Mass Mortality of Sea Lions Caused by Highly Pathogenic Avian Influenza A(H5N1) Virus.

We report a massive mortality of 5,224 sea lions (Otaria flavescens) in Peru that seemed to be associated with highly pathogenic avian influenza A(H5N1) virus infection. The transmission pathway may have been through the close contact of sea lions with infected wild birds. We recommend evaluating potential virus transmission among sea lions.

Determinants of food preparation and hygiene practices among caregivers of children under two in Western Kenya: a formative research study.

INTRODUCTION: Diarrhea is a leading cause of child morbidity and mortality worldwide and is linked to early childhood stunting. Food contamination from improper preparation and hygiene practices is an important transmission pathway for exposure to enteric pathogens. Understanding the barriers and facilitators to hygienic food preparation can inform interventions to improve food hygiene. We explored food preparation and hygiene determinants including food-related handwashing habits, meal preparation, cooking practices, and food storage among caregivers of children under age two in Western Kenya. METHODS: We used the Capabilities, Opportunities, and Motivations model for Behavior Change (COM-B) framework in tool development and analysis. We conducted 24 focus group discussions with mothers (N = 12), fathers (N = 6), and grandmothers (N = 6); 29 key informant interviews with community stakeholders including implementing partners and religious and community leaders; and 24 household observations. We mapped the qualitative and observational data onto the COM-B framework to understand caregivers' facilitators and barriers to food preparation and hygiene practices. RESULTS: Facilitators and barriers to food hygiene and preparation practices were found across the COM-B domains. Caregivers had the capability to wash their hands at critical times; wash, cook, and cover food; and clean and dry utensils. Barriers to food hygiene and preparation practices included lack of psychological capability, for instance, caregivers' lack of knowledge of critical times for handwashing, lack of perceived importance of washing some foods before eating, and not knowing the risks of storing food for more than four hours without refrigerating and reheating. Other barriers were opportunity-related, including lack of resources (soap, water, firewood) and an enabling environment (monetary decision-making power, social support). Competing priorities, socio-cultural norms, religion, and time constraints due to work hindered the practice of optimal food hygiene and preparation behaviors. CONCLUSION: Food hygiene is an underexplored, but potentially critical, behavior to mitigate fecal pathogen exposure for young children. Our study revealed several knowledge and opportunity barriers that could be integrated into interventions to enhance food hygiene.

Honduras: two hurricanes, COVID-19, dengue and the need for a new digital health surveillance system.

A recently published article of this journal stated that informatics solutions can guide better public health decision-making during the COVID 19 (Coronavirus Disease 2019) pandemic. Honduras is a country facing the COVID-19 pandemic with a weak health surveillance system while also fighting a dengue epidemic and the aftermath of two hurricanes that struck its territory in November 2020. In response, we as academics started a COVID-19 and Dengue Observatory combining several technological platforms and developing multidisciplinary research to help the country navigate the crisis. Mapping the pandemic and the natural disasters showed us that technology can be applied toward epidemiology to benefit communities in a time of need by quickly building a basic digital health surveillance system for Honduras.

Safety evidence on the administration of Fucus vesiculosus L. (bladderwrack) extract and lamotrigine: data from pharmacokinetic studies in the rat.

Fucus vesiculosus is often incorporated in weight loss dietary supplements to improve weight loss in overweight adults. Obesity is a common condition in epilepsy patients and is indeed increasing in refractory epilepsy and in patients under polytherapy. Since lamotrigine (LTG) is a first-line antiepileptic drug, used in monotherapy or adjunctive therapy, the main objective of this work was to investigate the potential pharmacokinetic-based interactions between F. vesiculosus and LTG in rats. In a first pharmacokinetic study, a single oral dose of F. vesiculosus extract (575 mg/kg, p.o.) was co-administered with a single-dose of LTG (10 mg/kg, p.o.). In a second study, rats were orally pretreated with F. vesiculosus extract (575 mg/kg/day, p.o.) for 14 days and received LTG (10 mg/kg, p.o.) on the 15th day. In the control groups, rats received water instead of the extract. After LTG administration, blood samples were taken until 96 h post-dose, and LTG concentrations measured in plasma were submitted to a non-compartmental pharmacokinetic analysis. The co-administration of F. vesiculosus extract and LTG caused no significant changes in the drug kinetics. However, the repeated pretreatment with F. vesiculosus extract significantly reduced the peak concentrations of LTG and caused a slightly decrease in the extent of systemic drug exposure. Overall, based on these results, no significant clinical impact is expected from the administration of F. vesiculosus dietary supplements and LTG.

