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Abstract Introduction Mentoring programs are one mechanism used to increase diversity and participation of historically underrepresented groups in academic medicine. However, more knowledge is needed about the mentoring experiences and how culturally relevant concepts and perspectives may influence diverse students, trainees, and faculty success. This case study utilized the Culturally Engaging Campus Environments (CECE) model which examines the experiences of students in higher education. We used this model to examine the mentoring experiences of Black and Latine faculty and offer practical implications for the medical education continuum. Methods Our research approach is best understood through qualitative inquiry stemming from a single-case study which allowed for in-depth understanding of the contexts informing the phenomenon. Phenomenology is well positioned to contribute to understanding science and health professions. Selection criteria included individuals who self-identified as Black or Latine; inclusive of all faculty ranks and tracks. This analysis focuses on 8 semi-structured interviews, averaging 3 h in length. Results Findings centered on the area of cultural relevance, and participant narratives revealed the connection of mentoring with cultural familiarity, culturally relevant knowledge, cultural service and engagement, and cultural validation. Conclusion The use of cultural relevance indicators can inform the creation and evolution of mentoring programs towards holistic support of historically underrepresented trainees and faculty. Implications also focus on the development of mentors and championing the incorporation of cultural humility in the mentoring process. The implications in praxis offers the possibility for a new framework for culturally relevant mentoring (CRM). Through this framework we aim to enhance and facilitate inclusive learning environments and career development.

Introduction Social networking sites (or social media [SM]) are powerful web-based technologies used to bolster communication. SM have changed not only how information is communicated but also the dissemination and reception of a variety of topics. This workshop highlighted the benefits of SM for clinician educators. The use of SM was explored as a way to maximize opportunities for clinician educators to network, establish themselves as experts, and build a national reputation leading to promotion. The target audience for this submission is faculty developers who would like to implement a similar workshop, and clinician-educator faculty motivated by promotion and advancement. Methods The training workshop involved an interactive session, with approximately 20 minutes of content, 20 minutes of individual and small-group activities, and 15 minutes of large-group discussion. The effectiveness of the workshop was evaluated by asking participants to complete a postsession survey of SM knowledge, attitude, and action. Results Survey responses (n = 14) demonstrated an increase in participants’ knowledge of SM platforms, ability to identify benefits of SM, skills to disseminate their work, and eagerness to build their personal brand. Discussion This workshop provided a foundation for clinician educators to think strategically about SM use in ways that highlight access to a broader network of colleagues and potential collaborators and that influence the impact of publications and work.

Introduction Academic medicine has long faced the challenge of addressing health inequities, reflecting on how these contribute to structural racism, and perpetuating negative social determinants of health. Most recently, we have constructed opportunities for dialogues about racism, discrimination, and microaggressions (RDM). As such, we created a professional development program that encouraged participants to (1) openly discuss RDM and the impact they have in academia, (2) learn about tools to address and respond to RDM, and (3) move towards the creation of inclusive environments. The target audience included institutional leaders, faculty, trainees, professional staff, and health care teams. Methods We sought to meet workshop goals by integrating anti-racist dramaturgical teaching, introducing concepts knowledge, and practicing communication tools. To assess learning and evaluate our workshops, participants completed a pre- and postsurvey. Results Results showed that 30 participants were more comfortable with discussing issues related to race/ethnicity, gender identity/expression, sexual orientation, and spirituality after participating in the workshops. Prior to the two workshops, the percentage of learners who felt confident initiating conversations ranged from 29% to 54%. After the workshops, the percentage of learners who felt confident ranged from 58% to 92%. The greatest increase, 100%, was observed in the levels of confidence in initiating conversations related to race/ethnicity. Discussion Despite medical education's commitment to cultural competence and institutional mission statements that value diversity, equity, inclusion, and justice, professional development opportunities are limited. Participants strongly agreed their participation in such a workshop was relevant and important to their professional work.

This article explores the experiences of project directors at two-year Asian American and Native American Pacific Islander serving institutions in the Midwest. Specifically, we examined how project directors faced racialized campus environments, navigated support structures (or the lack thereof), and continually combatted misperceptions about the Asian American and Pacific Islander (AA/PI) communities and the Midwest. We discussed the isolation, myths, lack of institutional support, and campus climate for project directors and AA/PI communities. We end with recommendations.

