Experiência no uso das ferramentas de abordagem familiar por uma equipe da Estratégia Saúde da Família / Experiencia en el uso de herramientas de abordaje familiar por un equipo de Estrategia de Salud de la Familia / Family Health Strategy team's experience in the use of family approach tools

Problema: Experiência da intervenção de uma equipe multiprofissional da Estratégia Saúde da Família (ESF) em uma família por meio das ferramentas de abordagem familiar. Entre os problemas identificados no caso estão a sobrecarga de trabalho da paciente índice, diagnóstico de Transtorno do Espectro Autista (TEA) nos filhos dela, etilismo crônico do esposo e relacionamento hostil no ciclo familiar. Método: Estudo descritivo, qualitativo, de relato de experiência, desenvolvido em uma família da área de abrangência da equipe da ESF no segundo semestre de 2019, escolhida em razão da hiperutilização do serviço pela paciente índice. As ferramentas aplicadas foram o genograma, ecomapa, Fundamental Interpersonal Relations Outcome (FIRO), problem, roles, affect, communication, time in life, illness, coping with stress, environment/ecology (PRACTICE) e ciclo de vida familiar. Resultados: Com a aplicação das ferramentas foram identificadas as estruturas e modos de compartilhamento das relações familiares, os problemas de saúde presentes, os possíveis vínculos identificados e o estágio no ciclo de vida. Como modos de intervenção, a equipe propôs consultas de cuidado em saúde, assistência psicológica e escutas qualificadas. Além disso, por meio de reuniões intersetoriais, foi solucionado o problema escolar que afetava a condição de saúde da paciente. Conclusão: A aplicação das ferramentas foi um excelente método para realizar o estudo, pois permitiu uma visão global da família, além de identificar fragilidades a serem corrigidas ou minimizadas com recurso a intervenções pela equipe de saúde.

Problem: Intervention experience of a multidisciplinary team of the Family Health Strategy (ESF) through family approach tools. Among the problems identified in the case are the work overload of the index patient, diagnosis of autism spectrum disorder (ASD) in her children, husband's chronic alcoholism and hostile relationship within the family circle. Method: Descriptive and qualitative experience report. Developed by an ESF team in a family in the coverage area. Experience conducted in the second half of 2019. The tools applied were the genogram, ecomap, FIRO, PRACTICE and the family life cycle. The tools were chosen because of the index patient's frequent use of the ESF's services. Results: Through the application of the tools, the structures and ways of sharing family relationships, the health problems, the possible bonds identified and the stage in the life cycle were identified. As modes of intervention, the team proposed health care consultations, psychological assistance and qualified listening. In addition, through intersectional meetings, a school problem that affected the patient's health condition was solved. Conclusion: The application of the tools was an excellent method to carry out the study. It allowed a global view of the family, in addition to identifying weaknesses to be corrected or minimized, through interventions by the health team.

Problema: Experiencia de la intervención de un equipo multidisciplinario de la Estrategia Salud de la Familia (ESF) en una familia a través de herramientas de abordaje familiar. Entre los problemas identificados en el caso están la sobrecarga de trabajo de la paciente índice, diagnóstico de Trastorno del Espectro Autista (TEA) en sus hijos, alcoholismo crónico del marido y relación hostil dentro del ciclo familiar. Método: Estudio descriptivo, cualitativo de relato de experiencia desarrollado en una familia de la zona de cobertura del equipo de la ESF en el segundo semestre de 2019. Las herramientas aplicadas fueron el genograma, ecomapa, F.I.R.O., P.R.A.C.T.I.C.E. y el ciclo de vida familiar, elegido por la sobreutilización del paciente índice de los servicios de la ESF. Resultados: Mediante la aplicación de las herramientas se identificaron las estructuras y formas de compartir las relaciones familiares, los problemas de salud presentes, los posibles vínculos identificados y la etapa del ciclo de vida. Como modos de intervención, el equipo propuso la consulta de salud, la asistencia psicológica y la escucha cualificada. Además, a través de reuniones intersectoriales se solucionó un problema escolar que afectaba el estado de salud del paciente. Conclusión: La aplicación de las herramientas fue un método excelente para la realización del estudio, ya que permitió una visión global de la familia, además de identificar debilidades a ser corregidas o minimizadas, a través de intervenciones del equipo de salud.

