Insights and Recommendations From Two Urology-Based Educational Interventions: Development of a Urology Teaching Programme and Out-of-Hours Urology Handbook.

Exposure and education in urology for medical students (MSs) and junior doctors (JDs) have long been overlooked, resulting in inadequate preparedness for the management of urological cases/patients. This study addresses this deficiency through the implementation of a Urology Teaching Programme (UTP) and the creation of an Out-of-Hours Urology Handbook (OOHUH). The UTP was delivered virtually, targeting senior MSs and JDs, and covered common urological presentations and management pathways from a JD's perspective. The OOHUH aimed to enhance the care provided by general surgery senior house officers (SHOs) at Lister Hospital (Stevenage, UK), offering guidance for nine common urological conditions in emergency and out-of-hours settings. Both initiatives demonstrated significant improvements in knowledge and confidence in urology. The findings underscore the importance of supplementary urology education and suggest strategies for bridging training gaps in medical curricula and clinical practice. Recommendations include tailored induction programs and simulation days for junior doctors, along with the widespread adoption of such educational interventions to enhance patient care and trainee preparedness in urology.

Water, Sanitation, and Hygiene (WaSH) insecurity in unhoused communities of Los Angeles, California.

BACKGROUND: Access to water and sanitation is a basic human right; however, in many parts of the world, communities experience water, sanitation, and hygiene (WaSH) insecurity. While WaSH insecurity is prevalent in many low and middle-income countries, it is also a problem in high-income countries, like the United States, as is evident in vulnerable populations, including people experiencing homelessness. Limited knowledge exists about the coping strategies unhoused people use to access WaSH services. This study, therefore, examines WaSH access among unhoused communities in Los Angeles, California, a city with the second-highest count of unhoused people across the nation. METHODS: We conducted a cross-sectional study using a snowball sampling technique with 263 unhoused people living in Skid Row, Los Angeles. We calculated frequencies and used multivariable models to describe (1) how unhoused communities cope and gain access to WaSH services in different places, and (2) what individual-level factors contribute to unhoused people's ability to access WaSH services. RESULTS: Our findings reveal that access to WaSH services for unhoused communities in Los Angeles is most difficult at night. Reduced access to overnight sanitation resulted in 19% of the sample population using buckets inside their tents and 28% openly defecating in public spaces. Bottled water and public taps are the primary drinking water source, but 6% of the sample reported obtaining water from fire hydrants, and 50% of the population stores water for night use. Unhoused people also had limited access to water and soap for hand hygiene throughout the day, with 17% of the sample relying on hand sanitizer to clean their hands. Shower and laundry access were among the most limited services available, and reduced people's ability to maintain body hygiene practices and limited employment opportunities. Our regression models suggest that WaSH access is not homogenous among the unhoused. Community differences exist; the odds of having difficulty accessing sanitation services is two times greater for those living outside of Skid Row (Adj OR: 2.52; 95% CI: 1.08-6.37) and three times greater for people who have been unhoused for more than six years compared to people who have been unhoused for less than a year (Adj OR: 3.26; 95% CI: 1.36-8.07). CONCLUSION: Overall, this study suggests a need for more permanent, 24-h access to WaSH services for unhoused communities living in Skid Row, including toilets, drinking water, water and soap for hand hygiene, showers, and laundry services.

Acutely altered mental status as the main clinical presentation of multiple strokes in critically ill patients with COVID-19.