The purpose of this narrative inquiry was to examine how Asian American college students made sense of themselves as racialized beings during the COVID-19 pandemic, a period that saw a drastic increase in anti-Asian hate. We were particularly interested in how emotions that students experienced in response to racism shaped their meaning-making of racial identity. We embraced tensions of a constructivist approach and a grounding in Asian critical theory to gain a more nuanced picture of Asian American college students' meaning-making of racial identity while also problematizing and critiquing racism. Data collection consisted of three interviews with 14 participants from the Midwest and East Coast of the US. To engage the reader's imagination and tell a nuanced story, we present findings as a fictional conversation between four individuals using direct quotes from participants. Our findings highlight the importance of considering transnational context when examining Asian American college students' racial identity development. Our findings further showcase the role emotions played in fostering development and the agentic ways participants responded to these emotions while also underscoring the high price participants paid for the more complex understanding of their racial identity. Implications for future research and practice are discussed.

Background: the quality of a health service is based on the level of competence and performance of its workers in fulfilling their job and social functions. Objective: to develop a system of job skills for health technologists Bachelors in Optometry and Optics. Methods: a technological development investigation was carried out in the field of medical education, from January 2021 to January 2022 in secondary level institutions of the Holguín municipality. Theoretical, empirical and statistical methods were used that allowed the methodological contrast of the results. The criteria of specialists was taken into account for the assessment of the developed competency system. Results: insufficiencies were identified to carry out optical-optometric procedures, limited participation in scientific research activities, low teaching and research ranking, weaknesses in the teacher-tutor function and little permanent improvement activity. A system of job competencies was developed for health technologists with degrees in Optometry and Optics designed in accordance with the exercise of their duties. Conclusions: the diagnosis carried out demonstrated the need for a system of work competencies to contribute to the improvement of the work performance of these professionals, which was valued as feasible, relevant and useful to be applied.

The access to molecular collections worldwide greatly improves the quality of scientific research by making a growing number of data available for investigation. The efforts on digitisation also aim at facilitating the exchange of material between institutions and researchers that must follow regulations in place and respect best practice. The handbook presented here proposes a workflow to follow to safely exchange materials, in accordance with international laws and legislation. We make numerous recommendations here to help the institutions and researchers to navigate the legal and administrative procedures, in order to manage molecular collections in the best way possible.

The objective of this study was to estimate trends in alcohol per capita consumption from 1990 to 2016 in the Region of the Americas, covering 35 Member States. Data from the WHO Global Information System on Alcohol and Health were used to calculate the annual percent change of alcohol per capita consumption in each of the 35 countries of the Americas. The Americas as a whole showed no change in the total period, with a slight decrease in the period 20102016. From 1990 to 2016, all the countries that presented a trend of annual increase in annual percent change of alcohol per capita consumption were in the Caribbean and Central America. Large increases were found in the recent years in Cuba, Colombia, Uruguay, El Salvador, and several countries of the Non-Latin Caribbean. In conclusion, alcohol use remains a significant obstacle to the achievement of Sustainable Development Goal 3.5. To date, the policy response has been inadequate in protecting the people in the Americas from alcohol-attributable harms. Improving country capacity to collect and analyze data on alcohol per capita consumption is urgently needed to monitor progress on the Sustainable Development Goals and to serve to promote proven alcohol policies for reducing the harmful use of alcohol.

Even as progress has been made in extending access to safe water and sanitation under the Sustainable Development Goals (SDGs), substantial disparities in water, sanitation, and hygiene (WASH) services persist in high-income countries around the world. These gaps in service occur disproportionately among historically marginalized, rural, informal, and Indigenous communities. This paper synthesizes results from a side session convened at the 2020 University of North Carolina, Chapel Hill, Water and Health conference focused on knowledge gaps, challenges, and approaches to achieve SDG 6 among marginalized communities in high-income countries. We provide approaches and next steps to advance sustainable WASH services in communities that have often been overlooked. HIGHLIGHTS HICs face similar challenges to LMICs in access to WASH, including reaching rural communities, building capacity, maintaining infrastructure, and improving water quality.; Historically marginalized communities are heavily impacted and massive socio-political change is needed to eliminate inequities.; HICs must improve access to services by filling data gaps, changing policies, and removing unjust social structures.;

