Context-dependent multimodal behaviour in a coral reef fish.

Animals are expected to respond flexibly to changing circumstances, with multimodal signalling providing potential plasticity in social interactions. While numerous studies have documented context-dependent behavioural trade-offs in terrestrial species, far less work has considered such decision-making in fish, especially in natural conditions. Coral reef ecosystems host 25% of all known marine species, making them hotbeds of competition and predation. We conducted experiments with wild Ambon damselfish (Pomacentrus amboinensis) to investigate context-dependent responses to a conspecific intruder; specifically, how nest defence is influenced by an elevated predation risk. We found that nest-defending male Ambon damselfish responded aggressively to a conspecific intruder, spending less time sheltering and more time interacting, as well as signalling both visually and acoustically. In the presence of a model predator compared to a model herbivore, males spent less time interacting with the intruder, with a tendency towards reduced investment in visual displays compensated for by an increase in acoustic signalling instead. We therefore provide ecologically valid evidence that the context experienced by an individual can affect its behavioural responses and multimodal displays towards conspecific threats.

Voxel level dense prediction of acute stroke territory in DWI using deep learning segmentation models and image enhancement strategies.

PURPOSE: To build a stroke territory classifier model in DWI by designing the problem as a multiclass segmentation task by defining each stroke territory as distinct segmentation targets and leveraging the guidance of voxel wise dense predictions. MATERIALS AND METHODS: Retrospective analysis of DWI images of 218 consecutive acute anterior or posterior ischemic stroke patients examined between January 2017 to April 2020 in a single center was carried out. Each stroke area was defined as distinct segmentation target with different class labels. U-Net based network was trained followed by majority voting of the voxel wise predictions of the model to transform them into patient level stroke territory classes. Effects of bias field correction and registration to a common space were explored. RESULTS: Of the 218 patients included in this study, 141 (65%) were anterior stroke, and 77 were posterior stroke (35%) whereas 117 (53%) were male and 101 (47%) were female. The model built with original images reached 0.77 accuracy, while the model built with N4 bias corrected images reached 0.80 and the model built with images which were N4 bias corrected and then registered into a common space reached 0.83 accuracy values. CONCLUSION: Voxel wise dense prediction coupled with bias field correction to eliminate artificial signal increase and registration to a common space help models for better performance than using original images. Knowing the properties of target domain while designing deep learning models is important for the overall success of these models.

Colony identity clues for Syntermes grandis (Blattodea: Termitidae) individuals using near-infrared spectroscopy and PLS-DA approach.

Termites are social insects with high species diversity in tropical ecosystems. Multivariate analysis with near-infrared spectroscopy (NIRS) and data interpretation can separate social insects belonging to different colonies of the same species. The objective of this study was to propose the use of discriminant analysis by partial least squares (PLS-DA) combined with NIRS to identify the colonial origin of the Syntermes grandis (Rambur, 1842) (Blattodea: Termitidae) in 2 castes. Six ground S. grandis colonies were identified and mapped; 30 workers and 30 soldier termites in each colony were submitted to spectral measurement with NIRS. PLS-DA applied to the termites' spectral absorbance was used to detect a spectral pattern per S. grandis colony by caste. PLS-DA regression with NIRS proved to be an approach with 99.9% accuracy for identifying the colonial origin of S. grandis workers and 98.3% for soldiers. The methodology showed the importance of qualitatively characterizing the colonial phenotypic response of this species. NIRS is a high-precision approach to identifying the colony origin of S. grandis workers and soldiers. The PLS-DA can be used to design ecological field studies to identify colony territorial competition and foraging behavior of subterranean termite species.

Does testosterone underly the interplay between male traits and territorial behavior in neotropical poison frogs?

