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Background People with low back pain (LBP) are often recommended to self-manage their condition, but it can be challenging without support. Digital health interventions (DHIs) have shown promise in supporting self-management of LBP, but little is known about healthcare providers’ (HCPs) engagement in implementing these. Aims We aimed to examine HCPs’ engagement in patient recruitment for the selfBACK app clinical trial and explore their perceptions of the app. Methods In a mixed-methods design, we conducted a process evaluation alongside the selfBACK trial, triangulating quantitative data from trial recruitment logs and a vignette-based survey, and qualitative data from trial procedure documents, interviews with HCPs, and survey free-text responses. From 2019 to 2020, we recruited 57 HCPs from Norway and 39 health clinics in Denmark and collected quantitative and qualitative data in parallel. Results were integrated using displays. Results Overall, 825 patients were recruited by the HCPs. The vignette-based survey showed high agreement among HCPs (n = 62) with the self-management plans generated by the app (84.1–88.9%) but also highlighted concerns about tailoring and content. Interviews with HCPs (n = 19) revealed challenges with recruitment due to busy schedules, competing tasks, and varying levels of interest and engagement in the study. Conclusions The study identified factors that impact HCPs’ engagement in recruiting patients for the selfBACK trial and highlighted overall positive views of the selfBACK app, although some concerns about the content and tailoring of the app were raised. Understanding HCP motivations and workload is crucial for the successful implementation of DHIs in clinical practice.

OBJECTIVE: This study aimed to investigate whether physical work demands modify the effect of the selfBACK app, which is designed to support self-management of low-back pain. METHODS: In a secondary analysis of the selfBACK trial with 346 employed participants, we stratified into low (N=165) and high physical work demands (N=181). Outcomes included the Roland-Morris Disability Questionnaire (0–24), a numeric rating scale for low-back pain intensity (0–10), the Pain Self-Efficacy Questionnaire (0–60), and work ability (0–10). Intervention effects were assessed at three- and nine-month follow-ups using a linear mixed model. RESULTS: At three months, high physical demand workers with selfBACK showed a significant reduction in pain intensity [-0.8, 95% confidence interval (CI) -1.3– -0.2] compared to usual care. By nine months, the high physical demands workers with selfBACK reported reduced pain-related disability (-1.4, 95% CI -2.7– -0.1), improved pain self-efficacy (3.5, 95% CI 0.9–6.0), and lower pain intensity (-1.0, 95% CI -1.6– -0.4) compared to usual care. Low physical demands workers with selfBACK also improved pain self-efficacy [2.8 (95% CI 0.3–5.3)] compared to usual care. The impact of selfBACK was more noticeable among workers with high physical demands compared to their low physical demand counterparts, but no statistically significant differences were found in any outcome. CONCLUSIONS: The selfBACK intervention had consistent effects across workers with high and low physical work demands, indicating that these demands did not modify its impact. Both groups experienced similar positive effects, highlighting the intervention’s effectiveness across varying levels of physical work demands.

Background Interest in alternative sources of tubers and legumes has increased due to the search for raw materials with bioactive antioxidant compounds. The objective of this study was to characterize taro (TF) and sacha inchi (Plukenetia volubilis) flours obtained by the wet (SIF-WM) and defatted (SIF-DM) methods, as alternatives for the formulation of functional foods. Methods Proximal tests were conducted to determine basic chemical composition, quantification of free polyphenols, antioxidant activity using the ABTS* radical method (2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid)) with Trolox as a standard, and rheological analyses, including pasting curves, flow profiles, and viscoelastic properties. Microbiological characterization of the flours was also performed. Results The highest protein content was found in sacha inchi flour obtained by the defatted method (72.62%), while carbohydrates were the main component in taro flour (85.4%). In terms of antioxidant activity, taro flour showed higher values of 2.71 µmol ET/g and 7.47 mg EAG/g. Rheological analysis showed that adding taro flour increased the viscosity peak and reduced breakdown, improving gel stability. Staphylococcus aureus and Salmonella spp. were detected in taro flour. Conclusions Taro and sacha inchi flours have great potential for the development of functional products like protein snacks, with good expansion due to taro starch and are naturally gluten-free, making them suitable for people with celiac disease.

Abstract Background Patients with persistent critical illness experience prolonged multi-system morbidity, functional impairments, and chronic conditions. As a result, these patients have prolonged intensive care unit admissions. If discharged, they return home with long-term medical dependencies. Care partners take on a variety of physical, mental health, cognitive, and social roles to support the provision of care for these patients. There is limited evidence, however, of the impact of being a care partner for this patient population during hospitalization. Methods A qualitative descriptive study was conducted to explore the impact care provision on care partners for patients experiencing persistent critical illness. Patients who have or have had persistent critical illness and care partners were recruited from two inpatient units in a single community academic hospital in Toronto, Canada to participate in semi-structured interviews. Data was analyzed using a team-based inductive content analysis. Results Seven (43.8%) participants were patient survivors, and nine (56.3%) were care partners. Patients and care partners reported physical, socio-emotional, and social stress as impacts of care provision during persistent critical illness hospitalization. Care partners identified several protective strategies that they used to mitigate the impacts of care provision on them such as seeking external mental health support and boundary setting. Features of formalized and care partner programs were also identified and suggest that these programs can be protective of care partner values, mitigate feelings of helplessness and stress, and may improve relationships between the family members who are in the care partner role and the healthcare team. Conclusions This study identified physical, socio-emotional, and social stress related impacts of care provision on care partners of patients with persistent critical illness during hospitalization. Additionally, this study identified protective factors initiated by care partners to mitigate the reported stresses of the role, as well as protective features of a care partner program. The results provide a better understanding supportive features of care partner programs that are specific to the experiences and needs of persistent critical illness and add to the growing body of evidence about how to provide equitable access to care during and post hospitalization.

In today’s interconnected world, data surged in volume. This exponential increase in data availability has sparked the rise of data science and artificial intelligence (AI), changing how we handle information (Aldoseri et al. 2023). In a world undergoing rapid change across various dimensions, it is important to involve data-driven methods to be able to assess and to follow, and assist citizens in their sustainable actions and projects. These methods help analyze, support, and motivate citizens in actions and projects, addressing complex issues like biodiversity loss, urban liveability, and local activism. With a focus on inclusivity and adaptability, the session aimed to discuss transformative potential approaches that integrate citizen science, data science, and human-computer interaction (HCI). Of particular importance was the focus on the ethical considerations of data science and AI, emphasizing fairness and equity in decision-making, and showcase real-world impacts. Additionally, we explored the conditions for cross-disciplinary collaborations among data scientists, citizen scientists, researchers, practitioners, within various citizen science projects. The current paper presents the session report, highlighting the main discussion points and conclusions.

OBJECTIVES: Both high and low levels of occupational physical activity are associated with back pain. Thus, there might be a “sweet- and sour-spot” of occupational physical activity for back pain. Our aim was to investigate if there exists an occupational physical activity “sweet- (lowest risk) and sour-spot” (highest risk) for back pain. METHODS: A total of 396 eldercare workers from 20 Danish nursing homes participated. Occupational physical activity was measured between 1–4 working days using thigh-worn accelerometry. Back pain intensity was reported monthly on a scale from 0–10 over 1-year. A zero-inflated mixed-effects model was developed regressing occupational physical activity against back pain, adjusted for confounders. The “sweet- and sour-spot” were defined as the occupational physical activity compositions (sitting, standing, light, and moderate-to-vigorous) associated with the 5% lowest and highest risk for back pain, respectively. RESULTS: The composition associated with the lowest risk of back pain – the “sweet-spot”– consisted of 71% worktime spent sitting, 18% spent standing, 5% spent on light physical activity and 6% spent on moderate-to-vigorous physical activity. The composition associated with highest risk for back pain –the “sour-spot”– consisted of 8% worktime spent sitting, 66% spent standing, 4% spent on light physical activity, and 21% spent on moderate-to-vigorous physical activity. CONCLUSIONS: The “sweet-spot” of occupational physical activity for back pain among eldercare workers involves more sitting and light physical activity time, while the “sour-spot” involves more standing and moderate-to-vigorous physical activity time. Research on the occupational physical activity “sweet- and sour-spot” is needed.