BACKGROUND AND AIMS: Cerebral infarction in COVID-19 patients might be associated with a hypercoagulable state related to a systemic inflammatory response. Its diagnosis might be challenging. We present two critically ill patients with COVID-19 who presented acutely altered mental status as the main manifestation of multiple strokes. METHODS: Clinical presentation and diagnostic work-up of the patients. RESULTS: Two patients in their sixties were hospitalized with a bilateral pneumonia COVID-19. They developed respiratory failure and were admitted to ICU for mechanical ventilation and intense medical treatment. They were started on low-molecular-weight heparin since admission. Their laboratory results showed lymphopenia and increased levels of C-reactive protein and D-dimer. Case 1 developed hypofibrinogenemia and presented several cutaneous lesions with biopsy features of thrombotic vasculopathy. Case 2 was performed a CT pulmonary angiogram at ICU showing a bilateral pulmonary embolism. When waking up, both patients were conscious but with a remarkable global altered mental status without focal neurological deficits. A brain MRI revealed multiple acute bilateral ischemic lesions with areas of hemorrhagic transformation in both patients (case 1: affecting the left frontal and temporal lobes and both occipital lobes; case 2: affecting both frontal and left occipital lobes). Cardioembolic source and acquired antiphospholipid syndrome were ruled out. COVID-19-associated coagulopathy was suspected as the possible main etiology of the strokes. CONCLUSION: Acutely altered mental status might be the main manifestation of multiple brain infarctions in critically ill COVID-19 patients. It should be specially considered in those with suspected COVID-19-associated coagulopathy. Full-dose anticoagulation and clinical-radiological monitoring might reduce their neurological consequences.

COVID-19 Outbreak: Infection Control and Management Protocol for Vascular and Interventional Radiology Departments-Consensus Document.

COVID-19 (SARS-CoV-2 virus) pandemic was recently declared by the WHO as a global health emergency. A group of interventional radiology senior experts developed a consensus document for infection control and management of patients with COVID-19 in interventional radiology (IR) departments. This consensus statement has been brought together at short notice with the help of different protocols developed by governmental entities and scientific societies to be adapted to the current reality and needs of IR Departments. Recommendations are the specific strategies to follow in IR departments, preventive measures and regulations, step by step for donning and doffing personal protective equipment, specific IR procedures which can not be delayed, and aerosol-generating procedures in IR with COVID-19 patients. It is advisable with this document to be adapted to local workplace policies.

Corticosterone mediated mate choice affects female mating reluctance and reproductive success.

The study of stress-related hormones as mediators of sexual selection has traditionally focused on the effect of glucocorticoids on male quality and competing ability. However, environmental stressors are expected to affect both males and females, and the strength of sexual selection might be affected by changes in female mating decisions, a hypothesis that has rarely been tested. Here, we investigated whether female common lizard (Zootoca vivipara) mating behaviour and mating preferences are affected by different levels of administered corticosterone and conditioned by the familiarity of their partners, which is known to influence Z. vivipara social behaviour. To this end, two females, one corticosterone-treated and one control female, were simultaneously presented with an unfamiliar male and the following day with either a familiar or an unfamiliar male. Females treated with corticosterone (Cort) were more aggressive towards males and mated less. Furthermore, copulation probability in Cort females, but not in control females, increased with body size. On the second day, Cort females only mated with familiar partners. In contrast, male behaviour towards females was not affected by treatment and only bigger males successfully copulated with Cort females. This shows that corticosterone directly affected female mating behaviour and mating preferences, while male mating behaviour was unaffected by the female's level of corticosterone. Environmental and social stressors may affect reproductive strategies of females, the strength of sexual selection, and sexual conflict through their effects on female glucocorticoid levels, potentially in a wide range of species.

Polysaccharide Coating of Gelatin Gels for Controlled BSA Release.

Self-assembly of natural polymers constitute a powerful route for the development of functional materials. In particular, layer-by-layer (LBL) assembly constitutes a versatile technique for the nanostructuration of biobased polymers into multilayer films. Gelatin has gained much attention for its abundance, biodegradability, and excellent gel-forming properties. However, gelatin gels melt at low temperature, thus limiting its practical application. With respect to the above considerations, here, we explored the potential application of gelatin gels as a matrix for protein delivery at physiological temperature. A model protein, bovine serum albumin (BSA), was encapsulated within gelatin gels and then coated with a different number of bilayers of alginate and chitosan (10, 25, 50) in order to modify the diffusion barrier. The coated gel samples were analyzed by means of Attenuated Total Reflectance-Fourier Transform Infrared (ATR-FTIR) and confocal Raman spectroscopy, and it was found that the multilayer coatings onto polymer film were interpenetrated to some extent within the gelatin. The obtained results inferred that the coating of gelatin gels with polysaccharide multilayer film increased the thermal stability of gelatin gels and modulated the BSA release. Finally, the influence of a number of bilayers onto the drug release mechanism was determined. The Ritger-Peppas model was found to be the most accurate to describe the diffusion mechanism.

