Relevant Actions Research Articles

Short occupational exposure to glyphosate and its biomonitoring via urinary levels of glyphosate and metabolite AMPA (Amino-MethylPhosphonic acid), in Italian vineyard workers

Glyphosate, an herbicide largely used in various contexts, can have adverse effects on human health. Although it is currently the most applied pesticide worldwide, few studies evaluated the extent of human exposure via biomonitoring. To expand such information, biological monitoring of exposure to glyphosate was conducted.The study has a before-and-after design to demonstrate the immediate impact of short-term interventions. Accordingly, the urine concentrations of glyphosate and its main biodegradation product (amino-methylphosphonic acid- AMPA) were measured before and the day after the single herbicide application in 17 male winegrowers. Urine samples were analyzed by high performance liquid chromatography coupled with a triple quadrupole mass spectrometer equipped with an electrospray ionization source.Glyphosate and AMPA were not detectable in pre-application urine samples (limit of quantification for glyphosate (LOQG) was 0.1 μg/L; limit of quantification for AMPA (LOQAMPA) was 0.5 μg/L). After application, glyphosate urinary levels were above LOQG in all workers. The median, min, and max values were 2.30, 0.51, and 47.2 μg/L, respectively. The same values were found for 50 %, 5 % and 95 % percentiles. After assigning numerical values, such as one half the LOQ, to each of the non-detects, the “z” of Wilcoxon matched-pairs signed-ranks test was −3.62 (p = 0.0003), suggesting the pre-application values being significantly lower than the post-application urinary glyphosate concentration. A similar analysis was not feasible with AMPA urinary levels, which were detectable only in 3 workers, after application. 12 (71 %) workers were significantly exposed to glyphosate, but adherence to the adoption of personal protective equipment was good: 14 (82 %) workers used gloves, 13 (76 %) used overalls and 13 (76 %) facial masks.Our data show that glyphosate can be absorbed by the workers after a single application and confirms the usefulness of biomonitoring in exposed workers. Further studies are needed in larger working populations and with multiple glyphosate applications, as well as to evaluate the correlations of glyphosate urine levels with exposure questionnaire data, in order to assess the actual relevance of risk and protection factors.

How cybercrime sentiment shapes mobile banking adoption in Islamic banking

Purpose – This study aims to identify the factors influencing the adoption of mobile banking in the context of cybercrime issues in digital banking services by focusing on a case study of Bank Syariah Indonesia (BSI) customers.Methodology – This study examined five independent variables as mediators: cybercrime issue sentiment, security perceptions, convenience, digital literacy, cybersecurity awareness, and trust. It involves 100 BSI customer respondents and is analyzed using the SEM-PLS method.Findings – The findings indicate that Cybercrime issue sentiment and perceived security positively impact trust. However, this trust does not influence mobile banking adoption, suggesting that other factors may dominate adoption decision-making. Convenience and cybersecurity awareness affect mobile banking adoption, whereas digital literacy does not.Implications – Cybercrime is a crucial aspect of mobile banking usage, making customer awareness essential. To increase customer trust, BSI needs to strengthen and enhance digital security and educate customers about cybersecurity risks. Improving the convenience of mobile banking services is crucial to attracting more users. Cybersecurity awareness is also essential; therefore, BSI needs to conduct educational programs and campaigns to improve digital literacy and reduce the negative impact of cybercrime.Originality – The implications provide insights for banks, especially BSI, in maintaining customer trust and increasing mobile banking adoption. The results are expected to assist customers and BSI in focusing on cybersecurity, protecting personal data, and enhancing user convenience. Understanding the factors influencing mobile banking adoption in the continually evolving digital banking environment can help banks take relevant action and focus on customer needs.

Promoting physical activity and healthy diets by modifying the social and/or physical environment at local level: a scoping review of evidence-based policy actions.

