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Introduction: Emergency department (ED) patients requiring immediate treatment often bypass a triage process that includes HIV screening. In this study we aimed to investigate the potential missed opportunity to screen these patients for HIV.Methods: We conducted this cross-sectional study in a municipal ED over a six-week period between June–August 2019. The patient population in this study arrived in the ED as a pre-notification from prehospital services or designated by the ambulance or walk-in triage nurse as requiring immediate medical attention. Medical student researchers collected demographic data and categorized patients into three clinical groups (trauma, medical, psychiatric). They documented the patient’s eligibility for HIV screening as determined by a physician and confirmed that the patient met criteria of clear mental status, controlled pain, stable vital signs, and ability to contribute to a medical history and physical examination. The student researchers did this at initial presentation and then again during the patient’s ED stay of up to eight hours. The study outcomes measured the percentage of total patients within each clinical group (trauma, medical, psychiatric) able to engage in the HIV screening process upon arrival and during an eight-hour ED stay.Results: On average, 700 patients per month are announced on arrival via overhead page, indicating that they require immediate medical attention. During the six-week study, 205 patients (approximately 20% of total) were enrolled: 114 trauma; 56 medical; and 35 psychiatric presentations. The average patient age was 53; 60% of patients were male. Niney-eight (48%) patients were eligible for HIV screening within an eight-hour ED stay; 63 (31%) were able to be screened upon initial presentation and 35 (17%) in the first eight hours of their ED visit. Within medical and trauma subgroups, there was no significant difference in the proportion (36%) of patients that could be screened upon presentation. Among the psychiatric presentations, only five (14%) were able to be screened during their hospital stay.Conclusion: Triage protocols for high-acuity medico-surgical patients resulted in a missed opportunity to screen 48% of patients for HIV. Acute psychiatric patients represented a particular missed opportunity. We advocate for universal HIV screening, facilitated through electronic best practice advisories and a modified triage tailored to higher acuity patients. Implementing these changes would ensure that HIV screening is not overlooked in high-acuity ED patients, leading to early detection and timely interventions.

