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Objectives/Goals: Develop trauma-informed, victim-centered care skills. Foster student-led, translational research on trauma and victim services engage students in public policy and public health engagement support professional growth through research presentation and publication. Methods/Study Population: A review of the 2018–2021 mentorship program that engaged ten graduate students from diverse institutions (seven from San Juan Bautista School of Medicine, one from Interamerican University, one from UPR-Medical Sciences Campus, and one from Ponce Health Sciences University). Students participated in trauma-informed and victim-centered research projects focusing on sexual violence, child abuse, and victim services. They were mentored by Dr. Linda Laras and Dr. Linda Pérez at the Puerto Rico Health Justice Center, receiving hands-on experience through case discussions, literature review, research design, data collection, and presentations at the Start By Believing Symposium. Results/Anticipated Results: From 2018 to 2021, students developed trauma-informed care skills and conducted research on topics such as therapy dogs in courtrooms, victim services, and the impact of child sexual abuse. The results of this mentorship program included a publication in Cureus (10.7759/cureus.13644) and presentations at the Start By Believing Symposium, attended by legal and community professionals. The Fundación Intellectus Sexual Violence Research Scholarship was awarded, and the research earned award winning posters at multiple symposiums, including the SJBSM Interdisciplinary Research Symposium. Discussion/Significance of Impact: This mentorship translates trauma-informed research into real-world applications for sexual violence intervention. Medical students gain practical skills to address trauma in residency, while public health students shape policy. These research efforts have resulted in best practices and policy changes in Puerto Rico.
The development of clinical practical guidelines (CPGs) has been evolving towards a standard methodology based on GRADE. While reviewing CPGs, we found valid recommendations and no evidence to update. Including these initial recommendations in addition to new recommendations as part of the scope can improve understanding of the issue.
Methods
To develop a standardized approach to the writing of recommendations when updating a CPG, we consulted several methodological handbooks: Scottish Intercollegiate Guidelines Network (SIGN) (2011 and 2019 version), National Institute for Health and Care Excellence (NICE) last update (2024), New Zealand Guidelines Group (NZGG) grading system, and Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence 2. We compared the wording and specific symbols used to express strength of recommendations and quality of evidence with those used by GRADE, as described in the methodology handbook for developing clinical practice guidelines in the Spanish National Health System (SNS).
Results
A table was developed to express the equivalence of wording and symbols of quality of evidence and grading of recommendations to align the expression of SIGN, NICE, OCEBM, and NZGG methods with GRADE terminology. SIGN and NICE methodologies did not utilize specific symbols to express strength of recommendations; SIGN did not utilize the GRADE approach to assess the quality of evidence. The NZGG system applied its own classification for quality assessment and grading of recommendations. Oxford OCEBM keeps the terminology of level of evidence and grading of recommendations.
Conclusions
Using wording and symbols equivalence to standardize the recommendations of different methods to GRADE could assist the process of updating CPGs with the GRADE-Adolopment approach. Recommendations that are still valid and have been developed rigorously could be integrated in an updated CPG avoiding the duplication of efforts, but this generates uncertainty, especially when the quality assessment is focused on the studies designs.
There is increasing focus on effective preventative interventions applicable at the population scale such as through technology and web-based approaches. We aimed to reduce cognitive decline with ageing using an online package of interventions delivered intensively for 12 months followed by monthly boosters for 24 months.
Methods:
Invitations were sent to people aged 55-77 years from the 45 and Up study, a population-based cohort study of one in ten people aged 45 years and older in New South Wales, Australia (n=267,000). Participants were required to be eligible for at least two of four modules addressing physical inactivity and associated health risks (Physical Activity), adherence to a Mediterranean-type diet and health risks associated with poor nutrition (Nutrition), cognitive activity (Brain Training) and mental well-being (Peace of Mind). Participants received modules based on their risks, with 1:1 randomized allocation to active personalised coaching modules (intervention) or static information-based modules (control). The primary outcome was change in an online combined multi-domain cognitive score measured using COGSTATE and Cambridge Brain Sciences tests using intention to treat analysis. Secondary outcomes included specific cognitive domain and ANU-ADRI risk scores.
