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Visceral leishmaniasis (VL) is a tropical disease that can be fatal if acute and untreated. Diagnosis is difficult, the treatment is toxic and prophylactic vaccines do not exist. Leishmania parasites express hundreds of proteins and several of them are relevant for the host's immune system. In this context, in the present study, 10 specific T-cell epitopes from 5 parasite proteins, which were identified by antibodies in VL patients’ sera, were selected and used to construct a gene codifying the new chimeric protein called rCHI. The rCHI vaccine was developed and thoroughly evaluated for its potential effectiveness against Leishmania infantum infection. We used monophosphoryl lipid A (MPLA) and polymeric micelles (Mic) as adjuvant and/or delivery system. The results demonstrated that both rCHI/MPLA and rCHI/Mic significantly stimulate an antileishmanial Th1-type cellular response, with higher production of IFN-γ, TNF-α, IL-12 and nitrite in vaccinated animals, and this response was sustained after challenge. In addition, these mice significantly reduced the parasitism in internal organs and increased the production of IgG2a isotype antibodies. In vivo and in vitro toxicity showed that rCHI is safe for the mammalians, and the recombinant protein also induced in vitro lymphoproliferative response and production of Th1-type cytokines by human cells, which were collected from healthy subjects and treated VL patients. These data suggest rCHI plus MPLA or micelles could be considered as a vaccine candidate against VL.
Giant smutgrass [Sporobolus indicus (L.) R. Br. var. pyramidalis (P. Beauv.) Veldkamp] is an invasive species in grasslands, and herbicide application has been the most efficient management method to suppress this weed. Experiments were conducted in 2017 and 2018 to determine the effects of wiping glyphosate and hexazinone on S. indicus var. pyramidalis. A dose–response experiment using a handheld weed wiper was established with 20 treatments comprising two herbicides (glyphosate and hexazinone), uni- and bidirectional wiping methods, and 5 herbicide concentrations (6.25% v/v, 12.5% v/v, 25.0% v/v, 50.0% v/v, and 100% v/v basis). Data were collected 30 and 60 d after treatment (DAT). An ATV-mounted roto-type weed-wiper experiment was established in a strip-plot arrangement, with mowing as the horizontal strip, the wiping method (unidirectional vs. bidirectional) randomized as the vertical strip with three dosages of each herbicide for a total of 12 wiping treatments. Data were collected at 35 and 90 DAT. The percent plant mortality was calculated using differences in pre- and posttreatment plant counts. ANOVA and log-logistic linear regression were used to analyze the data. The dose–response experiment showed that S. indicus var. pyramidalis mortality increased with herbicide concentration, and mortality was greater with the bidirectional wiping method compared with the unidirectional method. Treatments wiped bidirectionally with glyphosate at 70% v/v, hexazinone at 30% v/v, and hexazinone at 60% v/v resulted in S. indicus var. pyramidalis mortality ranging from 75% to 98% by 90 DAT across all locations. The ATV-mounted weed-wiper experiment showed that mowing before herbicide application with weed wipers decreased the efficacy of both herbicides. Overall, both experiments indicate that S. indicus var. pyramidalis should be wiped bidirectionally using either glyphosate (70% v/v) or hexazinone (at least 30% v/v) to obtain satisfactory control. Further work should be conducted to determine whether seasonality impacts the response of S. indicus var. pyramidalis to mowing and the application of these herbicides.
Primary care visits of persons with dementia often bring together triads composed of patients, family carers and general practitioners (GPs), as previously discussed (1). Communication dynamics potentially affect dementia outcomes, not least because primary care is a health setting where these triad encounters often occur naturally. Our aim is to present further data from Portuguese primary care consultations with persons with dementia, their carers and GPs.
Methods:
We refer to the conclusion of our study ‘Dementia in Primary Care: the Patient, the Carer and the Doctor in the Medical Encounter - Bayer Investigation Grant | NOVAsaúde Ageing 2018’ (1). Fieldwork was interrupted during the COVID-19 pandemic and resumed in 2022. Sixteen consultations with persons with dementia, their carers and GPs (purposive sampling) were audio- recorded and transcribed verbatim. Interactions were thematically analysed using NVIVO® software. The analytical framework combined codes derived from the transcripts with codes from the literature.
Results:
Dementia-related content took up less than half of consultations’ time, despite their considerable length (as compared to the average in primary care). Most GPs assessments lacked breadth, although efforts towards positive attitudes were present. Themes specifically related to social health in dementia were not (or were poorly) covered. Frequently, carers facilitated GPs’ assessment of dementia consequences, but their own needs were neglected. Patients’ self-expression tended to be limited.
