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In the following paper I propose an argument against internalism about thought content. After a brief preview of the recent debate between Sarah Sawyer and Åsa Wikforss, the paper outlines the central issue in their discussion. I show that, even if Wikforss’ objections against Sawyer are granted, externalism about thought content can still prevail. For my argument, I use Wikforss` own objection against externalism and show how, if accepted, it binds one to the mythical figure of the perfect speaker – an infallible creature that possesses complete understanding of all of her concepts.

Introducción: La aparición abrupta de la pandemia ocasionada por el coronavirus SARS-COV-2 ha generado profundos cambios sociales en el orden económico, político, ambiental, cultural, sanitario y educacional a escala global. En Cuba la Educación Médica Superior, al igual que la mayoría de los países, estimula las experiencias de la educación a distancia simultaneadas con el Trabajo Comunitario Integrado (la pesquisa activa) como parte de las soluciones de emergencia a dicha crisis. Objetivo: Socializar las experiencias de la educación a distancia como alternativa de la enseñanza aprendizaje en tiempos de pandemia del departamento de Marxismo Leninismo e Historia de la Universidad de Ciencias Médicas de Holguín. Métodos: La aplicación del análisis y crítica de fuentes consultadas, el empleo de la observación científica, la entrevista a informantes clave favoreció la triangulación de la información obtenida. Resultados: Las propuestas desarrolladas por el colectivo contribuyeron a materializar la concepción del Plan Estudios (E) de Medicina al favorecer la comprensión de los contenidos impartidos, el desarrollo de competencias para la resolución de problemas docentes, la promoción del aprendizaje autónomo que generó cambios significativos de las percepciones, actitudes y valores manifiestos en el comportamiento de los educandos. Conclusiones: Potenciar nuevas formas de experiencias de educación profesional a distancia en pregrado y sistematizar las de postgrados. La actual situación sanitaria es una oportunidad para apoyar el desarrollo de la identidad profesional de los estudiantes y contribuir afianzar la responsabilidad que se deriva de ella. Palabras clave: Educación Médica Superior, educación profesional, aprendizaje a distancia, enseñanza semipresencial, covid-19

Background: Both child temperament (specifically high shyness and fear) and environmental stressors like the COVID-19 pandemic are known to confer risk for elevated anxiety symptoms in children. However, few studies have examined the long-term impact of the pandemic on young children's anxiety. Objective: We examined the moderating effects of disruptions experienced during the early months of the pandemic on the longitudinal association between shy and fearful temperament at age 2 pre-pandemic and anxiety symptoms in the year following the start of the pandemic. Methods: Participants were 125 parents of toddlers (M[subscript age] = 26 months, 54% girls, 80% White) who were participating in an ongoing anxiety screening study when the pandemic started in 2020. Shy and fearful temperament were assessed pre-pandemic at age 2 years using the Early Childhood Behavior Questionnaire and anxiety symptoms were assessed within the first post-pandemic year (at ages 3 or 4) using the Spence Preschool Anxiety Scale. Parents completed the Epidemic-Pandemic Impacts Inventory at the start of the pandemic to assess types of disruptions experienced. Results: Shyness predicted higher anxiety symptoms among children whose parents experienced more work-related disruptions. Fear was associated with higher anxiety symptoms at lower levels of social activities disruption but was unrelated to anxiety symptoms at high levels of these disruptions. Conclusions: Results suggest that anxious temperament may serve as a meaningful screening target for identifying the children most in need of support during times of major stress.

