Parent training for the treatment of irritability in children and adolescents: a multisite randomized controlled, 3-parallel-group, evaluator-blinded, superiority trial.

BACKGROUND: Irritability is common in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and with anxiety/depressive disorders. Although youth irritability is linked with psychiatric morbidity, little is known regarding its non-pharmacological treatments. Developing non-pharmacological treatments for children with severe, chronic irritability is an important target for clinical research. To achieve this goal, we will test the benefits of parent-focused therapies in reducing irritability. The aim of the study is to compare Parent Management Training (PMT) and Non-Violent Resistance Training (NVR) programs with treatment-as-usual (TAU) on the improvement of irritability in children and adolescents with a baseline Parent-rated Affective Reactivity Index of 4 or higher, in the context of ADHD and other emotional and behavioural disorders. Additionally, we will assess (i) improvement of irritability at different times and according to different informants (parents, children, clinicians); (ii) improvement of parental strategies; and (iii) acceptability of the interventions, exploring possible mechanisms of the therapeutic effect. METHODS: Two hundred and seventy participants between 6 and 15 years with ADHD and other emotional and behavioural disorders will be recruited and randomly assigned with their parents to the PMT, NVR, and TAU groups. PMT and NVR programs have 10 online sessions and two booster sessions at 1 and at 3 months. The primary outcome measure is the change from baseline at 3 months after completion of the program of the Clinician-rated Affective Rating Scale (CL-ARI) assessed by a blind evaluator. Secondary outcome measures include the change from baseline from those scales: the CL-ARI, the Clinical Global Impression Improvement scale, the Parenting and Familial Adjustment Scales, the Child-rated Cranky thermometers and the Parent-rated ARI. We will assess the parent's expressed emotions and reflexivity during the online five-minute speech sample, clinical dimensions through the Child Behavior Checklist 6-18 and the Inventory of Callous Unemotional traits. Evaluations will be done remotely at baseline and at 1- and 3-months follow-up visits. DISCUSSION: We expect a benefit in controlling irritability in the treatment groups. This will constitute an important achievement in promoting parental support programs in the treatment of irritability in the context of emotional and behavioural disorders. CLINICALTRIALS: gov. Number: NCT05528926. Registered on the 2nd of September, 2022.

Change in Anopheles richness and composition in response to artificial flooding during the creation of the Jirau hydroelectric dam in Porto Velho, Brazil.

BACKGROUND: Anopheles mosquitoes are the only vectors of human malaria. Anopheles species use standing water as breeding sites. Human activities, like the creation of an artificial lake during the implementation of hydroelectric power plants, lead to changes in environmental characteristics and, therefore, may changes the species richness and composition of Anopheles mosquitoes. The aim of the present study was to verify whether or not there is an association between the artificial flooding resulting from the construction of the Jirau hydroelectric power plant, and the richness and composition of anophelines. METHODS: Mosquitoes samples were obtained monthly from the Jirau hydroelectric power plant area located at Porto Velho, Rondônia State, using Human Landing Catch (06:00-10:00 PM). Mosquitoes collected were transported to Laboratório de Entomologia Médica FIOCRUZ-RO where they were identified until species using dichotomous key. RESULTS: A total of 6347 anophelines belonging to eight different species were collected. The anophelines species richness was significantly lower during the first flooding stage. Differences in anophelines species composition were found when comparing the first flooding stage with the other stages. Furthermore, the mean number of Anopheles darlingi, the main vector of malaria in the region, increases during the first and the third flooding stages. CONCLUSIONS: The continual monitoring of these vectors during the late operational phase may be useful in order to understand how anophelines will behave in this area.