The World Health Organization (WHO) plays an Important role In developing evidence-based and ethically sound guidelines to assist health workers, programme managers and policy-makers, particularly in countries with limited capacities to create their own. While the development of these guidelines follows rigorous methods, contextualizing recommendations is often necessary to ensure their applicability, feasibility and acceptability at the country level. The adaptation and adoption of global guidelines should happen in a transparent, systematic and participatory manner to maintain credibility while ensuring the ownership necessary for implementation. Here, we present an example from Estonia that showcases the process, requirements and outcomes of implementing WHO guidelines through effective contextualization. The work in Estonia showed that contextualization can shorten guideline development time and reduce costs. To support countries in contextualizing guidelines, including those developed by WHO, to local contexts while maintaining trustworthiness and relevance, the WHO Regional Office for Europe has developed a handbook based on the GRADE- Adolopment approach to guide this process. Furthermore, a rapid assessment of 21 of the 53 Member States in the WHO European Region revealed that many countries need guidance and support to build capacity for contextualizing guidelines. To address the capacity gaps, we suggest a way forward that encompasses four areas of further work: standardizing methods; institutionalizing guideline programmes and initiatives; promoting continuous and shared learning; and providing support and identifying resources. Strengthening countries' capacities to contextualize global guidelines is crucial and will become especially relevant during future health threats, such as pandemics, climate change and conflict situations. [phrase omitted] L'Organisation mondiale de la Sante (OMS) joue un role crucial dans l'elaboration de lignes directrices ethiques et fondees sur des donnees factuelles qui viennent soutenir le personnel de sante, les gestionnaires de programmes et les responsables politiques, en particulier dans les pays qui ne disposent pas de capacites suffisantes pour developper les leurs. Bien que la mise au point de ces lignes directrices suive des methodes rigoureuses, il est souvent indispensable de contextualiser les recommandations pour les rendre applicables, faisables et acceptables a l'echelle nationale. Ladaptation et l'adoption de lignes directrices mondiales doivent s'effectuer en toute transparence, de maniere systematique et participative, en vue de preserver leur credibilite tout en assurant le niveau d'implication necessaire a leur deploiement. Ce document s'appuie sur un exemple provenant d'Estonie pour illustrer le processus, les exigences et les resultats lies a la mise en pratique de lignes directrices emises par l'OMS grace a une contextualisation efficace. Le travail realise en Estonie a montre que cette contextualisation pouvait reduire le temps consacre au developpement de la ligne directrice et faire baisser les couts. Afin d'aider les pays a adapter les lignes directrices, notamment celles elaborees par l'OMS, a chaque contexte local tout en conservant leur fiabilite et leur pertinence, le Bureau regional de l'OMS pour l'Europe a redige un manuel qui s'inspire de l'approche GRADEAdolopment pour guider ce processus. En outre, une evaluation rapide de 21 des 53 Etats Membres de la Region europeenne de l'OMS a revele que nombre d'entre eux avaient besoin d'assistance et de conseils pour developper leurs capacites de contextualisation des lignes directrices. Nous suggerons, pour combler les lacunes, une strategie constituee de quatre axes pour la poursuite des travaux: la standardisation des methodes, l'institutionnalisation des initiatives et programmes relatifs aux lignes directrices, la promotion d'un apprentissage commun et continu, ainsi que la mise a disposition d'un soutien et l'identification des ressources. Renforcer les capacites des pays a contextualiser les lignes directrices mondiales est essentiel et revetira une importance particuliere face a de futures menaces sanitaires telles que les pandemies, le changement climatique et les situations de conflit. [phrase omitted] La Organizacion Mundial de la Salud (OMS) desempena una funcion importante en la elaboracion de directrices basadas en evidencias y solidas desde el punto de vista etico para ayudar al personal sanitario, los gestores de programas y los responsables de formular politicas, sobre todo en paises que tienen una capacidad limitada para crear sus propias directrices. Aunque la elaboracion de estas directrices sigue metodos rigurosos, suele ser necesario contextualizar las recomendaciones para asegurar su aplicabilidad, viabilidad y aceptabilidad a nivel nacional. La adaptacion y la adopcion de directrices mundiales deben realizarse de forma transparente, sistematica y participativa para mantener la credibilidad y asegurar al mismo tiempo la apropiacion necesaria para su implementacion. En este documento, se presenta un ejemplo de Estonia que muestra el proceso, los requisitos y los resultados de la aplicacion de las directrices de la OMS mediante una contextualizacion efectiva. El trabajo realizado en Estonia demostro que la contextualizacion puede acortar el tiempo de elaboracion de las directrices y reducir los costes. Para ayudar a los paises a adaptar las directrices, incluidas las elaboradas por la OMS, a los contextos locales, manteniendo al mismo tiempo su fiabilidad y pertinencia, la Oficina Regional para Europa de la OMS ha elaborado un manual basado en el enfoque GRADE-Adolopment para orientar este proceso. Ademas, una evaluacion rapida de 21 de los 53 Estados Miembros de la Region de Europa de la OMS revelo que muchos paises necesitan orientacion y apoyo para crear capacidad a fin de contextualizar las directrices. Para abordar las carencias de capacidad, se sugiere una via de avance que abarca cuatro areas de trabajo ulterior: estandarizar metodos, institucionalizar programas e iniciativas de directrices, promover el aprendizaje continuo y compartido, y proporcionar apoyo e identificar recursos. El refuerzo de las capacidades de los paises para contextualizar las directrices mundiales es crucial y sera de especial relevancia durante futuras amenazas para la salud, como las pandemias, el cambio climatico y las situaciones de conflicto., Introduction The World Health Organization (WHO) has the mandate to develop guidelines and provide recommendations under its normative and global standard-setting function. (1) These guidelines assist health workers, programme managers [...]