In the past two decades, global manufacturing of per- and polyfluoroalkyl substances (PFAS) has shifted from long-chain compounds to short-chain alternatives in response to evidence of the health hazards of long-chain formulations. However, accumulating data indicate that short-chain PFAS also pose health risks and are highly mobile and persistent in the environment. Because short-chain PFAS are relatively new chemicals, comprehensive knowledge needed to predict their environmental fate is lacking. This study evaluated the capacity of machine-learned Bayesian networks (BNs) to predict risks of exposure to short-chain PFAS in a Minnesota region affected by PFAS releases from the 3M Cottage Grove facility. Models were trained using long-term monitoring data provided by the Minnesota Department of Health (n = 12,406), which we coupled to a comprehensive dataset created by curating 88 other variables that describe potential PFAS sources, soil and hydrogeologic characteristics, and land use. Model performance was assessed using the area under the receiver-operating characteristic curve (AUC), a common measure of the accuracy of machine-learned classification algorithms. In addition, exposure risks were visualized spatially by coupling model predictions to a geographic information system. We found that machine-learned BN models had robust predictive performance, with AUCs above 0.96 in cross-validation. Significant risk factors identified by the BNs include distance to the 3M factory, distance to a former landfill, and areal extent of wetlands and developed land. We also found that risks of exposure to and the areal extent of perfluorosulfonic acids were greater than for perfluorocarboxylic acids with the same carbon number. The results suggest that machine-learned BNs could provide a promising screening tool for assessing short-chain PFAS exposure risks in groundwater.

The genus Dirphys Howard 1914 syn. n. is synonymized with Encarsia Förster, and treated as a species-group of Encarsia, referred to henceforth as the Encarsia mexicana species-group. The monophyly of Encarsia is discussed in relation to Dirphys. The new synonymy is based on phylogenetic analyses of the nuclear ribosomal 28S-D2 gene region (43 taxa, 510 bp). The Encarsia mexicana species-group is recovered as strongly monophyletic within Encarsia. All species of the Encarsia mexicana species-group are revised. The group includes six previously described species, and fourteen newly described species. All species are described (or redescribed) and illustrated. Detailed distributional data, and, where available, plant associate and host records are provided for all species. Encarsia myartsevae Kresslein and Polaszek nom. nov. is here proposed as a replacement name for Encarsia mexicana Myartseva, now preoccupied by Encarsia mexicana (Howard). A dichotomous identification key, supplemented by an online multiple-entry key, is provided for all species.

Abstract Background Microorganisms, including Bacillus species are used to help control plant pathogens, thereby reducing reliance on synthetic pesticides in agriculture. Bacillus velezensis strain 1B-23 has been shown to reduce symptoms of bacterial disease caused by Clavibacter michiganensis subsp. michiganensis in greenhouse-grown tomatoes, with in vitro studies implicating the lipopeptide surfactin as a key antimicrobial. While surfactin is known to be effective against many bacterial pathogens, it is inhibitory to a smaller proportion of fungi which nonetheless cause the majority of crop diseases. In addition, knowledge of optimal conditions for surfactin production in B. velezensis is lacking. Results Here, B. velezensis 1B-23 was shown to inhibit in vitro growth of 10 fungal strains including Candida albicans, Cochliobolus carbonum, Cryptococcus neoformans, Cylindrocarpon destructans Fusarium oxysporum, Fusarium solani, Monilinia fructicola, and Rhizoctonia solani, as well as two strains of C. michiganensis michiganensis. Three of the fungal strains (C. carbonum, C. neoformans, and M. fructicola) and the bacterial strains were also inhibited by purified surfactin (surfactin C, or [Leu7] surfactin C15) from B. velezensis 1B-23. Optimal surfactin production occurred in vitro at a relatively low temperature (16 °C) and a slightly acidic pH of 6.0. In addition to surfactin, B. velenzensis also produced macrolactins, cyclic dipeptides and minor amounts of iturins which could be responsible for the bioactivity against fungal strains which were not inhibited by purified surfactin C. Conclusions Our study indicates that B. velezensis 1B-23 has potential as a biocontrol agent against both bacterial and fungal pathogens, and may be particularly useful in slightly acidic soils of cooler climates.

