Improving the mental health of farmers: what types of remote support are acceptable, feasible, and improve outcomes? A feasibility RCT.

BACKGROUND: The farming community have high rates of poor mental health, and are relatively 'hard to reach' with mental health services. The aim of this study was therefore to undertake a feasibility RCT, based on two mental health interventions. These were (1) CBT based 'Living Life to the Full for Farming Communities' (LLTTF-F; www.llttf.com ), and (2) a holistic social and emotional support service delivered by the Royal Scottish Agricultural Benevolent Institution (RSABI). The feasibility was supplemented by process evaluation. METHODS: This feasibility study aimed to recruit 40 individuals from the farming community who were experiencing a common health problem defined as a score of > = 8 on PHQ-9. A snowball approach was used to recruit interested individuals who had an association with farming. An initial telephone call screened for eligibility and obtained consent to randomisation to the two specified interventions, or to a thirdly group receiving a combination of both LLTTF-F and 'Social and emotional support'. Participants were permitted to override the randomised option if they expressed a strong preference before the interventions began. RESULTS: Thirty-two participants provided baseline and three-month data. All three interventions showed positive improvements on PHQ-9 scores as follows: the 'combined intervention' mean baseline score was 18.1 compared to 12.0 at 3-month follow-up (mean change 6.1). 'Social and emotional support' mean baseline score was 11.3 compared to 6.7 at 3-month follow-up (mean change 4.6). 'LLTTF-F CBT-based intervention only' mean baseline score was 11.8 compared to 4.5 at 3-month follow-up (mean change 7.3). The retention rate was 81% at three months. In a sub-group of the LLTTF-F CBT-based intervention online materials were supplemented by telephone guided support. This approach received very positive feedback. CONCLUSIONS: Recruitment from the farming community required intense effort, and good engagement can then be retained for at least three months. There is evidence that the interventions used were feasible, and tentative evidence that they had a demonstrable effect on mental wellbeing, with the LLTTFF providing the largest effect on PHQ-9 scores. Trial Registration Number ISRCTN27173711, submitted 25/08/2023, confirmed 22/092023.

Tracheoesophageal fistula development following radiotherapy and tyrosine kinase inhibitors in a patient with advanced follicular thyroid carcinoma: a case-based review.

INTRODUCTION: Tracheoesophageal fistulas (TEF) are a rare complication that can occur in patients with radioactive iodine refractory metastatic follicular thyroid carcinoma (FTC) following treatment with radiotherapy (RT) and tyrosine kinase inhibitors (TKI). METHODS: We describe the case of a TEF development in a 69-year-old male who underwent targeted therapy TKIs and adjuvant RT for radioactive iodine refractory FTC. RESULTS: In the case, staging investigations revealed a metastatic, poorly differentiated FTC refractory to radioactive iodine. After 2 years of disease control on Lenvatinib, the patient's condition progressed, necessitating a switch to Cabozantinib. Soon after, they presented with haemoptysis secondary to invasion of the primary thyroid tumour into the trachea. Radical radiotherapy (45 Gy/30 fractions) was also administered to the thyroid gland, ultimately complicated by radiation necrosis. Four months post-completion of RT and recommencing TKI, the patient presented with haemoptysis and hoarseness secondary to recurrent laryngeal nerve compression and tracheal invasion, as well as dysphagia secondary to oesophageal compression. Following an acute presentation with intractable throat pain, investigations revealed a TEF. Surgical and endoscopic management was deemed inappropriate given the patient's rapid deterioration and anatomical position of the TEF, and therefore a palliative approach was taken. CONCLUSION: This case report highlights a rare cause of TEF development in a patient having TKI therapy post-RT for advanced FTC. It highlights the importance of monitoring TEF development in this cohort of patients. It demonstrates the importance of patient counselling and education regarding treatment options and the rare side effects of treatments.

A Novel Algorithmic Structure of EEG Channel Attention Combined With Swin Transformer for Motor Patterns Classification.

With the development of brain-computer interfaces (BCI) technologies, EEG-based BCI applications have been deployed for medical purposes. Motor imagery (MI), applied to promote neural rehabilitation for stroke patients, is among the most common BCI paradigms that. The Electroencephalogram (EEG) signals, encompassing an extensive range of channels, render the training dataset a high-dimensional construct. This high dimensionality, inherent in such a dataset, tends to challenge traditional deep learning approaches, causing them to potentially disregard the intrinsic correlations amongst these channels. Such an oversight often culminates in erroneous data classification, presenting a significant drawback of these conventional methodologies. In our study, we propose a novel algorithmic structure of EEG channel-attention combined with Swin Transformer for motor pattern recognition in BCI rehabilitation. Effectively, the self-attention module from transformer architecture could captures temporal-spectral-spatial features hidden in EEG data. The experimental results verify that our proposed methods outperformed other state-of-art approaches with the average accuracy of 87.67%. It is implied that our method can extract high-level and latent connections among temporal-spectral features in contrast to traditional deep learning methods. This paper demonstrates that channel-attention combined with Swin Transformer methods has great potential for implementing high-performance motor pattern-based BCI systems.

