Positive Psychological Intervention Delivered Using Virtual Reality in Patients on Hemodialysis With Comorbid Depression: Protocol and Design for the Joviality Randomized Controlled Trial.

BACKGROUND: Depression is highly prevalent in individuals on hemodialysis, but it is infrequently identified and remains undertreated. In this paper, we present details of the methodology of a randomized controlled trial (RCT) aimed at testing the feasibility and preliminary efficacy of a 5-week positive psychological intervention in individuals on hemodialysis with comorbid depression delivered using immersive virtual reality (VR) technology. OBJECTIVE: We aim to describe the protocol and design of the Joviality trial whose main objectives are 2-fold: determine the feasibility of the Joviality VR software through metrics capturing rates of recruitment, refusal, retention, noncompliance, and adherence, as well as end-user feedback; and assess preliminary efficacy for outcomes measures of depressive symptoms, psychological well-being and distress, quality of life, treatment adherence, clinical biomarkers, and all-cause hospitalizations. METHODS: This 2-arm RCT is scheduled to enroll 84 individuals on hemodialysis with comorbid depression from multiple outpatient centers in Chicago, Illinois, United States. Enrollees will be randomized to the following groups: VR-based Joviality positive psychological intervention or sham VR (2D wildlife footage and nature-based settings with inert music presented using a head-mounted display). To be eligible, individuals must be on hemodialysis for at least 3 months, have Beck Depression Inventory-II scores of ≥11 (ie, indicative of mild-to-severe depressive symptoms), be aged ≥21 years, and be fluent in English or Spanish. The Joviality VR software was built using agile design principles and incorporates fully immersive content, digital avatars, and multiplex features of interactability. Targeted skills of the intervention include noticing positive events, positive reappraisal, gratitude, acts of kindness, and mindful or nonjudgmental awareness. The primary outcomes include metrics of feasibility and acceptability, along with preliminary efficacy focused on decreasing symptoms of depression. The secondary and tertiary outcomes include quality of life, treatment adherence, clinical biomarkers, and all-cause hospitalization rates. There are 4 assessment time points: baseline, immediately after the intervention, 3 months after the intervention, and 6 months after the intervention. We hypothesize that depressive symptoms and hemodialysis-related markers of disease will substantially improve in participants randomized to the VR-based Joviality positive psychology treatment arm compared with those in the attention control condition. RESULTS: This RCT is funded by the National Institute of Diabetes and Digestive and Kidney Diseases and is scheduled to commence participant recruitment in June 2023. CONCLUSIONS: This trial will be the first to test custom-built VR software to deliver a positive psychological intervention, chairside, in individuals on hemodialysis to reduce symptoms of depression. Within the context of an RCT using an active control arm, if proven effective, VR technology may become a potent tool to deliver mental health programming in clinical populations during their outpatient treatment sessions. TRIAL REGISTRATION: ClinicalTrials.gov NCT05642364; https://clinicaltrials.gov/ct2/show/NCT05642364. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/45100.

Estimating the costs for implementing a maternity leave cash transfer program for women employed in the informal sector in Brazil and Ghana.

BACKGROUND: Maternity leave policies are designed to protect gender equality and the health of mothers in the workforce and their children. However, maternity leave schemes are often linked to jobs in the formal sector economy. In low- and middle-income countries a large share of women work in the informal sector, and are not eligible to such benefit. This is worrisome from a social justice and a policy perspective and suggests the need for intervening. Costing the implementation of potential interventions is needed for facilitating informed decisions by policy makers. METHODS: We developed and applied a costing methodology to assess the cost of a maternity leave cash transfer to be operated in the informal sector of the economy in Brazil and Ghana, two countries with very different employment structures and socioeconomic contexts. We conducted sensitivity analysis by modeling different numbers of weeks covered. RESULTS: In Brazil, the cost of the maternity cash transfer would be between 0.004% and 0.02% of the GDP, while in Ghana it would range between 0.076% and 0.28% of the GDP. The relative cost of rolling out a maternity intervention in Brazil is between 2.2 to 3.2 times the cost in Ghana depending on the benchmark used to assess the welfare measure. The differences in costs between countries was related to differences in labor market structure as well as demographic characteristics. CONCLUSIONS: Findings show how a standard methodology that relies on routinely available information is feasible and could assist policymakers in estimating the costs of supporting a maternity cash transfer for women employed in the informal sector, such intervention is expected to contribute to social justice, gender equity, and health trajectories.

