Adoption of digital twins as a sustainable energy solution: Determinants to adoption in household.

Digital Twin (DT) consists of a recent technology that can enable sustainability. However, Digital Twins are still in early stages of adoption, especially in households, and so the determinants to this adoption have not yet been determined. The aim of this study is to fill this research gap through providing a conceptual model of the drivers to the adoption of Digital Twins in households and it's relation to well-being. This study is developed as a mixed-methods research. The model is produced qualitatively, based on literature discoveries and key findings from interviews with experts and possible consumers. Afterwards, the model was validated with data collected through a questionnaire with 149 respondents. Results show that a set of informational, social, environmental and utility factors can influence the intention to adopt Digital Twins as a sustainable energy solution, and consequently the perceived well-being.

Perspectives of adult patients with mental health disorders on the relationship with nurses: a focus group study.

BACKGROUND: The relationship between the nurse and the patient with mental health disorder is crucial to the recovery process. Thus, patients with mental health disorders should be active subjects in this relationship by having autonomy and self-determination. METHODS: This study aimed to explore the perspectives of adult patients with mental health disorders on the relationship with nurses. A qualitative, descriptive, and exploratory study was conducted in March 2023, using focus group meetings in an association to support patients with severe mental health disorders in the Northern region of Portugal. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). A total of 8 patients participated in the study. Two focus group meetings were conducted. The inductive method was used, and content analysis of the transcripts was performed. The QDA Miner Lite 4.0 and Microsoft Excel were used for content analysis. RESULTS: Participants considered the relationship with nurses important for their recovery and expected nurses to provide support and help, being able to identify their needs, thus personalising their care. Attitudinal and communication aspects were also considered crucial for establishing a solid, trusting, and meaningful relationship. CONCLUSION: According to the findings nursing care is expected to focus on the patient, his/her preferences, expectations, and the uniqueness of each individual. The results of this study may be useful for the reflection and improvement of nurses in their relational and communication skills and the driving force for nursing students' awareness of the perspective of the relationship with patients with mental health disorder and its relevance.

Chronic treatment with D2-antagonist haloperidol leads to inhibitory/excitatory imbalance in striatal D1-neurons.

Striatal dysfunction has been implicated in the pathophysiology of schizophrenia, a disorder characterized by positive symptoms such as hallucinations and delusions. Haloperidol is a typical antipsychotic medication used in the treatment of schizophrenia that is known to antagonize dopamine D2 receptors, which are abundantly expressed in the striatum. However, haloperidol's delayed therapeutic effect also suggests a mechanism of action that may go beyond the acute blocking of D2 receptors. Here, we performed proteomic analysis of striatum brain tissue and found more than 400 proteins significantly altered after 30 days of chronic haloperidol treatment in mice, namely proteins involved in glutamatergic and GABAergic synaptic transmission. Cell-type specific electrophysiological recordings further revealed that haloperidol not only reduces the excitability of striatal medium spiny neurons expressing dopamine D2 receptors (D2-MSNs) but also affects D1-MSNs by increasing the ratio of inhibitory/excitatory synaptic transmission (I/E ratio) specifically onto D1-MSNs but not D2-MSNs. Therefore, we propose the slow remodeling of D1-MSNs as a mechanism mediating the delayed therapeutic effect of haloperidol over striatum circuits. Understanding how haloperidol exactly contributes to treating schizophrenia symptoms may help to improve therapeutic outcomes and elucidate the molecular underpinnings of this disorder.

Adapted Portuguese folk dance intervention for subacute rehabilitation post-stroke: study protocol.

