A General Overview of Palliative Care in Morocco: Needs Far Beyond Means.

Morocco's approach to developing palliative care is notably constrained, with an almost complete scarcity of laws and regulations in this area. Despite some progress, palliative care remains fragmented and underdeveloped, with persistent disparities in its accessibility and provision. Nationally, there is a lack of sufficient and detailed information about its progress. This paper aims to fill this gap by offering an overview of the history, infrastructure, education, and legislation framework surrounding palliative care in the country. Significant strides have been made since its implementation, but challenges persist, including the need for a comprehensive legislation framework, more trained professionals, and expanded services beyond oncology to other chronic diseases. Strengthening infrastructure and policies is essential to meet the growing needs of Morocco's population.

Predictors of National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Recovery among Individuals in Alcohol Treatment: Implications for Social Work.

The National Institute on Alcohol Abuse and Alcoholism's (NIAAA) definition of alcohol use disorder (AUD) recovery stipulates two criteria: remission from DSM-5 AUD and cessation of heavy drinking. Importantly, these criteria allow for consideration of nonabstinent alcohol treatment outcomes. However, researchers have yet to assess potential predictors of the NIAAA recovery outcome. The current study examined associations between mental health and coping predictors of NIAAA recovery status in an AUD treatment sample. At baseline (BL) and end-of-treatment (EOT) research interviews in a clinical trial, participants (N = 118) completed questionnaires assessing alcohol dependence, mental health, and confidence levels in reducing heavy drinking, as well as alcohol use and DSM-5 AUD symptom endorsement. Logistic regression models tested the associations between chosen predictors and the odds of achieving NIAAA recovery. Twenty-four percent of individuals (n = 28) met both criteria for NIAAA recovery at EOT. Higher levels of BL state anxiety and anxiety sensitivity predicted lower odds of achieving NIAAA recovery, while greater confidence to reduce heavy drinking predicted increased odds of NIAAA recovery. Social workers are encouraged to continue assessing and addressing mental health in AUD treatment to help individuals with alcohol problems achieve their AUD recovery goals.

"I am there just to get on with it": a qualitative study on the labour of the patient and public involvement workforce.

BACKGROUND: Workers tasked with specific responsibilities around patient and public involvement (PPI) are now routinely part of the organizational landscape for applied health research in the United Kingdom. Even as the National Institute for Health and Care Research (NIHR) has had a pioneering role in developing a robust PPI infrastructure for publicly funded health research in the United Kingdom, considerable barriers remain to embedding substantive and sustainable public input in the design and delivery of research. Notably, researchers and clinicians report a tension between funders' orientation towards deliverables and the resources and labour required to embed public involvement in research. These and other tensions require further investigation. METHODS: This was a qualitative study with participatory elements. Using purposive and snowball sampling and attending to regional and institutional diversity, we conducted 21 semi-structured interviews with individuals holding NIHR-funded formal PPI roles across England. Interviews were analysed through reflexive thematic analysis with coding and framing presented and adjusted through two workshops with study participants. RESULTS: We generated five overarching themes which signal a growing tension between expectations put on staff in PPI roles and the structural limitations of these roles: (i) the instability of support; (ii) the production of invisible labour; (iii) PPI work as more than a job; (iv) accountability without control; and (v) delivering change without changing. CONCLUSIONS: The NIHR PPI workforce has enabled considerable progress in embedding patient and public input in research activities. However, the role has led not to a resolution of the tension between performance management priorities and the labour of PPI, but rather to its displacement and - potentially - its intensification. We suggest that the expectation to "deliver" PPI hinges on a paradoxical demand to deliver a transformational intervention that is fundamentally divorced from any labour of transformation. We conclude that ongoing efforts to transform health research ecologies so as to better respond to the needs of patients will need to grapple with the force and consequences of this paradoxical demand.

Anaphylaxis: Definition and criteria.