Interfaz entre formación en enfermería y actividades artístico-culturales en el espacio académico: visión de los estudiantes / The interface between the nursing formation process and artistic-cultural activities within the academic space: the students' perspective / A interface entre formação de enfermagem e atividades artístico-culturais no espaço acadêmico: visão dos estudantes

Objetivo Analizar la percepción de los estudiantes en relación con las contribuciones de su inserción en actividades artístico-culturales en el espacio universitario para la formación en enfermería. Método Investigación cualitativa, guiada por la epistemología de Fleck. Participaron 17 estudiantes de enfermería integrantes de movimientos artístico-culturales existentes en una institución de enseñanza superior, a saber: Grupo teatral, grupo musical y grupo de Maracatú. Los datos fueron recolectados por medio de entrevista semiestructurada y organizados por la técnica del discurso del sujeto colectivo. Resultados: Los estudiantes destacaron entre las ventajas de las actividades artístico-culturales el estímulo para estudiar, sentirse relajado y más preparado para las actividades académicas, así como propiciar el desarrollo de sensibilidad y competencias que puedan transformar los escenarios de la práctica clínica de enfermería. Fueron indicadas como dificultades, la credibilidad de estas actividades en la academia, frente a la lógica de la formación curativa. Conclusiones: Integrar actividades artísticas y culturales con la formación académica permite al alumno protagonizar modos renovados de pensar en el cuidado de enfermería y fortalecer conexiones con los diferentes conocimientos necesarios para la práctica del cuidado holístico.

Objective To analyze the students' perceptions of the impact which their participation in artistic-cultural activities within the university space has on their nursing-formation process. Method: This is a qualitative research guided by the epistemology of Fleck. Seventeen nursing students from a high level school, and also members of artistic-cultural movements such as theater, music and Maracatu groups, participated in this study. Data were collected through semi-structured interviews and then organized following the collective subject discourse technique. Results: Related to the positive influence of their artistic-cultural activities, the students highlighted their stimulus to study, feeling relaxed, and being more prepared for the academic activities including those which can help them develop competences and sensibilities to improve the clinical nursing practice scenarios. A remark on the academia who doubts the credibility of these activities and who follows a model in which health is only viewed as the absence of illness was also highlighted. Conclusions: The integration of artistic and cultural activities into the nursing formation process allows the students to develop renewed modes of thinking which can strengthen the links among their knowledge areas, and thus prepare them better for a holistic care practice

Objetivo Analisar a percepção dos estudantes em relação às contribuições da sua inserção em atividades artístico-culturais no espaço universitário para a formação em enfermagem. Método: Investigação qualitativa, guiada pela epistemologia de Fleck. Participaram 17 estudantes de enfermagem, integrantes de movimentos artístico-culturais existentes em uma instituição de ensino superior, a saber: Grupo teatral, grupo musical e grupo de Maracatú. Os dados foram coletados por médio da entrevista semiestruturada e organizados pela técnica de discurso do sujeito coletivo. Resultados Os estudantes destacaram de entre as vantagens das atividades artístico-culturais, o estímulo para estudar, sentir-se relaxado e mais preparado para as atividades acadêmicas, bem como propiciar o desenvolvimento de sensibilidade e competências que pudessem transformar os cenários da prática clínica de enfermagem. Foram indicadas como dificuldades, a credibilidade destas atividades na escola, perante à lógica da formação curativista. Conclusões Integrar atividades artísticas e culturais na formação acadêmica, permite ao aluno protagonizar modos renovados de pensar no cuidado de enfermagem e fortalecer conexões com os diferentes conhecimentos necessários para a prática do cuidado holístico.

Identification of microRNAs associated with abdominal aortic aneurysms and peripheral arterial disease.