Implementación de un sistema de hemovigilancia en el Hospital de Clínicas de Uruguay / Hemovigilance system implementation at the University Hospital of Uruguay

Introducción: la hemovigilancia es una herramienta para mejorar la calidad de la transfusión sanguínea, centrándose principalmente en la seguridad del paciente. Objetivo: identificar y conocer las características y la frecuencia de las reacciones adversas a la transfusión y desarrollar un sistema de hemovigilancia aplicable en nuestro hospital. Material y método: se realizó un estudio de tipo observacional, descriptivo, longitudinal y prospectivo, realizándose el seguimiento de todos los pacientes transfundidos con hemocomponentes en un Hospital Universitario durante 12 meses en un período de dos años (2014-2015). Se registraron las reacciones adversas a la transfusión, los incidentes y los casi incidentes. Resultados: se registraron en total 58 reacciones adversas a la transfusión, correspondiendo a una tasa de 8,3‰ hemocomponentes transfundidos. Conclusiones: el análisis detallado de las reacciones adversas reveló posibilidades de mejoramiento de los procedimientos y permitió la implementación de medidas correctivas y preventivas. El sistema de hemovigilancia utilizado es simple en su estructura y fácilmente aplicable.

Abstract Introduction: hemovigilance is a tool used to improve the quality of blood transfusion, and it mainly focuses on patients’ safety. Objective: to identify and learn about the characteristics and frequency of transfusion related negative effects and to devise a hemovigilance system to be applied in our hospital. Method: we conducted an observational, descriptive, longitudinal and prospective study, and all patients who received hemocomponents at the university hospital in a two year period (2014-2015) were followed up during 12 months. All reactions related to transfusion, adverse incidents and near misses were recorded. Results: 58 transfusion related adverse reactions were recorded, what represented 8,3‰ of the transfused hemocomponents. Conclusion: the detailed analysis of adverse reactions showed procedures to improve results may be adopted and allowed for the implementation of corrective and preventive measures. The hemovigilance system used is simple in terms of its structure and easy to apply.

Resumo Introdução: a hemovigilância é uma ferramenta para melhorar a qualidade da transfusão sanguínea e busca principalmente a segurança do paciente. Objetivo: identificar e conhecer as características e a frequência das reações adversas à transfusão e desenvolver um sistema de hemovigilância aplicável no nosso hospital. Material e método: foi realizado um estudo observacional, descritivo, longitudinal e prospectivo, com o seguimento de todos os pacientes transfundidos com hemocomponentes no Hospital Universitário durante 12 meses em um período de dois anos (2014-2015). As reações adversas à transfusão, os incidentes e os quase incidentes foram registrados. Resultados: foram registradas 58 reações adversas à transfusão, correspondendo a uma taxa de 8,3‰ hemocomponentes transfundidos. Conclusões: a análise detalhada das reações adversas mostrou possibilidades para o aperfeiçoamento dos procedimentos e permitiu implementar medidas corretivas e preventivas. O sistema de hemovigilância utilizado tem uma estrutura simples e é de fácil aplicação.

Modified bacterial cellulose scaffolds for localized doxorubicin release in human colorectal HT-29 cells.

