Earlier Approaches Research Articles

Hypoparathyroidism: Early Detection and Diagnosis Approaches

Hypoparathyroidism is an endocrine disorder characterized by low or absent production of parathyroid hormone (PTH). The most common cause of hypoparathyroidism is injury to the parathyroid glands or unintentional removal during thyroid surgery. The author aims to explore further the early detection and diagnostic approaches for hypoparathyroidism. The search was conducted through the Pubmed database using the keywords "Detection AND Diagnose AND Hypoparathyroidism." A total of 183 results were obtained. However, after applying inclusion and exclusion criteria, 7 publications were used in this literature review. The diagnosis of hypoparathyroidism is established through the assessment of clinical symptoms, physical examination, and laboratory tests.

Oncogenic KRAS, Mucin 4, and Activin A-Mediated Fibroblast Activation Cooperate for PanIN Initiation.

Over 90% of patients with pancreatic ductal adenocarcinoma (PDAC) have oncogenic KRAS mutations. Nevertheless, mutated KRAS alone is insufficient to initiate pancreatic intraepithelial neoplasia (PanIN), the precursor of PDAC. The identities of the other factors/events required to drive PanIN formation remain elusive. Here, optic-clear 3D histology is used to analyze entire pancreases of 2-week-old Pdx1-Cre; LSL-KrasG12D/+ (KC) mice to detect the earliest emergence of PanIN and observed that the occurrence is independent of physical location. Instead, it is found that the earliest PanINs overexpress Muc4 and associate with αSMA+ fibroblasts in both transgenic mice and human specimens. Mechanistically, KrasG12D/+ pancreatic cells upregulate Muc4 through genetic alterations to increase proliferation and fibroblast recruitments via Activin A secretion and consequently enhance cell transformation for PanIN formation. Inhibition of Activin A signaling using Follistatin (FST) diminishes early PanIN-associated fibroblast recruitment, effectively curtailing PanIN initiation and growth in KC mice. These findings emphasize the vital role of interactions between oncogenic KrasG12D/+ -driven genetic alterations and induced microenvironmental changes in PanIN initiation, suggesting potential avenues for early PDAC diagnostic and management approaches.

In-silico study of bacterial keratinase and optimization of extraction procedure for keratin from Country chicken and Indian blue rock pigeon feathers

Keratin, a versatile bioprotein, has seen a tremendous industrial exploitation due to its outstanding biodegradability and biocompatibility nature. Keratin is primarily derived from substrates such as feathers, nails, horns, beaks, hair and bovine hoofs. The generation of chicken and pigeon feather wastes has risen over the years in Vellore. When it is not discarded properly, this acts as a major root cause for the dissemination of various diseases to humans. The primary aim of this research is to remediate these wastes by extracting the keratin and to prove that beta-mercaptoethanol enhances keratinase activity by in-silico approach for degradation of these wastes. In light of this, the feathers from the dumped sites of Vellore were exploited and the keratin was extracted from country chicken and pigeon feathers which yields a concentration of 3.44 mg/L and 2.8 mg/L of keratin. This extraction procedure is significantly more cost-effective and yields more keratin than earlier approaches. The crystallographic structures of keratin were examined by X-ray diffraction studies. The functional group of the keratin was analyzed by using Fourier-transform infrared spectroscopy and confirmed the presence of cysteine-cystine, glutamic acid and tryptophan. The mode of action and degree of effectiveness of keratin were studied using Lipinski's rule of 5. In addition, the Protein Data Bank was used to retrieve the keratinase structure of Meiothermus taiwanensis WR-220, which has the National Center for Biotechnology Information (NCBI) and Protein Data Bank (PDB) accession ID-5WSL and the enzyme's tertiary structure was studied with the SwissModel tool. Using Autodock, beta-mercaptoethanol was docked with keratinase and enzyme-ligand in-silico interactions prove that ligand enhances the activity of microbial keratinase.

