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The CONTROL IS UP metaphor is an embodied cognitive mechanism that helps western speakers reason about power relations in terms of vertical spatial organization, This paper explores its multimodal elaboration in visual manifestations of pyramidal structured arrangements and kinetic practices such as genuflexion in medieval miniatures in order to (i) demonstrate the role of multimodal representations of metaphors in reasoning, (ii) unveil power relationships between different societal strata.34 miniatures (12th ct. Liber feudorum maior) were analised with the “multimodal genuflexion test” to describe and measure (CAD-software) distances between kinetic elements (facial/manual gestures, postures).Results indicate that (i) power relations are not just vertically represented (kneeling & bowing), physical distance between characters and position of hands are crucial, (ii) there is a significant positive correlation [U = 61,119; p = 0.003] between the power figure and the degree of “body bending” (bowing, kneeling) and hand distance.

To explore patient and health care provider HIV postexposure prophylaxis (PEP) decision making following sexual assault, semistructured interviews regarding HIV PEP provision with 15 patients and 10 health care providers were conducted. A qualitative, descriptive, thematic analysis approach was used. Four themes were derived: (a) medical concerns; (b) emotional, trauma, and support factors; (c) daily medication management; and (d) ensuring access to HIV PEP. How participants described these themes and the importance placed on factors within each theme varied between the two groups. Altering provider communication so that HIV PEP discussions better align with patient decision-making factors (e.g., trauma and ability to take in information, how to manage side effects) could facilitate improvement in HIV PEP decision making following sexual assault for patients. High-level policy changes would improve HIV PEP access for sexual assault patients without necessitating the extraordinary efforts individual providers currently undertake.

Objective Systemic lupus erythematosus (SLE) is characterized by widespread organ inflammation. Metformin, commonly used for diabetes mellitus type 2, has been explored for its anti‐inflammatory potential in SLE. This study investigates the association of metformin use on renal and cardiovascular outcomes in patients with SLE. Methods This is a retrospective study. We used the multicenter research network (TriNetX) database from 88 health care organizations globally. Patients with SLE aged 18 and above, admitted between January 1, 2014, and April 21, 2024, were included. Propensity score matching compared patients with SLE on metformin with those not on metformin, considering demographics, laboratory results, comorbidities, and baseline medication use. The study assessed outcomes, including lupus nephritis (LN), chronic kidney disease (CKD), and major adverse cardiovascular events (MACEs) at one and five years after SLE diagnosis. Results We identified 9,178 patients with SLE on metformin and 78,983 patients with SLE not on metformin. After propensity score matching, patients with SLE on metformin had higher levels of hemoglobin A1C, whereas patients not on metformin had higher levels of urea nitrogen. When comparing both groups, the risk of developing LN (risk ratio [RR] = 1.70 [1.17–2.41]; P = 0.004), CKD (RR = 1.27 [1.07–1.52]; P = 0.007), and MACEs (RR = 1.21 [1.00–1.46]; P = 0.04) was significantly higher among patients not on metformin at one year after SLE diagnosis. After five years, the risk of LN and CKD was also higher in patients with SLE not on metformin. MACE risk was no longer significant after five years of diagnosis between both groups. Conclusion Patients with SLE not on metformin have a higher risk of developing LN, CKD, and MACEs compared with patients treated with metformin. Metformin's anti‐inflammatory potential offers promise as a complementary therapy for SLE. Nonetheless, further research and clinical trials are needed to clarify its mechanisms, optimal dosage, and long‐term effects.

Substance use/abuse and suicide are two closely related phenomena, mostly due to neurobiological, psychological, and social impairments. In the present narrative review, the relationship between suicidal behavior (SB) and the use and abuse of common recreational drugs, such as alcohol, cannabis, cocaine, methamphetamine, heroin, nicotine, ketamine, psilocybin, MDMA, and LSD, has been explored. Furthermore, potential mechanisms linking the two have also been examined. According to current research, all substances appear to have a deleterious effect on SB except for ketamine and psilocybin, which could potentially confer a protective effect. Further studies are needed to understand the relationship between MDMA, LSD, and suicide.