Conjoined twins are very rare and some obstetricians may go through their career without ever managing a case. This case describes a thoraco-omphalopagus whereby the twins were joined at the chest and abdomen. Management of conjoined twins largely depends on the degree of conjoining and the availability of resources. In this case, the severity of the conjoining and lack of specialized resources resulted in managing via termination of the pregnancy. This is the first published case of conjoined twins from Trinidad and Tobago. The aim of this case report is to share our findings and management in a setting with limited resources.

BackgroundSince the COVID-19 pandemic, telemedicine has been widely integrated into primary care pediatrics. While initial studies showed some concern for disparities in telemedicine use, telemedicine uptake for pediatric patients in a low-income, primarily Latino community over a sustained period has yet to be described. ObjectiveWe aimed to assess the relationship between demographics, patient portal activation, and telemedicine visits, as well as characterize diagnoses addressed in telemedicine, in a low-income, primarily Latino population over time. MethodsA multidisciplinary team conducted outreach for telemedicine and patient portal activation with the adoption of a new electronic health record. Data were collected on all in-person and telemedicine visits from February 2020 through April 2021 for 4 community-based pediatric practices. The outcomes included patient portal activation, telemedicine use, and reason for telemedicine visits. Bivariate tests and multivariate regression analyses were conducted to assess the independent effects of demographics on the likelihood of portal activation and having a telemedicine visit. Telemedicine diagnoses were categorized, and subanalyses were conducted to explore variations by age and month. ResultsThere were 12,377 unique patients and 7127 telemedicine visits. Latino patients made up 83.4% (n=8959) of the population. Nearly all patients (n=10,830, 87.5%) had an activated portal, and 33.8% (n=4169) had at least 1 telemedicine visit. Portal activation decreased with age >2 years (2-4 years: adjusted odds ratio [aOR] 0.62, 95% CI 0.51-0.76; 5-11 years: aOR 0.28, 95% CI 0.23-0.32; 12-14 years: aOR 0.29, 95% CI 0.23-0.35; and 15-17 years: aOR 0.46, 95% CI 0.36-0.58). Spanish-speaking (aOR 0.52, 95% CI 0.45-0.59) and non-Latino patients (aOR 0.64, 95% CI 0.54-0.76) had decreased odds of activation and having a telemedicine visit (aOR 0.81, 95% CI 0.74-0.89 and aOR 0.71, 95% CI 0.62-0.81, respectively). The top 5 diagnostic categories for telemedicine were infectious disease (n=1749, 26.1%), dermatology (n=1287, 19.5%), gastrointestinal (n=771, 11.7%), well and follow-up care (n=459, 7%), and other specialty-related care (n=415, 6.3%). Infectious disease showed the most variation over time. Age-based patterns included a decrease in the proportion of infectious disease diagnoses by increasing age group and a higher proportion of well and follow-up care in older ages. Additional telemedicine diagnoses included common infant concerns for patients younger than 2 years of age; pulmonary, asthma, and allergy concerns for toddler or school-age children; behavioral health concerns for younger adolescents; and genitourinary and gynecologic concerns for older adolescents. ConclusionsThe high engagement across demographics suggests feasibility and interest in telemedicine in this low-income, primarily Latino population, which may be attributable to the strength of outreach. Language-based disparities were still present. Telemedicine was used for a wide range of diagnoses. As telemedicine remains a vital component of pediatric health care, targeted interventions may enhance engagement to serve diverse pediatric patient populations.

Amid mushrooming net-zero commitments and pledges made by states and non-state entities, a gap remains between those pledges, and the action needed in order to stay within the temperature goals of the Paris Agreement. In response, scholars and policymakers have started to examine physical, technological, economic, and policy pathways to net‐zero emissions across different sectors. This article examines the existing legislation and litigation for a net-zero world in four jurisdictions: Germany, the United States, Brazil, and China. We propose a taxonomy for identifying and comparing existing legal mechanisms to reach net-zero across these jurisdictions. We identify and analyze different legislative and regulatory mechanisms that incorporate net-zero mandates and three net-zero litigation strategies in these countries. These jurisdictions provide a useful snapshot of the variety of legal mechanisms currently being used by, or imposed on, large emitting jurisdictions and entities. We then consider the critical ways in which climate law can contribute to, or hinder, emissions reductions in line with net-zero targets.

Background Interest in alternative sources of tubers and legumes has increased in recent years because of the constant search for raw materials that provide bioactive compounds with antioxidant potential benefits for consumers. The functionality of new raw materials is sought through physical and/or chemical modifications to develop and innovate new foods. The objective of this study was to characterize taro (TF) (Colocasia esculenta) and sacha inchi (Plukenetia volubilis) flours, obtained by the wet (SIF-WM) and defatted method (SIF-DM), as an alternative for the formulation of new functional foods. Methods The free polyphenols of the different mixtures were analyzed, and the antioxidant properties of the extracts obtained were measured using ABTS.* (2,2′-Azino-bis(3-ethylbenzthiazoline-6-sulfonic acid). The ABTS radical method, which reacts with the phenolic compounds of the food matrix, using Trolox as a standard. The blends were subjected to pasting analysis, flow profile tests, determination of viscoelastic properties (temperature sweep). Characterization of common microorganisms in these foods was performed. Results The highest protein value was obtained in the sacha inchi flour obtained by the defatted method (72.62%). The majority of components in taro were carbohydrates (85.4%). About antioxidant and determination of free polyphenols, taro flour obtained values of 2.71 μmol ET/g and 7.47 mg EAG/g, higher than sacha inchi flours. In the rheological analysis (pasting properties, flow profile, and viscoelasticity), we observed that adding taro flour in different mixtures increases the viscosity peak and a lower breakdown, while there was an increase in setback. Except for defatted sacha flour, the others presented a flow index >1 before heating, showing a dilatant fluid behavior. The presence of taro flour improves gel formation and stability. Staphylococcus aureus and Salmonella were present in the taro flour. Conclusions The flours analyzed represent a raw material with great potential for the development of products such as protein snacks due to the contribution of sacha inchi, with good expansion due to taro starch, and naturally gluten-free for people with celiac disease.

Purpose/objective(s)Bridging radiation therapy (bRT) is increasingly being utilized prior to chimeric antigen receptor (CAR) T-cell therapy for large B-cell lymphoma (LBCL). It is unknown how the extent of cytoreduction during bRT impacts outcomes.Materials/methodsWe retrospectively reviewed patients with LBCL treated with bRT followed by CAR T-cell therapy. Metabolic tumor volume (MTV), maximum standardized uptake value (SUVmax), SUVmean, and total lesion glycolysis (TLG) were extracted from F18-fluorodeoxyglucose positron emission tomography (PET) scans acquired prior to bRT and between completion of bRT and CAR T-cell infusion. Delta radiomics based on changes of these values were then calculated. The association between delta radiomics and oncologic outcomes [progression-free survival (PFS), freedom from distant progression (FFDP), and local control (LC)] were then examined.ResultsThirty-three sites across 23 patients with LBCL were irradiated. All metabolically active disease was treated in 10 patients. Following bRT, median overall decreases (including unirradiated sites) in MTV, SUVmax, SUVmean, and TLG were 22.2 cc (63.1%), 8.9 (36.8%), 3.4 (31.1%), and 297.9 cc (75.8%), respectively. Median decreases in MTV, SUVmax, SUVmean, and TLG in irradiated sites were 15.6 cc (91.1%), 17.0 (74.6%), 6.8 (55.3%), and 157.0 cc (94.6%), respectively. Median follow-up was 15.2 months. A decrease in SUVmax of at least 54% was associated with improved PFS (24-month PFS: 83.3% vs. 28.1%; p = 0.037) and FFDP (24-month FFDP: 100% vs. 62.4%; p < 0.001). A decrease in MTV of at least 90% was associated with improved FFDP (24-month FFDP: 100% vs. 62.4%; p < 0.001). LC was improved in sites with decreases in SUVmax of at least 71% (24-month LC: 100% vs. 72.7%; p < 0.001). Decreases of MTV by at least 90% (100% vs. 53.3%; p = 0.038) and TLG by at least 95% (100% vs. 56.3%; p = 0.067) were associated with an improved complete response rate.ConclusionbRT led to substantial reductions in MTV, SUVmax, SUVmean, and TLG. The relative extent of these decreases correlated with improved outcomes after CAR T-cell infusion. Prospective cohorts should validate the value of interim PET following bRT for quantifying changes in disease burden and associated prognosis.