Development and assessment of an e-learning course on breast imaging for radiographers: a stratified randomized controlled trial.

BACKGROUND: Mammography is considered the best imaging technique for breast cancer screening, and the radiographer plays an important role in its performance. Therefore, continuing education is critical to improving the performance of these professionals and thus providing better health care services. OBJECTIVE: Our goal was to develop an e-learning course on breast imaging for radiographers, assessing its efficacy, effectiveness, and user satisfaction. METHODS: A stratified randomized controlled trial was performed with radiographers and radiology students who already had mammography training, using pre- and post-knowledge tests, and satisfaction questionnaires. The primary outcome was the improvement in test results (percentage of correct answers), using intention-to-treat and per-protocol analysis. RESULTS: A total of 54 participants were assigned to the intervention (20 students plus 34 radiographers) with 53 controls (19+34). The intervention was completed by 40 participants (11+29), with 4 (2+2) discontinued interventions, and 10 (7+3) lost to follow-up. Differences in the primary outcome were found between intervention and control: 21 versus 4 percentage points (pp), P<.001. Stratified analysis showed effect in radiographers (23 pp vs 4 pp; P=.004) but was unclear in students (18 pp vs 5 pp; P=.098). Nonetheless, differences in students' posttest results were found (88% vs 63%; P=.003), which were absent in pretest (63% vs 63%; P=.106). The per-protocol analysis showed a higher effect (26 pp vs 2 pp; P<.001), both in students (25 pp vs 3 pp; P=.004) and radiographers (27 pp vs 2 pp; P<.001). Overall, 85% were satisfied with the course, and 88% considered it successful. CONCLUSIONS: This e-learning course is effective, especially for radiographers, which highlights the need for continuing education.

Inter-speaker speech variability assessment using statistical deformable models from 3.0 tesla magnetic resonance images.

The morphological and dynamic characterisation of the vocal tract during speech production has been gaining greater attention due to the motivation of the latest improvements in magnetic resonance (MR) imaging; namely, with the use of higher magnetic fields, such as 3.0 Tesla. In this work, the automatic study of the vocal tract from 3.0 Tesla MR images was assessed through the application of statistical deformable models. Therefore, the primary goal focused on the analysis of the shape of the vocal tract during the articulation of European Portuguese sounds, followed by the evaluation of the results concerning the automatic segmentation, i.e. identification of the vocal tract in new MR images. In what concerns speech production, this is the first attempt to automatically characterise and reconstruct the vocal tract shape of 3.0 Tesla MR images by using deformable models; particularly, by using active and appearance shape models. The achieved results clearly evidence the adequacy and advantage of the automatic analysis of the 3.0 Tesla MR images of these deformable models in order to extract the vocal tract shape and assess the involved articulatory movements. These achievements are mostly required, for example, for a better knowledge of speech production, mainly of patients suffering from articulatory disorders, and to build enhanced speech synthesizer models.

Application of the Capabilities, Opportunities, Motivations, and Behavior (COM-B) Change Model to Formative Research for Child Nutrition in Western Kenya.

Background: Interventions aimed at improving dietary intake and feeding practices have alone proven insufficient for combatting stunting resulting from poor nutrition and repeated infections. Objectives: To support the development of an integrated water, sanitation, and hygiene (WASH) and nutrition, social, and behavior change strategy aimed at reducing stunting, formative research was conducted in 2 program sites in western Kenya. Methods: Twenty-nine key informant interviews were conducted with community leaders, health workers, and project staff, and 24 focus group discussions with caregivers of children under 2 y on topics related to feeding, sanitation, and hygiene behaviors. Three frameworks informed the study design and analysis of our formative research: the Capabilities, Opportunities, and Motivations model for behavior change, which identifies what needs to change in order for behavior change interventions to be effective; the Grandmother Project's Change Through Culture Approach, which values the important role of influential household and community members in producing household health; and Starr and Fornoff's approach to Theory of Change development. Results: Caregivers exhibited sufficient psychological capabilities (knowledge and skills) for many of the key maternal and infant nutrition behaviors. However, reflective motivation to perform optimal behaviors was undermined by limitations in physical and social opportunities, including limited time and competing priorities for mothers, limited accessibility and availability of diverse foods, low self-efficacy for exclusive breastfeeding, and fears of negative consequences related to specific foods and recommended practices. Conclusions: Interventions that aim to improve maternal and child diets should address the underlying social, cultural, and environmental determinants that contribute to motivations and opportunities to perform recommended practices.