Discussion:
Our findings suggest that doctor-patient interactions in many GPs’ consultations seemingly compromise patient-centred approaches. There are challenges regarding how to assess the biopsychosocial consequences of dementia in a context of fragmented care (2,3). Given the scarcity of evidence from live-recorded primary care consultations about triadic dynamics, our findings are important to guide further explorations.
Differences in psychiatry training vary substantially across Europe. Such organisations as the European Federation of Psychiatry Trainees (EFPT), the European College of Neuropsychopharmacology, and the European Psychiatry Association, have committed to offer international experiences based on the premise that it could foster international collaboration, aid early career professionals to progress professionally and spark discussion regarding different practices across Europe.
To date, there are no studies that focus on the exchange experience in mental health professionals.
Objectives
We present the synthesis of the first seven years answers from 2012 to 2019 to the post-exchange online evaluation form, which trainees had to fill in in order to receive an attendance certificate.
Methods
The present study analysed the answers of 182 psychiatry trainees or recent graduates who took part in the EFPT exchange program during 2012 and 2019 and filled in the internet-based evaluation form. The inclusion criteria were currently in training or recently finished training as a psychiatrist in Europe and filling in the questionnaire. The exclusion criterion was participation in the EFPT exchange program for the second or subsequent time.
All trainees were systemically asked to complete the online evaluation form after the exchange period. The form includes sociodemographic, training in host country-related, and exchange experience-related questions. Experience measures were evaluated using the 4-point Likert scale. Data was anonymized before the analysis. The study followed the principles of the Declaration of Helsinki.
Results
From the 198 individuals who filled the questionnaire, 182 were involved in final analyses. The majority of participants were females in the second half of their training. The average age was 29 years. The largest number of applicants were from Turkey, whereas the United Kingdom hosted the most participants. One-third of the participants had previous international exchange experience.
Most trainees were exposed to both outpatient and inpatient treatment settings and were involved in educational or research activities. 96.7% of participants indicated that they were satisfied or very satisfied with the experience, 95.6% said that the exchange was useful or very useful, and 98.9% were likely or very likely to recommend exchange to colleagues. A description of trainees and exchange placements is presented in a table (couldn’t be uploaded).
Conclusions
To our knowledge, this study is the first to assess the experience of psychiatry trainees who went on exchange during their professional training. Vast majority of trainees were satisfied with their exchange, thought it would be useful for their clinical practice and would recommend it to their colleagues. These findings are in line with other studies that examined medical exchange experiences .
The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA.
Objectives
To further validate the ISSME using Confirmatory Factor Analysis and to analyze[ATP1] the psychometric properties of a new version including additional sources of stress.
Methods
Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS).
Results
Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ2/df=3.274; RMSEA=.0581, p<.001; CFI=.917; TLI=.904, GFI=.919). The Cronbach’s alfas were α=.897 for the total and from α=.669 (F2-HD) to α=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, α=.543) and two additional COVID-19 stress-related-items (F7, α=.744) also showed acceptable fit indexes (χ2/df=3.513; RMSEA=.061, p<.001; CFI=.88.; TLI=.866, GFI=.892). This new version’s α was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students.
Conclusions
This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability.
The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA.
Objectives
To further validate the ISSME using Confirmatory Factor Analysis and to analyze the psychometric properties of a new version including additional sources of stress.
Methods
Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS).
Results
Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ2/df=3.274; RMSEA=.0581, p<.001; CFI=.917; TLI=.904, GFI=.919). The Cronbach’s alfas were α=.897 for the total and from α=.669 (F2-HD) to α=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, α=.543) and two additional COVID-19 stress-related-items (F7, α=.744) also showed acceptable fit indexes (χ2/df=3.513; RMSEA=.061, p<.001; CFI=.88.; TLI=.866, GFI=.892). This new version’s α was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students.
Conclusions
This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability.
In the frame of the IAEA-CRP (Coordinated Research Projects): Enhancing Nuclear Analytical Techniques to Meet the Needs of Forensic Sciences, an intercomparison exercise was organized between three AMS laboratories. Aim of the program is to promote the use of nuclear and accelerator-based techniques in routine forensics practice. In this view, one of the key points is the assessment of the precision and accuracy levels achievable on material of forensic interest. We review the general structure and status of the project, with emphasis on results obtained in the analysis of wines of different grape varieties and grounded coffee beans from different locations such as Brazil, Spain, and Italy. The three laboratories processed the samples according to different chemical protocols and performed the 14C measurements using different systems: MICADAS in Zurich and Debrecen and a HVEE 4130HC 3 MV Tandetron in Lecce. Within the quoted uncertainty, the results showed good reproducibility, indicating that uncertainty level of the order of 0.3% are achieved by AMS on a single sample while multiple sample analyses results in precision down to 0.1–0.2%. The measured 14C concentrations on coffee and wine samples resulted to be consistent with atmospheric 14C levels in the growing years.