Results:
From 96,418 invitations, 14,064 (14%) consented; 11,026 (11%) were eligible; and 6,104 (6%) completed all 10 baseline assessments. Over three years there was a significantly greater improvement in the global composite cognition z-score in the intervention group, ES = 0.106 (p<0.001). Significant benefits were also found in complex attention, executive function and learning and memory (all p<0.001), as well as on a validated dementia risk instrument (p=0.007).
Conclusion:
An online platform that tailored physical activity, nutrition, brain training, depression and anxiety interventions to an individual’s risk factor profile over three years significantly delayed cognitive decline in older adults. This platform is scalable and if rolled out at a population level may help reduce the prevalence of dementia globally.
Mesocestoides is a controversial tapeworm with significant lack of data related to systematics and life cycles. This helminth has an indirect life cycle with vertebrates, mostly carnivorous mammals, as definitive hosts. Theoretically, a coprophagous arthropod would be the first intermediate host, and herptiles, mammals, and birds, which prey on these insects, would represent the second intermediate hosts. However, recent evidence suggests that this life cycle would require only two hosts, with no arthropods involved. In the Neotropics, although there are records of mammals and reptiles as hosts for Mescocestoides, no molecular analyses have been performed. This work aimed to record an additional intermediate host and molecularly characterize the isolated larvae. Thus, 18 braided tree iguanas (Liolaemus platei) from Northern Chile were collected and dissected during 2019. One lizard was parasitized by three morphotypes of larvae compatible with tetrathyridia of Mescocestoides. To achieve its specific identity, a molecular approach was performed: 18S rRNA and 12S rRNA loci were amplified through cPCR. The inferred phylogenies confirmed the morphological diagnosis and stated that all morphotypes were conspecifics. The sequences for both loci formed a monophyletic clade with high nodal support, representing a sister taxon to Mescocestoides clade C. This study represents the first molecular characterization of any taxon of Mescocestoides from the Neotropics. Future surveys from potential definitive hosts would help to elucidate its life cycle. Furthermore, an integrative taxonomic approach is required in additional studies from the Neotropical region, which would contribute to a better understanding of the evolutionary relationships of this genus.
OBJECTIVES/GOALS: This study aimed to determine the prevalence of cardiovascular risk factors in a group of victims of CSA in Puerto Rico and determine the impact of both the offender and the number of victimizations on the presentation of cardiovascular risk factors. METHODS/STUDY POPULATION: A study design of a retrospective chart review at a clinical forensic service in Puerto Rico. The demographic variables were age, sex, and health plan; the CV risk factors were family health history, level of physical activity, blood pressure, BMI, and lipid profile. Sexual violence experience variables were sexual assault, sexual molestation, the relationship with the offender, and the number of victimizations. Medical records were used to identify cardiovascular risk factors and variables associated with child sexual abuse victimization. Central tendency and frequencies were used to describe the risk factors and victimization. The Mann–Whitney and Fisher exact tests were used to determine the differences between the type of victimization and the risk factors for cardiovascular health. RESULTS/ANTICIPATED RESULTS: Most of the victims were female (81%), with an average age of 10 (SD 3.8). According to the 31 reviewed charts, 55% were victims of sexual assault, the offender was a family member (84%), and the assault had occurred more than once (81%). The study also found that systolic blood pressure, diastolic blood pressure, total cholesterol, and body mass index (BMI) were at unhealthy levels (based on age and sex); when the victim reported sexual assault, the offender was a family member, and more than one assault occurred. Systolic blood pressure, diastolic blood pressure, and fasting blood sugar were statistically significant among victims who reported being either sexually assaulted or sexually molested when the offender was a family member, and the victimization occurred more than once. DISCUSSION/SIGNIFICANCE: This study indicated a higher prevalence of CVD risk factors in children victims of sexual assault. The blood pressure, lipid profiles, and BMIs were much higher than the standards. Early childhood screening is crucial in alerting health professionals to a child’s exposure to trauma.