Background We aimed to map evidenced-based policy actions proposed by public health institutes or organizations to promote physical activity and healthy diets by modifying the social and/or physical environment at the local level. Methods We conducted a scoping review to identify relevant evidence-based policy actions proposed by public health institutions. We used a two-step strategy to identify government-supported public health institutes or organizations that generate evidence-based recommendations for policy actions. We included policy actions if they 1) aimed at increasing physical activity or improving diet; 2) focused on modifying the physical or social environments; 3) were implemented at the local or community level; 4) were expressed as a concrete action rather than a general aim; and 5) were described explicitly as being based on evidence. Results Starting from 121 public health institutes, we identified 8 relevant organizations and reviewed 63 guidelines or reports that included actions to promote healthy diets and physical activity. Of the 540 proposed actions on diet and 358 on physical activity, 118 met the inclusion criteria. Given that many of the actions were recommended by multiple institutes, we synthesized the information in the infographics to provide recommendations on diet and physical activity in outdoor and indoor settings and schools. Conclusions Public health institutes have generated a wide range of evidence-based recommendations for the promotion of healthy diets and physical activity by modifying the physical and social environment that can be implemented in local settings. Future actions should address barriers to implementing these recommendations and analyze the determinants of local policy decisions.

A plea for urgent action: Addressing the critical shortage of cardiothoracic surgical workforce in the COSECSA region.

The College of Surgeons of East, Central, and Southern Africa (COSECSA) comprises 14 countries, many of which currently grapple with an increasing burden of cardiothoracic surgical (CTS) diseases. Health and economic implications of unaddressed CTS conditions are profound and require a robust regional response. This study aimed to define the status of CTS specialist training in the region (including the density of specialists, facilities, and active training posts), examine implications, and proffer recommendations. A desk review of COSECSA secretariat documents and program accreditation records triangulated with information from surgical societies was performed in May 2022 and September 2023 as part of education quality improvement. A modified nominal group process involving contextual experts was used to develop a relevant action framework. Only 6 of 14 (43%) of COSECSA countries offered active training programs with annual intake of only 18 trainees. Significant training gaps existed in Burundi, Botswana, Malawi, Rwanda, South Sudan, Zambia, and Zimbabwe. Country specialist density ranged from 1 per 400,000 (Namibia) to 1 per 8,000,000 (Ethiopia). Overall, the region had 0.2 CTS specialists per million population as compared with 7.15 surgeons per million in High-Income Countries. Surgical education experts proposed an action framework to address the training crisis including increasing investments in CTS education, establishing regional centers of excellence, retention incentives and opportunities for women, and leveraging international partnerships. Proactive investments in infrastructure, human resources, training, and collaborative efforts by national governments, regional intergovernmental organizations, and international partners are critical to expanding regional CTS training.

Legislative measures and legislators’ motives

This review of Wojciech Sadurski’s Constitutional Public Reason explores the relationship between the legislative measures voted on by legislators and their motivations for so voting. The relationship between such measures and motivations is examined by reference to GEM Anscombe’s famous example of a man at a pump to illustrate the different descriptions that may be given for a human action. Where the relevant action requires the participation of more than one person, only that aspect of each person’s plan of action that is shared with the others can be ascribed to them jointly, suggesting that the purpose of legislation does not encompass every motivation of the diverse legislators that voted for it.

Analyzing energy utilization influence on tourism and low-carbon development: Insights from Xianju National Park in China

National parks are rare natural resources that provide refuges for wildlife, harmonious ecology, and leisure activities. These protected areas, which include a variety of ecosystems, habitats for wildlife, and geological wonders, have been set aside to preserve and highlight the beauty of the natural world. Under the goals of carbon neutrality of all countries in the world, it is urgently need to pay attention to the relationship between climate change and protected natural resources. This study uses the Xianju pilot national park as an example to identify key activities that increase carbon absorptions and reduce carbon emissions, calculate the carbon sink of national park construction, and discuss whether tourism industry can achieve low carbon or even negative emissions based on the analysis of low-carbon measures of national parks. Using the Mento-Carlo method, we find that the total carbon sink in Xianju National Park is around 70832–97930 tons CO2, which accounts for about 10 % of Xianju County's total carbon emissions. This illustrates that the development of tourism has indeed brought benefits to the low carbon development of Xianju National Park. From the perspective of stakeholders, this paper also summarizes the stakeholders, relevant actions and policy tools for Xianju National Park to carry out low-carbon tourism. Finally, compared with the development experience of national parks in France and the United States, this paper gives policy suggestions on low-carbon development of Xianju National Park, and proposes to mobilize stakeholders to participate in low-carbon tourism and low-carbon governance.

