Missed opportunities in the prevention and diagnosis of pediatric tuberculosis: a scoping review

Abstract Objectives: Identify potential barriers, delays, and missed opportunities in the prevention and diagnosis of childhood TB. Methods: Scoping review according to the PRISMA extension. The definitions considered for the selection followed the acronym PCC where the population (P) is children under 18years of age with TB disease, the concept (C) refers to missed opportunities for prevention and diagnosis, and context (C) is defined as a diagnosis of TB disease. The authors searched systematically in the databases; VHL/Lilacs, Medline via PubMed, Cochrane, Scopus, and Web of Science, without date or language limitation. Results: Seven studies were included. In developed countries, with low disease burden, the main shortcoming is the delay in diagnosing bacilliferous adults in contact with young children. This problem is concentrated in the portion of the population with socioeconomic vulnerability. In underdeveloped countries, with a high burden of disease, the biggest challenge is tracking children who come into contact with bacilliferous patients. Conclusions: There are still many missed opportunities in the prevention and diagnosis of childhood TB. The positive legacy of the COVID-19 pandemic should be taken advantage of and the encouragement of scientific development in the management of infectious diseases should be taken.

Perceptions of the Future and Health Behavior in Adulthood.

Engagement in healthier lifestyle behaviors often is motivated by a focus on the future. However, there is limited research on the associations between health behavior and future time perspective, defined as people's tendency to perceive their future as expansive or as limited. Data came from a survey of U.S. adults (N = 805, 49.3% female; M = 50 years, range: 19 to 85 years). Participants completed measures of perceptions of future opportunities and time and health behavior. Opportunities and time factors were uniquely associated with health behavior. While the perceived opportunities factor was strongly associated with better health behavior, the time factor was associated with poorer health behavior. However, this latter association was dependent on individual demographic and health status differences. These findings suggest that perceptions of future opportunities can play an important role in health behavior engagement and thus represent an important target for health promotion.

Missed Opportunities: A Narrative Review on Why Nonoccupational Postexposure Prophylaxis for HIV Is Underutilized.

Postexposure prophylaxis (PEP) is an important tool for preventing HIV infection but remains underutilized. In this narrative review, we aim to summarize the frequency of missed opportunities for prescribing PEP among studies from around the world, discuss the complexities of the challenges facing PEP provision, and describe possible solutions. We identified 20 studies published in the last 10 years among 43 832 individuals, of whom an estimated 41 477 were eligible for PEP. Of those eligible for PEP, PEP was prescribed among 27 705 (66.8%). There was a significant difference in PEP prescriptions in acute compared with non-acute care settings (63.5% vs 94.5%; P < .001). Emergent themes contributing to PEP underutilization included lack of provider and patient awareness, reduced PEP acceptability, HIV stigma and homophobia, lack of access (either to care or to medication), and stigmatizing policies. Each of those issues should be the focus of future PEP implementation efforts.

Meeting proceedings of the 43rd Indian Association for Cancer Research (IACR).

The 43rd Annual Conference of the Indian Association of Cancer Research (IACR) was held between 19th and 22nd January 2024 at the Indian Institute of Education and Research (IISER), Pune, India. Cancer is the second leading cause of death globally; efforts have been made to understand and treat this deadly disease for several decades. The 43rd IACR, organised by Mayurika Lahiri, Kundan Sengupta, Nagaraj Balasubramanian, Mridula Nambiar, Krishanpal Karmodiya, and Siddhesh Kamat, highlighted recent advances in cancer research, with implications in therapeutics at the forefront of the discussions. The meeting proved to be a promising platform for cancer researchers ranging from graduate and postdoctoral students to subject experts in varied aspects of cancer biology to showcase their research, ideate with their peers, and form collaborations.

Exploring the barriers, facilitators, and opportunities to enhance uptake of sexual and reproductive health, HIV and GBV services among adolescent girls and young women in Zambia: a qualitative study.