Objectives This study aims to investigate the cost-effectiveness of individually tailored self-management support, delivered via the artificial intelligence-based selfBACK app, as an add-on to usual care for people with low back pain (LBP).Design Secondary health-economic analysis of the selfBACK randomised controlled trial (RCT) with a 9-month follow-up conducted from a Danish national healthcare perspective (primary scenario) and a societal perspective limited to long-term productivity in the form of long-term absenteeism (secondary scenario).Setting Primary care and an outpatient spine clinic in Denmark.Participants A subset of Danish participants in the selfBACK RCT, including 297 adults with LBP randomised to the intervention (n=148) or the control group (n=149).Interventions App-delivered evidence-based, individually tailored self-management support as an add-on to usual care compared with usual care alone among people with LBP.Outcome measures Costs of healthcare usage and productivity loss, quality-adjusted life-years (QALYs) based on the EuroQol-5L Dimension Questionnaire, meaningful changes in LBP-related disability measured by the Roland-Morris Disability Questionnaire (RMDQ) and the Pain Self-Efficacy Questionnaire (PSEQ), costs (healthcare and productivity loss measured in Euro) and incremental cost-effectiveness ratios (ICERs).Results The incremental costs were higher for the selfBACK intervention (mean difference €230 (95% CI −136 to 595)), where ICERs showed an increase in costs of €7336 per QALY gained in the intervention group, and €1302 and €1634 for an additional person with minimal important change on the PSEQ and RMDQ score, respectively. At a cost-effectiveness threshold value of €23250, the selfBACK intervention has a 98% probability of being cost-effective. Analysis of productivity loss was very sensitive, which creates uncertainty about the results from a societal perspective limited to long-term productivity.Conclusions From a healthcare perspective, the selfBACK intervention is likely to represent a cost-effective treatment for people with LBP. However, including productivity loss introduces uncertainty to the results.Trial registration number NCT03798288.

BackgroundmHealth has increasingly been touted as having the potential to help Sub-Saharan Africa achieve their health-related sustainable development goals by reducing maternal mortality rates. Such interventions are implemented as one-way or two-way systems where maternal clients receive pregnancy related information via SMS. While such technologies often view the users (the maternal health client) as having agency to adopt, we know from pregnancy literature that the pregnancy experience in Africa and other developing countries is often more collective. In addition to the maternal health client, other members of the community have high stakes in the pregnancy, and this often affects maternal healthcare-seeking behavior.ObjectiveThe aim of this paper, therefore, is to understand the pathways through which these other members of the community affect mHealth use.MethodsThe study used a qualitative approach and a case study research design. We analyzed two mHealth cases from Kenya and Malawi. In the Kenyan case, maternal health clients had mobile phones to receive pregnancy-related messages, while in the Malawi case, maternal health clients did not have mobile phones. Data were collected through interviews and focus group discussions. The study used an inductive thematic analysis to analyze the data.ResultsThe findings show that maternal stakeholders form a community of purpose (CoP) that plays a crucial role in the implementation, uptake, and use of mHealth. The CoP influences maternal health clients through a diverse range of mechanisms ranging from sensitization, bridging the digital literacy gap and legitimization of the intervention. The nature of influence is largely dependent on the contextual socio-cultural nuances.ConclusionOur results provide useful insights to mHealth implementers to know how best to leverage the CoP for better mHealth uptake and usage. For example, engaging healthcare providers could champion adoption and use, while engaging other family-related stakeholders will ensure better usage and compliance, encourage behavior change, and reduce mHealth attrition.

Indigenous LGBTIQSB+ individuals occupy a unique intersection of identities that inform their lived experiences and the ways in which they navigate colonial settler educational institutions. Despite a considerable body of evidence demonstrating the importance of inclusion, educational policies in Australia remain outdated. These policies are frequently informed by a deficit approach that justifies the absence of Indigenous and gender/sexuality diverse content within school curricula. This further acts to shore up discriminatory practices and policies. Using interviews and workshops held with young Indigenous LGTBIQSB+ people, this article reports on the ways participants experienced educational institutional settings. First, participants reported on the kinds of policies and curriculum content that discriminated against and marginalised them, as well as highlighting some positive aspects of school and university. Participants also revealed the potentialities for Indigenous and LGBTIQSB+ inclusivity that could be facilitated within educational spaces. The article demonstrates the need for safer and more inclusive educational environments, which could be achieved through the decentring of settler knowledges and heteronormativity, transforming educational spaces at an institutional level to facilitate safety at interpersonal and collective levels.

Food security is a pressing issue, emphasizing the necessity for food designs that address the current geopolitical and geoeconomic challenges. This study evaluates the impact of including different percentages (10 %, 20 %, 30 %, and 60 %) of high protein quinoa flour (HPQF) in the development of a new rice-based snack. The aim is to create four snack formulations with a protein content enriched with probiotics, surpassing those currently available in the market. Probiotics Bacillus coagulans were added at a 0.1 % concentration. Once the rice flour and quinoa flour are mixed, they are mixed with the probiotic, to move on to the extrusion process. Following the incorporation of probiotics, the snacks were packaged in a modified atmosphere, and their physicochemical properties, Bacillus coagulans probiotic viability, tolerance to artificial gastroenteric juice (TAGJ), starch digestibility, and sensory acceptance were assessed.Significant differences were observed in the expansion index, with the 60 % inclusion snack exhibiting the least expansion. Despite having a higher density, this snack reached a porosity index similar to that of the 20 % HPQF snack. Achieving a 17 % protein content in the snacks was possible with a 60 % inclusion rate. Texture was notably affected by the inclusion of HPQF, with snacks having higher inclusion levels showing increased hardness. Probiotic viability evaluation consistently remained above 106 UFC/g of snack, while TAGJ exhibited a viability of 75 %. Although HPQF inclusion led to a decrease in the glycemic index (GI), snacks still maintained a GI above 70 %. Regarding antioxidant properties, snacks with 60 % HPQF inclusion displayed superior results, reaching 35.29, 5.52, and 13.74 μmol of AA/g, measured via ABTS, DPPH, and FRAP methods, respectively. These findings demonstrate a heightened antioxidant capacity compared to other formulations. Our results indicate that the new probiotic snack serves as a rich source of protein and probiotics and is well-received sensorially. However, it is worth noting that it falls within the category of high GI foods, prompting the need for future studies aimed at reducing this parameter.