The yearly financing need of providing paid maternity leave in the informal sector in Indonesia.

BACKGROUND: The economic cost of not breastfeeding in Indonesia is estimated at US$1.5-9.4 billion annually, the highest in South East Asia. Half of the 33.6 million working women of reproductive age (WRA) in Indonesia (15-49 years) are informal employees, meaning they are working as casual workers or they are self-employed (small scale business) and assisted by unpaid/family worker(s). No specific maternity protection entitlements are currently available for WRA working informally in Indonesia. This study aims to estimate the financing need of providing maternity leave cash transfer (MCT) for WRA working in the informal sector in Indonesia. METHOD: The costing methodology used is the adapted version of the World Bank methodology by Vilar-Compte et al, following pre-set steps to estimate costs using national secondary data. We used the 2018 Indonesian National Socio-Economic Survey to estimate the number of women working informally who gave birth within the last year. The population covered, potential cash transfer's unitary cost, the incremental coverage of the policy in terms of time and coverage, and the administrative costs were used to estimate the cost of MCT for the informal sector. RESULT: At 100% coverage for 13 weeks of leave, the yearly financing need of MCT ranged from US$175million (US$152/woman) to US$669million (US$583/woman). The share of the yearly financing need did not exceed 0.5% of Indonesian Gross Domestic Product (GDP). CONCLUSIONS: The yearly financing need of providing MCT for eligible WRA working in the informal sector is economically attractive as it amounts to less than 0.5% of GDP nominal of Indonesia. While such a program would be perceived as a marked increase from current public health spending at the onset, such an investment could substantially contribute to the success of breastfeeding and substantial corresponding public health savings given that more than half of working Indonesian WRA are employed in the informal sector. Such policies should be further explored while taking into consideration realistic budget constraints and implementation capacity.

Síndrome de seno cavernoso secundario a una tromboflebitis por Streptococcus intermedius complicada con vasculitis de la arteria carótida interna y abscesos cerebrales / Cavernous sinus syndrome secondary to thrombophlebitis due to Streptococcus intermedius complicated with vasculitis of the internal carotid artery and brain abscesses

Introducción: La tromboflebitis del seno cavernoso es una enfermedad infecciosa grave con alta mortalidad y morbilidad. Su diagnóstico suele ser tardío y requiere múltiples visitas a urgencias en la mayoría de casos, y el pronóstico es altamente dependiente de su rápido tratamiento. A pesar de su gravedad, la evidencia con respecto al tratamiento con corticoides y anticoagulación es escasa y controvertida. Entre sus complicaciones se encuentra la arteritis, la cual puede confundirse con una vasculitis de mediano-gran vaso, como en este caso. Caso clínico: Mujer de 26 años, que acude por una cefalea y un edema palpebral izquierdo. En las pruebas de imagen se evidencia trombosis del seno cavernoso izquierdo y una estrechez importante de la arteria carótida interna. Se interpreta el cuadro como secundario a un proceso vascular inflamatorio y se inician corticoides, con buena respuesta. Sin embargo, al poco tiempo se presenta fiebre y edema palpebral contralateral. En los hemocultivos se obtiene un crecimiento de Streptococcus intermedius y se diagnostica una tromboflebitis del seno cavernoso. A pesar del inicio de antibióticos y anticoagulación, sufre una hemiplejía derecha secundaria a la formación de abscesos frontotemporales. Se procede al drenaje quirúrgico y la paciente cursa con buena evolución. Ante la ausencia de otros focos infecciosos, y debido a la procedencia oral del germen, se realiza una exodoncia múltiple profiláctica. Conclusión: Se recomienda considerar la tromboflebitis como una opción diagnóstica tanto en las cefaleas con síntomas oculares como en la arteritis de mediano-gran vaso para su tratamiento oportuno