INTRODUCTION: Adolescents and young women in low-middle-income countries face obstacles to accessing HIV, Sexual and Reproductive Health (SRH), and related Gender-Based Violence (GBV) services. This paper presents facilitators, opportunities, and barriers to enhance uptake of HIV, GBV, and SRH services among Adolescent Girls and Young Women (AGYW) in selected districts in Zambia. METHODS: This study was conducted in Chongwe, Mazabuka, and Mongu Districts among adolescent girls and young women in Zambia. Key informants (n = 29) and in and out-of-school adolescents and young people (n = 25) were interviewed. Purposive sampling was used to select and recruit the study participants. Interviews were transcribed verbatim, and a content analysis approach was used for analysis. RESULTS: The facilitators that were used to enhance the uptake of services included having access to health education information on comprehensive adolescent HIV and gender-based violence services. Non-governmental organisations (NGOs) were the main source of this information. The opportunities bordered on the availability of integrated approaches to service delivery and strengthened community and health center linkages with referrals for specialised services. However, the researchers noted some barriers at individual, community, and health system levels. Refusal or delay to seek the services, fear of side effects associated with contraceptives, and long distance to the health facility affected the uptake of services. Social stigma and cultural beliefs also influenced the understanding and use of the available services in the community. Health systems barriers were; inadequate infrastructure, low staffing levels, limited capacity of staff to provide all the services, age and gender of providers, and lack of commodities and specialised services. CONCLUSION: The researchers acknowledge facilitators and opportunities that enhance the uptake of HIV, GBV, and SRH services. However, failure to address barriers at the individual and health systems level always negatively impacts the uptake of known and effective interventions. They propose that programme managers exploit the identified opportunities to enhance uptake of these services for the young population.

Impact of Large Language Models on Medical Education and Teaching Adaptations.

Unlabelled: This viewpoint article explores the transformative role of large language models (LLMs) in the field of medical education, highlighting their potential to enhance teaching quality, promote personalized learning paths, strengthen clinical skills training, optimize teaching assessment processes, boost the efficiency of medical research, and support continuing medical education. However, the use of LLMs entails certain challenges, such as questions regarding the accuracy of information, the risk of overreliance on technology, a lack of emotional recognition capabilities, and concerns related to ethics, privacy, and data security. This article emphasizes that to maximize the potential of LLMs and overcome these challenges, educators must exhibit leadership in medical education, adjust their teaching strategies flexibly, cultivate students' critical thinking, and emphasize the importance of practical experience, thus ensuring that students can use LLMs correctly and effectively. By adopting such a comprehensive and balanced approach, educators can train health care professionals who are proficient in the use of advanced technologies and who exhibit solid professional ethics and practical skills, thus laying a strong foundation for these professionals to overcome future challenges in the health care sector.

Rural unpaid caregivers' experiences in northern Aotearoa, New Zealand during the Covid-19 pandemic: A qualitative study.

OBJECTIVE: Rural unpaid caregivers experience different opportunities and challenges than their urban counterparts. Our aim was to understand rural unpaid caregivers' experiences of challenges and opportunities during the Covid-19 pandemic in New Zealand. SETTING: Rural northern New Zealand during the Covid-19 pandemic. PARTICIPANTS: A convenience sample of 10 unpaid rural caregivers, most supporting an older person living with dementia. DESIGN: A qualitative descriptive design. Data included interviews and online workshops, and a thematic analysis. RESULTS: Rural unpaid caregivers observed that some aspects of living in a rural context were helpful during the Covid-19 pandemic. However, tasks such as shopping and long-distance travel and communication (both telephonic and digital) became more complex. Abrupt changes to routine and closure of resources and support groups created challenges. Unpaid caregivers worried about what would happen if they were hospitalised themselves. There was a diversity of experience both across caregivers, of familiar routines and rural context as resources, increased challenges requiring resourcefulness to adapt, and experiences of crisis. Many experienced all three states at different times. CONCLUSION: This research provides valuable insights into challenges and opportunities experienced by rural unpaid caregivers during the Covid-19 pandemic and may help policy-makers and healthcare professionals develop improved emergency preparedness. Multilevel, multisector responses are needed to ensure effective health and social support and access to resources including health care, access to groceries and medication, transport, and communications (telephone and digital). Enhancing rural access to effective and inexpensive online services is particularly important, as is recognition of the value of rural sites or hubs of connection and social interaction.

Oncology nursing in the Eastern Mediterranean Region: listening to the workforce.

BACKGROUND: Over half the countries in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) are experiencing conflict or are socially fragile, compromising cancer care. Nonetheless, throughout the EMR, competent nurses are major players in the cancer care team. The aim of this paper is to portray the challenges and opportunities for oncology nursing in the EMR. METHODS: This paper draws upon the relevant literature on oncology nursing across EMR with a focus on Afghanistan, Lebanon, Somaliland, and Iran. To enhance the scant nursing literature and obtain real-life experiences, short interviews were undertaken with nine nurses and two doctors, personal contacts of the authors, working in cancer care in those countries. RESULTS: Against the general background of vast economic constraints in health services, the lack of recognition of oncology nursing as a speciality and high rates of nurse migration, many oncology nurses in EMR are fighting for professional recognition and some are working under unsafe conditions. Undeterred by these circumstances, nurses are making every effort to care compassionately for people with cancer. CONCLUSIONS: The perspectives of the cancer workforce in EMR both foster an appreciation of cultural diversity and provide the evidence and motivation for oncology nurses worldwide to further collaborate via global nursing organisations to strive for country-specific recognition and change in nursing practice.