Abstract Background With the high demand for diesel across the world, environmental decontamination from its improper usage, storage and accidental spills becomes necessary. One highly environmentally friendly and cost-effective decontamination method is to utilize diesel-degrading microbes as a means for bioremediation. Here, we present a newly isolated and identified strain of Acinetobacter calcoaceticus (‘CA16’) as a candidate for the bioremediation of diesel-contaminated areas. Results Acinetobacter calcoaceticus CA16 was able to survive and grow in minimal medium with diesel as the only source of carbon. We determined through metabolomics that A. calcoaceticus CA16 appears to be efficient at diesel degradation. Specifically, CA16 is able to degrade 82 to 92% of aliphatic alkane hydrocarbons (C n H n + 2; where n = 12–18) in 28 days. Several diesel-degrading genes (such as alkM and xcpR) that are present in other microbes were also found to be activated in CA16. Conclusions The results presented here suggest that Acinetobacter strain CA16 has good potential in the bioremediation of diesel-polluted environments.

Abstract Background Mild asthma in horses decreases racing performance and impairs gas exchange. The efficacy of treatment on performance is unknown. Hypothesis Treatment targeting lung inflammation improves V˙O2peak in horses with mild asthma. Animals Thoroughbred polo horses (n = 12) with smoke‐induced mild asthma. Horses were exposed to increased ambient particulate matter (35.51 μg/m3 [PM2.5]; day mean, centrally measured) from day −33 to 0, from bushfire smoke (natural model). Methods Prospective, randomized, placebo‐controlled, double‐blinded clinical trial. All horses completed 3 V˙O2peak tests, measuring aerobic and anaerobic variables: day 0 ‐baseline; day 16 ‐after dexamethasone (20 mg IM q24h; DEX, n = 6) or saline treatment (SALINE, n = 6), under improved ambient PM2.5 concentrations (7.04 μg/m3); day 17‐15‐30mins after inhaled salbutamol (1500 μg). Bronchoalveolar lavage and mucus scoring were performed on day −8 and day 20. Linear mixed effects models were used to examine the effects of timepoint and treatment group on BAL differential cell counts, mucus scores, aerobic and anaerobic variables. Results Horses’ mucus scores improved significantly from day −8 to 20 by 1.27 ± .38 (P = .01). There was a significant increase in V˙O2peak of 15.5 ± 4.0 mL(min.kg)−1 from day 0 to 17 (P = .002), representing an average (mean) increase in V˙O2peak of 13.2%. There was no difference in V˙O2peak between treatment groups (SALINE versus DEX) at any timepoint. Conclusions and Clinical Importance This study highlighted the key role of improved air quality on functionally important airway inflammation. Evidence provided is central to increasing owner compliance regarding improved air quality for the treatment and prevention of mild asthma.

Abstract Background Bacillus velezensis is an endospore-forming, free-living soil bacterium with potential as a biopesticide against a broad spectrum of microbial pathogens of plants. Its potential for commercial development is enhanced by rapid replication and resistance to adverse environmental conditions, typical of Bacillus species. However, the use of beneficial microbes against phytopathogens has not gained dominance due to limitations that may be overcome with new biopesticidal strains and/or new biological knowledge. Results Here, we isolated B. velezensis strain 9D-6 and showed that it inhibits the in vitro growth of prokaryotic and eukaryotic pathogens, including the bacteria Bacillus cereus , Clavibacter michiganensis, Pantoea agglomerans, Ralstonia solanacearum, Xanthomonas campestris, and Xanthomonas euvesicatoria; and the fungi Alternaria solani, Cochliobolus carbonum, Fusarium oxysporum, Fusarium solani, Gibberella pulicaris, Gibberella zeae, Monilinia fructicola, Pyrenochaeta terrestris and Rhizoctonia solani. Antimicrobial compounds with activity against Clavibacter michiganensis were isolated from B. velezensis 9D-6 and characterized by high resolution LC-MS/MS, yielding formulae of C52H91N7O13 and C53H93N7O13, which correspond to [Leu7] surfactins C14 and C15 (also called surfactin B and surfactin C), respectively. We further sequenced the B. velezensis 9D-6 genome which consists of a single circular chromosome and revealed 13 gene clusters expected to participate in antimicrobial metabolite production, including surfactin and two metabolites that have not typically been found in this species - ladderane and lantipeptide. Despite being unable to inhibit the growth of Pseudomonas syringae DC3000 in an in vitro plate assay, B. velezensis 9D-6 significantly reduced root colonization by DC3000, suggesting that 9D-6 uses methods other than antimicrobials to control phytopathogens in the environment. Finally, using in silico DNA-DNA hybridization (isDDH), we confirm previous findings that many strains currently classified as B. amyloliquefaciens are actually B. velezensis. Conclusions The data presented here suggest B. velezensis 9D-6 as a candidate plant growth promoting bacterium (PGPB) and biopesticide, which uses a unique complement of antimicrobials, as well as other mechanisms, to protect plants against phytopathogens. Our results may contribute to future utilization of this strain, and will contribute to a knowledge base that will help to advance the field of microbial biocontrol.