Efficacy of a bacterial 6-phytase supplemented beyond traditional dose levels on jejunal mucosa-associated microbiota, ileal nutrient digestibility, bone parameters, and intestinal health, and growth performance of nursery pigs.

This study aimed to determine the efficacy of a bacterial 6-phytase (Buttiauxella spp.) supplemented beyond traditional dose levels based on jejunal mucosa-associated microbiota, apparent ileal digestibility (AID), intestinal health and bone parameters, and growth performance of nursery pigs. Seventy-two weaned pigs (36 barrows and 36 gilts at 21 d of age with 5.8 ± 0.5 kg BW) were allotted to six treatments based on randomized complete block design with sex and initial BW as blocks and fed in three dietary phases (phase 1 for 14 d, phase 2 for 10 d, and phase 3 for 14 d). The treatments included a negative control (NC) diet without phytase formulated meeting nutrient requirements by NRC and the other five treatments were deficient in calcium (Ca) and phosphorus (P) by 0.12% with increasing levels of a bacterial 6-phytase (0, 500, 1,000, 2,000, and 5,000 FTU/kg feed). Titanium dioxide (0.4%) was added to phase 3 diets as an indigestible marker to measure AID of nutrients. On day 45, all pigs were euthanized to collect ileal digesta to measure AID, the third metacarpus to measure bone parameters, and jejunal mucosa to evaluate intestinal health and microbiota. Data were analyzed using the MIXED procedure for polynomial contrasts and the NLMIXED procedure for broken line analysis using the SAS 9.4. Broken line analysis demonstrated that 948 FTU/kg feed increased (P < 0.05) the ADG and the bone P content. Increasing phytase supplementation increased (linear, P < 0.05) AID of CP, bone P, and ash content. Increasing phytase supplementation reduced (P < 0.05) the fecal score during phases 2 and 3. Broken line analysis demonstrated that 1,889 FTU/kg feed increased (P < 0.05) bone breaking strength. Increasing phytase supplementation (PC vs. Phy) increased (P < 0.05) AID of ether extract (EE) and P. The supplementation of phytase at 2,000 FTU/kg feed tended (P = 0.087) to reduce the relative abundance of Prevotellaceae. In conclusion, the supplementation of a bacterial 6-phytase beyond traditional dose levels improved bone breaking strength, bone ash, and P content, AID of CP, EE, and P, and growth performance of nursery pigs with reduced relative abundance of Bacteroidetes specifically Prevotellaceae in the jejunal mucosa. Supplementation of a bacterial 6-phytase between 1,000 and 2,000 FTU/kg feed provided benefits associated with growth performance and bone parameters of nursery pigs.

After weaning, pigs start to receive solid diets throughout nursery phase with high amounts of plant-based feedstuffs containing various antinutritional and allergenic compounds. Feed enzymes have been used in nursery diets to reduce or remove the negative impacts associated with these compounds. This study used the phytase at normal and beyond traditional doses, which specifically catalyze the hydrolysis of phytic acid and can provide benefits on bone and intestinal health, intestinal microbiota, nutrient digestibility, and growth performance of pigs. The aim of this study was to investigate the efficacy of a bacterial 6-phytase beyond traditional dose levels on intestinal microbiota, nutrient digestibility, bone parameters and intestinal health, and growth performance of nursery pigs. Phytase supplementation improved bone breaking strength and mineralization, apparent ileal digestibility of crude protein, ether extract, and phosphorus, average daily gain, feed intake, and reduced relative abundance of Bacteroidetes specifically Prevotellaceae in the jejunal mucosa.

Efficacy of zinc glycinate reducing zinc oxide on intestinal health and growth of nursery pigs challenged with F18+ Escherichia coli.