The ability of individual animals to defend a territory as well as various phenotypic and behavioral traits may be targets of sexual selection used by males to evaluate their competitors or by females to choose males. A frequent question in animal behavior is whether male traits and characteristics of their territory are correlated and what are the mechanisms that may mediate such associations when they exist. Because hormones link phenotype to behavior, by studying the role of testosterone in territoriality one may come closer to understanding the mechanisms mediating correlations or lack thereof between characteristics of territories and of males. We evaluated whether variation in characteristics of territories (size and quality) are correlated with variation in morphology, coloration, testosterone, heterozygosity, and calls in two species of poison frogs. The Amazonian frog Allobates aff. trilineatus exhibits male care and defends territories only during the breeding season, while the endangered frog Oophaga lehmanni displays maternal care and defends territories throughout the year. We found that morphological traits (body length, weight, thigh size), call activity, and testosterone levels correlated with size and various indicators of quality of the territory. However, the direction of these correlations (whether positive or negative) and which specific morphological, acoustic traits or testosterone level variables covaried depended on the species. Our findings highlight an endocrine pathway as part of the physiological machinery that may underlie the interplay between male traits and territorial behavior. We were able to identify some male traits related to territory attributes, but whether females choose males based on these traits requires further research.

A descriptive study of domestic and family violence presentations to an emergency department in the Northern Territory.

OBJECTIVE: Examine the nature of domestic and family violence (DFV) presentations to an ED in the Northern Territory and identify potential gaps in service delivery. METHODS: Prospective descriptive study of DFV presentations in November 2021. RESULTS: A total of 70 presentations were identified, representing 1.2% of all presentations aged 16 years and older. Disproportionately impacted were First Nations people (90%), women (77.1%) and those aged less than 40 years (67.1%). Most (81.4%) arrived outside of business hours and only 37.1% were assessed by the social worker. Case complexity was increased by high rates of homelessness (30%), concurrent alcohol consumption (44.3%) and pregnancy (11.1% of females). More than a third (37.1%) had attended on one to four occasions in the previous 6 months with a DFV-related injury. Compared to non-DFV attendances, the median ED length of stay was approximately twice as long (456 vs 210 min), admissions rates to the ED short stay unit five times higher (25.7% vs 5.7%; P < 0.01, odds ratio [OR] = 5.7 and 95% confidence interval [CI] = 3.3-9.8) and rates of self-discharge prior to completion of care 9 times higher (12.9% vs 1.5%; P < 0.01, OR = 9.5 and 95% CI = 4.6-19.7). CONCLUSION: The data highlights the need for a 24 h trauma-informed, culturally safe and integrated service to support people experiencing DFV. This could be achieved by a specialist unit designed and staffed by First Nations health practitioners.

[Sociological and geographical markers in favour of a distance and potential availability score for the children of the very elderly]. / Jalons sociologiques et géographiques en faveur d'un score de distance et de disponibilité potentielle des enfants de personnes très âgées.

Old age is a time of emotional, social and physiological challenges. The role of the family remains essential in coping with these challenges. This is particularly true of non-cohabiting children, who in 2020 accounted for just under half of all those helping elderly people with loss of autonomy and/or pathologies. Following on from sociological research on close caregivers, this article first looks at the level and influence of children's relationships and assistance towards their elderly parents, and then proposes the construction of a territorial indicator - in this case, a score - to measure the spatial proximity and potential availability of children. Subject to further development, this indicator represents a first milestone in the territorial understanding of children's relationships with and help for their elderly parents.

The Impacts of Burn Severity and Frequency on Erosion in Western Arnhem Land, Australia.

Wildfires are pivotal to the functioning of many ecosystems globally, including the magnitude of surface erosion rates. This study aims to investigate the relationships between surface erosion rates and wildfire intensity in the tropical north savanna of Australia. The occurrence of fires in western Arnhem Land, Northern Territory, Australia was determined with remotely sensed digital datasets as well as analogue erosion measurement methods. Analysis was performed using satellite imagery to quantify burn severity via a monthly delta normalised burn ratio (dNBR). This was compared and correlated against on-ground erosion measurements (erosion pins) for 13 years. The dNBR for each year (up to +0.4) displayed no relationship with subsequent erosion (up to ±4 mm of erosion/deposition per year). Poor correlation was attributed to low fire severity, patchy burning, significant time between fires and erosion-inducing rainfall. Other influences included surface roughness from disturbances from feral pigs and cyclone impacts. The findings here oppose many other studies that have found that fires increase surface erosion. This accentuates the unique ecosystem characteristics and fire regime properties found in the tropical Northern Territory. Scenarios of late dry season fires with high severity were not observed in this study and require more investigations. Ecosystems such as the one examined here require specialised management practices acknowledging the specific ecosystem functions and processes. The methods employed here combine both analogue and digital sensors to improve understandings of a unique environmental system.

