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Participatory science and "amateur" participation in scientific data collection and work has been common for hundreds of years, but has become a more formalised field of practice in recent decades. The inclusion and reliance on informally trained members of the public in scientific endeavours has especially helped connect natural history collections to the general public. In recent decades, the term used to describe these participants — citizen scientists — was intended to unite formal and informal scientists as global citizens working towards a common goal. However, the term 'citizen' today has negative connotations for many members of the public and can have a polarising effect on certain individuals. Given that the nature of participatory science is to be inclusive and inviting, it is time to change this terminology. The term 'community' science has been suggested as an alternative by some practitioners and programmes. This self-awareness within the scientific community is important, but lacks impact without input from the community members potentially participating in these programmes. We addressed this knowledge gap by posing the question of term preference to groups of volunteers who have attended participatory science activities from the Field Museum of Natural History (Chicago, Illinois, USA) and the Natural History Museum of Los Angeles County (Los Angeles, California, USA) from 2019 to 2023. A majority of respondents showed a clear preference for the term 'community' over 'citizen' science. This was especially true for younger individuals and those who belong to ethnic groups other than White. This information can impact which terms are used for specific programme populations and supports community involvement in selecting terminology and in project design. We advise stopping use of the term 'citizen' in all participatory science programmes and adopting terminology that is most appropriate depending on region, research, audience and activity. Moreover, participant populations should be solicited to hear their voices.

Abstract Background Reference intervals for simple body weight‐independent measurements of right heart size and function are limited. Objectives Generate reference intervals for measurements of right heart size indexed to the long‐axis aortic valve diameter (AoD) or corresponding left heart structure (right heart ratios) and describe the reproducibility of these indices. Animals Ninety healthy adult dogs of variable body weight. Methods Prospective study. All dogs underwent an echocardiogram performed by the same operator. Numerous linear 2‐dimensional measurements of right heart size and function from different imaging planes were performed. Eight dogs underwent repeated echocardiograms by the same operator on 3 different days, and 3 different operators performed repeated echocardiograms on the same day. Reference intervals were generated using the Clinical Laboratory Standards Institute method. Reproducibility was quantitated using coefficients of variation (CVs) and reproducibility coefficients. Results Reference intervals for right heart ratios were generated and allow simple assessments of right heart size and function that do not require a scaling exponent or body weight table. Right heart ratios did not show clinically relevant associations with body weight. All CVs were

Abstract Background The Brazilian supplementary health market has undergone transformations in recent years due to constant mergers and acquisitions of by large corporations, contributing to the increase in market concentration, especially in the poorest and least developed regions of the country. Thus, given the care it provides and its economic relevance, understanding the fundamentals of these movements, the likely consequences and trends for the health market are relevant, important, and strategic. Objective To understand the general and specific context of Brazilian supplementary health, its scenarios, and trends, with emphasis on the analysis of market concentration and recent mergers and acquisitions. Methodology The research is applied, descriptive and exploratory and uses secondary data from various sources, submitted to quantitative data analysis methods. The data are organized into three groups: historical and regulatory documents; industry data; and market. Results The results show the growing concentration of the market promoted by large publicly traded corporations, the growing relevance of tech startups on the healthcare landscape, the predominant use of the relative valuation model, with implicit multiples for asset pricing and the prevalence of corporate health plans. Conclusion The growing concentration of the system projects a market with fewer options and less competitiveness, since the growth of large operators is evident, in addition to the relevant increase in the number of complaints from users of the system, which signals the growing gap between the expectations of users and the levels of quality care offered. The study also highlights the predominance of corporate health plans, revealing the direct relationship between access to supplementary health services and employability rates. The analysis of M&A operations, in addition to the increase in market concentration, reveals the prevalence of the use of the relative valuation model and implicit multiples for the pricing of traded assets. This denotes the future expectation of wealth generation, at least equivalent to the historical series of the sector, on the part of investors, whose frustration may signal the decreasing attractiveness of resources and M&A operations in the sector in the coming years.