Empowering Voices: Cultivating a Supportive Network From the Women in Medicine and Health Care Symposium.

Description There are many studies, some discussed in this article, that recognize the numerous issues faced by women in medicine and the health care field. In response to the prevalence of these challenges, Riverside Community Hospital's General Medical Education department organized the second Women in Medicine & Healthcare Symposium on November 17, 2023. The symposium featured a panel of women leaders addressing challenges, such as work-life balance, maternity leave, fertility concerns, and family planning. Personal stories and studies on gender bias and infertility shed light on the shared experiences of women physicians. The positive response prompted Riverside Community Hospital to view the event as the first step in creating a supportive community.

Linking nursing students' professional identity, clinical learning environment, financial incentives, and career opportunities with migration intent: Structural equation modeling.

AIMS: To investigate how nursing students' professional identity, clinical learning environment, financial incentives, and career opportunities influence their intention to migrate. BACKGROUND: There is a preponderance of studies about nurse migration and its impact on the global nursing workforce. However, a critical gap remains about nursing students' intentions to migrate, particularly among developing countries like the Philippines. METHODS: Using a cross-sectional design, third- and fourth-year nursing students (n = 316) from the largest comprehensive university in Manila were conveniently recruited. Data were collected from November to December 2023 using five validated self-report scales. Descriptive (e.g., mean, standard deviation) and inferential statistics (e.g., Spearman rho, covariance-based structural equation modeling) were used to analyze data. RESULTS: The emerging model demonstrated acceptable model fit indices. Nursing students' professional identity (ß = 0.18, p = 0.043) and financial incentives (ß = 0.10, p = 0.046) significantly and positively influence the intention to migrate. The satisfaction with future career opportunities (ß = -0.12, p = 0.038) and clinical learning environment perception (ß = -0.15, p = 0.048) negatively influence the intention to migrate. These four predictors accounted for 4.60% of the total variance of intention to migrate. CONCLUSION: Nursing students' professional identity and financial incentives directly impact intent to migrate, whereas future career opportunities satisfaction and clinical learning environment inversely affect intent to migrate. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: This study underscores the imperative for nursing colleges and faculty to promote positive professional identity and provide a conducive clinical learning environment to develop sustainable nurses' migration policies.

Factors of engagement in research after graduation from EP fellowship: An HRS survey.

BACKGROUND: The declining number of electrophysiologists pursuing academic research careers could have a negative impact on innovation for patients with heart rhythm disorders in the coming decades. OBJECTIVE: The objective of this study was to explore determinants of research engagement after graduation from electrophysiology (EP) fellowship programs and to evaluate associated barriers and opportunities. METHODS: A mixed methods survey of EP fellows and early-career electrophysiologists was conducted, drawing from Heart Rhythm Society members. The survey encompassed 20 questions on demographics, research involvement, perceived research barriers, and perspectives on research time and opportunities. Responses were analyzed with robust Poisson regression. RESULTS: Of 259 respondents, those with dedicated research blocks during their fellowship had a significantly higher interest in future research (relative risk, 1.15; P = .04). The number of peer-reviewed publications modestly influenced interest in continued research (relative risk, 1.0034 per publication; P < .0001), but there was no relationship to gender or race. Educational resources, networking opportunities, mentorship, funding, and protected time to enhance research engagement were important themes in the qualitative analysis, whereas key barriers to post-fellowship research were lack of mentorship, insufficient resources, and time constraints, in that order, particularly with respect to women in research. Notably, no significant differences in barriers were observed between community training programs and academic centers. CONCLUSION: Research experience and mentorship during EP fellowship were key determinants of subsequent research success after training, with similar findings by sex and race. These findings explain how fellowship training influences a physician's research practice after training and highlights opportunities to modify EP fellowships and to augment research retention.

[Mobility of older people in public spaces from a gender perspective]. / Mobilität älterer Menschen im öffentlichen Raum unter Gendergesichtspunkten.