Consistency in Verreaux's sifaka home range and core area size despite seasonal variation in resource availability as assessed by Enhanced Vegetation Index (EVI).

Primates are adept at dealing with fluctuating availability of resources and display a range of responses to minimize the effects of food scarcity. An important component of primate conservation is to understand how primates adapt their foraging and ranging patterns in response to fluctuating food resources. Animals optimize resource acquisition within the home range through the selection of resource-bearing patches and choose between contrasting foraging strategies (resource-maximizing vs. area-minimizing). Our study aimed to characterize the foraging strategy of a folivorous primate, Verreaux's sifaka (Propithecus verreauxi), by evaluating whether group home range size varied between peak and lean leaf seasons within a seasonally dry tropical forest in Madagascar. We hypothesized that Verreaux's sifaka used the resource maximization strategy to select high-value resource patches so that during periods of resource depression, the home range area did not significantly change in size. We characterized resource availability (i.e., primary productivity) by season at Kirindy Mitea National Park using remotely-sensed Enhanced Vegetation Index data. We calculated group home ranges using 10 years of focal animal sampling data collected on eight groups using both 95% and 50% kernel density estimation. We used area accumulation curves to ensure each group had an adequate number of locations to reach seasonal home range asymptotes. Neither 95% home ranges nor 50% core areas differed across peak and lean leaf resource seasons, supporting the hypothesis that Verreaux's sifaka use a resource maximization strategy. With a better understanding of animal space use strategies, managers can model anticipated changes under environmental and/or anthropogenic resource depression scenarios. These findings demonstrate the value of long-term data for characterizing and understanding foraging and ranging patterns. We also illustrate the benefits of using satellite data for characterizing food resources for folivorous primates.

Entre territórios pandêmicos: cartografia de um Consultório na Rua durante a pandemia de covid-19 / Exploring pandemic territories: cartography of a street clinic during the covid-19 pandemic / Entre territorios pandémicos: cartografía de un Consultorio en la Calle durante la pandemia de covid-19

O objetivo do presente artigo foi realizar uma cartografia de um Consultório na Rua, durante o período da pandemia de covid-19. A cartografia foi produzida por uma vivência no consultório de um município de grande porte no sul do Brasil, de agosto de 2021 a janeiro de 2022. Foi perceptível que a locomoção e o funcionamento do serviço reconhecem outros territórios das Pessoas em Situação de Rua, muitas vezes não percebidos por outros pontos do Sistema Único de Saúde. Foram encontradas tanto as barreiras já estabelecidas historicamente quanto as emergentes da pandemia. Foi vivenciado que a esta população não utiliza o território do modo que a cidade racionalizada planeja, sendo, portanto, singular. O reconhecimento do serviço, aliado à compreensão de como as Pessoas em Situação de Rua vivem no território urbano, em cada realidade, mostrou-se essencial para a produção de cuidado.

The objective of this article was to conduct a cartographic study of a street clinic during the covid-19 pandemic. The cartography was based on an experiential approach in a street clinic located in a major city in southern Brazil, between August 2021 and January 2022. It became evident that the flows and operation of the service acknowledged the alternative territories inhabited by the homeless population, often overlooked by other parts of Brazil's Unified Health System. Both historically established barriers and those emerging from the pandemic were encountered. It was observed that the homeless population does not conform to rationalized urban plans, displaying unique patterns of engagement with the urban territory. Recognizing the significance of the service, coupled with a comprehensive understanding of the unique living conditions of homeless individuals, proved indispensable for the provision of effective care.

El objetivo de este artículo fue realizar una cartografía de un Consultorio en la Calle durante el período de la pandemia del covid-19. La cartografía fue producida por una experiencia en un Consultorio en la Calle en una gran ciudad del sur de Brasil, de agosto de 2021 a enero de 2022. Se pudo observar que la locomoción y operación del servicio reconocen otros territorios habitados por personas en situación de calle, a menudo no percibidos por otros puntos del Sistema Único de Salud. Se encontraron barreras, tanto históricamente establecidas como emergentes debido a la pandemia. Se constató que la población en situación de calle no utiliza el territorio de la forma planificada por la ciudad racionalizada. El reconocimiento del servicio, junto con la comprensión de cómo viven las personas en situación de calle en el territorio urbano en cada realidad, se mostró fundamental para la producción del cuidado.

