Search Results (1,213)

Introduction: Low medication adherence and low hypertension control are a public health challenge, particularly in low- and middle-income countries (LMICs). Healthcare system- and patient-related barriers hinder the successful management of hypertension. This study aimed to identify the perceptions of barriers and facilitators to hypertension management among health system stakeholders in Santander, Colombia. Materials and Methods: We conducted a qualitative, phenomenological, and interpretative study, comprising five focus groups, to explore the barriers and facilitators to managing people with hypertension. Each focus group was formed by stakeholders from territorial entities, healthcare insurers, or healthcare providers. Meetings were held between December 2022 and February 2023. The sessions were recorded and transcribed using NVivo Transcription and analyzed using NVivo version 1.6.1. Results: Seven categories of barriers and facilitators were identified: strategies, resources, access, risk assessment, cross-sector collaboration, articulation, and stewardship. Of these categories, articulation and stewardship emerged as the main barriers, as revealed through axial coding and cluster analysis, which highlighted deficiencies in stewardship practices, a lack of clear objectives, and misalignment with public policy frameworks. Conclusions: Multisectoral actions extending beyond healthcare providers and aimed at improving coordination and intersectoral collaboration are essential for enhancing hypertension control in LMICs, such as Colombia. Addressing social determinants and strengthening primary healthcare through community-based strategies are critical, making stewardship and improved access key priorities. Full article

As first-hand testimonies and accounts of the Holocaust fade, scholars and artists alike have struggled to depict and contextualize the genocide’s monumental violence. But depicting violence and its aftermath poses several problems, including the question of how to recall loss without artificially filling in or effacing the absence so central to its understanding. In essence, remembering the Holocaust is a paradox: the preservation of an absence. Marianne Hirsch’s influential concept of postmemory addresses this paradox and asks questions about memorial capacity in the twenty-first century. This essay considers Hirsch’s postmemory in the context of W.G. Sebald’s 2001 novel Austerlitz, which uses a combination of prose and photography to engage the difficulties inherent in memory work without access to eyewitnesses. Through the interaction of printed text and images, Austerlitz subtly references Lurianic mysticism’s concept of tikkun and Tree of Life (ilanot) diagrams. The result is a depiction of memory that is both process-based and embodies absence. My reading of Austerlitz traces a Jewish heritage within the work of a non-Jewish German author by attending to a tradition of mystical thought embedded in the novel. This situates Sebald’s fiction in a much longer Jewish history that stretches out on either end of the event of the Holocaust. Structurally, Sebald develops a tikkun-like process of (re)creation which relies on gathering material scraps of the past and imaginatively engaging with their absences in the present. Images, just as much as text, are central to this process. Reading Austerlitz in the context of Kabbalah reveals an intellectual and artistic link to a Jewish history that, while predating the Holocaust, nonetheless sheds light on post-Holocaust memories of loss. Full article

Background: Kidney transplant recipients (KTRs) exhibit a significantly diminished immune response to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) vaccines compared with the general population, primarily due to ongoing immunosuppressive therapy. This study evaluated the immunogenicity of a third SARS-CoV-2 mRNA vaccine dose in KTRs and assessed the association between antibody response and protection against SARS-CoV-2 breakthrough infection. Additionally, the clinical and immunological correlates of post-vaccination SARS-CoV-2 infection were examined. Methods: A prospective cohort of 135 KTRs received a third vaccine dose approximately six months following the second dose. Plasma samples were collected at baseline (pre-vaccination), six months after the second dose, and six weeks following the third dose. Humoral responses were assessed using SARS-CoV-2-specific Immunoglobulin G (IgG) titers and virus neutralization assays against wild-type (WT) and viral strains, including multiple Omicron sub-lineages. Results: After the third vaccine dose, 74% of the KTRs had detectable SARS-CoV-2-specific IgG antibodies, compared with 48% following the second dose. The mean IgG titers increased approximately ten-fold post-booster. Despite this increase, neutralizing activity against the Omicron variants remained significantly lower than that against the WT strain. KTRs who subsequently experienced a SARS-CoV-2 breakthrough infection demonstrated reduced neutralizing antibody activity across all variants tested. Additionally, individuals receiving triple immunosuppressive therapy had a significantly higher risk of SARS-CoV-2 breakthrough infection compared with those on dual or monotherapy. A multivariate machine learning analysis identified age and neutralizing activity against WT, Delta, and Omicron BA.2 as the most robust correlates of SARS-CoV-2 breakthrough infection. Conclusions: A third SARS-CoV-2 mRNA vaccine dose significantly improves SARS-CoV-2-specific IgG levels in KTRs; however, the neutralizing response against Omicron variants remains suboptimal. Diminished neutralizing capacity and intensified immunosuppression are key determinants of SARS-CoV-2 breakthrough infection in this immunocompromised population. Full article

