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Introduction: Continuous positive airway pressure (CPAP) is the gold standard therapy for obstructive sleep apnoea (OSA). However, non-adherence is common and costly. The COVID-19 pandemic required the use of novel solutions to ensure service provision and quality of care. This retrospective analysis determined the impact and value of a digital versus standard pathway for the management of OSA in Spain. Material and methods: A time-driven activity-based costing approach was applied to OSA management over 1 year using a standard or digital pathway. The standard pathway included face-to-face appointments at the time of diagnosis, then after 1–3 months and every 6 months thereafter. The digital pathway had fewer face-to-face appointments and utilised telemonitoring. A cost analysis was performed to determine the per-patient cost per healthcare professional (HCP) for a digital pathway for therapy implementation and follow-up compared with the standard pathway. Results: Compared with the standard pathway, the digital pathway decreased the waiting list time from 18 to 2 months, the overall pathway time from 12 to 6 months, HCP cost per patient from €95 to €85, and number of hospital appointments per patient from 6 to 3.1. Furthermore, CPAP device usage improved from 5.7 to 6.3 h/night and the proportion of individuals defined as adherent increased from 79% to 91%. Conclusions: Implementation of digital processes using available technology reduced HCP time and costs, and improved adherence to CPAP in people with OSA. Greater utilisation of a digital pathway could improve access to therapy, allow personalised patient management, and facilitate better clinical outcomes. Resumen: Introducción: La presión positiva continua en la vía aérea (CPAP) es el tratamiento de referencia para la apnea obstructiva del sueño (AOS). Sin embargo, su incumplimiento es frecuente y costoso. La pandemia de COVID-19 requirió el uso de soluciones novedosas para garantizar la prestación de servicios y la calidad de la atención. Este análisis retrospectivo determinó el impacto y el valor de un pathway digital frente a un pathway estándar para el manejo de la AOS en España. Material y métodos: Se aplicó el Time-DrivenActivityBasedCosting al tratamiento de la AOS durante 1 año utilizando el pathway estándar o digital. El pathway estándar incluía citas presenciales en el momento del diagnóstico, después de 1 a 3 meses y posteriormente cada 6 meses. el pathway digital tenía menos citas presenciales y utilizaba la telemonitorización. Se realizó un análisis de costes para determinar el coste por paciente y profesional sanitario (HCP) del pathway digital para la implementación y el seguimiento de la terapia en comparación con el pathway estándar. Resultados: En comparación con el pathway estándar, el pathway digital redujo el tiempo de la lista de espera de 18 a 2 meses, el tiempo total del pathway del paciente de 12 a 6 meses, el coste del HCP por paciente de 95 a 85 euros, y el número de citas hospitalarias por paciente de 6 a 3,1. Además, el uso del dispositivo de CPAP mejoró de 5,7 a 6,3 h/noche y la proporción de pacientes definidos como adherentes aumentó del 79% al 91%. Conclusiones: La implementación de procesos digitales utilizando la tecnología disponible redujo el tiempo y los costes del HCP y mejoró la adherencia a la CPAP en personas con AOS. Una mayor utilización de un pathway digital podría mejorar el acceso a la terapia, permitir una gestión personalizada del paciente y facilitar mejores resultados clínicos.

Pollen allergies have become one of the most wide-spread afflictions that impact quality of life. This has made automatic pollen detection, classification and monitoring a very important topic of research. This paper introduces a new public annotated image data-set of pollen with almost 45 thousand samples obtained from an automatic instrument. In this work we apply some of the best performing convolutional neural networks architectures on the task of pollen classification as well as some fully convolutional networks optimized for image segmentation on complex microscope images. We obtain an F1 scores of 0.95 on the new data-set when the best trained model is used as a fully convolutional classifier and a class mean Intersection over Union (IoU) of 0.88 when used as an object detector.