Identification of priority areas for territorial space ecological restoration in arid area of Northwest China: A case study of Zhangye City in Heihe River basin.

Determining priority areas for territorial ecological restoration in the arid region of Northwest China based on the holistic protection and systematic governance is an important measure to build solid national ecological security barrier and promote the construction of territorial ecological civilization. Taking Zhangye City, a typical arid area city in Northwest China, as an example, we constructed the research framework of "ecological network-ecological sensitivities-ecological degradation" from two aspects of internal defects and external threats of ecological networks by using circuit theory and assessment methods of ecological service function importance, ecological sensitivity, and ecological degradation. We then identified the priority areas of territorial ecological restoration in northwest arid region and put forward the restoration strategies. The results showed that the priority areas of ecological restoration in Zhangye City were concentrated in the artificial shelterbelt along rivers and the plain-desert-oasis transition zone with fragile ecology and strong human interference. The ecological network of the study area included 39 ecological sources and 99 ecological corridors, and the highly sensitive and degraded areas were 1595.40 and 6.65 km2. Based on the internal defects and external threats of the ecological network, we identified 31 ecological pinch points, 7 obstacle points, and 753.56 km2 ecological source areas in the territorial spatial ecological restoration priority area. These areas were related to the connectivity of the ecological network internally and the stability maintenance of the ecosystem outwards, and were the areas to restoration in the future. Following the concept of overall protection and system restoration of territorial space, we put forward the idea of territorial space restoration by integrating internal defects and external threats of ecological network, which could provide scientific decision-making basis for comprehensive ecosystem management and territorial optimization of Zhangye City.

Animal board invited review: Improving animal health and welfare in the transition of livestock farming systems: Towards social acceptability and sustainability.

The need to integrate more clearly societal expectations on livestock farming has led the authors of this article to consider that livestock farming systems must be redesigned to position health and welfare at the heart of their objectives. This article proposes a vision of the advances in knowledge required at different scales to contribute to this transformation. After defining health and welfare of animals, the article emphasises the need to consider health in a broader perspective, to deepen the question of positive emotional experiences regarding welfare, and raises the question of how to assess these two elements on farms. The positive interactions between health and welfare are presented. Some possible tensions between them are also discussed, in particular when improving welfare by providing a more stimulating and richer environment such as access to outdoor increases the risk of infectious diseases. Jointly improving health and welfare of animals poses a number of questions at various scales, from the animal level to the production chain. At the animal level, the authors highlight the need to explore: the long-term links between better welfare and physiological balance, the role of microbiota, the psycho-neuro-endocrine mechanisms linking positive mental state and health, and the trade-off between the physiological functions of production, reproduction and immunity. At the farm level, in addition to studying the relationships at the group level between welfare, health and production, the paper supports the idea of co-constructing innovative systems with livestock farmers, as well as analysing the cost, acceptability and impact of improved systems on their working conditions and well-being. At the production chain or territory levels, various questions are raised. These include studying the best strategies to improve animal health and welfare while preserving economic viability, the labelling of products and the consumers' willingness to pay, the consequences of heterogeneity in animal traits on the processing of animal products, and the spatial distribution of livestock farming and the organisation of the production and value chain. At the level of the citizen and consumer, one of the challenges is to better inter-relate sanitary and health perspectives on the one hand, and welfare concerns on the other hand. There is also a need to improve citizens' knowledge on livestock farming, and to develop more intense and constructive exchanges between livestock farmers, the livestock industry and citizens. These difficult issues plead for interdisciplinary and transdisciplinary research involving various scientific disciplines and the different stakeholders, including public policy makers through participatory research.

Assessing the social impacts of the COVID-19 crisis using phone helplines. The case of the Balearic Islands, Spain.