BACKGROUND: MicroRNAs are crucial in the regulation of cardiovascular disease and represent potential therapeutic targets to decrease abdominal aortic aneurysm (AAA) expansion. The aim of this study was to identify circulating microRNAs associated with AAA. METHODS: Some 754 microRNAs in whole-blood samples from 15 men with an AAA and ten control subjects were quantified using quantitative reverse transcriptase-PCR. MicroRNAs demonstrating a significant association with AAA were validated in peripheral blood and plasma samples of men in the following groups (40 in each): healthy controls, controls with peripheral arterial disease (PAD), men with a small AAA (30-54 mm), those with a large AAA (over 54 mm), and those following AAA repair. MicroRNA expression was also assessed in aortic tissue. RESULTS: Twenty-nine differentially expressed microRNAs were identified in the discovery study. Validation study revealed that let-7e (fold change (FC) -1·80; P = 0·001), miR-15a (FC -2·24; P < 0·001) and miR-196b (FC -2·26; P < 0·001) were downregulated in peripheral blood from patients with an AAA, and miR-411 was upregulated (FC 5·90; P = 0·001). miR-196b was also downregulated in plasma from the same individuals (FC -3·75; P = 0·029). The same miRNAs were similarly expressed differentially in patients with PAD compared with healthy controls. Validated and predicted microRNA targets identified through miRWalk revealed that these miRNAs were all regulators of AAA-related genes (vascular cell adhesion molecule 1, intercellular cell adhesion molecule 1, DAB2 interacting protein, α1-antitrypsin, C-reactive protein, interleukin 6, osteoprotegerin, methylenetetrahydrofolate reductase, tumour necrosis factor α). CONCLUSION: In this study, circulating levels of let-7e, miR-15a, miR-196b and miR-411 were differentially expressed in men with an AAA compared with healthy controls, but also differentially expressed in men with PAD. Modulation of these miRNAs and their target genes may represent a new therapeutic pathway to affect the progression of AAA and atherosclerosis.

Blocking CLEC14A-MMRN2 binding inhibits sprouting angiogenesis and tumour growth.

We previously identified CLEC14A as a tumour endothelial marker. Here we show that CLEC14A is a regulator of sprouting angiogenesis in vitro and in vivo. Using a human umbilical vein endothelial cell spheroid-sprouting assay, we found CLEC14A to be a regulator of sprout initiation. Analysis of endothelial sprouting in aortic ring and in vivo subcutaneous sponge assays from clec14a(+/+) and clec14a(-/-) mice revealed defects in sprouting angiogenesis in CLEC14A-deficient animals. Tumour growth was retarded and vascularity reduced in clec14a(-/-) mice. Pull-down and co-immunoprecipitation experiments confirmed that MMRN2 binds to the extracellular region of CLEC14A. The CLEC14A-MMRN2 interaction was interrogated using mouse monoclonal antibodies. Monoclonal antibodies were screened for their ability to block this interaction. Clone C4, but not C2, blocked CLEC14A-MMRN2 binding. C4 antibody perturbed tube formation and endothelial sprouting in vitro and in vivo, with a similar phenotype to loss of CLEC14A. Significantly, tumour growth was impaired in C4-treated animals and vascular density was also reduced in the C4-treated group. We conclude that CLEC14A-MMRN2 binding has a role in inducing sprouting angiogenesis during tumour growth, which has the potential to be manipulated in future antiangiogenic therapy design.

Global population structure of the spiny dogfish Squalus acanthias, a temperate shark with an antitropical distribution.

The spiny dogfish (Squalus acanthias) is a temperate, coastal squaloid shark with an antitropical distribution in the Atlantic and Pacific oceans. The global population structure of this species is poorly understood, although individuals are known to undergo extensive migrations within coastal waters and across ocean basins. In this study, an analysis of the global population structure of the spiny dogfish was conducted using eight polymorphic nuclear microsatellite markers and a 566-bp fragment of the mitochondrial ND2 gene region. A low level of genetic divergence was found among collections from the Atlantic and South Pacific basins, whereas a high level of genetic divergence was found among Pacific Ocean collections. Two genetically distinct groups were recovered by both marker classes: one exclusive to North Pacific collections, and one including collections from the South Pacific and Atlantic locations. The strong genetic break across the equatorial Pacific coincides with major regional differences in the life-history characters of spiny dogfish, suggesting that spiny dogfish in areas on either side of the Pacific equator have been evolving independently for a considerable time. Phylogeographic analyses indicate that spiny dogfish populations had a Pacific origin, and that the North Atlantic was colonized as a result of a recent range expansion from the South American coast. Finally, the available data strongly argue for the taxonomic separation of the North Pacific spiny dogfish from S. acanthias and a re-evaluation of the specific status of S. acanthias is warranted.

Characterization and activity studies of highly heavy metal resistant sulphate-reducing bacteria to be used in acid mine drainage decontamination.