Introduction: Thrombophlebitis of the cavernous sinus is a severe infectious disease with high mortality and morbidity. It is usually diagnosed at a late stage and requires a number of visits to the emergency department in most cases, and the prognosis is highly dependent on prompt treatment. Despite its severity, evidence regarding treatment with corticosteroids and anticoagulation therapy is scarce and controversial. One of its complications is arteritis, which can be mistaken for medium to large vessel vasculitis, as in this case. Case Report: A 26-year-old female, who visited due to headache and left palpebral oedema. Imaging tests revealed thrombosis in the left cavernous sinus and significant narrowing of the internal carotid artery. The clinical picture was interpreted as secondary to an inflammatory vascular process and treatment with corticosteroids was initiated, with a good response. However, soon afterwards, fever and contralateral palpebral oedema developed. In the blood cultures a growth of Streptococcus intermedius was obtained and thrombophlebitis of the cavernous sinus was diagnosed. Despite initiating antibiotic and anticoagulation therapy, the patient suffered a right hemiplegia secondary to the formation of frontotemporal abscesses. Surgical drainage was performed and the patient progressed well. In the absence of other infectious foci, and due to the oral origin of the germ, a prophylactic multiple exodontia was performed. Conclusion: Thrombophlebitis should be considered as a diagnostic option both in headaches with ocular symptoms and in medium to large vessel arteritis so that they can be treated in a timely manner

Deciphering the effect of food availability, growth and host condition on disease susceptibility in a marine invertebrate.

Food provisioning influences disease risk and outcome in animal populations in two ways. On the one hand, unrestricted food supply improves the physiological condition of the host and lowers its susceptibility to infectious disease, reflecting a trade-off between immunity and other fitness-related functions. On the other hand, food scarcity limits the resources available to the pathogen and slows the growth and metabolism of the host on which the pathogen depends to proliferate. Here, we investigated how food availability, growth rate and energetic reserves drive the outcome of a viral disease affecting an ecologically relevant model host, the Pacific oyster, Crassostrea gigas We selected fast- and slow-growing animals, and we exposed them to high and low food rations. We evaluated their energetic reserves, challenged them with a pathogenic virus, monitored daily survival and developed a mortality risk model. Although high food levels and oyster growth were associated with a higher risk of mortality, energy reserves were associated with a lower risk. Food availability acts both as an enabling factor for mortality by increasing oyster growth and as a limiting factor by increasing their energy reserves. This study clarifies how food resources have an impact on susceptibility to disease and indicates how the host's physiological condition could mitigate epidemics. Practically, we suggest that growth should be optimized rather than maximized, considering that trade-offs occur with disease resistance or tolerance.

Faciolingual Hemiparesis with Mild Limb Weakness of Cortical Origin.

The clinical combination of unilateral facial and hypoglossal palsy with upper limb weakness is known as the capsular genu syndrome and responds most often to an ischemic infarct in the internal capsule. We here describe a patient with this peculiar combination, in whom the responsible lesion was located in the contralateral prefrontal cortex, involving the corresponding areas of the Penfield's homunculus. Contralateral cortical frontal lesions should be considered in patients with facial and hypoglossal palsy with upper limb weakness.

Proteomic signatures of the oyster metabolic response to herpesvirus OsHV-1 µVar infection.