Background: Crises and health policies to tackle them can increase health inequalities. We explored the scope and usefulness of helplines set up during the COVID-19 crisis and characterised the vulnerability of their users. This study explored the geographic and socioeconomic effects of the telephone helplines set up by the Balearic Islands Government and aimed to characterise the vulnerability of their users. Methods: Telephonic survey combined with a geographical analysis of a sample of calls made between 15th of March and 30th of June of 2020 to five helplines: COVID-19 general information; psychological, social (minimum vital income), labour (temporary employment regulation), and housing (rental assistance) helps. The questionnaire included sociodemographic and housing characteristics, type of problem, and if it was solved or not. We used multinomial regression to explore factors associated with having solved the problem. We calculated the standardised rate of calls by municipality using Chi-squared and z-test to test differences. Results: 1,321 interviews from 2,678 selected (231 excluded, 608 untraceable, and 518 refusals). 63.8% of women, 48.7% were born in another country. They had no internet at home in 3.1%, only on the phone in 17.3%. The 23.5% had no income at home. The Problem was solved in 25.4%, and partly in 30.9%. Factors associated with not solving the problem were not having income at home (p = 0.021), labour (p = 0.008), economic (p = 0.000) or housing (p = 0.000) problems. People from 55 of 67 municipalities did at least one call. The highest rates of calls were from coastal tourist municipalities. Conclusion: Helplines reached most of the territory of the Balearic Islands and were used mainly in tourist municipalities. It probably has not been helpful for families with more significant deprivation. Digital inequalities have emerged.

Deprescribing in Older Poly-Treated Patients Affected with Dementia.

Polypharmacy is an important issue in older patients affected by dementia because they are very vulnerable to the side effects of drugs'. Between October 2021 and September 2022, we randomly assessed 205 old-aged outpatients. The study was carried out in a Center for Dementia in collaboration with a university center. The primary outcomes were: (1) deprescribing inappropriate drugs through the Beers and STOPP&START criteria; (2) assessing duplicate drugs and the risk of iatrogenic damage due to drug-drug and drug-disease interactions. Overall, 69 men and 136 women (mean age 82.7 ± 7.4 years) were assessed. Of these, 91 patients were home care patients and 114 were outpatient. The average number of the drugs used in the sample was 9.4 drugs per patient; after the first visit and the consequent deprescribing process, the average dropped to 8.7 drugs per patient (p = 0.04). Overall, 74 potentially inappropriate drugs were used (36.1%). Of these, long half-life benzodiazepines (8.8%), non-steroidal anti-inflammatory drugs (3.4%), tricyclic antidepressants (3.4%), first-generation antihistamines (1.4%), anticholinergics (11.7%), antiplatelet drugs (i.e., ticlopidine) (1.4%), prokinetics in chronic use (1.4%), digoxin (>0.125 mg/day) (1.4%), antiarrhythmics (i.e., amiodarone) (0.97%), and α-blockers (1.9%) were included. The so-called "duplicate" drugs were overall 26 (12.7%). In total, ten potentially dangerous prescriptions were found for possible interactions (4.8%). We underline the importance of checking all the drugs taken periodically and discontinuing drugs with the lowest benefit-to-harm ratio and the lowest probability of adverse reactions due to withdrawal. Computer tools and adequately trained teams (doctors, nurses, and pharmacists) could identify, treat, and prevent possible drug interactions.

A case of Trousseau syndrome: Screening, detection and complication.

Trousseau syndrome (TS) is a malignant tumor-mediated complication of the hypercoagulable state with an unknown etiology. Laboratory testing results in patients with TS have indicated elevated D-dimer levels. The imaging analysis in patients who had undergone stroke has shown the presence of several cerebral infarction lesions in multiple regions. Since patients have had malignant tumors for a long time when they suffer from a secondary stroke, the optimum time for radical tumor treatment is usually missed. This study reports a case to improve the early screening and detection of TS and reduce the risk of recurrence of cerebral infarction.

Consistent spatial lesion-symptom patterns: A comprehensive analysis using triangulation in lesion-symptom mapping in a cohort of stroke patients.