The personnel preparation of early intervention/early childhood special educator (EI/ECSE) candidates is a pivotal stage in supporting the development of professionals who can effectively work with young children with and at-risk of developmental disabilities, their families, and other service providers. This process encompasses a multifaceted approach to equip candidates with knowledge, skills, and attitudes/dispositions to successfully work within the field. This compilation article includes multiple authors of each section who share strategies, assignments, tools, and experiences to center the Initial Practice-Based Standards for Early Interventionists/Early Childhood Special Educators (Division for Early Childhood [DEC] of the Council for Exceptional Children [CEC], 2020; hereafter referred to as the EI/ECSE Standards) and DEC's Recommended Practices (RPs). These strategies are shared through a "spiraling curriculum" framework, and progress from an awareness level to reflection of candidates' own practice. In addition, this article shares related resources to consider in planning for innovative coursework and practicum/student teaching opportunities. Specific examples of spiraling experiences to deepen learning through opportunities to introduce content aligned to RPs and EI/ECSE Standards are included.

The following research reports on a collaborative effort between two university field supervisors for an elementary teacher preparation program in the Pacific southwest. Utilizing practitioner inquiry and situated learning as conceptual frameworks, the authors qualitatively examine the experiences ten elementary education teacher candidates have with promoting student engagement during emergency response teaching because of the COVID-19 pandemic. An interpretive phenomenological analysis of 20 lesson reflections and supervisor observation notes reveals teacher candidates (TCs) need more support with questioning, feedback and formative assessment, and technology tools to keep students engaged when teaching at a distance. Recommendations suggest a need for teacher preparation programs to provide TCs with opportunities to practice engagement strategies in distance education settings.

Background: Helicobacter pylori is acquired largely in early childhood, but its association with symptoms and indirect biomarkers of gastric damage in apparently healthy children remains controversial. We aimed to relate persistent H. pylori infection in apparently healthy school-aged children with clinical, laboratory, and noninvasive biomarkers suggestive of gastric damage using a case-control design. Materials and methods: We followed up 83 children aged 4–5 years with persistent H. pylori infection determined by stool antigen detection and/or a urea breath test and 80 noninfected matched controls from a low-income to middle-income, periurban city in Chile for at least 3 years. Monitoring included clinical visits every 4 months and annual assessment by a pediatric gastroenterologist. A blood sample was obtained to determine laboratory parameters potentially associated with gastric damage (hemogram and serum iron and ferritin levels), biomarkers of inflammation (cytokines, pepsinogens I and II, and tissue inhibitor metalloproteinase 1), and expression of cancer-related genes KLK1, BTG3, and SLC5A8. Results: Persistently infected children had higher frequency of epigastric pain on physical examination (40% versus 16%; P = 0.001), especially from 8 to 10 years of age. No differences in anthropometric measurements or iron-deficiency parameters were found. Persistent infection was associated with higher levels of pepsinogen II (median 12.7 ng/mL versus 9.0 ng/mL; P

Objectives: To assess the characteristics and risk factors for mortality in patients with severe coronavirus disease-2019 (COVID-19) treated with tocilizumab (TCZ), alone or in combination with corticosteroids (CS). Methods: From March 17 to April 7, 2020, a real-world observational retrospective analysis of consecutive hospitalized adult patients receiving TCZ to treat severe COVID-19 was conducted at our 750-bed university hospital. The main outcome was all-cause in-hospital mortality. Results: A total of 1,092 patients with COVID-19 were admitted during the study period. Of them, 186 (17%) were treated with TCZ, of which 129 (87.8%) in combination with CS. Of the total 186 patients, 155 (83.3 %) patients were receiving noninvasive ventilation when TCZ was initiated. Mean time from symptoms onset and hospital admission to TCZ use was 12 (±4.3) and 4.3 days (±3.4), respectively. Overall, 147 (79%) survived and 39 (21%) died. By multivariate analysis, mortality was associated with older age (HR = 1.09, p < 0.001), chronic heart failure (HR = 4.4, p = 0.003), and chronic liver disease (HR = 4.69, p = 0.004). The use of CS, in combination with TCZ, was identified as a protective factor against mortality (HR = 0.26, p < 0.001) in such severe COVID-19 patients receiving TCZ. No serious superinfections were observed after a 30-day follow-up. Conclusions: In patients with severe COVID-19 receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in addition to TCZ therapy, showed a beneficial effect in preventing in-hospital mortality.