Dance can be an innovative, well-accepted, and effective therapy for stroke survivors. The present protocol aims to assess the feasibility of adapted Portuguese folk dance as a post stroke rehabilitative activity. We will use a mixed-methods pilot study convenience sampling to recruit 16 stroke survivors with mild-moderate lower limb paresis from a rehabilitation center in Lisbon and Tagus Valley. In addition to usual care, participants will attend 3 days per week 1-h dance exercise for 8 weeks. The dance style used for this intervention will be an adaptation of the Portuguese folk dance. Assessment will be conducted before and immediately after the program intervention. Acceptability will be assessed by four key domains (enrollment, retention, satisfaction, and recommendation to others). Safety will be assessed based on the number and type of adverse events. Feasibility will be assessed based on balance performance and functional mobility. Quantitative data will be analyzed through descriptive statistics for sample characterization, followed by inferential statistics to evaluate differences in the balance recovery and functional mobility scores between the initial and final assessment. Qualitative data will be analyzed using an inductive process of content analysis. The Portuguese folk dance program has the potential to improve balance outcomes and functional mobility. Our results will help validate Portuguese folk dance as a tool for rehabilitation settings for stroke survivors. The potential of our program to enhance balance outcomes and functional mobility among stroke survivors bears implications for aging and public health initiatives. Positive results from this study could pave the way for integrating dance-based rehabilitative activities into standard stroke rehabilitation protocols, catering to older stroke survivors' specific needs and preferences.

Placebo-Controlled Trial of Daily Oral Cannabidiol as Adjunctive Treatment for Cats with Chronic Gingivostomatitis.

A placebo-controlled study evaluated the clinical efficacy and safety of a commercially available cannabidiol (CBD) oral formulation as an adjunctive treatment for pain management for feline chronic gingivostomatitis (FCGS). CBD was included in a multimodal treatment routinely performed on client-owned cats with FCGS that were submitted to dental extractions. Twenty-two cats were consecutively included in the study. The first group was treated using a fixed dosage of 4 mg per cat every 12 h for 15 consecutive days, and the second received a placebo of similar features. Treatments began 2 h before dental extractions. Pain and disease severity were assessed at days 0 and 15 using the Composite Oral Pain Scale (COPS-C/F) and the Stomatitis Disease Activity Index score (SDAI). Weight, vital and biochemistry parameters, and analgesic reinforcement needs were also registered at the same time points. In the treated cats, blood was collected after 4, 8, and 12 h to determine CBD serum concentrations using ultra-high-performance liquid chromatography-mass spectrometry (UHPLC-MS/MS). After data analysis using mixed models, a significant improvement in the SDAI scores of cats medicated with CBD was found. The protocol is safe since severe adverse effects and biochemical changes were not observed during the treatment period. This study suggests that the cats benefited from this treatment.

Construction and Validation of the Positive Mental Health Literacy Assessment Scale in Adults.

Low mental health literacy levels have a profound negative effect on healthcare outcomes, usage of healthcare services and healthcare expenditure. To date, there is little research and a lack of instruments available to address and assess positive mental health literacy levels in community-dwelling adults. Thus, this study sought to develop an instrument to assess positive mental health literacy in adults and to evaluate its psychometric properties. A scale developed in European Portuguese and composed of 32 items was designed to assess positive mental health literacy among community-dwelling adults and was validated using exploratory factor analysis. Five latent factors were identified (decision making, prosocial attitudes, perception of resources, community involvement, and problem solving), whose hypothesised structure was confirmed by confirmatory factor analysis using structural equation modelling. Evidence showed that the scale's factor structure is reliable and valid and adequately represents the theorised constructs. Thus, this may be a useful assessment tool for clinical practice since it will allow a more rigorous assessment of positive mental health literacy and better mental health promotion interventions in the population.

Transcultural adaptation and psychometric properties of the spanish version of the therapeutic relationship Assessment Scale-Nurse.

