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Ideally, in a real cyberattack, the early detection of probable hacker intent can lead to improved mitigation or prevention of exploitation. With the knowledge of basic principles of communication protocols, the reconnaissance/scanning phase intentions of a hacker can be inferred by detecting specific patterns of behavior associated with hacker tools and commands. Analyzing the reconnaissance behavior of the TCP Syn Scan between Nmap and the host, we built machine learning models incorporating the use of a filtering method we developed for labeling a dataset for detection of this behavior. We conclude that feature selection and detailed targeted labeling, based on behavior patterns, yield a high accuracy and F1 Score using Random Forest and Logistics Regression classifiers.

Abstract The Philippines is a high-incidence country for tuberculosis, with the increasing prevalence of multi- (MDR-TB) and extensively-drug (XDR-TB) resistant Mycobacterium tuberculosis strains posing difficulties to disease control. Understanding the genetic diversity of circulating strains can provide insights into underlying drug resistance mutations and transmission dynamics, thereby assisting the design of diagnostic tools, including those using next generation sequencing (NGS) platforms. By analysing genome sequencing data of 732 isolates from Philippines drug-resistance survey collections spanning from 2011 to 2019, we found that the majority belonged to lineages L1 (531/732; 72.5%) and L4 (European-American; n = 174; 23.8%), with the Manila strain (L1.2.1.2.1) being the most prominent (475/531). Approximately two-thirds of isolates were found to be at least MDR-TB (483/732; 66.0%), and potential XDR-TB genotypic resistance was observed (3/732; 0.4%), highlighting an emerging problem in the country. Genotypic resistance was highly concordant with laboratory drug susceptibility testing. By finding isolates with (near-)identical genomic variation, five major clusters containing a total of 114 isolates were identified: all containing either L1 or L4 isolates with at least MDR-TB resistance and spanning multiple years of collection. Closer inspection of clusters revealed transmission in prisons, some involving isolates with XDR-TB, and mutations linked to third-line drug bedaquiline. We have also identified previously unreported mutations linked to resistance for isoniazid, rifampicin, ethambutol, and fluoroquinolones. Overall, this study provides important insights into the genetic diversity, transmission and circulating drug resistance mutations of M. tuberculosis in the Philippines, thereby informing clinical and surveillance decision-making, which is increasingly using NGS platforms.

Background Simulated cases are widely used in medical education to develop clinical reasoning skills and discuss key topics around patient care. Such cases present an opportunity to demonstrate real world encounters with diverse patient and health provider identities, impacts of social and structural determinants of health, and demonstrate a generalist approach to problems. However, despite many calls-to-action for medical schools to better incorporate equity, diversity and inclusion (EDI) and generalism, it remains difficult to evaluate how well these goals are being met.Methods A quality improvement project was completed at a single medical school to evaluate the domains of generalism and EDI within simulated cases used in the preclinical curriculum. Generalism was evaluated using the Toronto Generalism Assessment Tool (T-GAT). EDI was evaluated using a locally developed novel tool. Analysis included descriptive statistics and Pearson correlation coefficient.Results A total of 49 simulated cases were reviewed. Twelve generalism and 5 EDI items were scored on a 5-point Likert scale, with higher scores indicating better demonstration of generalism or EDI within a case. Average generalism score across all cases was 45.6/60. Average EDI score across all cases was 11.7/25. Only 21/49 cases included representation of one or more diverse identity categories. The most common diverse identity represented was non-white races/ethnicities, and the identity represented the least was diversity in language fluency. Generalism and EDI scores demonstrated a weak positive correlation (R2 = 0.25).Conclusions Quantitative evaluation of simulated cases using specific generalism and EDI scoring tools was successful in generating insight into areas of improvement for teaching cases. This approach identified key content areas for case improvement and identities that are currently underrepresented in teaching cases. Similar approaches could be feasibly used by other medical schools to improve generalism and EDI in teaching cases or other curricular materials.

Abstract Over 60 million tons of polyethylene terephthalate (PET) fibers are produced annually for clothing, upholstery, linens, and carpeting. Despite its widespread use, the versatility of PET is constrained by its flammability, which poses a particular fire hazard to homes with synthetic furnishings. To mitigate this fire risk, a polyelectrolyte complex (PEC) solution composed of polyallylamine hydrochloride and poly(sodium phosphate) is deposited onto the surface of 100% polyester fabric to render it self-extinguishing and eliminate melt dripping. A buffered solution of acetic acid, citric acid, or formic acid is used to initiate ionic complexation, rendering the PEC water resistant. Buffer identity affects deposition, but does not significantly influence the intumescent mechanism. This rapidly deposited aqueous coating primarily operates by facilitating production of an insulating char layer that limits the heat release and degradation of polyester into volatile byproducts.

Abstract Background The progressive multimorbidity explosion has challenged Chile’s health systems and worldwide. The Centro de Innovación en Salud ANCORA UC implemented a new Multimorbidity Patient-Centered Care Model in Chile. Objective Evaluate the perspective of high-risk patients about the core elements of the model. Methodology We conducted a cross sectional telephone-based survey that considered the application of a 13 items questionnaire. Of them, nine were Likert scale questions with scores from 1 to 7, one dichotomic question, and three open-ended questions. 231 high-risk patients who received care through the model at primary care centers participated in the study. Quantitative data were encoded, consolidated, and analyzed with the SPSS software. We performed descriptive and analytic statistics techniques to assess different variables and their potential associations. Thematic analysis was conducted for qualitative data. Results The overall score was 5.84 (range: 1 to 7), with a standard deviation of 1.25. Questions with the best scores were those related with personalized care and the primary care teams. The lowest scored was for the item regarding the continuity of care between primary nurses and inpatient care at the hospital. There was a difference in patient outcomes depending on their health center. Regarding sociodemographic characteristics, age did not significantly affect the results. Conclusions The study reveals the perceptions about a complex multimorbidity intervention from the patient’s perspective. It complements the impact on health services utilization evaluation that supports decision-makers currently scaling up a similar strategy in our country and could be considered in other countries dealing with non-communicable diseases.

Abstract Thin polymer‐based coatings with high oxygen barrier at elevated humidity are needed for the protection of food and organic electronic devices. Polyelectrolyte‐based thin films (deposited via layer‐by‐layer assembly) perform well at ambient humidity, but their performance typically dwindles as humidity increases due to their hydrophilic nature. Retention of their high barrier can be achieved through the addition of chemical crosslinkers or the introduction of inorganic platelets that create a nanobrick wall structure. In this study, a nanobrick wall barrier prepared with two types of clay, with a thickness less than 200 nm, is shown to reduce the oxygen transmission rate (OTR) of 179 µm polyethylene terephthalate to less than 0.016 cm3 m−2 day−1 atm−1. At 90% relative humidity (RH), a quadlayer barrier consisting of polyethylenimine, boehmite clay, poly(acrylic acid), and vermiculite clay maintains nearly 90% of its barrier performance at 0% RH (OTR = 0.019 cm3 m−2 day−1 atm−1). This study demonstrates the potential of dual clay thin film nanocomposites to protect various consumer goods at high humidity.