Best Practices of circular economy as benchmarks for SMEs manufacturing sectorin Tijuana, Baja California, Mexico

The objective of this research is to identify the best business practices, actions and laws of Circular Economy at national and international level in manufacturing companies, which serve as a reference to adopt them to SMEs at the local level. It is a qualitative and descriptive research by documentary analysis to collect data in books, scientific journals, newsletters and newspapers, on environmental management in detection and evaluation of waste and residues generated in the production chain. The main countries that have implemented Circular Economy were analyzed, finding as a result laws and regulations that are a guide, due to the good practices implemented by some companies. In Mexico, large companies have initiated relevant actions and practices; these findings provide information that could be useful for awareness-raising and technical assistance actions for the development of capacities of SMEs in Tijuana, Baja California towards their transition to the Circular Economy.

<b>Seguimiento y acompañamiento que reciben las comisiones d</b>e <b>autoevaluación</b> de la División de Educología

The permanent activity Self-Evaluation and Quality Management of the Division of Educology (APAGCDE), carries out within its multiple tasks; accompany and follow up on the improvement plans of the self-assessment and accreditation commissions (CAE's) of own and shared careers, therefore, hold meetings and consult with different social actors involved in the substantive actions of the Academic Unit (UA) , as are the representatives of the Division of Educology (DED) in the CAE's, this with the purpose of offering the support required from the UA Directorate and this permanent activity. In 2023, the APAGCDE followed up, held an annual meeting and applied a consultation to the people participating in said commissions, to know the current status of the self-assessment and accreditation processes of the DED careers, as well as assess the support that They receive these commissions from the curricular advisory service of the Vice-Rector for Teaching (VD). The consultation responds to a formative evaluation that promotes suitable and relevant actions that benefit the DED and university bodies with the sole purpose of continuing to improve actions and seek excellent academics.

The Development and Evaluation of Alternative Communication Strategies to Facilitate Interactions with Refugees in Obstetric Triage: A Preliminary Study

Purpose: In this pilot study, we investigate the potential of pictographs to facilitate communication and accelerate care for non-English speaking birthing people in triage. The immigrant and refugee populations have been steadily increasing in the United States; reproductive age women are a large percentage of those who seek medical care. Barriers to care include timely access to interpreters, which can delay treatment. Pictographs have been used successfully in medicine in various situations such as pharmaceutical instruction and symptom description. We searched extensively for obstetric triage pictographs with little success. To address this, we created a pictograph sheet specifically for common obstetrical complaints. Methods: The most common reasons for visiting triage were ascertained. From these, key topics were identified for drawings. For each topic, the authors drafted scripts for a list of relevant actions. The actions for each topic were then represented by a professional illustrator in pictographs. Pictographs were developed using the following guidelines: focus on actions people should take, include prompts within pictures such as labels or arrows and exclude nonessential details such as room background and elaborate borders. After the pictographs were developed, its appropriateness, accuracy and relevance were reviewed and validated by two experts with experience in women’ care. The experts perceived that the drawings represented the actions well in a simple and clean manner. The following concerns were depicted: decreased fetal movement, abnormal vaginal discharge, rupture of membranes, vaginal bleeding, vision changes, shortness of breath, nausea, contractions, headaches, and overall assessment of wellbeing. Focus groups were developed collaboratively with Della Lamb, a resettlement agency. Inclusion criteria included women of reproductive age who are non-English speaking and currently pregnant. These focus groups were held at the University Health. Two focus groups were created: one with refugees from Afghanistan and one with refugees from the Congo. Each focus group was guided by a licensed medical interpreter of their native language: Dari and Swahili, respectively, and ranged from 3 to 4 participants. One by one the pictograms were introduced to the group. Each participant was asked what they think the illustration represents. For participants’ comfort, groups were not recorded; instead, notes were taken by observers during and after the discussion. The participants read the text and pictographs and were asked to identify if pictographs were clear, understandable, and acceptable. Results: Congolese Focus Group: Participants’ ages varied in their 30s. All had recently immigrated to the United States and lived in Missouri for less than 6 months. They were in the second trimester of their pregnancy and had at least one prenatal visit in the United States. They were all multiparous women with previous uncomplicated vaginal deliveries in their native country. All could read and write in Swahili but spoke no English. They all had no previous experience with the medical health system in the United States. Afghani Focus Group: Participants’ ages varied in their 20-30s. All had recently immigrated to the United States and lived in Missouri for less than 3 months. 3 women were in their second trimester, 1 was in her third trimester. Aside from 1, the rest (3) were multiparous women with previous uncomplicated vaginal deliveries in their native country. 3 of them could read and write in Dari but spoke no English. They all had no previous experience with the medical health system in the United States. Comprehension was significantly different between the two groups. Overall, the Congolese group of women misunderstood the purpose of the pictographs. No picture was understandable to the patients. It was also apparent that the patients did not realize these were issues for which to come to triage. There was also ambiguity regarding the color, i.e. they did not correlate green with nausea. The general prohibition sign was also absent in meaning for them. However, all of the patients expressed interest in learning what each picture meant and would like to have that option there if they came to triage and could not get an interpreter. The Dari group did not understand shortness of breath or nausea. However, they were familiar with the other symptoms and able to identify those as reasons to come to triage. The patients were also familiar with colors and scales. Conclusion: The pictograph-based approach might be an effective tool in developing health-care instructions for immigrant women with limited literacy skills. However, research is needed regarding limitations due to cultural backgrounds. Future research is also needed to compare the effect of pictograph-enhanced instructions with written text-based instructions on adherence to instructions and health outcomes.