Background: Outbreaks of carbapenemase-producing (CP) organisms (CPOs), including carbapenem-resistant Enterobacterales (CRE), in neonatal intensive care units (NICUs) are not well documented. The Centers for Disease Control and Prevention (CDC) identifies CP-CRE as an urgent threat to United States (US) healthcare facilities. Wadsworth Center, the New York State (NYS) Department of Health’s (NYSDOH’s) public health laboratory, participates in CDC’s Antimicrobial Resistance Laboratory Network to provide CPO identification, characterization, and surveillance. NYSDOH investigated an outbreak of CP-CRE Escherichia coli (E. coli) infections in NICU patients reported by one hospital. Method: Hospital A reported a CRE E. coli outbreak in their NICU to NYSDOH, as required by NYS Sanitary Code. In response, epidemiologists reviewed case data, conducted case finding, and provided infection control guidance to the hospital. Hospital A continued NICU clinical surveillance and conducted colonization screening to detect additional cases of CRE E. coli. The Wadsworth Center Antimicrobial Resistance Laboratory Network tested isolates from affected patients for CP genes and performed whole genome sequencing (WGS) to determine the CP gene variant, multilocus sequence type (MLST), and relatedness by mutation event (ME) analysis. NYSDOH epidemiologists assessed Hospital A’s infection control practices in affected areas and provided recommendations. Result: Hospital A identified two CRE E. coli infections in NICU patients with overlapping admissions in June-July 2023. Retrospective surveillance identified a third CRE E. coli case in an adult medical intensive care unit patient on admission to Hospital A in June 2023, with prior hospitalization April-May 2023. WGS analysis identified the blaNDM-5 gene in all three CRE E. coli patient isolates. The two NICU patients’ isolates had the same MLST (361/650) and differed by 9 MEs, indicating relatedness to each other and not the adult patient’s (MLST 167/2). NICU patient colonization screening identified no additional blaNDM-5 E. coli cases. NYSDOH’s NICU infection control assessment found that both cases were in adjacent isolettes within three feet of each other. Clean isolettes, equipment, and supplies for new admissions were stored in the clinical care space, not in a separate clean area. Conclusion: CP-CRE is an urgent threat to US healthcare facilities, including hospital NICUs. Though the incidence and prevalence of CP-CRE blaNDM-5 E. coli are not well-defined in NY, single healthcare-associated cases in NICU populations represent an outbreak. The Wadsworth Center Antimicrobial Resistance Laboratory Network’s contributions complement traditional epidemiologic surveillance and investigation methods to provide more specific, comprehensive infection

Abstract Introduction The frequency of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) in Latin America has decreased considerably. However, new infections continue to be recorded, and the pediatric population remains one of the most vulnerable groups in this region. The main objective of the study was to describe the clinical, epidemiological and psychosocial characteristics of new diagnoses of HIV MTCT in 2018 in the PLANTAIDS network (Paediatric Network for Prevention, Early Detection and Treatment of HIV in Children) during the 3 years following diagnosis. Methodology Retrospective, multicenter, descriptive study based on a 3-year follow-up of patients diagnosed with HIV infection due to MTCT in 2018 in 10 hospitals in 8 Latin American countries (Costa Rica, Ecuador, Mexico, Honduras, El Salvador, Panama, Guatemala and Venezuela). The hospitals belonged to the PLANTAIDS network, which is included in CYTED (Ibero-American Programme of Science and Technology for Development). Results The study population comprised 72 pediatric patients (38.9% male). The median age at diagnosis was 2.4 years (IQR: 0.8–5.4). There were 35 cases of opportunistic infections corresponding to 25 patients (34.7%), with tuberculosis being the most common. Adequate childhood vaccination coverage was achieved in 80.5%. There were 3 cases of acute SARS-CoV-2 infection, and these were asymptomatic or mildly symptomatic. According to the Centers for Disease Control and Prevention (CDC) classification, the most frequent clinical-immunological stage at all check-ups was C1. Three patients died from opportunistic infections and/or advanced HIV infection. Conclusions It is important to diagnose HIV infection early in pediatrics, since early initiation of ART is associated with a decrease in mortality. Despite this, HIV infection has a poor prognosis in children, necessitating adequate follow-up to ensure adherence to health care and ART, although it can sometimes prove difficult in children.

Abstract Background The global nutrition transition is associated with increased consumption of ultra-processed snack foods and sugar-sweetened beverages (UPF/SSB), contributing to the double burden of child obesity and undernutrition. Methods This cross-sectional study describes the prevalence of maternal and child UPF/SSB consumption and the factors associated with frequent consumption in a convenience sample of 749 children ages 6 months through 6 years and their mothers participating in a community-based child oral health program in five informal settlement communities in Mumbai, India. Mothers were interviewed regarding maternal and child oral health and nutrition characteristics, including consumption of beverages and foods associated with tooth decay—milk, soda, tea with sugar, sweets, and chips/biscuits—using standardized questionnaires. Spearman correlations were used to assess for associations between various social factors and the frequency of maternal and child consumption of the five food categories. Chi-square tests were used to assess differences in child consumption patterns by age groups. Results Though reported soda consumption was low among both mothers and children, nearly 60% of children consumed sweets and chips/biscuits daily, four to five times the rate of mothers. Factors associated with children’s frequent consumption of UPF/SSB included lower maternal education level, frequent maternal consumption of UPF/SSB, greater number of household members, greater amount of money given to the child, and closer proximity to a store. Conclusion Our findings demonstrate social factors that may promote UPF/SSB consumption. The nutritional dangers of sugary drinks and non-nutritious snacks for mothers and young children should be addressed across maternal–child health, education, and social service programs. Early childhood nutrition interventions should involve the entire family and community and emphasize the need to limit children’s consumption of unhealthy foods and beverages from an early age.

Exercise-induced muscle damage is associated with symptoms such as inflammation, delayed-onset muscle soreness, and impaired muscle performance. The intake of cocoa polyphenols has been suggested to improve muscle recovery due to their antioxidant and anti-inflammatory capacity. However, their bioavailability presents a challenge. Therefore, food microencapsulation may be an alternative to protect polyphenols, ensuring their biological effects. This study aimed to investigate the effect of a single dose of microencapsulated cocoa on the changes in muscle damage markers after eccentric exercise. In this randomized, double-blind, crossover study, fourteen healthy volunteers with previous resistance training experience performed 6 × 10 maximal isokinetic eccentric contractions of their elbow flexors using an isokinetic dynamometer after ingesting 25 g of microencapsulated cocoa or placebo. Peak isometric torque was measured using maximal voluntary isometric contractions, and pain was measured using a visual analogic scale both before and 24 h, 48 h, and 72 h after the damage protocol. Plasma glutathione and malondialdehyde levels were measured using high-performance liquid chromatography, and concentrations of myoglobin and C-reactive protein were determined using a fluorescence immunoassay analyzer. Significant decreases were seen in the peak isometric torque and pain measures from pre- to 72 h post-eccentric exercise. A significant main effect for time was found only for plasma myoglobin at 2 h, 48 h, and 72 h, and for C-reactive protein at 2 h, compared to the pre-eccentric exercise values. No significant time-treatment effects were observed (all p > 0.05). This study demonstrated that microencapsulated cocoa cannot improve muscle recovery after eccentric exercise, at least when a single dose is consumed.

Water is a resource that influences sustainable development in different ways in social, economic, and environmental aspects, being the Andes the major provider of this resource. However, they have been affected mainly by anthropogenic activities due to the proximity of settlements in the watersheds, so they tend to have more significant contamination, and their evaluation is essential to mitigate problems for those who consume them. However, despite being a fundamental resource and one of the main contributors of water, it is not so studied, so the present study aims to determine the studies based on the water quality of the high mountain rivers of the Andes by using a PRISMA methodology with the scoping review extension, based on search techniques, inclusion and exclusion criteria, and monitoring tables, in order to maintain a line of research attached to the objective of the study. After using the methodology, ten articles were obtained, which were analyzed after a bibliometric analysis to determine features of interest, such as countries in which the studies were carried out, years of publication, methodologies used, and authors' consensus. High Andean rivers' importance, the need for more studies within these areas, and the lack of suitable indexes for these unique ecosystems are highlighted.