Background: Preterm birth rates are consistently higher in African American (AA) pregnancies compared to White pregnancies in the United States. Neighborhood racial composition, experiences of racial discrimination, and systemic inflammation are factors that have been associated with preterm birth and other adverse pregnancy outcomes that may account for these disparities. Here, we investigated whether perceived neighborhood racial composition and experiences of discrimination were predictive of cytokine levels during pregnancy among AA individuals. Methods: 545 AA individuals completed surveys and had blood samples collected at prenatal clinics in the Midwest at three timepoints (8–18,19-29, and 30–36 weeks gestation) throughout pregnancy. Pro-inflammatory [interferon (IFN)-γ, interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, macrophage migration inhibitory factor (MIF)] and anti-inflammatory cytokines (IL-10) were quantified. Multivariate and multilevel models were used to examine associations of perceived neighborhood racial composition and experiences of racial discrimination with cytokine levels, controlling for relevant covariates. Results: Perceived neighborhood racial composition was significantly associated with MIF at 30–36 weeks gestation in multivariate regression (p

Abstract Background Complex health interventions involve deep organizational, structural, and cultural changes that challenge health teams and decision-makers. The explosion of chronic diseases has made the multimorbidity approach a global priority. The Centro de Innovación en Salud ANCORA UC implemented a Multimorbidity Patient-Centered Care Model in the Chilean public health system. Objective This study aims to evaluate the progress of the implementation of the Multimorbidity Patient-Centered Care Model in seven primary care centers through key performance indicators. Methods a set of indicators was designed to evaluate change management, operations, installation of new roles, and services and activities of the intervention strategy of the model. Key performance indicators were identified to monitor the implementation progress on minimal components for the model’s sustainability. Each item was assigned against an expected minimum score of 67% of progress from the overall score. They were monitored twice in seven primary health centers in 2019 and 2020, which intervened 22,642 patients with the intervention. Results The results showed that six of the seven primary care centers reached the minimum implementation threshold. The main advances were in operational conditions, and those with minor progress in implementation were the clinical services. Population size, organization, coordination of the health care teams, additional training, and decision-makers support were key factors that determined the degree of progress in a complex intervention. Conclusion It was possible to measure the progression of the implementation of a complex intervention through key performance indicators delivering relevant information for decision-makers that pursue a successful and faithful implementation. This study provides a valuable tool for the national scale-up of a similar model started in Chile by the Ministry of Health and other countries.

Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women’s well-being and ensure healthcare system preparedness during future public health crises.

Abstract Background Disruptions in essential health services during the COVID-19 pandemic have been reported in several countries. Yet, patterns in health service disruption according to country responses remain unclear. In this paper, we investigate associations between the stringency of COVID-19 containment policies and disruptions in 31 health services in 10 low- middle- and high-income countries in 2020. Methods Using routine health information systems and administrative data from 10 countries (Chile, Ethiopia, Ghana, Haiti, Lao People’s Democratic Republic, Mexico, Nepal, South Africa, South Korea, and Thailand) we estimated health service disruptions for the period of April to December 2020 by dividing monthly service provision at national levels by the average service provision in the 15 months pre-COVID (January 2019-March 2020). We used the Oxford COVID-19 Government Response Tracker (OxCGRT) index and multi-level linear regression analyses to assess associations between the stringency of restrictions and health service disruptions over nine months. We extended the analysis by examining associations between 11 individual containment or closure policies and health service disruptions. Models were adjusted for COVID caseload, health service category and country GDP and included robust standard errors. Findings Chronic disease care was among the most affected services. Regression analyses revealed that a 10% increase in the mean stringency index was associated with a 3.3 percentage-point (95% CI -3.9, -2.7) reduction in relative service volumes. Among individual policies, curfews, and the presence of a state of emergency, had the largest coefficients and were associated with 14.1 (95% CI -19.6, 8.7) and 10.7 (95% CI -12.7, -8.7) percentage-point lower relative service volumes, respectively. In contrast, number of COVID-19 cases in 2020 was not associated with health service disruptions in any model. Conclusions Although containment policies were crucial in reducing COVID-19 mortality in many contexts, it is important to consider the indirect effects of these restrictions. Strategies to improve the resilience of health systems should be designed to ensure that populations can continue accessing essential health care despite the presence of containment policies during future infectious disease outbreaks.

Abstract Chronic Venous Disorders (CVD) of the lower limbs are one of the most prevalent medical conditions, affecting 35% of adults in Europe and North America. Due to the exponential growth of the aging population and the worsening of CVD with age, it is expected that the healthcare costs and the resources needed for the treatment of CVD will increase in the coming years. The early diagnosis of CVD is fundamental in treatment planning, while the monitoring of its treatment is fundamental to assess a patient’s condition and quantify the evolution of CVD. However, correct diagnosis relies on a qualitative approach through visual recognition of the various venous disorders, being time-consuming and highly dependent on the physician’s expertise. In this paper, we propose a novel automatic strategy for the joint segmentation and classification of CVDs. The strategy relies on a multi-task deep learning network, denominated VENet, that simultaneously solves segmentation and classification tasks, exploiting the information of both tasks to increase learning efficiency, ultimately improving their performance. The proposed method was compared against state-of-the-art strategies in a dataset of 1376 CVD images. Experiments showed that the VENet achieved a classification performance of 96.4%, 96.4%, and 97.2% for accuracy, precision, and recall, respectively, and a segmentation performance of 75.4%, 76.7.0%, 76.7% for the Dice coefficient, precision, and recall, respectively. The joint formulation increased the robustness of both tasks when compared to the conventional classification or segmentation strategies, proving its added value, mainly for the segmentation of small lesions.

Abstract COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People’s Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions.