RESUMO Objetivo Desenvolver, atualizar e aprimorar um site autoinstrucional sobre sistemas de microfone remoto para estudantes com deficiência auditiva e seus fonoaudiólogos, professores e pais e validar o site como ferramenta de formação continuada para professores. Métodos Estudo transversal, descritivo, quantitativo. Todo o conteúdo do site REMIC foi convertido em infográficos com base no design instrucional. Treze professores do ensino fundamental responderam a três questionários (questionário teórico pré e pós-intervenção, Ficha de Pesquisa Motivacional e Escala de Autoavaliação do Impacto do Treinamento no Trabalho). Resultados Foram criados seis módulos utilizando infográficos, comunicando conteúdos específicos de forma objetiva ao público-alvo. Houve diferença estatisticamente significativa entre pré e pós-treinamento em relação ao questionário (p-valor 0,005). O domínio “Significativo” da Ficha de Pesquisa Motivacional teve a maior pontuação (19,23), e a média da Escala de Autoavaliação do Impacto do Treinamento no Trabalho foi de 42,3 pontos. Esses resultados indicam que o site é valioso para a formação de professores. Conclusão O site REMIC foi atualizado e está disponível em https://remic.fob.usp.br em português brasileiro e inglês americano. Os professores o consideraram eficaz como ferramenta de formação continuada.

O objetivo geral desta pesquisa foi investigar quais as consequências da precariedade ou inexistência da educação escolar nos sete (07) reassentamentos criados para alocar os deslocados da implantação das Hidrelétricas no Rio Madeira, em Porto Velho/RO. Foram entrevistados noventa e três (93) indivíduos desses reassentamentos através de um questionário semiaberto, com análise quantitativa e qualitativa. Os resultados indicam não haver diferença significativa que aponte melhorias na educação escolar e, as consequências da precariedade ou inexistência da educação escolar produziu risco e vulnerabilidade que se traduzem na atual condição de não reconfiguração socioterritorial dos reassentamentos.

ABSTRACT Background Coronary vascular dysfunction comprises VSA and/or MVA and is more common in women than in men with angina without obstructive coronary artery disease (ANOCA). Invasive coronary function testing is considered the reference test for diagnosis, but its burden on patients is large. We aimed to investigate the potential of electrocardiography (ECG) as noninvasive marker for vasospastic angina (VSA) and microvascular angina (MVA) diagnosis. Methods We systematically screened Pubmed and EMBASE databases for studies reporting on ECG characteristics in ANOCA patients with (a suspicion of) coronary vascular dysfunction. We assessed study quality using QUADAS‐2. We extracted data on diagnostic values of different ECG characteristics and analyzed whether the studies were sex‐stratified. Results Thirty publications met our criteria, 13 reported on VSA and 17 on MVA. The majority addressed repolarization‐related ECG parameters. Only 1 of the 13 VSA papers and 4 of the 17 MVA papers showed diagnostic accuracy measures of the ECG characteristics. The presence of early repolarization, T‐wave alternans, and inverted U waves showed of predictive value for VSA diagnosis. The QTc interval was predictive for MVA diagnosis in all six studies reporting on QTc interval. Sex‐stratified results were reported in only 5 of the 30 studies and 3 of those observed sex‐based differences. Conclusions ECG features are not widely evaluated in diagnostic studies for VSA and MVA. Those features predictive for VSA and MVA diagnosis mostly point to repolarization abnormalities and may contribute to noninvasive risk stratification.

