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Background. The need to develop team skills in medical students is due to their importance for the successful performance of professional duties. However, despite the high importance of teamwork, modern students are not sufficiently prepared for team interaction. Purpose: to analyze the ideas of medical students about teamwork and to propose methods that contribute to the development of team skills. Materials and methods. The study was conducted in three stages. A total of three focus groups were interviewed, each consisting of 14 fourth-year students majoring in General Medicine at KrasSMU. The discussions were recorded on audio and then transcribed for subsequent analysis. The method of thematic analysis was used to process the data. Based on the discussions in the focus groups, we compiled test tasks. The survey involved 102 fourth-year students majoring in General Medicine, of which 42 were focus group participants and 60 were students from medical universities in Russia. The practical part of the study used the focus group method, analysis of psychological and pedagogical materials, and the method of processing experimental data. Results. A contradiction was found between the requirements for medical university graduates in terms of knowledge, skills and abilities in teamwork and the level of focus of future doctors on team interaction. 21.43% of medical university students correctly understand the content of teamwork and only 7% know all the principles of team interaction; 90% of students confuse teamwork with group work. At the same time, medical university students have a correct understanding of the main characteristics of teamwork in various interaction situations. The need to introduce teamwork principles into the learning process at a medical university led to the development of practice-oriented training sessions with elements of training work. Criteria for the focus of medical university students on interaction when performing team learning tasks have been developed: emotional intelligence, the ability to unite, effective communication in a team, and the manifestation of collective creativity.

Abstract Background Safety remains a significant concern for biologic drugs, and studies are needed to ensure a comparable safety profile for biosimilars and their legacy treatments. Using Canadian administrative health data from 2015–2019, we compared the incidence of serious infection between biosimilars and bio-originators initiators for etanercept and infliximab, two of the most commonly used biologics during this time. Methods We performed a retrospective cohort study using pan-Canadian data (except Quebec) from the National Prescription Drug Utilization Information System linked to hospitalization data. We studied new users of infliximab or etanercept (January/2015-December/2019) and compared incidence rates of serious infection, defined as those which required hospitalization, by using Cox regression models adjusted by biological sex, age at treatment initiation, prior corticosteroid or biologic, province, and calendar year. Results We studied 6,583 etanercept users (mean age 62) and 7,202 infliximab users (mean age 45). Hospitalization with infections occurred in 7% of infliximab and 2% of etanercept users. Comparing the risk of infection between biosimilar to bio-originator, the adjusted hazard ratio (95% confidence interval) was 1.33 (0.77, 2.30) for etanercept and 0.93 (0.72, 1.18) for infliximab. Conclusions Our study found no clear difference between etanercept and infliximab biosimilars and their bio-originators for infection incidence, suggesting a similar safety profile.

Background. Breast cysts are a relatively common benign condition, accounting for 26.4% of all benign mammary dysplasias (BMD). Due to scientific and technological progress, in many cases, it is possible to achieve improvement from non-surgical and complex therapy, including minimally invasive technologies such as image-guided air injections with non-surgical treatment. Aim. To determine the optimal approach for the management of benign breast cysts and to provide a rationale for the combined use of air injections with phytotherapy. Materials and methods. The study included women aged 25 to 45 years (mean age was 37.7±5.6 years) taking combined oral contraceptives (COCs) for at least 3 years with benign breast cysts. Patients were randomized into two groups: Group 1 (n=26) included patients with a cystic form of BMD who received a fine-needle puncture followed by air mixture injections into the cyst cavity in combination with non-surgical therapy with the herbal medicinal product Mastopol®; Group 2 (n=19) included patients with a cystic form of BMD who received only air injections into the cyst cavity. The dosing regimen of Mastopol® in patients of Group 1: 1 tablet sublingually 3 times a day 20 minutes before meals. The non-surgical therapy was initiated on the day of the air injection. The duration of treatment with Mastopol® was 3 months. Results. A pain decrease was reported in 18 patients (69.2%) of Group 1; in Group 2, only 2 (10.5%) patients reported a pain decrease. Almost all patients of Group 2 (n=17; 89.5%) required repeated air injections for complete cyst reduction, while in Group 1, only 31% (n=8) of patients received repeated air injections. Comparative analysis showed a significant difference between the groups: φ*=1.7; p≤0.04. One month after treatment and air injections, mastalgia of varying intensity in Group 1 persisted in 31% (n=8) of patients and 89.5% (n=17) of patients in Group 2. Conclusion. While taking COCs, women may experience pain and tension in the breast, as well as an increase in the echo density of the breast and thickening of the glandular tissue and the wall of the cysts. These adverse effects of COCs must be reduced. The results of the study demonstrated the effectiveness of the antiproliferative herbal drug Mastopol®, prescribed in combination with an adequate, effective, and safe method such as air injection into the cyst cavity.