This study aims at identifying molecular biomarkers differentiating responders and non-responders to treatment with Tumor Necrosis Factor inhibitors (TNFi) among patients with axial spondyloarthritis (axSpA). Whole blood mRNA and plasma proteins were measured in a cohort of biologic-naïve axSpA patients (n = 35), pre and post (14 weeks) TNFi treatment with adalimumab. Differential expression analysis was used to identify the most enriched pathways and in predictive models to distinguish responses to TNFi. A treatment-associated signature suggests a reduction in inflammatory activity. We found transcripts and proteins robustly differentially expressed between baseline and week 14 in responders. C-reactive protein (CRP) and Haptoglobin (HP) proteins showed strong and early decrease in the plasma of axSpA patients, while a cluster of apolipoproteins (APOD, APOA2, APOA1) showed increased expression at week 14. Responders to TNFi treatment present higher levels of markers of innate immunity at baseline, and lower levels of adaptive immunity markers, particularly B-cells. A logistic regression model incorporating ASDAS-CRP, gender, and AFF3, the top differentially expressed gene at baseline, enabled an accurate prediction of response to adalimumab in our cohort (AUC = 0.97). In conclusion, innate and adaptive immune cell type composition at baseline may be a major contributor to response to adalimumab in axSpA patients. A model including clinical and gene expression variables should also be considered.

Abstract Dielectric materials that can withstand high voltages are of great interest due to the growing need for high‐performance insulation systems in electronics. Polymer nanocomposites have gained popularity as electrical insulators due to their processability, high operating voltage, and tortuous paths for current flow created by the nanoparticles in the polymer matrix. The dielectric breakdown strength of a relatively thick multilayer thin film containing polyethylenimine (PEI) and vermiculite clay (VMT), thickened with tris(hydroxymethyl)aminomethane (tris), is evaluated as a function of bilayers (BL) deposited. The resulting nanobrick wall structure of this clay‐based assembly is ideal for protective insulation. An 8 BL PEI+tris/VMT film achieves a dielectric breakdown strength of 245 kV mm−1, with a thickness of 5 µm. With increasing bilayers, the breakdown strength gradually decreases, but 20 BL of PEI+tris/VMT achieves a breakdown voltage of 2.36 kV. This nanoplatelet‐based system is the first “thick growing” layer‐by‐layer deposited film to be used as an insulating layer. Its unusually high breakdown strength can be useful for the protection of various high voltage electronics.

Introduction The rampant distribution of idealised images on the internet may lead the general public to improve their body appearance in a way that is sometimes excessive, compulsive or detrimental to other aspects of their lives. There is a decreasing appreciation of body image among emerging adults and an increasing trend on skin-lightening practices linked with psychological distress. This protocol describes the mixed-method approach to assess the relationships among body image perception, skin-lightening practices and mental well-being of Filipino emerging adults and determine the factors that influence them.Methods and analysis An explanatory sequential mixed-method approach will be used. A cross-sectional study design will involve an online self-administered questionnaire of 1258 participants, while a case study design will involve in-depth interviews with 25 participants. Data analysis will use generalised linear models and structural equation modelling with a Bayesian network for the quantitative data. Moreover, the qualitative data will use an inductive approach in thematic analysis. A contiguous narrative approach will integrate the quantitative and qualitative data.Ethics and dissemination The University of the Philippines Manila Review Ethics Board has approved this protocol (UPMREB 2022-0407-01). The study results will be disseminated through peer-reviewed articles and conference presentations.

In eastern North America, apple orchards are often attacked by several species of tortricid moths (Lepidoptera), including Cydia pomonella, Grapholita molesta, Argyrotaenia velutinana, and Pandemis limitata. Sex pheromones are routinely used to monitor male moth populations. Adding plant volatiles to monitoring traps could increase the capture of moths of both sexes and improve the effectiveness of mating disruption systems. This study sought to quantify the attraction of adults of four tortricid moth species to five olfactory treatments, namely (1) Pherocon® CM L2-P, (2) Pherocon Megalure CM 4K Dual® (=Megalure), (3) Megalure + benzaldehyde, (4) TRE 2266 (linalool oxide + (E)-4,8-dimethyl-1,3,7-nonatriene (DMNT)), and (5) TRE 2267 (linalool oxide + DMNT + benzaldehyde), in non-mating disrupted commercial apple orchards in Massachusetts. The commercial lure Megalure was attractive to both sexes of G. molesta and C. pomonella. The addition of benzaldehyde to TRE 2266 or to Megalure significantly increased the capture of male G. molesta during the mid and late season of 2021. Only when benzaldehyde was added to TRE 2266 did the latter lure attract P. limitata in 2020 and 2021. The greatest number of tortricid moths (all four species combined) was captured by TRE 2267. This finding highlights the opportunity to enhance the attractiveness of a commercial lure through the addition of benzaldehyde, an aromatic compound, to Megalure. The potential of these additional volatiles to detect moths in a mating-disrupted orchard and/or remove female moths as a component of a management system is discussed.

Abstract In an effort to improve the heat shielding ability of multilayer polymer-clay films, the influence of various small molecule additives was studied. Tris(hydroxymethyl)aminomethane (THAM), pentaerythritol (PER), and ammonium pentaborate (PB) are each utilized in flame retardant applications for the benefits they provide in reducing the propagation of fire. In the present study, these additives combined with polyethylenimine (PEI) and vermiculite (VMT) clay and the resulting growth of the coatings and the thermal resistivity were measured. THAM and PB salts contribute most to the overall growth of the layer-by-layer assembled films, generating an increase in film thickness of 50% or more, while PER has a greater impact on heat shielding. A 14-bilayer (THAM + PER + PEI)/VMT coating (~25 µm thick) on steel can achieve a temperature differential of over 125 °C due to a layering effect that occurs within the architecture of the macroscopic insulation bubble and disordered char. This improved thermal resistivity across a relatively thin film generates a heat shield that can be applied in novel applications such as a single-use protective barrier for aerospace components.

BackgroundLow back pain (LBP) is a long-term health condition with distinct clinical courses. Its characterization together with the identification of prognostic factors for a persistent LBP course may trigger the development of personalized interventions. This study aimed to investigate the courses of chronic LBP (CLBP), its cumulative impact, and the indicators for the persistence of pain.Material and methodsPatients with active CLBP from the EpiDoC, a population-based cohort study of a randomly recruited sample of 10.661 adults with prolonged follow-up, were considered. Pain, disability, and health-related quality of life (HRQoL) were assessed at three time-points over five years. According to their pain symptoms over time, participants were classified as having a persistent (pain at the baseline and at all the subsequent time-points) or a relapsing pain course (pain at the baseline and no pain at least in one of the subsequent time-points). A mixed ANOVA was used to compare mean differences within and between patients of distinct courses. Prognostic indicators for the persistent LBP course were modulated through logistic regression.ResultsAmong the 1.201 adults with active CLBP at baseline, 634 (52.8%) completed the three time-points of data collection: 400 (63.1%) had a persistent and 234 (36.9%) a relapsing course. Statistically significant interactions were found between the group and time on disability (F (2,1258) = 23.779, pConclusionIn the long-term, patients with CLBP may follow a persistent or relapsing course of pain. Being female, presenting depressive symptoms, having a manual job and higher disability at baseline predicts a persistent course of LBP.