Bacterial cellulose (BC) films modified by the in situ method with the addition of alginate (Alg) during the microbial cultivation of Gluconacetobacter hansenii under static conditions increased the loading of doxorubicin by at least three times. Biophysical analysis of BC-Alg films by scanning electron microscopy, thermogravimetry, X-ray diffraction and FTIR showed a highly homogeneous interpenetrated network scaffold without changes in the BC crystalline structure but with an increased amorphous phase. The main molecular interactions determined by FTIR between both biopolymers clearly suggest high compatibility. These results indicate that alginate plays a key role in the biophysical properties of the hybrid BC matrix. BC-Alg scaffold analysis by nitrogen adsorption isotherms revealed by the Brunauer-Emmett-Teller (BET) method an increase in surface area of about 84% and in pore volume of more than 200%. The Barrett-Joyner-Halenda (BJH) model also showed an increase of about 25% in the pore size compared to the BC film. Loading BC-Alg scaffolds with different amounts of doxorubicin decreased the cell viability of HT-29 human colorectal adenocarcinoma cell line compared to the free Dox from around 95-53% after 24h and from 63% to 37% after 48 h. Dox kinetic release from the BC-Alg nanocomposite displayed hyperbolic curves related to the different amounts of drug payload and was stable for at least 14 days. The results of the BC-Alg nanocomposites show a promissory potential for anticancer therapies of solid tumors.

Cumulative frequency-dependent selective episodes allow for rapid morph cycles and rock-paper-scissors dynamics in species with overlapping generations.

Rock-paper-scissors (RPS) dynamics, which maintain genetic polymorphisms over time through negative frequency-dependent (FD) selection, can evolve in short-lived species with no generational overlap, where they produce rapid morph frequency cycles. However, most species have overlapping generations and thus, rapid RPS dynamics are thought to require stronger FD selection, the existence of which yet needs to be proved. Here, we experimentally demonstrate that two cumulative selective episodes, FD sexual selection reinforced by FD selection on offspring survival, generate sufficiently strong selection to generate rapid morph frequency cycles in the European common lizard Zootoca vivipara, a multi-annual species with major generational overlap. These findings show that the conditions required for the evolution of RPS games are fulfilled by almost all species exhibiting genetic polymorphisms and suggest that RPS games may be responsible for the maintenance of genetic diversity in a wide range of species.

Mechanical properties of polyvinylalcohol/hydroxyapatite cryogel as potential artificial cartilage.

The technological advances in material science are not enough to overcome the challenge of construct a material be able to replace the cartilage. The designed material has to meet the mechanical properties of cartilage and has to be also capable to be integrated with the articulation. Articular cartilage damage is a persistent and increasing problem which affects millions of people worldwide. Poly vinyl alcohol (PVA) hydrogels are promising implants, due to their similar properties as soft tissue; however their low mechanical resistance and durability together with its lack to integrate with the surrounding tissue restrict their application in this area. The poor adhesion can be solved by the development a composite hydrogel with bioactive and biocompatible filler, as hydroxyapatite (HA). The aim of this work was to obtain and characterize (physically, chemically and mechanically) PVA/HA composite hydrogels for potential application as articular replacement. Hence, composite hydrogels were prepared by adding of different amounts of HA in an aqueous solution of PVA and subsequent freezing-thawing cycles. It was observed that the addition of HA modified the physical and chemical features of the hydrogel and promoted the material crosslinking and stability. Moreover, it was found that the mechanical properties (compression, tension and nanoindentation) of the hydrogels were improved by the addition of HA. All these result indicate that these materials could be used as a potential cartilage replacement. However, further in vitro and in vivo studies are mandatory for future possible clinical applications and are actually being carried out.

Poly(vinyl alcohol)/cellulose nanowhiskers nanocomposite hydrogels for potential wound dressings.