Abstract The proficiency of phyllosphere microbiomes in efficiently utilizing plant-provided nutrients is pivotal for their successful colonization of plants. The methylotrophic capabilities of Methylobacterium/Methylorubrum play a crucial role in this process. However, the precise mechanisms facilitating efficient colonization remain elusive. In the present study, we investigate the significance of methanol assimilation in shaping the success of mutualistic relationships between methylotrophs and plants. A set of strains originating from Methylorubrum extorquens AM1 are subjected to evolutionary pressures to thrive under low methanol conditions. A mutation in the phosphoribosylpyrophosphate synthetase gene is identified, which converts it into a metabolic valve. This valve redirects limited C1-carbon resources towards the synthesis of biomass by up-regulating a non-essential phosphoketolase pathway. These newly acquired bacterial traits demonstrate superior colonization capabilities, even at low abundance, leading to increased growth of inoculated plants. This function is prevalent in Methylobacterium/Methylorubrum strains. In summary, our findings offer insights that could guide the selection of Methylobacterium/Methylorubrum strains for advantageous agricultural applications.

Nature-like technologies are being introduced into many human activities including mining wastewater treatment. This work is based on long-term studies of the Sibay copper-zinc-pyrite deposit development. It is dedicated to assessment of geochemical barriers effectiveness in Cu, Zn, Cd removal from water of the Karagayly River (receiving quarry and dump drainage water). The research is based on the elements’ content and forms in water and bottom sediments, pH values etc. Four types of hydrogeochemical environment (formed due to changes in the water use over the past 20 years) were distinguished using discriminant analysis. The mechanisms of barriers formation and destruction were described. Statistical modeling of the metals’ precipitation was performed by multivariate regression analysis. Cu is adsorbed by recently formed Fe hydroxides, and, to a lesser extent, precipitates with sulfates as water pH increases. Antagonism to Mn hydroxides has been demonstrated, due to different physicochemical conditions for their precipitation. Zn enters solid phase mainly with sulfates, this element also forms its own mineral phases. The second mechanism is adsorption by recently formed Mn hydroxides, which corresponds to the idea of similar conditions for the precipitation of metal hydroxides. Cd behavior reflects conditions intermediate between these of Cu and Zn. Contribution of both mechanisms (related to Fe hydroxides and aqueous sulfates) is equal. Antagonism to Mn is absent. According to the assessment results using of nature-like technologies in situ in watercourses, canals and other water drainage systems is promising. Developed statistical models can be used for needs of experimental studies and artificial geochemical barriers engineering.

The world we live in today holds some uncertainties. The processes of automation, big data, the digital environment, global crises, and the interconnectedness of international society are changing common technological patterns and the educational system. Among the essential features of competitiveness of teachers in higher education are mobility, digital competencies, adaptability, participation in scientific networks and projects, and continuous acquisition of new technological skills. For this reason, teachers must continuously develop their professional skills to remain competitive and create professionals in higher education. Current conditions are fostering global demand for teachers who produce pedagogical and scientific developments. This article aims to solve the problem of defining the structure, content, and requirements of scientific and methodological support for higher education teachers' competitiveness in a digital world in the context of global challenges and risks. Theoretically, the problem is defined by the need for new approaches to explaining the concept of teacher competitiveness and the need to develop a psychological and teaching methodology for training and developing teacher competitiveness. In practice, we conclude that researchers must develop personal, professional, procedural, and technological enhancements to support higher education faculty competitiveness in a digital world.

Since its emergence in 2019, coronavirus disease (COVID-19) has spread worldwide and consumed public health resources. However, the world still has to address the burdens of other infectious diseases that continue to thrive. Countries in the tropics and neotropics, including Brazil, are affected by annual, cyclic dengue epidemics. Little is known about the impact of subsequent infections between DENV and SARS-CoV-2. Our study was performed on 400 serum samples collected from laboratory-confirmed COVID-19 patients between January and June 2021, months historically known for DENV outbreaks in Brazil. The samples were tested by serology and molecular assays for the presence of DENV and other arboviruses. While no DENV PCR results were detected, 6% were DENV IgM-positive, and 0.25% were DENV NS1-positive according to ELISA. IgM antibodies were isolated by chromatography, and 62.5% of the samples were positive for neutralizing antibodies (FRNT80) against DENV IgM, suggesting a recent infection. We also observed increased IL-10, TNF-α, and IL-1β levels in patients with overlapping SARS-CoV-2/DENV infections. Intriguingly, diabetes was the only relevant comorbidity (p=0.046). High rates of hospitalization (94.9%) and mortality (50%) were found, with a significant increase in invasive mechanical ventilatory support (86.96%) in SARS-CoV-2/DENV- infected patients, suggesting an impact on patient clinical outcomes. When analyzing previous exposure to DENV, secondary dengue patients infected with SARS-CoV-2 more frequently presented with dyspnea and respiratory distress, longer hospital and intensive care unit (ICU) stays (4 and 20.29 days, respectively) and a higher mortality rate (60%). However, a greater proportion of patients with primary DENV infection had fever and cough than patients with secondary dengue (87.50% vs. 33.33%, p=0.027 for fever). Our data demonstrate that differentiating between the two diseases is a great concern for tropical countries and should be explored to improve patient management.