Abstract Background Obesity and metabolic syndrome are major public health concerns linked to cognitive decline with aging. Prior work from our lab has demonstrated that short-term high fat diet (HFD) rapidly impairs memory function via a neuroinflammatory mechanism. However, the degree to which these rapid inflammatory changes are unique to the brain is unknown. Moreover, deviations in gut microbiome composition have been associated with obesity and cognitive impairment, but how diet and aging interact to impact the gut microbiome, or how rapidly these changes occur, is less clear. Thus, our study investigated the impact of HFD after two distinct consumption durations: 3 months (to model diet-induced obesity) or 3 days (to detect the rapid changes occurring with HFD) on memory function, anxiety-like behavior, central and peripheral inflammation, and gut microbiome profile in young and aged rats. Results Our data indicated that both short-term and long-term HFD consumption impaired memory function and increased anxiety-like behavior in aged, but not young adult, rats. These behavioral changes were accompanied by pro- and anti-inflammatory cytokine dysregulation in the hippocampus and amygdala of aged HFD-fed rats at both time points. However, changes to fasting glucose, insulin, and inflammation in peripheral tissues such as the distal colon and visceral adipose tissue were increased in young and aged rats only after long-term, but not short-term, HFD consumption. Furthermore, while subtle HFD-induced changes to the gut microbiome did occur rapidly, robust age-specific effects were only present following long-term HFD consumption. Conclusions Overall, these data suggest that HFD-evoked neuroinflammation, memory impairment, and anxiety-like behavior in aging develop quicker than, and separately from the peripheral hallmarks of diet-induced obesity.

Existing research suggests that mindfulness cultivates positive affect while reducing negative affect, and facilitates increases in resilience. More research is needed to examine the complex mechanisms by which emotional affect likely translates mindfulness into increased states of resilience in undergraduates. We hypothesised that the relationship between mindfulness and resilience in Maltese undergraduates is mediated by both positive and negative affect. Using a cross-sectional survey design and quantitative methodology based on mediation analysis, a questionnaire comprising the Kentucky Inventory of Mindfulness Skills, Positive and Negative Affect Schedule, and Brief Resilience Scale was circulated among 226 Maltese undergraduates. The results support previous research indicating significant relationships between mindfulness and both forms of emotional affect, as well as increased resilience. A path analysis revealed full mediation of the interaction between mindfulness and resilience by affective well-being. The indirect pathways through positive and negative affect to resilience, cumulatively accounted for a majority of the explanatory power attributable to mindfulness alone. Finally, an argument is presented in favour of mindfulness as a more formalised intervention within higher education settings, to support broader psychological wellness outcomes among Maltese undergraduates.

A combination of sisal fibers and bio-based epoxy resin offers good potential for producing environmentally friendly bio-composites with improved or equivalent mechanical properties compared to those obtained using 100% synthetic resins. However, the poor interaction between the two materials caused by the different distribution of electrical charge over the atoms joined by the bond in the functional groups of the chemical structure (polarity) necessitates the modification of one of the surfaces of the constituents through various techniques. The paper discusses available literature on several treatments to improve the adhesion between sisal fibers and thermoset epoxy matrices by achieving favorable wettability, mechanical interlocking, and improved interaction through chemical bonding. It is shown that fiber washing in an NaOH solution followed by rinsing and drying is the prevalent chemical treatment. With NaOH treatments, researchers observed cleaner fibers and this promoted better adhesion with the epoxy matrix. Coupling agents such as silane treatments showed an improved resistance to fiber moisture absorption. Thermal treatments affect the fiber’s morphology by increasing the crystallinity of the cellulose leading to stiffer composites. It was also observed that the improvement in fiber-matrix adhesion had an adverse effect on the impact strength of the composite.