Anaphylaxis is a systemic allergic reaction that may be severe and life-threatening. With more than a dozen anaphylaxis definitions proposed over the past several decades and several diagnostic criteria in circulation, there is a need for a multinational consensus definition to simplify management across specialties. Anaphylaxis diagnostic criteria are more alike than they are different, and approaches of the National Institute of Allergy and Infectious Disease, World Allergy Organization, and Brighton Collaborative help to add granularity and perspective to patient management. Anaphylaxis occurs across a spectrum of severity within populations, although, among individual patients, there is some evidence to suggest more consistency for an individual allergen. Still, severity is influenced by a number of factors that demonstrate variability: factors that relate to allergen triggers, patient characteristics, and treatments received. Severity of anaphylaxis impacts management, and recent guidelines provide approaches that consider individual factors to inform both strong and conditional recommendations. Conditional recommendations serve as navigational signals for shared decision-making when patient expertise is leveraged to inform individual preferences and values together with clinician expertise in anaphylaxis management to provide patient care bespoke to each patient. As novel approaches to both prevention and treatment of anaphylaxis emerge, an understanding of the significance of strong and conditional recommendations becomes critical to providing individualized and appropriate care for patients at risk for anaphylaxis.

Medicinal Chemistry in Bosnia and Herzegovina - Past, Present and Perspectives.

Although Bosnia and Herzegovina has had a rich history in medicines and traditional medicines, it historically had poor activity regarding the field of medicinal chemistry in the country. However, this has changed recently as Bosnia and Herzegovina has shown immense potential in this field. A significant milestone occurred in 2019, with the establishment of the Organization Pharmaceutical Research Institute. This non-governmental organization aims to improve medicinal chemistry in Bosnia and Herzegovina. Through research, partnerships, and educational initiatives, the organization has made substantial strides in promoting pharmaceutical research, education, and innovation. Moreover, the country's membership in the European Federation for Medicinal Chemistry and Chemical Biology (EFMC) has further facilitated collaboration with European experts, access to cutting-edge knowledge and technologies, and harmonization with European standards. Looking to the future, this organization endeavors to improve healthcare, encourage innovation in medicinal chemistry, and promote the development of new therapies. With the efforts to establish an Association of Chemists in Bosnia and Herzegovina, the nation's scientific community is poised to flourish, contributing to the advancement of medicinal chemistry and healthcare in the region.

The role of the Alzheimer's Association in the genesis of Alzheimer's Disease Neuroimaging Initiative.

Here we highlight the Alzheimer's Association's role since its inception, as a strategic collaborator with National Institutes of Health-National Institute on Aging in the development of the modern era of the Alzheimer's Movement and in making Alzheimer's disease (AD) a national priority in the United States by developing several initiatives to advance knowledge about the cause, diagnosis, and treatment of dementia. Among these collaborative undertakings, the Alzheimer's Disease Neuroimaging Initiative (ADNI) is an exemplary case, launched with groundwork by the Neuroimaging Working Group sponsored by the Association's Ronald and Nancy Reagan Research Institute on AD. The unique contribution of the Association to the development of ADNI includes participation as a member of ADNI's Private Partner Scientific Board and involvement in developing an AD biomarker standardization and validation subproject, which has led to a conceptual shift in the field to define AD based on its underlying biology. Furthermore, the creation of Worldwide ADNI (WW-ADNI) is highlighted, underscoring the global impact of these efforts. HIGHLIGHTS: The Alzheimer's Disease Neuroimaging Initiative (ADNI) is a keystone undertaking in the evolving landscape of Alzheimer's disease (AD) research, and is now in its fourth iteration. The Alzheimer's Association has partnered with ADNI since its inception. ADNI 4 and the Association continue to collaborate, ensuring representation within the study population.

Converting an HLA-B27 flow assay from the BD FACSCanto to the BD FACSLyric.