Abstract Sarcopenia is the age-related loss of skeletal muscle mass and function. Computed tomography (CT) assessments of sarcopenia utilize measurements of skeletal muscle cross-sectional area (SMA), radiation attenuation (SMRA), and intramuscular adipose tissue (IMAT). Unadjusted SMA is strongly correlated with both height and body mass index (BMI); therefore, SMA must be adjusted for body size to assess sarcopenic low muscle mass fairly in individuals of different heights and BMI. SMA/height (rather than $$SMA/height^2$$ S M A / h e i g h t 2 ) provides optimal height adjustment, and vertebra-specific relative muscle index (RMI) equations optimally adjust for both height and BMI. Since L3 measurement is not available in all CT scans, sarcopenic low muscle mass may be assessed using other levels. Both a mid-vertebral slice and an inferior slice have been used to define ‘L3 SMA’, but the effect of vertebral slice location on SMA measurements is unexplored. Healthy reference values for skeletal muscle measures at mid- and inferior vertebra slices between T10 and L5, have not yet been reported. We extracted T10 through L5 SMA, SMRA, and IMAT at a mid-vertebral and inferior slice using non-contrast-enhanced CT scans from healthy, adult kidney donor candidates between age 18 and 73. We compared paired differences in SMA between the mid-vertebral slice versus the inferior slice. We calculated the skeletal muscle gauge as $$SMG_{HT}=SMRA*SMI_{HT}$$ S M G HT = S M R A ∗ S M I HT . We used allometric analysis to find the optimal height scaling power for SMA. To enable comparisons with other published reference cohorts, we computed two height-adjusted measures; $$SMI_{HT}=SMA/height$$ S M I HT = S M A / h e i g h t (optimal) and $$SMI_{HT2}=SMA/height^2$$ S M I H T 2 = S M A / h e i g h t 2 (traditional). Using the young, healthy reference cohort, we utilized multiple linear regression to calculate relative muscle index z-scores ( $$RMI_{HT}$$ R M I HT , $$RMI_{HT2}$$ R M I H T 2 ), which adjust for both height and BMI, at each vertebra level. We assessed Pearson correlations of each muscle area measure versus age, height, weight, and BMI separately by sex and vertebra number. We assessed the differences in means between age 18–40 versus 20–40 as the healthy, young adult reference group. We reported means, standard deviations, and sarcopenia cutpoints (mean-2SD and 5th percentile) by sex and age group for all measures. Sex-specific allometric analysis showed that height to the power of one was the optimal adjustment for SMA in both men and women at all vertebra levels. Differences between mid-vertebra and inferior slice SMA were statistically significant at each vertebra level, except for T10 in men. $$SMI_{HT}$$ S M I HT was uncorrelated with height, whereas $$SMI_{HT2}$$ S M I H T 2 was negatively correlated with height at all vertebra levels. Both $$SMI_{HT}$$ S M I HT and $$SMI_{HT2}$$ S M I H T 2 were positively correlated with BMI at all vertebra levels. $$RMI_{HT}$$ R M I HT was uncorrelated with BMI, weight, and height (minimal positive correlation in women at $$\hbox {L3}_{inf}$$ L3 inf , $$\hbox {L4}_{mid}$$ L4 mid , and $$\hbox {L5}_{inf}$$ L5 inf ) whereas $$RMI_{HT2}$$ R M I H T 2 was uncorrelated with BMI, but negatively correlated with height and weight at all levels. There were no significant differences in SMA between 18–40 versus 20–40 age groups. Healthy reference values and sarcopenic cutpoints are reported stratified by sex, vertebra level, and age group for each measure. Height to the power of one (SMA/height) is the optimal height adjustment factor for SMA at all levels between $$\hbox {T10}_{mid}$$ T10 mid through $$\hbox {L5}_{inf}$$ L5 inf . The use of $$SMA/height^2$$ S M A / h e i g h t 2 should be discontinued as it retains a significant negative correlation with height and is therefore biased towards identifying sarcopenia in taller individuals. Measurement of SMA at a mid-vertebral slice is significantly different from measurement of SMA at an inferior aspect slice. Reference values should be used for the appropriate slice. We report sarcopenic healthy reference values for skeletal muscle measures at the mid-vertebral and inferior aspect slice for T10 through L5 vertebra levels. Relative muscle index (RMI) equations developed here minimize correlation with both height and BMI, producing unbiased assessments of relative muscle mass across the full range of body sizes. We recommend the use of these RMI equations in other cohorts.

ABSTRACT OBJECTIVES: To correlate the incidence of leptospirosis with sociodemographic data in the Brazilian Unified Health System from 2011 to 2022. METHODS: This ecological study used national health and economic secondary data sources. Secondary analyses summarized the scenario of disease-related hospitalizations among federative units. In total, two analyses were conducted: variable description for relationship analysis and a secondary analysis with population health and sanitation indicators and economic indicators from the Instituto Brasileiro de Geografia e Estatística (IBGE - Brazilian Institute of Geography and Statistics). The statistical analysis following this framework summarized raw data by year-month-federative unit. A time series regression was conducted, comparing the time variable with other national-level variables. Then, several simple linear regressions were performed. RESULTS: Linear regressions show the relationship between the reduction in cases and improved access to treated water and sewage collection, whereas an increase in per capita income seems to be inversely related to leptospirosis incidence. Geospatial distribution shows higher incidence in the Brazilian South and Southeast. Disease lethality varied over time but without significant change during the period. The average treatment cost remained constant over the years, despite its complexity. CONCLUSION: Leptospirosis incidence in Brazil from 2011 to 2021 decreased and was associated with improvements in socioeconomic conditions despite no changes in lethality.