A machine learning algorithm to predict a culprit lesion after out of hospital cardiac arrest

Abstract Background Between 50-90% of patients suffering from out-of-hospital cardiac arrest (OHCA) have a primary cardiac aetiology of arrest with the presence of a culprit coronary lesion. However, recent trials have failed to show a benefit from an early invasive angiographic approach following OHCA. Identification of patients with high likelihood of a culprit lesion may enable selection of patients likely to benefit from direct conveyance to cardiac arrest centres and for an early invasive approach. However, electrocardiogram (ECG) following return of spontaneous circulation, the current gold-standard, is a poor predictor of presence of a culprit lesion. Purpose We aimed to develop a machine learning algorithm to predict the presence of a culprit lesion in patients with OHCA. Methods We used a retrospective cohort of 398 patients admitted with primary cardiac aetiology OHCA to a tertiary cardiology centre in the United Kingdom, between May 2012 and December 2017. The primary outcome was the presence of a culprit coronary artery lesion, for which a Gradient Boosting model was optimised to predict. The algorithm was then validated in two independent European cohorts comprising 568 patients (346 and 222 patients respectively). Results The development cohort consisted of 398 patients (median age 64.3 years [IQR 53.3-75.4], 74.6% male), and the two validation cohorts consisted of 346 patients (median age 63.0 years [IQR 55.0-73.0], 81.5% male) and 222 patients (median age 63.0 years [IQR 52.0-74.0], 77.0% male). Of all patients, 85.6% had a witnessed arrest, 69.6% received bystander cardiopulmonary resuscitation, and 77.3% had an initial shockable rhythm. A culprit lesion was observed in 67.4% patients receiving early coronary angiography in the development cohort, and 67.9% and 61.1% in the two validation cohorts respectively. A Gradient Boosting model yielded an algorithm, named KOCAR Culprit Predictor, incorporating nine variables including age, a localising feature on ECG (≥2mm of ST change in contiguous leads), regional wall motion abnormality, history of vascular disease and initial shockable rhythm. This model had an AUC of 0.89 in the development and 0.83/0.81 in the validation cohorts with good calibration (Figure 1), and outperformed the current gold-standard ECG alone (AUC 0.69/0.67/0/67). Conclusions A novel simple machine learning derived algorithm (Figure 2) combining nine variables which are readily available to clinicians can be applied to patients with OHCA to predict a culprit coronary artery lesion with high accuracy. The algorithm, KOCAR Culprit Predictor, outperforms the current gold-standard ECG alone.Figure 1Figure 2

Rectum and Bladder Toxicity in Postoperative Prostate Bed Irradiation: Dose-Volume Parameters Analysis.

Although prostate cancer treatment is increasingly effective, its toxicities pose a major concern. The aim of our study was to assess the rate of adverse events (AEs) and the prognostic value of dose-volume histogram (DVH) parameters for the occurrence of treatment toxicity in patients treated with post-prostatectomy prostate bed radiotherapy (RT). The AEs were scored according to the CTCAE v.5.0. The rectum and bladder were contoured according to the RTOG Guidelines. The DVH parameters were assessed using data exported from the ECLIPSE treatment-planning system. Genitourinary (GU) and gastrointestinal (GI) toxicity were analysed using consecutive dose thresholds for the percentage of an organ at risk (OAR) receiving a given dose and the QUANTEC dose constraints. A total of 213 patients were included in the final analysis. Acute grade 2 or higher (≥G2) GU AEs occurred in 18.7% and late in 21.3% of patients. Acute ≥G2 GI toxicity occurred in 11.7% and late ≥G2 in 11.2% of the patients. Five patients experienced grade 4 AEs. The most common adverse effects were diarrhoea, proctitis, cystitis, and dysuria. The most significant predictors of acute ≥G2 GI toxicity were rectum V47 and V46 (p < 0.001 and p < 0.001) and rectum wall V46 (p = 0.001), whereas the most significant predictors of late ≥G2 GI AEs were rectum wall V47 and V48 (p = 0.019 and p = 0.021). None of the bladder or bladder wall parameters was significantly associated with the risk of acute toxicity. The minimum doses to bladder wall (p = 0.004) and bladder (p = 0.005) were the most significant predictors of late ≥G2 GU toxicity. Postoperative radiotherapy is associated with a clinically relevant risk of AEs, which is associated with DVH parameters, and remains even in patients who fulfil commonly accepted dose constraints. Considering the lack of survival benefit of postoperative adjuvant RT, our results support delaying treatment through an early salvage approach to avoid or defer toxicity.