HLA-B27 is a major histocompatibility complex (MHC) class I antigen which exhibits strong association (90%) with ankylosing spondylitis. HLA-B27 detection in patients by flow cytometry is a widely used clinical test, performed on many different flow cytometer models. We sought to develop and validate a test conversion protocol for the HLA-B27 test performed on the BD FACSCanto to BD's newer FACSLyric flow cytometers. The development and validation experiments were performed using anti-HLA-B27*FITC/CD3*PE antibody-stained whole blood patient specimens. The anti-HLA-B27*FITC logarithmic median fluorescence (LMF) results on the BD FACSCanto were converted to median fluorescence intensity (MFI) values on the BD FACSLyric. Clustering of the HLA-B27 positive and negative values, using a 3rd order polynomial equation, resulted in a conversion of the BD FACSCanto cutoff values, negative (<150 LMF) and positive (≥160 LMF), to negative (<4530 MFI) and positive (≥6950 MFI) on the BD FACSLyric. Accuracy was assessed by comparing the flow results obtained on the BD FACSCanto and BD FACSLyric to a molecular PCR based assay. Additional validation parameters (compensation verification, intra- and inter-assay precision, and instrument comparison) were performed per the recommendations outlined in the Clinical and Laboratory Standards Institute (CLSI) H62 guidelines for validation of flow cytometry assays.

Establishing a Research-Related Patient and Family Advisory Council for a Surgical Specialty.

Engaging patients and family members in formal feedback for health care processes can be impactful, especially when cultivating new care and research protocols. However, most surgical groups lack established systems for enlisting these critical stakeholders. This is a descriptive report of how we built our Patient and Family Advisory Council (PFAC) through a multistep process with patients, providers, research staff, and administrators. We also detail how it has advanced research, care, and mutually beneficial collaboration at our hand center. For example, our PFAC has provided vital input on multiple grant submissions, assisted with the development of a web-based digital application for thumb arthritis therapy, and improved our patient care approaches. To successfully create and sustain a PFAC, there must be commitment from multiple stakeholders across clinical, research, administration, and leadership spectra. Through this alliance, all stakeholders can develop better care and investigative strategies.

From brain cytoarchitectonics to clinical neurology: Polish Institute for Brain Research in Vilnius, 1931-1938.

The Polish Institute for Brain Research was established in Warsaw in 1928 to support scientific research on the brain and its functions. The director of the institute was Maksymilian Rose (1883-1937), a distinguished Polish neurologist and neuroanatomist, a disciple of Oskar Vogt and Korbinian Brodmann. In 1931, the Institute was moved from Warsaw to Vilnius. The Institute was well-known in Europe at the time because of the research in the fields of neuroscience, clinical neurology, and psychiatry, as well as the cytoarchitectonic analysis of social activists' brains-a fashionable, neophrenological way to link the mental functions of deceased geniuses with the cellular composition of their central nervous systems. In 1939, the work of the Institute was interrupted by World War II; some of the preparations and materials were moved from Vilnius to Warsaw, some were stored in Vilnius, and some were lost. In this article, we analyze the primary and secondary sources, some of which were obscure for over 80 years, and evaluate the most important scientific achievements of the Polish Institute for Brain Research, as well as its legacy in the early period of modern neuroscience and neurology in interwar Vilnius.

Beyond Step Count: Are We Ready to Use Digital Phenotyping to Make Actionable Individual Predictions in Psychiatry?

Some models for mental disorders or behaviors (eg, suicide) have been successfully developed, allowing predictions at the population level. However, current demographic and clinical variables are neither sensitive nor specific enough for making individual actionable clinical predictions. A major hope of the "Decade of the Brain" was that biological measures (biomarkers) would solve these issues and lead to precision psychiatry. However, as models are based on sociodemographic and clinical data, even when these biomarkers differ significantly between groups of patients and control participants, they are still neither sensitive nor specific enough to be applied to individual patients. Technological advances over the past decade offer a promising approach based on new measures that may be essential for understanding mental disorders and predicting their trajectories. Several new tools allow us to continuously monitor objective behavioral measures (eg, hours of sleep) and densely sample subjective measures (eg, mood). The promise of this approach, referred to as digital phenotyping, was recognized almost a decade ago, with its potential impact on psychiatry being compared to the impact of the microscope on biological sciences. However, despite the intuitive belief that collecting densely sampled data (big data) improves clinical outcomes, recent clinical trials have not shown that incorporating digital phenotyping improves clinical outcomes. This viewpoint provides a stepwise development and implementation approach, similar to the one that has been successful in the prediction and prevention of cardiovascular disease, to achieve clinically actionable predictions in psychiatry.