Changing community climate change attitudes: Evidence from a community exhibit intervention

Engaging communities through exhibits displayed at community-oriented events is a longstanding practice in community activism that could prove valuable for shifting individual and collective behavior toward measures that can help reduce climate change. In this investigation we examined the effect of a climate change community exhibit that focused on four environmental issues: switching to electric vehicles, switching to community solar for residential electricity needs, reducing meat consumption, and supporting forest conservation and reforestation efforts. Participants from the greater Boston area (N = 125) were surveyed before and after attending the exhibit. Attending the exhibit increased participants' perceptions of how many members in their community engaged in action for each issue and how morally right community members thought addressing the issue was. Further, increases in how confident participants felt in engaging in the relevant actions, as well as in ease of engagement were also observed. Participants also expressed increased interest (albeit inconsistently so) in, and likelihood of, engaging in action for each issue. Across all issues, exposure to the exhibit also increased whether engaging in action was rated as an effective way to reduce climate change. Implications and future directions for interventions utilizing climate change exhibits are discussed.

Conference of the Parties (COP) 28 Takeaways at the Intersection of Health, Climate, and Food.

The 28th session of the Conference of the Parties (COP 28) to the UN Framework Convention on Climate Change brought together 85 000 climate stakeholders to leverage solutions and accelerate climate actions in 4 key areas: energy transition; issue of funding and financing of climate actions; emphasis on nature, people's lives, and livelihoods; and ensuring inclusivity for all. This commentary highlights insights at the intersection of health, climate, and food gained by the author from participating in COP 28 events. The objective is to inform policymakers, researchers, and practitioners on emerging opportunities to scale specific, measurable, achievable, relevant, and time-based (SMART) climate actions that prioritize health and boost the resilience of food and public health systems.

The Role of Medical Societies and the Relevance of Clinical Perspective in the Evolving EU HTA Process: Insights Generated at the 2023 Fall Convention and Survey of the European Access Academy.

This work aimed to determine the role and action points for the involvement of medical societies in the European Health Technology Assessment (EU HTA) Methods: An online pre-convention survey was developed addressing four areas related to the EU HTA: (i) medical societies' role; (ii) role of clinical guidelines; (iii) interface with the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS); and (iv) approaching 'best-available evidence' (BAE). A descriptive analysis of questionnaire outcomes was conducted to inform the European Access Academy (EAA) Fall Convention 2023. Within the working groups (WGs), action points were identified and prioritised. A total of 57 experts from 15 countries responded to the survey. The WGs were attended by (i) 11, (ii) 10, (iii) 12, and (iv) 12 experts, respectively, representing a variety of national backgrounds and stakeholder profiles. The most relevant action points identified were as follows: (i) incorporation of clinical context into population, intervention, comparator, outcomes (PICO) schemes, (ii) timely provision of up-to-date therapeutic guidelines, (iii) ensuring the inclusion of MCBS insights into the EU HTA process, and (iv) considering randomized controlled trials (RCTs) as the gold standard and leveraging regulatory insights if development programs only include single-arm trials. The involvement of medical societies is a critical success factor for the EU HTA. The identified key action points foster the involvement of patient associations and medical societies.

