Advancements in dementia research, diagnostics, and care in Latin America: Highlights from the 2023 Alzheimer's Association International conference satellite symposium in Mexico City.

INTRODUCTION: While Latin America (LatAm) is facing an increasing burden of dementia due to the rapid aging of the population, it remains underrepresented in dementia research, diagnostics, and care. METHODS: In 2023, the Alzheimer's Association hosted its eighth satellite symposium in Mexico, highlighting emerging dementia research, priorities, and challenges within LatAm. RESULTS: Significant initiatives in the region, including intracountry support, showcased their efforts in fostering national and international collaborations; genetic studies unveiled the unique genetic admixture in LatAm; researchers conducting emerging clinical trials discussed ongoing culturally specific interventions; and the urgent need to harmonize practices and studies, improve diagnosis and care, and use affordable biomarkers in the region was highlighted. DISCUSSION: The myriad of topics discussed at the 2023 AAIC satellite symposium highlighted the growing research efforts in LatAm, providing valuable insights into dementia biology, genetics, epidemiology, treatment, and care.

An Opportunity for Management of Fatigue, Physical Condition, and Quality of Life Through Asynchronous Telerehabilitation in Patients After Acute Coronavirus Disease 2019: A Randomized Controlled Pilot Study.

OBJECTIVE: To compare the preliminary efficacy of asynchronous telerehabilitation in patients after acute coronavirus disease 2019 (COVID-19) on fatigue, physical condition, quality of life, and feasibility of this pilot study with that of a booklet format. DESIGN: Randomized pilot study with 2 intervention arms: asynchronous telerehabilitation group and booklet-based rehabilitation group, with 2 follow-ups at 3 and 6 months. SETTING: Hospital. PARTICIPANTS: Patients discharged after COVID-19 were recruited and evaluated (N=35). INTERVENTIONS: The intervention consisted of a 12-week multimodal rehabilitation program via telerehabilitation or by a booklet. MAIN OUTCOME MEASURES: Fatigue as the main outcome and functional status, quality of life, and feasibility as secondary outcomes were evaluated. RESULTS: After the intervention, there was no significant difference between groups in fatigue, but there were significant differences in favor of the asynchronous telerehabilitation group for the 6-Minute Walk Test (p=.008), the 30-Second Sit-to-Stand Test (p=.019), and physical quality of life (p=.035). These improvements were maintained throughout the 6-month follow-up. Telerehabilitation was shown to be a viable option, without incidents and with a higher adhesion (p=.028) than the booklet format. CONCLUSIONS: A multimodal rehabilitation program by means of asynchronous telerehabilitation appears as a more effective option than traditional formats in improving post-acute COVID-19 sequelae.

Influence of dengue virus serotypes on the abundance of Aedes aegypti insect-specific viruses (ISVs).

A comprehensive understanding of the virome in mosquito vectors is crucial for assessing the potential transmission of viral agents, designing effective vector control strategies, and advancing our knowledge of insect-specific viruses (ISVs). In this study, we utilized Oxford Nanopore Technologies metagenomics to characterize the virome of Aedes aegypti mosquitoes collected in various regions of Colombia, a country hyperendemic for dengue virus (DENV). Analyses were conducted on groups of insects with previous natural DENV infection (DENV-1 and DENV-2 serotypes), as well as mosquito samples that tested negative for virus infection (DENV-negative). Our findings indicate that the Ae. aegypti virome exhibits a similar viral composition at the ISV family and species levels in both DENV-positive and DENV-negative samples across all study sites. However, differences were observed in the relative abundance of viral families such as Phenuiviridae, Partitiviridae, Flaviviridae, Rhabdoviridae, Picornaviridae, Bromoviridae, and Virgaviridae, depending on the serotype of DENV-1 and DENV-2. In addition, ISVs are frequently found in the core virome of Ae. aegypti, such as Phasi Charoen-like phasivirus (PCLV), which was the most prevalent and showed variable abundance in relation to the presence of specific DENV serotypes. Phylogenetic analyses of the L, M, and S segments of the PCLV genome are associated with sequences from different regions of the world but show close clustering with sequences from Brazil and Guadeloupe, indicating a shared evolutionary relationship. The profiling of the Ae. aegypti virome in Colombia presented here improves our understanding of viral diversity within mosquito vectors and provides information that opens the way to possible connections between ISVs and arboviruses. Future studies aimed at deepening our understanding of the mechanisms underlying the interactions between ISVs and DENV serotypes in Ae. aegypti could provide valuable information for the design of effective vector-borne viral disease control and prevention strategies.IMPORTANCEIn this study, we employed a metagenomic approach to characterize the virome of Aedes aegypti mosquitoes, with and without natural DENV infection, in several regions of Colombia. Our findings indicate that the mosquito virome is predominantly composed of insect-specific viruses (ISVs) and that infection with different DENV serotypes (DENV-1 and DENV-2) could lead to alterations in the relative abundance of viral families and species constituting the core virome in Aedes spp. The study also sheds light on the identification of the genome and evolutionary relationships of the Phasi Charoen-like phasivirus in Ae. aegypti in Colombia, a widespread ISV in areas with high DENV incidence.