The objective of this study was to investigate effects of zinc glycinate (ZnGly) supplementation reducing zinc oxide (ZnO) in feeds on intestinal health and growth of nursery pigs challenged with F18+Escherichia coli (E. coli). In total, 72 nursery pigs (BW 6.5 ± 0.5 kg) were allotted in a randomized complete block design to nine treatments: (1) NC: no challenge/no supplement; (2) PC: E. coli challenge/no-supplement; (3) E. coli challenge/ZnO at 2,500 mg/kg; (4, 5, and 6) E. coli challenge/ZnGly at 400, 800, and 1,200 mg/kg; and (7, 8, and 9) E. coli challenge/ZnGly at 400 mg/kg and ZnO at 700, 1,400, and 2,357 mg/kg. Pigs were fed for 28 d based on two phases (phase 1: 14 d and phase 2: 14 d). On day 7, challenged groups were orally inoculated with F18+E. coli at 6 × 109 CFU/mL whereas NC received saline solution. The PC showed reduced ADG (P = 0.076) and G:F (P = 0.055) during phase 1 and increased fecal score (P < 0.05) during the first week of postchallenge when compared with NC, whereas supplementation of ZnGly from 0 to 1,200 mg/kg linearly increased (P = 0.092) G:F and decreased (P < 0.05) the fecal score of the pigs challenged with F18+E. coli. Supplementation of ZnGly from 0 to 1,200 mg/kg had quadratic effects on TNF-α (P = 0.065; minimum 1.13 pg/mg at 850 mg/kg ZnGly), IL-8 (P = 0.093; minimum 0.53 ng/mg at 494 mg/kg), and protein carbonyl (P = 0.054; minimum 2.30 pg/mg at 675 mg/kg) and linearly increased mRNA expressions of ZIP4 (P = 0.057) and ZnT5 (P = 0.075) in the jejunum of the pigs. Supplementation of ZnGly from 0 to 1,200 mg/kg linearly increased (P < 0.05) the relative abundance of Actinobacteria and had quadratic effects on Cyanobacteria (minimum 0.67% at 625 mg/kg ZnO) and Proteobacteria (maximum 45.6 g/d at 735 mg/kg) at the phylum level, with linearly decreased (P < 0.05) Enterobacteriaceae at the family level in the jejunal mucosa-associated microbiota of the pigs. There was no difference in growth performance during the overall period, although pigs fed with ZnO at 2,500 mg/kg had greater (P < 0.05) ADG than pigs fed with ZnGly at 400 mg/kg during the first week of the post challenge period. In conclusion, ZnGly could be an alternative to the pharmaceutical use of ZnO without negatively affecting the growth of nursery pigs by enhancing intestinal Zn absorption, reducing intestinal inflammation and oxidative stress, and providing positive changes in jejunal mucosa-associated microbiota.

Enterotoxigenic Escherichia coli (E. coli) strains such as F18+ and F4+E. coli are prominent harmful bacteria that cause impaired intestinal health to nursery pigs with postweaning diarrhea, leading to significant economic losses in the swine industry. In previous years, swine producers used excessively high levels of zinc oxide (ZnO) in feeds for therapeutic purpose as a growth promoter with diarrhea prevention. However, the pharmaceutical use of ZnO is prohibited by the legislation of several countries due to potential health and environmental concerns. Considering the biological functions of zinc (Zn) and the biological efficacy of the organic mineral, zinc glycinate (ZnGly) could effectively enhance the intestinal health of nursery pigs, leading to a decrease in the use of ZnO in feeds. This study aimed to investigate the effects of ZnGly supplementation, allowing the reduced use of ZnO for growth performance and intestinal health of nursery pigs challenged with F18+E. coli. Supplementation of ZnGly at a range of 400 to 675 mg/kg would reduce the negative impacts of F18+E. coli by reducing intestinal inflammation and oxidative stress with positive changes in jejunal microbiota, leading to improved growth performance and reduced diarrhea. In particular, ZnGly supplementation at 400 mg/kg could effectively reduce the use of ZnO in nursery feeds by having similar effects to the pharmaceutical use of ZnO.

Vitamin B12 supplementation post-gastrectomy: a service closed-loop audit at St. James's Hospital, Dublin.

BACKGROUND: Vitamin B12 (VB12) deficiency is a well-described complication post-gastrectomy. It is caused by the loss of parietal cell mass leading to megaloblastic anaemia. This closed-loop audit assesses patient understanding of and adherence with VB12 supplementation guidelines post-gastrectomy. METHODS: A closed-loop audit cycle was performed. After the first cycle, an educational intervention was actioned prior to re-audit. One hundred twenty-five patients who underwent gastrectomy between 2010 and 2020 were available for study (86 total gastrectomies (TG), 39 subtotal gastrectomies (STG)). Twenty-nine patients who had not been adherent with VB12 supplementation/surveillance were eligible for re-audit. RESULTS: 91.9% (79/86) of TG patients reported adherence in regular parenteral VB12 supplementation. Adherence was significantly lower for STG for checking (and/or replacing) their VB12, with only 53.8% (21/39) checking their VB12 levels. 67/125 (53.6%) of the patients stated that they knew it was important to supplement B12 post-gastrectomy. 37.8% (43/113) of participants could explain why this was important, and 14.4% (18/125) had any knowledge of the complications of VB12 deficiency. Following re-audit, 5/8 (57.5%) of TG patients who had not been adherent with VB12 supplementation in the first cycle were now adherent with VB12 supplementation following our educational intervention. 7/17 (41.2%) of the STG group had received VB12 or made arrangements to receive supplemental VB12 if it was indicated. CONCLUSION: This study demonstrates good adherence in those undergoing TG. Patient understanding correlates with adherence, suggesting that patient education and knowledge reinforcement may be key to adherence with VB12 supplementation. A simple educational intervention can improve adherence with VB12 supplementation in patients undergoing gastrectomy.