RESUMO Objetivo traduzir e validar para o português brasileiro o instrumento Childhood Hearing Loss Question Prompt List for Parents, visando apoiar a comunicação entre profissionais de saúde e famílias de crianças com perda auditiva no Brasil. Métodos abordagem metodológica compreendendo a tradução e adaptação transcultural do instrumento, seguida de validação por meio de um processo iterativo que envolveu especialistas e o público-alvo. A tradução foi realizada por tradutores bilíngues, com subsequente retrotradução e revisão por um comitê de especialistas, para assegurar a equivalência conceitual e cultural. A validação envolveu a coleta e análise de feedback de pais de crianças com perda auditiva e profissionais fonoaudiólogos, utilizando o Índice de Validade de Conteúdo para avaliar a adequação do instrumento. Resultados a análise indicou aceitação positiva do instrumento traduzido, com a maioria dos itens atingindo Índice de Validade de Conteúdo acima do limiar de 0,78, refletindo a relevância e compreensibilidade do instrumento no contexto brasileiro. Um item específico não atingiu o índice desejado, destacando a necessidade de revisão adicional para otimizar a clareza e pertinência. Conclusão o Childhood Hearing Loss Question Prompt List for Parents traduzido e validado demonstrou ser uma ferramenta eficaz para o contexto brasileiro, facilitando a comunicação centrada na família e o envolvimento em cuidados auditivos pediátricos. Este estudo reforça a importância de adaptar e validar instrumentos de avaliação para refletir as especificidades culturais e linguísticas, assegurando a aplicabilidade e eficácia no atendimento às famílias de crianças com perda auditiva.

AIM: The aim of this study was to describe psychosocial health factors in a community sample of men who sought care for sexual assault in the previous 3 months and who were recruited using Internet-based methods. METHODS: The cross-sectional survey assessed factors related to HIV postexposure prophylaxis (PEP) uptake and adherence postsexual assault: HIV risk perception, HIV PEP self-efficacy, mental health symptoms, social responses to sexual assault disclosure, PEP costs, negative health habits, and social support. RESULTS: There were 69 men in the sample. Participants reported high levels of perceived social support. A high proportion reported symptoms of depression ( n = 44, 64%) and posttraumatic stress disorder ( n = 48, 70%) consistent with cutoffs for clinical diagnoses. Just over a quarter of participants reported past 30-day illicit substance use ( n = 20, 29%), and 45 people (65%) reported weekly binge drinking (six or more drinks on one occasion). POTENTIAL IMPACT OF THIS WORK ON HEALTH EQUITY AND FORENSIC NURSING: Men are underrepresented in sexual assault research and clinical care. We highlight similarities and differences between our sample and prior clinical samples and also outline needs for future research and interventions. CONCLUSIONS: Men in our sample were highly fearful of acquiring HIV, initiated HIV PEP, and completed or were actively taking HIV PEP at the time of data collection despite high rates of mental health symptoms and physical side effects. These findings suggest that forensic nurses need not only to be prepared to provide comprehensive counseling and care to patients about HIV risk and prevention options but also to address the unique follow-up needs of this population.

Abstract Background Alumina particles from the grit blasting of Ti-alloy stems are suspected to contribute to aseptic loosening. An alumina-reduced stem surface was hypothesized to improve osseointegration and show comparable short-term outcomes to those of a standard stem. Methods In this prospective, double-blind, randomized trial, 26 standard (STD) and 27 experimental new technology (NT) stems were implanted. The latter were additionally treated by acid etching and ice blasting to remove alumina particles from the grit-blasting process. Follow-up occurred at 12 and 24 months. Bone mineral density (BMD) around the stem was measured by a dual-energy x-ray absorptiometry device (DEXA). Radiographs were reviewed for alterations. Clinical scoring comprised the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Harris Hip Score (HHS). Survival rates were calculated up to 50 months. Results Lower mean BMD and more severe cortical hypertrophies were found in the NT group. At 12 months, radiolucent lines were observed mostly in the metaphyseal zone for both groups, with a progression tendency in the NT group at 24 months. At 12 months, pain scores and the WOMAC total and physical activity scores were significantly lower in the NT group, without any differences thereafter. The number of NT stem revisions amounted to 6 (24%) and 11 (41%) at 24 and 50 months, respectively. Conclusion In the NT group, unexpected catastrophic failure rates of 41% caused by early aseptic loosening were noted within 50 months. Compared with the STD stems, NT stems lead to poor clinical and radiographic results. Level of evidence: II. Trial Registration: NCT05053048.