Informação e prevenção não farmacológica da COVID-19 no território de uma unidade de saúde da família em Pernambuco / Information and non-pharmacological prevention of COVID-19 in the territory of a family health unit in Pernambuco / Información y prevención no farmacológica del COVID-19 en el territorio de una unidad de salud de la familia en Pernambuco

Introdução: O conhecimento da magnitude em que a população implementa medidas de proteção emitidas pelas autoridades de saúde pública é essencial na prevenção da doença do novo coronavírus (COVID-19). A eficácia de medidas não farmacológicas de prevenção e das políticas públicas destinadas a reduzir o contágio pela COVID-19 depende de quão bem os indivíduos são informados sobre as consequências da infecção e as medidas que devem adotar para reduzir sua propagação. O entendimento, as atitudes e as práticas das pessoas em relação à COVID-19 e sua prevenção são basilares para a compreensão da dinâmica epidemiológica, demandando a realização de pesquisas sobre o cumprimento de medidas não farmacológicas de prevenção do contágio em diversos territórios. Para isso, em 2020, medidas não farmacológicas contra a COVID-19 foram divulgadas por fontes diversas, estatais e privadas, para a maior parte da população brasileira, com a finalidade de orientar comportamentos para conter a crise sanitária. As equipes da Estratégia Saúde da Família têm um papel fundamental neste processo de educação em saúde, pois compreendem elementos socioculturais das suas comunidades, alcançando-as tanto em capilaridade quanto em adequação local da informação técnico-científica. Este artigo abrange uma pesquisa de campo, parte de um projeto multicêntrico nacional. Objetivo: Avaliar se a população do território de uma unidade da Estratégia Saúde da Família da cidade de Condado-PE entende e aplica as informações que recebeu sobre medidas não farmacológicas de prevenção em suas práticas de proteção contra a COVID-19. Mais especificamente, a pesquisa visou determinar que informações foram recebidas pelos respondentes, quais as suas fontes, o grau de confiabilidade atribuído a estas, além da adesão deles às medidas não farmacológicas e sua relação com variáveis sociodemográficas. Métodos: O modelo do estudo foi observacional e descritivo, com abordagem quantitativa, a partir da coleta de dados primários com 70 usuários por entrevista presencial com questionário estruturado. Resultados: Os resultados mostraram que a população recebeu vasta informação sobre prevenção da doença. Conclusão: Com níveis variados de confiabilidade das fontes, atribuindo importância relevante às medidas de prevenção e adotou a maioria delas, com exceção do isolamento social total.

Introduction: Knowledge of the magnitude to which the population implements protective measures issued by public health authorities is essential in preventing coronavirus disease 2019 (COVID-19). The effectiveness of non-pharmacological prevention measures (NPM) and public policies aimed at reducing the spread of COVID-19 depends on how well individuals are informed about the consequences of the infection and the measures they must adopt to reduce its spread. The understanding, attitudes, and practices of people in relation to COVID-19 and its prevention are fundamental for understanding the epidemiological dynamics, demanding research on compliance with NPM to prevent contagion in different territories. To this end, in 2020, NPM against COVID-19 were released by various sources, state and private, for most of the Brazilian population, with the aim of guiding behaviors to contain the health crisis. The Family Health Strategy (FHS) teams play a key role in this health education process, as they comprise sociocultural elements of their communities, reaching them both in capillarity and in local adequacy of technical-scientific information. This article covers field research, part of a national multicenter project. Objective: To evaluate whether the population of the territory of an FHS unit in the city of Condado, Pernambuco, understands and applies the information it received about NPM prevention in their practices to protect against COVID-19. More specifically, the research aimed to determine what information was received by the respondents, what are their sources, the degree of reliability attributed to these, in addition to their adherence to the NPM and their relationship with sociodemographic variables. Methods: The study model was observational and descriptive, with a quantitative approach, based on the collection of primary data with 70 users through face-to-face interviews with a structured questionnaire. Results: The results showed that the population received extensive information on disease prevention. Conclusion: With varying levels of reliability of the sources, attributing relevant importance to prevention measures and adopted most of them, with the exception of total social isolation.

El conocimiento de la magnitud con la que la población implementa las medidas de protección emitidas por las autoridades de salud pública es fundamental en la prevención de la enfermedad por coronavirus 2019 (COVID-19). La efectividad de las medidas de prevención no farmacológicas (MFN) y de las políticas públicas dirigidas a reducir la propagación de la COVID-19 depende de qué tan bien se informe a las personas sobre las consecuencias de la infección y las medidas que deben adoptar para reducir su propagación. La comprensión, actitudes y prácticas de las personas con relación al COVID-19 y su prevención son fundamentales para comprender la dinámica epidemiológica, exigiendo investigaciones sobre el cumplimiento de las MNF para prevenir el contagio en diferentes territorios. Con ese fin, en 2020, MNF contra el COVID-19 fueron divulgados por diversas fuentes, estatales y privadas, para la mayoría de la población brasileña, con el objetivo de orientar comportamientos para contener la crisis sanitaria. Los equipos de la Estrategia de Salud de la Familia (ESF) juegan un papel fundamental en este proceso de educación en salud, ya que integran elementos socioculturales de sus comunidades, alcanzándolas tanto en la capilaridad como en la adecuación local de la información técnico-científica. Este artículo aborda una investigación de campo, parte de un proyecto multicéntrico nacional, con el objetivo de evaluar si la población del territorio de una unidad de la ESF en la ciudad de Condado-PE comprende y aplica la información recibida sobre la prevención de MNF en sus prácticas de protección contra el COVID -19. Más específicamente, la investigación tuvo como objetivo determinar qué información recibieron los encuestados, cuáles son sus fuentes, el grado de confiabilidad atribuido a estas, además de su adherencia al MNF y su relación con variables sociodemográficas. El modelo de estudio fue observacional y descriptivo, con enfoque cuantitativo, basado en la recolección de datos primarios con 70 usuarios a través de entrevistas cara a cara con un cuestionario estructurado. Los resultados mostraron que la población recibió amplia información sobre prevención de la enfermedad, con diversos niveles de confiabilidad de las fuentes, atribuyendo importancia relevante a las medidas de prevención y adoptando la mayoría de ellas, con excepción del aislamiento social total.

Representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada / Social representations of reproductive planning among women with unplanned pregnancies / Representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado

Objetivo: conhecer as representações sociais sobre o planejamento reprodutivo entre mulheres em gravidez não planejada na Estratégia Saúde da Família. Método: estudo qualitativo, orientado pela Teoria das Representações Sociais, realizado com 15 gestantes, entre abril e maio de 2019. Utilizou-se a entrevista semiestruturada. Os dados foram organizados por meio do Discurso do Sujeito Coletivo, com auxílio do software DSCsoft©. Protocolo de pesquisa aprovado pelo Comitê de Ética em Pesquisa. Resultados: as representações sociais das mulheres em gravidez não planejada evidenciadas pelo Discurso do Sujeito Coletivo foram representadas por oito ideias centrais, a saber: "eu não me preveni, nem ele", "nós nos prevenimos", "eu comprava", "pegava no posto", "construir uma família", "ter esse acesso", "estou por fora" e "eu sei que é disponível". Conclusão: as representações sociais nos discursos das mulheres em gravidez não planejada estavam pautadas no desconhecimento acerca do planejamento reprodutivo, dos anticoncepcionais disponíveis e seu uso correto.

Objective: to understand the social representations of reproductive planning among women with unplanned pregnancies in the Family Health Strategy. Method: qualitative study, guided by the Theory of Social Representations, carried out with 15 pregnant women between April and May 2019. Semi-structured interviews were used. The data was organized using the Discourse of the Collective Subject, with the aid of DSCsoft© software. Research protocol approved by the Research Ethics Committee. Results: the social representations of women with unplanned pregnancies as evidenced by the Collective Subject Discourse were represented by eight central ideas, namely: "I didn't prevent myself, nor did he", "we prevented ourselves", "I would buy it", "I would get it at the health center", "build a family", "have this access", "I am not aware" and "I know it is available". Conclusion: the social representations in the women's speeches about unplanned pregnancies were based on a lack of knowledge about reproductive planning, the contraceptives available and their correct use.

Objetivo: conocer las representaciones sociales sobre la planificación reproductiva de las mujeres con embarazo no planificado en la Estrategia Salud de la Familia. Método: estudio cualitativo, basado en la Teoría de las Representaciones Sociales, realizado con 15 mujeres embarazadas, entre abril y mayo de 2019. Se utilizaron entrevistas semiestructuradas. Los datos fueron organizados mediante el Discurso del Sujeto Colectivo, con ayuda del software DSCsoft©. El protocolo de investigación fue aprobado por el Comité de Ética en Investigación. Resultados: las representaciones sociales de las mujeres con embarazo no planificado reveladas por el Discurso del Sujeto Colectivo fueron representadas por ocho ideas centrales, a saber: "yo no me cuidé y él tampoco", "nos cuidamos", "yo los compraba", "los buscaba en el centro de salud", "construir una familia", "tener acceso", "no participo" y "sé que está disponible". Conclusión: las representaciones sociales en los discursos de las mujeres con embarazo no planificado se basaron en la falta de conocimiento sobre la planificación reproductiva, en los anticonceptivos disponibles y su uso correcto.

Do the benefits of learning to write a compare-contrast text transfer to other types of writing task? Analysing the effects of strategy-focused instruction / ¿Es posible transferir el aprendizaje de un texto de comparación-contraste a otro tipo de tareas? Análisis de los efectos de la instrucción estratégica

El programa de Instrucción de la Autorregulación Cognitiva (CSRI) se basa en la instrucción centrada en la estrategia e incluye tres componentes para la mejora del producto textual (enseñanza directa, modelado y práctica entre iguales). Se plantearon como objetivosanalizar si la instrucción con el programa CSRI en un género textual (texto de comparación) conducía a la transferencia espontánea en el producto textual (mejor coherencia, estructura y calidad) en un género no instruido (texto de opinión); y examinar si el orden de los componentes instruccionales presentaba algún efecto. Participaron 126 estudiantes de cuarto de educación primaria que fueron asignados a una de las dos condiciones experimentales en las que se aplicaba el programa CSRI (con diferente secuencia de los componentes instructivos), o a una condición de control en la que se seguía la enseñanza tradicional. Los resultados reflejaron que las dos secuencias de instrucción del programa CSRI mostraban beneficios en la estructura y coherencia del producto textual de los estudiantes en el posttest pero no 8 meses después. Para que los alumnos sean capaces de transferir adecuadamente lo aprendido a géneros textuales no instruidos, necesitan que los profesores les enseñen cómo hacerlo eficazmente.(AU)