Job-Related Performance and Quality of Life Benefits in First Responders Given Access to H-Wave® Device Stimulation: A Retrospective Cohort Study.

Current chronic pain treatments primarily target symptoms and are often associated with harmful side-effects and complications, while safer non-invasive electrotherapies like H-Wave® device stimulation (HWDS) have been less explored. The goal of this study is to evaluate first responder-reported effects of HWDS on job-related and quality-of-life measures. This is a retrospective cohort study where first responders were surveyed following voluntary use of HWDS regarding participant experience, frequency of use, job-related performance, and quality-of-life. Responses were analyzed using means comparison tests, while bivariate analysis assessed responses associated with HWDS usage. Overall, 92.9% of first responder HWDS users (26/28) reported a positive experience (p < 0.0001), with 82.1% citing pain reduction (p = 0.0013), while 78.6% indicated it would be beneficial to have future device access (p = 0.0046). Participants using H-Wave® were at least six times more likely to report higher rates of benefit (100% vs. 0%, p = 0.022), including pain reduction (91.3% vs. 8.7%, p = 0.021) and improved range-of-motion (93.3% vs. 69.2%, p = 0.044). Spending more time with family was associated with better job performance following frequent HWDS use (50% vs. 8.3%, p = 0.032). Repetitive first responder H-Wave® use, with minimal side effects and easy utilization, resulted in significant pain reduction, improvements in job performance and range-of-motion, and increased time spent with family, resulting in overall positive experiences and health benefits. Level of Evidence: III.

Functional roles of xylanase enhancing intestinal health and growth performance of nursery pigs by reducing the digesta viscosity and modulating the mucosa-associated microbiota in the jejunum.

This study was conducted to investigate the functional roles of an endo-ß-1,4-xylanase on the intestinal health and growth performance of nursery pigs. A total of 60 pigs (21 d old, 6.9 ± 0.8 kg body weight [BW]) were allotted based on a randomized complete block design with sex and initial BW as blocks. Dietary treatments had nutrients meeting the requirements with increasing levels of endo-ß-1,4-xylanase (0, 220, 440, 880, 1,760 xylanase unit [XU] per kg feed) and fed to pigs in three phases (phases 1, 2, and 3 for 10, 14, and 14 d, respectively). Titanium dioxide (0.4%) was added to the phase 3 diets as an indigestible marker. On day 38, all pigs were euthanized to collect ileal digesta to measure apparent ileal digestibility (AID), jejunal digesta to measure viscosity, and jejunal mucosa to evaluate intestinal health. Data were analyzed using the MIXED procedure for polynomial contrasts and the NLMIXED procedure for broken line analysis of SAS. Increasing xylanase in the nursery diets reduced (linear, P < 0.05) the digesta viscosity in the jejunum. Increasing xylanase tended to reduce the relative abundance of Cupriavidus (P = 0.073) and Megasphaera (P = 0.063); tended to increase the relative abundance of Succinivibrio (P = 0.076) and Pseudomonas (P = 0.060); and had a quadratic effect (P < 0.05) on the relative abundance of Acinetobacter (maximum: 2.01% at 867 XU per kg feed). Xylanase from 0 to 1,087 XU per kg feed reduced (P < 0.05) jejunal malondialdehyde. Xylanase from 0 to 1,475 XU per kg feed increased (P < 0.05) the AID of neutral detergent fiber. Increasing xylanase increased (P < 0.05) the AID of ether extract and tended to increase (P = 0.058) the AID of crude protein. Increasing xylanase did not affect growth performance on overall period, whereas xylanase from 0 to 736 XU per kg feed increased (P < 0.05) average daily gain (ADG) during days 31 to 38. In conclusion, xylanase supplementation showed benefits on intestinal health by reducing digesta viscosity, the relative abundance of potentially harmful bacteria, and the oxidative stress in the jejunal mucosa, collectively enhancing intestinal morphology and the AID of nutrients. Xylanase supplementation at a range of 750 to 1,500 XU per kg feed provided benefits associated with reduced oxidative stress, increased nutrient digestibility, resulting in potential improvement on growth performance of nursery pigs by increasing the average daily feed intake and moderately improving the ADG throughout the last week of feeding.

