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This article reviews the elevated prevalence and complex nature of voice complaints among teachers, highlighting their profound impact on students' academic performance, teachers' well-being, and overall school productivity. The text discusses the significance of teachers as occupational voice users, provides statistics on the prevalence, summarizes work-related factors and occupational policy contributing to the issue, and presents a comprehensive approach to intervention. This article facilitates recognizing and addressing work-related voice disorders among teachers while enhancing communication between educators and healthcare professionals.

The initiation of callus culture and the stabilization of cell suspensions are important steps in obtaining a callus mass for in vitro secondary metabolite production. The protocol described here could be used for efficient callus induction in a wide range of Passiflora spp. Murashige and Skoog medium supplemented with 2,4-Dichlorophenoxyacetic acid (2,4-D) and Picloram (PIC) in different concentrations and combinations with Benzylaminopurine (BAP) and Kinetin (KIN) were used for culture initiation. A total of 11 treatments and different plant organs as explant source were tested. Callus proliferation was performed in solid and liquid culture systems. The interaction of factors showed that internodal segments callused at 100% on medium containing 2 mg/l 2,4-D and 0.5 mg/l BAP. On this culture medium, the leaf fragments also performed the highest callusing rate (98.33%). For P. quadrangularis, the liquid culture system proved to be superior in terms of cell mass and dry matter content, which can be explained by the better access to nutrients and water in a liquid medium. This research demonstrates that P. quadrangularis callus culture is strongly influenced by the plant growth regulators combination, the type of explants and culture system. The cell suspension obtained is the first step in the secondary metabolite production system.

HPV vaccination rates remain below target levels among adolescents in the United States, which is particularly concerning in safety-net populations with persistent disparities in HPV-associated cancer burden. Perspectives on evidence-based strategies (EBS) for HPV vaccination among key implementation participants, internal and external to clinics, can provide a better understanding of why these disparities persist. We conducted virtual interviews and focus groups, guided by the Practice Change Model, with clinic members (providers, clinic leaders, and clinic staff) and community members (advocates, parents, policy-level, and payers) in Los Angeles and New Jersey to understand common and divergent perspectives on and experiences with HPV vaccination in safety-net primary care settings. Fifty-eight interviews and seven focus groups were conducted (n = 65 total). Clinic members (clinic leaders n = 7, providers n = 12, and clinic staff n = 6) revealed conflicting HPV vaccine messaging, lack of shared motivation to reduce missed opportunities and improve workflows, and non-operability between clinic electronic health records and state immunization registries created barriers for implementing effective strategies. Community members (advocates n = 8, policy n = 11, payers n = 8, and parents n = 13) described lack of HPV vaccine prioritization among payers, a reliance on advocates to lead national agenda setting and facilitate local implementation, and opportunities to support and engage schools in HPV vaccine messaging and adolescents in HPV vaccine decision-making. Participants indicated the COVID-19 pandemic complicated prioritization of HPV vaccination but also created opportunities for change. These findings highlight design and selection criteria for identifying and implementing EBS (changing the intervention itself, or practice-level resources versus external motivators) that bring internal and external clinic partners together for targeted approaches that account for local needs in improving HPV vaccine uptake within safety-net settings.

The role of gut microbe-derived metabolites in the development of metabolic syndrome (MetS) remains unclear. This study aimed to evaluate the associations of gut microbe-derived metabolites and MetS traits in the cross-sectional Metabolic Syndrome In Men (METSIM) study. The sample included 10,194 randomly related men (age 57.65 ± 7.12 years) from Eastern Finland. Levels of 35 metabolites were tested for associations with 13 MetS traits using lasso and stepwise regression. Significant associations were observed between multiple MetS traits and 32 metabolites, three of which exhibited particularly robust associations. N-acetyltryptophan was positively associated with Homeostatic Model Assessment for Insulin Resistant (HOMA-IR) (β = 0.02, p = 0.033), body mass index (BMI) (β = 0.025, p = 1.3 × 10-16), low-density lipoprotein cholesterol (LDL-C) (β = 0.034, p = 5.8 × 10-10), triglyceride (0.087, p = 1.3 × 10-16), systolic (β = 0.012, p = 2.5 × 10-6) and diastolic blood pressure (β = 0.011, p = 3.4 × 10-6). In addition, 3-(4-hydroxyphenyl) lactate yielded the strongest positive associations among all metabolites, for example, with HOMA-IR (β = 0.23, p = 4.4 × 10-33), and BMI (β = 0.097, p = 5.1 × 10-52). By comparison, 3-aminoisobutyrate was inversely associated with HOMA-IR (β = -0.19, p = 3.8 × 10-51) and triglycerides (β = -0.12, p = 5.9 × 10-36). Mendelian randomization analyses did not provide evidence that the observed associations with these three metabolites represented causal relationships. We identified significant associations between several gut microbiota-derived metabolites and MetS traits, consistent with the notion that gut microbes influence metabolic homeostasis, beyond traditional risk factors.