Cognitive Self-Regulation Instruction (CSRI) program is a strategy-focused instruction with three instructional components for im-proving students’ writing product (direct teaching, modelling, and peer-practice). The present study aimed to explore whether the CSRI program leads to spontaneous transfer, improving the writing product (in terms of quality, structure, and text coherence) of an uninstructed genre (opinion text); and to examine whether the order in which the instructional compo-nents were implemented had an effect. A total of 126 students in their 4thyear of primary school participated in the study. They were randomly as-signed to one of two experimental conditions which received the CSRI but differed in the order the instructional components were delivered, or to a control condition which followed the traditional teaching approach. Our findings show that both CSRI sequences produced benefits in terms of greater structure and coherence of the writing product in the opinion text at post-test but not 8months after the intervention. In consequence, for students to be able to adequately transfer strategies to uninstructed text genres, they need teachers to teach them how to do it effectively.(AU)

Contrasting Phenological Patterns and Reproductive Strategies in Closely Related Monoecious Fig Tree Species.

Understanding the ecological and evolutionary aspects of mutualistic interactions is essential for predicting species responses to environmental changes. This study aimed to investigate the phenological patterns and reproductive strategies in two closely related fig tree species, Ficus citrifolia and Ficus eximia. We monitored 99 F. citrifolia and 21 F. eximia trees weekly from January 2006 to April 2011 in an area close to the southern edge of the tropical region in Brazil. Our results revealed contrasting phenological patterns between the two species, with F. citrifolia displaying an annual flowering pattern (1.4 episodes per tree per year) and F. eximia a supra-annual pattern (0.5 episodes per tree per year). We also found significant differences in reproductive strategies, with F. eximia producing more pistillate flowers and, consequently, more seeds and pollinating wasps per fig than F. citrifolia, likely as an adaptation to overcome limitations of low population density by maximizing the gene flow. As the shorter-lived organism, the fig wasp was found to influence critical processes associated with the success and stability of mutualism, such as fig development and ripening. Our findings emphasize the importance of understanding the intricate interactions between mutualistic partners and their adaptive responses to environmental conditions in shaping fig tree populations' reproductive strategies and genetic structure.

A New Casjensviridae Bacteriophage Isolated from Hospital Sewage for Inactivation of Biofilms of Carbapenem Resistant Klebsiella pneumoniae Clinical Isolates.

Klebsiella pneumoniae, a member of the ESKAPE pathogen group, is a prominent cause of hospital-acquired infections. The WHO has recognized carbapenem-resistant K. pneumoniae as a critical-one priority pathogen. These resilient superbugs have the ability to form biofilms and present a significant global threat. In the present study, we isolated and characterized a bacteriophage SAKp02, from hospital sewage, infectious to carbapenem-resistant K. pneumoniae patient isolates. SAKp02 could infect 43 of 72 clinical isolates, indicating a broad host spectrum. Whole genome analysis classified SAKp02 within the family Casjensviridae, with a 59,343 bp genome encoding 82 ORFs. Comparative genomic analysis revealed significant differences between SAKp02 and its closest viruses, indicating a distinct genetic makeup positioning it as a novel phage strain within the lineage. The SAKp02 genome comprises bacteriolytic enzymes, including holin, endolysin, and phage depolymerase, crucial for bacterial lysis and biofilm disruption. It reduced biofilm biomass by over threefold compared to the control and eradicated 99% of viable cells within a 4 h treatment period. Scanning electron microscopy corroborated the ability of the phage to dismantle biofilm matrices and lyse bacterial cells. Safe and effective treatments are warranted, and hence, the fully characterized lytic phages with therapeutic potential against drug-resistant clinical isolates of bacteria are needed. Our study is the first to report the antibacterial and antibiofilm activity of Casjensviridae phages, and our discovery of a novel K. pneumoniae phage broadens the arsenal against the bacteria.

The Chameleon Strategy-A Recipe for Effective Ligand Screening for Viral Targets Based on Four Novel Structure-Binding Strength Indices.