Background Short sleep duration has been associated with an increased risk of cognitive impairment and dementia. Short sleep is associated with elevated blood pressure, yet the combined insult of short sleep and hypertension on brain health remains unclear. We assessed whether the association of sleep duration with cognition and vascular brain injury was moderated by hypertensive status. Methods and Results A total of 682 dementia‐free participants (mean age, 62±9 years; 53% women) from the Framingham Heart Study completed assessments of cognition, office blood pressure, and self‐reported habitual and polysomnography‐derived sleep duration; 637 underwent brain magnetic resonance imaging. Linear regressions were performed to assess effect modification by hypertensive status on total sleep time (coded in hours) and cognitive and magnetic resonance imaging outcomes. There was a significant interaction between sleep duration and hypertensive status when predicting executive function/processing speed (Trail Making B‐A) and white matter hyperintensities. When results were stratified by hypertensive status, longer sleep duration was associated with better executive functioning/processing speed scores in the hypertensive group (meaning that shorter sleep duration was associated with poorer executive function/processing speed scores) (self‐report sleep: β=0.041 [95% CI, 0.012–0.069], P=0.005; polysomnography sleep: β=0.045 [95% CI, 0.002–0.087], P=0.038), but no association was observed for the normotensive group. Similarly, shorter subjective sleep duration was associated with higher white matter hyperintensity burden in the hypertensive group (β=−0.115 [95% CI, −0.227 to −0.004], P=0.042), but not in the normotensive group. Conclusions In individuals with hypertension, shorter sleep duration was associated with worse cognitive performance and greater brain injury.

Abstract Introduction There is limited evidence to guide management of patients with avoidant restrictive food intake disorder (ARFID) admitted for medical stabilization. We describe variations in inpatient care which led to the development of a multidisciplinary inpatient clinical pathway (ICP) to provide standardized management and examine differences after the ICP was implemented. Methods A retrospective review of patients with ARFID admitted to Adolescent Medicine, Gastroenterology, and General Pediatrics at a single academic center was conducted. We compare hospital utilization and use of consulting services during the pre-ICP (2015–2017) and post-ICP (2018–2020) periods. Results 110 patients were admitted with ARFID (n = 57 pre- vs. n = 53 post-ICP). Most presented with moderate/severe malnutrition (63% pre vs. 81% post; p = 0.11) and co-morbid anxiety and/or depression (74% pre vs. 92% post; p = 0.01). There was some variation in use of enteral tube feeding by service in both periods (p = 0.76 and p = 0.38, respectively), although overall use was consistent between periods (46% pre vs. 58% post; p = 0.18). Pre-ICP, use of the restrictive eating disorder protocol differed across services (p

Abstract Background Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful, or otherwise reticent to disclose abuse, and many health providers are not confident in asking about it. In the No More Shame study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers’ recognition, response, and referral of elder abuse. Methods This is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e. clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training programme for health providers, implementation of a screening tool and use of site champions, or no additional training or support. Outcomes will be collected at baseline, 4 and 9 months. Our co-primary outcomes are change in health providers’ knowledge of responding to elder abuse and older people’s sense of safety and quality of life. We will include all inpatients at participating sites, aged 65 + (or aged 50 + if Aboriginal or Torres Strait Islander), who are able to provide informed consent and all unit staff who provide direct care to older people; a sample size of at least 92 health providers and 612 older people will provide sufficient power for primary analyses. Discussion This will be one of the first trials in the world to evaluate a multi-component elder abuse intervention. If successful, it will provide the most robust evidence base to date for health providers to draw on to create a safe environment for reporting, response, and referral. Trial registration ANZCTR, ACTRN12623000676617p . Registered 22 June 2023.