Characterizing neurocognitive endophenotypes of mental illnesses (MIs) could be useful for identifying at-risk individuals, increasing early diagnosis, improving disease subtyping, and proposing therapeutic strategies to reduce the negative effects of the symptoms, in addition to serving as a scientific basis to unravel the physiopathology of the disease. However, a standardized algorithm to determine cognitive endophenotypes has not yet been developed. The main objective of this study was to present a method for the identification of endophenotypes in MI research.
Methods
For this purpose, a 14-expert working group used a scoping review methodology and designed a method that includes a scoring template with five criteria and indicators, a strategy for their verification, and a decision tree.
Conclusions
This work is ongoing since it is necessary to obtain external validation of the applicability of the method in future research.
The Maintain Your Brain (MYB) trial is one of the largest internet-delivered multidomain randomised controlled trial designed to target modifiable risk factors for dementia. It comprises four intervention modules: physical activity, nutrition, mental health and cognitive training. This paper explains the MYB Nutrition Module, which is a fully online intervention promoting the adoption of the ‘traditional’ Mediterranean Diet (MedDiet) pattern for those participants reporting dietary intake that does not indicate adherence to a Mediterranean-type cuisine or those who have chronic diseases/risk factors for dementia known to benefit from this type of diet. Participants who were eligible for the Nutrition Module were assigned to one of the three diet streams: Main, Malnutrition and Alcohol group, according to their medical history and adherence to the MedDiet at baseline. A short dietary questionnaire was administered weekly during the first 10 weeks and then monthly during the 3-year follow-up to monitor whether participants adopted or maintained the MedDiet pattern during the intervention. As the Nutrition Module is a fully online intervention, resources that promoted self-efficacy, self-management and process of change were important elements to be included in the module development. The Nutrition Module is unique in that it is able to individualise the dietary advice according to both the medical and dietary history of each participant; the results from this unique intervention will contribute substantively to the evidence that links the Mediterranean-type diet with cognitive function and the prevention of dementia and will increase our understanding of the benefits of a MedDiet in a Western country.
Mental health services have changed the way they operate during the COVID-19 pandemic. We investigated the challenges and innovations reported by staff working in services for people with intellectual disability and/or autism in National Health Service (NHS) and non-NHS sectors, and in in-patient and community settings.
Results
Data were drawn from 648 staff who participated in a UK-wide online survey. Issues around infection risk and mitigation were more important to those working in the NHS and in-patient settings. Community staff were more likely to express concern about the practicalities of a rapid shift to remote working and engaging patients remotely. Qualitative data revealed support for maintaining remote staff working and remote service provision post-pandemic.
Clinical implications
Given the current emphasis on community support for people with intellectual disability and/or autism, the focus of research and clinical practice should be the development of accessible and effective models of remote service provision.
Substantial evidence has highlighted the importance of considering the mental health of healthcare workers during the COVID-19 pandemic, and several organisations have issued guidelines with recommendations. However, the definition of well-being and the evidence base behind such guidelines remain unclear.
Aims
The aims of the study are to assess the applicability of well-being guidelines in practice, identify unaddressed healthcare workers’ needs and provide recommendations for supporting front-line staff during the current and future pandemics.
Method
This paper discusses the findings of a qualitative study based on interviews with front-line healthcare workers in the UK (n = 33), and examines them in relation to a rapid review of well-being guidelines developed in response to the COVID-19 pandemic (n = 14).
Results
The guidelines placed greater emphasis on individual mental health and psychological support, whereas healthcare workers placed greater emphasis on structural conditions at work, responsibilities outside the hospital and the invaluable support of the community. The well-being support interventions proposed in the guidelines did not always respond to the lived experiences of staff, as some reported not being able to participate in these interventions because of understaffing, exhaustion or clashing schedules.