The RNA viruses SARS-CoV, SARS-CoV-2 and MERS-CoV encode the non-structural Nsp16 (2'-O-methyltransferase) that catalyzes the transfer of a methyl group from S-adenosylmethionine (SAM) to the first ribonucleotide in mRNA. Recently, it has been found that breaking the bond between Nsp16 and SAM substrate results in the cessation of mRNA virus replication. To date, only a limited number of such inhibitors have been identified, which can be attributed to a lack of an effective "recipe". The aim of our study was to propose and verify a rapid and effective screening protocol dedicated to such purposes. We proposed four new indices describing structure-binding strength (structure-binding affinity, structure-hydrogen bonding, structure-steric and structure-protein-ligand indices) were then applied and shown to be extremely helpful in determining the degree of increase or decrease in binding affinity in response to a relatively small change in the ligand structure. After initial pre-selection, based on similarity to SAM, we limited the study to 967 compounds, so-called molecular chameleons. They were then docked in the Nsp16 protein pocket, and 10 candidate ligands were selected using the novel structure-binding affinity index. Subsequently the selected 10 candidate ligands and 8 known inhibitors and were docked to Nsp16 pockets from SARS-CoV-2, MERS-CoV and SARS-CoV. Based on the four new indices, the best ligands were selected and a new one was designed by tuning them. Finally, ADMET profiling and molecular dynamics simulations were performed for the best ligands. The new structure-binding strength indices can be successfully applied not only to screen and tune ligands, but also to determine the effectiveness of the ligand in response to changes in the target viral entity, which is particularly useful for assessing drug effectiveness in the case of alterations in viral proteins. The developed approach, the so-called chameleon strategy, has the capacity to introduce a novel universal paradigm to the field of drugs design, including RNA antivirals.

Immunodeficiency-Related Vaccine-Derived Poliovirus (iVDPV) Excretion in an Infant with Severe Combined Immune Deficiency with Spillover to a Parent.

In order to maintain the polio eradication status, it has become evident that the surveillance of cases with acute flaccid paralysis and of environmental samples must be urgently supplemented with the surveillance of poliovirus excretions among individuals with inborn errors of immunity (IEI). All children with IEI were screened for the excretion of poliovirus during a collaborative study conducted by the ICMR-National Institute of Virology, Mumbai Unit, ICMR-National Institute of Immunohaematology, and World Health Organization, India. A seven-month -old male baby who presented with persistent pneumonia and lymphopenia was found to have severe combined immune deficiency (SCID) due to a missense variant in the RAG1 gene. He had received OPV at birth and at 20 weeks. Four stool samples collected at 4 weekly intervals yielded iVDPV type 1. The child's father, an asymptomatic 32-year-old male, was also found to be excreting iVDPV. A haploidentical hematopoietic stem cell transplant was performed, but the child succumbed due to severe myocarditis and pneumonia three weeks later. We report a rare case of transmission of iVDPV from an individual with IEI to a healthy household contact, demonstrating the threat of the spread of iVDPV from persons with IEI and the necessity to develop effective antivirals.

Non-visual spatial strategies are effective for maintaining precise information in visual working memory.

Visual working memory content is commonly thought to be composed of a precise visual representation of stimulus information (e.g., color, shape). Nevertheless, previous research has shown that individuals represent this visual information in different formats, historically dichotomized into "verbal" and "visual" formats. With growing popular knowledge of aphantasia, or the absence of sensory mental imagery, recent studies have demonstrated that individuals with aphantasia perform similarly to individuals with typical imagery on visual working memory tasks. This suggest that the use of non-visual strategies may be sufficient to perform visual working memory tasks, which were previously thought to be strictly visual. To investigate the effects of different strategies on performance in a visual working memory task, we recruited individuals across the visual imagery spectrum and tested their ability to identify relatively small (3°), medium (6°), or large (10°) changes in the degree of orientation of gratings held in working memory. Subsequently, participants indicated the extent to which they used five different strategies: visual, spatial, verbal, semantic, and sensorimotor. Results revealed that individuals with aphantasia and typical imagery performed similarly to each other across all task difficulty levels. Individuals with typical imagery dominantly used visuospatial strategies, but surprisingly, individuals with aphantasia overwhelmingly preferred the use of non-visual spatial and sensorimotor strategies over verbal strategies. These results suggest that non-visual spatial and sensorimotor strategies can be adopted in visual working memory tasks and these strategies are equally effective as visuospatial strategies. This calls for a rethinking of the "visual" versus "verbal" dichotomy, and provides evidence for the use of other non-visual mental representations in working memory tasks.

Role of Cardiolipin in regulating and treating atherosclerotic cardiovascular diseases.

Cardiovascular diseases, mainly caused by atherosclerosis, are the leading causes of morbidity and mortality worldwide. Despite the discrepancies in clinical manifestations between different abnormalities, atherosclerosis shares similar pathophysiological processes, such as mitochondrial dysfunction. Cardiolipin (CL) is a conserved mitochondria-specific lipid that contributes to the cristae structure of the inner mitochondrial membrane (IMM). Alterations in the CL, including oxidative modification, reduced quantity, and abnormal localization, contribute to the onset and progression of atherosclerosis. In this review, we summarize the knowledge that CL is involved in the pathogenesis of atherosclerosis. On the one hand, CL and its oxidative modification promote the progression of atherosclerosis via several mechanisms, including oxidative stress, apoptosis, and inflammation in response to stress. On the other hand, CL externalizes to the outer mitochondrial membrane (OMM) and acts as the pivotal "eat-me" signal in mitophagy, removing dysfunctional mitochondria and safeguarding against the progression of atherosclerosis. Given the imbalance between proatherogenic and antiatherogenic effects, we provide our understanding of the roles of the CL and its oxidative modification in atherosclerotic cardiovascular diseases, in addition to potential therapeutic strategies aimed at restoring the CL. Briefly, CL is far more than a structural IMM lipid; broader significances of the evolutionarily conserved lipid need to be explored.

