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Background: Documented inequalities in access to eye care for people with learning disabilities and/or autism are caused by poor uptake of primary eye care services, poor identification of eye problems, lack of signposting and reasonable adjustments of existing services, concerns about costs of care and the low priority historically given to these issues in eye care policy at a regional and national level. In 2019, the charity SeeAbility employed four eye care champions (ECCs) with lived experience of learning disability and/or autism to work in local communities in London and the Northwest of England. They provided peer-to-peer support on understanding the need for good eye health and engaged with policy makers, and learning disability, autism and eye care professionals at the local, regional and national levels to influence both the clinical practice of individual practitioners (within existing service/pathway models) and more widely to influence the commissioning of the Easy Eye Care pathway. This study explores the experiences of these ECCs. Methods: The study was conducted in April and May 2023. A case study approach was used to describe the experiences of the ECCs from March 2019 to March 2023. Data from structured interviews with the four ECCs and workload analysis were triangulated to provide a multifaceted understanding of this novel health promotion project. Findings: The ECCs found the role useful and reported that confidence in their practice and impact grew with time but they required ongoing support in the role. A good understanding of the promotional messages was reported. Developing a good network of contacts at an early stage, both people with learning disabilities and healthcare professionals, was key. Relationships with professionals were supportive and positive and a positive emotive response to their lived experience was reported in these interactions. Conclusions: From the perspective of the ECCs, the role is useful and beneficial. The work suggests some key recommendations for future development which include planning to build networks, support in presentation and communications skills and defining key messages and knowledge. Confidence of the ECCs builds with time in the role but also needs support the emotive impact of their lived experiences on audiences is highlighted. There is a need to evaluate how the programme is perceived by those who interact with it and how it changes behaviours which leads to better health outcomes.

Acute respiratory infections are a significant challenge in primary care and hospital settings. Viruses are the most common etiology and the overlapping symptomatology among major respiratory viruses, such as influenza, severe acute respiratory syndrome coronavirus 2, and respiratory syncytial virus, requires the use of diagnostic tests that deliver early and accurate results. With the increasing availability of rapid antigen tests (RATS), it is tempting to prefer them over polymerase chain reaction (PCR) tests. However, compelling arguments support the existing recommendations in some European countries to maintain PCR testing for patient management throughout the year. RATs show sensitivities below 30% with lower viral loads, which are common and can have significant clinical implications. RATs perform well at lower cycle threshold (Ct) values, with sensitivity reaching 97.9% for Ct values below 20, which drops significantly for values above 25. Factors affecting viral load include disease stage, vaccination status, and viral variants, all of which can compromise the accuracy of antigen tests. Multi-target PCR tests effectively overcome these issues, ensuring reliable diagnosis. Additionally, the early detection of paucisymptomatic cases is essential in primary care and hospital settings to facilitate isolation and prevent secondary infections. Economic analyses support the use of comprehensive PCR tests, such as triplex-type tests, detecting SARS-CoV-2, influenza viruses, and RSV, as a first-line approach, as they can reduce case numbers and healthcare resource utilization. Maintaining PCR testing year-round is therefore crucial for the effective management of respiratory infections.

Objectives We evaluated the ability of the assessment of regional wall motion abnormalities (RWMA) detected via transthoracic echocardiography to predict the presence of obstructive coronary artery disease (CAD) in patients presenting with acute chest pain to the emergency department.Design Prospective single-centre observational study.Setting Tertiary care university hospital emergency unit.Participants Patients presenting to the emergency department with acute chest pain suggestive of obstructive CAD.Primary outcome measure The primary endpoint was defined as the presence of obstructive CAD, requiring revascularisation therapy.Results Overall, 657 patients (age 58.1±18.0 years, 53% men) were included in our study. RWMA were detected in 76 patients (11.6%). RWMA were significantly more frequent in patients reaching the primary endpoint (26.2% vs 7.6%, p

Adolescents who become pregnant during their secondary education experience a range of challenges that intersect and limit their opportunities to complete schooling and take up university places. One approach to addressing this issue at an Australian regional university is through the Tertiary Preparation Pathway (TPP) which has been delivered within the Supporting Teenagers with Education, Mothering, and Mentoring (STEMM) program, since 2008. The STEMM program offers teen mothers an opportunity to continue or re-engage with education during and beyond pregnancy. Adopting an intersectionality lens, interviews with adolescent mothers identified three key elements underpinning the success of the TPP/STEMM program: recognising the educational aspirations of teen mothers, developing agency and independence and promoting a strong sense of self. This article aims to provide practical implications for educators wishing to establish or develop programs based on this transformative teaching.

A alimentação artificial tem por objetivo suprir a falta de alimentos (néctar e pólen), o xarope de açúcar é uma alternativa pra substituir a falta de néctar, sendo um alimento importante como fonte de energia para abelhas. Com isso teve por objetivo desse estudo analisar qual alimento mais adequado pra se fornecer as abelhas o xarope de açúcar ou xarope de açúcar invertido. Onde mostra, para obter o xarope de açúcar invertido a mistura deve se levar ao fogo e posteriormente é adicionado um ácido com função de se inverter a sacarose que é a constituição em básica de do açúcar em glicose e frutose, facilitando a metabolização pelas abelhas. Já o xarope de açúcar é um processo mais rápido onde a água com açúcar são agitados até total diluição do açúcar. O que preocupa com xarope de açúcar invertido é quando adicionado ácido na solução e deixando por mais tempo em fervura pode vir a forma o hidroximetilfurfural (HMF), um produto toxico para as abelhas, mas seguindo a recomendação da receita o alimento tem durabilidade por mais tempo. Em relação ao xarope de açúcar, após sua confecção o alimento deve ser fornecido no mesmo dia e dever ser consumida em um período máximo de 24 horas. Mas em comparação com os dois alimentos, ambos teve resultado satisfatório. Onde deixa em aberto um estudo mais detalhado comparando os dois tipos de alimentos.