INTRODUCTION: The relationship between brain lesions and stroke outcomes is crucial for advancing patient prognosis and developing effective therapies. Stroke is a leading cause of disability worldwide, and it is important to understand the neurological basis of its varied symptomatology. Lesion-symptom mapping (LSM) methods provide a means to identify brain areas that are strongly associated with specific symptoms. However, inner variations in LSM methods can yield different results. To address this, our study aimed to characterize the lesion-symptom mapping variability using three different LSM methods. Specifically, we sought to determine a lesion symptom core across LSM approaches enhancing the robustness of the analysis and removing potential spatial bias. MATERIAL & METHODS: A cohort consisting of 35 patients with either right- or left-sided middle cerebral artery strokes were enrolled and evaluated using the NIHSS at 24 h post-stroke. Anatomical T1w MRI scans were also obtained 24 h post-stroke. Lesion masks were segmented manually and three distinctive LSM methods were implemented: ROI correlation-based, univariate, and multivariate approaches. RESULTS: The results of the LSM analyses showed substantial spatial differences in the extension of each of the three lesion maps. However, upon overlaying all three lesion-symptom maps, a consistent lesion core emerged, corresponding to the territory associated with elevated NIHSS scores. This finding not only enhances the spatial accuracy of the lesion map but also underscores its clinical relevance. CONCLUSION: This study underscores the significance of exploring complementary LSM approaches to investigate the association between brain lesions and stroke outcomes. By utilizing multiple methods, we can increase the robustness of our results, effectively addressing and neutralizing potential spatial bias introduced by each individual method. Such an approach holds promise for enhancing our understanding of stroke pathophysiology and optimizing patient care strategies.

Emodin activates autophagy to suppress oxidative stress and pyroptosis via mTOR-ULK1 signaling pathway and promotes multi-territory perforator flap survival.

BACKGROUND: Multi-territory perforator flap reconstruction has been proven effective in treating large skin and soft tissue defects in clinical settings. However, in view of that the multi-territory perforator flap is prone to partial postoperative necrosis, increasing its survival is the key to the success of reconstruction. In this study, we aimed to clarify the effect of emodin on multi-territory perforator flap survival. METHODS: Flap survival was assessed by viability area analysis, infrared laser imaging detector, HE staining, immunohistochemistry, and angiography. Western blotting, immunofluorescence assays, and real-time fluorescent quantitative PCR were performed to detect the indicators of oxidative stress, pyroptosis and autophagy. RESULTS: After emodin treatment, the multi-territory perforator flap showed a significantly increased survival rate, which was shown to be closely related to the inhibition of oxidative stress and pyroptosis and enhanced autophagy. Meanwhile, the use of autophagy inhibitor 3 MA was found to reverse the inhibitory effects of emodin on oxidative stress and pyroptosis and weaken the improving effect of emodin on flap survival, suggesting that autophagy plays a critical role in emodin-treated flaps. Interestingly, our mechanistic investigations revealed that the positive effect of emodin on multi-territory perforator flap was attributed to the mTOR-ULK1 signaling pathway activation. CONCLUSIONS: Emodin can inhibit oxidative stress and pyroptosis by activating autophagy via the mTOR-ULK1 pathway, thereby improving the multi-territory perforator flap survival.

Enlarged Perivascular Space in the Basal Ganglia is Associated with Cerebral Venous Reflux in Patients with Recent Small Subcortical Infarction.

BACKGROUND: Research has linked enlarged perivascular spaces (EPVS) to cerebral venous reflux (CVR) in patients with hypertensive intracerebral hemorrhage, but it is unclear whether this association exists in recent small subcortical infarct (RSSI) patients. OBJECTIVE: This study aimed to investigate the correlation between EPVS and CVR in patients with RSSI. METHOD: This study included 297 patients, selected from patients with RSSI in the lenticulostriate artery admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University. CVR was assessed by time-of-flight magnetic resonance angiography (TOF-MRA). The relationship between EPVS and CVR was studied using multiple logistic regression analysis. RESULTS: This study included patients with an average age of 59.84±12.27 years, including 201 males (67.7%). CVR was observed in 40 (13.5%) patients. Compared to the group without CVR, the proportions of male patients and patients with a history of smoking and drinking were higher in the CVR group. The proportions of high-grade EPVS in the centrum semiovale region [23 cases (57.5%) vs. 108 cases (42.0%), p =0.067] and the basal ganglia region [30 cases (75.0%) vs. 133 cases (51.8%), p =0.006] were higher in the CVR group. After multiple logistic regression analysis, high-grade EPVS in the basal ganglia region was still associated with CVR (OR, 2.68; 95% CI, 1.22-5.87; p =0.014). CONCLUSION: In the population with RSSI, EPVS in basal ganglia is significantly associated with CVR, suggesting a close relationship between venous dysfunction and the formation of EPVS.