Objective: Our primary research objective was to assess the population uptake and contact tracer utilisation of the Bluetooth function of the New Zealand Covid Tracer App (NZCTA) throughout the pandemic. Methods: We adopted a retrospective cohort study design using all diagnosed COVID-19 community cases from December 12, 2020 to February 16, 2022. Results: At its height, more than 60% of the eligible population had the Bluetooth function of NZCTA activated. However, only an estimated 2.2% of the population was able to fully participate. Cases managed by the national case investigation service were 17 times (aRR 17.54, 95%CI: 13.02-23.90) and 9 times (aRR 9.27, 95%CI: 6.91, 12.76) more likely to generate a Bluetooth token than cases managed by local public health units during the Delta and Omicron periods, respectively. Conclusions: The Bluetooth functionality of the NZCTA likely had a low impact on the pandemic response in NZ despite its exceptionally high levels of public uptake. The primary reason for the lack of impact was the low utilisation by contact tracers. Implications for public health: The results highlight the need for greater consultation and collaboration with the public health sector during the development and implementation of digital contact tracing tools.

The PRECEDE-PROCEED model is a comprehensive planning and theoretical framework that incorporates epidemiological, environmental, behavioral, and social factors systematically to design, implement, and evaluate health promotion programs. As such, PRECEDE-PROCEED is a highly effective tool for addressing complex and significant public health concerns like postpartum depression (PPD). PPD negatively impacts mothers and their infants, with studies showing that approximately one in eight mothers experience PPD, leading to adverse effects on maternal functioning and infant development. However, access to specialized evidence-based treatment remains significantly limited due to barriers including social determinants of health. This paper explores the application of the PRECEDE-PROCEED model as a planning and theoretical framework for the design and development of MommaConnect, an innovative digital healthcare platform aimed at reducing PPD symptoms and improving maternal-infant interaction while overcoming barriers to treatment. Key components of the MommaConnect design and development process are mapped onto the steps of the PRECEDE-PROCEED model. MommaConnect features are aligned with specific stages of the model, from assessing, predisposing, enabling, and reinforcing factors to designing, implementing, and evaluating the intervention. By leveraging this model, MommaConnect represents a promising innovative approach to address PPD to improve maternal functioning and infant health in a digitally-enabled era. This paper underscores the importance of utilizing a framework like the PRECEDE-PROCEED model in the design and development of innovative healthcare solutions.

Background: Disabled people in Vietnam are some of the most vulnerable to disadvantage. Employment involving microenterprises can provide economic empowerment and wealth generation. This qualitative study aims to address a gap in the literature regarding the establishment of microenterprises for physically disabled people in Vietnam. Method: Semi-structured interviews were undertaken with seven physically disabled individuals, including the founder and Director of ‘Company of Grace’ a non-governmental organisation with a mission to support physically disabled people in establishing their own microenterprises. Company of Grace (COG) supported six entrepreneurs in establishing microenterprises that provided English language instruction to school-aged children after regular school hours. Data were analysed utilising a framework that improves the probability of entrepreneurial success in developing countries. This framework aided in examining the approach of establishing microenterprises by the non-government organisation. Results: The physically disabled entrepreneurs reported earnings above average wages and feeling empowered by participating in the microenterprises. These feelings of empowerment were reportedly associated with greater independence, increased self-efficacy and confidence in planning for their futures. Conclusion: Microenterprises, exemplified by COG’s model, empowered disabled individuals to teach English, enhanced student engagement and fostered confidence and economic self-sufficiency among disabled entrepreneurs, thereby making a notable contribution to entrepreneurship for disability inclusion.

Abstract Background Simple radiography in conjunction with pertinent medical history and a comprehensive physical examination is typically adequate for diagnosing chronic osteomyelitis (CO). However, radiographic manifestations of CO lack specificity; therefore, the concordance among specialists in this regard has not been systematically assessed. This study aimed to compare and evaluate the proficiency of orthopedic surgeons and radiologists in identifying radiographic indicators present in simple radiographs for diagnosing CO. Methods This cross-sectional study was a correlational investigation utilizing plain radiographs obtained from a cohort of 60 patients diagnosed with CO. Comprehensive assessments of the demographic and clinical characteristics, comorbidities, and microbiological parameters were conducted. Additional variables included the anatomical location of the CO, existence of fistulas, disease duration, and presence of pseudoarthrosis. This study meticulously documented the presence or absence of six specific findings: bone destruction, which incorporates erosion and radiolucencies around implants; bone sclerosis; cortical thinning concomitant with erosion; cortical thickening; sequestrum formation; and soft-tissue swelling. Results Most patients were men (75%), with a mean age of 45.1 years. Hematogenous etiology of CO represented 23%. Bone sclerosis (71.3%) and cortical thickening (67.7%) were the most common radiographic findings, followed by soft-tissue swelling (51.3%), sequestration (47.3%), bone destruction (33.3%), and cortical erosion (30.3%). The mean agreement was 74.2%, showing a marked disagreement rate of 25.8% among all radiographic findings. The presence or absence of soft tissue edema, a prominent radiographic finding that was more important than the other findings, showed the greatest disagreement. Conclusions Radiographic findings in CO were universally observed in all patients, demonstrating a high degree of concordance among specialists, with the exception of soft tissue swelling.