This study investigated associations of inflammation-based biomarkers with endothelial dysfunction and lipids and their predictive value for clinical outcome parameters in patients with giant cell arteritis (GCA). A total of 138 patients with inactive GCA were retrospectively analyzed to investigate potential differences in inflammatory biomarkers regarding clinical GCA subtypes and potential correlations between inflammatory parameters with markers of endothelial dysfunction and lipid parameters. Additionally, the predictive role of inflammatory biomarkers for clinical outcomes, including disease relapse, all-cause mortality, cardiovascular events, and glucocorticoid adverse effects, was analyzed. GCA individuals without concomitant symptoms of polymyalgia rheumatica and those who received initial glucocorticoid pulse therapy exhibited significantly higher levels of white blood cells and neutrophils (all with p < 0.05). No other significant differences were observed between inflammatory biomarkers and clinical GCA subtypes. Additionally, significant correlations were identified between selected inflammation-based ratios and specific markers of endothelial dysfunction and lipid parameters (all with p < 0.05). Elevated white blood cells and neutrophils were significant and independent predictors of disease relapse in GCA (all with p < 0.05) in multiple logistic regression analysis. No significant associations were found between any other inflammatory biomarker and the occurrence of cardiovascular events, mortality, or glucocorticoid-related adverse effects. In patients with inactive GCA, selected inflammatory parameters correlated with endothelial dysfunction and dyslipidemia and may be predictive of disease relapse. Full article

Background: More than three years have elapsed since the onset of the full-scale invasion of Ukraine by the Russian Federation, displacing millions of Ukrainians. While preserving cultural identity in the host country is important for gaining resilience among refugees, we found no studies about how cultural identity influences health care experiences during resettlement. Objective: This study explores how cultural identity shapes health care experiences among Ukrainian refugees during resettlement in the United States. Methods: We conducted an interpretive description study using focus groups to elicit the perspectives of Ukrainian refugees who resettled in North Carolina after 24 February 2022. Twelve Ukrainian women participated in one of four focus groups. Thematic content analysis was employed for case comparison, and themes were inductively derived. Results: Two themes were identified: troubled health care partnerships and imprecise notions of preventive practices. Troubled partnerships represented a lack of trust between refugees and U.S. clinicians and the health care system. Imprecise notions of preventive practices represented mistaken beliefs about prevention. Conclusions: This study adds to the science on refugee health in two ways. First, newly arrived refugees often maintain strong ties to their homeland, which shapes their health care decisions and reinforces their cultural identity. Second, despite being well educated, some refugees held misconceptions about preventive health care, highlighting the need for clinicians to provide clear guidance on primary and secondary prevention practices. Findings may help guide clinicians in delivering culturally sensitive care to refugee populations. Full article

Forests are a key terrestrial carbon sink, storing carbon in biomass, the forest floor, and the mineral soil (SOC). Since Pinus radiata D. Don is the most widely planted forest species in Chile, it is important to understand how environmental and soil factors influence these carbon pools. Our objective was to evaluate the effects of climate and site variables on carbon stocks in adult radiata pine plantations across contrasting water and nutrient conditions. Three 1000 m² plots were installed at 20 sites with sandy, granitic, recent ash, and metamorphic soils, which were selected along a productivity gradient. Biomass carbon stocks were estimated using allometric equations, and carbon stocks in the forest floor and mineral soil (up to 1 m deep) were assessed. SOC varied significantly, from 139.9 Mg ha⁻¹ in sandy soils to 382.4 Mg ha⁻¹ in metamorphic soils. Total carbon stocks (TCS) per site ranged from 331.0 Mg ha⁻¹ in sandy soils to 552.9 Mg ha⁻¹ in metamorphic soils. Across all soil types, the forest floor held the lowest carbon stock. Correlation analyses and linear models revealed that variables related to soil water availability, nitrogen content, precipitation, and stand productivity positively increased SOC and TCS stocks. In contrast, temperature, evapotranspiration, and sand content had a negative effect. The developed models will allow more accurate estimation estimates of C stocks at SOC and in the total stand. Full article