Cellulose is one of the most abundant natural polymers on earth and is mainly produced by plants, although many bacteria, especially those belonging to the genus Gluconacetobacter, produce a very peculiar form of cellulose with mechanical and structural properties that can be exploited in numerous industrial applications. Studies about the kinetic of microorganism’s growth, helps the researchers understand more about how to obtain bacterial cellulose (BC) films, within specific measurement based on fermentation process. On the last two decades, the public and scientific interest has increased regarding the use and evolution of biodegradable plastics. Beside the fact that biodegradable plastics have the desired chemistry and physics properties that most of the synthetic plastics own, it can be obtained from renewable sources. The agroindustry residue Corn Steep Liquor (CSL) was used to replace the yeast extract and peptone as carbon and nitrogen sources aiming to minimize the cost, environmental impact and to add value to BC production. The culture medium that uses CSL to produce BC according to the life cycle analysis (LCA) showed a considerable reduction of environmental impacts. Considering a production for industrial application of the biomaterial, the reduction of production costs can also be high. Keywords: Bacterial Cellulose, Gluconacetobacter hansenii; Life Cycle Analysis, Environmental im

Este artigo trata de imigrantes em região de fronteira na condição de pendulares. Abordamos este tema a partir da perspectiva do reconhecimento de diferenciais em relação aos outros imigrantes em geral, uma vez que os pendulares tem a outra nação como destino pontualmente, ou seja, seu deslocamento é relacionado às atividades por eles desenvolvidas (estudo, trabalho, etc.), e seu retorno ao país de origem ocorre de maneira regular. O objetivo desta pesquisa é identificar traços característicos de imigrantes pendulares em região de fronteira. Entendemos que esta seja um palco diferenciado nas relações interpessoais e de trabalho, quando comparadas ao restante do território nacional. Nossos estudos foram aplicados em Corumbá, MS, Brasil, por entendermos que ali há históricas presenças imigrantes e consolidados movimentos imigratórios pendulares.

Postmortem magnetic resonance imaging (MRI) is emerging as a valuable tool to accompany traditional autopsy and has potential for use in cases when traditional autopsy is not possible. This case report will review the use of postmortem MRI with limited tissue sampling to differentiate between metastatic neuroblastoma and hepatoblastoma which could not be clearly differentiated with prenatal ultrasound, prenatal MRI, or emergent postnatal ultrasound. The mother presented to our institution at 27 weeks gestation after an obstetric ultrasound at her obstetrician's office identified a large abdominal mass. Fetal ultrasonography and MRI confirmed the mass but were unable to differentiate between neuroblastoma and multifocal hepatoblastoma. The baby was delivered by cesarean section after nonreassuring heart tones led to an emergent cesarean section. The baby underwent decompressive laparotomy to relieve an abdominal compartment syndrome; however, the family eventually decided to withdraw life support. At this time, we performed a whole body postmortem MRI which further characterized the mass as an adrenal neuroblastoma which was confirmed with limited tissue sampling. Postmortem MRI was especially helpful in this case, as the patient’s family declined traditional autopsy.