Preoperative localisation techniques in breast conservative surgery: A systematic review and meta-analysis.

The preoperative localisation of non-palpable lesions guided by breast imaging is an important and required procedure for breast-conserving surgery. We conducted a systematic review and meta-analysis of the literature on the comparative impact of different techniques for guided surgical excision of non-palpable breast lesions from reports of clinical or patient-reported outcomes and costs. A literature search of PubMed, ISI, SCOPUS and Cochrane databases was conducted for relevant publications and their references, along with public documents, national and international guidelines, conference proceedings and presentations. From 5720 retrieved articles screened through title and abstract, 5346 were excluded and 374 assessed for full-text eligibility. For data extraction and quality assessment, 49 studies were included. Results of this review demonstrate that Radioactive Seed Localisation (RSL) and Radioactive Occult Lesion Localisation (ROLL) outperform Wire in terms of involved margins and reoperations. Between RSL and ROLL, there is a tendency to favour RSL. Similarly, Clip-guided localisation seems preferred when compared to ROLL, however further studies are needed. In summary, there seems to exist evidence that RSL and ROLL are better than Wire, representing potential alternatives, with a quick learning curve, better scheduling and management issues. Although, for recent techniques, more research is needed in order to achieve the same level of evidence.

Practices and Perspectives on Latrine Use, Child Feces Disposal, and Clean Play Environments in Western Kenya.

Exposure to fecal pathogens contributes to childhood diarrhea and stunting, causing harmful short- and long-term impacts to health. Understanding pathways of child fecal exposure and nutritional deficiencies is critical to informing interventions to reduce stunting. Our aim was to explore determinants of latrine use, disposal of child feces, and perceptions and provisions of a safe and clean child play environment among families with children under two (CU2) years to inform the design of a behavior change intervention to address water, sanitation, and hygiene (WASH), and nutrition behaviors. In 2016, we conducted a mixed-methods formative research in western Kenya. We conducted 29 key informant interviews with community leaders, health workers, and project staff; 18 focus group discussions with caregivers of CU2 years; and 24 semi-structured household observations of feeding, hygiene, and sanitation behaviors. We used the capability, opportunity, motivation, and behavior model as our theoretical framework to map caregiver behavioral determinants. Latrine use barriers were lack of latrines, affordability of lasting materials, and social acceptability of unobserved open defecation. Barriers to safe disposal of child feces were lack of latrines, time associated with safe disposal practices, beliefs that infant feces were not harmful, and not knowing where children had defecated. Primary barriers of clean play environments were associated with creating and maintaining play spaces, and shared human and animal compounds. The immediate cost to practicing behaviors was perceived as greater than the long-term potential benefits. Intervention design must address these barriers and emphasize facilitators to enable optimal WASH behaviors in this context.

Short-term effects of Garcinia cambogia extract on the pharmacokinetics of lamotrigine given as a single-dose in Wistar rats.

Garcinia cambogia supplements are widely used for weight loss. Knowing that epilepsy patients are at greater risk of developing overweight/obesity, the investigation of herb-drug interactions involving antiepileptic drugs of narrow therapeutic index is fully justified. This work was planned to assess potential pharmacokinetic-based interactions between G. cambogia extract and lamotrigine (LTG) through two independent pharmacokinetic studies. In the first study (co-administration study), rats were orally co-administered with a single-dose of G. cambogia extract (821 mg/kg) and LTG (10 mg/kg). In the second study (pre-treatment study), rats were orally pre-treated for 14 days with G. cambogia extract (821 mg/kg/day), being LTG administered (10 mg/kg) on the 15th day. Rats of the control groups received water instead of the extract. Following LTG administration, blood samples were collected until 96 h post-dose, and plasma LTG concentrations were determined and submitted to a non-compartmental analysis. Globally, no statistically significant effects were identified in the co-administration study of G. cambogia extract and LTG. In the 14-day pre-treatment study, a statistically significant decrease in the rate of systemic exposure to LTG and an increase of apparent volume of distribution were found. Even so, a minor or no clinical impact is expected from the administration of G. cambogia dietary supplements and LTG.

Learner's perception, knowledge and behaviour assessment within a breast imaging E-Learning course for radiographers.