Accelerating entrepreneurship: Evidence from the incubation centers of management institutes of Dakshina Kannada.

Purpose: Incubation centres are gaining significant prominence as they play a crucial role in providing supportive environment and encouraging entrepreneurship among students. Considering its importance, the study is intended to offer a thorough knowledge of incubators' role in promoting entrepreneurship growth using data acquired from Dakshina Kannada Management Institutes. It also intends to investigate the efficacy and success of incubators using a variety of metrics. Methods: This study is based on the mixed-method approach, where specifically the concurrent qual-quant approach is adopted. An in-depth interview was undertaken, and a structured questionnaire was formulated to collect the data from final year Masters' students from the Management Institutes. Qualitative analysis was narrated and quantitative analysis was carried out using SPSS 26 and AMOS 23, with descriptive statistics, t-test, regression analysis, and SEM which were utilized to evaluate the association between variables. Results: The study has highlighted the importance of reputation and credibility of the incubation centre, along with the significance of building a strong network as integral factors for learning from it. Overall, the study has found that students' perception of education collaboration, and policy regulatory framework pertaining to incubation centres highly impacted the effectiveness of the incubation centre, which further enhances its success. Implications: This study helps to handle challenges for young entrepreneurs through proper direction and support, by refining their business ideas and collaborations with local and regional businesses to create a healthy entrepreneurship environment by fostering the integration between government bodies, financial institutions, and venture capitalists with the entrepreneurs and key stakeholders. Originality/rationale: As an exceptional highlight than other studies, this study focused on assessing the impact of awareness, perception, education and collaboration, policy and regulatory frameworks, and challenges on the effectiveness of incubators, and success of incubation centre. This has provided the answers to more comprehensive questions pertaining to incubation centre using mixed method approach. The combination of qualitative and quantitative results has identified novel findings which urges the incubation centres to identify the startups with high growth potential where the major challenges lie in convincing the students to implement their own business ideas.

Effect of early pulmonary rehabilitation therapy on the pulmonary function of patients with stroke-associated pneumonia and analysis of its effectiveness.

Objective: This study aimed to evaluate the clinical effectiveness of early pulmonary rehabilitation (PR) treatment methods for stroke-associated pneumonia (SAP). Methods: This is a prospective, randomized controlled intervention study. Eighty SAP patients admitted to the rehabilitation department of Liuzhou People's Hospital from June 2020 to December 2021 were selected and divided into an intervention group (40 cases) and a control group (40 cases) using the random number table approach. Patients in both groups received conventional treatments. Patients in the intervention group received early PR interventions, while patients in the control group received conventional rehabilitation treatment. The clinical effectiveness and pulmonary function indexes were compared. Results: The intervention group showed shorter durations of stay in the intensive care unit, relief from symptoms, and mechanical ventilation compared to the control group following treatment (P < 0.05). The total clinical efficacy after intervention in the treatment group was 82.50%, significantly higher than the control group's rate of 47.50% (P < 0.05). After 21 days of treatment, the forced expiratory volume in one second (FEV1)/predicted value in the intervention group was 64.92 ± 8.53, while it was 52.69 ± 7.08 in the other group. The FEV1/forced vital capacity in the intervention group was 59.73 ± 7.18, compared to 50.36 ± 6.54 in the control group. The intervention group had a clinical pulmonary infection score of 2.62 ± 1.13, while the control group had a score of 4.17 ± 2.08. The intervention group showed a significant improvement in lung function, with statistically significant differences compared to the other group (P < 0.05). Moreover, the intervention group had significantly lower levels of interleukin-4 and interleukin-10 compared to the control group, with statistical significance (P < 0.05). The average National Institute of Health Stroke Scale score of the intervention group was significantly lower than that of the control group in the second and third weeks after treatment (P < 0.05). Conclusion: Early comprehensive pulmonary rehabilitation can significantly enhance the pulmonary function and respiratory status of SAP patients and facilitate the early recovery of brain function. This approach archives significantly better outcomes compared to conventional PR; therefore, it is worth clinical implementation.

Semi-field evaluation of aquatic predators for the control of Anopheles funestus in rural south-eastern Tanzania.