Abstract Background Presenting at professional and scientific conferences can be an important part of an individual’s career advancement, especially for researchers communicating scientific findings, and can signal expertise and leadership. Generally, women presenting at conferences are underrepresented in various science disciplines. We aimed to evaluate the gender of presenters at research-oriented chiropractic conferences from 2010 to 2019. Methods We investigated the gender of presenters at conferences hosted by chiropractic organisations from 2010 to 2019 that utilised an abstract submission process. Gender classification was performed by two independent reviewers. The gender distribution of presenters over the ten-year period was analysed with linear regression. The association of conference factors with the gender distribution of presenters was also assessed with linear regression, including the gender of organising committees and abstract peer reviewers, and the geographic region where the conference was hosted. Results From 39 conferences, we identified 4,340 unique presentations. Women gave 1,528 (35%) of the presentations. No presenters were classified as gender diverse. Overall, the proportion of women presenters was 30% in 2010 and 42% in 2019, with linear regression demonstrating a 1% increase in women presenting per year (95% CI = 0.4–1.6%). Invited/keynote speakers had the lowest proportion of women (21%) and the most stagnant trajectory over time. The gender of conference organisers and abstract peer reviewers were not significantly associated with the gender of presenters. Oceanic conferences had a lower proportion of women presenting compared to North America (27% vs. 36%). Conclusions Overall, women gave approximately one-third of presentations at the included conferences, which gradually increased from 2010 to 2019. However, the disparity widens for the most prestigious class of keynote/invited presenters. We make several recommendations to support the goal of gender equity, including monitoring and reporting on gender diversity at future conferences.

Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a monogenic disorder caused by mutations in the FOXP3 gene, required for generation of regulatory T (Treg) cells. Loss of Treg cells leads to immune dysregulation characterized by multi-organ autoimmunity and early mortality. Hematopoietic stem cell (HSC) transplantation can be curative, but success is limited by autoimmune complications, donor availability and/or graft-vs.-host disease. Correction of FOXP3 in autologous HSC utilizing a homology-directed repair (HDR)-based platform may provide a safer alternative therapy. Here, we demonstrate efficient editing of FOXP3 utilizing co-delivery of Cas9 ribonucleoprotein complexes and adeno-associated viral vectors to achieve HDR rates of >40% in vitro using mobilized CD34+ cells from multiple donors. Using this approach to deliver either a GFP or a FOXP3 cDNA donor cassette, we demonstrate sustained bone marrow engraftment of approximately 10% of HDR-edited cells in immune-deficient recipient mice at 16 weeks post-transplant. Further, we show targeted integration of FOXP3 cDNA in CD34+ cells from an IPEX patient and expression of the introduced FOXP3 transcript in gene-edited primary T cells from both healthy individuals and IPEX patients. Our combined findings suggest that refinement of this approach is likely to provide future clinical benefit in IPEX.

Objective Older adults constitute a heterogeneous group, and the focus of the individual physical exercise is often subject to the reasoning and experience of health professionals or exercise physiologists who prescribe them. Thus, this is the first effort to explicitly conceptualise the planning of individualised physical exercise training (IPET) for older adults in an outpatient setting and investigate individual exercise preferences.Design The concept of IPET was developed by researchers, exercise physiologists and health professionals from a real-life outpatient setting using an iterative approach. Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites form the basis of physical exercise recommendations. A cross-sectional study was conducted to assess the basis of implementing IPET.Setting Outpatient setting.Participants We included 115 older adults (70 females) from an outpatient setting with a median age of 74 years.Outcome measures Health indicators assessing aerobic capacity, strength, balance and musculoskeletal pain/discomfort sites were collected and informed the concept of IPET that structures exercise programmes based on the individual citizen’s needs and physical exercise preferences. Exceeding a health indicator cut-point results in exercise content mitigating the risk associated with the health indicator.Results We included 115 older adults (70 females) from an outpatient setting median age of 74 years. Approximately two-thirds of participants exceeded at least one health indicator cut-point for aerobic training. One-third of the participants exceeded the cut-point for upper extremity strength, and almost all participants >99% exceeded the cut-point for lower extremity strength. Approximately two-thirds of the participants exceeded the cut-point for functional/balance training. The most prevalent site of musculoskeletal pain was the lower extremities. Eight of 20 training combinations were used, clustering the 115 participants primarily in three main training combinations.Discussion This study shows that older adults vary in physical functioning, indicating that exercise preferences and rehabilitation needs are individual.Trial registration number NCT04862481.

BackgroundDigitally supported self-management tailored to an individual’s need, in addition to usual care, may reduce pain-related disability compared to usual care alone, and patients with low back pain (LBP) using mobile health (mHealth) solutions express positive experiences. Hence, implementing mHealth solutions designed to support self-management is desirable from a clinical and patient perspective. Easily accessible mHealth solutions that can support the self-management of patients with LBP are available, but interest may be subgroup specific. Understanding the characteristics and preferences of patients with LBP labeled as interested may help to reach relevant LBP patient groups and inform the development and implementation of effective interventions with mHealth for patients with LBP. ObjectiveThis study aims to explore the proportion of patients with LBP labeled as interested in testing an mHealth solution designed to support self-management in addition to usual care and to assess how these patients differ from those who were labeled as not interested. MethodsThis exploratory cross-sectional study analyzed demographic and patient-reported outcomes from the SpineData registry, a Danish registry of patients with LBP in an outpatient setting. Between February and December 2019, the SpineData registry was used to assess the preliminary eligibility of patients for a clinical trial (selfBACK). Patients were labeled as interested or uninterested depending on if they responded to an invitation to be tested for eligibility for the trial Outcomes were selected from the International Classification of Functioning core set of LBP using a clinical approach. Associations were assessed in a backward selection process, and the proportion of variance explained was assessed with pseudo-R2 statistic. ResultsThis study included 843 patients, with 181 (21%) individuals labeled as interested in participating in the selfBACK trial. Notably, the cohort labeled as interested differed from their uninterested counterparts in two key aspects: age (36-65 years: 116/181, 64.1% vs 347/662, 52.4%; P=.003) and smoking status (smokers: 22/181, 12.5% vs 174/662, 26.6%; P

La metacognición es entendida como el conocimiento que tienen las personas sobre sus propios procesos cognitivos, en ella se tiene en cuenta tres dimensiones fundamentales, estas son: el tipo de conocimiento, la conciencia metacognitiva y la regulación. Para este proyecto y artículo, se toma a la regulación como eje central, ya que es el proceso o habilidad que se fortalece desde la perspectiva de las acciones que realiza y las decisiones que toma el estudiante para controlar su aprendizaje. El objetivo de esta investigación fue fortalecer el proceso de regulación metacognitiva, utilizando la guía de interaprendizaje para la enseñanza del cuidado del medio ambiente en los estudiantes de la Institución Educativa La Sultana. Se seleccionó una metodología cualitativa con el fin de reconocer el contexto social y educativo en el que se implementó la investigación; asimismo, se implementó la investigación descriptiva como método. Esta regulación metacognitiva se desarrolló a través de guías de interaprendizaje, relacionado el cuidado del medio ambiente como tema eje, para esto se realizó un pretest y postest en el que se utilizó el instrumento denominado MAI (Metacognitive Awareness Inventory), en su adaptación al español. Los resultados mostraron un reconocimiento y actos de conciencia en los procesos de regulación metacognitiva y un análisis reflexivo frente a la categoría del cuidado del medio ambiente, con respecto a las problemáticas ambientales a nivel país.