PURPOSE: E-learning has been revealed as an a useful tool among continuing education within health professionals, namely for radiographers or radiologic technologists. Therefore like traditional learning, this teaching approach needs continuous evaluation in order to validate its effectiveness and impact. Kirkpatrick's model has been widely used for this purpose by health information management instructors. Our aim was to assess an E-learning Course on Breast Imaging for radiographers based on the first three levels of Kirkpatrick's framework: reaction, learning and behaviour. METHODS AND MATERIALS: An E-learning course was developed for radiographers in order to provide an easy-to-understand, succinct and current overview in breast imaging, namely mammography technique and image interpretation. The program structure were built based on the guidelines proposed by the European Society of Breast Cancer Specialists (EUSOMA). Learner's satisfaction was assessed through a questionnaire and Knowledge gain was assessed using pre- and post-testing. After 6 months of complying the course, the learners were contacted through a questionnaire in order to give feedback on whether their behaviour changed in workplace. RESULTS: Two editions of the breast imaging course were performed by 64 learners. In general, 97% of the learners stated that the program content was very good and excellent, all learners considered the content was delivered in a very good or excellent way. High percentages of learners stated to be satisfied with the distribution of the content among each module (94%) and 86% of learners stated that your level of dedication was high or very high. Concerning improvement of knowledge, we found an evolution of 4 percentual points between pre and post-tests (p = 0,001). The learners have identified two main changes on their practice, the first one related with patient care, improving communications and positioning skills and the second one related with image interpretation, improving the image processing and analyses. CONCLUSION: These global results show that e-learning can provide statistically relevant knowledge gains in Radiographers. This course is an important contribution to the improvement of mammography education, impacting on the development of students' and radiographers' skills.

Effects of Paullinia cupana extract on lamotrigine pharmacokinetics in rats: A herb-drug interaction on the gastrointestinal tract with potential clinical impact.

Paullinia cupana-containing preparations are being consumed worldwide for weight reduction. As obesity and epilepsy are common comorbidities and lamotrigine (LTG) is a broad-spectrum antiepileptic drug, it is likely to find epilepsy patients taking P. cupana and LTG simultaneously. Thus, this work aimed to investigate the potential interaction between P. cupana extract and LTG in rats. In a study, rats were orally co-administered with a single-dose of P. cupana extract (821 mg/kg) and LTG (10 mg/kg). In another study, rats were orally pre-treated for 14 days with P. cupana extract (821 mg/kg/day) receiving LTG (10 mg/kg, p.o.) on the 15th day. Rats of the respective control groups received the corresponding volume of the extract vehicle. LTG concentrations were determined at several post-dose time-points and submitted to a non-compartmental pharmacokinetic analysis. The co-administration of P. cupana and LTG induced a significant reduction of LTG Cmax and AUC0-24 and prolonged the mean residence time. However, no significant effects were observed on LTG pharmacokinetics following a 14-day pre-treatment period with the extract. In this study changes in the body weight of rats and in some biochemical parameters were also evaluated. Overall, the results revealed a pharmacokinetic-based herb-drug interaction between P. cupana extract and LTG, mainly after their co-administration.

Evaluation of the effects of Citrus aurantium (bitter orange) extract on lamotrigine pharmacokinetics: Insights from in vivo studies in rats.

Citrus aurantium extracts have thermogenic and lipolytic activities and are largely used for weight loss/management. Once epilepsy and obesity are prevalent comorbid conditions and herb-drug interactions can compromise antiepileptic drugs safety, we aimed to evaluate the effects of C. aurantium extract on the pharmacokinetics of lamotrigine (LTG) in rats. In the first pharmacokinetic study, a single oral dose of C. aurantium extract (164 mg/kg; p.o.) was administered with a single oral dose of LTG (10 mg/kg; p.o.). In the following study, the C. aurantium extract was daily administered (164 mg/kg; p.o.) during 14 days followed by a single dose of LTG (10 mg/kg; p.o.) on the 15th day. From the pharmacokinetic analysis, no significant effects were observed after the co-administration of C. aurantium extract and LTG. After the 14-day pre-treatment period, the main effects of the extract were limited to a significantly decrease in the time to reach peak drug concentration (tmax;p < 0.05). Considering the minor effects induced by C. aurantium extract on the pharmacokinetics of LTG in rats, no relevant interactions are expected to occur in the clinical practice. Notwithstanding, C. aurantium safety in patients under LTG therapy should be further assessed in controlled clinical trials.

Segmentation of tongue shapes during vowel production in magnetic resonance images based on statistical modelling.