Research on the analysis method of power system relay protection action characteristics based on fault recording data

The action characteristics of power system relay protection devices can well analyze whether the relevant actions are correct. An analysis method of relay protection action characteristics in power system based on fault recording data is designed. After analyzing the relay device structure and protection action characteristics and requirements, the power system relay protection action record data recorded by the fault recorder; The second order RC low-pass filter is used to preprocess the recorded data; The filtered data is input into the analysis model of relay protection action characteristics based on SVM algorithm. The SVM algorithm classifies whether the relay protection action characteristics recorded by the filtered fault recording data meet the expectations, and completes the analysis of power system relay protection action characteristics. The experimental results show that this method can effectively analyze the operation characteristics of power system relay protection, and can accurately check whether the relay protection device can operate correctly.

SDC-Net++: End-to-End Crash Detection and Action Control for Self-Driving Car Deep-IoT-Based System.

Few prior works study self-driving cars by deep learning with IoT collaboration. SDC-Net, which is an end-to-end multitask self-driving car camera cocoon IoT-based system, is one of the research areas that tackles this direction. However, by design, SDC-Net is not able to identify the accident locations; it only classifies whether a scene is a crash scene or not. In this work, we introduce an enhanced design for the SDC-Net system by (1) replacing the classification network with a detection one, (2) adapting our benchmark dataset labels built on the CARLA simulator to include the vehicles' bounding boxes while keeping the same training, validation, and testing samples, and (3) modifying the shared information via IoT to include the accident location. We keep the same path planning and automatic emergency braking network, the digital automation platform, and the input representations to formulate the comparative study. The SDC-Net++ system is proposed to (1) output the relevant control actions, especially in case of accidents: accelerate, decelerate, maneuver, and brake, and (2) share the most critical information to the connected vehicles via IoT, especially the accident locations. A comparative study is also conducted between SDC-Net and SDC-Net++ with the same input representations: front camera only, panorama and bird's eye views, and with single-task networks, crash avoidance only, and multitask networks. The multitask network with a BEV input representation outperforms the nearest representation in precision, recall, f1-score, and accuracy by more than 15.134%, 12.046%, 13.593%, and 5%, respectively. The SDC-Net++ multitask network with BEV outperforms SDC-Net multitask with BEV in precision, recall, f1-score, accuracy, and average MSE by more than 2.201%, 2.8%, 2.505%, 2%, and 18.677%, respectively.

Exploring the perspectives of healthcare professionals on providing supported asthma self-management for Bangladeshi and Pakistani people in the UK.

Self-management support improves asthma outcomes and is widely recommended in guidelines, yet it is poorly implemented in routine practice. There may be additional challenges in the context of ethnic minority groups, where making sense of culture may be necessary. This study aimed to explore the perspectives of healthcare professionals on supporting UK Bangladeshi and Pakistani patients to self-manage their asthma. One-to-one semi-structured interviews with professionals (primary and secondary care; medical and nursing) who routinely provide asthma care to Bangladeshi or Pakistani patients. Topics addressed included perceptions of professionals in supporting patients with asthma self-management and ideas for improving culturally competent care. Data were analysed thematically. Nine professionals, from a range of ethnic backgrounds, with considerable experience of treating patients from these communities were interviewed. Despite organisational restrictions (language and time/resources) and expressed gaps in cultural knowledge and training, all interviewees reported attempting to tailor support according to culture. They used their perception of the patient's culture (e.g., big families and family involvement), integrated with their perception of patients' ability to self-manage (e.g., degree of responsibility taken for asthma), to formulate theories about how to culturally adapt their approach to supported self-management, e.g., supporting barriers in understanding asthma. There was consensus that gaps in cultural knowledge of professionals needed to be addressed through training or information. Interventions recommended for patients included basic education, group meetings, and culturally relevant action plans. In the absence of formal training and constrained by organisational limitations, self-management support was adapted based on personal and professional perception of culture. These ideas were based on experience and formulated a chain of reasoning. Professionals recognised the limitations of this approach and potential to overgeneralise their perceptions of culture and adaptations of supported self-management. Interventions were desired and need to address professional training in cultural competence and the provision of culturally relevant materials.

Applying systems thinking in youth-centred participatory action research for health promotion in an underserved neighbourhood.