Citizen Science is a powerful tool for biodiversity research, as it facilitates data recording at large scales that would otherwise be impossible to cover by standard academic research. Despite its benefits, the accuracy of citizen science data remains a subject of concern among scientists, with varying results reported so far. Neither citizen science data nor academic records are immune to biases, which can significantly impact the quality and reliability of observations. Here, using insects in the Iberian Peninsula as a case study, we compare data collected by participatory platforms to those obtained through academic research projects, and assess their taxonomic, spatial, temporal, and environmental biases. Results show a prominent taxonomic bias in both academic and citizen science data, with certain insect orders receiving more attention than others. These taxonomic biases are conserved between different participatory platforms, as well as between groups of users with different levels of contribution performance. The biases captured by leading contributors in participatory platforms mirrored those of sporadic users and academic data. Citizen science data had higher spatial coverage and less spatial clustering than academic data, showing also clearer trends in temporal seasonality. Environmental coverage over time was more stable in citizen science than in academic records. User behaviour, preference, taxonomical expertise, data collection methodologies and external factors may contribute to these biases. This study shows the multifaceted nature of biases present in academic records and citizen science platforms. The insights gained from this analysis emphasize the need for careful consideration of these biases when making use of biodiversity data from different sources. Combining academic and citizen science data enhances our understanding of biodiversity, as their integration offers a more comprehensive perspective than relying solely on either dataset alone, especially since biases in these two types of data are not always the same.

In Peru, only 1 % of food processing companies located in Metropolitan Lima have obtained a technical validation for their HACCP plan. The low adherence to safety systems raises the goal of identifying the main barriers and difficulties for the implementation of the HACCP system. Data was collected by sending a questionnaire to 32 companies. In order to define the underlying structure of the barriers and difficulties identified we performed an exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) based on a selection of nineteen (19) items, identifying four new factors that account for 66,7 % of the overall variability. After assessing their relevance, it was found that barriers and difficulties at the organizational/managerial level (F1) and in adaptation (F4), such as infrastructure and employee’s perception, were more relevant than attributes involving execution (F2), which comprises singular processes such as time, staff turnover, technology and others.

Course-based undergraduate research experiences (CUREs) have been identified as a promising approach to engage large numbers of students in discovery-based investigations in the biological sciences. As the prevalence of CUREs continues to increase nationwide, the role of graduate teaching assistants (TAs) in facilitating these courses has simultaneously grown. In addition to serving as instructors of CUREs, previous research suggests that educators--including TAs--must also adopt additional roles, including that of a mentor. However, few studies have explicitly examined CURE TAs' beliefs and practices regarding mentorship. To address this need, we conducted an exploratory, concurrent mixed methods study to better understand TAs' self-reported mentoring skills levels and their experiences acting as potential mentors in the context of an online introductory biology SEA-PHAGES CURE. Results indicate that TAs (N = 12) believed themselves most skilled in areas related to listening and communication, building rapport with students, and encouraging independence with respect to student research projects. Analysis of open-ended survey data further demonstrated that the overwhelming majority of TAs (n = 10) considered themselves to be mentors, citing a diversity of rationales reflective of both psychosocial and instrumental forms of mentoring support. Collectively, these outcomes contribute to a growing body of literature on the nature and level of involvement of TAs within CURE learning environments, particularly with respect to their posited role as mentors. N n

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health.

O tromboembolismo aórtico felino (FATE) é uma condição incomum caracterizada pela formação de coágulos na aorta. O diagnóstico é baseado em sinais clínicos, como dor, paralisia, ausência de pulso, cianose e resfriamento dos membros. A etiologia frequentemente está associada à cardiomiopatia hipertrófica. O tratamento é controverso e depende de diversos fatores. A intervenção cirúrgica é uma opção e as diretrizes da AAFP Feline Anesthesia Guidelines são úteis nesse contexto. O prognóstico varia, sendo muitas vezes reservado, com baixas taxas de sobrevivência em casos graves. O estudo descreve um caso clínico de um gato, sem doença cardíaca preexistente, que desenvolveu FATE. Foi submetido à múltiplos procedimentos cirúrgicos (tromboembolectomia, cistectomia parcial e amputação bilateral dos membros posteriores) e teve uma recuperação notável, apesar das baixas expectativas de sobrevivência de acordo com a literatura. O paciente permaneceu em bom estado de saúde e qualidade de vida, mesmo após 55 dias após a última cirurgia. Isso sugere que, em casos selecionados, a intervenção cirúrgica pode ser benéfica para a recuperação de felinos com FATE que desenvolveram isquemia irreversível de membros.

AbstractObjective The primary objectives of this study were to 1) investigate the internal consistency 2) and construct validity of the Short Musculoskeletal Function Assessment Questionnaire (SMFA) in older adults commencing physical rehabilitation in an outpatient setting.Methods This cross-sectional study recruited older adults who had commenced physical rehabilitation in an outpatient setting. The SMFA consists of two indices: 1) dysfunction capturing the impact of musculoskeletal disorders on physical limitations, and 2) bothering capturing how the individual is emotionally affected by their disorder. SMFA holds four categories: ‘mobility’, ‘daily activities’, ‘emotional status’, and ‘function of the arm and hand’. Participants answered the SMFA alongside other patient-reported questionnaires (such as the 36-Item Short Form Survey, SF-36) and similar) and objectively measured muscle strength for the upper and lower body and functional capacity.Results We included 115 older adults with a median age of 74 years (IQR 9). Adequate internal consistency was seen with Cronbach’s alpha values of 0.90–0.94 for the SMFA indices and 0.77–0.91 for the SMFA categories. The strongest correlations between the SMFA indices were observed with the SF-36 physical component summary (SMFA-Dysfunction r = 0.74, p

Pursuing new packaging that contributes to the safety of meat products, that can also be from renewable sources and that has adequate mechanical properties is a challenge. Therefore, this study attempted to incorporate a layer of polylactic acid (PLA) containing nisin and oregano oil extract (OEO) into biocomposites of cassava bran (CB) and coffee husk (CH) to improve their mechanical properties and enhance their antimicrobial properties. A compression molding process is carried out, the operating conditions for the preparation of the biocomposite were pressure: 40 bar, temperature: 170°C, and time: 2.5 min. The composition of the biocomposite was 80, 18, and 2% of CB, CH, and glycerol respectively, with 30% moisture. The polylactic acid (PLA) layer was added by immersion and contained nisaplin and OEO. PLA layer was evaporated in forced convection oven. Once the active packaging was obtained, inhibition in vitro against Listeria monocytogenes was performed. The packing containing OEO and nisin that showed the highest inhibition on the pathogen was used for stability analysis in pork. In order to measure changes in pork meat quality, the biocomposite with and without coating and with commercial polystyrene packaging were compared. Raw meat muscle was kept at 4° C and was tested for color, pH, moisture, and texture profile analysis (TPA) for 0, 7, 14, and 21 days. The values of the flexural test of the biocomposite were: 11.08 MPa of maximum flexural strength (σF), 1.81% of maximum deformation (εF), and 842.22 MPa of elastic modulus (EM). According to the results of in vitro inhibition, the packaging can contribute to reduce the proliferation of gram-positive microorganisms, such as L. monocytogenes. During storage, the hardness and gumminess of the meat showed significant changes, mainly in the PLA-free biocomposite. Results on pork meat showed that packaging with antimicrobials and PLA can maintain color, texture, moisture, and pH similar to commercial packaging.

This thematic issue traverses refugee research that recognises the importance of networks in determining the paths that refugees undertake in their journeys to seek safety and protection. In recent years, scholars have increasingly pointed to the multifaceted nature of networks in the refugee journey. These articles demonstrate the importance of elucidating the distinct influences and factors that shape refugee networks, including the unequal power relations between refugees and refugee aid workers in transit countries, transnational family and community connections, the proliferation of technologies in strengthening refugees’ networks, the role of the state in privileging certain refugee groups over others, and the role of refugees themselves in mobilising both past and existing networks to activate supports.