BackgroundChile is implementing a Community Mental Health Model with a strong role of primary health care (PHC). PHC has great potential to early detection and provision of accessible and coordinated services to people who present mental illness and/or substance use issues (MISUI). However, stigma toward people with MISUI among PHC professionals is a significant barrier to accessing good quality of care. A wealth of literature supports the importance of reducing stigma for this population. The main goal of this research project is to determine the effectiveness of a comprehensive anti-stigma intervention in reducing stigmatizing attitudes and behaviors among PHC providers toward individuals with MISUI in the Chilean context, using Centros de Salud Familiar (CESFAMs) as the point of intervention.MethodsThe intervention is based on an initiative that was previously developed in Canada and then also pilot-tested in Lima, Peru, with the Center for Addiction and Mental Health (Ontario, Canada). The model will be culturally adapted with CESFAM PHC provider and user inputs to be relevant and valid to Chile. The 18-month intervention includes five (5) components that are simultaneously implemented in CESFAMs: (1) Develop a Team of Local Champions in each intervention CESFAM, comprising PHC providers and users; (2) Analysis of Internal CESFAM Policies, Procedures, and Protocols to determine areas of improvement in service delivery for individuals with MISUI; (3) Raising Awareness of stigma toward MISUI using various forms of media within the CESFAM; (4) Innovative Contact-Based Education workshops on anti-stigma and recovery principles, co-lead by academic/clinical trainers and a person with lived experience of MISUI; and (5) Recovery-Based Arts, a multi-week arts workshop for PHC providers and users to produce artwork related to MISUI and recovery, culminating in an exhibition to showcase artwork for the CESFAM providers, users, and community. The expected intervention outcomes are the following: Participation in the experimental group will result in a significant decrease in stigmatizing attitudes among PHC providers toward individuals with MISUI compared with the control group as measured by the Chilean version of the Opening Minds Scale for Health Care Providers Scale (OMS-HC); Participation in the experimental group will result in a significant decrease of PHC users experiences of stigma conveyed by PHC providers compared with the control group as measured by the Internalized Stigma of Mental Illness (ISMI) scale, validated for the Chilean population. The changes in attitudes and behaviors within the experimental group will be sustained over time as measured at 6 months-follow-up. To evaluate the effectiveness of this 18-month intervention, a 4-year, two-arm, cluster-randomized controlled trial is proposed, with CESFAMs being the unit of randomization (or “cluster”). Implementation Science approach will be taken to measure relevant implementation outcomes for each component of the intervention, and through qualitative data collection with CESFAM providers and authorities. Data analysis will be carried out using SAS 9.4 (specifically, using POC MIXED and PROC GENMOD) and R 3.5. Mixed-effect modeling will used for both PHC provider and user data, which will include individuals and CESFAMs as random effects and group (intervention/control) as fixed effects.DiscussionThis study represents a new stage of relevant and innovative research in mental health and stigma in Chile that will contribute to improving access and quality of care for people with MISUI. Evaluating the impact of the intervention model and its implementation will provide the necessary tools to scale the intervention up to other CESFAMs across Chile.Clinical trial registration[www.ClinicalTrials.gov], identifier [NCT05578066].

Urine testing on asymptomatic patients is not aligned with guidelines; however, stroke survivors have trouble communicating symptoms, and urinary tract infections (UTIs) are a recognised poststroke complication. All stroke inpatients at a tertiary rehabilitation hospital underwent urine testing on admission. We led a quality improvement (QI) project on one stroke rehabilitation unit aimed to reduce admission urine testing from 100% to 0%. Baseline audit representing 2 weeks of admissions identified 27 of 28 patients had urine tests; however, none required UTI treatment despite 3 positive culture results. Estimated cost of testing was $C675. QI tools identified that a standardised paper-based admission form facilitated automatic urine testing. Project intervention strategies included education, clinicians crossing off urine orders and unit clerks flagging unaddressed orders for reassessment. A chart audit after 4 weeks and prescriber survey after 6 months assessed impact. Postintervention audit (n=23) revealed 1 patient had admission urine tests, 22 orders were crossed out, 1 chart was flagged and estimated testing cost declined from $C675 to $C25. Six urine tests were completed after admission and two patients required UTI treatment. Post 6 months, unit clerks assumed the role to cross out the order on the standardised form, and no patient had routine admission urine testing. There was no clinical benefit in screening for UTIs prior to stroke rehabilitation. This project is a practical example of deadopting a practice promoted by standardised order forms.

In order to identify how the synovial microenvironment impinges on CD4+ T cells pathogenic functions in Rheumatoid Arthritis (RA), Amaral-Silva examined RA patient blood and synovial fluif and identified the presence of a TLR4+ follicular helper T (Tfh) cell-like population. They provided mechanistic insight into how TLR4+ T cells uniquely reconcile an ability to promote systemic antibody production with a local synovial driven-tissue damage program.

Objectives To estimate the prevalence of medical care-seeking among adults with low back pain (LBP) and to characterise and compare use of diagnostic procedures and medical management between primary and secondary care.Design Cross-sectional study.Setting Data from the EpiReumaPt, a nationwide population-based study conducted in Portugal including a representative sample of non-institutionalised adults (n=10 661) stratified by administrative territorial units was analysed.Participants Individuals who self-reported history of LBP within the previous 12 months (n=6434) and sought medical care for this problem in the same period (n=2618).Outcome measures Patients’ self-reported diagnostic workup and management procedures performed by medical care for LBP collected through a structured questionnaire. Medical care procedures were stratified by level of care.Results The prevalence of medical care-seeking for LBP was 38.0% (95% CI 35.9% to 40.1%). Primary care in isolation (45.3%) was the most sought level of care. Emergency departments (25.9%) and orthopaedics (19.4%) were the most sought secondary medical specialties. Several pathoanatomical diagnoses were used, supported by laboratory or imaging tests (91.1%). Disc herniation (20.4%) and osteoarthritis (19.7%) were the most frequent diagnoses, and X-ray (63.7%) was the most frequent diagnostic procedure self-reported by individuals. Most (75.1%) reported being treated for LBP: 80.4% with oral medication and 49.9% with injectables. The mean duration of pharmacological treatment was 104.24 (SD, 266.80) days. The use of pathoanatomical diagnoses, laboratory or imaging tests, and pharmacological treatments were generally more frequent for secondary care (p

This article expounds on the problem of the use of de-icing salts in the corrosion of steel rebars in bridge decks and their effect on post-tensioning elements. In particular, this paper focuses this problem on structures affected by an aggregate–alkali reaction and without any waterproof treatment using the example of one structure whose repair was carried out in 2020. In this structure, the internal stresses due to the aggregate–alkali reaction caused longitudinal cracks in the upper face of the deck, through which the penetration of chloride ions was concentrated, causing, finally, the brittle fracture of the steel bars and the corrosion of the prestressing elements. This article also explains some conclusions about the most probable mechanisms that resulted in the brittle fracture of the steel bars due to the extraordinary and unexpected nature of this phenomenon.