Childhood overweight is considered a complex problem influenced by a range of factors, including energy balance-related behaviours (EBRBs) and interacting drivers of these behaviours. There is growing support that applying a systems approach is required to tackle complex problems resulting in actions that attempt to change the system's dynamics. Additionally, a participatory approach is advocated to include the lived experience of the population of interest both in the understanding of the system as well as the development, implementation and evaluation of relevant actions. We therefore combined Intervention Mapping, Participatory Action Research (PAR) and system dynamics in the development, implementation and evaluation of actions contributing to healthy EBRBs together with adolescents. Four PAR groups comprising of 6-8 adolescent co-researchers (10-14 years) and 1-2 adult facilitators met weekly during 3-4 years. The structured Intervention Mapping protocol guided the process of the systematic development, implementation and evaluation of actions. System dynamics tools were included for the creation of Causal Loop Diagrams and development of systemic actions. Our approach comprised six steps that were executed by the PAR groups: (1) build Causal Loop Diagrams for each EBRB through peer research and identify overarching mechanisms, (2) determine leverage points using the Intervention Level Framework, (3) develop action ideas, (4) develop detailed actions including an implementation plan, (5) implement and, (6) evaluate the actions. PAR ensured that the actions fitted the lived experience of the adolescents, whilst system dynamics promoted actions at different levels of the system. The Intervention Mapping protocol ensured that the actions were theory-based. The main challenge involved integrating system dynamics within our practise in cooperation with adolescent co-researchers. We experienced that combining Intervention Mapping, PAR and system dynamics worked well in developing, implementing and evaluating actions that target different levels of the system that drive adolescents' EBRBs. This study serves as an example to other studies aimed at developing, implementing and evaluating actions using a participatory and systems approach.

Beyond coping and adaptation: Toward a sociology of coaching. A necessary paradigm shift to address contemporary dramatic social change

This article discusses how, in today’s world of disruptive and dramatic social change, non-sports related coaching, which includes a wide range of services such as life coaching, career coaching, executive coaching, and team coaching, can inadvertently fuel undesirable social dynamics. There is little or no awareness of this risk among coaches and coachees. The global, fast-growing, multi-billion-dollar industry aimed at supporting people and organizations to perform better and increase wellbeing while managing and adapting to change has been developed with limited sociological input. The article is based on 15 years of social constructionist-informed reflective practice by a sociologist-turned-coach, and uses a multi-layered theory-driven autoethnographic account to argue for a sociologically informed paradigm shift in coaching, as well as relevant sociological knowledge, learning sciences, and action research methodology in coaches’ education. It presents the rationale and key features of a new coaching approach that places dramatic social change-relevant sociological concepts at the heart of the process, helps people develop psycho-sociological awareness, and uses a learning-to-develop through research design. A new definition of coaching to address dramatic social change is derived. Coaching practitioners will find dramatic social change-relevant sociological concepts, critical reflections, coaching questions, and procedures to expand coaching effectiveness. Interdisciplinary research topics are proposed, combining coaching sociology – which must be developed to make coaching a well-founded profession – and coaching psychology, which currently dominates the knowledge production in the field. Implications for workplace strategies to attract, motivate, and retain employees in search of meaning or purpose in life are also suggested.

#1746 Comprehensive kidney care: adopting principles of comprehensive geriatric assessment within an advanced kidney care clinic