Characterizing viral species in mosquitoes (Culicidae) in the Colombian Orinoco: insights from a preliminary metagenomic study.

Mosquitoes (Diptera: Culicidae) are primary vectors of arthropod-borne viruses (arboviruses) that pose significant public health threats. Recent advances in sequencing technology emphasize the importance of understanding the arboviruses and insect-specific viruses (ISVs) hosted by mosquitoes, collectively called the "virome". Colombia, a tropical country with favorable conditions for the development and adaptation of multiple species of Culicidae, offers a favorable scenario for the transmission of epidemiologically important arboviruses. However, entomovirological surveillance studies are scarce in rural areas of the country, where humans, mosquitoes, and animals (both domestic and wild) coexist, leading to a higher risk of transmission of zoonotic diseases to humans. Thus, our study aimed to perform a preliminary metagenomic analysis of the mosquitoes of special relevance to public health belonging to the genera Ochlerotatus, Culex, Limatus, Mansonia, Psorophora, and Sabethes, within a rural savanna ecosystem in the Colombian Orinoco. We employed third-generation sequencing technology (Oxford Nanopore Technologies; ONT) to describe the virome of mosquitoes samples. Our results revealed that the virome was primarily shaped by insect-specific viruses (ISVs), with the Iflaviridae family being the most prevalent across all mosquito samples. Furthermore, we identified a group of ISVs that were common in all mosquito species tested, displaying the highest relative abundance concerning other groups of viruses. Notably, Hanko iflavirus-1 was especially prevalent in Culex eknomios (88.4%) and Ochlerotatus serratus (88.0%). Additionally, other ISVs, such as Guadalupe mosquito virus (GMV), Hubei mosquito virus1 (HMV1), Uxmal virus, Tanay virus, Cordoba virus, and Castlerea virus (all belonging to the Negevirus genus), were found as common viral species among the mosquitoes, although in lower proportions. These initial findings contribute to our understanding of ISVs within mosquito vectors of the Culicidae family in the Eastern Plains of Colombia. We recommend that future research explore deeper into ISV species shared among diverse vector species, and their potential interactions with arboviruses. In addition, we also showed the need for a thorough exploration of the influence of local rural habitat conditions on the shape of the virome in mosquito vectors.

Employing oxford nanopore technologies (ONT) for understanding the ecology and transmission dynamics of flaviviruses in mosquitoes (Diptera: Culicidae) from Eastern Colombia.

Studies focused on identifying the viral species of Flavivirus in vectors are scarce in Latin America and particularly in Colombia. Therefore, the frequency of infection of the Flavivirus genus and its feeding preferences were identified in the mosquito species circulating in the municipality of Puerto Carreño-Vichada, located in the Eastern Plains of Colombia. This was done by sequencing the viral NS5 and vertebrate 12S rRNA genes, respectively, using Oxford Nanopore Technologies (ONT). A total of 1,159 mosquitoes were captured, with the most abundant species being Aedes serratus at 73.6% (n = 853). All the mosquitoes were processed in 230 pools (2-6 individuals) and 51 individuals, where 37.01% (n = 104) were found to be infected with Flavivirus. In these samples, infection by arboviruses of epidemiological importance, such as dengue virus (DENV), Zika virus (ZIKV), and chikungunya virus (CHIKV), was ruled out by PCR. However, through sequencing, infection by different insect-specific viruses (ISFVs) and a medically important virus, West Nile virus (WNV), were identified in a mosquito of the Culex browni species. Additionally, the feeding patterns showed that most species present a generalist behavior. Given the above, conducting entomovirological surveillance studies is crucial, especially in areas of low anthropogenic intervention, due to the high probability that potentially pathogenic viruses could generate spillover events under deforestation scenarios.

Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS): Study design and harmonization.

INTRODUCTION: Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS) is the first non-pharmacological multicenter randomized clinical trial (RCT) to prevent cognitive impairment in Latin America (LA). Our aim is to present the study design and discuss the strategies used for multicultural harmonization. METHODS: This 1-year RCT (working on a 1-year extension) investigates the feasibility of a multi-domain lifestyle intervention in LA and the efficacy of the intervention, primarily on cognitive function. An external harmonization process was carried out to follow the FINGER model, and an internal harmonization was performed to ensure this study was feasible and comparable across the 12 participating LA countries. RESULTS: Currently, 1549 participants have been screened, and 815 randomized. Participants are ethnically diverse (56% are Nestizo) and have high cardiovascular risk (39% have metabolic syndrome). DISCUSSION: LatAm-FINGERS overcame a significant challenge to combine the region's diversity into a multi-domain risk reduction intervention feasible across LA while preserving the original FINGER design.

Long-term functional ability trajectories and mental health among older people before and after the COVID-19 pandemic onset in Chile.

OBJECTIVES: Despite the advances in understanding the complex association between functional abilities and mental health in old age, studies have overlooked two important aspects. First, traditionally, research has employed cross-sectional designs, measuring limitations at a single time point. Second, most gerontological studies on this field have been conducted before the COVID-19 pandemic onset. This study aims to explore the association between diverse long-term functional ability trajectories across late adulthood and old age, and older people's mental health in Chile, before and after the COVID-19 pandemic onset. METHODS: We use data from the population-representative and longitudinal 'Chilean Social Protection Survey', sequence analysis to reconstruct functional ability trajectory types from 2004 to 2018, and bivariate and multivariate analyses to measure their association with depressive symptoms in early 2020 (N = 891) and late 2020 (N = 672). We analyzed four age groups defined by their age at baseline (2004): people aged 46-50, 51-55, 56-60, and 61-65. RESULTS: Our findings indicate that erratic or equivocal patterns of functional limitations across time (with people transiting back and forth between low and high levels of limitations) show the worst mental health outcomes, both before and after the pandemic onset. Prevalence of people with depression increased after the COVID-19 onset in most groups, being particularly high among those with previous equivocal functional ability trajectories. CONCLUSIONS: The relationship between functional ability trajectories and mental health calls for a new paradigm, moving away from age as the main policy guide, and highlighting the need to adopt strategies to improve population-level functional status as an efficient policy to address the challenges of population aging.

Ice plant root plasma membrane aquaporins are regulated by clathrin-coated vesicles in response to salt stress.

The regulation of root Plasma membrane (PM) Intrinsic Protein (PIP)-type aquaporins (AQPs) is potentially important for salinity tolerance. However, the molecular and cellular details underlying this process in halophytes remain unclear. Using free-flow electrophoresis and label-free proteomics, we report that the increased abundance of PIPs at the PM of the halophyte ice plant (Mesembryanthemum crystallinum L.) roots under salinity conditions is regulated by clathrin-coated vesicles (CCV). To understand this regulation, we analyzed several components of the M. crystallinum CCV complexes: clathrin light chain (McCLC) and subunits µ1 and µ2 of the adaptor protein (AP) complex (McAP1µ and McAP2µ). Co-localization analyses revealed the association between McPIP1;4 and McAP2µ and between McPIP2;1 and McAP1µ, observations corroborated by mbSUS assays, suggesting that AQP abundance at the PM is under the control of CCV. The ability of McPIP1;4 and McPIP2;1 to form homo- and hetero-oligomers was tested and confirmed, as well as their activity as water channels. Also, we found increased phosphorylation of McPIP2;1 only at the PM in response to salt stress. Our results indicate root PIPs from halophytes might be regulated through CCV trafficking and phosphorylation, impacting their localization, transport activity, and abundance under salinity conditions.