Cereal grains and by-products from cereal processing are extensively used in diets for pigs. These feedstuffs contain soluble fiber that makes digesta viscous in the small intestine. Increased digesta viscosity interferes with the digestion process, changes the ecosystem of bacteria on the mucosal lining of the small intestine, and impairs the intestinal health of young pigs. Supplemental enzymes targeting soluble fiber have been used in feeding young pigs in order to remove the negative impacts of soluble fiber on nutrient utilization and intestinal health. This study used the enzyme xylanase that specifically targets xylan and arabinoxylan largely present in corn and corn by-products. The aim of this study was to investigate how effectively this xylanase work in the small intestine of young pigs by reducing digesta viscosity, positively modulating the bacterial ecosystem on the mucosal lining of the small intestine, improving intestinal health, nutrient digestibility, and finally supporting growth. Xylanase supplementation to feeds for nursery pigs showed benefits on intestinal health by reducing digesta viscosity, oxidative stress, and potentially harmful bacteria in the jejunal mucosa, collectively enhancing intestinal morphology and nutrient digestibility.

H-Wave® Device Stimulation: A Critical Review.

Pain treatments have historically centered on drugs, but an "opioid crisis" has necessitated new standards of care, with a paradigm shift towards multi-modal pain management emphasizing early movement, non-narcotics, and various adjunctive therapies. Electrotherapies remain understudied and most lack high-quality clinical trials, despite a desperate need for effective adjunctive options. A systematic search of human clinical studies on H-Wave® device stimulation (HWDS) was conducted as well as a comprehensive review of articles articulating possible HWDS mechanisms of action. Studies unrelated to H-Wave were excluded. Data synthesis summarizes outcomes and study designs, categorized as pre-clinical or clinical. Pre-clinical studies demonstrated that HWDS utilizes a biphasic waveform to induce non-fatiguing muscle contractions which positively affect nerve function, blood and lymph flow. Multiple clinical studies have reported significant benefits for diabetic and non-specific neuropathic pain, where function also improved, and pain medication usage substantially dropped. In conclusion, low- to moderate-quality HWDS studies have reported reduced pain, restored functionality, and lower medication use in a variety of disorders, although higher-quality research is needed to verify condition-specific applicability. HWDS has enough reasonable evidence to be considered as an adjunctive component of non-opioid multi-modal pain management, given its excellent safety profile and relative low cost. Level of Evidence: III.

Cell-free stem cell-derived extract formulation for treatment of knee osteoarthritis: study protocol for a preliminary non-randomized, open-label, multi-center feasibility and safety study.

BACKGROUND: Musculoskeletal conditions are highly prevalent, and knee OA is most common. Current treatment modalities have limitations and either fail to solve the underlying pathophysiology or are highly invasive. To address these limitations, attention has focused on the use of biologics. The efficacy of these devices is attributed to presence of growth factors (GFs), cytokines (CKs), and extracellular vesicles (EVs). With this in mind, we formulated a novel cell-free stem cell-derived extract (CCM) from human progenitor endothelial stem cells (hPESCs). A preliminary study demonstrated the presence of essential components of regenerative medicine, namely GFs, CKs, and EVs, including exosomes, in CCM. The proposed study aims to evaluate the safety and efficacy of intraarticular injection of the novel cell-free stem cell-derived extract (CCM) for the treatment of knee OA. METHODS AND ANALYSIS: This is a non-randomized, open-label, multi-center, prospective study in which the safety and efficacy of intraarticular CCM in patients suffering from grade II/III knee OA will be evaluated. Up to 20 patients with grade II/III OA who meet the inclusion and exclusion criteria will be consented and screened to recruit 12 patients to receive treatment. The study will be conducted at up to 2 sites within the USA, and the 12 participants will be followed for 24 months. The study participants will be monitored for adverse reactions and assessed using Numeric Pain Rating Scale (NPRS), Patient-Reported Outcomes Measurement Information System (PROMIS) Score, Knee Injury and Osteoarthritis Outcome Score Jr. (KOOS Jr.), 36-ietm short form survey (SF-36), Single Assessment Numeric Evaluation (SANE), physical exams, plain radiography, and magnetic resonance imaging (MRI) with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score for improvements in pain, function, satisfaction, and cartilage regeneration. DISCUSSION: This prospective study will provide valuable information into the safety and efficacy of intraarticular administration of cell-free stem cell-derived extract (CCM) in patients suffering with grade II/III knee OA. The outcomes from this initial study of novel CCM will lay the foundation for a larger randomized, placebo-controlled, multi-center clinical trial of intraarticular CCM for symptomatic knee OA. TRIAL REGISTRATION: Registered on July 21, 2021. ClinicalTrials.gov NCT04971798.

Programmatic implications of the TUMIKIA trial on community-wide treatment for soil-transmitted helminths: further health economic analyses needed before a change in policy.