Biological treatment with sulphate-reducing bacteria (SRB) has been considered as the most promising alternative for acid mine drainage (AMD) decontamination. Normally, these wastewaters contain high concentrations of sulphate and heavy metals, so the search for SRB highly resistant to metals is extremely important for the development of a bioremediation technology. A SRB consortium resistant to high concentrations of heavy metals (Fe, Cu and Zn), similar to those typically present in AMD, was obtained among several environmental samples, from a wastewater treatment plant. The phylogenetic analysis of the dsr gene sequence revealed that this consortium contains species of SRB affiliated to Desulfovibrio desulfuricans and Desulfobulbus rhabdoformis. The results show that the presence of usually lethal concentrations of Fe (400mg/L), Zn (150 mg/L) and Cu (80 mg/L) is not toxic for the sulphate-reducing bacteria present in this sample. As a consequence, a very good efficiency in terms of sulphate reduction and metals removal was obtained. Both ethanol and lactate can be used by this inoculum as carbon source. With the other samples tested sulphate reduction was inhibited by the presence of copper and zinc. This highly metal resistant consortium will be used to inoculate a bioreactor to carry out AMD decontamination.

Usefulness of fatty acid composition for differentiation of Legionella species.

Numerical analysis of fatty acid methyl ester (FAME) profiles of 199 isolates and 76 reference strains, belonging to all validly described species of the genus Legionella that can be cultured in laboratory media, was used to differentiate between the species of this genus. With the exception of the strains that autofluoresced red, it was possible to differentiate all the other Legionella species. The strains of the species L. bozemanii, L. dumoffii, L. feeleii, L. gormanii, L. maceachernii, L. micdadei, and L. quinlivanii did not form single clusters, showing some degree of variability in the fatty acid compositions. The strains of the blue-white autofluorescent species had very similar fatty acid compositions and were difficult to distinguish from each other. Nine isolates had fatty acid profiles unlike those of any of the validly described species and may represent different FAME groups of known species or undescribed Legionella species. The method used in this study was useful for screening and discriminating large number of isolates of Legionella species. Moreover, the results obtained can be included in a database of fatty acid profiles, leading to a more accurate automatic identification of Legionella isolates.

Characterization of Legionella species by numerical analysis of whole-cell protein electrophoresis.

The results of a computer-assisted whole-cell protein sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis of 291 isolates and 74 reference strains belonging to all known species of the genus Legionella revealed that the majority of the species of this genus can be adequately identified by this method. The type strain of Legionella bozemanii did not cluster with the other strains of this species, and the only strain of Legionella geestiana available clustered with the strains of Legionella feeleii. When we performed a numerical analysis by omitting certain portions of the pattern containing dense bands, all of the species could be distinguished. Our results also show that the type strains of Legionella nautarum and Legionella londiniensis deposited in the National Collection of Type Cultures do not correspond to the type strains deposited in the American Type Culture Collection. We used the results of a fatty acid and ubiquinone composition analysis to complement the SDS-PAGE results for several strains whose identities as determined by indirect immunofluorescence were doubtful. Computer-assisted SDS-PAGE of whole-cell proteins can be used in the classification of Legionella species and to identify and screen large numbers of isolates for further, in-depth taxonomic studies of smaller numbers of strains.

Relationship between Legionella spp. and antibody titres at a therapeutic thermal spa in Portugal.

The presence of Legionella spp. in the water of a Portuguese spa was ascertained during the spa season, between May and November. Simultaneously the prevalence of anti-legionella antibodies in people attending the spa was also investigated. The antibody titres of 172 randomly selected patients and 42 therapists were determined, and compared with a control group of 503 blood donors. Legionellae were present in the spa water at low concentrations, generally lower than 10(3) c.f.u./l. A total of 92 strains representing eight different species or serogroups were isolated; the predominant isolates belonged to Legionella pneumophila serogroup 6 and to L. londiniensis. During the study, no clinical cases of Legionnaires' disease were observed, and the antibody titres were generally low in the groups studied. However, the antibody titres of the patients increased slightly during their stay at the spa, approaching the values for the therapists. Mean antibody titres in the groups related with the spa were significantly higher than those in the blood donors against five of the seven legionella antigens tested. The largest number of elevated antibody titres in the exposed groups were to the L. pneumophila sg 5 and sg 6 antigens.