Biotechnology is the science that in the future will revolutionize the production of biomaterials for the markets, one of its most promising products is bacterial cellulose (BC). The BC has a high degree of purity, because it is not associated with other components such as lignin and hemicellulose of vegetable cellulose and, due to its nanofibrillar network in 3D, it is able to absorb water and has high tensile strength. Other characteristics, such as biocompatibility and biodegradability, result in the renewable character and in a wide range of technological applications, such as the manufacture of transparent / translucent nanocomposites and, in particular, biomedical applications, such as the production of dressings for the recovery of burned skin, where membranes release of drugs through the skin, polymeric materials for bone repair repair and cartilage, as well as several other technological areas and as reinforcement material in transparent / translucent nanocomposites. The BC membrane has been studied aiming at the usability in the production of garments, accessories and high value-added textile products and in the active packaging sector to avoid or identify contamination of food. In the biomaterials sector, numerous BC blends and composites have been synthesized to overcome their limitations and increase their applications. BC blends have antimicrobial, healing, conductive, magnetic and optical properties. The morphological and electrical characterization of BCs was the objective of this work. The BC production was carried out using agroindustrial residue. The biomaterial was morphologically characterized by MEV before and after impregnation with PHB. The incorporation of PHB into BC served to maximize the properties and physico-chemical and insulating biomaterial. Conductivity values ??compatible with semiconductors were identified for BC. The bio-nanoblend of BC + PHB also showed low conductivity value, similar to pure PHB. All the samples showed IxV behavior that suggests that the samples are

Children who rely on private well water in the United States have been shown to be at greater risk of having elevated blood lead levels. Evidence-based solutions are needed to prevent drinking water lead exposure among private well users, but minimal data are available regarding the real-world effectiveness of available interventions like point-of-use water treatment for well water. In this study, under-sink activated carbon block water filters were tested for lead and other heavy metals removal in an eight-month longitudinal study in 17 homes relying on private wells. The device removed 98% of all influent lead for the entirety of the study, with all effluent lead levels less than 1 µg/L. Profile sampling in a subset of homes showed that the faucet fixture is a significant source of lead leaching where well water is corrosive. Flushing alone was not capable of reducing first-draw lead to levels below 1 µg/L, but the under-sink filter was found to increase the safety and effectiveness of faucet flushing. The results of this study can be used by individual well users and policymakers alike to improve decision-making around the use of under-sink point-of-use devices to prevent disproportionate lead exposures among private well users.

Introducción: las cataratas congénitas e infantiles constituyen una amenaza para el desarrollo visual en los niños, pues inhiben o detienen potencialmente su maduración, unido a la complejidad de su tratamiento. Objetivo: evaluar los resultados visuales y anatómicos de la cirugía de catarata infantil con el uso de la incisión corneal pequeña autosellante. Método: se realizó un estudi o transversal, cuyo universo estuvo constituido por 19 niños ( 24 ojos) con catarata congénita e infantil, intervenidos quirúrgicamente en el Hospital Pediátrico de Holguín en 2016 y 2017. Se evaluaron las variables: edad, sexo, etiología, agudeza visual pre y postoperatoria a los 3 meses, técnica quirúrgica empleada, astigmatismo inducido, conservación de la transparencia y curvatura corneal, así como complicaciones. Resultados: predominó el grupo de edad de 3 a 8 años con el 47,4%, y el sexo masculino, con el 79% , y la etiología congénita ascendió hasta el 50%. La agudeza visual preoperatoria entre percepción luminosa a 0,1 se presentó en el 50%. En la postoperatoria del 62,5% de los casos se obtuvo entre 0,7 a 1,0. La técnica quirúrgica empleada fue la incisión corneal pequeña autosellante ,en el 75%, y el astigmatismo inducido fue bajo, menor de 1 D. La transparencia corneal se conservó en el 100%, y en el 62,5% la curvatura corneal tuvo variaciones mínimas (≤0,50 D). Las complicaciones más frecuentes fueron opacidad de la cápsula posterior con 50% y uveítis anterior con el 37,5%. Conclusiones: el uso de la incisión corneal pequeña autosellante en la cirugía de c atarata infantil garantiza buenos resultados visuales y anatómicos. Palabras clave: catarata, infantil, incisión autosellante.