Disease management programmes in Chilean table grape vineyards use the hydroxyanilide fenhexamid as a pivotal fungicide for Botrytis cinerea control. However, fenhexamid-resistant populations of this pathogen have progressively increased in vineyards under fungicide use. Botrytis cinerea isolates were collected in ‘Thompson Seedless’ vineyards under fenhexamid control programmes (>two sprays per season) from three regions of Central Chile, during the 2013-2014, 2014-2015 and 2015-2016 growing seasons. Focusing on the 2015-2016 growing season when the greatest level of resistance was measured, only 8% of recovered isolates were sensitive to fenhexamid with 92% of isolates exceeding the sensitivity threshold for mycelium growth. All fenhexamid resistant isolates analyzed carried a mutation in the Erg27 gene, which encodes for 3-keto reductase (3-KR) enzyme. The largest proportion of isolates presented a single-point mutation, leading to a substitution of phenylalanine by serine or isoleucine in the 412 residue of 3-KR (erg27F412S, 27%; erg27F412I, 48%). Substitution by valine in this position was observed in a lower proportion of isolates (erg27F412V, 2%). In contrast to a previous report indicating high fitness cost in isolates carrying erg27F412S or erg27F412I, mycelium growth and sclerotia development under different restrictive temperatures were not affected compared to wildtype Erg27 F412 in Chilean mutant isolates. At 0°C, erg27F412S and erg27F412I generated larger lesions than erg27F412V and Erg27F412 isolates in wounded and unwounded berry assays. Another five mutations were detected in low-resistance Erg27 F412 isolates; one was a previously unreported mutation: erg27R330P. This study has demonstrated a significant loss of sensitivity to fenhexamid, limited fitness cost and high aggressiveness levels (erg27F412S and erg27 F412I) in field isolates carrying Erg27 mutations, giving dirctions for the design of Botrytis control programmes based on fenhexamid.

On May 9, 2024, the Pan American Health Organization reported 5,193 cases of Oropouche fever (also called Oropouche virus disease) in Bolivia, Brazil, Colombia, and Peru and sent an alert [...]

Abstract The conservation profession is increasingly seeking effective ways to reduce societal impact on biodiversity, including through targeted behavior change interventions. Multiple conservation behavior change programs exist, but there is also great uncertainty regarding which behaviors are most strategic to target. Behavioral prioritization is a tool that has been used effectively to support behavior change decision‐making in other environmental disciplines and more recently for a small sub‐set of biodiversity behavior change challenges. Here, we use behavioral prioritization to identify individual behaviors that could be modified to achieve biodiversity benefits in the state of Victoria, Australia. We use an adapted nominal group technique method to identify potential biodiversity behaviors and, for each behavior, estimate the corresponding plasticity (or capacity for change) and positive impact on biodiversity outcomes. We elicited 27 behaviors that individuals could undertake to benefit or reduce their negative impact on biodiversity. This list was then used to prioritize 10 behaviors as determined by their likely effect(s) on biodiversity, plasticity, and current prevalence in Victoria. We take a first step in outlining a list of behaviors that can direct Victorian decision‐makers toward increasing positive and reducing negative impacts of society on biodiversity, guide motivated individuals to reduce their own biodiversity footprint, and more broadly, develop a behavior change research agenda for behaviors most likely to benefit biodiversity.

People may be more likely to exercise if they have self-efficacy for exercise (SEE). We conducted an exploratory analysis of SEE using data from a clinical trial designed to increase physical activity (N = 340). We evaluated correlates of baseline SEE and the relationship between baseline SEE and physical activity. Low SEE at baseline was correlated with lower well-being, physical activity, and higher depression at baseline. Participants with high (vs. low) baseline SEE had higher physical activity (but no differential change in activity) over time. These data highlight the potential role of SEE in psychological health and physical activity.

This study examines undergraduates' research practices, as described in reflective essays submitted in applications to a library research award. Thematic analysis of 24 student award essays identified three strong themes in student reflections about their research experiences. Students experienced research as a social process, made meaning closely tied to disciplinary ways of knowing and practicing, and underwent a transformative process from beginner to apprentice researchers. Through a discussion of these themes, the authors highlight implications for information literacy instruction and suggest this instruction be closely connected to disciplinary practices.

Objective: We examined the relative contribution of parental bipolar disorder (BPD) and psychiatric comorbidities (disruptive behavior disorders [DBD] and anxiety disorders) in predicting psychiatric symptoms and disorders in 2-5-year-old offspring. Methods: Participants were 60 families with a parent with BPD and 78 offspring and 70 comparison families in which neither parent had a mood disorder and 91 offspring. Parent and offspring diagnoses and symptoms were assessed using standardized diagnostic interviews and measures, with offspring assessors masked to parental diagnoses. Results: Offspring of parents with BPD had significant elevations in behavioral, mood and anxiety disorders and symptoms. Both parental BPD and DBD contributed to elevations in child disruptive behavioral symptoms, whereas child anxiety symptoms were more strongly predicted by comorbid parental anxiety. Parental BPD was a stronger predictor than comorbid DBD of child DBDs. Conclusion: Some of the elevated risk for disorders in preschoolers is accounted for by parental comorbidity.