This article discusses how cultural simulations promote teacher candidate cultural competence. The case study uses intercultural communicative competence to examine written reflections and focus group interviews of 21 undergraduate teacher candidates in Hawaiʻi who engaged in cultural simulation visits on the island of Oʻahu. Findings reveal that cultural simulations allowed teacher candidates to develop intercultural competency in knowledge, know-how, and being. Implications include how cultural simulations may promote teacher candidates’ intercultural competence and offer recommendations on how teacher educators may consist of cultural simulations in multicultural teacher education.

The fourth annual summer research summit organized by the Center of Excellence (COE) in Health Equity, Training and Research, Baylor College of Medicine (BCM) was held on May 20, 2021. The theme of this year’s summit was ‘Strengthening Our Commitment to Racial and Social Justice to Improve Public Health.’ Given the ongoing pandemic, the summit was conducted virtually through digital platforms. This program was intended for both BCM and external audiences interested in advancing health equity, diversity and inclusion in healthcare among healthcare providers and trainees, biomedical scientists, social workers, nurses, individuals involved in talent acquisition and development such as hiring managers (HR professionals), supervisors, college and hospital affiliate leadership and administrators, as well as diversity and inclusion excellence practitioners. We had attendees from all regions of the United States, India, Pakistan and the Demographic Republic of the Congo. The content in this Book of Abstracts encapsulates a summary of the research efforts by the BCM COE scholars (which includes post-baccalaureate students, medical students, clinical fellows and junior faculty from BCM) as well as the external summit participants. The range of topics in this year’s summit was quite diverse encompassing disparities in relation to maternal and child health (MCH), immigrant heath, cancers, vaccination uptakes and COVID-19 infections. Various solutions were ardently presented to address these disparities including community engagement and partnerships, improvement in health literacy and development of novel technologies and therapeutics. With this summit, BCM continues to build on its long history of educational outreach initiatives to promote diversity in medicine by focusing on programs aimed at increasing the number of diverse and highly qualified medical professionals ready to introduce effective and innovative approaches to reduce or eliminate health disparities. These programs will improve information resources, clinical education, curricula, research and cultural competence as they relate to minority health issues and social determinants of health. The summit received very positive response in terms of zealous participation and outstanding evaluations; and overall, it was a great success. Copyright © 2021 Lopez et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

In this paper, we look at pedagogies of care articulated by Latina high school teachers who teach Latinx multilingual students in a variety of content areas, including Latinx studies. We draw on raciolinguistics to understand how the teachers in this study practice "critical linguistic cariño," a radical form of care that considers how linguistic practices of Latinx students are racialized within the U.S. and beyond. The findings demonstrate how critical linguistic cariño is a pedagogical orientation that moves beyond simply caring for multilingual students. Instead, it is praxis that recognizes the sociopolitical contexts of language as central to care. As the teachers in this study have highlighted, to care for Latinx students is to love and actively create spaces for their full cultural and linguistic identities as they exist within these contexts.