Conclusions
Healthcare workers expressed well-being needs that aligned with socio-ecological conceptualisations of well-being related to quality of life. This approach to well-being has been highlighted in literature on support of healthcare workers in previous health emergencies, but it has not been monitored during this pandemic. Well-being guidelines should explore the needs of healthcare workers, and contextual characteristics affecting the implementation of recommendations.
Interactions between smooth muscle cells (SMCs) and biomaterials must not result in phenotype changes as this may generate uncontrolled multiplication processes and occlusions in vascular grafts. The aim of this study was to relate the hydrolytic stability and biocompatibility of polyurethanes (PUs) on SMCs. A higher polycaprolactone (PCL) concentration was found to improve the hydrolytic stability of the material and the adhesion of SMCs. A material with 5% polyethylene glycol, 90% PCL, and 5% pentaerythritol presented high cell viability and adhesion, suggesting a contractile phenotype in SMCs depending on the morphology. Nevertheless, all PUs retained their elastic modulus over 120 days, similar to the collagen of native arteries (~10 MPa). Furthermore, aortic SMCs did not present toxicity (viability over 80%) and demonstrated adherence without any abnormal cell multiplication processes, which is ideal for the function to be fulfiled in situ in the vascular grafts.
Philippine courts do not use a multi-step proportionality test in their constitutional rights analyses. Instead, they use a combination of balancing and tiers-of-rights analyses. We offer two reasons why Philippine courts do not use the proportionality test. First, Philippine courts regard US constitutional law as more persuasive authority than other foreign jurisprudence, and the proportionality test is also absent from the U.S. Reports. Second, Philippine constitutionalism is originalist, and proportionality is not part of the original meaning of the Philippine Constitution. The Philippine Data Privacy Act of 2012 can be interpreted as the legislative empowerment of courts to use the proportionality test for the adjudication of data privacy rights. We argue that Philippine Congress has the power to mandate the use of the test with respect to constitutional rights that are subject to Legislative Delimitation Provisos, which give Congress the power to determine, by statute, the limits or boundaries of certain constitutional rights, including the right to informational privacy. We propose a two-step process in adjudicating informational privacy cases which would retain the judicial use of legal categories while concurrently introducing proportionality stricto sensu. This will offer a structured, transparent approach to the constitutional adjudication of data privacy rights.
Carmen made its debut in the Spanish Americas when the local networks of opera were at their apex, with a constant stream of singers from Europe and a desire for new repertoires outside the main staples of Italian opera. In this chapter, considering sources from across the region, we discuss four layers of Carmen’s reception in the Americas. First, the reception of the opera beyond the stage, in the form of vocal scores, arrangements for military bands and isolated numbers. Second, the perception of Carmen as a French opera, and the way it served as a vehicle for French opera companies in the final decades of the nineteenth century. Third, the idea of Carmen as Spanish, and how different countries considered that hispanicity as part of their own culture and theatrical expectations. Finally, we discuss how the habanera in Carmen was perceived as part of a larger contemporary debate on the transatlantic popularity of the habanera as a musical genre, its origins, ethnicity and its moral and musical character.
Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. Although the main justification for shared decision-making is ethical, several randomized controlled trials support its effectiveness in improving the quality of decisions, but robust evidence in objective health outcomes is needed.
Aims
Analyze the degree of antipsychotic politherapy or monotherapy in patients discharged after their inclusion in the study and randomized to Share Decision-Making or Treat as Usual. Present preliminary conclusions after 20 months of follow-up.
Methods
Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Previous antipsychotic treatment is collected by interviewing patient and family and as included in digital history and health card, discharge and reviews conducted at 3, 6 and 12 months.