The job of public transport, ride-hailing and delivery drivers: Conditions during the COVID-19 pandemic and implications for a post-pandemic future.

Transport workers were among the most affected by the COVID-19 crisis. In several countries, public transport and delivery drivers were considered essential workers during the pandemic, while the demand changed dramatically. In this context, little is known about the actual effects of the pandemic on the lives of drivers, and whether those effects depend on the type and formality of the corresponding job. In this paper, we analyse the impact of the pandemic on the daily jobs of public transport, ride-hailing, and delivery app drivers: we study changes on working time and income, pandemic-related concerns, and deterioration of job satisfaction, through a survey applied to drivers during the first peak of the pandemic in Santiago, Chile. Probit regressions on job satisfaction identify the main COVID-related experiences that explain variations in subjective perceptions. We then discuss the implications for post-pandemic job relationships, drivers' working conditions and urban mobility. We show that the unstable characteristics of app-based jobs sharpened during the pandemic: Public transport drivers have kept their jobs, with a similar income as in the pre-pandemic situation and keep their social security, whereas ride-hailing and delivery app drivers do not have social security. Several ride-hailing drivers lost their jobs without any compensation, while delivery drivers earn less money per hour, are more exhausted, and express the greatest concerns and largest decrease in their job satisfaction. The COVID-19 crisis has emphasized that the sustainability of post-pandemic passenger and delivery on-demand services needs to rely on formal job regulation and worker protection.

Impact of Respiratory Syncytial Virus and Influenza Virus Infection in the Adult Population in Spain between 2012 and 2020.

Respiratory syncytial virus (RSV) infection is increasingly recognized as a cause of significant morbidity and mortality in adults. We aimed to estimate the rates of age-specific hospitalization and in-hospital mortality caused by acute lower respiratory tract infections (ALRTIs) in Spain between 2012 and 2020 and to compare the relative impact of RSV and influenza virus infection in adults. We used the discharge reports from the Minimum Basic Data Set to retrospectively analyze hospital discharge data on the basis of the ICD-9-CM and ICD-10-CM diagnosis codes. A total of 1,518,244 patients were hospitalized for ALRTIs, of whom 137,794 (9.1%) were admitted for RSV-related infections and 46,288 (3.0%) for influenza-related infections. In patients aged 60 years or older, the hospitalization rates (per 100,000 population) were estimated at 1.69 (95% CI 1.68-1.70) and 2.72 (95% CI 2.71-2.73) for RSV and influenza patients, respectively. However, in-hospital mortality rates were significantly higher among RSV patients than among influenza patients, 7.91% (95% CI 7.89-7.93) (83.0% of all RSV-related deaths) versus 6.91% (95% CI 6.89-6.93) (85.6% of all influenza-related deaths), respectively (p = 0.007). RSV-associated in-hospital mortality increases exponentially with age, posing a greater risk for older adults, particularly frail and high-risk patients.

A parsimonious description of global functional brain organization in three spatiotemporal patterns.

Resting-state functional magnetic resonance imaging (MRI) has yielded seemingly disparate insights into large-scale organization of the human brain. The brain's large-scale organization can be divided into two broad categories: zero-lag representations of functional connectivity structure and time-lag representations of traveling wave or propagation structure. In this study, we sought to unify observed phenomena across these two categories in the form of three low-frequency spatiotemporal patterns composed of a mixture of standing and traveling wave dynamics. We showed that a range of empirical phenomena, including functional connectivity gradients, the task-positive/task-negative anti-correlation pattern, the global signal, time-lag propagation patterns, the quasiperiodic pattern and the functional connectome network structure, are manifestations of these three spatiotemporal patterns. These patterns account for much of the global spatial structure that underlies functional connectivity analyses and unifies phenomena in resting-state functional MRI previously thought distinct.

Efficient calculations of NSS-based gaze similarity for time-dependent stimuli.

The degree of spatial similarity between the gaze of participants viewing dynamic stimuli such as videos has been previously measured using metrics which are based on the NSS (Normalized Scanpath Saliency). Methods currently used to calculate this metric rely upon a numerical grid, which can be computationally prohibitive for a variety of otherwise useful applications such as Monte Carlo analyses. In the present work we derive a new analytical calculation method for the same metric that yields equal or more accurate results, but with speeds than can be orders of magnitude faster (depending on parameters). Our analytical method scales well with dimensionality, and could also be of use for other applications. The drawback is that it can become very slow if the number of participants in the study is very large or if the gaze sampling rate is high. We provide performance benchmarks for a Fortran implementation of our method, and make available the source code developed.