Transient abnormal myelopoiesis of infancy associated with trisomy 21.

PURPOSE: A unique myelodysplastic syndrome referred to as transient abnormal myelopoiesis (TAM) has been reported to occur primarily in infants with Down's syndrome (DS) or other abnormalities of chromosome 21. This disorder raises basic questions regarding the pathogenesis of leukemia, yet its natural history is poorly documented and derives from small series and isolated case reports. PATIENTS AND METHODS: To better characterize TAM, we accumulated data on 35 cases identified through a questionnaire mailed to pediatric oncologists in the United States. These cases, pooled with two that we recently encountered, and 58 comparable cases reported in the literature comprise a series of 95 cases of TAM in DS. RESULTS: The patients in this series were notable for the high morbidity and mortality of this reportedly benign condition. Eleven percent of the patients died during the initial event, and the overall mortality for the entire series was 27%. Twenty-eight of the 85 patients (33%) who survived the initial event developed a subsequent hematologic disorder, most often acute nonlymphocytic leukemia, at a median age of 16 months. CONCLUSIONS: No initial clinical or hematologic features predicted the development of a subsequent hematologic disorder. However, those patients initially mosaic for the presence of trisomy 21 did not develop subsequent abnormalities. This series reviews questions regarding leukemogenesis in DS and underscores the importance of conducting future prospective studies of this unique hematologic disorder.

Distribution of Legionella spp. in hydrothermal areas in continental Portugal and the island of São Miguel, Azores.

Nineteen aquatic environment sites from three hydrothermal areas on continental Portugal and one area on the island of São Miguel, Azores, were examined for the recovery of Legionella spp. Physicochemical and bacteriological parameters were also determined for each site. Water temperatures varied between 22 and 67.5 degrees C, although the majority had temperatures above 40 degrees C; the pH varied between 5.5 and 9.2. The number of Legionella spp. recovered varied between 5.0 x 10(2) and 2.3 x 10(6) CFU/liter. A total of 288 isolates from 14 sites were identified by indirect immunofluorescence assay. The majority of the isolates belonged to Legionella pneumophila (74.3%), of which most belong to serogroup 1, but the relative proportion of L. pneumophila serogroups varied considerably. L. pneumophila serogroup 1 constituted 96.2% of the isolates in area 2 from central Portugal, but no isolates of this serogroup were recovered from São Miguel, where serogroup 6 strains were the predominant isolates. Ninety-six percent of the L. pneumophila serogroup 1 isolates belonged to monoclonal antibody subgroups OLDA and Bellingham. Other species identified were L. bozemanii serogroup 2, L. dumoffii, L. micdadei, L. moravica, L. oakridgensis, L. sainticrucis, and L. sainthelensi. Two undescribed species, which react by indirect immunofluorescence assay to antisera to "L. londoniensis" and "L. nautarum" and a group of isolates with strong cross-reaction to L. cincinnatiensis/L. sainticrucis/L. longbeachae by indirect immunofluorescence assay were also recovered. The latter were the only isolates recovered from area 3, in east central Portugal, over a period of 1 year.

A hot water supply as the source of Legionella pneumophila in incubators of a neonatology unit.

The humidification trays of five of seven incubators in a neonatology unit of a hospital were found to be colonized with Legionella pneumophila, serogroup 1. Bacteriological analysis of the water in the humidification trays showed very large numbers of heterotrophic bacteria, one of which also contained Pseudomonas aeruginosa. Two hot water systems supply the neonatology unit, either of which is used to add water to the humidification trays; one system (A) is maintained at about 60 degrees C, while the other system (B) is maintained at 45 degrees C. The latter was also found to be colonized with L. pneumophila, Sg1. Monoclonal antibody (Mab) subgrouping of the isolates, indicated that system B was the source of colonization of the humidification trays of the incubators.