The soil sorptivity, S, and saturated hydraulic conductivity, Ks, are fundamental soil hydraulic properties that can be estimated from the cumulative infiltration curve measured with a disc infiltrometer. The Haverkamp infiltration model is widely used to estimate S and Ks. This model includes as inputs the constants β and γ and the difference between the initial, θi, and final, θs, volumetric water contents, Δθ. Since Δθ would be expressive of the possible measurement errors, and assuming β, γ, and θi as known values, the first objective of this work is to analyze the influence of θs on the optimization of Ks and S. To this end, a sensitivity analysis, which consists of estimating Ks and S for a range of θs was applied on synthetic infiltration curves simulated for homogeneous columns of sand and loam soil. Then, and working on real soils under different tillage management, we evaluated different procedures to measure θs and analyzed its impact on Ks and S estimation. Four different techniques were compared: the gravimetric-core method and two TDR invasive (3 and 5 cm) and a non-invasive (NiP) probes. All TDR probes were connected to a low-cost NanoVNA. The sensitivity analysis showed that θs, Ks and S can be optimized simultaneously from the inverse analysis of an infiltration curve when β and γ are known values and the infiltration curve is near the steady-state zone. However, due to the intrinsic complexities of real soils and the fact that β and γ are unknown variables, we recommended to optimize Ks and S using measured θs. The NiP sensor connected to a NanoVNA provided a fast, inexpensive, clean, accurate and robust alternative to measure θs at the end of the infiltration experiments.

Background Inflammatory bowel disease (IBD) is a chronic gastrointestinal condition. While inflammatory biomarkers are valuable for diagnosing and monitoring the disease, their correlation with patients’ quality of life (QoL) is not well-established.Purpose This study aims to investigate the correlations between inflammatory biomarkers and the quality of life (QoL) variables of individuals diagnosed with IBD in clinical remission.Methods The sample of this cross-sectional study included 74 patients (80% women; 45 ± 11 years old) diagnosed with IBD. Outcome variables included faecal calprotectin (FC), C-reactive protein (CRP), cortisol levels from hair samples, and anxiety and depression assessed using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively), alongside QoL evaluated with the Inflammatory Bowel Disease Questionnaire 32 (IBDQ-32). Bivariate correlations were calculated using the Pearson correlation coefficient, and stepwise linear regression analyses were conducted to identify independent factors contributing to IBDQ-32 scores.Results The IBDQ-32 did not significantly correlate with any biomarkers. However, it exhibited a large and statistically significant negative correlation with HADS-A (r = −0.651) and HADS-D (r = −0.611) scores (p

Can contemporary cognitive science explain clinical expertise? We argue that the answer could be no. In support of this, we provide an analysis of two of the most essential expressions of clinical expertise in nursing and medicine, the ability to run a code blue and the ability to diagnose congestive heart failure. We show how it makes sense to treat both as examples of what we call inference to the best action, and we then argue that two of the standard explanatory paradigms of cognitive science - the Humean and Bayesian paradigms - are unable to provide a plausible analysis of inference to the best action.

This research note presents a conservation project of a Polynesian barkcloth belonging to the Musée Cantonal d’Archéologie et d’Histoire in Lausanne, Switzerland. The aims of this project were to deepen existing knowledge about the history of this barkcloth using information gathered from available archives, to place it in time using macro- and microscopic observations and analysis of its materials, to place it geographically through a comparison with other barkcloth pieces kept in different museums, and to consolidate and secure the object for future studies or exhibitions.

No presente trabalho, aborda-se a importância da modelagem matemática na compreensão e prevenção de pandemias, com foco em um modelo Suscetível-Infectado-Suscetível-Infectado-Recuperado. Este modelo compartimental, uma extensão do clássico modelo SIR, incorpora a possibilidade de reinfecção e estágios intermediários de suscetibilidade, além de considerar a competição entre diferentes variantes virais. O estudo propõe e analisa o modelo, investigando suas propriedades intrínsecas, como o equilíbrio em torno de um ponto crítico e o cálculo do número básico de reprodução. Além disso, o modelo é aplicado na cidade de Manaus durante um período crítico da pandemia de COVID-19, permitindo uma avaliação prática de sua eficácia na compreensão da dinâmica da doença e no desenvolvimento de estratégias de controle. Os resultados obtidos demonstram que o modelo enriquece o entendimento da epidemiologia da COVID-19, fornecendo insights cruciais para o planejamento de intervenções direcionadas e adaptadas às características específicas das variantes circulantes. Além disso, o modelo contribui para debates didáticos sobre sistemas dinâmicos, ampliando o conhecimento sobre a propagação de doenças infecciosas e a importância da modelagem matemática na saúde pública.