BACKGROUND: Biological control is a promising alternative or complementary approach for controlling vector populations in response to the spread of insecticide resistance in malaria vectors. This study evaluated the efficacy of three selected potential predators on the density and fitness parameters of Anopheles funestus larvae in rural Tanzania. METHODS: Common predator families Aeshnidae (dragonflies), Coenagrionidae (damselflies), and Notonectidae (backswimmers) and An. funestus group larvae were collected from natural aquatic habitats in rural south-eastern Tanzania. Predators were starved for 12-h while An. funestus larvae were given fish food before starting the experiment. Anopheles funestus larvae were placed into artificial habitats containing predators, exposing them to potential predation. The number of surviving An. funestus larvae were counted every 24-h. An emergence traps were placed at the top of artificial habitats to capture emerging mosquitoes. Emerged mosquitoes were monitored until they died. Female wings were measured and used as a proxy for body size. Generalized linear mixed models (GLMM) with binomial variates at 95% CI and Cox proportional hazard models were used to assess the proportion of dead mosquitoes and the daily survival determined. RESULTS: There were significant differences in the number of emerged mosquitoes between the treatment and control groups (P < 0.001). Thus, all predator species played a significant role in reducing the density of An. funestus mosquitoes (P < 0.001). Furthermore, these predators had notable effects on the fitness parameters and survival of emerged mosquitoes (P < 0.001). Among the three predators studied, Coenagrionidae (damselflies) were most efficient followed by Notonectidae (backswimmers), with Aeshnidae (dragonflies) being the least efficient. CONCLUSION: Selected aquatic predators have the potential to reduce the survival and density of An. funestus larvae. They might eventually be included within an integrated malaria vector control strategy, ultimately leading to a reduction in malaria transmission.

Fanconi Anaemia associated with café au lait spots: A rare case report.

Fanconi Anaemia is an autosomal recessive disorder, which is characterised by progressive pancytopenia, café au lait spots (>50%), bruising, petechie, recurrent infections, short height (50%), and thumb and radial bone anomalies (40%). Herein, is presented a case of a lean emaciated female child, who presented with the chief complaints of fever, loose stools and decreased appetite for one month reported at Sindh Government General Hospital, Karachi, on February, 1, 2023. She had cutaneous findings of hyperpigmentation and café au lait spots and a tri-phalangeal thumb. On investigation, pancytopenia and a low reticulocyte count of 0.7% was also observed. Karyotype and chromosomal breakage test induced by Diepoxybutane confirmed her as a case of Fanconi Anaemia.

[The first successful sex reassignment surgery: Magnus, Dora and the Institute of Sexology, Berlin in 1931]. / La première chirurgie de reassignation sexuelle réussie : Magnus, Dora et l'institut de sexologie de Berlin en 1931.

Magnus Hirschfeld was a brilliant German doctor campaigning for the decriminalization and destigmatization of homosexuality. During the very liberal Weimar Republic (1918-1933) he published his avant-garde articles, he created his Institute of Sexual Sciences (Institut für Sexualwissenschaft), where the first published transgender surgery took place, performed on Dora Richter in 1931 (we will be interested in this first report of successful intervention) and multiplied the interventions to abolish paragraph 175, penalizing "sodomy". Ultimately the rise of Nazism forced him to flee his country and end his life in France. Hirschfeld's work remained unfinished. His political activism and his over-media coverage earned him numerous criticisms even within the gay and lesbian movement of the time. Who was this strange doctor (the Einstein of sex, as an American promoter presented him during his conferences in 1930) who combined the faults, for the time, of being at the same time Jewish, homosexual and leftist?

NIH funding and journal selection: trends in dermatology publication models across tiers from 2021 to 2023.