‘Irrational Exuberance’: Behavioural Finance and Émile Zola’s L’Argent

Abstract Émile Zola’s L’Argent has been relatively neglected by critical studies. This interdisciplinary study adds to earlier approaches by examining the ways in which Zola’s novel anticipates strands of contemporary behavioural finance, notably in its analysis of the psychological and social conditions behind ‘irrational exuberance’ and a speculative stock-market bubble. A few avenues are explored, inspired by Robert Shiller’s Irrational Exuberance: precipitating factors, amplification mechanisms, news media, individual investor psychology, herding. The novel reflects contemporary thinking from behavioural finance, but goes further, in its greater human depth, its humour and complexity. Moreover, the novel displays, beyond behavioural finance, a conjunction of financial exuberance with bodily, philosophical, and artistic jouissance, further anticipating modern times.

Hydrological consequences of controlled drainage with subirrigation

Controlled drainage with subirrigation (CD-SI) could be a viable measure to cope with the imbalance in water demand and supply in groundwater dependent regions. CD-SI has the potential to i) retain, ii) recharge and iii) discharge groundwater, i.e. anticipate both dry and wet weather extremes. The aim of this paper is to specify the hydrological consequences of CD-SI at field scale. Four field CD-SI pilots with varying geohydrological conditions in Dutch sandy Pleistocene uplands were monitored (minimum 5 years) to study the effects on groundwater level, soil moisture content and soil water potential. Dynamic modelling using the SWAP-model, calibrated with PEST, was used to quantify all water balance components for the field pilots, needed for responsible implementation of CD-SI. Using SWAP-PEST, measured groundwater levels and soil moisture conditions were reproduced sufficiently accurate. Both the water supply rates and the water and crest levels in the control pit of CD-SI systems could be simulated dynamically, which is an important improvement to earlier modelling approaches. Model calculations were used to study the hydrological responses of CD-SI for meteorological dry to wet years and for each of the field sites. Simulations show that transpiration increases with 38 to 206 mm in dry years for sites with respectively low and higher hydraulic resistances in the subsoil. Simulations also show that the required water volume can be large (664 – 728 mm, respectively). CD-SI could thus improve hydrological conditions for crop growth, but the success depends on subtle differences in geohydrologic characteristics.

ACVIM Consensus Statement on the management of status epilepticus and cluster seizures in dogs and cats.

Seizure emergencies (ie, status epilepticus [SE] and cluster seizures [CS]), are common challenging disorders with complex pathophysiology, rapidly progressive drug-resistant and self-sustaining character, and high morbidity and mortality. Current treatment approaches are characterized by considerable variations, but official guidelines are lacking. To establish evidence-based guidelines and an agreement among board-certified specialists for the appropriate management of SE and CS in dogs and cats. None. A panel of 5 specialists was formed to assess and summarize evidence in the peer-reviewed literature with the aim to establish consensus clinical recommendations. Evidence from veterinary pharmacokinetic studies, basic research, and human medicine also was used to support the panel's recommendations, especially for the interventions where veterinary clinical evidence was lacking. The majority of the evidence was on the first-line management (ie, benzodiazepines and their various administration routes) in both species. Overall, there was less evidence available on the management of emergency seizure disorders in cats in contrast to dogs. Most recommendations made by the panel were supported by a combination of a moderate level of veterinary clinical evidence and pharmacokinetic data as well as studies in humans and basic research studies. Successful management of seizure emergencies should include an early, rapid, and stage-based treatment approach consisting of interventions with moderate to preferably high ACVIM recommendations; management of complications and underlying causes related to seizure emergencies should accompany antiseizure medications.

1975-1985: a catalyst for Global South-oriented advocacy by Dutch feminists

ABSTRACTThe article discusses the significance of the International Women's Year (IWY) and the United Nations (UN) Decade for Women for the development of Global South-oriented advocacy by feminists in the Netherlands. It examines how a focus on women evolved within Dutch development cooperation policy and development studies which persists to this day under the banner of ‘women’s rights, gender equality, and gender mainstreaming’. The article highlights instances of international advocacy fostered by the UN International Women’s Year Conference in 1975, the UN International Conference on Population in 1984 and the UN World Conference to Review and Appraise the Achievements of the UN Decade for Women in 1985, and how the advocacy efforts contributed to a reframing of the early Dutch policy approach of ‘women in development’.