Cancers of the small bowel could account for less than 5% of all gastrointestinal malignancies. Of these tumors, adenocarcinomas were the major histologic subtype and generally carried a poor prognosis. High expression of vascular epithelial growth factor (VEGF) could be seen in small bowel adenocarcinomas. A systematic review was conducted here to determine if bevacizumab, a recombinant humanized antibody against VEGF, could offer clinical benefit among patients with metastatic small bowel adenocarcinoma when combined with chemotherapy. A search for relevant published and unpublished studies was performed using PubMed, ScienceDirect, Google Scholar, the American Society of Clinical Oncology meetings library, ClinicalTrials.gov, and ISRCTN registry. Information on study design, methods, intervention, and outcomes were extracted from selected eligible studies. Methodological quality was then assessed using the Newcastle-Ottawa Scale. There was a significant improvement in mean overall survival with the addition of bevacizumab with chemotherapy versus chemotherapy alone. The use of bevacizumab with chemotherapy, likewise improved progression-free survival and objective response rate compared to chemotherapy alone. Continued use of bevacizumab beyond first progression also appeared to show benefit. The conduct of prospective controlled studies by consortia to offset the rarity of small bowel adenocarcinomas could further elucidate the efficacy of bevacizumab in the treatment of this disease.

Background: The effect of the COVID-19 pandemic on the diagnosis and management of lung cancer in Canada is not fully understood. We sought to quantify the provincial volume of diagnostic imaging, thoracic surgeon referrals, time to surgery after referral, and pathologic staging for curative surgery in the context of the pandemic, as well as explore the effect of a pooled patient model, which was implemented to prioritize surgeries for lung cancer and mitigate the effects of the pandemic. Methods: We conducted a retrospective cohort study of patients who underwent diagnostic imaging in Nova Scotia and were subsequently referred to a thoracic surgeon at the province&apos;s only tertiary care centre for surgical management of their primary lung cancer before (Mar. 1, 2019, to Feb. 29, 2020) and during (Mar. 1, 2020, to Feb. 28, 2021) the COVID-19 pandemic. We conducted a survey to capture the patient and surgeon experience with a pooled patient model of managing surgical oncology cases. Results: Compared with the pre-COVID-19 period, the overall volume of chest radiography and chest computed tomography decreased by 30.9% (p < 0.001) and 18.7% (p = 0.002), respectively, in the COVID-19 period. Thoracic surgeon referrals, operative approach, extent of resection, length of hospital stay, and pathologic staging did not significantly differ. Time from referral to surgery was significantly shorter during the COVID-19 period (mean 196.8 d v. 157.9 d, p = 0.04). A pooled patient approach contributed to positive patient satisfaction. Conclusion: The COVID-19 pandemic was associated with reductions in rates of diagnostic imaging and referrals to thoracic surgeons for management of pulmonary cancer. A pooled patient model was used to mitigate the effects of the pandemic on lung cancer management and was positively received by patients. An extended study period is needed to determine the full effect of this redistribution of resources. Contexte : L&apos;effet de la pand mie de COVID-19 sur le diagnostic et la prise en charge du cancer du poumon au Canada n&apos;est pas enti rement compris. Nous avons voulu conna tre le volume provincial d&apos; preuves d&apos;imagerie diagnostique et de demandes de consultation en chirurgie thoracique, de m me que l&apos;intervalle entre les consultations et les chirurgies et le stade de la maladie justiciable d&apos;une chirurgie vis e curative dans le contexte de la pand mie, en plus d&apos;explorer l&apos;effet d&apos;un mod le de cas group s pour tablir l&apos;ordre de priorit des chirurgies pour le cancer du poumon et att nuer les effets de la pand mie. M thodes : Nous avons proc d une tude de cohorte r trospective aupr s des personnes ayant subi des preuves d&apos;imagerie diagnostiques en Nouvelle- cosse et adress es en chirurgie thoracique dans le seul tablissement de soins tertiaires de la province pour une prise en charge chirurgicale de leur n oplasie pulmonaire primitive avant (du 1er mars 2019 au 29 f vrier 2020) et durant (du 1er mars 2020 au 28 f vrier 2021) la pand mie de COVID-19. Nous avons r alis un sondage sur l&apos;exp rience des malades et des chirurgiennes et chirurgiens dans le cadre d&apos;un mod le de cas group s pour la prise en charge chirurgicale en oncologie. R sultats : Comparativement la p riode pr -COVID-19, le volume global des radiographies pulmonaires et des tomodensitom tries thoraciques a diminu de 30,9% (p < 0,001) et de 18,7% (p = 0,002), respectivement, durant la p riode de COVID-19. Les consultations en chirurgie thoracique, l&apos;approche chirurgicale, l&apos;ampleur de la r section, la dur e du s jour hospitalier et la stadification de la maladie n&apos;ont pas diff r significativement. L&apos;intervalle entre les consultations et les chirurgies a t significativement plus bref durant la p riode de COVID-19 (moyenne 196,8 j c. 157,9 j, p = 0,04). Le mod le de priorisation des cas group s a contribu favorablement la satisfaction des malades. Conclusion : La pand mie de COVID-19 a t associ e une r duction des taux d&apos; preuves d&apos;imagerie diagnostique et de demandes de consultation en chirurgie thoracique pour la prise en charge du cancer du poumon. Un mod le de priorisation de cas group s a servi att nuer les effets de la pand mie sur la prise en charge du cancer du poumon et a t accueilli favorablement par les malades. Un volet de prolongation est n cessaire pour mesurer tout l&apos;effet de cette redistribution des ressources., Lung cancer is the leading global cause of cancer-related deaths among both males and females. (1) In Canada, lung cancer has the highest cancer mortality; Nova Scotia has one of [...]