Background/Objectives: Worldwide, men experience a higher incidence of pancreatic cancer (PC) than women. Methods: To increase understanding of the underlying reasons for this sex-related difference, we analysed general and sex-related risk factors for PC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (women/men No. = 293,682/136,728; 717/577 PC-cases). Results: Cox proportional hazards models showed a 1.31-fold higher risk of developing PC for men compared to women (HR, 95% CI 1.15–1.49) after adjustment for age, smoking history, BMI, diabetes, and alcohol consumption. Associations of PC with established risk factors did not differ between men and women, with the exception of a greater risk of PC among women with greater attained body height, meat consumption and cigarettes smoked (1.12 (1.05–1.19) per 5 cm, 1.18 (1.02–1.36) per 100 g/d, 1.42 (1.27–1.59) per 10/d; respectively). Among child-bearing women, long cumulative duration of breastfeeding was inversely associated with risk of PC (HR 0.74, 95% CI 0.61–0.89) for >5.7 months of breastfeeding (median) relative to ≤5.7 months and among HRT users, cumulative duration of HRT use was inversely associated with PC risk (HR 0.71, 95% CI 0.53–0.95, >2.4 versus ≤2.4 years). Further reproductive and hormonal factors, such as age at menarche, number of full-term pregnancies, age at menopause, or use of oral contraceptives, were not significantly associated with PC risk. Conclusions: Pooled analyses of large cohort studies are needed to confirm these results, and detailed data on the type and intensity of HRT are required to better evaluate its effect. Full article

Neuropeptide FF (NPFF) receptor antagonists prevent morphine-mediated antinociceptive tolerance, and compounds with dual mu opioid receptor (MOR) agonist and NPFF antagonist activity produce antinociception without tolerance. Compounds synthesized showed affinities in radioligand competition binding assays in the nM and µM range at the opioid and NPFF receptors, respectively, and displayed substitution-dependent functional profiles in the [³⁵S]GTPγS functional assay. From six compounds screened in vivo for antinociception and ability to prevent NPFF-induced hyperalgesia in mouse warm water tail withdrawal tests, compound 22b produced dose-dependent MOR-mediated antinociception with an ED₅₀ value (and 95% confidence interval) of 6.88 (4.71–9.47) nmol, i.c.v., and also prevented NPFF-induced hyperalgesia. Meanwhile, 22b did not demonstrate the respiratory depression, hyperlocomotion, or impaired intestinal transit of morphine. Moreover, repeated treatment with 22b produced a 1.6-fold rightward shift in antinociceptive dose response, significantly less acute antinociceptive tolerance than morphine. Evaluated for microsomal stability in vitro and in vivo pharmacokinetic profile, 22b showed suitable microsomal stability paired in vivo with a large apparent volume of distribution and a clearance smaller than the hepatic flow in rats, suggesting no extra-hepatic metabolism. In conclusion, the present study confirms that dual-action opioid–NPFF ligands may offer therapeutic promise as analgesics with fewer liabilities of use. Full article

The Internet of Things (IoT) is an upcoming technology that is increasingly being used for monitoring and analysing environmental parameters and supports the progress of farm machinery. Agriculture is the main source of living for many people, including, for instance, farmers, agronomists and transporters. It can raise incomes, improve food security and benefit the environment. However, food systems are responsible for many environmental problems. While the use of IoT in agriculture and environment is widely deployed in many developed countries, it is underdeveloped in Africa, particularly in West Africa. This paper aims to provide a systematic review on this technology adoption for agriculture and environment in West African countries. To achieve this goal, the analysis of scientific contributions is performed by performing first a bibliometric study, focusing on the selected articles obtained using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, and second a qualitative study. The PRISMA analysis was performed based on 226 publications recorded from one database: Web Of Science (WoS). It has been demonstrated that the annual scientific production significantly increased during this last decade. Our conclusions highlight promising directions where IoT could significantly progress sustainability. Full article

Legislative documents are crucial to democratic societies, defining the legal framework for social life. In Brazil, legislative texts are particularly complex due to extensive technical jargon, intricate sentence structures, and frequent references to prior legislation. The country’s civil law tradition and multicultural context introduce further interpretative and linguistic challenges. Moreover, the study of Brazilian Portuguese legislative texts remains underexplored, lacking legal-specific models and datasets. To address these gaps, this work proposes a data-driven approach utilizing large language models (LLMs) to analyze these documents and extract knowledge graphs (KGs). A case study was conducted using 1869proposals from the Legislative Assembly of Rio Grande do Norte (ALRN), spanning January 2019 to April 2024. The Llama 3.2 3B Instruct model was employed to extract KGs representing entities and their relationships. The findings support the method’s effectiveness in producing coherent graphs faithful to the original content. Nevertheless, challenges remain in resolving entity ambiguity and achieving full relationship coverage. Additionally, readability analyses using metrics for Brazilian Portuguese revealed that ALRN proposals require superior reading skills due to their technical style. Ultimately, this study advances legal artificial intelligence by providing insights into Brazilian legislative texts and promoting transparency and accessibility through natural language processing techniques. Full article