Avian species are in rapid decline worldwide, with 1 in 8 species facing extinction, and in North America shorebird species are declining at a higher proportion than other groups. The nearshore ecosystem in Maine (USA) supports several bird species that rely on intertidal and subtidal zones, including high densities of migratory shorebirds and wintering waterfowl. Additionally, Acadia National Park (ANP) includes some of the country's highest densities of declining populations of Purple Sandpipers (Calidris maritima) and state threatened Harlequin Ducks (Histrionicus histrionicus). We investigated whether the distribution of candidate umbrella species overlapped with the distribution of 5 waterfowl taxa (Common Eiders [Somateria mollissima], Long-tailed Ducks [Clangula hyemalis], Black Scoters [Melanitta americana], Bucephala spp., and Mallards [Anas platyrhynchos]), thereby examining whether conservation actions (e.g., conservation closures) taken to preserve these 2 species of high conservation concern might also benefit the larger taxonomic groups to which they belong, a concept known as umbrella species conservation. To answer this question, bird abundance surveys were conducted within ANP during 2021 and 2022, and detection and occupancy were compared among the focal groups using a hypothesis-driven model. The occupancy distributions of our 5 waterfowl taxa revealed that sites with the highest occupancy estimates for Common Eiders, Long-tailed Ducks, and Black Scoters included sites occupied by Purple Sandpipers and Harlequin Ducks. Bucephala spp. and Mallard occupancy, however, only weakly overlapped with our candidate umbrella detections, occurring in sites with the lowest and mid-range occupancy estimates. Thus, any positive effect of conservation closures based on these 2 species of concern might impact some, but not all, species we surveyed. Including more survey locations occupied by Purple Sandpipers and Harlequin Ducks would be necessary to see if this pattern is generalizable across the region. Our low sample size for umbrella species detections, however, also highlights the limited utility of using rare species as umbrellas. Received 12 August 2023. Accepted 2 March 2024. Key words: coastal ecosystem, Harlequin Duck, Purple Sandpiper, rockweed harvesting, single-species occupancy. (Spanish)-Las especies de aves estan en un declive rapido en todo el mundo, con 1 de cada 8 especies en riesgo de extincion y en Norteamerica las especies de aves costeras estan declinando a una mayor proporcion que otros grupos. El ecosistema litoral en Maine (EEUU) sostiene a varias especies de aves que dependen de zonas intermareal y submareales, incluyendo altas densidades de aves playeras migratorias y aves acuaticas invernales. Adicionalmente, Acadia National Park (ANP) incluye unas de las densidades mas altas del pais de las poblaciones en declive de correlimo Calidris maritima y de pato Histrionicus histrionicus, amenazados a nivel estatal. Estudiamos si la distribucion de especies sombrilla candidatas sobrelapaba con la distribucion de 5 taxa de aves acuaticas (eider Somateria mollissima, pato Clangula hyemalis, pato negro Melanitta americana, Bucephala spp. y pato Anas platyrhynchos), por tanto examinando si las acciones de conservacion (como cierres de conservacion) tomadas para preservar esas 2 especies en peligro critico tambien podrian beneficiar a los grupos taxonomicos mas amplios a los que pertenecen, un concepto conocido como conservacion de especies sombrilla. Para responder a esta pregunta, se realizaron reconocimientos de abundancia de aves en ANP durante el 2021 y el 2022, y se comparo la deteccion y la ocupacion entre grupos focales usando un modelo guiado por hipotesis. La distribucion de ocupacion de nuestras 5 taxa de aves acuaticas mostraron que los sitios con los mayores estimados de ocupacion para eider S. mollissima, pato C. hyemalis y pato negro Melanitta americana incluian sitios ocupados por correlimo C. maritima y pato H. histrionicus. Sin embargo, la ocupacion de Bucephala spp. y de pato A. platyrhynchos solo tuvo un debil sobrelapamiento con la deteccion de nuestras candidatas a especies sombrilla, en sitios con estimados de ocupacion de rango medio y bajo. Entonces, cualquier conclusion positiva del efecto de conservacion basada en estas 2 especies de interes puede tener algun impacto sobre algunas, pero no todas, las especies del reconocimiento. Seria necesario incluir mas localidades de reconocimiento ocupadas por correlimo Calidris maritima y pato H. histrionicus para ver si este patron es generalizable en toda la region. Nuestro bajo numero de reconocimientos para la deteccion de especies sombrilla, sin embargo, tambien recalca el uso limitado de usar especies raras como especies sombrilla. Palabras clave: correlimo Calidris maritima, cosecha de algas, ecosistemas costeros, ocupacion de una sola especie, pato Histrionicus histrionicus., During the Maine winter, the coastal areas of Acadia National Park (ANP) include some of the continental United States' highest densities of both Purple Sandpipers (Calidris maritima) and Harlequin Ducks [...]