Portugal has a Dementia Strategy that endorses care coordination in the community, but the strategy is not implemented despite there being a network of multidisciplinary primary care clinics that could support it. Recent research into barriers to dementia management in primary care has focused essentially on general practitioners’ (GPs) factors and perspectives. A comprehensive triangulated view on the barriers to dementia management emphasising teamwork is missing.
Aim:
To explore the barriers to the implementation of the Portuguese Dementia Strategy by primary care teams, from the perspectives of service users and professionals.
Methods:
Purposive sampling was used to recruit 10 GPs, 8 practice nurses, 4 social workers, 8 people with dementia and 10 family carers from 6 practices in different social contexts within the Lisbon metropolitan area. The analytical framework combined codes derived from the transcripts with codes from the available literature. Themes focused on the access to professionals/community services, care coordination within healthcare teams, and between health and community services.
Findings:
Several system barriers were identified (undefined roles/coordination within teams, time constraints, insufficient signposting to community services) along with individual barriers (limited competence in dementia, unrecognised autonomy, limited views on social health and quality of life (QoL)), hindering users access to dementia services.
Conclusion:
Enhanced competence in dementia, and nurse-led systematic care of people with dementia and their carers, are necessary. They can be effective in improving the QoL in dementia, but only if associated with better community support.
Experiments are conducted in a wave tank to investigate wave scattering by a three-dimensional submerged horizontal rectangular plate in a channel. The free-surface elevation around the plate is presented for various water depths and depths of submergence of the plate. The wave forces and moments are obtained using an underwater load measuring system. The numerical simulations are performed with a parallelized three-dimensional boundary element method. The numerical set-up follows closely the set-up of the laboratory experiments. The numerical results are compared with the experimental results for non-breaking waves. In most cases a good agreement is found for the free-surface elevation, the vertical force and the moment. A physical interpretation of the flow around the plate is provided. The pressure distribution on the lower surface of the plate differs from the linear distribution from the leading edge to the trailing edge that is obtained in the equivalent two-dimensional problem. The reflection by the lateral walls is investigated.
The movements of some massive (${O}(100)\ \textrm {t}$) clifftop boulders, once thought to have been caused by tsunami, have been reattributed to storm waves in several recent papers. However, the precise wave-impact modes and transport mechanisms are unknown. We present preliminary linear acceleration, pressure and displacement data recorded by a $1\,{:}\,30$ scale clifftop boulder impacted by a focused breaking wave in a laboratory flume. The 8 kg boulder was placed atop a 0.25 m high platform and struck with a breaking wave of 0.34 m amplitude. Wave focus position was varied from 0.8 m fore of the platform to 0.27 m aft of the platform to alter the breaking crest shape and wave impact type while maintaining total wave spectral energy. Pressure and acceleration time series measurements from within the boulder show distinct impact types across focus positions. All impacts produced boulder displacement, ranging from 5 mm to 42 mm (0.15 m to 1.3 m at full scale, assuming Froude scaling). The largest boulder pressures were recorded when the wave crest and trough struck the boulder at the same position (flip-through). The largest boulder displacements were measured when high pressures and long impact durations occurred simultaneously and wave focusing was close to flip-through.
To assess the influence of presbylarynx and presbycusis on Voice Handicap Index and emotional status.
Methods
A case–control, prospective, observational, cross-sectional study was conducted of patients aged 65 years or older referred to an otorhinolaryngology department from January to September 2020. Presbycusis was assessed by pure tone and vocal audiometry. Each subject underwent fibre-optic videolaryngoscopy with stroboscopy, and presbylarynx was considered when two or more of the following endoscopic findings were identified: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap. Each subject completed two questionnaires: Voice Handicap Index and Geriatric Depression Scale (short-form).
Results
The studied population included 174 White European subjects, with a mean age of 73.99 years, of whom 22.8 per cent presented both presbylarynx and presbycusis. Multivariate linear regression revealed that only presence and severity of presbylarynx had an influence on Voice Handicap Index-30 scores. However, both spindle-shaped glottal gap and presbycusis influenced Geriatric Depression Scale scores.
Conclusion
Presbylarynx has a strong association with the impact of voice on quality of life. Presbylarynx and presbycusis seem to have a cumulative effect on emotional status.