Comprehensive Characterization of the Bone Marrow Microenvironment Transcriptional Remodeling in the Progression from MGUS to Smoldering and Multiple Myeloma

Multiple Myeloma (MM) is a hematological malignancy characterized by the abnormal proliferation and accumulation of clonal plasma cells (PCs) in the bone marrow (BM). Despite significant advances in treating MM patients, most patients eventually relapse and succumb to the disease. Understanding the mechanisms driving progression from precursor conditions into clinically active MM may contribute to implementing early curative approaches. Accumulating evidence indicates that the tumor formation and progression process is influenced not only by the malignant cells but also by the microenvironment components and interconnectedness between them. However, the understanding of the contribution of the non-immune BM microenvironment (BME) to disease progression and relapse remains largely unknown. Our aim was to identify the transcriptional changes in the endothelial cells (ECs) and mesenchymal stromal cells (MSCs) during the transition from premalignant stages to MM to identify potential mechanisms of transformation and therapeutic targets. To this end, ECs and MSCs were immunophenotypically isolated from BM samples of healthy aged donors (n=19) and patients with (MGUS, n=10), Smoldering Multiple Myeloma (SMM, n=13), and MM (n=36). Bulk RNA sequencing analysis of ECs revealed enrichment in terms related to cell cycle and fatty acid metabolism in MGUS, SMM, and MM patients compared to old adults. Indeed, a selective upregulation of pathways associated with calcium signaling, cytokines, and angiogenesis was detected in ECs from MM patients. Regarding MSCs, our results revealed an increase in bone remodeling, inflammation, oxidative defense, and DNA damage repair in MM patients. Interestingly, during the transition from MGUS to SMM, MSCs exhibited enrichment in functions associated with cell morphogenesis and epithelial transition, while lipid-related functions were decreased. To gain a deeper understanding, single-cell RNA sequencing analysis of BME and PCs was performed in unique immunocompetent murine models recapitulating the principal clinical, genetic, and immunological characteristics of MGUS and MM patients (Larrayoz et al., 2023). Using as a reference a previous BME characterization in mice we conducted (Ye et al., 2022) and in line with findings in human patients, our results unveiled a compromised BME characterized by the angiogenic profile of ECs and the increase in the immune-related state of MSCs associated with the progression of the disease. Furthermore, MGUS ECs displayed enrichment in ion homeostasis, immune response, and cell signaling-related pathways compared to healthy controls. While MM ECs exhibited a significant increase in immune terms, migration, and vascular-related pathways when compared to MGUS ECs, indicating a more angiogenic functional profile. Moreover, MSCs in the MGUS stage depicted significant activation of pathways related to immune defense, detoxification, lipid metabolism, and bone remodeling. Likewise, genes upregulated in MM MSCs were associated with calcium signaling, cytokines, and interferon response-related pathways, demonstrating the inflammatory signature of MSCs that may be in relation to the immune exhaustion underlying MM transformation. Finally, subsequent single-cell derived cell-to-cell interaction analysis using Liana was conducted to characterize the interactions between malignant PCs and their niche and delineate the communication dynamics of the tumor-BM ecosystem. Our results showed that PCs interact with ECs mainly through Itga1 and Cd44, while they communicate with MSCs mainly via Egfr and Sdc1. Remarkably, the interactions initiated during the MGUS stage between ECs and PCs persisted, and MM-specific interactions were involved in adhesion, migration, and angiogenesis pathways. In the crosstalk between PCs and MSCs, MGUS-specific interactions were associated with fat and bone-related processes. In contrast, MM-specific interactions were related to the extracellular matrix, collagen organization, and immune-related processes. In conclusion, our findings provide several novel insights into the transcriptional profiles of the non-immune BME during MM disease progression as well as the cellular interactions established with malignant PCs that can drive a pro-MM environment. Additional analyses are ongoing to further comprehend the BME's remodeling through MM development.

Three-dimensional electric-field vector resistivity imaging for deep subsurface fractures network in heterogeneous crystalline rocks