In the context of Shared Autonomous Vehicles, the need to monitor the environment inside the car will be crucial. This article focuses on the application of deep learning algorithms to present a fusion monitoring solution which was three different algorithms: a violent action detection system, which recognizes violent behaviors between passengers, a violent object detection system, and a lost items detection system. Public datasets were used for object detection algorithms (COCO and TAO) to train state-of-the-art algorithms such as YOLOv5. For violent action detection, the MoLa InCar dataset was used to train on state-of-the-art algorithms such as I3D, R(2+1)D, SlowFast, TSN, and TSM. Finally, an embedded automotive solution was used to demonstrate that both methods are running in real-time.

Objetivos. Presentar la metodología de evaluación integral de la implementación del Programa de Acción Mundial para Superar las Brechas en Salud Mental (mhGAP) en Chile y exponer sus resultados. Métodos. Estudio evaluativo de corte transversal basado en una encuesta a referentes clave del programa, desplegados en los 29 servicios públicos de salud del país, y entrevistas individuales y grupos focales con actores clave y expertos. El foco de la evaluación estuvo en la relevancia e impacto del mhGAP en la prestación de servicios de salud mental y en la implementación del programa. Resultados. Los participantes evaluaron positivamente la implementación progresiva del mhGAP en Chile, en particular: 1) manifestaron contar con mejores herramientas de detección, diagnóstico y tratamiento de trastornos frecuentes, y estrategias eficientes de derivación; 2) calificaron todos los módulos como importantes; los más relevantes fueron autolesión/suicidio (x = 4,77) y trastornos mentales y conductuales del niño y el adolescente (x = 4,58); 3) evaluaron favorablemente las Jornadas Nacionales y sus réplicas y su contribución al éxito de la implementación del mhGAP; 4) coincidieron en la necesidad de incorporar nuevos actores, fortalecer algunos aspectos y ampliar la información sobre el programa. Conclusiones. La implementación del mhGAP en Chile constituye un caso emblemático de aprendizaje, apoyado por el desarrollo de la salud mental comunitaria y la salud familiar, entre otros factores. Lo logrado abre una oportunidad única para continuar avanzando en la implementación de este programa en el país y transmitir esta experiencia a otros contextos de América Latina y el Caribe.

Real-world data regarding the efficacy and safety of coronary intravascular lithotripsy (IVL) are lacking. We conducted a study of 50 consecutive patients (64 lesions) who underwent IVL. 3 patients suffered in-hospital mortality unrelated to the IVL; there was no other occurrence of MACE up to 30 days. Angiographic success was nearly universal (98% of patients with residual stenosis

The Indian leafwing butterfly Kallima paralekta (Horsfield, 1829) (Nymphalidae) is an Asian forest-dwelling, leaf-mimic. Genome skimming by Illumina sequencing permitted assembly of a complete circular mitogenome of 15,200 bp from K. paralekta consisting of 79.5% AT nucleotides, 22 tRNAs, 13 protein-coding genes, two rRNAs and a control region in the typical butterfly gene order. Kallima paralekta COX1 features an atypical CGA start codon, while ATP6, COX1, COX2, ND4, ND4L, and ND5 exhibit incomplete stop codons completed by 3’ A residues added to the mRNA. Phylogenetic reconstruction places K. paraleckta within the monophyletic genus Kallima, sister to Mallika in the subfamily Nymphalinae. These data support the monophyly of tribe Kallimini and contribute to the evolutionary systematics of the Nymphalidae.

Abstract Objective The aim of this study was to investigate if attitudes or behavioral beliefs about antiretroviral therapy (ART) influence ART adherence intention among pregnant and breastfeeding women in Zambia. Methods We recruited 150 HIV-positive women receiving ART in urban (Lusaka) and rural (Sinazongwe) districts of Zambia. Generalized modified Poisson regression models were used to assess the extent to which adherence intention was influenced by attitude toward ART or behavioral beliefs about ART. Results Intention to adhere to ART differed significantly by income, knowledge about HIV transmission, attitudes, and behavioral beliefs (all Ps

Abstract Background To investigate whether the reason to discontinue the first TNF inhibitor (TNFi) affects the response to the second TNFi in axial spondyloarthritis (axSpA). Methods Patients with axSpA from the Rheumatic Diseases Portuguese Register (ReumaPt), who discontinued their first TNFi and started the second TNFi between June 2008 and May 2018, were included. Response was assessed by the Ankylosing Spondylitis Disease Activity Score (ASDAS) clinically important improvement (ASDAS-CII), major important improvement (ASDAS-MI), low disease activity (ASDAS-LDA), and inactive disease (ASDAS-ID). The reason for discontinuation of the first TNFi was defined, according to ASDAS-CII as primary failure (no response ≤ 6 months), secondary failure (response ≤ 6 months but lost thereafter), adverse events, and others. The association between the reason for discontinuation of the first TNFi and response to the second TNFi over time was assessed in multivariable generalized equation (GEE) models. Results In total, 193 patients were included. The reason for discontinuation of the first TNFi did not influence the response to the second TNFi, according to the ASDAS-CII. However, a difference was found with more stringent outcomes, e.g., there was a higher likelihood to achieve ASDAS-ID with the second TNFi for patients discontinuing the first TNFi due to secondary failure (OR 7.3 [95%CI 1.9; 27.7]), adverse events (OR 9.1 [2.5; 33.3]), or other reasons (OR 7.7 [1.6; 37.9]) compared to primary failure. Conclusion Patients with axSpA with secondary failure to their first TNFi, compared to those with primary failure, have a better response to the second TNFi according to stringent outcomes.

The exopolysaccharide galactosaminogalactan (GAG) is an important virulence factor of the fungal pathogen Aspergillus fumigatus. Here, the authors study an A. fumigatus enzyme that deacetylates GAG in a metal-dependent manner and constitutes a founding member of a new carbohydrate esterase family.