Extending the Analysis of Functional Ability Trajectories to Unexplored National Contexts: The Case of Chile.

OBJECTIVES: Despite the enormous advances in the field, most evidence about functional ability trajectories in old age comes from studies conducted in developed and high-income countries. This research aims to build on these previous advances to examine functional ability trajectories in Chile. METHOD: Drawing on a robust, publicly available 15-year panel data set (2004-2018), and using sequence analysis, we examine functional ability trajectories types among 4 age groups (people aged 46-50, 51-55, 56-60, and 61-64 at baseline). Then, we analyze trajectories' dynamics looking at intraindividual health-declining and health-recovery transitions between functional ability statuses, within each trajectory type. Finally, we assess how multiple baseline individual characteristics predict the likelihood of following a functional ability trajectory type, using multinomial regression models. RESULTS: Across all age groups, an important fraction (between 26% and 50%) reports stable healthy trajectories, and between 10% and 20% follow equivocal-declining trajectories (i.e., exhibiting both health-declining and health-recovery intraindividual transitions), suggesting that age might not be the main source of heterogeneity in functional ability trajectories. Overall, women, lower educated people, nonworking individuals, and people with a higher burden of chronic conditions at baseline are more prevalent among health-declining trajectory types; however, these results are not constant across the age groups analyzed. DISCUSSION: This nationally focused study reinforces the feasibility and usefulness of an in-depth analysis of functional ability trajectories in old age. The study findings can be crucial to define different prevention strategies according to the functional ability path that an individual might follow, especially in countries like Chile that currently navigate the challenges of population aging.

Considerations for COVID-19 management in reception centers for refugees, asylum seekers, and migrants, Spain 2020.

Shortly after the declaration of the COVID-19 pandemic, governments around the world were urged to leave no population behind. Following a COVID-19 risk evaluation in a refugee and asylum seekers reception center, in September 2020, we considered the priorities of managing COVID-19 in these settings. We encourage actions on the following four fronts to reduce the COVID-19-associated burden among these vulnerable populations based on our interviews, observations, and recommendations: (i) decongestion, (ii) facilitated testing, (iii) screening for symptoms, and (iv) targeted public health and risk communication.

Feasibility of selective anthelmintic therapy to horses in tropical conditions: the Cuban scenario.

For the past several decades, selective anthelmintic therapy (SAT) has been recommended in temperate climate countries for controlling gastrointestinal parasites in horses. However, the feasibility of this approach in tropical climates remains unknown, given the very different parasite transmission patterns and a larger representation of working equids. The aim of this study was to evaluate the bio-economic feasibility of SAT in horses kept under tropical conditions of Camagüey, Cuba. Fecal egg counts were determined from 794 adult horses and used for evaluating three different putative treatment thresholds; > 500 strongylid eggs per gram of feces (EPG); > 1000 EPG; and treatments yielding > 80% of the total herd egg output. These scenarios were evaluated under three treatment frequencies (every 2, 6, and 12 months). The bio-economic feasibility of these nine possible selective anthelmintic therapy scenarios was evaluated taking into account the cost of parasitological tests, and the mean cost of anthelmintic treatment in Camagüey. The majority (96.7%) of the samples tested were positive for strongyle eggs, with a mean of 1549 EPG. The percentage of horses exceeding the cut-off points at the nine scenarios varied between 40.1 and 93.8%. All owners surveyed used extra-label anthelmintic product in their horses on a routine basis. The economic analysis demonstrated that selective therapy generally was much more costly than deworming the entire herd without determining egg counts. However, we consider that the deworming every 6 months of the horses that expel 80% of the eggs in the herd allows a reduction of the treatment intensity without increasing costs, and it can be considered as a viable selective deworming scheme under similar conditions.

A differential subcellular localization of two copper transporters from the COPT family suggests distinct roles in copper homeostasis in Physcomitrium patens.