SUMMARY Crystalline rocks, exposed in different parts of the world and over about one-third of India, have complex aquifer systems, which pose a challenge to mapping groundwater dynamics. Electrical resistivity tomography in quasi-3-D and electrical logging of some borewells carried out in an experimental ‘hydrogeological park’ in southern India, which has numerous boreholes and other geophysical information for validation, were unable to map the existence of deeper bedrock fractures and their connectivity. We have attempted electric-field vector resistivity imaging (EVRI), a new tool, to resolve the possible fracture-induced deep interconnectivity in a hard rock aquifer system. In the experiment, multiple two-orthonormal-channels independent receiver nodes for potential measurements are deployed and illuminated with several current injections between ∼ 0.9–3.7 A in full 3-D fashion, which allowed for improved mapping of resistivity variation than earlier approaches. The EVRI-derived full 3-D model shows the presence of fractures for depths between 20 and 70 m with substantial resistivity variations, supported by some borewells hydraulic investigations. It has also enhanced lateral resolution for depths &amp;gt; 30 m and almost doubled the depth of investigation than earlier electrical models. EVRI results revealed unweathered/unfractured granitic rock with no significant signature of fractures beyond 70 m depth that corroborates with existing borehole logs and hydrogeological conceptual model. Therefore, this study demonstrates the potential of EVRI for 3-D mapping of heterogeneous crystalline rocks, which would greatly help in groundwater management.

Impact of left ventricular end-diastolic pressure as a marker for diastolic dysfunction on long-term outcomes in patients undergoing transcatheter aortic valve replacement

ObjectiveThe aim of this study was to investigate the proportion of elevated left ventricular end-diastolic pressure (LVEDP) as an indicator of diastolic function after transcatheter aortic valve replacement (TAVR) and its implication in predicting long-term mortality. MethodsWe analyzed retrospectively collected data on 3328 patients with severe aortic stenosis undergoing TAVR in our institution between July 2009 and June 2021. Patients were stratified into two groups based on invasive post-procedural LVEDP measurements: normal (<15 mmHg) vs. elevated (≥15 mmHg) LVEDP. ResultsMean age of the patients was 81.6 years, and 53.3% were female. Elevated post-procedural LVEDP was identified in 2408 (72.3%) patients. The 5-year mortality rates were higher in the group with elevated LVEDP compared with the group with normal LVEDP (27.4% vs. 8.3%, p = 0.01; hazard ratio [HR] 1.22, 95% CI 1.05-1.41). A multivariate model revealed the following independent predictors of mortality after TAVR: post-procedural elevated LVEDP (HR 1.24, 95% CI 1.01-1.53), pre-procedural significant tricuspid regurgitation (HR 1.24, 95% CI 1.02-1.52) and pulmonary hypertension (PH) (HR 1.53, 95% CI 1.26-1.86). In the present study, a significant paravalvular leak after TAVR was not associated with higher mortality (HR 1.45, 95% CI-0.95-2.19, p = 0.75). ConclusionElevated post-procedural LVEDP in patients who undergo TAVR is an independent predictor of all-cause mortality. Furthermore, PH and tricuspid regurgitation were also identified as predictors of mortality. These data confirm that diastolic dysfunction is an important predictor of mortality in TAVR and should be considered to guide procedure timing, favoring an early interventional approach and management in aortic stenosis patients.

Multi-Dataset Comparison of Vision Transformers and Convolutional Neural Networks for Detecting Glaucomatous Optic Neuropathy from Fundus Photographs.

Glaucomatous optic neuropathy (GON) can be diagnosed and monitored using fundus photography, a widely available and low-cost approach already adopted for automated screening of ophthalmic diseases such as diabetic retinopathy. Despite this, the lack of validated early screening approaches remains a major obstacle in the prevention of glaucoma-related blindness. Deep learning models have gained significant interest as potential solutions, as these models offer objective and high-throughput methods for processing image-based medical data. While convolutional neural networks (CNN) have been widely utilized for these purposes, more recent advances in the application of Transformer architectures have led to new models, including Vision Transformer (ViT,) that have shown promise in many domains of image analysis. However, previous comparisons of these two architectures have not sufficiently compared models side-by-side with more than a single dataset, making it unclear which model is more generalizable or performs better in different clinical contexts. Our purpose is to investigate comparable ViT and CNN models tasked with GON detection from fundus photos and highlight their respective strengths and weaknesses. We train CNN and ViT models on six unrelated, publicly available databases and compare their performance using well-established statistics including AUC, sensitivity, and specificity. Our results indicate that ViT models often show superior performance when compared with a similarly trained CNN model, particularly when non-glaucomatous images are over-represented in a given dataset. We discuss the clinical implications of these findings and suggest that ViT can further the development of accurate and scalable GON detection for this leading cause of irreversible blindness worldwide.