For older people, a sufficient mobility offer is an essential prerequisite for participation in social life and a better quality of life. The goal should be self-determined everyday mobility that enables a satisfying and healthy life. Mobility depends on diverse individual abilities and needs. On the other hand, social structures as well as regulatory and spatial framework conditions limit the realisation of mobility services and their transport infrastructure. These framework conditions are characterised by the perception of social roles, the availability of resources and gender-specific attributions. For example, care and caring work is predominantly the responsibility of women in the age group of 50 years plus. The availability of transport infrastructure is geared towards goals that are characterised by the needs of gainful employment and not the goals of care work. Conversely, the availability of flexible means of transport, such as cars, also decreases for women in old age for economic reasons. For this reason, mobility planning should take greater account of specific needs, such as orientation towards care objectives, counselling, and health services and place a greater focus on the local area. For elderly people, especially women, security needs are often an important factor in the decision to become mobile or to forego mobility. This includes perceived subjective safety, accessibility and protection from weather conditions such as slippery surfaces or exposure to excessive heat. If these basic principles are taken into account, more people can be guaranteed self-determined participation in social life.

Investigation of the diversity, equity, inclusion, and belonging within the undergraduate student population within the Department of Animal Science at Iowa State University.

Iowa State University (ISU) provides resources for diversity, equity, inclusion, and belonging (DEI-B) to provide students with a comfortable academic home regardless of their demographics or prior experiences. The objective of this study was to investigate undergraduate students' DEI-B perspectives in the Department of Animal Science at ISU. One survey instrument was developed containing 14 questions that covered demographics, feelings of inclusion, comfort-seeking tools, and ways to improve DEI-B. Answer choices were either multiple choice, 1 to 5 sliding scale, or a specified text sliding scale. Eligible participants were undergraduate students enrolled in Animal or Dairy Science (n = 974). Demographics and comfort-seeking tools will be presented descriptively. Inclusion at the start and after 2 yr were compared using six different linear models. A variable was deemed significant if the P-value was ≤ 0.05. A total of 383 students (88% of total respondents) completed 50% or more of the inclusion questions. Seniors had the highest response rate. More students reported coming from a rural background. Primary species of interest was companion animals. There were no observed differences in feelings of inclusion in classes, with peers, or with faculty for hometown, admission type, ethnic group, and first generation when students started (P ≥ 0.067). There was a difference for primary species of interest (P ≤ 0.011) and with female students feeling less included (P ≤ 0.039). There were no observed differences after 2 yr in classes, with peers, or with faculty for classification year, admission type, or first generation (P ≥ 0.088). Suburban students felt the least included in classes compared to rural and urban students (P ≤ 0.036). Female students felt less included in all three categories (P ≤ 0.017). The majority of students reported having companion animal experience but almost half reported having no experience with livestock prior to ISU. A total of 51% of students said they never considered transferring to another major and 48% indicated that they plan to pursue a career in veterinary medicine. A total of 75% of students felt inclusion could be improved by creating more hands-on opportunities and 60% suggested the department provide more study space. In conclusion, the Department of Animal Science at ISU has some effective inclusion practices but needs to evolve and improve in its DEI-B practices for the undergraduate student population.

A Comprehensive Review on Starch-Based Hydrogels: From Tradition to Innovation, Opportunities, and Drawbacks.

Natural hydrogels based on renewable and inexpensive sources, such as starch, represent an interesting group of biopolymeric materials with a growing range of applications in the biomedical, cosmeceutical, and food sectors. Starch-based hydrogels have traditionally been produced using different processes based on chemical or physical methods. However, the long processing times, high energy consumption, and safety issues related to the synthesis of these materials, mostly causing severe environmental damage, have been identified as the main limitations for their further exploitation. Therefore, the main scientific challenge for research groups is the development of reliable and sustainable processing methods to reduce the environmental footprint, as well as investigating new low-cost sources of starches and individuating appropriate formulations to produce stable hydrogel-based products. In the last decade, the possibility of physically modifying natural polysaccharides, such as starches, using green or sustainable processing methods has mostly been based on nonthermal technologies including high-pressure processing (HPP). It has been demonstrated that the latter exerts an important role in improving the physicochemical and techno-functional properties of starches. However, as for surveys in the literature, research activities have been devoted to understanding the effects of physical pre-treatments via high-pressure processing (HPP) on starch structural modifications, more so than elucidating its role and capacity for the rapid formation of stable and highly structured starch-based hydrogels with promising functionality and stability, utilizing more sustainable and eco-friendly processing conditions. Therefore, the present review addresses the recent advancements in knowledge on the production of sustainable starch-based hydrogels utilizing HPP as an innovative and clean-label preparation method. Additionally, this manuscript has the ambition to give an updated overview of starch-based hydrogels considering the different types of structures available, and the recent applications are proposed as well to critically analyze the main perspectives and technological challenges for the future exploitation of these novel structures.