Preschool as a place of learning consists of various communities and belongings created in the intersection between children, teachers, and policy. The very essence of a good life in preschool is characterised by the sort of communities and the opportunities for belonging available to children. Being able to participate in various communities and to experience belonging is central to the wellbeing of every child in preschool. The aim of this study is to gain knowledge about processes of belonging in preschool peer communities. The following research questions guide the study: What categorisations, positionings, and identifications appear in the interactions between the children? What ethical and political value preferences are at stake? The study applies Nira Yuval-Davis’s theory about the politics of belonging and her analytical framework is used to interpret and understand data, including analytical concepts such as categorisation and social positioning, identifications, and ethical and political value systems. A case study has been used to explore processes of belonging in rich detail. Data consist of video observations of interactions between children in a Swedish Early Childhood Education (ECE) institution. Findings reveal how the children’s categorisations lead to various positions, identifications, and opportunities for belonging. We show how a grounded position is established, and how categorisations are used to justify exclusion. The study also illustrates various approaches used by the children to gain a sense of belonging in peer communities, here conceptualised as confrontation, adaptation, and defence. A conclusion is that children’s categorisations are deeply embedded in the social structures of preschool and that the work with belonging needs to be on every teacher’s agenda. Full article

Students with high intellectual abilities in higher education face a significant risk of underachievement due to a range of influencing factors. This systematic review explored their social–emotional and educational needs and examined interventions aimed at addressing both these needs and underachievement. A systematic literature search of a total of 118 records identified 20 social–emotional and 26 educational needs, organized into six overarching categories, illustrating the complex challenges these students face. Of the 42 records investigating an intervention, 38 focused on students directly, three on student advisors and one on teachers. While most interventions addressed multiple student needs, none fully integrated social–emotional and educational aspects. Ultimately, 17 studies examined underachievement, but only 5 implemented an intervention to reduce it. These findings underscore the need for integrated approaches to effectively support higher education students with high abilities. Full article

Much research has considered how physical appearance affects the way people are judged, such as how body size affects judgements of attractiveness and health. Less research, however, has looked at visual attention during such judgements. We used eye-tracking to measure the gaze behaviour of 32 participants (29 female) on male and female computer-generated bodies of different body mass index (BMI). Independent variables were sex and BMI of the model, area of interest of the body, and the judgement made (attractiveness, healthiness, and youthfulness). Dependent variables were the number and duration of fixations, and Likert ratings. Most visual attention was paid to the chest and midriff, but this pattern differed slightly depending on the judgement being made, and on the BMI of the body. The sex of the body also affected eye-gaze behaviour, possibly because most participants were female. The bodies at the lower end of healthy weight were judged most attractive and healthy, in line with previous research, but the lightest bodies were judged as most youthful. These results suggest that these social judgements cue similar but subtly different gaze behaviour, and broadly support the “health-and-fertility” hypothesis, that the most attractive bodies are those that indicate evolutionary fitness. Full article

Background: Eosinophilic esophagitis is a chronic immune-mediated disease with increasing prevalence. In pediatric populations, it often coexists with IgE-mediated food sensitization. This dual diagnosis presents unique therapeutic challenges, including on the one hand both temporary and lifelong dietary restrictions, and on the other hand, therapeutic interventions with a potential impact on quality of life (QoL). Objectives: This study prospectively evaluated the prevalence of IgE-mediated food sensitization and allergy in children with EoE attending a tertiary center in Flanders, Belgium. Additionally, it prospectively documented dietary habits and restrictions in these children, with or without concomitant IgE-mediated food allergies, and assessed the impact of dietary management on quality of life compared to pharmacological treatment. Methods: We consecutively followed 30 children with biopsy-confirmed pediatric EoE (PedEoE) attending a tertiary referral center for at least 12 months. Patient demographics, allergy testing, dietary history, and treatment modalities were recorded. Symptom score and PedEoE QoL were assessed using validated Pediatric Eosinophilic Esophagitis Symptom Score (PEESS 2.0) and Pediatric Quality of Life Inventory (PedsQL 3.0) questionnaires. Statistical analysis was performed using the Mann–Whitney U test and Kruskal–Wallis test with Dunn’s test as a post hoc test. Results: Among 30 children with EoE (60% male, median age 8 years), 60 PedEoE QoL (PedsQL) and 39 symptom (PEESS) questionnaires were collected at one or more time points over a median follow-up of 14.5 months. IgE sensitization to common dietary triggers was observed in multiple patients, with varying clinical reactivity. Symptom scores tended to be higher in children without histological remission, though differences were not statistically significant (median PEESS 23.75 vs. 17.50, p = 0.1934). Grouped by degree of dietary restriction, QoL scores showed significant differences (child p = 0.0102; parent p = 0.0203), with children in the 1–2 food elimination group reporting better QoL compared to the 0 food elimination and >6 food elimination groups. No clear statistically significant differences were observed between the 1–2 food elimination group and the 3–4 or 5–6 food elimination groups. Conclusions: IgE sensitization is prevalent among pediatric EoE patients and has significant clinical implications for disease management. Treatment choice can influence not only disease control but also the QoL of both patients and their families. Full article