Employer Strategies for Health Care Price Transparency.

This paper describes hospital, insurance, and pharmaceutical price transparency policies and applications in the United States and in selected countries around the world. Many of these policies apply to self-insured employers. So far, the experience in the United States and elsewhere is clear that federal and state price transparency regulations have had little impact on whether employees or dependents search for low-cost or high-quality providers or on the cost and quality of their health care. This is because of weak regulatory oversight, conflicting federal and state reporting requirements, and few economic incentives for providers and insurance companies to supply easily readable or analyzable price information. However, price transparency requirements are here to stay. This paper therefore offers several recommendations to maximize the utility of price transparency tools provided for employees and other insureds, by their employers, providers, commercial insurance carriers, or technology firms. From a policy perspective, coupling reporting requirements with clearer technological guidance and much stronger regulatory oversight would increase the utility of price transparency efforts. For individual employers, the impact of price transparency efforts may increase by coupling price transparency tools with health plan network and design strategies, behavioral economic nudges, and programs designed to improve health, well-being, and quality of care. Many program vendor partners, consultants, and actuarial, technology, and research firms can help make these efforts useful.

Delivery Strategy to Enhance the Therapeutic Efficacy of Liver Fibrosis via Nanoparticle Drug Delivery Systems.

Liver fibrosis (LF) is a pathological repair reaction caused by a chronic liver injury that affects the health of millions of people worldwide, progressing to life-threatening cirrhosis and liver cancer without timely intervention. Due to the complexity of LF pathology, multiple etiological characteristics, and the deposited extracellular matrix, traditional drugs cannot reach appropriate targets in a time-space matching way, thus decreasing the therapeutic effect. Nanoparticle drug delivery systems (NDDS) enable multidrug co-therapy and develop multifactor delivery strategies targeting pathological processes, showing great potential in LF therapy. Based on the pathogenesis and the current clinical treatment status of LF, we systematically elucidate the targeting mechanism of NDDS used in the treatment of LF. Subsequently, we focus on the progress of drug delivery applications for LF, including combined delivery for the liver fibrotic pathological environment, overcoming biological barriers, precise intracellular regulation, and intelligent responsive delivery for the liver fibrotic microenvironment. We hope that this review will inspire the rational design of NDDS for LF in the future in order to provide ideas and methods for promoting LF regression and cure.

Frailty Trajectories and Its Associated Factors in Japanese Older Adults.

BACKGROUND: Associated factors for frailty development according to age group remain unclear. OBJECTIVES: To identify frailty score trajectories among community-dwelling older Japanese individuals and examine their associated factors. DESIGN: 13-year longitudinal study. SETTING: Kusatsu Town in Gunma Prefecture, Japan. PARTICIPANTS: 1706 older adults aged ≥ 65 years who completed an annual frailty assessment at least once between 2007 and 2019. MEASUREMENTS: Frailty status was determined using an index based on the Fried frailty phenotype criteria. Potential associated factors for frailty trajectory included physical, biological, lifestyle-related, and psychological factors, as well as comorbidities. RESULTS: We identified five trajectory patterns in the frailty score from age of 65 to 90 years -individuals who were robust (Group 1, 10.5%) as well as individuals with late-onset frailty (Group 2, 16.1%), middle-onset frailty (Group 3, 25.6% and Group 4, 35.2%), and early-onset frailty (Group 5, 12.7%). Compared with the other groups, the early-onset group showed a higher prevalence of cerebrovascular diseases, bone and joint diseases, poor nutrition, sarcopenia, hospitalization, low cognitive function, and smoking at the end of follow-up. Associated factors in the middle-onset group largely overlapped with those of the early-onset group. The late-onset frailty group tended to have a higher association with heart disease and bone and joint diseases compared with the robust group. CONCLUSION: Our findings from a 13-year longitudinal study identified five frailty trajectory patterns and seven associated factors for frailty trajectory. Proposed effective population-based frailty prevention strategies in each age group may contribute to effective strategies to extend healthy life expectancy in aging, aged, and super-aged communities.

From Feeling Tough to Mental Growth: Coping with Sexual Bullying During Childhood in Gay and Bisexual Men.