School-based deworming programmes are currently the main approach used to control the soil-transmitted helminths (STHs). A key unanswered policy question is whether mass drug administration (MDA) should be targeted to the whole community instead, and several trials in this area have been conducted or are currently on-going. A recent well-conducted trial demonstrated that successful community-wide treatment is a feasible strategy for STH control and can be more effective than school-based treatment in reducing prevalence and intensity of hookworm infection. However, we would argue that it is vital that these findings are not taken out of context or over generalised, as the additional health benefits gained from switching to community-wide treatment will vary depending on the STH species and baseline endemicity. Moreover, community-wide treatment will typically be more expensive than school-based treatment. The epidemiological evidence for an additional benefit from a switch to community-wide treatment has yet to be proven to represent "good value for money" across different settings. Further work is needed before changes in policy are made regarding the use of community-wide treatment for STH control, including comprehensive assessments of its additional public health benefits and costs across a range of scenarios, accounting for the presence of alternative treatment delivery platforms.

Evaluation of Technology-Enhanced Learning Programs for Health Care Professionals: Systematic Review.

BACKGROUND: Technology-enhanced learning (TEL) programs are increasingly seen as the way in which education for health care professionals can be transformed, giving access to effective ongoing learning and training even where time or geographical barriers exist. Given the increasing emphasis on this mode of educational support for health care practitioners, it is vital that we can effectively evaluate and measure impact to ensure that TEL programs are effective and fit for purpose. This paper examines the current evidence base for the first time, in relation to the evaluation of TEL programs for health care professionals. OBJECTIVE: We conducted a systematic review of the current literature relating to the evaluation of TEL programs for health care professionals and critically appraised the quality of the studies. METHODS: This review employed specific search criteria to identify research studies that included evaluation of TEL for health care professionals. The databases searched included Medline Ovid, Cumulative Index of Nursing and Allied Health Literature Plus Advanced, Applied Social Sciences Index and Abstracts, ZETOC, Institute of Electrical and Electronics Engineers Explore Digital Library, Allied and Complementary Medicine, and Education Resources Information Center between January 2006 and January 2017. An additional hand search for relevant articles from reference lists was undertaken. Each of the studies identified was critically appraised for quality using the Crowe Critical Appraisal Tool. This approach produced a percentage total score for each study across specified categories. A proportion of the studies were independently assessed by an additional two reviewers. RESULTS: The review identified 21 studies that met the inclusion criteria. The studies included scored totals across eight categories within a range of 37%-95% and an average score of 68%. Studies that measured TEL using learner satisfaction surveys, or combined pretest and posttest knowledge score testing with learner satisfaction surveys, were found to be the most common types of TEL evaluations evident in the literature. The studies reviewed had low scores across reporting on ethical matters, design, and data collection categories. CONCLUSIONS: There continues to be a need to develop effective and standard TEL evaluation tools, and good quality studies that describe effective evaluation of TEL education for health care professionals. Studies often fail to provide sufficient detail to support transferability or direct future TEL health care education programs.

Royal Sun Culinary-Medicinal Mushroom, Agaricus brasiliensis (Agaricomycetes), Supplement in Training Capacity Improvement Parameters.

People seek a greater quality of life and healthy aging that culminates in improved self-esteem and vitality in the performance of daily activities; this is generating a growing number of people enrolled in gyms in search of quick results. However, this training can result in physical and metabolic damage. During physical exercise, under conditions of oxidative stress, changes take place that lead to the onset of fatigue. The Agaricus brasiliensis mushroom is native to Brazil and has therapeutic potential, with widely studied antioxidant and immunomodulatory capabilities. However, little is known about its potential benefits regarding muscular strength. Therefore, this study evaluated the possible effects of supplementation with this mushroom with respect to strength performance before and after a resistance training session. A blinded randomized trial was performed with male volunteers (n = 5) randomly divided into 2 groups (placebo and treatment with A. brasiliensis). Perceptions of muscle soreness and performance were assessed before and after high-intensity resistance training sessions. The study was executed over a 24-day period. Promising results were found related to intrasession rapid strength, most likely a result of antioxidant action and redox balance. The bioactive compounds in A. brasiliensis revealed the potential to improve conditions of muscle fatigue without altering other parameters. Thus, this mushroom has become a target of great expectations in the fields of fitness and athletics.

Interrupting transmission of soil-transmitted helminths: a study protocol for cluster randomised trials evaluating alternative treatment strategies and delivery systems in Kenya.