Abstract Background Circulating extracellular vesicles (EVs) are increased in preeclampsia (PE) and are associated with severity and progression. We examined in this exploratory cohort study if the mRNAs and long noncoding RNAs (lncRNAs) in plasma-derived EVs were dysregulated in PE compared to normal pregnancy and display different temporal patterns during gestation. Methods We isolated EVs from plasma at weeks 22–24 and 36–38 in women with and without PE (n=7 in each group) and performed RNA-seq, focusing on mRNAs and lncRNAs. We validated highly expressed mitochondrial and platelet-derived RNAs discovered from central pathways in 60 women with/without PE. We examined further one of the regulated RNAs, noncoding mitochondrially encoded tRNA alanine (MT-TA), in leukocytes and plasma to investigate its biomarker potential and association with clinical markers of PE. Results We found abundant levels of platelet-derived and mitochondrial RNAs in EVs. Expression of these RNAs were decreased and lncRNAs increased in EVs from PE compared to without PE. These findings were further validated by qPCR for mitochondrial RNAs MT-TA, MT-ND2, MT-CYB and platelet-derived RNAs PPBP, PF4, CLU in EVs. Decreased expression of mitochondrial tRNA MT-TA in leukocytes at 22–24 weeks was strongly associated with the subsequent development of PE. Conclusions Platelet-derived and mitochondrial RNA were highly expressed in plasma EVs and were decreased in EVs isolated from women with PE compared to without PE. LncRNAs were mostly increased in PE. The MT-TA in leukocytes may be a useful biomarker for prediction and/or early detection of PE. Graphical Abstract

Introduction The COVID-19 pandemic has had both direct and indirect impacts on the health of populations worldwide. While racial/ethnic health inequities in COVID-19 infection are now well known (and ongoing), knowledge about the impact of COVID-19 pandemic management on non-COVID-19-related outcomes for Indigenous peoples is less well understood. This article presents the study protocol for the Health Research Council of New Zealand funded project ‘Mā te Mōhio ka Mārama: Impact of COVID-19 on Māori:non-Māori inequities’. The study aims to explore changes in access to healthcare, quality of healthcare and health outcomes for Māori, the Indigenous peoples of Aotearoa New Zealand (NZ) and non-Māori during the COVID-19 outbreak period across NZ.Methods and analysis This observational study is framed within a Kaupapa Māori research positioning that includes Kaupapa Māori epidemiology. National datasets will be used to report on access to healthcare, quality of healthcare and health outcomes between Māori and non-Māori during the COVID-19 pandemic in NZ. Study periods are defined as (a) prepandemic period (2015–2019), (b) first pandemic year without COVID-19 vaccines (2020) and (c) pandemic period with COVID-19 vaccines (2021 onwards). Regional and national differences between Māori and non-Māori will be explored in two phases focused on identified health priority areas for NZ including (1) mortality, cancer, long-term conditions, first 1000 days, mental health and (2) rheumatic fever.Ethics and dissemination This study has ethical approval from the Auckland Health Research Ethics Committee (AHREC AH26253). An advisory group will work with the project team to disseminate the findings of this project via project-specific meetings, peer-reviewed publications and a project-specific website. The overall intention of the project is to highlight areas requiring health policy and practice interventions to address Indigenous inequities in health resulting from COVID-19 pandemic management (both historical and in the future).

Abstract Right atrial masses in dogs are commonly diagnosed as malignant tumors. This report describes a dog with a right atrial mass that appeared after successful electrical cardioversion of atrial fibrillation and resolved with antithrombotic treatment. A 9‐year‐old mastiff was presented for acute vomiting, and occasional cough of several weeks' duration. Ultrasonographic and radiographic examinations of the abdomen and chest identified mechanical ileus, as well as pleural effusion and pulmonary edema, respectively. Echocardiography indicated a dilated cardiomyopathy phenotype. During anesthetic induction for laparotomy, atrial fibrillation developed. Electrical cardioversion successfully restored sinus rhythm. An echocardiogram performed 2 weeks later disclosed a right atrial mass, which had not been apparent before cardioversion. Repeat echocardiography after 2 months of clopidogrel and enoxaparin treatment failed to detect the mass. Intra‐atrial thrombus formation is possible after successful cardioversion of atrial fibrillation and should be considered as a differential diagnosis for echocardiographically detected atrial masses.

La experiencia de contacto implica la atención de lo que se vive a nivel emocional, corporal y de pensamiento. Este concepto de la psicoterapia Gestalt fundamenta hoy diversos modelos y técnicas psicoterapéuticas; y se requiere investigar si la experiencia de contacto supone la base del cambio y de la eficacia en psicoterapia. Se desarrolló un estudio de caso con diseño mixto y metodología de investigación de proceso-resultado, aplicando técnicas experienciales a una consultante de 19 años durante siete sesiones videograbadas. Para la categorización de los procesos de cambio se seleccionaron segmentos con altos niveles de experiencia, según EXP Scale. Los efectos observados se analizaron comparando los puntajes pre y post del Inventario de Depresión Estado/Rasgo, (IDER), el Cuestionario de Ansiedad Estado-Rasgo (STAI) y las Escalas de Bienestar Psicológico de Ryff, y los efectos percibidos mediante una Entrevista Final de Cambio. Los resultados mostraron que la psicoterapia fue efectiva y que los efectos terapéuticos se relacionaron con los procesos de cambio.