Erectile dysfunction (ED) is considered a condition with a broad range of etiologies. Obstructive sleep apnea (OSA) syndrome is one of the lesser studied risk factors for ED. We intend to summarize the current evidence on the relationship between OSA and sexual impairment, focusing on the results in terms of erectile function of the different therapies offered to OSA patients. A systematic review was conducted, selecting articles related to the physiology of OSA and ED, and to the treatments of OSA syndrome and their reported outcomes in erectile and sexual function. Higher prevalences of ED in the OSA groups have been published. However, whether this effect on the erectile function occurs in the entire range of OSA severities remains unclear. Several hypotheses were proposed to explain the physiology of this association. Continuous Positive Airway Pressure as a treatment for OSA patients with ED has achieved a significative improvement in the sexual parameters in most of the studies. Phosphodiesterase type 5 inhibitors (iPDE5) on demand are useful as a treatment for ED in this subgroup of patients, with high satisfaction rates. The surgical treatment for the OSA evidenced benefits over the erectile function, and the effect on the sexual satisfaction of the therapy using Mandibular Advancement Devices is still undefined.

Background: Several clinical prediction rules (CPRs) are available for sleep apnoea-hypopnoea syndrome (OSAH), but they are difficult to apply in primary care (PC). Aim: Derivation and validation of a CPR using simple measurements available in PC. Design & setting: A prospective study conducted in health centres from the area of influence of three Spanish hospitals. Method: Patients (aged 18–70 years) who attended for any reason; who presented with at least one of the three key symptoms for OSAH (snoring, breathing pauses while sleeping, and daytime sleepiness); and who were not undergoing non-invasive ventilation or prior treatment with continuous positive airway pressure (CPAP) were included. Anthropometric data, smoking habit, comorbidities, and Epworth test were collected. Patients were subsequently referred to the sleep unit (SU), where the decision was taken whether or not to instigate treatment. A multivariate logistic model was constructed using a sub-sample and scores assigned based on the regression coefficients; the CPR was validated with the remaining sample. Both receiver operating characteristic (ROC) curves were plotted and the sensitivity, specificity, and predictive values calculated. Results: The derivation sample comprised 352 patients, with 260 in the validation sample. The final factors (arterial hypertension [AHT], age, body mass index [BMI], and sex) were used to develop a rule with scores ranging from 0.00–5.50. The cut-off point that optimises the area under the curve (AUC) is ≥2.50 points (AUC = 0.78; sensitivity = 86%; specificity = 54%; positive predictive value [PPV] = 45%; negative predictive value [NPV] = 90%; likelihood ratio [LR] = 0.26). The properties for the validation sample with this cut-off point are as follows: AUC = 0.68; sensitivity = 81%; specificity = 43%; PPV = 61%; NPV = 68%; LR = 0.44. Conclusion: As in similar cases, the specificity is low, meaning that healthy people are referred to a specialist. A negative result rules out the disease in most cases.

Cytomegalovirus (CMV) is a prevalent pathogen in the immunocompromised host and invasive pneumonia is a feared complication of the virus in this population. In this pediatric case series we characterized CMV lung infection in 15 non-HIV infected children (median age 3 years; IQR 0.2–4.9 years), using current molecular and imaging diagnostic modalities, in combination with respiratory signs and symptoms. The most prominent clinical and laboratory findings included cough (100%), hypoxemia (100%), diffuse adventitious breath sounds (100%) and increased respiratory effort (93%). All patients had abnormal lung images characterized by ground glass opacity/consolidation in 80% of cases. CMV was detected in the lung either by CMV PCR in bronchoalveolar lavage (82% detection rate) or histology/immunohistochemistry in lung biopsy (100% detection rate). CMV caused respiratory failure in 47% of children infected and the overall mortality rate was 13.3%. Conclusion: CMV pneumonia is a potential lethal disease in non-HIV infected children that requires a high-index of suspicion. Common clinical and radiological patterns such as hypoxemia, diffuse adventitious lung sounds and ground-glass pulmonary opacities may allow early identification of CMV lung infection in the pediatric population, which may lead to prompt initiation of antiviral therapy and better clinical outcomes.