INTRODUCTION: In recent years, an unprecedented emphasis has been given to the control of neglected tropical diseases, including soil-transmitted helminths (STHs). The mainstay of STH control is school-based deworming (SBD), but mathematical modelling has shown that in all but very low transmission settings, SBD is unlikely to interrupt transmission, and that new treatment strategies are required. This study seeks to answer the question: is it possible to interrupt the transmission of STH, and, if so, what is the most cost-effective treatment strategy and delivery system to achieve this goal? METHODS AND ANALYSIS: Two cluster randomised trials are being implemented in contrasting settings in Kenya. The interventions are annual mass anthelmintic treatment delivered to preschool- and school-aged children, as part of a national SBD programme, or to entire communities, delivered by community health workers. Allocation to study group is by cluster, using predefined units used in public health provision-termed community units (CUs). CUs are randomised to one of three groups: receiving either (1) annual SBD; (2) annual community-based deworming (CBD); or (3) biannual CBD. The primary outcome measure is the prevalence of hookworm infection, assessed by four cross-sectional surveys. Secondary outcomes are prevalence of Ascaris lumbricoides and Trichuris trichiura, intensity of species infections and treatment coverage. Costs and cost-effectiveness will be evaluated. Among a random subsample of participants, worm burden and proportion of unfertilised eggs will be assessed longitudinally. A nested process evaluation, using semistructured interviews, focus group discussions and a stakeholder analysis, will investigate the community acceptability, feasibility and scale-up of each delivery system. ETHICS AND DISSEMINATION: Study protocols have been reviewed and approved by the ethics committees of the Kenya Medical Research Institute and National Ethics Review Committee, and London School of Hygiene and Tropical Medicine. The study has a dedicated web site. TRIAL REGISTRATION NUMBER: NCT02397772.

[Teaching Bioethics to Students of Medicine with Problem-Based Learning (PBL)]. / Enseñar Bioética a Estudiantes de Medicina Mediante el Aprendizaje Basado en Problemas (ABP).

We present the experience of the introduction of the subject of bioethics in a medical school in order to give to the 73 students of 5th degree skills to handle ethical conflicts in their practice. The main teaching method used was problem-based learning (PBL). Skills objectives are described. The course was structured with a theoretical seminar (2 hours of duration), a workshop (2 hours of duration), 4 cases of PBL (24 hours of duration in total) and a role playing workshop (2 hours of duration). The seminar was aimed at the acquisition of theoretical knowledge. The PBL cases provided critical appraisal, obtaining knowledge, and application. The Role Playing set out for the practical demonstration of skills acquired in a simulated environment. A continuous assessment of students was performed throughout their practice on the PBL cases (40% of the final score) and also a final evaluation of the course was carried out via exam (60% of the final score). Students completed a course and faculty evaluation anonymously, which came out with positive results (median score of 8.5/10).

Mineral nutrition of campos rupestres plant species on contrasting nutrient-impoverished soil types.

In Brazil, the campos rupestres occur over the Brazilian shield, and are characterized by acidic nutrient-impoverished soils, which are particularly low in phosphorus (P). Despite recognition of the campos rupestres as a global biodiversity hotspot, little is known about the diversity of P-acquisition strategies and other aspects of plant mineral nutrition in this region. To explore nutrient-acquisition strategies and assess aspects of plant P nutrition, we measured leaf P and nitrogen (N) concentrations, characterized root morphology and determined the percentage arbuscular mycorrhizal (AM) colonization of 50 dominant species in six communities, representing a gradient of soil P availability. Leaf manganese (Mn) concentration was measured as a proxy for carboxylate-releasing strategies. Communities on the most P-impoverished soils had the highest proportion of nonmycorrhizal (NM) species, the lowest percentage of mycorrhizal colonization, and the greatest diversity of root specializations. The large spectrum of leaf P concentration and variation in root morphologies show high functional diversity for nutritional strategies. Higher leaf Mn concentrations were observed in NM compared with AM species, indicating that carboxylate-releasing P-mobilizing strategies are likely to be present in NM species. The soils of the campos rupestres are similar to the most P-impoverished soils in the world. The prevalence of NM strategies indicates a strong global functional convergence in plant mineral nutrition strategies among severely P-impoverished ecosystems.

Low-level laser therapy inhibits bronchoconstriction, Th2 inflammation and airway remodeling in allergic asthma.

Low-level laser therapy (LLLT) controls bronchial hyperresponsiveness (BHR) associated with increased RhoA expression as well as pro-inflammatory mediators associated with NF-kB in acute lung inflammation. Herein, we explore if LLLT can reduce both BHR and Th2 cytokines in allergic asthma. Mice were studied for bronchial reactivity and lung inflammation after antigen challenge. BHR was measured through dose-response curves to acetylcholine. Some animals were pretreated with a RhoA inhibitor before the antigen. LLLT (660 nm, 30 mW and 5.4 J) was applied on the skin over the right upper bronchus and two irradiation protocols were used. Reduction of BHR post LLLT coincided with lower RhoA expression in bronchial muscle as well as reduction in eosinophils and eotaxin. LLLT also diminished ICAM expression and Th2 cytokines as well as signal transducer and activator of transduction 6 (STAT6) levels in lungs from challenged mice. Our results demonstrated that LLLT reduced BHR via RhoA and lessened allergic lung inflammation via STAT6.