The diagnosis of visceral leishmaniasis (VL) has improved with the search of novel antigens; however, their performance is limited when samples from VL/human immunodeficiency virus (HIV)-coinfected patients are tested. In this context, studies conducted to identify more suitable antigens to detect both VL and VL/HIC coinfection cases should be performed. In the current study, phage display was performed using serum samples from healthy subjects and VL, HIV-infected and VL/HIV-coinfected patients; aiming to identify novel phage-exposed epitopes to be evaluated with this diagnostic purpose. Nine non-repetitive and valid sequences were identified, synthetized and tested as peptides in enzyme-linked immunosorbent assay experiments. Results showed that three (Pep2, Pep3 and Pep4) peptides showed excellent performance to diagnose VL and VL/HIV coinfection, with 100% sensitivity and specificity values. The other peptides showed sensitivity varying from 50.9 to 80.0%, as well as specificity ranging from 60.0 to 95.6%. Pep2, Pep3 and Pep4 also showed a potential prognostic effect, since specific serological reactivity was significantly decreased after patient treatment. Bioinformatics assays indicated that Leishmania trypanothione reductase protein was predicted to contain these three conformational epitopes. In conclusion, data suggest that Pep2, Pep3 and Pep4 could be tested for the diagnosis of VL and VL/HIV coinfection.
The limiting configuration of interfacial solitary waves between two homogeneous fluids consisting of a sharp $120^{\circ }$ angle with an enclosed bubble of stagnant heavier fluid on top is investigated numerically. We use a boundary integral equation method to compute the almost limiting profiles which are nearly self-intersecting and thus extend the work of Pullin & Grimshaw (Phys. Fluids, vol. 31, 1988, pp. 3550–3559) by obtaining the overhanging solutions for very small density ratios. To further study the local configuration of the limiting profile, we propose a reduced model that replaces the $120^{\circ }$ angle with two straight solid walls intersecting at the bottom of the bubble. Using a series truncation method, a one-parameter family of solutions depending on the angle between the two solid walls (denoted by $\gamma$) is found. When $\gamma = {2{\rm \pi} }/{3}$, it is shown that the simplified model agrees well with the near-limiting wave profile if the density ratio is small, and thus provides a good local approximation to the assumed limiting configuration. Interesting solutions for other values of $\gamma$ are also explored.
We aimed at evaluating the association of maternal pre-pregnancy nutritional status with offspring anthropometry and body composition. We also evaluated whether these associations were modified by gender, diet and physical activity and mediated by birth weight.
Design:
Birth cohort study.
Setting:
Waist circumference was measured with an inextensible tape, and fat and lean mass were measured using dual-energy X-ray absorptiometry. Multiple linear regression was used to adjust for possible confounders and allele score of BMI. We carried out mediation analysis using G-formula.
Participants:
In 1982, 1993 and 2004, all maternity hospitals in Pelotas (South Brazil) were visited daily and all live births whose families lived in the urban area of the city were evaluated. These subjects have been followed up at different ages.
Results:
Offspring of obese mothers had on average higher BMI, waist circumference and fat mass index than those of normal weight mothers, and these differences were higher among daughters. The magnitudes of the association were similar in the cohorts, except for height, where the association pattern was not clear. In the 1982 cohort, further adjustment for a BMI allele score had no material influence on the magnitude of the associations. Mediation analyses showed that birth weight captured part of this association.
Conclusions:
Our findings suggest that maternal pre-pregnancy nutritional status is positively associated with offspring BMI and adiposity in offspring. And this association is higher among daughters whose mother was overweight or obese and, birth weight explains part of this association.
Pharyngocutaneous fistula is a troublesome complication. Recently, synthetic materials such as fibrin sealant have been used as a secondary measure to treat fistula. This work assessed whether the primary use of fibrin sealant can reduce the rate of fistula.
Method
A retrospective review of 50 cases from 2 centres was completed. Tisseel was an adjunct to primary closure in all cases.
Results
In the first centre, 3 out of 34 cases developed pharyngocutaneous fistula (fistula rate of 9 per cent). All three were salvage cases. In the second centre, 0 out of 16 cases developed a fistula.
Conclusion
The incidence of pharyngocutaneous fistula post-radiation and post-chemoradiotherapy in laryngectomy cases has been quoted as 23 per cent and 34 per cent respectively. This study represents the first patient series on the use of fibrin sealant as an adjunct in primary closure following laryngectomy. The results are promising, encouraging the use of Tisseel as an adjunct to meticulous closure.
We aimed to assess the validity of maternal recall of exclusive breastfeeding (EBF) at 3 months obtained 12 months after childbirth.