Subdural empyema as a complication of odontogenic sinusitis: A case report

Odontogenic sinusitis represents between 10 and 40% of all cases of sinusitis in the population and may present with common symptoms such as nasal obstruction, anterior or posterior rhinorrhea, facial pain or pressure; and hypo- or anosmia. Although uncommon, intracranial and systemic suppurative complications have been previously reported in the literature and include brain abscess, epidural abscess and subdural empyema, associated with almost 100% morbidity and mortality, however, they are commonly related to meningitis, otogenic diseases and other sinus diseases. The aim of this study was to report a clinical case of intracranial subdural empyema associated with odontogenic infection in a previously healthy 17-year-old patient. This case highlighted the possibility of relevant complications, including even the patient's death, due to odontogenic sinusitis. Therefore, early dental planning and approach in a hospital environment are relevant and essential both in prevention and in the course of treatment, substantiating the multidisciplinary approach.

Factors Associated with Low Albumin in Community-Dwelling Older Adults Aged 75 Years and Above.

This study aimed to clarify the factors associated with low albumin in Japanese older adults aged ≥75 years. The data utilized were the health checkup data of older adults aged ≥75 years from 42 municipalities in Gifu Prefecture, which were provided by the National Health Insurance database system. After excluding the data of individuals with incomplete information on serum albumin, BMI, lifestyle habits, or weight at previous year, the data from 18,674 individuals' health checkup were analyzed. A logistic regression showed that low albumin was associated with smoking, not walking at least 1 h/day, slow walking speed, difficulty in chewing, slow eating speed, weight loss in the previous year, and underweight. Furthermore, an analysis conducted for older adults aged ≥85 years showed that low albumin was associated with not walking at least 1 h/day, difficulty in chewing, slow eating speed, weight loss in the previous year, and underweight. In the future, the number of older adults will increase in Japan; therefore, a strategic approach to promote the health of these aged individuals will become even more necessary. An early approach to maintaining an active physical life, an appropriate weight, and good oral function will lead to improved health in older adults.

Reconsidering the “Popular View” (俗覧 zokuran): Tracing Vernacular Precedents in a Modern Illustrated Hagiography of Kakuban 覺鑁 (1095–1143)

As a supplement to sermonizing, the use of images has been crucial to growing the lay Buddhist following in Japan since at least the tenth century. While it may be the case that Buddhist images, much more so than texts, have historically been better able to draw in popular audiences through their accessible means of communication, the emergence of contemporary literate audiences meant new modes of accessibility. This article explores both the textual and illustrative histories of a modern illustrated hagiography on the medieval Shingon Buddhist monk Kakuban 覺鑁 (1095–1143). By tracing earlier vernacular approaches to Kakuban’s narrative that emerged throughout the evolution of this hagiography, it becomes clear that images were merely auxiliary in their appeal to modern Japanese readers and that such an appeal had been a consideration for generations of Buddhist compilers. This example draws attention to the mutually constitutive relationship between otherwise traditionally distinct functions of text and image in Japanese Buddhist hagiography, but also common conceptual divisions between lay and monastic experiences and popular and elite reading practices.

5.L. Workshop: School health literacy as a means to achieve European public health goals

Abstract Background In recent years, health literacy has been acknowledged as crucial in context of school health promotion, prevention, and education. In 2020, the Schools for Health in Europe Network, linking the 53 WHO European Region Member States to collaborate on school health, released a milestone fact sheet on health literacy in schools, including an evidence synthesis on how health literacy impacts not only health goals but educational outcomes. In 2021, the World Health Organization Regional Office for Europe produced an evidence informed report, recommending the way forward regarding school health literacy in the realm of European public health. Organizational health literacy of schools is named a key responsibility for educational establishments alongside activities to address digitalization in education, climate and planetary health, the commercial determinants of health, the role of social media, and the aftermath of the Covid-19 pandemic. Achieving health literacy development throughout childhood and adolescence requires an early and systematic approach, ideally implemented in schools. Classroom learning and instruction by teachers qualified in health education are key to strengthen skills, behaviours, knowledge, and attitudes that schoolchildren will need to appropriately manage health information from various sources and form health decisions to promote their health in everyday life. Schools are widely accepted as the ideal setting for children to learn about and take responsibility for their own health and self-directed learning, bringing together all elements of health literacy including digital, mental, and organizational health literacy. Teaching materials and targeted sessions on health literacy, either embedded into a subject or as a cross-cutting topic, have several benefits: they reach all children regardless of their social, cultural or development background, they can be delivered over the course of a decade and longer, they can be repeated to enhance learning effects, with increasing grades the complexity and content can be expanded, and in schools it is possible to swiftly respond to contemporary health concerns of children. Objectives This workshop will present empirical findings and intervention research results from various school health literacy studies. (i) The first presentation will discuss findings of school principal's health literacy. (ii) The second presentation will provide key findings from the first ever study on organizational health literacy in schools. (iii) The third presentation will present the evaluation of a mental health literacy programme for students and teachers. (iv) The fourth presentation will introduce a digital health literacy intervention for schoolchildren. The format of this workshop will be 4x7-minute presentations followed by a 20-minute panel discussion, reflecting the relevance of the results to public health research, practice and policy. Key messages • School health literacy is an important topic within the context of school health promotion, prevention, and education. • Addressing health literacy as early as in schools will enable children and adolescent to become health literate, enabling them to face health challenges over the life-course.