Pacific oyster Crassostrea gigas were inoculated with OsHV-1 at low load (control) or high load (challenged) to better understand the pathogenesis of ostreid herpesvirus 1 (OsHV-1 µVar) and to determine which metabolic pathways might be affected during infection. Animals were sampled for proteomic analysis two days post-injection, at the same time as OsHV-1 initiated an intense replication phase in challenged oysters. Twenty-five abundant protein spots that showed a marked change in accumulated levels were identified using a two-dimensional electrophoresis (2-DE) proteomic approach. Overall, these proteins are involved in cytoskeleton organization, protein turnover, induction of stress signals, signalling pathways and energy metabolism. Challenged oysters exhibited an increased glycolysis and VDAC accumulation, which reflect a "Warburg effect" as initially reported in cancer cells and more recently in shrimp infected with virus. The results presented here should be useful for identifying potential biomarkers of disease resistance and developing antiviral measures. BIOLOGICAL SIGNIFICANCE: This study is the first 2-DE proteomic analysis dedicated to the pathogenesis of ostreid herpesvirus 1 (OsHV-1 µVar) in oyster Crassostrea gigas, the most important bivalve produced in the world. OsHV-1 has affected oysters every year since 2008. All the proteins identified in this paper are key targets involved in OsHV-1 infection processes. We presented evidence that the metabolic changes during infection in oyster somehow resemble the Warburg effect occurring in cancer cells. This work constitutes a real advance in the comprehension of the host metabolic pathways affected during OsHV-1 disease. Overall, this work contributes to a better understanding of disease mortalities in aquatic ecosystems which could guide management actions to mitigate their impacts.

Thermal dependence of clearance and metabolic rates in slow- and fast-growing spats of manila clam Ruditapes philippinarum.

Thermal dependence of clearance rate (CR: l h(-1)), standard (SMR: J h(-1)) and routine metabolic rates (RMR: J h(-1)), were analyzed in fast (F)- and slow (S)-growing juveniles of the clam Ruditapes philippinarum. Physiological rates were measured at the maintenance temperature (17 °C), and compared with measurements performed at 10 and 24 °C after 16 h and 14 days to analyze acute and acclimated responses, respectively. Metabolic rates (both RMR and SMR) differed significantly between F and S seeds, irrespective of temperature. Mass-specific CRs were not different for F and S seeds but were significantly higher in F clams for rates standardized according to allometric size-scaling rules. Acute thermal dependency of CR was equal for F and S clams: mean Q 10 were ≈3 and 2 in temperature ranges of 10-17 and 17-24 °C, respectively. CR did not change after 2 weeks of acclimation to temperatures. Acute thermal effects on SMR were similar in both groups (Q 10 ≈ 1 and 1.6 in temperature ranges of 10-17 and 17-24 °C, respectively). Large differences between groups were found in the acute thermal dependence of RMR: Q 10 in F clams (≈1.2 and 1.9 at temperature ranges of 10-17 and 17-24 °C, respectively) were similar to those found for SMR (Q 10 = 1.0 and 1.7). In contrast, RMR of S clams exhibited maximum thermal dependence (Q 10 = 3.1) at 10-17 °C and become depressed at higher temperatures (Q 10 = 0.9 at 17-24 °C). A recovery of RMR in S clams was recorded upon acclimation to 24 °C. Contrasting metabolic patterns between fast and slow growers are interpreted as a consequence of differential thermal sensitivity of the fraction of metabolism associated to food processing and assimilation.

Consumo de tabaco en la población derechohabiente del Instituto Mexicano del Seguro Social / Tobacco consumption among the active insured population of the Mexican Social Security Institute

Objetivo. Conocer la prevalencia derechohabiente usuaria del Instituto Mexicano del Seguro Social. Material y métodos. En un estudio transversal se entrevistó a la población usuaria de las 36 delegaciones, mediante un cuestionario estructurado y autoaplicable sobre el consumo de tabaco, edad de inicio, cantidad de cigarros y suspensión del consumo. Resultados. Se estudiaron 45 117 sujetos, en proporción similar por género. La prevalencia de fumadores fue del 40 por ciento en hombres, del 17.6 por ciento en mujeres y mayor en los estados del norte que en el resto del país. Existe un efecto de edad en el consumo de tabaco y más de la mitad de los fumadores iniciaron el hábito en la adolescencia. Conclusiones. La prevalencia de tabaquismo que se encontró es elevada, aunque el promedio de cigarros consumidos no es alto. No obstante, el índice de abandono es bajo. Se requieren medidas de intervención en salud pública para disminuir esta adicción