This qualitative study was conducted to understand how gay and bisexual men (GBM) in Taiwan cope with childhood bullying because of their sexual orientation or gender nonconformity. We explored their journey from feeling disturbed to receiving social support, developing coping strategies, and achieving self-growth. Colaizzi's phenomenological approach was used to investigate subject experiences. Semi-structured interviews were conducted with 21 GBM who had experienced high-level sexual bullying in childhood. Relevant data were collected to assess their experiences of sexual bullying, their coping strategies, and subjective effects of corresponding adjustments in interpersonal interactions. Subject experiences concentrated on six themes related to sexual bullying and coping strategies: bullying at developmental stages, bullying everywhere, facing bullying alone, various impacts of bullying, overcoming challenges of interpersonal relationships, and building a strong and carefree self. Our findings can provide mental health professionals with key insights into the contexts of sexual bullying and the associated psychological distress in GBM. This study further clarifies the coping responses of these individuals and their psychological growth following such adverse experiences.

Inhibitory effect of Jingfang mixture on Staphylococcus aureus α-hemolysin.

Staphylococcus aureus is a gram-positive bacteria, and its virulence factors can cause many kinds of infections, such as pneumonia, sepsis, enteritis and osteomyelitis. Traditional antibiotics can not only kill bacteria, but also easily lead to bacterial resistance. Jingfang Mixture (JFM) has the effects of inducing sweating and relieving the exterior, dispelling wind and eliminating dampness, and is commonly used in clinic to prevent and treat epidemic diseases and infectious diseases. The main purpose of this study is to explore the inhibitory effect of JFM on alpha-hemolysin (Hla) of S. aureus and to alleviate the damage caused by Hla. We found that JFM could inhibit the hemolytic activity, transcription level and neutralizing activity of Hla in a dose-dependent manner at the concentrations of 125, 250 and 500 µg/mL, without affecting the growth of bacteria. In addition, JFM reduced the damage of Hla to A549 cells and the release of lactate dehydrogenase (LDH). We also observed that in the S. aureus - induced pneumonia mouse model, JFM could significantly prolong the life of mice, reduce the bacterial load in the lungs, significantly improve the pathological state of the lungs and alleviate the damage caused by inflammatory factors, and the pathogenicity of gene deletion strain DU 1090 of S. aureus to pneumonia mice was also significantly reduced. In conclusion, this study proved that JFM is a potential drug against S. aureus infection, and this study provided a preliminary study for better guidance of clinical drug use.

One-Pot Catalytic Cascade for the Depolymerization of the Lignin ß-O-4 Motif to Non-phenolic Dealkylated Aromatics.

Aromatic monomers obtained by selective depolymerization of the lignin ß-O-4 motif are typically phenolic and contain (oxygenated) alkyl substitutions. This work reveals the potential of a one-pot catalytic lignin ß-O-4 depolymerization cascade strategy that yields a uniform set of methoxylated aromatics without alkyl side-chains. This cascade consists of selective acceptorless dehydrogenation of the γ-hydroxy group, subsequent retro-aldol reaction cleaving the Cα-Cß bond followed by in situ acceptorless decarbonylation of the formed aldehydes. This three-step cascade reaction, catalyzed by an iridium(I)-BINAP complex, resulted in 75% 1,2-dimethoxybenzene from G-type lignin dimers alongside syngas (CO:H2 ≈ 1.4:1). Applying this method to a synthetic G-type polymer, 11 wt% 1,2-dimethoxybenzene was obtained. This versatile compound can be easily transformed into 3,4-dimethoxyphenol, a valuable precursor for pharmaceutical synthesis, through enzymatic catalytic approach. Moreover, the hydrodeoxygenation potential of 1,2-dimethoxybenzene offers a pathway to produce valuable cyclohexane or benzene derivatives, presenting enticing opportunities for sustainable chemical transformations without the necessity for phenolic mixture upgrading via dealkylation.

Teach a man to fish: Hyper-brain evidence on scaffolding strategy enhancing creativity acquisition and transfer.

Creativity is an indispensable competency in today's innovation-driven society. Yet, the influences of instructional strategy, a key determinant of educational outcomes, on the creativity-fostering process remains an unresolved mystery. We proposed that instructional strategy affects creativity cultivation and further investigated the intricate neural mechanisms underlying this relationship. In a naturalistic laboratory setting, 66 instructor-learner dyads were randomized into three groups (scaffolding, explanation, and control), with divergent thinking instructions separately. Functional near-infrared spectroscopy (fNIRS) hyperscanning simultaneously collected brain signals in the prefrontal cortex and temporal-parietal junction regions. Results indicated that learners instructed with a scaffolding strategy demonstrated superior creative performance both in acquisition (direct learning) and transfer (use in a novel context) of creativity skills, compared to pretest levels. In contrast, the control and explanation groups did not exhibit such effects. Notably, we also observed remarkable interbrain neural synchronization (INS) between instructors and learners in the left superior frontal cortex in the scaffolding group, but not in the explanation or control groups. Furthermore, INS positively predicted enhancements in creativity performance (acquisition and transfer), indicating that it is a crucial neural mechanism in the creativity-fostering process. These findings reveal that scaffolding facilitates the acquisition and transfer of creativity and deepen our understanding of the neural mechanisms underlying the process of creativity-fostering. The current study provides valuable insights for implementing teaching strategies to fostering creativity.