Mediation of meaningful outcomes in early intervention: a commentary on Carruthers etal. (2023).

Across the spectrum of behavioral, naturalistic developmental behavioral, and developmental/relational interventions for young children with autism, there has been limited empirical testing of the mechanism of these early intervention approaches. Testing mediation provides insights to the how or why the intervention condition may be preferred in comparison to a control in the population sample (Kraemer, American Journal of Psychiatry, 2016, 173, 672). Combined with an understanding of moderation (for whom or under what conditions), we move toward a better understanding of how to personalize interventions to build on strengths and maximize skill gains for autistic children. Yet, to date there are very few published texts of mechanism in early intervention for young children with autism. This commentary explores a recently published article by Carruthers etal (2023) and examines themes and considerations for measurement of intervention outcomes and mediators.

The contribution of sleep deprivation to suicidal behavior

Objective: This study has the objective correlate sleep disturbances and mood disorders with suicide behavior, showing that the quality of sleep, when altered, interferes negatively in the individual's daily life, compromising social and labor aspects significantly, leading to a higher incidence of psychiatric disorders, which can incite suicidal behaviors. Methods: This article presents a narrative literature review based on the analysis of scientific articles published from 2009 to 2022 in PubMed on sleep deprivation and suicidal behavior. Results: The results certainly showed that quality and the minimum amount needed of sleep, when altered, interferes negatively in the individual's daily life, compromising social aspects significantly, leading to a higher incidence of disorders and acute and chronic diseases, such as schizophrenia , depression, anxiety, Alzheimer's and Parkinson's,increasing the risk of infectious diseases, cardiovascular diseases, cancer suggesting that the impact of the sleep-wake cycle on anatomy physiology is significant. Conclusion: The study showed that establishing a causal relationship between sleep and mood becomes indispensable to contribute to the development of conventional interventions to promote earlier approaches to sleep and mental health. It was also able to contemplate that sleep disturbance presents itself as a factor, worthy of incorporation into standardized frameworks, for suicide risk assessment and a growing body of research suggests that sleep complaints may be associated with an increased risk of suicidal ideation, suicide attempts and death by suicide, concluding that suicide is largely influenced by changes in the circadian cycle. ‎

Cultivating Healthy Smiles: Exploring Regenerative Therapy in Periodontics

Regenerative therapy is a cutting-edge therapeutic strategy used in periodontics with the goal of restoring the health and functionality of the tissues that support teeth, including the periodontal ligament, bone and gums. These supporting tissues can be destroyed by periodontal disorders, including gingivitis and periodontitis, which may result in tooth loss. Regenerative therapy encourages the regeneration of missing or damaged tissues in an effort to undo or heal this damage. Biological solutions to biological problems are emerging as a new paradigm in dentistry and medicine. Scientific discoveries in cellular, developmental and molecular biology have truly revolutionized our collective understanding of biological processes, human genetic variations, the continuity of evolution and the etiology and pathogenesis of thousands of human diseases and disorders. There have been a number of encouraging developments in periodontics and regenerative therapy. Guided Tissue Regeneration (GTR), osseous grafting and newer techniques like Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF), stem cell therapy, growth factors and biomaterial, gene therapy, 3D-printing and tissue engineering, anti-inflammatory drugs, microbiome-based therapy and minimally invasive methods have all advanced from these earlier approaches. The current improvements in regenerative therapy for periodontics that yield superior results are contextualized in this research.