Abstract Background The vasculitides are a group of rare diseases with different manifestations and outcomes. New therapeutic options have led to the need for long-term registries. The Rheumatic Diseases Portuguese Register, Reuma.pt, is a web-based electronic clinical record, created in 2008, which currently includes specific modules for 12 diseases and > 20,000 patients registered from 79 rheumatology centres. On October 2014, a dedicated module for vasculitis was created as part of the European Vasculitis Society collaborative network, enabling prospective collection and central storage of encrypted data from patients with this condition. All Portuguese rheumatology centres were invited to participate. Data regarding demographics, diagnosis, classification criteria, assessment tools, and treatment were collected. We aim to describe the structure of Reuma.pt/vasculitis and characterize the patients registered since its development. Results A total of 687 patients, with 1945 visits, from 13 centres were registered; mean age was 53.4 ± 19.3 years at last visit and 68.7% were females. The most common diagnoses were Behçet’s disease (BD) (42.5%) and giant cell arteritis (GCA) (17.8%). Patients with BD met the International Study Group criteria and the International Criteria for BD in 85.3 and 97.2% of cases, respectively. Within the most common small- and medium-vessel vasculitides registered, median [interquartile range] Birmingham Vasculitis Activity Score (BVAS) at first visit was highest in patients with ANCA-associated vasculitis (AAV) (17.0 [12.0]); there were no differences in the proportion of patients with AAV or polyarteritis nodosa who relapsed (BVAS≥1) or had a major relapse (≥1 major BVAS item) during prospective assessment (p = 1.00, p = 0.479). Biologic treatment was prescribed in 0.8% of patients with GCA, 26.7% of patients with AAV, and 7.6% of patients with BD. There were 34 (4.9%) deaths reported. Conclusions Reuma.pt/vasculitis is a bespoke web-based registry adapted for routine care of patients with this form of rare and complex diseases, allowing an efficient data-repository at a national level with the potential to link with other international databases. It facilitates research, trials recruitment, service planning and benchmarking.

Research developed in the last decades has allowed significant advances in the concrete technology, achieving remarkable improvements in its performancemainly related to its microstructure. In order to relate the behaviour under compressive stresses of high performance concrete (HPC) and the changes in its microstructure, an experimental campaign was developed with specimens of dimensions 160x40x40 mm3. A control mixture without additions and a series of mix designs with partial substitution of cement by of silica fume and metakaolin in different proportions were produced. A low water-to-binder ratio of 0.20 was used, which forced the use of a superplasticizer additive based on modified polycarboxylates, which improved the workability of the mixtures. Silica sand with 98% of SiO2 content and an average particle size of 0.75 mm was used. The specimens were subjected to compressive strength tests at 2, 7, 28 and 91 days, and complementary tests of electric resistivity, mercury intrusion porosimetry (MIP) and differential thermal-thermogravimetric analysis (DTA-TG) at 28 days. The results of the tests showed that the increase in compressive strength with the use of additions was directly related to the reduction in total porosity and the increase in the proportion of total CSH gel / total portlandite, shown by the MIP and DTA-TG tests, respectively. Mixtures with additions showed reductions of the porosity by up to 31.7% compared with the control mixture, while increasing the proportion of CSH gel/ total portlandite by up to 17.1%. The use of small particles of mineral additions significantly increased the electric resistivity of HPC specimens as evidenced in the present study. This is explained by the reduction in the percentage of large capillary pores and the relative increase of small capillaries, which could enhance the durability of the concrete elements. Resumen La investigación desarrollada en las últimas décadas ha permitido avances significativos en las prestaciones del hormigón, a través de la mejora de su microestructura .En este trabajo se presentan los resultados de una campaña experimental encaminada a mostrar la influencia de la microestructura del hormigón de altas prestaciones (HPC por sus siglas en inglés) en su resistencia a compresión. Se elaboró una mezcla de control sin adiciones y una serie de mezclas con sustituciones parciales del cemento con humo de sílice y metacaolín en diferentes proporciones. Se usó una relación de agua/conglomerante de 0,20, lo que obligó al uso de un aditivo superplastificante basado en policarboxilatos modificados, el cual mejoró la trabajabilidad de las mezclas. Se usó arena de sílice con 98% de contenido de SiO2 y un tamaño de partícula promedio de 0,75 mm. Con ellas se confeccionaron probetas de dimensiones de 160x40x40 mm3.Las muestras se ensayaron a compresión a los 2, 7, 28 y 91 días, y se realizaron ensayos complementarios de resistividad eléctrica, porosimetría de intrusión de mercurio (PIM) y análisis térmico termogravimétrico diferencial (ATD-TG) a los 28 días. Los resultados de las pruebas mostraron que el aumento en la resistencia a la compresión con el uso de adiciones estaba directamente relacionado con la reducción de la porosidad total y el aumento en la proporción de gel C-S-H/portlandita total. Estos aspectos se confirmaron con los ensayos de PIM y ATD-TG. Las mezclas con adiciones mostraron reducciones de la porosidad hasta en un 31,7% en comparación con la mezcla de control, a la vez que incrementaron la relación gel C-S-H/portlandita total hasta en un 17,1%. El uso de pequeñas partículas de adiciones minerales aumentó significativamente la resistividad eléctrica de las muestras de HPC, lo que confirma la reducción del porcentaje de poros capilares grandes conectados y el aumento de capilares pequeños, lo que además de la resistencia a compresión mejora la durabilidad del hormigón.

BackgroundMother-to-infant transmission of HIV is a major problem in Sub-Saharan Africa despite free or subsidized antiretroviral treatment (ART), but is significantly reduced when mothers adhere to ART. Because potable water access is limited in low-resource countries, we investigated water access and ART adherence intention among HIV-positive pregnant women and new mothers in Zambia.MethodsOur convenience sample consisted of 150 pregnant or postpartum women receiving ART. Descriptive statistics compared type of water access by low and high levels of ART adherence intention.ResultsMost (71%) had access to piped water, but 36% of the low-adherence intention group obtained water from a well, borehole, lake or stream, compared to only 22% of the high-adherence intention group. The low-adherence intention group was more rural (62%) than urban (38%) women but not statistically significant [unadjusted Prevalence Ratio (PR) 0.73, 95% CI: 0.52–1.02; adjusted PR 1.06, 95% CI: 0.78–1.45].ConclusionProviding potable water may improve ART adherence. Assessing available water sources in both rural and urban locations is critical when educating women initiating ART.

Baits and lures for trapping and monitoring the invasive vinegar fly Drosophila suzukii Matsumura (Diptera: Drosophilidae) are currently derived from fermentation volatiles. Volatile organic compounds from alternative sources could improve monitoring efforts and optimize capture of gravid females. Through electroantennography and behavioral assays, we evaluated male and female D. suzukii responses to blends of selected synthetic fruit volatiles in combination with the fruit compound isoamyl acetate and the strawberry leaf terpenoid β-cyclocitral. Blends that were attractive to both male and female D. suzukii were then evaluated for attractiveness to a non-target drosophilid, Drosophila melanogaster. A simple 3-component blend of isoamyl acetate, β-cyclocitral and methyl butyrate was attractive to D. suzukii, particularly females, relative to fresh blueberry volatiles. The 3-component blend was not attractive to D. melanogaster. Additional research is needed to determine the effectiveness of this blend to attract D. suzukii under field conditions.