BACKGROUND: The nurse-patient therapeutic relationship is considered a pillar of mental health nursing, contributing to improved person-centered care and shared decision making with the patient. Given the importance of the nurse-patient therapeutic relationship, appropriate evaluation instruments are required to assess its quality. The aim of this study was to adapt and validate the Spanish version of the Therapeutic Relationship Assessment Scale-Nurse. METHODS: A translation and back-translation of the scale was carried out. To analyze the psychometric properties, the scale was administered to 213 nurses working in the field of mental health care. Temporal stability or test-retest was examined by means of the intraclass correlation coefficient (ICC) in a sample of 100 nurses. RESULTS: Confirmatory Factor Analysis revealed a four-factor structure identical to the original version, with some poor model fit indices. The ordinal alpha values for the total scale and the four factors were 0.939, 0.654, 0.798, 0.801, and 0.866, respectively. The intraclass correlation coefficient was 0.928 (95% CI: 0.893-0.952). CONCLUSIONS: The results show that the Spanish version of the Therapeutic Relationship Assessment Scale-Nurse is reliable for determining the quality of the therapeutic relationship that mental health nurses can establish with their patients. However, more studies are needed to analyse the model fit of the instrument's factor structure in the Spanish population.

Translation, cultural adaptation and evaluation of the psychometric properties of the Hamilton Anxiety Scale among a sample of Portuguese adult patients with mental health disorders.

BACKGROUND: Only a few anxiety assessment tools that nurses may administer are validated forthe Portuguese population exist in the literature. Thus, this study aimed to translate and culturally adapt the Hamilton Anxiety Scale for the Portuguese population and assess its psychometric properties in a sample of adult people with mental health disorders. METHODS: This psychometric study uses a convenience sample of adult patients with mental health disorders. RESULTS: The confirmatory factor analysis confirmed the two factors of the original version of the tool. The internal consistency (Cronbach's alpha) was high, at .92, as well as the inter-rater reliability (intraclass correlation coefficient) (.91). CONCLUSIONS: The validity and reliability of the instrument are supported. However, the Hamilton Anxiety Scale should be used cautiously in the Portuguese population because the correlation with the "Anxiety State" subscale of the State-Trait Anxiety Inventory is not statistically significant.

Dynamics of Humoral Immunity to Myxoma and Rabbit Hemorrhagic Disease Viruses in Wild European Rabbits Assessed by Longitudinal Semiquantitative Serology.

Myxoma virus (MYXV) and rabbit hemorrhagic disease virus (RHDV) are important drivers of the population decline of the European rabbit, an endangered keystone species. Both viruses elicit strong immune responses, but the long-term dynamics of humoral immunity are imperfectly known. This study aimed to assess the determinants of the long-term dynamics of antibodies to each virus based on a longitudinal capture-mark-recapture of wild European rabbits and semiquantitative serological data of MYXV and RHDV GI.2-specific IgG. The study included 611 indirect enzyme-linked immunosorbent assay (iELISA) normalized absorbance ratios for each MYXV and RHDV GI.2 from 505 rabbits from 2018 to 2022. Normalized absorbance ratios were analyzed using log-linear mixed models, showing a significant positive relationship with the time since the first capture of individual rabbits, with monthly increases of 4.1% for antibodies against MYXV and 2.0% against RHDV GI.2. Individual serological histories showed fluctuations over time, suggesting that reinfections boosted the immune response and likely resulted in lifelong immunity. Normalized absorbance ratios significantly increased with the seroprevalence in the population, probably because of recent outbreaks, and with body weight, highlighting the role of MYXV and RHDV GI.2 in determining survival to adulthood. Juvenile rabbits seropositive for both viruses were found, and the dynamics of RHDV GI.2 normalized absorbance ratios suggest the presence of maternal immunity up to 2 months of age. Semiquantitative longitudinal serological data provide epidemiological information, otherwise lost when considering only qualitative data, and support a lifelong acquired humoral immunity to RHDV GI.2 and MYXV upon natural infection. IMPORTANCE This study addresses the long-term dynamics of humoral immunity to two major viral pathogens of the European rabbit, an endangered keystone species of major ecological relevance. Such studies are particularly challenging in free-ranging species, and a combination of longitudinal capture-mark-recapture and semiquantitative serology was used to address this question. Over 600 normalized absorbance ratios of iELISA, obtained from 505 individual rabbits in 7 populations over 5 years, were analyzed using linear mixed models. The results support a lifelong acquired humoral immunity to myxoma virus and rabbit hemorrhagic disease virus upon natural infection and suggest the presence of maternal immunity to the latter in wild juvenile rabbits. These results contribute to understanding the epidemiology of two viral diseases threatening this keystone species and assist in developing conservation programs.