Abstract Background Guidelines recommend operative treatment followed by cast immobilization for acute complete ulnar collateral ligament (UCL) ruptures, including Stener lesions. This recommendation is based on expert opinion, anatomic theories, and low-quality observational case series. High-quality studies comparing non-operative treatment to operative treatment are lacking. We hypothesize that primarily non-operative treatment with cast immobilization (cast immobilization) is non-inferior regarding functional outcome and carries concomitant lower costs compared with immediate operative treatment followed by cast immobilization (operative treatment) for complete UCL ruptures, including Stener lesions. Methods This is a multicenter randomized controlled non-inferiority trial (RCT) including patients of 18 years and above, requiring treatment for an acute complete UCL rupture, including Stener lesions. Patients are randomized to cast immobilization or operative treatment followed by cast immobilization. Immobilization consists of 4 weeks of a non-removable cast around the metacarpophalangeal (MCP) and carpometacarpal (CMC) joint of the thumb in a neutral position, followed by a removable cast for 4 weeks for both groups. Patients in the cast immobilization group are re-evaluated 2 to 3 weeks after the start of cast immobilization to examine thumb stability and determine if secondary surgery is required. In case of persistent laxity, secondary surgery is required. The primary outcome is hand function expressed as the Michigan Hand outcome Questionnaire (MHQ) at 6 months (from injury to 6 months after). Discussion If cast immobilization is non-inferior to operative treatment, the proposed treatment strategy will reduce patient burden by preventing surgery. It is expected that about one in ten patients who started with cast immobilization will need secondary surgery during re-evaluation. As a result, completion of the treatment will take longer for these patients compared to patients who received immediate operative treatment. Trial registration Central Committee on Research Involving Human Subjects (CCMO), NL78886.100.21; registered on 4 October 2021. Medical Research Ethics Committees United (MEC-U), R21.006; registered on 09 December 2021. Clinical Trial register, identifier: NCT05291260; retrospectively registered on 22 March 2022.

This paper discusses the role of the Catholic Church amongst the Maltese diaspora in Australia, and its impact on the maintenance of the Maltese language, a small community language spoken largely by the first generation of immigrants who left Malta after the Second World War. The study is based on interview data collected among three generations of Maltese in Melbourne and Sydney. The findings of this research demonstrate that the Church has been one of the main institutions that supported the Maltese community throughout the years and consequently it had a positive impact on language maintenance. On the other hand, the aging population of the Maltese community will be detrimental to the Maltese language in the years to come, and thus, probably, resulting in a complete shift to English, the dominant language of Australia.

A retrospective cohort study was conducted in Malta to assess the prevalence of threatened miscarriage. The study focuses on cases managed at a local state hospital over a 12-month period. Currently, data on pregnancies prior to 22 weeks’ gestation are not publicly available, which hampers understanding of the frequency and impact of threatened miscarriage. This research provides the basis for a potential prospective study which analysis the epidemiology and outcomes of threatened miscarriage and advocates for early intervention and appropriate patient counselling. The study included females who visited the Accident and Emergency Department in a local state hospital in 2019 with first trimester vaginal bleeding. It excluded patients with incomplete medical records. Data from various hospital departments were collected, anonymised and analysed to track outcomes such as miscarriage, ongoing pregnancy, ectopic or molar pregnancy. The research aimed to create a comprehensive local registry of pregnancy outcomes following threatened miscarriage, reflecting the national situation. In 2019, 711 pregnant women in Malta experienced first-trimester vaginal bleeding. Of these, 241 had successful births beyond 22 weeks’ gestation, while 412 experienced miscarriages, with other outcomes including ectopic and molar pregnancies and 58 women had an unknown pregnancy outcome. A significant association was found between maternal age and risk of miscarriage, particularly higher for women aged 35–46 and those under 19. Birthweight data revealed that threatened miscarriage complications likely led to low birthweights in a significant proportion of newborns. This study analysed pregnancy outcomes which were preceded by first trimester vaginal bleeding in pregnant women in Malta. Establishing a local register of pregnancy outcomes following first trimester vaginal bleeding provides clinicians with enhanced insights into the current local context. This resource may improve patient counselling and informed policy decisions and lay the groundwork for future research in the field.