Polyvinyl alcohol (PVA)/cellulose nanowhisker (CNW) nanocomposite hydrogels to be used for wound dressing were obtained by freezing-thawing technique and characterized by means of morphological, physical, thermal, mechanical, barrier and antimicrobial properties. First, cellulose nanowhiskers were obtained by the acid hydrolysis of commercial crystalline microcellulose (MCC) and characterized by its size, shape, morphological, structural and thermal properties. Then, PVA/CNW nanocomposites with several CNW contents (0, 1, 3, 5 and 7wt.%) were obtained. Morphological, thermal, chemical and physical characterization of the PVA/CNW nanocomposite hydrogels was carried out. It was found that the addition of CNW to the hydrogel allows controlling the pore morphology of the samples. On the other hand, the transparency of the samples was maintained, the thermal stability was increased, the mechanical properties were improved and the water vapor transmission rate was in the range of wound dressing applications after CNW incorporation inside the PVA hydrogel matrix. The evaluation of microbial penetration showed that the prepared hydrogels can be considered as a good barrier against different microorganisms. All obtained results indicate that the PVA/CNW materials are promising to be used as wound dressing.

Development and characterization of Poly (vinyl alcohol) based hydrogels for potential use as an articular cartilage replacement.

Hydroxyapatite (HA) reinforced Poly(vinyl alcohol) (PVA) hydrogel composites has been proposed as a promising biomaterial to replace diseased or damaged articular cartilage. Here, PVA/in-situ produced HA hydrogels with 0, 3 and 7.5 wt.% of HA content were obtained by freezing/thawing technique. Thermal, structural and mechanical characterizations were carried out. SEM micrographs revealed that HA was homogeneously distributed in PVA until 3 wt.% whereas partial agglomeration was observed for higher contents (7.5 wt.%). No significant changes were observed in the glass transition temperature (the average value was near to 78 °C ± 3 °C), the melting point and structural water content whereas the gel fraction slightly increased (from 0.72 to 0.78) with the increase the content of HA. The absorbed water decreased (from 85.7% to 80.5%) as a function of HA content The stress-strain curves were really different in hydrated and non-hydrated conditions, changing from non-linear, in presence of water, to linear behavior in a dried state, being in the first case consistent with the articular cartilage . The lowest friction coefficient was obtained for samples with 3 wt. % HA (0.067 ± 0.049), which is, together with a high resistance (721 ± 25 kPa), an important property for materials that will be used as articular replacement. The results indicate that this hydrogel could be used, after other studies, as articular cartilage replacement.

Integrative analyses of speciation and divergence in Psammodromus hispanicus (Squamata: Lacertidae).

BACKGROUND: Genetic, phenotypic and ecological divergence within a lineage is the result of past and ongoing evolutionary processes, which lead ultimately to diversification and speciation. Integrative analyses allow linking diversification to geological, climatic, and ecological events, and thus disentangling the relative importance of different evolutionary drivers in generating and maintaining current species richness. RESULTS: Here, we use phylogenetic, phenotypic, geographic, and environmental data to investigate diversification in the Spanish sand racer (Psammodromus hispanicus). Phylogenetic, molecular clock dating, and phenotypic analyses show that P. hispanicus consists of three lineages. One lineage from Western Spain diverged 8.3 (2.9-14.7) Mya from the ancestor of Psammodromus hispanicus edwardsianus and P. hispanicus hispanicus Central lineage. The latter diverged 4.8 (1.5-8.7) Mya. Molecular clock dating, together with population genetic analyses, indicate that the three lineages experienced northward range expansions from southern Iberian refugia during Pleistocene glacial periods. Ecological niche modelling shows that suitable habitat of the Western lineage and P. h. edwardsianus overlap over vast areas, but that a barrier may hinder dispersal and genetic mixing of populations of both lineages. P. h. hispanicus Central lineage inhabits an ecological niche that overlaps marginally with the other two lineages. CONCLUSIONS: Our results provide evidence for divergence in allopatry and niche conservatism between the Western lineage and the ancestor of P. h. edwardsianus and P. h. hispanicus Central lineage, whereas they suggest that niche divergence is involved in the origin of the latter two lineages. Both processes were temporally separated and may be responsible for the here documented genetic and phenotypic diversity of P. hispanicus. The temporal pattern is in line with those proposed for other animal lineages. It suggests that geographic isolation and vicariance played an important role in the early diversification of the group, and that lineage diversification was further amplified through ecological divergence.