Abstract Introduction Pseudomonas aeruginosa respiratory infections are challenging, and the risk of recurrence is a frequent problem. The aim of this study was to investigate the risk factors associated with the presence of P. aeruginosa, and the risk factors related to the recurrence and death of lower airway infections in inpatients in a Brazilian hospital. Methods Retrospective cohort with inpatients that had a sample of airways culture (tracheal aspirate or bronchoalveolar lavage) with the detection of P. aeruginosa. The patients with clinical criteria of infection were classified as ventilator‐associated, hospital‐acquired, or community‐acquired pneumonia. P. aeruginosa in respiratory samples without symptoms was considered colonization. The antimicrobial treatment adequacy and the clinical data were evaluated. Outcome variables included mortality and recurrence. Results One hundred and fifty‐four patients were included in the study, most of them were men, and the majority (102) were considered infected. The average length of stay was superior to 30 days. Previous pulmonary disease was associated with the occurrence of colonization. Aminoglycosides were the most active drug according to susceptibility tests and were successfully used as monotherapy. Septic shock was a risk factor for death in the infected patients. The use of adequate antimicrobial therapy was associated with major survival, independent of the infection classification. Conclusion It is possible to evaluate clinical data associated with recurrence and mortality in patients with different lung infections by P. aeruginosa. Aminoglycoside monotherapy is safe and effective in P. aeruginosa respiratory infections.

Abstract Objectives To optimise planning of public health services, the impact of high-cost users needs to be considered. However, most of the existing statistical models for costs do not include many clinical and social variables from administrative data that are associated with elevated health care resource use, and are increasingly available. This study aimed to use machine learning approaches and big data to predict high-cost users among people with cardiovascular disease (CVD). Methods We used nationally representative linked datasets in New Zealand to predict CVD prevalent cases with the most expensive cost belonging to the top quintiles by cost. We compared the performance of four popular machine learning models (L1-regularised logistic regression, classification trees, k-nearest neighbourhood (KNN) and random forest) with the traditional regression models. Results The machine learning models had far better accuracy in predicting high health-cost users compared with the logistic models. The harmony score F1 (combining sensitivity and positive predictive value) of the machine learning models ranged from 30.6% to 41.2% (compared with 8.6–9.1% for the logistic models). Previous health costs, income, age, chronic health conditions, deprivation, and receiving a social security benefit were among the most important predictors of the CVD high-cost users. Conclusions This study provides additional evidence that machine learning can be used as a tool together with big data in health economics for identification of new risk factors and prediction of high-cost users with CVD. As such, machine learning may potentially assist with health services planning and preventive measures to improve population health while potentially saving healthcare costs.

This article aims to evaluate the quality of education at Evangelical Protestant Church in Timor (GMIT) elementary schools (ES), henceforth shortened to GMIT ES, in mainland Timor. The evaluation method is used with the evaluation model of CIPP (context, input, process, and product). The research sample consists of 173 headmasters of GMIT ESs in mainland Timor. The data collection is done by using a questionnaire. The data analysis uses descriptive statistics (percentage calculation technique). The results show that the quality of the context, input, process, and product can be described as follows: the context is in the sufficient category, the input is in the sufficient category, the process is in a good category, and the product is in a good category. Overall, the quality of the implementation of education at GMIT ESs in mainland Timor is in the sufficient category. The supporting factors are the attention from the government, the church, and the Christian Education Foundation (Yapenkris) with varying weights, and the commitment of the teachers who understand their duties as part of the ministry. The inhibiting factors are related to the minor role of Yapenkris and the GMIT congregations, the lack of welfare for teachers, and the absence of a governance model for schools under GMIT.

Women with perinatal depression are at a high risk for unhealthy dietary behaviors but whether the coronavirus disease 2019 (COVID-19) pandemic has exacerbated this risk is unknown. Here we report the findings of a qualitative study exploring the impact of the COVID-19 pandemic on nutrition-related experiences of women with perinatal depression. Using a qualitative descriptive approach, in-depth interviews were conducted with 18 women with a history of perinatal depression and 10 healthcare providers. A semistructured format elicited how food and nutrition-related behaviors of women with perinatal depression were affected by the COVID-19 pandemic. Thematic analysis identified 4 themes related to the COVID-19 pandemic: (1) Adaptations in shopping and cooking behaviors; (2) increases in stress and declines in respite; (3) declines in support and increases in isolation; and (4) low levels of breastfeeding guidance. Our findings confirm the importance of resilience among women with perinatal depression and future research is needed to elucidate the mechanisms connecting resilience and dietary behaviors.