Realm of hepatitis E: Challenges and opportunities.

Hepatitis E virus (HEV), responsible for widespread viral hepatitis, infects approximately 2.3 billion individuals globally, with a significant mortality burden in Asia. The virus, primarily transmitted through contaminated water and undercooked meat, is often underdiagnosed, particularly in immunocompromised patients. Current HEV treatments, while effective, are limited by adverse effects, necessitating research into safer alternatives. Moreover, HEV's extrahepatic manifestations, impacting the nervous and renal systems, remain poorly understood. This study underscores the imperative for enhanced HEV research, improved diagnostic methods, and more effective treatments, coupled with increased public health awareness and preventive strategies.

Engineered crRNA for CRISPR/Cas-assisted biosensing.

CRISPR/Cas-based diagnostics (CRISPR-Dx) face challenges, including difficulty in detecting ultrashort nucleotides, preamplification dependency, cross-contamination, insufficiency in on-pot detection paradigms, and inconvenience in detecting non-nucleic acid targets. This forum outlines the advances in engineered CRISPR RNA (crRNA) that address the aforementioned problems, highlighting challenges, opportunities, and future directions.

Food Safety Exam Phrasing for Food Service Employees.

In many jurisdictions, foodservice workers are required to obtain food handler certification via written examination before being able to work. This study investigated the effect of the readability, or the ease in which one can read and comprehend written text, of food handler exam questions on exam performance. It was hypothesized that the reduction in cognitive load by improving the readability of exam questions would lead to improved scores. Participants received training in personal hygiene and basic food safety and were tested on their knowledge using questions that were worded using the traditional phrasing and updated phrasing that has improved readability. The results indicate that improved readability had a significant difference in the personal hygiene section but not on the basic food safety section. These results are due, in part, to the types of cognitive load (intrinsic vs. extraneous) that are required to solve different types of problems.

Prioritizing research needs and opportunities at the intersection of implementation science and engagement science.

BACKGROUND: There has been increased attention to the need for, and the positive impact of, engaged or participatory science in recent years. Implementation scientists have an opportunity to leverage and contribute to engagement science (ES) through the systematic integration of engagement into implementation science (IS). The purpose of this study was to gather information from researchers and others to develop a prioritized list of research needs and opportunities at the intersection of IS and ES. METHODS: We conducted three Zoom-based focus groups with 20 researchers to generate a list of unmet needs, barriers, and to describe normative themes about use of ES and IS. Then a panel of nine experts in IS and/or engagement ranked the needs and barriers using a survey and met via a Zoom meeting to discuss and generate research opportunities and questions, with reference to the focus group outputs. RESULTS: Respondents and experts concurred on the importance of engagement in IS. Focus group participants reported 28 needs and barriers under the themes of 1) need for best practice guidance related to engagement processes and outcomes and 2) structural barriers to integrating ES in IS. The expert panel prioritized six structural barriers and four barriers related to generating best practice guidance, with corresponding recommendations on research opportunities. Example research opportunities related to engagement processes included: define "successful" engagement in IS contexts; adapt engagement tools and best practices from other disciplines into IS. Example research opportunities related to outcomes included: assess the impact of engagement on IS outcomes; examine engagement practices that lead to optimal engaged research. Example research opportunities related to structural barriers included: leverage research evidence to create structural changes needed to expand support for engaged IS; examine factors that influence institutional buy-in of engagement in IS. CONCLUSIONS: Research needs exist that relate to engagement processes, outcomes, and structural barriers, even for scientists who value engaged research. Expert panelists recommended sequential and reinforcing research opportunities that implementation and engagement scientists can tackle together to advance both fields and health equity. Future work should assess insights from broader invested parties, particularly patients and community members.

Women in Natural Sciences (WiNS) at ETH Zurich Celebrates its 10th Anniversary - A Retrospective and Outlook.

For this CHIMIA special issue on the United Nations Sustainable Development Goals (SDGs) and the coincidental 10th anniversary of the association of Women in Natural Sciences (WiNS) at ETH Zurich, there is no better opportunity to share what we have achieved in the last decade. WiNS was originally founded by female PhD students and PostDocs at the Department of Chemistry and Applied Biosciences (D-CHAB) and has expanded to include three additional departments at ETH Zurich. Join us in celebrating our anniversary, reflecting on what we and other associations with the same mission have done to promote gender equality and reduced inequalities for all. We invite you to reflect on what yet has to be done to enact a systemic change towards achieving equal opportunities for all, rather than simply accommodating the female perspective to Switzerland's predominantly masculine working culture.