Resumen El amaranto y la quinoa, al igual que otros cereales, pueden emplearse para la obtención de productos con gran valor nutricional. Actualmente, son considerados alimentos básicos en la canasta familiar de los habitantes de las zonas andinas, esto ha conllevado a la necesidad de promover el desarrollo sostenible de sus cultivos. Por ello, el objetivo principal de este estudio se basó en evaluar las características fisicoquímicas de los cereales y las características funcionales de las harinas de amaranto y quinoa. Para el cual, se aplicó un modelo estadístico unifactorial completamente aleatorizado que constó de tres repeticiones. Donde se determinó que el amaranto presentó mayor contenido de proteína (12,41 %), grasa (6,74 %), carbohidratos totales (67,09 %) e índice de semilla (5,37 mg), en comparación a la quinoa que sitúo una mayor capacidad de hidratación (0,55 g/semillas) e hinchamiento (0,56 ml/semilla) de las semillas. En lo que comprende a las propiedades funcionales, el tipo de cereal no influye en las características de las harinas, debido a que no existió diferencia significativa (p < 0,05), sin embargo, se demostró que la harina de amaranto, tuvo una mejor capacidad de absorción (137,60 ml/100g) y retención (83,60 ml/100g) en agua, mientras que la harina de quinoa mayor capacidad de absorción (96,03 ml/100g) y retención (90,50 ml/100g) en aceite, por otro lado, harina de amaranto obtuvo una mayor actividad (3,00 %) y estabilidad (5,67 %) emulsionante, capacidad (2,52 %) y estabilidad (2,62 %) espumante. Por lo cual, se concluye que, los cereales estudiados, pueden ser utilizados para la obtención de harina y productos derivados de ellos.

selfBACK is an artificial intelligence based self-management app for low back pain (LBP) recently reported to reduce LBP-related disability. The aim of this study was to examine if age, gender, or education modify the effectiveness of the selfBACK intervention using secondary analysis of the selfBACK randomized controlled trial. Persons seeking care for LBP were recruited from primary care in Denmark and Norway and an outpatient clinic (Denmark). The intervention group (n = 232) received the selfBACK app adjunct to usual care. The control group (n = 229) received usual care only. Analyses were stratified by age (18-34, 35-64, ≥65 years), gender (male, female), and education (≤12, >12 years) to investigate differences in effect at three and nine months follow-up on LBP-related disability (Roland-Morris Disability Questionnaire [RMDQ]), LBP intensity and pain self-efficacy. Overall, there was no effect modification for any of the sociodemographic factors. However, data on LBP-related disability suggest that the effect of the intervention was somewhat more beneficial in older than in younger participants. The difference between the intervention and control group due to interaction was 2.6 (95% CI: 0.4 to 4.9) RMDQ points for those aged ≥65 years as compared to those aged 35-64 years. In conclusion, age, gender, or education did not influence the effect of the selfBACK intervention on LBP-related disability. However, older participants may have an additional long-term positive effect compared to younger participants. Trial registration: ClinicalTrials.gov Identifier: NCT03798288.

This paper summarises the achievements of the Dalarinji (in Dharug, ‘Your Story’) research project. The aim of the project was to understand the social and emotional wellbeing of Indigenous LGBTIQSB+ peoples (lesbian, gay, bisexual, trans, intersex, queer, sistagirl, brothaboy) living in the place now known as New South Wales (NSW), Australia. The project was codesigned and co-led by our project partners, BlaQ Aboriginal Corporation and the Aboriginal Project at ACON. Over the course of the project, we conducted interviews, workshops, and an online survey to collect Indigenous LGBTIQSB+ peoples’ needs, experiences and aspirations from across NSW. This article synthesises the available literature on Indigenous LGBTIQSB+ people at the start of the project in 2019 and tracks the progress of the field and the project outputs since then. Using information from each of the project’s publications, this article summarises the project’s findings in relationship to debates about human rights; identity, belonging and connectedness; viable alternative futures and service provision. The article concludes with a commentary on work in the field and some suggestions regarding the way forward.

La metacognición se aborda desde la perspectiva de Schraw & Moshman (1995), quienes la definen como la capacidad de un individuo para comprender, reflexionar y controlar su propio aprendizaje. Esto implica tener conocimiento sobre cómo funciona la cognición y cómo regularla. Esta investigación se realizó en un contexto de aula de filosofía, en el que es importante tener en cuenta que en esta área se ha investigado poco desde la perspectiva metacognitiva. Sin embargo, los estudios realizados hasta el momento, han demostrado un buen desempeño entre la filosofía y la metacognición, tal como lo mencionan Worley & Worley (2019), quienes sugieren que la filosofía puede mejorar la metacognición y la existencia de una conexión útil entre ambas áreas. El objetivo de este estudio fue determinar el efecto de un programa de estrategias de aprendizaje en el desempeño metacognitivo y la metacomprensión en una muestra de estudiantes de educación media en clase de filosofía de una institución privada en la ciudad de Manizales. Estas estrategias de aprendizaje se basan en el trabajo de Hattie (2009) y se adaptaron para ser utilizadas en esta intervención. Para evaluar los resultados, se aplicó el inventario de habilidades metacognitivas MAI estandarizado para Colombia por Huertas Bustos et al. (2014) y el inventario de habilidades metacognitivas en estrategias de lectura MARSI de Mokhtari & Reichard (2002), antes y después de realizar la intervención. Los resultados de esta investigación indicaron de forma mutua que el MAI y el MARSI, mostraron mejoras significativas en el postest, lo que sugiere un efecto positivo del programa de estrategias de aprendizaje utilizadas. Además, se observó un mayor impacto y potencia en cuatro de los componentes evaluados. Esto demuestra la importancia de implementar estrategias de aprendizaje metacognitivas en el aula de filosofía para mejorar la comprensión y el desempeño académico de los estudiantes.

Abstract Immunity with SARS-CoV-2 infection during the acute phase is not sufficiently well understood to differentiate mild from severe cases and identify prognostic markers. We evaluated the immune response profile using a total of 71 biomarkers in sera from patients with SARS-CoV-2 infection, confirmed by RT-PCR and controls. We correlated biological marker levels with negative control (C) asymptomatic (A), nonhospitalized (mild cases-M), and hospitalized (severe cases-S) groups. Among angiogenesis markers, we identified biomarkers that were more frequently elevated in severe cases when compared to the other groups (C, A, and M). Among cardiovascular diseases, there were biomarkers with differences between the groups, with D-dimer, GDF-15, and sICAM-1 higher in the S group. The levels of the biomarkers Myoglobin and P-Selectin were lower among patients in group M compared to those in groups S and A. Important differences in cytokines and chemokines according to the clinical course were identified. Severe cases presented altered levels when compared to group C. This study helps to characterize biological markers related to angiogenesis, growth factors, heart disease, and cytokine/chemokine production in individuals infected with SARS-CoV-2, offering prognostic signatures and a basis for understanding the biological factors in disease severity.

Abstract Background Good physical health and capacity is a requirement for offshore wind service technicians (WTs) who have substantial physical work demands and are exposed to numerous health hazards. Workplace physical exercise has shown promise for improving physical health and work ability among various occupational groups. Therefore, we aimed to assess the feasibility and preliminary efficacy of Intelligent Physical Exercise Training (IPET) among WTs in the offshore wind industry. Methods A within-subject design was used to assess the feasibility and preliminary efficacy of IPET (one hour/week individualized exercise during working hours). The intervention period was 12 weeks, with the first eight weeks performed on site as supervised or partly supervised exercise during work hours and the last four weeks planned as home-administered exercise after the seasonal offshore service period. Three assessments, T1 (six months prior to intervention start), T2 (start of intervention) and T3 (end of intervention), of physical health and capacity (self-reported and objective measurements) were conducted and the period between T1 and T2 served as a within-subject control period. Primary outcome was feasibility measured as compliance, adherence, adverse events, and participant acceptability. Descriptive statistics were used to present feasibility outcomes. Preliminary efficacy was reported as mean differences with 95% confidence intervals for health and physical capacity outcomes between T1 and T2, between T2 and T3 and between T1 and T3. Results All WTs at the included wind farm (n=24, age: 40 years (SD±8)) participated in the study. No serious adverse events were reported. Compliance and adherence of 95 and 80% respectively, were reached in the eight-week supervised part, but were lower when exercise was home-administered (

Articulating clear and achievable expectations is fundamental to both education and organizational management. In this article, we provide a simple intervention for clarifying expectations--and establishing that these expectations have been understood--which proved beneficial both to community college interns and to their internship mentors in biotech-related undergraduate research experiences. Internship mentors were asked to utilize a simple Expectation Clarity Tool to outline the expectations, success metrics, baseline assessments, and training strategy and support that would be foundational to their intern's project. These included expectations around conceptual, technical, performance, and professional skills and behaviors. Concurrently, but independently, community college interns were asked to complete the same type of exercise as a way of identifying gaps in their knowledge and understanding of their mentor's expectations and their internship project. The mentor's completed Expectation Clarity Tool was then shared with their intern. As a result of completing this relatively simple intervention, the majority of mentors reported that it increased their confidence as a mentor, taught them a new mentoring skill, changed how they will mentor trainees moving forward, and positively impacted their relationship with their trainee. On the intern side, the majority of interns reported that engaging in this intervention, both as an independent exercise and in obtaining their mentor's completed Expectation Clarity Tool, increased their confidence as an intern and positively impacted the success of their internship.