The performance of children and young adults with Down syndrome (DS) on reading subskills and nonword reading was investigated. The performance of the participants with DS (N = 42) was compared to that of typically developing (N = 36) peers matched on fluid intelligence abilities. The study accounted for the different depths in orthography presented by the two languages. The independent samples t-test, Mann-Whitney U-test, ANCOVA and correlation analysis were used to analyse the data. This study identified that the participants with DS had several strengths, such as nonword reading, visual discrimination (VD) and phonological awareness. Verbal short-term memory, visual perceptual processing skills other than VD and rhyming skills were identified as weaker in DS compared with the control group. Results call for educators to expose readers with DS to a phonological approach to reading while accommodating difficulties in VSTM.

The rapid increase in telehealth has the potential to bring informed decision-making for prostate cancer screening (PCS) at the population level to high-risk individuals. We utilized a global technology platform of electronic health records data repositories (TriNetX) to determine its utility for Navigator-guided decision-making aid for PCS in Black men ages 45–79 years with no history of prostate cancer and PSA testing. Patients from Pennsylvania were invited to participate in a telehealth-delivered informed decision-making session for PCS. Focus groups, social learning theory, visual diagrams, and quantitative data on PCS risks and benefits were used to develop the content of the sessions, which included numerical discussions of risks vs. benefits in Black men. Participants completed several surveys, including baseline demographic and numeracy questionnaires, a one-on-one telehealth session with a trained Navigator, post-Navigation surveys, and an optional follow-up session with a urologist. Eighty-seven participants were consented and recruited. Although the mean numeracy score was only 1.9 out of 6, more than 90% rated as good or excellent that the sessions aided their PCS decision-making skills. This study indicates that Navigation by telehealth offers the ability to assist in informed decision-making for PCS at the population level.

Edible mushrooms have high concentrations of vitamins and minerals. They are considered functional foods for their disease-prevention properties. Mushroom consumption may reduce the risk of gastric cancer, the fifth most common cancer worldwide. We investigated the association between mushroom consumption and gastric cancer risk in a pooled analysis within the Stomach Cancer Pooling (StoP) Project and in a meta-analysis that also included previously published studies. A total of 3900 gastric cancer cases and 7792 controls from 11 studies were included in the StoP analysis. Mushroom consumption was measured using food frequency questionnaires. Higher mushroom consumption was associated with a lower risk of gastric cancer [relative risk (RR) for the highest vs. lowest consumption categories, 0.82; 95% confidence interval (CI), 0.71-0.95]. The corresponding RRs were 0.59 (95% CI, 0.26-1.33) in a meta-analysis of four previously published studies and 0.77 for all studies combined (95% CI, 0.63-0.95; n = 15 studies). In geographic subgroup analysis, the pooled risk in Western Pacific countries was (RR, 0.59; 95% CI, 0.40-0.87; n = 6). The stronger effect in Asian countries may reflect high level of antioxidants in mushroom species consumed in Asia.

Background Plain language summaries (PLSs) are easy-to-understand summaries of research articles that should follow principles of plain language and health literacy. PLS author instructions from health journals help guide authors on word count/PLS length, structure and the use of jargon. However, it is unclear whether published PLSs currently adhere to author instructions.Objectives This study aims to determine (1) the degree of compliance of published PLSs against the PLS author instructions in health journals and (2) the extent to which PLSs meet health literacy principles.Study design We conducted a three-part systematic environmental scan.Methods We examined 26 health journals identified from a previous review. In part 1, we assessed the inclusion frequency of PLSs in the 26 journals; in part 2, we assessed the level of compliance of PLSs with PLS author instructions; and in part 3, we conducted a health literacy assessment of the PLSs.Results Part 1: we found PLSs for 20/26 (76.9%) included journals. Part 2: no journal achieved 100% compliance with PLS author instructions. The highest level was 88% and the lowest was 0%. Part 3: no PLS was written at a readability level suitable for a general audience. The mean reading level was grade 15.8 (range 10.2–21.2and mean percentage of complex words, 31% (range 8.5%–49.8%).Discussion PLSs are an important means through which consumers can access research findings. We found a lack of compliance between PLS author instructions and PLSs published in health journals that may impede access and use by consumers. This study highlights the need for better ways to support authors adhere to PLS instructions and improved monitoring by journals.