BACKGROUND: End-stage renal disease is associated with a high risk of cardiovascular events. It is unknown, however, whether mild-to-moderate kidney dysfunction is causally related to coronary heart disease (CHD) and stroke. METHODS: Observational analyses were conducted using individual-level data from 4 population data sources (Emerging Risk Factors Collaboration, EPIC-CVD [European Prospective Investigation into Cancer and Nutrition-Cardiovascular Disease Study], Million Veteran Program, and UK Biobank), comprising 648 135 participants with no history of cardiovascular disease or diabetes at baseline, yielding 42 858 and 15 693 incident CHD and stroke events, respectively, during 6.8 million person-years of follow-up. Using a genetic risk score of 218 variants for estimated glomerular filtration rate (eGFR), we conducted Mendelian randomization analyses involving 413 718 participants (25 917 CHD and 8622 strokes) in EPIC-CVD, Million Veteran Program, and UK Biobank. RESULTS: There were U-shaped observational associations of creatinine-based eGFR with CHD and stroke, with higher risk in participants with eGFR values 105 mL·min-1·1.73 m-2, compared with those with eGFR between 60 and 105 mL·min-1·1.73 m-2. Mendelian randomization analyses for CHD showed an association among participants with eGFR 105 mL·min-1·1.73 m-2. Results were not materially different after adjustment for factors associated with the eGFR genetic risk score, such as lipoprotein(a), triglycerides, hemoglobin A1c, and blood pressure. Mendelian randomization results for stroke were nonsignificant but broadly similar to those for CHD. CONCLUSIONS: In people without manifest cardiovascular disease or diabetes, mild-to-moderate kidney dysfunction is causally related to risk of CHD, highlighting the potential value of preventive approaches that preserve and modulate kidney function.

The persistence of the COVID-19 pandemic has led to a multitude of changes in the ways nursing education, research, and practice are carried out. In addition to the demands of shifting to remote education as well as finding alternatives to direct patient care learning, nursing faculty and students are directly confronting morbidity and mortality among classmates, colleagues, friends, and family members. These experiences unquestionably meet criteria for traumatic experience, and this must be accounted for in nursing education as they can have detrimental effects on learning, teaching, and well-being. The current generation of nursing students and faculty will necessarily carry the traumatic experiences of this chaotic time into workplace, classroom, and community settings. Understanding how to manage this trauma appropriately not only supports individuals through this experience but provides increased opportunity and capacity for the provision of trauma-informed care (TIC) to patients and colleagues going forward. This paper describes some of the ways COVID-19-related trauma may affect nursing faculty and students; and proposes application of TIC principles to research, education, and practice environments to enhance well-being and overall functioning in the profession.

Prdm1 mutant mice are one of the rare mutant strains that do not develop whisker hair follicles while still displaying a pelage. Here, we show that Prdm1 is expressed at the earliest stage of whisker development in clusters of mesenchymal cells before placode formation. Its conditional knockout in the murine soma leads to the loss of expression of Bmp2, Shh, Bmp4, Krt17, Edar, and Gli1, though leaving the β-catenin-driven first dermal signal intact. Furthermore, we show that Prdm1 expressing cells not only act as a signaling center but also as a multipotent progenitor population contributing to the several lineages of the adult whisker. We confirm by genetic ablation experiments that the absence of macro vibrissae reverberates on the organization of nerve wiring in the mystacial pads and leads to the reorganization of the barrel cortex. We demonstrate that Lef1 acts upstream of Prdm1 and identify a primate-specific deletion of a Lef1 enhancer named Leaf. This loss may have been significant in the evolutionary process, leading to the progressive defunctionalization and disappearance of vibrissae in primates.