Quantification of the anatomic and functional aspects of the tongue is pertinent to analyse the mechanisms involved in speech production. Speech requires dynamic and complex articulation of the vocal tract organs, and the tongue is one of the main articulators during speech production. Magnetic resonance imaging has been widely used in speech-related studies. Moreover, the segmentation of such images of speech organs is required to extract reliable statistical data. However, standard solutions to analyse a large set of articulatory images have not yet been established. Therefore, this article presents an approach to segment the tongue in two-dimensional magnetic resonance images and statistically model the segmented tongue shapes. The proposed approach assesses the articulator morphology based on an active shape model, which captures the shape variability of the tongue during speech production. To validate this new approach, a dataset of mid-sagittal magnetic resonance images acquired from four subjects was used, and key aspects of the shape of the tongue during the vocal production of relevant European Portuguese vowels were evaluated.

An easy-to-use liquid chromatography assay for the analysis of lamotrigine in rat plasma and brain samples using microextraction by packed sorbent: Application to a pharmacokinetic study.

A simple and rapid high-performance liquid chromatography method with diode-array detection (HPLC-DAD) using microextraction by packed sorbent (MEPS) during the sample preparation step was developed and validated to quantify lamotrigine (LTG) in rat plasma and brain samples. MEPS variables such as pH, number of draw-eject cycles, and washing and desorption conditions were optimized. The chromatographic resolution of LTG and chloramphenicol, used as internal standard (IS), was accomplished in less than 5min on a C18 column, at 35°C, using an isocratic elution with acetonitrile (13%), methanol (13%) and water-triethylamine (99.7:0.3, v/v; pH 6.0) pumped at a flow rate of 1mL/min. Detection was performed at 215nm. Calibration curves were linear over the range of 0.1-20µg/mL (r2≥0.9947) for LTG in both rat plasma and brain homogenate samples. The intra and interday imprecision did not exceed 8.6% and the intra and interday inaccuracy ranged from -8.1 to 13.5%. LTG was extracted from rat plasma and brain homogenate samples with an average absolute recovery ranging from 68.0 to 86.7%, and its stability was demonstrated in the assayed conditions. No interferences were observed at the retention times of the analyte (LTG) and IS. To the best of our knowledge, this is the first bioanalytical assay that uses MEPS procedure for the determination of LTG not only in rat plasma but also in tissue (brain) samples. This novel method was successfully applied to a preliminary pharmacokinetic study in rats and it seems to be a cost-effective tool to support non-clinical pharmacokinetic-based studies involving LTG treatment.

Dealing with perceptions related to thrombosis and COVID-19 vaccines

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Morphologic differences in the vocal tract resonance cavities of voice professionals: an MRI-based study.

UNLABELLED: The processes that take place during singing and acting are complex. However, morphologic and dynamic studies of the vocal tracts during speech have been gaining greater attention, mainly because of the rapid technical advances being made with magnetic resonance imaging (MRI) and image analysis and processing techniques. OBJECTIVES/HYPOTHESIS AND METHODS: Our aim was to describe the morphologic differences in the vocal tract resonance cavities among voice professionals using MRI, and with the three-dimensional models built from the MRI data, compare the volumes calculated for the whole vocal tract and its major resonance cavities. STUDY DESIGN: Prospective study. RESULTS: The images acquired during the spoken and singing tasks provided morphologic information about the whole vocal tract cavity and also its two major resonance cavities: the oral and the pharynx cavities; differences were observed in the volumes measured during the production of some vowels. CONCLUSIONS: The morphologic differences found in the singing voices indicated an increase in the oral cavity volume, resulting in an increase in the overall volumes measured. In the acting voices, both the resonance cavities of the vocal tract contributed to the differences measured.

Toward dynamic magnetic resonance imaging of the vocal tract during speech production.

OBJECTIVES/HYPOTHESIS: The most recent and significant magnetic resonance imaging (MRI) improvements allow for the visualization of the vocal tract during speech production, which has been revealed to be a powerful tool in dynamic speech research. However, a synchronization technique with enhanced temporal resolution is still required. STUDY DESIGN AND METHODS: The study design was transversal in nature. Throughout this work, a technique for the dynamic study of the vocal tract with MRI by using the heart's signal to synchronize and trigger the imaging-acquisition process is presented and described. The technique in question is then used in the measurement of four speech articulatory parameters to assess three different syllables (articulatory gestures) of European Portuguese Language. RESULTS: The acquired MR images are automatically reconstructed so as to result in a variable sequence of images (slices) of different vocal tract shapes in articulatory positions associated with Portuguese speech sounds. CONCLUSIONS: The knowledge obtained as a result of the proposed technique represents a direct contribution to the improvement of speech synthesis algorithms, thereby allowing for novel perceptions in coarticulation studies, in addition to providing further efficient clinical guidelines in the pursuit of more proficient speech rehabilitation processes.