Epidemiological characteristics of bovine besnoitiosis (Besnoitia besnoiti) in a beef cattle farm: a cross-sectional serological assessment.

Background: Bovine besnoitiosis is an emerging disease caused by the protozoa Besnoitia besnoiti that can have a serious economic impact on affected farms. The fact that there is no effective vaccine nor treatment, along with the lack of consistent epidemiologic data, renders the implementation of preventive medicine and control strategies much harder. Objectives: A cross-sectional serological assessment was performed to better understand the distribution and prevalence of this parasite in a large beef cattle farm in Portugal and to establish some epidemiological characteristics of besnoitiosis. Methods: A random blood sampling of 450 animals from a farm that keeps around 2,000 cattle head was performed and sera were submitted to an indirect immunofluorescent antibody test (IFAT). Data on breed, age, sex, and birthplace of the tested animals and their mothers were recorded. Results: The overall prevalence of positive animals was 16.89%, with significant differences between under 1-year-old calves (4.8%) and adults (19.67%). A higher antibody prevalence was shown in animals 1-2 years and >7 years old, in Salers breed and in cows imported from France or whose mothers had come from this country. Calves under 1 year old and crossbreed animals with ancestry born in the current farm presented the lowest antibody prevalence. Discussion and conclusions: The most significant risk factors revealed were age (>7 years old) and breed (Salers). Genetic studies should be carried out in order to confirm whether indeed there is a breed susceptibility to bovine besnoitiosis. We suggest that similar studies should be performed across southern Europe to establish strong epidemiologic data that would allow a rigorous transnational control program to be launched.

CURB-65 and Long-Term Mortality of Community-Acquired Pneumonia: A Retrospective Study on Hospitalized Patients.

Background Community-acquired pneumonia remains a significant factor in global mortality. Several clinical scoring models are used for predicting pneumonia severity and mortality, aiding in the clinical decision relative to the therapeutic approach, including the CURB-65 score. However, currently, no models exist to identify high-risk patients relative to long-term prognosis when recent evidence reveals a significantly higher mortality rate in the first year after community-acquired pneumonia (CAP) hospitalization. Purpose of the study The purpose of this study is to evaluate the application of the CURB-65 scoring model in our population and examine its potential to predict prognosis and subsequent mortality 6 months after hospitalization. Other potential factors influencing mortality during and after hospitalization were characterized: patient demographics, nosocomial infections, readmissions, and identified pathogens. Study design We conducted a retrospective observational study, enrolling 130 patients admitted with a diagnosis of CAP in the department of internal medicine of Centro Hospitalar Universitário Cova da Beira between January and December of 2018. Consultation of electronic medical records was used to calculate the CURB-65 score on admission at the first hospitalization by CAP, categorizing patients into five risk groups. Mortality and readmission were evaluated after 30, 90, and 180 days. Key results High-risk patients (CURB>2) accounted for 96.9% of our study population. Inpatient mortality of 13%, increasing to 21.5% after six months, was similar to previous studies and was correlated to the CURB-65 score on admission. A microbiologic agent was identified in 37% of cases, with 53% isolates of Streptococcus (S.) pneumoniae. Conclusions Identifying high-risk patients is important for more individualized healthcare and management. The CURB-65 score, only validated for a short-term (30 days) prediction, demonstrates a potential to also predict mortality and rehospitalization in the six-month period after hospitalization, as supported by our findings and previous studies.

Translation, Adaptation and Assessment of the Psychometric Properties of the Mental Health Knowledge Questionnaire in a Sample of Higher Education Students in Portugal.