IntroductionMetabolic dysfunction-associated steatotic liver disease (MASLD) affects nearly 25% of the population and is the leading cause for liver-related mortality. Bariatric surgery is a well-known treatment for MASLD and obesity. Understanding the fundamental mechanisms by which bariatric surgery can alter MASLD can lead to new avenues of therapy and research. Previous studies have identified the microbiome's role in bariatric surgery and in inflammatory immune cell populations. The host innate immune system modulates hepatic inflammation and fibrosis, and thus the progression of MASLD. The precise role of immune cell types in the pathogenesis of MASLD remains an active area of investigation. The aim of this study was to understand the interplay between microbiota composition post-bariatric surgery and the immune system in MASLD.MethodsEighteen morbidly obese females undergoing sleeve gastrectomy were followed pre-and post-surgery. Stool from four patients, showing resolved MASLD post-surgery with sustained weight loss, was transplanted into antibiotic treated mice. Mice received pre-or post-surgery stool and were fed a standard or high-fat diet. Bodyweight, food intake, and physiological parameters were tracked weekly. Metabolic parameters were measured post-study termination.ResultsThe human study revealed that bariatric surgery led to significant weight loss (p > 0.05), decreased inflammatory markers, and improved glucose levels six months post-surgery. Patients with weight loss of 20% or more showed distinct changes in blood metabolites and gut microbiome composition, notably an increase in Bacteroides. The mouse model confirmed surgery-induced microbiome changes to be a major factor in the reduction of markers and attenuation of MASLD progression. Mice receiving post-surgery fecal transplants had significantly less weight gain and liver steatosis compared to pre-surgery recipients. There was also a significant decrease in inflammatory cytokines interferon gamma, interleukin 2, interleukin 15, and mig. This was accompanied by alterations in liver immunophenotype, including an increase in natural killer T cells and reduction of Kupfer cells in the post-surgery transplant group.DiscussionOur findings suggest surgery induced microbial changes significantly reduce inflammatory markers and fatty liver progression. The results indicate a potential causal link between the microbiome and the host immune system, possibly mediated through modulation of liver NKT and Kupffer cells.