Abstract Background and Aims Chronic Kidney Disease (CKD) is increasingly prevalent among older people, a trend that presents significant healthcare challenges. This project introduces the Comprehensive Kidney Care (CKC) clinic model which incorporates elements from Comprehensive Geriatric Assessment within the Advanced Kidney Care clinic. By focusing on a holistic care, this model aims to enhance symptom management, facilitate appropriate referrals, improve documentation, and offer advance care planning (ACP), ultimately to improve care quality for older people with advanced CKD. Method We evaluated 27 patients ≥65 years old with CKD stage 4 and 5, attending the CKC clinic between 23/11/2022 and 22/11/2023. Demographics and clinical characteristics were recorded, including Charlson Comorbidity Index (CCI). Individual symptoms and total score were screened in each clinic using the Integrated Palliative Outcome Score (IPOS)-Renal Symptom Survey. Geriatric impairments were assessed including frailty (Clinical Frailty Scale [CFS]), mobility, polypharmacy (≥5 medications), activities of daily living (ADLs), falls and cognition. Actions were documented, including initiation of ACP discussions and other relevant interventions. Results Patients’ average age was 82 (SD 5.8), they were predominantly male (20 patients, 74%) and had a median eGFR of 18 ml/min/1.73 m2 (IQR 10). They exhibited a high burden of comorbidities (CCI mean 8.4, SD 2) and a high prevalence of geriatric impairments: 74% (20 patients) had a CFS score ≥4, 63% (17) required mobility aids, 26% (7) reported falls, 30% (8) required assistance with ADLs, and all had polypharmacy. IPOS was recorded for 20 patients. Mean total score was 10.25 (IQR 8). Fig. 1 demonstrates the symptoms reported as experienced ‘moderately’ or worse at first IPOS completion. Thirteen patients had more than one IPOS completed, allowing each symptom to be compared at two consecutive clinic attendances 239 times. Symptom improvement was more common than worsening (37 [15.5%] versus 11 [4.6%]). Most times symptoms remained stable (43, 18%) or were absent (132, 55.2%), with a minority appearing 16 times (6.7%). Seventeen relevant actions were identified, including symptom management (14 patients, 51.9%), physical activity advice (7, 25.9%), referrals to other teams (12, 44.4%; 2 referred to more than one), including dietitian (4), psychology (3), frailty team (2), physiotherapy (2), memory assessment clinic, social care, falls clinic and palliative care (1 each). Preferred kidney management was discussed with 9 patients (33%); 9 patients had documented preferences before attending the CKC clinic. Ten (37%) preferred conservative care, 4 (15%) haemodialysis and 13 (48%) remained undecided. Undecided patients had a significantly higher eGFR (median 21 [IQR 4] versus 12 ml/min/1.73 m2 [IQR 6.75], p-value 0.012). ACP was discussed with 8 patients; these patients had higher CFS scores (median 6 versus 4, IQR 1.25, p-value 0.005) and higher ADL dependence (Odds ratio 8.9, p-value 0.026). Conclusion The CKC clinic model shows promise as an effective approach for assessing and managing older people with advanced CKD. Most times symptoms improved or remained unchanged, suggesting actions were effective at managing symptom burden. ACP discussions were more commonly initiated in patients with higher frailty severity and ADL dependence; obtaining geriatric impairment information may help prompt ACP discussions.

Antifungal susceptibility and multilocus sequence typing (MLST) of Cryptococcus neoformans complex from HIV-associated cryptococcal meningitis patients in Manaus, Amazonas, Brazil.

Cryptococcus neoformans is primarily responsible for cases of cryptococcal meningitis in individuals with HIV/AIDS. This study evaluated the susceptibility of C. neoformans obtained from individuals with cryptococcal meningitis associated with HIV/AIDS in Manaus, Amazonas, Brazil, against the action of the antifungals amphotericin B, flucytosine, fluconazole, itraconazole and posaconazole and analyzed it using Multilocus Sequence Typing (MLST) in order to identify the Sequence Types (STs). We analyzed 30 isolates of C. neoformans, from 24 HIV/AIDS patients diagnosed with cryptococcosis from 2017 to 2019 in a reference hospital, in addition to 3 environmental isolates: 1 isolate obtained in the home of a patient and 2 isolates obtained from neighboring homes of patients. 86.6% (n = 26/30) of the clinical isolates were identified as C. neoformans VNI ST93, 6.6% (n = 2/30) as C. neoformans VNI ST5, 3.3% (n = 1/30) as C. neoformans VNI ST32 and 3.3% (n = 1/30) as C. neoformans VNB ST232. The environmental isolates were identified as C. neoformans VNI ST93 (n = 3/3). 96.6% (n = 29/30) isolates were sensitive to amphotericin B, though there was variation in the MIC. 60% (n = 18/30) presented a MIC above the proposed epidemiological cutoff values for one or more antifungals. All environmental isolates were sensitive to the tested antifungals. The MLST showed that there is an important relationship between C. neoformans VNI ST93 and individuals with HIV/AIDS, including in the environmental isolates analyzed. C. neoformans VNB ST232 was observed for the first time in Amazonas. Amphotericin B was proven to be the best drug, but fluconazole and posaconazole also showed relevant action.

Relevance of Behavioral Research in the Evolving State of Anti-obesity Medications: Is the Glass Half Empty or Half Full?

Obesity continues to be a significant public health challenge. While weight loss medications have been studied and available for several years, the newest generation of highly effective anti-obesity medications (AOMs) will shift how behavioral science professionals approach obesity treatment and research. With the unique skill set of behavioral science professionals, this commentary suggests ways to integrate behavioral science into the rapidly evolving landscape of AOM use to accelerate better obesity care and generate new lines of research. The goal of this commentary is to stimulate discussion and encourage responsive and relevant action to improve population health.