The challenge of creating reliable technology-based resources for science learning is a perennial challenge in Philippine education, with limited learning materials accessible to all learners. This study is about the development of a videocast embedded with physics education technology (PhET) simulation that served as supplementary learning material for grade 9 science in response to the scarcity of dependable visualization materials. The study employed the developmental research design with analysisdesign-development-implementation-evaluation (ADDIE) model as the developmental framework. The vodcast evaluation tool, achievement test questionnaire, and vodcast perception survey questionnaire for students and teachers were used in the data collection, while the Kendall's W statistic, mean, percentage, and gain score were used in the data interpretation. The teacher respondents (N=64) have moderate agreement on the ranking of topic difficulty, with Kendall's W of 0.45. The researcher-made vodcast attained an overall rating of 4.78 from experts, which implies that the vodcast can be very good material for classroom implementation. The developed achievement test has acceptable difficulty and discrimination indices. The implementation stage yielded a low normalized gain, which can be accounted for by unfocused attention during the pandemic. Nevertheless, the voicecasts were found very useful in learning projectile motion, as perceived by both students and teacher-observers.

Abstract Background selfBACK, an artificial intelligence (AI)-based app delivering evidence-based tailored self-management support to people with low back pain (LBP), has been shown to reduce LBP-related disability when added to usual care. LBP commonly co-occurs with multimorbidity (≥ 2 long-term conditions) or pain at other musculoskeletal sites, so this study explores if these factors modify the effect of the selfBACK app or influence outcome trajectories over time. Methods Secondary analysis of a randomized controlled trial with 9-month follow-up. Primary outcome is as follows: LBP-related disability (Roland Morris Disability Questionnaire, RMDQ). Secondary outcomes are as follows: stress/depression/illness perception/self-efficacy/general health/quality of life/physical activity/global perceived effect. We used linear mixed models for continuous outcomes and logistic generalized estimating equation for binary outcomes. Analyses were stratified to assess effect modification, whereas control (n = 229) and intervention (n = 232) groups were pooled in analyses of outcome trajectories. Results Baseline multimorbidity and co-occurring musculoskeletal pain sites did not modify the effect of the selfBACK app. The effect was somewhat stronger in people with multimorbidity than among those with LBP only (difference in RMDQ due to interaction, − 0.9[95 % CI − 2.5 to 0.6]). Participants with a greater number of long-term conditions and more co-occurring musculoskeletal pain had higher levels of baseline disability (RMDQ 11.3 for ≥ 2 long-term conditions vs 9.5 for LBP only; 11.3 for ≥ 4 musculoskeletal pain sites vs 10.2 for ≤ 1 additional musculoskeletal pain site); along with higher baseline scores for stress/depression/illness perception and poorer pain self-efficacy/general health ratings. In the pooled sample, LBP-related disability improved slightly less over time for people with ≥ 2 long-term conditions additional to LBP compared to no multimorbidity and for those with ≥4 co-occurring musculoskeletal pain sites compared to ≤ 1 additional musculoskeletal pain site (difference in mean change at 9 months = 1.5 and 2.2, respectively). All groups reported little improvement in secondary outcomes over time. Conclusions Multimorbidity or co-occurring musculoskeletal pain does not modify the effect of the selfBACK app on LBP-related disability or other secondary outcomes. Although people with these health problems have worse scores both at baseline and 9 months, the AI-based selfBACK app appears to be helpful for those with multimorbidity or co-occurring musculoskeletal pain. Trial registration NCT03798288 . Date of registration: 9 January 2019

The human rights of both LGBTIQ+ and Indigenous peoples are far from realized. When conjoined, intersecting identities reveal how racism and queer phobia affect well-being, negating the right to health and resulting in devastating impacts on people’s social, cultural, and emotional well-being. This paper documents the lived experiences of a sample of young gender- and sexuality-diverse Aboriginal and Torres Strait Islander peoples from a research project conducted in New South Wales, Australia. Their perspectives reveal how, for this cohort, discrimination and privation is manifest at the family, community, and institutional levels. This paper informs an understanding of human rights as experienced by Aboriginal and Torres Strait Islander LGBTIQ+-identified peoples, where racism and queer phobia are evident in the spheres of education, employment, and service provision. Adopting a critical human rights stance, our analysis illustrates how settler colonialism manifests through the processes and outcomes of settler colonial institutions and structures.

Access to adequate and appropriate service provision has a direct positive impact on health and wellbeing. Experiences of inaccessible, discriminatory, and culturally unsafe services and/or service providers are considered a root cause for the health inequalities that exist among Indigenous queer youth. Experiences of discrimination and cultural inappropriateness are commonplace, with Indigenous queer youth noting issues related to access to services and treatment, stereotyping, and a lack of quality in the care provided, which discourage Indigenous people from accessing care. This paper examines the perspectives of Indigenous LGBTIQ+ youth and health service providers to identify what challenges, obstacles and opportunities are currently being faced and what could be implemented to improve the health and wellbeing outcomes for Indigenous LGBTIQ+ youth in the future.

Abstract Selumetinib is an oral, potent, and highly selective allosteric MEK1/2 inhibitor approved for the treatment of pediatric patients (aged ≥2 years) with neurofibromatosis type 1 who have symptomatic, inoperable plexiform neurofibromas. A granule formulation of selumetinib is under development to improve dosing precision for younger pediatric patients who may be unable to swallow capsules. This phase I crossover study investigated the effect of food on the pharmacokinetic (PK) properties of selumetinib capsule and granule formulations. Healthy male volunteers were randomized to receive selumetinib granules (25 mg) or capsules (50 mg [2 × 25 mg]) under fasted or fed conditions (a low‐fat meal). Plasma concentrations and PK parameters were determined less than or equal to 48 h postdose. Safety and tolerability were assessed. Across 24 volunteers, selumetinib was absorbed quickly, with a time to maximum concentration (Tmax) ranging from ~1–3 h. Geometric mean ratios (90% confidence interval [CI]) for maximum plasma concentration (Cmax) in the fed versus fasted state were 0.61 (90% CI 0.51–0.72) and 0.40 (90% CI 0.33–0.48) for the granule and capsule formulations, respectively, whereas geometric mean ratios (90% CI) for area under the plasma drug concentration‐time curve in the fed versus fasted state were 0.97 (90% CI 0.91–1.02) and 0.62 (90% CI 0.55–0.70), respectively. Levels of less than 10% conversion to the N‐desmethyl selumetinib metabolite were observed. Selumetinib was well‐tolerated, with only a few adverse events of mild intensity reported. Selumetinib administration with a low‐fat meal resulted in lower Cmax and longer Tmax for both formulations versus fasted conditions. However, area under the curve for selumetinib granules was similar under fasted and fed conditions. Overall, these findings support further development of this formulation for pediatric patients.