A significant part of the worldwide population is affected by some mental disorder. Previous research conducted with the general population has revealed poor knowledge when it comes to mental health. Therefore, it is imperative to assess mental health literacy using robust assessment tools. Thus, this study aimed to translate, adapt and assess the psychometric properties of the Mental Health Knowledge Questionnaire in a sample of higher education students in Portugal. This study used a sample consisting of 2887 participants. Internal consistency for the psychometric study was estimated using Cronbach's alpha coefficient. Construct validity was tested using exploratory and confirmatory factor analysis, convergent validity, and discriminant validity. After data analysis, the final Portuguese version of the Mental Health Knowledge Questionnaire was composed of 14 items. The goodness-of-fit indices were adequate, confirming the quality of the model's fit to the empirical data (χ²/df = 2.459, GFI = 0.983, CFI = 0.969, RMSEA = 0.032, RMR = 0.023, SRMR = 0.032). This assessment tool is valid and reliable to assess higher education students' mental health literacy in Portugal. Analyses to confirm the scale's external validity, measurement equivalence and replicability are still required.

Age-dependent NMDA receptor function is regulated by the amyloid precursor protein.

N-methyl-D-aspartate receptors (NMDARs) are critical for the maturation and plasticity of glutamatergic synapses. In the hippocampus, NMDARs mainly contain GluN2A and/or GluN2B regulatory subunits. The amyloid precursor protein (APP) has emerged as a putative regulator of NMDARs, but the impact of this interaction to their function is largely unknown. By combining patch-clamp electrophysiology and molecular approaches, we unravel a dual mechanism by which APP controls GluN2B-NMDARs, depending on the life stage. We show that APP is highly abundant specifically at the postnatal postsynapse. It interacts with GluN2B-NMDARs, controlling its synaptic content and mediated currents, both in infant mice and primary neuronal cultures. Upon aging, the APP amyloidogenic-derived C-terminal fragments, rather than APP full-length, contribute to aberrant GluN2B-NMDAR currents. Accordingly, we found that the APP processing is increased upon aging, both in mice and human brain. Interfering with stability or production of the APP intracellular domain normalized the GluN2B-NMDARs currents. While the first mechanism might be essential for synaptic maturation during development, the latter could contribute to age-related synaptic impairments.

Patient Safety Training Programs for Health Care Professionals: A Scoping Review.

OBJECTIVE: This study aimed to map the evidence available on patient safety training programs for health professionals. METHODS: A scoping review was carried out. Several studies published between January 2010 and March 2020 in the following databases were investigated: CINAHL; MEDLINE; Nursing & Allied Health Collection: Comprehensive; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane; MedicLatina , via EBSCOhost; World Health Organization; Google Scholar; BVS- Biblioteca Virtual da Saúde ; PubMed; B-On; and RCAAP- Repositórios Científicos de Acesso Aberto de Portugal . RESULTS: A total of 2841 articles were found, 7 were included. Most studies report that the development of patient safety programs for health care professionals provides them with tools and techniques to recognize adverse incidents induced by the professional system/practice; recognize human factors related to patient safety, such as nontechnical skills or tiredness; understand high-risk clinical processes; develop strategies that influence and enhance patient safety culture; promote communication, teamwork, and organizational culture concerning patient safety; analyze other characteristic and emerging topics in patient safety; and develop project proposals to improve patient safety, allowing health care professionals to consolidate their knowledge, leading initiatives to improve patient safety. CONCLUSIONS: There are still few studies that test patient safety training programs, which is a concern given the importance of implementing safe practices. The existing evidence proves the efficacy of the training programs in improving patient safety, although there are some gaps.

Hypovolemic shock due to rectus sheath hematoma secondary to subcutaneous low molecular weight heparin: a case report.

Rectus sheath hematoma (RSH) is a rare clinical entity caused by the rupture of the epigastric arteries or the rectus abdominal muscle itself, leading to the accumulation of blood in this location. It is a potentially fatal condition that mimics an acute belly condition. It is crucial to identify and treat it early to avoid unfavourable outcomes. We present the case of an 85-year-old woman hospitalized for pneumonia and respiratory failure who developed refractory hypovolemic shock associated with an abdominal mass. Computed tomography with angiography was performed, which detected the presence of a large hematoma of the wall of both rectus abdominal. (www.actabiomedica.it).

Protective and Vulnerability Factors of Municipal Workers' Mental Health: A Cross-Sectional Study.