Multi-human detection and tracking in indoor surveillance is a challenging task due to various factors such as occlusions, illumination changes, and complex human-human and human-object interactions. In this study, we address these challenges by exploring the benefits of a low-level sensor fusion approach that combines grayscale and neuromorphic vision sensor (NVS) data. We first generate a custom dataset using an NVS camera in an indoor environment. We then conduct a comprehensive study by experimenting with different image features and deep learning networks, followed by a multi-input fusion strategy to optimize our experiments with respect to overfitting. Our primary goal is to determine the best input feature types for multi-human motion detection using statistical analysis. We find that there is a significant difference between the input features of optimized backbones, with the best strategy depending on the amount of available data. Specifically, under a low-data regime, event-based frames seem to be the preferred input feature type, while higher data availability benefits the combined use of grayscale and optical flow features. Our results demonstrate the potential of sensor fusion and deep learning techniques for multi-human tracking in indoor surveillance, although it is acknowledged that further studies are needed to confirm our findings.

At the interface of behavioral chemical ecology and pest management lays the evaluation of kairomones that can be used for either, monitoring or attract-and-kill of insect pests. Diluted Concord grape juice (DGJ) was previously reported to be highly attractive to male and female D. suzukii. Here, we conducted cage and field studies aimed at (1) comparing the attractiveness of fresh DGJ against that of commercial lures over a 3-year period in multiple locations, (2) quantifying the effects of DGJ aging for 1 and 2 weeks on D. suzukii attraction, and (3) ascertaining the effects of adding sodium chloride to DGJ prior to fermentation on the outcome. For all field studies, captures of non-target insects were recorded. Combined findings from the cage and field studies comparing DGJ and commercial lures indicate that fresh DGJ is as attractive or more attractive than the commercial lures that were evaluated. The results of the aging studies revealed that 7- and 14- day old DGJ baits are at least twice as attractive to female D. suzukii when compared to fresh DGJ. The response of other Drosophilids to the aged olfactory treatments mirrored that of D. suzukii. Remarkably, the addition of 2% sodium chloride to DGJ prior to aging resulted in a fourfold increase in attractiveness to male and female D. suzukii while reducing the number of non-target insects captured in traps. In conclusion, DGJ is an effective bait that can be deployed in traps and, when 2% sodium chloride is added, the resulting material outcompetes the performance of commercial lures and greatly reduces captures of non-target insects, thereby increasing bait selectivity. Overall, our findings increase our understanding of D. suzukii olfactory-driven behavior in response to fruit-based odor and demonstrate the potential use of a low-cost attractant for farmers who are not able to monitor for D. suzukii when commercially produced lures are expensive or less accessible.

The COVID-19 pandemic has abruptly changed care priority and delivery, delaying others like the multimorbidity approach. The Centro de Innovación en Salud ANCORA UC, the Health National Fund, and the Servicio de Salud Metropolitano Sur Oriente implemented a Multimorbidity Patient-Centered Care Model as a pilot study in the public health network from 2017 to 2020. Its objective was to reorganize the single diagnosis standard care into a new one based on multimorbidity integrated care. It included incorporating new roles, services, and activities according to each patient's risk stratification. This study aims to describe the perception of the health care teams regarding the impact of the COVID-19 pandemic on four main topics: how the COVID-19 pandemic affected the MCPM implementation, how participants adapted it, lessons learned, and recommendations for sustainability. We conducted a qualitative study with 35 semi-structured interviews between October and December 2020. Data analysis was codified, triangulated, and consolidated using MAXQDA 2020. Results showed that the pandemic paused the total of the implementation practically. Positive effects were the improvement of remote health care services, the activation of self-management, and the cohesion of the teamwork. In contrast, frequent abrupt changes and reorganization forced by pandemic evolution were negative effects. This study revealed the magnitude of the pandemic in the cancelation of health services and identified the urgent need to restart chronic services incorporating patient-centered care in our system.

BackgroundSpondyloarthritis (SpA) are the most common group of chronic inflammatory rheumatic diseases affecting about 1.5% of the adult Caucasian population. Low back pain is the most common symptom. The aetiopathogenesis of SpA is multifactorial, with well-known genetic and environmental contributions. Furthermore, muscle properties might also be involved in the pathophysiological process and these could be modulated by the genetic background. Alpha-actinin-3 (ACTN3) and Vitamin D receptor (VDR) genes are well-known genes related with muscle performance. Our aim was to analyze four SNPs of these genes and to evaluate their influence in axial SpA (axSpA) susceptibility, phenotype and muscle properties.MethodsWe performed a pilot study based on case-control approach involving 56 participants: 28 axSpA patients and 28 healthy controls matched by age, gender and levels of physical activity. Clinical, epidemiological and muscle characterization data—muscle physical properties (stiffness, tone, and elasticity), strength, mass, and performance, were collected. Two different muscles were considered for analysis, the Multifidus and Gastrocnemius. Four SNPs of ACTN3 (rs1815739) and VDR (rs2228570, rs731236, and rs7975232), were selected, analyzed and correlated with clinical, epidemiological and muscle characterization data.ResultsIn total, 51 individuals (27 axSpA patients and 24 matched controls) were eligible for further genetic analysis, 66.7% being male and with a mean age of 36 years. Muscle physical properties, muscle strength and muscle mass were similar in both groups; however, axSpA patients showed a decrease in muscle performance. None of the studied SNPs were associated with disease susceptibility/phenotype, muscle physical properties, muscle strength or muscle mass. However, ACTN3 rs1815739 and VDR rs2228570 were shown to be associated with muscle performance.ConclusionOur results suggest an association between ACTN3 and VDR polymorphisms and muscle performance in axSpA.