Introduction Current guideline recommend functional imaging for myocardial ischaemia if coronary CT angiography (CTA) has shown coronary artery disease (CAD) of uncertain functional significance. However, diagnostic accuracy of selective myocardial perfusion imaging after coronary CTA is currently unclear. The Danish study of Non-Invasive testing in Coronary Artery Disease 3 trial is designed to evaluate head to head the diagnostic accuracy of myocardial perfusion imaging with positron emission tomography (PET) using the tracers 82Rubidium (82Rb-PET) compared with oxygen-15 labelled water PET (15O-water-PET) in patients with symptoms of obstructive CAD and a coronary CT scan with suspected obstructive CAD.Methods and analysis This prospective, multicentre, cross-sectional study will include approximately 1000 symptomatic patients without previous CAD. Patients are included after referral to coronary CTA. All patients undergo a structured interview and blood is sampled for genetic and proteomic analysis and a coronary CTA. Patients with possible obstructive CAD at coronary CTA are examined with both 82Rb-PET, 15O-water-PET and invasive coronary angiography with three-vessel fractional flow reserve and thermodilution measurements of coronary flow reserve. After enrolment, patients are followed with Seattle Angina Questionnaires and follow-up PET scans in patients with an initially abnormal PET scan and for cardiovascular events in 10 years.Ethics and dissemination Ethical approval was obtained from Danish regional committee on health research ethics. Written informed consent will be provided by all study participants. Results of this study will be disseminated via articles in international peer-reviewed journal.Trial registration number NCT04707859.

Abstract Background Telemedicine has grown significantly in recent years, mainly during the COVID-19 pandemic, and there has been a growing body of literature on the subject. Another topic that merits increased attention is differences in patient and family experience between telehealth and in-person visits. To our team’s knowledge, this is the first study evaluating pediatric and obstetrics outpatients experience with telemedicine and in-person visit types in an academic maternal and children’s hospital, and its correlation with geographic distance from the medical center throughout 2020, during the COVID-19 crisis. Methods We aim to evaluate and compare patients’ telemedicine and in-person experience for ambulatory encounters based on survey data throughout 2020, during the COVID-19 pandemic, with particular focus on the influence of distance of the patient’s home address from the medical facility. A total of 9,322 patient experience surveys from ambulatory encounters (6,362 in-person and 2,960 telemedicine), in a maternal and children’s hospital during 2020 were included in this study. The percentage of patients who scored the question “Likelihood to recommend practice” with a maximum 5/5 (top box) score was used to evaluate patient experience. The k-means model was used to create distance clusters, and statistical t-tests were conducted to compare mean distances and Top Box values between telemedicine and in-person models. Logistic regression analysis was used to evaluate the correlation between Top Box scores and patients’ distance to the hospital. Results Top Box likelihood to recommend percentages for in-person and telemedicine were comparable (in-person = 81.21%, telemedicine = 81.70%, p-value = 0.5624). Mean distance from the hospital was greater for telemedicine compared to in-person patients (in-person = 48.89 miles, telemedicine = 61.23 miles, p-value

During the fruit sample preparation process, coconut fruits classified under the tall coconut variety in their post-harvest period are considered the subject of this article. All samples are pre-classified by local farmers and experts into three maturity levels; premature, mature, and overmature. Each coconut underwent the synchronized tapping and recording process using developed hardware and software. The analog recordings are then converted into digital signals. Sampled frequency and amplitude in discrete-time signals of each sample went through a quantization process. The data presented in this article provides the general differentiation of the coconuts according to their maturity levels through their acoustic properties. This dataset can also be useful in creating an advanced and intelligent classification system of fruits through machine learning and deep learning techniques.

Background: PIK3CA mutations have been reported to be associated with resistance to therapy in HER2+ breast cancers. This study, therefore, became imperative to determine the expression pattern of this mutant protein together with ER, PR and KI67 in order to serve as a useful predictive tool in the management of HER2 breast cancers. Methods: A total of 53 archived formalin-fixed, paraffin-embedded HER2+ breast cancer tissue blocks from 2015 to 2019 were used for the study in NAUTH Nnewi. The selected blocks were sectioned and stained with haematoxylin and eosin staining techniques. HER2, ER and PR status confirmation as well as PIK3CA and KI67 protein expressions were evaluated using immunohistochemistry (Avidin-biotin complex method). PIK3CA and KI67 expressions in the tissue were scored based on proportion and intensity of immune-labelling using the semi-quantitative method. Result: The mean age of subjects was 47 years and the breast cancers were all invasive ductal carcinoma. Twenty-nine (54.7%) were ER+ while 24 (45.3%) were ER-. Twenty-one (39.6%) were PR+ while 32 (60.4%) were PR-. Twenty-one (39.6%) were PIK3CA negative, 9(35.8%) showed low PIK3CA, while 13(24.5%) showed high PIK3CA. Thirty-four (64.2%) were negative for KI67, 11(20.8%) showed low KI67, while 8(15.5%) showed high KI67. There was weak and moderate positive relationship between ER/PR status and PIK3CA (r=-0.032; p=0.822) and KI67 (r=0.050; p=0.721) respectively. A weak negative correlation between KI67 and PIK3CA (r=-0.118; p=0.401) were observed with 12 (22.4%) of the 13 highly positive PIK3CA cases showing either negative or low for KI67 immunoreactivity while 7(13.2%) of the 8 highly positive KI67 cases showed either negative or low PIK3CA immunoreactivity. Conclusion: This study established a moderate expression of PIK3CA mutant protein. It also pointed out an existing interesting relationship between PIK3CA and KI67, which can be further revealed in future studies.