ABSTRACT: The objective of this randomized clinical trial was to assess whether early intervention with a nonsteroidal anti-inflammatory drug (NSAID) following a disease alert generated by automated milk feeders could reduce diarrhea severity and improve performance in dairy calves. A total of 71 Holstein calves were enrolled on an automated milk feeder (recorded milk intake and drinking speed) at 3 d of age and received up to 15 L/d (150 g/L) of milk replacer until 35 d of age. An alert that was previously validated as diagnostically accurate to identify calves at risk for diarrhea was used using automated milk feeder data (≤60% rolling dividends in milk intake or drinking speed over 2 d). At their first alert, calves were randomly allocated to receive a single subcutaneous injection of meloxicam (Metacam, Boehringer Ingelheim) at a rate of 0.5 mg/kg of BW (NSAID) or an equal volume of saline as a placebo control (CON). Fecal consistency was scored daily, and calves were diagnosed with diarrhea when they had loose feces for ≥2 d or watery feces for ≥1 d. Body weight was recorded at birth and weekly thereafter. A subset of calves (n = 32) were fitted with IceQube pedometers at 3 d of age to measure activity behaviors (lying time and step count). Mixed linear regression models were used to assess the association of study treatment with the duration of diarrhea after the alert and to evaluate the association of study treatment with milk intake, drinking speed, lying time, overall activity for 5 d following the alert, and ADG for 3 wk following the alert. On average, calves triggered an alert at (mean ± SD) 9.3 ± 2.3 d of age and were diagnosed with diarrhea at 9.6 ± 2.1 d of age. Diarrhea duration was similar between treatments (NSAID: 2.85 vs. CON: 2.94 ± 0.37 d), as were feeding behaviors (milk intake [NSAID: 8.2 vs. CON: 8.1 ± 0.4 L/d] and drinking speed [NSAID: 0.38 vs. CON: 0.37 ± 0.02 min/L]). Treatment was also not associated with ADG for the 3 wk after the alert (NSAID: 0.97 vs. CON: 0.97 ± 0.06 kg/d). However, calves provided an NSAID had reduced odds of being treated with electrolytes (odds ratio = 0.32, 95% CI: 0.10–0.98). In addition, calves provided an NSAID spent less time lying (NSAID: 17.64 vs. CON: 18.17 ± 0.19 h/day) and performed more steps over the 5 d following the alert (NSAID: 789.1 vs. CON: 628.0 steps/d), suggesting that CON calves may have been more lethargic. Overall, providing an NSAID at the time of a diarrhea alert did not affect diarrhea duration, feed intake, or growth. However, providing an NSAID increased activity in the 5 d following the alert, which may have reduced pain and symptoms of lethargy, indicating a milder response to the disease. We suggest that providing an NSAID at the time of diarrhea alert had little benefit on the calf; however, further work is needed to understand behaviors associated with malaise and pain in calves with diarrhea as well as the efficacy of NSAID under different management conditions.

BACKGROUND: Financial barriers in substance use disorder service systems have limited the widespread adoption-i.e., provider-level reach-of evidence-based practices (EBPs) for youth substance use disorders. Reach is essential to maximizing the population-level impact of EBPs. One promising, but rarely studied, type of implementation strategy for overcoming barriers to EBP reach is financing strategies, which direct financial resources in various ways to support implementation. We evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing two US federal grant mechanisms, organization-focused and state-focused grants, on organization-level A-CRA reach outcomes. METHOD: A-CRA implementation took place through organization-focused and state-focused grantee cohorts from 2006 to 2021. We used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, we calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding. We tested differences in certification rate by grant type using multivariable linear regression models that controlled for key covariates (e.g., time), and tested threats to internal validity from our quasi-experimental design through a series of sensitivity analyses. We also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. RESULTS: The overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants (p = .01). Sensitivity analyses suggested these findings were not explained by confounding temporal trends nor by organizational or state characteristics. We did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities). DISCUSSION: As the first published comparison of EBP reach outcomes between financing strategies, our findings can help guide state and federal policy related to financing strategies for implementing EBPs that reduce youth substance use. Future work should explore contextual conditions under which different financing strategies can support the widespread implementation of EBPs for substance use disorder treatment.