BackgroundFood insecurity is a global public health challenge, affecting predominately the most vulnerable people in society, including older adults. For this population, eHealth interventions represent an opportunity for promoting healthy lifestyle habits, thus mitigating the consequences of food insecurity. However, before their widespread dissemination, it is essential to evaluate the feasibility and acceptability of these interventions among end users. ObjectiveThis study aims to explore the feasibility and acceptability of a home-based eHealth intervention focused on improving dietary and physical activity through an interactive television (TV) app among older adults with food insecurity. MethodsA pilot noncontrolled quasi-experimental study was designed with baseline and 3-month follow-up assessments. Older adult participants with food insecurity were recruited from 17 primary health care centers in Portugal. A home-based intervention program using an interactive TV app aimed at promoting healthy lifestyle behaviors was implemented over 12 weeks. Primary outcomes were feasibility (self-reported use and interest in eHealth) and acceptability (affective attitude, burden, ethicality, perceived effectiveness, and self-efficacy), which were evaluated using a structured questionnaire with a 7-point Likert scale. Secondary outcomes were changes in food insecurity (Household Food Insecurity Scale), quality of life (European Quality of Life Questionnaire with five dimensions and three levels and Functional Assessment of Chronic Illness Therapy-Fatigue), physical function (Health Assessment Questionnaire, Elderly Mobility Scale, grip strength, and regularity of exercise), and nutritional status (adherence to the Mediterranean diet). ResultsA sample of 31 older adult individuals with food insecurity was enrolled in the 12-week intervention program with no dropouts. A total of 10 participants self-reported low use of the TV app. After the intervention, participants were significantly more interested in using eHealth to improve food insecurity (baseline median 1.0, IQR 3.0; 3-month median 5.0, IQR 5.0; P=.01) and for other purposes (baseline median 1.0, IQR 2.0; 3-month median 6.0, IQR 2.0; P=.03). High levels of acceptability were found both before and after (median range 7.0-7.0, IQR 2.0-0.0 and 5.0-7.0, IQR 2.0-2.0, respectively) the intervention, with no significant changes for most constructs. Clinically, there was a reduction of 40% in food insecurity (P=.001), decreased fatigue (mean −3.82, SD 8.27; P=.02), and improved physical function (Health Assessment Questionnaire: mean −0.22, SD 0.38; P=.01; Elderly Mobility Scale: mean −1.50, SD 1.08; P=.01; regularity of exercise: baseline 10/31, 32%; 3 months 18/31, 58%; P=.02). No differences were found for the European Quality of Life Questionnaire with five dimensions and three levels, grip strength, or adherence to the Mediterranean diet. ConclusionsThe home-based eHealth intervention was feasible and highly acceptable by participants, thus supporting a future full-scale trial. The intervention program not only reduced the proportion of older adults with food insecurity but also improved participants’ fatigue and physical function. International Registered Report Identifier (IRRID)RR2-10.2196/resprot.6626

Engagement through the use of technology requires a level of vulnerability and trust amongst teachers and learners. The emotional and social aspects of engagement can be significantly affected by the nuances of the learning setting. The study goal was to explore learner needs related to uploaded lecture-captured recordings and examine how the use of a commenting feature might enhance learning experiences. Building on self-determination theory, we postulated that affording commenting opportunities would increase engagement (relatedness), with learners choosing to engage in the potential learning value from comment over the vulnerability that could come with making public comments (autonomy), and improved learning outcomes (competence). Using a pre/post survey design, 100% (N = 190) of second year undergraduate medical and dental learners participated in this study. Pre-survey results demonstrated that 65% (n = 94) perceived value in seeing what others asked; 59% (n = 94) of participants wanted to view the responses of others. Post-survey results demonstrated that 6% (n = 12) indicated that commenting made them feel vulnerable. Twenty-nine percent (n = 55) preferred anonymous commenting. Engagement was impacted by technical issues with the new system, learners not perceiving significant 'value-add' due to alternative mechanisms in receiving answers to questions, and the timing of our technology change. Learners still perceived value in creating opportunities to ask questions and seek responses, though it must be balanced with ensuring that the learning environment allows vulnerability. Meaningful connections can be found in various ways throughout the learning environment in both the formal and parallel curricula.

Abstract Background Interventions to alleviate stigma are demonstrating effectiveness across a range of conditions, though few move beyond the pilot phase, especially in low- and middle-income countries (LMICs). Implementation science offers tools to study complex interventions, understand barriers to implementation, and generate evidence of affordability, scalability, and sustainability. Such evidence could be used to convince policy-makers and donors to invest in implementation. However, the utility of implementation research depends on its rigor and replicability. Our objectives were to systematically review implementation studies of health-related stigma reduction interventions in LMICs and critically assess the reporting of implementation outcomes and intervention descriptions. Methods PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of stigma reduction interventions in LMICs reporting at least one implementation outcome. Study- and intervention-level characteristics were abstracted. The quality of reporting of implementation outcomes was assessed using a five-item rubric, and the comprehensiveness of intervention description and specification was assessed using the 12-item Template for Intervention Description and Replication (TIDieR). Results A total of 35 eligible studies published between 2003 and 2017 were identified; of these, 20 (57%) used qualitative methods, 32 (91%) were type 1 hybrid effectiveness-implementation studies, and 29 (83%) were evaluations of once-off or pilot implementations. No studies adopted a formal theoretical framework for implementation research. Acceptability (20, 57%) and feasibility (14, 40%) were the most frequently reported implementation outcomes. The quality of reporting of implementation outcomes was low. The 35 studies evaluated 29 different interventions, of which 18 (62%) were implemented across sub-Saharan Africa, 20 (69%) focused on stigma related to HIV/AIDS, and 28 (97%) used information or education to reduce stigma. Intervention specification and description was uneven. Conclusion Implementation science could support the dissemination of stigma reduction interventions in LMICs, though usage to date has been limited. Theoretical frameworks and validated measures have not been used, key implementation outcomes like cost and sustainability have rarely been assessed, and intervention processes have not been presented in detail. Adapted frameworks, new measures, and increased LMIC-based implementation research capacity could promote the rigor of future stigma implementation research, helping the field deliver on the promise of stigma reduction interventions worldwide.

Abstract Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge—both approaches and methods—regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development’s Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described. The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.

Network security testing can be done at different levels of fidelity. This can involve simply scanning a network to identify any open ports for services and versions of services, to uncovering novel vulnerabilities in proprietary or undocumented services. The granularity of such an analysis depends not only on time and cost, but also on the availability of client software that can be used to interact with the different services. Complexity increases when the underlying protocol is undocumented or nontrivial. In this case, testers must first understand the protocols, and then develop software that can be used to interact; past the common handshake or initial connection behavior to uncover vulnerabilities. In this paper, we present an architecture that marries protocol reverse engineering and network fuzzing through a graphical interface. We have developed a proof of concept (PoC) that is capable of intercepting packets between source and destination nodes; allowing analysts to use the interface to interactively or pseudo-interactively (using hooks) observe, modify, drop, and/or forward the traffic during security tests. We designed our experimentation methodology with two perspectives in mind: blue-teaming (cooperative grey/white box) and red-teaming (non-cooperative, black box). We report performance of our PoC with the Transport Control Protocol.