COVID-19 increased the prevalence of clinically significant anxiety in the United States. To investigate contributing factors we analyzed anxiety, reported online via monthly Generalized Anxiety Disorders-7 (GAD-7) surveys between April 2020 and May 2022, in association with self-reported worry about the health effects of COVID-19, economic difficulty, personal COVID-19 experience, and subjective social status. 333,292 anxiety surveys from 50,172 participants (82% non-Hispanic white; 73% female; median age 55, IQR 42-66) showed high levels of anxiety, especially early in the pandemic. Anxiety scores showed strong independent associations with worry about the health effects of COVID-19 for oneself or family members (GAD-7 score +3.28 for highest vs. lowest category; 95% confidence interval: 3.24, 3.33; p

Phylogenetic analyses showed that the virus responsible for a May 2024 Oropouche fever outbreak in Cuba was closely related to viruses from Brazil in 2023. Pools of Ceratopogonidae spp. biting midges and Culex quinquefasciatus mosquitoes were positive for Oropouche viral RNA. No cases were severe. Virus extension to new areas may increase case numbers and severity.

Abstract Background There remain key knowledge gaps regarding HIV testing needs and priorities among refugee youth in low and middle-income country (LMIC) humanitarian settings. The HIV prevention cascade framework focuses on three domains (motivation, access, effective use) central to prevention uptake, yet is understudied in relationship to HIV testing, particularly among refugee youth. Uganda is an exemplar context to explore refugee youth HIV testing needs and priorities as it hosts 1.5 million refugees and is Africa’s largest refugee hosting nation. In this study, we explored perceptions and experiences regarding HIV testing among refugee youth living in Bidi Bidi refugee settlement, Uganda. Methods We conducted a community-based research study in Bidi Bidi Refugee Settlement, one of the world’s largest refugee settlements with over 195,000 residents. This qualitative study involved four focus groups (2 with young women, 2 with young men) with refugee youth aged 16–24 living in Bidi Bidi refugee settlement. We applied thematic analysis informed by the HIV prevention cascade to understand domains of motivation, access, and effective use that emerged as salient for HIV testing engagement. Results Participants (n = 40; mean age: 20 years, standard deviation: 2.2) included refugee young women (n = 20) and young men (n = 20), of whom 88% had a lifetime HIV test and 58% had ever heard of HIV self-testing. Participant discussions described HIV testing motivation was influenced by dimensions of: HIV treatment and testing knowledge; risk perception; positive and negative consequences of use; and social norms regarding gender and age. Access to HIV testing was shaped by: limited availability; distance and language barriers; confidentiality concerns; and affordability. Effective use of and engagement with HIV testing was related to HIV serostatus knowledge self-efficacy and in/equitable partner dynamics. Conclusions Complex, multi-level factors shape motivation for, access to, and effective use of HIV testing among refugee youth in Bidi Bidi. Findings align with the HIV prevention cascade framework that helps to identify gaps to inform intervention development with youth in humanitarian settings. HIV testing approaches tailored for refugee youth in contexts such as Bidi Bidi can foster HIV prevention and treatment literacy, gender equity, gender-based violence prevention, and intersectional stigma reduction.

The sustainability of coffee production is a concern for producers around the world. To be sustainable, it is necessary to achieve satisfactory levels of coffee productivity and quality. Pests and diseases cause reduced productivity and can affect the quality of coffee beans. To ensure sustainability, producers need to monitor pests that can lead to substantial crop losses, such as the coffee leaf miner, Leucoptera coffeella (Lepidoptera: Lyonetiidae), which belongs to the Lepidoptera order and the Lyonetiidae family. This research aimed to use machine learning techniques and vegetation indices to remotely identify infestations of the coffee leaf miner in coffee-growing regions. Field assessments of coffee leaf miner infestation were conducted in September 2023. Aerial images were taken using remotely piloted aircraft to determine 13 vegetative indices with RGB (red, green, blue) images. The vegetation indices were calculated using ArcGis 10.8 software. A comprehensive database encompassing details of coffee leaf miner infestation, vegetation indices, and crop data. The dataset was divided into training and testing subsets. A set of four machine learning algorithms was utilized: Random Forest (RF), Logistic Regression (LR), Support Vector Machine (SVM), and Stochastic Gradient Descent (SGD). Following hyperparameter tuning, the test subset was employed for model validation. Remarkably, both the SVM and SGD models demonstrated superior performance in estimating coffee leaf miner infestations, with kappa indices of 0.6 and 0.67, respectively. The combined use of vegetation indices and crop data increased the accuracy of coffee leaf miner detection. The RF model performed poorly, while the SVM and SGD models performed better. This situation highlights the challenges of tracking coffee leaf miner infestations in fields with varying ages of coffee plants, different cultivars, and other environmental variables.