Quality-by-design driven approach in the formulation of an anti-ulcer and gastro-protective oral suspension.

OBJECTIVE: This work aims to present a Quality-by-Design (QbD) step-by-step methodology to formulate anti-ulcer and gastro-protective oral suspensions. METHODS: Sucralfate was used as a drug model. The Quality Target Product Profile was established early during preformulation. Viscosity, resuspendability, pH, and density were assessed through the screening of several suspension platforms based on different prototype compositions. A compatibility study between the active pharmaceutical ingredient and the excipients was performed by thermal analysis and infrared spectroscopy. An Ishikawa fishbone diagram and Failure Mode and Effect Analysis were employed to identify the Critical Material Attributes (CMAs), Critical Process Parameters (CPPs), and Critical Quality Attributes (CQAs). CMAs' and CPPs' impact on identified CQAs was further assessed through a 22 full factorial experimental design at normal conditions after manufacture and one month at super-accelerated stress conditions. Results: The lead prototype exhibited no physicochemical incompatibilities. The risk assessment tools revealed that the concentration of the wetting agent and the total concentration of thickening agents represented critical factors for the quality profile of the preparation in terms of viscosity. The optimized formulation comprising 1.125 w/v% total concentration of Natrosol 250 HX and Avicel RC 591 exhibited an enhanced performance according to the established profile. CONCLUSIONS: The analytical and physicochemical tests showed the robustness and compliance of the final preparation with the quality profile. The proposed step-by-step methodology based on QbD, Design of Experiments, and Quality Risk Management presented in our research holds practical implications for local industries and formulation scientists involved in the development of oral suspensions.

Communication between alveolar macrophages and fibroblasts via the TNFSF12-TNFRSF12A pathway promotes pulmonary fibrosis in severe COVID-19 patients.

BACKGROUND: Severe COVID-19 infection has been associated with the development of pulmonary fibrosis, a condition that significantly affects patient prognosis. Understanding the underlying cellular communication mechanisms contributing to this fibrotic process is crucial. OBJECTIVE: In this study, we aimed to investigate the role of the TNFSF12-TNFRSF12A pathway in mediating communication between alveolar macrophages and fibroblasts, and its implications for the development of pulmonary fibrosis in severe COVID-19 patients. METHODS: We conducted single-cell RNA sequencing (scRNA-seq) analysis using lung tissue samples from severe COVID-19 patients and healthy controls. The data was processed, analyzed, and cell types were annotated. We focused on the communication between alveolar macrophages and fibroblasts and identified key signaling pathways. In vitro experiments were performed to validate our findings, including the impact of TNFRSF12A silencing on fibrosis reversal. RESULTS: Our analysis revealed that in severe COVID-19 patients, alveolar macrophages communicate with fibroblasts primarily through the TNFSF12-TNFRSF12A pathway. This communication pathway promotes fibroblast proliferation and expression of fibrotic factors. Importantly, silencing TNFRSF12A effectively reversed the pro-proliferative and pro-fibrotic effects of alveolar macrophages. CONCLUSION: The TNFSF12-TNFRSF12A pathway plays a central role in alveolar macrophage-fibroblast communication and contributes to pulmonary fibrosis in severe COVID-19 patients. Silencing TNFRSF12A represents a potential therapeutic strategy for mitigating fibrosis in severe COVID-19 lung disease.

Advancements in application of modified biochar as a green and low-cost adsorbent for wastewater remediation from organic dyes.

Synthetic organic dyes, which are resistant to biodegradation, pose a notable health risk, potentially leading to cancer and respiratory infections. Researchers have addressed this concern by exploring physicochemical methods to remove organic dyes from wastewater. A particularly promising solution involves modified biochar adsorbents, which demonstrate high efficiency in organic dye removal. Biochar, a charcoal-like material derived from biomass pyrolysis, offers advantages such as low cost, eco-friendliness, high efficiency and reusability. Beyond its role in sustainable soil remediation, biochar proves effective in removing organic dyes from wastewater after undergoing physical or chemical modification. Acid-base activation or metal-heteroatom impregnation enhances biochar's adsorption capacity. This comprehensive review examines the attributes of biochar, common methods for production and modification, and the impacts of raw materials, pyrolysis temperature, heating rate and residence time. It further elucidates the biochar adsorption mechanism in the removal of organic dyes, assessing factors influencing efficiency, including biochar feedstock, solution pH, adsorption temperature, particle size, initial dye concentration, biochar dosage and reaction time. It explores challenges, opportunities, reusability and regeneration methods of biochar in treating organic dye wastewater. It also discusses recent advances in organic dye removal using adsorption-based biochar. The review ultimately advocates for enhancing biochar's adsorption performance through post-modification.