Resumo OBJETIVO Analisar o grau de responsabilização e participação do usuário em tratamento no Centro de Atenção Psicossocial Álcool e Drogas (CAPS-ad) sob a perspectiva da política de redução de danos. MÉTODOS Trata-se de uma pesquisa de abordagem qualitativa, do tipo estudo de caso, com 12 usuários e quatro profissionais do CAPS-ad de um município de Minas Gerais. Os dados foram coletados entre abril e setembro/2017 por meio de entrevista semi-estruturada, observação participante e análise documental. RESULTADOS A partir da análise de conteúdo, as informações foram organizadas em duas categorias temáticas: objetivos do tratamento e motivação para o tratamento. Conclusões: os achados da pesquisa revelaram que os usuários devem ser mais responsabilizados e empoderados em relação ao seu tratamento. CONCLUSÕES Sugere-se maior escuta profissional, favorecendo a construção de metas condizentes com os interesses dos usuários, na forma de contratos.

Se presenta el caso de una niña de 6 años con diagnóstico de síndrome de Noonan, enfermedad genética que se caracteriza por variaciones fenotípicas similares al de Turner. Suele aparecer con carácter autosómico dominante. En ocasiones, muestra una expresión variable, con manifestaciones oftalmológicas como: hipertelorismo, ptosis palpebral bilateral, hendidura palpebral antimongoloide, puente nasal ancho, esotropia de pequeño ángulo y ambliopía. La paciente se atendió en el Hospital Pediátrico Provincial de Holguín. Palabras clave: síndrome de Noonan, genética, malformaciones oftalmológicas

Previous evidence has identified potential racial disparities in access to community water and sewer service in peri-urban areas adjacent to North Carolina municipalities. We performed the first quantitative, multi-county analysis of these disparities. Using publicly available data, we identified areas bordering municipalities and lacking community water and/or sewer service in 75 North Carolina counties. Logistic regression was performed to evaluate the relationship between race and access to service in peri-urban areas, controlling for population density, median home value, urban status, and percent white in the adjacent municipality. In the peri-urban areas analyzed, 67% of the population lacked community sewer service, and 33% lacked community water service. In areas other than those with no black residents, odds of having community water service (p

Type 3 secretion systems (T3SSs) are utilized by pathogenic Escherichia coli to infect their hosts and many proteins from these systems are affected by chaperones specific to T3SS-containing bacteria. Toward developing a recombinant vaccine against enterohaemorrhagic E. coli (EHEC), we expressed recombinant T3SS and related proteins from predominant EHEC serotypes in Nicotiana chloroplasts. Nicotiana benthamiana were transiently transformed to express chloroplast-targeted Tir, NleA, and EspD from the EHEC serotype O157:H7; a fusion of EspA proteins from serotypes O157:H7 and O26:H11; and a fusion of epitopes of Tir (Tir-ep) from serotypes O157:H7, O26:H11, O45:H2, and O111:H8. C-terminal GFP reporter fusion constructs were also developed and transiently expressed to confirm subcellular localization and quantify relative expression levels in situ. Recombinant proteins were co-expressed with chaperones specific to each T3SS protein with the goal of increasing their accumulation in the chloroplast. We found that co-expression with the chloroplast-targeted chaperone CesT significantly increases accumulation of recombinant Tir when the latter is either transiently expressed in the nucleus and targeted to the chloroplast of N. benthamiana or stably expressed in transplastomic Nicotiana tabacum. CesT also helped maintain higher levels of Tir:GFP fusion protein over time both in vivo and ex vivo, indicating that the favorable effect of CesT on accumulation of Tir is not specific to a single time point or to fresh material. By contrast, T3SS chaperones CesT, CesAB, CesD, and CesD2 did not increase accumulation of NleA:GFP, EspA:GFP, or EspD:GFP, which suggests dissimilar functioning of these chaperone–substrate combinations. CesT did not increase accumulation of Tir-ep:GFP, which may be due to the absence of the CesT binding domain from this fusion protein. The fusion to GFP improved accumulation of Tir-ep relative to the unfused protein, but not for the other recombinant proteins. These results emphasize the importance of native chaperones and stabilizing fusions as potential tools for the production of higher levels of recombinant proteins in plants; and may have implications for understanding interactions between T3SS chaperones and their substrates. In particular, our findings highlight the potential of T3SS chaperones to increase accumulation of recombinant T3SS proteins in heterologous systems.