Abstract Background X-linked myotubular myopathy (XLMTM) is a rare, life-threatening congenital disease, which is not well-defined. To our knowledge, no studies characterizing the XLMTM disease burden have been conducted in Brazil. We identified and described patients with suspected XLMTM using administrative claims data from the Brazilian public healthcare system. Methods Data from 2015 to 2019 were extracted from the DATASUS database. As no XLMTM-specific ICD-10 code was available, a stepwise algorithm was applied to identify patients with suspected XLMTM by selecting male patients with a congenital myopathies code (G71.2), aged

Abstract Fifty Holstein calves were allocated in randomized blocks and distributed in a 2 × 2 factorial arrangement; (A) two sources of Ig: (1) Control: bovine colostrum (25% Brix); (2) Enriched colostrum: mid-quality bovine colostrum (20% Brix) enriched with colostrum replacer to 25% Brix; and (B) two transition feeding diets: (1) Whole milk (WM): supply of 4 L/day of whole milk for 3 days after the colostrum feeding; and (2) Formulated transition milk (FTM): supply 4 L/day of whole milk enriched with 70 g/L of colostrum replacer for 3 days after the colostrum feeding. Blood samples were collected at 0, 24, 48, and 72 h of age to determine total serum protein (TSP), glucose, non-esterified fatty acids (NEFA), erythrocyte and leukocyte concentrations. IgG was measured at 48 h. During the preweaning period, calves received 6 L/day of whole milk. Blood samples were collected weekly to determine TSP, glucose, and lactate. The colostrum protocols were equally efficient for transfer of passive immunity with IgG concentration at 48 h ≥ 49.6 g/L. Colostrum or transition feeding program did not influence the erythrocyte and leukocyte concentrations. The TSP concentration measured until 72 h was higher for calves fed maternal colostrum. Calves fed milk in the transition period had higher glucose concentrations. Calves receiving bovine colostrum and FTM had higher glucose concentrations in the preweaning period, while the enriched colostrum decreased plasma lactate concentrations. In summary, enrichment of mid-quality colostrum is an alternative in situations of a shortage of high-quality colostrum; however, feeding 4 L/day of FTM only for 3 days after colostrum feeding does not show additional benefits.

ABSTRACT: Palicourea marcgravii is a lethal toxic plant widely distributed in Brazil. Ingestion of this plant causes cardiotoxic effects in animals, leading to acute heart failure without evident macroscopic changes in the heart due to the rapid progression of the disease. Currently, the diagnosis is confirmed based on microscopic identification of characteristic renal lesions. Although troponin is used as a biomarker for myocardial lesions in human and veterinary medicine, its serum levels in sheep poisoned with P. marcgravii remain unknown. The objective of this study was to determine serum levels of troponin I and evaluate its expression in incipient heart lesions in sheep. Eight male sheep were experimentally intoxicated with 1g kg-1 of fresh P. marcgravii plants. The animals were physically examined every two hours, and blood samples were collected before the administration of the plant material and during the agonizing period immediately before death. Additionally, necropsy and immunohistochemistry were performed on cardiac tissue samples. All animals presented minimal serum levels of troponin I before plant administration, with a significant increase in these levels immediately before death, indicating leakage due to the cardiac injury. These results confirm the hypothesis that troponin is released into the bloodstream before morphological changes in the myocardium can be observed through conventional microscopy and immunohistochemical testing. These findings contribute to understanding the pathological mechanisms of this toxicity and may assist in the early diagnosis and treatment of affected animals.

The research is relevant as educational computer games are included in students' mathematical activity and form additional opportunities to improve the quality of teaching mathematics in a digital school, to support the formation of the demanded professional competence - computational thinking. To form the appropriate skills that determine the essence of special computational thinking, the authors propose to include game educational spaces based on digital gamification resources into students' mathematical activities. The research aims to resolve the contradiction between requirements of the modern economy for specialists' high level of computational thinking and an insufficiently developed methodological base for training graduates that meets these requirements. The purpose of this research is to study the features of using gamification technologies in teaching mathematics to form the skills and abilities that make up the essence of computational thinking. The article describes directions of educational and cognitive mathematical activity based on the principles of gamification. The authors clarify the concept of "computational thinking", which includes a system of actions for activating patterns, connections between them from human memory, and compile an effective algorithm for solving them: to obtain relevant information on advanced technological developments; to state the problem and model; to use a software product with mathematical content.

High-throughput RNA sequencing offers broad opportunities to explore the Earth RNA virome. Mining 5,150 diverse metatranscriptomes uncovered >2.5 million RNA virus contigs. Analysis of >330,000 RNA-dependent RNA polymerases (RdRPs) shows that this expansion corresponds to a 5-fold increase of the known RNA virus diversity. Gene content analysis revealed multiple protein domains previously not found in RNA viruses and implicated in virus-host interactions. Extended RdRP phylogeny supports the monophyly of the five established phyla and reveals two putative additional bacteriophage phyla and numerous putative additional classes and orders. The dramatically expanded phylum Lenarviricota, consisting of bacterial and related eukaryotic viruses, now accounts for a third of the RNA virome. Identification of CRISPR spacer matches and bacteriolytic proteins suggests that subsets of picobirnaviruses and partitiviruses, previously associated with eukaryotes, infect prokaryotic hosts.