The moss Physcomitrium (Physcomitrella) patens is a bryophyte that provides genetic information about the adaptation to the life on land by early Embryophytes and is a reference organism for comparative evolutionary studies in plants. Copper is an essential micronutrient for every living organism, its transport across the plasma membrane is achieved by the copper transport protein family COPT/CTR. Two genes related to the COPT family were identified in Physcomitrella patens, PpaCOPT1 and PpaCOPT2. Homology modelling of both proteins showed the presence of three putative transmembrane domains (TMD) and the Mx3M motif, constituting a potential Cu + selectivity filter present in other members of this family. Functional characterization of PpaCOPT1 and PpaCOPT2 in the yeast mutant ctr1Δctr3Δ restored its growth on medium with non-fermentable carbon sources at micromolar Cu concentrations, providing support that these two moss proteins function as high affinity Cu + transporters. Localization of PpaCOPT1 and PpaCOPT2 in yeast cells was observed at the tonoplast and plasma membrane, respectively. The heterologous expression of PpaCOPT2 in tobacco epidermal cells co-localized with the plasma membrane marker. Finally, only PpaCOPT1 was expressed in seven-day old protonema and was influenced by extracellular copper levels. This evidence suggests different roles of PpaCOPT1 and PpaCOPT2 in copper homeostasis in Physcomitrella patens.

The Incomplete Tyranny of Dynamic Stimuli: Gaze Similarity Predicts Response Similarity in Screen-Captured Instructional Videos.

Although eye tracking has been used extensively to assess cognitions for static stimuli, recent research suggests that the link between gaze and cognition may be more tenuous for dynamic stimuli such as videos. Part of the difficulty in convincingly linking gaze with cognition is that in dynamic stimuli, gaze position is strongly influenced by exogenous cues such as object motion. However, tests of the gaze-cognition link in dynamic stimuli have been done on only a limited range of stimuli often characterized by highly organized motion. Also, analyses of cognitive contrasts between participants have been mostly been limited to categorical contrasts among small numbers of participants that may have limited the power to observe more subtle influences. We, therefore, tested for cognitive influences on gaze for screen-captured instructional videos, the contents of which participants were tested on. Between-participant scanpath similarity predicted between-participant similarity in responses on test questions, but with imperfect consistency across videos. We also observed that basic gaze parameters and measures of attention to centers of interest only inconsistently predicted learning, and that correlations between gaze and centers of interest defined by other-participant gaze and cursor movement did not predict learning. It, therefore, appears that the search for eye movement indices of cognition during dynamic naturalistic stimuli may be fruitful, but we also agree that the tyranny of dynamic stimuli is real, and that links between eye movements and cognition are highly dependent on task and stimulus properties.

Reconstruction of respiratory variation signals from fMRI data.

Functional MRI signals can be heavily influenced by systemic physiological processes in addition to local neural activity. For example, widespread hemodynamic fluctuations across the brain have been found to correlate with natural, low-frequency variations in the depth and rate of breathing over time. Acquiring peripheral measures of respiration during fMRI scanning not only allows for modeling such effects in fMRI analysis, but also provides valuable information for interrogating brain-body physiology. However, physiological recordings are frequently unavailable or have insufficient quality. Here, we propose a computational technique for reconstructing continuous low-frequency respiration volume (RV) fluctuations from fMRI data alone. We evaluate the performance of this approach across different fMRI preprocessing strategies. Further, we demonstrate that the predicted RV signals can account for similar patterns of temporal variation in resting-state fMRI data compared to measured RV fluctuations. These findings indicate that fluctuations in respiration volume can be extracted from fMRI alone, in the common scenario of missing or corrupted respiration recordings. The results have implications for enriching a large volume of existing fMRI datasets through retrospective addition of respiratory variations information.

