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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.

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 [...]

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.

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.

Abstract Background Healthcare systems aim to enhance the health status and well-being of the individuals and populations they serve. To achieve this, measuring and evaluating the quality and safety of services provided and the outcomes achieved is essential. Like other countries, Romania faces challenges regarding the quality of care provided in its public hospitals. To address this, the Romanian Ministry of Health initiated reforms in 2022, including implementing a pay-for-performance model based on quality indicators. This paper presents a descriptive analysis of processes, methods, results and lessons learned from developing and piloting a set of Quality of Care indicators for Romanian public hospitals. Methods World Health Organization’s Athens Office on Quality of Care and Patient Safety assisted Romania in developing and piloting a set of quality-of-care indicators for public hospitals. The development phase included defining indicator domains, identifying potential indicators across these domains, and defining the final indicator set. The piloting phase involved selecting and recruiting piloting hospitals, developing data collection and validation methods and tools, training hospital staff, and collecting and analysing indicator data. Piloting ended with an evaluation workshop. Mixed, quantitative and qualitative methods were used, including literature reviews, stakeholder consultation workshops, survey instruments developed for this study, modified Delphi panels and consensus-building meetings. National stakeholders were actively involved throughout the process. Results Four priority domains were defined for quality-of-care indicators for Romanian public hospitals: patient safety, patient experience, healthcare workforce training and safety, and clinical effectiveness. 25 core indicators were selected across these domains. During the pilot, hospitals achieved an average completion rate of 90% for data submission, with all domains rated equally relevant during post-pilot evaluations. Lessons included the need for supportive legislation, improved internal auditing practices and enhanced staff training, refinement of indicator data collection methods and alignment of indicators with hospital-specific contexts. Conclusions This work presents a significant stride in improving Romanian public hospitals’ quality of care and patient safety. It underscores the importance of high-level commitment, stakeholder engagement, and robust data practices in driving successful quality improvement efforts. Emphasising the role of data-driven and patient-centric approaches in achieving optimal healthcare outcomes, lessons learned offer insights for the continuation of quality improvement work in Romania but also for healthcare systems elsewhere.

Abstract Background Tajikistan has embarked on health reforms to orient the health system towards primary health care (PHC). The health labour market analysis (HLMA) was initiated by the Ministry of Health with the World Health Organization (WHO) on policy questions related to the PHC workforce team. This article presents the results with focus on family doctors as a critical part of the PHC team, providing lessons for strengthening family medicine and PHC in the European Region and central Asia. Methods The HLMA framework was used to guide the analysis. The data for analysis were provided by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan. Descriptive means were used to analyse the data. A Technical Working Group guided the process. Results There has been an increase in the number of health workers in the country over the last 7 years. However, there is a huge shortage of family doctors when compared with norms, with decreasing family doctor densities over the last 7 years. Family doctors have the highest vacancy rates among specialists and also constitute the highest proportion of specialists who migrate. There is inequitable distribution of doctors across the regions. Overall number of enrolments and graduates in family medicine are declining. Although salaries in PHC are higher than in hospitals, the overall health workforce salaries are lower than the national average. While there have been efforts to retain and attract doctors to PHC in rural and remote regions, challenges exist. The attraction of doctors to narrow specialties may be leading to undermining PHC and family medicine. While the optimal skill-mix and availability of nurses provide an opportunity to strengthen multi-disciplinary teams at the PHC level, shortages and unequal distribution of doctors are affecting health services coverage and health indicators. Conclusions Application of the HLMA framework has helped identify the bottlenecks in the health labour market flows and the possible explanations for them. The policy considerations emerging out of the HLMA have contributed to improving evidence-based planning for retention and recruitment of the PHC workforce, improvements in medical and nursing education, and higher investments in the PHC workforce and particularly in family doctors. Implementation of the Action Plan will require political commitment, financial resources, strong inter-sectoral collaboration, stakeholder management, and cross-country learning of best practices. Through this process, Tajikistan has shown the way forward in implementing the Central Roadmap for health and well-being in Central Asia and the Framework for Action on the Health and Care Workforce in the WHO European Region.

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.

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.

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.

The genus Brachycephalus includes miniaturized toadlets with two distinct morphotypes: brightly colored species with a bufoniform phenotype and smaller, cryptic species with a leptodactyliform phenotype. The diversity of leptodactyliform species is still underappreciated, and we generally lack fundamental information about their biology. Recent sampling efforts, including DNA analyses and recordings of advertisement calls, have improved our understanding of this group. In the present study, we describe a new species of Brachycephalus, one of the smallest vertebrates known. This new species is distinguished from its congeners by a combination of morphological, bioacoustic, and genetic data. Despite being among the smallest frogs globally (the second smallest amphibian species), it exhibits skeletal traits typical of larger frogs, such as the presence of cranial bones that are lost or fused in other miniature frogs, including other Brachycephalus. Our description underscores how new discoveries within the megadiverse fauna of the Atlantic Forest—a rich biodiversity hotspot—can provide insights into phenotypic variation, including vertebrate body size. By describing this new species, we also aim to revisit the hypothesis that the type series of B. hermogenesi includes two species, potentially including individuals of the species described here.

Tendon injuries disrupt successful transmission of force between muscle and bone, resulting in reduced mobility, increased pain, and significantly reduced quality of life for affected patients. There are currently no targeted treatments to improve tendon healing beyond conservative methods such as rest and physical therapy. Tissue engineering approaches hold great promise for designing instructive biomaterials that could improve tendon healing or for generating replacement graft tissue. More recently, engineered microphysiological systems to model tendon injuries have been used to identify therapeutic targets. Despite these advances, current tissue engineering efforts that aim to regenerate, replace, or model injured tendons have largely failed due in large part to a lack of understanding of how the mechanical environment of the tendon influences tissue homeostasis and how altered mechanical loading can promote or prevent disease progression. This review article draws inspiration from what is known about tendon loading from in vivo animal models and identifies key metrics that can be used to benchmark success in tissue engineering applications. Finally, we highlight important challenges and opportunities for the field of tendon tissue engineering that should be taken into consideration in designing engineered platforms to understand or improve tendon healing.

Abstract Aim Explore Australian‐Chinese immigrants' health literacy and preferences and engagement with translated diabetes self‐management patient education materials. Design The cross‐sectional survey was conducted with Australian‐Chinese immigrants at risk or with type 2 diabetes recruited via health services, and diabetes and community organisations. Methods The survey had three parts: (1) diabetes screening; (2) sociodemographic information, clinical characteristics and preferences for translated materials; and (3) Functional, Communicative and Critical Health Literacy (FCCHL) Scale. Results Of 381 participants, 54.3% reported diabetes (n = 207), the remainder pre‐diabetes or at risk (45.7%, n = 174); 34.1% male; mean age 64.1 years. Average total health literacy (FCCHL) scores were 35.3/56 (SD = 8.7). Participants with greater English proficiency reported higher health literacy (p 0.05). Although the majority of participants (75.6%, N = 288) were willing to receive translated diabetes information, only a small proportion (19.7%, N = 75) reporting receiving such materials. Conclusion There is a clear need for co‐designed diabetes patient education materials that meet the needs and adequately reach Australian‐Chinese immigrants. In particular, these materials must support people with limited English‐language proficiency. Implications for Nursing Practice This study highlights important considerations for nurses seeking to improve diabetes care for Chinese immigrants when incorporating patient education materials as part of their nursing education.

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.