This article highlights the work of a culturally responsive pedagogy (CRP) Professional Development School (PDS) initiative aimed at promoting teacher candidates' abilities to understand and work effectively with elementary-aged Micronesian students in Hawai'i. Findings from this research reveal that a PDS centered on CRP improved teachers' abilities to work with historically marginalized youth. TCs developed cultural understanding and defined culturally responsive dispositions. To enact CRP, TCs conducted research and used small group instruction to inform relationships with students. The article concludes with implications for PDS work in diverse schools.

Alterations of mitochondrial DNA copy number (mtDNAcn) in the blood (mitochondrial to nuclear DNA ratio) appear associated with several systemic diseases, including primary mitochondrial disorders, carcinogenesis, and hematologic diseases. Measuring mtDNAcn in DNA extracted from whole blood (WB) instead of from peripheral blood mononuclear cells or buffy coat may yield different results due to mitochondrial DNA present in platelets. The aim of this work is to quantify the contribution of platelets to mtDNAcn in whole blood [mtDNAcn(WB)] and to propose a correction formula to estimate leukocytes' mtDNAcn [mtDNAcn(L)] from mtDNAcn(WB). Blood samples from 10 healthy adults were combined with platelet-enriched plasma and saline solution to produce artificial blood preparations. Aliquots of each sample were combined with five different platelet concentrations. In 46 of these blood preparations, mtDNAcn was measured by qPCR. MtDNAcn(WB) increased 1.07 (95%CI 0.86, 1.29; p

The following research reports on a collaborative effort between two university field supervisors for an elementary teacher preparation program in the Pacific southwest. Utilizing practitioner inquiry and situated learning as conceptual frameworks, the authors qualitatively examine the experiences ten elementary education teacher candidates have with promoting student engagement during emergency response teaching because of the COVID-19 pandemic. An interpretive phenomenological analysis of 20 lesson reflections and supervisor observation notes reveals teacher candidates (TCs) need more support with questioning, feedback and formative assessment, and technology tools to keep students engaged when teaching at a distance. Recommendations suggest a need for teacher preparation programs to provide TCs with opportunities to practice engagement strategies in distance education settings.

In teacher preparation years, teacher candidates are often required to use personal video recordings of classroom instruction to reflect on teaching and learning. While it is well documented that video supports, scaffolds, and transforms teacher reflection, the literature on ESL-focused video reflection is scant. The present study discusses how four, final semester, undergraduate teacher candidates engaged in critical friendship to reflect on personally recorded videos of instruction delivered to elementary-aged ESL students. Twelve critical friendship lesson feedback sessions were collected over a 15-week period and were analyzed through ethnographic research methods using friendship metaphors and a member checking process. The article presents a video-mediated critical friendship framework that ESL teacher educators can use to structure video-mediated dialogue with teacher candidates and concludes with a discussion surrounding the benefits of using critical friendship in ESL teacher education.

Resumen El objetivo de esta investigación fue comprender las representaciones sociales asociadas al VIH y al Sida en un grupo de adolescentes y jóvenes universitarios colombianos. Para ello, se realizó un estudio cualitativo de diseño fenomenológico interpretativo en el que participaron 18 estudiantes universitarios. Las técnicas de recolección empleadas fueron las redes semánticas naturales (RSN) y los grupos de discusión. Las narrativas evidenciaron que existe desconocimiento sobre aspectos generales del VIH y del Sida. También dieron cuenta de la creencia de que el riesgo de contraer VIH recae únicamente en grupos etiquetados en riesgo. Se identificaron, además, actitudes que denotan estigma hacia personas con la enfermedad. Los pares, los padres, la familia y el internet se reportaron como los principales agentes de socialización sobre la enfermedad. En conclusión, se destaca la necesidad de empoderar a los diferentes agentes de socialización y de fortalecer los procesos educativos desde el reconocimiento de los derechos humanos de todas las personas. Se requiere, por tanto, un trabajo articulado, integral y transversal de los diferentes agentes, no solo para la deconstrucción de las creencias y actitudes negativas hacia la enfermedad, sino para la construcción de una sexualidad responsable y saludable que esté centrada en el autocuidado.