Results
Interim analysis shows there are no differences between groups (SDM and TaU) before intervention, we note the following results:
– the degree of antipsychotic politherapy prior to admission for the entire sample decreased at discharge;
– at discharge, there is a difference between SDM and TaU. Antipsychotic polytherapy in SDM decreases in a higher level.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. There has been extensive and growing interest in its application to long-term illnesses but surprisingly not in severe psychiatric disorders, such as schizophrenia. However, the great majority of schizophrenics are capable of understanding treatment choices and making rational decisions. Although the main justification for shared decision-making is ethical, several randomized controlled trials support its effectiveness in improving the quality of decisions, but robust evidence in objective health outcomes is needed.
Aims and objectives
Of the study: to demonstrate the effectiveness, measured as treatment adherence and readmissions at 3, 6 and 12 months, of shared decision making in the choice of antipsychotic treatment at discharge.
Of the oral presentation: to present the study design; to make an interim report of the data obtained at the moment of the congress.
Methods
Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Study population: Inpatients diagnosed of schizophrenia and schizoaffective disorders (ICD-10/DSM-IV-R: F20 y F25) at Adult Acute Hospitalization Unit at Jerez General Hospital.
Results
Currently in the recruiting phase with 55 patients included in the study. An interim analysis of at least half of the target sample size.
Conclusions
We will show the study design and decision tools employed. Conclusions in relation to the effectiveness (adherence and readmissions) and subjective perception.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The J-PAS survey will soon start observing thousands of square degrees of the Northern Sky with its unique set of 56 narrow band filters covering the entire optical wavelength range, providing, effectively, a low resolution spectra for every object detected. Active galaxies and quasars, thanks to their strong emission lines, can be easily identified and characterized with J-PAS data. A variety of studies can be performed, from IFU-like analysis of local AGN, to clustering of high-z quasars. We also expect to be able to extract intrinsic physical quasar properties from the J-PAS pseudo-spectra, including continuum slope and emission line luminosities. Here we show the first attempts of using the QSFit software package to derive the properties for 22 quasars at 0.8 < z < 2 observed by the miniJPAS survey, the first deg2 of J-PAS data obtained with an interim camera. Results are compared with the ones obtained by applying the same software to SDSS quasar spectra.
We examined if and when English-learning 17-month-olds would accommodate Japanese forms as labels for novel objects. In Experiment 1, infants (n = 22) who were habituated to Japanese word–object pairs looked longer at switched test pairs than familiar test pairs, suggesting that they had mapped Japanese word forms to objects. In Experiments 2 (n = 44) and 3 (n = 22), infants were presented with a spoken passage prior to habituation to assess whether experience with a different language would shift their perception of Japanese word forms. Here, infants did not demonstrate learning of Japanese word–object pairs. These findings offer insight into the flexibility of the developing perceptual system. That is, when there is no evidence to the contrary, 17-month-olds will accommodate forms that vary from their typical input but will efficiently constrain their perception when cued to the fact that they are not listening to their native language.
The Astroinformatics Program is funded by the Chilean Economy Ministry’s (FIE Grant FIE-2016-V022, CORFO Grant 16IFI6626) with the mission to identify and initiate investments to foster Chilean Digital Economy, using Astronomy data-centric tools (known as astroinformatics). Over 2017 we worked with communities across sectors identifying opportunities to achieve the program mission, the Data Observatory vision emerged from that work and will guide design activities throughout 2018.
When linguistic information alone does not clarify a speaker's intended meaning, skilled communicators can draw on a variety of cues to infer communicative intent. In this paper, we review research examining the developmental emergence of preschoolers’ sensitivity to a communicative partner's perspective. We focus particularly on preschoolers’ tendency to use cues both within the communicative context (i.e. a speaker's visual access to information) and within the speech signal itself (i.e. emotional prosody) to make on-line inferences about communicative intent. Our review demonstrates that preschoolers’ ability to use visual and emotional cues of perspective to guide language interpretation is not uniform across tasks, is sometimes related to theory of mind and executive function skills, and, at certain points of development, is only revealed by implicit measures of language processing.