Design:
A population-based birth cohort study. The gold standard is maternal report of EBF at the age of 3 months (yes or no) and age of introduction of other foods in the infant’s diet. EBF was considered when the mother reported that no liquid, semi-solid or solid food was introduced up to that moment. The variable to be validated was obtained at 12 months after childbirth when the mother was asked about the age of food introduction. The prevalence of EBF at 3 months, and sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of 12-month recall with 95 % CI were calculated.
Setting:
Pelotas, Brazil.
Participants:
3700 mothers of participants of the Pelotas 2004 Birth Cohort.
Results:
The prevalence of EBF at 3 months was 27·8 % (95 % CI 26·4, 29·3) and 49·0 % (95 % CI 47·4, 50·6) according to gold standard and maternal recall, respectively. The sensitivity of maternal recall at 12 months was 98·3 % (95 % CI 97·4, 99·0), specificity 70·0 % (95 % CI 68·2, 71·7), PPV 55·8 % (95 % CI 53·4, 58·1), NPV 99·1 % (95 % CI 98·6, 99·5) and accuracy 77·9 % (95 % CI 76·6, 79·2). When the analyses were stratified by maternal and infant characteristics, the sensitivity remained around 98 %, and the specificity ranged from 64·4 to 81·8 %.
Conclusions:
EBF recalled at the end of the first year of infant’s life is a valid measure to be used in epidemiological investigations.
This research communication describes the influence of diet, mammary quarter position and milking process on the temperature of teats and udder of cows fed diets containing different lipid sources. Five primiparous cows were fed diets containing cottonseed, sunflower seed, soybeans or soybean oil as a source of lipids and a reference diet without the inclusion of lipid sources in a 5 × 5 Latin Square design. Milk yield was determined in the last five days of each period. Milk samples were collected for SCC analysis on the last two days of each experimental period. The images of the mammary gland were obtained using an infrared camera and were analyzed with appropriate computer software. Milk yield was 14.8% higher for cows fed soybeans as a source of lipids. Diets and somatic cell counts did not influence the temperature of teats and udder. The milking process reduced the temperature of teats and udder by 0.79°C. Rear teats and rear quarters had higher surface temperatures than front teats and fore quarters. Changes in temperature of teats and mammary quarters occurred as a function of the milking process and quarter position. However, the diet and the SCC did not influence the temperature of teats and mammary quarters in this experiment.
Deficits in social functioning are a core feature of schizophrenia and are influenced by both symptomatic and neurocognitive variables.
Objectives
In the present study we aimed to determine the reliability and validity of the Portuguese version of the Personal and Social Performance (PSP) scale, and possible correlations with measures of cognitive functioning.
Methods
One-hundred and four community and inpatients with schizophrenia were assessed using measures of social functioning and symptom severity alongside measures of executive function, processing speed and verbal memory.
Results
The reliability of the PSP was found to be satisfactory, with a Cronbach's alpha coefficient of 0.789. Inter-rater reliability in the four domains of the PSP varied from 0.430 to 0.954. Low-functioning patients (PSP < 70) were older, had longer duration of illness, were more symptomatic and had worse cognitive performances, as compared to high-functioning patients (PSP ≥ 70). In a regression model, deficits in social functioning were strongly predicted both by symptomatic and neurocognitive variables; these together accounted for up to 62% of the variance.
Conclusions
The present study supports the reliability and validity of the Portuguese language version of the PSP and further supports the original measure. The co-administration of brief cognitive assessments with measures of functioning may lead to more focused interventions, possibly improving outcomes in this group.
The aim of postgraduate psychiatric training is to prepare psychiatrists to practice independently. The quality of care provided will depend on the training they received. Pregnancy and childbirth (usually called the perinatal period) are a high-risk period for many women with psychiatric problems. An illness episode at that time can have a devastating effect on women and the whole family, including the child's development.
Objectives
To understand how perinatal mental health training is organized within Europe and how it fits in the training curricula.
Methods
The European Federation of Psychiatric Trainees conducts an annual survey of all member country organizations. We have asked respondents if they received training in perinatal psychiatry, whether that was optional or mandatory and what was its duration. Where training in perinatal psychiatry was not available we asked if they felt it should be.
Results
Data will be presented from the 35 countries that responded in the 2016 survey. Six countries reported that training in perinatal mental health is available. But it is mandatory in only one, with the others offering a mix of theoretical and practical optional training. Of the 29 countries that do not offer perinatal psychiatry training, the majority reported it should be offered and mandatory.
Conclusion
There is a gap in the expectations of psychiatrists treating women in pregnancy and after birth, and a widespread lack of training for them to be able to do so effectively.
Disclosure of interest
The authors have not supplied their declaration of competing interest.