Conducting a health technology assessment in the West Bank, occupied Palestinian territory: lessons from a feasibility project.

OBJECTIVES: To achieve universal health coverage (UHC), countries must make difficult choices to optimize the use of scarce resources. There is a growing interest in using evidence-based priority setting processes, such as Health Technology Assessment (HTA), to inform these decisions. In 2020, the Palestinian Institute of Public Health (PNIPH) and the Norwegian Institute of Public Health (NIPH) initiated a pilot to test the feasibility of coproducing an HTA on breast cancer screening in the West Bank, occupied Palestinian Territory. Additionally, a secondary aim was to test whether using an adaptive HTA (aHTA) approach that searched and transferred published evidence syntheses could increase the speed of HTA production. METHODS: The applied stepwise approach to the HTA is described in detail and can be summarized as defining a core team, topic selection, and prioritization; undertaking the HTA including adaptation using tools from the European Network for HTA (EUnetHTA) and stakeholder engagement; and concluding with dissemination. RESULTS: The aHTA approach was faster but not as quick as anticipated, which is attributed to (i) the lack of availability of local evidence for contextualizing findings and (ii) the necessity to build trust between the team and stakeholders. Some delays followed from the COVID-19 pandemic, which showed the importance of good risk anticipation and mitigation. Lastly, other important lessons included the ability of virtual collaborations, the value of capacity strengthening initiatives within low- and middle-income countries (LMICs), and the need for early stakeholder engagement. Overall, the pilot was successfully completed. CONCLUSION: This was the first HTA of its kind produced in Palestine, and despite the challenges, it shows that HTA analysis is feasible in this setting.

Is tropical pus in the hand special? A retrospective study comparing hand infection cases in Darwin and Adelaide.

BACKGROUND: Hand infections are a common reason for presenting to hospital and can be associated with significant morbidity and prolonged antibiotic use. Factors recognized to influence patient outcomes include resistant organisms and delayed presentation. Surgeons working around Australia may assume that hand infections and appropriate treatment algorithms will be similar between sites. This is the first study to examine differences between hand infections presenting in Darwin (with its tropical climate) vs. those in a more temperate city (Adelaide). METHODS: This is a two-site retrospective study, where diagnostic discharge codes were used to identify cases for a 12-month period and patient age, sex and rurality, duration of hospital stay, microbiology results and subsequent trips to theatre were reviewed. RESULTS: Despite significant differences in rurality between FMC and RDH patients, there was no significant difference in length of hospital stay, duration of intravenous antibiotics or return trips to theatre across the two sites. RDH reported a 25% rate of MRSA, compared to 18% at FMC, as well as a statistically significant increase in uncommon microbes, with 30% compared to 12% of patients growing microbes that may not be covered by antibiotics routinely administered in metropolitan areas. A limitation of this study was that compliance with antibiotics and hospital stay were not accounted for. CONCLUSION: It is often our training years that determine our norms of everyday practice, but fewer Australian surgical training posts are located in tropical centres. The results of this study highlight the importance of not assuming that the spectrum of organisms causing hand infections are the same as that in the surgeons' state of origin.

Tecendo redes: discussões sobre intersetorialidade e articulação territorial de serviços de saúde mental / Weaving networks: discussions about intersectoriality and territorial articulation of mental health services / Tejiendo redes: discusiones sobre intersectorialidad y articulación territorial de servicios de salud mental