Efforts to identify anti-cancer therapeutics and understand tumor-immune interactions are built with in vitro models that do not match the microenvironmental characteristics of human tissues. Using in vitro models which mimic the physical properties of healthy or cancerous tissues and a physiologically relevant culture medium, we demonstrate that the chemical and physical properties of the microenvironment regulate the composition and topology of the glycocalyx. Remarkably, we find that cancer and age-related changes in the physical properties of the microenvironment are sufficient to adjust immune surveillance via the topology of the glycocalyx, a previously unknown phenomenon observable only with a physiologically relevant culture medium.

IntroductionWith aging, females often experience greater declines in functional capacity [e.g., gait speed (GS)] compared to males, highlighting the need for sex-difference considered in screening and intervention planning. In certain contexts, assessing GS may not be feasible. Handgrip strength (HGS) commonly used as a surrogate measure for physical performance, also serves as an indirect indicator of muscle strength in the lower limbs. This cross-sectional study aims to investigate the associations between HGS and common functional tests and to determine the optimal cut-off values for these tests in assessing GS.Methods142 community-dwelling older females aged 60–80 years old (mean age: 75 ± 6 years) were evaluated with HGS, the 30-second arm curl (30 s-AC), 30-second chair stand (30 s-CS), the Short Physical Performance Battery (SPPB), and the 8-foot Up & Go (8-UG) test. Pearson's correlation (r) was used to assess the strength of associations between HGS and functional variables, while multiple linear regression models identified determinants of GS. Receiver operating characteristic (ROC) curves were employed to evaluate the effectiveness of various tests in detecting slow GS (

La rehabilitación oncológica ha pasado de ser un aspecto secundario en el cuidado de los pacientes con cáncer a convertirse en un componente esencial de la atención integral. Inicialmente, el enfoque se centró en la prevención, el diagnóstico y el tratamiento de esta población, dejando de lado las consecuencias funcionales y psicosociales que causaba la enfermedad. Sin embargo, pioneros como Raven, Dietz y Rusk evidenciaron la necesidad de abordar estas secuelas, impulsando modelos multidisciplinarios con intervenciones físicas, cognitivas y emocionales. En Colombia, el Instituto Nacional de Cancerología ha liderado esfuerzos en el manejo del cáncer durante más de 85 años, integrando especialidades, tecnologías avanzadas y formación académica, situándose como referente regional. En el marco de estos esfuerzos, en 1968 se creó el servicio de rehabilitación oncológica. El aumento en las tasas de supervivencia de los pacientes oncológicos a nivel internacional alentó la implementación de programas que incorporan la rehabilitación oncológica de forma temprana. Aún se evidencia la necesidad de más profesionales especializados y mayor difusión de la importancia de la rehabilitación y de políticas que la respalden con el fin de garantizar una atención oncológica integral que incluya no solo la supervivencia, sino también la calidad de vida y la funcionalidad de los pacientes.

Desde 2019, Ecuador ha experimentado un aumento significativo en los homicidios y la expansión de bandas narcotraficantes, lo que alcanzó su punto álgido durante la crisis de seguridad de 2024, marcada por el ataque al canal de televisión TC y atentados en varias provincias del país. En este contexto, el presente estudio tiene como objetivo analizar el desorden informativo (DI) en la plataforma digital X durante dicha crisis a través del análisis de la difusión del DI mediante hashtags y posteos (corpus de 13.603 trinos) de ciudadanos, medios de comunicación y asambleístas, entre el 9 y el 17 de enero. Se empleó una metodología cuantitativa que combina técnicas de procesamiento de lenguaje natural (NLP) y análisis de contenido. Los resultados evidencian la presencia de DI durante la crisis. Se observa una predominancia de emocionalidad negativa en los trinos con DI, mientras que los trinos sin DI mostraron una tendencia hacia emociones más neutrales. El estudio subraya cómo las crisis de seguridad facilitan la creación y difusión del DI, destacando la importancia de desarrollar modelos automatizados que permitan su identificación en tiempo real.