Abstract Background Health care is a complex economic and social system, which combines market elements and public and social interest. This combination in Brazil, like systems in China and United States of America, is operationalized through the public and private system. The sector represents approximately 9% of the country’s GDP, of which 56% is privately sourced and 44% is of public origin. In the private sector includes a structure with 711 private health institutions, 47 million beneficiaries and revenues of US$30 billion a year. Methods Therefore, this research describes and analyzes the complementarity of Private Health before the Brazilian Unified Health System, highlighting its main characteristics, scenarios, and trends in the face of the health system and the Brazilian market. This descriptive and exploratory research uses secondary data from various sources, submitted to quantitative data analysis methods. The object of the research is the history of private health in Brazil and its main actors. Results The data are organized into three groups, each with its approach of collection and analysis. Thus, it is perceived as the notorious growth of large operators, to the detriment of operators with a lower concentration of beneficiaries; the increasing concentration of the market through mergers and acquisitions promoted by large publicly traded corporations, especially in regions with a lower rate of private health coverage; and the growth of the sector through business plans, whose central characteristic is the dependence on the country’s employability rate. Conclusions It is possible to perceive an intense trend of concentration of Brazilian private health in large institutions that have capitalized and have a great appetite for growth through mergers and acquisitions, whether from smaller operators or health institutions that integrate their health networks, following complementary health models already consolidated in countries such as China, and the United States of America, among others. This concentration projects a market with fewer options and competitiveness, reduction in transaction costs and increase the operational effectiveness of health care.

The agricultural sector is the mainstay of the economy in Central Moluccas. However, most agricultural soils on the island have low soil fertility. One of the efforts that farmers can make to improve soil fertility is to apply organic matter, which is widely found in Central Moluccas. This study aimed at elucidating the effect of mixing high-quality organic material (Glicidia sepium pruning) with low-quality organic material (sago pulp waste) on the improvement of available nitrogen in an acid soil (Dystrudept) and growth of maize. Two experiments were carried out in a laboratory and a greenhouse. The compositions of the mixtures of sago pulp waste (A) and pruning of Gliricidia sepium (G) were A0 G100; A20G80; A40G60; A60G40; A80G20, and A100G0. Six treatments and one control (no application of residues) were arranged in a completely randomized design. The results showed that the application of the mixture of 20% and 80% of Gliricidia sepium pruning (A20G80) increased the cumulative amount of mineral N in the soil higher than that of the other organic material mixtures, which in turn improved maize growth.

PURPOSEPain is among the most common and consequential symptoms of cancer, particularly in the context of lung cancer. Māori have extremely high rates of lung cancer, and there is evidence that Māori patients with lung cancer are less likely to receive curative treatment and more likely to receive palliative treatment and to wait longer for their treatment than non-Māori New Zealanders. The extent to which Māori patients with lung cancer are also less likely to have access to pain medicines as part of their supportive care remains unclear.METHODSUsing national-level Cancer Registry and linked health records, we describe access to subsidized pain medicines among patients with lung cancer diagnosed over the decade spanning 2007-2016 and compare access between Māori and non-Māori patients. Descriptive and logistic regression methods were used to compare access between ethnic groups.RESULTSWe observed that the majority of patients with lung cancer are accessing some form of pain medicine and there do not appear to be strong differences between Māori and non-Māori in terms of overall access or the type of pain medicine dispensed. However, Māori patients appeared more likely than non-Māori to first access pain medicines within 2 weeks before their death and commensurately less likely to access them more than 24 weeks before death.CONCLUSIONGiven the plausibility that there are differences in first access to pain medicines (particularly opioid medicines) among Māori approaching end of life, further investigation of the factors contributing to this disparity is required.

Post-harvested Musa acuminata banana species from a local banana plantation in the Philippines are the subject of this article. All banana tier samples used were pre-classified into four classes by a local expert. These four classifications are extra class, class I, class II, and reject. There are six images captured per banana tier sample from the six different views. Each captured image underwent a three-step image transformation to finely extract the RGB numerical values while the size measurement feature was gathered through manual measurement. The dataset presented in this article provides a brief differentiation of the different classes of banana tiers for commercial use through image processing. This dataset can be useful in establishing an advanced intelligent system in a non-invasive approach through machine and deep learning techniques.