Work is fundamental to an individual's mental health; however, an unfavourable work environment can lead to mental health problems. Despite existing studies addressing workers' mental health, it is essential to understand the reality of specific contexts to design effective tailored interventions. Thus, this study aimed to examine the influence of potential protective and vulnerability factors on municipal workers' depressive symptoms, anxiety and stress levels, and burnout. A cross-sectional study was conducted with data collection performed between July and December 2021 using online self-report measures. The sample comprised 115 municipal workers. The findings revealed that psychological vulnerability is a significant vulnerability factor for the presence of mental health symptoms. In addition, job satisfaction was found to be a significant protective factor for depressive symptoms, anxiety, and burnout of the municipal workers. The results of this study enhance the understanding of factors that influence worker mental health, which may facilitate the proper planning of specific interventions to promote mental health in the workplace.

Inherited myopathies in patients from Sub-Saharan Africa: Results from a retrospective cohort.

The clinical epidemiology of inherited myopathies in sub-Saharan Africa (SSA) is unknown but likely underdiagnosed due to problems of scientific research and social issues. We report a case series of patients born in SSA, evacuated to Portugal through an international health protocol and seen at a single neuromuscular disorders centre, between January/2004 and August/2021. We identified 9 patients (5 males), 35.6 ± 19.3 years-old (10-64), from Cape Verde (n = 4), Angola (n = 2), Sao Tome and Principe (n = 2) and Guinea-Bissau (n = 1), with a delay in diagnosis of 19.7 ± 14.3 years. Seven patients (77.8 %) had positive family history. Most patients had significant morbidity, requiring wheelchair (55.6 %), and nocturnal non-invasive ventilation (55.6 %). The diagnosis included Bethlem myopathy (n = 2), Duchenne muscular dystrophy (n = 2), Emery-Dreifuss muscular dystrophy (n = 1), LGMDR1 (n = 2), LGMDR2 (n = 1), and type-1 myotonic dystrophy (n = 1). Genetic testing was remarkable for 3 mutations previously not described. Despite the small sample, the spectrum of hereditary myopathies in our cohort is like western studies. Further studies are needed to better understand the epidemiology of muscle diseases in SSA.

Barriers to Gait Training among Stroke Survivors: An Integrative Review.

Gait recovery is vital for stroke survivors' ability to perform their activities associated with daily living. Consequently, a gait impairment is a significant target for stroke survivors' physical rehabilitation. This review aims to identify barriers to gait training among stroke survivors. An integrative review was conducted following Whittemore and Knafl's methodology. The research was carried out on the electronic databases Scopus, PubMed, and B-on, applying a time span of 2006 to 2022. A total of 4189 articles were initially identified. After selecting and analyzing the articles, twelve studies were included in the sample. This review allowed for the identification of several barriers to gait training among stroke survivors, which can be grouped into three categories: individual, environmental, and rehabilitation workforce-related barriers. These findings highlight that participation in gait training is not solely dependent on the stroke survivor. Instead, the uptake of rehabilitation programs may also depend on environmental and rehabilitation workforce-related factors.

Immunopathology and Trypanosoma congolense parasite sequestration cause acute cerebral trypanosomiasis.

Trypanosoma congolense causes a syndrome of variable severity in animals in Africa. Cerebral trypanosomiasis is a severe form, but the mechanism underlying this severity remains unknown. We developed a mouse model of acute cerebral trypanosomiasis and characterized the cellular, behavioral, and physiological consequences of this infection. We show large parasite sequestration in the brain vasculature for long periods of time (up to 8 hr) and extensive neuropathology that associate with ICAM1-mediated recruitment and accumulation of T cells in the brain parenchyma. Antibody-mediated ICAM1 blocking and lymphocyte absence reduce parasite sequestration in the brain and prevent the onset of cerebral trypanosomiasis. Here, we establish a mouse model of acute cerebral trypanosomiasis and we propose a mechanism whereby parasite sequestration, host ICAM1, and CD4+ T cells play a pivotal role.