Protocolo de Teleodontología para Asistencia al Paciente en el Manejo de Urgencia Dental. Cuarentena COVID-19 (SARS-CoV-2). Categorización Remota de Urgencia Dental y Asistencia (C.R.U.D.A.) / Teledentistry Protocol for Patient Assistance in Emergency Dental Management. Quarantine COVID-19 (SARS-CoV-2). Remote Categorization of Dental Emergency and Assistance (C.R.U.D.A. for its Spanish Acronym)

RESUMEN: En el contexto de cuarentena debido a la pandemia SARS-CoV-2, la odontología ha migrado a mecanismos remotos de atención para categorizar emergencias y urgencias. Sin embargo, no hay evidencia de protocolos validados de teleodontología aplicado al triaje remoto de urgencia en la literatura. Por ello, proponemos el instrumento denominado "Categorización Remota de Urgencia Dental y Asistencia" (C.R.U.D.A), aplicado a un protocolo de teleodontología. Para la construcción del protocolo, usamos la metodología de investigación-acción, un ciclo de autoreflexión frente al problema existente que buscamos solucionar, un espiral repetitivo de ciclos de planeamiento, acción, observación sistemática y reflexión, con el que fuimos perfeccionando el instrumento de forma colaborativa y rigurosa. Los objetivos del protocolo son estandarizar, optimizar y automatizar el proceso de categorización de urgencia dental gracias a su especificidad, disminuyendo el tiempo y complejidad de su aplicación a gran escala, permitiendo descongestionar el sistema de salud, y disminuir el riesgo de exposiciones innecesarias, protegiendo de esta forma al personal clínico y pacientes. Al mismo tiempo, su nivel de legibilidad permitiríamejorar la comunicación y orientación al paciente. En definitiva, el protocolo propuesto es viable y cumple con las características para optimizar el proceso de teletriaje actual, potenciando la atención personalizada entre odontólogos y pacientes. Sin embargo, es necesario realizar estudios de aplicabilidad y validez, además de incorporar las mejoras correspondientes según los errores o defectos detectados por pacientes y cirujano dentistas.

ABSTRACT: In the context of quarantine due to the SARS-CoV-2 pandemic, dentistry has migrated to remote care mechanisms to categorize emergencies and casualties.However, there is no evidence of validated teledentistry protocols applied to remote emergency triage in the literature. Therefore, we propose an instrument called "Remote Categorization of Dental Emergency and Assistance" (C.R.U.D.A., for its Spanish acronym), applied to a teledentistry protocol. For the construction of the protocol, we used the action-research methodology, a self-reflection cycle to solve an existing problem, a constant repetition of planning, action, systematic observation, and reflection, with which we perfected the instrument in a collaborative and rigorous way. The objectives of the protocol are to standardize, optimize and automate the process of categorization of dental emergencies thanks to its specificity, decreasing the time and complexity of its application on a large scale, allowing to decongest the health system and to diminish the risk of unnecessary exposures, thus protecting clinical staff and patients. At the same time, its level of readability would allow for improved communication and patient orientation. In short, the proposed protocol is viable and meets the characteristics to optimize the current teletriage process, enhancing personalized attention between dentists and patients. However, it is necessary to carry out applicability and validity studies, in addition to incorporating the corresponding improvements according to the errors or defects detected by patients and dental surgeons.

To live and age as who we really are: Perspectives from older LGBT+ people in Ireland.

This Open Letter discusses the theme of 'diversity in brain health' in research, practice and policy for older LGBT+ people. It is written by a multidisciplinary group of Atlantic Fellows for Equity in Brain Health at the Global Brain Health Institute in Trinity College Dublin (TCD), from a variety of disciplines (health economics, human geography, anthropology, psychology, gerontology) and professions (researcher, clinicians, writers, practicing artists). The group developed a workshop to explore the theme of 'Diversity and Brain Health' through the lens of lesbian, gay, bisexual, transgender/transsexual plus (LGBT+).  . Guided by two advisors (Prof Agnes Higgins, TCD; Mr Ciaran McKinney, Age and Opportunity), we invited older LGBT+ people and those interested in the topic of LGBT+ and ageing, healthcare providers, policy makers and interested members of the research community. We partnered with colleagues in the School of Law to include socio-legal perspectives. Following the workshop, Roe and Walrath wrote an opinion editorial, published in the Irish Times during the 2019 PRIDE festival, and were subsequently invited by HRB Open Research to provide a more detailed expansion of that work. In this Open Letter we describe the theme of 'diversity and brain health' and some of the lessons we learned from listening to the lived experience of older LGBT+ people in Ireland today. We illustrate why it's important to understand the lived experience of older LGBT+ people and highlight the failure of the State to evaluate the experience of LGBT+ people in policy implementation. We call on researchers, clinicians, service planners and policy makers, to recognize and address diversity as an important way to address health inequities in Ireland.