The concentration of nitrous oxide (N2O), an ozone-depleting greenhouse gas, is rapidly increasing in the atmosphere. Most atmospheric N2O originates in terrestrial ecosystems, of which the majority can be attributed to microbial cycling of nitrogen in agricultural soils. Here, we demonstrate how the abundance of nitrogen cycling genes vary across intensively managed agricultural fields and adjacent restored wetlands in the Sacramento-San Joaquin Delta in California, USA. We found that the abundances of nirS and nirK genes were highest at the intensively managed organic-rich cornfield and significantly outnumber any other gene abundances, suggesting very high N2O production potential. The quantity of nitrogen transforming genes, particularly those responsible for denitrification, nitrification and DNRA, were highest in the agricultural sites, whereas nitrogen fixation and ANAMMOX was strongly associated with the wetland sites. Although the abundance of nosZ genes was also high at the agricultural sites, the ratio of nosZ genes to nir genes was significantly higher in wetland sites indicating that these sites could act as a sink of N2O. These findings suggest that wetland restoration could be a promising natural climate solution not only for carbon sequestration but also for reduced N2O emissions.

In medieval Alsace, three main types of roofing materials were used in various forms and at the same time: thatch, wood and terracotta. The present contribution aims to provide an overview of the use of each of these materials. The period under consideration, from the 12th to the 16th century, is marked by several major developments, which are by no means linear in chronological and geographical terms: 1o the reappearance in the 12th-13th centuries of terracotta roofing in a landscape that had until then been largely dominated, as far as can be perceived, by thatch and wood roofing; 2o the development of the production of hollow hooked tiles, which became a permanent fixture in towns from the 14th-15th centuries onwards, to the detriment of other roofing materials; 3o a contrario, the continuation in thatched and wooden roofs in rural contexts, village and castles, far beyond the Middle Ages; 4o the appearance and unprecedented development, in the first half of the 16th century, of flat roofing tiles (to the detriment of the old hollow tiles whose production became marginal). The demonstration, based in particular on data from excavations and archaeological studies of the building, but also on the use of written and iconographic sources, will seek to specify the chronological stages of these developments and to determine the reasons for these changes.

Objetivo. Identificar a percepção dos gestores de saúde sobre as ações adotadas e os desafios encontrados no enfrentamento de HIV e sífilis em mulheres venezuelanas migrantes no Brasil. Métodos. Este estudo descritivo-exploratório, de abordagem qualitativa, foi realizado de janeiro a março de 2021 nos municípios de Boa Vista (estado de Roraima) e Manaus (estado do Amazonas). As entrevistas em áudio realizadas com os participantes foram transcritas na íntegra. A análise foi pautada na técnica de avaliação de conteúdo temática. Resultados. Foram entrevistados 10 gestores (cinco em Boa Vista e cinco em Manaus). A análise de conteúdo identificou os seguintes eixos e temas: estrutura disponível para diagnóstico e tratamento de aids e sífilis — acesso, vagas para atendimento/fila de espera, formação das equipes de saúde e suporte psicossocial; desafios enfrentados pelas mulheres venezuelanas — idioma, questões de documentação e frequência de alteração de endereço; e estratégias e ações adotadas e expectativas para o enfrentamento de HIV/aids e sífilis no contexto de migração. Conclusões. Apesar das ações de acolhimento das mulheres venezuelanas migrantes — garantido pela universalidade do sistema de saúde brasileiro — aspectos como o idioma e a falta de documentação permanecem como barreiras. Diante da inexistência de planos de ação e planejamento futuro da atenção a mulheres migrantes portadoras de HIV ou sífilis nos municípios, é importante desenvolver políticas públicas com o objetivo de minimizar as dificuldades enfrentadas por essa população.

Purpose: In this paper, the author reflects on her researcher experiences of attempting to construct co-productive epistemic relations in her ethnographic doctoral research about a gallery youth collective. The paper engages with debates about the nature of co-productive relations, advocating for a more affective approach which attends to multiple, temporary moments within the research, rather than seeking a grand or unified process of collaboration. Design/methodology/approach: This methodological paper draws on the records and reflections the author generated in the process of undertaking collaborative ethnographic research, considered with a specific theoretical resource (Lauren Berlant's Cruel Optimism (2011)) to construct a reflexive narrative from her doctoral research experiences. Findings: The paper discusses the multiple, shifting ways in which research relationships unfolded in the author's doctoral research and the impasse this generated in the author's understanding of desirable co-productive relations. Reflecting with Berlant's Cruel Optimism (2011) allowed the author to understand the COVID-19 crisis as the rupture of the author's attachment to this relational fantasy. Beyond this rupture, the author was able to more fully attend to fleeting, affective moments as a form of co-production within the research. Originality/value: The paper contributes to the growing anthology of critical and reflexive narratives about co-production; these collectively provide a resource for researcher reflection and for teaching about collaborative practices.