended CPP. The mean ICER for CPP was $29.86 per each 1% reduction in prevalence (95% CI: $21.05 to $50.71). CPP's ICER was similar to ICERs for Connect ($25.50) and COPE ($29.72), and less than ICERs for Incredible Years ($50.36) and Comet ($59.69). Conclusion: School-based CPP offered universally to parents of children transitioning to Kindergarten in extremely disadvantaged U.S. urban communities was found to offer relatively good value compared with similar parenting programs that are widely used in Europe.

BackgroundData are scarce regarding the development of hepatic decompensation in patients with non-alcoholic fatty liver disease (NAFLD) with and without type 2 diabetes. We aimed to assess the risk of hepatic decompensation in people with NAFLD with and without type 2 diabetes.MethodsWe did a meta-analysis of individual participant-level data from six cohorts in the USA, Japan, and Turkey. Included participants had magnetic resonance elastography between Feb 27, 2007, and June 4, 2021. Eligible studies included those with liver fibrosis characterisation by magnetic resonance elastography, longitudinal assessment for hepatic decompensation and death, and included adult patients (aged ≥18 years) with NAFLD, for whom data were available regarding the presence of type 2 diabetes at baseline. The primary outcome was hepatic decompensation, defined as ascites, hepatic encephalopathy, or variceal bleeding. The secondary outcome was the development of hepatocellular carcinoma. We used competing risk regression using the Fine and Gray subdistribution hazard ratio (sHR) to compare the likelihood of hepatic decompensation in participants with and without type 2 diabetes. Death without hepatic decompensation was a competing event.FindingsData for 2016 participants (736 with type 2 diabetes; 1280 without type 2 diabetes) from six cohorts were included in this analysis. 1074 (53%) of 2016 participants were female with a mean age of 57·8 years (SD 14·2) years and BMI of 31·3 kg/m2 (SD 7·4). Among 1737 participants (602 with type 2 diabetes and 1135 without type 2 diabetes) with available longitudinal data, 105 participants developed hepatic decompensation over a median follow-up time of 2·8 years (IQR 1·4-5·5). Participants with type 2 diabetes had a significantly higher risk of hepatic decompensation at 1 year (3·37% [95% CI 2·10-5·11] vs 1·07% [0·57-1·86]), 3 years (7·49% [5·36-10·08] vs 2·92% [1·92-4·25]), and 5 years (13·85% [10·43-17·75] vs 3·95% [2·67-5·60]) than participants without type 2 diabetes (p

Machado-Joseph disease (MJD) is an autosomal dominant spinocerebellar ataxia (SCA) caused by a polyglutamine expansion in the ataxin-3 protein, which initiates a cascade of pathogenic events, including transcriptional dysregulation. Genotype-phenotype correlations in MJD are incomplete, suggesting an influence of additional factors, such as epigenetic modifications, underlying the MJD pathogenesis. DNA methylation is known to impact the pathophysiology of neurodegenerative disorders through gene expression regulation and increased methylation has been reported for other SCAs. In this work we aimed to analyse global methylation in MJD carriers. Global 5-mC levels were quantified in blood samples of 33 MJD mutation carriers (patients and preclinical subjects) and 33 healthy controls, matched by age, sex, and smoking status. For a subset of 16 MJD subjects, a pilot follow-up analysis with two time points was also conducted. No differences were found in median global 5-mC levels between MJD mutation carriers and controls and no correlations between methylation levels and clinical or genetic variables were detected. Also, no alterations in global 5-mC levels were observed over time. Our findings do not support an increase in global blood methylation levels associated with MJD.

BackgroundPeople diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health. This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric hospitalization. ObjectiveThis study aimed to (1) engage staff and community advisors in participatory implementation processes to adapt the Thrive clinical pathway for all Medicaid-insured patients, including those with SMI; (2) examine utilization outcomes (ie, Thrive referral, readmission, emergency department [ED], primary, and specialty care visits) for Medicaid-insured individuals with and without SMI who receive Thrive compared with usual care; and (3) evaluate the acceptability, appropriateness, feasibility, and cost-benefit of an adapted Thrive clinical pathway that is tailored for Medicaid-insured patients with co-occurring SMI. MethodsThis study will use a prospective, type I hybrid effectiveness-implementation, stepped-wedge, cluster randomized controlled trial design. We will randomize the initiation of Thrive referrals at the unit level. Data collection will occur over 24 months. Inclusion criteria for Thrive referral include individuals who (1) are Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) reside in Philadelphia; (3) are admitted for a medical diagnosis for over 24 hours at the study hospital; (4) are planned for discharge to home; (5) agree to receive home care services; and (6) are aged ≥18 years. Primary analyses will use a mixed-effects negative binomial regression model to evaluate readmission and ED utilization, comparing those with and without SMI who receive Thrive to those with and without SMI who receive usual care. Using a convergent parallel mixed methods design, analyses will be conducted simultaneously for the survey and interview data of patients, clinicians, and health care system leaders. The cost of Thrive will be calculated from budget monitoring data for the research budget, the cost of staff time, and average Medicaid facility fee payments. ResultsThis research project was funded in October 2023. Data collection will occur from April 2024 through December 2025. Results are anticipated to be published in 2025-2027. ConclusionsWe anticipate that patients with and without co-occurring SMI will benefit from the adapted Thrive clinical pathway. We also anticipate the adapted version of Thrive to be deemed feasible, acceptable, and appropriate by patients, clinicians, and health system leaders. Trial RegistrationClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509 International Registered Report Identifier (IRRID)DERR1-10.2196/64575