Disadvantaged pre-schoolers attending day care in Salvador, Northeast Brazil have a low prevalence of anaemia and micronutrient deficiencies.

OBJECTIVE: To examine the micronutrient status of disadvantaged pre-schoolers from Northeast Brazil, following the introduction of pro-poor policies, by assessing the prevalence of anaemia and micronutrient deficiencies and the role of sociodemographic factors, genetic Hb disorders and parasitic infections. DESIGN: In a cross-sectional study, data on sociodemographic status, health, growth, genetic Hb disorders, parasites and nutrient supply from day-care meals were obtained. Fasting blood samples were collected and analysed for Hb, serum ferritin, transferrin receptor, folate, vitamin B12, retinol, Zn and Se. SETTING: Seven philanthropic day-care centres serving urban slums in Salvador, Northeast Brazil. SUBJECTS: Pre-schoolers aged 3-6 years from disadvantaged households. RESULTS: Of the 376 sampled children, 94 % were of black or mixed race; 33 % and 29 % had at least one genetic Hb disorder and intestinal parasite, respectively. Stunting and underweight were ≤5 %; 14 % were overweight. Day-care centres supplied micronutrient-dense meals and snacks each weekday. Less than 10 % of pre-schoolers had anaemia and micronutrient deficiencies. Predictors (P < 0·05) of Hb were α(3·7) thalassaemia, Se and retinol (but not ferritin). Micronutrient predictors (P < 0·05) were: elevated α1-glycoprotein for ferritin, Hb AS and BMI Z-score >1 for transferrin receptor, Zn and elevated α1-glycoprotein for retinol, sex and helminths for Se, helminths for vitamin B12, and Giardia intestinalis infection for serum folate. CONCLUSIONS: Impaired growth, anaemia and micronutrient deficiencies were uncommon among these disadvantaged pre-schoolers attending day care. A range of interventions including provision of micronutrient-dense, fortified day-care meals, deworming and vitamin A supplementation likely contributed to improved micronutrient status, suggesting expanded coverage of these programmes.

Chemical profile and antinociceptive efficacy of Rheedia longifolia leaf extract.

Different species of the family Clusiaceae, including Rheedia longifolia, are used in folk medicine to treat inflammatory diseases. This family is largely distributed in tropical and subtropical areas of Brazil, but their chemical and pharmacological properties have been the subject of a few studies. In previous studies, we found that the aqueous extract from R. longifolia leaves presented important anti-inflammatory and analgesic activity. We investigated the chemical profile of R. longifolia and characterized the pharmacological effect of different chemically identified fractions in pharmacological models of neurogenic and inflammatory nociception. The pharmacological tests showed that oral treatment with aqueous crude extract and fractions of methanol extract of R. longifolia leaf induced a significant antinociceptive effect using von Frey filaments. In addition, the most polar fractions presented antinociceptive activity in a neurogenic model of nociception (capsaicin model). The chromatographic analysis indicated the presence of bisflavonoids in the fractions obtained from the methanol extract. These results suggest that bisflavonoids found in methanol-extracted fractions are involved in the inhibition of inflammatory and neurogenic nociception. It is important that the R. longifolia aqueous extract treatment inhibited ulcer formation induced by indomethacin, suggesting an anti-ulcerogenic activity closely associated with its analgesic effect.

Effect of Rheedia longifolia leaf extract and fractions on the P2X7 receptor in vitro: novel antagonists?

Recently, the P2X(7) receptor has been reported to be associated with chronic inflammatory and neuropathic pain. Because Rheedia longifolia extract has analgesic and anti-inflammatory activity, we evaluated the in vitro inhibitory potential of methanol extract and fractions from its leaves on the P2X(7) purinergic receptor. The activity of P2X(7) was studied with a dye uptake assay and with the whole-cell patch clamp technique in mouse peritoneal macrophages treated with methanol extract of R. longifolia leaves and fractions. The dye uptake was evaluated by flow cytometry and fluorescence microscopy. The R. longifolia extract and some fractions showed an inhibitory effect on the P2X(7) purinergic receptor in a dose-dependent manner. The ethyl acetate fraction exhibited the most potent inhibitory effects. The methanol extract and the butanol fraction showed the same inhibitory effects, despite their lower potency compared with the other fractions. The R. longifolia extract and some of its fractions may be anti-inflammatory because of their inhibitory effect on the P2X(7) receptor. Further investigation is needed to determine the pattern of inhibition and selectivity. Chromatographic analysis indicated the presence of bisflavonoids in the methanol extract fractions. A member of this chemical family is the most probable active compound responsible for the P2X(7) inhibitory effects present in the R. Longifolia extract and fractions.