This study examines the influence of National Institutes of Health (NIH) funding on the publication choices of dermatologists, particularly in terms of journal tiers and pay-to-publish (P2P) versus free-to-publish (F2P) models. Utilizing k-means clustering for journal ranking based on SCImago Journal Rank, h-index, and Impact Factor, journals were categorized into three tiers and 54,530 dermatology publications from 2021 to 2023 were analyzed. Authors were classified as Top NIH Funded or Non-Top NIH Funded according to Blue Ridge Institute for Medical Research rankings. The study finds significant differences in publication patterns, with Top NIH Funded researchers in Tier I journals demonstrating a balanced use of P2P and F2P models, while they preferred F2P models in Tier II and III journals. Non-Top NIH Funded authors, however, opted for P2P models more frequently across all tiers. These data suggest NIH funding allows researchers greater flexibility to publish in higher-tier journals despite publication fees, while prioritizing F2P models in lower-tier journals. Such a pattern indicates that funding status plays a critical role in strategic publication decisions, potentially impacting research visibility and subsequent funding. The study's dermatology focus limits broader applicability, warranting further research to explore additional factors like geographic location, author gender, and research design.

[Trust in socialization institutions as a necessary social condition for effective integration of disabled children into society].

The article is devoted to the analysis of the problem of trust in the institutions of socialization of children with disabilities. The role of such institutions of socialization of disabled children as family, education, healthcare, public organizations, and the media is analyzed. The analysis was based on the results of a sociological study conducted in May-June 2023 among family members raising disabled children (Moscow, St. Petersburg, Belgorod, Kursk). The study revealed significant differences in respondents' assessments of their trust in socialization institutions. It has been established that the media has become an outsider of trust. In the course of the analysis, the authors concluded that it is necessary to apply an integrated approach to the activities of institutions for the socialization of children with disabilities, which should be based on interdepartmental interaction «family - NGOs - authorities - healthcare, education - media - business¼. The proposed approach, according to the authors, ensures the effectiveness, targeting and transparency of activities.

Diagnosis of Alzheimer's disease: Towards accuracy and accessibility.

Alzheimer's disease (AD) is a serious dementia afflicting aging population and is characterized by cognitive decline, amyloid-ß plaques, and neurofibrillary tangles. AD substantially impairs the life quality of the victims and poses a heavy burden on the society at large. The number of people with dementia due to AD, prodromal AD, and preclinical AD is estimated to stand at roughly 3.2, 69, and 315 million worldwide, respectively. Current clinical diagnosis is based on clinical symptoms, and clinical research demonstrated that positron emission tomography (PET) and cerebrospinal fluid (CSF) biomarkers had excellent diagnostic performance. However, the application of CSF biomarker tests and PET are restricted by the invasiveness and high cost. The presence of clinical symptoms means that AD pathology has been progressing for many years, and only a few drugs have been approved for the traetemnt of AD. Therefore, early diagnosis is extremely important for controlling the outcomes caused by AD. In this review, we provided an overview of developing clinical diagnostic criteria, diagnostic strategies under clinical research, developing blood based-biomarker assays, and promising nanotechnologically-based assays.

Quality of life and vision assessment with scleral lenses in keratoconus.

PURPOSE: The purpose of the study is to evaluate the visual outcomes and improvement in quality of life (QOL) of patients with keratoconus with scleral lenses. METHODS: In this prospective study, 14 patients (28 eyes) with bilateral keratoconus were fitted with scleral lenses (McAsfeer 16.00 mm) in Pune city, Maharashtra, India. Uncorrected visual acuity (VA), best spectacle-corrected VA, and VA with scleral lenses were evaluated. The patients were given the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) for judging the QOL, before and after using scleral lenses for 3 months. RESULTS: The mean uncorrected VA of the 14 patients with a mean age of 28.64 ± 6.57 years was 1.18 ± 0.19 logMAR. Best spectacle-corrected high-contrast VA improved from 0.47 ± 0.25 logMAR to 0.03 ± 0.07 logMAR with scleral lenses (P < 0.001). Best spectacle-corrected low-contrast VA improved from 0.68 ± 0.22 logMAR to 00.47 ± 0.10 logMAR with scleral lenses (P < 0.001). Along with the increase in overall median scores on the NEI VFQ-25 from 1735 to 2930 points (P < 0.001), the distance and near activities (P < 0.001), vision-specific mental health (P < 0.002), social functioning (P < 0.004), and driving (P < 0.005) improved after using scleral lenses for 3 months. CONCLUSION: Scleral lenses can be an effective and safe management option for patients with keratoconus leading to an improved vision and QOL.