What if the environment could be transformed in culturally-responsive and inclusive ways to foster high-quality interactions and spark conversations that drive learning? In this article, we describe a new initiative accomplishing this, called Playful Learning Landscapes (PLL). PLL is an evidence-based initiative that blends findings from the science of learning with community-based participatory research to transform physical public spaces and educational settings into playful learning hubs. Here, we describe our model for conducting this research, which is mindful of three key components: community input, how children learn best, and what children need to learn to be successful in the 21st century economy. We describe how this model was implemented in two PLL case studies: one in a predominantly Latine community and the second in early childhood education classrooms. Furthermore, we describe how research employing our model can be rigorously and reliably evaluated using observational and methodological tools that respond to diverse cultural settings and learning outcomes. For example, our work evaluates how PLL impacts adult–child interaction quality and language use, attitudes about play and learning, and community civic engagement. Taken together, this article highlights new ways to involve community voices in developmental and educational research and provides a model of how science can be translated into practice and evaluated in culturally responsive ways. This synthesis of our process and evaluation can be used by researchers, policymakers, and educators to reimagine early educational experiences with an eye toward the built environment that children inhabit in everyday life, creating opportunities that foster lifelong learning.

Abstract The need to develop alternatives to improve health assistance access and qualification was emergent and urgent even before the advent of Covid-19. Such demand is necessary in regard to both public and private systems. In this context, the theme of cost and effectiveness is technically adequate and viable to analyze these alternatives. Analyzing the history of research development on the topic and identifying its gaps is thus an essential step in facing this challenge. Therefore, the objective of this study was to modestly contribute to a bibliometric examination of scientific production based on the theme of cost-effectiveness to guide future research, despite the maturity of the theme, and as well as its future challenges. As a result, several essential aspects of the theoretical approach to the theme were observed, such as its conceptualization, purpose, and objective within public and private institutions, identifying its main authors, universities, reference countries, and funding institutions, authors’ relationship networks, and related themes. One of the most important factors identified is the absence of the theme applied to contemporary topics in health, such as telemedicine, telehealth, robotics, artificial intelligence, new drugs and medicines, and new healthcare protocols.

Previous research explicates ordinal and disordinal interactions through the concept of the "crossover point." This point is determined via simple regression models of a focal predictor at specific moderator values and signifies the intersection of these models. An interaction effect is labeled as disordinal (or ordinal) when the crossover point falls within (or outside) the observable range of the focal predictor. However, this approach might yield erroneous conclusions due to the crossover point's intrinsic nature as a random variable defined by mean and variance. To statistically evaluate ordinal and disordinal interactions, a comparison between the observable range and the confidence interval (CI) of the crossover point is crucial. Numerous methods for establishing CIs, including reparameterization and bootstrap techniques, exist. Yet, these alternative methods are scarcely employed in social science journals for assessing ordinal and disordinal interactions. This note introduces a straightforward approach for calculating CIs, leveraging an extension of the Johnson-Neyman technique.

O objetivo deste estudo é analisar o impacto das diferentes formas de ingresso sobre a evasão ou desligamento de curso dos alunos da Universidade de Brasília (UnB), ou seja, uma comparação da evasão entre ingressantes pelo SISU, Programa de Avaliação Seriada (PAS) e Vestibular, entre 2014 e 2018. Como metodologia, utilizou-se a taxa de desistência anual e a taxa de desistência acumulada propostas pelo INEP (2017) e concluiu-se que o PAS e o Vestibular têm um padrão semelhante de evasão, com picos no segundo e terceiro ano de trajetória universitária, enquanto o SISU tem uma taxa de desistência consideravelmente superior, e que ocorre mais cedo, com picos nos primeiros anos de curso.

Changes in phenology are a conspicuous fingerprint of climate change, leading to fears that phenological mismatches among interacting species will be a leading cause of population declines and extinction. We used quantile regression to analyze museum collection data and estimate changes in the phenological overlap of Baltimore checkerspot butterflies and 12 common nectar plant species over several decades in two geographic regions. We combined these museum data with field estimates of each species flower density and nectar sugar production to estimate changes in resource availability caused by shifts in phenological overlap. Phenological overlap (measured as the proportion of plant flowering during the flight period of an average butterfly) decreased through time, primarily because the flowering period of nectar plants was longer, but the flight period of butterflies was shorter in recent years. Our study was also motivated by the hypothesis that phenological mismatches may be more severe in the southern region due to a midsummer dearth in floral resources, but this hypothesis was not supported by our data. Although phenological overlap was somewhat smaller in the southern region, changes in overlap through time were similar in both regions. When phenological overlap was weighted by nectar sugar production of different species, the overlap increased in the southern region but decreased in the northern region (the opposite of our prediction). Overall, nectar resources were much more abundant at study sites in our northern region than in our southern region, possibly due to differences in land management. Our study demonstrates the complexities of phenological mismatch of interacting species and highlights that phenological changes may have small impacts on population viability.