El síndrome de Wolfram es una enfermedad neurodegenerativa progresiva con transmisión autosómica recesiva, caracterizada por la presencia de diabetes mellitus y atrofia óptica, también pueden estar presentes la diabetes insípida y la disacusia neurosensorial explicando el acrónimo DIDMOAD (diabetes insípida, diabetes mellitus, atrofia óptica y sordera). Cursa con diversas manifestaciones clínicas, además, como la dilatación de las vías urinarias, alteraciones neurológicas, alteraciones psiquiátricas y alteraciones gonadales. La diabetes mellitus, de aparición precoz y con poca prevalencia de cetoacidosis y la atrofia óptica se consideran criterios diagnósticos fundamentales en este síndrome. Se presenta en la infancia, lo que da lugar a una mayor dificultad diagnóstica y terapéutica, con una elevada morbimortalidad y deterioro de la calidad de vida por las afectaciones neurológicas y urológicas. Se presentaron dos pacientes, hermanos, con síndrome de Wolfram y sus manifestaciones oftalmológicas, cuyo diagnóstico se realizó por la presencia de diabetes mellitus en la primera década de la vida y atrofia óptica bilateral, ahora con 18 y 11 años de edad, respectivamente. Palabras clave: síndrome de Wolfram, DIDMOAD, atrofia óptica.

Congenital Pulmonary Airway Malformations (CPAMs) are abnormalities of lung parenchyma that are often diagnosed upon prenatal imaging as opposed to postnatal symptoms. With a clinical presentation identical to CPAMs, Pleuropulmonary Blastoma (PPB) is a rare pulmonary neoplasm of highly malignant potential. We present a rare case of a female infant with a vague medical history of respiratory distress syndrome (RDS) at birth, presenting with a tension pneumothorax at three months of age, thought initially to be secondary to CPAM, but found to be PPB upon surgical resection and histological analysis. PPB is a rare pulmonary neoplasm of childhood that originates from the primitive interstitium of the lung, resulting in lesions that can be highly malignant. It is classified as type I (cystic), type II (cystic/solid) or type III (solid), with a progression of disease and worsening prognosis from type I to type III. Due to the cystic nature of CPAM and PPB it is difficult to differentiate on imaging alone; diagnosis must be made based on histological analysis. The highly malignant nature and potential for morbidity and mortality of PPB should make clinicians consider early resection of cystic lung lesions preferentially on an elective basis.

BackgroundThis study estimates the potential health gains achievable in the United Arab Emirates (UAE) with improved controls on environmental pollution. The UAE is an emerging economy in which population health risks have shifted rapidly from infectious diseases to chronic conditions observed in developed nations. The UAE government commissioned this work as part of an environmental health strategic planning project intended to address this shift in the nature of the country's disease burden.Methods and findingsWe assessed the burden of disease attributable to six environmental exposure routes outdoor air, indoor air, drinking water, coastal water, occupational environments, and climate change. For every exposure route, we integrated UAE environmental monitoring and public health data in a spatially resolved Monte Carlo simulation model to estimate the annual disease burden attributable to selected pollutants. The assessment included the entire UAE population (4.5 million for the year of analysis). The study found that outdoor air pollution was the leading contributor to mortality, with 651 attributable deaths (95% confidence interval [CI] 143-1,440), or 7.3% of all deaths. Indoor air pollution and occupational exposures were the second and third leading contributors to mortality, with 153 (95% CI 85-216) and 46 attributable deaths (95% CI 26-72), respectively. The leading contributor to health-care facility visits was drinking water pollution, to which 46,600 (95% CI 15,300-61,400) health-care facility visits were attributed (about 15% of the visits for all the diseases considered in this study). Major study limitations included (1) a lack of information needed to translate health-care facility visits to quality-adjusted-life-year estimates and (2) insufficient spatial coverage of environmental data.ConclusionsBased on international comparisons, the UAE's environmental disease burden is low for all factors except outdoor air pollution. From a public health perspective, reducing pollutant emissions to outdoor air should be a high priority for the UAE's environmental agencies.