As ações e serviços de saúde brasileiros organizam-se seguindo a lógica das Redes de Atenção à Saúde (RAS). Considerando as necessidades específicas dos indivíduos em sofrimento psíquico e/ou abuso de substâncias psicoativas, estabeleceu-se uma rede temática de cuidados em saúde mental: Rede de Atenção Psicossocial (Raps). Para refletir e dialogar sobre atenção à saúde em rede, consideramos que ela se constrói em território mediante a circulação e interação de gestores, trabalhadores e usuários. Nesse sentido, a pesquisa objetivou identificar as parcerias intersetoriais diretamente relacionadas ao cuidado psicossocial, refletindo sobre suas contribuições para a continuidade da atenção à saúde mental em território no cenário estudado. Para tanto, realizou-se uma pesquisa de campo, com abordagem qualitativa e enfoque exploratório-descritivo, na cidade de Natal-RN, em serviços aleatoriamente selecionados, buscando contemplar os diversos componentes da Raps. A coleta dos dados aconteceu no período de maio a outubro de 2017, a partir da realização de sessões de grupo focal e observação descritiva de serviços e estratégias que compõem a Raps Natal/RN. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa sob CAAE nº 65226817.5.0000.5292 e parecer 1.997.883. O estudo revelou os serviços da assistência social, serviços socioeducativos para crianças e adolescentes que cometem atos infracionais, igrejas e organizações não governamentais como as principais parcerias intersetoriais na rede. Evidencia-se a necessidade de fomentar um 'agir intersetorial' que transite pelos micro e macro espaços das políticas de saúde, assistência e seguridade social para a articulação das RAS e concretização da Raps em território.

Actions and services provided by the Brazilian healthcare system are organized following the Health Care Networks (HCN) model. Considering the specific needs of individuals undergoing psychological distress and/or substance abuse, a thematic network for mental health care was established: the Psychosocial Care Network (PCN). To reflect on and discuss networked healthcare, we consider that networks are built within a territory by circulation and interaction of managers, workers, and users. As such, this research identified intersectoral partnerships directly related to psychosocial care, pointing out their contributions to the continuity of mental health care in the studied territory. A descriptive exploratory field study was conducted in the city of Natal, Rio Grande do Norte, Brazil, with randomly selected services to encompass the various PCN components. Data was collected from May to October 2017 by means of focus group sessions and descriptive observation of services and strategies provided by the RAPS. The research was approved by the Research Ethics Committee under CAAE 65226817.5.0000.5292 and approval number 1.997.883. Results identified social assistance services, socio-educational services for children and adolescents who commit infractions, churches, and non-governmental organizations as the main intersectoral partnerships in the network. This highlights the need to foster an 'intersectoral action' that moves through the micro and macro spaces of health, assistance, and social security policies to articulate Health Care Networks and implement the Psychosocial Care Network in the territory.

Las acciones y servicios de salud en Brasil se organizan desde la lógica de las Redes de Atención a la Salud (RAS). Teniendo en cuenta las necesidades específicas de las personas en sufrimiento psíquico y/o abuso de sustancias psicoactivas, se estableció la red temática de atención en salud mental: la Red de Atención Psicosocial (RAPS). Para reflexionar y dialogar sobre la atención de salud en red, consideramos que la red se construye en el territorio mediante la circulación e interacción de gestores, trabajadores y usuarios. Así, la investigación tuvo como objetivo identificar las alianzas intersectoriales directamente relacionadas con la atención psicosocial, reflexionando sobre sus contribuciones para la continuidad de la atención en salud mental en el territorio estudiado. Para ello, se realizó una investigación de campo con enfoque cualitativo y exploratorio-descriptivo en la ciudad de Natal (Rio Grande do Norte ­RN­, Brasil), en servicios seleccionados de manera aleatoria, buscando abarcar los diversos componentes de la RAPS. La recolección de datos tuvo lugar de mayo a octubre de 2017, mediante sesiones de grupo focal y observación descriptiva de servicios y estrategias que componen la RAPS Natal/RN. La investigación fue aprobada por el Comité de Ética en Investigación bajo el número CAAE 65226817.5.0000.5292 y el dictamen 1.997.883. Los resultados indican que los servicios de asistencia social, los servicios socioeducativos para niños y adolescentes que cometen actos infraccionales, iglesias y organizaciones no gubernamentales son las principales alianzas intersectoriales en la red. Es necesario fomentar una "acción intersectorial" que atraviese los espacios micro y macro de las políticas de salud, asistencia y seguridad social para la articulación de las RAS y la concreción de la RAPS en el territorio.